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HomeMy WebLinkAbout25-150STIME RECEIVED REMDTE CSID DURATION PAGES STATUS N6Vefiber 3, 2025 at 1:47:04 PM CST 7153724159 38 1 ReCeived Sep 13 2025 1&27 HP Faxpoliaosk Plumbing 7153724159 page 1 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 fl Time Change fl Discrepancy fl Other Phone Number Plumber: c ` <7 �1� p� f Fax Number II 5- 3 7 -2- -. '-f / f7 Homeowner: � a 344. 1 e.— Email Address I i B 0rt eCa✓C ✓�e/[O✓ d Immediate Phone Number So Zoning Sanitary S S Dept can call you right back (if needed) Permit#: a �— `?t 5 Lrj2-tf /S Plumber's Choice Zoning Dept Date: //_7-z5 Plumber's Choice Zoning Dept Time: I D Tkv\ Township; L Address#& p ,,s ,-o, R'- -rcfr.e QSII2_'To..JcrcI Road Name: . (2 4 or a''r-feS pi-- RI o , /4• art orGF?- S..; (�ss tome o-, c.�1c4 n L. yLf O Ca G J W, • f�f 1 yl J - , R+: : rn tt - . ✓'E W ry (,. Directions To Site: Y re Jr 7 ry o jcc. Uk e Comments: Plumbers you must verify any change(s) by fax or email Notes from Zoni u/formslsanitarylmquestforinspection Zoning Dept (C4N2/O4); ® June 2023 TRUST AGREEMENT OF RICHARD MILLER 1496 310TH ST GLENWOOD WI 54013 GENERAL INFORMATION )LDING TANK INSPECTION REPORT Permit Holder's Name ❑ City ❑ Village ❑ Town of Sanitary Permit No. Plan ID No. Tax Parcel No. Property ddress if Av able TANK INFORMATION TYPE MANUFACTURER/MODEL# CAPACITY SETBACKS Property Line Well Water Service Building All -Weather Road OHWM Swimming Pool DEVIATIONS FROM APPROVED PLAN COMMENTS (Persons present, discrepancies, etc.) COMPONENTS NOT INSPECTED Plan Revision Required Date: Slgnafure of Inspe Cert. Nu b r ❑ Yes ❑ Nc Sketch on other side 10 of 13 L (--, I, ' r a Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoningWbavfieldcounty.wi.00v Web Site: www bayfieldcounty.wi.aov/147 — TRUST AGREEMENT OF RICHARD MILLER - 1496 310TH ST GLEN WOOD WI 54013 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know /9i. / / O!ff°sI<( 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 /(/197'Q\ \ at I (AM I IQ the above -mentioned plumber contacted our office to conduct pre -cover inspection as required 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: ❑lformsfsanilaryprapelyowner-Input April 2019 . ., j,, RECEIVE® Department of Safety County& Professional Services1 2025 Industry Serviees.D'nSanitary Permit Number (to be filled in by Co.) t. :1 2 planning mitafrFermit Application `� •t� d, , _5-150S State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate vernmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. lS.04(1)(m), Stars. '7 / 7? v ketI. Application: Information - Please- Print All Information i0Property Owner's Name c / ^� C / Parcel # 391 / Property Owner's Mailing Address Property Locution j,�q� 31 ooh �* Govt. Lot City, State I Zip Code Phone Number �, ><3S 1,3 -7 l ✓�' l.{ S1 d 3.3 '/,, '/., Section 3 - II. Type of Building (check all that apply) Lot 0 T NR o lP1 I or 2 Family Dwelling —Number ofBedrooms 3 Subdivision Name Block # Cl Public/Commercial — Describe Use O City of O State Owned — Describe Use CSM Number O Village of Sp Town of III. Type of PO�'VTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C If a Ileable. „ . A. l New System y 0 Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. Holding Tank ❑ In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) I I C. ❑ Renewal Before FO Revision ❑ Change of Plumber 0 Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. bispersalTreatinent Area and Tank Information: Design Flow (gpd) Design Soil Application Ratc(gpolsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units B c New Tanks Existing Tanks w U ' " . a,U w Se tis.er Holding Tank Z � zD Q O Der E Aber y W 6'�S G tr C , (� V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's SignatureI /MPRS Number Business Phone Number • j Plumber's Address (Street, City, State, Zip Code) •, c a D( S-?-- ° i t, = L ≤-'{8 Y7 VI County/Department Use Only Approved I O Disapproved SPermit Fee Date Issued , L Issui g Agc ign O Owner Given Reason for DenialJL/y Conditions of Approval/Reasons for Disapproval AA Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x II Inches In size SBD-6398 (R. 03/22) R CEIVED III I J' V 6V VV I Ln1VfVl�Vcl a LVIVOW No.. 9975 P. 2 ACT 212025 Bay%eld Co. planning and Zoning Agency Pg I of Pg2of Pg3of9 Pg4of 8 PAGE 1OF $ Holding Tank Plan Index & Cover Sheet Component Manual Design Referencac: 1 ' o ULC1. I t " J ii )) z.o az. e , index & Cover Sheet Plot Plan Holding Tank Specificatirns z.. Management Plan Project Name I Description -m61+/ff —Fv M Owner Name(s):''r✓v5 4 r —Ki(.VL+of2 , J1.41 L Phone:q` S� t c Owner Address: i 3)0 1*Ip: .S f /3 Project Address: 7!'10 kcguc.c tea, r© vi j2.a✓`e-Yi 1'tJj S4 -9y7 I Sod_: Section �'' f �3s T -R E Township: e e I e [ County:4- Project Parcel ID #: "t 3 {g ! j Designer Information Designer Name: f /CL.i ? / i o s' Phone: Designer Address: Pt © jC S'Z-�- �- � vW.X' Zip; S'`rr f 5 E-mail: r� y. .6 •ems r,- v r -1..z c:- ,2 Thi space reserver for approval stamp. License Number: 7- Z o) 0 Remarks: ,Signature: l Da e: Original s€gnaturvo required on each submitted copy. F'roreV- y Owner o 1,�vSI 4c3P 2W�Q✓1+Oc w& I l -v- ttt9t(Q 10 ks+ &eo'4i s -q"3 (qqiL/] L p ; .• j N4 w m 5 r B vv�o ne ,..y i • 5 •k0 1 ' f /o'uy,1 �' �5 w� Sod tr e-5 f R : Kau 1ecc ,,,,t o Tw n f Or a .'dq :.zv oo ial"vi vJ1 ese.r concv `..+ nk= Co ci. vt `t 1'c4 �. 1�'i e � � Wit: k � '3 �` i�-a# b � "� LDlakf tQ+ a!1 r`ir61. ,-- n.c.I s C P53 )) qJA.FL, = Aba -� rP-Lce `• ze met r K1z'A L -r. " v gP 1� u u o.of I- -' �W 5ck Llo PvC: i/•-?1aw . ived ' 6-!61 r q "AST P*1 D 17 #S' c`P jV V-40 J ''t...4 p. p V' CL I I. 6 1'i �zg R%/ o U Sc I17t' 4.& I iiP ids 2�9 �n �e �2.-� ao Y ) 1kos k; v`dl f've v; w PROPERTY OWNER:yu S4 r.e. asue•e4 9--F r 1 441 l (ter PLUMBER: Allan Polkoski/ Polkoski Plumbing SIGNATURE: �--� SATE: LICENSE # 220090 HOLDING TANK SPECIFICATIONS tECEIV D 1. Number of bedrooms 1Non-residential estimated flow (gpd) C .T 212025 2460.D lMInimurn holding tank volume required (gal) . gaYfield Co. +x2000.0 Planning and Zoning Agency Proposed holding tank capacity (gal) • ...... •. •::r • -a .r..sr,�r:+� :'S•.::, r.•�F':Gt-:.uw, . 7 $ • •r....: r.:7.:•.a.� Wieser -Tank Manufacturer r^s� •�s^_rGcx'aru, t axsmtcvert-� r�gzm_ r a• ; „--awrcemsa• •�� sr -�• W2000 'Tank model number ...... -f S..�--- z �� , rn: ,.J Electro :: •??. �r,�r:azs:r�rn:f:: mraaa.rrmnr:;•,.. ftAlarm manufacturer „Alarm model number ................... Tank Dimensions and Data Tank Anchor Calculations : X for round tank u--0r....-.��.7. 15370 ; Ibs Weight of tank and cover 47.0„Liquid depth below inlet Invert (in) 1.50 Safety factor '8:cr Maximum depth of soil cover (ft) 5'. «...., u. .31055 Ibs Weight of anchor required 6.0 :Height (in) Qt.t;side 36.0 jin Soil cover req. for anchor or 151.0 ;Length (in) r Dimensions L 7,7 ydConcrete counter weight 86.0• Width (in) Only junction box _o conduit -� blind plug •to•seal outlet HOLDING TANK CROSS SECTION manhole cover with locking device and finished warning label grade 4" min. 24 Manhole and vent locations may be reversed. 1ventcap 12" min. vent pipe T 18" min. service 12.0 in. . ^. alarm on Note: All tank joints, and joints between tank openings and piping are Electrical as per 35.0 in. sealed watertight. All NEC 300 pipe and vent rnAtsrials and Comm 16 comply with 5PS 38,3. building sewer Inlet 3 In. bedding under tank. Tank is anchored as necessary to negate buoyancy. Project: 164" co rn A TOP VIEW N .9 o rn I1L, NI N U ` GECC.)�c c •� (/)0 CD d :. -h INLET — — —rk OUTLET LJi. PUMP PAD SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS WLP 2000- MR TANK SPECIFICATIONS DIMENSIONS: WALL: 3" BOTTOM: SEPTIC 3" HEAVY DUTY 5" (ADD 2,800 LBS.) COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 53" O.D. LENGTH: 164" O.D. WIDTH: 96" O.D. BELOW INLET: 41" O.D. LIQUID LEVEL: 36" WEIGHT: BOTTOM 11,260 LBS. COVER 8,170 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: 56.27 GAL/IN LOADING DESIGN: 8' 0" UNSATURATED SOIL HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 2,138 GALLONS 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: N O N 4! z m z Ix c 0 Iz,z!atn vto o 00 � N 0 co cV J3 N I Q Z o U w ND -u) cn ww SHEET NO. 1 oF� / RECEIVED OCT 212025 B_ayteld Co. HOLDING TANK MANAGEMEN IRL-96�h1 Zoning Agencgaoeia Co. Planning and Zoning Agency This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and s, ≥maintained according tof393 Wis. Admin. Code, the Holding Tank Component anual t4,5 e.d 'DER o and the e, County Sanitary Ordinance. e1 EV Z 1 j j LMa Zoz oz.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 19PS 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 'nstallation, the following persons should be contacted: a. Installer ............................. J©JJ(,sg Flaw, :+45 M.P.R$5. z i0o o Phone: / 37 .- Lf1$ b. Service Provider................... rovider................... R b !� Phone: ''� 3. — - va c. Co. Zoning or Health Dept. t of Phone: 713 ?7 11. Lo e ef L .? .5'!/l ls Sex 3`t{ 3 s Project Transaction Number: • RECEIVED • OCT 1 20Z5 HOLDING TANK SERVICING CONTRACT Bayfield Co. Contract Date I D — ( ( - S This contract is made between the Holding Tank Owner(s) Name(s) I s-).- i44 ((-- f7Pu Name (Print) •F� l ( s �c. e Pu I Signature Pumpers' Registration # We acknowledge the Installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) ••..� s-.. :..� ` ;.� •7. P, OlE . 3-`" a y ;_ S. i � ::t "Y ' Legal DescrI tton a ,SF .8 . ti- ? ' r. ,:': s:': . ► .,1 �' .t : i ., ,t r ;.Mn - _� •_'n -.i�•� '7�•���;'�'-J"�.,y"`�f_�bl. `a� � : - =� (Use Tax 5tnt� aieme} � � •r� j. a.�...r['. rt 7t:'w�.C:4. �S..y.viJJ3r"-iy.r�L�•l..c��.:._..�a. s ....:. .a.....ra. i . r �:. �._.._..� ...:. ... xJ•— ....., ., ,� :-':." .. � �.. � ..,, a .... �.N,RaRge JJ �¢ ,,•; C� ��� =� 1i c fir;:,,.. --=rt k.�, � �� �socti ,7ownsht +•aFx... ."!:> 's'xs..r.' �:�`Ss::•� F§: . ..a _. r4�.+ •t : . ... ...STS _ S. Y ,•;�•'��F: -� �,,,sF..w..la.. L.. rr. 1,..•...�4.r.F ., �S'1 .wu[.1. t- ..._ w -ti, �..T .. .J%.t.-..a .....�.i3�f: R' -;�� l.i&' ��:i?�. J'� �9..+-J7e' fir: �T: Y'-lY=' � = �{ . , . - I,.;,i �s:..1`. Lr�:'s��:•:.s.: J f r r�� >r t:Rt:...w•.y. ���`*I���:L+.:»��/����[r, - - Yat• a e. gam., ;. - - [ 'c 'l:'• . i 1 ! ��'n I� i ••a. l J i ) v , .;� - �f.�• I»� .,yam?.::::^M� -fie?':-S'-::'-`�::''.•• . = ' i a�--.�..yr`�-ay;. Y[f�� �V�1, 1. The owner agrees to file a copy of this contract with Barfield County as required in SPS 383.55, Wis. Adm. Code. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred In servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local government unit which has signed the pumping agreement required by SPS 383.55, Wis. Adm. Code, and the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank Is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; 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) ,,�%WIT16°@� 8q er's Signature(s) Subscribed and•Swom to me: on thisl ay ofOt_,2S 1 by: • Noty Public &Nj� • U B1' 0L. JZ mission expires on: D� OF W\s„ " Revised: May 2016 (®May 2018) 11101111 i 1 I'll 1 0 Drafted by le ro Personal information you provide may be used for secondary purposes [Privacy Law. s.15.04 (I)(m)] E I Y E D S� :1..• �I Cw 82025 SS�oo67S Document Number/Plan I.D.Novficid Co. HOLDING TANK ,%gan Y AGREEMENT Owner Name (s) L Ow er(s) Mailing Address u, re�es4 o) 31 J'I1 53 1GL�.I,1 W i 1. Z&r 6le_l�oDa. wT s�ol.3 Parcel Identifier Number (PIN) Agreement Date ( me as Notary•Date) We acknowledge that application is being made for the Installation of (a) holding tank(s) on the following property or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Slats. 1/4 of 1/4 Section Township N. Range ___W. Town of V r �, ►it, Additional Legal Description: S t' 4. Vi '^ $ Let't5 • Gov't Lot__ Lot3-_Biock Subdivision CSM# i'5�0J Lot CSM # Vol Page CSM Doc# DOCUMENT NUMBER 2025R-609722 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 10/27/2025 AT 10:24 AM RECORDING FEE: $30.00 PAGES: 2 Return To: ZriV\ ;'4.rh 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: Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tank installation and maintenance. If the owner fails to have the holding tank properly serviced in response to orders issued by Bayfield County or the Department of Commerce to prevent or abate a human health hazard as described In s. 254.59, Stats., Bayfield County may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Slats. 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. Slats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced in accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service contract. 4. The owner agrees to contract with a person .licensed pursuant to s. 281.48 (3) Wis. Scats., and Ch. NR 114, WI's Adm. Code who shall submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfield County may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may Indicate that the holding tank is not being properly maintained. 5. This agreement will remain in effect only until Bayfield County certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. SPS 383, WI's Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. _ 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to W get where the holding tank is installed. Owne s) Name — Please Print0 • .. Bed and sworn to before me on this date: /,2O; _______________ Notarized Own r ) -- Signatur (s)?- ,• Hotaly P. brc �% LSC ixr .���,9T • . OF Mb�1� ssion Expires: %S.``�� O% 9/e2 9 o Drafted by: % Oft c)1 \ O 5 I'L' Date: Personal Information you prov de may be used for secondary purposes (Privacy Law, s.15.04 (I)(m)J ulformslsanitarylhotdingtankagreement.doc(9June 2018 LJ s irefox https://novus.bayfieldcounty.wi.gov/access/REAL%20ESTATE/listin... Y . Real Estate Bayfield County Property Listing Today's Date: 10/21/2025 Description Updated: 4/4/2023 Tax ID: 34914 PIN: 04-036-2-49-09-34-1 01-000-23000 Legacy PIN: Map ID: Municipality: (036) TOWN OF ORIENTA STR: S34 T49N R09W Description: LOT 3 CSM #1509 IN V.9 P.88 (LOCATED IN NE NE SEC 34 & NW NW SEC 35) IN 2023R-598148 (TRUST AGREEMENT OF RICHARD MILLER DTD 6/29/2018) Recorded Acres: 19.330 Calculated Acres: 6.478 Lottery Claims: 0 First Dollar: No Zoning: (AG -1) Agricultural -1 ESN: 124 I Tax Districts Updated: 2/20/2008 1 STATE 04 COUNTY 036 TOWN OF ORIENTA 044522 SCHL-SOUTHSHORE 001700 TECHNICAL COLLEGE Recorded Documents Updated: 2/20/2008 ® WARRANTY DEED Date Recorded: 2/21/2023 2023R-598148 ® TRUSTEES DEED Date Recorded: 1/3/2017 2017R-566794 ® QUIT CLAIM DEED Date Recorded: 1/3/2017 2017R-566780 2 CERTIFIED SURVEY MAP Date Recorded: 1/8/2007 2007R-511518 9-88 Property Status: Current Created On: 2/20/2008 10:47:23 AM M Ownership Updated: 4/4/2023 TRUST AGREEMENT OF RICHARD MILLER GLENWOOD WI ¢filling Address: Mailing Address: TRUST AGREEMENT OF TRUST AGREEMENT OF RICHARD MILLER RICHARD MILLER 1496 310TH ST 1496 310TH ST GLENWOOD WI 54013 GLENWOOD WI 54013 10 Site Address * indicates Private Road 76790 KAUKAMO RD IRON RIVER 54847 Propjey Assessment Updated: 8/28/2023 2025 Assessment Detail Code Acres Land Imp. G6 -PRODUCTIVE FOREST 19.330 29,000 0 2 -Year Comparison 2024 2025 Change Land: 29,000 29,000 0.0% Improved: 0 0 0.0% Total: 29,000 29,000 0.0% RM Property History Parent Properties Tax ID 04-036-2-49-09-34-1 01-000-20000 ,?Z3 04-036-2-49-09-35-2 02-000-20000 26297 HISTORY ®Expand All History White=Current Parcels Pink=Retired Parcels ® Tax ID: 26297 Pin: 04-036-2-49-09-35-2 02-000-20000 Leg. Pin: 036109610000 © Tax ID: 26273 Pin: 04-036-2-49-09-34-1 01-000-20000 Leg. Pin: 036109405000 34914 This Parcel Parents 4Children RECEIVED OCT 282025 Planning aBayfizd C,o. 9 Agency of 1 10/21/2025, 9:37 AM e F.J s' ct< RECEIVED BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS C(:: 2 2025 Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) Bayfield Co. planning and Zoning Agency EX Check List Cr21' Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) ti Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) li2I Original Plot Plan (383.22(2)2. 3. & 4.a) (Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer llI Pump Tank Diagram, Alarm and Pump Curve (when applicable) I7 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) lI' Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) lZi Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) 1 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) IJ Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) 21 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) 1211 Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) U Project Address or Road Name where driveway is/will come off of) 121 (Owners Phone Number) 12111 Type of Building ®III Type of Permit Et IV Type of POWTS System ❑ V Dispersal / Treatment Area Information 9 VI Tank Information 121 VII Responsibility Statement (Plumber's Information) ❑ *Date Stamp* Plot Plan: (To Scale or To Dimension) 121 Signature and Plumber Information E 'Surface Elevation of Body of Water ❑ Direction and Percent Land Slope 21 Tank and Filter Information and Location J Wetlands / Navigable Bodies of Water ❑ Absorption Area (Proposed and Existing) 0 Bench Mark (Location, Elevation and Description) 121 Component Manual Version E^ r' $ F?ils+�3^ �1. a n +� ' c e zv ' ✓ r` i c x r I'ipl�,Material lnfoCintlon'(�onveyerlce lines bulb C. Address Number and Road El North Arrow 0 Contour Lines 121' Structures and Driveways 9 Boring Location Property Lines 10 Well Locations chi Legal Descriptions Turn Over ► OEVED OCT z 1 2025 Bayfield Co, Piann'sng and Zoning Agency Soil Test# j35 Bayfield County Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) i A Ii 4411 F-10 1 kO S Af t 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. ' C Property OwnerV&f Contractor Property Address 7(7 10 J ' 1 % � O 1 c. Authorized Agent_____________________ ,,,��" .≤-'(Fl Yi Agent's Telephone Telephone 1 / $ `t' 1 S 1 3 Written Authorization Attached: Y or N Accurate Legal Description is requested: t 1/4 of 1/4 Section 3�' Township LI? N. Range W. Town of_________ Additional Legal Description: Let 3 G -S Al id / So 1 Govt. Lot Lot Block __Subdivision Lot .3 CSM# /$) Vol. Page $ R CSM Doc #7°° _7 Le - s —I Fl Volume Page of Deeds Tax I.D# 3 L( 9 17 Acreage / Indicate reasoning for your determination: latfS a 1 1 1 h Q V e-ikO1 . L4 r c n 6 S t 4 �4 r-► i n S4, / (e� . /*77/' Signature of County Official e��e2�J Date Signa ure of Certified Soil Tester /t -(to -2 Date .. Pt"". 2 2 0 9 0 Certification # .(Submit a Plot Plan & Fee) u/forms/soiitestwaiver(KLK) June 2018 rprT)( Ow'r L '�..� ��► I D .cc.. r; "t•0-�f�''l o 4 11�..c�� ir��b o7�•,! stc2.r'i1N1 cj AJ Sc.k: i ' i'e /, & f O Y t e K-fc'r �. oo qcx j 1®n VA..ser cc,, -e .` asQc;: ap- c,S..vt 4y , id I4'4( " . aim . �s w®� b �'�"�'� 't B 1' r d'1, , �..� c . ) A we.. 4 .. ci €. J � , j41; ilJ_ j rip 1eui��.�� 5dd va PVC X9/4' 1 a 0i 4 A rec. a 8-', I ge�ASTOI D 3 i s a p f) v'0 pia P• . 1/M.be�.`'�'C� try cLL H 1J' a, (V1 O; yiLad7) Pa /k s k, Pdt t bQ �����K ≤"'2Z. BAYFIELD COUNTY SANITARY PERMIT (#04)-25-150S STATE SANITARY PERMIT OWNER: TRUST AGREEMENT OF RICHARD MILLER G OV'T LOT: LOT: 3 B LK: CSM: 1509 114 1/4 SEC: 34, T 44 N, R 9 TOWNSHIP: Orienta SOIL TEST: 139-25 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: ALLAN POLKOSKI TRACY POOLER Authorized Issuing Officer DATE: 11 /3/2025 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 11 /3/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION