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HomeMy WebLinkAbout25-58S^/ SS400.%1 Department of Safety & Professional Services, Industry Se^ic^ I^vpi^iu'm ii County Bayfield Sanitary Permit Number (to be tilled in by Co.) }} 55-52S Sanitary Permit ApplicatioiJJ JUN f] ;.State Transaction Number L f.A\/S) iL In uccon.liHK'e with SPS 3S3.21(^), Wis. Adin. Cociu, submission of tliis fonn to the appropriate governmental unit is required prior to obtuining a sanituiy permit. Note; Appticution tbnn.s tbrstnte-owp^^)1Q'(y]"I,&ar&snbi^tt]C(i|t^. the Depuitment of Safety aint Pivti.'ssiiinal Services. Personal infonnation you priwideni^yBeusettRn'^ecoi^aiy purposes in accoiilance with the Privacy Law, s. 15.04(l)(m), Stuts. I. Application Information - Please Print All Information Project Address (ifiliftereiit than niitilini; address) 10085 Co Hwy H, Iron River Proptfrty Owner's Nume Steven J Weiss Parcel# 13272 Property Owner's Mailing Address 347 Timberwood Rd. NW Property Location Govt. Lot City. State White, GA Zip Code 30184 II. Type of Building (check all that apply) 63 I or 2 Family Dwelling-Number of'Bedrooms a Public/C'ommercial - Describe Use D State Owned - Describe Use. Phone Number Lot if NW •/<. NW ./,. Section _3_ T^6___N R_8 _Eor^ Subdivision Name Block # D City of. CSM Number D Village of St Town of Delta III. Type of POWTS Permit: (Check either "New" or "Replacement' and other applicable on line A. Check one box on line B. Complete line C i applicable.) A,0 New System D Replacement System D Other Modification to Existing System (explain)D Additional Pretreatment Unit (explain) 8.[xl Holiliny Tank D In-Ground (L'tinventioiutt) D At-Orade D Mound G Individual Site Design D Other Type (explain) c.D Renewul Butbiv Expii'iition D Revision D ChaiiBe of Plumber D Trynster to New Owner;IList Previous Permit Number and Date Issued IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) | Design Soil Application Rate(gpd/sf) | Dispei-sal Area Required (st") | Dispersal Area Proposed (st) | System Elevation Tank Information Capacity in Gallons New Tanks Existing Tanks Total Gallons # of Units Manufacturer ^ s.rt uUs(S 0 I?i 2C/) "^." ^'£ U Seplic or Holding Tank 2000 Wieser Concrete Dosing C'lianiber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Edward B. Redinger Plumber's Signature\^^\^L^^MP/MPRS Number 221939 Business Phone Number 715-292-6670 Plumber's Address (Street, City. State. Zip Code) 1015 11th Ave. E. Ashland, Wl54806 VI.JCounty/Department Use Only Approved D Disnppimed D Owner Given Reason for Denial Permit Fee S^Z)' Date IssuedMPl',&LAS z'^/'/w/?~^^%1- Condition.s of Appiwal/RtiasonK for Uisapproval (^ $6^L cddQL^k^ (^ud.$^;( 1^7 Iff'ZZ Attach to complete plans for the system and submit to the County only on paper not less than 81/2x11 inches in sizc SBD-6398 (R. 03/22) ^ Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVJU^ in accordance with Comm 85. Wis. Adm. Code ^yfield Co.Page..of. Attach complete site plan on paper not less than 81/2x11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale ordimensions, north arrow, and location and distance to nearest road. P/ease print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m». County B?^1ELD Parcel I.D.13272 Date^W ^/A Property Owner STEVEN WEISS Property Location Govt. Lot NW 1/4 NW 1/4 S 3 T 46 MR 8 i7or)""^ Property Owner's Mailing Address 347 TIMBERWOOD RD NW Lot #Block # | Subd. Name or CSM# City WHITE State Zip Code I GA | Phone Number 30184 ] ( 404 )925-1128 Sity n Village l.'JITown FtPT TA Nearest Road CTY HWY H I'Jl New Construction Replacement Parent material Usel^i Residential / Number of bedrooms Public or commercial - Describe: FLUVIAL 2 OR 3 Code derived design flow rate .300-450 .GPD Flood Plain elevation if applicable Generai comments and recommendations:HOLDING TANK OR MOUND SYSTEM ELEVATION AT 102.57 ON 100.9 CONTOUR DESIGN LOAD RATE = .6 GPD/SQ. FT. Boring #Boring pit Ground surface elev. 100.9 ft.Depth to limiting factor ^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 *Efi#1 *Eff#2 0-4 5YR3/3 LS OSG MVFR cw 3M 1.6 4-16 5YR4/6 OSG ML cw 3M 1.6 16-26 5YR4/6 OF 5YR 6/8 OSG ML AW 2M 1.6 26-60 5YR4/6 C2D 5YR 6/6 OSG ML 2F 1.6 2 Boring # Horizon 1 2 3 4 Depth in. 0-4 4-16 16-26 26-60 Boring J Pit Groi Dominant Coloi Munsell 5YR3/3 5YR4/6 5YR4/6 5YR4/6 100.9id surface etev. Redox Description Qu. Sz. Cont. Color C1F5YR6/8 C2D 5YR 6/6 Texture LS s s s lepth to limitinc Structure Gr.Sz. Sh. OSG OSG OSG OSG KFactor Consistence MVFR ML ML ML in. Boundary cw cw AW Roots 3M 3M 2M 2F Soil Application Rate GPD/ff *Eff#1 .7 .7 .7 .7 *EfW2 1.6 1.6 1.6 1.6 * Effluent #1 = BOD, > 30 5 220 mg/L and TSS >30 5 150 mg/L * Effluent #2 = BOD, ^ 30 mg/L and TSS 5 30 mg/L CST Name (Please Print) BRUCE W BLAKEMAN Stature (/^/UM^L^ CST Number 708148 Address 64903 CHARLES JOHNSON ROAD ASHLAND, WI54806 Date Evaluation Conducted 08/01/2023 Telephone Number 715-209-2569 o] 4 /yi p.^?.-?^ /.A- Property Owner.WEISS ParcellD#. 3svfey Co. "-''iSUi'lftiU ;.;i^;; Z.::''i,!'.i /'"1Ct;CV 2 3Page ~ of_ 3 i Horizon 1 2 3 4 iring # Depth in. 0-4 4-12 12-18 18-36 Boring J Pit Gro Dominant Colo Munsell 5YR3/2 5YR3/4 5YR4/4 5YR4/4 98.7id surface elev. Redox Description Qu. Sz. Cont. Color C1D 5YR 5/8 C2D 5YR 5/6 Texture SL SL SL LS 'epth to limitinc Structure Gr. Sz. Sh. 2MGR 2MSBKL 2MSBK OSG Factor, Consistency MVFR MVFR MVFR ML in. Boundary cw cw cw Roots 3M 3M 2M IF Soil Application Rate GPD/fP *EfiW1 .6 .6 .6 .7 *Eff»2 1.0 1.0 1.0 1.6 Horizon E n iring # Depth in. Boring Pit Grc Dominant Colo Munsell nd surface elev. Redox Description Qu.Sz. Coni. Color 1. Texture 3epth to limitin Structure Gr. Sz. Sh. factor_ in. Consistence Boundary Roots Soil Application Rate GPD/ff *EfW1 *Ef»2 Horizon E n iring # Depth in. Boring I Pit Grc Dominant Colo Munsell nd surface elev. Redox Description Qu. Sz. Cont. Color •t Texture )epth to limitini Structure Gr. Sz. Sh. factor in. Consistence Boundary Roots Soil Application Rate GPD/ff *Efl»1 *Eff#2 * Effluent #1 = BOD^ > 30 5 220 mg/L and TSS >30 5 150 mg/L Effluent #2 = BOD ^ 30 mg/L and TSS .$ 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD.8330Test (R.07/00) 6^:^55 /VCV A/Cc/ SJ7 /^^ /^/C5?^L/ TO^^L/ Qf- ^^L^M ^T^r^'iU CT/ rh* r~ '^'^l 1-"^ ^b'*'"'-'',r-.L.^l-Jv1-^ 3ayfield Co. ft 1 ~/+(i^i^^> F!anrwy.u,d Zoning Agency P^^3^3 ft/ 5^?^- /•'<^__^i-4 j^-B^ - W7?L /^"/'1-Bo^^ 6rR.Qa^j _£^ /^" ^^z.r^ fx^^^, /i4) L/<^4 Ar T^^-S Tyme < s7//.^;23 /V^J^ S^T^- ^?/z7l/ ^Li-^^^h -c^ ^^Ld^<£^y1^^? e^T ^7o^/^ Ms^Ttf P l^ L-i-^^ LOU; -/\^.CLA CLtiA^A ^^ ' f^cfi^'^b ^zffr^c. ~!^^ uv ^^I . .k - N ^a-/?<" /\ ^fsui -ft^Zft- ^\^ 1^1^ •\/ ^J^^ Pg Pg^ Pg: Pg- 1 2 3 4 of 4 of 4 of 4 of 4 Attachments: Holding Tank Plan Index & Cover Sheet Component Manual Design References: Holding Tank Version 2.1 (May 2022-2027) Index & Cover Sheet Plot Plan Holding Tank Specifications Management Plan Enclosures: PAGE 1 OF 4 pw"|| n w^iw-!u' •^:.\^\^,ii~t in Per" POWTS Application for Review Soil Evaluation Report & Site Map (if applicable) Holding Tank Pumping Contract (if applicable) Holding Tank Agreement (if applicable) Project Name / Description 3 Beds Owner Name(s): Steve WeJSS Phone: owner Address: 347 Timberwood Rd. NW White, GA zip: 30184 Project Address: 10085 Co Hwy H Iron River,WI Govt. Lot:NW 1/4ofNW 1/4, Section3 .,T.46 N-R8 or W • Township: Delta county: Bayfield Project Parcel ID #: 13272 Designer Information Designer Name: Edward B. Redinger _ Phone: 715 .292 .6670 Designer Address: 1015 11 th Ave. E. Ashland, Wl _ Zip: 54806 E-mail: ed@superiorpmw.com , , License Number: 221939 Remarks: Signature:Date: 5/30/25 Original signature required on each surfmitted copy. SD; 1^1vi ^ I 11 .11 IN fm 075 W!'ii i.sui !ii]i(UJ';F[ ^SUPERIOR PLUMBING MECHANICAL (715)278-3456 Customer Name: Steven Weiss Adress: 347Timberwood Rd. NW White, GA 30184 SITE: 10085 /Co Hwy H Iron River Phone #: Email: CST#221939 Scale: 1" = 40' PIN:13272 9.9 Acres NW NW S3 T46N R8W Town of Delta Bayfield Co. /^i\ /a/^^" f^^tUJ^ ^ ^ <> <?rB^:i\ • •t;!,.' I..'1..' _U iN j6^J A^"];/J^. i^ie.^r'^k ^cj^ 1^~ IT?-»<i> PAGE 3 OF 4 !u1 " i !l ¥ i |[| ^ .. ..... !!!',ll!M 0 2 n'Z;: 'L'; HOLDING TANK SPECIFICATIONS (No Scale) ^^iK: !-!<^" Electrical must comply withSPS 316 and NEC 300 \1/ \^ 18"Min. v (typical) [0 Weatherproof •Junction and Alarm Box Conduit 4"0 Vent Pipe >1 Oft from Building Approved Vent Cap ^ Inlet N Approved Joints with Approved Pipe 3 ft onto Solid Ground -AirtightSeal 12" Min.or2.0ft above Established Flood Elevation (typical) Approved Locking Manhole with Warning Label Attached(typical) 4" Min. or 2.0 ft aboveEstablished Flood Elevation (typical) Inlet Invert v — Max. 12" or 90% of total volume if more than one tank Alarm-On HOLDING TANK VOLUME = 2000 gal ~A T 3" Approved Bedding Material Beneath Tank \1/ \1/ Finished Grade Tl -Watertight Plug TANK MANUFACTURER:Wieser Concrete Anchor tank as necessary pursuant to SPS 383.43(8)(g) Ballast Weight = [(cu.ft.tank.vol x 62.4 Ibs/cu.ft) - Ibs.tank.wt] x 1.5 Ballast Weight = [(.cu.ft.x62.41bs/cu.ft)-lbs]x1.5=Jbs PAGE 4 OF 4 Holding Tank Management Plan IMPORTANT: The owner of this holding tank(s) shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wise. Admin. Code. Pursuant to SPS 383.52 (2), Wise. Admin. Code, this holding tank(s) shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintqjn^r i® ^ accordance with SPS 383.52 (3), Wise. Admin. Code. ' ' " [^ g I?' 11 ^ ^ l^i •'- !^Estimated Daily Wastewater Flow = 45° gpd || jUN n ^ zoz Inspection Checklist INSPECT EVERY 3 YEARS ^c, ,^i o type of use o age of system o nuisance factors (/.e. odors, user complaints, etc.} o mechanical malfunction (/.e., pumps, valves, switches, floats, etc.) o material fatigue (/,e., leaks, breaks, corrosion, etc.) o neglect or improper use (/.e., exceeding design capacities, prohibited activities, etc.) o electrical components (;".e., wiring, connections, switches, controls, timers, alarms, etc.) o surface discharge of effluent or sewage back-up into structure served SERVICING FREQUENCY o The tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wise. Stats. when the wastewater in the tank(s) reaches a level of one foot below the inlet invert of the tank(s). Disposal of contents shall be pursuant to NR 113, Wise. Admin. Code. Tank pumping reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wis. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Superior Plumbing & Mech. Inc. p^ne: 715-292-6670 Local government unit: Bayfield CQ Zoning _ p^ne: 715-372-6138 Local government unit address: 117 5th St. E. Washbum, Wl _ ^ 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wise. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wise. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wise. Admin. Code. Contingency Plan In the event that any failed component of this holding tank(s) cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agecy for review and approval. System Abandonment If use of this tank(s) is discontinued, it shall be abandoned in accordance with SPS 383.33, Wise. Admin. Code. 164" <001 CZ:T^T:11 f- 4" CAST-A-SEAL 4" CAST-A-SEAL FILTER OR BAFFLE ^-_ TOP VIEW \: in PUMP PAD SIDE VIEW WLP2000-MR TANK SPECIFICATIONS DIMENSIONS:WALL: 3" BOTTOM: 5" COVER: 6"MANHOLE: 24" I.D. PRECAST CONCRETE RISERHEIGHT: 55° O.D. LENGTH: 164" O.D. WIDTH: 96" O.D.BELOW INLET: 43- O.D.LIQUID LEVEL: 36" WEIGHT: BOTTOM 14,060 LBS.COVER 8.170 LBS. INLET AND OUTLET:4" CAST-A-SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER:WISCONSIN. SEE DETAIL #10(OTHER STATES SEE CHART) LIQUID CAPACITT: 56.27 GAL/IN LOADING DESIGN: 8' 0" UNSATURATED SOIL HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 2,138 GALLONS CL_ TANK CAN BE USED AS: :_: - SEPTIC/ HOLDING/ PUMP OR SIPHON ,-^ COVER: MIX DESIGN j|f8 (NO FIBER) . ^TANK: MIX DESIGN jj!9 (SMALL FIBER) i:^ CUSTOMIZED TANKS: 1 .^.^FOR CUSTOM TANKS CONTACT WIESER CONCRETE?- ^1 TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS DRAWINGS SUBMITTEDFOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: g' .- ml ?'.^\^ ul ?< u=l|8 ml£ ^|z 00i3Q |L0|c^lro|I0|000 I CM 0s ILU(7) SHEET NO. )p 1 1 ^ '^j-n? j III HOLDING TANK - MANAGEMENT PLAN ^| ^ ;i ^ ;i^; The Private Onsite Waste Treatment System (POWTS) has been designec^,a.F»^:,is:to be • • installed and maintained according to SPS 383, Wisconsin Administrative Code, Holding Tank Component Manual for Private Onsite Waste Treatment Systems (SBD-10571-P)(R.6/99) and the Bayfield County Zoning Department Sanitary and Private Sewage Ordinance. 1. This POWTS has been designed to accommodate a maximum daily flow of ^ SO 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 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 N\A/1/4of^\A/1/4 Section ^ Township 4fc N. Range @ W. Town of 'Q£~LT^ Govt. Lot Lot Block Subdivision CSM# ^Additional Legal Description lt300£ r^-^\{ V+u^ Y H- X/^^cu- W^- S^B^I ;>-Z^2^Zb' Owners Signature *' Date u/forms/managementplan Revised: July 2013 HOLDING TANK SERVICING CONTRACT Contract Date 6-2-1-^-5' rt ^ '? E I ^ E llll^ '\n.J lil1<! w. d 9 l/n'/!-j;|j JUN s! ^ ^U^-J r^,;fipi;j fn, 'Ton;oc Lmr'l: This contract is made between the Holding Tank Owner(s) Name(s) S-i-^v^n -3-. <AJ<^ Pumper's Name (Print) -^^ ~^>^^y^ Pumper's Signature^/^Pumpers' Registration #/w We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT LOCATION Legal Description: (Use Tax Statement) Tax IDS ^^-z- Section ~J _ , Township "I <0 _ N, Range t-/ _ W Gov't Lot Lot»CSM#Vol. Page CSM Doc »Lot(s) No.Block(s) No. [W_l/4, f»/V/ 1/4, Town of: OE:L-riA Lot Size Acreage t^.c\ 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 semiannyal. basis. The pumper further agrees to include the following in the semiannual report: a. b. c. d. e. f. g. ^fl8(^,^^'^•^^ ":•**' ''•^1.^-^7"_ ""%^?^7 ^°^ \^sThe name and address of the person responsible for servicing the holding tank; The name of the owner of the holding tank; The location of the property on which the holding tank is installed; The sanitary permit number issued for the holding tank; The dates on which the holding tank was serviced; The volumes in gallons of the contents pumped from the holding tank for each servicing; ^^''•»o.,...,,.-'^'0^ The disposal sites to which the contents from the holding tank were delivered. '<ff 5 -^1^, ^.. 5;o/= -1: '""i; -a/"*^" ;<rE 9 ^^ ^//p^ KO^'.Q$y ''"•»r<(l».' 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local government unit and the County named above within (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) S^vjerv "^' \^)^^ Owner's Signature(s)Subscribed an,d Sworn to me: on this '2^dav of by: ^[ih- -,M£ Notary Bublic My commission expires on: /?"'/(', Revised: May 2016 (®May 2018) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (l)(m)] Drafted by Cccument Number/Plan I.D. No. Owner Name (s) S^-ev^n T LO^S< Parcel Identifier Number (PIN) O'\-01l» T-- 4b-<^ <?3--Z 0Z-, S$-^5~^f HOLDING TANK AGREEMENT Owner(s) Mailing Address looes- c^i^i i-»^^ •+ -^rw} ^ J^r \o^ 540 41 Agreement Date (same as Notary Date) Cf<W -\OC>OQ 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. h/W 1/4 of NW 1/4 Section 3 Township ^b M. Ran. Town of D 6 L.T ft ^^ /Us^k^J ^ Townghip ~to M. Range __B__W. ^-s^r.S w. •l^^ Additional Legal Description: 10005 Ce>\^T\^'\f t^W^ <-t Gov't Lot Lot__Block__Subdivision__CSM#_ Lot__CSM #_.Vo!-Page _CSM Doc# ^EIIT!8RB^\ ;-S-2St DOCUMENT NUMBER2025R-607-702 DANIEL J. HEFF-IMER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 06/03/2025 AT 8:00 AM RECORDING FEE: $30.00 PAGES: 2 A- Return To:$',^,1 l^^5 '?y? T.-^Le^^e t^k S2H- 1/^N'. 4,025 As an inducement to Bayfield County to issue a sanitary permit for a holding tank following: wyneic; C^. ^UDI'KJ DeK on the above described property, we agree to do the 1, Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tank installation and maintenance. If the owner fails to have the holding tank properly serviced in response to orders issued by Bayfield County or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Stats., Bayfield County may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats. 2. Owner agrees to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 3. The owner agrees to contract with a person who is licensed pursuant to s.281.17 (3) Wis. Stats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced in accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed pursuant to s. 281.48 (3) Wis. Stats., and Ch. NR 114, Wl's Adm. Code who shall submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfield County may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 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, Wl's Adm. Code. In addition, this agreement may be cancelied 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. 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. .•«"'^ 5. 6. ^*Su^cnbyl ani^ sworn to beforeme ^o this dat<^^j\l 1-L^' ^//\ , 2X)Z^ >^ ^-''•••''-•..^ Owner(s) Name(s) - Please Print S^CA ^ • ^ClS^ Notarized Owner(s) - Signature(s) 0- -[WanNotary P'ublft ^7' ..^^/ ^^^ ^s Notary P'ublft \\A\-'Z02^°^\ ~^BL\C » ~^- *«. My Commission Expires:'''^n>-""<<-W%^/m:'<^1"e'ti.'..\i\»Hi»nt 1<=^^ Drafted by:^•e.\Je^\U-^f/s«^s Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 ()}(m)] Date:- ^ ^^^r u/forms/sanitary/holdingtankagreement.doc ©June 2018 GOWEY Abstract & Title Company, Inc. (800) 673-8710 • www.goweytitle.com i|^ !E ^ 1^ 11 I K U'l Hte Number: 225355 ADDENDUM/EXHIBIT A ^ jUNU4Z02^ ^qvfieio d.' <.0ii"'!y '^ The South 350 feet of the North 450 feet lying between County Trunk Highway H and Eagle Lake in the Northwest Quarter of the Northwest Quarter (NW1/4-NW1/4), Section Three [3), Township Forty-six (46) North, Range Eight [8) West/ Town of Delta/ Bayfleld County, Wisconsin. Bayfield County Register of Deeds Document #2022R-596995 Page 2 of 2 pAyFIELD Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn/ WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: WEISS/STEVENJ 347 TIMBERWOOD ROAD NW WHITE, GA 30184 Description Private Sewage System (Holding Tanks) Total: Payment Amount: Submission Number: SS-00561 Transaction Number: SS-00561-2D479 Amount $400.00 $400.00 $400.00 Reference: 10287 Paid by: Superior Plumbing & Mech Inc/1015 llth Ave E/ Ashland WI 54806 Payment Type: Check Transaction Date: 6/20/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTS SANITARY PERMIT f#04)-25-58S STATE SANITARY PERMIT OWNER: STEVEN J WEISS GOVTLOT: LOT: BLK: NW 1/4 NW 1/4 SEC: 3, T 46 N, R 8 W TOWNSHIP: Delta SOIL TEST: 116-23 NEW SYSTEM SYSTEM JYPE: Holding Tank PLUMBER: EDWARD REDINGER TRACY POOLER Authorized Issuing Officer DATE: 6/20/2025 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 #: LICENSE: #221939 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 6/20/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION