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HomeMy WebLinkAbout012-771-00-0190-SAN-2024-024 ..��.\Ht1;\ COUIlfy / ,;-�� Department of Safety � ,/ , s G�.w Q r' ;�'; s =` & Professional Services, � i�; � $ ��� . . . Sanitaty Pe�7nit Number(lo be tilled in b� ��� �t� Pa �,/ Industry Services Division � � � .,.� �� � �r>, `_ ;: r \q� ��`l ��.j��i�.��� - � Sanitary Pennit Application Stat�T'�°Sa�t;°°N°"'he` �' - � In accordance with SPS 383.21(2),Wis.Adm.Code,submission of�his form to the appropiiate governmental unit .t, is required prior to obtaining a sanitary permit.Note:Application fonns for stale-owned POWTS are subuiitted to Project Address(if different than mailing addi ess) the Department of Safety and Professional Services. Personal information you provide may be used for secondary puiposes in accorda�ice with the Privacy Law,s. I5.04{I)(m),Stats. � � a��� 'Tj�L,r�- M J S�+y L-�1 L Application Information-Please Print All Information Prope�ty O�vner's Nmne Parcel# ec-ns 1-a.�.t I L LG C7la ��7 � - O� - d I`�� Propetty Owner's Mailing Address Property Location I laSl W T; er Mvs1C Ln .��— City,State Zip Code Phone Number C e�u d��ay � W Z ��/8 a�j ----��� Section_._3� IL Type of Building(check all that apply) Lot� T �0 N R �� E-o�W ❑ I or 2 Family Dwelling-Number ofBedrooms �n��5 ol(s�����'I g��� Subdivisio��Name slock# Tt(�E0. lyVSx,Y ExPAn�510�1 �Public/Commercial-Describe Use c�'G C-t" ti'\� � ❑Cityof ❑State Owned-Describe Use_ —_ CSM Number ❑Village of �_ �l�own of ��vY1�"G.-�" - III.Type of POWTS Permit:(Check either"New"or"ReplacemenN'and other applicable on line A. Check one box on line B.Complete line C if a licable.) A. ❑ New System ❑ Replacement System �Othcr Moditication to Existing System(explain) ❑ Additional Pretreatmcnt Unit(explai��) 5. ,s a- P.T, o�t B' t� ❑ Mound ❑ Individual Site Desi �Other T e �x lai�i ❑ Holding"I'ank �;In-Ground ���S � ❑ At-Grade �n yp (' P ) (conventional) D•�• Ta�K (te 10.�G C. ❑ Revision ❑ Chan List Yre�'ious Permit Number and Date Issued ❑ Renewal E3efore ge of Plumber ❑ �I�ranster to New Owner Expiration � ���jQ 7 � (,(,��� N.Dispersal/'I'reatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd'st� Dispersal Area Required(s� Dispersal Area Ptr�iesed-(� System Elevation 3,no � d.� ti��c. �3a� ?���,� a o�. �9� Capacity in Tota #of Manufacture�� :? "I'ank Information Gallons Gallons Units � U U �$ � New Tanks Existing Tanks � o ,� � � � � c`"s a. U �n � cn ii. C7 P. Septic or Holdin�Tank ���� x � � � �Q � �' C K Dosing Chambcr ���� �_ ���(� � 1 I /� V.Responsibility Statement- I,the undersigned,assum esponsibility for installaHon of the POW'I'S shown on the attached plans. Plumbci's'Vame(Print) Plumb�r Signature � � MP/MPRS Number F3usiness Phone Number � .�- ! T�na�;5 Q���-c.��';c 1C - . (0 7 '?�is-G 3y -8!7 Plumber's Address(Street,City,State,Zip Code) 1�3�/�W 5�}t R c�a d 7 7 1-f-ay c�.r�c�r d� !,v z- S^�/?� 5/3 VI.Count /Department Use Only Perniit Fee Date Issued Issuin;A�ent Signature �App•ov d Y ❑ Disapprovcd $ � - �� ❑Owner Given Reason for Denial ��' � �� -� �`�� �������� Conditions of Approval/Reasons for Disapproval r., _,*�►, � � D � ����:����� � ( 3 �`f_�.._. �� � �� I ���L, .���� .�__L__ � � FEB 0 9 2024�--- �hk# 3 3 S I _.___,.�. _________--- C� - � , �,, .. C � I � � � � d�" �� �r'��t,f� ! . ZC�vlf�,ia �ai%r� , Attach to complete plans for the system and submit to the County oniy on paper not less than S V2 x 11 inches in size NO R�FUNDS AFTER �� �j� sB�-639g�R.o3i22� ISSUE OF PERMiT �a�\ 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) r !�\ �'�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 Owner Name(s): Phone: - - Owner Address: Zip: Project Address: Govt. Lot: .1/4 of 1/4, Section , T N-R E ❑or W❑ Township: County: Project Parcel ID #: Designer Information Designer Name: Phone: - - Designer Address: Zip: E-11'181�: i'his s��� . ���sen�ed t��z��iE���rc,��al sta�n}, License Number: Remarks: Signature: Date: Original signature required on each submitted copy. ' ^�\ OQ � r� � P ca � v � � e4 t�� Ql N � O � v GJ ��P � (` � � � � � i� ,,,oaQ�+e) � t J . i� ��+�'� a � � � � � � p q v� � \ ��k � A � s.�°� �� � � F,. � � I i C — � eJ U� � c'° ° Fa � y � p �m ?• q� C./� � J (7 � � -1 -1 ( c g! N' �; -C � L £ (a � V N 3`� �� * . � W Y � t � R � W 3 � � � j n G y' l . 7 � ,� � ^_b '� 0 "' u � � V �b V (� N N C' V w p .�j o In � Q � t� (� � � � A rn C � n 9 s, �' � c Z m 4 M �i � 'H �° a '� CJP n (n, � � � M1 � � .0 1m - 'o � 3 — �- 3 -�u v C � .,,u _ , .. � P � .. 9 b S p o . D o � p N t C s ^ � aG 1 � � � � ' � � °° � 6� � ,� . � 3 � � -c 0 m i - v � a -p � �- ' „v�� y � m� Z X � n m � cn .n� Z [ V'� x � � 9 � " Y� � � � 5 O (` .. � \ � ° � F J `�J j \ dJ � - � a K � � � � a, � p E � N 6 j a "� �. � vp � c �^ `� ° � 7 dy /9 /\ - � °�v� � / \ �s` o .\ s � �� O d � j � �w °' C' 3 r p � ` � s� I(_ rn - z . C � � — — G � m� ac�,Yy� ^ TJ T� � W U :� ` G -� 'r" £ °1� �9i�=9. T y ��3, U� c� c � � � y � p E `'� � �c�" e '";"�'� S` O � C p (� Z ^�p 4' "d, � 'j'°cs .s � f• P old °cY`1 �3 S-; .� T T '� T �i- U �o V s °r Z �6 %'�u 'v1J c Z. rn e� a.J 4, s 3 ��� uy�J PAGE40F5 GRA�/ITY-DOSED SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) 4"fd Vent Pipe >10 ft fro m Building Electrical must comply with 12" Mln. or 20 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 IMP�RTANT: with Waming Label Attached (rypical) Anchor tank(s) as necessary �Conduit pursuant to SPS 383.43(8)(g) a�� Min. or 2.0 ft above Established Flood Elevation � � (typical) �Airtlght Seal Finished Grade � -- Qulck Dlsconnect a 18" Min. CAPACITIES @ 27.83 gaI�II1 . a � �. 8 ,�� ° <<yP'°ai> a, � ' . • . I Depth (in) Volume (gal) � ,q 17.0 473.11 * � I y�/eep � �Approved Joints with Hole Approved Pipe 3 ft onto B 2.0 55.66 A ',� So��d �ro�nd (�yp��p [C] 7.0 194.81 � � �Alarm D 10.0 278.30 B I��—o� f [c] a le� PUMP-OFF * 36 � ��mPs �—or� a ELEVATION = 89•73 ft Pump Tank Liquid Level = in } I ° INSIDE BOTTOM Force Main Diameter = 2 in Concrete B�°°k ELEVATION = 88•90 ft . � � � • ° w . Force Main Length = 400 ft 3" Approved Bedding Material Beneath Tank Force Main Void Volume = 65.20 gal [C] Total Dose Volume (TDV) = 194.81 gal/dose �— ( < 0.2X design flow + force main void volume) � l ' 11 9.71 � �Q Vertical Lift = ft � U ' � � PUMP TANK: SEPTIC TANK(S): I Volume = 1001 .88 gal Total Volume = 6000 gal Manufacturer: Wieser Concrete Inc Manufacturer(s): Wieser Concrete Inc Pump Manufacturer: Champion Install approved effluent filter at the septic tank outlet I Pum Model: CPS5 immediately u�stream of the pump tank inlet. {� (See attached pump curve.) Controls/Alarm Manufacturer. SJE Rhombus Filter Manufacturer: Polylok Controls/Alarm Model: PS Patrol Filter ModeL (Best) GF10 � Float switches containinq mercury are prohibited. � I 1 � • ,- , . 1 . . FEATURES/BENEFITS SSPMJ� �ERr.F,�� IMPELLER DESIGN PERFORMANCE Non-clog sryle,cast-iron vortex impeller Heads up to 28'TDH -Designed to help reduce clogging by foreign Flows up to 85 GPM materiai MOTOR POWER CORD High efficient,115v or 230v,oil filled, Sealed entry quick disconnect power cords permanent split capacitor motor with upper -Prevents water from entering the motor and lower ball bearings and thermal overload housing through a cut cord protection -Easy to replace in the field -Constant bearing lubrication -Available in lengths up to 100' -Maximum motor cooling -Runs cooler and lasts longer SWITCH -Internal overload protection Piggy-back switch design -Quiet operation -Defective switches can be diagnosed over -Fasteners and shaft made from rugged, the phone corrosion resistant stainless steel -Pump can be operated manually or supplied with other piggy-back switches SEAL DESIGN -Switch can be replaced without having to Type 21 inboard seal design with secondary replace the pump exclusion seal qppl�CATIONS -Rotating components of seal are in the motor housing,being lubricated by the Basements,dewatering,septic systems motor oil preventing foreign matter from and truck docks wrapping around the seal components -Seal will last longer if the pump runs dry -Secondary exclusion seal keeps debris from entering the seal cavity 1/2 HP submersible pumps that handle up to 1 1/4"solids with 2"discharge PERFORMANCE CURVE �o ss �q.7a � _ 0 � � _ ,5 � 0 � ,o CPS5 S � 80 TO � � o ,o �o a5 � �° �° — Gallons per Minute,GPM /� O�' Champion Pump Company, Inc • P.O. Box 528 • Ashland, OH 44805 0.g� � Phone 419-281-4500 • Fax 419-616-1100 • www.championpump.com RE\ 0817 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,Wisa 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 Operatiny Limits: Design Flow= 3000 ypd; BODs�220 mgL-'; TSS_<150 mgL"'; FOG<_30 mgL-' Insqection Checklist INSPECT EVERY 3 YEARS c 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 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 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,Wisa 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: BUtt2Cfleld I11C Phone: 7�5-634-8176 �o�ai go„e��me�t��;t: Sawyer County Zoning &Conservation Pno�e 715-634-8288 Local government unit address: �OO�O M81n 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. 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. � e ��. �1� �� � OfY7ce of ���, \� ,�: ' Sawyer County Zoning Administration � � 10610 Main Street Suite 49 � ` ������� � Hayward, Wisconsin 54843 �� � �R CD �� (715)634-8288 �, � � ����- �`-���� FAX (715)638-3277 � � �,��LJ�Z/," � � Q � � ��������.sawyercounty�o�.ore �/�� 3�j i y�.ti - !� � E-mail: zoninesec�ccsa�wercountvao��.� ��� �� ��� / � - � r1r"i;.. 7 / o � �A �_�- �� o � Toll Frec Courthouse/General Information 1-877-699-4ll0 � `��;.� +f � ` f.._f�Y � l� � � ,,����SCoNS�? ���✓�W�" ?�Z� � ������� �c'A��Q��'�3' �qT��V SAWYER COUNTY SANITATION DEPARTMENT TEMPORARY EMERGENCY TANK INSTALLATION APPROVAL PROPERTY OWNERS NAME: S pc ro S ��M�l y L L �- TOWN OF: �-� ,�_� r- ADDRESS: 11 �1 � � � � ae � M � 51<� L �1 I, T�—c,�: 5 Q � �' �-c � �';�e 1 c� , a Wisconsin Licensed Plumber-, author-ized by the owner, do hereby acknowledge that I am receiving temporary approval to install a septic tank/holding tank without a soil and site evaluation, or existing system evaluation, and private sewage system plan review due to inclement weather and/or health and/or safety emergency. Further, I acknowledge that a soil and site evaluation, or existing system evaluation, and private sewage system plan r-eview will be conducted by the deadline stipulated by the permit issuing agent, or as soon as weather conditions or circumstances perniit. If the private sewage system is found to be failing as defined in s. DSPS 381 .01 (92), Wisc. Adm. Code, corrective ineasut�es will be taken as such that the private sewage system complies with all applicable requirements of chapter DSPS. 383, Wis. Adm. Code, within 90 days of this agreement. I further acknowledge that failure to comply by obtaining all necessary permits after the deadline date may result in the issuing of a citation, under Section 11 .3 [2) Sanitary Permits], of the Sawyer County Citation Ordinance. DEADLINE FOR THIS AGREEMENT SHALL BE: `D� I ,� I '� � Signed: Date: U � I 3 � I a`1 Accepted by: �`� 1/f/"�/I � Date of temporary emergency approvaL• � � I � � �� Rev. 03/26/13 Sa.litary Permit T 40N, R 7W Sec 33 � NE-NW Reagnold Wolff. SAN 68-23559. Adam Silack, plumber. dba Chippewa Flowage Trailer Park. 2 mobile home sitea. Hunter. NE-NW Elmer Ni�nerguth. SAN 69-32159. Clarence Metcalf, plumber Mobile Home. Ilunter NE-NW Bergman. SAN 69-32160. CLarence Metcalf, plumber Mobile Home. Hunter SE-NE Glen Swetz SAN 70-8138. Charles Balczewski, plumber. Dwelling. Hunter. N�-NE-N47 Reagnold A. Wolff. SAN 71-29036. Adam Silack, plumber. Dwelling. Hunter. N'�-NE-NW Reagnold A, kTolff. SAN 73-009. Adam Silek, plumber. idobile Home Park, liunter. NE-NW Reggie Wp1Ee,. SAN 74-020. Charles Balczewski, plumber. tRobile Home Park. Hunter. SE-SW John Fahy. SAN 74-120. Charles Balczewski, plumber. Dwelling. Hunter. � NW-NW Re��ie Wolfe-Chippewa Flowage Trailer Park. Charles Balczewski, plumber. Mobile Home Park, tiunter. -15-CY�s NW NW Reagonld A. Wolff. SAN 77-011. Robert Vitcenda, plumber. Commercial. Hunter. NE NW Richard Speros. SAN 78-126. Robert Vitcenda, plumber. Dwelling. Hunter. SE iJ41 Irvin R, Dombrowski. SAt� 79-147. Bill Zawitowski, plumber Dwellin�. Ilunter. ��il�p'� SE NW Duane Foss. SAN 79-152. Bill Zawitowski, plumber. Dwelling Hunter. _a�� NE NW Darwin Berry. SAN 83-188. Robert Vitcenda, plumber. (Chippewa Flowage Trailer Park.) CST 83-168. Hunter. SE NW Melvin Weaver. SAN 83-240. Robert Vitcenda, plumber. CST 83-251. Dwelling. Hunter. -a��o�j SE-NW David Moore - Robert Moore. SAN 86-034. Robert Vitcenda, �..� plumber. CST 86-047. Dwelling. Hunter. .dMl$ NE-NW Richard Speros. SAN 88-170. Robert Vitcenda, plumber. CST 88-180. Dwelling. Hunter. r <:3. .�;� I uHre ° ^% x ur��o�rt- ois s . Pos I� °, ' e � ,�� � � .o, . SB9'O6L0'E / 1 . 1J09.2]' r vnnwnG �o� A � / Unis i�e �1 r.. o�. o�e , . 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C d S7"�N�&�9y�� ��; •�i �` 4�J �7` t^'��iC`! � ��j���rS;, , f'"� ��'41,,�'�.'��§ � �.�1 s..: �a33��u� ���� ,��� �;���� ��.,.... , ;� W ,. �.. , , �';��.^rM;�4� � �'� S1. Cy � O'ewr°N�,, " r, p� �`t a " h- h-y+R �s,# � s!' a .p.' a t�,G 4'� , � .} -. �, . ';i��ll ��- V ��5� T• ��� � ��'���4' � ` n.a � �j 1 x � ,�o �F i�. e� :. � ' '���.R,,_r� '�. 44Q� � r� ��� ! ,�;�'�s , '���, � � _w .�� �.`, �..:���: s�. ..�_ �.....� �`.7.r�'� �` . ��" "'"'f� PRIVATE ONSITE WASTE TREATMENT County , - r,;�_ �,� r�, �,'� ��� ���� SYSTEMS � S awyer �`'`���$�s�;%;' ( POWTS) \�°``--�5`P� INSPECTION REPORT Sanitary Permit No: �• FStiiuNT�i' �.,_ _ Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION � � � (� � � Personal infonnation you provide may be used for secondary purposes [ Privacy Law, s. 15.04 (1)(m) ] Permit Holder's Name: ❑ City ❑ Village C1� Town of: State Plan Transaction ID#: S os ��„1 L�L �{,��-}�.-. — Insp BM Elev. BM De cription: Parcel Tax No: � vo .�` N�; l ;�, e�c . � orz -- � � � - �o - o��o TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �� �,�, ;�r 3,C�o Benchmark (p� ,p � Dosin9 wiGs-Qr 1� �o� B I . I �' � ' Aeration Bldg. Sewer yy, ,� � Holding St / Ht Inlet � 3 � � TANK SETBACK INFORMATION St / Ht Outlet q� 8 � TANK TO P/L WELL BLDG AiR"iNr°KE ROAD Dt Inlet 9,? 3S � Septic +wc� }�co' t,s' ` �+-`S � NA Dt Bottom ��.� � Dosing „ �, �• `� NA Installation Contour Aeration NA Header/ Man. f�, � Holding Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative �o6 .S � Surface Manufacturer G �b Demand Final Grade Model Number CPS�"" GPM 8 -3 �`t< < � TDH Lift Friction Loss Sys Head TDH Ft ST� �/�I ct-?. 7.�� Forcemain L Dia Dist. To Well $'T a p� �.?, 3S� DISPERSAL CELL INFORMATION DIMENSIONS W � u # of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv � Aggregate INFORMATION P / L Bldg Well i/yaters � GP ❑ Chamber Model Number: ❑ EZFIow CELL TO ❑ Mound o Other — - - -- - --- —_ _—_ DISTRIBUTION SYSTEM x Pressure Systems Only Hea�der / Manifold Distgbution Pipe(s) p i`X Hole Size— i X Hole9 Observation Pipes '� Len th Dia Len th Dia S ac Spacin ❑ Yes ❑ No� SOIL COVER �Depth Over Depth Over �Depth of Seeded I Sodded Mulched ell Center Cell Etlges I Topsoil � ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ��� 1(� � 1 � I ��r f�� o�� S�l S�s � �,1 . `�n�/ � 1'ce'�iC2Me-��a� —�� - — - - � �� �� to � Plan revision required?❑ Yes ❑ No 'v i3 � � I I � � i— —_J Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710 (R.3/01) A��ITIONAL COMMENTS ANO SKETCH SANITARY PEAMIT NUMBER: oZ`j'��.Z�___ � � < � � (,+��`��g°'� u ���� _._ , � . �� � �a � ��w� o��� �. 8� 3� ,�� ���I�r� -� � ����.���lb� . � ��r,� ,.�� ti,y,� !< < < a _ _ `� �• 3� ' �, 3� ` 3 � �JCf, � � � �� ,/ ` � -e.� � � /�.� �,Wt � � � 8�9� �-