HomeMy WebLinkAbout024-741-30-5414-SAN-2024-119 _:�,`""-"=`�:- , Industry Scrvices Division County� (/)
= 4822 Madison Yards Way q W p/' �
� �S -, Madtson,ti�'I�3705 Sanitary Pcrmit tiu;nbcr(to bc fillcd in b� C�
� PS P.O. Box 7162 I
:;_` aF`, \4adison,VJl Si707-7162 � �✓5 ��LU �
— - --- -- - -- � ------ --- - Sta[e Tiansaction Numbcr--__— ,
Sanitary Permlt Application ^ �
In accordance ivith SPS 33321(2),WSs_Adm Code,submission ofthis focm to thc appropnate governmental unit
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is requir�d prior to obtaining a sauitary permit.Note:Application fotms for siate-owned POWTS are submitted to f'roject Address(it diLTerent U�:,n nc��lir.g add,c:,ti�
the Departmcnt of Safc.y and Prof�xsional Services.Personal informatiun yuu pro��ide may be uscd for seconduy
purposes in accordaucc with the Privacy Law,s. 15_04(1)(m),Stats.
I.Applicarion Information-I'teas�Pnnf;All=;inForm"ahon - ,Sqini
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Property Ownc�'.?�ame Yarccl tt
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Property O�vner;��lailing Address Propertv Location
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Cip-.State Zip Code Yhc:oz\umber
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U.Type of Buiiding(check alI th�t aPply) ���i T ti R 7 G ur v _
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�l or 2 F;unih ll��:clling-i�'umber ofBedrooms
3 Subdivision Nam�
Blo,.k-"-- ' -
ublic/Cammercial-Describe Use
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❑State O�:med- D�,cnbe Usc — Lj\q Numbcr ❑Villagz oF _____
�Tonn of_�a.v�LQ�__ . _— _-
Cl�/.7 � I� 0 — --- -
TII.Ty-pe of Pn1VT5 Permit:(Check cithei"New"or�`.`Re�lacemenY'�nd othe.r aPplicableon`line A Check`nne`I»i ori line I�.Complete tine C if
a�ficable.) . - - ,
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� I�Neu ���ten: �R�iReplacement System �er�4odification i.�Eaistin System(explain) �Addirional P,etrcatment lhu�te�r,!a�n?
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��Hulding I'ank � In-Ground �At-Grde �f ound Individual Srtc ll�s��r� X t)if: i�n�(���I,�n'�
onvenbonat}
La�k�PeP/4cca���
<-. ❑Raie«•al[3efa�.�ision ❑Change ofI'lumber �I'ransfer to New Oevner List Previous Pcirni�'v;n�'�er and I);c: I�s;:c,l p r �
IF,xE�ir�tinn QO + `'ZO Q//� qipQ
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1��.Dispersalli'rcatment Area and Taak lnformahon:: - - :. , ._; ` �,�
Design Plo«-(�c,1+D�sign SoiJ.�pplica n e , tirsfl Dispersal Area Rcquired(5� ��Dispets3l Arza➢�¢rro �vsa•m}_l��ation � ---
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Desing Cl�ambc ' !
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V.Responsibility Statement-I,ttie undcrsigned,assume responsibility-for inst�llatiori.of t6e`•POWT'S shown on`fhesttached pl:ins.
-- ---- --
Plur.�ber��Name fPnniy � Plumber's Signahire • i1�iPIbS Number I liusmess Phon�Aiimher
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Plumi�er's Addre�.(Sirci t.Citv_Stutc,Zip Codc)
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�'L C untv�Dcpartment Usc Only , ..y;;- ..:f . — --
I�� ,�L��,_d/ � i�D�������vi�1 Pennii Fee , Date Issued ]sswno Agevt S��ahire
7�^" � �_'O:��ncr Givcn Rc�son for Dcni�l � � (��,otl i S r�-i �"�`y /j'�/j,GC-�t<X�-� l�i-
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Conditions of:lpprovaUReasons for Disapproval ' �J
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r1tC+ch m compleic piaas[or the s_ystem antf svbmit to the faunty only on pape[oot kss than 81/2 z 11 inches in sue
san-�3�s ca o3n_�� NO REFUNDSAFTER
ISSUE OF PEAMIT -�r�,�; ;�
Verna Nichols Rev Trust Property Owners Name
10135N Filter Bay RD Property Address
24741305414 Tax Parcel Number
Sawyer County
Prt Govt Lot 4 Legal Description
30 Section
41N Town
7W Range
Page Index
1 Property information
3 Plot Plan
5 Tank Information
6 Maintenance Plan
7 Contingency Plan
Note:Tank Replacement
Bruce Vitcenda Plumber's Name
Plumber's Signature
.P.220498 Plumber's License Number
715-943-2382 Plumber's P one Number
5/10/24 Date
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Page 1 of 7
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IM-1530 General Specifications
and illustrations
LIFTING LUG(7YF?) ��R CONNECTION(TYP I
The IM-1530 is an injection molded two piece mid- ���w�Sr�mP,
seam plastic tank. The IM-1530 injection molded
plastic design albws for a mid-seam joint that has ' �
precise dimensions for accepting an engineered
EPDM gasket. Infiltrator's gasket design utilizes ° ° ° 61-'
technology from the water industry to deliver ¢ P � � � � P � � -- ����
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- o 0 0 ,r„o,.,
proven means of maintaining a watertight seal.
The two-piece design is permanently fastened _ �_
using a series of non-corrosive plastic alignment I
dowels and locking seam clips. The IM-1530 is � _ .„5_6�44���oR,�,,�T,,—
— — _ __ _-
assembled and sold through a network of certfied
Infiltrator distributors. TOP VIEW
Must be backfilled and installed in accordance
with Infiltrator Water Technologies, Infiltrator o�T�R��E
(TYPJ
IM-Series Septic Tank General Installation
Instructions and for shallow ground water ii
conditions reference tfie Innttrator IM-Series j �I �
Tank Buoyancy Control Guidance. � ��^�
EXTERIOR
HEIGHT
Please visit www.infiltratorwater.com/images/ �'"'�P I �
pdf/ManualsGuideslfANK0l.pdf for the tatest �i�
♦ LIFTNG STRAP
If1fOCt11'cI IIOII. (TYP.)
'' END VIEW
� Working Capacity 1537 gal (5818 Lj
Total CapaCity 1787 gel (6765 U 024D�610�ACCESSPOR7
ea 17�� wrtM LOcqNG tD(�)
Airsp2ce 16.9% i ic�� ,o.,�zsn F�EsonRo 04[+�1
avc art nes
Length 176" (4460 mm) o`n`tT�
�E7 � 16.9%NR
WIC�1 �� (1567 mm) 3.0 � Q- 1 OUTLET
Length-to-Width Ratio 2.8 to 1 P� �'s' �o °E _02,5,WA«
nucicr�ss
� �i.iiel
Height 55" (1384 mm) ua,� 2�5,�X 2�,i
pEp� FIBERGLASS
SUPPO(it H)
Liquid Level 44" {1118 mm) �"�P��
Invert Drop 3" (76 mm)
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F;berglass supports 4 SIDE VIEW
Compartments 1 or 2 �
Maximum Burial Depth 48" (1219 mm) t cor,rr,uous
TANKTOPHALF -�� . I � ELASTOMERIC
Minimum Burial Depth 6" (152 mm) casK�r
Maximum Pipe Diameter 4" (100 mm) TANK 1 �
Weight 501 Ibs (228 kg) �N�� � t ��`p
�
ALIGNMENT — 'i�
DOWEL I~- TANK BOTTOM FU1LF
////''''�� � �
� 4 Business Park Road �-.i
P.O. Box 768
Old Saybrook CT 06475
1 N F 1 LT R AT O R' �s�� �� F��577 �� MID-HEIGHT SEAM SECTION
,�-�,-�
www.irtfi watorwace._com
U.S.Patents:4,759,661;5,017,041;5,156,486;:5,336.017;5,401,116;5,401.459;5,511,903;5,716,163;5,588,778;5,839,844 Canadian Patents: 1,329,959;2.004,564 Other patents pending.Infdtrator,
Equali[er,Quick4,and SideWnder are registered tratlernarics oi Infiltratw WaterTechndogies.InfitVator is a registered vadernark in France.Infiltrator Waier Techndogies is a reoistered trademark in Mewco.
Contour,MicroLeaching,PoFyTuff,ChamberSpacer,MultiPort, PasiLock,OuickCut,QuickPlay,Snapl ock and StraighN.ock are trademarks of kAdtrator Water Technologies.
PoyLok is a trademark of PolyLok, Inc.TUF-T1TE is a registered trademark of TUF-71TE.INC. Ukra-Rib is a trademark of IPEX Inc.
rJ 2014 Intitrntor Watar Technobgies, LLC.All r�ghts reserved. Printeci in U.S.A. IM?1 1 i 16
• • • • • ' � ' • . • : 11 " •
ema Nichols Rev Trust
10135N Filter Ba RD
2.47E+10
Number of Bedrooms 3 Septic Tank zn, /SJO FN ; �
Estimated Flow(average)gauons�day 300 Effluent Filter t; �;,.� c�y
D@S19�FIOW(peak),(Estimated x t_5)gaUday 450
Soil Application Rate al/da/ftz 0 I
Influent/Effluent Qual" Monthl Average PRINT PAGE �
Fats,Oil&Grease(FOG) 30 mg/L
Biochemical Ox en Demand(BOD,) 220 mg/L
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)
Pum 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 foilowing 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 Ieaks,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 visualty 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 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 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 concenVations 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 surtace.
Page 6 of 7
Do not drive or park vehicles over tanks and dispersal cells.
Redudion or elimination of the following from the wastewater stream may improve the performance and probng
fhe Irfe 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, sani[ary 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 pds shall be disconnected and the abandoned pipe openings sealed.
-The contents of ail 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.
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)
OThe site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil
and sde 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 compaction and should no
be infringed upon by required setbacks from existing and proposed structures, lot lines and weils. Failure to
protect the replacements area will resuft in the need for a new soil and sde evaluation to establish a sudable
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 limdffifons. A holding tank may be
installed to replace the failed POWTS.
��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 resuft. Rescue of a person from the
interior of a tank may be df�cuR 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�34-8288
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SAWYER COUNTY SANITATION DEPARTMENT
TEMPORARY EMERGENCY TANK INSTALLATiON APPROVAL
PROPERTY OWNERS NAME: �JQr�no. WI- N��1'I�15 �2✓_����
TOWN OF: �ea.�.nr� (.�„IL�
ADDRESS: � ( ��3�N � �-�y � .
I, �(Z►t Z �� ''� <z✓1 � � , a Wisconsin
Licensed Plumber, authorized by the owner, do hereby acknowledge that I am receiving
temporary approval to install a septic tank/holding tank without a soil and site evahtation,
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 381 .01 (92), Wisc.
Adm. Code, corrective measures will be taken as such that the private sewage system
complies with all applicable requirements of cl�apter 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
Pern�its], of the Sawyer County Citation Ordinance.
DEADLINE FOR THIS AGREEMENT SHALL BE: 6�4���`�
,�
Signed: � '
Date: � ��d,T
Accepted by: � ry.�. ��,,�
Date of temporary emergency approval: ��O��.�
Rev. 03/26/13