HomeMy WebLinkAbout026-938-17-5202-SAN-2024-093 � " lndustry Services Division County ��� � �
' _ 4822 Madison Yards Wa� J , �
- _, ; - Madison. WI�3705 Sanitary Permit Nu 'ber(to be filled in by C�
� P= P.O. Box 7302
` Madison.WI 5302 �S � � j(l �
����,:��, �
Sanl+a PeY,ml+ A llCa+l�n Statc"1'ransaction Number ��
l, � � pp � o
hi accordance with SPS 383.21(2),Wis.Adm.Code,submission of this fonn to the appropriate governmental unit �
is required prior to obtaining a sanitary permit. Note: Application forn�s for state-o�med POWTS are submitted to Project Address(if different tha�i mailina adG W
the Department of Safety and Professional Services.Pcrsonal information you provide may be used for secondary
purposcs in accordance with the Privacy Law.s. I�.04(I)(m),Stats. ������ ���� � �� ��
I.Application Information-Please Print Ail Information
Property Owner�s Name Parce' "
—�- � � �R� � �So �,� � t� s�'I t� so� o��� .�) �7s ao �.
Property Owner's Mailing Address Propert Location
67�o G� +� ��?�L`� a��
Cit��,State 7.i Code Phone Number
S�M, ��. lN� Sp3s9� —�� � �', S��t;on �7 -
II.Type of Building(check atl that apply) Lot# T 3 g N' R O E o W
�Q 1 or 2 Family Dwelling-Number ofF3edrooms � `� Subdivision ame
( "
Block# ��
❑Public/Commercial-Describe Use
1
❑Cllv Of
❑State Owned-Describe Use CSM Number ❑Village of
� �Town of��
IIL Type of POWTS Permit: (Check either"New"or"Replacement"and other applicable on line A. Check one box on line B.Complete line C if
a licable.
'�' �New S stem ❑ Re lacemen[S stem
y p y ❑ Other Moditication to Existing System(explain) ❑ Additional Pretrcatment Unit(eYplain)
�' Holding TankS ❑ [n-Ground ❑ At-Grade ❑ Mound ❑ Individual Site Design ❑Other Type(explain)
(conventional)
��� ❑ Rene��°al Befure ❑ Revision ❑ Chan�e of Plumber List Previous Permit Number and Dale lssued
❑ Transfer to Ne�c O���ner
Expiration
IV.Dispersal/Treatment Area and Tank Information:
Design Flow(gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required(sfl Dispersa]Arca Proposed(st) System Elevation
C�O .�
Capacity in T otal #of Ma��ufacturer
:: _
1'ank Information Gallons Gallons Units � � � �
,� U � ..+
New Tanks E�isting T�iks ` o �; L Y � '� �c�o
\ n. C..� v� � v: i,.. V a.
Septic or Holding Tank � � �� '��
Dosing Chatnber
V.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Pi'�nt) Plun �,Sien tu � P�MPRS Number Business Phone Number
R� ; So�1 � ���t � isb3y �c �q
Plum���A�d�s(Str�et,City ,tate�,'I_ip Code) �, �� � ��
�� C J i
VI.Co nty epartment se Only
o Permit Fee Date[ssued Issuine Agent Signature
�A o�e ❑Disapproved � ,,- - � �
� $ ,l eo t� �, ��1 � j�>e.�,%':. 1,�� �
❑Owner Given Reason tor Denial �j U�. � �' � r ( r4 �G y ���� f��
Conditions of Approval/Reasons for Disapproval
� A '1� �--- i� 1 � 9 � ; '•.1
� � � ��ir�� ��:a`.�_ � 3��� 3n.`,�m�.�.._._�.. � j
�`{ � 1 �"J _" o,: �}
�r � ' �
� � � '?._J
::;�k�__ S� Sa �.�.. _ APR � 0 ��24 �
C�-r- /UD� , _ _ !3� � -----__,
c�qWY�R CG+��.:-�;u
� �
Attach[o comple[e plans for the s�stem and submit to the Countp only on paper not less than 8 1/2 x 11 inches in
�tl\�
SBD-6398(R.02/22) � )'I�`��
Sawyer County Zoning & Conservation Administration
������1'
]0610 Main Street, Suite 49
� �R C� 1� Hayward,Wisconsin 54843
��'l�' �Ci��� (715)634-8288
�Q� ��� FAX(715)638-3277
�N: _` _- _ �/ www.sawyercountygov.c�
� o �� ��� �o j 6-mail:sanitatian(a�,saw e�rcountv�ov.org
I � � Toll Free Courthousc/General Information 1-877-699-4110
�����"� �_����
��iScoN��
������
Holding Tank Approval Checklist
L Sanitary Cover Sheet: Date Stamp a`1� / 3a /__2` _
Parcel ID# 0,2 (o _ � 3 ?� _ l `7 _ g',10 �
II. Plot Plan:
� Property Lines �Benchmark BM �
�Site Address North Arrow
)C Structure �Scale w„s,a,y bA�sca�.??�
�Well <25' to Service Road�
�Legal Description �Nearest Road Intersection
/Setbacks to: Property Line, Well, Structure, Water bodies, Roads
IiI. Required Plans:
�Index Page wit11 Original Signature
►� Management Plan/Contingency Plan
)C Servicing Contract
�p Holding Tank Agreeinent Form ($30 to ROD)
IV. Holding Tank Specifications:
�Tank Cross-Section: Manufacturer ��In�r,�t�2�Gallons: W�a°� `''''��
�Tank Anchor Calculations [SPS 383.43 (8) (g)]
a( Locking device, chains/locks
�C Alann, electrical per SPS 383.43 (8) (e)
�( 3" Bedding Matei-ial < 1/2 "
V. POWTS Component Manual Reference:
D(Holding Tank Version 2.1 (May 2022-2027)
Owner: ���..� Plumber:
�/�s o�(Ly
Application Review Date: �y�3��Y
-�
POWTS Reviewer: �,��1,�,� ��
Name
G`���(o Rev. 4/27/2023
Credential#
PAGE 1 OF 4
Holding Tank Plan
Index & Cover Sheet
Component Manual Design References:
Holding Tank Version 2.1 (May 2022-2027)
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Holding Tank Specifications
Pg 4 of 4 Management Plan
Attachments: Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Map (if applicable)
Holdin Tank Pum in Contract if a licable)
Holdin Tank A reement if a licable
Project Name / Description
Owner Name(s): � N��. � S� ���� Phone: - -
Owner Address: �� �G �1 N � f ju•�.�. Zip: 5�35°LC"�
Project Address: 1 � \�lS vJ ��� �� �n.
Govt. Lot: 1/4 of 1/4, Section�_, T 3� N-R�`LE❑or W �
Township:�a�,r� �� � County: �,.�,c� �
Project Parcel ID #: �a c� 3$� l5 ��,
Designer Information
Designer Name: v � Phone: 7�S _ �`3 / _ !6 7 I
Designer Address: �i �� b3 Zip: �j_�u���
E-mail: �1 �50 0� • �� �
� ,_�,<< ��.�i �� ,
License Number: � �
Remarks:
Si nature: / Date: � �7 a�
� Original sign e required on each submitted copy.
Details that should bc shown:
SjTE PLf�� I. All property lines
��,� � ^ I �� 2. All buildings and driveways
Qr�� �"• 3. All wells within 200 feet
S �� •.r��1" 4. Water lines
RO�� }{olding tanks shall have the Tollowing minimum distances:
S� (� l. 5 feet from any dwelling
��6 2. 10 feet from adjoining property lines
� d� 3 g 5 3. 25 feet from potable water lines �
� �_ � \7 7A�. 4. 50 feet from any water well or watenva
-r��e a�9�5 ?�S'��� 1'��yo�
'r �a�*1c49. `S-� r—�
1� --
-�--o ��,
Id� _ _ y�,��r�.
SC No P �
b
��a�d�
g 6�
� l�"'j
�
�
L�
3•3 AC,R�S
� 1�1�k S� �.�.,� �'�c,'�n .
�.- abbo G�SL \���
HOLDING TANK SPECIFICATIONS
�Number of bedrooms
Non-residential estimated flow(gpd)
2000.0 Minimum holding tank volume required (gal)
2000.0 Proposed holding tank capacity (gal)
Wieser Concrete Inc Tank Manufacturer
W2000-MR Tank model number
SJE Rhombus Alarm manufacturer
Tank Aiert AB Alarm model number
Tank Dimensions and Data Tank Anchor Calculations
X for round tank 13540 Ibs Weight of tank and cover
47.0 Liquid depth below inlet invert(in) 1.10 Safety factor
8.0 Maximum depth of soil cover(ft) 20505 Ibs Weight of anchor required
66.0 Height(in) Outside 27.3 in Soil cover req. for anchor or
151.0 Length (in) Dimensions 5.1 yd' Concrete counter weight
86.0 Width (in) Only
HOLDING TANK CROSS SECTION
manhole cover with
locking device and finished ��ent cap
junction � warning label grade
box � _
�4"min. �,
r� F-23 in. 12"min.
conduit —�
Manhole and vent locations
vent pipe
18"min.
� telherweight _ `�'
/ service � 12.� In. —'_'—�—�—�_'— - buildingsewer
inlet
blind plug aiarm on Note: All tank joints, and
co seai joints between tank
ouciet openings and piping are
Electrical as per 35.0 in. sealed watertight. All
NEC 300 pipe and vent materials
and SPS 316 comply with SPS 384.
�
3 in. bedding under tank. Tank is anchored as necessary to negate buoyancy.
Project:
Transaction Number: Page 2 of 5
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 PONRS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
O
Estimated Daily Wastewater Flow= �6 gpd
Insqection 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 pumped by a certified septage servicing operator licensed under s. 281.48 Wsc 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: c
Name of individual or company: �"<� � ' Phone: ��`� �1 \ �� C�
Local government unit: �� �-O Phone: ��S 13� �J�"'�
Local govemment unit address 1 bb�� v � � �_Wi ZIP: S�l�_
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384,Wisc. Admin. Code.
Continaencv 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: / 0 / ,��
This contract is made between the Holding Tank Owner and the Pumper.
Holding Tank Owner's Name: Pumper's Name:
�ver�e � �olee,�n �t�n.�o r� `�,cs�
��
Parcel Identification Number:
(12 Digit Legacy ID) 0 0� � - � c3 � - �� - � a� a
1. The owner agrees to file � copy of this contract with the governmental unit, Sawyer County,
which has accepted and recorded with the Office of thc Register of Deeds, the Maintenance
Agreement for a Holding Tank required under the Sawyer County Private Sewage System
Ordinance far 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 far the purpose of servicing
the holding tank(s). The owner agrees to maintain the all-weather access road or drive so
that the pmnper can service the holding tank(s) with the pumping equipment. The owner
further agrces to pay the pumper for charges incurred in servicing the holding tank(s) as
mutuall}� 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 further
agrees to include the followiug in the report:
a. The riame and address of the person responsible for servicing thc holding tank;
b. The �iame of the owner of the holding tank;
c. The site address of the holding tank;
d. The �ate the holding tank was serviced;
e. The volumes in gallons of the contents pumped from the holding tank for each servicing;
f. The disposal sites to which the contents from the holding tank were delivered.
4. This agreement will remain in effect until the owner or pumper tei�rninates 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.
�Wri2I''S Na1Tle: � ri t� �WI10T''S Slgl]atl1T'e: (Only one owner signature required)
�vere,�f�2, � �e�ee. r� ��`h,�o ` � �, � ���'�
.�---
�l� , �-ti.i
Puinper's Name: (Print) Pun' �� 's Signature:
S�o�-� � �� �� ��
Pumper's Registrarion Number:
� 1 � �1�
Rev. 03/26/13
4I30124,10�11 AM Real Property Listing Page
R2dI EStdt2 Sawyer County Property Listing Proper[y5tatus: Current
7oday's Date:4/30/2024 Created On:2/6/2007 7:55:47 AM
�'Description Updated:4/29/2020 '�'i Ownership Updated:7/29/2022
Tax ID: 27985 EVERETfE R&JOLEEN F STINSON SUN PRAIRIE WI
PIN: 57-026-2-38-09-17-5 OS-002-000020
Legacy PIN: 026938175202 Billing Address: Mailing Address:
Map ID: :2.2 EVERETTE R&JOLEEN F EVERETTE R&JOLEEN F
Muni�ipality: (026)TOWN OF SAND LAKE STINSON STINSON
STR: Sll T38N R09W 6710 COUNN HWY N 6710 COUNTY HWY N
SUN PRAIRIE WI 53590 SUN PRAIRIE WI 53590
Description: PRT GOVi LOTS 2&7
Recorded Acres: 3.300
Calculated Acres: 3.573 �Site Address *indica[es Private Road
Lottery Claims: 0 16145W MUSKY POINT DR STONE LAKE 54876
FirSt Dollar: NO
Waterbody: Mud Lake '`.-�property Assessment Updated:9/28/2017
Zoning: (RR2)Residential/Recreational Two 2024 Assessment Detail
ESN: Code Acres Land Imp.
G1-RESIDENTIAL 3.300 24,300 0
�7ax Districts Updated:2/6/2007
1 � �� � State of Wisconsin Z-Year Comparison 2023 2024 Change
57 Sawyer County Land: 24,300 24,300 0.0%
026 Town of Sand Lake Improved: 0 0 0.0%
650441 Birchwood School DistriR TotaL• 24,300 24,300 0.0%
001700 Technical College
+ Recorded Documents Updated:7/29/2022 r.+'Proper[y History
WARRANTY DEED N/A
Date Recorded:7/19/2022 440227
WARRANTY DEED
Date Recorded:11/13/20ll 409729
EASEMENT
Date Recorded:l2/31/2014 393791
MAP OF SURVEY
Date Recorded:l0/20/2014 17389-37
QUIT CLAIM DEED
Date Remrded:3/5/1984 190458 360/231
https:l/tas.sawyercountygov.orglsystemlframes.asp?uname=Eric+Wellauer ���
NOtF MAP OF SURVEY N
`secv PAFCEL AS IN OUI7 CLAIM DEED
w+nss c� yOLUME 360, PAGE 231.
PART OF GOVERNMENT LOTS 2 AND 7, W — -- �E
SECTION 17, 70WNSHIP 38 NORTH,
RANGE 9 WEST, 70WN OF SAND LAKE. ,�- „� ,..,r,�„,
SAWYEF COUN7Y, WISCONSIN. S t`"°".\""�
��
'I � �� / "
� .- ��;�� :� �E.�E.,�o�E� oao� ���
690.68' 1699.20') � 234.81' 123�.98' �=•
4/�E — ` �
��ot a' 1 � NBJ'2T �r \ ^1 =
csw�susz �1 �—xri cm �
� 4A0. 1' o g �Or f �
3 rL3.bb - \ PP ^ CSNI]929 �Ot 6 CSM15592� ° S §
� i - N swix��r� csx�r..zs �Y �
,".,i '�T.... w� .. �.n�nc w� � m g$p'
y '_ � .
� : ' � N ' ot i� r '�J
:p \ _ �, . .- mm � i4 �d�q�'v
d
G �
F Y
..�.� �p ��_. .
�
' � PARLEL IN � �2 ' / s
� Q �[ED V3fi0 PG231 � ��,: '_
_ .. 3.3 ACRES � ' �
m m 143<19 t/- 5� FT ....._ - '
� � � IMCILOtNG 4L \ ��fqM 1 1/2'O] Iv
� aw�urFo�uos � � �.a e�sr ov�nc.
� �MI�O =R111Y � n' W I�'. lC0^# tx 9JIL
� � A
� ^ 29' �
( � .h�� p��
�� Q� BEARING REFERENLE
� � ye�/ �I.J h1EARtNGS IiEFEHNCEO TO
� - THE N/5 OTR LINE OP
SECTION 1l. ASSUMEO
�E� � � �o �' � � BEARING OF 500'5�'02'N
W;� x�°�� w NB9'02'58'X 219JJ'l � �
� 9 \ � �se*p� vz" m: �e� cv LEGEND
r- �-SEi 1 f/3' 00� XI" IP
U � u�5' xourry or sx ca+ Q' GOVERNMENT CORNER
oF uz w c���xc. FOlINO
� • - FOUN� 3/4' REBAq.
? EXCEPi AS Y.OT[0
•- SET MONUMENi
AS NOTEO
SCALE o � COMPUTEO POINT
`;CALE 1"=100' ONLV
F� ,W p � �_�r' o� 5 V2' SFP ONLINE
� M. �sr��� N _ _ _ .� ( ) = RECORDE� AS
LIHE
0 100 200 � ' wETLANnS
cascrt aco mc�s�` EASEMENT NOTE
aeono. 3eonf
�UIT CLAIM pEED V360 PG23f NOTES "..CERTAIN PRESENT ANO E%:STING POAO. ...' AS
ACLE55 FOR THIS PARCEL THE f5 FOOT NIDE ANEA SHOXN FROM THIS PARCEL TO TNE
E%ISTING 30 FOOT NIOE EASEMENT, ENCOMPASSES THAT PART OF THE NOTEO
E%ISTING ROAO THAT IS ACLE55 FOP THIS PARCEL.
m m TNE 3a FOQT NIDE EASEMENT SNOWN IS PART OF CSMf5692 ANO LIES ON PART OF THE
EXiSiING PRIVAiE R�AOpAY KNOMN AS 'MVSNY P�INi ORIVE'. 'MUSNY POINT �RIVE' IS
� A�50 PART OF THE NOTE� 'CERTAIN PPESENT ANO EXISTING ROAO' SYSTEM THAT
APPEAliS IN MANY DEE�S IN THIS AHEA aF �EV[LOVHENT.
'MUSkY POINT pRIVE" RUNS iNROUGN GV. GL3 ANo THE �
� �c*n om � � SE/NW OF SECTION 1]. ULTIMATELY CONNECTING t0
ry j \ RANCN ROAD. A TONN ROA�.
\
o SB]'49'4TE �
!� 1360.32' �ESCRIPRON
A PARCEL aF LANI] oEING A PART OF GOVERNMENT LOT 2 ANO A PAqT OF GOVERNMENT LOT "!.
o m SECiION 1], TOXNSHIP 38 NOflTH. PANGE 9 XESi. TOWN OF SAN� LAKE SAWYEfl COUNTY
�' � MISLONSIN, NORE VANTICULARIY �ESCRIBEO AS FOLLOWS:
m COMMENCING AT THE NORTH OUARTER LORNER OF SAIO SFCiION f�:
THENCE 500'5]'a2"X 262f.66' TO iHE CENTER OIIABTER COPNER;
THF.NCE 58�'49'4TE 1360.32' TO THE SOUTHEASi CORNER OF GOVEflNMENi LOT 3:
�h, o THENCF. N00'9'02"E 436.48' ON iHE XEST LINE OP GOVEBNMENT LOT 2
�s`"'2o°�' ; TO TUE VOINT OF OEGiNNIN6;
���� m iHFNCE L�AVINGISAIONWF.ST�LINETANONONN�ME550UTMELINE OF L�T 6 OF CSM15692.
N NB3'2]'AJ'E 440.21' TO THE NaFTHMEST CORNEH OF LOi 1 CSM/3529:
THENC[ LEAVING SAIO SOUTH LINE ANO ON TNE XESi LINE OF SAIO L�T 1. 506'3T 22'E
1b3.�0' i0 A POINI OF INTEf15EQI0N MITH A MEANOEF LINE OF MU� LAKE;
THENCE LEAVING SAIO NEST LINE OF LOT f ANO IX. SAIO MEANOER LWE.
N r�z�^ 59/'10'54'X 329.94':
THCNCE LEAVING SAIO MEANOER LINE, NB9'02'50'N 219.]�' TO THE POINi OP BEGINNSNG.
SAIO PAfICEI WNTAWS f43419 SOVARE FEET MORE OR LE55. INCLUDING ALL THE LANOS
BEiWEEN THE MEAN�ER LINE THE OP�INARY HIGH HATER MARK OF MUO LAKf ANO
THL LOi LINES [XiEN0E0.
N j
4
N ``��\S�oHs.� � �/ i i
CER7IFICATION �.k: • *i " V
I, MICHAEL C CLAMER. HERE�Y � / MICNAELG�5 �
CEPTIFV THAT THIS SURVEV � ( �M�R t � I�
OONE Ai THE �IPECTION OF — , �� ; _ /, I`I(
JEAN SXANSON � ' — �
soTa i5 CORRECT TO iNE BEST OF S�aqlake, j '
� " MY KNOWLEOGE ANO BE�IEF. �,l9M WiS �O�` SHEET 1 OF 1
BPA55 CAF �j�O;„;,+,��\
R�vf.N nr�bv�,.•.-.r. �cune.,.r rnr..,b�.
Zo i ac'mOGY_ s�iY
" ' _..e�
k�r" ;9�": :�5�. � ��. - ti �����r . ; '���� ��'��lr� �l .'`t... i� �� :�S 4 .�� � ��.,� � 4��+ •.�V�*. �.� �Ati:� - _
�#� M� �y�, , 'r � .i'� .�.;� 1 c � � ,.,5.�\. �,��y ; L: ��3�- i ^� �����rX �.�,.�...2n� •� +S
s'� . t '�°' �'. � {''rRe- '�:`"� y + �3�� � ������+�-� .'4�� � � a � r�`� � ^k��y"4���^ �ti
�k '�.�" `t �� 2aa ` �`� ` \\ '�� R { •1� j. f�.} � . t Y }�,k _ �, �•�
„ . ,.
� ij [ �.`L jJ 4 4 {'�'...�+��1 I :���1"� �1 � J..1r� .� ]��,�,((�J.j'� .�y��� � � ti:�'.'�j � +` "h
G �� `'ti,.' y.�x�� ,ep ' �'� � "'��` .�1�`'�-�r^. � � .'l, �'i.. t , . •�T'�'S�� K � �'� ^.y�J� 1�1{,{�►�r_�*�.''�.v�:ckti`,i,k "``�
_1j �' Sl��i,�� �' v �''� < ' Y �, "� �� . . '. .!: 4.k� '�h��",� ��^ , t-~l �a _ n
rh
1 � -��, `1 i .♦
���.�� �� �� ��I� � � 5.Jc: K °a -���i' � � ��q � � � . � �jl � � a•a`t�� y�-� +�'nr!
r � '�.;,; w. � S"' ` `* � ' y�. �' �� � .. �!' ,P: �_�. 1 +. ti
� �� . �'��. #°`; � :. �.�J�. �_ : ti� k� �'. 'ti'hl�y,�*"„�,� '1 ,� `+,z��'q� c�`4 � � �4 �
Y���'t h `F �Iw"� R, _ �.a-�,�.. � � . . ���� . . �' � _�+� ^,� ' �,�� '4a. ;.,_.' -!� �\ ''�„ '�
. +�
' ..+Ic �4w � � •�{ f . •l }R�� Y}- -" I„,i� \',�V y
Y �`, � � t (Y �p�" i' '�'�M"ti� � F �� � ti
�` ..,. � �.� .a � �� .. :�" ��'a�'Y�a. t` '� �.l,�..� '�_� hh �Iw ��'�", Al^'�°I}, 1°'r, .y.P #! '1 � *"+ 1 � �
, � � :5 ' t ...:. '. . � �= .. �4 T_ ,","4 't�. • : ,:,� 7�.� ��� .;' } fi_.-
! +� ����i, .. .'s.''�, c" �.;-: �.� �. � � �.�t� E r. .' �+, !��� 'a�... � �i �.' "^..'1y'. 7
. .� � , .- '4; . '$•+..' r � y_ . . �� _ � '.15 t'�..;tY' � +Tj :�""�y a .!\ -� �':� - T�{
'+�+ e t. ` �� � .<� �
�1� . � . ^ A :a � . r .�� - *� ' � �'iC � 1 � ~ �, ' iQ n,. n `� "*�'i
� �� � ��y�-.' � t:. � . t � 1�{�at• . � ti �. � ��-i�:.� .'1i�� �' +� , i �� i ��`�h �c.'i
, �.. �A .:,� c.a�- ..t,e�i`� � ' i4 �'i tit `�. � t ' " s.- i ,. {�v.� i
�` +ti , �,� .y. 1"., �d - 1 ., `' �. ti ' . . �' �4 '� e `4,. r '• �,, ,��,
+' �1 � � �� ';� ,,..« . � r i�}t� N 'GQ �y .�� , i
� � .� '�,r :�""� '�. k . . � .�. w � 4 . . y�-' �"� '� : �`:s
� • - . ^ i �. . `�"�' 4`' v �-"1' �r�.�� -!.� ,� �;��
. �'o. r� �fi ..�y.�° -�0 «.� - � , � w.. •,
� `� �r f. i �. �,y,�+'.J' . ,� ,r ?' _ "' �j y � f_ ' 1j .
-� •
ti ...�a�r+.' t,, . ,�', + �te' .� J� � �y�q�'Y �'�tr� ` ti �� � . ,�.TI x� ��+�\i �
'" ' .'`°�,k� �'� �,�'�� . ' i �,� { fJ' .�yt,.5 �, �' � . `ii� -, L�` a:vt.� .��;f ' 4� ... �
'p k a , y � r
� ., Si � �� � . .�4 i � y ' ��ks ''y ti*�w\,, '�y, �4 . �` :� } a�.Y� � �f� °G.,��
�1 4 . � �r' '�'�} � �,� '' h.�� I�� �e. �" .
i ti� 1 � �. "''F �� �'� ^T. � .i- � . . l . Y � ry�. � \ . � Y`i ' - ��..r
' �s� "�y+y��' A'. s � '�.sd l ..} y ry '.. •e�� '{� .4 � ,.,� .`4 � '� .��. .1�5'.+F . �y.,d
, , �',� �}(^�' � _._ S� 4_ �t w '�4 i ..r� t . �Pa.. w} *�� \ -` � -
� � T���` h� _ M � .�� ,!•. _ :. �. �i '1�'T a � } y„~ '` ..
e� � .� ,.< ,y�
4 y a y { � � .G c ,ak ' �" p, r - s. . aS},,, ., ,�, ,l �-
lli � A �,�ry Y Y � ���� a4 ., 'TR � .y�..� �� � _ . �lCa . . - � "�'"�" �i' ~ � i-.�.- _ '
F
Il 1 ��--. .� � ' a..��} �. ,,, .�4y'r.` tfpc i. :h -z�:.' . _ .
� �..'�`-f„i� '.;� f t � .y• s,ti i� ...y� •"Ly� �� .`�a ' � '1 ; ...�,� n 1� � ;�F. ,r+ ' , .
�` s.� � 4 a
� "w.- '4�. 4 " 4 • li P °� ~ � '��y��m '� i . . � � �'� a 'h� �y w^ "w` � "�. '-r a t�'.y
M�y
� .• +-r �S`� � [�o� ' .. "' " #s 3r. � ' . �: `` - '" �
�' �. h �' � �. .�1y,,,. -.. � �RJ 7k�. � T��-� e'; ��'' fR i'` ` '� �x 3' , Y , s
� * .. + ae II�f� �, .. (y}� �k y � , - s \ _ .� �� �"iu j +. ''°�"'� ��� �. yF� �1
r' , -
SY4
•.� � � LF . �� � �* �. r � M` � ��� � ����� .
t�„ � .
i � . } b�" � SK#J'YGdy t�� I�F�J' ' •� + .-�- ,�. � �1+� , .�' '"�'�� ��.
Y 1 �.; �L � . � '�� �� �1'}� ��� ��4
��y�'u�'ts�'��" �:,i r n"�i � "+1 � � ^ ,' '�r- �. p+yt. � r �, �}'+. .�� l. � . � i '+:
�� � . � °'�y�.#, +.,._ ��� � "��� '� 'S �U5 . � �-i "b-�'�-�..` . `.' _ a r .c. �' »... . . � � ?aa...
i "�'t ��,te4 � L� l�?I� I+Ti • . 1 ��'°.�4� y X � 'S'.,�,' . 1 yy'�
e L . X� . y � " : a !'�^ :� ' �� �1 I H � �
� e �i, fM. . h�M�- .. y�, Q 4.:: i �y . � i . � " R� q .` •i�..t . �. "
' � �;�� �� i� �� �� f�- :'k�fV �� '�_."f' 71�1•-.4 1 ,- . "n54 -4x . � ���, *�.t �ly�}�iy :+ . t� ,
"' � �.,�� i.d' VRs '��t°�,� _ . �� . . i� . k, � .
� �. �` i�1�,:4rf`i S.f " � �,. � ,,,. �'�. i � y �• � t-. �' ' "'�
'�a � r��' _ �� . 1� M �ASL _ Z� ��• ti� �4'� � ��4
..�. Y1 � 1 l ~ ' '' i :. .-i
.f� � :� ' t .. � M1`k� ' R -I;��Y♦�, � 4 - �s vt � . _ .4} `Ts ..'�1`' c '
_.� _� . .. . �' _.r,�' ii.iII`'ofi� l` .'M�.�' ''d}��twl �.���y`^t y'�.�.� � :�t� .' '�..-.
4.. � � � . }� i�,�r'� r�J, '4`��` ���.` v� �^i, •4 � � .:Il��.����h,%+� ti�� � '�iw�1�.`�f ���..'' r ���i
i ' v �,,� �,
,' rfl ,� �..., ��r`_ � �� �'`.��� ��Xf��.-.�'}" �+"'T,K'�+9�,e,'tlt��t' �`r��� � :��t^"�� e L7��I ��'"`*��� --
'#' 'KC i Y } 1, S�, t l' aw ., ..� �� l. n(�,+1�.5 ` P ,-1 P � -f •:A yt4. .�4
. t .�•' � � � • �y�,e,l �
•. � � . � �•s, 1r t� �_��y� 1�`f.. ,;-ti �.y,�; L�a �l.i�y r.�. . �Cw�4Y��1yT'J _
{ cT •�.
� � �! -� � � . . ..�, .'' '/# `�.:r � � t{j��4�,�y :.�*Xt�,i� ��hr � � , f+al�sk7 c ',�' M��� � 'l. ��'. �+:.
' + , x z a� , t ' �' _. S }"��-3
� ' }����'r .i�) ?'� �f�j,�l Xf��-.tr•�2J.y?G •Pw� �"„'?�.��,�?! Y'Y' .� 'Yt. �e'r�,��¢ �i`'�{j�� � y' �
4�,' ; � �i �y�;�� �/� t,� �r � �jti 1 r' � V�Sti �,- , ' �`�'x a �!'�/,(��[}�
,� }� f ;1 A.���( y '. �._ ..�� 4�(J _ � �. '9TY +VYR�'
e�Y C� J....�/Y t . - l�1' d}n f . A !'If}�,
Py �-,� . � . 11 '�*��h��a rt 3i���.+{��y . '!�I 'h . �L , k'�� �.�,t '.J' * " ""�
"*R
�` ; �2 ,..� a .l�y � . . . ' tivK,� !.. e�F,^� 1... _ - - ` q. .
. r e'i 5 ` � ,,� �� ': r,�'�-�.�m .�,.'�' :�� ��a w�� f#�:. �"+�. .
�� � . 4*��� ����.�� .( ~ f, .� 1 y � � �3�"q ..�
�
� y ,� c- �_ - �t i� �. 4s.; ' ,�' . ����� ' � " .
�� Il�", i .J �'1t�.,_ y� v .. y - i4:'
' � ,�_ .' .� .
� " ' ,���`' '��'r '��*ai�� ,�
',�'i "h���� " '": _ `. ,
' �` b r ���'� k y +�_� - , ,��y,, ,.�y.,� .
�-' '� y� '��� '�. �4 P _ 6� �, G,-: .ti "- '�}!i 'f �'l�M-: . '.
� .�� 14,a�� _ ,�.-- y �! . . . �+T� . ',�, ' Ft' �
'�" x ,� �y�,, : � ', ,4'kayk a.- ..� '�l � ..�k�+�(� '^1 �l7y.*�.
I ` f��p7�� t �f���ry1\t�.`F _ ���,��yp,y �.i ~(!��� '� '" `�.�!R�/' . ��cf1a� } �~_�
J .'u ' � �� � ` �,• � ��y � � � ,` t \ ++
' f k �` �y1 . /� ` �i �A �S�Ci� �{.1 {
� ys��
��, ��`�h i � � • a'"�y� a��� �����t ,��,� 1 -,� h -F .� i7~^S�. a .!' 4�*t-� ,,,�C!t
� ��li ,tj. ^C ��� y� . � •'�I1� '+�8 �• ��7;+" ;Fh':tiy
�f# fi . e tii `: � , . ` . {�:�."�- � 'j
M 's� 4 �•� � ` • -• �' .
r * � .7��� :�,�` � �` '�, �a y ��,.� - w � w.`-•; {„1�y-;�`.� .
.�; � %y�,�,. �� ��.�ii� y .� ,ti,�- � . _ :. _ .
, .I � 7 ��I r tt. ����' . K � r � ` �k, �. .� �.. . . .
,Y. `ff x � . . � . r1"t - . '��R���s`. . k.s� �I y -�4 �1 . . i . .
, ,r��•i '�� � . 5 " �� .dA� r :i;��. � , . '- SJ�w 4 ' ��► .
��(��� 1 �" � � �4 �: �I,> '. '
.'���� '�� � � . ��ri _ i,q.. 'h,,. : - .
��� � � i .. I i ` S � '� ;til',_ :y � .. �� wq 4� _ ' �
; ' .. �r ��.-Mt-� i . , sH�..� 1
4 ke �d��1� .5.� n,��� � ' �` � Y � �A '1��' +�� � � .� �.�! 7�f{
. �f..� �I j�(��' �� �L ♦ � �j�- � ` wiTS, - °�� +ti,a5 .` . �4- . �"dh
r bT-�
` i��.�R 1 1. � .g,j 1"� �'7�'a,,,.] ~.�4 - .� t � �R � ` e �
�t � � ,,.ti���yt.�wp, �} :� s . � ` �14 ' /��� y � ��' ��ty� 'r ;a,
- '� . v�'_ '.4� �'i ��k�� ��:7 y�l' � � 'S , � I P
. i• "t'�r',t.��� - 97�.i ' ,'�, t�.�'� � ����°t~'!~e�f'n`.`a +� � "f�6�"r'
: � . '.. �. . � . ; . I
? � 4y, ' a r L � . 1 * . ��. a�"- q
_ .. i... .�:�l��i!�S.a_wn�•,�°.. - � �_ii,. .'�.��� uia�2'1_ , ��._s'�4.�t.��.i.. _._ .;f.�..-t �;J
i � ❑ _ '
' ' a �a � O � � O � o o v m a
m m X % 2 � � < � < r > j m m <'o
3 3 z m D Z cn o � '^ y u,
oai m a � Q x m � A d o c `N°
� � � n x m �, = 3
� N n o � n � � a � m
� o o (T7 p N N
a > > �
N O (n �
N C �
y N �]
O �
� �
a
N
i�� ii��i� s i��a�si i�ioii��
e���:,:�L�����,�,
-USE BLACK IN K ONLY- -'i X;40515 i�
POWTS MAINTENANCE AGREEMENT 449553
For Holding Tanks ��uia cHassE�
R�GISTER OF DEEDS
Owner's Name(s)as shown on deed: SArWYEt� C011N�Y, WI
�G�il°X�..�CT@.R�� �ol@�'X1� 04��o,2oza io:z� aM
�'�t Yl�i'� RECORDING FE� so.o�
Parcel Identification Number: �] �t
(12 Digit Legacy ID) Q ��-��� '�!- � �v � ��'���' �
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 tr�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 upori 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 F�ealth 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.
-Only one owner signatur required- ACKNOWLEDGMENT
ner's Si nature: State of: ��
/ � �.c.c'��=--,
� � County of: �+�
ner's Name (Print): Subscri�ed and swor�},to before me on this
"`�ccQ�(� .5C,�1�7 �V�a e,'trC, U.l � day of :�'GPa*e....... 20 1-�-
Date: By(Owner's Na,`rr�?\�.°�, . ►` e� ��`�J��
2..3 �UZ Notary Public S��n�tt��. ''i.. �I� � -- ti
Drafted by: � Public Notary�am�.(,P�t)� `- � ��') . �'"`'"j'�'__
b�82�n ��nSDY1 My commissiCln'_e�7e�en'���°_ �'1�js --
'e :�:. �` .
, r��. 'j. ;� 4 •:c��er;�
=;;'�.,,, NH•..;..'.S.�p��,:
Personal information you provide may be used for secondary purposes[Privacy Law,§15.04(I)(m)] '' ���. S,i �., ,�` Rev.03/26/13
�''�iiiirniii�������
Parcel L•
That part of Government Lot 2 and part of Government Lot 7 of Section 17, Township 38 North,
Range 9 West(in the Town of Sand Lake), Sawyer County, Wisconsin,more particularly
described as follows:
Commencing at the North Quarter corner of said Section 17;
thence South 00° 57' 02" West 2,621.66 feet to the center quarter corner;
thence South 8 i°49'47" East 1,360.32 feet to the Southeast corner of Government Lot 3;
thence North 00° 57' 02" East 436.48 feet on the West line of Government Lot 2 to the point of
beginning;
thence continuing on said West line North 00° 57'02" East 333.14 feet;
thence leaving said West line and on the South line of Lot 6 of Certified Survey Map No. 5692,
Volume 19,Page 250, as Document No. 264795,North 83° 27'47" East 440.21 feet to the
Northwest corner of Lot 1 of Certified Survey Map No. 3529,Volume 14,Page 211, as
Document No. 229700;
thence ieaving said South line and on the West line of said Lot l, South 06° 37' 22" East 163.70
feet to a point of intersection with a meander line of Mud Lake;
thence leaving said West line of Lot 1 and on said meander line South 47° 10' S4" West 329.94
feet;
thence leaving said meander line,North 89° 02' S8° West 219,77 feet to the point of beginning;
including all land lying between the meander line,the ordinary high water mark of Mud Lake
and the lot lines exteded thereof.
Parcel IL•
Together with the right to use the present and existing road for ingress and egress as shown on
Map of Survey dated October 14, 2014, 17389-37 and Easement Agreement recorded December
31,2014,as Document No. 393791.
Tax Key No.: 026938175202