HomeMy WebLinkAbout010-941-33-4309-SAN-2023-247 _ � ` Industry Sen ices Division Counri �
` , a822 Madison Yards Way SaWy2f �
- , s' Madison,WI�3705 Sanitary Permit Number(to be tilled in by C
= P.O.Bos 7302 � r,
- Madison,WI 53707 �"� s � � -� 1 �
�
Sanitary Permit Applieation State Transaction Number �
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit �� �
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing ad ,�
the Department of Safety and Professional Services Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law,s. 1�.Od(I)(m),Stats. �:���
I.Application Information-Please Print,�11 Information
Proper[y O�rner�s Name Parcel#
Nancy Faupel 010941334309
Property Owner's Mailing Address Property Location
9782N Fairway Dr. �e�___,
Ciry,State Zip Code Phone Number
Hayward, WI 54843 952-500-3131 sw �,,sE ��,, Section 33
II.Type of Building(check all that apply) Lot# T 41 N R 09 E or
Qt or 2 Fam ily D�aelling-Number of Bedrooms_Z `Z Subdivision Name
Block# t--
❑Public/Commercial-Describc Use
�— �City of
�State Owned-Describe Use CSM Number �Village of
29/3 #7335 ❑✓ To�,�,oe Hayward
III.Type of PO�VTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C i
a licable.)
`�� e�v S�stem Re lacement S stem Other Moditication to Existin S�stem ex lain Additional Pretreatment Unit ex lain
� Y a p Y ✓ € y ( P ) ❑ ( P )
rainfield Replacement Only
B' �Holding Tank �In-Ground �At-Grade �Mound �Individual Site Design Other Type(explain)
(conventional)
C. �Renewal Before �Revision Change of Plumber �I ransfer to Ne���O�rner List Previous Permit Number and Date Issued
Expiration CST 09-073 SAN 07-328 10.15.2007
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required(st) Dispersal Arca Proposed(st� System Elevation
300 0.7 428 650 94.2
Capacit} in Total #of Manufacturer
Tank Information Gallons Gallons Units p � U ,�, �
'Ve�rTankc Esiatin�tTanks 'v o o � � � � �
� r
c. V v� � v� u.. C7 a.
Septic or Holding Tank $00 800 1 HUffCUtt �
Dosing Chamber � � �
V.Responsibility Statement- 1,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone Nwnber
Jason Kuettel ,� ,v _,� 675751 715-798-3355
Plumber�s Address(Street,Ciq,State,Zip Code) �' '�� �=-,=�';
PO Box 66 Cable, WI 54821 � a
VL Co n �/Department Use Only
Permit Fee Date Issued Issuing Agent Signature
�A ro ❑ Disapproved $ i, , �
� ��jGC.-�:(.�Jc..'L'-t_�:v1�;,c_:-
�7 O���ner Given Reason Yor Denial (��� `� 'cl-� I-1 i
Conditions of ApprovaUReasons for Disappro�al ���"",�t n�-��--,-.--��-
� � i��• G1' !� ;/,' �-
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.,�nk# -� �J
CST' O�`j - b�3 , 3;��� . sawYER cov►vn�
- -- ZONING ADMIIV15TRkT ON
Attach to complete plans for the system and submit to the County only on paper not less Ihan 8 I/2 x I1 inches in size _
� �J- 7 � C.
ss�-639g�u.ozi22> RSO R�JN�B AF'TER
ISS1)E UF PER�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
Faupel Bed Drainfield Replacement
Owner Name(s): Nancy Faupel Phone: 952 _500 _ 3131
Owner Address: 9782N Fairway Dr. Hayward, WI Zip; 54843
Project Address: Same
Govt. Lot: SW 1/4of SE 1/4, Section33 T41 N-R09 E ❑ or W ❑✓
Township: Hayward County: Sawyer
Project Parcel ID #: 010941334309
Designer Information
DesignerName: �ason Kuettel Phone: �15 _ 798 _3355
Designer Address: PO Box 66 Cable, WI ZiP: 54821
E-mail: tim@andryras.com
License Number: 675751
Remarks:
Signature: �/,,, Date: � � zt
Original si a re required on each submitted copy.
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IN-GROUND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with EZ1203HP Bundles
3-ft Trench (down-sizing credit)
i
�eO�e%"� I I imo��p TYPICAL TRENCH
ca�e�
soi�coveR CROSS SECTION VIEW
�z• T (No Scale) OBSERVATION PIPE DETAIL
in.trenctl� (No Swle)
m tlepih
(rypicaq 1 L —T —— ,�`• s��ew-ryva o� Fm�snaa�Boa
siio Cav(mosa) �mw�nad a aea)
System Elevation/94.2 ft ` ' 4"0 PVC Pipe TOP�o co�a�
Provideminimum3ft Topofpipa�o�erminate �m��.,��o
(typical) a�o�aeo�a r����snaa ymoe
separation between trenches.
(4)1/4"-tl"X 6"Sbis
@�apaN
TYPI CAL TRENCH (Show location of inlet/outlet pipe connection on plan view.) A„�ho�„9 o���a i�an�m�
s�na�
PLAN VIEW
(No Scale) 4��� oeseNauo�P�Pa snau ta ms�aoaa
ai i�nn�on oa�wea�'wo�m�s. �Q ft
Pertorated Lateral ObservationPipe
— (typical) (typical) -- OYpical)
r-----------
-f�------------- �—�
I ====_=I'====___ :_--`- _: ___ '______ ______" I A=3.0 ft �
�--------------- ----J (ryPicap D
��------------- — G�
g= 45 ft �; m
(rypic.al) W
INSTALL PER TRENCH: EZ1203H Bundle 0
(typical) �
4 10-ft bundles @ 50 Tt'EISA/unit=200 ft' (mtd by Infitraror Systems,Inc.) �
Install pursuant to manufacturers instructions.
+ � 5-ft bundles @ 25 ft EISA/unit=25 R'
=Proposed EISA per trench=225 R' Required Infiltration Area=429 ft' Distribution Method:
X 450 trenches=Proposed Total EISA= 450 f�= branched manifold
R�SET '
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, Wisa 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 Limits:
Design Flow = 300 9Pd; 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 priorto 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. 281.45 W is.
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, Wisc. Admin. Code.
o Effluent filter(sl 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 repoRs 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: Alldl'y R8SfT1USS81l & SOIIS Phone: 715-798-3355
�ocal government unit: SBwye� C0. Z011ing Phone: 715-634-8288
�oca� government unit address: 10610 Mairl St. #49 Hayward, WI Z�p 54843
Any defective paR 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.
Continctency 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.
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CS1 �7-Sf) �"
commerce.wl.gov Suk[y and lluildings Division cow,n� i
� ?01 N. 1l'uhingwn A��a,Y.O.�ox 71G2 I `�.'��' `- � � � � j
iscons�n I�tadison.\Il 5J7U'-7162 iSanire.� i'cnn;ttiun:!mrt���be611cil�nbyCu� --'I
Departmont ol Commorco �y�q ;
Sanitary Permit Application SwccTmnsa:tien•:�;nbcr
In x<oW.uue w�tli s Comm.87.21(2),\Vie.Adm.Codq submuvon ol��tus fomi�0 1he opproprtate govemmenlal
unit is �eyuucJ priur to obtaining e sonitary penNl Note: AppliCaUon fonns fur smte-oNned 1'OWT$ am prqoctAddmss(ifdi�lcrenllhanmailingudJre�s)
subrttineA �o �he Dcpanment of Commc¢e. Penotui infomution you pmviAe may be uscA for sc<andary F` �� ,r �� � �
ses in mcoN.�nce Mi�h the Priva Law s. I S 67 i)(ml Suu ��J l �I
1. A iliraiion Inlurnution-1'lease P(r�int All Infortnalion o a
Propert7'U��r.ct's t:ur.e �i Yv [.i rG G(1"�C$, u-L Yual t [/ �
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Property CA.na's pfyling Addmss 7'ruperty Luation
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Ciry,Stn:< Zip CoJ: 1'hon<Number � �
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'T �� N. R�� Lor6L'�
Il.l)�pc of lluilding(check all that�pply) I-ot� �
❑ I or 2 Farttily D�celling-Number of 6edrooms � SuWivisiun Nmnc
Illuck M
❑Pu6tiUCunmu�cial-Dcscribc Usc
❑Ciry of _
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.�Towno! ���Y Wc✓'d
lll.7'ypc uf PermiL (Chcck only one Lox on line A. Complete Gnc B if applicnble)
A. Nnvti�slcm
� y ❑ ReplucemeN Syrem ❑'frtaGnenVilolding'I'mik Iteplacement Only ❑ OO1C(MUIII�II:IOUO IU L'ClSllfl�'S)'Sll'lll�CX(�I.IIIIJ
IS. ❑ Pc:nit Rcne•.ml ❑ Pe.mit Rera:on ❑Qur.gc of Plu`r1+cr
❑Pemiit Talskr�o New� I.i>t Pra�io;i;I'e:mil Number a.id Da W I;v:eJ ,
lic(o¢Gapint�on Ov�ttcf
I\".7\�ce of('O\\TS S��stem/Com onenUllcricr. Check all that+ Ir —1
�Nami'mssuriud In-0round ❑ Prcssuriud ImGrounJ �A�-Gradc ❑ AfuunJ>2�t in.ofsuiLihlc suil ❑ Mound<,�,4 in af suitablc so:l
❑ IioldingTnn4 ❑Oehu Uis{+crsil Cmrywnent(explain) � ❑Pretrea�nunt U<vice(explain)
V.Du crsaVPreatmcut Am Infurmation: I
Dcsi�iklmclCi�l I DesigaSoil:\ppLut;unRait(CPSsQ Oispc`v1A�Nryuuul(sp UispersalArcaProposeABQ SysiemGeralion I
3. � i � �i ,�Y �i43 ` lC . y - 9°i.�i_5'
\7.'Innkhdu Capuiryin Toul MoC Afanu(acuver
Gullons Gallons Uniu a L o 9 �
w � V =
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C� U V. � N L:. I.�
sq�:��ii��a,�.�r.�� �,u �— �<a. � l 1-1.z �C�. r> ,�c_ ?C -t—��
�asing G`.uata �. I
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VIL ResponsiLilil)'Slalem<n[- 1,Um underslCoed,�aunm respomibilily fur Installalloo oft6e PO\\'(5 s6onv oo Ihe�Ilachcd plaos. � i
<Pl�mn'ber's Name p'rinQ Plu er's Si7na/tur�e �- Afl'A,iPILS Number I7usincss Phorc Numtxr
J L.fC ��J.0 _� <�---�, ) `l� �tC� ��ti=�'���. _`(L'�F�/
Plu�ntkr's AJdrcst(Strctt.Cii)•.$tam."Lip Code)
w�c�. F-!.�.. y �a },—c,,,�. L�. E�. �_.� - `� �' :(_ I
�'lIL Cuuntc/Uc i�rimenl Use Onlr� . ��--- �
❑ Appm�cl ❑ Uisappmeed Pmm�Pee Uetclsnad IssuuigAgar.t5iyraturc ""' ��-�
S
❑ Owner Giv<n Neuon for Denial , Q
IX.C Jilinnv nL\pproralflteusonv(or Daapprnv�J I
IMYOR7'AN'P NOTICG: Wisconsin State Statute , Chapter 145 . 'L45 ',
; (3) , s�ates you are reyuired to have your septic �ank
Ipumped/ inspecCed at ]easL 'once eveXy 3 years . -
AroaM1 m compleie pbm far tlir ryu.m u�J mLmi��o ILr Caunry only,�y�per not la Ihan�14 a 11 incho In�iu
SISU�63'>S(It.ulfo7)VuliJ thni 01/U'1 '
IA i4 /17
Soil Profile Sheet
Owner pr��sT Va..�/nn�e/'n✓+ CST: Trn��s gKY'teifielc� Pagc 3 of �_
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Sysc. Elevation ys System Runge r'/S7s �0 9y.� Load Race ._Z_,____
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Real Estate Sawyer County Property Listing PropertySWtus:Cu �_�
Today's Date:7/7/2009 Created On: 2/6/2007 7:55::
��"�DesCri don U dated: 11 20 2007 �Ownershtp Upda[ed: 11/20
Tax ID: 13315 CABIN LIFE HOMES LLC HAYWAF
PIN: 57-010-2-41-09-33-0 03•WO•000090
L a PIN: 010941334309 BIIIina Address: Mailina Address:
Ma ID: .15.9 CABIN LIFE HOMES LLC CABIN LIFE HOMES LLC
MunlGpality: (OSO)TOWN OF HAYWARD �BOX 752 PO BOX 752
STR: 533 T41N R09W HAYWARD WI 54843-0752 HAYWARD WI 54843-0752
DescripUon: PRT SWSE, LOT 2 CSM 29/3 #7335
RecoMed Aaes: 0.690 � Site Addreu
Calculated Aaes: 0.000 9782N FAIRWAY OR HAYWARD!
Lottery Clalms: 0
Firs[Oollar: Yes t� property Assessment Updated: 9/16
Zonlnq: (R-1)Resldentlal One
2009 Assessment Detail
Code Acres Land
�Tax Districts Updated: 2J6/2007 Gl-RESIDEM"fAL 0.690 29,100 1
1 SWte of Wlsconsln
57 Savryer Counly 2-Year Comparison 2008 2009 Ch
O10 Town of Havward ��d: 25,fi00 29,100 1
2478 Havward Communl[v Schoal Dlstrict Improved: 0 15,000 1(
17 TechnkalColleqe Total: 25,600 44,300 i
�� Rernrded Documents Uodated: 11/20R007 �
WARRANTY DEED L�J PrOperhr Nistory
Date Re[orded: 10l5/2007 349432 N�A
http://tas.sawvercountvQov.ora/Svstem/REAL PROPERTY/REAL%2DESTATE/listin_.. 7/7/�nn4
� "—r"`' <,� PRIVATE ONSITE WASTE TREATMENT counry
-1��o ' SYSTEMS
f;,�sPs ,� ( POWTS) Sawyer
h� `—�'%
"°` INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 2,'� ,.. �1.� �
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village [p�Town of: State Plan Transaction ID#:
N�,� �-� e� ►��,c�a� �
Insp BM Elev: BM Description: a y, — V�o,� �„��� Parcel Tax No:
�oo,� ' � 1��� aw� � o�- s,,. �b-�- 1�� n«-�rr- 33- �t3o�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic Benchmark � ��o.o'
Dosing �M � c�� �I
Aeration Bldg. Sewer ,
Holding St/Ht Inlet
TANK SETBACK INFORMATION St I Ht Outiet 96,f �
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. 9 i o�
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative QY� �,
Surface
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 �j L �(S S #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate
INFORMATION P/L Bidg Well Waters o IGP ❑ Chamber Model Number:
❑ AG � EZFIow
CELL TO �-s q-�p .�` � ❑ Mound o Other
- -- —_ - -- - - _ _ __ —___ _ _—
DISTRIBUTION SYSTEM X Pressure Systems Only
--- -- — — ,------
Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes�
Length Dia Length Dia Spac �_ _ Spacing ❑ Yes ❑ No
------—
SOIL COVER
- ----- _— ----_ _— -- —_ ----- —
Depth Over Depth Over Depth of Seeded/Sodded Mulched
—_
Cell Center Cell Edges � Topsoil ❑Yes ❑ No ❑Yes ❑ N�
---
_— . _ —_ �---
COMMENTS: (Include code discrepancies, persons present, etc.)
���/(� �°��-� �23
Plan revision required?❑Yes❑ Na fO3 ���I � � � ��.� — — -- �� /�/ � /
L—�_1 �J I (� ( � �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AOOITI�NAL COMMENTS AN� SKETCH
SANITAAY PEAMIT NUMBEA:____��:_��{�_
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