HomeMy WebLinkAbout024-741-31-2304-SAN-2023-270 ��, '°:"'`= ` In�ustry Services Division Ca�Y �
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��� = �8^_2 Madison Yards Way ,fky� � �
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Sanitary Permit Application 5tatcTransactionl�umbcr �
[n accordance�tiith SPS 333_21(2),\Vis_Ad�Code,submission oi this form to the appropriate governmental imit —� 0
is rcquired p:ior to obtaining a s�nitary permi�Note:Applicatien forms for state-owneci P01�'TS are submitted W Project r�ddress(if diII'ennt lh:m mailir.n addre�}
ehe De��anmcnt o(S�fct}•aud Prof�sional Scn�ic:s.Pcisonal information you pro�•x!c may be vscd for secondary
purposes in:tccordancc ti�ith thc Privacy Law,s.15.04(1}(m),Slats.
I.Application Inforfnation-Plcase=Rrint All.�nformation - / l,/ n/ �,.�
Propcm�O�vnc%�\a�ne Pancl�
f TC `P,3 l��/�e f e-✓t SN L Ga o
Proacrty On•n�r's:�Iailin�Address Proper[v Locaiion
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w f r��at
Cin�,Sfate `Lip Codc Prtcae\uinber
,f W �;, .tl U/ , Sectiim�
e L• !
II_7'ype of Buitding(checi:aIY thatappTy) La�;� T / ti R L•ur 7
�! or 2 Fainily D�ccllino-i�'umber ofBedrooms � Subdivision l�amc
Block= '�^
❑PubliclCa.imzrcial-Dcscribe Lisc �.�
❑City�f __
❑Stzte C'iw�n�ci-Dcx:ibe Use CS4t\cambcr �illage of
�-- �Toim of R�9un/d GQkP �__,
III.Typc of PO�V'TS Permit_(Cheek cither"Piew"or``RePIacement"and uttier applicable on line,� �:Clieck one_Uo�:on lirie B_G�mplete •ine C if
a (ical�le.) _
a� e«System �❑Re lacemcri S stcm ther\4odification ti E�isting S 5[em ex lain Addirionat P;ecrca:menc Unic �� 'uir.
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B� i❑Heidir���7'ank �In-Ground ��t-Grde �❑tifound 2ndividual Site Dcsiem nOiher T�7��(ex�lain)
(convcntional) j �
C. ❑t2cne«•al Be�or !❑Rcvision ❑Ghange o(Piumbcr �I'ransfer to New Ocvner List Pre�•ious P::m�it\��.-:md➢ate Isst�cct
Ez�i��tit�a • {
P:DFspersal/I'rcatment Area_and Tank;Informa[iqn:: � _ " _ ': = ,� -;=_ �
llesi�m Fta.�•t��) i Dr.i�n�oil tp�lication Rate(gpd's!1 Dispe:sal rLrea Recuired(s� Dispersal Area Progosed(s� System Ele�ation
30o j . 7 .� � ys'o .. 9 .,?'
Capaciry in # Total =�f Manufacturcr ^ �
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Tank[nfo�natiun Gallons Gallons i'nits � � � � � � ' , �
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V.ReS�onslbilih'Statement-I,the undersigned,assumc responsibility fur in�i.i[lation of the POW7"S sho�vn on thc attachcd ptans,-
Plur.�be;'s\am�i;Pnnt) i Piumber's Signaturz I�• rtiiPRS tTumbcr 13usiness Phone\umber
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Ap e ! C Di�s,:proved ,
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'"v � ,O�tii�cr Gi��en Rc:uon for Dcnial ��•
Conditions oF.�lpproval?Reasons forDisapproval ,�..._,
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,�t�,�t+i.���, , Department of Safety and Professional Services
��-: ,/, Division of Industry Services
' r� � `'�` Plumbing Product Review
�='��� � — 4822 Madison Yards Way
�4. ��P P.O.Box7162
't� t� S Madison,Wisconsin 53707-7162
�`".p����_ ��'�� Phone 608-266-2112
:__ Web htt : d�s.wi cv
Email dsps@wisconsin.gov
Governor Tony Evers Dan Hereth,Secretary Designee TTY:Contad Through Relay
May 31, 202�
Dept. of Safety and Professional Services
Bureau of Technical Services
Division of Industry Services
Brad Johnson-Section Chief
4822 Madison Yards Way
Madison WI 53705
Re: Descriptiori: POWTS Component Manual
Manufacturer: Dept.of Safety and Professional Services
Product Name: In-Ground Soil Absorption Component Manuat for Private Onsite Wastewater Treatment Systems
Version 21(May 2022-2027)
Model Number(s): v. 2.1
eSLA PT�No.: PP-051700077-PTOVPCR
The specifications and/or plans for this plumbing product have been reviewed and determined to comply with chapters SPS
382 through 384,Wisconsin Administrative Code,and Chapters 145 and 160,Wisconsin Statutes.
The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This
approval is valid until the end of May 2027.
This approval is contingent upon compliance with the following stipulation(s):
1. A copy of this approval letter shall be submitted with all plans using the In-Ground Soil Absorption Component
Manual for Private Onsite Wastewater Treatment Systems Version 2.1(May 2022-2027j.
Plans submitted without a copy of this approval letter may be denied.
2. rhis approval recognizes that POWTS systems designed, installed and maintained in accordance with this manual will
provide treatment and dispersal of domestic wastewater that is acceptable in the context of ch.383 Wis.Adm.Code.
3. Systems installed in accordance with this POWTS Component Manual shall use leaching chambers that conform to ch.
384 Wfs.Adm. Code.
4. 5ystems installed in accordance with this POWTS Component Manual shall be installed, maintained and used in strict
accordance with the manufacturer's published instructions,Chapters 381-386 Wis_Adm.Code and this product
approval. If there is a conflict between the manufacturer's instructions and the Wis.Adm.Code or this Plumbing
Product Approval,then the Wis.Adm.Code and this Plumbfng Product Approvaf shall take precedence.
5. Complete operation and maintenance instructions POWTS systems designed in accordance with this manual shall be
provided to each system owner and remain onsite.
6. Systems designed in accordance with this manual shall be installed by persons holding the proper license or
registration in accordance with Wis.Stats.§ 145.
7. Drain,waste and vent piping used to install these systems shall conform to s.SPS 38430(1j,(2)and(3)Wis.Adm.
Code.
�� Dept.of Safety and Professional Services
May 31,2022
Page 2 of 2
eSLA PTO No.:PP-051700077-0TOVPCR
8. Cleanouts shall be installed in drein piping associated with the installation of these systems in accordance wi[h s.SPS
38235 Wis.Adm.Code.
9. Commercial food processing,food production,fnod service,restaurants,[avems and similar establishments which
may generate greases,fats,oils or similar substances;shall have state-approved grease interceptors installed
upstream of POWTS systems designed in accordance with this manual in accordance with s.SPS 382.34 W is.Adm.
Code.
10. DSPS POWTS plan approval shall be obtained from the departmenYs Private Sewage Section,or the appropriate agent
munry,for:
a. each fnstallation of POWTS systems designed in accordance with this manual;and
b. high-strength and/or commercial POWTS systems designed in accordance with this manual.
ll. a sanitary permit shall be obtained,in accordance with s.SPS 383.21 Wis.Adm.Code,from the county,or other local
authority having jurisdiction,for each proposed installation of systems designed in accordance with this manual.
12. A complete and acceptable soil evaluation report,conforming to s.SPS 355.40 Wis.Adm.Code,shall be performed tor
all proposed syrtems designed in a¢ordance wfth this manual.
Technical notations: �
a. This approval supersedes the approval issued May 9,20ll under product file no.20170147.
The departmen�is in no way endorsing this component manual or any advertising and is not responsible for any situation
which may result from lts use.
Sincerely,
Brad lohnson—Sedion Chief
Department of Safety and Professional Services
Bureau of Technical Services
Division of industry Services
Phone: 920 492�5605
Email:5�z_uley_iqhnsonCv W isconsin.gov
Steffes Investment Inc Properiy Owners Name
12139W Cty Hwy B Property Address
24741312304 Tax Parcel Number
Sawyer County
Prt Frac SW-NW Legal Description
31 Section
41 N Town
7W Range
Page Index
1 Property Information
2 Data Entry
3 Plot Plan
4 Drainfield Cross-Section
5 Tank Information
6 Maintenance Plan
7 Contingency Plan
Bruce Vitcenda Plumber's Name
Plumber's Signature
M.P. 220498 Plumber's License Number
715-943-2382 Plumber's Phone Number
10/4/23 Date
SdD ' In7a,s-P v� .t� �
Page 1 of 7
n- roun o� sorpfion - - Component Manual Used
Version 2.1
2 Number of Bedrooms
0 Percent Slope (%)
119 Depth to Soil Limiting Factor (in.)
0.7 In Situ soil application rate
200 Estimated Wastewater Flow (gpd)
300 Design Wastewater Flow (gpd)
1 Number of System Elevations
93.2 Proposed System Elevation#1
- Proposed System Elevation #2
- Proposed System Elevation#3
96.5 Original Grade#1
96.5 Finished Grade#1
- Original Grade#2
- Finished Grade#2
- Original Grade#3
Finished Grade#3
Skaw 800 Septic Tank
Orenco 8" Biotube Effluent Filter
BioDiffuser ARC 36 Chamber Type
13 Height of Chamber(in.)
25 sq.ft. per chamber(ESIA)
4.5 sq.ft. per pair of end caps (EISA)
5 laying length of chamber(ft.)
1.17 length of endcap(ft.)
33.75 Chamber width(in.)
3 Rows of Chambers
3 Distance Between Cells (ft.)
6 Number of chambers in first row
6 Number of chambers in second row
6 Number of chambers in third row
18 Proposed Number of Chambers Used
428.6 Minimum Distribution Cell Area Required (sq.ft.)
463.5 Distribution Cel1 Area Proposed (sq.ft.)
Page 2 of 7
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CYose Section of a Three Cell Ingiound Component
Using Leaching Chambers
Finished Grade - �
Original Grade -
�������� TopofChamber #VALUE!
/ ` System Elevation -
Finished Grade 96.5 f \
Slope 0°k Par � � �— ___ Finished Grade 0.00
� �3 Feet
JFi.50 Original Grade ��,��j �1,; �.;sj`:��
94.28 Top of Chamber • `.. '�� y y.,✓ Original Grade -
....... ....... . ..",� :�,% �
� Y." �. ; 1 ; . ':'� Top of Chamber#VALUE!
✓ r ' r' S stem Elevation -
93.20 System Elevatan y����"�.�••/��.�._.�.�.��y ' " ' - ........... Y
.1• 4 •��Y��y,1Y��IVt� , �� TT •I
, � , •I.�fnflpfi�. .. •.1
OMRv�1i�lVat pips b be ma�Ycmd md E�pd w11h qipo�ed m�Isl�b�a(PoC p�6L91r Wt
Dia rams Not To Scale
32.34 feet �
- - --- - ---- __ n
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32.34 feet �
bservation!Vent Pipes to be located at the ends of the distribution cells.
Page 4 of 7
'.5'nFNING GEATrI I.I::( OC�Ln 7..�.n - c
IS ENTERED WITHOUT PROPER � � ' -K°w '-^o � e
EOUIPMENT i O � � � �
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o I I
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� 61.00" I
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TOP VIEW OF MANHOLE COVER '
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3.00 I�__________'__"__'__""______''
4���� �
OUTLET END VIEW OF TANK
7.0o zzoo
L Z�� Z�
500 � � _J_
� 16.00 �1.00
�� �� OUTLET
INLET 4I.00 9.00
P rrt�g.0 � �•viza sFu umcc*
aa¢.nsnwco ._ . .___________________.._______'_________."__.__..____ ________' ..
wd vaao 18.00
�2.00 �
BAFFLE FILTER
40.Do
1
S�
I �3.00
SECTION VIEW OF TANK & COVER
PAGE: 1 OF 2
MODEL NUMBER: B00 S KAW P R E-C A S T pHONE: (7l5) 987-2277
APPROVED FOR: SEPT10. SIPHON, HOLDING, OR PUMP TOLL FREE: 1-800-924-8825
28255 lO5th 57REET, NEW AUHURN HOME PHONE: (715) 987-2905
AEIGHT INLET DIM. OUTLET DIM. L18• DEPTH CAL. / IN. MAX. CAP. WISCONSIN 54757 FAX: (715) 987-2707 (SHOP)
� FAX: (715) 987-2708 (HOME)
7,830 LBS. 45" 43" 40" 20.12 805 GAL.
Steffeslnvestmentinc
12139W C H B
2.47E+70
Number of Bedrooms 2 Septic Tank Skaw 800
ESti1Y18i2d FIOw(average)gallons/day 200 Efftuent Filter Orenco 8" Biotube
DBSi9f1 FIOW(peak),(Estimated x 1.5)gal/day 300
Soil A lication Rate al/da lft� 0.7
Influent/Effluent Quali Monthl Average PRINT PAGE
Fats, Oil &Grease FOG 30 mg/L
Biochemical Ox gen Demand BOD,) 220 mg/L
Total Suspended Solids (TSS) 150 mglL
!!NOTEi! 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 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)shali 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 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 1l3 or more of the tank volume,
the entire contents of the tank shail 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.
SWrt-Up and Ooeration
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 soii conditions are frozen at the infiltrative surface.
Page 6 of 7
Do not drive or park vehicles over tanks and dispersal celis.
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, sandary napkins, tampons, and water softener brine.
Abandonment
When the POWTS fails and/or is pertnanently 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 disconneded and the abandoned pipe openings sealed.
-The contents of all tanks and pds shall be removed and properly disposed of by a Septage Servicing Operator.
-After pumping, atl tanks and pds shall be excavated and removed or their covers removed and the voidspace
filled wdh 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)
dThe sde has not been evaluated to identify a sudable 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 wells. Failure to
protect the replacements area will resutt in the need for a new soil and site evaluation to establish a suitable
replacement area. Replacement systems must comply wdh 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.
��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 resutt. Rescue of a person from the
interior of a tank may be drfficult or impossible.
POWTS Instalier 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
7of7
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Re�l �state Sawyer Counry Property Lisdng Property Status: Current
�'oday's Date: 10/8/2023 Created On: 5/29/2008 9:13:03 AM
:,��Descripdon Updated: 12/2s/2018 ;.��: Ownership Updated: 12/21/2018
_ ___....x _.__... .._._ .___.... . ._. .,_.�___ M ..._.__. _�,...--- .___. ...� _ _ ___ ___ _ _
'I�ac ID. 39917 STEFFES INVESTMENTS NAPLES FL
PIN: 57-024-2-41-0�-31-2 03-000- INC
000040
Legacy PIN: 024741312304 Billing Address: Mailing Address:
Map TD: .7.4 ST'EFFES STEFFES
Munici ali (024)TOWN OF ROUND INVESTMENTS INC INVESTMENTS INC
P �' LAKE ATTN: ALLAN P ATTN: ALLAN P
STR: S31 T41N R07W STEFFES STEFFES
Description; PRT FRAC SWNW 7463 BYRONS WAY 7463 BYRONS WAY
Recorded Acres: 24.590 NAPLES FL 34113 NAPLES FL "341]3
Lottery Claims: 0
First Dollar: No .�•. Site Address * indicates Private Road
loning: (F-1) Forestry One 12139W COUNTY HWY B HAYWARD 54843
ESN: 404
��: Property Assessment Updated: 7%1�/2019
�:�:�T�c Uistricts Updated: 5/29/2008 2023 Assessment Detail
. ___. _ ._ _ __ _
1 State of Wisconsin Code Acres Land Imp.
57 Sawyer Counry G5- 16.000 3,200 0
024 Town of Round Lake UNDEVELOPED
Hayward Community School �6-PRODUCTIVE g.590 12,900 0
572478 FOREST
District
001700 Technical College
2-Year Comparison 2022 2023 Change
:�.; Recorded Documents Updated: 5/29/2008 Land: 16,100 16,100 0.0°/o
__. . .... _. ___._. .. . .. .___.. ... _._ _ ... _ __ Improved: 0 0 0.0%
��. WA►ItRANTY DEED Total: 16,100 16,100 0.0%
Date 403060
Recorded: 9/20/2016
.-�,>. WARRANTY DEED ,�;: Property History
Date 268540 636/329 Parent Properties Tax ID
Recorded: 6/16/1998
57-024-2-41-07-31-2 03-000- zG091
000010
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HISTORY � Expand All History_ White=Current Parcels Pink—Retired Parcels
�.�. Tax ID: 26091 Pin: 57-0242-41-07-31-2 03-000-000010 Leg.Pin: 0247413123Q1 Map ID: .7.1
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