Loading...
HomeMy WebLinkAbout24-42S KlugAPR 26?02. j; Department of Safety uj & Professional Services, Industry Services Division CountyBayfield Sanitary Permit lumber ((o be filled in by Co.) Sanitary Permit Application In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. State Transaction Number I. Application Information - Please Print All Information Prqieg^A^iress (if different than mailing address) "/• XXX W Sunset Dr., Cornucopia, Wl 54827 Property Owner's Name Scott & Katherine Klug ^7 parcel#. _ ^. . ^ 5^/W.04-010-2-51-06-27-1 05-001-08100 ^W/ Property Owner's Mailing Address W5140AKST. Property Location Govt. Lot 1 Tax I D 38872 2.78 Acres City, State Spring Valley, Wl Zip Code 54767 H. Type of Building (check all that apply) H 1 or 2 Family Dwelling - Number of Bedrooms D Public/Commercial - Describe Use D State Owned - Describe Use Phone Number 612-868-7197 ',4, Section 27 ^ Lot #.51 __ _ 6T^'_N R E or W Block # D City of_ CSM Number 313 a Village of B Town of Bell III. Type ofPOWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i applicable.) A.New System ;m D Additional Pretreatment Unit (explain) B.E Holding Tank In-Ground (conventional) I At-Grade Mound Individual Site Design D Other Type (explain) c.Renewal Before Expiration Revision Change of Plumber D Transfer to New Owner IList Previous Permit Number and Date Issued IV. DispersaI/Treatment Area and Tank Information: Design Flow (gpd)450 Design Soil Application Rate(gpd/sf)Dispersal Area Required (sf)Dispersal Area Proposed (sf)System Elevation Tank Information Capacity in Gallons New Tanks Existing Tanks Total Gallons # of Units Manufacturer s I'£ §(E U ts|i i -u E U Septic or Holding Tank 3000 3000 Skaw DTDDosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Dean Blakeman Plumber's Signature I MP/MPRS Number 1092768 Business Phone Number 715-682-6050 Plumber's Address (Street, City, State, Zip Code) 44941 State Hwy 13; Ashland, Wl 54806 VI. County/Department Use Only Approved ^/ZI/ZV D Disapproved D Owner Given Reason for Denial Permit Fee I i Date Issued6-b'ci^ \AIssuing Agent Signature ^Conditions ofApproval/Reasons for Disapproval .^n\L ^o r^H- ^[\ ^4iCTC^C •ma^cr^^ f ^ n l-o Oi/rt^^ » m^n^a,-/--) ^/^v^ P^ ftco^c( °9^/yj^T^ »Co^^ C^^0^ ^r P^e '^cep^/ p^ ^^ ^-.rr^x/)?) Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 mches in size SBD-6398 (R. 03/22) ^RiOEiyED. ;=<!f 11 ^oilTest#^5^3Bayfield CQyjpJtt^^Waiver of a Thorough S'oTi^tt»1 (subject to 15-1-10(d)) I ^>Ku.^ ^ ^ LA-K^p^-^Ay g certified soil tester determine that in my professional judgment the following site (see below) is unsuitable for any treatment component other than holding tanks. Due to soil & site conditions, a thorough soil and site evaluation is not needed to make such a determination. Property Owner KA-T^^^- 4- ^coTf fc'Lci6- Contractor• Property Address IV 2)U-/(VS<:^/ Df^- Authorized Agent_ ^&.fu^-Co9^ , k/x- _ Agent's Telephone_ Telephone 6/^~?^- 7/f7 Written Authorization Attached: Y or N Accurate Legal Description is requested: _1/4 of_1/4 Section ^ Township-^7 N. Range ^ W. Town of ^CLL- Block__Subdivision_CSM#Govt Lot ^ Lot Volume -Page-of Deeds Parcel I.D#3^7^Acreage o2.i Additional Legal Description:. C^y Sj^r^ ^//L-^fl^^r^ s^cc [^ T^JZ^A/" Z^^ %U/ //< 76 Swr^<L S^C^ Indicate reasoning for your determination (1 ^ I I „ )' 2<9/t/ ^/CQ?74^? Signatufe of County Official •//WZ3TDate •i^ V^U^if^-'•ff*e<t^-t_ Signature of Qertifi^d Soil Tester i/^/^^3 Date 7w/<r Certification # (Submit a Plot Plan & Fee) u/forms/soiltestwaiver(KLK) February 2005 ^SO' W^3d^ KLLAdr G-ovt LoT JL S^/ r^/ A^^ Gk/ T^u^/ of ~S^L ^Ai.-F^c^ CTJ/ ^j§- /^zc^ ^^-^"=- ^0/ ^ /V(! ^/^t-L A/Q 74AM€SS/ AT 7^5 /$/%.<L/ ^W'J c^- csr ^ 7c^^/^ H^A^L-{ i(JiX^^ S^TI (^6^-^<^K M ?'^>3 t'i i.i.ng -; 'l' iing ' :• ./ \PR 2fcZOZ4 IUI /[/a^r^ PW. ^^€ S^^ Wy^ ^ ^e^i7s~~— ^ofto^A he^T WPft.^. ^0&t To U 5-^s^r A(^ . \^/^t^ SX^S. <5^/?t '5oay^J ^^ ^3^/t fi-> \C Pg Pg: Pg; Pg- 1 of 4 2 of 4 3 of 4 4of4 Attachments: Holding Tank Specs Holding Tank Plan Index & Cover Sheet Component Manual Design References: Holding Tank Version 2.1 (May 2022-2027) Index & Cover Sheet Plot Plan Holding Tank Specifications Management Plan Enclosures: POWTS Application for Review !pMEi|ipF4!UjAPR 2 6 2024 ^ vfieia Co. zoniny Oepl Soil Evaluation Report & Site Map (if applicable) Holding Tank Pumping Contract (if applicable) Holding Tank Agreement (if applicable) Project Name / Description KIug 3000-GalIon Holding Tank Phone: 612 -868 .7197Owner Name(s): Scott & Katherine Klug Owner Address: W514 OAK ST SPRING VALLEY Wl zip: 54767 Project Address: XXX West Sunset Drive, Cornucopia, Wl 54827 Govt. Lot: 1 Township: 1/4 of 1/4, Section 27^ , T51 N-R06 E|or W county: Bayfield Project Parcel ID #: 04-010-2-51-06-27-1 05-001-08100 Tax ID: 38872 Designer Information Designer Name: Dean Blakeman _ phone: 715 -682 -6050 Designer Address: 44941 State Hwy 13 E-mail: dean@blakemanplumbing.com Zip:. 54806 This space reserved for approval stamp. License Number: 1092768 Remarks: Signature:Date: 04/011/2024 Original signature required on each submitted copy. CHECK BOX AS APPLICABLE. SOIL EVALUATION SITE MAP PROJECT NAME: Klug - 3000 Gallon Holding Tank PROJECT ADDRESS: XXX W Riin?;pt Hr nnrnilf.npia Wl BM Symbol: -^- BM Elevation: 100 00' _ FT BM Description: Nail in i?" Ahnvfi ftmunri Birnh TrRfi CHECK BOX AS APPLH Scale: 1"= 40' 40 60 80 ^////////77^//////7ZZ 102 zz^ ^ SYST PLOT . [& 'y3LE."J '~J L_! LJ I'; !li API^<6WR! Slope Gradient(%)of Tested Area:Well Symbol (if applicable): Q Indicate north by drawing an arrow on the approprite line. ~^\wi?fd CG, %nii!a DeDi, DESIGN FLOW: 450 GPD Attach design flow calculations for commercial plans. Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) Sanitary Sewer: 4" PVC _ / SDR 35 Force Main:_ /_ IMPORTANT: Show ground elevation contours at suitable intervals. No well on site yet. Holding tank must be >25' from well. No Address Yet 2.78 Acres North Property Line I/Over 500" to Lake Superior Over 150'to Lake Superior /^7,0 Proposed Well Location ^ Proposed New 4" SDR 35 Pipe Approx 25' Proposed 3000 Gallon Holding Tank Parking Area Proposed Garage Over 300'^ \7 <XXX W Sunset Dr. Driveway <^ Proposed New 4" SDK 35 Pipe Approx 30'~c (DU)c303 South Property Line ^ :! '•''! :i", •~,ij !6jK ij ;1 s 1 APR 262024 IL Rawf6ld Or,.?!';!':r; i •-,'u PAGE 3 OF 4 HOLDING TANK SPECIFICATIONS (No Scale) Electrical must comply with SPS 316 and NEC 300 \1/ \^ tO Weatherproof -Junction and Alarm Box •Conduit 4"0 Vent Pipe >10 ft from Building Approved Vent Cap 18"Min. (typical) ^ Intet A .- n -Airtight Seal Ho^m Approved Joints with Approved Pipe 3 ft onto Solid Ground 12"Min. or 2.0 ft aboveEstablished Flood Elevation (typical) Approved Locking Manhole with Warning Label Attached(typical) Inlet Invert ^JI— Max. 12" or 90% of total volume if more than one tank Alarm-On HOLDING TANK VOLUME = 300CL gal 3" Approved Bedding Material Beneath Tank ^1 4" Min. or 2.0 ft above Established Flood Elevation(typical) ^k \1/ Finished Grade •^••^•. i.. 0--WatertightPlug" TANK MANUFACTURER:Skaw 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 = \( 400 cu.ft. x 62.4 Ibs/cu.ff) - 17930 |bs1x1.5= 10545 Ibs WARNING DEATH MAY OCCUR IF TANK IS ENTERED WITHOUT PROPER EQUIPMENT NOTE: SEE INNER WALL PHOTO ON THE "EXCLUSIVELY AT SKAW'S" PAGE. TOP VIEW OF MANHOLE COVER /"\ 4_00_\^ 4"PVC SCHEDULE 40 COUPLING (VENT) 5.00 4 INCH PRESS SEAL BASKET POURED INTO 1 FOOTRISER. RISER IS THEN POURED INTO TANK COVER. 1.00 -n- 56.00 I I 3.00 J SECTIONVJEW OF TANK AND COVER •3.00 INL^^j ^ ^ 1. ^ : 1. APR 2 0|3 .69.00' Savw^^f-M 78.00- 182.50I I 176.50 173.50 ] Liyp.: TOP VIEW OF TANK (TAPERED) OUTLET END VIEW OF TANK Model Number: 3000 HOLDING Approved for: HOLDING Weight 17,930 Ibs. Inlet Dim. 67" Outlet Dim. N/A" Liq. Depth 56" Gal. /In. 53.54 Max. Cap. 2998 gal. SKAW PRE.CAST 26255 105th Street, New Auburn Wisconsin 54757 www.skawprecast.com Phone: (715)967-2277 Toll Free: 1-800-924-8625 Fax:(715)967-2707 SS'-6G; BAYFIELD COUNTS CHECKLIST FOR SANITARY APPLICATONS ^ - i ^( :^oZ024 Submit the Following (Use Permanent Ink) (J~±\e 15, Section 15-l-10(e)) E Check List —'^d Co,/on!,^DepL E] Original Sanitary Application (Submitted in Deed Holders Name -not prospective buyers) (383.21(1)1.) B Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) E] Original Plot Plan (383.22(2)2. 3. & 4.a) El Cross Section, Over-Head Profile of the System and Schematic of Tank from Manufacturer Q Pump Tank Diagram, Alarm and Pump Curve (when applicable) B Contingency Plan / Management Plan (383.22-3(2)(b)l.f.) D Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) D Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) El Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) D ATU Servicing Agreement (Recorded at Reg. of Deeds) D Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) D 2 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies') B Soil and Site Evaluation Report (383.22-3(2)(b)l.e.) D State Plan Review (when applicable) B Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) E] I Application Information must include: E] 23 digit Parcel ID# - (do not use 12 digits anymore-obsolete) El Project Address or Road Name where driveway is/will come off of) E (Owners Phone Number) [3 II Type of Building B III Type of Permit E] IV Type of POWTS System E V Dispersal / Treatment Area Information \Z\ VI Tank Information El VII Responsibility Statement (Plumber's Information) E] *Date Stamp* Plot Plan: (To Scale or To Dimension) El Signature and Plumber Information E Address Number and Road D Surface Elevation of Body of Water B North Arrow D Direction and Percent Land Slope D Contour Lines B Tank and Filter Information and Location [Zl Structures and Driveways D Wetlands / Navigable Bodies of Water D Boring Locations D Absorption Area (Proposed and Existing) El Property Lines D Bench Mark (Location, Elevation and Description) B Well Locations D Component Manual Version El Legal Descriptions D Piping Material Information (conveyance line, building sewer line, material type and diameterj Turn Over > ^: ^ K j! i E i Cross-Section and Over-Head Profile of the System: li i . ,„ „ _ \APR 262024 1. El Surface and System Elevation .•.;;..,.,;:;.,,.,,-.v-^!''i Co, 7o;.;^,, ,^^ ED Position of Observation and Vent Pipes E Dimensions and Depths 0 Make, Model & Number of Chamber Units in each Cell ProBertv Information B How many systems will there be on this parcel of land? n Has this property been split? _ (Property Statement shows Property History) Fees: D Private Sewage System (Septic Tanks) $ 400.00 B Private Sewage System (Holding Tanks) $ 400.00 D Mounds or Systems requiring Pre-Treatment $ 500.00 D Sanitary Revisions $ 25.00 a Private Sewage System Reconnection $ 50.00 and Private Interceptor D Return Inspection $ 50.00 D Maintenance Agreements ^ $ 30.00 (checks made out to Reg of Deeds) u/farms/checklists/checklistforsanitaryapps(10/2009);(®7/2011);(®2/2012)(®5/2/2012-dc) Proofed by: 4/Za/^4,3:1^KIVI Novus-Wisconsin Access rev. l^.u^UB Real Estate Bayfield County Property Listing Today's Date: 4/29/2024 !i^S^ Description Updated: 2/14/2023 Tax ID: PIN: Legacy PIN: Map ID: Municipality: STR: Description: Recorded Acres: Calculated Acres: Lottery Claims: First Dollar: Zoning: ESN: Tax Districts 38872 04-010-2-51-06-27-1 05-001-08100 (010) TOWN OF BELL S27 T51N R06W LOT 1 CSM #313 IN V.3 P. 135 AS DOC334389 (LOCATED IN S 1/3 GOVT LOT 1)DESC IN DEED DOC 2023R-597669 2.780 2.780 0 No (R-l) Residential-1 107 Updated: 10/7/2022 1 04 010 044522 001700 * Recorded Documents STATE COUNTl' TOWN OF BELL SCHL-SOUTHSHORE TECHNICAL COLLEGE Updated: 3/15/2006 Q WARRANTY DEED Date Recorded: 1/5/2023 Q WARRANTY DEED Date Recorded: 7/11/2022 B WARRANTY DEED Date Recorded: 4/26/2022 Q CONVERSION Date Recorded: B QUIT CLAIM DEED Date Recorded: 9/20/2004 a CERTIFIED SURVEY MAP Date Recorded: 5/27/1980 2023R-597669 2022R-595455 2022R-594383 494479 760-891;901-804 2004R-494479 901-804 334389 3-135 a Ownership Property Status: Current Created On: 10/7/2022 10:35:58 AM Updated: 2/14/2023 KATHERINE C & SCOTT G KLUG Billing Address: KATHERINE C & SCOTT G KLUGW514 OAK STSPRING VALLEY WI 54767 SPRING VALLEY WI Mailing Address: KATHERINE C & SCOTT G KLUGW514 OAK ST SPRING VALLEY WI 54767 Site Address * indicates Private Road 89615 W SUNSET DR Property Assessment CORNUCOPIA 54827 Updated: 9/26/2023 2024 Assessment Detail Code Acres Land Imp. Gl-RESIDENTIAL 2.780 181,500 0 2-Year Comparison 2023 2024 Change Land: 181,500 181,500 0.0% Improved: 0 0 0.0% Total: 181,500 181,500 0.0% itt' Property History Parent Properties 04-010-2-51-06-27-105-001-08000 HISTORY B Expand All History White=Current Parcels Pink=Retired Parcels B Tax ID: 7744 Pin: 04-010-2-51-06-27-1 05-001-08000 Lea. Pin: 010105907990 Tax ID 7744 38872 This Parcel Parents ^ Children hHnc-//nnwi ic ha\/ficklrl^r»i mt\/ ihfi nn\//ar*r'Qco/rnaot)Qr ac*r>/?r>'ont-nlr<='^ftR7'5 y^ ^ "-^:^,<n>-\^': jt;'-.!-^. ;., .,; :;' ^.y^^f^g,^^ .*:-"•'£' ••;'". ;-P.'^* ..y1'-''"'•^^•'¥!WS?s] •^^•3],''^%'i^ 03 ','.r\- Bayfield County, Wl !W88we@rsa . ~ ^ IWeWWBWBB. .. ,„>>-' iPRPlb'/iTax.ICi'WBiyi B'l'LS.T/iri.UNOERER'LKJ EEESS£ffS53S)QQ3lSS13aOCa33SB<30@33vu>©CTO© EE53£Svt33QS>OSBaSQSBSSBSaieieiBSSS^EB^VSESQSSSSSQS'SSSl^^ 4/29/2024,3:12:51 PM Rivers Approximate Parcel Boundary Road Type —~' Town Lake Superior Shoreline Recession Segments The average annual rate of bluff recession in this reach of shoreline is approximately 0.5 feet. <- (iISI;aaTOaiEX3EEBBg vssssaesvsss, Flood Plain Boundaries Active Dec 16th, 2011 0 AE = Base floodplain where base flood elevations are provided. o Lake Superior Proposed Setback Line * Building 0.01 1:676 0.01 0.03 mi 0.01 0.03 0.05km Bayfield County Land Records Department Bayfield County Zoning Applicationhttps;//maps.bayfieldcounty.wi.gov/ZoningW/^/ Documeal Number State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Naaie THIS DEED, made between Paul T. Rengel ("Uranlor," wlietlier one or more}, and <alherme C. Klug and Scott 0. K.lue. husband and wife as survivorship marital property .("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in BAYFTELD County, State of Wisconsin ("Property") (if more space is needed, olease attach addendum): Lot One (1), Certified Sur/ey Map No. 313 as recorded in the Office of the Register of Deeds for Bayfield County, on May 27, 1980 in Volume 3 of Certified Survey Maps on Page 135 as Document No. 334389, iocated in the Town of Bell, Bayfield County, Wisconsin. Document Number 2023R-597669 APR Damel J. Heffher Register of Deeds Bavfield County, Wl Recorded 01/05/2023 at 1:41 PM Recording Fee: S30.00 Transfer Fee: S690.00 Pages: 1 Electronically recorded Recording Area Name and Return Address Kalherine C. and Scott G. Klug W514 Oak Street Spring Valley WI 54767 17450-22 04-010-2-51-06-27-! 05-001-08100 Parcel Identification Number (PIN) This IS NOT homestead property Grantor warrants that the title to the Property is good, indefeasible in fee simple and n-ee and clear of encumbrances except: EASEMENTS, RESERVATIONS AND RESTRICTIONS OF RECORD. Dated _ l^/_t ^/\ 3 ,_ _T .(SEAL).'^i ~7~f^ * Pau/T, Ren.gelI -(SEAL). .(SEAL) .(SEAL) AUTHENTICATION Sigrisrure(s} authenlicaled on TITLE; MEMBER STATE BAR OP WTSCONSTN (If not, authorized by Wis. Stat, § 706.06) THIS INSTRUMENT DRAFTED BY; ATTORNEY MAX T. LINDSEY. SBfflH2865_ Anich. Wickman & Lindsev, S.C.. Asliland, WI 54806 ACKNOWLEDGMENT STATE OF W\ ;•' h VY? ^ ^c^ ) )ss. .'^V\M>lV^ __^_ ^COUNTY '} Personally came before me on \ i- j ihe above-named Paui T. Rensel to me known to be the person(s) who executed the foregoing insln^n^nt and acknowledged the same.5^/K^ ^/'^W° * L l/l<-^i 1\^€ [ ^ o^ Notary Public, Stale of ^M My Commission (is pennanenl) (expires: Q •WL\ ) WARRANTY DEED * Type name below sigiialures. (Signatures may be antbcnticatcd or acknowledged. Bofb arc nut necessary.)NOTE: THIS IS A STANDARD FORM, ANY MODIFICATIONS TO T!!1S FORM SHOULD BE CLEARLY IDENTIFIED."5L»4lft^© 2(103 STATE BAR OF WISCONSIN<LUCY L KELSO'N Notary Public MinnesotaMy Commission Expires Jan 31, 2027 :2002 Bayfield County Register of Deeds Document S2023R-597669 Page 1 of 1 Owner Name (s)1^-rt: 6r. li4+hf;rt»\'/ c. Document Number/Plan I.D. No. \\\^t\ In^Parcel Identifier Number (PIN). otf-0 iC - 1-S- i - ci- -jil-1 ?-<y^ HOLDING TANKAGREEMENT Owner(s) Mailing Address V^Ti4 C^f^- ,„^^\fiL^/>^W^?pr!i^ iigreenWnt Dati\Q?t vStcft t Date (same as Notary Date) We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property or Ihat continued use of the existing p-cmi'sss requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sower, or any other type of private onsite wastewaler treatment system as permjlted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Stats. Section <X^ Township _^_[_N. Range 0, [y W..1/4 of..1/4 Town of J^lL Additional Legal Description: .SubdivisionGov't Lot I Lot_Block_ Lot_I_CSM #^l$ Vol ^_Page!_CSM Doc# _CSMff_WML DOCUMENT NUMBER2024R-602695 DANIEL J. HEFFNER KLGISI L-H Of- Dl-.l-l.'S BAYFIELD COUNTY. Wl RECORDED 03/2.5/202.-'}- AT 9:-'t5 AM KtCORDING FfcE: $3U.O(J PAGES: 2 Return To: Baytield County Planning and Zoning As an inducement to Bayfield County to issue a sanitary permjl for a holding tank on the above described property, we agree to do the following: 1. Owner agrees lo conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tank installation and maintenance. If the owner fails to have the holding lank properly serviced in response to orders issued by Bayfield County or the Department of Commerce to prevent or abate a human heallh hazard as described in s. 254.59, Stats.. Bayfield County may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. Tho charges will be assessed as prescribed by s. 66.0703, Stats. 2. Owner agrees to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or olherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. Bayfield County shall notify the owner cf any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 3. The owner agrees to contract with a person who is licensed pursuant to s.281.17 (3) Wis. Stats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced in accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any chanpes lo the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service coniract. 4. The owner agrees to contract with a person licensed pursuant to s. 281.48 (3) Wis. Stats,, and Ch. NR 114, Wl's Adm. Code who shall submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfield County may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 5. 6. This agreement will remain in effect only until Bayfield County certifies that the property is served by either a municipal sewer or a private onsite waslewater treatment system that complies with Ch. SPS 383, Wl's Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to (his agreement in such manner which will permit the existence of the certification to be determined by reference to the property. This agreement shall be binding upon the owner, tho heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the rogister of deeds, and the agreement shall be recorded by Ihe register of deeds in a manner which will permit the existence of the agreement to be determined by referonr-e to the property where the holding tank is installed. - Please Print ^c^6r. K(^ K-W^n^ ^-Kk Notarized Owner(s) - Signature(s) ^c^C\ ^' /^^?^ Drafted by: Porsona! information you provide may bo used (< Subscribed and sworn to before me on this date:^C^ '^ ^0^^vX\tW44+^-\D"3^ P^/?^w:; _^cNotary PublicVOAL OJW<. My Commission Eifpire^:nres:/&1 to.b I*: * -^-^s %^-'_- -~-<^0c>* :^uHunnC C -^ >ed (or socondary purpose9s[pf-ivacy U\\, R. ' '> 04 (l;^n Date3^-^y ^ ^.^ "/////«imi«>v' //-". '; ^.-w^y^%".^' u/'fonns/sanitory/lioldingtankagreerDenldoc: ©June 2018 MAR .tiW ~0 Docunieol Number State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Name THIS DEED, made behveen Paul T. Rengel ("Urantor," whether one or more), and Kainerine C. Kluf and Sicott U. K.lue. husband and wife as survivorship marital property .("Grantee," whether one or more), Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurlenant interests, in BAYFTELD County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lot One (1), Certified Survey Map No. 313 as recorded in the Office of the Register of Deeds for Bayfield County, on May 27, 1980 in Volume 3 of Certified Survey Maps on Page 135 as Document No. 334389, located in the Town of Bell, Bayfield County, Wisconsin. Document Number 2023R-597669 Daniel J. HefBier Register of Deeds Bayfield County, WI Recorded 01/05/2023 at 1:41 PM Recording Fee: $30.00 Transfer Fee: $690.00 Pages: 1 Electronically recorded Recoiding Ana Name and Return Address Katherine C. and Scott G. Klug W5l40ak Street Spring Valley WI 54767 17450-22 04-010-2-51-06-27.1 05-001-08100 Pared Idcnlificallon Number (PIN) This IS NOT homestead property Grantor warrants that the title lo (lie Property is good, indefeasible in fee simple and free and clear of encumbrances except: EASEMENTS, RESERVATIONS AND RESTRICTIONS OF RECORD.Dated /^/n/ t 3 _.~T .(SEAL)_'<^t ~7~t^^ * Pau/T, Reneel .(SEAL)_ .(SEAL) .(SEAL) AUTHENTICATION Signahire(s) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (Ifnol, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: ATTORNEY MAX T. UNDSEY.SB#1112865 Anich, Wickman & Lindsev. S.C., Aslilaud, W] 54806 ACKNOWLEDGMENT STATE OF W\ lV\ V^ S <^-a- lN><nWfl.(?f^ Personally came before me on \C- / (.^> | t-*-' l-t- Ihe above-named Paul T. Reneel ) )ss.COUNTY ) to me known to be the persoa(s) who executed the foregoing inslnynpptand acknowledged the same.((^c^ ^u^w^> * LlAO-1 AA^ 19, Pin Notary Public,*Siale ol' >A'*1My Commission (is permanent) (expires; J3JJJS ar acknowledged, Bolh are no! ncccaary.) -) NOTE: THIS IS A STANDARD FORM. ANY MODIMCATIONS TO THIS FORM SHOULD BE CLEARLY IUENTIPIBO;WARRANTYDEED" ------------- - eW3 STATS BAROF WISCONSU| • J_^« • • •,,",n^ll<JSUftlftt2u"^^bcToTv7giuitui<s. .--——--- ' ^^^ LSNPybslLUCYLNELS(Notary PublicMinnesota Jan 31, 2027 Bayfield County Register of Deeds Document #2023R-597669 Page 1 of 1 PAGE 4 OF 4 Holding Tank Management Plan APR ? e/o^ LMPORTANT: The owner of this holding tank(s) shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wise. Admin. Code. Pursuant to SPS 383.52 (2), Wise. 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), Wise. Admin. Code. Estimated Daily Wastewater Flow = _"l"^u _ gpd Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (/.e. odors, user complaints, etc.) o mechanical malfunction (/'.e., pumps, valves, switches, floats, ete.) o material fatigue (/.e., leaks, breaks, corrosion, etc.) o neglect or improper use (/.e., exceeding design capacities, prohibited activities, ete.) o electrical components (/.e., wiring, connections, switches, controls, timers, alarms, etc.) o surface discharge of affluent 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 Wise. 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, Wise. 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: Blakemsn Plumbing & Heating phone: 715-682-6050 Local government unit: Baytidd County Zoning _ phone: 715-373-6138 Local government unit address: 1 17 E 5th St. WaShbUU, Wl ^IP. 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wise. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wise. 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, Wise. Admin. Code. Contingency 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. System Abandonment If use of this tank(s) is discontinued, it shall be abandoned in accordance with SPS 383.33, Wise. Admin. Code. HOLDING TANK SERVICING CONTRACT APR 262024 Contract Date 3--^+This contract Is made between the Holcting Tank Owners) Name(s) |6cp-f+ &. ^<1^ CLn^ ^h^^^ ^.!<\^^ Pumper's Name (Print)I ^-w^n^W^«^^v^r^6. JWe- Pumper's Slgnat Pumpers' Registration » 2SS2. We acknowledge the instailation of (a) hoiding tank(s) on the following property: (Provide COMPLETE iegat descriptions) m»ECTLocsnoN ttgat &esieriBtfS»;:': ::::-; ; (UKTaKStetemGnt} Seeticm ,<^ I ^ :,.wmhto _ :^J :/W.» •SurtlatI :£<>t»'VSM^;. li2t- Vol. Pagd ">w\l. n?j2d^L—_W ®)WOw#.mm totfsf No,SSMW^: J/4;_. -ZfH, Town of; :w\'lotSte Acreage':w/:5uWl»l»ar»; • '/'1! : 11\:;;;:1';11^^:1,'11111::111::1..'; ^^ :,A: 1. The owner agrees to fife a copy of this contract with Bayfleld Coynty as required in SPS 383.55. Wis. Adm. Code. 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 tsnk(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tenths) with the pumping equipmerrt. The owner further agrees to pay the pumper for sli charges incurred in servicing the holcjlng tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local government unit which has signed the pumping agreement required by SPS 383,55, Wis. Adm. Code, and the County, a report for the seryidng of the holding tank(s) on a semiannual basis. The pumper further agrees to include the foltowing in the semiannual report; a. The name and address of the person responsible for sen/icing the holding tank; b. The name of the owner of the hoiding tank; e. The location of the property on which the holding tank is installed; d. The sanitary per-mit Rurnber issued for th@ holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tan!< for each servicing; g. The disposal sites to which the contents from the holding tank were delivere'd. 4. This agreement w!fi remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to fiie a copy of any changes to this sen/ice contract or a copy of a new service contract wtth the loca! goveroment unit and the County named above within (10} business days from the date of change to this service contract; Owner($) Name(s) (Print) Sc^-^ Cr- /<Lu^ ^Wn^C .K(l Owner's Slgn8tufe(s}]5c<^- ?f W^^M ^ •'^€^M^-[ Subscribed and Sworn to me: on thisd^L—day of r^ I C I .,JW Notary Public '-> emission expires on:QL|l / 51 Revised; May 2016 (®May 2018) ^^ _^ ^_^... •^._.v0 .'^?.Personal information you provide may be used for secondary purposes [Privacy ^wc^.<§.(^8^»)|.' c^<~s^s^7/"tni!'m\\^v DraftedkJt-^.'te.ri'vuz.C. Xl U&, BAYFIELD COUNTS SANITARY PERMIT f#04)-24-42S STATE SANITARY PERMIT OWNER: SCOTT & KATHERINE KLUG GOVTLOT: LOT: 1 BLK: CSM:613 1/4 1/4 SEC: 27, T 51 N,R6W TOWNSHIP: Bell SOIL TEST: 85-23 NEW SYSTEM SYSTEM T^PE: Holding Tank PLUMBER: Dean Blakeman ALESSANDRO HALL Authorized Issuing Officer DATE: 5/6/2024 CHAPTER 145.135(2) WISCONSIN STATUTES a. The purpose of the sanitary permit Is to allow installation of the private sewage system described in the permit. b. The approval of the sanitary permit is based on regulations in force on the date of approval. c. The sanitary permit Is valid and may be renewed for specified period. d. Changed regulations will not impair the validity of a sanitary permit. e. Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. f. The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. PREVIOUS PERMIT #: LICENSE: #221123 Condition: Tank to meet all setbacks. Management plan to owner. Properly maintain system per recorded agreement. Construct cleanout for private interceptor per State rquirements. THIS PERMIT EXPIRES 5/6/2026 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION