HomeMy WebLinkAbout012-640-06-3203-SAN-2023-224 _ Department of Safety c°°"ry �
� & Professional Services,
a Sanitary Perm� Number(to be filled in by G �
�_ , Industry Services Division
C� S I l�� � �'
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State Transaction Number �
Sanitary Permit Application �
In acwrdance with SPS 383.21(2),Wis.Adm Code,submission of this form to the appropriate govemmental unit �
is required prior to obtaining a sanitary pernut.Notc:Application forms for statcowncd POWTS aze submitted to Project Address(if diffcrcnt than mailing addi
the Department of Safety and Pmfessional Services.Personal information you provide may be used for secondary (y5 71� '.•ra Lr��eK �i1 --�
putposes in accordance with the Privacy Law,s.]5.04(1)(m),Stats. L� -''� y
I.Application Information—Please Print All Ioformation r}0. 'Jr
Property Owncr's Namc Parccl#
� i .llp r v� o
Property Owner's Mailing Address Property Location
(�Ol"'i C� � C �� Govt.Lot
City,State Zip Code Phone Number
�� 5 1,1 J�iyV,j _��.-_'/<,�JH�'/,, Section �___—
7 "1
tI.Type of Building(check all that apply) Lot# T (J._N R � E o
� 1 or 2 Family Dwelling—Number ofBedrooms � � Subdivision Name
�� Block#
❑Public/Commercial—Describe Use
❑City of
❑State Ov.med—Describe Use N A CSM Number ❑V illage of
�Townof H�n�er
III.Type of POW'I'S Permit:(Check either"New"or"ReplacemenN'and other appticable on tine A. Check one box on line B.Comptete line C if
a licable.
A' New S stem R lacement S stem
� y ep y ❑ Other Modification to Existing System(explain) ❑ Additional Pretreatrnent Unit(explain)
B' ❑ Holding Tank �In-Ground ❑At-Grade
❑ Mound ❑ Individual Site Design ❑Other Type(explain)
(conventional)
C• ❑ Renewal Befom ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner "�yt Previous Permit Number and Date Issued
Expiration (� _ �b8 9��a( �p �
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Desi�m Soil Application Rate(gpd/sfl Dispersal Area Kequired(stl Dispersal Area Proposed(st) Systcm Elevation
U �`� �o � �50 �}' ,v �
Capacity in Total #of Manufacturer
Tank Information Galloos Gallons Units D � U v � � �
New Tanks F�cisting Tanks y o Y � � p _ �
�
a. U rin .., v� i+. C7 P,
Septic or Holding Tank _ ' � 1 x
Dosing Chamber
V.Responsibility Statement-I,the undersigned,asseme responsibility for installation of t6e POW'fS shown on the attached p18ns.
Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone Number
aa�a a�r ��ti vy3.��o
Plumbcr's Address(Strcct,Ciry,Statc,Zip Codc)
O £t ot ►rr .I y 3
VI.County/Department Use Only
I j Permit Fee Date Issued Issuing Agent Signature
�A � ❑Disapproved $
�Tn/ ❑Owner Given Reason for Denial ��� � ��� �"� � ""'"�'E'�-�'Z
Conditions of 1��3proval/Reasons for Disapproval
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SEP 1 1 2023
<sT �3 — i�—�� .: a�K. ���,� _ __
SAWYER COUNT'(
NING ADM1N{STRAT;O�!
Attac6 to complete plans for the ayatem and aubmk to the County only on paper not less than S v2:11 inches in size
� � .i5 3
SBD-6398(R.03/22) NO REFJNDS A�TER
IS�JE OF�F{�17
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): Patricia A Miller Rev Trust Phone: - -
Owner Address: 2000 Schmidt Ct SE Rochester, MN Z;p: 55904
Project Address: 9533N Hay Creek Lane Hayward, WI 54843
Govt. Lot: NW �1/4 of SW 01/4, Section 6 , T 40 N-R 6 EQor W ❑✓
Township: Hunter County: Sawyer
Project Parcel ID #: 012640063203
Designer Information
Designer Name: Kurt Brown Phone: 715 _943 _2988
Designer Address: W10487 Old Murry Rd Exeland, WI Z�p: 54835
E-mail: brownk@bevcomm.net . ; � , ;; .
License Number: 224281
Remarks:
,� �
Signature: ; Date: �j'/�/.�3
Origi I signature required on each submitted copy.
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SITE PLAN: � `�� MPRS#224281 • i
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SIZING INFORMATION �
DESIIGN FLOW=450 GPD
SOIL LOADING RATE_.7 GPD/SQ FT
ABSORPTION AREA REQUIRED=643 SQ FT
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ELEVATIONS
SURFACE AT S!T=97.3'
INlET=97.3'-1.8'=95.5'
OUTLET=95.3' �
HEADER=94.5' �
SYSTEM=94.0'
SUITABLE RANGE=94.4'-93.T `�
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sz� �-�.s�. - ' ss� -
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-'� - 2 TRENCHES EACH CONTAINING
65'EZ FLOW BUNDLES=650 SQ FT
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�MII�1 f�Qi 1R QEyIAi@F�-�90�
Pab'ic�a A N�R�v Tnst
■ =So��VV�t Backhoe �+I Hay{k�e1c La�e
�!r =VVl��ell NW 1i4-SW 1/4-S6-T4qV-�,VY #
Ta�wn a�N� 1
Paro�#01215400� �
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. PAGE3oF3 I
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IN-GROUND GRAVITY DISPERSAL AREA SepticTank(s)Manufacturer
Huffcutt
Uniform Elevation Trenches with EZ1203HP Bundles SepticTank(s)Vdume(s)
3-ft Trench (down-sizing credit) �,200
gal gal gal gal
Effluent Filter Manufacturer:
' ' Tuf-Tite
� m��.�z• Etrwe��F�i�e�Moaei a: EF-6
GeatexNle I (ryplcal)
Cover
SOILCOVER TYPICAL TRENCH
min.,tench� CROSS SECTION VIEW
depth L
�ryP;�i� —— .�'e. .,; (No Scale) OBSERVATION PIPE DETAIL
(No$cale)
SystemElevation= 94.� ft �+,-� s«aw-Tyoao� F�,�;,,,adc�aa
(typicap ' Provideminimum3ft ShpCap�'°°'a� �m��=hao8saed�e�
separation between trenches. a�o cvc a�pa �;;, Toaso��co�a�
roo or a�aa�o�am,��a�a (mm.,tooq
a�o�aoo�e ri��isnee g�aae
(4)1l4"-1/"%8"Slots
TYPICAL TRENCH (Show location of inlet/outlet pipe connection on plan view.) � epen
PLAN VIEW A��ho��9���� ��,�����b�
Observation p'ipe ehall be�inslallac Surfaw
(No Scale) 4��� a�;���,�o���a��o��,m.
Perforated Lateral Observatlon Plpe ft
— (typical) (ryvica�) (typica�)
�---------- ��---------------�� �
I �-_-�_ -_--_-- .---�- I A—3.0 ft D
__ ___ '_____:
:_______ —
�----------------��-------------- -----� av���> G)
m
�- g= 65 ft �� c..�
(typlcal)
INSTALL PER TRENCH: EZ120YP e�ndle �
6 10-ft bundles @ 50 fP EISA/unit=300 ft� (mfd by Infltraror Systems,Inc.) �
Install pursuant to manufacturers instructlons.
+ � 5-ft bundles @ 25 TP EISA/unit=25 ft'
=Proposed EISA per trench=325 ft' Required Infiltration Area=643 ft� Distribution Method:
x 2 trenches=Proposed Total EISA= 650 ft� 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 383.52 (3),Wisc. Admin. Code.
Maximum Dispersal Area Oaeratinq 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 fadors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches,floats, etc.)
o materiai 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 adivities, 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(sl 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 (1l3)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£Iterls) 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: R 811d P EXC8V8tlflg Phone: 715 415 0661
�o�ai 9o�e�„me�t„�;t: Sawyer County Zoning Deptartment pnone: 715 - 634 - 8288
Local government unit address: 10610 Main Street, Suite #49 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 soiis.
Svstem Abandonment
It use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
" "='-"`�� PRIVATE ONSITE WASTE TREATMENT �ounty
= ��o$� 1�; SYSTEMS
�'� g ( POWTS) Sawyer
" �,�� `v
INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � 3_��t,{
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(�n)] �
Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#:
��r�c'r�-.�'Z,V�c lR.r'f-��J� ---
Insp BM Elev: BM Description: Parcel Tax No:
�Od.o� Na�� w/r��vo�, �� �� po�� ot2 �6�co-o6�3ao�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic U � � �p Benchmark 00.0 �
Dosing o�ri f��l �i8•6 '
Aeration Bldg. Sewer --
Holding St/Ht Inlet 9'S�. �l�
TANK SETBACK INFORMATION St/Ht Outlet rS 3 '
TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet
AIR INTAKE
Septic �F(o t�t�` ,�/ �- �v NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. �}Y�� '
Holding Dist. Pipe
PUMP I SIPHON INFORMATION Infiltrative
Surface 9'y�o �
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W 3 L p` 7p #of Cells Type of System Distribution Media Manufacturer'
SETBACK OHWM of Nav � Conv ❑ Aggregate
INFORMATION P/L Bldg Well Waters � IGP ❑ Chamber
❑ AG �c EZFIow Model Number:
CELL TO 6 N •�-� 7�j ❑ Mound o Other
___ ---- - ---_--____.
__ - - -._._ .__- -- --_—_----—
DISTRIBUTION SYSTEM X Pressure Systems Only
_— — - -- — _ -—
Header/Manifold � Distribution Pipe(s) � X Hole Size ,�Hole Observation Pipe�
Length Dia Length Dia Spac '� Spacing ❑Yes ❑ No
— - - -- __ _. -
SOIL COVER
__- - -- _ _ -
-
Depth Over Depth Over I Depth of Seeded/Sodded Mulched �
Cell Center Cell Edges I Topsoil � ❑Yes ❑ No � O Yes ❑ Vo
COMMENTS: (Include code discrepancies, persons present,etc.)
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-
Plan revision required?❑Yes❑ �'o I��3 �� �2�� ; ��� �<�/� - � I `� �� `Q �
!�t
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�DITIONAL COMMENTS ANO SKETCH
SANITARY PEAMIT NUMEER'___._�3"'a'�Y
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