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Home My WebLink About032-538-03-2106-SAN-2022-242 _ °` ` Department of Safety c°""�' � =\ � = & Professional Services, �� ,_ _ = Sanitary Perrnit Number([o be filled in by � �s , Industry Services Division C� 3 �t a.�.� �, Sanitary Permit Application State Transaction Tvumb� � In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit N is required prior to obtaining a sanitary permit.Note:Applicarion forms for state-0wned POWTS are submitted to Project Address(if different than mai►ing a .� the Department of Safety and Professional Services.Personal information you provide may be used for secondary � purposes in accordance with the Privacy Law,s.15.04(I)(m),Stats. ��e�� I.Apptication Information-Please Print All Information Property Owner's Name Parcel# � a -S - o� ^al� Property Owner's Mailing Ad ress Property Location P� ([� 't Govt.Lot City,State Zip Code Phone Number IG(.�(� �21,r� � �t S � SU�� L�S� N t Ya' x� %4, Section � II.Type of Building(check all that apply) � Lot# ` T O N R E o W �1 or 2 Family Dwelling-Number ofBedrooms �r Subdivision Name �_ Block# ❑Public/Commercial-Describe Use '�- �City of ❑State Owned-Describc Use CSM Number ❑Village of ��333 #L13a ��f Cv►r�-��- III.Type of POWTS Permit:(Check either"New"or"Replacement"and ot6er appGcable on line A. Check one box on tine B.Complete line C if a licabte.) `4' ew S stem y ❑ Replacement System ❑ Other Modification to Existing System(explain) ❑ Additional Pretreatment Unit(explain) B' �Holding Tank ❑In-Ground ❑At-Grade gn yp ( p ) ❑ Mound ❑ Individual Site Desi ❑ Other T e ex lain (conventional) C• ❑ Renewal Before ❑Revision ❑ Changc of Plumbcr ❑ Transfer to New Owner ist Previous Permit Number and Date Issucd Expiration .� IV.DispersaUTreatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(sfl Dispersal Area Proposed(s� System Elevation o�DU � la � I� l�( � Capacity in Total #of Manufacturer Gallons Gallons Units � o '" � Tank Information .fl �' v � ,, New Tw�ks ExistSng Tanks � o „ � � �� n. U �n � in t�. C7 a. Septic or Holding Tank 1 �f�� -'I 5�4� ce �t�L I �J J-- �� Dosing Chamber V.Responsibllity Statement-1,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumb Signature � MP/MPRS Number Business Phone Number C'r�.� � n R .�r ��sla ?t�a� -asS�la Plumber's Ad ress(Street,City,State,Zip Code) SC��1- l�4 �-� 5�n � c�-L��', �-(J.�- �`��'-L� VI.Co n /Department Use Only �Ap d ❑Disapproved Permit Fee Date Issued issuing Agent Signature _ OO �Owner Given Reason for Denial $ C�c�. �t ( I a-��.- -�.�� Conditions of ApprovatUReasons for Disapproval � � �'�s,��i� - q � I�-�2a �L� �� ' �}�.�I I�� (�c�o� SEP 0 7 2022 �=% n �ew Wortd # 3''`�� SAWYER C011NTY C ST N b�' K�.p, �� ZONING ADMINISTRATiON f� Attach to complete plans tor the system and submit to the County only an paper not less than 8 U2 x 11 inches in size sB�-639s(R.o3i22� NO REFUNDS AF1'ER fSSUE OF PEFMfT � Sawyer County Zoning & Conservation Administration �� 10610 Main Street,Suite 49 � � 1 j Hayward,Wisconsin 54843 � ��'� � ��I (715)634-8288 � ��5\��j FAX(715)638 3277 � � , �.t i r �' \�K,� t��ti��': u�cccrtt7S�^i)ti.t_i� I � �` = j..., i E-mail zoni:��c,c-,a��ic�u�it� ov_tu�� , �=7' .' Toll Free Courthouse/General Information 1-877-699-4170 I,��\\\t�`� Holding Tank Approval Checklist I. Sanitary Cover Sheet Date Stamp D� l D�/ � � Parcel ID#0 3� S 3 B_�3 - �- 1 O � II. Plot Plan X Property Lines x Benchmark BM ♦ �Site Address �North Arrow �Structure Scale �CWell �<25' to Service Road �Legal Description �Nearest Road Intersection � �Setbacks to: Property Line, Well, Structure, Water bodies, Roads III. 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: 3�� Jk�� 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: �ronsZ, S c,� Plumber: C`�� Application Review Date: � `� � < / POWTS Reviewer: �, l�- �� Ndme � � �� Liccnsc# Revised 4/11/2013 PAGE 1 OF 4 Holding Tank Plan Index & Cover Sheet Component Manual Design References: Version �;SBD-10855-P (N. 03/07; R 01/12),. , Pg 1 of 4 a \ 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): Kyal1 Kro�eb�.tSG�� Phone: ��? - aS`f- `IS� Owner Address: �01S 2 S� �ve ?�l� l��;n��L� "Zip: SS�I�� Project Address: p D�Jef"� �aC Govt. Lot: �C 1/4 of 1 y l�1/4, Section 3 , T�N-R S E Q or W � Township: l,V ��'��.f' County: Jctc�.��e,t Project Parcel ID#: �� S 3� �3 0� l 0 (O Designer Information Designer Name: cc.i � Phone: �IS -�- ag�a Designer Address: " — � � Zip: ��(�tl� , /� E-1'llal�: ��OI�Q�nl�C� 111 C . l_C�� 'l��lti:s�•,,�e rc,rn•cc1 f«r aE7pru��,�i st�:uut>. License Number: o�o��$�(� Remarks: . Signature: Date: ��-a�-aa Original ature required on ea h submitted copy. CHECK BOX AS APPLICABLE CHECK 00X AS APPLICABLE. � SOIL EVALUATION sca�e:�•'=ao' �SYSTEM PAGE 2 OF SITE MAP � � � � PLOT PLAN PROJECT NAME: oesicN F�ow�. c2UC� cao 1., 10' �r��-'(+J��lS11C ZL p Attach design flow calculations tor commercial plans. PROJECTADORESS: I�Jnk�n2fk I�cY Pipe Material/ASTM Standard(Tables 384.30.3&384.30-5) � N sa��we, K'� � C�vC BM Symbol:-$? BM Elevation: �(17•D FT Fwce Maln'. / BMDescnption: �� i!� CI„i.M{1 D��SjW�Q SiopeGrad�ient/) indi��enonnoy IMPORTANT: ( /.-�� Well bymbol�itappiicabte��. 0 a.awi�p a�a� Show ground elevafion contours at suitable intervals. o/Tested Area. n I�e approprile Ilrie. QJbbeC't (�cQ � � � 2 �cc� N 1- a�r � .� o Go h � bm �`we�1 �o`� � l ,�a. � P9• 333 cs,,.,# `�3� b32—�38-�3-�iDb PAGE 3 OF 4 HOLDING TANK SPECIFICATIONS (No Scale) WeaMerproof 12"Min.or 2.0 ft above Junclion and qPP�� Esis6lished F�ood Elevadon Alartn Boz Vent Cap (bPical) Electrical must comply with ` Approved Locking Manhole SPS 316 and NEC 300 4"0 Vent Pipe with Waming Label Attached f-Condui[ >10 ft from (typical) 4"Min.or 2.0 f[above Building I Esiablished Flood Elevation � (tyPical) ._ �AiNghtSeal " � Finished Grade 18"Min. RYPical) .:< . . .. � e 4 8 . Inlet Inlet Imert �—Watertight Appmved Joints with Plug Approved Pipe 3 ft onto � Max. 12"or 90q ot total wlume Solid Ground - if more than one lank n " Alarm-0n HOLDING TANK VOLUME = 3�°� gal . e ' . G . . �e � . ' - � . . 3'Approved Bedding Material Beneath Tank TANK MANUFACTURER: ��44/ PI e C25� 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.w[]x 1.5 Ballast Weight= [( ac�,a�s cu.ft. x 62.4 Ibslcu.ft)- 3 5 �C Ibs] x 1.5 = ��3 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 382384,Wisc. Admin. Code. Pursuant to SPS 383.52 (2),Wisc. Admin. Code, this holding tank(s) shall 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 registered POWTS Maintainer in accordance with SPS 383.52 (3),Wisc. Admin. Code. Estimated Daily Wastewater Flow= oZ L� gpd 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 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 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. Report any component failure or malfunction to: Name of individual or company: ��(1 1 nc�mPS�n d- �n5 �Y� «C Phone: �J I S-0�6(0` 0�2��/0? Local government unit: S4 W�/P��Z�y� Phone: 7(S �o3t/- �� Local govemmentunitaddress: !l��D /�t�i�/� �, rJw� ��T L'7r�� ZIP: ��y3 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. Contingencv 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. HOLDI\G T;�\K SEK\'ICI\G COV't'RAC'l Contract Da�c: i_/ This conlract ic madc bch�rcn thc ITnldin� Tank O��ncr:�nd thc Pumper. Holdin� l ank O��ncr's Namc Pmnper's Namr. � Northwest Sanitary, Inc. PO BOX 155 GL� �(��(�{� Radisson,W154867 Parcel Idenlification \�nnber: � I? Di�it Le�acy ID) 0 3 a - s 3 g - 0 3 _ a L o � I. Thr o�rncr agrccs to lilc a cupy of ihis contract wilh thc�o�crnmcntal unil. Sawycr Countv. which has acccptcd and rocordcd �vith Ihc OI'ficc ol thc Rc�istcr of Dccds. thc A�faimcnancc A�_rccmcnt for a Holding Tank rcquircd undcr thc Sa��ycr Counly Pricatc Sc�vagc S��s�em Ordinancc 1'or thc isa�ancc oCn Sanitary Pcrmit for thc installation of a holding tank(s). '. Thc rn��ncr m�rccs to hu�r thc holdine tnnk(s) scrciccd by thc pumper and guarantccs to pcnnit thc pumper to ha�c access and to enter upon thc propert� lor thc purpose of scn icin!_ ihc holdim,tnnklsl. Thc o��ncr a��rccs lo m;iinlain thc all-wcalhcr acccss road or dricc so Ihal Ihe pumper can scr�ice !hc holdin, mnk(s) ��ith �he pumping cquipmeni. The o�vner furlhcr:��_rccs tu pay lhc pumper for a clmrecs incurrcd in scrcicing Ihc holdinu tank(sl as mulualh� a,,rccd upon by Uic on�ncr and pumper. i. �Phc pumper a�sccs lo submil lo thc Goacrnmcnlal LniL Sa�cvcr Count�. a rcport lor thc scn icine of thc hofdine lankf5l �s requircd undcr SPS 3K3.��_ N'isconsin Adminisu�ati��c Code and the Sa�rycr County Prieatc Se��age Sqstem Ordinance. "The pumper fin ther agrces to includc thz ibllo��•ing in thc reporC a. 1'hc namc and nddress of�he person responsiblc for scn icing d�e holding tank; b. I'hc n�mc of thc o«ncr of thc holding lank; c. "1 hc si�c address ol'thc holding ianl:; d. I hc datc thc holding tank��as scr�iced: c. Thc �olumcs in ��nllons oCthc conicnts pwnpcd from the holding tank tor cach sciiicin!s: C l hc disposal sices to��hich thc contcros I'rom thc holding tank wcrc dcli�crcd. 4. This a��rccmcnt �vill rcmain in cl�lcct witil �hc o�vncr or pumper tcnninatcs this contract. hi thc c�rnt of a chnnec in this contract. thc o�vncr aerccs to Glc a copy ol am: changcs to this scr�icc conuacl or a copy of a ncw screicc contracl �+ith Sa��}cr County ��ithin tcn (I(Il busincss days Il�om thc d�tc of chnnec to this scn�icc conu'act. O�rncr�s Nanu: (Print) Owncr� Signaturc: �d,��.�,,.,��•� .��„o�� ,•y��..p ��1 F-ww� Pumper�s �amc: 1 Print) Pum rs Signaturc: Ronald L Vieceli,owner Norlhwest Sanitary,lnc � G, Pumper�s Rc,isiralion Numbcc #2389 Rec Oi�>G:I i ___ ( i i i �iii i�iii ii ii�iii i i -USE BLACK INK ONLY- 8 0 n 3 � � 1 POWTS MAINTENANCE AGREEMENT Th::4040626 441259 For Hoiding Tanks PAULA CHISSER Owner's Name(s)as shown on deed: REGIS7ER OF DEEDS SAWYER COUNTY, WI �9/09J2022 �1:27 PM • �� l 1� RECORDING FEE 30.00 Parcel Iden ification Number. (12 Digit Legacy ID) ��- s 3 �- o ,�- al a � pQ(',,ES: 2 Legal Description of Property: -SEE ATTACHED SHEET- We acknowfedge that appiication is being made for the installation of a holding tank(s)on the property described on the attached sheet. Retum 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 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. 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 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 govemmental unit. The govemmental unit may enter upon the property to investigate the condition of the holding tank when pumping reports may indicate tfie 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 governmentat unit to prevent or abate a human h�alth hazard as described in Section.254.59,Stats.,the govemmentat unit may enter upon the property and service,or cause the tank to be serviced. Pursuant to Section 145.20(4)Wis.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 Section 66.0703,stats. The owner agrees to pay atl charges and cost incurred by the govemmental unit for inspection,pumping, hauling,or othervvise 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 govemmental 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 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 agreement shall be rec�rdad by the register af 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. -On1 on owner si nature uired- ACKNOWLEDGMENT Owner's ' ature: State of: �:n n�5 o-F� County of: U I w.s�-e-� Own" ' e(Print): � �� Subs�,c,fibed and swom to before me on this r�n �� /S`� dayof � �. �� , 20 '�a Date: By(Owner's Name): r b �Sc,� �YS I-� �2�' Z� Notary Public Signature: Drafted by: , � � � Public Notary Name(Print): ,�,�. My commission expires on: ;� �1 aoas v�`'S J�� BEN E. BOYNTpN Notery Public Personal infortnation you provide may be used for secondary purposes[Privacy Law, )] Stete of Minnesota Rev.03/26/13 My Commission Expires January 31,2025 Lot 9 of Certified Survey Map No.430 recorded in Volume 2 of Certified Survey Maps Page 333 as Document No. 145377, being part of the NE t/4 of the NW 1/4 of Section 3, Township 38 North, Range 5 West,Town of Winter, Sawyer County, Wisconsin. , , � :.— "" C. :.. � s 4 `^1: .h.�'.'. f.t . v' y{ f �f�'�_ r � , � .�t �b ° J � .f., � .l'a � yy n`. �s ys - �� .._,C t�w�'_ �Y _ • � �YE•Of Y !�� 1Y' r�;ry , ? L� _ ,�� ,� C ::. � - _� ' ' " ��:—�'� t � 4�,°, �n .�'}'_ '� '��'4}+Y � v�p � i{ � �c.. ' �'� a -� iR �}'. � t -. Y _ . '� s � rk,'.�� '� ,,�,�� < � , �,� �< < . a � `��`�; �, siF ';.� �a��i�> bi .j y� � �- : Th O;��S 64 Y. A �(�� < �„j�� . ��"' :'.F \} �{t ..1 '...4 Q V`s '.vl":P � _� \*� 1� .e �� . 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'.1G115 � e 919122, 1247 PM Real Property Lis[ing Page Real Estate Sawyer County Property Listing v�oPerrysrat�5: c��.e�c Today's Date: 9/9/2022 � Created On: 2/6/2007 7:55:56 AM �Description Updated: 9/21/2005 '� Ownership Updated: 7/13/2022 7axID: 33709 �� RYANKRONEBUSCH � �� PLAINVIEWMN PIN: 57-032-2-38-OS-03-2 01-000-000060 LAURA RINN PLAINVIEW MN Legacy PIN: 032538032106 Map ID: .5.6 Billing Address: Mailing Address: Municipality: (032)TOWN OF WINTER RYAN KRONEBUSCH RYAN KRONEBUSCH STR: 503 T38N ROSW 615 15T AVE NE 615 15T AVE NE Destription: PRT FRAC NENW LOT 9 CSM 2/333 #430 P��NVIEW MN 55964 PLAINVIEW MN 55964 Remrded Acres: 1.500 m Calculated Acres: 1.500 r Site Address * indicates Private Road Lottery Claims: 0 N/A � � � First Dollar: No i�l O Zoning: (R-I) Residential One u property Assessment Updated: 10/10/2016 ESN: 428 2022 Assessment Detail � Code Acres Land Imp. � Tax Districts Updated: 2/6/2007 Gl-RESIDENTIAL 1.500 8,300 0 1 � � State of Wisconsin 57 Sawyer County Z-Year Compariwn 2021 2022 Change 032 Town of Winter Land: 8,300 8,300 0.0% 576615 Winter School Distric[ Improved: 0 0 0.0% 001700 Technical College Total: 8,300 8,300 0.0% .� Rewrded Documentr Updated: 7/13/2022 L��1 WARRANTY DEED � � � �'C�'Property History Date Recorded: 7/5/2022 440010 N/A � EASEMENT Date Recorded: 7/5/2022 440011 WARRANTY DEED Date Recorded: I/18/2021 429372 TRANSFER ON DEATH DEED Date Recorded: 3/8/2010 365525 WARRANTY DEED Date Recorded: 8/3/2005 332340 CERTIFIED SURVEV MAP Date Recorded: 9/15/1973 145377 https:lltassawyercountygov.orglsystem/frames.asp?uname=Eric+Wellauer �� p�bb�rt ,P� s�i�-� i � S � � I � � � I i � am�, i�� e� ��1� Q,5_O.IS H� /u�� IS �-�Jet S:Sa � I _�u,��n5 S�er r�o-E F I -� � i �n5ty/�e.� a-t -�h.s f� c �y I / '�`�_l��C"�r]Q �� J b �r0 i T K, ;�i r�5e,- �n �I.T, a�' � � �� `5`,-�e I k � gm i Office of Sawyc�• Couuty Zo��ing �.ct�i�i �u�i�M-<<lion � i�o ��x �>�� I�laywacd, W[ 54 843 . l�eL (715) G3�1-82RR I�ax: (715) G38-3277 Ultl.: hllp://sa�vvercoui�lvi:o�� ` L'mail: zo�wi .sec a�satiVYClCouiilygov_or�; . 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