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Home My WebLink About111-838-12-2104-SAN-2022-258 ::��=`�'"'t; Industry Services Division County (� = 4822 Madison Yards Way SAWYER � _ ,�_' = Madison,WI 53705 Sanitary Permit Number(to be filled in by � � = P.O.Box 7162 Madison,WI 53707-7162 �p 3 ��(..�3 � _ � Sanitary Permit Application StateTransactiontvumber � In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this fotm to the appropriate govemmental unit � is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing � the Department of Safety and Professional Services.Personal information you provide may be used for secondary 12332W State Rd27/70 purposes in acwrdance with the Privacy Law,s. 15A4(1)(m),Stats. I.Application Information-Please Print All Information Property Owner's Name Parcel# Arnold Malecha 1 1 1838122 1 04 Properry Owner's Mailing Address Property Location PO BOX 26 r r�_ City,State Zip Code Phone Number �-�-- Couderay,Wl 54828 r1E y,,NW '/4, Section 12 IL Type of Building(check ali that apply) Lot# T38 N R 8 Eor� J�1 or 2 Family Dwelling-Number ofBedrooms 3 ^ Subdivision Name ❑Public/Commercial-Describe Use Block# '1 ❑Cityof ❑State Owned-Describe Use CSM Number D�I'Village of Couderav � ❑Town of IIL Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. C6eck one box on line B.Complete line C i a licable. A. Y � P Y g Y ( P ) ( p ) ❑New S stem Re lacement S stem ❑Other Modification to Existin S stem ex lain ❑ Additional Pretreatment Unit ex lain B' ❑ Holding Tank �In-Ground ❑At-Grade gn ype p ) ❑Mound ❑ Individual Site Desi ❑Other T (ex lain (conventional) .ist Previous Permit Number and Date Issued C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner ,� Expiration (�y��[ IV.DispersaUTreatment Area and Tank Information: Design Flow(gpd) Design Soil Applicaiion Rate(gpd/s� Dispersal Area Required(s� Dispersal Atea Proposed(s� System Elevation � 450 7 642.9 6502 9325 ��S��la�_��a Capacity in Total #of Manufacturer Tank Information Gallons Gallons Units ` o '� � New Tanks Existing Tanks � _ � �' � � � � � o �- � a. U v� ti v� 'u. c7 a SepUc or Holding Tank 1000 1000 1 tesei Dosing Chamber V.Responsibility Statement- I,t6e undersigned,assume responsibility for installation of the POWTS showo on the attached plans. Pfumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone Number GERAI.D FROEMEL �, 9501]1 715-558-I 138 Plumber's Address(Street,City,State,Zip Code) 13502W Frcemel Rd Hayward,W1 54843 VI.Co n /Department Use Only �:App v ❑Disapproved Permit Fee Date Issued Issuing Agent Signature /� ' $ �vo� °►��c�(�.a ��:.G�.Q,Q�H��= � .v �Owner Given Reason for Denial Conditions of Appmval/Reasons for Disapproval ��I � _�� r_�> -_,�....i,-,r__. �-�}�1/i ,i:�-` :� �);t[f7, �' ' �� — ��, � � - 1f �r�� `' r�L�'_?�`� L �r r ��-=! ` �(� 9� � I �h+. .� � °� i� � �� s�P � s zoza � CS� ��. _ � S3 ��. N�W Werld � — - e,F,_ �,�;t':r�� C�.�%Uta I Y ! T Attach to rnmpkte plaos for ffie system and sebmit to t6e Coanty only oo paper oet kss thaa 8 t!2 i 11 inches in size �� NO R�FUNDS AFTER SBD-6398(R 03/21) ISSUE OF PE'�iNI�T Amold Malecha Property Owners Name 12332W State rd 27/70 Property Address 1.11838E+11 Tax Parcel Number Sawyer County � NE/NW Gov Lot or Qtr-Qtr/Qtr S 12 Section T38N 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 09/14/22 Date Not an endorsement,written or implied for the following companies and products;DelZotto Concrete,Wieser Concrete Products tnc.,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.,Simlfech Fifter Inc.,Sta-Rite Industries, Page 1 of 7 In-Ground Soil Absorption SBD-10705-P(N.01/01)Version 2,f Component Manuai Used 3 Number of Bedrooms Percent Slope (%) 90 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 93.25 �Proposed System Elevation #1 Proposed System Elevation #2 Proposed System Elevation #3 Original Grade#1 97 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)t Lifetltl1e �� Effluent Filter "'select only if NOT using combo tank Soil Boring Surface Depth to Lowest Highest System Number Grade Limiting Elevation Elevation Elevation Elevation (ft.) Factor (in.) Acceptable 1 96.75 88 92.42 95.50 TRUE 2 97.00 90 92.50 95.75 TRUE 3 96.50 84 92.50 95.25 TRUE 4 5 Page 2 of 7 PROJECT DESIGN FLOW RATE=450 GPD SOILAPPLICATION RATE=.7 GPD/SQ.FT. ARNOLD AND PHYLLIS MALECHA ABSORPTION AREA REQUIRFD=643 SQ.FT PO BOX 26 COUDERAY,WI 54828 NO RECORDS ON EXISTING SYSTEM RE RECORDED. VILLAGE OF COUDERAY � NE,NW,S12,T38N,RSW SIGNED: 12332W STATE HWY27/70 ��f'�/� �/// � N B-2 SCALE:1"=50' 97�0 � 06 5 r--� ❑ B-1 � 7) 96.75' w ❑ y'��y"�� 4 B-3 96.5' GARAGE � � � BM �a �`t� WELL� HOUSE ELEVATIONS •BM=100.0' NAIL W/RED RIBBON IN WALNUT TREE DR.WAY B-1=96.75' B-2=97 0' 83=965' #12332W S!T INLET=9525' SYSTEM EL.RANGE=94.1'-92.5' SITE IS LEVEL HWY 27I70 Cross Section of a Two Cell In Ground Ccmponent U.ing Leachinq Chambers ObservoUo�/Ve�ri Pipes � \ 97.00 Finished Grade -' - � ---- ----. Finished Grade —�� Slope .. � CeH S�eparation� � . �� I—�J' � , - � , . , � T- �,�'�� Orgfnal Grada- -.' � `�` ' '� Jf / �`� �, XSrginal Grade 94.50 Top of Chamber �'�� I '*1,�'To of Chamber 94.50 - 'd- - �' �� . ! �" ' `.--'-' P . �.' 9325 System Elevation '+• .. ,. �' _ System Elevatbn 93.25 '• � .Yreatn7en{pnd'D1�e�saV .Zoqe. ' . r . . . ` ' � . . , ' ' • . � - " '—� -' � . . . . ._.______ �. Limifinc Factor Obse�va;be/Ve�t pipes to be constucted and capped w'ih opproved mote�inis for the particulcr ose. Dia rams Not To Scale _—� , .- � .. ,ry:- ` � � �� _ .�. a��- �. .� �, � _.�,�..�.-��_ . : � n �, _ __ ___� , --� � __--� � � � �w�.,�.r�+r��-�u �� y.,< k _....E � j �- � ) � wnw�`.nd�aatw '"xs�:a. _aam:'�.rtst,,;�u`a'°-�a;r;�t � .+_.,;. bservation/Vent Pipes to be located 1/5 to t/70 the length of the distrution cell measured 6om the end of the cells Page 4 of 7 rnold Malecha 12332W State rd 27f70 1.12E+11 Number of Bedrooms 3 Septic Tank Wieser t000LP Estimated Flow(avera9e)gauons�day 3 Effluent Filter Li etime DBS19t1 FIOW(peak),(Estimated x 1.5)gaVday 4 Pump Tank #N/A Soil Application Rate gal/day/ft2 0.7 Pump Type Influent/ Effluent Qual' Monthl Average Fats, Oil 8 Grease(FOG 30 mg/L Biochemicai Oxygen Demand (BODS� 220 mg/L otal Suspended Solids (TSS) 150 mglL !!NOTE'! Servicing frequency of 12 months or less requires the Maintenance Schedule Management Plan be recorded with the Register of Deeds. 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 celi(s) At least once every 3 Year Clean effluent filter 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 volume 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 visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effiuent on the ground surface. The ponding of effluent 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. SWrt-Up and Oaeration For new construction, prior to use of the P01NTS 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 Sepfage Service Operator. System start-up shali 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 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. Continaencv Plan If the POWTS tails and cannot be repaired the following measurers have been, or must be taken to provide a code compliant replacement system: (Check One) r' The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation shaii be performed to locate a suitable repiacement area. If no replacement area is 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 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. ��. Septic, pump and other treatment 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 difficult or impossible. POWTS Installer Septic Pumper Name Gerald Froemel Name `Scott Poppe Phone# 715-558-113 Phone# ( S 4- 450 � POWTS Maintainer Local Regulatory Authority Name Jays Septic Agency Sawyer ounty Zoni�g Phone# 71 -5 -11 Phone# 715-634-8288 Page 7 of 7 ��'''R''`'`" PRIVATE ONSITE WASTE TREATMENT county - - ,;;,. !-%� � ,;r� ��j� �sP ,�1�;1 SYSTEMS SaW er ;:4,� s /.�, ( POWTS) y \\F�-__4�'`/ �''""`''='' INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION 22 � oL�g Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. l 5.04(1)(m)] Permit Holder's Name: ❑City ❑ Village � Town of: State Plan Transaction ID#: � 1'� �O�h �'V to'�,�`n.�t �>j�-� � Insp BM Elev: BM Description: Parcel Tax No: 1��O ' �� \ n��b� 1 ^ �.�.A��4 �I/��3gr( / —�� TANK INFORMATION ELEVATION DATA � TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic ��e�� (oCs� Benchmark 10�.O ` Dosing Aeration Bldg. Sewer q 5;�f Holding St/Ht Inlet QS'•�(1� TANK SETBACK INFORMATION St/Ht Outlet �,r-,�7 ' TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIRINTAKE Septic �-(a fi�` ;Lq� .� � ' NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. 5`Y��S � Holding Dist. Pipe PUMP 151PHON INFORMATION Infiltrative �3 a�� 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 ,3 � 6 b #of Cells Type of System Distribution Media Manufacturer: � Conv ❑ Aggregate �`� , SETBACK P/L Bldg Well OHWM of Nav � �GP �c Chamber INFORMATION Waters � AG ❑ EZFIow Motlel Number: CELL TO ❑ Mound o Other Q4,,� __ fi-5 �'•�-S _ _��__— N ---_ ___— --- _________-- -- DISTRIBUTION SYSTEM X Pressure Systems Only -- ----- _ _- —— Header/Manifoltl Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length Dia _ �Length Dia__ _Spac __ Spacing ❑Yes ❑ No SOIL COVER � Depth Over Depth Over I Depth of Seeded/Sodded Mulched Cell Center Cell Edges j Topsoil_ _ ❑Yes ❑ No I ❑Yes ❑ No COMMENTS: (Include code discrepancies,persons present,etc.) ��,5�� q�� I�-a � - �-- ---- --- Plan revision required?�Yes � No , / G� �� 3 �� _--�%�-_(�-��—�--_ .- - Use other sitle for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A�OITI�NAL COMMENTS AN� SKETCH SANITAAY PEAMIT NIJMBER: ��—�Sg___ �IL ? . �� r �?�c+ � �`�°� y� �o i , . _ ' _ d�''�PI -� io� �s\ `''"�' �.8� , , _ .... .__ , ��`�� b.e � ��. c� � ` . ._ ; . __ _ —= .._..; i �� S� . � . � �' /D . . . . . . l`/,' ` K I � \ � �. 5�g� � �� ? 3� O� , U � �`� �. � � � l �3�av� —Pd--- ��, µ,��. � T.�'��-,I�D