HomeMy WebLinkAbout028-642-36-5313-SAN-2024-004 ���'` '<%� Department of Safety c°"°ty �
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� i ,=�, & Yrofessional Services, , Y �
� $� - Sanitaq-I crmit Number(to bc i�illed in b}�G
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State Trai�saction Nwnbcr �
Sanitary Permit Application
In accordance with SPS 383.2112),Wis_Adm.Codc.submission of this fr�rm to the appropriate bovernmcntal unit �� �
i;reyuire�E�rior to obtaining a sanitai}�permit. Note:Application ti�rms for stttte-owned POW I�S are,ubmitted to Project Address(iY diflcrent than mailin�ad
the Dep�rlment ofSafety und I'rofes�ional Sen�iccs-Pcrsonal information��ou proride ma��be used for secondary
�iurposes in uccordancc with thc Privacy La�v,s. 1�.0-l(1)(in).Stati. �� ���� ����„� (,��
L Application lnformation-Plcasc Print,�ll Inforniation
��v
Properm O���ner',Name Parcel#
�et-ad � :ra. rl � d Oo18-Gya.- 36 5313
Propcity O�vner�s Mailine Address Propert}'I.ocation
1 E � bv C t U�,�.��� 3
City.Stnte Zip Codt Phone Nwnber
A rn �A 5bOc11 " -�=—�,, s�<<��,�, 3�
11."I'p�pc of 13uildinh(chccic all that appl��) I.ot#t � T yo� N R O�i ta� �'
�Ior2l�amil� D���ellina-NumberofR�droom; 3 Subdi��isionName
k;lo�k r
❑Public/Commercial-Describe Usc
� ❑Ci[}'of_
❑State O�cned-f)escribc llse CSM Number ❑VillaQe of
+i S YB 9 r�,,,,,�,�
v. .�b . 3�3 � _ sP��+�r_LaKc_ _
111.'1'ype of P0�1'TS Permit:(Chcck cithcr"\e���"or"ReplxcemenC'and nther applicable on linc:�. Checl:one bo�on line I3.Complete line C if
a licable.)
1.
�New S��stem ❑ Replacement S��stem ❑ Odier Moditication to Existing System(explain) ❑ Additional Pretreatmcnt Unit(explain)
�' ❑ Mound ❑ Indi��idual Site Design ❑ Other"�ype(expltiin)
❑ Holdin�Tank [irGround ❑ At-Grade
(conventional)
��• ❑ Rene��al Before ❑ Revision List Prc��ious Permit Number and Uate Issued
❑ Chan�e uf Plumber ❑ 'l�ransfer tu Ne�c O�cner
Fxpiration '—
IV. Dispersal/I'reahnent_lrea and Tank[nformation: � a, Q�:C K 4 �1.�� CY►cL.-+�,ijLrs W/c� Se�'8 efen d S
Desi;n I 1o�� (,pol Design Soil.�pplication Ratelgpd',t) Disper,al.�rea Reyuired(,f) I)ispersal Arca Pruposed(sl) S��stem Lleration �
yso 0•7 �y3 !os""� � 9y.sz�
Capacih�in fotal #of Manufacturer
J G
Gallon� Gallons llilits � � � �
I ank Information � � � ,�
\'c�v"I�anks Iizistin�=Ta��ks —y � o ` J � ;� �
-. U v; r�n v: �[i U I a.
Septic or Holdin��Tank �� ,� ���� �
' (,a�:GS¢f C�C�t �C"
Dosin��Chantber
V.Responsibility Statement- 1,the uudersigned,assumc res ility fm•install• im f the YON'TS sho�r�n on[he attaclicd plans.
Plwnhers Name(Printl Plumbcr-s Si uc MY/�1PRS Numhcr Busine;s Phoiu Number
T%��5 C3�+�1-«�'rc !d �sa879 7/S-G3N-817(0
Plumber's Addres5(Street,Cit��,State,7ip Code)
ly3'�Gt�S ..St-+��-c 2oad '77 I-�aYward� I.us Sz/g�13
VL Cou h�/Department Csc Onl��
Permit Fce Datc lssued issuine A�ent Sianature
��� � �z ❑Disap��roccd � _ _ _ _
❑O��ntr Gi��cn R�ason for Denial ��•� �� ����`� ������
Conditions of Approval/Reasons for Disappro�al � ,—�
; !F"+ , � D � � � 1��;��� ,
�,� ' � � r . � ( �.7I�� `"_!!I E
�
,����_.,..,�-.: _a.L,e..L�.._ ,_.....__. �; E
` W �� � d ..� W� . 3��. 3 .�AI� � 2 ZQ�� � ;
.hk y a.. ._.
C✓� � I r D � � 1 �� ,�ON N��R COUNT�Y
attach[o complete plans for[he system and subuiit to�he Countl�only on paper not Iess than 3 1/?s 11 inches in size � 3 r� �
- Eti�^. �!LFl1l��i a��l'�R
sBr�-�39s�R.o3iz?� !S�l1�CI4��r��1�i'
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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
Hyde - Scheers Rd
owner Name(s): Jerad & Kimberly J Hyde Phone: - -
Owner Address: 1617 NE Pittsburg Ct; Ankenny, IA Zip: 50021
Project Address: 12315N Scheers Rd
Govt. Lot: 3 1/4 of 1/4, Section 36 , T 42 N-R 06 E ❑or W ❑✓
Township: Lenroot County: Sawyer
Project Parcel ID #: 028-642-36 5313
Designer Information
Designer Name: Travis Butterfield Phone: 715 _634 _8176
Designer Address: 14346W State Road 77; Hayward, WI Z�p; 54843
E-mal�: OffIC@@bUtt@�12�C�C�r1��111g.COI71 'Tllis spaee reserved for appro��al titainp.
License Number: 652879
Remarks:
Signature: Date: o� /09 /ay _
O nal signature required on each submitted copy.
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Septic Tank(s) Manufacturer: '
IN-GROUND GRAVITY DISPERSAL AREA wieser Concrete Inc
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:
Best Filter LLC
I
Etf�uent Fi�ter Mode� #: GF10
min. 12"
SOIL COVER (typicap
12"
min. trench
de pth •
c�vp��ao '� < � TYPICAL TRENCH
� • . -' �� �� ��°�.a� � <. CROSS SECTION VIEW
�— 34�� �` . �e� �� � (No Scale)
��Ypical) •;'a . .
n ° • ' a
. • •" Provide minimum 3 ft
System Elevation — 94.50 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)
Installpermanufacturer's PLAN VIEW
instructions.
(No Scale)
� - - -. -.- - - - - - �� - - - - - - - �� - �� �, _ - - . -- �
� � ��,� ,7 , � ���� , ` � A = 3.0 ft
`' �,.�_ � (tYPical) �
_ .
� - - - - - - - - - - - ��- - - - - - - - �� - - - = - - - - � �
_ � G�
g = 67 ft m
(typical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (typica�) �
(mfd by InfiltratorSystems, Inc.) �
Install pursuant to manufacturer's instructions.
16 Quick4 Std-W @ 20 f� EISA/chamber = 320 ftZ �
+ � Pairs of end caps @ 6 ft2 EISA/pair = 6 ft2
= Proposed EISA per trench = 326 ft2 Required Infiltration Area = 643 {tz Distribution Method:
x 2 trenches = Proposed Total EISA = 652 ftz 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 pertormed by a registered POWTS Maintainer in
accordance with SPS 383.52(3),Wisc.Admin.Code.
Maximum Dispersal Area Operatinq Limits:
Design Flow= 450 9pd; 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,efc.)
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 surtace 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: BUttECfl2Id IIIC Phone: �15-634-8176 _
�o�ai 9o�e�nme�t�na: Sawyer County Zoning &Conservation Pho„e: 715-634-8288
Localgovernmentunitaddress: �OO�IO Malll 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.
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.
System Abandonment
If use of this POWTS is discontlnued,it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code.