HomeMy WebLinkAbout024-741-32-3102-SAN-2023-208 �`" ` Department of Safety �O°°ty U!
_ � � = & Professional Services, Saw e r �
, ` _ � Sanitary Permit Number(to be fdled in by C �
` ,�, �_ , Industry Services Division � s i � � ., �
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Sanitary Permit Application StateTransactionNumber �
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In acwrdance with SPS 383.21(2),Wis.Adm.Code,submission of this fottn to the appropriate govemmental unit
is required prior to obtaining a sanitary permit Note:Application fortns for state�wned POVI'TS are submitted to Project Address(if ditlerent than mailing adc of?
the Department of Safety and Professional Scrviccs.Pcrsonal intormation you provide may be used for secondary
purposes in accordance with the Privacy Law,s. 1�.04(I)(mj,Stats. �ag(p N (?r•pV,SC ln
I.Application Information—Please Print All[nformation
Property Owner's Name Parcel#
K a \Q 5 Qt c� : s�
O�y-7y1- 3� 310,
Property Owners Mailing Address Property Location
9 co S N C a v�n}y R oc d G c. �,����
City.State 'Lip Code Phone Number
`-�eiy w q�a � W Z S`1By3 N� '/<,�W_'/a, Section 3 .1
II.Type of Building(check all that apply) I.ot# S T 4 1 N R O'7 W
�I or 2 Family Dwelling—Number ofBedrooms 3 Subdivision Name
Block# �
❑Public/Commercial—Describe Use
❑Cityof-- -_--
❑State Owned—Describe Use CSM Number ❑V illage of
C5M 'I� 3135 �,'Townof I�ds(��t�',.____--
v. �3 . 83
lll.Type of POWTS Permit:(Check either"New"or"ReplacemenY'and other applicable on line A. Check one box on line B.Complete line C i
a licable.
� �New System p y g y P )
❑ Rc lacement S stem ❑ Other Modification to Existin S�stem(ex lain ❑ Additional Pretreatment Unit(explain)
B' ❑ Hotding Tank �In-Ground ❑ At-Grade ❑ Mound ❑ ladividual Site Design ❑Other Type(explain)
(conventional)
i ��• ❑ Renewal Before ❑ Revision ❑Change of Plumbcr ist Previous Permit Number and Date fssued
❑Transter to New Owner
Expiration �
[V.DispersaVTreatment Area and Tank Information: Q�;� y p)� Ght,+wb � w/ ,SGt o��nd
Design Flow(gpd) Design Soil App(ication Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation �C}��d
ys p o. c. 75�0 7�7a � 9�.0�, 9y.�s
Capaciry in Total #of Manufacturer y
Tank Information Gallons Gallons Units y � � �
N U U U iA V)
New Tanks Exis[ing Tanks ` o ;j ` � � ca ca
n. U v� � v� u, C7 0.
Septic or Holding Tank ' O V 0 � � OOd � �it��QdC P (�»C/t'k X
Dosine Chamber
V.Responsibility 5tatement— l,the undersigued,assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Signature MP/MPKS Number Business Phone Number
�6naW 14 5 r�e.cKels T� /¢ �aGlog$ 7�5-558-Gyrll
Plumber's Address(S reet,Ciry,State,7_ip Code)
�1�C�SN S�c►3�c Rcs¢d �"1 1-�4 war�� w= ��i8 �/ 3
VL C unty/Department Use Only
�A r ❑Disapproved Permit Fee Date[ssued Issuing Agcnt Signature
❑Owner Given Reason for Denial $ `�'� �I 3) I�3 ��� "
Conditions of Approval/Reasons for Disapproval ��j�
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Attach ro complete plans for the system and submit to the County only on paper not less than 8 lrz x I1 inches in size �� �1 ��
NO RCFUNDS AFTER
SBD-6398(R.03/22) ISSUE OF PER'�ItIT
C u�\
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
Pennings-Grouse Ln
Owner Name(s): Kayla J Pennings Phone: - -
Owner Address: 9657N County Road CC; Hayward,WI ZiP; 54843
Project Address: 9896N Grouse Ln
Govt.Lot: NE 1/4 of SW 1/4,Section 32 ,T 41 N-R �� E❑or W❑✓
Township: Round Lake County: Sawyer
Project Parcel ID#: 024-741-32 3102
Designer Information
Designer Name: Ronald A Spreckels Jr Phone: 715 _558 _6472
Designer Address: 9205N State Road 27; Hayward,WI Z�P: 54843
E-mail: ronspreckels@yahoo.com � , �t- � �� �= _ ��� ��
License Number: 226688
Remarks:
Signature: /�(�'� Date: 08�as /�3 _
riginal signature qw d on each submitted copy.
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IN-GROUND GRAVITY DISPERSAL AREA SepticTank(s) Manu(acturer:
Wieser Concrete Inc
Stepped Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit) SepticTank(s)Volume(s):
���� gal gal gal gal
Effluent Filter Manufacturer:
� Lifetime Filter LLC
SOIL COVER
min.12"
�hP'�'� EffluentFilterModel#: LT-�IH
,z°
min.Vench
TYPICAL TRENCH decU
CROSS SECTION VIEW �"P"��� ' � �1�1' P+ � C�QA D E T� 6 � /i L T E2 E�
__ _ __._
".a .. �-p � p� rpR v1 Provide minimum 3 ft
(NO SC81@) � sa• '` --� , separation between trenches.
t�vai�p , (iJ�T �i M I h�1!"� V M pE. P T i-/ ►'2 E GN i 2er E.si S'
. � e
Highest Trench Lowest Trench (as appiicable)
System Elevations= 95.00 ft; 94.75 ft; ft; ft; ft
Quick4 Standard-W
w/ End Cap Observatbn Pipe TYPICAL TRENCH
t ical (Show location of inlet/outlet pipe connection on plan view.) Ryai�O
� YP � InstallpermanufacNrefs PLANVIEW
instructlons.
(No Scale)
� — - - - - - - -�� - - - - - - - �� - - - � 'Rtter �AiR�{, � TA= 3.Oft
i , ` -, �'� � .�i 1
�° ��'� . . .� ' �tl����i��i �il��7C� (tYPical) �
� — — — — — _ — — — _ �� — _ — — — — — �� _ — — — �
B = 79 ft —i '�
m
�ryP���� Quick4 Standard-W Chamber W
INSTALL PER TRENCH: �ryP��l� O
(mfd hy Infflirator Systems,Inc.) �
19 Install pursuant to manufacturefs instructions.
Quick4 Std-W @ 20 ft� EISA/chamber= 380 ft' �
+ � Pairs of end caps @ 6 ft'EISA/pair= 6 ft'
= Proposed EISA per trench= 386 ft� Required Infiltration Area= 750 ft' Distribution Method:
x 2 trenches = Proposed Total EISA = 772 �� 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), 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 353.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area Operating 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 activities, etc.)
o extent of ponding in distributian 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 tankls) shall be pumped by a certifed 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 Effiuent filterls)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 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: ROIl21d A SpfeCk21S Jf Phone: 715-558-6472 _
�o�ai 9o�e��me�c ���c: Sawyer County Zoning & Conservation pnone: 715-634-8288 _
Local government unit address: �OO'I O M81� St, Suite#9; Hayward, 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.
�stem Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, W sc. Admin. Code.
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'�� ��Sps � SYSTEMS
Sawyer
:, ( POWTS)
,�,�__�.
r"'"���''' INSPECTION REPORT sa�itary Permit tvo:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � � 1���
Personal infonnation you provide may be used for secondary purposes[Privacy L.aw,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
� lC� `2 Y1�1 tNl. �,p�.t� �
Insp BM Elev: BM Description: Parcel Tax No:
� c�� �o' N�;l a- �,�1�0,., 1,.�_ o� -��f(-3 2 -3�o�
TANK INFORMATION ' ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic wie, �-p Benchmark 160.0 �
Dosing
Aeration Bldg. Sewer c�7,� '
Holding St I Ht Inlet 46,q �
TANK SETBACK INFORMATION St I Ht Outlet R6,6 �
TANK TO P/L WELL BLDG VENT TO ROAD Dt Inlet
AIR INTAKE
Septic kSp *�.S' 1'7� .t-t7' NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. ,�'
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative
Surface
Manufacturer Demand Final Grade
Model Number GPM � �f$;a�
TDH Lift Friction Loss Sys Head TDH Ft QY�6Y '
Forcemain � Dia Dist. To Well q3 r
DISPERSAL ELL INFORMATION
DIMENSIONS �N 3 L g • . #of Celis Type of System Distribution Media Manufacturer:
� Conv ❑ Aggregate �
SETBACK P/L Bitlg Well OHWM of Nav � IGP � Chamber '
INFORMATION Waters � AG ❑ EZFIow Model Number:
CELL TO �-(p �}'�f .}-� ��� ❑ Mound o Other fl_.�
-- --- _—_ _ - - `��
DISTRIBUTION SYSTEM X Pressure Systems only
_ _ �
Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes
Length Dia Length Dia Spac i Spacing ❑Yes ❑ No
- - -- -- --- - - --
SOIL COVER
Depth Over Depth Over Depth of Seeded I Sodded Muiched
Cell Center Cell Ed es To soil �Yes ❑ No ❑Yes ❑ Vo
-
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COMMENTS: (Include code discrepancies, persons present,etc.)
������I ��(►� 1�3
Plan revision required?❑Yes❑ No ,v 3�� �, � — =/ - J 6c� ,��
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Use other sitle for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITIONAL COMMENTS AN� SKETCH
SANITARY PERMIT Nl1M8ER ___�'3— ���_______
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