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Home My WebLink About002-121-18-1500-SAN-2022-346 �" ' � Industry Serviccs Di�ision County (/� 4822 Ma�lison Yards W'�y Sawyer � - ,�� . Madison,WI 53705 Sanitary Permit Number(to be tilled in by Co_) � S P.O.Box 7302 _. ,:;?� Madison,WI 53707 � 'j�j "� �;� ,� g-� - _ RJ Sanl+a� Pe1•1��1* An„llCa+l�n State Transaction Number r l l, Y l.l l, (�� p (/ � In accordance with SPS 38321(2),Wis.Adm Code,submission of this form to the appropriate govemmental unit 1 �"�,�'��•� ��l��I �' � ,� is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to Project Address(ifdifferent than mailing addres� � the Department of Safety and Professional Services.Personal inti>rmation you provide may be used for secondary Sa me purposes in accordance with the Privacy Law,s. 15.04(I)(m),Stats. I.Application Information—Please Print All Information Property Owner's Name Parcel# Robert Hammond 002121181500 Property Owner's Mailing Address Property Location 14392W County Hwy K �o�t �ot City,State Zip Code Phone Number Hayward, WI 54843 651-338-7532 '�, '�, Se��;o� 30 IL Type of Building(check all that apply) Lot# T 40 N R 08 E o �I or2 Family D��ellina—NumberofBedrooms 15-23 Subdivision Name �Public/Commercial—Describe Use Kitchen&Bar Waste a�o�k# Community Beach 8 �City of �State Owned—Describe Use CSM Number Village of �Town of Bass Lake [II.Type of PO�VTS Permit:(Check either"tiew"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C i a licable.) `�� Ne��S�stem Re Iacement S�stem Other ModiYication to Esistins S�Stem(ex lain Additional Pretreatment Unit ex lain ❑ � y � P Y � ,. Y= P ) ❑ ( P ) B' �Holding Tank �In-Ground �1t-Grade �Mound �Individual Site Design Other Type(e�plain) (conventional) C• ❑Rene�cal Before �Revision �Chanee of Plumber �ransCer to Ne��O��ner List Pre��ious Pennit Number and Date Issued Expiration NA IV.Dispersal/Treatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(st) System Elevation 282 0.7 NA NA TBD Capaciry in Total #of Manufacturer Tank Information Gallons Gallons Units � � �o 'n„ o \c��Tanks Fsistine Tanks '� � � `—' y � r '= c`. U v� �, v� .. C: G, Szptic or Holding Tank 2000 2000 1 WI2S@f � � Dosing Chambcr � � � V.Responsibility Statement- I,the undersigned,assume responsibili for installation of the POW'TS shown on the attached plans. Plumber's Name(Print) Plumber's Signature MP/MPRS Number Business Phone Number ,lason Kuettel �; 675751 715-798-3355 Plumber's Address(Street,City,State,Zip Code) �. PO Box 66 Cable, WI 54821 VL Counlv/Department Use Only �Ap ov ❑Disapproved Pennit Fee Date Issued Issuing Agent Signature $y�,°° I.�I. � i �� .r,��k--t-C�i-�-jNt/�e..--. ❑Owner Given Reason for Denial � � Conditions of ApprovaURcasons for Disapproval ��Cr� ��e �^�' .� ��: �t � �Gi�i�..;>�...r� ;, x�_ ;i � � � a i��-��2� „ ;I� ��'�� ' /�� I :hk# i 3�8� _ DEC 2 1 2022 ;';:;:�1:"`,�CNJ..._ l�,P 1 C.� ��,�-to C�� -�. - �S �c � SAWYER COt��ITY ZpN1NG A�MlNISTRATION :\t[ach to comple[e plans for the system and submit to the County only on paper not less than 8 1/2 s I 1 inches in size �� ss�-b�9s�R.ozizz� td0 R�!'Jt�DS�F7ER I�SlJ�OF PE('-��J�IT Sawyer County Zoning & Conservation Administration `�"`�`1 10610 Main Street, Suitc 49 � �R Cp �� Hayward,Wisconsin 54843 +.l , - i S1 i ��G�I (715)634-8288 �Q; ��j FAX(715)638-3277 i(q li{� www.sawvcrcounryeo�.org jo� ,:A„ -- ;o i E-mail:zonme.sccfrusaw'Vcrcountygov.oil; � �" � Toll Free Courthouse/General Inf'ormation 1-t377-699-4110 I�GL ��,-,� �� S� ��`oN�� Holding Tank Approval Checklist I. Sanitary Cover Sheet Date Stamp �a / � � / � � Parcel ID# O O a- I 2 I - \ � - l '� o a II. Plot Plan �C Property Lines � Benchmark BM ♦ 7C Site Address '�(North Arrow � Structure � Scale �Well J>C< 25' to Service Road �C Legal Description �Nearest Road Intersection �Setbacks to: Property Line, Well, Structitre, Water bodies, Roads 11I. Required Plans � Index Page with Original Signature �( Management Plan/Contingency Plan � Servicing Contract �Holding Tank Agreement form tV. Holding Tank Specifications � Cross-section—Manufacture, Gallons: �"''�� °�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) �3" Bedding Material < 1/2 " V. Holding Tank Plans per Component POWTS Manual �Version� SBD-10855-P (R.3/07)C?-��a?� 2•� Owner: �Q�w�o�o� Plumber: 'v J� Application Review Date: (2��-1 ��,z POWTS Reviewer: �.. �� Name 6� �bl� � License# Revised 4/11/2013 Wisconsin Depanment oCSafcty and Professio�al Services - � Phone:608-°66-211? Division of Induscry Services - Web:httpl/da�rs wf.euv 4822 Madiso�Yards Way - � �a = EmaiL dsncu`a�wi In.eov POBox7302 � �� _ �- scons n.�ad�so�,w15a�o7 ��i; Tony Evers,Governor `�k;,, -�- Dan Hereth,Secretary December 13,2022 Conditionally APPROVED CONDITIONAL APPROVAL tiEPT OF SAFETV AND PROFESSIONAL SERVICES DIVISIOH O�INDUS7RY SER'lICEc PLAN APPROVAL EXPIRES:2024-12-13 ��/� Plan Review:PWTS-122202904-C . . _ _ Jason Kuettel SEE CORRESPONDENCF PO Box 66 Cable,WI SITE: Robert Hammond 14392W County Hwy K Sawyer County Town of Bass Lake S30 T40 R8W FOR: Description:282 gpd-2000 gallan tank Hold Tank Component Manual Design References:Version 2.1(May 2022-2027) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes.The submittal has been CONDITIONALLY APPROVED.This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s)referenced above.7he owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec.145.19,Wis.Stats. • Inspection of the private sewage system installation is required.Arrengements for inspection shall be made with the designated county official in accordance with the provisions ot Sec.145.20(2)(d),Wis.Stats. • A copV of the approved plans,suecifications and this letter shall be on-site durinR construction and open to inspection bY authorized representatives of the Department,which may include local inspectors. Owner Responsibilities • The current owner,and each subsequent owner,shall receive a copy of this letter.Owners shall also receive a copy of the appropriate operation and maintenance manual(s)and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s.SPS 383.54�1). • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance trecking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In grenting this approval the Division of industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12�2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, ,jd��►ticw/2owl�y Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715) 634-5124 joshua.rowlev@wisconsin.�ov ��-2 �v` �" Ce '�� /�tn,c�ev�e4�� l/ • A minimum 4x6 inch permanent label shali be a�xed to the manhole cover of the grease interceptor identifying tM1e tank as a GREASE INTERCEPTOR per SPS 38234(S�(c)l.i.All other condkions of SPS 382.34(5)�c)shall be tollowed—including manhole sealing,proper inspection ports and baHle lengths. PAGE 1 OF 4 Holding Tank Plan Index & Cover Sheet Conditionally APPROVED DEPT.Oi SAFETV AND PROFESSIONAL Component Manual Design References seRvices DIVISION OF INDUSTRY SERVICES Holding Tank Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet �� Pg 2 of 4 Plot Plan SEE �oRHESF°"°E"�E 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) Holding Tank Pumping Contract if a ficable) Holding Tank Agreement (if applicable) Project Name / Description The Boulevard Owner Name(s): Robert Hammond Phone: 651 _338 _7532 Owner Address: �4392W County Hwy K Hayward, WI Z�P: 54843 Project Address: Same Govt. Lot: 1/4 of 1/4, Section 30 T 40 N-R �$ E�or W ✓❑ Township: Bass Lake County: Sawyer Project Parcel ID #: 002121181500 Designer Information Designer Name: Jason Kuettel Phone: �15 _798 _3355 Designer Address: PO Box 66 Cable, WI Z�P: 54821 E-mail: tim@andryras.com 675751 Conditionally �icense Number: _ APPROVED Remdrks: DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES �,� �� s � � �� .! SEE COR ES ONDENCE Signature: ��;u� Date: �z � z. t� Origi al ignalure rEquired on each 5ubmitted copy. _ _ - --- ----, _� ,_.. �. _�_ _ . _ ., . �_, . . . .. . _ .. Scale: t' -40' . `� ❑ SOIL EVALUATION - � SYSTEM PAGE 2 OF SITE MAP ° 40 6° a° PLOT PLAN PROJcCT MAME � r L y t�q n g�tl�. ��: ^E9 Gr-I 9�`;i ::PD /x��Lv,j/� � (Zl�„1-.��--b�-'—� Attarh tlesign Ban calculations for commercial pians veo�ECi qoDRE55 /°r 3'�Zyv <.� _ .�;; H u Y �e ^I P�pe Matedal/ASTM Siandard(Tables 384.30-3 8 384.30-5) �� i. 'V Sav�arySewer 4,.,fnJ y. �.y BM Symho'� �- 0AI Eievatron f, ew oe�npnoo� I�ceK c�-ti,•r�x z.�- �� ,�_ V.�� r� Fo•�e Ma�� N-t � Slope Graelenl('%) �^e'-a«^�^�^�r I MPORTANT: o!TestedArea 2� 'Neu Symboi�ilapc'+woie; p ��a�.�og a�a:«.•. Show ground eleva�ion con�ours af suitable inlervals on��e appropelte h:� ��,��,� , �Z�,�czr r�,��„_� �� ;�o�a�sS � J y��zw �� .. .� ,--, t-i-t-� � K It�,�� ,�-��, �� i iLLe%�Z : Cun.-ri.��, �: ( ��tAet+ Lc ,—r �s z3 t3� iL � S 3�. i y��N i�t% u �Tn� i � O��zIZ// �' /5�� S �w�� , �� N ��= i��4sS c ,� x_� I I (J�xTri I I I ?/L I � � � II cxiN.;r � �1S i3 - - ---_ __ I I I I -.__ .— I � I i ; -- - ;;,�.��_ _ —__— - ----� � I I I �^ �'i�"�J:�'.. � I � � '� n �� < ., � `=� y � I � 11 �n��n�t ^ W I I J J—f ` v ( I � J l � . � / - - - '-- �� w il-sert—zu�,,,�-J � .,_ � � ; , � y'j�., ti� �5: I. 1\�YD�•J(. --�� 5 Je��aA� I I n . _.. Z. .Tqr�l� / � �— �� l!r \r I� '� . . f , . _ � V � ti ia[;ti � � � � '� I I I U � � , , �- I �UcLL ' 1�'��.[�RJTfj..•P•'i�' I I � . , � Gx. �� 1��...a ..Jr a I � � , f��7„_�• L Z �jl'� �CCl��y::nv.F C izl�+12 y ,�`�, u' ( ,;�z,L�e:-z ` i � ��1 : i3��• w` � ... ._ ' - -- i I � �Y til-C�/_ / ._. .I_ . . � I ! - ( <�[/'�L�' � . I_ � : � ;� � � �� /, I I --- - - _ _ -- _ _----___--- --- , -- ._--� � ,,; I �__ --) �-- co r�1=; � .\ I I `I __'.'—_--_' ..) _.__'_ i _.__'—_—_�.—.__' __'___.'—.____—. ___—_— Ir�� E 'IS'75/ I ( ,7/7�zoz2. — — _ _ _- . _. .. _ I - -- ------�I pAGE 3 Q� :� HQLDI � G TANK SPECIFICATIQNS ( No Scale} � t �"l �A` rt � :��- . _� ='-r rr � � '-f . j i �—�—.1� r . . � E t '�: � �� r 1 t r . . � , E� ,a � 1��, _ . � �.-t /, , r .,, t i _a,; r! a. = ' ; �iirr , tm,�r �"� � , ! WS � t n � � . � � , £` s t r_:. ' ...•�r:a .r�r�-;, . , � .. � ` �.. .I . •t^ Y ry �� ' i f . I� a ..e�F�'�� '� � �i.;a • —~ � 4 � ' �'!� .� �_ i.1 � - `� i . 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T.�`�.�'Ji': i�.'�iti�_��Y,�=,TI�T«�: t� I�I �f=— �.c:��c,2Crt= r,�`rr ':7 a�= �-_ ,.�?ry ��: . .:ii' _, f� 3_ i r;;�C� . -�.=..t . .:", . — � ... .. t�• .. ? ':�: i: .. , — ...", . t ''r . ;� . i ._ :il � �I'��` - � _..a,. _�__�_ _ . - .w t u ., - . __, z _ i , , . - __...... �_f`';, HSW NOIdinR Tank ou ce Fsfimated rinw llni[ Tp�dl Bar/Oa�Scating�no Meals) A GI'D per scaf 10 SeatS 90 GVD Bar/Bai Sea[ing�with meais pa�er w,�5tc�Hi�h To�i 9 GI'U Oer se � 10 Seats 80 GPD Res�au�ant Ki[clien Was[e ONLY with0ut tli5hwestii�r anA'onC eva52e p,rir�,:C� 66P�G¢r seai 26 SPa I1?6PD F!oor Dra�ns(2� 25 6VD pe/drain 2 Ea<h5 50 GVD '•"1000GaIConcrctetanke�istingforgreaseinterceptor••' 7oralNMdingTank 282GP0 � ""2000GeIHOldingTankbeingAdded'•' ;ntutal[stun�letlGPO 3430�GP0 Mf�imumHO'I�TonkVatu�p32(IOpGaI�.��.. Resitlential 5[reng[h Tank$Drainfieltl Sivng $ou_ Eshmat tl flow Uni[ Total x� Restaurant(�athioum Waste Dnly 2B seat5� 14 GGU per Seat ]8 Seati 397 GPD i88 GPD Empioyees(3) t3 GPO per em loyee 3 Fmployees 39 Gvu 59 S GVD 1 BeU uostairs Res�oence(t00 G1'D! iW GVD •••DrainflelE9xing••• TOtO� .t�`��pialnfleW 9$�'S��PTP, , Drainfield Si:ing•�••See atta<hed EZ Flow Dlspersal Fage'•'• � �-�� , . . . .�d:7. . � 1352.143�S�i ""•Septic Tank Sixing�2000 Gal"•'• ••�fank 5izing•�• �Y�76.292 Gal Mlnimum� PAGE40F4 Holding Tank Managem�nt Plan IMPORTANT: The o�vner of this halding tank(s) shali be respcnsible for �ts perpetual Gperatr�n and maintenance pursuant t� requirements of SPS 332-33�, Wisc. A�min. Co�e. Pursuant �a S�'S ?83.52 (2j. V'Jisc. Rdmon. Cc�de, this hafding tank!s) shall be considered a hum�n healtt� hazard �f not maintained in ac,;ord�nce �vith tt:as approved management plan Furtnermore, ali inspsction and maintenance activities shall t�e performed 6y a registered POWTS Maintainer in aceardanc� with SPS 383.52 (3}, Wisc. Adman. Gode. Estimated Daily Wastewater Flow = � � �' gpd Inspection Checklist 1NSPECT EVERY 3 YEARS c type of use � age af system o nuisance factors (r.e. odors, user complaints, etc.} o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.} a material fatigue {r,e., leaks, breaks, corrosion, etc.} � negEect or improper use (i.e., exceed€ng design capacities, prohibited aciivities, et�.) v electrica( componanls (i.e., wiring, connections, s�xitches, cpntrois, kimers, alarms, efc.) o surface discharge of effluent ar se�rage back-up into structure served SERVICING FREC2UENCY � Tt~e tank{s) st�a;l be pumped �y � c�rtified s�ptage serv`rcing operat�r lic�nsed under s. 281 .�8 Wisc. Stat� when the wastewafer in #he tank(s) r�aches a level of one faot kelow the inlet invert of the tank(s) Disposal of contents shall be pursuant to NR 113, Wisc. Acmrn Gade. Tank pumping reports sha11 be submitted t� th� propar local government unif in accordance with SPS 383.55 Wis. Admin. Code. Report any camponent faiiure or malfunction to: Name o� ind�vidual or campany: A�CIC`y R8SfC1USSBtI � SOC15 Phone 71 �J-��-�3�5 ��ca� c�overnment unit SaWy�t' Co. ZOt11f1� � �_ Phone: 715-634-8288 ��e�� r,.�r��rl,��, s� �;��k,� �f�,�,�� '� �610 Main �t. #4� H�ywar�; !�!I Li�_ 5�843 Any defectiv� par# of this s;�st�m shall be repairAd, replacpd, or remove� pu�suar�t t� SPS 383.51 {1), Wisc. Admir. C��e, Repa�r o� re;�lacement of failec Qr malfunctionin� comE�onenls s�a(I com�ly urith SPS 383, Wisc. Admin. Gode. No product far chemical or physicai reskoratiun o� the PO�rVTS may be used unless ap�roved by th� de�artmen; in a�cardance v;ith SPS 384, Nlisc. A�rnin. Cad�. Contingency Plan In Ehe event tllat ariy f�ilad ec�mporeni of this holding t�nk(s? c3nnot b? re�arre�, it sh�ll bp r�placeC pursuanl ta a pl�n s�bmi�Eed Eo (he �ppropriate ageey far revie�,v an�J ��ro+.al. S+,Lstem Abandonment I; usr af tF:�s tank�sj i� ��sc�ntinu:d, i; sh.;�ll �r. ab�ndor;ec� in acc;�rd�r�ce �:��ti3 SPS 333.33, b�lisc F��Jmi��. C��jr. Rice Lake'iltiCities ECectric`tiVater•1Nastewctter 320�1N.CoCeman St. Rice Lake WI54868 � 7eCephone:(�tsl z34•�o04 � f.1X#:(7i5)236-7934 =�..�?b.� RICE LAKE WISCONSIN December 09,2022 Rasmussen&Soos,Inc.: We will accept the 2000 gallon holding tank that services the bar sink and kitchen waste that is considered high strength per residential code. We will also accept the 1000 gallon grease holding tank,but the grease must be hauled separately from any other waste,and be disposed of in our grease receiving station. Depending on if it is holding,septic,grease or settling basin,it will be billed out accordingly. That will be determined upon delivery. Please notify facility to schedule Thank You, / � � � Corey Margetta Wastewater Utility Superintendent 715/234-3681 HOLDI�G T,1'VK SER�'lCING CONTR��C't' Contract Datc: /'t_ / z�� zvLL � "This contract is m�dc bchvecn ihc Holding Tank O�cncr and thc Pumper. I [olding "Taok O�vuer's Namc: Pumpa�'s Namc: -- -� Northwest Sanitary, Inc. � ZC��3t�i. r t-i✓d.ti.Mo �� PO BOX 155 I Radisson, WI 54867 Parcel Identific�tion '�`umber: � ( l ? Di�it L�gac}� ID) 4 c 'Z - � Z 1 - 1 � - � S o �, — - - - - - - � � 1 . Thc o�vncr a�rccs to tile a coPy ot'this contrart with thc gu��ccnmcntal unit. Sawycr C'ciimt�-. whirh ha, acccpted and recordcci �� ith thc Officc oCthc Re;;i:tcr of Decds, thc �1aintenancc Agre�ment fi�r a I lulding "[�ank rc��uircd undcr thc Sa��•ycr C'ount� Private Se�va�c Systcm Ordinancc for the issuancc of a Sanitary Pcrmit t�ir thc installation of�a hol�iing tank(s). 2. Thc owncr agrecs to ha��c thc holding tank(s) scrviccd by thc p�unp�r ancl cuarantccs to �crmit the puniper to havc acccss �ind to enter upcm d�c prupcity fur thc purpose of.crvi�in� the hvldin� tank(s). 'I�hc owncr agrees to maintain thc all-�veather arerss road or drive so � th�t the pumper can service thc hulding tank(s) a� ith Ih� pumpin�� cyuipm�nt. The <x��ncr fw-thcr aszrces to pay thc rumper for a chargcs incurrcd in scr��icin�_ thc holain� tank{s) as mutuafly agrccd upon by thc o�vncr and pumper. 3. Thc Pwn�icr a�,rccs to subrnit to thc C;o�•cirmcntal Unit. Sawycr Coun�y, a rcport for thc scrvicing of thc holdiug tank(s) as mquircd undcr SPS 3f+3.55, �l�iscontiin Administrativc Codc and thc Sawyer County Privatr Scwagc Systcm Ordinancc. Thc pumper furthcr abrees to include the fo1loU�ing in thc reE�ort: a. Thc n�m� and address of thc person responsiblc for scrvicing thc holding ttu�k: b. "l�he na�nc of thc owncr uf thc holdin, tank; c. Thc site address of thc holding tank; � d. 'fhc datc thc holding tank wa. scrvi�cd; C. Thc vt�l�utics in ��Ilons uf tl�c contcnts ninn�e�i (i-��n thc holclinc tank for uacl�i scrvicing: t'. 'I'he t�isE�osal sitcs to which thc contcnts from thc holdinL tank ��crc delivcrcd. =1. 7�his agrecmcnt �vill remain in cffcct until thc ownrr �>r pwnper tcrminatcs this c<�ntract. In the event of a change in this contract, thc owner agrees t�� file a copy of any changes lo this scr� irc cc�ntcact �ir a copy of a nc�v scrvice cuntract ��ith Sa��ycr ( cnuity �vithin tcn ( 10) busincss days from thc datc ofchan��c to this sc� ��icc coi�trac�. OW[1Cf's Namc: (Print) ��Wlll"'.' l��IlAtLICC: (()nl� o � owncr si€nalurc rcyuirc<I) 20�-'�: ��mm� �' �� /� . � ; Pumper's i�amc: (Print) Pumper's Sirnawrr. Ronald L Vieceli, owner Northwest Sanitary,lnc ' I ,� , �� / IJ�-i�-�.t� L, !'.,�t°. f�.�; PumPer's Renistr.ltlOfl NUII1hCC: — #2389 Ret. ll; _'t� 1: 12/21/22,2:47 PM Real Property Listing Page Redl EStdte Sawyer County Property Listing PropertyStatus: Current Today's Date:12/21/2022 Created On:2/6/2007 7:55:02 AM �Description Updated:3/6/2018 `�Ownership Updated:3/6/2018 . . .. . . . ..___ _....__._._.__--- 7ax ID: 860 ROBERT A NAMMOND HAYWARD WI PIN: 57-002-2-40-OB-30-5 15-153-181500 Legacy PiN: 002121181500 Billing Address: Mailing Address: Map ID: -7.18.15-23 ROBERT A HAMMOND ROBERT A HAMMOND Municipality: (002)TOWN OF BASS LAKE 14392W COUNTY HWY K 14392W COUNTY HWV K STR: 530 T40N ROBW HAYWARD WI 54843 HAYVJARD WI 54843 Description: COMMUNITY BEACH LOTS 15-23 BLK 18 m Recorded Acres: 0.656 r Site Address *indicates Private Road Calculated Acres: 0.640 14392W COUNTY HWV K� � HAYWARD 54843 Lottery Claims: 1 First Dollar: Yes �Property Assessment Updated:5/29/2018 Zoning: (C-1)Commercial One 2022 Assessment Detail ESN: 445 Code Acres Land Imp. G2-COMMERCIAL 0.656 9,200 111,400 �7ax Districts Updated:2/6/2007 1 � State of Wisconsin 2-Year Comparison 2021 2022 Change 57 Sawyer County Land: 9,200 9,200 0.0% 002 Town of Bass Lake Improved: 111,400 111,400 0.0% SR478 Hayward Community School District Total: 120,600 120,600 0.0"/0 001700 Technical College • Recorded Documents Updated:3/6/2018 p.'�property History WARRANTY DEED . ...- .--. N/q . Date Recorded:10/4/2017 409019 WARRANTY DEED Date Recorded:8/4/Z014 391611 SCRIVENERS AFFIDAVIT Date Recorded:2/28/2012 377392 QUIT CLAIM DEED Date Recorded:1/1Z/2012 376591 https:Ntas.sawyercountygov.org/system/frames.asp?uname=Eric+Wellauer �� . : , ,,,�., , n. . .� , ,� � -n ...E .�a "`:.iE� .`w.....um�� ' ' ��,� �.�r� i . . i I � 'fa' 4 ;"o �� M:� 'i) ' Y '� �' � � � � �� _ � � ��',� "` I '+< « ' � , . '� � � . ., , .� I• � z � .� , " , _; a , �:� _, I -w .;! r. f. . 3 '-.r� K� � 1 '� � _ ' C . . 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I . ��. . i ` 1GY y' � ' �.l... �. 4 f'r �rJ. `e ; . . f r .. � � s .4` � a I . f _ p ; �e. �� '- �:f • � . �� F 4 �`1a � . � � � �Tl�' ��t �� : . . r � ,' r . �j,�. � � , � ' i ,, .. �� 4• �- k �� ' � - �l r' ,� •: t �l " � � t � �� ; �.: - �F �� 'e �f �`-_ f �, , i �� ,i I'��QI ,CII�II�Illllll ��,��I(}.i�.�.U��)Ub�l.�.� - USE BLACK INK ONLY - 1X:4042621 �t4Z802 I POWTS MAINTENANCE AGREEMENT PAULA CHISSER For Holding Tanks REGISTER OF DEEDS SAWYER COUNTY, iNI ' O�,mer's Namejs)as snoNm on de�d: I2/22J2022 09:4b AM RECORDING FEE 30.00 2ct3��-C ��t�;wn-�a:�� Parcel Idenfificafion Mumber PA('iES: � (12 Digit Legac�ID) D ('��-� Z�. •��-�S U C3 Legal Descripfion of Property: -SEE ATTACHEDSHEET- N/e acknowledge that application is being made for the installation of a holding lank(s)on the propeRy described on the attached sheet. Retum To:Sawyer County Zoning and Conservation Administration 10610 hlain St.Suite 49,Hayward,WI 54843 As an inducement to the County of Sawyer to issue a sanifary permif For a holding tank on the above-described property, the o�rmer is responsible for the operation and maintenance of the holding tank,locking device, afarm and access,and agre�s to conform to aii applicabl� requirements of SPS 383,V�lis.Adm. Code relating to holding tank management, including the follo�riing: 1. Tne oavner 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 seroice contract with the govemmental unit. The o��mer further agrees to file a copy of any cha�ges to the service contract,or a copy of a ne�v service contract,with the govemmental unit within ten(10)business days from the date of change to the service contract 2. The o�+mer agrees to contract with a person licensed under Ch. NR 113,V`/is.Adm.Code,who shall submit pumping reports to the govemmenfal unit in accordance�vith SPS 323.55,�Vis.Adm.Code,for the servicing of the holding fank. In the case of exemption under Section 281.48(3)(d), Stats., the o�rmer shall submit the report to the governmental unit. The govemmental unit may enter upon the proper-��to investigate the condition of the holding tank�vhen 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 governmentai unit to prevent or abafe a human health 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 145.20(4)Wis.Stats.,a governmental unit may assess the oavner of a private se��vage system for costs related to the pumping of a sepfic or holding fank. The charges N�ill be assessed as prescrioed by Section 60.0703,sfafs. The oa+mer agrees to pay ali charges and cost incurred by the govemmental unit for inspection,pumping,hauling,or otnerNise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the hoiding tank. 4. This agreement�vill remain in effect only until the go��ernmental unit responsible for the regulation of private sewage systems certifizs that either a soil absorption s�stem that complies with SPS 383,V�/is.Adm.Code,or a municipal se�rier 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 will permit the existence of the certification to be determined by reference to the proper�y. 5. Tnis agreement shall be binding upon the o�vner, the heirs of the o��mer, and assignees of the oti�mer.The o�,vner shall submil the agreement to the registzr of deeds, and the agreement shall be record�d by fhe regist�r oP deeds in a manner�rihich�viil permit the existence of the agreement to be det�rmined b�reference to the property where the holding tank is installed. ly pne owner s' ature required- ACKNOWLEDGPAENT O,vner's ' n� — Q � State of: i��S cvn , n O�vner' Name (Print): County o�: Su��_,�,�1 �.�-i" f}-. ��q�,�r�v..� Subscribed and s�vorn to before rne on this Dale: -- — ,`��r��oi�i►� q day of �-tLwl l2�✓ , 20 �-�. 1 Zl J t l Z'� `��•�` '�Y4�1,+� e��s Name}; --- o^� � � Not`��ry�Signature: �, D r a�ta d by: l n., r � ---- ?W .�¢ Pub'G*'yf�to��N�me (Prinf): G �Q.Y G.a'l t...L'�:Zl• - Vl') — - — _� � �y LjnmO i�n expires on: _ �J /� �Ua� = et , e „ — � id � , � . � ' � 6t `� ,�F ` P..rs-�nii i��om ��,�jou�;ru r:�1��n�s.i ba u, J ror s�cordary pu� �u �;� �� '�� . ' � �i 1 _ � � Al�, ��7 "u�j�5.1�.(I)(�,il] '>tap F;��i 03,2�;;13 !1?941\�Es\ Lots 15-23,inclusive, Block 18,Community Beach,Town of Bass Lake,Sawyer County,Wisconsin. '�`"�"��'�� PRIVATE ONSITE WASTE TREATMENT co�nty ,�� .. > , ;; , . r, ' pg { SYSTEMS Sawyer p �.� ��.� s �'�� ( POWTS) \k �--�;;; °z s"�' INSPECTION REPORT Sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �� 3�{�p Personal infonnation you provide may be used for secondary piuposes[Privacy Law,s. 15.04(1)(m)f Permit Holder's Name: ❑City ❑ Village Town of: State Plan Transaction ID#: re.�t-- u�.�.,o ��s l.�V.� f�T"S —��.�.22 �2�Y- Insp BM Elev: BM Description: Parcel Tax No: tDo•� � ��-�c c��1 �y�� s��-- �� - I�I� 1�-�S^da TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Benchmark (pp,p� Dosing Aeration Bidg. Sewer c� , ' Holding �,,,;�f- 2�� St I Ht Inlet 4�.0 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG vEr,r ro ROAD Dt Inlet AIR INTAKE Septic NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. Holtling �.��' �Sb' �{p � ,-I-�o' L� � Dist. Pipe PUMP 1�IPHON INFORMATION Infiltrative Surface Manufacturer Demand Final Grade Model Number GPM �-. Tv� 9 � TDH Lift Friction Loss Sys Head TDH Ft (,�, � p��- q .-o � Forcemain L Dia Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS W � #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav ° Conv ❑ Aggregate INFORMATION P/L Bldg Well Waters o GP ❑ Chamber Model Number: ❑ EZFIow CELL TO ❑ Mound o Other - -__------- -- — ----- __ _ -- - _-- DISTRIBUTION SYSTEM x Pressure Systems Only - ------ ---- --___--- Header/Manifold Distribution Pipe(s) i X Hole Size X Hole Observation Pip�s � Length_ Dia Length Dia_ Spac ! _ _ � Spacing ❑Yes ❑ No_ _ SOIL COVER - — ' --- Depth Over Depth Over Depth of Seeded I Sodded Mulched Cell Center I Cell Edges I Topsoil _ _ ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) �S��(� � `� I�°� 3 � G� . �- �t T� -��- �.�-�-,�-�.�- � � � - _�� '�� --- Plan revision required?O Yes❑ No ;�� i og � �- ---� Use other side for additional information Date POWTS Inspector's Signature Certification Number S6D-6710(R.3/01) AOOITIONAL COMMENTS ANO SKETCH SANITARY PERMIT NUMBEA:__ aa � 3`I� _ _ _ _. ___ , .,_.. _;._ -- _ ; ; _ , 5•1. w�,�r � �. �I,� � �� - � e�d� . ,,�.�I �� I�c3q�-"J u k - ��