HomeMy WebLinkAbout010-277-00-3400-SAN-2024-010 -�> �''' ` � De artment of Safe �°°°`y c/'
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$� ' Sanita�y Permit Number to be tilled in by C �
� � g Industry Services Division
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SaI1ltaly Pe1'1111t AppllCat1011 State��ransaction Number �
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In accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis fonn Lo the appropriate governmental unit d
is required prior to obtaining a sanitary permit.Note:Application fonns for slate-owned POWTS are subinitted to Project Address(if different than mailing ad�.,..,.,,
the Department of Safety and Professional Seivices.Personal information you provide may be used for secondary
puiposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. ��i C'��Cd1 I f�'� ��
I.Applicatioo Information-Please Print All Information
Property Owner's Name arcel ti
c -� e�n : �.owrn�n O► O- a� 7-�O'3`-�OU
Property Ownei's Mailing Address Property Location
1 q � Govt.Lot
City,State Zip Code Phone Number
5�' �au,I , Mnl ss►o5 _ _�i4, �i, se�r;o„ --19-�
II.Type of Building(check all that apply) 1_ot�s f L/1 N R U B �o W
'�I or2 Family Dwelling-NumberofBedrooms_ � 3 y Subdivision Name
���>�k� NArCi-lEriY G2�E<< Ua
❑ Public/Commercial-Describe Use
�— ❑City of
❑State Owned-Describe Use __ ____ CS'�1 Number ❑Village of
,_ �(l�oN�i of_ �LtYw��� - -
IIi.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one bos on line B.Complete line C if
a licable.)
A �New System p Y� � Y � P ) � p� )
❑ Re lacement S ytem ❑ Other Moditica�ion to Existin S stem ex lain U Additional Pretreatmeut Unit ex 11in
B' ❑ HoldingTank �In-Ground �/�'�� ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑ Other'Cype(cxplain)
(conventional)
C. ❑ Revision List Pre��ious Permit Number and Datc[ssued
❑ Renewal Before ❑ Change of Plumber ❑ Transfer to New Owner
Expiration �-
IV.Dispersal/1'reatment Area and Tank Information: u�GK �1 P 1�S Cb►a,rw h �.+/ a 5 t a F t s��
Dcsign Flo�v(gpd) Design Soil Application Rate(gpd s� Dispersal Are1 Requircd(sf� Dispersal Arca Proposed(s� System Glevation
y50 0.'7 �Y3 Gsa � 93 .00 '
Capaciry in Total #of Manufacturer
Tank[nformation Gallons Gallons Units � a U '� �
New Tanks Existing Tanks � o a; � � p � �
Co r►ao �. � � �, � �, c� a
Septic or Holding Tank � o o O � f�o O
; �r
Dosin,Ch�mber �D�� �(,�� /� � �
- W'v� K�-t
V.Responsibility Statement- I,the undersigned,assume responsibility for installation of the PO�VTS shown on the attached plans.
Plumber's�'ame(Printl Plumber's Signat � MP/�1PRS tiumber E3usines,Phonc i�umbe-
� �_ � -� � -
c�c.v�s S3�}}t rE;Y ) � t�->L==-'� -, CoS�8^79 7�S-G3y - 6/7(0
Plumber's Address(Sreeet,Ciry,State,Zip Code)
/ �/3 y�t,.�t S�c.+c R�a�+ '7'7 Na �a�d w s Sy 8 y 3
VI.C unt /Department Use Only
� Perrnit Fee Date Issued Issuing At�*ent Signiture
�A n � ❑Disapproved
❑Owner Given Reason for Denial $ ����� ����-�� � �� ��2�'���
Conditions of Approval/Reasons foi•Disapproval
I �; ' f•,�\•- ��
� � ��� �� A � � �-� l.a:y i :-:j___�/ � : ____:..
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_�k�° � ..._.,__._ .._ �
�ST �—`-( � ��� ��� � _ . _ _ _
��;�s.
Attach to complete plans for[hc system and submit to the County only on paper not less than 8 I/2 x 11 inches in sizc
NO RCFUNDS AFTEA t13.���°
sB�-�39s�R.o3iz2� ISSUE OF PERMIT
PAGE 1 OF 5
In -Ground Dosed -Gravity Plan
Index & Cover Sheet
Component Manual Design References:
In-Ground Soil Absorption for POWTS Version 2. 1 (May 2022-2027)
Pg 1 of 5 Index & Cover Sheet
Pg 2 of 5 Plot Plan
Pg 3 of 5 Dispersal Area Cross-Section & Plan View
Pg 4 of 5 Pump Tank Specifications
Pg 5 of 5 Management Plan
Attachments : Enclosures :
Pump Curve POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Lowman - Birken Trail Rd
owner Name(s) : Daryn & Jennifer Lowman Phone : - -
Owner Address : 1602 Palace PI ; St Paul , MN Zip : 55105
Project Address : Birken Trail Rd
Govt. Lot: _1 /4 of _1 /4, Section � 9 , T 41 N-R 08 E ❑or W ❑✓
Township: Hayward County: Sawyer
Project Parcel ID #: 010-277-00 3400
Designer Information
Designer Name: TraviS Butterfi2ld Phone: 715 _ 634 _8176
Designer Address : 14346W State Road 77 ; Hayward , WI Z�p: 54843
E-rpal� : OffIC@@bUtt2l�le�C�C� 1"I � � IIIg . C011l This spac� reserved foi- approval stantp.
License Number: 652879
Remarks :
Signature : -� --=-�'� Date : o � / i g / ay
Original signature required on each submitted copy.
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IN-GROUND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit)
�
�"'� 12�� TYPICAL TRENCH
SOIL COVER (typical)
,��,
CROSS SECTION VIEW
m,n.tren�h (No Scale)
depth •
(typical) '. . '
. , . .e• • '
, �• ' . .d ' e
�— 34„ •'• a, . . , .
<<yp'�a�� �:�a ' � . ' ' Provide minimum 3 ft
� . a ,. . a.
. � ° separation between trenches.
System Elevation = 93.00 ft
(typical)
Quick4 Standard-W
w/ End Cap Observation Pipe
(typical) (Show location of inlet / outlet pipe connection on plan view.) (typical) TYPICAL TRENCH
Install per manufacturer's
instructions. PLAN U�EW
(No Scale)
� ,�r����►y►�. , � - - - - �� - - - - - - - �� - - - - - - -��a�i���,'��r �
I n�� +;�:� �� I. � ��' �aJ�� '��t � I A — 3.0 ft
�� (typical)
= �'k= - - - - - -�—f— �
- - - - - ���-- - - - - - - - �� - - - - �
;-- B = ft - � D
(typical) Quick4 Standard-W Chamber m
INSTALL PER TRENCH: (typical) W
(mfd by Infiltrator Systems, Inc.) O
Install pursuant to manufacturer's instructions.
16 C�uick4 Std-W @ 20 ft� EISA/chamber = 320 ftz TI
+ � Pairs of end caps @ 6 ftz EISA/pair = 6 ftZ �
= Proposed EISA per trench = 326 ftZ Required Infiltration Area = 643 ft2 Distribution Method:
x 2 trenches = Proposed Total EISA = 652 ft2 branched manifold -
PAGE40F5
GRAVITY-DOSED
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4"(d Vent Pipe
>10 ft from
Building Electncal must comply with
12"Min.or 2.0 ft above SPS 316 and NEC 300
Established Flood Elevation Extend manhole riser as necessary.
(typical) Weatherproof
Approved Junction Box
Vent Cap Approved Locking Manhole
�MP�R7"A�JT: with Waming Label Attached
(typical)
Anchor tank(s)as necessary
�condu�t
pursuant to SPS 383.43(8)(g) a��Min.or 2.0 ft above
Established Flood Elevation
� (typical)
�Airtighl Seal � �I�
Finished Grade �
_ Quick Disconnect
a 18"Mln.
CAPACITIES @ 11.82 gal/in �=� � .. , . .�� � � � ° �'vP'�'>
a. � � . �
Depth (in) Volume (gal)
A 33.0 390.06 * Weep ��Approved Joints with
� Hole Approved Pipe 3 ft onto
8 2.� 23.64 q II Solid Ground
(typical)
[C] 6.0 70.92 �
_Alarm
� ��.Q 118.20 B I�_On
f ��� � PUMP-OFF
+ Pump ELEVATION = 88•83 ft
*Pump Tank Liquid Level = 51 in 1 �—Off a
Force Main Diameter = 2 in D Concrete INSIDE BOTTOM
B�°°k ELEVATION = 88•00 ft
. . , .6. ' e .
Force Main Length = 20 ft 3"Approved Bedding Material Beneath Tank
Force Main Void Volume = 3•26 gal
[C] Total Dose Volume TDV = 70.92 gal/dose �
(<0.2X design flow+force main void volume) � J �,n�.� /
� C.Jr -
Vertical Lift = 6'0 ft
PUMP TANK: SEPTIC TANK(S):
I Volume = 602.82 gal Total Volume = 1000 gal
Manufacturer: Wieser Concrete Inc Manufacturer(s): Wieser Concrete Inc
Pump Manufacturer: Champion
Install approved effluent filter at the septic tank outlet
Pump Model: CPS3 immediatel u stream of the um tank inlet.
(See attached pump curve.) Y P p p
, Controls/Alarm Manufacturer: SJE Rhombus Filter Manufacturer: Polylok
Controls/Alarm Model: PS Patrol
Filter Model: Best GF10
Float switches containinq mercury are prohibited.
PAGE 5 OF 5
In-ground Dosed-Gravity Management Plan
IMPORTANT:
The owner of this in-ground dosed-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= 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,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 priorto 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�13,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: BUtt21-fIAId IIIC Phone: 715-634-8176
�o�ai go�e�nme�t U�;t: Sawyer County Zoning & Conservation phone: 715-634-8288 _
Local government unit address: �OO�O M8111 St, Suite#9; 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.
ContinqencV Plan
In the event that any failed treatment component of thls 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.