HomeMy WebLinkAbout032-539-27-4305-SAN-2022-031 _ ���-' "'�- Industry Services Division County
_'�,,� _ 4822 Madison Yards Way �4 w �r�
t i, .,.\� - Madison,Wl 53705 Saniffiry Permit Number(to be filled in by Co.) �
�� . P.O.Box 7162 .
__ Madison,WI 53707-7162 � 39 U 3 � �
Sanitary Permit Application State Transaction Number i
In accordance with SPS 38321(2),Wis.Adm Code,submission oft3�is form to ffie appmpriate governmental unit '� �
is required prior to obtaining a sanituy pertnit Note:Application focros for staic-0wned POWTS are submitted to Projec[Address(if ifferent than mailing address) (�
the Department of Safety and Professional Services.Personal v►foimation you provide may be used for secondary
purposes in accordance with the Privacy Law,s. 15.04(1 xm),Stats. `
I.App6cation Information-Pkase P�iat Al)Informatioa L A 1�Q �'`�%h�"��'' 2 �
Property Owner's Name Pa�el ii
����� � Tl,� � c � �-ti b3a -53 �1 - a7 - y3oS
Property Owner's Mailing Address Property Locatioo
S�l y E �..�s�-mo ►- � ���v� � o�
City,State Zip Code Ptione Number � n
S�r i✓�� '[ �e �Gt � �!� �p s�� 9 ��7- a �' 8 ( �S(p —�_'��> S E %,, Section �
II.Type of Bailding(ch�k all th�t apply) Lot� T 3 9 N R s E o
❑1 or 2 Family Dwellmg-Number of Bedrooms � � Subdivision Name
Bl�k#
❑Public/Commercial-Describe Use
❑City of
❑State Owned-Descnbe Use CSM Number ❑Village of
�y�3� �36�`7 Town of (,�/;H k`
III.Type of POWTS Permit:(Chcek eit�er"New"or"Replacement"aad ot6er applicabk on tine A C�eck one box oo line B.Complete lioe C i
a licabla)
A. �New System ❑ Replacement Syslem B Y � P ) � P )
❑Ofher Modification to Existin S stem ex lain ❑Addi►ional Pretreatrnent Unit ex lain
B' �Holdin Tank ❑ In-Ground ❑ At-Grade gn ❑ Ott�er Type(explain)
g ❑ Moimd ❑ Individua!Site Desi
(conventanal)
C• ❑ Renewal Before ❑ Revision ❑ Change of Ptumber ❑Transfer to New Owner �t Previous Permit Number and Date Issued
Ea�piration
IV.Dispersal(1'reatmeet Area and Tank Informatioa:
Design Flow(gpd) Design Soil Application Rate(gpd/sfl Dispersal Area Requ'ved(s� Dispersal Area Proposed(s� System Elevation
oZ b O '— �
Capacity in Total tl of Manufacturer
Tank Information Gallons Gallons Units � � o � o
New Taaks Existiog Tanks w c � � a� a`� � �
�
a. U �n y in w C7 Ci.
Septic or Holding Tank �?�v v 3� � rC�tU'�-Y L'(/'�"7��/1/G X
�J
Dosing Chamba
V.RespoaSibility Stat�t- 1,tie a'dersigned,as4a�c respoesiMlity for iastallatioa of tYe POW TS s o oa the attac6ed plsos.
Plumber's Name(Print) Plumber's Signature PRS Number Business Phone Numbet
yh��� �rv�a,��- aMer-� `7Y�� �25'/!0 9 ��s-a��-3�s�o
Plumber's Address(S t,City,State,Zip Code)
Y3�J b ti1 L�4-/� �%�t�e� /�0 4� (.� ; ��t�.- �.�JT .���9l0
Vl.Co /Depa�ent Use Oety
�A� ro ❑Disapproved �� Date Issued Issuing Agent SignaWre
S
❑Owner Given Reason for Deoial ��'� ��. a'�' `���f,0/
Conditions of Approval/Reasons for Disapproval s 'j�r�r" ,
� � ti n' - ��� ';;`',
_ .. . b� � �,�d ,;';` �.� _ f�...��
c s� N ����� � � 2��z �-
� � �__ _________t
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z�::;d�,v�;�,�:v�vi��h�TiGN
Attach te compMte plaos tor the s�stm and submit te t�e Com�ty oely on paper eot le�s thaa 8�rz z 11 iecbes in s'ae
NO REFUNDS AFTER
ISSUE OF PERMIT
Sawyer County Zoning & Conservation Administration � �
```"�,1 10610 Main Strcet, Suite 49
� �R CO �� Hayward, Wisconsin 54843
��j� �_,1,�� (��s�F3a-s?Ks
: ' ,�i rAx��is��3x-3?��
�(/ry i� - ��� www.sawvcrcountygov.org
��o� __�� � � �o / E-mail:zoninR.scc(a>,sawycrcoimt �v�ov.org
���� ���y;;������ Toll Free Courthouse/General lnformation 1-877-699-4110
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Holding Tank Approval Checklist
L Sanitary Cover Sheet Date Stamp d3 / �g / o��
Parcel ID# � 3 � - s.3 `�-�7- �( 3 � s
IL Plot Plan
� Property Lines D� Benchmark BM ♦
� Site Address �North Arrow
�Stnicture �Scale
Well �<25' to Service Road
Legal Description �Iearest Road Intersection
�Setbacks to: Property Line, Well, Structure, Water bodies, Roads
III. Required Plans
� Index Page with Original Signature
Management Plan/Contingency Plan
�Servicing Contract
�Holding Tank Agreement fonn
IV. Holding Tank Specifications
Cross-section—Manufacture, Gallons: ��� ���
Tank Anchor Calculations [SPS 383.43 S) g)
Locking device, chains/locks
�p Alann and Electrical per NEC 300, SPS 316 & 383.43 (9) (e) and
State Statutes 101.862(2) and 101.862(3)
�3" Bedding Material < 1/2 "
V. Holding Tank Plans per Component POWTS Manual
�Version 2 SBD-10855-P (R.3/07) �
Owner: ��-� Plutnber: �o�nT�j
Application Review Date: 63 1 �-���'�
POWTS Reviewer: ��,,,�l.�,�
Namc
6���.�
L���„s�#
Revised 4/11/2013
PAGE 1 OF 4
Holding Tank Plan
Index & Cover Sheet
Component Manual Design Refer�ences:
Version 2.0, SBD-10855-P (N. 03/07; R 01/12) , ,,
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Pian
Pg 3 of 4 Holding Tank Specifications
Pg 4 of 4 Management P(an
Attachments: Enclosures:
POWTS Application for Review
Soii Evaluation Report & Site Map (if applicable)
Holdin Tank Pum in Contract if a licable)
Holdin Tank A reement if a licable
Project Name / Description
Owner Name{s): $ru�e. � ���� � �.�e e-�-� Phone: y�� - �9g_ �'/S�
Owner Address: S�l y � ��s�o�e ��^. �Pr�n,}-F;�I� MD Zip: �n s�� g
Project Address: L,q rc� w;n-�,.- 2�. (,c>r�+c.�- �,.�� Sy �y��
Govt. Lot: � __�1/4 of S� 1/4, Section � 7 , T��N-R s E 0 or W�
Township: W��✓f�� County: s� �v�e v-�
Project Parcel ID#: 0 3 a� - -�3 9 -a � - y3 a 5
Designer Information
Designer Name: N►i1;1L-e V�'�o�n'�o n'�e�y phone; ��S _ d�� _ 36 �b
�
Designer Address: �f 3 `�� � L�.�� w;.��-ev� Rae_ W%���� wr�p; -�y�%�o
E-mail' 1�1'l0✓��/�j ��,,,.� �i v� � ��✓�"��-� yY�i� • � � � This space reserved for appro��al�tanlp.
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License Number: M p � ot �/ � 9
Remarks:
C/yl -
signature: Date: .3- 2 z �2 Z
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- . . Holding Tank-Management Plan - .
�o�r�r-. - � _ . .
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�e�t SPS 3�t3},ltlf�Ad�Coae. • .
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• ' . SE�YIC�lG EREQtJEI�I� � -
0 7he#a�(s}sE�be p�tnpad tg►a�ae�r�Bed se�e�vk�ng oPeca�o�'�c�sed c�s.�'i.48 Wis�Sis�
- v�tl�e�LLn�e b�(s)e+w�es a ie�e[af ane ioc�t 6etvw�e T�f t�ert a��a�Na(s� - �
D�!a€t�oc�lerds s!�6e p�assi���NR 113.Wts�Adrrdn.Cale.
Tsnk�repoi€�si�ba�ad�tfis ptnper for.�t��in a�e�SPS 38�5 Wrs. -
� . �Nn.Cocle. E�e�ort a�Y compwnetrt�se o��to:�
�t�amsa��oEc�m�y;�ce Ntotttgom�y - _ � �15-26fi-3Q4� _ -
��,,,��Sawye�Count�Zoning - � 7'i 5-fi3�-8288
�cat�re�ee.r��� 1�'t0 Ma�n Street Suite 49, Hayward, VVl � 54843
Arry�ve pazt a�tMs sy�st�be�.re�c�ot r+�t�d ptusuarrt�a SE"S 383,5!(i},ifY'��.
Cod�Etepair or t�:�m�t o��eci ot m��g coc�on�shaB c�pty ti+r�SPS 383.Vk��Caie. -
NQ pca��or�t�r p�SE r�n a�the P�Ni'S rc�y 6e c�d un�ss ap�nnred bythe�a�te�'s�
- �wittt SPS 354,111�Ar�rua Cbcie.
• Co1i�1Q@�iCY P�Ti - � .
�e the�+rse#the�Prry�ed�aFti�s l�oi�ng i�dc{s)ca�r�a�t 6e�,���r�p�ese��o a � .
��i�i�ed t�the a�pprapEie�e a�gecy�ie�riaw and a�pno�r�, � ' - - -
- S`ltstent/Avandon[Yte11�t � .
� tE use a#�t�C(s)is�rx�ed,�s�aH be abaex�oned in a�t+d�ce w�h s'Ps s83.33,wis�A�in.c:ode. �
� � �
HOLDING TANK SERVICING CONTRACT , •
Contract Datr. �/?� / .2 �
This contract is madc bctwcen thc Holding Tank Owner and thc Pumper.
Holding Tank Owner's Name: Pumper's Name:
Northwest Sanitary, Inc.
$r��L �` �J l�� � ��� PO BOX 155
Radisson,WI 54867
Parcel ldenti�cation Number:
(12 Digit Legacy ID) � .� .z - S39_- o� � - y 3 D S
I. Thc owncr agrccs to �le a copy of this contract wilh thc govcrnmcntal unit, Sawycr County,
which has acceptcd and recorded with thc Officc of the Rcgister of Dccds,the Maintenancc
Agreement for a Holding Tank required under the Sawyer County Private Sewage System
Ordinance for the issuance of a Sanitary Permit for the installation of a holding tank(s).
?. Thc owncr agrccs to havc thc holding tank(s) scrviccd by thc pumper and guarantecs to
pennit the pumper to have access and to enter upon the property for the purpose of servicing
thc holding tank(s). Thc owncr a��ccs to maintain thc all-wcathcr acccss road or drivc so
that thc pumper can scrvicc thc holding lank(s)with thc pumping cquipmcnt. Thc ow�ncr
furthcr a�nccs to pay thc pumper for a chargcs incurrcd in servicing thc holding tank(s)as
mutu�lly agreed upon by the owner and pumper.
3. Thc pumper agrccs to submit to thc Govcrnmcntal Unit, Savvycr County,a rcport for thc
scrvicing of thc holding tank(s)as rcquircd undcr SPS 383.55,Wisconsin Administrati��c
Code and the Sawyer County Private Sewage System Ordinance. The pumper further
agrees to include the following in the report:
a. The name and address of the person responsible for senicing 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 agrccmcnt will rcmain in cffcct until thc owncr or pumper tcrminatcs this contract. In
thc cvcnt of a changc in this contract, thc owncr agrccs to filc a copy of any changcs to this
scrvicc contract or a copy of a ncw scrvicc contract with Sawycr County within tcn (I Oj
busincss days from thc datc of changc to this scrvicc contract.
Owner's Name: (Print) OWi1C ' ignature:ro one cr si�naturc required)
���.� /�. ��4
Pumper's Namc: (Print) Pumper's Signature:
Ronald L Vieceli, owner Northwest Sanitary,lnc � �/J
���� �,. l�� .��
Pumper's Rcgistration Numbcr.
#2389
Rcv.03/2C,13
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�j POWTS MAINTENANCE AGREEMENT -� � �x�403699� 5 �
For Hotding Tanks � 438333 �
�- PAULA CHISSER �
I Uwner'sName(sjasshomiondeed: FZEGiSTER QF DEEDS
?i ' SAWYER COUNTY, WI
� QrIJC �. f�' �J�i� � f ��� � Q�,1�$����� ln'AA QM �
RECORDING FEE 3�•�fl
Parcel tdenffication Numher_ , ' ,
� (t2oig�t�egacy�D) .�z��-53 9 _ � � _ y� o s � PAGES: Z �
Legal Description of Property: .
-SC�r'��fi�HE�SHE�T-
We adrnowledge that appl'�cation is being made for the insta0ation of a holdmg tank(s)on the
property descxbed on the attached sheet
�
Retum To:Sawyer County Zoning AdminisLation,PO 80X 676,Hayward.WI 54843 �
� i
As an induceinent to the County of Sawyer to issue a san�tary permit for a hoiding tank on the above-described property,the ovmer is
respans�ble for the operation and maintenance of the holding tank.toddng device,atarm and access,and agrees fo conform ta all
appl'icabfe requirements of Ch.Comm 83,Wis.Adm.Code relating to holdng tank management,induding the following:
1. The owner agrees to contract with a person who is ticensed under Ch.NR 173,Wis.Arlm.Code,except as provided by
Section 281_48(3)(�,Stats.,to have the haldng tank properfiy serviced and to fite a copy af the service o�ntract with the
govemmeMal uniL The atimer fu�ther ag�ee,s to file a copy of any changes to tfie senrice oorrtrac�,or a copy of a new service
contrad,w'rth the govemmenfal unit w�hin ter►(i0)business days from the date of change to the service contract
Z The owner agrees to contract w�h a person Cc�nsed under Citi P1R 113,Wis.Adm_Code,who shatl submit pumping reports b
tf�e govemmental un�Fn aa�ordar�ce w�h Ch.Comm 83.55,Wis_Adm_Code,for the servidng of the hoEding tank In the case
of exemption untier Secfiion 281.48(3}(d),Stats.,the awner shall subm�the reporf to the govemmental unit The
govemmenta!unit may e�er upan the property to investigate the cand�on of the hokiing tank when pumping reports may
indicate the Fwlding tank is not being propedy maintained.
3. If the owner faits to have the holdmg tank propedy serviced in response to orclers issued by the govemmenfal unit to pnevent
or abate a human health t�azaM as de.scn�bed in Section 254.59,Stats.,the govemmenta}unit may enter upon the property
and service,or cause the tank to be serviced_ Pursuant to Sedion�4520(4}Wis,Sfia4s.,a gavemmentat unit may assess the
• owner of a private sewage system for costs relafed to the pumping of a septic or holdmg tank.The charges wn�l be assessed
as prescribed by Seclion 66.0703,shats. The owner agrees to pay all charges and oost incurced by the govemmenta!unit for
inspection,pumping,hau�ing.or othennrise servic�ng ar�d ma'mtaining the hotdmg tank in such a manner as to prevent or abate
any human hea[th hararci caused by the holdng tank
4. This agreemerrt Nrll remain in efied onty un6'1 tha govemmental unit respansible for the regula6on of prnrate sewage systems
certfies that either a sol absocption system that complies wifh Ch.Comm 83,Wis_Adm.Code,or a municipal sewer sen+es
the property.ln addition,this agreeme�may be cancelted by executing and recording said c�rh'fication with referent�fo this
agreemerrt in such manner which vrnli permit the ebstence of the aertification to be determined by refer�nce to the properiy_
5. This agreement shall be bindng upon the owner,the heirs of the owner,and assignees of the awner_The owt�er shalt submit
the agreement to the register of deeds,and the agreement shall be rec�rded by the register of deeds in a manner whic:h witl
pertnit the e�astence of the agr�ment to be detemuned by reference to the property where ttie hofding tank is instaNed.
-on�y one ' 'rea- ACjCNOWLEDGEMENT
� ��� � State of_.
County of_
�S��' Subsrx��l and swom to before me on this
�' �. � ��day of 20�
� by .
'' ?- �z z Notary Pubr�c signa .
Drafted b��� N�� � No�ry Public N ` ��
/,� iNL�
My commtssion expir�e n:
JENNIFER SMITH
Notary Public-Notary Seal
pergpnal�orttta�on you p�pv(de may be used{or�ry pu�poses[Pcfiraq Law,§i5.04(q( Green e County-State of Missouri
Commission Number 14631820
3 My Commission Expires Nov 20,2023
Lot 2 as r�corded in Volume ]4 of Cert[fied Survey Maps, page 376, Survey No.
3b17 as Docum�nt No. 233229, tocated in the Town of Winter, S�wyer Cout�ty,
'V'Visconsin, be�n� a part of the S%aSF%, �ecti�n 2'7, To��nship 39 l�orth, Ra�ge 5� �.
VVest.
3/28/22,9:50 AM Real Property Listing Page
R2al EStat2 Sawyer County Property Listing Property5tatus: Current
Today's Date: 3/28/2022 Created On: 2/6/2007 7:55:59 AM .
�Description Updated: 2/26/2020 '� Ownership Updated: 3/1/2022
_
Tax ID: 354Z4 BRUCE A&]ULIE A LEETH REV TRUST SPRINGFIELD MI
PIN: 57-032-2-39-05-27-4 03-000-000050
Legacy PIN: 032539274305 Billing Address: Mailing Address:
Map ID: .15.5 BRUCE A&]ULIE A LEETH BRUCE A&JULIE A LEETH
Municipality: (032)TOWN OF WINTER REV TRUST REV TRUST
STR: 527 T39N R05W 5714 E EASTMORE DR 5714 E EASTMORE DR
SPRINGFIELD MI 65809 SPRINGFIELD MI 65809
Description: PRT SWSE LOT 2 CSM 14/376#3617
Recorded Acres: 0.760
Calculated Acres: 0.765
� Site Address * indicates Private Road
Lottery Claims: 0 N/A
First Dollar: No
Waterbody: Winter Lake � Property Assessment Updated: 10/10/2016
Zoning: (RR1) Residential/Recreational One 2022 Assessment Detail
ESN: Code Acres Land Imp.
G1-RESIDENTIAL 0.760 75,800 0
� Tax Districts Updated: 2/6/2007
1 State of Wisconsin 2-Year Comparison 2021 2022 Change
57 Sawyer County Land: 75,800 75,800 0.0%
032 Town of Winter Improved: 0 0 0.0%
576615 Winter School District Total: 75,800 75,800 0.0%
001700 Technical College
.� Recorded Documents Updated: 3/1/2022 n�� Property History
WARRANTY DEED N/A
Date Recorded: 2/22/2022 437730
WARRANTY DEED
Date Recorded: 3/16/1993 234005
CERTIFIED SURVEY MAP
Date Recorded: 1/21/1993 233229
https://tas.sawyercountygov.org//system/frames.asp?uname=Eric+Wellauer ���
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