Loading...
HomeMy WebLinkAbout24-82S BuddeY'l I Department of Safety ;; / . & Professional Services, -^ Industry Services .Division Cbunty g&/~A~^i .Sanitary Permit Number (to be filled in by Co..)2J4-^ Sanitary Permit Application State Transaction Number In accordance with SFS 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(l)(m), Stats. I;;Applicatloh Iriformation - Please Print 'All Information Project Address (if different than mailing address) -I <H t? LA} ^ ^-Q.^ '^^- Property Owner's Nanfc F) o ^ cz \C f ^'^cUe U j^Jfr^ M/WC Parcel #Jfi-'i ^< ^D -^^<?-7C7" Property Owner's Mailing Address Tl^ B^K -7^$~ ;ity. State Tav k-^/K $D -5'7<^3 Zip Code 5-7^^ II. Type ofBuildidg (check all that apply) ^t 1 or 2 Family Dwelling-Number of Bedrooms D Public/Commercial - Describe Use D State Owned - Describe Use Property Location Govt.Lot. Phone Number ^£•^"7^ {C1^Z\ Lot # ^>C-"/4. S'.I^- y,. Section r ^ N R ^ ^o^) Subdivision Name Block # a City of. CSM Number a Village of I? Town of ^•c.V JT ^. ^~ III.TypebfPOWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i applicable.) __ A.D New System D Other Modification to Existing System (explain)D Additional Pretreatment Unit (explain) B.IS Holding Tank D In-Ground (conventional) D At-Grade D Mound Individual Site Design D Other Type (explain) c.D Renewal Before Expiration D Revision D Change of Plumber D Transfer to New Ownerl List Previous Permit Number and Date Issued IV.Dispcrsal/Treatment Area and Tank Information: Design Flow (gpd) ^c-o Design Soil Application Ratc(gpd/sf)Dispersal Area Required (sf)Dispersal Area Proposed (sf)System Elevation Tank Information Capacity in Gallons New Tanks Existing Tanks Total Gallons # of Units Manufacturer ^lian ~m E U Septww Holding Tank •-^0 (5 0 Z£300|1 Uh'es<2-x C.o^C..^ AocinjirGlraiulwr .ViRespOnsiIlility Statement- I, the undersigned, assume responsibility for liisfaliaUori of the POWTS shown on the attached Plumber's Name (Print)All^h To\^s^Plumber's Signature ^M-^•KP/MPRS Number 2.Z-<oo<? 0 Business Phone Number -7^S~ 2-<?Z.-^/<^ Z7T^Plumber's Address (Street, City, State, Zip Code)r^ BC.Y. ^'^ ' ^^^^^^ ^^ ^^7 VI. County/Departmerit Use Only ipproved Pcn^itFcc ^^$ Hoc Issuing Agent Signaturenwv\ \/^gs^.}i ^/I?72^3il i^y^D Disapproved D Owner Given Reason for Denial Conditions ofApproval/Reasons for Disapproval Date Issued >-?'^r^^^n^rw^^^ ard ^ ^c^ i.^H'n z< op a \J(^!k'' \1 nL/. L -,^nG^ . rfY.^c.,^ <^/a/'/n Pf^ ^^-<.rrjp/ 0 v^^^ Pl^ ^ ^^r. r^'^^ <^^^r ^rcl4 ^^ »^^ o^^r^' W^j <,y^crr\ Ffr SP5' ^2> Attach to complete plans for the system and submit to the County only on paper not less than 81/2x11 Inches In site SBD-6398 (R. 03/22) Soil Test # Q^ ^' Bayfield County Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) I. ^ I I a-l/\. F£>/^-OS/<-^ _ 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. ^^^^1^. guUeProperty Owner P 0 ^^ ( ^ /5 J ^ ^-C Contractor. Property Address ^ <7^0 ij ^<^ 1^<[ Authorized Agent• <?^^ Ui^^ L^J ^ ^'Y <T<^ Agent's Telephone.~T~r Telephone hc^ "7 ^ I 9 ^ 2- _ Written Authorization Attached: Y or N Accurate Legal Description is requested: ij^_1/4 of 5 ^ 1/4 Section ^ Township /C7 N. Range ^ W. Town of /~c^^{ ^; Additional Legal Description:. Govt. Lot Lot Block Subdivision Lot _ CSM#_ Vol. _ Page _ CSM Doc # Volume_Page_of Deeds Tax I.D#__2_7_2_7_^_Acreage. Indicate reasoning for your determination: ;>^"i^^ i^e & ^^ ou^.^ <^/c^ A -H c? ^ Z- C'"-L /^S^ -fi^G^ V -f-<? ^€.^So-C^ ^^-f-^ ^^~^i 0^'^// Sigh^ittire -7' c^:-r - ^^-<^/L^ of Certified Soil Tester ^-7--2L:$ Date Z.Zoo^o Certification # Signature of County Official (SubmifaPlotPlan&Fee)fr/6/-/^ — ^ ^^0 -,|^y| ^Date u/forms/soiltestwaiver(KLK) June 2018 t^rcj?-e.irYy Ouj/^r^ '0 ^ i4 <••<. ( A • "B J J. J. e •K.O- ~&c.^ -7-2-ST Tc. ^ k-£..r £.:t>> ^^' fc 1^2 7 ci7€f' i-^<\{. JDeE.scir'^+"'ff>"n \^^ 9^rmsJ,=.2-L?^L kJ^crl^Me^\:... .- ^eri'fio^/^&e^s^ S^T^NMAA/ ^J'/'<^Z^^^^1 ^<^<.^-e-.S+ R<!** U5. •^-/ ^-cl | Tfl^n s^-:. •fcv^^^<j\ f^ZQoo^U^ UJ^e.r ^cv-e-^T^k-.^^y rf; c?^.< ^ ITy;:i?-^'^s;^%bB++^rf 0N^ A i-^ 'Z-o F'^t -7^Uo uJ. p^y gj AJo-^e; D[i ^'Jci s&^c -f-AM k ^^s-i- ^ f^fl<<].. ?oic,.,j^.€j r^^r^r^^s.'^ fr^t^-el ^InC^WQf^^ uj[-LS-&^ ^.o.u^.fc-^ ^£'/^'"^ Te!^K.i fe .•.^•€>"'A^^^r_^\^vA^<^ /v^y v T ^Zo/ Hv{l"t^<f7^rtkm^€^5 <x.// ^'in. S€.-^^c^:s..^$'PS2?S) A.E&. ^ A^>o^e. -^/M.OL / ^ i^x.cie, t -Q- -- uJe-H ^ ,^ fc^+T/-^ ^ ^'-^ <?^ ^i*1 £'>^"''^r--= ' gW & \^R.p^ £/e.u/oo.o/ 7 ^73 •= 5ck ^o p\/c ^/f t6 ^ c^ ^e.^ o^ r ^ , ^ H"/\STm & l-7?S~ a.ppv-e ^d p-p^ ^.Kt+^'o-t ^ Q^ 1^ !'-G ic<'^^1 ^^LM. Ho /<f< ^T^i ^ Co^j7<sne^ /y)^ r\ u.^/,us^ ; ^nu.«. ( T/p&Q/s n ^J); c^^^e 2'2-" zo'zi) JW^jn ^/: w.p^$.izco?o ?6/{Coski P/a^vj[)'n<5 R^, Qs ^ S-2JZ. ;Tr^ ^0€^^3:W<7 Alessandro Hall From: Alessandro Hall Sent: Tuesday, June 25, 2024 8:09 AM To: Allan Polkoski Subject: RE: 7940 W. Fay Rd Thanks Tony—I'll work on getting this processed for you. Alessaadro Hall Assistant Zoning Administrator Bayfield County Planning and Zoning Department 117 E 5th Street, PO Box 58 Washbum, WI 54891 Phone: 715-373-3517 Email: alessandro.haU(%bavfieldcounft-.\\'i.eov From: Allan Polkoski <bearguidenorth@icloud.com> Sent: Tuesday, June 25, 2024 7:37 AM To: Alessandro Hall <alessandro.hall@bayfieldcounty.wi.gov> Subject: 7940 W. Fay Rd [You don't often get email from bearguidenorth(aijcloud.com. Learn why this is important at https://aka.ms/LearnAboutSenderldentification] Good mourning. Enclosed is a pic of borings #'s 2,3, and 4. If u need anything else please let me know. Thanks again!! vs (D3 03 *<030) Alessandro Hall From: Alessandro Hall Sent: Monday, June 24, 2024 3:08 PM To: Allan Polkoski Subject: RE: Dave Budde holding tank Hi Tony, Thankyou so much for sendingthese photos and providing additional context. Can you send me a map/drawingof where on the property these holes were dug? If so, I will move forward with approving the wavier and will not require the full soil test. Thanks, Alessandro Alessandto Hall | Assistant Zoning Administrator Bayfield County Planning and Zoning Department 117 E 5th Street, PO Box 58 Washburn,WI 54891 Phone: 715-373-3517 Email: alessandro.hall(%,bavfieldcount\'.\vi.2ov From: Allan Polkoski <bearguidenorth@icloud.com> Sent: Monday, June 24, 2024 8:21 AM To:Alessandro Hall <alessandro.hall@bayfieldcounty.wi.gov> Subject: Dave Budde holding tank [You don't often get email from bearguidenorthOicloud.com. Learn why this is important at https://aka.ms/LearnAboutSenderldentification ] Good mourning Alessandro. Enclosed pics are 3 holes I dug at this site. Obviously your soil mapping is wrong which I knew allready but u didn't believe me. The soil test waiver says in my judgment the soil is unsuitable for any treatment component other than holding tanks a thorough soil and site evaluation is not needed. I guess after 48 years doing soiltesting and diggingthousands of holes in the county means nothing. I'm sure the Web soil mapping is much more accurate! Let me know soon if u still want a completed soil test of after seeing the pics of high ground water and mottling almost to the surface or is the waiver good enough for u. The property owner is pissed for spending the extra $ to dig these holes. Even he knew the results before I dug them. Thanks, Tony Sent from my iPhone BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): El Check List Index Page / Title Sheet (Optional) Ef Original Soil Evaluation Report (Submitted in Deed Holders Name - net prospective buyers) fit 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) VS Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used 13 Property Owner's Information (not prospective buyer's name) [3 Property Location (Accurate Legal Description with Sec/Twp/Range) [^ Road Name (where driveway is/will be coming off of) i6 Floodplain Elevation, Flow Rate, Comments and Recommendations Ef Complete Soil Boring / Pit Information ^] Date Soil Evaluation was conducted ^] CST Name, Signature, Number, Address and Phone Number D *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) [d Bench Mark (Description, Elevation and Location) 01 Contour Lines (Example = 98.0' ,96.0' ,94.0') \^ Property Location (Sec/Twp/Range/, Accurate Legal Description) d Borings (Locations and Elevations) (3 Percent and Direction of Land Slope 0i Well Location (Including Neighboring Wells, if applicable) El Location of Wetland Areas, Floodplain and Navigable Waters Ei Buildings, Driveways, and Structures (Location and Descriptions) Ef Location of Property Lines ri Existing System Location IS Address Number and Road Name @I Current Surface Elevation of Wetlands and Navigable Waters rf CST, Owner and Property Information rf North Arrow Fee: ^ Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforcsts ...L.U vy iLnnninu o( z.yni'NU No, 9975 P. 2 Holding Tank Plan | Index & Cover Sheet PAGE 1OF $ n Pg1of^ Pg2oK Pg3ofg Pg 4 of 8 Attachments: ComponQnt ManuQl Design RafQrences: \ /)WUA I -t v/pe" ^ \J^rs) o ^ 24) • ^ ^a^ 2.0 2-^ -2.o-2.-7 Index & Cover Sheet Plot Plan Holding Tank Specifications Management Plan ^ss -p?^ ^§ Fcj 7 ^ ^•^ s ^ ^ Enclosures: | POWT9 Application for|RevjewC^n<^a.cy P^^' + Affjp) Soil Evaluation Report & Site Map (nf applicable) Holding Tank Pumping Holding Tank Agreement (if applicable) contract (if applicable) Project Name / Description Owner Name(s): 2>c ^^7 / <L P J ^- ^ . Phona: \^c^7Q^Jl^2^ Owner Address: ?(P>^'oK7zS~ "r^ r ^- $b ^-r c'-^? _ ^jp; s~'7C^~3 Project Address: 7^l/ ° IAL ^^ ^d 'r^^Ui ^ \^! s^/^J" Govt. Lot: Township: rpo ^~V \J^' ^ $ ^ 1/4 of ^ 1/4, Section_Z_, T ^9 N-R ^ ~s . County: IS ^ -^^l F3or w[X| Project Parcel ID #: " • ^ X 1 0 u ^"7 9 y 9 Designer Name:ci. i-\ / o Designer Information / 1^. o J U,Phone: JT/J" -j-7'2.-_^ ^ Designer Address: F-&. '/§ o/c •S~^-~i-T^c^ ^L<^&.< '<MjZ zip: ^^j^Z. E-mgil: +"& /-». y (S. ^> • e-a. (--4 L/ .- <^- e.. (-i •s. ^-'Y'^! •' C ea ><-^.Thisj space reserved for approval stamp. License Number: Remarks: Z-2- &o <::/ 0 Signature:DatL: S-/0-^/ C/ t/riginal signature re^uir^d on each submitted copy. 'p'ro^'e.r^y C'co/i^.r^ '0 "r-i <•». (A' B^J. <!.e '^..0- B <: ^ ^' '1-s ^^+ Be^r^nsi .^2. TC. ^ k-e-r, ^- ?^ ^ D ^ Tfl ui n <s sr : •F'p. tr -I- J ^ <'" f ^ J"^. z Ooo Ta.^^b -Z7cf77 C&UL.^y O'-f; "Sci^~^ !J. ,(''''), X^- Z00.o e.^\[oy\ \>J .\se.r Le^cv-e^T^k-. '< li l^'!.//L^(f/^£^"-f^^b^+O^Qfk f-a Flc'wL^^'tnlt^ L e.^ <\ i D &sc ir' p +' ©>i ^ l " "7- vt'°r rrl^ /&• s- Soi I 6 01^-^c}.':.;S^SE^ S^c.7 T^N MAA/ ^jL:7^^^/^^o^J1 N<LX<./-^.,$+ R<K t^- ^/ ^•<1- QMm /- l&'t T<a^ 3 2.<- ' F|^-(L 7cj^ uJ. ^<-«.i/ gj ^o-^'e.; ol^ ^'J el scr.^ S-^ /"-.,<? R'iJ1""' ^ < « i- a v'- -t'nn k 'v\uS-i i^^ JB.U^/"<< ?<..Lo.,^<-J ^^r^^s.3-5 , r^l^-cl ^W^y^^,J;.t.^ ^^.<^^^-^ ^<?<i^ • ^\^ ...>'^^1^^^!,^:> ,^^ ..p\\'^'° "../^>AX /^J^',>" \. /"c^^ ^ —^-^A wy-E ^,f71^ ^ y^^ 7~^°-^ Zii^i'K^ R€^;(«» .;tC -^L ^ 7 ^2o/ ••{€' 1 Hsll'i^cj'~T<i}Hkm^~{~'S <t// ^n. S<2-^«-c^.s..C^PS3?5) A.F6-, = A^>o>^e. •^"/M.CL / cf i^.de -0- = \jJeJt 0-. <»+-<-/- -^ SCJ1.-^ ^'\ $^ £»f^^i/-r ' gWl £ \; RP » £:/^u/00.0./ 7 ~] 7 3 = Sck t/o ^vc ^/-P i0 <AJ 1 ^e.c^ <5;d ^ . . ./ H"/\yTm i>»-??s" ^ppv-eu^fi. p-p^ ^i<L-Hi. •'-'<=•-1 « Q^ !^ ^•_^&y^~ 1"0|ac| M.I^TM Ho/<T<^q"*T<^t^: O J I - I1 - / I - •/ . /ri(3t r\ u.^7,uS€.d ^^n^«. ( T/p6-[ve R 2.1); c.'m^zfl ^2-- zo/£7) . Ora-uM ^ : ^P.K$.izco?o ?6/^oski f/u.mJ1)'^ P.Q.Qo^. S-^-L Xrffi R^e-^ ^7 ^S"<'7 PROPERTY OWNER: T> c ^ <;J •u ^1 PLUMBER: Allan Polkoskj/ Potkoski PlumbingZTSIGNATURE: DATE: 3-/ ^v LICENSED 220090 HOLDING TANK SPECIFICATIONS ?Number of bedrooms -- jNon-residential estimated flow (gpd) I 2600.0 [Minimum holding tank volume required (gal) 2000.0 :|Proposed holding tank capacity (gal) '.7^'^T'i^^'^^h^^*i'^TA'T^7lrT?^'*»'1^7>T^-'f»J'-i''fr''^'*- itt^t^ ;-»ijt»^ ; . J- "t '[',>~*\^* >^i/* "iti^?^v*^';\*./r^:^~tWieser TffiT"'"^^rOT".'KTf*i';'--.>"''.fti"Hr".Krin.'t"rnr^';'.-iiW2000 jAlarm manufacturer .'.Tank Manufacturer •^•i'§Tank model number ;SJ Electro nwioT jAlarm model number Tank Dimensions and Data ~?X for round tank 47.0 JLiquid depth below inlet invert (in) 8.0 s Maximum depth of soil cover (ft) 66.0 i|Height(in) | Outside..•...„>,.....»-» - - - ^ -.-.... 151.0 ; Length (in) F Djmensions 86.0 :;Width (in) -> OnSy Tank Anchor Calculations "TT-^.r.-T.^.-.-.^.'inrCTI^15370 ilbs Weight of tank and cover Safety factorh.'s. >. i'.i. - •;. ;•;';. A"- . .'.I'^.ffT.TS'.tjr""""i'^n ..V.-T'^-S;31055 36.0 7.7 Ibs Weight of anchor required in Soil cover req. for anchor or yd3 Concrete counter weight HOLDING TANK CROSS SECTION junction box conduit / blind plug to seal outlet Project: . 24 in. F^ manhole cover with locking device and warning label 4" min. finished grade1 /vent cap Manhole and vent locations may be reversed. T 12"min. vent pipe service alarm on Electrical as per NEC 300 and Comm 16 12.0 in. 35.0 in. Note: All tank Joints, and joints between tank openings and piping are sealed watertight. All pipe and vent m.atarials comply with sy-5 3S^>. 3 In. bedding under tank.Tank is anchored as necessary to negate buoyancy. t 16" min.i3 building sewer inlet HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according \qSrf^3gS ^ER2-o and the 1, and is to be installed and , n toS>^3g3 Wis. Admin. Code, the Holding Tank Component jyi^nual^,^,!tl'yva.ny&l 't'/P6' 'B<iy-P-€- U County Sanitary Ordinance. ' i^'^^) ] C^ ^'zs.-zoz:?) 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'P$ 383 and584 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 363.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the fojjowing persons should be contacted: a. Installer.............................Po/^^; ^gm^At /n.RR,S 2.2.0oct0 Phone: 7,^ 372.' t/^6> b. Servjce Provider.. ,....^.......... fre^TC^y S^f-fie R&g h StZ-71 Phone:'-y/j- 3-7^- ^G<O^ c. Co. Zoning or Health Dept. Qa.yff^-t^ C&^ nty -Z^^^ _ Phone: 7, j- 3-73 ^ ^t3,§ 11. L^J D^' ^/<^ ^c7 -r^^ ^P^ To ^ n Q-f: Re - t ^ . ^ <j Cflu^ of-' ~ S^v-P^ /^ /^ 0^:ttp^^i TDU°. -r^j=^ff 2-7 <7^ Project Transaction Number: H 6 [^ i h.<\ •" ia. n K " BAYFIELD COUNTYCHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-l-10(e)) 0 Check List \3 Original Sanitary Application (Submitted in Deed Holders Name - not prospective buyers) (383.21(1)1.) 0 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) ET Original Plot Plan (383.22(2)2. 3. & 4.a) st Cross Section, Over-Head Profile of the System and Schematic of Tank from Manufacturer 1^(1 Pump Tank Diagram, Alarm and Pump Curve (when applicable) Ef 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) (Recorded at Reg. of Deeds) 0 Holding Tank Service Contract (Original Signature of Pumper and. Property Owner) (383.21(2)(c)5) D ATU Servicing Agreement (Recorded at Reg. of Deeds) 0 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 0 2 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies') 0 Soil and Site Evaluation Report (383.22-3(2)(b)l.e.) D State Plan Review (when applicable) a Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) 63 I Application Information must include: D 23 diait Parcel ID# - fdo not use 12 digits anymore-obsolete) S Project Address or Road Name where driveway is/will come off of) 0 (Owners Phone Number) ^ 11 Type of Building B III Type of Permit \£ IV Type of POWTS System a V Dispersal / Treatment Area Information 0 VI Tank Information Ef VII Responsibility Statement (Plumber's Information) D *Date Stamp* Plot Plan; (To Scale or To Dimension) Bf Signature and Plumber Information \M Address Number and Road 6f Surface Elevation of Body of Water ^\ North Arrow D Direction and Percent Land Slope D Contour Lines ri Tank and Filter Information and Location \^ Structures and Driveways 0 Wetlands / Navigable Bodies of Water 0 Boring Location D Absorption Area (Proposed and Existing) [3' Property Lines ffl Bench Mark (Location, Elevation and Description) 0 Well Locations [^ Component Manual Version Bl Legal Descriptions tf BJSSBSiiiSii^iB^fi^i^liffiiii^ Turn Over > Cross-Section and Over-Head Profile of the System: D Surface and System Elevation Bl 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) 0 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 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/checkllsts/checklistforsanitaryapps(10/2009);(®7/20ll);(®2/2012)(®5/2/2012-dc) Proofed by: HOLDING TANK SERVSCSNG CONTRACT This contract is made between the Holding Tank Owner(s) Name(s) O^ctU i3^e Pumper's Name (Pjint) , - I Pumper'^ Signaturej-r^o ^&s' ^o { ^®rk' I' "'j'" ^ Y e -v ^ J^,c •ri^ Pumpers' Registration # <6l^-7f We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT LOCATION Legal Description: (Use Tax Statement) fax \W z-r 9 -7 ^ Section 1_, Township ^9 N, Range T Town of:w FO Y-~t ij ,•^1 Lot Size Acreage ^0 Cov't tot tot»CSMtt Vol. Page | CSMOocS j lotis)No. | BiocX(s)No.Subdivision: 1. The owner agrees to file a copy of this contract with Bayfieid County as required in SPS 383.55, Wis. Adm. Code, 9 Thp nwn&r anrooc tn hawp tho hnlriinn +ank/c;^ carv/ifftrt hw +ho niimnor and nnaran+ppc tn normit tho nnmnar +n nauc. access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain tho across rnarl nr rlrivo cr> that tho nnmnor pan cein/ipp th<a hnlriinn tank/c^ with tho nnmninn onninnn&nt The" rnA/ncr 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. ^ Thp niimnpr anr&oc +n cnhmit tn thp Infal rinuornmont i mit wih'ir-h hac cinnpr) tho nnmninn anroome'nt ronnirprl h\/ C;PS, 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 Thp namp anrf ai-frlrpoc nf tho norcnn riacnnnc:ihlft fnr <sftr\/ir*inn th<= hnlriinn tani<- b. The name of the owner of the holding tank; r Thia Inr-atinn nf thn nrnnprtw nn whirh thp hnlriinn tanlc ie: inctallpri' d. The sanitary permit number issued for the holding tank; (a The rla+oc nn whifh the hnlrtmn tank uvac Cfan/irprj' f. The voiumes 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. A Thic anroiampnt \A/ill r&main in ftffpr-t until thp nu/npr nr niimniar +<arminato<s this nnntrar-t In tho o\/ont nf a r-hanno in thte. contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract >*<;+l-> +(—/% t<-»/./<.t -—/ot/^t*»->t^-m»->4- > it—I* nt-t/'l +1-..-1 ^">n>>»"i+i* >^/%t^o/^^4 -^l^<^»/,-> i*f!+t—!n /'i r\\ l-»» mln/orm /<l/^i/^ .Ft.^n", +1-,^ ^/^+/^ ^^; ^, |nm >n> /» /N 4-/o 4-l^im service contract. uwner(s» Name(s) (i-'nn^ii *i,1/r«II uwners s;gna:ure;s)suDscnoea ana sworn 10 me: ^ _^ ^ \ - — Nth- - f^a\| .loz*\jwM o^ w^^^-^\^^MmM^ Notary Public iy commjss^pgi 'iceSLonrHL y-on/20' 8*r Notary Puhlfe..^..,... South Dakota Document Number/Ptan I.D. No.HOLDING TANKAGREEMENT Owner Name (s) ^.-o \ Qwner($i Mailing Address' ^' I / ^ ,/1 jyy^^hM^^LK^^Da^ep^r^D. ^7^3 Parcel Identifier Number (PIN) I^ICT-1? -^•7<?-7< Notary Date) <-/<f-7-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 ^ C 1/4 SectionP^rTj^7 Township ^1». Range 8-w. Town of Additional Legal Description: DOCUMENT NUMBER2024R-603332 DANIEL J. HEFFIMER REGISTER OF DEEDS BAYFIELD COUNTY, Wl RECORDED 05/23/2024 AT 10:21 AM RECORDING FEE: $30.00 PAGES: 1 I GovtLot Lot Block Subdivision CSM# Lot CSM#^Vol -Page.CSM Doc# Return To: •To ^ Yo [ ^sk 7-0-'^,^^^-^r^ ^ 7<- ^^ ^T As an inducement to Bayfield County to issue a sanitary permit for a holding tank following: on the above described property, we agree to do the 1. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tank installation and maintenance. IT 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 Bayfield County for inspection, pumping, hauling, or otherwise sen/icing 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 114Wis. 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. 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. 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. 5. This agreement wit! 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 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. I Owner(s) Name(s) - Ptease'PrintI ^u^ ^b^c Subscribed and sworn to before me on this date: \^ dOH 0-f M<?M ^OZ4 Notarized Owner(s) - Signature(s) >o^^J^Z ^^W^-> Notary Public >PLMO^ My Coffimjssion Expires: ^ MELISSA MOSS Seal Notary Public South Dakota h\\^\ an. 9^&- Drafted bv:^K> ^ ^ </;£> //^<C> S. /C.Date:r-d-^y BAYFIELD COUNTY SANITARY PERMIT # 24-82S STATE SANITARY PERMIT I TRANSFER/RENEWAL PREVIOUS NO, OWNER: Donald & Roberta Budde PROPERTY LOCATION: Town of Port Wing SE V4 SE IA SEC 7, T49N, R8W PLUMBER: Allan Polkoski LIC. #: 220090 Alessandro Hall 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 permitwill 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. Properly abandon existing/old system per SPS 383. 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)