HomeMy WebLinkAbout010-941-36-2202-SAN-2024-040 r
%�""`"'`%�� Department of Safety c°°"ry �'
�.-.� }�.
��� = & Professional Services, SG`"' c� �
� � '<� Sanita�y Permit Number(to be filled in by(
�; '; ,, Industry Services Division
J'��nj\-- - . W S � � �� � �
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Sanitary Permit Application State Transaction Number �g
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In accordanec with SPS 38321(2),Wis.Adm.Code,submission ofthis foirri to the appropriate governmental unit Q
is required prior to obtaining a sanitary permit.Note:Application forms for state-0wned POWTS are submitted to Project Address(iY different tlian mailing addre,$)
the Depar[ment of Safcty and Professio��al Se�vices.Personal intorination you provide may be used for seconda�y
pwposes in accordance with the Privacy Law,s. 15.04(I)(m),Stats. ������ ���� � (,Z
I.Application Information-Please Print All Information ���
Prope�ty Owncr's Name Parcel#
`' M a �` 1��.-�► �.t�,�Dts�- o�o-4�!l- 36 -��o �
Propetty Owner's Mailing Address Prope�ty Location
���,7 WV+rf Vb L . o
City,Statc 7ip Code Phone Number
fTA 6.TAl'�i W= ,Syg y3 �'/�, u1� '/<, Section �
II.Type of Building(check all that apply) Lot# �� � / N R 9 -�o
�1 or 2 Family Dwelling-Nmnber ofBedrooms � �-- Subdi��ision Name
Block#
❑ Public/Commercial-Deseribe Use --
❑City of
❑State Owned-Describe Use CSM Nmnber ❑Village of
'�-- �`fo�wi of�0.t L'�
III.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if
a licable.)
�' �New S stem
y, ❑ Replacement System U Other Moditicacion co Existing System(explain) ❑ Additional Preh-eatment Uni[(esplain)
Q.
❑ Holding l ank �n-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑ Other Type(cxplain)
(conventional)
C• ❑ Renewal Beforc ❑ Revision ❑ Changc of Phimber ❑ Tra�isfer to Neti�O���ncr
Li,t Fre��ious Pem�it Number and Date Issued
Expiration
IV.Dispersal/Treatment Area and Tank Information: � ;�, y lv h bers SeFs o lnd
Dcsign I�lo�v(gpd) Design Soil Application Ratc(gpd st) Dispe�sal Area Required(st) Dispeisal Area Proposed(s� System Elevation ($hepptd
c,cro n.� as� s�a � qy.o�, qa. o 0
Capacity in �I'otal #of Manufacturcr
�
Tank Information Gallons Gallons Units p �? o "° �
New Tanks Existing Tanks � o � � � p � �
c U v� �, v, u, C7 P.
Septic or Holding Tank �� � �� � 1 �1 C JC f COriCrC.J't �hC x —
Do�in,Ch;�mbcr
V.Responsibility Statement-I,the undersigned,assu responsibility inst lation of the POWTS shown on the attached plans.
Plumbci's Vame(Print) Plumb ' Sienaiurc MP/MPRS Number Business Phone Numbe�
Tro.��'s „� o ,•e! G5�8'79 7�s-G3N- I'7!�
Plumber's Addre,s(Street,City,State,Zip Code)
/y3 y G t,.� S���c crad 77 � t.v t ti y
VI.Coun /Department Use Only
y Permit Fee Date Iss ed I,;uing Agent Signature
rA cd ❑ Disapproved �
`6��� ��6 p_va 3 I I �� �`�" �3'l.�,�.,-.i,��.��{uvu,��
❑Owner Given Reason foc Denial
Condili ns of A v e so s r Disa� �roval ^� ��' ''�� r
� p �� � p� [J � � '�?�,' ,lY'•`�'�i i
', Y....�......�...: ��
�, � �r�.��► y���I s�a_� . _ v;
MAR 0 8 2024 i--
�;�k#��y _ �_�...:�
CC (� ��� SAWYER COt.'� :
J� � I � `1'-��- ZCNVIfVG ADMItJIS"!��-sr,�iv��
A[[ach to complete plans fm'the s��s[em and submit to the County only on paper not less[han 8 1/2 x I1 inches in size
NO R�FUNDS AFTER
SBD-6398(R.03/22) ISSUE O�PERM{T � �yC,�
�o,\\
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
Max Disher - County Hwy B
Owner Name(s): Max Disher Phone: - -
Owner Address: 10853 Country Club Ln ; Hayward, WI Z;p: 54843
Project Address: COunty Hwy B
Govt. Lot: NW �1/4 of NW 01/4, Section 36 , T 41 N-R 9 E ❑or W �✓
Township: Hayward County: Sawyer
Project Parcel ID #:
Designer Information
Designer Name: TraviS Butterfield Phone: 715 _634 _8176
Designer Address: 14346W State Road 77; Hayward, WI Zip: 54843
E-mai�: office@butterfielddrilling.com =���,;s s���,�e�-�s�,�-e� r�„�a}�E�r��,-��� st��,���.
License Number: 652879
Remarks:
Signature: Date: 3 " � - a
riginal signature required on each submitted copy.
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IN-GROUND GRAVITY DISPERSAL AREA SeP"` Ta�kcs> "'a"°`a°`°�e�:
Wieser Concrete Inc
Stepped Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit) SeP��� Ta�kcs��o��mecsr
1250 gal gal gal gal
I Effluent Filter ManufacNrer.
Lifetime Filter LLC
SOIL COVER
roin. tT'
tn�Fi�a�� enwe�t �i�e�Moaei n� LT-1/8
,�..
mm.t�e��n
TYPICAL TRENCH tlepih
CROSS SECTION VIEW �"'"a�� . .
. �'�,a� � . Provide minimum 3 ft
(No Scale) � ac `—� ., separation between trenches.
(typicaq � , � .
. . • ' a
Highest Trench Lowest Trench (as applicable)
System Elevations = 94.00 ft 92.00 ft; ft; ft; ft
Quick4 Slandard-W
w/ End cap OesP"'aOonPipe TYPICAL TRENCH
(rypical (Show location of inlet / outlet pipe connection on plan view.) (�yv��a0
� Installpermanufacturers PLAN VIEW
inshuctions.
(No Scale)
� - - - - - - - - - - �f- - - - - - - - �� - - - - - - - � �
I . � . , � � �. . , . : . , A = 3.Oft
' (typlcalJ �
L- - - - - - - - - - - - �� - - - - - - - �f- - - - - - - - - - J D
g = 91 ft _ I G�
m
(typicaq Qulck4 Standard-W Chamber W
(typical) O
INSTALL PER TRENCH: �mra by i�rao-am�sYsiems. m�.� �
Install pursuant to manufacNrers instructbns.
22 Quick4 Std-W @ 20 fl� EISA/chamber = 440 g� �
+ � Pairs of end caps @ 6 ft' EISA/pair = 6 ft�
= Proposed EISA per trench = 446 ft- Required Infiltration Area = 858 ft' Distfibution Method:
x 2 trenches = Proposed Total EISA = 892 fc' branched manifold �
�
PAGE40F4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground graviry 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 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 distribufion 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, 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: BUtt@Cfleld InC Phone: 7�5-634-8176
�o�ai go„e��me„t �,,;t: Sawyer County Zoning & Conservation phone: ��5-634-8288
Local government unit address: �OO'I O M2111 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 a�propriate 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.