The URL can be used to link to this page

Home My WebLink About006-439-04-1204-SAN-2023-182 Deparhment of Safety c°""�' �/} Sawyer • &Profes.�ional Services, � =r - Sanitary Permit Number(to be filled in by C� � _ . Industry S�ervices Division t� S �v23 � _, � � Sanitary Permit Application StateTransactionNumber w �- � In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmenta)unit " is reyuired prior to obtaining a sanitary permit.Note:Application forms for sta[e-owned POWTS are submi[ted to Project Address(if different than mailing ad � the Department of Safety and Professional Services.Personal information you prov9de may be used for secondary � purposes in accordance with the Privacy Law,s. 15.04(I)(m),Stats. 3887W Meyer Rd.Winter WI 54896 I.Application Information—Please Print All Information Property Owner's Name Parce)# Theodore Potkonjak 006439041204 Property Owner's Mailing Address Property Location 586 Hillside Ave. Govt.Lat City,Sta[e Zip Code Phone Number Antioch IL 60002 NW y� NE y,, Section 4 II.Type of Building(check ail that apply) Lut# T 39 N R � E or W �r 2 Family Dwelling—NumberofBedrooms 3 Subdivision Name BI ock# ❑Public/Commercial—DescribeUse ❑City of ❑State Owned—Describe Use C:iM Number ❑Village of �T:own of Draper III.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C i a licable. `� �A[ew System ❑ Replacement System g y ( p ) ( p ) ❑Other Modification to Existin S stem ex lam ❑Additfonal Pretreaiment Unit ea lam B' ❑ Holding Tank In-Ground ❑At-Grade ❑Mound ❑ Individual Site Design ❑Other Type(explain) (conventional) C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑Transfer to New Owner �st Previous Permit Number and Da[e issued Expiration IV.DispersaUTroatment Area and Tank Information: Design Flow(gpd) Design Soil Applica[ion Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� S}stem Elevation 450 � 643 652 94.5� =ag.o' ��.. Capaciry in Total #of Manufacturer = • « , Tank Informauon Gallons Gallons Units D � v �,r � New Tanks Existing Tanks � e � _ � y ,y "RJ 0 0. U v� n v� [z. C7 C. Septic or Holding Tank j�QQ 10000 1 Wieser }{ Dosing Chamber V.Responsibility Statement-I,tAe undersigned,assume responsibility for iinstallarion of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Signature P/MPRS Number Business Phone Number Rick Brown ' Z3�ZS� 419-0739 Plumber's Address(Street,City,State,Zip Code) PO Box 637 Spooner WI 54801 VI.County/Department Use Only t Permit Fee D�.te Issued Issuing Agent Signature ,�A r� ❑Disapproved , � � � ( n ,_j�.,� ❑Owmer Given Reason for Denial � �� ` ' ��"/ � `f"'�?`` Conditions of Approval/Reasons for Disapproval 5-� r�� D ��' I��''' `_ � � A �� '��3 .a �� , � ��G I �,� � -�-- � �,..�__s _ .____ � � -� s � �.�k# `� .__ AUG 0 9 2�23 � ,.y.,».as�s c�r SJ��' Cs� �� — ( �� , SAL�v'f��, c,.-_-- Z r �� Attach to complete plens for the system nnd submit to the County only on paper not less than 8 tf2 x 11 inches in size � I y7 �.� � 1 SBD-6398(R.03/22) N�R�Ft1ND,qFT'ER la4►JL OF(�F�Ah7f 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 Potkonjak Owner Name(s): Theodore Potkonjak Phone: - - OwnerAddress: 586 Hiliside Ave.Antioch IL ZiP; 60002 Project Address: 3887W Meyer Rd.Winter WI 54896 Govt.Lot: NW 1/4 of NE 1/4,Section4 ,T39 N-R4 E❑or W❑✓ Township: Draper County: Sawyer Project Parcel ID#: 006439041204 Designer Information Designer Name: Rick Brown Phone: �15 _419 _0739 Designer Address: PO Box 637 Spooner WI Zip: 54801 E-mail: rickbrown2004@hotmail.com License Number: 231251 Remarks: Signature: � I Date: $�3/23 Ong nal signaNre required on each submitted copy. ��''j�'r�. �-�� .._____..�_._ __. __ .___. _ .. � ..,. . .. __.. __ . _ _. .._, .__�_.._. _ .__ . . ._. .� _ .� .. �,�. S ; �.. __ � �aa� � ] � ' I � e 1 � ( �� {� �J�� j j Q ( r s(�f i � � � v � �4/J C �� G� �� }t 8 �t ' r � f ` � , �� € �� , P� 1 y ��( �� , � o o , ._ _ _ _ -� � ,� m �s �— i r � ��'�*��. i � % �� :, . t � ! � I :�' t'�r= � 1 ( � � ; t � ^ a��AS:, _� Z � � t i � � 1 � -J (�� i� , � �n�,R �,�.a � t:� � � /dR' k � a P,a�,�' 4;� � r� i' r-� !� A�'r•�c� ! � ' r ? �l' : t `' � � � 1 ; ; s , , i ''�� ? ' � � � ; R � � � � i ' ' ?, .-.. i � 'IN�oDa� Pm-t F-orN J�t�- s � f �'�,.�F o� �;�- 1�1�- �'� , j �ii��k ��f�- '1�t��1+�1 f4?1 � � � � �/ ,j ,� - � �i j i IV 41�1'�rt �.��S�J�4%�-- C,c�rr�+�1� i , , � � r � � � i0 Zv �o � � { u t i � � u�r ! � f � � Y �� J Septic Tank(s)ManufacNrer: IN-GROUND GRAVITY DISPERSAL AREA wieser Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Vdume(s�: 3-ft Trench (down-sizing credit) �000 gal gal gal gal Effluent Filter Manufacturer'. Polulock I mi�.,z• em�er,�Fu�er Moaei#: PL-525 SOIL COVER (Np��) 72' min.trench depth iav��i • TYPICAL TRENCH a , CROSS SECTION VIEW ��r�P�> (No Scale) ��,� •� Provide minimum 3 ft System Elevation=94.5 g separetion between trenches. (typical) Quick4 Standard-W w/end Cap oo:ervac�,ai� TyPICAL TRENCH (typical) (Show location of inlet/outlet pipe connection on plan view.) Iryvicaq mscenve�ma�urxmrers PLAN VIEW 1osiuo0o°s (No Scale) r—. ..—::.:.:..—.----��-------��----.:— .—.::....�� n �� TA=3.Oft �.__.uu._uru ----��--------��--- u•..II=—_.u.•..W�I 1 cHP��> D 'r g= 8° ft —�i m (typical) Quick4 Standard-W Chamber W INSTALL PER TRENCH: (�yPi�� (mfd by Infiltrator Systems,Inc.) T Ins�el pursuant to manufacturers InsWclbns. � �9 Quick4 Std-W @ 20 fP EISA/chamber= 380 ft' + � Pairs of end caps @ 6 ft'EISA/pair= 6•0 ft' =Proposed EISA per trench= 386 ft' Required Infiltratlon Area= 750 ft' Distribution Method: x 2 trenches=Proposed Total EISA= 772 ft� branched manifold RESET Soil Fro�le Speet Owner: Po��L„��yk Soil T�fer: _ �t�n�c.�.5 System Elcvat�on:�� Load Rzte: D.(� System Range:4N_3 to_ � - � a 3 ,00 . . .. . . . .. . � . .. . . . . 49 -- ...... , ::: -wg.3 � � � : �8 . ... .. .. ...... .... , ...... .,.... � .... ...... o.� .. ... ... ._.. .- 9 7. 3 .. ...... 47 ..... ...... .. ... . ... ...... ...... ...... ...... _— Q�, - Rb .o� _.. ...... p .� ..:. 4� , ( .... ...._ .. _..... ..... ....:. , ..... . ..:... �.� ,..... ...... �tS ..... . . � �o. � .... ...... . .... ...... .. ,. - 9`1. 4 . .... . . 9 � ...... ......_ aY 3 � N� _.... ...... ...... .._ � O.-7 .. . . . 4Y. ?5 �- - ...... _ y q . ..... ...... ..... ...... S ' . , ::::� :�� -93 .�s' ._--, .. ... o .� � ...::: :�:... .. .. .. ... .. q3 + _... ...... � N � .. __., . _. _�r 3 � ' _— .. q1� :::: ::: � ::: +3 , -- 9.2 3 :o �, .... .....: � N, � . . � ...... ...... ..... ...... ... ...... � ... ..... � � ...... ...... k , ... ...-q1.3 . ... � ... ... -� .... ...... q� ..... .. ...... 9r.r � 0,4 _. .....: � ! � ..... ...... .... ...... , ..... — o,n � r ...... ...... ...... ...... ..-.-. --.... o ...... ...... -4o. a .. ...... ..... ...... ... ...... .... , ...... .._.. ..... g ... ...... Y ... ..... ... .._... ..... ...... , _.... ...... � ..... ...... ... -- . ...... ...... s7 � ..... ...... . _. ...._. _. ...... � . . ...... __ ...._. . g� _ ---� 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 performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3),Wisc.Admin. Code. Maximum Dispersal Area Operetina Limits: Design Flow= 450 gpd; 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 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 boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activifies, 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 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(s) shall be inspected every 3 years and shall be Geaned 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: K2f1 W8y S2PtIC Phone: 715-234-7677 Local government unit: SBWy@f COUIIty Z011lfl9 Phone: 715-634-8288 �oca� 9overnment unit address: 10610 Main Street Suite 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. Continaencv 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 wmponent 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. �' "'''� PRIVATE ONSITE WASTE TREATMENT county ,,,, � � SYSTEMS ��.�SPs '� ( POWTS) Sa.Wyer ` � i, '="�� INSPECTION REPORT sa�itary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �3 _ �g� 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#: �Cb.e�re.- 'Pa�t�o�i ak �ra r' Insp BM Elev: BM Description: Parcel Tax No: fOb.a� Na�l 4 �•�,s�'S,`�. b�' 1�� s ,..<< ��- �1��.-ay^ 12a�-( TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic � �� Benchmark (pc�.o' Dosing Aeration Bldg. Sewer qg_g ' Holding St/Ht Inlet � 3 ' TANK SETBACK INFORMATION St/Ht Outlet b � r TANK TO P/L WELL BLDG vE"TTo ROAD Dt Inlet AIR INTAKE Septic �lo �-$a� N h/ NA Dt Bottom Dosing NA Installation �p � Contour �p•YS Aeration NA Header/Man. � �o, Holding Dist. Pipe PUMP 151PHON INFORMATION Infiltrative , Surface `T`{.bs 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� � 'j6 7(�' #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate ^L,�`�� P I L Bldg Well ❑ IGP r� Chamber ' '"��' INFORMATION Waters � AG ❑ EZFIow Model Number: CELLTO -�-�p� /�/ {-ga N ❑ Mound o Other �Y� ___--- — - - - — _---- - __ _ _ _ -- -- --— 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 1 Depth of Seeded/Sodded Mulched Cell Center Tell Edges I Topsoil ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) ��,s�(l� ��s la� Plan revision required?0 Yes❑ No �i a3l�i � I �J �I - � �I � � 2 _ -�� Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A�OITIONAL COMMENTS AN� SKETCH SANITAAY PEAMIT NIJMBER: ___�.��__��_ ' . ._ __ ; --_, .__ _____; , � , , , ; � � - � ---� � P'�6�,�, I � _ � 30 , x��,, � 'O',�� ,�� s +2S � o� .,.,lP��`� �°� �� —� �Po�,,, � +'` � � �.> `�'` a�,Y�� P�c. ,� ��-S . �� '� �a� ��'� �� `Tb rv�Q,�s'- 1� . N SCALE I"_