Loading...
HomeMy WebLinkAbout25-15S^:BSP. ^"-:''.~ps .^ Vf^^' SS-005.2-0 Industry Services Division 4822 Mndison Yards Wiiy Miidisoii. Wl 53705 P.O. Box 7302 Madison, WI 5302 Connl ^Lh/^. Sanitar/Penhit Numlwr (to be filleij in by Co.) •2-<3-ISS Sanitary Permit Application , . ^ In iiccorAincc willi SFS 3X3.21(2). Wis. Adm. Code. sMbmission ol'ttiis rormito'lhe appruprialu guvdniriicnl.il l|nit i.s rvqilircd priur In olnainini: a •umilary pcrmil. Nolc: Application runns for stiUc-ownwl POWTS arc subniilled to the Depamnenl of Sat'cly and Proression.il Scn'iccs. Personal informnlion youprovide P^'l^: uSe9 fpiP secondary purposes in accorttiincc with the Privacy l.aw, s. 15.04(1 )(m). Slnts. Stale Transaction Number I. Application I nfurmatiun - Please Print All Information Project Address (if diftcrcm dinn mailiiiK adiircis) 8733.^ BricJfy^} C.^e^i /?^/:/^,^.r.<r^.y/</ loiwty Ownur's Name73X^ LU\Mb.I'run/rtv Owin Patcdffi ^^tic) I'rup^frty Ownrf's Mailiiii; Addro.'is 3o?y A4w^C/-J C'ily. Skttv ^AWA>c^JvlM II. Type of Building'(check all that apply) .or 2 Family Dwftling - Niunln.T orHcdiouins Zip Cudu ^O^JL. D Public/ComnKTci.il - Describe Use 0 Sniit.- Owned - Dt.wibe U.'.u I'ropcny Location C'HIVt. L»l Phom; Number 65-,- y^/^s/^ LolS <r -" 'A. "' •..-. Si.-cliun <^> ^ T ST? N R ^'2> P.o^ Subdivision Name Block It Ro^'S Po\<^+ SV^re. CSM Number ^W?=Tzr?Zl£~7 a City of. D Villa.ci; of [g4own or (3 ^ Fi" 'e-) (>l 111. Type of POWTS Permit: (Check either "New" or "Replacement" and other itpplicuble on line A. Check one box on line B. Complete line C if applicable.) A.Ncu-Sy.t.lcin Rcplacemeni Sysicin 0 Other Muili!'ic;)ti«n lu I:.xisting Sy.<tein (explain)Additional I'rcircatincin Unit (explain) H.Hulilinii Tank -i Iii-Ground (convunlionat) Al-Oraclc Muimd Individual Silc Design Other Type (explnin) c.Rciicwitl Hct'urc Kxpiraiinn D Revision Change of Plumber 't'ransl'cr lo New Owner l.ist Previous Pcmilt Number and Date Issued IV. Dispcrsul/Trcatnicnt Area and Tank information: Ofiiiin Fluw (lijKl)Design Soil Applicalinn Rati;(spd/.<f|Pi.spersal Area Rcquircil (.'.1')Dispersal Area Proposed (sf)Syiitcni Kleviilion T.uik li)Rinn;niun C.lpncily in Gallons New Tante lixistmg Tanks Total Gallon.'! ff of Units Manut'acltircr sIIc: 0 5 •Ss. § .§ 5W 7.•u£ u Scptk' iir ttotJini,; Tanl'HQOO WO AAJCe^v. C<»i\<. .A 1 losing Chamlw V. Responsibility Statement- I, the undcr.signul, assume rcipyniibility for installation nf the POWT.S shnn'n on ihc atlachud pluns,. number's Name (Prinl) Tf ^ D ru (.^^ be fiwgg]1C ?^t/-' MP/MPRS Numbw MP. i^clW Business Phonu Number •7^-.ZM-ofL{ l>luinbci<(? Atlilrr-s (Street. City, State, Zip Code)r>/^U 0 C.TH - H- . -X^ ^ i^/, )A} T. x-^.-f ^ 7 VI. County/Deparlincnt Use Only Approve J a ntattpprovcil D Owner Given Rcasun for Denial Pennll Feesto'1 Odd* Ift^tictl 4^Zb Issuing Accpl Signmurc6?Mj^^IV. C'undilions of Approvyl/Reasons for Disapproval po»ji ^ 'kl^OQ. 00 § /2^ 2-S SU^ Sd-e- <?i\V<\cWA c-<\,v<^ iC^ ss^o '.-'\ '• . a /.'•/' V^ 1t>_.;,e$/<^>:^~~~^?;'^'vSf^gsy <ENTEREB>^/21/^J Industry Services Division 4822 Madison Yards Way Madison, WI 53705 P.O. Box 7302 Madison, WI 5302 ^Saiiltary Permit Application ,,^Z In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate govemriientql pnit is required prior to obtaining a sanitary permit. Note: Application forms for state-ownedPOWTS are submitted to the Department of Safety and Professional Services. Personal in&imation you provi^Pi^y t!(s ule9 f^ secondary puqioses in accordance with the Privacy Law, s. 15.04(1 )(m), Stats. '-- - - Countv-^ S>^V^^i Sanitar/Perinit Number (to be filled in by Co.) r^^m^ State Transaction Number Project Address (if different tbyi mailing address) 9 7 S Si S" Bn^y^ Cr^e^l^Ji I. Application Infiu-iniatioa- Please Print All Inf<H-mation 97S3-S^ Ea^^^,^><s-^/y Property Owner's, NameH^kos LLC ParcefS ^^Li°l 3oc!if h^ttSLC\. Property Location/Govt.Lul. City, State £^\Lcbr. <Akj-* Zip Code ^0^^ H. Type of BuildingXchcek all that apply) ^or 2 Family Dwelling - Number of Bedrooms D Public/Commercial - Describe Use a State Owned - Describe Use Phone Number 657-W-57o^.'/<, Section 0^ Lot #5"T5~Z> N R 0'2> Eo^& Subdivision Nane Block # CSM Number ^D^^-^32.^ D City of. a Village of cehovm of S^S/F|'<-)(A IU. Type of PQWTSfermjt:;<Checfc either^ •applicable.y:l/'^,l'l^\\^,;;<^.,l'.:^-'-;'''^:;'1 ^•;:^1:;1' ;\;':'./^11'-' •;^.^:^:\^^1'^'.:,;^^,:^:1;^I^Y:1'1?^ :'^.!;;-^ll''i^^l''i.';:^'i,&;^l'1^ 1:-:/:1':'1'-':^1'^_^^. A.New .System Replacement System D Other Modification to Existing System (explain)Additional Fretreatment Unit (explain) B.Holding Tank In-Ground (conventional) At-Grade Mound Individual Site Design Other Type (explain) c.Renewal Before Expiration D Revision Change of Plumber Transfer to New Ownerl List Previous Pemiit Number and Date Issued IV, DispersaI/Treatment Area and T'anltlnfomiaiturti; ; Design Flow (gpd) | Design Soil Application Rate(gpd/sf) [ Dispersal Area Required (sf)Dispersal Area Proposed (st) [ System Elevation Tank Information Capacity in Gallons New Tanks Existing Tanks Total Gallons ffof Units Manufacturer 2 •Q S,.5 g15 §0: 0 ll£ 3m S £ S£ o s&< Seplic or Holding Tank 400(9 t^)00 {^J'uUi^ C<>fc\<. .A Dosine Chamber y^Re^onsibUity^Stateinent-J&the^ders^^ Plumber's Name (Print) Tft_ be nau»^ Plui MP/MPRS Number ^clci3^ Business Phone Number •7/s-^^-olL{ Plumber^ Address (Street, City, State, Zip Code) ( i^^o ^r^--H-. ^^S;^. /AJZ jr^/f ^7 VI.COunty/DepartmenfUseQnIy Approved D Disapproved D Owner Given Reason for Denial Permit Fee $ Date Issued Issuing Agent Signature Conditions ofApprovaVReasons for Disapproval S^-ooz.-z-o Bayfield County Soil Test #15-25 Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) ffs^-a certified soil tester determine that in my professional1 "Tfin t-W^/h^ judgment the folld^ing 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 Hv^hf^S L.Ld Contractor L^y^'&^-i- (3^&kl/c^»<^ 3~ Property Address ^T7/Q$" S<\^kvA^ Authorized Agent TTm jQ/-/& CMek ej ^vS^/d vi ^w Agent's Telephone__25^2s2il52^' Telephone ^l-W-^W Written Authorization Attached:^ Ylor N Accurate Legal Description is requested: _1/4 of_1/4 Section 06 Township '5i^N. Range 6>3 W. Town of Bo.yi'ii Additional Legal Description: ftoyS R>i^"V" <^V)^ Sc^Z - &/V &i^ A l^r-^ ^ OrQvl- U ± ^f- ^ m Govt. Lot _JL-l-ot ^Block _Subdivision Roy<$ ,3,-^ SArtw . Page _ CSIW Doc # ^M(/£-^)]^^7Lot. Volume CSM# -Page. Vol. of Deeds Tax I.D#_^3W .Acreage^/. Indicate reasoning for your determination: 'Si+& df^A A/O-f- MMJ- ft-f'€/^ of- /^^ M4^-'&4 ^H ^J^/y'^ C^. &A?x-'lin^^^ -z-^, of Certified Soil TesterSignature ^6^><T Date ;o?/3^5T Signature of Ctounty Official Ozilz^ Date i m 111 Certification # (Submits Plot Plan & Fee) ^fl! APR -I . W W uffonns/soiltestwaiver(KLK) June 2018 Bayfieki Co. Zoning DepiPcsJ.B ^SO.^0' "qBsl'^S" ^^ 0!\- 'J ^n Bayfield County Soil Test # Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) I r7^ CW^/ foll<£A.a certified soil tester determine that in my professional judgment the folldWing 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 Hvy^-hfA^S LL^ Contractor \\/k^- G^s\€ve^€^1 Property Address ^7/^&)S~ Bf\tkv^^ Authorized Agent *7/W D^/AS.J'^A~r C^SL &1 6^/&/^ ^/T SW^ Agent's Telephone_ZlS^2^1^2^' Telephone 6S/< W- <SW Written Authorization Attached :fY'\or N Accurate Legal Description is requested: _1/4 of_1/4 Section D 6 Township '5^)N. Range 03 W. Town of &.y//^l Additional Legal Description: Roy^ }^)\'v^\' Sk/)<^ S^-&/^ &ih^ A-l^^ ^ C^y-fr i^ ± Lot- ^j^ Govt-Lot JL Lot Lot_CSM#_ Volume_Page. Block Vol. _Subdivision h^)V/$ H>ir^^ SArtc^- / Page_ CSM Doc # ^0^ S. - M ^ ")/ ^ Acreage //of Deeds Tax I.D#yo?w Indicate reasoning for your determination: <5i"^ clAo^ A/H'f~ lAJUi^ /1 ^^. QJT ^Q^^^L fAf^Sr 'fiyrJ ^•j-l ^1^1-^1^ C.l^. J^A?^ ^O^uh Signature of Certified Soil Tester ^6^)CT Date ]^1^^ Signature of County Official Certification # (Submit a Plot Plan & Fee) Date API-::i.!^:' u/fonns/soiltestwaiver(KLK) June 2018 Hy^os LiC Scy^Soi}^^€)h5^c^^ IQ^O&y/e C^t 4; Gedc (Rrf g^^ Jrcw <S,w- WT W/f\ „ CST^ Ol3^<=r•T^i of ^Wl^m H^ ' \ a »r< ^ 114-<>< t <-^f^f PAGE 1 OF 4 Holding Tank Plan Index & Cover Sheet Component Manual Design References: Holding Tank Version 2.1 (May 2022-2027) J r\ r. ^ * i" -^ <-- .•- Pg 1 of 4 Index & Cover Sheet Pg2of4 Plot Plan Pg 3 of 4 Holding Tank Specifications Pg 4 of 4 Management Plan Attachments:Enclosures: POWTS Applrcabon for Review Soil Evaluation Report & Site Map (if applicable) Holding Tank Pumping Contract (if applicable) Holding Tank Agreement (if applicable) Project Name / Description Owner Name(s): /-)^^/^^S L L C^ _______ Phone: ^F/- //^/- S~/^ Owner Address: 3>OW f\-h^A C'/zA .^i7l^^^.l/0l{} Zip: '^<r6^^L Project Address: ^7^25- f?,~,/i^M^"G^ J^/ SwP,'^/^-LC^. S~y,y/</ Govt. Lot: _L_ - 1 /4 of — 1 /4, Section ^ . T S^-QM-R 0 3 E D or W Township: Scwff^U It _ County: S'^l^i <ilJ. Project Parcel ID #: -^.X. ^p. ^^^/^ Designer Information Designer Name: (^-^\ £>^L-^(.-^ _ Phone: 7/S' - <3o9 - °^ I Designer Address:/? fi,Q ,177^4^ JT&M K^^ k)'=r' Zip: J>3^z^Z- E-mail: q i/-e Cj ^^, L^C^Q/^.i^ 4'^i a) /UMA , i ' C^. ^— This space reserved for approval stamp. Ucenset^umber: IU. /?^99J7</ Remarks: . . . ^f Z.-^ooo ^ (+ -r, ^'/^^ ^ ^^ t-' /' J^.1 L ^L-^ ^--^ . ^yo 3"/'<" •A"^'T CYW^ Signature: ^^/i%-^-—^. _ Date: ^/^/Z$' ^^OnQinyf signature required on each submitted copy. CHECK BOX AS APPLICABLE. SOIL EVALUATION SITE MAP PROJECT NAME: CHECK BOX AS APPUCABLE. Scala:1"-40- 40 60_80 Q3.SYSTEM PAGE 2 OF ^^_u^//y//////>/\^r77//^ (10 ft grid) 22 10I 2Zi PLOT PLAN DESIGN FLOW:GPD :/?D?SS: 8 7 {? ^S' ^r;tk^*?/ ^ . ,00 / FT" PRCUEC1 BM Symbol: -^- ^ , BM Sevallon: BMDeacriplton: V^^i \^~ ^t^' Slope G.'adient(%) of Tested Area:Watt Symbol (if appBcaUe): 0 Indicate north by drawing an aicM on ihe approprftc finft. Attach design flow calculations for commercial plans. Pipe Material / ASTM Standagl fTables 384.30-3^384.30-5) Santery Sewer: "7" _ /. Force Main:_' /. IMPORTANT: Show groand elevation contours at suitable ioten/als. j^j^^^^^^^^ 1-a:^^- ^^ Er^/^-^/p^ ^/^i?^F^3^ ^r~4p-<^-U^ /' ? I '. ; ^o-^rfc.../ : ^-^o^.-;- WB.S^IOO ^Q0^^j (- » • ? fe :wr I? 1 i^{? ^" " - s •* « . » < " ' 3> -0 ^< - 1 c- ; > I' - O ': ^wmwQ"n APR f / vn?^ HOLDING JANK - PLAN The Private Onsrte Waste Treatment System (POWTS) has been designed and is to be installed and maintained according to SPS 383, Wisconsin Administrative Code, Holding Tank Component Manuat for Private Onsite Waste Treatment Systems (SBD-10571-P)(R.6/99) and the Bayfield County Zoning Department Sanitary and Private Sewage Ordinance. 1. This POWTS has been designed to accommodate a maximum daiiy flow of ^f S~^ gallons of domestic wastewater per day. 2. The owner of this POWTS is responsible for system operation and maintenance, iocking device, aiarm and access- 3. The owner or owner's agent is required to submit reports as required by SPS 383.55(1), Wis. Aa'm. Code, to the Bayfieid County Zoning Department 4. Design approval and site inspections before; during and after the construction are accompiished by the county or other appropriate jurisdictions in accordance with SPS 383 of the Wis. Adm. Code. 5. Maintenance Cycle. The holding tank must be sen/iced by licensed pumpers. An aiarm system is to be installed to actfvste when the tank is 5 90% fuii. 6. Performance monitoring. At the time of servicing, the service provider files a report with the departs-nent of designated agent. 7. A Users Manual will accompany the component. It will include the names and phone numbers of ioca! health authorities, component manufacturer or POWTS service provider to be contscted in the event of component malfunction or failure. 8. In the event that this POWTS or a coi-nponent of this POWTS fails and cannot be repaired the owner will find in the User's Manuai the names and telephone numbers of property licensed indrviduals to contact for such repairs. This agreement shall be binding on ail assignees and heirs _-_1 /4 of — 1 /4 SecUon^)(iTowns^ip57) N. Range Q^A! . Town of B^^j^J Govt. _B!ock — Subdivisiori S'!tlt<^.^d^<!Lot / Lot y Biock — Subdivisiori ^.^{<^^on^d ^r^^f^ C-SM# Addftig^af Leg^i Q^scffptjon ^/, Th ^ij"lL(c\ X Cf/^//9—, 4/i/^ Proberty,OWi)ef^~5ianature. | .i( r .^ / DatekLOSLLCu/forms/maTTacjeTi'iSrTtpIah 18 If t •» ; VK L f t Z O O O - M R SE P T I C M A N U A L Hi i i U i ?l iw m 16 t a p } ( "i iif ; Wt 7 l » U S H W 1 0 M W D E H R O B I t . W 5 4 7 B O _8 0 0 ~ 5 2 5 - 8 4 5 6 jB R A W H a y L W B P . fi S f f i - f i 9 f f l a Z 9 f l - i/ y - i ' y f f 1 ' . . !f t A . i s i - pn e - p o u n i -t > ~r ~ •I . 1 I . ' . in u i u t v s i r v n iF '^ - I; Document Number/Plan I.D. No. Owner Name (s) ^H€^ Lie.. Parcel Identifier Number (PIN) \oti -Qo(f -l^o -oy'o^ \ oo-^ -^cco HOLDING TANK AGREEMENT Owner(s) Mailing Address 3C?ciH {Uu^^a^ ^-•ii^.^r ^A{ ^?t>0a Agreement Date (same ss Notary Date)1/^/wz^ We acknowledge that application te being made for the instaUation of (s) holding tanj<(s) on the following property or (hat continued use of the existing premises requires that.a holding tank be instailed on the property for the purpose of proper conlainmsnf of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewaler treatmeni system as permitted under Ch. SPS 383, Wis. Adm, Code or Ch. 145, VVEs Stais. "' 1/4 of ~~ 1/4 Section f2^-Township _5u2-N. Range ^23_W. Tow" of 0 <M ^J^'^L Additiona! Legal DescrtpEion: Gov't Lot 4^ Loi__^',Block ^ SubdtvisJon^^5 {7^'/) t 5^1<^!C/CSM#_ Lot__CSM # ^ Vol _r__.P39e r_CSM Doc# ^O^^-l DOCUMENT NUMBER2025R-607202 OANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECOROED 04, 1 7/2025 AT 9:42 AM RECORDING FEE; $30.00 PAGES: 1 Return To: ^OV^v-t. << APR '< 'i Zi'/' As an inducemenS 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 Eo 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 sen/iced in response to orders issued by Bayfield County or the Department of Commerce lo prevent or abate a human health hazard as described in s. 254.59, Stals., Bayfleld County may enter upon the property and service the tank or cause to have the Sank to be sen/iced 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 al! charges and costs incurred by Sayfield 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 cosls which shall be paid by the owner within thirty (30) days from the date of notice. In ihe event the owner does not pay the costs within thirty (30) days, the owner specifically agrees thai aii 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 sha)! be coliected as provided by law. 3. The owner agrees Eo contract with a person who Is licensed pursuant to s.281,17 (3) Wi3. Stats., and chapter NR 114 Wis. Adm. Code, to have (he holding tank serviced in accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of ihe 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 sen/ice 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. Bayfleld County may enter upon the property to investigaie the condition of the holding lank when pumping reports and meter readings may indicate Ihat the holding tank is not being properly maintained. 5. This agreement will remain in effect only until Bayfield County certifies that the property is sewed by either a municipal sewer or a private onsite wastewater treatment systsm that compii&s with Ch. SPS 383, Wi's Adm. Code. In addiiion, this agreement may be cancelled by executing and recording said certification with reference to ihis agreement in such manner which wiil permit the exi^gj^g^te CQrtificaEion to be determined by reference id the property. ^ y, 0 S 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall ^i&nit?§-ii agreement to the register of deeds, and the agreement shali be recorded by the register of deeds in a manner which \^ll^^t]^! existence of the agreement to be determined by reference to the property where the holding tank is installed. ^ ^ 5? g s Owner(s) Name(s) - Please Print l4^te^ L.LC ^BeojuyA/+-a± lurtf(s) Y^FU/WA^CK Subscribed and sworn to before me on this date: Lihe>(we> j_Ua^j1<°^ My Commission Expires: (/31/20ZO Drafted by:Date:^Z2^_ Peisona! in'ormailon you pmvidf. may be usfd for seccndary purposes (Priyacy Law, s.15.04 (l)(m)]u/forms/sdnit3ry(;'hoIdinQlankagrRRmfin!.dOG®Jun-s.20l8 HOLDING TANK SERVICING CONTRACT Ah-' Contract Datef//t1/2^<This contract is made between the Holding Tank Owner(s) Name(s) HH^\<OC> LLC Pumper's Name fPrfnt) ^T^S^iC'pt-y^ *•: 0 Pymis^r'.g/StQ.pature^—-Pumpers' Registration #^3- We acknowledge the instailation of (a) holding tanf<(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT LO.CATiON Lega! Qescrtctton: (Use Tax Statement) . T&tJSSw°\-1/4,V4. sstiion ^» .Township i ;N,Range, .Town of; w B^-^eM. .tot Size Acreage1^3 Gov't Lot~±"tot H £, C5MS Vol. Page.CSMDscS^l.ot(s)No.Blotlt^Nfl,SubdfvTsIon:^ ^t sAc^E^W^^J^1. The owner agrees to ffle a copy of this contract with Bayfjeld County as required in SPS 383,55, Wis. Adm, Code. 2. The owner agrees to have the holding tank{s) serviced by (he pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the hoiding tank(s). The owner agrees to maintairi the access road or drive so thai the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for al! charges incurred In servicing the holding fank(3) as mutually agreed upon by the owner and pumper, 3. The pumper agrees to submit to the local governmenl 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 serniannual basifevv^Pi©^AAA• pumper further agrees to include the following in the semiannual report: ^ co 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 iocation 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 ihe contents pumped from the hoiding tani< for each sen/icing; 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 contract, {he owner agrees to fife a copy of any changes to this service contract or a copy of a new service with the local government unit and the County named above within (10) business days from the date of change sewice contract, 0 ~^a 5§^s ? 0 "3E a-M.is^|&<?11i-o 2:i wwwww Owner(s) Name(s) (Print) ^•^0^ LL^. Owner's Signal Ife C-Hi f^r ULmj^&r0- Subscribed and Sworn to me; on this 1^ day of /f^\\^_._, 202-S My commission expires on '—Motaiy Public •on: ll^l/T&Z/. Revised: May 201S (®May 2018) Psrsong! Infonnalloti you provide may be used for sscondaiy purposes {Privacy Law, s.16.0') (l)(in)j Drafted by 5/2/25, 4:23 PM BAYFIELD COUNPif Carmody™ STATE SANITARY PERMIT OWNER: HYTTEKOS LLC GOV'T LOT: LOT: 5 BLK: SUBDIVISION: Roy's Point Shore 1/4 1/4 SEC:6,T50N,R3W TOWNSHIP: Bayfield SOIL TEST: 15-25 NEW SYSTEM SYSTEM TfPE: Holding Tank PLUMBER: Greg Brown 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. PERMIT #: #699374 RUDNICKI Authorized Issuing Officer DATE: 5/2/2025 Condition: Properly Maintain System Per Recorded Agreement. THIS PERMIT EXPIRES 5/2/2027 POST IN PLAIN VIEW MUST BE From FRONTING THE LOT DURING CONSTRUCTION httn<?-//www narmndvinf nnm/P<=>rmitAnn/Pprmit .^inn aQnY'?Print=1^nftrmifanniH=74.Fl7 1/9