HomeMy WebLinkAbout026-182-12-2003-SAN-2023-216 � ��=`"�;�., Indust�y Se�vices Division Counry �
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-'e _ 4822 Madison Yards Way Sawyer �
_ , s� - Madison,WI 53705 Sandary Permit Nwnber(to be filled in by
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— <r-"/' Madison.WI�3707 �.S � � � N �, `'
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State Transaction Number �
Sanitary Permit Application �
In accordance with SPS 383.21(2),V:is.Adm.Code,submission ofthis torm to the appropriate�o�emmental unit '�� �
is required prior to obtaining a sanitary pennit.Note:Application torms for state-owned POWTS are submitted tu Project Address(it difFerent than mailine ac �
the Department of Safery and Professional Sen�ices Personal information you provide may be used for secondary .�5648W V�CT�RY HE�GHTS C�R
pwpose;in accordance�cith the Privacy Law',s 1�.0-1(I)(m),Stats
I.Application Information-Please Print:111 Information
Propert}'O�cner's Name Parcel#
JOSHUA K VAN SWOL 026-182-12-2003
Property O�aner's Mailin�Address Propert� Location
154 N ROSE ST ��._
City,State 7_ip Code Phone Number
PALATI N E, I L 60067 '�, ''a, Se°t'°n �o
IL'Cype of Building(check all that apply) �-��# �O _�� T 39 tv R 09 E o
�l or2 Pamily Dwcllin�-Numbero��Bcdrooms rJ �
Subdivision Name
Block# �� � � � �'� �
�Public/Commercial-Describe Use
� � �City of
�State O�v�ied-Describe Use_ __ CSM Number �Villaee of
CSM 38/87 #8688 ❑✓ "�������r� sand �ake
III.Type of POWTS Permit:(Check either"New"or"Replacemenf'and other applicablc on Iine�. Check one bos on line B.Completc line C if
a� licable.)
�� �New S��tem �IZe lacement Scstem �Other Rlodification to Existine S �lcm �� lain) �Additional Pretreatment Unit es lain
� >' P .. Y ' (' P ( p )
B' �Holdin�Tank �In-Ground �At-Grade �Mound ❑Indi��idual Site Design Other Type(ex�lain)
(conventional)
List Previous Permit Number and Date[ssued
C. �Renewal[3efore �Revi;ion �Chanee of Plumber �I�ranster to Ne�c O��ner �� � ���
F,spiration
IV.Uispersal/Treatment Area and Tank Information:
Design Flow(g{�d) Desi�n Soil Application Rate(epd/st� Dispersal Area Required(,t) I)isper,al Area Proposed(sf� System Elevation
750 0.7 1072 1098 93.00
Capacity in Total #oY Manufacturer
Tank[nformation Gallons Gallons Units � � o � �
U
Nzw Tanks Faisting Tanl:s y o �? ` y ,D ro cs
a U cn � cn �u. C: c..
SepticorHoldingTank 1645 1645 1 WIESERCONCRETE ✓ �
Dosin�Ch�mber � � �
V.Responsibility Statement- I,the undersigned,assum esponsibility f i tallation of the YOWTS sho��n on the attached plans.
Plumber's Name(Print) Pl�mibe s Si�nature MP/�4PRS Number Business Phone Number
Travis Butterfield 652879 715-634-8176
Plumber's Address(Strect,Cip',Statc,Zip Code)
14346W St. Rd. 77, Hayward, WI 54843
VL Co nh�/Department l�se Only
Permit Fee Date Issued Issuins Aeent Sig�iature
�,.4pp � � ❑Dis�pproccd ,G��I�
�y✓ O�+�ter Gi��en Reason for Denial � LO�.� ��� ��3 � -`"��
q_..
Conditions o1�Ap�roval/Reasons for Disapproval ��� ����� �\�
� � �, �_ y l � J�-.� _ �1�
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��,k#�.:�� ��-�.__:a_.,._.,�.. AIiC 3 1 2023
CST �� — I�I � � . ,,,�aA �q 1 l _ SAWYER COUNTY
� ��}{�ADRAi{VI�TF#ATlflf�
Attach to complete plans fm•the system and submit ro the County only m�paper not Icss than 8 1/2 x 11 inches in size y y,^��
n�e a�FUN��AFTER ��
sB�-639s�iz.ozia2� ISSUC UF F'ERM1T
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): JOSHUA K VJOS Phone: - -
Owner Address: 154 N ROSE ST., PALATINE, IL Zip; 60067
Project Address: 15648W VICTORY HEIGHTS CIR, HAYWARD, WI 54843
Govt. Lot: 1/4 of 1/4, Section �� , T39 N-R09 E❑or W ❑✓
Township: SAND LAKE County: SAWYER
Project Parcel ID #: 026-182-12-2003
Designer Information
Designer Name: TRAVIS BUTTERFIELD Phone: 715 _634 _8176
Designer Address: 14346W ST. RD 77, HAYWARD, WI Z�p; 54843
E-mail: OFFICE@BUTTERFIELDDRILLING.COM z�E,;;,�,��,�trz,�r�-���,�, a�,�,��,,�ti,��<«,���.
License Number: 652879
Remarks:
Signature: Date: �� � � � °��
Ori nal signature required on each submitted copy.
CHECK E30X AS APPLICABLE CHECK BOX AS APPLICA9LE.
� SOIL EVALUATION o Scale: 150 50 �5 �oo � SYSTEM PAGE 2 OF Y
SITE MAP PLOT PLAN
PROJECT NAME: 7S�
1Z 5Z DESIGN FLOW: GPD
J �S��� �� Ja n .$'r✓° � Attach design flow calculations for commercial plans.
PROJECT ADDRESS: l s6 Y8 � V�c�"c�� hPikl.tf CirC�q Pipe Material/ASTM Standard(Tables 384.30-3&384.30-5)
N Sanitary Sewer: �� ��4 � /
BM Symbol: � BM Elevation: ��'� FT Force Main: /
BM Description: ��"� �~ ��� � �h✓�_ ' I
�ndicate north by IMPORTANT:
Slope Gradient(%) Well Symbol(ifapplicable): Q drawing an arrow Show ground elevation contours at suitable intervals.
of Tested Area: on the approprite line.
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MPRs � �sa �� 9
Septic Tank(s) Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA WIESER CONCRETE
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s):
3-ft Trench (down-sizing credit) 1645 9al gal gal gal
Effluent Filter Manufacturer:
BEST
I Effluent Filter Model#: GF��-8
min.12"
SOIL COVER (tYpica�)
12"
min.trench
depth
��vP��a�� ��� •�� TYPICAL TRENCH
- - � • . - -� �� �� ��°�.a��<. CROSS SECTION VIEW
� (typc18��.• .a �, .. . . . (NO SCaIP.)
n . e,. . a.
. ` Provide minimum 3 ft
System Elevation =93.00 ft separation between trenches.
(typical)
Quick4 Standard-W
w/End Cap Observation Pipe TYPICAL TRENCH
(typical) (Show location of inlet/ outlet pipe connection on plan view.) (typical)
Installpermanufacturer's PLAN VIEW
instructions.
(No Scale)
� - - - - - - - - - - �� - - - - - - - �� - - - - .- - - - - — �
; i !� , 'I A= 3.0ft
' �tYPical) �
L-- - - - - - - - - - - - -�� - - - - - - - �� - - - - - - - - - --� D
�
B = 68 fc —� m
(typical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (typica�) �
(mfd by Infiltrator Systems,Inc.) �
Install pursuant to manufacturer's instructions. �
�8 Quick4 Std-W @ 20 f� EISA/chamber= 360 ftz
+ � Pairs of end caps @ 6 ftz EISA/pair= 6 ftZ
= Proposed EISA per trench = 366 ftz Required Infiltration Area = 1072 ftz Distribution Method:
x 3 trenches = Proposed Total EISA = �098 ftZ branched manifold �
PAGE40F4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground graviry 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 383.52(3),Wisc.Admin.Code.
Maximum Disqersal Area Operatinq Limits:
Design Flow= 750 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 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 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,Wisa Admin.Code.
o Effluent filter(s)shall be inspected every 3 years and shall be deaned 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 shail 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: BUtt21f12�C�, I nC. Phone 715-634-$�76
�ocal government unit: SaW�/@I"COUfIt�/ Z011lflg Phone: 7�5-634-SZHH
�ooa�go�e�nme�t U�it add�ess: 10610 Main St. Sulte 49, Hayward, V 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.
Contingency 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.
WLP1645— MR
TANK SPECIFICATIONS � o
o �
� ,
� 2�_2�� DIMENSIONS: � o
WALL: 3" a �
BOTTOM: 3"
COVER: 5"
. .. . MANHOLE: 24" I.D. PRECAST CONCRETE RISER Q
��,/�______________�=__=_=_______��,,I HEIGHT: 54 1/2" o
.l l 4" CAST-A-SEAL 4" CAST-A-SEAL � f LENGTH: 12��2" w
I I I I. WIDTH: 7 -0 �
i �ya� � BELOW INLET: 43"
� ��-�` ���lQ . r���`� LIQUID LEVEL: 38" o
� � � �� \ WEIGHT: 14,000 LBS. -� o L
I a o E
j i ��__�� �� ��� f WLET AND OUTLET: _� 3 0 �
•� � � � 4" CAST-A-SEAL BOOT OR EQUAL GASKET � m o Q
II FILTER OR II' o ;
i� BAFFLE � ��, INLET AND OUTLET BAFFLE AND FILTER: Q � � w
�,. ,.�
\� WISCONSIN, SEE DETAIL #10 N o o ;
�J__-__�_-�_ .___--_----_-�_;--�J
(OTHER STATES SEE CHART) t� o
�
�
LIQUID CAPACITY: 43.32 GAL/IN W �
� �
TOP VIEW HOLDING TANK: Y �
OUTLET HOLE PLUGGED � � �
ACTUAL CAPACITY: 1,733 GALLONS 0 � �
� w I
LOADING DESIGN: 8'-0" UNSATURATED SOIL Q N
o �
� TANK CAN BE USED AS: o j�
Q o SEP11C / HOLDING / PUMP OR SIPHON W 3 a
w � = o�
+� COVER: MIX DESIGN #8 (NO FIBER) W �
� TANK: MIX DESIGN #10 (STRUCTURAL FIBER) � �
---- ---- � CUSTOMIZED TANKS: � �
INLET - OUTLET FOR CUSTOM TANKS CONTACT WIESER CONCRETE
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REVIEWED BY � v
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M PUMP PAD REVIEW DATE � w
SIDE VIEW DRAWINGS SUBMITTED N
FOR APPROVAL
APPROVED BY: SHEET N0.
APPROVAL DATE: � /
OF
PRODUCTS NEEDED BY: / '�
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
"T'f�, pRIVATE ONSITE WASTE TREATMENT �ounty
�
�, ��SP$ ;� SYSTEMS Sawyer
��;��. ( POWTS)
�H �---��;,,
'-'�'� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � ���.l�
Pe�sonal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Hoider's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
�O ot VRv► Sliva \ /��1� lA K�
Insp BM Elev: BM Description: Parcel Tax No:
Ul`� •c7 ��:�. �r►, ��{�� �R��Q,_ ��.fo_���—���200�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS E�EV
Septic w� �c�S" Benchmark /�o,c�'
Dosing q 73 �
Aeration Bldg. Sewer
Holding St/Ht Inlet q3, �
TANK SETBACK INFORMATION St I Ht Outlet 93 0`
TANK TO P/L WELL BLDG VENT TO ROAD Dt Inlet
AIR INTAKE
Septic �FS'b� k�s �-� � � NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. �2,� '
Holding Dist. Pipe
PUMP I 51PHON INFORMATION Infiltrative
�
Surface 4�•a
Manufacturer Demand Final Grade
Model Number GPM � � 5'y. o
TDH Lift Friction Loss Sys Head TDH Ft Q` a 4Y,7
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W � �{ �( �( #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav ° Conv ❑ Aggregate
INFORMATION P/L Bldg Well Waters o GP ❑ Chamber Model Number:
❑ EZFIow
CELL TO } l� ' }-�g �� ❑ Mound o Other
-- -- ---- _-- ---- _
DISTRIBUTION SYSTEM X Pressure Systems Only
� — -- - P � ) -- 'y-- i — P�
Header!Manifold Distnbution Pi e s X Hole Size XP oleg Observation Pi s ll
Length Dia Length Dia Spac i S acin ❑Yes ❑ No �
SOIL COVER
fDepth Over Depth Over Depth of Seeded/Sodded Mulched
Cell Center �Cetl Edges Topsoil __ � ❑Yes ❑ No 1 ❑Yes ❑ Vo
COMMENTS: (Include code discrepancies, persons present, etc.)
�.����1 � l� ( 2�
Plan revision required?❑Yes❑ No �0,3 c g � '.� II ��^ � _ I' l�9 '�((a �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITI�NAL COMMENTS AND SKETCH
SANITARY PEAMIT NUMEEA ______2�_'�,�__S�._____
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