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Home My WebLink About028-742-33-5108-SAN-2023-169 ��;;��"�"'�;��. lndustry Seivices Division Counry C/� - -t822 Madison Yards Way Sawyer D - ��,�5� - Madison,Wl �370� Sanitary�Permit Number(to be filled in by � ` � a ; P.o. �oX�3oz �`-- '-�"' Madison. Wf�;707 '�y�:,�.:,,�: (y 510"l �3 � Sanitary Permit Application StateTransactionNumber ; In accordance with SPS 383 21(2),Wis Adm_Code,submission ofthis fo�m to the appropriate govemmental unit � is required prior to obtainin�a sanitary permiL Note: Application torms for state-o�vned POWTS are submitted to Project Address(if ditferent than mailing�� ,y'� the Department of Slfety and Professionaf Services.Personal information you provide may be used Yor secondary � �� p� purposes i�accordance��ith dic Privacy l,aw,s. I S.O�I(1)(m),S[ats « I.Application Information-Please Print All[nformation Property Ownu's Name Parcel# JEFFREY R NOWAK 028-742-33-5108 Propeity O�cner's Mailina Address Propert��Location 6972 W GREYHAWK CT U��t I.o� PRT 1 City,State Zip Codc Phone Number FRANKLIN, WI 53132 '%, '�. se�"°n 33 ___ ll.Type of I3uilding(check ail that apply) I.ot# T 42 N R �� E or W �I or 2 I�an�il}'U�cellin�_-NwnLicr��f Bedroom;� � Subdivision Name Block# �Public/Commercial-Describe Use �City of - -- --- �State ONmed-Describe Use CSM Numher �Village of C J M 35�V 9 ❑✓ ��o��„or Spider Lake_ _ _ IIL T3�pe of POW'TS Permit (Check either"�`ew"or"Replaccment"and other applicable ou line A. Check one box on line B.Complcte line C if a licable.) _ �� Ne��S�stem �Re lacement Scstem �Other htoditicatiun to I�;�istin�S��tem(es I iin) ldditional Pretre�tment Unit(ex�lain �/ y'� P . )� p� ❑' I ) B' �Holding"I'ank �In-Ground �t-Grade �Mound ❑Individual Site Design Other Type(eaplain) (conventional) C. �Rene��al Rcforc �Re��ision �Chane�of Plumber ��'ransfer to Ne�+�O��-ner List Previous Permit Numher and Date Issued Expiration �- IV.Dispersal/Treatment Area and'fank[nformation: Desi�n Flo�c(epd) Desi�n Soil Application Rate(gpd/st) Di;penal,Area Required(st� Dispersal.4rea Proposed(sf� Svstem F.levation 450 0.7 643 652 94.00 ' Capacity in Total #of Manufacturer "I�ank Information Gallons Gallons Units ,. � � � � ;� � U Nzw"Canl:s E�isting Tanks � � a� ` Y � �y � _ :� s r ✓: _... :7 _ Septic or Holdine Tank 1000 1000 1 WIESER CONCRETE ✓ � Dasing Chnmbcr � � � V.Responsibilit3�Stateinent- I,the undersigned,assum sponsibi'ty for ns Ilallon of the NOWTS shown on thc attached plans. Plwnber's Name(Print) Plumbz ' ,i,nature MP/MPRS Number Business Phone Number Travis Butterfield 652879 715-634-8176 Plumber's Address(Strect,City�,State,7ip Code) 14346W St. Rd. 77, Hayward, WI 54843 VL Co n /Department Use Only � Permit Fee Date Issued l.,suine Aeent Sienature �Ap o � ❑ Disapproved _ �� " �� .�.f,.�,,,, � �� ❑O��ner Gi��en Reason far Denial � ��•� � �� '�'�'�� "^'"`�*� Conditions of Appro��allReasons for Disappro��ah � � � � � �r�,�;� s_��_�� _.� �i � ,�� "� - . a__(_i a� .��,\;� ��i� '�'� � � ��..;��_ � JUL 31 2023 � �� GI�� L &� �hk# �- _ � � �- 'v1L1_3��..__._W_...��._..._ SAWYER C(JUS��"�r CS� �� --s"�"'� ZON1�G AUMINiS7'R,4TION Attach to comple[e plans for the sy'stem and submit to the County only on paper not less than 8 I/2 x 11 inches in size 1� ��41�� s��-6�9s�H.ozizz� NO R�FUi�D�AFTER ISSUE UF PERN�I"� 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 Pian Pg 3 of 4 Dispersal Area Cross-Section & Plan View Pg 4 of 4 Management Plan Attachments: Enciosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Owner Name(s): JEFFREY R NOWAK Phone: - - Owner Address: 6972 W GREYHAWK CT, FRANKLIN, WI Zip; 53132 Project Address: 11064W ALLAN RD Govt. Lot: 1/4 of 1/4, Section 33 , T42 N-R 07 E❑or W ❑✓ Township: SPIDER LAKE County: SAWYER Project Parcel ID #: 028-742-33-5108 Designer Information Designer Name: TRAVIS BUTTERFIELD Phone: 715 _634 _8176 Designer Address: 14346W ST. RD. 77, HAYWARD, WI Zip; 54843 E-mail: OFFICE@BUTTERFIELDDRILLING.COM ,�;;;�;,�,��t �� t;�v�t��„�E,;�,� �,:� 5f��,��;x,. License Number: 652879 Remarks: Signature: Date: �'� � � � gina nature required on each submitted copy. CHECK BOX AS APPLICABLE CHECK BOX AS APPLICABLE. � SOI L EVALUATION Scale: 1" =50' � SYSTEM PAGE 2 OFI.f SITE MAP o so �5 �oo PLOT PLAN PROJECTNAME: pEsi�NF�ow �lsU GPD /� � � 12.5- �e�T ey �p�-�k .,} J�prr rl�C/— /�u��ho Attach design flow calculations for commercial plans. PROJECT ADDRESS: �l�� / W /'t��a '1 ��JC Pipe Material/ASTM Standard(Tables 384.30-3�384.30-5) N SanitarySewer y �4 YJ / BM Symbol � BM Elevation. ��' � FT 3� O�/\ �� ForceMain / BM Description, �ndicate north by IMPORTANT: Slope Gradient(%o) Well Symhol(if applicable): � draw�r,9 ar,arro��- Show ground elevation contours at suitable intervals. of Tested Area: on the approprite line. �.�"t t� � �• ' I _ � � IJ �� / o�°q \\ �/ �� \ \ � _ e --- � / e2 W � � d � I � �5� � � J2f7lty Nt�l✓z,cG� `� �Pn/�i�"r J�a�•��io I � �m - �oo,� �9 �� ' ��Py �w�� cfi- /la;� ,�., 3�'�v�Fl� �rahk�.� , wr s>�� l8, ��u0 (,!J`P� GJnC'�e� ) � - Oas� �/�335/0� �� 98, S 3a C.�w�cl� c� �IUS ,�r' Ca� �G,.,�..s�s j a�„� o F S/� , 3� q'�S,D �,e�¢ �'�� SP� 3 3 T Y�✓�! � o�w � l„�-�' ��S � S�yf�� e L, 9Y- o � � / T�a J;S r��"1'�f�'J C(� �,PR.S. �l�� 9 � ��o��l w ��L�.� 2� _ _ — — �— — — — — — — — — — — ,41ia� �� 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 credit) �000 gal gal gal gal Effluent Filter Manufacturer: Best � Gf10-8 Effluent Filter Model#: min.12" (typlcal) SOIL COVER i 2" min.trencn depth c�vP��a�> . � TYPICAL TRENCH - — - • — - °.a a. CROSS SECTION VIEW �- 3d <<YP��a�� ., � (No Scale) , �. � ' 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.) (typical) Install per manufacturers PLAN VIEW instructions. (No Scale) � - - - - - - - - - - --��- - - - - - - - �� - - - - - - - - - -� �s�� fi��tia��p �� !�, � a �I '. , I �A= 3.Oft � . _. (typlcal) � �- - - - - - - - - - - - �� - - - - - - - ��- - - - - - - - - - -� D ,�_ � B = 64 ft -� m (typical) Quick4 Standard-W Chamber W (typical) O INSTALL PER TRENCH: (mfd by��fi�t�ato�sy5tems,��.) � Install pursuant to manufacturers instructions. � 16 Quick4 Std-W @ 20 f� EISA/chamber= 320 ftz + � Pairs of end caps @ 6 ftz EISA/pair= 6 ftz = Proposed EISA per trench= 326 ftZ Required Infiltration Area = 643 {tz Distribution Method: x 2 trenches = Proposed Total EISA = 652 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 383.52(2),Wisa 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 Operatinq Limits: Design Flow= 450 9Pd; BODS<_220 mgL-'; TSS<_150 mgL-'; FOG<_30 mgL"' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nulsance factors(i e.odors,user complaints,etc.) o mechanfcal malfunction(i e„pumps,valves,switches,floats,etc.) o material fatlgue(i.e.,leaks,breaks,corrosion,etc.) o solids volume in anaerobic treatment tank(s)and any distribution appurtenance(s)(i e.,dlstrlbutlon/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 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 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 VJis. 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 deaned 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: BUtt2Ifle�C�, �IIC. Phone 7�5-634-8�76 Local government unit SaWy2f COUnty Z011lllg Pno�e: 715-634-8288 _ �ooa�go�er�rne�t U�it addres5: 10610 Ma111 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.Wisa Admin Code No product for chemical or physical restoration of the PONlTS may be used unless approved by the department in accordance with SPS 384,Wisa Admin.Code Continqency 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. z,, � ` "`'`E`�; PRIVATE ONSITE WASTE TREATMENT �ounty �r� ��o�sp SYSTEMS ��,,,� s .� ( POWTS) Sa.Wyer \k �-�'-`�� ' " INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION ��•- �69 Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)] Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#: �"� p •--- .�� p...i a�` s l/�J L�►� Insp BM Elev: BM Description: � Parcel Tax No: r ? N,��, �,� � , t n ��O `C'�.wb , w.a' Ua-� �'�2 —,�,3 —S(Gg TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic w�Q,�� p� Benchmark s — Dosing a►v�� j�, loD.b' Aeration Bldg. Sewer �� ` Holding St/Ht Inlet �f y,� � TANK SETBACK INFORMATION St/Ht Outlet �' �6 � TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet AIR INTAKE Septic � � q ,� � NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. 13,�$3' Holding Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative 9��► Surface Manufacturer Demand Final Grade Model Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS �N � L ` #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav �. Conv ❑ Aggregate �,�� INFORMATION P/L Bidg Well Waters � IGP �c Chamber ❑ AG � EZFIow Model Number: CELL TO � � /./ .�-+�j ❑ Mound o Other � � _ _.— __—__ —__ _— _— — - ---— DISTRIBUTION SYSTEM X Pressure Systems Only _ _—. --- - ----__-- �--_.--— Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length Dia Length Dia Spac ! Spacing ❑Yes ❑ No _ -- -----________ SOIL COVER -- - -- - --� Depth Over Depth Over �—Depth of Seeded/Sodded Mulched Cell Center Cell Edges I Topsoil ___ I ❑Yes ❑ No ❑Yes ❑ No l COMMENTS: (Include code discrepa�cies,persons present,etc.) ��I(� �� ( a gf�3 Plan revision required?❑Yes ❑ No ' —1 �°3�J�`�� _ - � �i i ��1 � � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AODITI�NAL COMMENTS AND SKETCH SANITARY PEAMIT NUMBEA: � 7 ^ I 6q � "� ' : _; . ': _ _ ;_ �' / C�'�6 �v r� �►a"`� �k �� QY+ s� $,�� 3 11� '�r y� �,�5�°� � � � � 3 . g << W�� b0fl � � �t� w(c.�T'• y' �O Ct i �� l� ? �� -� �� N —�--- Tb �(��, c� .