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026-126-00-1400-SAN-2022-303
b � SAWYER COUNTY ZONING & CONSERVATION ADMINISTRATION � 10610 Main Street, Suite 49 � Hayward, Wisconsin 54843 � (715) 634-8288 0 sanitarian(a sa���crcount�•�o�.or� � COUNTY SANITARY PERMIT APPLICATION In accord with Chapter DSPS 383,Wis. Adm. Code and Sawyer County Private Sewage System Ordinance APPLICATION INFORMATION—TYPE OR PRINT Property Owner's Name Property Legal Description ROBERT M & RITA V OLSEN _' Sec.23 ,'['wp.39_ N, Range 09 _W Property Owner's Mailing Address Lot Number Block�'umber 9058 S M EAD E 14 City,State 7ip Code Phone Number Subdivision Name or CSM Number�� � � OAK LAWN, IL 60453 � � �k 93S ai �► � .S" TYPE OF BUiLDING: (Check one) ❑ State Owned ❑��ry n�ca�cs�Road Ma�de��a�e Public 1 or 2 Famil Dwellin No. of bedrooms 3 ❑v;ua�c � � y � -- �TO`�����+Sand Lake �'ire Number 5935N PUBLIC BUILDING/LAND USE: [Expla;n rhe use/purpose for rh�� Pareel Tax 1\'umber: (12 digit legacy number) pem�it,(i.e.,campground,festival,recreation/entertainment event etc.)� � � � ,� � � � � ,� 4 � � TYPE OF PERMI7': Additional Information: � YOWTS Reconnection(SAN# �s _ o�s � ❑ POWTS Connection (SAN#_-_ ) *Attach a Plot Plan with all requircd information per SPS 383.21 ❑ POWTS Revision(SAN#_-_� ❑ POWTS Repair(SAN#_- ) *Soil Test Information(CST# 8� - �9e ❑ Other: _ * Gallons per day� RESPONSIBILITY STATEMENT: I,the undersigned,assume responsibility for the installation of the POWTS activity for which this permit is issued. Plumber's Name:(Pri�t) ,ignatur MP/MPRSW No: Business Phone Numbec Travis Butterfield 652879 (715)634 -8176 Pltttnber's Address(Strcet,Ciry State,'Lip Co 14346W St. Rd. 77, Hayw d, WI 54843 OFFICE USE ONLY: �V�g ❑Disapproved Revic�t'Date: Perniit Fee: Date Isstted: Issuing Agent Signaritre �Approved ❑Owner Given Reason for �� � � ��,� � � a ��� ��/ Dcnial � � �� � COMM ENTS: **Expires 2 years from date of issue** Expiration date: � D �� ���`-{ CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: � �P-•;,.;���,,,-:-�.;-,�:---- .�-�.� � L� 2.�/�`�—�2� �-�_.�-��`:�`�� ``fI §...�..�A.. + ! �:.� V �f � , � ����� � _,c..C.4;'_. `.�_.` I��o�c� .. . P ,i 1 � � ��� J �.`� � �� �_�,_ �C��Z �Q �03� �- - aCT 17 _J CS� �� I�o I.vor�l I ���7Cv �� YER C��:NTY .. . ., w . - .,. Rev. 04/21/ . .�°�-.._�_.._ ___._.. ..._�.. - � ii7t�liE�!�f�n�!i�!l�TEi t�— �(��ti� NO REFJNDS AF1'ER ISSU�OF PERMIT Aii�i!fluiJ�1L CUP�ti�1ENT� Ai�G S�tFIC:1; ��Ii;TI�'+�i ✓!'fiy�ir I'�,J�YI:�4•'1 1�_OI� ._... - C.'��.�-�jS� Ca I�. � �� �'`�� �--- ___ aQ�k � ��. � .�.� . � �� � � � � , � 3�r ��t``t - -- '-'--- ��`'�q , N1 N. ~'l ��_ _� �o � ► I� .►aS` �a � `,� d� ���'�Iv ��'� (�- �--� 3 v� �� }��r 5 T I ,�, 5�,�o < -,s�l . y, w��'f� 3' � \ \ \ ¢x�' n�d- ; -�.— � � i � � Industry Smices Division Counry 1400 E Washivgton Ave �,�..w.�.:.,,�-- P.O.Box 7162 San@ary Pcrtnit Numbc(w be filled in by Co.) Madison,W1 ti7n7_7t6z � 87-i�8 588113 Z Sanitary Permit Application � S'°"T`"'u°"`°"N"'"°" - t� `�88- �o�S-7 ` In accordnnce with SPS 36311 2,Wis.Adm.Code,submission of this Crnm to the appropriaze govemmrntal unit �` is requimd prior m obtnining a snnitery permit.Nate:Appiication Corrtu fm state-ownnl POWfS ere submitted to Project Addms(if ditferent thmi mniling eddlese) � the Department oC5¢fery and Profasiond Srnices.Prnonel infotmelion you providc mny be used for secondan• , C u in eccordance with ihc Privac Lnw�,i 3.04 l m Stat�. L A IlcadouIn[ormaHon—PleasePrintAlllnformatloo ����1 5`-� /L' /Jla��e..� �-.�.� C Property(hmtt's Yamc Pucel p ) p..�,.\.w.o' �ki'l "� �\.".�-� Li\��• ,�� L�J(:jl,��cC:L. �cL . ....y....�ON9a'S Mld16g AEEfGSS PMpCRy IACLt1On ��-�� `� 1�71 t c-.�c�L. Govt.Lot Ciry,State Zip Code Phone Numba +/., Y.,Sation .,� 3 L'�- �: L<,�..:,..� L l G�ys-s �. �_ c�����,�, D.Type ot Bullding(c6eck ell that eppiy) �.o�ry i 3 � N; R -� E o�lV` �or 2 Fnmily Dwelling—Number of Bedroam� � aa�� /�� Subdivi�ion Nemc III«kp ���i:��l��-°�•.:�� ��<<<�, `%�:�c� ❑PubtidCommacid—Describe Use 2�•-) ❑Ciry ot ❑s�m o.ro�a-�;�vx A:-1 cs���,� ❑wu.��or �Town ot �.._._:.� �--../<V .. ID.Type af Permit: (C6eck ooly ooe bo:on iine A.Complete ilne B If applicable) A� ❑New S stem y ❑Replacemrnt Sya�em Trcam�mUtfoMitig�Tank Replecemmt Only ❑W�er Modificmian to Existing System(crzplain) B• ❑Prnnit Rmewa! ❑pertnit Rwision ❑Change of Plumber ❑Prnnit Trmsfa to New L'ut Pmiou�Pertnit Number and Date Luued BefineExpiration Owntt �''(.�_C.���.. �j (3 �C� IV.T e ot POWTS S tem/Cam onenUDevlce: Cbeek all t6at e I ❑xo�-r�:�a m-cro�a ❑r+��.�,�;��a�-c�o„�a ❑u-c�a� �owa>zo�.ot�,rc�ni��a ❑Aloimd<24 in.ofsuitable wil ❑Hoiding Tnnlc ❑Other Disyvsal Com�wnrnt(euplein) ❑P'etreatmrnt Device(enplein) V.DU endlfreatment Aree Inform�tlon: Dcsign Flow(gpd) Lksign Soil Application Rete(gpds� Dispersal Aree Rcquircd(e� Dispend Mea Proposed(aQ System Elevation �C�_� �,(-�� /C'����� VI.Tank info Capeciry in Tatei N of MenufeMurer Gailom Gallon� Units �E �� u New 7edu F.uaing Tmts e o � �i�1' � 6 U �ri�3 in :�.C� C SepncmHoWneTWc �OOO I �-,J GcJTf LG•v Daiog C6amber (�00 VII.Res ondbllity SGtement-1,tbe uodenlQoed,�uume mpondbllly tor Imhll�don of the POWTS shono 0o the�nached lens Plumba's tiame(Prinq Plumber's Si �.MF�RS Number Bminess Phone Numba JERRY RUID SOIL TESTIN � �, �_ _� ��i-� : „ � `1( �ii 5= ��1:�. �'�(c�� Piumbv' Ad �Rd<) �� �tone a e, o VIII.Coao /De ertment Uae Ool �Approved ❑Disspproved p���F« Daic lasued iesuing Agent$ignaturo"�' � � ❑awtt c;�«�a�ra�,� S 50•DD 3-l'7-l(� �jU/h/�aJ DL CondlHom otApprovaVReuom for D6�pprovd � NO REFUNDS AFTER ISSUE OF PERMIT Attach to mmpkte plm�(or Ihe ryitem aeA�abmlt 10 Iht Cuuoty ony oe paper eot leu tE�n!1!1 s l l Inchn In da SAD�6398(R.OB/14) ",��, , _ � �i. .� ��J <. 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' fr' 't p."-� �ar;C>Y � �� � '�.W �y''�+ .r , •. � 'r .v'' �° _ "'+� ' , M� '�a1��'. �' -?�,i �' , _ ., f. ,r .�!� ' �{' �t w 'k ilyJ. .J}'.1 _:_ r . . �', �,. ._}• � � � • �* T i -��� �I.��J�'- '�J� J �'I� f'�+ fr .i 91�iz� � ---r- r~ _K'� � ' ►:•�y �a 1 ri,'+, J � 7 5• 4� ._ ..i' � � � ..1 h�� Y�'� _ �•� .�, . �'.���_. : a i s ��I �,` �" �� �yYr t' A: .:.iF _ �"+ �r. �", , .F;f� ;.�" , ' �..-,�'.-' �: ,��07R3JfiC���1�t��y a�-�, �ri��. �. - - a,`+.+. .i � _ r f_ ;.r _ _ ��_m� , I'� I 1 I I I I I 1 I I'� I I I�I 11 I I'I DocId:80�445�� - USE BLACK INK ONLY - Tx:404?=#lU POWTS MAINTENANCE AGREEMENT 441881 For Statement of POWTS Capabilities REGISTER OF DE�s Owner's Name(s)as shown on deed: SAWYER COUNTY, WI 1OJ18/2022 10:02 AM ROBERT M & RITA V OLSEN RECORDING FEE 30.00 Parcel Identification Number: (12 Digit Legacy ID) 0 2 6 - 1 2 6 - 0 0 - 1 4 0 O P��ES' 2 Legal Description of Property: -SEE ATTACHED SHEET - We acknowledge that application is being made for the installation of a holding tank(s)on the property described on the attached sheet. Return To:Sawyer County Zoning and Conservation Administration 10610 Main St.Suite 49, Hayward,WI 54843 I (we) understand the POWTS serving the structure on the above parcel located at: (fire number and rOad narpg� 5935 Maiden Lake Rd was designed for the following capabilities: Treatment Tank(s) Approx. �- GPD, Soil Absorption Cell(s) Peak .3 ao GPD Permit Number SAN 16 _018 Year installed 2016 �qg$ �2� '�(p't- "�°r' �au R Y The POWTS serving this structure is,�?resently sized to accommodate a total of -�— (-�-- ) people, in a dwelling containing �� (�) bedrooms. With the addition of bedroom(s), the estimated daily wastewater flow of the structure will be based upon per capita occupancy rather than the total number of bedrooms. (75 GPD per Person) WI 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 installation of a code-compliant POWTS with the installation completed as ordered. -Only one owner signature required- ACKNOWLEDGMENT O ne 's Sign ure: State of: (.0 iSG a-v�S-i v-� County of: Sc,�-� -t..Y- Owner's Name (Print): Subscribed and sworn o before me on this ROBERT M & RITA V OLSEN _ 1 � day of C7C�vinz.r , 20 2�- Date: By(Owner's Name): 1��-a a\S-r�� �a �� 2 Z Notary Public Signature: Drafted by: �,�'�a�HWtl�� Notary Public Name (Print): ' C� Ktl l., L��..,-+}er-��,lc�i _ =�'�PUB��C i�I���/My commission expires on: 3 2 i� �Z �����1 Q i Personal information you provide may be used for�con ary p����'riv q�L�,§ 15.04(I)(m)] Rev.03/26/13 '�� VV `�` =i ',I��►q��sjq TE OF s��5c.,�s �►N1W����������� Highland Park Subdivision Lot 14 S�mp added to �apt�ce 1ma9e �D� m oevtu�e imaoe 10118/22,9:46 AM Real Property Lisling Page Real Estate Sawyer County Proper[y Listing PropertyStatus: Current Today's Date: 10/18/2022 Created On: 2/6/2007 7:55:45 AM �Description Updated: SO/11/2013 � Ownership Updated: 8/6/2015 ---------- - Tax ID: 26794 ��� ROBERT M&RIfA V OLSEN OAK LAWN IL PIN: 57-026-2-39-09-23-5 15-126-001400 Legacy PIN: 026126001400 Billing Address: Mailing Address: Map ID: -6.14.1 ROBERT M &RI7A V OLSEN ROBERT M &RITA V OLSEN Municipality: (026)TOWN OF SAND LAKE 9058 5 MEADE 9056 5 MEADE STR: 523 T39N R09W OAK LAWN IL 60453 OAK LAWN IL 60453 Description: HIGHLAND PARK SUBD LOT 14 1� Recorded Acres: 0.775 r Site Address * indicates Private Road Calculated Acres: 0.833 5935N MAIDEN LN �� �STONE LAKE 54876 Lottery Claims: 0 First Dollar: Yes l.� Property Assessment Updated: 9/28/2017 Waterbody: Whitefish Lake 2022 Assessment Detail � � � � Zoning: (RRl) Residential/Recreational One ESN: 423 Code Acres Land Imp. GS-RESIDENTIAL 0.775 147,900 55,300 �� Tax Districts Updated: 2/6/2007 2-Year Comparison 2021 2022 Change �1 � � � State of Wisconsin Land: 147,900 147,900 0.0% 57 Sawyer County Improved: 55,300 55,300 0.0% 026 Town of Sand Lake Total: 203,200 203,200 0.0°/a 572476 Hayward Community School District 001700 Te�hnical College �y tl3 Property History .. ...___ . _.. .. . ._ . __ _._.. �� Recorded Documentr Updated: 8/24/2022 N�q � -� � � ��-�� �-- . .._ - ----- —._._._... .. . _ . WARRANTY DEED Date Recorded: 6/26/2015 396393 SHORELAND RESTORATION/PRESERVATION AGREEMENT Date Recorded: 8/19/2022 440873 TERMINATION OF DECEDENTSINTEREST Date Recorded: 7/16/2013 386111 WARRANTY DEED Date Recorded: 10/17/1972 142064 239/684 https:Ntas.sawyercountygov.org//systemlframes.asp?uname=Eric+Wellauer ���