HomeMy WebLinkAbout024-741-31-5209-SAN-2023-167 -Y�;�, lndustry Se�vices Division County �
`��� _ d822 Madison Yards Way� SBWy@f �
�_ S� - Madison,WI �370� Sanitary Permit Number(to be filled in by �
a P.O. Rox 7302
�`'•,,;,-� — Madi�on.WI�3707 (Q s � 1��1 � �}-)
State Transaction Number �
Sanitary Permit Application !
[n accordance with SPS 38321(2),Wis.Adm.Code,submission of[his form to the appropriate governmental uni� �� �
is raquired prior to obtainin�a sanitary permrt Note�Application forms for state-owned POWTS are subinitted to Project Address(if different than mailing �1
the Department of Safery and Professional Services.Personal infomiation you provide may be used for secondary �
purposas in accurdanee���ith the Privacy l.aw�,s I5.0�(I)(m),S[ats.
I.Application Information-Please Print all Information
Property 0��ner�s Name Parcel tt
RICHARD S NEVILLE REVOC TRUST 024-741-31-5209
Propeity O�cner's Mailin�Addr�ss Propert}�Location
11742 MT CURVE RD c,o�� L��
Cit�-.State Zip Code Phone Number
EDEN PRAIRIE, MN 55347 ''�- '' �eC11O11 31
1L Type of Building(check all that apply) Lot# T 41 N x 07 �o�w
�I or2l�amil}�D�ccllin,-�lunibcrofBedrooms 3 � SubdivisionName
Rfock#
❑Public/Commeroial-Describe Use _
�City of______ _
�State Owned-Describc Use CSM Number �Village of
�-�-�,��„�t Round Lake
3�l �l� ��I�o — -
III.Type of POVVTS Permit: (Check either"New"or"ReplacemenP'and other applicable on line a. Check one box on line B.Complete line C if
a �licable.)
��� �Neti�System �Replacement S��stem �Other ModiYicution to Gsisting System(explain) �Additional PreVeatment Unit(explain)
�' �Holdin���ank �In-Ground �t-Grade �Mound ❑[ndividual Site Design Other Type(esplain)
(conventional)
C. �Renewal Beti�re �Revi;ion �ChanQe of Plumber �I�ran,fer to'V��c O���ner
Li,t Previous Pennit Number and Date�Issued
Espiration (�'� � �� ���"
IV.Dispersal/Treatment Area and Tank Information: �
I)esien Flo���(gpd) Desien Soil Application Rate(gpd/st) Dispersal Area Required(st) Di,persal Area Proposed(a y;tem I�;levation
450 0.7 643 646 94.00
Capaciry in Total #of Manufacturer
y c
fank[nformation Galluns Gallons Units � � v '� �
New Tanks Esisting Tarilzs '� � = � � � �
., U �:n. .n :n u:. C7 G.
Septic or xolding Tank 1000 1000 1 WIESER CONCRETE ✓ �
Dosin�Chamber � � �
V. Responsibilit}'Statement- l,the undersigned,assum esponsibilit for st ation of the PO��'TS shown on the attached plans.
Pluntbcr's Name(Print) Plumbe �. Si;nature MP/MPRS Number E3usiness Phone Number
Travis Butterfield �P 652879 715-634-8176
Plumber's Address(Street,City,Sta[e,Zip Cude)
14346W St. Rd. 77, Hayward, WI 54843
Vl.C un �/Department Use Onl�°
�A ❑Disapproved Permit I�ee Datc Issued Issuin_:1eent Sisnature
❑O��ner Gi��en Reason for Denial � l��� 7 � 3 � ��3 ����'����ZV7Jle2
Conditions of Appib"�dtY�f�easone ti�r DisapprovaL �
A :.��tE_.. ai a3 ._�__._�.�a� � � �t4�''1�_��r�� �
� � ``,;;;
r �� I ���v� ��k# a�3 0 .T_ ..._,._, JUL ?. 7 2023 � '
C�� 1 hCi�t# .___ �N I�,_,_. ._ SAWY�r� Cr.3�.;� �"��
I'� � ( � � ZCNING ADMii�iiS�i'ftt;�t,;;,7
Attach ro complece plans for[he system and bmi[to the Counq�only on p�per not less[han S I!2>1 I inches in size �� J� r_
J t.f/
NO R�FtJND�AFT'�R
sBi�-bs�s�R.oaizz� ISS�JE OF PER1�iT
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:
POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s): RICHARD S NEVILLE REVOC TRUST phone: - -
Owner Address: 11742 MT CURVE RD, EDEN PRAIRIE, MN Z;p: 55347
Project Address: Lot 1
Govt. Lot: 1/4 of 1/4, Section 31 , -1-41 N-R 07 E ❑or W ❑✓
Township: Round Lake County: Sawyer
Project Parcel ID #: 024-741-31-5209
Designer Information
Designer Name: Travls ButterField Phone: 715 _634 _8176
Designer Address: 14346W St. Rd. 77, Hayward, WI Z�p: 54843
E-mai�: office@butterFielddrilling.com �;�> ,E��.��� �:,,���r ,;,1���>��, .�l 5��at��;,.
License Number: 652879
Remarks:
�' � ,� � - �3
Signature: Date:
Original signature required on each submitted copy.
CHECK BOX AS APPLICABLE CHECK BOX AS APPLICABLE.
� SOIL EVALUATION o Scale: 1fio so' go �20 � SYSTEM PAGE 2 OF �-�
SITE MAP PLOT PLAN
PROJECT NAME: �Esi�N F�ow `�S� c��
(�+ / J 15'
I << C`'�=.,'z� L��v' `�� ��'v�� r�S� Attach design flow calculations for commercial plans.
PRO,IECT ADDREss, �%�N����' li�+'-� lZc'� Pipe Material/ASTM Standard(Tables 384.30-3 8 384.30-5)
i c
��=�+ � �% FT � Sanitary Sewer: y S �`� �'-)
BM SymboC � BM Elevation: Force Main �` /
BM Descripfion: �.� V�`�� (
��dicate noeh 5y IMPORTANT:
Slope Gradient(%) Weil Symeol(if aoplicable) � d�a��,i�9 ar,arroh� Show ground elevation contours at suitable intervals.
of Tested Area � on the approprite line.
I `lL��a/��l V'�l/I �1l ��1,��C/',f4� �
/ � 7 t�� � T �Lv�!i� 0'\Lt _ �--
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Septic Tank(s) Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA wieser Concrete
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s):
3-ft Trench (down-sizing cred it) �o0o gal gal gal gal
Effluent Filter Manufacturer:
BeSt
I
EffiUe�c F�iter nnodei#: Gf10-8
min.12"
(typical)
SOIL COVER
12"
min.trench
depth
c�vP��a�� < TYPICAL TRENCH
— • - °.a �. CROSS SECTION VIEW
��tYp��a,� �., (No Scale)
� e, .
� ` Provide minimum 3 ft
System Elevation — 94.00 ft separation between trenches.
(typical)
Quick4 Standard-W
w/End Cap Observation Pipe TYPICAL TRENCH
(typical) (Show location of inlet/outlet pipe connection on plan view.) Install per�manufacturer's
PLAN VIEW
instructions.
(No Scale)
� - - - - - - - - - - �� — - - �� — - -�
� ,
� � ����n ���I � � � �� :��' 1 � � �. �R � A= 3.Oft
� � " ''t g� 4 (tYPical) �
— — — — — — ° � ,
L- - - - - - -�� - - - - - - - �� - - - - — —' — � D
G�
a = �Zs ft -� m
(typical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (typical) �
(mfd by Infiltrator Systems,Inc.) —n
Install pursuant to manufacturer's instructions. �
32 Quick4 Std-W @ 20 ft� EISA/chamber= 640 ft2
+ � Pairs of end caps @ 6 ft1 EISA/pair= 6 ftz
= Proposed EISA per trench= 646 ftz Required Infiltration Area= 643 ftz Distribution Method:
x � trenches = Proposed Total EISA = 646 ftz 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 382-384,Wisc.Admin.Code. Pursuant to SPS 38352(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 POWTS Maintainer in
accordance with SPS 383.52(3),Wisc.Admin.Code.
Maximum Dispersal Area Operating Limits:
Design Flow= 450 gpd; BODS 5 220 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,corroslon,etc.)
o solids volume in anaerobic treatment tank(s)and any distribution appurtenance(s)(i.e.,distribution/drop boxes)
o neglect or improper use(Ce.,exceeding design capacities,prohibited activities,etc.)
o extent of ponding in dishibution cell prior to dosing
o dosing Irregulanties-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 dlstribution lateral or lateral orifice plugging (measure lateral dlstal 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 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(1/3)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: BUtt@1�12ICI, I nc. Pho�e: 715-634-8176
�o�a,go„e��me��U�;t Sawyer County Zoning Pnone: 7�5-634-82$$
�o�a�go�e��me�c U�a aaa�ess: 10610 Main St. Suite 49, Hayward, �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.
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 sultable soils.
SVstem Abandonment
If use of this POWTS is discontinued,it shall be abandoned in accordance with SPS 383.33,Wisc Admin Code.