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HomeMy WebLinkAbout032-539-29-3403-SAN-2020-185Industry Services Division4822 Madison Yaids Way 53705PO Box 7162^^"disoivWI 53705-7162 .i; J_CountySanitmy Permit Number (to be filled in by Co.)kSanitary Permit ApplicationIn accordance with SI'S 383.21(2). WIs. Adm. Code, submission ofthis form to the appropriate govcrameniai unitis required prior In obtaining n sanitary permit. Note: Application fomts for state-owned K)WTS arc submitted tothe Department of Safety and Professional Scrvics. Personal information you provide mi^ be used for secondarypurposes in accordance with the Privacy Law. s. lS.CM{t)(m). Slats.tState Plan Review NumberPWTS-s?I. Application Information —Please Print All InformatioaProject Address (if diflcrenl than moiling address)Parcel # "577^oiJ.'S'Sf' -3vosProperty Owner's NameIhopcrty Owner's Mailing Address-70Property LocationOovL LotCity, StaleZip CodeII. Type of Building (cbeck all that apply)CJSf'i or2 Family Dwelling - Number of DednxwiisD Public/Commercial - Describe UseD State Owned - Describe UsePhone NumberLot#S/l 'A, 'A Section ^T 37 N: R 5"(w^one)iSubdivision NameBlock#□ City of.CSM Numberi7%J 2'rlbOn Village of^ Town ofIII. Type of Permit: (Check only one box on line A. Complete line B if applicable)A.D New System'^Replacement System0 Treatment/Holding Tank Replacement OnlyD Other Modification to Existing System (explain)B.D Permit RenewalBefore Expir^onD Peimii RevisionD Change of Plumber□ Permit Transfer to NewOwnerList Previous Permit Number and Date IssuedIV. Type of POWTSSystem/Component/Devicc; (Check all that applyD Non-Prc.s.surLa:d In-Ground D ITcssuriTcd In-Croimd 0 At-Grade D Mound >24 in, of suitable soil D Mound <24 in. ofsuitable soil0OdoldingTank D Other Dispersal Component (explain) D Prciicaimeni Device (explain)V. Dispersal/Treatment Area Information:Design Flow (gpd)Design Soil Application Raic(gpdsf)Dispersal Area Required (sf)Dispersal Area Proposed (sf)System ElevationVi. Tank InfoCapacity inGallonsNew TanksExisting TanksTotalGallons#ofUnilsManufacturerii18dCO R§COu. OSeptic or Hoidins Tank3^00Doling ChsmberVII. Responsihility Statement- 1. the undersignetL assume responsibility for installation of the POWTS^bown on the attached plans.Plumhcf's Name (Print):t. City, Sate.;Plumber's SignatureMP/MPRS NumberBusiness Phone Number7i5-Plumber's Address (Streef City, S&e, Zip Code)HZHO sj LAt^ (^oa.(Q. LaJ LOTvni.y/Departmcnt Use OnlyU DisapprovedOwner Given Reason for DenialPermit FeeS ttoDate IssuedIssuing Agent SignaturehOAJjIX. Conditions of Approval/Reasons for DisapprovalORIGINALAttach (a cnmpltie plans for the syxtrm and »t>mil to the Coaoty anly on paperaatlfss Uiaa 8W il?]AUG 1 7 2020SAWYER COL'NTYZONING ADf.4INlS ri-iATlOM Sawyer County Zoning & Conservation Administration10610 Main Sireet, Suite 49CqU» Hayward, Wisconsin 54843(715)6.14-8288"•Ty ■ftfwtt 1 ^ TAX (715>638-.1277^ www.siiwvcrcounivuDv.orgt » Toll Krcc Cnurtliouse/Ochcral Informallon l-877-<99-4110Sanitary Cover SheetHolding Tank Approval Checklist/er Sheet Date Stamp / l*^ /_^ppjOParcel ID# 3. ^ SJ^3r.Y ^ 3Plot Plan7^ Property LinesX Site AddressX, Structure^Welly Legal DescriptionX-Benchinark BM ▲X North ArrowX Scale_^< 25' to Service Roady Nearest Road IntersectionX Setbacks to: Property Line, Well, Structure, Water bodies, RoadsRequired Plans^Index Page with Original Signaturey^anagenicnt Plan/Contingency PlanXServieing ContractHolding Tank Agreement fonnHolding Tank Specificationsy Cross-section - Manufacture, Gallons:^6C50Tank Anchor Calculations [SPS 383.43 8) g)]X Locking device, chains/locksXAlann 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 "Holding Tank Plans per Component POWTS Manual^Version 2 SBD-10855-P (R.3/07)Owner:Application Review Date;POWTS Reviewer:Plumber: ^ _J\WUccnscARevised 4/11/2013 Pg1 of4Pg2of4Pg3of4Pg4of4Holding Tank Planindex & Cover SheetComponent Manual Design References:Version 2.0, SBD-10855-P (N. 03/07; R 01/12)Index & Cover SheetPlot PlanHolding Tank SpecificationsManagement PlanPAGE 1 OF 4Attachments:Enclosures:POWTS Application for ReviewSoil Evaluation Report & Site Map (if applicable)Holding Tank Pumping Contract (if applicable)Holding Tank Agreement (if applicable)Project Name / DescriptionOwner Name(s): Dav; J ^ Tui/1 UJa r-PfOwner Address: Kit fpPhone: ^ - d^laSZip: SvnOProject Address: lJ jJjrGovt. Lot: 1/4of 1/4, Section ^ ? . jZI N-R S EPIor WTownship: lO'oA'fg. County:Project Parcel ID#: O"? 3>-5 - 3/^3Designer InformationDesigner Name: l/V); \Lt. Phone: TtS"Designer Address: jlji. uj^zio:E"mail: (jovC^O This space reserved for approval stamp.License Number Mp 0.7^51 6 ^Remarks:Signature:rm/nnal ei/matitraDate; '3 — 26 ^Ail ®Spf^ dec. C44fL -ZooSCALE1"- 10'tMAPLOT FLAN: ©ft. ^ Tol' <- yA P-Pu>n«i3. nJ) ToUT iHS9oPAGE 2 OF 5fi'.C.Py1/4 Mi't FoM 10BM= )00.0h)a.:\ ;a L«nr^<. ^;*;ciT. '• lr'et^<~L.CJ ft \ ^iS.wR.51^p;x) Jt SlD-hcsv^:i^lto PAGE30F4HOLDING TANK SPEOIFIOATIONS(No Scale)Hocfitcal must comply withSPS 316 and NEC 300O WaaBieqiaiof—JuncBoaandAfaanBax-Oonduitle-MIn. yfiWftaD-1Approved JoinlswffliApprevadP^SfiontoSoSdGnouidInlet3^-ac.■AMynSaal1? tUBn. or 2jD ftdioAieAppimed CiJnlflalridnood BevaSonVteMC^ / CMiiaQ>TOIMtaBi-v r-fT / 4-MiB.or2J0ftaho«/ 1 FitelUMied Rood SawaSon_\|/ I(AnAaO-® •- -' *- a.-^rr- .:■FtttehBd QreridhtfelbivortT"I—Maoe.12*ar90%ortotdvoliine^ I EFmoTB than am tankAtanaOnHOLDING TANKVOLUME = '?£>6 0J-gal*PllQTANK MANUFACTURER: //u-f/AnctK)rtank as necessaypureuantto SPS 383.43(8}(^Baltest Weight« Rcu Atanltvol x 62.4 IbsfcuA) - BisJank.wg x 1.5BallastW^g[( (f(^3 cuJtx62.4lb8teu.fQ. fyP e!7.SPJl th. HolcQr^ Tank Msff^iganent PlanPAGE4ggOCTAMriTtieoonerofSferaqAcenrtBor^OpiLi.' « >3:V'rautiuiiJai.i«»iMi^983JSag^WBc.iaBto.CddB.-BB8malBdI)a«rMMnMteltow« gpdfcwnarBfMaChaefcBrt - BSP^EVBOTSYEAS®o qpfttfop *o nsofai^Biniiwatocteria^W|>»i»(U. awiwaqdaii^ rFfwrMif n, pwMMMacBriBb^ qfa)AAtdfuCode. BafoAm^tmffioni^ibB^vm^SaBeaaafx715.26fr3040PtaH^ 715-634-8288Local gwtfnmartmfc'SswyM'COUP^Zani!^ ^ pfagig; 715-634-8!Local gninmmHnttirttBtMiBjMr 10610 Skjitst St^B 4Q« HflywsTd, W1 ^ip. 54843»s«tteK»vi8h ^8384.WlBaAdoob. Coda.\ tsi .I : t <{ x\^Vvi j'TTTf/. ) M ;l»^^-t» -.»_r.~a .Hi HOLDING TANK SERVICING CONTRACTI Contract Date: 3L 0This contract is made between the Hoiding Tank Owner and the Pumper.HoldincTank Owner's Name: . « ib /VLiJ^a-tclvofP-Jo »v-vD UJ^e^rof^J<a.irw«i p. UjAlctrofp-Pumper's Name:NorUiwest Sanitary, Inc.PO BOX 155Radlsson.WI 54867Parcel Identification Number:(12 Digit Legacy ID) (5 3 A-JC3 H 3 31. The owner agrees to file a copy of this contract with the governmental unit. Sawyer County,which has accepted and receded 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. 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 Govertunental Unit Sawyer County, a report for theservicing of the holding tank(s) as required under SPS 383.55, Wisconsin AdministrativeCode and the Sawyer County Wvate 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 sit» to which the contents from the holding tank were delivered.4. This agreement will remain in effect imtil 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) . , ,CJtivOd -1^ d A-Jo r* aX&fOfP-»ifv<ss ^ LO/xX^ro^Oiraefts Signature: (Onlyone^nerslgiiatunrraiiired)Pumper's Name: (Print)Ronald L Vieceli, owner Northwest Sanitary,lncPumper's Signature:Pumper's Registration Number:#2389Rev. 03/26/13 Real Estate sawyer County Property ListingToday's Date: 8/19/2020Property Status: CurrentCreated On: 4/11/2007 3:06:42 PMTax Districts57032576615001700uisr DescriptionUpdated: 8/24/2016Tax ID:39212PIN:57-032-2-39-05-29-3 04-000-000030Legacy PIN:032539293403Map ID:.12.3Munidpaiity:(032) TOWN OF WINTERSIR:S29T39NR05WDescription:SESW & PRT SWSE, LOT 1 GSM 29/60#7363Recorded Acres;5.000Calculated Acres:4.989Lottery Qaims:0First Dollar:YesZoning:(A-1) Agricultural OneESN:428Updated: 4/11/2007State of WisconsinSawyer CountyTechnical COiiegeRecorded DocumentsUpdated: 8/5/2015WARRANTY DEEDDate Recorded: 6/26/2015396376WARRANTY DEEDDate Recorded: 8/28/2006341195 587/287^ OwnershipUpdated: 3/13/2018Town of WinterWinter Schooi DistrictDAVID I & JULIE A WALDROFFHUDSON WIJON D WALDROFFNEW RICHMONDWIJAMES P WALDROFFNEW RICHMONDWIBiiiina Address:DAVID J& JULIE AWALDROFF398 RIVER RDHUDSON WI 54016Maiiino Address:DAVID J& JULIE AWALDROFF398 RIVER RDHUDSON WI 54016^ Site Address * Indicates Private Road5298N COUNTY HWY WWINTER 54896Property AssessmentUpdated: 10/10/20162020 Assessment DetailCodeAcresLand Imp.Gl-RESIDENTIAL1.2004,900 77,500G4-AGRICULTURAL3.800600 02-Year Comparison20192020 ChangeLand:5,5005,500 0.0%Improved:77,50077,500 0.0%Total:83,000 83,0000.0%Property HistoryParent PropertiesTax ID57-032-2-39-05-29-3 04-000-00001035488HISTORY B Expand All Histcrv Whtte=Current Parcels Pink=Retired ParcelsBTax ID: 35488 Pin: 57-032-2-39-05^9-3 04-000-000010 Leo. Pin: 032539293401 Mao ID: .12.139212 This Parcel ^Parents ^Children -USE BLACK INK ONLY-8 0 3Tx;40222nPOWTS MAINTENANCE AGREEMENTFor Holding Tanks425838PAULA CHISSERREGISTER OF DEEDSSAWYER COUNTY, WI08/20/2020 09:05 AMRECORDING FEE 30.00Owner's Name(8) as shown on deed:Dkiu,-dt cJ VJuJ. e JiParcel Identification Number(IZOIgiaegscylO) Q_ 5. 2^-SI^3.'2.!LQ_2.PAGES: 2Legal Oescrlption of Property:-SEE ATTACHED SHEET-We acknowledge that ei^licatlon is tieing made for the installation of a ttotdlng tankfs) on theproperty described on ttie attactied sheet\Return To: Sawyer County Zoning and Conservation Admlnistrstlon10610 Main SL Suite 49, Hayward, Wl 54843As an inducement to the County of Sawyer to issue a sanitary permK for a holding tank on the above-described property, the owner Isresponsible for the operation and malntenarrce of the holding tank, locking device, alarm and access, and agrees to conform to allapplicable requirements of SPS 383, WIs. Adm. Code relating to holding tank management. Including the following:1.2.3.4.5.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 serviced and to file a copy of the service conU'act with thegovernmental unit. The owner further agrees to file a copy of any changes to the service con^ct, or a copy of a new servicecontract, with the govemmenta! 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 governmental unit In accordance vnth SPS 383.55, Wis. Adm. 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 govemmenta! unit The governmentalunit may enter upon the property to investigate the condition of the holding tank when pumping reports may indicate thetralding tank is not being properly maintained.If the owner ^ils to have the holding tank properly serviced In response to orders issued by the govemmental unit to preventor at>ate a human health hazard as described In Section. 254.59, Slats., 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, slats. The owner agrees to pay all charges and cost incurred by the govemmental unit forInspection, pumping, hauling, or otherwise 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 govemmental unit responsible for the regulation of private sewage systemscertifies that either a soil absorption system that compiles with 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 cedification to t>e 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 pnaperty where the holding lank is installed.signgturejequlredOnly oneOwner'Owneame (Print);Drafted by:ACKNOWLEDGMENTlu' i5CC'^5l'^State of;County of; Scl u-'-fSubscribed and sworn to before me on thisday of , 20 ZoBy (Owner's Name):Notary Public Signature:Public Notary Name (Print): /L }Ltr\ r'\C£('^I- 2,1.-•^|My commission expires on:• sPersonal information you provide may be used forLaw. §15.04(1) (m)]Rev. 03/26/13 Part of the Southeast Quarter of the Southwest Quarter (SE1/4 SW1/4) and part ofthe Southwest Quarter of the Southeast Quarter (SW1/4 SE1/4), SectionTwenty-nine (29), Township Thirty-nine (39) North, Range Five (5) West, moreparticularly described as Lot One (1) of Certified Survey Map No. 7363 recorded inVolume 29, page 60 of Certified Survey Maps, Document No. 343937.