HomeMy WebLinkAbout010-941-23-3108-SAN-2024-108 . ' ar�g
' - lndustry Services Division �:Counry �
//�-���:;.. �A
-?;, I 4522 Madisun Yards Way S4W�.Q a-- �
- .,\SP �� ;' � Madison,Wi53705 i SanicaryPcr*nicl�'umber(robefitledinby�
r . _ :- P.O.Box 7302 �j
��•����j�� Madison,Wi 5�707 �S� ���� -C
t
53111t'dly PC,'11111t f�p�J11C3t1011 Statc Transaction Number G
In accordance with SPS 3A321(2),Wis.Adm.Codc,submission of this foim ro the appropriare govemmen�al unit �
fs rcquircd pnor to oFtaining a sanitary permit.Notc:Applica[ion forms for stam-owncd POWTS arc submittcd[o�Prqect Address(if dift'erent than mailing address)
[he Oepartment of Safery and Professionaf Services.Personal information you provide may 6e used for secondary ` 7
purposes in accordance with the Pnvacy Law,s.15.04(1)(m),Scaa. I O I�O 4 N �
i.ApplicaHon information-Please Print Ail)nfortnatlon alhl e Oh T�^
.Property Owncr's Vamc I Parccl�
Tpd� �4. �owt�.s f� - �ze• le bio —441-z3-3fo8
Property Owner's Mai ing Address Property Loca[io
I b���} A� N G,rvl k O Tr •e�r��c�
C�ry,State Zip Cale Phone Number
�� u.7ar� t.l�� ( Sy$'13 ��5-634_2�64
f uE', 5W '/.,Seccion Z3_
1�IIA.Type o uilding(check all tha[apply) Lo�n T y N R O Q E or
�y�lor2FamilyDwelling-VumberofBcdmoms J_ � SubdivisionName --_
�W —J
Block i?
�ubllc/Commercial-Descnbe Use
�—� ❑Ciry of
�StareOwned-DcceribeUce CS'vfVumber illageof
CS Yl 4�17��763 �Ta�",or F��wa r�
ili.Type of POWTS Permit:(Check either"tiea�"or'BeplacemenY'and other applicable on line A.Check one box oo line B.Complete line C if
a licable. I—I_ m
A� ❑Vew Sys[em � �tceplacement Sys[em �I Y IUther M�°ditica[ion to Existing System(zxplain) �❑Additional Prttmatment Unit(explain)
LJ ��� [.:S�E�: IaJ.�ri...
B' ❑HoldingTank �In-Gmund �4t-Gradc �Monnd �IndividualSiteDesign OtherTypemxplain)
(conventionel) I
C. �Rmewal Betbre �Revision hange of Plum6er �I'ransfer ro New OwnerList Previeus Pecmit Vumber nnd Dete Lcsued
E�piration C$"r"' Z7—�1 f/'��^��/
l0
IV.Dispersal/frea[ment Area and Tank Informadon: � EK'�S ,K 1c ts .K
Design Flow(epd) Design Soil Applicacion Ram(�pd/s� Dispersal Area Required(s� Uispersal Area Proposed(s� System Elcvation
3 .-7 4Lq (o3D GS.7S
Capacity in Totai k of Mana(a:turcr
Tank informa[ion � Gallons Galions linits I U� -
ewTa ExixtingTanks - �
?G -H c:J a
.p corHoldingTank ���� �_ 1p� ' (,JeiSeT
Dosing Chambcr I
� �
V.Responsibility S[atement-I,the undersigned,assume responsibility for insmliarioo of the POWTS shown on the attachM plans.
Plumber's Vamc(Pnnt) Piumber'.a Signat e � MP/MPRS Number Buiness Phon<Number
D �a.-, 5��,,Ifz j ISrb1z1 ��s-S58-S�o4-
Plumber's Address(Stree4 City.State.Zip Code)
107lo s�one L.�1�� 2d- S-Fon�lQke �.// 54 7
V[.CounN/Department lise Only
�, ❑Disapprnved ;permit Fec Date issued , Issuin�Agent Signanve
❑owr��G��-�,a��on r�����a� I S yOD•a° ,5�I S�3 4 ' ,�c,(;ul,l Qi w�iy,-
ConditionsofApproval%RersonsforDisapproval � _..��nnl
� � � 7 I ���(77 ��
�p �L-'�i�'C�J '✓.'r��-'7 I �''% �_�n n
'�rr��'Y�tlr"T►� , �70te �I�.Slay - —J� �
�CST � �— Q(�,��� !'hk# aa .�_
MAY 1 5 2024 `�
_��,; SAWYER COUNTY
ZONING ADMI �-
Attach to camplete plens for Ihe system end submi[to the Counh'oNr on peper not less thon 8 Ia x 11 inehes in size
SBD-6398(R.02/2?) NO REFUNDB AFTER
ISSUE OF PfRMIT
izSl�l
. � PAGE 1 OF
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 Piot 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
Owner Name(s): To � A T� o►� 4 s �Z�� � Phone: 1 �s - 635� - �7� q
Owner Address: ( oboy N ���c �o��'�— ����� w� Zip: S '�8��
Project Address: S4-►tit -
Govt. Lot: u� 1/4 of s�e.) 1 /4, Section z3 , T �! N-R o�t E � or W �
Township: {-�(�-.�. . �� �� County: s����v' —
Project Parcel ID #: O � o -- q`� t -- Z 3 — 3t a$
Designer Information
Designer Name: (�r�►� S�� � ��Z Phone: 1lS� - SS - Sqfly
Designer Address: 70?� S�eK� L�-��� i� , S�dKe-�ke W � Zip: �8`��O
E-mail: � . . . : .�_ � �, �:� :-��:. ., ,;, . ,
<:_ ro�•;' sta*,r.�_.
License Number: I S � (v � Z�
Remarks:
Signature: Date: s �- Z �
,
0 � in signatu ired on each submitted copy.
�,c�►1P>r : Le a.�: z 1�
��
ro� �.,�-t,�,�.�s ze�91-e s���,� eo, ��w�..� -�-�,�
1b60�-k iJ �G.n�.�kc�qOn -G'r PtN: O �0 — g�-E.l— �3 -� 3 t�6
��-ywar-�, �r 5��3 �1E'�sc,� �S' �3 i �ll�1 R.D R�v
"7 �s - �3�1 — a�6�_ Lo� 6 Gs E-i �� t-r� �t '►�3
- {�i` - �--�
. .
� q4�. ��,��
� �k z
� � - ,
�� �
� a`��� . � , .
� e�
v� � y
o V
� z bd.
o� � _ _
� �
� �.;
� � _
►Jo�' -bo ss�:l�
i —+zoo �
e
..___________.
Sh�oo
dr��e.
I O<o O�-4 1•1 _ .+3: '
..�.�, ��W.��.,,,�.,.:,� ._ ,,,��..-s -�,,�_�_ _.._,
_ ._ _ _ _. _� __ .
�
_,�.
S��e l =�E a
_ _ __ __, _.__.__.
�.3 N�o o To� �-� c.��_[l i� �a�e�_5��1 ��s-I-/�,rc�..
6l, qq.4g
Flc ST �N 97.�6. `o ro � se �
r . _ _ ..__ .. _ _._ . _ _ _ __ _ _
r �Y S�Sfew� pJ. R S;7S `
, r ._ . .. __. ;._____� _ .__r-_.__�__ .
. : ...�. _
3 " �` d�
.
. �._�_...
--_�__._.�_ �.�_.___. _.
� � _ _
�, - �_
}o -� �I b� -E�o ��s�s lL �.e�v s�r
� _ _ _ __. ._._:�_ ....___ _, : __ . ._____.. _- _
__._ _ _.'_________._�._ _ _ __
� • t
bwnev- : ��
31y
'T'od� ft-?"�o�45 �-, ze9�C irw�e.- Co ('{�.Jw2v-c� l4'�
10(�D�{ /J l.�c�w�e <<-c�.�o� T"v- f��nl O�o - 4�F�- Z3- 3�a8
�-}�.y w4v.1, c.c,( S�{Sy3 uE�sw .f z3 �' ��ni 2. oqW
�Kis'�•l,��c ({.oc,�C--be� st.�s�-ew�
JeK-�
!QB 4Z 1 ro.�ti.L�
U 6 � � O@J6O' I
i o C� o Do
�� �Rock- Bec� � � � �6�a �y��
o , { a TP
U��s s�u., a�x3o 0o O?roa� � Sys-�-��� 95.�5-
PAGE �l OF y
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuart 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 healtFthazard if not maintained in accordance with this 2pproved management plan.
Furthermore, all irspection and mainter:ance 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= .30Q gpd; BODS <_ 220 mgL-'; TSS <_ 150 mgL"'; FOG <_ 30 mgL-'
Inspection Checklist INSPECT EVERY 3 YEARS
c rype of use
c age of system
o nulsance factors (i.e. odors., user complaints, etc.)
o mechanic2l malfunction (i.e., pumps, valves, switches, floats, etc.)
o material fa?Igue (i.e., leaks, breaks, corroslon, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appuRenance(s) (i.e., distnbution i drop boxes)
c neglect or improper use (i.e., exceeding design capacities, proFibited activities, etc.)
c extent of pording in distribution cell priorto dosing
c 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 onfice plugging (measure lateral distal pressure -compare to design specificatior)
o surface discharge of effluer.t or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
., Seqtic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
S[ats. 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 cortents 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 manufacturers specifications. A servicing period will always be greater than '2
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:
Nameofindividualorcompany: $c��? �'FZ- P��c� Phone: ,�S- SSS - S40'-{
Locaigovernmentunit SqwHe�- �'O ZZOvi�n� Phone: -115- 63��$2.88
Local govemment unit address: I pb�b Ma��S+�Y� �'w�•c� UJ l ZIP: S`t8'-f3
Any defective part of this system shall be repzired replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin.
Code. Repair or replacement of failed or malfuncfonirg components shall comply with SPS 383, Wisc. Admn. Code.
No product for chem cal or physical restoration or the POWTS may be used unless approved by the department in
accordance with SPS 384. Wisc. Admin. Code.
Continaencv 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 fre appropriate agency for review ar.d approval. A failed in-ground dispersal component may be
abandoned and replaced by a code-complyina dispersal componert in a pre-determined area of suitable soils.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.