HomeMy WebLinkAbout002-940-26-5206-SAN-2023-239 i•"�'^�;, Industry Services Division Counry � �, �
- 4822 Madison Yards Way 4`'`'`p �
; ,�_ - Madison,W I 53705 Sanitary Permit Number(to be filled in by C
�' ps P.O.Box 7302 63�2��
' Madison,WI 5302 4-�
- W
Sanitary Permit Application State Transaction Number �
In accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate governmental unit ^- w
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing add ��
the Department 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. 8054N Highline Road
1.Application Information-Please Print All Information
Property Owner's Name Parcel#
Steven&Kathryn Robers 002940265206
Property Owner's Mailing Address Prope�cation
15981 Fourth St
Govt.Lot �
Ciry,State Zip Code Phone Number
Ha ward W[ 54843
Y �--J�E. '--' �i. Section 26
� -
II.Type of Building(check all that apply) Lot# � T 40 N R 9 E o�
�Q',l or 2 Family Dwelling-Number ofBedrooms 3 Subdivision Name
Block# �
❑Public/Commercial-Describe Use _
❑Ciry of
❑State Owned-Describe Use CSM Number ❑Village of
���6 ��7 y ,2�'I'own of Bass Lake
I
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.
�New System ❑ Replacement System ❑ Other Modification to Existing System(explain) ❑ Additional Pretreatment Unit(explain)
B' ❑ Holding Tank �In-Ground ❑At-Crrade ❑ Mound ❑ Individual Site Desi n
g ❑Other Type(explain)
(conventional)
r• ❑ Renewal Before �Revision ❑ Change of Plumber ❑ Transfer to New Owner ist Previous Permit Number and Date Issued
Expiration ��,� O� � ( $ �a
IV.DispersaUTreatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Eleva[ion
450 .7 642 652 95.4
Capaciry in Total #of Manufacturer
::
Tank Information Gallons Gallons Units � � v � �
New Tanks Exisring Tanks ` o Y � � � c_"d c`�
a U tn �, v� u. C7 C.
Septic or Holding Tank 1000 1000 1 Wiese� x
Dosing Chamber
V.Responsibility Statement- I,the undersigned,assume responsibility for instslla6on of t6e POWTS s6own on the attached plans.
Plumbers Name(Print) PIu ber's Si nature MP/MPRS Number Business Phone Number
Kelly Ferguson 224069 715-416-4597
Plumber's Address(Street,City,State,Zip Code)
W 9502 Dock Lake Road Spooner WI 54801
Vl.C un /Department Use Onty
�A ro Q�Dis roved Permit Fee Date Issued Issuing Agent Signaturc
❑Qwr�ep Given Reason for Denial $ �v•� � I ��I�3 '" �k��T '�"'"t'�i
Conditions of QrovaUReasons for Disapproval -
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Attach to complete plans f the system and submit to the County only on paper not Iess than S t2 x 11 inches in size --i
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� �j�ti "C51 63— .3c�.� NO R�FJND�i AF7'ER
SBD 6 8(R.02/22) IS�E Of f�R��
PRIVATE SEWAGE SYSTEM PLAN INDEX PAGE
Owner's Name: Steven&Kathryn Robers
Owner's Address: 15981 Fourth St
Hayward WI 54843
Site Address: 8054N Highline Road
ParcelID: 002940265206
Legal Description: S 26 T 40 N R 9 W
Subdivision Name: Lot No.
Block
Town o£ Bass Lake
County of: Sawyer
Page 1 Plot Plan and System Sizing
Page 2 Plan View and Cross Section
Page 3 SBD-8330
Page 4 SBD-8330 Continued
Page 5 SBD-8330 Continued
Page 6 Septic System Maintenance Agreement �
Plumber Name: Kelly Ferguson #224069
Plumber Address: W9502 Dock Lake Road
Spooner WI 54801
Telephone: (715 416-4597
Signature: `��'�'�
Date: 8/28/2 23
Cc��P � `MG�I�� 1 �"C"` � � �
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Site Plan
� �'Yl'V � � Page � of�—
s' Owner: Q� 0 Q�`S Dan Harrington CST#248357
� ��; 3 ♦ BM: As ed elevatio at 10 .00
Da : '
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ow,
Scale: 1" 0' y ` +�
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*For new systems,well must be>=50-feet �p00 S �� /v��t c/ �n �C
from absorption system. �
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Seplk Tank(s)MarwfacWrer:
IN-GROUND GRAVITY DISPERSAL AREA �A ���•-�
Uniform Elevation Trenches with Quick4 Standard-W Chambers sa���TB��e>���c9r
3-ft Trench (down-sizing credit) /o�Q� �� se� s��
Eflluenl Fllter Manufecturer.
/'/l�_
� S.?s' �
Em�em r�ue�n�od��:.
min 1Y
SOIL COVER ���
72"
min,vench
iry�P�> •: < ' TYPICAL TRENCH
, • • '•'a •. CROSS SECTION VIEW
h'—��vv�>. '... ', ' �.; .: .• �. (NoScale)
w , a•" a'�
, , r, _ � Provide minimum 3 fi
System Elevation =�5_ separatfon belween trenches.
(lypical)
Qu�k4 Standard-W
w/EndCap ObservalbnPlpe jyPICALTRENCH
(�YP���) (Show locatlon oi Inlet/outlet pipe connection on plan view.) f�l
mateuparmanuteeturer'e pLAN VIEW
„_ , ' " "�`""'°"' (No Scale)
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I� i� i r�p�;;! II II���II� 1:1�� �'i. �',I,I i I�IJ�� Int i�tl� ��� iluli�l TA= 3.0�
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_ _ — _ �� _ _ _ _ _ _ _ �� _ _ —
B_ � ft - -��' m
(ryP��O Qulck4 Standard-W Chamber W
l�YW��) (�
INSTALL PERTRENCH: (midnyinenra�orsys�ms.mc.) T
Inalall pursuant lo manulacmrera Inslruclbne. �
�.r�Quick4 Std-W� 20 flx EISA/chamber= �� �` ftx „
+ l Pairs of end caps Q 6 ft�EISA/pair= C ft' '
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=Proposed EISA per trench= �K 4' ft' Required Infiltration Area= ��� ft' DiStfibUtion Medlod:
x � trenches = Proposed Total EISA= � tt' �i/���a�� �
RESET,. :,
PAGE40F4
In-ground Gravity Management Plan
IMPORTAhIT:
The owner of this in-ground gravity system shall be responsible for its perpetua!operation and maintenance pursuant to
requirements of SPS 382-384,Wisc.Admin. Code. Pursuarrt to SPS 383.52(2),Wisc.Admin.Code,this system shall
be considered a human health hazard'rf not maintained in accordance with this approved management plan.
Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Ma(ntainer in
accordance with SPS 383.52 (3),Wisc.Admin.Code.
Maximum Dls ersal rea O eratin Limits:
Design Fiow= � gpd; BODS<_220 mgL''; TSS 5150 mgL''; FOG 5 30 mgL''
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors(i.e. odors, user wmpiaints, etc.)
o mechanical malfunction (i.e., pumps,valves, switches,floats, etc.)
o material fatigue (i.e., leaks, breaks,cortosion, etc.)
o solids volume in anaerobic treatrnent tank(s)and any distribution appurtenance(s)(i.e.,distribution/drop boxes)
o neglect or improper use(i.e.,exceeding design capacities, prohibited activides, etc.)
o exterrt of ponding in distribution cell prior to dosing
o dosing imegularities-'rf applicabie(i.e.,pump re-cyding,float switch settings, etc.)
o elecfical components-if appiicable(i.e.,wiring, cannections, smritches, corrtrois,timers, alarms,etc.)
o disVibution lateral or Iateral orifice plugging (measure lateral distal pressure—compare to design spec�cation)
o surFace discharge of eifluent 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 Wis.
Stats.when the volu�e of solids in the tank(s)exceeds one-third(1/3)the iiquid volume of the tank(s) or
as required by local or�iance. Disposal of contents shali be pursuant to NR 113,Wisc.Admin.Code.
o Effiuent fiker(s1 shall be inspected every 3 years and shail be deaned when neeessary to remove any
accumulated solids according to man�acturers specifiptions. A serviang period uvfll aiways be greater than 12
. months.
System maintenance reports shail be submitted to the proper local govemmerrt unit in accordance with
SPS 383.55 Wisc.Admin. Code. Report any component failure or malfunction to:
Name of individual or company: e//ic �/� G ,. �. Phone: ��S T��—��o�
Locai govemmentunit:,,��yr �'j,, ,�� 7 � Phone: J/S�—�3�f— ����
9 '+ �S'� s�".�i�' 1,� �
Local ovemment unit address:/o6%'O ��,�,y Z�P:���,rS,3
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 departrnent 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 repiaced pursuan{to
a pian submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be
abandoned and replaced by a code-compiying dispersal component in a pre-determined area of suitable soils.
S�tstem Abandonment
If use of this P01N7'S is discontinued, it shatf ba abandoned in accordance with SPS 383.33,Wisc.Admin.Code.
" R""`� PRIVATE ONSITE WASTE TREATMENT county
i�! SYSTEMS
J ' °$P ��' Sawyer
`�;,� s , ( POWTS)
�k �--�'
' ""' INSPECTION REPORT Sanitary Per o:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � "��� �2 ���
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(l)(m)J
Permit Holder's Name: ❑City ❑ Village [p�Town of: State lan Transaction ID#:
�-e.vc�n ¢'�MrY�1, Y��S 8aS5 �a� '�
Insp BM Elev: BM Description: Parcel Tax No:
(oa.�� I�,��l d' n�b�„� � 0�,� �r.. ''er�.o�.�� _ O��—`t`(o—�- S.2D�,
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS E_EV
Septic 1,,,�e5.es � Benchmark �,p '
Dosing
Aeration Bidg. Sewer y3 r
Holtling St/Ht Inlet �8'Q ►
TANK SETBACK INFORMATION St/Ht 0utlet 98 7 '
TANK TO P/L WELL BLDG vENrTo ROAD Dt Inlet
AIR INTAKE
Septic .��� t�1 �h�� NA Dt Bottom
Dosing NA Installation �
Contour q�•�
Aeration NA Header/Man. Sr 6 �
Holding Dist. Pipe
PUMP 151PHON INFORMATION Surface e 4'Y,6 �
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 (, b #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate ����
INFORMATION P/L Bldg Well Waters o GP D� Chamber Model Number:
❑ EZFIow
CELLTO ��' N ^/ ❑ Mound o Other (�},�
--- _ _----- --- -
-------- -- -
DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifold Distribution Pipe(s) �X Hole Size � X� Hole Observation Pipes I,
Length Dia Length Dia Spac , I Spacing ❑ Yes ❑ No �
--- --- ---
_ -----
SOIL COVER
__----- --- - -- - —
Depth Over Depth Over I Depth of Seeded/Sodded Mulched
Cell Center Cell Edges 'i Topsoil ___ __� ❑ Yes ❑ No 1 ❑Yes ❑ N�
COMMENTS: (Include code discrepa�cies, persons present,etc.)
����Ild��o �a3
� ��� ------- ! —
Plan revision required?0 Yes❑ No jp'� ( 11 � ': / �� '� � �
l �t' �d- C � V" 1 �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITI�NAL COMMENTS ANO SKETCH ,�3�
SANITAAY PEAMIT NUMBEA: a-����____ _��
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