HomeMy WebLinkAbout026-939-15-3309-SAN-2023-260 �` "'� Industry Services Division County �
4822 Madison Yards Way S8Wy2r �
,_ = Madison,WI 5370� Sanitary Permit Number(to be tilled in by C
�= P.O.Box 7302 �
Madison,WI 53707 (� � � � S�% W
Sanita� PeY,ml+ A„nllCa+lOn State Transaction Number �
l �J�. l.
[n accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate governmental unit �� �"
is required prior to obtaining a sanitary permit.No[e: Application forms tor state-owned POWTS are submitted to Project Address(if different than mailine ad �i
the Depamnent of Safety and ProYessional Services Pcrsonal inTormation vou procide ma}�be used for secondary �5653W State HWy 27�70 HayWaf, W�
purposes in accordance with the Privacy Laev,s. 1�_0-1(I)(m).Stats-
I.Application Information—Please Print All Information
Property Owner�s Name Parcel#
Michael Thomas 026939153309
Property Owner's Mailing Address Property Location
15629W State Hwy 27/70
City,State "l.ip Code Phone Number
Stone Lake, WI 54876 715-558-4501 sw ,, sw �,,, seC�;on ,5
II.Type of Building(check all that apply) Lot# � 39 N R 09 E or
�I or 2 Familv Dwelline-Number ofBedrooms 3 � Subdivision Name
Block# �
❑Public/Commercial-Describe Use
�— �City of
❑State Owned-Describe Use CSM Number ❑Village of _
20/281 #5886 ❑✓ ro��n or'Sand Lake
IIL Ty pe of PO��'TS Permit:(Check either"New"or"Replacement"and other applicable on line.a. Check one box on line B.Complete line C if
a licablc.)
`�� New S stem e lacement S stem
� y � p y ) �Additional Pretreatment Unit(erplain)
B' �Holding Tank �In-Ground �At-Grade �Mound Individual Site Design Other Type(e�plain)
(conventional)
C. �Rene�cal Before �Revision Change of Plumber �I ransfer to Ne�c O��ner List Previous Permit Number and Date Issued
Expiration �/� (��� (
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Dcsign Soil Appl ication Rate(gpd/st) Dispersal Area Required(st) �.persal rea Propo (st) System Elevation
450 0.7 643 � 93.5
Capacity in Total #of turer
Tank[nformation Gallons Gallons Units L ` c v �
Ne��Tankc F�is�ing Tnnks '�° � U " ti � � �
` 0 "� y t � C
1 U v� .�i� v7 C�-, C7 C�
Septic or Holding Tank 1060 1060 1 Infiltrator IM 1060 ✓ �
Dosing Chamber � � �
V.Responsibilit��Statement- 1,the undersigned,assume responsibility for installation of the PO�VTS shown on the att�ched plans.
Plumber�s Name(Print) Plumber�s Signature MP/MPRS Number Business Phone Number
Jason Kuettel 675751 715-798-3355
Plumber�s Address(Street,Citq,State,Zip Code)
PO Box 66 Cable, WI 54821
�'L Coun /Department L`se Onlv
�. � Pennit Fee Date Issued Issuine AQent Sienature
A� � ❑ Dis�pproced $ _ - , " r
� ❑Owner Given Reason for Denial `�'� (�' � �' � �� ` ��"����'�-���ti'z'�<:;_
Conditions ofApproval/Reasons for Disapproval � �`��.>,!%�i"��;s�`,i;r
1
,�, .�•+, !�� �,q A � 1 I�:� �� I� ,1�; ; �� '
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� � ��1 '�ti ir�,W--��t :�ate� a3 i ��
�y o�� OCT 0 4 2023
CS� ��"_ I �° � �hk# �
3;z.S SAWYER CG��ti-t�`�'
ZONIiVG AD!�iiN[STR.;TiJ�t
Attach[o wmplete plans for the sys[em and submit to the County only on paper not less than S I/2 s 11 inches in size
hQ R�FlJN�€�TER
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PAGE 1 �F 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
Thomas 3 Bed Replacement
Owner Name(s): Michael Thomas Phone: �15 _558 _4501
Owner Address: 15629W State Hwy 27/70 Hayward,WI Zip: 54876
Project Address: 15653 State Hwy 27/70 Hayward,WI
Govt.Lot: SW 1/4 of SW 1/4,Section 15 ,T39 N-R09 E❑or W❑✓
Township: Sand Lake County: Sawyer
Project Parcel ID#: 026939153309
Designer Information
Designer Name: �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: 1a '1 z3
Original signatur r uired on each submitled copy.
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IN-GROUND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit)
�
"""1z TYPICAL TRENCH
�na��au
soi�covER CROSS SECTION VIEW
,z.
m,�,,e��„ (No Scale)
depth
(rypica, .
�.n
r 34���'� . .
([ypical) � �� Provide minimum 3 ft
• . •' separation between trenches.
System Elevation=93•5 ft
(typical)
Quick4 Standard-W
w/End Cap Observation Pipe
(rypicap (Show location of inlet/outlet pipe connection on plan view.) (typical) TYPICAL TRENCH
Inslall per manufac[urer's
instrucoons. PLAN VIEW
� -----------�f--------��--------- —, T (NoScale)
, � JA=3Oft
� . , , +
L—————— —————J y (ryP�cal)
—————��—_—————��———— �
� g_ 70 ft —� G�
(typical) Quick4 Standard-W Chamber m
(�YPical) W
I NSTALL PER TRENCH: �mfd by��rn�a�o�syscems,��o.� O
Install pursuant�o manufac[urers inslmctions.
16 Quick4 Std-W @ 20 ft�EISA/chamber= 320 ft� TI
+ � Pairs of end caps @ 6 ft�EISNpair= 6 ft� �
=Proposed EISA per trench= 326 ft� Required Infiltration Area= 643 ft� Distribution Method:
x 2 trenches =Proposed Total EISA= 652 ft� branched manifold �
RESET
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 Disqersal Area Operatinq Limits:
Design Flow= 450 ypd; 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. 281.48 Ws.
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 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
manths.
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: AI1dl"Y R8Sf1"IUSS@Il & SOIIS Phone: �15-798-3355
Local government unit: S8Wy8f CO. ZOfllllg Phone: 715-634-$288
�oca� government unit address: 10610 Main St. #49 Hayward, WI Z�p 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.
Contingencv 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.
OYtice of �_'�,,
Sawyer County Zoning and �r�z�
Conservation Administration �%
I I)610 Main Street. Suitc-t9 � ��
Hayward, Wl 54843 ,� s O!� ��
TeL(715)634-4284 � 0 C�
Fax:(715)633-3277 �/��yF,� �?0
URL: http:%!sawvercountv�ov.org �f��f �J� D
Email:zonine.secLr�,sawvercounty�ov.or� �g+��
Toll Frcc:Courdiouse/Gcncral Inforniation �
I-8 77-699-�I I 0 •
Sawyer County Zoning and Sanitation "As - Built" Form �
Property O�vner's Name Michael Thomas
Fire Number and Road Name 1�6�3�V State Hwy?7/70. Stone Lake,WI
Plumber's Name _Andry Rlsmussen� Sons___
Date of Installation 10/13!23
County Sanitary Pem�it Numlxr 23-Zh0
12 Digit Yarcel Number 02693915330i
Descnption and Elevation of Benchmark _Decktop on front rear door
TankManufact�rcerandCapacity [n(ilU�atorlM 1060
Setback-Tank to Nearest Lot Line (0'+
Setback-Tank ro Nearest Well SR'+
Setbacl:-Tanl: t��I3uilding ��.
Cell Width 3'
Cell Length 66'
Number of Cells 2
Setback-Cell to Nearest Lot Line i�'-
Setback-Cel I to Nearest�Vell �p'+
Setback-Cell to Buiiding Si'
Setback-Cell to Navigable l�Vater NA
Make and Ivlodel of Dispersal Unit tnfiftiator Quick=1
Nlake and Model of Pilter Orenco FT-042?
Make and Modei of Punip NA
- Ple�se complete othei- side -
"As-Built Plot Plan"
Elevation Data
Benchmark 12S Pl��se include the followin�•
Building Sewer 4.55
Tank In _495 � Locatic�n of observation and vent pipes
Tank Out 5.?5 � Feet oi�risez-s used on tank(s)
Dose Tank In � Location of benchmarh and Noi-th a�1�o��
- Dose Tanlc Bottom � Location of�ll cornponents
Header or Manifold _6.78 � Length ofpipe beriveen conlponents
• Disti-ibutic�n Pi�ae � Number of cham6er units in each cell
Syste�tn Elevation 7.78 � L�ocation of�vell, lot lines and i-aad
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