HomeMy WebLinkAbout25-034244
CS _ WIlS BAYFIELD COUNTY Zoning District .
SANITARY PERMIT APPLICATION $ ZS r��
APPLICATION INFORMATION
Soil Test
ty
_
(Please Print All. Information)
No: Permit
No:
Property Owners Name: I
krherk, /UM 1?
County: Ba ield
-Bayfield Co. Zoning Dept.
Address of Property:
Property Location: PAR IN
Z' -V76 C
S E '/• SE '/e, S i T 47 N, R (p E (or)
Property Owner's Mailing Addresd:
Township:
Gov. Lot #:
2'-17 b RLj
P" IS
City, State
Lull
Zip Code
hone Number
Lot #
Block #:
I CSM #: I
CSM Doc #
I Subdivision Name
ICLn
4
-1IS- 4'7J
IL TYPE OF BUILDING: (Check One)
❑ State Owned
Tax ID#:
❑ Public (Explain the use/purpose )
Z Q B 3L
c�
1 or 2 Family Dwelling - No. of Bedrooms 2....
H. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) ❑ New ❑ Replacement ❑ County Private Interceptor
Reconnection ❑ Repair ❑ Revision *" ❑ Transfer of Owner (List Previous Owner below)
("l-7
B) A Sanitary Permit was issued. Previous Permit Numbe� Date Is ued: —
previously I _
IV. TYPE OF NON -PLUMBING SYSTEM: (Check One) * Replacements need previous permit number and date filled out above
C) ❑ Pit Privy ❑ Vault Privy (Vault size: gallons or _cubic yards)
❑ Portable Privy ❑ Camping Transfer Unit Container ❑ Composting Toilets ❑ Incinerating Toilet
V. ABSORPTION SYSTEM INFORMATION:
1. Gallons
2. Absorp. Area
I 3. Absorp. Area
I 4. Loading Rate
5. Perc. Rate
I 6. System
7. Final Grade
Per Day
Required (Sq.Ft.)
Proposed (Sq. Ft.)
(Gals. / Day / Sq.Ft.)
(Min. Inch)
Elev.(Feet)
Elev. (Feet)
VI. TANK
Capacity
Fiber
INFORMATION:
In Gallons
Total
Gallons
# of
Tanks
Manufacturer's
Name
Prefab.
Concrete
Site
Constructedglass
Steel
-
Plastic
Exper.
App.
New
Existin
Tanks
Septic Tank or
0
`Ldfl
'
X
Holding Tank
6
tL;a
Lift Pump Tank /
Siphon Chamber
VII- RESPONSIBILITY STATEMENT:
I the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Owner's Name(s): (Print) If applying for Section C above I
Owner's Signature(s): (No Stamps)
MA
N
Plumber's Name: (Print) If pplying for section A or B) above I
Plumber ure: No Stamps)
MP/MMPPRSW No:
5�3d3
Plumber's Address: Street, City State, Zip Code) Hom h ne:
Business Phone:
-y<<<,/ ,. 4.AL;'r4t'- —'ice ,/S'.% J -'%t/9
%� �9iZOd39
VIII. COUNTY / DEPARTMENT USE ONLY
Approved
❑ Disapproved I
I ❑ Owner Giveal
Sanitary Permit/Transfer Fee: I
Q(„n
Date Issued:
C/S/
I uing ent' Signature /
Adverse Determination
nation
L�G�
!IX. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
Plot Plan on reverse side
4 Name of Frontage Road ( )
1. Name the frontage road and use as a guideline, fill in the lot dimensions and indicate North (N).
2. Show the approximate location and size of the building. IMPORTANT
DETAILED PLOT PLAN
3. Show the location of the well, septic tank and drain field. IS NECESSARY, FOLLOW
STEPS 1-7 (a -o) COMPLETELY
4. Show the location of any lake, river, stream or pond if applicable.
5. Show the approximate location of other existing structures.
6. Show the approximate location of any wetlands or slopes over 20 percent.
7. Show dimensions in feet on the following:
a. Building to all lot lines i. Privy to building
b Building to centerline of road j. Privy to lake, river, stream or pond
c. Building to lake, river, stream or pond k. Drain field to closest lot line
d. Septic / holding tank to closest lot line I. Drain field to building
I
Septic/holding tank to building m. Drain field to well P Septic / holding tank to well n. Drain field to lake, river, stream or pond
g. Septic! holding tank to lake, river, stream or pond o. Well to building
h. Privy to closest lot line
Submit To: Bayfield County Zoning Department, PO Box 58, Washburn, WI 54891
u/forms/sanitary/bayrleldcountysanitaryapplication
Revise: June 2018 Proofed by:
EYISTINt,
U OL2U Jt ; TA7J 1t MAY .7 2025
0 Beytield Co. Zoning Dept.
ROUSE
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Ins I
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Letter of Authorization MAY 27 2025
Bayfield County Planning & Zoning Department Bayfield Co. Zoning Dept.
PURPOSE. This Letter of Authorization is used to authorize a single property owner to act on
behalf of multiple property owners or a designated agent to act on behalf of the property owner/s.
If multiple property owners, each property owner must submit this signed letter.
I, 7 W r IC (' l .I 42k"\ (propertyowner), authorize ki m e r / V V m r
(authorized agent) to submit a -Q (Example: land use, special
use, conditional use, rezone/map amendment appeal, variance, text amendment, etc.) for the
following described project (Example: construction of residence or other structure, short-term
rental or other use change, etc.) &n i tCerS[ r2C'Dn nec+lnn application on my behalf for
the following described property: perm 11 -
Legal description of subject property: PA Z ( V SE /4f S E
N , P Cc V1
Address of subject property: Z_ `t L U l , _ t -c )
ht nc9
Signature
-I1-2-O2S
Dated
St I '-rl
F.
Dated
Letter of Authorization II U u 2
Bayfreld County Planning & Zoning Department u MAY 2 7 2025
Bayfield Co. Zoning Dept
PURPOSE. This Letter of Authorization is used to authorize a single property owner to act on
behalf of multiple property owners or a designated agent to act on behalf of the property owner/s.
If multiple property owners, each property owner must submit this signed letter.
I, P.inu& 11O1 &,t (property owner), authorize Fyn h —J" 1k t-t/Yl e "ft...
(authorized agent) o submit a Sa r) t' +Q r'./ Q.Oni i CG.hUr(Example: land us , special
use, conditional use, rezone/map amendment, appeal, variance, text amendment, etc.) for the
following described project (Example: construction of residence or other structure, short-term
rental or other use change, etc.) 5Q t hi v Y� n-fCt TQQ application on my behalf for
the following described property: I f)Crrn c +
Legal description of subject property: is I N S t 5 E �4 51 r2-+i W'
R Co vr
I
BAYFIELD COUNTY
SANITARY PERMIT (#04)-20-177S
STATE SANITARY PERMIT
OWNER: KENNETH G & BILLIE L KMETZ
GOV'T LOT: LOT: BLK: 0
CSM:
SUBDIVISION:
1/4 1/4 SEC: 1, T 47 N, R 6 W
TOWNSHIP: Pilsen
SOIL TEST: 181-20 WAIVER
REPLACEMENT SYSTEM
SYSTEM TYPE: 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.
PREVIOUS PERMIT #:
N) LIVI1
Na
fo N
LICENSE: # 699374
TODD NORWOOD DATE: 10/20/2020 Condition: All gray and black water must discharge to tank. Tank must
of all-weather access road. Maintain per recorded agreement.
Authorized Issuing Officer
THIS PERMIT EXPIRES 10/20/2022
POST IN PLAIN VIEW
MUST BE VISIBLE FROM ROAD FRONTING THE LOT DURING CONSTRUCTION
25'
j sit
Industry Services Division
County /d
�7
1400 E Washington Ave
P.O. Box 7162
Sanitary Permit Number (to be filled in by Co.)
jyf
Madison, WI 53707-7162
\aryps;Aj
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 may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(I (m) Seats.
I. Application Information — Please Print All lnformatio
Property Owner's Name MAY 2.7 2025 UParcel
Kun&f Z-
#
-e.tiae'L
Z ?365
Property Owner's Mailing Address Bayfleld
l
Co. Zoning Dept.
P
Property Location
2 Y 7 Y O � 6-
Govt Lot
S 6 '/•, c 'A Section II
(circle
City, State
"f
Zip Code
)1
Phone umber
/-tQ L� •
.�
5- V
�� y�-
one)
T97N �; R --9rW
II. Type of Building (check all that apply)
Lot//[R-I
or 2 Family Dwelling - Number of Bedrooms Z
Subdiv'sioo6n Name
O Publi&Commercial- Describe Use
%% t4-
Block#
❑ State Owned — Describe Use
LA) V4-
❑ City of
O Village of
CSM umber
@,—Town of f S�
r rti
III. Type of Permit: (Check
only one box on line A. Complete line B if applicable)
A.
❑ New System
ateplacemaa System
❑ Treat men Hot dirt w Tank Replacement Only
❑ Other Modification to Existing System (explain)
B.
❑ Permit Renewal
O Permit Revision
❑ Change of
❑ Permit Transfer to New
List Previous PetmitNumber and Date Issued
Before Expiration
Plumber
Owner
IV. Type of POWTS System/Component/Device: (Check all that apply)
❑ Non -Pressurized to -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound≥ 24 in. of suitable soil
lJHolding Tank (J Other Dispersal Component (explain) ❑ Mound <24 in. of suitable soil.
p ) ❑ Pretreatment Device (explain) .
V. Dispersal/Treatment
Area Information:
Design Flow (gpd)
Design Soil Application
Dispersal Area Required (s0
Dispersal Area Pr
oposed roposed (s0
System Elevation
-
R3oO
-
_.
_.
Vi, Tank Info
Capacity in
Gallons
Total
Gallons
# of
Units
Manufacturer
'$
a
v =
a m
Nov Tanks
13 sMng Tanks
c
=U
2
inw
w
_c
a,
Septic or Holding Tank
f 0 0 C)
G Q Q
10Ct)
-
j,Li :3M- -
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print)
PI is Si3ature
MP/MPR,S Number
I Business Phone Number
re v r ,
. Q, eg97g
I 7/S-g_c/k
Plumber's Address (Street, City, State, Zip Code)
13J ,�,. s
VIII. County/Department Use Only
Ja Approved ❑ Disapproved
Permit Fee
Date Issued
IssuingAgent
C - cC ? ❑ Owner Given Reason for ocnial I
I
I! y7 9 g 7 ()
IX. Conditions of Approval/Reasons for Disapproval
/ / / ,"
tilt sisey oN j0ia.c lc. �yp..Ft.v /ftdl'- ci•y[tw Je It %%�%.� 1 y�6v.�GS .
Qo-.--
/a L,s lrtr ost ieeRG4% a,,rk,., 25 c1 a H — ujt -()u' ✓ A tee ss ✓o.:r)
/11rJ4...-r fu is-ct-i—J g
A"aeht 1 fo
o comp etc plan r the syswm and submit to the County eidy on prper net dos than 8 r2 x 11 inches in size
Soil Test #
Bayfield County
Waiver of a Thorough Soil & Site Eva i I
(subject to 15-1 -10(d))
1111 5
Ru cE It] L K4 2.7 my p
�� a certified soil tester determine that in p of ssionai
judgment the following site (see below} is unsuitable for any treatment cif t6nt4ifN n holding
tanks. Due to soil & site conditions, a thorough soil and site evaluation is not needed to make such a
determination.
Property Owner________________________ iw7`Z, Contractor
Property Address o13172o o jVtu) & Authorized Agent ; i^T n 2 ..,
5i-F4,fbt;1� r &Ix_ SYF'!o Agent's Telephone
Telephone 7f.V- '7440 - 2327 Written Authorization Attached: Y or N
Accurate Legal Description is requested:
SE 914 of Sri 114 Section 1 Township_7_N. Range _W. Town of ___SE 4/
Govt
Lot Lot Block Subdivision CSM#
Volume Page of Deeds Parcel I.D# 2731 S Acreage -�
Additional Legal Description:
Indicate reasoning for your determination: C «Y-S..Zrt w/z. i x» 5PrccC ,
ti
n
Signature of County Official
Date
7
c&- zse_
Signature of Certified Soil Tester
Date
Certification #
(Submit a Plot Plan & Fee)
utforms/soilestwaiver(KLK)
February 2005
•
SE 5E SZTy7A�j�,�} �tL �2ao2 N/
T�4X ar PZ IIF v czy� W
Sp�. — � .
MAY 2,7 2025
? BSI a p Baytield Co. ZoningDept .
\,1•tccc�. I.
c1 u
RIvgjr- P L-
Y� £LL
w
C
L
4
{
Holding flank Plan PA�E ' O�4
Index&Co
MAY 2721325
Compoiwii snuwlDesrgn R&bience&Ba"fleld Co. Zoning Dept.
Version 2-0, SBQ 1°855-P (K 03W; R 0IM2)
r' r' h
Pg 1 of 4 index & Cover Sheet
Pg 2 of 4 Plot Plan �.._ OCT 0 5 2020 I"
Pg 3 of 4 Holding Tank SPecflcauons a Cn. °Winn Dept
.
j Pg4of4 of 4 Management Plan GwS�.:
.1.
Renew
&SLteM
IJ
Owner ldame(s): R c K� e I -L 1` L4 -'c4 -z- Phn e —
Owner Address: Z 7 b' o C47 N,, L3 Y G A s_ L1_ Fd gyp: - y
Project Address 197 to C w 4jYY L) y ('r r l4 f Ln l a-oP W i.
Govt Lot — SE 114 of SE 114, Secfion T 7 ftR_E®or W C
Township _'Pr S e i- County:ati A=e i / c.Q
Project Parcel l l t? 7 3 b S
Designer Information
Designer Name: (s e O vv 'c -'t Phone: 7/f - 20 0/6
Designer Address 736 D /44" y ,$, JI'o t P� Gil zip: _ y 8 g 7
E-mail: t4 Lr ' LO �✓t1n lU_ cO COQ Thisspace reserved for approval stump.
Lire Nu miser: i
Remarks:
I ) ,000 5&I exciLfvt- j, 000g�l 4j
Signature: Date: d
ll MAY 272025 D
E-4—.z--
etE BOXASAM
L ON SYSTEM PRGE 2 OFP ,ME PLOT PLAN
R$ L MMaa 300
ai deagn aawratar�n 'al p
PROJECT A°°RESa.^, a go aftia! P�3n5.
BM neswpu= Force
1161POR7ANT
af'r�fetllcees:
TI TITII$C tz;zqu::;
tT ---v --n- --H
- i_
: , ®xm S��'omute�ragnn cunroias at su(fa6te inteivdls.
e {
x x
PAGE 3 OF 4
uflfl
fl MAY 272025
Bayfield Co. Zoning Dept
HOLDING TANK SPECIFICATIONS
(No Scale)
Electrical must comply with
SPS 316 and NEC 300
18'Min.
(tyP r
Approved JontstAAM -
Approved Pipe 3 it onto
Solid Ground
4`6 Vent Pipe
>10ftfmm—
t3as
irlI LW2,0flzbavee
ESWTMlmd Flood Elevaon
/ {tA/ ppm 1
j
With Warning Label Aftat S
i
f4m 12'orS05 oft Svokase
ii mote Han ova tank
HOLDING, TANK / G N C
ivOLL[w —gat
3' Approved aedt Mal Beneath Tank
TANK MANUFACTURER. McSt,: Co'Qz c7tT
tank as necessary
pursuant to SPS 363.43(8)(g)
Ballast Weight = I(cu.tt tank voI x 62.4 lbslcu.ft)- lbs.tar&wq x 1.5
4' Min. or 2.0 ft above
Established Flood Elevation
/ (typical)
Finished Grade
' Plug
DCI 0 5 ZUZ0 III
nnno = WLP1000-MR
a Na iv TANK SPECIFICATIONS
,w - N o 104" U DIMENSIONS:
CJ BOTTOM: WALU EPTIC 3"
2"
yr HOLDING 5" (ADD 1,300 LB.)
"11 E e_� - - COVER: 4.
�^ MANHOLE: 24" I.D, PRECAST CONCRETE RISER
HEIGHT: DOME COVER 61" 0.0.
FLAT COVER 53 1/4. O.DtA
4' CAST -A -SEAL LENGTH: 104" O.D.
CAST -A -SEAL V11DTH: 86' O.D.
BELOW INLET: 42" O.D.
024„� LIQUID LEVEL, 35"
e WEIGHT: 6,790 LBS.
to
TY� _ INLET AND OUTLET:
FILTER OR 4" CAST -A -SEAL BOAT OR EQUAL
BAFFLE GASKET, CAST -A -SEAL BOOT OR EQUAL
INLET AND OUTLET BAFFLE AND FILTER:
--� WISCONSIN, SEE DETAIL 1110
(OTHER STATES SEE CHART)
LIQUID CAPACITY: 27,83 GAL/IN
HOLDING TANK:
TOP VIEW �Iy OUTLET HOLE PLUGGED
-- Loc vl, --Loc.;, C.oMc, rt 'cr5' perG'"e ACTUAL CAPACITY: 1,085 GALLONS
Po I'r 1O IC. StS Y , I'[` . LOADING DESIGN: 8' D UNSATURATED SOIL
Mµ TANKS:
WILL HAVE ONE VENT OVER OUTLET
OPTIONAL FLAT COVER AND WILL HAVE TWO VENTS IN COVER OVER IP
-IS AVAILABLE FOR EXCHANGE
FOR DOME COVER. 7ANI< CAN SEPTIC/ HOLDING/ PUMP OR SIPHON
E USED AS:
COVER: MIX DESIGN /f8 NO FIBER)
INLET - UTLET TANK: MIX DESIGN jj1D (STRUCTU AL FIBER)
CUSTOMIZED TANI(S:
oo FOR CUSTOM TANKS CONTACT WIESER CONCRETE
r ^ v
to
SIDE VIEW
S ARE MANUFACTURED TO MEET OR EXCEED ASTM C - T.
PUMP PAD
CUSTOMER:
JOB NAME:
OA(E UEEOEO:
APPROVED BY:
APPROVAL DATE
MAY 272025
HOLDING TANK— MANAGEMENT PLAN Bayfeid Co. Zoning Dept
The Private Onsite 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.s9s) and the Bayfield County Zoning Department Sanitary and Private
Sewage Ordinance.
This POWTS has been designed to accommodate a maximum daily flow of
3 CJ 0 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.
5. 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 OCT 0 b t u L u
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
S114 of Se U4 Section J Township'-17N. Ranget) W. Town of Jam_
Govt
Lot ' Lot — Block — Subdivision CSM#
Additional Legal Description ?.7 3 (o S r> a�+ — 0 • , 1 A C 2
Rovise&.kdyZ13
HOWGT&NKSERWccc1lMAY 2 7 2025
floatrace rate
ii wwwfield Co. Zoning Dept.
1' - ISdtt j$ 35'detreeS the
g;rc3�S t€)ccavcc$14 -+Scpt
r trse7s ,ci oa-
safe I
I. The owner egrees to Ills a copy of ibis con;rad,.vjh BaIdWd
as required in SPS 383.55, Wis. Adm_ Code.
a The owner agrees to have the holding lank(s) serviced by the pumps and guarantees to permit the pumper to have
access and to the so t at the e property itt the puipose of g the g tank(4 The owner agrees to maintain
access
er toades t or
drive
ihe purr can service the lank(s) t the pumping equipment The owner
pumper charges insured in servicingg the holding₹ank(s) as mutually agreed upon by the
owner and pumper_
3. The pump agrees to suthit to the local Code and government u tvtnii�r has signed the pumping a meat required by SPS
umpe W's. Cow' a report forum ofthe holding tank(s) on a semiannual basis. The
ptinperfintfier agrees to include the follcwing in the semiannual report
a. The name and address oithe person responsible for servicing the holding tank;
b. The nave ofthe owner ofthe holding tank
C. The location of the property on which the holding tank is mstailed;
d- The sanitary panini number issued forthe holdarg tank;
a The dates ounnvt the holding tardy tsas serviCl
ced; a 5 'L020
f. The volumes in gallons attire contents pumped frown the holding tank for each servicing; O
g. The disposal sites to which lire contents horn He harrlrg tanker dared.
4. This agreement will remain in effect until the owner or pimg eriermkimes Ibis cantlact in the event of a chge ar in this
cntr owner agrees to file a copy of any char es to thus service co ihact or a copy of a new sea h ancontract
the teat
service contras t uai2 and the County inaec above within (10) �s front the date of change to -this
PumperstdemefPatt
0ouglc5 &d&AI
Piper s Reglstira5an Nun nbar
/ lO3
....... r
. HFFA, , e)
TARy' .'?- it6-2o2
202
6ormnisslor
•.¶LJBL'G �?a
I I AGREEMENT I
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, We Slats.
Sr 1/4 of SE 1/4 Secion_LTownship 4/7 N. Range _W.
Town of 7)
Return To:
Additional Legal Description: .5 L L 4 O
Gov't Lot — Lot_Block_Subdivision CSM#
Lot_CSM B Vol _Page _CSM Doc$
LVCVn'JU4UUJ
DENISE TARASEWICZ
BAYFIELD COUNTY;'WI
REGISTER OF DEEDS
10/05/2020 OB:35AM
SE.. EXEMPT #:
RECORDING FEE: 30.00
EoFGFD
MAY 2.7 2025 9
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, Stall.
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 ownerof 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) We. Scats., 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. State., 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. Bayfieki County may enter upon the property to
investigate the condition of theholding tank when pumping reports and meter readings may Indicate that the holding tank is not being
properly maintained.
5. This agreement will remain in affect 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.
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Owner(s) Name(s) = Please Print
Subscribed and swum to before me on this date:
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5 2020
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Notarized Owner(s) Signature(s)
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HAYFIELD Bayfield County
Planning & Zoning Department
117 E 5th Street
P.O. Box 58
Washburn, WI 54891
Phone: 715-373-6138
Fax: 715-373-4010
Property Owner:
Description
Private Sewage System Reconnection
Submission Number:
CS -00115
Transaction Number:
CS -00115-2C208
Amount
$50.00
Total: $50.00
Payment Amount: $50.00
Reference: 13489
Paid by: TERRI & SCOTT ZIFKO, 49166 ASHLAND BAYFIELD RD, ASHLAND, WI
54806
Payment Type: Check
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
Town, City, Village, State or Federal
Permits May Also Be Required
LAND USE -
SANITARY - Reconnect 20-177S
SIGN -
SPECIAL -
CONDITIONAL -
No. 25-0342 Tax ID# 38836
ZIFKO, TERRI L
BAYFIELD COUNTY
PERMIT
WEATHERIZE AND POST THIS PERMIT
ON THE PREMISES DURING CONSTRUCTION
Issued To: KMETZ, KIMBERLY A; DOLEYS, ASHLEY N; &
Location: SE /4 of SE '/4 Section 1 Township 47 N. Range 6 W. Town of Pilsen
in Doc # 2023R-600766
Residential Structure in an A-1 Zoning District
For: Sanitation Permit: Reconnect (2 1000 -gallon Wieser Tanks)
(Disclaimer): Any future expansions or development would require additional permitting.
Condition(s): To meet all setbacks. To be constructed per plan.
You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or
modification of construction that violates the law or other penalties or costs. For more information, visit the department of natural resources wetlands identification web page or contact a department of natural resources service center (715) 685-2900.
NOTE: This permit expires two years from date of issuance if the authorized construction
work or land use has not begun.
Changes in plans or specifications shall not be made without obtaining approval.
This permit may be void or revoked if any of the application information is found
to have been misrepresented, erroneous, or incomplete.
This permit may be void or revoked if any performance conditions are not
completed or if any prohibitory conditions are violated.
Tracy Pooler, AZA
Authorized Issuing Official
June 03, 2025
Date