HomeMy WebLinkAbout002-940-16-2410-SAN-2024-085 `� � ' � Industry�Ser��iccs Di��ision Count�� �
4822 Madison Yards Wa} SaWye� �
- ,�s� � Madison,WI 53705 Sanitary Permit Number(to be filled in by Co
t P.O.Bor 7302 2
Madison. WI�3707 � S 1 � �I J �j-�
Statc Transaction Number �
Sanitary Permit Application __ �
In accordance with SPS 383.21(2),Wis.Adm Code,submission of this form to the appropriate governmental unit �J
is required prior to obtaining a sanitary permit Note:Application fonns for state-owned POWTS are submitted to Project Address(if different than mailing add �
the Department of Safety and Professional Services. Personal information ti�ou providr ma��be used for secondary �+ame �
purposes in accordance with the Privac��La�v,s. I�0�3(1)(m�_Sta[s ��
I..4pplication Information-Please Print All Information
Property Owner�s Name Parcel#
Brad Bengtson & Susan Sudbrink 002940162410
Property Owner's Mailing Address Property Location
8705N Old 27 Rd.
Govt.Lot
City,State Zip Code Phone Number
Hayward, WI 54843 612-393-8414 sE ,,,,Nw �,, se�t;on 16
II.Type of Building(check all that apply) Lot# T 40 N R 09 E o��
�/ I or2 Famih D�celline-NumberofBedrooms 3 2
Subdivision Name
Block#
❑Public/Commercial-Describe Use
�Ciry of
�State Owned-Describe Use_ CSM Number Village of
22��Q� �������„�t Bass Lake
U
111.T�pe of P01�'TS Permit: (Check either"\e��"or"Replacement"and other applicable on line A. Check one box on line B.Complcte line C if
a licablc.)
��� �New System �Replacement System �Othcr Moditication to Existing System(explain) �Additional Pretreatment Unit(explain)
B' �Holding Tank �In-Ground �At-Grade �Mound �Individual Site Design Other Type(explain)
(conventional)
C• ❑Renewal Before �Revision �Change of Plumber �ransfer to Nc�v Owner List Previous Permit Number and Date Issued
F.xpiration ��Q� O y� '+' O�"�6�
I�'.Dispersal/Treatment Area and Tank Information:
Design Flo���(gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required(st) Dispersal Area Proposed(st) System F.levation
450 0.7 642 652 95.19
Capacity in Total #of Manufacturer
Tank Information Gallons Gallons Units L ` J � u
\e�c Tar�ka I�:�i<ting T�nks �` c `_' u _ =
_ U ✓� � v: — �: _
Septic or Holding Tank .�00� ���� 1 Wieser � �
Dosing Chamber � � �
V.Responsibility Statement- 1,the undersigned,assume responsibility for installation of the POW'TS shown on the attached plans.
Plumber�s Name(Print) Plumber�s Signature MPMPRS Number Business Phone Number
u
Jason Kuettel , � 675751 715-798-3355
Plumber's Address(Street,City,State,Zip Code)
PO Box 66 Cable, WI 54821
�'I.C unt /Uepartment Use Onl�•
�.A iclC �l ❑ Disapproved Pennit Fce Date Issued Issuine Asent Signature
��✓ $L� �, �� ? � � ` ; , -t-y,v�
❑Owner Given Reason for Denial �` I'� �/ `�" '�"�� �"�-
Conditions of Approval/Reasons for Disappro�al � � ���('�/
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,r� � � . ��'a 3;a�
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1Y� 3
; __ .__.
C � �c./ ^ � � � l"��� SAWY�R COUNTY
� ZONING ADMINISTRATION
:�ttrch ro comple[e plans for the s��stem and submit to the Counh�only on paper not less than 8 V2 x 11 inches in size
ssD-639s�R.oziz2> NO R�FtJND6 AFTER
ISSU�OF PfRMIT 5��-I S
PAGE 1 OF 4
Holding Tank Plan
Index 8� Cover Sheet
Component Manual Design References:
Holding Tank Version 2.1 (May 2022-2027)
Pg 1 of 4 Index&Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Holding Tank Specifications
Pg 4 of 4 Management Plan
Attachments: Enclosures:
POWTS Application for Review
Soil Evaluation Report&Site Map(if applicable)
Holdin Tank Pum in Contract if a licable)
Holdin Tank A reement if a licable
Project Name/Description
Bengtson/Sudbrink 3 bed septic
Owner Name(s): Bradley Bengtson&Susan Sudbrink phone: 612 393 8414
Owner Address: $�05N Old Hwy 27 Hayward,WI Zip; 54843
Project Address: Same
Govt.Lot: SE 1/4 of NW 1/4,Section 16 ,T 40 N-R 09 E❑or W ✓❑
Township: Bass Lake County: Sawyer
Project Parcel ID#: 002940162410
Designer Information
DesignerName: Jason Kuettel Phone: �15 _798 _3355
Designer Address: PO Box 66 Cable,WI Zip: 54821
E-mail: tim@andryras.com
License Number: 675751
Remarks:
��;..fr
Signature: .>����� Date: zz z-�
Origin sigfiature 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 SeP�;�Ta�kcs,,,�,�me,s�:
3-ft Trench (down-sizing credit) �oo0 9a, gal 9a� gal
Effluent Filter Manufacturer.
Orenco
I
��.iz..
ern�e�c Finer nnoaei a FT-0822
SOIL COVER (�pi���
ir
m���.i�ao�n
devm
�ryP��a�� • TYPICAL TRENCH
r 34.,
CROSS SECTION VIEW
ava��ao (No Scale)
���. � � Provide minimum 3 ft
System Elevation=95•19 ft separation between trenches.
(typical)
Quick4 Standard-W
w/End Cap Show location of inlet/outlet �bservation Pipe TYPICAL TRENCH
(rypicaq � pipe connection on plan view.) 1YP"a�� PLAN VIEW
Install per manufacturefs
instructions.
(No Scale)
� -----------��-------��-- — —�
, , , � �n=s.on
� �ryP��a�> �
L-----------��-------��---- ------� D
F B= �� n -� m
(rypicaq Quick4 Standard-W Chamber W
(typir.al) O
INSTALL PER TRENCH: �mfd ey i„f�i«a�o�sygiams�„�� �
Inslall pursuant to manufacturers insiructions.
16 Quick4 Std-W @ 20 ft`EISA/chamber= 320 ft� �
+ � Pairs of end caps @ 6 ft`EISA/pair= 6 ft'
=Proposed EISA per trench= 326 ft' Required Infiltration Area= 642 ft' Distribution Method:
x 2 trenches=Proposed Total EISA= 652 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 382-384, 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 = 450 gpd; BODS <_ 220 mgL''; TSS <_ 150 mgL''; FOG <_ 30 mgL''
Insqection Checklist INSPECT EVERY 3 YEARS
o type af 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 electricai 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 tankls) shall be pumped by a ceRified septage servicing operator licensed under s. 281.48 V�'is.
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: Alldf�/ RBSIIlUSS21l $c SOIIS Phone: 715-798-3355
�ocal government unit: SBWyEr CO. ZOI11Ilg Phone: 715-634-8288
Local government unit address: 10610 Malll St. #49 Z�p 54843
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 353.51 (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.
Continqency 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.