Loading...
HomeMy WebLinkAbout24-66SRequest for Sanitary Inspection (24 Hrs. in Advance) Fax this form to Zoning Dept (24 Hrs.) prior to when you want an inspection — (715) 373-0114 If you do not have a fax and must email the inspection; you must email all staff members. Note fl Time Change fl Discrepancy fl Other Phone Number Plumber: Superior Plumbing & Mech. Inc. Fax Number Email Address Homeowner: Brad & Melinda Olson ed@superiorpmw.com Immediate Phone Number So Zoning Sanitary Dept can call you right back (if needed) Permit #: 24-66S Plumber's Choice Zoning Dept No Inspection(s) during this time Date: Aug. 12 Monday OK Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice Zoning Dept Time: 11am OK Township: Bayview Address # & Road Name: 31985 Peacy Rd. Washburn or Directions To Site: Comments: * Plumbers you must verify any change(s) by fax or email ** Notes from u/forms/sanitary/requestfori nspection Zoning Dept (©4112/04): ® June 2023 POWTS HOLDING TANK INSPECTION REPORT (ATTACH TO PERMIT) GENERAL INFORMATION Permit Holder's Name Plan ID No. BRADLEYP & MELINDA S OLSON Property ddress if Ava able 31895 PEACY RD WASHBURN WI 54891 TANK INFORM TYPE MANUFACTURER/MODEL# CAPACITY WV LAJ1ESEL Z er=TDArVQ J" I✓ .1J Property Line Well Water Service Building All -Weather OHWM Swimming Pool Road [11120 b so63 N DEVIATIONS FROM APPROVED PLAN Zom6 &° LP kJii5 4 ok COMMENTS (Persons present discrepal ies, etc.) n �.r� - fv PPQ') ,��'Gn qll V(etilt'e� dIIVC Clow _J IaG�4 -Tc Q yneckScUI p-�er , 0-A V V < r i n ..N'( -.. �e�ba�kS � M I v.� 4'ern k Pr0ft eit' Sr4 p G�1t�t COMPONENTS NOT INSPECTED Rd;rc� Sc i no+ .rnPllFe of f oP c &\ Plan Revision Required I ❑ Yes No Date: o ZZ / Z4 S' nature of Ins ector: Ced,_NZ@ber I 15 S Sketch on other side 10 of 13 4 Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoninnObayfieldcounty.wi.gov Web Site: www.bavfieldcountv.wi.ciov/147 BRADLEY P & MELINDA S OLSON 31895 PEACY RD WASHBURN WI 54891 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know 11fcis / /°J V✓'' ?D I was contracted by you to install a private onsite wastewater treatment system on your property described as: tOA/ .it'J NeSE S 3 a -ry3 'C `7 Notes: Abandonment of Old System to meet all applicable code requirements: o Tank was pumped by: C Tank was crushed! removed and pipes disconnected by: on at AM/PM On at (AM I PM) the above -mentioned plumber contacted our office to conduct a pre -cover inspection as required under DSPS 383. One of the following applies: ❑� System was inspected and appears to meet all applicable code requirements. ❑ System was inspected and appears to meet all applicable code requirements; however, a plan revision is necessary because the installation was substantially different than the original approval. ❑ System could not be inspected because plumber covered prior to scheduled time of inspection. ❑ System could not be inspected because plumber was not ready at scheduled time of inspection. County was unable to return to complete inspection. System could not be inspected because plumber was not ready at scheduled time of inspection. A re -inspection and $50 fee are required. ❑ System could not be inspected because County could not respond to plumber's time constraints. Comments: E -e G Ll �fC�-(''�n� food f U/forms/sanilarypropertyowner-input April2019 5S'-057 [) i` II" r k'z s i`1J `ZU2Y 'I partment of Safety f1 rofessional Services, County Bayfield Sanitary Permit Number to be filled in by Co.) j, V'6 J UN L ,t In Division stry Services :on!n Dept Sanitary Permit'Application State Transa ion Number In accordance with SP5 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 Project Address (if different than mailing address) 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 L Application Information —Please Print An Information Property Owner's Name Parcel # Brad & Melinda Olson 6658 Property Owner's Mailing Address Property Location 31985 Peacy Rd. Govt Lot City, State I Zip Code Phone Number Washburn, W 54891 612-372-8855 NE '/. SE '%., Section 30 T 49 N R 4 E or W II. Type of Building (check all that apply) / Lot # IR I or 2 Family Dwelling -Number ofBedrooms 1 �/ Subdivision Name ❑ Public/Commercial - Describe Use Block # ❑ Cityof ❑ State Owned-DescribeUse - ❑ Village of CSMNumber 55 Town of Bayyiew Ill. Type of POWTS 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 y ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) ® Holding Tank ❑ In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner 1st Previous Permit Number and Date Issued Expiration IV. DispersaliTreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (sf) I Dispersal Area Proposed (sf) Elevation 150 Jtem Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units . C I New Tanks Existing Tanks " o u .c aU 0t, rn IEC7 Septic or Holding Tank X 2000 1 Weser Concrete x Dosing Chamber V. Responsibility Statement- I, the undersigned, assume respoasibllity for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature I MP/MPRS Number I Business Phone Number Edward B. Redinger 221939 715-292-6670 Plumber's Address (Street, City, State, Zip Code) 1015 11th Ave. E. Ashland, W 54806 VL County/Department Use Only Approved ❑Disapproved PPe it Fee Daattes Issued Issuing Agent Signature O Owner Given Reason for Menial I Conditions of Approval/Reasons for Disapproval / j� tsPDk 1c,ff)c'r{ oil S�'j'GGtlkS 'a/Q4t f'' a , /u'ii as' s f C11 WC04 ' for., free ded G7 `Pei rc- •fr1G,> CIh4n i P t1i 10 &,Jncr, '/4n S/4p for Inc system ann submit to the county only on paper not less than 8 In x It inches in size SBD-6398 (R. 03/22) L _Oo0L1� Wisconsin Department of Safety end Professional Services Division of Industry Services APR 29'[024 ge� of� SOIL EVALUATION REPORT 8avfie1d Co. Zoning Dept. In accordance with SPS 385, Wis. Adm. Code County Sri TES Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, Bayfield but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. 6658 Please print all information. Reviewed j by Da Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). A r 0 � 7 Z Property Owner Property Location ❑ El Bradley Melinda Olson Govt Lot NE V4 SE v4 s30 T 49 N R4 E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: 31895 Peacy Rd same City State Zip Code Phone Number ❑ City ❑ Village It Town j Nearest Road Washburn WI 154891 1172-8855 Bayview IPeacy Q NewConstructlon Use: El Resldlentlal/Numberof bedrooms 1 Code derived deslgnflow rate 150 GPD ❑Replacement ❑ Public or commercial —Describe: Flood Plan elevation if applicable ft. Parent material Sandy lacustrine/outwash General comments and recommendations: Holding Tank due to high ground water in area Lii Boring# ❑Boring 99.4 8 98.74 [Pit Ground surface elev. #. Depth to limiting factor in. / elev. ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots son Application Rate GPD/FF 'Eff#1 Eff#2 1 0-8 2.5yr 2.5/1 Is 0 ml Cw 3co .7 1.6 2 8-13 2.5yr 5/1 Gleyed ft 0 sg ml CW 2m .7 1.6 3 13-24 7.5yr 4/6 c2d 5yr 5/8 gr s 0 sg ml CW - .7 1.6 4 24-60 5yr 5/2 cos 0 sg ml 7 1.6 wllr .,,.,, Into Note .134' N.d �. I I Boring # ❑Boring ❑Pit Ground surface elev. ft. Depth to limiting factor in. / elev._ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. ConL Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots son Application Rate GPD/Ft' •Ef#1 •Eff#2 oMO,ti CST Name (Please Print) Signature CST Number Edward B. Redinger 221939 Address 1015 11th Ave. E. Ashland, WI 54806 Date Evaluation Conducted 4/22/24 Telephone Number I 715-292-6670 ' Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 £150 mg/L • Effluent #2 = BOD, s 30 mg/L and TSS 5 30 mg/L SBD-8330 (R04/21) Pd LSD D94 /4 "` r SUPERIOR PLUMBING MECHANICAL (715) 278.3456 Customer Name: Brad & Melinda Olson Adress: 31895 Peacy Rd Washburn, WI 54891 Phone #: 612-372-8855 Email: mellomom345@yahoo.com csT#���— Scale: 1" = 40' • 1/6 PIN: 6658 S Acres NE SE 530 T49N R4W Town of Bayview Bayfieid Co. A ti..ft1.=/66' 7hresLe/1aV)mc, Bayfield Co. Zoning Dept. NI t� g PAGE 1 OF 4 Holding Tank Plan Index & Cover Sheet D �, !! j��� Manual Design References: lil l JUN 0 5 2024 Componentg Holding Tank Version 2.1 (May 2022-2027) hr l Cr Z:j;nq Dept. 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 ap Holding Tank Pumping Contract (if appl Holding Tank Agreement (if applicable) Project Name / Description New 1 Bed Holdino Tank Owner Name(s): Brad & Melinda Olson Owner Address: 31985 Peacy Rd. Washburn, WI Zip: 54891 Project Address: Same Govt. Lot: NE 01 /4 of SE 1/4, Section 30 , T 49 N -R 4 E ❑ or W ❑✓ Township: Bayview County: Bayfield Project Parcel ID #: 6658 plicable) cable) Phone: 612 -372 -8855 Designer Information Designer Name: Edward B. Redinger Designer Address: 1015 11th Ave. E. Ashland, WI E-mail: ed@superiorpmw.com License Number: 221939 Remarks: Signature Phone:715 _292 _6670 Zip: 54806 This space reserved for approval stamp. Date: 6/6/24 Original signature required on each s bmitted copy. a. SUPERIOR PLUMBING MECHANICAL (715) 278-3456 Customer Name: Brad & Melinda Olson Adress: 31895 Peacy Rd Washburn, WI 54891 Phone #: 612-372-8855 Email: mellomom345@yahoo.com CST# 221939 Scale: 1=40 , yb PIN: 6658 5 Acres NE SE 530 T49N R4W Town of Bayview Bayfield Co. I ^ .&:jao' TArt5L o/de� VmC rz ci—ry brw/r_ 1066 4 l A N r AtI PAGE 3 OF 4 HOLDING TANK SPECIFICATIONS (No Scale) Weatherproof Junctlon and JJAlarm Box Electrical must comply with SPS 316 and NEC 300 —Conduit Ainight Seal 18"Min. (typical) Approved Joints with - Approved Pipe 3 ft onto Solid Ground a 12" Min. or 2.0 ft above Approved Established Flood Elevation Vent Cap (typical) Approved Locking Manhole 4"0 Vent Pipe with Warning Label Attached > 10 ft from (typical) 4" Min. or 2.0 ft above Building I Established Flood Elevation .-._ 1 — / (typical) Inlet Invert Max. 12" or 90% of total volume if more than one tank HOLDING TANK VOLUME = 2000 gal 3" Approved Bedding Material Beneath Tank TANK MANUFACTURER: Wieser Concrete Finished Grade Plug Anchor tank as necessary pursuant to SPS 383.43(8)(g) Ballast Weight = [(cu.ft.tank.vol x 62.4 Ibs/cu.ft) - lbs.tank.wt] x 1.5 Ballast Weight = [( cu.ft. x 62.4 lbs/cu.ft) - Ibs] x 1.5 = Ibs WLP2000-MR TANK SPECIFICATIONS 164" 4' CAST -A -SEAL 4" CAST -A -SEAL DIMENSIONS: WALL: 3" BOTTOM: SEPTIC 3" HEAVY DUTY 5" (ADD 2,600 LBS.) COVER: 6" MANHOLE: 24" I.O. PRECAST CONCRETE RISER HEIGHT: 53" O.D. LENGTH: 164" O.D. WIDTH: 96" O.D. BELOW INLET: 41" O.D. LIQUID LEVEL: 36" WEIGHT: BOTTOM 11,260 LBS. COVER 8,170 LBS. INLET AND OUTLET: 4' CAST -A -SEAL BOOT OR EQUAL FILTER OR BAFFLE -� INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL 1/10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 56.27 GAL/IN LOADING DESIGN: 8' 0" UNSATURATED SOIL TOP VIEW m a a - M I � PUMP PAD SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 2,138 GALLONS MN TANKS: WILL HAVE ONE VENT OVER OUTLET AND WILL HAVE TWO VENTS IN COVER OVER INLET TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #'8 (NO FIBER) TANK: MIX DESIGN #9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE JOB INFORMATION: CUSTOMER: JOB NAME: DATE NEEDED: APPROVED BY: ,PPROVAL DATE: J ^O � � N Z I Q Z O � � R V O F w w U' N D_ SHEET NO. 1OF 5S- 5 1 � �)� ) oIllpkpartment of Safety Cowry ro Bayfield �&jProfessional Services, f:jj� JUN 0 '2024Instry Services Division Sanitary Permit Numbr(to befilled inbyCoJ Sanitary Permit Application Sate Transaction Number 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 Project Address (if different than mailing address) 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. I. Application Information — Please Print All Information Property Owner's Name Parcel # Brad & Melinda Olson 6658 Property Owner's Mailing Address Property Location 31985 Peacy Rd. Govt. Lot City, State I Zip Code Phone Number Washburn, WI 54891 612-372-8855 NE /, SEA, Section 30 II. Type of Building (check all that apply) / Lot T 49 N R 4 EorW 12 I or2 Family Dwelling— Number of Bedrooms 1 V Subdivision Name Block # ❑ Public/Commercial — Describe Use ❑ Cityof ❑ State Owned — Describe Use CSM Number ❑ Village of _ ® Town of Bayyiew III. Type of POWTS 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 ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. 0 Holding Tank ❑ In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner ist Previous Permit Number and Date Issued Expiration IV. DispersaVrreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sl Dispersal Area Required (sf) I Dispersal Area Proposed (st) Jem Elevation 150 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units a oo $ u New Tanks Existing Tanks e u . m o — Z eU m V n J. Septic or Holding Tank x I 2000 1 Weser Concrete x Dosing Chamber V. Responsibility Statement- I,the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) I Plumber's Signature I MP/MPRS Number I Business Phone Number Edward B. Redinger 221939 715-292-6670 Plumber's Address (Street, City, State, Zip Code) 1015 11th Ave. E. Ashland, W 54806 VL County/Department Use Only 'Approved O Disapproved Fe i Fee Date Issu Issuing Agent Signature / 3 b ❑ Owner Given Reason for Denial g2,3 Conditions of Approval/Reasons for Disapproval a par to meri all Se+G (k5 - '° IGnI[ fo be W'h)i1) zc, ,P all wc&* Rf [o4J . •m4rtr ni P n fo at✓nnr, ,'ognnii,n syiP,--) per r?e d eol Pi(9lPc n¢* •'c- )a+r �� ki nt) Suer t-- St,r* r4 Attach to complete plans for the system and submit to the County only on paper not tens than 8 ml2 x II inches in size SBD-6398 (R. 03/22) PAGE 4 OF 4 Holding Tank Management Plan IMPORTANT: The owner of this holding tank(s) shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this holding tank(s) shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Estimated Daily Wastewater Flow = 150 Inspection 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 electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o surface discharge of effluent or sewage back-up into structure served SERVICING FREQUENCY o The tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wisc. Stats. when the wastewater in the tank(s) reaches a level of one foot below the inlet invert of the tank(s). Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. Tank pumping reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wis. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Superior Plumbing & McCh. Inc. Phone: 715-292-6670 Local government unit: Bayfield Co Zoning Phone: 715-372-6138 Local government unit address: 117 5th St. E. Washburn, WI ZIP: 54891 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. 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, Wisc. Admin. Code. JUN 06/0/4 HOLDING TANK— MANAGEMENT PLAN The Private Onsite Waste Treatment System (POWTS) has been designed and is to be installed and maintained according to SPS 383, Wisconsin Administrative Code, Holding Tank Component Manual for Private Onsite Waste Treatment Systems (SBD-10571-P)(R.6/99) and the Bayfield County Zoning Department Sanitary and Private Sewage Ordinance. 1. This POWTS has been designed to accommodate a maximum daily flow of /So gallons of domestic wastewater per day. 2. The owner of this POWTS is responsible for system operation and maintenance, locking device, alarm and access. 3. The owner or owner's agent is required to submit reports as required by SPS 383.55(1), Wis. Adm. Code, to the Bayfield County Zoning Department. 4. Design approval and site inspections before, during and after the construction are accomplished by the county or other appropriate jurisdictions in accordance with SPS 383 of the Wis. Adm. Code. Maintenance Cycle. The holding tank must be serviced by licensed pumpers. An alarm system is to be installed to activate when the tank is < 90% full. Performance monitoring. At the time of servicing, the service provider files a report with the department of designated agent. A User's Manual will accompany the component. It will include the names and phone numbers of local health authorities, component manufacturer or POWTS service provider to be contacted in the event of component malfunction or failure. 8. In the event that this POWTS or a component of this POWTS fails and cannot be repaired the owner will find in the User's Manual the names and telephone numbers of property licensed individuals to contact for such repairs. This agreement shall be binding on all assignees and heirs N 1/4 of 1/4 Section 36 Townshipy'N. Range _1/_ W. Town of 13ctyvs 't. o Govt. Lot Lot Block Subdivision CSM# ate Revised: July 2013 HOLDING TANK SERVICING CONTRACT J, Contract Date 1/-Z/2y Holding Tank Owner(s) Name(s) 3rJ/ey .- t' %/nh O/5i' This contract is made between the Pumper's Name (Print) Pumper's Signature Pumpers' Registration # g:r 3 u Ce /aa� We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) Legal Description: TaxI 15-91 1/4,St 1/4, OCATIO LOCATION (Use Tea Statement) IO 6 L/ 9 Section � Township i N, Range W Town of: � Lot Size Acreage , Gov't Lot Lot ft CSM N. Vol. Page CSM Doc ft Lot(s) No. Block(s) No. Su ivision: 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; ANN M. HUYBRECHT c. The location of the property on which the holding tank is installed; NOTARY PUBLIC d. The sanitary permit number issued for the holding tank; STATE OF WISCONSIN e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each sere icing: 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 with}'n (10) business days from the date of change to this service contract. / r / Owner(s) Name(s) (Print) 1 ner's Sig a re(, / ISubscribed � and Sworn to me: n thisyt day of fli ,2T)1 Note P blic My commission expires on: t7�-3� Revised: May 2016 (®May 2018) Drafted by1346i Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)) Document Number/Plan I.D. No. HOLDING TANK AGREEMENT OllwfnerName Not" 3/ 89S ,?eae y Parcel Identifier Number (PIN) Agreement Date (same as Notary Date) on the following property or that continued use of the existing premises requires that e 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 onsite wastewater treatment system as permitted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Stats. WE 1/4 of 114 Section Township 419N. Range / W Town of Additional Legal Description: U /. , 1E7 L_) /Z Gov't Lot Lot_CSM # Vol _Page CSM Doc# :=O24P-'.0:34'35 Return To: ,-3.Y6'. Id co 'fl JUN 0 57024 As an inducement to Bayfield County to issue a sanitary permit for a holding tank on the above described propeAx.stardtgToZOning UBpt. following:ce 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 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 a special assessment for current services rendered. The 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 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. 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 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. Slats., 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. 4. The owner agrees to contract with a person licensed pursuant to s. 281.48 (3) Wis. Slats., and Ch. NR 114, WI'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. 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, WI'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. 6. 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 deterrytined by reference to the property where the holding tank is installed. I s) Name( ) Please P 'n Subscribed and sworn to before me on this date: 3D, DS o ized O ner(s - IgnatureFslvtary Pu �Co�1mmission Expires: �L Drafted Personal inlom,arlon you provide may be used for secondary purposes (Pnva(y LAW, s.15.04 PAM)] I ANN M. HUYBREC T Date: S d yI NOTARY PUBLIC Wrnrrwsanuery '°91714�F&Od1�'WSCONSIN BAYFIELD COUNTY SANITARY PERMIT (#04)-2466S STATE SANITARY PERMIT OWNER: BRADLEY P & MELINDA S OLSON GOVT LOT: LOT: BLK NE 114 SE 1/4 SEC: 30, T 49 N, R 4 W TOWNSHIP: Bayview SOIL TEST: 60-24 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: EDWARD REDINGER Alessandro Hall Authorized Issuing Officer DATE: 6/14/2024 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: # 221939 Condition: Tank to meet all setbacks. Tank to be within 25 of all weather road. Managemen plan to owner. Maintain sytem per recorded agreement. Insulate building sewer per state code. THIS PERMIT EXPIRES 6/14/2026 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION