HomeMy WebLinkAbout010-277-00-2701-SAN-2024-100 _- ' Department of Safety c°°°ty SAWYER �
� = & Professional Services, �
� = Sanitary Permit Number(to be filled in by C� �
�= Industry Services Division
�S � '1 �s s
Sanitary Permit Application State Transaction Number �
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit �
is required prior to obtaining a sanitary perntit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing ad
the Department of Safety and Professional Services.Personal information you pmvide may be used for secondary
putposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. � ' �`��,�n��',1 �,
I.Application InformaHon-Please Print All Information
PropertyOwner'sName �-}alvf�k (7�PP��' �e�# �700
DYLAN J. & EMILY L. SUMNER `��� ��-� O 10-27'�00�
Property Owner's Mailing Address
14638W BIRKEN TRAIL ROAD Govt.Lot NA
City,State Zip Code Phone Number
54843 _�''/.,'Section 19
HAYWARD,WI �
IL Type of Building(check all that apply} Lot# T 41 N R Og �or W
C�or 2 Family Dwelling-Number of Bedrooms � � �� Subdivision Name
B��k# HATCHERY CREEK��I
❑Public/Commercial-Describe Use �7�
l� ❑City of
❑Stale Owned-Describe Use_ CSM Number ❑Village of
�, HAYWARD
NA
iII.Type ot 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.
A. X Replacement System ❑ Additional Pretreatment Unit
�w System Other Modification to Existing System (explain)
(explain)
B� ❑ Holding Tank X In-Ground ❑ At-Grade gn ❑Other T ex lain
❑ Individual Site Desi ype( p )
(conventional)
C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner ist Previous Permit Number and Date[ssued
Expiration
IV.DispersaUl'reatment Area and Tank Information:
Design6FlOowo(gpd) Design SoilOpp6lication Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
1000 1038 94.00 FT.
Capacity in Total #of Manufacturer
Gallons Gallons Units a� o � �
7'ank(nformation a �
New Tanks Existing Tanks � o � � � � R �
a. U v� v r7� ti U A.
Septic or Holding Tank �250 25� 1 WIESER
Dosing Chamber
V.ResponsibiGty Statement-1,the andersigned,assume responsibility for installadon of the POWTS shown on the attached plans.
P�umber's Name(Print) Pl er's Signa e MP/MPRS Number Business Phone Number
RYAN TRAND 798301 715-558-1673
Plumber's Address(Street,City,State,Zip Code)
10571N TOWN INDUSTRIAL PARK ROAD, HAYWARD, WI 54843
VI.County/Department Use Only
�A �e CJ Disapproved Permit Fee Date Issued Issuing Agent Signature
❑Owner Given Reason for Denial $ ��,oD S'�{ `� 1 ��L1X��-1 ����-
Conditions of Approval/Reaso�ns�for Disapprova] � �������
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Chk# �s o��,.�_�..,,�.�..,v_,_ MAY 0 6 2024
G ST ��,— ("��3 e�;,�i�}u �._�_�.��.__.,a . SAVVYER COUNTY
�ONING ADMINISTRATt�N
Attach to complete plans for the system and submit to the Coun Dnely�n p_aper�not less than 8 1/2 x 11 inches in s'u.e
NO REFUN F'T'E
SBD-6398(R.03/22) ISSUE OF PERMIT � 3���j
PAGE 1 OF 4
In-Ground Gravity Plan
Index 8� 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 8�Plan View
Pg 4 of 4 Management Plan
Attachments: I Enclosures:
-------+-------_ _ _ --
Tax Statement POWTS Application for Review
' Soil Evaluation Report&Site Map
_ _ _ __ __ _...
Project Name I Description
Lor za, �-�Tc� c{z�r� s�.�s� .
Owner Name(s): DYLAN J. &EMILY L. SUMNER phone: - -
Owner Address: �4638W BIRKEN TRAIL ROAD,HAYWARD Z�p: 54843
Project Address: (SAME)
Govt.Lot: NA 1/4 of 1I4,Section �9 ,T ��N-R �$ E Q or W Q✓
__
Township: HAYWARD County: SAWYER
Project Parcel ID#: 010 27 7002 800 TAX ID:43270
Designer Information
Designer Name: MARY JO HUPPERT Phone: 715 _426 _ 1775
DesignerAddress: 25720 FIREFLY LANE,WEBSTER,WI Z�F. ..�Q,8.9�
E-mail: hollisterdesign@outlook.com ,.�'�._,v -, f'��
LicenseNumber. �859-007 ���� �� • '�
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Remarks: H, . , • `
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Signature� � � � �• Date
Original� nature repuiretl on wbmineE copy-
Plot Plan Page d of��
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PROPERT'( OWNER: j�YU�J J�. � �N�iL�F L.S�.INW� ��� � 4p F-�-.
(e�piwhere noted)
legal Description: GdRr� �T�-y � SL��•� 'S1�� Tk��1, R8$h�+ Q == backhoe pit
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Septic Tank(s)Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA wieser
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s)Vdume(s)
3-ft Trench (down-sizing credit) 1250 9al 9a� gal ge�
EfFluent Filter Manufacturer
I EffluentFilterModel#: ��� �'-�� �R�Co�
min.12"
(rypical)
SOIL COVER
12^
min.Vench
�na°�o • TYPICAL TRENCH
' a CROSS SECTION VIEW
�- 34� No Scale
I�YPlcel�._� . . � �
� ' Provide minimum 3 ft
System Elevation = 94.00 ft separation belween lrenches.
(typical)
Quick4 Standard-W
w/EndCap O�servatbnPlpe 7YPICALTRENCH
(rypicaq (Show location of inlet/ outlet pipe connection on plan view.) instail pe�a�ufacturers
PLAN VIEW
— — — � instmctlons.
' I (No Scale)
i h4r.�rn���Y�kk'��'- - - - �� - - - - - - - ��- - � �rr�r��r�r.���'����1
o �s I A= 3.OR
s' l'I�'� �bPical) �
(
�t�fi`�'�_�Ya[YY��n�d/�lP�l _ _ _ _ �� _ _ _ _ _ _ _ �� _ _ _ YIFq�I�//.YiY1VY_Y.Y,(VYJ D
� B = 70 n �-_� m
(rypicaq puick4 Standard-W Chamber W
600 GPD I 0.6 = 1 ,000 FT_ 2 (typical) �
INSTALL PER TRENCH: i o0o i 2o EisA = so uNiTs (mfd by InfltratorSystems,Inc.) �
50 X 4 FT. = 200 FT. / 3 Install pursuant to manufecturers inswctions. �
�� Quick4 Std-W @ 20 fP EISA/chamber= 340 f�' TRENCHES = 66.67 OR 68 FT.
+ � Pairs of end caps @ 6 ft� EISA/palr= 6 ft= ��j> � FT X 68 FT- TRENCH
= Proposed EISA per trench = 346 ft� Required Infiltration Area= 1000 }�� Distribution Method:
x 3 trenches = Proposed Total EISA = 1038 ft= branched manifold �
PAGE 4 OF 4
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 Operatinn Limits:
Design Flow = 600 ypd; BODS <_ 220 mgL"'; TSS <_ 150 mgL''; FOG 5 30 mgL"'
Insaection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors(i.e. odors, user complaints, etc.)
o mechanical maifunction (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 electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
o distribution laterai or lateral orifice plugging (measure lateral distal pressure—compare to design specification)
o surface discharge of effiuent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Seutic and dose tankls) 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 shail 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: RYAN STRAND Phone: 715 - 558 - 1673
�ocal government unit: SAWYER COUNTY ZONING phone: 715 - 634 - 8288
local government unit address: 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.