HomeMy WebLinkAbout012-230-00-2300-SAN-2023-300 '�"""��;,. Industry Services Division County �
� 4822 Madison Yards Way Sawyer �
;;���:,��� '- Madison,WI 53705 Sanitary Permit Number(to be filled in b} �
� : :�- � P.O.Box 7302
��— ar�/ li � � l✓ 6 � �
=i Madison,WI 53707 �
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Sanitary Permit Application StateTransactionNumber �..v
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to tbe appropriate govemmental unit G
is required prior to obtaining a sanitary permit.Notc:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing auu�e„�
[he Department of Safety and Protcssional Services.Personal informa[ion you provide may be used for secondary D u n Rovi n Rd.
purposcs in accordancc with thc Privacy Law,s. 15.04(1)(m),Stats. ���7�n /
I.Application Information-Please Print All Informarion � �v
Property Owners Name Parcel# �� U�-; - ��C�j
01 ' �3C `
Jeff and Jessica Laeseke 57-012-2-40-06-06-5 16-725-00230
Property Owner's Mailing Address Property Location
25089
co�.►.ot
City,State Zip Code Phone Number
Blue River WI 53518 608-604-7634 NW '%,NW '�<, Se�t;on 6
IL Type of Building(check all that apply) Loc# T40 N R �2 E or W
� C3� Unit 23 Subdivision Name �f
�/1 or2 Family Dwelling-NumberotBedrooms Thfee BedfO0R1S ,.
�,o�k� Hay Creek Condo
�ublic/Commercial-Describe Use
N a ��,�y of
�Statc Owncd-Dcscribc Usc CSM Number illage of _
Na �✓T��,,,or Hunter
III.T,ype of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if
a licable.
`� ✓�Vcw Systcm nReplacement System �Other Modification to Existing System(explain) �Additional Pretreatment Unit(cxplain)
LJ
B' ❑Holding Tank �ln-Ground �4t-Grade �Mound Individual Site Design Other Type(explain)
(conventional)
C. �Renewal Before �Revision �Change of Plumber ❑Transfer to New Owner List Previous Permit Number and Date Issued
Expiration
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
450 .70 643 808 Eisa of Sq. ft. c-�-2=sa.2s'C-3-4=94.17'
Capacity in Total #of Manufacturcr
u
Tank Information Gallons Gallons Units � J V � N �
New Tanks Existing Tanks F o � � u p �e �
a U ri� � v, w C7 cL
Septic or Holding l'ank ���� 1000 1 �/12S@C COIICf@t@ ✓
Dosing Chambcr � �
V.Responsibility Statement- I,the undersigned,assume responsibility for installafion of the POWTS shown on the attached plans.
Plumber's Name(Print) P�tLbers � MP/MPRS Number Business Phone Number
Luke Schmitz 884121 715-468-2434
Plumber's Address(Street,City,State,Z,ip Code)
P.O. Box # 160 Shell Lake WI 54871
VI.Coun lDepartment Use Only
�� Permit Fee Date Issucd Issuing Agent Signature
�App � ❑Disapproved �/ �J � f��
� �
❑Owner Given Reason for Denial $ 1�' �� ��� �� � �l�'�'��'""��"���� �-
Conditions of Approval/Reasons for Disapproval [� � � 1 i% ;�
i
� ��q �� � �.:=��F:.` 1 � . �" ��3 ..._._..�...
�� �,� `,� ` NOV 0 7 2023
M� �r �ti
�
.hk# ���a .
�GCT 23_ l 3�" SA1l�YER COUh1TY
J � �" ' ' ZO(�1NG ADMINISTRAT�ON
�
At[ach to complete plans for the system and submlt to the County only on paper not less t6an 8 V2 i 11 Inches in size
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SBD-6398(R.02/22) RO RCFl1ND�AFTFFi
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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
Laeseke Three Bedroom Sanitary System
Owner Name(s): Jeff and Jessica Laeeske Phone: 608 _604 _7634
Owner Address: 25089 Fivepoints Drive Blue River WI Z;p: 53518
Project Address: Dun Rovin Rd.
Govt. Lot: NW �1/4 of NW 01/4, Section6 , T40 N-R6 E�or W ❑✓
Township: Hunter County: Washburn
Project Parcel ID #: 57-012-2-40-06-06-5 16-725-002300
Designer Information
Designer Name: Luke S�hmitz Phone: 715 _468 _2434
Designer Address: P•O. Box 160 Shell Lake WI Z�p; 54873
E-mail: digupnorth@gmaiLcom ����,,,��,.,<<� ;������,����, �;,� ��E�,������;z� ,���„�,:.
License Number: 884121
Remarks:
�
Signature: . � Date: 11/03/23
Original signature require su
Page 2 c�f 4
Sanitary Site Plan
For: Jeff and Jessica Laeseke
Hay Creek Acres Condo Unit 23
NWl/4 -NWl/4 Sec. 6 T40N-R6W
Hunter Tnsp. - Sawyer County o 20 �o
I�----�
GrapLla Scale (fbet)
1 Sach � 40 ft
Laeseke Property
Hay Creek Acres
; Lot 3 Block 1
� Tax ID#13439
�
� GL o�'Dun Rovin Rd.
� P/L
; 98.00' 98.00'
i
� �B # Proposed Well Site
� BM Cleared. Cut and Gruded �/ELL
� 3 Area 1 3% �
Wooded Area ► 97.17� 96.37'
� �, 9�.on�
� S,� �12,B #4 Proposed 3
I � 96.62' Bedroom Cabin
Proposed 4 Dispersal Cells consisting o
� 96.57' 1.12 Acre Parcel
Infiltrator Quick 4 Standard-W Chambers. �B
� Cells 1 +2 w/Il chambers per cell w/a B #1 96. ' \
�i
� S.E. oj94.25'equaling 46'. Cells 3+4 w/8
E chambers per cell w/a S.E. of 94.17' loo.00' Proposed 4"Sch. 40 P VC Bldg. Sewer
� equaling 34'. 6/ � Cut Bank Edge and Conveyance Piping
! Slope w/Select Trees�
� P/L Tax ID#13487
E � 456.f't.
Proposed �eser Concrete WLPI000-MR Septic Tank
w/a Poly-Lok PL-525 EfJluent Filter
� BM=Nail w/Pink Ribbon in Base of a 10"DBH Balsam Fir. �
� HRP=Same Elevation Data
ASSUMED ELEV.= 100.00' Proposed new bldg.sewer pipe at slab= �95.50'
Septic Tank(s) Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA Wieser Concrete WLP1000-MR
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s):
3-ft Trench (down-sizing credit) �oo0 9al gal gal gal
Effluent Filter Manufacturer�
Polv-Lok
�
- Er�Uer,c F�ice�nnodei#: PL-525
min.12"
SOIL COVER (�pi�l�
12„
min.trench
depth
�ap���� ��� • TYPICAL TRENCH For Cells 1 + 2
� • . --� � �� ��°.a <. CROSS SECTION VIEW
�._-_ aa„ �'. , .a. '. . � (No Scale)
c�vP��i� •:�, � . . .
a . a,. . �.
. ` Provide minimum 3 ft
System Elevation — 94.25 ft separation between trenches.
(typical)
Quick4 Standard-W
w/End Cap Observation Pipe TYPICAL TRENCH
(typical) (Show location of inlet/outtet pipe connection on plan view.) (tia���)
Install per manufacturer's PLAN VIEW
mstructions. ��JO SCa�@�
r*�' - - - - - -.- - - - ��- - - - - - - - �� - - - - - - - ,:�—l►�;���
.
�
� p � . � ,. .. �' �� A= 3.0 ft
,�.
,�.�. .. (bPical)
� l�iiilii�i _ _ �_ _ _ ' !C irilii��
- - - �� - - - - - - - �f- - - - - - - - �
�-- B = 46 ft _i t.��
m
(typical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (typica�) �
(mfd by Infiltrator Systems,Inc.) �
Install pursuant to manufacturer's instructions. �
11 Quick4 Std-W @ 20 f� EISA/chamber= 220 ftZ
+ 2 Pairs of end caps @ 6 ftZ EISA/pair= �2 ftZ
= Proposed EISA per trench = 232 ftZ Required Infiltration Area= 643.00 ft2 Distribution Method:
Ce11s � + 2 x 2 trenches = Proposed Total EISA = 464 ft2 branched manifold �
334 sq. ft.
Cel1s 3 + 4 = 344 sc�. fi. Total of 808 sq. ft.
Page 3B of 4
Septic Tank(s)Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA Wieser Concrete WLP1000-MR
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Volume(s):
3-ft Trench (down-sizing credit) �000 gal gal gal gal
Effluent Filter Manufacturer:
Polv-Lok
�
Et��e�t F�ice�nnodei�: PL-525
min.12"
SOIL COVER (typical)
12„
min.trench
depth •
c�vP��a�> ��. < � TYPICAL TRENCH For Cells 3 + 4
-- -� •-- —•' �� �� �''.a� <. CROSS SECTION VIEW
��ryp��� .:.,. . .�. .� � . . (No Scale)
w . a.. . a.
` Provide minimum 3 ft
System Elevation —94.17 � separation between trenches.
(typical)
Quick4 Standard-W
w/End Cap Observation Pipe TYPICAL TRENCH
(typical) (Show location of inlet/ outlet pipe connection on plan view.) (typical)
Install per manufacturer's PLAN VIEW
instructions. �nJO SCa�@�
— — — — — — — — — —
�—� -�� - - — - - - - — - - — — - - —�aFt[AI!: �
� ''��� � � �� � .tr ��� A= 3.0 ft
� (bPical) �
�—'� - - - - - - - - - - ��- - - - - - - - ��- - - - - - - - .���i'= � D
B = 34 ft _i G�
m
(typical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (typica�) �
(mfd by InfiltratorSystems,Inc.) �
Install pursuant to manufacturer's instructions. �
$ Quick4 Std-W @ 20 f� EISA/chamber= 160 ft2
+ 2 Pairs of end caps @ 6 ft2 EISA/pair= �2 ftZ
= Proposed EISA per trench= �72 ftz Required Infiltration Area= 643.00 ft2 Distribution Method:
Cells 3 + 4 x 2 trenches = Proposed Total EISA = 344 ftz branched manifold �
Cells 1 + 2. = 464 sq. ft. 464 sq. ft.
T�otal �f�308 sq. ft.
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 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 Septic and dose tank(s1 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 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: SCOttS S@ptlC S21VICe Phone: 715-699-7279
�oca� government unit: Sawyer County Zoning Office Phone: 715-634-8288
�oca� government unit address: 10610 Main St. Suite 49 Haywat-d 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.
Continctencv 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
�� ��o$ � SYSTEMS
_� � �s y. ( POWTS) Sawyer
\R,F� �%�
'"'"v�" INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 2,3�3 o O
Personal infonnation you provide inay be used for secondary purposes[Privacy Law,s. I 5.04(l)(in)]
Permit Holder's Name: ❑City ❑ Village I�Town of: State Plan Transaction ID#:
S�� �-5e.s�i�n (�Q.SQ� �-lu,.a-2r- �
Insp BM Elev: BM Description: Parcel Tax No:
lDo .o� �►�d-c�`b�oe� ��.. �s-e o� (�`� pBl-1 ��5a� 6��•a3�—oa - �3aa
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �,,,�e.�� �o Benchmark �op.b�
Dosing
Aeration Bitlg. Sewer --
Holding St/Ht Inlet �Y','7 �
TANK SETBACK INFORMATION St I Ht Outlet qs:S
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic ��� o �,��� ��b' NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA HeaderlMan. -�jS 3 �
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infiltrative
Surface
Manufacturer Demand Final Grade
Model Number GPM 5 S ��-� �Y'`3�
TDH Lift Friction Loss Sys Head TDH Ft 3�- 9 Y• ,2�
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS �N 3' L y' I(Y' � � #of Cells Type of System Distribution Media Manufacturer:
� Conv ❑ Aggregate
SETBACK P/L Bidg Well OHWM of Nav � IGP � Chamber ^ �'
INFORMATION Waters � AG c EZFIow Model Number:
❑ Mound o Other
CELL TO t'S� N - '� 1�► ------ — - -___ Q`�'�'
- - -- --____
DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifold Distribution Pipe(s) �X Hole Size X Hole Observation Pipes I
Length Dia � Length Dia Spac I i Spacing ❑Yes ❑ No
— -- --- — __ — --_ _1
SOIL COVER
( Depth Over Depth Over 1 Depth of �( Seeded 1 Sodded Mulched
Cell Center � Cell Edges Topsoil � ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present,etc.)
��(l� �t luo(�3
Plan revision required?❑Yes❑ No ,0� ��. �c�I � <jc't�1 �
( � ' �
—� , --
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A��ITIONAL COMMENTS ANO SKETCH
SANITAAY PERMIT NUMBER:__�_�3� __
16�a�
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