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Division of Safery ard Buadings �
i�accordance with SPS 385,Wis Adm. Code
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\\Safety and buildings Divisiun20! W, Washington Ave., P.O. Box7l62Madison. WI 53707-7162JC6-^oqSanitary Permit ApplicationIn accordance with s. Si'S 383.21(2), Wis. Adin. Code. sut>niissiun of this tbmi to the appropnatc governmentalunit is required prior to obtaining a sanitary permit. Note Appliealion forms for slate-owned POWTS arc submittedtothcDcpartmentofSafctyiuid f'rofessional Services. I'ersonai infoniiatioii you provide may be used forseeondaryniirrioses in accordance witli the I'rivuev Law, s. I.V(I4( i)(nt), Stats.Application Inrormadon - Please Print Alt InformationProperty Owner's NameHerbert & Susan NelsonProperty Owner's Mailing Addrcs.s1265IN Small RdCity. SlateHayward.W!/.ip Code5484311. Type of Building (check all that apply)I or 2 Pantily Dwelling - Number ofDcdrooms 3r~l ihiblic/Commcrcial - Describe User~i Stale Owned - Describe UsePhone NumberLot#4Block#ICSM NumberCoimtysawyerSanitary Permit Number (to be filled in by Co.)79S 7Stale Transaction NumberProject Address (if diO'creni than mailing adda-ss) tXParcel#0I4I14010402Property IxicalionGovl. Lot'A. 'A. Section 25T42N; r9 WSubdivision NameDoug-Mark Add.I I City ofI I Village ofI Town oflenrootIII. Type of Permit: (Check only one box on line A. Complete line B if applicable)nIXI ReplacementSystemA.New SystemI I PermitRenewal BeforeL.vpiralioni [ Trcatmcnt/l lolding Tank Replacement OnlyI I Other Modification to Existing System (explain)B.□Permit Revision□ Change ofPlumber□ Permit Transfer toNew OwnerList Pievious Peimit Number and Date Issued3T-OS-7IV. Type of POWTS System/Componcnt/Device: (Check all that applyNon-Pressurized In-Orouml I I Pressuri/ed lii-Oround I I Al-Griide I Mound > 24 in. of suitable soil I I Mound < 24 In. of suitable soilI I Holding "l ank Q Other Dispersal Component (explain) I I Prelreatment Device (explain)V. Dispersal/Treatment Area Information: Quick 4 PlusDesign Plow (gpd)450Design Soil Application Rale(gpdsf).7Dispersal Area Required (sf)642.9Dispersal Area Proposed (sOSystem lilevatkm96.50 'VI. Tank InfoCapacity inUallonsNew TanksHxisung TanksTotalGullorks# ofUnitsManufacturer;! oa §a. U«IJii£ aSqxic iioldingTank10001000skawDosin}! CkoJTibcfniter basket1wieserMnrVII. Rcspoiisibiiity Statement- I, the uoderslgncd, assume responsibility for Instiiialion of the POW'TS shown nn tlic attacheil plans.Plumber's Name (Print)Gerald FroemelPlumber's SiMP/MPRS Number9501)1Business Phone Number715-558-1138Plumber's Addrc.ss (Street. City. Slate. Zip Code)I3502W Froemel Rd Hayward.WI 54843VIII. Coqnty/Department Use OnlyCot>nty/t6^ a'rD Di.sapproved0 Owner Given Reason for DenialPermit FeeIX. Conditions of Approval/Reasons for DIsappixtvalDate Issued Issuing Agent SignatureNO REFUNDS AFTERISSUE OF PERMITAttach locampletr ptansfor thesysMnandsnhnil to the CoBUly only on paper not less than 81/2 x tl indies in sacSDD-6398(R. Il/ll)
Herbert & Susan Nelson12651N Small Rd014114010402SawyerProperty Owners NameProperty AddressTax Parcel NumberCountyS25T42NR9WGerald Froemel950111715-558-113810/05/20Gov Lot or Qtr-Qtr/QtrSectionTownRangePage Index1 Property Information2 Data Entry3 Plot Plan4 Drainfteld Cross-Section■AzDoie Taftk-6 Maintenance Plan7 Contingency PlanCounty Parcel ListingPlumber's NamePlumber's SignaturePlumber's License NumberPlumber's Phone NumberDateNot an endorsement, writtert or implied tor the fbflowing companies and products: DelZotto Concrete. Wieser Concrete ProductsInc., Skaw PreCast Co.. Huftcutt Concrete Inc., Zabel Environmental Technology. ITT Industries(Goulds). The Pentair PumpGroup(Myers), Inhltrator Systems, ADS Products, Polylok Inc., Orenco Systems Inc., SimTTech Fllterlnc., Sta-Rlte Industries,Page 1 of 7
In-Ground Soil AbsorpBon SBD-10705-P (N.01/01) Version 2Component Manual Used3Number of BedroomsPercent Slope (%)108Depth to Soil Limiting Factor (in.)0.7In Situ soil application rate300Estimated Wastewater Flow (gpd)450Design Wastewater Flow (gpd)1Number of System Elevations96.5Proposed System Elevation #1Proposed System Elevation #2Proposed System Elevation #3Original Grade #1100Finished Grade #1Original Grade #2Finished Grade #2Original Grade #3Finished Grade #3Infiltrator Quick 4 StandardChamber Type 115Height of Chamber (in.)20sq.ft. per chamber2Rows of Chambers5.1sq.ft. per pair of end caps3Distance Between Cells (ft.)32Proposed Number of Chambers Used642.9Minimum Distribution Cell Area Required (sq.ft.)650.2Distribution Cell Area Proposed (sq.ft.)Septic TankDose lank (if applicable)! jBest 8"Effluent Filter"select only if NOT using combo tankSoil BoringNumberSurfaceGradeElevation (ft.)Depth toLimitingFactor (in.)LowestElevationHighestElevationSystemElevationAcceptable199.76i(i294.2698.51TRUE2100.801(1)495.1399.55TRUE3101.3010895.30100.05TRUE45Page 2 of 7
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Cross Section of a Two Ceil In Ground ComponentUsing Leeching Chambers06servotion/Vent Pipes100.00Finished GradeSl<^97.75Original Grade. .Top of Chamber96.50 jSystem ElevationC^l SeperationFinished Grade ~N.' \^.-V'V-'\,Original GradeTop of Chamber97.75, .r-— . . . * f.Treotnjent ind* Olepereof .Zorie • ' * . n' '• v." • •• . • Li'LimSystem Elevation 96.50iting FoctorObservQtlon/Veni pipes to be constucted ond copped with opproved moleriols for the particular use.Diagrams Not To ScalFObservation / Vent Pipes to be located 1/5 to 1/10 the length of the distrution cell measured from the end of the cellsPage 4 of 7
Service EventService FrequencyInspect condition of tank(s)At least once every 1 3|Year |Pump out contents of tank(s)When combined sludge and scum = 1/3 of tank volumeInspect dispersal ce1l(s)At least once every3YearClean effluent filterAt least once every3YearInspect pump, pump controls S alarmAt least once everyHerbert & Susan Nelson12651N Small Rd1.41E+10Number of BedroomsEstimated Flow (average) gallons / dayDesign Flow (peak), (Estimated x 1.5) gal/daySoil Application Rate gal/day/ft^3oa0.7Influent I Effluent QualrtyFats, Oil & Grease (FOG)Biochemical Oxygen Demand {BODs)Total Suspended Solids (TSS)Monthly Average30 mg/L220 mg/L150 mg/LSeptic TankSkaw 1000Effluent FilterBests"Pump Tank#N/APump TypeIINOTEI!Maintenance ScheduleServicing 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 Plumber 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 ground 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 infItrative surface.Page 6 of 7
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, painting products, 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 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.Contingency 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 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 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.IIWARNINGI!Septic, 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 #715-558-1138POWTS MaintainerNameJays SepticPhone #715-558-1138NameScott PoppePhone#(715) 634-1450Local Regulatory AuthorityAgencySawyer County ZoningPhone #715-634-8288Page 7 of 7