HomeMy WebLinkAbout020-639-34-4303-SAN-2024-074 �,``-'="'�: _ Industry Services Division County �
'" 4822 Madison Yards Way �a� e �' �
i r: �.,�'j' - Madison,WI 53�05 Sanitary Permit Number(to be filled in by Co.; �
: s P.O.Box 7162
� x ,-� ..::,� Madison WI 53 707-7 1 62 �.O 5 � � lt� S �
�
Sanitary Permit Application State Transaction Number �
In accordance witfi SPS 383.21(2),Wis.Adm_Code,submission of t}►is form to the appropriate governmental unit �
is required prior to obtaining a sanitary permit.Note:Appiication fom�s for state-owned POWTS are submitted to Project Address(if different thau mailing addr�
the Departmen[of Safety and Professional Services.Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law,s. IS_04(lxm),Stats. �/ p
I.Applicxtioa Inform9tion-Pkase Print tUt Informatioo /9�,/✓ ,�b �,Q� d'
�hcd
Propert}Owner's Name Parcel#
I��� ��-�-� cq �'u���v���- : b�.o•i�39•3�•Y-3o �
Property Owner's Ma�7ing Address property LocaUon
7�}Z Lh�r��h;�1 � �v�P�� s�,T�?"�'� s'�2
City,State Zip Code Phone Number `L
�(,l�4(✓� W,� �y�0 3 I--_ sl.J �/,, �t %., Section �7
II.Type of Baildi�g(check all tiiat apply) Lot# T � N R � E o
�'(1 or 2 Family Dwelling-Number of Bedrooms � � Subdivision Name
Block#
❑PubliclCommercial-Describe Use
� ❑Ciry of
❑State Owned-Describe Use CSM Number ❑Village of
�Town of_��� b t.+��t
IIL Type of POWTS Pem�i�(Check either"New"or KReplacemeut"aed other a�lirnble oa li�A. Check one boa on liee B.Complete tine C i
a ticable.
A" �New S m ❑ R lacement S stem ❑ Other Modification to Existin S siem e lain
yste ep y g y ( �cp ) ❑ Additional Pretceatrnent Unit(explain)
B' �Hold'm Tank ❑ In-Ground ❑ At-Grade ❑ Moimd ❑ Individual Site Desi n
B g ❑ Other Type(explain)
(conventional)
C- ❑ R�ewal Before ist Previous Permit Number and Date Issued
❑ Revision ❑Change of Plumber ❑ Transfer to New Owner
Expiration '�
IV.DisperssVPreatment Area asd Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/sfl Dispersal Area Required(s� Dispeisal Area Proposed(sfl System Elevation
2 av — •- -- �-
Capacity u► Total #of Manufacturer
Tank Information Gallons GaUons Units � o '9 0
New Tanks Exi�ing Tanks w = � � u a`i � �
`'• � - t'. :: .c
a. U v� .n v) ti. C7 ?�.
Septic or Holding Tank '3 L�L' L� 3 K �'l����t .��
Dosing Chamber
V.Respoosibility Stat�t-I,t�e aadersigacd,assame respoesibility for ia�gllatioe of t�e POWTS s oe t�e athchcd plaes.
Plumber's Name(Print) Plumber's Signature MP RS Number Business Phone Number
hn:,� r���1�;.,,�� �i�� a .2 s� 6 y -� �s� � C� ,- 30�o
Plumber's Address(Street,Ciry,State,Zip Code)
`� 3`f p.!lI �.�-1t.z w;„L�f-+e�— ��. w ti�1� t.�� S y43 4(v
VI.C anty/Deparlment Use Onty
17 Permit Fee Date Issued Issuing Agent Signature
�.A� to ❑Disapproved
�� ❑dwner Given Reason for Denial s f�'� �1 i� I't� "� l������/ �""---"-
Conditions of ApprovallReasons for Disapproval D � �\�� �
t Rt;. (
.� � � ; � __ �J � � �.��-+ _ ___ � zJ I)
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��.� . APR 15 2024
C 5T ��,.� �� � i�r 3
gAWYER COU`��'
ZCjNlNG AJ�'1i�iSTRATION
Attac6 to co�pkte plaas for the system aed mbmit to the Couoty only oa paper aot less t�an 8�n:i l ioches in s¢e
NO REFUNDS AFTER ���� y
ISSUE OF FERMIT
Sawyer County Zoning & Conservation Administration
10610 Main Street, Suite 49
���R C,�� Hayward,Wisconsin 54843
��E_;O�l�� (7I5)634-8288
�Q� ���� FAX(7l5)638-3277
�� _ _ �,�/ www.sawycrcounty ov.org
- � � E-mail:sanitarian(d�sawyercountykov.org
�I o� ����_'�j�� Toll Free Courthouse/General[nformation 1-877-699-4110
����` ^:..'�Y `�_
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Holding Tank Approval Checklist
I. Sanitary Cover Sheet: Date Stamp d`� / lS / �ooZ`(
Parcel ID# 0 2 0 - 6 3 � - 3 Y - �( 3 03
II. Plot Plan:
�Property Lines � Benchmark BM ♦
�D Site Address �North Arrow
�p Structure D� Scale
�Well D� <25' to Service Road
Legal Description �,Nearest Road Intersection
�Setbacks to: Property Line, Well, Structure, Water bodies, Roads
III. Required Plans:
p�Index Page with Original Signature
� Mana�ement Plan/Contingency Plan
�C Servicing Contract
�Holding Tank Agreement Form ($30 to ROD)
IV. Holding Tank Specifications:
3,n°a
p�Tank Cross-Section: Manufacturer: � Gallons:
� Tank Anchor Calculations [SPS 383.43 (8) (g)]
�(Locking device, chains/locks
�C Alarm, electrical per SPS 383.43 (8) (e)
�j 3" Bedding Material < 1/2 "
V. POWTS Component Manual Reference:
�Holding Tank Version 2.1 (May 2022-2027)
�o,.�
Owner: `rkc,,•�(-'— Plumber:
Application Review Date: `�/l'� ��-Y
POWTS Reviewer:
i�.k. —T
Name
69 �( � Rev. 4/27/2023
G�edential#
PAGE 1 OF 4
Hoiding Tank Pian
Index & Cover Sheet
����
v��sBa,o��.o�.:R 01/12) �2 a-�-�'�
Pg 1 of 4 �,� Index�Cover Sheet
Pg 2 of 4 p�p�n
Pg 3 of 4 . Holding Tank Specifications
Pg 4 of 4 Management plan
Attachmertts• Enclosures:
POWTS fication fior Review
Soit Evafuation Report�Site Map(if applicable)
Holdi Tank Pum ' Contract rf a l�cabte)
Hotd'm Tank A reement r�a icable
Projed Name/Description
��5�:. 1\eVl tl '"T aN�%q `�—U V A�« Pf10fl@:
Owner Address: �Y Z Ch✓rn1-1`l I S-{-- `� s f s o�e w�Zip:SY_7 n �
Project Aadress: �$n� A b���.�� 2� o j '�ory r, w�
Govt L� S�W 1/4 of S�=1/4,Sec�ar 3 y .T_3% N-F2 � E0�W�
Township:_ O�';b..�:a County:��y��
Project Par�cellD# O"L G G 3 9 3�y 3 0 -3
Designer information
Designer N�ns: rn�►c�- Vn o.t�v.�/ phone••��S -���v _3a!o
Designer A�ddress� �t 3 y nnf t,��. w�,,��-` RR w�,�k� �S Zp; Sy S P�o
E-Illall' i'his space r�xerved for approvat stamp.
���N�_� a�s�� �
Remarks:
Sigr�tune:___`�1�%�G����GL Date: �5`-250
�,,:.�„�o.,�..�.�.. .a......�.�,.......,..
Piu � i��0-� 39- 3y-s��o 3 Le�ql D;S�.$�v��f5�1.���1 � "o(.J
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PAGE 4 C�F 4
Holding Tank Management Pfan .
IMPORTANT• -
The owner�ttris hddn9�NC(5)sh�i be�pasible far�s P�P���d ma�a�nce pawarrt to
requiranents of SPS 382�84.Wisc.Adntia Cod� Pust�ant to SPS 383.52(2�V�fsG Admu�.Code,Hvs holang tank(s)
shall be wnsiderad a hianan h�lu�haz�d iF rwt mairqainad in�with#ds apprwed managemeM plan.
Furthertnore.aU inspection and rt�a�4i5es shaB be pe�iom�ed t�e�e9is�ed POWr3 Mae�tain�in
acxordance wifh SPS 383.52 C3).Wi�e.Admin.Code_
EsUrt�atedDaily.WastewaterFlow= � ��
9Pd .
Insoection Checktlst � INSPECT EVERY 3 YEARS
o type�use
o age of system
o nuisance fadars(ie.odors,usercomp��,e��
o me�Cal malfundion(ie,�v�+es.��,eq�.)
o ma�i�fati9�(�e-,�,breaks.sbrrosion,ebc.)
o neglect or impoper use(i.e.,exoe�n9 de�c�c�dtiea.Pco+u'6ited adivities,dc.j
o e�ectrir�i comp�x,eMs(ie�wiring.�ons,s�tr�,s.oor�ols,irtners.alanns,e[c)
o- s�uface dsd�rge oP e4fltre�itor sawage badc-�irfio shucttae�rved .
' . SERVICOdG FREQUENCY '
o Ttie tank(s)shaB be pwnped by a cer6fied sepfage s�vic�t9 operahor ficersed utader s.281.48 Wisc.Stals.
when the wasEswater�n tl�e tank(s)taehes a level of ona foot betow the it►1�imert of fhs tank(s�
Disposai oF�stmB De piust�ent to NR 113.Vlflsc.Admin.Code.
Tardc P�P�+9�rts s}nll l�su6mtfted tio fhe pmper loc�govemment unit in aecorcfaneewitl�SPS 3�i.55 ws,
Admin.Code. RepoR anY comPo�nt failu�e or melFundion to:
xamB o��a�a�pary;Mke Montgomery ��:77 5-266-3040 -
���„�,8,;�Sawyer County Zoning �:715-634-8288
�yo„�„�,g,;t� 10610 Main Street Suite 49,Hayward,WI �:54843
Atry defedive part of th's system�a16e r�aaed.rePlaced.or ternoved pursuant to SPS 383.51(1),Wisa Admin.
Code.Repair w repiaa�nent of Taited or�on'u�9 compq�s shall comply with SPS 883,VYsc.Adrtan.Code_
No p[odud for chemical or physical res�ration oF tf�e POWTS rt�y be used unless apprpved by tlie�ctr�ent in
accordance with SPS 384,Wisa Adrnia Code.
Confinaencv Plan '
m me ev�a mac�r r�ed co�or�,c ot m�t�t�c(s)c�ne�,a�,sn be re�aoea�ar��s
p�n sunmimed m a,e�prapriate ageyrtor r�r and appraral.
Svstem AbandonmeM
If use of this fank(s)is discorHa�ued�ft shell be abandoned in accordance with SPS 383.33,Wisc.'Admin.Code.
HOLDING TANK SERVICING CONTRACT
Contract Datc: / /
This contract is madc bctwccn thc Holding Tank Owncr and thc Pumper.
Holding Tank Owncr's Name: Pumper's Namc:
Northwest Sanitary, Inc.
RO/1 � '�GtwyC� �UPti�t/ POBOX155
Radisson,WI 54867
Parcel Identification Number:
�i z D���t LeKacy iD) c� z a - !� 3 9 - 3 �-�` 3 o 3
I. Thc owncr agrccs to f ilc a copy of this contract wilh lhc govcmmcn�al unit, Sawycr County,
which has acccptcd and recordcd with thc Officc of thc Rcgistcr of Dccds,thc Maintcnancc
Agreement for a Holding Tank required under the Sawyer Coimry Private Sewage System
Ordinance ror the issuunce of a Sanitary Permit for the ins[allation of a holding tank(s).
2. Thc owncr ngrccs to havc thc holding tank(s) scrviccd by thc pumper and guarantccs to
permit the pumper to have access and to cnter upon the property for the purpose of servicing
thc holding tank(s). Thc owrocr a�Tces lo maintain the all-wcathcr access road or drivc so
that thc pumper can scrvicc[hc holding tank(s) with thc pumping cquipmcnl Thc owncr
furthcr agrccs to pay thc pumper for a charges incurrcd in scrvicing thc holding lank(s) as
mulually agreed upon by the owner and pumper.
3. Thc pumper a�,�ces to submit to thc Govcmmcntal Unit, Sawycr County, a rcport for thc
scrvicing of thc holding tank(s)as rcquircd undcr SPS 383.55, W'isconsin Administrntivc
Code and the Sawyer County Private Sewage System Ordinance. The pumper further
agrees to include the following in thc report:
a. The namc and address of the person responsible for servicing the holding tank;
b. The name of the owner of thc holding tank;
c. The site address of the holding tank;
d. Thc date the holding tank was sen iccd;
e. Thc volumes in gallons of the contents pumped from the holding tank for each servicing;
C Thc disposal sites to which the contents from the holding tank were dclivered.
4. This agrccmcnt will rcmain in cffcet until thc owner or pumper tcrminatcs this contract. In
thc cvcnt of a changc in Ihis contract,thc owncr agrccs lo filc a copy of any changcs to this
scrvicc contract or a copy of a ncw scrvicc contracl with Sawycr County within tcn(10)
busincss days from thc datc of changc to this scrvicc contract.
�WI1C��S N81T1C: (Pr1lll� �WOCi'S SI��i18�U(Q (�1nh�ooe awner rignatun•reyu{mJ�
� � , `�Lu"'^'l`- �-`^-�--�
���1 ��y� 9 ���ne�
Pumper's Namc: (Print) Pumper's Signaturr.
Ronald L Vieceli, owner Northwest Sanitary,inc -
��A�r^� L-� �.if�
Pumper's Rcgistration Numbcr.
#2389
Rcc.07;2l�'13
4/17/24, 8:34 AM Real Property Listing Page
Real Estate Sawyer County Property Listing PropertyStatus: Current
Today's Date: 4/17/2024 Created On: 2/6/2007 7:55:36 AM
�' Description Updated: 1/4/2003 °� Ownership Updated: 2/16/2016
Tax ID: 21674 RONALD W & TANYA TURNER EAU CLAIRE WI
PIN: 57-020-2-39-06-34-4 03-000-000030
Legacy PIN: 020639344303 Billing Address: Mailing Address:
Map ID: .15.3 RONALD W & TANYA TURNER RONALD W & TANYA TURNER
Municipality: (020) TOWN OF OJIBWA 742 CHURCHILL ST 742 CHURCHILL ST
STR: S34 T39N R06W EAU CLAIRE WI54703 EAU CLAIRE WI54703
Description: PRT S1/2 S1/2 SWSE
Recorded Acres: 10.000 � Site Address * indicates Private Road
Calculated Acres: 9.854 4908N ABORNE RD OJIBWA 54862
Lottery Claims: 0
First Dollar: Yes �,--� property Assessment Updated: 5/2/2022
Zoning: (RR2) Residential/Recreational Two 2024 Assessment Detai)
ESN: Code Acres Land Imp.
G1-RESIDENTIAL 1.000 6,000 30,600
� Tax Districts Updated: 2/6/2007 G6-PRODUCTIVE FOREST 9.000 9,900 0
1 State of Wisconsin
57 Sawyer County 2-Year Comparison 2023 2024 Change
OZO Town of Ojibwa Land: 15,900 15,900 0.0%
576615 Winter School District Improved: 30,600 30,600 0.0%
001700 Technical College Total: 46,500 46,500 0.0%
4 Recorded Documents Updated: 2/16/2016 (�
WARRANTY DEED L�' Property History
Date Recorded: 12/4/2015 398928 N/A
QUIT CLAIM DEED
Date Recorded: 4/1/1991 222642 463/119
https://tas.sawyercountygov.org/system/frames.asp?uname=Eric+Wellauer ���
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"'4Oi'��� "f - "'x✓"°"x"'� w Parcel Numbers
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-USE BLACK INK ONLY- DoCI :�0$O1?3
POWTS MAINTENANCE AGREEMENT Tx:4G51287
449380
For Holding Tanks PAULA CHISSER
REGISTER OF DEEDS
Owners Name(s)as shown on deed: SAWYER COUNTY, WI
Rdn ,�- '�-�f,l� -�-�rN�t� 04J17/2024 09:03 AM
RECORDING FEE 30.00
ParcelldeMification Number.
(12 Digk Legacy ID) o �.o_( 3 9 - 3 5� _,�3 0 3 pq(',ES: 2
Legal Description of Property:
-SEE ATTACHED SHEET-
We acknowledge that application is being rr►ade for the installation of a ho�ing tank{s)on the
properiy described on the attached sheet
Retum To:Sawyer County Zoning and Conservation Administra8on
10610 Maln St SuiEe 49,Hayward,YYI 54813
As an inducemerrt to the County of Sawyer to issue a sanitary permit for a holdir►g tank on the above-described property,the owner is
responsible for tt�e operation and maintenance of the hdding tank,lodong cievice,alarm and acoess,arxi agrees 10 conform to all
applicable requi►ements of SPS 383,Wis.Adm.Code relating to holdng tank rt�rcagement,induding the folbwing:
1. The owner agrees to contract with a person who is licer�sed under Ch NR 113,Wis.Adm.Code,except as prov'ided by
Section 281.48(3)(d),Stais.,to have the holding tank properiy serviced and to file a copy of the service contract with the
govemmental unit The owner further agrees to file a copy af any change,s to the service ca►tract,or a copy of a new service
contract,with the gov�emmental unit within ten(10)busines,s days from the date of change to the senrice contract
2. The owner agrees to contract with a person licensed under Ch_NR 1'!3,Wis.Adm.Code,who shall submit pumping reports to
the govemmental unit in aocordance with SPS 383.55,1N��.Adm.Cc�de,for the servicing of the holding tank. In the case of
exemption under Sedion 281.48(3)(d),Stats.,the owner shaA submit the report to the govemmerrtal unit. The govemmental
unit may enter upon the property to investigate the condition of the tsa#dmg tank when pumping reports may indicate the
holding tank is not being properly mairrtained.
3. If the owner fails to have the holding tank properiy serviced in resparse ta orders issued by the govemmental unit to prevent
or abate a human health hazard as described'm Sedion.254.59,Sfats.,the govemmental unit may enter upon the property
and service,or cause the tank to be serviced. PursuaM to SecBun 1452t3(4)Wis.Stats.,a govemmental unit may assess the
awner of a private sewage system for costs related to the pumping af a septic or holdirx,�tank_The charc�es will be assessed
as prescribed by Section 66.0703,stats. The owner agrees to pay a�d�arges and cost incurred by the govemmental unit for
inspection,pumping,hauling,or othervvise servicing artd rr�irrt�a'snin�the holdmg tank in such a manner as to prevent or abate
any human health hazard caused by the holding tank.
4. This agreement will r+emain in effed only un61 the govemmer�af tmit vesponsible for the regulation of private sewage systems
certifies that either a soil absorption system that complies with 8PS 3�i,Wis_Adm.Code,or a municipal sewer serves the
property. In addifion,this agreemeM may be cancelled by s�ting acxi rec:ording said certification with reference to this
agreement in such manner which will permit the existence af the certificxtion to be determined by reference to the property.
5. This agreement shall be binding upon the owner,the heirs af the awner,and assignees of the owner.The owner shall submit
the agreement to the register of deeds,and the agreement stra�be recorded by the register of deeds in a manner which will
permit the e�dstence of the agreement to be determined by reference to the property where the holding tank is installed.
-on one owner s' nawre - ACKNOWLEDGMENT
OwnePs Si nature: State of: N � � �
' �-- ���. �. -,
Owners Name(Print): Subscribed and swom to before me on this
'���-h G� Tt�►'Vl e� `�1 ih day of�, ,20,2�
Date: By(Owners Name): L.
��� � ��� Notary Public Signature: � �`
Drafted by: �.•�`���� �ER �y�'''��ublic Notary Name(Print): ��
���l.e. �b/l ���•�`y P• ... . Fj�A�commission expires on_ -
. •'' .,�.,,sj
:�„•'�o,�ARY Z
� Q � � �
Personal iMormation you provide may be used for seco�dary,puposes ',��15.04 p)(rr�)j Rev.03l26/13
. PU��'�2��
,r����jy��qT•....•��GO���,,`
.,,�����I F,�F",1�,,����.
The South Half of the South Half of the South�vest Quarter of the
Southeast Quarter (S '/2 S '/2 SW 1/4 SE '/4 ) ANI) the West I�alf of the
South Half of the South Half of the Southeast Quarter of the
Southeast Quarter (W '/Z S 1/Z S '/2 SE 1/4 SE '/a }, all in Section Thirty-
four (34), "To�i�nship Thirty=nine (39) North, Range Six (6) West,
Town of Ojib�va, Sa�v3�er Count��, Wisconsin.