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Home My WebLink About004-838-12-4403-SAN-2023-025 _;;��^"'^� Industry Services Division Ca�h'� � I . =� ` = 4822 Madison Yards WaY f pn. /' ,;, �DS = Madison,WI S370S Sanitary Pettni Num6cr(to bc fillcd m b ` Ps P.O.Box 7 t 62 �� .3�.] Z �`.:,,_:,��,% , Madison,WI 53707-7162 � � Sanitary Permit Application State Trensaction Nu�nb�� ,,� In accordance witli SPS 38321(2),Wis.Adm.Code,submission ofthis form to the appropriate govemmentai unit Q is rcyuirc:d priur to obtaining a sanitary permit.Note:Applicaoion forms for state-owned POWTS are submitted to Project Address(if diQen:nt than mailing r�, i the Dcpartmcnt of Safety and Professional Senices.Pcrson:il information you provide may be used for secoudary purposes in:iccordance with thc Privacy Law,s. 15.04(1}(m),StaLs. � I.Applicarion Informa6on-Plcase Print Al!Informallon - T` �' y Property Owner's!�;une Parcel# N' o e O°y�r /.� ye _. Property Owner's Mailing Address Property Location 7 2i� � � �� 3 N.28 ��-e .S City.State Zip Ccxle Phone Number i ��!.,�_'/., Section __l_�__ /M1 D - II.Type o Building(check all that-apply)� � � � ��>t" T 3� N R 8 E o � �i Subdivision Name �l or� Farni;g Ihreliirg-Number ofi3cdrooms __-- � Block# �iblic/Commercial-Describe Use_ ___ � ❑City of �Statc O��ied-De;cribe Gse_ CSA�t Vumber � illage of _ �own of�.__---- —---- . .. . ..*n�sx�ra ITI.Type of PO�'TS Permit:(Check either"New"or"ReplacemenY'and othe��a�j��pcabl�on luie A Gheck one�oa on"Iirie B_Complete tine C if a licabtc.) __ A e�c S•stem e lacement S stem er Maiificalion to Existin S m ex lain Addirional Pretreatment Unit ex lam I� Y � P Y � � Y� � P ) ( P ) LJ a: -�--- - �Holding Tank �In-Ground ❑At-Grade ❑Mound Indivictual Site Design Other Type(explain) (conventionaO �-• ❑Renewal Bzfore �Ftevision ange of�Plumber �I'ransferto New Owner �stPrevious Permit Numbcr and Datc lssued Expfntion . — iV.Dispersalfi'rcatment Area and Tank Infocmarion: - ` �" Design Plo�t�(�p�i) Design Soil ApplicaGon Rate(gpcL's� Dispersal Area Required(sfl� Dispersal Area Proposed(sf� System Eleroation 3� I -- ` -- _ Capacity in Total �of Maaufacturer _ _ c .n Gallons Gallons Units � � U � Tank[n�onnation � w " � 'm � ` � c� � i lc�v Taaks Facisting Tanks � y C :: � � j a U V� in i % :z. �. � CL i -.__ i � Scptic or Holdfng i�ank �/ S � � � —�-� � [� 0 Dcuing Chambcr �� _- ,� � i � V.Responsibility Statement-7,the undcrsidned,assume respunsibility tor ioaUllatiorrofthe I'OWTS stio�vn on the attached plans. Plumhc:'ti Name(Prinil Plumber's Signalin�e � i ,:�IPRS Number Business Phone�ucnber dC v ' C a0.� _-- -��O y9� � 7�3'��'Y3�� Plwnher'.�A�dr�:s fStrect,Cin�;State,Zip Code) / .v J w� U L�x� .N tu Y63.� VI.Coun �.�Department lisc Only _ __ � �A� y r— Pemiit Fcc Date Issued Issuing Agent Signature i 1� �I L Disap�rnccd � � - �� ' �'Otivne�Gi��en Reason for Deniai ��O'� 3�� I `�� u� Condition� r �a Z s forDisapproval � ^ t---� n�� `�rU ��» I! � � �� '` ��` Jat�.....�.�?��-w_, ,1� � � � <, � �� i c� �S M�R 2 3 2023 C S'� N��— a�r� ` )v.u.,,� ��r��ti� �GC�; SAWYER COUNTY ADMINIS i R6�TIOfd Attach to complete ptins for the system and soAmit to the<'ounty oniy on paper eot lus tAaa 812:11 inches io siu (1 Li�C�� —1 NO R�FJ�!DS AFTER SBD-6398(R.�3/21) IS�UE OF PER,MIT Sawyer County Zoning & Conservation Administration `�"`�, 1 10610 Main Street, Suite 49 ��R C� �� Nayward, Wiscoi�sin 54843 �S1/ �� (715)634-8288 � Q; �� .� � FAX (715)638-3277 �fq� '�=- �� www sawvcrcountyqo��.org �� o A � r o i P,-mail: zoninL sec(rr.saw�crcounty�o��.ore ' � Toll Free Courthouse/General InTormation 1-877-699-4110 �� `=.-- �_ �� i1`oN�,. Holding Tank Approval Checklist I. Sanitary Cover Sheet Date Stamp n3 / � / � � Parcel ID# D � `� - $ 3 S _ t a _� � o� II. Plot Plan � Property Lines �Benchmark BM ♦ f Site Address �North Arrow � Structure �Scale � Well < 25' to Service Road � Legal Description ��Nearest Road Intersection � Setbacks to: Property Line, Well, Strucritre, Water bodies, Roads IIL Required Plans � Index Page with Original Signature �Management Plan/Contingency Plan � ervicingContract � �— ��,� �S ��yl� �C Holding Tank Agreement fo w�o.�,��•� � �, ;�S� l��-�l . IV. Holding Tank Specifications , � Z� I7j'Y �,/ � Cross-section — Mamifacture, Gallons: ��`� � �� I�� '� Tank Anchor Calculations [SPS 383.43 8) g)] � Locking device, cl�ains/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 2 SBD-10855-P (R.3/07) „ , �a —�� Owner: �a�Q. a,Qy Plumber: �` �e�"�R Application Review Date: 63 l �3l � � POWTS Reviewer: ��- �-r�� Name �� License # Revised 4/11 /2013 CONCRETE HOLDING TANK DESIGN Single Combo Tank Option INDEX AND TITLE SHEET Project Gaffaney Holding Tank Owner Nicole Gaffaney Address 16370 Zirconium ST NW Ramsey,MN.55303-3754 Legal Description Prt SE-SE S.12-T.38N-R.8W Township CouderaY County Sawyer Subdivision Name Lot No. Parcel ID Number 4838124401 Plan Transaction ID Number Index and title sheet Page 1 Holding tank specifications Page 2 Site plan Page 3 Maintenance and contingency plan Page 4 Tank Info Page 5 NOIe' �✓%ll�of /Ooo/Lao Lombo i.✓ iffn;/Ters i..:ii.a.�re.n....../ Designer A-1 Plumbing Signature ,�.,��' Phone No. 715-943-2382 License Number M.P.220498 Date 03/20/23 Designed pursuant to: Holding Tank Component Manual For POWTS(Version 2.1) May 2022-2027 version 7.1(07/22) Page 1 of 5 HOLDING TANK SPECIFICATIONS �Number of bedrooms Non-residential estimated flow(gpd) 2000.0 Minimum holding tank volume required (gal) Side A Side B Total 1254.0 754.0 2008.0 Proposed tank capacity(gal) Skaw Tank manufacturer 1200/750 Tank model number SJE Rhombus Alarm manufacturer 1U7-10H Alarm model number Tank Dimensions and Data Tank Anchor Calculations X for round tank 16450 Ibs Weight of tank and cover 47.0 Liquid depth below inlet invert(in) 7.70 Safety factor 8.0 Maximum depth of soil cover(ft) 13225 Ibs Weight of anchor required 63.0 Height(in) Outside 19.3 in Soil cover req. for anchor or 754.0 Length (in) � Dimensions 3.3 yd' Concrete counter weight 77.0 Width (in) Only HOLDING TANK CROSS SECTION Electrical complies with NEC 300 and SPS 316 optional vent pipe vent pipe manhole wver with � finished location � locking device and grade junction waming label box � — �4"min. 4"min. F—23 in conduit 18"min. thether - � �weignt Note: All tank joints, and joints - � — between tank openings and building sewer aiarm on piping are sealed watertight. All in�et blind plug pipe and vent materials comply to seal ouuet with SPS 384. Manholes with 90% Full 34.5 in locking device are typical for each manhole opening . Side B 754.0 gal Side A 1254.0 gal 3 in. bedding under tank. Tank is anchored as necessary to negate buoyancy. Project: Gaffaney Holding Tank Transaction Number: Page 2 of 5 �,,,��f PlumbeP ORucc u,'}ta✓da ti�colt GaFya,✓cy lH7yNs� W IL37a2;rc N Yyo ouivm ff.uw• f.�e/aud,wt.,� RnmSey�mu.fS)o7'77fY �/1-9v . yslf /L_ 3 �3F'� m/d�ib493 ,v.�'- �6� � �r 43y, ��-�� Gef1 �� Qeti�83g-�2-�'(��- �� 5 ►4� -.- S �Id�� .. o ��y�P"� rr✓f '��N �.��87N W o0�( -�3$ - I�- �iK�3 0 : .. �' .�¢" roe�. �2� s�� lrfff•Sf t, _ �"""'4l� �� • f��= f i� :, f'7➢.� � R Y✓ -`I�9� pueel d oovYJY�f MMr� Tc v.v ca u�aa y �/fM iao.e� 7o/n1y,�he/CRistr Ikaw �,}f4/�!y fifSCrS u/LA�Jr'Lo�k O . 4"Pvc P�r 3f4-1a-j No w<�i To poic /o'�� HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to SP 383, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10855-P N. 03/07, R. 01/12), and the Sawyer County Sanitary Ordinance. 3'� yo� 1. This POWTS is designed to accommodate a wastewater flow of ��C�d to �gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s)and verify that the alarm system tunctions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and SPS 383 and 384 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 30 days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compiiant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with SPS 383.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons may be contacted: a. Installer.............................A-1 Plumbing Phone: 715-943-2382 b. Service Provider.................. Northwest Sanitary Phone: 7'15-943-2650 c. Co. Zoning or Health Dept. Sawyer County Zoning Phone: 715-634-8288 11. Project: Gaffaney Hotding Tank Transaction Number: Page 4 of 5 WARNING DEATH MAY OCCUR IF TANK IS ENTERED i S�cnW 1200/750 i Q WITHOUT PROPER EQUIPMENT i ^ i o � 70.00 l) � i NOTE:SEE INNER WALL PHOTO ON THE"EXCLUSIVELYAT SKAIMS"PAGE. i i I I 1 I I I I � I � II I j I I � I I � � � �3.00 i i � I I 4;00 i i L________'_______________'____J �Z''°° � �2''°°� 2700� OUTLETENDVIEWOFTANK za.ao za.00 F—zo.ao 5.00 I 16.00 � _�2.00 2.00 � INLET �G aoo � p,pp 18� 4 INCH L PRESS 41NCH PRESS S�� SEAL GASKET GASKET INSTALLED WHENPOURED / BAFFLE FILTER 47.00 s.00 SECTION VIEW OF TANK AND COVER 3.00 Model Number: 7200 � 7SO SKAW PRE-CAST Phone: (715) 967-2277 ApprovBdfo�: SEPTIGSEPTIC,SEPTIC/PUMP,SEPTIGSIPHONORHOLDING Toll Free: 1-800-924-8625 e�g n e im, u e im. 26255 105th Street, New Auburn Liq. Depth Gal./In. Nom. Cap. Wisconsin 54757 Fax: (715) 967-2707 16,1001bs. 54" 50" 47" 16.05 754.35ga1. www.skawprecast.com �5e 00 T4"I.D.MAM1'HOLE 3H 50 /i' — ` \`\� /i• — _•`\\� /;/ — _ \`\� I 1 � 1 � \ P.00 1 1 1 I 1 1 \ / \ I � / � I � / � / ♦ i �` i �� i 3As0 t09b5 I I—]6.00 70P VIEW OF COVER B]00 5100 90.50 SSDO 2A50 � � W z 1200 LL � 6�D0 ]iD0 ])DO � � LL 1/4.00 146.00 f5aD0 TOP VIEW OF TANK(TAPERED) Model Number: 1200 � 7.SO SKAW PRE-CAST Phone: (715) 967-2277 Approvedfor: SEPT/C/SEPTIC,SEPTIC/PUMP,SEPTIC/SIPHONORHOLDING Toll Free: 1-800-924-8625 Weight Inlet Dim. Outlet Dim. Liq. Depth Gal. /In. Nom. Cap. 26255 105th Street, New Auburn Wisconsin 54757 Fax: (715) 967-2707 13,0501bs. 53" 51" 47" 16.05 754.35ga1. www.skawprecasGcom ,. , , r..t � �4 �I 'i HOLDING TANK SER�'lCI?�G CONTRAC"T Contract Date: '� / �/ '? This contract is made bet�veen the Holding Tank O��ner and the Pumper. Holdin� Tank Owncr's Name: Pumper'� N�ime: ', i f r � Northwest Sanitary, Inc. , `1 � �.c�l..�. �,�',-��-L�1� { PO BOX 155 � J Radisson, WI 54867 Parcel Identification Number: � ( 12 Di�it Lcgacy ID) �� - � -Z -�- " y Z - � �' (, � 1 . Thc c��ncr a�rccs to filc a copy c>f this c<mtract with thc govcn�mcntal unit, Sawycr C'��i.mtv, _� -- - -� � -wiiicn nas acce�ted anci recordrd with the Of[ice �f the Rc�;ister of Deeds, the Maintenance nzrcement for a Holding Tank reyuired under the Sa��ycr County Private Sewage System Urdinancc for the issuance of a Sanitary Permit for the installation of a holding tank(s j. 2. The ��vnrr a�recs to have thc holdin� tank(s) scrviced by the pumper and guarantees to pcnnit thc pumper to have access and to cnter upon the property for tl�e purpose �f scrvicing thc h��lding tank(�). Thc owncr agrccs to maintain thc all-��cathcr acccss road or drivc tio that thc pumper can scrvicc thc holding tank(s) with thc pumping cyuipmcnt. Thc owncr furthcr a`�rccti to pay thc pumper for a chargcs incurrcd in scrricing thc holciing tank(s) as Il1UlUillly agrccd upon by thc �wncr and pumper. 3. "I'hc pumPcr agrccs to submit to thc Governmcntal linit, Sa��yer County, a rcport 1�ir the se►vicing of the holding tank(s} as required under SPS 383.55, V�'isconsin Administrati��e Code ane� the Sawyer County Private Se��age System Ordinance. The pun�per Curther a�*rccs to includc the following in thc report: - u. Thc name and address of the person responsible for sen�icing the holdin� tank; b. �Thc namc of thc uwner ot�thc holding tank; � c. Thc sitc address of thc holdinb tank; d. "nc� datc thc holdin� tank w�as scrviced; e. Thc volumes in �allons of the contents pumped from thc holding tank for each servicing: 1: 'I'hc disposal sites to which the contents f'rom the holding tank werc delivered. 4. 1 hi� agrcement ��ill remafn in eftect u��til the owner or pumper terminates this r��nu-act. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with Sawyer County within ten ( l0) business days ti�om the date of change to this service contract. , ,. , ! Owner s Nam�. ( Print) �)��i1C1''S SI�TII2IUCC: (()nl� oneoNnersignaturerequired� , �� /i ? /� ,! �J �.'' "`- � �� h(• �,'�...,'�'�"`;�.. ` `.. >-�/� �. � L� �L �..,� v �'� ;� �. \ Pumper'� Nairre: (Print) Pi►mper's Signature: Ronald L Vieceli, owner Northwest Sanitary,lnc ' . L �Pum4�cr'ti Rcci�tration Numbcr: #2389 Rcv. 03!?6 13 3123/23,1224 PM Real Property Lisling Page Real Estate Sawyer County Property Listing Proper[y5tatus: NextYear Today's Date:3/23/2023 Created On:3/13/2023 11:48:25 AM -i �'Description _.. . Updated:3/13/2023 �Ownership Updated:3/13/2023 _ _ Tax ID: 44709 VICKI 7 AKEN � �� RAMSEY MN PIN: 57-004-2-38-08-12-4 04-000-000030 ]ORDAN GAFFANEY RAMSEY MN Legacy PIN: 004838124403 NICOLE GAPFANEY RAMSEY MN Map ID: Municipality: (004)TOWN OF COUDERAY Billing Address: Mailing Address: STR: 512 T38N ROSW VICKI]AKEN VICKI]AKEN Descriptian: PRT SESE(MFL CLOSED) 16370 ZIRCONIUM ST NW 16370 ZIRCONIUM ST NW Recorded Acres: 34.288 RAMSEY MN 55303-3754 RAMSEY MN 55303-3754 Calculated Acres: 0.000 Lottery Claims: 0 �Site Address *indicates Private Road First Dollar: No 4193N OLD COUDERAY RD �� COUDERAY 54626 Zoning: (A-1)Agricultural One ESN: 454 J property Assessment Updated:N/A 2023 Assessment Detail -�Tax Districts. . . . _._Updated:3/13/2023 �ade Acres Land Imp. 1 5[ate of Wismnsin N/A 57 Sawyer County 004 Town of Couderay 2-Year Compariwn 2022 2023 Change 576615 Winter School Distrid Land: 0 0 0.0% 001700 Technical College Improved: 0 0 0.0% ToWI: 0 0 0.0% :�Recorded Documenis Updated:3/13/Z023 CERTIFIED SURVEY MAP � Date Recorded:2/20/2023 443396 G"�+'Property History MFL TRANSFER ORDER Parent Properties �� Tax ID Date Recorded:3/3/2023 443495 57-004-Z-38-OS-12-4 04-000-000010 4756 QUIT CLAIM DEED Date Recorded:1/12/2023 443002 MANAGED FOREST LAW-MFL Date Recorded:12/18/2003 318125 WARRANTY DEED Date Recorded:8/2/2001 292928 Child History Remrd Count�1- HISTORY O Expand All History White=Current Parcels Pink=Retired Parcels O Tax ID:4756 Pin:57-004-2-3 -0 -12-4 04-000-000010 Leg.Pin:004838124401 Map ID:.16.1 44709 This Parcel Parents Children https:Ntassawyercountygov.orglsystem/frames.asp?uname=Enc+yVellauer 1/1 � . i ___ � � _ _ • II(�I��III IdII��II�I I II) 443396 Tx:4043505 PAULA CHISSER REGISTER OF DEEDS SAWYER COUNTY, WI 02/20/2023 01:02 PM Thts map Is hereby approved on ____�___�_________ by the Sawyer RECORDING FEE 30.00 Gounty Zoning Dept. ___ �_—_ ____,_ PAGES: 2 VOL: 38 PAGE: 107 Jay Kozlowskl - Zoning Adminigtrator Vvrt�f IBd �r•V� MQp 1`W _ CSM MAP #: 8694 Wlthln the Sovtheast Quarter of the Southeast Qvarter, Ssctlon 12, Township 38 hlorth, Range 8 Wast, Town of Gouderay, 5awyer Gounty, WI. 3' �M p0o`��C�` ,Q Nd��d � � Found mawrnentLas notea 0��o�`LUCAS Jsl��'m• � ■ Fovnd 1.315" Iron pipe L� Utllity pole �� MEIER ��° � • Sat I.OS" x 20" OO SapNc tank � ` $-271 � i w u� �ron p�pe 1.19Ibs/IF �� SPOONER �'�;a � � Well �� \ Wl /:��m�'' Ix� ��ed posltlon s'�oe�O�U_.��• �� ` E I/4 corner Section 12 mag npll � m"�* �platted lands � � � Doc.#33'7350, � i i (1483 W H Stvth 19.9.98 GhJ �t5 �3 t� 586°55'36"W 131A.80' � 5B6°55'36"W NE - gE 586"r..��y.� 468.00� I33AQ � 846.80' 434.41' I � � 5E - � • � 586°52'51"W � � 1315.Z4' �OT I �I � a� (1983 W.N. 5tuth) �.� � �`!9 nq.ase cn.l� � 211460 5a FT �i rm-, � � �' 5.00 AGRES � � .Q N� � � total crea � � � W � iU , N tll LP taMc �55.'T2�' xW I �£ � � m 1 g� R 0 N � drNeway �� "• �� r � shed � . / /�/ry �_ �._ — `� I� � � � electrlc // .�6P(/. �,-I w � � � gar. /� �,�// .� � � � � / �\ry / I �p I � _ _ _ _. � - - - - - - - =._�� / � 2' � � - - ` _ _ --- - -� I —"�505"337A"W 31B`3� _ _ � - - - � ry I � o oeed �3' wida �j i ry � �� center � P`utt�n easemer+t m,� I auess and �! �l � � �' g� � � � ��i i '�� O '� 99' 33' � °I ' I 6 6� I �I � I y I '09 I a� 434.91' POB gj N86�55�36•E 4b8.00' g W � N- unplatted lands by owner m in� Doc. �443082 = 0 m O � 0 z SE corner POG Sectlon 12 3 I/4" aluminum cap - Meier 5urveytng, U..G W6581 L�ttle VaUe� Road GRAPHIC SCALE 1 "= 100 ''' �pooner, WI 5480 115-635-8q10 Fleld work completed 2!4/2023 5heet I o4 2 aassss i orz � 100 200 300 1 _ ; M� ,4 � � i � P / N : e.. t� y � ! ry� p�,�N�M�.� , � ,: . r ��}t' S !� . . ! } � 1'� +� �r�y} �j�`�l iG� , �'x�"`.�4 �{ `f' �� G�� y �K N' ,4+¢ .�' 71 r4. � h !.$''y � . 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N� In .�P�' r,.I. - USE BLACK INK ONLY - POWTS MAINTENANCE AGREEMENT For Holding Tanks Owners Name(s) as shown on deed: , '\; ' � t • �r; 4 � ` . '.�: e � . T v�li'•�'v � ��—,r�.\G:�'�iL✓� •V� , C }=i l ^ � 1 ' ' i�1 Parcel Identification Number: (12 Digit Legacy ID) �� - � � � - � � - � � O� 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. Retum To� Sawyer County Zoning and Conservafion Rdministration 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 opera'` �n and maintenance of the holding tank, locking device, alarm and access, and ayrees to conform to all appiicabie requirement5---�:^'S 383, Wis. Adm. Code relating to holding tank management, including the following 1. The owner agrees to contract with a person who is licensed under Ch. NR 113, W is. 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 governmental unit. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the govemmentai unit within ten (10) business days from the date of change to the service contract. 2. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. 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 governmental unit. The governmental unit may enter upon the property to �nvestigate the condition of the hofding 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 govemmental unit to prevent or abate a human heatth hazard as descnbed in Section. 254.5J, Stats., the goverrrmerrtaf unit may enter upon the property and service, or cause the tank to be serviced. Pursuant to Section 145.20(4) Wis. Stats., a govemmental 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 Section 66.0703, stats. The owner agrees to pay all charges and cost incurred by the governmental unit for inspection, pumpmg, hauling, or otherwise servicing and maintaining the holding tank �R such a manner as to prevent or abate � any human health hazard caused by the holding tank. 4. This agreement will remain in effect only unti� the governmental unit responsible for the regulation of private sewage systems certifies that either a soif absorpt�on system that complies with SPS 383, Wis. Adm. Code, or a municipat 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 will permit the existence of the certification to be determined by reference to the property. 5. This agreement shalt 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 shatl be recorded by the register of deeds in a manner which wil� pe�Tl; the existe.^,ce cf the agr�errrsnt to �e deterr,Tined by re�erence to the properhy w�ere thz ho!�:ir,y ±a��k :s mst�lled. - Only one owner signature required - ACKNOWLEDGMENT Owner's Signature: � � State of: M\�1\\�\(��Z ________ -.=-� `; �`-,. L -=_ > > .� ��-. .� County of: ��rr�P. +'� Owner s Nafie (Pnr�I� � 4 ' Subscribed and swom to before me on this , ' 1 ! ` , � ,�, � :, : � _ rv.�+ t�+�.2• � �� day of `�Y�C;.�C;� , 2� �..� -�-=------- -{ .� Date: � /, � I By (Owner's Name): � ��-O u� � _� � /�� Notary Public Signature: �� ' _ _ ` -t �_ c�r h.�� Drafted by. Public Notary Name (Print): hZ.-��t- Q-.� �r; � �2\`4�.�.� i My commission expires on: U� 3� ��L,o � --- - — J Personal information you pravide may be used for secondary purposes EPrivacy Law, § 15.0 (I) �a� - 'ev. 3/'L6i 13 �� : KELSEY REA BARNUI� '�"�'��' NOTARY PUBLIC-MINNESOTA ��,�� MY COMMISSION EXPIRES 0113112U26 ''�i•,m,,.�1 pa�� — The Sautheast Quarter of the Southeast Quarter(SE1/4SE 1/4)�of Section Twelve {12),Township Thirty-eight(38)North,Range Eight(8)West,Town of Couderay, Sawyer Counry,Wisconsin. - ��cc�ik `a�{- � crsw, ��)ta`7 � ��`� ��.�- yY33�1(�, �