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Home My WebLink About010-941-23-4317-SAN-2022-259 ��""' Industry Services Division Cow►lY (/) 4822 Madison Yards Way Sawyer � _ ,�_' = Madison,WI 53705 Sanitary Permit Number(to be filled in by � � = P.O.Box7162 � 3qa�� - Madison,WI 53707-7162 9j State Transaction Number � Sanitary Permit Application � In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit � is required prior to obtaining a sanitary pe[mit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing ac � the Departrnent of Safety and Professional Services.Personal information you provide may be used for secondary 10560W riverside rd � 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# Ronald&Bonnie Kubarek 010941234317 Property Owner's Mailing Address Property Location 15551 Davis Ave @vvC-t��• Ciry,State Zip Code Phone Number �.}- Hayward,Wl 54843 SW '/.,SE '/<, Section 23 II.Type of Building(check all that apply) Lot# T 41 N R 9 E I�1 or 2 Family Dwelling-Number ofBedrooms 3 2 Subdivision Name ❑Public/Commercial-Describe Use Block# � — ❑City of ❑State Owned-Describe Use CSM Number ❑Village of 33�b� ��t�� Town of_Jt-�lcY� III.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box oo line B.Complete line C i a licable. A" ❑New S stem Re lacement S stem y � p y ❑ Other Modification to Existing System(explain) ❑Additional Pretreatment Unit(explain) B' ❑ Holdin Tank �.In-Ground ❑ At�'irade g ❑ Mound ❑ Individual Site Design ❑Other Type(explain) (conventional) C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑Transfer to New Owner ��vious Permit Number and Date Issued Expiration �3 - �33 ►i�g�8� N.DispersaUTreatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation 300 .7 428.6 430.2 94.00 Capaciry in Total #of Manufacturer Tank Information Gallons Gallons Units � � o � � New Tanks Existing Tanks � o � � y � � � a U 'v� � v� v. C7 fi. Seplic or Holding Tank 750 50 1 teSer Dosing Chamber V.Responsibility Statement- I,t6e undersigned,assume responsibility for installation of t6e POWTS shown oo the attached plans. Plumber's Name(Print) Plumber s Si ture MP/MPRS Number Business Phone Number GERALD FROEMEL �i��j� 950111 715-558-1138 Z/ Plumber's Address(Street,City,State,Zip Code) 13502W Frcemel Rd Hayward,Wl 54843 VI.C unty/Department Use Only ,Q Ap d'Z �Disapproved Permit Fee Date Issued Issuing Apent Signature l'j3L� ❑Owner Given Reason for Denial $ ��'� � I�� I �� '�"� Conditions of Approval/Reasons for Disapproval �� c ,_�� D r �7at� . _°�_.L' .�e��_._ _: �' }' �.. ,, ► (��3 ,�..,N SEP 16 2022 '� � � ,.. r--- �;,-;c� N ew,_�.��o C S � � � — I� $ SAWYER COUNTY Zp��qpMiNISTRATlON Attach to rnmplete pl for t6e system and sabmit to the Couety o.ly oe paper not less thaa 8 tn:I1 inches in size �I��' '�S-e'e'"�� SM NO REFiJNDS AFTER SBD-6398(R.03/21) e'"�� cg��OF PERMtT Ronaid & Bonnie Kubarek Properly Owners Name 10560N Riverside rd Property Address 10941234317 Tax Parcel Number Sawyer County -� ! SW/SE Gov Lot or Qtr-Qtr/Qtr S23 Section T41 N Town R9W 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 �j 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 Inc.,Skaw PreCast Co.,HufEcutt Concrete Inc.,Zabel Environmental Techno4ogY,!7T Industries(Goulds),The Pentair Pump Group(Myers),Infiftrator Systems,ADS Products,Polylok Inc.,Orenco Systems Inc.,Sim/Tech Fiker Inc.,Sta-Rite Industries, Page 1 of 7 In-Ground Soil Absorption SBD-10705-P(N.01/01)Version 2,� Component Manual Used 2 Number of Bedrooms Percent Slope (%) 108 Depth to Soil Limiting Factor (in.) 0.7 In Situ soil application rate 200 Estimated Wastewater Flow (gpd) 300 Design Wastewater Flow (gpd) 1 Number of System Elevations 94 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.) 21 Proposed Number of Chambers Used 428.6 Minimum Distribution Cell Area Required (sq.ft.) 430.2 Distribution Cell Area Proposed (sq.ft.) Wieser 750 °Septic Tank ose an (if applicable) Lifetime A Eff1uent 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 97.26 96 92.26 96.01 TR U E 2 96.7 90 92.20 95.45 TRUE 3 98.2 108 92.22 96.97 TR U E 4 5 Page 2 of 7 ��e�: ��(: R01na�� O h✓lte 1�+� V�Qt'G� �CiW��- �O.� �'ct��.,,�Gpr� I W�. I SSS l �a.v�s ��e- {�[OJ : o L D- �t�{f- Z3-- `-f 3 11 �T4�t,c��"G�� l� ( S`'�8�3 SC,IJ/SE � z 3 T 4 [ N R �C'L C.� 1 S�e: loSbO►.� 6Z�vers:de G�-t CS1'� l.of Z. 33�(0�} # �q� Z. �—�� "'��1 K L�e.r =—� � 't S� � SGca.�2 ��—�O� ° �� u � `fo �3►-�too'� �-�o� o� c o��e.r 6oa.�� CO�'h2v O'� �o�N(�. PJ[. 4 7.2.(.,o � �K Z. ab. �` s�e( 3 `� � 3. qg. 2Z� � � �� ' .� SD.Is� s�s-� �l. q�' . 0 0 $�'l rao` 1�1�� . �0.�.�e 4z.s'4�.�'� _ �x S•�T" �•�.1e� q b :-1 S`�" Z • T C� r a o � � 1 9G�9e ��y��d�ll ,� -� � � �� ,� o � T � Cross Section of a Two Cell In Ground Ccmponent Using Leaching Chamber; Observo!io^./Ve�l Pipes � \ 97.00 Finished Grade � - -'-� - �---- ------.� Finished�rade—�� Slope _ e Cetl"Saperation '� � Orginal Grade- i / X,�Y,' '}J�f �`�T ,fSriginal Grade 95.25 Top of Chamber _ _� ��,�' I �_ . _'Top of Chamber 95.25 94.00 System Elevation +• .. .. System Elevation 94.00 ' • .Yreatrr,ent'pnd'Diepe-sol.Zope. ' � - "�._.• . •• •' ..• . , ._.•.._______ � l�mi?�nc, Factor Observat-o��/Ven; pipes to be constucted and wpped w'tr opproved moteriols for the porticular use. Dia rams Not To Sca�e _ � .��— Li�' � r► v��i�i�/�i�� ___.—_ ___-- —---� � i i � --- _.. — __ �, �*• 1 _� O �,_,O O � .� � � , bservation/Vent Pipes to be located 1!5 to 1/10 the length otthe distrution cell measured from the end of the cells Page 4 of 7 Ronald & Bonnie Kubarek 10560N Riverside rd 1.09E+10 Number of Bedrooms 2 Septic Tank Wieser 750 EstimatedFlow(average)9allonslday EffluentFilter Lifetime DeSign FIoW(peak),(Estimated x 1.5)gaVday 30 Pump Tank #N/A Soii Application Rate gal/day/ftz 0.7 Pump Type InFluent/ Effluent Qual' Monthl Average Fats, Oil &Grease(FOG) 30 mg1L Biochemical Oxygen Demand (BODs) 220 mg/L otal Suspended Solids (TSS) 150 mg/L !i N OTE!! Servicing frequency af 12 months or less requires the Management Pian be recorded with the Register of Deeds. Maintenance Schedule Service Event Service Frequency Inspect condition of tank(s) At least once every ear Pump out contents of tank(s) When combined slud e and scum = 1/3 of tank volume Inspect dispersal cell(s) At least once every 3 Year Clean effluent filter At least once every ear Inspect pump, pump controls 8 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 certificatlons:Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer, Septage Servicing Operator. Tank inspection must include a visual inspection of the tank(s)to identiry 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 effiuent 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 equais 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 infilVative surface. Page 6 of 7 Do not drive or park vehicles over tanks and dispersal cells. Reduction or eliminatlon of the following from the wastewater stream may improve the pertormance 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, paintlng 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 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 availabie a hoiding tank may be installed to replace the failed POWTS. ' A suitable replacement area has been evaluated and may be utilized for the location ot 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 P01NTS. ��WARNING!! 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# 715-558-1138 Phone# (715) 6 -145 POWTS Maintainer Local Regulatory Authority Name Jays Septic Agency awyer County Zoning Phone# 715-55 - 1 8 Phone# 715�34-8288 Page 7 of 7 ,�/� '�''f``'� PRIVATE ONSITE WASTE TREATMENT �o�nty �oi$-`,,��,�, SYSTE M S ,� p s \�,; S awyer �`�� ( POWTS) \k� �..-;r/ '='"""�'"'' INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION a� �� Peisonal infonnation you provide may be used for secondary purposes[Pnvacy Law,s. 15.04(1)(m)] Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#: �,nP,� �'.S�vntil�Q K-�.C�c�� }'�a !�c� Insp BM Elev: BM Description: Parcel Tax No: (�O'V� Vb� p 1 6/*i�ViJ �Gil� � �`�iT�/ ��. �'Q I ' I("��✓� l�(� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic w�¢.�� '�� Benchmark �,�� Dosing Aeration Bldg. Sewer ,g' Holding St/Ht Inlet 96� � TANK SETBACK INFORMATION St/Ht 0utlet �6,Y � TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIR INTAKE Septic .��.' �,-�. � .}�' �� NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. 9'�a ' Holding Dist. Pipe PUMP I 51PHON INFORMATION Infiltrative Surface `�Y�b � 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 � 6g !6` #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav � Conv ❑ Aggregate �.�I � INFORMATION P I L Bltlg Well Waters °� GP �c Chamber Model Number: ❑ EZFiow CELL TO .t-S-` �- � �- "b ❑ Mound o Other QY� -- —�-.�_- � '�" _- - DISTRIBUTION SYSTEM ? X Pressure Systems Only — — -- ---- _--- - — — Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length Dia Length Dia Spac 1_ __ _ Spacing ❑Yes ❑ No� - _ _ _ _ SOIL COVER _ Depth Over Depth Over —� Depth of Seeded/Sodded Mulched Cell Center Cell Edges I_Topsoil ___ � ❑Yes ❑ No � 0 Yes ❑ fJ� COMMENTS; (Include code discrepancies, persons present, etc.) �-�� q(�j��-� � s� ��"��°�, Csw�� 796a Plan revision required7❑Yes ❑ No �' I� o� �3 ` � 6� S�(� Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A�OITIONAL C�MMENTS AND SKETCH SANITARY PEAMIT NUMBEA�._____�-�- -��_ �� Aw�e�.�o►-, ��f %-�J �-�� PI�. � . �� _ � �� `"`��.r ��k I � �p�Vv\ Ln/ . . `^� . . . . . �, ...,_... . . . ; . . . . . dd+I � � 1 1 . .. . . � . . �. . � .. � ; �� 1�� . . ..., . .. . _i.. ......... .._.__., � �-� Q�CC� �� ' . dI1 �(i`\�` t ' ,v �,� 0 $�� . I C, y �� 1 �� p , n�`" � D ,�D� ��D �, �S _ D�`�5�� —