020-639-11-5203-SAN-2021-109 o��^"T"'�N, Industry Services Division County
F. �
��i �y 4822 Madison Yards Way 53705 S�y� 0�,..
=r� �g �� PO Box 7162 Sanitary Permit Number(to be filled in t
�I�,� P$ � / Madison,WI 53705-7162 � �
�
�-/ ��31 �,2�
t'�,p�n,���-\ .
Sanitary Permit Application State Plan►teview Number N
In accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate governmental unit PWTS- I
is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to
the Department of Safety and Professional Servies.Personal information you provide may be used for secondary Project Address(if different than mailin; O
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. ��
I. A lication Information-Please Print All lnformation �,.,�Ti S ti`��N ��vt11S�o�
Property Owner's Name Parcel#
�2��G-- .� �.��r ��C��v3,� ��\ ��c"�
Property Owner's Mailing Address Property Location
P���" a
��� C�vSCCvAy �7�'�+� Govt.Lot
City,State Zip Code Phone Number y,, '/a, Section � (
��{y�CLS.SS� �.�J JL- ��'��S �'L`�'���-���Z- / (circle one)
II.Type of Building(check all that apply) ,� Lot# T�N; R b E or Q
�l or 2 Family Dwelling-Number of Bedrooms � 3 Subdivision Name
Block# —
❑Public/Commercial-Describe Use �
❑ City of
❑State Owned-Describe Use CSM Number �,p T ❑ Village of
�1rn.vr�."s r'd
� � �Q�� I�Town of �S 4 d3`uv�
��,�� '��
III.Type of Permit: (Check only one box on line A. Complete line B if applicable)
`4' New S stem ❑ Re lacement S stem
� y p y ❑ TreatmenUHolding Tank Replacement Only ❑ Other Moditication to Gxisting System(explain)
�� RN�-
B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner ��4
IV.T e of POWTS S stem/Com onent/Device: Check all that a I
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil
�Holding Tank ❑Other Dispersal Component(explain) 1�'A ❑Pretreatment Device(explain) N�
V.Dis ersal/Treatment Area Information:
Design Flow(gp�,d) Design Soil Application Rate(gpds� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation
� a � �,z N� a,,� N�,
ENsu»a�
VI.Tank Info Capacity in Total #of Manufacturer
Gallons Gallons Units � � o � �
New Tanks Existing Tanks � o �' 2 � � `� `�
n. U in �, v� ii C7 ci.
Septic or Holding Tank �t� � (, �R�Z �(tF(,i�S'o j�
L,O�uP
Dosing Chamber _____ _ ,,�eT i �r�Q,�a«e�*, ru,t
( � S b� �
VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone Number
/�
�ev� .� C�.�� � �� <� �T;�� �0�-�6����tZ33
Plumber's Address(Street,City, tate,Zip Code)
��t�d,� �C�,,.�,.�.; �- f`��r„�� a� �'�-t�`i ��s��y [32v� � ���css�. , �►r S�'�o�
VIII. ount /De artment se Onl
�,Ap ro ed� ❑ Disapproved Permit Fee � Date Issued [ssuir��ge Si nature
$ (� U � ± /,
� ❑ Owner Given Reason for Denial �"`�' 7 �vL� r JC-
IX.Conditions of Approval/Reasons for Disapproval
� �(� P�'f �;�.Su-s V��
,�y � � NC3 r��FU�JflS l�FTER 1� �r. R F� ,
� j��G' �,�-.';�-�p lSSUE OF PERMIT
�
. — -, — — -
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/�l l l.inches in size �_ �
��,�� � I � � � � 7 Z U�� .-,, �. . __ �r.'��19 '�'�
� b3';-,,. � � �€�ri � J
' i
SBD-6398(R.04/19) � �—�--"�'l
_;��,�5�.��r-� �''`". .
;r
��;:�"v!�`J:;�,_ .. ,„�.,��,��:i�sJiJ
Sawyer Coun�ty Zoning & Conservation Administration .
�������� 10610 Main Street,Suite 49
��R_ Cp��� Hayward,Wisconsin 54843 .
�Q .� I (715)634-8288
�;��� ��� FAX(715)638-3277
�y � �-- ��,.(� ���N�wsawYcrcoimtvgor.ore
��� _� : ��o� E-mail:zoningscc(u�tiawvcrcountygov.orQ
� � Toll Free Courthouse/(General Information 1-877-699-4110
1 ,�_
,�����`O N��
Holding Tank Approval Checklist
I. Sanitary Cover Sheet Date Stamp �S / o? / �l
Parcel ID# (�� o -b 3 `Y - ( 1 - �� o �
II. Plot Plan
� Property Lines �Benchmark BM ♦
�Site Address �North Arrow
�Structure �Scale�o����> ��,p �
�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
�C Management Plan/Contingency Plan
�Servicing Contract
�Holding Tank Agreement form
IV. Holding Tank Specifications
�Cross-section—Manufacture, Gallons: C�sfi a�� �
�Tank Anchor Calculations [SPS 383.43 8) g)]
x Locking device, chains/locks
�Alann and Electrical per NEC 300, SPS 316 & 383.43 (9) (e) and
State Statutes 101.862(2) and 101.862(3)
�3" Bedding Material < 1/2 "
V. Holding Tank Plans per Component POWTS Manual
�Version 2 SBD-10855-P (R.3/07)
Owner: ��� Cv�r�� Plumber: ���� C'2'�'
Application Review Date: �5�� °7 (� �
POWTS Reviewer: �1�-.�
Nantc �6�� �
�
Liccnsc#
Revised 4/11/2013
PAGE 1 OF 4
Holding Tank Plan
Index & Cover Sheet .
Component Manua/Design References:
Version 2.0, SBD-10855-P (N. 03/07; R 01/12).,,
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
k Soil Ev ation Report & Site Map (if applicable)
�«�-•�' ,cr�t� �:•"�"'���``s-a�` X Holdin Tank Pum in Contract if a licable)
� Holdin Tank A reement if a licable
Project Name / Description
��T �;i��,�u�n.� Y �►.�V- �,� � S'��n..��t �el�.,�a`�p ��,;C`c�,a'l�►�. � �,pr � �al o bY.�9�'9 ��NUe19nn? �j�A�!Li
�ky,�� c, �c(3vA
Owner Name(s): �2�4� � ��c, Phone: ��`,- 7qL - S��C.
Owner Address: ��`� (�►��s�Ay i3�-N� ��C'n�.�st �-r� Zip; S y0 4�C��
Project Address: `-�T S ?�Joryk (���5��c �'a�q;�� �ywH 6F ���wA �i
Govt. Lot: 1/4 of 1/4, Section , T N-R E ❑or W ❑
Township: ��t`5��� County: s�y�'1-
Project Parcel ID #: 0�Q�a �`� I O �2 K�� �S��� f,��;� � �1D�.u.ki, �� P� ��1
-�1 �C��l �
Designer Information
r
DesignerName: �t�,v�� .ti_ �;;�a�QeN ��-���^Na Phone: �C'�� - 71��1 - ZZ��i
Designer Address: ��.� C�..sc�-�y J3��� ��ncsy� �.� Zip: S'�ba`�
.
E—Illal�: ���'�'��,L�2'1�C � �-�'+l��V(1��.,►�l'�• ►�iC� 1 i�i>c� :�c� r�s t:�l fia� �tf;pr�» �I tit«:,ip_
f
License Number: �F �t �152Z
Remarks:
�'� �- ;_ G1.
Signature: Date:
Original signature re red submitted copy.
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PAGE30F4
HOLDING TANK SPECIFICATIONS
(No Scale)
Weatherproof 12"Min.or 2.0 ft above
Junction and Approved Established Flood Elevation
Alarm Box Vent Cap (typical)
Electrical must comply with 1 Approved Locking Manhole
SPS 316 and NEC 300 4"fd Vent Pipe � with Warning Label Attached
�Conduit >10 ft from (typical) 4"Min.or 2.0 ft above
Building I Established Flood Elevation
� (typical)
Airtight Seal a �
1 __ � a Finished Grade
18"Min.
�tYPical) a . . � e
d ' ° ' 9 .
e e . .. d . � . .
Inlet Inlet Invert fWatertight
Approved Joints with Plug
Approved Pipe 3 ft onto Max. 12"or 90%of total volume
Solid Ground if more than one tank
c
° Alarm-On
0
e
HOLDING TANK
VOLUME _ ���`' � gal
a'
,���o��� 1►��y qF� Cn,z
�,,; S�s�;u�,� u5r AS ku F��
a � . d . • 'a . ' .� � . � ' ' � � � n .
3"Approved Bedding Material Beneath Tank
TANK MANUFACTURER: C�csi P�c�a�� 1►'�-
Anchor tank as necessary
pursuant to SPS 383.43(8)(g)
y Ballast Weight= [(cu.ft.tank.vol x 62.4 Ibs/cu.ft)- Ibs.tank.wt]x 1.5
ZF `''.
� '
*�„ yJ� �'��'r Ballast Weight= [( �a`��� � cu.ft. x 62.4 Ibs/cu.ft)- ���5�' Ibs] x 1.5 = �����° Z� Ibs
y
-�`' �R►�
�7 7,'`��-�5 l„c,5►,r
PAGE40F4
� Holding Tank Management Plan �
IMPORTANT:
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= � '�d� gpd ��s�H�� v�r C��-Y
Inspection Checklist INSPECT EVERY 3 YEARS
.� type of use
� age of system
.e- nuisance factors(i.e. odors, user complaints, etc.)
o- mechanical malfunction (i.e., pumps, valves, switches,floats, etc.)
�- material fatigue (i.e., leaks, breaks, corrosion, etc.)
er neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
�- electrical components(i.e., wiring, connections, switches, controls, timers, alarms, etc.)
fa surface discharge of effluent or sewage back-up into structure served
SERVICING FREQUENCY
,e� 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.
'� �V'wP�w•� �u��,-2:*i�: I HR.: ti(.1:-�.:;�i Sf�+.��i AhC.J
Acn Kcz�s .
Tank pumping reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wis.
Admin. Code. Report any component failure or malfunction to: �y�� �Mv+�i�.�r ��"'? ��,.-7�y-zz��
rI..�U..�Sr o'i Sy�`'�
Name of individual or company: Q����%"' �����""''j ' !��`� `��-� Phone: ����
Local government unit: J�u��'� �e"""y C`�""~� Phone: 7����3`'� �����J
Local government unit address: �b��Q �`"' S�' S�;i� `�� ��4y�*K� ZIP: 1 y�`� �
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.
Continqencv Plan
In the event that any failed component of this holding tank(s)cannot be repaired, it shall be replaced pursuant to a
plan submitted to the appropriate agecy for review and approval.
. �s . cc
System Abandonment
If use of this tank(s)is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc. Admin. Code.
��� � ��
1�-6�� - - - - - - - - - - - - - - - - 2000 SHT
� - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Inlet - 2�_$��
� � ' � GPI = 76.36 �
� , , �
� � I4"0 Inlet� � � _
, � i ,
i � � i
fyf f� 1
� f r f r �
�_k _ _ _ _ —
� r f r r �
, � t'k'� 24"fZJ Manhole � ,
, i With R6462 Casting � � 4"0 Oulet
I and frame when in
i i Seal with blind
� flood plain or concrete , plug and stainless
I i with chain/padlock i steel band
i ' � i
� — -- — — — — — — — — — — — — — — — — — — — J
� 18'-2° �
- - - 1
� � 17'-2"
� �
i i �.
i i �
' ' ol
i i
i i �'
16'-6"
a
� � -
v �
0
co '�„� 3� �L� � r� , �`?: o
� N \�i �• N N N ���. C7
`" Volume- (90" x 196" x 27") / 231 = 2061 Gallons
�n
6"6" 16'-2" 6" 6"
2000 Gallon Shallow Holding Tank
With Anti-floatation Collar
��-8,�
Notes:
Concrete-5000 PSI
Joint Sealant-High Grade CPS-210 or CS101
� Labels-Warning signs located on all manholes
Installation-See separate installation guide
� � Baffles are not required
Rubber Gaskets- Press Seal
� Multiple tanks can be connected for additional capacity
o'' _ �
I �`? � Can installed as a pump chamber
"' ``' c, Weight- 33,500 Lbs
� Crest P�ecast, lnc.
La Crescent, MN& Barneveld, Wl
6" 6" 7'-4" 6" 6" �9�st�er La Crescent,MN 55947
s�aie wa.�ey: �
5-19-20 "°��°^
Project: 2000 Shallow Holding Tank
�ontractor: �� ` 2000 SHT
HOLDING TANK SERVICING CONTRACI' .���,5 ,
fv�t`.W f,S1� $E Y�,���n�
Contract Datc: 5 / 3 I ��'Z
— — „y cf
This contract is madc between the Holding Tank Owner and the Pumper.
Holding Tank Owncr's Name: Pumper's Name:
�R�� � C��,e ,�r�,�ii�sr f�ww f�y
/
PArcel Identifcation Vumber:
(12 Digit Legacy ID) 0 a Q- t� 3 �-��- 5 2 0 3
1. The owner agrees to file a copy of this contract with the govctnmental unit, Sawycr County,
which has accepted and recorded with the Office of the Registcr of Deeds,the Maintenance
Agreemeut for a Holding Tank rcquired under the Sawyer County Private Sewage Systcm
Ordinancc for the issuancc of a Sanitary Permit for the installation of a holding tank(s).
2. The owner agrees to have ihe holding tank(s)serviced by the pumper and guarantees to
permit the pumper to havc access and to enter upon the properiy for the purpose of servicing
thc 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 pumping equipment. The owncr
further agrccs to pay the pumper for charges incurred in servicing thc holding tank(s)as
mutuatly 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 holdiug lank(s)as rcquired under SPS 383.55, Wisconsin Administrutive
Codc aud the Sawycr County Private Sewagc System OrdinAnce. The pumper further
agrees to include thc following in thc report:
a. The name and address of thc person responsible for servicing the holding tank;
b. The narne of the owncr of the holding tank;
c. The site address of the holding tank;
d. The date thc holding tank was serviccd;
e. The volunnes in gallons of the contents pumped from the holding tank for each scrvicing;
f. '1'he disposal sites to which the contents from the holding tank were delivcrcJ.
4. 1'his agreement wil[ remain in effect until the owncr or pumper terminatcs this contract. In
the event of a change in this contract,the owner agrees to file a eopy of any changes to this
service contract or a copy of a new service contract with Sawyer County within ten(10)
busincss days from the date of change to this service contract.
Owncr's Name: (Print) OWtler'S S1gIldtUiC:(Onty onc owner signvture requfnd)
E���. s Caq��
(oo -�9t-5;ti�2
Pum cr's Nam(e�: (Print) P 's Signaturc:
�i"�/l��s��.C�iu� � /,i , ��
G �I a n� � �� l.��f.i
Pumper's Rcgistration Number:
(.ui 3 N. �-�vrnsao tR��..s
>!.���> 'T�k..N GF �7�10�a
d
Rev.03/26/13
i i i�iii ii ii � �
i iii iii i i i
-USE BLACK INK ONLY- J � � � `� `� � �
Tx:402�i71
POWTS MAINTENANCE AGREEMENT '
For Holding Tanks 431737
PAULA CHISSER
Owner's Name(s)as shown on deed: � REGISTER OF DEEDS
(.vil�iavv� �. Cvx`.�� n..Qnaa+.Qen��-��rYl C.�nenawl} �AWYER COUNTY, WI
;.Z�K- � C�q.�, , 1} rk,�ta-��c�� QEaS� 05/Q7/2021 09:26 AM
Parcel Identification Number: REC+DRUING FEE 30.00
(12 Digit Legacy ID) � � � - �j_-��- � � - � � � 3
— — — PAGES: 2
Legal Description of Property:
-SEE ATTACHED SHEET -
We acknowledge that application is being made for the instailation of a holding tank(s)on the
property described on the attached sheet.
Return To:Sawyer County Zoning and Conservation Administration
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 of
exemption under Section 281.48(3)(d), Stats.,the owner shall 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 assessed
as prescribed by Section 66.0703, stats. The owner agrees to pay ali 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 abate
any 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 systems
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 shall submit
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.
.ti
�Pf� ?-.<,rt"'::::e-i;d;��
-Only one owner signature required- � � 1 ACKNOWLEDGMENT��:tFs�'� R��f���
Owner's Signature: - State of: v� �' •G C �
County of: L,q GI2C� - . ���
Owner's Name(Print): Subscribed and sworn to before me c��hi �''E
�2.� J 1�
�`� 5 day of m %� F��s7'
Date: Z i By(Owner's Name): �?.�
��� t`' Notary Public Signature: �
Drafted by: Public Notary Name (Print): 4 '�'i•,
E;z,� � C���� �
My commission expires on: � �
Personal information you provide may be used for secondary purposes[Privacy Law,§15.04(I)(m)] Rev.03/26/13
EXHIBIT A
Parcel I: Lot 3 of Sawyer County Certified Survey Map No. 5945, recorded on June
14, I999 in Volume 21 of Certifred Survey Maps on Pages 44-45 as Document No.
277111. Said Certified Survey Map being located in Government Lot 2, Section 11,
Township 39 North, Range 06 West, Town of Ojibwa, Sawyer County, Wisconsin.
Parcel II: Together with and subject to non-exclusive rights of ingress and egress
over and across the easements as more fully described on the following Certified
Survey Maps: Sawyer County Certified Survey Map No. 5945, recorded in Volume
21, Pages 44-45, Document No. 277111; Sawyer County Certified Survey Map No.
5946, recorded in Volume 21, Pages 46-47, Document No. 277112; Sawyer County
Certified Survey Map No. 5947, recorded in Volume 21, Pages 48-49, Document
No. 277113; Sawyer County Certified Survey Map No. 5948, recorded in Volume
21, Pages 50-51, Document No. 277114; and Sawyer County Certified Survey Map
No. 5984, recorded in Volume 21, Pages 116-117, Document No. 278562. Said
easement areas are also to be used for utility purposes.
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5/7/2021 Real Property Listing Page
Real Estate Sawyer County Property �isting Property Status: Current
Today's Date: 5/7/2021 Created On: 2/6/2007 7:55:35 AM
�'Description Updated: 3/18/2002 � Ownership Updated: 5/3/2021
Tax ID: 21109 ERIK]CRAIG LACROSSE WI
PIN: 57-020-2-39-06-11-5 05-002-000030 WILLIAM]CRAIG ONALASKA WI
Legacy PIN: 020639115203 AMANDA&BENJAMIN M CHENAULT ONALASKA WI
Map ID: ;2.3
Municipality: (020)TOWN OF OJIBWA Billing Address: Mailing Address:
STR: S11 T39N R06W ERIK]CRAIG ERIK J CRAIG
Description: PRT GOVT LOT 2 LOT 3 CSM 21/44 149 CAUSEWAY BLVD 149 CAUSEWAY BLVD
#5945 LACROSSE WI54603 LACROSSE WI54603
Recorded Acres: 1.900
Calculated Acres: 1.959 � Site Address * indicates Private Road
Lottery Claims: 0 N/A
First Dollar: No
Waterbody: Chippewa River �� property Assessment Updated: 8/20/2013
Zoning: (RR2) Residential/Recreational Two
ESN: 2021 Assessment Detail
Code Acres Land Imp.
G1-RESIDENTIAL 1.900 32,400 0
� Tax Districts Updated: 2/6/2007
1 State of Wisconsin 2-Year Comparison 2020 2021 Change
57 Sawyer County �and: 32,400 32,400 0.0%
020 Town of Ojibwa Improved: 0 0 0.0%
576615 Winter School District Total: 32,400 32,400 0.0%
001700 Technical College
= Recorded Documents Updated: 5/3/2021 �property History
QUIT CLAIM DEED N/A
Date Recorded: 4/27/2021 431487
WARRANTY DEED
Date Recorded: 2/8/2021 429864
WARRANTY DEED
Date Recorded: 3/15/2000 282844
CERTIFIED SURVEY MAP
Date Recorded: 6/14/1999 277111
tas.sawyercountygov.org/system/frames.asp?uname=Eric+Wellauer 1��
t)fticc c�f O�
Sawyer County Zoning and ��
Conservation Administi-ation r'�`qy �'/
]061 fl Main Str�ct, Sui�c�19 � S� I� � �
Haytivai•d, WI 54843 ��iiy��'�'1�FR ?OZ� O
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I'oll Prcc:Courthouse/G�ncr:tl lnfurmation
1-877-699-411U
Sawyer County Zonin; and Sanitation "As - Built" Form
Property Owner's Name _G�1k. � �'�;°r��,,
1'ire Number and Road Name tt��Ce� (�.��cR-S.o� 7tZ , �:.:t►.,;t�iz �,.�t-
Plumbcr's Na�ne �CTIf?tJ ��,,.;a.�•+a� �'�tG1�'�'�'�}�. Lo�'.�'
Date of Installation ��,i+y4 ��t� 2��-�
County Sanitary Permit Number _ �Ci 3���`'� -
l2 Dibit Parccl Numbcr _��(���'�1 1 "'���3
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f?escription and I�'lev�tion of Benchmarl: �� �Q-�'+� / f ��Y
l ank'�4anufacturer��nd Capacity ��x ty►:sc.Gz�V ��� �ku.��s
Setback-Tank to Nearest I.ot t,ine
��7
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Setback-7 ank to i�earest Vv'ell �-�
__
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Setback-Tank to }3uilding ° . _..
Ccil Width 1J(�
_
_ _ __ _
Ce(I Len�th N�
.. ___ _ ___
Nurober of C'etls _ ___.._ ___�a _ __
Setback-Cell to Nearest 1_ot I,ine ��
Setback-Cell to Nearesi Well �+�
_
Setback-Cell to fiuildine ni�
� _
Setback-C.ell to Navi`�able W'ater �:�
hlahc and Modcl of Dispersal llnit �+�
R-lake and h9i>del of'Filter �.1R
ivlake and h�iodel of Pump _ �A
- Please complete other sicie-
"As-Built Plot Plan"
Elevation Data
Benchmark t,2�y Please include th� �(�c�llc��vin�:
___.
Builciing Sewer t,�Z�t'>�
'Cank t,n _ ��'L�,�_ � Location of observati��n and vent pipes
Tank Out �� Feet�f risers used on lank(s)
___ ..............
[)ose ']'ank In j�;,� � Location �f benclvnark and Nc�rth ano��,�
Uose"Tazlk Bottom _ �;,P„ � Location of all compouents
Header or Manifold �,+1 � Lcn�th of pipc bet��een componenis
l�istribution Pipe �j� Number of chamber units in cach cell
System Flevation U�_ � Location of wetl, lot lines and road
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