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Home My WebLink About026-939-14-5202-SAN-2022-275 f ( � �.// _ ��""'`'',�; Department of Safety c°°"`�' �- � �� `'��_�°,, c�iL PPOfeSS1011a� .Set'VICCS� Sanitary Permit�um�b��e(�be filled in by C � �. � i-r Indust Services Division ��r-� � � � '� � 3� a 5� � ,��. �..... µ�^ �\�\lMl��\.�\_ : State Transaction Number � Sanitary Permit Application � v.� 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 permit. Note:Application forms for state-owned POWTS are submitted to Project Address(itdifferent than mailing ad (� the Department of Safety and Proiessional Services.Personal information you provide may be used for sr;condary �� purposes in accordance with ihe Privacy Law,s. 15.04(I)(m),Stats. �9 1..'N /,��;.�,�,F�Sy��Q��, L� I.Application Information-Please Print All lnformation w Yroperty Owner s Namc Parcel# M;c1�o.e\ Fa � er' oaCo - 939 - ly 5aoa Property Owner's Mailing Address Property Location p O �3 on 8 3'�1 c,o�c.Loc__a__ City,State Zip Code Phone Number RlA b��t"� � M N S Sej �'� %, '/<, Section� II.Type of Building(check all that apply) Lot# T 39 N K --� W �I or Z Family Dwelling-Number ofBedrooms � Subdivision Name Block# ❑Public/Commercial-Describe Usc ❑Ciry of ❑State Owned-Describe Use CSM Number ❑V illage of g�o�,ot� �a.,d L 0.k�_— 111.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. A ❑ New System �Replacement System ❑ Other ModificaUon to Gxistmg System(explain) ❑Additional Pretreatment Unit(explain) Te.�k c la�-ex�e.�� aY• 1 B' ❑ Holding Tank ❑ In-Ground ❑ At-Grade ❑ Mound ❑ Individual Si[e Design ❑Other Type(explain) (conventional) �'• ❑ Renewal Before ❑ Revision ❑ Chanee of Plumber ist Prevfous Permit Number and Date Issued ❑ Transfer to New Otiner Expiration l.(Y��, � IV.DispersaUTreatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(si) Uispersal Area System Elevation �O � a• '� tia9P}a Gx�s1��1 g�. SO �� Capacity in Total #of Manuf'acturer � Tank[nfonnation Gallons Gallons Uniu � � v ,�, � ,C3 U New Tanks Existing Tanks � o ;� � � � � � a U v� � �n w C7 0» SepLc or Holding Tank � �'C � �� L S e f•/-_C�� J �..�JT7 Dosing Chamber V.Responsibility Statement- [,the undersigned,assume respousibility for insWllaHon of the POWTS shown on the attached plans. Plumber�s Name(Print) Plumber's SignaWre MP/MPRS Number L3usiness Phone Numbcr n C� C � (' �� aa c��8 8 7/$'J`r58�iy�a Plumber's Address(Stree,City,State,Z.ip Codc) 9aasry s�a+,� �00.� a� N4Yward� c�l �y a ��3 VL Co nt /Department Use Only �Ap v C Disapproved Permit Fce Date Issucd Issuing Agent Signature ❑Owner Given Reason for llenial $ �/"-� � I a�/a°2 � Conditions f�proval/Reasons for Disapproval S ��' q f a��aa _ � .��`' ��:.E' `�w� ;,�'��.� � ��GI �a�. _ . _ _ �� , --�.--_-=- ��, L �'hk# a--�� I �,� SEP 2 7 2022 -� C S� �� I � �0 ;;,. �2W._ WOrtd #3c�a � c�AWYERCO°�NT`l �� DMINtS�"{i�;1C�N Attach to complete plans for t6e system and submit to the County unly on paper no[less t6an 8 I/2:11 inches in s�ze �� SBD-6398(R.03/22) NO R�FJNDS AFTER ISSUE OF PE"AMIT � ��7� \ � �6 a\\ Y AA � N� � � � V u �� V � � �� i �� v`8• e rk �� ♦ m � ' ♦ �'y F�: �. y.. ��1 �E,- 1n `' a S t�� J i "�s7 �,�� U Cp 3 ro � y, h &4� �, '4 d ,� �� '7 � o N o v d� �'v� b �5 (� � J � p�p P � £ £ � �` L � ,,� '►+ j C � U O � � s Y Z �b:,, � P� � � � � O :J O d � � u n o�- r p � + �' � `�� j (' � � � � X o -o , Nw+ > � . � . t_b 'h � � a .� � c � �✓ � i� � � � � � � � � d_ � �' � n (�' _ � °' L � � o � � � t- 7� 1� `� Ri t �p u� � � u � N � O \� � � � ^� �� 1 � "`'� +J � 7c J �1-�, �^ F m'� �{ � � ' �. �/ i4 O Z cs �H� 1^� � � p n � � �� , I '�-� + ? � � T e� C,rVTex 8�`I `� .�\ � p C (� I �oo��kc �-� � �L� \ P� In-ground Gravity Management Plan IMPORTANT: The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384,Wisc.Admin. Code. Pursuant to SPS 383.52 (2),Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3),Wisc.Admin. Code. Maximum Dispersal Area Operatinq Limits: Design Flow = 300 ypd; BODs � 220 mgL"'; TSS <_ 150 mgL-'; FOG <_30 mgl-' Insaection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches,floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution /drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities-if applicable(i_e., pump re-cycling, float switch settings, etc.) o electrical components-if applicable(i_e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure-compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s)shall be pumped by a ceAified septage servicing operator licensed under s. 281.48 Wis. Stats.when the volume of solids in the tank(s)exceeds one-third(1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(sl shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications_ A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accardance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: ROIl21C1 A Spf2Ck21S Jf Phone: 715-558-6472 �o�ai 9o�emme„t „�;t: Sawyer County Zoning & Conservation phone: 715-634-8288 �oca� 9overnment unit address: 10610 Main St, Suite 49 ; Hayward, WI ZiP: 54843 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1),Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383,Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384,Wisc. Admin. Code. Continqency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils. Svstem Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. '""'=''"E"�: PRIVATE ONSITE WASTE TREATMENT �ounty /��o'$ ��'� SYSTEMS SaW er �� y �`�� s�% ( POWTS) \h�F�yFS�� `�°��"� INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �� -- �.7� Pe�onal 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�+`i�a�� SGti� �� Insp BM Elev: BM Description: Parcel Tax No: .c� � $��'''1 a�St�c� u�"��V c�n.w'a'��W. ��o=1'3`��'1�(^ S"-2o� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic � �� Benchmark �Op �� Dosing Aeration Bltlg. Sewer � c��,S-� Holding St/Ht Inlet y$.�.. ' TANK SETBACK INFORMATION St/Ht Outlet q7,q�y` TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet AIRINTAKE Septic �1-S � t,�.S� 2f� fi ` NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. Holding � Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative 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 #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 ¢� Other p - -- _ _-- - - - - --- -- ---- ----- --- 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 ; Topsoil _ _ ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) � �,s�� la� ��r (�a a� S,`1� re`��ew,�..,�' 6.-�� e��s�'s� �.c�. �e.(l) Plan revision required?❑Yes ❑ No �-� �6� �� I— �— � G�(�� J I Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A�OITIDNAL COMMENTS ANO SKETCH SANITAAY PERMIT NUMBEA: �-.�^.27'� �- U�1��-�-�s�, 'l.s+l��-- - , . . _.___ � , . _ ,- -�--_ , �� '�o�" � � �• �� '' --- � ` ' � �� ' _ , _---- _ _ , �-- ; _ . , � . _ :_ _ _� . __ .___ : , ; ; $Y!�- � , ' �Pl� � T � � � �-, , � �� ; �� ,s"�a�Pjl7P, � f ' �NSP� ;�s� . � w,�Sa� 3 , �'��1�� i`�x�'�l� �� r � J �� `� �a�r� � �� ,� fi� g�y� �.-�-�