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Home My WebLink About010-173-00-0400-SAN-2022-080 i.nrw� l ,�" � Department of Safety °""n' �'� �`;'�`�� r & Professional Services, S�..0 y� e � �,`,�� TIIC�llStl�' S81'V1C8S�1V1S10II Sanitary Pecmit Number(to be filled in b � �� Y � , w Sanitary Permit Application StateTransactionNumber � � In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this foan to the appropriate gavemmental unit O is required prior to obtaining a sanitary permit.Notc:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing tha Department of Safery and Professional Services.Personal information you pcovide may be used for secondary /`,I(� � / ' d ,) f q�7 p oses in accordance with the Privacy Law,s.15.04(1)(m),Stats. � �'��^' �-'� �<<' � �?`�. '�t�a�rt�t��ea�B, ��a�o�oa7t�ilt�a Property Owner's Name Pazcel# �� s # k -Tk t�.z.�,., i�t-�Ic o�a i �3 0 0��t o�> Property Owner's Mailing Address Property Location ��"''Z VP1'NC��J Lry Crotrt-�.vt—� Citu,State Zip Code Phone Number `;�t Nc� �`�AJ `�J `"' �l�7 —��i+�—�Section �`{ �'�'��' ; ..-: . (C�[�iCIk�3�"t#fait�I1PF�3') Lot# T `-�I N R � Eor�j fj(1 or 2 Family Dwelling-Number ofBedrooms `� 7 Subdivision Name Block# �p.,�y� �-�(Qr �� ❑Public/Commercial-Describe Use � C7 City of ❑State Owned-Describe Use CSM Number ❑Village of / � I�TOWii Of ` '�•Y �'�• "•-r\` i III:�'}*�e ofPOW'�'S I'ermit:(Cheek either KNew"or'KRepisce�r►en:t"and other applica6le nn line��. Clte�ek one b4x fln lis�e 1B.Cucnp�ete iine f.'if ii�a6le. .,:,A I i � T , ❑New System '�Replacement System ❑ Other Modification to Existing System(explain) L�Additional Pretreatment Unit(explain) B' �Holding Tank ❑ in-Ground ❑ At-Grade ❑Mound �� Individual Site Design yp ( p ) � ❑ Other T e ex lain (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑Transfer to New Owner ist Previous Pemut Number and Date Issued E�u�;� �`I-o,.a , 61 �► ��, , . E � ; l�tim�io��adud Taak i�for,o�,t�;. �:� �.-. � ; Design Flow(gpd) Design Soil.Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation �� ,_ ._._. Capacity in Total #of Manufacturer 'I'ank Information Gallons Gallons Units � ` �o � ` y � New Taaks Existiag Taaks � o � 2 � � � � a U 'v� h rn 's: C7 0.. Septic or Holdiag Tazilc �3 OC�� — 3�2`> 1 � (..,t�S�/^ l� Dosing Chamber I � V:�e�Qss'ibti�fiy SCste�ent-�-i�e�.assame responsib#1&�foribaffiUa€ian of th�POW`£3 sbow�oa the attacbkd pleaa. Piumber's Name(Pzint) , Plumber's S:�nature i �IY�'?VFRS Number � Busi.^.ess Phone Number Jerry Ruid Excavating, LLC �,��i ,�� ,� a ��s-��z- �� Plum r C , e, Code) Stone Lake, Wi 54876 .�� s � . . . . . . _ ., �A �' �Disapproved Permit Fee Date Issued Issuing Agent S�ignature �� O Owner Given Reason for Deniat $ (�'� S 1�lS� ��` ��-�,"'1'l�-'��"�Tl�'�''�''^� Conditio�s of ApprovaUReasons for Disapproval ` � ' "'w �. z r ,,.,, �� . � � ��,; }� i � a� : MkY 2 5 2022 � � r �� I ��L c��--�- �� . �� a�� R COVNTY ZONING ADA4INISTRATIO . Attsch to complete plans tor the system and submit to the County only on psper not less than S SR z 11 inches ia size NO REFUNDS AFTER SBD-6398(R.03/22) ISSUE OF PERMIT Sawyer County Zoning & Conservation Administration �� 10610 Main Street,Suite 49 , 1� Hayward,Wisconsin 54843 � �� (715)634 8�88 �� FAX(715)638 3277 � �--� % � �._.,.,.,� ,� ; :: �i u u � `�' i E m�il t�i: � � � :i , in ��_v' �� —� Toll Free Courthouse/General Informat�on 1-877-699-4110 / � .. /'��1�� Holding Tank Approval Checklist I. Sanitary Cover Sheet Date Stamp o s / �'S / �-� Parcel ID# O l o -I �7 3 - � � -c7 `-( � O II. Plot Plan �Property Lines ?�Benchmark BM ♦ � Site Address X North Arrow 7� Structure �Scale �Well <25' to Service Road Legal Description Nearest Road Intersection � Setbacks to: Property Line, Well, Structure, Water bodies, Roads III. Required Plans 7� Index Page with Original Signature �Management Plan/Contingency Plan Servicing Contract ?�Holding Tank A�reement form IV. Holding Tank Specifications Cross-section—Manufacture, Gallons: �„��e,Ler 3,�° Tank Anchor Calculations [SPS 383.43 8) g)] Locking device, chains/locks �C Alann and Electrical per NEC 300, SPS 316 & 383.43 (9) (e) and State Statutes 101.862(2) and ]01.862(3) � 3" Bedding Material < 1/2 " V. Holding Tank Plans per Component POWTS Manual `� Version 2 SBD-10855-P (R.3/07) Owner: ��— Plumber: � �``- Application Review Date: -��'2�� POWTS Reviewer: ��c_ Namc 6`T �((� Liccnsc# Revised 4/11/2013 PAGE 1 OF 4 Holding Tank Plan Index & Cover Sheet Component Manual 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: Enciosures: POWTS Appiication for Review Soil Evaluation Report & Site Map (if applicable) Holdin Tank Pum in Contract if a licable) Holdin Tank A reement if a licable Project Name / Description Owner Name(s): 1-�� i�� # �I�eh; �I�� Phone: - - Owner Address:S��>� 1�',�-N�.� �,.... �'�[;N� Ni,,, Zip: ��-�i 3� Project Address: l//fd n1 L-�Ncf�� k�� Govt. Lot: 1/4 of 1/4, Section �`� , T �/� N-R � EQor W� Township: u�.y �� County: S G�ti� �� Project Parcel ID#: ��a l 7,� Go�yvc� Designer Information Jerry Ruid Excavating, LLC � Designer Name: Phone: ��J� - `a�- 2 ld� Designer Address: Stone Laka,�y� ;�g7,g Zip: �`{8 �6 E-mail: �l r t1 lcS (� G-e P..�Q'��-Y i�.� • /\!�C Tiiis space restr�•ed ti�r appt•o�•al stamp. License Number: �-`� �� Remarks: Signature• � �� Date: .�-2.� - z2 • —�' ginal signature required on each submitted copy. . CHECK BOX AS APPLICABLE. CF�ECK BOX AS APPLICABIE. � SOIL EVALUATION o s`�1e: a�o 40 so $o C� SYSTEM PAGE 2 OF SITE MAP PLOT PLAN PROJECT NAME: �o, DESIGN FLOW: �OC' GPD Df-�� Attach design flow calculations for commercial plans. PROJECTADDREss: �f I 1��( ��n.��e.i.s �� Pipe Material/ASTM Standard(Tables 384.30-3�384.30-5) /��.� N SanitarySewer. �/��5�+'i `�b / BM Symbd: � BM Elevation: FT Force Main: / BM Description: I oP m� '�Al�� Indicate north by IMPORTANT: Slope Gredierrt(%) Well Symbol(ifappiicable): Q drawing an arrav Show ground elevation contours at suitable intervals. Of TeSted AB2: on the approprke line. _ _ iQv�,.��_ _L��l� ___ _ ----.�__ �` 5 3 � J�-�,��,u za c� _ �� l O��S— fi'� �(Z � 3�7� '3occ� ��cL!/c.v w«s�,_ i--(o i d �,.�3 i:�K , Ru �'SC.'- � � �1�"1�Cc :� 2 ��,o 3 �3e�;l Roa,-,-, I tlN� 5 i'i-2 ��. n ��.��,. �z��•r �� ,� ��. o' �� -^r�-�e 7re,�' ��— Y 5��c T�c�� °$"' Jerry Ruid Excavating, LLC W208 County HWY A Stone Lake, WI 54876 MPkS - z �x y�� / a �, �Ilfla� � L L,:�� i RP_RI P.t PAdP_� � � • . PAGE30F4 H4LDING TANK S�ECIFICATI�NS (No Scale) weethe�r �r Mtn.or 2o n above Jundbn and ��F�� Atarm Baoc y� (tYP1�) Electrtcal must c�rnpy wtas � a►pprorea t.oddnS Manho�e SP3 316 and NEC 300 4�0�� ""�W�"�9��A�� 4•Mfin.or 20 ft ebwe Ca�duit BuBdfng �tYE��) EstabRsfied Flood Efevation (1YPi�) AIr�QM Seal • Fmished Ceads 18"NBn. (��) �. ' ' ,. ' . . , � � • . . , .. d . . , ` inle! lnlet Irnert W�� Approved J�nts wAth Max 1 Y ar 9096 oi to7a!vdume � f►PPrvrsd Plpe 81t anbo if mote thart one rank �� a r aarmor, f . , • HOLDING TANK VOLUME= 3�� gal ; � a • • . • • ' ' • • - . 3'Approwd Beddin�Ma�rial Ber�eath TaMc TANK MANUFACTURER: �-•��str Anchor tank as nec�sary pursuant to SPS 38;i.43(8)(g) Ballast Weight= [(cu.ft.tank.voi x 62.4 Ibs/cu.ft)-lbs.t�nk.wt]x 1.5 . Ballast Weight=[( !�=cu.ft.x 62.4 Ibs/cu.ft)- �',=tbsj x 1.5= /G,�=1bs PAGE40F4 Hoiding Tank Management Plan IMPORTANT: The owner of this holding tank(s)shall be responsible for its perpetual operation and mairrtenance 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 mairrtenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52(3),Wisc. Admin. Code. Estimated Daily Wastewater Flow= `��o gpd Insoection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance fadors(i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps,valves, switches,floats, etc.) o material fatigue(i.e.,leaks, breaks, corrosion, etc.) o neglect or improper use(i.e., exceeding design capacities, prohibited activities,etc.) o electrical cornponents(i.e.,wiring,connections,switches, controls,timers, alarms, efc.) o surface discharge of effluent or sewage back-up into structure served SERVICING FREQUENCY o 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. Tank pumping reports shall be submitted to the proper local govemment unit in accordance with SPS 383.55�s. Admin. Code. Report any component failure or matfunction to: Name of individual or company: SGoYs s�pYi G-- Phone: ��S G�c7' 72�� Local govemment unit S�w �l�r �o� Z�"`' �°`�`� Phone: �/�` 6 ��' $�$� Local govemment unit address: 1(3C��O Y►�A.t►v 5 e S v c TP� �-l� �y cs.b�(`a ZIp; S�I $t{'3 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 malfunc�ioning 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. Corttins�encv Pfan 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. Svstem Abandonment If use of this tank(s)is discontinued, it shall be abandoned in accordance with SPS 383.33,�sc.Admin. Code. HOLDING TANK SERVICING CONTRACT Contract Date: �/ � / Z�- This contract is made between the Holding Tank Owner and the Pumper. Holding Tank Owner's Name: Pumper's Name: � � � �� D�� !�/ � < 1�� < SY � Parcel Identification Number: (12 Digit Legacy ID) ��- �� - �� - .� � � �-- 1. The owner agrees to file a copy of this contract with the governmental unit, Sawyer Count��, which has accepted and recorded with the Office of the Register of Deeds.the Maintenance Agreement for a Holding Tank required under the Sawyer County Private Sewage System Ordinance 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 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 pumping equipment. The owner further agrees to pay the pumper for charges incurred in servicing the holding tank(s)as mutually 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 holding tank(s)as required 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 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. In the event of a change in this contract,the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with Sawyer Co�mty within ten (]0) business days from the date of change to this service contract. Owner's Name: (Print) Owner'S Sigriaiu]'e: (Only one owner signature required) � � � �� f � � �� Pumper's Name: (Print) Pumper's Signatur : S ' �` � �� Pumper's Registration Number: I ''`f�� I Rev.03/26/13 �S �,Q1��^,1 �a��~°�� ; � '� IIIIII II lil y /� T ��Q I I{Ij I I I I I I�I I!I��I I I 'J �� '� 1OI�``�g 1 Q�^�J V O J J J � t Document Number pocument Titie Tx:4038274 439348 PAULA CHISSER REGISTER OF DEEDS SAWYER COUNTY, WI 05 J 26/2022 09:28 AM RECORDING FEE 3Q.00 PAGES: 3 Recording Area Name and Return Address dqw�/2C� CouaC�. '�ni�n� �2�. �ob10 h/la;� S�-. 5.;.�i�e `�9 }{aY�,,as�l,,r.,Z SY$Y� p�o- (� 3-oo - oYoo Parcel Identification Number(PIN) THIS PAG� IS PART OF �rxis LEc�L vocUy��.�rT-�� voT �i�tovE. This information must be completed by submitter: document title name&return address.and PIN(if required). Other information such as the grarting c!ause, !egal description,etc., may be placed on this first page of the document or may be pl�ced on additional pages ef the document. 1/�JRDA Rev. 12/22l2010 - USE BLACK INK ONLY- POWTS MAINTENANCE AGREEMENT For Holding Tanks Owner's Name(s)as shown on deed: �(��( J/fs �-�.�P.�� ,� -e �f��L��I /�j-��' � �� Parcel Id tification Number: I (12 Digit Legacy ID) ��-��- ��-�� Legal Description of Property: -SEE ATTACHED SHEET- We acknowiedge that application is being made for the installation 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 all 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 properry. 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. -Only one owner si nature required- ACKNOWLEDGMENT Own r's Sign re: State of: �(H.tNN�so�-�a County of: ��.r��l 0�� a e (Print)� � �� Subsc�ibed and sworn to before me on this ��day of �'R�`�' , 20�_ Date: By(Owner's Name): Y-� ��/ ✓��L� Notary Public Signature: Drafted by: Public Notary Name(Pr N ��' ��'�-�— My commission expires on: " d "'� TRISTAN W M�RIS � � � NOTARY PUBLIC-MINNESOTA Personal information you provide may be used for secondary purposes(Privacy Law,§15.04(i)( 3�. . , � ��5,��3+I,A� 3 � �' .�„ Lot Four (4) of Round Lake Retreat, being a part of Government Lot Three (3), Section Fourteen (14), Township Forty-one (41) North, Range Eight (8) West, Sawyer County, State of Wisconsin. , `h � ' � �5'. , � .� . � _ o '` �"�i n„�t.i f� r, i ��... 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'� '+ ��,, ,�{;a� �' `4�- K T�'`s•:�. � ��'� �y � � �-.��h „Y°' � � . % , ,€''�' , '� -` "._��.:__ ��. � E•,�,��, ,� ,R *#„ aY�. � `'.,: �+� 5/26/22,8:50 AM Real Property Listing Page R2aI EState Sawyer County Property Listing Propertystatus: �urrent Today's Date: 5/26/202z Created On: 2/6/2007 7:55:18 RrN �Description Updated: 6/16/2017 � Ownership Updated: 4/27/20i7 Tax ID: 10060 DOUGLAS ALBERT DRAKE REV TRUST EDINA MN PIN: 57-010-2-41-08-14-5 15-227-000400 KATHLEEN DIANE DRAKE RtV TRUST EDINA MN Legacy PIN: 010173000400 Map ID: -5.4 Billing Address: Mailing Address: Municipality: (O10)TOWN OF HAYWARD DOUGLAS A&KATHLEEN D DOUGLAS A&KATHLEEN D STR: S14 T41N R08W DRAKE REV TRUST DRAKE REV TRUST Description: ROUND LAKE RETREAT LOT 4 5802 VERNON LANE 5802 VERNON LANE EDINA MN 55436 EDINA MN 55436 Recorded Acres: 0.800 Calculated Acres: 0.850 Lottery Claims: 0 � Site Address * indicates Private Road First Dollar: Yes 11110N LINDEN RD HAYWARD 54843 Waterbody: Round Lake I� Zoning: (RRi)Residential/Recreational One u Property Assessment Updated: 11/9/2015 ESN: 444 2022 Assessment Detail Code Acres Land Imp. � Tax Districts Updated: 2/6/2007 G1-RESIDENTIAL 0.800 308,300 143,100 1 State of Wisconsin 57 Sawyer County 2-Year Comparison 2021 2022 Change O10 Town of Hayward Land: 308,300 308,300 0.0% 572478 Hayward Community School District Improved: 143,100 143,100 0.0% 001700 Technical College Total: 451,400 451,400 0.0% +� Recorded Documents Updated: 5/16/2022 �Property History QUIT CLAIM DEED _ Date Recorded: 11/18/2013 388324 N/A BUNKHOUSEAGREEMENT Date Recorded: 4/25/2022 438782 WARRANTY DEED Date Recorded: 8/7/1984 192354 https://tas.sawyercountygov.org/system/frames.asp?uname=Eric+Wellauer ��1 _ FEBRUARY zot7 S M T W T F S 1 2 3 4 THURSDAY FRIDAY SATURDAY s 6 � a 9 io n 12 13 14 15 16 17 18 19 20 21 22 23 24 25 �O 089/276 • �� 090/275 � 091/274 26 27 28 .,r MARCH zoi7 S M T W, T F $ . 1 2 3 4 — 5 6 7 8 9 70 11' ,,., 12 73 14 15 16 U 1& _ t � C__ __ � t �; 19 20 21 22 23 24 25 � 26 27 28 29 30 31' � r.00 zoo zoo APRIL zoi7 '' �(y � ;� + S M T W T F 5 �� 30 }.�.w�4r� ,.'��_'�..� 3�wu.+es�� 'i..��_ 30.. —" 2 3 4 $ 6 � 8 s:oo a:oo a o0 9 10 11 12 13 14 15 �• 16 17 18 19 20 21 22 � f, � � '� -- ;� � � " 23 24 25 26 27 28 29 30 �; �. _ r` �. � a � �oT =-- — 30 �� 9:00 9_00 _ _. ty' i 9:00 MAY zoi7 so so 30' S M T W T F S � - 1 2 3 4 5 6 io:oo 0o fi000 � $ 9 10 11 72 13 14 15 16 17 18 19 20 30 � �'"�' '� � �j��1 �,J `_�.��'�"" �>,r � 28 29 30 34 25 26 27 s �tj.�, r 11:00 J \ �j'�(0$�� _ 1t:0o �'"�r �� ti�00 �. . . 4,_,_� �•-- — .._ �.�.� � � .� �J.. 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