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Home My WebLink About006-440-19-5601-SAN-2023-294 ��°'"--`"-'�,_� Department of Safety �O1°�' � �Y::��5 `;=� &Professional Services, �,;�,�xa��esueam�� !� 1 r Industry Services Division '`''�` * � S t (� �3 R' ,R�, �.r/=' '��N.�.+� Sanitary Permit Application ��T`�`'°��"` � In accordance with SPS 383.2I{2),Wis.Adm.Code,submission of this form to the appropciate govem�tal imit a is requirod prior bo obtaining a senitary pecmit Not�Application fomos fa�r steto-ownod POWTS are submitted ro Pmjax Address(if ditl'eria►t thaa maling-- � the Deparm�ent of Safety and Pmfes�onal Se�vices.P��onal infotmarion Y�P��Y be used Cor�condary ia mxordat�ce with the Pciv�y[.aw,s 15.04(ixm).Sta�. �� . I. qttius Informatioa--Ple,are Print AH Ioform�ien ��'O�, � �1+�(Je;- Property Otvner's I�me Parod# P�.;�l� � e� �� 7'r�St .� Oo6 � y<<o - ! 'S�o I Properry Omner's a9liag Address y} �P�Y�� RT � � S, ��h !rt V c�.��_ c�ty,sac� z�c� �x� /� �5 �a� Z �{(�� ^ � �� II.Type of BoildfaS(chcck atl that.spply) Lot# T l'l� N R E W L�i or 2 Family DareUing-Num6er ofBedcooms � ��' Subdivisi�Name c � Block# �— ❑Public/Commencial-DescnbeUs� 0 City of ❑State Qwned-Descn'beUse CSNi Number ❑wllegeof _ �- �.Tmvnof _ (��-� �.Type of POWI'S Pecmi�(Checic eiWer�Ne�r"or�Re�Leement"and ot�er appliCabia oa 6ne.A, G6edc one�►oa o�Iine B.Compk�e Hne C a l�cable. A. ❑New System Replace�t System ❑Other ModiScation to Existing 5ystem(wcplain) ❑Additional Pretreatmeat Unit(explaia) 8' Hoid'mg Tank ❑In-Ground ❑At-Cnade ❑Mo�md ❑ladividuel Site o md Design ❑Other Type(explain) (ca�v�riona() c- ❑x�� ❑x�on 0 en�of�� ❑TransferraNew P�v�an�sPamnNumber�dUaoelasaed Exp'raa°a �l h K ? N.Di rsalfPreatme�.Area and Taek ieformadon: Desig►Flow(�d) Design Soil Applicatioa Rate(gpd/s� Dispersel Area Reqni�ed(sfl UisPe�al Ane Pionosed(s� S�s�m Etevatiou � l�( 14 N 1``I �[;.'1��j �h in rom� #of Mann� , Tank Infmm�edon Galio�s Gallvns Linita � � c'g o l�SL�/lJ�O NewTmda Eui+tingT� � o V � m s � �� a.U v� m v� W C7 n. Septic or Hold'mg Tank t�� / Dosing Gl�arttba "�S V.RespansiflI�ty Stfltement-I,t6e aa�r�aed,assame respoaaibity for ios�oa ot t�rPORRS s6ovm oa thratbehed p3�ss. Plum Name(Priet) Pt�mba' � � � MP/MPRS N�ber Bos�ess Phone Namber �� ,��:� �l S ;�f�� >" Pl�ber's Ad (Stree4 City,S Zip Code) ��'� ��"—�( �� <�t�e� �v� �4�r� vT.co�n �nen,�rament C7se only � � m ❑D' �oved Peitmt Fx Date Issned Luamg Agent Sigoauue � a-l�.'� �� I� '�; �r;1,!-c c�2��,��.-}7M,ue-�- �ti✓ ❑Owner Given Reason for Ihoial Condirimu of AppmvaUReasons for Disappmval _- �.r-�. � � q r"w.`� ,,�� i � :, ��. � ;�a l� / ( oC. �aC � ' i�� L/� �.r��S �J �/ � �� I ��,�. �__!__ �� C5� 3-- I �� nk# t��w4 OCT 0 3 2023_. o� -�c��s � n ,-��, ��1 SAWYER CO�`�� Attieh to�aplele plam for tlw systes and ss6mk!o tl�e Ce�ety oaly ee paper sot las t6�n 817L z 1] � �� SBD-6398(R.0322} 'NO R�FU4vD.�,A��7'ER I�SUL UF('��f'1T Sawyer County Zoning & Conservation Administration �� 10610 Main Street, Suite 49 �ER Cp �� Hayward, Wisconsin 54843 � - ��Ci �� (715)634-8288 �� `-�I� FAX(715)638-3277 �Q�� , - _- �</ www.sawvercountY'o�org � o�` �o � E-mail:sanitarian/,n�saw�ercount ov.org I � '� � Toll Free Courthouse/Gencral Information 1-877-699-4110 , \�.�'Yry;�� ,� / ,�';\�N`� Holding Tank Approval Checklist I. Sanitary Cover Sheet: Date Stamp iD / a3 , a��-3 Parcel ID# � ��o- `�( `{ O- 1 R _ S� 01 II. Plot Plan: �Property Lines x Benchmark BM ♦ X Site Address �North Arrow �Structure �Scale �Well <25' to Service Road �Legal Description Nearest Road Intersection �Setbacks to: Property Line, ell, Structure, Water bodies, Roads III. Required Plans: Index Page with Original Signature anagement Plan/Contingency Plan ✓ ��1��-� � ervicing Contract �fS�� olding Tank Agreeinent Form ($30 to ROD) IV. Holding Tank Specifications: �Tank Cross-Section: Manufacturer: � Gallons: �� 7 Tank Anchor Calculations [SPS 383.43 (8) (g)] Locking device, chains/locks Alann, electrical per SPS 383.43 (8) (e) D( 3" Bedding Material < 1/2 " V. POWTS Component Manual Reference: �Holding Tank Version 2.1 (May 2022-2027) � G�' Owner: f v e- �-+�� —� Plumber: Application Review Date: ( o�d� f.2-G2—3 �� lZ��-3 POWTS Reviewer: �� Namc G`f'�( � Rev. 4/27/2023 Credential# CONCRETE HOLDING TANK DESIGN Sing/e Combo Tank Option INDEX AND TITLE SHEET Project Netznik Owner Phillip J Netrnik Trust II Address 11818 S 85th Ave Palos Park IL 60464 Legal Description Prt. Govt Lot 6 S-19 T-40N R-4-W Township Draper County Sawyer Subdivision Name Lot No. Parcel ID Number 006 440 19 5601 Index and title sheet Page 1 Holding tank specifications Page 2 Site plan Page 3 Maintenance and contingency plan Page 4 Designer Crai Thom son Signature � �L� ,� Phone No. 715-266-2842 License Number 220810 Date 09/28/23 Designed pursuant to: Holding Tank Component Manual For POWTS(Version 2 SBD-10855-P(N.03/07, R.01/12) � � � Version 8.0(10/13) �r�� Page 1 Of 4 HOLDING TANK SPECIFICATIONS 3 Number of bedrooms Non-residential estimated flow(gpd) 2GO�.Q Minimum holding tank volume required (gal) Side A Side B Total 750.0 1250.0 2000.0 Proposed tank capacity(gal} Huffcutt Concrete �� Tank manufacturer 1250/750 � Tank model number SJE Rhombus Alarm manufacturer Tank Alert 1 (101-01H) 120 VAC Alarm model number Tank Dimensions and Data Tank Anchor Calculations X for round tank 16100 Ibs Weight of tank and cover 54.0 Liquid depth below inlet invert(in) 1.50 Safety factor 8.0 Maximum depth of soil cover(ft) 20725 Ibs Weight of anchor required 67.0 Height(in) Outside 35.3 in Soil cover req. for anchor or � 146.0 Length (in) Dimensions 5.1 yds Concrete counter weight 69.5 Width (in) Only HOLDING TANK CROSS SECTION Electrical complies with NEC 300 and SPS 316 vent pipe manhole cove�with �j locking device and /— warning tabel f graded L/ junction box —� — 4"min. �23 in. 6"max. conduit sealed water �R^min tight thether -- /wei9nt Note: All tank joints, and joints � � �G between tank openings and building sewer blind plug a arm on piping are sealed watertight. All inlet to seal pipe and vent materials comply outiec with SPS 384. Manholes with 90% Full 39.6 in �ocking device are typical for each manhole opening . 750.0 gal 1250.0 gal 3 in.bedding under tank. Tank is anchored as necessary to negate buoyancy. Project: Netznik Page 2 of 4 HOLDING TANK SITE PLAN Project: Netznik N Legal Description: Prt. Govt Lot 6 S-19 T-40N R-4-W �___� Subdivision Name: Scale: ! 1"=40 ft ; Parcel ID: 006 440 19 5601 Lot No.: -____. . � �Qs-t �;?� �:�.;�� 2��er� /� �� .� .�— �— �` �-- �-- .� �— � -- ,.... �I� s�edZ _ 3A�-� ,��,r� �� i °� _ / .�Sa I� � � '��f � — � �,�' O � �,i� �a,.�,�z �` � y � ,�' a��;S��t �� R�' 3��+ L Page 3 of 4 � �� me� ��,.� ;z�s�a1� o�t Z-�7� a3 C3�^r1: 7�� o� 1..� e� Se�-�;L 7�� t-�,e.� 5�� 5 �-l.St� �� /�q.Sf� 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. 1. This POWTS is designed to accommodate a wastewater flow of 60 to 400.0 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 functions 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 repai�ed, a code compliant 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.............................Don Thompson & Sons Exc. LLC Phone: 715-266-2842 b. Senrice Provider.................. NorthWest Sanitary Phone: 715-943-2650 c. Co. Zoning or Health Dept. Sawyer County Zoning Phone: 715-634-8288 11. If this building is used as a year-round dwelling a mound system will be installed. _ Project: Netrnik Page 4 of 4 HOLDING TANK SERVICING CONTRACT Contract Date: / / (� 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 ��l ` � � � � Radisson,WI 54867 Parcel Identification Number: / (12 Digit Legacy ID) Q Q �o -��-��-� lD �� 1. The owner agrees to file a copy of this contract with the govcrnmcntal unit, Sawyer County, which has acceptcd and recordcd with the Office of the Register of Decds, the Maintenance Agreement for a Holding Tank required under the Sawyer County Private Sewage System Ordinance for the issuancc 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 owner agrees to maintain thc 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 a charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the Governmental Unit, Sawyer County, a report for the servicing of the holding tank(s) as required under SPS 383.55, Wisconsin Administrativc Codc and thc Sawyer County Private Sewage System Ordinance. 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 thc holding tank was scrviccd; 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 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 (10) business days from the date of change to this service contract. Owner's Name: (Print) OWrieT'S SI�ri8tU1'C: (Only one owner signature required) �� lft•�� . umper' Name: (Print) Pur�per's ig ture: Ronald L Vieceli, owner Northwest Sanitary,lnc /�� (�'��L�� l Pumper's Registration Number: #2389 Rev.03/26/I 3 3/28/23,6:54 AM Novus-Wisconsin Access rev.13.1108 Real Estate Sawyer County Property Listing Property Status:c��t Todav's Date:9/28/2023 Created On:2/6/2007 7:55:13 AM �Description Updated: 2/26/2016 �Ownership Updated: 2/26/2016 ---.__. _ _____ __ _... __ _ __ ___ __ _ _ _ _ __ --- .__ Tax ID: 7336 PHILLIP 7 NEIZNIK TRUST II PALOS PARK IL PIN: 57-006-2-40-04-19-5 05-006-000010 Legacy PIN: 006440195601 Billing Address: Mailing Address: Map ID: :6.1 PHILLIP J NETZNIK TRUST II PHILLIP 7 NETZNIK TRUST II Municipality: (006)TOWN OF DRAPER 11818 S 85TH AVE 11818 S 85TH AVE STR: 519 T40N R04W PALOS PARK IL 60464-1018 PALOS PARK IL 604b4-1018 Description: PRT GOVf LOT 6 Recorded Acres: 34.580 � Site Address *indicates Private Road Lotte Claims: 0 _. . ___ _ __ _ _ _ ry 8429N CLOVER RD NORTH WINTER 54896 First Dollar: Yes Waterbody: East Fork Chippewa River - Zoning: (RRi) Residential/Recreational One -�-� Properly Assessment Updated: 8/22/2016 _ __ -- -- _ ESN: 429 2023 Assessment Detail Code Acres Land Imp. � Tax Districts Updated: 2/6/2007 Gl-RESIDENTIAL 2.000 19,800 58,900 _.____ ___ ___ __ ___ _. _ _ ___ _-____ ___ G6-PRODUCTIVE FOREST 32.580 103,900 0 1 State of Wisconsin 57 Sawyer Counry Z_Year Compariso� 2022 2023 Change 006 Town of Draper �nd: 123,700 123,700 0.0% 576615 Winter School District Improved• 58,900 58,900 0.0% 001700 Technical College Total: . 182,600 182,600 0.0% .� Recorded Documents Updated: li/21/2007 _ _ _ ___ ____- --_ ---- ; � QUIT CLAIM DEED Property HisMry Date Recorded:4/29/2013 384733 __ _ _ _ _ _ _ _ __ __ __ _ N/A 0 QUIT CLAIM DEED Date Recorded:4/2/2013 384297 � TRUSTEES DEED Date Recorded: l0/10/2007 349540 https://tas.sawyercountygov.org/Access/master.asp?paprpid=7336 �� Sep 21 23 04:14p Don Thompson&Sons Excva � 715-266-2143 p.1 , C,�� Y3 � �� . �A � ar�«��r �,� `•y,,�� '�� % ��'�� .��'��e.�� t06�O R4ain Strcet Suite 49 a �� 'S + �' =��,��e�4 f�ay�vard, ��;scorsi�l 54843 � ; �p (7;5)t:>-1-S28S �� -�B I��A?:(7!S)b3S-3=77 ,.;,� � an .. � � i n '� 1�1! �1 V'� _R� 1:mail: ��r � � '�� s' 3'oEt f�rcc C{>vrehc�i�sclf;encr;i tnft3nxt�Ein�t 1-R77-fi�39-b120 � 0 48 ,' ✓ � o `�„1� ?Q9 s��... ::....:.:.. �j�y,y�� FR� �`� ��a'�.��''``� �,��`o�ar� \ � ��,�'�� .1I�I�� .�I�i�'�'��"l�'��l�l ��'�A��1��"� � � �l ��t��'��`�'1�,1'��.��' •�`�i��s �i�TS`�'t-'ali..�.��a.Y�P�I�,�'�9�� F'iL�J4'E�t��'Y <?�vVN�:Y'�c i�aJ�IVI�: l- �i t�� F N e..�"��i K ___.�__.�—______ TQWN ��: _____—�.��-� -------_____ --------�--------_�____- �,D�R.�S�S:��' � _.._��_�U U C'-t' ��X. �0�� 1 I,`��%L 4 c_�_�t C��'�.�� ,a �iisco�isin �,icefzscd�Ium�e�ai�Tl�arizec�bs�tl�e ativi�er, cio llereE�y acknocv�ed�e t��at I�n1 receivsn� tenipor�a�y approvaE �o install a s��7ti4 t�niti;'tt�lciin�tar�k vvi�ftout a sci� a��d site evaf�:ation, or cxis�ir��system evaIuation, a.i�d privatW sc�v��e systcm �lar�rcti�ic.v dtfe tr� incler��r�r:t ��eaE�her and%c�r bealt�l an�/c��-sa��'ety Fitler��e�icy- .. ruetl�er, I ac�ta�owtecl�e tIi�t «sail ar�c.i site c:�al��3eion, or existi��systenl ev�aYu�tion,and �riti�ate sewa��system �3lan.rcvi�w vaiil bc cone�uc.ed by tt7e cleact(in�;,stiptalateci[�y tlle per,nit issuinb aoes�t, or as �aai� as v��eati�er cot�dttions�3�circutnfital�ccs pcni�it. If ttte �rivate se�<<<�e; systei�7 is fc�und to bc fai[ing as de�ned 'zit s. �SPS ;8?.�; {42}, Wisc. Adm. Cocle, corrccYivc measl�res��%i13 be takei�as sucl� tilat thc private sewa�e syst�n� con�plies��,�it11 aIl at��licabie rcqi:ire��ents of cl�apter DS�'S. �8?, t�is. Adi��. Coc�c, �itl�i� 9�9�a��s o�'��a�rc;e��r�t. I.f�r�3�cz-ackno�vled�e t�1�t f1�Iuse ta co��}�:rlg- by c�btaininL ail nccess�� ent�its after t(�e deadlii�e clatc 7�zay result ii�tA�.c issui��af a ritatic��, :�izcer Sec:t7c�n 1?.3 [2),Sarritar�.> Pe�•ai�rrs], ��tl�e Sa�c�ye�-C:oi�:71y Ci'ratior� C�r�}ii�a��ce. gEl��t,'.��I'��'.�"� .t� !�CriZ�,�-�i1�1"�;�S'a-iA�.L, �'F': �� ''J ^ c`� Si�ncd:Y -" ._._-�� t�: ___�� 3 - Accepted by: _ ��te af teni�arary en�cr.�cncy u�ai�s�o�al: ! �"o�-��--� Rev. �?3;26/13 home go � SC1w _ �I B-J�7-054 CLOVER RD over CHIPPEWA RIVER 31 General Inventory Main Abutment Pier Span Geometry Approach Sufficiency Capacity Expansion Joint Appraisal ADT Desi n flood frequency 100 Max flowa e under (cu ft/sec) 4900 Max flowage velocity (ft/sec) 10.0 Draina e area (sq mi) 259.0 Vertical navigation permit clearance (ft) � Horizontal navigation permit clearance (ft) � Min lift clearance (ft) 0.0 Scour critical Stable- within footing limites (5) Scour calculated Pier protection Navi ation control No navigational control on waterway (0) Hi h water elevation (ft) 1382.4 Record low water elevation (ft) Record hi h water elevation (ft) Boat access location Inspection save cancel PatBrownSCZAC �61 3100608 -USE BLACK INK ONLY- i � i i i i i��i i�i i�i��i i; i i i i i ; �;�n�� CocIG;�.�. ,.._ POWTS MAINTENANCE AGREEMENT Tx,:4048�31 For Holding Tanks 447176 PAULA CHISSER Owners Name(s)as shown on deed: REGISTER OF DEEDS SAWYER COUNTY, WI �� 1 )�, e�Z n � � �� 11/fl2/2023 1I:27 AM � RECORDING FEE 3Q.D0 Parcel Identifi ion Number. q (12 Digit Legacy ID) � � �-��- � f -� 6 � ,1 — -- PAGES: 2 Legal Description of Property: -SEE ATTACHED SHEET- We acknowledge that appl'ication is being made for ihe installation of a holding tank(s)on the property described on the attached sheet Retum To:Sawyer Courrty Zoning and Conservafion Administration 10610 Maln St.Suite 49,Hayward,W154843 As an inducement to the County of Sawyer to issue a sanitairy permit for a holding tank on the above-described property,the owner is responsible for the operation and mainte�ance of the holding tank,locking device,alamn and access,and agrees to conform to all appiicabie requiremenis of SPS 383,Wis.Adm.Code relating to holding tank management,induding the faliowing: 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 govemmental unft 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 govemmental unit in accorciance with SPS 383.55,Wis.Adm.Code,fo�the servicing of the holding tank. In the case of exempfion under Secdon 281.48(3)(d),Stats.,the owner shall submit the report to the govemmental unit. The govemmental unit may enter upon the property to investigate the condition of the ho{ding tank when pumping reports may indicate the holding tank is not being properiy 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 health hazard as described in Section.254.59,Sfats.,the govemmental unit may enter upon the proper[y and service,or cause the tank to be serviced. Pursuant to Sec�tion 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 govemmental unit for inspection,pumping,hauling,or otherwise 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 regulatbn 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_!n addfion,this agreement may be cancelled by executing and recording said cefification with reference to this agresment in such manner which will pertnit the existence of the certification to be determined by reference to the property. 5. This agreement shatl be binding upon the owner,the heirs of the owner,and assignees of the ov►mer.The owner shail 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 agreement to be determined by reference to the property where the holding tank is installed. -On1 one owner si nature uired- ACKNOWLEDGMENT Owner's Signature: State of: ..l�rnec,y � County of: C�"d rC O er's Name(Pri t): Subscribed and swom to befare me on this Tn�s� �' ' . r� �day of �C+�iQ2� � 20 2� oa • gy(owners Name): P/��i/�p ��N�Tz�r�K / �D Notary Public Signature: _ Drafted by/: � � � Public Notary Name(Print : ,�Q�T�� f}. /�/!-} T.� C�I'�ct c � �/1 My commission expires on: ��io 1 ac�� I/r �`- .aA4�..�:.:.r!"s�,��.. .s5,.P:�- � �I"1�iVIP�o�..�:�. ��,�_. Personal ir�formation ou rovide ma be used for seoond (P' cy § (1( )) J�p��`�. �'��''��r;, �113 Y P Y aryPurposes nva Lew, 15.04 i m �.lotary�t�}�li�•�t<;: � 4�, My commi�Qi�it� �xu;•� - t�'io;'2:�2�; :ww...� AIl that part of Government Lot S�x �6), m Sect�on Nineteen �19), Towr,shsp Forty (40} North, Range Four (4} West, descrjbed as comrnenc�ng at the Southeast corner of Gov. Lot 6 in said Sect�on. Townsh�p and Ran�e and runn�n� thence North on the East L�ne of sa�d Lot b. a distance of approximately 1304 $ feet to the North E��ht l�ne of said Sec_ 19: thence West on sa�d Norih E�ght lme a distance of approx 132 feet, to the point of jntersect�on of tf�e North E�cht I�ne and the West Iine of Pubi�c H3ghway as naw constructed rn sa�d Lot b, to the point of be�inn�ng of the parcel of �and hereby conveyed, from thence West on the sa�d North eight �ine to the East Bank of the Chippewa R�ver, thence up sa�d nver ln a Northerly. Westerly and Easterl}� direction alon� the shore I�ne of said R�ver to the po�nt of mtersection of the sa�d r�ver and the West l�ne of said hi�hway in said Lot b, thence con. Southerly along the West lzne of said H�ghway to the Point of beg�nninc, bein� a parcel af land lymg North of the North E��ht ]�ne. Wesc of the publ�c highway and wholly w�thm the boundarles of Government Lot b Sa�d Sect�on. Township and Range� """`� PRIVATE ONSITE WASTE TREATMENT County ��o$ SYSTEMS `��s��s ( POWTS) Sawyer �' ""'';�' INSPECTION REPORT sanitary Permit rvo: Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION � 3 —0�9'� Personal infonnation you provide may be used for secondary purposes[Privacy L.aw,s. 15.04(1)(m)] Permit Holder's Name: ❑City ❑ Village �Town of: State Plan Transaction ID#: �:,�� 3. N�.��,,-�`T�.�-�.0 �� Insp BM Elev: BM Description: Parcel Tax No: (�Q.'J1 �� aT r^^i��a. C�L��' I i� 00�-�YO—(� -�O l TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Benchmark �p p,p� Dosing Aeration Bldg. Sewer �'�,S' � Hoiding y ` 2 -�� St/Ht Inlet (� � TANK SETBACK INFORMATION St/Ht Outlet ,7� TANK TO P/L WELL BLDG vE"TT° ROAD Dt Inlet AIR INTAKE Septic NA Dt Bottom �� Dosing NA Instailation Contour Aeration NA Header/Man. Holding .}��` � �1c7' •{-}a� L�S � Dist. Pipe PUMP 1 SIPHON INFORMATION Infiltrative Su rface 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 L #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav ° Conv ❑ Aggregate INFORMATION P/L Bidg Well Waters ❑ AG ° 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 � — -- - — __-- -- -- -- -- --- SOIL COVER __ Depth Over �epth Over ' Depth of (� Seeded I Sodded 1 Mulched � Cell Center Cell Edges i Topsoil __ � ❑Yes ❑ No � ❑Yes ❑ f�o COMMENTS: (Include code discrepancies, persons present, etc.) ��.s�/� 9 �a� ��3 � �� ' 03 I,�� I � -___----. Plan revision re uired.❑Yes ❑ No � � ' 6�� . q Y ' , �_— �_ Use other side for additional information Date POWTS Inspector's Signature Certification Number SBD-6710(R.3/01) A�OITI�NAL COMMENTS ANO SKETCH SANITARY PEAb11T NUMBER ________�3��'n(� ____ ��' �r.-�-�� 2;�.�1- ��' , , _ . - -:- , ; __ � .-- __; �� , � __ _ . ._ _ . . , . . _ . _ � d� �D��, d�k u � � �� V'� 1 I�`• �qy��.�� ,z�� s o r� y ��Q�n � ��>� �,c��' r 3�� ', Z� �Io� �/� S` � �ry + 2a ' Is P�Q�S� d,ril� �. �.n� � � g , � .�� cs� � ac�4 �� ►v c�b`.x.i� - � 'f�-�l`J ��