HomeMy WebLinkAbout25-115SV
GESKE,TODDA&SKEIE, )LDING TANK INSPECTION REPORT
KATHLEEN A
7626 DALLAS LN N
MAPLE GROVE MN 55311
TANK INFORMATION
TYPE MANUFACTURER/MODEL# CAPACITY
SETBACKS
Property Line
Well
Water Service
Building
All -Weather
Road
OHWM
Swimming Pool
DEVIATIONS FROM APPROVED PLAN
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COMMENTS (Persons present, discrepancies, etc.)
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COMPONENTS NOT INSPECTED
Plan Revision Required
❑ Yes ❑ No
Date: S ignature of
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Property Owner
Information
BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT
Telephone: (715) 373-6138
Fax: (715) 373-0114
e-mail: zonina(a�bavfieldcountv.wi.Oov
Web Site: www.bayfieldcountv.Wi.QoV/147
CESKE, TODD A & SKEIE,
KATHLEEN A
7626 DALLAS EN N
MAPLE GROVE MN 55311
Bayfield County Courthouse
Post Office Box 58
117 East Fifth Street
Washburn, WI 54891
As you know ®NC (x4( d 52"S 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: on at AM / PM
Tank was crushed / removed and pipes disconnected by:
On II 2 at O 3& A / PM) the above -mentioned plumber contacted our office to
conduc a p -cover inspection as requl under DSPS 383. One of the following applies:
System was inspected and appears to meet all applicable code requirements.
System was inspected and appears to meet all applicable code requirements; however, a plan revision
is necessary because the installation was substantially different than the original approval.
System could not be inspected because plumber covered prior to scheduled time of inspection.
❑ System could not be inspected because plumber was not ready at scheduled time of inspection.
County was unable to return to complete inspection.
System could not be inspected because plumber was not ready at scheduled time of inspection.
A re -inspection and $50 fee are required.
System could not be inspected because County could not respond to plumber's time constraints.
Comments:
Ulformsrsanitaryproperlyowner-input
April2019
SrgOb1,'t
Department of Safety
& Professional Services,
county 0
Sanitary Permit Number (to be filled in by Co.)
`:;
Services Industry Division
5-Il5S
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
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
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p es in accordance with the Privacy Law, s. 1S.04(1Xm), Stats.
L Application Information — Please Print All Information
Property Owner's Name
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Property Owner's Mailing Address
Property Location
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Govt. Lot
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% %, Section1
City, State /
f1;PVV11l
Zip Code Phone
Number
Zi4?
t
if
T v N R 4 E o
II. Type of Building (ched?c all that apply) '3Lot
#
Subdivision Name
X 1 or 2 Family Dwelling — Number of Bedrooms
Block #
O Public/Commercial — DescribeUse
O City of
❑ State Owned— DescribeUse
O Village of
CSMNumber
Town of
m. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C '
ap2licabIe.)
A.
New System
0 Replacement System
0 Other Modification to Existing System (explain)
0 Additional Pretreatment Unit (explain)
B
)(Holding Tank
❑ In -Ground
0 At -Grade
❑ Mound
❑ Individual Site Design
❑ Other Type (explain)
(conventional)
C.
0 Renewal Before
0 Revision
❑ Change of Plumber
❑ Transfer to New Owner
List Previous Permit Numbers and Date Issued
% l
Expiration
a3 ^'o 5 ` 2 )
IV. Dispersalrrreatment
Area and Tank Information:
Des Flow (gpd)
(�
Design Soil Application Rate(gpd/sf)
Dispersal Area Required (sf)
Dispersal Area Proposed (sf) jem
Elevation
Tank Information
Capacity in
Gallons
Total
Gallons
# of
Units
Manufacturer
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New Tanks
Existing Tanks
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Septic or Holding Tankt
IX
Dosing Chamber
V. Responsibility Statement- 1, the undersihadass ility for installation of the POWTS shown on the attached plans.
PI ber's Name (Print)
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MP/MPRS Number
Business Phone Number
Pl ber's Address (Street, City, State, Zip Code)
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ounty1Department Use Only
Approved
D Disapproved
I
Permit Fee I
Date Issued
/'f'Z3/j
O Owner Given Reason for Denial
4EX
Conditions of Approval/Reasons for Disapproval
RE' t9VED
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AUGAUG15Z025
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Attach to complete plans for the system and submit to the County only on paper not teas than is rrz x 11 meats in size
SBD-6398 (R. 03/22)
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4" CAST -A -SEAL 4" CAST -A -SEAL
FILTER OR BAFFLE
TOP VIEW
23' -
TANKS ARE MAN ACTURED TO MEET OR EXCEL
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OUTLET
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TANK SPECIFICATIONS
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DIMENSIONS:
CK 0
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WALL: 2 1 /2"
°'
BOTTOM: 4'
COVER: 6'
MANHOLE 24' I.D. PRECAST CONCRETE RISER
HEIGHT: 66'
LENGTH: 12'-7'
WIDTH: 7-2'
BELOW INLET: 53'
UQUID LEVEL: 46"
o
WEIGHT: 15,370 LBS.
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INLET AND OUTLET:
4 CAST -A -SEAL BOOT OR EQUAL GASKET
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INLET AND OUTLET BAFFLE AND FILTER:
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WISCONSIN, SEE DETAIL #10
(OTHER STATES SEE CHART)
LIQUID CAPACITY: 42.92 GAL/IN
X
HOLDING TANK.
OUTLET HOLE PLUGGED
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ACTUAL CAPACITY: 1,085 GALLONS
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LOADING DESIGN: 8'-0' UNSATURATED SOIL
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TANK CAN BE USED AS:
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SEPTIC / HOLDING / PUMP OR SIPHON
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COVER: MIX DESIGN #8 (NO FIBER)
co
TANK: MIX DESIGN #10 (STRUCTURAL FIBER)
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CUSTOMIZED TANKS:
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FOR CUSTOM TANKS CONTACT WIESER CONCRETE
RECEIVED
C-1227 REQUIREMENTS AUG Z 5 Z025
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REVIEWED BY
REVIEW DATE
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DRAWINGS SUBMITTED
FOR APPROVAL
APPROVED BY:
SHEET NO.
APPROVAL DATE:
1
PRODUCTS NEEDED BY:
O/ F
1
Bayteld Co.
Planning and Zoning Agency
BAYFIELD COUNTY
CHECKLIST FOR SANITARY APPLICATONS
Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e))
Tt Check List
Original Sanitary Application (Submitted in Deed Holders Name — nQt prospective buyers) (383.21(1)1.)
Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c))
Original Plot Plan (383.22(2)2. 3. & 4.a)
Cross Section, Over -Head Profile of the System id Schematic of Tank from Manufacturer
Pump Tank Diagram, Alarm and Pump Curve (when applicable)
Contingency Plan / Management Plan (383.22-3(2)(b)1.f.)
Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds)
Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds)
"�► Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5)
0 ATU Servicing Agreement (Recorded at Reg. of Deeds)
Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7)
�2Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be. attached
to all cow
1Soil and Site Evaluation Report (383.22-3(2)(b)1.e.)
❑ State Plan Review (when applicable)
0 Copy of Warranty/Quit Claim Deed (Optional)
Sapitary (Include the following Information)
1t I Application Information must include: $23 digit Parcel JD# -- (do not use 12 digits anymore --obsolete)
0 Project Address c. Lr Road Name where driveway is/will come off of)
11
Type of Building
III
Type of Permit
LIV
Type of POWTS System
❑ V Dispersal / Treatment Area Information
XVI Tank Information
❑ VII Responsibility Statement (Plumber's Information)
0 *Date Stamp*
Plot Plan: (To Scale or To Dimension)
Signature and Plumber Information
❑ Surface Elevation of Body of Water
❑ Direction and Percent Land Slope
❑ Tank and Filter Information and Location
❑ Wetlands / Navigable Bodies of Water
❑ Absorption Area (Proposed and Existing)
❑ Bench Mark (Location, Elevation and Description)
0 (Owners Phone Number)
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AUG 15 2025
B1 Co
Plannin
❑ Address Number and Road
❑ North Arrow
❑ Contour Lines
❑ Structures and Driveways
❑ Boring Locations
❑ Property Lines
❑ Well Locations
❑ Component Manual Version 0 Legal Descriptions
❑ Piping Material Information (conveyance line, building sewer line, material type and: diameter).
Turn Over ►
Cross -Section and Over -Head Profile of the System:
O Surface and System Elevation
O Position of Observation and Vent Pipes
O Dimensions and Depths
O Make, Model & Number of Chamber Units in each Cell
Pro y Information
❑ How many systems will there be on this parcel of land? 1
❑ Has this property been split? (Property Statement shows Property History)
Fees"
O Private Sewage System (Septic Tanks) $ 400.00
)'Private Sewage System (Holding Tanks) $ 400.00
❑ Mounds or Systems requiring Pre -Treatment $ 500.00
❑ Sanitary Revisions $ 25.00
❑ Private Sewage System Reconnection $ 50.00
and Private Interceptor
❑ Return Inspection $ 50.00
Maintenance Agreements + $ 30.00
(checks made out to Reg of Deeds)
AUG 15 2025
P;ann'rvi
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AUG 152025
HOLDING TANK — MANAGEMENT PLAN
The Private Onsite Waste Treatment System (POWTS) has been designed and is to be
installed and maintained according to SPS 383, Wisconsin Administrative Code,
Holding Tank Component Manual for Private Onsite Waste Treatment Systems
(SBD-10571-P)(R.6/99) and the Bayfield County Zoning Department Sanitary and Private
Sewage Ordinance.
1. T i fOWTS has been designed to accommodate a maximum daily flow of
iDO gallons of domestic wastewater per day.
2. The owner of this POWTS is responsible for system operation and
maintenance, locking device, alarm and access.
3. The owner or owner's agent is required to submit reports as required by SPS
383.55(1), Wis. Adm. Code, to the. Bayfield County Zoning Department.
4. Design approval and site inspections before, during and after the construction
are accomplished by the county or other appropriate jurisdictions in
accordance with SPS 383 of the Wis. Adm. Code.
5. Maintenance Cycle. The holding tank must be serviced by licensed pumpers.
An alarm system is to be installed to activate when the tank is < 90% full.
6. Performance monitoring. At the time of servicing, the service provider files a
report with the department of designated agent.
7. A User's Manual will accompany the component. It will include the names
and phone numbers of local health authorities, component manufacturer or
POWTS service provider to be contacted in the event of component
malfunction or failure.
8. In the event that this POWTS or a component of this POWTS fails and cannot
be repaired the owner will find in the User's Manual the names and telephone
numbers of property licensed individuals to contact for such repairs.
This agreement shall be binding on all assignees and heirs
W9114 of Ht1/4 SectionTownship 1QN. Range W. Town of { 1 LI
Govt.
Lot Lot Block Subdivision CSM#__,_ _
Additional Legal Description N wf r 3Za 2.c'hs PM t46 '
zoiq sif?
C?Q\Q SVLL _________
Property owners'Signature Date
ulformslmanagementplan
Revised: July 2013
AUG 15 2025
, r
HOLDING TANK SERVICING CONTRACT
Contract Date
This contract is made between the
Holding Tank Owner(s) Name(s)
Toy?
Pumper's Name (Print)
Pumper's Signature
Pumpers' Registration 4
tr oam
6 ZZ-3
We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions)
PROJECT
Legal ion:
I
xlD#
W1/4II1E1/4,
LOCATION
(Use Tax Statement)
4Town
of:
Lot size
Acreage
Section V , Township N, Range W
4'O
Gov't Lot
Lot #
CSM it
Vol. Page
CSM Doc U Lot(s) No.
Block(s) No.
Subdivision:
1. The owner agrees to file a copy of this contract with BavfieldCounty 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.
v
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 bases. The
pumper further agrees to include the following in the semiannual report
a. The name and address of the person responsible for servicing the holding tank;
b. The name of the owner of the holding tank;
c. The location of the property on which the holding tank is installed;
d. The sanitary permit number issued for the holding tank;
e. The dates on which the holding tank was serviced;
f. The volumes in gallons of the contents pumped from the holding tank for each servicing;
g. The disposal sites to which the contents from the holding tank were delivered.
4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event 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) Name(s) (Print)
Thvt2 &6Z
Revised: May 2016 (®May 2018)
Personal information you provide may be used for
Owner's Signature(s)
. vsa�, 4: ; ,t Public
Subscribed and Sworn to me:
on this _?4 aay of
by:
No Public
expires on: -1- 3 1— )-
brafted by -
AUG 15 2025
E•, O.
P!anninr, :: =~�/
DOCUMENT NUMBER
2023R-599956
Document Number/Plan I.D. No.
HOLDING TANK
AGREEMENT
Owner Name (s)
Owner(s) Mailing Address
TDB �Flo.v#
r4 c'%M l
Parcel Identifier Number (PIN)
Agreement Date (same as Notary Date)
UdSP ± WD hr's. vvwo�W—sw
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 an 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,
R f
VV'4 1/4 of_IM% 1/4 Section & Township N. Range W.
Town of
Additional Legal Descriptlon: fJ 1.4 t.j E 1' jo
Gov't Lot_ Lot Block Subdivision CSM#
Lo�_CSM # Vol Page CSM Doc#
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY, WI
RECORDED
O8/O4/2O23 AT 1:23 PM
RECORDING FEE: $30.00
PAGES: 3
Return To:
emft+ D & i' 2 W L7
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 Baylield 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. State., 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. State., 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 moon this date:
Notarized Owner(s) - 8ignature(s)
64 /1AMy
V
Notary ubi€c
1
Commission Expi
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Draftedby: %Itn47 vJ, j.pj
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personal lnformaUon you provide may be used for [Privacy t1IAtIi w 440 ultrnmsrsaniterylholdinPj*ag�evmentdhc!J.und 2011 rj
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Planning and ZoniAtIb? 3 •
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JULO 2 U 3 Soil Test #
Bayfield County_ 1 _
Waiver of a Thorough Soil ''& Site Evaluation
(subject to 15-1-10(d))
a certified soil tester determine that in my professional
judgment the following site (see below) is unsuitable for any treatment component other than holding
tanks. Due to soil & site conditions, a thorough soil and site evaluation is not needed to make such a
determination.
Property Owner hb Css �- Contractor
PropertV Address 32 6 2c 37 k Q(u-7 c- Authorized Agent
PiY` 4 t -h S-VVY Agent's Telephone
Telephone 76 3 - n2810 -- Written Authorization Attached: Y or N
Accurate Legal Description is requested:
ill'✓ 114 -of Alf, 1/4 Section _02° Township "d N. Range 41 W. Town of I J Z t(d
Govt.
Lot Lot Block Subdivision CSM#
Volume Page of Deeds Parcel I.D# 372-?/ Acreage /9 5 -
Additional Legal Description:
Indicate reasoning for your determination: C 4/Y ST -T' , "/Q + z c N
L'Z SS ;r &fl SMV*L 7 y47 o/cr�
t4 3/a
Signature of rtified Soil Tester
Date
a
Signature of County Official
iI2s1 Z�
Dater'—'
Certification #
tSubmi#: Plat Plan &t Fee)
u/formslsoUtestwaiver(KLK)
February 2005
Pt) ,'.c/)
AWAI£.S2e7moo// k1
7'M of i'Wica, my f £ L6 T/
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JUL 20 2023
SNAP
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BAYFIELD COUNTY
SANITARY PERMIT (#04)-25-115S
STATE SANITARY PERMIT
OWNER: GESKE, TODD A & SKEIE, KATHLEEN A
GOVT LOT: LOT: BLK:
NW 1/4 NE 1/4 SEC: 20, T 50 N,R4W
TOWNSHIP: Bayfield
SOIL TEST: 86-23 (WAIVER)
NEW SYSTEM
SYSTEM TYPE: Holding Tank
PLUMBER: RICHARD WSZALEK
TRACY POOLER
Authorized Issuing Officer
DATE: 8/27/2025
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 #: 23-105S
LICENSE: # 226002
Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all-
weather road.
THIS PERMIT EXPIRES 8/27/2027
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION