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Home My WebLink About020-638-03-4306-SAN-2022-189 _""" Department of Safety c°"°ty c � `� &Professional Services, `��'� �� ; � _ , Sanitary Permit Number(t be filled in by Co: �, �_ , Industry Services Division �3� � S a � State Transaction Number � Sanitary Permit Application _ t - In eccordance with SPS 3832IQ),W is.Adm.Code,submission of this form to ihe appmpriate goveromental unit � is required prior to obteining a sanitary pertnit.Note:Application foans for state-owned POW1'S ere wbmitted to Project Address(if different it�an mailing addr� � t6c Department oC Safery and Pmfessional Scrvices.Pe�xonal m(o�mation you pmvide may bc used for sceondary pwposes in accordance with the Pmacy Law,s.15.04(lxm),Stats. / � I.Applicstion Informatlon-Please Priot All Informaaon aa o w k�E Le/� Property Owner's Name arce# �;c.�.�v�� ka�hlee_,i Scl�.n,�P� U�o��3�-03-�13t�� Praperty Owner's Mailing Add�ess /� Pmperty Location �L ��I I ��Il� �lt� Govt.Lot City,State Zip Code Phone Number � � GL,� G-� V(�f' S3�J�'.S �� Y.. �� '/.,Secuoo II.Type of Building(check all that apply) � Lo[q T u N R � E or f�I or 2 Family Dwelling-Number of Bedrooms Subdivision Name Block k ❑Public/Commercial-Describe Use ❑City of ❑S[ateOwned-DescribcUsc CSMNumber W:9�J.A � OVillageof a`1 S'a �=7 �o�or c`�T�bw�-. III.Type of POWTS Permit(Check either`New"or�Replacement^snd other applinbie on line A.Check ooe boi oo line B.Complete lioe C i a licable.) A� �New System ❑Replacement System ❑Other Modification to Ezisting Syslem(explain) ❑Additionel PreVeatrnrnt Unit(explain) B' �,a,Holding Taok ❑In-Ground ❑°.t-Gwde ❑Mound ❑Individuai Sire Design ❑Other Type(uplain) � � (comentional) C. ❑Renewal Before ❑Rcvision ❑Changc of Plumber ❑Transftt lo New Owner ��ous Pttmit Num6er and Date Lssued Expiration — N.Dispersallfreatmen[Area and Tank Informallon: Design Flow(gpd) Design Soil Application Rate(p.pd/s� Dispersal Area Required(s� Dispersal Ama P�oposed(sfj System Elevation N A ri-!A- N�4 !�! Capaciry in Tatal N of Mmiufacturer Tnnk Infolmation Ga�bns Crellons Units �� '� .� New Tenks Exisuvg Tanla � � U J y A a`U � ? 4 CU e. SepticaHoldingTmk a(� � s�r�.ti, (G�,�C Dosing Chamber V.Responsibility Sfe[eme0[-I,the undersigned,assume respoosibility for insfalladm of tht POWTS showo on Ihe attachM pl�es. �Plum r s Neme(Prin Pium ' Signature MPIMPRS Number Business Phane Numbcr e ��a r� a�d�a ��sa��- Plumbe�r's dress(Strcet,City,State,Zip Code) SO 8`1'N �� >n � ��/t�er� (�CG� �Y�S� VI.Cou ty/Department Ux Only �A ❑Diseppmvcd Pertnit Fee Date Issued Issuing Agent Signazwe ❑Owner Given Reawn for Denial § 1�� I'S I a� /"I'� '""-�' Condirions of Approval/Reasons for Disapproval � � p 2� � �JL"�1� I1=�,1�� /'-��'� O�IGIN;�I ° , �,, L (,s1�� '�' AUG 0 3 2022 � l C�ST�o9 �� V.Icr ld ��SSS ` ,. _� � � � i ZONu u�,�r.��s�ti - nmcn w compkh p�.o.ro�ae ey,tem,nd.uemit m me ewmry o.�y on y,pe.m��w m.n a�rs i t t meees m s@e ssD-639s(e.o3i22� NO REFUNDS AFTER 13SUE OF PEkMtT �.03�� Sawyer County Zoning & Conservation Administration �� 10610 Main Street, Suite 49 �, .- -- 1� Hayward, Wisconsin 54843 �I (715)634 8288 � � ��\` ,°=�j FAX (715)638 3277 � r �,-i,y � :s � 1i:��'\i � ilcCC( Ui }_o-O}'_i�l�' / � -� � � 1 ; i E mail wn� i< <�c�r�iu��ca�mt<<ov.t��e � Toll Free Caurthouse/General Informahon 1-877-699-4110 I� �� , -,._�� ,,�3�\\��` Holding Tank Approval Checklist I. Sanitary Cover Sheet Date Stamp � � / �3 / � � Parcel ID# O �2 0 - (� 3 g_ O �_ �( 3 D � ll. PlotPlan � Property Lines � Benchmark BM ♦ X Site Address � North Arrow � Structure X Scale � Well � < 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 Management Plan/Contmgency Plan � Servicing Contract � Holding Tank Agreement form IV. Holding Tank Specifications � Cross-section — Manufacture, Gallons: _ `>� �6Z� 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 (R.3/07)„ , �. � Owner: �C��.�,,;�`� Plumber: C�T � Application Review Date: � 'S� �- . POWTS Reviewer: 6��/�--�- Namc � R � ��n Lsconso# Revised 4/11/2013 PAGE 1 OF 4 Holding Tank Plan index & Cover Sheet Componenf 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): I�;c,��.�� - �a�-�1�ee,�1 ��1m;�Q� Phone: �o� -��y - la�� Owner Address: ��l�3`1 !t-��IIP�,�:nt I�.Q �C�a.t'(r,�Q , �.c.1� Zip: 53 5 S� Project Address: k�oeQ P1 e�- � Govt. Lot: S�✓ 1/4 of S C 1/4, Section 3 , T 3 g N-R�E❑or W � Township: D�ib4l�� County: �4w��' Project Parcel ID#: �� 3� C7� `(30�a Designer Information g � � / �'l � Phone: 71S - ��- :�.� Desi ner Name: �`1 t Designer Address: �D\ �-� c��1�Y� /P� ��;�er' Zip: � � :�(o E-maiL• r'��/1�1,a �' f iV�� /� , License Number: a��l(� Remarks: Signature: Date: � `aC?-o� o� Ori ' I signature req red on each submitted copy. CHECK BOX AS APPLICABIE. CMECK BOX AS APPLICA6lE. � SOIL EVALUATION o s��e:4°o ao� � � �$YSTEM PAGE 2 OF SITE MAP PLOT PLAN �1 PROJECTNAME: oesicNF�ow: oIUJ cPo SCe'\Ih� io '�� Attach design flow calculadons for commercial plans. PROJECT ADDRESS: K�� QY � N Pipe Material/ASTM S[andard(Tables 384.30.3 8 384.30-5) I c.c�.0 Sa�Rary�we,�i PvC BM Symbol'.� BM Elevation' F7 Force MaM: / BM Descnption, N 4�I �n I�" /�4,�Ie. sioe�radient/) s� �"a�°a�e"°"n�' IMPORTANT: of rested Area�.( `�'e��SYmbd(i�applicable): p d�awinq a�a�m« Show ground eleva6on contours at suitable intervals. n u�aoo,oP�ae u�. a,�5°�n�., N,1: � �� s a� �� t9 0 ,�v�� w' w.� e � �_� NJ �'r�� C't p tr PAGE 3 OF 4 HOLDING TANK SPECIFICATIONS (No Scale) Weatherproof 12"Min.w 2.0 ft above Junc[ion and qPP�o�� Established Flood Elevation Alarm Box Vent Cap (hPical) Electrical must comply with 1 Approved Lodcing Manhole SPS 316 and NEC 300 4'0 Vent Pipe � with Waming Label Attached �Conduit >10 ft from (typical) 4"Min.or 2.0 ft above Building I Established Flood Elevatlon ( (rypicaq -_ �Airtigh[Seal � 1 Finished Grade 18"Min. (tyPical) .. _� a y . Inlet Inletlnvert �--Watertight Approved Joints wilh P��9 Approved Pipe 3 ft onto � Max. 12"or 90%ot total volume Solid Ground if more than one tank e ' Alartn-0n e HOLDING TANK VOLUME _ �c� gal e - . d . . . . . . .. . . 3"Appmved Bedding Ma[erial BeneaN Tank TANK MANUFACTURER: S��i✓ 7� rf' �i.S� 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= [( � ��rJ cu.ft. x 62.4 Ibs/cu.ft)- �b� �(.C� Ibs] x 1.5 = 1��)Ibs PAGE 4 OF 4 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) 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= aC� gpd Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system c nuisance factors(i.e. odors, user complaints, etc.) o mechanical malfunction (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 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 inveR 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 lowl government unit in accordance with SPS 383.55 Wis. Admin. Code. Report any component failure or malfunction to: Name of individual or company: �011 ��t�/)5)/� d-�nS ��C �-�.� Phone: 7(S'a6G; 'a�5�1� Local government unit: SQL✓�Pl �Uun��j 20(�i�-, Phone: �IS- �c3�I ' 0�� Local govemment unit address: �O�o�t� m��n �, S�rE.� �`� tT��l�� ZIP: 5�6��3 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. Continqencv Plan 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. MOLDIVG�TAnK SERVICItiG CON'IRACT (�ontract Datc: / / This contract is madc bch+rcn thc Iloldin�,Tank Owncr:�nd thc Pumper. Holdim� l ank O�cncr's hamc: Pmnper s Namc Northwest Sanitary, Inc. PO BOX 155 ;c �r�Q d- K leen Schm�&t Radisson,WI54867 Parcel IdentificTtion Vumber: ( IZ Digit Legacy 1D) � o� C�- �P 3 �- � 3 -�� O (� I. Thc owncr agrccs to fiic a copy of this conlracl wilh lhc go�crnmcnlal unit, Sawycr Counly, which has acccplcd and recordcd with thc Officc of thc Rc�istcr of Dccds. thc Mainlcnancc Agrcemcnt (or a Holding Tank requircJ under the Sa«ycr County Pri�atc Scwagc Systcm Ordinancc for thc issuancc of a Sanitary Perniit for thc installation of a holding tank(s). 2. Thc o�vncr agrccs to ha�c thc holding tank(s) scn iccd by lhc pumper and guaranlccs to permit thc pumper to ha��c acccss and to cntcr upon the propertq for thc purposc of servicing thc holding tank(s'). Thc owncr agrccs lo mainlain lhc all-wcalhcr acccss road or dri�c so lhat thc pumper can scrcicc thc holding lank(s) wilh thc pumping cquipmcnt. Thc owncr furlhcr a��ccs lo pay thc pumper for a charecs incurrcd fn scr�icing thc holding tank(sl as mutualh agrccd upon by thc o�ancrand pumper. 3. Thc pumper agrccs to submit to thc Govcrnmcnlal linit, Sa��ycr County,a rcport for thc scn icinc of thc holdine tank(s) as rcquircd undcr SPS 3tt3.S5. N'isconsin Administmti�c Codc and thc S�w�cr Coimty Pri�ate Sc��age Systcm Ordinance. The pumper further agrccs to includc thc follo��ing in thc report: a. I hc namc and address of the person responsible for scrvicing the holding tank; b. Che mm�c of thc o�vncr of thc holding tank; c. Chc sitc address of thc holding tank; d. 1'hc datc thc holdine tank was scniced; c. Thc�olumcs in gallons of the conicnts pumpcd from thc holding tank for each scroicing; C 'I hc disposal sitcs to��hich thc contcnts Gom thc holding lank wcrc dcliccred. 4. This agrccnunt will rcmain in cffcc� �mtil thc owncr or pumper tcnninatcs this contract. In thc rvcnt of n chan�c in this co��tract, �hc owncr agrccs lo filc a copy of any changcs to this scrvicc contract or o copy of a ncw scn ice contract w ith Sawycr County within tcn (10) busincss days I'rom thc datc of changc to lhis scrvicc contract. O�ancr's N;�mc (Prin1) Ownc�turc: �o�a� „��•��.��•� riL�a •«y��n•a� � ,��,�( 5�.��, ,. Pwnper's Namc: I Print) Pumper's Signa[urc: Ronald L Vieceli, owner Northwest Sanitary.lnc G, Pumper's R��islr,ition humbcr #2389 Ke� o;:�'b.�; i i i�iiii � � ; ; � � ��i ii ��i � -USE BLACK INK ONLY- � L� fi i y r � POWTS MAINTENANCE AGREEMENT T'�'��8�` For Holding Tanks 440fi 18 PAULA CHISS�R Owne�s Name(s)as shown on deed: REGISTER C1F QEEDS SAWYER COUNTY, WI �L'� 'D OS/Q5/2022 02.32 PM �'�"` d �� C� ��' RE�ORDING FEE 30.fl0 Parcel Identification Number. ) !- (12 Digit Legacy ID) ��-��-��- LI �C K� PAGES: 2 Legal Description of Property: -SEE ATTACHED SHEET- We acknowiedge that application is being made for the installation of a holding tank(s)on the property des�ribed on the attached sheet. Retum To:Sawyer County Zoning and Conservation Administration 10610 Main St.Suite 49,Hayward,W154843 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 t�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), 5tats.,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 govemmental 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. (VR 113,Wis.Adm.Code,who shall submit pumping reports to the govemmental 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 govemmental 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 govemmental 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 govemrnental unit for inspection,pumping, hauling,ar otherwise servicing and mafntaining 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 ce�tifies that either a soil absorption system that complies with SPS 383,Wis.Adm.Code,or a municipa!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 peRnit the existence of the certification to be deteRnined 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 agreeinent shall be recurdad 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. -Onl one owner si nature re uired- ACKNOWLEDGMENT Owne 's Signature: State of: � , County of: _ Owner's Name rint): �i',/ G �' Subscribed and swom to before me on this �i� nc1� �cd� �C JC /'�� _dayof , 20� Date: ,,,,,, �,,,,, ''�P SOBqk�''�-, BY(Owner's Name): f (' �� '�� ` G • • '�'� Notary Public Signature: Drafted by , I,•��-�qR y'., _ Public Notary Name(Print): C _ �� My commission expires on: 5 G'n1:5 ,;,�n - ��, A�B��G .'� - Personal infortnation you provide may be,usgc�fL�seoo�dary�p�qs2s(Privacy Law,§15.04(I)(m)] Rev.03/26/13 OF ��/1S �'''��,��,�,�,, That part of the Southwest Quarter of the Soutl�east Quarter(SW1/4SE1/4), Section Three(3), Township Thirty-eight(38) North, Range Six (6) West, more particularly described as Lot Four(4) of Certified Survey Map recorded in Volume Twenty-nine(29), page Fifty-two (52), as Survey No. 7359 of Certified Survey Map No. 343671. Fteal Estat� Sa,wyer County Property Property Status: Current Listing Today's Date: 7/1/2022 Created On: 2/6/2007 7:55 :34 AM Description Updated: l2/22/2021 Ownership Updated: l2/22/2021 Tax ID: 20387 RICHARD & MCFARLAND WI P�N: 57-020-2-38-06-03-4 03- K�►THLEEN 000-000060 SCHMIDT Legacy P1N: 020638034306 Map ID: .15.6 Billina Address: Mailin4 Address: Municipality: (020) TOWN OF OJIBWA RICHARD & RICHARD & STR: 503 T38N R06W KA►THLEEN KATHLEEN SCHMIDT SCHMIDT Description: SWSE LOT 4 CSM 29/52 2489 HILLPOINT RD 2489 HILLPOINT RD #7359 WISWIN INC - LC MCFARLAND WI MCFARLAND WI Recorded 10.000 53558 53558 Acres: Lottery � Site Address * indicates Private Road Claims: N/A . First Dollar: No Zoning: (A-1) Agricultural One property ESN: 427 Assessment Updated: 8/20/2013 2022 Assessment Detail Tax Districts Updated: 2/6/2007 Code Acres Land Imp. 1 State of Wisconsin G1- 57 Sawyer County RESIDENTIAL 1.000 6,000 0 020 Town of Ojibwa G5- 576615 Winter School District UNDEVELOPED 0.500 100 0 001700 Technical College G6- PRODUCTIVE 8.500 14,50� 0 Recorded FOREST Documents Updated: 12/7/2007 LAND CONTRACT 2-Year 2021 2022 Change Date Comparison Recorded: 11/24/2021 436148 Land: 20,600 20,600 0.0% JUDGMENT-FINAL Improved: 0 0 0.0% Date Total: 20,600 20,600 0.0% Recorded: 10/7/2021 435123 LAND CONTRACT Date Property History Recorded: 6/10/2020 424296 N/A QUIT CLAIM DEED Date 418958 Recorded: 7/25/2019 LAND CONTRACT Date 406159 Recorded: 4/12/2017