028-742-22-5504-SAN-2020-198Indusoy Services Division1400 E Washington AveP.O. 80X7162Madison, WI53707-7162; isji,Sanitary Permit Ap^icationIn accofdanee with SPS 383.21(2), Wis. Adm. Code, sobmisaion oftfau fbtmtoihe apprepriite governmental imiti* required prior to obtaining a sanitaty pemh. Note: ApplicatioD finmt for ftat^owned K>WTS b« lubmitCed tothe Pepaflmsnt of Safo^ std Piiiri Servioea. informalion you provide may be used for aeccodvyeuitpcaei tn**——'-~~withthePtivacvL«tv. s. lS.04(lXm\ Statt.CouUySanitaiy Permit Number (to be filled in by Co.)790 0)Strne Tmaactian NumberL AagBcatton iDfoneatlon-Please Pripr ATI TtrfnnnationPrt^ect Adtea (ifdiffirent that mailisg address)I ^ V CP (UCDj-,"SiIftoperQ' Owner's NameK ^ 0-) ejyj. L U C-Parceliloa& 7 v 3,2."^ S"5"<^Property Owna'i Mailing Addm^h'XS' H-e.cSTe<r-ftopecty LocatienOovtLoiCity, StateCcpX2jp Code5-Hct(on. Type ofBnfldlng (check all that apply) SOn ftrlP«mHyr>nwitlmg-Nlgnbcf ofBedroomsD Public/Commercial - Deactibe UseD State Owned - Describe UhPhone NunfoerV4.14, SeettoBLots(etrcleooT A Ni R 7 BorSnbdrvidonNeBlock «CSMNombs□ CiQ-ofD VtUaaeofyTownof S-p'^tL-ecr-HL Type of Parmltt (Check only one box on line A. Complete line B If eppUceble)¥New SystemQ Replecerueut System0 Treatment/Holding Tank Raplaccment OnlyC Other Mndificaticm to System (explain)B.D Permit RicewalBefoie Ej^indisoQ Pannit Revision0 ofPhtmberD Permit Tranafor to NewOwnerList Previous PermitNumber end Date latuedIV. Type of POWTS STftem/Component/Devlce; fChack all tiiat apply0 Non-Pce»urlzed In-Ground D Ptesaoiized In-Ground D At-Gtade D Mound>24 in. ofauimbleaoil D Momd <24 in. of suitable soil^^IdmgTank D OilterDispmil Compotent (explain) □ PMw»tTw>Mt rwir..V. DtopenalfTreatipent Are* TtiSiiiiwrt«B;Desi^ Flow (gpd)2.0Design Sod Ap^catioa Rate(gpdaf)Dispersal Area Requited (af)Dispersal Area Iftxrpoaed (af)S^t4D filflVttlOOVL Tank InfoC^ad^inKcwTskiE&ttiag TiqIbTotalGallooiSofUnitsMsnufitoturerJaas•8■8aII£ OS^tic oi Holding TnkDoains Chsmberc>aUj i,1^VILReepopalbBtty Statement- L the iuiderslgBed.aaaanereai)onsU>flhrlbr«"«^'t'ttenofthePOWT8 shewn on the-*—p*--*Plumber's Nme (Trint) i Plumber's Sisnmae I MP/MPPflNnmW IMP^IPRS NumberBorinePlunJerry Ruld Excavating, LLCWtycbiV^Q&T^cods}ei Fbcoe Number7^3"' H '=t'L'2vo^Stone Lake, WI 54376mLCotinronnty/Pepartment Use OnlyD DisapprovedD Owner Given Reason for DsniilPetmhFee^^00.'^DstelssnedIssuing Agent SigBStncDC Conditions ofApproval^UaMiu for DisapprovalAaseh n eempltts pIsB tftr tbt syataa tad ubstt to tba Coosty oaly a paper ael >sa tbaa S1/2 a 11.SBI>-«398(K. 08/14)
Sawyer County Zoning & Conservation Administration..... 10610 Main Street, Suite 49Cq Hayward, Wisconsin 54843(715)634-S2g8[^AX (715)638.3277U-mail: 7onmfl.scc@sawvercountvi;ov.OTgToll FreeCaurthouse/Gencral Inforinstion |.877.699'4II0Holding Tank Approval ChecklistI. Sanitary Cover Sheet Date Stamp / ^*7/Parcel ID# 0_ ^ F-J? if Zr^ ^Piol PlanProperty Lines Benchmark EM s% Site Address _5<. North Arrowy Structure _2£ Scaley Well < 25' to Service RoadLegal Description Nearest Road Intersection^ Setbacks to: Property Line, Well, Structure, Water bodies. RoadsRequired PlansK Index Page with Original SignatureY. Management Plan/Contingency Plan^ Servicing Contract_^HoldingTank Agreement fonnHolding Tank Specifications•^Cross-section - Manufacture, Gallons/ 3^U. w"!®:yC Tank Anchor Calculations [SPS 383.43''S) g)]Locking device, chains/locksAlarm and Electrical per NEC 300, SPS 316 & 383.43 (9) (e) andState Statutes 101.862(2) and 101.862(3)y 3" Bedding Material < I /2 "Holding Tank Plans per Component POWTS ManualbC Version 2 SBD-10855-P (R.3/07) .. .Owner;, HAycowrA Plumber: ^e<TyApplication Review Date:POWTS Reviewer:SZ{(oLicense #Revised 4/11/2013
Pg1 of4Pg 2 of.4Pg3of4Pg 4 of 4Attachments:Holding Tank PlanIndex & Cover SheetComponent Manual Design References:Version 2.0, SBD-10855-P (N. 03/07; R 01/12)Index & Cover SheetPlot PlanHolding Tank SpecificationsManagement PlanEnciosures:PAGE 1 OF 4POWTS Application for ReviewSoil Evaluation Report & Site Map (if appiicabie)Holding Tank Pumping Contract (if appiicabie)Hoiding Tank Agreement (if applicable)Project Name / Description_ Phone;>cttu Zip: ^H^lbOwner Name(s): R ^ ^ U«c>/u-/chn::C Ll-^Owner Address: 3 Suits'VAoc^s,Project Address: nJ /y?o<we<Ko.r>j'«'$ Q/-Govt Lot: 1/4 of 1/4, Section . T^^ N-R ^ EI I or W 0Township: ^pv-4.e<r County: fProject Parcel ID #: 7 HDesigner InformationJerry Ruld Excavating, LLCDesigner Name: WgOfl County HWY A Phone;Designer Address: Stone Lake, Wl 54876Zip:E-mail:License Number:Remarks:ThLt space reserved for approval stamp.Signature:I COKglnal stature Iiglnal stature rDate: ^-2G-^oZc=>equired on each submitted copy.
5 B \}<rSf0'O o -(R . ^ "? ^s^ " ~Xa!Oo c^^o^l/or^J UJi-e.S^IV-«X<9i4t?Jeny^(if(fS(cavatIng, LLCW20d bounty HWY AStone Lake, W154876ra»t-i5m1\i' ~ Lokt't'C.— / C?C' o (lro<t «uolC "" ^(^«! 2)s^T'feicctJirjPj-opo^Y UtoJeS ctA-^-»■ STo/ 3 / 2 O /?loc>*\c\^ Aicl»a-> I ^Ciaoi^l t^C -5^/eT I^ -XY0 7U /-(c»-YUJtoiA-ir ^ ^hluJ,So*^^ 3"V^/6
Cover wllh vraralng label/ a/id lock ir access opening Is/ gtealer than 0 inch dia.4" min. above surrounding grade or 2 ft aboveestablished regional flood elevation, unlessaccess port Is water and gas tight/Cover with warning labeland lock If access opening Is^ greater than 0 Inch dia.sZSuiLOIMCt L ^B inchinin. dia.0 inchmln. dia.Power sourceMaximum alarm on level setat 12" below tank inlet invertor 90% of the liquid impacltyof the tank below the tankInlet Invertetfcrercjit. Ar perkJBC. 3t30 A*JI9 ^olvtAn /Alarm lioatCross-Section of Holding Taiik& ■» ^g»e s^3'0eoo/A/c*AMCrtoie. TAMIC AS »/6e.afict>e^ Ta h/semArts CwoYaweV'HOCOHou»utm Tt\nK Cm»AcrrV_tJoLoitib TnUK. A'7A(VM=%cnv*£*ALmaM ruK£a ^ ^ ^ OALARAn Monet wu i*f *i»sn fOG>t9, "7 3^ )fc>sMoe>Mok-.V\ra-/NJcS>ft.o \-itsett —CoMf^MEUr ^^AtvlUOU kJu.WfitR '2tC? - T*-
PAGE 4 OF 4Holding Tank Management PlanIMPORTANT:The owner of this holding tank(s) shall be responsible for its p^etual operation and maintenance pursuant torequirements of SPS 382-364, Wise. Admin. Cods. Pursuant to SPS 383.52 (2), Wisa Admin. Cods, this holding tank(s)shall be considered a human health hazard If not maintained In aocordance with this approved management plan.Furthemiore, all inspection and meuntenance activities shall be performed by a registmtKl POWTS Mafntainer Inaccordance with SPS ^3.52 (3), Wisa Admin. Code.Estimated Dally Wastewater Flow B gpdInspection Checklist INSPECT EVERY 3 YEARSo type of useo age of systemo nuisance factors (/.e. odors, user complaints, ete.)o mechanical malfunction (/.e., pumps, valves, swlt^es, floats, etc.)o material fatigue {I.e., leaks, breaks, corrosion, ete.)o neglect or Improper use {I.e., stceeding dsdgn cai^cities, prohibited activities, efc.)o electrical conponents (/.e., wiring, connections, switches, controls, timers, alarms, efc.)o surface disch^e of effluent or sewage back-up into structure servedSERVICING FREQUENCYo The tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wise. Stats,when the waetewater in the tank(8) reaches a level of one fbot below the Inlet Invert of the tank(8).Disposal of contents shall be pursuant to NR113, Wise. Admin. Code.Tank pumping reports shall be submitted to the proper local government unit In accordance with SPS 383.55 Wis.Admin. Code. Report any component fellure or malfunction to:Name of Individual or conpany: ^O^TT'S d- Phone:Local government unit ^ V-df" Phone:Local govOTiment unit address: IQfelO S7T Sc.>fTC.» McLVtOaT^ZIP:Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wise. Admin.Code. Repair or replacement offalled or malfunctioning components shall comply with SPS 383, Wisa Admin. Code.No product for chemical or physical restoration of the POWTS may be used unless approved by the department inaccordance with SPS 384, Wisa Admin. Code.Contingencv PlanIn the event that any failed component of this holding tank(s) cannot be repaired. It shall be replaced pursuant to aplan submitted to the appropriate agecy for review and approval.System AbandonmentIf use of this tank(s) Is discontinued, It shall be abandoned In accordance with SPS 383.33, Wise. Admin. Code.
HOLDING TANK SERVICING CONTRACTContract Date: 6 / >4 / aaae>This contract is made between the Holding Tank Owner and the Pumper.Holding Tank Owner's Name:Punqier'sName:Stati Pe>pp^Parcel Identification Number:(12 Digit Legacy ID) qQ.-3La.-5*56M1. 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 the Register of Deeds, the MaintenanceAgreement for a Holding Tank required under the Sawyer County Private Sewage SystemOrdinance 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 topermit the pumper to have access and to enter upon the property for the purpose of servicingthe holding tank(s). The owner agrees to maintain the all-weather access road or drive sothat the pumper can service the holding tank(s) with the pumping equipment. The ownerfurther agrees to pay the pumper for charges incurred in servicing the holding tank(s) asmutually agreed upon by the owner and pumper.3. The pumper agrees to submit to the Governmental Unit, Sawyer Coimty, a report for theservicing of the holding tank(s) as required under SPS 383.55, Wisconsin AdministrativeCode and the Sawyer County Private Sewage System Ordinance. The pumper furtheragrees 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;e. The volumes in gallons of the contents pumped from the holding tank for each servicing;f. The disposal sites to which the contents from the holding tank were delivered.4. This agreement will remain in effect until the owner or pumper terminates this contract. Inthe event of a change in this contract, the owner agrees to file a copy of any changes to Thisservice 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.Owner's Name: (Print)VA»K\t4(-vOwner's Signature: (Onlune owner Ilgnitnre required)Pumper's Name: (Print)Pumper's Signature;Pumper's Registration Number:9l SI 3Rev. 03/26/13
• USE BLACK INK ONLY n8 0 3 4 8 6 ''Tx:4022589426133POWTS MAINTENANCE AGREEMENTFor Holding TanksREGISTER OF DEEDSSAWYER COUNTY, WI09/01/2020 01:48 PMOwner's Name(s) as shown on deed:RECORDING FEE 30.00if^EU L.L C.PAGES: 2Parcel Identification Number;(12 Digit Legacy ID) ^ ^ ^ ^ ^Legal (description of Property:• SEE ATTACHED SHEET •We acknowledge that application is being made for the installation of a holding lank($) on theprt^orty described on the attached sheet.Return To: Sawyer County Zoning and Conservation Administration10610 Main St Suite 49, Hayward, VVI 54843As an inducement to the County of Sawyer to Issue a sanitary permit for a holding tank on the at>ove-descrlbed property, the owner Isresponsible for the operation and maintenance of the holding tank, locking device, alarm and access, and agrees to conform to allapplicable requirements of BPS 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 bySection 281.48 (3) (d). Stats., to have the hrddlng tank property serviced and to file a copy of the service contract with thegovernmental unit. Tire owner further agrees to file a copy of any changes to the senhce contracL or a o^y of a now servicecontract, with the govemmental unit within ten (10) business days from the date of change to the service contracL2. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit pumping reports tothe govemmental unit in accordance with BPS 383.SS, Wis. Adm. Code, for the servicing of the Itolding lank. In the case ofexemption under Section 281.48 (3) (d). Stats., the owner shall submit the report to the governmental unit The govemmentalunit may enter upon the property to Investigate the condition of the holding tank when pumping reports may indicate tfieholding 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 govemmental unit to preventor abate a human health hazard as described In Section. 254.59, Stats., the governmental unit may enter upon the propertyand service, or cause the tank to be serviced. Pursuant to Section 145.20(4) Wis. Stats., a governmental unit may assess theowner of a private sewage system for costs related to the pumping of a septic or holdir^ tank. The charges will be assessedas prescribed by Section 68.0703, stats. The owner agrees to pay all charges and cost incurred by the governmental unit forInspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abateany 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 systemscertifies that either a soil absorption system that compiles with BPS 383, Wis. Adm. Code, or a municipal sewer serves theproperty. In addition, this agreement may be cancelled by executing and recording said certification with reference to thisagreement 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 submitthe agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which willpermit the existence of the agreement to be determined by reference to the property whore the holding tank is installed.Owner's I• Only one owner signature required nOwner's Name (Print): i 1741^UtVvVtirv RCU LLC9-31-^610Drafted by:gfrc. VA/tt.U^ „ ACKNOWLEDGMENTState of: / AJ/JCounty of:r PfSubscribed and ewpen to before ma on this.^/ day of U^U/irBy (Owner's Name):Notary ^j^bj|(^.&gnature: 6 ]A/^ jwjmtmtmH-j'&lzonPersonal Information you provkla may be used for secondary purposes (PiivaC "CtJi § 16.d«ll I ^ ^'i \ Anderson / |Rev. 03/26f13
Parcel No. 028-742-22-5504Legal Description:Parcel 1: Lot 1 as recordecl in Volume 11 of Certified Survey Maps, page 207-208, Survey No.2407 as Document No. 200040, located in the Town of Spider Lake, Sawyer County, Wisconsin,being a part of Government Lot 5, Section 22, Township 42 North, Range 7 West.Parcel 2: Together with a non exclusive easement for ingress and egress over the existing roadas shown on Certified Survey Map referred to herein and as recorded January 16,1975 in Volume257 of Records, page 310-311 as Document No. 150240 and as shown on Certified Survey MapNo. 2977 recorded In Volume 12 of Certified Survey Maps, page 247-248 as Document No.211313, over and across Government Lots 5, 6 and 8, Section 22, Township 42 North, Range 7West.
Real Estate Sawyer County PropertyListingToday's Date: 8/26/2020Property Status: CurrentCreated On: 2/6/2007 7:55:52 AMDescriptionTax ID:Legacy PIN:Map ID;Municipality:SIR:Description:Recorded Acres:Lottery Claims:First Dollar;Waterbody:Zoning:ESN;^ Tax Districts028572478001700Updated: 12/13/20193094657-028-2-42-07-22-5 05-005-000040:5.4(028) TOWN OF SPIDER LAKE522 T42N R07WPRT GOVT LOT 5 LOT 1 CSM 11/207#2407Spider Lake(RR2) Residentiai/Recreationai TwoUpdated: 2/6/2007State of WisconsinSawyer CountyTown of Spider LakeHayward Community School DistrictTechnical College^ Recorded Documents□ WARRANTY DEEDDate Recorded: 12/5/2019a WARRANTY DEEDDate Recorded: 7/24/2006S CERTIFIED SURVEY MAPDate Recorded: 5/19/1986Updated: 7/20/2010421482OwnershipREU HAYWARD LLCBilling Address;REU HAYWARD LLC3325 HEISERSTHUDSON WI54016Updated: 12/13/2019HUDSON WlMaiiino Address;REU HAYWARD LLC3325 HEISERSTHUDSON WI54016Site Address * indicates Private Road13120N MOONAHANIS DRi3 Property Assessment2020 Assessment DetaiiCodeGl-RESIDENTIAL2-Year ComparisonLand:Improved:Totai:Property History* HAYWARD 54843Updated: 9/10/2013Acres Land Imp.2.210 364,000 378,9002019 2020 Change364,000 364,000 0.0%378,900 378,900 0.0%742,900 742,900 0.0%htie://ias.s2Pwyercauntygov.orgMccess/ma9ier,asp8/26/20,4:33 PMPage 1 of 1