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HomeMy WebLinkAbout25-96SRequest 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 fl Time Change fl Discrepancy fl Other Phone Number 715-413-0122 Plumber: Superior Plumbing & Mech. Inc. Fax Number Email Address Homeowner: Tom Dymesich ed@superiorpmw.com Immediate Phone Number So Zoning Sanitary Dept can call you right back (if needed) Permit #: 25-96S Plumber's Choice o nI Dept No Inspection(s) during this time Date: 9/18/25 Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice Zoning Dept Time: 9:30am �} ■ V • •, Township: Mason & Address #& Road Name: 19151 Co Hwy E, Mason or Directions To Site: Comments: Holding tank inspetion ** Plumbers you must verify any change(s) by fax or email ** Notes from u/forms/sanitary/requestforinspection Zoning Dept (©4/12104); ® June 2023 POWTS HOLDING TANK INSPECTION REPORT THOMAS DYMESICH ATTN: DAVID TANNER DYMESICH 387 BILL LN NORTHGLENN CO 80260 TANK INFORMATION TYPE MANUFACTURER/MODEL # CAPACITY Cnop4c u cr'a.jcO SETBACKS Property Line Well Water Service Building All -Weather Road OHWM Swimming Pool DEVIATIONS FROM APPROVED PLAN COMMENTS (Persons present, discrepancies, etc.) 7aAll( COMPONENTS NOT INSPECTED Plan Revision equlred ❑ Yes oI i p cert. Number SCetcn on otner side 10 of 13 4, BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT 'i Telephone: (715) 373-6138 Bayfield County Courthouse Fax: (715) 373-0114 Post Office Box 58 e-mail: zoning0bayfieldcounty wi aov 117 East Fifth Street Web Site: www.bavfieldcountv.Wi.aOV/147 Washburn, WI 54891 Property Owner THOMAS DYMESICH Information _ ATTN: DAVID TANNER DYMESICH 387 BILL LN NORTHGLENN CO 80260 As you know Grp was contracted by you to install a private onsite wastewater tr atment system on your I operty described as: Notes Abandonment of Old System to meet all applicable code requirements: On condi o Tank was pumped by: Tank was crushed I removed and pipes disconnected by: on at AM/PM P at X PM____ ) the above -mentioned plumber contacted our office to inspection as required under DSPS 383. One of the following applies: 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: Ulfarmslsenitaryprapertyowner-input April 2019 ', {r 5 Department of Safety Ba eld p 7 & P fess><onal Servlees, Sanitary Permit Number (to be filled in by Co.) 8J) industry Services Division anitary 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 purposes in accordance with the Privacy Law, s. 15.04(1 km), Stats. 19151 Co Hwy E Mason, WI I. Application Information — Please Print All Information Property Owner's Name Parcel # Tom Dymesich 38833 Property Owner's Mailing Address Property Location 387 Bill Lane Govt. Lot City, State Zip Code Phone Number Northglenn, CO 80260 303-668-9068 NW ' ,NW 'V+, Section 7 11. Type of Building (check all that apply) Lot # T 46 N R 6 E or W - lI or 2 Family Dwelling — Number ofBedrooms 2 Subdivision Name Block # ❑ Public/Commercial — Describe Use O City of O State Owned — Describe Use CSM Number O Village of M Town of MASON ILL Type of POWTS Permit: (Check either "New" or 'Replacements aod.other applicable oa line A. Cti++e+etrniie�bax on lne B Complete Une C If livable.) - A. J New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. Holding Tank ❑ In -Ground ❑ At -Grade ❑ Mound 0 Individual Site Design ❑ Other Type (explain) (conventional) ❑ Change of Plumber List Previous Permit Number and Date Issued C. ❑ Renewal Before ❑ Revision g ❑ Transfer to New Owner Expiration N. Dis ersaI/Treatment Area and Tank:.Informatlon: Design Flow (gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units o New Tanks Existing Tanks c w rs. U rn r; i% o Septic or Holding Tank x 2000 Wieser Concrete X Dosing Chamber V. Responsibility Statement- I, the undersigned, assume resppnslbillty forinstalletion of the ,l'0WTS ho non the c p 119e Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Edward B. Redinger 221939 715-290-6670 Plumber's Address (Street, City, State, Zip Code) 101511th Ave. E Ashland, WI 54806 V Coanty/Department Use Only Approved O Disapproved Permit Fee Date Issued L, i g t Stale O Owner Given n� Reaso for Denial $ 4OD— g �( o2S � ' ►%' Conditions of Approval/Reasons for Disapproval rECVED c F. AUG 04 2025 saytold Co. rl:nn .h., n„ '; „ Attach to complete plans for the system and submit to the County only on paper not less than 8112 x II inches in size SBD-6398 (R. 03/22) 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: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map (if ap Holding Tank Pumping Contract (if appli Holding Tank Agreement (if applicable) Project Name I Description 2 Bed Home plicable) cable) Owner Name(s): Tom Dymesich �l4a�. Phone: 303 -668 -9068 Owner Address: 61875 Moonshine Alley , WI Zip: 54856 Project Address: 19151 Co Hwy E Mason, WI Govt. Lot: NW 1/4 of NW 1/4, Section 7 , T 46 N -R 6 E Liar W EI✓ Township: Mason County: Bayf eld Project Parcel ID #: 38833 Designer Information Designer Name: Edward B. Redinger Designer Address: 1015 11th Ave. E. Ashland, WI E-mail: ed@superiorpmw.com License Number: 221939 Remarks: Phone: 715 -292 -6670 Zip: 54806 This space reserved for approval stamp. AUG 042025 Qayrwtj co Planning and - ar+r. ; Signature: Date: 814125 Original signature required on each s miffed copy. Customer Name: Tom Dymesich Adress: 387 Bill Lane /V 4 Northelenn Co 80260 6SUPERIOR SITE: 19151 Co Hwy E Mason, WI PLUMBING MECHANICAL Phone #: 303-668-9068 (715) 278.3456 Email: CST# 221939 Scale: 1" = 40 o. PIN: 38833 10 Acres NW NW 57 T46N R6W Town of Mason Bayfield Co. A 3.m. -Well C U1e�� I a aDdD � a T k Ydie,a.( RENEWED AUG 0 4 2025 Nayfielu Cc. Planning and Zonis,,; PAGE 3 OF 4 HOLDING TANK SPECIFICATIONS (No Scale) Weatherproof 12" Min. or 2.0 ft above Junction and Approved Established Flood Elevation Alarm Box Vent Cap (typical) Electrical must comply with Approved Locking Manhole SPS 316 and NEC 300 4"0 Vent Pipe with Warning Label Attached Conduit > 10 ft from (typical) 4" Min• or 2.0 ft above Building I Established Flood Elevation r - (typical) Airtight Seal __ Finished Grade 18" Min. (typical) Inlet Inlet Invert Approved Joints with ---Watertight Plug Approved Pipe 3 ft onto Max. 12" or 90% of total volume Solid Ground if more than one tank Alarm -On e • HOLDING TANK • VOLUME = 2000 gal d a • d 3" Approved Bedding Material Beneath Tank TANK MANUFACTURER: Wieser Concrete k"' j1VED Anchor tank as necessary AUG 0 4 2025 pursuant to SPS 383.43(8)(g) 8ayretd co. a:/�ency Ballast Weight = [(cu.ft.tank.vol x 62.4 Ibs/cu.ft) - Ibs.tank.wt] x 1.5 Planning nd Zorir.•g Ballast Weight = [( cu.ft. x 62.4 lbs/cu.ft) - Ibs] x 1.5 = Ibs PAGE 4 OF 4 Holding Tank Management Plan IMPORTANT: The owner of this holding tank(s) shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this holding tank(s) shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Estimated Daily Wastewater Flow = 300 gpd Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o surface discharge of effluent or sewage back-up into structure served SERVICING FREQUENCY o The tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wisc. Stats. when the wastewater in the tank(s) reaches a level of one foot below the inlet invert of the tank(s). Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. Tank pumping reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wis. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Superior Plumbing & Mech. Inc. Phone: 715-292-6670 Local government unit: Bayfleld Co Zoning Phone: 715-372-6138 Local government unit address: 117 5th St. E. Washburn, WI ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed component of this holding tank(s) cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agecy for review and approval. System Abandonment If use of this tank(s) is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. R C:'ED AUG 04 2025 Bayiielci cr., Planning 3nd _. r. /•,,.ar y TOP VIEW INLET s 0 to to M 164" ua N M M U a SIDE VIEW OUTLET N) PUMP PAD TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS WLP2000-MR o-7 TANK SPECIFICATIONS • DIMENSIONS: ` o a a a WALL: 3" BOTTOM: SEPTIC 3" . a a HEAVY DUTY 5" (ADD 2,800 LBS.) °- o COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 53" O.D. `v LENGTH: 164" O.D. WIDTH: 96" O.D. BELOW INLET: 41" O.D. o LIQUID LEVEL: 36" N o WEIGHT: BOTTOM 11,260 LBS. COVER 8,170 LBS. INLET AND OUTLET: w >- 4" CAST -A -SEAL BOOT OR EQUAL m � INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 Ii (OTHER STATES SEE CHART) c W LIQUID CAPACITY: 56.27 GAL/IN LOADING DESIGN: 8' 0" UNSATURATED SOIL W HOLDING TANK: U co C -n OUTLET HOLE PLUGGED ir d - 0O ACTUAL CAPACITY: 2,138 GALLONS " I MN TANKS: WILL HAVE N ONE VENT OVER OUTLET rr} AND WILL HAVE TWO VENTS IN COVER OVER INLET W O TANK CAN BE USED AS: X 00 CO SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #9 (SMALL FIBER) 0 CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE JOB INFORMATION: CUSTOMER: JOB NAME: DATE NEEDED: APPROVED BY: APPROVAL DATE: SHEET NO. OF/ 1 HOLDING TANK SERVICING CONTRACT Contract Date Let 3ol & This contract is made between the Holding Tank Owner(s) Name(s) © •F4 ch Pumper's Name (Print) I Pumper's Signature Pumpers' Registration # We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT I Legal Description: Tax ID# , t, r /',, X1/4, 1/4, LOCATION (Use Tax Statement) 3 gg3 3 Section 7 N, Range b W Town of: I Lot Size I Acreage ,Township �sSen 3 Gov't Lot Lot # CSM # Vol. Page CSM Doc# 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; :"�'►a .!i ci b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; AUG 04 2025 d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; . sayaeid co. f. The volumes in gallons of the contents pumped from the holding tank for each serviq�a1,1,11/I?1 A. and ?oninc; A.Cenc\ 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 contra '`l t�i lbf A chige in this contract, the owner agrees to file a copy of any changes to this service contract of p ofa-news contract with the local government unit and the County named above within (10) business d4s fPom v'of ge to this service contract. Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed an ,,�•� aim 1 o/eqs i 4J.. `~- on this t_day of _ by: AlVvati- Notary Public IMy commission expires on: 1I/I ao3r Revised: May 2016 (®May 2018) Drafted by Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)] - Document Number/PiaID. 1o. HOLDING TANK AGREEMENT Owner Name (s) Owner(s) Mailing Address Parcel Identifier Number (PIN) Agreement Dafe (same as Notary Date) We a knowle ge that applicat on 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. fs,__114 of 1/4 Section TownshipN. Range w. Town of Additional Legal Description: ,}we. $� DOCUMENT NUMBER 2025R-608628 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED O8/O4/2O25 AT 1:59 PM RECORDING FEE: $30.00 PAGES: 2 Return To:•C y2 en.tiSr GoVt Lot Lot Block Subdivision CSM# Lot CSM # Vol Page CSM Doc# 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, Stats., Bayfield County may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats. 2. Owner agrees to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 3. The owner agrees to contract with a person who is licensed pursuant to s.281.17 (3) Wis. Stats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced in accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed pursuant to s. 281.48 (3) Wis. Stats., and Ch. NR 114, 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.% B1BBbeyj(I's Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification topferer�ri prop...'...... 8sll��iefhp�:t in such manner which will permit the existence of the certification to be determinedbyreference to the p rte. .� ' 6. This agreement shall be binding upon the owner, irsart assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agrei9ij sil�iib�G.aecordei Zr3he register of deeds in a manner which will permit the existence of the agreement to be determined by refe to ther' e, ' wJIe holding tank is installed. Owner(s) Name(s) — Please Print iy S •• ed and sworn to before me on this date: `•,� "�..•.'' & yy y F OF S# AUG 05 202 uLc'. gyp%% 13 o Boa Bay�ield Co. Notarized ure(s) Not Public () My Commission Expires: 6� to ency Drafted by: l p a1 (►) y/il esIC// Date: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)] uformslsanitarylholdingtankagreement.doc ®June 2018 File Number: 248123 ADDENDUM/EXHIBIT A The East One-half of the Northwest Quarter of the Northwest Quarter (E1/2-NW1/4-NW1/4), Section Seven (7), Township Forty-six (46) North, Range Six (6) West, Town of Mason, Bayfleld County, Wisconsin; EXCEPT the following described parcel: A parcel of land located in the E1/2-NW1/4-NW1/4, Section 7, Township 46 North, Range 6 West, Town of Mason, Bayfleld County, Wisconsin, more particularly described as follows: Commencing at the Northwest comer of said section; thence South 87°31'10" East, along the North line of the Northeast quarter of said section a distance of 1378.32 feet to the North one -sixteenth Northwest comer; thence South 00°16'47" West along the East line of the NW1/4-NW1/4, a distance of 651.67 feet to the Point of Beginning; thence South 00°16'47" West, and continuing along said East line a distance of 651.67 feet to the C one -sixteenth Northwest comer; thence North 88°0212" West along the South line of the NW1/4-NW1/4 a distance of 683.73 feet; thence North 00°03'06" East a distance of 654.87 feet; thence South 87°46'37" East a distance of 686.44 feet to the East line of the NW1/4-NW1/4 and the Point of Beginning. EC +WED AUG 052025 Bayfie:o Co PlanninLj •,gefCy Bayteld County Register of Deeds Document #20248-604417 Page 3 of 3 1. u r' U l l E U SOIL EVALLIA 10* jJ REPORT ���,rr,r.t r:n. Page I of 1�5�,1v1e:;1 (1t.l�aft t�t`n1 car l t�illEl`e. i e '+ r t n, t t .r,rilr (t 4r -d �:r,n{r.41 t,1 , in Accordance wtth Comm 85, Ws Adm. Code County IfAYFll•.l.O V0011�4'tn cite 111,111 on pater not less than 8 1(2 x 11 inches in size, Plan must ncht:c+ tail not 4r,1i'ed to vertical and horizontal reference point (UM), direction and Parcel ID. 3808% Percent SPe scale or dimensions north arrow, and location and distance to nearest road Reviewed by Date Please print all information. Y" S D r`cr��^"t tRr°rn"rk"` YOU rae mny be used fist secondary purposes IPrivacy low. s 1504 (1) (m)) ��'P'tY Owner Property Location AS'1 FR NWV 1/4 NW 114 S 7 T 46 N R 6 E (or) w Pr Govt lot o 'm' miner's Marling Addrecg Lot # Block # Subd. Name or CSM# City I SU3S S11' (i1 rVl; COI:R-)- TIG State Zip Code Phone Number Nearest Road AKl) sty ❑Village • Town OR 97223 ( 541 ) 666.0171 MASON L CfY NWY E QNew Con stn,ct►on Use Residential / Number of bedrooms 1 Code derived design flow rate 150 GPD ❑ Repla ent ❑ Public or com R�;-5 Parent matenal mercial - Describe - J General comments TI I.L Flood Plain elevation if applicable ft. andrnmendatrons- HOLDING TANK OR MOUND AUG 04 2025 SYSTEM ELEVATION AT 101.2 ON 99.7 CONTOUR DESIGN LOAD RATE _ .6 GPD/S . FT. BaYfiel;i rc. Q V�/ G WOODED SITE 1 Boring # ❑ Boring QPit Ground surface etev.1_ ft t•'i Depth to hmrig iti factor 18 onzon Depth Dominant Color Redox Description in Munsell Qu• Sz. Cont. Color Texture I 0-6 5YR3/2 6-12 5YR3/4 SL SL 3 12-18 5YR4/6 SL 4 18-24 SYR4/6 CID SYR 5/8 SL 5 24-48 5YR4/6 C2D SYR 618 LS 6 48-56 2.5YR4/4 C2P SYR 613 FS YYt = 1O1 • a?D 2 ❑ rn Boring # 99.7 18 El Pit Ground surface elev. ft. Depth to timitinn far4nr _ Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Corti. ColorGPDIff Texture Structure Gr. Sz. Sh. Consistence MVFR MVFR MVFR MVFR MFR MFI !Elcund:arry Boundary CW CW CW CW GW - 3C 3C 3M 2F IF Sod •Eff# % .6 .6 .b .6 .7 .5 Rate •Eff#2 1.0 I.0 1.0 1.0 1.6 1.0 I 0-6 SYR3/2 SL 3MGR 2 6-12 5YR3/4 SL 3MSBK 3 12-18 5YR4/6 SL 2MSBK 4 18.24 5YR4/6 CID sYR 5/S SL 2MSI3K 5 24-48 5YR4/6 C2D SYR 618 LS 0SG 6 48-56 2.5YR4/4 C2P SYR 6/3 FS 0SG • rta..__ y� _ err, �n n.►n ..n __. Teen _'.. --- �� ... vv ......s.... GIIlUGrrl NG - D%Ju a .au mgnL and 1 bS < 3o mgil CST Name (Please Print) Signature,,CST Number BRUCE W BLAKEMANv �� 708148 Address Date Evaluation Conducted Telephone Number 64903 CI IARLE.S JOIINSON ROAD ASIILAND, WI 54806 05/19/2022 715-209-2569 Wj'ety Owner Bonng # I'Ut KMASII'It Parcel ID 0 Bonng Pit Groundsurfaceelev 991 n nrCHVEfi I rlf r'ii Reytn'4 Win. 1MORft Pw)e _ — nl 16 f in enlh in Ienilina factor Horizon Depth In Dominant Color Munsell Redox Description Qu. Sz Cont Color Texture Structure Or Si Sh Consistence Boundary 1 1 11-8 8-13 5183/1 5181/4 St. SI. 3hi(iR 2MSI3K h7VFN MVFN (-w (Vi 3 13 -It' S1R4/6 SL 2MSIIK MVFN (-Vi 4 16-22 51'1t4;6 CID51'NSrS SL 2MSBK MVPR (_ S 22-50 51'84/6 (.'21)51'126/8 LS OS(; MPN (r-_-- 6 50-58 1.51-N4/4 C2I' 51'N (✓3 FS OSG MM Thn- /Ol. X' I l Boring # [Bonny I I Horizon Depth in Dominant Color Mansell Redox Description Qu Sz Cont. Color Texture Structure Gr Sz Sh Consistence Boundary Roots GPDO •Eff#1 •E8#2 a I .6 .- WnXnn fawn, _ in Roofs vr...r.1 .E n#I Eff# 3M • 1 3C .6 1 0 3M .6 1.0 2M .6 1.0 2F 7 1.6 IF Sog Wp-1,c Pion Rate OBonny Boring # Ground surface elev n Depth to limiting factor in [1 Po Soil Anoliravon Rate Horizon Depth in Dominant Color Munsell Redox Description Ou. Sz. Cont Color Texture Structure Gr. Sz Sh Consistence Boundary Roots GPD/ff Eff#1 Eff#2 - Effluent #1=BODE>30≤ 220 mgfL and TSS '30 150 mg1L ' Effluent #2= B001< 30 mgrt and TSS < 30 ng/L I lie I)cpanmcnt of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate lbmtat, please contact the department at 608-266-3151 or TTY 608.264.88EG! IVE f.' saa.umrm to moor AUG 0.4 2025 Bayfald Co Plannin- snd'a.! 4571Q ,>tscw/ Y1€w) CY fL( S RECEIVE() MAY 26 Z0R myn+ia cn ('1anr nq .f1701 Il,U A9erq � G £3 NJ NI I '8 AMn. as A4vc C--R&,v4 y'v Noy 74? s/lilA C-t��� Q � PRoPoSF.b �0 W fir, 98.E I. 9y3 a'3f 6 "'"" Department of Safety County �\ C Bayfield & Professional Services, •�-� Industry Services Division Sanitary Permit Number (to be filled in by Co.) —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 purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stars. 19151 Co Hwy E Mason, WI t. Annlirafinn infnrmntinn — Plnaae Print All rnfnrmoHnn Tom Dymesich Property Owner's Mailing Address 387 Bill Lane City, State Northglenn, CO H. Type of Building (check all that apply) 5d I or 2 Family Dwelling — Number of Bedrooms O Public/Commercial — Describe Use ❑ City of O State Owned — Describe Use CSM Number O Village of IX Town of MASON Jul. 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. i] New System ❑ Replacement System ❑ Other Modification to Existing Sy stem P Y� (explain) ❑ Additional Pretreatment Unit (explain) B. ® Holding Tank ❑ In -Ground ❑ At-GradeDesign ❑ Other Type (explain) ❑ Mound ❑ Individual Site (conventional) ❑ Change of PlumberList Previous Permit Number and Date Issued C. ❑ Renewal Before ❑ Revision g ❑ Transfer to New Owner Expiration 80260 303-668-9068 Lot # 2 38833 Govt. Lot NW '/., NW /.. Section 7 6 Application Rate(gpd/st) Elevation Capacity in Total #of Manufacturer Tank Information Gallons Gallons Units o v o , w c a W New Tanke I Existing Tanks U to •- rn ii V a Septic or Holding Tank x 2000 Wieser Concrete x Dosing Chamber V. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Edward B. Redinger 221939 715-290-6670 1 1015 11th Ave. E Ashland, WI 54806 �Q Approvedas / y$ O Disapproved O Owner Given Reason for Denial D- note .ucu V0 L g I(, S a n tl g u a roue Conditions of Approval/Reasons for Disapproval aka c C� AAd In the Cnnnry nnlc nn none net 1— than a in, II R C11VED AUG 042025 Bayfield Co. ?'' Inn n fl 8a SBD-6398 (R. 03/22) I C'.:;VED '/[j, MAY 'l. fi 'CU"(l EIREAEo� W't nsin tN•padnrnt of Comn*io. SOIL EVALUA IO REPORT Oaytold Co. Page I of 3 tIrisvn of Santry and Owtdinps Plannirg and ZonirgA',ncy in accordance with Comm 85, Ws Arlin Code County IIAYFIlID Attach oomPlete site plan on paper not less than 8 12 x 11 Inches in size Plan must ichMe• but 001 limited to vertical and horizontal reference point (OM), direction and Parcel II) 38088 Percent sbpe. scale or dimensions, north arrowand location and distance to nearest road Date Please print all Information. Reviewed by � �°^Yot+pwidemybeuseCr rs,condarypurpo,n(Prw,cylawt I50�(I)Im11 Property CMmer Properly Location , Prope DAVID BUCKMASTIER Govt Lot NW 114 NW 114 S 7 T 46 N R 6 E (or)III W rtY seer's Marling Address Lot # Block # Subd. Name or CSZA# Coy 15938 S\V 61 AZt'. COURT State Zp Phone Number 4Y �vdlage •Town Nearest Road TIGARll MASON OR 97223 ( 541 ) 666.0171I CTY IIWY E; ❑ epla ruapn UseO Residential I Number of bedrooms 1 Code derived design flow rate 150 RePacementGPO Parent material ❑ Public or Commercial -Describe EC!11IEf"1 General Comments TILL Flood Plain elevation if applicable ft. and reco'nmendatans HOLDING TANK OR MOUND AUG 042025 _ SYSTEM ELEVATION AT 101.2 ON 99.7 CONTOUR 1� DESIGN LOAD RATE _ .6 GPD/SQ. FT. PWnnin and )field Co. WOODED SITE 0=or,io- 1❑ Boring # ❑ Boring .. Pit Ground surface elev. 99.7 ft. Honz Depth to limiting factor 18 on Depth Dominant Color Redox De 'n Munson Qu. Sz. Co 0-6 5YR3/2 2 6-12 5YR3/4 3 12-I8 5YR4/6 4 18-24 5YR4/6 CID5Y 5 24-48 5YR4/6 CZDSY 6 48-56 2.5YR4/4 C2PSY Pm: /O).&'O Bonn # ❑ Boring n. of n Texture Structure Consistence Boundary Roots nt Color Gr Sz. Sh. Soil A I lion Rate GPO/f? 'EH#1 'Efk72 SL 3MGR MVFR CW 3M .6 I.0 SL 3MSBK MVFR CW 3C .6 1.0 SL 2MSBK MVFR CW 3C 1.0 R5r8 .6 SL 2MSBK MVFR CW 3M 1.0 a we LS OSG MFR GW 2F .6 L6 Ron FS OSG MFI - IF .7 .5 10 El Pit Ground 99.7 surfaceelev, ft. I8 Depth to Lmong factor Horizon Depth Dominant Color Redox Description n. Texture Structure Consistence Sod li cation R. in. Munsell Qu. Sz. Cont. Color Boundary Roots GPD/ft' Gr Sz Sh. I 0-6 5YR3/2 'E8#1 I Eff#2 SL 3MGR MVFR 2 6-12 5YR3/4 CW 3M .6 L0 SL 3MSBK MVFR CW 3 12-18 5YR4/6 3C .6 1,0 SL 2MSBK MVFR CW 3C .6 I 1.0 q 18-24 5YR4/6 CID SYR S/s 2MSBK 2MSBK MVFR CW 3M .6 1.0 5 24-48 5YR4/6 CZDSYRru8 LS OSG MFR GW 2F .7 1.6 6 48-56 2.5YR4/4 C21'SYR6/3 FS OSG MFI - IF .5 1.0 ol•D • Effluent # 1 = SOD, > 30 < 220 mg/L and TS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L ant TSS < 3o nV& CST Name (Please Print) Signatu CST Number BRUCE 1V IILAKF:MANy r4 zl 708148 Address Date Evaluation Conducted Telephone Number 64903 CHARLES JOHNSON ROAD ASIILAND, WI 54806 05/19/2022 715-209-2569 PSI sb'l) rnyrrtyOwner NUCKMASII.R T Parcel ID # Liii Boring # {,J Boring 0 pit Ground surfaceelev y9'3 won Depth Dom�nanl Color Redox Descnplron Texture StructuRh Reels rum •ER#I In Muns tl DU Sz Cent Color or 5z t3'S 51'R3/2 SI. }MG i� (r II) 1.0 2 8-13 5VR3,4 SI. 2MSI3 1C 3MSL .6 .G1.0 3 13-IG 5YR4/6 2MSH MVI ZM •(' 1.0 4 16-22 5VR4/6 CID5YIt5/8 SL 2N1511K 5 22-50 5YR4/6 C2DSYItG/8 I -S 0S(i MFR (,W 2F IF .7 I.6 1.0 6 50-58 2,51'12414 C2P 5YR 6/3 FS 0SG MFI - .5 - /D/. DO I I I I Bong ri# [Boring — S m I.ai,v, f.rtnr Horizon Depth m. Dominant Color Munsell Redox Description Qu Sz Cont. Color Texture Structure Cr Sz Sh. Consistence Boundary Roots GPDRP •Eff#1 'Eff#2 ❑ Boring # c:iBoring Ground surface elev fl. Depth to limiting factor in Pit Sod AooliCatron Rate Horizon Depth in. Dominant Color Munsell Redox Description Co Sz. Cent Color Texture Structure Cr Sz Sh. Consistence Boundary Roots GPD/ff •Eff#1 •Eff#2 rIAf /11 X11// Plaro,l•,0 •,t i n,,:np Mt,.n.,y 2 1 38(188 Page -- of _--- 16 in flesh to limiting factor Sod AoOheation Rate Effluent #1 = BODE > 30 ≤220 mg/L and TSS >30 ≤ 150 mg/L • Effluent #2 = BODE ≤ 30 mg&L and TSS c 30 mg/i. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access sere icesor need material in an alternate format, please contact the department at 608.266-3151 or T -7Y 608-264-8RECE ED WU IMr.IR m40) AUG 0 4 2025 Bayfield Co. Planning and Zoning Agency �rYi -57-R Nt S 7 77& 4J k/ ti of ,41rt2w1 YftO Sc+4c�- !'' Vol / r"s L/B.4-ck1 - ABM.NrzLg" K/!~/zcc._ /fir Tzs 7- s/ Est i rc' 'i2' ��OoS�D C-figZr� RECEIVED MAY 26 2u?t nnyMl'i (n. PlInning np) /u' 4 A7eoq I-ILoY CT"V R'3 RECEIVED, AUG 042025 Pannin0 s, :: , , 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: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map (if ap Holding Tank Pumping Contract (if appl Holding Tank Agreement (if applicable) Project Name / Description 2 Bed Home Owner Name(s): Tom Dymesich Mo.caA Owner Address: 61875 Moonshine Alley M�n, Project Address: 19151 Co Hwy Govt. Lot: NW 1/4 of NW Township: Mason Project Parcel ID #: 38833 E Mason. WI plicable) cable) Phone: 303 -668 -9068 WI Zip: 54856 1/4, Section 7 , T 46 N -R 6 E❑ or W ❑✓ county: Bayfield Designer Information Designer Name: Edward B. Redinger Phone: 715 -292 -6670 Designer Address: 1015 11th Ave. E. Ashland, WI Zip: 54806 E-mail: ed@superiorpmw.com phro,ai,t:,,,rp. License Number: 221939 Remarks: RECEaVED AUG 04 2025 ¢ayfiekj Planning ar Co. Zonir Agency Signature: Date: 8/4/25 Original signature required on each s milted copy. Customer Name: Tom Dymesich Adress: 387 Bill Lane A. 4 Northglenn Co 80260 SUPERIOR SITE: 19151 Co Hwy E Mason, WI PLUMBING MECHANICAL Phone #: 303-668-9068 (715) 278-3456 Email: CST# 221939 n Scale: 1" = 40' o, PIN: 38833 10 Acres NW NW S7 T46N R6W Town of Mason Bayfield Co. ,1 3m. weu C- 1 - a 11; k AUG 042025 Sayfieid Co. Planning and Zoning Agency PAGE 3 OF 4 HOLDING TANK SPECIFICATIONS (No Scale) Weatherproof 12" Min. or 2.0 ft above Junction and Approved Established Flood Elevation Cap (typical) Electrical must comply withI Approved Locking Manhole SPS 316 and NEC 300Vent Pipe with Waming Label Attached ft from (typical) 4" Min. or 2.0 ft above "BoxVent uilding I Establishe`Floo, Elevation Finished Grade 16" Mln. (typical) Approved Joints with Approved Pipe 3f1 onto Solid Ground r. 4. Max. 12" or 90% of total volume If more than one tank Alarm -On a. HOLDING TANK VOLUME = 2000 gal 3" Approved Bedding Material Beneath Tank TANK MANUFACTURER: Wieser Concrete Anchor tank as necessary pursuant to SPS 383.43(8)(g) Ballast Weight = [(cu.ft.tank.vol x 62.4 Ibs/cu.ft) - lbs.tank.wt] x 1.5 Plug RECEIVED AUG 042025 B Planning aand Zoning Agency Ballast Weight = [( cu.ft. x 62.4 lbs/cu.ft) - Ibs] x 1.5 = Ibs PAGE 4 OF 4 Holding Tank Management Plan IMPORTANT: The owner of this holding tank(s) shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this holding tank(s) shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Estimated Daily Wastewater Flow = 300 gpd Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o surface discharge of effluent or sewage back-up into structure served SERVICING FREQUENCY o The tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wlsc. Scats. when the wastewater in the tank(s) reaches a level of one foot below the inlet invert of the tank(s). Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. Tank pumping reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wis. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Superior Plumbing & Mech. Inc. Local government unit: Bayfield Co Zoning Local government unit address: 117 5th St. E. Washburn, WI Phone: 715-292-6670 Phone: 715-372-6138 ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed component of this holding tank(s) cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agecy for review and approval. System Abandonment If use of this tank(s) is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. REC IvEr) AUG 042025 Bayfield Co. Planning and Zoning Agency y WLP2000-MR TANK SPECIFICATIONS 164" DIMENSIONS: L7 WALL 3" G: BOTTOM: SEPTIC 3" HEAVY DUTY 5" (ADD 2,800 LBS.) COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 53" O.D. LENGTH: 164" O.D. WIDTH: 96" O.D. 4" CAST -A -SEAL 4" CAST -A -SEAL BELOW INLET: 41" O.D. LIQUID LEVEL: 36" WEIGHT: BOTTOM 11,260 LBS.COVER m2 8,170 LBS. O1 INLET AND OUTLET. TYP 4" CAST -A -SEAL BOOT OR EQUAL FILTER OR BAFFLE INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 56.27 GAL/IN LOADING DESIGN: 8' 0" UNSATURATED SOIL TOP VIEW io INLET iU OUTLET 'O rn � d M PUMP PAD SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 2.138 GALLONS MN TANKS: WILL HAVE ONE VENT OVER OUTLET AND WILL HAVE TWO VENTS IN COVER OVER INLET 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 JOB In CUSTOMER: JOB NAME: DATE NEEDED: APPROVED BY: ,PPROVAL DATE: J K z Q O O U HOLDING TANK SERVICING CONTRACT Contract Date Le 13 o I &Oa-� This contract is made between the Holding Tank Owner(s) Name(s) // I �y/Mr5i ch Pumper's Name (Print) Pumpers' Registration # 2rsSignature We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT I LOCATION Legal Description: (Use Tax Statement) Tax ID# 3&' 33 �/�,� / 14)1/4, c�1/4, N, Range Section Townshi e W � � Town of: Lot Size Acreage P� / rts0� /Q, J Gov't Lot Lot ft CSM # Vol. Page CSM Doc# 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; RECEWED b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; AUG 0420 d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; Bayneld co f. The volumes in gallons of the contents pumped from the holding tank for each serviQL A. g and Zoning Agency g. The disposal sites to which the contents from the holding tank were delivered. _.rte#r�� „ 4. This agreement will remain in effect until the owner or pumper terminates this contradt *Wrt Rt16f chAnge in this contract, the owner agrees to file a copy of any changes to this service contract ofp ofd -new s4 contract with the local government unit and the County named above within (10) business d4rs fm �of.�ge to this service contract. `sp., �2a Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed an r y. — Wr1„ o0A O,v[ fJy AZ,51-LC • on this -lam day of June` i /j r' -Q5 by: ,G A Q A. I U�w Notary Public My commission expires on: )] Revised: May 2016 (®May 2018) Drafted by Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (p(m)] Document Number/Plat I.D.'No. Owner Name (s) ^7� hPMr s{cH Parcel Identifier Number (PIN) T r\ A—1DO-a-I fyr00133 HOLDING TANK AGREEMENT Owner(s) Mailing Address 38 } aa_//z ,,,E 44 /L -K ,4V.(c Ci $ o7Jai Agreement Date (same as Notary Date) We abknowledgge that application is being made for the installation of (a) holding tank(: 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. Alk1/4 of 1/4 Section __Township 6 N. Range _____W. Town of Additional Legal Description: ) €c. DOCUMENT NUMBER 2025R-608628 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED 08/04/2025 AT 1:59 PM RECORDING FEE: $30.00 PAGES: 2 Return To: -& 7rr / J 'Co.f 1.Zon,',t4 Gov't Lot Lot Block Subdivision CSM# Lot_CSM # Vol _Page _CSM Doc# 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, Stats. 2. Owner agrees to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 3. The owner agrees to contract with a person who is licensed pursuant to s.281.17 (3) Wis. Stats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced in accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed pursuant to s. 281.48 (3) Wis. Stats., and Ch. NR 114, 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.� O'BUb 's Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with referer1,pE`Ii isAM®(efMgnt in such manner which will permit the existence of the certification to be determined by reference to the prop '•' '••.••4' \ • 6. This agreement shall be binding upon the owner, 2 I,irs fgISP$Xwndr, art assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreed s besecorde& $ahe register of deeds in a manner which will permit the existence of the agreement to be determined by refe Le e4 to their e. ' w e holding tank is installed. P��_ RECEIVED Owner(s) Nam (s) — Please Print %d)'..., •d and swom to before me on this date: AUG 05 202 WtlY OC V Bayfield Co. Notarized Not PublicPnln end ' a_frtaUt My Commission Expires: Lk Io i0a ency Drafted by: O,'4 t) y,✓%ES/C# Date: 6�3a__a� Personal information you provide maybe used for secondary purposes [Privacy Law, 5.15.04 (1)(m)] ulfomWsaniterytholdingtankagreemenldoc €Lune 2018 File Number: 248123 ADDENDUM/EXHIBIT A The East One-half of the Northwest Quarter of the Northwest Quarter (ES/2-NW1/4-NW1/4), Section Seven (7), Township Forty-six (46) North, Range Six (6) West, Town of Mason, Bayfleld County, Wisconsin; EXCEPT the following described parcel: A parcel of land located in the E1/2-NW1/4-NW1/4, Section 7, Township 46 North, Range 6 West, Town of Mason, Bayfleld County, Wisconsin, more particularly described as follows: Commencing at the Northwest comer of said section; thence South 87°31'10" East, along the North line of the Northeast quarter of said section a distance of 1378.32 feet to the North one -sixteenth Northwest corner; thence South 00°16'47" West along the East line of the NW1/4-NW1/4, a distance of 651.67 feet to the Point of Beginning; thence South 00°16'47" West, and continuing along said East line a distance of 651.67 feet to the C one -sixteenth Northwest corner; thence North 88°02'12" West along the South line of the NW1/4-NW1/4 a distance of 683.73 feet; thence North 00°03'06" East a distance of 654.87 feet; thence South 87°46'37" East a distance of 686.44 feet to the East line of the NW1/4-NW1/4 and the Point of Beginning. ^ECEII'ED AUG 052025 Bayfie:d Co. Planning and 1.y; Agency Bayfield County Register of Deeds Document #2B24R-604417 Page 3 of 3 3=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: DYMESICH, THOMAS 387 BILL LN NORTHGLENN, CO 80260 DYMESICH,DAVID TANNER 107 MADISON ST BROOKLYN, NY 11216 Description Private Sewage System (Holding Tanks) Submission Number: SS -00617 Transaction Number: SS-00617-31ECC $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 10393 Paid by: Superior Plumbing & Mech Inc, 1015 11th Ave E, Ashland WI 54806 Payment Type: Check Transaction Date: 8/11/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-25-96S STATE SANITARY PERMIT OWNER: THOMAS DYMESICH GOVT LOT: LOT: BLK: NW 1/4 NW 1/4 SEC: 7, T 46 N, R 6 W TOWNSHIP: Mason SOIL TEST: 49-22 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: EDWARD REDINGER TRACY POOLER Authorized Issuing Officer DATE: 8/11/2025 CHAPTER 145.135(2) WISCONSIN STATUTES a. The purpose of the sanitary permit Is to allow Installation of the private sewage system described in the permit. b. The approval of the sanitary permit Is based on regulations In force on the date of approval. c. The sanitary permit is valid and may be renewed for specified period. d. Changed regulations will not impair the validity of a sanitary permit. e. Renewal of the sanitary permit will be based on regulations In force at the time renewal Is sought, and that changed regulations may impede renewal. f. The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. PREVIOUS PERMIT #: LICENSE: # 221939 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 8/11/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION