Loading...
HomeMy WebLinkAbout24-80S Twedt:r... ^•^ Department of Safety & Professional Services, Industry Services .Division County "^^-Y^ ^ I i Sanitary Permit Number (to be filled in by Co.)2^ so ^ 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 puiposes in accordance with the Privacy Law, s. 15.04(1 )(m), Stats. State Transaction Number I, Application Information - Please Print All Information Project Address (if different than mailing address) ,<3]5% A^^^-^^L Property Owiyr's I^amee^J- ^ Alc,^^//^ ^T^e Parcel # ^4.oo Property Owner's Mailing Address W T^ -k^oc^ ^vr City, State (A;^nsti^// ry\ /\J Zip Code ^S~-7^~J II. Type of Building (check'all that apply) ^ 1 or 2 Family Dwelling - Number of Bedrooms D Public/CommerciaI - Describe Use D State Owned - Describe Use Property Location Govt. Lot Phone Number ^-/^ 3/0 ^r<^ Lot # [iA,J[UL./,, Section _A T ^ 7 N R <? ^o^) Subdivision Name BlockiV CSM Number a City of. a Village of I? Town of £? K< e ^ "hf III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on lineB. Complete line C if| applicable.) A.f8 New System Q Replacement System a Other Modification to Existing System (explain)D Additional Pretreatment Unit (explain) B.JS] Holding Tank D In-Oround (conventional) D At-Orade 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 OwnerlIList Previous Permit Number and Date Issued IV. Dispcrsal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) ' ^0 Dispersal Area Required (sf)Dispersal Area Proposed (sf)System Elevation Tank Information Capacity in Gallons New Tanks Existing Tanks Total Gallons # of Units Manufacturer itsco S3A .53£5 •j3§ Snptw er>Holding Tank -Z- S~GC Z5TCO LOt'C-S-O.K C,e.^C..^ Bmrns-einmber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print)Plumber's SignstureireAll ^ 7" 11^ k; I <^^—"/^^<•NP/MPRS Number 2,Z.^oe? 0 Business Phone Number -7^^^-^f^ Plumber's Address (Street, City, State, Zip Code)T^ B^ s-^ ' ^^^ ^^^ ^^ ^W7 VI» County/Department Use Only wApproveda Disapproved D Owner Given Reason for Denial Permit Fee106 \']tUHW\\/^SIsguing Agent Signature Conditions of Approval/Reasons for Disapproval ,']'S^S^"^. 9S£ y^.^»'^-"^ ^ /^^<'tj ^•^•n ^ ,^wl.y1^ :SK/i~"^ ^li fcr^., '/'^d . Attach to complete plans for the system and submit to the County only on paper not less than 81/2x11 Inches in size SBD-6398 (R. 03/22) n m Bayfield County Soil Test # 0 1 —%\-m ^ ?; A Waiver of a Thorough Soil & Site Evaluation ''Wl^yJ (subjectto 15-1-10(d)) ft.^1 FO / <!<-0 •$ K. ^ _ 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 C^i^\ Ma.^^Kc'T^^Contractor Property Address ^)l^*^ f^^-^or l /x<±. Authorized Agent. Agent's Telephone. Telephone.(<^ 310 l?-roS~Written Authorization Attached: Y or N Accurate Legal Description is requested: ^1/4 of ^^ 1/4 Section -L Township ^ ^ N. Range 7 W. Town of £> rl -^T^ Additional Legal Description:. Govt. Lot Lot Lot_CSM#_ Block_Subdivision . Vol. _ Page _ CSM Doc # Volume .Page_of Deeds Tax l.D# •Z-^<r3 °^Acreage.rfo Indicate reasoning for your determination : LJ<^+" (^/^ye-^ ^o,"/— )Jo D-/-^-e^ 7<^^jT^ ^,G /l ^3 ^ / i^l <i4 -^^:i (^^^0(^1 fc2-> Signature of^ounty pfficial~^/2t//^ Date Signature of Certified Soil Tester ^-( '-^-Y Date CS:T ^ 2.ZQQ ^o_ Certification # (Submit a Plot Plan & Fee) Po^A ^ SO ^2-(2M P.^ J „. 0^ ^ 0^-^c/ w"^ ^.^ pr^>^ op?ljfc/o"S;,;V.T^i' ^ .^^ ^^ ^ u/forms/soiltestwaiver(KLK) June 2018 *P ^ - G . > t . V^ i 4l ? I ' k . \ \ ^ - Q . ^y > ^ r> >^ - v; - ^ . ^ 6 s- -V vc - ^taA '^: p\» ~s i ^ft<;r- s +»0£9-<- ? '5(S r- _ ^- f - "svs& a•^n ?QT7 K^<0s •^ , - 00 .0 •<• f ^^ I" '^ c rp ll -d ^0 -V 6 (/>f- 0-0^-h f ?p^? ft£^~^ft(&~h t^^$ f A_ ; S ^ • (f t f\'+ . ?~^r-^- Vs ?r" .-? - /^y\~utA buoa^^g ^? - "^ ^ yj ? ^ ' ' ^? ? s? ? ( ^5 ! . c ( A ? ^ ^ ^ ^ ' ~ " ~ < ' '? s ^ ^ s " ? ' ^ 5 ? S o- : a * . 5" ^ f c <- a ^A ^ p •r ? i ^°&-€^> f o? ^ ^» ^^ "I l l " 0;? i ? ' ~ ? ^I L I ?J T ' ? b » © ^ N- < ' ~ f^ s0^i t^ z - o ^ ^ 0 I IK • p > S K -t - ^ L J 1 ^ 1 ^ ^% ^ ^y ? 0 -^ . - ^ i^ , T\ -s pt SA \» s 9 •s , •^ 0•^•+ ^-^ \^ s (^a yo< 2 k0 f% J 0 ^Al lH ^.@,^(f t s^ -Q0 1- < > ^ ^ o- a ; & ^ ~( 0 pr : - ' I €^ r? ^i i ^ s° ? y ^ ^ ~ ( t t ' ) ^v i \ 'S (&5 I/ '^p t/ -<•^ 0 -^d^u^ ^^^ « < > ^ <' 10 ^X F ^? -^ " " U) v ?? /• ft -^ ? A^ ^ - ^- ^ ^VI^^ 4^ ' ^± .^-0 »» ,J S -. J ^ . ^ u ff \ f ^ ^0 ^ 7^ ° < $ ^- - ^ - f ~ {i ^ x ?< ^ ° - ^. c . < ^ » « I- ' " E > r. ( ? i ?• * !L * ' o (t t \ A 4 > > •< 0 ' -r ^ "' o o i L <c . < a ^ ?. ^ ^' 5 ^ <( < - 3 « r^^iC3. ^ ;r r f -\ "v 0 -kyj^%x - s~ - s&^~OL ~ . w BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): 0 Check List E0 Index Page / Title Sheet (Optional) El Original Soil Evaluation Report (Submitted in Deed Holders Name - not prospective buyers) B} Original Plot Plan D Cross Section Soil Profile Sheet (optional) D Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) El Parcel Identification Number (must be 23_d\g^ Tax ID#) DO NOT USE 12 digit, they are no longer being used 0 Property Owner's Information (not prospective buyer's name) El Property Location (Accurate Legal Description with Sec/Twp/Range) El Road Name (where driveway is/will be coming off of) IZ1 Floodplain Elevation, Flow Rate, Comments and Recommendations 0 Complete Soil Boring / Pit Information 12 Date Soil Evaluation was conducted 0 CST Name, Signature/ Number, Address and Phone Number D *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) El Bench Mark (Description, Elevation and Location) G Contour Lines (Example = 98.0' ,96.0' ,94.0') 12 Pioperty Location (Sec/Twp/Range/, Accurate Legal Description) El Borings (Locations and Elevations) Q Percent and Direction of Land Slope 0 Well Location (Including Neighboring Wells, if applicable) E^ Location of Wetland Areas, Floodplain and Navigable Waters E] Buildings, Driveways, and Structures (Location and Descriptions) El Location of Property Lines Ef Existing System Location El Address Number and Road Name 13 Current Surface Elevation of Wetlands and Navigable Waters E3 CST, Owner and Property Information North Arrow Fee: g3 Certified Soil Tests - Review &. Filing Fee . $ 50.00 u/fprms/sanitary/checklist/checklistforcsts Ruth Hulstrom From: Allan Polkoski <bearguidenorth@icloud.com> Sent: Tuesday, July 2, 2024 4:26 PM To: Ruth Hulstrom Subject: Re: 81590 Airport Rd Ruth. It's done all the time. Just cross out the old fire # and replace it with the new. Do on plot plan, soil test waiver, sanitary permit app, and the holding tank cover sheet. Thanks. Tony Sent from my iPhone > On Jul 1, 2024, at 4:17 PM, Ruth Hulstrom <ruth.hulstrom@bayfieldcounty.wi.gov> wrote: > > Tony, > > Can the department update the Twedt sanitary application with the 81590 Airport Rd? > > Ruth Hulstrom, AICP | Director > Planning and Zoning Department > 117 E 5th Street, PO Box 58 > Washburn, Wl 54891 > Phone: 715-373-3514 > Fax: 715-373-0114 > Email: ruth.hulstrom@bayfieldcounty.wi.gov > > > -—Original Message-— > From: Allan Polkoski <bearguidenorth@icloud.com> > Sent: Tuesday, July 2, 2024 3:36 PM > To: Ruth Hulstrom <ruth.hulstrom@bayfieldcounty.wi.gov> > Subject: 81590 Airport Rd > > Chad Twedt new fire # is 81590. He said they applied for it but the > sign hasn't been placed yet. Hope this helps!! Tony Sent from my > iPhone -,,,,^UL. VL- iLnmnim 0( ^UIU'Ntt NO. 9975 P. 2 I PAGE 1 OF $Holding Tank Plan Index & Cover Sheet ii Component ManuQl Design References: \ kW^zuAt' "ti/fe"^\|Ar$^M.a4)j6^a-/ 2.oz-^-z.oz7> Pglof^ Index & Cover Sheet I ' Pg2of^ Plot Plan : Pg 3 of ^ Holding Tank Spedficatiqns Pg 4 of S Management Plan Attachments: •Ps" € ^•i-S' p^ ^F^ 7 ^ ^r4 s ^ ^ Enclosures:»: ___ i t, .. POWTS Application for Review Cc>^:^yp^ml ^ ^ Soil Evaluation Report & Site Map (iif applicable) Holding Tank Pumping pontract (if applicable) Holdins Tank Aqreeme^t (if applicable) Project Name / Description Owner Nam®(s): C-^i £ ^<-c^r^/^~T^^J.^ phona: ^ -^l€L- ^~7C5 Owner Address: t^^ %j<<^ooJ l>r. uJ r^^-^kc/f ^A/ ^JD: -^-T^ 9 7 Project Address; ^IS^O ^/>o/1L ?U-. ^^^^. ^ ^-Y^^ Govt. Lot: _ A1 ^ 1/4 of ^ ,1/4, Section A . T L/cf N-R £? _E DO/- W! Township: €^ <-e --f~^ _ County: ~^</H-:^L Project Parcel ID #; -^"^ ^b ^ zs-^c-o __]_ Designer Information S Designer Name: A 11^^ To / A: o-s' ^.'' _ Phons: r?/S~ -3"7'2-- '// ^ Designer Address: P-&. 3 o/c ^~^-^X~on /5.<^.<;-^ U.'^: :Zip:_d^2- E-mail: ~f"te ^.y (fj. ^> •<£-<3. ^-.^ L^,' ^e.. ^l ^ '^•'i"^ *' C & -•t^ Thi^ space reserved for approval stamp.1 —————— y lLicense Number: z-z. c?o^' o _ \ Remarks; -^.y. i . .._Signature: ^^>C—/ -^<^L, ^ _ Date: ^^-^ Original signature ?quire<Toh aach submitted copyF - - — — - j 1^ ^. - 11^S f < T^ ^i ' ?> ; s ~ ' ° ^ </ - < w jo t n s? t ^ c? o - ^ ^ 0 C ^& 6 ^• ^ y F l W[ - h . 0 ( & F I T ' " 3' ^ 1a - , 0 ^ i ^ ? c . ^4 - "? a -^ s ^ t \ ?r-<s . '?•< ? V ," &- > f c - \ •o ." ? ^ 6 « . J , •p . . > o~ s ^1 ^ ~ < f t $ -U - h { 6 0 ? " !/ > p }- ^ ~ ^ ^ ^ a_ S a • (f t'^r~?p.^w r\Vf \ -uIf t twoa^<.^ ^i ? 5 3 5 7 ^ J_ ^ ^ •a I " -& .Wi ' r> ^\ Y - p s y J t - g j . ^,^ " A ?- . ( i t T\ r«0 j/ ^ .^, .' g - r n . . 4- ". £ ? • w PROPERTY OWNER: _^A^ ^ ^ ^ '^ / /e -TLJ e J -^ f PLUMBER: Allan Polkoski/ Polkoski Plumhjnq SIGNATURE: •DATE: (j^-t-^LICENSED 220090 HOLDING TANK SPECIFICATIONS '-/• '• L....-2^UUU»»(***IW!UtWWWU^Number of bedrooms Non-restdential estimated flow (gpd) Minimum holding tank volume'required (gal) eserW288(TiTiras"WST JAIarm mod Tank Manufacturer ITank model number [Alarm manufacturer el number Tank Dimensions and Datar"""™w~l~w|X for round tank Tank Anchor Calculations "To~i BfUil'llWntl'iWt/ij'tSVffiltffl)159.5 BblUUUlWtlA'tttHWB UttWW Liquid depth below Intet invert (in) Maximum depth of soil cover (ft) ;Helght(ln) | Outside [Length (in) F DimensionsiWidth (in)Only tbs Weight of tank and cover Safety factor Ibs Weight of anchor required In Soil cover req. for anchor or |yd3 Concrete counter weight HOLDING TANK CROSS SECTION Junction box conduit 7' blind plug to seal outlet <—. 24 In. -^ II \ mannole cover withlocking device and warning label l4"mln. finlshnd grade~\0 Manhole and vent locations may be reversed. vent cap 12"mb». ventplps service alarm on 12.0 In. Electrical as perNEC 300and Comm 16 39.0 in. Note: All tank Joints, and Joints between tank openings and piping aresealed watertlght. All pipe and vent materials comply J~ 18" mln.1 building sewerIntel 3 In. bedding undortank.Tank Is anchored as neceaaaryto negate buoyancy. rt ^ l^T ^^ ~~^~& ^ ^ CHECKLIST FOR SANITARY APPLICATONS. Submit the Following (Use Permanent Ink) (Title 15, Section 15-l-10(e)) 0 Check List Q Original Sanitary Application (Submitted in Deed Htrtdera Name - HQt prospective buyers) (383.21(1)1.) 0 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) 0 Original Plot Plan (383.22(2)2. 3. & 4.a) EZf Cross Section, Over-Head Profile of the System and Schematic of Tank from Manufacturer I? Pump Tank Diagram, Alarm and Pump Curve (when applicable) Contingency Plan / Management Plan (383.22-3(2)(b)l.f.) D Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) ET Holding Tank Agreement (383.21(2)(c)(5) (Reeorfgdl at Reg. of Deeds) E3 Holding Tank Ser/ice Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) D ATU Servicing Agreement (Recorded at Reg. ®f Eeedis) 0 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 0 2 CemBlete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to ail copies) 0 Soil and Site Evaluation Report (383.22"3(2)(b)l.e.) D State Plan Review (when applicable) D Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application; (IncBude the foBBowiBDg Informatioira) E I Application Information must include: D 23 diait Parcel ID# - fdojnott use 12 digits anymore-obsolete) 13 Project Address or Road Name where driveway is/will come off of) Ef (Owners Phone Number) ^ II Type of Building 3 III Type of Permit Type of POWTS System D V Dispersal / Treatment Area Information 0 VI Tank Information Bf VII Responsibility Statement (Plumber's Information) D *Date Stamp* Plot Plan; (To Scale or To Dimension) BT Signature and Plumber Information Bf Address Number and Road 07 Surface Elevation of Body of Water ^ North Arrow D Direction and Percent Land Slope D Contour Lines t^f Tank and Filter Information and Location St Structures and Driveways H3 Wetlands / Navigable Bodies of Water Ef Boring Location D Absorption Area (Proposed and Existing) Ef Property Lines El Bench Mark (Location, Elevation and Description) St Well Locations Eg! Component Manual Version B' Legal Descriptions Ef Piping Material Information (conveyance line, building sewer line, material type and diamster) Turn Over t- Cross-Section and Over-Head Profile of the System: D Surface and System Elevation 0 Position of Observation and Vent Pipes D Dimensions and Depths a 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 0 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/chectdlsts/chec!<listforsanltaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012-dc) Proofed by: ^ HOLDING TANK SERVICINO CONTRACT Contract Date ^3--^(f This contract is made between the Holding Ta/ik Owner(s) Name(s) cL^ <i- '7-—'-^ Pumper's Name (Pririt), / / _ / 'c^^.Sj-^- / ^^iC. t>^A. ^-^ s^ ^. ^-e/- -S'-ep/-^ Pumper'j Pumpers' Registration # ^ / 2--7 / We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PRCMECT loomoN Legal Description: ^UseTaXStatementt """Z^W Section _^____ .Ttiwnship T / N.itanas / W Gov't tot lot*CSM»Vol. Page CSMDocH lot(s)No.Btock(s)No. WlM. ^iH. Tilwn>of;- / T ^^.^-^t^\ UN She Acreage^Subdhdsioh: 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 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 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 service contract. Owner(s),Name{s) (Print)iWi^\i Owner's Signature(s)Subscribed and Sworn to me: on this ^_day o«JVJVv^ '+< My co] Notary Public expires on: KRISTI J MOOS NOTARY PUBLIC MINNESOTA commission Expires Jan. 31,2025 Document Number/Plan 1.0. No. Owner Napne (s)CkoiL Tv^/e.d^ Parcel Identifier Number (PIN)^600 "1 c.y. ^b HOLDING TANKAGREEMENT Owner(s) Mailing Address j -^ ,. 13^ P^-^k-^oc |b0r^ .s ^ 11. ^ ^ ^'^^7 Agreement Date (same as Notary Date)'^-5-^Y 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 se\wage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treabnent system as permitted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Stats. 1,4 of ^-^ 1/4 Section Town of \^/f l < /^ ^ iX .Township Range._w. Additional Legal Description: Gov't Lot _ Lot_Block_ Lot CSM# Vot Subdivision -Page CSM# _CSMDoc# DOCUMENT NUMBER2024R-6035S3 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELO COUNTY. Wl RECORDED 06,12/2024 AT 1 1 :00 AM RECORDING FEE: $30.00 PAGES: 1 Return To:k:7~B^Y^F>^ l ^osl ^o/ ^~<^K^u^ ^I ^^~1(/ >• £s' 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 wilt be assessed as prescribed by s. 66.0703, Stats. 2. 3. 4. 5. 6. 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. Bayfietd 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 Bayfietd 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 properly 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, 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. 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. "T^£^Subscribed and sworn to before me on this date: Notarized Owner(s) - Signatures)Notary Public Oi/'5t/2.<E5~ My Conftnission'Expires: Drafted t,y:"7o .X ^ 7^? ^<? 5 ^ r Date:.0^-' 0?3" kaiSft^lN?^%" HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and • maintained according VERZ>0 1, and is to be Installed and . <, I according to,S»^ 3$3- V^is. Admin. Code, the Holding Tank Componentjyi^n.ual^ .J.*!.,,^. 1/& _'t'/^t and the ~ 'B<ty-P~€. U County Sanitary Ordinance. ' L^'^ ^ ] L^ ^23.^20^) 1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 400.0 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 tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and S'PS 383 and%}4 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business 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 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). Con- nection 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 £PS ^'63.33 Wis. Adm. Code. 10. If there is a problem with, or question about this jnstallation, the fojjowing persons should be contacted: a. Installer.............................Pfl/^k; fUvn^ftt mW,*H^oclO Phone: 7,^ 37%-' «/<'^_ b. Service Provider.. .....^.......... ^re^.^^- S'e^^^. R<^ tt ^Z7/ Phone: '7,^- S7'^- ^Qfflfo c. Co. Zoning or Health Dept. fik^^J C^otf^-t^^ _ Phone: 7, S 3-73 ^ &/3!ff 11. l^J^^^^^^ ^^ T^^ ^^^ TO vLn <a-f ^ €> <r 7 &- ^ ~t<^of^ B^-^^U- PAVC^..? ,TO "; -r^^ '^-^*L •2-^Tfc Cfc? Project Transaction Number: BAYFIELD COUNTY SANITARY PERMIT # 24-80S STATE SANITARY PERMIT D TRANSFER/RENEWAL PREVIOUS NO. OWNER: Chad C & Marielle R Hughes Twedt PROPERTY LOCATION: Town of Orienta NW V4 SW % SEC 1, T49N, R9W PLUMBER: Allan Polkoski LIC. #: 220090 AlessandroHall 7/2/2024 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 7/2/2026 UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R. 06/23)