HomeMy WebLinkAbout010-169-00-0900-SAN-2023-289 _'''� ' ` Department of Safety �°°"�y �
�\� '����1 & Professional Services, '�`w r �
= � �� Sanitary Permit Numbe (to be filled in by
,,, ', : �' Industry Services Division
`�x�;; ��� C�5 ( � �3 w
r
Sanitary Permit Application StateTransactionNumber �
In accordance with SPS 383.21(2),Wis.Adm Code,submission of this form to the appropriate govemmental unit �,
is required pnor to obtaining a sani[ary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address)
the Department of Safety and Professional Services.Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law,s. 15_04(i)(m),Stats. �ro� ��,
I.Application Information—Please Print All[nformation
Property Owner's Name Parcel#
G S�a�r o� c� -lc�9 - U�-Oqo
PropeRy wner's Mailing Address Property Location
�S � 1C c� 6e rr-to�
City,State Zip Code Phone Number
S W 0.�a W� s y B,�3 —j�� '� Dl�, Section�_
II.Type of Building(check all that appty) [.ot# T �'/ N R �E-or
�Ior2FamilyDwelling—NumberofBedrooms 3 � SubdivisionName
B�o�k# R6 i55NER Svao.
❑Public/Commercial—Describe Use .�
❑City of _
❑State Owned—Describe Use CSM Number ❑Village of
.-- �I�own of HAVW ArC�
!(L Type of POWTS Permit:(Check either"New"or"Replacement"and other appticable on line A. Check one box on line B.Complete line C i
a licable.
A �New S stem
y ❑ Replacement System ❑Other Modifica[ion to Existing System(explain) ❑ Additional Pretreatment Uni[(explain)
B' ❑ Holding Tank �In-Ground ❑ At-Grade gn yp•( p )
❑ Mound ❑ [ndividual Site Desi ❑Other T r ex lain
(conventional)
C• ❑ Renewal Before ❑ Revision ❑ Chan e of Plumber ist Previous Permit Number and Date lssucd
g ❑Transfer to New Owner
6xpiration `�
[V.DispersaUTreatment Area and Tank Information: v:�, v ha,�r►b r e +I�tnC�
Design Flow(gpd) Design Soit Application Rate(gpd/st) Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
ti�o o.� �y3 �sa � � � c, . SC� ��
Capacity in Total #of Manufacturer
Tank Infortnation Gallons Gallons Units � U �o ,'a, N v
-� o �, ��
New Tanks Existing Tanks ` o cr � � � ro �
a U cia � v� u, C7 a.
Septic or Holding Tank � � '�O ' ` � � `,
JC
Dosing Chamber
V.Responsibility Statement- I,the undersigned,assume responsibility for installafion of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Signature MP/MVKS Number Business Phone Number
�O(�� 2� N o�,�ito$ / .. —��
Plumber's Address(St et,City�Siate,Zip Code)
C) N �-a.�k Rc5 d 7 Kq wa.rd [.v.z $�J8
VL C u ty/Department Use Only
[I l Permit Fee Date[ssued Issuing Agent Signature
�Ap r � ❑Disapproved �^ L
�W ❑Owner Given Reason for Denial $ `�'� �� �� �� -�' ,`�'��"��'�{�L'`��
Conditions of Approval/Reasons for Disapproval
� r-- �- i e_`—.� —
� � �1,�n������ !�4:� r
E9 r! �.. � � 1'�
. r �_-. Y,: r�J�� �,.EJ.
�: --_Y_�'�% `
'� �� � ����-� � . _ _►�,J�.J. �3�._.� f —✓�,�? i
a��� OC�C 3 0 20Z3 ��__%
�s� �3- i � 5 :4� ��.� � -- -___�
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' �.
Z�/i�'i�vi�i�-^�i;i�;"•�iJ��"i�4i�j�~"�
Attach to complete plans for the system and submit to the County only on paper oot less than 8 I2:11 inches in size
R�? R�FJiV���+u`=T�R 9`i 37
sB�-639g�R.03�22� I�S�JE C?F(��S�i�
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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
Ratkovich - Carol Dr
Owner Name(s): Amy C Ratkovich Phone: - - _
Owner Address: 15926W Park Rd; Hayward, WI ZiP: 54843 _
Project Address: Carol Dr (no address yet)
Govt. Lot: 1/4 of 1/4, Section 33 T 41 N-R 09 E 0 or W ❑✓
Township: Hayward County: Sawyer
Project Parcel ID #: 010-169-00 0900
Designer Information
Designer Name: Ronald A Spreckels Jr Phone: 715 _558 _6472
Designer Address: 9205N State Road 27; Hayward, WI Z�p; 54843
E-mail: ronspreckels@yahoo.com �.;,,�:.� ,���,����,.._;E i.�.,��1,���Et�.��,�, .;�..,�„��.
License Number: 226688
Remarks:
Signature: .Gf Date: l�� �a �a3
Original s� at required on each submitted copy.
P t,c�T t� �.a N
BM
SG � L � = 1 : 30
s �° yo 3'a �S
(� G P�0.0 L 'C�I,L�v l:,
� l.oT �► , RE �ssr�ER Svf�O.
$1 SE G. 3 3 , T�-t�N � R O�i W
� Tnwni O f Wt�ywn+RT�
SAwyEI� GouwrY
,� n Pc�• a�o- 1t,q- o0 0900
�1 \1
'� 6M = �t-o p�� Pro pee�y 53a.�c
AA
A,s� c p`�y� B3� 5"�= tovogv�. pre�ab co�cn�e.SeP�cc
81� �,S T ��O �nK ma�+e bY W i t.kr Ca.+u,rie.
.
W/ Li Ce�tme �..T-�/6 F; 13e!'
AA� AbSccP�iOn (�ceaGcrnsiSlMQ
a� �lwo c�tts, spaced '-`3�� '�
'QropoSt�
3 t�e� � aPa��, coY,a-o.'.n:�9 c., ko+a�
Uw�..�ls�.4� R c��r 3,, Qv:CK-Y Plvs GYtan►bt�S
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._prapeSe.d v
w��� G
E L, t= V /� T 1 o rJ S
[i("� 1 O C� • v U F t
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Septic Tank(s)Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA wieser Concrete �nc
Uniform Elevation Trenches with Quick4 Standard�W ChaCnbGrS SepticTank(s)Volume(s):
3-ft Trench (down-sizing credit) �oo0 9al gal gal
gal
Effluent Filter Manufacturer:
Lifetime Filter LLC
�
Effluent Filter Model#: �-T-��$
min.12"
SOIL COVER �ryP��l�
12"
min.trench
depth
caa��n �. � TYPICAL TRENCH
� • . ' �� '.a� -. CROSS SECTION VIEW
�— 34�� �` �� � No Scale
��YPlcal) •:• ^ .' a .� :. . � �
` Provide minimum 3 ft
System Elevation = 96.50 � separation between trenches.
(typical)
Qufck4 Standard-W
w/End Cap Observatbn Plpe TYPICAL TRENCH
(typical) (Show location of inlet/outlet pipe connection on plan view.) (�yai�i>
Install per manufacturer's PLAN VIEW
Instructlons. �NO SCa�G'�
- - - - - - - - - - - - - - - - -;1
— — — — — — — —
� —
. .�, ;� i
� � o� ����i� � �� E� � � �'. ,�� � ,;� j� . ;,,,� , ��'�� A= 3.0 ft
i
(tYPical) �
L- - - - - - - - - - - - �jL - - - - - - - �j�- - - - - - - - - - -� D
B = 67 ft —� m
(typical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: �tYp���� O
(mfd by Infiltrator Systems,Inc.) �
16 Quick4 Std-W @ 20 fi� EISA/chamber= 320 ft2
Install pursuant to manufacturers instructions. �
+ � Pairs of end caps @ 6 ft�EISA/pair= 6 ft2
= Proposed EISA per trench = 326 ftZ Required Infiltration Area= 643 ft2 Distribution Method:
x 2 trenches = Proposed Total EISA = 652 ft2 branched manifold
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 Dispersal Area Operatinq Limits:
Design Flow= 450 gpd; 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 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(s)shalt 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 atways be greater than 12
months.
System mainten�nce 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: ROnald A Spl'eCkelS JI' Phone: 715-558-6472
�o�i 9o�e��me�t���t: Sawyer County Zoning & Conservation Phone: 715-634-8288
�oca� government unit address: 10010 Main St, Suite#9; Hayward, WI ZiP: 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.
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.