HomeMy WebLinkAbout018-837-14-1304-SAN-2023-240 .
_�i.�--- lndustry Services Division C���3' �
;' ' - 48�2 Madison Yards Way ,Sq u/ /' �
;, �ds : Madison,V+'I 53705 5anitary Pcrmit Numbcc(to bc fillcd in by< �
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'�,�.s_-._; Madison,WI 5370?-7162 (� �j � �L � �
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Sanitary Permit Appiication StateTrensaclionNumbcr — �
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!n accordance w�th SPS 3�33.21(2�Wis.Adm_Code,submission of this form to the appropriate govemmental imit �
is required Qrior to obuinins�a sanitary permit Note:Application fom�s for sbte-owneci POR'TS are submitted to Project Address(if ditTerent than cnailing ac O
the De�artmcus of Safety aud Prof�sionaS Scn�ices.Per�oual infoimatioo you pro�•i�c may be used for secondary
��,�o���:,���rd:,o��w�ta c��Privac}'Law,s.15.04(1)(m),Stats. /
L Application[nformation-Ptease PrinC A1L_�nformation ��7,3 �!l 'Ue _�,S,f L� __
Propert}�Orvncr's Nxme Pazcel#
/Ta c.� ' o��� �� a
Property Ou•n�r';ltai ing Address Property Loeation
� 3S S �`� -
Ciiy,Statc `Lip Code Phone\umber ! /
S �✓ �3T� J�✓ :i,,.[/C , Section _l�__
U.T}7�e of[�uilding(check all thatapply) L�t" T 3� N R �f G o
�! or2Pamilyll«c:llfno-NumberofBcdrooms� _
Subdivision lvamc
-�----,
Block'-'
�PubliclComm�rcial-Describe Use
❑Ciry of_ __.,
❑Stztc O�•.•i�ed- Dcscnbe Use CS?v1 Numbcr illage of __
�To�cn ot__/���P11� .
3� � - ��6/6 -----
III.Typc of POW7"S Permit:(Check cither"New"`or"Replacement"and uther applicab[e on'line A..:Gheck ane bot ori liiie I3_Completc line C if
a licable.)
A.
��Ieic System (❑Replacement System ❑Other A9odification to Existing System(explain) aAddirional Pretrcatment Un;t(esptain)
� !
B' �Holiling l�ank ❑In-Ground �t-Grade ��iound Individual Site Desi�m Othzr TJ7�e(cr�laial
(conventional}
C• ❑Rene�val[3efor �❑Re�-ision ❑Change of Plumbe:r ��I'rausfer to New Owner List Pre�•ious Pemiit Number and Datc Issucd
Espira�ion �
� ,
N,Dispertalft'rcatment Area and Tank Informatian:; -� :
-:. _ .... _� . ., _ ' ,
Dzsism Flo«•(�;�dt � Dr�ian So�; �pplicatiora Rate(gpei%sfl Dispersal.lrea Re.;uired(s� Dispe�al rlrea Propose�l(s� Sy,tem Elc.ation
�d '_ � � ..—
Capacity in Tolal � =of Maaufacturer
�
I'ank fnfosmatiun � Gallons Gallons Units n U U ? i ! J L
� \c�.�Tan!-s Existing Tarilts I � o u � � I � � cs
� c.. U cn u: :r, :s. iJ .�.
Scptic u HoldinR�����nA � �, / ! � �
I J
Dosin�Chambcr � .��� �
I t
. . . .. . . ,... ....,.- .,.:�� - . - _ . .. .
V.Responsibility Statement-I,the undcrsipned,assume responsibility for in�trila4on of the'POWTS shown on thc attachcd ptans.
Plumbcr�s Nam�i Prmi? � Ptumber's Signa[ur� biPRS�Iumber }3usiness Phone Number
�✓ �CP,[l�q � , 0 7.l �9%3'�3f1.�
Plumbc-'s Addre�.t Strcct.C.h�,Swtc,Zip Codcl
iy�
VI_C un •lDepartmeat Use Only
�Ap m�•� ❑Disapproved Pcnni:Fce Ba:e Issued Issuing Agent Signafurc
Lf�� ❑Owuer Given Reason for Dcnial S `�'� , � ) "�`2 1�3 ���/ ���'�``
Conditions of:\pproval/Reasons for Dis�pproval � ,V� � � , ��`�1
C LT --� ��-� ` '
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I"Q� �j� 3���._. ' ZOyING AD��11isiS(t=in�iC�iV
Attach ro complete ptans[o�ttrc s�stcm and submit to the Couutv onty on paper not�than 8 L2=ii�chcs in sue � 1 ) /
-7��1��U
NO R�FUNDF AFTER
SBD-6398(R.03/21} 'r,J+ +��OF�R�-�
Sawyer County Zoning & Conservation Administration
�������� 10610 Main Street, Suite 49
��R cp 1�, Hayward, Wisconsin 54843
� -VC� � (715)634-8288
i� � ����j FAX(715)638-3277
�� � _ ���� www s�wycrcounty�ov.or€
� E mail sanit i�ian a�suwvcrcounty�ov•c�rg
I���� �\�,y'j�� Toll Frec Courthouse/General Information 1-877-699-4110
i��;� "�-� '��'.-
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Holding Tank Approval Checklist
I. Sanitary Cover Sheet: Date Stamp � l !Zo� / ��j
Parcel ID# o( 8 - 8 3 7 - l � - � 3 � `{
II. Plot Plan:
�Property Lines �Bencllmark BM ♦
=��Site Address �North Arrow
Structure Scale
�Well �<25' to Service Road
Xj,egal 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
D�Servicing Contract
�Holding Tank A�neement Fonn ($30 to ROD)
IV. Holding Tank Specifications:
x Tank Cross-Section: Manufacturer: s�� Gallons: ��70
�C 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 Coinponent Manual Reference:
i/�Holding Tank Version 2.1 (May 2022-2027)
Owner: �br>��. Plumber: � -�
Application Review Date: ���—�- ��02�
POWTS Reviewer: «- Gv�/�,����c
Name
6�'� �� Rev. 4/27/2023
Credential#
CONCRETE HOLDING TANK DESIGN
Single Tank Option
INDEX AND TITLE SHEET
Project Loose Holding Tank
Owner Karen&Daniel Loose
Address 6435 S Park DR
Savage,MN.55378
Legal Description Prt SW-NE S.14-T.37N-R.8W
Township Meteor County Sawyer
Subdivision Name Lot No. 2
Parcel ID Number 18837141304
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
Tank Drawing Page 5
Powt's Maintenance Agreement Page 6
Servicing Contract Page 7
Designer Bruce Vitcenda
Signature �.� Phone No. 715-943-2382
License Number M.P.220498 Date 09/16/23
Designed pursuant to�
Hoiding Tank Component Manual For POWTS(Version 2.1)
May 2022-2027
Version 7.1(0722)
Page 1 of 7
HOLDING TANK SPECIFICATIONS
�Number of bedrooms
Non-residential estimated flow(gpd)
2000.0 Minimum holding tank volume required (gal)
2570.0 Proposed holding tank capacity(gai)
Skaw Tank Manufacturer
2570 Skaw Tank model number
Rhombus SJE Alarm manufacturer
Tank Alert 101-01H Alarm model number
Tank Dimensions and Data Tank Anchor Calculations
X for round tank 17930 Ibs Weight of tank and cover
48.0 Liquid depth below inlet invert(in) 1.10 Safety factor
8.0 Maximum de th of soil cover(ft) 14866 Ibs Weight of anchor required
58.0 Height(in) Outside 18.0 in Soil cover req. for anchor or
182.5 Length (in) Dimensions 3.7 yd' Concrete counter weight
78.0 Width (in) Only
HOLDING TANK CROSS SECTION
manhole cover with
locking device and finished ��ent cap
junctfon � waming label grade
box � I —
4"min. .Y 12"min.
�23 in.
Manhole and vent locations
conduit vent pipe 18"min.
� tetherweight I - �
.—._.—.—. .—._._.—.—.—'___.—._._`�._.—.—._._ -
building sewer
� � 12.0 in.
blind plug
� a arm on Note: All tank joints, and �niec
to seai joints between tank
ounet openings and piping are
Electrical as per 36.0 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: Loose Holding Tank
Transaction Number: Page 2 of 7
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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 Sawyer County Saniqry Ordinance.
1. This POWTS is designed to accommodate a wastewater flow of 60.0 to 514.0 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 verity that the alarm system functions and manhoie iocking 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
tank to the ground surface,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 tor 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.Installer......................... A-1 Plumbing Phone: 715-943-2382
b.Service Provider............... Northwest Sanitary Phone: 715-943-2650
c.Co.Zoning or Health Dept. Sawyer County Zoning Phone:715-634-8288
11.
Project: Loose Holding Tank
Transaction Number: Page 4 oi 7
INLET
5.00
�
BAFFLE
69.00
72.00
78.00
WARNING DEAiH MAY OCCVR IF TANK IS ENTERE�
Q WI7HOUTPROPEREqUIPMENT 782.50
Q 'GR[ASEINTERCEPTOft. 176.50
NOTE:SEE INNER WALL PHOTO ON THE"EXCWSNELY AT SKAW'S"PAGE. I I
17350
TOP VIEW OF MANHOLE COVER NOTE:WHEN THE OUTLET IS PWGGED THE LIQVID
DEPTH IS INCREASED TO 50 INCHES.
FILTER
�°� � —� ,zoo r
4�
��z�oo �z�oa�
24.00 24.00 � OUTLET
5.00
� I—is oo—I �� TOP VIEW OF TANK (TAPERED)
� z.00
��INLET � I n e.00 OUT� i1 O srcawas�o i
1800 � I�7L00 — —"'I
2.00 I I PRESS � �
4 INCH PRESS �
SEALGASKE7 gEq� j i
INSTALLEO I I GASKET
WHENPOURED �BAFFLE I I FILTLR/ I� '
I
48.00 NOTE:GREASEINTERCEPTOR i �
I I BAFFLE EMEN�S B"ABOVE 8 32" i �
I I BELOW THE LIQUID LEVEL. �i �
t �
� � i i
i �
i �
i �
l_________________________J
soo� SECTION VIEW OF TANKAND COVER �-3.0o OUTLET END VIEW OF TANK
Model Number: LS�o SKAW PRE-CAST Phone: (715) 967-2277
Approved for: SEPTIC, HOLDING, GREASE INTERCEPTOR, PUMP OR SIPHON Toll Free: 1-800-924-8625
26255 105th Street, New Auburn
Weighf Inlet Dim. Outlet Dim. Liq. Depth Gal./In. Max. Cap. Wisconsin 54757 Fax: (715) 967-2707
17,9301bs. 53" 51" 48" 53.54 2570ga1. www.skawprecastcom
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:
Northwest Sanitary, Inc.
PO BOX 155
� � Gdo Radisson, WI 54867
Parcel Identi�cation Number:
ti2 �:a�ti Le����y 1�) o � � - � � � - L `�- - -� �- ° `�
1. The owner agrees to file a copy of this contract with the governmental unit, Sawyer County,
which has accepted and recordcd with thc Office of the Rcgister of Deeds, the Maintenance
�,greci��e;�t for u H�l,�'.ing '''an:� r;;qui;e�' un�er th� �a��;���r Cou:�;r,, pri.,,�te CP,.va;,re Sysc�m
Ordinance for tl�e 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 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 pumping equipment. The owner
further agrees to pay tl�e pumper for a charges incurred in servicing the holding tank(s) as
mutually agreed upon by the owncr and 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 undcr SPS 383.55, Wisconsin Administrativc
Codc and thc Sawyer Counry Private Scwagc Systcm Ordinance. Thc pumper furthcr
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 thc holding tank was serviccd;
c. The voluil�es in gallons of the contents pumpcd from thc holding tank for cach servicing;
£ The disposal sites to which the contents from tl�e holding tank were del�ivered.
4. This aereement wi11 remain in effect until the owner or oumner ierininates tiiis contract. In
the event of a change in this contract, thc owner a�nees 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 this servicc contract.
�Wnel''S Name: (Pr1nt� OWriCP'S Sl�ri1h11'0: (Only one owner signature required)
,,�.::; G�J�.s�/l%� �� �
r � %✓j `� `
4/'P.✓ D ' L a s -:
Pumper's Name: (Print) Pumper's Signature:
Ronald L Vieceli, owner Northwest Sanitary,lnc ���� f- / / /�� /�
�.Lzl L. �i ��v�i
Pumper's Registration Number:
#2389
Rev. 03/26/I 3
�-,.__ _ ___
�e��'State Sawyer County Property Listing Property Staws: Current
'TipM��A%�cC�: 8l24/2023 Created On: 2/11/2�22 3:3E�::�`� PM
;.�,;Descripti�on Updated: 2/11/2022 d��� Ownership Updated: �r"_>4�ZU�2
,. _.__._._ _,�_,_. __.__� ._..._. w,..�.�---._...._..__..... .__. ..._....
'I�ut ID': 44438 KAREN K LOOSE REV S-1V%�C�I M N
F�y 57-018-2-37-OS-14-103-000- T1tUST
� 000040 DANIEL H LOOSE REV Sr\V.A(;i� ti'1N
Ze��cy:PIN: 018837141��4 TRUST
Map ID:
Municipality: (018) TOWN OF METEOR Bitfing Address: iVlailing,�ciclres5:
STR: S14 T37N R08W Kt1REN K Lt3�DSE �C�3��?� � I:�3()ST
Description: PR'I'SWNE LQT'2 C�1�1 REV T�UST itEV`�`��;�� ,
37/�62#8616 fi435 S PARK DE� 643� S Pt111E� iJK
Recorded Acres: 33.78f� SllVA(�F: �4'� ���'7�i S�1VA(_f�-� �tr'� �:��..�� z�
Lottery Claims: 0
first Dollar: No :, Site Addres� '� int�i�ate5 Priva€e d�u��ci
lo«ing: (KR2) Res�idential/l�.eeeeational 1534�V `�C�FS� �� EXi�:(,11�li� °��#�t��35
Twa
ESN: 431 ��� Property Assessment Updated: �3i1�%1U��3
Z0231�s�essu�eni �et�il
��, Taac Districts Updated: 2/11/2022 Code Acres �,��i�cl �►ti��.
_ _ _
l State of Wiscoctsin (SE;-PRC}lii_1t�[�iT�.
57 iawyes�Cottnty F�:?REST
33.780 2��,=�i;�� ()
U 18 Town of Meteor
��40735 Bruce School District 2-Year Comparison 2022 2U23 �:�a���ge
001700 Technical College Lan�� 0 25,4OU IUU.U�'%
Improved: 0 U U.U°,�,
_,-� Recorded Documents Updated: 2/7/2022 Total� 0 25,40� 10(L�°��,
_ __
:�:,_ �NAlZRA1V 1'Y DEED
Date 437586
Recorded: 2/14�2622 ,�� �rap��Ey Histc�ry
�> CERTTFIED SURVEY MAP Parent Properties 1�� 1 U
l)ate Recorded: 2/4/2022 437460 57-U1.8-2-37-_U8-14-1 02-000-
000(�20 1_�="UtS
�� T'RANSFER ON DEATH DEEI� 5%-U1�i-2-37=0�3-�4-] 03-000-
��a[e Recorded: 5/ll/2021 431�31_4 pppp�� 1z3'09
<� CONVEYAI�CE RE��R.DEI)NQ�'LISEI) 57-(}1�5-��-3i-€,�S-��<i-� f)�a�}€��t-
OOOU2Q 1�)?i U
Date 4294f�E
RE'COFC�E'(�: �/��<����
�;�3I��l�'.�'I�NCF �E���t83E� 1`�iti!`�'iE73'�D
[)ate �29300
BZecorcled� 1'�4/2021
� T�.R1VItNt��'ION f�F` �F,C�'I)E1�dT��
I lY'�'E;�tE,S'I,
Date 4Z3£303
Reco9-ded: �i/13/Z020
� PLAT OF SURVEY
1)are 14378-1
Rec�rd�d: 9/10/2009
: WARR/aiNTY D�ED
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I I��III �I.IIIIIIIIII �III)
- USE BLACK INK ONLY- �:rr�r�;�Q741w�
- Tx:404i593
POWTS MAINTENANCE AGREEMENT 445511
For Holding Tanks PAUL�I CNISSER
itEGISTER t)F DEEDS
Owner's Name(s)as shown on deed , �AWYER COUIVTY, WI
0�/22/2023 09:21 A�++1
k4 .i/ ie 0 s� RE�OR�IN� FEE 3�.0�
Parcel Identification Number:
(12 Digit Legacy ID) � ��-��2-��-�_,��� PAGE�: 2
Legal Description of Property:
-SEE ATTACHED SHEET -
We acknowledge that application is being made for the installation of a tiolding 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
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 coniract with a person who is licensed under Ch. NR 113,W�s. 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 govemmentai 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 report:>to
the governmental unit in accordance with SPS 383.55,Wis. Adm. Code,for the servicing of the holding tank. In the case ot
exemption under Section 281.48 (3) (d), Stats.,the owner shall submit the report to the govemmental 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 heatth hazard as descntred in Section. 254.59, Stats.,the goverrrmentaf unit may enter upori 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 ail charges and cost incurred by the governmental unit for
inspection, pump�ng, hauling,or otherwrse servicing and maintaining the hold�ny 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 untif the govemmental unit responsible for the regulation of private sewage systems
certifres that either a sa'rf absorpt'ron system that compties 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 shait be b�nding upon the owner, the heirs of the owner, and assignees of the owner. The owner shali 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 agreemerrt to be determined by reference to the property where tt�e noiding tank Is installed.
_--
-Only one owner signature required- ACKNOWLEDGMENT
I Owner's Signatur ,�, State of: /�`%��'c�;�'r�
. �p _ _—___—
�.)c�� ---��- � ' -- �iir.��vzECrJJ—�traa ,' County of: Sc��f�" ---
, Owner's Na e (Prin . � Subscribed and sworn to before me on this
X_�.el_ts°'Lf�—�QS'�' _���eh ,L.�Oo;� � S'``` day of S�P��-�b�t _, 20 2_�
` L.=��C--
i Date: I By (Owner's Name): D�' � ��sz � �.��
�—� _- ����___ � Notary Public Signature: r T�✓— ___
�Drafted by: � Public Notary Name (Print): �J.�G,.�/�-5 `l���-��- _
i R��� V�� �� I My comr�ission expires on: I���fZ�Z g —
Personal information you prouide may be used for secondary purposes(Privacy Law,§15.04(l}(m)] , N��,�,f?e_, ,/ °,
rflAJ�Mq�J TqI1W�
NO'iAA1�pU8(,�.���
AR1'COhMMSSION EXP 01/,MRppg
Lat Z of Cer�ified Survey M�p IVo. 861.6 recorded in the o�fi�� of the Regis�er of De�ds
for Sawyer County, VVis�onsln, on February 4, 20�2 in �folume 37 a� C�r��fi�d Survey
Maps, at P�ge �62, �s Document Na. 4374GU, being loc�ted ir� �he Southwest Quarker
Of tlle NOtthe�Sl: Qu�rtei�r Se�tion 14, Township 37 Nor�h� R�C1�2 8 W���� TOWt1 Of
�fG—'��'Ut", ��VVl�'@t' GO�d�l�jl, �/�/ISC{�I�51�1.