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HomeMy WebLinkAbout014-942-28-2307-SAN-2024-069 `,-��``A�R`-"`�, Department of Safety c°°"ry � �_;� � '�= & Professional Services, sa•�y e c' � � - Sanitary Permit Number(to be tilled in by( 1,�,� �; ,i; Industry Services Division 4-� \�;;;` Cp �1 "7 1p� -t State Transaction Number � Sanitary Permit Application ^ 6' � In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this fonn to the appropriate governmcntal unit is required prior to obtaining a sanitary permit.Note:Application fonns for state-owned POWTS are submitted to Project Address(if differei�t than mailing address) thc Department of Safety and Protessional Seivices.Personal infonuation you provide may be used for sccondary pu�poscs in accordarice with[hc Privacy Law,s. 15.04(I)(m),Stats. �a�� I.Application Information-Please Print All Information Prope�ty Owner's Name Parcel# Scok� � L; Sa 5 W;ed o�H- 9y�- a8—�30 Property Owner's Mailing Address Property Location �o 071 11J 1-1 c- O C',c G l e � - - V_ • 7� City,State "Lip Code Phone Number I-�ay w��c� � w s 5 y 8 y3 Sw �i,,aW �i�, s����o„ �$- iI.Type of Building(check all that apply) Lot# T �'/c3 N R �� ^�o�W �I oi'2 Family Dwelling-Nmnberofl3edrooms 3 � Subdi��ision Name �— Block# ❑Public/Commercial-Describe Use --- �� ❑Ciry oY ❑State Owned-Describe Use CSM Number ❑Village of CaJ 1'1 � a�4 `1 �r�own oC LGI1(`CO�' - — v• l0 , 19� III.Type of POWTS Per�nit:(Check either"Ne��"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if a licable.) A. ❑ New System �Replacement System ❑ Other Moditicacion�o Existing System(explain) ❑ Additional Preh�eatment Unit(explain) D. Holding Tank ❑ In-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑ Other Typc(cxplain) (conventional) C• ❑ Renewal Bet<ire ❑ Change of Plumber List Pre��ious Pennit Number and Daee Issucd ❑ Recision ❑ Transter to Ncw Owner Expiration Q�+��$ Ib 11 � IV.Dispersal/Treatment Area and Tank Information: Desi�n I�low(gpd) Design Soif Application Rate(gpd;sf� Dispersal Area Requircd(s� Dispersal Area Proposed(st) System Glevation 3 — .— — — Capacity in Total #of Manufactarer :' Tank Infom�ation Gallons Gallons Units p � v -° � � New Tanks Existing Tanks � o � � v ,n m � � U i7, �, �n i� C7 a. Septic or Holding Tank _� 300 � ,300 � W;esec�CancK Dosine Chamber V.Responsibility Statement-I,the undersigned,assume responsibility fm•installation of the POWTS shown on the attached plans. Pl�unber',Vamc(Prin�) Plumber's Sienatur� MPMPRS tiumber Busine;s Phone Numb�r T+-o.v; s ���e.��'tel � __ G5�8�4 7�5-G3y-81'y(c Plumbe�'s Address(Sh�cet,City,State,Zip Codc) I `�3yG w S�0.}C Roa� 7 1��y�a,-d, w r s�Y8 S'3 VI.Co nty/Department Use Only � �,t Perniit Fee Date I,sued I,suing Agent Signature �Ap 'o�' ❑Disappro��ed 5 ���.� .- �� ❑Owner Given Reason for Denial �I I`LI�y ' " t���'�'�"� Conditions of Appc�oval/Reasons for Disapproval ___ . _ � � �i ��' �``�c�.— -�- . t' i��� [ N� _ �( � �-��� �. _ ; : : AP� � � �a�4 `: � �.sr _3�f 1 �.. ; _. _ _____, C� �a�" ' j C85 SAWYER COU4V�'Y 7 • Attach to complete plans fm�the syst m and submit to the County only on paper not less than 8�/2 x ll inches in sizc NO RLFUND6 AFTER SBD-6398(R.03/22) ISSUE OF PERi1AIT 1 �N 31 Sawyer County Zoning & Conservation Administration ```"`11 10610 Main Street, Suite 49 ��R ����, Hayward,t5)6134-828xn 54843 �� \����� FAX(715)638-3277 �y �_ _ ��.�� www.sawycrcounty�ov.��� � o _ 10 � E-maiL sanitarianCr�'sawvercounty�rv.cire I� � �� - • � � Toll Free Courthouse/General Information 1-877-fi99-4110 \ s' �rz / � �� � �`� G�� � ,�'SC�NJ� i<<\\��� Holding Tank Approval Checklist I. Sanitary Cover Sheet: Date Stainp �Y/ (� / '� � Parcel ID# � ( `'f-9 �( 2 -�� _ �.-3 0� II. Plot Plan: �Property Lines DC Benchinark BM ♦ �Site Address DC North Arrow pC 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 Agreement Form ($30 to ROD) IV. Holding Tank Specifications: � Tank Cross-Section: Manufacturer: w 1e�r Gallons: 3�� � Tank Anchor Calculations [SPS 383.43 (8) (g)] � Locking device, chains/locks �Alarm, electrieal per SPS 383.43 (8) (e) �3" Bedding Material < 1/2 " V. POWTS Component Manual Reference: o�Holding Tank Version 2.1 (May 2022-2027) Owner: �^' �e-�1 Plumber: T, Qti`{}'• Application Review Date: �`f ` �2 ' � Y POWTS Reviewer: ��,v� Namc G9'�b lfo Rev. 4/27/2023 c��ed�„t���# CONCRETE HOLDING TANK DESIGN Single Tank Option INDEX AND TITLE SHEET Project Wied-Hard Rock Circle Owner Scott C&Lisa J Wied Address 16216W Hard Rock Circle Hayward,WI 54843 Legal Description SW 1/4,NW 1/4,Sec.28,T42N,R09W Township Lenroot County Sawyer Subdivision Name CSM#2192 v.10 p.195 Lot No. 2 Parcel ID Number 014-942-28 2307 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 Butterfield Signature Ji'"' Phone No. 715-634-8176 License Number 652879 Date 04/04/24 Designed pursuant to�. Holding Tank Component Manual For POWTS(Version 2.1) May 2022-2027 Version 7.1(07/22) Page 1 of 4 HOLDING TANK SPECIFICATIONS �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 WLP3000 Tank model number Rhombus SJE Alarm manufacturer Tank Alert 101-01 H Alarm model number Tank Dimensions and Data Tank Anchor Calculations X for round tank 22313 Ibs Weight of tank and cover 43.0 Liquid depth below inlet invert(in) 1.10 Safety factor 8.0 Maximum depth of soil cover(ft) 22977 Ibs Weight of anchor required 60.8 Height (in) Outside 21.2 in Soil cover req. for anchor or 184.0 Length (in) Dimensions 5.7 yd' Concrete counter weight 102.0 Width (in) Only HOLDING TANK CROSS SECTION manhole cover with locking device and finished ��ent wp junction � warning label grede box —� � — 4"min. 12"min. �"„ �23 in. Manhole and vent locations T conduit � vent pipe �g��min. � tetherweight � -- � 12.0 in. building sewer � O service � inlet blind plug alarm on Note: All tank joints, and co seai joints between tank ounec openings and piping are Electrical as per 31.0 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: Wied - Hard Rock Circle Transaction Number: Page 2 of 4 HOLDING TANK SITE PLAN Project: Wied - Hard Rock Circle N Legal Description: SW 1/4, NW 1/4, Sea 2S, T42N, R09W Subdivision Name: CSM#2192 v.10 p.195 Scale: 1" = 40 ft� Parcel ID: 014-942-28 2307 Lot No.: 2 � � � e �• ye / �/ NELSON �/ HT= 3000g�.�, +,}p��i;�7anK �• eF LP�KE /�/ 7rl.(-ab tone.-eLe by W;e�e� � Ge.ie K.ia 1.�C. �� i �� / � �,o (jl'1 = CSoI-law� o� S�din�C ai Noryl�.aW} /� / 3�� ttr•�r.e� eF dwe11;rq J � � � / � acf' c°� pN be �7 �� Q / � �� F Q � i J� � aS r � � o � J y��p.ItseLYo � AST„ F94 ( Oo- T'e Da Inlulqkd\ � S► Jr��alt J � J. �. t ��h � HnAO L `k�yni RocK c,acCC � � �� � � � � � � ���°,�e � Transaction I.D.: PG9e 3 0�' 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, induding 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......................... Butterfield Inc Phone: 715-634-8176 b. Service Provider....__.... .. ScotPs Septic Phone: 715-634-7279 a Co. Zoning or Health Dept. Sawyer County Zoning & Conservation Phone: 715-634-8288 11. Project: Wied - Hard Rock Circle Transaction Number Page 4 014 WLP3000 ,a4" TANK SPECIFICATIONS � � � o a � � , DIMENSIONS: w n WALL: 3" a a BOTTOM: 3" HEAVY - 5" o COVER: 6" � MANHOLE: 24" I.D. PRECAST CONCRETE RISER ,° 4" CAST-A-SEAL 4" CAST-A-SEAL HEIGHT: 60-3/4" O.D. � LENGTH: 184" O.D. WIDTH: 102" O.D. � > � N �24'\ � � \ BELOW INLET: 48" O.D. cQ, � o o LIQUID LEVEL:� 43" �' TYP � ` WEIGHT: TANK - 3 BOTTOM 13,013 LBS. o TANK - 5" BOTTOM 15,980 LBS. N \ � FILTER OR � WEIGHT: COVER 9,300 LBS. � > BAFFLE INLET AND OUTLET: '�' a 4" CAST-A-SEAL BOOT OR EQUAL m Q � � � :. . : . : . . , INLET AND OUTLET BAFFLE AND FILTER: � Q J , WISCONSIN, SEE DETAIL #10 � � � (OTHER STATES SEE CHART) `Y o � � LIQUID CAPACITY: 69.77 GAL/IN W � TOP VIEW HOLDING TANK: � � OUTLET HOLE PLUGGED � Y �p ACTUAL CAPACITY: 3,140 GALLONS C � � LOADING DESIGN: 8' 0" UNSATURATED SOIL 0 z o0 � w I 0 TANK CAN BE USED AS: � N SEPl1C/ HOLDING/ PUMP OR SIPHON � r� W � � COVER: MIX DESIGN #8 (NO FIBER) C� � p o � TANK: MIX DESIGN #9 (SMALL FIBER) W = 00 � ¢ � CUSTOMIZED TANKS: — � — , , . .,. ,; — FOR CUSTOM TANKS CONTACT WIESER CONCRETE � � INLET • OUTLET 3 0 (n _ J � oQ "*� 'n a Q � co � 3 a � � � � c� CD o Z N � � � � � o Q Q .. � ' . . . JOB INFORMATION : � � o CUSTOMER: � j w ''� JOB NAME: � SIDE VIEW DATE NEEDED: SHEET N0. APPROVED BY: � / APPROVAL DATE: OF � TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS � � HOLDING TANK SERVICING CONTRACT Contract Datc: Oy /�/ aoay This contract is made between the Holding Tank Owner and the Pumper. Holding Tank Owner's Name: Pumper's Name: Sco��' � L; so� IJJ��C� Sco+�S SeP}tC, Parcel Identification Number: (12 Digit Legacy ID) O I �- cl `-f �- ol B - � 3 O `�I� l. 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 thc 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 Perinit far the installation of a holding tank(s). 2. The owner agrees to have the holding tank(s) serviced by thc pumper and �iarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owncr agrees to maintain the all-weather access road or drive so that the pumper can scrvice the holding tank(s) with the pumping equipment. The owner further agrees to pay the piunper far 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 furlher 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 volumes in gallons of the contents pumped from the holding tank for each servicing; £ The disposal sites to which the contents from the holding tank were delivcred. 4. This agreeinent will remain in effect until the owner or pumper terminates 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 changc to this service contract. Owner's Namc: (Print) Owner's Signature: �oniy one o��ner s�gnaa,re req��rea� :, ,, _ � c�. ` , �, �'�',r-' ��,•1_-' �-� �; �: ,i�� t � , �. �', • �; �." Pumper's Name: (Print) Pumper's Signature: S c o�-F �o � (� e ��-'�,�� � Pumper's Registration Number: g � 8� 3 Rev.03/26/I 3 - USE BLACK INK ONLY - POWTS MAINTENANCE AGREEMENT For Holding Tanks e���J 1�T� Owner's Name(s)as shown on deed: �� \ _�. a v� .Sc,��k� C �- L; sa � (,.� ;e C. ���or����. � \�3� �� Parcel Identification Number: (12 Digit Legacy ID) O I `i - 9 �-� �- a v - a 3�� 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 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 o` exemption under Sec;tion 281.48 (3) (d), Stats.,the owner shail 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 assesse� 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 ab3te any human health hazard caused by the holding tank. 4. This agreement will �emain in effect only until the governmental unit responsible for the regulation of private sewage systeris 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 shali subrnit 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. -Onl oneownersi naturerequir �`"���������N�n� ACKNOWLEDGEMENT Owner's Sign�ture: -- < ��.•`� `� • ,.����.� State of: �a� �SCO�nst h . ; �.' , t r,�✓` c�. �..,.•••••... _ � - , ` , County of: cjCi,�,�7��✓ — Owner's Name (Print): =�'e p� � ��c!): Subscribed and sworn to before me on this �� c ;,` L�+ rc � a0� 2 i' ��G s �� dayof �� � , 202`� � P c . Date: r � •7� �•. •'. � , i % •. ���� BY�owner) �`j`j�� b�� ��'� S'��'_�-•'•' �� `� Notary Public Signature. �� n�����.:����'' . Drafted by: '''��., Notary Public Name: n�'le {'�'1- e � I�arc�.le1 A 5 re.c.Y.a,.1S�e' My commission expires on: Da- b _ Personal information you provide may be used for secondary purposes[Privacy Law,§ 15.04(I)(m)] Rev.09/29/23 4/12/24. 9:53 AM Real Property Lisling Page R2al EStdt2 Sawyer County Property Listing Property5tatus: Current Today's Date: 4/12/2024 Created On: 2/6/2007 7:55:31 AM �Description Updated: 7/25/2023 '"r Ownership Updated: 6/5/2023 Tax ID: 18431 SCOTT C&LISA J WIED HAYVJARD WI PIN: 57-014-2-42-09-28-2 03-000-000070 Legacy PIN: 014942282307 Billing Address: Mailing Address: Map ID; .7.7 SCOTT C& LISA J WIED SCOTT C&LISA 7 WIED Municipality: (014)TOWN OF LENROOT 16216W HARD ROCK CIR 16216W HARD ROCK CIR STR: 528 T42N R09W HAYWARD WI 54843 HAYWARD WI 54843 Description: PRT SWNW LOT 2 CSM 10/195 #2192 Remrded Acres: OJ00 w Site Address * indicates Private Road Calculated Acres: 0.630 16216W HARD ROCK QR HAYWARD 54843 Lottery Claims: 1 First Dollar: Yes -� property Assessment Updated: 9/26/2014 Waterbody: Nelson Lake 2024 Assessment Detail Zoning: (RRl)Residential/Recreational One �ode Acres Land Imp. ESN: 400 Gl-RESIDENTIAL 0.890 150,000 99,000 � Tax Districts Updated: 2/6/2007 2-Year Comparison 2023 2024 Change 1 State of Wisconsin Land: 150,000 150,000 0.0% 57 Sawyer County Improved: 49,000 49,OD0 0.0% 014 Town of Lenroot Total: 199,000 199,000 0.0% 572478 Hayward Community School Distric[ O01100 Technical College �Property History + Recorded Documentr Updated: 7/25/2023 N�q WARRANTY DEED Date Recorded: 7/2/2020 424796 MAP OF SURVEY Date Recorded: 7/24/2023 28429-11 DESIGNATION OF TOD BENEFICIARY Date Recorded: 9/19/2019 419965 WARRANTY DEED Date Recorded: 6/12/2006 339401 CERTIFIED SURVEY MAP Date Recorded: 8/2�/1984 192538 https:l/tassawyercountygov.orglsystem/frames.asp?uname=Eric+Wellauer ��� �' ° Addresses :-';:�;.�*'-� {f Parcels - - -.a:_. - �i'' i --•.�.�-» _'� �_;:.�, '� �,� Parcel Numbers . 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