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Home My WebLink About026-176-00-0300-SAN-2022-142 ;�" "' Industry Services Division County �J� - 4822 Madison Yards Way ��W� �✓ � � :_�= Madison,WI 53705 Sanitary Permit Num er(to be filled in by Cc � P= P.O.Box 7302 � Madison,WI 53707 ��j``� � 3� � Sanitary Permit Application state Transaction tvumber � ln accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate govemmental unit � is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than meiling adt the Department of Safety and Professional Services.Personai information you provide may be used for secondary � � purposes in accordance with the Privacy Law,s. 15.04(I)(m),Stats. �gC.�� !�Z�� (� I.Application Information—Please Print All Information PropeRy Owners Name -�-{ � � Parcel# lD�6N►�.S � �:2��-F Sc � p � oZ6•I��G•�as�oo Property Owner's Mailing Address Property Location I qr( sel6 Av� �— City,State Zip Code Phone Number � �:n�1' �'"'� � �J V �S�V y �� Section � II.T pe of Building(check all that apply) � Lot# T 3 q N R b 9 E or or 2 Family Dwelling—Number ofBedrooms � Subdivision Name Block# si,.�v�,S.Q,� �011^� �ublic/Commercial—Describe Use ^ ❑City of ❑State Owned—Describe Use CSM Number illage of � own of )01^C �ti�iC C.' II1.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if a lic bl A ew System eplacement System �ther Modification to Existing System(explain) �Additional Pretreatment Uni[(explain) B' olding Tank �In-Ground �4t-Grade �Mound Individual Site Design Other Type(explain) (comentional) C. �Renewal Before �Revision hange of Plumber �I'ransfer to New Owner �st Previous Permit Number and Date Issued Expiration `�-D33 � yl�.3 � IV.Dis ersaUTreatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation 3o v �' -- — -- Capacity in Total #of Manufacturer « Tank Information Gallons Gallons Units A 4 0 �„ v New Tanks Existing Tanks � o � � � � � c� a. U v� � cn i�. C7 G. Septic or Holding Tank "�pOv 3 O� ' �,�J I�f'Q r � � Dosing Chamber � � V.Responsibility Statement- 1,the undersigned,assume responsibility for installa' n ot the POW1'S shown on the attached plans. �� Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone Number Lo- Dylan Schultz 1516129 715-558-5904 Plumber's Address(Street,City,State,Zip Code) 7076N Stone Lake RD, Stone La , , 54876 VI.C u /Department Use Only ,�A ro ed ❑Disapproved Permit Fee Date Issued Issuing Agent Signature � ❑Owner Given Reason for Denial $ 1.�v� ��`' �`}`r '�`�'^��''��1��v��✓'" Conditions of ApprovaUReasons for Disapproval �, '��'�`�'f�"�';�',' � �''•,�:`` `'�� : ' '. .4. _� . • �� Ji'�\i'J ,� ' , � �, ; V=J\. �._`:;t �.___' �� i � ;� C 5-�-- N o-�-- '��• � JUt 0 5 2�22 � � �� IN� , SP►VtlYER COUNT`t g()NM�lt3 ADMINISTRATIUh+ Attach to complete plsns for ffie system and submit to the Counry only oo paper not less t6ao 8 tn x 11 inches in size NO REFLINDS AFTER SBD-6398(R.02/22) �gSUE OF PERMIT Sawyer County Zoning & Conservation Administration �� 10610 Main Street, Suite 49 � „ � �� Hayward, Wisconsin 54843 � � � �� (715)634 8�88 � FAX (715)638 3277 i . �� ' j / ,1li�;n �.c; o�.� i j � ' � i E-mul �on _ ct�rsil .c�� ,� ��r� � ` � Toll Free Courthouse/General Informahon 1 877-699-4110 /, `� � � �� (� �\�� Holding Tank Approval Checklist os' I. Sanitary Cover Sheet Date Stamp b7 /� v�a ParcelID# D �. � - ( -7 lo - b0 - 03 �O IL Plot Plan l Property Lines X Benchmark BM ♦ � Site Address � North Arrow x Structure �Scale N �Well �C < 25' to Service Road Legal Description —��Nearest Road Intersection � Setbacks to: Property Line, Well, Structure, Water bodies, Roads IIL Required Plans � Index Page with Original Signature �Manage�nent Plan/Contingency Plan Servicing Contract �( Holding Tank Agreeinent fonn IV. Holding Tank Specifications Cross-section �- Manufacture, Gallons: �''' �e� 3'� � 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 Materia] < 1/2 " V. Holding Tank Plans per Component POWTS Manual � Version� SBD-10855-P (R.3/07) , , , �•� Owner: �C�r1 w¢i � Plulnber: 5�`�1�1 I�I '� Application Review Date: O� �� --� , POWTS Reviewer: ��,; � � Namc 6q S7 I(� �;��n,�a Revised 4/11/2013 PAGE 1 OF 4 Holding Tank Plan Index & Cover Sheet Component Manual Design References: Holding Tank Version 2.1 (May 2022-2027) Pg 1 of 4 Index&Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Holding Tank Specifications Pg 4 of 4 Management Plan Attachments: Enclosures: POWTS Application for Review Soil 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): T�or�u•S � ��:z��,A}� S�l,ne��h✓ phone: - - Owner Address: �� e��y �F�t S� �'a�� i'`�n Zip: �.Sl��/ Project Address: S�y S N bZ��-c�� r�' Govt.Lot: 1/4 of 1/4, Section 2� ,T 3 y N-R�_E❑or W� Township: SF, � ��t County: ��.�-�� Project Parcei ID#: 1�Y`S Designer Information Designer Name: �vlan schunz Phone: - - 7076N Stone Lake Rd Designer Address: �, � �e,W! 5��76 Z�p' E-mal�: MPRS 1516129 ['his'sE7ace Teserve�;tcar api�rova�sn;.:�j=. License Number: Remarks: Signature: Date: �- �" Z Z Origin �gnature r n each submitted copy. �Reset Page CHECK BOX AS APPLICABI E. CHECK 60X AS APPLICA9LE. � SOIL EVALUATION s�ie: �"=ao� �$YSTEM PAGE 2 OF SITE MAP � 40 60 � 7�LOT PLAN PROJECT NAME io, oesicN F�ow�. 3�� GPD Attach design flow calculations for commercial plans. Pao�EcinDORESS: 7 D y� � 0."^''°� R? Pipe Material 1 ASTM Standard(Tables 384.30�$384.30-5) Sanilery5ewer / 9MSyrtiba". � BMElevation: �0�•� FT PorceMain' / eu oescnpt:nn�. �D a� �,JC(! 51 Gratlierit % mdiwtenortnby IMPORTANT: � ( 1 well SymEd(if applicable): p arawinq an arrox Show ground elevation contours at suihable intervals. O(TeS�etl N�'. on lhe appmprrfe line. 54�� r� c�� y�.SQ-� �e��-•� (,0'��3 pylan Schut�Rd �'}:° 7076N Stone I-a Sto�e Lake,W� `.�4676 � MPRS 1516129 �-�p�S C ' t 7r�1eSe� f �We.1( � on � � f�'� _'� L — s� ya / O �� 3n � � / �IV��'`�Q... ✓ , ��`��'`� � � � � u�� n Z� ( f � Reset Page PAGE30F4 HOLDING TANK SPECIFICATIONS (No Scale) yyeythe�Proof 12"Min.or 2.0 ft above Junction and qPP��yd Established Flood Elevation Alartn Box Vent Cap (�YPiral) Eledriral must comply with 1 Approved Locking Manhole SPS 316 and NEC 300 4"0 Vent Pipe � with Waming Label Attached Conduit >70 R tmm (typical) 4"Min.or 2A ft above Building Established Flood Elevation (typiral) Airtighl Seal . Finished Grade 18"Min. (�Yw�q . � � . ' . . ' y . . . � '- e. � . . Inlet Inletlnvert Watertight Approved Joinfs wi�h Plug Approved Pipe 3 ft onW � Man. 12'or 90%ot total volume Solid Gmund ' if rtare than one tank a • Aiartn-0n i < HOLDING TANK � VOLUME = �� gal �, � , a . . �� . � . . . . 3"Approved Bedding Material Beneath Tank TANK MANUFACTURER: �Q{ S e� Anchor tank as necessary pursuant to SPS 383.43(8)(g) Ballast Weight= [(cu.ft.tank.vol x 62.4 Ibs/cu.ft) - Ibs.tank.wt]x 1.5 Ballast Weight= [( cu.ft. x 62.4 Ibs/cu.ft) - Ibs]x 1.5 = Ibs Reset Page WLP3000 ,aa• TANK SPECIFICATIONS � � � a DIMENSIONS: w N WALL: 3' � a . ,, . . .. . . ,. BOTTOM: 5' - - - - - - - - - - - - - - - - - COVER: 8' o HEIGHT 82�3/4p�ODECAST CONCREiE RI�R �� .� � 4" CAST-A-SEAL 4` CAST-A-SEAL � � LENCTH: 184' O.D. � WIDTH: 102' O.D. �4 � � BELOW INLET: 50" O.D. Q � '�'� 02 � / LIQUID LEVEL 43' c� � o o l WEIGHT: TANK - BOTfOM 15,980 LBS. ' �� COVER 9,300 LBS. FILTER OR � S � � BAFFLE I ! INLET AND OUTLET: ' � � �� 4' CAST-A-SEAL B00T OR E�UAL m $ � 8 � � — — — — — — — — — — — — — — — — — . �C . .:. -' INLET AND OUTLET BAFFLE AND FlLTER: � Q '� . .. .. .... . . .. �. . .. , .. . .. .. . . . . NASCONSIN, SEE DETAIL #10 � � (OTHER STATES SEE CHART) W $ LJ�UID CAPACITY: 89.77 GAL/IN f" � TOP VIEW HOLDING TANK: W g � OUTLET HOLE PWGGED ACTUAL CAPAqTY: 3,140 GALLONS � � � LOADING DESIGN: 8' 0' UNSATURAlED SOIL � z o0 �� o I TANK CAN BE USED AS: �s N SEPiIC/ HOLDING/ PUMP OR SIPHON M W � � COVER: MIX DESiGN /8 (NO FlBER) � � O � TANK: MIX DESIGN ,�9 (SMALL FlBER) `Y y � < ' �' WSTOMIZED TANKS: � — ,. . , . — FOR CUSTOM TANKS CONTACT NAESER CONCRETE � ,`n� 3 INLET OUTLET J N 3" '�. :„' :�» r < � � � � < < • o Z I F: � o a L - - - T ; .- , J` �g � 3 F a DRAWINGS SUBMITTED c'''i, � FOR APPROVAL SIDE VIEW APPROVED BV: SHEET N0. APPROVAL DATE: TANKS ARE MANUFACNRW TO MEET OR EXCEED ASTM C-1227 REpUIREMENTS PRODURS NEEDED BY: � 1 PAGE40F4 Holding Tank Management Plan IMPORTANT: The owner of this holding tank(s) shall be responsible for its perpetual operation and mairrtenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this holding tank(s) shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Estimated Daily Wastewater Flow = 3�'v gpd Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical maitunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o surface discharge of effluent or sewage back-up into structure served SERVICING FREQUENCY o The tank(s)shall be pumped by a cert'rfied septage servicing operator licensed under s. 281.48 Wisc. Stats. when the wasteWater in the tank(s) reaches a level of one foot below the inlet invert of the tank(s). Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. Tank pumping reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wis. Admin. Code. Report any component failure or malfunction to: Name of individual or company: D��`"� S`�� Phone: ��r"�Sf' -f%r� � �7 Local government unit: �"y<_��^^�`i z�^J Phone: � ��- G3 Y"t�� 6 Local government unit address: �� ^C �✓� ZIP: �y�5'3 Any detective part of this system shail be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement oi failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Continqencv Plan In the event that any faiied component of this holding tank(s) cannot be repaired, it shail be replaced pursuant to a plan submitted to the appropriate agecy tor review and approvai. Svstem Abandonment , If use of this tank(s) is discontinued, it shali be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. . Reset Page HOLDING TANK SERVICING CONTRACT Contract Date: / / 2o L This contract is made behveen the Holding Tank Owner and the Pumper. Holding Tank Owner's Name: Pumper's Name: . � �d��S � F�:zt6e�4. C��n��nei �G6 �ap Parcel Identification Number: (12 Digit Legacy ID) 0 1 �' _ I � �p _ D (�j _ � 3 0� a I. The owner agrees to file a copy of this contract with the governmental imit, Sawyer Cou�ty, which has accepted and recorded with the Office of the Register of Deeds,the Maintenance Agreement for a Holding Tank required under die Sawyer CoLmty Private Sewage System Ordinance for tlte issuaoce of a Sanitary Permit for the installation of a holding ta�k(s). 2_ The owner agees to have tl�e holding tank(s) serviced by tl�e pumper and guarantees to pennit tl�e pumper to have access and to enter upon the property for tl�e purpose of servicing tlie holding tank(s). The owner agrees to maintain the all-weatlier access road or drive so that the pumper can service the holding tank(s) with Cl�e pumpiog equipment. The owner furtl�er agrees to pay the pumper for cliarges incuned in servicing tl�e holding tank(s)as nuitttally agreed upon by the owner and pumper. 3. The pumper agrees to submit to the Governmental Unit, Sawyer County, a report for the servicing of the holding ta�ilc(s) as required under SPS 383.�5,Wisconsin Administrative Code and the Sawyer County Private Sewage System Ordinance. The pumper furNier a�rees to include the follo�ving in the report: a. The i�ame and address of the person respo�sible for servicing the holding taiilc; b. Tlie name of the owner of the holding tank; c. The site address of tl�e holding tank; d. The date the holding tar�k was serviced; e. The volwnes in gallons of the conteuts pumped from Hie holdi�g tank for each servicing; f. Tl�e disposal sites to which the coutents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper tenninates this contract In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract wid� Sawyer Counry within ten (]0) business days from the date of change to this service contract. �WI10T'S NHI]]B: �PCIDt� �WI70f'S 5'lg CB: (Oniponcowqersignaturcrequired) 7.� � �� lGrGrn� s �� P,� �, � -�-.�-.�-�-- Ptunper's Name: (Print) Pumper's Sig re: � �°�� S Piunper's Registration Number: 61 g � '� Rev.03/26�13 i i i ii�i i � ii iii ii iiii 8 �' � (1 � b0 - USE BLACK INK ONLY - TX :4039?97 POWTS MAINTENANCE AGREEMENT aa�� 1 For Holding Tanks REGISTER OF D EDS SAWYER CUUNTY, WI Owner'sName(s) asshownondeed: Q7�0$J2Q22 Q1:51 PM �/`d��nS� � � �r Zc.�ic��5 SGhl1 F�P, ll RELORDII�iG FEE 3�.00 Parcel Identification Number QA��, � (12 Digit Legacy ID) � � � - � � � - b d - � 3 � b 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 all 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 1 13, 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 comp�ies 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 is installed. - Only o e o r ignature required - ACKNOWLEDGMENT � Owner' nat . �/��I� State of: �) iSC l�snJ� �� County of: W ner's N me (Print): ^n Subscribed and swor to before me on this G�yrt � � G�-'�-� a ^ �`. day of ��Ln.v�P , 20 a� Date: � Z �, Z C� Z Z By (Owner's Name): � l rnp�r•cx ti C_1n�c�e='. � ��nei�� Notary Public Signature: V'�/ Drafted by: ' �� 1� ��•�`P�p,S�A G(5��. �� Public Notary Name (Print): ��D.�G�`� �1 �v� pciv� �, � ,� � , • �L �, My commission expires on: �� ' a 1 � c��a� ; . s - * : _ * � • * c. 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Lottery Qaims: 0 5895N RUNZEL RD STONE LAKE 54876 First Dollar: Yes Waterbody: Sand Lake � property Assessment Updated: 7/26/2019 Zoning: (RRl) Residential/Recreational One 2022 Assessment Detail ESN: 423 Code Acres Land Imp. G1-RESIDENTIAL 0.977 148,900 136,800 �� 7ax Districts Updated: 2/6/2007 1 S[ate of Wisconsin 2-Year Comparison 2021 2022 Change 57 Sawyer County Land: 148,900 146,900 0.0% 026 Town of Sand Lake Improved: 136,800 136,800 0.0% 572476 Hayward Community School District Totai: 285,700 285,700 0.0% 001700 Technical College + Recorded Documents Updated: 2/21/2012 M�P�operty History .. ..... . . ..._ —___ __.._ ._._. WARRANTY DEED . . .. .. .- . . . .. N/A Date Recorded: 1/6/2012 376483 https://tas.sawyercountygov.orglsystem/frames.asp?uname=Eric+�n/ellauer 1/1 '��`"'`"��,� PRIVATE ONSITE WAST'E TREATMENT �ounty ;:r, >. ,, � ��'� o$ �� ; 'y SYSTEMS SaWyer PS ( POWTS) �;�� \-� INSPECTION REPORT �'ss"—>"=`y 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(1)(m)] Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#: �or��s I��i�� C.hn2;d�( �� KL � Insp BM Elev: BM Description: Parcel Tax No: 1��' a"t �, r 1� �� — �7�0—�Q-0�00 TANK INFOR ATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Benchmark �p,p � Dosing � t'7,67 ' Aeration Bltlg. Sewer � R7$2' Hoiding t�.ie5,�- 3,cTe� St I Ht Inlet q�7,p' TANK SETBACK INFORMATION St/Ht Outlet q'�,,g' TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIR INTAKE Septic NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. Holding k�.p` � '.2� +�1�� 2�' Dist. Pipe PUMP I 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 o Mound o Other DISTRIBUTION SYSTEM X Pressure Systems Only Heatler/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/Sodtled Mulched � Cell Center Cell Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Inciude code discrepancies, persons present, etc.) � �s�l I� �--�� :�, Plan revision required?❑Yes� No �3 a 1 �3 � L�- � G9��b Use other side for additionai information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AO�ITIONAL COMMENTS ANO SKETCH SANITAAY PEAMIT NIJMBER: ��_ �---_ S�h� C� . -�- a��' a 6� . : ._ _ � � _ .__ , . � .: :. .i.__.__. . .�...._ _;. � ' � . . � I . , i . . � �r fi � � I � �`� I w a�` �i a�.' n i _ � �/ , , � — s� ��' �� ►(�`�-"' �;w�' 3,�'° .�I�.-- �.�D, ,�N�- � � O+T �, �r �� °\ 3 �� —P�_ 1 � _ 10��