HomeMy WebLinkAbout024-741-06-2317-SAN-2023-305 ` Department of Safety c°°°ry � 1
, ,,, S�.W G� I
� = & Professional Services, �
= �\�' - Sanitary Permit Num er(to be filled in b}
,r, : ; _ Industry Services Division
'�:�,; w (�o S i � `� 3 w
�,.�,.�,:�-�-�
Sanitary Permit Application State Transaction Number �
In accordance with SPS 38321(2),Wis.Adm.Code,submission of this fomt to the appropriate govemmental unit �
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS aze submitted to Project Address(if different Ihan mailing a_._.,..,
Ihe Department of Safety and Professional Services.Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law,s. 15A�1(L)(m),Stats. .�--���, ��
1.Application Information—Please Print All Information
Property Owner's Name areel#
oay-�y�-a� a3�7
Property Owner's Mailing Address PropeK�atiQn C
�
�3 0�7 nt l.ars r� R ��",t
City,State 7.ip Code Phone Number
S W %, N UJ y,, Section�_
I�►� ���a w= svay3
II.Type of Building(check all that apply) Lot# T N R O� E-�r
�l or2 Family Dwelling—NumberofBedrooms 3 � Subdivision Name
Block# /b.yG s.c re. pcartGl
❑Public/Commercial—Describe Use
^ �Ciry of
❑State Owned—Describe Use CSM Number ❑Village of
�' �Townof �t>uvd Ln�C.o
Ill.Type 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.
'4" �'New S stem
y ❑ Replacement System ❑ Other Modification to Existing System(explain) ❑Additional Pretreatrnent Unit(explain)
B.
❑ Holding Tank �In-Ground ❑ At-Grade ❑ jvibund ❑ Individual Site Design ❑ Other'I�pc in)
(comentional)
C• ❑ Renewal Before ❑ Revision ❑Change of Plumber ❑ Transfer to New Owner �st Previous Permit Number and Date[ssued
��
Expiration
IV.DispersaUTreatment Area and Tank Informallon: S : ti P��S w/ �f s.�d
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
ysv o•s �'t0o 9 t � 9'i.00 `
Capacity in Total #of Manufacturer
�
Gallons Gallons Units � o 'n u
Tank Information a v � N
New Tanks Existing Tanks � o _ 2 Y � �° `�
a U v� �, �r: i:., C7 a,
Septic or Holding Tank '� �U � ��� � �G �C.OIICK�G !�
Dosing Chamber
V.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumbers Name(Print) � Plumbe ' Signatu MP/MPRS Number Business Phone Numher
Tra��+�. VV T7�.rT„t 'V r `` �7OiCJ7 / ��S�GJ��L)� I�
Plumber's Address(Street,City,State,'Lip Code)
1 y3 yG w 5}�.+� R e ad 77 �-/4 wa r�, w a s�a y3
V I.Co n /Department Use Only
�App ❑Disapproved Permit Fee Da[e Issued Issuing Agent Signature
O Owner Given Reason for Denial $�w•� � ''''�l`l 3 �����,'u'e'�'e.��V[/1'✓1�
Conditions of Approval/Reasons for Disapproval
..� � � � p �y '� , .''....� �: .. ,
!
� �- S � r —�',\i �!� �I
� W ir��� ��W�a � . .�.�.......I _.....e_.-., f— '� '— �l ,
` � � -_�1.�.�...�3 � .
� NQV ��
; ,,} 3►��_.m...._..,.L..�.m_,.�... 1 3 20�� �-
:�.�___..---
C�ST �-3- 2-t��� 3-,S - - --
I sAwY�r� .>��f�3��r.r_
ZONING ADMlry ` �
Attach to complete plans for the system and submit to the County only on paper not less ffian 8 1rz x ll inches io size
�13��`/�
rsc�?������:a.�=rr�
SBD-6398(R.03/22) (JJ�J�U�('cF�t1i;1�i
r����
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
SHU-BEN LLC-Tart Rd
Owner Name(s): SHU-BEN LLC Phone: - -
Owner Address: 13027N Larsen Rd ; Hayward,WI Z�p; 54843
Project Address: Tart Rd(no address yet)
Govt.Lot: SW 1/4 of NW 1/4,Section 06 T 41 N-R 07 E❑or W ✓❑
Township: •Round Lake County: Sawyer
Project Parcel ID#: 024-741-06 2317
Designer Information
Designer Name: Travis Butterfield Phone: ��5 _634 _8176
DesignerAddress: �4346W State Road 77;Hayward,WI ZiP; 54843
E-mail: office@butte�elddrilling.com ��« � ��-�,� � .. __ ,
License Number: 652879
Remarks:
��� . �� �3-a 3
Signature: Date.
Ori inal signature required on each submitted copy.
SCA LE = I : y O "° '� "° s° ao �LD7 ptp, �
�
STs IpUU94,�, P ,.��O,b CvnC^eFc Sap}�a }-o„�x �s.4de
SW�/v � Nw'/y by W.�r�e� C..�.t.s�t /•.� w/ Bcsf 6F/O Fi ��C.('
5�e. 06 . T41N � R 0 7 W
Town o� Re�..d �,aKc AGi > LlbSue�f:m Arpa cw�t:e�A-r� aF' 3ee)/s{�accd
� 3FF apaca, Co+.}o:�n:..y a �e�e.\ e� '-/s O�:�xY
54wytr G„�,�.�y Plrt Chaw.ltrt
Pal . Oay�74/ - O(n J31'7
3n: NA:� w�R'•bb.,., :n �
15" ow< Trcc
E L E V A T � O N 5
1. DM 1 0 �, . ou F� 9g BM
a� g � . � � FE
�°�� s
6� 9 S . f7 F(- ��
D3 47 . 67 C � g� � -
�
Aq
�
4'��JGSe.ti46 D3
RltHc89� —3
� �^ST
d•
�
�repe,SF.e
a oa�
��� ����y
��/ �// uR
'��✓�5 /> �i'�"��`'�� �repexd _ • ,y@,,, y'�h�,4p.,p
�/y�/!�S d 6 S�d�7 t�1 i �: t
PQye a �' `1
Septic Tank(s)Manufacturer.
IN-GROUND GRAVITY DISPERSAL AREA WieserConcrete�nc
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Vdume(s):
3-ft Trench (down-sizing credit) �000 gal 9a� gal gal
Effluent Filter Manufacturer:
Best Technoloaies
I
Ertwer,�F�icer Modei�: GF10
min.12"
SOIL COVER (rypl���
12•
min.Venc�
depth
�ac��n � TYPICAL TRENCH
—— a CROSS SECTION VIEW
F---�. .
�cYP���> (No Scale)
� , Provide minimum 3 ft
System Elevation= 94.00 ft separation between trenches.
(typical)
Quick4 Standard-W
w/End Cap Observa[lon Plpe
(typical) (Show location of inlet/outlet pipe connection on plan view.) (ryp�caq TYPICAL TRENCH
InstallpermanWacturefs PLAN VIEW
— "�,. ——_ —__——— —__�x�� �����no�s. (No Scale)
r ��— ��— �
���' ° � . , � � �"_,p1 A=3.Oft
L , �,�, - .. � ":.-3 �� ����.�� (ryPical) �
------��-------��---- -- — D
� B= gg ft _=i G�
m
�ryP���� Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (typlcal) 0
(mfd by In£Itrator Systems,Inc.) -n
Install pursuant to manufacturefs instructions.
15 Quick4 Std-W @ 20 ft�EISAlchamber= 300 ft� �
+ � Pairs of end caps @ 6 ft�EISNpair= 6 ft�
=Proposed EtSA per trench= 306 g� Required Infiltration Area= 9�0 ft' Distribution Method:
x 3 trenches =Proposed Total EISA= 9�$ ft= 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 pian.
Furthermore, all inspection a�d maintenance activities shall be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3),Wisc.Admin. Code.
Maximum Disaersal Area Ooeratinn Limits:
Design Flow= 450 gPd; BODS<_ 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 fadors(i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches,floats, etc.j
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids vo�ume 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 celi 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 tankls)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 (1l3)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 filterls)shall be inspected every 3 years and shall be Geaned 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: BUtt@i'fleld if1C Phone: 715-634-8176
�o�ai 9o�er�me�t���t: Sawyer County Zoning & Conservation phone: 715-634-8288 _
Local government unit address: �OO"I O M81Ct 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.
Continpencv Pian
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 P01M�S is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc. Admin. Code.