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022-739-24-4101-SAN-2022-139
-``"'�' Industry Setvices Division Counry �� _ p t :`. 4822 Madison Yards Way ��'`'��r � (: _* '.� Madison,W[53705 Sanitary Permit Number(to be filled in by Co.) �. � ,: P.O.Box 7162 � ,.�y;;„~_,��^ Madison,WI5 3 707-7 1 62 (1J �q � �j � � Sanitary Permit Application State Transaction Number � In accordance with SPS 38321(2),Wis_Adm_Code,submission ofthis form to the appropriate govemmental unit w is required prior to obtaining a sanifary permit Note:Application forms for state-owned POWTS are submitted to Pruject Addiess(ifdifferent than mailing addre! � the Departrnent of Safety and Professional Services.Personal information you provide may be used for secondary /� purposes in accordance wiih the Privacy Law,s. 15.04((xm),Stats_ ���,,, n n. /J /i I.Application Information-Pkasc Priot Ali Infoematioa '�� ►�p� �u�Cc SS�N Properry Qwner's Name el# Qob�•-� �' (�ar►+�14 �n IC�sK� OZ2 - 739 - Zy- `�/ol Property Owner's Mailing Address Property Location ! I Z N IAearL ���'�' City,State Zi Code P6one Number �j r� �/ Wi��0(/� SjP�'��At'S �� l�0 / S� 'l0�` ZD 8�0�9�8 /'� %. SC '/4, Section O` 7 II.'I�pe of Baildiag(check all t�at appty) Lot# T 3 N R � E W 1 or 2 Famiiy Dwell'mg-Number ofBedrooms � Subdivision Name Block# ❑Public/Commercial-Describe Use — ❑Ciry of �State Owned-Descnbe Use CSM Number �Village of 1 _ .t7.1 own of q/(�� $Sd�✓ llI.Type of POWTS Permit(Check eit�er"New"or"Replacemeat"aHd other appliesbk oe tine A. CLeck one box on Gae B.Complete line C i a Gcable. A. w Sys�m ❑ Replacement System g Y � P ) � P ) ❑ Otlier Modification w Exisbn S stem ex lain ❑Additional Pretreatment Unit ex lain B' Hold'm Tank ❑ In-Grouod ❑ At-Grade g ❑ Mound ❑ Individual Si6e Design ❑ Other Type{explain} (conv�tional} C• ❑ Renewal Befote ❑ Revision ❑ Change of Ptumber ❑Transfer to New Owner �st Previous Permit Number and Date Issued Expiration IV.DispersaUTreatmeet Area and Tank Informatioa: Design Flow(gpd) design Soil Application Rate(gpolsfl Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation Od --- �-- ._ �— Capacity in Tota! #of Manufacturer Tank Information Gallons Gallons Units � o � o New Tanks Existing Tanks '�+`-` c y " m a� � � a� o � o� � 4` U cn m �n w C� 0. Septic or Holding Tank 3 d O O 3�t � /� T� /(� X Dosing Chamba V.Respopsibility State�tat-I,the asdersi�atd,ass�me respoesiblity tar ie�atl��e of tYe POWTS s wa oa thc atfac6ed ptans. Plumber's Name(Print) Plumber's Si ature PRS Num6cr Business Phone Number n�r�ce �v'oM+���' `�� a�s� � ' ��s-.�c�- �oYo Plumber's Address(Street,City,State,Zip Code) `�3'�o �tJ L Arc.e. rN ;��'er �• l�t�%�t�` W� S y Sr� v�.co� �Pa���r u�oa� � ved ❑Disapproved �ermit Fee Date Issued Issuing Agent Signature , p0 � nn ❑Owner Given Reason for Denial �d�� � I�I�-� �C-r.�t-��X 2�-F'- Conditions pf ApproY�l/Rea�pns for Disa�roval � � �� V �.�'1���; � � s� N��-- ;� � �I I N� �� _ �1U1� 0 1 202Z �- ___�,� S�1WY�R G�{.li�r��f' ZONING�DMf�fS��,'�;;:�W Attac6 to compkte plaus for fhe system and sobmit to the County oeW on paper�ot less Ihaa 8 t/1:l 1 iuc�es in size NO REFUNDS AFTER ISSUE OF PEAMIT 7/8/22,825 AM Real Property Listing Page R2dl EStdte Sawyer County Property Listing Vroperty5tatus: Current Today's Date: 7/8/2022 Created On: 2/6/2007 7:55:39 AM �Description Updated: 6/21/2022 � Ownership Updated: 6/21/2022 .. .. . . .. .. _ .. . TaxID: 23281 � ROBERT]ANKUSKIJR WILLOW SPRINGS PIN: 57-022-2-39-07-24-4 01-000-000010 IL Legary VIN: 022739244101 Map ID: .13.1 Billing Address: Mailing Address: Municipality: (022)TOWNOFRADISSON ROBERT]ANKUSKI7R ROBERT]ANKUSKI]R STR: 524 T39N R07W 112N PEARL ST 112N PEARL ST WILLOW SPRINGS IL 60480 WILLOW SPRINGS IL 60480 Description: PRT NESE Recorded Acres: 5.000 m Calculated Acres: 5.069 r Site Address * indicates Private Road Lottery Claims: 0 N/A � �� � First Dollar: No Zoning: (F-1) Forestry One 0 Property Assessment Updated: 10/24/2011 ESN: 2022 Assessment Detail Code Acres Land Imp. ��� Tax Districts Updated: 2/6/2007 G6-PRODUCiIVE FOREST 5.000 7,500 0 1 SWte of Wisconsin 57 Sawyer County �-year Comparison 2021 2022 Change 022 Town of Radisson Land: 7,500 7,500 0.0% 576615 Winter School District Improved: 0 0 0.0% 001700 Technical College Total: 7,500 7,500 0.0% . Recorded Documents Updated: 6/21/2022 QUIT CLAIM DEED � � ��� Property History Date Recorded: 6/14/2022 439667 NJA � � WARRANTY DEED Date Recorded: 3/22/2022 438235 WARRANTY DEED Date Recorded: B/21/2017 408221 WARRANTY DEED Date Recorded: 4/28/2017 406435 PERSONAL REPRESENTATIVES DEED Date Recorded: 6/26/2003 312567 https://tassawyercounrygov.orglsystem/frames.asp?uname=Eric+�/yellauer ��� Sawyer County Zoning & Conservation Administration � ��������� I 0610 Main Street,Suite 49 � ��� Hayward,Wisconsin 54843 � I (715)634 R288 i � ��� �� FAX(715)G38 3277 i ��_yi �' ���u rt , v,L�� 3, ��- � �. � � \' C m1il. ���t � a�i i i> >:.��i:::: � �� Toll Free Courthouse/General Informahon 1-877-699-4110 t� ,° �, � t��l������ Holding Tank Approval Checklist I. Sanitary Cover Sheet Date Stainp b7 /o( / �� Parcel ID# D '2 �- � 3 �' -�. y_ �( � � � II. Plot Plan �Property Lines �enchmark BM ♦ /Site Address _�North Arrow �'Structure � Scale � �Well �<25' to Service Road �Legal Description �earest Road Intersection � Setbacks to: Property Line,�Vl'�ell, Structure, Water bodies, Roads III. Required Plans Index Page with Origina] Signature Management Plan/Contingency Plan Servicing Contract �Holding Tank Agreeinent form IV. Holding Tank Specifications �( Cross-section—Manufacture, Gallons:—��_�-�- 3aoa �Tank Anchor Calculations [SPS 383.43 8) g)] Locking device, chains/locks �Alarm and Electrical per NEC 300, SPS 316 & 383.43 (9) (e) and State Statutes 101.862(2) and 101.862(3) J� 3" Bedding Material < 1/2 " V. Holding Tank Plans per Colnponent POWTS Manual �Version 2 SBD-]0855-P (R.3/07) Y� ( � Owner: �dh����;, Plumber: �o�.,� Application Review Date: POWTS Reviewer: �,������ rva�»� �� ((� ��o����� Revised 4/11/2013 PAGE 1 OF 4 Holding Tank Plan Index � Cover Sheet Component Manual Design References: Version 2�,SBD-10855-P(N.03/07;R 01/12) . . , P 1 of 4 ` 9 �� Index&Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Holding Tank Specficafions Pg 4 of 4 Management Plan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report 8�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): Rob���g Pa�++e la 'S� uo s K: ph�e. 7n 8 _zo 4 _a 9/8 Owner Address:_ //Z �/ pe t r L [,I:Uou�s/.1��.5 =�. ZP. �o Y S n Project Address: rto�✓w (2� (l..l:S S,.J Go�R.Lot: �/� 1/4 of 1I4,Section S� ,T 3 9 N-R � E Q or W� Township:_ �•��1 SS•.�.� Courriy: _ S<wy,e.� Project Parcel fD�: n 2 Z -73 f-2 y-yio/ Designer Information Designer Name: Y►'t!K� �'►�1 o�'�j e,.,e.-y pho�;-j i S _�6 4 _ 3o S�o DesignerAddress: N3ya�t! Gtie�e w;�fc+�- �Q.l. w,•n�#e� �p• SYStG E'mal�: This space�servcd for appro�•al stamp. License Number. �tP 2 Z S� G 9 Remarks: � Signature: y/,�� y��ui�2�w � Date: �-�S- 2 Z ......d....�«�.�c��.. ._..�....... PS.N �# b ZZ - 73 4 - Z �/ - Y/a/ Leynl D;S�. N��vSc%r S�y �9 �c,> SCaIL ( '`- `�D ' PLOT PLAN PAGE a OF � � owuev s ° yb ' T �d�,.�-¢�nKvS�� Q � �mF�4 �'av� K�S.�� PL � r ��`� I l' `r'°° _ ,00.a � �s,� e r. � na�� 1� �'�b,uc 9 -�vt�' h fr°�� r��St.9 � �� 3� 3gw µ.�- �p5e. y p°vc D��� 1 � `towev �� l-I e k�.� Ra/ �/z nn:(�c 8M = �00 . o �t�M�. r na%I t .n MM�c�r� � 12" idbe�a 9ro.C� Mtl�l M�nff �'"`cy /vt� 2LS� L � l PAGE30� 4 H���� TAAIK �PE���lCATtON� - ��to Scai .. � - � � ��� �� - � � ���"�. �,r��8 � ��-�r a� io�m "� . �� ��� ��� ��` � _ - � � _ �a� i8'�. �- � � , �e- -_ ' ' � e - v- � $ ' � � .;` � _ � �� _ = ��VP�t �P�eH�m�n� ' �ci2`arffii�6at�� - � �i(�d Q �'�aa�+�� � � e + � �i��3i�i�€ � �fflL.� = � + - d _ _ , � � Q ' _ ` ' 1 _4 O . � _ ���1��tTaNc — v TA�1UC �A�NUF�T�RER: -- v C� ° ..��rJ��- • �i�tc � �y P�t� SPS �.4� ��=j(cu�t.�v+ot x 62.4 �_�s,�w�x f.5 ��` � �---�_c� x&2.��,ft}- 3 6 0 � x i.S =. ol—�_ S, t��s . � - . i�oldi � Ta�k-Mana _ _ p�E� � �9 9ement Plan � n+�oRraNr- . - - , Ihe o�r v�f�t�oa���?st�r�e�po��r�s � - ���a������{2kW����{���s) �v�t SPS��������+Y���PO�N�'S�P�. I��W'ts�Adm�.Cs� • � � ��rw��;= -3 o a � : . - �cn�wa� ' ��ret�r��s o t,ype a[us� - . � . o age of syrsl�n . . - o �e iscbaos{ie,od����� . - Q ��t�;�t�ps,va�ve�s,��ed�} � - � � ��(f�,�b�ics,��) o ����(�e,���,�acsvi�es,e�j_ - ' o- surt�ce �{i�.����,��rs,�e�} - - ���nc sewage badc-t�e��rt��red � . � ' � . SFJ�1tiCN6 FREQt�Y ` _ � ' " . o 'fbe ta�(sl st�be pianped by a��sereich9��c�det s.�i.481�1l�S'�. . �cf t�o����t�t�a ia�a�a�ie�ooR 6e�r tlie�#�ct c��e te�s}, . . P�fio t�il3,Wis��4�rdn.t�d� � T���si��a���P�P��t9�u�tn _ !�'Cala. E�ort�!I���r r��o:� �w#�e SPS�IM'cs, . ��rns c����1IlF�ce Nlontgome� �- � 7��-266,,3Q� _ . ���r S���Zon�ng � �,� 71��.g288 ��,►�e�,t�8� �0�'f0 Ma�n Str�et Sui�49, HayHrard, W! �,. 5�� ��'��of�d`x ����S�'S 38�i�!}�i�Ad� �for d��r��tt��ppYVTS rtiay be u���SPS 383't�A�Cocie. - a�w�SPS�4,Wis�qdm�.G� � aPP�oved by��� � . Con�---�.--.pi� - . �P��d�a���Y���d�ePpnon���'�s�!be rs�aoed Pts��a a � . � �m A6andonn�r�t ' - � tf use�ffiis f�k(a)is d�cr�������x:e w�h SPS 3gg,33.W�c,Adrzdn.Code,. . HOLDING TANK SER�7CING CONTRACT Contracl Datc: (�/�/Z Z This contract is madc bctwecn thc Holdin�Tank Owncr and thc Pumper. Holding Tank Owner's Name: Pumper's Name: Q Northwest Sanitary,Inc. !"_6�-1 SaKV 5„�,�. �� PO BOX 155 N � Radisson,WI 54867 Parcel Identification Number: (12 Digit Legacy ID) ���-���-��-���� I. Thc owncr agrccs to filc a copy of this contract wilh thc govcrnmcntal unit,Sa«ycr County, which has acccptcd and recordcd with thc Officc of thc Rcgistcr of Dccds,thc Maintcnancc Agrcement for a Holding Tank required under the Sawyer County Private Scwagc System Ordinance for the issuance of a Sanitary Permit for the installation of a holding tank(s). 2. Thc owncr agrccs to havc thc holding tank(s)scrviccd by thc pumper and guarantccs to pennit the pumper to havc access and to enter upon the property for the purpose of servicing thc holding tank(s). Thc owncr aSTccs to maintain thc all-wcathcr acccss road or drivc so lhnt thc pumper can scrvicc thc holding tank(s)with thc pumping cquipmcnt. Thc owncr furthcr a�,Rccs to pay thc pumper for a chargcs incurrcd in scrvicing thc holding lank(s)as mulually agreed upon by thc owner nnd pumper. 3. Thc pumper agrccs lo submif to Ihc Govcmmcntal Unit,Sawycr Coun[y,a rcpori for thc scrvicing of(hc holding tank(s)as rcquircd undcr SPS 3835$_N'isconsin Administratiac Code and the Sawycr County Private Sewage Sys[em Ordinancc. The pumper further agrees to include[he followi�g in the reporl: a. The name and address of the person responsible£or servicing thc holding tank; b. The name oF the owner of the holding tank; c. The site address of the holding tank; d. The date thc holding tank was serviced; e. The volumes in gallons oFthe contents pumped from[hc holding tank for each sen�icing; f. The disposal sites to wliich the contents from the holding tank were delivered. 4. This agrccmcnt u-ill rcmain in cCfcct until thc owncr or pumper tcrminatcs this contract. In thc c�cnt of a chan�c in this contract,thc owncr agrccs to filc a copy of any changcs to this scrvicc contract or a copy of a ncw scrvicc contract with Sawycr County within tcn(I O) busincss days Gom thc datc of changc to this scrvicc contract. Owner's Name�(Print) Owner's Signature: .�. �� � � ���'�ti Pumper's Namc:(Print) Pwnper's Signa[urc: � Ronald L Vieceli,owner Northwest Sanitary,lnc / ,//,w G U�.f. Pumper's Rcgistralion Numbcr: #2389 Rcv.03/2fi/13 i . � i • r � � � � � + - • � 1 � . . .: � __, . , , • . . • � � � ` � 4 : 1 1 • • : .- . � �� � .::, , � �: • • • • 1 t t � . - . �� i . � ' � . •-:��w ���i � �� � �.a. z �i � .��t ��� :.e,�.� 1 r _',��� - .� H;f.y � : , .` ': e.:. :�. � .' .�r.:":,�P.�� �I " 1 �: � r; _ t I: I�. 1�1-Y �' �r �111 ! - �iY, P .LI � - � • _ 1 � I � i :l •' � � � _ ' � 1 �v * � � � � ' � �. � ' � ' �� r � � = ���.��� ,�� : - � - s.:��t .r r:, : i i - _:� �� - ��:.-.�r ..�c� � . � � •�. � . •:�.� �-.i � . � t -: ... � � - �. . _ -- '=� �.•- •� i - t. �7� r r., ;� �.�.��, u r- ��•- _.1.1 I r h�- a��� I� 1. .. :�. 1� �' • � ' • :�►r�..� -! .e a`. a �� •r f��. 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