HomeMy WebLinkAbout012-640-17-2101-SAN-2023-179 `�' Department of Safety c°°°ty Ci�
t 0 � & Professional Services, aw r �
a Sanitary Pertnit umber(to be filled in by �
�s Industry Services Division
_ t� S I o � e�
Sanitary Permit Application StateTransactionNumber U'
In accordance with SPS 383.21(2),Wis.Adm Code,submission ofthis form to the appropriate governmental unit "���-
is required prior to obtaining a sanitary permit.Note:Applicarion forms for state-owned POWTS aze submitted to Project Address(if different than mailing ac �
the Department of Safcty and Professional Services.Personal information you provide may be used for secondary j p 5 w F�v r ��1 �j� �
puiposes in accordance with the Privacy Law,s. 15.04(i)(m),Stats. e '`
I.Application Information-Pkase Print Atl Information
Property Owner's Namc Parccl#
d
Properiy O er's Mailing Address Property Locat�on
[� Govt.Lot
City,State Zip Code Phone Number
5• � _�_'/.,��__'/a, Section�—
II. ype of Building(c6eck aIl that apply) Lot# T N R �o E or�
[�J or 2 Family Dwelling-Number of Bedrooms �-- Subdivision Name
Block#
❑Public/Commercial-Describe Use
❑City of
❑State Owned-Describc Use__ CSM Number ❑Village of
� �� � fSTown of�{(,LY�'I'"�
III.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one bog on line B.Complete line C if
a licable.
A.
❑ I�ew System �Replacement System ❑ Other Moditication to Existing System(explain) ❑ Additional Pretreatmen[Unit(explain)
B' ❑ Holding Tank �.In-Ground ❑At-Grade gn yp ( p )
❑ Mound ❑ Individual Site Desi ❑Other T e ex lain
(convcntional)
C• ❑ Renewal Before ❑ Revision ❑ Chanae of Plumber ❑ Transfer to New Owner ��t Previous Permit Number and Date Issued
lxpiration � S' ��3 �� - I�(J
IV.DispersaUTreatment Area and Tank Informallon:
Design F'low(gpd) Dcsign Soil Application Rate(gpd/st) Dispersal Area Required(sn Dispersal Area Proposed(s� System Gievation
�150 �S��
Capacity in Total #of Manufacturer
Tank Information Gallons Gallons Units � � o 'o„ �
Ncw Tanks Existing Tanks � o � � � � ro R
a. U �n „ ci� i�. C7 fi.
Septic or Holding Tank
/ ovo lo�o Z w 5 x
Dosing C'hamber •Z�� . ,�Y, �.l� ' �
J
V.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Signature MPMPRS Number [3usiness Phone Numbcr
a a�y� � 15 9Y 3 .� �
Plumber's Address(Strcct,Ciry,Statc,7ip('odc)
�l !�y E � � . "'
VI.Cou /Department Use Only
�1 Pertnit Fee Date Issued Issuing Agent Signature
�Ap ve ❑Disapproved $ ,,,� �
f�j�/✓ O Owner Given Reason for Denial l��/.� 5�(� ''`�'� �V�Gt,(tid.(.���'Vt�4.�--
Conditions of Approval/Reasons for Disapproval
� � � 1 l 1,,, � ��,--ti /��--� ��r��.-�r-1
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CS I 2.3- I I t�� ����#�. .��___.. _ __...__
SAVv'Y�r� C°,:;.:':
Attach to complete plans for tbe system and submit to the County ooly on paper not Iess than 8 IR x l l inches in size
sB�-6398�x.o3izz> NO R�FUND�AFTER
IS3UE OF PERMIT
PAGE 1 OF 5
In-Ground Dosed-Gravity Plan
Index & Cover Sheet
Componenf Manual Design References_
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 5 Index & Cover Sheet
Pg 2 of 5 Plot Plan
Pg 3 of 5 Dispersal Area Cross-Section & Plan View
Pg 4 of 5 Pump Tank Specifications
Pg 5 of 5 Management Plan
Attachments: Enclosures:
Pump Curve POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Owner Name(s): Daryl and Bonnie Hofer Phone: - -
Owner Address: $351 Old Hwy 70 Ojibwa, WI Z�P: 54862
Project Address: g105W Fiorelli Rd Hayward, WI 54843
Govt. Lot: B NE 0.1/4 of NW �1/4, Section 17 , T 40 N-R6 E ❑or W❑✓
Township: Hunter County: Sawyer
Project Parcel ID #: 012640172101
Designer Information
Designer Name: Kurt Brown Phone: 715 _ 943 _2988
Designer Address: W10487 Old Mut'ry Rd Z�P; 54835
E-mai1: brownk@bevcomm.net ,;ti �� a rt���, ;,��� _� :��, _ �,,; , >
License Number: 225281
Remarks:
Signature: Date: �'If�z�
Ori nal signature required on each submitted copy.
CHECK BOX AS APPIJCA�E � CHECK BOX AS APPIJCABLE.
� SOIL EVALUATION o �'�= �40' � � � SYSTEM PAGE 2 OF
SITE MAP � PLOT PLAN
PROJECT NAME:
a (10 fl gfd) �p� DESIGN FLOW: � GPD
���1 9 ��a'it� �.�ti\�f� !'ta��,�` Attach design flow piculations for commercial plans.
PRO.IECT ADDREss: R�Q��1/ �1�{�'E' �f� "'�3�'� A 1 Pipe AAaterial/ASTM Standard(Tables 384.30�8 3B4.3Q5)
�r sanuarr sewer: 1 .� ih c�1.
BM Symbol: � BM ElevaUon: ���.�l F7 • /
a; �„���r� I �► (� Force Maln: p�/�. / 2 IhC V�
BM Descripibn: ,�"�" ,r 'ti�� (M ��la i I�Lt�1 cJ' f :
Sb (�radier� %) !h ��"°"�'�' IMPORTANT:
of Te�sted Aiea:( �tL well symbd(dapp�icade): O d�^re�� Show gr�wwnd elevation contours at suitabie in6ervals.
an tlie approprMe ine
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IN-GROUND GRAVITY DISPERSAL AREA SepticTank(s)Manutacturer
Skaw Precast
Uniform Elevation Trenches with EZ1203HP Bundles SePt��Ta�k�s,�o��me�s,
3-ft Trench (down-sizing credit) �,000
gal gal gal gal
Ef(luent Filter ManufacNrec
` Lifetime
Geatextile I min.12" Effluent Filter Model#: ��$
Caver I (rypiwl)
soi�coveR TYPICAL TRENCH
m;�.te��h CROSS SECTION VIEW
��,P°�,> � —— .-�"� • (No Scale)
OBSERVATION PIPE DETAIL
/T� (No Sqle)
System Elevation=�5•4 ft ` � s`�a"'-TyPa°` Fm�snaac�aa
(typical)
• Provide minimum 3ft S°°caP�'°°sa� �m���naaasaaaea�
separation between trenches. a 9 Pvc P�Pa roPsou co�a,
Top of pipe�o�ermina�e (min,1 fooQ
et or above Ilnlshetl grede
(4)t/4"-1/Z"X 6"Slo�s
TYPI CAL TRENCH (Show location of inlet/outlet pipe connection on plan view.) c�o avan
PLAN VIEW n��non�9oa���e i�roo-aea�
Observa�ion O�ipe shall0a�installed Surface
(No Scale) 4��� a�;��n�o�ba�waa��wo���s.
Pertorated Lateral Observation Pipe ft
—— (typical) (typicap —— (tyPicaq
�-------- -----��------------- �� �
� ______:__:____ � A-3.0 ft D
_--'° ___ _______ ________
�---------------��-------------- -----� cryP��o G�
m
� B= ft -=i �,,)
(typical)
INSTALL PER TRENCH: EZ120YP B�ndle �
9 10-ft bundles @ 50 H`EISA/unit= 450 ft� (mfd by Infiltramr Systems,Inc.) �
Install pursuant to manufacturefs instructions.
+ 5-ft bundles @ 25 fl EISNunit= ft�
=Proposed EISA per trench=450 ft� Required Infiltration Area= 429 ft' Distribution Method:
x � trenches=Proposed Total EISA= 450 ft�
�
PAGE 4 OF 5
GRAVITY-DOSED
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4"0 Ven[Pipe
>10 fl from
Buildirg [IecUical musl mmply w�1h
72Min.or2.Oflabove SPS316andNEC300
Establishetl Flood Elevation 6dend manhole nser as necessary.
�NPiral) WealherProof
APP��� JunGion Box
Venl Cap APP���Lockirg Manhole
IMPORTANT: �wim wami�y�abei ni�acned
Anchor tank(s)as necessary (ryPi�l�
pursuant to SPS 383.43(8)(g) co�a�n
4"Min.or 2A 9 above
Fstablished Flood Bevation
(rypical)
�Airti9ht Seal '.
Finished Grade puick Disconnect
�I i8"Min.
CAPACITIES @ v •`� � gai�n � cryP'�'>
Depth(in) Volume(gal) , d �
A 24 201.84 't� \
Weep � `Appmvetl.lolnlsw�th
Hole Approved Pipe 3 fl onlo
B 2.� 16.82 q I SolidGmund
� �rowmn
[C] 7.0 58.87
_Alarm
D 6.0 50.46 �g —o�
I [Cl I PUMP-OFF
* 39 � PumP �—� ELEVATION = 9�•25 ft
Pump Tank Liquid Levei = in
° INSIDE BOTTOM
Force Main Diameter = 2 in c°""�`e
B1ock ELEVATION = 90�75� ft
FO�ce Main Length = 90 g 3"APP`°"`�s�aam9 Maie�ai oe„eam Ta�k
Force Main Void Volume = 14.67 9a�
[C] Total Dose Volume (TDV) = 75 gal/dose
�(<02X design flow+(orce main void volume)
Vertical Lift = 5.15 ft
PUMP TANK: SEPTIC TANK(S):
Volume = 328 gal Total Volume = 1,000 gal
Manufacturer: Skaw Precast Manufacturer(s): Skaw Precast
Pump Manufacturer: Zoeller
Install approved effluent filter at the septic tank outlet
Pump Modei: 53 �s�a����P�mP�Ne> immediately uostream of the pum�tank inlet.
Controls/Alarm Manufacturer: SJE Rhombus Filter Manufacturer: Lifetime
Controls/Alarm Model: 101 HW
Filter Model: 1/8
FI_oat switches containing mercury are orohibited.
---- 5 0
WARNIN6DE4THMAVOCCURIFTANKISEMEftEO i'' \\��` BAFFLE
WITHOUiPROPEREOUIPMENT � Q �
I o �
1 I
�� i R25.00
♦ �
—_— �R29.00
R31.00
TOP VIEW OF MANHOLE COVER
FIL7ER
��_ TOP VIEW OF TANK (TAPEREDJ
a.00
�
s�.00 �
L za.00
5.00
7,OOJ �-7600 �
�200 �
WLET \ 8.00 OUT� ; O srcnwaso i
i� \ I
41NCNPRESS 2�00 ` 41NCH �50.00�
SEALGASKE7 PRESS � �
INSTALLED \ GASKET j j
WHENPOURED
1 I
BAFFLE 39,00 FILiER � �
1 I
1 1
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3.00 i i
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L_'___"____'____'_____J
3.00
SECTION VIEW OF TANKAND COVER OUTLET END VIEW OF TANK
Model Number: 32O ROUND SKAW PRE-CAST Phone: (715) 967-2277
Approved for: SEPTIC, SIPHON, HOLDING, CATCH BASIN, OR PUMP Toll Free: 1-800-924-8625
26255 105th Street, New Auburn
e1g i��et nLm. Outlet Dim. Liq. Depth Gal. /In. Max. Cap. Wisconsin 54757 Fax: (715) 967-2707
38001bs. 44" 42" 39" 8.41 328 ga/. www.skawprecast.com
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MODELS 53°/55/57/59
Q 6 20
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Q 15
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5
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10 20 30 40 50
GALLON
LITERS 0 80 160
FLOW PER MINUTE
PAGE40F4
In-ground Dosed-Gravity Management Plan
IMPORTANT:
The owner of this in-ground dosed-gravity system shatl 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 shaii be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3),Wisc. Admin. Code.
Maximum Dispersal Area Operating Limits:
Design Flow= 300 ypd; BODS <_ 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 mechanica� malfunction (i.e., pumps, valves, switches, floats, etc.)
o materiai fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatrnent 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 appiicable (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 Seqtic and dose tank(s) shall be pumped by a certffied septage servicing operator licensed under s. 281.48 W is.
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(sl 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 wilf 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: R 211d P EBfth elld FOfES1 WO�kS Phone: 715 415 0661 _
�ocai government unit: Sewye� County ZO►l'lllg Dept. Phone: 715 634 8288 _
Local government unit address: 1061 O M8111 Stfe@t HB�Mafd, 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.
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.
System 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
�`���o�$ SYSTEMS
,�:�;�� Ps :, ( POWTS) SaWyer
��.., h `_���",
T '"�^ INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �. �-- `7 �
Personal infonnaYion you provide may be used for secondary purposes[Privacy Law,s. 15.04(I)(in)]
Permit Holder's Name: ❑City ❑ Village C�Town of: State Plan Transaction ID#:
( .—
D�,�- � `E^ DY1Y1�e. �\o� ��.I�a
Insp BM Elev: BM Description: Parcel Tax No:
I�D•�, � a� 7t1 • f�s—�' l:� �t;Z"G��—�7�.��b)
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �V�/ <yc;�� �o Benchmark �a.p`
Dosing K�-�.1 3�
Aeration Bldg. Sewer _,
Holding St/Ht Inlet --
TANK SETBACK INFORMATION St/Ht Outlet Q S'.R `
TANK TO P/L WELL BLDG AiR"iNT°KE ROAD Dt Inlet qY.Y �
Septic �- s� Fa,s �'j,s` f�—� NA Dt Bottom Q'o,S �
Dosing �. * • y NA Installation
Contour
Aeration NA Header/Man.
Holding Dist. Pipe y�:g �
PUMP 1 SIPHON INFORMATION Infiltrative
.- �
Surface �S•�
Manufacturer � Demand Final Gratle
Model Number s3 GPM � �� �• 3�
TDH 7 Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia `� Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS 1N L o� #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 ` �-a� }$' (csp ❑ Mound � Other
---- --��-�- ---------- - --- --
_-- _ _— -- ___-------
DISTRIBUTION SYSTEM X Pressure Systems Only
- -__ ____ — _ _ P ( ) -- — — -- —i--- -- --- -P___.—I
Header/Manifold Distribution Pi e s X Hole Size X Hole Observation Pi es �
Length Dia � Length Dia Spac Spacing ❑ Yes ❑ No '
SOIL COVER
__ _--- - - ------- --- — — - - - -- —
Depth Over Depth Over Depth of Seeded/Sodded Mulched
Cell Center Cell Edges Topsoil T ❑Yes ❑ No � 0 Yes ❑ N�
COMMENTS: (Include code discrepancies, persons present, etc.)
� ��-a l(�l ��s (�-3
Plan revision required?�Yes ❑ Na ;a � J� III � ' Gc�� �� �
_�3
� '
� �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A��ITIONAL COMMENTS AN� SKETCH
SANITAAY PERMIT NUMBER _ �_�=�7�____
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