HomeMy WebLinkAbout032-538-03-2113-SAN-2022-288 _ "'�� Department of Safety �°""�' � �
�`�`�\ = & Professional Services, ��```� �� �
_ �, _ : Sanitary Permit Number(to be filled in b:
'�, �'_ � Industry Services Division �
'-, � �� �.�0 �
Sanitary Permit Application State Tcansaction Number �
� �
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit h_
is required prior to obtaining a sanitary permit.Note:Application forms for state-0wned POWTS are submitted to Project Address(if different than mailing �r�
the Department of Safety and Professional Serviccs.Pcrsonal information you provide may be used for secondary �
puiposes in accordance with the Privacy Law,s.15.04(1)(m),Stats. ���� j � ��� ,�]
I.Application Information—Please Print Alt Informadon �'` �«t�
Property Owner's Name Parcel#
l�e��l�, a- �r;n Qe�c�r � o3a-S3�-o3 --�.l1�
Property Owner's Mailing Address PropeRy Location p� .
3 � 2.�.n � �� Govt.Lot
City,State Zip Code Phone Number
e( (� 5 b�� �1.�'-T S-[���O N�'/a, 7���1.) %, Section �
IL Type of Building(check all that apply) Lot# T N R E o w
.�l or2 Family Dwelling-NumberofBedrooms � �� SubdivisionName
Block#
O Public/Commercial-Describe Use
❑City of
❑Statc Owned-Dcscribe Usc CSM Number ❑Village of
�
�Town of � L����
III.Type of POWTS Permit:(Check either"New"or"ReplacemenN'and other applicable oo Gne A. Check one box on llne B.Complete line C if
a licable.
A' �New S stem ❑ Re lacement S stem
y p y ❑ Other Modification to Existing System(explain) ❑ Additional Pretreatment Unit(explain)
B' olding Tank ❑ In-Ground ❑At-Grade
❑ Mound ❑ (ndividual Site Design ❑ Other Type(explain)
(conventional)
C• ❑ Renewal Before ❑ Rcvision ❑ Changc of Plumber ❑Transfer to New Owner �st Previous Pcrmit Number and Datc Issued
Expiration F"s
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(st) Dispersal Area Proposed(s� System Elevation
3� �i� � � � � � �,
Capacity in Total #of Manufacturer
P:
Tank Information Gallons Gallons Units p a� v '° � �
New Tanks Existing Tanks v o ^ � Y �� �
a U v� � v� w C7 a
SepticorHoldingTank •� � t1K �C,j,""�[
J !-T Cv�
Dosing Chambcr
V.Respousibility Statement-I,t6e undersigned,assume responsibility for installation of the POW1'S shown on the attached plans.
Plumber's Name(Pnnt Plumbe Signature MP/MPRS Number Business Phone Number
�r4; � �D� n � c�l aa��lC� ��s-a��-a��a
Plumber's Ad ss(Street,City, te,Zip Code)
,S�5'�l- j� �i v m S�n � ��,� � �� S1 �l`�
VI.Coun y/Department Use Oniy
\o Permit Fee Date Issued Issuing Agent Signature
�App c�� ❑Disapproved $�.,/ ./j'�/�
�3'✓ ❑Owner Given Reason for Denial !�•� I� I'( I�a ' 'I'�^��
Conditions of A rovaUReasons for Disa mval ' / �"r'��+� L,y��,�� A - -
PP pP ���.�, �s�'y � ' � i
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C9 OCT 0 5 2022
� S) h10'� �• N'� �r�d �� � SAWYER COUNTY
ZONINC�ADMINISTRA��1�7tv
Attach to complete plans for the system ead submit to the County only on paper oot less t6an 8 t/2 a ll inc6es in size ^ � I��
5
SBD-6398(R.03/22) NO R�FJNDS AFTER
fSSUE OF PEFMtT
Sawyer County Zoning & Conservation Administration
��������� 10610 Main Street,Suite 49
� 1� Hayward,Wisconsin 54843
�.
� �� (715)634 8288
� �������\`,°j FAX(715)638 3277
�,�4i � ��� �_�`� �itiv�t �ati1(_'CUUli� Uvtib
� � _� _ , i E-mail:n��u � c,�,i e� ic�a�a*� gv.e����
�� -=�'� � Toll Free Courthouse/General Informat�on 1-877-699-4110
I�, .; �,,_',a��
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Holding Tank Approval Checklist
I. Sanitary Cover Sheet Date Stamp 10 / �S/ �2
Parcel ID# O 3 �-�3 $ - b 3 - � I I 3
II. Plot Plan
/Property Lines �Benchmark BM ♦
�Site Address D�North Arrow
�CStructure /Scale
�Well �<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
x Cross-section—Manufacture, Gallons: H�.'�C�+'� 3,��
�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)
D�3" Bedding Material< 1/2 "
V. Holding Tank Plans per Component POWTS Manual
CLVersion�SBD-10�55-P (R.3/07), .,
�,\
Owner: �Larzt� Plumber: C'` , '
Application Review Date: �o� I 1 f �2
POWTS Reviewer: �,���
Namc
Gq S���
L;ccnsc#
Revised 4/11/2013
CbhC r�e HOLDING TANK DESIGN
Single Tank Option
INDEX AND TITLE SHEET
Project Lake Winter Rd
Owner Keith 8 Erin Decorah
Address W3594 Zank Rd
Neillsville,Wi 54456
Legal Description NENW S-3 T-38-N R-5-W
Township Winter County Wi
Subdivision Name Lot No. 26
Parcel ID Number 032 538 03 2113
Pian Transaction ID Number
Index and title sheet Page 1
Hotding tank specifications Page 2
Site plan Page 3
Maintenance and contingency plan Page 4
Designer Crai Tf m son
Signature � � Phone No. 715-266-2842
License Number 220810 Date 10/01122
Designed pursuant to:
Holding Tank Component Manuai For POWTS(Version 2L) .. .
Version 7.0(i v12) Page 1 of 4
HOLDING TANK SPECIFICATIONS
3 Number of bedrooms
Non-residential estimated flow(gpd)
�JMinimum holding tank volume required (gal)
3000.0 Proposed holding tank capaciry(gal)
Huffcutt Tank manufacturer
3000 Tank model number
Tank Alert Alarm manufacturer
101 Alarm model number
Tank Dimensions and Data Tank Anchor Calculations
60.0 Liquid depth below inlet invert(in) 20300 Ibs Weight of tank
8.0 Maximum depth of soil cover(ft) 1.10 Safety factor
165.0 Length (in) 23275 Ibs Weight of anchor required
92.0 W;.��1� (in)}Outside Dimensions 26.5 in Soil cover req. for anchor, or
5.7 yd3 Concretecounterweight
HOLDING TANK CROSS SECTION
manhoie cover with
locking device and
vent finished junction ��'arning label
� � grade box � �
cap I
12" min. y ...,,.., IF 23 " min. � 4" min.
vent pipe conduit � tether �
weight 18"Imin.
blind Note: All tank joints, � W
plug and joints between
to seal tank openings and 12 ��� service building
piping are sealed sewer inlet
outlet Water tight. Pipe and
vent materials comply
with SPS 384. 48.0 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 lo negate buoyancy.
Because of this tank's rounded surface,soil cover alone may not be adequate to prevent Flotation.
Project: Lake Winter Rd
Transaction Number: Page 2 of 4
HOLDING TANK SITE PLAN
Project: Lake Winter Rd
N Legal Description NENW S-3 T-38-N R-5-W
Subdivision Name:
Scale: 1" = 30 ft Parcel ID: 032 538 03 2113 Lot No.: 26
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Transaction I.D.: Page 3 of 4
�
�t��� ke i i1 Or�Wer 5��� L Q 13YY1= /uJ. �
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, Wfs. 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 60.0 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 activates), the pumper listed in the current Servicing Contract must be called to
empty the tank's contents and dispose ot 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 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 from this hold-
ing tank to the ground surface, 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 compiiance 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 impossibie.
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 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 installation, the following persons should be contacted
a. Installer.....................___.._ Don Thompson & Sons Exc LLC Phone: 715-266-2842
b. Service Provider..................... Golat Pumping Phone: 715-868-6836
c. County Zoning or Health Dept. Sawyer County Zoning Phone: 715 634-8288 _
11.
__ _ .
Project: Lake Winter Rd
Transaction Number: Page 4 of 4
HOLDING TANK SERVICING CONTRACT
Contract Date: / / D
This contract is made between the Holding Tank Owner and the Pumper.
Holding Tank Owner's Name: Pumper's Name:
� , ��`"l�Lt��[ c�,l-V �-� '' ��L�V �� 1 ) !'uCs-
C�.�-h :�- r ' �eC.�7 �c�11
Parcel Identification Number:
(12 Digit Legacy ID) C7 j � - J� 3 � - � �J - � l � �
1 . The owner agrees to file a copy of this contract with the governmental unit. Sawyer County,
which has accepted and recorded �viti� the Office oftt�;. Register of C�eeds, the Maintenance
Agreement for a Holding Tank required under the Sawyer County Private Sewage System
Ordinance for the issuance of a Sanitary Pennit 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 p��mping equipment. The owner
further agrees to pay the pumper for charges incurred in servicing the holding tank(s) as
mutually agreed upon by the owner a��d 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 383.5�, Wisconsin Administrative
Code and the Sawyer County Private Sewage System Ordinance. The pumper further
agrees to include the following in the report:
a. The name and address of the person responsible for servicing the holding tank;
b. The na�ne 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. Chis agreement wiil reinain in effect untii tiie owner or pumper terminates thi� contract. :n
the event of a change in this contract, the owner agrees to file 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 rom the date of change to this service contract.
�Wllel''S N : �PI'lllt� �Wllel''S SI�TII ' (Onl�� une oH�ncr signaturc required)
, - Ov��
Pumper's Name: (Print) u�r�pe s Si nature:
�{ ��.
:.�—y,��-'�',„,�—
�--f�_J � Ci c��_���� � \
v
;; , ��
Pumper's Registration Number:
�� 2- L``
Re��. 03/26/13
-USE BLACK INK ONLY- I'I �IIIIIII I,III I!I III I!I III
�.aosazz�
' POWTS MAINTENANCE AGREEMENT Tx:4o41261
For Holding Tanks 441762
PAULA CHISSER
��:Owners Name(s)as shown on deed: REGISTER OF DEE DS
i 1 � 5AWYER COUNTY,WZ
Kp�}-� 2���f.�l �C��'fJ�(O..Yl � 10/117202210:09 AM
RECORDING FEE 30.00
.. Parcel Iden[ification Number. �
� (12�igit Legacy ID) ���-S 3 8 -0 3 -a I I 3
— — — PAGFS: 2
� Legal Descdptlon of Property
-SEE ATTACHEO SHEET-
'�� W e acknowledge that application is being made for the installation of a holding tank(s)on the
property descri6ed onlhe attached sheet.
�..-._
- Retum To:Sawyer County Zoning and Conservation Adminlstration �
�� 70810 Mala St.Suite 49,Hayward,WI 54843
As an inducement to the County of Sawyer to issue a sanitary pertnit for a holding tank on the above-descri6ed property,the owner is
responsible for the opera6on 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 hoiding tank management,induding 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 ot 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 untt 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 shali submit pumping reports to
the govemmental unit in accordance with SPS 383.55,Wis.Adm.Code,forthe servicing of the holding tank. In the case of
exempdon under SecGon 281.48(3)(d),Stats.,the owner shall submit the report[o the govemmental unit. The govemmental
unit may enter upon the property to invesfigate the condition of the holding Tank when pumping reporfs may indipte the
holding tank is not being properly maintained.
3. If the owner fails to have the holding tank properly senriced in response to orders issued by the govemmental unit to prevent
or aba4e 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 14520(4)Wis.Stats.,a govemmental unit may assess the�
owner of a ptivate sewage system for casts related to lhe pumping of a septic or holding tank.The charges will be assessed
as prescribetl by Section 66.0703,stats. The owner agrees to pay ali charges and cost incurred by the govemmental unit for
inspection,pumping,hauling,or othenrvise 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 wip remain in effect only unti�the govemmental unit responsible for the regulation of private sewage systems
certifies that eilher a soil absorpUon system that complies with SPS 383,W is.Adm.Code,or a muniGpal sewer serves the
property.In addition,this agreement may be cancelled by executing and recording said certification with refere�ce to this
agreement irt such manner which will pertnit the e�cistence 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 ownar 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.
- nl neownersignaturerequired_.�,,,,� ACKNOWLEDGMENT
iOwne� ure= ,,..P�PLEE{�q''•,,,, State of:i
�' C�%,County of: �C;.C'
wner' �Nam (Print): ,•'N O Tq �:s�gubscribed and swom to before me on this
,�- 1 - � = 3C7 day of ' l`��'� ,20��,
Date: � ;��, '�� ` ' Ety(Owner's Name): � �����
/�-3�'�a :����, 8��G •� filotary Public Signature: '
• ��`�� �f�
Drafted by� � .,O,�'"-'""� Public Notary Name(Prin -
WISG� -I �
My commission expires on:f
Cr�=�;� / ��
Personal infortnatlon you provide may be used for secondary purposes[Privacy Law,§15.04(t}(m)] Rev.03/26N3
Lot Twenty-slx {26) of Certified Survey Map No. 503 as recorded in Volume 3 of Surveys on Page 103, as
Document No. 147318, located in and being part of the Northeast Quarter of the Northwest Quarter (NE1/4-
NW1/4), Section Three (3), Township Thirty-eight (38) North, Range Five (5) West, Town of Winter, Sawyer
County, Wisconsin.
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10/11I22,9:41 AM Real Property Lisling Page
R2dl EStdt2 Sawyer County Property Listing Property5tatus: Current
Today's Date: 10/11/2022 Created On: 2/6/2007 7:55:56 AM
.:���'Description Updated: 10/22/2012 �-"� Ownership Updated: 12/9/2020
Tax ID: 33716 � KEITH &ERIN DECORAH NEILLSVILLE WI
PIN: 57-032-2-38-OS-03-2 01-000-000130
Legacy PIN: 032538032113 Billing Address: Mailing Address:
Map ID: .5.13 KEITH &ERIN DECORAH KEITH&ERIN DECORAH
Municipality: (032)TOWN OF WINTER W5394 ZANK RD W5394 ZANK RD
STR: S03 T38N ROSW NEILLSVILLE WI 54456 NEILLSVILLE WI 54456
Description: PRT FRAC NENW LOT 26 CSM 3/103 ..
#503 `���� Site Address * indicates Private Road
Remrded Acres 2.260 4795N LAKE WINTER RD �� WINTER 54896
Cakulated Acres: 2.258
Lottery Claims: 0 �..�.�.��� Property Assessment Updated: SO/10/2016
First Dollar. No �� � ��� �� � ��
Zoning: (R-1) Residential One 2022 Assessment Detail
ESN: 428 Code Acres Land Imp.
Gl-RESIDENTIAL 2.260 50,500 0
'� Tax Districts Updated: 2/6/2007 Z-year Comparison 2021 2022 Change
1 State of Wisconsin �and: 10,500 10,500 0.0%
57 SawyerCounty Improved: 0 0 0.0%
032 Town of Winter Total: 10,500 10,500 0.0%
576615 Winter School District
O01100 Technical College
�l`Property History
��� Recorded Documents Updated: 12/9/2020 N/A � �� ��� �� �
WARRANTY DEED
Date Remrded: 11/16/2020 428040
QUIT CLAIM DEED
Date Remrded: 5/12/20ll 406694
AFFIDAVIT
Date Recorded: l0/2/2012 381029
TRUSTEES DEED
Date Recorded: 5/21/2004 321777
CERTIFIED SURVEY MAP
Date Recorded: 4/15/1974 147318
htlps-.1/tas.sawyercountygov.org/systemlframes.asp?uname=Eric+Wellauer �/�
'``'"`-"E">� PRIVATE ONSITE WASTE TREATMENT co�nty
;ji p '''�
�-�, sYSTEms Sawyer
,�, � $ �����i�,
��'�,� e$ J�, POWTS)
���,�� (
�?ss'—�>�"'' INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION 2,2, -o2g�
Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. L5.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village Gt�Town of: State Plan Transaction ID#:
� �n`� �co�� (N��,� �
Insp BM Elev: BM Description: Parcel Tax No:
oo.a ' o�-- �-t;� 1f� o32—s�8-63�Il
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic Benchmark ��� �r
Dosing
Aeration Bidg. Sewer ,y. '
Holtling ?j aop St/Ht Inlet ,3S-�
TANK SETBACK INFORMATION St/Ht outlet q , '
TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet
AIR INTAKE
Septic NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man.
Holding k2S' N �'�Y` ty � � Dist. Pipe
PUMP 1 SIPHON 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 � IGP ❑ Chamber
❑ AG ❑ EZFIow Model Number:
CELL TO ❑ Mound o Other
- - ----- - - - -
DISTRIBUTION SYSTEM X Pressure Systems Only
_ _- - _-- ---- ----
Header/Manifold Distribution Pipe(s) ' X Hole Size X Hole Observation Pipes
Length Dia [ Length Dia Spac � S acin ❑Yes ❑ No �
-- -- ._- - - ___—�— P 9
SOIL COVER
- --- — — _
Depth Over Depth Over Depth of Seeded/Sodded Mulched
Ceil Center I Cell Edges Topsoil � ❑Yes ❑ No ( ❑Yes ❑ N�
COMMENTS: (Include code discrepancies, persons present, etc.)
��.,��� ��Is���.
� ��
- -_ - ___ _
Plan revision required?�Yes ❑ No p3 (o �- ` /
---- -- ----� ��� -b �
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
AODITIONAL COMMENTS ANO SKETCH
SANITARY PEAMIT NUMBER: �-� - z`�S
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