HomeMy WebLinkAbout026-939-17-5316-SAN-2023-157 :-"' Department of Safety �°"�ry SAWYER v�
� � = & Professional Services �
- _' � ' Sanitary Permit Number([o be filled in b}
t - Industry Services Division
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State Traosaction Number W
Sanitary Permit Application NA =
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit �
is required prior to obtaining a sanitary permit.Note:Application torms for state-owned POWTS are submitted to Project Address(if ditlerent than mailing J
the Deparlmcnt of Safery and Professional Services.Personal informarion you provide may be used for secondary
putposes in accordance with the Privacy Law,s. 15.04(I)(m),Stats. (SAME)
I.Application Information-Please Print Atl Information
Property Owner's Name Parcel#
HAROLD HOLVERSON 026-939-17-5316
Property Owner's Mailing Address Property Location
16336W S.T.H. 70 Govt.Lot 3
City,State "Lip Code Phone Number
STONE LAKE� YY 1 54876 ��`� '/a, Section 1 7
iI.Type of Building(check all that apply) Lot# T 39 N R 09 �t,r W
C�or 2 Family Dwelling-Number of Bedrooms C Subdivision Name
B�o�k# NA
❑Public/Commercial-Describe Use NA
❑City of
❑State Owned-Describe Use CSM Number ❑Village of
#885, V5, P3 �,.�,of SAND LAKE
III.Type of POWTS Permit:(Check either"New"or"Replaceme qt ' able on line A. Check one box on line B.Complete line C if
a licable.)
A� new S stem ►acement S stem
y �(Rep y ❑ Other Moditication to Existing System(explain) ❑ Additional Pretreatment Unit(explain)
B.
❑ Holding Tank In-Ground ❑At-Grade ❑ Mound ❑ Individual Site Design ❑ Other Type(explain)
X(conventional)
C• ❑ Renewal Before ❑ Revision ❑ Chan e of Plumber List Pre�ious Permit Number and Date Issued
g ❑ Transfer to Ncu�Owner
Expiration 11I�
IV.DispersaUTreatment Area and Tank Information:
DesignA`O(gpd) Design SoilOp�lication Rate(gpd/st� Dispersal Area Required(s� Dispersal Area Proposed(s� System F,levation ,� /
`�� 642.86 652 FT.'�13•�
Capacity in Total #of Manufacturer
Tank Information Gallons Gallons Units � � o v �
New Tanks Gxisting Tanks � � v � � � � �
o y
a. U in U in i.,.. C7 fs,
Septic or Holding Tank 1 06� 1060 1 INFILTRATOR X
Dosing Chamber
V.ResponsibilitV Statement-I,the undersigned,assume responsibility for instaltadon of the POWTS shown on the attached ptans.
Plumber's Name(PrinU Plumb 's Signawre MP/MPRS Number Business Phone Numbc•r
-, Q i ��S�� _
Plumber's Address(Street,City,State,Zip Code)
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I.C un /Department Use Only
� A r O Disappmved Permit Fee Date Issued Issuing Agent Signature
❑Owner Given Reason Yor Denial $ �d�� 1 � �� I �3 •� I���-�'�`"X"���"V�-
Conditions of Approval/Reasons for Disapproval
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Rcpt# a3�� JUL 0 7 2023
C s � ��" D� � �...__,.. �
SAWYER COUfVTY
ZONING ADMINISTRATsON
Attac6 to complete plans for the system and submit to the County only on paper oot less thAn 8 t!2 x 11 inches in si�e ��� ��
NO R�FUND�AFTER
sBn-639s�R.o3iz2> l�UE OF PER�ut1T
PAGE 1 OF 4
In-Ground Gravity Plan
Index $ Cover Sheet
Component Manua/Design References:
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 4 Index&Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross-Section& Pian View
Pg 4 of 4 Management Plan
Attachments: Enclosures:
Tax Statement POWTS Application for Review
Soil Evaluation Report&Site Map
Project Name/Description
Owner Name(s): HAROLD HOLVERSON Phone:
Owner Address: �6336W S.T.H. 70, STONE LAKE,WI Zp: 54g76
Project Address: (SAME)
Govt.Lot: 3 _ 1/4 of 1/4,Section » ,T 39 N-R 09 E❑or W ✓Q
Township: SAND LAKE County: SAWYER
Project Parcel ID#: 026 939 17 5316
Designer Information
DCS1911C�NaRIC: MARY JO NUPPERT Pho�e: 715 - 426 - 1775
DCSIJ�t@�Add�@55: 25720 FIREFLY LANE,WEBSTER,WI Z�P: Sqgg3
E-mai1: hollisterdesign@outlook.com ��N,�����• _.,,,ry
License Number: t as9-007 ����\�„. r^.=�'.;i���'�
Remarlcs: �* fJAlyY.1r� *-�
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SAFETY ISSUE--COLLAPSED TANK �1 •:R't`�►+�^:.i�;: =
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Signature: �l� ?' ' Date: O6-°��, 2023
O sqnature reqwred e h submrtteA copy
Plot Plan � �� y
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PROPERTYOWNER: �'�+��F�"L�j �` �LV�r��-�� lA � 40F7
{except wt,ere noted)
Legal Description: �"�::T i-cr ' 'T ' ,�A� zi = 1� �' = 5 �J. n =bxkFae pit
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Septic Tank(s) ManufacNrer
IN-GROUND GRAVITY DISPERSAL AREA INFILTRATOR
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s)
3-ft Trench (down-sizing credit) �oso gal gal 9a�
gal
ENluent Filter Manufacturer:
ORENCO
�
Effluent Filter Model#: $��
min.12"
SOIL COVER �ryP����
i z^
min.trench
aeP�h TYPICAL TRENCH
(�vai�q .
- ' a • CROSS SECTION VIEW
�_ 34„
(�YPical) ^ � •.,�. . . .SC8�2�
�,.,, � / Provide minimum 3 ft
System Elevation -� o� 3,� separation between trenches.
(typical)
Quick4 Standard-W
w!End Cap Observation Plpe TYPICAL TRENCH
(typical) (Show location of inlet/outlet pipe connection on plan view.) (ryci�i)
� InstailpermanWacNreYs PLAN VIEW
mstmctions. �rf O .SCO�e�
lelr..�ko�.�r.:�a�h�'Vh'�i$-- - - - -�� - - - - - - - �� - - - -`;��+.I.��..�.I�..,r.:!i A= 3Oft
�WYrtr�W.v��_v.�eenn1111�13" aer.�.�rrtirar�vtY�.re.vJ � (baicaq D
— — — — — '�f— — — — — — — — ��- - - — — — — — — —
f B - 66 ft �—�; m
(rypicaq Qwck4 Standard-W Chamber W
450 GPD / 0] LR = 642.86 FT. 2 (tYp��a�) �
INSTALL PER TRENCH: 642.86 ! 20 EISA/UNIT = 32.15 OR(mfd by�ntnrarorsystarns,�oo.) �
32 UNITS X 4 FT. = 128 FT. Install pursuant to manufacturers instructions. �
16 Quick4 Std-W @ 20 ft� EISA/chamber= 320 ft' �Zg � Z - 64 FT.
+ � Pairs of end caps @ 6 ft�EISA/pair= 6 �, (2) 3 FT. X 64 FT. TRENCHES
= Proposed EISA per trench = 326 ft' Required Infiltration Area = 642.86 ft, Distribution Method:
x 2 trenches = Proposed Total EISA = 652 ft, branched manifold �
� HAROLD HOLVERSON
PAGE 4 OF 4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384, Wisc.Admin. Code. Pursuant to SPS 383.52 (2),Wisc. Admin. Code, this system shall
be considered a human health hazard if not maintained in accordance with this approved management plan.
Furthermore, all inspection and maintenance activities shall be performed by a registered POVYTS Maintainer in
accordance with SPS 383.52 (3),Wisc. Admin. Code.
Maximum Disaersal Area Operating Limits:
Design Flow= 450 yPd; BODS S 220 mgL-'; TSS <_ 150 mgL''; FOG <_30 mgL''
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches,floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution/drop boxes)
o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
o extent of ponding in distribution cell prior to dosing
o dosing irregulanties- if applicabie (i.e., pump re-cycling, float switch settings, etc.)
o electrical components- if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure—compare to design specification)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Seqtic and dose tanklsl shall be pumped by a ceRified septage servicing operator licensed under s. 281.48 Wis.
Stats. when the volume of solids in the tank(s) exceeds one-third (113)the liquid volume of the tank(s) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113,Wisc. Admin. Code.
o Effluent filter(s)shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company: RYAN STRAND Phone: 715-558-1673 _
�ocal government unit: SAWYER COUNTY ZONING pnone: 715 - 634 - 8288 _
Local government unit address: HAYWARD, WI ZiP 54843 _
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384, Wisc. Admin. Code.
Contingencv Plan
In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be
abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils.
Svstem Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
�"'�" � PRIVATE ONSITE WASTE TREATMENT County
, .�
=��`J'�Sps � SYSTEMS Sa,W er
.� �—�'%,;
( POWTSj y
`�' "'` INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 2 3 � t S�
Personal infonnation you provide may ba used for secondary pu�poses[Privacy Law,s. 15.04(I)(�n)]
Permit Hoider's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#:
����, ������� �� ��.
Insp BM Elev: BM Description: Parcel Tax No:
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TANK INFORMATIO ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic ( ��p Benchmark �pp��i
Dosing
Aeration Bitlg. Sewer .—
Holtling St/Ht Inlet ��, �
TANK SETBACK INFORMATION St 1 Ht Outlet `�6�3 '
TANK TO P/L WELL BLDG vENrTo ROAD Dt Inlet
AIR INTAKE
Septic j� ��b` � �g � NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. �jY,-�'
Holding Dist. Pipe
PUMP I 51PHON INFORMATION Infiltrative
Surface �3���
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFOR ATION
DIMENSIONS W 3 L Y (� #of Cells Type of System Distribution Media ManufaCturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate `���Q
P/L Bldg Well ❑ IGP � Chamber `+''� � —
INFORMATION Waters ❑ EZFIow Model Number:
❑ AG
CELL TO �a2s� � -�-'�� � �__ ❑ Mound � Other
—- - -- - — - — - ---
--___
DISTRIBUTION SYSTEM X Pressure Systems Only
f Header/Manifold �Distribution Pipe(s) X Hole Size X Hole Observation Pipe�
� Length Dia Length Dia Spac � �� Spacing ❑Yes ❑ No
__ - ----- -
SOIL COVER
- -- — --- —— -
Depth Over Depth Over Depth of Seeded/Sodded 1 Mulched �
Cell Center C�II Edges Topsoil _ _ ❑Yes ❑ No � ❑Yes ❑ ��o
COMMENTS: (Include code discrepancies, persons present,etc.)
��.�� �� ��" l�3
p � ' ;03 '�i a � _ � _ � �� ���
Plan revision re uired.❑Yes ❑ No , � �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITIONAL COMMENTS ANO SKETCH
SANITARY PEAMIT NUMBEA: 2 �- t S�7 __
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