HomeMy WebLinkAbout024-741-01-2207-SAN-2023-293 _ ' � Department of Safety c°°°`'' SAWYER �
- � � _ & Professional Services, �
- �- t� � Sanitary Permit Number(to be filled in by�
,l ' t _ Industry Services Division
,: (� 5 1 l�d"� w
Sanita� PeY.l.nl* A p„tiCa+l�n State Transaction���ber �
l. t� �J1 6
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form ro the appropriate governmental unit 1V t� �
is required prior to obtaining a sanitary permit.Note:Application forms for state-ow�ned POWTS are submitted to Project Address(if different than mailing a�
the Department of Safcty and Professional Services.Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. (SAME)
I.Application Information-Please Print All Information
Property Owner's Name Parcel# p� � D � O
STEVEN J. & CYNTHIA L. STRUDEMAN 57-024-2-41-07-01-2 02-000-
Property Owner's Mailing Address Property Location O'�O
12058N UPPER A ROAD Govt.Lot NA
City,State Zip Code Phone Number
HAYWARD, WI 54843 NVkI NW �i4, se���on o�
II.Type of Building(check all that appty) Lot# T 41 N R"7 "E or W
C�or 2 Family Dwelling-Number of Bedrooms � G Subdivision Name
s�o�k# NA
❑Pub►ic/Commercial-Describe Use NA
❑Ciry of
❑State Owned-Describe Use CSM Number #6200 ❑Village of
V22, P6183 ��of ROUND LAKE
iII.Type of POWTS Permit:(Check either"New"or"ReplacemenN'and other applicable on line A. Check one box on line B.Complete line C if
a licable.)
A' new S stem Re lacement 5 stem
y X p y XOther to Existing System ❑ Additional Pretreatment Unit(explain)
(explain) TANK ONLY
B.
❑ Holding Tank In-Ground ❑ At- rade �Mound ❑ Individual Site Design ❑ Other Type(ezplain)
(conventional �
C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ist Previous Permit Number and Date Issued
❑ Transfer to New Owner
Expiration 13934:
79'- .20
IV.DispersaUTreatment Area and Tank Informallon: ,lnr.
Desi�n�l�ow�(gpd) Design Soil Application Ratc(gpd/s� Dispersal Area Required(s� Dispersal rea F�e�(s System Ele o �
�� .�-7 � �S- G�.� �@ 4�0.3 3
Capacity in Total #of anufacturer
Tank Infortnation Gallons Gallons Units a o 'b �
New Tanks Existing Tanks � e y ��' � p � �
a U iFi �v, �n ii. C'7 G,
SepticorHolding'Iank 25� 25� 1 WIESER X
Dosing Chamber
V.RespOnsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) P 's Signatur MP/MPRS Number Business Phone Number
RYAN STRAND � � - 5��5'��ol
Plumber's Address(Street,Ciry,State,Zip Code)
��. ,� �Y1 � �C� CQ�G�- f�, , CQ1-� J �t'.��
VI.Co n (Department Use Only
�Ap�p o�� SI ❑Disapproved Permit Fee Date Issued Issuing Agent Signature
$ y � �j'j/]
❑Owner Given Reason for Denial `�' �� I "� '1� " r `��� �'�L�t�[=' `
Conditions of Appro'val/Reasons for Disapproval __
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� S�Vi�YEP �,��E:_i,;�,; t•
�U' � ZOfv1NG A�Mi��6;�3"F�ti"1�N
Attac6 to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in srze � �� �-7
SBD-6398(R.03/22)
�u�1
-`���` `�F�f-�� PAGE 1 OF 4
In-Ground Gravity Plan
Index � Cover Sheet
Component Manua!Design Re�e�ences:
In-Ground Soil Absorption for POWTS Ve►sion 2.1 (May 2022-2027)
Pg 1 of 4 Index 8� Cover Sheet
Pg 2 of 4 Plot Plan
P�3-o�-4- Nh Bis�e�sal,A�ea�es�s £reetion�Plart�ieav NPr
Pg 4 of 4 Management Plan
Attachments: Enciosures:
Tank Specs POWTS Application for Review
Previous Paperwork Soil Evaluation Report 8 Site Map
j�ti ��r-'�ra���T
(11 P�GES TOThL)
Project Name / Description
Owner Name(s): STEVEN J. � CYNTHIA L. STRUDEMAN phone: - _
Owner Address: �2058N UPPER A ROAD, HAYWARD, WI Z�p: 548 43
Project Address: (SAME)
Govt. Lot: NA NW �1/4 of NW �1/4, Section �� , T 4� N-R 07 E Q or W �
Township: ROUND LAKE County: SAWYER
Project Parcel ID ft: 57'024-2-41-07-01-2 02-000-000070
Designer Information
DesignerName: MARY JO HUPPERT Pho�e: 7�5 _ 426 _ 1775
Designe� Address- 25720 FIREFLY LANE, WEBSTER, WI Zip: 54893
E-mai1: hollisterdesign@outlook.com ,,�,����""""""`"�'s���,
� • � h�i.
1859 - 007 ,.��'' ��-��!�� �•� 'A �-.
License Number: �,`� ��' .• ••• . ''°� �'y
;, .• . .
Remarks: ' ^�Y'" � • * �
'� ; �
F ,t 'rs• � _
_ �
� ' �
REPLACE TANK ONLY � �'M`' " ' � " ` �' � '
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��Jy ���'. ..; ., ''�� \`y.
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� ,/Cx� r . � Date: 10-27;��2023
Si nature. �
g or;�i sg�ac�re s�aed�r.
PIOt Plan �e �o� �
PROPERTY OWNER: S�f�v� � � �'�'�J�t!� L, �TR�,iGEh;A�} 1" _= 40 FT.
(except where noted)
Legal Description: LD� 2 � C5�'1�624a` V 2z� �'!Q�. N►���y D� Tt�E b —backhoe pit
NEi��y+ �� �1, T"�irn�� Ro7vJ� T ownl C.� RUtt,«3D i�F►�E� �w�FR �.�g� ���&-s
<<n�.��1Ty} '!i� :�z�t.� S1lv . �7- 04z'Z-yi-07-DI- "L Dz-aQ�- OQ��7�?
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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= 600 gp�� gODS <_ 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) shall be inspected every 3 years and shal� 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: RYAN STRAND Phone: 715-558-1673
�oca� government unit: SAINYER COUNTY ZONING Phone: 715 - 634 - 8288
�ocal government unit address: 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 uniess 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.
WLP1250-MR
TANK SPECIFICATIONS �
�20 .. DIMENS'IONS: � i
� WALL: 2 1/2• �
• y 80TTOM: SEPTIC 3"
COVER: 5" �
MANHOLE: 24' I.D. PRECAST CONCRETE RISER °
HEICHT: S2 1/2" O.D. ��
LENGTH: 120 1/4' 0.0. +
VNDTH: 84" O.D.
BELOW INLET: 41' O.D.
4" CAST-A-SEAL 4" CAST-A-SEAL LIQUIO LEVEI: 38' � �
IMEIGHT: 8,810 LBS.
� 024� � INLET AND OU?I.ET:
� .T,� ` 4" CAST-A-SEAL BOOt OR EQUAL
�/ \ GASKET, CAST-A-SEAL 800T OR EQUAI �
FILTER OR INLET AND OUTIFT BAFFLE ANO FILTER: m g �
BAFFLE WISCONS'IN, SEE DETAIL �10 � �
(OTHER STATES SEE CHART) < � �
UQUID CAPACIn: 34.81 GAL/IN �
�
HOLDING TANK; W�
OUTLET HOLE PLUGGED
ACTUAL CAPACITY: 1,323 GALLONS �
TOP VIEW LOADING DESIGN: 8� 0" UNSANRATED SOIL =� �
� `t
Y� 00
�
� �
N
TANK CAN BE USEO AS: o M
Q g SEPTIC/ HOLDING/ PUMP OR SIPHON � o
�, C O V E R: M I X D E S I G N /8 N O Fl B E R) �
TANK: MIX DESIGN �/10 �STRUCTURAL FIBER) � �
CUSTOMIZED TANKS: � 3
IN T _ OIIT T FOR CUSTOM TMIKS CONtACT WIESER CONCRETE
� ' N � . � �
� . 'n v � ��p � a , Q
d 2,�" =t r� ?V r' �' �Z
� � 4
�
N
U
F
"' DRAWINGS SUBMITTED �
FOR APPROVAL
SIDE VIEW APPROVED BY: $��T N0.
APPROVAL OATE: �
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASThI C-1227 REQUIREMENTS PRODURS NEEDED ev: � .�
167 �EPARTMENT�F COMMERCE Comm 83.14
� material such as perforated precast concrete ring,concrete block, When dosing is required,the dosing frequency shall be a maxi-
brick or other rr.aterial approved by the department which al]ows mum 4 times daily.
effluent to percolate into the surrounding soil.The pit bottom shall �]� FRESH p[ft INLETS wND OBSERVATTON PIPE. Fresh air
be left open to the soil.Aggregate of�/z to 21/2 inches in size shall observation inlets shall be provided and connected to the perfo-
be placed into a 6-inch minimum annular space separating [he rated dis[ribution pipe with an approved fitting or junction box
outside wall of the chamber and sidewall excavation.The aep[h and be placed so as to assure a free flow of air throughout the entire
of the annular space shall be measured from the inlet pipe to the installation.The vent pipes shall be at least 4 inches in diameter
bottom of the chamber.Each seepage pit shall be provided with and extend at least 12 inches above the final grade and terminate
a 24-inch manhole extending to within 6 inches of the ground sur- with an approved vent cap.The observation pipe shall be perfo-
face and a 4-inch diameter fresh air inlet which shall meet the rated and extend to the bottom of the aggregate. See following
requirements of sub. (7). An observation pipe is not required. sketch.Fresh air inlets shall be located at least 25 feet from any
Seepage pits shall be located 6 feet or more apar[.Excavation and window,door or air intake of any building used for human habita-
scarifying shall be in accord with sub.(4).The effective area of a tion.A maximum of 4 distribution pipe lines may be served by one
seepage pit shall be the vertical wall area of the walled-up cham- common 4-inch vent when interconnected by a common header
ber for the dep[h below the inlet for all sirata for which the percola- pipe.
[ion rates are less than 30 minutes per inch.The 6 inches of annular
opening outside the vertical wall area may be included for deter- F�ecn a�. i�iets And Obcervotion Pip�
mination of effective area.Table 3 may be used for determining
the effective sidewall area of cuculaz seepage pits: `�.--aov�o�.a v��, c,o
TABLE 3 Minimum iz"veo�e
EFFECTIVE ABSORPTION AREA FOR SEEPAGE F�^a� Grade
PITS
Inside diameter of a-
chamber in feet plus 1 zc-.z'aeo.�Pip� —Ve�� p�v•
foot for wall thickness To Final Grode
plus one foot for annu- Depth fn feet of Permeable Mprs�Hoy 0�Sym�etic CoverinQ
lar space Strata Below Inlet
Mm 2�ASqreOa�e
� 3 4 5 6 7 $ o•« Proa
O�sv�bwion —Tse
�7 75 101 126 151 176 201 P�De � o 0 0 0 0
I Xl gs ]]3 1�2 1�]Q� 19g 6~AQQ`�QOf� o PerforottE Pipe Belor
ly 9�n•otn Pip�
9 94 126 157 188 220 25 0 —co,����a Ts�minatinp a.
+� 10 104 :38 173 208 242 277 Bo�fam oi srz,.m
12 ;23 163 204 2�15 286 327 �8� W�ER INSTALLAT'fON. (3� General. Installation of soil
absorption systems during periods of adverse weather conditions
(4) ExcnvaT'toN wtvD coNs'['ttUCrtox. The bottom of a trench is not recommended. A soil absoiptio❑ system shall not be
or bed excavation shall be level.Seepage trenches or beds shall installed if the soil at the system elevation is frozen.
not be excavated when the soil is so wet that soil material rolled (b)Removal of snow cover Snow cove.r must be removed from
between[he hands will form a soil wire.All smeared or compacted �e soil absorption area before excavation begins.Snow must not
soil surfaces in the side walls or bottom of the seepage trench or be placed in a manner that will cause water to pond on the soil
bed excavation shall be scarified to the depth of smearing or com- absorption system area during snowmelt.
paction and the loose material removed.If rain falls on an open (c) Excavated and backfill material. Excavated soil material
excavation,the soil must be left until dry enough that a soil wire may be used as backfill for the system if the following conditions
will not form when soil from the excavation bottom is rolled aze met:The excavated material must be protected from freezing. �I I 5
between the hands.The bottom azea shall then be scarified and if the excavated material freezes solid,it shall not be used as back-
loose material removed. fill.The first 12 inches of bacl�'ill shall be loose,unfrozen soiL `:`�t
�S� AGGREGATE AND BACKFILL. A 1T11ri1I71um Of f) tIICI1BS Of The protective covering over the bed or trench gravel shall be a �l�
agb egate ranging in size from�/2[0 2 I/Z inches shall be laid into synthetic material approved by the department or 9 inches of `c?
the trench or bed below the disv-ibution pipe elevation.The ago e- uncompacted marsh hay or straw. �l
gate shall be evenly disv-ibuted a minimum of 2 inches over the (d) S}�stem inspection. Inspection of systems installed during `
top of the distribution pipe.The aggregate shall be covered with Winter conditions shall include inspection of the trench or bed
synthetic materials approved by the department or with 9 inches excavation prior to placement of o avel and inspection of backfill
of uncompacted marsh hay or su�aw. Building papershall not be material at the time of placement. tr r
used to cover the aggregate.A minimum of 18 inches of soil back History:G.Register,Deccmbzr, t980,No.300,eff. I-1-81;renum.from H �;
fill shall be provided above the coverina. 63.13.Rceisccr,lu❑c,1983,No.33o,r.ff.7-1-83;am.(6)(b),Register,Apri1,1992, � � y�
No.436.cff.5-I-92;azn.(6)(b)and(7).Register,February, 1994,No.458,eff. �
(6) D�snus[,-noh P�P�NG. (a) General. Distribution piping for 3-1-94. �
D avity systems shall be a minimum of 4 inch I.D.approved pipe.
The distribution header shall be constructed of approved solid Comm 83.14 Pressure distribution Systems.
wall pipe.The top of the disn-ibution piping shall be laid 8 to 42 (�) GEtiartnL. A pressure distribution system may be used on any
inches below the original surface in continuous strai�ht or curved site meeting the criteria listed in s.Comm 83.10.There shall be a
lines.The slope of the distribution pipes shall be 2 to 4 inches per minimum depth to the top of the distribution piping of 6 inches
100 feet. from origina!o ade.The minimum required suitable soil depths
t; ; (b) Distribution of effluent. Distribution of effluent to seepage from orisinal srade for a pressure disuibution network are as fol-
trenches on sloping sites may be accomplished by utilizin�a drop lows: � y
box desi=n. Where dosin�is required, the siphon or pump shall 1 inch distribution pipe--49 inches suitable soil
discharse a dose of minimum capacity equal to 759�of the com-
bined volume of the distribution pipin�in the absorp;ion system.. 2 inch distribution pipe—�0 inches suicable soil
Rceistcr,Fcbru:u}.1997,No 494
` '"``", PRIVATE ONSITE WASTE TREATMENT �ounty
������o SYSTEMS
�SPg ( POWTS) Sawyer
;�, _
\A"'~'-`�% INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 2 3 —���
Personal infonnation you provide may be�used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village [y�'Town of: State Plan Transaction ID#:
5��,r{y��,��.�„�a� �,,.�c�.
Insp BM Elev: BM Description: ��S�� � �f Parcel Tax No:
�a�•� 4 c�e�-��= �0�6� c.,,.� .n�-.r (, �.,IQ O��{7Yl—6 I��0'7
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic h,;,e�T` �,�j Benchmark �oD.o
�
Dosing g M �
Aeration Bidg. Sewer �p. q�$.,3 �
Holding St/Ht Inlet �Q,�.�
TANK SETBACK INFORMATION St/Ht Outlet �7,4-�
TANK TO P/L WELL BLDG vE"TTo ROAD Dt Inlet
AIR INTAKE
Septic �r�-�� t-�.5� (S"' .�-��—I NA DtBottom
Dosing NA Installation
Contour
Aeration NA Header/Man.
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative
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 W � #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate
INFORMATION P I L Bldg Well Waters o GP ❑ Chamber Model Number:
❑ EZFIow
CELL TO ❑ Mound RC Other p
DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifold Distnbution Pipe(s) X Hole Size i X Hole Observation Pipes
Length Dia___�Length Dia_ _ Spac ' _ _ � Spacing ❑Yes ❑ No _
SOIL COVER
- _-- —
Depth Over �Depth Over ' Depth of � Seeded/Sodded l Mulched
Cell Center Cell Edges ; Topsoil __ ❑Yes ❑ No � ❑Yes ❑ IVo
COMMENTS: (Include code discrepancies, persons present,etc.)
��s���Q� (c ( 8 ��3
�s�- ,�' . o,,.r
_�—___ _
Pian revision required?�Yes 0 No I� I� � ��
�
�i za ��Y'�, �_ - --- --- __J Sa r�
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AO�ITIONAL C�MMENTS ANO SKETCH
SANITAAY PERMIT NUMBER: ��_��__
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