HomeMy WebLinkAbout010-941-17-4213-SAN-2022-304 ` [ndustry Services Division County �
� � 4822 Madison Yards Way SAWYER
; �: -. Madisoq Wl 53705 Sanitary Permit Number(to be filled in by \
�S P.O.Box 7162 .,
Madisoq WI 53707-7162 �03� ��� �
- 4J
Sanitary Permit Application State Transact�%n Number �
In accordance with SPS 38321(2),Wis.Adm.Code,submission ofthis form to the appropriate govemmental�mit p
is required prior to obtaining a sanitary permit Note:Application forms for state-0wned POWTS are submitted to Project Address(if different than mailing: �
the Departrnent of Safety and Professional Services.Personal information you provide may be used for secondary 16462W Boyle Rd
pucposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats.
I.Application Information-Please Print All Informatioo
Property Owner's Name Pazcel#
Jordan Daleiden 010941174213
Property Owner's Mailing Address Property Location
W 5851 Shell Creek Rd
Govt.Lot
City,State Zip Code Phone Number
Minong,Wl 54859 NW'/.,SE_'/<, Section 17
[I.Type of Building(c6eck all that apply) Lot# T 41 N R 9 E o
�1 or 2 Family Dwelling-N�unber ofBedrooms 3 Subdivision Name
Block#
❑Public/Commercial-Describe Use
❑City of
❑State Owned-Describe Use CSM Number ❑V illage of
�Town of Hayward
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 S stem ❑ Re lacement S stem g y ( p ) ❑ Additional Pretreatrnent Unit(explain)
y p y ❑Other Modification to Existin S stem ex lain
B� ❑ Noldi Tank �'iround ❑ At-Grade
rtg �n ❑ Mound ❑ Individual Site Design ❑Otfier Type(explain)
(conventional)
C• ❑ Renewal Before ❑ Revision ❑Change of Plumber ❑Transfer to New Owner
ist Previous Pem►it Number and Date Issued
Expiration
IV.DispersaUTreatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevazion
450 .5 900 915.3 93.50
Capacity in Total #of Manufacturer
Tank Information Galbns Gallons Units p a o � ;
New Tanks Existing Tanks � c � � Y � � `�
0
a U v� � v� i�. C7 a.
Septic or Holding T�k 1000 1000 1 ieser
Dosing Chamber
V.Responsibility Statement- 1,the undersigoed,assume respoosibility for installa6on of e POWT5 shown on the attac6ed plans.
Plumber's Name(Print) Plumber' S� MP/MPRS Number Business Phone Number
Gerald Froemel , ��'�' 950111 715-558-1138
Plutnber's Address(Street,City,State,Zip Code)
13502W Frcemel Rd Hayward,Wl 54843
VI.Co n /Departmeot Use Only
�A� ,v ❑Disapproved Permit Fee Date Issue Issuing Agent Signature
❑,Owner Given Reason for Denial s l�.� �� I`& '�� ��'"�`�"' �"���'r
Conditions of ApprovaUReasons for Disapprova( ���„� r\ ����
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�a � � � � , � �
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_ (-}� .....�:�uvu Hl.)MINdSTR�1
Atbcb to rnmplete pla tor d�e system and submit to the Coenty oaly on paper eot less t6aa 81l2 t l l incYcs in size L,I,L�;
-1 T
SBD-6398(R 03/21) NO RCFUNDS AFTER
lSSU�OF PEftMIT
Jordan Daleiden Property Owners Name
16462W Boyle Rd Property Address
0�10941174213 Tax Parcel Number
aw County
NW/SE Gov Lot or Qtr-Qtr/Qtr
S17 Section
T41N 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
� Plumber's Signature
950111 Plumber's License Number
715-558-1138 Plumber's Phone Number
10/12/22 ��,�Tm�u�- 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),Infiltrator Systems,ADS Products,Potylok Inc.,Orenco Systems Inc.,SimlTech Fifter Inc.,Sta-Rite Industries,
Page 1 of 7
in-Ground Soil Absorption SBD-10705-P(N_01/01)Version 2.� Component Manual Used
3 Number of Bedrooms
;Percent Slope (%)
100 =Depth to Soil Limifing Factor (in.)
0.5 In Situ soil applicafion rate
300 Estimated Wastewater Flow (gpd)
450 Design Wastewater Flow(gpd)
1 °Number of System Elevations
93.5 T��Proposed System Elevation#1
3Proposed System Elevation#2
�Proposed System Elevation#3
Original Grade#1
97 #Finished Grade#1
���Original Grade#2
� �Finished Grade#2
;Original Grade#3
��4 �Finished Grade#3
Infiltrator Quick 4 Standard Chamber Type
�._.o.__��..�,.��.�.,..w...:_.__ . ..�
15 Height of Chamber (in.) 20 sq.ft. per chamber
3 �Rows of Chambers 5.1 sq.ft. per pair of end caps
3 1 `Distance Between Cells (ft.)
45 Proposed Number of Chambers Used
900.0 Minimum Distribution Cell Area Required (sq.ft.)
915.3 Distribution Cell Area Proposed (sq.ft.)
Wieser 1000LP Septic Tank ose an (if applicable) �
Lifetime ��� �p 'Effluent Filter ""select only rf NOT using combo tank
Surface Depth to System
Soil Boring Grade Limifing Lowest Highest Elevation
Number Elevation (ft.) Factor(in.) Elevation Elevation Acceptable
1 97.30 108 91.30 96.05 TRUE
2 96.20 96 � 91.20 94.95 TRUE
3 96.90 102 F 91.40 95.65 TRUE
4
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5
Page 2 of 7
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Cr�s Section of a Thc+ee Cell��+o�md Com�t
Uaing Leaching Chambe�a
Finished Grade
Oric,�"nal Grade
lypiw+oe�oe.�tiorv..t r�s Top of Chanber 94.75
� �System Elevation $3.Sd
Finished Grade 97
slope :� eP� � __ Finished Grade 96.50
'�� � Feet '
Originai Grade �;j ,X l �X�,
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94.75 Top of Chamber - .. X� �� Onginal Grade
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. �'' " ' '�;' - 'j-'� Top af Chamber 90.90
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93.50 System Etevartion � =-:.,..;. • • j' system Elevation 93.50
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bservation/Vent Pipes to be located 1/5 to 1/10 the length of the distrution cell measured from the end of the cells
Jordan Daleiden
16462W Bo le Rd
1.09E+10
Number of Bedrooms 3 eptic Tank Wieser 1000LP
Estimated Flow(avera9e)gallons/day 300 Effluent Filter Litetlme
DeSign FIOW(peak),(Estimated x 1.5)gaVday 450 Pump Tank #N/A
Soil Application Rate gaUday/ft 0.5 Pump Type
Influent!Effluent Quali Month Average
Fats,Oii 8 Grease(FOG 30 mg/L
Biochemical Oxygen Demand(BODS> 220 mg/L
otal Suspended Solids(TSS) 150 mg/L
, �,�,.,��,, Servicing frequency of 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 3 Year
Pump out contents of tank(s) When combined slud e and scum=113 of tank volume
Inspect dispersal cell(s) At least once every 3 Year
Clean effluent filter At least once every 3 Year
tnspect pump,pump controls&alarm At least once every
Maintenance Instructions
Inspections of fanks and dispersal celis 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 efHuent levels in the observation pipes and to check for any ponding of effluent 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.
Start-Uo and Oceration
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 treatrnent 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 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, 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;
-NI piping to fanks and pits shall be disconnected and the abandoned pipe openings sealed.
-The contents of all tanks and pits shall be removed and property 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.
Continqencv 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 pertormed to locate a suitable replacement area. If no replacement area
is available a holding tank may be installed to replace tfie 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 protec[ed from disturbance and compaction and
should not be infinged upon by required setbacks from existing and proposed strudures, Iot lines and
wells. Failure to protect the replacements area wil� resuR in the need for a new soil and site evaluation to
establish a suit2ble 2placement area. Replacement systems must comply with the rules in effect at that
fime.
A suitabie replacement area is not available due to setback and/or soil limitations. A holding tank may
be installed to replace the faited POWTS.
��WARNING�'
Sep6c, pump and other Veaiment tanks may contain lethal gasses and/or insufficient o�cygen. 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 Frcemel Name Scott Poppe
Phone# 715-558-1138 Phone# (715)634-1450 �
POWTS Maintainer Local Regulatory Authority
Name Jays Septic Agency Rusk County Zoning
Phone# 715-558-1138 'w���' Phone# 715-532-2156
Page 7 of 7