Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
25-100S
INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY ' TIME RECEIVED REMOTE CSID DURATION PAGES STATUS September 29, 2025 at 8:38:33 AM CDT 7153724159 46 1 Received Sep 12 2025 16:50 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. Note Time Change fl Discrepancy fl Other e n L/ �ofrp s k t` Phone Number Plumber: Fax Number -7 3.7z—L11s`� Homeowner: _ j t •-.�'2- v� v pt Cl Email Address kt eo-tc r+k. Sanitary Z S-( o e 5 Immediate Phone Number So Zoning Dept can call you right back (IF needed) Permit #: Plumber's Choice n Dept t Date: /0— 3ZS I Time: Plumber's Choice 1 ept ) Of 0 Am r Township: ( sz RoadeNam : Road Name: Fr�t"� �(( �S�rn �- c S T t —t 13 S��c iL S `T ry �f e LtS rt!s ≥ 6D c-pj or Directions To Site:fur c -L, Lf wt of U4 Get...e-t-e.Y 9j. 6O li7? �.(e f F 1 r: a c:tom e Comments: q51\ Plumbers you must verify any change(s) by fa.r or email ** I Notes from Zoning Dept: UlfOrrns/senitarv/reeueetrerinsnec7 nn tit Zoning Dept (®41l2f04): ® June 2023 ( POWTS HOLDING TANK INSPECTION REPORT JEFFERY A LUNDA 315 PEARL ST BALSAM LAKE WI 54810 TANK INFORMATION TYPE MANUFACTURER/MODEL# CAPACITY 6AGre't I ,;c-Ae_ A �G�o SETBACKS Property Line Well Water Service Building All -Weather Road OHWM Swimming Pool DEVIATIONS FROM APPROVED PLAN COMMENTS (Persons present, discrepancies, etc.) yea 1b� tL COMPONENTS NOT INSPECTED Plan Re s( Required ❑ Yes No a / D Signature of Inspector: Cert. Number O,KM lI 1pn uuIer sjue 10 of 13 Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Bayfield County Courthouse Fax: (715) 373-0114 Post Office Box 58 e-mail: zoning(dbayfieldcounty wi 9ov 117 East Fifth Street Web Site: www.bayfieldcounty.wi.gov/147 Washburn, WI 54891 JEFFERY A LUNDA 315 PEARL ST BALSAM LAKE WI 54810 As you know '70i f &' '% was contracted by you to install a private onsite wastewater trea ment system on your property described as: Notes: Abandonment of Old System to meet all applicable code requirements: Tank was pumped by: Tank was crushed I removed and pipes disconnected by: [in: at AM/PM i On at 0& PM) the above -mentioned plumber contacted our office to conduct a pre -cover inspection as requi d under DSPS 383. One of the following applies: TASK 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: Ullormslsanilarypropertyowner-input April 2019 55 V1 �cnartiu y� f t Department of Safety county` I & Professional Services, Sanitary Permit Number (to be filled in by Co.) Industry Services,Division Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit, Note; Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary urposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. .7 ro Q `t e I. A plht:atlon Information —Please Print All Information rP ` " !.. Property Owner's Name Parcel # Property Owner's M ling Address Property Location 3 i.� ?€q. 11 SE /� KR City, State Govt. Lot y _ Zip Code Phone Number Q $4/1 L4 Ice ink 1 ( O —7 l ,,$-' 9-5-7-607y,, Section f l IL Type of Building (check all that apply) Lot # T t{'? N R 'o I or 2 Family Dwelling —Number ofBcdrooms Subdivision Name ❑ Public/Commercial — Describe Use Block # O City of O State Owned — Describe Use CSM Number 0 Village of Town of Pi ( 5 4 h I1T. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on IineB. Complete line C if a licable. A. 19 New System ❑ Replacement System ❑ Other Modification to Existing System (explain) 0 Additional Pretreatment Unit ex lai ( P n) B. Holding Tank ❑ In -Ground ❑ At -Grade I ❑ Mound 0 Individual Site Design 0 Other (conventional) gType (explain) C. ❑ Renewal Before 0 Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration .IV. DispersaltTreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) Dispersal Area Proposed (so Jtcmcvation Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units w a New Tanks •� Existing Tanks' — Septio-ar Holding Tank 7i,5'�O a` U c w Go w C7 a �TQw�w-'y. -- z6bo l t�na. . '� r V. Responsibility Statement- I, the undersigned, assume responsibility for lnstalin n of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb Si ature / WIMPRS Number Business Phone Number Aileu, `�� e�o5 � Plumber's Address (Street, City, State, Zip Code) _ d• f a K S+ Z. Z y {rn c v tr t;J .L " Y'8 �'7 VI County/Department Use Only Approved 0 Disapproved Permit Fcc Date Issued Issuin Ag Signa ❑ Owner Given Reason for Denial Conditions of ApprovalfReasons for Disapproval C,/e tiro 05 2025 Attach to complete plans rot the system and submit to the County only on paper not less than 8 to x II inches in size Ba�fie�ci Co SBD-6398 (R. 03/22) p,ann;r�o and Zcro Fg�ncY • PROPERTY OWNER: -s e F v PLUMBER: Allan Pnikneir:t SIGNATURE: Ci�iL�--%_ 'DATE:`? / LICENSE # 22O9U HOLDING TANK SPECIFICATIO NS Number of bedrooms -- Non-residential estimated flow (gpd) Minimum holding tank volume're p qulred (gal) Tank Dimensions and Data X for round tank 6 . Liquid depth below Inlet 8.O Maximum depth of soil ert cover ()ft) JHelght (in) L OutsideII 1896 ilLength (in) Dimensions 9 '.� Width (In) i Only Junction box . _ conduit .—+ blind plug to coal outlet Manufacturer model number manufacturer fiber Tank Anchor Calculations 16840 lbs Weight of tank and cover o.5O Safety factor 02 lbs Weight of anchor required 40.8 In Soil cover req. for anchor or 8,9 yd3 Concrete counter weight HOLDING TANK CROSS SECTION manhole ooverwith locking device and finished warning label grade 4" min. 24 In. W Manhole and vent locations may be reversed, vent cup ,,,... 12 Mtn. vent pipe --, 18E' min. Benrlce 12.0 In, building sewer a alarm on " Note: All tank InlhtInlet Electrical as per NEC 300 and Comm 16 3 in. bedding under tank. Joints between tank openings and piping are• 39.0 in. sealed watertight. All pipe and vent materials comply withsp a3 Tank Ii anchored as neceasey to negate buoyancy, s;. a. AUG 052025 Bayfield Co. Planning and Z.c-ning Agency Ic cuJ INLET u 3" 1834" 4" CAST —A —SEAL 4" CAST -A -SEAL FILTER OR BAFFLE TOP VIEW co to to SIDE VIEW 3- OUTLET M )0 WLP2500 TANK SPECIFICATIONSo. a o DIMENSIONS: Q a I- WALL: 3" • o BOTTOM: 3" HEAVY - 5" COVER: " MANHOLE: 24" I.D. PRECAST CONCRETE RISER 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. LIQUID LEVEL: 36" WEIGHT: TANK - 3" BOTTOM 12,560 LBS. TANK - 5" BOTTOM 15,527 LBS. WEIGHT: COVER 9.300 LBS. Iii N a INLET AND OUTLET: m a 4" CAST -A -SEAL BOOT OR EQUAL A INLET AND OUTLET BAFFLE AND FILTER: a Iii tn -� WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 69.44 GAL/IN 18.1 HOLDING TANK: C O OUTLET HOLE PLUGGED ACTUAL CAPACITY: 2,639 GALLONS ® zap �0 1 LOADING DESIGN: 8' 0" UNSATURATED SOIL N TANK CAN BE USED AS: o r7 SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) c TANK: MIX DESIGN #9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE N DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: .J5 N ►n m a N '7 � U p H- W 0U) W j U w m 1171 LVOF1] HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and << maintained according to E4393 is. Admin. Code, the Holding Tank Component M nual le0edoo ``W &n va..I 1yp- 'IER200 ' and the ' + R. t4 County Sanitary Ordinance. � � j L l�/ a a"ZOZ ? 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 SP5 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 cPS 883.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer.............................r©JI(o.s1G rluyn :rq Iih.rl4 �,S ? oogp Phone: i( 37..- � 'tri b. Service Provider................... V Se Rpb 12 Phone: '7j5 37a. - 41 c , c. Co. Zoning or Health Dept j3a.y4€JJ CeJ va ,�,ni r Phone: 7/3 3Z- �/ 11. XO.4 ��.�� %Scc 1 r' g4 Less 3.17 P' LSQ'1 Z7./( Project Transaction Number: AUG 052025 Bayit•ld Co. Planning and Zoning Agency • BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): 0 Check List I6 Index Page / Title Sheet (Optional) G0 Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) l6 Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) ® Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used I!I Property Owner's Information (nQt prospective buyer's name) ® Property Location (Accurate Legal Description with Sec/Twp/Range) I6 Road Name (where driveway is/will be coming off of) d Floodplain Elevation, Flow Rate, Comments and Recommendations CI Complete Soil Boring / Pit Information CZ] 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) fJ Bench Mark (Description, Elevation and Location) fU Contour Lines (Example = 98.0' /96.0' /94.0') El Property Location (Sec/Twp/Range/, Accurate Legal Description) m Borings (Locations and Elevations) Ci Percent and Direction of Land Slope 91 Well Location (Including Neighboring Wells, if applicable) I Location of Wetland Areas, Floodplain and Navigable Waters 0 Buildings, Driveways, and Structures (Location and Descriptions) EZi Location of Property Lines l6 Existing System Location WI Address Number and Road Name d Current Surface Elevation of Wetlands and Navigable Waters A CST, Owner and Property Information C6 North Arrow L AUG 0 5 2025 Bayfieid Co. Planning and Zoning Agency Fee: WI Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checkiist/checkiistforests BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) 21 Check List Ei• Original Sanitary Application (Submitted in Deed Holders Name -- not prospective buyers) (383.21(1)1.) 0 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) EJ Original Plot Plan (383.22(2)2. 3. & 4.a) 'Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer 1jJ Pump Tank Diagram, Alarm and Pump Curve (when applicable) 21 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) 21 Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) 21 Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) PJ 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) @1 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) 211 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) Ef (Owners Phone Number) 2111 Type of Building ® III Type of Permit E12I IV Type of POWTS System ❑ V Dispersal / Treatment Area Information 9 VI Tank Information 21 VII Responsibility Statement (Plumber's Information) ❑ *Date Stamp* Plot Plan: (To Scale or To Dimension) E1 Signature and Plumber Information Ex!' Surface Elevation of Body of Water ❑ Direction and Percent Land Slope •96 Tank and Filter Information and Location 0 Wetlands / Navigable Bodies of Water ❑ Absorption Area (Proposed and Existing) 01 Bench Mark (Location, Elevation and Description) lid Component Manual Version 1�ria noriinationtrconuvenae:tine:: bull E9 Address Number and Road lid North Arrow ❑ Contour Lines it Structures and Driveways E6 Boring Location 0( Property Lines 10 Well Locations 9 Legal Descriptions R ` I\'ED AUG 05 2025 Bayfi&d Co. Planning and Zonir.g Agency Turn Over ► K HOLDING TANK SERVICING CONTRACT Contract Date 152,c2.5 Holding Tank Owner(s) Name(s) This contract is made between the Pumper's Name (Print) Pu p is Signature Pumpers' Registration # We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT A LOCATION. Legal Dascrirstian; (Use tax Statement), Taxio# i , r S E 4, Aj i/4, x-15 F- *?"� 1/�.-- .; Section � ,Township 97N,fiange IN Town of: XJ Lot SizeAcreage Gov't lot ' Lot # ` : CSM # Vol: Page CSM Dcc # Lot(s) No. Block(s) No .:Subdivisions ` 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; .. ¢ = a _ • 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; AUG 0 5 2025 g. The disposal sites to which the contents from the holding tank were delivered. Bayfi&la Co. 4. This agreement will remain In effect until the owner or pumper terminates this contract. In the event of a Elarigsnt 1sng Agency 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)�1 Owner' gna ur Subscribed and'Swom to me: •J �( 1.•-� �� •on this li 5 day ofJJ,i,,, byyJ_edttt�� �••. Notary Publ' f • pTA My commission expires on: -� Revised: May 2016 (®May 2018) Personal information you provide may be used for secondary purposes [Privacy Law, 8.15.04 (I)(m)) '2- �y Drafted by __'••••••• ' �, • I� v L�'��fl Document Number/Plan I.D. No. HOLDING TANK AGREEMENT Owner Name (s) Owner(sR41R ddress t�t�A 11A 5.e ,--- J�F y �V '�jprl..ZP,r-\ LONCE W1 Sygt Parcel Identifier Number (PIN) Agreement Date (same as Notary•Date) We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Stats. SE 1!4 of _W 1/4 Section I _ Township 1.41 N. Range w. Town Town of �S�_�l — L-55 12 g tiW Additional Legal Description: Gov't LotLot Block Subdivision CSM# Lot CSM # Vol Page CSM Doc# ��iiH r; Y 76.rrKL DOCUMENT NUMBER 2025R-608301 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED O7/ 1 5/2O25 AT 9:28 AM RECORDING FEE: $30.00 PAGES: 1 Return To: 72/ksk.' c `(8 Y 7 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. 254.59, Stats., Bayfield County may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Slats. 2. Owner agrees to pay all charges and costs Incurred by Bayfleld 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. Bayfleld County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. in the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 3. The owner agrees to contract with a person who is licensed pursuant to s.281.17 (3) Wis. Stats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced in accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service contract. 4. The owner agrees to contract with a person .licensed pursuant to s. 281.48 (3) Wis. 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. i 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, VVi's Adm. Code. in addition, this agreement may be_canrelladabyy,r, executing and recording said certification with reference to this agreement In such manner which will permit the existence- of s th— L1 certification to be determined by reference to the property. n[� 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner sh W`br4�{t5h?025 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. Bays el;i Co. Planning and or rn Apnry Owner(s) Name(s) — Please Print LJr* Subscribed and sworn to before me on this date: �ttttllll!!/i,,,p: 7/f/ . Notarized Owner(s — Signature(s) ?'c Nota Public P L1G M miss on Expires: >► • •• 1 ks Drafted by:10 ft 72oa Date: =1 f f5/.z0 � Personal information you prov de may be used for secondary purposes [Privacy Levi. 8.15.04 (l)(m)j ulforms/sanitary/hotdingtankagreement.doo ®June 2018 --- ...,,,,,,.,,l u L.vIvUUVtd No, 99/b P. 9 PAGE 1 OF 8 •' Holding Tank Plan. Index & Cover Sheet It Conn onent Manual Design References: 13')a uA. VPe"V, r -s oh ? £, YAK. z e z -Zoz7 y Pg 1 of Index & Cover Sheet Pg 2 of 9 Plot Plan Pg 3 of 9 Holding Tank Speclficatl nsaw z p A f s Pg 4 of 8 Management Plan Attachments: nct surer: i -F POWTS Application for Review cs4,� ©-� 9 Soil Evaluation Report & Site Ma P 7 oj f g Holding in ontract if Holding Tank A reeme iif a licable Project Name 1 Description Sri perrn��A, Eplicable) [cable) Owner • � er Name(s) f fPhone: L � � -71s - Owner Address: 315 ?Qct r ≤) 1$c L ke y Zip; S I o Project Address: 142d,L loo L Lr As L1t i s'( io 3,p4. 1; 5 f 114 of A 114, section , T I -R ' E []or w Township:(c Project Parcel I D #: x 97 4 2 73I( 1( Designer Information Designer Name: / /cam � ? / ko s /' Phone: is -,3 - ' s - Designer Address:' _e, •3 �ic..L-�.. n i�, e..� WX :Zip,- SY�' fl' E-mail: *rs ky►' L v- v r cLe.L-L C Thf space reserved for approval stamp. License Number: Z 'c"? 0 Remarks: RECEIVED AUG 052025 Bayfieki Co. Planning and 7:,117i jn.y . I Signature: C]at�e:� Original signature required on each submitted copy. PFIELD Property Owner: LUNDA, JEFFERY A 315 PEARL ST BALSAM LAKE, WI 54810 Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00311 Transaction Number: SR -003U -32B36 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 6222 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 8/14/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. YFIELD Property Owner: LUNDA, JEFFERY A 315 PEARL ST BALSAM LAKE, WI 54810 Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Description Private Sewage System (Holding Tanks) Submission Number: SS -00619 Transaction Number: SS -00619-3237D Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 6222 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 8/14/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-25-1 00S STATE SANITARY PERMIT OWNER: JEFFERY A LUNDA GOVT LOT: LOT: BLK: SE1/4 NE1/4 SEC: 11,T47N,R6W TOWNSHIP: Pilsen SOIL TEST: 100-25 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: ALLAN POLKOSKI TRACY POOLER Authorized Issuing Officer DATE: 8/14/2025 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 8/14/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION [Soil Test # Bayfield County Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) _4 I c4 ]'g> I ko s k d 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 e- �` v L u n N Y Owner Contractor Property Address 76 a O 4 Authorized Agent Ce rvt-C F -e -v L S . vt i•✓LS `��o �'° Agent's Telephone Telephone i i c- ,cs-'1 ()4P77 Accurate Legal Description Is requested: Written Authorization Attached: Y or N 114 ofk E114 Section Township N. Range le W. Town of �• s `Q A+ Additional Legal Description: L e SS 3. 1 7 A R.,1. Govt. Lot Lot ,Block ____Subdivision Lot CSM# _ Vol. _____Page CSM Doc # Volume Page of Deeds Tax I.D# Z7≤ / ( Acreage S—+ r Indicate reasoning for your determination: l a 'e S r' ( + h -t L c v-e...co - i-i kot; ��� Lo cq / oito { ?c mil! r•S f _i +cci 1b Signature of Certified Soil Tester /�?( ignature of County Official Date Date c -r Zeo'go Certification # .(Submit a Plot Plan & Fee) iifosldo�ttesiwaiver(KLK) June 2018 AUG 05 ZOZ5 Ba,fiald co. planning and Zoning Agencf p� a p a c4'ti'vY1$4 2• �-�pQ�t� vwrlero ov [ D(,scri p+1 V1 a SOI BI�V'111 �. ✓' ,r, � N S ee.. l ! '�` `� - 31$T ?�. v 1. a sS , L71 R + i3a Is a La ce w '► e f a . 0 .s .� �, � � �o jQ l 1 ov! VJt.$C.r c: encrrr .. I k= l 3 a"k av to "vj � 43 0r -F iro by1 b a t'a rat ® f Coor.+v 1.IwvG We l a►f 7 `bte.4s ot.I1 sin, se.1-Lr.,c_6r.s Csisars). A.F& A b®t,e.. -cit. c% j ctcJ F l Ew+tows sS i j i ✓.t o+? S E CC' r vta r M -7 -- = Sck /® PVC vi/-va .r s aec..-�- a -y q"ASTei D 17 �Laa v -o v�� F1' rF tri CL l -B 1i+ etqT' t&z j[ J � ry) V►ua1 us a 4AV"0Ld"ryP Y � Pe/kcisk1 Phut. ! vcj c zZ w ≤V (7 n Department of Safety & Professional Services, County � r+s / 7 Sanitary Permit Number (to be filled inlay Co.) Industry Services.Division a 5- iuo 5 Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application fonns 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 Law, s. 15.04(I)(m), Stats. I. Application Information —Please Print All Information (� 8' �lo� J n Gehl-�/,eVr Property Owner's Name Parcel # Properly Owner's M ling Address 315Pew V, .54 Property Location 2ess3.l7A" KR City, State / Zip Code Phone Number [act' 54 'vj La [ce lAj 1 S�f 7 ( D -7 / S— SS7-o&77 Govt. Lot � ( / 3E ' 1Jt y,, , Section II. Type of Building (check all that apply) Lot# t(7 .o I or 2 Family Dwelling — Number of Bedrooms Z T N R Subdivision Name ❑ Public/Commercial — Describe Use Block # ❑ State Ousted— Describe Use ❑ City of CSMNmnber O Village of X Town of I r( S fl at IIL 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 if applicable.) A. New System ❑ Replacement PSystem❑ Other Modification to Existing System (explain) I ❑ Additional Pretreatment Unit (explain) B'S Holding Tank ❑ In -Ground Ground ❑ At -Grade I ❑ Mound ❑ Individual Site Design 0 Other T e (explain) YP ( tn) (conventional) P C. 0 Renewal Before ❑ Revision 0 Change of Plumber List Previous Permit Number and Date Issued ❑ Transfer to New Owner Expiration IV. DispersallTreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/st Dispersal Area Required (si) Dispersal Area Proposed (st) System Elevation 3°0 Tank Information Capacity in Gallons Total Gallons # of Units Manufacturer ° e E _ v ,, is New Tanks Existing Tanks Septia•tr Holding Tank 'ZS DO — ZSOO -�- ld) v ✓ C.a vt.C, 6 U t/ in to '4. C7 'a l _ V. Responsibility Statement- I, the undersigned, assume responsibility for Installs o of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb Si store h r _�7 'MP/MPRS Number Business Phone Number ,JjPlumber's Address (Street, City, Stale, Zip Code) c� a K S Z Z y ✓o n L t tl a tr ajT c'{8 `f7 VI County/Department Use Only Approved ❑ Disapproved Permit Fcc Data Issued L Issui • Ag M Signs ,��-}�_ ❑ Owner Given Reason for Dcntol U V $ 5 Conditions of Approval/Reasons for Disapproval 0 5 2025 Attach to complete plan, for the system and submit to the Caunl oni Y Yon paper not leas lhanaunx l l Inchesln atze BaCo• A SBD-6398 (R. 03/22) planning and z Zoninere/g 9 • 5OO3(/ _______ 'Z.4i19 Soi Test # Bayfueld County ► b - �.5 Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) A //myi PvJlzosk, 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 z e_*4c L L) 2 1 N y vContractor Property Address ' 761 fYi a Q 4 Authorized Agent C "j2 L K �Ls A en#'s Telephone_____________________ g pone Telephone /S S1 b '1'7 Written Authorization Attached: Y or N • Accurate Legal Description is requested: 1/4 of 1/4 Section / ( Township7 N. Range 10 W. Town of �•` l S `Q h Additional Legal Description: _ - e S≤ • 1"? .4 K Govt. Lot Lot Block Subdivision Lot____ CSM# Vol. Page CSM Doc # Volume. Page of Deeds Tax I.D# Z75/ ( Acreage ' Indicate reasoning for your determination: CL S ° h 'f L o -P ko I Ct. n -, L Loc-clr o Qn ( ?ccu TS '4 k I ( cL a- ?}L Signature of Certified Soil Tester iignature of County Official Date Date csr ao'io Certification # .(Submit a Plot Plan & Fee) .u/forfnsida` testwalver(KLK) June 2018 AUG 05 2025 a : Co. Planning and Zon'rv; Aulat+GY Pr_cpev'tt9w,ier eio.l Awscr p+;E'er SeerY Lu4Ac 5E KPJSec l( " l Blew 313r hc1V 1 S* Less 3.t-rpr RR 3ci I s a -n La to !s- /Vla) c w n ear : r l."CU.rl4 ec; sYFi el �ivc leg /4O wl1,,4lt Ceruc-lcrl kI weT8Cdrflsd 2- • - 50F 1 8ovdn9/.. I N S I@.: ! rw gon 1es$ n O4e d ! Ntctrts+ gc1; n)o$ ua% Ce.stclery RI 7 7COO Ib3 "L 1at„vJt•#3" Fvoeu1 bo{-tor.1e{ 'Tank *O F4c'uCr,e-;nle.+ County NwvG G LcLfrr fk" (sII ry�rs�l;'0 2 'f?ieC�t^ c oa• a�_ V 1 _. ff 6, N AUG 052075 Baylield Co. Planning and Zoning Agency l !2P FMtd;ncjrikmtdsccllnl;/',. sEFLa�ks C5Ps3Bl) A.1=&. = E4Lovc. -c;c.( y v-ctJe- �° Melt Pro Fos•e.cL e®�-tooh 5���ri55 on SECornQr t OAl g JRp �y-a—j ' 3= .5ch ND I'vC W!/c l O W 4 r reL4 Oral I 4'ASTAII DlVQS«aare t>:pe ntcIev CL! 1. He lJ' v r rt Ic Conipxe„%� fl' vi Lt4/ L{sc'C(a/'r4nuA 1p}0p vRz•J), Cfl .yze12- cal) �rctiin. 0y /t7,tR,5 22eop P /ecorskr PILtfrb�vrc� Re.13oK Sr2.2 Tron w2 SYe'7 PROPERTY OWNER: PLUMBER: Allan PniknQkll Dr,ii,...:: SIGNATURE: DATE: `? - / z s LICENSE #_220090 HOLDING TANK SPECIFICATIONS ,.0 Number of bedrooms II�"w.uY.auw Non-residential estimated flow (gpd) 2000,0 Minimum holding tank volume'required (gal) eons and Data for round tank quid depth below inlet Invert (in) aximum de th of soil cover (ft) sight (in) I Outside ingth (in) rDimensions Idth (In) Only Manufacturer model number manufacturer iber Tank Anchor Calculations IplYp1IAVYtiM M Ibs Weight of tank and cover Safety factor Ibs Weight of anchor required In Soil cover req. for anchor or yd3 Concrete counterweight HOLDING TANK CROSS SECTION manhole cover with Junction lc looking device and finished vent cop box warning label grade Ti- 241n. 12" mi. conduit --� Manhole and vent locations `"�^---- may be reversed, vent pipe 18" min. -_-_._._,� - — - ---� service 12,0 In, building sewer blind eeelg alarm on Note: All tank Joints, and Inlet outlet Joints between tank Electrical as per openings and piping are NEC 300 39.0 in. sealed watertight, All pipe REC r~ and Comm 16 and vent materials comply Y ` '`' IVED with 5 pL, Jca3 AUG 0 5 2025 Bay&:ld Co. 3 in. bedding under tank Planning and Zoning Agency Tank is anchored as necessary to negate buoyancy. 1834" 4" CAST -A -SEAL 4" CAST -A -SEAL FILTER OR BAFFLE a rc INLET 3" v a D a M TOP VIEW SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS W7 - OUTLET n C WLP2500 A N g TANK SPECIFICATIONStI o Lo DIMENSIONS: iia = m WALL: 3" BOTTOM: 3" HEAVY - 5" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 52-3/4" O.D. 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 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 II DRAWINGS TED APPROVAL FORI) APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: 111 Q O � N o Q N w 0 a 5 w N w w w SHEET NO. 1 oF1 HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to 9f' 393 Wis. Admin. Code, the Holding Tank Component Anual wstd; "wt I tyrt '.f ER 2vo and the By.P g (ci County Sanitary Ordinance. V n z!) , LM&y zoz2.-Zn27) 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 BPS 383 andi84 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 5PS 363.33 Wis. Adm. Code. 10. If there is a problem with, or question about this f'nstallation, the following persons should be contacted: a. Installer .............................po/ k P/ambi.q m.P.R5. ZZ.0040 Phone: 7/S 37a -'/S70 b. Service Provider.................. „ s' J Re+ /y Phone: •7/.4' 37. - waafo c. Co. Zoning or Health Dept.[ ten ay Phone: 7/5 -s— btP _3 ff&y 11. Lo_eei i)O_.GL° -kr sE tJi'�LL " SCC9'�4 rtP —U & L�2.55 3.17 A R �- N Project Transaction Number: i L. v.�WED AUG 052025 Bayfield Co. Planning and Zoning Agency BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): Check List m Index Page / Title Sheet (Optional) [�] Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) 21 Original Plot Plan O Cross Section Soil Profile Sheet (optional) O Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) E Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used d Property Owner's Information (rt prospective buyer's name) I0 Property Location (Accurate Legal Description with Sec/Twp/Range) m Road Name (where driveway Is/will be coming off of) d Floodplain Elevation, Flow Rate, Comments and Recommendations l Complete Soil Boring / Pit Information Gil Date Soil Evaluation was conducted d CST Name, Signature, Number, Address and Phone Number O *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) d Bench Mark (Description, Elevation and Location) [.3 Contour Lines (Example = 98.0' /96.0' /94.0') m Pioperty Location (Sec/Twp/Range/, Accurate Legal Description) m Borings (Locations and Elevations) Cl Percent and Direction of Land Slope 91 Well Location (Including Neighboring Wells, if applicable) CAS Location of Wetland Areas, Floodplain and Navigable Waters m Buildings, Driveways, and Structures (Location and Descriptions) 16 Location of Property Lines Ci Existing System Location fd Address Number and Road Name L Current Surface Elevation of Wetlands and Navigable Waters U CST, Owner and Property Information i6 North Arrow RECEWED AUG 052025 Bayfield Co. Planning and Zoning Agency Fee: 0 Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checkllst/checklistforcsts f'C6 . ttiy I✓l1< BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) �1 Check List LAY Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) 0 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) 21' Original Plot Plan (383.22(2)2. 3. & 4.a) Pf Cross Section, Over -Head Profile of the System ar Schematic of Tank from Manufacturer 10 Pump Tank Diagram, Alarm and Pump Curve (when applicable) E 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) ®' Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) 121 Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) 0 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 2 ComDlete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) © 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 ADDlication: (Include the following Information) 121 I Application Information must include: ❑ 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) 1g Project Address or Road Name where driveway is/will come off of) 2111 Type of Building ®III Type of Permit 12'IV Type of POWTS System ❑ V Dispersal / Treatment Area Information 21 VI Tank Information 21 VII Responsibility Statement (Plumber's Information) ❑ *Date Stamp* Plot Plan: (To Scale or To Dimension) 19 Signature and Plumber Information R'Surface Elevation of Body of Water ❑ Direction and Percent Land Slope Tank and Filter Information and Location Z Wetlands / Navigable Bodies of Water 0 Absorption Area (Proposed and Existing) 121 Bench Mark (Location, Elevation and Description) M Component Manual Version d Legal Descriptions a Piping Material Information (conveyance line, building sewer line, material type and diameter) 9 (Owners Phone Number) 1st Address Number and Road 10 North Arrow ❑ Contour Lines d Structures and Driveways lit Boring Location Gd Property Lines t2T Well Locations RECEIVED AUG 0 5 2025 Bayfield Co. Planning and Zoning Agency Turn Over ► Cross -Section and Over -Head Profile of the System t9 Surface and System Elevation t�' Position of Observation and Vent Pipes Ed Dimensions and Depths I Make, Model & Number of Chamber Units in each Cell Property Information ❑ How many systems will there be on this parcel of land? l ❑ Has this property been split? YJo (Property Statement shows Property History) Fees: i1 Private Sewage System (Septic Tanks) $ 400.00 ❑ Private Sewage System (Holding Tanks) $ 400.00 ❑ Mounds or Systems requiring Pre -Treatment $ 500.00 ❑ Sanitary Revisions $ 25.00 ❑ Private Sewage System Reconnection $ 50.00 and Private Interceptor ❑ Return Inspection $ 50.00 i6 Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) u/farms/checkilts/check[Istforsariftaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: HOLDING TANK SERVICING CONTRACT Contract Date ju et5\2OZ5 This contract is made between the Holding Tank Owner(s) Name(s) a€ fPtCH `-UNDH We acknowledge the Installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT LOCATION Legal Descrletlon: Tax IDg —1 1 Tax Statement) t L 5 €3/4, �� 1 4 t -55 f2'R- �„ +' / (Use y Section �_,Township �7N,Range. w - Town of: s Lot Size Acreage _ _ r •�73)' •S Gov't Lot Lot # - CSM It 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: c. The location of the property on which the holding tank Is installed; d. The sanitary permit number issued for the holding tank; E2,ft"; V LE) 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; AUG 0 52025 g. The disposal sites to which the contents from the holding tank were delivered. 63v1a;:i Co. 4. This agreement will remain In effect until the owner or pumper terminates this contract. In the event of a P,haPigednithisng AOency 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. on this J ti day of My commission Revised: May 2016 (®May 2018) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)] me: son: 't(di ldwo-TW �, : �� 9z ?co \�. • Drafted by "••'G� p' OF II W,g`\\``�` v Document Number/Plan I.O. No. HOLDING TANK AGREEMENT 3 €cFEL' A- WeJ.DA l-1-1 LP,\C.e Wt e (same as Note 7_IS-- 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. S C 1/44 of N =. 1/4 Section -I Township )"'� 1 N. Range ______w.W, Town of;\LSrN - L�25S RR RouJ Additional Legal Description: Gov't Lot — Lot_Block_Subdlvision CSM#_ Lot_r,SM # Vol _Page _CSM EHTF#ZED ey DOCUMENT NUMBER 2025R-608301 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED O7/15/2O25 AT 9:28 AM RECORDING FEE: $30-00 PAGES: 1 Return To: -ovva,( fr / Irez-Sk As an inducement to Bayfield County to issue a sanitary permit for a holding tank on the above described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tank installation and maintenance. If the owner fails to have the holding tank properly serviced in response to orders issued by Bayfield County or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, 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. 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. Scats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced In accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service contract. 4. The owner agrees to contract with a person.11censed pursuant to s. 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, Wis Adm. Code. in addition, this agreement may bgance;:ed,by�. executing and recording said certification with reference to this agreement in such manner which will permit the existence of -ti d — certification to be determined by reference to the property. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner sh84lUQe1Mt�M8025 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. Bayfield Co. Planning and Zoning Agency Owner(s) Name(s) — Please Print Subscribed and sworn to before me on this date: J ���r r�. NOPr FFw `tttlulllltrlrrrr .\CADpT: 7IIIao5 Notarized 0wner(s — Signature(s) Nota Public n 41 = / .• P \G 7r 6....._-,--.,.....-- M colas on Expires:., �% aaa9 t7 /Drafted by: It h �h54c.1 Date: I i5/o7�%2/ rrrrrrftlllttttttty� Personal Information you pmv de maybe used for secondary purposes IPrlvacy Law, s.15.04 (g(m)i Wformslsanitarymoldinglankagreemenidoe ®.tune 2018 No, 99/5 F. 2 PAGE 1 OF $ Molding Tank Plan Index & Cover Sheet Ll Compponent Manuel Design References: ldis\nural t/re tkkr aovlli)y(w0./ ZOZZ Zca-) Pg 1 of 9 Index & Cover Sheet Pg 2 of 9 Plot Plan Pg 3 of S Holding Tank Speclfications_. z T e f t s Pg 4 of S Management Plan Attachments: C 9 POWTS Application for!ReviewCsct ]I 'i© F 3' Soil Evaluation Report & Site Map (if ap Sc' o4 & Holding Tank PumpingContract (if appli g Holding Tank Areement if alicable Project Name J Description Perm: f• 1;p Owner Name(s): J cge-ry L u n d q Phone:7rs -S57- o97 Owner Address: 31 S ?ect r ( S # f3,t 154 », L 4 k,e v L dip, S `{u I D Project Address: L47(0I l e ir, Cernt+erf 1A A4IQn Z k1i s Y2ol° L€55317Ps RP\ 5el 114 of /J 01/4, Section lI ,T V7N-R (' E❑or W Township: (s-ei County: a<<T F e ( d Project Parcel ID #; Z 7,5 ( ( Designer Information Designer Name: A /cL �. Pc, Kos , Phone: /Lr - 17Z - / S(o Designer Address: Pb ©,r Szz y- en ;nJtC WI zip:S'FSS17 E-mail: +.c a,7 cam' L , Je. u %/� - C Thi$ space reserved for approval stamp. License Number: -a cc 9 o Remarks: RECEIVED AUG 05 2025 • Bayfe!d Co. Planning and Zcnu Lg A jen y .Signature: C5 p '7. l Y— 7 S ate: ori9lnal signalurrf required Un each submitted copy. AFIELD 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: LUNDA, JEFFERY A 315 PEARL ST BALSAM LAKE, WI 54810 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00311 Transaction Number: SR -00311-32B36 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 6222 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 8/14/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. 3 A -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: LUNDA, JEFFERY A 315 PEARL ST BALSAM LAKE, WI 54810 Description Private Sewage System (Holding Tanks) Submission Number: SS -00619 Transaction Number: SS -00619-3237D Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 6222 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 8/14/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-25-100S STATE SANITARY PERMIT OWNER: JEFFERY A LUNDA G OV'T LOT: LOT: B LK: SE1/4 NE1/4 SEC:11,T47N,R6W TOWNSHIP: Pilsen SOIL TEST: 100-25 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: ALLAN POLKOSKI TRACY POOLER Authorized Issuing Officer DATE: 8/14/2025 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 8/14/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION