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HomeMy WebLinkAbout25-27S'55-00531 Department of Safety & Professional Services, Industry Services .Division County l^^y-^t-e /^ Sanitary Permit Nbmber (to be filled in by Co,) ^S-.?7S Sanitary Permit Application A^[ /:) 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 purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. State Transaction Number I. Application Information - Please Print All Information Project Address (if different than mailing address) ?/^r ^u ^.^ /y7 Property Owner's Namc^ nJ(^(^» i ^d^-^ f-r^S^ ^v^ Parcel # -•^T^?C H 2. -7 2- -2^3 Property Owner's Mailing Address -7/^3^- C>^[^ -^^^lc ^^ Property Location Govt. Lot City, State 8^^. ^3J1 Zip Code ^/S'20 II. Type ofBuflding (check all that apply) ^S 1 or 2 Family Dwelling -Number of Bedrooms D Public/Commercial - Describe Use D State Owned - Describe Use Phone Number 2 9 ^ 9 ° <7/<3 /^ ^'/<, ^S ./,, section 3/ Lot #-ULN _R_3LjS:o<® Subdivision Name Block # CSM Number a City of__ a Village of I? Town of 0 — f V III. Type ofPOWTS Permit; (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if] applicable.) A.D New System D Other Modification to Existing System (explain)D Additional Pretreatment Unit (explain) B.^Holding Tank a In-Ground (conventional) D At-Grade D Mound a Individual Site Design a Other Type (explain) c.D Renewal Before Expiration D Revision D Change of Plumber D Transfer to New Ownerlitist Previous Permit Number and Date Issued3&cm^ IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd)^S-o Design Soil Application Ratc(gpd/sf)Dispersal Area Required (sf)Dispersal Area Proposed (sf)System Elevation Tank Information Capacity in Gallons New Tanks Existing Tanks Total Gallons A! Of Units Manufacturer ll.§ 5oo t3 3&E 0 Sofrtiofir Holding Tank -^00 7.SCQ T~U)t€-S-&K C-c'^C..^ "Daciiifi Chmndei7 V. Responsibility Statement- I, the undersigned, assume responsibility forjustjllatig^ of the POWTS shown on the attached plans. Plumber's Name (Print) l£t^ J7£> I 1/-£>S k-1 Plumber's Siao&turewr^NP/MPRS Number 2,2. £>oci 0 Business Phone Number -7iS~ 2.?2^-^' IS~(fl Plumber's Address (Street, City, State, Zip Code) ^ L^^ ,?M Bc,)C ^-^ ' ^^^ ^^^ •^)^ ^^7 VI. County/Department Use Only Approved D Disapproved D Owner Given Reason for Denial Permit Fee$",7.'."o0 Date Issuedlr)W—5/2-1/15 Issuing Agent Signature^W3 ^^ Conditions ofApproval/Reasons for Disapproval SS^O^IACI^JI Q^jrd.7 Attach to complete plans for tlic system and submit to the County only on paper not less than 81/2x11 Inches In size SBD-6398 (R. 03/22) No, ',(. H 9975 1;J ,';J PF -• p. PAGE G /.l;.- 2 10F§ t\ Pg1 of Pg 2 of ^ Pg 3 of S) Pg4of^ Attachments: *i.i.L' vv i Lnnmnu fl( ^UIS{IVU Holding Tank Plan Index & Cover Sheet Component Manual Design RafQrences: \ W^nuA-I 't/f& ^VArs^^^i^Y.^®-/ z.o^z.-'z'oz^ Index & Cover Sheet !( Plot Plan ! Holding Tank SpecificatiOjns - ^ r «? ^ Management Plan | Enclosures: •v^r ^-f-s ' ^ ^§^t_l_r^s ^ / ._....; sPOWTS Application" for I Review C^n;^/pelrn'1' ^ A^ Soil Evaluation Report & Site Map (iif applicable) Holdina Tank Pumping Contract (if applicable) Holding Tank Agreement (if applicable) Project Name / Description Owner Name(s)\:A^^^^ ^ i^^i^ F/^5/.t^v.h Phone:• ' Ir'~"" * -^^- - v — -^r »-'— • •" \ ..._^_.. - I.. ___ •__ \ • ••^^••a^n Owner Address: -7/ o3^70^ '^c^^^l B^jle ^'^ Zip: ^"<^p^ o Project Address; ^<^e <sj" c. Lc,ue J^-i /J/^1/4 of AJ'^ 1/4. Section ^/ ,T ^Govt. Lot: Township: (P ^l ^ Project Parcel ID #; "T<^K ~^t> ^ -^ ^ 3 County: -71t>~^ -2^2^. €l C- '/O N-R_0 or W| Designer Information t ! Designer Name: A 11^^ to / A'-' ° ^ ^-' _ Phone: 7/S~-3t~72.- ^ '< ^ Designer Address: P-&. BQ-< •S""^^-'/^ on ^.'^•^ '^UjZ :Zip: _Oj^Z. E-mail: ~^"te ^y ^L-e-a i^^m d-e- ^ ^ ^""^'^ *' <-' ^ •<'t-^-. Thi^ space reserwd for approval stamp. License Number; Remarks: 2.2- css 0 <:"/ 0 Signature:Date:3 - ^ z - z S "&^nal signature require on aach submitted copy. Hr^t 1:^ ^ -^.^\r BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-l-10(e)) 0 Check List \3 Original Sanitary Application (Submitted in Deed Holders Name - nfit prospective buyers) (383.21(1)1.) 0 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) 0 Original Plot Plan (383.22(2)2. 3. & 4.a) Ef Cross Section, Over-Head Profile of the System and Schematic of Tank from Manufacturer Ip Pump Tank Diagram, Alarm and Pump Curve (when applicable) Ef Contingency Plan / Management Plan (383.22-3(2)(b)l.f.) D Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) 0' Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) 3 Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) D ATU Servicing Agreement (Recorded at Reg. of Deeds) 0 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 0' 2 Complete Sets of Plans (383.22f2)(2.) fNote: Sanitary Application and Maintenance Agreements are to be attached to all copies) 0 Soil and Site Evaluation Report (383.22-3(2)(b)l.e.) D State Plan Review (when applicable) D Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) 13 I Application Information must include: D 23 digit Parcel ID# - (do not use 12 digits anymore-obsolete) B Project Address or Road Name where driveway is/will come off of) 0' (Owners Phone Number) ^ II Type of Building 0 III Type of Permit 0" IV Type of POWTS System D V Dispersal / Treatment Area Information @} VI Tank Information 3! VII Responsibility Statement (Plumber's Information) D *Date Stamp* Plot Plan: (To Scale or To Dimension) BT Signature and Plumber Information \M Address Number and Road St Surface Elevation of Body of Water ^ North Arrow E Direction and Percent Land Slope D Contour Lines ri Tank and Filter Information and Location ^ Structures and Driveways 0 Wetlands / Navigable Bodies of Water 0 Boring Location D Absorption Area (Proposed and Existing) Gf Property Lines 0 Bench Mark (Location, Elevation and Description) 0 Well Locations Sl Component Manual Version El 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: D Surface and System Elevation S Position of Observation and Vent Pipes D Dimensions and Depths D Make, Model & Number of Chamber Units in each Cell Property Information D How many systems will there be on this parcel of land? D Has this property been split? _ (Property Statement shows Property History) Fees: D Private Sewage System (Septic Tanks) $ 400.00 0 Private Sewage System (Holding Tanks) $ 400.00 D Mounds or Systems requiring Pre-Treatment $ 500.00 D Sanitary Revisions $ 25.00 D Private Sewage System Reconnection $ 50.00 and Private Interceptor D Return Inspection $ 50.00 D Maintenance Agreements ^ $ 30.00 (checks made out to Reg of Deeds) u/forms/checklists/checklistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012-dc) Proofed by: •**• o-? 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S&4 L^c ^;,s C^'PS 3 I?S) A.F.fr. i A^e^fe. ^'i'-^i cji^.ck ...e»- s vUa.H i ^ =" gW s\;f.P« £:/fe.u/co.o."' .^—g 3 g ^ Sck ^0 P\fC ^/-fi & yj cl '< ^&<-4-' e^ ^ „ ^ n" /\sTm i> i-y^s" a-pp vs ^-d. f-p^- ^m+^''r<e'~<-" ^Ot>7^| ^' v)Ql^c He U > ^"T^n 1c Cem'fs^^ /y)& ^ i-<-^ /. u s'e-c( . /fcn u.®^. i[V£'R Z,j); ^m^/Z®^2-"^'S7)^^rcuJn ^y: m.KKS.aZc^O *) fe lfC.e'5, ^.i Pl a ^». fc« n^ B©,0^K: &~2-Z. -s:r^^ /z^^; ^7 ^ywz c- PROPERTY OWNER: jLlAjl€:tJ c ^ ^ ^<£=</--"^ <=- SrT' t^i-G ^ PLUMBER: Allan Polkoski/ Polkoski P^mhjnq <-"': SIGNATURE:. •DATE: _3-^' ^3 / LICENSE # 220090 '/ s HOLDING TANK SPECIFICATIONS ^[MwMfiV^UtVSltWMHM^Number of bedrooms Non-residentlal estimated flow (gpd) Minimum holding tank volume'required (gal) I 2500^1Pi°e13^ JITank Manufacturer ITank model number iAlarm manufacturer leser^500—~1 a'uintwu (uru> 'M i] waftwnuuv/iUinttuurt WfoT ;fw»w**w.uwftmtiu^larm model number Tank Dimensions and Data x for round tank Liquid depth below inlet Invert (in) Maximum depth of soil cover (ft)iHeight(in) [Length (in)iWtdth (in) Outside DimensionsOnly Tank Anchor Calculations |lbs Weight of tank and cover Safety factor |tbs Weight of anchor required |ln Soil cover req. for anchor or40.8 9.9 ycf Concrete counter weight HOLDING TANK CROSS SECTION Junction box manhois cover with locking device andwarning label I 4"mln, finished grade'1 C=3 blind plug to sealoutlet service alarm on Electrical as perNEC 300and Comm IS Manhole and vent locations may be reversed. vent cap $ 12"m(n. vent pipe 12.0 in. 39.0 in. Note: AH tank Joints, andjoints between tank openings and piping are sealed watertlght. All pipe and vent materials comply Tl8"mln.A3) building sewerIntel 3 In, bedding under tank.Tank Is anchored as neceasary to negate buoyanoy, 18 5 ^ " 4" C A S T - A - S E A L 4" C A S T - A - S E A L FI L T E R O R BA F F L E TO P V I E W SI D E V I E W TA N K S A R E M A N U F A C T U R E D T O M E E T O R E X C E E D A S T M C - 1 2 2 7 R E Q U I R E M E N T S WL P 2 5 0 0 TA N K S P E C I F I C A T I O N S DI M E N S I O N S : WA L L : 3 " BO T T O M : 3 " HE A V Y - 5 " CO V E R : 6 " MA N H O L E : 2 4 " . 1 . 0 . P R E C A S T C O N C R E T E R I S E R HE I G H T : 5 2 - 3 / 4 " O . D . LE N G T H : 1 8 3 - 1 / 4 " O . D . WI D T H : 1 0 1 - 1 / 4 " O . D . BE L O W I N L E T : 4 1 " O . D . LI Q U I D L E V E L : 3 6 " WE I G H T : T A N K - 3 " B O T T O M 1 2 , 5 6 0 L B S . TA N K - 5 " B O T T O M 1 5 . 5 2 7 L B S . WE I G H T : C O V E R 9 , 3 0 0 L B S . IN L E T A N D O U T L E T : 4" C A S T - A - S E A L B O O T O R E Q U A L IN L E T A N D O U T L E T B A F F L E A N D F I L T E R : WI S C O N S I N , S E E D E T A I L # W (O T H E R S T A T E S S E E C H A R T ) LI Q U I D C A P A C I T T : 6 9 . 4 4 G A L / I N HO L D I N G T A N K : OU T L E T H O L E P L U G G E D AC T U A L C A P A C I T f : 2 . 6 5 9 G A L L O N S LO A D I N G D E S I G N : 8 ' 0 " U N S A T U R A T E D S O I L TA N K C A N B E U S E D A S : SE P T I C / H O L D I N G / P U M P O R S I P H O N CO V E R : M I X D E S I G N # 8 ( N O F I B E R ) TA N K : M I X D E S I G N ^ 9 ( S M A L L R B E R ) CU S T O M I Z E D T A N K S : FO R C U S T O M T A N K S C O N T A C T W I E S E R C O N C R E T E DR A W I N G S S U B M I T T E D FO R A P P R O V A L AP P R O V E D B Y : AP P R O V A L D A T E : PR O D U C T S N E E D E D B Y : (p gi n K. ^ 00 s TSi n SC M r0 ° I >- p £ 0 X6 o (01~ - <3 Cs lQIN 5 z uh-a,uen SH E E T LO F - NO . 1 AFh >• i-;/!;^:^ HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and , „ {naintained according tojS>f% '3]gS Wis. Admin. Code, the Holding Jan\( Component ^nua\^^S^^n^ 't"/r& \t£H 2.0 and the 'B^/f'e. U County Sanitary Ordinance. C^£R &i? J ^<<-/ 202^<-20Z.?J 1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 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 Servicing 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 5PS 383 and?84 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business 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 &PS 3^3.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the fojjowing persons should be contacted: a. Installer.............................Po/^^; ^/amj);^ m-Rft,^ ZZ^O Phone: 7/.ST 3-?x.- t/<'^'& b. Service Provider.................. ^^fC^^r S^:^ Reg ti StZ7t Phone: --7 is- 3-7^ - ^0£t(e c. Co. Zoning or Health Dept. Qa.yfi. s-U Cis. <j n-^ •X<&^ /»o-y _ Phone: 7/j- 3-7.3 ^M3S^ n. u^L^^^ ^^^L^^^^f ^^ ^Lu •Tfiwn^^ ^y ' ^ . o^; 'i^^y-f-'.ePs^^l^QJLl^^sJ^EZ-Z^2--Z-J' Project Transaction Number: HOLDING TANK SERVICING CONTRACT Contract Date-^-^This contract is made between the Holding Tank Owner(s) Name(s) ^ i^. (i i^-e t-j £'t>€.^=-^c- ^^-( ''s Name (Print) /^- •-To'^ p^'/ ^:^s ^> ^^^*n /$-. N/^i^- <>e^?--/'*< Pumper's Signature Pumpers' Registration # <Zi ~^-7( We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT LOCATION Legal Description: (Use Tax Statement) TaxlDff 575,53 ^u^a^\'377 Section , Township \N,Range 0°1 w Town of: Ou\v Lot Size Acreage 10 Gov't Lot Lot #CSIV1S Vol. Page | CSMDocff [ Lot(s) No. | Block(s) No Subdivision: 1. The owner agrees to file a copy of this contract with Bayfield County as required in SPS 383.55, Wis. Adm. Code. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local government unit which has signed the pumping agreement required by SPS 383.55, Wis. Adm. Code, and the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local government unit and the County named above within (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) .J\v\^n«.uj 'fro^mai^ fi^Va ^ro^wc/n Owner'^ Signature's-)'^%^Subscribed and Sworn to me: on this s31d_.dayof J^hcua.4 ,cX)3i.$ \^A^'^a^^--.?^r<-^ ?mmission Notary Public expires on: L' f-5'^OS^L oni'^b/i u-1 Revised: May 2016 (©May 2018) i. \ HAAN Personal information you provide may bo used for secondary purposes [Pi%pc^iP^w, s. 15.04 (JJ^Drafted by-fr? Document Number/Plan I.D. No. /ner.Name (s).}ndf&u.'' 'Fwslw^f lO-^lo-^ py^i^ian ~-r^~^ 2,7'Z'2-3 HOLDING TANK AGREEMENT Owner(s) Mailing Address t)lt? -'5$ C^c'ly ^'^ ^u\t l^' ~^^0 Agreement Date (same as Notary Date) ^-?--2-<T Parcel Identifier Number (PIN) OW- \OW-€>'7- ?0 We acknowledge that application is being made for the 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. t^ 1/4 of Ju_^l/4 Section 31 _Township _L/iL_N. Range ^GI__W. Town of 00\0 LAdditional Legal Description: M !/^ ME^/ ME-^ L€65 V/ ?^ r'5'77 $^ Gov't Lot _ Lot Block Subdivision CSM# I 3M#Voi ,_Pdye _, OOCUMENT NUMBER2025R-606662 OANIELJ. HEFFIMER REGISTER OF DEEDS BAYFIELD COUNTY. Wl RECORDED02/25/2025 AT 1 1 ;45 AM RECORDING FEE: $30.00 PAGES: 2 Return To: -7-^y ^e.lk-^^k', ^-2-3 0/^^<le-^ £><^ ^6€ T^O^^sC^: i"^ ^50-fO 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: ,. ^r'i- 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 bo paid by the owner within thirty (30) days train the dale of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that ali the costs and charges may be placed on tho tax roll as a special assessment for the abatement of a human health ha/ard, 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, Wl's Adm. Code who shall submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfiold 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 sowor or a private onsite wastewater treatment system that complies with Ch. SPS 383, Wl'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 Ccii'tificaiion lo be ueteriniiiyd by ie(erern;e to iHe properiy. 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of tho 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. /Y- Owner(s),Name(s) - Please Printft ^y^ i:^c7~l'^^ I^^T^^^^.Notarized Qwner(s) -^ignat^^ y /^^^-:: ^- / Subscribed and sworn to before me on this date: fibwiLi S^o^^ Notary Publi»; '00^ /: ^n^/ ?" {\^o5 k-<Drafted by: Personal information you provide may be used lor secondary purposes [F'rivacy Law. s.15.04 (l)(m)j My Commission Expires:"°^S , L.l5,o!03^^^ Date:,.Z,-^_-_'ZL5, u/lorms/sanitary/holdingiankagreement.doc ®.)une 2018 /arce Document Number STATE BAR OF WISCONSIN FORM 1 - 2000 WARRANTY DEED This Deed, made between Andrew F, Frostman and Debra E. Frostman. husband and wife. Grantor. and Joseph A. Merila, a single person. Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in Bavfield County, State of Wisconsin (the "Property") (if more space is needed, please aUach addendum): South One-half of North One-half of Northeast Quarter of Northeast Quarter (Sl/2 N1/2 NE1/4 NE1/4) and South One-half of North One-half of Northwest Quarter of Northeast Quarter (Sl/2 N1/2 NW1/4 NE1/4), all in Section Thirty-one (31), Township Forty-eight (48) North, Range Nine (9) West, Town of Oulu, Bayfield County, Wisconsin. PATRICIA A OLSON BAYFIELD COUNTY, WIREGISTER OF DEEDS 2004R-492844 07/09/2004 9:30 AM TRANSFER FEE RECORDING FEE Pages 30.0011.00 Recording Area Name and Return Address Attorney Matthew F. Anich 220 Sixth Avenue West P.O. Box 677 Ashland, WI 54806 '//'A AL-.I Together with all appurtenant rights, title and interests.038-1069-07 * 038106909 Parcel Identification Number (PIN) This is not homestead property (is/is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, reservations and restrictions of record. ^. T^Dated this 0 " day ofigNB, 2004. 2^t'.u:" J. ^ANDREW F. FROSTMAN '^n^^ C DEBRA E. FROSTMAN AUTHENTICATION Sienature(s) ACKNOWLEDGMENT STATE OF WISCONSIN ) )ss. County ) authenticated this day of _•inir... ,^t"'"""f//^^^'^^^^^-~^fc^/^/^^,>v\^o^ft^ TITLE: MEMBER STATE BAI %^4ISCONSIN f 8 £^yBKC/.<?$ &•"Ofnot._ authorized by S706.06. Wis.'%a'(i8><^-^<^»'^'^fOUNTiy THIS INSTRUMENT WAS DlATTOffiS'EY MATTHEW F. ANICK,i3S1017169 DALLENBACH & ANICH, S.C.. ASHLAND, WI 54806 (Signatures may be authenticated or acknowledged Both are not necessary ) AS^A^D Personally came before me this _0 '- day of WNE ;7t//y _. 2004 the above namedANDREW f. FROSTMAN AND DEBRA E. FROSTMAN, HUSBAND AND WIFE. to me known to be the oersonfs) who executed the foreeoine instrument and acknowledeed the same. ^^(^AC^/C^*^, * ,/t4^rTH:^J ;ZT/i^f.^-i'-t Notary Public. State of WISCONSIN Mv Commission is oermanent. (If not, state expiration date: ..) • Names of persons signing m any capacity must be typed or printed below their signature.WARRANTY DEED FORM No. 1 - 2000 INFO-PRO (800)655.2021 www mfoprofonns cornV896 P377 % PO^C(^ in accordance with SPS 383, Wis. Adrn. Code Attach complete site plan on paper not less than 81/2x11 inches in size. Pjan must ! include, but not limited to: vertical and horizontal reference point (BM), dfrection'and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Al ! Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). County Bayfield : Parcel I.D. 04-038-2-48-09-31-1 QI^OC^^ /C'.>^t> Reviewed by Date /^/-^/ Property Owner Andrew Frostman Property Location Govt.Lot NE 1/4 NE i/4s 31 T 48 NR 8 E(or)W Property Owner's Mailing Address 71035 Oulu Rock Road Lot #Block #Subd. Name or CSM# North 1/2 10 acres City State Zip Code Phone Number Brule Wl ] 54820 j(715 ^292 - 9040 ity I Village Onlii ]Town Nearest Road Oulu Rock Road |B| New Construction Useftfl Residential / Number of bedrooms Replacement Q Public or commercial - Describe: Parent material General comments and recommendations: Code derived design flow rate 450 GPD Flood Plain elevation if applicable -NA. The site is suitable for a Mound system. The benchmark =100' Boring #Boring pit Ground surface elev.__94_4__ft.Depth to limiting factor 21"in.Soil Application Rate Horizon Depth in. Dominant Color] Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz. Sh. Consistence Boundary Roots GPD/fF *Eff#1 *EfW2 0-5 7.5yr 3/2 SL 2fsbk mvfr cs 2f 1.0 5-21 7.5vr4/4 Rl 2fsbk mvfr cs 1.0 21-29 7 5vr 4/4 C2D 5yr 6/8 SL 1fsbk mfr cs 29-50 7. Svr 4/4 C'JD 5yr 6^i SCL Ifsbk ml'i 2' 'Boring # Horizon 1 2 3 4 Depth in. 0-5 5-26 26-31 31-50 Boring y Pit Groi Dominant Coloi Munsell 7.5yr3/2 7.5vr 4/4 7.5yr 4/4 7.5yr 4/4 94.6' id surface elev, Redox Description Qu, Sz. Cont. Color C2D5yr6/8 t. Depth to limitinc Texture SL SL SL SCL Structure Gr.Sz, Sh. 2fsbk 2fsbk 2fsbk Ifsbk 26 factor Consistence mvfr mvfr mfr mli in. Boundary cs Cfi f"=> Roots 2f 0 0 D Soil Application Rate GPD/ff *Effi»1 .6 .6 n 0 *Eff#2 1.0 J'D_ n D * Effluent #1 = BOD, > 30 ^ 220 mg/L and TSS >30 ^ 150 mg/L * Effluent#2 = BOO ^ 30 mg/L and TSS ^ 30 mg/L CST Name (Please Print) Stfven f. .Inhnsdn Signature^^c^"CST Number # 227037 Address 9111 East Potter Road South Range, Wl 54874 United States Tlate Evaluation Conducted 10-18-24 Telephone Number 218-590-6678 SBD-8330(R07/13) Property Owner_^Andrew Frostman ParcellD#04-038-2-48-09-31-1 Page of _ 3 E Horizon 1 2 3 4 iring# Depth in. 0-6 6-21 21-30 30-50 Boring H Pit Groi Dominant Color Munsell 7.5yr 3/2 7,5vr4/4_ 7.5yr 4/4 7.5vr 4/4 92.7' id surface elev. Redox Description Qu. Sz. Cont. Color C2D 5vr 6/8 ClD5vr6/8 &(-€., t. Depth to limiting Texture LS LS SL CL Structure Or.Sz. Sh. Osg OSQ 2tsbk llsbk U, - /0-5^ 21factor Consistence mvfr mvfr mfr mfi in. Boundary cs C.K n.c; Roots 2f 1f 0 0 Soil Application Rate GPD/ff *Effi»1 .7 ,7 0 0 *Effi?2 1.6 1.R n 0 Horizon [ n Horizon ring # Deptr in. Boring Pit Grc )ominant Colo Munsell 1 Boring #•ing # Depth in. Boring I Pit Grc lominant Cola Munsell nd surface elev. Redox Description Qu. Sz. Cont. Color nd surface elev. Redox Description Qu. Sz. Cont. Color 1. Texture 3epth to limitin Structure Gr.Sz. Sh. t. Depth to limitin; Texture Structure Or.Sz. Sh. factor»r.,r, ' '. .in.}\f\[\ ^ Consistence Boundary factor in. Consistence Boundary Roots Roots Soil Application Rate GPD/ff *Eff#1 *Eff#2 Soil Application Rate GPD/ff *Efl#1 *Eff#2 * Effluent #1 = BODg > 30 5 220 mg/L and TSS >30 $ 150 mgA-Effluent #2 = BODg ^ 30 mg/L and TSS 5 30 mg/L SBD-8-130(R07/].3) ^ ^ s^ t ^ [ 5 I? 1^ 1 ^ 1 . ^t t I? ^j^ - - j - ^ - !- M ^ . i^ . . - ^»t^ T - ^- . a<,M. AV .< • -, o f i . ^T ^0»^^ 15 0 (4 •^ ! \ ^ ^ ?' i c 9 -? '.o * . - L- A ,^ . . ]r ^;v io * |.» < - .[ < - > . 5- ; ( " ;f t ^ .< > i^.0 .<»0 '~ pX: ' ff S » ^ M \m ^ 'M ? ^t ^ i ^ ^l ! f ^ o , - \ <^ 1^ ; ' 1^ 1 1^y; [^ 'S » i ^^ J , <^ i 9 !> . iu BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): 121 Check List El Index Page / Title Sheet (Optional) El Original Soil Evaluation Report (Submitted in Deed Holders Name - not prospective buyers) Ef Original Plot Plan D Cross Section Soil Profile Sheet (optional) D Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) B Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used Q Property Owner's Information (not prospective buyer's name) El Property Location (Accurate Legal Description with Sec/Twp/Range) E] Road Name (where driveway is/will be coming off of) [3 Floodplain Elevation, Flow Rate, Comments and Recommendations 0 Complete Soil Boring / Pit Information E! Date Soil Evaluation was conducted 13 CST Name, Signature, Number, Address and Phone Number D *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) @3 Bench Mark (Description, Elevation and Location) 0 Contour Lines (Example = 98.0796.0794.0') 12 Pioperty Location (Sec/Twp/Range/, Accurate Legal Description) 13 Borings (Locations and Elevations) 23 Percent and Direction of Land Slope 0 Well Location (Including Neighboring Wells, if applicable) 1^ Location of Wetland Areas, Floodplain and Navigable Waters 12 Buildings, Driveways, and Structures (Location and Descriptions) [?} Location of Property Lines El Existing System Location IZI Address Number and Road Name 13 Current Surface Elevation of Wetlands and Navigable Waters IZl CST, Owner and Property Information El North Arrow S5 Certified Soil Tests - Review & Filing Fee $ 50.00 . u/forms/sanitary/checklist/checklistforcsts 5/21/25, 1:27 PM BAYFIELD COUNTS Carmody™ SANITARY PERMIT (#04)-25^7S STATE SANITARY PERMIT OWNER: ANDREW F FROSTMAN GOVTLOT: LOT: BLK: NE 1/4 NE 1/4 SEC: 31, T 48 N, R 9 W TOWNSHIP: Oulu SOIL TEST: 174-24 REPLACEMENT SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: Allan Polkowski TRACY POOLER Authorized Issuing Officer DATE: 5/21,2025 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 #: 389456 LICENSE: # MPRS 220090 Condition: Properly maintain system per recorded agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 5/21/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION https://www.carmodyinc.com/PermitApp/Permit_Sign.aspx?Print=1&permitappid=7472 1/2