HomeMy WebLinkAbout008-938-34-5112-SAN-2024-039 � ' �`� `� Department of Safety �°°"�' �
�,���— ��.,;< <j[..n� � r- �'
i=�� � `�=1 & Professional Services,
� -' Sanitary Permit Number(to be tilled in by C �
� ��� �� ��� Industry Services Division
��"k-,%;�;��;�� to S I � 3C.� �
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Sanitary Permit Application State Transaction Numbcr W
�— �
In accordauce with SPS 383.21(2),Wis.Adm.Code,submission of this toim to the appropiiate govemmental unit
is required prior to obtaining a sanitary permit.Note:Application fonns for state-owned POWTS are submitted to Project Address(if different tltan mailing nddress)
the Department of Safety and Yrofcssional Service,.Personal inforn�ation you provide may be used for seconda�y
puiposes in accordance�vi�h thc Priv2cy Law,s. 15.04(1)(m),Stats. ����� �45� ���� ��
I.Application Information-Please Print All Information
Prapeity Owner's Name Parcel#
� � M v o,��� oo �- 938 - 3y-5�� a
Property Owner's Mailing Address Proper(y Location
1y83`� 1�o5ewc�od Lc� cP`i�t I
City,S[ate Zip Code Phone Number
V('(15V� ��� �� S.5 3��p ---�4 � �. Section 3�
II.Type of Building(check all that apply) Lot# 'l' 3$ N R,v�_�;o�
�I or 2 Family Dwelling-Number ofE3edrooms 3 3 Subdivision Name
Block# �'
❑ Public/Commercial-Describe Use ��
❑City of
❑State Owned-Describe Use_ CSM Number ❑Village of
Csih# !19a 1�r�W„�r� EdG�wa�c r'
.i c 1. (., , . t'-I 5
III.Type of POWTS Permit:(Check either"New"or"Replacement"and other aPplicable on line A. Check one box on line B.Complete Iine C if
ap licable.)
A' �[New S stem
y ❑ Replacement System ❑ Other Moditica[ion to Gxisting System(explain) ❑ Additional Pretreatment Unit(explain)
B.
�I-lolding Tank ❑ hi-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑ Other Type(cxplain)
(conventional)
List Previous Pennit Number and Date Issucd
C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfcr to Ne��Owner
Expiratian --
IV.Dispersal/Treatment Area and Tank Information:
Detii�n Flow(gpd) Design Soil Application Rate(gpd/st� Dispersal Area Required(st) Dispersal Area Proposed(s� Sys[em Elevation
�00 — '— ` —
Capacity in 'I'otal #of Manufacturer
�
Tank Infonnation Gallons Gallons Units � U U � N �?
New Tanks Existing Tanks � � � � � p � r
n. U �n �, v� ts. C7 P.
Septic or Halding Tank �� � � _ 3�� �
WiGS�C' C/G'F'G �C
Dosing Chamber
V.Responsibility Statement-I,the undersigned,assum sponsibility for installation o!the POWTS shown on the attached plans.
Plumbei's Name(Print) Plumb '.igilature MP/'�1PRS Number Business Phonc Number
'1—ra�;s I3�++e��;� �d �sa8�� 7�s- �3y -8�'7 (�
Plumber's Address(Sh�eet,City,State,Zip Code)
�ti3�4 W S�'�.k 2oad 7� ��/q wa�d w= .S�ati3
VI.Cou ty/Department Use Only _
� �/ Pern�it Fee Date Issued Issuing Agent Signature
� �ok� ❑Disapproved ,�f
�� ❑Owncr Given Reason for Denial � ����� ���S���� �' I���='���i1/1/L!�-�
�� R c-;� r--�
Conditions of Approval/Reasons for Disapproval D .r� �`���� j� •��t� ;�;�..�
'�`-.��t..� �� I _:�,
� ��, � � .� ��� S1�� �
1.. �r ��i
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-�3� SAWYER CJi!'rdT'.;
GS� /vo� �. ZONINC ABMtNIST��;i��y
At[ach[o complete plans for the systent and submit to the County only on paper no[less than 8 I/2 x 11 inches in size
NO RCFUNpS qF7'ER
sB�-639g�x.o3ia2> ISSUE OF PERiIAIT ��5�3
Sawyer County Zoning & Conservation Administration
10610 Main Street, Suite 49
������11
� �R CD 1� Hayward,Wisconsin 54843
�,��i'� -'�C� �� (715)634-8288
' ����� FAX(715)638-3277
�y/ _ -� . ,�/ wwwsaw�count �ov.�irg
� o l ' � �o j E-mail:sanitarian(ci saw cy�rcoun�ov.o�
I ` =� �� ' � Toll Frce Courthouse/General[nformation 1-877-699-4110
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Holding Tank Approval Checklist
I. Sanitary Cover Sheet: Date Stamp �.3/�/ -��.2�
Parcel ID#d o B- 4 3 $ - 3� - S�� 1 �
II. Plot Plan:
� Property Lines g Benchmark BM ♦
�Site Address �North Arrow `
j�Structure /Scale ��--
�D Well �25' to Service Road �
�Legal Description �Nearest Road Intersecti n
D�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 Agreement Form ($30 to ROD)
IV. Holding Tank Specifications:
o( Tank Cross-Section: Manufacturer: �"'�`��- Gallons: 3,oan
K Tank Anchor 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 Coinponent Manual Reference:
�Holding Tank Version 2.1 (May 2022-2027)
Owner: Ud�-�5 Plumber: T ��T�r�-���-��
Application Review Date:
POWTS Reviewer: � A
-�� �,�
Name
6`�'� ((p Rev. 4/27/2023
Credential#
CONCRETE HOLDING TANK DESIGN
Single Tank Option
INDEX AND TITLE SHEET
Project Vowels-East Shore Dr
Owner Scott M Vowels
Address 14839 Rosewood Ln
Bumsville,MN 55306
Legal Description P/O Govt Lot 1,Sec.34,T38N,R09W
Township Edgewater County Sawyer
Subdivision Name CMS#1192 vol.6 pg.145 Lot No. 3
Parcel ID Number 008-938-34 5112
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
Designer Travis eRterfield
Signature Phone No. 715-634-8176
License Number 652879 Date 03/07/24
Designed pursuant to:
Holding Tank Component Manual For POWTS(Version 2.1)
May 2022-2027
version 7 t(o7/2z) Page 1 of 4
HOLDING TANK SPECIFICATIONS
3 Number of bedrooms
Non-residential estimated flow(gpd)
2000.0 Minimum holding tank volume required (gal)
3000.0 Proposed holding tank capacity (gal)
Wieser Concrete Inc Tank Manufacturer
W3000-MR Tank model number
Rhombus SJE Alarm manufacturer
Tank Alert AB Alarm model number
Tank Dimensions and Data Tank Anchor Calculations
X for round tank 25485 Ibs Weight of tank and cover
Liquid depth below inlet invert (in) 1.10 Safety factor
8.0 Maximum depth of soil cover(ft) 23300 Ibs Weight of anchor required
71.0 Height (in) Outside 23.3 in Soil cover req. for anchor or
186.0 Length (in) Dimensions 5.8 yd' Concrete counter weight
93.0 Width (in) Only
Complete liquid clepth in cell A16.
HOLDING TANK CROSS SECTION
manhole cover with
locking device and finished �vent cap
junction � warning label grade
bax � � —
�4"min. 12"min.
r`~ �23 in.
Manhole and vent locations T
conduit —� vent pipe �g^min.
� tetherweight I �
_ —._"_._.—`�'_._._.—.— _
building sewer
� service 12.0 In. inlet
biind pmg aiarm on Note: All tank joints, and
to seai joints between tank
ouciec openings and piping are
Electrical as per i�. 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: Vowels - East Shore Dr
Transaction Number: Page 2 of 4
HOLDING TANK SITE PLAN
Project: Vowels - East Shore Dr
N Legal Description: P/O Govt Lot 1 , Sec. 34, T38N, R09W
Subdivision Name: CMS #1192 vol. 6 pg.145
Scale: 1" = 40 ft� Parcel ID: 008-938-34 5112 Lot No.: 3
r �
N
Q
� M'- To oF ro t�� Fei/ _ O.O lev.
� �
�O 4cce;s o y��pvCfc+�yo
pstr�fb91
T a �
�j nT �
/� cio' II� . - Q�Pese.a
� P�oPoaec+ well
�, � ��I� t�b,�
�
�
17ropexa D�^� -''e way
�
� ,
Hrc ��o � a,�. � �ab c�nc�e.�c l-�+oldc �� T4nX
(r�ar,e by W�c st r Ccrn c re.�e.
CAccess oC 6asf 51�.-re D��
Transaction I.D.: Page 3 of 4
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 60.0 to 600.0 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 Iethai gases,and rescue
of a person from the interior of the tank may be difficult or impossible.
8. In the event that this POWTS falls 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..._....._.... ...... . Butterfield Inc Phone: 715-634-8176
b.Service Provider... ........... ScotPs Septic Phone: 715-634-7279
c.Co.Zoning or Health Dept. Sawyer County Zoning&Conservation Phone: 715-634-8288
11.
Project: Vowels-East Shore Dr
Transaction Number: Page 4 014
HOLllING TANK SERVICINC CONTRACT
Contract Datc: 63 / 07 / aa�y
This contracYis made bet���een the Holding Tank Owncr and the Pumper.
Holdii�g Tanl< Owne�'s Name: Pumper's Namc:
SGo{� M Vowe.ls S cok� Poppe
Parcel Identification Number:
(l 2 Digit Legacy ID) U O � - � � $ - .3 y - S 1 1 �
1 . Thc owncr a�-ees to file a copy of this contract with the governmental unit, Sawyer County,
which has accepted and recorded with the Office of the Rcgistcc of Dceds, the Maintenance
Agrccnlent for a Holding Tank required under the Sawycr County Privatc Scwagc Systcin
Ordinance for the issuance of a Sanitary Permit for thc installation of a holding tank(s).
2. The owner agrccs to have the holding tank(s) serviced by thc pumper and guarantees to
permit the pu�nper to have access and to enter upon thc property for the purpose of servicing
thc L�olding tank(s). The owner agrees to maintain thc all-weathei- access road or drive so
that the pumper can service the holding tank(s) with thc pumping ec�uipinent. The owner
fui-thcr �igrccs to pay the pumper for charges incurrcd in sci-vicing the holdin� tank(s) as
mutually agreed upon by the owner and pumper.
3. Thc pumper agrees to submit to thc Govcrmnental Unit, Sawycr 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 Systein Ordinance. Thc pumper further
agrces to include thc following in the report:
a. The name and address of the person responsible for servicing thc holding t�nlc;
b. The name of thc owner of the holding tank;
c. The site address of the holding tanlc;
d. Thc date the holding tanlc was serviced;
c. The volumcs in gallons of the contents pumped from thc holding tank for cach servicing;
f. The disposaL sites to which the contents froin thc holding tanl< were ciclivered.
4. This agrcement will remain in effect until thc owncr or pumper terminatcs this contract. In
thc cvcnt of a change in this contract, the owner agrees to iilc a copy of any changes to this
scrvice contract or a copy of a new service contract with Sawycr County ��ithin ten (l0)
busincss days fi�om the date of change to this servicc contract.
�WIICC'S N1111e: �p2'111T� �WriCI�S S1�Ilahll'C: (Onh' onc o�cner signaturc required)
�l�k_J� V 0 W�/�
Pumpci's Name: (Print) n r' Signaturc:
�C�� �D �- �- ��"'�-�
Pumpci's Rcgistra ion Number:
� � �� � �
Rcv. 03/2(i/I 3
Real Estate Sawyer County Property Listing PropertyStatus:current
Today's Date:3/5/2024 Created On:2/6/2007 7:55:17 AM
L�'Description Updated:1/23/2020 '�Ownership Updated:6/3/2021
._.. ...__ _._ _.. . ._.. ..___. _.__ __._ ._._ ._._ ........._ .........__..
Tax ID: 9583 SCOTT M VOWELS BURNSVILLE MN
PIN: 57-008-2-38-09-34-5 DS-001-000120
Legaty PIN: 008938345112 Billing Address: Mailing Address:
Map ID: :1.12 SCOTT M VOWELS SCOTT M VOWELS
Municipality: (008)TOWN OF EDGEWATER 14839 ROSEWOOD W 14839 ROSEWOOD W
STR: 534 T38N R09W BURNSVILLE MN 55306 BURNSVILLE MN 55306
Description: PRT GOVT LOT 1 LOT 3 CSM 6/145 Io
k1192 r Site Address *indicates Private Road
Remrded Acres: 0.530 2886N EAST SHORE DR BIRCHWOOD 54817
Lottery Claims: 0
First Dollar: No f '
Zoning: (RRl)Residential/Recreational One u Property Assessment Updated:6/28/2021
ESN: 2024 Assessment Detail���� � �� ��� � ������
Code Acres Land Imp.
�Tax Districts Updated:2/6/2007 Gl-RESIDENTIAL 0.530 21,300 0
--_. ___. ._..._ ... ...... ...___ .........._...
1 State of Wisconsin Z_year Comparison 2023 2024 Change
57 Sawyer Counry Land: 21,300 21,300 0.0%
008 Town of Edgewater Improved: 0 0 0.0%
650441 Birchwood School District Total: 21,300 21,300 0.0%
O01100 Technical College
•�Recorded Documents Updated�6/3/2021 �
._._..__---- ....._ ....._ .._. .._. .... �Property History
� WARRANTYDEED —__ _... .__. ...._._. . _._..._...
Date Recorded:5/28/2021 432238 N�A � ��
�TERMINATION OF DECEDENTSINTEREST
Date Recorded:5/28/2021 432237
O WARRANTY DEED
Date Remrded:SO/27/1994 244904
� CERTIFIED SURVEY MAP
Date Recorded:12/7/1978 167908
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- USE BLACK INK ONLY- �'���'�;:G,�;'u�'ji1
Tx.:4G506�6
POWTS MAINTENANCE AGREEMENT ��89�5
For Holding Tanks PAULA CHISSER
REGIS7ER OF DEEDS
Owner's Name(s)as shown on deed: SAWYER COUNTY, W:
�3/14/2024 {19:43 AM
S Go�"� M Vo we.l S ����RDI�+IG FEE 3Q.fl0
Parcel Identification Number. ��GES: 2
(12 Digit Legacy ID) c� U$-��$- 3 y - S � f pr
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 Recording Area-Leave Blank per s.59.43(2m)
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
appiicable 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.
- n one owner signature required- ACKNOWLEDGEMENT
Owner's S g t . State of: W I SCAY���� �
County of: �i,�y�t'
Ow er' e ( rint): .��`"'�t�� ���,,,,'��. ,
/ �,•` EIEYER '�. Subscribed and sworn to before me on this
CQ �l.v�,/ ,r` �.............� '� ��+�.' day of I�GLvGh , 20 Z�
.
Date: :2=.��• ,��y 's gY(owner) �JCD� �
3/7/2� =�'a� .— Z? Notary Public Signature:
Drafted by: s�" i, PUg�,�G �,Vj,? Notary Public Name: 7 �1n� C�er C1� �
yVDnr�� �t� �.4��1G-1"1 I '` ° � My commission expires on: a-�(o/a!v
'•., • ...........
,,,,qlF�F�y�5�:,
''���„�u���w►�`�
Personal information you provide may be used for secondary purposes[Privacy Law,§ 15.04(I)(m)] Rev.09/29/23
PARCEL A:
Lot 3 Certified Survey Map#1192 recorded in Volume 6 of Certified Survey Maps,Page 145 as Document#167908 being
located in Government Lot l,Section 34,Township 38 North,Range 9 West,Town of Edgewater,Sawyer County,Wisconsin.
PARCEL B:
An undivided h interest in that part of Certified Survey Map k ll 93 recorded in Volume 6 of Certified Survey Maps,Page 146 as
Document#167909 being located in Government Lot 1,Section 34,Township 38 North,Range 9 West,Town of Edgewater,
Sawyer County,Wisconsin described as follows:Commencing at the NE comer of said Government Lot 1;thence along the
North line of said Govemment Lot 1,S87°25'W,1137.90 feet to an iron pipe on the Westerly right-of-way of a Town Road being
the point of beginning,thence along said right-of-way Sl S°02'15"W,46.94 feet to an iron pipe;thence S87°25'W,116.24 feet to
an iron pipe on the shore of Lake Chetec;thence along said shore on a meander line N25°54'I S"E,50 feet to an uon pin on the
North line of said Govemment Lot 1;thence along said North line N87°25"E,108.92 feet to the point of beginning.