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HomeMy WebLinkAbout022-638-25-1301-SAN-2024-057 �'`'�' "'? Department of Safety c°""t` c- �,� l� - & Professional Services, ���t � C'� � _' = Sanitary Pernut Number(to be filled in b� C� � _ � Industry Services Division � 5 � 1 S � � ,, . .,z. �. .....,. _ � Sanitary Permit Application State Transa��tion Number � In accordance with SPS 383.21(2).�4`is..-�dm.Code,submission ofthis focm to the appropriatz governmental unit �— lJ1 is required prior to obtaining a sanitan'permit.\ote:Application forms for statz-owned PO\�'TS are submitted to Project Addrass(if different than mailing adc ..} thz Department of Safaty and Profassional Sen°ices.Prrsonal infonn:ttion rou provide ma��be used for secondan• purposes in accordance with the Pri��ac��La�i�.s. 1�.04(1)(m).Stats. 1) /� t I.Application Information-Please Print All Information ;��<%�� � (,I ��1.1c.t �(� Yropem Chtiner's tiame Pazcel» � � c� il� �- ��t�-1� �� l�-L �:��- C�3£� ��S= 1 .�,o j Property Owner's b3ailing Address PropertV Location ,:�3 C l � �`�'�� � v� ��-�-- City,Statz Zip Codr Phone Number �C�(G.���1 L� �'� �L[ ( ✓� � l!t� —��\> �.. � ( l 4� ��� l,a ! ' � 1 a. SZCtt011�� II.Type oi Building(check all that apply) �t# T � N R �'= E o 1�' �1 or 2 Famil}�Ihvzlling-'.vumber ofBadrooms � �� Subdi��sion\ame Block� ❑Public'Commercial-Des�:ribe L'se � O Cit��of ❑State Owned-Describe L'se_ CS?�1 Number ❑Village of -� (�Town of f�G� �.SSiC1/�I IIL T`-pe of POWTS Permit:(Check either"NeR"or"Replacement" and other applicabtc on 6ne A. Check one box on line B.Complete line C i a licabie. `�' �' Nzw System �Replaxmeirt Svstzm Other>fodification to Existing System(e�plain) � Additional Prauaaunent Lnit(zsplain) B' �,Holding Tank ` Li-Ground - .�t-Grade g p ( .p ) ❑ Mound ❑ Individual Site Desi n ❑ Other T� e eY lain (conventional) - � J r- � ist Previous Pernut Numbzr and Date Issued C'. .' Renewal Bafo� Revision `Change of Ptumber �l Transfer to New O�vner E�•piration ��'`v� IV.DispersaUTmatment Area and Tank Information: Design Flo�(gpd) I3asign Soil.applicaiion Rate(gpd s� Dispersal Area Required(s� Dispersal Araa Pmposed(s� S}stnn Elevation �C.L� � �1� N r-� 1��1 Capacih•in Total �of Manufactwer y Tank Inforn�aiion Gallons Gallons Units �, ti U 'v � ?�evr Tanks E�cisting Tanks '� � y -' � � r " .-L'. U V; 'v U .., :.i .-. Se tic or Holdi Tank �� P �s f � c�.; (' S�� :�° C�5-E IIosing Chamber V.Responsibilifv Statement- I,the nndersigned,assume maponaibilih for i�llat�on of the POWTS show•n on the attached plans. Plumber s\a�nz(Print) Plumbzr�s�Signature � �iP�iPRS tiumber Business Phone\umber C�<i � j�c���t ?��i�, �t��_ ' �-�Si'�� -� , 7 ��;�. ���y: �?�2�.�1C. � l5�-.� � Plumber's Address(Street,City,State.Zip Code) �_ � �� u��`1- l� ?���:����5��� ,��� C��E,�e�, C�-� ��(�S�l�v VI.C u tv/Department Use Onl �.�p •ed` ❑Disappro��ed P�it Fee Date Issue,d Issuing Agent SignaYure �J ❑O�a�ner Gi��en Rzason for Drnial � `�D'� � �J I 1� ' " 1�`""""`''��tl I�"''�w-� Conditions of Approval Reasons for Disapproval � � � �{J�.��.cl ` ' ` ` ` _ � � + +,, . ._... ...-..,,. . 1 �'��! ��f ! �� A � Y Yr� ���4Y"� � � �� . �� �y I 3 � � . ��,' F�� 0 5 2024 �_� C.� ���l�, �o�� _ -���_—� _ _ .. :.�'�� Attach to complete plans for the system and submit to the County only on paper not less than 8 L2 x 1 mc es�n s� e ` ' NO REFUNDS AFTER ISSUE OF PERMIT �� � c���c� Sawyer County Zoning & Conservation Administration �������t 10610 Main Street, Suite 49 � �R Cp 1� Hayward,Wisconsin 54843 '�-� �VL �� (715)634-8288 � � �?' � FAX(715)63R-3277 i Q� \�/ /�� _ -- ��/ www.sawYcrcountYgov.��� � r � _ ; � E-mail:sanitarian(n�sawvcrcounty�ov.or, / o�� �.A�_...- ;o I � ���, ;������ Toll Frcc Courthousc/General Information 1-877-699-4110 ,���jSCc�N�� ������ Holding Tank Approval Checklist I. Sanitary Cover Sheet: Date Stamp �Z/ 0 S / �`� Parcel ID# C� 1- -? - G 3 g -2� _ ( 3 0 ( II. Plot Plan: �Property Lines �Benchmark BM ♦ Site Address p( North Arrow Structure DCScale D�Well �<25' to Service Road D� Legal Description p�Nearest Road Intersection g Setbacks to: Property Line, Well, Structure, Water bodies, Roads III. Required Plans: �Index Page with Original Signature � , f c,�- �-t�- D� Management Plai�/Contingency Plan a�'„�'� ,�30 Servicing Contract � Holding Tank Agreement Form ($30 to ROD) �(1� IV. Holding Tank Specifications: C� �'S`^ �Tank Cross-Section: Manufacturer: S �i"� Gallons: ��� �Tank Anchor Calculations [SPS 383.43 (8) (g)] �D Locking device, chains/locks �J 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: _���`..�v� Plumber: C� � Application Review Date: a 3 � �-�- � � POWTS Reviewer: ` ��z%� Name ������ Rev. 4/27/2023 Credential# PAGE 1 OF 4 Holding 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 i OwnerName�s): ��n�ilc, t `��t`�<� �'���lu�'''� Phone:�IS - 313 - �?l(v � Owner Address: �3���4> - G.:����_�✓�' C�:��c�f ,_ �-�_ Zip: S�!7.�7 Project Address: 7��-'`t'C� l-{ ��h���.��� ��� Govt.Lot: .5�.� 1/4 of N E 1/4,Section �S- ,T �� N-R lr% E❑or W Q Township: �1<<cQ.r55c�r1 County: ��<<r,JTC�(' Project Parcel ID#: �:�;�u2 ��'S� �� ���� j _ Designer Information Designer Name: �('c;,� ��L��`i'�S�i�� Phone:��IS -G �� - ��7� , Designer Address: ,5-�'�`/-N ��r�����i ���� �-���'���' Zip: v�l��I'�� E-fllfll�: l���C-''���(��j7`�������' /�I�f. �c:i'� l i,.space re-�n�r,l for apF rn�a(stac.o. License Number; c Co2L��/C� Remarks: � � ' �� i ��..- 'J Signature: � `� �� �����I Date: ��- �y �t Onginale?iature required on ach submitled copy. CHECK BOX AS APPLICABLE. CHECK BOX AS APPL�ABLE. ❑ SOIL EVALUATION o Scale: 1�� 40� � 80 � SYSTEM PAGE 2 OF SITE MAP PLOT PLAN J,.` PROJECTNMAE: ��� gnd) 102 DESIGNFLOW: i����1 GPD f. �in� C'.� ri �VC'" c-� G`� I �1 Attach design flow caicutations for commercial plans. `_ l ��'��� PRQIECTADORESS: �SC�r[— ltii !� ��-,�t�i'1�.�' }c�r� Pipe Materiai /ASTM Standard (Tables 384.30-3 & 384.30-5) - � N SanitarySewer. �f(� i 1� L!C�. eM symea: � sae o�waao�: �L.. L� � BM DescNption: SP� �� i n l�" m4��f-' %/'Ce Force Main: / s�ope Gradiert(%) �^d�^��' IMPORTANT: �T��� �� well Symbol(if ap�plicable): 0 drswing an artow Show ground elevation contours at suitable intenrais. on the apQroprite line. �� Y � ��7h►u� �.� `1a � ���� 7s�y-r�.l � �„�, .5�t►�„� t�7. l ` I � o �� ,� s��ttt� � � 1 � I I I ��-� I I I I I o � � ������� i � I I ( I I I I I I I I I I � I I � : I I � I � I � I � I � I � I � � I � � PAGE30F4 HOLDING TANK SPECIFICATIONS (No Scale) yy�y���F 12"Min.or 2.0 ft above Juncfion and Established Flood Elevation Approved Alarm Box Vant Cap (tYPical) Electncal must comply with � Approved Locking Manhole SPS 316 and NEC 300 4'H Vent Pipe with Waming Label Attached C�w� >10 R trom (typical) 4'Min.or 2.0 ft above Building Established Flood Elevation (�YPical) . 'A"utight Seal \ � Finished Grade 18'Min. (tYP�9 .. ' � y. .. a , ���� ���0� Watedight Appmved Joinis xnM Plug Apprared Pipe 3 ft onBo � Max.72'or 90%of total volume Salid Ground 'rf more than one tank a Alarm-0n HOLDING TANK VOLUME= a.� gal . a . . . � . 3'Approved Bedding Material Beneath Tank TANK MANUFACTURER: St��ei� ��C'- CCt-S� Anchor tank as necessary pursuant to SPS 383.43(8)(g) Ballast Weight=[(cu.ft.tank.vol x 62.4 Ibslcu.ft)-Ibs.tenk.wt]x 1.5 Ballast Weight=[( � �� cu.ft.x 62.4 Ibs/cu.ft)- ��,1 c;(:, Ibs]x 1.5= �i7 O Ibs PAGE40F4 Holding Tank Management Plan tMPORTANT: 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 = a� gpd Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance tac[ors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, fioats, etc.) o materiai 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, co�trols, timers, alarms, etc.) o surface discharge of effluent or sewage back-up into structure served SERVICING FREOUENCY 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 shali be submitted to the proper local government unit in accordance wkh SPS 383.55 Wis. Admin. Code. Report any component failure or malfunction to: Name of individual or company: �On ���'�n d' �a��tS ��C phone: � �S- ���'-��[�� � Local government unit: S�4��C'� ��c.����/ 20R�� Phone: � �S � �0 3����a�`� Local govemment unit address: �v��U mli�� 5�. jcc��'���`( �-��7/</�-�Z�P: S��r6��3 _ 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, ii 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. 9k% . T„r�+�, . ., �r t+ r °�c � x� � atw i�,sq s�� �'f��^' y! �IIF�� !� f�.e"y�dr� .��3L�{ i.� .. '��� .�� .. �f�� • Addre55e5 �L��� ��'���4�1�,¢ � �-� �`� t. ,,�'], �*` '' �']����j j'� '�,�* ';�I�� � ��� �'4�'���� * F f-�"` ' - Parcels ���� ��� � � Y� �����L�S����C�'�F�!P�M' � -.��°�����',i����- ��- _- ParcelNumbers � :�.+ i3 �� �.� y��� lr°'�i+:ad�+'dF1� �...� '�- , . .H d� ='9 � �. 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N � .'',d,� . ` Fi `+; �.� � ',��^r .. �t4y�i� ��'���� �'*� ► � 'a.�� 'L��� '�r , r4 ��� �� c-�} ...��.. ,f . . d M 5 �fre Y�i}�i� � � , J a � � �v �i 1 1 . .�[,�y'�@�.'pF E� a f�, ��'�w Y+�,�'t yn� ��fi �!- t��E ' 4�' 1 Sl �� sb�' l [- ➢ � t' �N�e... � ..i.�. � ' � Y. �� _ � . E'" .� i � 4 ! "a i�y • r � N .�, k ''�'�t 1 ��„�,a #`- Ig � •.,��e' �y .�� � F'^ � ��n �� �.,�. �tM� � ��� ft � .� �: �� ������ �, �a`'�a�;�;;, °' a�� � r�� � �. '� ,��Y"�:�r x*�i._(,'a'�i "�°^�r �."�..�. , ��#«y�' �;� '�, . 1/1 Ll?R,7:59 AM Novus-Wisconsin Accces cev,13.1108 Real Estate Sawyer County Property Listing Property Status:Current Today's Date:1/11/2024 Created On:2J6/2007 7:55:37 AM �'Description Updated:1/3/2004 �Ownership Updated:12/19/2016 .___ .._.. .__. ____. .._.. _...___ .__. ..._.. ........ ._.._. .._._ ..__. Tax ID: 21909 WAYNE R&SUSAN K HOLUM CADOTT WI PIN: 57-022-2-38-06-25-1 03-000-000010 Legacy PIN: 022638251301 8illing Address: Mailing Address: Mao ID: .3.1 WAYNE R�SUSAN K HOLUM WAVNE R&SUSAN K HOLUM Municipality: (022)TOWN OF RADISSON 23018-68TH AVE 23018-68TH AVE SiR: 525 T38N R06W CADO'iT WI 54727 CADOTT WI 54727 Description; SWNE Recorded Acres: 40.000 �Site Address *indicates Private Road ..__ -____ _...__. ._...___ ..__. .. _ .. Lottery laims: 0 N/A First Dollar. No Waterbody: Brunet River Zoning: (A-1)Agricultural One --�Property Assessment . , . Updated:10/24/2011 ESN: 441 2023 Assessment Detail Code Acres Land Imp. GS-UNDEVELOPED 10.000 2,500 0 ��Tax Districts Updated:2/6/2007 G6-PRODUCTIVE FOREST 30.000 44,500 0 ._. ._.. .__. ._.__ ...... _._.._. i State of Wisconsin 57 SawyerCounty 2-YearComparison 2022 2023 Change 022 Town of Radisson �nd: 47,000 47,000 0.0% 576615 Winter School District Improved: 0 0 0.0% O01100 Technical Coilege Total: 47,000 47,000 0.0°k +�Rewrded Documents Updated:7/22/2014 —_... _._. . _.__ .---_..... �WARRANTY DEED �Property History Da[e Recortled:11/23/2016 � N/A � � � � � � � O WARRANTY DEED Date Recorded:3/6/2000 28 699/431 HOLDING TANK SERVICING CONTRACT Contract Date: � / _ / a�� This contract is made betwcen the Holding Tank Owner and the Pumper. Holding Tank Owner's Name: Pumper's Name: Northwest Sanitary, Inc. ) � � PO BOX 155 WGI. (�� � SC,I��,(� �(7`(�,� Radisson, WI 54867 Parcel ldentification Number: (12 Digit Legacy ID) d c� � - � � �' - c2 s - 1 3 (� .� l. The owner agrees to file a copy of this contract with the governmental unit, Sawyer County, wl�ich has accepted and recorcied with the Orfice of ihe Zegisier oi�7eecls, tiie i�1ai,;t�,�a��ce �y� -a�-^E - * �n a i101 il iani: �Pniltj'��� ullCii.I' i�1e .Sd�h'T ia j .i �ui.. .'i�.`r'ru'b'�. Cj'Si::if1 t �_" Ordinance for the 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 agrces 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 pumper for a charges incurred in servicing the holding tank(s) as mutually agrced upon by the owner and pumper. 3. The pumper agrees to submit to the Governmental Unit, Sawyer County, a report for the scrvicing of the holding tanic(s) as rcquired under SPS 383.55, Wisconsin Administrative Code and thc Sawyer County Private Scwage System Ordinance. The 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 the holding tank was serviced; c. The volumcs in gallons of thc contents pumpcd from thc holding tank for cach scrvicing; f. The disposal sites to which the contents from the holding tank were delivered. rn -�r. fi tli� u�i,:;cil:�:f:i vi�"i�: CCiI]Ai.i lit C',!ICC. �!�i��� L�1C OV!!eCI :1C ��LAI11��i,i IE_'r;lilJl'3I:;S Li11S COi)T:uCt, lIl 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 cllange to this scrvice contract. �Wner's Name: (Print) OWrief'S SI�Tri8tL1T'e: (Only one owner signature required) I � ' i I r �f�J��y���. �`:,�,���, �,�;��; , �_ ,�--�� ! . � � � u �� Pumper's Name: (Print) Pumper's Signature: Ronald L Vieceli, owner Northwest Sanitary,lnc ��� C.- Pumper's Registration Number: #2389 Rev. 03/26/l3 I II Ili��I i'I'�f 1►i11'i i'I i'i f?nrTr•�ii''�Q^ -USE BLACK INK ONLY- �ry•�ntis��r�F J i POWTS MAINTENANCE AGREEMENT ; 4'�9243 For Holding Tanks I PAULA CHISSER R�GISTE[t C1F DEED� Owner's Nametsl as shown on deed: ! SAWYER COUNTY, WI ; 04/0$/2024 12:Q7 PM �� ne �.� ���n ( l ��� �� RECURDING FEE 3Q.00 r Parcei ldentiRcation Number ; F�A[iES: � t12 Digit Laoacy IDI .���-� 3 �.-a s -� 3 0 .� � ` Legai Descnp6on of Pra�rty: ; -SEE ATTACHED SHEET- i i We adtnowledge that application is being made for the installation of a holdiny tank(s)o�tfie ! property described on the attacfied sheet. i � Retum To:5awyer County Zoning and Conservation AdministraHon + Recording Area-Leave Biank per s.59.13(2m) � 10610 Main St..Suite 49,Hayward,WI 54843 , As an i�ducement to the Cou�ty of Sawyer to issue a sanitary permit for a holding tank on the above-descnbed property,the owner is responsible fior the operation and maintenance of the holding tank,locking device,alarm and access,and agrees to conform to all applicabie requiremenis of 5PS 383,Wis.Adm. Code relating to holding tank management, including the following: 1. The flwner agreeslo contract with a person who is iicensed under Ch.NR 193.Wis.Adm.Code,except as provided by Section 281.48(31(d),Stats.,to have the holding tank properiy serviced and to file a copy of the service contract with the governmentai unit. 7he owner furiher 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 hom the date of change to the service contract. 2. The owner agrees to contract with a person licensed under Ch. NR 113,W is.Adm.Code,who shall submit pumping reports to ihe govemmental unit in accordance with SPS 383.55,Wis.Adm.Code,for the servicing of the holding tank. in the case of exempnon under Section 281.48(3)(d).Stats..the owner shall submit the report to the govemmental unit. The govemmental unit may enter upon the property to investigate the conditio�of the holding tank when pumping reports may indicate the holding tank is not bemg properly maintained. 3. If the owner fails to have the hoiding tank properly serviced in response to orders issued by the govemmental unit to prevent or abate a human heafth hazard as descxibed in Section.254.59,5tats.,the govemmental 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 pnvate sewage system for costs related to the pumping of a septic or holding tank.The charges will be assessed as p►esc�ibed by Section 66.0703,stats. The owner agrees to pay all charges and cost incuRed by the govemmental unit for inspection,pumping,hauling,or othervvise servicing and maintaini�g the holding tank in such a manner as to prevent or abate any human health hazarc3 caused by the hoiding tank. -0. This agreement wili remain i�effeci only unti!the governmental unit responsible for the regulation of pnvate sewage systems certifies that either a soil absorption system that complies with SPS 383,Wis.Adm.Code,or a municipal sewer serves the proQerty. in addition,this agreement may be cancefled 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``e`�ppl�wA������, 5. This agreement shall be binding upon the owner,tfie heirs of the owner,and asslgnees of the owner.The o� l aub �,N�, i� the agreement to the register of deeds,and the agreement shail be recorded by the register of deeds in a r�'a rwhlch will �'•.�Q� permit the existence of the agreement to be determi�ed by reterence to the property where the holding tadk�.i�tS[al(�AR}' �; _ r• = .►�� _ -On one ow�e�s' �ature�equired- ,ACKNOWLEDGEM T ' ; �wner's 5ignat re: 1, ' �• v+'�, pUB�`�' :'�2� _�--�-- - �.� Countyfof: � � t ("� �°�� �, ' ,.•G���: I � � �er's Name(Pn )� �� I Subscribed and swom o��,ore me on thisr,�i��������������� � �� day of � . 20� � Oate: _a i By(owner) 1�1c� � � r• i �` � Notary Pubiic Signature: � Drafted by: ! Notary Public Name: c�� o-�^ ' t ^ � My commission expires on� a(,/!]�2�'�? �cM�s ����10� Personal i�farmadon you vfde may be used for seco ary purposes jPrivacy Law,§15.Od(i)(m)] Rev.09l29/23 Parcel I: The Southwest Quarter of the Northeast Quarter(S1V�/�lti'Ej/�),Sectiun Ttiventy-five{2�),Township Thirty-eight (38) North, Range Six {bj `�'est,To�vn of Radisson,Sawyer County,�F'isconsin. Parcel II: An easement for ingress,egress and utility�purposes over the Easterly 1 rod of the East Half of the North�vest Quarter,Section 25,Township 38 Nortf�, Range 6��est,extending South from the center tine of Highsand Road 120 rods.