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HomeMy WebLinkAbout25-112S" INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY "' TIME RECEIVED REMOTE CSID DURATION PAGES STATUS September 3, 2025 at 8:54:09 AM CDT 7153724159 38 1 Received Sep 04 2025 00:14 HP Faxpolkosld Plumbing 7153724159 page 1 Request for Sanitary Inspection (14 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. mote Time Change Discrepancy Other Phone Number Plumber: I o VL y o -o S -7 l S Fax Number 1 Sl 3-7-Z-,'-F/s Homeowner: S c o f t G 44( 4 Email Address Immediate Phone Number So Zoning Sanitary S_ ' ( 2 S Dept can call you right back (if needed) Permit #: at Plumber's Choice Zoning Dept Date: -� _ Z S ( NU Y Time: /I 3oA Township: D J J Address #& 8 `' Road Name: [� v o ` y"' R_ e 7ThC T 1— A /V o 4 J C✓ �/Z .-n �tf f �"J✓r �-71G� 0✓1 Cfi �'� B� O D C�� or / / Directions .. , o Y2 E To Site: �, Comments: , �Q `Plumbers you must verify any changes) by fax or email ** Notes from Zoning Dept: u/forms/sanitary/requestfodnsp action Zoning Dept (2'4112104); ® June 2023 POWTS HOLDING TANK INSPECTION REPORT SCOTT C RANTALA 73110 BOULEVARD RD IRON RIVER WI 54847 TANK INFORMATION TYPE MANUFACTURER/MODEL# CAPACITY liw4# a SETBACKS Property Une Well Water Service Building All -Weather Road OHWM Swimming Pool >217 a 317 DEVIATIONS FROM APPROVED PLAN COMMENTS (Persons present, discrepancies, etc.) �#k ;u5%kd.', p /ar,*7W %y/crevL/d9J 1v1 c 4 COMPONENTS NOT INSPECTED Plan Revl Ion Required ❑ Yes No D • 2 Signature of I c Cert. Number O)WLUI I UII ULII i 51Uv i/ v - . - • / f 10 of 13 Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoningCai)bavfieldcounty wi.gov Web Site: www bayfieldcountv.wi.govl147 SCOTT C RANTALA 73110 BOULEVARD RD IRON RIVER WI 54847 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know(` /g/ ��d.!4q 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! removed and pipes disconnected by: on at AM/PM On at j2/?PM) the above -mentioned plumber contacted our office to conduct a pre -cover inspection as required under DSPS 383. One of the following applies: co( V� Imo" vas 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. LIISystem 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: UIformsfsanitarypropertyownarinput April 2019 fl 6 Department of Safety County ,,F' & Professional Services, CxI c:! - s pSanitary Permit Number (to be filled in by Co.) S*ti Industry Services.Divxsion 5 .. 3 Santa mit 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 Project Address (if different than mailing address) of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. J I: Application Information — Please Print All Information 7-3 f 7 0 �5 o v 1 w J c c {� Property Owner's -Name �l IRc 4l Q Property Owner's Mailing Address 73 11 0 �©� ��e.,� IZ � Property Location mot, . r Govt. Lot S•% City, State Zip Code Phone Number �V G h �� • V 'e t/ c og V % 7 l r el Z Z 4 % `s ? Y,, .S '/,, Section 1 'P IL Type of Building (check all t1at apply) Lot # T N R • 'o l 1 or 2 Family Dwelling —Number of Bedrooms 2Subdivision Name O Public/Comntercial — Describe Use Block # ❑ State Owned — Describe Use O City of CSM Number O Village of _ (9Townof O u 1 0 M. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line a iicable. A. Check one box on line B. Complete line C A. 0 New System Y 1 Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. Holding Tank ❑ In -Ground ❑ At -Grade I ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. 0 Renewal Before 0 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 Ratc(gpd/sf) Dispersal Area Required (st) Dispersal Area Proposed (sf) System Elevation 300 _ Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units New Tanks Existing Tanks Seprio-or Holding Tank . O c,_- �.O ` a d iz 0 UA w a V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's i tore M ItpP/MPRS Number Business Phone Number r q Plumber's Address (Street, City, State, Zip Code) ., fax L J€V 4)j 9-'Kff'7 Approved 1 O Disapproved rr r mR rec Date Issued f t. Iss g Si tore O Owner Given Reason for Denial liO g d5 V02A., Conditions of Approval/Reasons for Disapproval RECEIVED AUG 12025 0 Bayfeld Co. Planning and Zoning Agency Attach to complete miens mOr the system sln,i auh,,,tt In #1.n f'nu.........t..-------- _ v -•-•✓ -•- ,--r-• ••�• ••+++ s+.nu o us A Ii ,nCACS 1n 817.9 SBD-6398 (R. 03/22) - -- . � � ��,� A.V+V twu 1Vo, 9915 P. 2 PAGE 1, OF 8 Holding Tank Plan i Index & Cover Sheet Component Manuel Design References: I"ivrsv� X I 't e"e 1 D . ry -oz) Pg I of $ Index & Cover Sheet Pg 2 of9 Plot Plan Pg 3 of 9 Holding Tank Specifioati ns-- v I y f Pg 4 of � Management Plan Attachments: Enciosures: POWTS Application for Review C4 ��.�•� 1 A � Soil Eva luation � aluation Report & Site Ma �f applicable) EC7 c 8 Holding Tank Pum in ontract (if a licable Holding CoW,} 4�o� Tank A reeme t if a licable o Project Name / Description scription Owner NamQ ,s : Scoff - -F 4M A 4 t I Phone., Owner Address: 73110 9o. .,< </'er/. Op:,aLix V7 Project Address: 731 o j3O J 1 c r L d w Govt. Lot: _5 N w,- , 114 of SKI ; lI4, Sectivn 1 T '{R_7 E E0 w - Township: u ( County: i3 ct?-, •e / J Project Parcel ID #: a x. Tb . 2- ( g 38 Designer information Designer Name: f /c c / / ©- Phone: Deli ner Address. .. z �� n t V le -e ,2.. :dip: �4,r ' f17 E-mail: a i► -� C© _.._...,. "°'� Thispace reserved for approval stamp. License Number; Z 0 0 Remarks; REC!IVED AUO 212025 Bayfield Co. Plan in9 and Zoning Agcy ,Signature: z- Qatle: Original signature required on each submined copy. I •-" "—" BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) f Check List Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) l I Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) ET Original Plot Plan (383.22(2)2. 3. & 4.a) i Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer LJ Pump Tank Diagram, Alarm and Pump Curve (when applicable) Icy Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) ❑ Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) l9 Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) 0 Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 2 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) l�l Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) Gd I Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) ® Project Address or Road Name where driveway is/will come off of) i (Owners Phone Number) II Type of Building ® III Type of Permit 1' IV Type of POWTS System ❑ V Dispersal / Treatment Area Information 9 VI Tank Information [ii VII Responsibility Statement (Plumber's Information) ❑ *Date Stamp* Plot Plan: (To Scale or To Dimension) l?f Signature and Plumber Information L' Surface Elevation of Body of Water ❑ Direction and Percent Land Slope l6 Tank and Filter Information and Location 0 Wetlands / Navigable Bodies of Water ❑ Absorption Area (Proposed and Existing) 11 Bench Mark (Location, Elevation and Description) 09 Component Manual Version ipino: la grialInfbrmation (conveyance _'line ; but Elt Address Number and Road lVi North Arrow ❑ Contour Lines iif Structures and Driveways 10 Boring Location if Property Lines E Well Locations l�l Legal Descriptic RECEIVE® AUG 212025 Bayfield co. Planning and Zoning Agency Turn Over ► �y of �Yw� f5wrie O Lr Mr��r l ����..�f i/ 1 lC: ¢il •e. a �•n � ;,4s'4 S .c.. J ! TY ' I W 731 2 c4 of: Y4 "s'. 'No 1 !! tt d jt v 7 319 j,o, I e- t Ci r C/ #3 e Z os frI r!1 --•--- 300 �, �AJV, jco O I / ubo oil I `k i ` n. s e-4 Le -,.c ks C Ps 3 s) A.F. A L c ve.. -c i ei c. ( v-c�. J e � - Je.i t c`i}' o wK 5 ,'i' o h &-a v et e RAC► � � P leu/oM 3-- Sc�® �vC vas/ d a �v� v e�, , �,a� q"ASTa91 1) 17IPS- ctat� wo ve.c� F p Q. ALtL'{'$ V CL E t . Sct 18orsi Js ? N Scoko 4t d jlJ,c:�tiv 5+ R o l3 c J l e Jat v 't -.c[ 2 s Lo go Iov ws: r l g3 °r,• °/v J E , /'3" -F' -aii'1 b co f'o m of 1 , IC t"F 6 c v L. f -it f n l e.+ I c4 e 1Ct S '.'L c e .b v cu � e. j £ A i�i� t► K e (tc.cc .sif i AUG 21 2025 Byfieki Co. Planningaand Zoning Agency x46 1d'I 4,1y z��k CEtit,� tLI.eL/ sJ1'ype' (VER ai) (fl&yOi2a7) t)rLub 3y coC t'd'lkctskFlu.`�t rrof'i kue..� w2 ≤'VSJY7 PROPERTY OWNER: - c +4 PLUMBER:&AInP lkoskll Pilk ski rlumh1nn SIGNATURE: L1'-- ) 'DATE:" Z$ -z. £� LICENSE # 220 90 HOLDING TANK SPECIFICATIO nos ` Number of bedrooms Non-residential estimated flow (gpd) tli'6'6. Minimum holding tank voiume'required (gal) Tank k Dimensions and Data X for round tank 6 .O Liquid depth below Inlet Invert (in) 0 Maximum ds th of soil cover (ft) o 183' Weight (In) Outside Length (in) Dimensions Width (in) Only junction box _.> conduit ----..o blind plug to Goal outlet Manufacturer model number manufacturer tber Tank Anchor 840 Calculations lbs Weight of tank and cover P30'521 Safety factor IT4021r1Ibs Weight of anchor required 40.8 1In Soil cover req. for anchor or L.9IJyds Concrete counterweight HOLDING TANK CROSS SECTION manhole cover with locking device and finished4vent cep warning label grade 1/ 4" min. Pj, 24 in. 1 ' min. Manhole and vent locations may be reversed. e T Ian min. rw,-.f•.r,........r•�,f........A.,w,1�•w service 12.0 in. alarm on Note: All tank joints, and joints between tank Electrical as per openings and piping are - NEC 300 39.0 In, sealed watertight. All pipe and Comm 16 and vent materials comply withS 4'S building sewer inlet RECEIVED AUG 212025 Bayfield Co. 3 In. bedding under tank. Tank is anchored as necessary to negate buoyancy, Planning and Zoning Agency WLP2500 1831" 4" CAST -A -SEAL 4" CAST -A -SEAL .gyp / FILTER OR BAFFLE o � Ix INLET e -z 3"e!- ►r TOP VIEW SIDE VIEW W C) au 99 OUTLET M U M d TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS TANK SPECIFICATIONS N o ° f DIMENSIONS: WALL: 3" N g BOTTOM: 3" HEAVY — 5" °B c, COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 52-3/4" O.D. LENGTH: 183-1/4" O.D. WIDTH: 101-1/4" 0.0. BELOW INLET: 41" O.D. LIQUID LEVEL: 36" WEIGHT: TANK - 3" BOTTOM 12,560 LBS. TANK - 5" BOTTOM 15,527 LBS. WEIGHT: COVER 9,300 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 69.44 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 2,639 GALLONS LOADING DESIGN: 8' 0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: t 0 04 68� LO CAQI f N Luo O lw w N J Q N o Z N U F w a_ to w > Cl) w w SHEET NO. F O/ �1 BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): d Check List m Index Page / Title Sheet (Optional) 121 Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) 56 Original Plot Plan O Cross Section Soil Profile Sheet (optional) O Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) ® Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used El Property Owner's Information (not prospective buyer's name) m Property Location (Accurate Legal Description with Sec/Twp/Range) 10 Road Name (where driveway is/will be coming off of) d Floodplain Elevation, Flow Rate, Comments and Recommendations 61 Complete Soil Boring / Pit Information 0 Date Soil Evaluation was conducted 121 CST Name, Signature, Number, Address and Phone Number O *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) 121 Bench Mark (Description, Elevation and Location) 91 Contour Lines (Example = 98.0' /96.0' /94.0') 121 Pt operty Location (Sec/Twp/Range/, Accurate Legal Description) m Borings (Locations and Elevations) 121 Percent and Direction of Land Slope Ll Well Location (Including Neighboring Wells, if applicable) U Location of Wetland Areas, Floodplain and Navigable Waters 0 Buildings, Driveways, and Structures (Location and Descriptions) 121 Location of Property Lines 19 Existing System Location 121 Address Number and Road Name 9 Current Surface Elevation of Wetlands and Navigable Waters Ed CST, Owner and Property Information 91 North Arrow RECEIVED AUG 212025 Bayfield Co. Planning and Zoning Agency Fee: 121 Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checkiist/checklistforests HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according tof383 3 Wis. Admin. Code, the Holding Tank Component Manual 4As e cJo 0."y -( "type, ' FER 2o ' and the 'Bcty4. 1L County Sanitary Ordinance. Z°1) j Lam"y0)7) 1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 400.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and !'PS 383 and384 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with 51 X63.33 Wis. Adm. Code. 10. If there is a problem S, ' with, or question about thisinstallation,.the following persons should be contacted: a. Installer .............................P© k P1u :rPhone: 7/ 3- Lj,�4, b. Service Provider................... 5 e a 1a7I Phone: -7/$- 37j. - Woad c. Co. Zoning or Health Dept. L3zy44JG�� v� cn _ Phone: 7'3 e, 11. Ld_n 1 a 5i --e S fl,ii(gU gcJ •r O u v CLubkb/O4 ( I 'f_ 0 ti o cLic 7-D Z y, 8 3 fl Project Transaction Number: REC AUG 212025 Ba„f.&d co. 'Planning and Zoning AgencY HOLDING TANK SERVICING CONTRACT Contract Date This contract is made between the Holding Tank Owner(s) Name(s) RathJ Pumper's Name (Print) Pu p is Signature Pumpers' Registration# We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) 1 1 PROJECr 61 gescrInticn• ° " Tax Tax ID# , �- t : . . , ' 1/,/4, h LOCA110N' (Use Statement) , r 7 �:� s Y ~ V .�+c . l .. -aF r •`� �^_• tlai Section x •c t N, Town of: �, -r;g '.1 Lot Size` . Acreage .yJ ,•'�ownshlP Range W ,;_ Govt Lot r t Lot # 7={ + : 3, CSM M! u c r, Vol Paged a ' CSMDoe U A- Lot(s) No Block(s) ' No; Subdivisionr ', ; :. r ; `• l`' 1 .1 Rf- �!:.IY •1. _ $.I"M. ift`�{�' y'..a' .1'�. .1. . 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; Recal aD c. The location of the property on which the holding tank is installed; d. The sanitary permit number Issued for the holding tank; AUG 212025 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; eayfieki �, g. The disposal sites to which the contents from the holding tank were delivered. Fl5flnIg and Zoning Agency 4. This agreement will remain In effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local government unit and the County named above within (10) business days from the date of change to this service contract. Owner's Slgnatu Scatb ¶o%rcL Subscribed and -Sworn to me: on thJs,l2— day of . O-fA ' . Notary Public My c*mission gkilres on: is Revised: May 2016 (®May 2018) ���> ' . B,, • O�y��` Drafted by /� Personal Information you provide may be used for secondary purposes [Privacy Law. s.15.0 /IIIIlll1 i itlt"�� • Document Number/Plan I.D. No. HOLDING TANK AGREEMENT Owner Name (s) Owner(s) Mailing Address Vi31to11C. �voA S�� 15 r o � �N' Vf g'17 Parcel Identifier Number (PIN) Agreement Date (same as Notary -Date) we acxnowleage mat appucation Is oeing mace Tor ine installation or (a) nolaing taniw 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, � OJ' 1/4 of e1 1/4 Section Township N. Range W Town of LC Additional Legal Description: ��� t0J Gov't Lot — Lot Block Subdivision CSM# Lot CSM # Vol Page ,CSM Doc# DOCUMENT NUMBER 2025R-608833 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFiELD COUNTY. WI RECORDED O8/ 19/2O25 AT 1 1 :O1 AM RECORDING FEE: $30.00 PAGES: 2 Return To: Zoklvtc As an inducement to Bayfield County to issue a sanitary permit for a holding tank on the above described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tank installation and maintenance. If the owner falls to have the holding tank properly serviced In response to orders issued by Bayfield County or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, 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. Bayfleld County shall* notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 3. The owner agrees to contract with a person who Is licensed pursuant .to•s.281.17 (3) Wis. Stats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced in accordance with Ch. NR113, Wis, Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service contract. 4. The owner agrees to contract with a person. licensed pursuant to s. 281.48 (3) Wis. 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. Bayfleld 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. 6. 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 Iii o Jt executing and recording said certification with reference to this agreement in such manner which will permit tile` e o e 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 ownbtUs't'ial�sUbm2 it fiis agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner whiciv)p,8Rit the existence of the agreement to be determined by reference to the property where the holding tank is installed. Planning and Zoning Agency Owner(s) Name(s) -- Please ��Print ,x`\11 / Ste- iaJ.— �,,��` p,MY 9Ai , bscribed and sworn to before me on this date: F ., i lI2Lc Notarized Owner(s)— Signature(s) •p ota t}tbilc om. ?c :�-y��. • B 1..� M a lmisslon Expires• -� Drafted by: 1 ft ?7I b 5 k Date: Personal information you prove maybe used for secondary purposes tPrivacy Law, s.15.04 (l)(m)I ulforms/asnitarytholdingiankagreemenLdoo ®June 2018 Document Number State Bar of Wisconsin Form 3-2003 QUIT CLAIM DEED Document Name TBIS DEED, made between A mY R R PI K1Tb L or more), and —3L_ T I ("Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together th r it therents, profits, fixtures and other appurtenant interests, in 13 4"J i Lb County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): s '/ of thJ t/ of S t ►'14 of '1q- ?tJ �`� 03�-a-q9-c)q-1L-3 03-0 Dated AUTHENTICATION Signature(s) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) 7TMS jTItEjME DRAF I"ED BY: DOCUMENT NUMBER 2024R-605354 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 1 1 /01 /2024 AT 11:15AM 1 5 AM RECORDING FEE: $30-00 TF EXEMPT a: 8 PAGES:1 Recording Area Name and Return ddress I Send �a_ln t a. b 7 11 © E o u ie- va_i ci C,ntcl Trim Riu`tr,LU' Stf)?Y7 Parcel Identification Number (PIN) This /...S homestead property. (is) (is not) RECEIVED AUG 202025 sayfiea Co. Planning and Zonlna ACKNOWLEDGM IT -TA _ STATE OF WISCONSIN = ) s F?ra�(Fi� — COQ �c,B� - Personally came before me on Mo)% the above -named Y ,LACt 11I11n to me known to be the persofl(s) who executed the foregoing 2NoPub and ac owledg thesame. li , State of Wisconsinission (is permanent)(expires: ,9 2t t -.2CP (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: 11118 15 A STANDARD FORM ANYIDO3 STATE BAR OF S TO THIS FORM WISCONSIN SHOULD BE CLEARLY IDENTIFIED.FORM N 0.3-200.3 QUIT CLAIM DEED ® • Type name below signatures. Wisconsin Department of Safety and Professional Services Reset 9(7 /` DMsian of Industry Services SOIL EVALUATION REPORT Page 1 of in accordance with SPS 383, Ws. Adm. Code County Bayfield Attach complete site plan on paper not less than 812 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Pa I I 04-038-2-48-09-16-3 03-000-3000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Re 'ew by Date Personal information you provide may be used forsecondary purposes (Privacy Law, S. 15.04 (1) (m)). Property Owner Property Location Scott Rantala Govt, Lot SW 114 SW 114 S 16 T 48 N R 09 E( (or)W Property Owner's Mailing Address Lot # Block # Subd. Name or CSN # 73110 Boulevard Rd S 1/2 of NW 1/45 acres City State Zip Code Phone Number ity ®Village !Town Nearest Road Iron River WI 54847 ( 715) 292- 2679 Boulevard Rd New Construction Use@) Residential! Number of bedrooms Replacement D Public or commercial - Describe:, Parent material r,1a 'inl drift General comments d dti an recommen a ons. The site is suitable for a Mound system. The benchmark = 100'. 9 Code derived design flow rate .3D() GPD Flood Plain elevation if applicable NA ft. 1 Boring # 13 Boring pit Ground surface etev. 97.7' ft. Depth to limiting factor 12" in. I Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. ConL Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPOIfF "Eff#1 "Eff#2 1 0-5 5yr 3/2 -- SL 2fsbk mvfr cs 2f .6 1.0 2 5-13 5vr 4/4 '� GI 2fsbk mvfr cs 0 ,6 1.0 R 13-40 Svr 414 C2O Syr 6/s SCL lfsbk mfi - 0 0 n 2 Boring # Boring 96.7' 18' pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz Cont. Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots GPDIfF 'Eff#1 "Etf!#2 1 0-5 5yr 3/2 -- SL 2fsbk mvfr cs 2f .6 1.0 2 5-18 5vr 4/4 --- SL 2fsbk mvfr rs 0 , 6 1,0 3 18-30 5yr 4/4 C2D Syr 618 SL 2fsbk mfr n. 0 n 0 4 30-50 5yr 414 C2P aYr 6'8 SCL Ifsbk mfi - n C AUG 1 4 202 Effluent #t - BOD > 3O220 mg1L and TSS >30 c 150 mq/L Effluent #2 = BOD 30 ,k 30 , _ /L CST Name (Please Print) Si na a CST Numbei ' Steven f'. Jnhnsnn C-i # 227037 Address Date Evaluation Conducted Telephone Number 3620 South County Road D Poplar, WI 54864 8-5-25 218-590-6678 SBD-8330 (R07/ 13) • •p. i . � r Property Owner Scott Rantala 04-038-2-48-09-16-3 Parcel ID# Boring # Boring 98.0' o7 loo o �► a oaf o Pit Ground surface elev. ft. Depth to fintUng factor 19 In. 2 3 Page of I Rnil Annff;;Fnrt Ralw Horizon Depth in. Dominant Color Mansell Redox Description Qu. Sz. Cont. Color Texture Structure Cr. Sz Sh. Consistence Boundary Roots GPO/IF 'Eff#1 'EffII� 1 0-5 5yr 3/2 --- SL 2fsbk mvfr cs 21 .6 1.0 2 5-19 5vr 414 --- SL 2fsbk mvfr rq 0 R n 3 19-25 5yr 414 C2D 5vr 6/8 SL 2fsbk mfr rc 0 0 n 4 25-40 5yr414 C2D 5vr 6/8 SCL Ifsbk mu - 0 0 0 Boring #8121t: Boring Ground surface eiev. ft. Depth to firniting factor in. Snil Annlleafinn Rata Horizon Depth In. Dominant Coloi Munsefl Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots GPO/IF 'Eff#1 Eff#2 Boring # Boring Pit Ground surface elev. fl. Depth to findting factor In. Soil AnnnrRfinn Rata Horizon Depth In. Dominant Co!oi Mansell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots GPDIIF 'Efl#!1 'Eff#2 ' Effluent #1= BOD > 30 220 ng/t. and TSS >30 c 150 ng1L Effluent #2 = BOD6 30 ng/L and TSS ≤ 30 mglL 4 SBD-$330 (P07113) BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Follow na (Use Permanent Ink): "%I Check List ❑ Index Page! Title Sheet (Optional) ,&Original Soil Evaluation Report (Submitted in ed Holders Name — 1M prospective buyers) Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report; (Include the following Information) Parcel Identification Number (must be 23 dlcjt Tax ID#) DO NOT 12 git, they are no longer being used AM Property Owner's Information (f prospective buyer's name) W Property Location (Acanate Legal Description with Sec/Twp/Range) A2 Road Name (where driveway is/will be coming off ot) `f9 Floodplain Elevation, Flow Rate, Comments and Recommendations Complete Soil Boring I Pit Information b Date Soil Evaluation was conducted V CST Name, Signature, Number, Address and Phone Number a*Date Stamp* Plot Plan: (Indude the following information drawn to dimension or to scale) p -Bench Mark (Description, Elevation and Location) �► Contour Lines (Example = 98.0' /96.0' /94.0 l,Property Location (Sec/TWP/Range1, Accurate Legal Description) Borings (Locations and Elevations) 0 Percent and Dimon of Land Slope 'Well Location (Inducting Neighboring Wells, If applicable) Location of Wetland Areas, Floodplain and Navigable Waters Buildings, Driveways, and Structures (Location and Descriptions) - rQ Location of Property Lines 19 Existing System Location 'Address Number and Road Name ® Current Surface Elevation of Wetlands and Navigable Waters 'CST, Owner and Property Information 34 North Arrow AUG 14 20l� BaefCr Certified Soil Tests - Review & Filing Fee $ 50.00 Wfams/sanitary/checid6/th kiistforests I f 41 j_kk61k ... ... _c JA __ - - - i A'L' I ___ 1 I I •4•-•• 1HI _\ i: r lJ 1_i V3'\"i ___ `"7 frZ9 NL QTN I � � I ` I __ _Eii � ( � Gcr(�G k ( 1� I � ___ = ___ ____I_iii . t _ ` .. .. In l_ _ L.LL.li?±i_, _____LL ^c. 'L1111 -1f1 -i-1H V iL � f -'- LLLIIl _ �� I_ ► LiLi I i I- I I I I l l l l BAYFIELD COUNTY SANITARY PERMIT (#04)-25-112S STATE SANITARY PERMIT OWNER: SCOTT C RANTALA GOV'T LOT: LOT: BLK: SW 1/4 SW 1/4 SEC: 16, T 48 N, R 9 W TOWNSHIP: Oulu SOIL TEST: 110-25 REPLACEMENT SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: ALLAN POLKOSKI TRACY POOLER Authorized Issuing Officer DATE: 8/22/2025 CHAPTER 145.135(2) WISCONSIN STATUTES a. The purpose of the sanitary permit Is to allow Installation of the private sewage system described in the permit. b. The approval of the sanitary permit Is based on regulations in force on the date of approval. c. The sanitary permit Is valid and may be renewed for specified period. d. Changed regulations will not Impair the validity of a sanitary permit. e. Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. f. The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. PREVIOUS PERMIT #: LICENSE: # 220090 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 8/22/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION