024-741-20-4104-SAN-2022-087 " ' County �
Safety and Buildings Division sawyer �
�� �S P " 201 W.Washington Ave.,P.O.Box 7162 San�tary Permit Number(to be filled in t
a _ Madison,WI 53707-7162 �1 �
� �9 3�� �� 6 �
Sanitary Permit Application State Transaction Number 4.�
� �
In accordance with s.SPS 383.21(2),Wis. Adm.Code,submission of this form to the appropriate govemmental �
unit is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted project Address(if different than mailim, �
to the Departrnent of Safery and Professional Services. Personal information you provide may be used for secondary ��
u oses in ace;ordance with[he Privac Law,s. 15.04 1 m,Stats. �
1. Application Information-Please Print All Information 1 1412W Oriole Ln
Property(hvner's Name Parcel#
Amy Spies&Catherine Conway 024741204104
PropeRy Owner's Mailing Address Property Location
17515 Snake Trl
��
City,State Zip Code Phone Number NE '/<,SE'/<. Section 20
Waseca,MN 56093
T41N; R7 W
II.Type of Building(check all that apply) Lot#
� 1 or 2 Family Dwelling-Number of Bedrooms 2 " Subdivision Name
Block#
� Public/Commercial-Describe Use ._
� City of
� StaYe Owned-Describe Use CSM Number ❑ Village of
— � Town of Round Lake
I11.Type of Permit: (Check only one box on line A. Complete line B if applicable)
A � New System � Replacement � Treatment/Holding Tank Replacement Only � Other Modification to Existing System(explain)
System
B. � Pertnit � Permit Revision � Change of �Permit"Transfer to List Previous Permit Number and Date Issued
Renewal Before Plumber New Owner � �'!, ?
Ex iration ��
IV.T e of POWTS S stem/Com onenUDevice: Check all that a 1
� Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound>24 m.of suitable soil ❑ Mound<24 in.of suitable soil
❑ Holding Tank ❑Ott�er Dispersal Component(explain) ❑Pretreatrnent Device(explain)
V.Dis ersaUTreatment Area Information: Quick 4 Plus
Design Flow(gpd) Design Soil Application Rate(gpds� Dispersal Area Required(sfl Dispersal Area Proposed(s� System Elevation �
3oD 0�� S�o sto. 8�•�S
VI.Tauk Info Capacity in Total #of Manufacturer
Gallons Gallons Units � � o� o
New Tanks Existing Tanks � o � � Y � � �
a tJ cn � c� w C7 cL
Septic or Holding Tank '750 750 1 wieser � � � � �
Dosing Chamber ❑ ❑ ❑ ❑ ❑
Vll.Responsibility Statement- [,the undersigned,assume responsibility for installation of the POW"I'S shown oo the attac6ed plans.
Plumber's Name(Print) Plumber's S� MF'/MPRS Number Business Phone Number
Gerald Froemel V��� 950111 715-558-1138
Plumber's Address(Sucet,City,State,Zip Code)
13502W Froemel Rd Ha ward,Wl 54843
VIII. ount /De artment Use Onl
Z Permit Fee Date Issued (ssuing Agent Signature
�A�m ed ❑ Disapproved
❑ Owner Given Reason for Denial $ ��'o� � 1� I �� `�"^'--� '
IX.Conditions of ApprovaUReasons for Disapproval
,`
�I � �Q �cs-� �a - ac� � �
JUN 0 1 2022 �
SAINYER COUNTY
Attach to complete plans for the system and submit to the County only on paper not less than 8 t/2 x ll inches in size
sB�-639s�a. i vi i� NO R�FUIVDS AF'fER
ISSUE OF PERMIT
Amy Spies 8� Catherine Conway Property Owners Name
11412W Oriole Ln Property Address
p 24741204104 Tax Parcel Number
Sawyer County
��.�.,�.�._�
�
NE/SE Gov Lot or Qtr-Qtr/Qtr
SZO Section
T41 N Town
R7W Range
Page Index
1 Property Information
2 Data Entry
3 Plot Plan
4 Drainfield Cross-Section
5 Dose Tank
6 Maintenance Plan
7 Contingency Plan
County Parcel Listing
Gerald Froemel Plumber's Name
�
�� Plumber's Signature
950111 Plumber's License Number
715-558-1138 Plumber's Phone Number
06/01/22 Date
Not an endorsement,written or implied for the following companies and products;DelZotto Concrete,Wieser Concrete Products
Inc.,Skaw PreCast Co.,Huffcutt Concrete Inc.,Zabel Environmental Technology, ITf Industries(Goulds),The Pentair Pump
Group(Myers), Infiltrator Systems,ADS Products,Polylok Inc.,Orenco Systems Inc.,SimlTech Filter Inc.,Sta-Rite Industries,
Page 1 of 7
In-Ground Soii Absorption SBD-10705-P(N.01/01)Version 2 ... Component Manual Used
2 umber of Bedrooms
Percent Slope (%)
105 Depth to Soii Limiting Factor (in.)
0.6 In Situ soil application rate
200 Estimated Wastewater Flow (gpd)
300 Design Wastewater Flow (gpd)
1 Number of System Elevations
88.75 Proposed System Elevation #1
Proposed System Elevation #2
Proposed System Elevation#3
Original Grade #1
9 Finished Grade#1
Original Grade#2
Finished Grade#2
Original Grade #3
m��,-re���� � 'Finished Grade#3
Infiltrator Quick 4 Standard � Chamber Type
15 Height� o��hamber�m ('in� 20 sq.ft. per chamber
2 Rows of Chambers 5.1 sq.ft. per pair of end caps
3 Distance Between Cells (ft.)
25 Proposed Number of Chambers Used
500.0 Minimum Distribution Cell Area Required (sq.ft.)
510.2 Distribution Cell Area Proposed (sq.ft.)
Wieser 750 �Septic Tank ose an (if applicable)
Lifetime � EfFluent Filter **select only if NOT using combo tank
Surface Depth to System
Soil Boring Grade Limiting Lowest Highest Elevation
Number Elevation (ft.) Factor(in.) Elevation Elevation Acceptable
1 92.15 108 E 86.15 90.90 TRUE
2 91.75 05 � 86.00 90.50 TRUE
3 .45 1 8 � 86.45 91.20 TRUE
4
5 .�.�_.�__.__
Page 2 of 7
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Cross Section of a Two Cell In Ground Ccmponent.
Using Leaching Chamber�-;
Observaiion/Ve�t Pipes
// \
-- -- -- - .
92.00 Finished Grade - ----- Finished�rade —��
Slope _ /I Celi"Seperation � �
-_ . � �=f�' t
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Original Gradc- -, � >,�y ' .'/ ?`.Y.�''�,�,.Ciriginal Grade
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90.00 Top of Chamber ____ _� �'" �� - . ' � _ �_��_�'Top of Chamber 90.00
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88.75 System Elevation .'•• . . . � V System Elevation 88.75
:. _ . . , � . ; • ---;r--•
.• .7'reotrr,ent'pnd'Dispe�sol.Zone-, �
; •� . , •' •~• •. , , •• ^ . . , '' '•5•••'
• ' � ' .
+ .-- - ---- .-- ' '.r' • ' . lirr7iting Factor
Observa;'.on/Ven: pipes to be constucted and copped w th approved matenais for the particulcr use.
Diagrams Not To Scale
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Observation/Vent Pipes to be located 1/5 to 1/10 the length of the distrution cell measured from the end of the cells
Page 4 of 7
my Spies &Catherine Conway
11412W Oriole Ln
2.47E+10
Number of Bedrooms 2 Septic Tank Wieser 750
Estimated Flow(average)gal�ons/day 2 Effluent Filter Li etime
Design Flow(peak),(Estimated x 1.5)gal/day Pump Tank #N/A
Soil Application Rate gal/day/ft2 0.6 Pump Type
Influent/Effluent Quality Monthl Average
Fats, Oil &Grease(FOG) 30 mg/L
Biochemical Oxygen Demand (BODS> 220 mg/L
otal Suspended Solids (TSS) 150 mg/L
f. . Servicing frequency of 12 months or less requires the
� � �a`� � Management Plan be recorded with the Register of Deeds.
Maintenance Schedule
Service Event Service Frequency
Inspect condition of tank(s) At least once every 3 Year
Pump out contents of tank(s) When combined slud e and scum = 1/3 of tank volume
Inspect dispersal cell(s) At least once every 3 Year
Clean effluent filter At least once every � 3 Year �
Inspect pump, pump controls &alarm At least once every
Maintenance Instructions
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following
licenses or certifications:Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer, Septage
Servicing Operator. Tank inspection must include a visual inspection of the tank(s)to identify any missing
or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and
to check for any backup or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually
inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on
the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and
requires 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 tank
volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and
disposed 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 service
event.
Start-Up and Operation
For new construction, prior to use of the POWTS check treatment tank(s)for the presence of
painting products or other chemicals that may impede the treatment process and/or damage the
dispersal cell(s). If high concentrations are detected have the contents of the tank removed by a
licensed 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 and
prolong 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, painting products, pesticides, sanitary napkins, tampons, and water softener brine.
Abandonment
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to
insure that the system is properly and safely abandoned in compliance with Wisconsin Administrative
Code 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 Servicing
Operator.
-After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void
space filled with soil, gravel or another inert solid material.
Continqency Plan
If the POWTS fails and cannot be repaired the following measurers have been, or must be taken to
provide a code compliant replacement system: (Check One)
'' The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a
soil and site evaluation shall be performed to locate a suitable replacement area. If no replacement area
is 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 replacement
soil absorption system. The replacement area should be protected from disturbance and compaction and
should 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
establish a 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
be installed to replace the faited POWTS.
!!WARNINGi!
Septic, pump and other treatment tanks may contain lethal gasses and/or insufficient oxygen. Do not
enter a septic, pump or other treatment tank under any circumstances. Death may result. Rescue of a
person from the interior of a tank may be di�cult or impossible.
POWTS Installer Septic Pumper
Name Gerald Froemel Name Scott Poppe
Phone# 715-558-11 8 Phone# 4-� 4 0
POWTS Maintainer Local Regulatory Authority
Name Jays Septic Agency Sawyer Cc�unty Zoning
Phone# 15-55 -1 � Phone# 715-634-8288
Page 7 of 7
� "'"" PRIVATE ONSITE WASTE TREATMENT county
,
��'��o '�� SYSTEMS
�� sP I ( pOWTS) Sawyer
��4�,'1 s :_.�
���U `_y��
�'''�"-��"� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT) p
GENERAL INFORMATION o�-oZ "' �o�
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village l�Town of: State Plan Transaction ID#:
� ��12$fi����Ce�t�wwc.l (�,oi..v�o` �st� ^
Insp BM Elev: BM Description: Parcel Tax No:
�o�.c� ` ��,-�. ch c�o�s;� o�`� _�Y(—�o - `l r�`/
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic w,�Q 7� Benchmark (oo.o'
Dosing
Aeration Bltlg. Sewer G?�.��
Holding St I Ht Inlet 4'7,(o �
TANK SETBACK INFORMATION St/Ht Outlet q�, 3 '
TANK TO P/L WELL BLDG VENT TO ROAD Dt Inlet
AIR INTAKE
Septic ,1-�5� ��(o' � ` .�.(S-� NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. g�,�g�
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative ��a,r
Surface
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist.To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W 3 � � �< < #of Cells Type of System Distribution Media Manufacturer:
Conv ❑ Aggregate '�'
SETBACK OHWM of Nav � �^ I
INFORMATION P/L Bldg Well Waters o G R� Chamber Model Number:
❑ EZFIow
CELL TO �y'S �� �` -�-(o�� ❑ Mound o Other QY�
_ --- -- - --___-------- --
DISTRIBUTION SYSTEM x Pressure Systems Only
-- — -- T
— ---
Header I Manifold Distribution Pipe(s) i X Hole Size X Hole Observation Pipes �
Length_ Dia Length Dia Spac � Spacing ❑Yes ❑ No
— ------------ --�---- -
SOIL COVER
f Depth Over � Depth Over ! Depth of Seeded/Sodded Mulched �
� Cell Center Cell Edges j Topsoil_ ❑Yes ❑ No ❑Yes ❑ �do
COMMENTS: (Include code discrepancies, persons present, etc.)
���Ic�l 6�4 ���
� � � � � _ �. � --- � 6 ^�
Plan revision required?� Yes ❑ No �� �3 ��� - ����
�
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL COMMENTS ANO SKETCH
SANITARY PEAMIT NUMBEfl: ��—O�7
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