HomeMy WebLinkAbout026-839-07-5208-SAN-2023-278 ` `"' [ndustry Services Division County
� 4822 Madison Yards V1�'ay Sawyer
; �a : Madison,WI 5370� Sanitary Permit Number(to be tilled in by C
P= P.O.Bos 7302 �
- Madison.WI�3707 �s� �y'�(i� W
�.��w-
Sanitary Permit Application State Transaction Number na`
In accordance with SPS 383.21(2),Vvis Adm.Code,submission ofthis form to the appropriate govemmental unit
v
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 ofSufety and Professional Services Personal information�ou provide may be used for secondan 14352W ThOU hfare Rd. Stone Lake, WI
purposcs in accordance���ith the Privacv Law�,s I�Od(I)(m),Stats. 9
L Application Information-Please Print All Information
Propem O�vner�s Name Parcel#
Patrick & Pamela Prokop Rev Liv Trust 026839075208
Property Owner�s Mailing Address Propertv Location
23286 Weatherman Ave �"fi 2
Govt.Lot
Ciry,State Zip Code Phone Number
Port Charlotte, FL 33954 651-233-3642 NTa J�Section ��
II.Type of I3uilding(check all that apply) Lot# T 39 N R 08 E o[b✓
� I or2 Family Dwelling-NumbcrofBedrooms 2 4
Subdivision Name
Block#
❑Public/Commercial-Describe Use
r---
City of _
�State Owmed-Describe Use CSM Number �Village of
2�� 3� #3�� �To«„of Sand Lake _
llL T�pe of PO��'TS Permit:(Check either"Ne��"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if
a licable.)
'�� �Ne�c System �Replacement System �Other Moditication to E�istin_System(e�plain) �Additional Pre[reatment Unit(explain)
B' �Holdine Tank �In-Ground �At-Grade �Mound �lndividual Site Design Other Type(e�pl�in)
(conventional)
C. �Rene�val E3efore �Rcvision Change of Plumber �i ransfer to Ne���O�vner��ist Previous Permit Number and Date Issued
F�piration �$'���� q�_ ���
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required(sf) Dispersal Area Proposed(sf) System Elevation
300 0.7 429 450 98.0
Capacity in Total #of Manufacturer
L
Tank Information Gallons Gallons Units � � U ,'�, �
Ncw Tnnl:t F.�isting Tanks '� o Y � y s `�" "�''
c. U :n v, cn u. C7 G.
Septic or Holding Tank 1000 1000 1 Wieser ✓ 0
DosingChamber 600 600 1 WleSef �/ � Q �
�'.Responsibility Statement- I,the undersigned,assume responsibi' for installation of the POWTS shown on the attached plans.
Pl�unber's Name(Print) Plumber's Sio MP/MPRS Number Business Phone Number
Jason Kuettel • „����-}' 675751 715-798-3355
Plumber's Address(Street,City,State,Zip Code)
PO Box 66 Cable, WI 54821
VL Counri�/Department t'se Only
�p Permit Fee Date Issued Issuing Aeent Signature
�A �� C Disapprovcd (,,� _
❑Owner Given Reason for Denial $ l��•� 1 ` ��' ? ,� � �? /���
Conditions of A�proval/Reasons for Disapproval = r-�
F"� � ��,,;,�,�r.,,�--`i,�'s;'1 t;��
� � ,C,, 'VS,;[�i'i��l ,i L�/��
�
r �r��� �I�W-li� ;t� l l: � �-o a-3 � � ��
� �
� �� ,;�# + ���.s �CT 19 2023
C S � �� � SAWYER COtJNTY
����J ZONiNG ADMINISTRATIVN
Attach ro comple[e plans for the system and submit to Ihe County only on paper not less than S 1/2 x 11 inches in size �y
c�.�1�j��uc�
ss�-639g�R.ozizz� NO R:F:1ND�AF�'�R
18�JE O�F'�FiAl�1T
���1
PAGE 1 OF 5
In-Ground Dosed-Gravity Plan
Index & Cover Sheet
Component Manual Design References:
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 5 Index&Cover Sheet
Pg 2 of 5 Plot Plan
Pg 3 of 5 Dispersal Area Cross-Section &Plan View
Pg 4 of 5 Pump Tank Specifications
Pg 5 of 5 Management Plan
Attachments: Enclosures:
Pump Curve POWTS Application for Review
Soil Evaluation Report&Site Map
Project Name/Description
Prokop Septic Replacement
Owner Name(s): Patrick&Pamela Prokop Living Trust phone: 651 233 3642
Owner Address: 23286 Weatherman Ave. Port Charlotte, FL ZiP: 33954
Project Address: 14352W Thoroughfare Rd. Stone Lake,WI
Govt.Lot: 2 1/4 of 1/4,Section�� ,T 39 N-R O$ E❑or W❑✓
Township: Sand Lake County: Sawyer
Project Parcel ID#: 026839075208
Designer Information
DesignerName: Jason Kuettel Phone: �15 _798 _3355
Designer Address: P�Box 66 Cable,WI ZiP: 54821
E-mail: tim@andryras.com
License Number: 675751
Remarks:
Signature: Date: o / z
Ori inal signature required on each submitted copy.
o� �lers � ��
� r D
ra-t-C'.c�L C• 1 fawy�l4 � . 1 ro�(j� I'jeJ. T+fvS� �wc.i,2tr- �� Sa,►1 � L.46e- ��
23Z- S�o t,t9eq�kerrn4►� f��-e �� rJ oZ� -- 839 -- 0-7 --5`Lo8
�°�-k" �-I��.r( b t'f'� � �'-�- 3395� S' bZ T 3�'t1�J 2 o8w
5��2 '. l�3SZ W �oro�Jc In-�Y�. l.r� �.d� �f L' S ►1 Z-� !3( "� 3b 1
� Lr
L��.� C,��c,e �_ + �b , _ N
�--,. �� -_ s�l� 1"�40 '
-� La-�- y - � e� ( � l
-� ;v� �lvv►�c � Sor I Tesf- f� T
1 o to 20 3o yo
T !� �
U�lad--f�,S�.�e "
� ), �f�100� 6o�p►v� CD ��e��04v.�1, SE Cor-►ler
I .g (� 100 :75 �
l.Jell Z. la�. b�t '
� 3_ f o�t.'I� �
� So; �5 � 5�-f-�►� e�. �8'
� �'ccv� c� � 9 �1 � —�-t.4` 1
� F rs-�,'�.,� s . T i �► +_ et`�r. 5 `
z �d � reyc,►res P� ri,, � -�.�
3M !ao _ . . ,_ �
i 4 `'�C H' t{J '
' � ; �JL
�
�
py
�
1
�,�tSrn. kc ,
' ��/60� �
w / a,�"`-� Z 3
J r t�T��` �
s
�,
�� �d'�
�\ =�:<,E�s:R.t.
'�1 F:�� F
k' '
�_ � �., �-�s�
iQ/, c� � � Z3
�o r�,
.F
IN-GROUND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit)
�
'"'",Z TYPICAL TRENCH
m��«��
SOIL COVER CROSS SECTION VIEW
�z•
,�,,e�h (No Scale)
�'dec�n
�yn����� .
� 34. '
'.< •.
«yp"a�� „ � �� Provide minimum 3 ft
• • . �' separation between trenches.
System Elevation=98�0 ft
(typical)
Quick4 S[andard-W
w/End Cap ooservanon Pope
(lypicaq
(Show location of inlet/outlet pipe connection on plan view.) (�yv���� TYPICAL TRENCH
Ins�all per manufacWrers
insimcuons. PL{�rJ y�EW
r ----------��-------��--------- —, � (NoScale)
�� „ , � '�� A=3,Oft
. ," . . . � (ryPical)
�—_—_———————��——_————��—__— —————J �
g- 46 ft - � C,��
(rypical) Quick4 Standard-W Chamber (7�
INSTALL PER TRENCH: (�ypicaq W
(mfa by Infiltraror Systems,Inc.)
Install pursuan�m manufacturefs instruaions. 0
11 puick4 Std-W @ 20 fl�EISA/chamber= 220 ft� TI
+ � Pairs of end caps @ 6 ft�EISAlpair= 6 ft� �
=Proposed EISA per trench= 226 ft� Required Infiltration Area= 428 ft' Distribution Method:
x 452 trenches=Proposed Total EISA= 452 ftz branched manifold �
�
PAGE40F4
In-ground Dosed-Gravity Management Plan
IMPORTANT:
The owner of this in-ground dosed-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), Wisa 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 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, 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 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 Seqtic 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 (1l3)the liquid volume of the tank(s) or
as required by local ordinance. Disposal of contents shail 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 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: AIICII')/ RBSIIIUSS@Il 8c SOIIS, IIIC phone: 715-798-3355
Local government unit: SaWyef CO. Z011lll9 Phone: 715-634-8288
�ocal government unit address: 10610 M81n St. #49 HayWBrd, 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.
Continaencv 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 suitabie soils.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned In accordance with SPS 383.33,Wisc. Admin. Code.
PAG E 5 O F 6
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4"0 Vent Pipe
>10 ft from
Building Electrical musl comply with
12" Min. or 2.0 ft above SPS 316 and NEC 300
Established Flood Elevation Weatherproof Extend manhole riser as necessary.
(rypical) Junction Box
Approved Approved Locking Manhole
IMPORTANT: Vent Cap with Warning Label Attached
(typical)
Anchor tank(s) as necessary f—Conduil
pursuant to SPS 383.43(8)(g) 4" Min, or 2.0 ft above
Established Flood Elevation
(rypical)
�Airtighl Seal
Finished Grade �
Quick Disconnect
e 18" Min.
CAPACITIES @ 16.76 gal/in �: � � .. a . .�� � � � ' <<yp���>
- a. . . . . . i
Depth (in) Volume (gal)
A 19 318.44 * I Wei p • �Approved Joints with
Hole Approved Pipe 3 ft onto
B 2.0 33.52 A �'I so��d ��ound
(typical)
[C] 3 50.28 �
� � �Alarm
D 12 201 .12 B i�_on
} [c� PUMP-OFF
* Pump Tank Liquid Level = 36 �� + Pump �_Off : ELEVATION = 95 ft
� � �
° INSIDE BOTTOM
Force Main Diameter = 2 in Concrete
� B�°°k ELEVATION = 94 ft
. � � � . � : .. �
Force Main Length = 20 ft 3"Approved Bedding Matenal Beneath Tank
Vertical Head = �ft
Force Main Void Volume = 3•26 gal
+ Min. Supply Head = NP` ft
[C] Total Dose Volume TDV = 43.26 gal/dose
+ FM Friction Loss = 0.66 �
(5X total lateral void volume < TDV < 0.2X design flow) �
+ (force main drainback volume) + Fitting Loss" = NA ft
*(min. supply head x 0.3) �
MIN. PUMP DISCHARGE RATE = 40 gpm = TOTAL DYNAMIC HEAD = �•6�ft:
PUMP TANK: SEPTIC TANK(S):
Volume = 600 gal Total Volume = 1000 gal
Wieser Manufacturer s : Wieser
Manufacturer: ( )
Pump Manufacturer: Champion
Install approved effluent filter at the septic tank outlet
Pump Model: CPES3 �see a«a�ned P�mP ��Ne.> immediatel�upstream of the pump tank inlet.
Controls/Alarm Manufacturer: SJE Rhombus Filter Manufacturer: Orenco
Controls/Alarm Model: HW 101 Filter Model: FT-0822
Float switches containing mercury are prohibited.
;. _ a
� hd111 101�1 �' �� � F �' ,�" 1/3-1/2 HP
� ��
�,_.;,: �. � - � EFFLUENT/SUMP
�� Every pump tested in water to ensure pump _
meets peformance curve.
��
..�. , ���'
� ' : �a- Ft;�..., n.:` , '�!!�
'• •'' a.� � � ;`
-..- . . . .. � �i�,_�" ;
�• 1`j"q�ts 3+�� �i�� ,
.� �,• I �
• � • ' • • � � � ;'�
• -� • ,��
• ••
.• � � 11 _,;�
• •• �- • -
.�. • • � •�- . � • �.
�-. � • •.• � • - • ::
•. �-
�• - �- �. � -� • . ---''
• •- • • •- - ' ..
. •
• � •• - .
•� - • •
� •- •�- -� •
� �.• • • - •
�• -• • �• •.
� •�• • • �- '�. •� � �
� .�• � '•
•� . ' • •
• • • � � � � � ��:
_.
•- -• �,� �p,.,:;.
�
• �. � • •' • • "
• .�� • ' • • •
�- - �• • ' • •
s '
� �:�`;Y 1 . , '
• •• • •' . . . w
�' '• • • '• • • �
� • • ' • • • ' •
� � � � .�.•
.t . � .. � � � .
� � ----�--�-�--��-����-���-�---�����������-
������� ����-�������������
�-�������������������������������
� -"----�---�--�--��-���----�---����-�---
����-�������_���������������������������
�����-����������������������������������
����������������������������������������
�
'������_-������������������������������
��������_`_�����������������������������
� � ��������_����������������������������
�����'������`���������������������������
����������������������������������������
����������������� ����������������������
����������������������������������������
' ����������������������������������������
����������������������������������������
����0������������ �����������������
� � �������������������\���.\����������������
��������������������� �� ��������������
�������������������_�����\��������������
������������������� ���� \�����������
� ���������������������������������������
����������������������������\���������
������/����������������0�� � �����
��������������������������������������
� . �������������������������������� ����
iiii�i�ii�iii�iiii��i�i��iii■�i�i "--�'�jls����
�������������������������■����a`-.��•
' iii���ii�i��iii���■�iii�i����ii i�i������
�..�..u...■.���..��..���_���:��::��_�:�C=��:_
���..�===_ _-------
. � ������������������������������������
. �
. '
. �� ; . � :•
� • ' • • •. �
, • ; �/ • • • �! • � • • •
�
%,,
�""'""� PRIVATE ONSITE WASTE TREATMENT �ounty
,�`;l�sPs , , SYSTEMS Sawyer
�— .
( POWTS)
""� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �3 -��7�
Personal info�nation you provide may be used for secondary purposes[Pnvacy Law,s. 15.04(1)(in)]
Permit Holder's Name: ❑City ❑ Village (�Town of: State Plan Transaction ID#:
��c�C.�+w►e\a Pro���9�/L�1r�,y �aKo� �a K� ^
Insp BM Elev: BM Description: Parcel Tax No:
�(�(��c�� !� Co rue.ra�sa�1 ��Co�/'�C—dl� . 026-3�`�-�?-��--�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic � ��� Benchmark (q�,�r
Dosing � � p
Aeration Bidg. Sewer �cR.,��
Holding St/Ht Inlet 96•Y �
TANK SETBACK INFORMATION St/Ht Outlet 4b •� �
TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet
AIR INTAKE �7 b•�.S �
Septic t� �� (7 � -f-6' NA Dt Bottom ��,'� �
Dosin � NA Installation
9 n �� 'n� `���� Contour
Aeration NA Header I Man. �q,v�
Holding Dist. Pipe
PUMP I 51PHON INFORMATION �nfiltrative ��o�
Surface
Manufacturer Demand Finai Grade
Model Number 3S GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L� � Dia "' Dist. To Well
DISPERSAL CELL INFOR ATION
DIMENSIONS W � #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate �
P/L Bitlg Well ❑ IGP ya- Chamber
INFORMATION Waters � AG � EZFIow Model Number:
CELL TO ¢-(S ,�..�� .f--� ,�.�� ❑ Mound o Other Q Y fi
-- -- --__-
DISTRIBUTION SYSTEM X Pressure Systems Only
—- --- — �
Header/Manifold Distribution Pipe(s) X Hole Size _, X Hole Observation Pipes �
Length Dia Length Dia Spac j Spacing ❑Yes ❑ No
__ --- ---
— - -
SOIL COVER
Depth Over 1 Gepth Over I Depth of f Seeded/Sodded � Muiched �
Cell Center � Cell Edges Topsoil � ❑ Yes ❑ No ❑Yes ❑ Vo
COMMENTS: (Include cotle discrepancies, persons present,etc.)
�����( <<��3 Ja3
Plan revision required.�Yes ❑ No 'I v 3;�� i,��/ �'I �,� - � J q �� � �
' , '� ! 6 �
Use other sitle for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
ADOITIONAL COMMENTS ANO SKETCH
SANITAAY PEAMIT NlJMBER ____�Z�_--�7�__
�- L CO C�. �-
_— - __
�
�,
3'
�
a-a�,n
��.
t
-. ��
�
�I�� �6'�`
�� ��
,�c e�b � -� � �1 K 3��
�`� ��j� �"�-
�
�j�
s,��-
//
T
�,a�.,��� ,
-^,�--
��--
y�y�-