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026-126-00-3001-SAN-2020-149tosi.i'jxOIndustry ServicesOivision4822 Madison Yards Way 53705PO Box 7162• Madison, Wl 53705-7162 ^CST ito-o77^Sanitary Permit Ai^licationIn accordance with SI'S 383.21(2), Wis. Adin. Code, suhmisbion ol ihib fomi to the <^)propriaie governmental unitis required prior to ohiaining a sniiiiar>' peniiit. Note; Application fornis Ibr stale-owned POWTS are submitted tothe Department of .Safety and l^rofebbioiial Servies. I'ersonal infurmutioii you provide may be used for secondary'purposes in accordance with the Privacy I.aw, s. I5.04(l)(m). Stats.1. Apnlication Information — Please Print All InformationProperty Owner's Namefit. Loof^x ^Property Owner s Mailing Address^otrPigigJ Aug.City. SlateClcXtif C , CO^"Zip CodeII. Type of Buildinf; (check nil that apply)^ I or2 Family Dwelling - Number ofBedrwms _□ Piiblic/Conimereial - Describe UseD State Owned - Describe UsePhone NumberLot #Block nCSM Number1^/335-lIl.TypcofPeritiil: (Check only one box on line A. Complete line B if applicable)County5Sanitary Permit Number (to be filled in by Co.)ad /State Plan Review NumberPWTS-__Project Address (if different than mailing address)Parcel #Property LocationGovl. Lot'A, Section_ (circle one)T J3_N; R_03_l;or©Subdivision Nameily 01□ CityD Village of^ Town or_A.B.D New SystemD Permit RenewalBefore E.xpirationD Hcplaecnicnt Systemn Permit RcvisioTrealnicnliioldin» Tiuik Replacement OnlyD Change of PlumberIV. Type of POWTS Systetn/Componcnt/Device; (Check all that applyD Permit Transfer to New-OwnerD Other Modincaiion to Existing System (explain)List Previous Permit Number and Date IssuedISmo,;0 Non-Pressurized In-Ground □ Pressurized In-Ground □ Ai-Grade □ Mound > 24 in. of suitable soil □ Mound < 24 in. of suitable soil□ FloldingTank □ Otlicr Dispersal Component (explain) □ Pretrcatmcnt Device (explain)V. Dispersal/Treatment Area Information:Design Flow (gpd)Design Soil Application Rate(gpds6c.oVI. Tank InfoDispersal Area Required (sfiCapacity inGallonsNe\s TanksHxisting TanksTotalGallons«orUnitsDispersal Area Proposed (sOManufacturerSystem Elevation3^: 6II13d2Seplic or Holding Tank/OOQ/COOjrtX/4ra:hrADosing ChamberVII. Rc-sponsibllity Statement- 1, the utidersigiieil. iis.vyMflt^respoiislhiHty fij liistalliillop iiflhc I'OWTS shown on the atlnclieJ plans.^2:Plumber's Name (Prim)OfbtAoWs WlfXvjtlfPlumbcr'»JiPfumbcr'»jfddress (Street, City, .Stale,^f?Codc)PlumbsMP/MPRS NumberjnooxxBusiness Phone Number~C8LZ•S"3.oSS M- LoJlf=^ Ot>Jetz\ CVtu< Oiztpf^ ^VIII. Coupty/Depnrtment Use OnlyB-AijprovW T ^ DisapprovedD Owner Given Reason for DenialPermit Fee^^00.Date IssuedIssuing Agent SignatureIX. Conditions of Approval/Reasons for DisapprovalORIGINALNO REFUNDS AFTERISSUE OF PERMITIM JUL 2 3 2020 0complete plnai for the system and aubmtl to the County only on poper not less than 8 l/l » 11 Inches in slieZONING ADMINISTRATION Allyson A. Loomis5942N Vans Lane026-126-00-3001SawyerLot 2 Highland Park Subdivision2339N09WProperty Owners NameProperty AddressTax Parcel NumberCountyLegal DescriptionSectionTownRangeDouglas Manthey230722715-739-68687/21/20Page index1 Property Information2 To.y\Vi3 Plot Plan4-10 Seil Tesri"11 Ma»AWwtWftC£ PlavA12 CoKViK^encY PlfltKPlumber's NamePlumber's SignaturePlumber's License Number'plumber's Phone NumberDateNot an endorsement, written or implied forttre following companies and products; DelZotto Concrete, Wieser Concrete ProductsInc., Skew PreCast Co., Huffcutt Concrete Inc., Zabel Environmental Technology, ITT Industrles(Goulds), The Pentair PumpGroup(Myers), Infiltrator Systems, ADS Products, Polylok Inc., Orenco Systems Inc., Sim/Tech Filter Inc., Sta-Rite Industries,Page J of fl. n UFTING STRAPRISER CONNECTION rTYP.)ACCESS PORT RIM—i ^1^(38)FLEXIBLE RUBBERGASKET (TYP.)62.2tLSBOlEXTERIORWIDTHINIETITANKINTERIORCONTINUOUSEIASTOMETRICGASKETTANK TOPTANKSEAM CLIPINTERIORDOWEL (W)TANK BOTTOMHALFLIFTING LUG(TYP.)©PIPE PENETRATIONSECTION DETAILMID-HEIGHT SEAMSECTION DETAIL-127.0 (3.2261 EXTERIOR LENGTH -TOP VIEW' 0 24.0 [610] ACCESS OPENINGWITH LOCKING LID (2)TANK 0aERtORLENGTH127.013^WIDTH62.2 n.560]HIEGHT54.711.389)UQUlO DEPTH44.0(1.118]INVERT DROP3^)76]FREEBOARD10.2 (260)TOTAL CAPACTTY1.247 GAL (4.720 L]WORKING VOLUME1.070 GAL (4.0501)04(102]PVCORABSINLET TEE/ INLET04(102]PVCORABSOUTLET TEE10.2 (260] FREEBOARDLAIRSPACEIcSLIQUIDEPTH2(9I|X2IS1|SUPPORTEND OUTLET •SEAM CLIP(TYP.)LIFTING STRAP(TYP.)54.7tLMSlE}^RIORHEIGHTFIBER- •GLASSSUPPORTSECTION A-A'END VIEWSECTION B - B'I'O<40NOTES:1. ALL DRAWING DIMENSIONS IN INCHES (MILUMETERS] OR AS NOTED.2. EXTERIOR OF ACCESS OPENING LID INCLUDES THE FOLLOWING WARNING INENGUSH, FRENCH & SPANISH: "DANGER DO NOT ENTER: POISON GASES."3. TANK MARKINGS WILL INCLUDE: MANUFACTURER NAME, MODEL NUMBER,UQUIDCAPACITY, DATE OF MANUFACTURE, MAXIMUM BURIAL DEPTH, INLET, AND OUTLET.4. MAXIHUM BURIAL DEPTH IS 48 In (1,219 mm].5. MINIMUM BURIAL DEPTH IS 6 In (152 mm].6. MAXIMUM VEHICLE LOAD IS 4,S00-II> [20-kN] AXLE LOAD.7. TANK IS FOR NON-TRAFFIC APPUCATIONS.8. AIRSPACE IS 16.5%.9. OUTLET TEE IS COMPATIBLE WITH EFFLUENT RLTER.10. INTERIOR LENGTH TO WIDTH RATIO IS 2J:1 (11834NCH INTERIOR LENGTH I51.7-lNCH INTERIOR WIDTH ° 2J).ISOMETRICVIEWSIDE INLET/OUTLET (TYP.)INFILTRATOR'tanksINFILTRATOR SYSTEMS INC.4 Business Paik Rd. Old Ssyttfook. CT 08475(800) 221-4436INFILTRATOR IM-1060 TANK1-COMPARTMENT CONFIGURATIONEMBScOj-OT TO CCm£CMdodCr. DFHon 0805/2013lofi -0) 'Hi Ibht/O QZI/SI "^^1 *J ®'-S 00^-9} Q olof-wr A^mq 'X'^X. ,ii~€b ^) -LC gz"2 b ■'1^ "^^>'3'pi s):<?5 ' g*<?fc n ,S *Ab /% ,Z-5b "2 ,thb 19 ^1% )l*Z^ r'^ VJ|]W -;)•<' ^V^OQl t \h9 Gf7'I ^1^^ ¥ _$•££/£! WSp ^ 4°^ 05 40-, f I "S •?!-'<) raAo^ rvAgX £7^ f O0£ — 00-'9^1—*5^0 N?i-<4trvL^^^4 P'^5 "^th^ -A^P |H / •0>7 Su-toj) fY -2.Ai?5 I OLhS Ipn •^ovsiui£?c7"y u>^t?&A]]V :a3l/irr)0 Allyson A. LoomisNumber of Bedrooms3Estimated Flow (average) gallons / day300Design Flow (peak), (Estimated x 1.5) gal/day450Soil Application Rate gal/day/ft^Infl uent / EffI uent Quality Monthly AverageFats, Oil & Grease (FOG)30 mg/LBiochemical Oxygen Demand (BODg)220 mg/LTotal Suspended Solids (TSS)150 mg/LService 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 every5942N Vans Lane026-126-00-3001Septic TankEffluent FilterOrenco 8" BlotubePump TankPump TypeIINOTEIIMaintenance ScheduleSen/icing frequency of 12 months or less requires theManagement Plan be recorded with the Register of Deeds.Maintenance InstructionsInspections of tanks and dispersal ceils 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 falling 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. NR 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 Inflltratlve surface.Page II of 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, 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 service the following steps shall be taken toinsure that the system is properly and safely abandoned in compliance with Wisconsin Administrative CodeComm. 83.33;- 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.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£1.1 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 soli limitations. A holding tank may ber italled to replace the failed POWTS.IIWARNINGIISeptic, pump and other treatment tanks may contain lethal gasses and/or insufTicient 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 J2s_of_Z2i_