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Home My WebLink About014-842-03-3101-SAN-2023-210 �'' ' Industry Services Division County � 4822 Madison Yards Way X'.cfv� •�r— �_' = Madison,WI 53705 Sanitary Pemut Number(to be fi(led in by( : P.O.Box 7162 ` � Madison,WI 53707-7162 �D s � �G'�� Sanitary Permit Application StateTransa`ctionNumber � � ln accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate govemmental unit is required prior to obtaining a sanitary pertnit.Note:ApplicaUion forms for state-0wned POWTS are submitYed to Project Address(if different than mailing ad� C the Departrnent of Safety and Professional Services.Personai information you provide may be used for secondary puiposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. ... I.Application Information-Pksse Print All Informatioe Properiy Owner's Name Parcel# ��s R��,><� GL c ptY-gy;t-d 3 - .��o/ Property Owner's Mailing Address Properry Location ! 02 �' /V S c�e ' Q� @o ot-�bE� City,State Zip Code Phone Number C_ (/� �� {�i� � �� /e,�� e, Section� li�� p II.Type of Building(check all that apply) Lot# T � N R � E o� � 1 or 2 Family Dwelling-Number ofBedrooms �-`��t'�i B�-�� Subdivision Name ��Q .S►'1� Block# '�— ❑Public/Commercial-Describe Use � ❑City of ❑State Owned-Describe Use CSM Number ❑Village of '— �Town of ��`�/'�� llI.Type of POWTS Permit:(Check either"New"or"ReplacemenY'and other applicable o�line A. Check one boa on line B.Complete line C i a licabie. '�� New System �Repiacement System g y ( � ) ( ap ) ❑Other Modification to Eacistin S stem e lain ❑ Additional Pretreatrnent Unit e lain B' ❑Holding Tank �In-Ground ❑At-Grade gn ❑Other Type(explain) ❑Mound ❑ Individual Site Desi (conventional) C• ❑Renewal Before ❑Revision ❑Change of Plumber ❑Transfer to New Owner �st Previous Permit Number and Date Issued Expiration 03- y3 7 �_�6"� Q,�= 2,3 g IV.DispersaUTreatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/s� Bispersal Area Required(sfl Dispersal Area Proposed(s� System Elevation �a0 • 7 �l��,b �5�. �a iS,o0 Capacity in Total #of Manufacturer Tank tnfocmation Gallons Gal(ons Units � � U �, � � � New Tanks Enisting Tanks � o �a„ � Y p c_`� `c� W G r!) r"'ii V� W (.�J 0.� Septic or Holding Tank �� f ES�,r Dosing Chamber V.Responsibility Statement- I,the andersigned,assume responsibility for instaltation of the POWTS s6own on thc attac6ed plans. Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone Number .�� .��1 /�� G.j�2`'� �5�//� 7�s=s-s� ��,�� Plumber's Address(Street,City,State,Zip Code) � 3sv;� w F�� ,��I N�. �-�.-� G�.� .�y Yy� VI.Coun /Department Use Only �A ov, ❑Disapproved Permit Fee Date Issued Issui�g Agent Signature ❑Owner Given Reason far Denial $ 1�� i I a 3 ��u'Q�('f��--_ Conditions of ApprovaUReasons for Disappmval � �� . , � � �, � � �a�`"�c""��3`� �� AUG 2 9 2023 l � �a � ��-� 3$I`t �, � � .hk# CS I �-�— I �'I li >�;�tt' ....:,_�$��_.�.,..�—.�..----'.a SAWYER COUNTY Z{?fd1NG ADM�NISTRATlON Attach to rnmplete plans for the system and sabmit to the Coaoty oaly on paper not less then 8 tn a 11 inches in size i �y u ) NO RCFUNUS AF��A SBD-6398(R 03/21) (c��Q�pERIlA11 Neas Rentals LLC Property Owners Name 14258N Mosbaek Rd � Property Address 014-842-03-3101 Tax Parcel Number Sawyer County � � NE/SW Gov Lot or Qtr-QtNQtr S3 Section T42N 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 Pian County Parcel Listing Gerald Froemel Plumber's Name ,/! Q��/ Plumber's Signature 950111 Plumber's License Number 715-558-1138 Plumber's Phone Number 08/29/23 Date Not an endorsement,written or implied for the following companies and products;DeiZotto Concrete,Wieser Concrete Products Inc.,Skaw PreCast Co.,Huffcutt Concrete Inc.,Zabel Environmental Technology,ITT Industries(Goulds),The Pentair Pump Group(Myers), Infiftrator Systems,ADS Produds,Potylok lnc.,Orenco Systems lnc.,Simlfech Fifter Inc.,Sta-Rite Industries, Page 1 of 7 2z-�� 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 iln Situ soil application rate 200 Estimated Wastewater Flow (gpd) 300 Design Wastewater Flow (gpd) 1 Number of System Elevations 95 Proposed System Elevation#1 Proposed System Elevation #2 _Proposed System Elevation#3 �Original Grade#1 99 �:Finished Grade#1 �Original Grade#2 �i 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 Befinreen Cells (ft.) 22 Proposed Number of Chambers Used 428.6 Minimum Distribution Cell Area Required (sq.ft.) 450.2 Distribution Cell Area Proposed (sq.ft.) Wieser 750 Septic Tank ose an (if applicable):' ; Lifetime �� Effluent Filter ""select only if NOT using combo tank SurFace Depth to System Soil Boring Grade Limiting Lowest Highest Elevation Number Elevation (ft.) Factor (in.) Elevation Elevation Acceptable 1 3.00 -1.25 FALSE 2 3.00 -1.25 FALSE 3 3.00 -1.25 FALSE 4 5 Page 2 of 7 a.�,�� Ial�'�l�i �2'Q1^� "�L''lnSlnl �' �� I , s•Lb� �'!' 1's �-53 � ,s�b � hb a �� ,s7�b •�� -�S►�s s�-os L' � �t_bb ' £ ,�9 L�b '2 ��C£'bb �1� --�oop�.��a�4-�.�a,�-�; �d�lno, c141�iS T �.� � a�a�� },Z'b 1 t � b' � P � � ^ � oE o= o� v � 5 � � � 3 �o� =„� a�b� 8 �s�b � 3 � � I �� i • ��p/,r,`� 1t.rq�<,, y � I Q ( %/ 0 � 3 /��2 L,ao�s �NZ ( � .- , o �to 0 Z .. Iv � y6��o�,s�a�ti��6 A � I � Y � T W H � I � � ��.IC1��t1J�S /tJOS9�;J:ik: v�: �a��ea� aq �ou ��eys L � _ ;?tt. 'Fr+;R[� '�Fr'IT�]If'"f'i_i L la�s�� 73 Z,'b] . �,ieo� rzh ...� £o � Msl3r tzs�s 1 � ' �19� 1 a1� -- £O "Z�t$—�� N�d 1�?J >la�qsolM N Ss�hl •��,� �oJ1�1a"7 �O� �a�n'►bS' 71J1 51��-�a�_— 1�'1 S�aU M4 Cress Section of a Two Cell In Ground Ccmpone�: Using �eaching Chambers obs/ervatio�/ve-�t Plpes / \ 99.00 Finished Grade - — --- Finished Grade—� Slope_ S Celf�Seperation� i —__ �.�:1' �. :j T�� ,. Orginal Grada--� ,\Y, �`� �,,.ffrginal Grade 96.25 Top of Chamber � �'Top of Chamber 96.25 "" '�.. ' '�� . _ �" " _'' /�`. 95.00 System Elevation • . ,. '_System Elevation 95.00 �. .Yreo tr*,en;�pnd'Dispe�saV.Zo�e. . � • .•.__' - -, .• . .._..______ ' t�miilnc Factor Obse•vo:�o��/Ve�; pipes to be constucce0 and capped w�th opproved mote�io�s !or the particulcr use. Dia rams Not To Scaie � --��,��.,.�, 5_ ,. �..�. l�� __ _ . �— _�---= —� i __ I 1 � I-�� ., �- .:;' .�.-. ,.�,,- �`1 ��,�.�r.:��. ��..,,.. I ., , .. "�. ,-� `- ----- - _— _, bservation/Vent Pipes to be located 1l5 to 1/10 the length of the distMion cell measured from the end of the cells Page 4 of 7 Neas Rentals LLC 14258N Mosbaek Rd 014-842-03-3101 Number of Bedrooms 2 Septic Tank Wieser 750 Estimated Flow(average)gallons�day 2 0 Effluent Filter Lifetime Design Flow(peak),(Estimated x�.5)gavday 300 Pump Tank #N/A Soil Application Rate gaUday/ft� 0.7 Pump Type Influent/Effluent Qual' Monthl Average Fats, Oil 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 Plan be recorded with the Register of Deeds. Maintenance Schedule Service Event Service Frequency Inspect condition of tank(s) At least once every �p 3 Year Pum out contents of tank(s) When combined siud 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 fnstructions Inspections of tanks and dispersal cells shall be made by an individual carrying one of the foilowing licenses or certifications:Master Plumber, Master Plumber Restricted Sewer, POWfS 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 effiuent 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 surface. 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 ot 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 Operation For new construction, prior to use of the POWTS check treatment tank(s)for the presence ot painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concenhations 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 infiRrative 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, oii, 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 ali 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. Contingencv 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) r The site has not been evaluated to identity 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 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 wmpaction 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 tor a new soil and site evaluation to eslabiish 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. �'�WAftNING!t Septic, pump and other treatment tanks may contain lethai gasses and/or insufficient oxygen. Do not enter a septic, pump or other Veatment tank under any circumstances. Death may resuft. Rescue of a person from the interior of a tank may be difficult or impossible. POWTS Installer Septic Pumper Neme Gerald Froemel Name cott Poppe Phone# 715-558-1138 Phone# (715) 634-1450��W ��µ�« POWTS Maintainer Local Regulatory Authority Name Jays Septic Agency Sawyer County Zoning Phone# '715-558-1138 � x� Phone# 715-634-8288 Page 7 of 7 °` �'-'"�' PRIVATE ONSITE WASTE TREATMENT county %_,� �� = � oS sYsrEms Sawyer �>�� PS �~ ( POWTS) �9GFT�_.%"yP;�� ='"��-��' INSPECTION REPORT sa�itary Perrpit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION � 3 .� �� Personal infonnation you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(in)J Permit Holder's Name: ❑City ❑ Village l�Town of: State Pian Transaction ID#: Ne.ai ��-��s «�- ��,No�fi- -- Insp BM Elev: BM Description: � Parcel Tax No: �O.�p� Co�n C . �� e v��j d�C�.�" a I�-( --- �(,� ��,� '.3l� � TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic � �p Benchmark ��0 tj Dosing Aeration Bltlg. Sewer � Holding St/Ht�nlet Q'7.Y � TANK SETBACK INFORMATION St I Ht Outlet �7, � � TANK TO P/L WELL BLDG vENrTo ROAD Dt Inlet AIR WTAKE Septic kto,j ttoa� *�a.` i-�{p� NA Dt Bottom Dosing NA installation Contour Aeration NA Header/Man. ��p � Holding Dist. Pipe PUMP 151PHON INFORMATION Infi�trative �6 � � Surface Manufacturer Demand Final Grade Model Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFOR ATION DIMENSIONS W 3� L #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav 'P�Conv ❑ Aggregate �,�1, INFORMATION P/L Bltlg Well �raters o GP �Chamber Model Number: ❑ EZFIow CELLTO {.(csa fi� �t-� -�/6D - -❑ Mound_ ❑ Other �Y� ------—- DISTRIBUTION SYSTEM x Pressure Systems Only Header/Manifold Distribution Pipe(s) ' X Hole Size , X Hole Observation Pipes Length Dia Length Dia Spac , _ _ _ _ j Spacing ❑Yes ❑ No SOIL COVER Depth Over Depth Over Depth of �Seeded/Sodded 1 Mulched � Cell Center Cell Edges Topsoil �Yes ❑ No � ❑Yes ❑ �o COMMENTS: (Include code discrepancies, persons present, etc.) ',��,�(� ��Zl �3 � � ��a� �� Plan revision required?❑Yes❑ No �� ..� � I � i e� � �� _ � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) ADOITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER:__�.�-o�-_�O _ . . _ _ _ : . , _ . , , . . \ �, �� o�' � �� QY+ x�� , ;��P� 51�� a� �+ • - - - - - - - - - - - ; 1� � • � . 6,� � ��, s (�`� � �� -1�� 5� .��- �` � ja � �� (� � � � r - r a ��