HomeMy WebLinkAbout012-640-09-4209-SAN-2023-034 Department of Safety Counry C�1
9 S & Professional Services, Sanitary Pe it Number(to be filled in b; � I
Pg Industry Services Division Z
(v 3°I �3 S�-i �
Sanitary Permit Application state Transaction N�mber �
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit �
is requircd prior to obtaining a sanitary pcnnit.Notc:Application fortns for state-0wned POWTS are submitted to Projcct Address(if differcnt than mailing W
thc 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. q�6� N TrQ p Qlr��`�
I.Application Information-Pkase Print All Information (1 H
PropcRy Owncr's Namc Parccl
h Ol O
Property Owner's ailing Address Property Location
6 G�
City,State 7_ip Coc1e Phone Number
5� f� �' � ��-'/<,_� '/<. Section _� _
ll.Type of Buildirtg(c6eck all that apply) i-��� T O N R_ �C__E or�
�I or 2 Pamily Dwelling-Number ofBedrewms_� Subdivision Name
N sio�k#
❑Public/Commercial-Describe Use____�
^ ❑City of _
❑State Owned-Describe Use NA — CSM Number ❑V il lage o1� _
�T�,�,o, Hllh`F e�r
2�i//�W # �
III.Type of POW'I'S Permit:(Check either"New"or"Replacement^and other appiicable on line A. Check one box on lioe B.Complete line C if
a licable.)
1.
�New System ❑ Replacement System ❑ Otfier Modification to Existing System(explain) ❑ Additional Pretreatment Unit(explain)
B' � Holding Tank ❑ In-Ground ❑At-Grade
❑ Mound ❑Individual Site Design ❑Other Type(explain)
(conccntional)
C• ❑ Renewal Before .ist Previous Permit Number and Date Issued
❑ Revision ❑ Change of Plumber ❑ Transfer to New Owncr
Expiration �
IV.DispersaUTreatment Area and Tank Informafion:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
Oa t�lA
Capacity in Tolal #of Manufacturcr
Tank Infortna[ion Gallous Gallons Units � � � �„ :
Ncw Tanks Existing Tanks y o v � � p <a c`"c
a. :J in �, c7 w C7 a.
Septic or Holding Tank 2'�O ��� � Y
.7 /�
Dosing Chambcr
V.Responsibility Statement-1,the undersigned,assume responsibility for installsfion ot the POW7'S shown on the attached plens.
Plumber's Name(Print) Plumber's Signature MP/MPRS Numbcr Business Phone Number
O h d
Plumbcr's Ad ress(Strcct,('iry,Statc,Zip Codc)
o� r� z
VI.Co n /Department Use Only
o Permit Fee Date Issued Issuing Agent Signature
�A ov� ❑Disapproved
� � Y� o� y (� �� 3 -n'���-P-�`t�'�"-�=
❑Owner Given Reason for Denial �
Conditions of Approval/Reasons for Disapproval j ,
c�a�� �'1� I�a�. _ �_ ° �' � ��f : ;
�� � ;_�,�
���,�, _
�' Chk# S 3� I APR Z 0 2023 ,
C5� �� _ ��� �Cot#�_��5��--�---_v'._....'" Si�v�t�,"FR �:��:`.,.�;�,��,.,,
;
� ZO?JiNG AD1AIiViSTr�;;��G:v
Attach to complete plans for the system and submit to[he Counh�only on paper not less than 8 1R x 1 I inches in size i �c�' �
6
ssD-�39s�R.o3nz� NO REFUNDS AFTER
I�SUE OF PEf�MI�
Sawyer County Zoning & Conservation Administration
```"� ` 1 10610 Main Street, Suite 49
��R_ Cp �� Hayward, Wisconsin 54843
,:�/ ��G��, (715)634-8238
�Q� A a � FAX (715)638-3277
� (� � :_; - � � � www tawvercountyeov.orq
� o � o � E-mail: ronin� sec(resawvcrcountveo��.or�
� � Toll Free Courthouse/General InTormation 1-877-699-4110
I� � ��y� _ �" "-� �
S 5� �
/� j 1;O1J`�
Holding Tank Approval Checklist
I. Sanitary Cover Sheet Date Stamp d � / �O /��
Parcel ID# v l � - � �( O- O j _ �( � O g
II. Plot Plan
'� Property Lines � Benchmark BM ♦
�C Site Address �C North Arrow
Structtire Scale
Well � 25 ' to Service Road
� Legal Description —�Nearest Road intersection
� Setbacks to: Property Line, Well, Structure, Water bodies, Roads
IIL Required Plans
Index Page with Original Signature
anagement Plan/Contingency Plan
Servicing Contract
� Holding Tank Agreement form
IV. Holding Tank Specifications
Cross-section - Manufacture, Gallons: -�-�,���1 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)
� 3" Bedding Material < 1 /2 "
V. Holding Tank Plans per Component POWTS Manual
�Version �SBD- 10855-P (R.3/07) �a -2-��
t
Owner: 7��� �kS�(,, Plumber: � . ��
Application Review Date: Y a-v I �` �
POWTS Reviewer: ��� ��i�
Name
6� � I �
Licensc #
Revised 4/11 /2013
PAGE 1 OF 4
Holding Tank Plan
Index & Cover Sheet
Component Manual Design References:
Holding Tank Version 2.1 (May 2022-2027)
Pg 1 of 4 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): Eric Shymanski Phone: 715 _451 _6575
Owner Address: 467 Fairview Ln Nekoosa, WI Z�p: 54457
Project Address: 9061 N Trapper Trail Hayward, WI 54843
Govt. Lot: NW �1/4 of SE �1/4, Section 09 , T 4� N-R �6 E❑or W ❑✓
Township: Hunter County: Sawyer
Project Parcel ID#: 012640094209
Designer Information
Designer Name: Kurt Brown Phone: 715 _943 _2988
Designer Address: W10487 Old Murry Rd Exeland, WI Z�p; 54835
E-mail: brownk@bevcomm.net , ,
License Number: 224281
Remarks:
Signature: Date: 4 - 10 - 23
Orig' al signature required on each submitted copy.
ERIC SITYMANSKI
467 FAIRVIEW LN SIGNED: �� �''L'�
NEEKOOSA,WI 54457
A 3,000 GALLON HOLDING TANK
715 451 6575 IS BEING PROPOSED TO SERVE
���, NW,SE,S9,T40N, R6W THIS SITE.
L,t 5 C3r"► �`lrlo`� #'6��$ DESIGN FLOW=450 GPD
TOWN OF HUNTER-TRAPPER TRAIL
TRAPPER TRAIL
#9061 N
N
SCALE: 1"=40'
DR.WAY
SITE CONTAINS 4.3 ACRES.
A DR.WAY IS IN AND A BUILDING SITE
HAS BEEN CLEARED. OTHERWISE, LOT
IS COMPLETELY UNDEVELOPED.
3,000 GAL. H/T
B 2 PROPOSED P/EAREST
97�, CABIN
❑ • BM
❑
SUITABLE g_� CLEARED
MOUND 97 9, AREA
AREA 408'
_ _ _ _ _
❑ -- _
B-3
97.7'
�a!\
������
ELEVATIONS � ��O°
� BM=100.0', NAIL IN 16"DIA. MAPLE TREE 16"ABOVE GRADE.
B-1 =97.9'
B-2=97.7'
B-3=97.7'
MOUND AREA IS LEVEL
HOLDING TANK SPECIFICATIONS
3 Number of bedrooms
300.0 Non-residential estimated flow(gpd)
��Minimum holding tank volume required(gal)
3000.0 Proposed holding tank capacity(gal)
Huffcutt Tank Manufacturer
3000 Tank mode�number
SJ Rhombus Alarm manufacturer
101HW Alarm model number
Tank Dimensions and Data Tank Anchor Calculations
X for round tank 17000 Ibs Weight of tank and cover
57.0 Liquid depth below inlet invert(in) 1.50 Safety factor
8.0 Maximum de th of soil cover(ft) 32781 Ibs Weight of anchor required
67.0 Height(in) 36.0 in Soil cover req.for anchor or
159.5 Length(in) 8.1 yd3 Concrete counter weight
86.0 Width(in)
HOLDING TANK CROSS SECTION
manhole cover with
locking device and fnished ��ent cap
jundion � warning label grade
� �4"min. 12"min.
�24 in.
Manhole and vent locations
conduit —� vent pipe
18"min
y
building sewer
� service � 12.0 in. inlet
blind plug aiarm on Note: All tank joints,and
to seai joints between tank
oune� openings and piping are
Electrical as per 45.0 in. sealed watertight. All pipe
NEC 300 and vent materials comply
and Comm 16 with Comm 84.
3 in.bedding under tank. Tank is anchored as necessary to negate buoyancy.
Project: Eric Shymanski
Transaction Number: Page 2 of 4
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 382-384,Wisc. Admin. Code. Pursuant to SPS 383.52 (2),Wisc. Admin. Code, this holding tank(s)
shall be considered a human health hazard 'rf not maintained in accordance with this approved management plan.
Furthermore, all inspection and maintenance activities shail be perfortned by a registered POWTS Maintainer in
accordance with SPS 383.52 (3),Wisc. Admin. Code.
Estimated Daily Wastewater Flow= 3OO 9Pd
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisa�ce 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, tlmers, alarms, etc.)
o surface discharge of effluent or sewage back-up into structure served
SERVICING FREQUENCY
c 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 govemment unit in accordance with SPS 383.55 Wis.
Admin. Code. Report any wmponent failure or malfunction to:
Name of individual or company: KUft BfOWII phone: 715 943 2988
�o�i 9o�e��me„t ��;t: Sawyer County Sanitary and Zoning phone: 715 634 8288
�oca� government unit address: 10610 Main St. #49 Hayward, WI Z�P 54843
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.
Continqencv 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.
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�--� PR❑JECT� 4154 123rd STREET =_ � � N.P.C.A. CERTIFIED PVWT
HUFFCUTT ��VA FALLS, VI 54729 � N� �
q 3,000 H.D. LOW PROFILE � � a � &
� SEPTIC OR (715) 723-7446 � (800) 924-1516 — " a MEMBER OF:
G R E A S E I N T E R C E P 7 0 R C 0 A C R E T E. IA C F A X (7 1 5) 7 2 3-7 1 1 1 � NNN.I I U f fCU t t.COi'1 � � � ; N A l I O N A L d c N 1 S C IX J 9 N P R E C A S T C O N C R E T E A S S O C I A 7 1 0 N S
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PR❑JECT� HU�FCUTT %`l o�
�, 4154 123rd STREET ,y��, N.P.C.A. CERnFIED PLANT
� 3,000 H.D. L�V PR�FILE CMPPEVA FALLS, VI 54729 �'��_ �
SEPTIC oR (715) 723-7446 ■ (B00) 924-1516 g��a MEMBER OF:
� G R E A S E I N T E R C E P T�R C 0 A C R E T E• I A C F A X (7 1 5) 7 2 3-7 1 1 1 ■ •w w.h u f f c u t t.�o n r�o o N A l I O N A L d c I M S C O N S I N P R E C A S T C O N C R E I E A S S O C I A T I O N S
HOLDING TANK SERVICING CONTRACT
Contract Date: / / / 'Z
This contract is made betwcen the Holding Tank Owncr and the Pumper.
Holding Tank Owner's Name: , Pumper's Name:
(�/_ Northwest Sanitary, Inc.
�'Yt �ivrl��l�s �" POBOX155
Radisson,WI 54867
Parcel Identi�cation Number:
(12 Digit Legacy ID) ���-�G � �-Q �'_J - � o� ��
L Thc owner agrees to file a c��py of this contract with the govcrnmental unit, Sawyer County,
which has accepted and recordcd with ti�e Urficc of the itcgistcr oi i�ecds, tnc iviaintenance
Agrcement for a Holding Tank requircd under thc Sawyer Co�mty Private Scwage System
Ordinancc for the issuancc of a Sanitary Pcrinit for tl�e installation of a holding tank(s).
2. The owner agrees to have the holding tank(s)scrviced by the pumper and guarantces to
permit the ptimper to have access and to enter upon the property for the purpose of servicin�
the holdin�;tank(s). Tl�e owner agrees to i��aintain the all-weathcr access road or drivc so
that the pumper cai� service the I�olding ta��k(s) with thc pim�ping equipment. The owner
furthcr agrees to pay the pulnper tior a charges incun-ed in servicing the holding tank(s) as
mutually agrced upon by thc owncr and pumper.
3. Tl�e pumper agrees to submit to the Govcrnmental Unit, Sawyer County, a report for the
servicing of the holding tank(s) as required undcr SPS 383.55, Wisconsii� �ldministrative
Codc and thc Sawycr County Private Scwagc System Ordinancc. Thc pumper furthcr
agrees to include the following in the report:
a. Thc name and address of the person responsible for scrvicing the holding tank;
b. The name of the owner of the holding tank;
c. The sitc address of the holding tank;
d. Thc datc the holding t�nk was serviccd;
e. The vol��mes in gallons of the contents pumpcd fro��� thc holding tai�k for cach scrvicing;
£ The disposal sites to which the conte��ts from tl�e 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,thc owner agrees to file a copy of any changes to this
servicc contract or a copy of a new service conh-act with Sawyer County within ten (10)
busincss days from the date of change to this scrvice contract.
�WI1CT''S N2171e: (PCII]t� �wnel''S SlgnahlT'C: (Only one m��ner signature required)
�YI c �'��'"'"'c'"f/�� �
Pumper's Name: (Print) Pu �per's Signattire:
Ronald L Vieceli,owner Northwest Sanitary,inc ��Z'�<� / G�C�
�-� (....
Pumper's Registration Nuinber:
#2389
Rev.03126/I 3
-USE BLACK INK ONLY - ( IIIIII II (I(II III II I (I I I
�l,r,��T,�;;ftfjn�i�1
POWTS MAINTENANCE AGREEMENT Tx:4044��8
For Holding Tanks 444158
PAULA CHISSER
Owner's Nam ),as shown on deed: • REGISTER OF DEEDS
�►i'i���1 l�Yf2Q/�S�L-�- SAWYER COUIYTY, WI
04/2fl/2023 11:54 AM
Parcel Identification Number: / �' / ^� RECORDING FEE 30.Ofl
(12 Digit Legacy ID) �-1 L p�-���- � �- ! v, � !
PAGES: 2
Legal Description of Property:
-SEE ATTACHED SHEET -
We acknowledge that application is being made for the installation of a holding tank(s)on the
property described on the attached sheet.
Return To:Sawyer County Zoning and Conservation Administration
10610 Main St.Suite 49, Hayward,WI 54843
� I _
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 addiiion, t��is agreemeni may b2 c�,r�ceii�d b�exc�uti��y and recoiu'i^g :=aiu cert;`;catior,v✓i',h 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.
-Only one owner signature required- � � ACKNOWLEDGMENT
Own�'s S� ture�-� State of: w + S L���S^�i✓
� County of: �� �(,1��
Owner' ame (Print): Subscribed and sworn to before me on this
�rl� S�i.. �•,-,�•,S'�/ L`�y day of yL�����- , 20 2�
���T7►t�t�,, ,�
Date� �d�v����lar�ie): t � Si-1?�.�'/ ✓���
r �Y/ �� `���•Puf�liC•�gnat,ar
Drafted by: 1/ n ���1ic A�I�t�r�Na'me (�'rint): . I�Ci�� �9 ����
S� `
'I��n�'�" r�� ; = � c�►mis�ion�ezp�es on: /��l.�l`� �� , �c,"�l�
_ : ,,�;�;t,�,>i.° ' �V _v_
� �� . � :
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Personal information you provide may be used for secondary purposes[Privacy y'�`Q'E lo�,��\� Rev.03/26/13
''`I T
�!�!�i�i��►g�.�,
Parcel I:That parl of the Norlhwest Quarter ofthe Southeast Quarter(NW'/<SE%)and Southwest Quarter ofthe Southeast
Quarter(SW%SE%),Section Nfne(9),Townshfp FoRy(40)NoRh,Range Six(6)West,Town of Hunter,Sawyer County,
Wfsconsin,more particularly described as Lot 9 as recorded in Volume 24 of Certified Survey Maps,page 104-105,Survey No.
6528 as Document No.306796.
Parcel II:Together with and subject to a non-exclusive easement for ingress and egress and utilily as shown on Certifed Survey
Map referred to herein.
Forinformational purposes only:
Property Address:Trapper Trl,Lot 9,Hayward,W/54843
Tax Key Number:012-640-09-4209
4/20/23, 11:41 AM Real Property Listing Page
R2al EStat2 Sawyer County Property Listing Property Status: Current
Today's Date: 4/20/2023 Created On: 2/6/2007 7:55:24 AM
.:pa' Description Updated: 3/31/2020 � Ownership Updated: 3/22/2021
Tax ID: 13893 ERIC SITYMANSKI NEEKOOSA WI
PIN: 57-012-2-40-06-09-4 02-000-000090
Legacy PIN: 012640094209 Billing Address: Mailing Address:
Map ID: .14.9 ERIC SITYMANSKI ERIC SITYMANSKI
Municipality: (012) TOWN OF HUNTER 467 FAIRVIEW LN 467 FAIRVIEW LN
STR: 509 T40N R06W NEEKOOSA WI 54457 NEEKOOSA WI 54457
Description: PRT NWSE LOT 9 CSM 24/104 #6528
Recorded Acres: 4.340 `�� Site Address * indicates Private Road
Calculated Acres: 4.343 9061N TRAPPER TRL * HAYWARD 54843
Lottery Claims: 0
First Dollar: No �.••w Property Assessment Updated: 9/Z8/2009
Zoning: (RR1) Residential/Recreational One 2023 Assessment Detail
ESN: Code Acres Land Imp.
G1-RESIDENTIAL 4.340 31,700 0
�'�" Tax Districts Updated: 2/6/2007
1 State of Wisconsin 2-Year Comparison 2022 2023 Change
57 Sawyer County Land: 31,700 31,700 0.0%
012 Town of Hunter Improved: 0 0 0.0%
572478 Hayward Community School District Total: 31,700 31,700 0.0%
001700 Technical College
�• Recorded Documents Updated: 3/22/2021 � Property History
TRUSTEES DEED N/A
Date Recorded: 3/15/2021 430508
QUIT CLAIM DEED
Date Recorded: 2/18/2008 351858
WARRANTY DEED
Date Recorded: 4/15/2003 310248
COVENANTS
Date Recorded: 3/4/2003 308777
CERTIFIED SURVEY MAP
Date Recorded: l2/30/2002 306796
https://tas.sawyercountygov.org//system/frames.asp?uname=Eric+Wellauer 1/1