HomeMy WebLinkAbout032-539-02-5305-SAN-2022-285 '�°` I�us ServiceaDivision ��H �
;->', V _ 4822 Madisan Yards Way .S��c/-(f��-� �
- `_'I,,,y- Msdiso4 WI 53705 Saniury P�it Number(ro be fiiled'm by Co.)
9 `, : ,;;;' P.O.Box 7162 �
�'%;;;'�;;;:% Madisoq WI 53707-7162 �v 3���� cU
Sanitary Permit Application StMeTnnsactionNumber �
In eccordance wiW SPS 38321(2).ws.Adm.Code.submivion ofihis foim W t6e appropna[e Bovef��ml imit 4j
is requiced prior ro obteinmg a sanitary pemtit Note:Applicatian fo`ms for suteowoed POVlIS me su�ined ro Project Address(if diH'e�t tL�mailing add �
[he Dcparenmt of SeCUy md Rofesaooal Sa��as.Pecsovel iufo`matiou you proride msy be used for saondary /�/
uryoses in eccoxdavice wit6 the Priwcy Law.x 15.04(Ixm).Smu. J��l�'1`1 m�(�i'\ F'^
i.Ap tidtloe Informatlm-Pleaae PriM AR IoformatSoe
Property Ownri s Neme P+ree�p
�zr d� 111�r- aret a l� 03� 53 t d� 5'�5
Propetty Owner's iling Address FropMy Location
�38 1u,�1� F.� ��.�� 3
City,Stane Zip Code Phme Number
_ (�}Lc�SO(1 S�IIJ��O 2 Y. Ya Sectiw� �
II.Type of Baildiag(chedc aR that�pply) Loi# T:J N R � E W
1 or 2 Femily Dwelliug-Number afBodmoms� Subdivision Neme
61ock#
�ublidCommmciel-DeuribeUu
�iry of
tem Owncd-AscnLe Use CSM Numbc illage of
�o�of (�,i�nf��
III.Type of POR'TS Pe�mia(Check eltber"New*or"ReplseemenY'aml other appNcsbk on tlne A.Check one box on dne S Complebe llne C'
a licable. �j� �
A. ❑New Sysiem �)Cpcep�zcement Syslem �Dther Modificetion to Exisbng System(uplaiu) Additional Pcehutmmt lhut(uplain)
Iis
B. oldingTaok ❑�-Gmund ❑4c-C de �Mamd IndividuelSiteDaigu OWttType(uplain)
(conveotimal)
C. Rmeaal Before ❑Revivon ge of PI�6er ❑I'reosfer4o New � �O�Pamit Numbcr md Da2 tmad
�p�re�� 'J
�
N.Dis neVCrestment Arca and Tmk InformaHou:
Desip,F�ow(�d) nesige soi�app�icatlw Rete(sPd/s� Dispu�i nroa Requirea(s� Dispe�sal nree a�qwsca(s� sysoem H�
�� ��� N a N� r�`�°°
Cepe�aty in Totel q oF MmufacLuer
Taok Infom�ation Gaibns GeOoav Uviu a� �7i k .�
Nnv7miu ExisUngTaole y � N 3^ �
&U '� i:.(7 G
Sep�ie a Holding Tmk X (y,j� 1 li 4J f E' �7
Uwieg Chwber �
V.Responeibility Shtemeat-4 me on�nigned,aname rapeasibWry for imh0atlou o[Ne POWTS sAawo on t6e awched plaos
Plumber's Neme(Prin[) Pi''�Si�enue MP/MPRS Number Business Phone Nmnba
�l'<<. ��;� � L;�� � �?,�u5(v 715 oZ6G���
Plumber's A s(Stre�et,Ci Sute,7rp Code) 1
�,�� - / /L'L �,��1 /X !� P1� �������
V[.Co ty/Department Use Only
�A� ❑D'uepproved Pumit Fx� iMte Iswed�2 Issuing AgeM Si�atme'I�
❑Owner Given Rwson for Deoial �w• I � � `" - I"
Coeditiona of ApprovellReaso�for Disappmval i_ 5'G�1�. F.�,��,., ; � �
��C.,�� ' � _ �',.
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�,(�s� ___..__ � SEP 2 9 2Q22
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ZONWG AJUIIC�ibf r�"�,ON
em�nm�p�ne..a.m�.�.oa,.ueumu.co.�.�eewn.��k..u..s�a.�ic�wd.a� 34�a(�
5Bn-s3vs(�.o3rzq NO R�F:JNDS AFTER
ISSUE OF PERMI7
� Sawyer County Zoning & Conservation Administration
������ 10610 Main Street, Suite 49
�� a>> 1� Hayward, Wisconsin 54843
, g �I (715)634 8288
� ��:������� �� FAX (715)638 3277
� � "� � ,,
� �� �Lz �� � �.w��,� ��cxc�u�ti�.o�.oi�
� '� �� < i .�. � E-mail ,oni,i� «c a,atin t� ct ai3 �<o1-.or�
� �—`� � Toil Frce Courthouse/General Information 1 877-699-4110
/ �;:. ..
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Holding Tank Approval Checklist
L Sanitary Cover Sheet Date Stamp �`� / %Z� / � 2
Parcel ID# D 3 -� - S 3 `1 - o�- S 3 � �
II. Plot Plan
� Property Lines �Benchmark BM ♦
Site Address North Arrow
x Structure D� Scale
� Well < 25' to Service Road
Legal Description Nearest Road Intersection
� Setbacks to: Properiy Line, Well, Structure, Water bodies, Roads
IIL 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: s �w ��aoa
1� 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), , ,
�. I
Owner: �a � 1 Plumber: C ��
Application Review Date: �O� l ( ��
POWTS Reviewer: ��� ����
Namc �� S� � �
Liccnsc#
Revised 4/11/2013
Concnc�. HOLDING TANK DESIGN
Sing/e Tank Option
INDEX AND TITLE SHEET
Project Barber Lake Holding Tank
Owner Gary and Margaret Hall
Address 738 Badlands Rd
Hudson Wi54016
Legal Description Prt.Govt Lot 3 S-2 T-39-N R-S-W
Township Winter County Wi
Subdivision Name Lot No.
Parcel ID Number 032 539 02 5305
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
Designer Crai om son
Signature t Phone No. �15-266-2842
License Number 220810 Date 09/17122
Designed pursuant to:
Holding Tank Component Manual For POWTS(Version 2,�)
C►n�^y a�aa:�a�d��
version 7.0(1 tnz) Page 1 of 4
HOLDING TANK SPECIFICATIONS
2 Number of bedrooms
200.0 Non-residential estimated flow(gpd)
��Minimum holding tank volume required (gal)
2000.0 Proposed holding tank capacity (gal)
Skaw Pre Cast Tank manufacturer
2000 Tank model number
Tank Alert Alarm manufacturer
101 Alarm model number
Tank Dimensions and Data Tank Anchor Calculations
49.0 Liquid depth below inlet invert(in) 16100 Ibs Weight of tank
8.0 Maximum depth of soil cover(k) 1.10 Safety factor
152.0 Length (in) 10578 Ibs Weight of anchor required
75.0 W�d�}i�(in)}Outside Dimens ons 16.0 in Soil cover req. for anchor, or
2.6 yd3 Concrete counter weight
HOLDING TANK CROSS SECTION
manhole cover with
locking device and
vent finished junction �warning label
� grade box —> �
cap 1
12" min. y , F23" min. � 4" min.
_�.. ....... T
vent pipe conduit � tether
weight 18"Imin.
blind Note: Ail tank joints, � W
p��9 and joints belween "--------'�
to seal tank openings and 12 in� building
piping are sealed W service sewer inlet
outlet Water tight. Pipe and
vent materials comply
with SPS 384. 37.0 in.
Manhole and vent locations Electrical is as
may be reversed. per NEC 300
and SPS 316.
3 in. bedding under tank. Tank is anchored as necessary to negate buoyancy.
Because of this tank's rounded surface,soil cover alona may not be adequate to prevent flotation.
Project: Barber Lake Holding Tank
Transaction Number: Page 2 of 4
HOLDING TANK SITE PLAN
Project: Barber Lake Holding Tank
A!
' Legal Description: Prt. Govt Lot 3 S-2 T-39-N R-5-W I
� Subdivision Name:
Scale: � 1" = 30 ft Parcel ID: 032 539 02 5305 Lot No.:
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Transaction I.D.: '���g� �U t�. Page 3 of 4
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f,�= lu�.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 Wi County Sanitary Ordinance.
1. This POWTS is designed to accommodate a wastewater flow of 80.0 to 400.0 gpd.
2. The owner of this POWTS is responsible for system operation and maintenance, inciuding ail provisions in
the attached Hoiding 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 activates), the pumper listed in the current Servicing 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 visually 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. All 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 shali 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 from this hold-
ing tank to the ground surtace, including intentional discharges and discharges caused by neglect, consti-
tutes 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). Connection to
municipal services would also be considered at this time if they are deemed avaiiable 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 installation, the following persons should be contacted:
a. Installer............................... Don Thompson & Sons Exc LLC Phone: 715-266-2842
b. Service Provider..................... North West Sanitary Phone: 715-943-2650
c. County Zoning or Health Dept. Sawyer County Zoning Phone: 715 634-8288 _
11.
Project: Barber Lake Holding Tank
Transaction Number: Page 4 of 4
Ho���tic r,a�vk seKvici�c co:v�rknc.i
Contract Datc: �l l5 / a�;�a
I'his coniract is made belween Ihe Holding"I'ank O�ner and the Pumper.
Holding Tank Owncr's Namc: Pumper�s Namc:
Northwest Sanitary. Inc.
I PO BOX 155
�c�f p� �u('c�i��{ cj l( Radisson,WI 54867
ParcelldentiTication Vumber: �
� i z �;�;� L��:���y iD� O a 2 - S 3 � - O �- S 3 O 5
l. Thc owncr agrcc� to lilc a cupy uf this cnntract wi�h thc gnvcrmncntal uni1. Sauycr Counry,
which has accrplcd anJ rccurdcd with thc Officc uf thc Rcgistcr uf Uccds,thc Maimcnancc
Agrccmcnt for a Holding'fank rcquircd undcr Ihc Sawycr County Pnvatc Scwagc Syslcm
Ordinancc for thc issuuncc oCa Saniiary Pcrmit for lhc installation of a holding �ank(s).
2. Thc owncr agrcc,to havc thc holding tankl�) scrviccd hy thc pwnper and guarantccs tu
pcnnit thc pumper lo ha�c acccss and to entcr upon dic property for thc purposc of scrvicing
thc holding t�nk�s). Thc owncr abRccs �o maint�in thc all-wcathcr acccss road or drivc so
thut thc pumper can scn-icc thc holding�ankf�) with thc pumping cyuipmcnt. Thc owncr
furthcr agrecs to pay thc pwnper for a chargcs incurrcd in scrvicing thc holding tank(s)as
mutually agrccd upon by thc owncr ancl pumper.
3. I'hc pumper a�Rccs Io submil to thc Govcmmcn�al Uni1, Sawycr Coimty,a rcport fix�hc
servicing of Ihe holding tank(s)as required imder SPS 3R3.55, Wisconsin Administrative
Codc and ihc Sawycr County Privatc Scwagc Sysicm Ordinancc. Thc pumper furthcr
agrecs to includc thc lollowing in thc report:
.i. l'hc nsimc and address of thc pcnon responsiblc Cor scrvicing thc holding tank;
b. l hc namc of thc owncr of lhc holding�ank;
c, l'hc sitc addross of Uu hulding tank;
d. �fhc datc thc hulding lank was scn-iccd;
a "I'hc volumcs in �.dlons of thc conicnts pumpcd from dic holding lank for cach scrvicing;
C 7'hc disposal sitcs to which ihc contcnts from �hc holding tank wcrc dclivcrcd.
4. This agreement �vill remain in effect until the owner or pumper terminates this convact. In
the event of a change in this contnct, the owner agrees ro file a copy of any changes to this
service contract or a copy of a new service contract with Sawryer County within ten� I q)
business days from the date of chanee to this service contract.
Owner's Namc: (Prinl) �)N'Ol`��S SI�I1dlUfl': Onh nne owner siRnamre requireAl
�� A i�-� � A-c.,L a��--
Pumper's Name: (Print) Pumper's Signature:
Ronald L Vieceli, owner Northwesl Sanitary,lnc � �
�- G �� '
Pumper's Rcgistratiun Numhcr:
#2389
Rcr.Ol!?fi'13
Redl EStdt2 Sawyer County Property Listing Property Status: Current
Today's Date:9/17/2022 Created On: 2/6/2007 7:55:58 AM
�'Description Updated: 3/13/2018 � Ownership Updated: 10/4/2018
Tax ID: 34626 � GARY D&MARGARET S HALL HUDSON WI
PIN: 57-032-2-39-OS-02-5 OS-003-000050
Legacy PIN: 032539025305 Billing Address: Mailing Address:
Map ID: :3.5 GARY D&MARGARET 5 HALL GARY D&MARGARET 5 HALL
Municipality: (032)TOWN OF WINTER 783 BADIANDS RD 783 BADLANDS RD
STR: 502 T39N ROSW HUDSON WI 54016 HUDSON WI 54016
Descripdon: PRT GOVT LOT 3
Recorded Acres: 0120 � Site Address * indiwtes Private Road
Lottery Claims: 0 7150N MALM RD WINTER 54896
First Dollar: Yes
Waterbody: BarberLake Updated: 10/10/2016
Zoning: (R-1) Residential One J Property Ass�sment _
ESN: 428 2022 Assessment DeWil
Code Acres Land Imp.
� Tax Dlstricts Updated: 2/6/2007 GI-RESIDENTIAL 0.220 42,000 15,500
1 State of Wisconsin Z_Year Comparison 2021 2022 Change
57 Sawyer County �y�d: 42,000 42,000 0.0°k
032 Town of Winter Improved: 15,500 15,500 0.0%
576615 Winter School District Total: 57,500 57,500 0.0%
001700 Techniwl College
+ Recorded Documents Updated: 10/4/2018 �property Fiistory
O WARRANTY DEED N�A � � � � �
Date Recorded: 10/3/2018 414683
O QUIT CLAIM DEED
Date Recorded: 12/23/1998 2%3443
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-llsE BLACK i�K ONL�- Dc�Id:8064221
POVVTS �.���TEI�IANC� AG�'EEMEtdT' �x:404125fi
�or Hofding TankS 441759
PAULA CHISSER
Owner's Name(s)asshown on deed: REGISTER OF DEEDS
SAWYER COUNTY, WI
�'u,i', � ;�- �u��° c=c!'��, -S �a l L 10/11/2022 03:Q1 AM
P2rcei Iden ification Num6er. � RECORDING FEE 30.08
(72 Digit Legacy iD) V ��- J � ` -v� - � � � ��
PAGES: 2
Legal Description of Property:
-S��A"f�'ACS�ED SH��r�
We acknovvledge that appiication is being made for the instalia6on of a hofding tank(s)on the
property described on the attached sheet
Retum To:Sawyer Coun2yZoning and Conservation Administration
20640 Main SL Suite 49,Hayward,Wi 54843
As an inducement to the County of Sawyer to issue a sanitary permit for a hoiding tanic on ihe above-described oroperty,the owner is
responsibie for the operaGon 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 reiating to holding tank management,including the following:
1. The owner agrees to contract vath 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 hofding tank properiy serviced and to file a copy of the service contracf with the
governmental unit. The o�vner further agrees to file a copy of any changes to the service contract,or a copy of a ne�v service
contract,with the governmental unit within ten(10j 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 shail submit the report to the govemmentai 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 tanlc 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 setvice,or cause the tank to be serviced. Pursuant to Section 14520(4}Wis.Stats.,a governmentaf unit may assess Ihe
owner of a private sewage system fior costs related to the pumping of a septic or holding tanl:.The charges will be assesssd
as prescribed by Section 66.0703,stats. The owner agrees to pay all charges and cost incurred by the govemmental unit for
inspec[ion,pumping,hauling,or otherwrise senricing and maintaining the holding tank in such a manner as to preveni or abate
any human health hazard caused by the holding tank_
�. This agreement will remain in effecE 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 cancefled 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 th2 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.
-Only one owner signature required- f�C�Cf�i01lULEDGflAEl1l�'
Owne�s Signature: State of: � /�'(- —
✓/� " /���-�-J County of: C
Owner's Nam (Print}: Subscribed and swom to before me on this
/{ % � y�,�— Gt �� �t'h- day of ' � . 20�z
Date: By(Owne�s Name : ,
� - � �—�'� Y p ry Public Signature�
�rafted by: � , �O� � otary Name(Print):
,L S%� � ission expires on: �-i��,,/(0,.1���_
SKY
C��`' `5 ��''i'�5�n � ANDERSON �
nva Law 15. (I)(m)� Rev.03/2fi!'13
Personal information you provide may be used far seconda r�� [F' �Y
�
9�F��SG��
�
Legal Description
A parcel of land in Government Lot Three(3),Section Two(2),Township Thirty-nine(39)North,Range
Five(5)West(in the Town of Winter),Sawyer County,WI,Descrihed as commencing at the Southeast
corner of Lot One,Section Three(3),Township Thirty-nine(39)North,Range Five(5)West,thence Three
Hundred feet in Easterly direction to point of low water mark on shore of Barber Lake,thence from
point of beginning on shore of said Barber Lake,straight North one hundred twenty five feet,thence
straight East one hundred feet,thence straight South to North Shore of said Barber Lake,thence in a
southerly and westerly direction along Low Water mark of said Barber Lake to point of beginning.Also
ingress and egress to above parcel.
Office of
Sawyer County Zoning and �
Conservation Administration
� . 10610 Main Street, Suite 49 ��
Hayward, WI 54843 ��+� � � `�"
Tel: (715) 634-8288 20�`��9�, � �Q �
Faa: (71�) 638-3277 ��FR�� �
URL: http://sawyercounty ov�.orQ ,�H/S �I'y
Email: zonina.sec(c�sawyercountv�ov.ors �T�
Toll Free: Courthouse/General Information
1-877-699-4110
Sawyer County Zoning and Sanitation "As - Built" Form
Property Owner's Name ��t�'y �' � � I�'tl�`''K-cf'eZ� �-1�, z 1
Fire Number and Road Name 7(� '� N / � I Q�li� �(,�
Plumber's Name (.� ✓Y.� � �; / �0 M �5�i°I
—�
Date of Installation l �— l j ` �� �
County Sanitary Permit Number � � ^ <� ��
12 Digit Parcel Number � � � �E� � � � 53��
Description and Elevation of Benchmark 7U� d� muR I�J �� � ;c:.�
Tank Manufacturer and Capacity J ��� �C,�
i
Setback - Tank to Nearest Lot Line ��
Setback - Tank to Nearest Well l�� W�'-1� � E��
Setback - Tank to Building a� �
Cell Width � �
Cell Length /�-� ��
Number of Cells r`� �
Setback - Cell to Nearest Lot Line �1 �
Setback - Cell to Nearest Well � �
Setback - Cell to Building ��
Setback - Cell to Navigable Water � �
Make and Model of Dispersal Unit � �
Make and Model of Filter � J I
Make and Model of Pump / �t 1 I
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