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Home My WebLink About24-84S Kreuser Trust-CookDepartment of Safety & Professional Services, Industry Services .Division County <3^Y-T^ I <i_ Sanitary Permit Number (to be filled in by Co.)l^W^ 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 purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. State Transaction Number Project Address (if different than mailing address) I. Application Information - Please Print All Information „J_^^0 /<^Ar UK ^-W Propeny Owner's Name •PC-'-K'- C C.{\^ I' h^UJ^ L^ j\ IR^c^-^ <^oK te^-^7^3i^£S; ?^-1 Parcel # t&-)c Z ^ ~ f -^ / <? Q t3^?0 ^.'Ca^^ TZ<L^C>O ^f/q^TUJW City, State ^4-^ u\ //<. ^^ II. Type of Building (check all that apply) IjS 1 or 2 Family Dwelling-Number of Bedrooms D Public/Commercial - Describe Use D State Owned - Describe Use Zip Code L/-7 DG^ i Phone Number •Z/l? Z-/^ cl 0^-^ Property Location ^ Govt. Lot ^, -'/-,- 10"-, ^y^^^t^ -JL^^r^l .'/<, Section Lot #T -5 f V R "7 Xof^) Subdivision Name Block r a City of. CSM Number a Village of P Town of.dJo VfL.^ III. TypeofPOWTS Permit: (Check either "New" or "Replacement" and other applicable on Une A. Check one box on line B. Complete line C if | applicable.) A.D New System Replacement System D Other Modification to Existing System (explain)D Additional Pretreatment Unit (explain) B.IS Holding Tank a In-Oround (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 Permit Number and Date Issued IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) 1c £"0 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 i II•S3W Ta s(S 0 Sep«i»w Holding Tank ^^- CG 2L^O U)^S-e-»r C-e.^C..^ BaaiutFGftm*er V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print)All^ T^l^sk-'' Plumber's Signature 1^•NP/MPRS Number 2.Z.<30<? 0 Business Phone Number -7iS~ Z^-Z.-^IS~(fi Plumber's Address (Street, City, State, Zip Code) _;TM B^ jr'^z- " ^V^ ^^^ ^}'X ^^7 V[. County/Department Use Only y, Approved a Disapproved D Owner Given Reason for Denial Permit Fee Date Issued'HOO'^IHi^Issuing Agent Signature t/W'u,••/^^'^^^_ °=L. ^$2...3/'S_ Conditions ofApproval/Reasons for Disapproval , ^ , [ ) •• ^/Y^n^o^noH p/y/-i /-o .^iJner,/^^^) S/^'v) [^'•/" K^ rr(Gd/ w<y^c^~ « T^ -h^ /^cc^- ^/i 9-i^C^f ^•5» ?^/j^- ^^-,^^ ,^^ 5^^n Pp/"" <J' s ^ Attach to complete plans for the system and submit to the County only on paper not less than 81/2x11 Inches In she SBD-6398 (R. 03/22) <'Dy -oc^--n-?^W} v^»^^_^'Bayfield County Soil Test #^-M Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) ^ ^ I l^i/l J '^ I f<-0 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 eyal.vatiori, is nofneeded to make such adetermination, p^, C^JT^^ft^/^ ^£?^ ^l6T(£fc3p[w^^^W^ 'r^rr'^' Property Owner t^o^^r'\~\ (Coo ^ _ Contractor. Property Address ^<\H^° 'Ba^l^ PQ^"^^ Authorized Agent• }\^< ^s-^- r <-^» '£- _ Agent's Telephone. Telephone ^^ 2-/z-<;7o2-^ _ Written Authorization Attached: Y or N Accurate Legal Description is requested: J/4 of_1/4 Section ^ Township ^l N. Range 7 w. Town of ^-/°^^^ y ^ / J- ^-Additional Legal Description: ^-o ^ ~t- L-^S ^ ^ <* ^ Govt. Lot Lot Block Subdivision Lot _ CSM#_ Vol. _ Page _ CSM Doc # Volume_Page_of Deeds Tax I.D#_/_2J_°_0_Acreage ^3 Indicate reasoning for your determination: \^^\~ cl'a.^^ SP'I!- /^ s of^e^ pc'tAjTs ^^ ^ ^si-^/lv-i ^-r-^f /occ,^;<s-i/_^^^( Signature of Certified Soil Tester ^/-^/ Date C^f iZoo^o Certification # ?<\\^$0 -71Z1ZM (^.HSignature of CoUnty Official I'n /"')/! (Sybmit a Plot Plan & Fee) Date u/forms/soiltestwaiver(KLK) June 2018 -» ^ : ^? ? ^ ^ 7 "5 ' y r y ^ i? C a A : ? & . ° C/l?1 ^ '• " < ^> 9 C ^f j r ^ 0- . ^ / > " ( ^ ^ t\ ? Ck05' J ? : ^ ? ^ s : -? 0 ? ^ ' ' PA ^ ^(S ^ ^ ! f "£ ' " ' 5°Q-€"S f "f e 1 c^ ' J ! ^o L ^ - ^ f ^ ^ { "^ B V ^5 " ^ ' 81 ^ ^ - £ M^ " y ?I L t? "5 v- 0 t& °< A ^ ^f a ' ^ Vt0 ' ^ ' 2 - ^ ? , ^^ - ^ ' ?j y ^ ^s ^- ± ^ •^ ^ f J\ f p - ~ ^ < s l ? r : —• ^ f j «- ^ ^^ f g - ' • f6 _ \ A •• Q -f - — ; _ ' G & ^ " ? % $ 0- < 9 ? °. ^ . ^^ $ " t ^ ^^J f e O 5 ?r r ; o ^^ & [d v - i ^ \ S ' ^ S ~ t/ ® ( / - S t . t l - ^ - C^ s u M f £ t U < f t , i - :7 M . ^ ' i " - < / " s ^ 'A F . 6 - . ' BAYF1ELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS s Submit the Following (Use Permanent Ink): 0 Check List 53 Index Page / Title Sheet (Optional) E! Original Soil Evaluation Report (Submitted in Deed Holders Name - not prospective buyers) [Z? Original Plot Plan L] Cross Section Soil Profile Sheet (optional) n Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) 0 Parcel Identification Number (must be 23 digit Tax ID#1 DO NOT USE 12 digit, they are no longer being used 13 Property Owner's Information (not prospective buyer's name) B Property Location (Accurate Legal Description with Sec/Twp/Range) El Road Name (where driveway is/will be coming off of) [Zl Floodplain Elevation, Flow Rate, Comments and Recommendations 0 Complete Soil Boring / Pit Information El Date Soil Evaluation was conducted 13 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) EJ Contour Lines (Example = 98.0',96.0' ,94.0') [2 Property Location (Sec/Twp/Range/, Accurate Legal Description) El Borings (Locations and Elevations) [3 Percent and Direction of Land Slope 0 Well Location (Including Neighboring Wells, if applicable) [/1 Location of Wetland Areas, Floodplain and Navigable Waters [2 Buildings, Driveways, and Structures (Location and Descriptions) ^ Location of Property Lines Ef Existing System Location [Zl Address Number and Road Name 12 Current Surface Elevation of Wetlands and Navigable Waters \A CST, Owner and Property Information North Arrow Fee: S3 Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checklist/chec.ktistforcsts -,,,,.^L, vy iLniumm tt ^UIU'NU N0,9975 P. 2 PAGE 1 OF SHolding Tank Plan Index & Cover Sheet |i Component Manual Design Refewnceft: \ lW^nuA.i -tyfeYVAr$?^4)Y^a.t/ 2-02.^-Z.OZ7' Pg 1 of ^ Index & Cover Sheet I " I P@2of^ Plot Plan Pg 3 of Sl Holding Tank Spedficatiqns Pg 4 of S Management Plan i Attachments: p^r ^4-^Pc^ ^rf 7 0^ ^ r{ s ^f- Enclosures:» t \ ^ •1 POWTS Application for|RevjewC^^n;^^p^w'+ ^) Qoi[ Evaluation Report &, Site Map (iif applicable) Holding Tank Pumping pontract (if applicable) Holding Tank Agreemetft (if applicable) Project Name / Description Owner Name(s): 'R^ ^^r'h< (/^o ^ _ Phone: ^/^ -2-,^- <9^ 2-^ Owner Address: /3^o ^Go^ ^^y_R<J-l/ec>-^ '^ ^ •/''/^' z^ 2jD: ^ 0 c- ^ Project Address; ^^/^o g^-^^^-f'^1 ^^i>s-^< ^U X Govt. Lot: ^,^£ ^ 1/4 of 1/4, Section 2-^ . T ^/ N-R "7 E Q or W ^ Township: C. (o^^<^ _ County: Sa^j-^^ Project Parcel ID #; "TA^ X D^i^/oo _^ Designer Information Designer Name: A I 1^^ To / /^'-^S ^i, Phone: 7/S~ -S-7-2-- </'/ ^ Designer Address:'F-&. BoK ^~~^-^-2^-c<n ^-'^'^ ^'X :Zip: ^^K^L. E-mail: "f~'» ^ V (^.. -^ '<=-G-l/' .4 i-/.' ci^- ^i ^ "'"'f'^-i *' <-' e» •('<-^-. Thi^ space reserved for approval stamp. 7••'" License Number: z-2.ootf/ o Remarks; Signature: ^U ^ V —^y ^- _____ Date: ^-^^Y Original signature rtsquired onaach submitted copy. ! •4 ^ 4<4*K ^ - 0 - ^ , ^ ~ if so ' g s S4 ^ -S t . - t - . " - 5 ? - H< J I p> << f l 5 ^' ? Q §? ? " • ^ o t n ^ ^i f ^ 1 1 +1 - . 0 5 - ^f ^ ~L E ?" 9 ~ . ft ^ S i j^^. ^ -^P ( i ?ft-? - <6 - *? E£ ^ 1 =? ? ' I ^ p ^ -h ? !' ^ <- a ^' i s § a— s ^ " ' if t ft .+. ?~ ~ Af^w r\ v> . ~y ^.^<%^ ^i0-0 <^+ ^ •^ 7 . f^ ^ ^ u / ^ ?0 / fr - . . D 0 ^r>^p +. - . E f. 3v\00 .< ^ I-0 Bs — 1-—I ,l .&•• ' ^ - —a ^L ^Vt <A^\n VK S '^te \M\y .( « , . •>f>~v ?f^It p- a r-a p- la (&p— s c Ir t "t - ^ c- (•"( f c 1. '?JI ^ IS — -% ^a>~i - ft '*n "t ^. '(5 -i . , -p -" ^ y ^ ' &- a^ l 7 v ^N ' 5 - ^ & !» ' ^ ^ _ _ P C i f - f A — i e< ? ~ v c- ^ c ^ r^ - t j ^ ^ . ^ ^ ? ? 0 ' S ^ - ;- / < » % " o & S Q- . < 0 r: ? j - j i ?j ? l l % A? ~ ^ ^ 2^ o ^ s s < f / ' — 1 (, k a ^ ( £ ^ f t ^ S ^ ; i/ < / 4 . < s " ^ , . - t / " s c ^ . i / 0 ( / • & " ^ ~ 'f ^ " A F . 6 - , 2^ / PROPERTY OWNER: _& J> ^ ^+ - C <-- K PLUMBER: Allan Polkoski/ Polkoski Pluming SIGNATURE: '^//^ — <7 DATE: ^^-^LICENSED 220090 HOLDING TANK SPECIFICATIONS Number of bedrooms Non-resldential estimated flow (gpct) Minimum holding tank volume'required (gal) Cn^G^3pro@.o?^9ld.^^^^ITOseTW2SOT tWWWMweuMwi Esm"^Alarm mod Tank Manufacturer Tank model number [Alarm manufacturer el number Tank Dimensions and Data {X for round tank Tank Anchor Calculations ~5170~ •^UU&WWtfMi1.0ifiUiUftWitttWHOWWMUUH!169.5lBMa9srw UbrtUUt.itlAWMttKlUW Liquid depth below inlet Invert (in) Maximum depth of soil cover (ft) Height (In) | Outside [Length (in) F Dimensions[Width (In) -> Only ""TeTin ^g^ -40.8 Ibs 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 iunctton box / blind plug to seal outlet service alarm on Electrical as perNEC 300 and Comm 16 manhole cover with locking device and warning label 4"mln. fintehad gradeT /vent cap Manhole and vent locations may be reversed. 12"mln, ventplps 12.0 (n. 39.0 in. Note: All tank Joints, and joints between tank openings and piping aresealed watenight. All pipe and vent materials comply T:18"mln.A3) building sewertnlet 3 In. bedding under tank.Tank Is anchored as necossBiyto negate buoyancy. CHECKLIST FOR SANITARY APPLICATIONS Submit the Following (Use Permanent Ink] (Titie 15, Section 15-l-10(e)) 0 Check List S Original Sanitary Application (Submitted in Deed HciBdeirs Name - aot 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) Ef Cross Section, Over-Head Profile of the System and Schematic of Tank from Manufacturer I? Pump Tank Diagram, Alarm and Pump Curve (when applicable) 0 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 st Reg. of Deeds) ET Holding Tank Agreement (383.21(2)(c)(5) (Recorfgd afe 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) @f 2 CQmBlete Sets of Plans (383.22(2)(2.) (NfiteiiMBQLABl2licat!on 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) D Copy of Warranty/Quit Claim Deed (Optional) SanitaryApplication; (Indud® £he ffoBlowBiriig IinifoirmatBoin]) E3 I Application Information must mdude: D 23 diait Parcel ID# " fdlo no>t use 12 digits anymore-obsolete) E Project Address or Road Name where driveway is/will come off of) Elf (Owners Phone Number) ^ II Type of Building E2 III Type of Permit Type of POWTS System D V Dispersal / Treatment Area Information 0 VI Tank Information 0 VII Responsibility Statement (Plumber's Information) D *Date Stamp* Plot Plan: (To Scale or To Dimension) ET Signature and Plumber Information ^ Address Number and Road 6f Surface Elevation of Body of Water ^ North Arrow D Direction and Percent Land Slope D Contour Lines ^ Tank and Filter Information and Location M Structures and Driveways 0 Wetlands / Navigable Bodies of Water \3 Boring Location a Absorption Area (Proposed and Existing) ^ Property Lines \S Bench Mark (Location, Elevation and Description) 0 Well Locations 0 Component Manual Version S Legal Descriptions Ef Piping Material Information (conveyance line, building sewer line, material type and diametQr) Turn Over > Cross-Section and Over-Head Profile of the System: D Surface and System Elevation El 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 0 Private Sewage System (Holding Tanks) $ 400.00 D Mounds or Systems requiring Pre-Treatment $ 500.00 D Sanitary Revisions D Private Sewage System Reconnection and Private Interceptor D Return Inspection D Maintenance Agreements ^ (checks made out to Reg of Deeds) $ $ $ $ 25.00 50.00 50.00 30.00 u/forms/checkllsts/checklistforsanitaryapps(lO/2009);(®7/2011);(®Z/2012)(®5/2/2012-dc) Proofed by: HOLDING TANK MANAGEMENT PLAN 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. Actm. 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 5PS 383 and)84 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 installation, the fgjjowing persons should be contacted: a. \ns\a\\er.............................Polf^s^ fUvn^ m.^v2.2.e>oci0 Phone: -71 S- 37%- ^^ b. Service Provider............... '^rc^.^^f S^4-^. Re^ jt Sti'yl Phone: -7 IS- S7-^ - ^ OQ^ c. Co. Zoning or Health Dept. Qa.'/ff^U C^wb* "t^-f^ ^_^^ Phone: 7, j- 3-73 ^MM_~3 —~' n. L^^ b^^.s..?^^<L\ \s^}^\ ^o^-tLc-js Z^-h S^Z^-T^-/^^7^ "To^n^f^ <2.(p^/<Lr yO^ 3^-^'^LP&^TQUa. • •^^^S^A^l^L Project Transaction Number: HOLDING TANK SERVICING CONTRACT Contract Date ^-Y.-^Y This contract is made between the Holding Tank Owner(s) Name(s) 'j^ o <=> c&. ^ -t^ (^ E--0 ^L Pumper's Name (Print) y- C' *•-> ^L I "'~&_'^' ^-^,^ ^<^-e:}"?' $^f.</ ^^ Pumper's, Signature ^ Pumpers' Registration # gl^~7l We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT LOCATION Legal Description: (Use Tax Statement) TaxlDtt/^/ Section " f .Township -/ I _ N, Range. Gov'tLotz^LotS CSM«Vol. Page CSMDoctt n>0 w Lot(s) No.Block(s) No. .1/4, _ 1/4, Town of:^[f)\/^K lot Size Acreage Subdivision: 1. The owner agrees to file a copy of this contract with Bayfield County as required in SPS 383.55, Wis. Adm. Code. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local government unit which has signed the pumping agreement required by SPS 383.55, Wis. Adm. Code, and the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In 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) Rob(?rT<a C^^K '^asaasseaseis-esesf ,..;;•;•"„•;.„ HURGORE1^CATHERINE NoeLE-MUCH^ /§^''~v'^i Not*'y P^SI!?:.%te-?f lndiana 1 CSEALI) CominlM]upNumbor!X>0684lol ;^lCommiutofi ExpiresAPRIL 24, 203J Owner's Signature(s) iu- Subscribed and Sworn to me: on this _4T_day of ^OY\tL .2o24 b^^^fi^f\^^Ajjt^')ift^e^u&^\\ Notary Public My commission expires on: 0411A. \10?>2 Revised: May 2016 (®May 2018) Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (l)(m)] Drafted by -r? Document Number/Plan I.D. No. Owner tfameKok&rrr^ cw^6j Parcel Identifier Number (PIN)(?<+-oi4-a-$t -c, 7 -jz.to/;' OST-oOU- -'I 000 >^ct 12.100 HOLDING TANKAGREEMENT Owner(s) Mailing AddressWSD A/. do^A^n}€j^^W^ Agreement Date (?ame as Notary Date)^^-^ 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..1/4 Section ^.Township ^7 .N. Range 7 _w. Town of C.[0\J^r I Description: $ce-^ llo<~>^<, 5 ^e^-Additional Legal Description: Gov't Lot _ Lot_Block. Lot_CSM #_ Vol .Subdivision. .Page _CSM Doc#. _CSM#_ DOCUMENT NUMBER2024R-60364 1 DANIEL. J. HEFFNER REGISTEF? OF DEEDS BAYFIELD COUNTY. Wl RECORDED 06, 1 7/2024 AT 9: 1 8 AM RECORDING FEE: $30.00 PAGES: 2 Return To:•^^c ^y f'<£> I k^s k f-^O. So^ ^'~- ">^S^7 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 hoMing 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 Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 3. The owner agrees to contract with a person who is licensed pursuant to s.281.17 (3)Wis. Stats., and chapter NR 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 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 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. Owner(s) Name(s) - Please Print P.a^^'V^ CooK Subscribed and sworn to before me on this date; Od 0412024 otarized Owner(s) - Signature(s)^r ^/Notary Public .Geiyu^u^A' My Commission Expires: 04\7-4bc^Z Drafted by: J °<^ f c I 1^-^S ^C,IPersonal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (l)(m)] Date: ^-\^-~^1 u/forms/sanitary/holdingtankagreement.doc ®June 2018 Document Number STATE BAR OF WISCONSIN FORM 7 - 2000 TRUSTEE'S DEED DECQRBIN6 FEE;TRflHSFER FEE: POSES: a 38,88leea.ea R.ecording Area JOHN C. KREUSER AND KATHERINE A. LVMANtttk/n KATHARINE A. LYMAN, as Successor Co-Tiustees of ROBERT J. KREUSER AND RUTH M. KREUSER JOINT LIVmG AND DEVOLUTION TRUST U.T.A. MARCH 19, 1993, for a valuable consideration conveys without wairanty to PETER C. KiREUSER AND ROBERTA R. COOK. AS TENANTS IN COMMON, Grantee, the following described real estate in BAYFIELU County, State of Wisconsin: A parcel of land in Gov't. Lots 2,5 & 6, Section 26, T.51 N., R. 7W-, Town of Clover, Bayficld County, Wisconsin, described as follows: To locate the point of beginning, commence at the South'/ corner of said Section 26,and run N. 1°01' W. along the '/, line 1467.94 feet to an iron pipe; Thence run N. 89°03' E., (passing thru iron pipes at 84.07 feet and 1952.74 feet) 1992.74 feet, more or less, to the waters edge of Lake Superior in Bark Bay, which is the point of beginning; Thence from said point of beginning by metes and bounds as follows: S. 89°B3' W-, (passing thru an iron pipe at 40 1'cct, more or less,) 1908.67 feet to an iron pipe on the Northeasterly woods line of the Keithley access road; Thence N. 49°03' W., along said woods line 439.27 feet to an iron pipe on the Southeasterly right of way line of the Bark Point Road; Thence N. 47°44' E. along said right of way line 1186.29 feet to an iron pipe on the East-West '/s line of said Section 26; Thence N. 89°03' E., 1141.19 feet to an iron pipe; Thence S. 0°57' E., 646.S feet to an iron pipe; Thence N. 89°03' E. (passing thru an iron pipe at 462.60 feet) 502.6 t'eet, more or less, to the waters edge of Lake Superior, in Bark Bay; Thence S. 30°20' W. along said waters edge 50432 feet to the point of beeinnine. Exceptine Therefrom A parcel of land located in Government Lot Five (S), Section Twcnty-six (26), Township Fifty-one (51) North, Range Seven (7) West, Town of Clover, Baydeld County, Wisconsin, more particularly described as follows: Commencing at the quarter corner located on the section line between Sections 26 and Thirty-five (35) in Township Sl North, Range 7 West; thence proceeding North I°l' West along the Nortli- South quarter line, a distance ofOnc-thousand Nine-hundred Seventy-four and 61/100 (t,974.61) feet to the intersection of the North-Soutll quarter line with the right-of-way of the Bark Point Road; thence proceeding North 44°47' East along the right-of- way of the Bark Point Road, a distance ofEight-hundred Sixty-three and 21/100(863.21) feet, to the intersection oftlic right-of- way of the Bark Point Road with the North line of Government Lot S; thence Easterly, North 89°3' East, along the Norfli line ol' Government Lot 5, a distance of cight-hundred Forty-three and 79/100 (843.79) feet, which is the point of beginning; thence continuing North 89°3' East along the North line of Government Lot S, a distance ofTwo-hundred Sixty (260) feet, to a point which is the Northwest corner of Lot One (1) of Certified Survey Map No. 000237, which is recorded in the Office of the Register of Deeds for Bayt'ield Count, Wisconsin at Volume 3 of Certified Survey Map at page 8; thence South 0°37' East, along the West line of Lots I and Two (2) of said Certified Survey Map, a distance ofTwo-hundred Ninety-eigtlt and 28/100 (298.28) feet; thence west 89°3' West, along a line parallel to (he Nortll line of Government Lot S, a distance of Fifty (50) feet; thence Northwcstcrly in a straight line not previously surveyed, a distance ot'Three-hundred Scventy-rive (375) feet, more or less, to the point of beginning. PATRICIA A OLSDNBAYFIELD COUHTY, WI'REGisfER~OF"r>EfeDS' s<ai<ziR—53&a-7a 12/17/2018 a3:B8PM TF EXE?T t! T^ctu^p Address^f-C.^ret/ser'^s&^^ff^^i/^^^y/^'^ 9weL ^J/y-tJ-/- 014-1094-05 000 Parcel identiHcation Number (PiN) Dated (^s. _f^_ day of DECEMBER, 2010. * JOHN C. KREUSER :7^ */KATHER1NE A. LYMXN »/k/a KATHAKINE A. I.YMAN Successor Co-Trustee Successor Co-Trustee AUTHENTICATION Signahire(s) ACKNO^/LEDGi STATE OF WISCONSIN i DEBRAl.WOtfF'PutXctot Wisconsin authenticated this day of ') )ss. n€_ _ County. ) ~nQWW^ TITLE: MEMBER STATE BAR OF WISCONSIN (If not,. authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY ATTORNEY MATTHEW F. ANICH. SB#10l7169 DAU-ENBACH. ANICH & WICKMAN. S.C.. ASULAND. Wl (Signatures may be authenticated or scknowledfied. Both are not necessary.) Personally came before me this f _^ day of DECEMBER _ , 2010 the above named John C. Kreuser. Successor Co-Trustee ofRobertJ. Kreuser and Ruth M. Kreuser Joint Living and Devolution Trust U.T.A. March 19, 1993, to me known to be the person(s) who executed the foreRoiiig instrument and acknowledged the same. /}./!^* i]/w/^ y^//j<w>'k Notary Public, State of WISCO^ISlff My Commission is permanent. (If not, state expiration date:-f/^^ _. /3 .^'/ y " * Names of persons signing in any capacity must be typed or printed betow their signature. tNFOPRO (800)6S5.202l www.mfoprofoms.eomSTATE BAR OF WISCONSINTRUSTEE'S OEED FOIIM N0.7.IOOB BAYFIELD COUNTY SANITARY PERMIT # 24-84S STATE SANITARY PERMIT I TRANSFER/RENEWAL PREVIOUS NO. 23303 OWNER: Peter & Tamara Kreuser Trustees & Roberta Cook & Kreuser Family Trust PROPERTY LOCATION: Town of Clover Par in Govt Lots 2, 5 & 6 SEC 26, T51N, R7W PLUMBER: Allan Polkoski LIC. #: 220090 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. Alessandro Hall AUTHORIZED ISSUING OFFICER 7/2/2024 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)