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HomeMy WebLinkAbout24-167SRequest for Sanitary Inspection (24 Hrs. in Advance) Fax or email this form to Zoning Dept (24 Hrs.) prior to when you want an inspection Fax (715) 373-0114 or Email zoning(a bayfieldcounty.wi.gov Note Time Change fl Discrepancy fl Other Phone Number Plumber: ' t ��Ca\j`eWSc1 5 ° Fax Number Homeowner: �I Cc a kt- Sety c.r \tcs \cw Email Address rn�\.e ©b 1GI.� 1\AJAk Immediate Phone umber o Zoning Sanitary Permit #: Dept can call you right back (if needed) Plumber's Choice Zoning Dept No Inspection(s) during this time Date: 6 5 X0;7 r� Tuesday (9:30 am - 12:15 pm) (Tracy) Time: Plumber's Choice g Dept .. \�'-00p1V\� Township: C_10V@� Address # & Road Name: 01100\ c&ck OJk orSV�ovl`f\ WI S484 1 Directions To Site: Comments: ** Plumbers you must verify any change(s) by fax or email ** Notes from Zoning Dept: cow' July 2025 TARiV INSPECTION REPORT (ATTACH TO PE MORGAN GERK & JENNIFER KASTNER PO BOX 111 GENERAL INFO HERBSTER WI 54844 Parcel No. TANK INFORMATION TYPE MANUFACTURER/MODEL# CAPACITY I5Pw ' RGoo SETBACKS Property Line Well Water Service Building All -Weather OHWM Swimming Pool I Road v b — DEVIATIONS FROM APPROVED PLAN COMMENTS (Persons present, discrepancies, etc.) II� �JGw - r► a4 1OOO(S A O(tW G') kOA I &W?r 1 tP `( _ msAta\< <f - nkv4 a,4.ar m Cvr s�allerlk -1 !/c*4sk t4c14qf COMPONENTS NOT INSPECTED Plan Revislo Required Elves No ate: I_ Signature fin pec C . Number Sketch on other side 10 of 13 J 0 Property Owner Information As you know BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373.6138 Fax: (715) 373-0114 e-mail: zonina(&bayfieldcounty.wi.gov Web Site: www.bavfieldcountv.wi.00v/147 MORGAN GERK & JENNIFER KASTNER PO BOX 111 HERBSTER WI 54844 onsite wastewater treatment system on your property described as: Notes: Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 was contracted by you to install a private Abandonment of Old System to meet all applicable code requirements: 1 Tank was pumped by: o Tank was crushed I removed and pipes disconnected by: on at _____AM/PM PM On at (AM / PM) the above -mentioned plumber contacted our office to con7t 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. 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 $50 fee are required. System could not be inspected because County could not respond to plumber's time constraints. Comments: lades 1L <1U(i!e1- Z1iy (i.P/P C/!r/U/.-7 j G-7 OPcuP, fl1/ hG flit,' /h</l/11—' Wforms/sanitary prop arty owner -input Apri12019 n �5 IN, artment of Safety ns Iv! & ofessional Services, PS '1 OCT 8 2U2ncikry Services Division Sanita erimt Application In accordance with SPS 3g3,21(2). Wis. Adm. Code, submission of this form to the uppmpriele governmental unit is required prior to obtaining a sanittuy permit. Note: Application forms for state-owned POWTS arc submitted to the Dcparntent of Safety and Professional Services. Personal information you provide may be used for secondary _.,_... the Privaev Law. s. 15.04(11(m), Stats. rrupcny vwnn /�46C GeCk't- Tt'I1At�s�` "Ot f�roperty O cr-s Mailing Address eo,oXjli City. State 'Lip Code 1a& sNer , 1rJS 5Y$�y 1I. Type of Building (check all that apply) XI or 2 Family Dwelling- Number ofBedrooms het cQC1 WI ia3gC\ Eli Govt. Loi ac Numberr A. Section � 1 '1' . N R 171 E or ' 8 Subdivision Name . _1 ❑ Public/Commercial - Describe Use _- ❑ City of ❑Stare Owned - Describe Use CSM Number ❑ Village or `Town of_____________ 111. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on Hoe A. Check one box on hat B. Complete line C a Ii cable.) A. tt��ll,,f New System F. Replacement System r Other Modification to Existing System (explain) ❑ AddiuunW Preaeatment Unit (cxplainl B. ,7t \Plolding Tnnk ❑ Indimund ❑ At -Grade ❑ Mound ❑ Individual Site Design 17 Olhur'1'Ype (cxpluinl ' \ (conventional) O. Q Rencwnl Be(orc 0 Revision (] Change of Plumber 0 Transfer to New Owrim ist Previous Permit Number and Date Issued Expiration aJvv Capacity in - Total Capacity not Units aaanumcmmr E e " Gallons Gallons ` 3 U u Tank Information New Tanks Tanks E G o. Li v '¢• tJ L !;Woe or I1aldin5 Tank 'aOO p t7 o d ni. - UosinFChmdxr V. Responsibility Statement- 1, the undersigned, assume respomibiHty for installation of the POWTS Mown on attachethe dpi liusin�s Phone Number Plumber's Nome IPrint) Plumber's " e C_ 1 L\asLuja1 Ut Permit Fee Irra�a"w �.•. c�.o /-- - c_._� Approved ❑ Ulsapp pmvcrovcd s !,UC) I�J{ f O Owner Given Reason for Denial 4O(?.Z.U'- militio of Approval/Reasons for Disapproval �;J S7 5 $ L • .�P(.il) (Cr ) (1�1� inulllle 2/iktl j . ?l I �l7 In the Count' only no paper not Io than 9 in • 11 betel in at SBD-6398 (R. 03/22) Soil Test # Bayfield County Waiver of a Thorough Soil & Site Evaluation I (subject to 15-1-10(d)) I EDWARD J WROBLEWSKI a certified soil tester determine that in m y p; essional; ;, 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 luation is not needed to make such a determination. ,n'b Property Owner MORGAN GERK & JENNIFER L KASTNER Contractor EDS MECHANICAL LLC Property Address 89100 BARK POINT RD Authorized Agent EDWARD J WROBLEWSKI HERBSTER, WI 54844 Agent's Telephone 715-2094055 Telephone 715-944-7887 Written Authorization Attached: Y or (J Accurate Legal Description is requested: SE 1/4 of SE 1/4 Section 27 Township 51 N. Range 07 W. Town of CLOVER GITCHEE GUMEE SHORE LOT 18 IN DOC 2020R-582128 TOG WITH UNOIV INT IN OUTLOT 1 Additional Legal Description: Govt. Lot Lot 18 Block Subdivision GITCHEE GUMEE SHORES Lot CSM# Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# 12399 Acreage 371 Indicate reasoning for your determination: CLAY SOILS AND EVIDENCE OF SEASONAL HIGH GROUNDWATER Signature of ounty Official )O)LSI Z4 - Date Signature of Certified Soil Tester g/t3 Z'-( ate SP -72000013 Certification # (Submit a Plot Plan & Fee) Uftormsfsoi8estwaiver(KLK) June 2018 EDWARD J WROBLEWSKI. CST SSP-72000013 SOIL TEST PLOT PLAN MORGAN J GERK & JENNIFER KASTNER 89100 BARK POINT RD GITCHEE GUMEE SHORES LOT 18 IN DOC 2020R-582128 TOG WITH UNDIV IN IN OUTLOT I 527 T51 N R07W TOWN OF CLOVER, WI SCALE V=50' ll OCT 18 2uy4 Bayfield Co. Zoning Dept 1 P 40 '� SHEET 2 OF2 ufou 0CT 18 20Y4 CONCRETE HOLDING TANK DESIGN Bayfield Co. Zoning Dept. Single Tank Option INDEX AND TITLE SHEET Project Morgan Gerk & Jennifer Kastner - Holding Tank Owner Morgan Gerk & Jennifer Kastner Address 89100 Bark Point Road Herbster, WI 54844 (715) 944-7667 Legal Description Gitche Gumee Stores Lot 18, S27, T51N, R07W Township Clover County Bayfield Subdivision Name Parcel ID Number 12399 Plan Transaction ID Number Designer Michael Wroblewski Lot No. 18 Index and title sheet Page 1 Holding tank specifications Page 2 Site plan Page 3 Maintenance and contingency plan Page 4 Soil test Page 5 Soil test plot plan Page 6 Holding tank agreement Page 7 holding serviicing contract Page 8 Holding tank specifications Page 9 Signature._i2 Phone No. 715-209-7521 License Number 1288503 Date 10/14/24 Dashed pursuant to: Holding Tank Component Manual For POWTS (Version 2.0) SBD-10855.P (N. 03/07. R. 01/12) Version7.0(11/12) Page 1 of 9 HOLDING TANK SPECIFICATIONS Number of bedrooms Non-residential estimated flow (gpd) 2000.0 Minimum holding tank volume required (gal) 2000.0 IProposed holding tank capacit , al) Wieser concrete Tank Manufacturer W2000MR Tank model number SJ Electro systems Alarm manufacturer WH101 IAlarm model number junction box, conduit dind to s2al" outlet OCT 182024 Bayfield Co. Zoning Dept. sions and Data Tank Anchor Calculations X for round tank 13540 lbs Weight of tank and cover Liquid depth below inlet invert (in) 1.10 Safety factor Maximum de th of soil cover (ft) 20505 lbs Weight of anchor required Height (in) Outside 27.3 in Soil cover req. for anchor or Length (in) Dimensions 5.1 yd3 Concrete counterweight Only Width (in) HOLDING TANK CROSS SECTION 23 in. tether weight service alarm on Electrical as per NEC 300 and SPS 316 3 in.b riding under tank manhde cover with locking device and finished warring label grade 4"min. 1 Manhole and vent locations may be reversed. 12.0 in. 41.0 in. Note: All tankjoints, and joints between tank openings and piping are sealed watertight. All pipe and vent materials comply with SIPS 384. Tat is anchored as necessary to negate buoyancy. vent cap 12" min. vent pipe 18" min. building sewer inlet Project: Morgan Gerk & Jennifer Kastner - Holding Tank Transaction Number. Page 2 of 9 MORGAN J GERK & JENNIFER KASTNER HOLDING TANK PLOT PLAN 89100 BARK POINT RD GITCHEE GUMEE SHORES LOT 18 IN DOC 2020R-582128 TOG WITH UNDIV IN IN OUTLOT 1 S27 T51 N R07W TOWN OF CLOVER, WI SCALE 1' = 50' OCT 182024 Bayfield Co. Zoning Dept. N i Q w IL" S ti 0 C V C 0 37 O No 12'-7" U cD rFR1=== m CAST —A —SEAL 4" CAST —A —SEAL �ge FILTER OR BAFFLE 0 w w INLETiuu1L; 2Hb. L ASTM C-1227 I W2000 -MR TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1/2' BOTTOM: 4" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 66" O.D. LENGTH: 12'-7' O.D. WIDTH: 7'-2' O.D. BELOW INLET: 53" O.D. LIQUID LEVEL: 46" WEIGHT: BOTTOM 9,430 LBS. COVER 5,940 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: 42.92 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 2,126 GALLONS 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 #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: r o� 0 0 a w 0F� BAYFIELD COUNTY \ 1y CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) OCT 18 2024 Ch a: LL. Hayfield Co Zoning Dept. I Original Sanitary Application (Submitted in Deed Holders Name — I>� 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 i 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) 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.) iState Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) I Application Information must include: 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) Project Address or Road Name where driveway is/will come off of) (Owners Phone Number) II Type of Building III Type of Permit xl/❑ 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 7 Address Number and Road ❑ Surface Elevation of Body of Water 1� North Arrow Direction and Percent Land Slope Contour Lines Tank and Filter Information and Location uA Structures and Driveways ❑ Wetlands / Navigable Bodies of Water Boring Locations Absorption Area (Proposed and Existing) j�I Property Lines Bench Mark (Location, Elevation and Description) < Well Locations Component Manual Version }J Legal Descriptions Piping Material Information (conveyance line, building sewer line, material type and diameter) Turn Over ► Isz -t • r • r ' ►r ' r 1 Surface and System Elevation Position of Observation and Vent Pipes Dimensions and Depths Make, Model & Number of Chamber Units in each Cell OCT 182024 Bayfield Co. Zoning Dept. How many systems will there be on this parcel of land? .1 ] Has this property been split? I4fl (Property Statement shows Property History) 77" ❑ 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/checkllstforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/212012 -dc) Proofed by: IU aent of Safety [lo=e County o n� onal Services,0CT i C U2Iry Services Division Sanitary Permit Number (to be filled in by Co) sanitaryermit1hcation Stetu'I'mnseelion Numbe In accordance with SPS 383,21(2). Wis. Adm. Code, submission of this farm to the appropriate governmental unit Project Address (if different than arlidmss) is required prior to obtaining a sanitary permit. Note: Application forms for stateowned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary n\a o pct tk F� k purposes in accordance with the Privacy Law. s. 15.04(l Xml. Scats. eCusteC WT 548 Ny Please Print All Information I. Application Information — Property Owner's Name oc ar Geck - Senccer iCUS ner Parcel?? 1'a3`lg operty c1'5 Mailing Address Property Location Po 9'ax 111 Gapuail %' •. Section City. State 1aec�s�e 11.1 I I Zip Code Phone 5-M'.1 -11 Number S- 9 �I 4 -7667 T Z) N R t or 11. Type of Building (check all that apply) 1431 # Q S Subdivision Name I or 2 Family Dwelling - Number ofliedrooms_�y_ X 11- &,kcoSoctiS Block# e. ❑ Public/commercial — Describe Use _ O City of ❑ State Owned — Describe Use _._ __ O Village of — 9Townor Cone X- CSM Number Ill. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one boa on One B. Complete line C If eppllcabIe.) A. New System E. Replacement System fl Other Modification to Existing System (explain) ❑ Additional Pretreatment I Init (explain) ' I Inkling' lank ❑ Inliround n At -Grade 0 Mound ❑ Individual Site Design n Other 'type (explain) ' \ (conventional) C. : Renewal Before 1.3 Revision f" Change of Plumber 9 Transfer to New Owner .in Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpolst) j Dispersal Area Required (sl) (sf) System Elevation Capacity in Total # of u eTank Information Gallons Gallons Unitsi :DLs�oposed e v L & 3 _New Tanks Pxistinp Tank% Septic arllolding Tank a000 O o t Dosing Chunber V. Responsibility Statement- I. the undersigned, assume responsibility for installation of The POWTS shown on the attached plans. Plumber's Name (Print) Plumber's " MP/MPRS Number Business Phone Number I CLe Sic: t_)i %l 8}?SO3 IS -awl -7 Plumber's Address (Street City. State. Zip Code) c-, jt SgzCt 1►4a CAw VI. County/Department Use Oly Ca AppmvcJ ❑ Disapproved Permit Fee S4 �)(' J Date Issued )W/ [ Issuin Si re � ✓ "I'� - -- ❑ Owner Gfvcn Keuson for Denial .µ (/ Conditio of ApproIv.a'l/,RIe'asons for Disapproval r 11 1;1.ut<aae k.c�lc@u5 er si's 3i2.1il)(c' Attach to complete plans nor the syettm end submll to the County only on paper not Ins 5155150 to 11I SBD-6398 (R. 03/22) Bayfield County Waiver of a Thorough Soil & Site (subject to 15-1-10(d)) Soil Test # Evaluation OCT 1 b n1a I EDWARDJ WROBLEWSKI 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 MORGAN GERK & JENNIFER L KASTNER Contractor ED'S MECHANICAL LLC Property Address 89100 BARK POINT RD Authorized Agent EDWARD J WROBLEWSKI HERBSTER. W1 54844 715-944-7667 Accurate Legal Description is requested: Agent's Telephone 715-2094055 Written Authorization Attached: Y or ND SE 1/4 of SE 114 Section 27 Township 51 N. Range 07 W. Town of CLOVER GITCHEE GUMEE SHORE LOT 18 IN DOC 2020R-582128 TOG WTH UNDIV INT IN OUTLOT I Additional Legal Description: Govt. Lot Lot 18 Block Subdivision GITCHEE GUMEE SHORES Lot CSM# Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# 12399 Acreage 377 Indicate reasoning for your determination: CLAY SOILS AND EVIDENCE OF SEASONAL HIGH GROUNDWATER I i Signature of ounty Official ;c) HC' - Date Signature of Certified Soil Tester gi13ZL1 ate SP -72000013 Certification # (Submit a Plot Plan & Fee) uformslS01IIestwa,ver(KI. K ) June 2018 v D jD � � artment of Safety County pa \�\� � E,{rrF III (II 0 S P S II u OCT & ofessional Services, 8 2 02fn try Services Division Sanitary Perm t Number (to be filiedm b , I �7 Sani erimt pplZQflIIlQ ication State T msaction N umber In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Project Address (if different than tilin(gdress) 8°'O o pct is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department Safety and Professional Services. Personal information you provide may be used for secondary of ek t!\ l`t) purposes in accordance with the Privacy Law, s. I5.04(l)(m), Stats. 11'' e cnsct1 W= 54&tiy Print All Information 1. Application information — Please Property Owner's Name (� 1 �c-Gel k - 'Sel%AAOt 1 1c snTer Parcel # la3q� perty er's Mailing Address Property Location 1 0 ?>OX It' Govt Lot �1 City, State I Zip Code Phone Number �r /-f L I / 5zi A U % P1 1 S— L14 — I €0 1 %, '/y Section s\e: 1 { T t N R 01 E or H. Type of Building (check all that apply) ^^ Lot # is Subdivision Name XIor2Family Dwelling — Number ofBedrooms oL a I_ &&Cs Block# se e, c�Yl ❑ Public/Commercial — Describe Use O City of ❑ State Owned — Describe Use O Village of CSM Number Town of C 0Ue r 111. 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. pX New System 0 Replacement System ❑ Other Modification to Existing System (explain) 0 Additional Pretreatment Unit (explain) B' Holding Tank ❑ In -Ground ❑ At -Grade I ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision 0 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/sf) Dispersal Area Required (sl) Dispersal Area Proposed (st) I System Elevation 300 Capacity in Gallons Total Gallons # of Units Manufacturer ° U Tank Information ❑ New Tanks Existing Tanks y sue, M. rn ,fl i 0 Septic or Holding Tank 1 OO6 CY`� O Coo , \ sp 61\CN X Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. %uQrber1's Name (Print)Plumber's e // jr' MP/MPRS Number Business Phone Number /\ic ae Sic: (.J Ia.88S63 Plumber's Address (Street, City, State, Zip Code) SLI$S I4a -W C-1 Lit VL County/Department Use Oily ❑ Approved O Disapproved I Permit Fee $y Date Issued I Issuing Agent Signature cC>' ❑ Owner Given Reason for Denial Cond' ' of Approval/Reasons for Disapproval Sca -mod Attach to complete plans for the system and submit to the County only on paper not less than b 1/21 11 inches m size SBD-6398 (IL 03/22) Soil Test # Bayfield County Waiver of a Thorough Soil & Site Evaluation V I (subject to 15-1-10(d)) OCT 182014 I EDWARD J WROBLEWSKI a certified soil tester determine that in my3pgies;Sion4Iirlg Dept. 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 MORGAN GERK & JENNIFER L KASTNER Contractor ED'S MECHANICAL LLC Property Address 89100 BARK POINT RD HERBSTER, W1 54844 Authorized Agent EDWARD J WROBLEWSKI Agent's Telephone 715-209-4055 Telephone 715-944-7667 Written Authorization Attached: Y or NO Accurate Legal Description is requested: SE 1/4 of SE 1/4 Section 27 Township 51 N. Range 07 W. Town of CLOVER GITCHEE GUMEE SHORE LOT 18 IN DOG 2020R-582128 TOG WITH UNDIV INT IN OUTLOT 1 Additional Legal Description: Govt. Lot Lot 18 Block Subdivision GITCHEE GUMEE SHORES Lot CSM# Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# 12399 Acreage 3.71 Indicate reasoning for your determination: CLAY SOILS AND EVIDENCE OF SEASONAL HIGH GROUNDWATER Signature of County Official tQ Signature of Certified Soil Tester 3/ 13 2L, ate SP -72000013 Certification # (Submit a Plot Plan & Fee) Date Wformslsoiltesiwalye r(KLK) June2018 HOLDING TANK MANAGEMENT PLAN OCT 18 20'14 This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is tga66e1 �sPt�llg8n�aii'tlept. maintained according to SPS 383, Wis. Admin. Code, the Holding Tank Component Manual (SBD-1 0855-P N. 03/07, R. 01/12), and the Bayfield County Sanitary Ordinance. 1. This POWTS is designed to accommodate a wastewater flow of 60.0 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 ......................... Big Lake Plumbing Phone: 715-209-7521 b. Service Provider ............... Birch Street Sepiic Service Phone: 715-373-5683 c. Co. Zoning or Health Dept. Bayfield County Planning & Zoning Phone: 715-373-6138 11 Project: Morgan Gerk & Jennifer Kastner- Holding Tank Transaction Number. Page 4 of 9 HOLDING TANK RRillp �CMIMTtCT REBECCA BENTON IIU Notary Public OCT 182024 State of Wisconsin Contract Date / I I 2r1_f This coWfl§12dWtween the Holding Tank Owner(s) Name(s) / \or uN C,t plct Ter rs\Qi' Pumper's Name (Print) Pumper's Signature Pumpers' Registration # Oo We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT I LegalDescriotion: TiYIIIN 5a= SL 1%4, 1/4. LOCATION (Use Tax Statement) ,% SiTownot Section a"l 1 N, Range 07 w (� c Ve J Lot Site Acreage 3.-I ,Township 10 Gov'ttot Lot# I CSM# I Vol. Page CSM Doc>< tot(a)No. Block(s)No. Subdivsin: 6l 6u mee S1\o fl2S 1$ c ee 1. The owner agrees to file a copy of this contract with Bay£eld 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. Owners) Name(s) (Print) Owner's a refs) Subscribed and Sworn to me: on this C' ,day of �J}J MW %� V,1`- by: �p ______ ` M o ry Pu ho My commission 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)] 0HOLDING TANK AGREEMENT DOCUMENT NUMBER 2024R-605096 Document Number Document Title DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 10/14/2024 AT 8: 1 0 AM RECORDING FEE: $30.00 PAGES: 2 Recording Area Name and Return Address Big Lake Pluuuuuu bi ' l D 1491 County l ig� U# Washburn,` 54s. 182024 Parcel Identification Number (PIN) M _lT.`I7T11 �l�y 7\Sy ILIJ X11 Y I�.Y1�IH;lll IZIZ�111T/� �l►I11D 1Z1W11111I D1'LCI1TA This information must be completed by submitter: document title, name & return address, and PIN (if required). Other information such as the granting clause, legal description, etc., may be placed on this first page of the document or may be placed on additional pages of the document. WRDA Rev. 12/22/2010 HOLDING TANK uwnerts) nranmg nuweas n 6PCIC d- PO 13oX lit, REBECCABENTON Notary Public ier ktsk er �1t?r�sa�V , W= s484g� State of Wisconsin as T3S°¼ on the following properly 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. S,E 1/4 of SE 1/4 Section 1Township SI N. Range _7W Town of Additional Legal Description: Gov't Lot _ Lot IS Block Subdivision 6%& c e 6utnee csM#_ Shute S. Lot_CSM # Vol _Page _CSM 00o# Dept. \.J< Return To � ` tI „J ii EDClk(OVA, �1� W�tslr lDu�r., CG f24 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, Scats., 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. State., 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. Scats., 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 property 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)__N^aam,e(�s)__—' Please � �_Print McNY 4� Subscribed and sworn to before me on this date: to r / �l r / ` t Ole `� Notarized r(s) al nature(s) No Public My Commission Expires: {^ Drafted by: M II``P i). c \e W Sic Date: 9 l S\ a4 personal information you provide may be used for secondary gaposes IPdvacy Law, x.15.04 (n(mll wfortnslsanitaryll,ddinelanhagreemanLdoc ejune 2016 10/29/24, 2:09 PM CarmodyT'" BAYFIELD COUNTY SANITARY PERMIT (#04)-24-167S STATE SANITARY PERMIT OWNER: MORGAN J GERK & JENNIFER L KASTNER G OV'T LOT: LOT: 18 BLK: SUBDIVISION: Gitche Gumee Shores 1/4 1/4 SEC: 27, T 51 N, R 7 W TOWNSHIP: Clover SOIL TEST: 136-24 (waiver) NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: Michael Wroblewski CECE RUDNICKI Authorized Issuing Officer DATE: 10/29/2024 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 1288503 Condition: Management plan to owners. Properly maintain system per recorded agreement. Tank to meet all setbacks and be within 25' of an all weather road. Install/Insulate building sewer per SPS 382-30(11)(c). THIS PERMIT EXPIRES 10/29/2026 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=7404 1/2