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Home My WebLink About008-938-34-5203-SAN-2022-214 ;��.,.�t� County � - Department of Safety � � - & Professional Services, � � - a Sanitary Permit Number(to be filled in by C �_ � Industry Services Division �3�a� 3 � Sanitary Permit Application State Transaction Number , In accordance with SPS 383.2I(2),Wis.Adm Code,submissioo of this form to ihe appropriate govemmental unit � is required prior to obtaining a sanitary permit.Notc:A�lication forms for stateowned POW�I�S are submitted to Projcct Address(if diffcrcnt than mailing adc ,� the Department of Safety and Professional Services.Personal infortnation you pmvide may be used for secondary �7y�� R 5.� s H�+ZE D� purpases in accordance with the Privacy Law,s.15.04(1)(m),Stats. I.Application Information—Please Print AO Informatioe T�C, r Property Owncr's Namc Parccl# Q jy � Property Owner's Mailing Address Property Location Govt.Lot � City,S[ate Zip Code Phone Number �y/0 � �J� �O -----'b,-- — '/,, SecUon�—F — II.Type of Building(c�eck all t6at apply) Lot# T � N R E or� �1 or 2 Family Dwelling—Number ofBedrooms �j Subdivision Name �� Block# ❑Public/Commercial—Describe Use �/4 ❑City of ❑State Owned—Describe Use �A CSM Number ❑Viliage of �Town of ��.Ewq rF� III.Type of POWTS Permit:(Check either KNew"or KReplacemeot"and other appticable on 6oe A. Check one box on line B.Complete line C i a licable.) A. �New Syslem ❑ Replacement Sys[em ❑ Other Moditication to Existing System(explain) [I Additional Pretreatment Unit(explain) B' �Holding Tank ❑ In-Ground ❑At-Grade gn ype( p ) ❑Mound ❑ Iudividual Site Desi ❑Other T ex lain (conventianal) L- ❑Renewal Before ❑ Revision ❑Change of Plumber ❑Transfer to New Owner 11rt��ous Permit Number and Date Issued Expiration ��$ `— "7 a` � [V.DispersaU'Creatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Nroposed(s� System Elevation O ` Capacity in Total #of Manufacturer � Tank Infortnation Ga►lons Gallons Units � U U� � � New Tanks E�cisting Tanks � o m � � � � � a V cn �, i� cc. C7 Ci. Septic or Hold'mg Tanlc 2 �•.1 �' � � X Ih�sing Chamber V.Responsibility Statement- I,t6e undersigned,assume respoosibility for installation of the POWTS shown on the attac6ed plans. Plumber's Name(Print) Plumber's Si�mature MP/MPRS Number Business Phone Number � � � 3 � Plumbcr's Address Strcet,City,Statc,Zip Codc) O - I ' � Vl.County/Depxrtment Use Only � �q Permit Fee Date Issued Issuing Agent Signature Ap 4 � ❑Disapproved l,� I p� � �W ❑OwnerGiven Reason forDenial $ `�'� 8l � l l a� 3— Conditions of ApprovaUReasons for Disapproval �i��° `�,f�� J��'�� ._ � 4 — `—_--- r il G' �` `� 1 a 3`�S �.=:t J U L 2 5 2022 ;- �s� a-o�— � � q N�,u�/ l�°r�°� �3 o�4i . -- � �HvVY�� GC;_:s,. ; : LONING ADMINiSI-Fii�ilt3�l Attach to complete plans for the system and submit to the County only on paper not less t`ao 8 1!Z z 11 inc6n in size SBD-6398(R.03/22) NO REFJNOS AFTER ISSUE OF PE�iMIT �j S 9 � Sawyer County Zoning & Conservation Administration �� 10610 Main Street,Suite 49 � , � Hayward,Wisconsin 54843 �� (715)634 8288 � �� ,�� FAX(715)6�8 3277 / �� i;� aw�,t 4 tii t� iNt o�_;�� / � � � _ i E-mail �t._ � � :,i in �� Toll Free Courthouse/General Informat�on 1-877-699-4110 � � ''��\\�� Holding Tank Approval Checklist I. Sanitary Cover Sheet Date Stamp �7 / a�/ �� Parcel ID# O o$ -�( 3 g-� �(- S� d� II. Plot Plan �Property Lines �Bench�nark BM ♦ Site Address �North Arrow �➢ Structure �( Scale /�Well �<25' to Service Road �Legal Description �Nearest Road Intersection �p Setbacks to: Property Line, Well, Structure, Water bodies, Roads III. Required Plans '� Index Page with Original Signature Management Plan/Contingency Plan ervicing Contract � g��9�� olding Tank Agreement form IV. Holding Tank Specifications �Cross-section-Manufacture, Gallons: sk�c� 3 i2$7 �Tank Anchor Calculations [SPS 383.43 8) g)] Locking device, chains/locks �Alann 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 �CSBD-10855-P (R.3/07).. . 2•t Owner: �1 , ��ec�� Plumber: Y`� ��`^' "� Application Review Date: _ b $�� a-� POWTS Reviewer: � �.e�� N<��„� 6�� Liccnsc# Revised 4/11/2013 PAGE 1 OF 4 Holding Tank Plan Index & Cover Sheet Component 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 applicablej Already on fiie Holdin Tank Pum in Contract(if applicable) Already on file Holdin Tank A reement if a licable Project Name/Description Owner Name(s): Nicholas Zimmerman Phone: �15 215 _0081 owner address: 3706 Glen Way Eau Claire,WI Z�P;54701 Project Address: 2741 N East Shore Dr. Birchwood,WI 54817 Govt.Lot: 2 1/4 of 1/4,Section 34 ,T 38 N-R 9 E Q or W ✓❑ Township: Edgewater county:Sawyer Project Parcel ID#: 008938345203 Designer Information Designer Name: Kurt Brown Phone: 715 _943 2988 DesignerAddress:W10487 Old Murry Rd Exeland,WI Zip: 54835 E-mait: brownk@bevcomm.net . License Number: 224281 Remarks: Signature: -� n � , Date: ��7��z- Origin I signature required on each su6mitted copy. � SRE PLAN THE SfiE CURRENTLY HAS AN OLD NICNOLAS ZIMMERMAN �`B�N,HOLDING TANK�d0 POINT N 2741NEASTSHOREDR. �LLWHICHWILLALLBEABANDONED BIRCHWOOD,WI 54817 FOR NEW CONSTRUCl10N. scn�:,-= so� Gt,. z , Say, r38N, �9W �---� rx�oPeRrr uNEs LAI� DR.WAY �aq+ a5 q' P�o�Q,`°�q�o: CHETAC I 7 1 ❑ � I • 8M � r �3 1 �:-,: j 96.9' :;%r;%l;! ❑ PROPOSED PROP � �� B-1 HOUSE �� '`�";`l' 99.G � I ❑ , > / �2 ( 96.T BUILDING SEWER BM=100.0',WUl 8"ABOVE GRADE IN " A 21'DIA OAK TREE. TESTED AREA IS APP.25'ABOVE LAKE_ A 1568/1566 GAL.COMB.TANK WfTH A TOTAL EAST SHORE DR. CAPACffY OF 3,287 GALLONS WHEN USED AS A H/T IS PROPOSED TO SERVE THIS SfTE. OWNER MAY CHOOSE TO PURSUEA MOUND SYSTEM IN THE FUTURE. PAGE30F4 HOLDING TANK SPECIFICATIONS (No Scale) 4"0 Vent Pipe Wealherproof >109 from Junclion end Alarm Box qpproved Building VentCa �Z"Mia.or2.0ftabova Approved Locking Menhole P Estebllshed Flootl Elevation Eleclncal musl comply with w�th Werning Lebel Atteched 4'Mln,or2.011 abova SPS 316 and NEC 300 (�YP��) Eetabllshed Flood Elevation (bPical) �--Condult I (Iyplcal) � . �AirtighlSeal � � �� Finished Grede 18"Min. (�YPical) '�, . � � .'p�.. . . E .. � : Inlet I�' Inlellnveh Wetehight Appmved Joinls Wrth , P�OB Approved Pipe 3 fl anto I� �Max.12"ar 90°/,ollatel valume Salid Ground � ii more lhen one tenk � (�YPi�I) Alertn-On a, comvanma�i i voi=1,568 yai comPanmem z voi= 1,568 yei TOTAL HOLDING TANK + VOLUME = 3�28� gal . ,. e A , 3"Approved Badding Meterial Beneeth Tenk TANK MANUFACTURER: SkBW Pf@CBSt Anchor tank as necessary pursuant to SPS 383.43(8)(g) Ballast Weight= [(cu.(t.tank.vol x 62.4 Ibs/cu.tt)-Ibs.tank.wtJ x 1.5 Ballast Weight= [( 506 cu.ft. x 62.4 16s/cu.ft)- 2�,800 Ibs]x 1.5 = �4,662 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) shall be considered a human health hazard if not maintained in accordance with this approved management pian. 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= 400 gPd Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance fadors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o materiai 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 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 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. RepoR any component failure or malfunction to: Name of individual or company: HBfOIC� BfOWII EXCaVBtlllg Phone: 715 943 2390 �o�ai 9o�e��me�t„�;t: Sawyer County Zoning Administration Phone: 715 634 8288 �oca� 9overnment unit address: 10610 Main Street Hayward, WI Z�P: 54843 Any defective part of this system shall be repaired, repiaced, 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 depaRment 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 approvaf. 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 Conhact Date: _ / / This contract is made between the Holding Tank Owner and the Pumper. Holding Tank Owner's Name: Pumper's Name: � I . ��^W�r ic4o��s �r�WL/wt�� `�^�1 .•��c/1 St�J:�t Parcel Identi£►cation Number: Q (12DigitLegacyID) ��-�� 0 -��-�� 1. The owner agrees to file a copy of this contract with the govemmental unit, Sawyer County, which has accepted and recorded with the Office of the Register 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 propercy 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 servicc the holding tank(s)with the pumping equipment. The owner further agrees to pay the pumper for charges incurred in servicing the holding tank(s)as mutually ageed upon by the owner and pumper. 3. The pumper agrees to submit to the Govemmental Unit, Sawyer County,a report for the servicing of the holding tank(s)as required under SPS 383.55,Wisconsin Administrative Code and the Sawyer County Private Sewage System Ordinance. The pumper further agrees to include the foltowing 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 holding tank was 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 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 this service conffact or a copy of a new service conttact with Sawyer County wi[hin ten(10) business days from the date of change to this service contract. �_r" Owner's Name: (Print) � Owner's Si t e �o �y a� wner signature required) �t L�'�7�4 '"_�------� _ J �Mi!tiJ�<� Pu1mper's Name: (Print) Pumpar's tur . {JQi-�.�.��'dre�'�,/�:i:v�W�„< - '��, ) �--t_ . _ �,� Pumper's Regisharion Number: �/ ��1 � � � �� Rev.03/26/13 qf1G 19 2022 ��NIOSTAATIOt� �C�w IJ Y •\a�4�-e.VIAv�CR_ /�t�2A'^^Q�� I I 1 IIIIIIIIIIIIII�IIIII�II 1 � I � � Kv��.� `�a��.�-S 8 0 � � i � Document Number pocument Title TX :��'��!�I�6 44Q880 �'AULA �HISSER 12�GISTER OF DEEDS S�4WYER CflUNTY, WI �8� 19/20�2 12:12 PM RECORDING FEE 3�.00 PAG��: 3 Recording Area Name and Return Address Sawyer County Zoning Dept. 10610 Main Street, Suite #49 Hayward, WI 54853 oog- �38 - � Y -- � � �3 Parcel identification Number (PIN) T�-IIS PAG� IS PaRT O�'' THI`'J LEGAL I�"QCUNIEI�T - 1)� NOT R�' M�VE. This i^formation must be completed by submitter. documert title name & retum address, �rd PIN (if required). Other information such as the grantng c!ause, !egai description, etc., may be plac�d on ,his first page of the decumeni or may be placed on addiiional pages ef the documert. V�JRDA Rev. 12l22/2010 ��[� �_ � , � ,. ,.; , j ; , �; � -USE BLACK INK ONLY - ' `�ti ' '` AUG 19 2022 POWTS MAINTENANCE AGREEMENT �-` For Holding Tanks Sq�{ER GOUNTY Own r's Name(s)as s n on deed: ZONING ADMINISTRATION ;C � �`�� //'►'1 ,n,�,//YI t!� Parcel Identification Number: r-w - _ _ (T� D \\��\"CA'$/Al��'/��iii�� (12 Digit Legacy ID) �� ,�� J——� \�� lLG. . . :v�.�s, ifi � � � � •. �� '� ' � � Legal Description of Property: � ��' NOTqRy �'Z � -SEE ATTACHED SHEET - _ �.� _ We acknowledge that application is being made for the installation of a holding tank(s)on the � �� p�B��G �. - property described on the attached sheet. ��',9 '�. .•'��`�\;' � ��iPFOF'I�iSc`��\,� 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 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 will 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. one wner signature required- ACKNOWLEDGMENT O ' Si9 r ' -- _____� State of: �J'Gon�•n County of� � �ii�G O er's ya rint : . Su scribed and swo to before me on this , �1„�j �rrl vl�(/!/�'l�i �day of , 20 � Date: ` r ^ By(Owner's Name): ` � i � `�C �Q� Notary Public Signature: D afted by: Public Notary Name (Print): f' o '� My commission expires on: `7 Z rtV /:i t,tiJ� Personal information you provide may be used for secondary purposes[Privacy Law,§15.04(I)(m)] Rev.03/26/13 All that part of Government Lot 2,Section 34,Township 38 North,Range 9 West,described as follows: Commencing at the Quarter corner common to Sections 34 and 35 in said Township and Range;thence West on the East-West Quarter line 3,685 feet,more or less,to the water's edge of Big Chetac Lake;thence I�'ortheasterly and along the water's edge of said lake 700 feet for a point of beginning;thence N89°E,400 feet to an iron pipe;thence N30°E,90 feet to an iron pipe;thence S86°W,392 feet,more or less,to the water's edge of Big Chetac Lake and 100 feet East Nor[heasterly from the place of beginning;thence Southwesterly,along the water's edge of said lake, 100 feet to the place of beginrung. Tas Parcel Number:008-938-34-5203 Property Address 2741N East Shore Drive,Birchwood,WI 54817