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HomeMy WebLinkAbout008-937-08-5316-SAN-2022-145 . C/�1 � - Department of Safety �O1"ry sWa er � - Y _ � � - & Professional Services, � = Sanitary Permit Number(to be tilled in by Co.) � � `. �_ . Industry Services Division � % � ���;� (� z�l I y , Sanitary Permit Application StateTransactionNumber L [n acwrdance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit (� is required pnor to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if differen[than mailing addres� the Department of Safen�and Professional Services.Personal information you provide may be used for secondary purposes in accordance with the Yrivacy Law,s 15 04(1)(m),Stats. Counry Rd.F � i ts�;� a� I.Application Information—Please Print All Information Property Owner's Name Parcel# Lesli BarronL;v;�ty'j�,,,�5'fi 008937085316 � .J Property Owner Mailing Address Prope�Location 7 U Ferret Crossing � Govt.Lot 3 /'�) City,State Zip Code Phone Number `j Oswego II. 60543 .��� Section� II.Type of Building(check all that apply) �ot# T�� N R ` E o �l or2FamilyDwelling—NumberofBedrooms 3 2 SubdivisionName Block# � ❑PublidCommercial—DescribeUse ❑Ciry of ❑State Owned—Describe Use CSM Number ❑Village of 25/120#6709 �1 Town of Edgewater III.Type of POWTS Permir(Check either"New"or"Replacement"and other applicable on line A. Check one box oo line B.Complete line C if a lica le. A New S stem y ❑ Replacement System ❑ Other Modification to Existing System(explain) ❑ Additio�al Pretreatmen[iJnit(explain) B' Holding Tank ❑ In-Ground ❑At-Grade ❑ Mound ❑ Individual Site Design ❑ Other Type(explain) (conventional) L• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner �st Previous Permit Number and Date issued Expiration r-- IV.Dispersal/Treatment Area and Tank Information: Design Flow(gpd) Uesign Soil Application Rate(gpcUs� Dispersal Area Required(s� Dispersal Area Proposed(s� System Eleva[ion �op �— � — — Capacity in Total #of Manufacturer Tank Inf'ormation Gallons Gallons Units � � �o '� o New Tanks Exis[ing Tanks � c c� � � D R � 0 a`. U �n � v� u. C7 Ci. Septic or Holding Tank z000 4000 2 Wieser X Dosing Chamber V.Responsibility Statement- I,the undersigned,assume respansibility for instxllation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Signa re MP/MPRS Number Business Phone Number Rick Brown 231251 419-0739 Plumber's Address(SVeet,City,State,Z.ip Code) PO Box 637 Spooner WI�4801 Vl.County/Department Use Only � A��� �7c ❑Disapproved Permit Fee Date Issued Issuing Agent Signature c,a � $ ' ❑O�mer Given Reason for Denial �' 7 � `�i �`t ���1��ti`- ��`� Conditions of ApprovalQ2easons for Disapprov 1 � ���`�1��.�;>t� r�1 1.��-�;� ,J r�� � �, �� G� �l"��`� � � .lUL 1 1 2022 ' �� �IGI N� � ��r�,;:�r.�_----------- ?��#��:ii i��Ui:�i;�i�i i-i:-�t i�JfJ Attach to complete plans for the system and submit to the County anly on paper not less than 8 I/2 x I1 inches in size sBD-639a�u.o3i2z> NO REFJNDS AFTER ISSUE OF PEAMIT Sawyer County Zoning & Conservation Administration ```�`,�`' 10610 Main Street,Suite 49 � < � � .� i� Hayward,Wisconsin 54843 � ���� (71>)634 8288 � " �� . FAX(715)6"i8 �277 / ,�� ����� � .'� t,,4-,1 , 1 c:c'cr t a --ut��:r�� j � - i E-nnil �;l.;: �.��.s,t ti i .<,,_�n , �i:r �� � ���-i� '� Toll Free Courthousc/General Informat�on 1 877-699-4ll0 '� ,I1��\�����` Holding Tank Approval Checklist I. Sanitary Cover Sheet Date Stamp �7 / �� /_�� Parcel ID# D v �-`� � 7-O �_ S.3 1 (o II. Plot Plan �Property Lines ( Benchmark BM ♦ �Site Address �North Arrow Structure �Scale �Well �<25' to Service Road �Legal Description �Nearest Road lntersection Setbacks to: Properly Line, Well, Structure, Water bodies, Roads III. Required Plans Index Page with Original Signature Manageinent Plan/Contingency Plan Servicing Contract � Holding Tank Agreement form N. Holding Tank Specifications �Cross-section—Manufacture, Gallons: 2�w��� ��°� �i Tank Anchor Calculations [SPS 383.43 8) g)] �Locking device, chains/locks �y 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 (R.3/07) �, � , . , Owner: � �v��n.s�., Plumber: �:�V� �"'h Application Review Date: °�� l l � �� POWTS Reviewer: 5��„�, �ju��j�-� Namc / ���b Liccnsc# Revised 4/11/2013 CONCRETE HOLDING TANK DESIGN Two Concrete Tank Option INDEX AND TITLE SHEET Project Barron Owner Lesli Barron Address 717 Gerret Crossing OswegolL60543 Legal Description Gov lot 3 Sec 8 Range 37N Town 9W Township Edgewater County Sawyer Subdivision Name Lot No. 2 Parcel ID Number 8937085316 Plan Transaction Number Index and title sheet Page 1 Holding tank specifications Page 2 Site plan Page 3 Management&Continency Plan Page 4 Designer Rick Brown Signature � /��—�- Phone No. 419-0739 License Number 231251 Date 06/26/22 Designed pursuant to�. Holding Tank Component Manual For POWTS(Version ) �� SBD-10855-P(N.03/07,R.Ot/12)_., Version 7.0(11/12) Page 1 of 4 HOLDING TANK SPECIFICATIONS Two Concrefe Tanks In Series 3 If one-or two-family, number of bedrooms And/Or....Non-residential estimated flow per day 2000.0 Minimum holding tank volume required 4000.0 Total holding tank capacity proposed (gal) 2000.0 Tank 1 capacity (gal) �X for round tanks 2000.0 Tank 2 capacity(gal) Wieser Tank manufacturer SJE Alarm manufacturer SJE1031021 Alarm model number 1.1 Anchor weight safety factor Tank in Exterior Dimensions (in) Ibs Ibs in ft Information Liq Level Length Width Height Tank Wt Anchor Wt Soil Cover Max Bury Tank1 46 151 86 66 15370 18675 24.8 8 Tank 2 46 151 86 �_66Y 15370 18675 24.8 8 � HOLDING TANK CROSS SECTION Vent Manhole cover with locking 112"min. �P � q��min. device and warning label Finished grade \ y �y unction box � \ --�'`� � Vent pipe�- 18��mi� Blind plug to seal `' outietopen�r,y ___ Note: Manhole �/ " and vent locations iniet i2.o �n retner may be reversed. servlce a�arm on weignt Manhole diameter is 23" min. 34.0 i 2000.0 gal 2000.0 gal Tank 2 Tank 1 3 in. min. bedding under tanks. Anchor tanks as necessary to negate buoyant forces. Electrical as per NEC 300 and SPS 316. Note: All tank joints, and joints between tank openings and piping are sealed watertight. Project: Barron Transaction Number: Page 2 of 4 HOLDING TANK SITE PLAN Project: Barron N Legal Description: Q�•Gov lot 3 Sec 8 Range 37N Town 9W Subdivision Name: -- — Scale: 1" =Q ft � Transaction Number. Lot No.: 2 , � � ja i i , W'` � ti �'� � � '` �.�' o w�a„� � ,1 � �� � ;�f- � �'� �'^�af-- S. C�-O--_ �"'1�' /1 w. I ��N J✓�^[l� /.�..- 1�-t� � �(�,� � � � L �- � �7T�D �- w� �r—r � o„ ti,� Page 3 of 4 1�/,�� �-��S ��sv� (v�i �2S� ' � , e 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 03/07, R.11/12), and the Sawyer County Sanitary Ordinance. 1. This POWTS is designed to accommodate a wastewater flow of 60.0 to 800.0 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 second tank reaches a level of 12" below the inlet invert (at which time the alarm will activate), the pumper listed in the current Servicing 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. All 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. 281, Wis. Statutes. The discharge of wastes from this holding 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). Connection 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 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer........................... Rick Brown Phone: 419-0739 _ __ _ — b. Service Provider................ Ken Way Phone: 234-7677 -- -- _ . a County Zoning or Health Dept. Sawyer County Phone: 634-8288 11. Project: Transaction Number: Page 4 of 4 l HOLDING TANK SERVICING CONTRACT Contract Date: ,'� / _ / � This contract is made between the Holding Tank Owner and the Pumper. Holding Tank Owner's Name: Pumper's Name: � �Q ��,/.,�� �,�,� ,���5� � /f ��t.�.+d�,�ia,�sTi�s� O�/�i,i���,���',� � . /�B.S"� /f�L�/'/'� — T�s7�c� Parcel Identification Number: (12 Digit Legacy ID) � � � - �� � _ � � _ �� �� L The owner agrces to file a copy of this contract with the govcrnmental unit, Sawyer County, ��:�hich ha� accepted and rec�rded ;v;rh th� Office of the Reb�ster ef!�ceds, ±he n�!air.±cr.ance Agreement far a Holding Tank required Lmder the Sawyer County Private Sewage System Ordinance 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 to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for charges incurrcd in servicing the liolding tank(s) as muttially agreed upon by the owner and pumper. � 3. The pumper agrees to submit to the Governmental Unit, Sawyer Co�inty, a report for the servicing of the holding tank(s) as required under SPS 383.55, Wisconsin Administrative Code and tl�c Sawyer County Private Sewage Systcm Ordinance. Tl�c pumper further agrees 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 holdin� tank was serviced; e. The voluines in gallons of the contents pumped froin the holding tank for eacl� servicing; f. The disposal sites to which the contents from the holding tanlc wcre delivered. 4. This agreement will rernain in effect until the owner oi• pumper terminates 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 ncw scrvice contract with Sawyer County within tcn (10) business days fi-oiz: the date of change to this service contract. Owner's Name: (Print) Owner's Signature: (oniy one ow�e� s�g�a��re reyu�rea) �'.S� /� fJIC/'/'G�/7�1��'/ag,� � G��G�/Li; - -�L� ..� Pumper's Name: (Print) Pui er's gna � •e: Qt, ��i'J,c:.� ��i �'c� ,���`� `` �1�� h� � Pumper's Registration Number: ���� Rev. 03;26/13 . , � r ,�x . , ,� :rrk^ a ,,��. . � .� : - ��,� . . , i ,ti " ' u ,- , : . ,>r �' �. '.. ,.�''Y ��r` ��'�s� �. ;� . ' ,,��. � .� , ._�.�t .j}�" � � �� .L� � x �,: ,. _ j�.�' ' s�` �Ii�M��� .� r': :. . � �i .:��a* . k���� �. � n` it` „�'S�_ * � +;.P "�'�y� Yi-�RL* "�' � J :..� �� # �.+". � A '� ,�s ', x�,. r� A 6 i� N f��� ,� � ��p+ 'Mtl ..b�.. ., ' .d °i'4K���;?�p. 1 m 3 � �`� �r. ,, _ -' Q „ � � � n'�. 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'�� +��� �f� ��� - C � �, i i i iiii� iii�i��ii���iiiii 8 0 G �� 9 3 3 - USE BLACK INK ONLY - T>;4039243 POWTS MAINTENANCE AGREEMENT 440112 For Holdin Tanks PAULA CHISSER g REGISTER OF DEEDS �AWYER COUNTY, WI Owner's Name(s)as shown on deed: fl7/11/2Q22 02:24 PM ��S-� ��Q./%'D/7 �/�///�G TGL� RECORDING FEE 3Q.00 Parcel Identification Number: ( 9 9 Y ) ���'���-/��2'��L�' PAGES: 2 12 Di it Le ac ID 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 i I 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 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 wili 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 one owner signature required- ACKNOWLEDGMENT Owner's Signature: State of: � � �! I�i'(��i J County of: ,�.�.(�C.��:--�L.L Owner's Name (Print): Subscribed and sworn to before me on this i'a � � ��"�I'1 day of ,� ,(n � , 20 �,L Date: By(Owner's Name): ���L i f{ �QXrL(� � �S���� Notary Public Signature: Y Drafted by: Public Notary Name (Print): - '"f � ��cl� �o�+� My commission expires on: `� Z � OFFICIAL SEAL Personal information you provide may be used for secondary purposes[Privacy Law,§15.04(I)(m KELLY A PAYERev.03/26/ NOTARY f'UBLIC,STATE OF ILLINOIS My Commission Expires March 8,2025 Lot 2 of Certified Sur�•ey D'1ap No.6709,Volume 25,Page 120,as Document No.318348,being a part of Covernment Lot 3,Section 8,Tnwnship 37 IVorth,Range 9 West,(in the Town of Edgewafer), Sawyer County,Wisconsin. 7/11122,2:08 PM Real Property Listing Page R2dI EStdte Sawyer County Property Listing Property5tatus: Current 7oday's Date: 7/11/2022 Created On: 2/6/2007 7:55:15 AM �Description Updated: 7/19/2018 '� Ownership Updated: 9/21/2020 ... ... . . .. . . . . . .. .. . .. . __ . Tax ID: 8231 LESLI A BARRON LIVING TRUST � � OSWEGO IL PIN: 57-008-2-37-09-OB-5 OS-003-000160 Legacy PIN: 008937085316 Billing Address: Mailing Address: Ma ID: :3.16 LESLI A BARRON LIVING LESLI A BARRON LIVING Municipali[y: (008)TOWN OF EDGEWATER TRUST TRUST STR: 508 T37N R09W 717 FERRET CROSSING 717 FERRET CROSSING Description: PRT GOVT LOT 3 LOT 2 CSM 25/120 OSWEGO IL 60543 OSWEGO Il 60543 #6709 e� Recorded Acres: 0.600 r Site Address * indicates Private Road _. . ___.__ ___ . . . ... . .. ._. .. Calculated Acres: 0.620 N/A Lottery Claims: 0 First Dollar: No 0 Property/lssessment Updated: 6/28/2021 Waterbody: Chetac Lake 2022 Assessment Detail Zoning: (RRl) Residential/Recreational One �ode Acres Land Imp. ESN: 430 G1-RESIDENTIAL 0.600 136,500 0 -� Tax Districts Updated: 2/6/2007 2-Year Comparison 2021 2022 Change 1 State of Wisconsin Land: 136,500 136,500 0.0% 57 Sawyer Counry Improved: 0 0 0.0% 008 Town of Edgewater Total: 136,500 136,500 0.0% 650441 Birchwood School Distric[ 001700 Technical College �Property History a Recorded Documentr Updated: 5/18/2022 N/A WARRANTY DEED � Date Recorded: 9/2/2020 426173 ACCESS EASEMENT Date Recorded: 5/2/2022 438866 EASEMENT DEED Date Recorded: 9/2/2020 426172 WARRANTY DEED Date Recorded: 1/25/2005 319120 CERTIFIED SURVEY MAP Date Recorded: 12/30/2003 318348 https:Ntassawyercountygov.orglsystem/fremes.asp?uname=Eric+�nlellauer ��� '�`'`''�T"`��':�<F,_ PRIVATE ONSITE WASTE TREATMENT cou�ty �;= �'����b$ �,�'; SYSTEMS SaWyer ����� �s� �� ( POWTS) \��,-`—';�% INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �� _ ��� Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)] Permit Holder's Name: ❑City ❑ Village I�Town of: State Plan Transaction ID#: C�sl� � . 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Well Waters °� G ❑ Chamber Motlel Number: ❑ EZFIow CELL TO ❑ Mound o Other DISTRIBUTION SYSTEM X Pressure Systems Only Header I Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipe� Length Dia Length Dia Spac , Spacing ❑Yes ❑ No — --- —_ _— SOIL COVER — — -- — Depth Over � Depth Over � Depth of Seeded/Sodded Mulched � Cell Center Cell Edges I Topsoil __ ❑Yes 0 No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) ��/�Il� �(�7��� � �� � _� • S Plan revision required?❑Yes❑ No 6 3 iD� �3� I ' �� bq �l � �_� �_—��� — -� � Use other side for additional information Date POWTS inspector's Signature Certification Number SBD-6710(R.3/01) AO�ITIONAL C�MMENTS ANO SKETCH SANiTARY PERMIT NUMBEP�._ _��.i���_ ___ �" l.dY`c ��C_�� � .� _ � �-� ��`�G`���1�t. F�--- �v' � � � ��IG�.C' ��4 t, , ` `� I �. L ' � }�S j�� `1 �'`°�' 3X�� �— � �� � _ _ _ 1 , � '`, I — .� �,�. ���� ��b�� � ., � �b CY. ��r � � ��