HomeMy WebLinkAbout006-439-11-3202-SAN-2022-324 %,: - T Industry Services Divisioa ���Y �
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���3;;_-���- Medison,WI53707-7162 (0 3°� �C 3 v
$tace Trensection Numbv
� `� Sanitary Permit Applicarion __ w
In eoco,dan«wim ses sa3.z1(z�ws.naro.code,sunm;u;on ormis fom,ro we appropfi.tc go�e�nmenm�wit =
is required Pnor ro obininin6 a smitarY PC^nit Noh:AppGcatim fomu for sua�owoed POW'IS ate mbmitled b Roject Add�eaa(f diffaat d�m ma�l'mg ac ,
the Dcpvtmmt af SefelY and Rofesvoml Servicrs.Persmel iufo'mation you provide�y be used fw s¢oudary
uryoses iu eccotdmce with the Privacy Law.s 15.04(lxm).Suts.
I.Appliqtioo Informadou-Ple�se Print AR[atormadon � - (Al
PmpeRy Owcer s Name Pucel#
-�or �- �� D `' �2
Property Owner s Msiling Add(ess ProPMY I-ocaTwo Q'�''' `
GovG I.ot '—'"
aa.suu� z�,c� �oa x� �4d
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II.Type of Bqil ing(c6eck all fhat apply) Lot# r N A E o
�1 or 2 Femily Dwelling-Number ofBedrooms__�_ Subdivision Neme
Blocic#
�ublidCommacinl-DcsaibeUm
iry oF
tate Owned-bescn'beUse CSM Numbc iilage ot
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III.Type of POR'1S Permit:(Check dther"New"or"Replaew�M and other appllcabk on Bne A.Check oee boz on llne&ComplMe line C
a licable.
A. I�Ir,rew System �Plaumeu[Sysbem �ModiScetion ro F"uinB SYuem(uPlam) Additional Preuntmmt Umt(o�lain)
t�S.a..
B. l�fioldiog Tedc ❑In-G+ouud ❑4bGnde ❑Mamd Iodivlduel Site Deeign Ot6es Type(e�cPlain)
`�' (cwnventionaq
C. �Rrnewal Before �Revisioe ge of M�ber �frensfam New Own �O�P«mit Numba end Daoe I.sucd
Ezpiretion �
N.DisperssUTreatment Ares and Tmmk Informslion:
Design Pow(@pd) Dai�Soil Applica[ian Rate(gpd/s� Dispcml Area Re9u'ued(s� Dispe�l Area Pmposed(s� system Elevetion
�
�P°��Y in Toal q of Manu�chrter s ,
Tedc Infolmation Galloas Gellons Units a� � .�
NewTmks F isN�gTmk y �m
�U in � ii(� �
Seplic or Holdi�Taok 1 j� r
nos;�s cn,mxr Q
V.Responsibflity ShOemeut-4 me aMeN�N,anume`eapoo+ffiIIItY fw imh6�d°a ottM POVYiS ehowo oa He athrLcd pi�m.
Plumber's Neme(Print) Plumber' igaatwe . MP/f�P�•Nwnber Busiass Phone Nmnber
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y ry ❑Owne Gven Reason for Dmial - -_ "
CondiNons of ApprovsUReasons for Disapprovel i ( '` '�
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SBD-6398(R 03121) NO RL-FUNDS AFfER
ISSUC OF PEfiM�T
Sawyer County Zoning & Conservation Administration
��������� 10610 Main Street,Suite 49
� ; � Hayward,Wisconsin 54843
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�" �� �I (715)634 8288
� ��\ :r�j � FAX(715)638 3277
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Holding Tank Approval Checklist
I. Sanitary Cover Sheet Date Stamp � � / �2 / � �
Parcel ID# 0 d 6 - �( 3 `� - l ( -3 �, b �
II. Plot Plan
�Property Lines �Benchmark BM ♦
X Site Address p� North Arrow
�C Structure �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
olding Tank Agreement form
IV. Holding Tank Specifications
�Cross-section—Manufacture, Gallons: �� a�01��
�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-10a55-P (R.3/07),. .
�•�
Owner: � o�-,Se Plumber: �,��
Application Review Date: �� �,3 ���t
POWTS Reviewer: �� ��c�%�_
Namc �Q� ��
l
Liccnsc#
Revised 4/11/2013
�'o���{,� HOLDING TANK DESIGN
Single Tank Option
INDEX AND TITLE SHEET
Project County Rd. M
Owner Jordan Sell
Address E 9851 County Rd. V
Strum Wi 54770
Legal Description N1/2 NWSW S-11 T-39-N R-4-W
Township Draper County Wi
Subdivision Name Lot No.
Parcel ID Number 006 439 11 3202
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 Craig Thompson
Signature + Phone No. ��3`^ ��"";���/:�
License Number 220810 Date 10/17/22
Designed pursuant to:
Holding Tank Component Manual For POWTS (Version 2.�� a�_a-��
Version 7.0(11/12) Page 1 Of 4
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HOLDING TANK SPECIFICATIONS
2 Number of bedrooms
Non-residential estimated Flow(gpd)
L-;'_JMinimum 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) 20300 Ibs Weight of tank
8.0 Maximum depth of soil cover(ft) 1.10 Safety factor
152.0 Length(in) 6378 Ibs Weight of anchor required
75.0 (,�,�;�'{h (in)}Outside Dimens;;ns 97 in Soil cover req.for anchor,or
1.6 yd' Concrete counter weight
HOLDING TANK CROSS SECTION
manhole cover with
locking device and
vent finished junction �Warning label
� grade box —� �
cap 4"min.
12"min. � , F 23"min. �
.�..�. � � �
vent pipe conduit—� tether
weight 18"min.
blind Note: All tank joints, � �
p�u9 and joints between ---------"
to seal tank openings and 12 in� building
piping are sealed �� 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 lank's rounded surface,5oil cover alone may nol be adequate to prevent flotation.
Project: County Rd.M
Transaction Number: Page 2 of 4
HOLDING TANK SITE PLAN
Project: Counry Rd. M
N Legal Description: N1/2 NWSW S-11 T-39-N R-4-W
�� Subdivision Name:
Scal : 1" = 30 ft Parcel ID: 006 439 11 3202 Lot No.:
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NO '�"
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GN6�1-N
Transaction I.D.: Page 3 of 4
13�"1 ' S{����e �n 5�«+h 5 ;�e ���' r�le Trce 13m= iu90 �
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 ot 40.0 to 400.0 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) capaciry 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 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. 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 corcection orders or a citation by the county or state.
7. No one should enter a holding tank for any reason without being in futl 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 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 insta�lation, the following persons should be contacted:
a. Installer.__..__.................._ Don Thompson &Sons Exc lLC Phone: 715-266-2842
b. Service Provider..................... NorthWest Sanitary Phone: 715-943-2650
c. County Zoning or Health Dept. Sawyer County Zoning Phone: 715 634-8288 _
11.
Project: County Rd. M
Transaction Number: Page 4 of 4
HOLUItiG TANK SERVICING CON'IRAC"T
Convact Datr. r / / • �
This contract is made between the Ffolding Tank Owner and the Pumper.
Holding Tank Owncr's Namc: Pumper's Namc:
Northwest Sanitary, Inc.
�o;�;Qnr1 Sc'�) aoeox ,ss
Radisson,WI 54867
Parcel ldenti�cation Number: /
(12 Digit Lcgacy ID) �� �J - L� � t -� ( - 3 ���
I. Thc o��mcr agrccs tn filc a cupy of lhis contract with thc govcrnmcntal unit, Sawycr C'ounty.
which hati acccplcd und mcurdcd wilh thc Officc of lhc Rcgistcr uf Dccds,�hc Maimcnancc
Agrccmcnt for a Holding l'ank rcyuircd undcr Ihc Sawycr County Privatc Scwagc Sys�cm
Ordinancc for thc issu.mcc of a Sanitary Pcrmit for lhc inst.dlation of a holding tank(s).
2. Thc nwncr agrccs lo havc Ihc holding tank(s) scrciccd by [hc pumper and guaranlecs to
perniit thc pumper to havc acccss and to cntcr upon thc property for thc purposc of scrvicing
thc hulding tank�s). Thc owncr agrccs to maintain thc all-wcathcr acccss roed or drivc su
th:�t thc pumper can scn icc thc holding tank(s) N ith thc pumping cyuipmcnt. Thc owncr
furthcr agrccs tu pay thc pumper for a chargcs incurrcd in scrvicing thc hulding tank(s) as
mutnally agrccd upon by ihc owncr and pumper.
3. fhc pumper x�Tccs�o submil to thc Govcmmcn�al Unit, Sawycr County,a rcport for Ihc
servicing of thc holding tank(s)as required under SPS 3R3.59,N'isconsin Administrative
Cudc and Ihc Sawycr County Privatc Scw��gc Systcm Ordinancc. Thc pumper furlhcr
agrccs�o includc thc following in thc rcporl:
ai. Thc numc and address uf ihc person msponsiblc for scrvicing Ihc holding tank;
b. Thc namc uf thc owncr of lhc holding tank; �
c. Thc sitc address of thc holJing t.mk;
d. "I'hc datc thc holding tank uas scrviccd:
c. Thc volumcs in gallons of thc coMcnls pumpcd from thc Iwlding Iank for cach scrvicing:
f. Thc ditiposul siics to which thc contcnts from Ihc holding tank wcrc dclivcrcd.
4. This agreement �t ill rcmain in cffect until the o�+�ner or pumper terminates this contract. In
thc cvent 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 ne�v service contract with Sauyer County within ten (10)
busincss days t7om the date of change to this service contract. •
Owncr's Namc: (Print) Owncr's Signawre: io�y���e�w�e.x�R��m�e.«��irea�
• �o��� �� �- ��-�'L%�"C�.
Pumper's Name: (Print) Pumper's Signalum:
Ronald L Vieceli, owner Northwesl Sanitary.lnc /� .'�( ��`
Pumper's Rcgixtraliun Numbcr:
#2389
R cv.0 f,pb:13
Real Estdte Sawyer County Property Listing v�ore�ey s�w::c���c
Today's Date:8/13/2022 Created On: 2/6/2007 7:55:12 AM
�'Descripdon Updated: 10/8/2020 � Ownership Updated: SO/8/2020
... _ .. . _ _ .. . .
TaxID: 6644 IORDAN SELL STRUM WI
PIN: 57-006-2-39-04-11-302-000-000020 SAMANTFIATOMSEN STRUM WI
Legacy PIN: 006439113202
Map ID: .10.2 Bil ing Address: Mailing Address:
M�nicipality: (006)TOWN OF DRAPER )ORDAN SELL )ORDAN SELL
STR: Sll'f39N R04W E9851 COUNTY RD V E9851 COUNTY RD V
Description: Nl(2 NWSW STRUM WI 54770 STRUM WI 54770
Recorded Acres: 20.000
Lottery Claims: 0 � Site Addr�s *indicates Private Road
First Dollar: Yes 6668N COUNTY HWY M WINTER 54896
Waterbody: Fly Blow Creek
Zoning: (A-2)Agrialtural Two � Updated: 8/22/2016
ESN: 429 - Properly Assessment
2022 Assessment DMail
� Tax Districts Updated: 2/6/2007 Code Acres Wnd Imp.
G1-RESIDENTIAL 1.000 4,500 200
1 State of Wismnsin G6-PRODUCTIVE FOREST 19.000 21,300 0
57 Sawyer Counry
006 Town of D2per Z_year Comparison 2021 2022 Change
576615 Winter School District �nd: 25,800 25,600 0.0°n,
001700 Technical College Improved: 200 200 0.0°i�
Total: 26,000 26,000 0.0°io
+� Recorded Documents Updated: 10/8/2020
O WARRANTY DEED
Date Rxorded: 9/21/2020 42 593 '�D pro�rty„��ry
O TRANSFER BY AFFIDAVIT N/A
Da[e Rxorded: 9/21/2020 426592
O WARRANTY DEED
Date Recorded: 7/8/2005 33ll07
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- U S E B L A C K I N K O N L Y - DocI� :8064948
POWTS MAINTENANCE AGREEMENT Tx :�04172 i
442118
For Holding Tanks PAULA CNISSER
REGISTER OF DEEDS
Owners Name(s) as shown on deed: SAWYER COUNTY, WI
� 11/�3/2022 08:26 AM
�l�J� � G�.I� CJ�% � � �QM���� a T�MSF RECORDING FEE 3D.00
Parcel Identification Number. j� � / G f �
(72 Digit Legacy ID) V `' lG - � �� l - � ` - \J � � `��, PAGES: 2
Legal Description of Property:
- SEE ATTACHED SHEET -
We acknow�edge that appl'ication is being made for the installation of a hoiding 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 54543
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 t� holding tank management, induding the foltowing:
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 shail submit pumping reports to
the govemmentat 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 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 tank properly serviced in response to orders issued by the govemmental unit to prevent
or abate a human heafth hazard as described in Section. 254.59, Stats., the govemmental 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 all charges and cost incurred by the govemmental 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 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 municipa! sewer serves the
properry. In addition, this agreement may be cancelled by executing and recording said certification with reference t ' � �..,,
��..n�
agreeme�t in such manner which will permit the existence of the certification to be determined by reference to th fQpetty. �..;, <
'�:•`��r�SSM � ' �•.
5. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The ow tf�ir�bAt�C••..�� "%;
the agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a m�►�tf1 �rich 'va3ft ' ',.`l�, =:
permit the existence of the agreement to be determined by reference to the property where the holding tank+i�� a�ls�.\1 Q n d �'; r �.
, N
i : �.�
-Onl one owner si nature re uired - ACKNOWLEDGMENT ';o ' '� � e 1 o N :�m
:
Owner's Si nature: � �. �' �' , ' ,. ' 1-
9/_ ��� State of: L��SCr�ll S, /� s, �y,,y� .��..••'`��.�
� �'�' � Countyof: �r'�t-y��J�'C.2( c'��liL ''• 0� '3 `•
Own�r's ame (Print): Subs ribed and swom to.before me on this
�_,
•—�.�, �V1 � �, -f� day of nC-�t3�� , 20 22-
Date:l � I r. i �v� � By (Owner's Name): � � �l� ,
� t Notary Public Signature:
Drafted by:��, Public Notary Name (Print): i'1 ,�l�
� ' � G� � My commission expires on: c� —�J-�2 C?�
Personal infortnation you provide may be used for secondary purposes [Privacy Law, § 15.04 (I) (m)J Rev. 03/26/13
The North Half(N1/2)of the Northwest Quarter of the Southwest Quarter
(NWI/4SWI/4), Section Eleven(11), Township Thirty-nine(39)North,Range Four
(4) West.
`�''"'"��: pRIVATE ONSITE WAS�E TREATMENT county
���oS �j�'� SYSTEMS
'';%�� PS �j1 ( POWTS) Sawyer
�k\F�-__--.;:,
INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� ��a Y
Personal infonnation you provide may be used for secondary purposes[Pnvacy Law,s. I 5.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#:
� r�/WrhS2. J—JGMo (1'ow, �s� ^
insp BM Elev: BM Description: Parcel Tax No:
I�a-J r s �c-� ►� So.� S,�. �� 1R-�_ o�-�139-�l -3��
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic Benchmark po,a �
Dosing
Aeration Bitlg. Sewer
Holding ,S �(�p St/Nt Inlet �'7,3S�
TANK SETBACK INFORMATION St I Ht outlet
TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet
AIRINTAKE
Septic NA Dt Bottom
Dosing NA Installation
Contour
Aeration NA Header/Man.
Holding ±�� �f _<a Dist. Pipe
PUMP 1 SIPH N 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 � #of Celis Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav ° Conv ❑ Aggregate
INFORMATION P/L Bldg We�� Waters o G ❑ Chamber Model Number:
❑ EZFIow
CELL TO ❑ Mound � Other
-- _ ----- —----
DISTRIBUTION SYSTEM X Pressure Systems Only
Header/Manifold Distribution Pipe(s) TX Hole Size X Hole Observation Pipes
Length Dia Length _ Dia Spac � _ Spacing ❑Yes ❑ No
SOIL COVER
� Depth Over Depth Over Depth of Seeded/Sodded Mulched
Cell Center Cell Edges Tpsoil _�❑ Yes ❑ No ( ❑ Yes ❑ No
COMMENTS: (Include code discrepancies,persons present,etc.)
��s�l� <<I1��a�
� �•�,
Plan revision required?0 Yes 0 No a3 �3 23 � � , —�j� ��� �
—�� .
Use other side for additional information Date POWTS Inspector's Signature Certifcation Number
SBD-6710(R.3l01)
AD�ITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBEA:_ �� �- 32�
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