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POWTS MAINTENANCE AGREEMENT 434772
PAULA CHISSER
For Statement of POWTS Capabilities i2EGISTER OF DEEDS
SAWYER COUNTY,WI
Owner's Name(s)as shown on deed: 09/17/2021 0 2:33 PM
� �� �j RECORDING FEE 30.00
0.(��` � ������ Un� �1C���� C'F, �,�2�
Parcel Identifcation Number: n
(i2DigitLegacylD) 0 L�-���- 4��-31�� PAGES:2
Legal Descriplion of Property:
•SEE ATTACHED SHEET-
We acknowledge that application is being made for ihe installation of a holtling lank(5)on�he
property described on[he attached shee[.
Return To:Sawyer County Zoning and Conservation Administration �Np�'� �y�3
10610 Main SL Suite 49,Hayward,WI 54843 �
I(we)understand the POWTS serving the str cture on the above parcel located at:(fire number and
road name) 13oa3� ��^"e�^tu �;c�qe was designed for the foliowing capabilities:
Treatment Tank(s)Ap rox.�g� I�/S�GPD,Soil At�,sorption Cell(s)Peak �S� GPD
Permit Number SAN�-�Year installed ryY
The POWTS serving this structure is presently sized to accommodate a total of -1 we (�)
people,in a dwelling containing �f�-O ( � )bedrooms. With the addition of bedroom(s),the
estimated daily wastewater flow of the structure wili be based upon per capita occupancy rather than
the total number of bedrooms.(75 GPD per Person)
W I Dept.of SPS 383.54 outlines the management requirements for these POWTS and I agree to
comply with those maintenance provisions as they apply to this system.
Should the use of the structure described above increase flows above the capacity of the POWTS,
I agree to upgrade my system to meet the standards required in WI Dept.of SPS 383.
Should my POWTS fail, as defined in Section 145.01 (16) Wisconsin Statutes, I will obtain the
required permit for the instailation of a code-compliant POWTS with the installation completed as
ordered.
-Onl oneownersi naturere uired- ACKNOWLEDGMENT
0��� e: � ,i_ _ Stateof: ��;�
�� ��'���� County of: _� i
Ownef s Name(Print):
.��� �S`� Subscribed and swom to b�e on this
i/�TiZ�/� fir �i��<�. I��-}�dayof ,20 �
Date: g Owner's Name
� � C� Y( Y 5Er`
Notary Public Signature: ^''�
Drafted y_T i,� '��Gp�NT C/��{otary Public Name(Print):
r—� ��'W�^'���' � �F�commission expires on: ���_
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Personal infortnation you pmvide may be used for secoy�dl�og�R�FYdv�cy,a.�iC§15.04(I)(m)] Rev.03126/13
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Part of the Northeast Quarter of the Southwest Quarter "
(NE'/4SW'/4), Section 21, Township 42 North, Range 9 West;
described as Lot 10 recorded in Volume 9 of Certified Survey
Maps, pages 428-429, Survey No. 2067, Document # 189331 .