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Home My WebLink About002-133-01-0300-SAN-2023-048 ��-`e'`-'��; - Industry Services Division County �1 - 4822 Madison Yards Way SAWYER � ;` ,�_' = Madison,WI 53705 Sanitary Permit Number(to be filled in by� � = P.O.Box 7162 = Madison,WI 53707-7162 (jj `�C'� "j�'� � Sanita.ry Permit Application State Transadion Number w In acwrdance with SPS 383.21(2),Wis.Adm.Code,submission ofthis fortn to the appropriate govemmental unit '� C is required prior to obtaining a sanitary permit Note:Applicarion forms for state-owned POWTS aze submitted to Project Address(if different than mailing ,,,� the Depattrnent of Safety and Professional Services.Persona(information you provide may be used for secondary 15281 W Circle Rd � purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. I.Appiicatioo Information-Please Print All Information PropeRy Owner's Name Pazcel# Olympus One Trust 002133010300 Property Owner's Mailing Address Property Location 2828 Prairie Ciover PL Govt.Lot City,State Zip Code Phone Number ONALASKA 54650 y., '/,, Section 2 II.Type of Building(check all that 9pply) Lot#3&4 prt 5 T 39 N R 9 E or W t�l or2 Family Dwelling-NumberofBedrooms 1/garape-0ffice SubdivisionNan�e Block#1 ❑Public/Commercial-Describe Use ❑City of ❑State Owned-Describe Use CSM Number ❑Village of 13/332 #3372 �Town of Bass Lake III.Type of POWTS Permit:(Check either"New"or"ReplacemenY'snd ot6er applicable oe line A. C6eck one box on line B.Complete line C i s licable. `�� New System ❑ Replacement System g y p ) p ) ❑Other Modification to Existin S stem(ex lain ❑Additional Pretreatment Unit(ex lain B' �Holding Tank ❑ In-Ground ❑ Ai-Grade ❑ Mound ❑ Individual Site Design ❑Other Type(explain) (conventional) r• ❑Renewal Before ❑ Revision ❑ Change of Plumber ❑Transfer to New Owner ist Previous Permit Number and Date Issued Expiration ---�--- IV.Dispersal/Treatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/sfl Dispersal Area Required(sfl Dispersal Area Proposed(s� System Elevation /00 If� h`� Y`�`T �y`� Capacity in Total #of Manufacturer Tank Infortnation Gallons Gallons Units ,t, � o $ � New Tanks Exisling Tanks � o �; � Y � i� c`� n, U v� v, �n w :7 Ci. Septic or Holding Tank ppQ 000 1 ieset Dosing Chamber V.Responsibility Statemeet- I,thc HBdersigned,assome responsibility for iastallation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Si MP/MPRS Number Business Phone Number GERAI.D FROEMEL /' 950111 715-558-1138 � Plumber's Address(Street,City,State,Zip Code) I3502W Frcemel Rd Haywazd,Wl 54843 VI.Coun /Department Use Only �Ap�r ❑Disapproved Permit Fee Date Issued Issuing Agent Signature �1� ❑Owner Given Reason for Denial $ (�-� 5 I� � �� '" l�c�f�f�"U�'`��- Conditions of ApprovaUReasons for Disapproval f� �� > - �� a�� - MAY 0 8 2023 '� � :�i�k# ►�38 --.�--�.._,.�.rr:.� �-�-- ^ I SqAWI(ER COU.�Np7�Y �� 'V� ��.1 1il`e� r�,�'ent#?_.._�.��.�-� . ......_.,.,.. ... . �V1`1n'M^"""'_�J f rY'�� I � AttacY to rn�plete plaas for the syste�o aed sabsit to the Couety ooly oa paper oot kss Ws�8 U2:11 iecbes m size �'� SBD-6398(R 03/21) Sawyer County Zoning & Conservation Administration 10610 Main Street, Suite 49 ��R C�� Hayward, Wisconsin 54843 �'��OCi�� (715)634-8288 �� FAX(715)63R-3277 �y/_ __ _ �% wwwsawycrcount ov.org � o` �� - '� � E-mail:sanitanan(n sawyercounty oQ v.c�rg I, \�=�_�� Toll Free Courthousc/Gcncral Information I-877-699-4110 ` " �� 1`Q N:�� Holding Tank Approval Checklist I. Sanitary Cover Sheet: Date Stainp OS d� / 23 Parcel ID# (7 O� - 1 3 3 - b t - 0 �o� II. Plot Plan: D�Property Lines y�Benchmark BM ♦ �Site Address �North Arrow �Structure �Scale �Well �<25' to Service Road �CLegal Description �Nearest Road Intersection �Setbacks to: Property Line, Well, Structure, Water bodies, Roads III. Required Plans: � Index Page with Original Signature � Management Plan/Contingency Plan � Servicing Contract �Holding Tank Agreeinent Form ($30 to ROD) IV. Holding Tank Specifications: �Tank Cross-Section: Manufacturer: w��r Gallons: �,� �Tank Anchar Calculations [SPS 383.43 (8) (g)] �Locking device, chains/locks �Alann, electrical per SPS 383.43 (8) (e) �" Bedding Material < 1/2 " V. POWTS Component Manual Reference: �Holding Tank Version 2.1 (May 2022-2027) Owner: �`(h-��L,S Q,,,��.,�� Plw-nber: �� `S'. Application Review Date: d S(og(�3 POWTS Reviewer: ��µ � � Name �� _ ( F Rev. 4/27/2023 Credential# PAGE 1 OF 4 Holding Tank Plan Index & Cover Sheet Component Manual Design References: Version 2.0,SBD-10855-P(N.03/07;R 01/12) Pg 1 of 4 Index&Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Holding Tank Specifications Pg 4 of 4 Management Plan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report&Site Map(if applicable) Holdin Tank Pum in Contract if a licable) Holdin Tank A reement if a licable Project Name/Description Owner Name(s): Olympus One Trust Phone: Owner Address: Z82$Priarie clover PI Onalaska,Wl Z�p; 54650 Project Address- 15281 W Circle Rd Govt Lot: 1/4 of 1/4,Section2 ,T39 N-R9 E❑or W� Township: Town of Bass Lake County: Sawyer Project Parcel ID#: 002133010300 Designer Information Designer Name: G�rald Froemel Phone: ��15�558-1138 DesignerAddress: �3502W Froemel Rd Hayward,Wl Z�P; 54843 �-Illa��: la�fOeRlel Q�9R1811.CA�lI Chi,space resetved Tor appruc;il stamp. License Number: 950111 Remarks: � Signature:��`" � Date: y22�23 Original signature required on each submitted copy. SGa.Qt`c 1 :y0 ' � . � ,V, w . �i,�� lP � 01 D�y /�7 P li3 o"K i �``S/ �,. I S"�sr I�/ c;��le �2� Prc��oo�l330/030o y�`5� •N� � lown o�84sfLwkf _I • 9f , s��-y�, ��Y �� >��<�� g.r'"+�0/0�,4':0 �� NGM,l / � Tt I�pbwPB IP I �yh = /OC�.o d � !«, �c �° �0a �� a�D00 l�v ic5« �f� r� PI � ii�' ` _ �� r�/�f�y-Solrl PAGE 3 OF 4 HOLDING TANK SPECIFICATIONS (No Scale) Weatherproot 12"Min.w 2.0 ft above Junction and q �,� Established Fbod Elevadon Alarm Box Vent Cap (ryw�� Electripl mus[comply with � Approved Locking Manhole SPS 316 and NEC 300 4"0 Vent Pipe with Waming Label Attached Condui� >10 ft from (tyw�y�j 4"Min.or 2.0 it above 8uilding � Eshablished Flood Elevation (bPical) .- �Air�ghtSeal� " " Finished Grade 16"Min. (�YW�4 ' a. 9 a Inle� Inlet Invert Watertight Approved Joints v%th � _ � Plug Approved Pipe 3 ft onto Maz. 12"or 90°,6 of total volume Sdid Gmund � it more than one tank n Alarm-On e e HOLDING TANK VOLUME = 2,000 9a� a' a ' . A . . .o . . . . . . 3'Approved Beddirg Material Beneath Tank TANK MANUFACTURER: Wieser Concrete Anchortank as necessary pursuant to SPS 383.43(8)(g) Ballast Weight= [(cu.ft.tank.vol x 62.41bs/cu.ft)- Ibs.tank.wtJ x 1.5 Holding Tank exterior dimensions in inches: (Length "x Width_"x Height ")/1728=0.00 fh' Baliast Weight= [( 0.00 cu.ft.x 62.4 Ibs/cu.ft x 1.5) - Ibs = 0 Ibs PAGE40F4 Holding Tank Management Plan IMPORTANT: The owner of this holding tank(s)shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384,Wisc.Admin. Code. Pursuant to SPS 383.52(2),Wisc. Admin. Code, this holding tank(s) shal� be considered a human health hazard 'rf not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52(3),Wisc. Admin. Code. Estlmated Daily Wastewater Flow= �� gpd Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors(i.e. odors, user complaints, etc.) o mechanical malfunction(i.e., pumps,valves, switches,floats, etc.) o material fatigue(i.e., leaks, breaks, corrosion, etc.) o neglect or improper use(i.e., exceeding design capacities, prohibited activities, etc.) o electrical components (i.e.,wiring, connections, switches, confrols, timers, alarms, etc.) o surface discharge of etfluent or sewage back-up into structure served SERVICING FREQUENCY o The tank(s)shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wisc. Stats. when the wastewater in the tank(s) reaches a level of one foot below the inlet invert of the tank(s). Disposal of contents shall be pursuant to NR 113,Wisc. Admin. Code. Tank pumping reports shali be submitted to the proper local govemment unk in accordance with SPS 383.55 Wis. Admin. Code. Report any component failure or malfunction to: Name of individual or company: �ays Septic Phone: ��15) 558-1138 Local govemment unit: Sawyer County Zoning Phone: ��15) 634-8288 Local govemment unit address: 10610 Main St, Ste 49 Hayward, WI Z�P: 54g43 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1),Wisc.Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383,Wisc.Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Continaencv Plan In the event that any failed component of this holding tank(s)cannot be repaired, it shall be replaced pursuant to a plan submitted to fhe appropriate agecy for review and approval. Svstem Abandonment If use of this tank(s)is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc. Admin. Code. HOLDING TANK SERVICING CONTRACT Contract Datc: 01 / /O l ?0.23 This contract is made between the Holding Tank O�vner and the Pumper. Holding Tank Owncr's Namc: Pumper's Namc: (� G �'� ��y � it/� 7"/��11" G�% 5 co�7` �a�Q, � ��1�' Parcel Identitication Number: , � ( 12 Digit Legacy ID) � U � - � �� - � � - � �� _ I . Thc ownci- abrccs to file a copy of this contract with thc govcrnmcntal unit, Sawycr Counly, which has accepted and recorded with the Office of the Register of Deeds, the Maintenance Agrcement for a Holding Tank required under the Sawycr County Private Sewagc Syst�m Ordinancc foc thc issuancc of a Sanitary Pcrmit for thc installation of a hoidinb tank(s). ?. The ownci- agrees to have the l�olding tank(s) serviced by the pumper and guarantecs to permit the pumper to have access and to enter upon thc property for the purpose of servicing the holding tank(s). Thc owner agrees to maintain the all-weather access road or drive so that thc p�impa- can scrvicc thc holding tank(s) with thc pumping equipmcnt. Thc owncr fiirth�r agrecs to �ay the pumper i�or charges incurred i❑ servicing the holdiil� tank(s) as mutually a�recd upon by thc owncr and puinper. 3. The pumper agrces to subi��it to the Gove►-nmental Unit, Sawycr County, a report for the servicing of the holding tank(s) as required under SPS 383.55, Wisconsin Administrativc Codc and the Sawyer County Privatc Sewagc Systcm Ordinancc. The pumper furthcr agrccs to i►�cludc thc followiug i�� thc report: a. Thc name ai�d address of the perso�� responsible for servicing the holding tank; b. Thc ilamc of thc owncr of the ho]ding tank; c. The site address of the holding tank; d. The datc dle holding tank was serviced; c. Thc volumcs in gallons of thc contcnts pumpcd from thc holding tank for cach scrvicing; f. The disposal sites to which the contents fi-om the holding tank were dclivei�ed. 4. 7�his a�reement will remain in effcct until the owncr or pumper terminates this contract. tn the evci�t of a change in this contract, the owner agrecs to file a copy of aily chan�cs to this scrvicc coil�ract or a copy of a ncw scrvice contract with Sawycr County within tcn (IO) business days fi'om the date of change to this service contract. Owner's Nainc: (Print) Owner's Signature: �oniy one oH��e�- s;g�ar�re requ�redl ��'��US G/�`� �!.'�.s% , ,.s � � �. - � - �—�� T�T�E�, �v �� ! � /�'7,�� C�-�A-�-�� Pui��per's Name: (Prii�t) Pumper's Signature: S�orr {�o/P-P ��-��i'�� J Pumper's Rcgistratioi� Nun�bcr: �lc�l 3 a��. o?�,��i � Real Estate Sawyer County Property Property Status• Current Listing � Today's Date: 2/22/2023 Created On: 2/6/2007 7:55:02 AM Description Updated: l0/2/2020 Ownership Updated: l0/2/2020 Tax ID: 914 OLYMPUS ONE ONALASKA WI 57-002-2-39-09-02-5 15-170- TRUST OF 2018 P�N' 010300 Legacy PIN: 002133010300 Billing Address: Mailing Address: Map ID: -20.1.3-5 OLYMPUS ONE OLYMPUS ONE Municipality: (002)TOWN OF BA55 LAKE TRUST OF 2018 TRUST OF 2018 STR: 502 T39N R09W 2828 PRAIRIE 2828 PRAIRIE CLOVER PL CLOVER PL Description: COURT OREILLES PARK 2ND ONALASKA WI ONALASKA WI ADDN LOTS 3&4& PRT LOT 54650 54650 5 BLK 1 PRT LOT A CSM 13/332 #3372 Recorded Site Address * indicates Private Road Acres: 2'089 15281W CIRCLE RD HAYWARD 54843 Lottery 0 Claims: Property Updated: 5/31/2022 First Dollar: Yes Assessment Waterbody: Lac Courte Oreilles 2023 Assessment Detail Zoning: (RRl) Residential/Recreational Code Acres Land Imp. One G1- 2,089 396,900 325,900 ESN: 407 RESIDENTIAL Tax Districts Updated: 2/6/2007 Z-Year 2022 2023 Change 1 State of Wisconsin Comparison 57 Sawyer County Land: 396,900 396,900 0.0% 002 Town of Bass Lake �mproved: 325,900 325,900 0.0% Hayward Community Total: 722,800 722,800 0.0% 572478 School District 001700 Technical College Property History Recorded N/A Documents Updated: 927/2021 TRUSTEES DEED Date 426754 Recorded: 9/28/2020 SHORELAND RE STO RATI O N/P R E S E R VATI O N AGREEMENT Date 434904 Recorded: 9/24/2021 QUIT CLAIM DEED Date 344199 Recorded: 1/19/2007 � .� 'e � r� :S f. �!; .Y:�. � .. . �3 1C�+ �� I . . ,-�r _ , r . ,, , sy��.. - , �', ¢, � ,. � / .F. � ' � f ' . 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F'; d � ' _ .1- �r s " 2a'� � i ., � � �' / r .,,� t � � f� ;5rsr {�.� i , { �` x:r q °' �i �� 1 ��- .F'� �� r.sr � f V' � l�;, ,�, � � r �� k .� � ��(y-(��a�� r //��{ l, ff,f�rt'. � � �� •,_� n}h,sr�.��' � � �i{8s '1�" � } . * ~ f�� r��,v'�',K�.,e� � �� LR'�� / �[{'� j � � � � .4 � E, /. �. �Y�� .�. 1 fr '" / ✓' !:` �y . ! � � � � � :�- PIIMrr . �� . i'� . �` �\�: / .• .. i i i i-��)7 �, . '!� � r: _„ . � � z �, . r i � iiiii� �i i i� i�i�� iiii - USE BLACK INK ONLY - ��.T ,Q�L��y;F^ �. �l,a .U.,U.. L � POWTS MAINTENANCE AGREEMENT �� 0��`�� For Holding Tanks 444405 PAUlA CNISSER Owner's Name(s) as shown on deed: REGISTER OF �EEDS SAWYEIt COUNTY, iNI aL �� '�S �ti�z 7.r, vs� 0�� 5/08J2023 12:11 PM Parcel Identification Number: RECORDING FEE 3Q.0(1 ,. (12 Digit Leyacy ID) 0 C� � - l 3 3 - 0 _ - D s � U — PAGES; � Legal Description of Property: - SEE ATTACHED SHEET - We acknowledge that application is being made for the installation of a holding tank(s) on the property described on the attached sheet. Return To: Sawyer County Zoning and Conservation Administration � 10610 Main St. Suite 49, Hayward, WI 54843 As an inducement to the County of Sawyer to issue a sanitary permit for a holqing tank on the above-described prop�vrty, th�e owrier is -^sponsible for the operation and maintenance of the holding tank, locking device, alarm and access, and agrees to conform to all applicable requirements of SPS 383, Wis. Adm. Code relating to holding tank management, including the following: 1 . The owner agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, except as provided by Section 281 .48 (3) (d), Stats., to have the holding tank properly serviced and to file a copy of the service contract with the governmental unit. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the governmental unit within ten (10) business days from the date of change to the service contract. 2. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shail submit pumping reports to the governmental unit in accordance with SPS 383.55, Wis. Adm. Code, for the servicing of the holding tank. In the case of exemption under Section 281 .48 (3) (d), Stats., the owner shall submit the report to the governmental unit. The governmental unit may enter upon the property to investigate the condition of the holding tank when pumping reports may indicate the holding tank is not being properly maintained. 3. If the owner fails to have the holding tank properly serviced in response to orders issued by the governmental unit to prevent or abate a human health hazard as described in Section. 254.59, Stats., the governmental unit may enter upon the property and service, or cause the tank to be serviced. Pursuant to Section 145.20(4) Wis. Stats., a governmental unit may assess the owner of a private sewage system for costs related to the pumping of a septic or holding tank. The charges will be assessed as prescribed by Section 66.0703, stats. The owner agrees to pay all charges and cost incurred by the governmental unit for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. 4. This agreement will remain in effect only until the governmental unit responsible for the regulation of private sewage systems certifies that either a soil absorption system that complies with SPS 383, Wis. Adm. Code, or a municipal sewer serves the property. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by i-eference to the propert�. 5. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The ownep�qel it the agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a m��r(duP�ic e permit the existence of the agreement to be determined by reference to the property where the holding tatr�#'�� e . �i r �'? 5�"�(� . - Only one owner signature required - ACKNOWLEDGM T s P�ER . rOwner's Si nature� � ` �N s M�F��$�(� � I 9 �_%� /i /,�,, —_ State of: p � _ r � I ' � �� County of: � �' Owner's Name (Print): h�� Subscribed and sworn to before me on OF �$G �"7;�/�/L C'/�i�l> �Ll� %jCC ��day of �JL�le��(a�„�' , Owner's Name r �� Date: BY � �� 7 �(� ��2 Notary Public Signatur — Drafted by: Public Notary Name ( rin : ? � �� ,'�'� �q,�/L C'/-l�rlti,',��,q-� My commission expires on: � � a-- v�o=�2 ' _ Personal information you provide may be used for secondary purposes [Privacy Law, § 15.04 (I) (m)] Rev. 03/26/13 That part of Lots Three(3),Four(4)and Five(5},Block On2(1),Second Addition to Court Oreil�es Park, more particularly described as Parcel"A"of Certified Survey Map No.3372,Vo(ume 13,Page 33Z,as Document Na.222603,EXCEPT Outlot 1 of Certified Survey Map No.4113,Volume 16,Page 213,as Dccument No.245Z32,Town of Bass Lake,Sawyer County,Wisconsin. '�'"E� PRIVATE ONSITE WASTE TREATMENT county �'� � � SYSTEMS �' '�°� � S awyer ', �Sp _ ,,. s - ( POWTS) �— _-�; "'�^ INSPECTION REPORT sanitary Permit tvo: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �� _ Q�{g Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)J Permit Holder's Name: ❑City ❑ Village Town of: State Pian Transaction ID#: O��(�^'+ '^5 D^-�•�M!il �ass L�tK�— ` Insp BM Elev: BM Description: Parcel Tax No: c (C�l�o �'�P o� �� (�s�r� �i o02- �33 -6(-6.300 TANK INFORh�ATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Benchmark �o o.o` Dosing Aeration Bldg. Sewer ,g' Holding W i e��- �p L� St/Ht lnlet g'�.S'� TANK SETBACK INF�ORMATION St I Ht Outlet q�,,3 ' TANK TO P/L WELL BLDG ��ENTTO ROAD Dt Inlet A�R WTAKE Septic NA Dt Bottom Dosing NA Installation Contour Aeration NA Header I Man. Holding ` .r.�' ��° �� L�� Dist. Pipe PUMP 151PHON INFORMATION �nfiltrative 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 �N L #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav ° Conv ❑ Aggregate INFORMATION P/L Bldg Well Waters o GP ❑ Chamber Model Number: ❑ EZFIow CELL TO ❑ Mound o Other _._.-- -- — — DISTRIBUTION SYSTEM X Pressure Systems Only Header/Manifold Distribution Pipe(s) ' X Hole Size , X Hole Observation Pipes � Length _ Dia �Length Dia Spac _ ' �i Spacing �Yes ❑ No _� SOIL COVER Depth Over Depth Over i Depth of Seeded/Sodded Mulched Celi Center � Cell Etlges ; Topsoil _ ___ ❑Yes ❑ No ❑Yes ❑ �lo COMMENTS: (Include code discrepancies persons present,etc.) ��l(� ��z3��3 � �-��. �- ��,�- -, - Plan revision required?�Yes ❑ No I�� I2c� �� I � /,, ' � `( � ~ "� _ _j �� Use other side for atlditional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AOOITI�NAL COMMENTS ANO SKETCH SANITAAY PERMIT NUMBEA:___�_�-_��___ � C.��9 � l° {� �� , ��k w��P ° �P(� ��°� \ ��n. �1�' I T , i,, �� co �� r3' G��y�- � �-�I fi� �t�� -- � ,