HomeMy WebLinkAbout002-840-18-5403-SAN-2024-062 Industn Se�ices Di�ision Coimty �
4822 Madison Yards Way Sawyer �
- ,�5� - Madison,WI �3705 Sanitary Permit Number(to be hlled in by Co.
� P.O.Bor 7302 4J
_ -.;�'` Madison.WI 53707 � s � 1 s� �
� '
Sanitary Permit Applieation State Transaction Number �
� �
In accordance�cith SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit �
is required prior to obtaining a sanitary permit Note:Application fbnns for state-o���ned POWTS are submitted to Project Address(if different than mailine addn
the Deparnnent of Safety and Professional Services.Personal information you provide may be used t'or secondar}� g674N NO�WIS. Rd. H2yW8rd, WI 54843
purposes in�ccordance�vith the Privacy I,aw,s. I�04(I)(m),Stats
1.Application Information-Please Print All Information
Property O�cner�s Name Parcel#
Darlene C Melton Trust 002840185403
Property O�vner�s Mailina Address Pro_pe� Location
PO Box 310 �o�f� 4
City,State Zip Code Phone Number
Townsend, TN 37882 708-846-0599 '— �� '-' � Section �$
IL Type of Building(check all that appl�•) Lot# T 40 N R 08 E or W
�/ 1 or2 Famih D�celline-NumherofE3edrooms_5
Subdivision Name
Block#
�Public/Commercial-Describe Use
^ �City of _
�State Owned-Describe Use_ CSM Numbc� �Village of
�ro��n or Bass Lake _
[II.Type of PO��'TS Permit:(Check either"Ne�r"or"Replacement"and other applicable on line A. Check one bos on line B.Complete line C if
a licable.)
A' �New System �Replacement System �Other Modification to Existing SYstem(explain) �Additional Prctreahnent Unit(explain)
B' ❑Holding Tank �ln-Ground �1t-Grade �Mound [ndividual Site Desien Other T}'pe(e�p ain)
(conventional)
C. �Renewal 13etore �Revision �Chanoe of Plumber �I'ransfer to New O�vner List Pre��ious Permit Nwnber and Date Issued
EXP�«t�on � 24-051 3.22.2024
IV.Dispersal/Treatment Area and Tank Information:
Design Flo�v(gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required(st) Dispersal Area Proposed(st) System Elevation
750 0.7 1071 1098 94.0
Capacity in Total #of Manufacturer
�
Gallons Gallons Units ` o '� �
Tank Information � v v
Vew Tanks G�isting Tanks '� o � `—' y L, � r
n. U v: �, i: u. C7 G.
Septic or Holding Tank 1645 1645 1 Wieser � O
Dosing Chamber � � �
V.Responsibility Statement- 1,the undersigned,assumc responsibility for installAtion of the PON'TS shown on the attached plans.
Plumber s Name(Print) Plwnber�s Si:nature MP/MPRS Number 6usiness Phonc Nwnber
Jason Kuettel "� �.��'"' 675751 715-798-3355
Plumber's Address(Street,City,State_7_ip Code)
PO Box 66 Cable, WI 54821
�'I.C unty�/Department Use Onl��
ennit Fee D te Issued Issuin�A�cnt Sienature
�A r �c� ❑ Disapproved � _
�y� � �� y�I c I�� ���-����z�c�-
❑Owner Given Reason for Denial
Conditions of Approval/Reasons for Disapprova -� � /�`•� `�` ;��'�,� !�`�.y
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Z�IVi�la l�:ut�?ti�d:�;I i�:rS'���'!y
A[tach to complete plans for the s��stem and submit to the Counh�onl}on paper not less than 8 1/2 x I l inches in size
NO R�FUNp6 aFT�q
sB�-639g�R.ozizz� ISSU�O�F'ERNfl7' ���D
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
Melton Trust 5 Bed
Owner Name(s): Darlene C Melton Trust Phone: �08 _846 _0599
Owner Address: PO Box 310 Townsend,TN Zip; 37882
Project Address: 8674 Nor Wis Rd. Hayward,WI 54843
Govt.Lot: 4 1/4 of 1/4,Section�$ ,T 4� N-R O8 E❑or W❑✓
Township: Bass Lake County: Sawyer
Project Parcel ID#: 002840185403
Designer Information
Designer Name: Jason Kuettel Phone: �15 _798 _3355
Designer Address: PO Box 66 Cable,WI Zip: 54821
E-mail: tim@andryras.com
License Number: 675751
Remarks:
Signature: -=i�'}��-�. Date: i �z
Original si na ure required on each submitted copy.
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Septic Tank(s)Manufacturer
IN-GROUND GRAVITY DISPERSAL AREA wieser
Uniform Elevation Trenches with Quick4 Standard-W Chambers SePt,�Ta�k�s��o,�mecs,:
3-ft Trench (down-sizing credit) 1645 9�, 9a, gal gal
Effluen�Fflter Manufacturer:
Orenco
I
�.,z.
ernuenc Fii�er Moaei a FT-0822
SOIL COVER (rypicai�
iz
min.vench
tleP�h TYPICAL TRENCH
«vo��e�� .�
r 3�..
a CROSS SECTION VIEW
ovP��ao (No Scale)
���. � � Provide minimum 3 ft
System Elevation=94�0 ft separation between trenches.
(rypical)
Quick4 Standard-W
w/End Cap Observation Plpe TYPICAL TRENCH
(rypical) (Show location of inlet/outlet pipe connection on plan view.) pvvi�ap
��s�auPe�ma��ra����ers PLAN VIEW
��s"u`����5 (No Scale)
� ---��-------�'�--------- —� 1
�.��,� .. , I A=3.0 ft
L----- MPicaq �
-------�f--------��---- ------J D
I g= 74 rt -I m
(typical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (typica�) O
(mfd hy Infilirator Systems,Inc.) �
Install pursuant to manufacturers insvuctions.
�$ Quick4 Std-W @ 20 ft�EISA/chamber= 360 ft' �
+ � Pairs of end caps @ 6 ft`EISA/pair= 6 ft'
=Proposed EISA per trench= 366 ft' Required Infiltration Area= �072 ft� DiSt�ibUtiOn MOthOd:
x 3 trenches=Proposed Total EISA= 1098 ft� branched manifold
RESET ::
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 382-354, 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 Operetinq Limits:
Design Flow = 750 gpd; BODS <_ 220 mgL''; TSS <_ 150 mgL-'; FOG 5 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 priar 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 discharye 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 1?.
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: Afldl')/ R8SI1lUSS@Il 8c SOI1S Phone: 715-798-3355
Local government unit: SaWyOf CO. Z011ing Phone: 715-634-8288
Local government unit address: 1061 O Malll St. #49 H8yW8fd, WI ZiP 54843
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1),Wisa 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.