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Home My WebLink About032-106-00-0900-SAN-2023-271 `rpARTNfI! 1��'d'iI JCi�ri�o�� " ,-/ �r 4822 Madison Ya+ds Way S o.�t tue� � R-��s � i' Madisoq WI 53705 Sanilary Permit umber(to be filled in by Co � ��L � �f i �' „ . �, P.�_Box 7162 ��—,4f _ ��,w�s3��agz_ _ _ (�S 1 l�Cv l v�,, \�5�7ii\Al/ - ..-- � - Sanitary Permit Application �Transaction Number � in accordance with SPS 38321(2�Wis.A�Code,submitision ofthis form to the appropc�te govemmental unit � is tequited prior to obtammg a sffiilaip pemiit Note:Application forms for stateowned POW'fS ue submrtted to Project Address(if diPferent lhan mailing addre:.., the Department of Saf�y aed Professanal Services.Personal"mfo�mation you provide may be used for secondary purposes in accordance with the Privacy L.aw,s.15.04(lxm�Stafs_ , s L Appticatioa[nfornatio�—Pkax Priot AA infor�atioe Iv " .3�.� G .:, � <„+,,5�+;.. �'�f property pwner�s Name ' Pa�ei# t �f� P•"'^2 I n/ F,n �.� �`�C:C '� �-..1• •�•!'Ytl•f``=�: Properiy Owner's Mailing Address Property Location , , <. ;..� �. � . �� .� 1.�.� ; € � ��: �..,c� Go City,State Zip Code Phone Number � , A ' . .�, Section �.. "?� , t � . .-. ��' f t.r^� r� h-y �'_ �? ,; ,r �'^�-; � ,�: I[.Type of&tildiag(ckeck all t6at aPply) Lot# �� T sr�; N R p�' E W� '@S 1 or 2 Fami l y Dwelling-Number ofBedrooms � Subdivision Name � � Bbck l! t" F•,t„ ,' '_ "1 ❑Public/Commercial-Descnbe Use �- �City of �S�te Owned-Descnbe Use CSM Number ❑V�llage of - _� ��I'own of �-''�`°•' :=-�' I[L Type of POWTS Permi�(Check either"New"or"Replac�eut"aod ot�er applicabk oo liae A. Check o�e boz on line B.Comptete line C' a licsble A_ ❑ New System r Replaoemcnt Sys6em ❑Qdier Modification m Existing System(explain) Additional Pretrcatrnent Unit(explain) B' �I-I�Iding Tank ❑In-Ground ❑Ai-Grade ❑ Mound ❑ Individual Site Design ❑Other Type(explain) (conventional) C• ❑ Renewa(Before ❑ Revision ❑C6angc of Plvmber ❑Transfer to New Owner ��V1O�P��Number and Date Issued • Expiiation �+�� [V.Dispersailfreatment Area aad Tank Iaformstion: Dcsign Flow(gpcl) Desigu Soil Application Rate(Spd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation /�� 4 1, ,? �F �1. ��v� �'`eft �-n� _ Capacity in Total #of Manufacturer Tank Infottnation Gallons Gallons Units ,a � o a�, � �, `t-�' ab U � U m •t� New Tanl:s E�ustinS T�cs °�'+ o � o � � m �'� [G U v� m v� ti C7 ti. ;�.� ^z� �r- c"� Septic qr Holding T�k �,r '7 A " -F:_- a.,,,,..- Dosmg Cl�nber V.Respa113ibility Statement-1,ffie uqdersigeed,a��me respoasi6ifity for iestallatioa ot t6e POWTS s6own oa t�c�ttsc�ed�aos. Plumber's Name(Print) Plumber's ignature MP/MPRS Number Busroess Phone Number �� ,4 �. '!-� � ?� � i ____.._._. . ,.:��i."t,.,,,.., ,,�,f(,'.�.:�'1 t4,,^'�;.,r..� � '?. l�4S o� Plumber's Addtess(Street,City,State,Zip Code) #. � � ' , ,,, -,, .t- . .. _ _ ' � �_, ' E. _ VL Coan /Depar6ment Use Only �A(p ��io�� Permit Fee Date lssned Issuing Agent Signature (� � �� o0 �^ �� n,, ❑Owner Given Reason for Denial � �� I I �3 ""1'�'�%�C-��''�- Con ' ' o vaUReasons for Disapp�oval J � �' �� __.__��-� � 2 � i S Lc(o .....------�- ;�--� - °�k#�---------_._ � ►J oT `�,� 3�3�� _ ; A _,� ; �: ru?' _; � , . ,, , Attach to compkte pla�a for the systen�aod sebe�it to the Coaety ooly oe p�per oot!ess tbaa 81l2 z i l ikhes ie sue ' f`�=�+ ' -' RC P�FJtv��A�7�R -__ ;�� ;,-�r- -�a s 3� SBD-6398(R.03/21) IS�.1�Or�f5�1r'��i �::�•.ii��_: ��.::�',;if•,;:i�;,;��;::;". Sawyer County Zoning & Conservation Administration ��' 10610 Main Street, Suite 49 � �R Cp i� Hayward,Wisconsin 54843 '� -' �� Ci I (715)634-8288 �� FAX(715)638-3277 � i Q �a�/ /y�__- _ —- �� wwwsawvcrcount ov��rg � E-mail:sanitarian a�saw ercountvt�ov.or� I° =\� ' j�� Toll Free Courthouse/General Information 1-877-699-4110 , ��\i�-y'/�� \ ��1 iSCON�` ��\�� Holding Tank Approval Checklist I. Sanitary Cover Sheet: Date Stamp 10 / 10 / �3 Parcel ID# v 3 2 - � o (� _ po _ O � v o 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 A��reement Form ($30 to ROD) IV. Holding Tank Specifications: � Tank Cross-Section: Manufacturer: �� Gallons: � 9( Tank Anchor Calculations [SPS 383.43 (8) (g)] �C Locking device, chains/locks �Alarm, 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: � ka c� Plumber: Sqvv� T�+�'Q� Application Review Date: �o( la(d�aa-3 POWTS Reviewer: ��,�,i�G,? � Name G��j� Rev. 4/27/2023 Credential# � � �,�� ~� � C�OJCG '� .� o l-,� 1<o G k ► ►�GS t�, � �i `�I Placc c� ! e�,,-l-c, �r. c (� 1�,c.c t� 5 � CA � � .� ��.�� , Eu .� 3 a� �. �.}ea G�w,.:��L� '�' . � b� � C!�k � '�E.+�n.� r^�"� t,�� , 3� ,-� � �.; , J- ��,� u�r �� /� � � �, � �� # �4 ° ' '�� 'n,� —�� 4 2-2 � �.�--"�,r :s ��"�� °4".w. 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I E � _�__ __ _._. _ _ ! n � � S� ` � e ,., �. � � � • � , �: t� = � �,t� .� � � � PAGE30F4 HOLDING TANK SPECIFICATIONS (No Scale) Weatherproof 12"Min.or 2.0 f[above Junction and Approved Es[ablished Flood Elevation AlarmBox VentCap (iYPical) � Elecfical must com I with �, SPS 316 and NEC 300 � 4"0 Vent Pi e Approved Locking Manhole P with Waming Label Attached � ---Condui[ >10 f[from (typical) 4"MIn.or 2A f[above � Building I Eslablished Flood Eli�vation � (rypical) -- �AirtightSeal a " � I� � __ - Finished Grade ' 18"Min. �bPical) .. a I � n 9.- Inlet Inlet Invert a 4 I / --Watertight Approved Joints with J P�09 I, Approved Pipe 3 ft onto � Max.12"or 90%of[otal volume Solid Ground - if more Ihan one tank ' d Alarm-0n ��. HOLDING TANK I VOLUME_� gal � a . 3"Approved Bedding Materia�Beneath Tank TANK MANUFACTURER: C.`��e� Cb. ��„�. Ph�1. . "Anchor tank as necessary pursuant to SPS 383.43(8)(g) Ballast Weight= cu. .an .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 - - _ - HOLDING TANK SERVICING CONTRACT Contract Date: io / � / _�� This contract is made between the Holding Tank Owner and the Pumper. Holding Tank Owner's Name: Pumper's Name: ,� � � w �v� t< �11� �'i�?�eS` ��. Parcel Identification Number: (12 Digit Legacy ID) b 3�_ - 1 �� - QQ._ - �� CZ. 1. The owner agrees to file a copy of this contract with the governmental 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 Pernut 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 the pwnper for charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner 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 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 tetrninates 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 this service contract. Owner's Name: (Print) OWIIeT'S SIgII3tUre: (Only one owner signature required) �� F� �- T l�.� c.__C. � T /�-� c.. J� Pumper's Name: (Print) Pumper's Signature: �'?�� K��1�S ��t1�- Pumper's Registration Number: c�V1 l� � Rev. 03/26/13 �g 3 �: 7 CONTINGENCY PLAN FOR H4LDING TANK A.O. JOHNSON & SON`S, INC. Johnson Hardware Hank 195 North Lake Avenue Phillips, WI 54555 715-339-3331 aoj isaok@pctcnet.net MP#007072 If this holding tank or any part of this system should ever fail a licensed individual shall be contacted to make any repairs or replacements. Should the tank fail it shall be replaced with an approved tank along with necessary permits and approvals for the installation. When the alarm is signaled a licensed pumper shall be called and pump the tank and dispose of the contents as per all state laws and codes. CAUTION: Be sure tank cover remains locked at all times except when pumping. Always check tank after pumping to be sure it is locked. NEVER ENTER TANK FOR ANY REASON, GASES IN TANK WILL CAUSE DEATH. Ps �� f' � Tank Anchoring: All tanks must be anchored whenever ihey are installed in a satutated conditions_ Using so1 as the anchor has become an acceptable ahemative to concrete_ o Flota�ior potential is the displacement oi the tsalc catculated by its volume in cubic feet Line A Calculate cubic feet oi tank. ,�6 inches high,x 7� inches wide, x /�inches I.ona, _ 7�11�i� cubic inc�es. Divide this n�nber by 172&to equal ySS,li cnbic fect. Line B Ne�ct convert the dasplacement to the weight of water. 5� ,1! (from L'm�A)cubic feet x 62.4(weight of 1 cubic foot of water) x I.S(fudge facbor)_ H� iq,04 Ibs of lift poternial. Line C Calculste r��eigkt neede�ta co�mter buo5�ancy. �ar�7`�:L9 lbs (Bisplace�e�weight from Iine B.)- j S�SGD Ibs. (weighY of tank from manufacilse)=Ihs. Of soiI reeded to an�hor tank. �V�3 74. fl 4 # Line D Weight over the tank caver needed, plus safety factor. -7 b �ct�es wide of tank co�r x J�mches long of tank cover,divided by 1_44 _• y 5,16 Squsre feet ofcover x 0.083 ( 1 i�h in faot dec�a()= g, i y cubic foot s�ace of 1 inch of tank cover. Line E Calculated weight of 1-inch of space over entae cover. � .1 y cubic feet of space (from li�e D)x I 10 Ibs./cubic foot of= 895, `I ibs/inch space above cover. Line F Calculate mches of soil needed m caunter buoyancy . a�I 3 M(Ibs. (from lme C)divided by �fS H lbs.per inch of soil(from line E)=�` inches needed over tank cover. ��.� ''So : Ic�� Pg d° � � 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 if not maintained in accordance with this approved management plan. Furthermore, 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 = �� gpd Inspection 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: vJ�"�`!s Phone: C7�S� 33� � 33� � T' \, Local government unit: S w�{i 9 Phone: ��, J 63�� g��o � T� �7 Local government unit address: S� �{`j' �dbi0yl'Ly�� , ZIP: �( � �f S 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. System Abandonment If use of this tank(s) is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. _ � � �, - USE BLACK INK ONLY iiii � �ocId :8074?38 POWTS MAINTENANCE AGREEMENT Tx :4047953 For Holding Tanks 446811 PAULA CHISSER Owner's Name(s) as shown on deed: REGISTER OF DEEDS SAWYER COUNTY, WI J �•r �� a � ifl/ lOJ2(323 01:33 PM Parcel Iden6fication Number: � � Q G RECORDING FEE 3fl.Q0 (12 Digit Legacy ID) U 3 � - � � � - � �% - �— — — PQGE5: 2 Legal Description �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 Retum To: Sawyer County Zoning and Conservation Administration 10610 Main St Suite 49, Hayward, W154843 As an inducement to the County of Sawyer to issue a sanitary permit for a holding tank on the above-descnbed 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 properiy 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 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 shall submit pumping reports to the govemmental unit in accorclance 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 repo�t 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 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 govemmental unit for inspection, pumping, hauling, or othervvise 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 municipal sewer serves the property. In addition, this agreement may be cancelled by executing anil 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 ovmer, 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. �`��,"�--+KO�''��. -Onl one owner si nature required - ACKNOWLE � � T• • . ,��i� Owner's Signature:� �`-�t--r State of: w _ •� T � ' ��' County of: = • ' = Owner's ame (Print): Subscribed and sworn to befc�e�ne � t is G ' = - 7'� G�-u. �(- KJ � !.L -�'"� dayof �J�.t��• sJ` ' VBI.� .?�8� Date: By (Owner's Name�� `�� "'.��` � `� �--� Notary Public Signature: �� Drafted by: Public Notary Name (Print) ��r:.nc�. l,. 1�n7_t,..,(.� �qr�„ �a�nv�S�� My commission expires on: �.Ql�� 1� ��,�� : P5 5 �? F � Personal information you provide may be used ior secondary purposes [Privacy Law, § 15.04 (I) (m)] Rev. 03J26/13 Lot Nine 191, Bauer's Heights, being a part of Government Lot One (1 ►, Section Twenty- two (22) Township Thirty-eight (38) North, Range Three (3) West. 10/10/23, 1 :19 PM Real Property Listing Page Real EState Sawyer County Property Listing Property Status: Current Today's Date: 10/10/2023 Created On: 2/6/2007 7:55:54 AM -_� ;a' Description Updated: 6/25/2018 � Ownership Updated: 6/25/2018 _.._ . _ _ - _ ---- _ _ _. __ . _ -- Tax ID: 32537 )OHN T KOCH OLATHE KS PIN: 57-032-2-38-03-28-5 15-214-000900 Legacy PIN: 032106000900 Billing Address: Mailing Address: Map ID: -2.9 ]OHN T KOCH ]OHN T KOCH Municipality: (032) TOWN OF WINTER 11695 W 144TH PL 11695 W 144TH PL STR: S28 T38N R03W OLATHE KS 66062-8818 OLATHE KS 66062-8818 Description: BAUER'S HEIGHTS LOT 9 Recorded Acres: 0.580 � Site Address * indicates Private Road Calculated Acres: 0.667 3Z26N IOHNSON RD WINTER 54896 Lottery Claims: 0 First Dollar: Yes � Property Assessment Updated: 10/10/2016 Waterbody: Connors Lake 2023 Assessment Detail Zoning: (RRl) Residential/Recreational One Code Acres Land Imp. ESN: 428 G1-RESIDENTIA� 0.580 105,000 69,100 � Tax Districts Updated: 2/6/2007 2-Year Comparison 2022 2023 Change _ _ _ _- -_ -- 1 State of Wisconsin Land: 105,000 105,000 0.0% 57 Sawyer County Improved: 69,100 69,100 0.0% 032 Town of Winter Total: 174,100 174,100 0.0% 576615 Winter School District 001700 Technical College r � Property History _ _._ . + Recorded Documents Updated: 6/25/2018 N/A TERMINATION OF DECEDENTS INTEREST Date Recorded: 8/3/2015 396961 WARRANTY DEED Date Recorded: 9/13/1999 279341 685/47 https:lltas.sawyercountygov.orglsystem/frames.asp?uname=Eric+Wellauer 1l1 '.( -.�. ~` �� %�`S. 1 �4'� �4 1' �y . �5' .j�r . 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