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HomeMy WebLinkAbout020-638-04-5504-SAN-2020-029/i-A#, %(^1 ^ rV'Industry Services Division1400 [-: Wasliiiigton AveP.O. Box 7162Miidisoii. W1 53707-7162\^-aQo)CountySd'(VSanitary Permit Number (to be tilled in by Co.)Sanitary Permit ApplicationSlate Transaction NumberIn accordance with SPS 383.21(2). V^'i.s. Adm. ('o<lv. submission ol'this lonn to llic appropriate governmental unitis required prior «> obtaining a sanitary |>crmil Note: Aiiplicalion t'onns for slate-owned POW' TS are submitted tothe Depaninent of Safety and Professional Services. Personal inlbmiaiion you provide may be used Ibr secondarypurposes inaccoitlance with the Priv.icy Law, s. I.'i.l)4t I Km), Suits.]. Application Information - Please Print All [nformatlonProject Address (ifdilTercnt than mailing address)ggHlV RiverProperty Owner's NameA . ■*- L' PopPiParcel ttProperly Owner's Mailing Address7^.37 VCity, State\/AA.Y^Kcili, ^Zip CodeS-VVV9II. Type of Biiil(lln|i (check all that apply)(5 I or 2 I'ainily Dwelling - Number of liedroomsD Publiiv'CommcTPial - Describe Use _D State Owned - Describe UseI'tionc NumberLot#Property IxscationOovt. Lot'/•. Section(circle oneT N: R 4*Subdivision NameBlock#CSM NumbertA^P cf iii^vwv-1D City of_D Village of.B Town of _Dj ihioa,III. Type of I'crmll: (Clicck only one box on line A. Coiiipletc line B if npplicnhic)A,□ New Sy.slcniD Replacemail SystemD Trealmenl/I loUling I'ank Replacement OnlyD Other Modillcaiion to Existing System (explain)B.D Permit RenewalBefore ExpirationD Pennn Revision^.Change of PlumberD Permit Transfer to NewOwnerList Previous Permit Number and Date IssuedIV. Type of POWTS Svstcm/ConiDoncnl/Dcvlee: (Check all that applyD Non-Picssurired ln-(lround D l'ie.ssuri/e<l Iti-tii ound D Al-Grade D Mound > 24 in. of suitable soil D Mound < 24 in. ofsuitable soil^^Lnoldiiig i'iiiik D <3lher Dispersal Cimiponeiit (explain) D Prelrentineiit Device (explain)V. Dispcrsairrrcalmcnt Area Information;Design Flow (gpd)Design Soil Applic.ilion Rate(gpdsf)Dispersal Area Requited (sf)Dis|>ersal Area Proposed (st)System ElevationVI. Tank InfoSeptic ^teldiw^t Bii~Capacity inGallonsNew TanksExisting TanksTotalGallons«ofUnitsNianufacturcr31lA tS5531£ O/8fO(ScoiUie<,e/LDosing C)13tuberHooUcoyt-Tj/oL'Vll. ResponslbllUy Statement- 1. tlic undcrslgnctL assume rcsponsibiliij for Insiallaiion of the P03VTS shown on the attached plons.riui^T's Name (PiinllPltinil>er's SignaliiiePlumber's Atldress (Street. City, Stale, Zip Coil.,MPtMPWNumber(ffiris'tBusiness Phone Number0saP I U DisapprovetlD Owner Gnen Reason for DenialPcTinil Fee^ 52>-o®Date Is.suedV-/^-r5P.Nstiing Agent SignatureIX. Conditiuiis of .Approval/Reasons for DisapprovalORIGINALNO REFUNDS AFTEHISSUE OF PERMIT^ ■ y.\ ■: , i •••I\ 7 2Q2QAIlucli locum|)ti'(« pkiiis fur lljr iyslem aiiij sultiiilt t<i IhoCuuiily fluty tin piapri iicil iris lliiiii S 1/2 x It iiiclici in ■!» (JUUNT^^ _ ,, AMacli to ciimpti'ir pLuis fiirilir system »mj !uion, 2>| 17/201020NINQ administrationSBD-6398(R. 08/14) Sawyer County Zoning & Conservation Administration10610 Main Street, Suite 49V** Hayward, Wisconsin 54843V (71 SyiS-t-SZHXFAX(7I.S)63X.3277jo * li-mail: yoniiip..sgc<«isiiwvcrcmiiilVL'Uv.(iri!m Toll Frco Coiirtliousc/Gcncrnl InFormaliun l>X77-£Q9-4II0Holding Tank Approval ChecklistSanilary Cover Sheet Date Stamp/ i"? / aoAoParcel ID#^O-_fc1.-2. 2*-1H2Plot PlanProperty Linesy Site Address)( Structure)( Well)C Legal DescriptionBenchmark BM sX North ArrowX ScaleX <25' to Service RoadNearest Road IntersectionSetbacks to: Property Line, Well, Structure. Water bodies. RoadsIII. Required PlansX Index Page with Original Signaturey Management Plan/Contingency PlanX Servicing Contracty Holding Tank Agreement foniiIV. Holding Tank SpecificationsX Cross-section - Manufacture, Gallons: w'esftj- iSoo/ll&oX Tank Anchor Calculations [SPS 383.43 8) g)]X Locking device, chains/locksX Alann and Electrical per NEC 300, SPS 316 & 383.43 (9) (e) andState Statutes 101.862(2) and 101.862(3)_2 3" Bedding Material < 1/2 "V. Holding Tank Plans per Component POWTS Manual^ Version 2 SBD-10855-PIR.3/071 .Owner:Plumber:Application Review Date;03/\ZPOWTS Reviewer:License#Revised 4/11/2013 CONCRETE HOLDING TANK DESIGNSingle Combo Tank OptionINDEX AND TITLE SHEETProject POPPY HOLDING TANKOwner JAMES A. AND MONICA L. POPPYAddress 7237 COUNTY VMARSHALL, W! 54449Legal Description S 4, PT OF GL 5 & S 9. PT OF GL 1, T 38 N. R 6 WTownship OJIBWA County SAWYERSubdivision Name 8819W RIVER RDParcel ID Number 020-638-04-5504Plan Transaction ID NumberLot No.index and title sheetHolding tank specificationsSite planMaintenance and contingency planHolding tank agreementHolding tank servicing contractPage 1Page 2Page 3Page 4Page 5Page 6Designer JASON KUETTELSignatureLicense NumberMP 675751Phone No, 715-798-3355Date 03/16/20Designed 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 6 HOLDING TANK SPECIFICATIONS2000.0Number of bedroomsNon-residential estimated flow (gpd)Minimum holding tank volume required (gal)Side A Side B Total1100.0 I 1800.0 I 2900.0 IProposed tank capacity (gal)WIESER1800/1100RHOMBUS101HWTank manufacturerTank model numberAlarm manufacturerjAlarm model number1.5Tank Dimensions and DataX for round tankLiquid depth below inlet Invert (In)Maximum depth of soil cover (ft)Height (in) "i outsideLength (in) ^ DimensionsWidth (in) J Only8.061.0184.0102.0243501.50Tank Anchor Calculationslbs Weight of tank and coverSafety factorlbs Weight of anchor requiredin Soil cover req. for anchor oryd^ Concrete counter weight3766334.79.3FALSEFALSEjunctionboxHOLDING TANK CROSS SECTIONElectrical complies with NEC 300 and SPS 316optionalvent pipelocation23 in.conduitthetherweightservicealarm on90% FullSdeA1100.0manhole cover withlocking device andwarning labelvent pipemm.blind plugto sealoutletgfinishedgrade4" min. j,Note: 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.Side B 1800.0 gal1"18° min.building sewerinlet3 in. bedding under tank.Project: POPPY HOLDING TANKTransaction Number:Tank is anchored as necessary to negate buoyancy.Page 2 of 6 HOLDING TANK SITE PLANProject: POPPY HOLDING TANKLegal Description; S 4, PT OF GL 5 & S 9, PT OF GL 1, T 38 N. R 6 WSubdivision Name: 8819W RIVER RDScale:1" = 50ftParcel ID: 020-638-04-5504Lot No.:"Bm = too weu.1^1= /do.S'62' lol. I'B2(5>Q)63' G75v5(©R>V£F- "^M>t^Co///<Sn •■n9jWSiJc.(»> ^foCO".Homc■LUi-eu-\ ^v\/ -tiQOV ^(^06tPage 3 of 6 HOLDING TANK MANAGEMENT PLANThis Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be instalied andmaintained according to BP 383, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10855-PN. 03/07), and the SAWYER County Sanitary Ordinance.1. This POWTS is designed to accommodate a wastewater flow of 60^ to 580.0 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 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 presentDiscrepancies are reported to the owner in a timely manner for corrective action. All corrective actionsshall comply with the county sanitary ordinance and BPS 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 be abandoned inaccordance with BPS 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 ANDRY RASMUSSEN & SONS Phone: 715-798-3355b. Service Provider NORTHWEST SANITARY Phone: 715-634-2394c. Co. Zoning or Health Dept. SAWYER COUNTY ZONING Phone: 715-634-828811.Project: POPPY HOLDING TANKTransaction Number: Page 4 of 6 HOI.DJNG I AiNK SLRVICING CO.NTIUCljfej Contract Date: felO 2.5/ VThis contract is made between the Holding Tank Owner and the Pumper.1 iolding Tank Owner's Name:Pumper's Name:Northwest Sanitary, Inc.PO BOX 155Radisson.W! 54867Parcel Identification Number:(l2DiuilLcitacvID) O 2. 0The owner agrees lo file a copy of this comraei 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 rcc|itirod 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 lo have the holding tank(s) serviced by the pumper and guarantees topennit the pumper to have access and to enter upon the property for the purpose of servicingthe holding tjnk(s). The owner agrees lo maintain the all-weather access roail 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 ilie Governmental Unit, Sawyer County, a ivport for thescivicing of the holding tank(s) as re(|uired under SPS 383.55, Wisconsin AdministrativeCode and the Sawyer County Private Sewage System Ordinance. The pumper furtheragrees lo 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 lank;c. The site addre.ss of the holding tank;d. The dale 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 lo which the conienls from the holding lank were delivered.4.This agreement will remain in ctTcct 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)Owner S Signature; tOnlv nnf n« ngr Ugnalure reniilredt•Vl/VPumper's Name; (Print)Ronald L Vieceli, owner Northwest Sanitary,IncPumper's Signature:Pumper's Registration Number;#2389IDRev. nj'y.'i-iMfcR 3O20Z0.-»rrtJlNG T/ jIBhRRBi >,•* /;w;onta- orSawyer County Zoning AdministrationlOfilO Main Sirccl Siiilc 49Hayward, Wisconsin 54843(7I51634-82S)ITAX 1715)638-3277WNVw N cicOilnt\ g0 oi y •R*ni.ii!; /oniim snwvcicoutUv^ovJ Toll FreeCourtlioiwc/GcncTBl lnforin:idon l-A?7^)W-JII0SAWYER COUNTY SANITATION DEPARTMENTTEMPORARY EMERGENCY TANK INSTALI.ATION APPROVALPROPERTY OWNERS NAME: L <?-TOWN OF: Qj-f /Sy/.Q-ADDRESS: 881 ^7^^ g.tYL-e, a Wisconsin1.Licensed Plumber, autliorized by the owner, do hereby acknowledge that I am receivingtemporary approval to install a septic tank/holding tank without a soil and site evaluation,or existing syslejii evaluation, and private sewage system plan review due to inclementweather and/or health and/or safety emergency.Further, 1 acknowledge that a soil and site evaluation, or existing system evaluation, andprivate sewage system plan review will be conducted by the deadline stipulated by thepennit issuing agent, or as soon as weather conditions or cii cumstanccs pcmiit. If theprivate sewage system is found to be failing as defined in s. DSPS 381.01 (92), Wise.Adm. Code, coirective measures will be taken as such that the private sewage systemcomplies with all applicable requirements of chapter DSPS. 383, Wis. Adm. Code,within 90 days of this agreement.I further acknowledge that failure to comply by obtaining all necessary permits aller thedeadline date may result in the issuing ol'a citation, under Section 11.3 [2J SanilaryPcrniils], of the Sawyer County Citation Ordinance.DEADLINE FOR THIS AGREEMENT SHALL BE: A^H- I ? oiL"Signed:Dote; //a /t,"'«U3Accepted by:Date of temporary emergency approval:Rev, 03/26/13 Real Estate Sawyer County Property ListingToday's Date: 3/12/2020Property Status: CurrentCreated On: 2/6/2007 7:55:35 AMum DescriptionUpdated: 1/27/2020^ OwnershipUpdated: 1/27/2020Tax ID:20497MMES A 8i MONICA L POPPYMARSHALL WIPIN:Legacy PIN:Map ID:57-020-2-38-06-04-5 05-005-000040020638045504:5.4Biiiina Address:JAMES A & MONICA L POPPYMailina Address:JAMES A 8t MONICA L POPPYMunldpallty:(020) TOWN OF OJIBWA7237 COUNTY V7237 COUNTY VSTR:S04T38NR06WMARSHALL WI 54449MARSHALL WI 54449Description:PRT GOVT LOT 5 SEC 4 & PRT GOVT LOT1SEC9^ Site Address * Indicates Private RoadRecorded Acres:3.9908819W RIVER RDOJIBWA 54862Calculated Acres:4.309Lottery Claims:0CJ Property AssessmentUpdated: 8/20/2013First Dollar:YesWaterbody:Chippewa River2020 Assessment DetailZoning:(RRl) Residential/Recreational OneCodeAcresLand Imp.ESN:442Gl-RESIDENTIAL3.99054,400 56,000^ Tax DistrictsUpdated: 2/6/20072-Year Comparison20192020 ChangeLand:54,40054,400 0.0%1State of WisconsinImproved:56,00056,000 0.0%57Sawyer CountyTotal:110,400110,400 0.0%020Town of OJIbwa576615Winter School District001700Technical Q)llegei Property HistoryRecorded DocumentsUpdated: 1/27/2020N/AWARRANTY DEEDDate Recorded: 1/24/2020422226TRUSTEES DEEDDate Recorded: 4/17/2014390037WARRANTY DEEDDate Recorded: 9/14/2012380702MAP OF SURVEYDate Recorded: 3/18/20104386-18PLAT OF SURVEYDate Recorded: 4/29/2009WARRANTY DEEDDate Recorded: 3/23/2000282999 701/3 ^wstostanfro cori:Gu8t9ozc sotstmaozo eotei'Oggao^^n .fif>irS»0a£9oroii k.'..-jA^:;-V-^V^^ wi - USE BLACK INK ONLY -8 0 3 0 2 3 4Tx:4019322POWTS MAINTENANCE AGREEMENTFor Holding TanksPAULA CHISSERREGISTER OF DEEDSSAWYER COUNTY. WI04/16/2020 10:37 AMRECORDING FEE 30.00Owner's Name(s) as shown on deed:jAMfcS A. ^ poPFXParcel Identification Number(12 Digit Legacy ID) .O ZjQ -PAGES: 2Legal Descrlpllon of Property:- SEE ATTACHED SHEET -We acknowledge that application Is being made for the inslallallon of a holding tank(s) on theproperty described on the attached sheet.Return To: Sawyer County Zoning and Conservation Administration10810 Main St Suite 49, Hayward, Wl 54843"** " i— 1As an Inducement to ttie County of Sawyer to issue a sanitary permit for a holding tank on the above-described property, the owner isresponsible for the operation and maintenance of the holding tank, locking device, alarm and access, and agrees to conform to ailapplicable requirements of SPS 383, Wis. Adm. Code relating to holding tank management, including the following:The owner agrees to contract with a person who Is licensed under Ch. NR113, Wis. Adm. Code, except as provided bySection 281.48 (3) (d). Stats., to have the holding tank properly senrlced and to file a copy of the senrice contract wrfth thegovernmental unit. The owner further agrees to file a copy of any changes to the sen/ice contract, or a copy of a new senricecontract, with the govemmental unit within ten (10) business days from the date of change to the service contract.The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit pumping reports tothe govemmental unit in accordance with SPS 383.55, Wis. Adrh. Code, for the servicing of the holding tank. In the case ofexemption under Section 281.48 (3) (d). Stats., the owner shall submit the report to the govemmental unit. The govemmentalunit may enter upon the property to investigate the condlb'on of the holding tank when pumping reports may Indicate theholding tank is not being property maintained.If the owner falls to have the holding tank properly serviced in response to orders Issued by the govemmental unit to preventor abate a human health hazard as described in Section. 254.59, Stats., the govemmental unit may enter upon the propertyand service, or cause the 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 the pumping of a septic or holding tank. The charges will be assessedas prescribed by Section 66.0703, stats. The owner agrees to pay all charges and cost Incurred by the govemmental unit forInspection, pumping, hauling, or othervrise servicing and maintaining the holding tank in such a manner as to prevent or abateany human health hazard caused by the holding tank.This agreement will remain in effect only until the governmental unit responsible for the regulation of private sewage systemscertifies that either a soil absorption system that compiles vyith SPS 383, Wis. Adm. Code, or a municipal sewer serves theproperty. In addition, this agreement may be cancelled by executing and recording said certification with reference to thisagreement In such manner which will permit the existence of the certification to be determined by reference to the property.This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submitthe agreement to the register of deeds, and the agreement shall be recorded by the register of deeds In a manner which willpermit the existence of the agreement to be determined by reference to the property where the holding tank Is Installed.1.2.3.5.one owner slgnaturo roqulrod -Owner's Nafne (DateState of:County of:ACKNOWLEDGMENTSubscribed and sworn to before me on thisday of A-ffl IBy (Owner's Name): fot.20 ^Drafted by:Notary Public Signature: ;Public Notary Name (Print): f-f A>e ^My commission expires on: °l/l ! '6Persona! infomiatlon you provide may be used for secondary purposes (Privacy Law, § 15.04 (!) (m)]MATTHEWFOX That part of Government Lot Five (5), Section Four (4) and Government Lot One (1), SectionNine (9), all in Township Thirty-eight (38) North, Range Six (6), West, in the Town ofOjibwa, Sawyer County, Wisconsin, described as follows: Commencing at the Southwestcorner of Section Four (4), Township Thirty-eight (38) North, Range Six (6) West; thencealong the line between Sections Four (4) and Nine (9), N88°4r22"E,660.62 feet to an ironpipe, being tlie point of beginning; thence N01''10'26"E, 509.74 feet to an iron pipe on theSoutherly right of way of River Road; thence along said right of way, N79®02'07"E, 216.94feet to an iron pipe; thence 124.15 feet along the arc of a curve to the left with a central angleof 11°35'40" and a radius of 613.48 feet and whose chord bears N73°14T7"E, 123.93 feet toan iron pipe; thence leaving said right of way, S01°10'26"W, 422.64 feet to an iron pipemeander corner that is 25 feet more or less from the Chippewa River; thence along a meanderline, S51''18'23"W, 257.64 feet to an aluminum monument at the meander comer betweenSection Four (4) and Section Nine (9); thence S38°32'04"W, 217.94 feet to an iron pipe whichis 32 feet more or less from the Chippewa River; thence N01®10'26"E, 167.49 feet to the pointof beginning, includes all lands between the meander line and the thread of the ChippewaRiver between the lot lines extended.(Legal Description as shown on Map of Survey filed in Sawyer County Land Records)For informational purposes onlyProperty Address: 8819W River Rd, Ojibwa, WI54862Tax Key No.: 020-638-04-5504