010-841-27-5112-SAN-2020-227Safety and Duildings Division201 W. Washington Ave,. P.O. Box7162Mudison. Wi 53707-7162CountysawyerSanitary Permit Numlrcr (to be filled In by Co.)Sanitary Permit Ap|nicationin accordanec wilh s. SI'S 383.21(2). Wis. Acim. Code, submission of this form (o the appropriate govcmmcnfalanil is rcifuircd prior to ohiaining a sanitary pcnnil. Note: Applienlion forms for slnlo-owncd i*OWTS arc submittedto the tX-pHnmenl ofSafety and Professional Services. Pcrsooiil itirormiilmnyou piovitlc may be used for secondarypurposes in neamlimce with the Privacy Law, s. IS.0411)(ni). Slats.State Transaction NumberProject Address (ifdilTcrent than mailing address)I. Application Information - Please Print All Information!h0488N Meir RdPProperly Owner's NameAlan & Gina Amatuzioarcel H010841275112l^pcTly Owner's Mailing Address226 Paine Farm RdCity, StaleDuluth.MN/.ip Code5580411. Type of Building (check all that apply)I or2 i'anuly l>Mclling - Number ofBednxims 4□ Ihrblic/Commerciai - Describe UseI I State Owned - Describe UsePhone NumberLot#Property LocationGovl. Uil I'A. 'A, Section 27T41N; r8 WSubdivision NameRlockfiiCSM NumberI I City ofI I Village of^ Town of Hay wardIII. Type of Permit: (Check only one box on line A. Complete line B If applicable)A.New SystemReplacementSystem, TreBtmcnl>HiilJin(i Tank Replacement OnlyI I Permit Transfer toNew Owner. Other Mudificalitm to Existing System (explain)Bigger tank for future expantionB.PermilRenewal HeftrreExpinilion□Permit Revision□ Change ofPlumberList Previous Permil Number and Date Issued04-436^ 10/22/04ly. Type of POWTSSystem/Component/Dcvlce: (Check all that apply)^ Non-i'ressurized in-Oround I I Pressurized In-Oround Q Al-Grade ^ Mound >24 in. of suitable soil [~1 Mound <24 in. ofsuitable soilI I lIoldingTank I I Other Dispersal ComoonenI (explain) Q Pretrcalmcnt Device (explain)V. Dispersal/Treatment Area Information: Quick 4 PlusDesign Tlow (gpd)600Design Soil Application Ralc(gpd.sf).7Dispersal Area Required (sf)857Dispersal Area9 IBSystem Elevation92.5-91.24VI. Tank InfoCapacity inGallonsTotalGallonstfofUnitsManufacturerPrefabConcreteM guuFiberGlassPlasticNew TanksExisting TanksSeptic or lloiditi^tTank18001800IwieserDrrsing Chaiiiber11001100IwieserVn. Responsibility Statement- I, the undersigned, assume rcspun.iiiiilllty fnr insHiiatiun of Ihe POW'I'.S shown on the attached plam.Plumber's Name (Print)Gerald FroemeiPlumber's SigpmureMP/MPRS Number950111Business Pliunc Number715-558-1138Plumber's Address (Street, City, State. Zip Code)13502W Froemcl Rd Hayward.WI 54843VIIDCoailment Use Onlyn DisapprovedD Owner Given Reason for DtmialPermit PecSIssuing Agent SignatureiX. Conditions of Approval/Reasons for DisapprovalSBD-6398 (R. ll/ll)Date IssuedAttarti to compirte plans for the systrm andanbnil to theCoanly ooly on paper not les than 8 lAvrradiSEHe 2 3 2020SAWYER COUNTYlONlHO ADMINISTRATION
Alan & Gina Amatuzio10488N Meir Rd(JTI0841275112SawyerProperty Owners NameProperty AddressTax Parcel NumberCounty827141NR8WGov Lot or Qtr-Qtr/QtrSectionTownRangePage Index1 Property Information2 Data Entry3 Plot Plan4 Drainfield Cross-Section - ^6 Maintenance Plan7 Contingency PlanCounty Parcel ListingGerald Froemel950111715-558-113809/23/20Plumber's NamePlumber's SignaturePlumber's License NumberPlumber's Phone NumberDateNot an endorsement, written or Implied for the folfowing companies and products; DelZotto Concrete, Wleser Concrete ProductsInc., SkawPreCastCo., Huffcutt Concrete lnc.,Zabel Environmental Technology, ITT Industries(Goulds), The Pentalr PumpGroup(Myers), Infiltrator Systems, ADS Products, Polylok Inc., Orenco Systems Inc., SimrTech Filter Inc., Sta-Rlte Industries,Page 1 of 7
In-Oround Soil Absorption SeD-10705-P (N.01/01) Version 2 . _ Component Manual Used4Number of BedroomsPercent Slope (%)120Depth to Soil Limiting Factor (in.)In Situ soil application rate400Estimated Wastewater Flow (gpd)600Design Wastewater Flow (gpd)2Number of System Elevations92Proposed System Elevation #188Proposed System Elevation #2Proposed System Elevation #3Original Grade #196Finished Grade #1Original Grade #2Finished Grade #2Original Grade #3Finished Grade #3Infiltrator Quick 4 StandardHeight of Chamber (In.)15Chamber Type20 sq.ft. per chamberRows of Chambers5.1sq.ft. per pair of end caps45#DIV/OI#DIV/0(Distance Between Cells (ft.)Proposed Number of Chambers UsedMinimum Distribution Cell Area Required (sq.ft.)Distribution Ceil Area Proposed (sq.ft.)I9oo///o<^Septic TankDose 1 ank (if applicable)! 1Best 8"Effluent Filter"select only if NOT using combo tankSoil BoringNumberSurfaceGradeElevation (ft.)Depth toLimitingFactor (in.)LowestElevationHighestElevationSystemElevationAcceptable13.00-1.25FALSE23.00-1.25FALSE33.00-1.25FALSE45Page 2 of 7
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184"4" CAST-A-SEALFILTER ORBAFFLE4" CAST-A-SEALATOP VIEW4" VENTo<o§inlet -*= r.t§£O fiin9zoQ.Q.V =3OUTLETSIDE VIEWTANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTSWLP1800/1100TANK SPECIFICATIONSDIMENSIONS:WALL 3*BOTTOM: 3"COVER: 6"MANHOLE: 24" I.D. PRECAST CONCRETE RISERHEiaST: 60-3/4" O.D.LENGTH: 184" O.D.WIDTH: 102" O.D.BELOW INLET: 48" O.D.LIQUID LEVEL 43"WEIGHT: TANK 15.050 LBSWEIGHT: COVER 9,300 LBSINLET AND OUTLET:4" CAST-A-SEAL BOOT OR EQUALINLET AND OUTLET BAFFLE AND FILTER:WISCONSIN. SEE DETAIL «10(OTHER STATES SEE CTART)UOUID CAPACITY: 41.86 GAL/lN (SEPTIC)25.58 GAL/^N (PUMP)LOADING DESIGN: 8-0" UNSATURATED SOILTANK CAN BE USED AS:SEPTIC/SEPTIC. SEPTIC/PUMPOR SEPTIC/SIPHONCOVER: MIX DESIGN #8 (NO RBER)TANK: MIX DESIGN #9 (SMALL RBER)CUSTOMIZED TANKS:FOR CUSTOM TANKS CONTACT WIE^R CONCRETEiiJOB INFORMATION:CUSTOMER:JOB NAME:DATE NEEDED;APPROVED BY:APPROVAL DATE:s i°3 <s52 o oQ, P UJ5 Q. C/)* UJ SW Q(X.SHEET NO.1^OF1
Service EventService FrequencyInspect condition of tank(s)At least once every j 3|YearPump out contents of tank(s)When combined sludqe and scum = 1/3 of tank volumeInspect dispersal cell(s)At least once every3YearClean effluent filterAt least once every3YearInspect pump, pump controls & alarmAt least once everyTotal Suspended Solids {TSS)Maintenance ScheduleAlan & Gina Amatuzio10488N Meir Rd1.08E+10Number of BedroomsEstimated Flow (average) gallons / dayDesign Flow (peak), (Estimated x 1.5) gal/daySoil Application Rate gal/day/ft^influent I Effluent Quality41(35""555"Fats, Oil & Grease (FOG)Biochemical Oxygen Demand (BOD5)Monthly Average30 mg/L220 mg/L150 mg/LSeptic Tank/1/00Effluent FilterBest 8"Pump Tank#N/APump TypeIINGTEI!Servicing frequency of 12 months or less requires theManagement Plan be recorded with the Register of Deeds.Maintenance instructionsInspections of tanks and dispersal cells shall be made by an individual carrying one of the followinglicenses or certifications.Master Plumber, Master Piumt>er Restricted Sewer, POWTS Maintainer, SeptageServicing Operator, Tank inspection must include a visual inspection of the tank(s) to identify any missingor broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum andto check for any backup or ponding of effluent on the ground surface. The dispersal cell(s) shall be visuallyinspected to check the effluent levels in the observation pipes and to check for any ponding of effluent onthe ground surface. The ponding of effluent on the grounci surface may indicate a failing condition andrequires the immediate notification of the local regulatory authority.When the combined accumulation of sludge and scum in any tank equals 1/3 or more of the tankvolume, the entire contents of the tank shall be removed by a Septage Servicing Operator anddisposed of in accordance with ch. NR 113, Wisconsin Administrative Code.A service report shall be provided to the County Zoning Department within 30 days of any serviceevent.Start-Up and OperationFor new construction, prior to use of the POWTS check treatment tank(s) for the presence ofpainting products or other chemicals that may impede the treatment process and / or damage thedispersal cell(s). If high concentrations are detected have the contents of the tank removed by alicensed Septage Service Operator.System start-up shall not occur when soil conditions are frozen at the infiltrative surface.Page 6 of 7
Do not drive or park vehicles over tanks and dispersal cells.Reduction or elimination of the following from the wastewater stream may improve the performance andprolong the life of the POWTS: antibiotics, baby wipes, cigarette butts, condoms, cotton swabs,degreasers, dental floss, diapers, disinfectants, fet, foundation drain (sump pump) water, gasoline,grease, oil, painting products, pesticides, sanitary napkins, tampons, and water softener brine.AbandonmentWhen the POWTS falls and / or is permanently taken out of sen/ice the following steps shall be taken toinsure that the system is properly and safely abandoned in compliance with Wisconsin AdministrativeCode SPS 383.33:- All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.- The contents of all tanks and pits shall be removed and properly disposed of by a Septage ServicingOperator,- After pumping, all tanks and pits shall be excavated and removed or their covers removed and the voidspace filled with soil, gravel or another Inert solid material.Continoencv PlanIf the POWTS fails and cannot be repaired the following measurers have been, or must be taken toprovide a code compliant replacement system: (Check One)■" The site has not t)een evaluated to identify a suitable replacement area. Upon feilure of the POWTS asoli and site evaluation shall be performed to locate a suitable replacement area. If no replacement areaIs available a holding tank may be installed to replace the failed POWTS.' A suitable replacement area has been evaluated and may be utilized for the location of a replacementsoil absorption system. The replacement area should be protected from disturbance and compaction andshould not be Infringed upon by required setbacks from existing and proposed structures, lot lines andwells. Failure to protect the replacements area will result In the need for a new soil and site evaluation toestablish a suitable replacement area. Replacement systems must comply with the rules in effect at thattime.A suitable replacement area Is not available due to setback and/or soil limitations. A holding tank maybe installed to replace the failed POWTS.IIWARNINGIISeptic, pump and other treatment tanks may contain lethal gasses and/or Insufficient oxygen. Do notenter a septic, pump or other treatment tank under any circumstances. Death may result. Rescue of aperson from the Interior of a tank may be difficult or impossible.POWTS InstallerSeptic PumperNameGerald FroemelPhone#715-556-1138POWTS MaintainerNameJays SepticPhone #715-558-1138NameScott PoppePhone #(715) 634-1450Local Regulatory AuthorityAgencySaviyer County ZoningPhone#715-634-8288Page 7 of 7
Real Estate Sawyer County Property ListingToday's Date: 9/23/2020Property Status: CurrentCreated On: 2/6/2007 7:55:20 AMIPIUpdated: 9/21/2010SSkTax ID:11382PIN:57-010-2-41-08-27-5 05^01-000120Legacy PIN:010841275112Map ID::1.12Municipality:(010) TOWN OF HAYWARDSTR:S27T41NR08WDescription:PRT GOVT LOT 1 LOT 14 GSM 8/187#1671Recorded Acres:3.000Lottery Claims:0First DollarYesWatertrody:Round LakeZoning:(RRl) Residential/Recreational OneESN:444^ Tax DistrictsUpdated: 2/6/20071State of Wisconsin57Sawyer County010Town of Hayward572478Hayward Community School District001700Technical College4>^ Recorded Documents Updated: 6/29/2012Q WARRANTY DEEDDate Recorded: 2/21/2020422664Q CORRECTION INSTRUMENTDate Recorded: 12/13/2018 415786B CONVEYANCE RECORDED NOT USEDDate Recorded: 11/21/2018 415518B QUIT CLAIM DEEDDate Recorded: 9/7/2010368411B WARRANTY DEEDDate Recorded: 6/10/1982182976 340/134OwnershipUpdated: 2/24/2020AU\N & GINA AMATUZIODULUTH MNBMIIno Address:AI^N & GINA AMATUZIO226 PAINE FARM RDDULUTH MN 55804Mailino Address:ALAN & GINA AMATUZIO226 PAINE FARM RDDULUTH MN 55804Site Address * Indicates Private Road10488N MEIR RDHAYWARD 54843^ Property AssessmentUpdated: 11^/20152020 Assessment DetailCodeAcresLandImp.Gl-RESIDENTIAL3.000656,200299,1002-Year Comparison20192020ChangelAnd:656,200656,2000.0%Improved:299,100299,1000.0%Total:955,300955,3000.0%^Property HistoryN/A