The URL can be used to link to this page

Home My WebLink About032-437-11-2201-SAN-2023-185 � Department of Safety c°°°ty � i & Professional Services, .S GJ L'�' -� $� - Sanitary Permit Number(to be filled in by � ; Industry Services Division i�, 5 �� Sanitary Permit Application State Transaction Number -� In accordance with SPS 38321(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit �3 is required prior to obtaining a sanitary permit.Note:Application forms for stateowned POWTS are submitted to Project Address(if different than mailing a � thc Department of Safety and Professional Serviccs.Personal information you provide may be used for sewndary purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. i.ApplicaHon Information-Please Print All Information —�— �L��L�'C�'�L �7�'k" Property Owner's Name lt�� -Lr�, �� E�. Parcel# p 3 Z � �-(3'�- 1� � ',.�. � O Q O �-.,�� ,I =��(�-"� " -A..�oo�-!Z Property Owner's Mailing Address Property Location G/ � � Govt.Lot City,State Zip Code Phone Number �O/(� �'f/ �( S /J!J�� "/(�✓ O�/ �'/4,�'/3, Scction �— IL Type of Building(check all that apply) Lot# T �7 � N R �'o �1 or Z Family Dwclling-Number ofBedrooms � Subdivision Name Block# ❑Public/Commercial-Describe Use ❑City of ❑StateOwned-DescribeUse CSMNumber ❑Villageof �Town of �/� �/ IIL Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if a licable. A' �New S stem y ❑ Replacement System ❑ Othcr vlodification to Existing System(explain) ❑ Additional Pretreatment Unit(explain) B. �Holding Tank ❑ In-Ground ❑ At-Grade ❑ Mound ❑ Indi�idual Site Design ❑ Other Type(explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ist Previous Permit Number and Date Issu�d ❑ Transfcr to New Owner Expiration IV.DispersaUTreatment Area and Tank Information: D sign Flow(gpd) Design Soil Application Rate(gpdistl Dispersal Area Required(s� Dispersal Area Proposed(st) System F.le��ation d�Z� � �— •---- Capacity in Total #of Manufacturcr v Tank Information Gallons Gallons Units p � v '° ; New Tanks Existing Tanks '° ^ '' y y � � N p .�.. � N F ,� w U v, " �n s. :. a Septic or Holding"Iank ��0 / s a �/ T Dosing Chamber V.Responsibility Statement-I,the undersigned,assume responsi 'lity for installation af the POWTS shown on the attached plans. �lumber's N me(Pr nt) Plum r's�ign re MP/MPRS Number Business Phone Number ' � � �'g ��,v a�� ,s-�ss-�ooy Plumber's Address(Street,Ci ,State,"Lip Code) ��0 9 9 �lw �� fo%o,� � � ►��s"y7y5� VI.Coun /Department Use Only �App �°� ❑Disapproved Permit Fee Date Issued Issuing Agent Signature �./ � � :+ ❑Owner Given Reason for Denial � `��'� J( �� '� n��.(,�-�F� �"C�/�✓�=�- Conditions of Appi-oval/Reasons for Disapprobal ` t '� '� �8te �! �� 5 �-� a ;- ` , ;, � ��GII�� _ f ,�f �-. � L -, .________.__._.___.__ ,. �,nk# a��"�r , { . — �,�� , �S'I �3 - ) �-o� �c�t# �"�0 a �'_ .'� r s. , � 3 ;>�,>� A[tach[o complete plans for the system and submit to the County onl,y on paper not less than 8 U2 x]1 inches in size "� 3 C�� NO R�FJN�S AFTER - � ss�-639s�x.o3ia2� ISS�J�OF PERU�IT Sawyer County Zoning & Conservation Administration �� 10610 Main Street, Suite 49 � �R c� � � Hayward, Wisconsin 54843 �'� -' ��i �� (715)634-8288 �� ' FAX (715)638-3277 i Q� \��/ j � - _ _ _ _ - � < % www.sawycrcounty >ov.org � o o � E-maiL' samtarian<alsawycrcountyeov.ore I �� y � � Toll Free Courthouse/Cencral Information 1-877-699-4110 �I��;y - � = � ScoNS� � � ��. Holding Tank Approval Checklist I. Sanitary Cover Sheet: Date Stamp a$ / 03 / 23 Parcel ID# � 3 � - K 3 �- � � - 2 � � ( IL Plot Plan: / Property Lines � Benchinark BM ♦ �Site Address � North Arrow �Structure � 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 � Management Plan/Contingency Plan � Servicing Contract _�C�-Iolding Tank Agreement Fonn ($30 to ROD) IV. Holding Tank Specifications: � Tank Cross-Section: Manufacturer: �►�/`� Gallons: �� X Tank Anchor Calculations [SPS 383 .43 (8) (g)] � Locking device, chains/locks � Alann, electrical per SPS 383 .43 (8) (e) � 3" Bedding Material < 1 /2 " V. POWTS Component Manual Reference: �Holding Tank Version 2. 1 (May 2022-2027) Owner: �a�. � oaM Plumber: _�^,y��q � Application Review Date: b �( � `� ��-3 POWTS Reviewer: � ��t � ��— Name G� � ) � Rev. 4/27/2023 cr�e„r;d� # CONCRETE HOLDING TANK DESIGN Single Tank Option INDEX AND TITLE SHEET Project VAN DOORN Owner JOHN VANDOORN Address NO ADRESS Legal Description NW NW S11 T37N R4W Township WINTER County SAWYER Subdivision Name ' Lot No. Parcel ID Number 57-032-2-37-04-11-202-000-000010 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 RITCH A GHMAN Signature Phone No. 715-595-6004 License Number 231282 Date 07/25/23 Designed pursuant to: Holding Tank Component Manual For POWTS(Versi 0) `1 1 SBD-10855-P(N.03/07)R C oE \�-�,) Version 7A(03/12) Page 1 of 4 HOLDING TANK SPECIFICATIONS `�2 Number of bedrooms � ' OA �Non-residential estimated flow (gpd) i. 200U (7 Minimum holding tank volume required (gal) 2000.0 Proposed holding tank capacity(gal) SKAW Tank Manufacturer SKAW 2000 '� Tank model number SJ ELECTRO Alarm manufacturer WH101 Alarm model number Tank Dimensions and Data Tank Anchor Calculations X for round tank 16100 Ibs Weight of tank and cover 54.0 Liquid depth below inlet invert (in) 1.10 Safety factor 8.0 Maximum depth of soil cover(ft) 10189 Ibs Weight of anchor required 65.0 Height(in) Outside 17.3 in Soil cover req. for anchor or 146.5 Length (in) Dimensions 2.5 yd' Concrete counter weight 69.5 Width (in) Only HOLDING TANK CROSS SECTION manhole cover with locking device and finished ��ent cap junction warning label grade box � — �4"min. �. 12"min. 23 in Manhole and vent locations conduit —� vent pipe 18"min. � tetherweight - 12.0 Ifl. building sewer � service � inlet blind plug aiarm on Note: All tank joints, and to seal joints between tank ounet openings and piping are Electrical as per 42.0 in. sealed watertight. All NEC 300 pipe and vent materials and SPS 316 comply with SPS 384. 3 in. bedding under tank. Tank is anchored as necessary to negate buoyancy. Project: VAN DOORN Transaction Number: Page 2 of 4 HOLDING TANK SITE PLAN t Project: VAN DOORN � • � / Legal Description: NW NW S11 T37N R4W Y �S �1�� Subdivision Name: Scale: 1" =40 ft ', ParcellD: 57-032-2-37-04-11-202-000-0000 Lot No.: �NI=iCC =.�as� �� l�'� /�of�la/� , w�aU�S _ — �_ _ . , -„ � , � " � �-, l�ti� � ��" 1-�� —�� I �$/✓1 , � No �e�l ' i e -I � — — — X � P�o pvs e� � � � abeo� � ,� � � ��Y�p;�� cc � �� Z,�� °J �,:`y � � � � �to �� 5�Ql � ��ppyQ� S�cL� fq�(/� � �� J � / �I / / �-a X �_3 X � �� / � . ��.� / / � L. i Transaction I.D.: I I Page 3 of 4 � 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), and the SAWYER 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) 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 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 ot wastes tank to the ground surtace, 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 installation, the following persons may be contacted: a. lnstaller......................... BAUGHMAN Phone: 715-595-6004 b. Service Provider....._........ 1�1�../ ,�g,��„ Phone: c. Co. Zoning or Health Dept. SAWYER COUNTY Phone: 715-634-4866 11. Project: VAN DOORN Transaction Number: Page 4 014 HOLDING TANK SERVICING CONTRACT This contract is made beN✓een the Holding Tank Owner(s)and Pumper Contrad Date � � �31 � �3 Holding Tank Owner(s)Name(s) Pumpers Name Northwest Sanitary,Inc. J `�_n 1/u� ��yl Ronald L Vieceli, ovmer/operator w, � Parcel ID Number Property Address 57-o3a a 3� �f�1 aoa� a� ��o We acknowledge the installation of(a)holding tank on the following property: (Provide legal description ot property) N � N� S � � l 3��1 � `f�v 1) Owner agrees to file a copy of this contract with County. 2) 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 servici�g the holding 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) t�S��County, as required by Comm 83.55, Wis. Admin. Code. Pumper further agrees to inclu e 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 property on which the holding tank is installed; d. Sanitary permit number issued for the holding tank; e. Dates on which the holding ta�k was serviced; f. Volumes in gallons 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 t file a copy of any changes to this service contract or a copy of a new service contract with'""�`__County within ten days from the date of change to this service contract. ��s� � NO Uvner(s)Name(s)-Please Print Subscribed and swom ro before me on te,:A\ � .t y y •� 37 � ,� �► Qon �,� �7-3�-�3 _--- m -a�,� �. Nofari d Uvnefs Si nature(s) Notary Public �` I 9 D� _. (�-- w� CONs�� C'ti_✓ _ LXl __— --; Pum Name-Please Print My Commission Ezp s � Nort st Sanilary, Inc. Ronald L Vieceli,ownedoperator � -- ', � Pumper Sgnature Drafted by: �I� , / /- . /� f�L-t�� . ��-({LL�' Pumper Registration NumDer Personal infortnatlon you provide may be used for •2369 secondary puryoses[Privaq Laws. 15.04(1)(m)] - USE BLACK INK ONLY- I; ,IIIIIf,I III II IIII,II,I I III POWTS MAINTENANCE AGREEMENT DocId � For Holding Tanks T�:AU�E�� 445872 Owners Name(s)as shown on deed: � PAULA CHISSER REGISTER OF DEEDS � ' � �e��(' — SAWYER COUNTY, WI ��l OS/14/2023 10:51 AM Parcel Identfication Number: /\ 1 µ1 / / RECORDING FEE 3D.00 (72 Digil Le9acY��) 1L� �L` -!,��-� ! -�� I PAGES: 2 Legal Description of Property� -SEE ATTACHED SHEET- We adcnowledge 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 70610 Main St.Suite a9,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 ot the holding tank, locking device,alarm and access, and agrees to conform to all applirable 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, excepl as provided by Sedion 281.48(3) (d), Stats.,to have the holding tank properly serviced and to file a copy of the service contract with the govemmental unit. The owner further agrees to file a copy of any changes to the service contract, or a copy oi 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 shall submit pumping reports to the govemmental 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 maiMained. 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 ihe 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, stafs. The owner agrees to pay all charges and cost incurred by the govemmental unit for inspedion, 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 effed only until ihe govemmental unit responsible for the regulation of private sewage systems ceRifies that either a soil absorption system that complies vnth 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 witl permit the existence of the certffication to be determined by reference to the property. 5. This agreement shall be binding upon ihe 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 in �ANDq�9� -Onl one owner si nature required- ACKNOWIEDGME � NO GJ�' Owne Si nature: r m State of: ti '9 � �� — County of: Gt.JG�- D '�� Owne N1ame(Prin�tf): Sub cribed and sworn to before me f�j� </C � Jd1'�n/ ;YA� DOt�frJ �dayof I.c� Date: By (Owner's Name) 0 h NS� ' � � ��+�3 Notary Public Signature: _ Drafted by: �p Public Notary Name (Print): G✓ M��'�-�l �u� ��a v� My commission expires on: ��U '.9Z Personal infortnation you provide may be used for secondary purposes(Privacy Law,§15.04(I)(m)] Rev.03/26/13 The Northwest Quarter of the Northwest Quarter (NW 1/4 NW 1/4) of Section Eleven (11), Township Thirty-seven (37) North, Range Four (4) West, all in the Town of Winter, Sawyer County, Wisconsin. PBfCE! ".O. 0324371122C1 �` "T""�;,; PRIVATE ONSITE WASTE TREATMENT cou�ty ��' � � � SYSTEMS � �SPS ='� Sawyer ;:^ ,�, ( POWTS) .� �—�;: ' "�' INSPECTION REPORT sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION � 2 _ � ��' Personal infonnation you provide may be used for secondary purposes[Privacy Law,s. 15.04(1)(m)] J Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#: J��✓► VAw �UOt✓1 W�� '� Insp BM Elev: BM Description: Parcel Tax No: ��c�-�` � � � �I. )^ �:� l�r� 03�_ �37— c� - �2pI TANK INFORMATI N ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Benchmark �pp,a � Dosing Aeration Bldg. Sewer 9'� S'"� Holding },� �� St I Ht lnlet �j s;,�' TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIRINTAKE Septic NA Dt Bottom Dosing NA Installation Contour Aeration NA Header I Man. Holding -}-� o -l-,Lp �-,2.D �,Z� Dist. Pipe PUMP 151PHON 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 o GP ❑ Chamber Model Number: ❑ EZFIow CELL TO ❑ Mound o Other --- ------- -- ---- -- ----- — —----- --- DISTRIBUTION SYSTEM X Pressure Systems Only � i � -- - � X Hole Size X� Observation Pipes Len�}hr/Manrfold Dla I Denri hution Pipe(s) Dia S ac ' ! Spacing ❑Yes ❑ No� —9 1 g p — -- SOIL COVER Depth Over �Depth Over ', Depth of — - i Seeded/Sodded Mulched � Celi Center Cell Edges I Topsoil I ❑ Yes ❑ No ❑Yes ❑ Vo COMMENTS: (Include code discrepancies, persons present,etc.) ��1� (�- ��-0��3 � �:�. Plan revision required7�Yes ❑ No ; II � � � �ct �� 3 �3 a� � Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AOOITI�NAL COMMENTS �3 S�� SANITARY PEAMIT NUMBER: �a (�-�,g�1�. G�� b�r� ��• � � � a- �� , f ao � � � �� fi36� ,,��' �2� � � a,�°� N� � ��l�i�. ��fi� �N� �-�t �— .�,�—