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Home My WebLink About026-938-14-3204-SAN-2022-342 �i�>�'-"�;�. Industry Services Division County � _ ` 4822 Madison Yards Way Sawyer � - ,�SP �.' Madison,WI 53705 Sanitan Pennit Number(to be filled in by � , _ : P.O.Box 7302 `',�� '— ;�`" Madison,WI 53707 �y � �� 3 � � � -"�;.�::�, State Transaction Number � Sanitary Permit Application .� �;,, In accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis fonn to the appropriate governmental unit .� is rcquired prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing a � thc Departmcnt of Safety and Professional Services. Personal infonnation you provide may be used for secondar}� �p�� + �W � purposes in accordance��ith the Pri��ac� La�c,s. 15.04(l)(m),Stats. U �y y I.Application Information—Please Print All Information Property Owner's Name Parcel# FUTUREWOOD CORP 026-938-14-3201 Property O��ner's Mailing Address Property Location 9676N KRUGER RD Ga�t ��t City,State Zip Code Phone Number Hayward, WI 54843 NW ��<,SW ��,, Se�,;on 14 II.Type of Building(check all that apply-) Lot# T 38 N R 09 I:or W �I or 2 Family D�vclling Numbcr ofBcdrooms 3 Subdivision Name F31ock# � �Public/Commercial—Describe Usc �City of _ �State Owned—Describe Use CS M Numbcr �Vil lage of �T��",�r Sand Lake IIL T��pe of PO�i'TS Permit:(Cheek eithcr"Ne��"or"Replacement"and other applicable on line A. Check one box on line I3.Complete line C if a licable.) `� �Ne�c S��stem �Re lacement S stem Other Moditication to Existin,S�stcm ez I im �Additional Pretreatment Unit ex lain ✓ P )'� � }' ( P� ) ( P ) B' �Holding Tank �[n-Ground �At-Grade �Mound ❑Individual Site Design Other Type(explain) (conventional) C• ❑Renewal Before �Rcvision �Change of Plumber �I'ransfer to New Owner List Previous Permit Number and Date Issued Expiration �� - �� '$ �� IV.Dispersal/Treatment Area and Tank Information: Design Flow(gpd) Design Soil Application Ratc(gpd/s� Dispersal Area Rcquired(st) Dispersal Arca Proposed(s� System Elevation 300 NA NA NA Capacity in Total #of Manufacturcr Tank Information Gallons Gallons Units � � o 'D � U U Ncw Tanks Eaisting Tanks � o a� � y p � � a U cn �, v� ct. C7 c. SepticorHoldingTank 1250/750 1250/750 1 WIESERCONCRETE ✓ � Dosing Chamber . � � � V.Responsibility Statement- I,the undersigned,assume r �ro sibility for in al tion of the POWTS shown on thc attached plans. Plumber's Name(Print) Plumber. St2nature �- ` �`\ MP/MPRS Numbcr I3usiness Phone Number Travis ButterField ' � 652879 715-634-8176 Plumber's Address(Street,Cit�-,State,Zip Code) 14346W St. Rd. 77, Hayward, WI 54843 Vl.Coun -/Department lise Only �App �� ❑ Disapproced Pennit I�ee Date Issued ]ssiiin�Agent Signature Ls►�/ � �{O�,`c0 i :-.I(�1 I �;��. �✓��Lc��t t,L�f-t/�%/.•C<"=-__ �i- - ❑Owner Given Reason for Denial Conditions of Approval/Reasons for Disapproval •- � � t�a��!�' � � `1 �a� "` �:;: � � `�� - .�_ . _ - _ : � �� '� � . ' . � ,,* s ,➢ .,n� r�►� _ . t;hk# i� �� , �....a. ; �. ��Z �ST �b`� F !/ '�".�-�� h 12�nr 1n)?r l<i_ �;��.-SCO' -. _ _ 1 , . ._.. � �n� .. , Attach to complete plans for the system and submit to the County only on paper not Iess than S U2 x 11 inches in size �.-,t� , � .,�'� fd0 REFJNDS AFT�R sB�-639s�R.o2iz2> ISSUE OF PEFtMIT Sawyer County Zoning & Conservation Administration `�"`�` 1 10610 Main Street, Suite 49 j�R Cp �� Hayward, Wisconsin 54843 �� (715)634-8288 i � � � FAX (715)638-3277 i `'" ,r �- `� % � - . 1L -•.f � � � w�w sawvcrcountygov.org / o � � ; o i E-mail: zonui� scc�cdsawycrcountvg��'.�� - � � Toll Free Courthouse/General Information i-f377-699-4ll0 ��.��" - "��'.► �� j�`\oN�� Holding Tank Approval Checklist I. Sanitary Cover Sheet Date Stamp (� /�/ �� Parcel ID# O 2 (o - �( 3 g - ( �/- 3 � d ( il. Plot Plan � Property Lines � Benchmark BM ♦ � Site Address �North Arrow � Structure �Scale � Well < 25' to Service Road / Legal Description Nearest Road Intersection � Setbacks to: Property Line, Well, Structure, Water bodies, Roads III. Required Plans �Index Page with Original Signature � Management Plan/Contingency Plan Servicing Contract �Holding Tank Agreement form IV. Holding Tank Specifications � Cross-section — Manufacture, Gallons: a'$� 7St� 7C 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 l Ol .862(3) � 3" Bedding Material < U2 " V. Holding Tank Plans per Component POWTS Manual � Version �SBD-10855-P (R.3/07) �, � � �2 _�'�� Owner: �,��,,� Plumber: � _ 4 . Application Review Date: I �- I � �� POWTS Reviewer: � �,�� Name � � �� ` License # Revised 4/l ] /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 Futurewood Owner Name(s): Futurewood Corp Phone: - - Owner Address: g676N Kruger Rd., Hayward, WI Zip; 54843 Project Address: 3842N County Hwy F, Stone Lake, WI 54876 Govt. Lot: NW 01/4 of SW �1/4, Section �4 , T 38 N-R�g E ❑or W ❑✓ Township: Sand Lake County: Sawyer Project Parcel ID #: 026-938-14-3201 Designer Information Designer Name: Travis Butt2rfield Phone: 715 _634 _8176 Designer Address: 14346W St. Rd. 77, Hayward, WI Z�p: 54843 E-rpal�: OffIC2@bUtt@If12�C�C�I'I��IIIg.COI�"1 This sp�ice resert�ed for approval�tain}�. License Number: 652879 Remarks: Signature: Date: 13 �� Original signature required on each submitted copy. �-�t::',j �:. �� ,� � ��5t-�i�`� 1�LI-1 a,c�r� � L� �-i-l2 ��.�� _ �-------�� -��,��;� C�r�� Z�' 3�'�2N Co�,�;�-�-� 1-1�� j I.�N�C. �-l�1 I�C: , ��_� `.�zr o,--�� • C�Z� - `'13� - !'� - �201 � �T:.. � /U�.0 r lc�,j � � h �-+D ��r�� "��N� �V�� an�< C'�-. ��, v 1 o��r.l �r SY�tiD �W�� I 2� ��S(.� v�1�e_S�-+"- Cs',c,�u�T cL,,,�k /V�,rSV.J � ►'o�V t S ��h�� , ; � f "� —� ! 5 lo�Z�I`� � � / ' � f i l/�� ) % ' l`° "IS � i �, � / � ; � ,�� %� � , ------' --J ;� � ; >, � J ' X .'-�•� `�� S ---- J _ � ,�'" .� �� _�, / . �-'�-'i`\ L �- �--�- —J �� r•�, 1� � // :�� % 6�'' _ ,i,-- j. __._n„�.. �\ ,Lf� ` . , 4. ...... , ,; . / ,� - . — � __---�'. �� ,p � "":- :' . - r � � � � �_,...__. , . - �.D0 - ic.nq0 " / -'" V :' �'' ' :..,. ,`"" /:. �; _ ,�� / . T � _38�2 N_------------ 2��" � �v>,� �,/ � ! PAGE 3 OF 4O HQLDING TANK SPECIFICATIONS (No Scale) 4"<�Vanl Pipe Vveatl�.erprno` >10 fl irom Junclinn and Alarm 6ox Eiullding Approv�d t:"Isin or 2.0 ft above Clr,qirical r i i_I corn�!v wi'�� Approv�d Lo�41ng Ma�hole Venf Cap Establis^ed F'ood Etevzfior, F �.�il'n Vda nc�t�hel Atlacned G M n.or2.0`t aoc�ve. SPS 316 r c NF_C 300 �ty,��:�} � �ty- �'% Estab i_^.ed F!ood E!evalior ---Condui: � f�vf�'��? � �Airtic3ht Seal � � . � �, Fin;shed Grade 18"1�1'r. ��YPical} . 'a , � . •�qa•. �. e � �a. a � , � . . , ^.ie'. „ie; c�;�� —Watedigel Approved.ioinls;vitb� P,ug Approved Plp��:i'ft onlo Max.12"or 90'%nf total volume So6d Ground � if moi'e than one tank (lypicalj Aiam�-On 4, Compartmenl�I Vol- �250 yal Compahmenl�Vol= 75� gal TOTAL HOLDING TANK J VOLUME = 2�00 ga� , ,•,• ,p ' . . . � , d: . 3"Nppinved Dedding h4atenal Deneath Taok TtiN;� ��r�NUFHc,-u��R: Wieser Concrete Anchor tank as necessary pursuant to SPS 383.43(8)(g) oallast W'eigh� _[(cu.ft.tank.vol x 62.4 Ibs/cu.ftl-Ibs.tank.v✓tj r. 1.5 Ballast Weight= [( cu.ft. x 52.4 IbsJcu.it)- Ibs]x 1.5= ibs � =�� W125�/750-MR �� TANK SPECIFICATIQNS � � � (�� O a a � I � '�-�� DIMENSIONS: � o ";J ; WALL• 2 1�2" � � `�� 4" CAST-A-SEAL 4" CAST-A-SEAL � BOTTO�A: 3" °J COVER: 6° ;�,. ��=__-___====�C1�====_�� MANHOLE: 24" I.D. PRECAST CONCRETE RISER a � .�� Il li � �:\� HEIGHT: 66" � ii II'II � �� I �� i i i i a_ �� LENGTH: 12�-11" �� I ��, \ � _ iiii-� \�� WIDTH: 7'-2" �I �� . , ��i�i " r�----��5,� BELOW INLET: 53" � :v �� \� � �iL ( � LIpUID LEVEL 48" �I� E � � � 1 , a WEIGHT: 14,8fi0 LBS. ��-� o 0 � � � / �r.��T � .�,� �� c,'!� � n �� `-- - �� ``-- ; INLET AND OUTLET: - i 'i p � �� rj � � \'�� rILT�R OR-' �iii ��/, '�" CAST-A-SEAL BOOT OR EQUAL GASKET al mi o p �� BAFr�E ii�ii �� w �� .� ��I� �� INLET AND OUTLET BAFFLE AND FILTER: a -$c' k'-' w � - -._----=-11L�-__-_�==' WISCONSIN, SEE DETAIL #10 :n °�o an � (OTHER STATES SEE CHART) �� o � �P �FW LIQUID CAPACITY: 27.66 GAL/IN (SEP11C) W � 16.12 GAL/IN (PUMP) j� s C, `c CJ LOADING DE51GN: 8�-0" UNSATURATED SOIL C� rc � � TANK CAN BE USED AS: � w I cn°' SEPTIC/5EPT1C, SEPTIC/SIPHON, � N �a �-4" VENT OR SEPT1C�SiPHON � o�� : COVER: MIX DESIGN #8 (NO FIBER) `� � a `D �i� TANK: MIX DESIGN #10 (STRUCTURAL FIBER} � � `r� �� f ____ � ` __ __ i CUSTOMIZED TANKS: �� " INLET � ^ FOR CUSTOM TANKS CONTACT WIESER CONCRETE � � -�- — - � - - - OUTLLT � '-' i � � i � --�--- - II I � d� 1 = I'II - � � n U � � �� `n I I � v I � � � � J I � � '� � � { � � � � 2�� .�- �,^� p Z � � I n � --- - --- -_J '�-,1----�-'� -'J tt� Q REVIEWED BY a c� �; �PUMP PAD REVIEW DA1E c�v � DRAWINGS SUBMITTED � � SIDE VIEW FOR APPROVAL APPROVED E�Y: SHE"cT N0. APPROVAL DATE: � / /CF PROOUCTS UEEDED BY: � TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTio1 C-1227 REQUIREMENTS 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),Wisa 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 maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52(3),Wisc.Admin.Code. Estimated Daily Wastewater Flow= "�e'�a gpd Inspection 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 fatigue(i.e.,leaks,breaks,corrosion,etc.) o neglect or improper use(i.e.,exceeding design capacities,prohibited activities,etc.) ,. electrical components(i.e.,wiring,connections,switches,controls,timers,alarms,etc.) o surtace 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,Wisa 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 company: BUtt21"fIEId, IIIC Phone:715-634-8176 Local government unit:SBWyei'COUllty Z011lllg Phone:715-634-8288 _ �oca�9overnment unit address: �0610 Main St. Suite 49, Hayward, WI Z�P 54843 _ Any defective part of this system shall be repaired,replaced,or removed pursuant to SPS 383.51 (1),Wisa 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. Continqency 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 a6andoned in accordance with SPS 383.33,Wisc.Admin.Code. Real Estate Sawyer County Property Listing Property Status: Current Today's Date: 9/27/2022 Created On: 2/6/2007 7:55:47 AM �Description Updated: 3/16/2018 � Ownership Updated: 3/16/2018 . .. .... ._. . _ . ... ... . .. .. . . .. . . . . .. . . . . . .. . . . . . .. . . . . . . . . . . . . .. . . TaxID: 27904 FUTUREWOOD CORP HAYWARD WI PIN: 57-026-2-36-09-14-3 02-000-000010 Legacy PIN: 026938143201 Billing Address: Mailing Address: Map ID: .10.1 FUTUREWOOD CORP PUTUREWOOD CORP Municipality: (026)TOWN OF SAND LAKE 9676N KRUGER RD 9676N KRUGER RD STR: 519 T38N R09W HAYWARD WI 54843 HAYWARD WI 54893 Description: NWSW 11 ACRES IN LAKE Retorded Acres: 28.000 w Site Address * indicates Private Road Lottery Claims: 0 3842N COUNiY HWY F � � � STONE LAKE 54876 First Doilar: Yes Waterbody: Rogers Lake '�-� Property Assessment Updated: 7/6/2022 Zoning: (Fl) Porestry One . . . . . ESN: 423 2022 Assessment Detail Code Acres Land Imp. G1-RESIDENTIAL 2.000 46,000 2,300 �� Tax Districts . Updated: 2/6/2007 GS-UNDEVELOPED 19.000 2,500 0 1 State of Wisconsin G6-PRODUCTNE FOREST 7.000 60,500 0 57 Sawyer County 026 Town of Sand Lake Z_year Comparison 2021 2022 Change 650441 Birchwood School Distrid Land: 109,000 109,000 0.7°/o O01100 Technical College Improved: 22,500 2,300 -89.8°/a Total: 131�500 111�300 -15:1°/a • Recorded Documents Updated: 10/26/2010 O SPECIAL WARRANTY DEED � � � � �� Date Recorded: 4/15/2016 400625 �property History � SHERIFFS DEED N�p Date Recorded: 6/4/2014 390694 � QUITCLAIMDEED Date Recorded: 10/19/2010 369334 .; _ y�• �,�a� ' 1..._' �.�� .� � h.l �'1 ''i / '.�1 w + ,� 5 }t�,r � , y : i: � '� / .cv >� ��: � ~ ��'�:� °� '•2`� � l �' t\ y ' t. / J ,.,.� if�S x�''��v..,. +�R �bw I.��t1n��'in x . � ..-r ',{, �`"'v... 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" _ s ��_ *e�` f2� y ��* n- - �,�j, �+�;Y�d,t�e.��'��?�1 mN�t�"Y, .y��. _ . j�,,� J�C � i\.:^'?� l�. � — � . . . � � . b�' -'1�' c �r"_ t�' �'-� y, �'a� .� "�.'�� .',��"nr'�p�'_�,..yy„�F" �,��cy�„ .,+'1.�- ix.. . . :�".-�'�' ,� ...� � �' � . i � 4 . t �,� r �, � ��h r � � N L�� `�,ti'' 'a�ii � t',r i"'1� A"`y�� 5.,� n '�, 4i#t �SjJ,Y, y „'� S� `��'�';� `�n ', .. _ _ 5 � :; `�7r �i' ��'� "4 y�� ..�1'� a .� � � ...�� . � F � � r� � �d�' Y r . ,� � � � F -�ir� �� ! ...•� ,� jA��. T� . 1 lW`�.- �;� :��'� �� .- -y` �- �-^•.•'s � }'y'ryµ sc' ��` L Y ' ,� "�"'.�•�' �, �5 <,� .V'l�'�M1 . ti .M1 '.) 1�. } ai ' � _ •4. �i.- -:;;i - � � a � : '. � ...•` �� i ' {4 �`��1�'•=E +1 *� )' �� ) ..j �y � ��. \� j �Y i.=. �� ." � ��_ � ^� � -� fy � '- .:M. • `' „'`�r.. .:\ (! J�. //� ' ```Y� . '\ 4K � . ! . / �, ,q, � 5`y�y�-. �i>�. , �� r, �' � •t;*'�� u�•'�� . ,. �. > y'��;j . _�� ,'.. ��ti ' .� ;: Tl.'•"��t � \ l �� .'/ t �y� . qy r�. � c �ti � � p ��'.'t,�, ��e'Y ;�, ' •� � r Ti.: � r'�r r � ' t�� .�'� � .a� 1x�..Y a � r'..-�a�.�;- . ,r I L�'j..�� — �.��`.i!(.�.y�/+ J! � �� .r h� I/ � i� � .4 i� �y, ,�"•« a � ;r,. �, d, �. ;,� !d� ?: = [� 4V ��i k )J �i. � d. , ��y�� ro�� IIOLDING TANK SERVICINC CONTRACT Contract Date: �!LZ / 2.D 21 � This cootract is made between the Hoiding Tank Owner and the Pamper. Holding Tank Owner's Name: Pumper's Name: FurU 2�Uk»n C�2� SC6ir�oP� Parcel IdeotificaHon Number: (12 Digit Legacy ID) � 2 lv -� 3 $ -��-�Z O � I. The owner agrees to file a copy of this contract with the govemmental unit, Sawyer Counry, which has accepted and recorded with the Office of the Register of Deeds,the Maintenance Agreement far a Holding Tank required under Ihe Sawyer County Private Sewage System Ordinance for the issuance of a Sanitary Permit for the installation of a holding tank(s). 2. 1'he owner agrees to have the holding tank(s)serviced by the pumper and guarantees to permit the pumper to have access and to etrier upon the property for the purpose of servicing the holding tank(s). The owner agrees to meintain the all-weather access road or drive so that the pumper can service the holding tank(s)with the pumping equipment. The owner fwther agrees to pay the pumper for charges incurred in servicing the halding tank(s)as mutually agreed upon by the owner and pumper. 3. The pumper agees to submit to the Governmental Unit,Sawyer County,a report for the servicing of the holding tank(s)as required imder SPS 383.55,Wisconsin Administrative Code and the Sawyer Courty Private Sewage System Ordinance. The pumper further agrees to include the following in the report: a. The name and address of ihe 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 tenk 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. 1'his agreement will reroain 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 conhact or a copy of a new service contract with Sawyer County within ten(10) business days from t6e date of change to tlils service contract. -_ Owner's Name:(Print) Owi 's Signature:�oo oo�owo«dio.rorcrey�tRa� Fi,cruR� wa�o Coap (W��AVvi JoHMSo+� �r�) Pumper's Name:(Print) Pum ature: �- �� Pumper's Regishation Number: � � $ 13 Rev.0326/13 i �iiiii,ii iiiiiii ii -USE BLACK INK ONLY - POWTS MAINTENANCE AGREEMENT 435590 PAULA CHISSER For Holding Tanks REcisTER oF uEE�s SAWYER COUNTY, WI OwnersName(s)ass�ovmontleed: 11/03/2021 OS:1D AM RECORDING FEE 30.00 Futurewood Corp. Parcel Identification Number: PAGES: 2 (12 Digil Lepacy ID) 0 2 8 9 3 8 _ 7 4 3 2 0 7 Leqal Descriptlon of Property: -SEE ATTACHED SHEET - We ackrwwledge thal application is being made for the installatbn of a holding tank(s)on ihe properry tlesdibed on the attached sheet. Retum To:Sawyer Counry 2oninp and ConsenaUon Administratlon 10610 Maln St.Suite 49,Hayward,WI SG843 As an inducement to the County of Sawyer to issue a sanitary permit for a holding tank on the above-described property,lhe owner is responsible for the operation and maintenance of the holding[ank,locking device, alarm and access,and egrees to conform to all applicable requirements of SPS 383,Wis. Adm. Code relating to holding tank managemenl, including the following: t. The owner agrees to contract with a person who is licensed under Ch. NR 113,W is.Adm.Code, except as provided by Sectbn 281.48(3)(d). Stats.,to have the holding tank propeAy serviced and to file a copy of the service contract with the govemmental unit. The owner further agrees to file a copy oi any changes to the service contract,or a copy of a new service contrad,with lhe governmental unil within ten(10)business days from the date of change to lhe service contrect. 2. The owner agrees to contract with a person licensed under Ch. NR 113,W is.Adm. Code,who shall submit pumping repoAs to the govemmental unil in accordance with SPS 383.55,Wis.Adm. Code,for the servicing oi the holding lank. In fhe case ot exemption under Section 281.48 (3)(d),Stats.,lhe owner shall submit the raport to Ne govemmental unit. The governmental unit may enter upon the property to inves6gate the condition of the holding lank when pumping reports may indicate the holding tank is not being properly maintained. 3. If ihe owner fails to have the holding tank properly serviced in response to orders issued by the govemmental unit to prevent or abale a human health hazard as described in Section.254.59, Stats.,the govemmental unit may enter upon the property and service,or cause the lank to be serviced. Pursuant to Section 14520(4)Wis. Stats., a govemmental unil 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 incurted by Ihe governmenlal unit for Inspection,pumping, hauling,or othenvise servicing and maintaining the holding tank in such a manner as to prevenl or abate any human health hazard caused by the twlding tank. 4. This agreement will remain in effect onty until the governmental unit responsible for the regulation of pnvate sewage systems certifies that either a soil absorption system that complies with SPS 383,W is.Adm. Code,or a municipal sevrer serves the property. In addition,lhis agreement may be qncelled by executing and recording said certification wilh reference to this agreement in such manner which wili permit the existence of the certification to be detertnined by reference to the property. 5. This agreement shall be binding upon the owner,the heirs oi the owner, and assignees of the owner. The owner shall submil the agreement to the register of deeds,and the agreement shall be recorded by the regisler of deeds in a manner which will �iCtFe�tence of the agreement to be determined by reference to lhe property where the holding tank is installed. -Onl 0 6 ownar al nature re ulred• ACKNOWLEDCaMENT O er's Si at State of: '^'�^s�^ �-�_ _— � - County of: se.�ye� Owne (Print): RY P Subscribed and sworn to before me on this William Johnson Jr. (Futurewood Corp) �P B(� vm d2y Of a�ooe� 20 os ,e �oz, Date: � �OWf1Q(S NBfTIB�: �'�'illiamJOMsonJr (FUWrewooECorp�ppp �¢�ry 10l27/2021 � KF�Y � ary Public Signature: I� �k Drafted by: N F blic Notary Name(Print): Kt u Kelly Butterfield �/j y �� y commission expires on: 3 4s LZ �t��h�W��`" Personal informaUon you pmvide may be used tor secondary purposes[Pnvaq law,§15.04(q(mp Rev.03/26l73 The North Half of the Southwest Quarter (NYZSW%4), Section Faurteen (14}, Township Thirty-eight (38) Nor�h, Range Nine (9) West, Town of Sand Lake, Sawyer County, Wisconsin, EXCEPT that portion lying West of C.T.H. "F".