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Home My WebLink About022-738-32-4101-SAN-2023-148 `��nYtii��.'�_ . /_,",%�—�-.�.;,, Industry Services Division County ��[� ' 4822 Madison Yards Way �Q , C� V� ' � �\'s - MadisOn,V��I 53705 Sanitary Pctmrt Num6cr(to bc f I Icd in b� � � '�' P.O.Box 7162 � �<{�+;-�;;F=`' Madison,WI 53707-71 b2 � � I U��„�^ „�,,.. . Sanitary Permit Application Sta[e Trensaction Numbcr � In accorclance�vitli SPS 33321(2),Wis.Adm_Code,submission of fhis form to thc appropriate governmental unit •— � is required prior to obtainiiig a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(ifdi(Tcrent than m:�iling� [lie Departmeut of Safety and Professional Secvices.Pex�oaal infoimation you provide may be used for secondary - pu�poses in accordancc wi[h tha Privacy I.aw,s_15.04(1}(m),Statc. ..0 I.Applicarion Information—Tleas�P�an�tSlkf�mform"fia6on; ' " '' ,:.: 4 _. . .. � _ _ . __. _.�<. , ... . ` __-=" � We�/'�o/'�� Property Owncr's Neme --- ------ Parccl�l pa,�it/d KRP e,��et�r rp,,/ i d�;7 8d 4 e Property Owner's Mafling Address Propctty Location �3 6 e �►f _ T�c - City,State Zip Code —�-P�ioi;r\umber ,�/�� s N /►1N. �f' SSo69 �`��--.f�-___ `:;. Sccun�: ,3�- - - ll.Type of Building(check a1l tbat�apply) Lu� T 3�' N R _Z �-,�r , � � --�--- --__ . �( 1 or?Famiiy Dn•cll�n�-Number ofl3edrooms Subdivision Namc f3iu,:k = '"� �'abiidCcimmzrcia{ Describe lise_ -__ __ ___ _ �- City of-_- - -. -.---- __--- - -- State Owned- Dcscribe Usc___ CS,�•t Number illage of �� 2y8 -�7/1) C�o.�a of_,��---- —�_— -- III.Type oFPOWTS Permit:(Checic etEticr."New"o_r.`Repla'cement"and othe_r apphealfCe�onlineA EheckAne'l�oi on"(irie T3:Cnmpletc line C if a licahle.) x=: q. -,----- -- , ,' ---- �e�c Systetn �[�eplaceinent System �ther ibfodiftca[ior:�. t:xisting System(explain) ' �Additional Preircatment Uni�(c�plami �� - _ - --- -- --- -- B. -- i nHolding 1'ank ❑�-Ground �bGr�de ,❑Vlound lndividual Site lles��m OtLe� I yne(expl�:n; - --- Yc . -- --- �-------- (convco[ional) � --L------- ----- � ❑Rene��al Liefurc �Revi;ion �Change of Plumber �I'nuisferto New Ocvner List Prcvious Pcrmit Num;�e�;�tul I);ii; Issi;:,l Expir.�uon i �- TV.Dispersal/Trcatmcnt Area:and.Tank. nfoiinat�on:`�:. '� " ''.' := �^ � � � .�._ .•,- ,�r�..a..�.� � t,- - �,_�>a : Design Flc�.v(,�d) desion Soil Aprlication Ratc(gpols� Uispersal Area Rzquired(sn Dispcisal Area Proposed(s� System S:levatior� -- oa � -� —.__�--- ! � -- `� I /e�.o' --,---- ' Capaciry in '• 'I�otal ; -of Manufacturer � r- � - l ank Informaron � Gallons I � " i ^ � �— Gallons l'niki � o �n � i ,. hc��Tae�ks � I � ^ � J � _ . f � ; � - i i � - � � c " C � � i � � I cc " '-i ' :/% � � 'r. � :.c. (i i Srptit o olJinp,'l�an� '� / -- - / ' Z ��' ��_ pesmo(�hxmhcr I �� 7J U CD PO _ � f�QW i�!� � , V.I2esponsibility$tatement-I,tfie undersigned,aasume respousi6iLty.for iast i11aUo7qokthe3��'OW TS showri on thc att iched ptnns. Plumber','uam�jPrmt) Plumber's Signature At itiiPRS Numher � t3usincs;P!ione Numher , � __,�Rdce v�t�e�---- � �� i.�o yQa� L 7i<s-q r,�-.�s�,�_ Plun:oe:'a Addres�;Strcc;.Cih�.Statc,Zip Codc) --- -- --- - ----- - y w v � c., VL Cou❑ vIi)cparimeni Use Only �:" • - - �� , �;�pp''�'L, � ❑Dis��Pr��ed Pennit Pee Date tssued Isswne Agent S�gnainre � 1 �� 7 Owner Given Reason for Denial � � ��,� � 7�� -�' �.Gi�.c,�.�✓+it�. Cunditions o�=Cpprova(./Reasons for Disappraval D t3ate � � �`��-� i � ' �hk# i��J� z 1 � 2023 ��i JUL 1 �cpt# ��b�� — �!t�,��-�;� G S T D�p — �0�7 __,___.,_. SAWYER CG' ,-,_'i�iVIP�G /-:��Ilif�ti�l`1=il�TIC�N� Acuch ro compiete pians fur ihe sys[em and snbmit to t6e Cnnnte onl}on paper oot kss th:a 8 i2 z il inchec in s'vc �_��;�� NO R�FUN��qFT�R SBD-6393(R 03,��; ISSUE aF P'ER1AlT Sawyer County Zoning & Conservation Administration �� 10610 Main Street, Suite 49 � �R c0 � � Hayward, Wisconsin 54843 �-1 --� ��fi �� (715)634-8288 �� `�� FAX (715)638-3277 � y _ � � � www sawvu'county og v.org ` � � o � E-mail st�nitdnan alsawyc�_cotmt ov_o� �I�° \� � y � i � Toll Free Courthouse/General Information 1-877-699-4110 I �2 � _ �-'" '�'— /� lt`�N:=� Holding Tank Approval Checklist I. Sanitary Cover Sheet: Date Stamp �� / �� / ��-� Parcel ID# � �- � - �? .3 g - 3 2 _ �( ( D ( II. Plot Plan: � Property Lines � Benchmark BM ♦ �C Site Address � North Arrow p� Structure / Scale pC Well �< 25' to Service Road � Legal Description D�Nearest Road Intersection Setbacks to: Property Line, Well, Structure, Water bodies, Roads III. Required Plans: � Index Page with Original Signature �Manageinent Plan/Contingency Plan Servicing Contract � Holding Tank Agreement Fonn ($30 to ROD) IV. Holding Tank Specifications: �C Tank Cross-Section: Manufacturer: S �v✓ Gallons: � , 7 D� Tank Anchor Calculations [SPS 383 .43 (8) (g)] � Locking device, chains/locks �J Alann, electrical per SPS 383 .43 (8) (e) �}j 3" Bedding Material < 1 /2 " V. POWTS Component Manual Reference: � Holding Tank Version 2. 1 (May 2022-2027) Owner: ��S o � Pluinber: � - Application Review Date: o� �� a-�� 3 POWTS Reviewer: �il� !/t�� Namc �9 �� Rev. 4/27/2023 Credcntial # CONCRETE HOLDING TANK DESIGN Single Combo Tank Option INDEX AND TITLE SHEET Project Peterson Holding Tank Owner Daniel 8 Karen Peterson Address 13896 Belmont Trl Rosemount,MN 55068 Legal Description Prt-N1/2-NW-SE 8NE-SE S.32-T.38N-8W Township Radisson County Sawyer Subdivision Name Lot No. Parcel ID Number 22738324101 Plan Transaction ID Number Index and tiUe sheet Page 1 Holding tank specifications Page 2 Site plan Page 3 Maintenance and contingency plan Page 4 Tank Drawing Page 5 Powts Agreement Page 6 Servicing Contract Page 7 Designer A-t Plumbing Signature �,�9' Phone No. 715943-2382 License Number M.P.220498 Date 07/15/23 Desgncd pursuant to: Holding Tank Component Manual For POWTS(Version 2.1) May 2022-2027 version�.1(0�22) Page 1 of 7 HOLDING TANK SPECIFICATIONS �Number of bedrooms Non-residential estimated flow(gpd) 2000 0 Minimum holding tank volume required (gal) Side A Side B Total 1254.0 750.0 2004.0 Proposed tank capacity(gal) Skaw Tank manufacturer 1200/750 Tank model number SJE Rhombus Alarm manufacturer 101-10H Alarm model number Tank Dimensions and Data Tank Anchor Calculations X for round tank 16100 Ibs Weight of tank and cover 47.0 Liquid depth below inlet invert(in) 1.10 Safety factor 6.0 Maximum depth of soil cover(ft) 13575 Ibs Weight of anchor required 63.0 Height(in) 1 Outside 19.8 in Soil cover req. for anchor or 154.0 Length (in) } Dimensions 3.4 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 pfpe manhole cover wRh � finished location � locking device and grade junction wamfng label box � �4"min. 4"min. �23 in conduit 18"min. thether - � weignt Note: All tank joints, and joints " 7� � — between tank openings and building sewer / serv�ce piping are sealed watertight. All inlet blind plug alarm on io seai pipe and vent materials comply o�ciei with SPS 384. Manholes with 90% Full 34.4 �n locking device are typical for each manhoie opening . Side B 750.0 gal Side A 1254.0 gal 3 in.beddirg urWer tank. Tank is anchored as necessary to negale Wwyancy. Project: Peterson Hoiding Tank Transaction Number: Page 2 of 7 Q/v,�b t/' Ow,��r ,tfRu[c v�',rer�el4 At.,;��.� Kw'e,� /�tc�do.✓ �y�yus�NwYyo /3116 Qer.nawr J�c ��/a � Ros��" .vA, wr.,fyf a,�r,�+,v.6�n6 y 943-R l d�� 1�� '�'��Ov4� 1300�*- � � � 0 � 6yr'"� prf N� - �vw-sf� ,vE-sF 60l1 S.�.� T. 39�v a R• lw �`".�.. o,nu�o�ra�3t�.tYior t� ' o � roww If��f�Jlo,✓ � �o �fM .t7/.t41-�7i// ..S � �� S �M -w;�iy�roPp��Pr4r � ` a I1 wealht�q��4 C3!'� Y Se�v�tu�,O. * r,, 3 . Prp,.rt Pa �py_�o.? Ie,v:�t � '�� SKaw �'�60�73'0 wNl�t 1eT�.vx j0.1/�t�p�M/ by �(lifli�✓fr4y� r 4 ,O O �'�f � � + .� � x�ta� G6d wc�rgor Ad 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.D1/12),and the Sawyer County Sanitary Ordinance. 1. This POWTS is designed to accommodate a wastewater flow of 40 to 400.8 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 eveni,the service provider should visually inspect the condition of the tank,risers and manhole cover(s)and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. AII corrective actions shali 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 POWfS fails and cannot be repaired,a code compPiant replacement holding tank may be installed in the same location(a new sanitary permit is required tor such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed availabie to the P��Pe�Y 9. If this POWTS is replaced,or its use discontinued,components no longer in use it shall be abandoned in accordance with SPS 38333 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:715-943-2650 --- c.Co.Zoning or Health Dept. Sawyer County Zoning Phone: 715-634-8288 11. Project: Peterson Holding Tank Transaction Number: Page 4 of 7 WARNING DEATH MAY OCCUR IF rANK IS ENTERED i SKAw 120m750 � Q WITHOUT PROPER EOUIPMENT � O � � � 70.00 � i NOTE:SEE INNER WALL PHOTO ON THE"EXCLUSNELYAT SKAIMS"PAGE. � � I � I � I � I 1 I � II I j I I I 1 1 1 I I I 3.00 �i i �� -� 4.00 �I i L'__________'__"_' _'_J �Z''0° 1 f-2700 1 2700� OUTLETENDVIEWOFTANK za.00 za.00 �--2a.00—� s.00 I � �—�s.ao--{ �.� �z.00 zoo I INLET q �� 9.00 � �� 18.00 41NCH 41NCHPRESS � PRESS SEAL GASKET S�� GASKET INSTALLED WHEN POUREO / BAFFLE FILTER 47.00 s.00 SECTION VIEW OF TANK AND COVER I—s.oa Model Number. �I ZOO � 7JrO S KAW PRE-CAST Ph01le: (715) 967-2277 ApprovBdfOf: SEPTIC/SEPTIC,SEPTIC/PUMP,SEPTIC/SIPHONORHOLDING Toll Free: 1-800-924-8625 eig n e im. u e �m. Liq. Depth Gal./In. Nom. Cap. 26255 105th Street, New Auburn Wisconsin 54757 Fax: (715) 967-2707 16,10016s. 54" 50" 47" 16.05 754.35ga1. www.skawprecasf.com 15a�0 24"ID.MANHOLE 38 50 /, � � / i � % i � / \`� / `\� / `\� / \ / � / \ I � I � 1 � ]1.00 1 1 � I 1 I \ / \ I � / \ / \ / � I \ / \ / \ / \ 3830 f09b5 � �—t6.00 roP viEw oF coveR e�o� 53 a� 90.50 5600 29.50 0p I— nI00 LL � 6]AO It00 ]I.00 I � 190.00 i<BDO i50D0 TOP VIEW OF TANK (TAPERED) Model Number. �I ZOO � 7J�O S KAW P RE-CAST Phone: (715) 967-2277 Approvedfor: SEPTIC/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,OSO lbs. 53" 51" 47" 16.05 754.35 gal. www.skawprecast.com • HOLDING TANK SERVICING CONTRACT X Contract Date: �_ � /C� / �� .� ; This contract is made betwcen thc Holding Tank Owner and the Pumper. Holding Tank Owner's Name: Pumper's Name: Northwest Sanitary, Inc. PO BOX 155 �, � j � Radisson, WI 54867 Parcel Identification Number: (12 Digit Legacy ID) Q � � - � � � - � � - � � o / 1 . The owner agrees to file a copy of this contract with tlie governmental unit, Sawyer County, which has acccpted and recorded with the Office of the Register of Decds, the Maintenance :'1br��:-:ent f�- a Ho;±ir.g Tank requ�red �mder the Sawver County Private Sewage System Ordinance for the issuance of a Sanitary Permit for the installation of a holding tank(s). 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owncr agrecs to maintain thc all-weathcr acecss road or drive so that thc pumper can service the holding tank(s) with the punlping equipment. The owner further agrees to pay the pumper for a charges incurred in servicing the holding tank(s) as mutually agreed upon by thc owner and pumper. 3. The pumper agrees to submit to the Governmental Unit, Sawyer County, a report for the scrvicing of the holding tank(s) as required undcr SPS 383.55, Wisconsin Administrativc Codc and thc Sawycr County Privatc Scwagc Systcm Ordinancc. The pumper furthcr agrees to include the following in the report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The site address of the llolding tank; d. The date thc holding tank was serviccd; c. Thc volumcs in gallons of thc contents pumpcd from thc holding tank for cach scrvicing; f. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event oT a change in tni� contract, itic uw�iiei ugre�s tc f:;:, a ccpy cf ar.y c!:ar.g�s te this service contract or a copy of a new scrvice contract with Sawyer County within ten ( 10) busincss days from the date of changc to this service contract. �Wriet'S N1IIle: �PI71lt� �Wriel''S S1�Tri8t111'C: (Only one owner signature required) , � X l_�,�.�� <.�� ,-� l�r.�- � �� -� -� --� � Pumper's Namc: (Print) Pumper's Signature: � Ronald L Vieceli, owner Northwest Sanitary,lnc �'lk�� / ��C� li Pumper's Registration Number: #2389 Rev. 03/26/I 3 Real Estate Sawyer County Property Listing Property Status:Current Today's Date:7/11/2023 Created On:2/6/2007 7:55:38 AM ..DescripUon Updated:3/6/2018 �_Ownership Updated:3/6/2018 Ta�c ID: 22948 DANIELA&KAREN G ROSEMOUNT PIN: 57-022-2-38-07-32-4 O1-000- PET'ERSON MN 000010 Legacy PIN: 022738324101 Billing Address: Mailing Address: Map ID: .13.1 DANIEL A&KAREN DANIEL A&KAREN Municipality: (022)TOWN OF RADISSON G PETERSON G PET'ERSON STR: S32 T38N R07W 13896 BELMONT TRL 13896 BELMONT TRL Description: N1/2 NWSE&NESE LOT 1 ROSEMOUNT MN ROSEMOUNT MN CSM 27/248#7111 55068 55068 Recorded Acres: 59.400 Lottery Claims: 0 r.Site Address *indicates Priva[e Road First Dollar: Yes 2654N WEIRGOR RD EXELAND 54835 Zoniog: (A-1)Agricultural One ESN: �_Property Assessment Updated:4/19/2023 2023 Assessment Detail .�.T5x Districts Updated:2/6/2007 Code Acres Land Imp. 1 State of Wisconsin G1-RESIDENTIAL 1.000 5,000 29,700 57 Sawyer Cou�ty G4- 8,000 1,200 0 022 Town of Radisson AGRICULTURAL 576615 Winter School District G8- 001700 Technical College AGRICULTURAL 50.400 40,300 0 FOREST �_Recorded Documents Updated: 1/21/2011 2-Year Comparison 2022 2023 Change �_ TRUSTEES DEED Land: 46,400 46,500 0.2% Date Recorded:3/5/2018 411338 Improved: 29,700 29,700 0.0% �.. QUIT CLAIM DEED Total: 76,100 76,200 0.1% Date Recorded:ll/6/2014 ;9;0'� .. PLAT OF SURVEY Date .. ProperTy History Recorded:ll/19/2010 32387-5 N/A .. WARRANTY DEED Date 3634d5 Recorded:10/29/2009 �. EASEMENT Date ��3758 Recorded:9/24/2005 ��Y� _ 0.` k •_ ' . � . T � � � . ( Y'. � � � � �� ' � �r ��" � ' , ' _�� 3,. � '�� .i7' � ht � � -. � � �],�^' .+.� +�° � ,G,J'�;i��y��l! . i [� h .,t� �fy� . . Jy, � �. _ )'4 _' "�S'��t^�4'" t i .T�iL�� ;EY-7'�'�l'13l >d : - . + ��4' + 1' � M� rr �� .. ^` � � .,8 �SLrS I `� I �i�j,,r. � � $� ,,,� � � ,,r'd �' ar�s231U1� - .� ,. �- `` '� F � �?22 r.i8322�1 . - . x ....n ��...� 'M��'�r•°w.�� ` . � • _ f, � ., 4'tl II'.„� �� hl� �^� I "(. f. l,. ;.. ''� � r�'... . -. .. _ j��m . . .� f- t, - �..�. . . . �iIE�R��Vk �<U . _ N � i ! .l�,S. r�. 1 i �t l�y I-! ." " _ ... \ +F+ ' ' , . � , a"�+.•-�+• f � r' .� . �- _-- "� q :Y' �. h. �. . � . � e ma^�� i! �� J f: i �e .�. .� �Jt '.j ia _ •t'� 1. � . ;�'+Y.d � . �i . _ r �� r , . � � y- �'t �';�� . 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R r3 �Y � � ��^. �I A,� tl.� � 1 . �?..� � ''�" ��-T. �•✓ "•y�� 3 �'S �� _ 7� WKl'� ' r?'1_' •}' i ii iii i i�i i�� iii�� -USE BLACK INK ONLY- DOCid:80?2022 Tx:4046250 POWTS MAINTENANCE AGREEMENT 445505 For Holding Tanks PAULA CHISSER RE�ISTER OF DEEDS Owners Name(s)as shown on deed: . SAWYER COUNTY, WI 07/21/2023 09:24 AM o,� RECOROING FEE 30.00 Parcel Ident�cation Number: (12 Digit Legacy ID) 0 �,�-� 3 �-,��-�� d L PAGES: 2 Legal Description of Property: -SEE ATTACHED SHEET- We acknowledge that application is being made for the instaliation of a holding tank(s)on the property described on the attached sheet. Return To:Sawyer County Zoning and Conservation Administration 10610 Main St.Suite 49,Hayward,WI 54843 As an inducement to the County of Sawyer to issue a sanitary permit for a holding tank on the above-deseribed property,the owner is responsible for the operation and maintenance of the holding tank, locking device,alarm and access,and agrees to conform to all applicable requirements of SPS 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,Wis_Adm.Code,except as provided by Section 281.48(3)(d), Stats.,to have the holding tank properiy 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 govemmental unit within ten(?0)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 govemmental 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 investigate the condition of the holding tank when pumping reports may mdicate 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 described�n Section.254.59, Stats.,the govemmentaf unit may enter upon the property and service, or cause the tank to be serviced. Pursuant to Section 14520(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 govemmental unit for inspection, pumping, hauting,or otherw�se servicing and maintaining the holding tank in 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 until the govemmental unit responsible for the regulation of private sewage systems certifies that either a soit absorpfron system ttrat campl�es with SPS 383,Wis.Adm. Code,or a municipal 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 properry. 5. This agreement shalt tre bind'mg uporr the owrter,the heirs of the owner,and assignees of the owner.Tne owner shall submit the agreement to the register of deeds,and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of ttte agreemerrt to be determined by reference to the property where the hotding tank is instatted. -Onl one owner si nature required- ACKNOWLEDGMENT Ovyner's Signature: �� y State of: ��y'�'��1� \/, '� (�/o�ru�.� l.'�. .v+4-,� �� _`.� County of: /��hf}- Owner's Name (Print): Subscribed and sw� to before me on this �','��;� �, `,. ' E��Y, UGtn,' � �✓Seti �_dayof J�� , 20 �3 Date: By(Owner's Name}: � Fn, � i�sGti � , ��Tc��, ��j/(�--��,( ;�z Notary Public Signature: �� - Drafted by: Public Notary Name (Print): �w c � �n-� �vr ft�� My commission expires on: 3 i �� _ ♦�,I.J�y.,....�.........,...i_��i..�... � Y'J�P�h 4 � ERIC J JUCKEM Personal information you provide may be used for secondary purposes[Privacy Law,§15.04(I}(rx►}} NOTARY Pj18LIC-MINNES�}�,. /26/13 ^Y COMMISSION EXPIRES Dil31/2024 Lot 1 0£Savcyer County Certified Survey Map No. 7111 recorded in the office of the Regis#er of Deeds for Sawyer County,Wisconsin,on September I9, 2005,in VoIume 27 o�Certified Survey Maps on Page 248,as Document No. 333541;beina•a part of the Northwest Quarter of the Southeast Quarter(NW 1/4-SE1/4) and�the Northeast Quarter of the Southeast Quarter(NEI/4SEI/4)of Secrion 32,Towz�ship 38 Narth,Range 7 West,in the Town of Radisson, Sawyer County,Wisconsin. � � �y::�`'"""`c;;; PRIVATE ONSITE WASTE TREATMENT County �� SYSTEMS t\ ��,�s��s �� ( POWTS) SaVVyer `-- ... �`"� ��'�� INSPECTION REPORT sanitary Permit No: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION �?j � � �{� Persona]infonnation you provide may be used for secondary purposes[Privacy Law,s. I 5.04(I)(m)] Permit Holder's Name: ❑City ❑ Village (�.Town of: State Plan Transaction ID#: V�c�l�'�� ct'"""�`'"l ��h`�'� YCc�� iJtt>� •—_ Insp BM Elev: BM Description: Parcel Tax No: �oo�o `��.� o� �,,�e.\\ v1� -�3�- 32-Ylo l TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Benchmark �ap,p' Dosing Aeration Bidg. Sewer 47,�,� Holding S�� ? St I Ht lnlet �(, ` TANK SETBACK INFORMATION St I Ht outlet 9 Y Y� TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIR INTAKE Septic NA Dt Bottom 4�•`f 3� Dosing NA Installation Contour Aeration NA Header/Man. Holding �.�� 31 ` y3 � �,2 S Dist. Pipe PUMP 1 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 � #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav ° Conv ❑ Aggregate INFORMATION P�L Bldg Well Waters � GP ❑ Chamber Model Number: ❑ EZFIow CELL TO ❑ Mound o Other ---_ _ ---- _ --_ _—_ _ — — ---- - ---- -_-- ---- — DISTRIBUTION SYSTEM X Pressure Systems Only — -- - - ---- Header/Manifold Distribution Pipe(s) X Hole Size ; X Hole Observation Pipes Length Dia Length Dia Spac , Spacing ❑Yes ❑ No � ._ _ __ _ - --- — --- SOtL COVER ( Depth Over Depth Over Depth of Seeded I Sodded � Mulched � � Cell Center Cell Edges �I Topsoil ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ��,s�ll�Q �l�Y��3 � �� 3 I `1 i Plan revision required?❑Yes❑ No —��-� � G �� --___--�,�. --_J G�� (� � Use other side for atlditional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) AOOITI�NAL COMMENTS ANO SKETCH SANITAAY PEAMIT NUMBEA: �.3 ^ ��_ � � ( � '^ �� -�°° / �` �'�^n` `� �.� �;��al S�� `�s � , e S � s �°��`' � � ��'� n ��c-� �"'r / �a�'^�If � � G ! � � \�-��lS��"_ T \ ,, � t��.�--`�� _ �� I6� �Y, 7` `�� t P"�. � �� G,b�^ gw�. �y—� ��r ��5 � �' f � �� ,�,. ��,�J �a � -�— s��--�°-