HomeMy WebLinkAbout032-338-23-5103-SAN-2024-015 1
Industry Services Division County � '
4822 Madison Yards Way Sawyer � �
�$P Madison,WI 53705 Sanitary Permit Number(to be filled in by � '
S P.O.E3ox 7302
Madison,WI 5302 � S � �� � � ��
r
Sanitary Permit Application State'I'ransaction Number �
In accordance with SPS 38321(2),Wis.Adm.Code,submission of this form to the appropriatc govemmental unit —� �
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS aze submitted to Project Address(if different than mailing address)
the Department of Safety and Professional Services.Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. N361 1 Adams Rd
I.Application Information—Please Print All Information Winter, WI 54896
Property Owner's Name Pazcel#
Dustin T Reid and Lawrence M Reid 032338235103
Property Owner's Mailing Address Property Location
�c'r
E3301 Colrue Road �ov�.►,o� 1
City,State Zip Code Phone Number
Ogdensburg, W I 54962 *7 I FS Z - e O �� ���, Section 23
II.Type of Building(check all that apply) ot#
T 38 N R 3 F?or
x 1 or 2 Family Dwelling—Number of Bedrooms 4 ^ Subdlvlston Name
❑Public/Commercial—Describe Use B�����# NA
❑Statc Owned—Describe Use ^ ❑City of
CSM Number ❑Village of
� �,Town of Winter _
III.Type of POWTS Permit:(Check either"New"or"ReplacemenY'and other applicable on line A. Check one box on line B.Complete line C if
a licable.)
`�� ❑ New S stem � p ys g y ( p ) ❑ Additional Pretreatment Unit(explain)
y �Re lacement S tem ❑ Other Modification to Existin S stem ex lain
B' � Holding Tank ❑ In-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑ Other Type(ezplain)
(conventional)
�-• ❑ Renewal Before ❑ Revision ❑ Changc of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued
Expiration POWTSnotrecorded utik ?
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
�{0� NA NA NA NA
Capacity in Total #of Manufacturer
Tank Information Gallons Gallons Units p i o v �
CC U U
New Tanks F.xisting Tanks F o ?? � � p � `c�
n. U v� � cn w U 0..
Septic or Holding Tank 3000 ------------ 3000 1 Huffcutt x
Dosing Chamber
V.Responsibility Statement- I,thc undersigned,assume responsibility for installa6on of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone Number
Kurt Brown 224281 715 943 2390
Plumber's Address(Street,City,State,'Lip Code)
W 10487 Old Mu Rd Exeland, WI 54835
VI.Co� /Department Use Only
/ Permit Fee Date[ssued Issuing Agent Signature
�A ro e ❑Disapproved $ �oo/dp �� ' � �y ����� � ,
� <- ✓�.c�=
�Owner Given Reason for Denial
Conditions of Approval/Reasons for Disapproval -
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Attach to complete plans for the system and submit to the County only on paper not less than S 1/2 x I 1 inches in size S��y y�
I��R��UNDS AFTER '
w�U�OF PERMIT
Sawyer County Zoning & Conservation Administration
10610 Main Street, Suite 49
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��R C� 1� Hayward, Wisconsin 54843
�Ci �� (715)634-8288
� �/�� `2 � FAX(715)638-3277
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�� . _ ��� wwwsawyercouniv�ov.�ir�
� o � �o � E-mail:sanitarian(q sawvcrcount��*ov.ore
I � � ; -��� Toll Free CourUiouse/Ceneral Information I-877-699-4110
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Holding Tank Approval Checklist
I. Sanitary Cover Sheet: Date Stainp �I / 3 1 � �oaY
Parcel ID#v 3 �- 3 3 � - 23 - S f o 3
II. Plot Plan:
�C Property Lines �Benchmark BM ♦
� Site Address �North Arrow
➢C Structure �Scale
3C Well p�<25' to Service Road
� Legal Description � Nearest Road Intersection
�C Setbacks to: Property Line, Well, Structure, Water bodies, Roads
III. Required Plans:
�Index Page with Original Signature
�Management Plan/Contingency Plan
�Servicing Contract
�D Holding Tank Agreeinent Form ($30 to ROD)
IV. Holding Tank Specifications:
➢< Tank Cross-Section: Manufacturer: � Gallons: .3,�
�Tank Anchor Calculations [SPS 383.43 (8) (g)]
Locking device, chains/locks
�Alarm, electrical per SPS 383.43 (8) (e)
�0 3" Bedding Material < 1/2 "
V. POWTS Component Manual Reference:
� Holding Tank Version 2.1 (May 2022-2027)
Owner: ��� Plumber: �_ Q�v�
Application Review Date: O� �3( ` �a l
POWTS Reviewer: � �,�
Name
G�I��(o Rev. 4/27/2023
Credential#
PAGE 1 OF 4
Hoiding 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
DKs�ir�T and Lawrtnce N� tZeid
Owner Name(s): Hunts End Deer Ranch Phone: �t�_-zsi - ���o�
Owner Address: E3301 Colrue Road Ogdensburg, WI Z;p: 54962
Project Address: N3611 Adams Road Winter, WI 54896
Govt. Lot: � 1/4 of 1/4, Section 23 , T 38 N-R 3 E Q or W �✓
Township: Winter County: Sawyer
Project Parcel ID #: 032338235103
Designer Information
Designer Name: Kurt Brown Phone: 715 _943 _2988
Designer Address: W10487 Old Murry Rd Exeland, WI Zip: 54835
E-mail: brownk@bevcomm.net _
License Number: 224281
Remarks:
Signature: Date: � -aq--aW
Origi al signature required on each submitted copy.
PROJECT
Lake of the Pines
HUNTS END DEER RANCH
E330"I COLRUE RD
OGDENSBURG,WI 54962
SITE ADDRESS �
N3611 ADAMS RD
WINTER,W154896 ry
PRT GOVT LOT�,S23,T38N,R3W SCALE:1"=60'
TOWN OF WINTER
ESTIMATED FLOW=400 GPD SLOPE
A3,000 GAL.H!f IS BEING
PROPOSED TO SERVE DWELLING.
AN EXISTING DWELLING ON THE
SITE HAS BEEN DEMOLISHED. NO
WELL IS ON SITE.
BM=100.0',NAIL IN BASE OF
ELECTRIC POLE W/TRANSFORMER. PROPOSED
46EDROOM
B-1=99.45' DWELLING
B-2=97.75'
LAKE EL.ISAPF 3,000 �
20'LOWER THAN GAL.H/T �Z
BUILDING SITE 97'75
SIGNED:
#224281 —
-550' '�a'
O
�1 BM•
99.45'
PROPERTY
LINES
DR.WAY
TOADAMS RD
#N3611
HOLDING TANK SPECIFICATIONS
1} Number of bedrooms
Non-residential estimated flow(gpd)
��Minimum holding tank volume required (gal)
3000.0 Proposed holding tank capacity(gal)
Huffcutt Tank Manufacturer
3000 Tank model number
Rhombus SJE Alarm manufacturer
Tank Alert 707-01H Alarm model number
Tank Dimensions and Data Tank Anchor Calculations
X for round tank 23600 Ibs Weight of tank and cover
57.0 Liquid depth below iniet invert(in) 1.10 Safety factor
8.0 Maximum depth of soil cover(ft) 20078 Ibs Weight of anchor required
72.0 Height(in) 22.7 in Soil cover req. for anchor or
166.0 Length (in) 5.0 yd' Concrete counter weight
92.0 Width (in)
HOLDING TANK CROSS SECTION
manhole cover with
locki`g device and finished ��nt cap
jundion waming label gratle �
box —� I —
�4"min. y 12"min.
E--23 in.
Manhole and vent locations
conduit � �QM P�� 18^min.
� tether weght yI - �
---'---� -- --'---�—�—�`---�—�—'— -
� Service � 12.0 Ili. buiidii�sewer
biind plug a�arm on Note: All tank joints, and
to seai joints belween tank
out�et openings and piping are
Elechical as per 45.0 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: BearTalesLLC
Transaction Number Page 2 of 5
PAGE40F4
Holding Tank Management Plan
IMPORTANT:
The owner of this holding tank(s) shall be responsible for its perpetuai 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 perfortned by a registered POWTS Maintainer in
accordance with SPS 383.52(3), Wisc. Admin. Code.
Estimated Daily Wastewater Flow= 400 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 electncal 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: R ellCl P EBfih 811d FOf2St WOI'kS phone: 715 415 0061
�o�ai 9o„e��me„�,,,,;t: Sawyer County Zoning Dept. Pno�e: 715 634 8288
�ocal government unit address: 10610 Maiil St. # 49 H8yw8rd, WI Z�p 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.
Continaencv 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: p� / � / 10�
This contract is madc bctwcen thc Holding Tank Owncr and the Pumper.
Holding Tank Owner's Name: Pumper's Name:
� Northwest Sanitary, inc.
p� � � Cl `J� r� �, n C?,/� PO BOX 155
� 1 �aw ��,���� Radisson, WI 54867
Parcel Identification Number: �
(12 Digit Legacy ID) �' �� � - � � � - � � - �J � �J �
1 . The owner agrccs to file a copy of this contract with the governmental unit, Sawyer County,
which l;ss acccu'�c+ and :-ca�r:��d �vith tl�e OFtic�: of tl,e Re�istcr of Lcec?s, the Maintenance
Agreement for a Holding Tank requircd under thc Sawycr County Private Sewagc System
Ordinance for tl�e issuancc of a Sa��itary Pcrinit 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
�ermit the pumper to have access and to enter upon the property for the purpose of servicing
the holding tanl<(s). The owner agrees to maintain the all-weather access road or drive so
tl�at the pumper can scivice the holding tank(s) with the pumping cquipment. The owner
furtl�er agrees to pay thc pumper for a charges incurred in scrvicing the holding tank(s) as
mutually agrecd upon by thc o�vner and pumper.
3. The pumper agrees to submit to the Governmental Unit, Sawyer County, a report for the
scrvicing of the holding tanlc(s) �s requircd under SPS 383.55, Wisconsin ndministrative
Codc and the Sawycr County Private Scwage System Ordinancc. Tl�c ��m�per fucther
agrees to include the fo(lowing in the report:
a. The name and address of tl�e person responsible for scrvicing the holding tank;
b. The name of the owner of the holding tank;
c. Thc site address of the holding tank;
d. The date thc holding tank was serviccd;
c. Thc volumes in gallons of thc contents pumped fi-om thc holding tank for cach scT•vicing;
f. The disposal sites to which the contents from the holding tank were delivered.
4. Tnis agreement wiii remain in eiiec� un�ii tiie owner ��r f�uillper t�rn.;nates tr�is co,ltr;�ct. In
the cvent of a change in this contract, the owner a�,�rees to file a copy of any changcs to this
scrvice conti-act or a copy of a ncw servicc contract with Sawycr County within tcn ( 10)
busincss days from the date of change to tLis se�vice contract.
�wllCi'S Nam�: (pl'1nt) �wnGC'S S1�Tn3tt . nly owner si�nature required)
�� �
f-�- !.t rl�"S �/'1C� ��C'�r�YIC`_h
�
Pumper's Name: (Print) Pumper's Signature:
Ronald L Vieceli, owner Northwest Sanitary,inc ,i��������C� � �� �
d
� Pumper's Registration Number:
#2389
Rev. 03/26/I 3
_ i iiiiii ii i
- USE BLACK INK ONL
Y ( ( (I I
GocI :8�78142
POWTS MAINTENANCE AGREEMENT Tx :4049961
For Holding Tanks 448436
� PAU�A CHISSER
Owner's Name(s) as shown on deed: 1 r- REGISTER OF DEEDS
.. - � �ST��,�ei� � SAWYER COUNTY, WI
����-� �v �.�� �,Y- ��� C�W,r,���W�' �c 01/3!j2024 01:23 PM
Parcel Identification Number: L RECORDING FEE 30.00
(12 Digit Legacy ID) � t� t� - � � � - Q� ,� - =� / � •�
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 maintainea.
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 14520(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
pro��rty. ;n addi+ier, this a�reement m�y he r,ancelled by executing and recordinq 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 bincJing 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 ner ' atu i d - ACKNO LEDGMENT
Owner's Signature: . State of: W�SC��
County of:
Owner's Name (Print): (� � 1_� Subscribed and swor to before me on this
`I�JUgTl�1 � --_� �_day of 3Anuw,r.� , 20 �
Date: . `B�(�(Cit�t Ns+1�1�,me): 'R�144-i r. (��d �
a -
_ � : , c� - . ..
� � � ��' ��oi�r�, . J�r��igr�ature: �.�, , ..�_ (��,�M.. �r .��t,
� �' ' 1�
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Drafted by: t� ,`y�S�iC� pte��/�'+;�E, (P�int)'CC,►rtr� L � Kv.��Y'-�.S:51C,�
� , . ; �'I�I �m ssion' ifes on: — — S'
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Personal information you provide may be used for secondary purposes [Privacj/��up,�'�fj�4JJ� �K1r�C. Rev. 03/26/13
••., �u�rF �
LEGAL D�SCRIPTION
A parcel of land in Government Lot One (1), Section Twenty-three (23), Township Thirty-eight (38) I
North,Range 1'hree(3)West,described as follows:
Beginning at the Southwest corner of said Lot I;thence North along the West line of said lot,566.6 feet '
to an iron pipe on the Southerly shore of the Lake of the Pines; thence East 100 feet to an iron pipe;
thence South parallel with the West line of said Lot 1, approximately 566.6 feet to the South line of
Lot 1; thence West along the South line of said Lot 1, 100 feet to the place of beginning, Town of
Winter,Sawyer County,Wisconsin.
Together with an easement for ingress and egress, 20 feet in width centered upon fhe existing
driveway commending at Adams Road near the Southeast corner of Certified Survey Map No.221
as recorded in Volume 2 of Surveys on Page 4,as Document No.138232,located in and being part
of Government Lot One(1),Section Twenty-three(23),Township Thirty-eight(38)North,Range �
Three (3) West; thence continuing northwesterly until reaching the East line of the above
described real estate.
1/31l24. 739 PM Real Property Listing Page
Redl EStdt2 Sawyer County Property Listing Property5tatus: Current
Today's Date: 1/31/2024 Created On: 2/6�2007 7:55:55 AM
�Description Updated: 1/23/2015 `� Ownership Updated: 1/9/2024
TaxID: . 32946 DUSTIN T REID OGDENSBURG WI
PIN: 57-032-2-38-03-23-5 OS-001-000030 LpWRENCE M REID OGENSBURG WI
Legacy PIN: 032338235103
Map ID: :1.3 Billing pddress: Mailing Address:
Municipality: (032)TOWN Of WINTER DUSTIN T REID DUSTIN T REID
STR: 523 T38N R03W E3301 COLRUE RD E3301 COLRUE RD
Description: PRT GOVT LOT 1 OGDENSBURG WI 54962 OGDENSBURG WI 54962
Remrded Acres: 1300
Calculated Acres: 1.173 � Site Address * indicates Private Road
Lottery Claims: I 3611N ADAMS RD WINTER 54896
First Dollar: Yes
Waterbody: Lake of the Pines i., property Assessment Updated: 10/10/2016
Zoning: (RR2)Residential/Recreational Two Z023 Assessment Detail
ESN: 428 Code Acres Land Imp.
G1-RESIDENTIAL 1.300 75,000 103,600
� Tax Districts Updated: 2/6/2007
1 State of Wisconsin 2-Year Comparison 2022 2023 Change
57 Sawyer County Land: 75,000 75,000 0.0%
032 Town of Winter Improved: 103,600 103,600 0.0%
576615 Winter School District Total: 178,60D 178,600 0.0%
001700 Technical College
• Recorded Documents Updated: 1/9/2024 �C:�property History
TRUSTEES DEED N/A � �
Date Recorded: 11/30/2023 447557
EASEMENT
Date Recorded: 11/20/2023 447432
WARRANTY DEED
Date Recorded: l2/1/2014 393408
WARRANTY DEED
Date Recorded: 11/22/1993 239059 522/470
https:lltas.sawyercounrygov.orglsystem/frames.asp?uname=Eric+Wellauer ���