The URL can be used to link to this page

Home My WebLink About008-937-16-2102-SAN-2023-200 Department of Safety c°""ry � � I y�j &Professional Services, Saw er . � - . �'_ . �I I, Sanitary PermiWumber(to be filled in by C 3 Industry Services Division @�10' (r51 (001 � w Sanitary Permit Application stace ire�sacnoo r�umber � In accordance with SPS 3832!(2),Wis.Adm.Code,submission oCthis fortn to the appmpn�te govemmrntal unit '� � s required pnor to obtaining a sanitazy pertnit Note:Application torms Por stateowned POWTS are submitted to Project Addr (if � ent than ailing adc thc Depertment of Safety arid Pmfessionaf Scrvices.Personal information you provide may bc uscd for sccondary puryoses in accordance wilh the Privacy Law,s.15A4(I xm),Sta[s. � �5 I 7 1.ApplicaKon Intormation-Please Print All Informadon �� f. Propetty Owner's Name Parcel# GREGORY J 6 CARA L MC DONALD 008937162102 Property Oumer's Mailing Address Pmperry Location 1320 32ND ST NORTH Ciry,State Zip Code Phone Number Q� WISCONSIN RAPIDS WI 54494 NE y,, NW �i,se��o� 16 II.Type of Buildtng(check all thot apply) Lot q T 37 N R 09 E or W �1 or 2 Family Dwelling-Number oCBedroomd:onvanienCP BathfpO ^ Subdivision Name sized as 1 bedroom eiock u —� ❑Public/Commercial-Descdbe Use — ❑Cityof _ ❑StareOwned-DcxribeUsc CSMNumber ❑Villageof _ �-- I81 rown of EDGEWATER III.Type of POWTS Permih(C6eck either"New^or"ReplacemenP and other applicable on line A.Check one box on line B.Complete line C i a licable. `,� pCl New Syscem ❑ReplacemeN System ❑Other Modification to Ezisting System(explain) C Additional Retreaenent Unit(explain) B' I�Holding Tank ❑In-Ground ❑At-Grede ❑Mound ❑Individual Site Design ❑Other Type(explain) (canventional) C. '�Renewal Before ❑Rcvision ❑Change ofPlumber ❑Transfer to New Owner ist Pmvious Pemti[Number and Date Issued Ezpiration �- IV.DispersaVTreatment Area and 7ank Intormatlon: Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(sQ Dispersel Aree Proposed(sfl System Elevation �Q �oo n/a n/a n!a ._ Cepacity in Total #of ManufacNrer Tank Information Gallons Gallons Unita �e U� g YewTanks ExislingTanks '� - �+ a � �` = 2 ��'.0 a se��<o.Hma�gre�k 3000 3000 1 Wieser Concrete X Dosing Chembcr V.Responsibidty Statement-1,the undenigoed,aesume respoosibJity for instellation of t6e POWTS a6own oo the ettached plans. Plumber's kame(Prinp Plumber's S� ature MPMPRS Number Business Phone Number Joel Myers 918453 ' 715-418-1272 Plumber's Address(Shect,Ciry,State,Zip Code) P.O.Box 64 Chetek,WI 54728 VI.C uuty/Department Use Only �q Lpp�m_/ ❑Disappmved Pertnit Fee Daie Issued Issuing Agent Signemre Y'_ ❑Owner Given Reason for Denial 5 10�•�� &��a�I�"'3 ' !"'`�"^"`�(�"� Conditions of ApprovaVReasons for Disappmval �5� �� I�I" �`�� '� � � ��a��3 �� L ��'�� • ��:�. sqt�� AUG 21 2023 �'��3_ �3� '�� SAWYERCOUNT`( ZONING ADMINISTRATION Att�ch m complele plaos(or syshm md submit ro Ihe County ooly on peper not lees ihm 8 1/i x 11 inches in s've � ��,�3� ss�-53vs(e.o3i2z� NO Rr.FUNDS AFTER :8dte� ^�� lSSUE OF f�EH?J!!l' _ .,�.i:�::i p :itructures � Sawyer County Zoning & Conservation Administration �� 10610 Main Street, Suite 49 � �R Cp �� Hayward, Wisconsin 54843 �`� .'" VCi �� (715)634-8288 �� `�' FAX (715)638-3277 � Q/ � .��I � V�� _ - — � % �i�wwsawyercountygov,�� - � o = �o � E-mail: sanitarianCa'sawycrcounly�ov.c� I =�.y � � Toll Free Courthouse/General Information 1-877-699-4110 � ��2 � .. - .c� 1 �S S 1 � 1 `p�J�� Holding Tank Approval Checklist I. Sanitary Cover Sheet: Date Stamp o8 / � ` / av� 3 Parcel ID# D d g - 9 3 7 - ( (o - � � 0 2 II. Plot Plan: �Property Lines � Benchmark 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 III. Required Plans: � Index Page with Original Signature �Management Plan/Contingency Plan � Servicing Contract �Holding Tank Agreeinent Fonn ($30 to ROD) IV. Holding Tank Specifications: � Tank Cross-Section: Manufacturer: �,v i Q.�� Gallons: 3,�� Tank Anchor Calculations [SPS 383.43 (8) (g)] � Locking device, chains/locks �G Alann, electrical per SPS 383.43 (8) (e) � 3" Bedding Material < 1/2 " --;;�k�itab�� Living are� V. POWTS Coinponent Manual Reference: •�dll not be ereated .��ssory structures � Holding Tai1k Version 2. 1 (May 2022-2027) Owner: �, , � �-� a�^gt � Plumber: --�� r " I ��S Application Review Date: 0$I �2� �013 POWTS Reviewer: � � �� Namc `� 6�� Rev. 4/27/2023 Gedential # 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 McDonald HT Owner Name(s): Town of Edgewater Phone: - - Owne�Addr'eSS:1320 32nd St North Wisconsin Rapids,WI ZjP; 54494 Project Address: 1773N EAST SHORE DR BIRCHWOOD Govt.Lot: NE 01/4 of Nw �1/4,Section�6 ,T 32 N-R 09 E�or W Q✓ Township: Edgewater County:Sawyer Project Parcel ID#: 008937162102 Designer Information Designer Name: �oel Myefs Phone: �15 _418 _1272 Designer Address: P.O. Box 64 Chetek,WI Z�p; 54728 E-maiL• License Number: 918453 Remarks: Signature• ��„� �� Date: �� ginal signa�ure r uired on each submitted copy. s�� plQ� .�� ; � ('T rC�o�y � �a.r a_ �c �cg�l�lr/� NE �� nJw y� .S l6 �37 �l �� cu � 7o,c,�rl d-� �c�Q ��. � ,r � . _ o Ning ar�� bitab�e L 6� 5�,\� = �f �hall not be �re�tu es � � r�i ;ro a�ceSSorY Stru �"` � C�' "�� r , , � f \e� \ � ,,,.�,,,..---�-� .� � a 3 ,--� � '� 'r` � �� i��'( � / `�:, �., � �� . �� • '�._- - � � S�j �.,,�, c:t� `, ,� w� 3 1 �,� � � � � `�� . ` ��3 , '� ; �� i � �S` +�u Pv� i ''�,, s,�� t��. , � �� `,� A " �l S + � b �a7�C ,/ ; � ; �o %� �,Q � I �m 1o�,e �� 4� ��i�9 , � � ,, � �-�3 � r � � �- � ,.--, � �� .� ` _ �yPIr�MU.S1.7.�L-�� a `�x �y � �i e �r lJ,� ��r��J �1 P � ��53 J� �� ar.5 PAGE 3 OF 4 HOLDING TANK SPECIFICATIONS (No Scale) Weatherproof 12"Min.or 2.0 ft above Junclion and qPPro�� Established Flood Elevatlon Alartn Box Vent Cap �ryP��) Electrical must comply witl� + Approved Locking Manhole SPS 316 and NEC 300 4"0 Vent Pipe with Waming Label Atlached �—Conduit >10 ft fmm (typical) 4"Min.or 2.0 ft above Building I Esfablished Flood ElevaBon � (tyPical) �_ �AirtightSeal� � Finishad Grade 18"Min. (ryP��) g a Inlet Inlet Invert Watertight Approved Jaints with Plug Approved Pipe 3 ft onto � Max.12"or 90%of total volume Solid Ground ' if more than one tank a Alarm-On HOLDING TANK VOLUME= 3000 gal d 3"Approved Bedding Material Beneath Tank TANK MANUFACTURER: Wieser Concrete Anchor tank as necessary pursuant to SPS 383.43(8)(g) Ballast Weight=((cu.ft.tank.vol x 62.4 Ibs/cu.ft)-Ibs.tank.wt]x 1.5 Ballast Weight=[( cu.ft.x 62.4 Ibs/cu.ft)- Ibs]x 1.5= Ibs PAGE40F4 Holding Tank Management Ptan 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 if not maintained in accordance with this approved management plan. Furthertnore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52(3),Wisc. Admin. Code. Estimated Daily Wastewater Flow= 100 9Pd Insaection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance 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, timers, alarms, etc.) o surface discharge of effluent or sewage back-up into structure served SERVICING FREQUENCY o 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 government unit in accordance with SPS 383.55 Wis. Admin. Code. Report any component failure or malfunction to: Name of individual or company: My PIUmb@PS LLC Phone: 715-418-1272 �o�ai go�e��me�t ��c: Sawyer County Zoning & Conservation pnone: 715-634-8288 �oca� government unit address: 10610 Malrl StreetSuite 49 Hayw2rd, WI ZiP 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. Continstencv 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. HOLDING TANK SERVICING CONTRACT Contract Date: / / This contract is made between the Holding Tank Owner and the Pumper. Holding Tank Owner's Name: Pumper's Name: � � �,�e� � �,�a Y��n al d ��n .� < t/l C� Parcel Identification Number: (12DigitLegacyID) Q��-�3 �-�- ��(� � 1. The owner agrees to file a copy of this contract with the govemmental unit, Sawyer County, which has accepted and recorded with the Office of the Register of Deeds,the Maintenance Agreement for a Holding Tank required under the Sawyer County Private Sewage System Ordinance for the issuance of a Sanitary Permit for the installation of a holding tank(s). 2. The owner agrees to have the holding tank(s) serviced by the pumper and guara�tees to permit [he pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). 7'he owner agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s)with the pumping equipment. The owner further agrees to pay the pumper for charges incurced in servicing the holding tank(s)as muNally agreed upon by the owner and pumper. 3. The pumper agrees to submit to the Govemmental Unit, Sawyer County, a report for the servicing of[he holding tank(s)as required under SPS 383.55,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 name 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. This agreement will remain in effect until the owner or pumper temtinates this contract. In 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 from the date of change to[his service contract. �WIICC's Name: (Print) Owner'S Sl�&2Ui0: (Onty one owaer sigmture required) c� � �,-,a� � i� � ` Pumper ame: (Frint) Pumpe s Si a e: 1�e-t,t-1�9, Su�v� �'� �.c �,� Bae..a.�. Pumper's Registration Number: � l� Rev.03/26/13 - USE BLACK INK ONLY - II�'I�� I I! ' ,II , _ �' II� I � [1r,�T:1 ;�ij,7�� i� POWTS MAINTENANCE AGREEMENT T.x. :4046963 For Holding Tanks 446037 Owner's Name(s) as shown on deed: REGISTER OF DE DS cnvyvFR rni�r�Tv wT Oc �. � C� �, Vl/� C � pv�q ' 08/22JZ023 09:48 AM Parcel Identification Number: / C RECORDING FEE 30.OU (12 Digit Legacy ID) V � � - l 3 I �p � � d � - - - -� - - - - - 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 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 addition, this agreement may be cancelled 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 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 Ow Signature: f��C� State of: � •Stc,�.�y'� �� ^ ` - County of: ,Sc�w �iz Owner s N ( rint): Subscribed and sworn to before me on this �s r C�r J� V i C ��+�,,,�d��r��of . .-S�� , 20 �3 Date: .� ��,,'��la'h_. .��.r�f2��;ne): G �c��, �� S y`'�c �.�n�� 1 � � �� otar blic. Si � ;��V '� ,�r�� sjature: � '`'�_� ��,. Drafted by: = ;P�c Not ry Nari�e (Print): � �Z�awSK' �h �-- W� (q,�� _ _My�m�`�ion��ires on: ` a� . ' . UB ��; �"'-,,;��',y'•• • . . . . •''�0,�'�� Personal information you provide may be used for secondary purposes [Privacy LaW��„�A��n�)] Rev. 03/26/13 i � The Northeast Quarter of the Northwest Quarter,EXCEPT CerHfied Survey Map No. 8345,Volume 35,Page 319, as Document No. 416021; All in Section 16, Township 37 North, Range 9 West (in the Town of Edgewater), Sawyer County, Wisconsin. ` `'"`�;; PRIVATE ONSITE WASTE TREATMENT county ';��Sps ; ', SYSTEMS `�� ,�� ( POWTS) Sawyer � r '"�� INSPECTION REPORT sa�itary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �2 � �� Personal infonnation you provide may be used for secondary puiposes[Privacy Law,s. i 5.04(l)(m)] J Permit Hoider's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#: � � ��, ��., C r-- insp BM Elev: BM Description: Parcel Tax No: C W.C� (� 1N'Q- �v O�9�(r�-b �� TANK INFORMA ION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic t,�;e�s �j Benchmark p O,�j� Dosing Aeration Bldg. Sewer � Holding St/Ht Inlet 6 � TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIRINTAKE Septic � 7 g� �-S� .}.S- � NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. Holding 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 � IGP ❑ Chamber — a AG EZFIow Model Number: u CELL TO ❑ Mound o Other —------- -- --- - _----- -- -- _ --------- - ---- -- - DISTRIBUTION SYSTEM X Pressure Systems Only _ - - - - -- -- — — --- . --_— p � Header/Manifold Distribution Pipe(s) X Hole Size � X Hole Observation Pi es Length Dia Length Dia Spac _ � Spacmg ❑Yes ❑ No I --- _ __ — _-- -- - --- SOIL COVER ---- _ _-- - ---- — - - Depth Over Depth Over 1 Depth of Seeded/Sodded Mulched Cell Center Tell Edges � Topsoil _ � �Yes ❑ No � ❑Yes ❑ PJ� COMMENTS: (Include code discrepancies, persons present, etc.) ��<< ��3 = �..s��.� � �T � ,--- �, ---�----- ! �� Plan revision re uired.❑Yes ❑ No � -__ — q ' 3 ts-?` �� -- � - - �� Use other side for atlditional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AOOITIONAL COMMENTS AN SKETCH SANITARY PEAMIT NUMBER: �_o�_�_ __ :_._.__�_ : .___.., �__;_ � -- • __ - _ __ : _ __. _. :_ __, .__ _. _ . . _� _ : ._ . : �_ : : - . - � : . _ : : ; ;__ : ' ;_ , , : , . _ _: , -. .. _ :_. ,,. ... ._:... . _ <... �. "..:— ._ , ._ _!..._.__, i . ., �.: . . _.... . . ...... _ e . ..�;.. __ 4... .._t_. _i—.,.__ �__ ._ ___.... ..._.. . ._. .. .. .._. ... . . . - _..-t.. i . .�. . ... � . . ' . � '' , : ' . . ; . . 1 . . �... . . �' '�. �� "'�3p�°��d�` � ,�,�\�. �� o � w� s 3, 8, �� << �� 3$� �1 � � � � �,�� - � , �- ��W �� -� -�3� � �� . SCA�