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Home My WebLink About020-638-07-5304-SAN-2022-123 _�I��.._ V � _ Industry Services Uivision County �� 4822 Madison Yards\�ay Sa.vyer � ��-�S� - Madison,WI 5370$ Sanitary Pcimil Numbcr(to bc tillcd in by Co.) S P.O. Box 7167. � �� .:� ` Madison,WI 53707-7162 __- _ - - _ _- - _ __ __ --- -- _ ----- -- ----- - _--- Sanitary Permit Application S�ateTransactionNumbcr � In uccordance with SPS 3:t3.7.1(2),AVis.Adm.Codc,submission of thi�form to the appropriate guvernmental unit � is iaquired prior tu obtainin�,a sanitary pennit.Note:Applic.�tion forms for state-uwned POW'1'S are submittcd to Project Address(itdifferent ihan mailing addr � thc Departmcnt of S�fely and Profe,.ional Sen�ires.Personal information you procide may be used for secondary purpu.e.iu�iccordance��ith the Pric,icy Law,s. 15.0=1(I)(m),Stats. 9475�V State Hwy 70,Ojibwa,WI 54862 � I.Applicatinn[nformation-Please Print All Information __ __. ------- ------ ---- -------- ------- - �- - -- - Pru�i�it� ONnu V;imc P�uccl D.«/'6'��p'7'S�DY Bri:ui H.Kri�ta 57-020 Z 38-U6-07-5 OS-003-000040 - __ ---- __ -_ _ - ---- ---------- ------- Prup��ity O�vnu s M,iilinr Address ---- — property I,oca[ion 10834 161"Sh�cet ��.. _ ----------------- ------ (iurL Lot i Ciiy.State 7ip Code------ Phone Number -- - - Chippewn Falls.WI 54729 NE___'/, SW '/, Scction 07 --- ------- ---— T 3S N R 06 �V f 1.Typc of Building(check all that apply) Lot tl --- X I or Z Family�D��clling-Kumhcr ufl3edrooms 3 ------ Subdivision Namc -----------.. --------___.. Block# --- ;Public Commrrci:il - f)�,cribc U;r ----- - ----- _ _ _ ___. _ __-_ ❑City of- --- ---- - - ---—--- I Statc Owncd �Describc Usc CSM Numbcr ❑Village of__ ------- �"fo��n of Ojib�ra ---- ❑III.T��pc of POW"1'S Permit:(Check cither"Ne�v"or"Replacement"and other applicablc on linc A. Chcck one boa on line B. Complcte linc C if ap�licablc.)_ _ -- _._- ____ __- _ _ _ __ - --- ___- -------- ------ -_ � �r�� Systrm �., U �R�plt�cement Sy�stcm ❑<)ther Moditicution tu I.xi�tin,�System(explain� ❑Addrtional I i�veatment Unit(explain) -- -- - -.__. . _ _ _-_ __ _ _ -- B. ❑In(�round ----- -___ � I loldin�Tank ❑;11 Giade ❑ Indi�idual Si��Design 1�Odiei Type(esplainl -��un�cn�ional) ❑Moimd ._- - _ --- --- - -- — --� - _ -- �. ❑Renrwal 13efore ❑Trantifer to New Lisl Prcvious Permit Numbcr�nd Date Issued f��iralion ❑Rcvision ❑Chan�c uf Plumbcr Owncr 19�6 Installation ��_��g i�'.Dispersal/Treatment Area and Tank Information: _ -- -- ---- _Dcygn�lo��'(�pd) D�ugn Soil Application Ra[e(gpd/st) Dnp�rs.il Aica Rcyuu�d(titj Ditiputi.il Aie.i Proposed(st) Systcm Elevation(ft� �fl 3ot� - -- _ - _ ___ _ ---_ -- - - - � -- --- --__ __. __ _ _ - Capacity in To�al #of Manulacturer � � �I��ink Inlurin�uiun Gallons Galluns Units � v o v � _._.____ _.__.__ _ _.___ .._..............._.._. .J U � .' . a.. .. ��w l�.mks I�xi..lin�. I�mks � G � � � � c'o r 0 G l.I fn v. :/: Lt-. v a. _ . . .._.__ _-__' _ "—_-__— .--_._- _-_- __—.-.--- _— .'.._— ._.__--'__'--___-'___.'_— _. - __ _.. _ _. ticptic nr Iluldin�fank 3000 3000 I N'eiser Concrete,Inc. X Uosinh Chambcr ��.ReSponsibility StatCment- 1,the undersigned,assumc responsibility For installa on of the PON'"I'S shown un the attached plans. _ _ _ _ . _ - - --- — ._ _—_. Plumbu ti Namc I Prinll � � Plumbu' .'i natu - vIP/MPRS Numbcr Busin�tit Phonc Numbcr R:ind��'�larlin � fi75R42 � (7l5)225 22117 `�v � _. __ _ . __ _ _ _ - -- -- — —_ __ Plumher'.Addic�s IStrc�l City.Statc.Zi�i Codc) 11663 Count��H�w F',Chippcwa Falls,WI 54729 VI. ou h�/Department Use Only � --_ _- ----_ --- _ _ - _—-- _ __ �I ,- �prcl��c� L]Dis.ippioved Pcnnit Fe�� Datc Issued Issuing Agent Signatwe (� h i �1,q� { 1 � J � _ � fl Owncr Gi��cn Rc�ison for Dunial � ��",� �j7�� ,i� ., ��i T,�,�,(��l1X,T'?U/� 3- Cunclition,of.�pprovt�l/Rea,on�tiir Dis:ipproval [-'�1��1 ,-=y��:��+.� }-+r,-"' -` !� L:. • +,.. � .:'Fz��J �s��', \,� �s: 'i_ � � CS 1 /�b`� �� JUN 17 2022 �I IN� � � b � \ n� - SAWYER COUNTY �-I.T. Q ��, s�- �,QNit�G ADMlNISTRATiON Attach tu complctc plans fm��hc systcm und submit tn thc County only on paper nu�Icss than R i/'_s I I inchrs in size �131�_�,3y�;�ii ��;;,�� NO REFUNDS AFTER ISSUE OF PERMIT Sawyer County Zoning & Conservation Administration �� I 0610 Main Strcet, Suite 49 � - � � , 1 � Hayward, Wisconsin 54843 �� g� �� (715)634 R2A2i � � �' � FAX (715)638 �2"77 �� , , �� i / � '_ ,....s.�,� ._:. � � y.,.,a tc( 33 0 ;;� ��? � � � �7 �_� , / E 0191� �Uti t,_ � ;� SI tt� � < .711 � ".. 'tL.. � ��i� � � Toll Free Courthouse/General Informatwn 7-877-699-4110 I� .' � +' � � \�� Holding Tank Approval Checklist I. Sanitary Cover Sheet Date Stamp � �o / 1 �l / � � Parcel ID# c� � � - 6 3 B - O? _ S 3 o Y lI. Plot Plan x Property Lines �( Benchmark BM ♦ � Site Address x North Arrow � Structure �( Scale �( Well _� < 25 ' to Service Road �( Legal Description � Nearest Road Intersection �C Setbacks to: Property Line, Well, Structure, Water bodies, Roads III. Required Plans �C Index Page with Original Signature Management Plan/Contingency Plan Servicing Contract {�,., ,�{ � Holding Tank Agreement fonn�v�c.e� �'`-��`� 6�� IV. Holding Tank Specifications X Cross-section — Manufacture, Gallons: w �2S2c- 3�0� -`^� � � Tank Anchor Calculations [SPS 383 .43 8) g)] � Locking device, chains/locks � Alarm 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 � SBD-10855-P (R3/07) , , , � .1 Owner: ,�� a� 1,c.�is� Plumber: �h�y Yi/��-��,,� Application Review Date: �6 � ��7 1 �- .� POWTS Reviewer: ��L,,. l.� Namc 69' S� !(o Liccnsc # Revised 4/ll /2013 CONCRETE HOLDING TANK DESIGN Single Tank Option INDEX AND TITLE SHEET Project Krista Owner Brian H.Krista Address 10834 161st Street Chippewa Falls,WI 54729 Legal Description Part of GL 3,Sec.7,T38N,R6W Township Ojibwa County Sawyer Subdivision Name Lot No. Parcel ID Number 57-020-2-38-06-07-5 OS-003-000040 Plan Transaction ID Number Index and title sheet Page 1 Holding tank specifcations Page 2 Site plan 1:20 scale Page 3 Site plan 1 40 scale Page 4 Maintenance and contingency plan Page 5 Alarm specifica[ions Page 6 ,,1,�5{IS[ �dD,' .•' �C� d . � � �j,• • Designer Leroy�. k LER'�Y G. Signature "� �� Phone No 715-723-0408 '� c q F�LLS License Numbe� rDN�05&�SS Date 06/14/22 •�� O N�P��` Designed pursuant to�. ��••�It�l��'T�rytc`�omponent Manual For POWTS(Version 2.1) �� ,' May2022 version zi�osi22� Page 1 of 6 HOLDING TANK SPECIFICATIONS 3 Number of bedrooms Non-residential estimated flow (gpd) 2000.0 Minimum holding tank volume required (gal) 3183.0 Proposed holding tank capacity (gal) Wieser Concrete Inc. Tank Manufacturer W3000-MR Tank model number Rhombus SJE Alarm manufacturer Tank Alert 101-01H Alarm model number Tank Dimensions and Data Tank Anchor Calculations X for round tank 20630 Ibs Weight of tank and cover 50.0 Liquid depth below inlet invert (in) 1 .00 Safety factor 8.0 Maximum de th of soil cover (ft) 23720 Ibs Weight of anchor required 71.0 Height (in) Outside 23.7 in Soil cover req. for anchor or 186.0 Length (in) Dimensions 5.g yd' Concrete counter weight 93.0 Width (in) Only HOLDING TANK CROSS SECTION manhole cover with vent cap locking device and finished � junction �---� warning label grade box —� � 12" min. vent pipe �4" min. �, T F-- 24 in � conduit Seal watertight \ 18" min. �i blind plug to seal �, outlet � � tether waight — — — — — — — _ — _ — I — — — _ — — y � Building service 12.0 Ill. sewer O alarm on Note: All tank joints, and inlet joints between tank openings and piping are Electrical as per 38.0 in. sealed watertight. All pipe NEC 300 and vent materials comply and SPS 316 with SPS 384. 3 in. bedding under tank. Tank is anchored as necessary to negate buoyancy. 24" Plus cover over tank is recommended. Project: Krista Transaction Number: Page 2 of 6 � p U� � w�J o � m� Uw�Ju� N N M _ �(n U w W ii � � �Q��a - o ��-U �Q F�O � � J � ��W W (n F=-��d Q � (n=��(n Q F- I L W �Z Z Y F (n _o YFF-�U Z��UUJ Z c�O¢N Oa��]O Q j m� a a p w¢ �'�O '�N JQ(�(�(� m �C�O �QQwz rn� u' w��W p 00 �F-O�� Z Y �Z -(n�� " w Q� �W YOm 'i; � d0 pZzz mU m ~ Zt�H . c�iJ� �x ~ a d O W �o a O a � � w� � CL � Z¢Q°� X ~� X�W v � �� LL Wa� a y o°. � � F � _ C� J� O l �Y �a 2�6"y�'Oa°�b � ,' �, � a Z � �i s �.� �- oF w3 �� s/ � � 1 �z �c? °��ti�d'd, \ � --- �o z� rn ��- z� �� '" ��' `s� �." i-- C0 �m� °�O z w ) O � Q m 5�,�� a N f Za s�b O� oU �'d, � ~w �a' - b o� Qo�' - � �w �0 � �� - / m0 Np �� — � �. �Q 1 � oo�� F \ Y F-} � / W Q 07 ,\ O�y`� Q �? F�,-ma� 7. � (n(n xJ�W r� O. \ =LL w��„� � �'� � Y I-O �Y� o� � �___.._� / Q Y W Q �Z Z� H U F� 0 Q Q d �' JQ� OQ ZFmcn -w F �� N _---- — -_ � '_"__'_— _'-_. PAGE 3 OF 6 GENERAL SITE PLAN BRIAN H. KRISTA 9475 W STATE HWY 70 / PIN: PART OF GOVT LOT 3, SEC. 7, T38N, R6W � TOWN OF OJIBWA, SAWYER CO., WIS. �/�0� / � 2.02 ACRES S P.��N / ' ��i. / o`N . �oo �RP\��. R � ann= i oo.ao ro� -- �Q OP VvELL WFLL E%ISTWG 750 ��b GAL ST AND 7X11 � SEf'PAGEPITTO RF Af3ANDONF:U � V-:NT APPX SLOP[ RREAK O ��P� NEW 3,000 GAL 0�� HOLDING TANK Ci DECK R �5 oe �� Q �� o`` �P PP �� J � �P `` Nz`Qa G I Scale: 1 " = 40' 0' 10' 20' 30' 40' PAGE40F6 HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System(POWTS)has been designed,and is to be installed and maintained according to SPS 383,Wis.Admin.Code,the Holding Tank Component Manual(SBD-10855-P N.03/07,R.01/12),and the Sawyer County Sanitary Ordinance. 1. This POWTS is designed to accommodate a wastewater flow of 60.0 to 636.6 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance,including all provisions in the 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 whlch time the alarm will activate),the pumper listed in the current Service Contract must be called to empty 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 and manhole 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 actions shall comply with the county sanitary ordinance and SPS 383 and 384 Wis.Adm.Code. 5. Ali 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 be removed by any person not authorized to do so under Ch.251,Wis.Statutes.The discharge of wastes tank to the ground surface,including intentional discharges and discharges caused by neglect,constitutes a 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 standards for entering a confined space. The atmosphere within these tanks may contain lethal gases,and rescue of 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 tank may be installed in the same location(a new sanitary permit is required for such a replacement) Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced or its use discontinued,components no longer in use it shall be abandoned in accordance with SPS 383.33 Wfs.Adm-Code. 10. If there is a problem with,or question about this installation,the following persons may be contacted: a.lnstaller. _.._ __.. . .. Randy Martin Phone: 715-225-2203 b.Service Provider_. _ ...... Phone. c Co Zoning or Health Dept. Sawyer County Zoning Phone: 715-634-8288 11. Project Krista Transaction Numbec Page 5 of 6 I-IOLDING TANK SERVICING CONTRACT Contract Date: � /--�%-,� _Z This contract is made between the Holding Tank Owner and the Pumper. Holding T'anlc Owner's Name: Ptuiiper's Name: �1�� .�..,�"� ��Y��es� �du�}a.�-� �� Parcel IdentificAtion Number: Y � (I2 Digit Legacy ID) � `� � - �� _ �2 � _ � ��j � 1 . The owner a�rees to file a copy o1'this contract with the governmental unit, Sawyer County, which has accepted and recorded with the Office of the Register of Deeds, the Maintenance A�reement for a T-Iolding Tank required under thc Sawyer County Private Scwage System Ordivance for the issuance of a Sanitary Permit for the installation of a holdin� tank(s). 2. The owner agrees to have the holding tank(s} serviced by the pumper and guarantees to pernvt the pumper to have access and to enter upon the property for the purposc of servicing the holding tank(s). The owner agrees to maintain the all-weather access road or drive so that the pumper cazi service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for charges incurred in sea�vicin� fhe holding tank(s) as rnutually agrecd upon by the owner and pumper. 3. The pumpex• agrecs to submit to tl�e Governinental Unit, Sawyer County, a report for thc servicirig of the holding Cank(s) as required under SPS 3$3.55, Wisconsin Administrative Code and Che Sawyer County Private Sewage System Ordinance. The puinper fiirther . agrees to include tl�e following in the report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the ow�ier of the holding tanlc; c. The site address of the holding cank; d. Tl�c date the holding tanlc was serviced; e. The voIumes in gallons of the contents pun�ped from the holding tank for each servicing; f, The disposal sites to which the contents from the holding tank were delivered. 4. This agreentent will reinain in effect until the owner or pumper ternlinates this contract. In the event of a c(iauge in this contract, the owner agrees to file a copy of any changcs to this service contract o�� a copy of a new service contzact with Sawyer Counly within ten (10) business days from the date of change to this service con�ract. Owner's Nauie: (Print} Owner'S Slg[1dCUCe: (On1y ouc otivncr stgnature reqtdred) �r�Gh �Cr,�s�� . �. �� Purnper's Name: Print) Pum er's Signature: A ll��r�hw�sf ��;� /u� 1... � V� ��` Pumper's Registration N�unber: �� Rev. 03/26!13 � � � 0 � . � Easy-to-install liquid level alarm system for indoor use. This alarm system monitors liquid levels in lift pump chambers, sump pump basins, holding tanks, sewage, agricultural, and other water applications. � �� ..; The Tank Alert�'I alarm system can serve as a high or low level alarm depending on the float switch model used. «� #, a � � ,y The alarm horn sounds when a potentially threatening liquid level condition occurs.The horn can be silenced, but the warning light remains on until the condition is remedied.A green "power on"light indicates power to the alarm paneL s �� , � / NEMA 1 enclosure, designed for ease of installation, rated for indoor VOLTAGE FOR 120 VAC MODEL: use. Primarv: 120 VAC, 50/60 Hz, 5 watts max. / Red"alarm" light, green "power on" light, alarm "tesY switch, and (alarm condition) horn "silence"switch. Secondarv: 12 VAC / Alarm horn sounds at 86 decibels at 10 feet(3 meters). VOLTAGE FOR 230 VAC MODEL: / Can be used with any UL Listed/Recognized switching mechanism (not Ul.Listed or CSA Certified) rated to include 1 amp, 12 VAC load. Primarv: 230 VAC, 50/60 Hz, 5 watts max. (alarm condition) / Alarm system (when installed on separate circuit) operates even if Secondarv: 12 VAC the pump circuit fails. / Complete package includes standard SJE SignalMaster°control ALARM ENCLOSURE: 6 x 4 x 2.5 inch switch with 15 feet(4.57 meters) of cable (other lengths available) (15.24 x 10.16 x 6.35 cm), NEMA 1 metal and mounting clamp. / Switching mechanism operates on low voltage and is isolated from ALARM HORN: 86 decibels at 10 feet the power line to reduce the possibility of shock. (3 meters) / UL Listed. WsicNnunc Sno 0. �L POWER CORD: 6 foot(1.8 meter) / CSA Certified. �� .r�s4zas ��STED FLOAT SWITCH CONNECTION TERMINAL: zssx / Three-year limited warranty. ° For float switch connection only. Do not �Hv-G�Y'Gl1�ClZG apply power. (Voltage across terminals is 12 VAC. Maximum line impedance for � � � initiating device: 5 ohms). When ordered with the alarm, this system is available with: FLOAT SWITCH: SJE SignalMaster�'control switch with mounting clamp / alternate float switch models for high or low level warning. Cable: 15 feet(4.57 meters), flexible 18 gauge, 2 conductor(UL) SJOW, water- / 120 VAC primary voltage or 230 VAC primary voltage (230 VAC resistant(CPE) model is not Ul_Listed or CSA Certified). Float: 2.74 inch diameter x 4.83 inch long (7 cm x 12.3 cm), high impact, corrosion resistant polypropylene housing for use in sewage and non-potable water up to 140°F (60°C) S E �� Rh busk PO Box 1708, Detroit Lakes, MN 56502 1-888-DIAL-SJE • 1-218-847-1317 1-218-847-4617 Fax SEE BACKSIDE FOR ORDERING INFORMATION. email: sje@sjerhombus.com www.sjerhombus.com �� ADDITIONAL SITE INFORMATION AND SYSTEM SPECIFICATIONS FOLLOW FOR: Brian H. Krista Replacement POWTS Holding Tank System Y l n ... m': . r .. .. .. . . . . .. . . . . `fi A "w w + O � ' � ,k E `\ Sii'- o \ MSq�. . . � � � . 1�. , o N j o 1'> O d N °� o � A " 7 0 � � M � 4a x�� . I o � `O �r .:' . I u'� �G+ �6 4 �I � f'. r. � �� . . . . .. . . . . `� O � J t YI ...! � � (� �n � , �'� �^ :; x � h � . �� Q � H � .1 r� f.l 00 N- � " a Q) � �Q P`, vl �[ M1l Cl. r�'i � N � ffl `.��+ � ~ r . � � � W . 4 �O � M `�+�� ii a � ., . y� w�r� . . U -� V , "" � fV t: � �1 � U � j,`. IO (a � M h �i" � r � d iJ ✓i �� C j ' � C ' oi o�i o�. . I�fi ? G� � d � y � � � � � � a "� a iL o O � o ! �'�' O c .yY--' 8 G�.� ir e-� � � -�, _ r- h '-s �� 'a �i�; G 1 � ��' ��` �:� � c y,f •� _ � � h n � -- � a A�' `� r y s �P�$ � nt � c. -----.._ ._.__. . _.._. .. ._. `' a. �'`�.�.� t c '",-.��.�..... ..- V . �t 3p8 '� �$0�=' 4 '�- 6R� � � � �, ,� � � � „ � := # � �' � �: � � ,T � � � a o M r n n ;� 4 O 1 Q � � o u 0 ri ! 'J�; - a; i: � �-c; �; „-, tacs�oeeso� 1 F: � t� ,. f�'r/OaegQl.O �y 0 N � � W3000—M R TANK SPECIFICATIONS � o ,.s-s�� ' DIMENSIONS: o , WALL• 2 1/2" - - : BOTTOM: 4" 1 _-------------------- ' COVER: 6" _'� � MANHOLE: 24" I.D. PRECAST CONCRETE R1SER �', ,�%' \\ ' I ��,' �� HEIGHT: 71.. �' ' ��i� 4" CAST-A-S�A� �„ CAST-A-S�AL ��` ' LENGTH: 15'-S" � ' i� �� WIDTH: 7'-9° ' i i� _ -, �� '� � �' �� ,' � � , BELOW INLET: 57" o� `� � � LIQUID LEVEL: 50" �I I j ' � � '� � WEIGHT: BOTTOM 12,260 LBS. ��, '� o, ` � �``,__� T 2 ` __�'�i COVER 8.350 LBS. � I � ^, E Q•. � �� _ 1� �I �� o i o �` �� -_ � i � m � o �� _ "R OR BA�r L� � INLET AND OUTLET: „_ � o `�� 4" CAST-A-SEAL BOOT OR EQUAL GASKET z �', a �� i w, �, ,:;'I \`� ' ' INLET AND OUTLET BAFFLE AND FILTER: ��, �, a''i J `�---------------------� WISCONSIN, SEE DETAIL #10 � � (OTHER STATES SEE CHART) W '�' � '� LIQUID CAPACITY: 58.94 GAL/IN � 3 TOP VIEW C.� Y � HOLDING TANK: C � � OUTLET HOLE PLUGGED 0 Z � u, ACTUAL CAPACITY: 3,183 GALLONS � w ; � � � Q Q� LOADING DESIGN: 8'-0" UNSATURATED SOIL � � � � � � TANK CAN BE USED AS: W } o � C° SEP11C / HOLDING / PUMP OR SIPHON � 3 � � ____ � ____ � COVER: MIX DESIGN #8 (NO FIBER) � � i Ih�L=T -� _ _ _ , �J- _- TANK: MIX DESIGN #9 (SMALL F1BER) � � -i—� - �- - - - r— - - �—_� � � CUSTOMIZED TANKS: `D � i I �F �o�� , FOR CUSTOM TANKS CONTACT ` �: i ` � � I WIESER CONCRETE ;� -' � � � ;D - ; 2_ � o �� - i � I � � � J i I �i � � , Q � 2�" I~-----------1------------�-- --JJ ' � Z i I i a � o � 0 REVIEWED BY o v M F.. � REVIEW DATE � d w SIDE VIEW DRAWINGS SUBMITTED � FOR APPROVAL APPROVED BY: �NEET �0. APPROVAL DATE: / , �` PRODUCTS tiEEDED BY: / TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS - USE BLACK INK ONLY - i i i iiii iii iii i i iii i i 8u60324 POWTS MAINTENANCE AGREEMENT Tx:4038864 For Holding Tanks 439818 PAULA CHISSER Owner's Name(s)as shown on deed: REGISTER OF DEEDS SAWYER COUNTY, WI p '� � � ` O6/22/2022 10:20 AM L� RECORDING FEE 3Q.00 Parcel Identifcation Number: � ��2��9�c�e9a�y io� _ -� �- ' — — PAGES: 2 o � o - 6 � o -- 3 0 Legal Description of Property: - SEE ATTACHED SHEET - We acknowledge that application is being made for the installation of a holding tank(s)on the property described on the attached sheet. Return To:Sawyer County Zoning and Conservation Administration 10610 Main St.Suite 49, Hayward,WI 54843 As an inducement to the County of Sawyer to issue a sanitary permit for a holding tank on the above-described property, the owner is responsible for the operation and maintenance of the holding tank, locking device, alarm and access, and agrees to conform to ali applicable requirements of SPS 383,Wis. Adm. Code relating to holding tank management, including the following: 1. The owner agrees to contract with a person who is licensed under Ch. NR 113,Wis. Adm. Code, except as provided by Section 281.48 (3)(d), Stats.,to have the holding tank properly serviced and to file a copy of the service contract with the governmental unit. The owner further agrees to file a copy of any changes to the service contract,or a copy of a new service contract,with the governmental unit within ten (10) business days from the date of change to the service contract. 2. The owner agrees to contract with a person licensed under Ch. NR 113,Wis.Adm. Code, who shall submit pumping reports to the governmental unit in accordance with SPS 383.55,Wis.Adm. Code, for the servicing of the holding tank. In the case of exemption under Section 281.48 (3) (d), Stats., the owner shall submit the report to the governmental unit. The governmental unit may enter upon the property to investigate the condition of the holding tank when pumping reports may indicate the holding tank is not being properly maintained. 3. If the owner fails to have the holding tank properly serviced in response to orders issued by the governmental unit to prevent or abate a human health hazard as described in Section.254.59, Stats.,the governmental unit may enter upon the property and service, or cause the tank to be serviced. Pursuant to Section 145.20(4)Wis. Stats., a governmental unit may assess the owner of a private sewage system for costs related to the pumping of a septic or holding tank. The charges will be assessed as prescribed by Section 66.0703, stats. The owner agrees to pay all charges and cost incurred by the governmental unit for inspection, pumping, hauling,or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. 4. This agreement will remain in effect only until the governmental unit responsible for the regulation of private sewage systems certifies that either a soil absorption system that complies with SPS 383,Wis.Adm. Code, or a municipal sewer serves the property. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 5. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner.The owner shall submit the agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank i�i�t�fl�d!p.,,, +� �A LYe��y,� ,,�,��N,...... ., qp.s -Only one owner signature required- `,, / ACKNOWLEDGM€�'4�� _� Owner's Signature: � State of: VV �S �1(1 ' '; :� .��ARY e : � County of: ! e � •'2 -'�` Owner's Name (Print): �, Subscribed and wos r to before me��n� ts UB � .��.y�'� ��" Gy1 �� `/�"'� �'b, 15-t�, day of � ••`�'' ••,.20•�' ��• I Date: By(Owner's Name): i �• • `'a 6 � s- a� Notary Public Signature: Drafted by: �Q p Public Notary Name (Print): l'i S VC'i.. 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ESN : 442 Gl� 2 , 020 36,300 61 ,600 RESIDENTIAL Tax Districts Updated : 2/6/2007 2-Year 1 State of Wisconsin . 2021 2022 Change 57 Sawyer County Comparison 020 Town of Ojibwa Land : 36, 300 36,300 0. 0% 576615 Winter School District �mproved : 61 , 600 61, 600 Q.0°/a 001700 Technical College Total : 97 , 900 97 ,900 0.0% Recorded Documents Updated : 4/12/2012 Property History PERSONAL REPRESENTATIVES DEED N/A Date 420825 Recorded : 10/30/2019 WARRANTY DEED Date 42Q824 Recorded : 10/30/2019 SPECIAL WARRANTY DEED Date 377855 Recorded : 3/27/2012 i,,��o�- `` .. PRIVATE ONSITE WASTE TREATMENT �ounty �s�;`;`�� SYSTEMS �'�� Ps )��1 ( POWTS) Sawyer \%FUf`�V=/ �r"'��='' INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �� '2� Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(I)(m)J Permit Holder's Name: ❑City ❑ Village C�Town of: State Plan Transaction ID#: ��a� I�;S�-a o-�.,.rq Insp BM Elev: BM Description: Parcei Tax No: 1 �oa�o �� NT c�� :d d�v-63g-b�-S3o Y TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELE'✓ Septic Benchmark (Oo.o� Dosing Aeration Bldg. Sewer qb`1S� Holding 5k 3 Oa� St I Ht Inlet gs;(�' TANK SETBACK INFORMATION St/Ht outlet TANK TO P/L WELL BLDG VENT TO ROAD Dt Inlet AIR INTAKE Septic NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. Holding �Sp� 36 � h�(o� �}-(p� '�2.�' Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative Surface Manufacturer Demand Final Grade Model Number GPM TDH Lift Friction Loss Sys Head TDH Ft Forcemain L Dia Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS W � #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav ° Conv ❑ Aggregate INFORMATION P I L Bldg Well Waters o GP ❑ Chamber Model Number' ❑ EZFIow CELL TO ❑ Mound � Other - —_—._ —_ ---- DISTRIBUTION SYSTEM X Pressure Systems Only Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes� Length Dia Length Dia Spac Spacing ❑Yes ❑ No SOIL COVER ---- -- -- ---- --- Depth Over Depth Over � Depth of Seeded/Sodded Mulched Cell Center Ceil Edges Topsoil _� �Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) ��il� ��2��-.� � �t.� Plan revision required?❑Yes❑ No p� �.$ �..3 �---��_.—_ � G�j'� �� L � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3I01) A��ITI�NAL COMMENTS AN� SKETCH SANITAAY PEAMIT NIJMBEA: �� —I �3 � C_t,,;r�,.,,,q rQ;�.,� �-- w� �{w►h d-c�ra�t � �'1�'. 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