HomeMy WebLinkAbout028-742-29-1107-SAN-2022-305 t . .. � *c::':�,'-� ��-.-::5:-;�*?>:,5�:::- ? {'c���niV �
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� i 4!{22 ti•tacii�cm Y�rcis VUaV I JHW TCl(
� = . �s , j Madison, W l Jj%UJ I Sanitary Permit Number(to be filled in by �
�� , P.O.Box 7162
Mad�son, W I 53707-7162 � 3� ��S �
Sanitary Permit Application State Ttansaction Number �
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this fortn to the appropriate govemmentai unit �
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 Safely and Professional Services.Personal information you provide may be used for secondary 11495W Cleaz Lake 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 Pazcel#
Nathan Gassman 028742291107
Property Owner's Mailing Address Property Location
609 Ronell St
Govt.Lot
City,State Zip Code Phone Number
St.Peter,MN 56082
NE y.,NE '/., SecUon 29
Il.Type of Building(check all t6st apply) Lot# T 42 N R 7 E o�
�1 or 2 Family Dwelling-Number ofBedrooms,2� � Subdivision Name
❑PublidCommercial-Describe Use Block#
❑City of
❑State Owned-Describe Use
CSM Number ❑Village of
,�4Towti of�ider Lake
IQ.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on liue B.Complete line C i
a licable.
A �Iew System ❑Replacert�trt System g Y � P ) � XP )
❑ Other Modification to Existin S stem ex lain ❑Additional Pretreatment Unit e lain
B' ❑ Holding Tank �[n-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑Other Type(euplain)
(conventional)
C• ❑ Renewal Before ❑ Revision ❑Change of Plumber ❑Transfer to New Owner
ist Previous Permit 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(sfl System Etevation
38d"_j�� C, .7 4�i�.(r,G c��-• �� '4'���S�. � 92_00
_�
Capacity in Total #of Manufacturer
Gallons Gallons Units � o b ;
Tank Information � ., �,
New Tanlcs E�cisting Taoks � c « " Y � � �
0
a U 'v, � v� �.z. C7 a.
s�;�a Hoia�og T� �-- l�-�iF' �m��, � ���
�g cn�n�
V.Responsibility Statement- I,the undersigned,assume responsibility for installa6on 6e POW7'S shown oo the attac6ed pl�ns.
Plumber's Name(Print) Plumber' MP/MPRS Number Business Phone Number
Gerald Frcemel 9501 I 1 715-558-1138
Plumber's Address(Street,City,State,7.ip Code)
13502W Frcemel Rd Hayward,Wl 54843
VI.Co n /Department Use Only
A`� t� Di roved Permit Fee Date Issued Issuing Agent Si
PP �P u �7��
❑Owner Given Reason for Denial s `0�� 10 I(�'
Conditions of Approval/Reasons for Disapprovat - �� ...h.!`.��� �
f ` `-_-=-��c==.i-y_. '�
f� i
;;f��:� �� �(�I�� :_,. _, oCT � 2 ��22
I IN
�
�� �� � � ` •�' ' r'n� r^,�-r�,
C� l � — a i � � l�0�(d 3�SZ� �ZrJ�.;�;.�.�._., _..,._ ..._,?a
� �W �
Amch to rnmplete plaos for the system aod sabmit to t6e Coanty oely on paper not kss tAan S tn:11 ieches in size 3 0 5��
NO RCFUNDS AF7ER
SBD-6398(R 03/21) ISSUC OF PEMl,AIT
Nathan&Julie Gassman Property Owners Name
11495W Clear lake rd Property Address
p 28742291107 Tax Parcel Number
Sa er County
NE/NE Gov Lot or Qtr-Qtr/Qtr
S29 Section
T42N Town
R7W Range
Page Index
1 Property Information
2 Data Entry
3 Ptot 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
10l12/22 Date
Not an endorsemerrt,written or implied tor the following companies and produds;DelZotto Concrete,Wieser Conuete Products
Inc.,Skaw PreCast Co.,Huffcutt Concrete Inc.,Zabel Environmental Technology,ITT Industries(Goulds),The Pentair Pump
Group(Myers),Infik2tor Systems,ADS Products,Polylok Inc.,Orenco Systems Inc.,Sim/Tech FiRer Ina,Sta-Rde Industries,
Page 1 of 7
In-GrourW Soil AbsorpGon SBD-1070SP(N-Ot/01)Version 2,� Component Manual Used
2 � Number of BedroomsF���
Percent Slope (%)
108 �Depth to Soil Limiting Factor (in.)
0.7 ��In Situ soil application rate
�66 s��c Estimated Wastewater Flow (gpd)
396 Sc Design Wastewater Flow (gpd)
1 'Number of System Elevations
92 Proposed System Elevafion #1
Proposed System Elevation #2
Proposed System Elevation#3
�Original Grade#1
95 '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 J� iDistance Between Cells (ft.)
�-2� � :Proposed Number of Chambers Used
�y ,�� -42&fr Minimum Distribution Cell Area Required (sq.ft.)
E,� -, 450.2 Distribution Cell Area Proposed (sq.ft.)
Wieser�5B �� Septic Tank ose an (if applicable)
�
Lifetime Effluent Filter "select only rf NOT using combo tank
Surface Depth to System
Soil Boring Grade Limiting Lowest Highest Elevation
Number Elevation (ft.) Factor (in.) Elevation Elevation Acceptable
1 94.91 100 89.58 93.66 TRUE
2 95.60 105 89.85 94.35 TRUE
3 95.90 108 89.90 94.65 TRUE
---..._��___ �._�_..
4
_. _..____.__,_L.____.____�_.
5 �µ
Page 2 of 7
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�-w�cl �o wl�-� codes-I-bks �
-�f- S�ze � l0�-4.��dr1 o�Ino�uecz��roX. �.
C•css Sectior. of a ?wc Ce!I In Ground Ccmpcne�:
Using Leaching Chombers
C�Serva'io^�Ve'�l P'pes
� \ \
�I —
g.�7.� �f1611Cd Cil�B - �� ,: . . ._ _.. . _� � FIM5�12�(�#dQC__
S�C /; C.CN$!`pPl�lOfl %
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�f121 GTad6. . � .>��` `�� . �.,:�`� ..�flgfidl GI3de
93.25 Top of Chamber _-__ $ l' �"-'. . � -' ' ;��Top of Giarrber 93.25
92.00 System Elevalian--""_�'i. . . .. �' _ -_A_ System Elevarion 92_00
' � .Yreatn!e�t'F�d'D1ype�ea�.Zo�e. '
. � . ` ' - • � . � ' •
' _ ' . _ • ' . •. . . . __. _ _`^. l;miUng Factor
OL•se•va:-o^./Ve�: D�PeS to b� cons;uctea antl capped w-9Y ppp�oveC molenol5 fer the po•t�culer use.
Dia rams Not To Scale
-- __— — -
— . �=����P'�l�i,t!�F=7��sIJ�-�'�`ri►�T�e"rcn'""' ��
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bservation I Veni Pipes to be bcated 1/5 to 1I10 the�ength of the distrution cell measured from the end of the ceils
Page 4 of 7
Nathan 8 Julie Gassman
11495W Clear lake rd
2.87E+10
Number of Bedrooms 2 Septic Tank Wieser 759
ESiifil8f2d FIOw(average)galbns/day -�9B- � Effluent Filter Lifetime
D2S19f1 FIOW(peak),(Estimated x 1.5)gaYday �36� �jr% Pump Tank #N/A
Soil Application Rate gaUday/HZ 0.7 Pump Type
Influent/Effluent Quai' Monthl Average
Fats, Oil& Grease(FOG 30 mg/L
Biochemical Ouygen Demand (BODS> 220 mg/L
otal Suspended Solids (TSS) 150 mg/L
,,,..-,� 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 Year
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 3 Year
Inspect pump, pump controls&alarm At least once every
Maintenance Instructions
Inspections of tanks and dispersal cells shali 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, idenGty 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 effluent levels in the observation pipes and to check for any ponding of effluent on
the ground surtace. 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-Up and Operdtion
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 performance and
prolong the life of the POWTS: antlbiotics, baby wipes, cigarette butts, condoms, cotton swabs,
degreasers, dental floss, diapers, disinfectants, fat, foundation drain (sump pump)water, gasoline,
grease, oil, painting produds, 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 wifh 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 pertormed to locate a suitable replacement 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 infinged 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 sRe evaluation to
establish a suitable replacement area. Replacement systems must comply with fhe 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 instailed to replace the failed POWTS.
I PJARNING':
Septic, pump and other treatment fanks may contain lethal gasses andJor 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)634-1450� � � �w
POWTS Maintainer Local Regulatory Authority
Name Jays Septic Agency Sawyer County Zoning
Phone# 715-558-1138 � -__..._.____ Phone# 715�34-8288
Page 7 of 7
,/;'�"'''"T''E'r:. PRIVATE ONSITE WASTE TREATMENT county
��-��.,.
' SYSTEMS
,=!;�Sps ���' Sawyer
�`'\�-_i%' ( POWTS)
�H°"ts='��'"� INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� ^ 3�S
Personal infonnation you provide may be used for secondary purposes[Piivacy Law,s. L5.04(1) m)]
Permit Holder's Name: ❑City ❑ Village own of: State Plan Transaction ID#:
N��4� �,ss�4 n i� ��Ce— �—
Insp BM Elev: BM Description: Parcel Tax No:
(QO,c� � ai� (> �c �j" `+ ul.� �,'�e.. 2�` (b����"l� -aq-�lC�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic �,,,�e�r � � Benchmark ,� ��,o �
Dosing gh.� � 9,5;,��. '
Aeration Bldg. Sewer �yZ,y�. �
Holtling St/Ht Inlet �t(,'�3 �
TANK SETBACK INFORMATION St!Ht Outlet S� �
TANK TO PIL WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic a-nj NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man. � ,o �
Holding Dist. Pipe
PUMP 1 SIPHON INFORMATION Infiltrative 5,p oQ�
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 L (� #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav � Conv ❑ Aggregate `G'�I �
��.i
INFORMATION P/L Bidg Well Vyaters � �GP � Chamber Model Number:
❑ AG ❑ EZFIow
CELL TO � � � � ❑ Mound � Other
_ _ �_ _�_ � _- - --- -- Q�--
DISTRIBUTION SYSTEM X Pressure Systems Only
_ _— -- -- -
Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes
Length Dia l Length Dia Spac I Spacing ❑Yes ❑ No �
- ---- —
--- -----—
SOIL COVER
_----_ ---— --- --- - --
Depth Over Depth Over —1 Depth of Seeded/Sodded Mulched
Cell Center Cell Edges I_Topsoil __ __ � p Yes 0 No ( ❑Yes ❑ N�
C OMMENTS: (Include code discrepancies, persons present, etc.)
���l(� �((� �a�3
Plan revision required?❑ Yes � No 03 �3 � � � ���7 l �
—, v C� �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AD�ITIONAL COMMENTS ANO SKETCH
SANITARY PERMIT Nl1MBEA:___�2 �,��5 _.
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