HomeMy WebLinkAbout024-641-24-4211-SAN-2023-263 Department of Safety c°°"'Y �
� &Professional Services, Sawyer z
� .. f' - Sanitary Pcrmit Nwnbcrpo tm filled in by(
_ , Industry Services Division �
CD 5 I(,�5� �,
State Transaction Numt�er �
Sanitary Permit Application � �
In accordancc with SPS 383.2112).Wis Adm Code,submission of ihfs(onn m the appropriate gouemmental unit
s requinel pnor to obtaining a sani Wn�pennit.Nute Application forms for stateowned POWTS are submitted to Projtti Address(i(dilTerent than rnailing ad...,,.,.,W
�he�am„e�<<,r s�r ry��a v«,i�ti..���ai sern«s.rr�s���i��rom,auo�yo�Pro��ae may be�scd r�s�c��d�ry 10644N Forest Circle Road
puiposes in accordance with the Pnvecy I,aw,s.15.04(I�(m),S[ats
1.Application Informatlon-Please Print All Informallon
Propeny Owner's Name Pasel#
Paul Hasler Sr Trust 24533 �p��_/�!_� _U��
b I I
Property Owner's Mailing Addrcss Propeny Location
8540 Sandy Ridge Road
ciry,seate zipcoac rnoneNumner
Kewaskum WI 53040 715-340-7683 NW �, SE �;, stt.�;,,,, 24
II.Type of Building(check all that apply) Loc u � T 41 N R 6 �or w❑�
01or2FamilyDwelling-NumberoBedrooms 3 __ SubdivisionName
F31ock# �-
0 Wblic'Commercial-DescribeUse �_
o c�ry or
�State Owned-Describe Use CSM Number 0 Village o(
�39 �,I�ct$ OT,,,�,,�rRoundLake
III.Type ot POW'►'S Permit(Check either"New^or"Repiacement^and other applicable on line A.Check one box on line R.Comple[e line C i
a licablc.
`�� ❑New 5 tem ❑Re lucement S �em 0(kher Modification to Existin S tem ez lain) �Additional Pmtrc�imenl Uait(ec lain)
ys � y� Tank Replacement � P P
B' Holdin Tank
❑ g ❑In-(hwud ❑At-Grade ❑Mound �Individual Site Design Q Other Type(esplain)
(conve�rtional)
t ist Previnus P��nnit Numbcr end Do��•[�surd
C� ❑Renewal Be(ore ❑Rcvision ❑Change of Plumber ❑Trans(er to New Owner"
FxP;�d„o� uwk. ?
IV.DispersaUTreatment Area and Tank Intorma6on:
Design Flow(gpd) Design Soil Application Rat Kgpd/sQ Dispersal Area Required(sQ Dispersal Area I4pg�eedrtsQ System Elevation
450 EXISTING � EXISTING 7 EXISTING 96.8'
Capacityin Total uof Manuf'acwrer
Tank Information Gallons Gallons Uni� ' V�, _
NcwTank� F!xi�tingTanks � — A �
au V 2 ��.'.�7 a
s���v<�,.H�ia���r,�k 1000 1000 1 Wieser Q✓ Q � Q �
Dosi�g Chambc� � � � � �
V.Responsibility Statement-1,[he undersigned,assume respoosibility for installafion of tAe POWTS shown on the attached plans.
Plumber's Name(PrinU Plw r's Signa MPiMPRS Number Busincss Phone Number
Ryan Sirand � 798301 715-558-1673
Plumber's Addrcss(StreeL Ciry.Stam,Zip Code1
8959N State Road 27,Hayward WI 54
VI.Cou ty/Department Use Only
�A ❑Disappmved Permit Fee Date Issued Issuing Agent Slgnature
$ �(�� �0 ��14 ��-3 rv�k.C��?�{/z�,s-,
�Owner Given Reason fur Denial � �
Conditions of ApprovaUReasons for Disapproval
� � ��G������r-,
� `., nl �
'�Y V����4ir�S1� :8:e_I�1..�"_L3.. _� OCT 0 3 2023
��� ��— �1 l�� ��hk# ��- -----._�
331�� SAWYER COUNTY
ZONING ADMINISTRATION
41itc�lo eompietr planslor Ihe sys�em md submif lo Me Covnry only on paper nol kss Ih�n B IIE�11 inchn in sh.e ����S j-�
NC R�FUND�AFTER
S6D-6398(R.03/22) ISSUE OF F'ERiJf1T
T uli
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)
Page 1 Index Sheet
Page 2 Site Plan
Page 3 Tank Cross Section
Page 4 Management Plan
Attachments: Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Hasler - TANK REPLACEMENT ONLY
Owner Name(s): Paul W Hasler Sr. Trust Phone: 715 _340 _7683
Owner Address: $540 Sandy Ridge Road, Kewaskum WI ZiP: 53040
Project Address: 10644N Forest Circle Road
Govt. Lot: NW 1/4 of_SE ____1(4, Section z4 , T41 N-R6 EQor W �✓
Township: Round Lake County: Sawyer
Project Parcel ID #: 24533
Designer Information
Designer Name: Ryan Strand Phone: 715 _558 _1673
Designer Address: $959N State Road 27, Hayward WI Zip: 54843
E-maiL• strandsmidwest@gmail.com � _ �,�_�,; ,�,�, ,,, � ,,,
License Number: 798301
Remarks:
� ' 9/29/2023
5ignature: Date:
:Original signature required on each submitted copy.
�
PLOT PLAN
No setback issues with
neighboring properties
Moose
Lake
Proposed 1000 �$$
gallon Wieser tank
with outlet filter
Dwelling
o �
Pro ert Li °
�
hed �
wa
10644 Property Line
Existing system - System
elevation = 96.8'
� = Benchmark 100'
Top of decking on porch
Vertical and horizontal reference Paul W Hasler Sr Trust
+ = well 10644N Forest Circle Road
NW 1/4 - SE 1/4 - S24-T41 N-R6W
� = Soil pits with backhoe Town of Round Lake
1" = 40' �40'-0"� Tax I D 24533
NORTH
Page 3 of 3
Anaerobic Treatment Tank Cross Section and Plan View
With Outlet Filter
Plan View
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Typical Manhole '
.
24" I.D. Opening \ ;>
Inlet -� Manhole y `>
;� Opening �;
>
>`
Outlet
Outlet
Inlet Baffle Filter
>`
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Cross-Section �
0
� — � � " — � � — — � Finished Grade — — — ' � � — t—�
� �
o ri � 4" Dia. Vent 't
Max. 6" Below 12" Above —� Min. 4
Grade & Sealed Grade With Above
Watertight Vent Cap Grade
> > > > > > :. > : , > > > > > > > > > > �„
< < .. .. ..... . ........
Tank Manuafcturer: W�ESER
rr
>�> ,�".
Inlet , , Tank Capacity: �000 Gallons Oudet
Tank Maximum Depth of Bury: 8 Ft
> ; 67�� 96., 57�,
'`' Tank Outside Dim.: Width Ft, Length Ft, Height Ft
<
'�' Outlet Filter Manufacturer: POLYLOK '
'`' Outlet Filter Model Number: 525
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;'>
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1<'<
GENERAL INSTALLATION: The tank is bedded and back filled in accordance with the
manufacturer's product approval specifications. Maximum depth of bury as specified by
the manufacturer may not be exceeded without prior approval. Manhole covers exposed to
grade have an effective locking device (padlock) installed. Manhole covers below grade
are seaied watertight. Piping at the inlet and outlet is of approved matenal, connected to the
tank with watertight fittings, and laid on stable soil to prevent settling or sagging.
Page 3 of 4
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 pertormed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Dis�ersal Area O�eratina Limits:
Design Flow= 450 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 nuisa�ce 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, eic.)
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 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 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 local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
o Effluent filter(s1 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: REDS SEPTIC Phone 715-934-9412 _
Local government unit: SAWYER COUNTY ZONING Phone: �15-634-8288 _
Local government unit address: HAYWARD WI Z�p 54843 _
Any defective part of this system shali be repaired, replaced, or removed pursuant to SPS 383.51 (7), Wisa 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 shail 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.
Svsiem Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
"'-""` PRIVATE ONSITE WASTE TREATMENT county
, >
`�����osp ,���, SYSTEMS
�� S awyer
�;:�� s � ( POWTS)
�H� �--s>.
' =" ' INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION � 3 —2b�
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village I�Town of: State Plan Transaction ID#:
�P��� �s1�' S-�, `r� �R.�.� (�I� r--
Insp BM Elev: BM Description: Parcel ax No:
�t�� :a t •h, e �-��c..�1` b,,, -�� °�-�( - 6Y 1�Y- K 2�I
TANK INF RMATION ELEVA ION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic (N;�.s�� � pop Benchmark ��,p�
Dosing
Aeration Bidg. Sewer �$,��
Hoiding St/Ht Inlet c�$�( �
TANK SETBACK INFORMATION St/Ht Outlet c��,� '
TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet
AIR WTAKE
Septic �'` �I--�.�� �-� c .�t7 f NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header I Man.
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative
Surface
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist. To Weli
DISPERSAL CELL INFORMATION
DIMENSIONS �N L #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav
Conv �Aggregate
INFORMATION P�L Bldg Well Waters � IGP ❑ Chamber Model Number:
❑ AG � EZFIow
CELL TO ❑ Mound � Other
— -- -------- --- ---- --.
__ _ ___------- --___ -
DISTRIBUTION SYSTEM X Pressure Systems Only
_ _ --- --- -- —
Header/Manifold �Distribution Pipe(s) X Hole Size I X Hole Observation Pipe�
Length Dia Length Dia Spac '�i Spacing ❑Yes ❑ No
SOIL COVER
____ — _ _ —
Depth Over Depth Over i Depth of Seeded/Sotlded Mulched
Cell Center Cell Edges j Topsoil ❑Yes ❑ No l ❑Yes ❑ N�
COMMENTS: (Include code discrepancies, persons present, etc.)
i�;�-,�'(� 1°��-3 f� �
.� S,`j r��- o''��Y
_ __ I -- —
Plan revision required?❑Yes ❑ No 3 � � �, � � � � ��� ���
�--- —�_� � � l�
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�DITIONAL C�MMENTS A1NO SKETCN
SANITAPY PEAt�11T NUMBEA ___ __ o�� - �6 3__
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