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Home My WebLink About014-842-23-4106-SAN-2023-284 :xl`�%; County � � i i� � �� Department of Safety Saw er � ,.y, y /r;', � , ,� & Professional Services, � ts� $p . , . Sanitary Permit Number(to bc fifled in by C� � �`� a lndustry Services Division ��, - � (� s � t� �l 3 st� �.�:.,.:,>'` w __ __ Sanitary Permit Application stateT`a°sa°t`°°N°",e�� —.--- 9J [n accordance with SPS 383.21(2),Wis.Adm.Code.submission otthis foroi to the appropriate governmental unit � is required prior to obtaining a sanitary penuit Note:Application fonns for state-owned POWTS are submitted to Project Address(if ditTerent than mailing adc r^ the Department oY Safery and Professional Scrvices.Personal information you provide ma}'be used for secondary �� purposes in accordance with the Privacy l.a�v,s 1�.04(I)(m),Stats- � �� fJ � L Application Information-Please Print AllInformation ��n I�i� . Property Owner's Name Parccl# JORDAN & MICHELLE SMITH 014-842-23-4106 Property O��ier's Mailing Address Propert} I.ocation ��r 2626 E SENNETT ST � � City,Statc 7.ip Code Phone Number WICHITA, KS 67211 �'/, -S� '/<, section 23_ II.Type of Building(chcck all that appl��) I.ot�' T 42 N R 08 ��„ - � 1or21�amilyDwelline-NumberofRedinums 5 SubdivisionName Block# `�-� ❑Public/Commercial-Describe Use �— ❑City oC ❑State Owned-Describe Use CSM Numbcr ❑Village of _ CSM 38/209 # 8741 � ��r Lenroot III.T��pe of PO«-TS Permih(Check cither"Ne��"or"Replacement"and other applicable on line A. Check one box on line I3.Complete line C if a licable.) �� New System p }� � � ❑ Re lacement S stem ❑ Other Modification to ExisUn�System(esplain) ❑ Additional Yretreatment Unit(explain) B. ❑ Holding Tank In-Ground ❑ At-Grade ❑ Mound ❑ Indi��idual Site Design ❑ Other Type(espl,iin) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of�Plumber I.ist Previous Permit Number and Date Issued ❑ Transter to Ne��Owncr Gspiration �� N.Dispersal/Treatment�rea and Tank Information: Desisn flo��(�pd) De,i�n Soil Application Ra[e(gpd./,� Dispersal Area Required(sf) Dispersal Area Proposed(st) System I:Ic��ation 750 �� 1072 1092 92.00 Capacity in �I�otal #of Manufacturer �' c Tank[nfonnation Gaflons Gallons Units � � v '� � � New Tanl:s Existing Tanks `'- o � " �' "~' �y" ` ` Y ,n cs a a U cn � v� u. C7 - SepticorHoldin�Ta„k 1665 1665 � WIESER CONCRETE X Dosing Chambcr V.Responsibility Statement-I,the undersigned,assume responsibility fm•installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber' MP/MPRS Numbcr Business Phone Number Travis Butterfield 652879 715-634-8176 Plumber's Address(Street,Ciry,State,ZiFi Code) 14346W St. Rd. 77, Hayward, WI 54843 VI.County epartment Use Onl�- �Ap r v� ❑Uisapproved Permit Fee Date[ssued Issuina Agent Signaturc �,, $ YZ�o.�° ��1�� /.�3 •�/��'�{-}�.��u�� ❑Owmcr Given Reason for Denial Conditions of Approval/Reasons for Disapproval • � - „ � � � �, ' �� . /?� ��\' __ __ __ I' ;. � G0 � : .._..� _� � � , ; � � �� ; s;,�,�� hk# �...o�--�—°---- ,'.�;��i OC� 2 4 �a23 �---� C,S 1 2 3� I C� � � ..Y,-�d 3 5��S' .--.___.�.._._._....- — - :i Y ) .� ?�Tirkf'ii Attaeh to complete plans for the sys[em and submit to d�e County only on paper not Iess d�an S 1/2 x 1 I inches in size ss�-639a�x.o3iz2> RJ R�JlV��A�'TER ISS�J�OF F�£n�1� 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 JORDAN & MICHELLE SMITH Owner Name(s): JORDAN & MICHELLE SMITH Phone: - - Owner Address: 2626 E SENNETT ST, WICHITA, KS Zip: 67211 Project Address: TID: 44838 Govt. Lot: PRT N E �1/4 of SE 01/4, Section 23 , T42 N-R 08 E❑or W ✓❑ Township: Lenroot County: Sawyer Project Parcel ID #: 014-842-23-4106 Designer Information Designer Name: Travis Butterfield Phone: 715 _634 _8176 Designer Address: 14346W St. Rd. 77, Hayward, WI Zip: 54843 E-mal�: OffIC@@bUtt21"C�fI��I11g.COI�TI "I�tlis sp�tce reserved for approv<il stamp. License Number: 652879 Remarks: � Signature: ��-- Date: /� � d`�� a3 Original signature required on each submitted copy. CHECK BOX AS APPLICABI.E CHECK BOX AS APPL�CABLE. � SOIL EVALUATION o Scale: 1�o so' go �20 � SYSTEM PAGE 2 OF y SITE MAP PLOT PLAN PROJECTNAME: / �52 DESIGNFLOW: /S�� P� ��-�u„ + /Yl�C`��l-� S✓'^��` Attachdesignflowcalculationsforcommercialplans. PROJECT ADDRESS: F/�7 n� � ^�C. Pipe Material/ASTM Standard(Tables 384.30-3 8�384.3Q-5) N y y��Y.�, /V� � Sanitary Sewer: BM Symbol: � BM Elevation, FT Force Maln: / BM Description: ��.:� ,� �a � s�� Indicate nonh by IMPORTANT: Slope Gradient(%) Well Symbol(if applicable): Q draw�r,9 ar,arrow Show ground elevation contours at suitable intervals. of Tested Area' on the approprite line. � � Jo��v� � /1�iC�P�IR 5.�.� ;� �C �S �1 �� . � ��a� � s��,�P � �- � S � �ai, �,�, � � (,� ;�C�:� , S �N� c� ow h 01 C�n'�'� E° � 5 a3 �`�a N R °�``' I O � oiygYaa3 `f1�6 �yl,i —��o,D ( �1 9(p. l� /�v�C� �✓�etd Ce��rr�_ / �� 9s, s : 0�5 b4� 3) �s, 7s s y ;�(��{v� �C�..� , �,,s �- -�1�� a .Sys � �`�� 8��" 93�/� � � - �3� S7S.�,� �� _ �a � � �er'� 3 J' —��a�..�j 12u-I"�� e(-�' lhPRS # �sa �� 9 Septic Tank(s) Manufacturer: IN-GROUND GRAVITY DISPERSAL AREA wieser Concrete Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s): 3-ft Trench (down-sizing credit) 1665 gal gal gal gal Effluent Filter Manufacturer: Lifetime � Efflue�c F�ite�Modei#: LT 1/8 m�r,.iz" (typical) SOIL COVER �z„ min.trench depth ;�vp��ao ' < TYPICAL TRENCH � a <. CROSS SECTION VIEW , e . . .a f 34,� (typical) �NO J�CB�e� � e, . � ° Provide minimum 3 ft System Elevation — g2.00 ft separation between trenches. (typical) Quick4 Standard-W w/End Cap Obseroation Pipe TYPICAL TRENCH (typical) (Show location of inlet/ outlet pipe connection on plan view.) (typical) Install per manufacturer's PLAN VIEW �nstructions. � (No Scale) � �� - - - - - - �� - - - - - - - �� - - - - - �u��r — � — � " ` , � �A= �Oft � i �-,al�� = ��r�� '� -�� i �j ii ; '" 1� '� �r�` , � � � T . . . . �+�•i�.;� ..— — — —� � I al) V .. . vv. .. . �. � - - - - - - - - - - - �� - - - �f- - - - - — D G� �_ - B - ��o ft -� m (rypical) Quick4 Standard-W Chamber W (typical) � INSTALL PER TRENCH: (mfd by inf�itratorsystems,i��.) � Install pursuant to manufacturers instructions. � 27 Quick4 Std-W @ 20 f� EISA/chamber= 540 ft2 + � Pairs of end caps @ 6 ftz EISA/pair= 6 ftz = Proposed EISA per trench = 546 ftz Required Infiltration Area = 1072 ftz Distribution Method: x 2 trenches = Proposed Total EISA = 1092 ftZ branched manifold - PAGE40F4 In-ground Gravity Management Plan IMPORTANT: The owner of this in-ground gravity system shall be responsible for its perpetual operetion 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 Dispersal Area Operatinq Limits: Design Flow= 750 gpd; 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 malfuncYion(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.28t48 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(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: BUttefflE,'Id, IC1C. Phone: 715-634-8176 Local government unit: SaWyel"COUflty ZOnlllg Phone: �15-634-8288 �oca�govemment unit address: 10610 Main St. SUite 49, Hayward,WI _ Z1P 54843 Any defective part of this system shall be repaired,replaced,or removed pursuant to SPS 383.51(1),Wisa Admin. Code.Repair or replacement of failed or malfunctioning components shall comply with SPS 383,Wisc.Admin.Code. No product for chemlcal 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. "'-""" PRIVATE ONSITE WASTE TREATMENT county �y`,o$ ,� SYSTEMS �'�: �� s � ( POWTS) Sawyer ' h t� `.�j:, '"� INSPECTION REPORT sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �3^�$� Personal infonnation you provide may be used for secondary pu�poses[Privacy Law,s. 15.04(i)(m)] Permit Holder's Name: ❑City ❑ Village C�.Town of: State Plan Transaction ID#: 'S�r�«�,, �-tM��e��CL,�w,� 1-e.��' '—. Insp BM Elev: BM Description: Parcel Tax No: (�D� r �ai � �y. �a-�, ,��''''�c�� I�{-��{� - �3 ^��C� TANK INFORMATION ELEVATION DATA �. TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �„��- (�(o� Benchmark �oa.o' Dosing Aeration Bldg. Sewer R Y,3' Holding St/Ht Inlet �t 3•$"� TANK SETBACK INFORMATION St/Ht Outlet 43� 3 ' TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIR IN?AKE Septic .�-e' � �.a.S'� ,�..ar NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. Qi�.,S� Holding Dist. Pipe PUMP 151PHON INFORMATION Infiltrative ��5. � 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 �N 3' L �� og #of Cells a Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate �� INFORMATION P�L Bldg Well Waters � IGP ta` Chamber Model Number: ❑ AG ❑ EZFIow CELL TO �i-(c� fi� N f�l ❑ Mound o Other — -- - __. - �fi -- _ _- - - — - __--- ___ _ DISTRIBUTION SYSTEM X Pressure Systems Oniy — -- - -_ ---- ---_ _ _ _ Header/Manifold Distribution Pipe(s) X Hole Size i X Hole Observation Pipes Length Dia Length Dia Spac � � Spacing ❑Yes ❑ No � -- -- -- -- ---- -�--- -----� SOIL COVER _ - - — — - --- De th Over De th Over Depth of Seeded/Sodded Mulched � Cell Center � Cel�l Edges � Topsoil � ❑Yes ❑ No � ❑Yes ❑ Pdo COMMENTS: (Include code discrepancies, persons present, etc.) ��I l� �a-(�t la 3 Plan revision required.0 Yes ❑ No � �j3 �� I �--_��` / ---J � �� iv � �� 'S� (� � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A�OITIONAt COMMENTS AND SKETCH SANITARY PEAMIT NUMBER: �3 "'�g� \ �1��;� �jQ �,�� P��-, � `,�-� �� , � `°' 3� �1, � ,,.nP��' 6" j��c�o� \ �\a�rro l� w(�T ^ � I � '„s� � ''` ��, . . �fv c�. � �� ? g�'.`� � �� a � � � � � �� —.p�--- �o �----