The URL can be used to link to this page

Home My WebLink About026-939-21-5212-SAN-2023-232 r�� ' _'�,, Industry Services Division County (,/) '=�' �, 4822 Madison Yards Way SAWYER � � ��,,�� fv' Madison,WI 53705 Sanitary Permit Number(to be filled in by C� ` P$ ;� � P.O.Box 7302 '` '"�;=%'� Madison,WI 53707 � �j � �7 �� ,\kr:;�..� ,.'._ �."I..�.11f i�.�'.�.;' . Y t.l V� Sanitary Permit Application StateTransactionNumber ; In accordance with SPS 38321(2),Wis.Adm.Code,submission of this form to the appropriate govemmental unit w is required prior to obtaining a sanitary permit.Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing adc the Department of Safety and Professional Services.Personal information you provide may be used for secondary � � purposes in accordance�vith the Privacy Law,s. 15.04(1)(m),Stats. I.Application Information-Please Print All Information Property Owner's Name Parcel# CHRISTOPHER & KENDRA LOHMER & GREG & KATHLEEN LOHMER 026-939-21-5212 Property Owner's Mailing Address Prope y Location 3305 OSGOOD COVER N Go��, -a City,State Zip Code Phone Number STILLWATER, MN 55082 —'� � se0�;�n 21 lI.Type of Building(check all that apply) Lot# T 39 N R 09 E or W �1 or2 Family�Dwelling-NumberofBedrooms 3 � Subdivision Name Block# ❑Public/Commercial-Describe Use �_ �City of �State Owned-Describe Use CSM Number ❑Village of 8/435 #1814 ❑✓ rO"n�t'SAND LAKE IIL Type of POWTS Permit: (Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if a licable.) A� ew S stem Re lacement S stem Other Modification to Existin S stem ex lain Additional Pretreatment Unit ex lain � Y � P Y g Y � P ) ❑ ( p ) B' �Holding Tank ❑In-Ground �At-Grade �Mound ❑Individual Site Design Other Type(explain) (conventional) C. �Renewal Before �Revision �Change of Plumber �ransfer to New Owner �st Previous Permit Number and Date Issued Expiration ^—� IV.Dispersal/Treatment Area and Tank Information: Design Flow(gpd) Design Soil Application Rate(gpd/sfl Dispersa]Area Required(s� Dispersal Area Proposed(st) System Elevation 3oa _ `_ . Capacity in Total #of Manufacturer .?� c Tank Information Gallons Gallons Units � U U '� V ^ New Tanks E�stiug Tanks � ❑ a� y � � �s � 0 a U v� �n v� i� C; a SepticorHoldingTank 1250/750 2000 WIESERCONCRETE ✓ � Dosing Chamber � � � V.Responsibility Statement-I,the undersigned,assume res ibility for installa6o of e POR'TS shown on the attached plaus. Plumber's Name(Print) Plumbcr's Si � ure MP/MPRS Number Business Phone Number Travis Butterfield 652879 715-634-8176 Plumber's Address(Street,City,State,Zip Code) 14346W St. Rd. 77, Hayward, WI 54843 VL Coun /Department ilse Onl�� A � ❑Disapproved PennitFee Date[ssued Issuing Agent Signature P �./ n^ � �� / �j,,57✓ ❑Owner Given Reason for Denial � 1�� y f`�3 ,r '�`x�A�� Conditions of Approval/Reasons for Disapproval �} G �' � �r �.� � � �a�� `� I.`�..,�3�.�..��az��.� � ` �! �� ,�� chk# �-�� _ SEP 15 2023 �� .�-- ^r ,��; 3o s5 ��^r�r�R c�u��r .--�,� . �5 �"o� � ._ ....._..�.,.�.�...�.�......._�Y.. zONjNG ADhaiNIwTRATl01`� Attach to comple[e plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size �-Ii� 1� ss�-639s�u.oaia2> Np F��FtlNt3�AFT'F�i a��c��- Sawyer County Zoning & Conservation Administration �� 10610 Main Street, Suite 49 � �R c� �� Hayward,Wisconsin 54843 '� _ -VG I (715)634-8288 �� `�� FAX(715)638-3277 �y r y -� _, �% www.sawYercountY'o�g � o — f o i E-maiL sanitarianCd;saw�rcountygov.c�� /� ��'—�__��i � Toll Frec Courthouse/Ceneral Information 1-877-699-4110 i��- '=` ��- ��\oN�- Holding Tank Approval Checklist L Sanitary Cover Sheet: Date Stamp b`� / �S / �.3 Parcel ID#��o - 4'3 q -� l - S-� 1 � II. Plot Plan: ►� Property Lines �Benchinark BM ♦ l Site Address 'X North Arrow � Structure � Scale �CWell )G<25' to Service Road lLegal Description �Nearest Road Intersection � Setbacks to: Property Line, Well, Structure, Water bodies, Roads III. Required Plans: �Index Page with Original Signature Management Plan/Cotztingency Plan �Servicing Contract �Holding Tank Agreement Fonn ($30 to ROD) IV. Holding Tank Specifications: �( Tank Cross-Section: Manufacturer: 4�;eS'-ef" Gallons: ��I �� X Tai1k Anchor Calculations [SPS 383.43 (8) (g)] �CLocking device, chains/locks XAlarm, electrical per SPS 383.43 (8) (e) X3" Bedding Material < 1/2 " V. POWTS Component Manual Reference: �Holding Tank Version 2.1 (May 2022-2027) Owner: �,o�r�— Plumber: `T, �j., t� Application Review Date: � � � � �� POWTS Reviewer: �� Name 6`�S�� Rev. 4/27/2023 Crcdential# 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 OWI�er NaITIE(S); CHRISTOPHER&KENDRALOHMER&GREGBKATHLEENLOHMER phone: - - Owner Address: 3305 OSGOOD COVER N, STILLWATER, MN Z;p: 55082 Project Address: TID: 41218 Govt. Lot: 1/4 of 1/4, Section 2� , T 39 N-R 09 E ❑or W ✓❑ Township: SAND LAKW County: SAWYER Project Parcel ID #: 026-939-21-5212 Designer Information Designer Name: TRAVIS BUTTERFIELD Phone: 715 _634 _8176 Designer Address: 14346W ST. RD. 77, HAYWARD, WI Zip; 54843 E-mail; OFFICE@BUTTERFIELDDRILLING.COM �1��,�,s�,��CeJt�G,E.� t�>, ��„��>tir�� t�.,,E. License Number: 652879 Remarks: Signature: Date: ��S � °�� Original signature required on each submitted copy. � SOIL EVALUATION o sca�e:�40 40 so ao c�eSYS�TEM PAGE 2 OF y SITE MAP PLOT PLANt� PROJECT NAME: oesicN F�ow�. 7 S� cNu �^� / / 10` �/ty,a � I.H/;S L ph w.e� Attach design flow calculations tor commercial plans. PRo�Eci aooRess SQ wd �.�-2 �- Pipe Ma[erial/ASTM S[andard(Tables 384.303&3R4.30-5) /oo.o N sa��ryse,ve�� v s�4 yA BM Symbol:� BM Elevalion�. FT Force Main�. / BM Descrlp�lon'. �"�/ �n ��` �� md��caie norm bN IMPORTANT. Slope Gradlent(%) Weli Symhol(Ifappllcable)�. 0 drewing an Show ground elevation contours a[sultable intervals. of Tested Area'. on the appropaite line. ,�,n�- l�G_-e _—_ � , � � o� �# (a„q �-�n3 4�ti- �n Od�939�ISa 1 3 �s o,,� �K� � � o�2b 93 9a ISa�a � 3%os" 5 51�11w��'�✓�/N s�8 �pa6939 ais aia �i,J/1 d r��ol /-d� S a/T�yru RoPw i � -+ � /dsa�� µ� , �,;c�v-e.,��,�.e ' �'aHlt eC, 97,0 Y � i S�,K� � 0 0 � `� i � i � i n>� i � °° I�fi�— , fe�a. � '� � ' � ' �,. � ��,s Bw��'�C/ �' � �p.z s, � 6 s'a 8'�� ,��°` PAGE30F4 HOLDING TANK SPECIFICATIONS (No Scale) 4"fd Vent Pipe Weatherproof >10 ft from Junction and Alarm Box Building Approved 12" Min. or 2.0 ft above Approved Locking Manhole Vent Cap Established Flood Elevation Electrical must comply with 4" Min. or 2.0 ft above SPS 316 and NEC 300 with Waming Label Attached (typical) Established Flood Elevation (typical) --Conduit I (typical) � `�' j �Airtight Seal " " � Finished Grade � 18" Min. �tYPical) II � �p; � . ' � a'. Qa ' ' • �. . � , e ,Q , . � . �a I . . . .� �. • a. • . n Inlet ' Inlet Invert ' f Watertight /� Plug Approved Joints with J I Approved Pipe 3 ft onto 'e Max. 12" or 90% of total volume � Solid Ground if more than one tank ^'� (typical) Alarm-On 4, e• Compartment 1 Vol = � 250 gal Compartment 2 Vol = 750 gal e � �� TOTAL HOLDING TANK J � VOLUME = 2000 gal . 'a . •a. a � � d.� ',♦ . . , A ' . � . a ' . 'b . .; .. . ' . . . 3" Approved Bedding Material Beneath Tank TANK MANUFACTURER: WIESER Anchor tank as necessary pursuant to SPS 383.43(8)(g) Ballast Weight = [(cu.ft.tank.vol x 62.4 Ibs/cu.ft) - Ibs.tank.wt] x 1 .5 Ballast Weight = [( cu.ft. x 62.4 Ibs/cu.ft) - Ibs] x 1 .5 = Ibs 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,Wisa Admin.Code. Pursuant to SPS 383.52(2),Wisc.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),Wisa Admin.Code. Estimated Daily Wastewater Flow= 4�0 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,efc.) o material fatigue(i.e.,leaks,breaks,corrosion,etc.) o neglect or improper use(i.e.,exceeding design capacities,prohibited activlties,etc.) o electrical components(i.e.,wiring,connections,switches,controls,timers,alarms,etc.) o surface 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,Wisc.Admin.Code. Tank pumping reports shail 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:BUtt@Ifleld, If1C Phone: 715-634-8176 �o�ai 9o�e��me�t u��t:Sawyer County Zoning Pno�e 715-634-8288 �oca�govemment unit address: 10610 Main St. Suite 49, Hayward, WI Z1P 54843 Any defective part of this system shall be repaired,replaced,or removed pursuant to SPS 383.51 (1),Wisc.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. Continqencv 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 abandoned in accordance with SPS 383.33,Wisc.Admin.Code. W1250/750— M R TANK SPECIFICATIONS � o o � � , � � 12'-11" DIMENSIONS: � o WALL: 2 1/2" � a 4" CAST-A-SEAL 4" CAST-A-SEAL BOTTOM: 3" COVER: 6" w ��,_--_-_----��---__,\\ MANHOLE: 24" I.D. PRECAST CONCRETE RISER o '� i i"i i �` HEIGHT: 66 vi' � �1 � � `�� . � �, i i i i � ��, LENGTH: 12 -11 > ii � � � � c� �� WIDTH: 7'-2" � �� -- �� -� � I I I � r �--� �� BELOW INLET: 53" ' � ��e � i' 1 i i� �' �� LIQUID LEVEL: 48" � � �I � � \ j O� WEIGHT: 14,860 LBS. � � o0 0 i\ � � _�� y �� u 3 0 � �� - - � � i � -� �i INLET AND OUTLET: � } � o \�� FILTER OR i i i i „� 4" CAST-A-SEAL BOOT OR EQUAL GASKET � m g N �� BAFFLE IIII ��' J � w 3 �;�, _____ Illi ,�r' WLET AND OUTLET BAFFLE AND FILTER: � � Q � `,�—___ - ' WISCONSIN, SEE DETAIL 10 N � � � �� / (OTHER STATES SEE CHART) �, o .LIQUID CAPACITY: 27.66 GAL/IN (SEPTIC) W � TOP VIEW 16.12 GAL/IN (PUMP) � � � U � LOADING DESIGN: 8'-0" UNSATURATED SOIL CO � � o TANK CAN BE USED AS: C� o � � SEPTIC/SEPTIC, SEPTIC/SIPHON, a N Q � 4" VENT OR SEPTIC/SIPHON � � `� o � w � COVER: MIX DESIGN #8 (NO FIBER) v, _ � + � TANK: MIX DESIGN #10 (STRUCTURAL FIBER) �, � � ---- ' . � • --- . : . . �_ CUSTOMIZED TANKS: � `° INLET - OUTLET FOR CUSTOM TANKS CONTACT WIESER CONCRETE � � �Q i - - - - L J '. IT - - i �N 1 co � � 1 - I•'I � � I r U r � r,� � � � � u� 1a 1 � U � � � ` � J u� I � I I � _ � � � Q � I I e I � � � O � Z 2 r'� i i � r � �'� — -� ` ----�-"_� REVIEWED BY �o F �, PUMP PAD REVIEW DATE � w 3 N DRAWINGS SUBMITTED SIDE VIEW FOR APPROVAL APPROVED BY: SHEET N0. APPROVAL DATE: � / OF PRODUCTS NEEDED BY: / � TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS HOLDING TANK SERVICING CONTRACT Contract Date: l�l o�oa 3 This contract is made between the Holding Tanl�Owner and the Pumper. Holding Tank Owner's Name: Pumper's Name: 6'�`�j L.o�r �f SCOTT POPPE ch�%s Lo �i rh�� Parcel Identification Number: (12 Digit Legacy ID) D � � - � 3 � - a I _ S � I a 1. The owner agrees to file a copy of this contract with the governmental unit, Sawyer County, which has accepted and recorded with the Office of the Register of Deeds,the Maintenance Agreement for a Holding Tank required under the Sawyer County Private Sewage Systcm Ordinance for the issuance of a Sanitary Permit for the installation of a holding tank(s). 2. The owner agrccs to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and t�o enter upon the property far the puipose of servicing the holding tank(s). The owner agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for charges incurred in servicing the holding tank(s)as mutually agrced upon by the owner and pumper. 3. The pumper agrees to submit to the C'�overnmental Unit, Sawyer County, a report for the servicing of the holding tank(s) as required under SPS 383.55, Wisconsin Administrative Code and the Sawyer County Private Sewage System Ordinancc. The pumper further 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 holding tank; d. The date the holding tank was scrviced; 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. This agreemcnt will remain 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 contract or a copy of a new servicc contract with Sawyer County within ten (10) business days from the clate of change to this service contract. �W11eT''S Nc�Tlle: �Pilllt W118 ' 1 3tUi ' r signature required) i.Y4'�'g`�V`v� WY"�'^Q�Y C� (..�1�� % Pumper's Name: (Print) Pui s � ature: SCOTT POPPE `�� i�� Pumper's Registration Number: 81813 Rev.03/26/13 9/19/23.8:40 AM Real Property Listing Page Redl EStdte Sawyer County Property Listing PropertySWtus: Current Today's Date:9/19/2023 Created On:12/13/2011 11:11:35 AM �Description Updated:1/26/2022 �Ownership Updated:9/13/2023 ._.._. . .. . _ .... .___... ___ ___... ... . ___.____... Tax ID: 41218 CHRISTOPHER&KENDRA LOHMER STILLWATER MN PIN: 57-026-2-39-09-21-5 OS-002-000120 GREG&KATHLEEN LOHMER STILLWATER MN Legacy PIN: 026939215212 Map ID: :2.12 Billing Address: Mailing Address: Municipality: (026)TOWN OF SAND LAKE GREG&KATHLEEN LOHMER GREG&KATHLEEN IOHMER STR: 521 T39N R09W 3305 OSGOOD COVER N 3305 OSGOOD COVER N Description: PRT GOVT LOT 2 LOT 1 CSM 8/435 STILLWATER MN 55082 STILLWATER MN 55082 #1814 t� Recorded Acres: 1.850 f Site Address *indicates Private Road Calculated Acres: 2.004 N�A � � - -� - Lottery Claims: 0 First Dollar: No U property Assessment Updated:7/6/2022 Waterbody: Sand Lake 2023 Assessment Detail Zoning: (RRl)Residential/Recreational One ESN: 423 Code Acres Land Imp. Gl-RESIDENTIAL 1.850 129,300 0 �.TaxDistricks ... Updated:l2/13/2011 z-yearComparison 2022 2023 Change -__—__. _... 1 State of Wisconsin Land: 129,300 129,300 0.0% 57 Sawyer Counry Improved: D 0 0.0% 026 Town of Sand Lake Total: 129,300 129,300 0.0% 572476 Hayward Community School District 001700 Technical College �Property History • Recorded Documentr Updated:9/18/2023 "�-�� --�� . ...._ __. . . .. .. Parent Properties Tax ID WARRANTY DEED 57-026-2-39-09-21-5 OS-002-000100 28786 Date Recorded:11/24/2021 436124 COVENANTS Date Recorded:9/12/2023 446345 MAP OF SURVEY Date Recorded:l0/11/20Z1 21399-14 QUIT CLAIM DEED Date Recorded:4/5/2013 384369 WARRANTY DEED Date Recorded:9/13/1985 197247 WARRANTY DEED Date Recorded:9/13/1965 197246 QUIT CLAIM DEED Date Recorded:9/4/1985 197110 CERTIfIED SURVEY MAP Date Recorded:3/29/1982 162206 Child History Remrd Count'1- HISTORY O Expand All History White=Current Parcels Pink=Retired Parcels O Tax ID:28786 Pin:57-026-2-39-09-21-5 OS-OOZ-000100 Leg.Pin:026939215210 Map ID:2.10 41218 This Parcel Parentr Children https://tas.sawyercountygov.orglsystemlframes.asp?uname=Eric+Wellauer �� . � "" " , ' 'i �:o � c.. ,�.�: , �'�` f ° a w "� -� ;' * ~�� v � y t � .� �- ' x� �,y�:" r �� n��, � , S� ?'' v �if.4{ 7� . e�_ . i �` t� � j �' �#` ��y� }T�`��'�fC��u��n�{-Y'�r.» �a� � y� . r _ h �X L'^�.W'".�'k� *y 1 S �',14��5�t��f� py �� .'�� n�J � �F �� C 1. � '� d, � ,r Yg �'�Cn ,3r.,-�,r_yi(,"y,�' yrh b .I f �1 �.s� a vd n��` !r p M .�' :, 4, 'r r.�, s i �`' � y�,i i. � `�rl�r`l�r ., s . �C`�d. , .� _ ?,. � 'B''.f .ay ; y'-` �� d �.y .� r :. �,�' f+� �*�s�¢;'f r p -i .a e �� ,9 �1G: �� p�l M '�]"hi Fh .. � i � ` �'Tt�:. � .. yK � f4- ✓� s � � slyf � h�7'�:_ 9r h' �L t � r v -� > ' . ' � � �. t� L k.. � _ w� n� 5� �b.�� . ,. ' S t I+�y �� t�`<i '�� rf�'�ir�. � : faj. ^ � u y�` � ; 'b�. ��a,j�.�'T� �! ,k"% 1 i � t��t�� _ �� d v�4� . �j�' . y�� a,��;�p �d�i R n �� .c r. +' ..� r ry � iA�� f t� .�u y{�"�.� .._�. �t ir�. .rt�t,_� ��+�ry' �x f" 1�,:t k*3s.�r r .�s� ," 'y h .[4��.. + .,bP X�l. .f �Y s� �k t .,, i'4� ,�! � r�. t�� y'� A�'� i5�:5 �� : r ; ,�,s�T .r .k tP �'r � r 'L°W-. s ,�a( b . y7,s ;� i. ' � _. w ! f ! �:: � '� xf�a�! i. wd`�i ?X,� �r ,� �w i.:. z § �.�"r �A�X y .i'1"� � � � k�; `� ��ks � �,, � x r ��`r. �t � � ^a�k ��' . i��sgf, , < <F +. sY '� :> 1 � f Y + .iy � f �� ' . � % �y(�{i� �s Kv�7 ,4y�i/ k+x 1r� J1 �' .1{A,<r �1`!,3 ,�`��::� �t �� . � �� `— � 4 �„��tryt , f� ,� � L � 'Py� � .4^�h' �F'.7)r . �p�Na�y.l" _ r y f �fn.� o- �J :-i i 4 S S 1,�.'a t r� R 4 � �^�' `I � ;t�h�fv ..6'i� ,$'�� F76 ..�' I ,"' 7�u � k �� ,'��y'��Ya�Rr�� A f�Y .rrF �t p9 3 i�, � t t -�aff <� w=h� F✓' �.' � � �i. �� j!i' -.� . F,�t,�. vs "�ir4`�' ''�+2 '� c w r't �+ 1�i'. -v' a`Y'i °'P« '§'im�,k :�. ' �i� ��.. ,��+�`''�'��ydr� � cYa w, $�7�.r F��'��. x r� �f f � Ti l �; ; � y a� 44'3" yr l� i - . II .,�i $6 '1' • � y�i ry +F J-t • r / �&. . � v:'� ..;3 q•M F_ � �, s 'w 0.�,�w .. �i 'tp r `_ - x .�:: S j l,f a, a -` � °. ; ,.: • ..; , • _ , _ . a `:C, �r1 -�� - � � � ..�. y s w 4.i i sn . . , r � r &-F T y� �.,', a�tia ��,e 4q ,_� � � �'. ye� u � 1 r•. dna�� s � �`X � :�..�'� � M��t i u I r M+ri'r �;_ ,�. `T, � '�.5,.�'S e1 Lr•sg ,.5� `J° .. . �' � �',� � ' [ �� F .�• a � ., ��,�. �f .7 r M� �" t f��.. 'i`f r;�� . "�y�'� , , k � 1 ,.x .i � "S ♦ J .F. J 5,�,�r�Kl . :: �, �,W f�f �. a6 dc�� ,aF';Y 4; � -3 qa•> ' r +T ti ^!�� rY: F�. t',�r � v ' �`}b�r'� r 7� t'�'al�T #�rE. t .. a F l�y f IA�:"� 'r+C [ � � '��-�! +t �� iS1 �V'� {✓i� � t' �I{�.:-n � �. �r � �rs.'. , 4 '. ': � ' .�.� , . �, y t. �L''�y:4g:a.'F� t / a: � ' ti s s �i�� r � : , .: � '. 's7.i�' 4� y��.��i J � > � � .. cf � '� Y�j �x �� ' , �` r �p�' �i� • a � . '. '.� *+w. ' � � � � 1 i-��""is� x x 1� �� q+� ."�� n ; .� ,x 3�, ii .a F ;�7 :3�. ,} � i� i,w ! ..,�, ��`" e j� j � ,�' � - � s.: � n ��'.: �� f:�,� � � wr. � � �-�'`�t�� " -,�L . z. 5��? .,�� A ; . �. �� ' �'a;. i ��t �y"�r �.. t � , n t y, 1 . ' :� ��( '�`'�` �:.. �� '�� ,�i ,�. �'',57. • i+ i �+��hy.: �r � � "�,-�.. .s .•{ '}. i{y M�C.t �t1.d r . 1' , �y��{t � j �l : '� i}��,1 IA�'� �J'�r�L � ?'' � �y�,0 � ��t. .'1��.�c111r�3��i �1"(j,�� '��c�"y�r� 6Z J`�' Ii"Ti Da' , i ��h -�� 3' �IY�Y�(�. �s� "'� � y�+F�. � � � v F � �� '°"v�; 4 i . s l�j,4.?}`' ��r,�;9S h� '�: '. .� �: ... �i 1. <F -� - u �, �, �tkr .3.,� �� y �I�l J�'3��.1 if- r+ 2� .'': �� - � � �a._r � 4E.. ..:.,aw w �R ^� �''. ;��.. d � :.: s r�.� ', il fi�. ' .'..W � '� '� � . �t .��" � .. �_/ : �y .71}�'�y 3 i�� F � ¢' ' � , � '�' s�y(�ic#4s �?�s`a j !��s� '.. S r,��JI ' 'Y' r .,: i',°4�^38 �� y ty �-�I ��F' � �. �t :J' {� 'r�y �� w� t �' l.� i' 1 rt '�¢ V i :�r . ��: n�+, rS�.F � �..�JfAi .�t� . J .= 1".w a� F? ;, � . F � <41 � ` ,�i 7'" _� ' ' ��. S ic�' N -�+'s I � �� '� y i »'�f'(��t[rt� �yd�f�Y�`�- ( � � : ��I � �T 9t� f� �r� N! My �^j "�" i JY .'{�w�s'� y2 t . �� • � r k �' i'� �x''" � '�.es a'AC I i ..i �� i � � j+ � � ;fi� r, ��'1 �� !��\�.� I ..s- i� ��iiii , �i ��iii ��ii ��ci� :sc�;�005 - USE BLACK INK ONLY - Tn :4U475G�7 POWTS MAINTENANCE AGREEMENT ��64�� For Holdin Tanks PAU�A CHISSER g �EGIS��R OF QEEDS Owner's Name(s) as shown on deed: SAWYER COUTYTY, WI �j �Ca�'In �jr `,p�W1�2,r 09/19I�(I23 i�R,44 AM �r� `� IK�Q L�'rC� �h.Vv�-e,►� RECORDIPdG FEE 3�,00 Parcel Identifica ion Number: 12 Di it Le ac ID 2. �j � �� , ' ��GES: � � 9 9 Y ) � —� - � - - - - � - - � � 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. 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-described 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 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 governmental 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 investigate the condition of the holding 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 governmental unit to prevent or abate 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 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, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abatt: any human health hazard caused by the holding tank. 4. This agreement will remain in effect only until the governmental unit responsible for the regulation of private sewage systems certifies that either a soil absorption system that complies 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 property. 5. This agreement shall 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 shall be recorded by the register of deeds in a manner which will permit the existence of the agreer�r�to be determined by reference to the property where the holding tank is installed. i/ - O o owners� at ere ' ed ACKNOWLEDGMENT w Si t ; State of: W �SCa-Y�� County of: �o�.wU-fX Owner's Name (Print): Sub cribed and ws o n to b f e me on this ��i W�l�V Jc�day of � , 20 Z� Date: ql i5 Z� ��'PU$(� yhN By (Owner's Name): � 5 �r�.r�i Y'e. a Ww►'1'�-�� Q` � otary Public Signature: Drafted by: 2 � ��blic Notary Name (Print): K. ��-t.,1� � ' �..-� ��,�- Q M�commission expires on: 23 s i ?� �v�� ` ,. . _s .� � w Personal information you provide may be used for secon�� t� i�,�ew, § 15.04 (I) (m)] Rev. 03/26/13 � 1F �F v�1 ;,, ��11t�1��\��`. Lot One (1) of Certified Survey Map No. 1814 as recorded in Volume 8 of Surveys on Page 435, as Document No. 182206, located in and being part of Government Lot Two (2) of Section Twenty-one (21), Township Thirty-nine (39) North, Range Nine (9) West, Town of Sand Lake, Sawyer County, Wisconsin.