018-837-21-1102-SAN-2020-249AS'illIndustry Scmcts Ui\'ision1400 F Wiishingliin AvcPO box 7162Madisciii.WI 53707 7!62CST/ Mo (17 7!62)micati(_Sanitary Permit Ap^cationIn »cciiit!anix wicli Si'S 383.2!(2), Wis. Ailm. Code, submission of this fomi to (he ■pprupfiaic govciiinicntal unitIS fctjuired poor to obtaining a sanitary pcrmii. Note: Application forms fur stalc-invncd POWTS arc .suhtnitted tothe Department ol Safety and Professional Services Personal inl'ormation you provide may be usetl for secondarypinpostsin aceordance with thcrrivacy Law, s. 15.04(1 Km). Staoi.t. Application Informatton - Please Print All InfomtalionProject Ad(Jics.s (it Jirfaenl than rnoiiing uddres.s)^y?u/ co^a^ty cPrtipcny Owner's NaincH Ha/JaIt WthhProperty Owner's Mailing Address6^(0 CicJl'iAJil OrlotCity, Stale6\taC^Al^r , fL-Zip c;odeII. Type of Building (chock all that apply)12 I or 2 family l>wclling - Number ol'nedroomsD Publie/Commcrclui - Describe UseD Stale Ovfaed-DescnbeUsePhone NumberLot#Block "CSM NumberCountySanitary Permit Nuiiibri (lo be tillcii in by Co.)6'^79S3Stite Tranf;;itiion NumberIPiucol «Ovg-^37-5^(-floaProperly I ocalioneot'l l.ttTI. Stcnoii X /(eit.leoaiy.^T_1_7__N. R 8 _Ro;(^Subdivision Namen City of□ ViUagc of[2 Tout, of /^_Q_-J'£arin. Type »r Permit: (Check only one box on line A. Cumplete line R if applicable)A.IS NewSyxtemD Replocement Systemn Treatment/Holding I'ank Replaccmenl Only0 Other Modification to Hxisting System (explain)D Permit RenewalBefore ExpirationD Pcrmll RevisionD ChangeofPlunihcrD Pemiit Transfer to NewOwnerlist Previous Permit Numlicr and Date IssuedTV. Type of POWTS Syslcm/Component/Devicc: (Check all that applyn Noii'Prcs.sunreil tn-Ciround [D Ptcssurizetl iii-Ground 0 Al-Gradc G Mouad > 24 in. of suitable soil G Mound < 24 In of ^ulrable soilSI Holding Tanli □ Other Dispersal Coniponcni (explain) ^ □ PrcirtMitmcni Device (explainj_V. Dispersal/Treatment Area Information:Desigft Klow (.gpd)"WoV^TinU InfoSefifk ff''Design Soil Applicaiion Ratc(gpdsf)'(nfTtoldinB 73nl<^~Dispersal Area Ret)uired (sOCapacity inGallonsKcw TanksKxisting TanksTolalGailiutsa ofUnitsDispersal Area Proposed (sOManufaclurciSystem Elevationas P03 U"5 §Q. UIfVt u.2 3£ O.HJfibXC'iiambec\T1. RctpoDsibllily Statement- I, the nadenigned. assume responsIbUlty fur Installailtm of the POWTS shotvn on the attached plant,(^{p/MPRS NumberPlunibei s Name (I'tiiil)Plumber's Sign.tiurcllusin/iAuctcss Phone NumberI'limiba's Addivss (Street, City. Stale, 21ip Ctxlc)jV?VA^ ST At/ Vf) u/Z yyg-jr'Vlll. Ciiunty/Pcparlmenl U.tc Only.^.Ap^livelr I D Disapproved\ □ OVrTicf Giviui Uej^un Toi Driu.ilPcnnil Fee'Woo.'Due IssuedIssuing Agent SignatureLX. Ctmdiiions of Appriival/Reasiins for Disapprovalt;;Aiiach lo vinnptclc jilani frir (he «yt(cm and tDlimii (i> Ihe t'liunly tinty nn paper nutleas tlSBn-63yX(R 08/14)iVh^t^sVrtTjr^K \ \ 'ilTplOCT 0 \ 2020SAWYER CO- "rfZONING ADMINIS i nmriON
Sawyer County Zoning & Conservation Administration10610 Main Street, Suite 49Cq^i Hayward, Wisconsin 54843(715)6.14.828«V I'AX (715)638-3277H-inail: zcnine.accftisawvcrcoutnvuov.orgToll Free Courlliuutte/Gcneral Inrormation 1-877-699-4110Sanitary Cover SheetHolding Tank Approval ChecklistjQT Sheet Date Stamp lO / C> I /Parcel ID# P_ \ ^ ^ ^ - I ^ On. Plot PlanProperty LinesV Site Address^ StructureVWellX Legal Description)C Setbacks to: Property Line^ Benchmark BM A (IS**XjNlorth ArrowX ScaleX|< 25' to Service Roadr/ Nearest Road IntersectionincTwcll, Structure, Water bodies, RoadsIII. Required PlansIndex Page with Original SignatureX Management Plan/Contingency PlanServicing ContractX^Holding Tank Agreement fonnIV. Holding Tank Specifications_X Cross-section - Manufacture, Gallons:'^^0^XTank Anchor Calculations [SPS 383.43 8) g)]X Locking device, chains/locks^ Alarm and Electrical per NEC 300, SPS 316 & 383.43 (9) (e) andState Statutes 101.862(2) and 101.862(3)3" Bedding Material < 1/2 "V. Holding Tank Plans per Component POWTS Manualy Version 2 SBD-10855-P (R.3/07).Owncr;"*^,Application Review Date:POWTS Reviewer:Plumber:License ItRevised 4/11/2013
CONCRETE HOLDING TANK DESIGNSInglo Tank OpitonINDEX AND TITLE SHEETProject Webb HoldingOwner Randall WebbAddress 6460 Cardinal DriveCtegwatar, FL 33760L^al DracripSOT W1/2-NE1/4-NE1/4 S.21-T.37N-R.8WTownship Meteor County SawyerSutxtivision NmneParcel ID Number 18837211102Plan Tians»:tton ID NumberLot No.Index and title sheetHolding tank spedficalionsSite planMaintenance ^ contingency planPage 1P^2Pa«e3Page 4Designer A-1 PiumbingSignatureLicense Number M.P.220498Phone No. 715-943-2382Date 09/27/20Designed ptnsuant to;Holding Tank Component Manual For POWTS (Version 2.0)...StlD-10d5»-P (N. 03/07). ,,Version 7.0 (03/12)1 of 4
HOLDING TANK SPECIFICATIONS2000.0Number of bedroomsNon-residential estimated flow (gpd)Minimum holding tank volume required (gal)2000.0 Proposed holding tank capacity (gal)SkTew2000 SepticSJEfUiombus01Hank ManufacturerTank model numberAlarm manufacturerJAIarm model numberTank Dimensions and DataTank Anchor CalculationsX for round tank16100lbs Weight of tank and cover52.0Liquid depth below inlet invert (in)1.10Safety factor8.0Maximum depth of soil cover (ft)14988lbs Weight of anchor required66.0Height (in)Outside21.8in Soil cover req. for anchor or154.0Length (in)" Dimensions3.7yd^ Concrete counter weight77.0Width (in) -1OnlyHOLDING TANK CROSS SECTIONjunctionbox -conduit^ tettier weightmanhole cover withlocking device andwaming labelfinishedgrade4/vent capManhole and vent locationsblind plugto sealoutletI12*min.vent pipeservicealarm onElectrical as perNEC 300and SPS 31612.0 in.40.0 in.Note: All tank joints, andJoints between tankopenings and piping aresealed watertight Allpipe and vent materialscomply with SPS 384.~r18'min.building sewerinlet3 in. bedding under tank.Tank is anchored as necesswy to negate tunqrancy.Project; Webb H<^ir>gTransaction Number:Page 2 of 4
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HOLDING TANK MANAGEMENT PLANThid Private Onsite Wastewater Treatment S^tem (POWTS) ha& i)een deigned, and is toinstalted andmaintained accwding to SPS 383, Wis. Admin. Code, tlw Hddir^ Tank Cmnponent Manual (SBD-10855-PN. 03/07), and the Sawyer County Sanitary Ordinance.1. This POWTS is designed to accommodate a wastewater flow of 40.0 to 400.0 gpd.2. The owner of this POWrS is respcm^t^fw system and maintenance. inchiC&^aB provisions inthe attached Holding Tank Servicing Contract and Maintenance Agreements.3. time the wastewater in the tank readies 90% of the tank(s)<apac% or a tevel of IZ'tjetow the iniet(at which time the alarm vnl] acthfflte), the punier listed in the cuneid Serace Conlral imfit be c£^ to^pty the tank's contents and of them in accordance with NR113. Wis. Adm. Cocte.4. At each service event the service provider should visually inspect the condition of the tank, risers andm^itiole cover(s) and verify tt^ ttie ateim s)st^ functions and n^ntiole kxddng device se presentOscrepandes are rep(»ted to the ovm«r in a tintefy manner for corrective adkML AH e«rredive adionsshall comply with the county sanitary ordinance smd SPS 383 and 384 Wis. Adm. Code.5. Ail service events or inspections of tliis POWTS strati be repwted to the county wktiin 30 days.6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to bemnoved t)y any p^son notautftcHized to (to so und^Ctu 281, Wis. Statutes. Ttie decti^e of wast^ias^ to Ure ground surf^ie, todudit^ intediond disc^ges arui discha^es caused by neg^d, c^nstiiutesa telling POWTS and may result in issuance of correction orders or a citation by tfiecounfyorstate.7. No one stiouid enter a tioiding tank for any reason witlioultieii^ in full compUance with 0&1Asl£UKiardsfor entermg a confined space. Ttre atmospliere ndtiin ttrese tmte may contam letfid g^es, surd r^cuecS a person from the interior of the tank may t>e difficult or impossftrfe.8. In the event that this POWTS fdls and cannot be repaired, a code compliamt replacement holding tankmay beinstdledinttiesamekrcationfanewsanfiarypennkisrequiiedforsuchareffiacemenQ. C(m>-nection to munidpd services would also l>e consider^ at this time if they are deermd avaBable to theproperty.9. if this POWTS is r^iiaced, or its use (fiscontimted,aMnponents(»>k»^er in use kshsfi be abandoned inaccordance with SPS 383.33 Wis. Adm. Code.10. If there is a protitem with, or question ai>out ttiis InstaHation, the following p&scms may iae contacted:a. Installer A-1 Plumbing Phone: 715-943-2382b. Service Prowder. Gotet Septic Ptwne: 715-^8-6835c. Co. Zoning or Health Dept Sawysr County Phone: 715-634-828811.Project Webb HoldingT ransaction Number: Page 4 of 4
HOLDING TANK SERVICING CONTRACTContract Date:This contract is made between the Holding Tank Owner and the I'umper,Holding Tank Owner's Name:Pumper's Name:Parcel Identification Number:(12 Digit Legacy ID) I S---Sl2—2—--2, ^-_Z ^ 2_2_1. The owner agrees to file a copy of this contract with the governmental unit. Sawyer County,which has accepted and recorded with the Office of the Register of Deeds, the MaintenanceAgreement for a Holding Tank required under the Sawyer County Private Sewage SystemOrdinance for the issuance of a Sanitary Permit for the installation of a holding tank(s).2. Tiie owner agrees to have the holding tank(s) serviced by the pumper and guarantees topermit the pumper to bave,access and to enter upon the property for the purpose of scivicingthe holding iank(s). The owner agrees to maintain the all-weather access road or drive sothat the pumper can service the holding taak(s) with the pumping equipment. The ownerfurther agrees to pay the pumper for charges incurred in servicing the holding tank(s) asmutually agreed upon by the owner and pumper.3. The pumper agrees to submit to the Governmental Unit, Sawyer County, a report for theservicing of the holding tank(s) as required under SPS 383.55, Wisconsin AdministrativeCode and the Sawyer County Private Sewage System Ordinance. The pumper furtheragrees to include the following in the report:a. Tlie name and address of the person responsible for servicing the holding tank;b. The name of the owner of the holding tank;c. The site address of the holding tank;d. The dale the holding tank was serviced;c. The volumes in gallons of the contents pumped from the holding tanlc for each servicing;f. The disposal sites to which the contents from the holding lank were delivered.4. This agreement will remain in effect until the owner or pumper terminates this contract. Inthe event of a change in this contract, the owner agrees to file a copy of any changes to thisservice contract or a copy of a new service contract with Sawyer County within ten (10)business days from the date of change to this service contract,Owner's Name: (Print)Pumper's Name: (Prinf) .Piimper^s^^^t^;Pumper's Registration Number:,Rev. 03/26/13
WARNING DEATH MAY OCCUR IF TANK IS ENTEREDWITHOUT PROPER EQUIPMENTNOTE; SEE INNER WAU PHOTO ON THE 'EXCLUSIVELYAT SKAWS'PAGE.TOP VIEW OF MANHOLE COVER note: when the outlet is plugged the liquid• DEPTH IS INCREASED TO 49 INCHES.■3.00INLET4 INCH PRESSSEAL GASKETINSTALLEDWHEN POURED10.00-H47.00FILTERINCHPRESSSEALGASKETSECTION VIEW OF TANK AND COVERINLETBAFFLE-67.00--71.00-■77.00-154.00148.00I I144.00FILTER12.00OUTLETTOP VIEW OF TANK (TAPERED)SKAW2000OUTLET END VIEW OF TANKModel Number 2000Approved for SEPTIC. SIPHON, HOLDING. OR PUMP CHAMBERWeightInlet Dim.Outlet Dim.Liq. DepthGal./In.Max. Cap.16,100 lbs.52"50"47"44.192077 gal.SKAW PRE-CAST26255 105th Street, New AuburnWisconsin 54757www.skawprecast.comPhone: (715) 967-2277Toll Free; 1-800-924-8625Fax: (715) 967-2707
-USE BLACK MK ONLY-POWTS MAINTENANCEFor HoMQf^ TairiisOwim^NaniaMMihoHnondaed:Bared MenOlcaSanMinbS:ildenI)lcaSanMinber~(laowusKrB)LeBdOasatpBonoinopeit^- SEE ATTACHED SHEET-WeadoMMtedBBltel anAMionb bdngnndBfiirDM insialUon G«a hoUng tonk(s)on teimiieriy desoted on IwaBBdiedciiMLRatum Toe 8aw]^r Cmmly ZbiAv and CoBsenmSan AdmbristaOon10810 Mdn & SiiRe 49^ Hqnmnl, tW 8tt4S8 0 3 6 3 6 7Tx:4023566.427004PAULA CHISSERREGISTER OF DEEDSSAWYER COUNTY. WI10/05/2020 01:35 PMRECORDING FEE 30.00PAGES: 2As an Inducmenl to the CtMmiy of Sswysr to issue a eaiAoiy pwinB fbr a hokflng tank on lie obciviB-described piopeily, lie oMiner latoepondbte for ttis ^railiMi end iminteiianee of the Mifing lank, (oekkig dewtoa, alarm and aooass, and agrees to corform to ^applleabte requbaniBnls of SP3 383, Wla Adm. Code relating tohokflng laidc manaoemenl, bidudlng the ttaouAig:1. TlieMm8raotB8Stoeanl)BetHdh8pei8onwliolsBesnssdwndarCli.MR11S.Vtns.AdRi.Code,ew^taspnwldBdtiySection 281 ^8 (3) (d). Stab., to hava lha hddirm lankpnpeily arevlced and toflla a copy of flw sarvleaoontfactwni ttioSo^reninnntaluniL Ihamnierfiiitheragnastoneaoofytfaiiydiangoatollieadhdaaoontredlioraoo^ytdaneMraenicAoontrad. wUh Bis gowminenlal aid idtto ten (10) budnasedBys Ikon flie dato chai^ to file satvica oantiscL2. The owner agrees to contract wHh a person Rcensed under Ch. NR113, Wls. Adm, Code, shall submit pumping tEpods totoagowmmental un& In aeeotdanca with SPS 383.55, Wia. Adm. Code,torl|ieservidngaf the twidbig toilc In Oiacasa ofexampdon uialar SaeSon 281.48 <3) (d), Slats., the owner dnl subnti Bis report to the-oewooiina^ linlL Tlw goweniinentalimtt may anire'upon lha preperty to bivasBg^ ^ condSon of the hokSno 1^ whan puntobig r^ieito may Indlesto lhahokhtg lank b not bekig pnipaly ntofaitdnad.3.or abatoa htmm health Imard as descrbad bi Sectian. 254J59, SalB., lha govammeidd unit may ants'upoi die pa^aifyand seiyios, or causa toe tank Id basaivtoed. Puisuato to Section 145^4) Wis.StabnasnBonRtoild unit may essaas toeowner^piftrato SBwe^ system fbr cosb raltoed to toe pURiftolS of a atoiOB or hoitoiin tortt. "Bie chaiBSs wB he assasaadn prescribed by Section 69.0703, state. The owner agrees to jWaf i^atges and eoBtlfiaiitad'liy die govunmaiital (uto-ftirbspecdan, pumping, hauBng, or oUianNtoe aaiYlcftig and ntehilaMno lha holtflin tank to audi antannar as to iraveiil sfM^any human iiealto hazard caused by lha holding lank.4.oertiflas ihal efthera soS absoipdon system ihslcoii«flss wQh SP8 383, Wls. Adni. Code, (8<a nunlcjpeiBBwareaamibHtopn^eity. In adifiilon, iMs a^eemenl may ba canoeOad byeniaitoigaiid reomfliq saidasEWbaBMiwBfaidPfBaOB to^7^ ^feemani shan ba bkiding upon the owno; toa heiis of toe owner, and asdgneaaohUiaawRar. Tha ownersbaH anbnUthe agreement to toa legistBr of deeds, and lha ^mement shtfl be reeonied by lha redstarafd^ds In a mamttewtlhilMidBpwmiltoe azblanoe of the agreamentlo be dataimtnad by lefBtenca to toa propei^wtomtoB haMbv^tankb kisteia^^'Only OPSOwner'aSig)stanstare reqldradSlalBofc l~(nt^ffr.OKWier's Nma (Print):County oft _BA£ZtoLSubsCTibed and swooi^iQ^flgitMn^ Oitertovof_.20i^QDate;^(OwneraNane): £?&Notaiy PuUio ^natuie:Drafted by:unfenrTfe'in (AjflrA/.Myoommtsdoni&04(i)onj)s:.^^.oatS8tw• •
The West One-half CW*^) of the East One-half (EV^) of the Northeast Quarter (NEV^),Section TwenQr-one (21), Township Tlurty-seven (37) North, Range Eight (8) West.
Real Estate Sawyer County Property ListingTodays Date:Propoty Status: CunentCreated Oir 2/8/2007 7:S5;38 AMDescriptionUptteted: 4/22/20^^ OwnerstiipUpdated: 2/6C007Tax ID:19859RANDALL BWSBCLEARWATER FLPIN:57-018*2-37-<»-21-l 01-00(M)00(»0Legacy PIN:018837211102Mailbm Addrmts:Map ID:.1.2RANDALLBWEBB6460 CARDINM. DRIVECLEARWATER FL 33760RANDALLBWEBBMunicipality:(018) TOWN OF METEORo<K>u univcCLEARWATER FL 33760SIR:S21T37NR{»WDescription:W1/2NENEmReconted Acres:19.9»)* SOB Aoaress * maicags mvaie KoaoLotteiy Claims:013M9W COUNTY HWY CEXELAND 54835First DoiterNoWaterbody:Deer Late^ Pnqrerty AssessmentUpdated; 9/4/2012Zoning:(F-1) Forestry One(RR2)Reslrientel/Recreationanwo2020 Assessment DetailCodeAcresLandImp.431G5-UNDEVELOPED0.930300aG6-PR0DUCTIVE FORESTi9ixn42,8000^ TaxDisCrtetaUpdated: ZWr/UU/1State of Wisconsin2-Year Comparison2019zamChange57Sawyer CountyLand:43,10043,1000.0%018TowntriMeteo?Impioved:000.0%650441Birctrwood Scttotri DistrictTotal:4340043,1000.0%001700Technical College^ Recoided DocumentsUpdated: I/IT/ZOUQ WARRANTY DEEDDale Reconted: 10/14/1997263753 615/427e MAP SURVEYDate Reconted: 12/31/2(Ki321378-3r Property HistofyN/A