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"" INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY TIME RECEIVED REMOTE CSID DURATION PAGES STATUS I—" October 21, 2025 at 9:12:00 NI CDT 7153724159 40 1 Received Sep 13 2025 12:33 HP Faxpolkosld 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 !f you do not have a fax and must email the Inspection; you must email all staff members, Note Time Change iii Discre! e �ot'�USKr Plumber: , J RC I / �o S '� 1 iJ wi , J Homeowner: o CJ� e 1 - — u v✓ c j J Other Phone Number -7t& zqz-1f(S 7/S' 37Z--((S'� -taw.(L Lcz r u h c n t r+ti• cumin rnone Number So Zl Sanitary 2 — S Dept can call you right back (If r Permit #: Date: Plumber's Time: it: 3o I ownsnip: O v l J Address#& Road Name: r Z ` o -e- 4o ! ova S U ? .; QC or 60 4 i ; s ^^l�f Jr� -z, Lo r1 �GsfJQLj (t Directions To Site: 6oJ e , �:rEka(sISSsfV.��, Comments; 2G 81t( ** Plumbers you must verify any cita igefs,J by fax or email Notes from Zoning Dept; u/forns/sanita ry/requesttorinspection Zoning Dept (®4/12!04); ®June 2023 P0WTS HOLDING TANK INSPECTION REPORT (ATTACH TO PERMIT) ROCHELLETUURA 12950 E CO RD FF MAPLE WI 54854 TANK INFORMATION TYPE MANUFACTURER/MODEL# CAPACITY I 11l,ets�cv dcco SETBACKS Property Line Well Water Service Building All -Weather Road OHWM Swimming Pool + (0 DEVIATIONS FROM APPROVED PLAN COMMENTS (Persons present, discrepancies, etc.) -4 c t &UUa / b�r�M(caah —3d WcLM✓ f -h,\U utl m c 4J$3I0 W a f� -t4 (v & alurM COMPOJIENTS NOT INSPECTED Plan flevlslo Required ❑ Yes No Date: U Signature of Inspect h/ cert. Numbe d JKeicn on diner side 10 of 13 �J V J a A' Property Owner Information As you know onsite wastewater treatment system on your property described as: BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zonina anbavfieldcounty wi ciov Web Site: www bavfieldcountv.wi.00vl147 ROCHELLETUURA 12950ECORDFF MAPLE WI 54854 Notes: Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 was contracted by you to install a private Abandonment of Old System to meet all applicable code requirements: 1 •Y Tank was pumped by: o Tank was crushed I removed and pipes disconnected by: on at AM/PM On at (AM! PM) the above -mentioned plumber contacted our office to conduct a pre -cover inspection as required under DSPS 383. One of the following applies: System was 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: at,1 �< ( nS� (%I (J t( U/!arms/sanitarypropertyowner-input April2019 1911) 07 /'yj\ Department of Safety Ly & Professional Services, ps' Industry Services.Division Sanitary Permit Application 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. I. Application Information — PleasePrintAll Information Property Owner's Name Roth 'e1 !•e v v'c Property Owner's Mailing Address Lzdl.co C C4L '� F City, State Zip Code Phone Number krpIc w I s -Y �� S_7 O - Z-7-7≤ II. Type of Bull 1ng (check all that apply) Lot # I or 2 Family Dwelling — Number ofBcdrooms 3 0 Public/Commercial — Describe Use Block # State Transaction Number t-( [f . S r....Gt S f v', 'e c.! tL 3 Sc T7 '{ Govt. Lot —_ es r {. I :'=_ 4,='/+, Section ___7 T 'I 9 N R 9 •tt�.,,ltsi';`0 O City of O State Owned — Describe Use CSM Number ❑ Village of Q1Townof �v J III. Type of PO�'VTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C appftcable.) A. New System ❑ Replacement System ❑ Other Modification to Existing System (explain) 0 Additional Pretreatment Unit (explain) B. Holding Tank 0 In -Ground 0 At -Grade I 0 Mound 0 Individual Site Design 0 Other (conventional) gType (explain) C. 0 Renewal Before 0 Revision 0 Change of Plumber 0 Transfer to New Owner List Previous Permit Number and Date Issued Expiration v. Pispersau1rreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Ratc(gpd/sf) Dispersal Area Required (at) Dispersal Area Pr Capacity in I Total # of Manufacturer Tank Information L Gallons f Gallons Units I New Tanis I VICH"., Tnnlc Ssptie ar Holding Tank ' .,S o o l ogia&Charkber V: ResponslbiiityStatemen t- I, the u, Plumber's Name (Print) AlIgui jTo1Gt-o5i, Plumber's Address (Street, City, State, Zip rd : L1°° 1 , idersigned, assume responsibility for installation of the POWTS shown on the attach Plumber's S nature MP/MPRS Number �— 22.00q O "ode) w 5• U B r ad plans. 4Q J Approved ❑ Disapproved 1 rcrmrt rcc Date Issued Issu' pg A Signa c ,r O Owner Given Reason for Denial b 1 7 t30 25 ';1/3 � / Conditions of Approval/Reasons for Disapproval d . U s 1 JUL 2'L Attach to complete plans for the system and submit to the County only on paper not less than 8 u2 x 11 Inches In yfield Co. of r � SBD-6398 (R. 03/22) • -- ... -. 110&elN „I �.IIIV{IVu No. 99/5 P. 2 PAGEIOF8 Holdfl ing Tank Plan Pg I of Pg2of Pg 3 of 9 Pg4of Attachments: index over tineet Component Manual Design References: 1'Ylanuuia. ��' � e'r � � p4)e . _oa) Index & Cover Sheet Plot Plan Holding Tank Speclflcatl ns - z 4 s Management Plan ' a 4-9 POWTS Application for Review Csah, YPz -m I 1 AP � Soil ®�� Evaluation Report & Site Map if $ pilcable) 8 Holding Tank Pum in ontract (if a !!cable) Holding Tank A teems needs/ Project Name / Description Owner Name(s): o c �'( I - ,n, • : Z _ o r Phone. s r r Owner Address: ! 2 6-b £4'k?( LdT dip: . S . Project Address: '( `P S'C R1L 'J�r -t.'i 'tf'? 1tv.tI " �' 1/4 of 1"E,1/4, Section 3 T S N_R 'TE Eor i1 Township: U I County: LF c1 Project Parcel ID #: a Sc �• t) 3 I F 7Y Designer Information � r Designer Name: / /a. P / o s I Phone: r7/S -�' z - f S Designer Address• ., a pia. --. ._...�.,,..--.��..,n /� J;e.� f�t.i.2 :Zip: S`{c?.V E-mail: >4 h�y .ls �� v Le.' -t c:: 4 "�'� Thij space reserved for approval stamp. License Number: o Remarks: 1111 JUL 2.2 ?.025 hayfield Co. Zoning Dept. 4�Signature: "`r Date: 7— I — ≥- S1 Original stenaturt3 requirsd on each submfaed copy. I j -c fs L O ! cL vt K BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) 1 Check List ®' Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) frZf Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) Original Plot Plan (383.22(2)2. 3. & 4.a) .(Cross Section, Over -Head Profile of the System and_ Schematic of Tank from Manufacturer V Pump Tank Diagram, Alarm and Pump Curve (when applicable) ii!1 Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) ❑ Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) if Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) IZI Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) 91 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) Wr 2 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) L1 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) 0 I Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) ® Project Address or Road Name where driveway is/will come off of) Rr (Owners Phone Number) 66 II Type of Building ®III Type of Permit 1' IV Type of POWTS System f� G❑ V Dispersal / Treatment Area Information D l5 II ' ( R1 VI Tank Information JUL 2 2 2.025 59 VII Responsibility Statement (Plumber's Information) ❑ *Date Stamp* Bayfield Co. Zoning Dept. Plot Plan: (To Scale or To Dimension) i2f Signature and Plumber Information 1 Surface Elevation of Body of Water ❑ Direction and Percent Land Slope 96 Tank and Filter Information and Location i Wetlands / Navigable Bodies of Water ❑ Absorption Area (Proposed and Existing) iBench Mark (Location, Elevation and Description) C ! Component Manual Version '�ariafofrnatidr f �anvexanre liras; bui d Address Number and Road 10 North Arrow 0 Contour Lines [ Structures and Driveways 2 Boring Location Property Lines Cry Well Locations Ei Legal Descriptions Turn Over ► • BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): 9'1 Check List 21 Index Page / Title Sheet (Optional) I?1 Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) 66 Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) l Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used El Property Owner's Information (aQt prospective buyer's name) m Property Location (Accurate Legal Description with Sec/Twp/Range) iRoad Name (where driveway is/will be coming off of) d Floodplain Elevation, Flow Rate, Comments and Recommendations ? Complete Soil Boring / Pit Information tZl Date Soil Evaluation was conducted d CST Name, Signature, Number, Address and Phone Number 0 *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) IYi Bench Mark (Description, Elevation and Location) l?1 Contour Lines (Example = 98.0' /96.0' /94,0') tl Property Location (Sec/Twp/Range/, Accurate Legal Description) m Borings (Locations and Elevations) f?'J Percent and Direction of Land Slope Vl Well Location (Including Neighboring Wells, if applicable) Ell Location of Wetland Areas, Floodplain and Navigable Waters IZI Buildings, Driveways, and Structures (Location and Descriptions) C?J Location of Property Lines. iK! Existing System Location I Address Number and Road Name Cpl Current Surface Elevation of Wetlands and Navigable Waters U CST, Owner and Property Information [i North Arrow 1111 JUL 222025 Bayfield Co. Zoning Dept. Fee: It Certified Soil Tests - Review & Filing Fee , $ 50.00 u/forms/sanitary/checklist/checklistforests VWtpl- ;x v� •38g-7 `( L o1 Dsc.rph�� !LJi'°Th1 w C.tvt4 c: 3 � Id 4Ea lcfl yt J cr n k ,z L a dS at l fld;,1. 5 e4 dic kS Mode.. - ";6t ( h = w sck I' m PVC '/fI' uJ Cl r rec.` 1 t,!'% A T�i ;� 7 c �`�� w� �,�. p . L+'Lfr'Ct! a i d*' o -r (S tts rnj; N4SC,dko 1 ' �o'Lty► l�.�s 07 c°1 4e NtLUr"L5+ R:≤+ •1 z$_ ac djdllove vj tcev v- ik 193 "La/o( » i *43 F tra -.34 b a l'a v� ec ' rccdM k -f-Q j jc'w L.`&.t H 8 ii; `icjTn k Cep` rvk n,t.4.a% 14s c�Q m r���.d(° � /E R aj° Jra' R' IeJ w2 s'�VY7 L a.. PROPERTY OWNER: o .e .r- . PLUMBER: Allan ! os it Po! ski PlUrnhiimm SIGNATURE: DATE: ? - - -1s LICENSE # g 90 HOLDING TANK SPECIFICATIONS Number of bedrooms Non-resident#a! estimated flow (gpd) Dom` Minimum holding tank volurne'requjred (gal) Tank Dimenslons and Data X for round tank $ •0 8.0 Liquid depth below inlet Invert (in) "' Maximum de th of soil cover (ft) Wei ht in g ( ) Outside 169.6 Length (in) 3Dimensions 9" T"' Width (in) Only Manufacturer model number manufacturer iber Tank Anchor Calculations 1884 lbs Weight of tank and cover Safety factor 47 lbs Weight of anchor required 40,8 In Soil cover req. for anchor or 9.9 yd3 Concrete counter weight HOLDING TANK CROSS SECTION manhole coverwith junction locking device and finished box ...a warring label grade , 4" min, conduit -w-.-� Manhole and vent locations may be reversed. JUL 2.2 2015 vent a$pBaYfield Co. Zoning Dept. 121' min. vent pipe t 1&' min, / r..rr.wrr.r..w..,,,r,,,..r..w.r.1.�.wN..�..�•�.fr.wr ric LIservice 12.0 in. building sewer • blind plug Inlet a arm on Note: All tank Joints, and to s$ai joints between tank culiet openings and piping are• Electrical as per 3gp in. sealed watertight, All pipe P comply and Comm 1 B with s , 'a3 rr- is Sin, bedding under tank. Tank is anchored as necessary to negate buoyancy. r w WLP2500 TOP VIEW INLET 3" d- SIDE VIEW 2 U Co d e D • TANK SPECIFICATIONS QC O a. a ENSIONS: WALL: 3" w a ~ UI a �,t5 �" BOTTOM: 3" HEAVY -5" o Z" L- COVER: 6" �- MANHOLE 24" I.D. PRECAST CONCRETE RISER Z°n�ng 3y '."-r HEIGHT: 52-3/4" O.D. LENGTH: 183-1/4" O.D. WIDTH: 101-1/4" O.D. ¢ w a BELOW INLET: 41" O.D. o LIQUID LEVEL: 36" WEIGHT: TANK - 3" BOTTOM 12,560 LBS. TANK - 5" BOTTOM 15,527 LBS. 0 WEIGHT: COVER 9,300 LBS. U INLET AND OUTLET: m a 4" CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: o o WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) ... ti LIQUID CAPACITY: 69.44 GAL/IN L HOLDING TANK: x co OUTLET HOLE PLUGGED Qom: 8 to ACTUAL CAPACITY: 2,639 GALLONS ® z o0 LOADING DESIGN: 8' 0" UNSATURATED SOIL < to TANK CAN BE USED AS: F) I SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) =o TANK: MIX DESIGN #9 (SMALL FIBER) �� CUSTOMIZED TANKS: OUTLET FOR CUSTOM TANKS CONTACT WIESER CONCRETE 0) M DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: N i3 N Q N a U o 1-w w N ww Ix SHEET NO. 1 /F1 f HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and mnaintained according to 9 383 Wis. Admin. Code, the Holding Tank Component nual 45 e4 �''W G.n ve.l "'ry/PQ tER 2 o and the e, t d County Sanitary Ordinance. ev E 2J)1 L �. 2a �-zvG� ay l 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 5P5 963.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer ............................ Pi__ i &lam = ry m.Pg,S.. zZDogo Phone: -.� 372- 1«'" b. Service Provider................... £ep4-: : a 2 Phone: `iig- 3-a. - c. Co. Zoning or Health DeptPhone: 7'J 3-7„ h 11. Project Transaction Number: JUL � 2 2025 [3ayfield Co. Zon�°9 Dept. HOLDING TANK SERVICING CONTRACT Contract Date a"7 (ca This contract is made between the Holding Tank Owner(s) Name(s) fi och �.i 1 er emu. ,r c�, Pumpe�yr�'/s/Name (Prinat) Pu p is Signature Pumpers' Registration # We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT . ,', Legal Aescriptlon.-: LOCATION Tax !0g /� L t Yd1/4 /cV 1/4, • (Use Tax Statement) ✓) ! -• Town of: L t Size Acreage Soctian ,Township, , J;!Range . 1N V 411. Q Gov't Lot Lot # CSM U Vol. , Page CSM Doc o .: 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; fi; ff D r� r c. The location of the property on which the holding tank is Installed; IS d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; JUL 2 2 20Z5 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. Bayfield Co. Zoning Dept. 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) Owner's Signature(s) Subscribed and•Sworn to me:• rDiiJ 1fL on this _day of $O06 •'-1-'Notary Public JOSE HINE NONA YOKI My commission expires on: t ti 0 tate of W sconsin .� Revised: May 2016 (@May 2018) Drafted by 1�po Personal information you provide may be used for secon ary purposes P vacy Law, s.15.04 (l)(m)] 1 Document Number/Plan I.D. No. I HOLDING TANK AGREEMENT T FftarceParcel Identifier Number (PIN) Agre ent ate (same as Notary Date) 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 Slats. 114 of 114 Section ,3�t TownshipN. RangeW. Town of fl Additional Legal Description: J .-e. ot-}- C'r LJa d Gov't Lot _ Lot Block Subdivision CSM# Lot -CSM # Vol Page CSM Doc# DOCUMENT NUMBER 2025R-608226 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. Wl RECORDED O7/O9/2O25 A1 -2:O2 PM RECORDING FEE: $30.00 PAGES: 2 Return T9:. zor0 eper1rrt -r+ 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: 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. 254.58, 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. 68.0703, 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, Slats., 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, 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 a �errqntshJ I tqie4y the register of deeds In a manner which will permit the existence of the agreement to be determined b erehc!tb the froertwij the -holdingtank is installed. Owner(s) Name(s) — Please Print II I v L 1020 V ti gub ed and sworn to before me on this date: _ B�ytiE:Icl Co. Boni iD�. L Notarized Owner(s) — Signature(s)N a c U\ ILW.LCommission Expi s: Drafted by:to v ih/ c ' ) kC► Personal inrormatton you provffa may be used for secondary purposes (Privacy Law, 9.15.04 (m)) JOSEPHINE NONA NA Y Notary Public State of Wisconsin ®June 2018 ADDENDUM/EXHIBIT A A This transfer is exempt from fee per statute 77.25(2). A PARCEL OF LAND LOCATED IN THE NORTHEAST % OF THE NORTHEAST %, SECTION 34, TOWNSHIP 48 NORTH, RANGE 9 WEST, TOWN OF OULU, BAYFIELD COUNTY, WISCONSIN, MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHEAST CORNER OF SAID SECTION; THENCE S0°50'10"W ALONG THE EAST LINE OF THE NORTHEAST % OF SAID SECTION A DISTANCE OF 651.41; THENCE S89°16'09"W A DISTANCE OF 608.73'; THENCE N0°50'10"E A DISTANCE OF 185.40'; THENCE N89°22'37"E A DISTANCE OF 233.58'; THENCE N0°50'10"E A DISTANCE OF 467.15' TO THE NORTH LINE OF THE NORTHEAST % OF SAID SECTION; THENCE N89°22'37"E ALONG SAID NORTH LINE A DISTANCE OF 375.12' TO THE NORTHEAST CORNER OF SAID SECTION AND THE POINT OF BEGINNING. THE ABOVE DESCRIBED PARCEL OF LAND CONTAINS 287,650 SQUARE FEET OR 6.60 ACRES INCLUDING THE RIGHT OF WAY OF EASTVIEW AND MUSKEG ROAD. Subject to the following restrictions: A habitable structure ust be built and/or renovated on this parcel within 24 months ofthe recording date. If no habitable structure is built, the property shall revert to Bayfield County upon an Affidavit stating that no such structure was built. No short term rentals can be on the parcel 10 years from the recording date. JUL 1' 0 2025 Bayfield Co. Zoning Dept. I Bayfield County Register of Deeds Document #2024R-603568 Page 2 of 2 ff c ieJ • 5JZc9O1'tt Bayfield County Waiver of a Thorough Soil & Site (subject to 15-1 -1 0(d)) Soil Test # Evaluation I 'P / 1,(�c) S G 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. Property Owner R o C- IL -Q / 1--f- TJ 0 f4 Contractor rr Property Address q .S≤ ITJ Li 1cLAuthorized Agent '� ro L -e J t r� Agent's Telephone Telephone 7-I ' •c - y Z 77 Written Authorization Attached: Y or N Accurate Legal Description is requested: t � 3' � � ay �v 1/4 of/ /4 Section, '( Township N. Range 7 W. Town of Additional Legal Description: _F'L v 1bI Govt. Lot Lot ___Block Subdivision Lot CSM# Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# 3 9 0 -7 `( Acreage Indicate reasoning for your determination: t'f C tet . S 0 </_• < a V-.. 4 8 I I L Sc /iec ;'4 /Jo o iL L, -e .s' T ZZ:) c,AJ � _S" /z3 Signature of County Official Date y'LM Signature of Certified Soil Tester Date cr aocIo Certification # J Submit a Plot Plan :'& Fee) I�� JUL 222025 Co. Zoning Dept, u/forms/soiltestwaiver(KLK) gclyf i('. June 2018 prop*-'V^r/ OwrjerrL)U .,.-r' .3Ur-( �.. �1, l !�i (i. G U' i '� t E r1 c.� j t? t'.G3 r PPfl j qy N 4 e %iE4 $j'�'pj c ? w Sck: / ' ' le ti �a (, -r f !1 QAI.r•rZ 5 f j J; L c "'T v' vz �J s D � . as gaItout tA�'.� tcev C'.�rcv-e �JilC_ lJ � �`' r ( C l ex! F „�3I+tr , ' by��i "® �'Y16 Sas-t t/a"LJ-A 1 L (r�r� AL rs dy r o G � i ►� � L. 4e cs rs ` 'a F3 avfilcln caning Dept. a j cLf btCr od7 k, ii yZl r 0'1. s .4- LeLI C LS c5 p.5 1 8 1cJ 1 dtcj 7 t.rt k ccd�bl pa i i Ab tv� c c r Jifc.' L)r.t.,LM 3y 5.acco10 JP ScI &/a p/ vc yi/-c1 �J�f�. %wie -4 V - 1 ". 1 ♦� �t r S I �i7 /L�cS�i/ r • l 6 u dbt J[ q"AS / f/, D 1 ! 05- "-Pp pC vt J 'po e ALq, a v-( C. I U P 1 rr dl R. is a D; w2 s'(7 S.�- ho? County j \Ep Department of Safety Y �� Ir,A & Professional Services,Sanitary Permit Nurn6er (to be filled inby Co.) ServicesDivision Industry � s Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form Lathe appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary _ _ _ 1 purposes in accordance with the Privacy Law, s. 15.04(l)(m), Scats. S /._ S Lis 1 V r C I. Application Information —Please Print All Information Property Owner's Name Parcel # RocLcll.e "1Thuv�3g197�( Property Owner's Mailing Address !19s0 C tiLL P_ �C/iity. Stale ' Zip Code YI r O'pI•£ 14J/ s-y1Sr II. Type of Building (check all that apply) I or 2 Family Dwelling — Number of Bedrooms 0 Public/Commercial — Describe Use Govt. Lot lP,n r CL I n 'hone Number T 1/ Z19 SS f O Z7��. /'G -7 /',/—n/ rE., section 37 .Ot# T X x, o 9 .&.'_/ ❑ City of ❑ State Owned— Describe Use CSM Number 0 Village of IA Town of �� J III. Type of POWTS Permit: (Check either "Newry or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if a livable. A. ® New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) D. Holding Tank ❑ In -Ground ❑ At -Grade I ❑ Mound 0 Individual Site Design 0 Other Type (explain) (conventional) C. ❑ Renewal Before 0 Revision 0 Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date issued Expiration -•••e•• • •-^ arw It. 5.. aura rsppncuuon nanc(gpeisp Dispersal Area Required (at) Dispersal Area Proposed (at) System Elevation Capacity in Total #of Manufacturer Tank Information Gallons Gallons Units Nam Tnnks Existing Tanks e 'u a U E5ti o W Saptiv'erHoldingTonk Z,f00 — ZS00 1 W I• tS - Cone r/ V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's S,nture ttW/MPRS Number Business Phone Number Aiiah 1^'0 I (�os/Cr l 22.00q o '71Sz9zBFI SYA Pluummber's Address (Street, City, State, Zip Code) 1-� Bo)t S7 -z- 5vov, LUT c'`frrly% Approved 0 Disapproved Permit Fee Date Issued ,JL Issu' g A9Signjc 0 Owner Given Reason for Denial Ivb Z 25 9/ / Conditions of Approval/Reasons for Disapproval /it.7/ D U JUL 22 (U%) Attach to complete plans for the system and submit to the County only on paper not less than a 1/2 x Ii Inches in s.,{'1eld Co. LOfl111Y SBD-6398 (R. 03/22) 51Zc9D1' _________ 7 1Zs.Z Soil Test # Bayfield County 0 U Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) J / / u.t/I P�os k i 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. Property Owner o L -Q r /-4? TJ f� Contractor Property Address 4R1 ..S≤ 1EEc s 4 J;f U Authorized Agent 1" "7 Agent's Telephone Telephone Z i S"7 O z-7? J Written Authorization Attached: Y or N Accurate Legal Description is requested: A-1I4of_NtJ1I4 • 3 ' i �t(� ©v ( Q Section�Townshrlp N. Range�W. Town of Additional Legal Description: FL v Govt. Lot __Lot Block Subdivision Lot CSM# Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# 390'7 Acreage �• 4P Indicate reasoning for your determination: t1e± C 0; < h a V 44 o -� . ,� "'.�- `. /I Lis c 4 . c7s•� / o o -e r �a c� .S �� h .L , S� l hec+f y G� S /7/3 Signature of County Official Date Ls Signature of Certified Soil Tester -7— fT�--Z5 Date Csr aocIo Certification # \ fl\ 2 Submit a Plot Plan & Fee) JUL 2025 g De t u/forms/solltestwaiver(KLK) gayfield Co. Zo" June 2018 OW dr" r � U fit IrfL P1/Iupk WTs'≤y Tex -rl�o •310 t7�( ltj E iJE4 3rWN ? w Sk: i ' io'a 1 N4 5 i: jc≤+ 's (-4 1 ¢' a J ( J '�-z� OO 2,ix,110A w'° �..SC.rr� ('_ancv-�'k_T ktg� Ll 43a 1 �o� ,r - '`tra Fyn b-+ &F �Y f, e' 'P 'i4d►k *o. FjowL:s ( cL f bL 1 ei k,' ee4s 0.11 kiif,i. --Lae. k5 egP.53�3� ' V + h � ., --3- 4 = 5ch Ala PVC vu/-F1ct# 4 a;O ( L, 43-'1 �I "ASTa i 1� ) 7 ��' ct, jap v0 VC-� lam. p e. &'.L I— rr1 CL ( ; Li .Y4 mw.t/` —C( 1u' L&A pe VET a.j; (wkAiO l2 a® ) 13Y pl .5. acco 10 PO !kcs kr PILL Rei3 IA ,,,twu No, 99/5 P. 2 Holding Tank Plan PAGE 10F8 Index & Cover Sheet Component Manuel Design References: I�lcetwal /pe,rCV rCo2.J)(M9Z0Zl ZoZ7) Pg1of6 Pg2of9 Index & Cover Sheet Plot Plan Pg 3 of St Holding Tank Specifications c Pg 4 of 9 Management Plan Attachments: F 5' POWTS Application for Review(src„ o . g Soil Evaluation Report & Site Map (if ap c4 2 Holding Tank Pumping Contract (if appli y Holding Tank Areemerit (if a licable Project Name I Description + Ref o f5 Dins Owner Name(s): iz CC 4 / 9 Phone: z / 8 - .≤1° Owner Address: I z9 So e C i— Fp t dT Zlp: Project Address: -r j b Y7 fiy` 4I'"/v E 1/4 of N`E 114, Section 33 ( ,T s/g N -R % E ❑or W © Township: C 0 County: e. y -F. Project Parcel ID#: ' KTb `Y 3 8'v7{ —' Designer Information Designer Name: A / /cL in Pc, / K , s Phone: 7/Y -ti72 - /r6 Designer Address: RD. . ©K c Lr, 'S/uZ Zip: E-mail: J',;. h L •j frc^ e Lt �-t<e L `"� Thfs. space reserved for approval stamp. License Number: z a o fl C) o Remarks: ll JUL 222025 Bayfield Co. Zoning Dept. ,Signature: Dafe: Original signature required on each submitted copy. )14bl./�ahcy CLvt V, BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) Check List Cd' 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)) G[f Original Plot Plan (383.22(2)2. 3. & 4.a) Elf Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer l0 Pump Tank Diagram, Alarm and Pump Curve (when applicable) Q Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) ❑ Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) i Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) rd Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) a Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 6,d 2 Comolete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) �f Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ State Plan Review (when applicable) 0 Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) Cd I Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) ® Project Address Road Name where driveway is/will come off of) f¢7 (Owners Phone Number) f1i II Type of Building ® III Type of Permit 6d' IV Type of POWTS System 0 V Dispersal / Treatment Area Information Ill VI Tank Information Ed VII Responsibility Statement (Plumber's Information) 0 *Date Stamp* Plot Plan: (To Scale or To Dimension) 19 Signature and Plumber Information Is' Surface Elevation of Body of Water ❑ Direction and Percent Land Slope i Tank and Filter Information and Location l4 Wetlands / Navigable Bodies of Water ❑ Absorption Area (Proposed and Existing) 19 Bench Mark (Location, Elevation and Description) 1111 JUL 222025 Bayfield Co. Zoning Dept. E9 Address Number and Road fj3 North Arrow ❑ Contour Lines I Structures and Driveways fr3 Boring Location 4 Property Lines E Well Locations [ Component Manual Version WI 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): 0 Check List 1 Index Page / Title Sheet (Optional) m Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) [Z Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) 23 Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used 16 Property Owner's Information (not prospective buyer's name) 2 Property Location (Accurate Legal Description with Sec/Twp/Range) 16 Road Name (where driveway is/will be coming off of) l Floodplain Elevation, Flow Rate, Comments and Recommendations 0 Complete Soil Boring / Pit Information 121 Date Soil Evaluation was conducted d 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) C✓ Contour Lines (Example = 98.0' /96.0' /94.0') m Pioperty Location (Sec/Twp/Range/, Accurate Legal Description) f0J Borings (Locations and Elevations) 21 Percent and Direction of Land Slope 0 Well Location (Including Neighboring Wells, if applicable) u ) C 16 Location of Wetland Areas, Floodplain and Navigable Waters A Buildings, Driveways, and Structures (Location and Descriptions) JUL 222025 E6 Location of Property Lines Bayfield Co. Zoning Dept. LP1 Existing System Location 0 Address Number and Road Name Rl Current Surface Elevation of Wetlands and Navigable Waters d CST, Owner and Property Information ❑✓ North Arrow Fee: Eli Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/check) ist/checkl istforests V'r®ptvi-y I-)w.1er. jKTuuvw jz9so +y?kFi Vb(apk irsy' sl Lto.l AgScr;p+nt l'& E $IJE N 5ec3 %"igtfl R I vv I -a Y c -f i IfrI 5 Twin afou (u c.tt..t4yec:13et`e,.c /d ,e S 2dtl[[`i S£ I a �GLWrr(' ytic . IC d l'81�, AIVJ Jr.1 kikt tL e --s 0.11.21, /Love - Ci-,ck(y cJe c = we -it _Ta�gf�Q�f( �IA4 81Y1£vi`p Elvleo.o. 4c=SckwwePvc vu/Flo"., ;YeL-f;G-M = q"ASTOI jjI7p5-ctpfv-evee� 1 •pE v.ut'fevIci(I o4 Sea rnls. •= Se1I ' N Scoot: 1'. &/o'anlfcs ne4f.d. Ne,.tr-e,s+ RAE4+ v. t J �zd 1,zs- gallon W.ese.r cencr 1tT&nk= In at_Ioj "W k 3 v-on'1 b ,fte,' of iunk to FdowL.;e 1 "IE-F. JL 5 a e oEcEoIEB JUL 222025 Bayfield Co. Zoning Dept. CJ lie lcl i.1cjt;I k Ceng7calf r ,y) �u.al u.s_JQin4n�,vyFype &ER&4; C vs9t6Yzozl-z®2.7� Y/rctOnn /'/Y s nI,F1 5 a2 c' o Po/keskl Plan b t?a,aoK sa-a Sren p;vei w17 CY8v7 PROPERTY OWNER: o tt I f� PLUMBER: Allan Pniknet,lf e.....__._, ... SIGNATURE: DATE: 7-1O -zS LICENSE # 220090 HOLDING TANK SPECIFICATIONS 4.3 Number of bedrooms Non-residential estimated flow (gpd) 2f100,0` Minimum holding tank volume'required (gal) I enK ufinenslons and Data ) .w" X for round tank depth below Inlet Invert (in) ium de th of soil cover (ft) (in) Outside i (in) Dimensions (in) 1 Only Manufacturer model number manufacturer ber Tank Anchor Calculations 18840 Ibs Weight of tank and cover 1.50 Safety factor 4020_ Ibs Weight of anchor required 40.8 in Soil cover req. for anchor or 9.911Yd3 Concrete counter weight HOLDING TANK CROSS SECTION JUL 222025 manhole cover with Junction locking device and finished vent eapBayfield Co. Zoning Dept. box Warning label grade / l� 4 min. E-- 24 In. $ 12"min. conduit --_> Manhole and vent locations may be reversed. vent pipe IS mm, service 12.0 in. building sewer blind plug too se stem, on Note: All tank Joints, and inlet utlet Joints between tank Electrical as per openings and piping are NEC 300 39.0 In. sealed watertight. All pipe and Comm 16 and vent materials comply wlth5 S J33 3 In, bedding under tank. Tank Is anchored as necessary to negate buoyancy. WLP2500 M 12� TANK SPECIFICATIONS 183j" (ta V WENSIONS: WALL: 3" lei BOTTOM: 3" Z �O Z5 HEAVY - 5" 1 '� C C Ui 4" CAST -A -SEAL 4" CAST -A -SEAL FILTER OR BAFFLE ml M TOP VIEW SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS � - COVER: 6 MANHOLE: ea je1d GD ZQning 0ep4 O.D.CAST CONCRETE RISER HEIGHT: 52-3/4" LENGTH: 183-1/4" O.D. WIDTH: 101-1/4" O.D. BELOW INLET: 41" O.D. LIQUID LEVEL• 36" WEIGHT: TANK - 3" BOTTOM 12,560 LBS. TANK - 5" BOTTOM 15,527 LBS. WEIGHT: COVER 9,300 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL - OUTLET M INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 69.44 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 2,639 GALLONS LOADING DESIGN: 8' 0" UNSATURATED SOIL 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: f i I 2OF 1 1I HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and ;maintained according to Sf5393 Wis. Admin. Code, the Holding Tank Component A nual tn.stdp "lY%&niiet I tyr' 4ER2o and the 'Bct,Y-fie. U County Sanitary Ordinance. ` e z.1) i C.NV1 ay Z0ZA_Zn[.7) 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 and84 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 SP$ 383.33 Wis. Adm, Code. 10. If there is a problem with, or question about this IIinstallation, the f wing persons should be contacted: a. Installer .............................p©! osg Plambsn m.fas.. ZZoogo Phone: 7i$ 3zz-. 4isfo b. Service Provider ...................j- Se !: r R2yh nzI Phone: 7/,c- 37y _ Woo& c. Co. Zoning or Health Dept. (3a, . tan;.sy Phone: 7/3 3-7,,1— Ufl 11 !fig[ bescr. Parc2) .h tJEJ9 1J!`J1, Sc( 3L( -1 lW n,ni', n-6 ..` 0 u I J Project Transaction Number: U JUL 22n 5 Bayfield Co. Zoning Dept. HOLDING TANK SERVICING CONTRACT Contract Date Q'1 ( pg This contract is made between the Holding Tank Owner(s) Name(s) f� uJq e,l I e_ TLt.LkX o., We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT I Legal Description: LOCATION (Use Tax Statepm�en(�t) Tax IDd ^ �� 1 l—yI ,^ C1 1/4 �f /4,. Town L tgixa Acreage (-{]J Section 34 4e> J, Range O 1 ,Township. w - \ U emu, l� Gov't Lot Lot U CSM U Vol. Page CSM Doc U 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; p� D c. The location of the property on which the holding tank is installed; d. The sanitary permit number Issued for the holding tank; IfiJ e. The dates on which the holding tank was serviced; JUL 222025 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. Bayfield Co. Zoning Dept. 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) Owner's Signature(s) Subscribed and•Sworn to me: c'chQ11}Ifl (t on this day of Notary Public ���� JOSE HINE NONA YOKI I JJ �aoa� u tnn, D. kll My commission expires on: Revised: May 2010 (®May 2018) f P �.. Drafted by )a Personal Information you provide may be used for secondary purposes Pr vacy Law, s.15.04 (I)(m)] DOCUMENT NUMBER 2025R-608226 AGREEMENT Owner Name(s) Owner(s) Mailing Address (zaso E. ctt. Rcl FF �N Parcel Identifier Number (PIN) Agre mart atei(same as Notary -Date) �aXZDst3$5f'7t% o-1t0SIaWAT 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 es permitted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Slats. 1/4 of 1/4 Section 3'k Township N. Range (Y' W. Town of ()tokiA Additional Legal Description: J 2Q. n 4-4. a P \'te CA Gov't Lot — Lot_Block_Subdivision CSM#_ Lol,�_CSM # Vol _Page _CSM Doc# DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED O7/O9/2O25 AT 2:O2 PM RECORDING FEE: $30.00 PAGES: 2 Return To: ZertV Dapnr rn2,t" + As an inducement to Bayfield County to issue a sanitary permit for a holding tank on the above described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tank Installation and maintenance. If the owner falls 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, Slats., 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. 68.0703, 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. Slats., 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 a. 281.48 (3) Wis. Slats., 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 shell submit this agreement to the register of deeds, and the agKgen�ntpshg(g(cgiie4 y the register of deeds in a manner which will permit the existence of the agreement to be determined by er s �roWerw1 the holding tank is Installed. In Owners) Name(s) — Please Print Bayfield y j 1 1 020 Co. Zoni hub ed and sworn to before me on this date: J t.� Notarized Owner(s) — Signature(s)N c 1 / v Commission Expi I Drafted by: 1 lPdvacy law. s.15.Od m)I JOSEPHINE NONA YQ Wssnll4mcldingtankagreemenldcc eJune 2018 ]J Notary Public State of Wisconsin ADDENDUM/EXHIBIT A This transfer is exempt from fee per statute 77.25(2) A PARCEL OF LAND LOCATED IN THE NORTHEAST Y. OF THE NORTHEAST%, SECTION 34, TOWNSHIP 48 NORTH, RANGE 9 WEST, TOWN OF OULU, BAYFIELD COUNTY, WISCONSIN, MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHEAST CORNER OF SAID SECTION; THENCE S0°50'10"W ALONG THE EAST LINE OF THE NORTHEAST % OF SAID SECTION A DISTANCE OF 651.41; THENCE 589°16'09"W A DISTANCE OF 608.73'; THENCE N0°50'10"E A DISTANCE OF 185.40'; THENCE N89°22'37"E A DISTANCE OF 233.58'; THENCE N0°50'10"E A DISTANCE OF 467.15' TO THE NORTH LINE OF THE NORTHEAST % OF SAID SECTION; THENCE N89°22'37"E ALONG SAID NORTH LINE A DISTANCE OF 375.12' TO THE NORTHEAST CORNER OF SAID SECTION AND THE POINT OF BEGINNING. THE ABOVE DESCRIBED PARCEL OF LAND CONTAINS 287,650 SQUARE FEET OR 6.60 ACRES INCLUDING THE RIGHT OF WAY OF EASTVIEW AND MUSKEG ROAD. Subject to the following restrictions: A habitable structureAust be built and/or renovated on this parcel within 24 months of the recording date. If no habitable structure is built, the property shall revert to Bayfield County upon an Affidavit stating that no such structure was built. No short term rentals can be on the parcel 10 years from the recording date. oESEoVE0 JUL 102025 Bayfield Co. Zoning Dept. Bayfield County Register of Deeds Document #2024R-603568 Page 2 of 2 Bayfield County . ;FIELD Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: TUURA, ROCHELLE 12950 E CO RD FF MAPLE, WI 54854 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00299 Transaction Number: SR -00299-314B9 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 6217 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 7/30/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. 13 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: TUURA, ROCHELLE 12950 E CO RD FF MAPLE, WI 54854 Description Private Sewage System (Holding Tanks) Submission Number: SS -00607 Transaction Number: SSIIIMIYS IUII aiiDiui.II $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 6217 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 7/30/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-25-88S STATE SANITARY PERMIT OWNER: ROCHELLE TUURA GOVT LOT: LOT: BLK: NE1/4 NE1/4 SEC:34,T48N,R9W TOWNSHIP: Oulu SOIL TEST: 88-25 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: ALLAN POLKOSKI TRACY POOLER Authorized Issuing Officer DATE: 7/30/2025 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: # 220090 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 7/30/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION