HomeMy WebLinkAbout002-940-16-2111-SAN-2022-104 ` [ndustry Services Division Counry �
, �_ 4822 Madison Yards Way Sawyer �
- , t� - Madison,WI 53705 Sanitary Permi[Number(to be filled in by Co.)
: P.O.Box 7302
- Madison,W I 53707 �9 .�C� � C� �
�
Sanita� PeY,mit AppliCatl�n Statc Transaction Number _
In accordance with SPS 38321(2),Wis.Adm.Code,submission ofthis form ro the appropriate govemmental unit �,5"��eZ�00� �o(^� �
is required prior to obtaining a sanitary permit Note:Application forms for state-owned POWTS are submitted to Project Address(if ditYerent than mailine addre�.
the Department of Safery and Professional Services.Personal information you provide may be used for secondary Same
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats.
I.Application Information—Please Print All Information
Property Owner's Name Parcel#
Susan Benson 002940162111
Property Owners Mailing Address Property Location
8839N Old Hwy 27 �o�� �ot
City,State Zip Code Phone Number
Hayward, WI 54843 715-634-6757 "E �%,"W �, Section 16
II.Type of Building(check all that apply) I.ot# -�40 N R 09 E orNb
I or 2 Family Dwelling—Number ofBedrooms
Subdivision Name
b� � B�ook#
Public/Commercial—Describe Use ��`��"�
�: �.. a �Ciry of
❑State Owned—Describe Use CSM Number ❑Village of
23/117 # 6353 �Tow�,of Bass Lake
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 i
a licable.)
� �New System �eplacement System ❑�Other Modification to Existing System(explain) �Additional Pretreatment Unit(explain)
Drainfield Addition
B.
�Holding Tank �[n-Ground �At-Grade Mound �✓ Individual Site Design �Other Type(explain)
(conventionap OSed
C• ❑Renewal Before �Revision �Change of Plumber �I'ransfer to Ne���Owner List Previous Permit Number and Date Issued
Expiration 568541 - 14-065
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(sf) System Elevation
450 0.7 1345 1450.6 . �j,/. �
Capacity in Total #of Manufacturer
Tank lnformation Gallons Gallons Units � � o b„ o
�lew Tanks Existing Tanl:s y c v � � � � �
0
� U cn � v� w C7 0.
Septic or Holding Tank 1000 1000 1 HuffCut ✓ �
Dosing Chambcr ]6� 7F)� 1 Rasmussen �/ � � �
V.Responsibility Statement- I,the undersigned,assume responsibil' for installation of the PO��'TS shown on the attached plans.
Plumber's Name(Print) Plumber's Si n MP/MPRS Number Business Phone Number
,,
Jason Kuettel �,���' ..`�<,� 675751 715-798-3355
Plumber's Address(Street,City,State,7ip Code)
PO Box 66 Cable, WI 54821
VL Coun y/Department Use Only
�Ap � � ❑Disapproved Permit Fee Date Issued Issuing Agent Signature
$ pp ..,�p
�y� O Owner Given Reason for Denial Y��• �(��I`l� Y� .���(.�/��''�`
Conditions of Approval/Reasons for Disapproval D � �����
� �.
�' GST � �-0�-(S� JUN 1 3 202�
'
�
�
SAWYER COUNTY
ZON I N
Attach to complete plans for[he system and submit to the County only on paper no[less than 8 U�x 11 inches in size
sB�-639s�x.oziaz> NO REFUNDS AFTE}q
ISSUE OF PEAMR
,�t:�aar,iiF;�.�� DIVISION OF INDUSTRY SERVICES
�`'�� � ���'��. 2331 SAN LUIS PL
�� � ?,� GREEN BAY WI 54304-5211
� `
�`� � �S '�i Contact Through Relay
��� � P S ��! http://dsps.wi.gov/programs/industry-services
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\'i � ��% www.wisconsin. ov
`�,''.o'� �—,��"� 9
����j�si<������`
_ Tony Evers-Governor
Dawn Crim-Secretary
June 9,2022
CONDITIONAL APPROVAL Conditionally
APPROVED
PLAN APPROVAL EXPIRES: 2024-06-09 DEPT OF SAFETY AND PROFESSIONAL
SERVICES
Plan Review: PWTS-062200152-[ DIYISION OF INDUSTRY SERVICES
Timothy J Clark
42940 US Highway 63 �, %Q„�„�.z ���'
Cable WI 54821
SEECORRFSPpNDENCE
siTE: Benson At-Risk
�sr�y;� u�� -� �zd
Town of BASS LAKE
Sawyer County
Total Amount: $450.00
FOR:
Description:450 GPD(3 Bedrooms—Dosin�In-Ground—Adrlitional Cells)
Maintenance Required
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be
constructed and located in accordance with the enclosed approved plans and with any component manual(s)
referenced above. The owner,as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance
with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shail be met during construction or installation and prior to occupancy or use:
• Preserve dispersal area prior and during construction to avoid disturbance,compaction and use of the site.
• Divert surface water from POWTS Area.
• All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5
• Insulate building sewer beyond 30 feet per SPS 382.30(11)(c)
• Tank Installation to follow all manufacture's recommendations.
• Verify property line(s)prior to installation.
Owner Responsibilities
• The current owner,and each subsequent owner,shall receive a copy of this letter including instructions relating
to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and
maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard,the property owner must follow the contingency plan as described in the approved plans.
A copy of the approved plans,specifications and this(etter shall be on-site during construction and open to
inspection by authorized representatives of the Department,which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance.As per state stats 10112(2),nothing in this review
shall relieve the designer of the responsibility for designing a safe building,structure,or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation,operation or maintenance of the POW'I'S.
Thanks,
�� ����
POWTS Plan Reviewer—Wastewater Specialist
Department of Safety&Professional Services I Division of Industry Services
en�iail: tim.vanderleest��Uwisconsin.aov
Cell: 608-516-6134
PAGE 1 OF 5
In-Ground Dosed-Gravity Plan �
Index & Cover Sheet
Component Manual Design References: pi U�a ��-��S k
Version 2.0,SBD-10705-P(N.01/01,R. 10/12) `
�nc��iiiCtiv�l Sr}e
Pg 1 of 5 Index&Cover Sheet ��.����
Pg 2 of 5 Plot Plan
Pg 3 of 5 Dispersal Area Cross-Section&Plan View
Pg 4 of 5 Pump Tank Specifications
Pg 5 of 5 Management Plan
Attachments: Enclosures:
Pump Curve POWTS Application for Review
Soil Evaluation Report&Site Map
t �i '�.L<e,,i �C�a'n '�e ��r � �,�,_`�
1 =,li _1 US�'I'�ICLI+�L'l'�
Project Name/Description
� �
Owner Name(s): ��„t��;,;� L.�_�,,_.0�� Phone: 71� -c�3� - �<i= i
OwnerAddress: ��'�����t N ��Ic� 2'� (�C� Zip; �y,�-��
� Project Address: �1. s';,� C,(c� �7 l;c
Govt.Lot: N� .1/4 of N t,�% 1/4,Section t�:- ,T '-{U N-R E❑or W�
Township: ��-'>G�5 �_i��� � County: ��z�:✓y.e��
Project Parcei ID#: ��G z- `7�-G - I� - ?(l 1
Designer Information
1 � J aso�1�u`'�"f�I
DesignerName: �i�l�Vv �GSntu�i<�� �`.S�ei_� Phone: 7i� --7`i4� - s3��1�
—�n
Designer Address: t'G. t�L�c C�� �_"_aG�(� �.,���- Zip: 5 y� �/
E-mail: ��r�.Y�✓���' Civ�c���rc�S. cotv�
Condifionally
License Number. C-� 7 5 '7�/ APPROVED
DEPt.OF SAFETY AND PROFESSIONAL
Rema�kS: SERVICES
f�iVISION OF INDUSTRY SERVICES
�, �/a,,.,/..� .L.=-.t
SEECORRESPONDENCE
Signature:��'7���`�""' Date: �/z c,���Z.-L
OrigiM1al signature required on each submitted copy.
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�X�s-��;ti5 ,Fe,�},c "�G-K k o.r�' �e"� 96 .37'
��ased � e o�'F� 80.o '
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IN-GROUND D(�SED-GRAVITY DiSPERSAL AREA
Uniform Elevation Trenches with EZ1203HP Bundles
3-ft Trench (down-sizing credit)
I min. 12"
Geotextiie I (lypical) TYPICAL TRENCH
Cover
SOILCOVER CRQSS SECTION VIEW
'2" � (No Scale)
min. trench ' e . OBSERVATION PIPE DETAIL
dep(h L , �w ' • (No Scale)
�tYP���) — r —.: ,'�: � -• Screw-Type or •,�„ , Finished Grade
e Slip Cap (loose) W '"' • (��ched 8 seeded)
/9� ..5� r , �. , '';•'
S)/StC'(il EIEV2tlOf1 = fC. • � ; 4"0 PVC Pipe +' � ;;t. Topsail Cover
(typicai) ' ` Provide minimum 3 ft Topotpipetolerminate �'� i ' (min. t foot)
atorahovefinishedgrade .'"' �" �•��
separation between trenches.
(4)1/4"-V�"X 6"Sbts
@ 90 apaA
. �
TYPI CAL TRENCH (Show location of inlet / outlet pipe connection on ian view.1 �'�'• .. '• �'
P ! Anchonng Device ... •.•:.,' ' Infiliration
�•• �'^ �.� " SuAace
PLAN VIEW
{No Seale} 4n � Observation pipe shall be installed
at junclion belween iwo units.
Perforated Lateral ft
Observa6on Pipe
(typical) (typical (typical)
)
- - - - - - - - -
� - - - - - ��- - - - - - - - - - - - - - - -
� ------ ------- -_— ------- ___=___= I A = 3.0 ft �
-- ------- ----- __ - — ------- �
L - - - - - - - - - - - - - - - -i� - - - - - - - - - - - - - - - - - - - --� ltYPicaq �
g = 30 - 65 ft �� m
(tYPical) 1�.,� �.�����, c � ����i i'�� �� C.�l
INSTALL PER TRENCH: EZ1203H Bundle �
(typical) —�-�
�� 10-ft bundles @ 50 fr EISA/unit = 750 f�Z (mfd by Infiltrator Systems, Inc.) �
Install pursuant to manufacturer's instn.ictions.
+ � 5-ft bundles @ 25 ft� EISA/unit = 25 ftZ
= Proposed EISA per trench = 775 ft2 Required Infiltration Area = 1345 ft2` � _`p�, pistribution Method:
�,�N
x � trenches = Proposed Total EISA = 7_7.S ftz branched manifold
•—'�— {�a_]�• �� -�Y�� l,�.,.... C T,11T� `l �J 7^! G.L'� � �Z.C'n.,.^��li`J
RESET ,,,,<, _.
� t{ `�c) . Cv Sr=
;
Dispersal Area Required Using Organic Laading
• Sample BODS concentration values:
262 mg/L 638 mg/L 2?4 mg/L
• Determine geometric mean of sample values(to modulate effect of high value):
(262 x 638 x 274)1�3 mgjL= 358 mgjL
• Conversion of [mg/LJ to (Ibs/GA�]:
358 mg/L x 8.3465x10�6(conversion factor)=2.988 x 10 3 Ibs BODs/GAL
• Calculate total BODS load per day given design flow of 450 gpd:
(2.988 x 10-3 Ibs BODs1GAL)x(450 GAL/day�= 1.345 Ibs BODsjday
• Calculate required dispersal area given recommended Organic Loading Rate= 1.0 x 1Q�3 Ibs
BODs/ftZ/day:
(1.345 (bs BODS/day)j(1.0 x 10-3 Ibs BQDs/ftz/day)= 1,345 ft2
�+ �� _ `��
,i ���� ,��,��,�, Arlalytical Peport ' ' r `' ° '
��;'�; � ! �
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ANDRY RASMUSSEN&SONS Project Number: 2200�932
42940 US HWY 63/P.O.BOX 66 Report Date: 4/6/2022
CABLE,WI 54821 Sampled By: CLIENT
Attn: TIMCLARK/MISSY #Samples: 1
Sarnpie Number. 5201Q647
Sample ID: BENSON 123
Sample Date: 3/22/2022
Date Received: 3/24/2022
SUSAN BENSON ADDRESS 8839 N OLD 27 HAYWARD�VI
Parameter Resul;s Unii> LOD .OQ Dil. h9ethod Analyzed Codes
--- _ _-_---
__ _.- --- ____ . __.._.
GENERQLANALYSIS — -, --._._-_---______---______-
80D5 262 mg/I 1�0 100 SM521�8 3f24/2022
OILANDGREASE(HEXANE) 43 mg/I 1.8 1.8 EPA1664A 3/25/2022
pH-LAB 7.1 S.U. SM�SOOHB 3/24/2p22
SUSPENDED SOLIDS 118��T__mgJl 20 20 SM2540D 3J25/2022
RII LOD/LOQs adjusted for dilution and/or solids content.
LOD=Limit of Detection COQ=Limit of Quanti[ation
BACGER LABORATORIES,WC.
WDNR Certified Lab#445023150
Approved B�/:
l��t��4� ����
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PAID-THANK YOU
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W 1 5 C O N S 1 N W 1 S C O N 5 I N W 1 f C O H L I M �
SP-4VDNR Cert.Lab k?50110405 rq-�n;L.+tp Cerc.Lab�4ti5t;23;�J GB�4`1GPlA Cert.Lab a:.�7522'_670
'sP-vATCP C_rL#105-Sz5 HO-0exTCP C2rt-�10i-2u5 G6-D-4TC�:et c ti?QS-',SO
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ANDRY RASMUSSEN&SONS Projzct Number. 22005908
42940 US HWY 63/P.O.BOX 66 Report Date: 4/25/Z022
CABLE,WI 54821 5ampled By: CLIENT
Attn: TIM CLARK/MISSY #Samples: 2
SUSAN BENSON
Sample Number: 52012957
Sample ID: 21972
Sampie Date: �/12/2022
Date Received: 4/14/2022
Parameter Re,ul;s Units LOD LOQ Dil. Method Anaiyzed Code�
_._-- —______ _ ._..._..- ___.. .
GENERALANAlY515 _____ _. _ _T_- _. -.-.-_
BODS 638 mg/I 50 SO SPn521DB 4/14/2022
OILAND GREA5E(HEXANE) 54 mg/I 1.7 1J EPA1664A 4/21/2022
SUSPENDEd50UD5 378 ��� mg/I 56 So SM2540D 4/15/2022
Sample Number. 52012958
Sample ID: 21988
Sample�ate: 4/13f2022
Date Received: 4J14J2022
Parameter Resuit, Ur.lts LQD LOQ Dil. Method Analy>_e�i Code,
--- __ ---_ ___� ---
GENERALANALYSIS `- - -� ----_ .__._-_
BODS 274 mgfl Sd 50 Sfv15210B 4/14/2022
OILANDGREASE�HEXAi�fE) 49 mgJl 2A 2A EPAlb64A 4/21j2022
SUSPENDEDSOLIDS 223 mgJl 33 33 SM2540D 4/15/2022
All LOD/LOQs adjusted for dilution and/or solids content.
lOD=Limit of Detection LOQ=Limit of Cluantitation
BA�GER LABORATORIES,INC.
WDNR Certifizd La6 kk445023150
Approved By:
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BL:dh
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Si"e�i/£!��Sy{7t�17 3+d�.�.�lAf� ' � Gr2�E'd E3a��
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SR��;i CPCe�t..;'DSi.iS ii-L.I�C:�Cen -Ct?CS GE3�CAi�pr
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Analy_fiical Fe�ort � ''` ' `
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ANDRY RASMUSSEN&SOyS Project Number. 22006151
42440 US HWY 63/P.O.BOX 66 Report Date: 4J26j2022
CABLE,WI 54821 Sampled By: CLIENT
Attn: TIM CLARK/MISSY #Samples: 1
Sample Number: 52013549
Sarnple ID: WASTEWATER 22062
Sampie Date: 4/19/2022
Date Received: 4/20j2022
Parameter Resu!; Urits LOD LOQ OiI. P�tethod An�lqzed Codes
____
_-_..__ _ _ ___._.__ _ __ ____- ...__._._.�
GENERALANALYSIS ----. ----.___._ --__,- - �-.-
BODS 251 mg/� 50 50 SM5210B 4/20/2022
OILAN�GREASE(MEXANE� 4� mg/I 1.9 1.9 EPA1664A 4J21/2022
SUSPENDEDSOlIDS 76 mg/I 20 20 SM2540D 4/21/2022
All LOD/LOQs adjusted For dilution a�d/or solids coneertt.
lOD=Limit of Detection LOQ=L;mit of Quantitation
BADGER EABORATORIES,INC.
WDNR Certified Lab#445023I50
Approved By:
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ST��/�AiS P�i�dY �� i�lE�'1�1H
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E�I1-`i��DN R Cert.�ab,`,',450�3';y� G6�VdpNA CerL Lab#;05222�2�
SP-DAiCP G rt.z;p5-525 H�e-pATCP Cer:.l:1C�5-ZOS
G9-L�<;TCPCer!;:1�75-45G
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ANDRY RASMUSSEN&SONS Project Number: 22006222
42940 U5 H�NY 63 J P.O.BOX 66 Report Date: 5/2/2022
CABLE,�tl 54821 Sampled By: CIIENT
Attn: TIM CLARKJMISSY #Samples: 1
Sample Number: 520137fl7
Sample ID: 22070
Sample Date: 4J20/2�22
Date Received: 4/21/2022
Parameter �z�ui:5 _._ Jrrs LOD LGQ Dd. Method Analyzed CoCe;
-----— _. _. _ . ._ -- _ _.
_. ___._.._. ---____. . _____ _...._ ___
R L NALYSIS
BObS 296 mg/I 100 10� SM5210B 4/21/2022
�ILANdGREASE(HEXANE� 51 mg/I 1.9 1.9 EPA1664A 4/28/2022
SUSPENDEDSOlIDS 71 � mgJl 10 10 SM254pD 4f22/202Z
All LOD/LOQs adjusted ior di(ution and/or solids content.
LOO=Limit of D2tectlon LOQ=Limit of Quan[i[ation
BADGER IABORATORIES,WC.
bVDNR Certified Lab k445023150
Approved By:
(����r2��. ���
Bl:dh
.._. _ �____..,..3 �.r'�!1�I t,( r_E��vri ,`: � _.....y._.__�.____R.,_ ��,
ST�Vz3�S€�i7i�tT �#�E3�AH vFt���f3.Af
W 1 3 C D N;I N W 1 f{O N f 1 N W I 8{ O N 1 1 X
sP-i�,�hF� r. ab:r7-3i�Oc<':t; t-;i v:C ryf r :et� -ti .��23�<� C.ib�.P��
��L,+TCaCtr.,ilu^S-�S •I��.f-�tC.a rr.rt.��;5-2G�= G3 4 ��.J,a'`�C:�ri.a�.Gs G=Q
�� LJ���.t�� �!'�t��1.� ACia.�.tJca�epor� �. � � � ,. :,
ANDRY RASNIUSSEN&SONS Project Number. 22�06292
42440 US HWY 63/P•O.BOX 66 Report Date: 5/2/2022
CABIE,WI 54821 Sampled By: CLIENT
Attn: TIM CLARKJMISSY #Samples: 1
Sample Number; 52013865
Sample ID: 22p71
Sample Date: 4j21/2D22
bate Received: 4/22/2022
Parameter Res�lc, Units LC� EDQ �il. Method <\naiy�ed CodP;
_,._.._-- -_--..__..____.
GcNERALANALYSIS --___ _ .._ ____
BQDS 365 mg/I 50 SO SM521QB 4/22j2022
OILAND GREASE(HEXANE) 28 mg/I 1.7 1.7 EPA1664A 4/28/Z022
SUSPENDED SOU�S �R 315 v���� mg/I v� 38 38��_ SM2540D 4/25J2022
AII LOD/LOQs adjusted for dilution and/ar solids content.
LOD=Limit of Detecticn LOQ=limit of 4uantitatian
BADG_R LABORATORIES,INC.
WDNR Certified Lab K445d23150
Approved By:
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AT-RISK POWTS MANAGEMENT PLAN ADDENDUM
SITE ADDRESS PARCEL ID#
� � c� , o�.�7 � �. � ►� 1.
PROPERTY OWNER TYPE OF POWTS
S �:� S ' ` u ' �..,
LEGAL DESCIPTION OF PROPERTY
1
� � t.vY S�c- ,'a /�: i � �N
DATE:
!O�l 3 2c. z�
This POWTS serves an At-Risk Facility, which means that there is a higher risk of failure
because of the potential for high-strength waste to be generated at the facility. Proper
inspection, maintenance and monitoring of the system will help to prevent a health hazard,
however, in the event that the system does show signs of failure, the contingency plan is to
install a pretreatment device that will properly treat the wastewater to acceptable standards and
reduce tne likeiihood of failure. The property owner shall abide by the maintenance,
management and service requirements included in the management plan, and more specifically:
• Septic tank and grease interceptor: The septic tank and grease interceptor shall be
pumped by a certified septage hauler within one (1) year after the date of installation and
at least once every 12 months thereafter, unless, upon inspection by a licensed POWTS
Maintainer, the tank is found to have less than one-third (1/3) of the liquid volume
occupied by sludge and scum.
• Septic effluent filter: Any effluent filters installed in the system shall be inspected
annually and maintained as necessary, in accordance with the manufacturer's
specifications.
• POWTS dispersal cell: The dispersal cell shall be visually inspected by a POWTS
Maintainer within one (1) year of the date of installation and at least once every 12
months thereafter, to determine whether septic tank effluent is ponding. In the event of
the presence of six inches or more of ponding, the ponding level shall be monitored
monthly. If the ponding occurs for more than 6 consecutive months, the dispersal cell will
be considered not to be in compliance and the contingency plan shall be implemented,
including:
o Effluent sampling and testing according to standards set forth by the Department. Effluent
will be tested to determine the levels of BODS, TSS and FOG being discharged into the
UIJt.IGIJQI lrGil. TI IGJG ICVGIJ JIiC111 IIVI C/�VCCU LLV Illl�(I IJVDS� IJV 1115��TSS a��u 3v riyil
FOG.
o Flow monitoring to ascertain that wastewater discharge to the system is not exceeding
the design flow.
o Reviewing and adjusting practices within the facility which improve volume and strength
of wastewater.
o Installing a pretreatment device which will properly treat the wastewater to acceptable
levels.
• The owner or the owner's agent shall submit inspection reports to the county within 30
business days of the date of the inspection, maintenance or service event.
• Upon transfer of title of the property, a copy of the POWTS Management Plan and this
addendum must be furnished to the new property owner(s).
• This Management Plan shall be binding upon the owner, heirs of the owner and
assignees of the owner, as provided under the At-Risk POWTS Agreement recorded
with the deed to the property.
Rev. 03/28/13
�����11
�1ER-CO�1
=s? �Z�� Sawyer County Zoning&Conservation
�y� , �It� 10610 Main Street,Suite 49
�o�, - ��-�-o Hayward,W I 54843
�j — -� � Phone:p15)634-8288
i��i\'`-y.�— FaX:pis�saa-szn
��S�ON�� E-mail:sanitarian@sawyercountygov.org
March 2013
Sawyer County At-Risk Policy pursuant to the
Department of Safety and Professional Services(DSPS)
Policy for Processing High-Strength Wastewater POWTS Plans,April 2009
Summary of policy and how Sawyer County will implement it:
High-strength waste that is discharged to a holding tank is not affected by this policy.
HIGH-STRENGTH WASTEWATER PRODUCING FACILITIES
DSPS presumes that any restaurant or other food preparation/processing facility that prepares
food as a major part of the operation is expected to produce high-strength waste and owners of
these facilities are required to treat the high-strength waste appropriately OR provide acceptable
justification why it is not necessary.Sampling shall be done on replacement POWTS of existing
facilities that fall under this category and wish to be excluded from pretreating the high-strength
waste.Sampling shall be done according to DSPS standards.Examples of facilities that are
expected to produce high-strength waste include:
• Fast food restaurants
• Full Service restaurants
• Dining Halls
• Grocery Stores with Deli's and butcher shops
Similar facilities
Exterior grease interceptors are required.Pressure distribution is required on systems where
effluent is treated to certain standards.
AT-RISK WASTEWATER PRODUCING FACILITIES
For public/commercial buildings that have food preparation as part of their operation,but less than
tha!of a full se^✓ice res?aurant,Szvr,�er Ccun;y will accept oversight as At-Risk systems,as long
as DSPS validates that it truly is an At-Risk Facility and does not require pretreatment according
to the DepartmenYs standards.
NEW POWTS
Sawyer County recommends pretreatment of these systems,however,if pretreatment is not
included in the initial design,Sawyer County will accept plans for new POWTS for at-risk facilities
where:
• Pressure distribution is installed in the dispersal cell or dispersal cell components are
installed that can easily be retrofitted to pressure distribution(e.g.EZ Flow)
• Kitchen waste is separated from other domestic strength wastewater and an exterior
grease interceptor,if required by DSPS,is installed
• The system is monitored on an annual basis by a POWTS Maintainer and reported to the
county with additional specific monitoring written into the management plan
• A detailed contingency plan is included that addresses the measures to be taken should
signs of early failure be observed including pretreatment unit locations identified and
planned for at the time of application.
REPLACEMENT POWTS
Sawyer County recommends pretreatment of these systems, however, if pretreatment is not
included in the initial design, Sawyer County will accept plans for replacement POWTS for at-risk
facilities where:
• Pressure distribution is installed in the dispersal cell or dispersal cell components are
installed that can easily be retrofitted to pressure distribution (e.g. EZ Flow), if the cell is
being replaced
• Kitchen waste is separated from domestic wastewater and an exterior grease interceptor
is installed if other,vise required by DSPS 3E2
• The system is monitored on an annual basis by a POWTS Maintainer and reported to the
county with additional specific monitoring written into the management plan
• A detailed contingency plan is included that addresses the measures to be taken should
signs of early failure be observed including pretreatment unit locations identified and
planned for at the time of application.
Examples of At-Risk Facilities include:
• Licensed daycare facilities
• Schools with cafeterias
• Small bar and grills where food is a minor part of business
• Coffee shop
Additional Forms that need to be submitted with Sanitary Permit Application for an At-Risk
Facility:
o Written determination from DSPS that the facility is, in fact, an At-Risk Facility rather
than a High-Strength facility.
o An At-Risk POWTS Agreement needs to be signed and notarized by the property owner
(additicnal $3� fe�for recording at the Register of Deeds)--ferm is included (Dcpc
38321(2)(c)5)
o An At-Risk POWTS Service Contract with a licensed individual/company for the specific
monitoring of the system -form is included (DSPS 383.52(1)(c))
o A Management Plan addendum that identifies the specific monitoring because it is an at-
risk facility- example included (DSPS 383.54)
o A Contingency Plan indicating the measures that will be taken should signs of early
failure by observed and a map showing the type and location of pretreatment units that will
be installed if signs of early failure are observed.
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BUREAUOFFIELDSERVICES SUMMARY
4822 Madison Yards Way SPS 381 defines"At-Risk"as a POWTS serving a new public or commercial facility
Madison WI 53705 that may produce effluent in excess of the quantities specified in s. SPS 383.44
(608)266-2112 �.This definition does not indude existingfacilities where the influent has been
www.dsps.wi.Rov tested and determined to produ�e influent below the quantities specified in
s. SPS 383.44 2) or facilities that are known to produce influent exceeding the
influent quantities(high strength uses).
ResoURCeS At-risk facilities may not be considered high-strength most of the time, but
SPS 381.01(13m) depending on factors such as wastewater volumes, number of people served,
SPS 383.44(2)�d) etc., they may generate high-strength streams and therefore require additional
Table A-383.43-1 monitoring to ensure system longevity.
SPS 383.44(2�(b)
SPS 383.54121(b) qDDITIONAI INFORMATION
DSPS POWTS Website
Table A-383.43-1 notes which uses are considered at-risk.These uses include:
• Churches with kitchens
• Daycare facilities with meals prepared
• Nursing homes, rest homes and community-based residential facilities
If any of these types of uses are proposing a new POWTS an at-risk approval
may be done as described in s. SPS 383.44(2)(d). Maintenance and monitoring
information will need to be completed and sampling verified by the
governmental unit(county). If sampling reveals concentretions of BODs,TSS and
f0G are above code parameters, additional steps will need to be taken to meet
code compliance.
If any of these types of uses are proposing a replacement POWTS, the existing
wastewater flow will need to be sampled and the replacement system must be
adequate for the strength of wastewater received. If concentrations of BODz,TSS
and FOG are below parameters, a standard POWTS can be installed. If
concentrations are above parameters, a POWTS to serve high strength waste
will need to be designed and installed.
POWTS sampling needs to follow requirements in s. SPS 383.44(2)(b), which is
At-Risk Facilities an average of at least 6 samples over a 30 consewtive day period.
Rev. 2/12/2021
Page 1 of i The Department may require the metering or monitoring of any POWTS to
evaluate the operation of the POWTS per s.SPS 383.54(2)(c).
See High Strength Facilities factsheet for additional information.
Published under s. 35.93,Wis. Statx.,by Ihe I.cgislative Reference Bureau.
21 I SAFETY AND PROFESSIONAL SERVICES SPS 383 Appendix
Table A-383.43-1 (Continued)
Public Facili[y Wastewater Fluws
F.stimated Wastewater
Source Uni[ Fluw(gpd)
Nursing,rest home,community—based residenlixl Bed space 65
facility n
O�tdoor sport facilities (toilet waste only) Patron 3S
Parks(roile[s waste only) Patron(75��atrons/acre) 3.5
Parks(roilets and shuwers) Patron (75 patrons/acre) 6.5
Public shower facility Shuwer uiken 10
Rcstaurant',24—hr. (dishwasher and/or food w�istc Pxtrun scatin�tipacc A
_rinder only7
Restau�ant�,24—hr. (kitchen waste only without Pxtron seating space l2
dishwasher and/or fuud waste grinder)
ReatauranL 24—hc (toilet waste) Patron �eating space 28
Restaarant", 24—hc (toilet and kitchen waste with- Patron.ceating space 40
out dishwasher and/or food wacte grinder)
Restam�ant°,24—hc (toilet and ki[chen waste with Patron seating spaee 44
dishwasher and/or(ood waste g�inde�y
Reslaurant°(dishwasher and/or food waste grinder Patron seating space 2
only)
Restauranl'(kitchen wasre unly without dishwusher Pxtron seating space 6
and/or food waste grindcr)
Restaurant(roilet waste) Pavon sea�ing spuce 14
Restaucant°(toilet and kitchen waste without dish- Pa[ron seatin�tipace 20
washer and/a�food waste�rinder)
Re�taurxnt�(toilet xnd kitchen was[e with dish- Patron seu�in�space 22
washer and/or food waste grinder)
Retail etore(no food preparution) Patron (70%of to[aI retail I
area=30 sq. ft.per pa[ron)
School°(with meals and showers) Classruum (25 smdents/ 500
classroom) �
School a(with meals or showersj Classroom (25 smdents/ 4IX)
classmom)
School (without meals or showers) Classroom(25 smdents/ 300
clxssruom)
Sclf—scrvice lai_�nd.ry(�ni!et�.vasie oniv) Clnthes���..=.he. .
Self—service laundry(with only rcaidential clo[hes Clo[hcs washer 400
washers)
Swimming pool bathhouse Patron 6.5
� [xpec¢d lu be hiEh In biWugicul oxygen dcmnnd(HODi,to�al e�u>pended wlld��TSSi_ur tm>.oile�.unJ=reu>r�POGi.
� A�—risk x}',aicm ipoi.ndully high In biocheinicul oxypen deinxnd fHOfl),miul su>µ.ndcd�olld ITSS i,or pu..oils.and�ecnec IFOGn.
A-383.43(6)(a) Acmnl mzter readings may be uled to calculxte Ihe combined etitimated de+ign wxscewater Flow from
a dwelling. To calculate the es[imated design was[ewater flow uae the following formula and compare the answer ro die
pexk metered flow. Choose the larger of the two estimated design flows.
([otal me[er flow/number of readings)(1.5)=estimated design wastewurer flow
The freyuency of ineter readings shuuld be daily (or commemial.
A-383.43(6)@) A detailed per capita and per f�netion flow may be established for commercial facilities. The per function
❑ow ratings shall be substantiated by man�fac�ures data of the per function flow and detailed use da�a from the Cxcilily
in yuestion or a similar facility under similar conditions of use. Estimatcd design wastewater flow shall be at least 1 S�imcs
the total estimated dxily Flow calculated from the per capita xnd per function flow information.
Publishetl under s.35.93,Stafs.Updated on the Iirsf day oi each monfh. Enfire code is always currenf. The Regisfer date on each page
fslhedafefheehapterwaslast published. ReEinierinne�olx�a»o �
Wblishcd undcr..3593,Wis.Sm�c.,by the Le�LclaGve Re(erence Rurcau.
SPS 383 AppendlX WISCONSIN ADMTNtSTRATTVE CODE 210
A-383.d3 Ifi)COMMERCIAG FACiLTTiES. Table A-383.4?—I may he uced to estimate wasrewater Flowa from a com-
mercial building.
Table A-383A3-1
Public Facility Wastewa[er Fluws
Soarce Unit Eslimated Wastewa[er
Flow (gpd)
Apartmen[or condominium Bedroom l00
Assemhly hall(no kitchen) Person (10 sy.fL/persun) 13
Bar or cocktail lounge(no meals served)° Pxtron(10 sy. R./pavon) 4
Bar or cocktail lounge°(w/meals—all paper ser- Pxtron(10 sy. fc/patron) 8
vice)
Beauty salon S[atinn 90
&owling�dlcy Bowlinn Iane 8U
Bowling allcy'(witli bar) Bowling lane I50
Camp.day and night Pcrson 25
Camp.day usc only(no mcals scrvcd) Person 10
Campground or camping resort Space,with sewer 30
cunnection and/or eervice
huilding �
Campground sanimry dump slation �' Camping uni�ur RV 25
.erved
Catch basin Rasin 65
Church (�o kitchen) Person . 2
Church �wilh kitchcn) Persun 5
Dancc hall Person (10 sy. Ct./person) 2
Day cam fucility(no meuls prepared) Child 12
Day cnre fucility (wi[h mexl prepara[ion) Child 16
Dining hall "(kitchen waste only without dish- Meal served 2
washer and/or food waste grinder)
Dining hall "(toile�an�kilchen waste wilhwl dish- Mcal sen�cd 5
wenher aiid/or food waste grinder)
Dining hall °(toile�and ki�chen wastc with dish- Meal served 7
washer and/ur food wastc grinder)
Drive—in restxuran[°fell paper service wi[h inside Pntron sea[in�space 10
seating)
Drive—in re5txurant"(all paper service withuut Vehicle space 10
i�iside,seating)
Drive—in theater Vchicle spacc 3
Employecs Rutel all shifts) Employee 13
Floor drain(not discharging to calch basin) Drain 25
Gas stxtion/convenience store Patron 3
Hospital" Bed space 135
Hotel. motel,or to�rist rooming house Room 65
Manofacmred home Iservcd by its uwn POWTS) Bcdruom 100
Manul'acmrcd home commm�iry Manufacmred homc sitc 200
Mediarl uffice building
Doc[orc,nurses,medical staff Person 50
Office persunncl Person 13
Patients Person 6.5
Migrant labor camp(central bathhouse) Employee 20
Pu6lished under s.35.99,Stats.Updattd on the�irsf day o/each monfh. Entire code!s always currenf. The Reglsfer dafe on each pege
Regn�er June 2ulM�u.�Su is fhe date fhe ehapter was lasf publlshed.
i �i i iioi�i����i����,ii��iii
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- USE BLACK INK ONLY - �� �`�U�����'
POWTS MAINTENANCE AGREEMENT ��g66❑
For At-Risk S stems PA!)LA C�iISSER
Y REGISTEft OF DEEDS
Oumer's Name(s) as shown on deed: SAWYEFZ ��UNTY, WI
Q6 J 14/2Q22 U8:34 AM
RECORDING FEE 30.08
s - �
Parcel Identification Number. �
P�1���: 2
(12DigitLegacylD) '�� � - � � Q - �� - � � ��
Legal Description of Property:
- SEE ATTACHED SHEET -
We acknowledgc that application is being made for dic installation of an at-risk system on the propcity
described on the attached sheet.
Rr�h��ro T�v C;�.yypr (�i.��nr� 7nnina •�nr1 (��nnc�r��gti{1^ A(If!2lnicMa�Ipt1
I 1061U Main SL Suite 49, Hayward,WI 54843
L
As an inducement to the county to issue a sanitary permit for a POWTS (Private Onsite Wastewater Treatment System)
considered to be at-risk by the Department of Safety and Professional Services and pursuant to the "Policy for Processing
High-Strength Wastewater POWTS Plans" dated April 2009, we agree to do the following:
1 ) The owner agrees to conform to all applicable requirements of Chapter DSPS 383, Wis. Adm. Code relating to the
maintenance requirements for the proposed POWTS. The owner also agrees to conform to the At-Risk POWTS
Management Plan Addendum included with the plans.
2) The owner agrees to maintain a contract with a licensed POWTS maintainer for the life of the system. The POWTS
maintainer will perform annual inspections and evaluation of the performance of the system including, but not limited
to: depth of ponding in the dispersal cell and sludge depth in the tank(s). It may also include sampling of the
wastewater and water meter readings if applicable.
3) The owner agrees to follow the contingency plan immediately upon any malfunction of the system and to maintain the
system so as to not create a human health hazard as described in s. 254.59, Stats.
4) The owner recognizes that the county, DSPS or POWTS maintainer may make periodic inspections of the
components to complete performance monitoring of the system.
5) The owner or the owner's agent agrees to report to the county at the completion of each inspection, maintenance or
servicing event in a manner specified by the county within 30 business days from the date of inspection, maintenance
or servicing.
6) This agreement will remain in effect only until the governmental unit responsible for the regulation of POWTS certifies
that the property is no longer served by the system. In addition, this agreement may be cancelled by executing and
recording said certification with reference to this agreement in such manner which will permit the existence of the
certification to be determined by reference to the property.
7\ Thic a�raamant ch�ll ha hirr�iin� iirnn thg n�ninar tha hairc pf tha n�ninar �nri acci�ncac nf tha nwnar. Tho C�ninar chall
submit this agreement to the Register of Deeds, and the agreement shall be recorded by the Register of Deeds in a
manner which will permit the existence of the agreement to be determined by reference to the property where the at-
risk system is installed.
' ;r t
- Onl one owner signature required - ACKNOWLEDGMENT
Owner's Signature: State of: �a'�', � � /1 S � h
County of: --�G. �.+ � Y"'
Owner's Name (Print): Subscribed and swo n to before me on this
.S 5� " 3 �Li1 So t'1 � day of -Su h F' , 2� �
Date: By (Owner's Name): a QP o
�o . � - o � � Notary Public Signature: L�.i, �4"d+
Drafted by: Public Notary Name (Print): �is a 7��ft �' � 4�y
n.. C�,'�..-L� My commission expires on: /-6 10 �lS �
Wis. Stats.
i4(�.10 t1) (f) and (2) County Clerk
Personal information you provide may be used for secondary purposes [Privacy Law, § 15.04 (I) (m)] Rev. 03/27/13
That part of the lvortheast Quarter of the Northwest Quarter(NE'/4NW'/4)and
the Northwest Quarter of the Northwest Quarter(NW'/4NW'/o),Section Sixteen
(16),Township Forty(40)North,Range Nine(9)West,more particularly
described as Lot Four(4)as recorded in Volume Twenty-three(23)of Certified
Survey Maps, page l l7-1 l8, Survey No. 6353. � �q�S��
��""` E� PRIVATE ONSITE WASTE TREATMENT �o�nty
;�
�os�� ��'��` SYSTEMS
{����y`�%-� ( POWTS) Sawyer
�Fss'—°"^-' INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 2 � � l dy
Personai infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(i)(m)]
Permit Holder's Name: ❑City ❑ Village [�Town of: State Plan Transaction ID#:
J�tSa ,�e�,Sp� s (.R� P�3-66�-26U 1 S� 1
Insp BM Elev: BM Description: Parcel Tax No:
(c�0.� � ��w, a� o �°M� ,s�' c��9 Ko-(6-�-1��
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic Benchmark
Dosing
Aeration Bldg.Sewer
Holding St I Ht Inlet
TANK SETBACK INFORMATION St I Ht Outlet
TANK TO PIL WELL BLDG vENr ro ROAD Dt Inlet
AIR INTAKE
Septic NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header I Man.
Holtling Dist.Pipe
PUMP 151PHON INFORMATION Inflitrative
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 � L �� 6b� � #of Cells�}�3 Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate
INFORMATION P I L Bldg Well Waters � IGP ❑ Chamber Model Number:
❑ AG ❑ EZFIow
CELL TO -��o� fi(oo� �pa� ❑ Mound � Other
- - __._ _ __- - - —
DISTRIBUTION SYSTEM X Pressure Systems Only
- - ---
-
Header/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 Edges —�Topsoil_ ❑Yes O No ❑Yes ❑ No
COMMENTS: (include code discrepancies, persons present,etc.)
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b� '���~���
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Plan revision required?�Yes ❑ No 02 �,3 �,� l � � /°��1�
C�
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL COMMENTS ANO SKETCH
SANITAAY PEAMIT NUMBEA: �:1—l0�
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