HomeMy WebLinkAbout028-742-29-3304-SAN-2023-158 ��'" "''% Department of Safety c°""n' �
� = & Professional Services, Sawyer �i
S . Sanitary Permit Number(to be filled in by `
`� r: , Industry Services Division
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' Sanitary Permit Application StateTransactionNumber ,
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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 forms for state-owned POWTS are submitted to Project Address(if different than mailing� �
the Department of Safety and ProYessional Services.Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law,s. 15.04(1 xm),sc�ts. �12536N Cty Rd 00
L Application Information-Please Print All Information
Property Owner's Name Parcel#
Mitchell Miller 028742293304
Property Owner's Mailing Address Property Location
854 Bluff Ave
Govt.Loc
Ciri�,State Zip Code Phone Number
St. Charles, MN 559�2 507-313-9920 S W '%,SW �i<, Section 2 9
II.Type of Building(check ail that apply) Lot# T 42 N R 07 E or W
� 1 or2 Family Dwelling-NumberofBedrooms 3 Subdivision Name
Block#
❑Publ ic/Commercial-Describe Use
❑City of
❑State Owned-Describe Use CSM Number ❑V iilage of
�T�wn�f Spider Lake
[Il.Type of POWTS Permit:(Check either"New"or"ReplacemenN'and other applicable on line A. Check one box on line B.Complete line C i
a licable.)
A.
� New System ❑ Replacement System ❑ Other Modificahon to Existmg System(explain) ❑ Additional Pretreatment Unit(explain)
B' ❑ Holding Tank g] fn-Ground ❑ At-Grade
❑ Mound ❑ Individual Site Design ❑ Other Type(explain)
(conventional)
C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ist Previous Permit Number and Date Issued
❑Transfer to New Owner
Expiration
IV.DispersaUTreatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
450 0.7 642.9 652 94.0
Capacity in Total #of Manufacturer �
Tank Information Gallons Gallons Units � � o � �
New Tanks Exis[i�g Tanks y U 2 y _p ^, c�
4� C Y V N � �
O
a U in y v� w C7 0,
Septic or Holding Tank 1000 1000 1 Wieser Concrete x
Dosing Chamber
V.Responsibility Statement-I,the uedersigned,a u respoosi 'ty r installedon of the POWTS shown on the attac6ed plans.
Plumber's Name(Print) Plu er' Signat�r MP/MPRS NUmber Business Phone Number
Douglas Manthey 230722 715-739-6868
Plumber's Address(Street,City,State,Zip Code)
PO Box 196 Drummond, WI 54832
VI.Coun /Department Use Only
Pem�it Fee Date Issued Issuing Agent Signature
�,Ap rov �� ❑Disapproved (� , -
�Owner Given Reason for Denial $ LQQ.00 '� ` r/� j `'�'-� �"�>���s:." ' ��t�I�.�-
f
Conditions of Approval/Reasons for Disa provaP ���� � �
D r� � .
�� � "� ��a-c.� �- --�� -�---��� 1
� ��; � -,���_..� �- �.��:_ � ;_
� `� ���q JUL 2 5 2023 �..-
:,#<#
C S� ��- ( ( `� --- -
, _,_.rt: ;Z�13�i.._.._..�._____._---� SAV4`YER C�
______.
ZONING ADtJ�iiv1.�i:-�% . . �
Attach to complete plans for the system and submit to the County only on paper not less than S 1/2 x 11 inches in size � ` S��,7
N4 R�FJN��AFTER
SBD-6398(R.03/22) 1�5UE OF PER�VIIT
� PAGE 1 OF 4
In-Ground Gravity Plan
Index & Cover Sheet
Component Manual 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&Plan View
Pg 4 of 4 Management Plan
Attachments: � Enclosures:
Tank Manufacturer Specs POWTS Application for Review
Real Estate Property Listing Soil Evaluation Report&Site Map
Project Name/Description
Miller Conventional
OwnerName(s): MitchellMiller Phone: 507 _313 _992p
Owner Address: 854 Bluff Ave St Charles,MN Zip: 55972
Project Address: 12536N Cty Rd 00 Hayward,WI
Govt.Lot: SW 1/4 of SW 1/4,Section 29 ,T42 N-R�� E�or W 0✓
Township: Spider Lake County: Sawyer
Project Parcel ID#: 028742293304
Designer Information
DesignerName: DougManthey Phone: 715 _739 _6868
DesignerAddress: PO Box 196 Drummond,WI Z�P: 54832
E-mail: norpines@cheqnet.net __ , �
License Number: MP230722
'������✓��i
Remarks: �- a'=`!i
i �
��� JUL 2 4 2023 J
SAWYER CC�UNTY
ZONING ADMINISTPAT!ON
Signature: Date: 07/10/23
Original � ure required on e itted copy.
CHECK BOX AS APPLICPBLE CHECK 90X AS APPI ICABLE.
� SOIL EVALUATION o s��e: ��so� 90 Zo � SYSTEM PAGE 2 OF 4
SITE MAP PLOT PLAN
PROJECT NAME: oeSicN F�ow: 450 cPo
15'
Miller Conventio�al Attach design flow calculations for commercial plans.
Pao�ecT nooaess: 12536N CTY Rd 00 � Plpe Material/ASTM Standard(Tables 384.30.3 8 384.3b5)
100A sanrtarysewer_ 4"PUC � ASTMD1785
BM Symbd'. � BM Eleva�ion: FT Force Maln: /
eM oescnpiion: Nail in 18"Pine
Slo eGradierit(% inamatenonnby IMPORTANT:
P ) Well SymbW(H applicable): 0 d.aw��g a�a,ro., Show ground eleva6on contours at suitable intervals.
Of TeSIBd Area: on(he approprite Ilrie.
�}W.� O�
�
���Y\!.W'J �lN
Th 9n�,...-ol Sa:� � 3M = �no.o
�4bs��p4�r,,, �,,,r 3� = 9�1.S
4�9�.�T5 t31 = �! �,v
u�n,o� �tCs�ii-S 1� i33 = 9+� . 0
sy sE�N.. E l�� : 9tii.o
- � C�IIs ��a,N.�,
6 1�. Qv:,c� �{ e�e.��s
) e.o�l�
� (.�ies.z,i IvooS...� }�,,,,,�
.`
Q w�� Ore,..w 1`lD F.�
� � �,ell
� �eos
q�o Q
Pro(+�sr/
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Septic Tank(s)Manuhacturer:
IN-GROUND GRAVITY DISPERSAL AREA wieserConcrete
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Vdume(s):
3-ft Trench (down-sizing credit) �oo0 9al gal gal gal
Effluent Filter Manutacturer:
Orenco
i
Effluent Filter Model#: �4B
min.12"
SOIL COVER (ryo'�I�
tz^
min.o-encn
depN
cnoi�i� • TYPICAL TRENCH
' a CROSS SECTION VIEW
��ry�,� (No Scale)
� • � ' , Provide minimum 3 ft
System Elevation = 94•0 ft separation belween trenches.
(typical)
Quick4 Standard-W
w/End Cap Observatbn Plpe NpICAL TRENCH
�tYP.�� (Show location of inlet/ outlet pipe connection on plan view.) (bai��)
) Ins�anoermanutacwrers PLAN VIEW
Inshuctlons. �ND S,Ca�e�
— �� - - - - �� - - � �
i t s.os�e�weR - - - ..,: �. ��,I �A= 3.Oft
� � c�vP���� �
� '1v�ifxtaaiY-�$- - - - �� - - - - - - - �� — _ - - — _ - - - J �
g = 66 ft -; m
(typicap Quick4 Standard-W Chamber W
(bPical) O
INSTALL PER TRENCH: �mtd by�nfl�traro�sys�a�,���.� �
InsfaA pursuaM to manufacWrefs instruc[ions. �
16 Quick4 Std-W @ 20 fl' EISNchamber= 320 ft�
+ � Pairs of end caps @ 6 ft�EISA/pair= 6 ft'
= Proposed EISA per trench= 326 ft' Required Infiftration Area= 64z•9 ft' Distribution Method:
x 2 trenches = Proposed Total EISA = 652 R' branched manifold
�
PAGE40F4
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 382384,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 pertormed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3),Wisc. Admin. Code.
Maximum Disaersal Area Oqeratinca Limits:
Design Flow = 450 yPd; BODs � Z20 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 boxesl
o neglect or improper use (i.e., exceeding design capacities, prohibited adivities, etc.)
o extent of ponding in distribution cell prior to dosing
o dosing irregularities- if applicable (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 surtace discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tank(s)shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats. when the volume of solids in the tank(s) exceeds one-third (1l3)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 filterlsl 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: HK S2pfIC Phone: 715-79H-3494
Local government unit: SaWye� COuflty ZOnIIIg Phone: 715-634-8288 _
�oca� 9ovemment unit address: 10610 Main St Ste 49 Hayward, WI Z�p; 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.
Continqencv 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.