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Home My WebLink About014-942-25-3302-SAN-2024-005 Department of Safety �°°°�y p r�� s�w -e.r Z • = & Professional Services, - _ f � Sanitary Permit umber(to be filled in by Co.) � �_ , Industry Services Division �.c�S /�l C�� -� ,.. . � Sanita� Pel l,nit AppliCa+l�n State Transaction Number � 6 ln accorclance with SPS 383._i(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit �— � is required prior to obtaining a sanitary pennit.Note:Application forms for state-ow-ned POWTS are submitted to Project Address(if different than mailing addre..,, the Deparhnent of Safety and Professional Scrvices.Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s. 15.04(I)(m),Stats. � ' � �� . I.Application Information-Please Print All Information �K��" Property Owner's Name Parcel# ��c.v � . N Yer1 Co c- i hne N1 . � rcr� ply _ 942 —LS- 33oZ Property Owner's Mailing A ress Property Location �9 ZZ�' �,b� �� /4�t �G c;ovc.�ot City,State Zip Code Phone Number S� '/s S� Z� �1.� O►ti1 1►�1 �� J�.S ��I Z. �'I.SZ —ZOCh ---.SD�{� - _/,, Section IL Type of Building(check all that apply) Lot# � � �Z. N R O C( E o W [�1 or 2 Family Dwelling-Number ofBedrooms 2 Subdivision Name Block# ^ ❑Public/Commercial-Describe Use �-- ❑City of ❑State Owned-Describe Use CSM Number ❑Village of �7� ( 3 0�e'��. �Town o f �vL�'0 0 {" — III.Type of POWTS Permit:(Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C i a licable.) `4 �New System ❑ Replacement System g y ( p ) P ) ❑ Other Modification to Existin S stem ex lain ❑Additional Pretreatment Unit(ex lain �' �Holding Tank ❑ In-Ground ❑ At-Grade Sn YP � P ) ❑ Mound ❑ Individual Site Desi ❑ Other T e ex lain (conventional) C• ❑ Renewal Before ❑ Revision ❑ Changc of Plumber ❑ Transfer to New Owner List Previous Pemut Number and Date Issued Expiration IV.DispersaU'I'reatment Area and Tank information: Design Flow(gpd) Design Soil Application Rate(gpd/s� Dispersal Area Required(sf� Dispersal Area Proposed(s� System Elevation �. -- — — — Capacity in Total t�of Manufacturer � � Tank Informarion Gallons Gallons Units � � v � � � New Tanks Existing Tanks � o Y' � a°'i p � � a. U �in �, �n i�. C7 C. Septic or olding Tank ��Q D —� 3�� ' W�l S,C y� /` llosing Chambcr V.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plum ' Si�mature _-_ MP/MPRS Number Business Phone Number R �- 5-��,,d �� 3� ��s-ssg_�� Plumber's Address(Street,City,State,Zip Code) 10�5�t ►`� T'o�' T��v s�ci�, I � c.,��.�� t.c�� S`�-�s 4 3 VI.C u ty/Department Use Oniy Pertnit Fee Date Issued Issuing Agent Signature �p� ❑Disapproved � ��J ❑(}wner Given Reason for Denial $ �16p� �� -�� :��z� � Conditions of Approval/Reasons for Disapprovai �,.�-,�, `•f;�w.'+r r<' � �� s�,:, , �, �, � � ��°r �� `'"';' ; : _ � � ; � � � �y . ... ._ ��.� ; � ,►�i ��,�-� �. . . �. �1.._.�._. . , JAi� 13 �� .�,k�._._.M....a3�;� _ :. _ __ __.; C,5� /�� , s,a,wY�R c�u:,.-:o, ZONING ADN,1N15T{�:�il��t Attach to complete plans for t6e system and submk to the County only on paper not less than 8 u2 a I 1 inches in size � � � ,G 0 E�C F�`:F'�'rrJzi r�+�l�R SBD-6398(R.03/22) la�,�;�{��y�'�' � '�`�� Sawyer County Zoning & Conservation Administration 10610 Main Street, Suite 49 '��1 ER Cp 1� �Iayward, Wisconsin 54843 ��'l�'-��Ci�� (715)634-8288 �Q� �� FAX(715)638-3277 �y; - - � �/ www.sawyercounty�rv.<�ra � o`\ � - �o � E-inail:sanitarian(a sawyercoun��*ov.ot't; I� —�' �i � Toll Free Courthouse/General Information I-877-fi99-4110 ��`J�"`"'�'- ?� I��`�C (J5� ��`�� Holding Tank Approval Checklist I. Sanitary Cover Sheet: Date Sta�np � I / l`� / �y Parcel ID# D l `f - �'`f �Z - 2 S -3 3 0� II. Plot Plan: x Property Lines �Benchmark BM ♦ �Site Address �North Arrow �Structure �Scale �Well �<25' to Service Road �Legal Description �Nearest Road Intersection ��etbacks 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 Form ($30 to ROD) IV. Holding Tank Specifications: �oo�� Tank Cross-Section: Manufacturer: �� Gallons: -3i`�� Tank Anchor Calculations [SPS 383.43 (8) (g)] x Locking device, chains/locks � Alarm, electrical per SPS 383.43 (8) (e) �3" Bedding Material < 1/2 " V. POWTS Component Manual Reference: �Holding Tank Version 2.1 (May 2022-2027) Owner: t'e.r� Plumber: s��`�V' Application Review Date: 6 `a '�-�� POWTS Reviewer: ,�;,,�,�i�� Namc 6�S�(.� Rev. 4/27/2023 Crcdcntial# PAGE 1 OF 4 Holding Tank Plan Index & Cover Sheet Component Manual Design References: Holding Tank Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Holding Tank Specifications Pg 4 of 4 Management Plan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map (if applicable) Holdin Tank Pum in Contract if a licable) Holdin Tank A reement if a licable Project Name / Description �a.� 1 � , Cr o�'��-e M . t1�9 �-,e�► Owner Name(s): Phone:�tS 2 - Z�- SO`-E� OwnerAddress: 6ZZS ZOZ �'' A�e iJ(. '^�`�b""`"`S Zip: SSoSZ Project Address: Tc�.v�►�,;�c �-1- (L � Govt. Lot: 5"w 1/4 of 5 w 1/4, Section ZS , T 4Z N-R a�_E 0 or W x❑ Township: L��c-no�- County: �i' 4�-✓�{V- Project Parcel ID #: b �� -�c�kZ - ZS -- 33�Z. Designer Information Designer Name: R�� .5-��-,-�.� Phone: -1�� - SSb� - !��3 Designer Address: l o S-7� � �t"o� `��s�►�'w-� l� �-�aw� Z�P� �'��`�3 E-mail: -- , , ! , ,,, License Number: �� 8 3d � Remarks: __..._.__ Signature: Date: �� t t�' �-�� Original signature required on each submitted copy. Q ' � � � i�/ � t�li � � � / N�pOtNS P�0��_ � / �I �' S j� f / 9T6�9d'T8'A 0330 � , i _ _ ZLBLB p,7pQ 1/V3W35b'3 :� 'I � � f.o9� l,s�rrl e / �" 1,c9l_..._ ,o[09____ — � —� --�.�� .Z[09 ,It.EON -- �' 96,Q2.£OS — �.a`�'---- CI � "' �� (.9 �'v � , G � b,'��: M� !— °'`' e e� `^ � � � �� r-y N � C�C y �� Ye �Z _� QI; �S I� / '& ' ��` �I. 2 e� � � � a' � �O '` ��69 �� (� � Qf � 2$ a 4'�'E,e� f� � � � 0�1� I� ��i � \ o � ��, 3 � ; � � 0 � V � ��e � � � � � � ,� (.. � c '' � � � � ti �� N � � S � ` W t� `7 � r' �e � � "� 1�i n, 1 > oo ; z �r � I � � � � ��.j � # �j � ` N . �� Ja�'p 1 ft t' �' �7�/ � � � � 0 j ! '��F ` t � m � �'� � � (� � L} ) N e A r.� 4 p w � �, 3 �� ° � ,� — � �� o I � � � W W � � Y � � �.,• _� � . �,.�� p� U Q � ' i+ � 3 � �, � � � / �� O O � �� 'd � 0 3 a Q ��pj� W � O T� I H U Q i � � a �P ,� U � OQ � � pQl— � ,�h�ti� Z �O � ao rn � � � � � � Q O�� Q fF'89 � �� O � J J N V { 3„9t.50.9pN �1/ �G � � � � �l �„� O � �� Z w � > oz � � � a W W � � � .. W > � O Z � � � � 3 � v � 3 � Qo � � PAGE 3 OF 4 HOLDING TANK SPECIFICATIONS (No Scale) Weatherproof 12"Min.or 2.0 ft above Junction and A�� Esiablished Flood Elevation Alartn Box Vent Cap (lyPical) Electrical must comply with � Approved Locking Manhole SPS 316 and NEC 300 4"4/Vent Pipe with Waming Label Attached --Conduit >10 ft from (typical) 4"Min.or 2A ft above Building I Established Flood Elevation ` I ' � (rypical) -' �Airtight Seal� " • Finished Grade 18"Min. (lYPical) , . 1 a 8 a � Inlet Inletlnvert fWatertight Approved Joinis with P��9 Approved Pipe 3 fl onto � M�. 12"or 90%of total volume Sdid Ground � if more tha�one tank d " Alarm-0n HOLDING TANK VOLUME = j_/�/p _ gal ; � ' . d . . . . . . . . . i . 3"Approved Bedding Material Beneath Tank TANK MANUFACTURER: /,C,�,`cyu,� 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= [( �y' �/ � cu.ft. x 62.4 Ibs/cu.ft) - 21 �i �Ibs] x 1.5 = ,��`� WLP3C00 ,a4�� TANK SPECIFICATIONS � � _�� O a aj DI1olENSIONS: i:, v�i ___ _ WALL: 3" a cvi BOTTOM: 3" HEAVY - 5" � COVER: 6" � MANHOLE: 24" I.D. PRECAST CONCRETE RISER ° 4" CAST-A-SEAL 4" CAST-A-SEAL HEIGHT: 60-3/4" O.D. � LENGTN: 1$4" O.D. � ..� ,� � WIDTH: 102" O.D. � W k' BELOW INLET: 48" O.D. N � o N �24 � / LIQUID LEVEL: 43" � TYP � l WEIGHT: TANK - 3'� BOTTOM 13,013 LBS. TANK - 5" BOTTOM 15,980 IBS. �' N � f FILTER OR � WEIGHT: COVER 9,300 LBS. �^' �- BAFFL.F INLET AND OU7LET: '� a 4" CAST-A-SEAL B00T OR EQUAL m � � z �' � - ---- - INLET AND OUTLET BAFFLE AND fILTER: � Q � - WISCONSIN, SEE DETAIL #10 � � '�- (OTHER STATES SEE CHART) 4, o LIQUID CAPAGTY: 69J7 GAL/IN 1� � TOP V1EW HOLDING TANK: W,,,, � OUTLET HOIE PLUGGED � Y �p ACTUAL CAPACITY: 3,140 GALLONS `.. o � � d- LOADING DESIGN: 8' 0'� UNSATURATED SOIL 0 z o0 � o I TANK CAN BE USED AS: a � SEPTIC/ HOLDING/ PUMP OR SIPHON � � rN W � � COVER: MIX DESIGN #B (NO FIBER) � y p p - �, TANK: MIX bESIGN #9 (SMALI F18ER) W = � N (7 � ¢ a CUSTOMI2ED TANKS: � - - , , � • . . „ - FOR CUSTOM TANKS C�NTACT WIESER CONCRETE � n INLET � � ; OU TLF T '- � �c h d � � Q a O �° o0 3'� � v �n � `r � � � � � � � � � `� o Q z o � � JOB INFORMATION : � � � CUSTOMER: w > - cn w `'' 706 NAME: � SIDE VIEW DATE NEEDED: �_ SNEET N0. Af'PROVED BY; T�---- � / APPROVAL DA7E: UF ' TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS � ^ / � � PAGE 4 OF 4 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,Wisc.Admin.Code. Pursuant to SPS 383.52(2),Wisc.Admin.Code,this holdi�g tank(s) shall be considered a human health hazard if nol 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. �� l`1�� Estimated Daily Wastewater Flow= � 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,etc.) o material fatigue(i.e.,leaks,breaks,corrosion,etc.) o neglect or improper use(i.e.,exceeding design capacities,prohibited activities,etc.) o electncal 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 p�mped 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:�1��,(,(/� ��L/�Fi� Phone: ��S�J��-`(O_7� Local govemment unit: Phone: ��J�'D �C�p Local government unit address:� ��I��_��ly _�-�' ��a�IP: 5�y�,3 0 Any defective part of this system shalt be repaired,replaced,or removed pursuant to SPS 383.51(t),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 pian 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. ROLDING TANx SERVICFi�'G CONTRACT Coi�tract Date: L /� /�2 ; � �'his contract is made beh��een the �ioldin� Tank ��i>nee and tiie Purnper. --- -- — — --- —_-------- HoIdin; Tank Ot��er's Name: Pumn�r`s �ame: ��-- f�"G� ✓/ //. ��Y-e7� � 11�o w�� l�es� 5a.v� , �-�. �'� n� - -- -- ----_ ___ _ _----- _ _—--------. Parcel Ide�€t€f€ca�i�n ;��umber: � (12 Di6it LeQacy ID) � � � _ �j �f � - 2 � - � 3 d 2 ' 1 The o�t�Qer a�rces to file a eapy of tlus coi�tract �{�ith t�ie governmentat unit, 5awyer County, «rhicll has accepte� and recorded �;-it11 the Office of the Re,ister of Deeds. tl�e il�faintenauce Agceement for a Holdin, Tac�t� requjred under the Sa�tye.r County Pri��ate Se�,z�age System Ordinance for the is.euance of a Sanitan� Permit fo4- the installation of a holdi:�a taril:(s}. ?. T(ie o�vn�r aQrzes to ha�-e tt�e holdin�� tank(s) sen-ic�d b�- the pumper and �uarantees to pernut the ptimper to lia�re acccss and to enter upo�� the property for the purpose of sen�icing the llolding tar�k(s). The o«�ner a�rees to ma�ntain i(�e ail-i�-eather access road or drive so that the �umper can sen�ice thc holdi�� tan�i:{i t� idi the punzping equipment. Tl�e ot��ner furdler aarees to pay the pumper fo; cl?ar�es incur�ed in sen•icing dle holding tank(s} as muhtaily aJreed upan by the o�vner and pumger. 3. Ti�e pumper agrees to submit to the Go�-crnmentaI L7?;t Sa`�ver County; a report for thc setvicing of the holding tai�lc(s) as rcquircd u�ldez- SPS 38�.��_ 1[risconsin .�dministrative Cade and ihe Sa�-��er County- Pn�-ate Sc�r•aQ� S�-stem Ordinance. Ttie pumper Further a�-ees to include t]�e follo��-in, �n tl�e report: a. Thz name and address of il�e per�on responstble ;`or se.r��icin� the holding tanl:; b. The name of thc owner of tlle hold�n, tani:: c. Tl�e site address of ft�e holdu�g tank_ � d. The date the holding [ank «-as scrt iced. e. The volumes in aallous af tUe conteu�s pumped from the bolding tai�k for eact� servicing; f. The clisposal sites to �;r3�ich the contents from the hoIding tank �eere delivered. 4. Tt�is aQ�•eement lvill temain iti effect until t��c o«�ncr or pumper ferminates this contract. In t1�e evec�t of a ciiaage in thic contract. the oi��ner a�-ees to file a copy of an}� chanoes to tlzis ser�-ice contract or a copy of a ne�i seiz-ic� contract �ti�tth Sa«yer County tit�ithin ten {10) business days fi-�m thc date of cl�ange to th:s se��ice contract. O�vner's Name: (Print) O��nel-'s �i�tl8tlll'�' (On1}�oneo�tinersignaturerequired) / !� �f /V. / ��'°��'�� J��j /� �' ' Pumper�s Narrte: (Print) Pumper'� SIo11c1Ci11"C: , � / � ' n , , , ' P�,`sd'-Ti�t 1,.; cs� �t�t 1�% ;i� , �,�f �� , C,; , � ;z �z.z� ' Pt�mper's ReQistration �umber: ; '�� .�-- Rev. 03i2Gi13 1/18l24,10:15 AM Real Property Listing Page Redl EStdt2 Sawyer County Property Listing Property5tatus: Current Today's Date:1/18/2024 Created On:2/6/2007 7:55:31 AM �Description Updated:11/7/2023 �Ownership Updated:11/7/2023 Tax ID: 18318 PAUL D&CORINNE M NYGREN WYOMING MN PIN: 57-014-2-42-09-25-3 03-000-000020 Legacy PIN: 014942253302 Billing Address: Mailing Address: Map ID: .11.2 PAUL D&CORINNE M PAUL D&CORINNE M Municipality: (014)TOWN OF LENROOT NYGREN NYGREN STR: 525 T42N R09W 6225 207TH AVE NE 6225 207TH AVE NE WYOMING MN 55092 WYOMING MN 5509Z Description: PRT SWSW LOT 1 CSM 38/205#8739 Recorded Acres: 0.479 Calculated Acres: 0.477 w Site Address �indicates Private Road Lottery Claims: 0 First Dollar: No Waterbody: Nelson Lake �.-�property Assessment Updated:2/6/2007 Zoning: (RRl)Residential/Recreational One 2023 Assessment Detail ESN: 400 Code Acres Land Imp. Gl-RESIDENTIAL 0.400 75,000 0 ��Tax Districts Updated:2/6/2007 1 State of Wisconsin Z�Year Comparison 2022 2023 Change 57 Sawyer County Land: 75,000 75,000 0.0% 014 Town of Lenroot Improved: 0 0 0.0% 572478 Hayward Community School District Total: 75,000 75,000 0.0% 001700 Technical College .� Recorded Documents Updated:11/7/2023 �-�'Property Nistory WARRANTY DEED N/A Date Recorded:il/6/2023 447244 TERMINATION OFDECEDENTSINTEREST Date Recorded:11/6/2023 447243 EASEMENT AGREEMENT Date Recorded:I1/6/2023 447242 CERTIFIED SURVEY MAP Date Recorded:8/21/2023 446024 CERTIFIED SURVEY MAP Date Recorded:7/25/2023 445560 QUIT CLAIM DEED Date Recorded:5/18/2015 395689 TERMINATION OF DECEDENTSINTEREST Date Recorded:5/18/2015 395688 WARRANTY DEED Date Recorded:5/4/1949 087392 �l1 https:lltas.sawyercou ntygov.orglsysie mlfra mes.asp?u n ame=Eric+W e I laue r � � ' `.. 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F"� . •. � '��a 1 � 4 '`y - �,,. s' , aw� '�+� ..� .�� '�e �€-,.M�,r» . . �� . . � ,.�,;,1''� ��'�. ` a �,y' �. - � M!'r � , '�'`-a' Q$ ,pq ?'� , � �q,,7r ! �� t ' � !!'°�'� s+�"'Ww 1 �'•,.'� �-;7Y� r .�rt � ... " �� F 's` � - �� f.�s � � _.� . ��'•�� ' �� . , �,��f� i� ��` '�_ .?" a•' e � � r �•�-�1 �� q� ' �, � . � . � w � 5 � p � .' + � ', . '��:i� ,�. Y �FY � � "X.�. . �i9r f't.. � D 1 " t�,1�.a4225-�316 � " .�, `' �*` ';�" �, - , , '� � � ,r s ; t�" � �� -` s i � . � � � ' � A �� „� t «x � _ . > w � � p � 'w . � ' R='�y` -� � � � .� '"'a. +X��" � , e �x� � .- y. ,.'� . _ � � �, � ��►��a� � • �► „� `L�;� ,� ; ,! -�,,_ +� `4 �7�i _ .�r ' ��ti . J y,� ,. ,� � Yd ' i s � '� ` ��. ,}�' �� =Y � � � t'� '��.. � '��' .. 1.. ,.. x .-��, � .%� �� ,+R _ ft `"�„ � �„�.�� ,� ..� �°�.�-�''� �' :�'" x_ . i� _ _ — • II IIIII II �IIIIII III _ __ DocI�:80777%�3 Tx:4049738 -E1SE BLACK tlVK OhlLY- 448�85 - PAULA CHISSER ��TS IV�d�IN�E�A}�!v'C�G��E�� i REGdSTER OF DEEDS �=or F�Qtding Tanks j SAWYER �OUNTY, WI + O1/18/Z024 10:26 AM owners ntame(s°:as snown on deed: RECORDING FEE 30.D0 P�:��I' C �� r��, u�� C�r,r►ti e /l�. �-�r�y, � Parcel tc�ri�nca;�-.h��r ✓ �AGES: 2 . (��D�yit Legacy!�) l/ � �-�!�- f- �- J 3 � ,� . ' Legai Des;.riptior:�Property� �_ --------- _ -L'c'E A3'TACHE�Sii�ET- We a:knc•.�ir�ice th�t applica5on is be;,;g rrs�E ior tne ir�staliatior of a holding rn<(s}on the proParty describe�on!ne attached sheet. ; ' r2etum To:S-wyer County 2ontng and Gor.serration Adminis.rz>ian ?9590:lain S=Sui+.z 49,Haywar�,WI 54843 As an inducem�nt to�he Ceu�y;,z Sawyer:o issue a s2nitary oerr;�ic icr a ho�dinc�ank or,the above-descri6ed pro responsib!e for the operation and m�intenance of the holding tark,IocR�ng dev,ce,aiarm and access,and agrees t peonfornm to a)1 r�s applicaole requirements of SPS 383,Wis.Adm_Code refaang ta hoic�ing ia�f;r.,a�agsment.including ifie iollowing: '. The owne��grees io ccr;*;�ci vrith a person,�ho is iicensed under C^.;v:�;;3,Wis.Adm.Code,except as provided by Seehor 28i.48(3)(c),Sta�s.,tp have the holding tank prope�ty ser�iceo ano to fiie a copy of the se�,i��ntract wi�h tne g:.vernr„e��:4 unit. l'ne own�r`urtk:E�agrees io r":!e a copy a;ary c:�a�ges zo:h�service con�-ac�,or a copy of a new service �!'Lfc'�.`�.rvi::h ihe govemma:ital unit v�iihin ten(10)business cays irom tie cai�of change to the service contract. 2. Ttra o�vner agrees ta conf;act evi2h a person lic2nsed under Ch !JR 4`3,v�l;s.Adm.Code,who stiai!submit pumping repoKs to ii:�gcvernmsnza!unit;�sc�ordance witn SPS 383.5�,Wis.Adr.Code,;or ihe servicing of the holding tank. In the case of zxempficn.�;der�,ior,%81 tg t3);dJ,St2ts.,ine owr;er si�ail submii the report io the governmental unit. The governmentai �ni:may enter upcn tne p;operiy to irvesiigate tns condition of,he holding tar.k��hen pumping reports may indicate the hoiding i2�k is noi bsi:;g�,ro?r�y m�in�aE�?d- 3_ I�ine ow�er iails to!�!ave t�e hoiding t2nk prcperly serviced in;zsponse to o�ders issued by the governmental unit to prevent or abai�s numan h�aii��azard as cescribed in Section.254.59,Si2ts.,the aov2rnmentai unit may erner upon the property ar.a senri�e,or cause Lye:ank qfl b2 serviced. Pursuani�e Section i4�.20{4)W!s_Stais.,a govemmental unit may assess fhe o�=iner oi a pn.vate se�roage sys;am Ur cos:s�etaeed to the pu;nping o�a sep:�c cr holding tank.The charges wiH be assessed 2s prescriced by Seciicr.06.0703,sia?s. The o�vner agrees to pay all charges and cost incurred by the govemmental unit for :.^.specL�an,pumping,haui:r:g;o,o+ha�w;se servicing and mai�iaining ihe holding;ank�n s;tch a manner as ta preveni or abate e.�y numar.iealtn hazard caus�d by the raEding fank. 4. T�is�gr2ement wi�'remai�in effect only un81 the governmentat��ni:resYor.sib?e for the regulation of pmra,e sewage systems c�:�iP:es:h�i eith�;�soil a�sorc�C;;sy�#�m that com�iies wi�;^:S�c 3g3,U�lis.Acfm.Code,or a municipa!sewer serves the �:�2ry.;n 2dditicr. tn,��c;�:nani rn2y��can�z(;ed�y E�z��:-rg a�d r2:.ord;ng said certificaiion with reference to this �g+esmar:;ir.s;�c^:,:anne;which yy:;;p2�m;i�h2 axistence of�he cer�fica.ion io be determined by reference to the property. 5. �:^is ayic20721t SlS2iI B8 ps.^.ding upen the owner,tne nairs af`he owner,and asstg;�ees of fhe owner.The o�nmer shall submit tre agreement to fhe r��ster of deeds,and tna agreemeni shali be reccrded by t�e;egister of deeds in a manner which wifl Gc.^�:r�,e axi�tenca o`:he agr2zmenf to be determined By;eference to�he nroper�y where the ho�ding tanlc is installed --..:;,cne ourr:s.>�'_..:___:�:��:�::ec- ACK[VOU#lLEDGW1ENi' Owner's Sig::�tur�-`� , Sts2e oi- �� ; Qwner's��r-e�?rint)� - Ccuniy of: `1J('/, �W I � �/'y y�N Subscribed and swom to cr2 me on this r� ~�ate: - - �_p____day of ,200�3 �J C'� � 44 3 =v i�ivn�r's Name): �u1 re c�_ Pdctary?ublic Signature: Draft�d�}: , � h�. ^ /� u.,ic No4ary Name(Pnnt): 'Y.. �; a�v .vy (,o�,y� --�---___�---_ f�iy commission expires on: _�� `��5"� ��.. Personai iniorr�a;ion you provide may b2 used for second2ry purposes[Privacy Law,§i 5.04(!)(m)j Rev.03/26/13 a�f .,.`, Mary�• Bruss � � „�,,,,�_M�•��a ��,: �'�Mary£. Bruss � --�r1��,�,3t.2027 91\�,? Np��p�-Minnesota I ��^�- �`'�''*"`•'�My Commi55ion E:Oires Jan^1 7077 I �i� .. ��r..�.�ee�...: .. � _— . — _� Lot 1 of Certified Survey Map No. 8739 recorded in Volume 38 of Certified Survey Maps, page 205 in the office of the Register of Deeds for Sawyer County as Document No. 446024, a survey of Lot 1 of Certified Survey Map No. 8724 recorded in Volume 38 of Certified Survey Maps, page 173, as Document No. 445560, located in the Southwest Quarter of the Southwest Quarter of Section 25, Township 42 North, Range 9 West, Town of Lenroot, Sawyer County, Wisconsin.