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Home My WebLink About024-641-24-2105-SAN-2023-313 �,�.' �"'` Department of Safety ��°"°cy � �� Saw er � _'�'� 9 - & Professional Services, y 1 ' Sp ` l�` Sanitary Perniit Number(to be tilled in by� t.,,�s / Industry Services Division � �"�y�`,,.,;�./r� (� S I ��p0 w �.__ Sanitary Permit Application s`a`e T`a°sa°"°"N�",ee` `�' In accordance with SYS 383.21(2),Wis_Adm.Code,submission of this form to the appropriate govemmental unit W is required prior to obtaining a sanitaiy permit Note:Application Yom�s Yor state-owned POWTS are submitted to Project Address(it different than mailing address) the Department of Safety and Profes,ion�l Services.Personal information}'ou provide ma�°be used for secondary purposes in accordance w°ith the Privacy I.aw,s. 15.04(1)(m),Stats. �'10873N DEER LN I.Application Information—Please Print All Information Property Owne�'s Name Parcel# GARY JOHNSON De2`� -byl - a�{ `��5 Property Owmer's Mailing Address Propertp Location 2677 8TH ST � City,State Zip Code Phone Number CUMBERLAND, WI 54829 ��'/<, �J�/✓ '/. sectioi� _24 II.Type of Building(check all that apply) Lot# � ��-41 N � 06 �� w � I or2PamilyDwelling—Numberoll3edrooms � SubdivisionName Block# ❑Public/Commercial—Describe Use ^ ❑City of ❑State O�+med—Describe Use CSM Number ❑ Villa�e of LOT 4 CSM 4/292#825 ��,��,of Round Lake LOT 8 CSM 4/294#826 llL Typc of P0�1"1'S Permit:(Check either"New"or"Replacemcnt"and other applicable on line A. Check one box on line B.Complete line C if a licable.) 4. ,,�/ ❑ New S}�stem LJ Replacemcnt S}�stem ❑ Od�er Moditication to Gxistin�System(explain) ❑ Additional Pretreatment Unit(cxplain) B. �HoldingTank ❑ In-Ground ❑ At-Grade ❑ Mound ❑ Indi��idual Site Design ❑ Other I�ype(ex�lain) (conventional) List Previous Permit Number and Date Issued C. ❑ Renewal Before ❑ Revision ❑ Chan,c of Plumber ❑ Transfer to New O��°ner � Espiration Couldn't locate (,�y�k � IV.Dispersal/Treatment Area and Tank Infbrmation: Desian[low(gpd) Design Soil npplication Rate(gpd/s� Dispersal Area Required(s� Dispersal Area Proposed(s� System Elevation 200 — ` ._ .--- Capacit} in Total #of Manufacturer :? Tank Information Gallons Gallons Units � � v "O � 'R U U � � � � New Tanks Existing Tanks y o a� L y � � � a U v� � v� r�. C7 a Septic or Holdin,Ta��k 1060 2�2� 2 Infiltrator X Dosin�,Chamber V.Responsibility Statement- 1,the undersigned,assume responsibility fm�installa6on of the POW1'S shown on the attached plans. Pfumber's Name(Print) Plumber's Signat� � MP/MPRS Number Business Phone Nwnber Travis Butterfield ' 652879 715-634-8176 Plumber's Address(Slreet,Ciry,State,Zip Code) 14346W St. Rd. 77, Hayward, WI 5 43 VL Cou ty/Department Use Only Permit Fee Date Issue Issuina Agent Signature App o e ❑ Disappro<ed ` � ❑Owner Civen Reason for Denial � �.� � � �� '�"��"�� Condition of ApprovaVReasons for Disapproval - ��, ,'_'' r ' � r,..� � �� "' 1, �� '' I � � �.. ��.., _ — - �.� j� " u Y Ir li 4 r r' '3 j �� .x�._,._..l�...��-�--�.�...� � D�� 23 �—1 �� 1._.__._.__.r._ — T � C'cS� /Vr�� • ;��,� ,�sAVVYER COUN, t ZONi�3G ADMIN�STRATIJt� Attach to complete plans fm•tlie system and submit to tlie Counry only on paper not less chan 8 l/2 a 11 inches in size �N`-(� sB�-639s�u.o�iaa� NC Ri:FtJ�DS A�=T�Ft I�SUC UF F'�R!JfiT C�i�\ Sawyer County Zoning & Conservation Administration �� 10610 Main Street, Suite 49 � �R Cp �� Hayward,Wisconsin 54843 d-'"—��(� l� (715)634-x288 .. � `��I� FAX(715)638-3277 i %�� - - �/ wwwsawycrcount >ov.��i� � o� _,� � I o � E-mail:sanitarian�n��sawyercountygov.o� I _�;`ry�`�= Toll Frec Courthousc/General Information 1-877-699-4ll0 ,��11`�N:� Holding Tank Approval Checklist I. Sanitary Cover Sheet: Date Stamp �� / a�7 / �3 Parcel ID# o� �- (o Y f -�� - a- l � � II. Plot Plan: �Property Lines �C Benchmark BM ♦ x Site Address �Nortll Arrow �Structure �Scale �Well �< 25' to Service Road Legal Description �Nearest Road Intersection �Setbacks to: Property Line, Well, Structure, Water bodies, Roads III. Required Plans: �Index Page with Original Signature �Management Plan/Contingency Plan �Servicing Contract �Holding Tank Agreement Fonn ($30 to ROD) IV. Holding Tank Specifications: �C Tank Cross-Section: Manufacture •2� Gallons: l�� 7C Tank Anchor Calculations [SPS 383.43 (8) (g)] �( Locking device, chains/locks �Alarm, electrical per SPS 383.43 (8) (e) �3" Bedding Material < 1/2 " V. POWTS Component Manual Reference: x Holding Tank Version 2.1 (May 2022-2027) Owner: (�, , ��NSbL, Plumber: T' 8�+��e. Application Review Date: l01- I 8'02-_j POWTS Reviewer: �d� � N��ne �� b 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 Owner Name(s): GARY JOHNSON Phone: - - Owner Address: 2677 8TH ST., CUMBERLAND WI Zip; 54829 Project Address: 10873 DEER LANE, HAYWARD, WI 54843 Govt. Lot: 1/4 of 1/4, Section 24 , T 4� N-R 06 E ❑or W � Township: ROUND LAKE County: SAWYER Project Parcel ID #: 024-641-24-2105 Designer Information Designer Name: TrBviS Butterfield Phone: 715 _634 _8176 Designer Address: 14346W St. Rd. 77, Hayward, WI Zip: 54843 E_Cpal�: OffIC2@bUtt@t�12�C�C�rl��I I'lg.CO11"1 'l'his space reserved for approval stam}?. License Number: 652879 Remarks: , �._..._.__ _ ___ _ Signature:-- � Date: 12 �.5 �2-3 Original signature required on each submitted copy. CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. � SOIL EVALUATI4N o Scale: 160 60 90 �zo 0 SYSTEM PAGE 2 OF lY SITE MAP PLOT PLAN PROJECT NAME: 15z DESIGN FLOW: �`� GPD ��'�'t� �o�nS� >1 Attach design flow calculations for commercial plans. PRo,IECTADDREss: �?c��j �v �L�� -� Pipe Material/ASTM Standard(Tables 384.30-3&384.30-5) Sanitary Sewer. y yS`�` ��v / BM Symbol: � BM Elevation: �U�• � FT / � Force Main: ��- / BM Description: (,Z��"� C� ��iS �ndicate nonh ey IMPORTANT: Slope Gradient(%) Well Symbol(if applicable): � drawing an arrow Show ground elevation contours at suitable intervals. of Tested Area: on the approprite line. / �� r �/ — / � �� .�G��S�-� �}��.��.� U ��-�� ,� S � �--- � C�,,,,,�.er(u�,� wr s��Y' 3 � � �� a a v� y�� Ya i�s- " �� T � v �i' c�c� _ S��Y y '` '�� i ou� l—�c��' �,�o j�� - �o(p� G� ( �, / ; ( ��l-\>�� J r`�/� �J. 1 � ��-- S�S�� L - `�� ' Nl�, l� I�>_ �j�;�� ' �o i�� ,; � U ��,��1� «� � G�� `� �I , a � - �/�ci -__� [ y��/'` Y. ' � _ �l�✓i S �,,�'T1 Cr�?-C%�cL� �1�'� � '�`�S�2 � �`� PAGE30F4 HOLDING TANK SPECIFICATIONS (No Scale) Weatherproof 12"Min.or 20 ft above Junction and Approved Established Flood Elevatlon Alerm Box Vent Cap Qyplcal) Electrical mustcomplywi[h � Approved Locking Manhole SPS 316 and NEC 300 4"Q'Vent Pipe with Weminy Label Attached �Candui[ >10ftfrom (typiwl) 4"Min_orZ.Oftabove E3uilding � Established Rood Elevation (ryplcal) �AlrtightSeal � 1 _ Finished Grade 18"Min. ��YPical) .. d 9. Inlet Inletlnvert �Watertlght Approved Joints with� Plug Approved Plpe 3 ft onto � Max 12"or 90%of total volume Solid Ground � if more Ihen one tank e Alarm-On HOLDING TANK �� VOLUME= 1060 gal l ,1-) \ a 3"Approved Bedding Ma[erial Beneath Tank TANK MANUFACTUR �) Infiltrator 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 t5 Ballast Weight-[( cu.ft.x 62.4 Ibs/cu.ft)- Ibs]x 1.5= Ibs � d � ) � INFILTRATOR � 1 k','. 'tw,' �..P L ( i.l 4 bA €�2 8 � Pi. « F�ati�eLs � �enef�E�: , • Strong injection molded polypropylene � E construction � ��. ' �� • Lightweight plastic construction and � ` `' : ,_�'�� ^ ' � � �� inboard lifting lugs allow for easy r , � , '� : � �' •" ��=v delivery and handling '� � , ��' �� • Integral heavy-duty green lids that �I Z g�° � � �� ; �' g �� interconnect with TW�"' risers and pipe � ... �.F. �x . a { ' J f� . riser solutions � ;: • Structurally reinforced access ports '.�>;, ' eliminate distortion during installation g=' {� �Z �r� , `"� � ��,��'� �,� and pump-outs �� :. , , a. � a�'". � ,,.< �,�' x , ' � `• � • Reinforced structural ribbing and �'� � ��° " fiberglass bulkheads offer additional �°"� '�.� strength • Can be installed with 6" to 48" of cover The Infiltrator IM-1060 is a lightweight strong and durable septic tank. • Can be pumped dry during This watertight tank design is offered with Infiltrator's line of custom-fit pump-outs risers and heavy-duty lids. Infiltrator injection molded tanks provide a • Suitable for use as a septic tank, pump revolutionary improvement in plastic septic tank design, offering long-term tank, or rainwater (non-potable) tank exceptional strength and watertightness. • No special water filling requirements Inlet Side are necessary � • The tank may be backfilled with s�itable TANK CUTAWAY Infiltrator native soil. See installation instructions TW Riser for guidance. System '`~ ... ,., i ��.�� Partition baffle wal� � -. HEAVY DUTY LID �, : �� CUTAWAY �� 3:, � , � �� y ' �. Reinforced ' e '. 24" structural " :a p iii j 1',`;' •�, , access port ; , ' � � k � ` � ; �Y� Structural ` bulkheads t �r�� . � .� _ � � . � ` ;. MID-SEAM CUTAWAY �: " r't Reinforced water tight mid-seam gasketed connection 7� ', `l i �I INFILTRATOR"' ; Protecting the Environment with Innovative Wastewater Treatment Solutions water technalogies IM-1060 General Specifications and Illustrations LIFTINGSTf�AP LIFTINGLUG -RISERCONNECTION (TYPICAL) (4 TOTAL) (TYPICAL) The IM-1060 is an injection molded two piece mid-seam plastic tank. The IM-1060 injection molded plastic design allows for a mid-seam joint that has precise dimensions A A for accepting an engir�eered EPDM gasket. Infiltrator's °o °o B gasket design utilizes technology from the water industry � °o� b °o'� 6�.� to deliver proven means of maintaining a watertight seal. ° ° E�ER°oR W IDTH The two-piece design is permanently fastened using a series of non-corrosive plastic alignment dowels and locking seam clips. The IM-1060 is assembled and sold through a network of certified Infiltrator distributors. ,2,.o�3Z�6,E�ER,oR�EN�T„ Must be backfilled and installed in accordance with TOP VIEW Infiltrator Water Technologies, Infiltrator IM-Series Septic o�T�ET Tank General Installation Instructions and for shallow � ground water conditions reference the Infiltrator IM- Series Tank Buoyancy Control Guidance. � 54.� Please visit www.infiltratorwater.com/images/pdf/ n389, EXTERIOR ManualsGuides/TANK01.pdf for the latest information. HE��HT SEAM CLIP (TYPICAL) I � I LIFiING STRAP Working Capacity 1094 gal(4141 L) crYP�cnu Total Capacity 1287 gal(4872 L) END VIEW Airspace 16.5% Length 127 (3226 mm) �4[102] 0 24[610]ACCESS OPENINGS WITH LOCKING LIDS(2) PVC OR ABS Width 62.2°(1580 mm) MLETTEE 101[260]FREEBOARD �BS[OUTL TTE�E Length-to-Width Ratio 2.3 to 1 w�ET 16.5°� I I AIR SPACE OUTLET Height 54.7°(1389 mm) PER �7fi�-� � i PE�R co� i �a� Liquid Level 44°(1118 mm) Q4�o FIBERGLASS �1118� FIBEAGLASS Invert Drop 3� (76 mm) SUPPORT —_ LIQUID I�—SUPPORT (TYPICAU , DEPTH (TYPICAL) WITH BAFRE Fiberglass Supports 2 i wauwHeRe REQUIRED Compartments 1 or 2 —�--�'' Maximum Burial Depth 48"(1219 mm) SIDE VIEW Minimum Burial Depth 6"(152 mm) Maximum Pipe Diameter 6"(152 mm) CONTINUOUS TANKTOP Weight 320 Ibs(145 kg) HALF GASKET , TANK INTERIOR SEAM CLIP ALIGNMENT DOWEL TANK BOTTOM � 4 Business Park Road HALF � P.O.Box 768 Old Saybrook,CT 06475 I N F I LT R AT O R� 860-577-7000�Faz 860-577-7001 MID-HEIGHT SEAM SECTION 1-800-221-4436 l"JatGY t@C�IYIO�Og185 �`�'�•�nfiltratorswater.com U.S.Patents:4,759,661;5,017,041;5,156,488;5,336,017;5,401,116;5,401,459;5,511,903;5,716,163;5,588,778;5,839,844 Canadian Patents:1,329,959;2,004,564 Other patents pending.Infiltrator,Equalizer, Ouick4,and SideWinder are registered trademarks of Infiltrator Water Technologies.InfiRrator is a registered trademark in France.Infiltrator Water Technologies is a registered trademark in Mexico. Contour,MicroLeaching,PolyTuff,ChamberSpacer,MuttiPort,PosiLock,QuickCut,�uickPlay,SnapLock and StraightLock are trademarks of Infittrator Water Technologies. PolyLok is a trademark of PolyLok,Inc.TUF-TITE is a registered trademark of TUFTITE,INC.Ultra-Rib is a trademark of IPEX Inc. OO 2016 Infiltrator Water Technologies,LLC.All rights reserved.Printed in U.S.A. IM02 1116 • � • • . - � - • . - � - : 11 • '3 � IM-1060 General Specifications and Illustrations LIFTINGSTRAP LIFTINGLUG RISERCONNLCTI�)N (TYPICAL) (4 TOTAL) (TYPICAL) The IM-1060 is an injection molded two piece mid-seam — plastic tank. The IM-1060 injection molded plastic design ailows for a mid-seam joint that has precise dimensions a �, for accepting an engineered EPDM gasket. Infiltrator's �o �o � B gasket design utilizes technology from the water industry ` °o� � °o� 6�.z to deliver proven means of maintaining a watertight seal. ° ° E�ER�oR The two-piece design is permanently fastened using a W�°T" series of non-corrosive plastic alignment dowels and � locking seam clips. The IM-1060 is assembled and sold through a network of certified Infiltrator distributors. ,�,.o�,zz6,E�ER,oR�EN�TH Must be backfilled and installed in accordance with TOP VIEW Infiltrator Water Technologies, Infiltrator IM-Series Septic o�T�� Tank General Installation Instructions and for shallow I ground water conditions reference the Infiltrator IM- Series Tank Buoyancy Control Guidance. � 54.� Please visit www.infiltratorwater.com/images/pdf/ ' EXTER9oR ManualsGuides/TANKOi.pdf for the latest information. "F��{T SEAM CLIP (TYPICAL) � i � LIFTING STRAP Working Capacity 1094 gal(4141 L) crvP�cnu — Total Capacity 1287 gal(4872 L) END VIEW Airspace 16.5% Length 1 27��(3226 mm) 04[102) �24[610]ACCESS OPENINGS WITH LOCKING LIDS(2) PVC OR ABS m 4(102]PVC OR W�Uth 62.2��(1580 mm) INLETTEE 10.2[260]FREEBOARD ABS OUT!.EfTEE Length-to-Width Ratio 2.3 to 1 iN�er �esr AIR SPACE OUTLET3 PER 3.0 J I � � � Height 54.7"(1389 mm) �,6� PER co� i �aL Liquid Level 44"(1118 mm) 44.0 FlBERGLA55 I �1118� FlBER6LA55 Invert Drop 3°(76 mm) SUPPORT —ii ��Qu�o —suaaoar (TYPICAL) DEPTH (TYPICAL) WITH BAFFLE FlberglasS SuppOYtS 2 wnuwHeRE pEQUIRED I —_ Compartments 1 or 2 - Maximum Burial Depth 48"(1219 mm) SIDE VIEW Minimum Burial Depth 6"(152 mm) Maximum Pipe Diameter 6"(152 mrn) TANKTOP � CONTINUOUS Weight 320 Ibs(145 kg) � �ASKET HALF % i /;=-,:,�.! TANK ; ,j:�' , INTERIOR � SEAM CLIP �- ,\�< ALIGNMENT � � s% DOWEL � , ��-- TANKBOTTOM f,,'� � � 4 Business Park Road \ HALF P.O.Box 768 Old Saybrook,CT 06475 I N F I LT R AT O R� 860-577-7000•Fax 860-577-7001 MID-HEIGHT SEAM SECTION 1-800-221-4436 water technologies �'�'�•�nfiltratorswater.com U.S.Patents:4,759,661;5,017,041;5,156,488;5,336,017;5,401,116;5,401,459;5,511,903;5,7Y6,163;5,588,778;5,839,844 Canadian Patents:1,329,959;2,004,564 Other patents pending.Infiltrator,Equ 3lizer, Quick4,and SideWinder are registered trademarks of Infiltrator Water Technologies.Infiltrator is a registered trademark in France.Infiltrator Water Technologies is a registered trademark in Mexico. Contour,MicroLeaching,PolyTuff,Chamber5pacer,MuttiPort,PosiLock,QuickCut,(�uickPlay,SnapLock and StraightLock are trademarks of Infiltrator Water�iechnologies. PolyLok is a trademark of PolyLok,Inc.TUF-TITE is a registered trademark of TUF-TITE,INC.Ultra-Rib is a trademark of IPEX Inc. OO 2016 Infilhator WaierTechnologies,LLC.All rights reseived.Printed in U.S.A. M02 1116 � � - - � � � - - � ' � . � - : 1 1 • 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 352-384,Wisc.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),Wisc.Admin.Code. Estimated Daily Wastewater Flow= 300 9pd Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors(i.e.odors,user complaints,efc.) o mechanical malfunctlon(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 activities,etc.) o electrical components(i.e.,wiring,connections,switches,controls,timers,alarms,etc.) o surface discharge of e(fluent 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 shall 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:BUtt2ff12Id, ItIC Phone:715-634-8176 _ �ocal government unit:SaWyel'COU11ty ZOning Phone:715-634-8288 �oca�government 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 deparlment 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. HOLDING TANK SERVICING CONTRACT Contract Date: I � /1� / �� This contract is made between the Holding Tank Owner and the Pumper. Holding Tank Owner's Name: Pumper's Name: �� —�'p h �S �l SCOTf POPPE J Parcel Identification Number: (12 Digit Legacy ID) � 2 � - �G � � - 2.. � - Z � D '� 1. The owner agrees to �le a copy of this contract with the governmental unit, Sawyer Count� , w�hich 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 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 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 agreed upon by the owner and pumper. 3. The pumper agrees to submit to the Governmental Unit, Sawyer County, a report for the servicing ofthe holding tank(s) as required under SPS 383.55, Wisconsin Administrative Code and the 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 the holding tank was serviced; e. The volumes in gallons of the contents pumped from the holding tank for each servicing; £ 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. �Wriel''s Name: (Print) �Wri 's Signatur : ` �y one owner signature required) ��T� � � v� S � h ;, � Pumper's Name: (Print) Pumpe 's Signa SCOTT POPPE ,��ty�� Pumper's Registration Number: 81813 Rev. 03/26/13 12I8/23,832 AM Real Property Listing Page Redl EStdt2 Sawyer County Property Listing Property5tatus: Current Today's Date:12/8/2023 Created On:2/6/2007 7:55:41 AM �Description Updated:1/11/2022 �Ownership Updated:1/I1/2022 TaxID: 24480 � GARYJOHNSON CUMBERLAND WI PIN: 57-024-2-41-06-24-2 01-000-000050 Legacy PIN: 024641242105 Billing Address: Mailing Address: Map ID: .5.5 GARY IOHNSON GARY lONN50N Municipality: (024)TOWN OF ROUND LAKE 2677 STH ST 2677 8TH ST STR: 524 T41N R06W CUMBERLAND WI54829 CUMBERLAND WI54829 Description: PRT NENW LOT 4 CSM 4/292#825 LOT 8 �p CSM 4/294#826 r Site Address *indicates Private Road . . . .. ..... ..... _. . . Recorded Aaes: 2.170 10873N DEER W * HAYWARD 54643 Calculated Acres 2.312 Lottery Claims: 0 J property Assessment Updated:7/16/2019 First Dollar. Yes � Waterbody: Moose Lake 2023 Assessment Detail Zoning: (RRl)Residential/Recreational One Code Acres Land Imp. ESN: 402 G1-RESIDENTIAL 2.170 201,400 211,600 2-Year Comparison 2022 2023 Change ��Tax Districts . _ . Updated:2/6/2007 Land: 201,400 201,400 0.0% 1 State of Wisconsin Improved: 211,600 211,600 0.0% 57 Sawyer County Total: 413,000 413,000 0.0% 024 Town of Round Lake 572478 Hayward Community School District 001700 Techni�al College �property History N/A . Recorded Documentr Updated:1/11/2022 WARRANTY DEED Date Recorded:12/17/2021 436570 TRANSFER ON DEATH DEED Date Recorded:1/11/2019 416151 TERMINATION OF DECEDENTSINTEREST Date Recorded:i/11/2019 416150 CERTIFIED SURVEY MAP Date Recorded:9/17/1976 156805 CERTIFIED SURVEY MAP Date Recorded:9/17/1976 156804 WARRANTY DEED Date Recorded:8/19/1976 156458 273/415 CERTIFIED SURVEY MAP Date Recorded:6/18/1976 155590 CERTIFIED SURVEY MAP Date Recorded:6/16/1976 155589 https:lltas.sawyercountygov.orglsystem/frames.asp?uname=Eric+yyellauer �� '•�� -_� ,yti. �. :�� y .,�^••��,cv v ; -„� .` . dj� f , �,"�,�, �, r �r �t � � .,� �j ��.�R�'' � aJ'1i4'' �?/! .`r� � yi� �� x � � 6"'��. Y�4 � ;`it .�� AY. , � ` ' . ...,. . \�`-'. � - � ,� �� 1 � �.� ., � �� M��5 >{}� "'� ��" '�� =�. 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T? ��, °h;�3.��. y . �,� .�"v� �w -`�tu" a 'NS � �i�v s .. � �� v �.'4S ,,�< � r �,�tY,�P13 �,�1�" _��.-' `� ''� '� . ��' 1`. ��"c w �I.p; `� 5 ' \tµ�� .'/, - I I4 � � � � I � II � � - USE BLACK INK ONLY - I I i ! � � I �ni,J. :�� , ' ; POWTS MAINTENANCE AGREEMENT Tx :40�9�65 For Holding Tanks `�4��g� PAULA CFIISSER Owner's Name(s) as shown on deed: �EGIS7ER �F DEED� SAWYER Cf)UNTY, WI GARY JOHNSON ��/��1202� 09:€33 AM RE�ORC)ING FEE 3�t=�0 Parcei Identification Number: (12 Digit Legacy ID) 0 2 4 _ 6 4 1 _ 2 4 _ 2 1 0 5 - - - - - - - - - - - - �Qra��J: � Legal Description of Property: - SEE ATTACHED SHEET - We acknowledge that application is being made for the installation of a hoiding 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 atl 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 hoiding 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. T�e 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 properf� 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 abate 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 ement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to,ty��1a�ureference to the properry where the holding tank is installed. ,� ;,� ^o;P �� bh� - Onl owner si nature re uir yc �% ACKNOWLEDGMENT Owner Signature. � s KE��Y � � ' y �tate of: �Jl�I S L.3�� rl � ~-1 � '' FIEL s�ounry of: � Owner's Name 'n • j� � s — GARY JOHNSON 'j�i�t � •,, �� ¢Sub3scsbed and sworn before me on this � � {- day of ��(2�.,t— , 20 � Date: G �� \ ZL 1� �►1��`��. By (Owner's Name): Notary Public Signature: Cl, Drafted by: Public Notary Name (Print): �k.� � My commission expires on: 3 Z-�o Personal information you provide may be used for secondary purposes [Privacy Law, § 15.04 (I) (m)] Rev. 03/26/13 Lc��l Descriptio��: Pttrcel I.11. No.: Q24-6��1�2�-2105 P�rcel 1 ; Lot 4 as �ecordec� in Volunle 4 of Certified Survey Maps, �age 292-293, Survey I�ca, 82S as Document Nc�. 1.56$Q4, AND Lot 8 as r�coxded in Volit�ne 4 of Cextifieci Suz�v�y Ivf�ps, �age 29�-296, Suz�vey No. 826 as lllocument Na. 1 S680S, ]pcat�d in tl�e T�w�i o:f Raunci I��l�e, S�twy�� ou�lty, Wiscatlsii�, bc�ix�g a paz•t. o�' i.��e NE1/�NW�/�, Sectiati 2�, 'i'owx�slazp 41 No��ti1, Ra��ge C West. ParGe12: Together with � .nan exclusi�ve eas�meni; fo�• �n�;ress a��d �grc�s ov�:r ai�d across t�e cur.rent �nd existin� ro�dway lcnown as Deez� Ln to �i��d frozn Fin & reathe� �.d. ,t.��`'`,, PRIVATE ONSITE WASTE TREATMENT county <,. `;��gp ,��, SYSTEMS - � s ( POWTS) Sawyer �:'� � — �%� � INSPECTION REPORT Sanitary Permit No: Safety and Buiidings Division (ATTACH TO PERMIT) GENERAL INFORMATION � 3 r3�3 Peisonal infonnation you provide may be used for secondary purposes[Vrivacy Law,s. I 5.04(I)(m)] Permit Hoider's Name: ❑City ❑ Village � Town of: State Plan Transaction ID#: �� Jo1/��n.TOh �J�r.� �,,q� r-- Insp BM Elev: BM Description: Parcel Tax No: fla .a' �o o-� �t r a r;�,�,- I;� "o�-le�'� �-2Y-6y1- �-�_ �(oS TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Benchmark I oo,o' Dosing Aeration Bidg. Sewer �g.s Holding � ` � 1p(,�S St/Ht Inlet 9g 2S'� c ANK SETBACK INFORMATION St l Ht 0utlet qg,17� TANK TO P/L WELL BLDG vENrro ROAD Dt Inlet AIR INTAKE Septic NA Dt Bottom Dosing NA Installation Contour Aeration NA Header/Man. Holding -1-�0� N .�-Vp .1-�0� �ZS Dist.Pipe PUMP/�IPHON INFORMATION Infiltrative Surface Manufacturer Demand Final Grade Model Number GPM �� $�� t TDH Lift Friction Loss Sys Head TDH Ft t-{��-- p � �-- Forcemain L Dia Dist.To Well DISPERSAL CELL INFORMATION DIMENSIONS �N L #of Cells Type of System Distribution Media Manufacturer: SETBACK OHWM of Nav ° Conv ❑ Aggregate INFORMATION P/L Bldg Well Waters o G ❑ Chamber Model Number: ❑ EZFIow CELL TO ❑ Mound � Other -- —-- -- — - —-— —__— — --- ---- ____ ___—.-- _—__ DISTRIBUTION SYSTEM X Pressure Systems Only [Header/Manifold Distribution Pipe(s) I X Hole Size I X Hole Observation Pipes Length Dia �Length __ Dia Spac __ � _ Spacing ❑ Yes ❑ No SOIL COVER Cell Center Cell Edges Depth of Seeded/Sodded Mulched Depth Over 1 Depth Over II — � Topsoil ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) �.�S�l� �aI� Y��3 �� . -_ 3 T -� _ _-' , � Plan revision re uired?�Yes O No ' ' � / 4 I� Ia5- I�- I__ C�� Use other side for adtlitional information Date POWTS ins ector's Signature Certification Number SBD-6710(R.3/01) A�OITIONAL COMMENTS ANO SKETCH SANITAAY PEAMIT NIJMBEA:___�3 "' 313___ � � � \ r�' �oa5-2_ �� \ �' � �\ ; � / ' il �ll 7-$�� _ Cb` " � a � I � j I � o�p i � `I�' � �Id' . 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