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Home My WebLink About010-841-27-3404-SAN-2022-062 _`a�.n:�u�. COUi1I)' / � � Safety and Buildings Division sawyer �/ I �8 P - 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled in t � _ � Madison,WI 53707-7162 2 t �,, � - � J�� C ls��17 Sanitary Permit Application State Transaction Number , N In accordance with s. SPS 38321(2),Wis.Adm.Code,submission of this form to the appropriate govemmental ^ \ unit is required prior to obtaining a sar►itary permit. Note:Application fortns for state-0wned POWTS are submitted � �� Project Address(if different than mailin� � to ihe Departrnent of Safety and Professional Services. Personal information you provide may be used for secondary oses in accordance with the Privac Law,s.15.04 1 m,Stats. �-�"- � I. Application InformAtion-Please Print Ail Information � Property Owmer's Name Parcel# � Samuel&Peggy Carlson 010841273404 PropeRy Owner's Mailing Addcess PropeRy Location 13286W Cty Hwy B Govt.Lot City,State Zip Code Phone Number SE '/4,SW'/., Seclion 27 Haywazd,WI 54843 T41N; R8 W II.Type of Building(check all that apply) Lot# � 1 or 2 Family Dwelling-Number of Bedrooms 3 Subdivision Name Block# ❑ Public/Commercial-Describe Use ❑ Ciry of ❑ State Owned-Describe Use CSM Number ❑ Vi(lage of � Town of Hayward Ill.Type of Permit: (Check onty one box on line A. Complete line B if applicable) A' ❑New System � Replacement ❑ TreatrnendHolding Tank Replacement Only � Other Modification to Existing System(explain) System B. � Permit ❑ Permit Revision � Change of ❑Pertni[Transfer to List Previous Per[nit Number and Date Issued Renewal Before Plumber New Owner .p Ex iration ��' �I / �I I� �R o� IV.T e of POWTS S stem/Com onent/Device: Check all that a I Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil Holding Tank ❑Ott�er Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersaUTreatment Area Information: Quick 4 Plus Design Flow(gpd) Design Soil Application Rate(gpds� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation 450 .7 642.9 650.2 94.50 VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units � � o � ^ New Tanks Eacisting Tanks � c � � � � � � o . y a`. U v� y vz u. C7 n, Septic or Holding Tank 1000 1000 l wieser � � � � � Dosing Chamber ❑ ❑ ❑ ❑ � VII.Responsibility St9tement-I,the undersigaed,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Si ature MP/MPRS Number Business Phone Number Gerald Froemel 95011 1 715-558-1138 PlumbePs Address(Street,City,State,Zip Code) 13502W Froemel Rd Ha ward,Wl 54843 VIII.C u /De artment Use Onl �App v ❑ Disapproved Permit Fee Date Issued Issuing Agent Signature $ �e��' � I �I z� �j�:e�..�Q.e�+-�{-�� nial .... - IX. n �' ' �. � a e . ; isapproval r:.i,1, ---�.._-----1:• � C-��-� �ts;�`( Q 2 2�� '� NO REfUNDS AFTER �� ____` _� ISSUE OF PERMR �.;�a�N.-�-s� �c��.;�vr�r F��'¢�te plaos for the system and submit to the County only on paper not less t6an 8 In z 11 inches in size sBn-639s�R >>ii>> �. S� 22 �Ut-1 � Samuel 8� Peggy Carison Property Owners Name ' � 13286W Cty Hwy B Property Address 010841273404 Tax Parcel Number � Sawyer County SE/SW Gov Lot or Qtr-Qtr/Qtr �� S27 Section T41 N Town R8W 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 05/01/22 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,ITT Industries(Goulds),The Pentair Pump Group(Myers),Infiltrator Systems,ADS Products,Polylok Inc.,Orenco Systems Inc.,Sim/Tech Filter Inc.,Sta-Rde Industries, Page 1 of 7 In-Ground Soii Absorption SBD-1070�P(N.01/01)Version 2.. • Component Manual Used 3 Number of Bedrooms �� 1 Percent Siope (%) 100 Depth to Soil Limiting Factor (in.) � 0.7 In Situ soil application rate 300 Estimated Wastewater Flow (gpd) 450 Design Wastewater Flow (gpd) 1 Number of System Elevations 94.5 Proposed System Elevation#1 Proposed System Elevation#2 Proposed System Elevation#3 Original Grade#1 98.75 ,Finished Grade#1 � Original Grade#2 Finished Grade#2 Original Grade#3 ��"�" Finished Grade#3 Infiltrator Quick 4 Standard ; Chamber Type .. _ ,_. ,. _. : _.._�_��._�.,�..,... 15 Height of Chamber (in.) 20 sq.ft. per chamber 2 Rows of Chambers 5.1 sq.ft. per pair of end caps 3 �� Distance Between Cells (ft.) 32 � Proposed Number of Chambers Used 642.9 Minimum Distribution Cell Area Required (sq.ft.) 650.2 Distribution Cell Area Proposed (sq.ft.) Wieser 1000LP !Septic Tank ose an (if applicable)' x 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 qcceptable 1 98.85 102 93.35 97.60 TRUE 2 98.45 100 93.12 97.20 TRUE 3 98.55 102 93.05 97.30 TRUE 4 ; � _...�r��..�_.�_�._..,�,..�.�.�.M.a. a Page 2 of 7 ��.c9 21�= l.—�•� . �W1Ue � �• l�e�� C.. CGV��SD✓1 ,Sqw��r CO. �'�'c�� trcJ�'c.r� "T`v(� ► 3zSslow Co ��,c.�� (3" P�nJ : �ip - 8�1_ Z7- 3�l0�1 �a.�t,c�c�r C�� 1.c.7 I 5`-�S�(3 SE lS l.v `�` Z? T � ( 1�7 �. �8 w . R.� e�- = Y� c�.� C� C�r`►�I., S: 3 Z �� } �•�3�c�L 7, �,e •. l �'d 6 �v Co N Sca�e (`= 58� I . o co 2o io 4o SD iZ F O � /� r ` � �f'(. l O D� 'f0'� 0 Y lal e(,� ~ "' P�(, q$.a5 � ti r ' � �, a g. K.� o � 3. 98. S�� N 3 • .� 50: �,s, sc.�s't'�w� ��,. 44.7S� �'� �s-F new ST i� qS,g' t 0 3 b� ' . l �►ti �o0 �-w�t1 t •y ��5��//� � � I3z8�W �oo, Co {-�cJ,,� �,�,� Cross Section of a Two Cell In Ground Ccmponen; Using Leaching Chambers Observotion/Ve�t Pipes � � 98.75 Finished Grade - �.•--------- Finished�rade—�� Slope 1% /I Celi"Seperation ^ ,� __ / . . 3 , _ , � , j� , : , , ,, �,-A, , �� :� �: - ,, Orginal Grade -i�� ,�y,, �' �� , ;Y,-''��,PSriginal Grade 95.75 Top of Chamber �'"�� -'` I �'"`,,�'�Top of Chamber 95.75 ---- -�- - �� ' . , � �-- -- ��--�-- j,, , , 94.50 System Elevation ___ '�• . .: '� _ System Elevation 94.50 •. . . , • . • , � .r--� � •.• .l�reotr*;ent�pnd'Dispe-sol,Zorle- ' • . ' . • • . ti . . • . ', .- -..— . . �` .' '' .• .• .._.•._.�____._ '. l�miting Factor Ubse•va;o�/Ven; pipes to be constucted ond capped with opproved materiols for the particular use. Diagrams Not To Scale - --- _. - — ---- -_ , — ^� i� !r�rs` `�rt'r�" i1�1► �� 'F�` � �' . O � � � _��.__. O. _ ` �� '" � _� -- —. ___--__� Y -- � --_ � e --- f � _.- '�■�n p�.... � � �PF�;. —_��...�.:r ,��--a..� 'T- ,...►�,�.�' / bservation J 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 Samuel & Pe Carlson ' 13286W Cty Hwy B 1.08E+10 Number of Bedrooms 3 Septic Tank Wieser 1000LP Estimated Flow(average)gallons/day Effluent Filter Li etime Design Flow(peak),(Estimated x 1.5)gaUday 450 Pump Tank #N/ Soil Application Rate gal/day/ftz 0.7 Pump Type Influent/Effluent Quality Monthty Average Fats, Oil& Grease (FOG) 30 mg/L Biochemical Oxygen Demand (BODS� 220 mg/L otal Suspended Solids (TSS) 150 mg/L , Servicing frequency of 12 months or less requires the � 3'�� Management Plan be recorded with the Register of Deeds. Maintenance Schedule Service Event Seroice Frequency Inspect condition of tank(s) At least once svery � ear Pump out contents of tank(s) When combined sludge and scum = 1/3 of tank volume Inspect dispersal cell(s) At least once every = 3�Year Clean effluent filter At least once every �'�'� 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 efffuent 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 infittrative surface. Page 6 of 7 Do not drive or park vehicles over tanks and dispersal cells. , Reduction or elimination of the fotlowing 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. Continqencv 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 availabte 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 failed POWTS. !�WARNING?, Septic, pump and other treatment tanks may contain lethal gasses andlor 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 difficult or impossible. POWTS Installer Septic Pumper Name Gerald Froemel Name �Scott Poppe Phone# 715-558-1138 Phone# (7 5 4-14 POWTS Maintainer Local Regulatory Authority Name Jays Septic Agency Sawyer County Zoning Phone# 715-558-1138�'�'��"��'�� Phone# 715-634-8288 Page 7 of 7 I �2/�- `` PRIVATE ONSITE WASTE TREATMENT county ;,...K,,,`\;P� j��; os� „;i�'� SYSTEMS `\��j j1 ( POWTS) Sawyer '•k `_ C� ``=s�'"�',='' INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION 2� — OC�� Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(I)(m)] Permit Holder's Name: ❑City ❑ Village I�Town of: State Plan Transaction ID#� hii M2. �I'�'e C�i��H T`°c w� — Insp BM Elev: B scription: Parcel Tax No: ��o.o' � we-1 1 0�o� �`� � ��7- 3 Ya TANK INFORMAT ON ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic � � Benchmark �e�o,o� Dosing Aeration Bldg. Sewer 9 6.63' Holding St/Ht Inlet r-�'�, �3 ' TANK SETBACK INFORMATION St/Ht Outlet , 9�s 88' TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet AIRINTAKE Septic �� S� �p' -�(O� NA Dt Bottom Dosing NA Installation Contour Aeration NA Header I Man. r'tS,S'r Holding Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative i Surface `�'Y•S Manufacturer Demand Final Grade Model Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFOR ATION DIMENSIONS W � L (� � (�Y #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate �� (� INFORMATION P/L Bldg Well Waters o IGP Q�Chamber ❑ AG a EZFIow Model Number: CELL TO �,�'_ ,�,2� �i'6p n/ ❑ Mound � Other � � �__ DISTRIBUTION SYSTEM X Pressure Systems Only Header I Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length Dia Length Dia Spac Spacing ❑Yes ❑ No SOIL COVER - ---- ---- — — - - --- - ------ Depth Over Depth Over Depth of Seeded/Sodded Mulched _Cell Center Cell Ed es Topsoil � ❑Yes ❑ No � ❑Yes ❑ No� COMMENTS: (Include code discrepanaes, persons present,etc.) ��1(� ��-(�� Plan revision required?0 Yes ❑ No o a� �3 ` /� � (� — — __ �� Use other sitle for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A�OITIONAL COMMENTS ANO SKETCH SANITAAY PEAMIT NUMBEA: ��—OE�� i �—��S�'� --� �b� �Cto� �� y°/C-, �L �?K'r _ __._"._� _:..__....4._.... •..... �.__......_4--..._.Y_ . .. . . . , . . . -' . '__ _.,_ ..._. . . . . , . .__.��.._.. ...._-�__ ..._.'_ __.'"__.. .. .� . 5� : : . 6' � . ._ . . : �� - •e� ; ..._ : �� : - ' , ; , ; _ � . _._ _ , _:-_ �____ _ .'_ _ , _ ._� 3` ;.,>�� ; - -- -- - - _- � i , , , , _._ : __ _ _ : __ _;._ , . _ . � _ _ .__ : _ � : � � , : : :. , ,. ; . � ; . � ,h�.� _;.. ...i . , �� i. � ,. - � - .; � : :. , .; , . . . . _.. . . _. .. � .. _._.__ ._ . , . . '� . , . .. : . .. .. .. , _ . .. .. . .... . ... ....... . . . . . . . � _ _.. . . - .. . . /'s/ r ��5, 'fp 1 1 ' �/excT. 3 �� ' �� o- � � �C �� `� �� 4 � ��