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HomeMy WebLinkAbout25-101SRequest for Sanitary Inspection (24 Hrs. in Advance) Fax or email this form to Zoning Dept (24 Hrs.) prior to when you want an inspection Fax (715) 373.0114 or Email zoning@bay(iolrlcountyyil.aov Time Change L_j Discrepancy I Other P one Number 7Homeowner: Fax Numberet `,r ✓1 G 5 co Email Address C/ eor �Q N� t__My� Immediate Phone Number So. Zoning Sanitary r^'O' S Dept can call you right back (if needed) Permit#: ,1` Plumber's Choice Zoning Dept No Inspection(s) during this t.me Date: Tuesday (9:30 am - 12:15 pm) (Tracyi Time: Plumber's Choice Zoning Dept. Township: Cob Address # & Road Name: n 7S/Lo } a(� Irv, c Y1d or / I(cn Ri✓Lr Vj. S', Directions To Site: —-- Comments: ** Plumbers you must verify any change(s) by fax or email ** Notes from Zoning Dept: July 2025 ( POWTS HOLDING TANK INSPECTION REPORT JEREMY E & MISTY S FRANCISCO _ 5100 HOKKANEN RD IRON RIVER WI 54847 _ TANK INFORMATION TYPE I MANUFACTURER/MODEL# CAPACITY cnlrAtfti ,4 q .d SETBACKS Property Line Well Water Service Building All -Weather Road OHWM Swimming Pool DEVIATIONS FROM APPROVED PLAN COMMENTS (Persons present, discrepancies, etc.) G4✓a- 1' COMPONENTS NOT INSPECTED /ac(4 ACA/%f Plan Revisjdn Required Q Yes No Date: J Z Signature of Inspe r: Cert. Number jcetull oil ulfier SUB v 4 / v - r -' 10 of 13 Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zonino(a bayfieldcounty wi t1ov Web Site: www.bayfieldcounty.wi.00v/147 JEREMY E & MISTY S FRANCISCO 5100 HOKKANEN RD IRON RIVER WI 54847 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know ( was contracted by you to install a private onsite wastewater treatrpkit system on your property described as: Notes: Abandonment of Old System to meet all applicable code requirements: 1 Tank was pumped by: .• Tank was crushed I removed and pipes disconnected by: on at AM/PM On i / � at(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. fl System was inspected and appears to meet all applicable code requirements; however, a plan revision is necessary because the installation was substantially different than the original approval. System could not be inspected because plumber covered prior to scheduled time of inspection. ❑ System could not be inspected because plumber was not ready at scheduled time of inspection. County was unable to return to complete inspection. System could not be inspected because plumber was not ready at scheduled time of inspection. A re -inspection and $50 fee are required. System could not be inspected because County could not respond to plumber's time constraints. Comments: U/formslsanitarypropertyowner-input April 2019 <"Rt"vr ooze Industry Services Division Madison Yards Way County4822 _ `r ; '' Madison, WI 53705 P.O. Box 7302 Sanitary Permit Number (tu u be filled in by Co.) Madison, WI 5302 )S3— 10)3 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 the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address) 7 / 1.0 J)C.o,w+ C�1 purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. b On , w.e.•/ vJ f 9 I I. Application Information -Please Print All Information Property Owner's Name V Pr'5#Jyn G to Parcel # S Property Owneer's Mailin Address s,,,� C0.' SiC) 0 � �� `� Property Location �► 1 Govt. Lot ) L) '/., 1 v y., section 3 City, State 1� •e, t- G� Zip Code �' 5 ` �'7 Phone Number / S 9 (9 aaag T __NR_ or W II. Type of Building (check ilhthataapply) Lot # 0l or 2 Family Dwelling —Number of Bedrooms Subdivision Name ❑ Public/Commercial — Describe Use Block # 0 City of ❑ State Owned — Describe Use 0 Village of CSM Number fown of )0/L) III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if auolicable.) A.113 New System I .Replacement System I ❑ Other Modification to Existing System (explain) I ❑ Additional Pretreatment Unit (explain) B. $ Holdin Tank 0 In -Ground ❑ At-GradeDesign ❑ Other Type (explan) g❑ Mound 0 Individual Site (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Numbs- and Date Issued Expiration IV .plspersaliTreatmentArea andTanklnformation: Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 30 - Capacity in Total # of Manufacturer I I Tank Information Gallons Gallons Units . New Tanks Existing Tanks c d .a - aU rn ylcd, iioICL. Septic or Holding Tank 3oIc) C~ 1 ?itA• (i'O{ Q(' c4. �t I CX. I I V. Responsibility Statement I, the undersigned, assume responsibility onsibility for installation of the POWTS shown on the attached plans. Plumb 's Name (Print) C' Plumbe 'S Signat MP/MPRS Number Business Phone Number C) � s��C l 0 ')lSs3 I')O� Plumber's Ad ress (Street, City, State, Zip Code) DO) topdel . d /1cor cr VI CogntyfDepartmept Use Only Approved 0 Disapproved Permit Fee Date Issue 06 L Issui g nt ' ature ���/ ❑ Owner Given Reason for Denial t0 1(d, 4 ID5 /f 37/ Conditions of Approval/Reasons for Disapproval L4 AUQ 052025 Bayfeld Co. Planning and Zoslino AtIol .y Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 02/22) PAGE 1 OF 4 • HoQdhig Tank Pan Index & Cover Sheet Component Manual Design References: Holding Tank Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Holding Tank Specifications Pg 4 of 4 Management Plan Attachments: Enclosures: POWTS Application for Review Soil, Evaluation Report & Site Map (if applicable) Holding Tank Pumping Contract (if applicable) e 1 o Holding Tank Agreement (if applicable) Project Name I Description �r1 ��iS Fr G / s c Q Phone. Owner Name(s): �. y � Owner Address: slot a� "`-'-' JqJ Zip: 54 d �� Lvi� Qd Zroi'+ r� 1'l,' i �( S4/ Ycf Project Address: Lot: t....j1/4, Section T'it N -R_ J_..E ❑ or W Govt. S 1/4 of /� Township: Qy 1 V County: Project Parcel ID #: 24551 Designer Information Designer Name:eze,4sf-TJ�cl- Designer Address: � 4z L. E-mail: License Number: /037 Remarks: Phone: '''T- i'o Zip: 5 u6. This space reserved for approval stamp. RECEIVED AUG 052025 Bayfieid Co. Planning and ZnrinAgency Signature_j5i . Date: i signature required on each submitted copy. Bayueld County, WI N J.= DAVID R COLEY -3a D`n Cti5 SO 95.8' 0 q ( �y, N VIDTD I N Ta'z ID%'2658NANCYIX1ST ALFRED KANE l6b 2o%63 IEREIN'r E S I'dISfl S FRANCISCO C ti 7a. IDs dsEsl - 1 un z � 7112/2025, 11:23:21 AM 1:753 Soils - L. ri All Roads Fxistin a 0.01 0.01 0.03 ml Approximate Parcel Boundary 9 Clayey Section Lines Town New o 0.01 0.03 0.06km Rivers Q Municipal Boundary Building Footprint 2009-2015 Driveways Bayfleld Meander Lines Demolished ' Buildings Beyfad County Land Records Department flip Hliidpi�6d00 "Vfil'W1.9PW®dyhEU'AMA 7/10/25, 10:00 AM Novus-Wisconsin Access rev. 12.0206 Real Estate Bayfield County Property Listing Property Status: Current Today's Date: 7/10/2025 Created On: 3/15/2006 1:15:53 PM Description Updated: 5/3/2021 Ownership Tax ID: PIN: Legacy PIN: Map ID: Municipality: STR: Description: Recorded Acres: Calculated Acres: Lottery Claims: First Dollar: Zoning: ESN: Tax Districts 26551 04-038-2-48-09-03-1 03-000-10000 038100402000 (038) TOWN OF OULU S03 T48N R09W PAR IN SW NE E OF TN RD IN DOC 2021R-588287 32-1 10.000 8.346 0 Yes (AG -1) Agricultural -1 125 2025 Assessment Detail Code Updated: 5/3/2021 JEREMY E & MISTY S FRANCISCO IRON RIVER WI Billing Address: Mailing Address: JEREMY E & MISTY S JEREMY E & MISTY S FRANCISCO FRANCISCO 5100 HOKKANEN RD 5100 HOKKANEN RD IRON RIVER WI 54847 IRON RIVER WI 54847 Site Address * indicates Private Road 75660 KAUKAMO RD IRON RIVER 54847 11 Property Assessment Updated: 5/5/2025 1 -_ 04 038 044522 001700 3i Recorded Documents ® WARRANTY DEED Date Recorded: 4/26/2021 ® QUIT CLAIM DEED Date Recorded: 12/26/2018 ® WARRANTY DEED Date Recorded: 11/5/2018 ® WARRANTY DEED Date Recorded: 10/29/2018 ® CONVERSION Date Recorded: Sm-AGRICULTURAL FOREST Updated: 3/15/2006 G1 -RESIDENTIAL STATE G4 -AGRICULTURAL COUNTY TOWN OF OULU 2 -Year Comparison SCHL-SOUTHSHORE Land: TECHNICAL COLLEGE Improved: Total: Updated: 3/15/2006 202IR-588287 13 Property History N/A 2018R-575857 2018R-575268 2018R-575165 336-131;662-86;714-23&24+ Acres Land Imp. 5.000 3,300 0 2.000 16,000 20,500 3.000 600 0 2024 2025 Change 19,800 19,900 0.5% 20,500 20,500 0.0% 40,300 40,400 0.2% Gr: ED AUG 05 2025 Hayfield Co. planing and Zoning Agency },}}nc-/lnn.nic k f,c I lmn,inh,ud nnvl'ecacc/macfaracn 1/1 Bayfield County, WI 7112/2026, 11:23:21 AM Soils Approximate Parcel Boundary Ail Roads 0Wr1 I Section Lines Municipal Boundary Building Footprint 2009-2015 Demolished Clayey ,Rivers Meander Lines Existing New Driveways Buildings 0 0.01 0.01 0.03 ml 0 0.01 0.03 0.06 km BeyfOId B yfetd county land ReCONt oepcnmen( SUPERS LP3©© I -Compartment Tank PiECRERWTE PRECAST CONCRETE I PRECAST CONCRETE TOP VIEW Tank (in 154 Ta Tnk 15,12'` Lid: 9.7'5 Total; 24,902 / Volume of Concrete Total: 6.2 Yd' Gallons Per Inch: 74.5 Maw Lid. Enlarged Detail CondWonafy APPROVED DEPT. OF SAFETY AND PROFESSIONAL 1 4' SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE 96" 102" 3029 Gallon- 1 ✓' f i a SIDE VIEW r-i .s 4" flsdet „ 9' &s Space I -tr.- j 43' Depth 48" _______________ C.TOL45's Manhole Openings. 12" Tapes du Proced by Superior I recas3 Concrete, ➢.LC I nm KW'ywaerd, WI �-�� t Po➢;-echr➢eae ����� Baffle P d U PRECAST CONCRETE Design conforms to ASTM C1227, Specification or Precast Mr^ic Concrete Septic Tanks and WISPS 384.25, POWTS Holding Rope Components or Treatment Components. The information provided on any Superior Precast Concrete (SPC) drawing or document shalt be verified by the purchasers licensed professional engineer for suitability of use. Configuration may change from drawing consult with SPC. !'I Gasket ayed in P'm-ce) i AUG 052025 mole proPtlemiYiMotmeHon, entl remamsme Pr^PertyotsupMorPrcrast Concrere,LLG e2V d. Co. a30514 Document NumbedPian I.D. No. I HOLDING TANK AGREEMENT (s) JLRE P1 I cWc-ISi o Parcel Identifier Number (PIN) 5100 HoKKAASJ 1L,Q Agreement Date. (same as Notary We acknowledge that application is being made for the installation of (a) holding tank(. an 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. 114 of 1/4 Section Township N. Range W. Town of Additional Legal Description: SFt A7744WR Gov't Lot_ Lot Block Subdivision CSM# Lot CSM # Vol Page CSM Doc# DOCUMENT NUMBER 2025R-608177 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED 07/07/2025 AT 2:08 PM RECORDING FEE: $30.00 PAGES: 2 Return To: JfR1.my f: Air.Isc 5100 HoKK4i%/(iV RD As an inducement to Bayfleld 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 tails to have the holding tank property serviced in response to orders issued by Bayfield County or the Department of Commerce to prevent or abate a human health hazard as described in a. 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, Stats. 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 ail 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. NR1 13, Wis. Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed pursuant to s. 281.48 (3) Wis. Scats., and Ch. NR 114, WI's Adm. Code who shall submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfield County may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may Indicate that the holding tank is not being properly maintained. 5. This agreement will remain in effect only until Bayfield County certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. SPS 383, WI's Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank Is Installed. Owner(s) Name(s) -- Please Print Subscribed and sworn to before me on this date: 11 f r r s, m (.S c ° 7 7 - Z02S Notarized Owner(s) — Signatur of Public Commission Expires: . 80 LTZS _ Drafted by: G cc' Date: Po sonai You Provide may so used for secondary purposes (Privacy Law. x.15,04 6Xm)I ullo mIsona ryRwidtaytankapreemonl.doc Oiuno 2018 Bayfield County Register of Deeds Document #2025R-608177 Page 1 of 2 • I fI 800 673-8710 • www.n f i ie Ahuseher. 204866 ADDENDUM/EXHIBIT A That part d the Sottttrwcst Quarter d the Nottl+east Quarter (SW1/#NE1/4), Section TNw (3), Tavns ip Forty-eight (48) North, Range Nine (9) West, Hhg East d the tarn road, Tarn of Oulu, 8nylield County, 1l=stn. For InfmmationaI Ptnposes Only, d* above described lands are dsgnatzd with the l n9: Tax ID Nernber: 04-038-2-4809.03-103-00040000 Property Address: 75660 Xoru mo Road Iron Rirey WI 54847 11 ¶\. rr:i ;r. Li : 3 • \ .1. �w•i I� Bayfield County Register of Deeds Document #2025R-608177 Page 2 of 2 HOLDING TANK SERVICING CONTRACT R E tract Date %1l/ 95 Holding Tank Owner(s) Name(s) JE.RFi�1 Y FRa ` )Sco This contract Is made between the -JUL U 7 2025 Pumper's Name (Print) .pa 114&sk-/ Pu ' p is Signature ---�•- Pumpers' Registration' # We acknowledge the Installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) Tax Ipq PJtOJECT Legal Description :.. LOCATION; (Use Tax Statement); 1�4' if4' • Town of: Lot Site Acreage Section ,Townshipr.N 'Range W Gev't Lea I;:,lLath C . , : SM # : , „•Val: gages • :, ° CSM Dec il' i Lot(s) No: Block(s) Nc. Subdivi3ions 1. The owner agrees to file a copy of this contract with Barfield County as required In SPS 383.55, Wis. Adm. Code. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local government unit which has signed the pumping agreement required by SPS 383.55, Wis. Adm. Code, and the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes In gallons of the contents pumped from the holding tank for each servicing; ,���piflfll/I/►/ g. The disposal sites to which the contents from the holding tank were delivered. ``x.•01% NICp�'''1•.,, 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event�,`�hange inth• contract, the owner agrees to file a copy of any changes to this service contract or a copy of a n& ss, [G1 Aj9ehisi% C with the local government unit and the County named above within (10) business days from the date of cflar]g�c service contract. - •n_ : AUR VAG Owner(s) Name(s) (Print) Ow s Signat e(s) Subscribed and•Swom to me.'•.,,�''••.... a, �F .i ce t i • Y -F W/vt - is C ' on this day of by: e4.1 VltpJ.JtAI Notary Public My commission expires on: Revised: May 2016 (®May 2018) Drafted by o ps Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)] HOLDING TANK — MANAGEMENT PLAN JUL 072025 The Private Onsite Waste Treatment System (POWTS) has been designed and is to be installed and maintained according to SPS 383, Wisconsin Administrative Code, Holding Tank Component Manual for Private Onsite Waste Treatment Systems (SBD-10571-P)(R.6199) and the Bayfield County Zoning Department Sanitary and Private Sewage Ordinance. 1. This POWTS has been designed to accommodate a maximum daily flow of Q gallons of domestic wastewater per day. 2. The owner of this POWTS is responsible for system operation and maintenance, locking device, alarm and access. 3. The owner or owner's agent is required to submit reports as required by SPS 383.55(1), Wis. Adm. Code, to the Bayfield County Zoning Department. 4. Design approval and site inspections before, during and after the construction are accomplished by the county or other appropriate jurisdictions in accordance with SPS 383 of the Wis. Adm. Code. 5. Maintenance Cycle. The holding tank must be serviced by licensed pumpers. An alarm system is to be installed to activate when the tank is < 90% full. 6. Performance monitoring. At the time of servicing, the service provider files a report with the department of designated agent. 7. A User's Manual will accompany the component. It will include the names and phone numbers of local health authorities, component manufacturer or POWTS service provider to be contacted in the event of component malfunction or failure. 8. In the event that this POWTS or a component of this POWTS fails and cannot be repaired the owner will find in the User's Manual the names and telephone numbers of property licensed individuals to contact for such repairs. This agreement shall be binding on all assignees and heirs 1/4 of 1/4 Section Township N. Range W. Town of Govt. Lot Lot Block Subdivision CSM# Additional Legal Description i< y Owners Signature • . Date ulforms/managementplan Revised: July 2013 File Number. 204886 ADDENDUM/EXHIBIT A That part of the Southwest Quartet of the Northeast Quarts (SW1f4-NE)/4), Setlbn Tham (3), Township Forty- ght (48) North, Range Nine (9) West, lying Fast of the town mad, Tawn of Oulu, BayfkW County, WNmnsi. For Informational Purposes Only, the above described lands are designated with the (oltawingt Tar ID Number: 04-038-24&09-03-103.00010000 PreperNAddmss: 75660 Kaulamo Road Iron River, WI 54847 ____ Soil Test # Bayfield County µ � Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) 1 ijT4C Mon 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 Own i Mv�& W 1 Property Address75!dO LAur-4mo 2r Contractor Authorized Agent i2o-q 2,y6,Q-. t )1 S('-1) Agent's Telephone, Telephone, Accurate Legal Description is requested: Written Authorization Attached: Y or N .TL'. -)1I4 of 114 Section 5 Township '1 Range7 W. Town of (a ___ Additional Legal Description: OF 7R ij 72≥x. X) - 7 gad Govt. Lot Lot Block Subdivision Lot CSM# Vol. Page CSM Doc # Volume Page of Deeds Tax I.D#doss I Acreage JO Indicate reasoning for your determination: Signatu a of County -Official Date Signa f C ified oil Tester 7 -Jo Date - o3 I OoC0 I Certification # RCtVED(Submit a Plot Plan & Fee) AUG 05 2025 f ayBsld Co. u/forms/soiltestwaiver(KLK) Ptainning and Zoning Agency June 2018 CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. LI SOIL EVALUATION Scale: 50' SYSTEM PAGE 2 OF 0 75 100 SITE MAP LOT PLAN PROJECT NAME: (12.5 ft grid) 125121 DESIGN FLOW: GPD Attach design flow calculations for commercial plans. PROJECT ADDRESS: T%5l�� 0 a- V oyylre ,aV,j Pipe Material / ASTM Standard (Tables 385.30-3 & 384.30-5) NSanitary sewer V C- _1 BS Symbol: BM Elevation: , d� FT Force Main: J BM Description: Indicate north by IMPORTANT: Slope Gradient (%) Well Symbol (If applicable): p drawing an arrow Show ground elevation contours at suitable intervals. of Tested Area: on the approprite tine. r � 1 I j�� ► I 1 I i i 1 T. i__i- ' -P-- —: ... AUG O.5 205 Baytield Co. I:?Ian;=an0r Z��inc,, A5ar, _. 2 I Industry Services Division 4822 Madison Yards Way County BC.Aj j� 1e-I� a� _ � '*C!L,a"icy Madison, WI 53705 P.O. Box 7302 Sanitary Permit Number (U be filled in by Co.) ii Madison, WI 5302 a5 0 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 arc 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 !�/ b o f j3jCarvt O La, purposes in accordance with the Privacy Law, s. 15.04(I)(m), Stats. / 5 b Z{or\ g , , rJ SV(yh 1. Application Information —Please Print All Information Property Owner's Name �Z�2M is 37ric,,nGiSGd Parcel # c�S1 Property Owner's Mailing Address Property Location Govt. Lot Su %. C 'h, `ection3 City, State I W� Zip Code 5`�gLf� Phone Number rli5 919 aafl T "IS N R gC or W U. Type of Building (check all that apply) Lot # 011 or 2 Family Dwelling — Number of Bedrooms Subdivision Name ❑ Public/Commercial — Describe Use Block # 0 City of ❑ State Owned — Describe Use 0 Village o! CSM Number Mown of 00/0 III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if a licable. A. ❑ New System Y .Replacement System � P Y ❑ Other Modification to Existing System (explain) y ( p ) ❑ Additional Pretreatment Unit (explain) B' Holdin Tank g ❑ In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site DesignType ❑ Other (explain) (conventional) C. ❑ Renewal Before ❑ Revision 0 Change of PlumberList g ❑ Transfer to New Owner Previous Permit Number and Date Issued Expiration IV.Dispersal/TreatmentArea and Tank Information: Design Flow (gpd) Design Soil App]ication Rate(gpw/sl) Dispersal Area Required (s0 Dispersal Area Proposed (sl) System Elevation 3oc� Capacity iu Total # of Manufacturer Tank Information Gallons Gallons Units o u U v New Tanks Existing Tanks W y . , u.0 E Septic or Holding Tank II(iCt{ CCC0. ,0( Dosing Chamber V. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumb s Name (Print) �o�. 5J Plum 's Signal MI'/MFRS Number Business Phone Number `715 l o3t� � i3 Ii00 Plumber's Ad ress (Street, City, State, Zip Code) VI. County/Department Use Only Approved 0 Disapproved Permit Fee Date Issued Issui g at store O ❑ Owner Given Reason for Denial 0` r6 19 as �j Conditions of Approval/Reasons for Disapproval RECEIVED AUG 0 5 2025 Bayfield Co. Planning and Zoning Agency Arisen to complete plans for the system and submit to the County only on paper not less than a Ills II inches in size SBD-6398 (R. 02/22) tl-703 ( Soil Test # Bayfield County �D Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) IA%C.TeZn a certified soil tester determine that in my professional judgme t 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 OwneQ2v9R7j\WCJSLaO Property Address]S'(dY)ur.4mO 2r) Contractor Authorized Agent IBC 2wey.,. t)1 L17 Agent's Telephone Telephone Written Authorization Attached: Y or N Accurate Legal Description is requested: of NC114 Section Township N. Range W. Town of__________ Additional Legal Description: - F Govt. Lot Lot Block Subdivision Lot CSM# Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# c?(.oSS I Acreage lb Indicate reasoning for your determination: Signatu a of County -Official Date Signs f C ified oil Tester 7-/5 -a_ Date p3laoc o i Certification # R CE'VED (Submit a Plot Plan & Fee) AUG 052025 Bayfeld Co. u/forms/soiltestwaiver(KLK) Planning and Zoning Agency June 2018 CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. SOIL EVALUATION Scale: 1=50' SYSTEM PAGE 2 OF 0 100 SITE MAP LOT PLAN PROJECT NAME: (12 5 ft grid) L2 52VA DESIGN FLOW: GPD Attach design flow calculations for commercial plans. PROJECT ADDRESS: '75G 0 IG- i) �� o A%o j Pipe Material I ASTM Standard (Tables 38.30-3 & 384.30-5) NSanitary Sewer. V C' / BM Symbol: BM Elevation: , a� FT Force Main:________________I________________ BM Description: Slope Gradient (%) Indicate north by IMPORTANT: P Well Symbol (if applicable): 0 drawing an arrow Show ground elevation contours at suitable intervals. of Tested Area: an the approprite line. I � s 1 i 1 ( 1 ( i f Ic iI ! E i � � r �• 'D V\7r � f -- — .........- * RCEiVE1i r AUG 05 2025 Bayfield pa. ___ .. Planning and Zoning Agent •: PAGE 1 OF 4 Holding Tank Plan Index & Cover Sheet Component Manual Design References: Holding Tank Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Holding Tank Specifications Pg 4 of 4 Management Plan Attachments: POWTS Application for Review Soil Evaluation Report & Site M-, ornt Gonad 44 Holding Tank Pumping Contract (it appj k c i( Holding Tank Agreement (if applicable) Project Name / Description 1 Owner Name(s): JtIt-/mil/ -f fl'S/v Frc^' c/sc0 Phone:>/S _ e/Iri - Owner Address: SId0 11,,E Project Address: I� '�5�O no kA' ' o l ci Zion f.hlc6'rh Govt. Lot: SJ'.- 1/4 of /J� 1/4, Section J T 4f N-RE❑or W J�J Township: Oujo County: Project Parcel ID #: 9455 I /% Designer Information Designer Name: &i( Sc,i "r"t Designer Address 4°'° 0a_ fl. E-mail: License Number: Remarks: o3 Phone:')/r_y/3__ blob Zip: SUg56 This space reserved for approval stamp. RECEIVED AUG 052025 Bayfieid Co. Planning and Zoning Agency Signature: Date: signature required Zn each submitted copy. L O.-. ,.IA fl,..., +., %A/l cv 7/1212025, 11:23:21 AM 1:783 Soils I Approximate Parcel Boundary All Roads Existing 0 0.01 0.01 0.03 ml 00 Clayey ® Section Lines Town New 0 0.01 0.03 0.06 km Rivers 0 Municipal Boundary Building Footprint 2009-2015 Driveways sey� Meander Lines Demolished y Buildings aryoid Courtly Land Reads Deparimem 7/10/25, 10:00 AM Novus-Wisconsin Access rev. 12.0206 Real Estate Bayfield County Property Listing Today's Date: 7/10/2025 S Description Updated: 5/3/2021 Tax ID: 26551 PIN: 04-038-2-48-09-03-1 03-000-10000 Legacy PIN: 038100402000 Map ID: Municipality: (038) TOWN OF OULU STR: S03 T48N R09W Description: PAR IN SW NE E OF TN RD IN DOC 2021R-588287 32-1 Recorded Acres: 10.000 Calculated Acres: 8.346 Lottery Claims: 0 First Dollar: Yes Zoning: (AG -1) Agricultural -1 ESN: 125 '1 Tax Districts Updated: 3/15/2006 STATE 04 COUNTY 038 TOWN OF OULU 044522 SCHL-SOUTHSHORE 001700 TECHNICAL COLLEGE Recorded Documents ® WARRANTY DEED Date Recorded: 4/26/2021 M QUIT CLAIM DEED Date Recorded: 12/26/2018 ® WARRANTY DEED Date Recorded: 11/5/2018 ® WARRANTY DEED Date Recorded: 10/29/2018 U CONVERSION Date Recorded: Updated: 3/15/2006 2021R-588287 2018R-575857 2018R-575268 2018R-575165 336-131;662-86;714-23&24+ Property Status: Current Created On: 3/15/2006 1:15:53 PM 9. Ownership Updated: 5/3/2021 JEREMY E & MISTY S FRANCISCO IRON RIVER WI Billing Address: Mailing Address: JEREMY E & MISTY S JEREMY E & MISTY S FRANCISCO FRANCISCO 5100 HOKKANEN RD 5100 HOKKANEN RD IRON RIVER WI 54847 IRON RIVER WI 54847 PSite Address * indicates Private Road 75660 KAUKAMO RD IRON RIVER 54847 ® PropertyAssessment Updated: 5/5/2025 2025 Assessment Detail Code Acres Land Imp. Sm-AGRICULTURAL FOREST 5.000 3,300 0 GS -RESIDENTIAL 2.000 16,000 20,500 G4 -AGRICULTURAL 3.000 600 0 2 -Year Comparison 2024 2025 Change Land: 19,800 19,900 0.5% Improved: 20,500 20,500 0.0% Total: 40,300 40,400 0.2% per' Property History N/A RECE E D AUG 0 5 2025 Bayfield Co. Planning and Zoning Agency https://novus.bayfieldcounty.wi.gov/access/master.asp 1/1 Bayfield County, WI Ln O O cc �Yn !S DAVID F CDLB- T. ID. 6550 t. JEFEMI E 6 t.1i5, 5 FFAfI[ISCD £fi or,.Bt... Ti' IDe ±6551 psP $J T• hi s . Y., 7/12/2025, 11:23:21 AM Soils Approximate Parcel Boundary All Roads Existing Clayey { 1 section Lines Town New .Rivers Municipal Boundary Building Footprint 2009-2015 Driveways Meander Lines Demolished Buildings 1:783 0 0.01 0.01 0.03 ml 0 0.01 0.03 0.08 Y.m 6eylbe gypgd County Land Records Deperlmenl i ill�r� LP30001-Compartment Tank An. . pRECAST CONCRETE Weight (in lb:) Tanl:: 18,13 Lid: 9"S Total: 34903 Volume of Concrete Total: 6.2 Yd' Gallons Per Inch: '0.8 �7avc lid hall Enlarged Detail coShlonmy APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE TOP VIEW 184" 1'S 3029 Gallon: SIDE VIEW I. _8 T 1 9" Air Space _ .rr ii II �I it 43" LiquidLL SO" 3 PRE CA AST'.CIINC NK II ETE' 4" 96" 102" 48" 64' --"---- ------------ Manhole Openings 2-I '°Tai eT l�'� !(f Produced by Superior Precast Concrete, LLC PO Box 1390 m Hayward, WI 54843 Polyethylene Baffle Ma;tic Rope 5 SUPERIOR PRECAST CONCRETE Design conforms to ASTM C1227, Specification or Precast Concrete Septic Tanks and WI SPS 384.25, POWTS Holding Components or Treatment Components. The information provided on any Superior Precast Concrete (SPC) drawing or document shall be verified by the purchasers licensed professional engineer for suitability of use. Configuration may change from drawing, consult with SPC. RECEIVED AUG 05 2025 I RMurtRte Nn • I Tn:s Ie ppnabry Imonnannn,ana remaN,ihe pmpem'ol Supeek:Preean Cmerere. LLC. Bavfleld Co. Document Number/Plan l.D. No. HOLDING TANK AGREEMENT Owner Name (s) Owner(s) Mailing Address 5100 HoKKM RD JLRE Ply WCISc.o Parcel Identifier Number (PIN) Date. (same as 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 promises 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 Township N. Range W. Town of Additional Legal Description: .'Cc A77txfP Gov't Lot_ Lot Block Subdivision CSM#, Lot CSM # Vol Page CSM Doc# DOCUMENT NUMBER 2025R -6y/0817 l? DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED 07/07/2025 AT 2:08 PM RECORDING FEE: $30.00 PAGES: 2 Return To: J EJUJn Y R.vc isaJ 51O0 HO1<K4v£il RD M2lvEA. ws SLtg7 As an inducement to Bayfletd 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, Scats., 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 far current services rendered. The charges will be assessed as prescribed by 8.66.0703, 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 roil 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. NR1 13, Wis. Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed pursuant to s. 281.48 (3) Wis. Scats., and Ch. NR 114, WI's Adm. Code who shall submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfield County may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may Indicate that the holding tank Is not being properly maintained. 5. This agreement will remain in effect only until Bayfield County certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. SPS 383, WI's Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement In such manner which will permit the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is Installed. Owner(s) Name(s) — Please Print Subscribed and sworn to before me on this date: 111 t 1 r ►i F f4vco I S C 0 7 Notarized Owner(s) — Signatur o Public 1u; z ava- ( /9 My Commission Expires: �'•, B L% ,-v7 25- Drafted by: G c Date: ''�r c r wit t PersonalIrdomon you IxeAdo nay be used tar secondary pulp 3 (Pflvscy I.aw. $.15.04 (ixmll w orcruiaaaiterymausnQtankagoeement.doc dune 2018 Bayfield County Register of Deeds Document #2025R-608177 Page 1 of 2 File Nut 204886 ADDENDUM/EXHIBIT A That part arthe sank es Qmrtrdde PCTh Quair(6w6H4Ne1M, smMn TNT (3), TowaaS Forty-eight (48) North. Range Nbe (9) west, Nbg Rau Of the Wvn nod, TM. of Oulu, BWW County. nsbi. For }n/onre6'ovd PWpmea 0,*, the a de -sat& Mods are desgnaml rMlt the ro8ud 3: Tax ID Nundc 04.838-2-48.0903-1 03-000-1 P, Pddm: )5660 Yeakemo Road Iron RNer, WI 5484) cOPY Bayfield County Register of Deeds Document #2025R-608177 Page 2 of 2 HOLDING TANK SERVICING CONTRACT Contract Cate IISi� :folding Tank Owner(s) Name(s) AP -F -0y FR4 Jc isco This contract is made between the JUL 072025 Bayfield Co. Zoning Dept. Pumper's Name (Print)Pump is Signature Pumpers' Registration # Ittt ��_ / // We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT Legal Description, Tax IDe LOCATION (Use Tax Statement) 1/4, 1/4, Town of: Lot Size Acreage Section ,Township N, Range w u'm?t Lct L ct e I CSM R Voi. Page I CSM Doc.# I Lot(s)No. I 'eiockis) No. • . Subdivision: 1. The owner agrees to file a copy of this contract with Bayfield County as required in SPS 383.55, Wis. Adm. Code. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local government unit which has signed the pumping agreement required by SPS 383.55, Wis. Adm. Code, and the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain In effect until the owner or pumper terminates this contract. In the event contract, the owner agrees to file a copy of any changes to this service contract or a copy of a nq with the local government unit and the County named above within (10) business days from the del service contract. ,JcQEWl.Y'F( N(,isCd NIC°'��%.. f ,`k hangs ithl s$irvjGtA$r�Ct of cttanggjp fhlst on this _day of q by: Notary Public My commission Revised: May 2016 (®May 2018) § Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)] on: s• Drafted by Ic HOLDING TANK - MANAGEMENT PLAN JUL 07?O?5 The Private Onsite Waste Treatment System (POWTS) has been designed and is to be installed and maintained according to SPS 383, Wisconsin Administrative Code, Holding Tank Component Manual for Private Onsite Waste Treatment Systems (SBD-1 0571 -P)(R.6/99) and the Bayfield County Zoning Department Sanitary and Private Sewage Ordinance. 1. This POWTS has been designed to accommodate a maximum daily flow of 3()C gallons of domestic wastewater per day. 2. The owner of this POWTS is responsible for system operation and maintenance, locking device, alarm and access. 3. The owner or owner's agent is required to submit reports as required by SPS 383.55(1), Wis. Adm. Code, to the Bayfield County Zoning Department. 4. Design approval and site inspections before, during and after the construction are accomplished by the county or other appropriate jurisdictions in accordance with SPS 383 of the Wis. Adm. Code. 5. Maintenance Cycle. The holding tank must be serviced by licensed pumpers. An alarm system is to be installed to activate when the tank is < 90% full. 6. Performance monitoring. At the time of servicing, the service provider files a report with the department of designated agent. 7. A User's Manual will accompany the component. It will include the names and phone numbers of local health authorities, component manufacturer or POWTS service provider to be contacted in the event of component malfunction or failure. 8. In the event that this POWTS or a component of this POWTS fails and cannot be repaired the owner will find in the User's Manual the names and telephone numbers of property licensed individuals to contact for such repairs. This agreement shall be binding on all assignees and heirs _1/4 of 1/4 Section_Township_N. Range W. Town of Govt. Lot_ Lot_ Block Subdivision CSM# Additional Legal Description I',' ro y Owners Signature u/farms/managementplan Revised: July 2013 6/23/�s Date file Number. 204886 ADDENDUM/EXHIBITA That part of the Southwest Quarter of the Northeast Quartet (SWl/4NE3/4), S&lon Thos (3), Township Forty.dght (48) North, Range Nine (9) West Meg East of the town road, Turn of Oulu, 8ayneld County, Wstonsln. For lnfamnatlonal Purposes onry, the above descdbad lands am designated with the fallowing: Tax ID Numbeer, 04.038-248'0903-103-000-10000 Psoperty Address: 75660 Naulemo Road Iron River, WI 54847 JUL 072025 Bayfield Co. Zoning Dept. A FIELD 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: FRANCISCO, JEREMY E & MISTY S 5100 HOKKANEN RD IRON RIVER, WI 54847 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00313 Transaction Number: SR -00313-323E3 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 1058 Paid by: Schaffers Well Repair LLC, 60300 Mason Delta Rd, Mason WI 54856 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. 134- -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: Submission Number: FRANCISCO, JEREMY E & MISTY S SS -00621 5100 HOKKANEN RD IRON RIVER, WI 54847 Transaction Number: SS -00621-323E1 Description Private Sewage System (Holding Tanks) Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 1058 Paid by: Schaffers Well Repair LLC, 60300 Mason Delta Rd, Mason WI 54856 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)-25-101 S STATE SANITARY PERMIT OWNER: JEREMY E & MISTY S FRANCISCO GOVT LOT: LOT: BLK: SW 114 NE 1/4 SEC: 3, T 48 N, R 9 W TOWNSHIP: Oulu SOIL TEST: 101-25 REPLACEMENT SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: CORY SCHAFFER 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: # 1037 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