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Home My WebLink About002-278-00-0400-SAN-2023-307 °'` ' ` Department of Safety c°°°�' � �� =, & Professional Services, S�^^�Ye� � :, � = Sanitary Permit Number(to be filled in by� � ', `, �= Industry Services Division �� `., - �lOo2� '� Sanitary Permit Application State Transaction Number � In accordance with SPS 38321(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit — � is required prior to obtaining a sanitary permit.Note:Application forms for state�owned POWTS are submitted to Project Address(if different than mailing ad , the Department of Satety and Professional Services.Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s. l�.04(1)(m),Stats �� . �� I.Application Information-Please Print All Information Property Owner's Name Parcel# i ��vl- �7 � ' 0 �"� �'/� � Property Owner's Mailing Address Property Location c1 H 9 lo N .SP_C�u�e d Tr� r,�Yc ��,1 City,State "Lip Code Phone Number q w 0.f�G� W= S'�a y 3 " _��, Section ��! _ [I.Type of Building(check all that apply) Lot# T Y� N R V S �-o W �l or2 Family Dwelling-NumberofBedrooms 3 � Subdivision Name B�o�k# aRo�� awE Es7�r�s ❑Public/Commercial-Describe Use �_ ❑City of _ ❑State Owned-Describe Use CSM Number ❑Village of "— �Town of__�_�5 ��- [[!.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. A� �New S stem y ❑ Keplacemen[System ❑ Other Modification[o Existing System(explain) ❑Addi[ional Pretrca[ment Uni[(explain) B' ❑ Holdin Tank ❑ Mound ❑ lndividual Site Desi g �In-Ground �.� ❑ At-Grade gn ❑OtherType(explain) onventional) C• ❑ Renewal Bef �Revision ❑ Change of Plumber ist Previous Permit Number and Date Issued ❑Transter to New Owner Expiration �ovlV• -� (iS�0a11 OG/.l7/a [V.DispersaUTreatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Glevation y SO o. cP 7�s"� �-sc� 9 0.5 8 Capacity in Total #of Manufacturer Tank Infortnation Gallons Gal(ons Units � a o � u New Tanks Existing�I'anks � o y � � � � � a. U i7n � v; u. C7 ci. Septic or Holding Tank U — QQQ � I�C SCC" K 1L Dosing Chamber V.Responsibility Statement- 1,the undersigned,assume responsibility for installation of the POW7'S shown on the attached plans. Plumbers Name(Print) Plumbers Sign re MP/MPRS Number F3usiness Phone Number Trqv:� 3v�}t��:c Id �Sa��9 7/5-G3y� 817(� Plumber's Address(Street,City.State,Zip Code) 1Y341� W S�a�-t R�ad 77 /�4y�Gr d� ws .�i8ti3 Vl.C un y/Department Use Only / Permil Fee Da[e Issued Issuing Agent Signature �Ap r ❑Disapproved $ �1i✓ ❑Owner Given Reason for Denial �O'�� << � I�' �� -r�-�-�.4��"�'A/I/w.�- Conditions of Approval/Reasons for Disapproval .�__.. 6�,�_ . , �. �, ...n. r,� �a � er� -� � 3! v ��r � � ' . � .. �' �. �� `�� --�'� _�_ 11_�_LS- a3 .._.�... `_� - ._. ___ _ � � �u ' � � ,_�i N,`�...__.. �._____. __....... - - ��P 13 2D23 �...y. C�� 3 - �� 1 � . _ � 3�1Si.o SAWYER CC�UNTY �QNIIy��QMIMSTRATI�� Attach to complete plans tor the system and submit to the Couoty only on paper not less than 8 t2 x l l inches io size ��Nti S�S r.o��F��tv��A�T:A �,\ SBD-6398(R.03/22) I�S�-��O��S�`V 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 Blackman - Brodi Ln Owner Name(s): Kyle & Gina Blackman Phone: - - Owner Address: 9496N Secluded Trl ; Hayward, WI Z�p; 54843 Project Address: 9324N Brodi Ln Govt. Lot: 1/4 of 1/4, Section 04 , T 40 N-R �9 E�or W � Township: Bass Lake County: Sawyer Project Parcel ID #: 002-278-00 0400 Designer Information DesignerName: Travis Butterfield Phone: 715 _634 _8176 Designer Address: 14346W State Road 77; Hayward, WI Z�p; 54843 E-mail: office@butterfielddrilling.com License Number: 652879 Remarks: Signature: Date: � ' , Z3 Original signature required on each submitted copy. / ` � � , . ' w D p v i� O -p -{ f� r .9 ` �,,� v 3 r 3 � E � °+ W � ` �� d a Rf " t QJ Cl \ ' � .p .o a G D � p a r � Z r�.. � � .c c o -1 � � o rn \ o, v �t a o � v i p � m w y� Q v N p r -� �� \ 9 � '�" k ,� + Z � � r Z Z � .� \ Q' p P � If •" �• � ` � � � � � o tr (— `C � t p � 1 � � . \ O� v \ O� � rn � � o � N q In \ '91 p e ,9 ;,� \ Q 3 a Rq � � � � N N ul � ,� \ �� i � 'a P e p� � "o , \ O rt a d N � 6 \ <�� \ o � � � � $ � � � Y w T A 0 � 90,•O4' \ \ T w r S t z A Q t. � V \ n � 3 9y ae. P �tl � \ � � < o. � �w, E'> �v y \ W w9 � s � � �� < p ��f P �� \ N' '� � rv,� 3r• ' � � � ` b. J �� y. � �S • a C° � .' -j4 � a � 3 r „ „ .r�'w * T j t 3 �,�Qm �� p , � � � � � IQl , �_•y �� ' o a i+ F,n � _._ ao IN-GROUND GRAVITY DISPERSAL AREA SepticTank(s) Manufacturer Wieser Concrete Inc Uniform Elevation Trenches with EZ1203HP Bundles SepticTank(s)Volume(s)� 3-ft Trench (down-sizing credit) �000 gal gal gal gal Etfluent Filter Manufacturer. Best Technoloqies � m�. �z• etn�e�t Face�Modai�: GF 10 Geotextile I (rypical) Caver SOILCOVER TYPICAL TRENCH 'r CROSS SECTION VIEW min. trench � s � depth • ��,Pi�� _ T _ — � ,,• . (No Scale) OBSERVATION PIPE DETAIL n. .. (No scale) System Elevation/90�58 ft. ` �• � siiPcso Poosa� FiniehetlGrsde (rypical) Provide minimum 3ft �m��,aaasa�,�e� separation between trenches. a^mPvcv„� roP��co�a� Top ol pipe to tertninala (min. 1 loot) at ora0ove finishetl gratle (4�1/4"-1/ "X6"Sbb TYPICAL TRENCH (Show location of inlet / ounet pipe connection on plan view.) �9� eaan PLAN VIEW A��ho��g �� f�n�,�o� 4�� Observation piPe shall be ins�allatl Sudace (No Scale) atjundionGetwaentwounHs. �Q ft Perforated Lateral Observation Pipe �tYPical) (ryPical) — — (typical) �- - - - - - - - - - - - - - - �� - - - - - - - - - - - - - �_`_� � � :_____ :___:__= I A - 3.0 ft D :-___ __ ___ _______ :__'____ � - - - - - - - - - - - - - - - -�� - - - - - - - - - - � (h'Pical) � - - - - - - - - - m � B = 50 ft --=i C,,) (typical) INSTALL PER TRENCH: EZ1203H Bundle � (typical) � 5 10-ft bundles @ 50 ft� EISPJunit = 250 ft' (mfd by Infiltraror Systems, Inc.) Install pursuant to manufacturers instructions. + � 5-ft bundles @ 25 ft EISA/unit = � ft' = Proposed EISA per trench = 250 ft' Required Infiltration Area = 750 R' Distribution Method: x 3 trenches = Proposed Total EISA = 750 h= branched manifold � PAGE40F4 in-ground Gravity Management Plan IMPORTANT: The owner of this in-ground gravity system shail 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 Disaersal Area Oneratinq Limits: Design Flow= 450 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, efc.) o mechanical malfunction (i.e., pumps, valves, switches,floats, etc.} o matenal fatigue(i.e., leaks, breaks, corrosion, efc.) 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 distribu5on 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 Seatic and dose tank(sl shall be pumped by a certfied 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 Iiquid 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 filteHsl shall be inspected every 3 years and shall be deaned when necessary to remove any accumulated solids according to manufacturer's spec�cations. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local govemment unit in accordance wkh SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: BUttEffl@Id if1C Phone� 715-634-8176 �ocai 9ove��me�t��t: Sawyer County Zoning & Conservation pnone: 715-634-8288 _ �oca� govemment unit address: 10010 Main St, Suite#9; Hayward, WI Z�P: 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 w physical restoration of the POWTS may be used unless approved by the departme�t 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. �=�"'""� PRIVATE ONSITE WASTE TREATMENT County � � � SYSTEMS ��'%;��$�s� ��`� ( POWTS) SaWyer ti �- �%�' ' '�'� INSPECTION REPORT sanitary Permit rvo: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �. 3 -30� Personal infonnation you provide may be used for secondary purposes[Privacy L.aw,s. 15.04(1)(m)] Permit Holder's Name: ❑City ❑ Village � Town of: State Plan Transaction ID#: � � �`i,1hA 111aC.�t�a� 1�aj5 �-r'^� ^ Insp BM Ele : ' BM Description: Parcel Tax No: �oo.a �a�r-. �� s,��n �� -Z�B—a�- oYo a TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �,�,ie,��- c7b�p Benchmark ��o .d� Dosing Aeration Bldg. Sewer `�6 •S � Holding St/Ht Inlet qS;g � TANK SETBACK INFORMATION St/Ht Outlet q��{ TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet AIRINTAKE Septic a-�� S� ` � NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. �I�6 � Holding Dist. Pipe PUMP 151PHON 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 ,3 L�' �' a #of Cells 3 Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav �C Conv ❑ Aggregate INFORMATION P/L Bldg Well Waters � IGP ❑ Chamber Model Number: ❑ AG � EZFIow CELL TO �' ¢-�� ,/ ❑ Mound � Other -- _ _---- -- — ----- _ _ __ DISTRIBUTION SYSTEM x Pressure Systems Only --- __ - Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes � Length Dia �Length Dia Spac ! Spacing ❑Yes ❑ No� - - - --- — � __-- -- -- SOIL COVER ( Depth Over Depth Over I Depth of Seeded/Sodded Mulched Cell Center �ell Edges � Topsoil ___ � ❑Yes ❑ No �❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) �I��(� (a(ac (�.3 _ _�-_-� �-_ _ � Plan revision required?�Yes � No 03 ��'I�Y � � � G�'-(�j� �_1`" �'� �/(/v � � ! � -- --- --- 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:____��_30�____ , . _ _: . . _ _ _ � _ . : . . , ; ' _ ' . , ; .._ . . _, : : . .. _ _; _ �__ , �_ �'6S� r � I �� $ _ �� ►., . , �b. w�- 4(� 1��. 3, I , �, �. , / Y 1` �o 5a`�� I 3 (�c . 6� '' �, � �. t-- ��--� ��- , � �� bo� 3 �� 6a�� ,` l'" � r � ��-�