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Request 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 zonin bavfieldcounty.wi.aov Note Time Change r Discrepancy f Other P---- Phone Number Plumber: O ij S'1 1��--- Fax Number Email s Homeowner: I �. 11 r f1 L (*q l7rQGt Immediate Phone Number So Zoning Sanitary as _ [y� Dept can call you right b. ck (if needed) Permit #: 1 ) l Plumber's Choice Dept .i No Inspections) during this time as .! Date: , - � � Tuesday Time: Plumber's Choice Zoning Dept Township: '. Address # & Road Name: b 1510 J M toon51,nv- �llcy or / Directions . Comments: "" Plumbers you must verify any change(s) by fax or email ** Notes from Zoning Dept: July 2025 POWTS HOLDING TANK INSPECTION REPORT (ATTACH TO PERMIT) ANNIE & CALEB URQUIDES 61510 MOONSHINE ALLEY RD MASON WI 54856 TANK INFORMATION TYPE MANUFACTURER/MODEL# CAPACITY OZ GrGi vc_ 3y®7 — •r SETBACKS Property Line Wall Water Service Building All -Weather Road OHWM Swimming Pool - DEVIATIONS FROM APPROVED PLAN S (Pets �s present, discrepancies, etc.) COMMENTL Gfi I(/ 5 �tit 4% sSeAj,/Du1 S-,., �/i 'll COMPONENTS NOT INSPECTED Plan Revi io Required ❑ Yes No D to Signature spj. Cert. Number OJWLUI r Ul i ULIder SIU@ V r / w / / "'1 r' 10 of 13 BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT St Telephone: (715) 373-6138 Bayfield County Courthouse Fax: (715) 373-0114 Post Office Box 56 e-mail: zonina@bavfieldcountv.wi.aov 117 East Fifth Street Web Site: www bayfieldcountv.Wi.00V1147 Washburn, WI 54891 Property Owner ANNIE & CALEB URQUIDES Information 61510 MOONSHINE ALLEY RD MASON WI 54856 As you know Eq was contracted by you to install a private onsite wastewater treatment system on your property described as: Notes Abandonment of Old System to meet all applicable code requirements: Tank was pumped by: Tank was crushed I removed and pipes disconnected by: on at AM/PM On v at i1 (AM thIithe above -mentioned plumber contacted our office to conduct a pre -cover inspection as required under DSPS 383. One of the following applies: j� Sy emi'was inspected and appears to meet all applicable code requirements. ❑ System was inspected and appears to meet all applicable code requirements; however, a plan revision is necessary because the installation was substantially different than the original approval. ❑ System could not be inspected because plumber covered prior to scheduled time of inspection. ❑ System could not be inspected because plumber was not ready at scheduled time of inspection. County was unable to return to complete inspection. System could not be inspected because plumber was not ready at scheduled time of inspection. A re -inspection and $50 fee are required. System could not be inspected because County could not respond to plumber's time constraints. Comments: U/formslsanilaryproperlyowner-Input April 2019 V�pABT&I A�: 5 l�� -- S�Z Industry Services Division 4822 Madison Yards Way County f 1 0.1 '�` WI 53705 SanitaryPermit Number (to be filled in by Co.) �, 01 P.O. Box 7302 Madison, WI 5302 e J ��' \2iitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Project Address (if different than mailing address) 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 j q� & pp , 't purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. ! (Vi ` c 0/75 • n.t A L Application Information= Please Print All Information Property wner's Name f�nn' r Parcel # Property Owner's Mailing Address Property Location G 15 i c`l. /4C)t10N ��, Lev Govt. Lot 5 t '/.,J " '/., Section City, State Jv" Zip Code rj ��� Phone Number / 71c a o9 2 �! �5� 1/1 ,^ TN R __h E or W U. Type of Building (check all that apply) Lot # 1 or 2 Family Dwelling — Number of Bedrooms 3 Subdivision Name ❑ Public/Commercial — Describe Use Block # O City of O State Owned — Describe Use O Village of CSM Number 'Town of M 50 z'i W. Type of POWTS-Permit: (Check either "New" or "Replacement" and -other applicable on lone A.Check one box on line B. Complete line Cif a liable. A. 'New System ys ❑ Replacement System p y ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. 'gHolding Tank ❑ In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) • (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and -Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units New Tanks Existing Tanks all rn wt7 C, Septic or Holding Tank 3 aoo 3 bo© 6 e, -J �• t rQC,c Dosing Chamber V. Responsibility Statement, I, the undersigned, assume:res responsibility for installation of the POWTS shown on the attached plans. b g t3' Plumbe 's Name (Print) II 5&' f Plumbe ' Signature MP/MPRS Number • I0 3) Busiress Phone Number W s- c//3 / �o - Plumber 'dres s s (Street, City, State, Zip Code) �03od /21e. i . � s�.� C� yfS6 CouQty/Department UseiOnly Approved O Disapproved Permit Fee Date Issued Is ng t Si urn Q' $ vv O Owner Given Reason for Denial — l l oZ Conditions of Approval/Reasons for Disapproval / a l/ a ( n� AUG 0 5 2025 Attach to complete plans for the system and submit to the County only on paper not less than g 112 x 11 inches in size aayrre�a 'a. Planning and Zor„r.g Agency SBD-6398 (R. 02/22) PAGE 1 OF4 Hokng Tank Pan llndex & Cover Sheet Component Manual Design References: Holding Tank Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet 1 ,ED Pg 2 of 4 Plot Plan AUG 052025 Pg 3 of 4 Holding Tank Specifications Bay{eid Co. Pg 4 of 4 Management Plan Planning and Zo,-�ing.;gen, Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map (if applicable) /-1o,ieOt),Jf Took Holding Tank Pumping Contract (if applicable) Cc Holding Tank Agreement (if applicabIe Project Name / Description i '''�,�►r_,9;z__rPhone:erNamesOwn � : ),�ALJ�$� Owner Ad dress: /c10 /icon SI. -,, .t Zip: Project Address 1/ !'1D /�%AMcl,' .�. s Govt. Lot: _ $.J 114 of Township: ot Sc » 1/ 4, Section i 3 , T 7=� N -R E❑ or w r County: _yz Project Parcel ID #: 61 3 L/s� Designer Information _5764 �l� / Phone:' _' P0O Designer Name.. Designer Address:JO M&co', � L? Zip: �YgY4 9 _ E-mail: O+r` C1�4. /-e .S �-�/ • I • G This space reserved for approval stamp. License Number: X03' Remarks: Signature: Date: mal signature required on each submitted copy. Bayfield County, WI P•RPID/Tax II) # 23477 LUKE 5 . ANNELI R 5CHRAUFNA GEL PRPIU/Tax Ib # 23451 CI1AL' E & KIMBERLY J CZAPIGA Sod Name: ODANAH SILT LOAM. 15 TO 25 PERCENT SLOPES DRDIU/Tox IU #23452 Soil System: 280D H,4 b E & KI MPERLY J CZADIG,4 Soil Key: 433412 O N L CD C Sail Name: SAPIBORG-ODANAH COMPLEX, 2 TO 6 PE Sal System: 12808 Soil Key 1144329 517/25, 10:23 AM Novus-Wisconsin Access rev. 12.0206 Real Estate Bayfield County Property Listing Property Status: Current Today's Date: 5/7/2025 Created On: 3/15/2006 1:15:44 PM Description Updated: 2/19/2021 Tax ID: 23452 PIN: 04-032-2-46-06-13-2 03-000-30000 Legacy PIN: 032102509990 Map ID: Municipality: (032) TOWN OF MASON STR: S13 T46N R06W Description: S 1/2 SW NW W OF RR IN DOC 2021R- 586395 Recorded Acres: 17.000 Calculated Acres: 17.538 Lottery Claims: 0 First Dollar: No Zoning: (AG -1) Agricultural -1 ESN: 122 I Tax Districts Updated: 3/15/2006 1 STATE 04 COUNTY 032 TOWN OF MASON 041491 SCHL-DRUMMOND 001700 TECHNICAL COLLEGE S Ownership Updated: 2/19/2021 CHAD E & KIMBERLY J CZAPIGA MASON WI Billing Address: Mailing Address: CHAD E & KIMBERLY J CHAD E & KIMBERLY J CZAPIGA CZAPIGA 61420 COUNTY HWY E 61420 COUNTY HWY E MASON WI 54856 MASON WI 54856 V Site Address * indicates Private Road 61510 MOONSHINE ALLEY RD MASON 54856 Property Assessment Updated: 4/22/2014 2025 Assessment Detail Code Acres Land Imp. G6 -PRODUCTIVE FOREST 17.000 20,400 0 2 -Year Comparison 2024 2025 Change Land: 20,400 20,400 0.0% Improved: 0 0 0.0% Total: 20,400 20,400 0.0% Recorded Documents Updated: 3/15/2006 property History © WARRANTY DEED N/A Date Recorded: 1/8/2021 2O2IR-586395 U PERSONAL REPRESENTATIVES DEED Date Recorded: 4/20/2017 2017R-568023 ® CONVERSION Date Recorded: 4 357 873-788 ® QUIT CLAIM DEED Date Recorded: 10/7/2003 2003R-486357 873-788 AUG 05 2025 6ayfie i Co. Planning and Zoning Agency Mu..... U......... ......1............1..-.....e.....e...7w...,...:.i—')4 A C') Ill LP3O©OI-Compartment Tank S1J! M tI I PRECAST CONCRETE TOP VIEW i$a.. Weisht (in lb:) Tank: 15,1 Lid: 9.7'5 Total: 24,902 Volume of Concrete Total: C Td' Gallons Per Inch: ?0.5 lid WAR Enlarged Detail Cm dfifamNy APPROVED DEPT. OF SAFETY AND PROFESSIONAL �` SERVICES ' .Slat ONNSION OF INDUSTRYSEERVICES flTR�� �.�.`� 50'. SEE CORRESPONDENCE Manhole Openings 9"Air Space T LClndl 0th I.--------------------- 96" I0'_" 4" QSalEt 4r 2-1T'T-per Produced by Supernor ftecas& Concrete, Lit PO BDX L39© Hayward, WI 54843 Pala-et4�glene Baffle at tic Rope SUPERIOR PRECAST CONCRETE Design conforms to ASTM C1227, Specification for Precast Concrete Septic Tanks and Wl SPS 384.25, POWTS Holding Components or Treatment Components. The information provided on any Superior Pt ecast Concrete (SPC) drawing or document shall be verified by the purchasers licensed professional engineerfor suitability of use. Configuration may change from drawing, consult with SPC. L.......,..... I mb b Pmpdmnrylnlmtatlnn. and,emainrtae F:ovemyo:Sucengri sa C..n . LLC. III In O f• ?n? "ffii:j Bayfieid Co. ,:..,;flfl mercy Mark Barker From: Cory Schaffer <corydaleschaffer7@gmail.com> Sent: Monday, August 11, 2025 11:32 AM To: Mark Barker Subject: Re: Urquides (Czapiga) Sanitary Application 61510 Moonshine Alley Yes that sounds good. They informed me after I mailed in that they had changed it so I assumed it would have to be changed. Thanks. Regards, Schaffers Well Repair LLC 7154131700 *please disregard any short responses as this email is sent from iPhone. On Mon, Aug 11, 2025 at 11:15 AM Mark Barker <mark.barker@bayfieldcounty.wi.gov>wrote: Hi Cory, We received a sanitary application for Chad and Kimberly Czapiga (attached), however they no longer own the property and we need to update the owner information to reflect the new owners. I'm just emailing to ask for your permission to change that information on our end. Thanks, Mark Barker I Clerk Planning and Zoning Department 117 E 5th Street, PO Box 58 Washburn, WI 54891 Phone: 715-373-3515 Email: mark.barkerPbayfiieldcoun , .wi.goy 1 • HOLDING TANK SERVICING CONTRACT AUG 07 2025 eaytield co. FLCon,rac;tDate Piannin f � r %� 1n Agency II &-p �.� This contract is made between the Holding Tank Owner(s) Name(s) Mi� u S G {P p sNa a (Print) w Pumper's Signet Pumpers' Registration # We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) 0 CT tegI;Descr tion �' , r ` " 1/4, �/4• f r _ ,. , , ,� LOCATION (UseTax Statement) ' �. r :, = �_ N, Town of: l at 5i=el , `� F �:: T Acreage, Section ,Township Range W _ i 4y 1 ; � .. ~='z� s `�E %.. j..! .. .J .4�. _/! \. •� �; h,. 1• J.. ti f4 o � yt t. �v 3sa � i1..S' S. ti �I....Yit.i.� .'_t. 'w..�•I1.�.' Govt tot , - ' ____Lot #_' Y" # ;'t. Vo). age t � �% CSM Dock; 'Lot(s`) No' "' '�•ei �'� 1 f atock(s) Flo: ^ S:, f Subd1vlscn.r � a ,;� L-�` I Y! 'i I Y1 I• 1 r - 2DZ5 � - (QO8O0Z 1. The owner agrees to file a copy of this contract with Bayfi►eld 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; .�`\$E A. f. The volumes ingallons of the contents pumped from the holding tank for each servicing���� .•••""'' �� ��'� P p �• �. .• •. •. g. The disposal sites to which the contents from the holding tank were delivered. p ;••• •'••. ��': : %AOTAR.s 4. This agreement will remain in effect until the owner or pumper terminates this contract. In tie eient of-eehangein t$is contract, the owner agrees to file a copy of any changes to this service contract or a copy ip ny [ ie gt i ct with the local government unit and the County named above within (10) business days fron%t41date of'chanr 1ais service contract. S �^`A-''• `l Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed and Sworn to iL n it Uk �. is Le on this Ol day of ______ \ LLLUL42 'UL4 by : � � Notary Public __________ My commissionexpires_on:it/_U)!iizr Revised: May 2016 (®May 2018) Drafted by AIIVI l e Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (l)(m)] 5/ /,,I s. Document Number/Plan I.D. No. HOLDING TANK AGREEMENT Owner Name (s) Owner(s) Mailing Address Ann 1-e. r ,t,+cte S 58355 N2%soc 9-OOk t%4 SO" , W t 5&/g5(2 Parcel Identifier NumbN) Agreement Date (same as Notary Date) -23 ti5z ' 3'31 i / ions We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Stats. u 5t 1/4 of &(A,)114 Section 13 Township �14 N. Range (0W. Town of M ct5on Additional Legal Description: Gov't Lot Lot ���Block Subdivision CSM# Lot�CSM # 2"7y Nol Page 25 CSM Doc# �/� GV �VJ1/(Z DOCUMENT NUMBER 2025R-608693 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED O8/O7/2O25 AT 1:30 PM RECORDING FEE: $30.00 PAGES: 1 Return To: Zon w' REC D, ED As an inducement to Bayfield County to issue a sanitary permit for a holding tank on the above described property, we ryia do the ynef „d following: Planning an, Zoning Agency 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. 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. Stats., and Ch. NR 114, WI's Adm. Code who shall submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfield County may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 5. This agreement will remain in effect only until Bayfield County certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. SPS 383, WI's Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the 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: Ann'e.,I LArc,. L4 lC u.�GCQS MICHAEL K. SCHNEEBER -7 - 1 S NOTARY PUBLIC Notarized Owner(s) — Signature(s) Notary Public STATE OF WISCONSI My Commission Expires:. • r r Drafted by: 7" I i V'y iA 1 eS Date: 9/7/U 2� Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)) ulforms/sanitary/holdingtankagreement.doe ®June 2018 8/12125, 7:48 AM Novus-Wisconsin Access rev. 12.0206 Real Estate Bayfield County Property Listing Property Status: Next Year Today's Date: 8/12/2025 Created On: 7/11/2025 3:24:58 PM N Description Updated: 7/11/2025 Ownership Updated: 7/11/2025 Tax ID: 39637 CHAD E & KIMBERLY 3 CZAPIGA MASON WI PIN: 04-032-2-46-06-13-2 03-000-32000 Legacy PIN: Billing Address: Mailing Address: Map ID: CHAD E & KIMBERLY J CHAD E & KIMBERLY 3 Municipality: (032) TOW CZAPIGA CZAPIGA 13 T 06W 6142 COUNTY HWY E 61420 COUNTY HWY E Description: L 1 CSM 2409 IN DOC 2025R 608002 N WI 54856 MASON WI 54856 Recorded Acr ' Calculated Acres: 0.000 Site Address * indicates Private Road Lottery Claims: 0 61510 MOONSHINE ALLEY RD MASON 54856 First Dollar: No Zoning: (AG -1) Agricultural -1 10.. Property Assessment Updated: N/A ESN: 122 2025 Assessment Detail ' Tax Districts Updated: 7/11/2025 Code Acres Land Imp. N/A 1 STATE 04 COUNTY 2 -Year Comparison 2024 2025 Change 032 TOWN OF MASON Land: 0 0 0.0% 041491 SCHL-DRUMMOND Improved: 0 0 0.0% 001700 TECHNICAL COLLEGE Total: 0 0 0.0% 'r Recorded Documents Updated: 3/15/2006 © CERTIFIED SURVEY MAP M Property History Date Recorded: 6/25/2025 2O25R-6O8OO2 14-25 Parent Properties Tax ID 2 WARRANTY DEED 04-032-2-46-06-13-2 03-000-30000 23452 Date Recorded: 1/8/2021 2O21R-586395 © PERSONAL REPRESENTATIVES DEED Date Recorded: 4/20/2017 2017R-568023 © CONVERSION Date Recorded: 486357 873-788 © QUIT CLAIM DEED Date Recorded: 10/7/2003 2003R-486357 873-788 HISTORY ® Expand All History White=Current Parcels Pink=Retired Parcels © Tax ID: 23452 Pin: 04-032-2-46-06-13-2 03-000-30000 Leg. Pin: 032102509990 39637 This Parcel 1 Parents 11 Children https://novus.bayfieldcounty.wi.gov/access/master.asp?paprpid=39637 1/1 ERD Bayfield County Waiver of a Thorough Soil & Site (subject to 15-1-10(d)) Soil Test # qq-� J Evaluation I4TQ.&ra 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. LtVIsTTA Contractor Authorized Agent M , L4 StQ Agent's Telephone, Telephone, Accurate Legal Description is requested: Written Authorization Attached: Y or N )/& 114 of 114 Section 13 Township N. Range, W. Town of 1%&i Additional Legal Description: .J OF 2 iii DX, 2/g- (a39t'c Govt. Lot Lot Block Subdivision Lot CSM# Vol. Page CSM Doc # I Volume Page of Deeds Tax I.D# =Y� Acreage f 7 Indicate reasoning for your determination: _Lter_cS_._ >I Date Sign ure of County Official Date N(Submit•a Plot Plan & Fee) AUG 0 5 2025 Bayfield Co. Planning and Zoning Agency u/forms/soiltestwaiver(KLKT June 2018 CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. SOIL EVALUATION Scale: 1,� = 50' 100 SYSTEM PAGE 2 OF 0 50 75 SITE MAP PROJECT NAME: FAWI PLOT PLAN r, DESIGN FLOW: V GPD ^ t Attach design flow calculations for commercial plans. V'3 PROJECT ADDRESS: (' I 1 O 4 I1-4, Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) NSanitary Sewer�I `t t / BM Symbol: .4. BM Elevation: FT 3O Force Main: / BM Description: 'o••' 5�S -f � )'—` - Indicate north by IMPORTANT: Slope Gradient (%) Well Symbol (if applicable): 0 drawing an arrow Show ground elevation contours at suitable intervals. of Tested Area: on the approprite line. : � I• Lr ► ; � i 1 I i cc'- •1•i,i•I T\>;L 9 -I i — \ ________ _Hi I \ - cf'c/ .... ...._ rte i - -- AUG 05 2025 Bayfiald . I ,Jvr "xrartv) /- ``+� 5 Industry Services Division 4822 Madison Yards Way County nI� / p0. "I' � G. ci Madison, WI 53705 Sanitary Permit Number (to be filled in by Co.) ,af.Fr P.O. Box 7302 Madison, WI 5302 �, Il itary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law. s. I i.04(I)(m). Slats. / rr / 5 / & M eons h • r7.C- ,4/'.cy L Application Information - Please Print All Information Property wner's Name /3.„n t t rzY.t; _ /&5 Parcel?? Property Owner's Mailing Address Lt; Property Location /,] Si o /Aoo .s tt Al Lay'Govt Lot 5 VVA /3 City, State I Zip Code Phoncee Number / Aso v-' w S K¢'5 6 7cc 3o9 2/4 b _ v.,_ A, Section 'I'N R G or W II. Type of Building (check all that apply) Lot?? (TV I or 2 Family Dwelling — Number of Bedrooms 3 Subdivision Name Block N ❑ Public/Commercial — Describe Use O City of ❑ State Owned — Describe Use ❑ Village of CSM Number {Xrownof MAson 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 ❑ Other Modification to Existing Syrlrm ieqpl aim) ❑ Additional Pretreatment Unit (explain) B. 'WHoldin Tank g ❑ In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design g ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner ist Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Ratc(gpd/sl) Dispersal Area Required (sl) Dispersal Area Proposed (sf) System Elevation Capacity in Total P of Manufacturer Tank Information Gallons Gallons Units o .t o New Tanks Existing Tanks u - 0_U in w r ii U a Septic or Holding Tank rf %J bQQ O .(I I . ( PreCc4 Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibilityfor installation of the POWTS shown on the attached plans. Plumber's Name (Print) / m Plumbe ' Signature SGhJe'v PRS PRS MP/MNumber Busirss Phone Number Plumber's A4dress (Street, City, State, Zip Code) 0300 / 4ic so ql //a coil 5 V'56 County/Department Use Only Approved ❑ Disapproved Permit Fee $ Date Issued Is ng t Si lure Q� ❑ Owner Given Reason for Denial Conditions of Approval/Reasons for Disapproval AUG 052025 Attach to complete plans for the system and submit to the County only on paper not less than S 112x 11 inches in size aayneld CO. Planning and Zoning Agency SBD-6398 (R. 02/22) ENTER D 00 Soil Test # ' ay. ou my Waiver of a Thorough Soil & Site Evaluation (subject to 15-1 -1 0(d)) I VZMa certified soil tester determine that in my professional judgment the following site (see below) is unsuitable for any treatment component other than holding tanks. Due to soil & site conditions, a thorough soil and site evaluation is not needed to make such a determination. Property Owner 4im?ii€Ly CzVi6M- Property Address - f:ltLI Contractor Authorized Agent {r\, k,tg Agent's Telephone Telephone, Accurate Legal Description is requested: Written Authorization Attached: Y or N _r )1& 114 of Nk,114 Section 13 Township N. Range W. Town of__________ _IN Additional Legal Description: (i 2 IN DLE— 63 Govt. Lot Lot Block Subdivision Lot CSM# Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# � Acreage /7 Indicate reasoning for your determination: '4.j t.c k) cS3iL. 5-7-6S Sign ure of County Official Date Date Submit a Plot Plan & Fee) Eli° 1VED AUG 05 2025 ulforms/soiltestwaiver(KLKr'" June 2018 Bayfield Co. Planning and Zcning Agency ' CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. SOIL EVALUATION Scale: 1" = 50' 1 SYSTEM PAGE 2 OF 0 50 75 00 SITE MAP PLOT PLAN r� PROJECT NAME: ` (12.5 ft grid) 12 2FVA DESIGN FLOW: .O GPD C. z o.. ` e.� }- p l -+' �,,. I/ Attach design flow calculations for commercial plans. PROJECT ADDRESS: 6 IS IC) M oo�ski A 114.j' Pipe Material / ASTM Standard (Tables 384.3(-3 & 384.30-5) N Sanitary Sewer: `1dS� /_____________ 3� BM Symbol: BM Elevation: O FT Force Maln: BM Description:��-t- indicate north by IMPORTANT: Slope Gradient (%) Well Symbol (if applicable): 0 drawing an arrow Show ground elevation contours at suitable intervals. of Tested Area: on the approprite line. J! ic ii r� �/�[/�� �j4...i�de4i/[/ -�i� -�y_iCI ^� Vim- d\ 4& ( f 1 1 i • \ \: '- __ A frl�iYl J G� 1 ef� t rya 2 c''TV AUG Q 52025 Bayfield Co. 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 Pg2of4 Pg 3of4 Pg4of4 Attachments: C re - Owner Name(s) Owner Address Project Address:. 5' Govt. Lot: Township: Index & Cover Sheet Plot Plan Holding Tank Specifications Management Plan RECEIVED AUG 052025 Bayfield Co. Planning and Zoning Agency Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map (if applicable) Holding Tank Pumping Contract (if applicable) Holdinq Tank Agreement (if applicable) Project Name ! Description c/,i + 1c, s10 (/57O /4eN1 Phone:D(C - Ai C zip: 5`fg5` s✓ 1/4 of /1/9'1 /4, Section T '/ N -R b E U or W "y5c�rl County: Project Parcel ID #: a 3Lf � Designer Information �K 1GL10 Phone: ' Yf _!?0C Designer Name: �`y Designer Address: fj /n O // yM/Mcc ±i Dc -h A� zip: 4. E-mail: Corld - /., 5'Cihr 1/ ) Q% %o.. I. (,1P Chs space reserved 10 z, ,'O%a! License Number: .1O3 Remarks: Signature: Date: / a� �S g 4 anal signature required on each submitted copy. Bayfield County, WI DRDID; TOR IG:• CHA6 E d: KIPl,BERL PRPIU/• LUKE S.3 ANN TO 25 PERCENT SLOPES 80O 412 Soil Name: SANBORG-ODANAH COMPLEX, 21O6 PER Sal System: 12808 Soil Key: 1144329 54 517/25, 10:23 AM Novus-Wisconsin Access rev. 12.0206 Real Estate Bayfleld County Property Listing Today's Date: 5/7/2025 Description Updated: 2/19/2021 Tax ID: 23452 PIN: 04-032-2-46-06-13-2 03-000-30000 Legacy PIN: 032102509990 Map ID: Municipality: (032) TOWN OF MASON STR: S13 T46N R06W Description: S 1/2 SW NW W OF RR IN DOC 2021R- 586395 Recorded Acres: 17.000 Calculated Acres: 17.538 Lottery Claims: 0 First Dollar: No Zoning: (AG -1) Agricultural -1 ESN: 122 Tax Districts Updated: 3/15/2006 1 STATE 04 COUNTY 032 TOWN OF MASON 041491 SCHL-DRUMMOND 001700 TECHNICAL COLLEGE 4 Recorded Documents Updated: 3/15/2006 0 WARRANTY DEED Date Recorded: 1/8/2021 2021R-586395 9 PERSONAL REPRESENTATIVES DEED Date Recorded: 4/20/2017 2017R-568023 0 CONVERSION Date Recorded: 486357 873-788 C QUIT CLAIM DEED Date Recorded: 10/7/2003 2003R486357 873-788 https://novus.bayfiieldcounty.wi.gov/access/master. asp?paprpid=23452 Property Status: Current Created On: 3/15/2006 1:15:44 PM a Ownership Updated: 2/19/2021 CHAD E & KIMBERLY J CZAPIGA MASON WI Billing Address; Mailing Address: CHAD E & KIMBERLY J CHAD E & KIMBERLY J CZAPIGA CZAPIGA 61420 COUNTY HWY E 61420 COUNTY HWY E MASON WI 54856 MASON WI 54856 P Site Address * indicates Private Road 61510 MOONSHINE ALLEY RD MASON 54856 ® Property Assessment Updated: 4/22/2014 2025 Assessment Detail Code Acres Land Imp. G6 -PRODUCTIVE FOREST 17.000 20,400 0 2 -Year Comparison 2024 2025 Change Land: 20,400 20,400 0.0% Improved: 0 0 0.0% Total: 20,400 20,400 0.0% Property History N/A R E:C AUG 052025 8ayfield Co. Planning and Zoning Agency 1/1 / Yia 9li:f-Mfl l(� PREATII itlE PRECAST CONCRETE Weight (in Ib:1 Tank:. 18.1. Lid: 9.7'S Total: 24,90: Volume of Concrete Total : 6. Vd' Gallons Per Inch: 0.S Lid LP3000 1 -Compartment Tank TOP VIEW 184' 1's °PRECAST ECPTCONCRETE 96.. 10,.. SIDE VIEW Enlarged Detail ` 4 H CaM/Ea�ly 'II 4' oatLei APPROVED T., 9" Air Space ii DEPT. OF SAFETY AND PROFESSIONAL ti SERVICES _ g i I 1 nMSION OF INDUSTRY SERVICES I I S43 i,. 10 l— ----------------3' l c BEE CORRESPONDENCE Manhole Op2Ldngs 0 '-1" Taper Produced by Superior Precast Concrete, LLC PO Box 1390 Hayward, WI 54843 rPolyethylene ; ` �r Baffle !3 i 5 RIOR j PRECASTCONCRETE Design conforms to ASTM C1227, Specification for Precast 1ltaaic 4 Concrete Septic Tanks and WI SPS 384.25, POWrS 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. r'rc mVED o..m,n ( TNsisPmpsl,q IMP:ms.Icn,a, dremalnsmePmpet/o15upericarccan Co,xme. LLC. .1 rn n r ?n? fl.305d",I Bayfield Co. planning and Zoning Agency Mark Barker From: Cory Schaffer <corydaleschaffer7@gmail.com> Sent: Monday, August 11, 2025 11:32 AM To: Mark Barker Subject: Re: Urquides (Czapiga) Sanitary Application 61510 Moonshine Alley Yes that sounds good. They informed me after I mailed in that they had changed it so I assumed it would have to be changed. Thanks. Regards, Schaffers Well Repair LLC 7154131700 *please disregard any short responses as this email is sent from iPhone. On Mon, Aug 11, 2025 at 11:15 AM Mark Barker <mark,barker@b ieldcoun wi gov> wrote: Hi Cory, We received a sanitary application for Chad and Kimberly Czapiga (attached), however they no longer own the property and we need to update the owner information to reflect the new owners. I'm just emailingto ask for your permission to change that information on our end. Thanks, Mark Barker I Clerk Planning and Zoning Department 117 E 5th Street, PO Box 58 Washburn, WI 54891 Phone: 715-373-3515 Email: mark.barkeraa bayfieldcounty.wi.gov RECE?VEC HOLDING TANK SERVICING CONTRACT AUG 072025 Bayfield Co. PlannlnP arxi 7c,^�^g Agenq Contract Date This contract is made between the Holding Tank Owner(s) Name(s) Annie P p 's Napie (Print) No , Pumper's S]gnat Pumpers' Registration # ass We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT Legal Description: Tax IDp /L L r t t LOCATION ' (Use Tax Statement) - `/'vj /-- Section_, .j _,Township V N, Range W Town of: AaCon Lot Size Acreage �.l , Godt Lot Lot N CSM U I_J2St)6 Vol. age 1' -I -2S CSM Dot U Lot(s) No. Block(s) No. Subdivision: 2UZ512 — (pOSWL 1. The owner agrees to file a copy of this contract with BaVfield 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; 0tittttttirrrrr„4, e. The dates on which the holding tank was serviced; .•`°�1NE A. M'''•,, 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. p ; -e: OTAR ••:'�� N )- 4. This agreement will remain in effect until the owner or pumper terminates this contract. In te event ofeehangein contract, the owner agrees to file a copy of any changes to this service contract or a cop $' nJjm3Qe gUg with the local government unit and the County named above within (10) business days frorj bate of'chanpea, service contract. R'_........... �nlp lJ{�WcAes ( on this_dayof ,_ v� C/V/�� by: a. VVI.Lf�1�^- C� Notary Public �� ✓ /L//// l% My commission expires on: I t f U av33' Revised: May 2016 (®May 2018) Drafted by ,4'1'7111t Mv(Af tf r^ es 5/Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)] � i /202' Document Number/Plan I.D. No. HOLDING TANK AGREEMENT 'Owner Name (s) Anne t.Jll-olt tlde5 Owner(s) Mailing Address 59355c& 0. vv�e5on WI5'/85(o Parcel Identifier Number (PIN) —t 3°1c,31 Agreement Date (same as Notary Date) i/ I / ZS 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. 511.) U 1/4 of Nw 1/4 Section 13 Township 40 N. Range (.W. Town of Mason Return To: Additional Legal Description: Gov't Lot — Lot_ Block_ Subdivision CSM#_ Zo1n ICJ )��q �h7�r� n�w� RECEIVED LotLCSM # 2'4OVol Page 25 CSM Doc# Wry f2 _cvrMJ2 AI It` n Q 9f19C DOCUMENT NUMBER 2025R-608693 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED O8/O7/2O25 AT 1:30 FM RECORDING FEE: $30.00 PAGES: 1 As an inducement to Bayfield County to issue a sanitary permit for a holding tank on the above described property, we %%ryael�9joo the following: Planning and Zoning Agency 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, Scats. 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. 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 Print6. Subscribed and sworn to before me on this date: " Ann i t Vlrc1 vt icl e hUrq u �d eS MICHAEL K. SCHNEEBER - I -;JNOTARY PUBLIC o)S Notarized Owner(s) — Signature(s) Notary Public STATE OF WISCONSIN y Commission Expires, Cl.. Drafted by: r) V 1 V1 1P_ `yC11/i I d eS Date: tJ / 7/ Z -f Z S Personal information you provide may be used for secondary purposes [Privacy Law, s,15.04 (I)(m)) ulformslsanitarymoldingtankagreement.doc ®June 2018 8/12/25, 7:48 AM Novus-Wisconsin Access rev. 12.0206 Real Estate Ba)eld County Property Listing Today's Date: 8/12/2025 Z Description Updated: 7/11/2025 Tax ID: 39637 PIN: 04-032-2-46-06-13-2 03-000-32000 Legacy PIN: Map ID: Municipality: (032 TOW ST'R: 13%T 06W Description: LOT 1 CSM 2409 IN DOC 20258-608002 Recorded Acr 5.500 Calculated Acres: 0. 00 Lottery Claims: 0 First Dollar: No Zoning: (AG -1) Agricultural -1 ESN: 122 i Tax Districts Updated: 7/11/2025 1 STATE 04 COUNTY 032 TOWN OF MASON 041491 SCHL-DRUMMOND 001700 TECHNICAL COLLEGE T vJ Recorded Documents Updated: 3/15/2006 ® CERTIFIED SURVEY MAP Date Recorded: 6/25/2025 2025R-608002 14-25 0 WARRANTY DEED Date Recorded: 1/8/2021 2021R-586395 © PERSONAL REPRESENTATIVES DEED Date Recorded: 4/20/2017 2017R-568023 © CONVERSION Date Recorded: 486357 873-788 ® QUIT CLAIM DEED Date Recorded: 10/7/2003 2003R-486357 873-788 Property Status: Next Year Created On: 7/11/2025 3:24:58 PM a Ownership Updated: 7/11/2025 CHAD E & KIMBERLY J CZAPIGA MASON WI Billing Address: Mailing Address: CHAD E & KIMBERLY J CHAD E & KIMBERLY J CZAPIGA CZAPIGA 6142 COUNTY HWY E 61420 COUNTY HWY E MAdN WI 54856 MASON WI 54856 P Site Address * indicates Private Road 61510 MOONSHINE ALLEY RD MASON 54856 P Property Assessment Updated: N/A 2025 Assessment Detail Code Acres Land Imp. N/A 2 -Year Comparison 2024 2025 Change Land: 0 0 0.0% Improved: 0 0 0.0% Total: 0 0 0.0% Is Property History Parent Properties Tax ID 04-032-2-46-06-13-2 03-000-30000 23452 HISTORY ® Expand All History White=Current Parcels Pink=Retired Parcels ® Tax ID: 23452 Pin: 04-032-2-46.06-13-2 03-000-30000 Leg. Pin: 032102509990 39637 This Parcel t Parents 4 Children https://novus.bayfieldcounty.wi.gov/access/master.asp?paprpid=39637 1/1 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: Annie & Caleb Urquides 61510 Moonshine Alley Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00312 Transaction Number: SR -00312-326D4 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 1059 Paid by: Schaffers Well Repair LLC, 60300 Mason Delta Rd, Mason WI 54856 Payment Type: Check Transaction Date: 8/12/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. 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: Annie & Caleb Urquides SS -00620 61510 Moonshine Alley Transaction Number: SS -00620-323A4 Description Private Sewage System (Holding Tanks) Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 1059 Paid by: Schaffers Well Repair LLC, 60300 Mason Delta Rd, Mason WI 54856 Payment Type: Check Transaction Date: 8/12/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-25-99S STATE SANITARY PERMIT OWNER: ANNIE & CALEB URQUIDES GOVT LOT: LOT: BLK: SW 1/4 NW 1/4 SEC: 13, T 46 N, R 6 W TOWNSHIP: Mason SOIL TEST: 99-25 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: CORY SCHAFFER TRACY POOLER Authorized Issuing Officer DATE: 8/12/2025 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 8/12/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION