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Home My WebLink About002-127-00-0102-SAN-2022-187 -��' Department of Safety �°""�' e (�� .wy � � & Professional Services, � ., a - Sanitary Permit Number(to be filled in b � �, �: � Industry Services Division � 3� � �,� '-. State Transaction Number �, Sanitary Permit Application _ � In accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate governmental unit � is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS aze submitted to Project Address(if different than mailin� q� the Department of Safery and Professionai Services.Personal information you provide may be used for secondary \ purposes in accordance with[he Privacy Law,s. 15.04(1)(m),Stats. ,3 I Z N ��-�'� �� I.Application Information-Please Print All Information Property Owner's Name Parcel# J�� I �S�ne A�I�c.rM�,'}{' Oo2,- l2 �•ao-0 I o Z Properiy Owner's Mailing Addrress Property Location r�(� ! f fn�/'he..q?' �}v� 6e�t-be6-� City,State Zip Code Phone Number ST' ��^�f MN S.�r C�S � � Section 3� II.Type of Building(check all that apply) [,ot# T y0 N R � y E or �1 or 2 Family Dwelling-Number ofBedrooms -1 1 Subdivision Name (y� � �� B�o�k# a.<t o�;�.�s Pa�kS�..��C . c�'�- ❑Public/Commercial-Describe Use ❑City of ❑State Owned-Describe Use CSM Number ❑Village of q/�3 Z � I g 1 u g�ro,�of �.r s � �. III.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check ooe box on line B.Complete line C if a licable A �Replacement System ❑ Other Modification to Existing System(explain) � ❑ Additional Pretreatment Unit(explain) B' �olding Tank ❑ In-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑ Other Type(explain) (conventional) C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Frevious Permit Number and Date Issued Expiration $p� -. �� ` �� l� IV.Dispersal/Treatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpcUs� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation �o� N� N�+ � � Capacity in Total #of Manufacturer Tank Information Gallons Gallons Units � U V „ � N ^ New Tanks Existing Tanks '�» c � �' � � � � a. U v� � ci� u: C7 Gi. Septic or Holding Tank QO U 3 p O n � W 1 C$e.l x Dosing Chamber V.Responsibility Statement- I,the undersigned,assume responsibility for installadon of the POW'I'S shown on the attached plans. Plumber's Name(Print) Plumber's Signatu e MP/'v1PRS Number Business Phone Number p (� s�t,�c+�z t�'I 6 (L � 7�S-sS�'-S`��y Plumber's Address(Street,City,State,Zip Code) 7e T G.N g.f.arti.� �..�c.c, � � S�n� ��.� vJ � S�ra 71 VI.County/Department Use Only Permit Fee Date Issued Issuing Agent Signature ❑ Approved ❑Disapproved I - , , ! ❑OwnerGivenReasonforDenial $ / �� $'`S I �a �'�"�1 0^f�it�,� Conditions of Approv`a�lYReasons for Disapproval �. � � �� J �y . � �� S �a_ � '�� ate � � �:!�3�._..�,�a._.__�,._. .., �UG 0 3 2022 � 1 �.hk#� ._ . GS��°-1� `�. �,� W� �d �- a-�'`�l� SAWYER COUNTY v � ZONING ADMINISTRATION Attach to complete plans for the system and submit to the County only on paper not Iess ao 8 lrz x 11 inches in size NO REFi1NDS AFTER SBD-6398(R.03/22) 1$$UE�F P�{�lll'� Sawyer County Zoning & Conservation Administration �� 10610 Main Street, Suite 49 � .� _T �� 1� Hayward, Wisconsin 54843 � ' �� „�� (7 I 5)634-8288 � ��i�� \t°,�j FAX (715)638 3277 � / s �� =y� t��titi_�� »�c�cou��o�-_c,i r j � � : �� , i E-ma�l zqn3�7� `�c'.�?;�.iu�uc�_ua�1 soc t'�r;� I� �� Toll Free Courthouse/General Information 1 877-699-4110 I �_ ' �� ; , ti.�� ,�.. �4�\�� Aolding Tank Approval Checklist I. Sanitary Cover Sheet Date Stamp � � / �3 / � � Parcel ID# O O � _ 1 �� _ D D- O � Z�� ll. Plot Plan � x Property Lines � Benchmark BM ♦ �Site Address /North Arrow � Structure � Scale � Well � < 25' to Service Road � Legal Description � Nearest Road Intersection � Setbacks to: Properiy Line, Well, Structure, Water bodies, Roads IIl. Required Plans _ X Index Page with Original Signature Management Plan/Contingency Plan _ Servicing Contract � Holding Tank Agreement form N. Holding Tank Specifications X Cross-section - Manufacture, Gallons: 1n��erlu' 3.� � Tank Anchor Calculations [SPS 383.43 8) g)] K 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) � 3" Bedding Material < 1/2 " V. Holding Tank Plans per Component POWTS Manual � Versionj� SBD-10855-P (R.3/07) , . , a.� Owner: � ��-v�4'�' Plumber: Sc.-�n� �'1'� Application Review Date: 0�� 'S �a .Z POWTS Reviewer: �� Namc (�� ( � Liccnsc# Revised 4/11/2013 PAGE 1 OF 4 Holding Tank Plan Index & Cover Sheet Component Manual Design References: Holding Tank Version 2.1 (May 2022-2027) 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 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 OwnerName(s): �� £ A-�1�^� ��rMR`� Phone: OwnerAddress: �ysg F4"(M�m� a�� s�' �4� x'� Zip: SS—ias Project Address: �3�2 N �w,Gc /� Govt.Lot: 1/4 of 1/4,Section 3 S ,T yU N-R a 5 E❑or � Township: �"SS �G� County: Ssuy� Project Parcel ID#: °p 2 1'Z 7 ou c!02 Designer Information Designer Name: Phone: - - Designer Address: 7076N Stone take Rd Z�p: one a e, E-1i181�: MFRS 1516129 �Lli1s sptue reserved tor�ppro�al stain�,. License Number: ��l��Z�1 Remarks: Signature: Date: �'� —�� 0' i I signat required on each submitted copy. CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. � SOIL EVALUATION o Scale: 1�ao� � 80 � SYSTEM PAGE 2 OF y SITE MAP PLOT PLAN l PROJECT NAME: �a, DESIGN FLOW: �� GPD Attach design flow calculations for commercial plans. PRodecr nDDREss: '�—] 3 i Z (v �� H Pipe Material/ASTM Staadard(Tables 384.30-3 8 384.30-5) N Sanitary Sewer 5�5 �/U l BM Symbd: � BM Elevaflon: � FT Face Mairc / BM Deacrlp�lan: md�cete nann by IMPORTANT: Siope Greoierrt(%) �ry��yymbd(Rapp11ca01e): Q arawmg a�a�,o� Show ground elevation contours at suitable intervals. of Testetl Nea: an ihe epproprke line. '^— QDZ IZ� (� ODIDZ / � v w e � J--- -, - _ - �. � �—�� rp�s�� r ��;� � Ho,.� LCd / Sen,t�e " S � Pw.�� o �✓iaa/ � �� -!� ��,� 300o NT' N� wel� �� hue l.� Dy�an Schul� 7076N Stone Lake Rd Stone Lake, WI 54876 MPRS 1516129 PAGE30F4 HOLDING TANK SPECIFICATIONS (No Scale) Weatherproof 12"Min.or 2.0 ft above Jundion and Approved Established Flood Elevation Alartn Box Vent Cap (tyP�� Eledrical must comply wi�h 1 Approved Locking Manhole SPS 376 and NEC 300 4"0 Vent Pipe � with Waming Label Attached Conduit >10 ft from (ypical) 4"Min.or 2.0 ft above Building Established Flood Elevation (typicap Aidight Seal . Finished Grade 18"Min. (�YPical) ��:. � .. � y . . . e " d Inlet Inletinvert Watertight Appmved Joinfs with Plug Approved Pipe 3 ft onto � Max. 12"or 90%of total volume Solid Gmund ' if more than one tank e " Alarm-0n : : HOLDING TANK VOLUME _ �dOO gal . , a . - , � . . 3'Approved Bedding Material Beneath Tank TANK MANUFACTURER: `J� GSR� Anchor tank as necessary pursuant to SPS 383.43(8)(g) Ballast Weight= [(cu.ft.tank.vol x 62.4 Ibs/cu.ft) - Ibs.tank.wt]x 1.5 Ballast Weight= [( cu.ft. x 62.4 Ibs/cu.ft) - Ibs] x 1.5 = Ibs 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) shali be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, ail inspection and maintenance activities shall be performed by a registered POWTS Maintainer in acxordance with SPS 383.52(3), Wisc. Admin. Code. Estimated Daily Wastewater Flow= �� gpd Insaection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors(i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatlgue (i.e., leaks, breaks, corrosion, etc.) o negiect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) 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 government unit in accordance with SPS 383.55 Wis. Admin. Code. Report any component failure or malfunction to: Name of individual or com an 'V��h S��`° �` � Phone: ��' �� S � � ( P Y� Local government unit: Sti"'`/ �� c=�� 2'"'y Phone: 7'��" 6j v- �z�`� Local government unitaddress: Im 6fD Mw,� Sk I'�a7 ti�r� �.v� Z�p: SY�'�l3 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. Svstem Abandonment If use of this tank(s) is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. � �� j% ZZ� ^ �' r; =D Sy � �i � KY 7�Y N� =N i � J Z �y� r � r �� P �� ! ��$ ��ss�' t sF � �'Q �$� �*� � 3 � r �o , . � � �� ' N � � i i � ; � �'� r �.�Q ! ��i:; - a i r itp I_P ! _ � . : ,,:_ HOLDING TANK SERV[CING CONTRACT Contract Date: Z!�/ 20 2� This contract is made between the Holding Tank Owner and the Pumper. Holding Tank Owner's Name: Pumper's Name: —nhn ,�. �n�� SI��rM�-�- SG�� 4�� P(�e Parcel IdenHfication Number: (12 Digit Legacy ID) 0 d 2 _ I L 7_ o o _ m 1 p 3 l. The owner agrees to Sle a copy of this contract with the govemmental unit, Sawyer County, which has accepted and recorded with the Office of the Register of Deeds,the Maintenence 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 ro pemut 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 fiuther agrees to pay the pumper for charges inciirred in servicing the holding tank(s)as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the Govemmentai Unit,Sawyer County,a report for the servicing of the holding tank(s)as required under SPS 383.55,Wisconsin Administrarive Code and the Sawyer County Private Sewage System Ordinance. The pumper further agrees to include the following in the repott: a. The nazne and address of the pe�on responsible for servicing the holding tanlG 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. rhe disposel sites to which the conterns from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper teiminates this contract. In the event of a change in Uus contract,the owner agrees to file a copy of any changes to this service contract or a copy oFa new service contract with Sawyer County within ten(10) business days from the date of change to this service contract. hvner's Name: (Pdnt) OWIICL'S SlgRfltill'e: (OvlyoneownvaignaNrcrequired) ` � �/� �t �-.�� '`� .��,,-, ��,,,� � � Pumper's Name:(Print) P er's Si re: � �� 3 Pumper's Registration Number: � ! 8 I'� Rev.0326/!3 i �i�i iiii� iiii� iii��i:iiiii B 0 6 1 6 G 3 -USE BLACK INK ONLY- ?x:40396;0 POWTS MAINTENANCE AGREEMENT 440454 PAULA CHISSER For Holding Tanks REGISTER OF DEEDS SAWYER COUNTY, WI Owner's Name�s)as shown on deed: �J7 j 29 J 2022 O 1:21 PM ,501�✓1 1� p( f�nn � I RECORDING FEE 3�.00 ��f A7'� Parcel Identification Number. � n PAGES: 2 (12 Digit Legacy ID� � � � - 1 C � - � 8 - � 1 o Z Legal Description of Property: -SEE ATTACHED SHEET- We acknowledge that application is being made for the insWllation of a holding tank(s)on the property described on the attachetl sheet. Retum To:Sawyer CountyZoning antl Conservation Administretlon 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,alartn and access,and agrees to conform to all applicable requirements of SPS 383,Wis.Adm. Code relating to holding[ank 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 govemmental uniL The owner further agrees to file a copy of any changes to the service contrad,or a copy of a new service contract,with the govemmental unit within ten(10)business days from the da[e of change to the service contract. 2. The owner agrees to contract with a person licensed under Ch.NR 113,W is.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 govemmental 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 healih 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 14520(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 Sec[ion 66.0703, stats. The owner agrees to pay all charges and cost incurred by ihe governmental unit for inspection,pumping, hauling,or othenvise 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 wiil remain in effecl only until the govemmental unit responsible for the regulation of private sewage systems certifies that either a soil absorplion system that complies with SPS 383,W is.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 wili 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 agreemeot to be determined by reference to the property where the holding tank is installed. �Onlyoneownersi naturere uired- ACKNOWLEDGMENT Owner' ' natur .�� _ _ � State of: �.�� S fo yl S � h County of: S�WN P r' Qyv 'eL Name(Print): / ,,r �b� ''��<<�� Subscribed and swom tp before me on this � O� L. l 7�/m�i� �7'��`Y Cl.�, ✓v 29 day of Sa I , 20 01�. Date: � ,2�I� Z L � By(Owner's Name): �� h n �tc r �y,a Notary Public Signature: �s 1E�c-,�y, £c DraRed by: 1 1 Public Notary Name (Print): �;sa Ho�+i,,, �o �lity J� � Sc�� IT2 `"� My commi�0�8fPiX8R��i°Ce�iryrvriis��ta s0.1 S 740.10 (1) (f) and (2) County Clerk Personal information you provide may be used for secontlary puryoses�[Privacy Law,§15.04(I)(m�] Rev.03/26/13 Lot One {� � pf G�rtified Surv�y �iap No. � 894 in Va� ume 9 , Page 13�, as qacument No. �184a'� �1 , Part of �a� CJne �1 } ' �� Su �divis�an o� I�ots �i & z Gourt areil�es Park, Gove�t� ment .l...n� �.a�� ,��►r �� "��r�� , �'�'rr�`t��r ,�`�r� �'�f�� North, Range N�ne �9} 1�est (in fhe To�nrn af Bass Lake} , Sawyer Coun�y , 1�Vl. ll..__.__. . .� . .� . � _ . _ . _ �� a- i � � � ao - T� � C � 8I5/22,1:59 PM Real Property Listing Page Real Estate Sawyer County Property Listing Property5tatus: Current Today's Date:8/5/2022 Created On:2/6/2007 7:55:02 AM �Description Updated:5/19/2020 'u Ownership Updated:5/19/2020 Tax ID: 887 ]OHN E&ANNE ALTERMATT ST PAUL MN PIN: 57-002-2-40-09-35-5 15-176-000102 Legacy PIN: 002127000102 Billing Address: Mailing Address: Map ID: -17.1.2 ]OHN E&ANNE ALTERMATT ]OFIN E&ANNE AL7ERMATT Municipality: (002)TOWN OF BASS LAKE 1959 FAIRMOUNT AVE 1959 FAIRMOUNT AVE STR: 535 T40N R09W 5T PAUL MN 55105 ST PAUL MN 55105 Description: COURT OREILLES PARK SUBD OF LOTS 1 t� &2 PRT LOT 1,LOT 1 CSM 9/132#1894 r Site Address 'indicates Private Road Remrded Acres: 0.950 7312N PARK LN � HAYWARD 54843 Calculated Acres: 0.977 Lottery Claims: 0 l.�Property Assessment Updated:5/12/2021 First Dollar: No Waterbody: Lac Courte Oreilles 2022 Assessment Detail Zoning: (RRS)Residential/Recreational One Code Acres Land Imp. ESN: 407 G1-RESIDENTIAL 0.950 209,800 0 2-Year Comparison 2021 2022 Change ��Tax Districts Updated:2/6/2007 Land: 209,800 209,800 0.0% 1 State of Wisconsin Improved: 0 0 0.0% 57 Sawyer County Total: 209,800 209,800 0.0% 002 Town of Bass Lake 572478 Hayward Community School District 001700 Technical College �property History � N/A • Recorded Documentr Updated:5/27/2020 WARRANTY DEED Date Recorded:1�/29/2018 415109 TERMINATION OF DECEDENTSINTEREST Date Recorded:10/29/2018 415108 WARRANTY DEED Date Recorded:10/18/1982 184421 344/105 https:lltassawyercountygov.orglsystem/frames.asp?uname=Eric+yyellauer 1/1 s� �: iP� � i i � j � a 2 � '� � . � �. .s �4 � � �y �f1�( ' f �F �TFl�Y � M ��A. . �� / � / �'`1 �'��'y�� J � ' ��'��l•. �� •F' �,{ Q� 7� i �y i_ __�/,, .;l�}7i� .e �, i . �� . . _ f� �_��w ,�:S��{J >Y . �� ,J� i�• �i6 � F i�''St �r. )f ( �.'Fy-v'�`. .� . �.1 ' ,1 J w , �::' �/'.. 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