HomeMy WebLinkAbout022-638-33-2301-SAN-2022-272 ","'"'r � Industry Services Division Coun
,:0�=_-�f 4�, ry �
/F`, �
I,;/� ��'r\ 4822 Madison Yards Way ._y„ ,;/- -
�-�� � � Madison,WI 53705 Sanitary Per�iit Number(to be filled in b} �
��� ���P ���� P.O.Box 7302 �
�'.'t S ''.' � s
��� -` '�% Madison,WI 53707 (_p � �' �
�°='%�.���:,:t�`i
Sanitary Permit Application State Transaction Number �
,
In accordance widi SPS 38321(2),Wis.Adm.Code,submission of this fonn to the appropriatc governmental unit � �
is required prior to obtaining a sanitary permiL Note:Application forms for statc-owned POWTS are submitted to Projcct Address(if differenl than mailing
�hc Dcpartment of Safety and Profcssional Serviccs.Pcrsonal information you provide may be used for secondtuy ,�,7,�1/� �
pwposes in accordance with the Privacy Law,s. 15.04(I)(m),Stats.
I.Application Information-Please Print All Information f'c!� *'i� i�
Yroperty Owner's Namc Parcel
�/_ � �'�/� � �- x i 52.. JT �'y��� '� ;�;' " ��� -.,-�3z�/
Property Ownei's Mailing Address Property Location
�7.�, > ! co 7w � �/%- Geut-�e�
City,State Z,ip Code Plione Number
.
J, `L� Y,, !{f '/,, Sectian ;i "r'
!%i"� -i 3 v �' S �� � 7 L.. rC� -if-Si 5�
II.Type of Building(check all that apply) �-�t# I' �� N R�E �
�Ior2FamilyDwclling-NumberofBedroonis � ' SubdivisionName
Qlock# �
�ublic/Conmiercial-Describe Use
^ �City of _
❑State Owned-Describe Use CSM Number Village of
� �lown of l�%�r �a��yr —
IIL Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Co►nplete line C if
a licable.)
`�' Ncw S stem Rc laeement S stem ther Modification to Existina S stem ex�lain Additional Yretreatmen�Unit ex lain
❑ Y � P Y� � b Y � 1 ) ❑ � p )
�' �[lolding Tank ❑In-Ground �At-Grade �Mound Individual Site Design Other Type(explain)
(conventional)
C• ❑Renewal Before �Revision �Change of Plumber �I'ransfer to New Owncr ��t Vrevious Pennit Number and Date[ssued
Expiration (,�v�k i ?
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Desi�n Soil Application Rate(gpci/s� Dispersal Area Requircd(s� Uispersal Area Proposed(s� Systcm I:levation
�t'i�i
Capacity in Total #of Manufacturer
7 ank Inforniation Gallons Gallons Units a o '� �
New Tanks Existing Tanks � G � � � � � �
o r
ci c� v� � v� i.�, c7 a
Septic r Holding Tan . : ,
.� G'iC`i.�i �% l/_''.C,�=-.' G/' � �i9 �
Dosin�Chambcr � � �
V.Responsibility Statentent- 1,the undersigned,assume responsibility for installation of the POWTS shown on the atfached plans.
Plumbei's Name(Print) Plumber's Signature 1)'MPRS Number I3usiness Pllone Number
�_
= � t -� -y �-7
��/ � :i C�LI � - �"�Ccf' .j�� i�� � ��gri _s`c�`'� � �:"-;- - -_-'>' ' �/
Plumber's Address(Strcet,City,Stat� _ip Code)
�� �%" =� ,t�-�i/ � 1-_�1 �,��r,'�> l� ' s-y�.,-��.
VI.Coun /Department Use Only
�A o � ❑Disapproved Perniit Fee Date Issued Issuing Agent Signature
❑Owner Given Reason for Denial $ 1 U�'�� 1 f a�I a� "l'�'`e�1 rG�'��''�r
Conditions of Approval/I2easons for Disapproval
� ,�02 a . _ �_ ,�, .�/,.\ �-'S�r-,.:-1�--},=��
a ��� i
�� � ��� � � � ' �� 1 i r _ e
O ^ �r`._.....� � :... .. .. . r , ,', !
�hk#. (�`��� r- _.� ��� f� ,;
' � 1
�� /�� .or Ic�`�3�0�� '__ � �_s ..C1�2 _.�
�� , N�ew I.J
� � i "�`� c� fi _ _.. . ^ � _
_ ,., . _ _. ,.._w._._ µ .
�►•�
. _.._. . . .._.. ..
Attach[o complete plans fm�the system and submil[o the County only on paper not Icss than 8 1/2 x(1 inches in�5ize�� � � - � � �''��`�•� �����
ssD-�39s�R.o2i22� NO R�FJNDS AFTER
I�SUE O�PERMI'T
� Sawyer County Zoning & Conservation Administration
�������� ]0610 Main Street,Suite 49
�,,: : -, 1� Hayward,Wisconsin 54843
k I
-%� � I (715)634 8288
�, �� �� �ra��I FAX(715)638 3277
� � ��� ; t.� �-tivti�, iti�cfc�>s�aiti ��..���
i '
/ ,� ;' ,� �„ i E-ma�l zoni� «c�i;sal���cttua�t� t��.ar��
�� `:a � Toll Free Courthouse/General Informahon 1-877-699-4110
x,�
I�','„ r`
1�1�����
Holding Tank Approval Checklist
I. Sanitary Cover Sheet Date Stamp �`� l 027/ o�-a
Parcel ID# � a-�-G 3 g-3�- �3 � (
II. Plot Plan
�Property Lines �Benchmark BM ♦
�Site Address �North Arrow
�Structure �p Scale
�Well �<25' to Service Road
�Legal Description �Nearest Road Intersection
�Setbacks to: Properiy 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:
���,-}}- l-lfl 3,ao�
�Tank Anchor Calculations [SPS 383.43 8) g)]
�Locking device, chains/locks
1(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 I�,SBD-10855-P (R.3/07) _ _
�- �
Owner: �e�-� _ Plumber: ��� To��q
Application Review Date: D5 j�-`7 / a-2
POWTS Reviewer: �,�
Name
l�� � 'lo
Liccnsc#
Revised 4/ll/2013 �
CONCRETE HOLDING TANK DESIGN
Single Tank Option
INDEX AND TITLE SHEET
Project Genthe
Owner Herbert M.Genthe
Address 14760 W.Honey Lane
New Berlin,WI 53151
414-870-4554
Legal Description SW NW S33 T38N R6W
Township Radisson County Sawyer
Subdivision Name Lot No.
Parcel ID Number 022-638-33-2301
Plan Transaction ID Number
Index and title sheet Page 1
Holding tank specifications Page 2
Site plan Page 3
Maintenance and contingency plan Page 4
Page 5
Holding Tank Agreement Page 6
Holding Tank Service Contract Page 7
Page 8
Page 9
Designer Ronald R.Young
Signature L�����„�G Phone No. 715-532-3777
License Number MP226713 Date 09/22/22
Designed pursuant to: ` / ^
Holding Tank Component Manual For POWTS(Version� /
SBD-10855-P(N.03/07,R.01/12),__ �
version zo(iviz) Page 1 of 9
HOLDING TANK SPECIFICATIONS
�Number of bedrooms
300.0 Non-residential estimated flow (gpd)
2500 0 Minimum holding tank volume required (gal)
3000.0 Proposed holding tank capacity (gal)
Huffcut Tank Manufacturer
HD3000 Tank model number
SJE Rhombus Alarm manufacturer
Tank Alert Alarm model number
Tank Dimensions and Data Tank Anchor Calculations
X for round tank 21000 Ibs Weight of tank and cover
60.0 Liquid depth below inlet invert (in) 1.50 Safety factor
8.0 Maximum depth of soil cover(ft) 32827 Ibs Weight of anchor required
75.0 Height (in) �utside 42.8 in Soil cover req. for anchor or
156.8 Length (in) Dimensions 8.1 yd' Concrete caunter weight
84.5 Width (in) Only
HOLDING TANK CROSS SECTION
manhole cover with
locking device and fnished �vent cap
junction � warning label grade
box � I —
�4"min. y 12"min.
l� E-23in.
Manhole and vent locations
conduit � vent pipe
18"min.
� tetherweight -- �
building sewer
� O service � 12.0 in. inlet
blind plug a�arm on Note: All tank j0ints, and
to seai joints between tank
ouuet openings and piping are
Electrical as per 48.0 in. sealed watertight. All
NEC 300 pipe and vent materiais
and SPS 316 comply with SPS 384.
3 in. bedding under tank. Tank is anchored as necessary to negate buoyancy.
Project: Genthe
Transaction Number: Page 2 of 9
/ T•
nr ��,�
�to�af�� r,�n��c s�r� ���
� Project: Genthe
� Legal Description_ SW NW S33 T38N R6W
�
� ����`-`�' ����p Subdivisio� Name:
Scale: 1" = 40 ft Parcei fD: 022-638-33-2301 lot No.:
cr� ��r .�/o�'�d y
F�e"r! � G � v� �j�`% �,//Qb��
�'�.5�'h,4�o Pv�� o �_� c'i�r�a'�o.+�
_ .
.3 oc�o�r���oat', j�/,� , �
a
w �
` �C a
�
� � �
p' !� Bed•
�
� � � ;�o�� ^ ��� �ca
rt o e � gM �-` �� � ` �
�
. �.''S-•
�86N °�
�
D,"�'ve t.�/<z - �
^
� � 9'- c� "
M
�
96�,s-,.
---.� ._.____ __--______---_
/o �-i5�
�Soo��
�
�
Transaction I.D.: Page 3 of 9
a � ���/
HOLDING TANK MANAGEMENT PLAN
This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and
maintained according to SPS 383, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10855-P
N. 03/07, R. 01/12), and the Sawyer County Sanitary Ordinance.
1. This POWTS is designed to accommodate a wastewater flow of 100.0 to 600.0 gpd.
2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in
the attached Holding Tank Servicing Contract and Maintenance Agreements.
3. Each time the wastewater in the tank reaches 90% of the tank(s)capacity or a level of 12" below the inlet
(at which time the alarm will activate), the pumper listed in the current Service Contract must be called to
empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code.
4. At each service event, the service provider should visuaily inspect the condition of the tank, risers and
manhole cover(s)and verify that the alarm system functions and manhole locking devices are present.
Discrepancies are reported to the owner in a timely manner for corrective action. Ali corrective actions
shall comply with the county sanitary ordinance and SPS 383 and 384 Wis. Adm. Code.
5. All service events or inspections of this POWTS shall be reported to the county within 30 days.
6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be
removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes
tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes
a failing POWTS and may result in issuance of correction orders or a citation by the county or state.
7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards
for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue
of a person from the interior of the tank may be difficult or impossible.
8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank
may be installed in the same location (a new sanitary permit is required for such a replacement). Con-
nection to municipal services would also be considered at this time if they are deemed available to the
property.
9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in
accordance with SPS 383.33 Wis. Adm. Code.
10. If there is a problem with, or question about this instailation, the following persons may be contacted:
a. Installer......................... Ron Young PH&Exc. Phone: 715-532-3777
b. Service Provider............... Northwest Sanitary Phone: 715-943-2650
c. Co. Zoning or Health Dept. Sawyer County Zoning Phone: 715-634-8288
11.
Project: Genthe
Transaction Number: Page 4 ot 9
9/27/22,12:17 PM Real Property Listing Page
Real Estate Sawyer County Property Listing Property5tatus: Curren[
Today's Date:9/27/2022 Created On:2/6/2007 7:55:37 AM
.=��Description Updated:10/31/2007 �*Ownership Updated:7/25/2007
Tax ID: 22079 � HERBERT M&DENISE A GENTHE� � NEW BERLIN WI
PIN: 57-022-2-38-06-33-2 03-000-000010
Legacy PIN: 022638332301 Billing Address: Mailing Address:
Map ID: .7.1 HERBERT M&DENISE A HERBERT M&DENISE A
Municipality: (022)TOWN OF RADISSON GENTHE GENTHE
STR: S33 T38N R06W 14760W HONEY W 14760W HONEY LN
NEW BERLIN WI53151 NEW BERLIN WI53151
Description: SWNW
Recorded Acres: 40.000
Calculated Acres: 38390 '-�Fl Site Address 'indicates Private Road
Lottery Claims: 0 2786N BUGYIE BLVD ��� � OJIBWA 54862
First Dollar. Yes
Zoning: (F-1)ForestryOne -�..�propertyAssessment Updated:8/9/2017
ESN: 426 2022 Assessment Detail �
Code Acres Land Imp.
��Tax Districts Updated:2/6/2007 G1-RESIDENTIAL 2.000 7,000 70,300
1 State of Wisconsin GS-UNDEVELOPED 50.000 2,SOD 0
57 SawyerCounty G6-PRODUCTNE FOREST 28.000 36,400 0
022 Town of Radisson
576615 Win[er School Distrid Z-Year Comparison 2021 2022 Change
001700 TechnicalCollege Land: 45,900 45,90D 0.0%
Improved: 70,300 70,300 0.0%
�:� Recorded Documents Updated:10/1/2021 Total: 116,200 116,200 0.0%
VERSONAL REPRESENTA7IVE5 DEED �� � � �
Date Recorded:5/14/2007 346406 -�
7RANSFER ON DEATH DEED ��Property History
Date Recorded:9/30/2021 435009 N/A � � �
https:l/tassawyercountygov.org/system/frames.asp?uname=Eric+�n/yllauer ���
} t,.� M /Y - i
a .., � >F, ' �' rSnYi q � �'^'f (� � 5 n" �Y �%^ 4a� ry, ���'!�.i�yfc '° y� �`'�i �?1�+ f �`ri� y
�; Y .�. . � �1 ��� � f � . � ! [
.�y �: �� '}� ��� „ � �aj �a;N�?d�ry w ;i�s�,�4` 'r � - r"r� ti"�` - y�K +="�r'�..Y.��{. : ..c#`' ���'
;C,�tt � 49'� ' � �YY+.::' �y ""' ;. �y' �1}` �,�� p,i.t� � �.�1 w 'M��♦ M1 vl� y '}t' '4i ��
�n Y�ir5,'x�1 'sx � ,'.� ir ..�.s e` sk� � M: i.N`��°iFy� `^b "`'p,; ''Y''6 T�^�•3,`k M � 1''t C;`
�` i < ' 2-,�.�, `�w � a^'� �. K S '3`d ' 2 r� .�`'n` e h ic;_ ,�:� � a���iw�aw�C �a.� -b..."vy�`'4
-� -�,t i r '4 .�i7 Y7,. .i = +1k. .9' �� �}}^` � � {�i�i� l* .. 1 ��
> ,� Y ... "s4'f � �yl^ ♦ � P,� � '� t �•; �,. ypF �`a t ? t�+ � •
FL`�, a . �.'4 Y � � �t � �, .
J ,r � A>f r�� . ��Yy�� .,
�4 � ��-_ ���4� h,�y�+��'�� tI b���, , c`�; � � y 4�1�rr�..�r�2 Y. '1 t 91 �•_, '"}; d.�i�) �' .�
�A- :Ls -v � ^ri � 4 11 f yfi`�P t �: �!��t• L ,,.i x a,.:s4ti''"{p�.�
.g$ _ � � ., C ,� �'�S'$Wiii�_�'?° ,.9a• � '.` h .'. ��4�n��t � �e. +l
a,�- 'vk, 'f.� C� F � �„'�� �- �icL 7� -v '3 5 rtY i i �, y � ��! 'FM 'S,
3., r. \, v '�^u .�h- ti' .y 4 ...yF y4 L v �±�
�.' b,�h i j�y"� ��i. �'.c. h'�., :�',� � gp � :} �R,�it .k, Y, ���. �*f � `S��c4�� ;� Y�;'
'.� ^,1 �`�i " �Sz w y� �,45ct+ �'K' "5" T .'�.� -,> ^ Y' �43'i,�J+� i,2 'LC �
1^s�- i f- . . '�e.k4 n '�`i a,,. l.a�" �, .h ���„�, i ,n .� .. �i ,�,� "�K;
,,. � v,.' ,:�1^y ^ P: f + �� �'•, ct�t �. § .� 1i�,.� +S.'� SA,i f�}� �y'< o- ,
k �� at� �',b ri `}:."'Lw �.��..{�AA. µe9 N.'. �'t � r K � h 9p'.,t " � N�` r[� � �Y.��
.:��tG.CSfG.ti..:,.iD� i �ii;�.'� f�'�'1a,X^:�r �*�.- � ,�..�'R'�ie4 � :�.i>S . .'�l'•^�.��t:��7x�� i '��`:�!��,.+.z�'�i:�.
' Y'•C'9 s��-;:
1 . y� �„ .�. <'3 :.,,y��a% ..r ,,,v ^. i .:.+,it,r y� � � . . ;C
r,)s�•+� � .. � �'a �i'� 'R''�,�,�vx�`�"`. S� �isE��� 1 3b��IG� S!f:�4� F'��r q y*�;',�� 9���;
�� :-;ti � i Y: h ��: } .K,"k_;r �r+Ci!V��°� w �ii�. �%. � : 1 �f�F -1 . 42°'` � �Y '�5t C ':
r� w .* tl.ib�t �f 1.�j���J1 � '�, w'♦ � 21 �` �lC"�..x' �r.� �+� �"`N 5� . _ ��.
C,. J . � � ' �: r� i :r..� ��;�i
-s - "'.l Y 1 ��4rr °`' ?ry, •,a.Y ..� '� y(� � `"' ,�; {L�s,. {,, . - -,
. 4'S�W' '+ �.:K �T��y �T 3 � J1Y' 4- C+..t vyy y, ... kX� 'W ..< R � �.
-� �}' t' �M V' h `N '�} Jt_ .I�r�Y .ti � y. 'Y � Q�:. d .
. '� N�` .��tY��1. �AR �`y �� f�., q �p��"�r.�:c°�l'�'yf� _ �; . Frh, .. � � i r`fi- �� .
�L,„ ;y �i �r r x t � �A a ���<
�' r 4 �� �t t �.+`���. 4 y. �i�Y R
! Y } -: � . '��-e¢ �`.`�' ,8�.'� r �'ri 'p'i �..� �'�`'<�'� y�,."ti'.
- y2 �.� ,� < eh1e� ' '4s .r r`d. � �7M ..
t':Js�Nh� ' R �Ls � �r+. `y� 2q+. '�'�' ,� ` '� � t�� � � e4,-:..
� � P� y�� ��i�� � �h ���U�` � . .,
��,4}.�. 1{ ,��yFti..� }1�..t� � Y- }! I� �a . � T �
J'y ss
1 M d A �yi� PY' . `V ( F 1 i.
��rY ; � � L
� yy J^�d^^�.y t �j - �411 j. -w�� r.� �'^Y� � 1lft
� t 'S 3 i' .� :t�
'�i d7 a �. LS y�. } '�3}�'r����4 "�lt�^.�M �:.i �+`.�" '�*:, b`4,�.r. '�` µ� � .."r ,y�'
:t~r .�y �Ty '��,${i�P%��a�� y'al. 1.�Y * a;����,s�i "NtC� , �T _3 34 ';_k a+:.
� S h� �. 8 N f > ''Sv+v ��` 'v r+�Ja. +. .� /r! , � � '(�S`� ..,,+i� E �!R
� -•��!�.�.;'��'��,�{�� /as 4,�G. � .ri��z��� S �;,y} ,��l�;P «4ti ~ y �',�'Y��j 1'T�,r� .h4`4�,7�Mti',.
x`r - �. s<"'�v��;� x'wr��, '�' s�r � rl� h_ a�'` '� � *��������� �•'�� � °t . �
t's�,- {' x� ,t i J � Yw r � pv „y ti'�W -� y� �
- � � rtK� �?x tin��.`tz; f + �Yt .r� t� w�,� ��� °^� �y:� �4 �tf��,t_� , � -�.�j i�4 s r��rM�` � 'i .
�i�c :�i:Y,+ OY�f .,i, �NFh�J .n't �iy_ , t5� r -{ �1'�L c�� • ��-' ` "a.:. x� /+. *� t# Z �'�', q�
� M aS^y' �
.c �,.d��„'f�,3 t+j.�,,45 �r +o-s 'x.X ,�n"s .; + t �l.MJ �, '�"�s'A".L iA.�^k,t��£x�i r Y� p � .• ,,,� s„�'.� ,,�� <-y,��' �.,'
4 � 3 a2., kM � ,i i ��� � � e,�y�. rL �W hfz t f-:,n4J P � 1'w�C y� `V� �t -F�eg„y
t��� .�xn,! z5� vr�.�L t4� �;� �.) I ay'..�r y� ,,x��",�'lv �. 'Jy� � . 'h� �` � r��k^� ��{ ,},y� y( 1°{
��. , n' `� �`� v 7 r � ��'i ' §fiTt`'>. lSr ,
° � fPi � �li� � �ti�� I�1�,� � t � t' h -b <
' > ���yt�r v i�. '� o�i14 , f� �C . +�f? : � zi.^h.r ¢,n� i' r t %�r a�.t't '�zL yl ..
��!?�v� t''NSq4s a 1 1 S'�r' '�.'.�i.�`. `' f z � i � �j., _ 1 a'y?�iSy4 l. (f�'r ` � ri � vi N r : ` 1�.
z,,-`��4t'�3I°. '�'T�,��> . (��^•,iSP �y � ���"�+ .; ,� '�. K v" +�'�`�'-Y��,r�� ._ f-:
r W�t �.�3 �y M �,i^°i F < ?' �a : x... wv^}'s-t' � 1 � y�'i4rF y Y: ;
I.G4 S" � i } '•'G A`~•• � 3 F � SA�l. 1� .« '� `I,(� "Il Y Z ;��� 'F \ <eY� S
' +Y �i�.j, y�� '�e '' , � �'y c � 95,(^p�"k y� - � ti r�a!�^ �'.�r� � a
, S�,}{ �.� �� .',�. �>� � .'K'H'` 5 . +.1#f 3 �l, :.: 4, t �sY/' r2+.Y ' c^
� '-r' � Y� _ Y T � , � � ,b��1. .. A� �;"�'�f•f�n�}yer "F.,. .
„Yd;.l.'1`"° .�i,".:µ .� �:�`u:tr. .�i'i`�` �r tt'i �'"m r .rl:yi:� i.,.'��
1..1'f � p',3",y � . ; . • : �3-`tn � I w � ,� �ai ��x+ .{ .f i': � .
or + y"� �, '+: �. �. �5'S •. 1 -y � . .
M �;� j� `� .. t b �
x -. �� " �v�". "�1... ~ r.- ^.. t� �i�3�` ��,f L ' �,y.�,y ':
f , � 'cA' e� ar Y - .1 ��� �y, ' g "�\� r . �'
� � �
� �_ � : , �, ,,.i� � ' fi � ,� .
"�'�y�'i �� i .� � 1^� ; r`�� I. r°" lii . y
. . �r £ . n !' ' � i�'i'. �:.
�yn .F� Y F� . �. ),:. +�� � � � �ry1�.s � .
^*r� CC♦_� . j .r!- "T
III
I
. 'W. Y��S,_ ' p� - - r
Lt 'C E� Y'�'.tl �r ��,' iT�c. t j 1. Y r . ..
� Y -a�4J,t�f��, ,R}I �� ��+5`' �` Ja ».� t'tf � , .s� � �..�.�j���
�a-... F'-� '�i �T �:A.'.� F� �.�� � • ' . '��:�� v k � �
k �r} .,.i 'Tlr^ i+�� � �,k r�a n ;4 ,�Q 3 PJ� 'i �1 a ���,.t�a,w a{ f� ; �
'te 1i�' � t °'�'i ' '(,ai • ' N` r �}�,, � '�,,�'`,,i�r 1° r.''�5� *4 y�,��� }`'� k�� iy '.
1 7p��a �4 „S� � e'��,k��x " � 1> a ,Y �.`}�``� F�y!�` .. \ . ^X '� �,s.
'+ }�.1-''�J"!� z � �'iY y_� 5"a�� � rrv^�� 7�" .J., ' �� ..M1,i�4 1 n�s.�
e. �'�,�
+�,J "W >.�� � �� ! �+� y� C' pc .1,�.�t�� rZ � � �
�` "F(`���'� .,. ,F`.�y�? 'u K � 1'> K� � �<r f `� �.+-..
4J G� � '_s� ���f+��r,� '�5�� L. � �' �"�' ✓!•:�+�4 '..M��l� ��f 'i.`'�' t +:. �� ��$ ,+4d i5 -�
� t � v �!� ti3 �as I r..v.'�A .i �^ Yc y �' t �j 4��k{w �'! . �M r + X4k}�j' a$. .e�.{,'A7 y ,<
����� ,r(� � � ;��������d�t S4�y,ac Y� >`L3 � Ly'i� � 1`+¢ .� 4 � .:/ < �`e°�".ji'��� �2�'� �I,x�!�` p
.. 'j .. �-< �'`i ��*eY,F"� ��.; ����i�:. � ��.4`�s��,�,3 n'\ � �,t ,� '`Z1'ti,` � �.a x' d� skx C
� s i`S i r ' i. � ` �� �°``��v ti. �+ }�f ' t 1 . I r . � . i "
nP .+. ♦ �V-41 �S �i,� �vs; � :� Y f�'� � Y r � ,�.r 9 F e x S. �` �i ' t
a 1.: - ;n w�(' L � 1 t rF, �liy .;i'3 1 .�. '.� � ;��c� �. o �1w � fy n �, '�a�g `� ,
> y'1�� .-�'.: e 'S^'�i111�.� b i � w S. I�� � � �Fu vx y. � i � � • � � :� b. ,/�� S i •
S � �� �,
.�.5 ,y/ �� ,1y'j f n }ik jY '',b t � � �1.� �y� '�+�� • 4 l 'r bX s v}�"Sr : � Zt ;Fa� t'
� ��s�.� 't-•�7 v,G� � �, i t;s .�'1> a 5L�. s �: �p� � '..r � �k v��*d .
S 4 k�x �' '� �d�x t 'Ac . rf ,'s ,y �' _ �� ., . M�� �c � �� aa9{ Y' }' � i>3�' rS r �.
, � • .t Y �-1 t 17 ..'�$ lq 4 �� t
�.t'...., ? .�yi
HOLDING TANK SERVICING CONTRACT
This contract is made befinreen the Holding Tank Owner(s) and Pumper
Contract Date
�� �a-��a�
Holdi�g Tank Owner(s) Name(s) Pumpers Name
Northwest Sanitary, Inc.
Ronald L �eceli, ovmer/operator
� T �n
Parcel ID Numb � 3 j _ a �� ` Property Address
o�- �� � _ /
v`'� 'O - - - o � 3 � ' Oj - l.�o� •c�r- cz/ G i� '� /1/ � J�Q
We adcnowiedge the instailation of(a) holding tank on the foliowing property: (Provide legai descri ion of property)
S�v - N u.� 1c? �, �� 3 � �" 3 sf/V-R f t.�� __ _ .�
o h .' �t� �di' c� _.5'qtc-��r C�ocf�
1 } Owner agrees to file a copy of this contract witt� .5�4 r,���y �-,- Co� mty.
,
2) Owner agrees to have the holding tank(s) serviceci ay the pumper and guarantees to permit the
pumper to have access and to enter upon the property for the purpose of servicing the hoiding
tank(s). The owner agrees to maintain the access road so the pumper can service the holding
tank(s) with the pumping equipment. Owner further agrees to pay the pumper for all charges
incurred in servicing the holding tank(s} as mutually agreed upon by the owner and pumper.
3) Pumper agrees to submit reports for the servicing of the holding tank(s) to ;,>�_f��k��=.� County,
as required by Comm 83.55, Ws. Admin. Code. Pumper further agrees to include the following in
these reports:
a. Name, address and registration number of the person servicing the holding tank;
b. Name of the owner of the holding tank;
c. Location of the praperty on which the holding tank is installed;
d. Sanitary permit number issued for the holding tank;
e. Dates on which the hoiding tank was serviced;
f. Vofumes in gallvns of the contents pumped from the holding tank for each servicing;
g. 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, owner agrees to fiie a copy of any changes to this service
contract or a copy of a new service contract with s�r4�•�=� � County within ten (10) business
days from the date of change to this service contract.
Owner(s) Name(s) - Please Print Subscribed and swom to before me on this date:
tif. � �i - a� -a� � �
No rized Own s Signa (s) Notary Publi� ;
i �
� / v� n
li!; /%(i �
Pumper Name - Please Prin My Commission Ex�Sires
Northwest Sanitary, Inc. Ronald l Vieceli, ownerloperator -% _i � _ � �N�N��Y„B�E h��
� �
��� �i,
Pum er Signature DraRed by� n \ l `,��. �.,�,-''"''•.� �s;
. � • '• s
,zt��t� �� �` 2 � `K,��.. `Co�� _ .• Tq :
Pumper Registratio� Number Personal info �on you�rovi e ay be used or � s
#2389 secondary purposes [Pryacy�aws. i'5'�(m)J � =
L � ' :
� .
.
sN `. B : 2 :
.� � , , � �.
�''•.�9T'•--..-•G ay�' .
ti,����F�F 'W 1S',O �.
i � iiiii� i �ii �i ��i �� � ii i�i
- USE BLACK INK ONLY - �o�Id :80fi3822
?x :404098'r
POWTS MAINTENANCE AGREEMENT 44158�
For Holding Tanks P�t3LA CHISSER
RE�YSTER OF �EEDS
Owner's Name(s) as shown on deed: �AWYER COUI�ITY, WI
09J27/2022 12:34 PM
er Nr �''1 � �ii �ECORDING FEE 3g.UU
Parcel Identification Number:
(12 Digit Legacy ID) � ,'�`� - ry � �- � � - �- 3 � L �AGF�: �
Legal Description of PropeRy:
3w -Nki _ , - SEE ATTACH�D SNEET -
S� �33 ._7-3 .�N /Z6 �
We acknowledge that application is being made for the installation of a holding tank(s) on the
p pert described on the attached sheet.
dGfi .' n� �.'S:5'
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.
- O y one owner signature required - ACKNOWLEDGMENT
er' " nat e:
State of: �1�; ',��C (7�� ���
O ner' Nam (Print): County of: �;�
� � �G ,``,�����.���"�����..,,���� Subscribed and sworn to before me on this
Y B , �_day of ^ r , 20 <��
. •,
Date: ��.�'�P�.•''�� �'•.� '•.,� By (Owner's Name): ' ��� " �'
� . . .�
� 22 �2d ` • ` ; Notary Public Signature: 1 f' �
: •
Drafted by: ` I e � _�` public Notary Name (Print): t`�I `^ �
�o�1a\C� �t0�� "s � ,My commission expires on: 7 -� �}-��
. . . -
;�N� .� ,. _�:
., . . � .
•. 9�. '•---•--<' � �.
Personal information you provide may be used for se�qp��/�'�a,��acy Law, § 15.04 (I) (m)j Rev. 03/26/13
The Southwest Quarter of the Northwest Quarter (SWl/_NWl/)
and the Northwest Quarter of the Northwest Quarter (NWl/4-
NWl/�) all in Section Thirty-three (33), Township Thirty-eight (38)
North, Range Six (6) West, Town of Radisson, Sawyer County,
Wisconsin.
,'„t-"�`'"E� PRIVATE ONSITE WASTE TREATMENT county
�..-� r�`,�
(;�SPS,.���K�,, SYSTEMS Sawyer
��'� � ( POWTS)
��. � �j
��� ��,
�s—"'�'=`'' INSPECTION REPORT sa�itary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 2� �a7�
Peisonal infonnation you provide may be used for secondary purposes[Piivacy Law,s. 15.04(1)(m)J
Permit Holder's Name: ❑City ❑ Village � Town of: State Plan Transaction ID#:
��zv(11tie.�'i��c.Q K�c SS �
Insp BM Elev: BM Description: Parcei Tax No:
IU� .o� � a� }-�1—�ci�.s- �i� ��— 0�2 -(�3�-33 —�-..3o I
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic Benchmark �c�p,o�
Dosing
Aeration Bldg. Sewer y�,�y�
Holding }.� 4 St/Ht Inlet �6•8S�
TANK SETBACK INFORMATION St/Ht Outlet 66•7� `
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic NA Dt Bottom
D�sing NA Installation
Contour
Aeration NA Header/Man.
Holding � ' K3 � ,�.�-` ���-� 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 L #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav ° Conv ❑ Aggregate
INFORMATION P/L Bldg Well Waters � ►GP ❑ Chamber Model Number:
❑ AG ❑ EZFIow
CELL TO ❑ Mound o Other
__ — --
--- ---- —- ----- - -- -_-
DISTRIBUTION SYSTEM X Pressure Systems Only
--- --_. ---- — -—
Header I Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes
Length Dia Length Dia Spac �_ Spacing ❑ Yes ❑ No �
SOIL COVER
- — -- ——_—__— ---
Depth Over Depth Over �epth of Seeded/Sodded Mulched
Cell Center Cell Edges , Topsoil ___ � ❑Yes ❑ No T ❑Yes ❑ Na�
COMMENTS: (Include code discrepancies, persons present,etc.)
��,� l� �b���l�a
� ��
_ ___ -
Plan revision required?❑Yes ❑ No O3 p� a3 � � _ ._J /�( '�I�
E� �
Use o t her si de for a d ditional information Date POWTS Inspector s Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL COMMENTS AN� SKETCH
SANITAAY PERMIT NUMBEA:_ �02 ��__
,
, _ :_. . _ ;
��� ,
3�0 ; � — . _ _ _ ;__ . -- �
�a.W • � -�
�l, �'sb � ,�,� �►,
_ �` O ��� 7`
���'^ , �
. � . _�. _ � s � � . _ : _
. . _ ,
_o ;
� � �co � . �._ ; : __ .
,._ _ ;
. . _ , � _ ;
'��� .
/ c,f3 '
. �,3a�•
�
� �'6�� ���
� �g� ����'
��way
�
To ������� B��d .
-�—
sc�--�--