HomeMy WebLinkAbout022-738-32-4301-SAN-2024-120 y,�Tr"--4--T"-�� Industry Services Division County ln
o ,i�N '; 4822 Madison Yards Way �w� �� �'
= � �� ,•' � Madison,WI 53705 Sanitaty Pei7iut Number(to be filled in by Co.) �
� � S P.O.Box 7302 �
?a,, �- ,c` Madison,WI 53707 �5� 3'O � S
��O`raioxnGs`��
Sanitary Permit Application StateTransactionNuinber �
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this fonn to the appropriate goveizunental tuiit �� � -'� �
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to roject Address(if different than uiailing;iddress)
the Department of Safety and Professional Seivices.Personal information you provide may be used for secondary
pmposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. r��
I.Application Information-Please Print All Inforinafion o�-� ��p N �' , , ,� ��
Propeity Owner's Name � Parcel# O1�_ p
�D � � � � 38-3 - K3 1
Property Ownei's Mailing Address � , --=-'-"'�+a....�.,��__
� -- --- '-_—v-�.
� ,(�
� � �;1 �yr r„«—_
City,State Zip Code Phone Number
. , .� s Lr�� 5 c� �
/<, /<, Section�_
�II.T ,e of Building(c k all at apply) Lot# T � N R _ •E�W�_
�I or 2 Fanuly Dwelling-Number ofBedrooms D�. Subdivision Name
��
B lock#
❑Public/Coirunercial-DescribeUse
�--r ❑City of _
❑State Owned-Describe Use_ CSM Number ❑Village of _
----� �Town of �' � S`�f��� —
"IIT:Type of POWTS Perinit: (Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if
ap licable.)
A� �New S stem Re lacement S stem Other Modification to Existin S stem ex lain Additional Pretreatment Unit ex lain
Y ❑ P Y � g Y � P ) ❑ � P )
B' ❑Holding Tank �Tn-Ground �At-Grade �Mound �Individual Site Design Other Type(cxplain)
(conventional) � ���
C• ❑Renewal Before �Revision ❑Cl�ange of Plumber �I'ransfer to New Owner ist Previous Pennit Number and Date Issued
Expiration
IV.DispersaUTreatment Area and Tank Information:
Design Flow(gpd) Design Soi1 Application Rat (gpd/s� Dispersal Area Requi�ed(s� Dispersal Area Pr osed(s� System I;levation /
�� •� O � 2 �'' �i'3. �
Capaci in Total #of anufactur •
Tank Infonnation Gallons Gallons Units � � o '� o
New Tanks Existing Tanks � o � � y Q � �
a U cn ti rn w U p-,
Scptic Holding Tank � �
U /�-
Dosmg hamber � � �� � � � ��
V.Responsibility Statement-I,the undersigned,assume responsibili for installation af the POWTS sho attached plans.
Plumber's Name(Print) PI nber�Signature P P wnber Business Phone Nwnber
r � � � � � 7� 7l����-���'�-
nbet's Address(Sh�eet,City,State, ip Code)
j ,� / )
�-� S �t�Ir�� G /'� � �Zd�L�� �C�� �y����
VI.Co ty epartinent Use nly
,� v ❑Disapproved Pennit Fee Date Issued Issuing Agent Signature
❑Owner Given Reason for Denial $ l w� _ S � "� I "`� ����'�-���./2Y,�-
Conditions of Approval/Reasons for Disapproval '
�
. � � � ; _ ��/,�.,
;�a�� � �t �-`� 'r � �i� D l�� �� �5�' ' �
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SAWYER CGU�f"��`
Attacli to complete plans for the system and submit to tlie County only on plper not less than 3 1/2 s 11 yTQ�
NO REFUNDB A�'1'ER
SBD-6398 (R. 02/22) ISSUE OF PERMIT .�;�;,��s�
' t ".kl �l/,�;��
�'Visconsin Deparimem of Salbty �+iid Prol�essional Services �,'- � '��,�•� Phone: 60R-'Gfi-Z L 12
Division of litdustry Sercicc5 ,% ;i �' `.%'<< Vl'�•b: htin://dsn�.wi.gov
48'Z MaJison Yards �Vay �- � �+_i limail dsp�,ir;wi,contiui. ��
PO Box 7302 � � , � � ���`�
�
Madison, Wl 53707 '�', � TOn�� EVet'S, G0�'CP[l0Y
` ',c . ' `�';,
`��,, � _ , < .� Dan Hereth, Secretary
� .�_:�„��: �
May 14, 2024
CUST 1D NO.: ?20728 � �� � � �����' Identification�Numl3c,rs �
CLARENCE L GLOTFELTY Plan Revicw IVo.: PWTS ���''�n"�7O_(' � � � � � ���
.��,�, . _-_
N4955 SlT]VNY IIILL RD Application No.: DIS-042418R79
W�,YERfIAEUSEK. WI 54895 Sitc fll vo.: SI'I�- 129976
� � Plea�e reFc�'�to al1'��identiiic.iti��n ��umbers in��r;acll � �
�con�espontien�� with the Departmet�t. �� � � �
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: O�i 14�2026 coHr�noNa��v
APPROVED
DEPT. OF SAFETY AND PR+JFESSIONAL SERVICES
MUNICI PALITY: DIVISION 6P IN6USTRY SERVIGES
TOWN OF RADISSON
SAWYF;R COUNTY `e.��' ,_`�r.�.•.
elde�xmvn, 05�1412024
SITE' SEE CORRESPONDEMCE
ENGHOLM MOUND
WIERGOR ROAD
RADiSSON, Vl"i 54867
40 ACRES SW 1/4 SE I,'4 SEC 32 T38;v'R7w'
FOR:
Design Wastewater Plow �'aluc: 4�0 Gcomat Mound Component Manual - 5/I Ri22
Bedrooms: 3
Limiting Factor(s): 18 Inches
1Vlaintenance Required: Effluent F'il�er
SITE REQUIREMENTS
• A full size copy oCthe approvcd plans. specifiications, and this Ietter shall be on-site during construction and open to inspectiun
by authorized repr�sentatives oCthe Dep��rtment, which may include local inspeciors. A l�eparnnent electronic stamp and
signature shall be on tl�e plan5 whicl� .ue used at the job site for construction.
The foilowing conditions shall be met during construction or installation and prior to occupancy or use:
• Preserve dispersal area prior and dw�ing construction to avoid disturbance, compaction and use of thz site.
• With new construction; it is recommended not to acti��atc the pump in the dose tank until the tanks are pumped prior to
homcowner occupanc��.
• Wastewater generated from contractors cleaning of eqiiipment and tools aiid/or 1efi over constn�ctio�i products sliall iiot be
discharged into thc drains dischar�!iug to the pri�'ate onsite �4�aste�-ater treatmont systcm (POWTS). w`astc gencrated shall be
properly disposed of on-site or off sitc.
• Any tall grasses, leaves and shrubs shall be cut .hort and removed prior �o tilling thc sl�rlace for installation to prcvent matting
under tbe dispeisaL arca. All loose organic matcrial to be removed from POtiVTS Dispers�l Area.
• Divert suri'ace water Iro�n all POWTS Area�.
• Prior to construcNon of the dispersal area, check thc moisture content of the soil to a depth of 8 inches. Smcaring and
compacti��g of «-et soil will resuJt in rcducing the intilrratfon capaciry of the soiL Proper soil moisture con�ent can be determined
by rolling a soil sample betwcen [he hands. If it rolls into a 1 /4- inch wire, thc site is too wet [o }»�cpare. If it crumbles, site
preparation can proceed. Tf� the site is too wet to prcpar�, de procecd unlil it dr. �s.
• ,411 piping shall conform to SPS Table 3R4.3O-3 and SI'S "1'able 3R4.30-5
• lnsulate building sewer beyond 30 fcet per SPS 342.30 ( 1 1 )(c)
• Well setbacks to meet chs. NR R 1 1 & R 1 ?
• Tank installation to follow all manufiacturc's recomn-,�nd�__.�s.
• Vcrif,y propert��linc(s)prior to inst�llatiou.
• Pump Floats to be set and vcri�ed per approved plan. Any chan�cs may result in pump resizing to mcet TDH and GPM
SpQcifcations.
• Areas that are oecupied with rock fi�agments,trec rovts,stumpa and boulders rcdiicc the amount of soil availablc for proper
treatment. If no other site is available,trecs in the basal area of thc mound must be cut off at ground leveL A larger fill area is
necessary when any of the above conditions are encountered,to providc sufticieut infiltrative area.
OWNER RESPONSIBILITIES
• The curreut owner,aud each subsequent owncr,shall rcccive a copy of this lette�r includinb instructions relatin�to pro�er u�e
and maintenance of the system. Owners shall reccivc a copy of the appropriate operation ai�d maintenancc manual and/or
owner's manual for the POWTS described in this appro�a! and Wis. Admin. Code � SPS 383.54(I).
• Tn the evcnt this soil absoiption system or any of ils component parts maH�unctions so as to creatc a hcalth harard,the property
owner must follow�the contin�ency plan as described in the appro��ed plan;.
The submittal described abovc has been reviewed for conformance with applicable Wisconsii� Administrative Cudes and Wisconsin
Stahrtes. The submittal has bcen CONf�ITIONALLY APPROV�D. This system is to be constructed and located in accordance with
the enclosed approvcd plans and w�ith auy componcnt manu.�l(s)r�Cerenced abovc. The o�vner,as defincd in chaptcr 10 LO1(10),
��'isconsin Statutes, is responsible for co�npliance�vith all code requirements.
No person may engage in or�vork at plumbing in lhe state unless liceused to do so by the DcparLncnt per s.14�.06,stats.
All permits required by the stale or the local mimicipality shall b��btaiued prior�o cor unencement oC
constniction/installation/operation.
In granting this appro��al, the Division of[ndust�y Services rese►1-es tlle rigl�t to require changes or addi�ion;,sllould conditions arise
inaking the�u�iecessary fur code compliance. As�er statc stats 10!.I 2(2),no�l�ing in this re��iew shall relicve tl�e designer o{�the
responsibility for designing a safe building,strucnu-e,or component. The Division doe�not take responsibility for[he cicsign or
construction oY thc rcvie��ed items.
Inquiries concerning this correspondence may be made to me at the contact information listed below,or at tl�e address on this
lettenc�ad.
Sinecrely, �Fce IZcquired: $2.50.00
Fee Received: $250.00
� Balance Due: $0.00
:�'` Rcfund 1'x�ected: �0.00
M��' ��
Heidi Eide
Division of Industry Scrviccs
Phone:
EmaiL• heidi.eide@wisconsin.gov
APPROVED
� .
,o zo�. ,,.:,, �.� .�„, ^ : . : :.
s�corzx¢m�oerice .,_., . .:�a� ...,�. .., s.,.'..r... .,,, ' ' ' �.
il". C� �:
Resid�nti�l�lpp(ica�ior�
IND�X t�E�D TI7LE PAC�
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Pr�ject hfarne: En,c�haim Ntound � .�.4
(�wner's Name: Jonathon Enc�holm ,_ �. �_
Owner's Adc�ress: 30�9h1 East Riuer Rd.
Radisson, �1V1 54867 �
._ r.,�� ..�...
���`� \\ �' � \ � . `., ? ��� �.> ��.:�
,'
Prop�rty�4ddress ?} Wi�rgor Rd.� ___.�..�__
Legal Descripiion: SW S� S 32 T 38 N R 7� W
Towns�hi�_ Radisst�n Ccaunty: Sawyer.��
Subdivision t��me: n.a.
Lot Nurnber: n.a. Biock Number: n.a. CSM#: n.a.
Parcef {.�. �lumbe��: t�22-7383-�A01 � '
Plan� Transactic�n No.: '
..
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r ,.. � ��� � � ����..�. � .. af�
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,�.. �� � .,
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f'age 4 lndex and title Page 9 Tank erc�ss sections
Page 2 Data entry
Page 3 GeoMat mc�und dra�vings ___.�.. _.�_._��__�__. ,
Page�4 �a�eral and dose tank. � ._� �
Page� Distrib�tian medie �--�---�—.._..�,..� � _
Page 6 Systet�n mairtenance specificatians �� �
I'age 7 M�nagemeni and contiragenev p§�n __...._.._ �
Page 8 Purn�curve and specificatiQns �
Cl�rcnce Glotfelt License Ivumber: 220i28
Y_.__..._..e._�______.._.
bate: Q�1221�4 ��, , Phone N�.�mber� �745�368583'f
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Si�nature: � , � � ' . A �;�„�,�-
�esigner S _ � �� � 5tate of Wisccansin Approval �tarnp_ '
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C3esigned Pursuant ta the
Synet�gy Systems L.L�C., ��oMat Mound Comp�nent�.•lanual {Ec�itifln 1, 201;), (N.4!1 r'�, �
SSWit9P Publication 9.6 �esign of Pre�sur� pisfribution Neivyorkv for ST-SA� (01/$�} and ��
Pressur�C�istnbuii�n Catrpon�nt nAanua(Vee. 2.{� SB�-1C37t�6-P (�v.01fC71,�. 1�Dt12} �
Geoli�l�t Mound Ed�tion '(. 2C��7 � ��
lJnda�ed manuals fio �a�e � ofi �
be das�d
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S 69.25 ft F 15.Ofl in ! 9.41 �t L ss.45�-6� ft '
D 6.Q(3 in G t1.50 f# J 5.58 ft W 1£.2� ft
225.06 (ft�) G�spersai Gell Area 1Qpp.pC (ft`) Basal Area Available
6.5Q 4gpd/fE) Line�r Laading Rate 6.93 (ft) 1l10 B Obs. Pipe Placement
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Gec��l[�t �3isp�rsa! Ar�� '
t�bservation Pipe
12"ASTM C 33 s�nd as � �eoMat
required for Geo Mat L�istribution Cell
component �' � GeaMat+12"ASTM C-33 sand
�r�{` /
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95.�� Fir7ish Grade .�-��"" � ��'' �%°` C�ver I��aterial �
94.58 Laieral Inve�t Eleuati�r, ''�`��' r- �
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93.50 Dispersa{t�eli � ,.�- � _ �;���� � � � Siape 7.0 �
€levation ,�� '��`� ��:���
�---- Go�ttour Elevation 93.00
:�.,,- �`� Tilled Area '
� � Forcemain
�"---- In situ 5oi1
!n situ soil �
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1 � 'f'vpsail G��S
2 � Su�bsr�iE �,�p
� � ASTf� �3� �arad �F�
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5 � 'i'I1Eed ��yer, �
6 [� Geo �at
See details an page 4 for nu, _,:r.size, �n� spacinc�of laterals.
Praject: Engh��im Mound Page 3 of 9
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Service Provider's hlame Norihwest Sanita f'hone 715-943-2650
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POWTS R�guf�tor's Name Sa er County SPIA-ZoFlin�,4dmmistration � � E�hnne((71�)B34-828$
System F{�v+�,� ' Load Parameters
Design Flow-Peak 450 gpd Maximurn Influent Partrcle Size 118 in
Estimated Flnw-Average 3�0 gpd M� �imum BCJ�5 2�0 mg/L
5eptic Tank Capacity 100� ga{ f49aximurn T5S 150 mg/L
Soii Absorption Component Size 225.6G25 fr Maxirnum FOG 34 mg/L
Type of Wastewater pomestic Maximum Fecal Coliform >10E4 cfu/1�Q ml
Service Fr�equencv
Septic and Pump Tank lns ec#ar�dlor service once_ .. 3 ears
Efftuent �iiter lnspect and cfaan as necassa at leasf'once eve 3 years
Purrtp and Controi� Test once eve 3 years
Alarm Shouid test periodical( '
Pressure System Latsrals should be flushed ana�ressure tested euer 3 ears '
Mound Ins ect far pondin and seepa�e once every 3�ears�m� '
CtPa�r � �`
Miscellaraeous Construetion a�d Materiafs Siandarcfs
�. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap and are secured in as '
shown in the Synsrgy Systems Geot+,iat Mound Compor�eni Manual Versian 1,20�7.
2. DispersaE cell m�dia conforrns to GeoMat products approved for use with the Synergy Systems GeoMat P✓�ound Component '
Manual Version 1,L017. Media is covered with an approved geotextife fabric. ',
3. Ali gravity and presstare piping matersals cc�nf�rm to the requir�ments in SPS 384 V1lis.Adm_Code.
4. Tillage t�f tMe basal area is accompi9shed�uith a moid L�aru .,� chisel plow. ',
5. The rriound structure and other disturbed areas wili be s�eded and rnulched to pr�vent soii erosion end hei;�reduce#east
penetration.
Latera'Turn-up Detail
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'��6-8"Diameter � ��'% ,i � ,, „ � ��, Threaded Clear�ou[ �
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�`�;Lat�ral Ends at Last Orifice Where , ,
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Proisct: Engholm P�ound Page 6 aF 9
Maur�d �ystem Management Plar�
Pursuan�to 5PS 383.54,Wis.Adm. Code
General
This system shall be operated in accordance with SPS 382-84 Wis Adm.Code,and sha�t maintained in accordance with its'component
manuats[Synergy Systems L.L C.,Geomat Niound Cornponent Manua{versian 1,2017,Pressure Distributian Companent Manusl Ver.2.4
SSD-10706-P(M 01t01}and SSWMP Publication 9 6(01/81)]and'� il or state rules pertaining to system maintenance and maintenance
reporting.
Septic and pump tank abandonrrient shall be in accordance wif 'S 383,33,Wis.Adm.Corle when the tanks are no lor�ger
u5ed as POL'VT5 compor�enfs.
Septic or pump tank manhole tisers,acc�ss risers and covers should be inspecfed far water tightness and soundness. Access openirrgs
used for service and assessm�n#shal!ae sealed watertight upon the campletion o#service. Any opening deemed unsound,defective,or '
subject to failure rnust be replaced. Exposed access opanings greater than 8-inches in diameter shal!be secured by an effective locking
device to prevertt acciden#ai or unauthorized entry into a tank or con�ponent.
Se�tic Tank
The septic tank sholi be maintained by an individuai certified ta seivice septic tanks under s.281.43,Siats The contents of the septic
tank shaii be disposed of in accordance�vith NR 1 i 3,Wis.�ldm Code The operating condition of the septic tank and outlet filter shall be
assessed atieast onr.e every 3 years by inspecfion.
The outlet filter shail be cleaned as necessary to ensure proper operaiion The filter ca�tridge should not be removed unless provisions
are made tfl retain�sotids in fhe tank tM�t may slough aff th�filter when removed from its enciosure. if the fsiter is eq�Eipped wlth an afarm,the
filter shal!b8 serviced if the alarm is activated continuously. intermittent filter alarms may inc.'icate surge f€aws or an impending continuous
alarm.
The septic tank si�afl have its contents removed when 4he vai�: �f sludge and scum i.,the tank exceeds 113 the��quEd volume of the
tank. if the cantents vf the tank are not removed at the time of a triennial assessment,maintenance personnei shall advise the nwner as to
when the next service needs to be perforrrFed to maintain less than^�ximum scum and sluc+e ai,cumuiation in the tank.
The�ddition of bi�alogical or chert-iicaf additives to enhance sepuc ta+ik performance is generaliy rio4 required. However, if such products
are used they shall be approved#or septic fank use by the Wisconsin�epartment of Commerce.
Pumn Tank '
The dosing(pump)tank sl�all be inspected atleast once every 3 years. All switches,alarr�s,and pum�s shall be tested to verify psoper
operatiort. If an effluent filter is instal3ed wi#hin t?�e lank i(shaii be inspsctsd and serviced as necessary. ii the force main has a weep hale,it �
shouEd be no#ed�f i€is fiunctional during pump operation,and if not,it should be cieaned_ '��
''*""*Mo one sfroufd ever enter a septrc or dose tank since dangeraus gases may be�oreseni that cauld cause death.**�*
Mouncf and Pres� _Distribution S+�stem
tVo trees or 5hrubs should be pl�nted on tiie mound. Plantingc may be made around the mound's�erimeter,and the mound shall be '
seeded and mulched as necessary ta prevent erosion an�tfl prouide some protectio��from frost penetration. Traffic(other than for
vegetative maintenance)on the enound is not recommended since....;,ompaction may h'inder eeration of the infiitrative sur#ace within ihe
mound ai7d s€�ow corripaction irr the�winter+,vPil promot�frost penetratipn. Cald weather in�t�E(ations(Octaber-F�bruary}dictate that the �
m'ound be heaviiy muiciieu as proteciion from freezing.
ln(luent quality into the mcund�syste€n rnay noti exceed 22�mgll BO@7;, 150 r�gl�TSS,and 30 mgll�FOG for septic tank effluent ar 3t� ��
mg/E BODs,3d mgrL TSS,10 rng?L FOG.and 10`'cfuJ1�4 mL for highiy treated efFluent. Influent flow�rnay rot exceed maxirnum d�sign flow
specified in the permi#far this instailation.
The pressure distribution system is provided with a fiushing pcint at the�nd of each later�i,and ii is recommended thet�ach latera3 be
flushed of accumulated solirJs at least once every 3 years. When a press:ire test is performad it shauld be compared ta the initiei test when
Yhe sysiem was installed to determine if nriiice clagging has occurred and if orifice cleaning i4 requored to msintain equat drstribution within
ths dispersal celi.
Observation pipes within the c�ispersal cell shali be checked for effluent ponding. Ponding levels shall be reported to fhe owner,and any
leveis above 4 inches consid8red as an impending hydr�ulic failure requiring additional,n�ore frequent monitoring '
Gontinaencv Plan
If the septic tank or any af its componen4s become defecti���thc k ar component shal.t�e€epaired or repiaced 4o k�pp the system in
proper operating condition.
If the�dosing#ank,pump,�pump controls,alarm�r related wiring becornes defective the�e�ecfive component(s)shall t�e irr�metlEately ��
�epa(r�d or repiaced with a companent of tlie same or equai performance.
If Yhe moUnd component faiis to accept wastewa�sr or begi��s to u,��narg�wasteuvafer to tne ground surf�c9-it wiii�ie,epai�ed or
replaced in its'present 1oc,atic,n by increasing basal area if iae leakage occurs or by rzmovinca b���logically clogged abscrption and dispersai
media,and related piping anci rs�lacing said components as cteemed nec�ssary to bring ihe sysir�m into proper operating conslition.
�See Page 6 of fhis pian fitir�he name an�telaphone r�umber of yaur locai PC)llUTS regulator�and service provid�r.
Pro�ect: (���� Mound Pa e 7 of 9
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