HomeMy WebLinkAbout002-121-06-0101-SAN-2024-110 .arW V !
` ;����``" `� Department of Safety c°°"ry �
'�=\ & Professional Services, S c.w cr' �
� � � �.� Sanitary Pernut Number(to be tilled in by C�
' � �� �./ Industry Services Division �
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Sanitary Permit Application State Transaction Number i
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this fonn to the appropiiate governmental unit
� G
is required prior to obtaining a sanitary permiL Note:Application fonns for state-owned POWTS are submitted to Aroject Address(if different than uiailing addr<ss)
the Department of Safety and Professional Se�vices.Personal infomiation you provide may be used for secondaiy
pmposes in accordaiice with thc Privacy I.aw,s. 1�.04(1)(m),Stats. � �l�It�/� L�� ���� ��-
I.Application Information-Please Print All Information
Property Owner's Namc Parccl#
l I F a+a G a. Iec� / e�� OUa-I,1-OG G4Ua U�OI
Property Owner's Mailing Address Propeity L,ocation
lDJ� �~ p'IV� ` . r�. _
Ciry,State Zip Code Phone Number
K2t10S�0. l.n-�l Jr3�y10 -�—� ��3<, Section _ 3�
II.Type of Building(check all that apply) L�r# �-$,9-1 O T yU N R V Y+ �o W _
� or2FamilyDwelliiig-Numberoff3edrooms_ __ 3 _ 3n�3(��'��'yQ SubdivisionName
Block# GpMP'�UN �TY QEACH
❑Public/Commercial-Describe Us�, �
❑Cityof-- --_--- -
❑State Owned-Desa�ibe Use CSM Number ❑Village of
� �T�»,of _ 13as_s_ L�K�___
IiI.Type of 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.)
:�.
�New System ❑ Replacement Sy�tem U Other Vloditica[ion to Existing System(explain) ❑ Additional Pretreatment Unit(explain)
B.
❑ Holding�Cank �In-Ground ❑ At-Grade ❑ Mou�id ❑ Iiidividual Site Design ❑ Other"Cype(caplain)
(conventional)
C• ❑ Renewal Beiore � ❑ Change of Plumber List Previous Permit Number and Date Issued
❑ Re��is'�on U 'I�ran;fer to Ne��O�vner
Expiration
IV.Dispersal/Treatment Area and Tank Information: u:CK (�/vs Ch�..�+6 er s w I c�. S e/3 oF e tie+S
Design Flow(�pd) Design Soil Application Rate(gpd's�l Dispc�sal Area Required(st� Di;persal Arca ProE�osed(st� Systen�I;le��ation
ys C� o.-� C�y3 45a �f 9�.sU _
Capacity in Total #of Manufacturer �
Tank Infonnation Gallons Gallons Units � � U "O � �
� U .U+ N N V'
Vew'I�anks Existing Tanks � o � � � � ro cs
� U vn rv, cn [i. C7 0..
Septic or Holding Tank �O U O � '�OU � /_���s e� /'�_C�� x _
l�J V�+i l
Dosing Chambar
V.Responsibility Statement- I,the undersigned,assume ponsibility for' st lation of the POW'CS shown on the attached plans.
Plumbei's Vame(Printl Plumber' ignaturc MP/MPRS Numbcr Business Phone Numb��r
Tc�c�v;s �U�t�-t��:'c/d G 5"a87 9 7ir-G3`�-�17�
Plumber's Address(Street,City,State,Zip Code)
l'J3 yG 4� 5 fa�c. Ract� 7� l-�a �..rn r d, t�:- S'�'8�/3
VI.Coun /Department Use Only -- --
�c� � ❑Disapproved E'e�����Fee Date Issued Issuing Age�it Signature
�� � 4 �
❑Owner Given Rcason for Denial ���
� �I I� I�-y 7v).�.t�,���.t�-a�v�.�.
ConditionsofApproval/Reasonsfa Disapproval �� �G �',%��r `
D J� ��!'%� v f,���,� ��i
�� '" � :��te J �' �Y �__ �
='i
,; ,�� � �',,,�-�� 3s(�o MAY 0 7 2024 -
�hk# ,
C S` a C.J— C� �� �?G�`�^"" � 5�.�.—.__.s__.._.�. SAWYER COUNT`�
1 ZONING AD�J!I�;ISTRATlCJN
Attach to complete plans fm'[he s�•slem and submit ro the County only on paper not less than 8��2 x I1 inches in siie
td0 RCFUNDB AFTER
sBD-��9s(x.o3i22) ISSUE OF PERMi7 ����� �
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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
Fulkerth - Pine St
Owner Name(s): Daniel & Natascha Fulkerth Phone: - -
Owner Address: 6318 60th Ave ; Kenosha, WI Z�p: 53142 _
Project Address: 14419W Pine St
Govt. Lot: 1/4 of 1 /4, Section 30 , T 40 N-R 08 E ❑ or W �
Township: Bass Lake County: Sawyer _
Project Parcel ID #: 002-121 -06 0900 & 0101
Designer Information
Designer Name: Travis Butterfield Phone: 715 _634 _8176 _
Designer Address: 14346W State Road 77; Hayward , WI Z�p; 54843 _
E-mai1: office@butterfielddrilling.com �r���s s��a�e reseT�-ed ror� a��,r����,� st��r,».
License Number: 652879
Remarks:
Signature: _
� Date: S � � � � y
riginal signature required on each submitted copy.
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S:'�'�^;�YER �OU�E7Y
�c�lir,�.� R;D?.yf�;�iCT?A�i� y
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Septic Tank(s) Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA wieser Concrete �nc
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s) Volume(s):
3-ft Trench (down-sizing credit) � 000 gal gal gal gal
Effluent Filter Manufacturer:
Best Filter
I Effluent Filter Model #: GF� �
min. 12"
(typical)
SOIL COVER
12"
min. trench
depth
criP��ao �� < ' TYPICAL TRENCH
— — -� .a� � <. CROSS SECTION VIEW
, ,e .e..
��typc,a��'• , a �, .• . . . �NO SCa�e�
n . d • ' a
. " Provide minimum 3 ft
System Elevation = 96.50 ft separation between trenches.
(typical)
Quick4 Standard-W '
w/ End Cap Observation Pipe TYPICAL TRENCH
(typical) (Show location of inlet / outlet pipe connection on plan view.) (typical)
Install per manufacturers PLAN VIEW
instructions. �NO SCa�@�
� — - - - - - - - ---�� - - - - - - - �f- - - - - � - - - - .. � � . ��
I ,� � I�.� � ���i_��� A ���a
��� � � �
�-- - - - - - - - - - - - ��- - - - - - - - �� - - - — _ - - - y
G�
B = 67 ft - � m
(typical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (typical) �
(mfd by Infiltrator Systems, Inc.) �
16 Install pursuant to manufacturer's instructions. �
Quick4 Std-W @ 20 f� EISA/chamber = 320 ftz
+ � Pairs of end caps @ 6 ft� EISA/pair = 6 ftz
= Proposed EISA per trench = 326 ft2 Required Infiltration Area = 643 ft2 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 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 9pd; 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 I drop boxe=)
o neglect or improper use(i.e.,exceeding design capacities,prohibited activities,etc.)
o extent of ponding in distributian cell priorto dosing
o dosing irregularities-if applicable(i.e.,pump re-cyding,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('l/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^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:
Name of indivldual or company: BUttel'f12ICI ItIC Phone: 715-634-8176
�ooai 9o�ernment�n�t: Sawyer County Zoning &Conservation phone: 7�5-634-8288
�oca�government unit address: 10010 Main St, Suite#9; Hayward, WI Z�p 54843 _
Any defective part of this system shall be repaired,replaced,or removed pursuant to SPS 383.51 (1),Wisa Adrnin.
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,Wisa 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.
System Abandonment
If use of this POWTS is discontinued,it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code.