010-182-00-1100-SAN-2024-012 ;:�%'�'-''`'��� Department of Safety c°°°�y �'�
-=, � �. ��
,�B �=�� & Professional Services, �^`^' e-� �Z.
� $p ' Sanitaiy Permit Number(to be filled in by�
r�, � g , Industry Services Division
\�:�:�,<<:= \ (.p 5 I �1 I c,� s
�
SaI11ta� PeY'1111t AppllCat10I1 State Transaction Number d
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this fonn to the appropiiate governmental unit �
is required prior to obtaining a sanitary peimit.Note:Application fornis for state-owned POWTS are submitted to Project Address(if different than mailing addr��ss)
thc Depaitment of SaYely and Prot�essional Services.Pcr,onal information you provide may be used for seconda�y
puiposes in accordance with the Privacy Law,s. 15.p4(I)(m),Stat,. �y�5N �"Q� �C WO(�C� ��CbJ�
I.Application lnformation-Please Print All Informatioo g
Propeity O�i�nci's Namc Parcel#
.►e 4 c- n �- o ► c� - , 8a- oa-I (OD
Prope�ty Owner's Mailing Address Property Location
3 7�- 1 n c1; � �d� ��E—�.,
City,S[ate 'Lip Code Phone Number
u r►-�-a,n , M� SS�i 3S !�'���'�.se��;on D I
II.Type of Building(check all that apply) L���# �� N K D� f=o W
�I or2 Pamily Dwelling-NumberofBedrooms__� _ � � Subdivision Name
B���k# TP�N6(,CW00D ar�Y
❑ Public/Commercial-Describe Use —
❑Ciry of
❑State Owned-Describe Use CSM Number ❑Villa�e ot�
,�To���i of f
III.Type of POWTS Permit:(Check either��New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if
a licable.)
�' �Ne���S ,tem
� y; ❑ Replacement System U Other'�loditication to Existin�System(explain) ❑ Additional Pretrcanucnt Unit(e.rplain)
B.
❑ Holding Tank �In-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑ Other Type(explain)
(conventional)
List Pre��ious Pennit Number and Date Issued
C• ❑ Renewal Before ❑ Re��ision ❑ Change ofPlumber ❑ �I-ransferto'Veti�O�vner _
Expiration
N.Dispersal/Treatment Area and Tank information: a'a pv:e 1< </ /� Cha,rv�i,t � w S e!-S uF-an d
Design I�lo�v(gpd) Design Soil Application Rate(gpd�st) Dispersal Area Required(s�) Dispersal Area Proposed(s� System Ele��ation
�300 0. '7 ya9 y�a 93 . 00 �
Capacity in Total #of Manufacturer
�
Cank Infonnation Gallons Gallons Units � � U �° � � �
New Tanks Existing Tanks � o g; a � � �c c�'s
a. U v� � rn ii C7 P.
Septic or Holding Tanl: w�c/l 7 SQ � ��`� �('-Cp�.�GAG k �p
�JV
Dusin�Chambu'
V.Responsibllity Statement- l,the undersigned,assu e esponsibility f ' n-of the PO�VTS shown on the attached plans.
Plumbe�'s'�amc(Print) Plumb s ignatw'c MP/MPRS Numbcr Business Phone Number
T �3� ►�c�-kr 1� �sa?'i 9 ��s- �3v -���
Plumbcr's Address(Street,City,State,Lip Code)
��3 v�w s�-�.+� �2�.d � �a�, w��d, w z s-L�a�3
VI.C unty/Department Use Only
Pennit Fee Date Issued Issuing Agent Signature
�A ro�e � ❑Disapproved
� ❑Owner Given Reason for Denial � 1 ���� �� ��� � 2� �"����
Conditions of Approval/F2easons for Disapproval ,
���- � ���
�"A � � i _i ��i
::' _m.� 3 C� �`-1 - W,�x � ,;��L.� �i
.;'w Y��� ��;�+�..� � � a < <�
a� 1 � `t
�:#._�...3 3`-�-e..�.- t-� JAN 2 9 20�4
C ST ��— O I � �� _,.�SS . ___.._�... S,4WYER COUNTY
LO�vlNG ADMINISTRATION
Attach to complete plans for[he scstem and submi[to the Counh�only on paper not less tl�an 8 ll2 x 11 inches in size
NO REFUNpS qFTER
SBD-6398(R.03/22) �SSUE OF PEAfK11' (01 3�-f
PAGE 1 OF 4
In-Ground Gravity Plan
Index & Cover Sheet
Componenf Manual Design References:
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross-Section & Plan View
Pg 4 of 4 Management Plan
Attachments: Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Utke - Tanglewood Pkwy
owner rvame(s): Steven & Sharon Utke Phone: - -
Owner Address: 30974 Indigo Rd ; Fountain, MN Z;p: 55935
Project Address: g405N Tanglewood Pkwy
Govt. Lot: 1/4 of 1/4, Section 01 , T 40 N_R 08 E ❑or W ❑✓
Township: Hayward County: Sawyer
Project Parcel ID #: 010-182-00 1100
Designer Information
Designer Name: Travis Butterfield Phone: 715 _634 _8176
Designer Address: 14346W State Road 77; Hayward, WI Z�p; 54843
E-mal�: OffIC2@fJUtt@�12�C�C�1"1��111g.001'Tl 'I'liis space reserved for appr«val stamp.
License Number: 652879
Remarks:
Signature: Date: o� I �q ��`+ _
riginal signature required on each submitted copy.
) �
� , � '� 11
° � , � �
9 � � �� � � �
� �� 1
� W
l l�c � l) � �
� �
,, „
� ,�' l � �v � � �
1 �- _, �
f 1 u � N rn C
C � �r- �j �r .�
(� 'D � A
f)` J) ` �� � :
� /�� � � � � � � � �
� ^ " v
a „
�`�. �� ° U � Z � � r
�/ 3 D p � n �
� q� � � '�
� Vr � � � � 3 � �1
//' � rn �
a ., �
/ 3 r`. A r '� �
-� c
� �N po
-r r
�i � Q O � l� r►
_o W o_ �. � o '0 �
, � Z
0 p �' �
. �� � �
�
� �� � � , x
�` p " 3
�
,1'� � cn �
; � h x �b w
��� �.a'��,a� t � �
_ �,� ,^�, �`
1 ►
Q� � wPQm � � � o � o :�
s � W v — 3 r 3 ;— � � �' t G -U
I�i �I �
`� � 11 �) �r �t �G 3 �—
., � Z C �e r' ; Z C� C
-� e
c � .r -a � -�i � o C� � -i � � � �
07 .r � Q
-
� � � Q � z � � � .� � � r `,� �
� ''�r -t- T � � A � � P Z K � � 'J�
,�,. � �
�T' Q , � 0 0 �• z
2 p �' '� 0 � -_.
z � ¢ � �
v
�� � °° c �p �
�' c � �
�Q1 X �
0
�
1-�
Septic Tank(s) Manufacturer:
IN -GROUND GRAVITY DISPERSAL AREA wieser Concrete Inc
Uniform Elevation Trenches with Quick4 Standard-W Chambers SepticTank(s) Volume(s):
3-ft Trench (down -sizing credit) � 000 gal gal gal gal
Effluent Filter Manufacturer:
Best Filter LLC
�
— Effi�e�t F�ite� Modei #: GF10
min. 12"
(typlcal)
SOIL COVER
12"
min. trench
depth
criP��ao ��� < � TYPICAL TRENCH
.a � � <. CROSS SECTION VIEW
_ _ ,a .a. .
��cyP�a�> �:�a � �• �"� � . . (No Scale)
w d • ' a
. " Provide minimum 3 ft
System Elevation = 93 .00 ft separation between trenches.
(typical)
Quick4 Standard-W
w/ End Cap Observation Pipe TYPICAL TRENCH
(typical)
(Show location of inlet / outlet pipe connection on plan view.) (typical)
Installpermanufacturer's PLAN VIEW
instructions.
(No Scale)
- - - - - - - - - - �f- - - - - - - - �� - - - - - - - �
I ; � ; I A = 3.Oft
' . , �tYPical) �
►-- - - - - - - - - - - - -�� - - - - - - - �� - - - - - - - - - -� �
G�
B = 47 ft - � m
(typical) Quick4 Standard-W Chamber W
(typical) O
INSTALL PER TRENCH : (rr�fd by ��fi�tratorsysterr�s, ��o.)
�1
Install pursuant to manufacturers instructions. �
11 Quick4 Std-W @ 20 f� EISA/chamber = 220 ftZ
+ � Pairs of end caps @ 6 ft2 EISA/pair = 6 ftZ
= Proposed EISA per trench = 226 ftz Required Infiltration Area = 429 ftz Distribution Method:
x 2 trenches = Proposed Total EISA = 452 ftz branched manifold �
PAGE40F4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground gravity system shall be responsible for its perpetual operation and malntenance pursuant to
requirements of SPS 382-384,Wisc.Admin.Code. Pursuant to SPS 383.52(2),Wisc.Admin.Code,this system shall
be 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 Maintainer in
accordance with SPS 383.52(3),Wisc.Admin.Code.
Maximum Dispersal Area Operatinq Limits:
Design Flow= 300 gpd; BODS<_220 mgL-'; TSS<_150 mgL"'; FOG<_30 mgL-'
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o 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.)
c sollds 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,prohiblted activities,etc.)
o extent of ponding in distribution cell priorto dosing
o 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 served
Maintenance Checklist MAINTAIN EVERY 3 YEARS(or when necessary)
o Septic and dose tank(s)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)or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113,Wisc.Admin.Code.
o Effluent filter(s)shall be inspected every 3 years and shall be deaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc.Admin.Code. Report any component failure or malfunction to:
Name of individual or company: BUtt21 fl@ICI IIIC Phone: 715-634-8176 _
�ooai go�ernment�n�t: Sawyer County Zoning &Conservation Pnone: 715-634-8288
�ocal government unit address: 10010 Main St, Suite#9; Hayward, WI Z�p 54843 _
Any defective part of this system shall be repaired,replaced,or removed pursuant to SPS 383.51 (1),Wisc.Admin.
Code.Repair or replacement of failed or malfunctioning components shall comply with SPS 383,Wisa Admin.Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384,Wisc.Admin.Code.
Continqency Plan
In the event that any failed treatment component of this POWTS cannot be repaired,it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be
abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils.
System Abandonment
If use of this POWTS is discontinued,it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code.