024-641-25-1303-SAN-2020-132Industry Services Division4822 Madison Yards Way 53705PO 1)0x7162Madison. WI 53705-7)62CST:iO-0Hi?)CountySanitary Permit Number (to be filled in by Co.)Sanitary Permit Applicationtn aecord.iiicc with SPS 383.21(2). Wis. Adni. Code, submission of this I'omi to the appropriate governmental unitis required prior to obtaining a sanitary peniiit. Note: Application forms for state-owned POWTS are siibmiiled tothe Depannicnt of Safety and Protessional Servies. Personal information you provide may be used for secondarypurposes in aecordanee with the Privacy f.aw, s. 15.(14(1)(in), Stats.State Plan Review NumberPWIS -§iI. Application Information - E'lease Print All InformationProject Address (if difTcrent than mailing address)C<3rA,-w.\ U.Property Owner's NameWx-ftex m . F.ct\ CLOnCZ Trusj^Parcel#Property Owner's Mailing Address j-'41 "i ^ S'Vree'lCZip CodProperty l.ocationGovi. Lotity, StateXLeII. Type of Building (check all that apply)or 2 Family Dwelling - Number of BedroomsD Pubiic/Commereiai - Describe Use.D State Owned - Describe UsePhone NumberLot #Stj ■/.. jue- Section .AS_. (circ^one)T HI N: R 0(a Eot(SgSubdivision NameBlock #CSM Number□ City of.□ Village of,51 Town of ^Ouvtei LoJ^^111. Type of Permit: (Check only one box on line A. Complete line B if applicnblc)A.D New SystemD Replacement Systemi&lTreaiment(H»ldinB Tank Replacement OnlyD Other Modification to Kxisting System (explain)B.D Pennit RenewalBefore ExpirationD Permit RevisionD Change of Plumbern Permit Transfer to NewOwnerList Previous Permit Number and Date Issued-fIV. Type of POWTS System/Component/Device: (Check all that apply(^Non-Pressurized In-Ground D Pressurized In-Ground D At-Crade D Mound >24 In, of suitable soil D Mound < 24 In. of suitable soil□ Holding Tank D Other Dispersal Component (explain) D Pretreaimcni Device (explain)V. Dispersal/Treatment Area Information:. ^Dispersal AreaPiuyoJuml (sf)Design Flow (gpd)3ooDesign Soil Application Rate(gpdsf)0,(0Vi. Tank infoSeptic or Holding TankDosing ChamberDispersal Area Required (sf)^7>oCapacity inGallonsNew TanksFxisting TanksTotalGallonsISO«ofUnitsMtmufaclurerSystem Elevation ^a o£ UVi i. Responsibility Statement- I, the uiiderslened. Hssyfme^cspoiisibiiiiyvfnr inslalliition of the POWTS shown on the atlachcU plans.MPBZ aPlumber's Name (Print)(V\avC^'-e'-;Plumb'Plumber's Address (Street, City, State, Zip Code)OojQi^ Q-vV/MPRS Numberusiness Phone Number91.$-739-6868Vlii. Connty/Department Use OnlyD DisapprovedI D Owner Given Rea.son for DenialPennit Fee00Date IssuedIssuing Agent SignatureiX. Conditions of Approval/Reasons for Disapproval01ATTINO REFUNDS AFTERISSUE OF PERMITAtlncli Id complete plans for tlic system and submit to Ilic County only on paper nul less Ihan 8 I/I X ISBD-6398(R. 04/19)1JUL 1 0 2020SAWYER COUNTYZONING ADMINISTRATION
John J., Barbaara M. Figlewicz Trusts10343N Cardinal Lane024-641-25-1303SawyerSW 1/4 NE 1/42541N06WProperty Owners NameProperty AddressTax Parcel NumberCountyLegal DescriptionSectionTownRangeDougiaManth23072715-739-68687/9/20Page Index1 Property Information2 TojftVi Specs3 Plot Plan4-1 Soil Tear^ Moun\eir\«vvceC[ CbiAVigevvc^ P\c\.vvPlumber's NamePlumber's SignaturePlumber's License NumberPlumber's Phone NumberDateNot an endorsement, written or Implied for the following companies and products; DelZotto Concrete, Wieser Concrete Productsinc., Skaw PieCast Co., Huffcutt Concrete Inc., Zabel Environmental Technology, ITT Industriss(Goulds), The Pentair PumpGroup(Myers), Infiltrator Systems, ADS Products, Polylok Inc., Orenco Systems Inc., Sim/Tech Filter Inc., Sta-Rite Industries,Page_/ of ^
WLP750-MRTANK SPECIFICATiONSFILTERBAFFLE4" CAST-A-SEALDIMENSIONS:WALL: 2 1/2"BOTTOM: 3"COVER: 4"MANHOLE: 24" I.D. PRECAST CONCRETE RISERHEIGHT: FLAT COVER 54" O.D.OUTSIDE DIAMETER: 84" O.D.BELOW INLET: 42" O.D.LIQUID LEVEL: 37"WEIGHT: 6.150 LBS.INLET AND OUTLET:4" CAST-A-SEAL BOOT OR EQUALGASKET. CAST-A-SEAL BOOT OR EQUALINLET AND OUTLET BAFFLE AND RLTER:WISCONSIN. SEE DETAIL #10(OTHER STATES SEE CHART)LIQUID CAPACITY: 20.28 GAL/INHOLDING TANK:ACTUAL CAPACITY: 790 GALLONSOUTLET HOLE PLUGGEDTOP VIEWLOADING DESIGN: 8* 0" UNSATURATED SOIL0OUTLETTANK CAN BE USED AS:SEPTIC/ HOLDING/ PUMP OR SIPHONCOVER: MIX DESIGN #8 (NO FIBER)TANK: MIX DESK^ #10 (STRUCTURAL RBER)CUSTOMIZED TANKS:FOR CUSTOM TANKS CONTACT WIESER CONCRETEPUMP PADSIDE VIEWTANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTSDRAWINGS SUBMITTEDFOR APPROVALAPPROVED BY:APPROVAL DATE:PRODUCTS NEEDED BY:>-yS0sU1_1iZI inI z>COm00ImCMroIoo00,gccsIomr~.Q.<z>z<uI—Q.LJinSHEET NO.1.OF1
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Service EventService FrequencyInspect condition of tank{s)At least once every3|Year |Pump out contents of tank(s)When combined sluege and scum = 1/3 of tank volumeInspect dispersal cell(s)At least once every3YearClean effluent filterAt least once every18MonthInspect pump, pump controls & alarmAt least once everyJohn J., Barbaara M. Figlewicz Trusts10343N Cardinal Lane024-641-25-1303Oesign Flow (peak), (Estimated X 1.5) gal/daySoil Application Rate gal/day/tfFats, Oil & Grease (FOG)Biochemical Oxygen Demand (BODs)Total Suspended Solids (TSS)Maintenance ScheduleNumber of BedroomsEstimated Flow (average) gallons / day200300nfluent I Effluent QualityMonthly Average30 mg/L220 mg/L150 mg/LSeptic TankWieser 750Effluent FilterOrenco 8" BiotubePump TankWieser 750Pump TypeHNOTEllSen/icing 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 following licensesor certifications:Master Plumber, Master Plumber Restricted Sewer, POWTS Malntalner, Septage ServicingOperator. Tank inspection must include a visual Inspection of the tank(s) to identify any missing or brokenhardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check forany backup or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected tocheck the effluent levels in the observation pipes and to check for any ponding of effluent on the groundsurface. The ponding of effluent on the ground surface may indicate a failing condition and requires theimmediate 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. MR 113, Wisconsin Administrative Code.A service report shall be provided to the Douglas County Zoning Department within 30 days of anyservice event.Start-Up and OperationFor new construction, prior to use of the POWTS check treatment tank(s) for the presence of paintingproducts or other chemicals that may Impede the treatment process and / or damage the dispersalcell(s). If high concentrations are detected have the contents of the tank removed by a licensedSeptage Service Operator.System start-up shall not occur when soil conditions are frozen at the Infiltrative surface.Page_2i_of_3_
Do not drive or park vehicles over tanks and dispersal ceils.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, fat, foundation drain (sump pump) water, gasoline, grease, oil, paintingproducts, pesticides, sanitary napkins, tampons, and water softener brine.AbandonmentWhen the POWTS fails 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 Administrative CodeComm. 83.33;- Ail piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.- The contents of ail tanks and pits shall be removed and properly disposed of by a Septage Sen/icingOperator.- After pumping, ail tanks and pits shall be excavated and removed or their covers removed and the voidspace filled with soil, gravel or another inert solid material.Continaencv PlanIf the POWTS fails and cannot be repaired the following measurers have been, or must be taken to providea code compliant replacement system: (Check One)P The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS asoil and site evaluation shall be performed to locate a suitable replacement area. If no replacement area isavailable 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 replacement■iX.I 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 and wells.Failure to protect the replacements area will result in the need for a new soil and site evaluation to establisha suitable replacement area. Replacement systems must comply with the rules in effect at that time.A suitable replacement area is not available due to setback and/or soil limitations. A holding tank may ber stalled to replace the failed POWTS.llWARNINGtlSeptic, pump and other treatment tanks may contain lethal gasses and/or insufficient oxygen. Do not entera septic, pump or other treatment tank under any circumstances. Death may result. Rescue of a personfrom the interior of a tank may be difficult or impossible.POWTS InstallerNameDouglas MantheyPhone #715-739-6868POWTS MaintainerNameAffordable SepticPhone #715-634-3355Septic PumperNameAffordable SepticPhone #715-634-3355Local Regulatory AuthorityAgencySawyer County ZoningPhone #715-634-8288Page.of