Loading...
HomeMy WebLinkAbout24-77S Neuberg^"^ ^-•'v^b7 j^l ^ D— / i-'j .'' '•G'^' Industry Services Division 4822 Madison Yards Way Madison, WI 53705 P.O. Box 7302 Madison, WI 5302 County Bayfield Sanitary Permit Number (to be filled in by Co.) I'-t-T?^ 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(l)(m), Stats. State Transaction Number Project Address (if different than mailing address) 15850 Bark River Road I. Application Information - Please Print All Information Property Owner's Name Norman Neuberg Parcel# 04-014-2-50-07-21-4 04-000-10000 Property Owner's Mailing Address 5327BumettRd Property Location Govt. Lot City, State Culver MN Zip Code55779 H. Type of Building (check all that apply) X 1 or 2 Family Dwelling - Number of Bedrooms _3_ D Public/Commercial - Describe Use D State Owned - Describe Use Phone Number 715-969-7848 SE Lot #T 50 _'/4, SE_'/4, Section _N R_07_WSubdivision Name Block # CSM Number D City of. a Village of X Town of Clover HI. 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.lew System replacement System Pc'yy O^.\<L D Other Modification to Existing System (explain)D Additional Pretreabnent Unit (explain) B.£1 Holding Tank D In-Ground (conventional) D At-Grade D Mound D Individual Site Design D Other Type (explain) c.D Renewal Before Expiration D Revision D Change of Plumber D Transfer to New OwnerlEList Previous Permit Number and Date Issued IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) | Design Soil Application Rate(gpd/sf) | Dispersal Area Required (st)Dispersal Area Proposed (sf) | System Elevation Tank Information Capacity in Gallons New Tanks Existing Tanks Total Gallons # of Units Manufacturer IIII 3'8'5 w ~z •o .sE 0 Septic or Holding Tank ^000 2000 Wieser x Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibUity for installation of the POWTS showp^m the attached plans. Plumber's Name (Print)ADRIEN CADY I MP/MPRS NumberL^'2139 Business Phone Number 715-373-2378 Plumber's Address (Street, City, State, Zip Code) 31160 Birch Grove Road. Washbum WI54891 VI. County/Department Use Only ennit Fee K.U'l I Date Issued ] Issuing Agent Signature . h/JU/'t400. co'' 11 ( ((ZH | )^> "gX" 1^Approved D Disapproved Q Owner Given Reason for Denial 7^Conditions of Approval/Reasons for Disapproval } . ^•-^ftb }o'fr^a ^ W^Qf^ 6c ^^ ^•h ?S' oP (7^ ^wtf'r ^^'•^^cM ^ '^'^w~r.- ^^ s>^ "^ [cw^ ^fii\"^r^ CQic:/ '^f ^ ^ jt^^.^^^ 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. 02/22) y^5R-©,e®%'"\yl;:./..:: w w)\ '!jul'; i ^.^.^..^\i 2iJ24 '^ 'w^y Soil Test # Bayfield County Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) l r\ (\}T ig.i/1 (»^_rzO-V _ a certified soil tester determine that in my professional judgment the following site (6ee 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 1\/01/'(/H Cti4 \>J. Ufi.uS/\€}/o\ Contractor. Property Address i'^<8<^1p Bi^^{\£'^ ^J Authorized Agent. H-^b5+€t^/ UJ^ ^^-$?<y-c/" Agent's Telephone. Telephone 775^ f ^(?- ~?^<^^ _ Written Authorization Attached: Y or N Accurate Legal Description is requested: S ^1/4 of 5S-1/4 Section 3.) Township £)?)N. Range OT W. Town of Cloven Additional Legal Description: 5E 5^ Le^S V. / V> RlK ^ ^S.^-5^^57 4-77 Govt. Lot Lot Block Subdivision Lot _ CSM#_ Vol. _ Page _ CSM Doc #. Volume_Page_of Deeds Tax I.D# \\ "^ ^ • Acreage ^ Indicate reasoning for your determination: C^.iaL\/ <>0( /< , V^JDWe^/i HpHri^ -htif ^/O^^C^^ Signature of Certified Soil Tester S-^I-^L-0^ Date <^>-l\^0003^ Certification # Signature of County Official / /-> _ / -in (Submit a Plot Plan & Fee)^/ LP / ^ — ?c<\<^ ^$o (W\-llU2MDate u/forms/soiltestwaiver(KLK) June 2018 0>^rvT ^3 ,^ t" ^f-^ ^- .^^'a ^ ^/v< ^ ^OV-^l FV»^|/+y ^i-^ ^(Or ^ \<ovw[a^ \JJ /Veut 1^350 6=c</KRv-^^ hfei/bs-^ U^yf-W, PJ:1\J O^-O^-SrS'0-01-21-^ ' Ot-OCO-lOQ^ S^^J-f^o^ R07L^ 7^t<3i4ofC^oe^ ?Uc^> BbV-Fl gM^CAlon^sl^ ^^l00' ^ ^-Ke^^e^id /-fc/d/^fa/f Dye -fo c/cc^ ^r/s s^^a 5^ l€ ^LL st -aL%^^^ -^ •s.0^Of ^-^ ( _-J ^ s.^0: -4V3^ -> ^ ^,i\ye^ P,c?<xc3t BAYF1ELD COUNTYCHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): •^f Check List 1^-Index Page / Title Sheet (Optional) ^Original Soil Evaluation Report (Submitted in Deed Holders Name - not prospective buyers) ^"Original Plot Plan fl^Cross Section Soil Profile Sheet (optional) ^Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) arcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used property Owner's Information (not prospective buyer's name) 'Property Location (Accurate Legal Description with Sec/Twp/Range) 'B^oad Name (where driveway is/will be coming off of) Floodptain Elevation, Flow Rate, Comments and Recommendations Soil Boring / Pit Information 0^Date Soil Evaluation was conducted ^.CST Name, Signature, Number, Address and Phone Number a *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) Bench Mark (Description, Elevation and Location) Sr&ontour Lines (Example = 98.0' ,96.0' ,94.0') Location (Sec/Twp/Range/, Accurate Legal Description) 'MBorings (Locations and Elevations) ^Percent and Direction of Land Slope -&'Well Location (Including Neighboring Wells, if applicable) KClocation of Wetland Areas, Floodplain and Navigable Waters ;, Driveways, and Structures (Location and Descriptions) Location of Property Lines Existing System Location Address Number and Road Name Current Surface Elevation of Wetlands and Navigable Waters CST, Owner and Property Information North ArrowNO] Fee: 'rtified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforcsts Norman Neuberg (Holding Tank) 15850 Bark River Road Herbster WI 54844 S21 T50N R07W Town of Clover 39 Acres PIN 04-014-2-50-07-21-4 04-000-10000 page 1-2: Bayfleld county checklist page 3: Tax statement (for informational purposes) page 4-5: Soil and Site Evaluation page 6: Plot plan page 7: Holding tank details page 8: Holding tank management plans page 9: Holding tank servicing contracts page 10: Holding tank agreements page 11: Wisconsin sanitary application Reference material; SPS 381-387 POWTS component manual (Version 2.1) (May 2022-2027) These plans prepared by ; AdrienCadyMP922139 31160 Birch Grove Road WashbumWL 54891 phone:715-373-2378 fax:715-373-0646 pw^j y}^^ ^ t- ?' CA."-+ r^ -?- r- ) ^Ta ^J -F0 •s <- >4 ^x>-5. ^ '^">4-'<1^/^^Si^}^^~"~7/ ~ ' ^s<^<^ ^ ,^5^ ^\\^ •^o^ot ^%os(a(<i ^^ ^ TO? ,^s p1 J . I^^ ^ S/Jc?$ ^-^ 04 9^]^^A</p^ p^a^wg^^ ^ ,00]^^^ulviv~)^w ^<3Q 1~B^^^V\.i ^nffj^^wcn^ ^}i.Q^ ^0^^l7°s^^ <2s?(?0/-0^0-h0, •h-^-LO-^-'e^O-hO f^Rt ^g^lm ^s(vs))-i p^j^^^^ OSS^l to^oyj ^T) ^^1^^ -^ ,Q]^ °"/ln 4/'9^a^ t/v+^°^ji ^ ^- .^v> -I- ^ -§> ^^ ^' ^ ^0 -> 151" 4" CAST-A-SEAL 4" CAST-A-SEAL FILTER OR BAFFLE ..-.w^.^^^^1\^ TOP VIEW;C^L,^<fis^t n W2000-MR TANK SPECIFICATIONS DIMENSIONS:WALL: 2 1/2"BOTTOM: SEPTIC 3"HEAVY DUTY 5" (ADD 2,050 LBS.) COVER: 6"MANHOLE: 24" I.D. PRECAST CONCRETE RISERHEIGHT: 66" O.D.LENGTH: 151" O.D. WIDTH: 86" O.D.BELOW INLET: 53" 0.0.LIQUID LEVEL: 47"WEIGHT; 13.540 LBS. SEPTIC15,370 LBS. HOLDING INLET AND OUTLET:4" CAST-A-SEAL BOOT OR EQUALGASKET, CAST-A-SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER:WISCONSIN, SEE DETAIL #10.(OTHER STATES SEE CHART) JLIQUID CAPACITY: 42.92 GAL/IN>V£Xi?diLOADING DESIGN: 8' 0" UNSAWRATED SOIL HOLDING TANK:OUTLET HOLE PLUGGEDACTUAL CAPACITY: 2,146 GALLONS [>1 n Lf'l P\/G ,5^40 Exi-eiA^Fn^ i^'lv/i(we $-vwi^ -Call OUTLET MN TANKS:WILL HAVE ONE VENT OVER OUTLETAND WILL HAVE TWO VENTS IN COVER OVER INLET TANK CAN BE USED AS:SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN jj!8 (NO FIBER)TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS:FOR CUSTOM TANKS CONTACT WIESER CONCRETE '5 0^ \AAOV€ €>t B^Ui'1^ ^^d SIDE VIEW ^ewvy ^v^e^v'[AA^f@. ^0% ^oli TANKS ARE MANUFACWRED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS JOB INFORMATION CUSTOMER: JOB NAME: DATE NEEDED: APPROVED BY: IAPPROVAL DATE: 1^i<K a Q: 3,I <3 <2 0Fa-Q cs <-3 QLUV)?uu- SHEET NO. >F 1 6/17/24, 9:37 AM Real Estate Bayfield County Property Listing Today's Date: 6/17/2024 Novus-Wisconsin Access rev. 12.0206 Property Status: Current Created On: 3/15/2006 1:15:13 PM i^ty Description Tax ID: PIN: Legacy PIN: Map ID: Municipality: STR; Description: Recorded Acres: Calculated Acres: Lottery Claims: First Dollar: Zoning: ESN: •S Tax Districts 1 04 014 044522 001700 Updated: 10/28/2022 11764 04-014-2-50-07-21-4 04-000-10000 014106109000 (014) TOWN OF CLOVER S21 T50N R07W SE SE LESS V. 180 P. 145 & 2022R-596357477 39.000 39.189 0 Yes (AG-1) Agricuttural-1 109 Updated: 3/15/2006 STATE COUNTi' TOWN OF CLOVER SCHL-SOUTHSHORE TECHNICAL COLLEGE « Recorded Documents Updated: 6/14/2022 Q WARRANTY DEED Q TERMINATION OF DECEDENT'S INTEREST Date Recorded: 5/27/2022 Q QUIT CLAIM DEED Date Recorded: 2022R-594814 361290 422-403 •^ Ownership NORMAN WADE NEUBERG Billing Address: NORMAN WADE NEUBERG5327 BURNETT RDCULVER MN 55779 Site Address * indicates 15850 BARK RIVER RD Property Assessment 2024 Assessment Detail Code Gl-RESIDENTIAL G5-UNDEVELOPED G6-PRODUCTIVE FOREST 2-Year Comparison Land: Improved: Total: S Property History N/A Updated: Mailing Address: NORMAN WADE 10/28/2022 CULVER MN WADE NEUBERG5327 BURNETT RDCULVER MN Private Road Acres 1.000 23.000 15.000 2023 37,200 12,000 49,200 I 55779 HERBSTER 54844 Updated: Land 10,000 9,200 18,000 2024 37,200 12,000 49,200 I: 7/30/2018 Imp, 12,000 0 0 Change 0.0% 0.0% 0.0% https://novus.bayfieldcounty.wi.gov/access/master.asp?paprpid=11764 1/1 BAYFIELD COUNTS CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-l-10(e)) Check List ^Original Sanitary Application (Submitted in Deed Holders Name - not 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 sump Tank Diagram, Alarm and Pump Curve (when applicable) ^Contingency Plan / Management Plan (383.22-3(2)(b)l.f.) .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) ^Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) \TU Servicing Agreement (Recorded at Reg. of Deeds) / "B^Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) &-2 Comolete Sets of Plans (383.22(2)(2.) (Note; Sanitary Appiication and Maintenance Agreements are to be attached to a H copies) -Soil and Site Evaluation Report (383.22-3(2)(b)l.e.) ate Plan Review (when applicable) :opy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) 5>^I Application Information must include: 1B"23 diait Parcel ID# - (do not use 12 digits anymore-obsolete) Project Address or Road Name where driveway is/will come off of) ^(Owners Phone Number) XII Type of Building .iS^III Type of Permit -BJV Type of POWTS System Dispersal / Treatment Area Information ^B</I Tank Information ^VII Responsibility Statement (Plumber's Information) D *Date Stamp* Plot Plan: (To Scale or To Dimension) ^^ignature and Plumber Information /fe-Address Number and Road •S-Surface Elevation of Body of Water ^TMorth Arrow ^Direction and Percent Land Slope ^Contour Lines .Tank and Filter Information and Location .^Qs5tructures and Driveways ^Q-Wetlands / Navigable Bodies of Water Scoring Locations -&-Absorption Area (Proposed and Existing) ^/Property Lines ^Bench Mark (Location, Elevation and Description) ja^A/ell Locations -^Component Manual Version JXJ-egal Descriptions Material Information (conveyance line, buiiciing sewer line, materia! type and diameter) Turn Over > Cross-Section and Over-Head Profile of the System: Surface and System Elevation M Position of Observation and Vent Pipes ^Dimensions and Depths lake. Model & Number of Chamber Units in each Cell Property Information K]How many systems will there be pnthis parcel of land? SWas this property been split? 1\J(^/ (Property Statement shows Property History) Fees: D Private Sewage System (Septic Tanks) $ 400.00 D Private Sewage System (Holding Tanks) $ 400.00 D Mounds or Systems requiring Pre-Treatment $ 500.00 D Sanitary Revisions $ 25.00 a 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/checklistforsanitaryapps(10/2009);(®7/2011);(®2/2012)(®5/2/2012-dc) Proofed by: HOLDING TANK SERVICING CONTRACT Contract Date This contract is made between the Holding Tank Owner(s) Name(s) klc>fr^3Lf\ (\/Cu^O ef c^ Pumper's Name (Print) ?C3t-t«^ \; Pumper's Signature /^G^T^— Pumpers' Registration # l7o3 We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT LOCATION Legal Description: (Use Tax Statement) TaxlOT_? Section _-*.l , Township ^3 C-> _ N, Range Gov'tLot Lot #CSMff Vol. Page CSMDocff o7 w Lot(s) No.Block(s) No. :SC_1/4, ^t 1/4, Town of: <^\Q \je.r Lot Size Acreage ^1_ Subdivision: 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 semiannuai 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; y b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; ,f , ;y.^'iil d. The sanitary permit number issued for the holding tank; it '' ''"* ' '1;' 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. 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 sen/ice contract. Owner(s) Name(s) (Print) .u,~l^^^^u^ ^^L ^e^^- Owner's Signature(s) ^;zy'^.^^^:^-^\ /i/"J^'sil:^ Subscribed and Sworn to me: on this /S day of r^O/ltL Z^)^ by:/^.^ I^JZ^ffOLJ) Notary Public My commission expires on: ryfv \ '^/jp^ Revised: May 2016 (®May 2018)Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (l)(m)] Drafted 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 ^-^0 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. 5. 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. 6. Performance monitoring. At the time of servicing, the service provider files a report with the department of designated agent. 7. A User's Manual will accompany the component. It will include the names and phone numbers of local health authorities, component manufacturer or POWTS sen/ice 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 ^^1/4 of .S^T/4 Section^J.Township^.N. RangeOZ.W. Town of C/CV <^L/' Govt.Lot Lot Block_Subdivision_CSM#_ Additional Legal Description L-£^ \]^0 P./^^-^O^^R -5-?^$$"? ^-?7 ^..w-' ^'y^^^^ /i 'L^^c'^tyt- i'-f, Property Owners Signature ^ <^ Date u/forms/managementplan Revised: July 2013 Owner Name (s) !r\<s^<<^cv~o <\cA->io<=rc< <J Doctment Number/Plan I.D. No. (y ^i Parcel Identifiero 4-GI 4-5-5-6- 6 7-oL | -4 0^-000-10000 HOLDING TANKAGREEMENT Owner(s) Mailing Address\S32n ^(^bt ^ ^.U.L.vASR,^ 5C-?77 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 other type of private onsite wastewater treatment system as permitted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Stats. .1/4 of ->E^ 1/4 Section oU Township ^0 N. Range 07w. Town of < _ (g?^i -^ L/* Additional Legal Description: Gov't Lot_ Lot_Block Lot. CSM #l_ acsAR-5?W7 Subdivision _CSM#_ Vol_ _Page CSM Doc# DOCUMENT NUMBER2024R-60369 1 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, Wl RECORDED 06/20/2024 AT 10:55 AM RECORDING FEE; $30.00 PAGES: 3 Return To:^^CA C^^ ^"V(A5 As an inducement to Bayfield County to issue a sanitary permit for a holding tank on the above described property, we agree to do the following: 1. 2. 3. 4. 5. 6. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tank installation and maintenance. If the owner fails to have the holding tank property serviced in response to orders issued by Bayfield County or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Stats., Bayfleld 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. 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. 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, Wt's Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. Owner(s) Name(s) - Please Print ^- ;- .,-1,,—-—•'•\^ ^ ^.^^y <<--^—< ^..^' — (-^ Notarized Owner(s) - Signature(s) J/^^^Oc^i^ —^ Subscribed and sworn to before me on this date: G?/i8/^ Notary PublicJ^^er m^nC^ My Commission Expires: ^i) °[ 1^2J£ Drafted by: K \l&^ Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04(l)(m}] Date: u/forms/sanitary/holdingtankagreemBntdoc ©June 2018 $.''•..I,?.'.': . t .' 'K MC'-;';'11" -; v f^i- WARRANTY DEED This deed, made between Kay Ann St. John, Grantor, and Norman Wade Neuberg, Grantee, Witnesseth, That the said Grantor, for a valuable consideration conveys to Grantee the following described real estate in Bayfield County, State of Wisconsin: As Described in Attached Addendum/Exhibit A Parcel No. 04-014-2-50-07-21-4 04-000-10000 This is not homestead property. DANIEL J. HEFFNERBAYFIELD COUNTY, WIREGISTER OF DEEDS 2022R-596357 09/14/2022 08:32AMTF EXEMPT #:RECORDING FEE: $30.00TRANSFER FEE: $150.00 PAGES: 2 Return to:Norman Wade Neuberg5327 Burnett RoadOliver, MN 55779 File No. 225261 Together with all and singular the hereditaments and appurtenances thereunto belonging; And the said grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except exceptions, reservations, easements and restrictions of record, and will warrant and defend the same. Dated this \2^ day of September, 2022. Kaly^mSt.John " ^ State of Wisconsin Winnebago County Personally came before me this known to be the person(s) who executed the foregoing instrument and hereby acknowledge the same. iMLJlA^fS^ FNicole J. SchroecQ- Notary Public, State of Wisconsin Q^ ) )S.S.) day of September, 2022, the above named Kay Ann St. John to me This instrument drafted by: Michael S. Brandner Gowey Abstract & Tide Company Inc.My Commission Expires: 01/04/2023 ^Wl't,.^\\'sc^//.^^rlw^H!/'^Ry"^ «•-•-"' '• z \^.ft^.^/^t°"^'//"mn"n<xvv Bayfield County Register of Deeds Document # 2022R-596357 Page 1 of 2 GOWEY Abstract & Title Company, Inc. (800) 673-8710 • www.goweytitle.com Rle Number: 225261 ADDENDUM/EXHIBIT A The Southeast Quarter of the Southeast Quarter (SE1/4-SE1/4), Section Twenty-one (21), Township Fifty (50) North, Range Seven (7) West, Town of Clover, Bayfield Count/, Wisconsin; EXCEPT Commencing at the Southeast corner of the SE1/4 of the SE1/4, which is the Point of True Beginning; thence North along the section line to the town road; thence Southwesterty along the town road to the South section line; thence Easterly along the section line to the Point of True Beginning. Bayfield County Register of Deeds Document # 2022R-596357 Page 2 of 2 BAYFIELD COUNTY # 24-77S STATE SANITARY PERMIT I TRANSFER/RENEWAL PREVIOUS NO. OWNER: Norman W Neuberg PROPERTY LOCATION: Town of Clover SE V4 SE >/4 SEC 21, T50N, R7W PLUMBER: Adrien Cady LIC. #: 922139 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 dale 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. All grey and black to be discharged into tank. 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)