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Home My WebLink About24-78SRequest for Sanitary Inspection (24 Hrs. tin Advance) ✓ Fax or email this form to Zoning Dept (24 Hrs.) prior to when you want an inspection Fax (715) 373-0114 or Email zoning(cbbayfieldcounty.wi.gov Note f Time Change fl Discrepancy fl Other A.t',ke, e`{t,, � Phone Number i S 3 13 ;379 Plumber: C�Ly PC1rU rl }7Ut�V ('�— Fax Number % t Email Address Homeowner: Cad" (tu-n btng Uzi �''co . c Immediate Phone Number So Zoning Sanitary Permit #: sDept s can call you right back (if needed) I ( S, 29 Z 0( L9 Plumber's Choice Dept No Inspection(s) during this time Date: �� vliu L Tuesday (9:30 am - 12:15 pm) (Tracy:. ycl Y�v Time: Plumber's Choice Dept 0* e Township: L� C �s C�6uk Address # & Road Name: 7i1 ZO CVI.fabici'"✓tt /-kt�rIa5 R� . or £tL)&41/Lbb{.M'u LA)) 5` CM1 U Directions To Site: Comments: �°t I'1 ** Plumbers you must verify any change(s) by fax or email ** Notes from Zoning July 2025 POWTS HOLDING TANK INSPECTION REPORT (ATTACH TO PERMIT) GENERAL INFCRnnATIMI Permit Holder's Narr ALEXANDER LA! Plan ID No. 1716 SPYGLASS RD PETALUMA CA 94954 Sanitary Permit No. Propertyddress if Available TANK INFORM._ - TYPE MANUFACTURER/MODEL# CAPACITY C&4r lA ' o S 0 2 4r/,e QCTRAr'VQ Property Linev Well Water Service Building All -Weather Road OHWM Swimming Pool DEVIATIONS FROM APPROVED PLAN COMMENTS (Persons present, discrepancies, etc.) /Mctf(5d C t,ity c'Q' w/ 'fh�E/11f/r 4larA17 COMPONENTS NOT INSPECTED Plan RSI Required ❑ Yes No [yet . 1� Signature of Inspec Cert. Number Sketch n other side 10 of 3 ELEVATION DATA Point Backsight Height of Instrument Foresight Elevation Comments Bench mark Bldg. sewer �' $ Tank inlet Tank outlet Tank inlet Tank outlet Bottom of furthest tank Top of all- weather road SKETCH OF COMPONENT & ADDITIONAL COMMENTS 11 of 13 Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoningabayfieldcountv.wi.aov Web Site: www.bayfieldcounty.wi.govl147 ALEXANDER LA! 1716 SPYGLASS RD 13ETAI-UMA CA 94954 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know nY was contracted by you to install a private onsite wastewater tr ment system o i your property described as: Notes: Abandonment of Old System to meet all applicable code requirements: C. Tank was pumped by: on at AM I PM .• Tank was crushed I removed and pipes disconnected by: On at / (AM Ie above -mentioned plumber contacted our office to conduct a pre -cover inspection as required u dF er DSPS 383. One of the following applies: Hz teK Sye 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: UlformslsanilarypropeOyowner-input April2019 /'"�"r"'w�. Industry Services Division County BAYFIELD \ / 4822 Madison Yards Way Sanitary Permit Number (to be filled in by Co.) =1 �4Sp 'r 7• �; S JU 1 Madison, WI 53705 d LOt4 P.O. Box 7302 1 9 �� . i i"sunrc`+"P• %1, Madisoq WI 5302 (� --1 S Sanitary Permit Application State 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 am 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 74720 Chequamagon Heights Road purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. Washburn, WI 54891 L Application Information —Please Print All Information Property Owner's Name parcel # Alexander Lai 04-002-2-48-04-07-2 03-000-10000 Property Owner's Mailing Address Property Location 1716 Spyglass Road Govt Lot City, State Zip Code Phone Number Petaluma, CA 94954 707460-8194 SW '/�_y. Section 07 T 48 N R 04 W 11. Type of Building (check all that apply) Lot# X 1 or 2 Family Dwelling — Number ofBedrooms 3 Subdivision Name ❑ Public/Commercial — Describe Use Block # 0 City of ❑ State Owned — Describe Use --" — 0 Village of CSMNumber X Town of BARKSDALE 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 if applicable.) A. H New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. 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. Dispersal/Treatment Area and Tank Information: Design Flo gpd) Design Soil Application Rate(gpd/s I Dispersal Area Required (st) Dispersal Area Proposed (st) I System Elevation 450 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units ` a' '00 New Tanks Rdsting Tanks C to u u ai r, a7 w U rn m m a C7 Septic or Holding Tank 000 000 I SER Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum 's ignaI MP/MPRS Number I Business Phone Number ADRIEN CADY 922139 715-373-2378 Plumber's Address (Street, City, State, Zip Code) 31160 BIRCH GROVE ROAD WASHBURN WI 54891 VI. County/Department Use Only 1s Approved ❑ Disapproved Permit Fee Date Issued I I Issuing Agent re (D• -p"1 ❑ Owner Given Reason for Denial 00.o 1 Z� Conditions of Approval/Reasons for Disapproval 3) iwt 1) 1-t- I° fui ail g64Dcac wmtuh aS o- a,�l Amen to complete plans ror the system and submit to the County only on paper not less than 8 In ill inches in size SBD-6398 (R. 02/22) Soil Test # Bayfield County 5 - Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) JUNL. a Li l " 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 /7'L LXtit i� L>'1L Contractor Property Address ff. y c t L H"<< N b Authorized Agent IL r1ti! <<r\fL I Agent's Telephone Telephone /('/ V&c ,)/%l Written Authorization Attached: Y or N Accurate Legal Description is requested: 1/4 of n'1/4 Section 7 _TownshipLN. Range W. Town of !', �k'4/�� Govt. Lot Lot Block Subdivision CSM# Volume Page of Deeds Parcel I.D# / / Acreage Additional Legal Description: Indicate reasoning for your determination: /% }/',<7'.'k' Lt)S /t/,lit Signature of County Official Date r Signature of Certified Soil Tester Date Certification # (Submit a Plot Plan & Fee) info rms/solltestwa ive r(KL K ) February 2005 S k? W Ski NR! S7iy AIKyG✓ of 13fQtCSbRc�c u4Y&rL15 CTj/ /O,3 Ac,ES S Cft Let •_ ¼U ' G IL it ic,/s,4 cc L He WiL-L Ok A1Ak4SS AT T,./ZS 'lzM4 ds V5'Sr.wc c, w �.-. o5 r #-7 � ►JcrzM Lt,' - 1 oeocc-b S.zr€ � ZLI NlP4.Ok }3( . fl PAGE Z&FL rD � s J d N 1 9'[024 LI Co. Zoning Dept. y I tic Qe $6� SLT� , -33• .lJT4 F'i2c%V L -"-'E �D) LCLIl�VU Axexander Lai JUN 1 9 2024 (Holding Tank) Bayfield Co. Zoning Dept. 74720 Chequamegon Heights Road Washburn WI 54891 SW NW 507 T48N R04W Town of Barksdale 10.3 Acres PIN 04-002-2-48-04-07-2 03-000-10000 page 1-2: Bayfield 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; Adrien Cady MP922139 31160 Birch Grove Road Washburn WI. 54891 phone:715-373-2378 fax:715-373-0646 O 7 4(�X0�dev(�-�i 747a.d C,heua(�te7ou erqL �s 5 u vA Le/r Sy gQ l P k O*00 4 g oC 07-L Off- 0ec- j 00cc) $ 7 -rci-BN kOtW TouJr4 ofaysda llaQcrcs .5e ��al`e✓1 ,o puli� I0GQ�o✓i `' �rq� pYo�pos ed ' 5? s e P 11� C Lam` ev 5_ PVx„11PV1 V iinP repe&oK a9 &, Ldp 5 1 6 ,Cr c>ww :5cc. l t O Lw' W2000 -MR TANK SPECIFICATIONS TOP VIEW ckA v\ 1��wc"✓0019 rs ≥tip�(N&vu �oG114' Vi�'je FLETt M DIMENSIONS: WALL: 2 1/2" BOTTOM: SEPTIC 3" HEAVY DUTY 5" (ADD 2,050 LBS.) COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 66" O.D. LENGTH: 151" O.D. WIDTH: 86" O.D. BELOW INLET: 53" O.D. LIQUID LEVEL: 47" WEIGHT: 13,540 LBS, SEPTIC 15,370 LBS. HOLDING INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL CASKET, CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 42.92 GAL/IN u)� �Pu LCb J LOADING DESIGN: 8' 0" UNSATURATED SOIL et'C HOLDING TANK: OUTLET HOLE PLUGGED i--II Pvc- ACTUAL CAPACITY: 2,146 GALLONS / �� ! (r, MN TANKS: t- WILL HAVE ONE VENT OVER OUTLET AND WILL HAVE TWO VENTS IN COVER OVER INLET I e St/IoW TANK CAN -Ecdl SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN # NO FIBER) OUTLET TANK: MIX DESIGN #10 ( (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WESER CONCRETE UU, -j`cvwove of BcddiM s4k/ eev'cc v I"I/tee ,kovvI/l SIDE VIEW SCt @Q% EU/ r II JOB INFORMATION: CUSTOMER: JOB NAME: DATE NEEDED: APPROVED BY: r N W C0Lr) - 70F1 TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS 4 Bayfield County, WI 6/24/2024, 8:12:00 AM 1:1,591 Wetlands = Approximate Parcel Boundary Building Footprint 2015 0 0.02 0.04 0.ocml Rivers Road Type * Building 0 0.05 0.05 0.12 km Town Bayrsdd County Land Rooxds Depanmont Bayfield County ZOMng Appiim4on bnps://maps.bayreeldmuntywi.govioning WAB/ Real. Estate Bayfield County Property Listing Today's Date: 5/16/2024 4 Description Updated: 8/1/2022 Tax ID: 17 PIN: 04-002-2-08-04-07-2 03-000-10000 Legacy PIN: 002100110000 Map ID: Municipality: (002) TOWN OF BARKSDALE STR: S07 T48N R04W Description: PAR IN SW NW IN 2022R-595621 16 Recorded Acres: 10.300 Calculated Acres: 9.808 Lottery Claims: 0 First Dollar: No Zoning: (R-1) Residential -I ESN: 103 1 Tax Districts Updated: 3/15/2006 1 STATE 04 COUNTY 002 TOWN OF BARKSDALE 046027 SCHL-WASHBURN 001700 TECHNICAL COLLEGE a Recorded Documents Updated: 8/12/2008 0 WARRANTY DEED Date Recorded: 7/22/2022 2022R-595621 0 QUIT CLAIM DEED Date Recorded: 6/11/2015 2015R-559094 1143-916 0 WARRANTY DEED Date Recorded: 6/17/2008 2008R-521330 997-597 U ( LI Property Status: Current it JUN "I C' u rnea JJ On: 3/15/2006 1:14:41 PM a Ownership. ALEXANDER LAX Billing Address: ALEXANDER LAI 1716 SPYGLASS RD PETALUMA CA 94954 c(,pl Updated: 8/1/2022 PETALUMA CA Malting Address: ALEXANDER LA! 1716 SPYGLASS RD PETALUMA CA 94954 P Site Address * indicates Private Road 74720 CHEQUAMEGON HEIGHTS RD WASHBURN 54891 5 Property Assessment Updated: 6/22/2009 2024 Assessment Detail Code Acres Land Imp. G1 -RESIDENTIAL 2.000 30,000 0 G6-PRODUCRVE FOREST 8.300 13,300 0 2 -Year Comparison 2023 2024 Change Land: 43,300 43,300 0.0% Improved: 0 0 0.0% Total: 43,300 43,300 0.0% Li Property History N/A BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) 1 ':heck List n HH I1 �Inuj JUN 19 2024 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 Wump Tank Diagram, Alarm and Pump Curve (when applicable) I�1 Contingency Plan / Management Plan (383.22-3(2)(b)1.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) ATU Servicing Agreement (Recorded at Reg. of Deeds) -Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) og Dept. 'B-2 :omolete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) *State Plan Review (when applicable) Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) nt f Application Information must include: 19,23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) ❑ Project Address or Road Name where driveway is/will come off of) ❑ (Owners Phone Number) ;)-II Type of Building iiI Type of Permit Env Type of POWTS System Dispersal / Treatment Area Information _Kv_, Tank Information -$'VII Responsibility Statement (Plumber's Information) ❑ *Date Stamp* Plot Plan: (To Scale or To Dimension) Signature and Plumber Information .NSurface Elevation of Body of Water Direction and Percent Land Slope .,Tank and Filter Information and Location Wetlands / Navigable Bodies of Water I^ Absorption Area (Proposed and Existing) Bench Mark (Location, Elevation and Description) Komponent Manual Version Address Number and Road 4 North Arrow -,/Contour Lines y Structures and Driveways oring Locations -Property Lines ell Locations .� Legal Descriptions '2 aping Material Information (conveyance line, building sewer line, material type and diameter Turn Over ► Cross -Section and Over -Head Profile of the System: ❑ Surface and System Elevation D L L ❑ Position of Observation and Vent Pipes liii JUN 1 91UZ4 ❑ Dimensions and Depths Eayfield Co. Zoning Dept. ❑ 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? (Property Statement shows Property History) Fees: ❑ Private Sewage System (Septic Tanks) $ 400.00 ❑ Private Sewage System (Holding Tanks) $ 400.00 ❑ Mounds or Systems requiring Pre -Treatment $ 500.00 ❑ Sanitary Revisions $ 25.00 ❑ Private Sewage System Reconnection $ 50.00 and Private Interceptor ❑ Return Inspection $ 50.00 ❑ Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) u/forms/checklists/checklisttorsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: / \ tutu 14 I1� LS l InServices Division LS u V LS4adison Yards Way Countygc BAYFIELD Permit Number (to be filled in by Co.) JU W153705Sanitary 19 2024O. Box 7302 Ap,+uavnt �J - Madison, WI 5302 - 2 -16 S SatlltaryN ermir� W ICatlon State 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 74720 Chequamagon Heights Road purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. Washburn, WI 54891 I. Application Information — Please Print All Information Property Owner's Name Parcel # Alexander Lai 04-002-248-04-07.2 03-000-10000 Property Owner's Mailing Address Property Location 1716 Spyglass Road Govt Lot City, State I Zip Code Phone Number Petaluma, CA 94954 707460-8194 SW '/.,NW 7., Section 07 148 N R 04 W H. Type of Building (check all that apply) Lot # X I or 2 Family Dwelling — Number of Bedrooms 3 Subdivision Name ❑ Public/Commercial — Describe Use Block # ❑ City of ❑ State Owned — Describe Use ❑ Village of CSM Number X Town of BARKSDALE 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 if applicable.) A. S New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. S Holding Tank ❑ In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision 0 Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Information: Design Flo gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (sf) I Dispersal Area Proposed (sf) I System Elevation 450 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units a2 ` t? .� New Tanks Existing Tanks c a U 9 v y y w V a Septic or Holding Tank 000 - 000 I ESER Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum 's igna MP/MPRS Number Business Phone Number ADRIEN CADY 922139 715-373-2378 Plumber's Address (Street, City, State, Zip Code) 31160 BIRCH GROVE ROAD WASHBURN WI 54891 VL County/Department Use Only Approved 0 Disapproved Permit Fee P 4 0o oO Date Issued I I I ZA Issuing Agent re 19- ❑ Owner Given Reason for Denial • Conditions of Approval/Reasons for Disapproval 3) TUYVE v3'kt&A as' i) �a w DAw4 ail tSQMoaIACS 0- ail a� wpwni Q (D 0w►%LA' c 4.t c.. per rvak Attach to complete plans for the system and submit to the County only on paper not tens man alas ii mcnes In size SBD-6398 (R. 02/22) 55 -u036% HOLDING TANK Owner Name (s) I LOir(s)Mailing Address sPygs n..___—, t Parcel Identifier Number (PIN) _ Agreement Date (same as Notary Date) a 4.C1d2-2r4W'-o4tioTaa! _ (0--1- 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. X)) 1/4 of_i'JuA4 Section 7 Township N. Range a W. Town of Additional Legal Description4, t ttJ S1Jf.,J 25r222,S5S102_(cc. Gov't Lot Lot Block Subdivision CSM# LotCSM # Vol _Page _CSM Doc# Return To: DOCUMENT NUMBER 2024R-603674 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED O6/19/2O24 AT 1: 1 5 PM RECORDING FEE: $30.00 PAGES: 2 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. 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, Stets., 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. Stats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced in accordance with Ch. NR1 13, 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. Stats., 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 property 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 a �I`W'-F1sub it this agreement to the register of deeds, and the agreement shall be recorded by the register of dsbWil6 In hlc well per it the existence of the agreement to be determined by reference to the property where the holding tank Installe�otary Public ..etn Owner(s) Name(s) — Please Print Subscribed and sworn to be re m� i June 7 Notarized Owner(s) — Slgnature(s) Notary Pub' My Commission Expire iO-7 ate_ Drafted by: fr/ `, e l (e " Date: — — �t 9" Personal Informadon you pmvlde may be used ror secondary purposes (Privacy Law, s.15.04 (n(m)) ulromisanitaryhddingtankagmement.dac dune 2018 File Number: 223802 ADDENDUM/EXHIBIT A A parcel of land located in the Southwest Quarter of the Northwest Quarter (SW1/4-NW1/4), Section Seven (7), Township Forty-eight (48) North, Range Four (4) West, Town of Barksdale, Bayfleld County, Wisconsin, described as follows: To locate the Point of Beginning, commence at the West 1/4 corner of said Section 7, and run North 00°22'54" East, 990.00 feet along the West line of said Section 7, to the Point of Beginning; thence from said Point of Beginning by metes and bounds: Continue North 00°22'54" East, 332.44 feet to the North 1/16 corner on said West line; thence leaving said West line, South 89°48'42" East, 1320.50 feet along the North line of said SW1/4-NW1/4, to a 2" iron pipe at the NW 1/16 corner of said Section 7, (passing through a 2" Iron pipe at 33.00 feet); thence leaving said North line and along the East line of said SW1/4-NW1/4, South 00°22'35" West, 330.98 feet, to a 2" iron pipe; thence leaving said East line, North 89°5229" West, 1320.54 feet to the Point of Beginning, (passing through a 2" Iron pipe at 880.54 feet and a 1" iron pipe at 1287.54 feet). Bayfield County Register of Deeds Document # 2022R-595621 Page 2 of 2 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-1 0571 -P)(R.6/99) and the Bayfield County Zoning Department Sanitary and Private Sewage Ordinance. This POWTS has been designed to accommodate a maximum daily flow of y co 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 c 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 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 51.1)114 of W11914 Section o! Township '4 N. Range O' W. Town of Govt. Lot Lot Block Subdivision CSM#. Additional Legal Description ?c StJ 5 WN P.,J 2 d Z' St 2.. I Property Owners Signature u/forms/managementplan O? J -F Zo Z `( Date Revised: July 2013 HOLDING TANK SERVICING CONTRACT Contract Date JuAc 7��y This contract is made between the Holding Tank Owner(s) Name(s) Pumper's Name (Print) Pumper's Signature Pumpers' Registration # 2c3 We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT I Legal Descrintlon: Tax tD# L N 1/4' 1, LOCATION (Use Tax Statement) I 7 , zy Section ,Township 48 N, Range w Town of: -,� Lot Size Acreage /0.3 Gov't Lot Lot # CSM # Vol. Page CSM Doc # Lot(s)No. ebck(s) No. Subdivision: 1. The owner agrees to file a copy of this contract with Bayfield 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. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In ige this contract, the owner agrees to file a copy of any changes to this service contract o g rvice co tract with the local government unit and the County named above within (10) business d s oe�r�t@1a161an e t this service contract. N ® of Vjtsconsltl Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed to me: on this 2dayof /) by: G. Notary PubHJ My commission expires on: Revised: May 2016 (®May 2018) Drafted Personal information you prqvide may be used for secondary purposes [Privacy Law. s.15.04 (I)(m)] BAYFIELD COUNTY SANITARY PERMIT # 24-78S STATE SANITARY PERMIT El TRANSFER/RENEWAL OWNER: Alexander Lai PROPERTY LOCATION: Town of Barksdale SW'/a NW Ya SEC 7, T48N, R4W PREVIOUS NO. _________ PLUMBER: Adrien Cady LIC. #: 922139 McKenzie Slack 7/1/2024 AUTHORIZED ISSUING OFFICER DATE 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. (1) 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. 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)