HomeMy WebLinkAbout004-146-12-3900-SAN-2023-244 v / i
Department of Safety c°°°ty �
SAWYER �
� � � & Professional Services,
_' - Sanitary Permit Number(to be filled in by(
= Industry Services Division
,.. . (c,SI '193� w
Sanitary Permit Application State Transaction Number �
ln accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit NA ..C,
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing ac -�.
the Department of Safety und Professional Services.Personal information you provide may be used for secondary
purposes i�accordance with the Privacy Law,s. 15.04(I)(m),Stats.
I.Application Information-Please Print All Information 12381 W N.BAG-WAKI DRIVE
Property Owner's Name Parcel#
ROBIN RECKINGER 004 146 123 900
Property Owner's Mailing Address Property Location
4114 MCCULLOCH STREET
Govt Lot NA
City,State Zip Code Phone Number
DULUTI l,MN SSR04 '/4, '/4, Section 24
II.Type of Building(check all that apply) Lot# T 39 N R 09 &7t�(w
� 1 or 2 Family Dwelling-Number ofBedrooms 3 39-42 Subdivision Name
Block# LAKE A-SHE-GON HEIGHTS
❑Public/Commercial-Describe Use
12 0 City of
❑State Owned-Describe Use CSM Number ❑Village of
NA ❑Town of COUDERAY
X
IIT.Type of POWTS Permit:(Check either�New"or"ReplacemenN'and other applicable 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(explain) ❑ Additional Pretreatment Unit(explain)
X
B.
❑ Holding Tank 0 In-Gmund ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑ Other Type(cxplain)
(conventional)
C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner �st Previous Permit Number and Date lssued
Expiration ,vK Llv��, �
IV.DispersaU'I'reatment Area and Tank Informallon:
Design Flow(gpd) Design Soil Applieation Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� S s m ( vation
��•o�,q(.o'/89.3��
450 0.7 642.86 678
Capacity in Total #of Manufacturer
Tank Information Gallons Gallons Units � � o ',� ^
New Tanks Existing Tanks � o y � � � � �
a`. U v� y tn u. � a
Septic or Holding Tank 1�60
1 INFILTRATOR X
Dosing Chamber
V.Responsibility Statement- 1,the undersigned,assume responsibility for installation ot the POWTS shown on the attached plans.
�ber's Name(Prin[) Plu s Signa ur MP/MPRS Number Business Phone Number
���'1 S��.t `� ----------- �9�3a r ���5=�����z3
Plumber's Address(Street,Ciry,State,Zip Code)
����7� N `T 'n �'�-����� �'��6�--,�C�. ��� u� J���
VI.C un /Department Use Only
�R pro ❑Disapproved Permit Fee Date Issued Issuing Agent Signature
�J Uwner Given Reason for Denial $ �v�i� !� 1 ���"�'� , - 1��'�`'�� �
Conditions of Approval/Reasons for Disappmval
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SEP 2 5 2023
C s� �3— I c� a _ ___ . __ _._
SAWYER G�RAr�N
Attach[o complete plaas for the system and submit to the County oal}on paper not less t6an 8 1/2 x 11 inches in size
C�,�� `i �z�
SBD-6398(R.03/22) NO R�FUNDS A�TER
ISS�J�Or(�RlVf1'1
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
p9 2 af 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross-Section & Plan View
Pg 4 of 4 Management Plan
Attachments: Enclosures: __
Tank Specs POWTS Application for Review __
Filter Specs Soil Evaluation_Report&Site Map __
Tax Statement _ _ _
Project Name/Description
Owner Name(s): ROBIN RECKINGER Phone: - -_
Owner Address: 4114 MCCULLOCH ST., DULUTH, MN Z�P; 55804
Project Address: �238�W N. BAG-WAKI DR., COUDERAY, WI 54828
Govt.Lot: NA 1/4 of 1/4,Section 24 ,T 39 N-R 08 E 0 or W❑✓
Township: COUDERAY County: SAWYER
Project Parcel ID#: 004 146 123 900
Designer Information
Designer Name: MARY JO HUPPERT Phone: �15 _ 426 _ 1775
Designer Address: 25720 FIREFLY LANE, WEBSTER,WI Z�p; 5489,^.-�
E-mail: hollisterdesign@outlook.com ,<<''''����°'"`
� �COIVs;�,�'�.,.
License Number: 1859-007 < �►� ,, ... `'''�.
Remarks: '� '�Pi�'� .*�
: Hi:MP�iNl' :
;Nv��iii.�;� ;
wi : ��
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Signature: /� lG���/l' %�flCj'�=�'�, Date: 09-23, 2023
s�,awre rea y�eacn�,b�tee copr.
Piot Plan �� °� `�
� .
PROPERTY OWNER: �o�i N 1�i�cK�nt�b K 1" _= 40 FT.
(excepc r+►+ere noced)
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IN-GROUND GRAVITY DISPERSAL AREA SepticTank(s) Manufacturer
INFILTRATOR
Stepped Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit) SepticTank(s)Volume(s).
�06� gal gal gal
gai
ENluent Filter Manufacturer:
� ORENCO
SOIL COVER min.ir�
�h"`�'� EHluent Fiiter Model#: O62�-�H
,r.
TYPICA� TRENCH m�aecm�h
CROSS SECTION VIEW �ryP1a1> _ • .
".a '•. Provide minimum 3 ft
(No Scale) r aa��-� ; separation between trenches.
(bPical) ., .. � .
, . •.
Highest Trench Lowest Trench (as applicable)
System Elevations= 92.75 ft; 91.35 ft; 89.85 ft; ft; ft
Quick4 Standard-W
w/End Cap (Show location of inlet/ outlet pipe connection on plan view.) obse(YPlcal)PIPB TYPICAL TRENCH
(fypIC81� Install per manufacNrers PLAN VIEW
— _ — — — — inshuctions.
_ _ _ _ _ _ _ _ � � (NoScale)
� '.�ei�d+���l1r�� �� � �� � ��,�rn.�r:�lii.�.i
��f�i'WerrerrYtf.d'�h�' — �'� - - - - - - - �� - - -�Yi"�If",Ma'✓�..._rw_rrr,n..a� l �A = 3.Oft
— — _ — _ — � (tyPical) �
D
�. B = 44 ft - � ,n
m
(rypicaq 450 GPD / O7 LR = 642.86 FT. 2 Quick4 Standard-W Chamber W
INSTALL PER TRENCH: 642.86/ 20 EISA/UNIT = 32.14 UNITS (typica�) O
OR 32 X 4 FT. = 128 FT. (mfd by�nfl�tratorsystems,�nc.) �
� � 220 z 33 UNITS X 4 FT. = 132 FT. Install pursuant to manutacwrefs instructions
Quick4 Std-W @ 20 fl� EISA/chamber= ft �
(3) 3 FT. X 44 FT.
+ � Pairs of end caps @ 6 ft'EISA/pair= 6 ft�
= Proposed EISA per trench= 226 ft� Required Infiltration Area = 642•$6 ft' Distribution Method:
x 3 trenches = Proposed Total EISA = $�g ft= branched manifold �
ROBIN RECKINGER
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 inspedion 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 Limits:
Design Flow= 150 gPd; BODS 5 220 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, etcJ
o material fatigue (i.e., leaks, breaks, corrosion, 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 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 Seotic 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 (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 filterlsl shall be inspected every 3 years and shali 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 governme�t 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, 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.
Svstem Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
IM-1060
� INFILTRATOR �
�
;,.��, ��,�.�, .
� Strong injection molded pdyproPY��
construction
• Lightweight plastic co�strudion and
inboard lifting lugs aUow for easY
�r � delivery and handling
� � - Integral heevy-duty green lids that
� interconnect with TW"' nsers and pipe
riser sdutiore
• Strudurally reinforCec aCcess PoRs
eliminate distortion dunng installatbn
and pump-ouls
�``` � " • Reinforced 5tnicturai ribbing and
fiberglass bt�kheads offer additional
� � strength
• Can be instailed wi[h 8"to 48"
of cover
fhe Infittrator IM-1060 is a lightweight strong and durabfe septic tank. ' �a" ��"T'�dry during
fhis watertight tank design is offered with Infiltrator's line of custom-fit pump-outs
isers a�d heavy-duty lids. Infiftrator injection molded tanks provide a • SuitaWe fa use as a septic cank, pump
�evolutionary improvement in plastic septic tank design, offering long-term tank, w rainwater(non-potab�e)tank
�xceptional strength and watertightness. • No spec�al waeer filling requ�remerns
Inlet Side ���
• The tank may be backfilled with suitable
ra�c c�rrAwar Infiltrator native soil. See installation instnictions
rn a�. ;. ro�q��a�e.
syscern '��,
Partition
baffle wall
�►vr ourr uo
CUTAWAY
�� ReiMorced
Z4� SINGtUI�
aCCC53 POff
,
$tfUCtUfO�
" bulkheads
Mio-sEaM arrawar
� Remforced water tight mid-seam
gesiceted connection
1
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_ . . ... . . __ -. - -. ,._....---- INFfLTRATOR'
N-1060 General Specifications and IIIusVations __ �w���,.�
� IYIW[.SIpA� Y�iM.,U%, fl'IVLLN:
.��k. ♦Ii1N '
fhe IM-1060 is an injection molded two piece mid-seam � ,�+ y y , ; � ' � ;� ; ,,� ��, �
�lastic tank. The IM-1060 injection molded piastic design � A�,� J ! 'I ' I �� �," •
albws for a mid-seam joint that has precise dimensions � "
. �� ��� � � � I
for accepting an enginee►ed EPDM gasket. Infittrator's ' � , ,+I � ' " � - o : u,
gasket desgn uti6zes technology from the water industry � "1 . � I i ' � ' ��
}� J� �,��
to detiver proven means of maintaining a watertight seal. � � ��} I 'iFi' �,#I � "�- +Q'"
I� I I L
The two-piece design is permanentiy fastened usin9 a � � I � � � , , �� �, i �
series of non-corrosive plastic alignmeM dowels and j
locking seam dips. The IM-1060 is assemb�ed and sold - -J'
through a network of certified Infiftrator distributors. � _— -- _ �>,� ��m�•�,^��^,�^�,�� —
TOP VIEIM
Nust be backfilled and installed in ecco►dance with
nfiltrator Water Teehnolo9ies, IMiitrator IM-Series SePtic v��,
fank Ge�eral InstaHation Instructions and for shalbw - , '
around wate►eonditions reference the I�Itrator IM- i i ,f ', ?�
Se►ies Tank Buoyancy Control Guidance. � �,�',' �
N-
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Please visit www.infittratorwater.com/images/pdf/ � r. �� �j t•���
y �i �H; �r,
ManualsGuides/TANK01.pd(for the latest information. ��„�� ; II ;t �
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Workirg Capacity 1094 gal(4141 U _ ..
--�---- �--- -- - _. _ __.-' ��h�
__.._---�--------- .
Tolal Cepacity 7287 gal(4872 L� .
a�e ------ -----16.5% -- �
�g�h I 127�(3126RYf1) e�,�az. e:��,o�,a�:c.,ircwrwwir�crnw�o+:
wc an ws �f.�.'-oz.an un
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LefKJtMto-WidthRatq � 2.3IO1 , . �•�•� .. 1 ... g „�,�.�� ,. «mt, .
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�ryt 54.7"(1389 mm) _ �� "' <ot
Liqud Level 44"(1118 mml . �° �
nKKawSt _.A� f![KUSS
�f1V8A�IOp -� 3�(761flffl) wrax� - ��•�'nu stnrm
� vV[nli :4V'r� TWKKI
win wr�[ .
µA� NMER(
Fiberglass Supports � � �<..,>r� �
�•�,.��,.,�_ _ --
Corrperlmerrts 1 or 2
rnax�mum B�r�ai oep�n aa�1�2i9 mm� SIDE YIEW
--- ---__ _ —__
Mirumum Bunal Depth 6"(152 rtml
____—t..
Ma�cimum P�pe Diameter � 6"(�52 rtxn) �� rANKroa — coNnHuc,us
yy�ry� } 320Ibs(745 kg) HALF � GASKET
___.. . ... _ '_ . . TANK
INTERIOR --- >�AMCLIP
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PSC-Series Biotube° Efifluent Fiiters
Applications
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� ` "`""` PRIVATE ONSITE WASTE TREATMENT County
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`�''""v�''�' INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION oZ 3 .—�Y Y
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village [�Town of: State Plan Transaction ID#:
(�,�bW. ��k� �, �--
Insp BM Elev: BM Description: Parcel Tax No:
too .a� � ��-c.��c, . bla�,L�.� �L� � oo�l -(Y6 -(2, -- 39�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic (O(Q p Benchmark (�o.o'
Dosing
Aeration Bldg. Sewer 5�,/
Holding St I Ht Inlet (�,$ '
TANK SETBACK INFORMATION St/Ht Outlet �6.c �
TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet
AIR INTAKE
Septic k�S� fi-�S� -�p .��pi NA Dt Bottom
Dosing NA Instailation
Contour
Aeration NA Header I Man. y� ,�-�
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative
Surface
Manufacturer Demand Final Grade
Model Number GPM S S. � 4a$r
TDH Lift Friction Loss Sys Head TDH Ft S , 2 �� ,3r�
Forcemain L Dia Dist.To Well $Q.BS�
DISPERSAL CELL INFORMATION
DIMENSIONS �N 3 L 1.� �� ' #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav �+ Conv ❑ Aggregate �,�t �
INFORMATION P/L Bldg Well Waters °� GP �Dc Chamber Model Number:
❑ EZFIow
CELLTO t� ��� .�-�� ❑ Mound o Other �Y�
- - - - _—__ _ .—_ --— ---_-- -- —
DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifold Distnbution Pipe(s) — — - 'T
X Hole Size ! X Hole Observation Pipes
Length Dia � Length Dia Spac �, _ Spacing ❑Yes � No J
SOIL COVER
— ---- — -- --
De th Over De th Over l De th of Seeded/Sodded Mulched
P P P
Cell Center Cell Edges I Topsoii ❑Yes ❑ No � ❑Yes ❑ No ,
COMMENTS: (Include code discrepancies, persons present,etc.)
�`��►f(�4 (2(a� (�3
Plan revision required?�Yes ❑ No �03 � �u� ^ ; /
__ �� / I � -- - — ' �� � �b �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL C�MMENTS ANO SKETCH
SANITARY PERMIT NUMBER _ __�L�_^s��(�_ __
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