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Home My WebLink About002-840-20-5209-SAN-2023-302 �`��`�'��\ Department of Safety �"��nt Saw er � i�.�_ y _�r, y � /=-'; 9 ,� & Professional Services, , � S � -� Sanitary}�rmit Number(to be filled in by( ',;+, ; Pa � Industry Services llivision � �,z, ` _ .�� (.,� 5 I l�� W '�ry .:,;�= State Transaction Number � Sanitary Permit Application va In accordance with SPS 383.21(2),Wis.Adm.Code.submission oT this form to the appropriate governmental unit � is required prior to obtaining a sanitary permit.Note:Application Yorms for state-o�vned POW'fS are submitted to Project Address(if difterent than mailing ad � tlie Department of Safety and Proiessional Servicea Personal infonnation you provide ma��be uscd ior secondary purposes in accurdance with the Privacy Law,s. 1�.04(1)(m),Stats. $337N BLACKBERRY LN I.Application Information-Please Print All Information Property O�vner�s Name Parcel# MICHAEL L & MELISSA K HILL 002-840-20-5209 Property Ownc�'s Mailing Address Prope�rt�Location 2636 HALLQUIST AVE G�'P,A�L�t � 1—S' Cit}.State Iip Code Phone Number RED WING, MN 55066 ' _=_��^�, se�t�o� 20 IL Type of Building(check all that apply) Lot� T 4'� N R 08 E o W � 1 or 2 Pamily DN�elling-Number ofRedrooms 4 � Subdivision Name L31ock# ^ ❑Public/Commercial-Describe Use -'— ❑City of ❑S[ate Owned-Describe Use_ CSM Number ❑Village of PRT GOVT LOT 2 LOT 1 CSM 10/35 �T��\��- BaSS L8I(E #2275& LOT 5 CSM 12/124#2911 IIL T��pc of PO��"I'S Permit:(Check either"1'c�s"or"ReplacemcnY'and othcr applicable on line A. Check onc box on line B.�`omplete line C if a licable.) �� r Replacement S��stem � � p � ) E ��) ❑ Other Modification to Existin,System(ez lam ❑ Additional Pretreatment Unit(ex�lain �. ❑ Holding"I�ank In-Ground ❑ At-Grade ❑ Mound ❑ Indi��idual Site Design ❑ Other Type(expl�in) (conventional) C• ❑ Renc��al Before List Pre��ious Permit Number and Da�e Issued ❑ Revision ❑ Chan,c of Plumber ❑ 'I�ranster to he��O�cner Expiration �� q �� 1V.Dispersal/Treatment Area and Tank Information: Desian I�lo�c(,pd) Desi;n Soil npplication Rate(gpd/s� Dispersal.Arca Required(st) Dispersal Area Proposed(st) System Elevation 600� � � 0.7 858 892 92.00 ` Capacity in l�otal #of � ManuYacturer � �ank Information Gallons Gallons Units � � U -° � � New Tanks Existing�I'a�ks � o v � � � � � a U v� � v� u. C7 c. sz�t��arHoia�� ra„k 1250 1250 1 WIESER CONCRETE X Dosina Chamber V.Responsibility Statement- I,the unde�signed,assume esponsibility fm•i stallation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumbc' ,ignatw�e "'O=—.�� MP/MPRS Number Businass Phone Number Travis Butterfield 652879 715-634-8176 Plumber's Address(Street,City.Statc.7ip Code) 14346W St. Rd. 77, Hayward, WI 54843 VI.Cou y/Department Use Only � �\ Permit Fec Date Issued Issuia�Aeen�Signature Ap o ❑ Disapproved ❑O��ner Gi�en Reason for Denial $ `�� '~ � �3 ��,w�- Conditions of Approval/Reasons for Disapproval � - � r---, t i � ! ��- "'�+, �� p {� _. ` ��s�-.�'.J'�-` � -- _..�_ �; �°�� ,�{ ��3 _ ._. � �'--- ;; . �. � ..,. � � �, � �� ....�_...e_.._� j � �..a-��, z.F .._. 3 i 4 I Nf�V 1 3 2�23 -----, C<5��-3 - �0 5 y�� _ _ ; � '��° sAw�rE� cc>u�T�Y G ADMIVISTR,�l�4��s"�! At[ach to complete plans for die system and submit[o[he County only on paper not less[hdn S I/2 x 11 inehes in size ss�-639s�R.o3iaa� ��C RLFJN��A.�'7'ER ISSUE OF F'�R�1 i 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 Owner Name(s): MICHAEL L & MELISSA K HILL Phone: - - Owner Address: 2636 HALLQUIST AVE, RED WING, MN Zip: 55066 Project Address: 8337N BLACKBERRY LN, HAYWARD, WI 54843 Govt. Lot: 1/4 of 1/4, Section 20 , T40 N-R 08 E ❑or W ❑✓ Township: gASS LAKE County: SAWYER Project Parcel ID #: 002-840-20-5209 Designer Information Designer Name: TRAVIS BUTTERFIELD Phone: 715 _634 _8176 Designer Address: 14346W ST. RD 77, HAYWARD, WI Z�p: 54843 E-maiI: OFFICE@BUTTERFIELDDRILLING.COM �I�i,;sSE,�,��,�;�,„�� r�,a��E„�>,��st��r„�. License Number: 652879 Remarks: _.o� Signature: Date: �f /� - �'� Original signature required on each submitted copy. CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. � SOIL EVALUATION 0 Scale: 150 50 �5 �oo � SYSTEM PAGE ZOF '-� SITE MAP PLOT PLAN PROJECT NAME: �Esi�N F�ow: �a� �Po � / �,,�/ 12.5' !U.�GI�� '� Y'''e-�r SS� `-��// Attach design flow calculations for commercial plans. PRo,1ECTADDRESs: � 3l� N ��"`�c�Se�r�' LN � Pipe Material/ASTM Standard(Tables 384.30-3&384.30-5) N Sanitary Sewer. �� YD / BM Symbol: � BM Elevation: �� FT /� Force Main: / BMDescription: 51�� o� 19�� R- �ndicate north by IMPORTANT: Slope Gradient(%) Well Symbol(if appilcable): Q drawing an arrow Show ground elevation contours at suitable intervals. of Tested Afea: on the approprite line. C j�,%�S�e �-k-2 �m��h�.� ( � !Me �;ss a �,`�� o �� 3� N�,L C q��s�-- �4-�-e uP•�1-�- (�PcQ I,�� ✓u N 5�� S ec �� T Yo N ��o F� w � �C,.�v� c� � I�U�S �a.�2 � D �l�„K�� , �� ooa��oa a sa o 9 �� i�� , � ' , � � � ` � Y c65 � �`�'t — /G27 ,o l�a��+�i o�Si �h�, � \ \ / � � � y�,v � , ^ '; !? �� gs�5 ) � � � ; � q�s � ��---- �v � a� �a1 SG L✓1 f��0+1(i'��Q ` yy Q,�;ck � PI�S ��,,�� o �� i�� 5y s�„-L CL 9�2,v r � � n �`� � � T�Lv 15 �J�-7��P��C� FK � �33� ^l rviPRS � �S"� �79 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) 1250 gal gal gal gal Effluent Filter Manufacturer: B@St I Erflue�c F�ite�Modei�: GF10-8 min.12" (typical) SOIL COVER 12„ min.trench depth crip��a�� TYPICAL TRENCH �— � ° a �. CROSS SECTION VIEW � 34�� (No Scale) �rYpical) �:'a � � ° a . •° Provide minimum 3 ft System Elevation — 92•00 ft 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. �NO SCa�e� �, ��CRR�t �� - - - - - �� - - - - - �� - - - -,.—��l�'�,- - - �� , � � Q �� .. ��'r iff !. r ��S�' � ��';� �:� �A= 3.0 ft ,� , �� (tYPical) � � � ;��` - - - - - - - - - ��- - - - - - - - ��- - - - - �� — �- - -� �� D � ;-- B = 88 ft - � m (rypical) Quick4 Standard-W Chamber W (typical) O INSTALL PER TRENCH: (mtd by�nfl�tratorsystems,�nc.) � Install pursuant to manufacturer's instructions. � 22 Quick4 Std-W @ 20 fP EISA/chamber= 440 ftz + � Pairs of end caps @ 6 ft�EISA/pair= 6 ftZ = Proposed EISA per trench = 446 ftz Required Infiltration Area= 858 ft2 Distribution Method: x 2 trenches = Proposed Total EISA = 892 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= 600 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) 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: BUtt2C'f12IC�, It1C. Phone: 7� 5-634-8�76 Local government unit: SaW�/@f COUCIt�/ ZOC11Clg Phone: 7� 5-634-HZSH �o�a� go�ernment unit add�ess: 10610 Mairl St. Suite 49, Hayward, V Z1P: 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. System 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 SaWyeT ,'�.�Sps �- ( POWTS) \H `—r% ' "�� INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION � 3..,3�a Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)] Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#: IM�c�,t'�!t` C.. d�W1�,�Sj�1 � �•� \ Dq55 �a � Insp BM Elev: BM Descri tion: Parcel Tax No: �d o�a� �6--I� s��, �. y�s� a�a - �-ro -ao - s�, TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic w��c..�- 1�rp Benchmark �Vo,d� Dosing Q q7� ' Aeration Bldg. Sewer .Z � Holtling St/Ht Inlet 9Y.3 ' TANK SETBACK INFORMATION St I Ht Outlet �Y,o' TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet AIR INTAKE Septic �'(,' d�p� h'�i� �,tc�` NA Dt Bottom Dosing NA Installation Contour Aeration NA Header I Man. �� o� Holding Dist. Pipe PUMP 151PHON INFORMATION Infiltrative Surface �1•�� 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 .3' L �p' � �y$ #of Cells 3 Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav �- Conv ❑ Aggregate � , INFORMATION P/L Bidg Well Waters °� GP �c Chamber Model Number: ❑ EZFIow CELL TO � fi� �Fbo` -}-SO ❑ Mound o Other QY� — --- ----- -- ----_ --- -- - ----- DISTRIBUTION SYSTEM X Pressure Systems Only — — - CHeader/Manifold Distribution Pipe(s) �I X Hole Size X Hole Observation Pipes ength Dia Length Dia Spac ; Spacing ❑Yes 0 No � _- - ---- ---------- -- -�-- - -- __---- SOIL COVER ( Depth Over Depth Over I Depth of � Seeded/Sodded � Mulched � � Cell Center Cell Edges �I Topsoil ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ��1��1�,-( ��f g(�3 � _� Plan revision re uired?� Yes ❑ No ' � p �b 3�s-�-� '� - � -- -- 6 � s�r� Use other sitle for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A��ITIONAL C�MMENTS ANO SKETCH SANITARY PERMIT NLIMBER: �3� 30� �� --- — (,k �-- — l— \ � � 5� � �� p�1'. �..� —� ys C�' � ' �>> ( �� C�> o � , � � ��c �t l � I , �� , � �, � �� —� , y . y' a � y �' �, � ��? ' — — — _ � H �� — — — — � , ,� � 1- �� zs" � � ,�� c�,� , ,� � � i�-- � � I � ( � d�.k � `'� �` Q � �� ,� "� c �� `, �5� � � \ �� ''IY'—� ��' �,SV 6 �, a�k