HomeMy WebLinkAbout024-841-12-4302-SAN-2023-189 �'' Department of Safety c°°"ty SAWYER
�L� - & Professional Services, �y
_ � Sanitary Pertnit Number(to be filled in b} `
`� �_ � Industry Services Division C
� sia �c�
.. , . �
Sanitary Permit Application S pWT�S�082301700-C �
�
In accordance with SPS 38321(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit —
is re uired rior to obtainin a sani ermit.Note:A lication forms for state-owned POWTS are submitted to Pro ect Address �f ditTcrent than mailin ��
9 P g �'Y P PP J ( � �
the Depariment of Safety and Professional Services.Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats.
I.Application Information—Please Print All Information 12370W TWIN LAKE ROAD
Property Owner�s Name �IUC�•e n .���,�,e,��f� �'1�uS'� Parccl#
ED PATEFIELD DMW 024-841-12-4302
Property Owner's Mailing Address Property Location
12382 TWIN LAKE ROAD c��t.��, NA
Ciry,State 'Lip Code Phone Number
HAYWARD, WI 54843 715-462-4949 SW���, SE �,,, se�non 12
II.Type of Building(check all that apply) Lot# T 42 N K �g "E or W
❑ 1 or 2 Family Dwelling-Number ofBedrooms NA Subdivision Name
B�o�k# NA
�Public/Commercial-Describe Use SMALL VET CLINIC NA
❑City of
❑State Owned-Describe llse CSM Number ❑Village of
NA ��or ROUND LAKE
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.)
�l �vv System X Repiacement ❑ Other Moditication to Existing System(explain) ❑ Additiona)Pretreatment Unit(explain)
System
�' ❑ Holding Tank �ln-Ground GEOMAT ❑ At-Grade b'n YP ( P �
❑ Mound ❑ Individual Site Desi Other T e ex lain
(conventional)
C. ❑ Renewal Before ❑ Revision ❑ Change of Plwnber ist Previous Permit Number and Datc Issucd
❑ Transfer to New Owner
Expiration NK
IV.Dispersal/Treatment Area and Tank Information:
Design^�O(gpd) Design Soil^pplication Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(sY) System Glevation
Y G � 225 227.50 96.75 FT.
Capacity in Total #of Manufacturer y
Tank Information Gallons Units ,a ;; v � y �
New Tanks Existing Tanks � o ;: � � � � �
n. U i7� v v: ci C7 A.
Septic or Holding Tank 1000 1�lJ(/ 1 WIESER X
Dosing Chamber 540 540 1 INFILTRATOR
V.Responsibility Statement-i,the undersigned,assume responsibility for iostallaHon of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumb i ature MP/MPRS Number Rusiness Phone Nu�nber
�-'' 7 ��--s�'-��,�3
Plum e' . dress treet,City,S e,'Lip Code) �
�� C�GG�- �- �Jc-
I.County/Department Use Only
� 13 Permit Fee Date Issued Issuing Agent Signature
�Ap oZ�cf ❑Disappmved ( y�^ /
�� ❑Owner Given Reason for Denial $ ��• �D � 1��'�3 "!�-��-l�
Conditions of Approval/Reasons for Disapproval
..;d i"���� ._....._. D � `---�� �E-.�.d
�I IN�
�,. Q
:���t._. a ►S8 AUG 16 20�23
Cs� �.3 _ o�g �:�A a�s�_ .__ __ n..
SAWYE� CCUt4:ry
ZONf
Attach to complete plans for the system and submit to the County onl�on paper not less than 8 U2 x 11 inches in sve " '�
��t� SS
NO R�FUN�S AFTER
SBD-6398(R.03/22) ISSUE OF PER�1'f —
`i��.�K.I\���,r'/
Wisconsin Deparhnent of Safety and Professional Services ;�� Phone:608-266-2112
Division of Industry Scrviccs �� :� Wcb:httn: dc�t.�ci.eo�
4822 Madison Yards Way `, ,� J� EmaiL�,�„u�ci:cun.n�_�u�
PO Box 7302 '', � p s ,
Madison,WI 53707 �j�� �` ,,/ Tony Evers,Governor
'k;__ .,i Dan Hereth Secretary
'�csi���.�.i' �
August 15, 2023 Conditional/y
APPROVED
CONDITIONAL APPROVAL DEPT.OF SAFETY AND PROFESSIONAL
SERVICES
�IVISION OF INDUSTRY SERVIGES
PLAN APPROVAL EXPIRES: 2025-8-15 �� /����
Plan Review: PWTS-082301700-C
Mary Huppert SEE CORRESPONDENCE
25720 Firefly Lane
Webster, WI
SITE:
Haugen Patefield Trust
12370W Twin Lake Road
Sawyer County
Town of Round Lake
SW'/o SE'/a 512 T41 RSW
FOR:
__ --__ - —-- - -- --- -_._ ------- -- ,
Description:450 GPD—45" to limiting factor— '� In-Ground Soil Absorption Component Manual 5/22-
Effluent Filter- Maintenance required— I 5/27 i
Pressure Distribution Component Manual—Ver.
2.1 (May 2022-2027)
I _ _ _ ._ _ - . �
L�.-- --— -- -- ___ _ ---- -- ---
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes.The submittal has been CONDITIONALLY APPROVED.This system is to be constructed and
located in accordance with the enclosed approved plans and with any component manual(s) referenced above.The
owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Reminders
• If using the existing septic tank,it must be inspected for watertightness and structural soundness,size and
baffles,and must be brought into conformance with the requirements of ch.SPS 383,Wis.Adm. Code.
• A sanitary permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.19,Wis.Stats.
• Inspection of the private sewage system installation is required.Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d),Wis.Stats.
• A state approved effluent filter is required.Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required.
• A coav of the aAproved plans,specifications and this letter shall be on-site durina construction and open to
inspeciion by authorized representatives of the Department,which mav include local inspectors.
Owner Responsibilities
• The current owner,and each subsequent owner,shall receive a copy of this letter.Owners shall also receive a
copy of the appropriate operation and maintenance manual(s)and be responsible for ensuring that POWTS is
operated and maintained in accordance with this chapter and the approved management plan under s.SPS
383.54(1).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard,the property owner must follow the contingency plan as described in the approved plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes.Reports shall be submitted at intervals appropriate for the component(s)utilized
in the POWTS.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall
relieve the designer of the responsibility for designing a safe building,structure,or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation,operation or maintenance of the POWTS.
Sincerely,
,ja���/2o�ul�y
Joshua Rowley
POWTS Plan Reviewer,Division of Industry Services
(715)634-5124 ioshua.rowlev@Wisconsin.Rov
GeoMat tN GROUND AND DOSING DlSTRISUTfON COMPONENT DESIGN
INDEX AND TITLE PAGE �,'v� �2 D`�i` $
-, �
< _ _ Ia'v�. C i-�7_ L�L-
,
Owner Info
Project Name ED PETEFIELD DMV
Owners Name: HAUGEN PATEFIELD TRUST
Owners Address 12382W TWIN LAKE ROAD
HAYWARD, WI 54843
Property Info
Property Address: 12370W TWIN LAKE ROAD
Legal Descnption- SW_ SE S __12 T 41 N R 8 W__
Townsh� Round Lake _ County S�er
Subdivision Name NA
Lot Number NA Block Number: NA CSM# NA
Parcel I D Number 024 -841 - 12 -4302
Plan Transac6on No
Index Pages
Page 1 Index and trtle Page 9 Plot plan
Page 2 Data entry Page 10 Tank Cross Sectior� � F+'a:,,
__ -
Page 3 GeoMat dist cell drawings 8 caiculations Page 11 Pump Curve
Page 4 Lateral and cell cross section Page 12 Soil test
Page 5 Management& confingency Page 13 So�l test _
Page 6 Maintenance 8 specifications Page 14 Soil test
Page 7 Tank cross sections Page 15 Aerial
Page8 Distnbutionmedia q�q�N:��yj _' i�y1 C,O�JGI,� ' '
���y� L..� �en�R
MARY JO HUPPERT ��� ��-License Number 1859-007
Date 07109/?3 Phone Number 715-d?6-1775
_ -- _ __
Signature ',
/ /� ' �
Design���� y�, State of Wisconsin Approval Stamp:
,,���d� � r'�� ' ^ — Conditionalty
,:- ,,:` � ` � APPROVED
� • • ..� DEPT.OF SAFETY AND PROFESSIONAL
- • � , ' SERVICES
� � : . ' � DIVISION OF INDUSTRV SERVICES
- '. . - � �' Desgned Pursuant ro the
' '• k'. > %. Geoisat In Ground Component Manual Apnl 2019 Version� �
: �
: `•. ?.. � �1ay zs�z-t��� _
�j �q '�.,,_,,.• � ,;�� ( SEECOR ESPONDENCE
di�'`�.�t..��..-.... , "��1 `\�.
���.i�;.`.�..�1fN
��4'��.'ti8tl:1111U'.tt�•�
Page 1 of 15
In Ground and Dosing Distribution Component Design
Design Worksheet
Ali W aIe'?rgalmem Syv,ea��s � ue Ren�u�c c 1;orn Sys[em
Sfte Information
�_ C Residential or Commercial Design � ISD Required?
300.00 Estimated Wastewater Flow(gpd)
1.50 Peaking Factor(e.g. 1.5= 150%)
450.00 Design Flow(gpd)
0.00 Site Slope(%)
96.75 Prop. System Elevation(ft) Sand 8 Nalive soil Contour
45.00 Depth to Limiting Factor(in)
0.80 In-situ Soil Application Rate(gpd/ft�)
� 98.42 Lowest Original Grade Ele. In System Area(ft)
98.64 Highest Onginal Grade Ele. In System Area(ft)
94.67 Limiting Factor Elevation(ft)
0.39 Depth Below Grade
stribution Cell In ortnation
325 Cell W idth(ft) ._2. Number of Cells
'� _2.00� Dispersal Cell Design Loading Rate(gpd/ft2)
2�'� InFluent Wastewater Quality(1 or 2)
Distribution Mformation
- -
E Center or End Manifold. Dist. 8ox or Drop Box
�- 2 Number of Laterals System dosed Y
. . _ _ ..... _._. .. . . .. . .
9.82 Lateral Spacing (ft)
4.08 Forcemain Drainback(gal) Does the forcemain drain back? Y
0.50' Forcemain Filter Loss(ft)
2.00 Forcemain Diameter(in)
25.00 Forcemain Length(ft)
�-- 93.00 Inside Pump Tank Elevation(ft)
3.50 System Head(ft)x 1.3
4.52 Vertica�Lift(ft)
0.35' Friction Loss(ft)
9.91 Total Dynamic Head(ft) Designer must enter fnction loss and systam demand (ypm)
25.00; System Demand(gpm)
an cturer Information
Treatment Tank Information Effluent Filter Information
1000.00 Septic Tank Capacity(gal) SEE PUMP TANK � .Filter Manufacturer
�--- --—_.— -._------�
Wieser Concrete Products, Inc. IManufacturer SEE PUMP TANK �Filter Model Number
Dose Tank Information Gallonslinch Calculator(optional)
540.00 Dose Tank Capacity(gal) Total Tank Capacity(gal)
see chart Dose Tank Volume gal/in) ___ Total Working Liquid Depth(in)
INFILTR,4TOR Manufacturer gal/in(enter result in cell DoseTankVolume)
Projec[: ED PATEFIELD DMV Page 2 of 13
In Ground Plan View
2 cev�'reoFi7at
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alculations
I ft A 3.25 ft Basal Area Required 562.5 ftz
K ` 1 ft B 35 ft Basal Area Proposed 562.5 fl2
S 6.57ft L 37ft
W 16.07 ft
Basal Area Calculation GeoMat Dis ersal Cell Basal Area Calculation
GPD Loadin Rate GPD Loadin Rate
450 0.8 gaVsq tVday 450 2.00 gallsq fUday
Total 562.5 ft2 Total 225 fl2
Pro osed 227.5 ft
Number of Cells 2 GeoMa[Width 3.25 ft
Cell Length 35.00 ft Lineal Feet of GeoMat Required 69.2
Min. Cell Len th 34.6 ft Lineal Feet of GeoMat Pro osed 70
Cell Spacin 6.57 ft NOTE:Min S dimension= 1'
S stem Elevation 96J5 ft
Limitin Factor 94.67 ft
Se aration 2.08 ft 2•Mr�
Directions:
Play with cell length to get desired cell spacing, length and width. Remember system SHOULD be longer than it is
wide. It must also Satisf basal loadin rate and GeoMat cell loadin rate.
Project: ED PATEFIELD DMV Page 3 of 13
End Connection Lateral Layout Diagram
aa�
-,�:,
Hde spacing is every 12', 1/2"hole at 4&8 O'clock,slarting 4 O'clock 6'from end antl
e O'Uock Holes at 12'from end. 4'Pertorated pipe may be used.
Pioe Levrc^=GeoMat Le���r� .
Lateral Spacing 9.82 ft Pipe Diameter 4".in
Distributlon�� el�� ross Sect on - � � �� �-
E:.,:�n.n r d� `�W� v V'� `IJ"Y
. ;.: ." •- Distr�afim
I��� 12"-42 BaAfi� .' ��'a�11M�
0.39 ft —
` :..C, .^ ._T... !n@utiw
4"in �� PRIGDLL �' ITv \ F�EIC
. � -� PiK I`._'_ �— . ,
Topofgeomattobeator . - - - - ' �� �� � � �—+��T
6elow original grade ��I I � I � I I �2:-��;� � � 1 , I � I � Ii ���
SnfilVaave Slafite
` _--NATIVESO[L=-J__y=�
� (_= ----�----__--- � L�r'rr,eFaa
45in y
ervation Plpes � � ��
.�++w�
Pu4s1UM
� YlM1OY�
12"Mia
42'Max.
s"" � . -k.n�.
ton i m��
� � I
�isf_ � \ � �
G� ruv
_. -� . _ �"s�^ _I_ L_ � _
uuoec�r
A"fERC145EfCOIIAR i �+'�s DURowy�'
1 ASiT1^J)�JmfvOm�S:
�.�5
Project: ED PATEFlELD DMV Page G M 13
Notes/ Maintenance Requirements
MANAGEMENT PLAN
This private onsite wastewater(POWTS)has been designed,and is lo be installed and maintained in accordance with SPS 383,W is.Admin.
Code,the in-Ground Soil Absorption Component Manual for Private Onsite WastewaterTreatment Systems Version 2.0 SPS-10705-P
(N.01/01). GeoMat in ground Component manual April 2019 Version.
1.This POWTS has been designed to accommodate a maximum daily Flow of 45Ql9Aons of wastewater per day. The quality of
inFluent discharge into the POWTS treatment or dispersal component shall be equal[o or less than all of the following.
A monthly average of 30 mglL fats,oil and grease
A monthly average of 220 mglL BODS
A monthly average of 150 mglL TSS
Wastewater shall not discharge to the POWTS in quantities or qualities that exceed these limits or that result in exceeding the enforcement
standards and preventative action limits specified in ch.NR 140Tables 1 6 2 at a point of standards application,except as provided in DSPS
383.03(4),Wis Admin.Cotle.
2.The owner of[his POWTS is responsible for system operation and maintenance.
3.Defects or malfunctions identified during maintenance described above shall be repaired in confortnance with SPS383 Wis.Admin.Code,
and the pertaining county Private Sewage Systems Ordinance. The user's manual,provided to the owner of the POWTS includes the names
and telephone numbers of the properly licensed individuals to contact for such repairs.
5.No product for chemical or physical restoration or chemical or physical procedures for POWTS may be used unless approved by the Dept.
of Commerce in accordance with SPS.384,W is.Admin.Code.
6.If the POWTS is replaced,or its use discontinued,it shall be abandoned in accordance with SPS 383.33,Wis.Admin.Code.
NOTES
Two EfFluent Filters to be installed where possible 1 to be installed in ST,and or 1 in pump tank in
order to insure paAicle size less than or equal to 1/8". Filters should be cleaned once in spnng,and once in fall. Also,strainers in sinks in
the building shall be maintained,so that solids and fats are minimized to Flow into system.
A minimum of 2 observation pipes per cell shall be installed. These pipes shall be located approximately at the end of each cell.
The plumber,or county shall see to it that a copy of these plans including this page,maintenance folder,and maintenance agreement is
given to the homeowner.
This system may contain a dose chamber. If a pump,float,electrical outage causes the tlose tank to fil,the homeowner should see to it that
the effluent level in the tank is brought down gradually and not all dosed to the system at once. One large dose could cause damage.
Contact a pumper or your installer if this problem occurs.
The homeowner is responsible for formulating a water conservation plan that will ensure the system is rarely ovedoaded. I.E.spread laundry
out over time,not 6 loads in 2 hours,while everybody showers,and uses the toilet,ETC.
CONTINGENCY PLAN FOR COMPONENT FAILURE
A Septic Tank.Any structural failure resulting in cracks or leaks in the tank must be corrected by replacement of the septic tank component.
Leaks in the joints between manhole risers or covers shall be repaired by replacing faulty seals with approved matenals to make joints water-
tight.
B.Outlet Filter.The outlet f Iter shall be replaced or repaired when it is either no longer capable of preventing the discharge of particles larger
than tl8 inch or when it has become permanently degraded by dogging so as to inteAere with ihe design flow out of the septic tank.
C. Dosing chamber and pump.The dosing chamber shall be replaced if any structural faiWre is found.Leaks in joints between manhole
nsers or covers shall be repaired 6y replacing faulty seals with approved matenals to make joints water-tight.The pump and conirols shall be
replaced when they are no longer capable of functioning according to the design plan.
D.Pressure Distribution Piping.Partial clogging of the distrihution network may result in unduly long dosing cycles.The ends of the
distribution laterals may be exposed and the threaded end caps removed.The piping can be disconnected on the outlet end of the pump.
The distnbution piping may then be back Flushed to cleanse any accumulated matter from Ihe piping.It is recommended that the dosing
chamber then be pumped by a licensed plumber.
E.Soil Absorption Cell.The discharge of sewage or wastewater to the ground surface is strictly prohibited due to the human health hazard
created by the effluent.All faiWres created by surface discharge shall immediatety be reported to the appropriate county.The pump shall
then be immediately disconnected to prevent further discharge to the ground surface via the soil absorptioa cell.The ezisting septic tank and
dosing chamber shall be used as a temporary holding tank until the necessary repairs to ihe soil absorption cell can be achieved.The
replacement shall be initiated on�y aRer any necessary plan approvals have been obtained from the
appropnate plan review authonty and the required sanitary pertnit is obtained from the county.
Project: ED PATEFIELD DMV Page 5 of 13
In Ground System Maintenance and Operation Specifications
Service Providers Name'�RED'S SEPTIC SERVICE Phone 715-798-3033
POW TS Regulators Name�Sawyer County SPIA-Zoning Administration Phone (715)634-82N8
Svstem Flow and Load Parameters
Design Flow- Peak 450 gpd Maximum InFluent PartiGe Size 1/8 in
Estimated Flow-Average 300 gpd Maximum BODS 30 mg/L
Septic Tank Capacity 1000 gal Maximum TSS 30 mg/L
Soil Absorption Component Size 113.75 ftZ Maximum FOG 10 mg/L
Type of Wastewater Commercial Maximum Fecal Coliform 10E4 cfu/100 mL
Service Freauencv
Septic and Pump Tank Insped and/or servfce once eve 3 ears
Effluent Filter Ins ect and clean as necessa at least once eve 3 ears
Pump and Controls Test once eve 3 ears
Alarm Should test periodicall
Pressure System Laterels should be Flushed and ressure tested eve 3 ears
In Ground Ins ect for ponding and seepage once eve�3 years
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table SPS 384.30-t, have a watertighl cap
and are secured in as shown in the GeoMat In Ground Component Manual Ver.April 2019.
2. Dispersal cell media conforms to GeoMat products approved for use with the GeoMat In Ground Component
Manual Ver April 2019. Media is covered with an approved geotextile fabric.
3. Ail gravity and pressure piping materials conform to the requirements in SPS 384,Wis.Adm. Code.
4. Scarification of basal area is accomplished with a rake or other tool.
5. All disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration.
Lateral Turn-up Detail
6-8"Diameter Finished Threaded Cleanout
Lawn Sprinkler Grade \ Plug or Ball Valve
Box �
y Vent if i � ot Dosed
Lateral Ends at Last Orifice Where
� Long Sweep 90 or Two
�45 Degree 8ends Same
Diameter as Lateral
st`> � , ... . . .. _.
�
�DistribuUon Lateral � � Lateral Cleanout
9675 Feet
Project: ED PATEFIELD DMV Page 6 of 13
pose Tank infortnation
i , ., ,� , .. ,�m..,��� � �•:' �
,� � .d„ �,� _
i.�.�.n�._�.+ . .�. .a.i ��:r. .
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. . I ini.Iw�dGrnJc .. . •• • •• . J �jUNiIDcd'
.. • � �Ip:�on.dh�II.�M.
1"l Ir:u�oul I'q•c � � i,�.,,,�v„I.nYJ nt
\\irr.I rum 1 !c:lri:.ourc.• � dll,,.m h�u��J�..nl
��p�i.nul iad.�
�,.�i��.,, . Forcemam d�ameter
r i�,i., ! . Z
�. ' i � / � �,i.i;n:i��i.�.,� in.
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'i�p��i I lit I lo:�t _
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�Pwnp 1 ll' I loa�•� � Pu,, ,.p = �---- PUmp OR elev300n(R)
93.33
a ,�.;,
pose tank Aevatqn IR)
{;;':.:,�."i=i�:T3�v::i }.. Rrddm� unJrr ianl... ��! .. ._ . . ._� ~— 93.00
..
;r........i.tii.:................ .. . . .. .._ . .
Dimension Inches Gallons INFILTRATOR
A ��� � Capacit 540.00
B 2 pp � Votume see chart gal/inch
� Max dose Is 35 gallons plus drainback.
C �{.�� - /_
p - p.0o 5s � � _ �!C$"<ju,(5 c{;:Ns�t�A.c/_� .�/.�Z �'�`b
Total Q � �1 ��� '
-------_ _ _
Filter Manufacturer Ctearflow y� ,,,,,.j - j�/.��Z.9��� "
� — __
Filter Model Number NSSCFF324 --�: _)��� �
_ _ -- �Z.� �'rZ5
Alarm Manufacturer SJE Rhombus -� 1�!
Alarm Model Number IAB �� �
- - --- - _
PumpManufacturer r2cellerCompany __,_.___,_______. ____
Pump Model Number ___9T—
Pump Must Deliver 25-00 gpm at 9.91 ft TDH
Project: ED PATEFIELD DMV Page 7 of 1$
GaoMffi Distribution Cell Media Layout
325 Cell Width(k) 2.63 Sidewall lo Lateral(tl)
Distribution Cell Cross-section Arrangements
. . _.. . Q S _ � .
Compone egend
O Disbibution Pipe
GeoMat is coveretl with approved geoterzfile fabric as per Ue their protluct apP�oval.
Distribution Celf Plan View Layout-Typical
325 Cell Width-A(tt) 35.00 Cell Lengih-B(R)
� � � � � � .�� �.� � .� � � � �� ��:
� � � � � � � � � � � � � � ��
Typiaal Dlspersal Cell
F:..:.hMC:rnAr YV'Y Y `� ` V`YV
. . . . •�- QIMbImOC
I Ca�v�aeammmded
12 d2" .' N.c\fn .�. �f1(.CYe�
4 .� . .....�;( ---�� �-�' ican.5ve
pipeDj� �- � iwv Fa6'i[
. ,� na �_-� _
. �1' " ' ' ' p.. . _ _ -_ — . �—GEAASAT
I � I � I � I R�ASTM 33°� � � I , I � I � I C��
Infiltnaw SnrSce
� =__=NATIVE�SOILJ__=J=�
� �_- -= - -_' --�_—_- - J L'a^-i�+RFtlQ
See aetals on page 6 for rvmber.s¢e,aritl spacing of laterals.
ProjecC ED PATEFIELD DMV Page 8 of 13
Plot Plan Page ? of y
�
PROPERTY OWNER: -t I�U.=� r ( - - , _� 1" _= 40 FT.
(excepttvhere noted)
Legal Description: �'�� i'- 54�l4 .z f*�E � /� '"�'- . I� �y�,�� �`�'��_, '�1 =backhoe pit
Tr,�,i�i Cs L .ur,�� _ . � jak,�{�� � � ri � -�.,/ � il �� _.� �.A:`I, � +t�n� -�FT� .
'� �4 ;tit I-� -4`sc� � i _--:c,. � I�a'r.� �r�D
North
I'
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� � .�� � , � � NE
� — I ��i�.'it�� � � FI1.'�6F
� �c,4a � 44
i = ^- t z��o, � :.t._rc � = �i�• -r�'k
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F n.��l/ :a .��}'y ��EI` : ''� �A(•u'
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�__-..._ 1 �i � NE+� `W �'�:'�`,�T-AUKS ro �E At�N�oNEG
,,y 't % j sn+iooeon«�m ' �,�,1C�� I PF�•_ SPS 38�.33 (IJ1S.
-I f :�a��y
� / tv' �-� /4r.q. . ^OE
' `�� Of=U� �U� �� r,
" 1-__ J
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- 10�� �tR �1,v i 'vt�� �
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S�iR�ERIE`�) °,N'
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IM-540
�
� tanks
Features & Benefits
• Strong injection molded
polypropylene construction
• Lightweight plastic construction
� ' and inboard litting lugs allow for
easy delivery and handling
` � ' • Integral heavy-duty green lids that
interconnect with TW" nsers and
pipe riser solutions
f�
• Structurally reinforced access
ports eliminate distortion during
installation and pump-outs
• Reinforced structural ribbing
offers additional strength
• Can be installed with 6" to
48" of cover
• Can be pumped dry during
pump-outs
• Swteble for use as a pump tank
or rainwater(non-potabie) tank
• No specia� installation, backfdl
The Infiltrator IM-540 is a lightweight strong and durable septic/pump tank. or water filling procedures
This watertight tank design is offered with Infiltrator's line of custom-fit are required
risers and heavy-duty lids. Infiltrator injection molded tanks provide a . No speciai water filling
revolutionary improvement in plastic tank design, offering long-term requirements are necessary
exceptional strength and watertightness. • 7he tank may be beckfiiled with
suitable native soil. See installation
instructions for guidance.
..;� �: � � . �
Reinfwced 2»' - Custom fit -�
..��"' . struttur;:.� TW RiSer �.
�,y� access poC
\ �
RemfOrced �,��
` watertight �
mid-seam
gasketed .
connecuon
.
,
�
��
Protecting the E�v�ronment w�th Innmative Wastewater 7reatment Solutions � N F I LT R ATO R
IM-540 General Specifications and Illustrations
A A.
� �
The IM-540 is an injection molded two piece mid-seam _
plastic tank. The IM-540 inject'an molded plastic design — .�- 6„
allows for a mid-seam joint that has precise dimensions c e�;'6�abn
for accepting an engineered EPDM gasket. Infiltrata's _ "�0n'
gasket design utilizes technology finm the water industry
to deliver proven means of maintaining a wateRight seal.
The two-piece design is pertnanently fastened using a
series of non-eorrosive plastic alignment dowels and asi+e+ei�e.�re�or+�en�n ,srwmw
locking seam clips. The IM-540 is assembled and sold ca c*v� ��' ��
through a network of ceRrfied Infiltrator distributors. "�91
.ae,cnnrcnon
Must be backfBled and instaNed in accordance with "`91
Inflkrator Water Technobgies, InHttratw IM-Series Septic �
Ta�k(ienxal InstaNatan Instrvctions and for ahallow ��
ground water conditions roference the Inflltratw IM-
Series Tank Buoyancy Control Guidance. s�e
n�en
Please visit www.infikretorwater.co�mages/pdf/ �HE`�`
Manuals(iuides/TANKOt.pdf for the latest information. �
i
�+o v�ry
Total Capacity ��� 552 gaI(2090 Lj i
--. . -----__.___. _. .. .. . . _._._. _.. _----------.._,
Length 64.9'11648mm) � :•��ata..��ssacew.c.«.w.x��.c.c
Width 61.7"(7567 mm) _�
w�.Er
FlEght 54.8'(1387 mm)
Maximum Buriat Depth 48"(1219 mm)
_,
Minimum Bunal Depth 6"(152 mm) �
Maximum Pipe Diartieter 4'(100 mm) i
Weight 1691bs(77 k9) �
-- �------- —.._---- ----J
SECTION A-A'
cournwn
ws�¢r
rwamv
� srwuas
r�rac
fliERiOa
NlU1�@rt
OOMB
i�MtlOtIOM
� 11Mf
,an.wss vsa aone M�D�ME�cMi sEAY
v o.Bo.�se SECTION OETAIL
p0 Saybod.Gi ON�S
INFILTRATOR �a�B605";°°,
.■..wwnw.,r..ean
u 5.va.�n�.+.�se.em�.s.on.ai.s.ise..ee�.s.xn.on�.s..oi,�it�.s..o�.'sv ssn.sw�.s.»e.�m�.s.see.ne:s.eaoe+.ar.o�.�P,..e�.�.�zu.sso-z.00..ws oe+oa.�a o�ro.veeatr.
EaeCa.ouaa.ana Sioew.m ae rtyAaM traoen�nu a rtro-mar waer teGnappes.mfio�ma e a ropmsatl oaomin n F2na.hiAuaar wad iatr�oqva a a�eqrs�traoertw�n bk:m
wn�., r,ti.�x..ss�.y r�*un.en..�..�n...> rwnF+n n�u�.ca.ac;u�.w.�v�nr sse+u.su5vymuwren.u.�w�.�+�nnr�uweu+*euran.�
con�i.,.r��,yu.nv�o�cmtd..� n a..i�E�..�.,,y,.i...n u�.,..d n�r rrh.�Ni: �M.a a�o n.,rvao�+�y.d iaEv m�
.�^o�a�.mn.wmw r.r..r.+op.a u� nn.,ynrc�ese�.v«� R.v.e n u 5 4 mn� i n6
• •
_ � � � ' �. • :�� •
20130182 �
Infilintor IM•500 tank
Volume u a iunction oi t'puid lavel in 1-Mch Increme�ts
Volume
11quW uvel Above 8onam o(Tank WN�s Lilen
Ind��s CenW�aMn �
0
0 � 3 11
� 3 30
8
Z 5 la 53
3 a 80
10 21
4 29 309
S 13 140
15 37
6 46 173
� lB 207
20 55
A 6d 243
9 Z3 279
25 »
30 8A 317
11 �R 35G
12 � �
SOS 391i
13 33 437
14 36 116
38 127 4�
15 338 523
16 41 �
17 43 150
�6 161 611
18 173 656
19 4S 702
Zp 51 �H6
53 198 709
21 ��
22 56 210
23 58 223 843
61 235 R91
20 939
25 64 J.68
26
66 261 3�
Z� 69 274 1,03A
2A 71 Z97 1��
7,� 3pp 1.137
29
� 76 31; 1,185
31 79 326 1,233
32 81 338 1,261
33 A4 351 1•3Z8
31 86 3fi3 1.375
3�, g9 375 1,421
36 91 387 1,46fi
37 � ;gq 1,511
38 q7 411 1,555
39 99 427 1,598
40 102 43i 1.�
41 301 4a4 1,681
02 107 455 1.722
43 3pg 165 3,761
112 175 1.799
y qs 114 485 1.835
96 117 49a S,A/l
47 119 503 1.905
48 122 512 1,938
49 124 520 1,970
50 11/ 528 1.999
51 130 535 2,026
52 132 542 2,050
53 135 547 2,071
�q 137 551 Z.��
55 738 552 Z��
lofl ��. ^t . -.
�
�
WLP1000-MR
TANK SPECIFICATIONS
iw' oiu�s�a+s: � �
------- -- wnu.: 2 i/2' �
eotTo►�: sEPnc a'
Haaric s' (noo �,aoo �e.) a
.._ CO�ER: 4'
r--- �—�. MANHOLE: 21' I.D. PRECAST CONCREIE RISER i
� � HEIGFIT: FLAT COVER 53 7/4" O.D.
IENGiH: 10�' O.D.
/ 4" CAST-A-SEAL 4" CAST-A-SFnL M9DTH: 88" O.D. � �
BELOW iNLET: 42' O.D. � n
m2,���\ LIQUID LEVEL 3B' `�
ip —�� WEIGHT: 6,790 LBS.
e0
\ ��/ _ �NLET AND W1LET: � 8
FiLTFR OR 4� CAST-A-SEAL 8007 OR EWA� � �
\ BAFFLE/ CASKET, CAST-A-$EAL BOOT OR EQUAL �
m �
IN1�T ANU OUTLET BAFFlE AND FIL7ER:
�_ _.�• WISCONSIN, SEE DETAIL /10 � k'
--- — (Oh1ER STAIES SEE CHART) E o G
LIQUID CAPApTY: 27.83 GAL/IN W �
HOLDING TANK: W �
TOP VIEW OUiLET HOI.E PLUCCED �
ACiUAL CAPACI?Y: 7,085 GALLONS Y ��
� LOADING DESICN: 8' 0� UNSATURATED SOIL � d.
TANK CAN BE USED AS: �
� SEP11C/ HOLDING/ PUMP OR SIPHqV � � u�
N
v� CAVER: MIX OE51f�1 /8 NO FlBER) "�
i
TANK: MIX DESICN /10 SIRUCTURAI Ftacal � I
1_ � U
CUS70A112ED 7ANKS: � r
_ FOR CUSTOM 7ANKS CONTAC7 NAESER CONCRETE �
� T - OUTLET ,F,
- '- - '— s
M �
N � �V m�
tV '2�" � I\ V � J
~ �f j� � Q
7
-- --- -- � <
�
� U
� PUMP PAD �
dRAWING5 SUBMIITED W
SIDE V1EW FOR APPROVAL N
APPROVED 8Y: SHEET N0.
APPROVAL 0.4TE: �_
%tODUCTS NEFDED BY:--- '--i / ���
TANKS AFF MANUfACIURED TO AIEET OR EXC£ED ASTM C-1227 REGl11REMENTS --
�_ , .�:_ --_ , --..
,a„ w .'~`•.�---�HEAD CAPACITY (:URVE` .. �
� � tiODEI "98' 4 5�8 '�{ I
JO I
e B
ls 3 S�8 .�
6 �
i � i � } +
� �,�_i_.__�. . ,__-__ '—�.i � I i
� -I � � , � � � , 3j,6
i i
a:�l: . :_ ; y e '
i � .
3
\ j 1 1/2-11 I/2 NPT �
° .0 50 60 10 e0
s uua/s '� 3O y` �O
_�
:'� O � �5p 2s0
i� PER wNU7E .
YOOEl 98 6O CYQE
._�
F�{ �pppM 11lIM 1i1M5
a n �s na
p a. >i ia.
n .s �s �n 72
m a i. a .
a.e+.`c xr I �
aos++
4 3/16
_ �
—�
,.,.., �
CO�IS�LT ��:G�ORY Fa�Z SPECIA� ;=�PPLIC".-��iC����
E�earical aleemators. for dw�X��. are available and • variab�e�vel noet swisches are available for wntroYn9 single
supptied wAh an al�arrn and fhree Phese sYs�r�•
��� {pr d�qlex Sys�rt�s ���� � �� �,p�veriaple Ie��sl lioat switches are avaiWWe
witt�or wilhout alartn switdies.
for variable level bng q'de contrWs.
o=L"cC�IOii GUIDE
1. WBg�a��ug We�a�d 2 C����SwiMl�,no exlert�i:canYd raWYad.
Standard aIf models -WeioFi 39 �bs. - '� ii.=- 2 S:�u�eo������0fd01���'���'
CaMdSMo�iue loYlsr�lcftRlllrbF'MO�I77.
p Sa16 a ��t60072 ar 100075.
Mod�1 Vob-PA Nod� ' �. Ses FMD71Z.bt mnQ nndd of EkcYiral AIIMnibr.
Myg �is � �+o a� �o i a� — s caew aw�� io-o�s w.a n o m�.+�.�. war�@)�•Nl
N9g 115 1 Non 9! 2or26 3�485 �y�
oie x!0 7 ,Wlo �.7 1 or t a 7 — 6 wr H)nae.Wak.r��^�r°r'r�mr�wm w.Nad-�
F9B 230 1 NOn �.7 2af286 3Q�85 s+nP�arh�W�1Q00L1.
7. Two(2)hole.lPek.(ar�r6pM am^ec�an ar spNce.
:,��.i�i101!
r�m�m���b��aP��y�py��� nl!!ntWWitionoreontrolz.pmt.ctionde••ieesantl'::irin9sunulubxJonebYawollticE
�:���.���.���yy4�yRqp�: lia�ued el�c:ridan..ill xlectrical and saieiY cates sAauUi he iaYoved indWin9 Ne most
���A��������,� recen:Y.a�bnal Eleclric Code I�EC)ant tl�e OccuVatbnal5alelY 0�M tl�alUi Act fOSHAI.
..._. _ .. .`s�7`�k� .'\.d��c�.e aG.. ... _:�:�.. . .
For unusual co�d�itions a reserve safety iac�r is engineered iMo fhe design of every Zoeller pump-
--_—.-- --�---_— WI47RP.0.841(16i(T
1ai�it XY�@5E9317 - -IY�iwd..
31liR 3Q19Au�Rr�flo�d
`�. � Caiei.KYlOt/t-1981 �rurrl�✓i,cfk�J
PUMP !O_ '�'��.� _
,keo.aw.o.m.w+,.cvn --------- -
� .'. . . . ,- ...,J
1 4
Page__of__
W isconsin DeP��^�d SaletY 8 Pra(essional
Semces
- , D�vsanollnd�stryServlcxs
_' SOIL EVALUATiON REPORT
s �°"'tY
m accadance wrth SPS 385.W�s ndm Code gp,WYER
er not less than 8 t�2 x 11 tnches In s¢e.pan��� Parcel I.D.
Attach complete srte plan on PaP tal rMerence DaM(BM).drcedan and Per 024-B61 - 12-4302
put rot i�mrtetl ro veR�ca�anC honm^ I Date
scale a dirnensans,nortli arrow.anC ioc�on and disiance to nearest roaC. Reviewed Dy
PMis�print a�l infortnatpn. �
Persoral rtiformatron You M�'�de maY be used for secondary P�Tos°s(PmacY Law.s. 15.OM�llm)1. ❑
PropertY LocaOon +N
� PropertY Ov+ner �vt. Lol SN/': SE"• S 12 T 41 N R p8 kX�
HAUGEN PATEFIEID TRUST S�e��.�5 a�M and���#-
PropertY O�vner's Ma6ng Adtlress (SAME)
12370 W TW�N LAKE ROAD � C fi, ❑Viliage C.�To�+�+ '� Nea�est Road
Gry. State. Z�p Phw+e Number TWIN LAKE ROAD
( 1 ROUNOLAKE ._ .
HAYWARD.WI ��3 - � -
_. _ . . .. _ . ---Code dertved Aes�9^�+'rale 450 GPD
� �.('p�structwn Use.� Res�dert�lNumberofbednoR�s
VETERINARY CLINIC Flood P�an elevatan A applKaWe NA R
� Redaceme^� Q �a��°f�`�""����-�� WITH 5-6 CUSTOMERS
Parent matenai SANDY OUTWASH CLINIC IS OPEN 9-5 S DAYS/WEEK. 4 EMPLOYEES
ESTIMATED DAILY FLOW 130 GALLONS
General comments a^��e�^"x^datans GEOMAT INGROUND TRENCHES- p g��np rate�l�/�� _ . _ ..
_.. ��{NSIAL{INGASVSTEMSFZEDiARGER �60
�8onng gg 74 ry. pepM to tim�ting racta 47 in. �Hev �_Bz ft
C gonng a n prt GrounC wrtace elev 3 92 R
�-x
SoB Application Rate
j TexNre Structure Consrstence I Boundary Roots GPD!FY �
Honzan DeWh Dominant Cobr '.�, Redox OescnPtron i Gr Sz Sh. I 'Effitt � 'Efl7t2
In M�nsell ; �u.Az.Cont Cobr 0.8
7.SYR32 - � I 2fsbk ds ' cs 2d-co 0.6
� �'� � 1vf-co 0.6 0 B
7 SVR4�4 i _ � I N`�k ds u
2 7-23 � � N� mvh as 1vf-m, 06 � 10
3 7 SYR3/4 - ��� 0 6
7 SVR14 m2d SYR4i4 I Om mh aw - 02 ;
q 47-57 � 0.5 10
5 57b1 � 7.SYR7/3 m2d 7.5VR4i6 i h Om mh '- - �
i
sorne gr
1�� QBonrg 98.52
L Z J Bon�9 i� �pit Ground wRace elev ft Dept�to I�mmng faGa 46 in !eiev��
3B3R
$pl Applicalwn Rate
i pommant Cobr Redox Descriptan � Textwe Stnicture Conslstence ' Bou^dary Roots GPD�Ft=
Honzon DePth � •Eit#t 'EPot2 �
In. Munseli '� Qu. A2. Cont. Cobr i Gr Sz. Sh
1 0-8 7.SYR3/2 _' I 2f-msbk
ds cs 2v!-co 0 6 0 8
ds cs 1vf- O6 08
y &30 7.SVR414 - � ��
I �_ 51 2isbk mvh a5 tvl Ob 1A
3 30-a6 7.SYR3r4 �: 0.6
4 46-55 I 7.SYR3l4 �'� � �^' � -' '- O Z i
�
some r, I
i
sg�atu�e ST Number
CST Name�P�ease Pnnt� 1 �' 224832
MARY JO HUPPERT (HWlisteYs Soll Testin &Des�gn)�/
Da1e EvaluaLon C uded Telephone NUmber
Address 7�5-426-1775
25720 FIREFLY LANE,WEBSTER,WI 54893 06-2t.2023
' Ettiuent bt =BOD>30 s 22�rr�y��TSS>30 s 150 mglL 'Etfluent t�2=BOD. s 30 rtxyl antl T55 s 3omgi� SBD-8330(R03/22)
HAUGEN PATEFIELD TRUST Page�W 4
I � ' Bonng A Q PBi�'� GrauW suRace elev. 9BA2 ft. Depth to lerxtirg tacfor 45 i�. /elev. 94.67 ry
�— 3J5 fl
Sal App6catan Rate
Horizon DepN Dartnnant Cdor Retlox Oesuiptan Texhrre Struclure Consatence Bo�nWary � Roo4s GPO�Ft= i
in Munsell Qu Az. Conl. Cobr Cx. Sz. Sh. .ERMt 'ERJt2
� 0.5 7.SVR3/2 - � dg a 2v1-m 0.6 0 B
2 S22 7.SVRM4 - I 21,bk � ds cs tvf p.g 08
3 22�5 7.SYR3/4 - sl 2fsbk I mvfr as ��_� O6 1D
4 45-55 7.SVR3i4 m2f SVR416 y a^ � - - 02
05
sorne '
C �,,,�# °e°`'� —
�PR GrourW surface elev. fl Deptli to Ircrahrg facta_�n. /elev fl
Sa1 Applicatron Rate
Honion pepth DominaM Cdor Retlox Descnpta� Teriure Structure i Conslstence BourWary , Roots GPDiFt�
In. Munsell Qu Az. Cont. Cola Gr Sz. Sh. i � •Eff#1 � 'ERK2
C ��# ❑ �I� —
� Pit Ground wrtace elev. tt. DepM to I�mmng facta in !elev. f1
Spl Appticat�on Rate
Honzon Depth Dommant Cobr Redox Descnptan Texture StruUure i Cons�stence BourWary Rods GPD/FY
I�. Munsell Ou.Az CorN. Cola Gr. Sz.Sh. j .EIT#1 ' 'EMf2
�
'Eflluent x1 =BOD>30 s 220 myL and TSS>30 s t 50 mg/L ' Efttuent ft2=BOD,s 30 myl and TSS s 30 rtKyL
Plot Pfan Page � of y
��_J
PROPERTY OWNER: -� �-f-r1:=�.'_ � � ' _. . � • , � 1" _= 40 FT.
(except where noted)
Legal Description: � '�' .:� cy��y .c "�i�E ".� /'�� �� . I� ' �I�f.). �^,4t�Y . ;_' _=backhoe pit
�TcWN et 1-' nuND L1�kE SAwVE1Z C � Utit'��J U� t•,,'��15�N� �. .���n f;�La
� %Y 9�1� �.z_y�o� � I-;7vvJ '� v��r.i L�+r.� ��R1>
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State of Wisconsin Tony Evers,Governor
DEPARTMENT OF NATURAL RESOURCES Adam Payne,Secretary
101 S.Webster Street Telephone 608-266-2621
P.O.Box 7921 FAX 608-2673579 "'�01�'"
MadisonWI53707-7921 TTYAccessviarelay-711 ����NNLLNESOUPCES
August 14,2023 Project No.5-2023-0602
Mary Jo Huppert
Hollister's Soil Testing and Design
25720 Firefly Lane
Webster,Wisconsin,54893
Subj: Mixed Wastewater POWTS in Town of Round Lake for Patefield Veterinary Clinic
Dear Ms.Huppert,
The Department of Natural Resources has received and reviewed your recent submittal which proposes a mixed-
wastewater Private Onsite Wastewater Treatment System in Dane County(SW%,SE'/<,S12,T41N,R8W),in the
Town of Round Lake.The proposed POWTS consists of a 1,000-ga]Ion concrete[ank manufactured by Wieser,
and a 540-galbn Infiltrator dose tank with a Clearflow filter and Zoeller pump.The system has a 450 gallon per
day design flow.
The proposed POWTS is for the disposal of sanitary waste for employees and customers(est.168 gpd).There is
zero expected industrial wastewater contributions into this system.Mixed wastewater is being approved as a
conservative approach,as it is possible that a small amount of non-domestic waslewater(i.e.pet wastewater)may
reach the POWTS on some days even though the expected discharge is zero.All products used will be
biodegradable.
Based upon the information provided,the Bureau of Water Quality finds the inclusion of the industrial wastewater
described above is acceptable. The Department of Natural Resources does not regulate sanitary wastewater flows
that are under 12,000 gallons pec day,so the final authorization for this application will come from the
Deparhnent of Safety and Professional Services(DSPS). Please note that DSPS is also responsible for review and
approval of any catch basins,sewer lines/connections,and other plumbing appurtenances associated with the
installation of the proposed POWTS.
Exemplions
Limiting Factor:An exemption can be ganted under s.NR 2 L4.06 Wis.Adm.Code for s.NR 214.(6(l)(c)Wis.
Adm.Code to allow the bottom of the subsurface treatment system to be installed at less than five feet of distance
to a limiting facror because the industrial pollutant is reported to be of domestic strength waste.This means that
three feet of distance will suffice to Qrovide aporopriate aollutant dispersion,as recommended by the minimum
separation requirements shown in SPS 3R3.44,Table 383.44-3.
Condirions oj'concurrence
7'his Ictter documents the DcpartmcnYs POWTS design review for the industrial wastewater described above.
Based on this review,the Department of Natural Resources concurs with the proposal to combinc and treat the
domestic wastewater and non-domestic wastewater generatcd at ihis faciliry via the proposed POWTS.
Discharge of wastewaters not identified above.
dnr.wi.gov �
wisconsin.gov Naturally WISCONSIN pg�
This concurrence ooly covers the disposal of thc industrial wastcwater described above through the POWTS
system, also described above. If a future change in operations may lead to other industrial wastewater being
discharged to the POWTS, please contact the Department of Natural Resouroes for review to ensure underground
sources of drinking water remain protected, and so this letter of concurrence can be appropriately modified.
Please keep a copy of this correspondence for your records. [f you oc your client have any questions concerning
this concurrence, please contact Laura Rodriguez Alvarez at the Department of Natural Resources,at
lauru.rodri�_uzzakurczii ���iscon,in.ao��
STATE OF WISCONSIN
DEPARTMENT OF NATURAL RESOURCES
For the Secretary
._�^"^�-l-�^b--
Jason R. Knutson, P.E.
Wastewater Section Chief
Bureau of Water Quality
��MlIC�L �
Laura Rodriguez.Alvarez
Wastewater Engineer
Bureau of Water Quality
Cc: Katie Petzel Wastewater Specialist, Deparhnent of Safety and Professional Services � -_
"T�`��,;, PRIVATE ONSITE WAST'E TREATMENT county
�=����o� SYSTEM S
� S awyer
�:�.:�SPS ,� ( POWTS)
k ,� ,_�,'
'�� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION o23 ..- ���
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(l)(m)]
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Tra�saction ID#:
� a� �.► �a b�-�e-� i��� C��Cs-_ ��3-C��3 d 17bo- �--
�nsp BM Elev: BM Description: Parcel Tax No:
�oo.�' '.�.� a c�,i.�i C- 02 �- �Yf-f�- �{3v�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic . � Benchmark IU�.O'
Dosing '� � p
Aeration Bltlg. Sewer 9�. �
Holding St/Ht Inlet �r� �
TANK SETBACK INFORMATION St I Ht outlet �s; '
TANK TO PIL WELL BLDG AIRINTA�KE ROAD Dt Inlet S; 6 '
Septic �-tC� �-a.s-� .�.5' �-'' NA Dt Bottom q�,g �
Dosing � � ' � NA Installation
'�� '�� � '� Contour
Aeration NA Header/Man.
Holding Dist. Pipe 5'�.� '
PUMP 1 SIPHON INFORMATION Infiltrative �
Surface �'('C•'�S
Manufacturer Demand Final Grade
Model Number 9g GPM ����� 9 • �
TDH S' Lift Friction Loss Sys Head TDH Ft G3 �C7•75��
Forcemain L �d Dia 2" Dist. To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W �(� � 3� #of Celis Type of System Distribution Media Manufacturer:
Conv ❑ Aggregate
SETBACK OHWM of Nav � ,e
INFORMATION P/L Bldg Well Waters °� G ❑ Chamber Model Number:
❑ EZFIow
CELL TO -(-S �-�o �4-� N ❑ Mound � Other
- - ___. -- -- -- ------
DISTRIBUTION SYSTEM X Pressure Systems Only
Header I Manifold Distnbution Pipe(s) --- ,�X Hole Size �X Hole Observation Pipes
� Length Dia _ �Length Dia Spac � Spacing ❑Yes ❑ No !
'
SOIL COVER
------- -
fDepth Over Depth Over ; Depth of Seeded/Sodded Mulched
Cell Center �ell Etlges j Topsoil ❑ Yes ❑ No 0 Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
��s���� $��-Y�a3
-- ----_ ___
� - -- -- - � �
Plan revision required?❑Yes❑ No I Q3 I�S � I , , I , /�'� �
�! I/v C�
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITI�NAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBEA: oZ3 � ���
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