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Home My WebLink About24-78S Lai./^""^/^f/' '<yAy'- •S"vB..:":^n'\ l • /^-/ ".--- .', ',"~^v—>^/^: '',''1' •• < Industry Services Division 4822 Madison Yards Way Madison, WI 53705 P.O. Box 7302 Madison, WI 5302 CountyBAYFIELD Sanitary Permit Number (to be filled in by Co.) 2^-'7g>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 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. Project Address (if different than mailing address) 74720 Chequamagon Heights Road Washbum,WI 54891 I. Application Information - Please Print All Information Property Owner's NameAlexander Lai Parcel # 04-002-2-48-04-07-2 03-000-10000 Al Property Owner's Mailing Address 1716 Spyglass Road Property Location Govt. Lot. City, State Petaluma, CA Zip Code 94954 U. 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 707-460-8194 Lot # sw '/4.NW '/4. Section T4S _N R_04_WSubdivision Name Block # CSM Number a City of _ D Village of X Town of BARKSDALE III. 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.d New System D Replacement System D Other Modification to Existing System (explain)D Additional Pretreatment Unit (explain) B.'S. Holding Tank D In-Ground (conventional) D At-Grade D Mound D Individual Site Design C] Other Type (explain) c.D Renewal Before Expiration D Revision D Change of Plumber D Transfer to New OwnerlList Previous Permit Number and Date Issued IV. Dispersal/Treatment Area and Tank Information: sign Tloy^g)-Design Flcy^gpd)450 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 trt£ S& 0 Itll sE o Septic or Holding Tank [2000 ^tzooo IWIESER Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) ADRIEN CADY Plumtiei^sjiign:MP/MPRS Number922139 Business Phone Number 715-373-2378 Plumber's Address (Street, City, State, Zip Code)31160 BIRCH GROVE ROAD WASHBURN WI54891 VI. County/Department Use Only Permit Fee Ps^\| $4oo.oo|^l|2.4.Approved la-M-an D Disapproved D Owner Given Reason for Denial Date Issued Issuing Agent /^rl7£//S Conditions ofApprovaVReasons for Disapproval i.) Tow w m^ an &rt)a[X 3^) Tow \M\srtu»i as' o(' ai\ ^ta\w road. /1/VW^t P' <° 0>W^- C^^^A'^^ Attach to complete plans for the system and submit to the County only on paper not less than S 1/2 x 11 inches in size SBD-6398 (R. 02/22) Bayfield County Soil Test #^-^ Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) I B»<aCl ^ /S^^/"^'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_^.M^^k. Li^i-Contractor Property Address CH-^\ <-<ri <^ L -'6-.",-/i/t.^H ^ Authorized Agent t.\^>;L,'^//i)c^WL ii/C Agent's Telephone. Telephone_y^cf ^/y^Written Authorization Attached: Y or N Accurate Legal Description is requested: _1>__1/4 of A (v 1/4 Section 7 Township V^ N. Range 7 W. Town of ^^<^^r'L ^ Govt.Lot_Lot_Block_Subdivision_CSM# Volume .Page.of Deeds Parcel I.D#,7 .Acreage./^ Additional Legal Description:. (( ^ //cW7 Z.'^Indicate reasoning for your determination:. /> '^ -1 /i^ Qf^^lL '^^i/'i., /^-) 7;; ,^ ^ i 3 3 /7//~//L ..-' /.\/^^^-L - i/J)^ /l/.... - Signature ofjCertified Soil Tester/7,^-,^,^ Date /ZW<A Signature of County Official Date Certification # (Submit a Plot Plan & Fee) u/forms/soiltestwaiver(KLK) February 2005 ^t < \ . ' ^ i T 6 - ^ r s n 1^ .i !^ S-;^^, |r A T'( » \ -^ \ <» • 1^ ' \^ - . t[°J^' ? / ^ . / is / I ^ - j !' ' ' ! z~ l ft \ \ •? w) 'A J» ^t' i -ArA l ^. ^t-vk- \r.^ <p ' f0-c0 I/ "y\v i^0- r- " ' fy ^h r» Tr- '731 \/ 7.r."^r-^T- (K > ^^Vk S ^ ^ ^ r' ^r <.< ^ - \ ) d^ ^ 7 0 ^' . 7 ? . ~^ & ^>f"rA ^^~<^'V . L4 <^ N <T ^^•o^l "Q ^•^ '< : ,^ r~ t^ co r~ < ?^^^^p Axexander Lai (Holding Tank) 74720 Chequamegon Heights Road WashbumWI 54891 SW NW S07 T48N R04W Town ofBarksdale 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 ; AdrienCadyMP922139 31160 Birch Grove Road WashbumWL 54891 phone:715-373-2378 fax:715-373-0646 GLI/} f-^xa ^ Q/ e ^ L-GL i 74-73-0 Chec^uw^o^ ^/^9' uja^^u^iA a/r^g%/ R-^ 0^-00^-2-^-0^07'^ ^-ooo-i oooo ^ S^W, 507 T^-SIV {^Ott^ T<^u offe^rs^c, /c ,0.^0.^5 ^ N ^CCcl^ S~^ — »— I0' 5&' Lfo' _N.R^pe^_i^P ^1-—^/^-^0%^e:^3.^ ^'^^^^'^v ^^^v^^s^•^y^^^sw^^_^ NO u^a_ F 5+oL«e ^T-m K^^^ i^p^^n-fr^ ^U^ sA/fcC^pofy" ^E ^cd^Z'^^?v^ T^J^u^^\" TOP VIEW •o \^^^\Je^ W2000-MR TANK SPECIFICATIONS DIMENSIONS;WALL: 2 1/2"BOTTOM: SEPT1C 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" O.D.LIQUID LEVEL: 47"WEIGHT: 13,540 LBS. SEPTIC15,370 LBS. HOLDING INLET AND OUTLET:4" CAST-A-SEAL BOOT OR EQUALCASKET, CAST-A-SEAL BOOT OR EQUALINLET AND OUTLET BAFFLE AND FILTER:WISCONSIN. SEE DETAIL #10.(OTHER STATES SEE CHART) JJQUID CAPACITT: 42.92 GAL/tN 'LOADING DESIGN: 8' 0" UNSATURATED SOIL6 ^ HOLDING TANK;OUTLET HOLE PLUGGEDACTUAL CAPACin: 2,146 GALLONS W TANKS: _ . _ , _ .WILL HAVE ONE VENT OVER OUTLETAND WILL HAVE TWO VENTS IN COVER OVER INLET ^(p\/c/M^(=xteiAc)-n/i'y l^/tk'L'e 5W\^ TANK CAN BE USED AS:~^a\\ SEPTIC/ HOLDING/ PUMP OR SIPHON n COVER; MIX DESIGN ffS (NO FIBER)TANK: MIX DESIGN ^10 (STRUCTURAL FIBER) CUSTOMIZED TANKS;FOR CUSTOM TANKS CONTACT WESER CONCRETE '^OV\AAO^t €>t B&'cUFMc? ^\d s/ SIDE VIEW ^•evc^vy ^/ce^^v[A/[5eh@/ 'ci0% ^ot( TANKS ARE MANUFACWRED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS 30B_IJiFORMATIQISLL CUSTOMER: JOB NAME; DATE NEEDED; APPROVED BY: APPROVAL DATE: £ 5@! I y LU <D§Lt?£ ^)-00 3 io!s CM If0|9. i-0.!!§iw:3 ^ 3! I2 ^ s g.sw^ UJu. I ^ SHEETMO,^r Bayfield County, Wl eE5SS!ff333SE>Of£SS> GEiGEOTEaasoeEsepgm'sso^QssssaQSSs'sss CESB3®ENBK3{PCSSSSSSSSEBCSB ^wao^cassieagataasewG® ISESSEBffvt'a/SQOSSEQ<S£fftQ'3!33S .^@?@aagwc<a8g8iN»sffiBa«) %i3t)fl(iSassoca3C!Ea3esB3 Ga;aa%oa30B3SSS&&@3SSSS?ESSaCS0S CSS8SffSa38!>083S3SlQ356S@<333333 6/24/2024, 8:12:00 AM :;'iifc~: Wetlands L .............I Approximate Parcel Boundary Rivers Road Type ^^ Town Building Footprint 2015 Building 0.02 1:1,591 0.04 0.08 mi 0.03 0.06 0.12km Bayfield County Land Records Department Bayfield County Zoning Application https://maps.bayfleldcounty.wl.gov/ZoningWAB/ Real; Estate Bayfield County Property Listing Today's Date: 5/16/2024 Property Status; Current Created On: 3/15/2006 1:14:41 PM -i*? Description Tax ID: PIN: Legacy PIN: Map ID: Municipality: STR: Description: Recorded Acres: Calculated Acres: Lottery Claims: First Dollar: Zoning: ESN: ^ Tax Districts 1 04 002 046027 001700 < Recorded Documents Q WARRANTY DEED Date Recorded: 7/22/2022 B QUIT CLAIM DEED Date Recorded: 6/11/2015 63 WARRANTY DEED Date Recorded: 6/17/2008 Updated: 8/1/2022 -•** Ownership ALEXANDER LAI Billing Address: ALEXANDER LAI1716 SPYGLASS RDPETALUMA CA 94954 Site Address * indicates Updated:: 8/1/2022 PETALUMA CA Mailing Address: ALEXANDER LAI1716 SPYGLASS RDPETALUMA CA 94954 Private Road 74720 CHEQUAMEGON HEIGHTS RD —S Property Assessment 2024 Assessment Detail Code Gl-RESIDENTIAL G6-PRODUCTIVE FOREST 2-Year Comparison Land: Improved: Total: Acres 2.000 8.300 2023 43,300 0 43,300 WASHBURN 54891 Updated: Land 30,000 13,300 2024 43,300 0 43,300 6/22/2009 Imp. 0 0 Change 0.0% 0.0% 0.0% 17 04-002-2-48-04-07-2 03-000-10000 002100110000 (002) TOWN OF BARKSDALE S07 T48N R04W PAR IN SW NW IN 2022R-595621 10.300 9.808 0 No (R-l) Residential-1 103 16 Updated:3/15/2006 STATE COUNTi' TOWN OF BARKSDALE SCHL-WASHBURN TECHNICAL COLLEGE Updated: 8/12/2008 2022R-595621 2015R-559094 1143-916 2008R-521330 997-597 Property History N/A BAYFIELD COUNTS CHECKLIST FOR SANITARY APPUCATONS Submit the Following (Use Permanent Ink) 0'itle 15, Section 15-l-10(e)) ^.^.^. ^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)) ^briginal Plot Plan (383.22(2)2. 3. & 4.a) ross Section, Over-Head Profile of the System and Schematic of Tank from Manufacturer 'urnp 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) Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) Servicing Agreement (Recorded at Reg. of Deeds) -KFee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) •S2 ^mo'ers Sets of Plans (383.22(2)(2.) 'Iig£^:^^^.=S;^£^L_^_^B^^AiL^se£L^ ;o all copies) ^sCsoil and Site Evaluation Report (383.22-3(2)(b)l.e.) ate Plan Review (when applicable) Spy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) I Application Information must include: .^23 diait Parcel ID# - (do not use 12 digits anymore-obsolete) D Project Address or Road Name where driveway is/will come off of) D (Owners Phone Number) JZMI Type of Building p~TII Type of Permit yfe-IV Type of POWTS System tAv Dispersal / Treatment Area Information \VI Tank Information -S^VII Responsibility Statement (Plumber's Information) D *Date Stamp* Plot Plan: (To Scale or To Dimension) ^Signature and Plumber Information -^Address Number and Road fi^Surface Elevation of Body of Water ^Q North Arrow ^Direction and Percent Land Slope •Q Contour Lines Jank and Filter Information and Location \I3^Structures and Driveways /etlands / Navigable Bodies of Water ^Boring Locations iibsorption Area (Proposed and Existing) -S^Property Lines ^Bench Mark (Location, Elevation and Description) -/G/Well Locations component Manual Version ^SL Legal Descriptions Turn Over I 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 D How many systems will there be on this parcel of land? D Has this property been split? _ (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 d 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: Document Number/Plan I.D. No. Owner Name (s) ^lcy.cv-c^.cy L.,<3L-» Parcel Identifier Number (PIN) 0 4- 002-2<- 4?- o4- ol-AOS -<300- iQOCaQ HOLDING TANK AGREEMENT Owner(s) Mailing Address JltC. -Sp^ks^ ^. ^l^We^'C^ CJWS~l-f Agreement Date (same as Notary Date) io--\- 2£^ZJ-f 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 i\}U^I4 Section '7 Township t4& N. Range A^ W. Town of J^oLrfc^c.Je Additional Legal Description:^AlR. Xk/ S<-^~ijJ '2syi2,(?-kS<T5'(o2-l tG Gov't Lot_ Lot_Block_Subdivision_CSM#_ Lot_CSM #_Vot -Page._CSM Doc# 5-ce /Wfi^ ^—cM^C DOCUMENT NUMBER2024R-603674 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, Wl RECORDED 06,19/2024 AT 1 ; 1 5 PM RECORDING FEE: $30.00 PAGES: 2 Return To: . C^AA <^—^ »./^^ 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 properly serviced in response to orders issued by Bayfield County or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Stats., Bayfield County may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats. 2. Owner agrees to pay all charges and costs incurred by Bayfietd 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, Wl's Adm. Code who shall submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfietd County may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 5. This agreement will remain in effect only until Bayfield County certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. SPS 383, Wl'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 1Jj| iwiif'i IheAWiafiqlWfisubtiit this agreement to the register of deeds, and the agreement shall be recorded by the register of cleedsDtlW6*n^^cl1 will Pert1it the existence of the agreement to be determined by reference to the property where the holding tank i^ inst ^ip8^soon!!n-Owner(s) Name(s) - Please Print ^fc/^JD^u^i- Subscribed and sworn to bel m® JZ^e <7°^A</ Notarized Owner(s) - Signature(s) ^A^ ^ Notary Pub]^ My Commission Expires: ^c^, ^'7^o3^ Drafted by:i/(~^^ C^l^ Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)J Date:-7-5,^ u/forms/sanitary/holdingtankagreement.doc ®June 2018 GO WEY Abstract & Title Company, Inc. (800) 673-8710 • www.goweytitle.com 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, Bayfield 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 comer 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°52'29" 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 feeQ. 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-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 l-t^° 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 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 ^LLZ1/4 of MJ/4 Section^L.TownshipJ^.N. Range^LW. Town of ^Barfs^ ^.^ ®- Govt.Lot_Lot_Block_Subdivision_CSM# Additional Legal Description ? AR X^ <5L^>'v(fir^ Z^^-^^-S'Cz.l (C^ ^^- ^ _ _ °n T^ ^^ Property Owners Signature Date u/forms/managementplan Revised: July 2013 HOLDING TANK SERVICING CONTRACT Contract Date ^A//ic 7^o^y This contract is made between the Holding Tank Owner(s) Name(s) P\€L^^n^er Lca^ jumper's Name (Print) Douc^ ^e\c^j-^c Pumper's Signature Pumpers' Registration # 12^3 We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT LOCATION Legal Description: (Use Tax Statement) TaxlKf 17 Section Or7 .Township 4S _ N, Ranee 0 *-( W Gov'tLot Lot <»CSM#Vol. Page CSM Doc ft Lot(s) No.Block(s) No. S/Jl/4. <Vl4/l/4. Town of: Tbc«-l=5^=J<^ Lot Size Acreage/o3 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 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 sen/iced; 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 contract, the owner agrees to file a copy of any changes to this service contract Q( with the local government unit and the County named above within (10) business d; service contract. Owner(s) Name(s) (Print) Al<?/A^^- t-^r Owner's Signature(s) ^u^ ^- Subscribed on this y^- day of i^//7 <£— , ^</ by: \/ y/a^^ Notary Pubtt My commission expires on: /^ '7'S^S^ Revised: May 2016 (®May 2018) Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (l)(m)] Drafted b'lv/m/^^^iY BAYFIELD COUNTY SANITARY PERMIT # 24-78S STATE SANITARY PERMIT D TRANSFER/RENEWAL PREVIOUS NO. OWNER: Alexander Lai PROPERTY LOCATION: Town of Barksdale SW V4 NW V4 SEC 7, T48N, R4W PLUMBER: Adrien Cady LIC. #: 922139 McKenzie Slack 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)