HomeMy WebLinkAbout24-76S Dean•^yt'"i\,^
y, "•%N'v:^ • ^:':<-?''•"i^^y-'
Department of Safety
& Professional Services,
Industry Services Division Sanitary Permit climber (to be filled in by Co.)
County
•m -%^
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 infomiation you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats.
State Transaction Number
I. Application Information - Please Print All Information
Project Address (if different than mailing address)
Hoc^r,!- ^e- ^
T(^ ^c-t, ur S-^8^7
Property Owner's Name
^oick ^ R^^o.V\ ^ea^(\
Parcel#^6-^
Property Owner's Mailing Address
~]^6S~ tioo^r LA<\& ftj
City, State
lrc^^^l.u:c
Property Location
Oovt. Lot.
Zip Code^Wl
II. Type of Building (check all that apply)
1 or 2 Family Dwelling - Number of Bedrooms
D Public/Commereial - Describe Use
a State Owned - Describe Use
Phone Number
~]\6~-^0-^8t^
Lot #
NV/ •/<. ^Vs/'/,. Section <S -2>
T_^L_N R_Ol_Eor^Subdivision Name
Block #
CSM Number
a City of.
DVfflageof
J^Town of ^ ^ \ \\
m. 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.^[ 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 (gpd)w 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
.0i I^3 lisW V
w
•° .sE b
Septic or Holding Tank 5'coo 0 52»c LJy2.sor ^Actc^e 2^Dosing Chamber
V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print)
A^&e^ Lko\^&^
Plumber's Si;
^/^^-MP/MPRS Number
1^.88 ^^>
Business Phone Number
7/6--3>C^7^}
Plumber's Address (Street, City, State, Zip Code)
?V C^ Hi^6/ , U^&klo^^.UX 6-^/^7,
VI. County/De(»artment Vse Only Ws^Approved D Disapproved
D Owner Given Reason for Denial
Permit Fee400,Poll HtLMDate Issued Issuing Agent Signature 7^-^|^/Zo/2L</ pl /^23/^
Conditions ofApproval/Reasons for Disapproval
•W^ t-o ^ n^ ^ ^l^cts Gf^ loc ;ocaTZ-e4 ^^ 2-So? a)' v!e<^^ ro<^L
• pwa^n^ ?/) ^ o^c^./^^^n ^y^/^ ^ AYO^(
ffi^/^v\},
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)
Bayfield County
Soil Test go-^/c
Waiver of a Thorough Soil & Site Evaluation
(subject to 15-1 -10(d))
I EDWARD JWROBLEWSKI _ g certffied 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 RYNOLD DUANE & DEBORAH K DEAN _ Contractor EDis MECHANICAL LLC
Property Address xxxxx HOOVER LINE RD _ Authorized Agent EDWARD j WROBLEWSKI
IRON RIVER, wi 54847 _ Agent's Telephone 715-209-4055
Telephone 715-570-6184 _ Written Authorization Attached: Y or IN J
Accurate Legal Description is requested:
Nw 1/4 of NW 1/4 Section °3 Township 48 N. Range °9 W. Town of OULU
Additional Legal Description:.
Govt. Lot _Lot _Block _Subdivision
Lot _ CSM#_ Vol. _ Page _ CSM Doc #
Volume_Page_of Deeds Tax I.D# 26555 _Acreage.13.17
Indicate reasoning for your determination: EVIDENCE OF HIGH SEASONAL GROUNDWATER IMMEDIATELY BELOW
THE A HORIZON
~^ /-? n^ ^ L^^-^-
Signature of Certified Soil Tester
5//8/Z^
Date
SP-72000013
Certification #
Signature of County Official
(Submit a Plot Plan & Fee)
Date
u/forms/soittestwaiver(KLK)
June 2018
EDWARD J WROBLEWSKI, CST^SP-72000013
.SOIL TEST PLOT PLAN
RYNOLD DUANE & DEBORA K DEAN
XXXXX HOOVER LINE RD
W1/2W1/2N1/2NW35
803 T48N R09WTOWN OF OULU Wl
SCALE 1"= 50'
N
LOT LINE >100'
FUTURE DRIVEWAY
FUTURE MOBILE HOME SITE
FUTURE HOME Sn-E SOIL BORINGa
LOTUNE>100-
LOT LINE >100'
1(1 20 30 40 50!SHEET 2 OF 2
CONCRETE HOLDING TANK DESIGN
Two Concrete Tank Option
INDEX AND TITLE SHEET
Project Zach Dean - Holding Tanks
Owner Zach Dean
Address 75865 Hoover Line Road
Iron River, Wl 54847
Phone: (715)570.6184
Legal Description W1/2W1/2N1/2NW35S03T48NR09W
Township Town of Oulu County Bayfield
Subdivision Name
Parcel ID Number 26555
Plan Transaction Number
Lot No.
Index and title sheet Page 1
Holding tank specifications Page 2
Site plan Page 3
Management & Continency Plan Page 4Soil Test _ Page 5Soil Test Plot Plan _ Page 6
Holding Tank Agreement _ Page 7
Holding Tank Servicing Contract Page 8
Holding Tank Specifications _ Page 9
Designer Michael Wroblewski
S.na.ur.^'^-^ >^^Signature,
License Number ^§&6-o3>
Phone No. 0^15)209-7521
Date 06/18/24
Version 7.0 (11/12)
Designed pursuant to:
Holding Tank Component Manual For POWTS (Version 2.0)
SBD-10855-P (N. 03/07, R. 01/12)
Page 1 of 9
RYNOLD DUANE & DEBORA K DEAN
HOLDING TANK PLOT PLAN
75865 HOOVER LINE RD
W1/2W1/2N1/2NW35
SOS T48N R09W
TOWN OF OULU Wl
SCALE 1°= 50'
N
LOTUNE>100'
RJTURE DRIVEWAY
FUTURE MOBILE HOME SITE
FUTURE HOME SITE
Connection to
future home
4" Cleanout
—4"PVC
2 - 2500 Gallon
[/Holding Tanks
LOT LINE >100'
LOT LINE >100'
40 SHEET 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
Minimum holding tank volume required
JIQ.QOJLJ Total holding tank ca(
LJSSjOOJLJTank 1 capacity (gal)(LGyi.V.'^i'.t^iBUilBEiBn/ta-SeESKSi'
,J2500.,0__jTank 2 capacity (gal)-^ai"t;-A:-ffiBEUBffit»-BaiR^E2S=-
(9al)
for round tanksXSXSS-t
IWieser Concrete Products, Inc^.vesr'-.-isisc.ITank manufacturer
I Alarm manufacturer
ITAAB-OIH _ JAIanm model number
Tank
Information
Tank 1
Tank 2
in
Liq Level
J»050_LJ^L
Anchor weight safety factor
Exterior Dimensions (in)
-W[d?_LHeicI-.TSSCSOliWWSSS: llE^aasSVSSEiSS'^SSSQKVBVSBXSK'WSSKSSESZZ^aSaSStX
1601_|___93___j_71_160 8 93 I 71em
Ibs
Jaflk_Wt_
16840.
J6840.
Ibs
Anchor Wt
25126
25126
in
Soil Cover
29.2
29.2
ft
Max Burv
-L2:
12" min.4" min.
HOLDING TANK CROSS SECTION
Manhole cover with locking device
and warning label
Blind plug to seed
iJ, outlet opening
Service alarm on
2500.0 gal
41-C
Tank 2
Note: Manholeand
vent locations may
be reversed.
Manhole diameter is
23"min.
2500.0 gal
Tank 1
3 in. min. bedding undertanks.
Anchortanksas necessary to negate buoyant forces.
Electrical as per NEC 300 and SPS 316.
Note: All tank joints, and joints between tank openings
and piping are sealed watertight.
Inlet
Project: Zach Dean - Holding Tanks
Transaction Number:Page 2 of 9
^:....._.. .. _.„ . __';??;v//-4" CAST-A-SEAL 4" CAST-A-SEAL-
0>I
r^
-13'-3i"
FILTER OR BAFFLE
TOP VIEW
(D
j_
0in
T
'<-
SIDE VIEW
W2500-MR
TANK SPECIFICATIONS
DIMENSIONS:
WALL 2 1/2"
BOTTOM: 4"
COVER: 6"
MANHOLE: 24" I.D. PRECAST CONCRETC RISER
HEIGHT: 71"
LENGTH: 13'-3 1/2"
WIDTH: 7'-9"
BELOW INLET: 57"
LIQUID LEVEL 50"
WEIGHT: BOTTOM 10,500 LBS.COVER 6,340 LBS.
INLET AND OUTLET:4" CAST-A-SEAL BOOT OR EQUAL GASKET
INLET AND OUTLET BAFFLE AND FILTER:WISCONSIN. SEE DETAIL #\0(OTHER STATES SEE CHART)
UQUID CAPACITY: 49.46 GAL/tN
HOLDING TANK:OUTLET HOLE PLUGGEDACTUAL CAPACITY: 2,621 GALLONS
LOADING DESIGN: 8'-0" UNSATURATED SOIL
TANK CAN BE USED AS:SEPT1C / HOLDING / PUMP OR SIPHON
COVER: MIX DESIGN #8 (NO RBER)TANK: MIX DESIGN j|9 (SMALL RBER)
CUSTOMIZED TANKS:FOR CUSTOM TANKS CONTACT VWESER CONCRETE
IAHI'C; ARF MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
REVIEWED BY
REVIEW DATE
DRAWINGS SUBMITTED
FOR APPROVAL
APPROVED BY:
APPROVAL DATE:
PRODUCTS NEEDED BY:
Q:
0
a,3(7)
"SHECT NO.
1 OF 1
Bayfield County, Wl
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PRPH>7.Taxfriy#J26574
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6/20/24, 9:13 AM Novus-Wisconsin Access rev. 12.0206
Real Estate Bayfield County Property Listing
Today's Date: 6/20/2024
Property Status; Current
Created On: 3/15/2006 1:15:53 PM
ll?l. ^Description
Tax ID:
PIN:
Legacy PIN:
Map ID:
Municipality:
STR:
Description:
Recorded Acres:
Calculated Acres:
Lottery Claims:
First Dollar:
Zoning:
ESN:
^Tax Districts
1
04
038
044522
001700
* Recorded Documents
B QUIT CLAIM DEED
Date Recorded: 5/16/2024
B CONVERSION
Date Recorded:
Updated: 5/30/2024
26555
04-038-2-48-09-03-2 02-000-20000
038100406000
(038) TOWN OF OULU
SOS T48N R09W
W 1/2 W 1/2 N 1/2 NW 35 IN DOC
2024R-603273
13.170
13.010
0
No
(AG-1) Agricultural-1
125
Updated: 3/15/2006
STATE
COUNTS
TOWN OF OULU
SCHL-SOUTHSHORE
TECHNICAL COLLEGE
aa Ownership Updated: 5/30/2024
Updated: 3/15/2006
2024R-603273
517-203;621-93;634-1;760-520
ZACHARY A DEAN
REBEKAHJ DEAN
Billing Address:
ZACHARY A DEAN75865 HOOVER LINE RD
IRON RIVER WI 54847
IRON RIVER WI
IRON RIVER WI
Mailing Address:
ZACHARY A DEAN
75865 HOOVER LINE RD
IRON RIVER WI 54847
v Site Address * indicates Private Road
75860 HOOVER LINE RD
Property Assessment
2024 Assessment Detail
Code
G4-AGRICULTURAL
G5-UNDEVELOPED
2-Year Comparison
Land:
Improved:
Total:
IRON RIVER 54847
Updated: 9/22/2022
Acres
12.000
1.170
2023
1,800
0
1,800
Land
1,700
100
2024
1,800
0
1,800
Imp.
0
0
Change
0.0%
0.0%
0.0%
Property History
N/A
https://novus.bayfieldcounty.wi.gov/access/master.asp?paprpid=26555 1/1
BAYFIELD COUNTVCHECKLIST FOR SANITARY APPLICATONS J U ^ I
Submit the Following (Use Permanent Ink) CTitle 15, Section 15-l-10(e))
/IQ Check List
)^I Original Sanitary Application (Submitted in Deed Holders Name - QC& 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
Pump Tank Diagram, Alarm and Pump Curve (when applicable)
Contingency Plan / Management Plan (383.22-3(2)(b)l.f.)
a 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)
J^f Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5)
D ATU Ser/icing Agreement (Recorded at Reg. of Deeds)
Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7)
t £fi!liu!ete Sets of Plans (383.22(2)(2.) (Note: SapiKrv Ao&lication and Maintenance Agreements are to be attachgd
rQ_aILcQDiesl^Soil and Site Evaluation Report (383.22-3(2)(b)l.e.)
D State Plan Review (when applicable)
D Copy ofWarranty/Quit Claim Deed (Optional)
Sanitary Application: (Include the following Information)
I Application Information must include: ^1 23 diait Parcel ID# - (do not use 12 digits anymore-obsolete)
Project Address or Road Name where driveway is/will come off of) J^ (Owners Phone Number)
II Type of Building
^ III Type of Permit
IV Type of POWTS System
V Dispersal / Treatment Area Information
VI Tank Information
JS^TVII Responsibility Statement (Plumber's Information)
^f *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
D Tank and Filter Information and Location
0 Wetlands / Navigable Bodies of Water
D Absorption Area (Proposed and Existing)
D Bench Mark (Location, Elevation and Description)
^Component Manual Version
j:liping Mares;a' snformsl'ion (cor'veyan;:;e i;ne, &ui;d!ng yewei' ihs:
Address Number and Road
North Arrow
n Contour Lines
j^ Structures and Driveways
Boring Locations
Property Lines
Well Locations
]a\ Descriptions
itf'ys;yi tv
Turn Over >
Cross-Section and Over-Head Profile of the System:
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
Property Information
JX[How many systems will there be on this parcel of land?
% Has this property been split? 1\1 £> (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
0 Maintenance Agreements ^ $ 30.00
(checks made out to Reg of Deeds)
u/forms/checklistsi/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 1000.0 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 sen/ice 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 manhote 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, orquestion about this installation, the following persons should be contacted:
a. Installer........................... JBi^Lsk^lymbin^_.____ Phone: _(715) 209-752.1
b. Service Provider................ JB!rcJl.;^ree^E>??^aIiD5AsePtic»._ Phone: .(7115^373-5683
c. County Zoning or Health Dept. .BaYfietd^CoyntYZonJnjg_ Phone: _(7_15),373-6138
11.
Project:
Transaction Number: Page 4 of 9
Document Number
HOLDING TANK AGREEMENT
Document Title
DOCUMENT NUMBER2024R-603457
DANiEL J. HEFF-NER
RE.GISrER OF OF-EOS
BAYF'iELD COUNTY, Wl
RECORDED
Ot5./'0372024 AT 2:56 PM
^b.COKDING FE.'C: $30.00
PAGES: 5
Recording Area
Name and Return Address
BIG LAKE PLUMBING
1491 CTY HWY C
WASHBURN, WI 54891
Parcel Identification Number (PIN)
THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE.
This information must be completed by submitter: document title, name & return address, and PIN (if required). Other information such as
the granting clause, legal description, etc., may be placed on this first page of the document or may be placed on additional pages of the
document.
WRDARev. 12/22/2010
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lof2
Document NumberiPlan ID. No.
OwrayNamefs)^y-Q ^ • ^ Weks^ 3~.
.^te»AParcel Uenffier Number (PIN)^6S-ST^~
HOLDING TANK
AGREEMENT
Ownei(s)Ma>§ngAcUressfS'3^5~_^w-l^<^- W-;T/w%^ mj ^Wf-
Agreement Date (same as Notary Date)^/z^h^
Wead(ncNiledgethal^>pBcsdi<xiisbeir^madeforlhems»aart>onof(a)hotdingtan^^
on the fttoimig property cir that conlmued use of the exiding premises requires 1hat a
holding taik be iretrifed on the pnyerty fiw the pupose rf proper coiitainment af
sewage. Also, Ihe property cannot no«> be served by a muntevat sewer, or any ofter
type of pimteonsfteiNasfewrter treatment system as penniMed under Ch. SPS383,
WE AAn-Code or Ch. 145, Wis State.
MVj w or HW 1/4 Sedion 0^ TawnstBp i^S N. Range Ol W.
Twmof ^u|y^
Additional Legd Description:
Govl Lot_ Lot Block Subdivision
Lot CSM * _ Vol Page.
!_CSN»_
_CSMDoc#.
RehnnTo: . _i . >
^ ^-cj<<5-, ^^<^\r^
F4^\<^ H^</<—UasUo^'U^ S^\
As an inducement to Bayfield County to issue a sanitary permit for a hokling tank on the above described property, we agree to do thefollowing
1. Owner agrees to confbim to al applicable requiremente of Ch. SPS 383, Wis. Adm. Code relafing to hoUmg tark instaflalun and
maintenance- If the owner tafe to have the hokfing tank property senriced in response to orders issued by BayfieU County or the
Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, State., Bayfiehi County may enter upon
BK prepeity and se»vi? the tank or cause to have the tank to be servn^ and darge the owner by (riacing ttre charges on ^
specalKsessment for cunwit services rendered. The charges will be assessed as prescraiedl^s. 66.0703, Stats.
2. Owner agrees to pay all changes and costs incurred by Bayfield County for inspection, pumping, hauling, or dheiwise servicing andmaintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. BayfieU
County shaB wtify the owner of any costs which shaU be paid by the owner within thirty (30) days from the date of notice. In the event the
cwfw does not pay the costs within thirty (30) days, the owner specificatly agrees that all the costs and changes may be placed on the taxroB as a special assessment (orlhe abatement of a human health hazard, and the tax shall be collected as provkled by law.
3.
6.
The wins 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 Ihe hokfing tank sawed in accoidance wah Ch.NR113,Wis.Adm-Code, and to file a copy <rf the ccmtra^ County.
The owner further agrees to f3e a copy of any changes to the service contract or a copy of a TOW service contract, with the county within
30 days from the (tete of change to the senice confaact.
The owner agrees to contract with a person ficensed pursuant to s. 281-48 (3) VWs. State.. and Ch. NR 114, Wl's Adm. Code who shall
submit to the county within 30 days a report detaUng the servicing of the hoMing tank. BayfieU County may enter upon the property to
nv&sfigate the condition of the hotding tank when pumping reports and meter readings may indicate that the holding tank is not being
property maintained.
This agreana* wB remain in effect orty unH Bayfietd County certifies that the property is served by either a municipal sewer or a private
onsjtewastewalertreabnert system that compBes with Ch- SPS 383, Wl's Adm- Code. In ackaion, this agreement may be cancelled by
executing and recording said certification with referwice to this agreement in such manner which will permit the existence of the
certificaSon to be detennmed by reference to fte property.
Ttas agreement shafl be binding upon the owner, the bars of the owner, and assignees of the owner- The owner shall submit thisagreement to Bie register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will pennit the
aostence of the agreement to be detemur^ by reference to the property where the hoUing tank is installed.
Owners) Name(s) ^ Ply^e Print
fc^l/^A 3. O^l
'0«me5%-^Signatun(s)tfff^i S^^i/
'•W^S-^^i
Subscitied and sworn to brfore me on this dde:
^/23/^
'" itl (^
My Commission Expires: _,'^i^n
Mi^ LJniblevJ^cvDrafted by.
Pasmal rfcnaefim ycu immde nay to used hr secuniary p*F°8» [Pnrai^ La»
Date:skihw
uaD<ns(saniU»<liuWiiali«ilui|i>!emert.dDcAlune2018
JEB JOHNSON
Notary Public
State of Wisconsin
5/21/2024, 8:41 AM
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HOLDING TANK SERVICING CONTRACT
onbqctDate6b^ l^o^This contract is made between the
2 of 2
lolding Tar^ Owner(s) Nan^s)
"^ ^- /^" ^\c^c^A CT -
1-3 sz^7
Pumper's Name (Print)
i-t)c S^p^c- \ft(.
Pumpers' Rugistrafion #
J)tm~7
We acknowtedge ihe installation of (a) hdHing tank(s) on fte following property (Provide COMPLETE tegal descriptions)
PROJECT
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legal Desaijplkni:
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Subdhiston;
1. The ownef aQrees to fite a copy of this wntract with Bavfield County as required in SPS 383.55, Wis. Adm. Code.
2. The owner agrees to have the holding tank(s) senriced by the pumper and guarantees to permit the pumper to have
access and to enter upon the property for the purpose of servteing the holding tank(s). The owner agrees to maintain
the access road or drive so that the pumper can service Ihe hokJing 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 senricing of ttie hokling tank(s) on a semiannual basis. The
pumper further agrees to indude ttre foUowmg in the semiannual report:
a. The name ami address of the person responsible for senridng the holding tank;
b. The name (rf the owner of the holding tank;
c. The tocation of the property on whch the holding tank is installed;
d. The sanitary permit number issued for the holding tank;
e. The dates CTI which the holding tank was serviced;
f. The volumes in gatons of Ihe contents pumped from the hokling tank for each servicing;
g. The disposal sites to whteh the contents from the holding tank were delivered.
4. The agreement will remain in effect untfl 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 Biis service contract or a copy of a new service contract
with the kxal government unit and the County named above within (10) business days from the date of change to this
service contract
Owner(s) Name(s) (Prirrt)^ t^^^A
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Subscribed and Sworn to me:
/7^ .. A/on this _f_^A_day of I'Hlci.
by:
^f-ZM
f ! Notary Public
My commission expires on:
Revise* May 2016 (®May 2018)Personal irionnatkm you provkte may be used for secondajy gyrggs^ [eriv3cyla^s.l5.!tt (U(m)]Drafted by /w
JEB JOHNSON
Notary Public
State of Wisconsin
5/21/2024, 8:41 AM
BAYFIELD COUNTY SANITARY #
STATE SANITARY PERMIT
D TRANSFER/RENEWAL PREVIOUS NO.
OWNER: Zachary & Rebekah Dean
PROPERTY LOCATION:
Town of Oulu
NW '/4 NW V4
SEC 3, T48N, R9W
PLUMBER: Michael Wroblewski LIC. #: 1288503
Alessandro Hall 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 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.
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.
THIS PERMIT EXPIRES 7/1/2026 UNLESS RENEWED BEFORE THAT DATE
POST IN PLAIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (R. 06/23)