HomeMy WebLinkAbout024-841-13-5415-SAN-2022-182 .;:�Y_��"_%�jj., Industry Services Division County �
- 4822 Madison Yards Way Sawyer �
-J _�_' = Madison,WI 53705 Sanitary Permit Number(to be filled in by( �
= P.O.Box 7162
Madison,WI53707-7162 �9 �� � ��
State Tcansaction Number �
Sanita Permit A lication �
rY PP - —
In accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate govemmental unit 1
is required prior to obtaining a sanitary permit.Note:Application forms for state-0wned POWTS aze submitted to Project Acidress(if different than mailing a _.
the Departrnent of Safery and Professional Services.Personal information you provide may be used for secondary 11257N Sun n sno Rd p�
purposes in accordance with the Privacy Law,s. 15.04(1){m),Stats. � `
L Application Information-Please Print All Information �`�
Property Owner's Name Pazcel#
Brandon Chandler 024841135415
Property Owner's Mailing Address Property Location
3451 CR 625 E
Govt.Lot 4
City,State Zip Code Phone Number
Foosland,IL 61845 %., '/., Section 13
Il.Type of Building(check all that apply) Lot#2 T 41 N R 8 E o
I�-or 2 Family Dwelling-Number ofBedrooms 4 Subdivision Name
Block#
❑Public/Commercial-Describe Use
❑Ciry of
❑State Owned-Describe Use CSM Number ❑Village of
13/371#3396 �Town of Round Lake
III.Type of POWTS Permit:(Check either"New"or"Repiacement"and other appiicable on line A. Check one box on line B.Complete line C i
a licable.
A �New System ❑ Replacement System g y p )
❑Other Modification to Existin S stem(ex lain ❑ Additional Pretreatment Unit(ea�plain)
B' �liolding Tank ❑ In-Ground ❑ At-Grade gn ❑Other Type(explain)
❑ Mound ❑ Individual Site Desi
(comentional)
C. ❑ Renewa!Before ❑ Revision ❑ Change of Plumber ❑Transfer to New Owner '�st Previous Permit Number and Date Issued
Expiration
IV.Dispers'UTreatment Area and Tank Information:
Design Fiow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
400 HT HT HT HT
Capacity in Total #of Manufacturer
Y
Tank Infortnation Gallons Gallons Units � � o '� .^
New Tanks Existing Tanks ` o � � � � � c`�
a. U v� � cn w C7 0.�
Septic or Holding Tank I gpp 1800 1 IESER
Dosing Charnber 1100 1100 1 IESER
V.Responsibility Stateroent- I,the nodersigued,assume responsibility for installation of t6e POWTS shown oo the attac6ed plans.
Plumber's Name(Print) Plumbers Signature MP/MPRS Number Business Phone Number
(�Ns�,�dl �`i'LrO�h�d � � /.���/ /l.S'-S.J�—//.��
Plumber's Address(Street,City,State,Zip Code)
!��� 2 w �.-�.e�,.,.�.� /�a� �Xc �..0 � �y ,f'Y��/3
VL County/Department Use Onty
�AppY 8 ❑Disapproved 1'ertnit Fee Date Issued Issuing Agent Signature `
'Y''" ❑Owner Given Reason for Denial $ l� •a� `��� r �3 ��I"`^"^�"�"`! ►w�'�"''y'
Conditions of ApprovaUReasons for Disapproval
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GS�— ���— 1 c�c��._R�_ �.�_�._._. AUG 0 1 2022 �
�� �t. ER COUNTY
!�Q.Wt i�Y o r 1 r� otd'`OC`� yv�}} SAWY RATIOc�!
�C� �� � Ai(�ch to cenpkce plans for We system sod submit to the Couoty oaly on paper not less t9ae 8 t!t:11 ie
J O� I
J NO REFJNDS AFTER
S 398(R.03/21) I�SUE OF PE�tiMIT �(��0�,
Sawyer County Zoning & Conservation Administration
```"��'' 10610 Main Street,Suite 49
� -�, � � Hayward,Wisconsin 54843
i
��'�: �i� (715)634 8288
� � � �� TAX(715)638 3277
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�� '� � Toll Free Courthouse/General Informat�on] 877fi99-4710
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Holding Tank Approval Checklist
L Sanitary Cover Sheet Date Stamp Og/ �� / �2
Parcel ID# �a y -� Y I - ( 3- S``'( � �
II. Plot Plan
�Property Lines �Benchmark BM ♦
x Site Address North Arrow
x Structure �Scale
�(Well �<25' to Service Road
�Legal Description �Nearest Road Intersection
�Setbacks to: Property Line, Vfiell, Structure, Water bodies, Roads
ILI. Required Plans
�Index Page with Original Signature
Management Plan/Contingency Plan
Servicing Contract
Holding Tank Agreement form
IV. Holding Tank Specifications
�Cross-section—Manufacture, Gallons: �\e�_ ���o�
�(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.$62(3) �
3"Bedding Material < 1/2 "
V. Holding Tank Plans per Component POWTS Manual
�Version'.�SBD-10855-P (R.3/07)
a-�
Owner: �a�f�� Plumber: ��"� �•
Application Review Date: ��3���
POWTS Reviewer: � ��% c--�_
Name /' �
E�� ,C� ��n
Licc�sc#
Revised 4/11/2013
PAGE 1 OF 4
Holding Tank Plan
Index & Cover Sheet
Component Manua/Design References:
Version � SBD-10855-P (N. 03/07; R 01/12)
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 �
�
�
�
f
Owner Name(s): Brandon Chandler Phone: - - �
Owner Address: 3451 CR 625 E Fooslanc� Z�p. 61845 �
Project Address• 11257N Sun-N-sno Rd i
Govt. Lot: 4 1/4 of 1/4, Section �3 , T 41 N-R 8 E�or W�
Township: Town of Round Lake County: Sawyer }
Project Parcel ID#: 024841135415 �
�
�
Designer Information �
Designer Name: Gerald Froemel Phone• �71�) 558-1138 �
�
Designer Address: 13502W Froemel Rd Hayward,Wl Z�P: 54g43 �
E-mail: Jayfroemel@gmail.com 7'his.pace reserved for appirn=al sta�31}?. �
a
License Number: 950111 �
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Remarks: �
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Signature: G - Date: $���22 �
�
Original signature required on each submitted copy. �
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PAGE 3 OF 4
HOLDING TANK SPECIFICATIONS
(No Scale)
Weatherproof 12" Min. or 2.0 ft above
Junction and Approved EstaWished Flood Eleva6on
Alarm Box Vent Cap (�YPical)
Electrical must comply with � Approved Lodcing Manhole
SPS 316 and NEC 300 4"l7J Vent Pipe with Waming Label Attached
Conduit >10 ft from (typi��) 4"Min. or 2.0 ft above
Building Established Fiood Elevallon
{typical)
. " g
�
_ �Airtight Seai �
_ ° Finished Grade �
18" MGn. �
(�YPica�) �� . - ' ° • �
' ° " a
� d ' ` ' '� 9 .
, a . e .. - •• a • . _ . = s
Inlet I�let Invert
Watertight
Approved Joints with � _ Max. 12"or 90% of totai volume P'�9
Apprrned Pipe 3 ft onto
�� G�� � if more than one tank �
a
" Alarm-0n
's
�
a �
HOLDtNG TANK �
VOLUME = 3,000 ga� .a �
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;
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a . d . • ' a . � : � . � - - • • ' ° -- £
_ �
e
3`Approved Bedding Material Beneath Tank E
€
�
TANK MANUFACTURER: Wieser Concrete $
�
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�
t
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 �
Holdin Tank exterior dimensions in inches: Len th " x Width " x Hei ht " 3 �
9 ( 9 g ) /1728 = 0.00 ft �
Ballast Weight = [( 0.00 cu.ft. x 62.4 Ibs/cu.ft x 1.5) - Ibs - 0 Ibs �
PAGE40F4
Holding Tank Management Plan
IMPORTANT:
The owner of this holding tank(s}shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384,Wisc.Admin. Code. Pursuant to SPS 383.52(2),Wisc.Admin.Code,this holding tank(s)
shail be considered a human heatth hazard if not maintained in accordance with this approved management plan.
Furthermore,all inspection and maintenance activities shall be performed by a regis#ered POWTS Maintainer in
accordance with SPS 383.52(3),Wisc. Admin. Code.
Estimated Daily Wastewater Flow= 400 gpd
Insaection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors(i.e. odors, user complaints, efc.)
o mechanical malfunction(i.e., pumps,valves, switches,floats, etc.)
o material fatigue(i.e., leaks, breaks, corrosian, etc.)
o neglect ar improper use(i.e., exceeding design capacities, prohibited activities, etc.)
o electrical componen#s(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 certified 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 shalf 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: �AYs Septic Phone: ��15) 558-1138
Local govemment unit: SaWyer County Zoning Phone: �715) 634-8288
Local government unit address: 10610 Main St, Ste 49 Hayward, WI Z�P: 54843
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1),Wisc.Admin.
Code. Repair or replacement of 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.
Continaencv Plan
1
In the event that any failed component of this holding tank(s)cannot be repaired, it shall be replaced pursuant to a �
plan submitted to the appropriate agecy for review and approval.
Svstem Abandonment
If use of this tank(s)is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc. Admin. Code.
HOLDING TANK SERV�CING CONTRACT
Contract Date: �/ ( / 2Z
This contract is made between the Holding Tank Owner and the Pumper.
Holding Tank Owner's Name: Pumper's Name:
s��T,c���
Parcel Identification Number:
�12 ����t Lega�y i�� D a �- 4s� 1 - 1 3 - ,�� I s
1. The owner agrees to file a copy of this contract with the governmental unit, Sawyer County,
which has accepted and recarded with the Office of the Register of Deeds,the Maintenance
Agreement for a Holding Tank required under the Sawyer County Private Sewage System
Ordinance far 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 pu�nping equipment. The owner
further agrees to pay the pumper for charges incurred in servicing the holding tank(s)as
mutually agreed upon by the owner and pumper.
?. The putnper agrees to submit to the Goveir,mental Unit, Sa��ryer County, a report for the
servicing of the holding tank(s)as required under SPS 383.55,Wisconsin Administrarive
Code and the Sawyer County Private Sewage System Ordinance. The pumper further
agrees to include the following in the report:
a. The naine and address of the person responsible for servicing the holding tank;
b. The naine 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;
£ The disposal sites to which the contents from the holding tank were delivered.
4. This agreement will remain in effect until the owner or pumper terminates this contract. In
the event of a change in this contract,the owner agrees to file a copy of any changes to tl�is
service contract or a copy of a new service contract with Sawyer Counry within ten(10)
business days from the date of change to this service contract.
�wnel''S N2me: (PT'lnt� �WneT'S gll e: (Onl�one o�vner signature required)
B�o+� �..�,� �e/'
Pumper's Name: (Print) P pei s Signature:
SCc� ����� ���� � ��
Pumper's Registration Number:
���/ 3
Rcv.03/26/13
i II I IIIIII(II�IIII
I I IIIIII � I
s �� � � � � �
- USE BLACK INK ONLY- Tx:�039801
POWTS MAINTENANCE AGREEMENT 440555
PAULA CHISSER
For Holding Tanks REGISTER O�DEEDS
SAWYER COUNTY, WI
Owner's Name(s)as shown on deed: OS/p3/2fi22 02:54 PEy!
RECORDING FE� 3fl.00
�d ovi S.5 ' i
Parcel Identification N mber: Q
(12 Digit Legacy ID) � � �1 y�-1 3 '�y ' S PAGES: 2
— � -- —
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 hoiding 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 siiall submit the report to the governmental unit. The governmentai
unit may enter upon the property to investigate the cundition 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 wiil 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.
I on o ner si ature required- ACKNOWLEDGMENT
Owner' i ature� State of: W1�L anS.��
County of: �a w�r
O er s ame rint): Subscribed and sworn to before me on this
lJvc,, � �,. �day of -S�� y 20 a a
Date: B�.(�`r���','�'iV�ne): _ /.�t�o� G�.���e('
��2 2 �,�la�Pd�yPubla��ture: ,�}� �
Drafted by: ; Pu6l��lqt�r Na��Print): �'.�y �C�Z(ow5�'t:
�►
' My com�iss da expi�5es on: ����1� ab
.y�' A�6`L i C ,,;
Personal information you provide may be used for secondary purposes[�ivacy'F.p��15.OA.(I)•QQ�j��J�� Rev.03/26/13
y',��''���w��sCO``�,`,•
Lot 2 as recorded in Volume 13 of Certified Survey Maps, page 371-372, Survey No. 3396 as Document No.
223541 , located in the Town of Round Lake, Sawyer County, W isconsin, being a part of Government Lot 4,
Section 13, Township 41 North, Range 8 West.
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8/3/22,2:50 PM Real Property Listing Page
Real EStdte Sawyer County Property Listing Property5tatus: Current
Today's Date: 8/3/2022 Created On: 2/6/2007 7:55:45 AM
�Description Updated: 2/5/2021 � Ownership Updated: 2/5/2021
Tax ID: 26706 BRANDON J &CARISSA L CHANDLER FOOSLAND IL
PIN: 57-024-2-41-OB-13-S OS-004-000150
Legacy PIN: 024841135415 Biiling Address: Mailing Address:
Map ID: :4.15 BRANDON] &CARISSA L BRANDON J&CARISSA L
Municipality: (024)TOWN OF ROUND LAKE CHANDLER CHANDLER
STR: 513 T41N R08W 3451 CR 625 E 3451 CR 6Z5 E
FOOSLAND IL 61645 FOOSLAND IL 61845
Descrlption: PRT GOVT LOT 4 LOT 2 CSM 13/371
#3396 m
Recorded A�res: 9310 r Site Address * indicates Private Road
Cakulated Acres: 9162 11257N SUN-N-SNO RD HAYVJARD 54843
Lottery Claims: 0
First Dollar: No � Property Assessment Updated: 7/16/2019
Zoning: (RRl) Residential/Recreational One Z022 Assessment Detaii
ESN: 404 Code Acres Land Imp.
GS-RESIDENTIAL 2.000 16,000 0
�� Tax Districtr Updated: 2/6/2007 G6-PRODUCTIVE FOREST 7310 11,000 0
1 State of Wisconsin
57 SawyerCounty 2-YearComparison 2021 2022 Change
024 Town of Round Lake Land: 27,000 27,000 0.0°/o
572478 Hayward Communiry School District Improved: 0 0 0.0%
001700 Technical College Total: 27,000 27,000 0.0%
.� Recorded Documentr Updated: 2/3/2021
TRUSTEES DEED ����Property History
Date Recorded: 2/2/2021 429761 N�q
QUIT CLAIM DEED
Date Recorded: 8/18/2017 408193
SCRIVENERS AFFIDAVIT
Date Recorded: 9/24/1992 231208
WARRANTY DEED
Date Recorded: 6/24/1991 223795
CERTIFIED SURVEV MAP
Date Recorded: 6/6/1991 223541
https://tassawyercountygov.orglsystemlframes.asp?uname=Eric+�n/ellauer 1/t