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Home My WebLink About24-62S Kurtz-Nevala1.". i^:\r^ 'K,-'^^-'^' Department of Safety & Professional Services, Industry Services Division <^-^^cl SilWf^ mj^ County &>c\^\(S\^ Sanitary Permit ^iuinber (to be filled in by Co.):?^5 Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this foroi to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state<iwned POWTS are submitted to the Dq)artment of Safety and Professional Services. Personal information you provide may be used for secondary piuposes in accordance with the Privacy Law, s. 15.04(1 )(m). Stats. Project Address (if different than mailing address) I. Application Information - Please Print All Information Property Owner's Name Ui>\V<a\A/\ \c\^ Parcel# \\^\2-'^\n^ Property Owner's Mailing Address ^4-1 ^ ^'^a.^ PA- Property Location Govt.Lot. City, State /v^o^, ^X Zip Code ^§s6 II. Type of Building (check all that apply) 1 or 2 Family Dwelling - Number of Bedrooms D Public/Commercial - Describe Use a State Owned - Describe Use Phone Number ~~]^-^ci'OISLf _'/4,__%, Section -30 Lot #3 T L\~\ N R OS' Eor( Subdivision Name Block # CSM Number w\i D City of. D Village of ^Town of £Fi i ee y\ m. Type ofPOWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C il applicable.) A.New System D Replacement System D Other Modification to Existing System (explain)D Additional Pretreatment Unit (explain) B.Holding Tank D In-Ground (conventional) D At-Grade D Mound D Individual Site Design D Other Type (explain) c.D Renewal Before D Revision D Change of Plumber D Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Information: Design Flow (gp^4SO^Design Soil Application Rate(gpd/sf)Dispersal Area Required (sf)Dispersal Area Proposed (st)System Elevation Tank Information Capacity in Gallons New Tanks $A Existing Tanks Total Gallons # of Units Manufacturer i? vs ~w s %•" 3tS U Septic or Holding Tank 060 L\oo^•9<l^e.Ser (^ACK-^G.xDosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) ^jA&e^ lA&UeiiJski' J Plumber'MP/MPRS Number Al88^C^ Business Phone Number "1\^-^-~IS^{ Plumber's Address (Street, City, State, Zip Code) \l\°\\ ^ ti^G U^\W^ D^ SH^C[[ VI. County/Det)artment Use Only ut Fee )L !H I Dgte Issuedwed r^oRK D Disapproved D Owner Given Reason for Denial Issuing Agent Signature,IllT^~r~7'iGon^i^ Conditions of^Approval/Reasons for Disapproval ^c^ \Q vy^r- S^^','"^ 'Wi^^s ^ MAW^tvw+ W ^0 Q^w. Attach to complete plans for the system and submit to the County only on paper not less than 81/2x11 inches in size SBD-6398 (R. 03/22) S^-ooo^ ew<?d % Bayfield County Soil Test # ^fj;^7-^ Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) I EDWARD J WROBLEWSKI _ 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. Property Owner WILLIAM N KURTZ JR Property Address xxxxx NEIVIEC RD MASON Wl 54856 Telephone.715-209-0154 Contractor EDIS MECHANICAL LLC Authorized Agent EDWARD j WROBLEWSKI Agent's Telephone.715-209-4055 Written Authorization Attached: Y or |N| Accurate Legal Description is requested: NE 1/4 of SE 1/4 Section so Township 47 N. Range °5 W. Town of EILEEN Additional Legal Description: LOT30FCSM2316INDOC2024R602613 Govt. Lot Lot Block Lot CSM# Vol. Subdivision Page Volume -Page. CSM Doc # of Deeds Tax I.D# 39145 Indicate reasoning for your determination:CLAY SOILS AND HIGH GROUNDWATER .Acreage.20.21 Signature of County Official 1^1Datefffff^O^ ^u-^. Signature pf Certified Soil Tester b I 2-2/-/ -Z. ^ Date SP-72000013 Certification # (Submit a Plot Plan & Fee) u/forms/soiltestwaiver(KLK) June 2018 ^^ -/^ ^7/ ^fr EDWARD J WROBLEWSKI, CST#SP-72000013 SOIL TEST PLOT PLAN WILLIAM NKURTZJR XXXXXNEMECRD MASON Wl 54856 LOT 3 OF CSM 2316 IN DOC2024R-602613 S30 T47N R05W TOWN OF EILEEN, Wl SCALE V= 50' N FUTURE GARAGESITE FUTURE DRIVEWAY >1000' TO WEST LOT LINE WELL0 FUTURE HOMESITE SOILBORING >400' TO SOUTH LOT LINE 40 50f SHEET 2 OF 2 BAYFIELD COUNTYCHECKLIST FOR CERTIFIED SOIL TESTS MMSubmit the Following (Use Permanent Ink): Check List a Index Page / Title Sheet (Optional) Jp Original Soil Evaluation Report (Submitted in Deed Holders Name ~ not prospective buyers) fJZT Original Plot Plan D Cross Section Soil Profile Sheet (optional) D Additional Information (Warranty/Quit Qaim Deed) (Optional) Soil Evaluation Report: (Include the following Information) ^ Parcel Identification Number (must be 22Jigrt Tax ID#) DO NOT USE 12 digit, they are no longer being used Property Owner's Information (noi prospective buyer's name) Property Location (Accurate Legal Description with Sec/Twp/Range) Road Name (where driveway is/will be coming off of) D Floodplain Elevation, Flow Rate, Comments and Recommendations D Complete Soil Boring / Pit Information ^ Date Soil Evaluation was conducted CST Name, Signature, Number, Address and Phone Number &*Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) D Bench Mark (Description, Elevation and Location) 0 Contour Lines (Example = 98.0796.0794.0') ^6 Property Location (Sec/Twp/Range/, Accurate Legal Description) tJZ] Borings (Locations and Elevations)\D Percent and Direction of Land Slope Well Location (Including Neighboring Wells, if applicable) D Location of Wetland Areas, Floodplain and Navigable Waters Buildings, Driveways, and Structures (Location and Descriptions) Location of Property Lines D Existing System Location Address Number and Road Name Current Surface Elevation of WeUands and Navigable Waters CST, Owner and Property Information ^North Arrow ^1 Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklisVcheckllstforcsts CONCRETE HOLDING TANK DESIGN Two Concrete Tank Option INDEX AND TITLE SHEET Project William Kurtz - Holding Tanks Owner William Kurtz Address 65475 Nemec Road Mason, Wl 54856 Phone: (715)209-0154 Legal Description LotSofCSM 2316Vol 13Page249CSM Doc^)23R-601132S30T47N R05W Township Eileen _ County Bayfield Subdivision Name Parcel ID Number 39145 Plan Transaction Number Lot No. MAY 3 Index and title sheet Holding tank specifications Site plan Management & Continency Plan Soil Test Soil Test Plot Plan Holding Tank Agreement Holding Tank Servicing Contract Holding Tank Specifications Designer MichaeLWroblewski Signature ^<%^' ) L-/ License Number \^§S^03 Page 1 Page 2 Page 3 Page 4 Page5 Page 6 Page 7 PageS Page 9 Phone No. (715)209-7521 Date 05/30/24 Designed pursuant to: Holding Tank Component Manual For POWTS (Version 2.0) SBD-10855-P (N. 03/07, R. 01/12) Version 7.0 (11/12)Page 1 of 9 WltLIAM N KURTZ JR HOLDING TANK PLOT PLAN 65475 NEMEC RD MASON Wl 54856 LOT 3 OF CSM 2316 IN DOC2024R-602613S30T47NR05W TOWN OF EILEEN, Wl SCALE 1"= 50' MAV i 'I ?!MAY J N'f FUTUREGARASESITE FUTURE DRIVEWAY ylOOO'TO WEST LOT LINE WELL0 FUTUREHOMEsrre 2 - 2000 Gallon Holding Tanks 4" pvc cteanout >400' TO SOUTH LOT LINE 16 20 30 40 SHEET 3 of 9 HA?/U/-'l HOLDING TANK SPECIFICATIONS Two Concrete Tante In If one- or two-family, number of bedrooms [And/Or....Non-residential estimated flow per day•'•SviSSSKSSlSSiSSaSSSSSSSSSSS,2000.0 | Minimum holding tank volume required 4000.0 ITotal holdina tank capacity proDos^-ii'is&'sfsssSsssasessSsssss^ssssssi'ig^ ^000.0_jTank 1 capacity (gal) L____JX for round tanks JiOOO.fiLjTank 2 capacity (gal) [WeseLConcrete_^ProductejJnc:;_JTank manufacturer [sjE^ombus^^^ manufacturer iTAAB-OIH jAlarm model number Tank j ,j__I Anchor weight safety factor in Exterior Dimensions (in)Ibs Information ! Ljq Level I Length ^;3£g^.s®^®--^^s^;^;»j^^i5®SBa^^^^^^^ss^^B»^sta^sss^»a Ibs Anchor Wt Tank 2 .53_L_JL51_1._86___,|_66_|_1537^ZIZiHZJZZls^ZJZZssZZIZ^18675 J_5370_J 18675 in ft Soil Cover I Max 24-6 L_I_ _7_24.8 TANK CROSS SECTION Manhde cover with locking device 2° min. ^~~'' ^ 4" mm. and warning label ^ _^uncgonbox 12° min. Vent cap Blind piug to seal outlet opening Finished grade*: Note: Manholeand vent locations may be reversed. Manhole diameter is 23"min. 2000.0 gal Inlet Tank 2 Tan k1 3 in. min. bedding undertanks. Anchortanks as necessary to negate buoyant forces. Electrical as perNEC 300 and SPS 316. Note: Alltankjoints, and joints between tank openings and piping are sealed watertight. Project: William Kurtz - Holding Tanks Transaction Number Page 2 of 9 CMI r^ -12--7" 4" CAST-A-SEAL 4" CAST-A-SEAL FILTER OR BAFFLE TOP VIEW SlDEJflBtt W2000-MR TANK SPECIFICATIONS DIMENSIONS:WALL; 2 1/2- BOTTOM: 4" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 66'' O.D. LENGTH: 12'-r O.D. WIDTH: T-T O.D. BELOW INLET: 53s 0.0. UQUID LEVEL: 46'' WDGHT: BOTTOM 9,450 LBS.COVER 5,940 LBS. INLET AND OUTLET:4" CAST-A-SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTCR:WISCONSIN, SEE DETAIL f10(OTHER STATES SEE CHART) UQUID CAPACITT: 42.92 GAL/lN HOLDING TANK:OUTLET HOLE PLUGGEDACTUAL CAPACITf: 2.126 GALLONS LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN ^ (NO RBER)TANK: MIX DESIGN f\0 (STRUCTURAL OBER) CUSTOMIZED TANKS:FOR CUSTOM TANKS CONTACT WESER CONCRETE TANKS ARE MANUFACTURED TO MEET OR D(CEED ASTM C-1227 REQUIREMENTS REVIEWED BY REVIEW DATE DRAWINGS SUBMITTEDFOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY; a: 000 <=3 u CL^ SHEET NO.1 OF 1 BAYFIELD COUNPfCHECKLIST FOR SANITARY APPLICATONS Submit the R)llowinq Ink) fTitle 15, Section 15-l-10(e)) Check List Original Sanitary Application (Submitted in Deed Holders Name - sgt prospective buyers) (383.21(1)1.) 'Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) Original Plot Plan (383.22(2)2. 3. & 4.a) Cross Section, Over-Head Profile of the System and Schematic of Tank from Manufacturer D Pump Tank Diagram, Alarm and Pump Curve (when applicable) 'W 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) Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) ff 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) Fee (Make Check Payable to BayHeld County Zoning) (383.21(2)(c)7) 2 Comfiiete Sets of Plans (383.22(2)(2.) (Note: Sanitary ADpijcation and Maintenance Agreements are to be attached . ro.slLc.QBJesl 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) Sa.nltary ADpllcations (Include the following Information) I Application Information must include: fl 23 digit Parcel ID# - (do not use 12 digits anymore-obsolete) Project Address or Road Name where driveway is/will come off of) % (Owners Phone Number) II Type of Building ^ Ill Type of Permit IV Type of POWTS System J_D V Dispersal / Treatment Area Information VI Tank Information VII Responsibility Statement (Plumber's Information) *Date Stamp* Plot Plan; (To Scale or To Dimension) Signature and Plumber Information Surface Elevation of Body of Water D Direction and Percent Land Slope Tank and Filter Information and Location a Wetlands / Navigable Bodies of Water D Absorption Area (Proposed and Existing) D Bench Mark (Location, Elevation and Description) Component Manual Version 1 Address Number and Road North Arrow Contour Lines 'Structures and Driveways Boring Locations Property Lines Well Locations 'Legal Descriptions rom Turn Over »• jCnKfcS^dton-andJlver-Heaei Profile of D Surface and System Elevation D Position of Observation and Vent Pipes D Dimensions and Depths D Make, Model & Number of Chamber Units in each Cell {^How many systems will there be on this parcel of land? Has this property been split? N f\ (Property Statement shows Property History) D Private Sewage System (Septic Tanks) $ 400.00 ^Private Sewage System (Holding Tanks) $ 400.00 D Mounds or Systems requiring Pre-Treatment $ 500.00 D Sanitary Revisions $ 25.00 D 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/forms/checklists/checktistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012-dc) Proofed by: Bayfield County, Wl P?Itl-4Tm<;.ID;-#il5996 %£!SS°£^Sls%5M PWI&^T^IKglWM! PRPIWTax.l?»l39i45 SPRM^Ta^BSJlBSM:";E§,IfiERSjSmOEM?HlWrLUAM'N~KURTZ;JR ffi^i%f^^^"^-Nf^iai wwys'ritsr^ww erort>/?^i6%39i<3ttBKEnNXM-ANOytSCHbLZE IBBIEYANYROSSINyLEWISB 6/5/2024, 3:56:51 PM Ai?"? Wetlands Road Type Rivers Town —.—i Approximate Parcel Boundary Building 0.02 1:1,788 0.04 0.09 mi 0.04 0.07 0.14km Bayfieid County Land Records Department Bayfield County Zoning Application https://maps.bayf!e!dcounty.wLgov/2oningWAB/ 6/5/24, 3:56 PM Novus-Wisconsin Access rev. 12.0206 Real Estate Bayfield County Property Listing Today's Date: 6/5/2024 I?.,Description Updated: 5/28/2024 Ownership Property Status: Current Created On: 11/9/2023 1:56:34 PM Updated: 5/28/2024 Tax ID: PIN: Legacy PIN: Map ID: Municipality: STR: Description: Recorded Acres: Calculated Acres: Lottery Claims: First Dollar: Zoning: ESN: Tax Districts 1 04 020 020170 001700 39145 04-020-2-47-05-30-4 i01-000-13000 (020) TOWN OF EILEEN S30 T47N R05W LOT 3 OF CSM 2316603206 20.210 20.160 0 No (AG-1) Agricultural-1 113 a" Recorded Documents IN DOC 2024R- Updated: 11/9/2023 STATE COUNT*' TOWN OF EILEEN ASHLAND SCHOOL TECHNICAL COLLEGE Updated: 3/15/2006 WILLIAM N KURTZ 3R KERRIE 3 NEVALA Billing Address: WILLIAM N KURTZ 3R 65475 NEMEC RDMASON WI 54856 Site Address * indicates 25475 NEMEC RD Property Assessment 2024 Assessment Detail Code Sm-AGRICULTURAL FOREST G5-UNDEVELOPED 2-Year Comparison Land: Improved: Total: Mailing Address: WILLIAM MASON WI MASON WI NKURTZJR65475 NEMEC RDMASON WI Private Road Acres 4.000 1.000 2023 0 0 0 54856 MASON 54856 Updated: Land 2,900 >/, 100 2024 6,500 0 6,500 1: 3/13/2024 Imp. 0 0 Change 100.0% 0.0% 100.0% H QUIT CLAIM DEED Date Recorded: 5/10/2024 a WARRANTY DEED Date Recorded: 3/15/2024 S3 CERTIFIED SURVEY MAP Date Recorded: 11/7/2023 3 TRANSFER BY AFFIDAVIT Date Recorded: 12/27/2017 a CONVERSION Date Recorded: 2024R-603206 2024R-602613 2023R-601132 13-249 2017R-571343 497-407 Property History Parent Properties 04-020-2-47-05-30-4 01-000-10000 Tax ID 16011 HISTORY S Expand All History White=Current Parcels Pink=Retired Parcels a Tax ID: 16011 Pin: 04-020-2-47-05-30-4 01-000-10000 Lea. Pin: 020106405000 39145 This Parcel T Parents '<r Children https://novus.bayfleldcounty.wi.gov/access/master.asp?paprpid=39145 1/1 Document Number/Plan I.D. No. Owner Name (s) L1\\^<^W^ Parcel tdsntifler Number (PIN)^CU4€- HOLDING TANKAGREEMENT Owner(s) Mailing AddressiTn"'CT^&^^^\1 Afc\\\o^,LJX 54866 Agreement Da(e {same as Notary Date)^ll^^ We acknowtedge 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 property cannot now be served by a municipal sewer, or any other type of private onsfte wastewater treatment system as permitted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Stats. -1/4 Of.-1/4 Section ^»0 Township L(~i N. Range 05'W. Town of £\le<°r\ Additional Legal DescnpUon: Gov't Lot _ Lot_Block..Subdivision._CSM#_ Lot.l_CSM #3^ Vol B Page ^<\ CSM Don ^^k-^<S I I 3^j DOCUMENT NUMBER2024R-G03327 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTS, Wl RECORDED 05/23/2024 AT 8:OS AM RECORDING FEE: $30.00 PAGES: 1 Return To: ^Q Va^ p^VVs^ m\ c-^y H^v <-' l^sU^^LJt: 5L^ As an inducement to Bayfield 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 alt 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 properly 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 aspecial assessment for current services rendered. The charges will be assessed as prescribed by s. 6S.0703, Stats. 2. 3. 4. 5. 6. Owner agrees to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otheiwise servicing and maintaining the hoUing tank in such a manner as to prevent or abate any human health hazard caused by the hokling tank. Bayfield 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 alt 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 senrice 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. Bayfeld 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. 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 thecertification 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. agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a^ existence of the agreement to be determined by reference to the property where the holding tank is instatl$&',^y-<• '<^"_.' ^c^&isd^:1 =^^/^^L iVfri^Aubmit this^4>l/(f<'SWit the:"^^ Owner(s) Name(s) - Please Print w/Notarizeij Owner(s) - Sigiyafur^(s) 5/(S^"/and sworn to before me 1C- My Cogimissign Expii'^7s;/////;r;?^ Drafted by: A >^ ( ^ \-6 Uaj&M Personal Information you pnm'de may be used for secondary purposes [Priuacy Law, s.lS.04 (])(m)) Date: 5//5-[^L1 u/fomis/sanitaiy/holdlngtankagreement.doc ^Uuns 2018 HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to SPS 383, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10855-P 03/07, R.11/12), and the _Bayfietd _County Sanitary Ordinance. 1. This POWTS is designed to accommodate a wastewater flow of 60.0 to 800.0 gpct. 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 second tank reaches a level of 12" below the inlet invert (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 covers) 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 SPS 383 and 384 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 30 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 from this holding 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). Connection 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 SPS 383.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer........................... _BigJ^e_Ptymbing|t_phone: JZl5)-20-9-752.^ b. Service Provider................ JBi^Street_Excavating SS^egtic_ Phone: .(7j_*^373-5683 c. County Zoning or Health Dept. _Ba^fiel^Cpynt^2onjng_ Phone: _(L1J>L3jr3-<138. 11. Project: Transaction Number: Page 4 of 9 HOLDING TANK SERVICING CONTRACT Contract Date This contract is mad® between the Holding Tank Owner(s) Name(s) u\\\\<^ ^\^v Pumper's Name (Print) C)0^\ ^S>e\^(?r Pumper's Signature (S^ Q~e£^^ Pumpers' Registration # \^0^> We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) •^jWK^Bffl^^soSfamM^ ^iiS® ;®W<tt»»t^ :w{J ^te^tbt^'iBttihi^1^'.1^; ':,^ /^;,.S:<B?e;nx5t^^ :3SiriiBK;'la ,sai^^'^iS^Si res^vwV' Bis .-_,iWK y^$.y_,i/g ;i-'R"w*<ifci^^%^,\';;s''y.^A|.toll :Si^iiW^y:,,'%%^ V^S:.i% 1. The owner agrees to file a copy of this contract with Bavfield County as required in SPS 383.55, Wis. Adm. Code. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of sen/icing the holding tank(s). The owner agrees to maintainthe access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. ^\\1>1111)//3. The pumper agrees to submit to the local government unit which has signed the pumping agreerQ^dWtiN'gdJi^PS 383.55, Wis. Adm. Code, and the County, a report for the servicing of the holding tank(s) on a s^ihWmaf pumper further agrees to include the following in the semiannual report: ^' <j\--' N D > - '''.rf^. The name and address of the person responsible for servicing the holding tank; = co i „ ^»^ ^ V$ = The name of the owner of the holding tank; =^:. ^. ;.torThe location of the property on which the holding tank is installed; ';^'-. The sanitary permit number issued for the holding tank; The dates on which the holding tank was serviced; '^7. .^IS'cio^^ The volumes in gallons of the contents pumped from the holding tank for each servicing; ////)mn'x^ The disposal sites to which the contents from the holding tank were delivered. a. b. c. d. e. f. g. ^,^'c ./^ ^''^r.c^^ 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) ^}, i/ <=t/1^-u ^ Owner's Signature(s) v^^-^ Subscribed and Sworn to me: an this ASlday of Or\^ . ^ by: IJ^^^~l^/^ V/V- Notary Public My commission expires on,:>J5 Revised: May 2016 (®May 2018) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (l)(m)] Drafted by /W BAYFIELD COUNTS SANITARY PERMIT (#Q4Y24r62S STATE SANITARY PERMIT OWNER: WILLIAM KURTZ JR GOVTLOT: LOT: 3 BLK: CSM: 2316 1/4 1/4 SEC: 30, T 47 N, R 05 W TOWNSHIP: Eileen SOIL TEST: 59-24 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: MICHAEL WROBLEWSKI 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: #MP 1288503 MCKENZIE SLACK Authorized Issuing Officer DATE: 6/10/2024 Condition: Tank to meet setbacks. Properly maintain system per recorded agreement. Management plan to owners. THIS PERMIT EXPIRES 6/10/2026 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION