HomeMy WebLinkAbout032-539-27-1401-SAN-2023-291 �� � Induslry Scr�-iccs Division ('ounry� (�
� -4K?� Vlaclition Yards Way Q.L(,! L Q.1� �
' $� - Madison,WI 53705 Sanitary Permit Numb 'l�o be tilled in by C
$ P.O. Box 7162
� Madison.W1 53707-7162 � S � � ,}� �' �
W
State Transaction Number �
Sanitary Permit Application y�
In accordance with SPS 38�21(?).Wi,.Adm.Codc,submi.;ion��t'this torm to thc appropriatc govcrnmcntal unit �� -�
is required prior to obtaining a sanitar��pcnnit.Note: A�,�licution furm: (ur state-u�i�ned POl'�"TS are suhmitted to Project Address(it dif�feren[than mailing add ,�
thc Dcpartmcnt uf Sut�[y t�nd Protissiuntil Scn�icc,, Pcr.�mal inti�rmtitiun��uu prucidc may bc uscd ibr,ccondaiy �"�'���/� � �; f� �/n��. �
ttr osr�in accurdnncc���ith the Prir�acv Lan�.s. I�.li��I il ml.Stai:. �.J �v/� `�y`-�
i.A lication Information-Please Prin All Information ���Y�f r' �,.(.}J
P rrtc Owncr',A'umc � Parcel i#
��� "�/� ��,C. fj�.nc� S��nle �.�au��
-5 -1 v
Property(�wner's Vlailing Address Property Lc -ation
�o�� �v cid Y�� �aQ d �a ����� ����
City,Statc Zip C'uJc Phonc Numbcr �
(}/'� S i.t� j�/C �/7
�� �• I�._� � ! �V / � ������� ���V� �� %y��/i. SCCllO❑ � I
f�_N R o�" L�or�
II.Ty�pe of Building(check all that apply) Lot:
� Subdicision Namc
�1 or?Famih�D�c�lling-AumhcrufRcdroums �
P I„�•k
❑Public Commercial—Describe Cse �(� � f I City of
❑State Owned—Describe Use �� CSM Number ❑�"illage of
�QTo�cn of_ �L�l�G 1�
III.Type of POw'TS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one bo�on line B.Complete line C if
a licable.
:�.
New System eplacement System Uiher Vtoditication to Existing System(e�plainJ Additional Pretreatment Unit(explain)
B.
Holding Tank In-(iround At-Grade Mound Individual Site Design Other Tync(cx�lain)
(convcntional)
C• Rcne�val Refore � ist Prerious Permit Number and Date Issued
Re��isiu❑ Chan�e uf Plumber Tr,�nsfer to'�c���Ow�ner �
�:�niradon V(v�� ,
IV.Dis ersal/Treatment Area and Tank Information:
Design Plo�c I�pol De�ign Suil:Applicuuun Raiei�s�J.il I)i,persal:Arca Required 1.1) Di,pers:�l:1rea Propu,ed�,�) S}�stem Ele��ation
o � A
Capacityin Tutal #of Manuti�cturer pre�ab Site Steel I�iber Plas
Tank Infurmation Gallons Gallons Units
V���r Tanks Esi.iine�I�anl.s C�OiI �'On- Ci �
� crcte struct I
cd a
s
ti
Septic or Hulding Tank �. �7�� / 1�. � �./
aC 6 !"f /�
r)�„ �,r'h::e,h�r �
V.Res onSibilitV Statement- 1 the undersi ned assume res onsibilit•far installation of'the PO�VTS shown on the attached lans.
Plumber's T�amc(Print) Plumbcr�s Si�n�turc ? MP/MPRS Numbcr Businzss Phonc Nttmhcr
�.�.2. 6 l 5 (�1 Z. Qo
Plumber';Addrrss(StrceL City.State.Zip Cude)
lv ^ .
VI.Countv/De artment Use Onl
11 ( �3 Pcrmi� !�:c Datc I„ucd Isuing:lgcnt Signaturc
� n r v � ❑Duapprovcd ,
� �,/ oa
CO�cncr Gi�cn Rca�un ti�r Dcniul !��- F j� I �:,�i �' �L`j.�� t.2<�'�('�._'f�C�.�Z�t.C�
Conditions of npproval/Reasons for Disappro�al -•- •, � �',�r •'`,` �
�� t p� '�` � � .�.�-�� 5�� _.� .._. �_' � :____-- - - - , 1'
�ri li��� �ti�w"1i i'',+ a � -
� ,_ @' _
23- I�� \ `:���:&�w �.o�� t��` ��� 0 i 2023
C � /v o`� � ) 3�00`-� ,..__n.....-... .._ c���� y .� ,...� ,
i . �� � =�l ii�i�l
._�:�l;�v_,h�i,, :.
attach to complete plans for the s�stem anJ submit to thc Count�only on paper nut less than R li2�11 inches in size ��•���U
SBD-6398 (R.03/21)
Sawyer County Zoning & Conservation Administration
``"`\`t 10610 Main Street, Suite 49
� �R Cp �� Hayward,Wisconsin 54843
-t ,-----_
� �Ci �� (715)634-8288
�� ���I� FAX(715)63R-3277
�
�t� , _ _ � i<� www.sawyercount ov.org
�I°� � ���- �� ' � E-mail:sanitarian(�sawycrcountY`c�oi�
` �'—��'�� � Toll Frce Courthouse/Gencral Information 1-877-699-4110
� =�,=��= �1�
,���5 C O����
�\�����
Holding Tank Approval Checklist
I. Sanitary Cover Sheet: Date Stamp � ( / d � /�
Parcel ID#� 3 �- ���- �.? - I `� 0 1
II. Plot Plan:
�Property Lines rC Benchmark BM ♦
�CSrte 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:
y�Index Page with Original Signature
�Management Plan/Contingency Plan
Servicing Contract
�Holding Tank Agreement Form ($30 to ROD)
IV. Holding Tank Specifications:
Tank Cross-Section: Manufacturer: H Gallons: ����
Tank Anchar Calculations [SPS 383.43 (8) (g)]
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: ��rTa� LLL' plumber: �, -�� �
Application Review Date: �� l� l a-D� �
POWTS Reviewer: �7i ;, �
Namc
�1'��� Rev. 4/27/2023
Credential#
CONCRETE HOLDING TANK DESIGN
INDEX AND TITLE SHEET
Project Bear Tales LLC
Owner Randy Sonley
Address 5018 Ciover Road South
Winter, WI 54896
Legal Description Prt SENE & SWNE, S27, T39N, R5W
Township Winter County Sawyer
Subdivision Name NA Lot No. NA
Parcel ID Number 32539271401
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
Soil Evaluation Report Page 5
Designer Kurt Brown
Signature '���j,,rt,•v`� Phone No. 715 943 2988
License Number 224281 Date 10/29/23
Designed pursuant to:
Holding Tank Component Manual For POWTS (Version 2.1)
May 2022-2027
Version 7.1 (07/22) Page 1 of 5
HOLDING TANK SPECIFICATIONS
2 Number of bedrooms
Non-residential estimated flow(gpd)
��Minimum holding tank volume required (gal)
2000.0 Proposed holding tank capacity(gal)
Huffcutt Tank Manufacturer
2000 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 16150 Ibs Weight of tank and cover
47.0 Liquid depth below inlet invert(in) 1.10 Safety factor
8.0 Maximum depth of soil cover(ft) 10045 Ibs Weight of anchor required
64.0 Height(in) 16.8 in Soil cover req. for anchor or
161.0 Length (in) 2.5 yd3 Concrete counter weight
64.0 Width (in)
HOLDING TANK CROSS SECTION
manhole cover with
locking device and finished �vent cap
junction � waming label grade
box � �
„ 4"min. 12"min.
�—23 in.
Manhole and vent locations
conduit —� vent pipe
18"min.
� tether weight `I' - �
— —�—�—•—�— —�—•— — --- —�—�—•— —�—.`�—�— — —�— -
12.0 Ifl. building sewer
� service /, intet
blind plug alarm on Note: All tank joints, and
to seal joints between tank
outiet openings and piping are
Electrical as per 35.0 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: Bear Tales LLC
Transaction Number: Page 2 of 5
CHECK BOX AS APPLICABLE. CHECK BOX AS APPLN',ABLE.
❑ SOIL EVALUATION o �'�� �4°' � � Q✓ SYSTEM PAGE 2 OF
SITE MAP PLOT PLAN
PROJECT NAME: {�ortyna� �pZ DESIGNFLOW: 3OO GPD
Bear Tales LLC Attach design flow calcu4ations for commeraiat plans.
PROJECT ADDRESS: rJrJZTN La{C6 Wlflt@�RCI Pipe Material/ASTM Standard(fables 384.30-3 8 384.30-5)
100.0 N s�rtary sewer. ASTM D3034 �ASTM D1785
BM Symbol: � BM Elevation: FT Force Main: �A /
BM��,��,: Top of Well
i�,a��onn by IMPORTANT:
Slope Grad�ent(%) NA wdi symbd(if appaca��: p drawhg an a�o.v Show ground elevati�contours at suiTabte intervals.
of Tested Area: o„�a��;��
% ','� I
.t
THIS PLAN PROPOSES TO REPLACE A FAfLING CONVENTIONAL '
SYSTEM WIT A 2,000 GALLON HUFFCUTT HOLDING TANK.
:� I
SIGNED: ���(E VJINT�K RD
MPRS: 224 1 `\
,
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-. ._—_. ___.: . . .. ..___ `_ I
.. ..._.. �.__—__._ -._.._ . . .___—_. . . -._ ._ (
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 Sanitary Ordinance.
1. This POWTS is designed to accommodate a wastewater flow of 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 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 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. Installer......................... Randy Dennis Phone: 715 415 0661
b. Service Provider............... Northwest Sanitary Phone: 715 945 2650
c. Co. Zoning or Health Dept. Sawyer County Zoning Dept. Phone: 715 634 6288
11.
Project: Bear Tales LLC
Transaction Number: Page 4 015
HOLDING TANK SERVICING CONTRACT
Contract Date: r0 /���1��
This contract is made bchveen the Holding Tank Owner and the Pumper.
Holding Tank Owner's Name: Pumper's Name:
���y � y Northwest Sanitary, Inc.
r.�N�.E
PO BOX 155
Radisson, WI 54867
Parcel Identification Number:
(12 Digit Legacy ID) (� ��- ,���- o� � -� � C7 /
I. The owner agrees to file a copy of this contract with tl�e governmental unit, Sawyer County,
which Las accepted ai�d reccr�iad with the 7ffice ot thc Regi�ter�f Dc�eds, t'�e M�intenanec
Agreement for a Holding Tank required undcr the Sawyer County Private Sewage System
Ordinanec for the issuancc of a Sanitary Perinit for the installation of a holding tank(s).
2. The owner agrees to llave 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 own�r agrecs to maintain thc all-weather access road or drive so
that the pumper can service the holding tank(s) with the pumping equipment. The owner
furthcr agrees to pay the pumper for a charges incurred in servicing the holding tank(s)as
mutually agrced upon by the ��wner and pumper.
3. The pumper agrees to submit to the Governmental Unit, Sawyer County,a report for the
servicing of the holding tanlc(�) as required undcr SPS 383.55, Wisconsin Administrative
Codc and thc Sawycr County Privatc Scw�gc Systcm Ordinancc. Thc pumper furthcr
agrees to include the followin`, 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. �he site address of t}ie holding tank;
d. The date the holding tank was scrviced;
c. The volumcs in gallons of thc contcnts pumpcd from thc holding tank for cach scrvicing;
f. The disposal sites to which the contents from the holding tank were delivered.
4. This agr�eizie«t wiil �eniain in a�fect uniii �he owner or pulrrper terminates this contract. In
the event of a change in this cuntract,the owner agrees to file a copy of any changes to ttiis
service contract or a copy of a new scrvice contract with Sawyer County within ten (10)
business day� from the date of change to this service contract.
Owner's Name: (Print) OW17Cf'S Sl�ri3tU1'C: (Only one owner signature required)
%"fi3,e�fJ� �.r/��'y '7� ��,,�1
Pumper's Name: (Print) P nper's Signature:
Ronald L Vieceli, owner Northwest San+tary,lnc '
���/LL- L- U�c.�
Pumper's Registration Number:
#2389
Rev.03126i 13
��,u� ���u�� .�avvy�i �,vui i�y r i vNci�y u�ui iy . �..r..��� ..�a�..�. .....�����
'oday's Date: 10/17/2023 Created On: 2/6/2007 7:55:59 AM
�'Description Updated: 3/29/2023 �' Ownership Updated: 3/29/2023
Tax ID: 35390 BEAR TALES LLC WINTER WI
PIN: 57-032-Z-39-05-27-1 04-000-000010
Legacy PIN: 032539271401 Billing Address: Mailing Address:
Map ID: .4.1 BEAR TALES LLC BEAR TALES LLC
�unicipality: (032)TOWN OF WINTER 5018W CLOVER RD SOUTH 5018W CLOVER RD SOUTH
�TR: S27 T39N R05W WINTER WI54896 WINTER WI54896
)escription: PRT SENE&SWNE
;ecorded Acres: 31.080 � Site Address * indicates Private Road
.ottery Claims: 0 5527N LAKE WINTER RD WINTER 54896
�irst Dollar: Yes
llaterbody: Brunet River � property Assessment Updated: 10/10/Z016
'oning; (A-1)Agricultural One
_SN: 428 2023 Assessment Detail
Code Acres Land Imp.
G1-RESIDENTIAL 1.000 12,800 48,100
Tax Districts Updated: 2/6/2007 G6-PRODUCTIVE FOREST 30.080 39,900 0
State of Wisconsin
�7 S�:wy�r�cur:�y 2-4ear�omparison 2022 2U23 Change
132 Town of Winter Land: 52,700 52,700 0.0%
�76615 Winter School District Improved: 48,100 48,100 0.0%
)01700 Technical College Total: 100,800 100,800 0.0%
+ Recorded Documents Updated: 10/5/2021
� WARRANTY DEED l.�Property History
)ate Recorded: 1/20/2023 443072 N/A
9 TRUSTEES DEED
)ate Recorded: 10/4/2021 435072
� QUIT CLAIM DEED
)ate Recorded: 5/8/2018 412�64
� TERMINATION OF DECEDENTS INTEREST
)ate Recorded: 4/17/2018 411948
� WARRANTY DEED
)ate Recorded: l2/31/2015 399z90
� WARRANTY DEED
)ate Recorded: 8/10/2011 373847
� WARRANTY DEED
)ate Recorded: 5/2/1972 140148
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-USE BLACK INK ONLY - I I l�IIII I�III il�Ill Iill)I
�nri�:g0�5Y11
POWTS MAINTENANCE AGREEMENT Tx:�04�4U7
For Holding Tanks 447157
PAULA CHISSER
Ow r's Name(s)as shown on deed: i�EGISTER OF DEEDS
� ���. �-- SAWYER COt)NTY, Wi
''�'�� ,��,r�� �y ����'a�_s LL� ii,oi,z�z3 oi:zs o0
Parcel Identification Number: — RECORDIN� FEE 3
(12 Digit Legacy ID) Q�p�-_ �� - U� � - � � C� �
PAGES: 2
Legal Description of Property:
-SEE ATTACHED SHEET -
We acknowledge that application is being made for the inst�llation of a holding tank(s)on the
property described on the attache��sheei.
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 �ssue 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 �vho 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 �censed 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 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 maintaineo.
3. If the owner fails to have the holding tank pruperly 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 servicea. 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 hotding 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 unt�l the governmental unit responsible for the regulation of private sewage systems
certifies that either a soil absorption system that compiies with SPS 383,Wis.Adm. Code, or a municipal sewer serves the
property. In addition,this agreement may be cance!!ed 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 jetermined by reference to the property where the holding tank is installed.
-Onty one owner signature required-_ ACKNOWLEDGMENT
Owner' r� atur.�e j��� State of: GUiSC c���)_=�r�
-���� ti/" OWV���' of: ���Zu.�V.� r"
Owner' ame (Print): .
� KAF;�IvJ M. TOSC BE61'�ubs ribed and sworn to before me on this
,��-�'��� �>i�� ��A - IC day of (1^to(,,'r� , 20:�
Date: STATE O�WlSG (�SlI�'�O ner's Name): ��N�� ��
/`'" ��' � Z -� o ary Public Signature:^ l����lf �:���=12 �-�^�
Drafted by: n I j Public Notary Name (Print): 1���-e-r> /�1 %�c'�'�/��� ��
'h(�+v�� ��h 1e � My commission expires on: ,5 ;?�% �L•'�t�
Personal information you provide may be used for secondar, purposes[Privacy Law,§ 15.04 Q)(m)] Rev.03/26/13
That part of the South half of the Northeast Quarter, Section 27, Township 39 North,
Range 5 West, Town of V�inter, Sawyer County, Wisconsin, lying South of the right
of way of the Chicago-St. Paul-Minneapolis and Omaha Railway Co. and West of
Brunette River.