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Home My WebLink About002-940-35-5206-SAN-2022-179 �;:��"t"`r'�: Industry Services Division County `/� 4822 Madison Yards Way SAWYER � .� _�_ = Madison,WI 53705 Sanitary Permit Number(to be filled in b� '' '= P.O.Box 7162 � `��'�k.. Madison,WI 53707-7162 ��j� � � � Sanita.ry Permit Application State Transaction Number � In accordance with SPS 38321(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit � is required prior to obtaining a sanitary pertnit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing;. � the Deparlrnent of Safety and Professional Services.Personal information you provide may be used for secondary 7569N White Beach Ln 1 pu�poses in accordance with the Privacy Law,s. 15.04(1)(m),Stats. �� l.Applicatioo Information-Please Print All Information --� Property Ownefs Name Pazcel# David Menz 002940355206 Property Owner's Mailing Address Property Location 16122 Huron Cir Govt.Lot 3 City,State Zip Code Phone Number Lakeville,MN 55044 y., Y., Section 35 Il.Type of Building(check all t6at appty) Lot# T 40 N R 9 E or �1 or 2 Family Dwelling-Number ofBedrooms 2 3 Subdivision Name Block# ❑Public/Commercial-Describe Use ❑City of ❑State Owned-Describe Use CSM Number ❑Village of 9/303 #1995 �Town of Bass Lake III.Type of POWTS Permit:(Check either"New"or"Replacement^and other appiicable on line A. Check one box on line B.Comptete line C i a licable. "4' ❑New System �Replacement System ❑ Other Modification to Existing System(explain) p�ain ❑Additional PreVeaUnent Unit(ex ) B' ❑ Holding Tank �n-Ground ❑ At-Grade gn ❑Other Type(explain) ❑ Mound ❑ Individual Site Desi (conventional) C• ❑ Renewal Before ❑ Revision ❑Change of Plumber ❑ Transfer to New Owner `' .ist Previous Pertnit Number and Date Issued Expiraiion �y — �� S'�� 6 Y IV.DispersaU'I'restment Area and Tank lnformation: Design Flow{gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(sf System Elevation 300 .7 Existing*"• Existing'*' 96 Capacity in Total #of Manufacturer � Tank Information Gallons Gallons Units � ;; v � ^ New Taaks Existing Tanks � o � � Y � � `c� a U v� � c� w C7 Li� Septic or Holding Tank ]QpQ 1000 I ESER Dosing Chamber V.Responsibility Statement- I,the nodersigued,sssume respoosibility[or installa6on of t6e POWTS shown on the attached plans. Plumber's Name(Print) Plumber's S re MP/MPRS Number Business Phone Number Gerald Frcemel 950111 715-558-1138 Plumber's Address(Street,City,State,Zip Code) 13502W Frcemel Rd Hayward,Wt 54843 VI.County/Department Use Ooly �A� ❑Disapproved Pertnit Fee Date Issued Issuing Agent Signature l ❑Owner Given Reason for Denial $ [�D'� � ��I`� � ��'�`�'�"�� Conditions of ApprovaUReasons for Disappmval �JJ �^�'�r�� .F ��.,>.�:':�;!. `��.�'�'��' � G I �� l� � �� .�s.__S�. ____ ., � F ��e _�. - � v '�r ` �� . E,� �� A�}� 0 1 20�2 L5 � �� —C�`�� e,�,�r 'v�Y�d �. a�`'� s��ivvE�cou►v�v Attach to compkte plaes for the sysMm and submit to t6e Couety oely on paper eo than 8 t/1 x I1 ioc6es io size SBD-6398(R.03/21) NO REFJNDS AFTER ,,,� I�SUE OF PEFMtT 1,,�C�� David Menz Property Owners Name 7569N White Beach Ln Property Address �2940355206 Tax Parcel Number � Sawyer County � 3 Gov Lot or Qtr-Qtr/Qtr S35 Section T40N Town R9W Range Page Index 1 Property tnformation 2 Data Entry 3 Plot Plan 4 Drainfield Cross-Section 5 Dose Tank 6 Maintenance Plan 7 Contingency Plan County Parcel Listing rald Froemel Plumber's Name � Plumber's Signature 950111 Plumber's License Number 715-558-1138 Plumber's Phone Number 08/01/22 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), Infiftrator Systems,ADS Products, Polylok Inc., Orenco Systems Inc., Sim/Tech Filter Inc., Sta-Rite Industries, Page 1 of 7 In-Ground Soii Absorption SBD-10705-P(N.01/01)Version 2.1 Component Manuai Used 2 Number o edrooms 1 Percent Slope (%) Depth to Soil Limiting Factor (in.) In Situ soil application rate 200 Estimated Wastewater Flow (gpd) 300 Design Wastewater Flow (gpd) 1 �Number of System Elevations 96 Proposed System Elevation#1 Proposed System Elevation #2 Proposed System Elevation #3 Original Grade#1 99.32 Finished Grade#1 Original Grade#2 Finished Grade#2 Original Grade#3 Finished Grade#3 ��'sr-� � Infiltrator Quick dard Chamber Type 15 Height o T �„�er(in.) 0 sq.ft. per chamber 2 Rows of Chambers 5. sq.ft. per pair of end caps 3 Distance Betw 22 $Pr umber of Chambers ed #DI . Minimum Distribution Cell Area Requi (sq.ft.) IV/0! Distribution Cell Area Proposed (sq.ft.) Wieser 1000LP 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 99.3 96 94.32 98.07 TR U E 2 3.00 -1.25 FALSE 3 3.00 -1.25 FALSE 4 5 � Page 2 of 7 0� er : L�_ �J� � �_ L�v�� M, � ev�Z. S4w�i�r' t� / �4SS La.�e l l61 ZZ. vro►n C.�►r P� N- ooz - 4��- 35' -SZo(p . (�cc�.eJ�, L�2 � 1'-'1 ►J SSO�l�/ ,S' 3S T �I a n7 12. 04 w s��: �156� /�J tvh:-{r B�L, lZ.� La� 3 CS ►�t 4/3D3 � ��t4S � -� Sc�n ob( �l.O U S 2 �..�l<��` t SZ..3Z.� � �� sCa.�e ( "= 4 0� _ � s�� ° �0 2c, 3o ya _ _ O d«k 6 do � ,+e. R�� G r' � �BK.I�p� �a�Ctaw� Cor.�er {�a.r� SW Coc'v1e� �G 8 l . aq.3 z, �� N $(� Sewe�r�In,oa ��P `'tSS-[ � — +� 1n �X Se�e.� be� e(,. �' -�ib' � Q d�<<{ .� s�� ls sh�� z 6� _ �l P��?t-- `�o Ce��acc ol� S�ec � `'•T , �h roo o W , L1 1bbU Sc4� CohcvG'fic S.T_ - k �w`��w i ;, � � $- �s6g� � ��5��'j0/�� roo lv(n�TG 6�(n Rc� -!�� C'a `l��„-� � r• �'�� X" /, . N � N � � orr��oe n �o�. � �n, ,�,� Sawyer County Zoning Administration `� / � 10610 Main Street Suitc 49 �(�l I �� .�� Hayward, Wisconsin 54843 �ER_Cp�� (715)634-8288 �SJ� .�Z Ij FAX(715)fi3R-3277 �Qj �.►I ��.��v_sawYcrcuuntygov.or �Vl� :. -- -- �:�j E-mail:roninR.sccrcusawyercotmlveuv.org ��o' _��_ .- ;o� Toll Free Courthouse/General Information 1-877-699-4110 �� -:.;,,._,.�'`�,= ��jSCoN�� SAWYER COUNTY SANITATION DEPARTMENT TEMPORARY EMERGENCY TANK INSTALLATION APPROVAL PROPERTY OWNERS NAME: ��;� � LY�v1 {Nle�� TOWN OF: �SS L�ILA ADDRESS: � 7�q N w�„�. (�,��, �d . � l'�� 1, � , a Wiscons�n License� it�mbcr, authorized by the owner, do hereby acknowledge that 1 am receiving temporary approval to install a septic tank/holding tank without a soil and site evaluation, or existing system evaluation, and private sewage system plan review due to inclement weather and/or health and/or safety emergency. Further, I acknowledge that a soil and site evaluation, or existing system evaluation, and private sewage system plan review will be conducted by the deadline stipulated by the permit issuing agent, or as soon as weather conditions or circumstances permit. if the private sewage system is found to be failing as defined in s. DSPS 381.01 (92), Wisc. Adm. Code, corrective measures will bc taken as such that the private sewage system complies with all applicable requirements of chapter DSPS. 3R3, Wis. Adm. Code, within 90 days of this agreement. I further acknowledge that failure to comply by obtaining all necessaiy permits after the deadline date may result in the issuing of a citation, under Section 11.3 [2) Sanita�y Permits], of the Sawyer County Citatiou Ordinance. DEADLINE FOR THIS AGREE„1VIENT SHALL�; � � 2c�( �a2 `�., � �j_ ��_�' . Signed: �� Date: �� 02 Accepted by: ��_l�t�� Date of temporary etnergency approvaL• �6(��2-�� Rev. 03/26/13 David Menz � 7569N White Beach Ln 2.94E+09 Number of Bedrooms 2 Septic Tank Wieser 1000LP Estimated Flow (averac�e) ga��ons /day Effiuent Filter Li etime Design Flow (peak), (Es�imated z �.5) gauday Pump Tank A Soil Application Rate gaUday/ft Pump Type Influent/ Effluent Qual' Monthl Average Fats, OiI & Grease (FOG) 30 mglL Biochemical Oxygen Demand (BODs> 220 mg/L otal Suspended Solids (TSS) 150 mg/L !'N OTF!! Servicing frequency of 12 months or less requires the 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 ear Pump out contents of tank(s) When combined slud e and scum = 1/3 of tank volume Inspect dispersal ceil(s) At least once every 3 Year Clean effluent fitter At least once every ear 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 vofume of combined sludge and scum and to check for any backup or ponding of effluent on the ground surtace. The dispersal cell(s) shall be visuaily 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 surtace 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-Uo 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 performa�ce 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 fai�s and/or is permanentiy taken out of service the following steps shail 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. Continaencv 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 repiacement area. Upon failure of the POWTS a soil and site evaluation shall be pertormed to locate a suitable replacement area. If no repiacement area is available a hoiding tank may be instalied to replace the failed POWTS. A suitabie replacement area has been evaluated and may be utilized tor 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 soii and site evaluation to esfablish 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. ��WARNINGf! Septic, pump and other Veahnent 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 Geraid Froemei Name cott Poppe Pho�e# 715-558-113 Phone# - 450 POWTS Maintainer Local Regulatory Authority Name Jays Septic Agency Sawyer County Zoning Phone# 71 -558-11 Phone# 715-634-8288 Page 7 of 7 �� ' "'`"'`�; PRIVATE ONSITE WASTE TREATMENT county -�'�oS � '� SYSTEMS Sawyer �� s ��' ( POWTS) \h\ �-� ' " ' '� INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �� —l�� Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)] Permit Holder's Name: ❑City ❑ Village � Town of: State Plan Transaction ID#: �q�� eti� �q s (,a Insp BM Elev: BM Description: Parcel Tax No: �0 O.O� � rn 8 M�f`� ,�' c�.+�' C`.w . aba.-cl�O..3�=�2��0 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic �,�,j e�� o0o Benchmark �p�,o� Dosing Aeration Bldg. Sewer ��7' Holding St/Ht Inlet Qg.��` TANK SETBACK INFORMATION St/Ht Outlet �g.�,2' TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIR INTAKE Septic ��' y S� i�ti �a� NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. Holding Dist. Pipe PUMP 1 SIPHON INFORMATION Infiitrative � Surface �7•81� 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 �N � #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav Conv � Aggregate INFORMATION P I L Bldg Well Waters � GP ❑ Chamber Model Number: ❑ EZFIow CELL TO ❑ Mound o Other DISTRIBUTION SYSTEM X Pressure Systems Only Header I Manifold Distribution Pipe(s) I X Hole Size I� X Hole Observation Pipes ' Length Dia Length Dia Spac I� 'i Spacing ❑ Yes ❑ No i SOIL COVER Depth Over Depth Over Depth of Seeded I Sodded Mulched Ceil Center Cell Edges �Topsoil __ __ � ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) �c�/� 6�e�f '02� �) � s-�. .�..��9��-,�- �� Plan revision required?�Yes 0 No p ,�� a q� �� 3 � 3 �- . � -- - _� � 6 � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AOOITIONAL COMMENTS AN� SKETCH SANITARY PEAMIT NUMBER:_____��_��_`l_ �� f�k�� I , . . �. . .. � . i . . � ' . . i - � � - ;____.i_.. :..__...�.-- '-;.__. ., ._.._ : ___.� _ ., - ; . _ __--- -`__ - - - - _ _ _ _, t , i ; I ; , , _ .. __. lly,�'r� . _ . __ , �_. _i-_ --t . _ � 2��c� � I ,��, �l� -�� a�, , �s ��\ � �� I�� w;� �� ,� tJ. ��''` w�� -' �� \� Q �� — � �,,iti,;��`�' � ` `D SRh6€ '"-._ `