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°` INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY °TM TIME RECEIVED REMOTE CSID DURATION PAGES STATUS June 24, 2025 at 9:23:44 AM CDT 7153724159 38 1 Received Jun 25 2025 00:43 HP Faxpolkosl6 Plumbing 7153724159 page 1 Request for Sanitary Inspection (24 Hrs. in Advance) Fax this form to Zoning Dept (24 Hrs.) prior to when you want an Inspection — (715) 373-0114 If you do not have a fax and must email the inspection; you must email all staff members. wore I Time Change Discrepancy fl Other en�/ �o f fro s /' Phone Number Plumber: / / 'Pp 1 �oS�, �f v,,,.t [,, n •/S Fax Number 3vz-q!s'� Homeowner: D o h Lt o w l Email Address I LLeo,,vtu"lov1er+!t•4 Sanitary immediate Phone Number So Zoning Permit #: S 9 S Dept can call you right back (if needed) Plumber's Choice Zo Dept Date: o� Time: Plumber's Choice Zo ' pt �f d Township: C (o e v Address#& Road Name: Fvo'', He.! fhe. TAlce 34 k ro j{ fog (< or r-, ve t 2 U90 Yicrr ft;..- /2 Directions Comments: ** Plumbers you must verify any change(s) by fair or email wa Notes u u/fonns/sanitary/r equeetforinsparllon ZoNng Dept (04/12/04); ® June 2023 POWTS HOLDING TANK INSPECTION REPORT (ATTACH TO PERMIT) RUTH S DONHOWE 2298 FOLWELL AVE ST PAUL MN 55108 TANK INFORMATION TYPE MANUFACTURER/MODEL# CAPACITY P 2 SETBACKS Property Line Well Water Service Building All -Weather Road OHWM J — Swimming Pool DEVIATIONS FROM APPROVED PLAN COMMENTS (Persons present, discrepancies, etc.) )n %a✓41 4 qrR COMPONENTS NOT INSPECTED Plan Rev sl Required ❑ Yes No Datg/ Signature of Inspect Carl. Number SKetcn'on otner side 10 of 13 I (fl// r/ Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zonino(a).bayfieldcountV.wi.Qov Web Site: vwVw.bayfieldcounty.wi.gov/147 RUTH S DONHOWE 2298 FOLWELL AVE ST PAUL MN 55108 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know d �C 44954' was contracted by you to install a private onsite wastewater treatment system on your property described as: Notes: Abandonment of Old System to meet all applicable code requirements: Tank was pumped by: on at AM / PM •r Tank was crushed I removed and pipes disconnected by: On 7 at ��� A M) the above -mentioned plumber contacted our office to conduct a pr -cover inspection as requ ed under DSPS 383. One of the following applies: alas inspected and appears to meet all applicable code requirements. ❑ System was inspected and appears to meet all applicable code requirements; however, a plan revision is necessary because the installation was substantially different than the original approval. System could not be inspected because plumber covered prior to scheduled time of inspection. ❑ System could not be inspected because plumber was not ready at scheduled time of inspection. County was unable to return to complete inspection. System could not be inspected because plumber was not ready at scheduled time of inspection. A re -inspection and $50 fee are required. System could not be inspected because County could not respond to plumber's time constraints. Comments: U/forms/sanitarypropenyowner-Input April 2019 ✓�I;_ •", of Safety . SpS..� / Industr Servic ,Divisfow `� Sanitary Permit Application In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appiop�ridicf�oiieritineni4iitlitg 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(1)(m), Stats. -I. Annllcatliin Information — Plence Print All Tnfnrmafinn f}-uI IowQ ,sa C�Zv,s Property Owner's Mailing Address v2 ct F'(i&/( & / j A - v - City, State Zip Code IL Type of Building (check all that apply) ;K I or 2 Family Dwelling —Number of Bedrooms O Public/Commercial — Describe Use O State Owned — Describe Use So--{ 1A. Phone Number 'sl 3-'g -717 Lot # A •• ') - 0105 7 I unty - -e t lIPermit Number (to be filled in by Co.) !9° C3cark t�e141 Parcel # -r Ibt(z(1 Property Locatiop Govt. Lot 1 £3 t c.Q1 - %, %, Section 2 T / N R "7 XnL'WJ ❑ City of M Number ❑ Village of i� Town of G I O• %I*- tr P .: Type of POVVTS Permit: (Check either "°New" or "Replacement"- and other applicable on line A. Check one box on line -B. Complete line C if licable. ❑ New System S . y � Replacement System 0 Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) I3. E Holding Tank 0 In -Ground ❑ At -Grade 0 Mound ❑ Individual Site Design 0 Other Type (explain) (conventional) C. ❑ Renewal Before 0 Revision ❑ Change of Plumber 0 Transfer to New Owner List Previous Permit Number and Date Issued Expiration 1V: Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Ratc(gpd/sf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units B o a New Tanks Existing Tanks u U ' arn, aU ri y wV 9ertIerorHolding Tank 2 a O a0 J. UJ 6e&e. tr CG . Responsibility Statement- 1, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) r' Plumber's Si ature W/MPRS Number Business Phone Number g At L;l I k—o5kr Plumber's Address (Street, City, State, Zip Code) _ ! d- Bog S- 'Z 'S trowi tiJ v' 1� �L '8r'7 71roved ❑ Disapproved Permit Fee Date Issum� Issuing Si rc 11APP O Owner Given Reason for Denial Conditions of Approval/Reasons for Disapproval Affnrh M ..mm�lam nln«e 4:....1... -..-.-.« .....z-..z.._z.._ •.._ n_____._ ---- •-- --- -_'- -�____.. _..- .-............... v.,««y .....,V vu I'I'' (WI WS HUIII 6 Ila X ii inenes in Size SBD-6398 (R. 03/22) — — - - `left IM tX L.ViV4IVU No, 99/f P. 2 PgIof Pg 2 of Pg 3 of 9 Pg4ofi Attachments: HoldingTank Plan Index & Cover Sheet J JUN 12 101b ti► Com onent Mamral Design Referenceq: Bayfield Co. Zoning Dept /Ylanua. t � ,�,. a e �f'� % r oi}i o Y Zo 2_©z)7 Index & Cover Sheet Plot Plan Holding Tank p ecifice#I 2 � ns �- s -e.t 4s Management Plan +- POWT$ R plication for Review cs��� p Soil Evaluation Report & Site Ma E5 7 f a a Holding Tank Pum in ontract (if apj g (- ' Holding Tank A regime t iii a Iieable Project Name 1 Description r` cav-n�%+ A; licable) able) Owner Name():v+ ) 0 h o w e- Phon • ≤i _ . `7 � � �. 3 aS` 4 Owner Address: ZZ •c u.+�. I / ve RL u ( *c N ip: s ,5-10oo Project Address: -----..,., Govt. Lot: t A r`Q I ' h Section Z T S1 _R '7 ('''� Township: County: 734. V e ( c Project Parcel ID #: 1Z �s"( Designer information Designer Name: / /Q. c, a s r Phone: ? _ Designer Address: ' P. is o S`'�-z.- n i -i v '&tr' WX Zip= .S`Yg.fl E-mail: .G v �r�--'l L• ''� Thi space reserved for approval stamp. License Number: 2 ©o ei o Remarks: r _ .Signature: Date: ' z original stgnetur required on each submifted copy. I rcpt -if ©wnero �Ll'fL be#'1Lowe i;54 +1Cbiv,s+hsov P.6,A, r Qo Le.9o.1 ,Dc,scv;p+,Cho ` �av-l- *I!35ec-2jTSYN 97W TeLun &f:ej.ouev Cewn4 tf:1&.4y-Ce / 4) '181�aate1 �etrilCbit¢e-'�5 0..i1 *1fl. SE+/ctc.ks GP.53fl) A.F.C•. #bove cinccj `j v2dz - well (3d%i£wt5 dsn en seeor, - ty =Sell Noe'vC�s/�lew�ire�F;o:� = q"ASTni D 17QS c pp re ve-g p: p. wuL+t vi' « l c -F Be.drnls: 2• -Sell Bov;n9�, I N Sco.1@ !'o'do'ur lass no le NerLrt...s+ RA, 3cvk ?c..1 vJecer ik'('!_qYll w I qi " 4 rann bttcM of 'flnk 1-a Ptc'wCo.e initi +'dam !D) iu n J, JUN " 22025 Bay6el( Co.zomny Dept tl 2 oL J L1.F''^r Y C. use i l 1-it!4iit1tbi k can, ,flanucil®®LtsC 4%�a6UleAaxI'�" p (V&R 2.j); c PYla.Y2o Z.Z—Zo, 7) PLC.430K S2.2 Sroi IVue.� w2 C' fY7 • PROPERTY OWNER: , +L• bo L, r a PLUMBER: Allan Polkoski/ Polkoski Plumbing SIGNATURE: ----� DATE: s -z- ( r- LICENSE # 220090 -. HOLDING TANK SPECIFICATIONS Z Number of bedrooms iNon-residential estimated flow (gpd) [igAdO.D Minimum holding tank volume required (gal) 2000.0 4Proposed holding tank capacity (gal) -Wies...+r: e�,?d2. .r .'ear�7 �..r3'M ••i'I�cacJ•C.a.:r -.r Tank Manufacturer "'f ••'•-•�r.^.•s�'ram�srtxha•rr:�rarx�+�ar�r.:mripon•en+oe:�:rar•�:mr 1N2o00 Tank model nu • ��..._a.-T:--- � ..... mbar • SJ Electro dAlarm manufacturer •••NTY=N•itRSS74.'TdfSifi^.,7.'7h'i'iAMA:':._^•• .•, IN.:7G5'.7:6?"I�"ti.�^Iw 901 yAlarm model number Tank Dimensions and Data X for round tank 47.6 4Liquid depth below inlet invert (in) 8.0 .Maximum depth of soil cover (ft) 66.0 Height (in) Outside 151.0 :Length (in) rDimensions 86.0. Width (in) Only junction box --.. conduit ---> blind plug •to•seal outlet JUN 12 zU25 E aayfiela Co. Zoning Dept. Tank• Anchor Calculations 15370 lbs Weight of tank and cover ka.».. ..• r. s.. e . ca xams� 1.50 Safet y factor 31055 lbs Weight of anchor required 36.0 in Soil cover req. for anchor or 7.7 ydd Concrete counter weight HOLDING TANK CROSS SECTION manhole cover with locking device and finished warning label grade 4' min. W 24 In. -•� Manhole and vent locations may be reversed. service 12.0 in. ' alarm on Note: All tank joints, and joints between tank openings and piping are Electrical as per 35.0 in. sealed watertight. All NEC 300 pipe and vent rns%ferials and Comm 16 comply with SF5 333. vent cap 12"min. vent pipe 18" min. -H I building sewer inlet 3 In. bedding under tank. Tank Is anchored as necessary to negate buoyancy. Project: n WLP2000-MR TANK SPECIFICATIONS ;� ,v 0) 164" - o ..:J ..rte 4" CAST -A -SEAL 4" CAST -A -SEAL rn FILTER OR BAFFLE a ui INLET t d- Cp (0 TOP VIEW SIDE VIEW OUTLET 0) M PUMP PAD TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS DIMENSIONS: WALL: 3" BOTTOM: SEPTIC 3" HEAVY DUTY 5" (ADD 2,800 LBS.) COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 53" O.D. LENGTH: 164" O.D. WIDTH: 96" O.D. BELOW INLET: 41" O.D. LIQUID LEVEL: 36" WEIGHT: BOTTOM 11,260 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 CAPACITY: 56.27 GAL/IN LOADING DESIGN: 8' 0" UNSATURATED SOIL HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 2,138 GALLONS TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: N i5 � Q N � a a C'4 CU p Pw 0- V) N W SHEET NO. 1V [OF 1 I 1 c JUN 1 2 L05 HOLDING TANK MANAGEMENT PLAN ;r; tt ,r,ca De. This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and s, • maintained according to 33 Wis. Admin. Code, the Holding Tank Component nual N,s'e.dp `'Wlan ve I -type, tER 2ao * and the By -P. id County Sanitary Ordinance. O �- 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 'PS 383 and384 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 BPS ge3.33 Wis. Adm. Code. 10. If there is a problem with, or question about this 'nstallation, the following persons should be contacted: a. Installer ............................Pal k's PiaiJiiij m.PA.s.. z .pogo Phone: -71 S' 72.- W0M b. Service Provider.................. ≤ p4 ag,ai Phone: '7/,fir- 3 _ c. Co. Zoning or Health Dept. Phone: 7/33-z 11. Le. j �a rcy2 l► n 4 o1*i f3 . "e c Z 4 -[- SI 1 7J!R7) 7 w PrA.v'Go- I O tL: 'Ta X 17 t Zi Project Transaction Number: (�(5/28/25. 7:48 AM Novus-Wisconsin Access rev. 12.0206 V , • Real Estate Bayfield County Property Listing Property Status: Current Today's Date: 5/28/2025 Created On: 3/15/2006 1:15:57 PM +Z- Description Updated: 1/2/2020 Tax ID: 28032 PIN: 04-042-2-49-08-10-3 03-000-20000 Legacy PIN: 042102703000 Map ID: Municipality: (042) TOWN OF PORT WING STR: 510 T49N R08W Description: W 15A OF SW SW IN DOC 2019R - 580080 212 Recorded Acres: 15.000 P Site Address * indicates Private Road Calculated Acres: 14.929 80240 MORRISON RD PORT WING 54865 Lottery Claims: 1 First Dollar: Yes Property Assessment Updated: 6/27/2022 Zoning: (AG -1) Agricultural -1 ESN: 127 2025 Assessment Detail Code Acres Land Imp. V Tax GS -RESIDENTIAL 1.000 8,000 116,500 Districts Updated: 3/15/2006 G5 -UNDEVELOPED 9.000 2,700 0 1 STATE G6 -PRODUCTIVE FOREST 5.000 5,500 0 04 COUNTY 042 TOWN OF PORT WING 2 -Year Comparison 2024 2025 Change 044522 SCHL-SOUTHSHORE Land: 16,200 16,200 0.0% 001700 TECHNICAL COLLEGE Improved: 116,500 116,500 0.0% Total: 132,700 132,700 0.0% Recorded Documents Updated: 1/2/2020 © QUIT CLAIM DEED Date Recorded: 11/26/2019 2019R-580080 Is Property History 1i Ownership Updated: 1/2/2020 ROLLIN D & JUDITH A LARSON PORT WING WI Billing Address: Mailing Address: ROLLIN D & JUDITH A ROLLIN D & JUDITH A LARSON LARSON 80240 MORRISON RD 80240 MORRISON RD PORT WING WI 54865 PORT WING WI 54865 N/A https://novus.baytiieldcounty.wi.gov/access/master.asp?paprpid=28032 1/1 a �`s — 11(JFJTyw� Y .. 71 (t •c ENTERED pS I?r-7 Department of Safety & Professiona er c .. v CI County 9a 4 ` an Permit Number be filled in ,�! Industry Servic D isll"oi (to by Co.) �� �5_59S Sanitary Permit Application State mnsac[ion Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appro�r2idt(ilryerlj M 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 Project Address (if different than mailing address) purposes in accordance with the Privacy Lew, s. lS.04(I)(m), Stars. , / � ✓ _ �� n / i IL T I. Application Information— Please Print All Information Property Owner's Name Pw L1 Dor41owe E I 5 be�C�irS Qtn-n 1aA. Parcel N TuK ID (Zlo'1 Property Owner's Mailing Address - Property Locatiop _ Z-Z9a F4wQ1I Av'-t Govt. Lot1t3 1?4v LQj,n /a, City, Stale e+_ (� VI r{/(N jCCbt Zip Code Phone Number (PS( 7!e74p 3-08 /<, Section T 51 7 'o II, Type of Building (check all that apply) Lot 8 � I or 2 Family Dwelling —Number of Bedrooms - N R Subdivision Name O Public/Commercial — Describe Use Block N ❑ City of ❑State Owned —Describe Use CSM Number 0 Village of FTownof G io'11ty 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 if applicable.) A, ❑ New System y j' ReplacemenJ;; dification to Existing System (explain) ❑ Additional Pretreatment Uni[ (explain) B' N Holding Tank ❑ In -Ground❑ Mound ❑ Individual Site Design ❑ Otlter Type (explain) (conventionC• ❑ Renewal Before ❑ Revision❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dis ersal/Treatment Area and Tank Information: Design Flow (gpd) 3OO Design Soil Application Rate(gpd/sf) — Dispersal Area Required (si) — I Dispersal Area Proposed (so — System Elevation _ Tank Information Capacity in Gallons Total Gallons It of Units Manufacturer By New Tanks Existing Tanks „''e- 6 E o . S� � u a ii = `e{ 0.O m n wU ScpE. Holding Tank Z L. p p ZCDO 1 W t•eser Cc.vtc, ✓ V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) I' '/ Plumber's Si ature Ailh � r , A ttTp/MPRS Number Business Phone Number a oilr�os/C.l z2000 '7tsz�z_�FISYo Plumber's Address (Street, City, State, Zip Code) i Box szz 5t -oh i ftv' ,,U -L- CY'BY7 VI. County/Department Use Only pproved 0 Disapproved PPermit Fee — Dale Issued L Issuing a Si rc 0 Owner Given Reason for Denial / �� (p ,;0 5 Conditions of Approval/Reasons for Disapproval e Avara m rnn.nrmn aorta ra. ,e..............a o......... m u.0 on,Y 011,7 un papa,- nor has Than a JIZ S II a1MCs In is, SBD-6398 (R. 03/22) ENTEBEG, 5P0O2%c-r Il Il JUN 122025 U 3C Soil Test# Bayfield County 3ayfield Co. Zoning DelWaiver of a Thorough Soil & Site Evaluation sou hsT (subject to 15-1-10(d)) t SS - Z.S w.t1i Fl..)) RO S 1� t a certified soil tester determine that in my professional judgment the following site (see below) is unsuitable for any treatment component other than holding tanks. Due to soil & site conditions, a thorough soil and site evaluation is not needed to make such a determination. 1 1,s� �z f ( LI.�•sfc�rs�- ?z A. Property Owner Ru on L o e Contractor Property Address S Q`E `l o k f' W= P+ R d i Telephone iS( 3 t8 7 4 6, Accurate Legal Description is requested: Authorized Agent Agent's Telephone Written Authorization Attached: Y or N 1/4 of 1/4 Section 2-' Township 5/N. Range 7W. Town Additional Legal Description: AP _ _ _ / ti Govt. Lot i-3 Lot Block Subdivision Lot CSM# Vol. Page CSM Doc # /oV'Q✓ Volume Page of Deeds Tax I.D#11 �I_ ZI o// Acreage Indicate reasoning for your determination: W c l �Y e c0( ti -°t are YI1BI ci. rts K/C-Z e_j`e oa, -AJO cl L,e, 1uTr TS Signature of Certified Soil Tester S -z( -≥LS Date C.S,9. -9 22oO9 o Certification # (Submit a Plot Plan & Fee) Date u/forms/soil testwaiver(KLK) June 2018 ?re v t/ Owner. Le.�o I :Ae.scv; p+ic+v, o ` .R ban6,o8 ErvfLcfID35rca(°"P$ifl 97W PoA ftSpa✓c2� v,� 2298 elweit Ave. Town &f:L'late✓ 57 PC, pA, n't tJ SS t at? (re uati y e &icy -P e l i 'b Nf R ial�rnI Jaeii<)nee'Itsalbn-l�n. Se4Lacks (SP.S383) ALe,,e. fi;•,a 1€J -�- = u;eil ae4f s;�in .eq secoe- �M /co.o., -aa=SckNoPVCw/-Flaw ive� O'm 4"AST6%9 pi 'Sapp ueve p: pc. n.uy,+erle_(;! :trd-f" lleurvrsd % •-S,I Bor 9,r , . N. SCA!eo! oa',1essne4ed Akztras+ Rc1 ` 73c rle P',+ tz 1 ylio'(Coy./ion wls ¢u -one. 6 �0.�f_ yank to P`dwL.ne inle-h JUN 1 2 2025 1 payfleld Co. Zoning Dept. J 1 -Ha Id i ncTan L Coni p ai%i± J i+ .t /YJa nU.tt/ use-rn4utu.o.t"r" pa (VU ad C MXY20 nZ-ao 77 ti fro jet //it m t�,P,PZ5. aao070 po lkck S , ph t.t bl v<N pae, A3oC szz ry an FVvev; wr s'y8Y7 Pg1of6 Pg2of9 LUJUIUA NO, 99/5 P. 2 Holding Tank Plan D �' Index & Cover Sh i H JUN 1 2 2025025 eet 1 Bayfield Co. Zoning Dept. Component Manual Design References: i dab ®,wc l /rerC\J€d^Sato2McAll LOZZ-Zot?) Index & Cover Sheet Plot Plan Pg 3 of S' Holding Tank Specifications — z s s. -e s Pg 4 of� Management Plan Attachments: 6 + Y j POWTS Applic� � t, -c. 9 Soil Evaluation Pc- - c f ' Holdin Tank PI r`l 9 Of- 9 _- HoIdinq Tank Ac Project Name I Description It5c 6 Lcrvrs pv$e R fi: Owner Name(s): Rv i Dc nhcwe- Phone: hs/ _ 3.^g _ -74<-l- Owner Address: zz.gf i=c/ ellAV5-f/ „( PH/J Zip: s`S/ og Project Address: ?5L/90 r?4 SL j V1 , _t f Zk !-ft r 6 s+E r ;'JS Govt. Lot: I 3 pd r -c I Qection Z k , T -I N_R ' E ❑ or w_ Township: n 2 County: 2'__ t e l c� Project Parcel ID #: i �>< i l> 1 z t c Designer Information Designer Name: /_� h Pc, /J:s o s Acit Phone:17/5-37z.. -3 7z _ L,7/S% DesignerALddress.- "Rb, 6K S -%z_-2_ Lrnn Kru' y <(� Zip: _SOSS�7 E-mail: ! .�L % Cry L -c l7r cE ich v-"_ V L '"�. ThI4 space reserved for approval stamp. License Number: z 2 OO e; o Remarks; Signature: Date: s- a y z S Original signature required on each submitted copy. I Prmp eu'i Ownnro Le.1ULI Dasc rlp-h en o ' ti wFk. Sehllcwt EosfLclvssscc 2e'i5(M R7W Ei;5c,"Olchv s+chsc^ P,O.A. Tswn of:Clcue✓ Cct;vL4 c:.Bcyf e (1 d 41 c -f $trots: /2• I N ScnJt: !'=Wlo'an(ecs no-(eri Mutras+ 4vk i?t r - t Z',z0ooC4Jlon tJ.'eser cencvel-tTank= 1/c`O'L-%"w £4,1 ".Fv-o.n bmttcrl of 1'ecnk to Ftc"vC..e in)f+ UN i6�,gti 00 JUN 1 22025 U r.,f G` L4 55�field Co. Zoning Dept. A, 1 .�3 u �,•d?,•,age, ly'r".j`' „kale sy,_ „r F6. /51 V"scti a! Ztvs�alao je..ia--IZ a 1'i GN �a •��rotee�Sa/!oleo, SEiLne.lrC5 CSPS383) A.FG- Abovy r«je = v.:eJt BflfPtE/e.tr/ao.C' emr jZt5chWoPvC/$10c1;rett 4"Asrm D i c ccpp re pp c %Lt -ft (r' ct t� C' t1 V .�.f �'c_Jol! I0 He 1dI ncj /cork �yyoo�Mo'�t°"tet /Y) flbt&/ 4[Sf..JyJdAL�UdAd.d7c.(1Pe. &ERad); c n&yzozz-aon) praLjk'it V; ?.S5. z2co90 Polkclsk! PIu.n.tb nq T,.on ivev, ws SY8Y7 PROPERTY OWNER l;.Sal-C t,Cl,v;s/efrs P.i/%. PLUMBER: SIGNATURE: Li DATE: S=z/_ Zr LICENSE # 220090 HOLDING TANK SPECIFICATIONS 2 Number of bedrooms _ 3Non-residential estimated flow (gpd) 20t1o.0 Minimum holding tank volume required (gal) 2000.0 'Proposed holding tank capacity (gal) Wieser __ �_. Tank Manufacturer W2000 Tank model number SJ Electro T .n.- . dAlarm manufacturer 101 H W _ --_ ^Alarmmodel number JUN 1220z5 2025 Bayfield Co. Zoning Dept. Tank Dimensions and Data Tank Anchor Calculations X for round tank 1637C' lbs Weight of tank and cover 47 0 'Liquid depth below inlet invert (in) 1 60 Safety factor 8.0 Maximum depth of soil cover (ft) 31055 lbs Weight of anchor required 66.0 .Height (in) 11 Outside 36.0 in Soil cover req. for anchor or 161.0 ..Length (in) I Dimensions 7.7 yd3 Concrete counterweight 86,0 Width (in) Only junction box —_ conduit —9 blind plug to seal outlet HOLDING TANK CROSS SECTION manhole cover with locking device and finished warning label grade 4" min. 24 in. -+ Manhole and vent locations may be reversed. service 1 12.0 in. alarm on .n Electrical as per NEC 300 and Comm 16 35.0 in. Note: All tank joints, and joints between tank openings and piping are sealed watertight. All pipe and vent materials comply with 5P5 383. vent cap 12" min. vent pipe T 18" min. building sewer Inlet Project: 3 In. bedding under tank. Tank is anchored as necessary to negate buoyancy. a 0 a> 164" C N TOP VIEW 4" CAST -A -SEAL 4" CAST -A -SEAL •m2A FILTER OR BAFFLE INLET OUTLET o co N PUMP PAD SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS WLP2000-MR TANK SPECIFICATIONS DIMENSIONS: WALL: 3" BOTTOM: SEPTIC 3" HEAVY DUTY 5" (ADD 2,800 LBS.) COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 53" O.D. LENGTH: 164" O.D. WIDTH: 96" O.D. BELOW INLET: 41" O.D. LIQUID LEVEL• 36" WEIGHT: BOTTOM 11,260 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 CAPACITY: 56.27 GAL/IN LOADING DESIGN: 8' 0" UNSATURATED SOIL HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 2,138 GALLONS TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: Q � 0 z I Q o 0 N 0 of P W N flUII JUN 12 Z0Z5 HOLDING TANK MANAGEMENT PLAN Bayfield Co. Zoning Dept. This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be Installed and maintained according to S 393 is. Admin. Code, the Holding Tank Component M Huai t use c1 N�� ��c I ype- VER2vo and the Bay -Pe. (� County Sanitary Ordinance. (�n 21) 1 LM zoza._zcz7) 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 SPS 383 and384 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 SPS 983.33 Wis. Adm. Code. 10. If there is a problem with, or question about this jnstallation, the following persons should be contacted: a. Installer.............................Poi l4 olam n9 m.P,RS.zzoo40 Phone: 7/S 37z- L/1flo b. Service Provider.................. SepJe R ' l a Phone: 7iyr 37Z - '6o®f, c. Co. Zoning or Health Dept. &y44J £au4y nh4r Phone: 7is 3-72- bl3P 11. riPn J D�sG:.Tctrc4l gn Lc. [ j£3.uecz0 TS/ N 97W sun4p ° A 1 Q Pa)¼rc.QJtD Tax =lb 17-4O1 Project Transaction Number: HOLDING TANK SERVICING CONTRACT u u Contract Date 5-- 2 2 2 C This contract is made between the sMIro✓Ls,�w, JUN 1 2 2025 vfield Co. Zoning Dept. We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT Legal Description: Taxiau „r LOCATION- (Use Tax Statement) 12-1 O 3/4 /4Q / Section .'f ` � f N, Range / Town of; Lot Size Acreage ,Township w, GqA at Lot Is CSM # I Vol. Page CSM Doc Is Lot(s) No. Block(s) No. Subdivision: 3 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. p4„1/Owner(s) Name(s) me(Print) Owner's /Signature(s) //��VVl Subscribed and. $warn to me: • f? 1 Dt , re D1JJC- on this �ay �N/Vvf �/ of Lit Notary Public LISA L. GRILL My commission expires on: i • 5V My Commission Expires Jan. 31.2028 Revised: May 2016 (®May 2018) v"vti "` Drafted by IC p Personal Information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)) Document Number/Plan I.D. No. HOLDING TANK DOCUMENT NUMBER AGREEMENT 2025R-60771 2 (�(/t y�/nt� �,, M �,�1 Owner(s) Mpilin Address �/ DANIEL J. HEFFNER Pp�t/`C� �5� �) I l[ftJt,- ? ' RC€ U " 1 • REGISTER OF DEEDS rT I'ew I M ^ V ®2 BAYFIELD COUNTY, WI Parcel Ide���ntifier Number (PIN) /rU(rAggro/e/m�e/nt Date (same as Notary -Date) O Oiti/-SI Q7 I (.� co D D ZZ—'ZS RECORDED O6/O3/2O25 AT11 1 :O3 AM We acknowledge that application is being made for the installation of (a) )holding tank(s) RECORDING FEE: $30.00 on the following property or that continued use of the existing premises requires that a PAGES: 3 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,// 1/4 of_ 1/4 Section7. 4 rnu_mnhlp 51 N. Range _7_?_._.W. Town of C-1a,er Return To: /9 t to .Y: r �• 7-' •0 d ( D Additional Legal Description: �i ae t f $ �'��e"S Ian = Gov't Lot _ Lot_Black_Subdivislon CSM#_ IJ _-, �S d X 5` zI`v I Lot_CSM # Vol _Page _CSM Doc# v o' ,� '�� ,, CILW. r-7� % As an inducement to Ba old County to Issue a sanitary Bayfield Co. Zoning Dept. yfi 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 falls to have the holding tank property 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, State., 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, Slats. 2. Owner agrees to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 3. The owner agrees to contract with a person who Is licensed pursuant to s.281.17 (3) Wis. State., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced In accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed pursuant to s. 281.48 (3) Wis. Scats., and Ch. NR 114, Wi's Adm. Code who shall submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfield County may enter upon the property to Investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank Is not being properly maintained. 5. This agreement will remain in effect only until Bayfield County certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. SPS 383, Wi's Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement In such manner which will permit the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. Ownner(s) Name(s) — Please Print Subscribed and sworn to before me on this date: j `— PVk Elt5&be-J'i N≤4t'a tiS�' w Notarized Ownnerr((s)(11—SSIgggnaturee(ss)� ota P blic 'C Q Q4 J o Zo r Drafted by: l o h t� �C> a' S �Lr Date: 22-^ 2 ,� y.�Personal lnforrnedan veuorovde may ha„eed!cree^.^.^._. *;•P�:. as i:'r:•o:2:a•,,s•1?.`»Fiimil utfomwaeniteryroldingmnkagreement.doc®une201 ;j'-{}"'1`' j-tal��hc� � ���oV[� BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS JUN 12 2025 Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) Bayfield Co. Zoning Dept. IZl Check List GZ' Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) fd Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) ®' Original Plot Plan (383.22(2)2. 3. & 4.a) 21'Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer 10 Pump Tank Diagram, Alarm and Pump Curve (when applicable) ( Contingency Plan / Management Plan (383.22-3(2)(b)l.f.) ❑ Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) d Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) li Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) PI Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 2 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) m Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) R1 I Application Information must include: ❑ 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) ® Project Address QE Road Name where driveway is/will come off of) ( (Owners Phone Number) II Type of Building fr7 III Type of Permit fl1V Type of POWTS System ❑ V Dispersal / Treatment Area Information d VI Tank Information 21 VII Responsibility Statement (Plumber's Information) ❑ *Date Stamp* Plot Plan: (To Scale or To Dimension) ( Signature and Plumber Information Address Number and Road (Surface Elevation of Body of Water l0 North Arrow ❑ Direction and Percent Land Slope O Contour Lines ITank and Filter Information and Location iif Structures and Driveways Z Wetlands / Navigable Bodies of Water 10 Boring Location ❑ Absorption Area (Proposed and Existing) Property Lines 121 Bench Mark (Location, Elevation and Description) liZ Well Locations 5 Component Manual Version Legal Descriptions Piping Material Information (conveyance line, building sewer line, material type and diameter) Turn Over ► BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): Id Check List 91 Index Page / Title Sheet (Optional) 1111 JUN 1 2 2025 Bayfield Co. Zoning Dept. WI Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) It Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) m Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used CJ Property Owner's Information (rnot prospective buyer's name) ❑ Property Location (Accurate Legal Description with Sec/Twp/Range) 1 Road Name (where driveway is/will be coming off of) WI Floodplain Elevation, Flow Rate, Comments and Recommendations LI Complete Soil Boring / Pit Information 0 Date Soil Evaluation was conducted WI CST Name, Signature, Number, Address and Phone Number ❑ *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) d Bench Mark (Description, Elevation and Location) U Contour Lines (Example = 98.0' /96.0' /94.0') m Pi aperty Location (Sec/Twp/Range/, Accurate Legal Description) 0 Borings (Locations and Elevations) L^ Percent and Direction of Land Slope I Well Location (Including Neighboring Wells, if applicable) t6] Location of Wetland Areas, Floodplain and Navigable Waters WI Buildings, Driveways, and Structures (Location and Descriptions) Iii Location of Property Lines C1 Existing System Location 121 Address Number and Road Name d Current Surface Elevation of Wetlands and Navigable Waters A CST, Owner and Property Information o North Arrow Fee: III Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checklist/checkI Istforests H.CMIIuerCompanyjg DOCUMENT NO. 344347 Charles W. E conveys and warrants to — Donhowe hiE the following described real estate In Bayfield County, State of Wisconsin: STATE BAR OF WISCONSIN - FORM 2 WARRANTY DEED THIS SPACE RESERVED FOR REQORDING DATA REGISTER'S OFFICE 4 S.S. Bayfield County. Wis. RECORDED AT 3.4/0 p M. ON AUG 2-1982 IN Vol..3�7 of &a, Page o// —alai' O REGISTER OF DEEDS RETURNTO G1e)r&O� lh Liot. u'e G-& 13 5 Kn" p & pdG.rro sf bal, M N s 6- Pd . Tax Key No. - A parcel of land i9 Government Lot 3, Section 26, and Government Lot'lection 25, Township 51 North, Range 7 described on the Schedule attached hereto. West, JUN 1 2 2025 This deed is given in performance of that certain Land BB�ii@fglN. Dept. between the parties dated May 6, 1978, and recorded in Volume of Records, at Pages 449-451, inclusive. This is nothomestead property. (is) (is not) Exception to warranties: Dated this day of AUTHENTICATION Signatures authenticated this .19 _. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) This Instrument was drafted by Atty. R. W. Norlin TRANSFER FEE 1g 82 (SEAL) ✓ t. 4" (SEAL) Charles W. Egstad (SEAL) day of (SEAL) ACKNOWLEDGEMENT STATE OF WISCONSIN ss. Bayfield County. JJ Personally came before me, this R H" day of 3 -+,.. 1 L. , 1982 , Charles W. Egstad the above named Washburn, Wt to me known to be the person_whoexecutedtheforegoingin- .strument and acknowledged the same. (Signatures may be authenticated or acknowledged. Both are not necessary.) .� a ti u a y y G ) 9 Notary Public Bayfield County, Wis. act •Names of persons signing In any capacity must be typed or printed below their signatures. O mission is p 0. ma ent. If not, state expiration date: ryn `sar�csstOn t-�4 .19 t.) -I' A parcel of land located in Gov't Lot 3, Section 26, and Gov't. Lot 1 Section 25, T. 51 N., R. 7 W., Bayfield County, Wisconsin, described as follows: To locate the Point of Beginning, commence at the South 34 corner of said Section 26 and run N. 01° 01 00" W, along the North - South 11 line of Section 26, 1974.61 feet to an iron pipe on the Southerly R. 0. W. line of a Town Road; Thence N 47° 44' 00" E, along said Southerly R. O.W. line; 863.21 feet to an iron pipe on the East-West 34 line of Section 26; Thence N. 89° 03' 00" E, along the East-West 34 line (parallel to the South line of Section 26), 1144.25 feet, (passing thru an iron pipe at 1103.79 feet) to a 1" iron pipe, which is the Point of Beginning. Thence from said Point of Beginning by metes and bounds. N 89° 03' 00" E, along the East - West 1£ line 619.54 feet (passing into Section 25 at 568.55 feet) to an iron pipe near the shore of Lake Sup- erior; Thence along a meander line near the shore of Lake Superior, NOO° 01' 38" W, 100.02 feet to a 1" iron pipe; Thence leaving said meander line, S 89° 03' 00" W, 621.15 feet, (passing into Section 26 at 51.76 feet), to a 1" iron pipe; Thence S 00° 57' 00" E, 100.00 feet t) the Point of Beginning. Intending to include that land lying between the meander line and the shore of Lake Superior and the extensions of the North and South lot lines to the shore of Lake Superior. 1111 JUN 1 2 2025 Bayfield Co. Zoning Dept. 1 YFIELD 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: DONHOWE, RUTH S 2298 FOLWELL AVE ST PAUL, MN 55108 Description Certified Soil Tests - Review & Filing Fee Submission$ Number: SR -00264 Transaction Number: SR -00264-2E329 Amount $50.00 Total: - $50.00 Payment Amount: $50.00 Reference: 6200 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 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. TFIELD 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: DONHOWE, RUTH S 2298 FOLWELL AVE ST PAUL, MN 55108 Description Private Sewage System (Septic Tanks) Submission Number: SS -00571 Transaction Number: SS-00571-2E32A Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 6200 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 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 COUNTY SANITARY PERMIT (#04)-25-59S STATE SANITARY PERMIT OWNER: RUTH S DONHOWE GOVT LOT: LOT: BLK: 1/4 1/4 SEC: 26, T 51 N, R 7 W TOWNSHIP: Clover SOIL TEST: 55-25 REPLACEMENT SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: ALLAN POLKOSKI 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: # MPRS 220090 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 ° APPLICATION FOR PERMIT C tlrthWe, Annex P.O..Box, 56 117 East Sixth St. BAYFIEL© COUNTY, Washburn, Wl 54891 �ifll5 APp ttion No------ - �S-- -- �� 3 s 6 3 Date ------------------------- Zoning Distrito ��ECIAL - - AND USE SANITARY El CONDITIONAL � Land: -------- t/4 of -------- 1/4 of See. _2L T... s LN. R. _-___ W. Town of C_ D vQ_____ Volume ------- -- Page ---------- of Deeds. Fire Number ------------------------------ _______ Name s $Ss? nksLu- --------------- Contractor ___. ---lr ------ - Address 0113 .11rr SC n f M�Plumber Jlpt - ---------------- SS/o8 Telephone lFJR=?Y5_7_---------------------Well Driller ------_--------------------------__---- Structure — New --______ Addition ___ ___ Number of Stories Bay-ment — Yes '_---------- __ a _. L ----- No ---------------Square Feet of Floor Space ------------------------ Estimated Cost of Construction .----------------------------7--------------------------------------------- Structure Use __ 5 7 fit' -c14 / Q----------------`- - -------------------------- ---------------------------- (Residence, Garage, Storage, Drugstore, Tavern, Etc.) Sanitary — Septic Tank & Disposal Field --------------- Privy ---------------Holding Tank ------------------F ---?__ Td.- = F4-- r- -CiA-/ 9G ------------------------------------------------------------------------I Remarks: Fee: -------- Amount Paid; I, the undersigned, attest that the information contained herein is accurate and true. Owner(or Agent) --------------------------------------------------------------------------------------- Address (if different from above) -------------------------------------------------------------------------- APPLICANT -- PLEASE COMPLETE REVERSE SIDE Note: Submit completed application and fee to: Zoning Department, Courthouse, Washburn, WI 54891. Do not start construction until all permits have been received by the applicant. Changes in plans must be approved by the Zoning Department. A permit may be revoked if misrepresentation of any of the information conveyed herewith is found to exist. Zoning Department: (715) 373-6138 or 373-6139. — OFFICE USE ONLY - Permit issued: s State Sanitary Number . ___ Permit Denied (Date) Date--____-� o __3 �- --'-�----� PPermitNumber --_---- O ---- Reasonfor Denial: -------------------------------------------------------------------------------------- Inspection Record: _?G_� - �_ _^ L� ✓�� _-_ 2 � �[� �b ° t__--- _ �--- �p , L P ---------------------- By -------------- Date ---------------- Variance Condition ------------- Signed ---------------------------------- -------------------------- e4aefvd,%� / �"- . jC..,.F / % Inspector �'-ate-ti's 1. Using the frontage road as a guideline, fill in the lot dimensions and indicate North (N). 2. Show the approximate location and size of the building. 3. Show the location of the well, septic tank, and drain field. 4. Show the location of any lake, river or stream if applicable. 5. Shaw dimensions in feet on the following: a. building to' all lot lines ® �� b. building to centerline of road c. building to lake, river, or stream d. septic tank to closest lot line e. septic tank to building f. septic tank to well g. septic tank to lake, river, or stream h. drain field to closest lot line i. drain field to building j. drain field to well k. drain field to lake, river, or stream 1. well to building lB Lot Line �XrSY'is� gcrvrs9 Z' C jJ /?met' O o l tJ 7 j. Frontage Road Indicate whether or not the following locations are staked: Ilb Structure. . . . Yes No _____ Drain Field . . . Yes _____ No Septic Tank . . . Yes -__-_ No _____ Well . . . . . Yes . No _____ 6tl//I &i3 �¢8� 17 APPLICATION FOR SPECIAL USE PERMIT II #H##fllllf####Uff�lfllNl11fffMll{fi##//�flfflllfflffll{f�llflllllf�lHlfllflllHili�l####lllll�f�l########lfflllfl�llffllff{######/H/## THE UNDERSIGNED HEREBY REQUESTS THE BAYFIELD COUNTY ZONING COMMITTEE TO GRANT A SPECIAL USE PERMIT: opy I. NAME /ell) S C/cM /�azvc� ADDRESS /3 5 422 �,dp ST TELEPHONE (/'2-) 6f4- &/-/_55/05 CITY STATE ZIP LOCATION OF PROPERTY: }, }, Section c?, T. S/N., R. ADDITIONAL DESCRIPTION: TOWN OF G/i.r_.- DESCRIBE PROPOSED PERMIT (Use reverse side or attach separate sheet, if necessary) II. LIST THE FOLLOWING: Provide the names and full addresses of the owners of all property abutting the applicant's property. (List all adjacent owners surrounding the subject property.) %Qtt,. Pa wl M w q(.s J S M n wKr Ca.! w PL , (Use reverse side or separate sheet, if necessary) III.ATTACH COMPLETED BAYFIELD COUNTY APPLICATION FOR PERMIT FORM AND PLOT PLAN DATE: &pi 'l`t , 191..E SIGNED: (Appl icant Agent f.. COPY October 13, 1993 Ruth Donhowe 2135 Knapp St. St. Paul, MN. 55108 Dear Mrs. Donhowe, Please be advised that on October 12, 1993 the Bayfield County Zoning Committee reviewed and subsequently approved the issuing of an after -the -fact permit for the establishment of a garage with a guest room on your property and for authorization to construct a 20' x 16' studio addition to that structure. Authorization was granted with the expressed understanding that this structure be provided with an approved private sewage system satisfying code criteria of the Wisconsin state plumbing code. You are asked to obtain a sanitary permit for that system and assure that the upgraded system is installed by June 15, 1994. Please contact the Master Plumber of your choice and ask that he work with this Department in securing the required sanitary permit. Please find enclosed the permit for your guest cabin and studio addition. If you have any questions decision on this matter or you with either the permit contact me. Best of luck. Sincerely, David K. Lee Zoning Administrator DKL: ebz Enclosure regarding the Zoning Committee's if I can be of further assistance to process or code requirements, please TO: HAYFIELD COUNTY -ZONING COMMITTEE. FROM: ____/GGU-ex-- TOWN BOARD SI°JBJE=T: TOWN BOARD RECOMMENDATION We. the Tcwn Board-, Town or do hereby recommend the acprcval C7 disapproval at the issuance of a permit [ (Check one) to �' G�+/ swhose proq.erty is located in, the irC G/ -6 -(Name ce applicant) 1/4 c -f the 1/4, Section Township S% North, Range 7 West. To cffl y C /% G�acl��i-i /i7 - 7 / G-GI.Ci .Z ii� / Llii,z/ c G�ly•PS' (Skate was- applicant is rsquesting) 5 7 ,/o t22 iinr -e a'7: Becaus'a (St ason rd recclnniendaticn c{'approval or disapproval Signed, Town Board Datzd: O i2. i99S CNcse: When Town cart nas c_mols':ec .n_5 farm, plaase mail.te: E4YFiELD rOUNTY ZONING DEPT. P.O. BOX �8 uu'°SHEIJFN, WI f-LEa. July 21, 1994 Ruth Donhowe 2135 Knapp St. St. Paul. MN. 55108 Dear Mrs. Donhowe, As you may recall I wrote you a letter in October of 1993 advising you that the Bayfield County Zoning Committee reviewed and subsequently granted an after -the -fact permit for the establishment of a garage with guest room on your property and for the authorization to construct a 20' x 16' studio addition to that structure. This authorization was granted with the expressed understanding that the structure be provided with an approved private sewage system that satisfies the code requirements of the Wisconsin State Plumbing Code. You are asked to obtain a sanitary permit for that system and assure that the upgrade had occurred by June 15, 1994. It appears that to date, no action has been initiated by you to correct this matter and I must, therefore, refer this matter to the Zoning Committee of the Bayfield County Board of Supervisors. Your apparent disregard for the sanitary regulations of this County and State cannot go unheeded, so this matter will be called to the attention of the Zoning Committee at their meeting slated to be held at 6:00 P.M. on Tuesday, August 9, 1994 at the Bayfield County Courthouse in Washburn, Wisconsin. You are, of course, welcome to attend that session. If, in the interim, you have any questions regarding either permit procedures or code requirements, I encourage you to contact me. Your cooperation in correcting this matter will be appreciated. Sincerely, David K. Lee Zoning Administrator DKL:ebz — fr� zDc ice zL� 5 z/. �s a°. inso. August 10, 1994 Ruth Donhowe 2135 Knapp St. St. Paul, MN. 55108 Dear Mrs. Donhowe, Please be advised that at the August 9, 1994 Zoning Committee meeting I advised the Zoning Committee that you have taken action to obtain a sanitary permit and install a code complying private sewage system at your property on Bark Point in the Town of Clover. I advised the Zoning Committee that we have received from Certified Soil Tester, Lad Strzok a soils test and that Plumber, Ed Wroblewski has contacted this office and informed us that he will be making application to obtain approved plans from the State Dept. of Industry, Labor and Human Relations for the installation of a holding tank private sewage system. The Committee wishes to thank you for following up on this matter and wishes you the best of luck with this endeavor. Sincerely, David K. Lee Zoning Administrator DKL:ebz