HomeMy WebLinkAbout012-640-17-2116-SAN-2023-177 ` ` Department of Safety c°°°ry L�
, & Professional Services, a �
$ � Sanitary Pe it Number(to be filled in by �
�= Industry Services Division
�3� 37 � �
Sanitary Permit Application State Transaction Number `�'
tn accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate govemmental unit �
is requircd prior to obtaining a sanitary permit.Notc:Application fonns for state-0wncd POWTS are submittcd to Project Address(if diffcrent than mailing a� �
the Department of Safety and Professional Services.Personal information you provide may be used for secondary Q 1�e�N ���('t 'A�
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats.
I.Application Information-Please Print All Information 3
PropcRy Owncr's Name Parcc #
d o t2 0 6
Property Owner's Mailing Address Property Location
5y D . �o,�.Lot
City,State Zip Code Phone Number
� ,IJ 'rJ�{ f.�J N�_'/.,. ��'/4, Section—_�y_ _
II.Type of Building(check aH that apply) Lot# T___ � N R_ E or�
�4 1 or 2 Family Dwelling-Number ofBedrooms 3 ( Subdivision Name
��
N s�o�k#
❑Public/Commercial-Describe Use_A
�1 �City of _
❑State Owned-Describe Use N� CSM Number ❑Village of
CS�I 331223 �8o2F tn To.�'"of l�Urtfe,r _
III.Type of POWTS Permit:(Check either"New"or"Replacement"and other appiicable on line A. Check one box on line B.Complete line C if
a licable.
A' ❑ New S stem
y ❑ Replacement System ❑ Other Modification to Existing System(explain) ❑ Additional Pretrcahnent Unit(explain)
B' ❑ Holding Tank ❑ In-Ground ❑ At-Grade
❑ Mound ❑ Individual Site Design ❑Other Type(explain)
(conventional)
C• ❑ Renewal Before � Revision ❑ Change of Plumber ist Previous Permit Ntunber and Date Issued
❑ Transfer to New Owner
�xpiration 2'��52 S )� �j
IV.Dispersal/Treatment Area aod Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd�s� Dispersal Area Required(sf� Dispersal Area Proposed(sfl System Glevation
�o �eN3 7an ± 9 •8 r
Capacity in Total #of Manufacturer
Tank Information Gallons Gallons Units � U o � n �
New Tanks Existing Tanks L o v � v p ^a cy
a U v� � rn w C7 a.
Septic or Holding Tank � �� � 0� � ,Y
Dosing Chamber
V.Responsibility Statement-I,the undersigned,assume responsibility for installaGon of the POWTS s6own on the attached plans.
Plumber's Name(Print) Plumber's Signaturc MP/MPRS Tv'umber Business Phone Number
rp�a��, a2 1 32 0
Plumber's Address(Street,Ciry,Statc,Zip Codc)
o Id la y83
VI.County/Dep$rtment Use Only
�A �f � ❑Disapproved Permit Fee Date Issued Issuing Agent Signature
��i✓ ❑Owner Given Reason for Denial � O•� 6�� I `�� �`-`•'�'��
Conditions of Apptoval/Reasons for DisapQroval
;. ;�a�t� �' � �� - ��_, � �,!`_,.``���,,5,--=,r---:
�� '�
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::hk# '� �� AUG 0 4 2023 J- �
CS� �--3 — I 1 � �cpt�_._.�s►-3 _—. . sAwY�� c��;,.:;r
Attac6 to complete plrns for t6e system rnd submit to the County only on paper not less than 8�rz z 11 inches in size
SBD-6398(R.03/22) NO R�F'JP1D5 AFTER '�1�� 7 3
ISSUE OF PER�!!T
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): Lena Land LLC Phone: - -
Owner Address: 754 Glenwood Drive Fon Du Lac, WI Z;p: 54935
Project Address: g119N Fiorelli Rd Hayward, WI 54843
Govt. Lot: NE �1/4 of NW �1/4, Section � 7 , T 40 N-R 6 E Q or W Q✓
Township: Hunter County: Sawyer
Project Parcel ID #: 012640172116
Designer Information
Designer Name: Kurt Brown Phone: 715 _943 _2988
Designer Address: W10487 Old Murry Rd Exeland, WI Z�p: 54835
E-mail: brownk@bevcomm.net
License Number: 224281
Remarks: �
Signature: Date: 7��n/�3
iginal si ature required on each submitted copy.
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IN-GROUND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with EZ1203HP Bundies
3-ft Trench (down-sizing credit)
i m�� ,z�
Geotextile � I �roP���> TYPICAL TRENCH
Cover
SOILCOVER CROSS SECTION VIEW
,z• � (No Scale) OBSERVATION PIPE DETAIL
min.trench (No Sceie)
depth
(fyplCalJ L —r -- .�w� , Scraw-Type or Flnls�hed Grade
si'�P caP Oooae� �m�i�n a a saaaaa�
/93.8 � ° 4"0 PVC PiDe Topsoil Cover
SystemElevation= ft. � roPorP�Pam�a���a�a (m��.�+���)
(rypicaq Provide minimum 3ft a,o,abo�ar��snaa9aae
separation between trenches.
�a>va��_ai2,x s^sio�s
�4a aPan
TYPI CAL TRENCH (Show location of inlet/ounet pipe connection on plan view.) A��non�9 oe��� i�nuaro�
Surtace
PLAN VIEW
(No Scale) 4„� obsarva��o�P�Pa sha��be��s�a��ad
a�;��aio�eanVaa��wo����s. �p ft
Perforated Lateral Observation Pipe
(typIC81) (typical) —— (tYPical)
_———��————————————— �
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I =_____ ___:___ �:-___ _:_____= I A—3.0 ft D
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�---------------�,�------------- -----J (�YPical) ln
B= ft ---I m
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INSTALL PER TRENCH: EZ1209P B�ndle �
� 10-ft bundles @ 50 fl EISAlunit= 350 ft� (mtd by Intltramr Systems:Inc.) �
Install pursuant to manufacturer's instructions.
+ 5-ft bundles @ 25 fl EISA/unit= ft'
=Proposed EISA per trench= 350 ft� Required Infiltration Area= 643 {�' Distribution Method:
x 2 trenches=Proposed Total EISA= ��� n= branched manifold �
PAGE40F4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground gravity system shail 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 activifies shall be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Cade.
Maximum Dispersal Area Operatinq Limits:
Design Flow = 450 gpd; BODS <_ 220 mgL"'; TSS <_ 150 mgL"'; FOG <_ 30 mgL"'
lnspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfuncfion (i.e., pumps, vatves, switches, floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatmerrt 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 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 specfication)
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 serviang period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local govemment unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company: R clCld P's Earth and Forest Works Phone: 715 266 0661
�o�ai 9oVernme�t un�t: Sawyer County Sanitary and Zoning phone: 715 634 8288
L.ocal yovernment unit address: 10610 Main St #49 Haywa�d, 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.
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.
System Abandonment
ff use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
::��
� ' -`""`%; PRIVATE ONSITE WASTE TREATMENT counry
�'�'�°�s ���k SYSTEMS SaWyer
�:,.,1 Ps :� ( POWTS)
�ry �- �`%
' "� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � 2 v 1-7-7
Personal infonnation you provide mav be used for sccondary purposes[Privacy L.aw,s. 15.04(1)(m)] �
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
� C�� C � K��- �
Insp BM Elev: BM Description: Parcel Tax No:
��_a Ma;1 ti.�..-c�" dbl, c�(�.�_3�'41�-� o��.- G�to - (7-��t(�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic „� � (d� Benchmark �po,o'
Dosing
Aeration Bldg. Sewer .—
Holding St/Ht Inlet �lb.oa'
TANK SETBACK INFORMATION St/Ht Outlet 53:66 `
TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet
AIRINTAKE
Septic ,�..�o' N � � fi� NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. �Y� � �
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative gy � r
Surface �
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 o� 7b' #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate
INFORMATION P/L Bldg Well Waters � IGP ❑ Chamber Model Number:
❑ AG � EZFIow
CELL TO � � n Mound o Other
----- _�_�__�� �_/�" `��--_ ____ _ ---- -- -- -- -------___
DISTRIBUTION SYSTEM X Pressure Systems Only
— ---- _ _ --__ --.�
Header/Manifold Distnbution Pi e s X Hole Size X Hole Observation Pipes
Length Dia �Length Dia Spac II Spacing ❑ Yes ❑ No I
P � )
— --
SOIL COVER
_ ___ __-_ —____ _-- ----- ---- _ -
Depth Over Depth Over Depth of Seeded/Sodtled Mulched
-
Cell Center Cell Edges II Topsoil__ � ❑ Yes ❑ No � ❑Yes ❑ N�
COMMENTS: (Include code discrepancies, persons present,etc.)
���Il��(3b la�
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Plan revision required?�Yes 0 No ��3 �3 I��� I , �'! /
�__l _- ---_______ �
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Use other side for additional information Date OWTS Inspec s � na Certification Number
SBD-6710(R.3/01)
A��ITIONAL C�MMENTS AN� SKETCH
SANITARY PERMIT NUMEER �3�I7�
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