The URL can be used to link to this page

Home My WebLink About010-941-33-3101-SAN-2023-303 �',��'� ��"`' � De artment of Safe c0u°�y � �� p � Sawyer _ � 9 = & Professional Services, �;�� $ - Sanitary Pcrmit Number(to be fillcd in b�� ' � P� �_' Industry Services Division � ;; �,�_._ � .' (p `j � (D� � W yt\41��t-.�l�. ��_�v� Sanitary Permit Applicatiion state T`a°sa°t'°"N�"'ee` �;,� r--- In accordance with SPS 38321(2),Wis.Adm.Code,submission of d�is form to the appropriate eovernmental unit � is required prior to obtaining a sanitary pennit. Note:Application Yonns for state-owned POWTS are submitted to Project Address(if different than mailin�ac (,�1 the Department of Safety and Prolessionai Scrvices.Personal infonnation��ou provide ma� be used tor secondary purposes in accordance with the Privacy La�v,s. I�Od(1)(m),Stats �" 9803 State Hwy 27 I.Application Information-Please Print All Information Property Ownei's Name Parcel# JEFFREY D&JENNIFER L BOSWORTH 010-941-33-3101 Property O�vner's Mailing Address Propert��Location PO Box 498 C� City.State Zip Code Phone Number Hayward , WI 54843 ,SW y,S�S�✓ ��, se�t;�„ _ 33 lI.Type of Building(checic all that apply) l.ot# _ T 41 N R 09 E o W � 1 or2 Family D�rclling-NwnberofE3edroums 2 Subdivision Name �� Block# ❑Public/Commercial-DescribeUse — ❑Cit}'of ❑State O��med-Describe Use_ CSM Number ❑Village of � 0 T��.,,,�,t Hayward lll.Type of PO«'TS Permit:(Check cithcr"New"or"ReplacemcnY'and other applicablc on line A. Check one box on line B.Complete line C if a licable.) 1. ❑New S�stem �Replacement S}°steiu ❑ Other Modification to Existin�System(explain) ❑ Additional Pretreatment Unit(explain) B. ❑ Holding Tank In-Ground ❑ At-Grade ❑ Mound ❑ Indi�°idual Site Design ❑ Other'Cype(explain) (conventional) C• ❑ Renewal Before ❑ Revision ❑ Chan�e of Plumber ❑ Transfer to New Owner ist Previous Permit Number and Date]ssued Expiration Couldn't locate --- 1V.Dispersal/Treatment Area and Tank[nformation: Desien Flo�c(opd) Desien Soil.Application Rate(epd/s� Dispersal Area Required(s� Dispersai Area Proposed(sf) System Elevation 300 0.7 429 Y 94.0� Capacity in Total #of Manufacturer Tank Information Gallons Gallons Units p � o � � Ne�v Tanks E�isting Tanks � � � � � � ro � o y � a U c� � v� u: C7 0.. Szptic or Holdino Tank 75O 750 � WIESER CONCRETE X Dosing Chunber V.Responsibility Statement- I,the unde�signed,assum esponsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumb� Sianatur MP/MPRS Numbcr Business Phonc Nuinber Travis Butterfield j� 652879 715-634-8176 Plumber's Address(Strect,City,State,Zip Code) 14346W St. Rd. 77, Hayward, WI 54843 VL C unt�/Department Use Only �A�� 6 � ❑ Dis�pproved Permit Fee nate issued Issuino AQe�u SignaWre (�/ L- -�� ,�e.e� ❑OUTicr Given Reason for Denial � l�•r �� ) /��3 i� � Conditions of Approval/Reasons f'or Disapproval �`��`f 4' t` / �i`.'-..., � �`�-'��!, ��.,=�-'--,'i' ° �� '�� .�- ��,�.,..�.�.�3.�.--��- _ ,@, �� .. . . , �}y 3 . NOV 1 3 2023 C s,..r 2��21 �y�)��) 'hk�....�.�.___�- , ,y 4 'G./ ` ��V W �e...-.�...._...� C�ft\�'�d IF f� �r 1 .i '.��. �7Y� "� � � t�� 7 7 Zo�ii�i(.Y L'/��',; . . Atmch to cmnplete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size I 3�:.Co G sB�-639s�u.o3izz� R!0 F?4Ft1�!�£J�,�7�� ISS�.;�J��;`��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): JEFFREY D & JENNIFER L BOSWORTH phone: - - Owner Address: PO BOX 498 Zip: 54848 Project Address: 9803N STATE HWY 27 Govt. Lot: 1/4 of 1/4, Section 33 , T41 N-R09 E❑or W ✓❑ Township: Hayward County: Sawyer Project Parcel ID #: 010-941-33-3101 Designer Information Designer Name: Travis Butt field Phone: 715 _634 _8176 Designer Address: 14346 W State Rd 77 Zip: 54843 E-mai�: office@butterfielddrilling.com �r�„5 s��a�e r��r,;zd,U,�a�,��,��cl� �tar„p License Number: 652879 Remarks: Signature: Date: I/�/,, �2-3 O ginal signature required on each submitted copy. CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. � SOI L EVALUATION o Scale: 1so so' go �Zo � SYSTEM PAGE 2 OF►t} SITE MAP PLOT PLAN PROJECT NAME: �5z DESIGN FLOW: �� GPD �Q I-t�� } -��i!'�l1Er (i-�SW�r r ` Attach design flow calculations for commerciai plans. PROJECT ADOREss: /g03 N 5�,� �w� '?� Pipe Material/ASTM Standard(Tables 384.3D-3&384.30-5) N Sanitary Sewer: Y�S� ��/ BM Sym6ol:� BM Elevation: �V�' � FT Force Main'. / BM Description: �� ^ �� O�� Slo e Gradient % Indicate north by IMPORTANT: P ( 1 Well Symbol(if applicable): � drawing an arrow Show ground elevation contours at suitable intervals. of Tested Area: on the approprite line. ��e � — � N� � �� l o� � � � I w z , 4� �. � v � � � A � . ,,�"� � I� � � � ��'�y �3��;�-- ��5�� o �,� y�8 �� u��e�- <�-�� f�a y w� �C`�y �yd'Y3 aa Q��c� Y �lKs cG�.��-- Srs�e.-. l�'c_ 9Y,o SP� 3� T Y��11 �?�9w T�,,, °� �`y`''`�� l3es� �'�l/�' � p/o5 Y133% ��/ �i �rM -��,� �1u�� j,,, ` U ��V � � _. I) 9�� r a) 9�, s 3 97,5( J��—Av��S l��—�'�'�� 'e�� #�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) 750 gal gal gal gal Effluent Filter Manufacturer: Best � Efri�e�t F�ice�Modei#: Gf10-8 min.12" SOIL COVER (typlcal) 12" min.trench de pth criP��a�� < TYPICAL TRENCH - a �. CROSS SECTION VIEW . < . . .a 34" ' � (typical) a' ' �NO SCa�@� e a e ' Provide minimum 3 ft System Elevation — g4.00 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.) (rypical) Install per manufacturers PLAN VIEW instructions. �NO SCB�e� � I�M�IP'X1lflt' - - - - �� - - - - - - - �� - - - -.— ,y�'wM'�ar'+�,t'�`Ml►- - , � ��,' �4.�.,�: a� ��..�� ffi� �� .� , ,G ��a ,,�°�+ n.�� A= 3.Oft � �NX_�i�_�4�.�f— — - — — — — �� — — — — — — — �f— — — — ��e $Riio��r�rl�iti�_ � (�YPical) �-� UJ ��- B = 44 ft —� �l (rypical) Quick4 Standard-W Chamber W (typical) O INSTALL PER TRENCH: i 1 a (mfd by infiitrato�sy5tems,i��.) —n � "`' Install pursuant to manufacturer"s instructions. � Quick4 Std-W @ 20 f� EISA/chamber= ftZ + � Pairs of end caps @ 6 ft1 EISA/pair= ftZ = Proposed EISA per trench= ft2 `�� Required Infiltration Area= 429 ftZ Distribution Method: i-/ � x � trenches = Proposed Total EISA =�, ftz �� 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 io 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= 300 gpd; BODS 5 220 mgL"'; TSS <_ 150 mgL-'; FOG 5 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: TfaVIS BUtt2tfl@ICI Phone: 715-634-8176 �o�ai go�ernment un�t: Sawyer County Zoning & Conservation Pnone: 715-634-8288 �oca� 9overnment 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), 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. Continqency 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 �-��QSp ,��; SYSTEMS ��,� s ,_ ( POWTS) Sa.Wyer �_ ,,;�.,� ��.�. �Fk --,Y�� '`-"'��'y' INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION e� '� _,3a3 Personal infonnation you provide may be used for sccondary purposes[Privacy Law,s. l�.04(I)(m)] Permit Holder's Name: ❑City ❑ Village [�Town of: State Plan Transaction ID#: �x.�c`� Y�2Hv�:�'�aSwa�l� �aty�.rc�- '_ Insp BM Elev: BM Description: Parcel Tax No: (po.o' Na,< i,� ��` o �U �,�, �It� �Y(-33 ^ 3�0 ) TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �„��eSs�f" ��j Benchmark �oa.o' Dosing Aeration Bldg. Sewer ,6 � Holding St/Ht Intet � TANK SETBACK INFORMATION St I Ht Outlet �.�^ 3 r TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIR INTAKE Septic �-�o f-�S l6 }-{6' NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. �S c�� Holding Dist. Pipe PUMP I 51PHON INFORMATION Infiltrative , Surface �`r•� 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' �(�' #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate ��, INFORMATION P�L Bldg Weli Waters °� GP �C Chamber Model Number: ❑ EZFIow ❑ Other CELL TO h_� 'f-�-S Sb !� ❑ Mound Y f- _ —. _..- - -- - -- -- - ------_ --- DISTRIBUTION SYSTEM � (', X Pressure Systems Only -- Header/Manifold Distnbution Pipe(s) i X Hole Size , X Hole Observation Pipes Length Dia � Length Dia Spac _ I j Spacing ❑Yes ❑ No - - -- SOIL COVER — -- -- fDepth Over Gepth Over Depth of Seeded I Sodtled Mulched Cell Center �Cell Edges �I Topsoil � ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) �.ti,s�(�� 2��9(�3 __ - �_, �__— _ Plan revision required?❑Yes❑ fJo I o3 I�5-II,Y I, '�� I ��' � �� I� -- - - Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A�OITIONAL COMMENTS AN� SKETCH SANITARY PERMIT NUMBEfl: � 3' 3�3 `(�� Y7. � � ��1 • a , w� �� Q,��. S, � �, �o� f ��C.. �� • � i6` � I , y `�� ,�yQ, � . i i �L, i I S�`� W � �,.�.,Q- �^ � \'� �- ` ' �'�V c��P\�` �,��. �P� �� `' 3� �4 �R�aan� �a " �S ��, �7 � \b �—