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HomeMy WebLinkAbout024-741-30-5238-SAN-2024-011 �„'�< ,'.; Industry Sen�ices Di�ision County � ��� _ 4822 Madison Yards Way S8W)/2f � � , �� = Madison,WI 5370� Sanitary Permit Number(to be hlled in bti C = P.O.Box 7302 — Madison.WI 53707 l,p s ( 1 �� .� r� � Sa�l*a� Peri.nit A„pllCa+lOn State Transactio�Numbcr Q l l.J L _� In accordance with SPS 38321(2),Wis.Adm.Code,submission of this form ro the appropriate governmental unit is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department oFSafety and Prolessional Services.Personal inti�rmation you provide may be used fo��«o�d�� 10349N Sandy Beach Rd. Hayward, WI purposes in accordance with the Privacy La�v,s. 1�.04(1)(m),Stats. I.Application Information—Please Print All Information Propert�O��ner�s Name Parcel# Karen Wick 024741305238 Property O��'ner's Mailine Address Proper[�'Location 8920 Itasca Trail N. f`�fi 2 c�vc.Loc City,State Zip Code Phone Number Stillwater, MN 55082 952-935-9100 - "�- � ,�Q: Se�t+on 30 11.Type of Building(check all that apply) I.ot# T 41 N R �� E or`W � I or2l�amil}�D�celling—Numberoff3edrooms 5 7 Subdivision Name f3lock# ❑Public/Commercial—Describe Use �City of ❑State Owned—Describe Use CSM Number �Village oY 36/250 #8464 �To"n°f' Round Lake I11."Cype of PO��'TS Permit:(Check either"�ew"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if a licable.) `�� New S stem Re lacement S stem Other Moditication to Existin S�stem ex lain Additional Pretreatment Unit(cx lain) �✓ Y � P Y � €-Y ( P ) ❑ P B' �Holding Tank �In-Ground �At-Grade �Mound �Individual Site Design Other Type(ex��lain) (conventional) C• ❑Renewal Before �Revision �Change of Plumber �I'ransfer to Ne�v O�vner List Previous Permit Number and Date Issued Expiration 20-291 (Expired before install) IV.Dispersal/Treatment Area and Tank Information: �1 O�.O Design Flo�v(gpd) Desien Soil Application Rate(gpd/st) Dispersal Arca Required(st) Dispersal Area Proposed(st) System Elevation 750 0.7 1071 1200 94.5 � Capacity in Total #of Manufacturer y Tank Information Gallons Gallons Units � � o ,'n, � 'Vcw Tank� F.�isting Tanks � � " a� � � � 0 c, U rn r v: ._ :7 — Septic or Holding Tank 1530 1530 1 Infiltrato� � �o���,�Ct,a�„b« 1060 1060 1 Infiltrator � Q � ✓ �'.Responsibility Statement- 1,the undersigned,assume responsibility for installHtion of the PO��'TS shoNn on the attached plans. Plumber�s Name(Print) Plumber�s Signature � � MP/MPRS Number Business Phone Number Jason Kuettel f'��`�� 675751 715-798-3355 .,;�.���.;,;, Plumber's Address(Street,City,State,Zip Code) �' PO Box 66 Cable, WI 54821 V1. oun y/Department Use Only �Approve ❑Disappro��ed Pz���Fee Date Issued Issuine Agent Signaturc �k/ $ �7�.�° \�7 L�'2� �✓1 Gc-fii,t���vcv.c' �O�tincr Given Reason for Denial Conditi � r a �n�fo Disapproval �r � k� L,,{� �„ '�� � � Kg �t�c N �R�� • D � �� �'`"�—��^'�''� �� � '� r i�i li�� Li 4J:r�i 1 5_�% �`�._._...__._.�, ���,/ ` � �� JAN 2 6 2024 - ���ic# � �1 I �S C, �1 ��- �3-1 � SAW�E� ��:.�:��� ��� ZONING�DAAINiSTRATION Attach ro wmplete plans for the system and submit to the County only on paper not less than 8 I/2 x l I inches in size ss�-639s�x.o2iza> NO REFUNDS AFTER ISSUE OF PERMIT PAGE 1 OF 5 In-Ground Dosed-Gravity Plan Index & Cover Sheet Component Manual Design References: i✓-t;,i....nD Sc-� A�,;�nu.� r=��— P�W'rJ V�S';�_ Z. 1 ��-.�r7cz -z�� Pg 1 of 5 Index&Cover Sheet —� Pg 2 of 5 Plot Plan Pg 3 of 5 Dispersal Area Cross-Section &Plan View Pg 4 of 5 Pump Tank Specifications Pg 5 of 5 Management Plan Attachments: Enclosures: — _ — — — Pump Curve POWTS Application for Review Soil Evaluation Report&Site Map Project Name/Description Karen Wick-5 Bedroom septic Owner Name(s): Karen Wick Phone: 9sZ_ I'3s -53ao Owner Address: $920 Itasca Trail N. Stillwater, MN Z�P: 55082 ProjectAddress: /�3�19� s'AN�Y �c�e�- 2� y�Y,�,y��, �,�,� Govt.Lot: 2 1/4 of_ �1/4,Section 30 ,T 41 N-R�� E❑or W ✓❑ Township: Round Lake County: Sawyer Project ParcellD#: 024-741-30-5238 Designer Information Designer Name: �ason Kuettel Phone: �15 _798 _3355 Designer Address: PO Box 66 Cable,WI Zip; 54847 E-mail: �ason@andryras.com License Number: 675751 Remarks: -f� „_`— _ `�;i ,, ,,_-_, Signature: = ���"����"' , �� � Date: I. 2 a zrT�l Onginal signature required on each submitted copy. ow✓Ecrs� Le a : S�ev� l�. , ka.ce,� R W.��C Saw�er �o.� I�ouH d l���e I,w� . pr�.l : Oz�{ —�41-30— SZ3S 84 Z-O T'�'aSG4 T�m.. � lJ Gau L+ Z- 5' 3 oT �1 N /Z o 7� S'�'�l�taa,�"cr� N �.J SSOSZ- I—o+ �7 CS M 3 L�2,Sa � SYb�f � � ( \ \ SCAIG I ��_ (00' ' � �` � \ . 000 .� ; ► � r�� � � +� �� I � � s-�ard9c I N � "' 3 � � � � _ J . . z . � v � � � L � / / Bn roc � I I � / £xCs��.gTn�:/ _ s/l � ,.7`� / _' —` - �. d+-''---r .... ...� 1 ^ �' �-d,e""'� �' .M�° �' �5�S 1 y� ,�.t.o' I /ZL/"t-`Z� •\ , i �. Z�•,f<M4a VJc i=czce M.��7 � l��ox�ma'{c Loc�'��o� I I p� f�ew g bZ home I ♦BhIDO� na.� 2��+p oh� S.c�4 ` , o� 2Z" diq Re�(�k— ortthge � — — J_ �, I �,.�' r,-bboh . �+\ �� � F31 98 .03' � y„lu,Nof \ +� � j, ,.� t.-_ ' y 9�.3 � s+�t� � , ,I ' �ls l ' 3 q-t.4 s' 'i5 � 7S • � .1 So.�S� Sc�S�e Ieu. 9`I•�� '� C�Ui Y�CS �J.�t�� J� ��Tp �cF �� p S� � ��� / f--' ��� �ZUVr� 1A1�t �� . �NGi�Tu+n��- �M �53� SEC'n� nz�+L w/ O�ZLMCV ;1L�TR�L. � WH�.T�AT(� �M 1060 rviyP 'r'9N�� IN-GROUND DOSED-GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down-sizing credit) -��' �� � min.1Y ce°�e�'a I �HP;�,� TYPICAL TRENCH cove. SOILCOVER CROSS SECTION VIEW ,z• � (No Scale) min.tranch : OBSERVATION PIPE DETAIL depm L '�, (No scak) (�YPical) T — — .'. . S`rew-TyPeor SlipCaPQoose� FinislreCGrade //p� (mulched 8 seede0) `,.• System Elevation= �''•5 R Y �� ' a•0 avc P�� ,'�� . TOUsoa co,rer ' ToP of P��la tertninate (min.1 foot) �ryP��y�� Provideminimum3ft atora0ovelnisneGgratle separation between trenches. (4)1/4'-1/$'%6'Sbts �96 apan 1,'..' TYPICAL TRENCH (Show location of inlet/outlet pipe connection on plan view.) Anchoong Oevice i�r�n�eo� PLAN VIEW Su�� (No Scale) 4n � O�servalion piDe s�all ba instatleG atjunWon Cetween hvo units. �Q ft Perforated Lateral Observation Rpe �tYPical) (ry��0 (Hpica�) r — — — — — — — — — — — — — — ��— — —— — — — — — — —— — — — — — — — � °__"_ '__°__' I A- 3.0 ft � _-___ _= ___ =_=___' _______= D � - - - - - - - - - - - - -- - �f- - - - - - - - - - - - - - - - - - - - J cryP��o G� g = ao ft I m ctyw�n w INSTALL PER TRENCH: E21203H Bundle � (typical) � $ 10-ft bundles @ 50 ft EISA/unit=400 g= (mfd by Infiltrator Systems, Inc.) � Install pursuant to manufacturefs instn�ctlons. + � 5-ft bundles @ 25 ft EISA/unit= � ft' = Proposed EISA per trench= 400 ft' Required Infiltration Area= 1071 ft� Distribution Method: x 3 trenches = Proposed Total EISA= �200 ft� branched manifold � RESET �,-- � INFILTRATOR IM 1530 tan ks Features & Benefits The Infiltrator IM-1530 is a lightweight strong and • Strong injection molded durable septic tank. This watertight tank design is polypropylene construction offered with Infiltrator's line of custom-fit risers " a • Lightweight plastic construction and heavy-duty lids. (nfiltrator injection '� ' , :.� and inboard lifting lugs allow for molded tanks provide a revolutionary �: '1'°� easy delivery and handling improvement in plastic septic vR • Integral heavy-duty green lids that tank design, offering long-term .�,,,, ���: ' interconnect with TWTM risers and exceptional strength and �' ,x pipe riser solutions watertightness. � ; , . `��`� �` y m r - � , • Structurally reinforced access � " ports eliminate distortion during . ��� : j �. '" installation and pump-outs �-.,.���-�,`� � � • Reinforced structural ribbing , and fiberglass bulkheads offer � ��`` � additional strength , � � • Can be installed with 6" to 48" � � � x of cover b ,,,, _ � * , f s / • Can be pumped dry during � w.�._. � pump-outs • Sultable for use as a septic tank, - pump tank, or rainwater (non-potable) tank Inlet Side • No special water filling Infiltrator � requirements are necessary TANK CUTAWAY � Riser • The tank may be backfilled with System � suitable native soil. See installation � - instructions for guidance. -� ,�. - Partition �, ,�.. _' " �`� baffle wall`, t *_ ��' . • . � � �� � ' r � � � � �� '� , " HEAVY DUTY LID � ` � y CUTAWAY � Reinforced ��� •_ � E , ti y � . � ' '� .,�;,,� 24" structural , , � :� access port / ' � � "'4'1+ � .;... � _ �,.,� ,, � ' ���` � Structural �� °� '� � � -`��' bulkheads � � � �, ; ' ` �� �� � � � � � � � MID-SEAM CUTAWAY � i ; �� ���- .� Reinforced water tight mid-seam ` , � •` � � gasketed connection ., , ,, �� �., ;��� x - � >.. .. ..,� ,`� � ; � �',:- � . ..,:.�, ..,.. � a .,, , � Protecting the Environment with lnnovative Wastewater Treatment Solutions � N F I LT R ATO R� water technologies IM-1530 General Specifications and Illustrations --IIFfING lUG(IYP.) R�SER CONNECTION(7YP.) The IM-1530 is an injection molded two piece mid- ��FT�N�ST�,P R�P., seam plastic tank. The IM-1530 injection molded i 7 T*f 1 r �r�'�f isrr. r�'T i`t �t', i- � i* r ir,�i: 'T - __ plastic design allows for a mid-seam joint that has �, l� �i�'I.�' �f1 I � r II�JI �rT ��° f '���' precise dimensions for accepting an engineered �,,?�_ : �� � !j� I ��t-�S f"��; �� � '� i�: ;�' ;;�, � /.__._.\, ./--� , 1 ��'' EPDM gasket. Infiltrator's gasket design utilizes � �� '; � •4 , � �y � � � �,� � ' ,� technology from the water industry to deliver ' ; ����, �'. =� �' r f' ��i'l o �-''' • � EXTEROR s �� e � � x,! WIOTtI proven means of maintaining a watertight seal, '�T;�,��� � ;,�`_,�� . � _ _��/:%- .,� 7i.' '� �� 1� � rt t � � � � The two-piece design is permanently fastened �� � (,��f��� � �'( � � � � � �I � �E O I��,� � ���' ��'tr_.'�2� �L._� 't�. ��..-.,t�}�Y��•F�i_..L�x.u.�+, t,�r'� � using a series of non-corrosive plastic alignment - "� � � dowels and locking seam clips. The IM-1530 is _ „5.8�.,46o�ExTER�oR�EN�TH _� assembled and sold through a network of certified Infiltrator distributors. TOP YIEW Must be backfilled and installed in accordance with I�fltrator Water Technologies, Infiltrator o�nETTEE , IM-Series Septic Tank General Installation `ryP' \ Instructions and for shallow round water � '; ' �' + conditlons reference the Iniiltrator IM-Series l���'��' ( �����' �I����l � ; j I��� �� j � ��l � u '� i �.�, Tank Buoyancy Control Guidance. ,,.,s�ri.-�l'�� l�_,�J��„�• n,3�, [iw.� r � i.�r-inri�nau� ex7eR�oa Y I�i(',I{T Please visit www.infiltratorwater.com/images/ S�^^AOL�' j '� � � �` ����1��� pdflManualsGuides/TANKOi.pdf for the latest `TM��' � �C �� f��_� _ ix(( ! � LIFTINGSfRAP `�,,,��� �,���d �I�, ���-(� ! intormation. cTMP, � END VIEW Working Capacity 1537 gal(5818 L) Total Capacity 1787 gal(6765�) 024A�BtOjACCESSPORT 04(102� � WITH LOCKING LID(3) AlrspaCe 16.9% Pvc oanes / `INLET TEE ( 10.1�257J FREEBOARD 94[102� Length 176"(4460 mm) T , / PVC ORA85 1 _ /,_ � OUTLETTEE Wldth 62"(1567 mm) �"r�� �-� 1 +e.sxrua sanc� ��� i _—_- . . �? �...— —1 ._ , WIthI ' 1(I - i � � Len th-to-Width Ratio 2.8 t0 1 r �"� : ; co�E ���7�5�WALL 9 a, � aa,o �_ 4 n+icKr�ss h.�� I Ff_R j (1.11BJ � € _-F Helght 55"(1384 mm) `"OfiF ���UID - - 2I51J X 2(51) DEPTH j � F18ERGLASS � . SUPPORT(4) Liquid Level 44"(1118 mm) i 1 I ( _ `TMP' _u.k: . :-L ...._r-._-1... .. . �. . �.� Invert Drop 3"(76 mm) Fiberglass Supports 4 SIDE VIEIN Compartments t or 2 Maximum Burial Depth 48"(1219 mm) �� CONTINUOUS TANK TOP HALF --�- �-� I �t4 ELASTOMERIC Minimum Burial Depth 6"(152 mm) I � 4 GASKET Maximum Pipe Diameter 4°(100 mm) TANK � ��� �1ni�_ INTERIOR �-��-�� , �j�1��I .� SEAM CUP Weight 501 Ibs(228 kg) �� ��� ���-_;� ��I._,, �_ AIIGNMENT � "� , , OOWEL I - TANK BOTTOM HALF , � 4 Buslness Park Road �i X f� P.O.Box 768 Old Saybrook,CT 06475 sso�s�,-;000.F.,x aso-a��-�oo, MID-HEIGHT SEAM SECTION I N F I LT R A T O R� '1-90p-2y1-4436 �vater technologies www.inrftratorwater.com U.S.Patents:4,759,661;5,017,04t;5,156,488;5,336,017;5,401,116;5,401,459;5,511,903;5,716,183;5,586,778;S,B39,94a Canadlan Patents:1,329,959;2,WA,564 Other patants pending.Inflftretor, Equalizer,4uick4,and SideWinder are repistered trademaAcs of InfdVatw Water Technobgies.InfilUator is a registered trademark in France.Infittrata Water Technologias is a registered Vademark in Mexlco Contour,MicroLeaching.PoryTuff,ChambeiSpacer.MuWPort,Pos{lock,OulckCut,OulckPlay,Snaplock and Stralghtlocic are trademarks of In0ltrator Weter Technobgles. PolyLok is a tredema.k of PoryLok,Inc.TUF-TITE is a registered trademark of TUP-TITE,INC.U0.ra-Rib Is a hedemerlc of IPEX Inc. �2074 Infiftrata Wate!7echnologies,LLC.Ali nghts resarved.Pnnted in U_S.A. IM21 1116 � • • • . - � • • :11 . . . 9_. _.� .s_._ ,� �_. .. ,. �._. � � I N FI LTRATO R " IM- 1 O�O � �:��t}L ; � � �.. . • Strong injection molded polypropylene " construction a�,+� ., � • Lightweight plastic construction and "� ,� inboard lifting lugs allow for easy � j delivery and handling :� ,, '" � • Integral heavy-duty green lids that � � x '�` interconnect with TWT""risers and pipe , �, � ��, �� � ; riser solutions �' -�r,.r • Structurally reinforced access ports , ,� ��,���' . �, ' eliminate distortion during instailation and pump-outs ' � � • Reinforced structurai ribbing and f� �" ��� � �"� fiberglass bulkheads offer additionai '� • strength t. • Can be installed with 6"to 48" of cover The Infiltrator IM-1060 is a lightweight strong and durable septic iank. • Can be pumped dry during This watertight tank design is offered with Infiltrator's line of custom-fit pump-outs risers and heavy-duty lids. Infiltrator injection molded tanks provide a • Suitable for use as a septic tank, pump revolutionary improvement in plastic septic tank design, offering long-term tank,or rainwater{non-potable)tank exceptional strength and watertightness. • No special water filling requirements Inlet Side are necessary • The tank may b�backfilled with suftable TANK CUTAWAY Infiftrator native soil.See installation lnstructions S s em r for guidance. Y .�-.pp�� ' .:'-. ��� �.t�:� - _ ,, �: ��" � , ���� Partition � ��`'� ,��, baffle wall� � r ` �, . .� , ti, ��;� ` �'� � '; HEAVY DUTY LID � �: , ;=<. '� CUTAWAY r''� j�V � Reinforced � � � 24" structural -a,tl;�;�`i ,� ' .��� ,� �,�P� � � �°" �� �� ' access port � ,,. ; �� �: �� x, ; � � � � F�� � �� �� �� �, �,�` � `�, Structural �: �,, � y. bulkheads r MID-SEAM CUTAWAY � Reinforced water tight mid-seam `'�s,. gasketed connection ,>. � � � rf t � Protecting the Environment with Innovative Wastewater Treatment Solutions � N F� LT R ATO RA water technologies IM-1060 Generai Specifications and Illustrations ` imcnu�� i:roieu�G moKeor'vcarow The IM-1060 is an inJection molded two piece mid-seam � — plastic tank.The IM-1060 injection molded plastic design � �`I I I F� I i ! i allows for a mid-seam joint that has precise dimensions n � '� I, � ! _ —� .. a for accepting an engineered EPDM gasket.Infiltrator's t� �t- QG\'�. ' �o � gasket design utilizes technology from the water industry `�— . ° -��r � =o-� J ,B, 10 deliver proven means of maintainmg a watertight seal. ` ' " 15°01 0 The two-piece design is permanently fastened using a �\- � i� �°TM series of non-corrosive plastic alignment dowels and C' I � locking seam clips.The IM-1060 is assembled and sold through a network of certified Intiltrator distributors. �� il�Alli3b1EN1EP10RlENGiH _ Must be backfilled and installed in accordance wfth TOP YIEW Infiltrator Water Technologies,Infiltrator IM-Series Septic Wr� Tank General Installation Instructions and for shailow II _ � ground water conditions reference the Inffitrator IM- Series Tank Buoyancy Control Guidance. c Please visit www.infiltratorwater.com�mages/pdf/ I I ��a9, ManualsGuides/TANKOi.pdf for the latest information. I `E`�ro" SF�MC�W��� fnvK�L� 1�1 LIRINGSTR�P Working Capacity 1094 gal(4141 L) 1Y°""`� Total Capacity 1287 gal(4872 L) END VIEW Airspaoe 16.5% LeflJth 12T(3226�I1m) m��mzi- m:aiaiol�ccEssovtHirmswrtHwcriHcuos�i wcoxees 0n�o�i rvcon �✓�h 62.2"(1580mri1) �"�TTEE ..�ozi:ea�vneeeo�no �esamnhe Length-to-Width Ratio 2.3 to 1 _l �es. •IpSVMF (wR(1 Height 54.7"(1389 mm) in 3O C0� V61 vEA Uquid Level 44"(1118 mm) , �L_ Inveli Dro fBfN"�`"�s.—�I �i;n'u°o _ wova s P 3"(76 mm) surroxr i oevrH �nvxeu �*mrc�u wim eu«[ Fiberglass Supports 2 I w,uw�rne I _ 1_ I ' MEQUflED / Compartments 1 or2 �'"'�'�'^�"`-L-��` �-�;✓ Maximum 8urial Depth 48"(1219 mm) SIDE VIEW Mlnimum Burlal Depth 6"(152 mm) Maximum Pipe Diameter 6"(152 mm) TANKTOP— CONTINUOUS Wei9ht 3201bs(145 kg) HALF GASKET TANK INTERIOR � ——SEAM CLIP ALIGNMENT I � DOWEI _ —TANKBOTfOM / 6 eusinea.a Park Road HALF � P.o.Box�89 Ob SeYbrook�CT OBA]5 I N F I LT R AT O R° esa-s„-,�o.F�.a�o.s�,-,�o, MID-HEIGHT SEAM SECTION i�eoo•sz�-uaa �v��ar,achi,oioqies M'�'��fihretwsweteceom U.S.GatenLq:4,159,fi61;5,011,0a1;5,i5fi,488;5,336,017;S,a01,116;5,�01 p59;5,511.903;5,]16,169;5.588,]]e;5,839,840 Canedlan Palents�.1,329,959;2,OOa,564 qner paten6 pendiry.Infihator,Equairzer OuickC,ene$IOeWeWer ere repisteretl 4atlemarks ol Infillretor Water TeeMqbgles,yifipatw ie a registereE Irtden�erk in Grance.InLlbgtor Water TecMologies Is a registeretl tratlemsrk in Mmico. CaMour,MxroLexhlrg,PoyTUH,C�arMaSpecer,MupWort.PosiLock,OukkCuG OukMPby,SnapLp ii aM SlralghM,ock era haCamarks of Inllltratur Watm Tochnobgks PolyLok Is a trntlemark ot PoyLek,Inc.NF-71TE Is a registazatl hetlemerk ol TUF-TRE,INC.Uttn�iib a a fredemark of IPE%Inc. O 2016 IMiRreta Waier TecNwbgies,LLC.NI ngMs emervetl.hntetl n U.S.F. IM021116 � . • �'• • :1� �E narMEh, Departmen�of Safety and Professional Services F�' . ��,,, Division of Industry Services �^` � ���T`, Plumbing Product Review 1=� ` 0 \ 4822 Madison Yards Way �,r�',.... \SPS `JI P.O. Box7162 b� � � �� Madison,Wisconsin 53707-7162 ��`q`� �—�4�� Phone 608-266-2112 ..,ppf`i.lUSP�ti,� R5 � - - Web htto:/idsus.wi.aov Email dsps@wisconsin.gov Governor Tony Evers Dawn Crim,Secretary TTY:Contact Through Relay April 28, 2022 Infiltrator Water Technologies Government Affairs Departmen[ 4 Business Park Road P.O. Box 768 Old Saybrook CT 06475 Re: Description: Sewage Tanks,Thermoplastic(PE or PP) Manufacturer: Infiltrator Systems Inc. Product Name: Two Compartment HoldinR or Septic Tanks:CM-1060, IM-1060 and IM-1530 Riser Svstems: EZ Set and EZ Snap Model Number(s): Two Compartment HoldinR or Septic Tanks: CM-1060, IM-1060 and IM-1530 Riser Svstems: EZ Set and EZ Snap eSLA PTO No.: PP-042200016-PTOPHTC The specifications and/or plans for these thermoplastic sewage tanks and riser systems have been reviewed and de[ermined to be in compliance with chapters SPS 382 through 384,Wisconsin Administrative Code, and Chapters 145 and 160,Wisconsin Statutes. The department hereby issues an alternate approval to s. SPS 384.25(7) (b)Wis.Adm. Code based on the Wisconsin Statutes and the Wisconsin Administrative Code. This alternate approval is valid until the end of April 2027. This approval is contingent upon compliance with the following stipulation(s): 1. These tanks and riser systems shall: a. conform to s.SPS 384.25(2)(b)Wis.Adm.Code. b. be labeled as required by s.SPS 38415(11)(c)Wis.Adm.Code. c. be placed in accordance with s.SPS 383.43(8�(i)Wis.Adm.Code. d. have an internal partition,securely attached to a structural support column,separating chambers A and B that has a watertight seal at the joints with the tank top,6ottom and sidewalls. e. be watertight in accordance with s.SPS 354.25�2)(d)Wis.Adm.Code. f. be designed to withstand the pressures to which it they are subjected. g. be fitted with locking manhole mvers in acmrdance with s.SPS 384.25(7)(h)Wis.Adm.Code. The manhole cover must be secured to the riser using screws which are not standard or Philips head m be considered an effectivelocking device. h. bear warning labels,that are visible after installation,that mnform to s.SPS 384.25(S). i. be anchored in ac�ordance with s.SPS 383.43(8)(g)Wis.Adm.Code when installed in areas subject to saturated soil mnditions. j. be vented in accordance with s.SPS 384.25(5)Wis.Adm.Code. k. be installed by persons holding the proper license or registration in acmrdance with Wis.Stats.§145. I. be installed,maintained and used in strict acmrdance with the manufacturer's pu6lished instructions,Chapters 381387 Wis.Adm.Code and this product approvai. 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 Plumbing Product Approval shall take precedence. 2. DSPS POWTS plan approval shall be obtained from the department's Private Sewage Section,or the appropriate agent county,for each installation of[hese tanks. SBD-10564-E(N.10/97) File Ref:20190125.DOC Infiltrator Systems Inc. April 28, 2022 Page 2 of 3 eSLA PTO No.: PP-042200016-PTOPHTC 3. 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 these tanks. No person shall purchase, or install, a private on-site wastewater treatment system unless the owner of the property on which the private on-site wastewater treatment system is to be installed holds a valid sanitary permit issued under § 145.19. No person shall sell at retail, as defined under § 100.201 (1) (d), a septic tank for installation in this state unless the purchaser holds a valid sanitary permit issued under § 145.19. 4. Campgrounds shall obtain required permitting from the Wisconsin Department of Health Services under HFS 178 prior to installing or using these tanks. S. Drain, waste and vent piping used to install these tanks shall conform to s. SPS 384.30 (1), (2) and (3) Wis. Adm. Code. 6. Cleanouts shall be installed in drain piping associated with the installation of these tanks in accordance with s. SPS 382.35 Wis. Adm. Code. 7. Tank contents removed shall be treated as septage and disposed of in accordance with NR 113 Wis. Adm. Code. 8. This approval shall not include consideration of these tanks for any fresh/potable water uses. 9. The manufacturer must keep at the manufacturing plant a set of plans and specifications bearing the department's stamp of approval. The plans and specifications must be open to inspection by an authorized representative of the department. 10. Bedding and backfilling of these tanks shall be in accordance with the manufacturer's published instructions. (attached) 11. The following are approved for use with these tanks: a. 4-in. inlet, outlet and vent openings; b. 4 in. ASTM C923/C923M-20 and ASTM C1644-06(R2017) compliant pipe connectors; c. watertight electrical openings <_ 2-in. ID in access risers; d. EZ Snap riser systems (24-in. diameter, 2, 6 and 12-in. heights), or other code compliant riser system; e. EZ Set riser systems (24 and 36-in. diameters, 6, 12 and 18-in. heights, or other code compliant riser system); f. Safety Star Systems, or other code complaint safety system; g. ASTM F477-14 compliant mid-seam elastomeric seals; h. Approved effluent fiiters installed in outlet tees; and i. Bottom connection holding tank configuration. 12. Use of the EZ Snap, EZ Set and Safety Star systems shall not be limited to, or required for, use with Infiltrator tanks by this approval. The EZ Snap, EZ Set and Safety Star systems may be used with any compatible tank in accordance with infiltrator's and the tank manufacturer's instructions. Any code compliant riser, lid and safety system may be used with these tanks in accordance with Infiltrator's instructions. Two Compartment Tank Specifications Model Liquid Level (in.) Gal./in. Gal./day' ' Max. Depth of Bury (in.) CM-1060 QQ.Q Ae�er to Table 7 in�he infiltrator IM-and CM-Series Septic Tank General Installation Instructiuns 356 4$ IM-1060 44.� Thefirstrompartmentis'/.ofthetotalvolumeandtheserondmmpartmentisRofthetotal 35� 48 IM-1530 44.0 "o�°'"` a9z 4$ ♦=When Useo as a Septi<Tank Based on a 3�yc Serviu•Interval for Fesidential Wastewater 1=at the Plan Reviewer's di5cretion,a(actor of 1.04(i.e.5 4%)may be applied to account for a mulfi-Aedroom resiAential pmperty. Infiltrator Systems Inc. April 28,2022 Page 3 of 3 eSLA PTO No.:PP-042200016-PTOPHTC Technical notations: a. This approval supersedes the approvals issued on April 11,2022 under eSLA PTO No.PP-042200010-PTOPHTC,October 22,2020 under eSLA P70 No.PP-102000070-PTOPHTC and lune 7,2019 under eSLA PTO No.PP-042000060-PTOPHTC. b. Manufa[[urer's webtite: https://www.infiltratorwater.mm/products/infiltrator-tanks/cm-series-plastirseptio-tanks-1/ https://www.infiltratorwater.mm/productz/infiltra[or-tanks/im-series-septio-tanks/ c. ASTM C923/C923M-20 and ASTM C1644-06(R2017)s[andards for re5ilient connectors pertain to pipe connections to reinforced concrete risers and tanks respectively. The department is in no way endorsing these tanks,riser assemblies or any advertising and is not responsible for any situation which may result from their use. Sincerely, Glen W.S�hluter Plumbing Product Reviewer Departmen[of Safety and Professional Services Division of Industry Services Bureau of Technical Services (608)267-1401 Phone glen.schlueter@wi.gov E-mail 7:45AM-4:30PM CDT M-F Work Hours Table 2: Nominal Volume Chart Liquid height a6ove Liquid volume in tank at' � ated height(measured from tank bottom to liquid surface)' tank bottom' IM-540 IM-1060 CM-1060 IM•1530 in cm U.S.Gal Liters U.S. a i ers U.S.Gal Liteis U.S.Gal Liters 1 3 3 11 3 11 5 21 17 64 2 5 8 30 73 49 17 64 34 128 3 8 14 53 28 106 31 119 51 192 4 10 21 80 46 174 50 168 68 256 5 13 29 109 65 246 70 263 94 357 6 15 37 141 86 326 91 344 122 463 7 18 46 �73 107 405 113 429 152 573 8 20 55 207 �pg q88 137 517 180 681 9 23 64 243 152 575 160 608 212 802 10 25 74 279 176 666 185 700 245 928 11 28 64 317 200 757 210 795 280 1,061 12 30 94 356 225 852 236 892 312 1,182 13 33 105 396 257 950 262 991 351 1,328 14 36 116 437 p77 �,pqg 288 1,091 387 1,463 15 38 127 480 303 1,147 315 1.192 422 1,597 16 41 138 523 330 1,249 342 1,293 464 1,756 17 43 150 566 357 1,351 369 1,396 500 1,892 18 46 161 611 384 1,454 396 1,499 537 2,034 19 48 173 656 411 1,556 423 1,602 575 2,177 20 51 186 702 43 1,656 451 1,706 614 2,322 21 5? 198 749 465 1,760 478 1,811 652 2,468 22 5E 210 796 49 1,866 506 1,916 690 2,612 23 SE 223 843 521 1,972 534 2.022 729 2,758 24 61 235 891 549 2,078 562 2,129 770 2,914 25 64 248 940 577 2,184 591 2,236 808 3,058 26 66 261 988 605 2,290 619 2,344 847 3,208 27 65 274 1,038 633 2,396 648 2,453 887 3,356 28 71 287 1,088 662 2,50fi 677 2,563 928 3,513 29 74 300 1,137 691 2,616 706 2,671 968 3,665 30 7E� 313 1,185 719 2,722 734 2,778 1,007 3,814 31 75 326 1,233 747 p,gpg 762 2,885 1,048 3,966 32 81 338 1,281 775 2,934 790 2,991 1,087 4,113 33 84 351 1,328 802 3,036 8l8 3,096 1,126 4,262 34 86 363 1,375 830 3,142 846 3,201 1,165 4,410 35 89 375 1,421 857 3,244 873 3,305 1,204 4,557 36 91 387 1,466 884 3,346 901 3,409 1,242 4,701 37 9< 399 1,511 911 3.449 928 3,512 1,280 4,846 38 9i 411 1,555 g38 3,551 955 3,614 1,318 4,986 39 99 422 ��598 965 3,653 982 3,716 1,355 5,131 40 102 433 1,640 gg2 3,755 1,008 3,817 1,393 5,272 41 104 444 1,681 7,018 3,854 1,035 3,917 1,430 5,412 42 107 455 7,722 1,044 3,952 1,061 4,016 1,466 5,550 43 109 465 1,761 1,p69 4,047 1,087 4,113 1,502 5,685 44 112 475 1,799 1,094 4,141 1,111 4,207 1,537 5,817 45 114 485 1,836 �,��g q,p3p 1,136 4,302 1,572 5,950 46 117 494 1,871 1,142 4,323 1,160 4,393 1,604 6,070 47 119 503 1,905 1,165 4,410 1,184 4,481 1,638 6.201 48 122 512 1,938 1,187 4,493 1,206 4,566 t,667 6,310 49 124 520 1,970 1,208 4,573 1,228 4,648 1,697 6,422 50 127 528 7,999 1,228 4,648 1.248 4,724 1,724 6,527 51 130 535 2,027 1,247 4,720 1,267 4,794 1,749 6,621 52 132 542 2,050 1,265 4,789 1,282 4,851 1,766 6,684 53 135 547 2,071 1,278 4.838 1,293 4,896 1,777 6,726 54 137 5512 2,087 1,287 4.872 1.3002 4,922 1,785z 6,758 1.Liquid height measured from lowermost insitle surface at bottom of corrugation in tank to the liquitl surface elevation. 2 The total capacity of ihe IM-5401ank is 552 gallons;the total capacity of the CM-1060 is 1,309,the total capacity of the IM-1530 tank is 1 787 gallons. 3.To determine liquitl volume between liquid heights,subract lhe Table 2 volume intlicated for the upper and lower heigh[s.Example:CM-1060 volume between 60 In(127 cm)and 40 in(�02 cm)=1,248 gal(4,724 L)-1,008 gal(3,81�L)=240 gal(907 L). � :�� PAGE 5 OF 6 SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) 4"O Venl Pipe >1091rom Building Beclncal musl mmpty vnin 12"Min.or20 ft abova SPS 376 and NEC 300 EstabllshedFloodElevallon Wealherpr�f Exlendmanholenserasnacessary. «Yp��) J�ncllun Box AnpfO� qppravatl Locking Manhole IMPORTANT: Ve"�CdP with Waming label AlWched Anchor tank(s)as necessary (ryp"a�> pursuant to SPS 383.43 B —cond��� O(9) 4"Min.or 2.07t above Eslablished Flood Elevellon (rypical) �Ainight Seal Finishad Grade � - Ouick Disconnect CAPACITIES 24.86 +e M�. @ galfin , , .. ' c�rv��aq • ` I Depth(in) Volume (gal) — A 22.5 559.35 boj *� wee, �qpp�ovedJoinlswilh Hole Apprwed Pipe 3 fl onlo B 49.72 � q SofdGrounE [C] (0 186.45 � I 3 � ��YP���� D 1 298.32 eZ2S' -B�-�— 0 0���' � ['c� P mp PUMP-OFF *Pump Tank Liquid Level = 44 i� � b_orr ELEVATION = � 6� ft ° INSIDE BOTTOM Force Main Diameter = 2 in �ea�ku ELEVATION = 64 ft Force Main Length = 200 ft 3"Approved 6etlding Malanal Berree�h Tank Force Main Void Volume = 32.6 9a� Vertical Head = 31.5 ft + Min. Supply Head = - ft [C] Total Dose Volume TDV = 182.6 gal/dose + FM Friction Loss = 9•98 ft (5X total lateral vad volume<_TDV 50.2X design Oow) +(force main drainback vdume) + Fitting Loss" _ - ft �`(min.supply head x 0.3) MIN. PUMP DISCHARGE RATE = 50 gpm = TOTAL DYNAMIC HEAD = 41 .48 ft PUMP TANK: SEPTIC TnNK(S): Volume = 1287 gal Total Volume = 1787 ga� Manufacturer: Infiltrator Manufacturer(s): Infiltrator Pump Manufacturer: Zoeller Install approved effluent filter at the septic tank outlet Pump Model: 165 i immediately upsire�m �f the qump tank inlet (Seo atlachetl pump curva Controls/Alarm Manufacturer: SJE Rhombus Filter Manufacturer: Orenco Controls/Alarm Model: HW101 Filter Model: FT0822 Float switches containina mercury are prohibited � � w w PUMP PERFORMANCE CURVE w � " M O D E L S 1 61/41 61 - 1 6 3/4 1 6 3 - �5/4 6 so 24 80 1 5/4165 a 70 w 20 163/4163 _ � 60 � ¢ } 16 0 50 J �� � ���/ � �2 30 8 20 161/4161 4 10 0 10 20 30 40 � 60 70 80 90 100 110 GALLONS `'-=� LITERS 0 80 160 240 320 400 FLOW PER MINUTE PAGE40F4 In-ground Dosed-Gravity Management Plan IMPORTANT: The owner of this in-ground dosed-gravity system 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 system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, aIl inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Disaersal Area Operatinq Limits: Design Flow= 750 gpd; BODS <_ 220 mgL''; TSS <_ 150 mgL''; FOG <_30 mgL'' Inspection Checklist INSPECT EVERY 3 YEARS o type oi 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 solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution/drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump recycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure—compare to design specification) o surtace discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operetor licensed under s. 281.48 Wis. Stats.when the volume of solids In the tank(s)exceeds one-third (113) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s1 shall be inspected every 3 years and shali be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: AC1CIf'y RaSfT1USS0C1 & SOfIS Phone: �15-798-3355 �ocal government unit: SaWyer CO. Zonitlg Phone: �15-634-8288 �ocal government unit address: 10610 Mairl St. #49 Haywal'd, WI Z�p: 54843 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. Continuencv Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. 1126124, 1:07 PM Real Property Lisling Page R2dl EStat2 Sawyer County Property Listing Property Status: Current Today's Date: 1/26/2029 Created On: 8/5/2020 1:08:00 AM �Description Updated: 8/5/2020 '� Ownership Updated: 9/15/2021 TaxID: 43878 � KAREN A WICK STILLWATER MN PIN: 57-024-2-41-07-30-5 OS-002-000380 Legacy PIN: 024741305238 Billing Address: Mailing Address: Map ID: KAREN A WICK KAREN A WICK Municipality: (024)TOWN OF ROUND LAKE 6920 ITASCA TRAIL N 8920 ITASCA TRAIL N STR: 530 T41N R07W STILLWATER MN 55082 STILLWATER MN 55082 Description: PRT GOVT LOT 2 LOT 7 CSM 36/250 #8464 � Site Address * indicates Private Road . . _ _ ._.___ . . . _. ... . Recorded Acres: 5.450 10349N SANDY BEACH RD HAYWARD 54843 Calalated Acres: 0.000 Lottery Claims: 0 L� Pro e First Dollar: No P KY Assessment Updated:4/5/2021 Waterbody: Round Lake 2023 Assessment Detail Zoning: (RRl) Residential/Recreational One �ode Acres land Imp. ESN: 404 G1-RESIDENTIAL 5.450 443,600 0 2-Year Comparison 2022 2023 Change �� Tax Districts Updated: 8/5/2020 Land: 443,800 443,800 0.0% 1 State of Wisconsin Improved: 0 0 0.0% 57 Sawyer Counry Total: 443,800 443,800 0.0% 024 Town of Round Lake 572478 Hayward Communiry School DistriR 001700 Technical College ��property History Parent Properties Tax ID . Recorded Documents Updated: 4/15/2021 57-024-2-41-07-30-5 OS-002-000310 43760 TERMINATION OF DECEDENTSINTEREST Date Recorded: 3/26/2021 430806 WARRANTY DEED Date Recorded: 7/6/2020 424837 CERTIFIED SURVEY MAP Date Recorded: 6/19/2020 424527 EASEMENT Date Recorded: 6/5/2020 424213 EASEMENT Date Recorded: 6/1/2020 424099 IUDGMENT Date Recorded: l/28/2020 422275 QUIT CLAIM DEED Date Recorded: l2/17/2019 421660 CERTIFIED SURVEY MAP Date Recorded: 12/13/2019 421609 AMENDEDFINAL]UDGMENT Date Recorded: 11/21/2019 421244 WARRANTY DEED Date Recorded: ll/8/2019 421016 CERTIFIED SURVEY MAP Date Remrded: 10/28/2019 920791 QUIT CLAIM DEED Date Recorded: SO/19/2018 415001 TRUSTEES DEED Date Recorded: 10/19/2018 414999 QUIT CLAIM DEED Date Recorded: 10/17/2018 414927 WARRANTY DEED Da[e Recorded: l0/11/2004 325714 QUIT CLAIM DEED Date Recorded: 2/14/2003 306253 https:lltas.sawyercounrygov.orglsystem/frames.asp?uname=Eric+Wellauer 1�2 1/26/24, 1�07 PM Real Property Lis�ing Page QUIT CLAIM DEED Date Recorded: 2/8/2001 289077 QUIT CLAIM DEED Date Recorded: 2/8/2001 289076 DEED IN TRUST Date Recorded: 2/11/1963 115752 QUIT CLAIM DEED Date Recorded: l/3/1958 104375 (_.hild Historv�Ld o�mt 7- HISTORY O Expand All History White=Current Parcels Pink=Retired Parcels 0 Tax ID: 25982 Pin: 57-024-2-41-07-30-5 OS-002-000040 Leg. Pin: 024741305204 Map ID: :2.4 O Tax ID:43703 Pin: 57-024-2-41-07-30-5 OS-002-000250 Leg. Pin: 024741305225 O 7ax ID: 25981 Pin: 57-024-2-41-07-30-5 OS-002-000030 Leg. Pin: 024741305203 Map ID: :23 O Tax ID: 25980 Pin: 57-024-2-41-07-30-5 OS-002-000020 Leg. Pin: 024741305202 Map ID: :2.2 O Tax ID:437ll Pin: 57-024-2-41-07-30-5 OS-002-000260 Leg.Pin: 024741305226 O Tax ID:43720 Pin; 57-024-2-41-07-30-5 OS-002-000290 Leg. Pin: 024791305229 D Tax ID:43760 Pin: 57-024-b41-07-30-5 OS-002-000310 Leg. Pin: 024741305231 43878 This Parcel Parents Children https:l/tassawyercountygov.org/systemlframes.asp?uname=Eric+Wellauer 2�2