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Home My WebLink About24-75S Tellier^%s-rp^€) %^y i^s-^ '••^MM^^'v^—~y/ Department of Safety & Professional Services, Industry Services Division County lCi Sanitary Permit Nuhiber (to be filldd in by Co.)74-7% 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(1 )(m). Stats. State Transaction Number Project Address (if different than mailing address) I. Application Information - Please Print All Information Property Owner's Name Bo^ TeUxe F Parcel#36(1^ Property Owner's Mailing Address '5^> 0<)cu\o.^o V^^- Property Location Govt. Lot City, State lAJa5U">U\N,!\ . L3^- II. Type of Building (chick all that apply) 1 or 2 Family Dwelling - Number of Bedrooms a Public/Commereial - Describe Use a State Owned - Describe Use Zip Code ^8ci\ ^. Phone Number -TytA-L?-Lmy^J^^Bioce ^love/^i>^ ^3xJ_>/4,_S<jj_/4, Section 6 <=. T ^ N R_^L_Eor(& ^^e^. Subdivision Name , n-'•^sk5Clniuli5t<^N^ cl^ JM^'^^^/^^^-a-^ ^ City of Ltol CSM Number D Village of a Town of. m. Type ofPOWTS Permit: (Check either "New" or "Replacement" and other applicable on Bne A. Check one box on line B. Complete line C if | applicable.) A.C] New System 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 Olfaer Type (explain) c.D Renewal Before D Revision D Change of Plumber D Transfer to New OwnerlUst Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd)t^O 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 I jJ i e^r sII£l (3| W Tc E 0 uiE Septic or Holding Tank ^000 0 Ll600 9.xDosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans, Plumber's Name (Print) /UcAfi\ Ufok\^-_'< \». Plumber's Address ("Street, City, State, Zip Code) Plumber's Si MP/MPRS Number i^6~C^ Business Phone Number -7 ] S-^ 7^1 m\ c\^ ;4^ L , LJ^I^N- i u^ ^L/^(VI. County/D<4»arfmentVse Only Permit Fee ISAIt I Date Issued | IipprovedD Disapproved D Owner Given Reason for Denial 1^0.00 n/i/zoM Issuing Agent Signature ^/t^/w 91. (^2^<T nditions of Approval/Reasons for Disapproval , ... , /"'»• Toni^ ^ ff)£ci ^l\ ^^s a^d 4c bca^ (^/Q ^ o-< <3D \^C^(T CQC^. ^ ^n^rv^t ^ ^-<y o^r>^. /rt<^^l~^^ ^y^hy^ f-u- f^d^ ^^m^ »(W/ ^^Joo <?yr^A<'i ys-^c^ P(/ '^ps4-.0 ^^ y^c^ P(/ '? ps ^j Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 03/22) ^-z-^ Bayfield County Soil Test # Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) 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 BARBMTELLIER Contractor ED'S MECHANICAL LLC Property Address_^OOWANNEBORD_Authorized Agent.EDWARD J WROBLEWSKI WASHBURN, Wl 54891 Agent's Telephone 715-209-4055 Telephone 715^924926 Written Authorization Attached: Y or |N| Accurate Legal Description is requested: sw 1/4 of sw 1/4 Section o6 Township 48 N. Range 04 W. Town of WASHBURN Additional Legal Description: CIT/ OF WASHBURN Govt. Lot _Lot Lot _ CSM#_ Vol. Volume_Page_of Deeds Tax I.D# Block , Subdivision Page_ CSMDoc#. 36116 .Acreage.21.48 Indicate reasoning for your determination: CLAY soll-s AND EVIDENCE OF SEASONAL HIGH GROUNDWATER Signature of County Official Date Signature of Certified Soil Tester ^h\z.\ Date SP-72000013 Certification # (Submit a Plot Plan & Fee) u/fonns/soiltestwaiver(KLK)June 2018 EDWARD J WROBLEWSKI, CST #SP-72000013 SOIL TEST PLOT PLAN BARBARA M TELLIER 500 WANNEBO RD WASHBURN REAL ESTATE & INV CO 1ST ADD TO WASHBURN & PAR IN SWSW DESC AS LOTS 1, 2, 3, 20, 21 & 22 BLOCK 5 & LOTS 2, 3, 20 & 21 BLOCK B & 31/2 SW SW LESS ALLALLEYS;STS; AVES S RDS 2043; 2061 ;2075;2092 & 2514 306 T48N R04W CITY OF WASHBURN, Wl SCALE 1"= 50' N >3W TO NORTH LOT LINE EXISTINGSEPTICTANK 0SOILBORING >1000' TO EAST LOT LINE -^- 1& 2& 3t) 46 501 SHEET 2 OF 2 CONCRETE HOLDING TANK DESIGN Two Concrete Tank Option INDEX AND TITLE SHEET Project Barb Tetlier - Holding Tanks Owner Barb Tellier Address 500 Wannebo Road Washbum,WI 54891 Phone: (715)492^926 Legal Description si/2ofswi/4ofswi/4S06T48N R04W Township City of Washbum Subdivision Name County Bayfield Parcel ID Number 36116 Plan Transaction Number Lot No. 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 Michael Wroblewski Signature,A.^ License Number \^3.SO ^ Page 1 Page 2 PageS Page 4 Page 5 Page 6 Page 7 PageS Page 9 Phone No. (715)209-7521 Date 06/14/24 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 BARBARA MTELLIER HOLDING TANK PLOT PLAN 500 WANNEBO RD WASHBURN REAL ESTATE & INV CO 1ST ADD TO WASHBURN & PAR IN SWSW DESC AS LOTS 1, 2, 3, 20, 21 & 22 BLOCK 5 & LOTS 2, 3, 20 & 21 BLOCK B & S1/2 SW SW LESS ALLALLEYS;STS; AVES & RDS 2043; 206-1; 2075; 2092 & 2514 S06 T48N R04W CITY OF WASHBURN, Wl SCALE 1"= 50' N >300'TO NORTH LOT L!N'E 4" PVQ pipe 2 ~ 23P° 9allon hoiding ianl'<s >t000'TO EAST LOT LINE -»• WANNEBO RD d l6 20 36 4Q 50PT PAGE 3 OF 9 HOLDING TANK SPECIFICATIONS Two Concrete Tanks In Series ] If one- or two-family, number of bedrooms |And/Or....Non-residential estimated flow per day 2000.0 | Minimum holding tank volume required >J3,J Total holding tank capacjtyjBroeosed (gal)• 'a-^sxi.wv'swKifn.faifa'.wi-, L-JtOOOJlJTank 1 capacity (gal) L__.,_JX for round tanksWi.^^s^'^^-^^'^-^^'a^-.-.-.^ ~ —--•- - "-"r~"'J \V"~/ dTi-.LlSEu.KCaiaSK^-lKE'^^.Say^^S:JZOOOJELJTank 2 capacity (gal)••--•ysyK's'^ir^sscessaiaKS.r^ss lwfie^el£o!IC£^.productefcJncs.,.^JTank manufacturer iJSJE_Rhornbus ..,„_.„_.__..,,_,., ___JAIamri manufacturer-^4Kra^^^W^,^'.E-3.ira^^^Aa^'3^*^^^^^^i^^L^;-.i^ ^AB^H ______ JtMarm model number'a^?.!s^-2iESffi!!aiSE3=»i3^^'^=saiaraiw»»a^^ Tank Information Tank1 Tank 2 ..^M.^in ,(*^-^NSr-.UFi3:-UieUrKWieL-S'iK3KSE-,'6 Anchor weight safety factor Exterior Dimensions (in) .Lenflth_LWjdth_L.Hejc^^IKt^'va?'&&'SSS'.^Si'I^^.S^K!niS^^W^^W^3ruS^WS^Ii~^^1_JB6_I_66_.^S3E3H4&?25? .15i__l___86_i_66. Ibs .Tank.WLtsmsssxsiswssswtSi'sssr^KayiKj^ J_1537Q__VfTST-, 1^JL53ZO_ Ibs Anchor Wt 18675 18675 in Soil Cover 24.8 24.8 J: MaxBui .I_JJZJ HOLDING TANK CROSS SECTION Manhde cover with locking device 2" min. ^~r ^- 4" mm. and warning label ^ function box 12" min. Vent cap Blind plug to seal outlet opening Finished grade*: Note: Manholeand vent locations may be reversed. Manhole diameter is 23"min. 2000.0 gal Inlet Tank 2 Tank 1 3 in. min. bedding undertanks. Anchortanks as necessary to negate buoyant forces. Electricalas perNEC 300 and SPS 316. Note: All tank joints, and joints between tank openings and piping are sealed watertight. Project: Barb Tellier - Holding Tanks Transaction Number:Page 2 of 9 ^Y//-A" CAST-A-SEAL 4" CAST-A-SEAL MI r~. -12'-7" s« FILTER OR BAFFLE TOP VIEW SIDE VIEW 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"-7" 0.0. WIDTH: 7'-2" O.D. BELOW INLET: 53" O.D. UQUID LEVEL: 46'' WEIGHT: BOTTOM 9,430 LBS.COVER 5,940 LBS. INLET AND OUTLET:4" CAST-A-SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER:WISCONSIN. SEE DETAIL flO(OTHER STATES SEE CHART^ UQUID CAPAdTf: 42.92 GAL/tN HOLDING TANK:OUTLET HOLE PLUGGEDACTUAL CAPACITI': 2.126 GALLONS LOADING DESIGN: 8'-0" UNSATURA7ED SOIL TANK CAN BE USED AS:SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN #8 (NO HBER)TANK: MIX DESIGN ftO (STRUCTURAL OBER) CUSTOMIZED TANKS:FOR CUSTOM TANKS CONTACT WIESER CONCRETE TANKS ARE MANUFACWRED TO MEET OR EXCEED AS7M C-1227 REQUIREMENTS REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: a: => u &V) SHEET NO. 1 OF 1 6/20/24, 7:59 AM Novus-Wisconsin Access rev. 12.0206 Real Estate Bayfield County Property Listing Today's Date: 6/20/2024 Property Status: Current Created On: 6/13/2011 3:14:15 PM Description Tax ID: PIN: Legacy PIN: Map ID: Municipality: STR: Description: Updated: 6/14/2011 36116 04-291-2-48-04-06-3 00-313-21200 (291) Cn-Y OF WASHBURN 506 T48N R04W WASHBURN REAL ESTATE & INV CO 1ST aa Ownership Recorded Acres: Calculated Acres: Lottery Claims: First Dollar: Zoning: ESN: Tax Districts 1 04 291 046027 001700 ;* Recorded Documents ADD TO WASHBURN & PAR IN SW SW DESC AS LOTS 1, 2, 3, 20, 21 & 22 BLOCK 5 & LOTS 2, 3, 20 & 21 BLOCK 8& Sl/2 SW SW LESS ALL ALLEYS; STS; AVES & RDS 2043; 2061; 2075; 2092 & 2514 21.480 21.480 1 Yes (R-l) Residential-1 102 Updated: 6/13/2011 STATE COUNTi' CITY OF WASHBURN SCHL-WASHBURN TECHNICAL COLLEGE Updated: 6/14/2011 N/A BARBARA M TELLIER Billing Address: BARBARA M TELLIER500 WANNEBO RD WASHBURN WI 54891 Updated: 6/13/2011 WASH BURN WI Mailing Address: BARBARA M TELLIER 500 WANNEBO RD WASHBURN WI 54891 Site Address * indicates Private Road 500 WANNEBO RD Property Assessment WASHBURN 54891 Updated: 8/28/2023 2024 Assessment Detail Code Gl-RESIDENTIAL 2-Year Comparison Land: Improved: Total: Property History Acres 21.480 2023 61,200 134,800 196,000 Land 61,200 2024 61,200 134,800 196,000 Imp. 134,800 Change 0.0% 0.0% 0.0% Parent Properties 04-291-2-48-04-06-303-000-50000 04-291-2-48-04-06-3 00-313-20000 04-291-2-48-04-06-3 00-313-24000 04-291-2-48-04-06-300-313-39000 04-291-2-48-04-06-3 00-313-46000 HISTORY B Expand All Histon/White=Current Parcels Pink=Retired Parcels B Tax ID: 33851 Pin: 04-291-2-48-04-06-3 00-313-46000 Leg. Pin: 291113608000 B Tax ID: 33844 Pin: 04-291-2-48-04-06-3 00-313-39000 Lea. Pin: 291113601000 B Tax ID: 33829 Pin: 04-291-2-48-04-06-3 00-313-24000 Leg. Pin: 291113406000 Q Tax ID: 33825 Pin: 04-291-2-48-04-06-3 00-313-20000 Lea. Pin: 291113402000 Q Tax ID: 32658 Pin: 04-291-2-48-04-06-3 03-000-50000 Leg. Pin: 291101804000 36116 This Parcel "T Parents ^ Children https://novus.bayfleldcounty.wi.gov/access/master.asp?paprpid=36116 1/1 EESSBffSsaQQOSSSSB@3=la®3i?yi)(^]riBi_^) Bayfield County, Wl BSSSff&aSQOEBS!WSSSfiGSSB Q3SESff333SE>Q8SSS?oasssQvasssBS i^^BSBSf^^IS W 3n';tnTO"v... i-'<'i1Ea-'->-;.;.i..,T>irai^'.:1^ V?":IW?&^?^ eES3SS\iSS3SS!>OS33SC3QSvSS3SlffQQ33SSSX^S3ESS3S CSSSBSvSSESSiOSBESSQCEEOSQeyQSSSEQ '~SSS«ssisSsas>GEBi?23S30£8fB?'ssssssyassassss'ss :Wi3ias6E?iM- ISSESSS3S3S083SS?WBSSSS^USESSSBS EES8!ffSSS:>e3SESS)IsEEBSSSisSSSSfQSeSEQsa&sc, si'gEe'isaaciiBagiE® 6/20/2024, 7:59:21 AM :;;*;": Wetlands 1.............1 Approximate Parcel Boundary Rivers Road Type Building Footprint 2015 Building s'S21a Lakes Town 0.02 1:1,828 0.04 0.09 mi 0.04 0.07 0.14 km Bayfield County Land Records Department Bayfield County Zoning Application https://maps.bayfieldcounty.wi.gov/ZoningWAB/ BAYFIELD COUNTS CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) Qltle 15, Section 15-l-10(e)) )^C,.U. )^ Original Sanitary Application (Submitted in Deed Holders Name - Dfii 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)^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) ft Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) a ATU Servicing Agreement (Recorded at Reg. of Deeds) J^( Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 102mae]g Sets of Plans (383.22(2)(2.) (aae£_^M^ l£..sJL£fi£i!e5Ll ^Liuiiiirj Maintei ::eme;~i;s are so DC Qttc ^ Soil and Site Evaluation Report (383.22-3(2)(b)Le.) D State Plan Review (when applicable) n Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) I Application Information must include: yfa 23 diait Parcel ID# - (do not use 12 digits anymore-obsolete) Project Address or Road Name where driveway is/will come off of) AP (Owners Phone Number) ^S II Type of Building ^ III Type of Permit ^1 IV Type of POWTS System D V Dispersal / Treatment Area Information VI Tank Information J^l VII Responsibility Statement (Plumber's Information) ^ *Date Stamp* Plot Plan: (To Scale or To Dimension) Signature and Plumber Information D Surface Elevation of Body of Water D Direction and Percent Land Slope Tank and Filter Information and Location D Wetlands / Navigable Bodies of Water D Absorption Area (Proposed and Existing) D Bench Mark (Location, Elevation and Description) 1'Component Manual Version Address Number and Road J^l North Arrow Contour Lines Structures and Driveways Boring Locations ^p Property Lines Well Locations Legal Descriptions Turn Over > Cross-Section and Over-Head Profile of the System: D Surface and System Elevation n Position of Observation and Vent Pipes D Dimensions and Depths D Make, Model & Number of Chamber Units in each Cell Property Information ^ How many systems will there be on this parcel of land? Has this property been split? P10 (Property Statement shows Property History) Fees: 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 D Private Sewage System Reconnection and Private Interceptor D Return Inspection D Maintenance $ $ $ $ 25.00 50.00 50.00 30.00 (checks made out to Reg of Deeds) u/forms/checklists/checklistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012-dc) Proofed by: 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 _Bayfield _County Sanitary Ordinance. 1. This POWTS is designed to accommodate a wastewater flow of 60.0 to 800.0 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 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 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 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........................... ^ig.j-.ake-p!ljmbln9_Phone: ._(715)^Q&-7521 b. Service Provider................ .^!rc!L.?treel..Excav3tin9.A-Se.P^F_Phone: iZ.L'^l.?Z?.:§§,9.3. c. County Zoning or Health Dept. _Ba^ejd^ounty_Zoning_ Phone: J7J.5)_373-6138 11. Project: Transaction Number: Page 4 of 9 Document Number/Plan I.D. No. Owner Name (s) ^^k T^V^r" Parcel Identifier Number (PIN)•u^ HOLDING TANKAGREEMENT Owner(s) Mailing£oo ^r^^e^ ^UO^WN<UX^WI Agreement 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 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 othertype of private onsite wastewater treatment system as pennftted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Stats. ^VJ 1/4 of'SW 1/4 Section ^^ Township J^_N. Range O^/ W. TewXf UA.&WY) ^ t< <T\ Additional Legal Description: Gov't Lot_ Lot,_ Block_Subdivision Lot_CSM #_ Vol. ^^MI^S^ tubdhrision. Page. _CSIUUL _CSMDoc#. DOCUMENT NUMBER2024R-603360 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTy. Wl RECORDED 05/24/2024 AT 2:33 PM RECORDING FEE: $30.00 PAGES: 1 Retum^o: i i - riL \..'.-ak-e. n^v^tou \^\ c4y H^ <-Uc^v^^x s~H^\ As an inducement to Bayfiekt County to issue a sanitary permit for a holding tank on the above described property, we agree to do the following: 1. 2. 3. 5. 6. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code refatfng to fiofding tank installation and maintenance. If the ovimer fails to have the holding tank property serviced in response to orders issued by Bayfeld 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. 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. BayfieldCounty 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 to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being property 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, 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 wilt 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. Owners) Name(s) - Please Print fca r fcx^ ^ \Y\ a r ^ I ^- I \; ^ Q, Subscribed and sworn to before me on this date:,^'/?^/-;^L/;7:^^ Notarized Owner(s) - Signatures)Notary Public u' My Commission Expires: c r^ ^-^^M • .^l"".'^ ^/"/>^V<>^\l=>CH^:;--".... 4^ _Q^L?m^Ni^ s 0 =Drafted by: />I/IT(°- (Aln&IJ^jJ^'Date: S-f^j^ Pereonal Womiation you pmvide may be used for seconday puiposes [Privacy law, s.15.04 (l)(m))11-/ I > -'S/ ; S-' —unoiinsf5anitaiyfholdingtankagreei3m^<»c¥>j6Te2018 ^)~ /OS°T'VC^."^^ '>"—"^<.'5?L<?''%,5S:r'io^ HOLDING TANK SERVICING CONTRACT Contract Dates|This contract is made between the Holding Tank Owner(s) Name(s) S^ ~^\\<e ^ Pumper's Name (Print) ^>cs<^\ ^<a\(^cioF\J • ' \J Pumper's Signature 0-^f^^ —^ Pumpers' Registration # V-^3. We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT LOCATION Leeal Desaiotion: (Use Tax Statement)Mt ^\u Section 0( , Township H8 _ N, Range 0 tY W Gov'tLot Lot»CSMff Vol. Page CSMDoctf Lot(s)No.Block(s) No. sw 1/4, sw V4, €v^f t^d&kt^l totStee Subdhriston: Acreage S 1.^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 holding 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. ^yyf1^^\SCH^^>"";^— -n>. '\^. "\^ E'.'Sy^'4. This agreement will remain in effect until the owner or pumper terminates this contract. In the eve«<^< ch&Sge in tEflsi-z contract, the owner agrees to file a copy of any changes to this service contract or a copy of a ffi^ier@« cont^ct| 0 = with the local government unit and the County named above within (10) business days from the d^eftpt^nge^t^lhi&'i^^ service contract. 1 the dSe^ft^nge^ihi&^c^\ Y?^€? Owner(s) Name(s) (Print) tj^)^^\Q^ ^c\ \^\c\r^ T~<2-\\<^ Owner's Signature(s)/^^u^W\a^ 1/^^->~ Subscribed and Sworn to me: ' ''////^I'l^t^ on this ^Lf day of i^(5L^ ^?/>^^ ^:~~~V^V^.1 \-.'^i..y--il: ( Notary Public My commission expires on: c 7^ Revised: May 2016 (®May 2018) Personal infoimation you prov'rie may be used for secondary purposes privacy Law, s.15.04 (l)(m)] Drafted by BAYFIELD COUNTY # STATE SANITARY PERMIT D TRANSFER/RENEWAL PREVIOUS NO. OWNER: Barbara Tellier PROPERTY LOCATION: City of Washburn WASHBURN REAL ESTATE & INV CO 1ST ADD TO WASHBURN & PAR IN SW SW DESC AS LOTS 1,2, 3, 20, 21 & 22 BLOCK 5 & LOTS 2, 3, 20 & 21 BLOCK 8 & Sl/2 SW SW LESS ALL ALLEYS; STS; AVES & RDS SEC 6, T48N, R4W PLUMBER: Michael Wroblewski LIC. #: 1288503 AJessandroHalL 7/1/2024 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 a specified period. (d) Changed regulations wilt 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. AUTHORIZED ISSUING OFFICER DATE Condition: Management plan to owner. Properly maintain per recorded agreement. Tank to meet all setbacks and to be within 25' of an all weather road. Properly abandon existing/old system per SPS 383. THIS PERMIT EXPIRES 7/1/2026 UNLESS RENEWED BEFORE THAT DATE POST W PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 fR. 06/231