HomeMy WebLinkAbout028-742-22-5706-SAN-2024-097 (/�
Industn Sen ices Division Coimn �
� 4822 Madison Yards Wa� Sawyer Z
-� � Madison,WI 53705
= t� = Sanitary Permit Number(to be tilled in by
: P.O.Box 7302 �
Madison. WI 53707 (� j� � c��- „_,
i
Sanl*a� PeY,1,i11t A„„llCa*l�n State Transaction�umber �
6 1J1J 6
In accordance with SPS 38321(2),Wis.Adm Code,submission ofthis form to the appropriate govemmental 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 a�
the Department of SafeR and Professional Services. Personal infonnation you provide may be used for secondan �Z947N BaISaC71 RC�. Ha ward, W�
purposes in accordance with the Privacy La���,s. I�.Od(I�(m),Stats. y
I.Application Information—Please Print All Information
Property Owner�s Name Parcel#
Chelsea Real Estate Inc 028742225706
Propert} O�cner�s Mailing Addresi Prope � Location
1125 S 103rd St STE 425 ���&�
City,State Zip Code Phone Number
Omaha, NE 68124 607-731-7123 �' �^ �. Se�t�on 22
II.Type of Building(check all that apply) Lot# T 42 N R �� E or W
� 1 or2 Family D���elling—Numberofl3edrooms 4
r'� Subdivision Name
E31ock#
❑Public/Commercial—Describe Usc
�--. �City of
�Sta[e Owned—Describe Use CSM Number Village of
�-- �Town of Spider Lake
❑I.T��pe of PO�VTS Permih(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if
a licable.)
`�� �Ne���S}�stem �Replacement System �Other Modification to Ezistin_Sysrem(e�plain) �Additional Pretreatment Unit(eaplain)
B' �Holding Tank �In-Ground �At-Grade �Mound ❑Individual Site Design Other Type(explain)
(conventional)
C. �Renewal Before �Revision �Change of Plumber �I'ransfer to Ne�c Owner List Previous Permit Number and Date Issued
Expiration CST 93-424 SAN 93-351
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Desien Soil Application Rate(apd/st) Dispersal Area Required(st) Dispersal Area Proposed(st) S��stem lile��ation
600 0.7 857 858 95.01
Capacity in 'lbtal #of Manufacturer
v
Tank Information Gallons Gallons Units � � v 'D �
Ne���Tankc E�istin��Tanks �� � `—' � � � �
— U v: h v: _ U -
Septic or Holding Tank 1250 1250 1 Ro�h � �
Dosing Chamber 1000 1000 1 Roth �ly�•j' � Q � ✓
�'.Responsibilit}�Statemenh I,the undersigned,�ssume responsibility for installation of the PO��'TS shown on the attached plans.
Plumber�s Name�Print) Plumher�s Sianature r/ � 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
Vl.Co n /Department Use Only
�Ap v ❑Disapproved Pennit Fee Date Issued Issuing Agent Si�naturc
❑O�vnerGiven Reason for Denial $���� �� � �� ��`� ��/{����f��!/✓�.����
:-T-'r' :7�.:_
Conditions of Appro�al/Reasons for Disappro�al ��):' �,��� � � ;' ` '�
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Attach to comple[e plans for the sys[em and submit to the County only on paper not less than 8 V2 x I I inches in size
�u�� SBD-6398(R.02/22)
NO R�FUND6 AFTER
ISSUE OF PERi1AIT `;�cj���
PAGE 1 OF 5
In-Ground Dosed-Gravity Plan
Index & Cover Sheet
Component Manua/Design References:
In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
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
Chelsea Real Estate - 4 Bed
Owner Name(s): Chelsea Real Estate Inc. Phone: 607 _731 _7123
Owner Address: 1125 S 103rd St. STE 425 Omaha, NE Z�p: 68124
Project Address: 12947N Balsam Rd. Hayward, WI
Govt. Lot: 7&1 1/4 of_ _ __ _1/4, Section 22 , T 42 N-R07 E ❑or W❑✓
Township: Spider Lake County: Sawyer
Project Parcel ID #: 028742225706
Designer Information
Designer Name: Jason Kuettel Phone: 715 _798 _3355
Designer Address: PO Box 66 Cable, WI Zip; 54847
E-mail: tim@andryras.com
License Number: 675751
Remarks:
� �a
A ��,..
Signature: � y;�==-��i�" Date: -�-` ti'�
Origin I signature required on each submitted copy.
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IN-GROUND DOSED-GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down-sizing credit)
�
`"'" 1z� TYPICAL TRENCH
SOIL COVER (rypicep
,z..
CROSS SECTION VIEW
m�� �,e��h (No Scale)
dep�h
(typlcal) . •
. �.a
F 34.. �'� . .
�rypicap , � � � Provide minimum 3 ft
� . � ' separation between trenches.
System Elevation = 95.01 ft
(typical)
Quick4 Standard-W
W/Elld C8p Observa�lon Plpe
(rypicaq (Show location of inlet/outlet pipe connection on plan view.) ('vP�°a�� TYPICAL TRENCH
Install per manufac[urefs
��s«����o�s. PLAN VIEW
� - - - - �� - - - - - - - �� - - - — — � T (NoScale)
- - � , iya= s.on
�— — — — — t — — - —._ J 1 (rypical)
_ _ — — — �� — — — — — — _ �� — _ _ — �
� B = 58 ft - � �
(typical) Quick4 Standard-W Chamber m
INSTALL PER TRENCH: (rypica�) W
(mfd by Infiltra�or Systems.Inc.) O
Inslall pursuant�o manufacwrets instmctions.
14 Quick4 Std-W @ 20 ft� EISA/chamber= 280 ft` T
+ � Pairs of end caps @ 6 ft�EISA/pair= 6 ft' �
= Proposed EISA per trench = 286 ft` Required Infiltration Area = 857 ft' Distribution Method:
x 3 trenches = Proposed Total EISA = 858 ft' branched manifold
RESET
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, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area Operatinq Limits:
Design Flow = 600 gpd; BODS<_ 220 mgL-'; TSS <_ 150 mgL-'; FOG <_ 30 mgL-'
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 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 distributian cell prior to dosing
o dosing irregularities - if applicable (i.e., pump re-cycling, 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 surface 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 operator licensed under s. 281.48 Wis.
Stats. when the volume of solids in the tank(s)exceeds one-third (1/3) 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(sl shall be inspected every 3 years and shall 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: Alldl')/ RBSIIlUSS21l & SOIIS Phone: 715-798-3355
Local government unit: SBWyef CO. Z011lllg Phone: �15-634-8288
�oca� government unit address: 10610 Mairl St. #49. Hayward, 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.
Continqencv 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.
Svstem Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc. Admin. Code.
\� s,� � PAGE50F6
��
p� 6 ti�'�k SEPTIC / PUMP TANK SPECIFICATIONS
Mp,�t � N-� ,� (No Scale)
��GQS �P-�\� 4"� Vent Pipe
"� >10 ft from
SP� P�M�N Building Electncal must comply with
N�N('j 12" Min. or 2A ft above SPS 316 and NEC 300
Established Flood Elevation Extend manhole riser as necessary.
Z� Weatherproof
(typical) Junction Box
Approved Approved Locking Manhole
IMPORTANT: Vent �ap with Warning Label Attached
(typical)
Anchor tank(s) as necessary
�-Conduit
pursuant to SPS 383.43(8)(g) a° M��. o�2.o rt abo�e
Established Flood Elevation
(typical)
�Airtight Seal
Finished Grade �
-- Quick Disconnect
� a a 18" Min.
CAPACITIES @ 29 gal/in < s . < (typical)
Depth (in) Volume (gal)
a i
A 24.7 623.5 * f Weep � Approved Joints with
Hole Approved Pipe 3 ft onto
B 2.0 58 � IIII Solid Ground
(typical)
[C] 4.5 130.5 ` 1 �
_Alarm
D 12 348 B } �,�—o�
f [c] PUMP-OFF
* 40 ± PumP �—aff a ELEVATION = $� ft
Pump Tank Liquid Level = in
i
° INSIDE BOTTOM
Force Main Diameter = 2 in Concrete
B'°°k ELEVATION = $� ft
a_ a
Force Main Length = 80 ft 3" Approved Bedding Material Beneath Tank
13.04 Vertical Head = � 5 ft
Force Main Void Volume = gal
+ Min. Supply Head = - ft
[C] Total Dose Volume TDV = 133.04 gal/dose
+ FM Friction Loss = 2•64 ft
(5X total laterai void volume < TDV < 0.2X design flow)
+ (force main drainback volume) + Fitting Loss* = ft
*(min. supply head x 0.3)
MIN. PUMP DISCHARGE RATE = 40 gpm = TOTAL DYNAMIC HEAD = � 7.64 ft
PUMP TANK: SEPTIC TANK(S):
Volume = 1000 gal Total Volume = 1250 gal
Manufacturer: Roth Manufacturer(s): Roth
Pump Manufacturer: Champion
Install approved effluent filter at the septic tank outlet
Pump Model: CPES3 immediatel upstream of the um tank inlet.
(See attached pump curve.) y {� p
Controls/Alarm Manufacturer: SJE Rhombus Filter Manufacturer: Orenco
Controls/Alarm Model: HW101
Filter Model: FT0822
Float switches containinq mercury are prohibited.
RMT•1000E Ca aci Chart
Height(inches) Gallons in Tank
0 0
1 7
2 13
3 24
4 35
5 52
6 58
7 92
8 115
9 139
1� 163
11 186
12 208
13 241
14 273
15 302
16 330
17 357
18 383
19 411
20 436
21 468
22 498
23 528
24 558
25 583
26 608
27 636
28 663
29 591
30 719
31 749
32 779
33 806
34 833
35 861
36 888
37 915
38 941
39 966
40 990
41 1009
42 1028
43 1051
44 1073
45 1093
46 1113
47 1130
48 1147
49 1154
50 1161
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HORIZONTAL STRUCTURAL REINFORCING RIBS GAS(TOP)/LIQUID(BOTTOM) TOP
(FULL CIRCUMFERENCE) PASS-THRU SLOT INSIDE TANK
LIFTING O
HOLES
(4 TYPICAL)
THREADED cNo
ACCESS O�P� p�P °
OPENING `L�` O O 2�` �
24"I.D.DIA. �
(2 TYPICAL) �
O O
4.25"TYP.
} 29 1/2"TYP.
�
� LENGTH=148"
N
� WIDTH=62"
8.66"
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TANK SPECIFICATIONS w �
DESIGN CAPACITY TOTAL CAPACITY WEIGHT �
GALLONS LITERS GALLONS LITERS POUNDS
1250 4730 1469 5561 560 S I D E
DWG SCALE: 1:1 p n TU ROTH GLOBAI PLASTICS
PLOT SCALE:1:2
I\�/ I I � M u I t i Ta n K O �� One General Motors Drive
1250 GALLON MODEL RMT-1250 Syracuse N.Y. 13206
SHEET�J: II Toll Free 866.943.7256
1 OF 3 rpw�rt�dw���a www.fralo.net
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8s„
ELEVATION
INLET PORT � OUTLET PORT
Note: RMT-1250 may be used as
a gravity septic tank as shown in the I I
section view (tanks in series). It
also is approved for use as a lift I I
station/pump tank per IAPMO listing. ,n
n
Note: State or local authorities may =
require all installed septic tanks to �
be equipped with an effluent filter w
listed to ANSI/NSF Std 46 or
_
applicable local code.
LENGTH = 148"
THREADED ACCESS HORIZONTAL STRUCTURAL THREADED ACCESS
INLET PORT 12�„ OPENING $�� REINFORCING RIBS OPENING 122"OUTLET PORT
Z 24" I.D. DIA. (FULL CIRCUMFERENCE)� 24" I.D. DIA.
INV IN.
g�� 924�� ��g" _ INV OUT
� m �21�� 2 411,
4 Effluent $
ii . 1� - Filte
1
=U' � $ �nRnrioN wn��sEE�ocn��$4 3�, o
w REGS.FOR OPENING $ V
= RE�UIREMENT
28 �2��
858,� 3 4��
8
2/3 TANK LENGTH 1/3 TANK LENGTH
0" LIQUID LEVEL � SECTION
DWG SCALE: 1:1 ROTH GLOBAL PLASi1CS
PLOT SCALE: 1:2 R 0 TH M u I t i Ta n K O �� One General Motors Drive
F Syracuse N.Y. 13206
SHEET #: � ��J O G A L L 0 N / M 0 D E L R M T- 12 5 0 �� Toll Free 866.943.7256
2 � �M���p���� www.fralo.net
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HORIZONTAL STRUCTURAL REINFORCING RIBS ISOMETRIC
(FULL CIRCUMFERENCFI
MULTI PORT
GAS (TOP) / LIQUID (BOTTOM) OUTLETS
PASS-THRU SLOT INSIDE TANK (3 TYPICAL)
THREADED ACCESS OPENING
24" I.D. DIA. (2 TYPICAL) f LIFTING
HOLES
(4 TYPICAL)
MULTI PORT
INLETS
(3 TYPICAL)
�
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WARNING
TANK NOTES
1 . Access at or above grade level must be secured against unauthorized access.
2. Tank is not rated for vehicular traffic loading.
3. All resin used is compliant with ASTM D 1248 as required by CSA B66 and IAPMO / ANSI Z1000.
4. Tank material of construction is HMW-HDPE.
5. Primary dimensions are in inches
6. Minimum tank wall thickness is 1/4".
7. Labeling will include: manufacturer name, liquid capacity, date, maximum burial depth, and model number.
8. Riser cover contains the following: 6" x 3" warning:
"Danger - Do not enter - Poison Gas" - written in English, French & Spanish.
9. Maximum burial depth from manufacturer is 36" unless specifically instructed otherwise by the factory.
10. Models RMT-500, RMT-750, RMT-1000E, RMT-1060, RMT-1250 and RMT-1500 are all certified to NOTES
CSA and IAPMO standards.
DWG SCALE: 1:1 ROTH GLOBAL PLASTICS
PLOT SCALE: 1:2 R 0 TH M u I t i Ta n K O �� One Generol Motors Drive
SHEET #: � ��O GALLON / MODEL RMT- 1250 II ToISFr�ee 866.943.7256
3 OF 3
py�Mywp�R�pw�I��L www.fralo.net
Details Provided by APPIAN Consulting Engineers — www.appianengineers.com Feb. 2008
HORIZONTAL STRUCTURAL REINFORCING RIBS GAS (TOP) / LIQUID (BOTTOM) TOP
(FULL CIRCUfviFERENCEj PASS-THRU SLOT INSIDE TANK
LIFTING O
HOLES
(4 TYPICAL)
THREADED cNo
ACCESS O�P p�P ii
OPENING `L�` O O �,�` �
24" I.D. DIA. �
(2 TYPICAL) �
O O
4.25" TYP.
} 29 1/2" TYP.
�
� LENGTH = 118"
N
d' WIDTH = 62"
8.66"
i�
N
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ii
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TANK SPECIFICATIONS w �
DESIGN CAPACITY TOTAL CAPACITY WEIGHT �
GALLONS LITERS GALLONS LITERS POUNDS
1000 3780 1161 4395 450 S 1 D E
DWG SCALE: 1:1 � ROTH GLOBAL PLASi1CS
PLOT SCALE: 1:2 R 0 TH M u I t i Ta n K O One General Motors Drive
1000 GALLON / MODEL RMT- 1000E R� Syracuse N.Y. 13206
SHEET /�� II Toll Free 866.943.7256
7 OF 3 ��R�q���� www.fralo.net
Detoils Provided by APPIAN Consulting Engineers — www.oppianengineers.com Feb. 2008
ELEVATION
59"
INLET PORT OUTLET PORT
� �
Note: RMT-1000E may be used as a gravity I I _
septic tank as shown in the section view �n
(tanks in series). It also is approved for use ��
as a lift station/pump tank per IAPMO listing. �
w
Note: State or local authorities may require
_
all installed septic tanks to be equipped with
an effluent filter listed to ANSI/NSF Std 46 or
applicable local code.
LENGTH = 118"
THREADED ACCESS THREADED ACCESS OUTLET PORT
INLET PORT �2�" OPENING _ OPENING
��� 2 24" I.D. DIA. "��' 24" I.D. DIA.
12Z"
INV IN. - -o� - -
63$" b � Z INV OUT
g a'� � 63$' �N 4�'
�n `"' 158 Effluent
1
F Filter 184
= PARTITION WA�L SEE LOCAL
M
� � ��� REGS.FOR OPENING 3�� �
LL1 W REQl11REMENT 8
= N
55$" `�o� 354'
2/3 TANK LENGTH 1/3 TANK LENGTH
40�� LIQUID LEVEL � HORIZONTALSTRUCTURALREINFORCING SECTION
RIBS (FULL CIRCUMFERENCE)
DWG SCALE: 1:1 � ROhi GLOBAL PLASTICS
PLOT SCALE: 1:2 R 0 TH M u I t i Ta n K O �One General Motors Drive
SHEET �/
1000 GALLON MODEL RMT- 1000E R� II ToISFree 866.943.7256
2 OF 3 �����p���� www.frolo.net
Details Provided by APPIAN Consulting Engineers — www.appianengineers.com Feb. 2008
HORIZON?^,L STP.UCTURi^-,L REINFORCING RIBS ISOMETRIC
(FULL CIRCUMFERENCE)
GAS (TOP) / LIQUID (BOTTOM)
PASS-THRU SLOT INSIDE TANK
MULTI PORT
OUTLETS
THREADED ACCESS OPENING (3 TYPICAL)
24" I.D. DIA. (2 TYPICAL)
LIFTING
HOLES
(4 TYPICAL)
MULTI PORT
INLETS
(3 TYPICAL)
�
�
WARNING
TANK NOTES
1 . Access at or above grade level must be secured against unauthorized access.
2. Tank is not rated for vehicular traffic loading.
3. All resin used is compliant with ASTM D 1248 as required by CSA B66 and IAPMO / ANSI Z1000.
4. Tank material of construction is HMW-HDPE.
5. Primary dimensions are in inches
6. Minimum tank wall thickness is 1/4".
7. Labeling will include: manufacturer name, liquid capacity, date, maximum burial depth, and model number.
8. Riser cover contains the following: 6" x 3" warning:
"Danger - Do not enter - Poison Gas" - written in English, French & Spanish.
9. Maximum burial depth from manufacturer is 36" unless specifically instructed otherwise by the factory.
10. Models RMT-500, RMT-750, RMT-1000E, RMT-1060, RMT-1250 and RMT-1500 are all certified to NOTES
CSA and IAPMO standards.
DWG SCALE: 1:1 � ROhI GLOBAL PLASTICS
PLOT SCALE: 1:2 R 0 TH M u I t i Ta n K O �One General Motors Drive
� 1000 GALLON / MODEL RMT- 1000E �0 Syracuse N.Y. 13206
SHEET II Toll Free 866.943.7256
3 F 3 �M�p��q���� www.fralo.nei
4l29124, 10:1 S AM Real Property Listing Page
R2dl EStat2 Sawyer County Property Listing PropertyStatus: Current
Today's Date: 4/29/2024 Created On: 2/6/2007 7:55:52 AM
� Description Updated: 6/20/2017 `� Ownership Updated: 8/25/2023
TaxID: 30965 CHELSEA REALESTATEINC OMAHA NE
PIN: 57-028-2-42-07-22-5 OS-007-000060
Legacy PIN: 028742225706 Billing Address: Mailing Address:
Map ID: J.6 CHELSEA REAL ES7ATE INC CHELSEA REAL ESTA7E INC
Municipality: (028)TOWN OF SPIDER LAKE 1125 5 103RD ST STE 425 1125 5 103RD ST STE 425
STR: 522 T42N R07W OMAHA NE 68124 OMAHA NE 68124
Description: PRT GOVT LOT 7&PRT GOVT LOT 1 SEC
27 � Site Address * indi�ates Private Road
Recorded Acres: 1J00 12947N BALSAM RD HAYWARD 54843
Calculated Acres: 1393
Lottery Claims: 0 l.� Property Assessment Updated: 10/2/2023
First Dollar: Yes
Wa[erbody: Clear Lake Z024 Assessment Detail
Zoning: (RRl) Residential/Recreational One Code Acres Land Imp.
ESN: qp3 G1-RESIDENTIAL 1.700 300,600 372,000
2-Year Comparison 2023 2024 Change
� Tax Districts Updated: 2/6/2007 Land: 300,600 300,600 0.0%
1 State of Wisconsin Improved: 372,000 372,000 0.0%
57 Sawyer County Total: 6R,600 6R,600 0.0%
OZ8 Town of Spider Lake
572478 Hayward Community School District
001700 Technical College ��.+�property History
N/A
.� Recorded Documents Updated: 8/25/2023
WARRANTY DEED
Date Recorded: 8/15/2023 445898
WARRANTY DEED
Date Recurded: 8/12/2022 440735
WARRANTY DEED
Date Recorded: 9/3/2013 387056
https://tas.sawyercountygov.orglsystem/frames.asp?uname=Eric+yyellauer 1I1