Loading...
HomeMy WebLinkAbout24-83S Hoffmany^l ^.""-'^.^i" "~%x:i/^^;'t'tM,K^->" Department of Safety & Professional Services, Industry Services Division County Bayfield Sanitary Permit Number (to be filled in by Co.) y - %% 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 secondarypurposes in accordance with the Privacy Law, s. t5.04(l)(m), Stats. I. Application Information - Please Print AM Information Project Address (if different than mailing address) No site address yet - Kelly Rd. Property Owner's Name Kylar & Kayla Hoffinan Parcel»39287 Property Owner's Mailing Address 29350 Kelly Rd. City, State Mason, Wl Zip Code 54856 II. Type of Building (check all that apply) B I or 2 Family Dwelling - Number of Bedrooms D Public/Commercial - Describe Use D State Owned - Describe Use Property Location Govt. Lot Phone Number 715-413-0696 Lot # SW y^ NE •/.. Section _14 T 46 N R 5 Eor^ Subdivision Name Block ft a City of. CSM Number a Village of B Town of Kelly III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete Une C if| applicable.) A.B New System D Replacement System Other Modification to Existing System (explain)D Additional Pretreatment Unit (explain) B.B Holding Tank D In-Ground (conventional) D At-Grade D Mound D Individual Site Design D Other Type (explain) c.D Renewal Before Expiration D Revision D Change of Plumber D Transfer to New OwnerlIList Previous Pemiit Number and Date Issued IV. Dispersal/yreatment Area and Tank Information: Design Flow^gpd) 600 • Design Soil Application Rate(gpd/sf) N/A Dispersal Area Required (sf)Dispersal Area Proposed (st)System Elevation Tank lntbrmation Capacity in Gallons New Tanks Existinu Tanks Total Gallons 11 # of Units Manufacturer g£ u b S.n su: 0 Seplit or Holding Tank 3000 Wieser Concrete Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for instaUation of the POWTS drown en the attached plans. Plumber's Name (Print) Edward B. Redinger Plumber's Signature MP/MPRS Number 221939 Business Phone Number 715-292-6670 Plumber's Address (Street, City, State, Zip Code) 1015 11th Ave. E. Ashland, Wl 54806 ^ VI. Cnunty/Department Use Onty Permit Fee ^SA\ $ c\oo.ooApproved In-SU}-^ d Disapproved a Owner Given Reason for Denial Date Issued -llltlM Issuing Agent Sigmturc L.1^37^19 Conditions ot'Approval/Reasons for Disapproval Oiav^ ^ m^^H ^^a^s. ^^WWyMM PW fe Wl^- <^c^ cC^6».d^<ll Ipe^n^'t^- ccird Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x tl inches in sUe SBD-6398 (R. 03/22) < ^ At~:W - i 1^f\•\/'^ ,,^S?SI"c^ .^,;w'^^//Wisconsin Department of Safety and Professional Services Division of Industry Services SOIL EVALUATION REPORT -;UH ;i ^/ij/4 Page /_0^ In accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 81/2x11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1 )(m)). CountyBayfield ,SQ^/ Parcel I.D.39287 7>!-/,- <yft-^'7 Reviewed by ms Date\s-\zv\~Q~ E (or) W Property OwnerKylar & Kayla Hoffman Property Locajwn Govt. Lot S^\\l y< N E y< s 14 T 46 N R 5 Property Owner's Mailing Address21485 Kallgren Rd/Site Address or CSM and Lot #:No Address yet City Mason StateWl Zip Code54856 Phone Number ( ) D CityKelly D Village B Town Nearest RoadKelly Code derived designflow rate 600 GPD Flood Plan elevation if applicable_ft. •| New Construction Use: 1MJ Residential/Numberof bedrooms I Public or commercial - Describe: Parent material ClaveV Till General comments and recommendations: Holding Tank OF Mound With Interpretive Report on 98.9' contour @ .4 Loading Boring #QBoring 98.9 "•HPit Ground surface elev._ft.Depth to limiting factor. 99.42 Jn. / elev._ft. Horizon 1 2 3 Depth In. 06 6-9 9-12 Dominant Color Munsell 5yr 3/2 5yr 5/2 5yr4/4 Redox Description Qu. Az. Cont. Color c2d 5yr 6/8 Texture sil sicl c Structure Gr. Sz. Sh. 2mabk 2mabk 1fabk Consistence ml ml ml Boundary cw gw Roots Sco 3m 2co Soil Application Rate GPD/Ft2 *Eff#1 .6 .4 0.0 *Eff#2 .8 .6 0.0 Boring #QBoring 97.52 gjPit Ground surface elev._ft.Depth to limiting factor 6 98.02 Jn. / elev._ft. Horizon 1 2 3 Depth In. 0-6 6-8 8-12 Dominant Color Munsell 5yr 3/2 5yr 5/2 5yr 4/4 Redox Description Qu. Az. Cont. Color d d 5yr 6/8 Texture sil sicl c Structure Gr. Sz. Sh. 2mabk 2mabk 1fabk Consistence ml ml ml Boundary cw gw Roots Sco 3m 2co Soil Application Rate GPD/Ft2 *EfF#1 .6 .4 0.0 *Eff#2 .8 .6 0.0 CST Name (Please Print) Edward B. Redinger Address 1015 11th Ave. E. Ashland, Wl 54806 Signature3Z:—^?n^-^~c^af ^ •---—- - T Date Evaluation Conducted6/5/24 CST Number221939 Telephone Number 715-292-6670 * Effluent #1 = BOD > 30 S 220 mg/L and TSS > 30 fi 150 mg/L * Effluent #2 = BOD, < 30 mg/L and TSS <. 30 mg/L SBD-8330 (R04/21) fa $SD W-^ M- Boring # D Boring•Pit 97.52.Ground surface elev._ft. Page 2 ..3of _ ^M Q^L^ADepth to limiting factor_98.02in. / elev. ft. Horizon 1 2 3 Depth In. 0-6 6-9 9-12 Dominant ColorMunsell 5yr 3/2 5yr 5/2 5yr 4/4 Redox Description Qu. Az. Cont. Color c2d 5yr 6/8 Texture sil sicl c Structure Gr. Sz. Sh. 2mabk 2mabk 1fabk Consistence ml ml ml Boundary cw gw Roots Sco 2co 1m Soil Application Rate GPD/Ft2 *Eff#1 .6 .4 0.0 *Eff#2 .8 .6 0.0 Boring #D BoringD Pit Ground surface elev._ft.Depth to limiting factor.in. / elev._ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cant. Color Texture Structure Gr.Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 *Eff#1 *EfW2 Boring #D BoringD Pit Ground surface elev._ft.Depth to limiting factor.jn. / elev.__ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr.Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 *Eff#1 *Ef?2 * Effluent#1 = BOD > 30 s 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, £ 30 mg/L and TSS £ 30 mg/L SUPERIOR PLUMBING MECHANICAL (715)278-3456'^y-^ CST# 221939 Scale:!" =40' L PIN:39287 10 Acres SWNES14T46N R5W Town of Kelly Bayfield Co. </&• c?-3 Customer Name: Kylar & Kayla Hoffmann Adress: 21485 Kaleren Rd Mason, wl 54856 SITE: Kellv Rd. Town of Kellv - no address Phone #: 715-413-0696 Email: kayroxyhoff@Kmail.com NO SITE ADDRESS YET No Well A 13.^1. ^60' A^-.'/.'A 7^'U^^f S6"A^^ ^£~^^.^.' <H.^' '^ ,1 ^T -^ ^'^ ^- AT^^U ^ ropdIi?°5^ \^ ^^ f;-<r^<c ^' ' K^fy ^<l. ^c.c u^- <?-)^' W.'?' i&i3' Pg Pg: Pg: Pg- 1 2 3 4 of 4 of 4 of 4 of 4 Attachments: PAGE 1 OF 4Holding Tank Plan Index & Cover Sheet Component Manual Design References: Holding Tank Version 2.1 (May 2022-2027) Index & Cover Sheet Plot Plan Holding Tank Specifications Management Plan Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map (if applicable) Holding Tank Pumping Contract (if applicable) Holding Tank Agreement (if applicable) Project Name / Description 4 Bed holding tank owner Name(s): Kylar & Kayla Hoffman _ phone: 715 .413 .0696 owner Address: 29350 Kelly Rd. Mason, Wl _ Zip: 54856 Project Address: NO Adress Yet Govt. Lot: _ sw 1/4 of NE |J 1/4^ Section 14 , j46 N-R^ E Township: Kelly _ County: Bayfield Project Parcel ID #: 39287 or W Designer Information Designer Name: Edward B. Redinger _ Phone: 715 .292 .6670 Designer Address: 1015 11th Ave. E. Ashland, Wl _ Zip: 54806 E-mail: ed@superiorpmw.com _ n^ space reserved ior app,<« ai slamp License Number: 221939 Remarks: Signature: /^/—!^//^-^T^/^^L- _ Date: 6/17/24 copy. SUPERIOR PLUMBINO MECHANICAL (715)278-3456 CST#221939 Scale: 1" = 40' L. PIN:39287 10 Acres SW NE S14 T46N R5W Town of Kelly Bayfield Co. '/&• I Customer Name: Kylar & Kavla Hoffmann I ^ress: 21485 Kaleren Rd Mason, wj 54856 SITE: Kellv Rd. Town of Kelly - no address I Phone #: 715-413-0696 ! Email: kavroxvhoff@Rmail.com NO SITE ADDRESS YET No WellA A?./»I. ^AO' A^-.V.A TS'i^^/ As"^A7^< ^^'^'s.^i.' <?^..o' ^ ^^-//oo t^^' -^0-+- ^'^•<£-^ri^.U 0?e-<^ //"^L^ Bo. U-^' ^u^r '^mptff-J'^7u^ \.v ^±K^tly ]^. ^^^' . <%^' f?-3. - ^.s-' 9^<?1 l&f 3- PAGE 3 OF 4 HOLDING TANK SPECIFICATIONS (No Scale) Electrical must comply withSPS 316 and NEC 300 \1/ \J/ I tO WeatherproofI \- —Junction and Alanm Box \^-U Approved Locking Manholewith Warning Label Attached(typical) -Conduit 4"0 Venl Pipe >10 ft from BuildingApp;<wed 12" Min: or 2.0 ft above Established Flood Elevation(typical) 18"Min. v (typical) ^ Intel •AirlightSeal?'Nn Approved Joints with Approved Pipe 3 ft ontoSolid Ground (typical) \r\ ^\1/ Finished Grade ."A ^'^. * • •• • .'«. Intel Invert ~n 4" Min.or2.0ft aboveEstablished Flood Elevalion(typical) ^L N kl \[/ \^_ I— Max. 12° or 90% of total volume If more than one tank Alarm-On Compartment 1 Vol 1800 •^ Compartment 2 Vol = I I UU gal TOTAL HOLDING TANK VOLUME = 3000 gal -Water! Plui A.'- ••.« Watertight TANK MANUFACTURER: 3" Approved Bedding Material Beneath Tank Wieser Concrete Anchor tank as necessarypursuant to SPS 383.43(8)(g) Ballast Weight = [(cu. ft.tank.vol x 62.4 Ibs/cu.ft) - Ibs.tank.wt] x 1.5 Ballast Weight = [(_cu.ft. x 62.4 Ibs/cu.ft) - _ Ibs] x 1.5 = _Ibs 184" 4" CAST-A-SEAL FILTER ORBAFFLE CAST-A-SEAL TOP VIEW 4" VENT WLP1800/1100 TANK SPECIFICATIONS DIMENSIONS:WALL: 3" BOTTOM: 3" COVER: 6"MANHOLE: 24" 1.0. PRECAST CONCRETE RISERHEIGHT: 60-3/4" O.D. LENGTH: 184" O.D. WIDTH: 102" O.D.BELOW INLET: 48" O.D.LIQUID LEVEL: 43"WEIGHT: TANK 15,050 LBSWEIGHT: COVER 9,300 LBSINLET AND OUTLET:4" CAST-A-SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER:WISCONSIN, SEE DETAIL j?10(OTHER STATES SEE CHART) LIQUID CAPACITr: 41.86 GAL/IN (SEPTIC)25.58 GAL/IN (PUMP) LOADING DESIGN: S'-O" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/SEPTIC. SEPTIC/PUMP OR SEPT1C/SIPHON COVER: MIX DESIGN #6 (NO FIBER)TANK: MIX DESIGN #9 (SMALL FIBER) CUSTOMIZED TANKS:FOR CUSTOM TANKS CONTACT WIESER CONCRETE 0:13101Q-lIh-to I01Q-l slw\ <10:1 sl z| ^<1 SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS JOB INFORMATION: CUSTOMER: 308 NAME: DATE NEEDED: APPROVED BY: APPROVAL DATE: 00 0000 5 S| 0F Q.(4.1(7) QlQl(/1151Ld|^1 SHEET NO. 1 /OF Bayfield County, Wl BSSEEffvBSQQW^Q(soBosaacsscEsaaocs S3SSSff3338S08SEBffyxs!WRRi3 G3s8SeS!38!>OSEEEffGffliflaooczsaoQcasaTOSR) BSSSSffvBaSQOaSfEQH8!'ESB8Q@!B3SSI@SSSES3sS3 fSSsff&sassoasB^!SSBQQeS3eSSIQC!S53S3SS&SSSSiffQSSSSSOQSSEBl&£SK3S5a8e5e!& 6/26/2024, 8:49:38 AM Rivers --i Approximate Parcel Boundary Road Type Town Building Footprint 2015 Building 0.02 1:1,740 0.04 0.08 mi 0.03 0.07 0.13km Bayfield County Land Records Department Bayfield County Zoning Application hUpsrf/maps.bayfleldcounty.wi.gov/ZonlngWAB/ 6/26/24, 8:49 AM Real Estate Bayfield County Property Listing Today's Date: 6/26/2024 Novus-Wisconsin Access rev. 12.0206 Property Status: Next Year Created On: 5/16/2024 10:03:57 AM —^^Sr Description Tax ID: PIN: Legacy PIN: Map ID: Municipality: STR: Description: Recorded Acres: Calculated Acres: Lottery Claims: First Dollar: Zoning: ESN: Tax Districts 1 04 026 020170 001700 Updated: 5/16/2024 39287 04-026-2-46-05-14-1 03-000-12000 (026) TOWN OF KELLY S14 T46N R05W SE 10 ACRES IN SW NE IN DOC 2024R-603062 10.000 9.997 0 No (AG-1) Agricultural-1 119 * Recorded Documents B QUIT CLAIM DEED Date Recorded: 4/25/2024 B CONVERSION Date Recorded: HISTORY Q Expand All B Tax ID: 21121 Pin: Updated: 5/16/2024 STATE COUNTY TOWN OF KELLY ASHLAND SCHOOL TECHNICAL COLLEGE Updated: 3/15/2006 2024R-603062 578-379 Ownership Updated: KYLAR R & KAYLA R HOFFMAN Billing Address: Mailing Address: KYLAR R & KAYLA R HOFFMAN KYLAR R & KAYLA R 21485 KALLGREN RD HOFFMAN MASON WI 54856 21485 KALLGREN RDMASON WI 54856 Site Address * indicates Private Road 29690 KELLY RD Property Assessment 2024 Assessment Detail Code N/A 2-Year Comparison Land: Improved: Total: Property History Acres 2023 0 0 0 Parent Properties 04-026-2-46-05-14-1 03-000-10000 I History White=Current Parcels Pink=Retired Parcels 04-026-2-46-05-14-1 03-000-10000 Leg. PinI: 026102706000 5/16/2024 MASON WI MASON 54856 Updated: N/A Land 2024 0 0 0 Imp. Change 0.0% 0.0% 0.0% Tax ID 21121 39287 This Parcel 'I'Parents ^Children https://novus.bayfieldcounty.wi.gov/access/master.asp?paprpid=39287 1/1 1! /'U•i/.-~! ?YvM¥M•J'.) '. !,; • "-' ^ i Document Number/Plan I.D. No. Owner Name (s) I^ICL.- K^k HoU^v^ Parcel Identifier Number (PIN) 3?^^ HOLDING TANK AGREEMENT Owner(s) Mailing Address^^0 \^L\\v Y^AC^v\. u^> I ^9-{^Slo Agreement Date (same as Notary Date)toW9U 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 A/^ 1/4 Section |Ll- Township L| (o N. Range _S_W. Town of ^\\^\ Additional Legal Description: Gov't Lot___ Lot _ Block Lot_CSM #_ Vol •<?<; fWStjC-^-e-t Subdivision _Page _CSM Doc# ^ ,CSM#_ DOCUMENT NUMBER2024R-603695 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, Wl RECORDED 06/20/2024 AT 1 1:55 AM RECORDING FEE: $30.00 PAGES: 2 Return To:^^ Co. z^-j 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 maintenSnce. If the owner fails to have the holding tank properly serviced in response to orders issued by Bayfield County or the Department Qf Conyierce to prevent or abate a human health hazard as described in s.. 254.59, Stats., Bayfield County may enter upon the property Shd 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 msinner 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. 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 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 \A^ 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. sworn to before^h^'i^te^j o^^o^( ^/y-'" ' ••^•^ Owner(s) Name(s) - Please Print ^[c^r ^o^r\c-^\^^\{c^ H^<rn&-o Subscribed and -^, ^2^^- ^\^0]5A/? i:%Z Notarized Owner(s) - Signature(s)Notary'Public S+(lu hJ My Commission Expires:'^'y^-^BUO ,.^<s/^5>^ ^/^WIO^^//d'i'i'n^vv7Drafted by: ^W Date: (A^\-^4 Persona! information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (l)(m)]u/forms/sanitary/holdingtankagreement.doc ©June 2018 Exhibit A Legal description of the real property being conveyed by this instrument. The South 660 feet of the East 660 feet of the Southwest Quarter of the Northeast Quarter, Section 14, Township 46 North, Range 5 West, Town of Kelly, Bayfield County, Wisconsin. Bayfield County Register of Deeds Document #2024R-603062 Page 4 of 4 PAGE 4 OF 4 Holding Tank Management Plan IMPORTANT: The owner of this holding tank(s) shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wise. Admin. Code. Pursuant to SPS 383.52 (2), Wise. Admin. Code, this holding tank(s) shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wise. Admin. Code. Estimated Daily Wastewater Flow = 600 gpd Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (/.e. odors, user complaints, etc.} o mechanical malfunction (/.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, eto.) o neglect or improper use (/.e., exceeding design capacities, prohibited activities, etc.) o electrical components ((.e., wiring, connections, switches, controls, timers, alarms, etc.) o surface discharge of effluent or sewage back-up into structure served SERVICING FREQUENCY o The tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wise. Stats. when the wastewater in the tank(s) reaches a level of one foot below the inlet invert of the tank(s). Disposal of contents shall be pursuant to NR 113, Wise. Admin. Code. Tank pumping reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wis. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Superior Plumbing & Mech. Inc. p^e: 715-292-6670 Local government unit: Bayfleld GO Zoning _ phone: 715-372-6138 Local government unit address: 117 5th St. E. Washbum, Wl _ ^ 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wise. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wise. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wise. Admin. Code. Contingency Plan In the event that any failed component of this holding tank(s) cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agecy for review and approval. System Abandonment If use of this tank(s) is discontinued, it shall be abandoned in accordance with SPS 383.33, Wise, Admin. Code. 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 <^<5£> 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 .1/4 of_1/4 Section I'-! TownshipL^N. Range S W. Town of j^iU\^ Govt. Lot Lot Block Subdivision CSM# Additional Legal Description L^-'.. 4<<<;??^— (,/s-/aJ-I'V^' I L- ^! .''' .' .-'"Property 0\^riers Signdfurri^ " Date u/forms/managementplan Revised: July 2013 HOLDING TANK SERVICING CONTRACT Contract Date (oy This contract is made between the Holding Tank Owner(s) Name(s) K^o<- \Wrr\6-^ , ^i.jh; W-f'm^r-) Pumper's Name (Print) ^Aa'o^c^^k Pumper'r Signature Pumpers' Registration # ^3-^ We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT LOCATION Section Gov't Lot Lot # Legal Description: (Use Tax Statement) .Townshipihip CSM#Vol. N, Page R; Tax ID# nge CSM Doc 3\\ St\ ^ w »Lot(s) No.Block(s) No. -1/4, Town of: UsC-AV Subdivision:^4. 1/4, Lot Size Acreage JO 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) sen/iced by the pumper and guarantees to permit the pumper to have access and to enter upon the propc-rty 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 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 d^t,e ^ change to this^M:A%^service contract. Owner(s) Name(s) (Print) U\^ Ho^ma^ ^:^lc^ ^\o^'Y\o-n Owner's Signaturejs)Subscribed and^w^ntevTOT.n ^ •?€^t- '/- •..'•^••^ on this _^___aay of ^\^'^i^, ,'• ^ by:A^^^?^U^ -dy^S>r\/ Diihlin- *C^- N>a.Fy.Ry.bte^b^'^^ISgO^, My commission expires 6hi.l£)l\^t Revised: May 2016 (®May 2018) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (l)(m)] Drafted by Ky/^r ^'-/>w» BAYFIELD COUNTY SANITARY PERMIT # 24-83S STATE SANITARY PERMIT I TRANSFER/RENEWAL PREVIOUS NO. OWNER: Kylar & Kayla Hoffman PROPERTY LOCATION: Town of Kelly S 660' OF E 660' OF SW V^ NE V^ SEC 14, T46N, R5W 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. PLUMBER: Edward B. Redinger LIC. #:221939 McKenzie Slack _ 7/2/2024 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)