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ooll��'���ri Date���s�3-� _ _—�ii)
JUL 2 2 2022 �
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SBD-6398(R 0?l12) ..
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Sawyer County Zoning & Conservation Administration
��������� 10610 Main Street, Suite 49
� , 1� Hayward, Wisconsin 54843
� ,�� �� (715)fi34 828R
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� �" y � Toll Frec Courthouse/General Informat�on 1-877-699-4110
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Holding Tank Approval Checklist
I. Sanitary Cover Sheet Date Stamp �� / �a /_�
Parcel ID# 4 v �- ��'7- f '�- � `� o �
Il. Plot Plan
�Property Lines � Benchmark BM ♦
Site Address � North Arrow
_C Structure Scale
� Well � < 25' to Service Road
� Legal Description � Nearest Road Intersection
� Setbacks to: Property Line, Well, Structure, Water bodies, Roads
III. Required Plans
r \Index Page with Original Signature
� Manage�nent Plan/Contingency Plan
� Servicing Contract
� Holding Tank Agreement fonn
IV. Holding Tank Specifications
� Cross-section — Manufacture, Gallons: �'`� � ��-�' �.°�
�Tank Anchor Calculations [SPS 383.43 8) g)]
x Locking device, chains/locks
�C 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) . , ,
2• 1
Owner: � ( �-V� Plumber: �h� I5� '�
Application Review Date: � �a� �o
POWTS Reviewer:
Namc
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����ns�#
Revised 4/11/2013
PAGE 1 OF 4
Holding Tank Plan
index � Cover Sheet
Component Manua!Design Referer�es:
hidding Tank Version 2.1(May 2022-2027)
Pg 1 of 4 Index 8�Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Holding Tank Specifications
Pg 4 of 4 Management Plan
Attachmerrts: 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): (�,.�c (s�cn Phone: - -
Owner Address: 93 7 P����err,,� Zip: 5,.y95/o
Project Address: /(�3 q8 GtJ Or?o�+G �N I�,r��i c�m 59B/7
GovL Lot:�� 1/4 of 1/4,Sectio���,T 3� N-R `� E❑oi W�
Township:_�p e�a e✓' CouMy:_�,�.�ve/' _
Project Parcel ID#: �7-D08�2-3 7-b9-/7-3 D5,Oo�/- �bUD 70
Designer Information
Designer Name: ��� e Phone: 7!S -��y
Designer Address: LJ 93�D LI,GYxQ y�,,,•- S�.e���k� Zp: 5�/�7/
E-mail: �r� ,���._ i��,r„ .f,,.,��.
License Number. �'�OfX�9'
Remarks:
Signature: � � � ;
� Date:
����«��n��.
CHECK BOX AS APPLICABLE CHECK BOX AS APPL�LE.
❑ SOIL EVALUATION p s�'�: '� 40' � � � SYSTEM PAGE 2 OF
SITE MAP PLOT PLAN
PROJECT NAME ��oft�� 10z DESIGN FLOW: `� �> GPD
� . Attach design flow calculations for commercial plans.
PROJECTADDRESS: �� ��!'� 7 �, . Pipe Material /ASTM Standard (Tables 384.303 & 384.30-6)
��7(�. l� N s�naryse�r /
BM S�mbol: � BM Elev ' n: . FT
We � I I Farce Mai�: I
BMDescripllon: , �7G��✓j � —
Indicate rwrm by IMPORTANT:
slope Gradient(%) � G`7 W�I Symbol (If applicable): � drewing an arav Show ground elevation c�ntours at suitable intervals.
of Tested Area: �_� on the approprile fine.
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WLP3000
,aa• TANK SPECIFICATIONS � �
DIMENSIONS;
WALI: 3"
�+�, . BOTTOM: B"
----------------- COVER: 8"
MANHOLE; 24" L�. PRECAST CONCRETE RISER �
HEIGHT: 82-3/4 O.D, e
� � 4" CAST-A-SEAL 4" CAST-A-SEAL I LENGIN: 1B4" O.D. a
WIDTH: 102" O.D.
BELOW INLET; 30" O.D.
mq4 /�� UQUID LEVEL 43" ��k�
� TYP� � WEIGHT; TANK - BOTTOM 15,980 LBS,
' �� � COVER 9,300 LBS.
FILTER OR �
i BAFFLE i : INLET AND WTLET;
4" CAST-A-SEAL 800T OR EQUAL � g
8 �
—————————————— — INLET AND OUiLET BAFFLE AND FILiER: � � �
WISCONSIN, SEE DETAIL{�10
(OTHER STATES SEE CHdRT)
' LIt1UU10 CAPACITY: 89J7 CAl/IN ��
TOP VIEW HOLDING TANK: =;
OUTLET HOLE PLUCCED
ACTUAL CAPACITY: 3,140 GALLONS
�
�
LOADINO DESION: 8' 0" UNSATURAIE� SOIL Y p�
TANK CAN 8E USE6 ASt �uj
SEPTIC/HOLDINC/PUMP OR SIPHON N
M
o �
COVER: MIX DESIGN �18 (NO FIBER) ��
S ie TANK: MIX DESIGN �9 (SMALL FIBER) p�
�
� CUSTOMI2ED TANKS: '
— _ FOR CUSTOM TANKS CONTACT WIESER CONCRETE �
I
� 3� � l, �
� � �� � � � �,' �
� � Q
�L_ - - --- - ---J` � F
DRAWINGS SUBMITTED �
� FOR APPROVAL
SIDE VIEW APPROVED 8Y:
SHEET N0,
APPNOVAL DATE�
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS PRODUCTS NEEDED 6Y; /OF�
PAGE 3 OF 4
HOLDING TANK SPECIFICATIONS
(No Scale)
w�mer�r �r Mm.or z.o e�
Jimcfion and p�� Esta6tished fbotl Elavaeon
Alarm Bon Vent Cap (tYp��)
Elec6ical nust mmpty wiTh Appmved Lodccg Manhole
SPS 316 ar�d NEC 300 4'0 VaM Pye � wiTh Wam' Label Atted�ed
Conduit >10 ft fran �
(ryqcal) 4'Mrt�.or 2A ft ahove
g��9 I Esfadished Fbod Elevation
1 (typifal)
Air6ghl Seal � �
1 _ • Fmished Grade
16'Min.
(tYP�q •
� ..
a.
Inlet Inlellm�ert
WaleNgh[
Appmved,loaits wiTh Plug
APPmved Pipe 3 ft mto � Max. 72'or 90°6 of�ofal vdume
Sdid Giound � rf����n one tank
' Alarm-0n
HOLDING TANK
VOLUME - 3� gai
a . .
3'Apprwed Beddirg RAaterial Beneath Ta�k
TANK MANUFACTURER: GtJf�5 c✓'
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= [( �30 cu.ft.x 62.4 Ibs/cu.ft)- g/I 2 Ibs]x 1.5= 12���
PAGE40F4
Holding Tank Management Plan
IMPORTANT:
The oxrner of this hd3ng tank(s)shali be�ble for its perpeWai operation and maintenance pursuant to
requirements of SPS 382384.Wisc.Admin. Cade. Piasuant to SPS 383.52(2),wsc,At�mn.Code,ttus hdd�g tank(s)
shall be c�sidered a hunari t�ealfh harard if n�maintained in accadarKx wiU�llus a�xwed managarnerrt p�n_
Furthertnare,all ir�specUon and mantenance ac�vities shall be performed by a registared PO1N�S�i�
axordance with SPS 383.52(3),Wi�.Adrnin.Cade.
Estimated Da�y Wasbewater Flow= �� 9Pd
Inscection Checktist INSPECT EVERY 3 YEARS
o type of use
o aqe a�system
o nuisance factors{i.e. odors,user complairrts, etc.)
o me�cal malha�dion(i.e., PumPs.v�ves, switches,floats.etc.)
o materi�fafigue(i.e.,leaks, breaks,�on, etc.)
o naglect or improper use(i_e., exceadin9�9��p�.P�ibited adivities,etc.)
o elect�ical componeMs{i.e..wiri►nJ. cartnedions,switches.conhals.finers, alartns. etc)
o siuface dscharc�e of�tluent or sewage back-up irMo sWclu►e served
SERVICINCa FREQUENCY
o The tank(s)shall be pumped by a certified septage serviarg operator lice�sed under s. 281.48 Wisc. Stats.
wt�en the waste�erater in fhe tank(s)reaehes a level of one foot below tl�o iNet inve�t of the tank(s�
Disposal of contents shall be pursuant to NR 113.VYrsc.Admin. Code.
T�k pumping reports shall be s�mitted tio the proper local govemrnent unit in accordance wRh SPS 383.55 YYis�
Admin.Coda Report arry compone�t f�lure or rt�alfurtction to:
NameotindividualorcomPany_ SILVER T!P EXCAVATWG p�: 715-645-0744
��g���e�� ' ' S�W.r�_ COUNTY ZONING ph�: .7.13_�?�-g�88
►.��,�,��rit aad�: Ha.�wu�.►! cd7 ziP: - �sy�y3
Any defective part of this system shall be repaired.replaced. or removed pursuant to SPS 383.51 (1),Wisc.Admin.
Code. Repaa or replacement of failed or malFunctlaning components shaB cornphr wiUi SPS 383,Wisc.Admin.Code.
No product for chemit�l or physical restoration of the POWTS may be used unless approved by the departrnent's�
accordance wilh SPS 384,Wisc.Admin.Code.
Continaencv Plan
In ihe event that arry failed corttponent of tl�s Irolding iank(s)cartnot be reQaired, it shall be replaced pursuant to a
plan submilted to the app�opriate age�y for review arn1 approval.
Svstem Abandonment
If use of this iank(s)is discontinued, it shaN be abandoned in accordant�with SPS 383.33,Wisc.Admin, Code,
HOLDING TANK SERVICRVG CONTRACT
Contract Date: �/ 13/ �u a a
This coatraet is made between the Holdieg Taok Owger and the Pamper.
HolAing Tank Owner's Name: Pumper's Name:
�q`� �- � �E,J Lynn's Honeywagon Inc.
Farcel Ideotificstion Namber:
�ia Di�t��y m> I� o g -�3 -1 -__L_-7-���-7
I. The owner agrees to file a copy of this con6act with the goveminental unit,Sawyer County,
which 6as accepted and cecorded with the Office of the Register of Deeds,4he Maintenance
Agreement for a Holding Tanlc required under t6e Sawyer County Private Sewage System
Ordinance for the issuance of a Sanitary Permit for the installation of a 6olding tank(s).
2. The owner agrees to have the holding wuk(s)serviced by the pumper sud guarnntees to
permit the pumper to have access and to enter upon the propecty for the ix�rpose of servicing
the 6olding tank(s). The owner agnees to mainta�n the all-weat6er access road or drive so
that the pumper can service the holding tank(s)with the Pwnpmg equipment. The owner
further agrees to pay the pwnper for charges incurred in servicing the holding tank(s)as
mutu»Ily agreed upon by the owner and pumper.
3. The pmnper agees to submit to the Govemmental Unit,Sawyer County,a report for the
servicing of the holding tank(s)as required imder SPS 383.55,Wisconsin Administrative
Code aud the Sawryer County Private Sewage System Ordinance. The pumper fiuther
agrecs to include the following in the teport:
a. The name and address of thc person respousible for servicing the holding tank;
b. T6e aame of the owner of the holding mnk;
a The site addcess of the holding tank;
d The date the holding tanlc was serviced;
e. The volumes in gallons of the conlents pumpcYi froro►he holding tank for each servicing;
f. The disposal sites to wbich the contents from the holding tank were delivered.
4. This agreement witl remain in effect unril t6e owner or pumper temiinates this conhack In
the event of a change in ilris conhact,the owner agrees to 51e a copy of any changes to this
se�vice contrxt or a copy of a oew scrvice contract with Sawyer County within ten(10)
business days from the date of change to this service contract.
Owner's Name:(Print) Owner's Signatm'e:t�r�K�+�+��a�)
f�FtL£ l� . Cv LcN �aQ-- 2 i___1sC.---
Pumper's Name: (Print) Pumper's Sig�a
Lynn Kupsch
Pumper's Registration Number:
2018
�.o3ns�ts
7I25/22,826 AM � Real Property Lisling Page
Real Estate Sawyer County Property Listing Property5tatus: Current
Today's Date: 7/25/2022 Created On: 2/6/2007 7:55:15 AM
�Description Updated: 9/20/2021 y Ownership Updated: 3/16/2018
Tax ID: 8560 DALE R&KAREN A GLEN NEENAH WI
PIN: 57-008-2-37-09-ll-5 OS-004-000070 RAYMOND C&]EANETTE M GLEN WISCONSIN
Legacy PIN: 008937175407 RAPIDS WI
Map ID: :4.7
Municipali[y: (008)TOWN OF EDGEWATER Billing Address: Mailing Address:
STR: 517 T37N R09W DALE R&KAREN A GLEN DALE R$ KAREN A GLEN
Description: PRT GOVT LOT 4 937 PANSY CT 937 PANSY Ci
NEENAH WI54956 NEENAH WI54956
Recorded Acres: O.11O
Calculated Acres: 0.183 m
Lottery Claims: 0 r Site Address * indicates Private Road
First Dollar: Yes 16398W ORIOLE W BIRCHWOOD 54817
Waterbody: Chetac Lake
Zoning: (RRl) Residential/Recreational One ��-� property Assessment Updated: 6/28/2021
ESN: 430 2022 Assessment Detail
Code Acres Land Imp.
� 7ax Districts Updated: 2/6/2007 G1-RESIDENTIAL 0.170 88,100 39,200
1 State of Wisconsin
57 Sawyer County Z-Year Comparison 2021 2022 Change
008 Town of Edgewater Land: 88,1OD 88,100 0.0%
650441 Birchwood School District Improved: 39,200 39,200 0.0%
001700 Technical College Total: 127,300 127,300 0.0%
. Recorded Documentr Updated: 9/20/2021
WARRANTY DEED '��Property History
Date Recorded: 9/17/2021 434749 N/A
LAND CONTRACT
Date Recorded: 3/15/2018 411465
WARRANTY DEED
Date Recorded: 1/9/2002 297066 WD786/402
https://tas.sawyercountygov.orgl/system/fremes.asp?uname=Eric+Wellauer ���
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- USE BLACK INK t?NLY - � t1 g ; 3 ? �
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POWTS MAINTENAI�CE AGREEMENT 44[�347
For Holding Tanks �Au�A cHassER
R�t;ISTER OF DEE�S
Owners Nerne(sy as alwwn on deed: SAWYER C�UNTY, tNI
07/25/2022 08:39 AM
�a t lGv1 a rc � REC{�6tDING FEE 3�.00
Parc,el Identific�tlon Number:
c,2o��b� d c�� - `� 3 Z - LZ - S y O 7 Pa��s: z
L�aa �cri�ion ot�ro�ertr
- SEE A7TACHED SHEET -
We ada�a�wfe.tfge lhat application is being mede for ihe ir�llatia►d a holding tank(s}on the
prvperly desaibed on the atfadted sheet.
Retum To: Sawy�er Counl�r Zonirg and C.o�aavation Adm�n�aKOn
106/0 MsM SL Suibs 4�, tlsyward,VYf 5�845
As an induoert�ent to the County o#Sawy�er to issue a sanitary pertnit for a hold'+ng tatek on the above-descxibed ProPertY. the owner is
r,esp�nsible i�the aqera6on and maintenance of the holding tank. loc�ting devioe. alam► and access, arx! agrees to oonform to a11
appGc�ble �equi�emenis of SPS 383. Wis. Adm. Code rel�ting ba holding taMc managernent, induding the followin9:
1. The owner agrees to contrad with a person who is licensed under Ch. NR i 13, Wis. A�n. Cocfe, excePl as Pr'Q�ideci bY
Sedion 281.48 (3) (d}, Stals., to have the h4lding taMc properly serviced and to file a copy of the servioe oor�trad with the
govemrr+entat unit The owner further egrees to file a copy af any changes to the service coMrad, w'a copY oi a new servic�e
conUact. witt► the govemmerda! unit witi�in �en (10) business days irom the date of charge to the servioe coMract.
2. The o�wner a9rees to contract with a person kcensed under Ch. NR 113, W is. Adm. Code, who shaN submit pumping r�orts tio
Ehe gov�nmenta�l unit i� accorda�no6 with SPS 383.55,Wis. Adm. Code. irx the serviang af the hoWing ta►dc. In the c,ase of
s�oemp4on under Section 28t_48 (3) {d}, Stats.. the ativrier shall subrnit 1he report to ihe govemmer►tal unit. The ga+remmental
u�it may e�ter upoct fhe property � investigaee the c�onditian of the holding tanic wt�en pumPing reporls maY fndir.a�e the
holding tank�s not being ProPertY mairnained.
3. If the owner fads to have the ho{ding tank properly servioed in response to onders issued by tt►e goverrxr�er�af u�d to pr�eve��t
or abaEe a human h�llh hazard as described in Sec�ion. 254.59, Stahs., tt�e gavertxner+tal unit may entsr upon tt►e ProPertY
arb se�vic�. or cause the hank ko De serviced. Pursuant to Secbon 145.20(4}Wis. Stats.. a gavemmental unit may as�ess 1he
owner of a private sew'age sYstem for oosts related to t#�e peunPin9 of a seP�ic or holding tank. The dsarges wia be �
as pnes�cxibed bY Sediort 66.0703, stats. The owr�a9rees to peY ap cha�ges and cost iricumed by the govemmental u�it for
i�spe�ion� Pun►P�9. hauting, or othefMrise servicin9 and mairrtaining the holding tank in such a manne�as 6o prevent or atsate
ar�y human heaiM hazard cawed by the holding tank.
4. This agreemenl wiN remain in e�fect onfy unb7 the govemmental unit resPa�,sible f�the regula� °fi WTMa� �'� SY'�
ceRifies that either a soil absorption system that oompiies witl� SPS 383, Wis. Adm. Cade� or a municipa� sewer serves the
Wnpe�tY. la addiaon, this agreemern may be cancelled by executing and recording said �tion witl� referenoe to tteis
agr�r»eM in sud� manner which will permit the e�dstence ot the cer�ification to be determined by referer�ce to the property.
5_ This agreement sha� be binding upon the owner, the t►eirx of tlte owner, and assignees of the owr�er. The owner sh�l submit
the a�r+�emer►t to the regisEer of deeds. and the agreement shali be reoorded by the register of deeds in a manner which will
permit the existerx:e of the agneerr�eM� be deteRnined by rei�erence to the prope�'h+where 1he hddin9 tank is instaNed.
_�� ��,� � _ ACKNOWLEDGMENT
rs Signatu� n State of: �{ 1��()f l�_1'n
�[.�—�— Ccwntyof: _ iY1YlEb0�0
Owners Name {Print): Subscxibed and swom to before me on this
� � _ 13 day of . 20�.
Date: gY ?' 1
� - 13 ' Z 2 1 � re: _
Drafted by_ No � �nt): u l i u� C�
1 E Q, � lx � M c�'t�'Ssx�'e "r n: l /� 15 C�o��
`� Z
N�► pUBL1G �v,
Perso�a! infotmation You Provide ►'naY be used for ser.o�xlary Purposes IPrivacY •� I�1 (m Q Rev. 03l'16/13
OF W�SG
That part of Government Lot 4, Section 17, Township 37 North,Range 9 West,
described as follows: Starring on the shore of Chetac Lake at the iron pipe at the
Northeast corner of the Meyer property as described in Volume g6 of Deeds, Page
604; thence Westerly along the North line of said property 81 feet; thence at right
angles and North 72 feet; thence at right angles and East to the Lake shore;
thence Southwesterly along the Lake shore to the place of beginning,
Together with Easement to cross Frank W. Jilek property as
set forth in Volume 202 of Deeds, Page 644, Sawyer County Records.
Being property as described in Volume 202 of Deeds,
Page 644, Sawyer County Records.
'�'-°"—"'��`�%;;� PRIVATE ONSITE WASTE TREATMENT county
�,
���,`; o�s� ��'�, SYSTEMS SaWyer
P ( POWTS)
����1 s_ :.�
\f,�--,r�%:
����'-- INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� _ � b�
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)�
Permit Holder's Name: ❑City ❑ Village C�Town of: State Plan Transaction ID#:
1 �^ �
�a e.�\t�.+n L� 2.�a
Insp BM Elev: BM Description: Parcel Tax No:
��O.a � t>`� ��►'��� a� 1�08—�'l3?--1�? -.S-Yo7
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic Benchmark d�,�y
Dosing
Aeration Bldg. Sewer q�,o$'
Holding 1,,,���sZT 3�C?�0 St/Htlnlet 96.0'��
TANK SETBACK INFORMATION St I Ht Outlet q 5,83'
TANK TO P/L WELL BLDG vENrTo ROAD Dt Inlet
AIR INTAKE
Septic NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man.
Holding kS` �3p` ��� -4-(� ��._$" 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 o Conv ❑ Aggregate
INFORMATION P/L Bidg Well Waters o GP ❑ Chamber Model Number:
❑ EZFIow
CELL TO ❑ Mound o Other
_- - - ----____- --__ --- --- --
DISTRIBUTION SYSTEM X Pressure Systems Only
--- -_____ --___T
Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes ';
Length Dia Length Dia Spac i �! Spacing 0 Yes ❑ No �
- — — --_ — ---- -- -�
SOIL COVER
Depth Over Depth Over �Depth of Seeded/Sodded Mulched
Ceil Center Cell Edges j Topsoil ___ � ❑Yes ❑ No ❑Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
�.�s�l� 81 Y� 2-2
� N�
Plan revision required?�Yes❑ No �U�,.S, � � a3� ����� ----� �`��O �� �
I�� —
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AO�ITIONAL COMMENTS AN� SKETCH
SANITARY PERMIT NIJMBEP�.__._��_(�_�___..
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