HomeMy WebLinkAbout028-642-31-2402-SAN-2024-055 !��`�"`="`%� Department of Safety cou„cy (/)
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& Professional Services, �
�� -� Sanita�y Permit Number(o be tilled in by C
1 ` '_ , Industry Services Division �
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7-;.�,�.., -�
State"I'ransaction Number �'
Sanitary Permit Application �
In accordance with SPS 38321(2),Wis.Adm.Code,submission ofthis(onn to the approp�iate governmental unit �� �
is required prior to obtaining a sani4lry permi[. Note:Application forms for state-oN�ned POWTS are submitted to Projcct Address(if different than mailing aduress�
Lhe Department of Safcty and Profcssional Services.Personal inforivation you provide may be used for secondary
pu�poscs in accordancc with thc Privacy Law,s. 15.04(1)(m),Stats. � �A Z� � M��G� ��
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I.Application Information—Please Print All Information
Propeily Ownci's Namc Parccl#
1`�lar a vad - c�ya-3�-ay oa
Property Ow r's Mailing Address Property Location
f
7 33 cc- r �.� �� 6S�
Ciry,State Zip Code Phone Number
Sc.:��t �a u 1 I`'i1V 5510 J S E ���,/V� v<, s������, 3� _
iI.Type of Building(check all that apply) L�t� T y a N R U�o .E-e W
�l or2 Family Dwelling—Numbcr�.�fBedroom, _ __ __ _ � Subdivision Name
Block t� �—
❑ Public/Commercial—Describe Use ,�
❑City of
❑State Owned—Describe Use CSM Number ❑Village of
� �dT�,�,or- spc �c r La.K c
Ii7.Type of POWTS Permih (Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.CompleYe line C if
applicable.)
�� �CR'S tit0nt
� y; ❑ Keplacement Sys[em U Other Vloditicauon to Existing System(explain) ❑ Additional Preh'eatment Unit(explain)
B.
❑ Holding Tank �In-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑ Other Type(eaplain)
(conventional)
List Previous Pernlit Number and Date Issued
C• ❑ Renewal Before ❑ Revision ❑ Change o�Plumber ❑ Transfcr to New Owner
Expiration ��
IV.Dispersal(Treatment Area and Tank Information: * 3a �; K 4 �lv Gha�.wb�r5 � �f a t
Desigii I�low(gpd) Design Soil Application Rate(gpd;�,t) Dispersal Area Required(st) Dispersal Arca Proposed(st� System Ele��ation �
ysd o.� �Y3 �5-� � g5'�.ov
Capaciry in Total l�of Manufacturer
�
Tank Infonnation Gallons Gallons Units � � U �, , �
New Tanks Existing Tanks ` o y � y p � �
a U cn � v� u. C7 P.
Septic or Holdine Tank ���� � (I,MJ � I�L�.5�•1� C�i� �
Dosing Chamber
V.Responsibilit��Statement- I,the undersigned,assun responsibility for installation of the POVV'1'S shown on the attached plans.
Plumbei's'Vame(Print) Plum Simiatur MP/MPRS 1�'uniber I3usine,s Phone Number
Trc�v:5 Q���-t.c�1e)d �saa�9 7/S-G3y �817�v
Plumbe�'s Addre;,(Su�cet,City,State,Zip Codc)
I y 3Y�w S+�c.�R�� 7 7 Nc. �►a-d, c,�s z .S'y 8 w3
VI.Count /Department Use Only _
�.�p r� ❑ Disappro�'ed PcmlitFce D��e Issued Issuim�Ageni Signature
❑Owner Givcn Reason for Denial � ���'� ��'���' �"�� ���"��������
Conditions of Approval/Reasons for Disapproval
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� ,. ���� ����►� a.s a�r _ ;; ,
,
},>..._3.�..�..._�..__ MAR 2 2 2�?4 � _
GST a � �- � � ,�_ _3���.c __.�.�_���_ _ _ _----. .
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s`(� ZOF1f�`!G F:.ifJ�i�'>+:,i F,: .v
Attach[o complete plans fm'the s��stem and submit to[he Counh�only on paper nol Iess[han 8 I/2 x 11 inches in size
NO R�F�JJ�fD6 NFTER
SBD-6398(R.03/22) ISSUE OF PERilA1T �
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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
Kottman - Morgan Rd
owner rvame(s) : Margaret J Kottman Phone: - -
Owner Address: �33 Mercer St ; St. Paul , MN Z�p; 55102
Project Address : 12231 N Morgan Rd
Govt. Lot: 1 /4 of 1 /4, Section 31 , T 42 N-R 06 E ❑ or W ❑✓
Township: Spider Lake County: Sawyer
Project Parcel ID #: 028-642-31 2402
Designer Information
Designer Name: Travis Butterfield Phone: 715 _ 634 _8176
Designer Address : 14346W State Road 77 ; Hayward , WI Zip: 54843
E-mai1 : office@butterfielddrilling .com zt,;; s�����e re,e,-,-�a r��� a���>> <����tl st��r,��.
License Number: 652879
Remarks :
Signature : Date:
3 � a� - ��
� Original signature required on each submitted copy.
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Septic Tank(s) Manufacturer: '
IN-GROUND GRAVITY DISPERSAL AREA wieser Concrete
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s) Volume(s):
3-ft Trench (down -sizing credit) � oo0 9al gal gal gal
Effluent Filter Manufacturer:
Polvlok
� Best GF10
Effluent Filter Model #:
min. 12"
(typical)
SOIL COVER
� 2"
min. trench
depth
c�vP��a�> ��� � � TYPICAL TRENCH
� • ---: -� �� �� ��°�:a � � <. CROSS SECTION VIEW
���yp�,al) � .:d . .. ,a. . � � . . (No Scale)
n . a , . . a .
. " Provide minimum 3 ft
System Elevation — 95 .00 ft separation between trenches.
(typical)
Quick4 Standard-W
w/ End Cap Observation Pipe TYPICAL TRENCH
(Show location of inlet / outlet pipe connection on plan view.) (typical)
(typical) Installpermanufacturer's PLAN VIEW
instructions.
(No Scale)
� - - - - - - - - - - - - - �� ,�, Y - -� �, ,��
- - - - �� — —
f ��.� " � � f i � . '� A = 3.0 ft
�
���t�.��_ _, �r�� �� �tYPical) �
�-- - - - - - - - - - - - ��-- - - - - - - - �� - - - - - - �
G�
B = 67 ft — I m
(typical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH : (typica�) �
(mfd by Infiltrator Systems, Inc.) �
Install pursuant to manufacturers instructions. �
16 Quick4 Std-W @ 20 f� EISA/chamber = 320 ftz
+ � Pairs of end caps @ 6 ftz EISA/pair = 6 ftZ
= Proposed EISA per trench = 326 ftZ Required Infiltration Area = 643 ftz Distribution Method:
x 2 trenches = Proposed Total EISA = 652 ftz 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 activitles 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)
c 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@I'FI2ICI I I1C Phone: 715-634-8176
�ooai go�ernme�t�n�c: Sawyer County Zoning &Conservation Phone: 715-634-8288 _
�oca�government unit address: 10010 Main 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.
SVstem Abandonment
If use of this POWTS is discontinued,it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code.