HomeMy WebLinkAbout014-280-00-0100-SAN-2022-339 ''' ' Department of Safety c°°"ty c/1
' , - & Professional Services, �
Sani (to be filled in hy �
r
'.;�: J Industry Services Division �'Permit Num
,
F��� � 3«, 31 � �
�
Sanitary Permit Application State Transaction Nvmber �
u�accordance�vith SPS 383.?I(2),VVis.Adm Code,subrnission oFthis foim to the appropriate governmerital unit ^ W
is required prior to obtaining a sanitary permit Note:App}ication forms for state-0���ned POWTS are submitted to Project Address(ifdifferent than mailing a �
the Department of�Satety and Professiona)Secr�ces.Pcr;onal information you pro�•ide may be used for sec.rondary
pwgoses in accordance ii�ith the Privacy Law,s. 15.04�11(m).Stat�.
I.Application Information-Piease Print All Informatioa 0 l�{-2 �.-��-O I�U
Property Owner's Narnz Parcel l�
(Yl'i .5� ' S7' o'`���.�i-3s-�-
Property Ow�ner's Mailing Address Property Location `
� � ' Govt Lot
City.State Zip Code Pl�orn Namber
(� �'— � t� �/ r��� '/., '/,, Section_�
_�,�
II.1'ype o uilding{check all that apply} � Lot# T N R E or
�1 or'_[=amilyf�wciling-IVumhrrofBedrooms ���� � Sutxiicisionhame
Block� �
❑PubliclCommercial—Describe Use a �h.- o''� d
^ fl City of
❑State Owned-Describe Use - CSM Number ❑Village of
� �Town of ��,,f7'.��— ---
ID.Type of POWTS Permit:(Chec1:either"Ne�^or"Replacement"and other applicable on line A. Check one box on line 8.Complete fine C if
a ticable.)
A.
❑ Ne�•System �Replacement System ❑O[tier Modification to Eaisling System{explain} ❑Additional Pretreatment Unit{explain)
B.
Holding"Cank ❑ 1n-Grou� ❑ At-Grade ❑ Mound ❑ Indir•idual Site Design ❑Ocher"Cype(cxplain)
(conventional)
C- ❑ Renewal Before ❑ Reeision ❑Chan e of P3umber ist Pm�-ious Pecmit Number and Date Issued
g ❑Transfer to New Otvner
Expitation
�h�C. �
[V.Dispersal/Treatment Area and Tank Information:
i�si�m Eloce(�d} Ihsign Soii:lppiication Ratc.�{ep�'s fl Dispeesat Arc.-a Require�(st1 Ditpersai Arza Propaseci(sf} System Ele�ation
��a �-- r-- _.
Capacity in Total #of Manufacturer
T'ank lnformation Gallons Gallons Units � y o � �
iVZ1i'T371�C5 E7(ISilfl�t Te77�:S � ^ V J L vi
� U. �
� O i.�, u .D = c1
C U tn :n VI L. v G7..
Sep�ic or Hutding Tank O n/� „^„ �
(.JI.J (�� ��
Dosi�Chamber
V.Responsibilih'Statement-I,t6e andersigned,assume responsibitih�for iAstaltation of the POWTS sE�ativn un the attached pians.
Plumber's\ame{PrinU Pium - " nat i�fP(MP2S Number B�uiness Pho�m!�'umber
-�.
Piumber's Address(Street, ity,State,"Lip Code) � `" v '���
- �!nJ T �a.7c- �. a�, u1� ,�j�g�!*
VI.County/Department Use Only
� � Permit Fec Bate Issued Issuin A ent Si nature
�A- � d �llisappro��ed S € �
l 5 �q,� �
Q Owner Ciiven Reason for Ueniai vv.� � �.Z'C�I� ;� Lr�i'..�-Q��'f'�t�/L�,,_
Conditions of Approval/Reasons for Disapproval '
� � d � ��.�r�S:jS��
��=�-' !
� � '� ����_ � `� s �� � � i)'
� chk#__I ��� SEP 2 7 2022 �
G S�� nf�'�- ''����` 1�►`��...!%`�o r 1�l `���(p'� SAWYEP CO:;iVTY
x�• � ZONING ADf�91i�11aTRATIODG'
Attae4 tn eumpleEc plans fnr the scstem aed submii to the Counh onh on paper not tess than S V2 x 11 inches ip size z
`t.s� '��-'� 7
SBD-6393(R.03/2Z�
Sawyer County Z-oning & Conservation Administration
��������� 10610 Main Street,S�iite 49
� �� �� Hayward, Wisconsin 54543
� ��{s� � �I� (ili)6�4R�88
�� � ��' �,/ t Aa(715 fi38 3�77
��. � �
� ���.,�, �. � �r��U i,,�Ut_ �
� �.�-� � E in ul _:.! � r_ i� ..�� �.���.:�.
� ��.����� ' .. Toll rrce Cowthous�/Gcncral Informahon I-877-699-4110
�/ ; .,
p��\\�����
Holding Tank Approval Checklist
(. Sanitary Cover Sheet Date Staulp o`� _i� �.� i �..�
Parcel [D# � I_ �- 2 g � -D � -o � O c7
I�. Plot Plan
� Property Lines �Benchmark BM ♦
��� Site Address North Arrow
� Structur� _�Scale
_�Well � <?5' to Service Road
/ Legal Description �Nearest fZoad I��tersection
_� Setbacks to: Property Line, Well, Structure, Water bodies, Roads
![l. Required Plans
� Index Page with Origu�al Sibnature
�Manage?uent Plan/Contingency Plan
_xSe:-vicing Contract �2�7��.� I �
� i���din� Tank Agreement fo�m
7V. Holding Tank S��eci�ications
_ n Cross-sect:cn—Manufacture, Gallons: w'e�r 3�°�
�( Tank .A_�chor Calculations [SPS 383.43 8) g)]
_�Locking device, chains/lock�
� Alarnz ar,d Electrical per NEC 300, SPS 3l6 & 383.43 (9) (e) and
State Statutes 101.862(2) and 101.862(3)
� 3" Bedding Material < 1/2 "
V. Holding Tank Plans per Colnpollent POWTS Manual
� Versiol�,��SBD-10855-P {�.3/0?�
? I • �
Owner: `���nSV-�_----____ Plumner: .7�`^�
— -----..-- ---
Application Review Datc: �� l �� ( a �
_ __-----_ _--- _—__—
POWTS Reviewer: '
----- --
—---- --
N���„�
__ ___ 6�_��_�
i.���,s�� —
Revised 4/1 l/2013
. �
PAGE 1 OF 4
�al�ftng T�nk R�a�
�n�fe�c � �o�er �ne��
Con?po nt Manuat Design References:
`Jersion 0, SB�-10855-P (N. 03%0?: R 01112� .
. ,
Pg 1 of 4 e�.` index & Cover Sheet
�g Z Qf� p1�t P�an
Pg 3 of 4 Holding Tank Specifications
�g � Qf � (1�a�agernent �I�n
Attaehments: ; Enctosures:
_ ; POWTS Application for Review
_ ; Soii Evaluatian Report & Site Map (if applicable)
; Hofdin� Tank Pumping Contract (if appiicable)
" 1��1t��nu �� ,f�_A�?-�emert (�f appli���fe�
Project Name / Description
Owner Name(s): (�,`V' �.� S,�(JY�1]`51G` Phone:2�- ��J��,�7�P�
;�i11i�1�= A��r�s�_ V�J3(� ! Y���A��..p-�._�`�l.�l�i,,'1QIz1��(t!t ���?= __��---
Project Address:
,r--i �—�--;
����. ��t: ';i�: �3f 4�d ��rt�r�;���, T�;�!--�. � E i_ 1 t J- '•L:� �;
Tovvnship: �"�0-� County: `aG��S�.(�
�r�►��=t '� � • -C���, �
�1rr�: 3�+� �'. '� — 9(� — �
' —��-�'--�-� 'J,--�---�--��--�-�U-��Q__ —_._—
Designer information
.
rt3S#C�1t"iP:" �'+�c��71�: _
""_.__...."__'__._'___ �`f,4�l I�4s. �i�V � l�-�/.—tJ.-.��c.��
� _ " -------- --- -
Designer Address:���7�,�f�� � r,�t�;0 �a/LQ� Zip: ���;�';3
�-•�t,ai�; �47Q.�� Gu`�
License Number: - '?��_ . _------------
����s��.
�
�' .-- ��__...__.._ _.
Siq�tature. ---- - -_- . _ Cate: -�
- ... .,��.v�S.,f�3Ii:�'..,_ , .''B(}�.�Fc:^^............... .,OL%; �
�L,,`�r�e.r - � �
, � ,
+fYl.�Gh�t,�t S• �r���• S
�9��� Gv, , L��rocr�''t,��p.
�����' �J "���� ��� �
� �� _ ��� :S'/- d��'_��'`��` ����-�
i'
��i,���, � �'��"� ,._, p �� '� ��"�`��t�00 l 0a
� t �` _ � �.� `i`.'�/�. 1�11 �,���
� � �'rfe; 153�� v� R.�S !��s �-
�c�� \ ��h'a'1 �an�c� Nv�;�'-t►���
, ._.__________-___---, �
E I
� i,
` � � _ ..---_'"�.
_..
` . �,.�b/y� � _.�
� � e'� o
�f ---____, r - --____ _ �
� � �.���- �/
� ' . �
� cU.�r`�,� � ��,�,E`�-�
� } # �
�---_ ---- - -—
� � .,.;
�r---- � , .
s'�__: �a�i£`�—�
� \ {
1
.ti
//%- /
��
U\ �
�
I
i
� nS � #
� �"� �w ?
; •, � ;
� •'m �.;�: ( �
� � �� � ;
� ;
�
! ;
� �_ ______.- ,
a ;
s
� . !
i f
� !f
t
� �
!
# J�
� S
�
1
� e � � �� � S ��
PAGE 3 OF 4
HOLDING TANK SPECIFICATIONS
(No Scale)
LVeatherproaf 12"Min.or 2.0 ft above
Junction and Approved Established Flood Elevaticn
. Alarm Box Vent Cap (bPical)
Elecincal must comply with � Approved Lockiny h1anhole
SPS 316 and NEC 300 4'm Ven!Plpe with N,�aming Label Attached
f—Conduit >10 f[fmm (fypicat) 4'Min.or 2.0 ft above
Building � Established Rood EIe�alion
(rypical)
_ �Airtiyht Seal �
� Finished Grade
18"Min.
��YPical) ..
� � 8.
Inlet ' Iniet Invert �yVa[ertight
Approved Joints with� � Plug
Approved Pipe 3 tt onto � '. �N�ax.12"or 90',0 of tota{volumc
Solid Gmund ' if more fhan one tank
a
Alarm-On
HOLDING TANK
VOLUME= 3,l�� gal
a
3"Approved�edding Matarial Ben=atn Tank
TANK MANUFACTURER: WIESER CONCRETE
Anchor tank as necessary
pursuant to SPS 383.43(8)(g)
Ballast Weigh!_[(cu.fttank.vol x 62.4 Ibs/cu.ft)-Ibs.tank.wt]x t5
Batlas[UV2i h:_ <�:7f�cu,f[.x 62.4 Ibslcu.fr �S 2 � �
g [( )- �� ies�X i_5� _=,�ibs
PAGE40F4
Holding Tank Management Plan
IMPORTANT:
The owner of this holdirg Yank(s) shall be resqonslble for its perpetual operaiion and maintenance pursuant to
requirements of SPS 382-384. `,Nisc. Admia. Code. Pursuant:o SPS 383.52 (2), Wisc. Admin. Code, ;his holding tank(s)
shali be ccnsidered a human nea!th nazard �f not maintained in accordance with £nis approved management plan.
FuRhermore, zl! !nspection and maintenance activities shall be per'ormed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3j,VVisc. Admin. Cod2.
Estimated Daily Wastewater Flow= /(nn gpd
Inspection Checklist INSPECT EVERY 3 YEARS
type of use
2ge of system
. nuisar,ce factors (i.e. odors. user como'aints, etc l
_ ��echanical mal�ur:ction (i.e., pumps. valves. switches.. floats. etc-)
, material fatigue (i.e-. leaks, breaks. corrosior. etc)
� neglect or imprcoer use (i.e_ exceeding design capacities. orohibited activities, etc.)
el�ctncal components (i.e_ wir;ng, cor.rectior,s, switches controis, timers: a!arms. eic.)
„ surface discharge of effluent or sewage back-up into structure served
SERVICING FREQUENCY
,. The tank(s) snall be pumped 'oy a certified septage servicing ooerator licensed under s. 281.48 Wsa Stats.
when the wastewater in the tank(s) reaches a Ievel of one foot below the inlet invert of the tank�s).
Disposal cf centents shali 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 indivldual or cemoary � �. .�T6� Phone: �%� ��'�(c7��
Local government unit. 2 _ Phone: ''���(O�CJ�—�'��'
Local govemment unit address�. � Z1P� 'r] �Q y�_
Any defective part of tnis system sha!I be repaired. reolaced. or removed pursuant to SPS 383.51 (1). Wisc. Admin.
Code. Repair or replacement c`faled cr malfurctlor,ing componen;s shall comply with SPS 383. Wisc. Admin Code.
No prodact`or chemicat or physical restora:�on of the POVVTS m2y oe used unless approved by the department in
accordarce with SPS 384, Wsc Admin Code.
ContinqencV P�an
In the event that any failed component of thls nolding tank(s) cannot be repatred. It shall be replaced pursuant to a
plar suGmitted?o the aoprcpriate acecy fcr review and approval
Svstem Abandonment
If use or t�is tank(s) is discontinued it shall be abandoned in accordanca wiih SPS 383.33. Wsc Admin. Code.
Y Y �.— � �h4� , s . S . :
t _ — •
. N � (_ ���� •. �_ ;aC.. `�Y+�tr '
—�'_ . H t4 ' _ " .y . A V� �t w� .
^R t� �y.�¢y�Q�a� ' � c4YK t i ' x '
�� . . ... n .�iy�� '.�.-rMuq�`..[ � y'���x��� L /'�l��J!� lv'.
W'. . �� ♦ • �}V wf. . �. rY:�t,;T� �1�� ^'
'`�a` � �,L � � . Y . .`nF ��n�= A�i �4 � A S �,�`.
.�, ��+, _�'�'S�� ��A `� y ��e �E. � ~� �y`�",��` '� S�.' ��?c
':'. �.� � _ r �4� �' {,�'^"9'���:. ��� 9J
_ ..�� �� �/ ��,�� �.,!' r�y.. {��. � '.� � p �� ' :.Y 4�
A s' ��A�'{ _P� "Y` e '
_�^!!�. #I. h ,t3C ' ;�e . �� � 4> '
�� `�, � r r � �+ � ...�
��� �+ � � �+� y'`l►� � � �;
- � , '"��" �,�� �' ��,� �. �.��� ;` � �.
'�'` 2 w�` i y , �} r., `�a ,�� ," ".,Ap ��y�. :
. � ���}t�, � #
:;;�1 k�l S�"`w w, � � �'�" �'fi+f " ���'
} � — ��9i �� �:�1:;, �,t ` ,', M
� _ l, '� i�' _ �'i'ZS 'ie+'^'f ����¢s�
. 9 ,�.. i�A� .� .m
�P w f
: i�•' �e � l � p _ ,Kf ..
I r a
z'.� � i � � ��.
�' �c: �,� `�e- ' s� t ? :x .d'> ^k%� � u
` :� . ' '�y, p �� �„ .���,� � �v
�,,,.�.�°'���1���}� ��:X�3 J���- �R '+�,i.�tYd.'a �°�'fQ'_"
� ��i., w �',rs h S�— M1 t_ . a ;6 ( J ' , � .�i sry Y�vhy ��s"4�,
y� s �5
-�����'k i � __ —F . -..� �� 4 �1 �� _! '�'.;..
r
;`a. �.. _ a ae ?. _ �„� x� ..���'�.t� ':�'. 4L.+
T� 1 ;:� � �"�. �. '� . �
As� �� k ` � , ����+f ,�/� �t 3�����• l '� \����S'�,.
..:' ' :.. 4.ra , .,... � ��Dk � :,G � � ':YP� ��i�.�L [ ���
3�t
a-�. � ` � Y �urp,�, , :g ���k ,-k:i fi�'� _:9� !'
� w ., ��� �i . . riy . � Ak�' .�- � ��r*, .
+ ''°� • '� � �
° !�3 � : �� � �`.;r- t't"f .!,'
� d.�, � -r.;is .�:s .:� � ' ^' i-- �� � �` 14 's� - xY .
r,�-i: '��f r+C�� . ��� '� ��j,N3�; '.ti1!°�`' .�,�(�
' s;- . 5 '�'' ye �.��n.� i "t
Mz�'J iTy ��� �I �� - �� .� t��� t .,.`,�- 7Q ,•s_ ':� � ��
� � ' ._ s:'..- . 6s'Y 'k- w S ;t{ L� �'�' '�a`� .. 'Ic`
� `� r�.. � i �.r x.'t�j �. ' k '� �'..
..e 3 3b'i. _;�� t ''�.K' � y ae ..:� � �a..
�� ��T�yF1+ ��� ��fr�� � �{,�Vy'y t �14 ' . .Zl
. � t��.�� � i + 1 •. �.��� � t Y� �yT .�.. ,' M i f ��l -'
���Y. 1 �r .l ,��Zi
�� Si . N' N{-a.... 7� t` ��'�'7� �`.. '*`'j`"°"_. •t
�y, t�� l�^., I '�r�. yF '� M S . r��rLaR�, �;eg�� 5��•�. .y,
'uP�.� '°.�i'.t� �.��7 �". V'lF" l � i _6 L [ +C� R
��
§ � ��- � ,
i���Jr� .. � t++ � "r, Y rY�tr''. ...
.� � � -`• w'�` '�.
- �:��. x # t�� �F � � ��
�e� :.Y�� �_�a �v Y.��; �1.� •.i \� .i.� '�4 }f�, . � �y� .,.
.� ' s �
f �k p `�''�C rF�2iY
`xi .��� 4 ,�X > y.. S. ,sf
•� .✓ e �'� I� !
� .
� -�' y r`4�� �r�t ,w er ~ , � t .s
µ y�. � �t
�. _.. 1 � �.�� 4E � r �A:'.S`S� } e Sl 1�. ^
}# ��. � �. � ��. � ���
_ ,�. �,.�� �� �� °��,
�. , � .
.
i ��9 i� .`.. '' � i ��'��...t.�'�4 y _ �-. i .� .
w �Y�'�� 'x' �' � ��. ��� �� � :�� ����:.
'= : y .i � ��� s � y'p�,, � .� ���
� � �i� � �'V � /+,},. `�� _ 7�YPA`_ z � . ' y. z';:
� � �tr o !�! .
w ��a'a��.�, f�t �ti��, �� . � '�;«,.{� a — �•.
>, �_ •� .- '. ."
�
�� � ���� �� � '� � � €
,.
i r" . �
� ¢ y �, .i.�' a�,Sy� r v.� asa�.
�
° ��
,a:.:, oee�e af �1I9���'R.0 ��p�,d
�� . . .
� ' � �' Saw er Count Zonln Administration
-�'� � Y Y g
.�
��' 10610 Main Street Suite 49
l j j�
������� ' Hayvvard, Wisconsin 54843 ��.� �
� �R C0 1� (7I5)634-8288 �����I�/'�
=�'�,' -•G�♦ FAX (715)638-3277 � % �
. A �
� Q;' ��\J��j www.sawyercounty�o� v_org /�^
�(q! � � •.�C � E-mail: zoningsec(a�sawyercountv o�v_org Z��� �
/ Q{, _� � ;'o �' Toll Free Courthouse/General Information 1-877-699-4110 � ���?
� �7; ;,,.Y=,, _ Sq
�.- . c'— R
�Y�Aq Cp��1l
I �
,����SCoN��" N!g
����.� M� �R TK�1
SAWYER COUNTY SANITATION DEPARTMENT
TEMPORARY EMERGENCY TANK INSTALLATION APPROVAL
PROPERTY OWNERS NAME: IM�cviq�. 1 S . Jo�tiS��
TOWN OF: L.eh �a�"
aDD�ss: � I�3�J � �sl�s � .
I, ��,Q�L� G� ��"�,,�' , a Wisconsin
Licensed Plumber, authorized by the owner, do hereby acknowledge that I am receiving
temporary approval to install a septic tank/holding tank without a soil and site evaluation,
or existing system evaluation, and private sewage system plan review due to inclement
weather and/or health and/or safety emergency.
Further, I acknowledge that a soil and site evaluation, or existing system evaluation, and
private sewage system plan review will be conducted by the deadline stipulated by the
permit issuing agent, or as soon as weather conditions or circumstances permit. If the
private sewage system is found to be failing as defined in s. DSPS 381 .01 (92), Wisc.
Adm. Code, corrective measures will be taken as such that the private sewage system
complies with all applicable requirements of chapter DSPS. 383, Wis. Adm. Code,
within 90 days of this agreement.
I further acknowledge that failure to comply by obtaining all necessary permits after the
deadline date may result in the issuing of a citation, under Section 11.3 [2) Sanitary
Permits], of the Sawyer County Citation Ordinance.
DEADLINE FOR THIS A�EEMEN � E: � I � 'a-��- oZ
�:
, . � .,
, _._..
/:
Signed: X -��- P�� �� .�ta -
�
Date: x �� I I �0 2 �
Accepted by: � "—
Date of temporary emergency approval: g� ( I a--a� �
Rev. 03/26/13
8/30/22,11:14 AM Novus-Wiscansin Access rev.13.1108
Real Estdte Sawyer County Property Listing vroce�sraa,5:cu�.e��
Today's DaM:8/30/2022 Created On:2/6/2007 7:55:27 AM
�'Description Updated:10/21/2011 �Ownership Updated:10/21/2011
Tax ID: 16203 MICNAEL S DORENSKI HAYWARD WI
PIN: 57-0142-42-09-35-5 16-639-000300
Legacy PIN: 014280000100 Billing Address: Mailing Address:
Map ID: -7.1 MICHAEL S DORENSKI MICHAEL 5 DORENSIQ
Municipality: (014)TOWN OF LENROOT 15366W REISKES RD 15366W REISKES RD
STR: 535 T42N R09W HAYWARD WI 54843 HAYWARD WI 54843
Descrip[ion: TALL PINES CONDO UNIf 1&1/6 INT
IN COMMON ELEMENTS �Site Address *indicates Private Road
Recorded Acres: 0335 15364W REISKES RD HAYWARD 54843
Lottery Claims: 0
First Dollar. Yes .-J pro e Assessment Updated:9/26/2014
Waterbody: Nelson Lake P �
Zoning: (RRl)Residential/Recrea[ionaf One 2022 Assessment Detail
ESN: 400 Code Acres Land Imp.
Gl-RESIDENTIAL 0335 43,600 33,300
�Tax Districts Updated:2/6/2007
2-Year Comparison 2021 2022 Change
1 State of Wisconsin ��d: 43,600 43,600 0.0%
57 Sawyer Counry Improved: 33,300 33,300 0.0%
014 Town of Lenroot Total: 76,900 76,900 0.0%
572478 Hayward Community School District
001700 Technical College
.� Recorded Documents Updated:5/20/Z011 �Property Nistory
0 QUIf CLAIM DEED N�A
Date Recorded:9/11/2008 355802
O CONDO DECLARATION AMENDED
Date Recorded:12/29/2021 436763
0 WARRANTY DEED
Date Recorded:6/26/1995 248600 555/3S8
0 CONDO DECIARATION AMENDED
Da[e Recorded:8/24/1992 230690 492/54-57
O CONDOMINIUM DECLARATION
Date Recnrded:6/11/1986 200366 389/326-350
https://tassawyercounrygov.org/Access/master.asp ���
- .__
� � I
(I !�Iillli II II ( Illtllll II III
D��c1d :806�`��Ory
T:; :�040849
- USE BLACK lI�4C ONLY - 441464
' �fl�tFTS fV1�ii�T�NAI�GE �GREEMENT PAULA CHISSER
� REGISTER OF DEEDS
For F6e�ide�� `�anks SAWYER COUNTY, WI
� 09j20J2022 02:34 PM
Owner's Name(s1 as shown on deed: RECORDING FEE 30.00
i
i �` ( �� Fj ` l����'S ��' PAGES: 2
� P2rcet Identificat:on tiumber.
(12 Dig�t'�eg2cy i�) � � 1� ' ��SL - � O - V� SL(.� �
i
i Legai Description oi Property: i
- SEE A�'ACHE�J SNEET - �
4 We acknowledge thai agplication is being made 'or the installation of 2 hoiding tan;(s) on the !
; property descri�ed on the attached sheet. I
�
i
� i
; Retu�- To: Sawyer Cour,tv Zoning and Canservation AdminisYra?ion {
� 10570 ri,+izir. St. Sui3e 49, Hayward, WI 54843 �
�
i
As an inducement io ihe County of Sawyer to issue a saniiary permi[ fior a hoiding tank or the above-described property, the owner is
responsib!e for the operation and maintenance of the holding tank, IOCKIrg device; alarm and access, and agrees to conform to all
applicabie requirements of SPS 383, Wis. Adm. Code relating to hoiding iank management, including the following:
1. The owner agrees to cc�Trac: a.rith a person who is Iicensed under Ch. NR ' 13, Wis. Adm. Code, except as provided by
Sectian 281.48 (3) (d), Siats., to have the holding tank properfy seviceci and to file a copy of the service contract with the
gcvernmental unit. Tne a�rvner;uRher ag�ees io file a cepy of any changes to *he service contract, or a copy of a new service
ccr,tracc, wi:h tne governmenial unit within ten (10} business days from tne date of change to the service contract.
2. The owne; agrees ta contract�vith a person licensed under Ch. NR 1 '3, Wis. Adm. Code, who shell submit pumping reports to
the governmental unit in accordance with SpS 383.55, Wis. Adm. Coe+e, ror the servicing of the hoiding tank. In the case of
exemption under Sectior, 231�8 (3j (d), Stats., the owner shaii submit ?he report to the governmental unit. The govemmental
ar�ii may enter upan the �roperry to investigate the condition of the holding tank when pumping reports may indicate the
r�olding tank is no; heir;g prooeriy main�ained.
3. !f the owner fails to have tne holding tank properly serviced in response to orders issued by the govemmenta( unit to preven!
or abG'� a numan heaith hazard as described in Sectian. 254.59, Stats., the governmer,tal unit may enter upon the property
and service; or cause the tank to be serviced_ Pursuant to Sect;on 1452o(4) Wis_ Stats., a governmental unit may assess tne
ov�ner of a pnvate sewage ;ysiem for cos!s related to the pu;nping of a sepiic or holding tank. The charges wili be assessec
�s prescnbed by Secticr� 66.0703, stats. The �w�er agrees to pay all charges and cost incurred by the govemmental unit fcr
;^s�,ec:ien, pumping, hau;s.;,g, or otherwise se:vicing and maintaining the holding �ank in such a manner as to prevent or abate
any human healih hazard caused by the holaing 'tank. �
4. This ag�eement wiii remain ;n effe� oniy until the governmental un�t respansible for the regulation of private sewage systems
ce;iifies tn�i either a soii ahs�rp;iar? system that compiies with S?S 383, Wis. Adm. Code, or a municipal sewer serves the
prJpe�y. in additio;,; :h:s agree:r�ent may oe cancel�ed by executing and recording said certification with reference to this
agreem�r:: ;n such :�anner which wif' �2rmit ihe e�stence o�the certificat;on to be determined by reference to the property.
5. T^is agraement shali be b�nding upcn ihe owner, the neirs of the owner, and assignees of the owner. The owner shall submit
the agreement to the register of deeds, and the agreement shail be recorded by the register of deeds in a manner which wili
permit tha existenca o�ihe agr2zmen! to be determined Cy reference to the property where the holding tank is installed.
- ^nlv cne owne :+a+.�re :e 'red - ACKNOWLEDGME111T
� Ow e ' ign ure: ' State oT: l �T����
� ; � '� �If1S;
� ,� ' County of: �(��,� i �{�s—
Owner's Na,�,e ;. rint): ``���»uiui��,,� ,
lt��� -. /�y�/� � �/ ��� E pR� ��,: Subscribed and swom to before me on this
�1L,LL,,�".f�i,,s�:������N C��'�. �_dayof 7 , 2Q �,�
. � �'j .
I Date: ;� , • O-� A R y • � ; gy (Owner's Name): S• r �'
_ " ''� = iVc.ary Public Signature: �
i Drafted � :: /�'* : � ;�Z ; Public Notary Name (Print): }�[� ����n�_
�/ � ��'i C kC+'{'
a �
� l � �� �'i15� % � '°U B�- • � �� �v1y commission expires on: �� � � Z(r2,�
',� • .-----� �. �-l.T.��
���'�qTF OF W�SG`��``
�i�,,i►i�����t����
Personal irformation you provioe may be used for secondary purposes (Pri�iacy Law, § 15.04 (I) (m)J Rev. 03/26/13
,
Units One(1). of Tall Pines Condominium
together with an undrv�ded U6 interest appurtenant ta each Unit in the common elements
and facilities of Tall Pines Condominium,a condominium declared and existing under an
by virtue of the Unit Ownership Act of the State of Wiscoasin dated June 11, 1986 and
recorded by a declaration of such condominium in the office of the Register of Deeds for
Sawyer County,Wisconsin on June 11,1986 in Volume 389 of Records,pages 326-350,
Document No.200366. Subsequent Amendment to the Declaration dated July 17, 1992 a�
recorded August 24,1992 in Volume 492 of Records,pages 54-57,Document No.230690.
Subsequent Amendment to the Declaration for removal of property from Tall Pines
Condominium dated July 19,2004 and recorded Jufy 22,2004 as Document No.323480;
� � ���-'--u�' } �`.
HOLDIl�TG TANK SERVICING CONTRACT �.�
DEC 0 � 2022 �-�
Contract Date: j /���Z j _----_--
SA1/d4`�� !�=. .
ZONWG �4Qi�^ilti,y , , .. �. ,,
This contract is made bet��•een the Holding Tank Ocvner and the Pumper.
Holding Tank Owner's Name: Pumper's Name:
j �'n�C,�C�-�_ �ti ISY.,y � ��C.���S ��.'��1 C_. �
� � �
1 i
Parcel Identification Number: `�
(12 Digit Legacy ID) � � -1 _ � � � _ Q (� _ � � � � �
1 . Tl�e o�vner agrees to file a copy of this contract ���ith the governmental unit, Sawyer County,
whicIi has aceepted and recorded �vith the Office of the Register of Decds, the A�aintenance
Agreement for a Holdin� Tank r�quired under the Sa��ye1- County Private Sewage System
Ordinance for the issuance of a Sanitary Permit for the installation of a l�olding tank(s).
2. The ov�mer a�rees to l�ave the holding taulc(s) serviced by thc gumper and guarantces to
permit the pumper to have access aizd to enter upon the property for the purpose of senriciilg
the holding tank(s). The owner agrecs to maintain the a11-weather access road or drive so
that the pumper can seivice the l�oldin� tank(s) �;�ith the pumping equipment. The owner
fiirther agrees to pay the pumper for cliarges incurred in servicing dle holding tank(s) as
mutuatIy a�reed upon by the owner and pum�er.
3. The pumper agrees to submit to t(ie Governrnental Uni[. Sav�ryer County, a report for the
servicing of the holding tank{s} as required under SPS 383.5�, VVisconsin Administrative
Code and the Saw_yer County Private Se��7age S��stem Ordinance. The pumper further
a�rees to inclttde tl�e following in tl�c report:
a. The name and address of tl�e person ►-espoi�sible for sen�icin� the holdina tank;
b. 1-t�e name of the owner of the holdina tank;
e. The site address of the holding tank;
d. Ttze date the holdin� tank u�as serviced;
e. The volumes in galions of the contents pnmped from the tiolclin� tank for ea�h servicing;
£ The disposal sites to which the contents from the holding tank were delivered.
4. This agreement will remain in �ffcct until tl�c owtler or pumper terininates this contract. In
the event of a chaage in this contract, the a«rner agrees to file a copy of any changes to this
service contract or a copy of a new service contract �trith Sawyer County within ten (10)
business days from thc date of chan�e to this service contract.
Ov�jnet-'s Name: (Print) � O«-ner'S S1�IIdElli'e: (Onl�� one o�f-ner signature required)
U ' I) .
��C.���C���11s1�� 7 � �/ i
i � //�� f 1,{I/Y� r
7
Pumper's Name: Pr�nt) Pun-� er'�s Si,na
� --_ ��
_. ,
���- `� �, � � ; �j c.�,�� �
�
Pumpec's Registration t umber:
I 4� 1t`� � � �
� ;
' Rev. Q3/26/13
"���T"t`� PRIVATE ONSITE WASTE TREATMENT �ounty
�.;-� r,,,
�i�:o y�
;�� � P �� , SYSTEMS Saw er
�s s ;J� y
��k�����' ( POWTS)
�is="'"'`'y' INSPECTION REPORT Sanitary Permit No:
Safety and Buildings Division (ATTACH TO PERMIT)
GENERAL INFORMATION �� �3'��
Personal infonnation you provide may be used for secondary purposes[Privacy L.aw,s. 15.04(1)(m)]
Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#:
W1►' Q� DD��Sk� ,�,r,�,o�- r—
Insp BM Elev: BM Description: Parcel Tax No:
� � O(y —��--UO-olo�
loo.o -}roP �� �1�� c,.s-�,- 1;
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic Benchmark ��,o �
Dosing
Aeration Bldg. Sewer qq,Y �
Holding w���� 3�$� St/Htlnlet a7,� '
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG vENr ro ROAD Dt Inlet
AIR INTAKE
Septic NA Dt Bottom
D�sing NA Installation
Contour
Aeration NA Header/Man.
Holding � .�-�s' (, �...(�` ��5 � Dist. Pipe
PUMP/SIPHON INFORMATION Infiltrative
Surface
Manufacturer Demand Final Grade
Model Number GPM
TDH Lift Friction Loss Sys Head TDH Ft
Forcemain L Dia Dist. To Well
DISPERSAL CELL INFORMATION
DIMENSIONS W L #of Cells Type of System Distribution Media Manufacturer:
SETBACK OHWM of Nav ° Conv ❑ Aggregate
INFORMATION P/L Bldg Well Waters � IGP ❑ Chamber
❑ AG ❑ EZFIow Model Number:
CELL TO ❑ Mound o Other
__—._ -- — -- ___ __--
- -- - -----
DISTRIBUTION SYSTEM X Pressure Systems Only
- - _ -- — --- — -
Header I Manifoltl Distribution Pipe(s) X Hole Size X Hole Observation Pipes
Length Dia Length Dia Spac Spacing ❑Yes ❑ No l
- --- — __
------ -
SOIL COVER
Cell CeOnter Cel�l E gesr � Topsoil f_ _ ❑Yes/S❑ No �❑eslche�d N�
COMMENTS: (Include code discrepancies,persons present,etc.)
��,S��I� 8�� � � �
� ���
Plan revision required?❑ Yes ❑ No ; — �
i 63 �3 � �-- �.; --- �G Sb 1
Use other side for additional information Date POWTS Inspector's Signature Certification Number
SBD-6710(R.3/01)
A�OITIONAL COMMENTS ANO SKETCH
SANITARY PEAMIT NUMBEA. 2�__�
N��.s�� l�l�—
_ _: —-�_ . _ _ __. —.- : ;__ , _ � , - . - -- � ——— _ _ _ - _ _ _._ _
,
. _ . .
: . _ : �3���
� �� ,
. _ _ _ __. _:. . __.__ -- E _ �_ - ; . _ _
,
��k �
. : ._ _ ,.
. ;.____. �_ : . __ __ .
�
, _ . : . . . _ _
__ � . . . ._ �____.
: �
. _ , . _ �b�" � ''
�
� 3��,,,�
6'
,
� �'
� y, w��
3 �
►
a�". /
��,�.�''�
�
'�_ ,� �-�` .
� ��S