010-841-27-3210-SAN-2020-182/^iIndustry Survicos Division1400 K Washington AvcP.O. »ox7162Madison. Wl 53707-7162County»Sc».v«oye/~Sanitiuy Permit Number (to be llllud in by Co.)Sanitary Permit Applicationbtalc Transaction NumberIn accordance xvilb .SI'S 383.21(2). Wis. Adni. Code, submission of ibis form to die nppniprialc govcmmenlai unitis requited prior to obtaining a sanitary permit. Note: Applieaiioii fonns for state-owned POWT'S are submitted totfie ffcpanmcnl of Safely and Profcs.sional Services Persona! iiilbmiation you provide may be used for secondarypurposes in accordance with the Privacy laiw. s. 15.04(1 Km). Stats.I. Application Information - Please Print AH InformationProject Address (if different tlian mailing address)Property Owper's NameMoc^VVsevOParcel tt0\0-aH\-3"3 3'5\0Properly Owner's Mailing Addressi6^0HM LaXe ScUoO^Properly txrcalion(rOVl. t,()lCity. StateV-locyLoOsf ^ I XZip CodeI [. Type of Building (check all that apply)1 or 2 Paniily Dwelling - Number of Bedrooms0 Public/Commercial - Describe Use.D State Owned - Describe UsePhone NumberLotsMcJ '/«. friVO Section 5 T(circle oneTT N: R ?. ■&or^Subdivision NameBlock 0CSM NumberCSHvo 1. . t i-S"D City of□ Village of,[33"own ofA111. Type of Permit: (Check only one box on line A. Complete line B If applicable)A."H~New SystemD Replacement SystemD 'Ireatmcm/iioiding'i'ank Ucplaeeineni OnlyD Otlicr ModiUcntion to Existing System (explain)B.D Permit RencwaJBefore ExpirationD Permit RevisionD Change of PlumberD Permit Transfer to NewOwnerList Previous Permit Number and Dale issuedIV. Type of POWTS System/Component/Dcvlce: (Check all that apply^Non-Pressurized in-Oround D Pressurized In-Ground G At-firadc Q Mound > 24 in. ofsuitiiblc soil D Mound < 24 in. of suitable soil□ 1 lolding Tank □ Other Dispersal Component (explain) □ Pretreatnient Device (explain)V. Dispersal/Treatment Area Information: 3/r 3.^Design Flow (gpd)ViTODesign Soil Application Raic(gpdsOO .-7Di.spersal Area Required (sO0^3Dispersal Area I'roposed (sOSystem Elevation94.OOVI. Tank InfoCapacity inGallonsNew TanksHxisling TanksTotalGallons«ofUnitsManufactureran ai2 S£o<31II■£ oS0.•Sqiuc or 1 lolding Tanklooaicx>o(/Ji'eSf z-eDosing ChamberVII. Responsibility Statement- 1. the undersigned, assum^csponalhljfly f</injftllilion of the POWl'S shown on the attached plans.Plumber's Natne (Print)Tr-o.sj I i /ciPlumber'sjngnaiureMP/MPKS NumberBusiness Phone Number7/5"- 6r3 - 2'7 6,Plumber's Address (Street, City, State, Zip Code)-SArx-k. (?oo.d Tl Ueeyi>r-<3 , t/o-xnty/Department Use OnlyD DisapprovedD Owner Given Reason for DenialIX. Conditions of .Approval/Reason^for DisapprovalPermit FeeWoo-Dale IssuedIssuing Agent Signaturey\nath III coin|ilrl« plan, fur lh« sy.ilera and sulimil In Ihe (.'ounly only on paper nul Ins than H 1/2 * 11 i ctrtjjiito-'f . 1 I ' ■ I'jn A-—•. / /■-AUG 1.2 2020S13n-6398 (R. 08/14)SAWYER COUNTYZONING ADMINISTRATION
PAGE 1 OF 4In-Ground Gravity Planindex & Cover SheetComponent Manual Design References:Version 2.0, SBD-10705-P (N.01/01, R. 10/12)Pg1 of 4index & Cover SheetPg2of4Plot PlanPg3of4Dispersal Area Gross-Section & Plan ViewPg 4 of 4Management PlanAttachments:Enclosures:POWTS Application for ReviewSoil Evaluation Report & Site MapProject Name I DescriptionFosterling - Phelan RdOwner Name(s): Matthew Fosterling ^Owner Address: 10204N Round Lake School Rd; Hayward, Wl zip: 54843A 13397W Phelan RdPhone:WlProject Address: 13397W Phelan RdGovt. Lot: NW 1/4 pf SW 1/4^ Section , T 41 n-R 08 EPor W IZlTownship: Hayward County: SawyerProject Parcel ID #: 010-841-27 3210Designer informationDesigner Name: Travis Butterfield Phone: 715 .634 .8176Designer Address: 14346W State Road 77; Hayward. Wl zip: 54843E.maj|: office@butterfielddrilling .com This space reserved for approval stamp.License Number: 652879Remarks:Signature:Date:Original signature required on each submitted copy.
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IN-GROUND GRAVITY DISPERSAL AREAUniform Elevation Trenches with Quick4 Standard-W Chambers3-ft Trench (down-sizing credit)Septic Tank(s) ManufacturerWieser Concrete IncSeptic Tank(s) Volume{s);1000Effluent Filter Manufacturer.Lifetime Filter LLCEffluent Filter Model ff: LT-1/8SOIL COVER12'mifi.fivnchdepin(typical). mm. 1?(typical).** *•4 •-— 34' —(typical)TYPICAL TRENCHCROSS SECTION VIEW(No Scale)Qulck4 Standard-Ww/End Cap/— (typical)System Elevation - 94.00 ft(typical)(Show location of inlet / outlet pipe connection on plan view.)Provide minimum 3 ftseparation between trenches.Observation Pipe(typical)iRslall per manufacnrrei's/ instnictlons.B= 67I A = 3.0 ft(typical)TYPICAL TRENCHPLAN VIEW(No Scale)(typical)INSTALL PER TRENCH:Quick4 Std-W (g 20 ff EISA/chamber = 320_ Pairs of end caps (@ 6 ff EISA/pair = 6= Proposed EISA per trench = 325^Quick4 Standard-W Chamber(typical)(mfti by InfStralor Systems, inc.)Inslal pursuant to manu^cturet's instnictlons.fl^ Required Infiltration Area = 643 ft' Distribution Method;trenches = Proposed Total EISA = 650 ft= branched manifoldL5ET jl
PAGE 4 OF 4In-ground Gravity Management PlanIMPORTANT:The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant torequirements of SPS 382-384, Wise. Admin. Code. Pursuant to SPS 383.52 (2), Wise. Admin. Code, this system shallbe 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 Matntalner inaccordance with SPS 383.52 (3), Wise. Admin. Code.Maximum Dispersal Area Operating Limits:Design Flow = ^50 gp^. eODg ^ 220 mgL ^ TSS ^ 150 mgLFOG i 30 mgU^Inspection Checklist INSPECT EVERY 3 YEARSo type of useo age of systemo 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 / drop boxes)o neglect or improper use {i.e., exceeding design capacities, prohibited activities, etc.)o extent of ponding in distribution cell prior to dosingo 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 servedMaintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)o Septic and dose tankfsl 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) oras required by local ordinance. Disposai of contents shall be pursuant to NR113, Wise. Admin. Code.o Effluent fllterfst shall be inspected every 3 years and shall be cleaned when necessary to remove anyaccumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12months.System maintenance reports shall be submitted to the proper local government unit in accordance withSPS 383.55 Wise. Admin. Code. Report any component hillure or malfunction to:Name of individual or company: TraviS ButtGrfield Phone: 715-634-8176Local government unit: Sawyer County Zoning & Conservation phone: 715-634-8288Local government unit address: 10610 Main St. Suite 49 ; Hayward, Wl zip. 54843Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wise. Admin.Code. Repair or replacement of failed or malfunctioning components shail compiy with SPS 383, Wise. Admin. Code.No product for chemical or physical restoration of the POWTS may be used unless approved by the department inaccordance with SPS 384, Wise. Admin. Code.Contlnaencv PlanIn the event that any ^iled treatment component of this POWTS cannot be repaired, it shall be replaced pursuant toa plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may beabandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils.System AbandonmentIf use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wise. Admin. Code.