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HomeMy WebLinkAbout24-46S HamiltonI': ''• Department of Safety & Professional Services, Industry Services .Division County B^^:^ii Sanitary Pi 0/L^^°A_I.LSanitary 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 secondaiypurposes in accordance with the Privacy Law, s. 15.04(1 )(m), Stats. State Transaction Number Project Address (if different than mailing address) I. Application Informatiqn - Please Print All InformationII ^^TYJ, _. / ^-^^TcV '^\y^ ^-t ^ ^ ' ( T c? ^ Parcel# "•i <-\^ -/ s ^ 0 Property Owner's Mailing Address U I f £> L ^ ^ s /-< ^ City, Stale ^^e.^, g_.^^^ -J^L II. Type of Building (check all that apply) 1 or 2 Family Dwelling - Number of Bedrooms. Zip Code 5~Y-?Y7 3 D Public/Commercial - Describe Use D State Owned- Describe Use Property Location Oovt. Lot. Phone Number -7 i£~ ^c(7--^(c /J ^IA/,^ /J^,\'/<, Section 3(- Lot #/^' N _R_5_^o_<© Subdivision Name Block # CSM Number a City of__ a Village of ?B Town of OL>IY III. Type ofPOWTS Permit; (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if| , applicable.) A,8 New Systen D Replacement System D Otlier Modification to Existing System (explain)Q Additional Pretreatment Unit (explain) B.8 Holding Tank D In-Oround (conventional) a At-Grade D Mound a Individual Site Design D Other Type (explain) c.D Renewal Before Expiration D Revision D Change of Plumber D Transfer to New Owner List Previous Permit Number and Date Issued IV, DispcrsaI/Treatinent Area and Tank Information: Design Flow (gpd)i( STO Design Soil Application Ratc(gpd/sf)Dispersal Area Required (sf)Dispersal Area Proposed (sf)System Elevation Tank Information Capacity in Gallons New Tanks Existing Tanks TotalGallons # of Units Manufacturer £. 3 te•S5 Suptitwr Holding Tank z-S-<?o ^5~oo ^Uh'-e.s.o.K C.ef^C..^ Jlosiiitj Chnnibar V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) ) eui 7^ ^ ^-ffS^< Plumber's Signqture^<T^L^L •MP/MPRS Number 2.2.^0C? 0 Business Phone Number -^S""^^-^l<S~(ft Plumber's Address (Street, City, State, Zip Code) - ~_ ., J=>.a Bc.?c ^^. ' ^-^^<?.^^^J^^^7 VI. County/Department Use Only iproved^0 Disapproved D Owner Given Reason for Denial late Issued^^-^'-1 Issuing Agent SignatureA- Conditions ofApproval/Reasons for Disapproval „ ' ^^ '^o rc\^ a\) S4^C^J w^^^.h y^^-ti oy^-wtz>/-n^i ^^, ?r\. ^y^-^y-^ ^/" r!"r<J rk ^ ^ < \^ ^ ^ v^h^ 7 $-' o^ ^ ^ v^4^^' ° c'4 Attach to complete plans for the system anit submit to the County only on paper not less thnn 8 Itt x II Inches In size SBD-6398 (R. 03/22) CO. n/?SK' Wi ;'^%s.;'\t pe/7%JWWI/ ,MAT OG^Bayfield County SoilTest#/|| j :-y I,Hti •Q/(-V " ••'firi-i r. ^ Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) OS a 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. . , \ ^o Q cH-h^ p/6', /y^ ^^\ Property Owner.!<.i K/-v ^4-^ <^i,0 6\Contractor Authorized Agent.Property Address ^ / ^o ^- ^ ^ '^€^ •^i^^^ ^-t ^ ^-y i^ T- S~~({S<{'7 Agent's Telephone. / Telephone -7 / ^ ^ 2- - H^/3 Written Authorization Attached: Y or N Accurate Lega! Description is requested: ^1/4 of A-)f^l/4 Section s^ Township ¥ ^ N. Range 7 W. Town of ^ ^ ^ Additional Legal Description: Govt. Lot Lot Lot_CSM#_ Volume_Page. Block __Subdivision Vol. _ Page _ CSM Doc #. _of Deeds Tax LD# •Z-"7 ^ 3 o Acreage l/° Indicate reasoning for your determination ^>o^-r5 c.^^L<„ _^_^^ 1: tJ-^t^ C/cii^^^. $ o, /j; -- ^^ o 't'^-s&<< 1-_^e <L '^ Signature of Certified Soil Tester ^- c^^ ^-Y^ Date oci o Signature of County OfficialS/6/^ Date Certification # (Submit a Plot Plan & Fee) u/forms/soiltestwaiver(KLK) June 2018 J & ^A.^ ^-^i,-;,11 Q"" ^/lJ-) c...^U L-^- ^M.Ti // ^/•H.^L'•"zy1-/•7-DH /M ,1^^y^J^A H 7 9 ^ P r "i ' ( i & ~ ^ 1 & s ? ? ? & ° - E> i ?M 5 o c, 5- ^ o ^^ /< - , s^ ^ - y -^ '^;? y< { ~t - s : ^ . - / , v^ s ^ i i <^ ^ : Y ^ ^" A ^ \^ ^ ^ - . ^ ~T ^-. " ^ ^ 0 R I ^ t . 0 -< r - 4 - p- , - ^ cw 4-£0en (~ 0 cr ; r^ o U-u - i J / ^ % 0 r ^ •f t ^•I N 0 w^)0 c.k^IK n6 rftc v^r-- - • 0 ^- ( 0 ^,- f ,9 . as^^ r' r ^ ~ 1 Q & • ? & s; ?•+ "^ : -^^ ^ & ^ - r > *. « 1 a nj ^ c ^ ?? IAc- «. » ? -4 - o ^' + a^ - . • , z ' ' » , ^? 1 V ri ^ K ^— < s % 0 ' kr ! s \< J i ±- ^ C» I A < - — ^3 (* •^p.Oi -t -»0- ^ f t ^ •* n ? - -' s' ^ f ? ' ^1 s- c ^J ° <y £ > iS •s . r Il l ft b . V ' 4 •« ( 5 —: _ ' q 'r 0 a ^ < Q — ^ 0 T1. - • ft ' $ ^ ^ ' — S « < (S " - ; " . " I / .v ' <A .+ • 1/ 1 -? ^ ^ .. ^ ~ }y & ~ p^ - 0j^a. i s . •^ l ? ^ BAYFIELD COUNTY (fij | (^ ^' | I |J j^CHECKLIST FOR CERTIFIED SOIL TESTS ^ ~ ^ fjjjV MAY 062021 ^ Submit the Following (Use Permanent Ink): 0 Check List 10 Index Page / Title Sheet (Optional) [3 Original Soil Evaluation Report (Submitted in Deed Holders Name - not prospective buyers) ^ Original Plot Plan D Cross Section Soil Profile Sheet (optional) D Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) Z Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used 13 Property Owner's Information (not prospective buyer's name) B Property Location (Accurate Legal Description with Sec/Twp/Range) E] Road Name (where driveway is/will be coming off of) iZi Floodplain Elevation, Flow Rate, Comments and Recommendations 0 Complete Soil Boring / Pit Information 13 Date Soil Evaluation was conducted 13 CST Name, Signature, Number, Address and Phone Number D *Date Stamp* plot Plan; (Include the following information drawn to dimension or to scale) El Bench Mark (Description, Elevation and Location) 0 Contour Lines (Example = 98.0' ,96.0' ,94.0') G3 Pioperty Location (Sec/Twp/Range/, Accurate Legal Description) El Borings (Locations and Elevations) 33 Percent and Direction of Land Slope 0 Well Location (Including Neighboring Wells, if applicable) ri Location of Wetland Areas, Floodplain and Navigable Waters \S Buildings, Driveways, and Structures (Location and Descriptions) gj Location of Property Lines Ef Existing System Location El Address Number and Road Name 13 Current Surface Elevation of Wetlands and Navigable Waters Ei CST, Owner and Property Information North Arrow Fee; E3 Certified Soil Tests - Review &. Filing Fee .. $ 50.00 , . u/forms/sanitary/checklist/checklfstforcsts ,,--.» vu i i.nnnnm Of /.VimUB No.99?5 P. 2 Holding Tank Plan Index & Cover Sheet PAGE 1 OF §> 062024 Hi! u Component Manual Design RQferenoefs: J -tyreYVAr.s)»^.!.);^,^U^ ^e^.^.-^oz^' Pg1 of S Pg 2 ©f '§ Pg3ofg Pg 4 of S Attachments^ Index & Cover Sheet I Plot Plan { Holding Tank SpeolficatiOjns Management Plan | Rnelosur©ss p^< ^fs»'^ ^^ P^ 7 ^ ^rii ^-i POWTS Applicatjon for Review CStin^a^/ 'ip<l-lrm' Soil Evaluation Report & Site Map (if applicable) Holding Tank Pumping <pontract (if appliGable) Holding Tank AgreemeiH (if applicable) Project Name I Doscripfion Owner Name(s): ^'^ N<-< ^0 t-1 Phone: \ ~7^~- ^^ ^ ^ Owner Address: k -I 0 o L-a. u s f-e ^J_ 'J^-' - -. p. ^ ^^j^Zip: JL£jC£2- Project Address; S^< -—^. ^c J c< ^^C __,,j Govfc Lot: S -^ 1/4 of ^'^ .1/4, Section JE4_, T ^€\N-R T _E Uo^" w I7<Township: 0 ^ { ^ Project Parcel ID #; County:'{^ci ^i-p. "e-_( r^_^^_•££2- -7 ~^0 Designer Information d ' '. Designer Name: A / 1^^ r© / f^^sk:, Phone: 7/S~ -^"7'2-.-, L/' t ^ Designer Address:'P-&>BQ^ ^"-z-^Z^o-i ^.'^•^ 'W^ :Zip: _ai^2- E-mail: ~b"f- ^'7' <es-. ^ "e-a- <^~ ^ <-!> •' <^-v~z/l t::;l '"''i"^" <-' ^ *'^~. Thi^ space re&erved for spproval stamp. License Number: Remarks; 2-2- e?o '? 0 Signatur®: --. rft.e.^L'Datie: €~"'_ (-^^ Original slgnftluna required on aach submlued copy. W^ d . 0 ^ , A.pl p> 0 y TK ^ !3 ' ^ ^ -- S 1 1^ 1 ^^ f» ®t ^-^ s * , ^ Ec f ^ l ^ . ^ ?% ^ - ^ 7 - / ' r {^ ^ € ^ s ^ . '' e ' 2 ^ . w ^ y ' £ ^ ^ ^" ^ . ^ T -Y \ 'S ^ R ^ -^0 E (^ rp c.\f l -+ -p^- -<(& ^. :- s ^ ^ ? - ^' " 0 s ° 6 ?, ^ cw c. 0 ^f6Q r ? '• © ~: > d ^^ -^ ' c : : £ " ^ > -. ( " >^a i p- J c^ ~ i 0 & • € £ w^1 0 '\ ^:0-+ ^ <a '" - IH? ft fi > -J n ^ -< \ - J & •f c ^ ^- ~ t3 U\ (&& tAr^ -^ . ^ - + ya - ' z ^ y3 ' . V' ri ^ R ^~ - ' < S f c O ' 7^ - r - o i' J S -t " A ? > Oy i r f — y^n ., l bOt -n %& I^^•= ; 1' ^ ^ '^^r» ^ o .. - . 5 v- v^x l» c r& v > > ^ ® c ( 5 <~ ~ : _ ' - 0 :3 0 " ~ 0 0 ft - ^ ° " ^ 00 0 ' ? r" & . - S ^ 5- < - 5 i ; L f w ^ +3^ 9 ., ^ y Q ~ "u .0 ' ^~ Q. s •h ? c - c- PROPERTf OWNER: _^L^, ^^ ^ ^ l"^<^ PLUMBER: Allan Polkoski/ Poikoski Plum^nq SIGNATURE: ^Z^-— ^-^.^^_ DATE: —^r--r-^Y LICENSE # 220090 s. * HOLDING TANK SPECIFICATIONS MAY 062024 INumber of bedrooms jNon-residential estimated flow (gpd) '2006,6 I Minimum holding tank volume'required (gal) ^toiwrtw.1) f^ |"^5ioT"1Proposed holding tank capaciliafr<^<MWWl»?MU«il|WWMKWW(WWil(»i^^Tank Manufacturer ITank model number [Alarm manufacturer larm model number Tank Dimensions and Data IX for round tank ILiquid depth below inlet invert (in) IMaximum depth of soil cover (ft) VWWKitWtlWVSt^159.5-ssrH 'AtttilEfAWWUlfftUtorit IHeight(in) [Length (in)[Width (in) Outside Dimensions Only Tank Anchor Calculations Te840w|lbs Weight of tank and cover Safety factor [Ibs Weight of anchor required I in Soil cover req. for anchor or |yd3 Concrete counter weight HOLDING TANK CROSS SECTION junction box mannola cover with locking device and warning label $ 4" mln. finished grade'1 /vent cap C=3 blind plug to seat outlet service alarm on Electrical as perNEC 300 and Comm 16 Manhole and vent locations may be reversed. $ 12"min. vent pipe 12.0 In. 39.0 In. Note: All tank joints, an<3 joints between tank openings and piping are sealed watertlght. All pipe and vent materials complywithSps^gS :t:18"mln.A3) building sewer Intel 3 In, bedding under tank.Tank Is anchored as necessary to negate buoyanoy. f-t6 [6 ~i i^<\ ^ \ CL n K BAYFIELD COUNW 1^ !(i CHECKLIST FOR SANITARY APPLICATONS !|1| MAY 062024 Vi Submit the Following (Use Permanent Ink) (Title 15, Section 15-l-10(e)) 0 Check List 3 Original Sanitary Application (Submitted in Deed Holders Name - not prospective buyers) (383.21(1)1.) 0 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) K Original Plot Plan (383.22(2)2. 3. & 4.a) ^Cross Section, Over-Head Profile of the System and Schematic of Tank from Manufacturer P Pump Tank Diagram, Alarm and Pump Curve (when applicable) 0' 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) 0" Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) 0 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) 0 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 0 2 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to alLcopjesl 0 Soil and Site Evaluation Report (383.22-3(2)(b)l.e.) D State Plan Review (when applicable) D Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) 0 I Application Information must include: D 23 digit Parcel ID# - (do not use 12 digits anymore-obsolete) 53 Project Address or Road Name where driveway is/will come off of) 0' (Owners Phone Number) £i II Type of Building 0 III Type of Permit 12" IV Type of POWTS System D V Dispersal / Treatment Area Information 0 VI Tank Information S VII Responsibility Statement (Plumber's Information) D *Date Stamp* Plot Plan: (To Scale or To Dimension) Ef Signature and Plumber Information [St Address Number and Road Bf Surface Elevation of Body of Water . 10 North Arrow D Direction and Percent Land Slope D Contour Lines Bi Tank and Filter Information and Location ^ Structures and Driveways 0 Wetlands / Navigable Bodies of Water 0 Boring Location D Absorption Area (Proposed and Existing) Qi Property Lines [3 Bench Mark (Location, Elevation and Description) 52 Well Locations \S Component Manual Version 13 Legal Descriptions Sf PjgjhgJMatenallnlpnnatidn (conveyance line, building sewer line, matenal type and diameter) Turn Over > Bayfield County, Wl 5/7/2024, 10:09:30 AM :W'~ Wetlands t~—.,.i Approximate Parcel Boundary Rivers Road Type Town Building Footprint 2015 Building 1:3,481 0.04 0.09 0.17ml 0.05 0,1 0.2km Bayfleld County Land Records Department Bayfield Counly Zoning Application https^/maps.bayfiei.dcounty.v^.gov/ZonjngWAB/ 5/7/24, 10:15 AM Novus-Wisconsin Access rev. VZ.U2W Real Estate Bayfield County Property Listing Today's Date: 5/7/2024 \m..Description v Updated: 2/25/2013 Tax ID: 27330 PIN: 04-038-2-48-09-36-2 03-000-10000 Legacy PIN: 038108006000 Map ID: Municipality: (038) TOWN OF OULU STR: S36 T48N R09W Description: SW NW IN V.1101 P.607 648 Recorded Acres: 40.000 Calculated Acres: 39.843 Lottery Claims: 1 First Dollar: Yes Zoning: (AG-1) Agricultural-1 ESN: 125 Tax Districts Updated: 3/15/2006 1 04 038 044522 001700 '*B' Recorded Documents STATE COUNTS TOWN OF OULU SCHL-SOUTHSHORE TECHNICAL COLLEGE Updated: 12/9/2008 83 TRUSTEES DEED Date Recorded: 2/20/2013 E3 QUIT CLAIM DEED Date Recorded: 1/23/2007 a CONVERSION Date Recorded: 3/15/2006 2013R-548294 1101-607 •a Ownership Property Status: Current Created On: 3/15/2006 1:15:55 PM Updated: 2/25/2013 JONATHAN G & KIMBERLY3 HAMILTON IRON RIVER WI Billing Address: JONATHAN G & KIMBERLY 3 HAMILTON 6100 LAUSTE RD IRON RIVER WI 54847 Mailing Address: JONATHAN G & KIMBERLY J HAMILTON 6100 LAUSTE RD IRON RIVER WI 54847 Site Address * indicates Private Road 6100 LAUSTE RD Property Assessment IRON RIVER 54847 Updated: 9/22/2022 2024 Assessment Detail Code Acres Land Imp. Gl-RESIDENTIAL 2.000 16,000 143,200 G5-UNDEVELOPED 16.000 400 0 G6-PRODUCTIVE FOREST 22.000 24,200 0 2-Year Comparison 2023 2024 Change Land: 40,600 40,600 0.0% Improved: 143,200 143,200 0.0% Total: 183,800 183,800 0.0% Property History 2007R-511868 963-48 N/A 784-616 https://novus.bayfieldcounty.wi.gov/access/master.asp?paprpid=27330 1/1 HOLDING TANK SERVICING CONTRACT MAY !'i6/0^ Contract Date c,•^[c\^This contract is made between the Holding Tank Owner(s} Name(s) ^ i n-\ H" ^ i^-v i I't <":? Pumper's Name (Print) , , . -fJ^f&trtA.ca.s pofk.&S^.n ^sr«"\ 't^iif-^tf- $'«&.'p+«,.> Pumpgr'y Signature ^%^—=^y-^^ - Pumpers' Registration # ^iz-^i We acRno'A'.'edgs the iristaSiatiCi-s of (s) holding tank(s) on the fo!!ov/ing property: (Provide COMPLETE iegai descriptions) PROJECT LOCATION Legal Description: (Use Tax Statement); , TaxlDff .•Zl-73-31yllllll:;ii Section .•$.(? .TOwnshlB T Q N.Ranee ~] Gov'tLot lot»CSMti Vol. Page CSMDocff w l.o((s)No.Block(s)No. &L^^. /JJ^. .Town.of!';;^1;:",,1 ^!: 1^1 lll:;ll.l:110u-l^llllll: -s \ LotStee Subdivision; Acreage i/0 1. The owner agrees to file a copy of this contract with Bavfield County 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 tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local government unit which has signed the pumping agreement required by SPS 383.55, WIs. Adm. Code, and the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the hoiding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local government unit and the County named above within (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) -ft( Owner's Signature(s) .i.^'&^l^^\ R&^^ Subscribed and Sworn to me: on this 1^ day of /l^'i ^ •^.. ] '.,' P^y;%!^U^^ {UCUVY^- 'v.^.. %%:-h'".Notary Public %"^.My-pOiTirpi^sion expires on: ^^1^. Ss \ "•HAAN Revised: May 2016 (®May 2018) %. ,A / <?Personal information you provide may be used for secondary purposes [Privacyi^;;s.itSi,p4 (l)(m^|, .' ? .^ Drafted by r.n Document Number/Plan I.D. No. Owner Name (s) 1^1^[c. ^i t / ''^n Parcel Identifier Number (PIN) '-T^K^Z)^ ^--^^'JO HOLDING TANKAGREEMENT Owner(s) Mailing Address ,.^l^-b L^^^-e- ^o/i ^.- ^-^r ^JT"^/<?/7| Agreement Date (same as^ Notary Date) l/~^'z/ We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the properly cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Stats. Town of. /JuY. 0^ i ^ _1/4of 1/4 Section 3^Township . Range c\ w. Additional Legal Description: Gov't Lot _ Lot_Block..Subdivision._CSM#_ _CSM#_.Vol._CSMDoc#. DOCUMENT NUMBER2024R-603067 DANIEL J. HEF-F-NER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 04/26/2024 AT 1 1:1 5 AM RECORDING FEE: $30.00 PAGES: 1 Return To: •^"""0 v\ ^ 'Py£'' I ^— ^S ^<- • \^v-~-~ 3'oy .s -^v^^ ^^•e.^'^JS. -S'^SY'? K..,V, ~ . ..'. "~" ~ ''"I .".'•'rp~~ As an inducement to Bayfleld County to issue a sanitary permit for a holding tank on the above described property, we agree to do thefollowing: 1, Owner agrees to 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 tank property serviced in response to orders issued by Bayfield County or the Department of Commerce to prevent or abate a human health 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 speciai assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats. 2. 3. 4. 5. 6. Owner agrees to pay all charges and costs incurred by Bayfield County 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, Bayfleld County shall notify the owner of 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. 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 changes to 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 contract. 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 toinvestigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 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 wastewater 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 this 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, the heirs of the owner, and assignees of the owner. The owner shall submit this 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. _^fS^V^Sa'^Owner(s) Name(s) - Please Print //K ^-^ ^•>yi •'1 -^-" ^. '''•' .^/Frf-cia-d'^&tl g~ ..'••^ ^•"i -^ff s ? t, f-^ ^ „ SBGs^jbed and sworn to before me on this date: \'^ 's%. i^.^o^'i Notarlzed Owner(s) - Signature(s) ^ P^I "", ^71I," \ HAA|% \^. -pX '%-y:i:^-^w:"1G'F V;i|'i»>v^' lie<i ,"' /g/^S^vwLm. ti^^^ ,.My<eorBinlssion Expires: ^y b-i^-^o^^ ,"Ton^ po / k:tf.$k<Drafted by; Personal Information you provfde may be used for secondary purposes [Privacy Law, s,15.04 (l)(m)] Date;<-ici-^ u/forms/sanllary/holdlngtankagreemenl.doc ®June 2018 IA''! li n /IJZ4 HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and • gnaintained according ^ER 2.0 J, and is to be installed and . A I according tq^f^3$S V^is. Admin. Code, the Holding Tank Component ^anyalj^^«-^ ^^nv& .1 -f^f& and the ~ 'B^y-P'€. U County Sanitary Ordinance. ' C\^ 2'J) J ^<t-/ zoz.&^^o^J 1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 400.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and S'PS 383 and?84 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with £PS ^63.33 Wis. Adm. Code. 10. If there is a problem with, or question about this jnstallation, the fgjjowing persons should be contacted: a. Installer............................,'Pg I ^-^ f/uwil ^S m.^* f'i2.0oc{0 Phone: 7LSL3j^^L£&. b. Service Provider.... ..^.......... T^e^fC^y S^>4-^ ^^a Stir! Phone: '7,^- jiy-.j. - ^offlfo c. Co. Zoning or Health Dept. Qa^^&.j^ C^v^'~t.e^^_ ,,,_,„_ Phone: 7/j- 3-73, ^ &t^ n. L^J b^^i s^ fj^ s^^^^^r^^ ^^ "TO u» n, <3-^ i' 0 -^ ( ^TfFffun^f;. B^fjj P-av^?.T& "°. ^T^k Z i 2-7? SO Project Transaction Number: BAYFIELD COUNT/SANITARY PERMIT (#04)-2446S STATE SANITARY PERMIT OWNER: JONATHAN G & KIMBERLY J HAMILTON GOVTLOT: LOT: BLK: SW 1/4 NW 1/4 SEC: 36, T 48 N, R 9 W TOWNSHIP: Oulu SOIL TEST: 44-24 NEW SYSTEM SYSTEM P(fPE: Holding Tank PLUMBER: Allan (Tony) Polkoski ALESSANDRO HALL DATE: 5/9/2024 Authorized Issuing Officer 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: # 220090 Condition: Tank to meet setbacks. Management plan to owner. Properly maintain system per recorded agreement. Tank to be within 25" of all weather road THIS PERMIT EXPIRES 5/9/2026 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION