HomeMy WebLinkAbout006-440-33-4205-SAN-2020-063saisii®;rino»»)SIndustry Scivitcs Division1400 r Washinglon AvcP.(J. Box 7162Madison. UT 53707-7)62Cir Ajei-%Sanitary Permit ApplicationIn acciii-dancc widi SI'.S 3SJ.2I{2), WIs. Adm. Code, suhniissioii of ihis form lo ihc appiopiialc govijimicnlai uniiIS required pniir in ohtainjog a sanitary permit. Nulc: Application forms foi sulc-ow-ncil POWTS arc submitted tothe Dqiartmenlot Safety and Proft«ional Services Personal inlbnnaiioii you provide may he iiscsl for secondarypuiposts in accordance with the Privacy Law, s. I S.04(l)(iii). Suts.I. Application Information - Please Trittt All InfoinnaiionProperty Owner's Name\f/lirid./r\d A,-AaCCA MhfiPCountySanitary Pcimil Niinilici (tu be filled in by Co,)State Tnnsactiori NumberPtujcti Add/C7i.N (if ditTacnt ihao mailmg a(Jdre$$)HmiiILXk1(propcity Owner's Mailing Addres<iCity, StatePfi/ff fOA/ . U^-T11.1'ytte of Buildine (tdieck all (hat apply)0 I or 2 Family llwclling - Number ofRcdmomsZip CodeD Publlc/Commeicial Describe Usc_D Stale Owned - Descnbe U.sePboue Numbal.ol #3niock nC5M Numberin. Type of rermit: (Check only one bi)x on line A. Complete line H if applicable)Parcel f)Property t4>CtilionGovi, l-Ol _A/f 'A, si Secnon 33(ciri:!!: cmc)T N; R V F.ur@Subdivision NameD City of□ village of.I Town of Dfa0 New SvslcmQ Pcnnit RenewalBefore EixpiratignD Replacement SystemD Permit RevisionQ Treatmcnl/IIoldingTanlr Replacement OnlyD Change of PlumbciTV. Type of POWTS Syslem/Component/Hevicc: (Check all that applyD Permit Transfer to New-OwnerD Other Moditicanon in Hxisiing System (eiplain)List Previous Permit Number aad Dale IssuedD Noii.prcssiiri7cd Tn-Oround D Prtssiirizcii In-Ctnimid D .M-Gnidc D Mound > 24 in. tif suitable soil D Mound < 24 in of suitable soil0 Holding Tank D Oilier Oispcrsal Component (explain) _ □ Pielrcaniicnt Device (explain)V. Dlspersal/Trcalment Area InformatioB:Design Flow (gpd)jooDesign Soil Application Rate(gpdsf)VI. Tank InfoDispeisal Area Required (sOCapacity in(ialloii-SNew TanksHxisling TanksTotalGallons3 ofUnitsDispersal Area Pr^osed (sf)ManufacturerSystem Elevation, 99.0'A (tUa|-IIC Da./f^OoZ-JSoreniicXoog!&L.Do'iing CliambeiVII. Responsibility Stalenicoi- (be Dndersijrocd. assninc responsibility for insiallotinn of (he POWTS shown on (he attached plans."'^/MPRS NumberPlumber's Name (I'liiit)Plumber's SignaiuieBusinHAt/ce. ly^rceA^O/f2Xc yf yess Photic Number7/f-f<fJ-A59ZPlumba's Addjcis (SticcJ, City. Slate, Zip Code)/(^7'fA' sr 90 Zjfc/d.^a, u/x s-'/gJJ'VllU Count^cpartmcnt Use Only' □ DisapprovedD Owner Given Reason for DenialS.Appf.Ai:iPennit Fee%Plate IssuedIX. Cnndltinns uf Approval/Reasons for DisapprovalORIGINALIssuing Agent Signature- dLOdiOti 'NO REFUNDS AFTERISSUE OF PERMITAnach to cumpklipUni rsr Ihr tydrin anil mbmlt tuih. C.anty uBty an paper not Ids ibaa * v1SBD^398(R 08/14)P-MAY 1 3 imSAWYER COUNTYZONING AOMlNlSTRAriON
Sawyer County Zoning & Conservation Administration..... 10610 Main Strcci, Suite 49* * ICq 'j Hayward. Wisconsin 54843(7I5)6.M.«SK'llMtlX**'/ l'AX(7l5KOX-.t277> /Jv -"•vvxxx"E'HuII: /onini?.scc^/_^a^•vcrconnivi;ov.or^Toll Free Courlhousc/Gcncral Infarmallon 1-877»699*4I10Holding Tank Approval ChecklistSanitary Cover Sheet Date Stamp ^ / I 3 / OParcel ID# _^_o O ^II. Plot Plan'i\ Property Lines/ Site Addressy. Structurey WeilX Lcaal DescriptionBenchmark BM AyC^ North An'owScale^ < 25' to Service RoadNearest Road Intersectiony Setbacks to: Property Line, Well, Structure, Water bodies, RoadsIII. Required PlansX Index Page with Original SignatureV Management Plan/Contingency PlanA Servicing Contract•X Molding Tank Agreement formIV. Holding Tank SpecificationsCross-section - Manufacture, Gallons: ^I^^Tank Anchor Calculations [SPS 383.43 8) g)]X Locking device, chains/locks_x Alarm and Electrical per NEC 300, SPS 316 & 383.43 (9) (e) andState Statutes 101.862(2) and 101.862(3)X 3" Beddinu Material < 1/2 "V. Holding Tank Plans per Component POWTS Manualt/ Version 2 SBD-1Q855-P ('R.3/n7tOwner:Application Review Date:POWTS Reviewer:Plumber: 5ivCa-License «Revised 4/11/2013
OOC4-»33-;207HYDRO» T- X-a,^Xr407Jfc00e-UJ)33-(20SJ, N-'-x11'"tit40064403342053 3006440334204S-.00&440334203Zs This map is net qucmai^iccvxatf, cofT»ct. cuuei^pttcifv^&v>4nc>Lr$tMS 4fa*i>
CONCRETE HOLDING TANK DESIGNSingle Combo Tank OptionINDEX AND TITLE SHEETProject William&Rebecca Moe HoldingOwner William&Rebecca MoeAddress M320 Redtail LnAppleton, Wl. 54915Legal Description NW1/4-SE1/4-S.33-T.40-R.4WTownship DraperSubdivision NameParcel ID Numtjer 6440334205Plan Transaction ID NumberCounty SawyerLot No. 3Index and title sheetHolding tank specificationsSite planMaintenance and contingency planTank DrawingPage 1Page 2Page 3Page 4Page 5Designer Bruce VitcendaSignatureLicense NumberM.P. 220498Phone No. 715-943-2382Date 04/29/20Designed pursuant to;Holding Tank Component Manual For POWTS (Version 2.0)SBD-10855-P (N. 03/07)Version 7.0(03/12)Page 1 of 5
HOLDING TANK SPECIFICATIONS2000.0Side A754.0Skaw1200/750SJENumber of bedroomsNon-residential estimated flow (gpd)Minimum holding tank volume required (gal)Side B Total1254.0 I 2008.oHProposed tank capacity (gal)Tank manufacturerTank model numberAlarm manufacturerTaab-OINJAIarm model numberTank Dimensions and DataTank Anchor CalculationsX for round tank16100lbs47.0Liquid depth below inlet Invert (in)1.508.0Maximum depth of soil cover (ft)25008lbs64.0Height (in) Outside36.4in154.0Length (in) L Dimensions6.2yd^77.0Width (in) J OnlyFALSEFALSESafety factorWeight of anchor requiredSoil cover req. for anchor orConcrete counter weightjunctionbox -conduitHOLDING TANK CROSS SECTIONElectrical complies with NEC 300 and SPS 316optiona!vent pipelocationC•23 in.blind plugto sealoutletmT^"manhole cover withlocking device andwarning labelmin.vent pipethetherweightservicealarm on90% Full 34.5Side A 754.0ingalNote: All tank joints, and jointsbetween tank openings andpiping are sealed watertight. Allpipe and vent materials complywith SPS 384. Manholes withlocking device are typical for eachmanhole opening .SIdeB 1254.0 galfinishedgrade14" min.I~r18" min.iHDbuilding sewerinlet3 in. bedding under tank.Tank Is anchored as necessary to negate buoyancy.Project: William&Rebecca Moe HoldingTransaction Number:Page 2 of 5
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HOLDtNG TANK MANAGEMENT PLANThis Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed andmaintained according to SP 383, Wis. Admin. Code, the Holding Tank Component Manual {SBD-10856-PN- 03/07), and the Sawyer County Sanitary Ordinance.1. This POWTS is designed to accommodate a wastewater flow of 40_ to 401,6 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 \Arastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet(at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called toempty the tank's contents and dispose of them in accordance with NR 113, 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 alarm 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. Ail 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 discharges 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 tie abandoned inaccordance with SPS 383.33 Wis. Adm. Code.10. If there is a problem with, or question about this installation, the following persons may be contacted:a. Installer A-1 Plumbing Phone: 715-943-2382b. Service Provider Northwest Sanitary Phone: 714-943-2650c. Co. Zoning or HealUt Dept. Sawyer County Zoning Phone: 715-634-828^11.Project: Wiiliam&Rebecca Moe HoldingTransaction Number: Page 4 of 5
WARNING DEATH MAY OCCUR IF TANK IS ENTEREDWITHOUT PROPER EQUIPMENTNOTE; SEE INNER WAU PHOTO ON THE 'EXCLUSIVELY AT SKAWS'PAGE.i:.m.:£3.00Ar4.00■27.00--27.00--27.00-SKAW1200/750OUTLET END VIEW OF TANK-zooINLET4 INCH PRESSSEAL GASKETINSTALLEDWHEN POUREDTl2.00--BAFFL£18.00—^—2.00FILTER47.00~J6.00^ 1.00-19.00- ^ OUTLET ^—4INC^Iioo-' SECTION VIEW OF TANK AND COVERPRESSSEALGASKET\-3.00Model Number: 1200 / 750Approved for. SEPTIC/SEPTIC,SEPnC/PUMP.SEPTIC/SIPHON OR HOLDINGweigmInlet Dim.Outlet Dim.Liq. DepthGal./In.Nom. Cap.16,100 lbs.52-50"47"16.05754.35 gal.SKAW PRE-CAST26255 105th Street, New AuburnWisconsin 54757www.skawprBcast.comPhone: (715) 967-2277Toll Free: 1-800-924-8625Fax: (715) 967-2707
Real Estate Sawyer County Property ListingProperty Status: CurrentToda/s Date: 4/26^20Created On: 2/6/20077:55:14 AMDescription Updated: 1/1/2005® OwnershipUpdated: 2/6/2007Tax ID: 7501WILLIAM R & REBECCA C MOEAPPLETON WiPIN: 57-006-2-40-04-33-4 02-000-000050Legacy PiN: 006440334205Bliiino Address:Maliino Address:MapiD: .14.5WILLIAM R & REBECCA C MOE WILUAM R & REBECCA C MOEMunicipality: (008) TOWN OF DRAPERrM3Z0KbUIAILLl«lAPPLETON Wl 54915mSiS} KtUIAILLNADDi crriM Ufl KAOli;SIR: 833 T40N R04WDescription: PRTNWSE LOT 3 GSM 20/166 #5828IBRecorded Acres: 3.780r site Address indicates Private RoadLottery Giaims: 0N/ARrst Dollar: NoWatertx)dy: Brunet Flowage@ Property AssessmentUpdated: 8/22^016Zoning: (RR1) Residential/Recreational One2020 Assessment DetailESN:CodeAcresLand Imp.G1-RESIDENTIAL3.78041,900 0^ Tax Districts Updated: 2/6/20071 State of Wisconsin2-Year Comparison20192020 Change57 Sawyer GountyLand:41,90041,900 0.0%006 Town of Draperimproved:00 0.0%576615 Winter School DistrictTotal:41,90041,900 0.0%001700 Technical Gollege^ Recorded Documents Updated: 2/18/2014@ Property Historya WARRANTY DEEDN/ADate Recorded: 3/15/1999 275046 666/13
HOLDING TANK SERVICING CONTRACTContract Date: S I 7 / ^0^0This contract is made between the Holding Tank Owner and the Pumper.Holding Tank Owner's Name:Pumper's Name:Northwest Sanitary, Inc.PO BOX 155U/iihAAn d /teAf/iea Ai^PRadisson, Wi 54867Parcel Identification Number:(12 Digit Legacy ID)- y ^ ^ ,r1. The owner agrees to illc a copy of this contract with the governmental unit. Sawyer County,which has accepted and recorded with the OfTicc 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. 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 all-weather access road or drive sothat the pumper can service the holding tank(s) with the pumping equipment. The ownerfurther agrees to pay the pumper for a charges incurred in servicing the holding tank(s) asmutually agreed upon by the owner and pumper.3. The pumper agrees to submit to the Govemmental 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 pumper furtheragrees to include the 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 pumped from the holding tank for each servicing;f. The disposal sites to which the contents from 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 eontract with Sawyer County within ten (10)business days from the date of change to this service contraet.Owner's Name: (Print)Owner's Signature: (Onl}'one owner algnalure required)Pumper's Name: (Print)Ronald L Vieceli, owner Northwest Sanitary,IncPumper's Signature:L lAiu^Pumper's Registration Number:#2389Rev. 0.t/26/|.t