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HomeMy WebLinkAbout24-136SINBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY ** (TIME RECEIVED REMOTE CSID DURATION PAGES STATUS May 7, 2025 at 8:37:51 AM CDT 46 1 Received From: To:7163730114 06/06/2022 09:4' ff011 roy], 001 / Request for Sanitary Inspection (Fax this form to Zoning Dept when you want an inspection — 373.0114) Note: Time Change Discrepancy fl Other From Zoning Dept a J-' pl \�� Phone Number Plumber: (, /b�LVYt/ % kb i6&-Dzo [k/v1d/ Fax NumberI Qr,ot ({(/ C, I5 c51qS Home Owner: obey t ~ o U4t % /3/tv lumber's Choice Zoning Dept No inspection during these times I 9:30 am —12:30 Tues. qDate: pm (Tracy) !■ 9:30 am —12:30pm Thurs. (Tracy) umber's Choice Immediate Phone Number so Zoning l� �DepY Dept can call you right back (if needed) Address # & Road Name: k..QLeEJ 3vlre Le} or 13S\\or,d w\ Directions Comments: Reminder: You must confirm any change(s) that have been made prior to or this Inspection will not be scheduled and a memo will be sent voiding the inspection. Thank You! ** Plumber must verify any change(s) by fax or no inspection will be scheduled ** uMonns/sanitary/repuestronnspecUon Zoning Dept (®4/12/04) ® June 2018 PO" ..". "r"h"`'"teOFCTIONI REPORT (ATTACH TO PERMIT) ROBERT & DEBORAH LULICH • 23920 US HWY 2 TANK INFORMATION TYPE MANUFACTURER/MODEL# CAPACITY .1•u n I IraCa /7t'Ua w w nr-ro nnvo ocr�nvnv Property Line Well Water Service Building All -Weather Road OHWM Swimming Pool J DEVIATIONS FROM APPROVED PLAN COMMENTS (Persons present, discrepancies, etc.) T ___ Sa4 b`td`nD. ✓' Qu�Ul Q1u�. ✓ &tr\o(one $ecvev-,• IvA �6t gl&m. tkki i ✓ & 1anK wrG-c+ j'q& ' (ties I CitW45 sAsv -u�tr k -ant specs. 116-O/ ', Ink sv" " jk', Iles" dTh: 7q" COMPONENTS NOT INSPECTED Plan Revision Required Dyes ❑No Signatur of Inspector 'i Sketch on other side 10 of 13 t--: BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Bayfield County Courthouse Fax: (715) 373-0114 Post Office Box 58 e-mail: zoning(a)bayfieldcounty.wi.gov 117 East Fifth Street Web Site: www.bayfieldcountv.wi.gov/147 Washburn, WI 54891 Property Owner ROBERT & DEBORAH LULICH Information 23920 US HWY 2 ASHLAND WI 54806 As you know was contracted by you to install a private onsite wastewater treatment system on your property described as: Notes: Abandonment of Old System to meet all applicable code requirements: 1 Tank was pumped by: C. Tank was crushed I removed and pipes disconnected by: on si_uafJr!1 On at (AM! PM) the above -mentioned plumber contacted our office to con ct a pre -cover inspection as required under DSPS 383. One of the following applies: System was inspected and appears to meet all applicable code requirements. ❑ System was inspected and appears to meet all applicable code requirements; however, a plan revision is necessary because the installation was substantially different than the original approval. System could not be inspected because plumber covered prior to scheduled time of inspection. ❑ System could not be inspected because plumber was not ready at scheduled time of inspection. County was unable to return to complete inspection. System could not be inspected because plumber was not ready at scheduled time of inspection. A re -inspection and $50 fee are required. System could not be inspected because County could not respond to plumber's time constraints. Comments: 't a�\V1 wt64(4I Q j iw \V. Q (V\C.woc w/� U/formslsanitarypmpertyowner-input April 2019 ,c 'B Industry Services Division County \ 3 ;� f' Fi� J L ti-- 4822 Madison Yards Way Madison, W 153705 3e.4jZ1. Sanitary Permit Number (to be filled in by o Z �`Mc " ",•g iieyi181d L. L<nDept.g Dept. P.O. Box 7162^ Madison, WI 53707707 —7162 & C.pAJ' 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 Department Project Address (if different than nailing address) the of Safety and Professional Services. Personal information you provide may be used for secondary ' 5 s purposes in accordance with the Privacy Law, s. 15.04(1 xm), Stats. .e•c& 4 ✓r3 I. Application Information — Please Print All Information Property Owner's Name Copy Parcel # 4Y 029.2 y7 OG•Z✓-g o2.O0O-/il oc Tax 39 Z6 2 Property Owner's Mailing Address Property Location n `.tC 512 o MS JI(.tit/ Z. Govt. Lot ^ ' NW SW '/, ZN City, State Zip Code Phone Number sA/afire! a. SYpo& 7/C-22°9-/(py3 %. Section T 'W1' N R Of. E o() II. Type of Building (check all that apply) Lot # for 2 Family Dwelling - Number ofBedrooms 3 Subdivision Name ❑ Public/Commercial - Describe Use Block # O City of ❑ State Owned - Describe Use O Village of CSM Number (9'Fown of Kt____h� III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if s licabl A New S y System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. Holding Tank ❑ in -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber g ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. DispersaltTreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units U U U New Tanks Existing Tanks c , y " 10 �� , O ti rn ii C7 a Septic or Holding Tank 200O ,• Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' aNI MP/MPRS Number I Business Phone Number / °sa1Y1 44'!! 0 Plumber's A ress (Street, City, State, Zip Code) 3/s ve. 5y VI. County/Department Use Only Approved O Disapproved 1,9/211-241 Permit Fee r —jO /aat�jt slued ajl,I Issuing Agent Signature p J t.Is&z-&,c ❑ Owner Given Reason for Denial —1 onditions Approval/Reasons for Disapproval cr " an S(f,()cck S . r)a,n#al?) SiS{c>'I PCC lr&o/p(pd Q5feer'/l* r'- a' ... •.....=+y...., .nu noun., m n: Cuu uy oniy on paper not less roan a lax 11 inches in size SBD-6398 (R. 03/21) _ _ Soil Test # Bayfield County Waiver of a Thorough Soil & Site Evaluation (subject to 15-1 -1 0(d)) 1 Calvin Rowley 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 Robert &Deborah Lulich Contractor. Property Address xxxx Janecek Rd Authorized Agent Telephone Accurate Legal Description is requested: Agent's Telephone Written Authorization Attached: Y or N NW 1/4 of SW 1/4 Section 24 Township 47 N. Range 6 W. Town of Keystone Additional Legal Description: Par in NW SW lying N of Twn Rd & S of V107 P829 in Doc 2024R-60244 Govt. Lot Lot Block Subdivision Lot CSM# Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# 39262 Acreage 11.25 Indicate reasoning for your determination: Unable to locate any area on site for a traditional POWTS system. AuG 1 52024 3ayfield Co. Zoning Dept Signature of County Official Sigma nature of ed Soil Tester 7/15/2024 Date SP -072400025 Certification # (Submit a Plot Plan & Fee) Date u/forms/soillestwaiver(KLK) 12 •n ��S�v ,oa ^ June2o18 r a - T✓ I z r r e? OE tnS ARE DM0 ECEO IISCS-84WIELD cW nnIlH THE WLW4E CF THE SN SWMEASURED TO Earn SEC. 24 - 14714 -REV? NOT TO SCALE O —SET 1 1/4" 0.0. a I8" IRON PIPE • —FD, 3/4" CAPPED REBAR (PLS #2393) ( )—PRENIOBSLY RECORDED AS 200 0 200' 400' 600' SCALE FEET 6NBDS 5(RIETEN IRE PLAT OF SURVEY APARCEL Of IOGIEO MI EIENCRI1M1fESTY OF THE SOUTIM£ETV SECT!N, TOISNSHIPITNORTk RWOEOWEST, TOWN OF NEVSTONE 94 WIELD COUNTY WRSC0NSIN, LEGAL CEEGRWN0.Y' •PAFCFLOF(ANp IOGTEOWTNE MYY. awl'.3EC IIIXI N, TITN 90 W. TOWNP' KEYS/ONE 94 YFIEfOCOUYIY NBSCONSIµ EIOgE PARIRYNAPLY 0E3CN0EDA9 � n I TOLLOWS: nn rn Ba CO I010MnnM 181St I 10].u• 341.15• WOSVp• I AUG 1 5 2024 CONCRETE HOLDING TANK DESIGN Bayfield Co. Zoning Dept. Single Tank Option INDEX AND TITLE SHEET Project Lulich POWTS Owner Robert and Deborah Lulich G✓,32S Address Project: xxxxx Janecek Rd, Ashland, WI Mailing: 23920 US Hwy 2 Ashland, WI Legal Description NWNW S24 T47N R06W Township Keystone County Bayfield Subdivision Name Parcel ID Number 04-028-2-47-06-24-3 02-000-14000 Plan Transaction ID Number Lot No. Index and title sheet Page 1 Holding tank specifications Page 2 Site plan Page 3 Maintenance and contingency plan Page 4 Tank Specifications Page 5 Designer Tony Bro Signature Phone No. 715-682-0444 License Number 664303 Date 08/14/24 Designed pursuant to: Holding Tank Component Manual For POWTS (Version 2.0) SBD-10855-P (N. 03/07) Version 7.0 (03/12) Page 1 of 5 HOLDING TANK SPECIFICATIONS 3 Number of bedrooms t� 26.0 Non-residential estimated flow (gpd) IQ V t5 D 2000.0 Minimum holding tank volume required (gal) �UU^IIII(Illl AUG 152024 2000.0 IProposed holding tank capacity (gal) Wieser Tank Manufacturer Bayfield Co. Zoning Dept. WLP 1200/800 Combination Tank Tank model number Septronics Alarm manufacturer SW100 lAlarm model number Tank Dimensions and Data X for round tank 41.0 Liquid depth below inlet invert (in) 7.0 Maximum depth of soil cover (ft) 53.0 Height (in) Outside 164.0 Length (in) rDimensions 96.0 Width (in) Only junction box - conduit blind plug to seal outlet Tank Anchor Calculations 22970 lbs Weight of tank and cover 1.00 Safetyfactor 7162 lbs Weight of anchor required 7.9 in Soil cover req. for anchor or 1.8 yd' Concrete counter weight HOLDING TANK CROSS SECTION - 23 in. tether weight service alarm on Electrical as per NEC 300 and SPS 316 3 in. bedding under tank manhole cover with locking device and finished vent cap warning label grade �,,4" min. .1• 12" min. Manhole and vent locations vent pipe 18" min. 12.0 in. 29.0 in. Note: All tank joints, and joints between tank openings and piping are sealed watertight. All pipe and vent materials comply with SPS 384. Tank is anchored as necessary to negate buoyancy. building sewer inlet Project: Lulich POWTS Transaction Number: Page 2 of 5 13-8" II 1 44" CAST -A -SEAL Iii II Ii I I I _ mtia ,_, illi U � II II, IIII 11 FILTER OR I I 11 BAFFLE IIII I I • r---------------- 111 ____- --_j. 4" CAST -A -SEAL 0 w 4" VENT w INLET ft� _ OUTLET d" I I na f nv : ' I l a I. IMl TANKS ARE MANUFACTURED WLP1200/800-MR TANK SPECIFICATIONS DIMENSIONS: WALL: 3" BOTTOM: 3" COVER: 6" MANHOLE: 24' I.D. PRECAST CONCRETE RISER HEIGHT: 53" LENGTH: 13'-8" WIDTH: 8'-0' BELOW INLET: 41" LIQUID LEVEL 36" WEIGHT: BOTTOM 14,800 LBS. COVER 8,170 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 33.46 GALAN (SEPTIC) 22.24 GAL/IN (PUMP) LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE PAD[ E V E I'! ��Un11 AUG 1 Bayfield Co. Zoning Dept; REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: M : 1 J 'C z z Q U F w Cl', 1 GENnz,4L NOTES 1. ALL WORE IS TO BFPLR[ORMID IN ACCORDANCE WITH THE WISCONSIN _SJB BYILOM6. PLYNBIN6. ELECTRICAL ANT) IISMC COP[ (YIX) CYRPFNiIY IN °3 16_E S. ME CONTRACTOR MBST YOUY ALL EXISTING coNDITIONS ArnIE JOB SITE. ^-- TN _ f. r CONTRACTOR II TO HAVE ALL OIEUm TN TSLLINES YflMELED BY [ "-5.1B` RESr[CIM YTILITYCOMPANIES IF APPLICABLE. ME CONTRACTOR SNALL IIAYE A LIXAFE DONE!? DIGGER'S NOTLIN[ PRIOR TO RILAUNG GROUND. PNOM I d.O.SFE.•'I I. A. CONTRACTOR SNAIL BEAWARE OF ALL PRIVATE UTILITRS LOCATIONS PARCELI ¢ -�•-�-z SNAILCN AL INTER. SEWER. A. GAS. 488,83JSq.FE VL - WITH MS. ALL!OUDMEWTAND MATERIAL INSTALUTIONSNOYLD SE IN STRICT T' M -_-_ ACCORDANCE WITH UTI LICOMPANIES INVOLVED AND r 11.25 Acres • �^ i I MANYFACTYRINSTALLATION INSLLATION INSTRUCTIONS. V _ 6. ALL STATE AND LOCAL BUILDING PERMITS WILL BE OBTAINED STOLE LL�� ._.� • OWNER AND MUST!! POSTED Al ME JOB SITE BY ME CONTRACTOR. la� F. SEVER TO ENGINEERED MNlS DRAWINGS IF APPLICASLE FOR 1 •'` PS ` PLACEMENT OFMYSS COMPONENTS CONTRACTOR ISTO FIELD I • VERITY ALL MUSS OIMExIIONS BEFORE PRODUCTION OT MUSSES. ...J fl. n.A L S1,L '7tA 76: 39242 41" 9VL ••� F<ATtLRE5H� PIN': OY-D2Y-2-47-04-24-3 02-Lbo-/4Doe rozAan 0r k s ts%rn. 524 -i44eJ"wOLN.C 2000 HY-wiIAAA-3 0 Mn:l;n.: 23120 LAS r4wy 2 AsiSnr/ sat SH2o& :20./Sr 'ut PROPOSED HOUSE O I '� I TiT.J+s+•1 3Lv aG+k talc 3%e.A WS SV4o1. W'/,. SW CORNER NORTH aD LAWN ENCROACHES I �� Ij - S.LINE NW'/ ' S °" FD.'/.° LAPPED RERAR (PLS S 2393) N85'4952°E . 32.86' FROM W1156 6 SW CORNER U L L L (s SITE PLAN SDIoyss•CN.•s1077 PLANSNCWSIll AUG 1 „NL%COWRA TV WRIT? UT Foil %ACDIO:IAAe3TAEEW(ILDPNLRS Narn GLE 1 j�24 HaVGeld Co Zeeing Depl. aS N 3M.LmA A.. Ach ln..t u6. me : 1.4v3os LULICif RESIDENCE SHEET! OF S Iti) Uod� BAYFIELD COUNTY hi CHECKLIST FOR SANITARY APPLICATONS 1111 AUG 1 520/4 Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) Bayfield Co. Zoning Dept. heck List 2Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) Ild"I"ndex Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) Original Plot Plan (383.22(2)2. 3. & 4.a) Z�Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer E Pump Tank Diagram, Alarm and Pump Curve (when applicable) ('Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) R(Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) 9 Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) //Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) IVATU Servicing Agreement (Recorded at Reg. of Deeds) Ig"Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) l2 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) tISState Plan Review (when applicable) /Copy of Warranty/Quit Claim Deed (Optional) Sanitary ADDlication: (Include the following Information) 13'I Application Information must include: 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) I" Project Address or Road Name where driveway is/will come off of) 4bwners Phone Number) CdII Type of Building IJ III Type of Permit Q'1V Type of POWTS System Q'V Dispersal / Treatment Area Information I/VI Tank Information R'VII Responsibility Statement (Plumber's Information) 2 *Date Stamp* Plot Plan: (To Scale or To Dimension) L9"Signature and Plumber Information IWurface Elevation of Body of Water L7 �DDirection and Percent Land Slope f9"/Tank and Filter Information and Location IS Wetlands / Navigable Bodies of Water E//Absorption Area (Proposed and Existing) 1H Bench Mark (Location, Elevation and Description) Component Manual Version Vdress Number and Road ItNNorth Arrow SContour Lines Structures and Driveways Q/Boring Locations Q"Property Lines M9 Locations Legal Descriptions Piping Material Information (conveyance line, building sewer line, material type and diameter) Turn Over ► Cross -Section and Over -Head Profile of the System: E G f U E ['Surface and System Elevation 1111 AUG 1 52024 C3 Position of Observation and Vent Pipes Bayfield Co. Zoning Dept I�Dimensions and Depths tB'Make, Model & Number of Chamber Units in each Cell Property Information E1ow many systems will there be on this parcel of land? C7Has this property been split? NSA (Property Statement shows Property History) Fees: ❑ Fjrivate Sewage System (Septic Tanks) $ 400.00 Ef/Private Sewage System (Holding Tanks) $ 400.00 ❑ Mounds or Systems requiring Pre -Treatment $ 500.00 ❑ Sanitary Revisions $ 25.00 ❑ Private Sewage System Reconnection $ 50.00 and Private Interceptor ❑ Return Inspection $ 50.00 ❑ Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) u/forms/checldists/checklistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: 7/10/24, 7:43 AM Novus-Wisconsin Access rev. 12.0206 Real Estate Bayfield County Property Listing Today's Date: 7/10/2024 I' Description Tax ID: PIN: Legacy PIN: Map ID: Municipality: STR: Description: Recorded Acres: Calculated Acres: Lottery Claims: First Dollar: Zoning: ESN: I Tax Districts 1 04 028 020170 001700 Property Status: Next Year Created On: 4/24/2024 3:13:54 PM Updated: 4/24/2024 11 Ownership Updated: 4/24/2024 39262 ROBERT D & DEBORAH L LULICH ASHLAND WI 04-028-2-47-06-24-3 02-000-14000 (028) TOWN OF KEYSTONE S24 T47N RO6W PAR IN NWSW LYINGN OF TWN RD& S OF V1097 P829 IN DOC 2024R-602447 11.250 11.244 0 No (AG -1) Agricultural -1 120 Updated: 4/24/2024 STATE COUNTY TOWN OF KEYSTONE ASHLAND SCHOOL TECHNICAL COLLEGE Billing Ad r s: Mailing Address: ROBERT D & DEBORAH L ROBERT D & DEBORAH L LULICH LULICH 23920 US HWY 2 23920 US HWY 2 ASHLAND WI 54806 ASHLAND WI 54806 P Site Address ' indicates Private Road N/A O Property Assessment Updated: N/A 2024 Assessment Detail Code Acres Land Imp, N/A 2 -Year Comparison 2023 2024 Change Land: 0 0 0.0% Improved: 0 0 0,0% Total: 0 0 0.0% 4' Recorded Documents Updated: 1/11/2013 © WARRANTY DEED Property History Date Recorded: 3/4/2024 2024R-602447 Parent Properties Tax ID 0 QUIT CLAIM DEED 04028-2-47-06-24-3 02.000-11000 35658 Date Recorded: 12/20/2012 2012R-547379 1097-829 O ABRIDGEMENT OF JUDGMENT & RELEASE OF US PENDENS Date Recorded: 9/12/2012 2012R-545684 1090-597 O QUIT CLAIM DEED Date Recorded: 12/21/2009 2009R-530616 1032-476 HISTORY © Expan All History Whlte=Current Parcels Pink=Retired Parcels 39262 This Parcel i Parents + Children ECEoVE 11 AUG 1 52U'14 D Bayfield Co. Zoning Dept. hops:/Inovu.s.bayriieldcounty.wi.gov/access/masterasp?paprpid=39262 ill f7 IC rN it n 11f1 IS ILfl I tW I U tyIndustry �� Services Division 4822 Madison Yards Way County AUG 1 52024 Sanitary Permit Number (to be filled in by o I' ~ p ) Madison, WI 53705 ,y i \ehsxrP;`. Ba�eld Co. Zoning Dept. P.O. Box 7162 Madison, WI 53707-7162 t�, c b. -t — L50 S Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide maybe used for secondary svw Sa.r i_c �( 4 4q purposes in accordance with the Privacy Law. s. 15.04(1 )(m), Slats. 7 1. Application Information - Please Print All Information Property Owner's Name Parcel # OY-02f-1-y�-oa-2+=g o2-000-/y axo 39 Z6 Property Owner's Mailing Address Property Location x2392 o 44$ N/[Z Govt. Lot ^ I NW ' ''4, ZH City. State Zip Code Phone Number A/ ( a -w SYpUL 7/S -C 09' 103 . W Section T All N R 06 E s ;) 11. Type of Building (check all that apply) Lot # Subdivision Name Ial or 2 Family Dwelling -Number of Bedrooms 3 Block # ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned- Describe Use O Village of CSM Number EWt wn of Ksaj3 m.,t Ill. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if a licabl A. New System y 0 Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. Holdin Tank g0 0 In -Ground ❑ At -Grade Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation Capacity in Gallons Total Gallons # of Units Manufacturer Tank Information s New Tanks Existing Tanks /zoo/key . -r- & a U ins rn fL U Septic or Holding Tank q� �•t/r�/ Dosing Chamber V. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown an the attached plans. Plumbers Name (Print) I Plumber'MP/MPRS Number I Business Phone Number !o GM o �7ir rl2^�/NN Plumber's Acaress (Street, City. State. Zip Code) 3!S vc. 55/ V1. County/Department Use Only Approved I O Disapproved Permit Fee /0 0 9Date Issued al W24 I Issuing Agent Signature ( I S8z1S' g�2glZH: ❑ Owner Given Reason for Denial / ondition of Approval/Reasons for Disapproval At fd all Sc1Lcck S • p lOi5emC'n !n }t, Uu-nci • 1'7a,nate SAS{ Pew l? 1c ed a&rcer1e,i-. Attach to complete plans for the system and submit to the County only on paper not less than 8 1Q x 1I inches in size SBD-6398 (R. 03/21) HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to SPS 383, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10855-P N. 03/07), and the Bayfield County Sanitary Ordinance. 1. This POWTS is designed to accommodate a wastewater flow of 65.2 to 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 Service 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 SPS 383 and 384 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 30 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 SPS 383.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons may be contacted: a. Installer ......................... Brown Plumbing & HVAC, Inc. Phone: 715-682-0444 b. Service Provider ............... Halvorson Pumping Phone: 715-682-8364 c. Co. Zoning or Health Dept. Bayfield County Zoning Phone: 715-373-6138 11 Project: Lulich POWTS Transaction Number: AUG 1 52024 Bayfield Co. Zoning Dept. Page 4 015 DII AUG 1 5 2024 HOLDING TANK SERVICING CONTRACT Bayfield Co. Zor Contract Date ty 7o2f This contract is made between the Holding Tank Owner(s) Name(s) k'D&aAJ 2rtcf 2&64 ,L / Pumper's Name (Print) Pumper's Signature I Pumpers' Registration # icr>I +lalv+ns+n a33o� We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT Legal Description: Tax to# I 1/4, 1/4, LOCATION (Use Tax Statement) 2 s Section '4'+ N, Range 010 w Town of: Lot Size Acreage ___ ,Township I t 1.2 Gov't Lot Lot St CSM # Vol. Page CSM Doc ft Lot(s) No. Block(s) No. 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) Owner's Signature(s) Subscribed and Swom to met7ANEC�KJER on this E;� )oi& L Li1 No ommission expires on: Revised: May 2016 (®May 2018) Drafted by Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)] uocument NumberIIlan 1.O. No. HOLDING TANK AGREEMENT 23920 uy d 2. as 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 a q�/ !' Township _____N.N. Range,,t D4 W. X Town of —C YChheC 7 Additional Legal Description: Gov't Lot Lot_ Block Subdivision CSM#_ Lot_CSM # Vol _Page CSM Doc# 0 `:OMEN__ ?'i! NIL Eh 2024R-604375 RetumTo: �is�\o mac\ SLICE L4 Co. Zoning Dept. 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 falls 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., Bay leld 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 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, WI'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, 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. Owner(s) Name(s) — Please Print Subscribed and swom to before me on this date: Luh11 IL \L - Notarized Owner(s) — Signature(s) II uisuoosiM �o a7p15 // (k,L>L// lgnd RJfloN y mi Expires: N3M73NNIZ 3YUWVN G � Drafted by: DVtA Persons! informa8on you provide nay a used for secondary purposes [Privacy law, s.15.04 (1)(m)) Date:\ A. '-- uxonrelsanilarylhaldinglankagmement.doc ®June 2018 II - —. ' �. l .. � is �' '1 'i l�'_. State Bar of Wisconsin Form 1-2003 WARRANTY DEED DOCUMENT NUMBER 2024R-602447 Document Number Document Name DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI THIS DEED, made between Robert Arthur Truchon Jr ("Grantor," whether one or more), and Robert D. Lulich and Deborah Lulich. husband and wife as survivorship marital property ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the re{,, profits, fixtures and other appurtenant interests, in „errLr',W O.yR .Ii Zounty, State of Wisconsin ("Property") (if more space is needed, please attach addendum): See Attached Exhibit "A" RECORDED 03/04/2024 AT 8:00 AM RECORDING FEE: $30.00 TRANSFER FEE: $90.00 PAGES: 2 ELECTRONICALLY RECORDED Recording Area Name and Return Address 18368-23 Robert D. Lulich and bLhQ J 23920 US Hwy 2 I lJ Ashland, WI 54806 iJ 'I 10'14 Dept. Parcel Identification Number (PIN) This IS NOT homestead property Grantor warrants that the title to the Property is good, indefeasible In fee simple and free and clear of encumbrances except: EASEMENTS, RESERVATIONS AND RESTRICTIONS OF RECORD. Dated OS/al _ _a; y FOWARH C. HPOICAN [ Nobly public,Sldtro1ftwns§I1 AUTHENTICATION Signature(s) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: ATTORNEY TYLER W. WICKMAN, SB#1057612 Anich, Wickman & Lindsey, S.C., Ashland, WI 54806 (SEAL) ACKNOWLEDGMENT STATE OF WISCONSIN ) (A ,AShipyii COUNTY Personally came before me on U 3, / C I / e9!i3 1 the above -named Robert Arthur Truchon Jr �— to me known to be the person(s) who executed the foregoing instrument and Notary Public, State of Wisconsin My Commission (is permanent) (expires: O 7/o6 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED a 2003 STATE BAR OF W ISCONSIN FORM NO. 1-2003 • Type name below signatures. Bayfield County Register of Deeds Document #20248-602447 Page 1 of 2 oUUHVE AUG 29ku D EXHIBIT "A" Bayfield Co. Zoning Dept. That part of the Northwest Quarter of the Southwest Quarter (NW%SW'/.), Section Twenty-four (24), Township Forty-seven (47) North, Range Six (6) West, Town of Keystone, Bayfield County, Wisconsin, lying north of the town road and lying south of the following described parcel: A parcel of land located in the N'/Z of the SW 1/4, Section 24, T. 47N., R. 6W., Keystone Township, Bayfield County, Wisconsin, described as: Commencing at the quarter corner common to Sections 23 and 24, T. 47N., R. 6W.; thence Southerly along the Section line common to Sections 23 and 24 350.00 feet to the point of beginning; thence from said point of beginning Easterly parallel to the East-West % line 1205 feet more or less to the westerly Right-of-way line of Janecek Road; thence Southwesterly along said Right-of-way line 495 feet more or less to a point that is 750.00 feet South of the East-West''/a line; thence Northwesterly 950 feet more or less to a point that is located on the Section line common to Sections 23 and 24 and is 201.00 feet south of the point of beginning; then Northerly along said Section line 201.00 feet to the point of beginning. Bayfield County Register of Deeds Document w2024R-602447 Page 2 of 2 9/3/24, 12:02 PM CarmodyTm BAYFIELD COUNTY SANITARY PERMIT (#04)-24136S STATE SANITARY PERMIT OWNER: ROBERT D & DEBORAH L LULICH GOVT LOT: LOT: BLK: NW1/4 /4 SW1/4 /4 SEC: 24, T 47 N, R 06 W TOWNSHIP: Keystone SOIL TEST: 129-24 (WAIVER) NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: Tony Brown ALESSANDRO RO HALL Authorized Issuing Officer DATE: 91312024 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 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. PREVIOUS PERMIT #: LICENSE: # 664303 Condition: Tank to meet all setbacks on to be within 2T of an all-weather road. Management plan to owners. Properly maintain system per recorded agreement. THIS PERMIT EXPIRES 913/2026 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION https://www.carmodyinc.com/PermitApp/Permit Sign.aspx?Print=1&permitappid=7364 1/2