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Home My WebLink About032-540-31-5615-SAN-2024-117 ;•��'` `" Industry Services Division Counry � - � 4822 Madison Yards Way �G� ) L'✓',f� ;~��=p - Madison,WI 53705 Sanitary Permit Number to be filled in by( � : P.O.Box 7302 ,�'` Madison,WI 5302 �s � 1�� (� � — --C Sanitary Permit Application StateTransactionNumber ! In accordance with SPS 38321(2),Wis.Adm.Code,submission ofthis form to the appropriate govemmental unit � is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing au�� the Deparhnent 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. 2 p L Application Information—Piease Print Ail[nformation C�TC.I� U l�Lp_,�-�--� Property Owner's Name �P��e� �� i�.. Parcel# �r�u T' Q � � rl �7�J1.Z 5�a I�`i C�3�-j Ll C `�i j- 5(�!S Property Owner's Mailing Address Property Location iZT � (c+ i(�C.�1l�E'-1,;..1 U (�• Govt.Lot lP City,State Zip Code Phone Number �I �� t,��S h�� "i�p��j� �OO��aR7� a�7 � ^ �Section Q.Type of Buiiding(check all that apply) Lot# T �� N R �J E o W� �lor2FamilyDwelling—NumberofBedrooms � a SubdivisionName Biock# •-- ❑Public/Commercial—Describe Use � O City of O State Owned—Describe Use CSM Number ❑Village of __ � �Town of ��'��' 3� � !7 8�y � - III.Type of POWTS Permit:(Check either"New"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 g y p ) ❑ Additional Pretreatment Unit(ex ❑ Other Modification to Existin S stem{ex lain plain) B' �Holding Tank ❑ In-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑ Other Type(e�plain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑Transfer to New Owner �st Previous Permit Number and Date Issued Expiration IV.DispersaUTreatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation �c,0 N� N� I`E� lY Capacity in Total #of Manufacturer Y Tank Information Gallons Gallons Units � � o ,��, .� ,/S�fs/�rS�Ss New Tanks Existing Tanks � o � � y � _ � a � Ci,'/�C n. U �n � v� w V ri. Septic or Holding Tank � 1 S / 5 K4W p('� ��ts'� Dosing Chamber Y .S � SK4i./ �!'L' Ct�� /� V.Responsibility Statement- I,the undersigned,assume respoosibility for installallon of the POW7'S shown on the sttached plans. Plumber's Name(Print) Plumber'Y Signature MP/MPRS Number Business Phone Number C ' "�o�n 5��1 �� l'- —j�'7 v2�D�S�O �/5 -�G�, - �z�-'/� r�. Plumber's A ress(Street,City,State,Zip Code) � ��- � �� n ��.� �r/� ; �1 � �� S �1�� VL C un /Department Use Only �A d ❑Disapproved Permit Fee Date Issued [ssuing Agent Signature �Owner Given Reason for Denial $ (�•�� S I� �-� ��`— Conditions of ApprovaUReasons for Disapproval -'o p M E [� �( I-�`!�\, �C� � Y, r ��.%�� - � K' �. r� ' �`'�.W�� . — ,i 1 �i � � Date S I� � � Check# (,o��(, �- M1AY 1 6 2024 �-% C�ST Rcpt# i C�S � --- � N�� C{'� ^ :`��`,. ,._ �C3.�,/Yl:.�l.l:.�..j:.:�, .._ . �1 I� _ Attach to complete plans for the system and submit to the County only on paper uot less than 8 tn x I1 inches in size SBD-6398(R.02/22) NO RCFUNDB AFTER ,��..D ISSUE OF PERMIT Sawyer County Zoning & Conservation Administration ��' ]0610 Main Street, Suite 49 � ,�p� �� Hayward,Wisconsin 54R43 �'li� —�Ci �� (715)634-8288 �� FAX(715)638-3277 ��y� _� _ ' _ �� www.sawyercountv og v rn'g � o� ��, ��-�= i o � E-mail:sanita�ian�saw ercounty ov.org I� �-y;,:�� Toll Frec Courthousc/Gencral Inf'ormation 1-877-699-4110 I��.. �"/��. �i�;oN�� Holding Tank Approval Checklist I. Sanitary Cover Sheet: Date Stamp �S/ �� / �� Parcel ID# � 3 2 - S�`( o _ 3 I _S!o t � II. Plot Plan: DCProperty Lines �Benchinark BM ♦ �Site Address �North Arrow �Structure /Scale �Well <25' to Service Road �Legal Description Nearest Road Intersection �Setbacks to: Property Line, ell, Structure, Water bodies, Roads III. Required Plans: �Index Page with Original Signature Management Plan/Contingency Plan �Servicing Contract �D Holding Tank Agreement Form ($30 to ROD) IV. Holding Tank Specifications: 9( Tank Cross-Section: Manufacturer: �'1iV`�`"' Gallons: I��t�8 �(Tank Anchor- Calculations [SPS 383.43 (8) (g)] � Locking device, chains/locks �Alann, electrical per SPS 383.43 (8) (e) �c 3" Bedding Material < 1/2 " V. POWTS Component Manual Reference: �Holding Tank Version 2.1 May 2022-2027) � Owner: � p�„� _ Plumber: C�� Application Review Date: ��'� ��Y POWTS Re��iewer: �� Name 6`t � ((p Rev. 4/27/2023 Credential# CONCRETE HOLDING TANK DESIGN Single Combo Tank Option INDEX AND TITLE SHEET Project East Fork Chippewa River Owner Frederick B&Erin N Genz Address W 6473 Birchview Dr Onalaska Wi 54650 Legai Description PRT.Govt Lot 6 S-31 T�0-N R-5-W Township Winter County Sawyer Subdivision Name Lot No. 2 Parcel ID Number 032 540 31 5615 Index and title sheet Page 1 Holding tank specifications Page 2 Site plan Page 3 Maintenance and contingency plan Page 4 Designer Crai Tho son Signature �� /� Phone No. 715-266-2842 License Number 220810 Date 05/03124 Designed pursuant to: � y \ Holding Tank Component Manual For POWTS(Ve io O) I SBD-10855-P(N.03/07,R-Oi/12) da�� version e o(ton3) Page 1 of 4 HOLDING TANK SPECIFICATIONS 3 Number of bedrooms Non-residential estimated flow(gpd) 2000 0 Minimum holding tank volume required (gal) Side A Side B Total 1568.0 1568A 3 t 36 0 Proposed tank capaciry (gal) Skaw Pre Cast Tank manufacturer 1568/1568 Tank model number SJE Rhombus Alarm manufacturer Tank Alert 1 (101-01 H) 120 VAC Alarm model number Tank Dimensions and Data Tank Anchor Calculations X for round tank 21800 Ibs Weight of tank and cover 48.3 Liquid depth below inlet invert(in) 1.50 Safety factor SA 'Maximum depth of soil cover(ft) 34481 Ibs Weight of anchor required 68.0 Height(in) l Outside 39.0 in Soil cover req. for anchor or 160.0 Length (in) } Dimensions 8.5 yd' Concrete counter weight 95.5 Width (in) J Only HOLDING TANK CROSS SECTION Electrical complies with NEC 300 and SPS 316 vent pipe manhole cover with y locking device and waming label finished � grade junction � — box � ,. 4.'min. �23 in. 6"max. conduit sealed water 1R"min tight thether - /weignc Note: All tank joints, and joints - J� �� — between tank openings and building sewer / alarm on piping are sealed watertight. All iniet blind plug pipe and vent materials comply to seal outiet with SPS 384. Manholes with 90°/a Fuil 38.6 in locking device are typical for each manhole opening . - 1568.0 gal 1568.0 gal 3 in.bedding under tank. Tank is anchored as necessary to negate buoyancy. Project: East Fork Chippewa River Page 2 of 4 HOLDING TANK SITE PLAN Project: East Fork Chippewa River N Legal Description: PRT. Govt Lot 6 S-31 T-40-N R-5-W Subdivision Name: Scale: 1" =5o ft Parcel ID: 032 540 31 5615 Lot No.: 2 F-----� �a5f �,K c�:,pp�;�« R�.�; �— � � � � �- �-- �-- �-- �` r--~ N��P�L � C,;,6c fi 0 �, ��L` � 3Yx�c � � ` I i � c n ¢ N� �'.rc �_-___ �� _ � C�I' _ !_ �— Page 3 of 4 �j'� = �U�� I� � �� C$�pWe� �run5�`m�r UtIX _ HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to SP 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 to 627.2 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 Servicing 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 manho�e 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 hoiding tank for any reason without being in full compiiance 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 insta�lation, the following persons may be contacted: a. Installer.............................Don Thompson 8,Sons Exc. LLC Phone: 715-266-2842 b. Service Provider.................. Golat Pumping Phone: 715-868-6836 c. Co. Zoning or Health Dept. Sawyer County Zoning ___ Phone: 715-634-8288 __ 11. — — Project: East Fork Chippewa River Page 4 of 4 HOLDINC TANK SERVICING CONTRACT Contract Date: / � / � This contract is made between the Holding Tank Owner and the Pumper. Holding Tank Owner's Name: Purnper's 1�ame: -�r�.�.r�c:_�,C d- �r;� Get�z ,- __ . ��OL/�� JI.4vC. � � �K��J �1T1 (�;C�' Parcel Identification Number: (12 Digit Legacy ID) C� � � - � � � - 3 � - s �O �. � � l . The own�r agrees to file a copy of this contract with the ;overnmental unit, Sawyer County, , 1 • .�_ i, _. ,_ ,..._ _ �.) _...�t . , , a . � ...�+1, ��.. . -•rr,,. ._.c..� :.,,,.;r� �- � _,..i�. {-!,., n .a :, to.... VVill(,ii IIQ.� tS.C�.G�..lCV. Q:lU I�.CrU?Cit..� �Vii�� U��. �ti1�+�' C�f Llefr _��.LJ'�.�LC'�� .v�GUJ� ii�a, iVIC�li�wuajlGt�i Agreement for a Holding Tank required under the Sawye� County Private 5ewag�e System Ordinance for the issuance of a Sanitary Permit for t1�e instaliation o:�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 agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s) with the p��mping equipment. The owner further agrees to pay the pumper for charges incurred in servicin�; the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pwnper agrees to submit to the Governmental Unit, Sawyer County, a report for the servicing of the holding tank(s) as require�d under SPS 383.55, Wisconsin Administrative Code and the Sawyer County Private Sewage System Ordinance. The pumper further agrees to include the following in the report: a. The name and address of the person responsible for servicing the holding tank; b. "The na�ne of the owner of the holdin� tank; c. The site address of the holding tank; d. The date the holding tank was serviced; e. The volumes in gallons of the contents pumped froin the hoiding tank for each servicing; f. The disposal sites to which the contents from the holding tank were delivered. 4, This agreement wi!! ?'e]nain ,:,, effPrr !!nril tl�� ,Ar,Pr nr r�,mrer +.er,.r.;r.ates this centrac±. In the event of a change in this contract, the owner agrees to tiie 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 change to this service contract. �WI78I'�S Nallle: �PI'lllt� �W � S1�,TI11tU' : Only one owner signaturc required) �' �►ri n (��2 Pumper's Name: (Print) Pumper's Si >nature: , �� ;ti V ��' i.r�i — - �-----� Pumper's Registration Number: 2 � L�� Rcv. 03/26/13 Real Estate Sawyer County Property Listing Property SWtus:Current Today's Date:4/8/2024 Created On:11/3/2023 2:28:18 PM �Description Updated:11/15/2023 '�Ownership Updated:11/15/2023 Tax ID: 44880 FREDERICK B&ERIN N GENZ ONAtASKA WI PIN: 57-032-2-40-OS-31-5 OS-OOCr000150 Legacy PIN: 032540315615 BillinA Address: Mailing Address; Map ID: FREDERICK B&ERIN N GENZ FREDERICK 8&ERIN N GENZ Municipality: (032)TOWN OF WINTER W6473 BIRCHVIEW DR W6473 BIRCHVIEW DR STR: S31 T40N ROSW ONALASKA WI54650 ONALASKA WI54650 Description: PRT GOVT LOT 6 LOT 2 CSM 38/217 #8744 C N LEIN-LC ��p�� t indicates Private Road Recorded Aaes: 1.370 N�A � � Lottery daims: 0 First DoIWr. No Waterbody: BarkerWke JPropertyAssessment Updated:3J26/2024 Zoning: (RRI)Residendal/Recreational One 2024 Assessment Detail ESN: 428 Code Acres Land Imp. G1-RESIDENl7AL 1370 44,700 G �Tax Districis Updated:11/3/2023 2-YearComparison 2023 2024 Change 1 State of Wisconsin �nd: 0 44,700 100.0% 57 Sawyer County Improved: 0 0 0.0%� 032 Town of Winter T��: 0 44,700 100.0% 576615 Winter Schaol Disfid 001700 Technical College ��Recorded Documents Updated:11/3/2023 C"D'PropeRy HisYory 0 LAND CONTRACT � � Parent ProperOes Tax ID Date Recorded:11/13/2023 447354 57-032-2-40-OS-31-5 OS-006-000010 36422 O CERTIRED SURVEY MAP Da[e Recorded:9/19/2023 446453 O TRUSTEES DEED Date Recorded:12/29/2021 436759 �QUIT CLAIM DEED Date Recorded:5/8/2018 412263 O TERMINATION OF DECEDENTSINTEREST Date Recorded:4/17/2018 411947 �WARRANTY DEED Date Rxorded:12/31/2015 399291 O WARRANTY DEED Date Recorded:8/10/2011 373848 � WARRANTY DEED Date Recorded:6/14/1982 183001 .._ ._._- ----- . ___. --- ---- --- - -- ------_.—. HISTORY�Expand All History White=Curtent Partels Pmk RMired Parcels O Tax ID:364 Pin:57-032-2-40-OS-31- 5-006-00001 Leg.Pin:032540315601 Map ID::6.1 44880 This Parcel Parents Children � ! I' I I ; - USE BLACK INK ONLY _ li �!IIIIII II II I� II I � I'll (II �o�I :8081102 POWTS MAfNTENANCE AGREEMENT Tx :4051889 For Holding Tanks 449s2s � • PAULA CHISSER Oume�st3ame(s)asshownondeed: REGISTER OF DEEDS SAWYER COUNTY, WI `�f � r , n r+ __ll Q5/17/2024 08:Q0 AM y �� RECORDING FEE 30.D0 Parcei identification Number. (12 Dig�T f_egacy!D} a 3 a -�1�- 3 L- s�� PAGES: Z Legal Description of PraA�}r - SEE ATTACHED SHEET - W e acknowledge that application is being made for the instailation of a holding tank(s)on tlte property described on the attachal sheet Retum To: Sawyer Cuunty Zoning and Conserva�on Admini.abation 10610 Maln Sk 5utbe 49, Hayward,W!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 operaCon and maintenance of the holding tank locidr�g device, alarm and access, and agrees to conform ta ati appGcabfe requirements of SPS 383,Wis. Adm. Code relating to holding tank management, induding the fo8owing: 9_ The owner agrees to contract with a person who is ticensed under Ch. NR 193, Wis. Adm. Code, except as protided by Sec6on 281.48 (3) (d), Stats., to have the hofding tank properly senriced and to file a copy of the service contract with the govemmental uni� 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 govemmental unit wifhin 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 1 i 3,�s. Adm. Code, who shatl submit pumping reports to the govemmenfial unit in accoMance with SPS 383.55, Wis. Adm. Code, for the serviang of the holding tank in the case of exemption under Sec�tion 281.48 (3) (d), Stats., the owner shall submit the report to the govemmental unit. The gavemmentat unit may enter upon the property to invesEigate the conddion of the holding tenk when pumping reports may indicate tfie holding tank is not being properly maintatned. .. 3. If the ovmer fails to have the holding tank praperly serviced in response to orders issued by the govemmental unit to prBvent or abate a human health hazard as described in Section. 254.59, Stats., the govemmantal unit may enter u on the property and service, or cause the tank to be serviced. Pursuant to Seetion 945.20(4)Wis. Stats., a gove assess the owner of a private sewage system for costs related to the pumping of a septic or holding tank. ssed as prescdbed by Sec�on 66.0703, stats. The owner agrses to pay al! charges and cosf incu e govem nit for inspectian, pumping, hauling, or otherwise servicing and maintaining fhe hatding tank in su nner as to pre bate any human health hazard caused by the hotding tank. * �TA� * 4. This agreement wlll remain in effect only until the govemmental unit responsible for the rie fa n �g ys ms certifies that either a soit absorption system that compfies wlth SPS 383, Wis. Adm. Code, nicipa! sewer se e properiy. ln addition, this agreement may be cancelled by executing arnl recording said certi ' with referen s agreemerrt sn such manner which will permit the existence of the cert'dication to be determine � � erty. 5. This agreement sha{t be binding upcn the owner, the heir5 of the owner, and assignees of the owner. r shalf submii the agreement to the register of deeds, and the agreement shall be rec�rded by the register ofi deeds in a manner which will permit the existence of#he agreement to be determined by reference to the property wf�ere the holding tank is ins#alled. -Oni on r si nature re uired- ACKN0INLEDGMENT Owner's Signature• Shate of: `v�j -1— - County of: I �� `►2;��L_, Owner's Name (Print): n �, Subscribed and swom to before me on this �f i✓� l�►� f��i day of �>i�� 20 �'��f Oate: � BY (Owner's Name): L� � �, , -`�_�-►') L-. � � '� Notary Public Signature•�� , `�' L-- � � ��-`�'-� -- I Drafted by: �� Public Notary Name (Print): " ✓l � � . � C'�'�-� C�� ,/ 6Z0 ,� My commission expires on: �S � ='� � �ti`' Personal Inf'ormation you pravide may be used for secondary purposes[Privacy Law. § 15.04(i) (m}] Rev. 03/26/13 Lot 2 of Certifed Survey Map No. 8744 recorded in Volume 38, page 217 as Document No. 446453, located in part of Government Lot 6, Section 3I, Township 40 North, Range 5 West, Town of Winter, Sawyer County, Wisconsin.