HomeMy WebLinkAbout006-439-02-3313-SAN-2020-187-vit-rv,)..'Aog .y'\h^ '"Safety and Buildings Division201 W. Washington Ave., P.O. Box 7162Madison, Wl 53707-7162ho CST■%4Sanitary Permit J^>plicationIn sccordnncc with SPS 381.21(2), \Vi>. iXdin. Code, submiuion of itiis fcnn to Ihe oppropriste goioiuncntal unitis required prior to obtaining a sanitary' ttcnnil. N'otc: .'Vppticatlcci forma for alalc*€aMtod POW13 arc aubmiUcd tothe Depaftmenl of Safety and Profttsional Scr\-ies. Personal information you provide may be used for aecandatypurpoaea inaccordanee with the Privacy Ijvv.s. 15.04(1 )(ni), StaLs.L -Appliiarion Information—Please Print All InfomationicrXloteCountySanitary Permit Mumber'flobc niiedinhy Co,)State Transaction NumberIVojcct Address (if diSerent than mailing address)5"^,55VFVopcrty Ovvtier's NamelilinQ (\i:5 fi/ccrhhParcel#/3Properly Owner's Mailing IK S-j.noU ^l3Ffnc3Property ICity, StateZr)rg-(:fA rZip CodeIL Type of Building (check all that apply)I or 2 Family Dwelling - Number of BedroomsPubiio/Commetcial - Describe Use,Stale Owned - Describe UsePhone Number6yS)Lots.ocation p)^"^Ciov^ LotfiiiJ U SCtJ 'A Section 3T.11 »■ R ^ nSf)Subdnision NameBlaekaCSM NumberCity ofVillage ofTovvd of111. Typej)f (Check ottly one htnt on line A. Complete line B If applicable)Tf New' Syalon JA.Replacement SystemTrcatment/Koldiog Tank Replacement OnlyOther Kfodincalion to nxitting System (expbin)B.Permit RenewalBefore £.xpiratlonPermit RevisionChange ofPlumbcrPermit Transfer to NeivOwnerList Previous Barail Ftonber vd Date issuedI\^ Type of POXATS .Systctn/Ciunponcnt/Dcvice: (Check >H that applysurired ln«Ofound IVcsaurizcd In-Oround At-Orade Mound > 24 in. of suitable soil Mound < 24 in. ofsuitable soilHolding Tank ) Oilier Dlapcninl Component (oxplnin) IVctrcatmenl Device (ctplain)\'. Dispersal/Treatment ;kfea Information:Design Flow (g>d)Acf)Design Soti .Aj^licatioo RAlc(gpdsONf\Dispersal .Area RetpiumJ (sJ)NflDisposal Area Proposed (af)M ASystem ElevatiooNPj-VI. Tank Infop5-y75DCapacity illGallonsliauiaig TsrSnTotalGallons#ofUnitsManufacturerX 1"S §cu OIViMi£ OS«piie or Motdii'g TankzIMSOi3\uDosing Clumber\'II. Responsibility Statement- I. the umltrslgncd. assume retponslbilllT forinstallatfcinofihePGAATSsbonn on the attached planaPlumJ^'s Name (Prini^Plumber's .AoHress (Street. City, Slalc, Zip Code)\ aMStsv^s s •lowata'so yova•-•si *i ••isasw^ r<t|> «-Piumboii' SignatureMP/MPR-S NumberBusiness llionc Number■ t'T^o^y^OStA RJ) UMi SH'Sit.VIII, Cpuntv/Dcpartmeni Use Only11. cauntv'KDisapprovedOwner Given Reason for DenialPertnil FeeDate IssuedIssuing Agcnl Signaturel\. Conditions of Approval/Reasons for DisapprovalORIGINALAttach to eompltle plau ter the sysUn and anhniit to the County only on paper not Ins than# ta c II lacbn In dieSBD-6398 (R. 11/11)- AUG 2 0 2020SAWYER COUNTYZONINQ AOMtNiSTRATION
Sawyer County Zoning & Conservation Administration10610 Main Street, Suite 49Hayward, Wisconsin 54843(7I5)63-«.82K8i'AX (715)638-3277Owner;Toll Free Courlhousc/Gcncrel Informalion 1-S77-699-4110Holding Tank Approval Checklist/er Sheet Date Stamp / ^O/Sanitary Cover SheetPlot Plan/ Property Lines~7 Site Address^ StructureKWell^ Legal DescriptionParcel ID# ^ O 6-V S A" 3 J o AX Benchmark BM sy North Arrow_2<Scale25' to Service RoadNearest Road Intersectiony Setbacks to: Property Line, Well, Structure, Water bodies, Roadsin. Required PlansK,Indcx Page with Original SignatureX Management Plan/Contingency PlanX. Servicing Contract_5^Holding Tank Agreement fonnIV. Holding Tank SpecificationsCross-section - Manufacture, Gallons;Cross-section - Manufacture, Gallons; 1^5^/^Tank Anchor Calculations [SPS 383.43 8) g)]^Locking device, chains/locksI^Alann and Electrical per NEC 300, SPS 316 & 383.43 (9) (e) and^ State Statutes 101.862(2) and 101.862(3)_K 3" Bedding Material < 1/2 "Holding Tank Plans per Component POWTS Manual/^Version 2 SBD-10855-P (R.3/07)Plumber;Application Review Date;POWTS Reviewer:License ivRevised 4/11/2013
CONCRETE HOLDING TANK DESIGNSingle Combo Tank OptionINDEX AND TITLE SHEETProject Heath Log HomeOwner Jeffery S HeathAddress 7010N Forth StLorella Wi 54896Legal Description PRT. SWSW S-2 T-39-N R-4-WTownship DraperCounty SawyerSubdivision NameLot No.Parcel ID Number 006 439 02 3302Index and title sheetHolding tank specificationsSite planMaintenance and contingency planPage 1Page 2Page 3Page 4Designer Craig ThompsonSignatureLicense Number220810Phone No. 715-266-2842Date 07/15/20Designed pursuant to:Holding Tank Component Manual For POWTS (Version 2.0)SB0-10855-P(N. 03A)7, R. 01/12)Version 8.0 (10/13)Page 1 of 4
HOLDING TANK SPECIFICATIONS2000.0Side A1250.0Skaw Pre CastNumber of bedroomsNon-residential estimated flow (gpd)Minimum holding tank volume required (gal)Side B TotalProposed tank capacity (gal)Tank manufacturer750.02000,01250/750SJE RhombusTankAlertI (101-01H) 120 VAC jAlarm model numberTank model numberAlarm manufacturer54.0Tank Dimensions and DataX for round tankLiquid depth below inlet invert (in)Maximum depth of soil cover (ft)Height (in) *1 OutsideLength (in) L DimensionsWidth (in) J On'y8.067.0146.069.5161001.10Tank Anchor Calculationslbs Weight of tank and coverSafety factorlbs Weight of anchor mquiredin Soil cover req. for anchor oryd"' Concrete counter weight1090518.62.7vent pipeHOLDING TANK CROSS SECTIONElectrical complies with NEC 300 and SPS 316manhole covet withlocking device andwaming labeljunctionboxconduitthetherw^htservicealarm on90% Full1250.0S de A6" max.3:sealed watertightblind plugto sealoutletNote; All tank joints, and jointsbetween tank openings andpiping are sealed watertight. Allpipe and vent materials complywnth SPS 384. Manholes withlocking device are typical foreach manhole opening .Side 8750.0 galfinishedgrade14" min.3 In. bedding under tank.Project: Heath Log HomeIB* mIn13)building sewerinletTank Is anchored as necessary to negate buoyancy.Page 2 of 4
Scale: r = 30flHOLDING TANK SITE PLANProject: Heath Log HomeLegal Description: PRT, SWSW S-2 T-39-N R-4-WSubdivision Name:Parcel ID: 006 439 02 3302Lot No.:WCkixyy k5pite lA" ^ffuce. Tree ^yr\-fcO.O'Page 3 of 4
HOLDING TANK MANAGEMENT PLANThis Private Onsite Wastewater Treatment System (POWn'S) has t)een designed, and is to lie instaiied andmaintained according to SP 383, Wis. Admin. Code, the Holding Tank Component Manuai (SBD-108S5-PN. 03/07, R. 01/12), and the Sawyer County Sanitary Ordinance.1. This POWTS is designed to accommodate a wastewater flow of 40^ to 400.0 gpd.2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions inthe attached Holding Tank Servicing Contract and Maintenance Agreements.3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a levei of 12" beiowthe inlet(at which time the aiarm wili activate), the pumper listed in the current Servicing Contract must be called toempty the tank's contents and dispose of them in accordance with NR113, Wis. Adm. Code.4. At each service event, the service provider should visually inspect the condition of the tank, risers andmanhole cover(s) and verify that the aiarm system functions and manhole locking devices are present.Discrepancies are reported to the owner in a timely manner for corrective action. Ail corrective actionsshall comply with the county sanitary ordinance and SPS 383 and 384 Wis. Adm. Code.5. All service events or inspections of this POWTS shall be reported to the county within 30 days.6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to beremoved by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastestank to the ground surface, including intentional disdrarges and discharges caused by neglect, constitutesa failing POWTS and may result in issuance of correction orders or a citation by the county or state.7. No one should enter a holding tank for any reason without being in full compliance with OSHA standardsfor entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescueof a person from the interior of the tank may be difficult or impossible.8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tankmay be installed in the same location (a new sanitary permit is required for such a replacement). Connection to municipal services would also be considered at this time if they are deemed available to theproperty.9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned inaccordance with SPS 383.33 Wis. Adm. Code.10. if there is a problem with, or question about this instaiiation, the following persons may be contacted:a. installer Don Thompson & Sons Exc. LLC Phone: 715-266-2842b. Service Provider Steve Golat Phone: 715-868-6836c. Co. Zoning or Health Dept. Sawyer County Zoning Phone: 715-634-828811. if this building Is used as a year-round dwelling a mound system will be installed.Project: Heath Log HomePage 4 of 4
HOLDING TANK SERViaNG CONTRACTContract Date: y ! 1^1 SioJnThis contract Is made between the Holding Tank Owner and the Pumper.Holding Tank Owner's Name: Pumper's Name;I wParcelldentilicationNumber: _ _(12 Digit Legacy ID)1. The owner agrees to file a copy of this contract with the governmental unit. Sawyer County,which has accepted and recorded with the OfBce of the Register of Deeds, the MaintenanceAgreement for a Holding Tank required under die Sawyer County Private Sewage SystemOrdinance for the issuance of a Sanitary Permit for the installation of a holding tank(s).2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees topermit the pumper to have access and to enter upon the property for the purpose of servicingthe holding tank(s). The owner agrees to maintain the ail-weather access road or drive sothat the pumper can service the holding tank(s) with the pumping equipment The ownerfurther agrees to pay the punqier 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.SS, Wisconsin AdministrativeCode and the Sawyer County Private Sewage System Ordinance. The punier furtheragrees to include die following in the report:a. The 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 date the holding tank was serviced;e. The volumes in gallons of the contents punqied from the holding tank for each servicing;f. The disposal sites to which the contents fixnn the holding tank 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 diis service contract.Owner's Name: (Print)Owner's Signature: (Only one owner tignattire required)Pumper's Name: (Print)Cpolct-hPumper's Signature:^ ^Pumper's Registration NumberfRev. 03^/13
. USE BLACK INK ONLY -POWTS MAINTEMANCE AGREEMENTFor Holding TanksOwnei's Name{8) as shown on doeO:NtenbE!Parcel Idenlrficalion Nimber ^ tnQ^-tLZfL-l.eoa1 Dascripfion of PiDperty:-SEE ATTACHED SHEET-Wa acknov^sdge that appllcaUon is being mads for the installation of a holding tank(s) on Uteproperty descritied m the attadiad shssLReturiTo; Sawyer CountyZoning and Consanistion Admtnlstiafion10610 Ualn St Suits 49, Howard, W> 848438 0 3 4 3 9Tx:4022252425870PAULA CHISSERREGISTER OF DEEDSSAWYER COUNTY, WI08/21/2020 08:18 AMRECORDING FEE 30.00PAGES: 2As art Inducament to Ihs County of Sawyer to issue a sanilary permit for a holding tank on the ahove-desoibad property, the otMter isresponsible for the operBllon and maintenance of the holding lank, loddng device, alarm and access, and agrees to conform to allapplicable requirements of SPS 383. Wis. Adm. Code relating to holding tatdt management, including the folIotMng:1. The owner agrees to contract vnlh a person who is licensed under Ch. NR 113, Wis. Adm. Code, except as provided bySection 281.4S (3)(d), Slats., to have the holding tank properly serviced and to file a copy of the service contract with thegovernmental unIL The owner forther agrees to file a copy of any changes lo the service conlracl, ore copy of a new servicecontract, with the govammental unit within ten (10) business days from the date of change to the service contract.2. The owner agrees to contract with a person licenssd under Ch. NR 113, Wis. Adm. Code, who shall sutunil pumping rsporls tothe governmental unit In accordance wflth SPS 383.55, Wis. Adm. Code, for the servidng of the holding tank. In die case ofexemption under Section 2ai>i8 (3) (d). Stats., the owner shall submit the report lo the govemmanlal unit The governmentalunit may enter upon the property lo investigate the condition of the holding lank when pumjung r^orts may Indicate theholding tank is not being properly maintained.3. if the owner fails to have the holding lanir property serviced in response to orders issued by the govemmanlal unit lo preventor abate a human health hazard as described In Section. 254.59, State., the governmental unit may enter upon ihe propertyand service, or cause Ihe tank to be serviced. Pursuant to Section 145.20(4) Wis. Stats., a govemmental unit may assess theowner of a private sewage system for costs related to Uie pumping of a »pb'c or holding tailc The charges will be assessedas prescribed by Section 66.0703, stats. The owner agrees to pay all charges and cost incurred by the governmental unit forinspection, pumping, hauling, or otherwise servidng and maintaining the holding lank in such a manner as to prevent or abateany human health hazard caused by Ihe holding tank.4 This agreement will remain in effect only unti) Ihe govemmental unit responsible for the regulation of private sewage systemscarfifies that either a soli absorption system that complies writh SPS 383, Wis. Adm. Code, or a munidpal sewer serves theproperly. In addition, this agreement may be cancelled by executing and recording s^d certificalion wilh reference to thisagieemenl in such manner which wiD pairoit ihe e»stence ofthe certfficalion to be determined by reference to the property.5 This agreement shall be binding upon the owner, the hairs of the owner, and assignees of the owner. The owner shall submitthe agreement to the register of deeds, and the agrsemanl shall be recorded by Ihe register of deeds In a manner whir^ willpermit the existence of the agreement to be determined by reference to the property where the holding lank Is Installed.Own^^ Sigrtj- Only ons owner stgnatutetapiirsd -OwnBT's Name (Prfnl): , , __Date:7-/g;,P-c?Drafted by: / 'State of: UCounty of: -S>Yl x ") iACKNOWLEOGDDENTh/tS7 ri \Subscribed and swom (o before me on this/T-^davof -y. C\/ . 20BylOwner'sNotary Public Signature:Public Notary Name (Print): Sr"My commission expires"CLtc)Personal Informakjnyoo provide may be used forsecondaiy purposes Priwcy Law. § 16.04 (I) (m)|ROBtRT S BILLERState ofWisconsin
The West 198 feet of the East 693 feet of that part of the Southwest Quarter of theSouthwest Quarter (SWl/4 SW Section 2, Township 39 North, Range 4 West, which liesNorth of Wisconsin Highway 70
nseal Estate Savvyer County Property ListingToday's Date: 8/24/2020Property Status: Next YearCreated On: 8/U/ZD20 1:53:02 AMDesciipliociUpdated: 8/11/2020OvvncrshinUpdated: 8/11/2020Tax ID:43910PIN:57-006-2-39-04-02-3 03-000-000130Legacy PIN:006439023313Map ID:Munidpalitv:f006) TOWN OT DRAPERSTR:S02T39NR04W . > "Description:PRT SWSWRecorded Acres:3.290Calculated Acres:0.000Lottery Oalms:0First Dollar:NoZoning:(A-2) Agricultural TwofP-lT Forestry OneESN:429? Tax DistrictsUpdated: 8/11/20201State of Wisconsin57Sawyer County006Town of Draper576615Winter School District001700Technical CollegeJEFFREY S HEATHLORETTA WrBtlllna Address:JEFFREYS HEATH7010N FOURTH STLORETTA WI 54896JEFFREY S HEATH7010N FOURTH STLORETTA WI 548961*^ Site Address " Indicates Private RoadN/AJ Property AssessmentUpdated: N/A2020 Assessment DetailCodeAcresLandImp.N/A2-Year Comparison20192020 ChangeLand:0.0%Improved;0.0%Total:0.0%Property History« Recorded DocumentsUpdated: 8/11/2020 parent PropertiesTax IDQ QUITCLAIM DEEDDate Recorded: 6/18/202057-006-2-39-04-02-3 03-000-00012043909424479a QUITCLAIM DEEDDate Recorded: 12/11/2014393526a WARRANTY DEEDDate Recorded: 11/10/2010369787a QUIT CLAIM DEEDDate Recorded: 10/30/2009363457HISTORY O Expand All History White=Current Parcels Plnk=Retlred ParcelsOTax ID: 6249 Pin; 57-006-2-39-04-02-3 03-000-000020 Lea. Pin: 006439023302 Mao ID: .11.2a Tax ID: 6248 Pin; 57-006-2-39-04-02-3 03-00O-0Q0Q10 Leo. Pin: 006439023301 Man ID; .11.1a Tax ID: 43909 Pin: 57-006-2-39-0^02-3 03-000-000120 Leo. Pin; 00643902331243910 This Parcel ^ Parents -^Children•
Page 1 of 1Real Estate Sawyer County Property ListingProperty Status: CToday's Data: 7/14/2020Created On: 2/6/2007 7:5!DescriptionUpdated: S/21/2020^ OwnershipUpdated: 5/2Tax ID:6249JEFFERY SHEATHLOREPIN:57-006-2-39-04-02-3 03-000-000020Leqacv PIN:006439023302Billina Address:Maiilno Address:Map ID:.11.2JEFFERY S HEATHJEFFERY SHEATHMunldpallty:(006) TOWN OF DRAPER7010N FOURTH STLORETTA WI 548967010N FOURTH STLORETTA WI 54896STR:S02 T39N R04WDescription:PRTSWSWI' Site Address ® indicates Private RoadRecorded Acres:1.850Lottery Claims:0N/ARrst Dollar:NOZoninq:fp-n Forestrv OneEi Property AssessmentUpdated: 8/2ESN:2020 Assessment DetailCodeAcresLand^ Tax DistrictsUpdated: 2/6/2007Gl-RESIDEfTTIAL1.8504,2001State of Wisconsin2-Year Comparison57Sawyer County20192020 C006Town of DraperLand:4,2004,200S76615Winter School DistrictImproved:00001700Tedinical CollegeTotal:4,2004,200• Recorded Documents Updated: 11/18/2009Property HistoryQ QUn CLAIM DEEDDate Recorded: 12/11/201-1393526N/Aa WARRANTY DEEDDate Recorded: 11/10/2010369787Q QUn CLAIM DEEDDate Recorded: 10/30/2009363457"7^=" ^ , T-WLocii 0"®- ' ' 'IilJ '-rnihttp://tas,sawyercountygov,org/Access/REAL%20ESTATE/1isting,asp?tid=795308&pid=6... 7/14/2020
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