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Home My WebLink About026-126-00-2400-SAN-2024-088 ``� ' Department of Safety �°°"`� SAWYER � _ � � & Professional Services, e gP Sanitary Permii Nmnber(to be filled in by C � �. g Industry Services Division Lo 5 (^114� � s Sanitary Permit Application s`a`eTr�°`a";°°N°"'""� , In accordance with SPS 383.21(2),W'is.Adm.Code,submission o�this tbrm to die appropriate governmcntal unit NA � is required prior to obtaining a sanitary permit Note: Appli�ation forms tur state-ow�ned POWTS are submitted to Project Address�ifdift�crcnt duui mailing 1d� � the Department of Sulety and Yrofe,sion�l Sei��ice;. Personal information yuu pro��ide ma� be tued for secondaiy ptirpuscs in accordancc��ith thc Prfvac}'Law,s. I j.04(1)Im),Stats. �� L'.� I.Application Information-Please Print All Information Propcny Owner's Name Parcel# �6.1e� 'GD -�y� JAH CONSTRUCTION LLC 57-026-2-39-09-23-5 15-126— Properry Owner's Mailing Addre Property Location ��r1400 G 8894N CONNER LAKE c�o�c.Lo�� City,State Zip Code Yhone Number HAY Vy A�� Wj '/,, Section 23 54843 iL Type afBuitding(check all tha�appty) �� T 39 tv R 09 w �XX Ior2FamilyDwelling-NumberofBedrooms � 24 Subdivisio��Name H��k# HIGHLAND PARK ❑Public/Commercial-Describe use NA ❑c;ry�r CSM Number#7684 ❑Village of O State Owned-Describe Use SAN� LAKE NA �T�,�„�,e IiI.Type of POWTS Permit:(Check either"Ne�r�"or"Reptacement"and other applicable on line A. Check one box on line B.Complete line C if a licabte.) t X �le�v Sy�stem Rr��lacement Scstem �� Other Vludillcauon to Esiuwng S��.aeiu(rrpluinl �� :�dditiunal Preueaunent��nit(explain) B� X Holding Tank In-Ground � At-Grade u Mound U Indieidual Site Design �I O[her T'ype(explain) (conventional) C• �� U Chxnge of Plumber List Pre�'ious Pennit Number and Date[ssued U Rcncwal Bcfore u Rccision U Transfer to New Owner Expiration "'� IV.DispersaUTreatment Area and Tank Information: Des'i<m Ilo�� ;;pd) Desi�n Soil npp�ication Rutc(gpd.,t) Dispersal Area Required(s� Dispersal nrea Proposed(s� Sys'tem lile��ation 3� N�y NA NA NA Capaciry in Total �of Manufacturer l�ank Information Gallons Gallons Uni[s � i �o 'D � Ne�v Tanks Existing Tanks � o y � � � � �,`"y ... U v: v v; _ :7 A- stp"�°�"°'d�°��'��„� 1250/750 , 1 WIESER (COMBO) X Dosing Chamber V.Responsibitity Statement- I,the undersigned,assume s ansib f fnstailation of the POWTS shown on the attached plans. Plumbcr's Vamc(Prin�) Plumbcr�s � .i�ure MPIMPRS Number Business Phone Numbc� DAN BURCH �;;BOH ��s-a�b-i��z Vlumber's Address(Street,City,State,Zip Code) N5921 C.T.H.K,SPOONI:R,WI 54801 VI.C un /Department Use Only �A� fci �� ❑ Disappro��ed Pennit Pec �)ate Issued � Is,uing_�eent tii�naturc �11✓ ❑Owner Given Rcason fiir Denial � �Q�� `�� "�� =-f�-�`�-`�'✓WJ- 9 S'^i /"''f�.'`� Conditions of Approval/Reasons for Disapproval � � � �� '1 - .,,, �" .-.-,, : t,+,�J�� v�..,�`�.''�i'.__° '�/�� ''s � � � I� �l �f(�-S J�� , � f, s � ��G[ ��. � � , _.�.�__. � e ,a,P� 2 4 zo � U � 2 Io�� . 4 C5T N��— {2a�,\ 1 a s 3 ��ao a�onRn�v°T�a on� ) At[ach to complete plans for the sys[em and submit to the County onl�'on paper nut less than R 1�2�11 inches in size NO RCFUND6 AFTER sBD-c�9s cR.o3i2�> ISSUE OF PERMIT a��3 Sawyer County Zoning & Conservation Administration ``"`\11 10610 Main Street, Suite 49 ��R Cp�� Hayward,Wisconsin 54843 (715)634-8288 �� FAX(715)638-3277 �y� _` _ _ �j www.sawyercountygov org � � � E-mail:sanitaiianCa�sawyercount ov org I o��''��.�, j�� Toll Free Courthousc/General lnformation 1-877-699-4ll0 I�I�� CON``� �� Holding Tank Approval Checklist I. Sanitary Cover Sheet: Date Stamp �Y l a Y l �Y Parcel ID# D z 6 - l � Io _ oo _Z �( o0 II. Plot Plan: �p Property Lines �1 Benchinark BM ♦ ? �p Site Address � North Arrow DCStructure �Scale �Wel1 �<25' to Service Road �Legal Description y�Nearest Road Intersection � Setbacks to: Property Line, Well, Structure, Water bodies, Roads III. Required Plans: ➢�Index Page with Original Signature p� Manageinent Plan/Contingency Plan DC Servicing Contract ?� Holding Tank Agreement Form ($30 to ROD) IV. Holding Tank Specifications: �Tank Cross-Section: Manufacturer: l�v�a�� Gallons: l�� 7SD �Tank Anchar Calculations [SPS 383.43 (8) (g)] �Locking device, chains/locks Alann, electrical per SPS 383.43 (8) (e) �3" Bedding Material < 1/2 " V. POWTS Component Manual Reference: 1CHolding Tank Version 2.1 (May 2022-2027) Owner: �� C,�}, Z�L Pluinber: rx+2� Application Review Date: Oy��s��Y �� POWTS Re�•iewer: �� Name 6q�� Rev. 4/27/2023 Credential# E'AGE � O�4 Ma�ding Tank Plan Index & Cover Shee# Component Manual Design References: Hntding Tank Version 2.1 (May 2022-2027) P� � af 4 lndex � Cover �hee# Pg 2 of 4 PIc►t P1an Pg 3 of 4 Halding Tank Speci�cations Pg 4 0#4 M�nagemeni Plan Attachments: �Enc#osures: T�nk spe�cs I F'�JWTS AppEicatior� for Rev'rew _ ..��_�.�._._� � ._�.___�.�._.__ -(�.��, st-��r' Soil Evaluation Report & Site^Map {if applicab{e} _ _ �� Holdin Tank Pum ip ng Cont�act �if ap�ticab(e) � Holdin�g Tank_A�gre�ment if a _ licable _, __�___.___._.�._r_�._ �.___�.�.__�� _ Project Name / Dascr�ption Owner Name(s�: ��H GONSTRUCTI�N L�,C p�a�e; _ _ awner Address: �$�� CC)NNER LAlVE, �-�lA1fWARD, W1 Z��; 54843 Project Addre�s: �`��W MAPLE STREET Gavt. Lat: NR _ 1/4 af 114, Sectia� 23 a T 39 �_R Q9 E Qor W � Tov�mship: SANC3 LAKE County: SAWYER Prcr�ect ParcellD#: 57-�26-2-39-�9-23-5 15-126-00244� Designer inforrr�ation Designer Name: ��RY JO HUPPERT Phvne: �15 w 425 _ 1�75 Designe�r Address: 25720 FIREFLY L�NE, WEBSTER, Wl Z��; 54893 ,..� E.�� hollis#ertlesign@outlook.com � .:�° ' ,�.,r# ,� ri s�.',�y�� ,, s. 's ° ' ' � � LiCettBe 1Vu1Tib@r: �8��-40� �� : v' `� ��`� �� , ` � t �fa. �� Rema�rks. � ��•`�� s, � � ,. � `�� ;�.`' i��f � . � �'� - •� � n�".�� *i 1.;:.3w,e� � �9r. �: .r �� `!*y �+� � �,� .,:f, `� e � -�, l :>�.d;, 5ignature: C`i��` �' t�"^ ' �- Date: a4-18, 202� Of; ' signalura reyu' each sut�rni�:ed copy. CtiEGK BOx:45 AF'f�1CABLE C!i€CK BOX,`S APQi1C�Bt.E. [] SC7[L EVALUATION o �'�� qo 40' � � �] SYSTEM p�� aF� SITE MAP PLOT PLAN PRt�JEGT NAME: 10, b�s�cN F�.ow �� c� J„Q,}-� ��p� (.-(�(,°-- Attsch design flow catcutatitms ter comme7xsat Plerrs. �a�� pRn.��Ci'ADDRI�S9 !''�`��`�W �� '-�''�� Pipe AA�te�i�f AS7M St$ntiarti(Tabtes 384.34.��384.3t#£) eM sy�aoi � s�a��, I D 0.00 -� ��i s��.,�! �a �arce Ma� I eMDesc�iptlor� '�'..�`�f � 1a �-^�►� �� ` rwan by IINPURTANT: s+ope Grad�era[�C7 w�E symbol�ir appNcs�e) Q dra�g n�enwz Show grE�lruf etevatioin conEours at suit�e sntervats. of TasteO AreE: � on trre app�opme Yre. ,�,�,-./`��`. �� F � ,t"' '(�,..+�`v� ��` � � 1�� s �� (,��c s � � . � 1��S � `� w\ � � � �\w � \�� 'l C` f �� A�'�5� e� � � � =� �� - �� -�� -�� , ;��. �� v i f �}g & � ¢ . . . _. .. .. . . . . . .. .:-��! .. . •�Q�"/'fi� /+i` . . . � ?i+�)'�. �Q HC)LD1NG TANK SPECtFICATIONS �3,��Number o#bedt�ms Plon-residential estima#esi fi�+v{gpd} � Minimum holding#ank vatume required(gal) Side A Side B Totai 1250 0 R��750 0�>��Pro�sed tank capacity(9aq ._. - Wieser Concrate ��Tank Manufacturer �..�,,w. ,..._w,..r,� _ ,aw.�.,< �W1Z50/750 mTank model number � ;.A _ __. ,�::. . . SJ Etectro Aiarm manufacturer fH,� . . AB'TANK ALERT �A{arm m�de4 nt�mber �.F �_w � _ ��.,. ��.�,w� - �a� Tarrk Dlrrrensians and Data Tank Anchor Calculations ��'� ,n.M`��X�ar round tank � 14860m�m�lbs Weight of tar�k and c�v�r d�53 0 N�Liquid depth below inlet inv�rt�ir�) � i 50 Safety factor x 8.0 �Maximum de th of soi!Cav�r(�t� �p30026 Ibs WeigMt af art�h�r reqtsir� � 66 0 :,rf�Height{in) 36.0 in s Soil cover req.for anchor or 145.3 �Length (in) . �. _ 7.4 yd Concrete count�r w�s�#�t � .$6 4 ��Width(in) .M� HULDING TANK CROSS SECTION Electrieai complies with NEC 30fl and Comm 16 manhaie c4vet with 4/ vent pipe vent pipe �' ��9��$�d �� junctiort . wamir;g Iabei � � box --� � �, 4"mFn. 4"min. E--24 in- conduit 18"rntn Nate: AI!t�nk joints, and jnints � between tank openings and t�ut�ding s�r ��, prpmg are sealed watertight. Ail �'� �io seai4 pip�and vent materials comply �� with Comm 84. Manholes with 90% Fu11 44,5 in ��ng device ars typical for each manhale opening . ��';�<= ��. 125{3.0 ga! , . 750.0 ga� 3 in.badding under tank Tank is anchored as necessary to negate buoyancy. Project: J3N't CO�CTtoN f.t� Transaction Number: Page?�of 4 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,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. 300 Estimated Daily Wastewater Flow= � gpd Inspection Checklist INSPECT EVERY 3 YEARS o type of use c age of system nulsance factors(i.e.odors,user complaints,etc.) o mechanical malfunction(i.e.,pumps,valves,switches,floats,etc.) material fatigue(i.e.,leaks,breaks,corrosion,etc.) " neglect or improper use(i.e.,exceeding design capacities,prohibited activities,etc.) c 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 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: Nameotindividua�orcomPany:DANIEL BURCH PLUMBING Pnone: 715-416-1642 Local government unit: SAWYER COUNTY SANITATION/ZONING phone: 715-634-8288 Local government unit address: HAYWARD, W I Z�P 54843 Any defective part of this system shall be repaired,replaced,or removed pursuant to SPS 383.51 (1),Wisc.Admin. Code.Repair or replaceme�nt 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. tN12�0/750-- MF� TANK SPE�IFICATIONS � � � a � , -�---'12'-11" DIMfNSI0N5: � o WAIL: 2 1J2" 4" CAST--A_5�AL 4" CA�T-A-SEt+t.� BOTfif7�t; 3" � � COVER: 6"' w, � --- �- -,____�,;:�� -=� ,»,�--` I MANHOIE: 24' t.D. PREGAST CQNCR£TE RISER a ' �r" iPl6 "'�* FIEiG1'IT; f16` ;;° ��1s � �`;. � � . �• u �, a .� IENGTH: 12 -11 > « � �� t� c� �� WfC1TH: 7'-2` a �� .- � Qr'�.A` •. �1 iF '� � �.•....�, �� B�LQ1Rl �NL��: 53° � �, -�- � �„��v . .r-� ;� � �� LIQt3lD LEV��.: 48" d I E i '� � ; ; d WEIGHT: BOT10M B>74d �.BS. " a� $ v�, '� t , ,` `.. .. }� �"�..�'' r Ct3�ER 6,12t3 LBS. �d � �, r� il � , � , � „ `~ �� 'k �� INLET AND OUTLET: � ml o n' �� FILTER pR- 114� f1�� 4 GAST-A-SEAL 8<�T t� fQUAI GASK�T w� �+ � � � ��4 �ir; r� a < �' � i� F3AF'FLE 1 Pt� rr,, ��` t��` '•� INLET AND OUTLET BA�FLE AND FILTER: ^ � o � _ �_�.._� - -=�_=_=__�'�=__=*`'�' WISCONS4N. SEE QE7Ail �t0 0 (L17HfR 57A7E5 SEE CHAR7} � + TG7P vIEW �IQUID GAPAC#TY: 27,$6 GAL,/fN (SEPTiG} j�. �B ,t- � € tis.�s c�/�ra (�au►�P} y 1�p x � Xtk4" s'i-�4� qa�+ t3�2�� `d� �t t0A0tNG DESiGN: 8'-0� UNSATURATED SOII R�1 Z � a TANK GAN 8� USED AS: � � � aQ _�„ ��ENT SERTICJ5EPTIC. SEFTiC/SiPH�+I, a j o "� � OR SEPTiC/5iPHQN � � � � � � , � r------•-, COVER: MIX DESIGN �S (NO FIBER) � 4� _ ___ ___ ..._ -.-� tAhlK: MIX QESfGN �E10 (S7Rl1CTURAL FtBER) �� I INLET - � y 4T ^ � � GUSTOb112Eq TANKS: � n i OUtLET FpR CLiSTOM TANKS COIVTACT W4ESER CONCRE7E } � �� N ._._ _ _ ''��_� _ _ � �sn v i , �•,� • � i r. '¢ � o„ , � x� ,� � o a i �' `Q � �.'' d` ° � u' t � � � � � �a- : u7 r� �a� t t � s f � � a i f ( ' '{ ` � j � 1 � F' t � O Z' ��~ ��_m m�_._ _., ___.J`.�.�. _ _.�-i"='i=:Y� � !"�� '� REVIEWED BY p U � ��p �a� REv�Ew oarE � � DRAWINGS SUBMIT-tED s�a� w£w FOR ,APPRaVa�L AVPROVED 8v: SttEE' No APPROYA4 QATE; I .°� �,, � PRODJCTS NEEDEO BY: � '� TANKS ARE MANUfACTUREQ TO �lfET OR £xCEED ASTM C-t22? REQUtREMENTS / HOLDING TANK SERVICING CONTRACT Contract Date: �/ �ZJ ��L:—� This contract is made between the Holding Tank Owner and the Pumper. Holding Tanlc Owner's Name: Pumper's Name: Northwest Sanitary, Inc. PO BOX 155 J'��-1- l�.v„�S��1""i>�--l.! Radisson,WI 54867 Parcel Identification Number: (12 Digit Legacy ID) �Z �'- � Z- � -�v - L � � � 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 Re�ister of Deeds,the Maintenance Agreement for a Holding Tank required under the Sawyer County Private Sewage System Ordin�nce for the issuance of a Sanitary Perinit for the installation of a holding tank(s). 2. The o�vner 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 th��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 mutuallly 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 Administrative Code and the Sawyer County Private Sewage System Ordinance. The pumper furthcr agrees to include the following in the report: a. The name and address of the person responsible for servicing the holding tank; b. The;narne 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 pumpcd from the holding tank for each servicing; £ The disposal sites to which the contents from the holding tank were delivered. 4. This a�reement 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 Na�me: (Print) OWrieP'S S1�ri8h,lT'e: (Only one owner signature required) J� 4�- LC:v`J-�'��TLu'�-> i,u. Pumper's Name: (Print) P mper's Signature: Ronald L Vieceli,owner Northwest Sanitary,lnc I 7 1 f� � � � � C.GCL%��. Pumper's Registration Number: #2389 Rev.03l26/l3 � 4I25124.8:16 AM Real Property Listing Page R2al EStdte Sawyer County Property Listing PropertyStatus: Current Today's Date:4/25/2024 Created On:2/6/2007 7:55:45 AM �Description Updated:S/16/2019 `�Ownership Updated:1/4/2024 TaxID: 26803 JAH CONSTRUCTION LLC HAVWARD WI PIN: 57-026-2-39-09-23-5 15-126-002400 Legacy PIN: 026126002400 Billing Address: Mailing Address: Map ID: -6.24.1 JAH CONS7RUCTION LLC JAH CONSTRUCTION LLC Municipality: (026)TOWN OF SAND LAKE 8894N CONNER LN 8899N CONNER W STR: 523 T39N R09W HAYWARD WI54843 HAYWARD WI59843 Des�ription: HIGHLAND PARK SUBD LOT 24 Recorded Acres: OJ92 w Site Address *indicates Private Road Calculated Acres: 1.040 15199W MAPLE ST * STONE LAKE 54876 Lottery Claims: 0 First Dollar: No -�property Assessment Updated:2/6/2007 Zoning: (RRS)Residential/Recreational One 2024 Assessment Detail ESN: 4z3 Code Acres Land Imp. GI-RESIDENTIAL 0.792 7,900 0 �Tax Districts Updated:2/6/2007 1 Sta[e of Wis�onsin 2-Year Comparison 2023 2024 Change 57 Sawyer County Land: 7,900 7,900 0.0% 026 Town of Sand Lake Improved: 0 0 0.0% 572476 Hayward Community School DistriR Total: 7,900 7,900 0.0% 001700 Technical College • Recorded Documents Updated:1/4�2024 C_9'property History WARRANTY DEED N/A Date Remrded:11/20/2023 447455 TERMINATION OF DECEDENTS INTEREST Date Recorded:8/5/2019 419170 WARRANTY DEED Date Remrded:1/21/1987 203473 399/462 https:lltas.sawyercounrygov.orglsystemlframes.asp?uname=Eric*Wellauer �� i _. '� - � ._ . �� r �:,.� �.� J ^�1 r, - � � � ' 4�w '4'�� Addresses � � R ' ' + . . � � � '^_i � •. ,�� .� ..i. B m i .E �� . .. � . .�r � �� "'''. � '�' �: �ga� ; ,�. Parcels . ' t � s F' y� f $ �1 ' ��. * qR'. ' � . �+ _ �t _ . �. w • �"�� . 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Si p,? . .� . y . ,. . ... ,s� < � �_ d 1pPa..., � . . �t i I II Illi I� I)I I I I�II III��I�) - USE BLACK INK ONLY— sir:'=��'�=;�+��',�?�'�''�; ;n:405;43� POWTS MAINTENANCE AGREEMENT 4�94gp For Holding Tanks Pd�UL}� CH�SSE� RE�IST�t3 O�DE�t}5 Owner's Name(s)as shown on deed: �AI�YER CO�NTY, WI .� � `� �S �t��s�.r► lLl�� i�� F��s:�i o.�o Parcel Identification Number: j� > (12 Digit Legacy ID) l.� Z{_-� 2 �-� U - �� .� ��; �. 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 maintaineci. 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 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 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. -Onl one owner si nature re uired- ACKNOWLEDGMENT Own s Signature: State of: �etir�S ��S �� _ �_�_ , County ofi �� z- ner's Name (Print): Subscribed and swbt to be�q�re me on this ; ;A �-� ��...3�YL-u r!e •-v �day of �-.n,J( , 20 � Date� By(Owner's Name): ^""'�s `� r--`t �='�� Notary Public Signature: Drafted by: Public Notary Name (,�r ��Y �� " �'�`- � � „v, �� ,.� My commission ex��""' ' � ��1-� ; �� NoTARy •�'' — �� ' R�.03/26/13 Personal information you provide may be used for secondary purposes(Privacy Law,§ 15.04(I)(m)] _ '. .; ` :n�''_ '°(IB��G :'2: 9�• ••�5 /,��'�.c��F W1SG�e�`��. riiii Lot Twenty-four(24)of Highland Park Subdivision,Town of Sand Lake, Sawyer County,Wisconsin. 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