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Home My WebLink About008-937-20-5228-SAN-2024-053 Department of Safety c°""�' � Sawyer � = & Professional Services, � : - Sanitary Permi[Number([o be tilled in by Co �= Industry Services Division � �,. . �v � � -] �-I�Y s , Sanitary Permit Application StateTransactionNumber p — � In accordance with SPS 38321(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit � is required prior to obtaini�g a sanitary permit.Note:Application forms for state-owned POWTS are submi[ted[o Project Address(if difl�erent than mailing add the Departmen[of Safety and Professional Services.Personal fnformation you provide may be used for secondary purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats Wildwood Dr. � I.Application Information-Please Print All Information Property O�mer's Name Parcel# \Thomas Harder 008937205228 Property Owner's Mailing Address Prope Location 16297W State Hwy 48 �'`�� Govt.Lot 2 City,State Zip Code Phone Number Birchwood Wl 54817 ^��11� Section 20 II.Type of Building(check all that apply) Lot# T 37 N R � E or W [�qr 2 Family Dwelling-Number ofBedrooms 2 2 Subdivision Name / Block# ❑Public/Commercial-DescribeUse r-- ❑City of _ ❑State Owned-Describe Use CSM Number �Village of �,�� own of Jackson �l(69 -- III.Type of POR'TS Permit:(Check either"New"or"Replacement"and ot6er applicable on line.4. Check one box on line B.Complete line C i a licable. A �New S stem ❑ Re Iacement S stem ❑ Other Modification to Existin S stem ex lam (explain) y p y g y ( p ) ❑ Additional PreVeatmen[U�it B' ❑ Holding Tank �pI -Ground ❑At-Grade g ❑ Other Type(explain) ❑Mound ❑ Individual Site Desi n (conventional) C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber is[Previous Permit Number and Da[e Issued ❑ Transfer to New Owner �- E�piration IV.DispersaUTreatment Area and Tank Information: Design Flow(gpd) Design Soil Application Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation 300 Rate(gpdst) 5 600 6�2 101.0 Capaciry in Total #of Manufacturer Gai(ons Gallons Units ;? o � � Tank InformaUon � � U �, New Tanks Existing Tanks ` o � � Y �;c � 0. U v� v v� u- C7 0.. Septic or Holding Tank 750 750 1 W�eser }� Dosing Chamber V.Responsibility Statement-I,the uodersigned,assume responsibility for installa600 of the POWTS s6own on the attached plans. Plumber's Name(Print) Plumber's Signat MP/MPRS Number Business Phone Number Rick Brown �- / 231251 419-0739 Plumber's Address(SVeet,City',State,Zip Code) PO Box 637 Spooner WI 54801 VI.Coun /Department Use Only �A'� ov � ❑Disapproved $ermit Fee Date Issued Issuing Agent Signature ❑Owmer Given Reason for Denial I�� -J�'��1 r`�}'�'�1'L�'k"`�j'�� Conditions of Approval/Reasons for Disap'proval �—, � !�� t�;'��..,_-�Ci i, . "'."'1 � � )� �'Z 1 �� '' ' � � � �'' i �� r�� W-� s�� s � � --- � �4AR Z 1 2�24 -�a L � ' � � �� .J� --- -- ._.__ �:,:��: , Attach to complete plans for Ihe system and aubmit to the County only on paper not lesa than 8 V2 x ll inches in size � � SBD-6398(R.03/22) NO R�FUt�1DS AFTER ISSUE OF F'ERMIT �f�-17�'� 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 Harder Owner Name(s): Thomas Harder Phone: - - Owner Address: 16297W State Hwy 48 Birchwood WI Z�P; 54817 Project Address: Wildwood Dr. Birchwood WI 54817 Govt. lot: 2 1/4 of 1/4, Section 20 , T 37 N-R 9 E❑or W ❑✓ Township: Edgewater County: Sawyer Project Parcel ID #: 008937205228 Designer Information Designer Name: Rick Brown Phone: 715 _419 _0739 Designer Address: PO Box 637 Spooner WI Z�P; 54801 E-mail: rickbrown2004@hotmail.com License Number: 231251 Remarks: Signature: I- � C��— Date: 3/18/2024 Original signature required on each submitled copy. GHECKBOXi�SAPPLICaBLE. CHECKO ASAPa��E. PAGE 2 OF 4 � SOIL EVALUATION s��e: ,"=ao� �YSTEM SITE MAP ° 40 60 80 pLOT PLAN � PROJECT NAME: oEsicN F�ow: 300 cro (�ongna) 10' / �l�` 5 [[� �.L/�J. Attach design flow calwla6ons tor commerdal plans. l.� /1 L aaodeci nooaess�, Wildwood Dr. Pipe Malenal I ASTM Standard(Tables 3&1.30-3&384.305) NSanllary5ewer: 4 � BMSymbol: � BMEleva�lon: 100 FT ForceMain'. � eM oescnWwn: 9round levei at power pole nexl to driveway Indkate notlh bf IMPORTANT: SlopeGratlieM(%) W¢�ISymbd(ifapP��b�R O tlrawinganarto.v ShoWyfoufideleVatlwlCont0Urs315u113ble101¢Na15. O!TCs(2d Area' 2 on 1Fe aDP�opMe k�e. � � � I�f I . i w ; � f ;j �,�� I �t n �S � ,�� u �'� � ; �5 v �,�� t�,,,�-.�� \ �� j y l� .�. l�— � � � --�� T� �: r�,�f� i � `� � � , � SL : � �� ` � � � � �' i � , � 1�-.1.�. n� j � ��. .��v� � �� ; 3 I , � � � : � l � � , \q �� — � I ., , , � 1�3.� .� I ��f �f �� I � . I i �,� ' � �J I � �� I � �I i J Septic Tank(s)ManufacWrer: IN-GROUND GRAVITY DISPERSAL AREA Wieser Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Vdume(s): 3-ft Trench (down-sizing credit) �5o gal 9a� gal gal Effluent Filter Manufxturec Polvlock I Em�e�c Fu�er nnoa�»: PL-525 min.12" IbPlcap SOIL COVER ir min.Vench depth �yP��n • TYPICAL TRENCH � a CROSS SECTION VIEW �ryP a�> (No Scale) ��. � Provide minimum 3 ft System Elevation = 101.0 ft separation belween trenches. (typical) Quick4 Standard-W w/End Cap OCservatbnPlpe TypICAL TRENCH (rypical) (Show location of inlet/ outlet pipe connection on plan view.) (hvi�D Ire[all per manutxturels PLAN VIEW �°s"oc0ais (No Scale) r i.r....�.r�- - - -�� - - - - - - - �� - - - -�wewrxi..—...—. ..... -1 L ' ��ol � . .. �d � TA= 3.Oft �_ta��ai� — — — — '��uu��u�uuu 1 (Hviwp � �� - - - - - - - �� - - � g = 60 ft —�i (rypical) Quick4 Standard-W Chamber W INSTALL PER TRENCH: (rypica�> Q (mftl by Inflltretor Systems,Inc.) � Instal pursuant to manufactmers instmctbns. � 15 quick4 Std-W @ 20 ft' EISA/chamber= 300 {�� + � Pairs of end caps @ 6 fP EISA/pair= 6�0 ft' = Proposed EISA per trench= 306 ft� Required Infiltration Area= 600 {�� Distribution Method: x 2 trenches = Proposed Total EISA = 612 ft= 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 performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3),Wisc.Admin. Code. Maximum Dispersal Area Oqerating Limits: Design Flow= 300 gpd; BODS_<220 mgL''; TSS_< 150 mgL"�; FOG <_ 30 mgL'' Inspection Checklist INSPECT EVERY 3 YEARS o type af use o age of system o nuisance fadors(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 distnbution 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 specifcation) 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 (1l3)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 deaned 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: Ken WaY Phone: 715-234-7677 Local government unit: S8Wy21' COUflty ZOfllllg Phone: 715-634-8288 �oca� government unit address: 10610 Main Street Suite 49 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. Contingencv 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. Svstem Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc. Admin. Code.