HomeMy WebLinkAbout026-939-14-5216-SAN-2023-283 Industry Services Division Counri �
4822 Madison Yards Way SaWyet' �
- � Madison,WI 53705
� S� - Sanitary Permit Number(to be filled in by
i P.O. Box 7302 �
-- ,��! Madison. WI 53707 �js ( � •-j � (�
Sanitary Permit Application State Transaction Number o`
__--- �-+
ln accordance with SPS 38321(2),Wis.Adm.Code,submission ot this form to the appropriate govemmental unit �
is required prior to obtaining a sanitary permit.Note:Application tbrms Yor state-owned POWTS are submitted to Project Address(if different than mailing ad W
the Department ofSafety and Professional Services.Personal information you provide may be used for secondary 6202N Mornin side Ln. Stone Lake, W�
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. g
1.Application Information-Please Print All Information
Property Owner's Name Parcel#
Holloway Trust 026939145216
Property Owner�s Mailing Address Property Location
PO Box 13069 Govt.Lot � &2
City,State Zip Code Phone Number
Hayward, WI 54843 715-558-3704 ��, �%, Section 14
II.Type of Building(check all that apply) Lot# T 39 N R 09 E or�
�I or 2 Family Dwelling-Number ofBedrooms� Subdivision Name
Block#
❑Public/Commercial-Describe Use
�City of _
�State Owned-Describe Use CSM Number Village of
� 0�� 29 #2� 53 �To��n of Sand Lake
III.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C i
a licable.)
A� �New System �Replacement System Other Modifie ion to F,xisting System(explain) �Additional Pretreatment Unit(explain)
rainfield Only
B' �Holdin Tank �In-Ground t-Grade � �
g ✓ Mound Individual Site Desien Other Type(explain)
(conventional)
C• ❑Renewal Before �Revision �Chanee of Plumber �I'ransfer to Ne�c O��ner List Previous Permit Number and Date Issued
Expiration 03-308 O I�s �3
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required(st) Dispersal Area Proposed(st) System Elevation
450 0.7 642 678 96.0
Capacity in Total #of Manufacturer
�
Tank Information Gallons Gallons Units � � �o v o
New Tanks Esisting Tanks � c � " ti � � ' r
� U v� � v� w c7 a
Septic or Holding Tank 1260 1260 1 Wieser ✓ 0
Dosing Chamber 76� 76� 1 Wieser � � � �
V.Responsibility Statement- I,the undersigned,assume responsibili �for installation of the PO��'TS shown on the attached plans.
Plumber's Name(Print) Plumber�s Signature MP/MPRS Numbcr Business Phone Number
Jason Kuettel �=��:q;�`N� 675751 715-798-3355
Plumber's Address(Street,City,State,Zip Code)
PO Box 66 Cable, WI 54821
�'I.C un �/Department Use Only
� Ap rov ❑ Disapproved Permi[Fee Date Issued Issuin2 Age;t Si2nature '
$ I-, > '���c�f C:�t-� {�7,c-'c.!�
�� ❑Owner Given Reason for Denial �00� �L I `��'-�'� ' I'
Conditions of Approval/Reasons for Disa�proval
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Attach[o comple[e plans for the sys[em and submit to the County only on paper not less than 8 V2 x l I inches in size � � - � f
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SBD-6398(R.02/22) �C������,�R
IS��J�OF t'�t��VrffT
PAGE 1 OF 5
In-Ground Dosed-Gravity Plan
Index 8� 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
Holloway Septic Replacement
Owner Name(s): Holloway Trust phone: 715 _558 _3704
Owner Address: PO Box 13069 Hayward,WI Z�p: 54843
Project Address: 6202N Morningside Ln.Stone Lake,WI 54876
Govt.Lot: 2 1/4 of______.1/4,Section�4 ,T 39 N-R 09 E�or W❑✓
Township: Sand Lake County: Sawyer
Project Parcel ID#: 026939145216
Designer Information
Designer Name: Jason 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: G� "z� �
Origi 'nature requiied on each submitted 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
�tiP����
SOIL COVER CROSS SECTION VIEW
i Z"
m,�„e��h (No Scale)
aePm
(NPicap .
r 34.
«yp"a�� ., � '� provide minimum 3 k
, . •' separalion behveen[renches.
System Elevation=g6.0 ft
(typical)
Quick4 Slandard-W
w/End Cap ooservauoo a�Pe
(typicap (Show location of inlet/outlet pipe connection on plan view.) c�va��an TYPICAL TRENCH
Ina�ell per rndnufar.Wrers
inso-u��o�s. PLAN VIEW
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� . . � . . . . I A=3.Oft
�-------- (ryPicaq
---��___—_--��---- ---_—J �
� B= 46 ft � D
(typicaq Quick4 Standard-W Chamber m
INSTALL PER TRENCH: (rypicaq W
(mftl by Infilireror Systems,Inc.J O
Inslall pursuan'to manufacturefs instruc�ions.
�� Quick4 Std-W @ 20 ft�EISA/chamber= 220 R� TI
+ � Pairs of end caps @ 6 ft'EISA/pair= 6 ft� �
=Proposed EISA per trench= 226 ft� Required Infiltration Area= 642 ft� Distribution Method:
x 3 trenches= Proposed Total EISA= 678 ft� branched manifold �
RESET
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 382384, Wisc. Admin. Code. Pursuant to SPS 353.52 (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 Operating Limits:
Design Flow = 450 gpd; BODS <_ 220 mgL''; TSS <_ 150 mgL"'; FOG <_ 30 mgL-�
Insuection 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 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 filterls)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: AI1d1'y RBSmUsseil & SOnS, InC phone: 715-7J$-3355
Local government unit: SaWy@f C0. Z011lll9 Phone: 715-634-82$$
�ocal government unit address: 10610 M81n St. #49 HayWal'd, 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 353,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.