HomeMy WebLinkAbout022-738-26-5315-SAN-2020-020•ONBIndustry Services Division1400 E Washington AveP.O. Box 7162tdison.WI 53707-7162Oo OT ^Sanitary Permit Applicationtn accordance with SPS .1S3.21(2). Wis. Adni. Code, submiuion oflhis form lo the appropriate govemnienlal unitb ret|uircd prior lo obtaining a sanitary pennil. Note: Application forms for state-owned POWTS are submitted tothe Depannienl of .Safety and Professional Services. Personal information you provide maybe used for secondarylaimoses in accordance with the Privacy Law, s. 15.040 Xm), Stats.L Application Information - Please Print Alt InformationCountySAWYERSanitary Permit Number (lo be filled in by Co.)State Transaction NumberIProject Addresa (ifdifferent tlian mailing address)3042N EAST RIVER DRIVEProperty Owner's NameDAVID J. ST CHRIS rOPHERParcel# Oi2 S"J7-022-2-38-07-26-5 05-003-000150TAX #22803 MAP #:3.15Properly OtMter's Mailing Addresa651 lO^'STNProperty LocationChy, StateHUDSON. WIZip CodeS40I6-230III. Type of Buildlne (check ail that apply)[2i or 2 family Dwelling - Number of Bedrooms,[~l Publio'Commercial - Describe Usei I State Owned - Describe UsePhone NumberSe>Arcea.l\«d fi jmait.ttTM,Oovt Lot 3'AT38NYi, Section 26(circle one); ROTWEorWLot#PTOFOULOT2Subdivision NameBlodc#GSM Number12/116 #2906Q City ofD Village of13 Town of RADISSONIII Type of Permit: (ChcckonJy one boi online A. Complete Hue B If applicable)13 New SystemO Replacement SystemQ Treatment/Holding Tank Replacement Onlyn Other Modification to Existing System (explain)B.D Permit RenewalBefore ExpirationD Permit Reviaionf~l Change ofPlumberO Permit Transfer lo NewOwnerList Previous Permit Number and Dale Issued•70-S-?-7V7 ?IV. Type of POWTS Sysiem/Componeni/Devicc: (Check all that apply)Q Non-Pressuiized In-C>round Q Pressurized In-Oround l~l Al-Qrade Q Mound > 24 in. of suitable soil IH Mound < 24 m. ofsuitable soil^ Holding Tank O Other Dispersal Component (explain) Q Preireaimcnt Device (explain)V. DispersatfTreatmcnt Area Information:Design Klow(gpd)Design Soil ApplicationRaic<gpdsf)Dispersal Area Required (sOsystem ofchoice _Dispersal Area Proposed (s()HOLDING T,\NKSystem Elevationn/aVI Tank InfoCapacity inGallonsNew TanksExisting TanksTotalGallons# ofUnitsManufacturerIm ££du- OcsO.Septic or Holding Tank25702677Skaw Precast□□□□Dosing Cliamber□□□□□Vn. Rcsponsihillty Statement- I, the underalgned. assume respunalbUlty for liMlaliatlon ofthe POWTS shown on the attached plans.Plumber's Name (Print)Mel Ferguson dbaM&K SEPTIC-ms;LINF ROADMP/MPRS NumberMPRS 224879Business Phone NumberPlumber's Address (Suect, City. VVl 54801715-635-7482VIIL, County/Department Use OnlvI I Disapprovedr~l Owner Given Reason for DenialPermit Fees '-{Oo.^Date IssuedL:?-Issuing Agent SiogDC Condins of Avai/Rcasons for DisapprovalNO REFUNDS AFTERISSUE OF PERMITnature1mm.MAR 1 6 202C^ Attach In complete plaas for the aystem and lubiKCPr-*09Q^, iftifi [zozoAttach Incomplete pla« for the lystem and submit lo the County only on paper not leu than# 11x11 Inches In ilie^AWYER COUNTYZONING ADMINISTRADOW
Sawyer County Zoning & Conservation Administration10610 Main Street, Suite 49Hnyward. Wisconsin 54843<715>63-1-82«Xmmsm W/ ax t? 15 )63k.3 2 771:*iiiail: /uniiig.sccff?!^iwvofcoiin(vifov.or^Toll Free Courthouse/General Infdrinudon t^77-699-4U0Sanitary Cover SheetHolding Tank Approval Checklistrer Sheet Dale Stamp Q3/ \Cp /Parcel ID# o3.3-'?-3^-,2L(5-S3 1.^II. Plot Plan)S Property LinesSite Address{^Structurey Well•j/ Legal DescriptionBenchmark BM sX North ArrowX* Scale^ < 25' to Service RoadX Nearest Road Intersectiony Setbacks to: Property Line, well, Structure, Water bodies, RoadsIII. Required Plansindex Page with Original Signaturey Management Plan/Contingency PlanServicing Contract » N i /y Molding Tank Agreement fomiIV. Holding Tank SpecificationsX Cross-section - Manufacture, Gallons: -y■^Tank Anchor Calculations [SPS 383.43 8) g)]Locking device, chains/locksAlarm and Electrical per NEC 300, SPS 316 & 383.43 (9) (e) andState Statutes 101.862(2) and 101.862(3)X 3" Bedding Material < 1/2 "V. Holding Tank Plans per Component POWTS ManualVersion 2 SBD-I0855-P (R.3/07)rner: Plumber:Owner: .WiCAApplication Review Date:POWTS Reviewer:License 1Revised 4/11/2013
CONCRETE HOLDING TANK DESIGNsingle Tank OptionINDEX AND TITLE SHEETProject ST CHRISTOPHER 2570 HTOwner DAVID J ST CHRISTOPHERAddress 651 10TH ST NHUDSON. Wl 54016-2301Legal Description SEC26 T38N R07WTownship RADISSON County SAWYERSubdivision Name PartofGL3CSM 12/116 #2608 Lot No. LOT 2Parcel ID Number 57-022-2-38-07-26-5 OS-OO^OOOISOPlan Transaction ID NumberIndex and title sheet Page 1Holding tank specifications Page 2Site plan Page 3Maintenance and contingency plan Page 4users manual Page 5Designer Mel Femuyn ihiL CfCPTIP. ft PXCAVATION.i N6228 COUNTY LINE ROADsignature SPOONER. W 54801 Phone No. 715 635 7462C) 715^35-7482License Number 224879 Date 03/14/20Destined pureuant to:Holding Tank Component Manual For POWTSSBMoayt P(n.ftta!^_560-vereion 2.0 (03/01) Page 1 of 5
HOLDING TANK SPECIFICATIONS2000.0Number of bedroomsNon-residential estimated flow (gpd)Minimum holding tank volume required (gal)2S70.0 iProposed holding tank capacity (gal)SKAW PRET-CAST CO. INC.2570s.j.electro101HWJAiarm motank ManufacturerTank model numberAlarm manufacturerel numberTank Dimensions and DataTank Anchor CalculationsX for round tank17930lbs Weight of tank and cover50.0Liquid depth below inlet invert (in)1.50Safety factor5.0Maximum depth of soil cover (ft)31571lbs Weight of anchor required66.0Height On) 1 Outside34.3in Soil cover req. for anchor or181.0Length On) r Dimensions7.8yd'' Concrete counterweight76.5Width On) J OnlyL.TbJunctionbox -□conduitblind plugto sealoutletff^HOLDING TANK CROSS SECTIONiT-24 In.manhole cover withlocMng device andwarning label^ 4*mln.finishedgradei/Manhole and vent locationsmav be reversed.servicealarm onElectrical as perNEC 300and Comm 16ri2.0 in.\ <^^8.4833Note: Ail tank Jointstleap12"mln.vent pipeA38.0in.(20^^.523, andjoints between tankopenings and piping aresealed watertight. Allpipe and vent materialscomply with Comm 84.t18" min.ibuilding sewerinlet3 In. bedding under tank.Project; ST CHRISTOPHER 2570 HTTransaction NumberTank is anchored as necessary to ne{^ buoyancy.Page 2 of 5
HOLDING TANK SITE PLANProject: ST CHRISTOPHER 2570 HTLegal Description: SEC26 T38N R07WScale: 1: 50'Subdivision Name: Part of GL3 CSM 12/116 #2906Parcel ID: 57-022-2-38-07-26-5 05-003-0001 Lot No.: LOT 2Transaction I.D.:ATTflCMfcOPage 3 of 5C.a^^QeAM'\,
M & KSEPTIQ^^^^^AVATIONN6228 Cty. Line Road* ^"i>ppber,'Wl 54801Phone (715)635-7482DAVID ST CHRISTOPHER (2570) GALLON HOLDING TANKHOLDING TANK USER'S MANUALSYSTeMDESION IN ACCORDANCE WITH SBD-IOSSS-P (N.03/07)THE OWNER OR OWNER'S AGENT IS REQUIRED TO SUBMIT REPORTS AS REQUIRED BYSPS 383,55 (1). Wl ADM. CODE. TO THE COUNTY OR OTHER APPROPRIATEDEPARTMENTS.TELEPHONE NUMBERS: TO BE CALLED IN ORDER AS NEEDEDPUMPER (INFO FURNISHED TO COUNTY BY OWNERS)MEL FERGUSON MPRS 224879M AND K SEPTIC AND EXCAVATION (TANK INSTALLER)LOCAL HEALTH AUTHORITY SAWYER COUNP/ ZONING715-635-7482715-634-8288PERIODIC MAINTENANCE OF SYSTEM MAY BE REQUIRED FOR GENERAL REPAIRS.PLEASE USE THE ABOVE NUMBERS AS NEEDED.CONTINGENCY PLAN; REPLACE TANK OR REPAIR AS NECESSARYIF YOU HAVE ANY QUESTIONS PLEASE FEEL FREE TO CALL MEL @ 635-7482 or 520-2288THANK YOUIWE APPRECIATE THE OPPORTUNITY TO SERVE YOUMEL AND KATHLEEN FERGUSONWisconsin Certified Soil Testing, Complete Septic System Design & Installation.FEATURING THE "EzFLOW" GEO-SYNTHETIC ROCK "INSULATED" ABSORPTION CELLSInstalling Pre-cast Concrete Tanks, Driveway installationWell and septic evaluations. Septic effluent pump servicingLight Trucking, Rubber Tire BackhoesFree Eafimates mandk@centurytel.nel PuUv insured
HOLDING TANK MANAGEMENT PLANThis Private Onslte Wastewater Treatment System (POWTS) has been designed, and Is to be Installed andmaintained according to Comm 83, WIs. Admin. Code, the Holding TanK Component Manual (SBD-10S71-P6/11/1999), and the SAWYER County Sanitary Ordinance.3001. This POWTS is designed to accommodate an estimated domestic wastewater flow of WtO opd.2. The owner of this POWTS is responsibie for system operation and maintenance. Including ail 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 Servidng 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 alarm system functions and manhole locking devices are present.Discrepancies are reported to the owner In a timely manner for corrective action. All corrective actionsshall comply with the county sanitary ordinance and Comm 83 and 84 WIs. Adm. Code.5. All service events or Inspections of this POWTS shall be reported to the county within 10 business 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 falling 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 fuli 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 falls 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 replaeed, or its use dlscontinuetf,"components no longer in use It shall be abandoned Inaccordance with Comm 83.33 WIs. Adm. Code.10. If there Is a problem with, or question about this Installation, the following persons should be contacted:a. Installer M & K SEPTIC AND EXCAVATION Phone:715-625-7482b. Service Provider Owner provided Info to county Phone:c. Co. Zoning or Health Dept. Sawyer County ) Phone: 715 634 828811- U \ irProject: ST CHRISTOPHER 2570 HTTransaction Number: Page 4 of 5
HOLDING TANK SERVICING CONTRACTContract Date: /a /3lJ, / ^This contract is made between the Holding Tank Owner and the Pumper.Holding Tank Owner's Name:J)f\vid d'lyrishphcC,Pumper's Name: ^ >Ulhrfc/i^ ^/isscc.cd^SFarce! Identification Number: /-^oO-7•2.<? 0/ t:r d i(12 Digit Legacy ID) Q ^ O - / 31.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).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 charges incurred in servicing the holding tank(s) asmutually agreed upon by the owner and pumper.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. 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;c. 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.This agreement will remain in effect tmtil 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.Ojyner's Name: (Print)Si--Chriiihipf^cTOwner S Signature: (OBly one owner signature required)Pumper's Name: (Print)fr /-)Pumper's Signature:Jumper's Registration Number:Rev. 03/26/13
• USE BLACK INK ONLY •POWTS MAINTENANCE AGREEMENTFor Holding TanksOwner's Name(8) as shown on deed:Si^.Chr/S-h phParcel IdentiTicatlon Number(12 Oigii Legacy ID)Legal Description of Property:• SEE ATTACHED SHEET •We acknowledge that appHcation is being made for the InslaHaUon of a holding tank(s) on theproperty described on the attached sheet.Return To: Sawyer County Zoning and Consorvatlon Administration10610 Main SL Suite 49, Hayward, Wl 548438 0 2 9 6Tx:4018907423054PAULA CHISSERREGISTER OF DEEDSSAWYER COUNTY, WI03/18/2020 01:24 PMRECORDING FEE 30.00PAGES: 21.As an inducemenl to the County of Sawyer to issue a sanitary permit for a holding tank on the alwve-descriliod property, the owner Isresiranslble for the operation and maintenance of the holding tank, locking device, elarm and access, and agrees to conform to allapplicable 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. NR 113, WIs. Adm. Code, except as provided bySection 281.48 (3) (d). Stats., to have the holding tank property sendced and to file a copy of the service contract with thegovemmental unit. The ovnier further agrees to file a copy of any changes to the service contract, or a copy of a new servicecontract, 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 gowmmental unit In accordance with SPS 383.55, WIs. Adm. Code, for the servicing of the holding tank. In the case ofexemption under Secbon 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 condition 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 governmental 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 p^ate sewage system for costs related to the pumping of a septic or holding tank. The charges wrill be assessedas pr^nbed by Secbon ^.0703, stets. The owner agrees to pay all charges and cost Incurred by the govemmental unit forinsp^on. PumP'Ofl. hauling, or othenMse servicing and maintaining the holding tank In such a manner as to prevent or abateany human health hazard caused by the tiolding tank.This agreeioent will rernain in effect only until the govemmental unit responsible for the regulation of private sewage systemscertlflM that ^mer a I absorption system that complies with SPS 383, WIs. Adm. Code, or a municipal sewer serves theproperty. In addition, this agrmment may be cancelled by executing and recording said certification with reference to thisagreement in such manner which will permit the existence of the certificafa'on to tie determined by reference to the property.ih!! 1^" ''®''® "^® assignees of the owner. The owner shall submit?. 7S. tlseds. 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.5.• Only ono owner slnnaturo required nOwner's Name ^ ,'VifWriA S-f. (Date: . / f'' /o!3(1^Drafted by:ACKNOWLEDGMENTState of:County of: DaKCrXZ^Subscribed and sworn to before me on this ^__2j:^davof 20By (Owner's Name):Notary Public Signature:PublicMy commissionlie Notary Name (PriPersonal Information you provide may be used for secondary purposes (Privacy Law. § 15.04 (I) (m)Jnt): ^»mmission expires on: t 7 ^~ la alOURV ^ilicMinnesota|OfnmiMlon Expire JMiia~rion22^1
Part of Government Lot Three (3) Section Twenty six (26) TownshipThirty eight (38) North Range Seven (7) West, described as Lot Two (2)recorded in Volume Twelve (12) of Certified Survey Maps page 116,Survey No 2906 #
Real Estate sawyer county Property ListingToday's Date: 3/16/2020Property Status: CurrentCreated On: 2/6/2007 7:55:38 AM001700DescriptionUpdated: 8/23/2019Tax ID:22803PIN:57-022-2-38-07-26-5 05-003-000150Legacy PIN:022738265315Map ID::3.15Municipality:(022) TOWN OF RADISSONSIR:S26738N R07WDesciiptlon:PRT GOVT LOT 3, LOT 2 CSM 12/116#2906Recorded Acres:1.130Calculated Acres:1.148Lottery Claims:0First Dollar:YesWateitody:Chlppewa RiverZoning:(RRl) Residential/Recreational OneESN:7 Tax DistrictsUpdated: 2/6/20071State of Wisconsin57Sawyer County022Town of Radlsson576615Winter School DistrictTechnical College« Recorded DocumentsUpdated: 8/23/2019WARRANTY DEEDDate Recorded: 5/1/2009OwnershipUpdated: 8/23/2019DAVID 3 ST CHRISTOPHERHUDSON WIBiiiina Address;DAVID 3 ST CHRISTOPHER651 lOTHSTNHUDSON WI 54016-2301Mailino Address:DAVID 3 ST CHRISTOPHER651 lOTH ST NHUDSON WI 54016-2301Site Address * Indicates Private Road3042N EAST RIVER DR »Property HistoryN/ARADISSON 54867Property AssessmentUpdated: 8/9/20172020 Assessment DetailCodeAcresLandImp.Gl-RESIDENTIAL1.13027,50045,9002-Year Comparison20192020ChangeLand:27,50027,5000.0%Improved:45,90045,9000.0%Total:73,40073,4000.0%360030