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Home My WebLink About030-737-25-2201-SAN-2023-290 . _:��="="-"�; , Indushy Scrvices Division County � `.�: � ' 4822 Madison 1'ards Way ,s W /' � ,:, �: j Madison,VdI�3705 Sanitary Pcrmit Numbcr(to bc fillcd in by � PS P.o_Box 7162 �;� ` - Madison,WI 53707-7162 �' s � � 1 `� W �:,,_-_ -- - � Sanitary Pennit Application Sta[eTr.�nsactionA�umbcr � In accordancc��th SPS 333.21(2),\Vis_Adm_Codr.,submission of this form to thc appropriate governmental unit O is required prior to obtaining a sanitary permit.Note:Application fozms for state-0wned POWTS aie submiiYed to Project Address(if different than m:�iling� the Departmcut o(Safe.��and Profcssional Sen�ices.Peisoual informaUon you provide may be used for secondary purposes in acwrdancc�vitL thc Privacy Iaw�,s. 1�.04(1)(m),3tals. ��_ [.Applicafion Infi�rmation-Plcase=Print Alt Iniormation Propem�Owner':?�ame Parcel# C/'.vaP�I Si� .✓ ' v � 7 Ao/ Property O«�ner's:�iailing Address Property Location �� f/ .✓ Gsw� City,State "Lip Code Ph�ne\umber �,re/q,�d 1�✓L ✓�' b'3.�' .flG/ '/, •d1✓ '.<, Section��__ Il.Type of Biiiiding(check all that appty) L��i�` T 7___ti R__7 G or v 3 '� Subdivision Namc �1 or2 Famifyi)�t•cllin�-NumberoiBedrooms -- Block= �"�- ❑f'u�lidCommercial-Describe Use_ � - ❑City of _ ❑State Owned--Describe Use — CS�-1 Numbcr illage�f _ — �To��n of�0/' __�_ 7II.Typc of P01VTS Permit:(Check cither"iVew"or."Replacement"and ottier applicabte ou line A. Check onel�ot:on Iirie B.Complete line C if a licable.) A. �te�c Sy,tem e�tacement System ❑Other��fodification to Existing System(explain} ❑Addirional Prctrcatment Unft(explain) E 7arKcal �� ❑Ho(ding Tank ❑In-Ground ��t-Grade �Mound Individual Site llesien Od�er"f}7�e(crplainl (convcnbonal) C• ❑Rene��ai Befnre �Re��ision ❑C6ange of Plumber �I'ransferto New O�vner List Pre�•ious Pcmiit Number and Datc Issi:cd F>:�r:at�,�, �`I—�$� io 3� � 1V.Disper-saUt'reatment Area and Tank Information:•- - ';`3 `` Desi�m Flo�v(�ndt , Desi�n Soi!�Pplication Ratc(gp�l%stl Dispc*sel Area Required(sfl Dispersal Arca s System F_]evation yso -- o.5 -- �o 0 1 39(o �- �s��► 7 Capacity in � Total � =of Manufa er , � l'ank[nformarun Galions � Gallons � 1'niLe � � I J?_', � � \ctir Ta�ti:� Exisiing Tanks � � I u � � � a �" `� � ; n � ' .., v v: r :n ... 0 _ Scpu ;cSolJin,�fanl: ..�._. . � � i O�o i 440 � f�4 u/ Dosing Chambc� � � � � i � i V.Responsihilit}�Statement-I,tHe undersipned,ass�me responsibility for iastdlation oi t6e POWTS shown on the attacfied pl:ms. Plumbcr'�Vamc;Pnnt) � Plumber s SiRnature � .v i1tPRS Number f3usincss Phonc\umber I ` ,�c� v<�zP� � ,� � .l.�oy9� �iS-�Y� �d.��,j F'li�cr.nc;'s Addre.s(S�rcc:.C�h.titatc,Lip Cod�} 7�/� T d f�//� f' VL C u tr'IDepartment Usc Only �A�� , ve n Disapproved Permit Fee I Date Issued Issuing Agent Signaturc �� 1 S K�� I � � � � / c� � ' ��Ct,t�ie�(�rF�t��> � ��:encr G.ven Reason for Dcnial Cunditions of:lppro��aL'Reasons for Disapproval � �....' f�.,, ,'--�G- --1 F'1 A � ) � I �,5 , _,�3. \�f r,� �, i � � � /, ' '�i�. ., ��'�-=�'� I I I O�f �.,,.._�-- n �-J.. ''� .�.�__l�, � ri�� hi`u�r r� � ';'1k# � cs��-3 � i�� ..: 5�0� _ c�� t ��3 , , �,_�•,�•.;-_�-;-;r'.. �,:-Y _, :ltGch co comptete pians tor the s_ysEem ami svbmit to the County vnly on paper�t las than 8 t/2 z 11 iach�in s�ie RO R`.:FJ�D��u`=7�R �'� f 3 z-t SBD-6393(R.03'2t) ��UF f�� Bernard Sihsmann Trust Property Owners Name 878N Sihsmann RD Property Address 30737252201 Tax Parcel Number Sawyer County Prt NW-NW Legal Description 25 Section 37N Town 7W Range Page Index 1 Property Information -_ - , 3 Plot Pian 5 Tank Information 6 Maintenance Plan 7 Contingency Plan Ta,� R a� ,�r ou�y y o r 9yo /Ooo l. i/t � - ' T�' r � Bruce Vitcenda Plumber's Name Plumber's Signature M.P. 220498 Plumber's License Number 715-943-2382 Plumber's Phone Number 10/29/23 Date SB D - /o �os Vc� �o Page 1 of 7 �W.UC/ /�lv�,be� �c�,vard��'�s�nQ,�r,J �Rv�e�;a�e,�,�� t,V s' /y�Y,vs�Hwy4o r ��16m a AJ�J�� "xe�a.vd,wS.fy CXe��'✓d/ Wr. ��"943-�3f1� f3s 5�y3.� ,L_,__. MP-.7.ZoY9y iis•fq S; N R�! � � S�P,y � Pl'T'Nw-�vw f.a3 T, 37,� R� �w t4rcersf epe7J�:f�,tnr f Tov.i wer'tpa� I 4M • /.lf��or.qs'Borto,� � � �Ff;J;u! 8i- ic.�s• � i (�1' 17.45' � Q3- 46-ys` � �eui a,��ary �3.;� �Kaw �Ooo � ,F � G i r f,'�,��%I lu QiSei'sw/cl,a,'r-[o�K { �Jcll TG,�K�CPIQ[PTf.��O.v/y Itoe K�w 7 f'�rooNsyst�em ; 38dr � bataf� : ! � � co y o ��cr NO('f0 SG a 1 C 8� �°� CX�61;� p B gi �h�� e ( - 03 i I — � � � lsc4it ��:4a� I N� - �� E Bernard Sihsmann Trust 878N Sihsmann RD 3.07E+10 Number of Bedrooms 3 Septic Tank Skaw 1000 EStif718t2d FIOw(average)gallons/day 300 Effluent Filter L� � �' � / DeStgn Flow(peak), (Estimated x 1.5)gal/day 450 Soil Application Rate al/day/ft2 0 Influent/ Effluent Quality Monthl Average PRINT PAGE I Fats, Oil &Grease (FOG) 30 mg/L ---� Biochemical Ox en Demand (BODS� 220 mglL Total Suspended Solids (TSS) 150 mg/L !!NOTE!! 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 3 Year(s) 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(s) Clean effluent filter At least once every 3 Year(s) Maintenance Instructions Inspections of tanks and dispersal cells 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 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 surface may indicate a failing condition and requires the immediate notification of the local regulatory authoriry. 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 Sawyer County Zoning Dept 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 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 IDo not drive or park vehicles over tanks and dispersal ceils. 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, oil, painting products, ! pesticides, sanitary napkins, tampons, and water softener brine. � �' Abandonment I 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 voidspace 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 performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed to replace the failed POWTS. � DA 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 no 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 I installed to replace the failed POWTS. � i ►�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 Bruce Vitcenda Name Northwest Sanitary Phone# 715-943-2382 Phone# 715-943-2650 POWTS Maintainer Local Regulatory Authority Name Northwest Sanitary Agency Sawyer County Zoning Phone# 715-943-2650 Phone# 715-634-8288 7 of 7 , . � � � ,�� ) ��•`�� y � Officeof . • ��3al�a � � ��`� Saw er Count Zonin Adminlstration � �'�°�� Y Y g 10610 Main Street Suite 49 �� Hayward, Wisconsin 54843 ,�;-, :- �E�_�p�l� (715)634-8288 �' : [� ��J� ��.�I� FAX(715)638-3277 �`,� C��/ �Q/ ..�� -.�� wuu sawve�coun o��.orq " ', ,r C�/�� (A� _�; -- ! �'i�� F.-mail:ronink sec(a;tiawvcrcounty�o��.ore �y � o� o Toll Free Courthouse/General Information 1-877-699�110 � i \�\_'- � � �` �Cj? �� } ��. �I��, ` �'��_ `� � I �iScoN�� ``-'Niti�✓rF ?��3 �� G��'��T� � SAWYER COUNTY SANITATION DEPARTMENT 4��" TEMPORARY EMERGENCY TANK INSTALLATION APPROVAL PROPERTY OWNERS NAME: �� s;�5r,nav�h �Tn,.,S`fi TOWN OF: ��9a� ADDRESS: �"�� y,�ctrv� Y��. � I, � �� i'�/ , a Wisconsin Licensed lumber, authortzed by the owner, do hereby acknowledge that I am receiving temporary approval to install a septic tank/holding tank without a soil and site evaluation, or existing system evaluation, and private sewage system plan review due to inclement weather and/or health and/or safety emergency. Further, I acknowledge that a soil and site evaluation, or existing system evaluation, and private sewage system plan review will be conducted by the deadline stipulated by the permit issuing agent, or as soon as weather conditions or circumstances permit. If the private sewage system is found to be failing as defined in s. DSPS 38l.O1 (92), Wisc. Adm. Code, corrective measures will be taken as such that the private sewage system complies with all applicable requirements of chapter DSPS. 383, Wis. Adm. Code, within 90 days of this agreement. I further acknowledge that failure to comply by obtaining all necessary permits after the deadline date may result in the issuing of a citation, under Section 11.3 [2) Sanitary Permits], of the Sawyer County Citation Ordinance. DEADLINE FOR THIS AGREEMENT SHALL BE: I 1 3 0 �2 Signed: `� Date: � 1 0 � �d�� Accepted by: ^ Date of temporary emergency approvaL• ��l �� 3 Rev. 03/26/13 BAFFLE 54.00 58.00 i�� ^�� 64.00 / � WARNING DEATH MAY OCCUR lF TANK IS ENTERED � WITHOUT PROPER EQUIPMENT r � � I o � 1 � �` � 124.50 �� 118.50 TOP VIEW OF MANHOLE COVER I ( 14.50 FILTER �3.00 23.00� 12.00 �23.00 4.0� I 27.00 27.00� J— 24.00 24.00 s.00 �� TOP VIEW OF TANK (TAPERED) � ��s.oo--� �.007 —1- 2.o0 INLET � / 11.00 �— � i O sw�w i000 i �' OUTLET� � � ---------------------- — — —� ' 56.0 — � 4 INCH PRESS 2'00 18 0o PRESS �i � SEAL GASKET INSTALLED S�� I i WHEN POURED \ GASKET � i BAFFLE 36.50 F/LTER � j I I I I I I 1 I I I I � L'________'__"__________'J s.5o T SECTION VlEW OF TANK AND COVER 3.00 OUTLET END VIEW OF TANK Mode/Number: 7000 S KAW P RE-CAST c � Approved for: SEPTIC, SIPHON, HOLDING, OR PUMP Phone: 715 967-2277 26255 105th Street, New Auburn Toll Free: 1-800-924-8625 Weight Inlef Dim. Outlet Dim. Liq. Depth Gal. /In. Max. Cap. Wisconsin 54757 Fax: (715) 967-2707 83001bs. 42" 40" 36.50" 28.32 1034 gal. www,skawprecast.com