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Home My WebLink About022-738-09-2401-SAN-2022-197 Department of Safety �°°"ry � � � i - & Professional Services, S Samtary Pen t Number(to be tilled in by Co.) � �g Industry Services Division � ,3 � ' � � Sanitary Permit Application S`a`e T�°�°t'°n"""'be`'r�"v� � In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this fortn to the appropriate govemmental�mi 3 7 N G►a��rk�L�-' � is requircd prior to obtaining a sanitary permit.Notc:Applicarion forms for statcowned POWTS aze submitted to Project Address(if difierent than ma ing addre the Department of Safety and Pmfessional Services.Personal information you provide may be used for secondary G,4�efka L�. � pucposes in accordance with the Privacy Law,s.15.04(1)(m),Stats. t.Application Information-Please Print All Information d j �y$' rf Property Owncr's Name Parcel# ��/0 � ' Z.,,Z —`7:3�'� C�g c Property Owner's Maili A dress PropeRy Location h '� GovL Lot Ciry,State Zip Code Phone Number � �7 O� / 5 554S��J�,1 ��/<,J-�'�--�/a, Section �____ II.Type of Building(check all that apply) I- # T__ _N R E or fjZ I or 2 Family Dwclling-Number ofBedrooms 3 Subdivision Name � Block# �Public/Commeicial-Describe Use_� �City of ❑State Owned-Describe Use_, t A _ CSM Number ❑Village of aeTo„�,of�_ 'iladi SSo h III.Type of POW'CS Permit:(Check either"New"or KReplacement"and other applicable on line A. Check one box on line B.Complete line C if a licable.) A' Ncw S stcm � y, ❑ Replacement System ❑ Olher Moclification to Existing System(explain) � Additional Pretreatment Unit(explain) B' � Holding Tank ❑ In-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑ Other Type(explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑Change of Plumber ❑ Transfer to New Owner ist Previous Permit Number and Date Issued �xpiration '� IV.Dispersal/Treatment Area and Tank Information: Design Flow(gpd) Dcsibm Soil Application Ratc(gpcl/sf� Dispersal Area Required(s� Dispersal Area Proposed(s� System Glevation �o� N,� N # Capacity in Total #of Manufacturer Tank Information Gallons Gallons Units p � �o ,'Q, � U y fA Ncw Tanks Existing Tanks � o � � y p � Ry w U in �, �n i.�. C7 0. Septic or Holding Tank �O �. s�7 Ska � ^ Dusing Chamber Y.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attac6ed plans. Plumber's Name(Print) Plumber's Si�mature MP/MP�S Number Business Phone Number rt 8 rpwK 'l I S q�t o Plumber's Address(Street,Ciry,Statc,Zip Code) 23 N N S! VI.Co n /Department Use Only �Ap ed ❑Disapproved Permit Fee Da[e sued Issuing Agent Signature �'✓ ❑,Qwne,;,C;i„�en Reason for Denial $ ��i� 6�I�I�a � ' f.�o- Conditions of ApprovaVReasons for Disapproval [� `1,ll�C�,]��`1' �t�.'� C L-t`;-,.4 � � l7ate___ �I�o �- V !° �'�; ; �� I `�� ,� AUG 202 � _, ��o► .0-g 2 , �. _�a_s►� �aq�3 SAWYER CC3UlVTY ''" ZONING ADMINISTRATIUN CS� No 1��' �. ,_ _ .�.. w�� d .4ttach to complete plaes for t6e aystem and submit to the County only on paper not less than 8 vz x 1 t inchea in size SBD-6398(R.03/22) NO RcFJNDS AFTER 15SUE OF PE�sMIT �a-a3� Sawyer County Zoning & Conservation Administration �� 10610 Main Street, Suite 49 � - _`< = Hayward, Wisconsin 54843 � ;< �`,� ►� � „ � (715)634 8288 �� \`',_;�/ FAX (715)638 3277 / � J....cv � / R'��'VA S�ttVCi"Cc)31�tt],�Ob.C�I� / � � � � .� - / EIll31� ?Uri�t1a ��Ci,�,ii �'UCi?UI7� �OV.O7'�: � � Toll Free Courthouse/General Informahon 1-877-699-4710 I� =� ' , � ��;� � ,.�� 1\�� Holding Tank Approval Checklist � o I. Sanitary Cover Sheet Date Stamp � �/ � /� Parcel ID# D � �-� .3 � - D �( _ � `� � � II. P1otPlan � Property Lines � Benchmark BM ♦ � Site Address � North Arrow � Structure � Scale � � Well � < 25' to Service Road � Legal Description � Nearest Road Intersection Setbacks to: Property Line, Well, Structure, Water bodies, Roads � III. Required Plans . 1� Index Page with Original Signature � Management Plan/Contingency Plan Servicing Contract Holding Tank Agreement fonn IV. Holding Tank Specifications � Cross-section — Manufacture, Gallons: Sk�v�1 3,� �`i 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) J� 3" Bedding Material < 1/2 " V. Holding Tank Plans per Component POWTS Manual � Version ,� SBD-10855-P (R.3/07) _ , , �_ ( Owner: ��j� c� Plumber: �. �5�� Application Review Date: D�l (a , �-� POWTS Reviewer: �� O/� Namc G� � l� Lsocnsc# Revised 4/11/2013 PAGE 1 OF 4 Holding Tank Plan Index & Cover Sheet Component Manual Design Refe�ences: 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): Vicki L Lynch Phone:�,�� -,`j�g - 35�� Owner Address: 10596W Church Street Radisson, WI Z;p: 54867 Project Address: Galetka Lane Radisson, WI 54867 Govt. Lot: SE 01/4 of NW �1/4, Section 09 , T 38 N-R 07 E Q or W ❑✓ Township: RadiSSOn County: Sawyer Project Parcel ID #: 022738092401 Designer Information Designer Name: Kurt Brown Phone: 715 _943 _2988 Designer Address: 10487 Old Murry Rd Exeland, WI Z�p: 54835 E-mail: brownk@bevcomm.net ;,,. , �_,4j ;, ,;,,,�, ,� ,, �, :. License Number: 224281 Remarks: Site is undeveloped as of July 30, 2022. Signature: Date: July 30, 2022 Original signature required on each submitted copy. Site Plan A 3,000 Gallon H/T is proposed to be installed on this site. A soil evaluation was not conducted per Vicki L Lynch owner's choice. 10596W Church St Radisson,WI 54867 Site contains 40 acres. Property east of property line is owned by the owner's parents. No well or Site Address utilities on site as of 7/30/22. Galetka Lane Town of Radisson SE,NW,S9,T38N,R7W � Existing Shed N SCALE:1"=40' Dr.Way-to Galetka Ln 3,000 Gal H!T Proposed House Nearest � PropeRy Line PAGE 3 OF 4 HOLDING TANK SPECIFICATIONS (No Scale) Wea�herptoof 12"Min.or 2.0 ft above JunGion and qPP�� EstaWished Flood Elevation Alartn Box Vent Cap (�YPiql) Elec[ri�al must comply with � Appmved Locking Manhole SPS 316 and NEC 300 4"0 Vent Pipe with Waming Label Attached CaMui� »�R from (rypical) 4"Min.or 2.O Tt above Building j Established Flood Eleva�ion (rypicaq - �AirOghtSeal � Finished Grade 18"Min. (bPi�q _ � Y _• d Inle� Inlet Invert Walertigh� Approved Joinis with Plug Approved Pipe 3 ft onW - Max. 12"or 90%of total volume Solid Gmund � if more[han one tank e " Alarm-On . e HOLDING TANK VOLUME = 3,000 gal , a . . .� . . 3"Approved Bedding Ma[erial Beneath Tank TANK MANUFACTURER: Skaw Precast Anchor tank as necessary pursuant to SPS 383.43(8)(g) Ballast Weight= [(cu.ft.tank.vol x 62.4 Ibslcu.ft)- Ibs.tank.wt]x 1.5 Ballast Weight= [( cu.ft. x 62.4 Ibs/cu.ft)- Ibs] x 1.5 = 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 = 300 9pd 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 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 adivities, 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�icensed 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. RepoA any component failure or malfunction to: Name of individual or company: BfOWf1�S EXC8V8tlllg Phone: 715 943 Z3J0 �o�ai 9o�e��me„t,,,,;t: Sawyer County Zoning Administration pnone: 715 634 8288 Local government unit address: 10160 Main Street Suite #49 Hayward, WI ZiP: 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, Contins�encv Plan In the event that any failed component of this hoiding 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 SERVICING CONTRACT Contract Date: / Z / 1,c �.� This contract is made between the Holding Tank Owner and the Pumper. Holding Tank Owner's Name: Pumper"s Name: 1�1.C.L� '�.y r� f,� C%�C�`,F� l �J[�Tvrt-i� Y �-I��V}� 1 � f�i' Parcel Identification Number: �- �( � (12 Digit Legacy I D) � L Z - �7 � � - � � - _ 1 . �The owner agrees to file a copy of this contract with the governmental unit, Sawyer County, which has accepted and recorded with the Office of the Re�ister of Deeds, the Maintenance Agreement for a Holding Tank required under 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 pumpin� equipment The owner further agrees to pay the p�imper for charges incurred in servicing the holding tank(s) as mutually 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 tank(s) as required under SPS 383.55, Wisconsin Administrative Code and the Sa�vyer County Private Sewage Sy�stem Ordinance. The pumper f�u-ther agrees to include the follo�ving in the report: a. The name and address of the person responsible for servicing the holding tank; b. The naine of the owner of the holdin� tank; c. T'he site address of the holding tank; d. The date the holding tank �vas serviced; e. The volumes in gallons of the contents pumped from the holding tank for each servicing; f. The disposal sites to which the contents from the holding tank were delivered. 4. This a�reement will reir�ain in effect until the owner or pumper terminates this contract. ln the event of a c}�ange in this contract, the owner agrees to tile a copy of any changes to this service contract or a copy of a new service contract with Sawyer County within ten (10) business days from the date of change to this service contract. Owner's Name: (Print) Owner's Signat re: �o�i.- o�e ow�er s�goar�re req��red> �� Pumper's Name: (Print) Pumper's Signature: �x.-v z. �-�c�L A i ;�— �` __ _._._-,�--.__ Pumper's Registration Number: 2`_� L--<� Kt�. o�iz�i i 3 �.,. _. I��I�1 i 1 I I I�!h�!i I I i i i ; I 1I so5zo � c -USE BLACK INK ONLY- Tx:4039954 POWTS MAINTENANCE AGREEMENT .: 440668 For Holdin Tanks PAULA CNISSER A 9 FiEGIST�ER OF DEEQS` �AWYER COUNTY, WI Owner's Name(s)es shown on deed: OS/10 j 2022 01:43 PM � L L C RECORDING FEE �D.Ofl Paroei IdentiflcaGon Number. {�z o�en�eAacy m) ��z-� .3�-Q g-�� PAG ES: 2 .2 O Legal DescrlpUon of PropeAy: -SEE ATTACHED SHEET- We acknowledge ihat appfication is being made for the installatbn o(a hofding taMc(s)on lhe property described on the attached sheet Retum To:Sawyer County Zoning and Conservation/4dminisiration 10610 Main SL Suite 49.Hayward,WI 54843 As an inducement to the Counry of Sawyer to issus a sanitary permit for a holding tank on the above-described property,the owner is responsible for the operation and maintenance ot the hoiding tank,locking device,alarm and access,and agrees to conform to aN applicable requirements of SPS 383,Wis.Adm.Code relaGng to holding tank management,including the following: 1. The ovmer agrees to contract with a person who is licensed under Ch.NR 113,Wis.Adm.Code,except as provided by Seciion 281.48{3){d),Stats.,to have the holding tank properly serviced and to file a copy of the service contract with the govemmental unit. The owner furiher agrees to tile a copy of any changes to the service contract,or a copy of a new servlce contract,with the govemmental unit wiihin 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 govemmental unit in accordance with SPS 383.55,Wis.Adm.Code,for the servicirx,�of the holding tank. In the case of exemption under Sec6on 281.48(3)(d),Stats.,the owner shalt submit the report to the govemmental unit. The govemmental unit may enter upon the property to investigate the condiGon of the holding tank when pumping repo�ts may indlcate the holding tank is not being properly maintafned. 3. I(the owner fails to have the holding tank properly serviced in response to orders issusd by tfie govemmental unit to prevent or abate a human health hazard as desaibed 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)W�_Stats.,a govemmental 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 Saction 66.0703,sGats. The owner agrees to pay all charges artd cost incurred by the govemmental unit for inspection,pumping,hauling,or otherwise servicing and maintaining the holdirtg tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. 4. This agreeme�t wv+ll remain in effect only until the govemmental unit responsible for the regulation of private se�nrage systems ce�tifies that eilher a soil absorption system that compties with SPS 383,Wis.Adm.Code,or a munippal sewer serves the property.I�addition,th�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 certificafion to be determined by reference to the properiy. 5. This agreement shall be binding upon the owner,the heirs of the owner,and assignees of the owner.The owner shall submit the agreernent to the register of deeds,antf ihe agreernent shall be recorded by the register of deeds In a mennet which will permit the existence oi the agreement to be detertnined by referer�e to the property where the holding tank is installed. -on� o ownersi re ulred- ACKNOWLEDGAAENT Owner's S(gn State of: � �' County of: � Owner's Name( nt): : � C ��„� ,,,�,,��Subscribed and s m to before me on this � R. •, day of 20� . � Date: _ `�.�`�P�••' ••., Qwner's Name): � Z-c�zZ. . R i�Fo Pubiic Signature: � Drafted by: _ _ _ �p�ib(ic�lotary Name(Print): lc � �►C�C� � i-- �C : �GMy cor�mission expires on: ' : �•. � :�2�, �'-.,��'o.......GO��. Personal in(om�afeon you provide may be used(or secondary pur�beq,��0lir.§15.04 p}(m11 Rev.03l26/13 nn�� The Southeast Qaarter (SE '/�) of the Northwest Quar�er (NW ��4� , Section Nine (9), Township Thirty-eight (38) North, Range Seven (7) West, all being located in the Town of Radisson, Sawyer County, Wisconsin. �/.�e { f . 7� 1'' 1 I� , i{ I: � O, AZ�. � . I �, �t � � . �" �1 :W��\��` � - k b a m' ? �\T `` i N�]✓��. _ _ S_ Oh �l� . \ `_ . -rT ♦ a.�_ �.` "�� _ � m,�.�� -� �r.��: • \ . .� ,� r . .•f -_ ' . � t, x '�... �' _�tr4tp. — . �� ,a� � � _ �-_ ,� J ,. ,+��' . � � ��= T`e'3id '� ,� ��„ - t*"�'1 � ' � '� �Ar �,;:;,s- '�9'y,;.�� i�� } "�{, �€ .�,. �'��s.rr��. n .jy[��rK+t xv� . _ ,� �" �+ . 1F /'y � Y °a �3�.. / �.,. x��-- ,icr .1� . '+. ' . �?- � ' t � �.! r � ��.. • �.t h�, � y .�.�,..�" +��.. ..w ! {.' �'� ' i� � '�s�..r.y ��:��. 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Acres: 40.000 Lottery � Property Updated: 4/27/2021 Claims: Assessment _ _ _ _ _ _ First Dollar: No 2022 Assessment Detail Zoning: (A-1) Agricultural One Code Acres Land Imp. ESN : G4- 40.000 2,500 0 AGRICULTURAL Tax Districts Updated: 2/6/2007 1 State of Wisconsin 2-Year 2021 2022 Change 57 Sawyer County Comparison 022 Town of Radisson Land: 2,500 2,500 0.0% 576615 Winter School District �mproved: 0 0 0.0% 001700 Technical College Total: 2,500 2,500 0.0% Recorded Documents Updated: 6/11/2007 Property History TRUSTEES DEED N/A Date 439183 Recorded: 5/17/2022 QUIT CLAIM DEED Date 345542 Recorded: 4/2/2007 WARRANTY DEED Date 159116 280/354 Recorded: 4/25/1977 WARRANTY DEED Date 154709 269/205 Recorded: 4/1/1976 ��^"T";�-�';> pRIVATE ONSITE WASTE TREATMENT County ,�_--"� , �„� ! �� o� , '; SYSTEMS SaWyer ;.�,� � ( POWTS) s . �%V�F�-/e/� ��'=��'v�'' INSPECTION REPORT Sanitary Permit No: Safety and Buiidings Division (ATTACH TO PERMIT) GENERAL INFORMATION ��_ l�� 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#: l��`cv� j L._ `� y�C. a� c S5� r- Insp BM Elev: BM Description: Parcel Tax No: .c� � o� ��. ci S�r � d —o`I- �Yo) TANK INFORMAT N ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Benchmark ��j,p � Dosing Aeration Bldg. Sewer �7,83' Holding �jk 3 � St/Ht Inlet G'7,c� ' TANK SETBACK INFORMATION St/Ht Outlet qS:93' TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIRINTAKE Septic NA Dt Bottom Dosing NA Installation Contour Aeration NA Header I Man. Holding �(p` ,U � ` t$` �2S� Dist. Pipe PUMP 1�IPHON 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�L Bldg Well Waters °� GP ❑ Chamber Model Number: ❑ EZFIow CELL TO ❑ Mound o Other - — -— --- ---- — --- DISTRIBUTION SYSTEM x Pressure Systems Only Header/Marnfold Distribution Pipe(s) il X Hole Size I X Hole Observation Pipes _ � Length Dia Length Dia Spac �� Spacing ❑Yes ❑ No j SOIL COVER _ -- Depth Over Depth Over : Depth of Seeded/Sodded Mulched Cell Center Cell Edges _Topsoil__ _ � ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) � �,S�l��,( 1 � l�-(�� '. Plan revision required?�Yes❑ No I�o3 �i O�o � �� ` --�I �j� � 0 `� � __ -- --� Use other side for additionat information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) i A�OITIONAL COMMENTS ANO SKETCH SANITARY PERMIT NUMBER: �_^L��__ . _ �-3 �� . ,,,�.1\ 7 i Y --� ��:�� T � �� .� $' ' � 1 6 , g!�'� ' S� 3,a°� e ��,,,� ,,.e,,,�- �(�I�r, �D �1 � � / , ! �(-nLe� �2�� \ c _�v�-- �