HomeMy WebLinkAbout010-130-00-1000-SAN-2023-243 _ �''`� Department of Safety c°°°ty �
- SAWYER �
� / = & Professional Services, Z
- _, _' = Sanitary Permit Number(to be filled in by 1
,, ', s � Industry Services Division
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Sanitary Permit Application State Transaction Number �
NA SIn accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit.Note:Application forms for state-0wned POWTS are submitted to Project Address(if different than mailing ad W
the DepaRment of Safery and Professional Services.Personal informarion you provide may be used for secondary SAME
purposes i�accordance with the Privacy Law,s. 15.04(1)(m),Stats_ � �
I.Applicallon Information-Please Print All Information
Property Owner's Name Parcel# �
ROBERT& KAREN A. CHURITCH 010 130}0� 1000
Property Owner's Mailing Address Property Location
10765N PINECREST DRIVE Ga�--�;;
City,State Zip Code Phone Number
HAYWARD, WI 54843 715 -634- 2583 r'—�'�^ �'4, Section 2� _
II.Type of Building(c6eck ail that apply) Lot# T 41 N R 09 ��y
�l or 2 Family Dwelling-Number ofBedrooms
3 10 Subdivision Name
slock# HAYWARD HEIGTHS
❑Public/Commercial-Describe Use NA
❑Ciry of
�State Owned-Describe Use CSM Number ❑Village of
NA q(r��oe t�y�lllAkRn
ITI.Type of POWTS Permit:(Check either"New"or"Replacement"and other applica6le on line A. Check one box on line B.Complete line C if
a licable.)
A.
❑ New System �`,(Replacement System ❑ Other Modification to Existing System(expiain) ❑ Additional Pretreatment Unit(explain)
B' ❑ Holdin Tank In-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Desi
g Q( gn ❑Other Type(explain)
(conventional)
C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date[ssued
F,X��,�c�o� NK �
IV.DispersaUTreatment Area and Tank Information:
Desi esign Soil A li Rate(gpd/sfl Dispersal e u Dispersal s S
�lSc� o.� 4��f�. ��- aS�.a �
apacity ui Total #of Ma�ufacturer
Tank Informarion Gallons Gallons Units � o 'b �
New Tanks Existing Tanks � c v " � � � �
o -- 2
a U v� �n cn iz. C7 a.
SepticorHoldingTank 1060 1060 1 INFILTRATOR X
Dosing Chamber
V.Responsibility Statement-I,the undersigned,assume responsibility for installadon of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumb 's Signamre MP/MPRS Number Business Phone Number
� 5 �� d l �`��S`�(o �3
Plumb �s Ad ess(Street,City,State,Zip Code)
C � �h 'I�� GZf`�'�� L l�G�(J�: (,.e�— j�'c�,�
VI.C unty/Department Use Only
�A ❑Disapproved Permit Fee Date Issued Issuing Agent Signature
�� � $ c��.00 q �a���3 .�� - .
❑Owner Given Reason for Denial
Conditions f Approval/Reasons for Disapproval D � ������
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G sT 2 3 — l � I SEP 2 5 2023
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SAWYER COtJNTY
ZON�NG ApMINISTRATIOfd
Attach to coroplete plans for the system and submit to the County only on paper not less than 8 tn x 11 inches in size � ,y�
NO R�Ft1N�g q�-jrER
SBD-6398(R.03/22) �����F F�R�II;»'
(�A\�
PAGE 1 OF 4
In-Ground Gravity Pian
Index 8� Cover Sheet
Component Manua/Design Re%rences:
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 8 Ptan View
Pg 4 of 4 Management Plan
Attachments: Enclosures:
�NK ��-> �L ���-•, POWTS Application for Review __
�i�rER s�Ees (z a�s.l Soil Evaluation Report&Site Map _
"f�K 'STlITEMFN i —_ '_
—
_-- --�_.— — --
Project Name I Description
Owner Name(s): ROBERT&KAREN A.CHURITCH Phone: "►�5 -b3�1 _L`�;
OwnerAddress: �0765N PINECREST DR., HAYWARD Z�p: 54843
Project Address: (SAME)
Govt.Lot: NA 1/4 of 1/4,Section 2� ,T 4� N-R 09 E a or W Q✓
--__
Township: HAYWARD C��ty; SAWYER
Project Parcel ID#: 010130001000
Designer Information
Deaigner Name: MARY JO HUPPERT Phone: �15 _ 426 _ 1775
Designer Address: 25720 FIREFLY LANE, WEBSTER, WI Z�p; 54893
E-mail: hollisterdesign@outlook.com ,,,, ".�';;�'` •.y,,,�
1859-007 ��� ��.(.�_,r?,;,,,''%,
License Number: ,; y�•;.•-�• ,.
Remarks: ;,* f,�AHY j:l Y(=%
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Signature: � % �l�lf�._/l�� (/� `+'C � / Date: 09-��',"'�23
agnature reQuved on wWnitted copy.
Plot Plan �e a��r
�------�
PROPERTY OWNER: ���� f �A��N �, �-��u�'TCH 1" = � �.
(e�ccept wrhere noted)
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IN-GROUND GRAVITY DISPERSAL AREA INFILTRATORTa�k(slManutacwrer
Uniform Elevation Trenches with Quick4 Standard-W Chambers Sep�icTank(s�Vdume(s�
3-ft Trench (down-sizing �redit) ���� a,; ,�; yai ya�
Effluent Filter MarnAxturer
ORENCO
11
EfflueN Filter Model#�
-mm 17
SOIL COVER ��p��
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min trencn
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�am�� • TYPICAL TRENCH
��`� ' a • CROSS SECTION VIEW
• . (No Scale)
\ � Provide minimum 3 ft
System Elevation = 95.50 ft separation between trenches.
(bpica�)
Quick4 SWndard•W
w!End Cap ObaervatqnPlpe NpICAL TRENCH
��YPi��) (Show location of inlet I outlet pipe connection on plan view.) �hv�l
instau pei marwracturers p�,qN VIEW
� �°StUC"°�� (No Scale)
r— . .�. i.i..—.ew�n. - - - - �j'- - - - - - - - -�� - - - -..—,.�..—...—.—.:..- 1
� o� �e �I TA = 3.Oft
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g = n I �
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�ryP���� -Quick4 Standard-W Chamber W
INSTALL PER TRENCH: ` � ��YP���� �
. �JN�TS X --� (mftl by Infiltrata Systams,Inc.) T
I�-T X f;.; - Install pursuant to manufacWrefs instructions �
Quick4 Std-W @ 20 fF EISA/chamber= ft`
+ Pairs of end caps @ 6 ft EISA/pair= ft'
= Proposed EISA per trench = ft' Required Infiltration Area = 642.86 g= Distribution Method:
x trenches = Proposed Total EISA = �� ft- branched manifold �
RFSFT
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 382384, 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 Operatinq Limks:
Design Flow = 450 yPd; BODS <_ 220 mgL"'; TSS 5 150 mgL"'; FOG 5 30 mgL''
Insaection 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 material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treaVnent 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 surtace 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 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 Iocai ordinance. Disposal of contents shall be pursuant to NR 113,Wisc. Admin. Code.
o Effluent filter(s) 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: RYAN STRAND phone: 715-558-1673
�oca� government unit: SAWYER COUNTY ZONING pnone: 715 - 634 - 8288
Local government unit address: HAYWARD, W I 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 repiaced 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.
Svstem Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
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'� INFILTRATOR ` -� 060
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- • Strong injectlon mdd�� polypropylene
construction
,;� • Lightweight plastic ccnstruaion and
,a�� ,, , ' inboard lifting lugs aliow for easy
� �.,, .:.. delivery and handling
/ � • Integral heavy-duty gieen lids that
� .4. �nt2ICOf1liBCI WiSh 11N-W fIS6l5 8f1d plpB
fiS6f SOIU[iO�IS
� • Strudurally reinforcecl access ports
eliminate distortion diuing instailation
and pump-arts
+ • Reinforoed structural nbbing and
�'. > fiberglass bulkheads offer additio�
� 5trength
• Can be installed with 8"to 48"
of cover
fhe Infiftrator IM-1060 is a lightweight strong and durable septic tank. • can be pumped dry dunng
�his watertight tank design is offered with Infiltrator's line of custom-fit P�P-0�
isers and heavy-duty lids. Infikrator injection molded tanks provide a • Surt�Ie fa use as a sepcic 2ank, pump
�evolutionary improvement in plastic septic tank design, offering long-term tank, a rainwater(non-pot�le)tank
:xceptional strength and watertightness. • r�o specia� wa�e�rninq requ�remems
Inlet Side are necessary
• The tank may be backfilled with suitaWe
ranc curAw�r Infiltrator native soil. See installation instructions
TW Riser for guidance.
System
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baifle wall
HEAW DIJfY UD
CUiAWAY
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:3cces5 poR
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bulkheads
MID-SEAM qJTAWAY
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yesketed c;onnection
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M-1060 General Speciflcations and Illustrations
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The IM-1060 is an injection molded two piece mid-seam �, � � i — �
plastic tank. The IM-1060 in�ection molded plastic design � ] , , ; ' I�� J � : �1 I
albws for a mid-seam joint that has precise dimensions n �`- � � � � :
for accepting an engineered EPDM gasket. InfiRrata's � + .+� � � e
gasket design utilizes technology from the water industry "f � �� ' � ' "� ' � —
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to deliver proven means of maintaining a watertight seal. > ~,�/ ; � i�}�I �p �_,�` ' �^,�,p�
The two-piece desig� is permanentty tastened using a i � ;, i ��, �� , _ i
series of non-corrosive plastic alignment doweFs and � � '
locking seam clips. The IM-1060 is assembied and sold � �
through a netwak of certrfied InfiRratw disfibutors. ____- —_ ,:,o „m,�..,,«,�,�«<.�„ -
Must be beckfiNed and instalkd in accordance with T���
I�Itrator Water Technologies, Irrtikrator IM-Series Septic �„�„
Tank General installation Instructions and for shalbw �
grou�d water conditions retere�ce the Infiltrato►IM- ,' , � � +,
Series Tank Buoya�cy Control Guidance. l .�
Please visit www.infiftratorwater.com/images/pdf/ l "'"'
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ManualsGuides/TANKOt.pd(fo►the latest i�fortnation. �, r
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raa�capecrty �ze�gai las�z �i �h�
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Length-to-Width Ratio 2.3 to 1 �K�� , I _ "`• ��—
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HBK�M 54.7"(i 389 mm) "'" 'n � — � ree
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M2xifnUm PiPe D�m2t@f -��� 6"(752 fml) TANNTOP - .-- CONTINIK�US
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' �'�^ ' INSPECTION REPORT sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �-3 � ��3
Personal infonnation you provide may be used for secondary purposes[Privacy L.aw,s. ]5.04(1)(in)]
Permit Holder's Name: ❑City ❑ Village Town of: State Pian Transaction ID#�
�,�sir�" �-�rre� C1n�r' i� �QY�c� —
insp BM Elev: BM Description: Parcel Tax No:
c oo .o� 9 t,,o1.Q. R��..�s c. ��� o�o-130-ao- � oo�
TANK INFORMATION ELEYATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic � p(o� Benchmark too,o'
Dosing
Aeration Bitlg. Sewer �g.3'
Holding St/Ht Inlet q7,6 '
TANK SETBACK INFORMATION St/Ht 0utlet �7 Y ►
TANK TO P/L WELL BLDG vE"T To ROAD Dt Inlet
AIRINTAKE
Septic Y�S� .��5` �}-�o .��p� NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header l Man. �b ,�.►
Holding Dist. Pipe
PUMP 151PHON INFORMATION Surface e `�S�� �
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORM TION
DIMENSIONS �N 3 L s/ 6� #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate ��,
iNFORMATION P/L Bldg Well Waters o GP 6� Chamber
a EZFIow Model Number:
CELLTO �-o2j ��o� �F(6D� �tJ /� ❑ Mound o Other �,cr�...
DISTRIBUTION SYSTEM X Pressure Systems On�y
Hea�der/Manifold Distgbution Pi e s - P - Hole S¢e � X Hole Observation Pipe�
_� � __ i Spacing ❑Yes ❑ No
Len th Dia Len th Dia S ac ,
P
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SOIL COVER
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Depth Over Depth Over Depth of Seeded I Sodded Mulched
Cell Center Cell Edges � Topsoil _ � ❑Yes ❑ No � ❑Yes ❑ N�
COMMENTS: (Include cotle discrepancies, persons present, etc.)
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Plan revision required?❑Yes❑ No 63 �c� jac,�J! -- - G���/
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Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITIDNAL COMMENTS AN� SKETCH
SANITAAY PERMIT NUMBEA� a�3 ^��___
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