Loading...
HomeMy WebLinkAbout24-162SRequest for Sanitary Inspection (Fax this form to Zoning Dept when you want an inspection — 373.0114) Note: I Time Change fl Discrepancy Other From Zoning Dept A c x 1 en Phone Number Plumber: i4 VA -C. I IC -1 ( S- 3-73- L3'7 g Fax Number - 313 - Home Owner: a-\-her,nom ac.d al -c- limeybe_lc.-es Sanitary Permit # Plumbers Choice Zoni Dept No inspection during these times 9:30 am -12:30 pm Tues. (Tracy) Date: hurt �� L` I2Ia/a o 9:30 am -12:30 pm Thurs. (Tracy) Time: Plumbers Choice my ept Immediate Phone Number so Zoning 07O1✓ &� r Dept can call you right back (if deg{) 'irS-I-cM-O&S (c 6 -w L 216-373-2378 Township: (s P, SL bccr'V Address#& Road Name: Z9ct0O (�c..ccabo i�a . Wp S c.i is or Directions To Site: Comments: Reminder. You must confirm any change(s) that have been made prior to or this inspection will not be scheduled and a memo w!11 be sent voiding the inspection. Thank You! ** Plumber must verify any change(s) by fax or no inspection will be scheduled ** ufomislsanitarytrequssttodnspecgon Zoning Dept (O9117104) l'd 9t90£L£SLL OII OVAHPue 6uigwnld 1(pe0 e dune 2018 e£:80'SZZ unr peAiaJay T Sb 9b90£LESTL 10] 1* pZ:6Z:6 le SZ0Z 't' aunt Sn1ViS S39Vd NOI1VLna OIS7 31OW3N 03AI303H 3WI1 n K1indSS3JOnS 03AI3D3N XVd : N0I1'd0IdI10N ONnOBNI xn 11I.. ITf..I/1• ....I,. TAG../ INSPECTION REPORT (ATTACH TO PE KATHERINE AND PETER KEBBEKUS 1911 CHINOOK DR TANK INFORMATION TYPE MANUFACTURER/MODEL# CAPACITY Wo a O 76° OCTD A ('I/O UL I U/1Vlw Property Line Well Water Service Building All -Weather OHWM Swimming Pool Road 0 80 go DEVIATIONS FROM APPROVED PLAN /J/fl COMMENTS (Persons present, discrepancies, etc.) Caly fiJ$ocicyc j, (ii6 Cl�4'vk5 COMPONENTS NOT INSPECTED Plan R�vlslQn Required ❑ Yes No Da — Signature of Inspector• Cert. Number Sketch on other side 10 of 13 Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoning(7abavfieldcounty.wi.gov Web Site: www.bayfieldcounty.wi.gov/147 KATHERINE AND PETER KEBBEKUS 1911 CHINOOK DR DULUTH MN 55811 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know 1¢ , '4 € A"- was contracted by you to install a private onsite wastewater trea ment system o your property described as: Notes: Abandonment of Old System to meet all applicable code requirements: ❑ :• Tank was pumped by: on at AM 1 PM C. Tank was crushed ) removed and pipes disconnected by: On /6A I at : 0 ( (AM) -tie above -mentioned plumber contacted our office to conduct a pre -cover inspection as required under DSPS 383. One of the following applies: bY i9� 9ystETrt was inspected and appears to meet all applicable code requirements. fl 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: U/forms/sanitarypropertyowner-input April 2019 'ai- utn.tt au J • o�"a'"'E.,� Industry Services Division County\ C+ - •��•r'•t�•t I(I` R Ii �P fi' s S l5 ( L5 U LS 4822 Madison Yards Way Sanitary Permit Number (to be filled in by FQ P ! Madison, WI 53705 OCT 1 1 2024 U P.O. Box 7302 Madison, WI5302 Bayfield �d4ioe?ermit 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 secondary Project Address (if different than mailing address) purposes in accordance with the Privacy Law, s. I5.04(l)(m), Slats. 27'1 cc a.nf C%7ca L A'Sr.6.&r r L Application Information — Please Print All Information Property Owner's Name ^S' I lt+t meT"1ne, tan - 2'�-c I� '�kl•l5 Parcel # TAL 1D3et58-j play: oy—ose—Z 'lB—O0 o Property Owner's Mailing Address o .pee-yd.o.ea• Property Location IRI1 G1h.noc(C Tbr. Govt Lot %., E/., City, State I b.JLCk Zip Code Phone Number /vi b 11 J� ga / O Section a 2.. T MS N R GS E IL Type of Building (checkall that apply) Lot # K1 or 2 Family Dwelling — Number ofBedrooms _ Subdivision Name ❑ Public/Commercial — Describe Use Block ❑ City of ❑ State Owned — Describe Use ❑ Village of CSM Number G QITown ofy�ti5bk ___✓ 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' a 6cable A. 'New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B• yet rxolding Tank r ❑ In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Des�g.Elr Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber j ❑ Transfer to New Owner ist Previous Permit Number and Date Issued Expiration IV. DispersaVFreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required (sf) Dispersal Area Proposed (sO System Elevation Tank Information Capacity in Gallons Total Gallons # of Units Manufacturer u c U New Teaks Existing Tanks o G ^ v a T)^ U ca rn w C7 a Septic or Holding Tank ill ..yam oo A e ev Dosing Chamber _____ V. Responsibility Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) (;trn C lkJk`." Plumb 's Sign /J C MPMH'RS Number Business Phone Number —11&-313-23-1 AaP Q2..2.13cj Plumber's Address (Street City, State, Zip Code) 31 f 6 o &; Eck G- &'o ue 1 1 11&/flu % 8Q( VL County/Department Use Only Approved I ❑ Disapproved Permit Fee $ y 0V Date Issued I Issuing Agent Signature �•D jJ O Z31 )s 71•j ❑ Owner Given Reason for Denial It (g •p Conditions of Approval/Reasons for Disapproval • last to meal' on Se1jackS Grd (jc located w'T'n z< o P a)I Wec4htr [cod. 01,(ru ' Sts pr rn cdea bets e -than Z5 fto,r 54RAin o roperlY e. orc to completc plans for the system and submit to the county only on paper not less than 81/2x11 inches in size SBD-6398 (R. 02/22) I� js Liiu U.0 OCT 1 12024 U Bayfieltl Co. Zoning Dept Jt/F2J9 Bayfield County Soil Test # Waiver of a Thorough Soil & Site Evaluation (subject to 15-1 -1 0(d)) I A Jr t e I/L �a d —1 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 OwnerPe Fel!{� Contractor �• t' �I % tJ Z i � • v Accurate Legal Description is requested: 5E1/4 of 5E 1/4 Section62Township N. Range Q.> W. Town oftLacti l/)OVL'/ Authorized Agent Agent's Telephone Written Authorization Attached: Y or N Additional Legal Description: R 6 In SC Sc zzhl U. ?'7' P 52 3 N DOC aO 3 6 yR Govt. Lot Lot Block Subdivision Lot CSM# Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# Acreage________ Indicate reasoning for your determination: Signature of County Official Date of Certified Soil Tester Date 313-i l 2ccQi Certification # (Submit a Plot Plan & Fee) u/forms/soiltestwaiver(KLK) June 2018 I PHev febbeku> Pay T w SC s L� 5 0� rt4 8 N R 05� s -off 4cves 76- cov I,��s>nGovvl� &LO j IOC Uatiuel kd 14Ke-160 0 DJELL— N o Dv l / I I I I.H Hi RGE�vE 0 OCT 112024 Bayfleld Co. Zoning Dept. Dl HHU dil OCT 1 1 2024 katherine and Peter Kebbekus Bavfie!d Co, Zoning Dent. (Holding Tank) 29900 Wannebo Road Washburn WI 54891 SE SE S02 T48N R05W Town of Washburn 5.02 Acres PIN 04-050-2-48-05-02-4 04-000-20000 page 1-2: Bayfield county checklist page 3: Tax statement (for informational purposes) page 4-5: Soil and Site Evaluation page 6: Plot plan page 7: Holding tank details page 8: Holding tank management plans page 9: Holding tank servicing contracts page 10: Holding tank agreements page 11: Wisconsin sanitary application Reference material; SPS 381-387 POWTS component manual (Version 2.1) (May 2022-2027) These plans prepared by ; Adrien Cady MP922139 31160 Birch Grove Road Washburn WI. 54891 phone:715-373-2378 fax:715-373-0646 f-fvit4f aud Pelev^ (C��O�e�Cv5 octoso L- OQQ9 - to©o 5oa yLf N I o5 u) JCO� acv+owu of k&s4%vvu Pctlr r" SE --� V-1 P38 34,4 i u Doc �oa`fR-6O3638 LJavtvle tK-iO LVeL I EcEovE 0 ccT 112024 Bayfield Co. Zoning Dept. tle& p1 I00 aV Tzcjk S ve c D D W1250/750 -MR TANK SPECIFICATIONS 0 0 ,r-„' a. CCT 112024 DIMENSIONS: $ WALL: 2 1/2" a 4" CAST -A -SEAL 4" CAST -A -SEAL 3ayfleld Co. Zoning Dept. BOTTOM: 3" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER o rn �7� � HEIGHT: 66" ilii a �:;:LENGTH: 12'-11" // 11110 WIDTH: 7-2" rc BELOW INLET: 53" N i i1 U LIQUID LEVEL: 48"1 WEIGHT: BOTTOM 8,740 LBS. COVER 6,120 LBS. n\\ a O 0 �\ INLET AND OUTLET: 'm o N �`\\ FILTER OR ii•ii i 4" CAST -A -SEAL BOOT OR EQUAL GASKET J . 1111 •%r ¢ a -_-------__�__ INLET AND OUTLET BAFFLE AND FILTER: 0 o o WISCONSIN. SEE DETAIL #10 W (OTHER STATES SEE CHART) La s TOP VIEW LIQUID CAPACITY: 27.66 GAL/IN (SEPTIC) C 16.12 GAL/IN (PUMP) v i cc LOADING DESIGN: 8'-0" UNSATURATED SOILo O z 00 TANK CAN BE USED AS: ao 4" VENT SEPTIC/SEPTIC, SEPTIC/SIPHON, a OR SEPTIC/SIPHON �' Y of 3 O COVER: MIX DESIGN #8 (NO FIBER) v, = tb __ TANK: MIX DESIGN #10 (STRUCTURAL FIBER) 0 INLET - CUSTOMIZED TANKS: R OUTLET FOR CUSTOM TANKS CONTACT WIESER CONCRETE I ¢ I a I.t dU 1 D'v N Q i D JI I •I 7 a I LF'1 Z 23 " 1' 1 $ ---- - - ---- -I. REVIEWED BY F PUMP PAD REVIEW DATE 1O N cL DRAWINGS SUBMITTED (I) SIDE VIEW FOR APPROVAL APPROVED BY: SHEET NO. APPROVAL DATE: 1 OF PRODUCTS NEEDED BY: / 1 TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS BAYFIELD COUNTY pIl CHECKLIST FOR SANITARY APPLICATONS U D Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) llj OCT 1 1 2024 0 Check List Bayfield Co. Zoning Dept. ❑ Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) ❑ Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) ❑ Original Plot Plan (383.22(2)2. 3. & 4.a) ❑ Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) ❑ Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) ❑ Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) ❑ 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) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) ❑ Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) ❑ 2 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.) ❑ State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) ❑ I Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) 0 Project Address or Road Name where driveway is/will come off of) ❑ II Type of Building ❑ III Type of Permit ❑ IV Type of POWTS System ❑ V Dispersal / Treatment Area Information ❑ VI Tank Information ❑ VII Responsibility Statement (Plumber's Information) ❑ *Date Stamp* Plot Plan: (To Scale or To Dimension) ❑ Signature and Plumber Information ❑ Surface Elevation of Body of Water ❑ Direction and Percent Land Slope ❑ Tank and Filter Information and Location ❑ Wetlands / Navigable Bodies of Water ❑ Absorption Area (Proposed and Existing) ❑ Bench Mark (Location, Elevation and Description) ❑ Component Manual Version 0 (Owners Phone Number) ❑ Address Number and Road ❑ North Arrow ❑ Contour Lines ❑ Structures and Driveways ❑ Boring Locations ❑ Property Lines ❑ Well 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: ❑ Surface and System Elevation ❑ Position of Observation and Vent Pipes ❑ Dimensions and Depths ❑ Make, Model & Number of Chamber Units in each Cell Property Information OCT 1 I ZOZ4 Bayfield Co. Zoning Dept ❑ How many systems will there be on this parcel of land? ❑ Has this property been split? (Property Statement shows Property History) Fees: ❑ Private Sewage System (Septic Tanks) $ 400.00 ❑ 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/checklists/cheddistforsanithryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: 9/3/24, 858 AM Novus-Wisconsin Access rev. 12.0206 Real Estate Bayfield County Property Listing Property Status: Current Today's Date: 9/3/2024 Created On: 3/15/2006 1:16:05 PM Description Updated: 8/2/2024 a Ownership Updated: 11/6/2023 D IE C ; p V Tax ID: 30587 KATHERINE AND PETER KEBBEKUS DULUTH MN PIN: 04.050-2-48-05.02.404-000-20000 GCT 1 12024 LI Legacy PIN: 050100308000 Billing Address: Mailing Address: Map ID: KATHERINE AND PETER KATHERINE AND PETER Bayfield Co. Zoning Dept. Munidpality: (050) TOWN OF WASHBURN KEBBEKUS KEBBEKUS SIR: S02 T48N R05W 1911 CHINOOK DR 1911 CHINOOK DR Description: PAR IN SE SE IN V.391 P.386 34A IN DULUTH MN 55811 DULUTH MN 55811 DOC 2024R-603638 Recorded Acres: 5.020 P Site Address * indicates Private Road Calculated Acres: 5.023 29900 WANNEBO RD WASHBURN 54891 Lottery Claims: 0 First Dollar: Zoning: Na (AG -1) Agricultural -1 Property Assessment Updated: 7/30/2024 ESN: 130 2024 Assessment Detail Code Acres Land Imp. © G6 -PRODUCTIVE FOREST 5.000 58,100 0 Tax Districts Updated: 3/15/2006 1 STATE 2 -Year Comparison 2023 2024 Change 04 COUNTY Land: 8,500 58,100 583.5% 050 TOWN OF WASHBURN Improved: 0 0 0.0% 046027 SCHL-WASHBURN Total: 8,500 58,100 583.5% 001700 TECHNICAL COLLEGE y Recorded Documents 0 TRUSTEES DEED Date Recorded: 6/17/2024 O WARRANTY DEED Date Recorded: 10/13/2023 O WARRANTY DEED Date Recorded: 9/21/2023 O CONVERSION Date Recorded: Updated: 3/15/2006 S Property History 2024R-603638 N/A 2023R-600821 2023R-600542 391-386;530-382 https://novus.bayrieldcounty.wi.gov/access/master.asp?paprpid=30587 1/1 SS- OfU(oL J (I+y 2 M �y I Industry Services Division 4822 Madison Yards Way Cow t LS 1I IS U IS Sanitary Permit Number (to be filled in by S P 1 S D D Madison, WI 53705 P.O. Box 7302 r °�.� a OCT 11 Z024 Madison, WI 5302 �1 Application Bayfield 0$.240d(;Permit pp 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 may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. 29'4 OO LD c.-nf e p 7t-3 - Ljps-bu.r r LApplicationInformation- Please Print All Information Property Owner's Name 110.14`erjr%, Fcc Ik e kus Parcel # TAF 130AB-1 Prat: o'(-aso otia�- andT1?e .-a Property Owner's Mailing Address Property Location V 1( a -; O O �C Thr • Govt. Lot '/., F'/,. Section City, State Zip Code Phone Number b -J -4k ,5 b 1 7/c- ga -y /J6ry� T B N R GS E H. Type of Building (check all that apply) Lot # Subdivision Name K1 or 2 Family Dwelling — Number of Bedrooms Block # ❑ Public/Commercial — Describe Use ❑ Cityof ❑ State Owned— Describe Use O Village of CSM Number QI Town of L 1fL x"1346/ 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 i applicable.) A. ,New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B' *olding Tank ❑ 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 Total # of Manufacturer •,'�, Tank Information Gallons Gallons Units m '- v = New Tanks I Existing Tanks c 6U a3 h y ii C7 a O_ y Septic or Holding Tank ' •'1 e/1 �CO �_ •7/Yfo O(.</ 1 ( i qe• l.. V Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) (�J c-%cA C Plumb� MP/MPRS Number Business Phone Number -115-313-2318 1.Whc (0--Q 92213' Plumber's Address (Street, City, State, Zip Code) 3,ll ( O (3, vck G va l,to R.EI (th5 4 bt)1114 / VI. County/Department Use Only • ..uit Approved fgf ❑ Disapproved Permit Fee Date Issued $ q UU io I (5 �( I Issuing Agent Signature l �� '����' 2y) O Owner Given Reason for Denial Conditions of Approval/Reasons for Disapproval 1- • 1Qnt to c� G+Ii setbudCS o4 6c }OCQ¢ea 4✓t1t'n ZsoP 01 .M"erMt4 p/At' 4tdWnc/. occcvI1eM i rf,p,;hlc^r� S�S� ft nw1dta 4Ha^ z5 flb M 53fra►"1 on Pr°P y b«, a ore Attach to complete plans for the system and submit to the County only on paper not less than 8 I2: II lathes in size SBD-6398 (R- 02/22) OCT 11 2024 U HOLDING TANK - MANAGEMENT PLAN Bayu;T @,PF(Ns:Qnsite 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. This POWTS has been designed to accommodate a maximum daily flow of LfjJ 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. 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 5E1/4 Section a2-Township'kb N. Range OSW. Town of pl—s .tr•r-j Govt. Lot Lot Block Subdivision CSM# Additional Legal D ription?ft c Mr 3yIN Owners u/forms/managementplan V. 3ct l r�. 3 Sejst )3122y 5pi Z3, ?Oe y Date —� Revised: July 2013 HOLDING TANK SERVICING CONTRACT p[( V1111 Li E D Contract Date OCT 1 1 2024 This contract is made between the '.ayfield Co. Zoning Dept. Holding Tank Owner(s) Name(s) pumpers Name (Print) Pumper's Signature Pumpers' Registration # U We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT Legal Descriodon: Tax ID# S&7 IC*I' r P386 (.- 1/4, 1/4, LOCATION (Use Taz Statement) 5 <5 . r @ '_ 6S Town of: r Lot Size Acreage Section ,Township N,Range W • i ur. n 5Cl `�C. Gov't Lot Lot # CSM # Vol. Page CSM Doc # Lot(s) No. alock(s) No. Subdivision: 1. The owner agrees to file a copy of this contract with Bavfield 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. contract, the owner agrees to file a copy of any changes to this service contract or a with the local government unit and the County named above within (10) business days service contract. /afllehne kebbektcd Subscribed In the event of a change in this copy of a new service contract from.the_date_of chance to this on this I7 --day of commission expires on: ERIN KAYE Expires Jan 31, Revised: May 2016 (®May 2018) Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (I)(m)] Drafted Sub5C l bid TAR C. BICKFORD bn R�S otaryPublic-MinnesotaCommission Expires Jan 31, 2027 twO *Wf) -}-his uocurnant Number/Man I.U. No. HOLDING TANK AGREEMENT V C,einGclC �( , as We acknowledge that 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. Pr — L^ 1/4 of f' 1/4 Section off. Township `I8 N. Range "W. Town of x't -P?*iH'ZE1E -ty V. 36 34A =rJ Additional Legal Description:". -2.6L-4 Q^ o Gov't Lot _ Lot _Block_Subdivision CSM#_ Lot_CSM # Vol 3JPage 3&(O CSM Doc# Return To: DOCUMENT NUMBER 2024R-605074 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 10/1 1/2024 AT 10:57 AM RECORDING FEE: $30.00 PAGES: 4 As an inducement to Bayfield County to issue a sanitary permit for a holding tank on the above described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tank installation and maintenance. If the owner fails to have the holding tank properly serviced in response to orders issued by Bayfield County or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Stats., Bayfield County may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges 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 sworn to before me on this date: Peter Kti+btkvs Ka'-herine gebbekud Notar' Owner(s)—S n refs) Notary Public ., 1/ Qn'stort ERIN KAVE My Commission Ex' res: Notary Public r. y n Mycomn Drafted bye �,a... �tt W Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 pkmti 0HNS0 Minnesota Jan 31. q2a Date: I^ ^ i7` Da-1-f- ulfonne/eanlaiyfloldingtenkagree,mnldoc ®June 2016 f 4 SUbscn vd um Wan f� Is STAR C. BICKFORD D� �y Notary Public -Minnesota My Comm _1,. Ezpirec Jan 31,27 DOCUMENT NUMBER State Bar of Wisconsin Form 7-2003 2024R-603638 TRUSTEE'S DEED Document Number II Document Name THIS DEED, made between Kevin M. Tetzner and Jacqueline A. Tetzner as Co -Trustees of The Kevin M. Tetzner and Jacqueline A. Tetzner Revocable Living Trust - (whether one or more), and Katherine Kebbekus and Peter Kebbekus. wife and husband as survivorship mproperty ("Grantee," whether one or more). Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in BAYFIELD County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): See the annexed Exhibit A. DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED O6/17/2O24 AT 8:45 AM RECORDING FEE: $30.00 TF EXEMPT #: 13 PAGES: 2 ELECTRONICALLY RECORDED Recording Area Name and Return Address Max T. Lindsey Anich, Wickman & Lindsey, S.C. 220 Sixth Ave. W Ashland, WI 54806 Part of 04-050-2-48-05-02-4 04-000-10000 Parcel Identification Number (PIN) Dated . The Kevin M. Tetzner and Jacqueline A. Tetzner �'�� Revocable Living Trust AUTHENTICATION Signature(s) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) (SEAL) (SEAL) (SEAL) ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. S I+r (CLnd COUNTY ) Personally came before me on Lv -5 • aG� q the above -named Kevin M. Tetzner, Trustee, and AV to me known to be the person(s) who executed the instrument and acknowledged the same, THIS INSTRUMENT DRAFTED BY: J ) < * a'� ATTORNEY MAX T. LINDSEY, SB#1112865 ��J�� Notary Public, State of Wisconsin ANICH, WICKMAN & LINDSEY, S.C., ASHLAND, WI My Commission (is permanent) (expires: 11 SG . (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. TRUSTEE'S DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 7-2003 * Type name below signatures. Bayfield County Register of Deeds Document #2024R-603638 Page 1 of 2 Exhibit A A parcel of land located in the SE ¼- SE '/4, Section 2, Township 48 North, Range 5 West, Town of Washburn, Bayfield County, WI more particularly described as follows: Commencing at the SE corner of said section; Thence N89°59'29"W along the south line of the SE 1/4 of said section a d distance of 688.00 feet to the Point of Beginning; Thence N89°59'29"W and continuing along said south line a distance of 150.00 feet; Thence N00°00' 31 "E along a line perpendicular to said south line a distance of 330.00 feet; Thence S89°59'29"E along a line parallel to the south line of said section a distance of 150.00 feet; Thence S00°00'31"W along a line perpendicular to said south line a distance of 330.00 feet to the Point of Beginning. The above -described parcel is to be combined with the parcel owned by the Grantees and identified as Bayfield County PIN 04-050-2-48-05-02-4 04-000-20000, which is legally described as follows: A parcel of land in the Southeast %4 of the Southeast 1/4 of Section 2, Township 48 North, Range 5 West, in the Town of Washburn, Bayfield County, Wisconsin, described as follows: Starting at the Southeast corner of Section 2, Township 48 North, Range 5 West, which is in the center of the Wannebo Road; thence West 25 feet to the point of beginning; thence West 633 feet; thence North 330 feet; thence East 663 feet parallel with the South line of the section to an iron pipe driven in the ground, thence South to the place of beginning. The full legal description of the newly combined parcel shall be as follows: A parcel of land located in the SE ¼- SE 1/, Section 2, Township 48 North, Range 5 West, Town of Washburn, Bayfield County, WI more particularly described as follows: Commencing at the SE corner of said section; Thence N89°59'29"W along the south line of the SE 1/4 of said section a d distance of 175.00 feet to the Point of Beginning; Thence N89°59'29"W and continuing along said south line a distance of 663.00 feet; Thence N00°00'31"E along a line perpendicular to said south line a distance of 330.00 feet; Thence S89°59'29"E along a line parallel to the south line of said section a distance of 663.00 feet; Thence S00°00'31"W along a line perpendicular to said south line a distance of 330.00 feet to the Point of Beginning. Said parcel contains 218,790 square feet, which is 5.02 acres including the right of way of Wannebo Rd. Bayfield County Register of Deeds Document #2024R-603638 Page 2 of 2 10/15124, 9:26 AM CarmodyT"" BAYFIELD COUNTY SANITARY PERMIT (#04)-24.-162S STATE SANITARY PERMIT OWNER: PETER & KATHERINE KEBBEKUS GOVT LOT: LOT: BLK: SE1/4 SE1/4 SEC:2,T48N,R5W TOWNSHIP: Washburn SOIL TEST: 141-24 (WAIVER) NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: Adrien Cady ALESSANDRO HALL Authorized Issuing Officer DATE: 10/15/2024 CHAPTER 145.135(2) WISCONSIN STATUTES a. The purpose of the sanitary permit Is to allow installation of the private sewage system described In the permit b. The approval of the sanitary permit Is based on regulations In force on the date of approval. c. The sanitary permit Is valid and may be renewed for 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: # MP 922139 Condition: Tank to meet all setbacks and be located within 25' of all-weather road. Management plan to owner. Maintain system per recorded agreement. Tank to be located more than 25' from stream on property. THIS PERMIT EXPIRES 10/15/2026 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION https://www.carmodyinc.com/PermitApp/Permit Sign.aspx?Print=l&permitappid=7399 1/2