HomeMy WebLinkAbout010-118-00-4108-SAN-2024-023 "ut��\
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� Department of Safety y (�
l�� �,,, S�w �r �
�:;'; � ���-''���� & Professional Services
��� � $ i�� � Sanitary Permi�Number(to be filled in by Cc �
����� Pg �; Industry Services Division � �3 �
\�; �_. :,;;�i" 3� � s
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State Transaction Number �
Sanitary Permit Application —, o �
[n accordance with SPS 383.21(2),Wis.Adm.Codc,submission of d�is form to the appropriate governmental unit �
is required prior to obtaining a sanitary permiL Note:Application forms fa�state-owned POWTS are submitted to Project Address(if different than mailin���dd___..,
the Depaitmcnt o1�Safery and Professional Se�vices.Personal intiinnation you provide may be used for secondaiy
pmposes in accordance with the Privacy Law,s. 15.04(I)(m),Stats. ��(�31.�ln� ,�j0 u}� �j�p.� ��.
I.Application Information—Please Print All Information
Prope�ty Owner's Name Parecl#
�'c,�a�c..J ; e�o 'r�Sfi OI O - i 1 $ - C7C��l108
Property Owner's Mailing Address Prope�ty Location
SS�� �f llC�. Rt� Ge�H�et---�
Ciry,State Zip Code Phone Number
1..� Ka ,I.1... Ga2`/c} _�- �^ � s�����„ a4
II.Type of Building(check all that apply) ����� T y I N R_0 8 -Eo W
�Ior2FamilyDwelling—NumberofBedrooms_ �_ ��� �v�. t.� � � Subdi��isionName
Block# 1��
❑Public/Commercial—Describe Usc
^ ❑City of
❑State Owned—Describe Use CSM Number ❑Village of
�� I�Town of—��4�/LJa�d ----
III.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
ap licable.) _ _
A' �New S stem � �
y, ❑ Replacement Systcm ❑ Other Vloditicauon to Exist�ng System(ex�lain) U Additional Pretreatment Unit(esplain)
�' W1 ❑ Mound ❑ Individual Site Desi n
❑ Holding Tank �In-Ground �.�F�' ❑ At-Grade g ❑ Other Type(explain)
(conventional)
C• ❑ Renewal{3efore �12evision ❑ Change of Plumber ❑ Transfcr to New Owner
List Previous Permit Number and Date Issued
Expiration a�—�3� � U T /O 7 �d. .�
IV.Dispersal/Treatment Area and Tank Information: � yy �c,/� y P/v� l�a,,.,, w 5 e fs�+F e r�d
Design Flow(gpd) Design Soil Application Rate(gpd,f� Dispersal Arca Required(st) Dispersal Area Proposed(st) System k?levation
Lc,o o. 7 852 9io � QJ. 3 3
Capacity in Total #of Manufacturer
�
Tank Information Gallons Gallons Units � V U '° N �
New Tanks Existing Tanks � o a� � y � � �
� M(3� a` U ii� �, cn t�. C'J P.
Septic or Holding Tank , a S O � 'a / ��,e C�,
lilJ
Dosing Chamber �S(� 7sa
V.Responsibility Statement- I,the undersigned,assu responsibility for installallon of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber' Signamre MP/MPRS Number Business Phone Number
Tfb-d:S L�v��-C� �:t �C� �iS7�7g 7/.5�G3�/^�/7�i
Plumber's Address(Strect,City,State,Zip Code)
I y 3 y(��-.� S�.�t 2 oo�.d ^��l 1-14.y�.rard� ws. S�'� y 3
VI.C unt /Department Use Only
ut Fee ate Issued Issuing Agent Signature
�Ap ro�'ed ❑Disapproved /' _
�� ❑Owner Given Rcason for Den' $J�•� '� �� 7�`��� �������� ��
r, r�-- .
Conditions of Approval/Reasons for Disapprov ���;� �� ;� , �= f�� ��
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�� l'7_ � (�31 SAWYCR COUt�I�?"1'
J 'j$,� 701VING ADPJIINISTRATIUfV
Attach to complete plans for tl�e systent and submil to[he County only on paper not less than 8 Il2 x 11 inches in size
�a�� sBD-639a�x.o3i22> NO REFUNDS AFTER �;v��5
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
Winn - South Shore Rd
Owner Name(s): Richard G Winn Revoc Trust Phone: - -
Owner Address: 5501 Bru�e Rd; Luka, IL Zip: 62849
Project Address: 12634W South Shore Rd
Govt. Lot: 1/4 of 1/4, Section 26 , T 41 N-R �$ E ❑or W❑✓
Township: Hayward County: Saywer
Project Parcel ID #: 010-118-00 4108
Designer Information
Designer Name: Travis Butterfield Phone: 715 _634 _8176
Designer Address: 14346W State Road 77; Hayward, WI Zip: 54843
E-mail: OffICe C�bUttet�l2�C�C�f1��111g.0011`1 This space reserved for 1pproval starnp.
License Number: 652879
Remarks:
Signature: Date: �`��y
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)
�
""n.'2�� TYPICAL TRENCH
SOIL COVER (rypicap
CROSS SECTION VIEW
,2��
min.trench (No Scale)
d e pth •
(lyplCel) �. <
. , a . •d" �
. ' • •d a.
r 34�� '' a, .. , .
�cyp'�ai� :�^ � . Provide minimum 3 ft
+ °• • a
. � ° separation between trenches.
System Elevation = 92.33 ft
(typical)
Quick4 Standard-W
w/End Cep Observation Pipe
(typical) (Show location of inlet/ outlet pipe connection on plan view.) (typical) TYPICAL TRENCH
Install per manufacturer's
instructions. PLAN V�EW
� - - - - - - - - �� - - - - - - - �� - - - - - - ���,��: - �
(No Scale)
{� �`�,, i� '« � � A= 3.0 ft
� .
� — — — — — �i�ti�� ` � �tYpical)
— — - - — �� — - - — — — — ��— — — — — — — — �
B = 39.00 ft — � D
(typical) Quick4 Standard-W Chamber m
(typical) �
INSTALL PER TRENCH: �. 11ess G1�+c.,•�b« (mfd by InfiltratorSystems,�no.) O
� Install pursuant to manufacturer's instructions.
g Quick4 Std-W @ 20 ft� EISA/chamber= �80 ftZ [n o�e ce 11 —�-�
+ � Pairs of end caps @ 6 ftZ EISA/pair= 6 ft2 �
= Proposed EISA per trench = �86 ftz Required Infiltration Area = 858 ft2 Distribution Method:
x 5 trenches = Proposed Total EISA = 91� ftz branched manifold �
PAGE40F5
GRAVITY-DOSED
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4"PJ Venl Pipe
>10 ft from
Building Electncal must comply with
12"Min.or 2A 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
(MPORTANT: with Waming Label Attached
(rypical)
Anchor tank(s)as necessary
--Conduit
pursuant to SPS 383.43(8)(g) a°nn���.o�2.o f�aeo�e
Established Flood Elevation
(typical)
�Alrtight Seal
Finished Grade 1
Quick Disconnect I
a 18"Min.
CAPACITIES @ 16.12 gal/in �:� .. a ..�� � � � (typical)
a �
Depth(in) Volume (gal)
A 3�.� 483.60 * � Weep ��ApprovedJointswith
Hole Approved Pipe 3 ft onta
B 2.0 32.24 q Solid Ground
(typical)
[C] 6.0 96.72 �
_Alarm
D 10.0 161.20 B —o�
� ��� � PUMP-OFF
* 48 �_ P"mP _off : ELEVATION = $3.50 ft
Pump Tank Liquid Level = in � �
�
° INSIDE BOTTOM
Force Main Diameter = 2 in c°"°�e'e
� B�°°k ELEVATION = 82�67 ft
. . , .d. - e . �
3"Approved Bedding Material Beneath Tank
Force Main Length = ���ft
Force Main Void Volume = 19.23 gal
�
[C] Total Dose Volume TDV = 96.72 gal/dose
(<0.2X design flow+force main void volume)
10.66
Vertical Lift = ft
PUMP TANK: SEPTIC TANK(S):
Volume = 773.76 gal Total Volume = 1250 gal
Manufacturer: Wieser Concrete Inc Manufacturer(s): Wleser Concrete Inc
Pump Manufacturer: Champion
Install approved effluent filter at the septic tank outlet
Pump Model: CPS3 �see aaa�ned P��,P��Ne.> immediatelk upstream of the pump tank inlet.
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= 600 yPd; 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,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 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: BUtt21�fIEId IIIC Phone: 715-634-8176 _
�o�ai 9o�ernment�na: Sawyer County Zoning &Conservation phone: 715-634-8288
Local government unit address: 1001 O M8111 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,Wisa 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.
System Abandonment
If use of this POWTS is discontinued,it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code.
� 1 1 � •
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SSPM�
FEATURES/BENEFITS �ERr�F�Eo
POWER CORD ,��
PERFORMANCE Sealed entry quick disconnect power cords
Heads up to 20' TDH - Prevents water from entering the motor
Flows up to 42 GPM housing through a cut cord
-Available in lengths up to 100' ``
MOTOR ( ; ' � �
High efficient, 115v, oil filled, permanent split SWITCH
capacitor motor with upper and lower ball Piggy-back switch design �
bearings and thermal overload protection - Defective switches can be diagnosed over �` '
- Constant bearing lubrication the phone �
- Maximum motor cooling - Pump can be operated manually or
- Runs cooler and lasts longer supplied with other piggy-back switches
- Internal overload protection -Switch can be replaced without having to
- Quiet operation replace the pump
- Fastenersandshaftmadefromrugged, APPLICATIONS
corrosion resistant stainless steel
Basements, dewatering, and septic
SEAL DESIGN systems
Mechanical with secondary dynamic lip seal
- Provides added leakage protection
IMPELLER DESIGN
Non clog style vortex impeller
- Designed to help reduce clogging by foreign
material
Wide-Angle Float Verlical Float
1/3 HP submersible pumps, built for reliability,
handle up to 1/4" solids with 11/2" discharge
PERFORMANCE CURVE
�
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zo
x 16
0
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a
m
RI�.��
0
,o
5 CPS3
0
0 6 10 15 20 � � '� '�
Gallons per Minute, GPM
Champion Pump Company, Inc • P.O. Box 528 • Ashland, OH 44805
Phone 419-281-4500 • Fax 419-616-1100 • www.championpump.com REV0817
""``=—"'-�`'��?�; PRIVATE ONSITE WASTE TREATMENT county
��� SYSTEMS
����,�SPS '� ( POWTS) Sa.Wyer
\hof.�--__�.r;/
'""'"�'" INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �y " 6�3
Personal infonnation you provide may be used for secondary pucposes[Privacy Iaw,s. 15.04(1)(m)f
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
R��'la�l .tr/�H✓t K2✓�4 1(�`'.3� c� t..rcc
Insp BM Elev: BM Description: Parcel Tax No:
/ 1 �.
(c�O.a �a. ��u bbvi ��"�. °`,, �C7 w. ��� o�o - I lg- Oo- Ylo�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic «,,�r _ � Benchmark tc�o.a �
Dosing ��„� 7�
Aeration Bidg. Sewer .s'�
Holding St/Ht Inlet � ,p �
TANK SETBACK INFORMATION St I Ht Outlet � '
TANK TO P/L WELL BLDG vENrTo ROAD Dt Inlet
AIRINTAKE
Septic ��a' �-Sv� ' �',t5' NA Dt Bottom ,7 �
Dosing �` �, h k NA Installation
Contour
Aeration NA Heatler/Man. �3,33 `
Holding Dist. Pipe
PUMP 151PHON INFORMATION Infi�trative q�33 �
Surface
Manufacturer � Demand Final Grade
Model Number �j�j GPM
TDH (3 Lift Friction Loss Sys Head TDH Ft
Forcemain L �1 Dia 2" Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS �N 3� L 36` ' . �,' 3�` #of Cells �' Type of System Distribution Media Manufacturer:
� Conv ❑ Aggregate
SETBACK P/L Bldg Well OHWM of Nav � IGP � Chamber ^ l �
INFORMATION Waters � AG ❑ EZFIow Model Number:
CELL TO � �f-f p
�/-s3 �%� ❑ Mound o Other �Y,�
- ---_ _ ----_—__— ------ ----- ---——
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 gver �ePth of �eeded I Sodded I Mulched
Cell Center � Cell Ed es To soil ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
���ll� �I�Y(�3
�� �ls� �-� - 13 ��
�,- T �
Plan revision required?❑Yes❑ No I D�� �2 � II � . �c�-���
� �� I_- �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�DITIONAL C�MMENTS AND SKETCH
SANITAAY PERMIT NUMBER __ .2���� ___
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