HomeMy WebLinkAbout014-842-15-4305-SAN-2024-126 f `��.�Nf\/l/� COIIIlCy �
_.— Department of Safety �
�, saw � � z
� � - & Professional Services,
�� - Sanitary Pcrmit Number(lo be filled in by C
� _ , Industry Services Division �
''��l hr\�\ .µ ` � � ���� �
State"I'ransaction Number �
Sanitary Permit Application �
[n accordance with SPS 383.21(2),Wis.Adm.Code,submission of this Yonn to the appropiiate governmental w�it �
is required prior to obtaining a sanitary permit.Note:Application fonns for state-owned POWTS are submittcd to Project Address(iY different than mailing a
the Department of Satety and Prot�essional Services.Pcrsonal inforniation you provide may be used for secondary
puiposes in accordance with the Privacy Law,s. 15.04(I)(m),Stats. � � �� �(� ��
I.Application Information-Please Print All Information �,ep ( _1
Propeity Owner's tiame ������� � .� � Pareel#
��� � � c ; � s�h,,. ; d `�► �=��I�y o� - y -. -,Y
Proper[y Owner's ailing Address PropeiTy Location
J � ti i w o�a o (?cl ��
City,State Zip Code Phone Number
�ZW '/, S� '/, Section _1�_
�c. ard W� .SilSy3 - --
II.Type of Building(check all that apply) L�t� T�N R d�___: V
�'1 or 2 Family Dwelling-Nwnber ofBedrooms____ _e1_ � Subdivision Name
Block#
❑Public/Couiulercial-Describe Use __ �---
- ❑Ciry ot�
❑State Owned-Describe Use — CSM Number ❑Village of
- _ .
CSM *1 753�/ �ro�,or- -Lcnr-c�o�
_ _ ___- —----- ---
Vo1•3b ��
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
applicable.) _
�' �'New S ytem
y� U Replacement System ❑ Other Moditication to Existina System(explain) ❑ Additional Pretreatment Unit(explain)
B.
❑ Holding Tank �[n-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑ Other"l�ype(explain)
(conventional)
C. ❑ Recision List Previous Permit Number and Date lssued
❑ Renewal L3efore ❑ Changc of Plumber ❑ Transfer to New Owner
Expiration
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Design Soil 4pplieation Rate(�pd;tl Dispersal Area Required(sY) Dispersal Are�Propo;ed(,t� Sy,tem Ele��ation
30 � o•� Va9 �,,�� t-�3.� '
Capacity in Total #of Manufacturer
�
Gallons Gallons Units � � v �'
Tank[nfonnation °J . `-'
r c�
New Tanks Existing Tanks ` � a; � y ,� � c`"-„
c. U in �, v� u. :7 ci.
Szptic or Holdina Tanl: .7 � ^" ��J� � ��Y,S(��' C.A1 C/'C 7'C.-
Dosing Chamber �
V.Responsibility Statement- I,the undersigned,assume responsibility for installarion of the POWTS shown on the attached plans.
Plumbe�'s Name(Print) Plw r Signa[ure MP/MPRS Number [3usiness Phone Number
Ttv.v�S �iv�-�c��r+c �4� GS�a79 7i�-G3y' 8���
Plumber's Address(Strect,City,Stare,Zip Code)
/y3y6w 2�� 77 ti �vc► rd wt 5^Y B�I,�
VI.County/Department Use Only _
Pennit Fee Date Issued Issuing Agent Signature
❑ Approved ❑Disapproved
Lf 6 �j�
❑Owner Given Reason for Denial $ 1�• D s�:�`�- `'1 i� ' "r�`-���a�-�l/vL�r
Conditions of Approval/Reasons for Disapproval r� �' r;;:,_ .,
� � � � � i7-a- � a.��_. D � ����� V s i �i
; , d)8�G L..�.�-� �
: v�� I �'���
�
G �! �._
Chk# 3 �'i� � MAY 2 1 2�024 � -
GS�C` �-`� -- b 8� R��,+� 1 ��1 _ SAWYER COJPiT���
ZONING ADMiNISTr�AI-ION
Attach ro complete plans for[he s}'stem and submit to[he County only on paper no[less[han 8 V2 x I l inches in sizc .
NO REFUNDB AFTER
sB�-639a�x.03�22� ISSUE O�PERMIT .z w�� � 3
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
Schmid - Old 00 Rd
Owner Name(s) : Jeffery W & Cynthia G SChmid Phone: - -
Owner Address : 13141 W Old 00 Rd ; Hayward , WI Z�p; 54843
Project Address : Old 00 Rd (Lot east of 13141 W)
Govt. Lot: SW 01 /4 of � 1 /4, Section � 5 , T 42 N-R 08 E ❑ or W ❑✓
Township: Lenroot County: Sawyer
Project Parcel ID #: 014-842-15 4305
Designer Information
Designer Name: Travis Butterfield Phone : 715 _ 634 _8176
Designer Address : 14346W State Road 77 ; Hayward , WI Z�p: 54843
E-mail : office@butterfielddrilling . com �l�i��s ��a« ��e,rr�re�� ror d��� ���-�1 �r�� ���.
License Number: 652879
Remarks:
Signature : Date : S/ Lo / z y
Original sign ure required on each submitted copy.
D (n
D -i
,i + �(J
r J c�
o � 9 y ¢ � C
�"'� ' �g � �+�°
y m .V
_' N � t� 'D O'
�� � � E �
� „
� ay �� �
aWi � �
c T � � �
�
s� ;� ; F �
�? ` xN ''
� -,
w �� �-� �
�
+
" F B
r ; - o
�
�
3 7 £ � ; ' 4 c�Q o�� y
�� � � � Q ti e � .
u y
� �a '� z o�
�
�a•c '
J,�eD` 0
q���4 W Q '�
a� c r
O
o' ^�
o -o
� r
G Z
.
�t- p � Q a � Y �" � t,,
r �
u� � �• ' � L - 'o C�
� = n1 Z Q � � N f+ :c
- o
W P O 3 m � - n' 7�. t � �y s � G � �
'- X �, > m n r a � f'_
m �, o� E � � > °� � a ¢ v cT�
'v a -� -0 c � � " P. ' �, o z .wc p v i'
�p J P J O +� ^ 0 d Ol�C � ^'1 ` ' � —
n _ 5 +
r �� a a o -1 � � � W �� � �.
�QJ � p p � p p _ n � . -.0
C .,, „ T ,, Z — ' K � m O
� ,� T �. U o
JS
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) 75o gal gal gal gal
Effluent Filter Manufacturer:
Lifetime Filter LLC
� � ii � ii
Effi�ent F�ite� Moaei #: LT-1 /8
min. 12"
SOIL COVER (typlcal)
12„
min, trench
depth
c�vP��ao < �� TYPICAL TRENCH
� .a� � <. CROSS SECTION VIEW
, . _ ,o .• . ..a..
�ypc,a�) • . a �, .• � . . �NO SCaIP.�
n d • ' a
. " Provide minimum 3 ft
System Elevation = 93.25 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)
Installpermanufacturers PLAN VIEW
instructions.
(No Scale}
� - - - - - - - -�� - - - - - - - �� - - - -: — — - �
�` � A = 3.Oft
, ,
�� � � `'������ �' (
� — — — — — — — — — — — �� — — — — — — — �� — — — — — — #���� _ � �tYPical) �
UJ
B = 47 ft - I m
(typical) Quick4 Standard-W Chamber W
INSTALL PER TRENCH: (typica�) �
(mfd by Infiltrator Systems, Inc.) �
11 Install pursuant to manufacturer's instructions �
Quick4 Std-W @ 20 ft� EISA/chamber = 220 ftz
+ � Pairs of end caps @ 6 ftz EISA/pair = 6 ft2
= Proposed EISA per trench = 226 ft2 Required Infiltration Area = 429 ftZ Distribution Method:
x 2 trenches = Proposed Total EISA = 456 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= 300 gpd; 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.)
c mechanical malfunction(i.e.,pumps,valves,switches,floats,etc.)
c 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)
c neglect or improper use(i.e.,exceeding design capacities,prohibited activities,etc.)
c 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 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(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 specificatlons. 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: BUtt@I fl@ICI II1C Phone: �15-634-8176
�ooai go�ernmenc�n�t: Sawyer County Zoning &Conservation phone: �15-634-8288
Local government unit address: �OO�O M81t1 St, SUite#9; Hayward, WI Z1P 54843 _
Any defective part of this system shalt be repaired,replaced,or removed pursuant to SPS 383.51 (1),Wisa 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 t�y 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.