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HomeMy WebLinkAbout25-137SSm 13 2025 04:43 HP Faxoolkosk Plumbing 7153241b9 page I " INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY TIME RECEI.:D REMOTE CSID DURATION PAGES STATUS October 17, 2025 at 8:04:07 AM CDT 7153724159 38 1 Received Request for Sanitary Inspection (24 Hrs. in Advance) Fax this form to Zoning Dept (24 Hrs.) prior to when you want an Inspection — (715) 373-0114 If you do not have a fax and must email the inspection; you must email all staff members. Note Time Change fl Discrepancy JJ Other to n ro fro s /<r Phone Number Plumber: os JVK AS Fax Number -71S 3?�-`{ls `j Homeowner: M -cus #4 �wtc( Email Address j'o�.Y �eavC,J:1"Picr'i-k Immediate Phone Number So Zoning Sanitary 2- 5 _ 3 —, $ Dept can call you right back (if needed) Permit#: -71 Plumber's Choice Z Dept Date: Plumber's Choice Zoning Dept Time: ______________ ________________() Township: J Address#& /ro t - ti cv YG iGQ L'rf—t A- /moo✓+4 Road Name: or tjr, 24 ah 60 i Directions To Site: yyi v's'lc� . <l.el c (vin, L —f ... f a lr )4S- , /Y733`/S/14vs Comments: $ q ""Plumbers you must verify any change(s) by fax us' email Notes from Zoning Dept: e) ufformslsanltarylrequestfodnspection Zoning Dept (®4112104); ® June 2023 MARCUS AND ADRIENNE HALMA 73345 MUSKEG RD IRON RIVER WI 54847 JLDING TANK INSPECTION REPORT (ATTACH TO PERMIT) GENERAL INFORMATION Permit Holder's Nam ❑ City ❑ Village 0 Town of Sanitary Permit No. a cu Plan ID No. I Tax Parcel No. Pro ertyddress if Avar able S TANK INFORMATION TYPE MANUFACTURER/MODEL# CAPACITY (Jos*cn'ttW 'e SETBACKS Property Line Well Water Service Building All -Weather Road OHWM Swimming Pool DEVIATIONS FROM APPROVED PLAN COMMENTS (Persons present, discrepancies, etc) / ��/ Pf 7h7er,VaI Q`4r1� t d/�c nrc Srd t' , 9I`aAt Loj'Ri a c�a n5 7 '4 5• � COMPONENTS NOT INSPECTED Plan Revision squiredI ❑ Yes . o p�te• Signof I ect Cart. Number opcuat uu uu tet roue V -/ v- - r / r J' f / ✓ 10 of 13 HAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Bayfield County Courthouse Fax: (715) 373.0114 Post Office Box 58 e-mail: zoningPbavfieldcountv.wi.gov 117 East Fifth Street Web Site: www.bayfieldcountv.wi.gov1147 Washburn, WI 54891 Property Owner - MARCUS AND ADRIENNE HALMA Information _ 73345 MUSKEG RD IRON RIVER WI 54847 MI As you know �4 was contracted by you to install a private onsite wastewater trea lent system on your property described as: Notes: Abandonment of Old System to meet all applicable code requirements: Tank was pumped by: o Tank was crushed I removed and pipes disconnected by: on at AM/PM On [� at 2 (AM / e above -mentioned plumber contacted our office to conduct'a pre -cover inspection as required under DSPS 383. One of the following applies:rcy1;0: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. E. 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/forms/sanitarypropedyowner-Input Apra 2019 ss_ oo6S-7 Department of Safety County # �S 3 2025 & Professional Services, SEP 2 Sanitary Permit Number (to be filled in by Co.) Industry Services,D' 'Sion Bayfleld Cc.J 0 c 5 -! 3 7 $ Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropr overninental unit P tj.STS . V`! 2.S O,Z. is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, S. 15.04(l)(m), Slats. q I. Application Information. Please Print All Information -• Property Owner's Name Parcel # 44a• '5 a / c p 8' r Property Owner's Mailing Address ( Property Location 7 3 3 t(5- Yy1 iske- JC Govt. Lot City, State Zip Code Phone Number y'o 72. • v -e S" Lf7 y'``?i .s—' 13 6X77 /' E '/+, Section II. Type of Building (check all that apply) Lot!! T '1 g N R •o or 2 Family Dwelling — Number of Bedrooms Subdivision Name j9 Public/Commercial — Describe Usc'" 1010° I' J 1'6b Block # $rnaIt t. j+ .t,v S Lop -- O City of 0 State Owned — Describe Use CSM Number 0 Village of F Town of p ✓ 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. 15 New System 0 Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ® Holding Tank ❑ In -Ground ❑ At -Grade 0 Mound 0 Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New OwnerList Previous Permit Number and Date Issued Expiration IV. Dis ersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required (at) Dispersal Arco Proposed (sf) System Elevation Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units pis New Tanks I Existing Tanks w C� iu Srfits�+rHoldinb Tank 'b Z 5O0 W 6 e S.e r �.G vi. C 17€hamber - r r �- - V. Responsibility Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sig; lure ItalP/MPRS Number jBusiness Phone Number Iii Plumber's Address (Street, City, State, Zip Code) _ S • y sro �l t v �e_ v t, U 9-T 6 Y% VI. County/Department Use Only Approved ❑ Disapproved Permit Fee Date Issued L IssuinWgenatu- $ O Owner Given Reason far Denial YO— Q F) /� ✓L Conditions of Approval/Reasons �/for Disapproval da* ,flL!1// 1�iI't a T Attach to complete plans for the system and submit to the County only on paper not less than a 112 x 11 Inches In size SBD-6398 (R. 03/22) Wisconsin Department of Safety and Professional Services Division of Industry Services 4822 Madison Yards Way Madison, WI 53705 September 22, 2025 CUST ID NO.: 224832 MARY JO HUPPERT 25720 FIREFLY LANE WEBSTER, WI 54893 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES:9/22/27 MUNICIPALITY: TOWN OF OULU BAYFIELD COUNTY SITE: MARCUS HALMA 73345 MUSKEG ROAD SaY5eld Co. Planning and Zoning Agency IRON RIVER, WI 54847 NE 1/4 OF THE SE 1/4, S 15, T48N, R 19W Phone: 608-266-2112 Web: http://dsps.wi.gov Email: dsps( wisconsin.aov Tony Evers, Governor Dan Hereth, Secretary Identification Numbers Plan Review No.: PWTS-092502226-C Application No.: DIS-092539865 Site ID No.: SIT -151198 Please refer to all identification numbers in each correspondence with the Department. Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES R!CEIVED DIVISION OF INDUSTRY SERVICES SP 23 2025 9t4a FOR: Design Wastewater Flow Value: 400 SEE CORRESPONDENCE SITE REQUIREMENTS • A full size copy of the approved plans, specifications, and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. A Department electronic stamp and signature shall be on the plans which are used at the job site for construction. OWNER RESPONSIBILITIES • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval and Wis. Admin. Code & SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval, the Division of Industry Services reserves the right to require changes or additions, should conditions arise making them necessary for code compliance. As per state stats 101 .12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. The Division does not take responsibility for the design or construction of the reviewed items. Inquiries concerning this correspondence may be made to me at the contact information listed below, or at the address on this letterhead. Sincerely, Fee Required: $180.00 Fee Received: $180.00 04&h"MR"Ak4 Balance Due: $0.00 Refund Expected: $0.00 Joshua Rowley Division of Industry Services Phone: Email: joshua.rowley@wisconsin.gov R!CEIV!D Bayne d Co. Planning aim Zlaiing Agency r ivy SEP 232025 BayfIeld Co. Planning and Zoning Agency SR-oo3q. Soil Test# �� � + �� Bayfield County Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10 (d)) ij. `/ c%.Vl 1g) / lZo S L 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 M A V l- v S �-/,RI I'. Contractorp Y• Property Address -7 3 3 (5- 1')") v.kj Rrk Authorized Agent ✓© - s {.'. Agent's Telephone, Telephone -7 1 S Y' 1Y- 5-7-1 Accurate Legal Description is requested: Written Authorization Attached: Y or N 146 114 of 5 E 114 Section / Township 'I8 N. Range 7W. Town of Additional Legal Description: .I 24221 9 Govt. Lot Lot Block Subdivision Lot CSM# Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# 2 -it' 1! ! Acreage 04 0 a Indicate reasoning for your determination: C 10-,VS13, (S `7 — l ei ] cl. '-r k i-rs r+ s4/I A! � y Sign ure of County Official 7%f/;c Date Signature of Certified Soli Tester Date csr 4aOoo Certification # (Submit a Plot Plan & Fee) u/forms/solltestwa(ver(KLK) June 2018 6r+�i� o lfl4 c, v � v 5 % Q / tyi.qx I1Liq SV.c l.s'I R 7 W -7*3• 3gscf'vskTcL T a d J l V y n j2 v I. ff/7 f : i4 (J. 132.0 - J w• prey 733�S pmj5 C -c5 .� 4 m.1bs IBeV-;n�a, ! Sk: e ' qo' i e'e N4 j�1extr-.5+ R(: 1*1 v s ke� 9 ... z- 7- �O g dt l oil W� tce r cane 'eA l�l.�l k - L.. 1 1 14A1 - 'tr•oovj b RC!IV6O()LIP i'ld Bayf►eld Co. Planning and Zoning Agency - -__, .. _ l50_ ---Y _ dam-- r-_____•_ _ �_..._.. p/ ° ( IAI f? •� � ,v�a����kQ�,��, � 3b' 0 e L1 - F, cS a �P ate.- - N `iN N � 31100rav4�ys -~- Std _ ___ 3tp� I ---- 77 W y 132-0 Q 1-scl `4 L.v<f f of k fyt 2 E_s o. / l fr`a l i I'1. CT' LL(. kS � ✓ t�.� z�S ��� A&eve. +14�a j cj vtJE. JJcLlt ehf...gt+$'z Cc.&- 0� Pale i,avh 8a1)f ✓ gP EJe.u/oO.O' /"AS7`Zl ,� 17gS' et�.7� v-�► v't`:!,A 16�• j7 . I ! H /i if7ei k �o)E1t J y)uc/ L(s 1'yp (vr-R aj); (ylLa7) j.'P% a2cc10 'l kc k; vcj RECEIVED HOLDING TANK SERVICING CONTRACT SEP 232025 Contract Date Bayfield Co. -4; (2, � This contract is made between thePlanning and Zoning Agency Holding Tank Owner(s) Name(s) 14LYtL c fl/L&v c 14 /in Pumper's Name (Print)• I Pu pr's Signature I Pumpers' Registration # We acknowledge the Installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT Legal Description: Tax IDtt -114, LOCATION:: (Use Tax Staternerit) f l/4, Town of: Lot Size Acreage Section=` ,.Township N,:Range N Cd__________ Gov't Lot Lot # CSM # Vol. Page CSM Doc g Lot(s) No. Block(s) Na,: Subdivision:: 1. The owner agrees to file a copy of this contract with Bayfield County as required in SPS 383.55, Wis. Adm. Code. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local government unit which has signed the pumping agreement required by SPS 383.55, Wis. Adm. Code, and the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; JACOB B• ANDERSON b. The name of the owner of the holding tank; j Notary Public c. The location of the property on which the holding tank is installed; I State of Wisconsin 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) �eiGn ne, L.. P. tlwr, 'mar' IWA4,rc�' Owner's Subscribed and -Sworn to me: on this day of by: Notary Public My commission expires on: ._r�U Revised: May 2016 (®May 2018) Personal information you provide may be used for secondary purposes [Privacy Law. s.15.04 (I)(m)] Drafted by l�.p� Small Capacity Non -Domestic Wastewater Holding Tank Plan Approval Application State of Wisconsin Page 1 of 3 Bureau of Natural Resources Form 3i00-185 (R 07)2025) Bureau of Water Oualiry PO Box 7921. Madison W153707.7921 Notice: Under S. 281.41. Wis. Stets, and chs. NR 108 and 213, Wis, Adm, Code, Wisconsin Dept. of Natural Resources (hereafter WDNR) approval of non domestic wastewater storage structures is required prior to installation. Owners of proposed nomdomestic wastewater holding tanks must complete and submit this Plan Approval Application form. WDNR plan review and approval under sbe . 281.41, Wls. Stall. and ch. NR 108. Wis, Adm. Code, may be required as at d n Part ill under W Wisconsin form. n Pperric Records law [silo 19.31 a819. 9n 11 Wis. Slatsfor program administration and may be made available to gapeplumbing wash, io ditewate, and genergafrom residential l cleaning s defied asdomesticwastewater. tures and es such as Wastewater sanitary rom restaurantsis also generally wash, garbage considered `asr lied domestic wastewater. tNon.domesti wastewaterymay ilncllude wastewaterfrom dwellings other sour a including Industries and m commercial establishments and .. ..,.,,,t i„ raraities_ kennels, car washes. milkhouses, etc. Mixed In tractions• Redd and comoletii 2L11[S_foCm. Complete and submit this form to the WDNR for non -domestic wastewater or mixed wastewater holding tank proposals that include proposed installation of holding tank products pre -approved by Wisconsin Department of Safety and Professional Services. WDNR does NOT charge a fee for plan review. If the holding tank proposal is for mixed wastewater, you must also obtain approval from the Wisconsin Department of Safety and Professional Services for the domestic wastewater component prior to installation. • Submit completed form 3400-185 along with any supporting documentation or plan attachment if required by Part III of this form via one of the following options: o Email: - - - o FAX: 608-267-2800 o Mail: Nate Willis - WY/3, Department of Natural Resources, PO Box 7921, Madison, WI 53707-7921 • Any approval granted under Part IV of this form will be void unless you complete and submit this form along with any required supplemental documentation or plans to the WDNR prior to commencing installation. AU.Jnfonnation must becomoteled_lD teppr-o.Yalltbe_ .all ., Owner or Business Name - (Area Code) Telephone Number Email Address MS0/rrlc 44AI AAA '715-H13-517 733H5MuskcG ROAD j1Zvr1 RtUSR, Iw2 owner I business address above) rovide a brief description of the activity or business that will be generating wastewater requiring storage and disposal and indicate the )proximate design flow rate, general wastewater type and cons ituenfs (check appropriate boxes below . Description of Activity / Business: —WLL 1' wktB[t op/was IS.ctf `ND As Design Flow Rate: 339 gallons/day General Wastewater Type: O Non -domestic only ® Mixed non -domestic and domestic Wastewater Source/Constituents (select all that apply): M Domestic wastewater from toilet, hand wash sink, shower. etc. ❑ Rainwater, snowmeil, or washwater from vehicle or equipment storage areas. o Motor vehicle fluids (oil, grease, tc.) drippings or spillage from vehicle or equipment service areas. Animal, Fruit (Vegetable or Food processing wastes (describe - provide attachment if necessary): 5W4t- gtt( IER Sffop (] Other (describe - provide attachment if necessary): 's SOIL ?15-4210- 1775 1 NA RECEIVED SEP 232025 Bayfield Co. planning and Zoning Agency Small Capacity Non•Do cWater Holding Tank Plan ApprovalApplication n,! -, r 9 _ I :. O1 V (.- II S IC ano it ll •n IP 1 fc- JI . ' nln NOrn I v'I 1! I r r.6:m - 'L o,w.,j t'C.Gn.3 :aro I CC' rl lin,.: Ie,13 Pn ao LLIJ. .,.. _!r CPb-n.` �B-5 tlH N! .n I> f.)I Ca1••xl L?nr1. Nlldb!r. "VVDNR 1 .11ry 1 51 1 I tI 6 I I s. SI r 1 I S' 1- - I . I S. c tD${ S' pr "IVDrO I bi10500 f 1Ill f II 5 1- R v:lll It-crc0.,, o 1'..Il 51 n v.J(I 11Jt.l 'nY fc s \ln il: ,l 1 1.1 lia :e .,s Ic-1 DSr 5.tl-a II ,r3J,S .'CI SIiieI:^ IA tJ II C ,?rvjl III ri. )I. III h...IC 1 v..U. I lrutlirs ,alton5l '-- - TImN Malorial No. of ianNs Tolal Capatllg 19 1 YU5 t,I'JJ e .............. I.......it)!], ., _. .. II'4. J ,Llc_.!, T,)lc; U NC • ,,. _ ... A;n. c:,d.:. I) 0.]14 St 'I) 6r.11 V 1 nl 1 I • II -- Tdbl at . •i,.1. n.:. till Ik,a v.. 'set -,l, ....._. !•pdysfl ! .-..n .. .:. .. ... gn!vt^. i'r.:. If t ♦1 . c.nnlu^1 I YC IiR I,:. v '...re. dr .n„ - I„ e,. +4 .i:,• 1C' e:.l , aqe r :ot ul fI ,IL1,11 .ul:. '1 . .Il:per or PLer,Vr,Fp2 wrl]Gn nI r ...... ,.r ., l i ...q L'r -d C. I-. 1 • L.n :. I r. I _�_ sr. (. 1.1 ... .,.....Lu• f n..;r 5't 1 '1.1grr` I t II tIlr 11ty 1rinw Nr r?Th{Zlder SeP4 c Slz7 1 \110.,ti5• C i. t LTY , II L C 7620 1 oL4CoS{C_ X f.�ev ,WZ ....................'7)'1•......, .... Ina r:nrrl 11,7% I ... _ . ....I-. tNt, . aIV ( .I " iq zOzs Receiver) SEP 232025 Bayfield Co. Planning and Zoning Agency Small Capacity Non -Domestic Wastewater Holding Tank Plan Approval Application Form 3400-165 (R 07/2025) Page 3 of 3 1'�"ill Q'\�rxlgnu Nuaa�.n,y - - - - _ if you answered Nob any of the questions A. through H. in Part It -Tank Information, then you must submit supplemental information and/or construction plans as specified In ch. NR 108, Wis. Adm. Code, detailing how the project will meet the applicable requirements of ohs. SPS 383, 384 or NR 213. Wis. Adm. Code. It Is generally recommended that applicants contact the WDNR to discuss tCode, s the necessary c the WDNR ant of any supplemental tal in ofor information prior wastewater completion and submittal of this form. Chapter NR t0Wis. lans. If you answered YY to the questions A. through H. in Part II - Tank information, and all onot other information o eation on this form by o Vis completed in full and has been submitted to the WDNR, then this oronosed,Li41ding-t00kSr.;; subject to the following additional conditions: 1. That for proposed mixed non -domestic and domestic wastewater holding tanks, the owner or designer shall also obtain plan approval from the Wisconsin Department of Safety and Professional Services (or designated agent) prior to commencing installation. 2. That a competent resident inspector be provided during the course of construction. 3. That periodic inspections be performed to ensure that water tightness and the integrity of the holding lank are maintained, in accordance with s. NR 213.15(1)(d), Wis. Adm. Code. 4. That solids be collected and disposed of as needed in a sanitary landfill, and that oil and grease be managed such that they are collected before they enter a drain or catch basin and that they are pumped off and disposed of by a commercial waste oil recycler or other disposer as needed. 5, That hazardous waste be withheld from the holding tank. 6, That if bedrock Is encountered in the excavation, the bedrock be excavated and backfilled with adequate bedding material to prevent damage to the holding tank. 7. That if any portion of the holding tank is expected to come Into contact with groundwater at any time (based on review of soils maps, observations of the soil profile during excavation, observed groundwater levels, etc.), the tank be Installed with adequate anchoring support such that the empty holding tank will not be floated upwards by groundwater. 8. That if the holding tank will include service suction or discharge lines, the lines shall comply with s. SPS 383.43(8)0), Wis. Adm. Code. 9. That if the holding tank is located in a floodplain area, the vent pipe terminates at least 2 feet above the regional flood elevation. 10. That the holding lank and appurtenances be installed in accordance with the above conditions and statements made on this form. The plans and specifications are subject of a review in accordance with s. 281.41, Wis. Stats. Where necessary, submit plans and specifications to the Department of Safety and Professional Services or other State or local agencies to ensure conformance with applicable codes and regulations of such agencies. The WDNR Division of Environmental Management reserves the right to order changes or additions should conditions arise making this necessary. This approval is not to be construed as a WDNR determination on the issuance of a Wisconsin Pollutant Discharge Elimination System (WPDES) permit or a determination as to the ability of the proposed system to comply with any terms or conditions in such permit. It is also not an approval of an Environmental Assessment that may be prepared for this project, or an approval for any activities requiring a permit under chs. 30, 31, or 281, Wis. Stats. The WDNR reserves the right to order changes or additions should conditions arise making this necessary. In case installation of these improvements has not been commenced within two years from the date of receipt of this application, this approval shall become void. Therefore, after two years, you must submit a new application for approval of these or other plans and specifications before any construction is undertaken. FOR THE SECRETARY RECEIVED Wastewater Section Manager Bureau of Water Quality SEP 23 2025 Phone No. (608) 535-2369 Plannin �Yfreld Co. Website for additional informntion and guidance on WDNR holding tank plan eubmittais: g and Zaring Ag�� .......� %A UVll V. }IV Rio, 9975 P. 2 RECEIVED SEP 232025 Bayfleldco. Planning and Zoning AgencY Pg I of Holding Tank Plan lnaex & cover bneet i Component Manuel Design References: t.1sj Index & Cover Sheet PAGE 1 OF 8 Pg2of Plot Plan Pg 3 of 9 Holding Tank Speclflcatlans-Z c k -c 4s i Pg 4 of 9 Management Plan Attachments: res: -#--' POWTS Application for Review C i F ,.4. ? Soil Evaluation Report & Site Me 4f ' C,4Z 2 Holding Tank Pumping Contract if appil f Holding Tank A reemer# if applicable) Project Name I Description f ltcable) able) Owner Name(s): Ma r c. v 5 4-4' l 1,4 Phone: ? t 5" - _. Owner Address: '73 �5~ 1 vS .e s• .T� 'Yv w� /�, v rr' t.�.r� vip. S`',8 Y7 Project Address: e �� E, s' k a -� Govt. Lot: N e 1/4 of S.r - ' ,1/4, Section, T�IV_,,,,,,,_ R �' � or W Township: C? ° County: j 7� Protect Parcel ID #: X :L J 2-4'/7 Sf Designer Information Designer Name: l /CL 4-�% c: f /r s Phhone::"//S" Deaf nerr Ar dress: ? D, 9 } 4 �"�' �- :ZIP: .Y8V7 «� I w�rr,yy ..�.. E-mWailr L'l~ ���� � i.✓ r L. `� L -" "L � Thi4 space reserved fps a ro 1 CondF�ona l� StaiY1p. License Number: z Z ca c.-) 9 O APPROVED RC3n1otrks: DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES 4. I SEE CORRESPONDENCE Signature: ��• �,<+..'•2./-" Date: Original gndtur s required on each submitted copy, O.. • PROPERTY OWNER: M 4 v G,, s jj kV PLUMBER: Allan LO&W/ Polkp8kl Plumbing SIGNATURE: .-.--. DATE: T!- z s LICENSE # 220Q90 HOLDING TANK SPECIFICATIONS RMgiIIGl...ilMji► — Number of bedrooms moo Non-reeldentiai estimated flow (gpd) 00,0 Minimum holding tank volurne'required (gal) SEP 23 2025 Tank Dimensions and Data X for round tank Liquid depth below Inlet invert (in) Imernmal Maximum de th of soll cover (ft) Height (in)Length (in)3"Dimensions Width (In) Only junction box .,..-> conduit blind plug to seal outlet Bayfield co. - Planning and Zoning Agency Manufacturer model number manufacturer iber Tank Anchor Calculations 16840 lbs Weight of tank and cover 1.1•b Safety factor 02 lbs Weight of anchor required 40.8 in Soil cover req. for anchor or 9.9 _yd Concrete counter weight • HOLDING TANK CROSS SECTION manhole eoverwith locking device and finished vent cap warning label grade 4 4'1 min. fl"izurn,n, Manhole and vent locations ____ f may be reversed, vent pipe T • .____, 18" min, �.w-.,.r,wr,w.w.rr.�....r..aw..r.r.ur..+wrlr.w- .. service st 12,0 in, buIlding sewer alarm on `----+ -~ Notes _AU tajnk oints Inlet Electrical as per NEC 300 and Comm 16 and joints between tank openings and piping are - 39.0 in. sealed watertight. All pipe and vent materials comply withSF, '$3 3 in. bedding under tank, Tank Is anchored as necessary to negate buoyancy, RECEIVED I C c SEP 2 3 2025 Bayfeld Co. 1831" Planning and Zoning Agency 4" CAST -A -SEAL 4" CAST -A -SEAL' f / 3 FILTER OR — BAFFLE v� vEL4.. ::. ° a � — INLET w ., 0 < if)3 d TOP VIEW SIDE VIEW OUTLET a M U D TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS t WLP2500 TANK SPECIFICATIONS ca 0 DIMENSIONS: a w ai WALL: 3" a a BOTTOM: 3" HEAVY - 5" o COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER 2 HEIGHT: 52-3/4" O.D. LENGTH: 183-1/4" O.D. WIDTH: 101-1/4" O.D. BELOW INLET: 41" O.D. o LIQUID LEVEL: 36" 0 cv WEIGHT: TANK - 3" BOTTOM 12,560 LBS. TANK - 5" BOTTOM 15,527 LBS. N WEIGHT: COVER 9,300 LBS. 2 >- INLET AND OUTLET: m z 4" CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: o o WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) W r- LIQUID CAPACITY: 69.44 GAL/IN to HOLDING TANK: 1 co OUTLETHOLE PLUGGED ACTUAL CAPACITY: 2,639 GALLONS ® z t0 LOADING DESIGN: 8' 0" UNSATURATED SOIL W if) TANK CAN BE USED AS: tto) SEPTIC/ HOLDING/ PUMP OR SIPHON 0 1 �=0 COVER: MIX DESIGN #8 (NO FIBER) N-. c TANK: MIX DESIGN #9 (SMALL FIBER) ® m CUSTOMIZED TANKS: in FOR CUSTOM TANKS CONTACT WIESER CONCRETE N J 0 N N 0 - w c DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: SHEET NO. APPROVAL DATE: 1 PRODUCTS NEEDED BY: OF 1 / 1 • HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and F, maintained according to r✓-' f i,�� 383 Wis. Admin. Code, the Holding Tank Component nual de°, `` Wa.n v t and the County Sanitary Ordinance. LV 21) j L � �R 2oo ,rg f 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 5PS p83.33 Wis. Adm. Code. 10. If there is a problem with, or question about this Jnstallation, the following persons should be contacted: a. Installer .............................p© sk PJgnJi.vj PR5 Do Phone:7/.1' 3-1a.- Lsc40 b. Service Provider ...................f S �' Z Phone: -- 71 37a.— 'Eor K c. Co. Zoning or Health Dept. i3&y4ehIof Phone:m- - 3Z-11. Lo e e l -j Si'{ S ec. l �T fiI ! Project Transaction Number: R!C�lV� SEP 232025 Bayfield Co. Planning ar. J Zoning Agency N -4'-_ I Document Number/Plan I.D. No. I HOLDING TANK AGREEMENT owner Name (8) I Uwner(s) Mailing Add ess 41,E k 33 C -k WI as 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 Slats. t t 114 of_- 1/4 Section Township `{ N. Range 9" W. Town of 0 J fy Return To: Additional Legal Description: Gov't Lot — Lot Block Subdivision CSM# Lot CSM # Vol Page CSM Doc# DOCUMENT NUMBER 2025R-609068 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED O9/O8/2O25 AT 8:OO AM RECORDING FEE: $30.00 PAGES: 1 Ei4J► i r 1/ As an inducement to Bayfleld County to Issue a sanitary permit for a holding tank on the above described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tank installation and maintenance. If the owner fails to have the holding tank properly serviced in response to orders Issued by Bayfleld County or, the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Stats., Bayfleld 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 th e 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. Slats., 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, 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 Boyfield 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. Owners) Name(s) — Please L Printt /4 4 X 'I"%%r&P Subscribed and sworn to before me on this date: Notarized Owner(s)—Signature(s) Notary Public 7'c L_& My Commission xpires: ______________ s: t Drafted by: % d h c, 1 kb S V- i Date: - Personal Information you prov de may be used for secondary purposes (Privacy Law, s.15.04 (I)(m)i I. JACOBuBnANDERSONjmenLdoc axiur E4 2 3 2025 Notary:Puhlic BayfieldCo. State of-WiSco11Si11 planning an i Zoc ing Agency BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following I v ' (Use Permanent Ink): D SEp 232025 d Check List Planning a, l, . Cdr Index Page / Title Sheet (Optional) gAge,ncy C0 Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) izl Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) m Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used Lrl Property Owner's Information not prospective buyer's name) ® Property Location (Accurate Legal Description with Sec/Twp/Range) 21 Road Name (where driveway is/will be coming off of) d Floodplain Elevation, Flow Rate, Comments and Recommendations 9 Complete Soil Boring / Pit Information 21 Date Soil Evaluation was conducted d CST Name, Signature, Number, Address and Phone Number 0 *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) 171 Bench Mark (Description, Elevation and Location) n Contour Lines (Example = 98.0' /96.0' /94.0') m Property Location (Sec/Twp/Range/, Accurate Legal Description) 91 Borings (Locations and Elevations) Ii Percent and Direction of Land Slope iJ Well Location (Including Neighboring Wells, if applicable) l! Location of Wetland Areas, Floodplain and Navigable Waters m Buildings, Driveways, and Structures (Location and Descriptions) El Location of Property Lines EZI Existing System Location 171 Address Number and Road Name R1 Current Surface Elevation of Wetlands and Navigable Waters 171 CST, Owner and Property Information E6 North Arrow Fee: 0 Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checkllst/checklistforests rtoL4. � i,MY 6-1_1 BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS SEP z 9 2025 Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) Planning an : no. 11 Check List g Agency 9 Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) Q Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) i�' Original Plot Plan (383.22(2)2. 3. & 4.a) 'Cross Section, Over -Head Profile of the System an Schematic of Tank from Manufacturer lI Pump Tank Diagram, Alarm and Pump Curve (when applicable) LT 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) 56 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) C6 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) $5 2 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) l I 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) 11 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) i7 (Owners Phone Number) 56 II Type of Building l I III Type of Permit Lf IV Type of POWTS System ❑ V Dispersal / Treatment Area Information 56 VI Tank Information 69 VII Responsibility Statement (Plumber's Information) ❑ *Date Stamp* Plot Plan: (To Scale or To Dimension) if Signature and Plumber Information Ci Address Number and Road [ ' Surface Elevation of Body of Water I7 North Arrow ❑ Direction and Percent Land Slope 0 Contour Lines 56 Tank and Filter Information and Location Ci( Structures and Driveways E4 Wetlands / Navigable Bodies of Water E1 Boring Location 0 Absorption Area (Proposed and Existing) i( Property Lines Cf Bench Mark (Location, Elevation and Description) Gd Well Locations i iJ Component Manual Version 1i Legal Descriptions 1 ",1+"t'i1^'—w—. ..s++. -!r""^""` PST.• r'-!'rT » .^"1 :.f I a i.g rT 5� .r ���.� �.�.e Li iping Iaterialpinforrnatior (conve nce line,'building sewQr If�eK'triateriaY N , d diam ery Turn Over ► State of Wisconsin DEPARTMENT OF NATURAL RESOURCES 101 S. Webster Street P.O. Box 7921 Madison WI 53707-7921 October 23, 2025 Mary Jo Huppert Hollister's Soil Testing & Design 25720 Firefly Lane Webster, WI, 54893 Tony Evers, Governor Telephone 608-266-2621 Toll Free 1-888-936-7463 TTY Access via relay -711 Subj: Mixed Wastewater Holding Tank for Marcus Halma in the Town of Iron River Dear Mary Jo: WISCONSIN DEPT. OF NATURAL RESOURCES Project No. 5-2025-0784 The Department of Natural Resources has received and reviewed your recent transmittal of completed WDNR Form 3400-185 for your proposal to install one concrete mixed wastewater holding tank manufactured by Wieser Concrete Products Inc. at 73345 Muskeg Road in Iron River, Wisconsin. The tank will have a 2,500 -gallon capacity (338 gpd design flow) and will hold a mixture of domestic and industrial wastewater. The industrial wastewater will be generated from animal, fruit/vegetable or food processing wastes from a butcher shop. The owner of the holding tank will be Marcus Halma. According to your submitted form, the wastewater to be contained in the proposed holding tanks will be hauled by Iron River Septic to the Ashland Wastewater Treatment Facility for ultimate treatment and disposal. Based on this review, the Department of Natural Resources concurs with the Department of Safety and Professional Development's decision regarding the proposed mixed wastewater holding tank installation. Since the holding tank will be used to store mixed wastewater, please include a copy of this concurrence letter with your proposal request to the Wisconsin Department of Safety and Professional Services and/or the local County designee. As part of this acceptance, please review the conditions of approval with the tank owner, as outlined on page 3 of WDNR form 3400-185, prior to installation and startup of the proposed holding tank. Please note that the Department of Safety and Professional Services is responsible for review and approval of any catch basins, sewer lines / connections, and other plumbing appurtenances associated with the installation of the proposed holding tank, as well as the use of the proposed holding tank for storing sanitary wastewater. If you have any questions concerning this concurrence, please contact Alexa Mydlach, WDNR Madison office, alexa.mydlach@wisconsin.gov. STATE OF WISCONSIN DEPARTMENT OF NATURAL RESOURCES For the Secretary Digitally signed byMydlach Date: 202 0y9830d5Yp' Alexa Mydlach Wastewater Engineer Bureau of Water Quality Cc: Katie Petzel— DSPS POWTS Inspector, District 4 Katie.Petzelydwisconsin.goy Ruth Hulstrom —Planning & Zoning Director, Bayfield County Planning & Zoning ruth.hulstromr&bavfieldcountv.wi.aov Alison Conniff— DNA Wostewater Specialist, Ashland Field Office Alison.Conniffi6 wisconsin.00v dnr.wi.gov wisconsin.gov Naturally WISCONSIN Save... Clear Data State of Wisconsin Small Capacity Non -Domestic Wastewater Depart mentof Natural Resources Holding Tank Plan Approval Application Pof water Quality POO Box 7921. Madison WI 53707-7921 Form 3400-185 (R 07/2025) Page 1 of 3 dnr wi.00v Notice: Under s. 281.41, Wis. Stats. and chs. NR 108 and 213, Wis. Adm. Code, Wisconsin Dept. of Natural Resources (hereafter WDNR) approval of non -domestic wastewater storage structures is required prior to installation. Owners of proposed non -domestic wastewater holding tanks must complete and submit this Plan Approval Application form. WDNR plan review and approval under s. 281.41, Wis. Scats. and ch. NR 108, Wis, Adm. Code, may be required as stated in Part III of this form. Personally identifiable information will be used for program administration and maybe made available to applicants as required under Wisconsin Public Records law [ss. 19.31 - 19.39, Wis. Stats.). Definitions: Wastewater originating from residential plumbing fixtures and appliances such as sanitary (toilets), bath, laundry, dish wash, garbage disposal, and general cleaning is defined as domestic wastewater. Wastewater from restaurants is also generally considered as domestic wastewater. This wastewater is typically discharged from dwellings and from commercial establishments and is commonly called sewage. Non -domestic wastewater may include wastewater from any other source including industries and commercial operations such as vehicle service facilities, vehicle storage facilities, kennels, car washes, milkhouses, etc. Mixed wastewater refers to a combination of domestic and non -domestic wastewater. Instructions: Read and complete all parts of this form. • Complete and submit this form to the WDNR for non -domestic wastewater or mixed wastewater holding tank proposals that include proposed installation of holding tank products pre -approved by Wisconsin Department of Safety and Professional Services. WDNR does NOT charge a fee for plan review. If the holding tank proposal is for mixed wastewater, you must also obtain approval from the Wisconsin Department of Safety and Professional Services for the domestic wastewater component prior to installation. • Submit completed form 3400-185 along with any supporting documentation or plan attachment if required by Part III of this form via one of the following options: o Email: DNRHoldingTankReview(aWisconsin gov o FAX: 608-267-2800 o Mail: Nate Willis - WY/3, Department of Natural Resources, PO Box 7921, Madison, WI 53707-7921 • Any approval granted under Part IV of this form will be void unless you complete and submit this form along with any required supplemental documentation or plans to the WDNR prior to commencing installation. All information must be completed for an approval to be valid. Code) Telephone Number iEmail Address (if above) rovide a brief description of the activity or business that will be generating wastewater requiring storage and disposal and indicate the )proximate design flow rate, general wastewater type and constituents (check appropriate boxes below). Description of Activity / Business: Design Flow Rate: gallons/day General Wastewater Type: 0 Non -domestic only 0 Mixed non -domestic and domestic Wastewater Source/Constituents (select all that apply): Domestic wastewater from toilet, hand wash sink, shower, etc. Rainwater, snowmelt, or washwater from vehicle or equipment storage areas. Motor vehicle fluids (oil, grease, etc.) drippings or spillage from vehicle or equipment service areas. Animal, Fruit / Vegetable or Food processing wastes (describe - provide attachment if necessary): Other (describe - provide attachment if necessary): of Designer Code) Address License Small Capacity Non -Domestic Wastewater Holding Tank Plan Approval Application Form 3400-185 (R 07/2025) Page 2 of 3 Proposed holding tanks receiving non -domestic wastewater are generally subject to the WDNR site and design requirements of ss. NR 213.08 and 213.15, Wis. Adm. Code. However, proposed holding tank designs in conformance with s. SPS 384.25, Wis. Adm. Code and applicable sections of chs. SPS 382, 383, and chs. NR 811 and 812, Wis. Adm. Code will be acceptable to WDNR. A. Has Wisconsin Dept. of Safety and Professional Services (DSPS) pre -approved the proposed holding tank product specifically for use in holding tank applications, and will the proposed tank(s) meet DSPS specifications contained in s. SPS 384.25, Wis. Adm. Code, for water tightness, strength, and protection from the elements and will the tank(s) be installed in accordance with the manufacturer's specifications? Q Yes 0 No Tank Manufacturer Tank Material No. of Tanks Total Capacity (gallons) B. Will the tank(s) have an inspection manhole? 0 Yes 0 No C. Will the tank(s) have a vent? Q Yes 0 No D. Will the tank(s) be equipped with a high-level alarm? 0 Yes Q No E. Will the tank(s) be located in compliance with all of the following minimum separation distances? Q Yes 0 No • 8 feet from all public water supply pipelines (s. NR 811.75(1)(a), Wis. Adm. Code) • 10 feet from all private water supply / service pipelines (s. SPS 383.43(8)(1), Wis. Adm. Code) • 25 feet from all private water supply wells (s. NR 812.08(4)(b)3, Wis. Adm. Code) • 200 feet from all community water supply wells (s. NR 811.12(5)(d)3, Wis. Adm. Code) • 50 feet from a community water supply well if the holding tank will serve a community water supply pumping or treatment building (s. NR 811.25 (1)(h)2c, Wis. Adm. Code) (Note: This alternative separation distance is a special exception to the standard 200 feet minimum separation distance from a community water supply well that may apply if the proposed holding tank is installed below the ground surface and will only contain water from: a pump gland drainage, pressure relief or control valve, sampling faucet, or floor drainage) If the answer to the above is No, contact the WDNR to request consideration of a variance for all code setback distances that cannot be met prior to submittal of this form and installation of the holding tank, and indicate below which separation distance(s) cannot be met and why not: F. Will the tank(s) be located outside floodway and wetland areas? Q Yes 0 Nc If "No", contact the WDNR to request consideration for coverage under the applicable WDNR permit(s) for construction within a wetland or floodplain and include a copy of such permit(s) or other WDNR written authorization with this form and prior to tank installation. G. Will the holding tank contents be hauled off -site by a licensed septage or wastewater contract hauler? 0 Yes 0 No If yes: Hauler Company: License No. Address: City State ZIP Code H. Will the holding tank contents be hauled to a publicly -owned wastewater treatment facility covered by a Wisconsin Pollutant Discharge Elimination System (WPDES) discharge permit, and have the owner of the tank and the licensed hauler (noted in item G) been notified of the disposal location? 0 Yes 0 No If "Yes", indicate the name or location of the receiving facility (required): If "No", contact the WDNR to request consideration of an acceptable alternate discharge option for the holding tank contents and include a copy of the WDNR written authorization with this form and prior to tank installation. Signature of Designer (required) Signed Small Capacity Non -Domestic Wastewater Holding Tank Plan Approval Application Form 3400-185 (R 07/2025) Page 3 of 3 If you answered NO to any of the questions A. through H. in Part II - Tank Information, then you must submit supplemental information and/or construction plans as specified in ch. NR 108, Wis. Adm. Code, detailing how the project will meet the applicable requirements of chs. SPS 383, 384 or NR 213, Wis. Adm. Code. It is generally recommended that applicants contact the WDNR to discuss the necessary content of any supplemental information prior to completion and submittal of this form. Chapter NR 108, Wis. Adm. Code, allows the WDNR a 90 -day review period for wastewater plans. lSThIk'flJETTs.ju If you answered YES to the questions A. through H. in Part II - Tank Information, and all other information on this form is completed in full and has been submitted to the WDNR, then this proposed holding tank installation is hereby approved by the WDNR, subject to the following additional conditions: 1. That for proposed mixed non -domestic and domestic wastewater holding tanks, the owner or designer shall also obtain plan approval from the Wisconsin Department of Safety and Professional Services (or designated agent) prior to commencing installation. 2. That a competent resident inspector be provided during the course of construction 3. That periodic inspections be performed to ensure that water tightness and the integrity of the holding tank are maintained, in accordance with s. NR 213.15(1)(d), Wis. Adm. Code. 4. That solids be collected and disposed of as needed in a sanitary landfill, and that oil and grease be managed such that they are collected before they enter a drain or catch basin and that they are pumped off and disposed of by a commercial waste oil recycler or other disposer as needed. 5. That hazardous waste be withheld from the holding tank. 6. That if bedrock is encountered in the excavation, the bedrock be excavated and backfilled with adequate bedding material to prevent damage to the holding tank. 7. That if any portion of the holding tank is expected to come into contact with groundwater at any time (based on review of soils maps, observations of the soil profile during excavation, observed groundwater levels, etc.), the tank be installed with adequate anchoring support such that the empty holding tank will not be floated upwards by groundwater. 8. That if the holding tank will include service suction or discharge lines, the lines shall comply with s. SPS 383.43(8)(j), Wis. Adm. Code. 9. That if the holding tank is located in a floodplain area, the vent pipe terminates at least 2 feet above the regional flood elevation. 10. That the holding tank and appurtenances be installed in accordance with the above conditions and statements made on this form. The plans and specifications are subject of a review in accordance with s. 281.41, Wis. Scats. Where necessary, submit plans and specifications to the Department of Safety and Professional Services or other State or local agencies to ensure conformance with applicable codes and regulations of such agencies. The WDNR Division of Environmental Management reserves the right to order changes or additions should conditions arise making this necessary. This approval is not to be construed as a WDNR determination on the issuance of a Wisconsin Pollutant Discharge Elimination System (WPDES) permit or a determination as to the ability of the proposed system to comply with any terms or conditions in such permit. It is also not an approval of an Environmental Assessment that may be prepared for this project, or an approval for any activities requiring a permit under chs. 30, 31, or 281, Wis. Stats. The WDNR reserves the right to order changes or additions should conditions arise making this necessary. In case installation of these improvements has not been commenced within two years from the date of receipt of this application, this approval shall become void. Therefore, after two years, you must submit a new application for approval of these or other plans and specifications before any construction is undertaken. FOR THE SECRETARY Wastewater Section Manager Bureau of Water Quality Phone No. (608) 535-2369 Website for additional information and guidance on WDNR holding tank plan submittals: htto://dnr.wi.aovftoo'ictwastewaterTholdinatanks.html BAYFIELD COUNTY SANITARY PERMIT (#04)-25-137S STATE SANITARY PERMIT OWNER: MARCUS AND ADRIENNE HALMA GOVT LOT: LOT: BLK: NE 1/4 SE 1/4 SEC: 16, T 48 N, R 9 W TOWNSHIP: Oulu SOIL TEST: 128-25 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: ALLAN POLKOSKI TRACY POOLER Authorized Issuing Officer DATE: 10/1/2025 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: Insulate and maintain as required. Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all-weather road. THIS PERMIT EXPIRES 10/1/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION