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Home My WebLink About25-161SI Industry Services Division County yy t r - !%rn d 4822 Madison Yards Way I- Sanitary Permit tmrber(to be filled in by Co.) p'jS Madison, WI 53705 W15302 lS� S Madison, Sanitary Permit Application State Transaction Number In accordance with SPS 38311(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit a sanitary permit Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) is required prior to obtaining 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(t)(m), Slats. qq)//'' ! a' C' z't rG/l :'Print All Information '-? - IApplication Information -Please Property Owner's Name ^ -T Parcel #` Property Owner's Mailing Address Property Location ZGtisc) s,Ck"* RA Gnvt.Lrt 4 5t).) '/ J__ /. Sccoa L0 City, State (\o D0Yi V t Zip Code gLh51& Phone Number �I tiyt-o96s T 1 N R E or II. TypebfBuilding (check ull"ihat_apply)", .2- Lot # Subdivision Name . I or 2 Family Dwelling — Number of Bedrooms Block # ❑ PublidCommereial — Describe Use ❑ City of ❑ State Owned — Describe Use 0 Village of CSM Number own of s (t, f,y\ IIL Type of POWTS Permit: (Cheek either "New" or oRepIneement""and other applicablcon line A. Check one ban online B. Couiplete4inc: C is licable.)r. A. New System y Replacement Rc pSystem ❑ Other Modification to Existing System (explain) Additional Pretreatment Unit (explain) B. In -Ground At -Grade Mound Individual Site Design Other Type (explain) (conventional) C- Renewal Before ❑ Revision Change of Plumber Transfer to New Owner Usl Previous Permit Number and Date Issued Expiration IV. Dis ersai/TreatmentArea and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) Dispersal Area Proposed (st) System Elevation Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units , c 'g New Tanks ExistingTanks o r5 c.. Septicor Holding Tank too �(7�U I wi,S cr to'c Dosing Chamber V. Responsibility Statement I the g6dersigoed ,assume arts bititytorhi$al radon oftke POWTS.shawn on the attached plans. Ylum�lcr's Name (Print) PI b rs MP/MPRS Number Business Phone Number ( i C f j V v vj v\ il/�— (9 `1 `13 `� 11 S -loci - O 16r Plumber's Address (Street, Ci State, rp Code) � VI. County/DepaftmebtUse;Only -- - . - - Approved 0 Disapproved Permit Fee Date Issued „ry, J— 11' x' issuing t ature ❑ Owner Given Reason for Denial — ,e ,/i ! ' � / Conditions of Approval/Reasons for Disapproval RECEIVED / DEC 15 2025 �17/�7!/� ///''' /!!!I.9 Planning and Zoning Agency Soil Test # 5 3 a3 Bayfield County Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) Li L, ' a certified soil tester determine that in my professional judgment the following site (see below) is unsuitable for any treatment component other than holding tanks. Due to soil & site conditions, a thorough soil and site evaluation is not needed to make such a determination. Property Owner rvl4 ii 71d /}1=L$NOSL.I Contractor Property Address •1G t'' o S L cK l Crj ICb Authorized Agent's Telephone Telephone %/- 1 �'� Written Authorization Attached: Y or N Accurate Legal Description is requested: 1/4 of k1/4 Section 21 Township '/7N. Range 5 Govt. Lot Lot Block Subdivision W. Town of ( IL<2". Volume Page of Deeds Parcel I.D# i� 808 Acreage )/ Additional Legal Description: Indicate reasoning for your determination: /1 41 C' L __ z ti l I .» it//ia '/ T :)`(/i'i a/I L :_)II lei X4 /T c:N. Signature of County Official Date Signature of Cer tified Soil Tester i Date '7° .Y/ VI' Certification # (Submit a Plot Plan & Fee) RECEIVED uffonns/soiltestwa iver(KLK) February 2005 DEC 15 2025 8ayi5e4d Co. Planning and Z✓ _"4 Aeq f,y�, �11 r�No�KZ Y ? Cr L rc2 of 5W Sw Sale ry7 N RCG✓ leln',1 cf tcc A- T3, yi j≥c.(Ty 1�1 39s 4ci2cj /1& FTLLb tiO LL tt� rzs Tai .5-1314 C,ST � /vniY RECEIVED DEC 15 2025 Bayfietd Co. Planning and Zoning Agency PAPc?rr L .ZA/'j 0 ¶3 PAGE 1 OF 4 Holding Tank Plan Index & Cover Sheet Component Manual Design References: Holding Tank Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Holding Tank Specifications Pg 4 of 4 Management Plan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map (if ap Tank Pumping Contract (if appl Holding Tank Agreement (if applicable) Project Name / Description pplicable) icable) Owner Name(s): N''° u"cS K , Phone: 1 tS - 7-g1 - O16 Owner Address: Z� 2 $6 c; 1 c k¼ .C'i' � ,�. Zip: 94'S SC, Project Address: Z4 2 S. Govt. Lot: 5 0� 1/4 of S'' 114, Section 2-° , T H_1 N -R S Ell or w' Township: E l -cc h County: __ Project Parcel ID #: (5 'ot Designer Information Designer Name: b f t 'J ra v- ^ Phone: lf5 -Z' - GU l Designer Address: 13 G f<o C r'j UM Ij Zip: C1 9 'Vi E-mail: 6) d"' bo itt w' This space reserved for approval stamp. License Number: l: k P, 4 672 37' RECEIVED Remarks: DEC 152025 Bayfield Co. Planning and Zoning Agency Signature: Date: 2 /c/Zr Original signatu required on each submitted copy. Reset Page PAGE 3 OF 4 HOLDING TANK SPECIFICATIONS (No Scale) Weahtnupmof 1r it. w201tdwve PloodSuvation Jundionand Approved Jj At= Box vac tap «�) Elecbimi most comply wnlh SPS 316 and NEC 300 4'0 LP wi0i' Winning Labe) Att chad h (t*al) y 4' ftA6e. or20fta(»ve Established Flood Elevation (typical) P_\!/ ______ ______ finished Grade 18'Mm. qA Inlet Inte_lnvartWasrtght Approved JoPlug Approved Pipe 3Itonto Max-12'Solid Gmund a ftm ° AlamrOn HOLDING TANK VOLUME=200d 2 0 0 gal a - e a- 3' AppmuedetiffiBg M'-J--'ed BTart � TANK MANUFACTURER: � i e S -f/, RECEIVED Anchor tank as necessary DEC 15 2025 pursuant to SPS 383.43(8xg) hayfield Co. Planning and Zoning Agency Ballast Weight = ((cu.fttank.vol x 62.4 Ihslcu.ft) - Ihs.lankwt] x 15 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. This POWTS has been designed to accommodate a maximum daily flow of gb gallons of domestic wastewater per day. The owner of this POWTS is responsible for system operation and maintenance, locking device, alarm and access. 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. 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. Performance monitoring. At the time of servicing, the service provider files a report with the department of designated agent. 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 ate ,1/4 of SW1/4 Section L() Township_ N. Range 5 V Town of_____________ Govt. Lot Lot Block Subdivision CSM# Additional Legal Property Owners Signature u/formslmanagem enlplan '2. /u/ RIECEIVED Date DEC 15 2025 Sayfield Co Planning 0 and Zoning Agency Revised: July 2013 164" 4 CAST -A -SEAL 4" CAST -A -SEAL - �\ TIP / II FILTER OR BAFFLE SIDE VIEW WLP2000-MR TANK SPECIFICATIONS 5 8 DIMENSIONS i• WALL_ 3' BOTTOk SEnC Y A a HEAVY DUTY 5' (ADD 2,600 LBS.) COVER: 6' MANHOLE: 24ID. PRECAST CONCRETE RISER 'e HEIGHT: 53" O.D. LENGTH: 164' OD. - IY®TTt 96' OD. BELOW INLET: 41' OD. LIQUID LEVEL- 36' WEIGHT: BOTTOM 11,260 LBS. COVER 8.170 LBS. INLET AND CUTLET. • H 4" CAST -A -SEAL BOOT OR EQUAL . S ¢ INLET AND CUTLET BAFFLE AND FILTER: m g iF T SEE DETAIL (OTHERS T (OTHER STATES SEE R CHART) S 9 LL W� H LIQUID cAPaarr: s6.z7 PAL/IN LOADING DESIGN: B' 0' UNSATURATED SOIL HOLDING TANK: %xto CUTLET HOLE PLUGGED ACTUAL CAPACITY: 2,138 GALLONS -am M W� iii3S TANK CAN 8E USED AS W SEPTIC/ HOLDING/ PUMP OR SIPHON CO VEt MIX DESIGN 08 (NO FIBER) Sm TANK MD( DESIGN 09 (SMALL FIBER) K CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WESER CONCRETE -1 a rc Q NE REWED BY S RENEW DATE V F DRAWINGS SUBMITTED m FOR APPROVAL APB® BY: SHEET NO. APPROVAL OATS: / I/OF PR000CIS NEEDW BY: 1 RECEIVED DEC 15 2025 aYeId Co. Planning �antl Zoning Agency Document Number/Plan I.D. No. HOLDING TAN K AGREEMENT l�iseax,�t," 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 Stats. 1/4 of_1/4 section7fl Township _____N. Range _____w. Town of EitPPIn � ] Additional Legal Description: Ip65 Return To: DOCUMENT NUMBER 2025R-610337 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 12/16/2025 AT 9: 1 0 AM RECORDING FEE: $30.00 PAGES: 1 RECEIVED Gov't Lot_ Lot_Block_Subdlvislon CSM# 204;7 DEC 17 2025 Lot CSM # Vol _Page _CSM Doc# Barfield Co. Planning and Znnina Agency 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 fails to have the holding tank properly serviced in response to orders issued by Bayfield County or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Stats., Bayfield County may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats. 2. Owner agrees to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 3. The owner agrees to contract with a person who is licensed pursuant to s.281.17 (3) Wis. Stats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced in accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed pursuant to s. 281.48 (3) Wis. Stats., and Ch. NR 114, WI's Adm. Code who shall submit to the county within 30 days a report detailing the servicing of the holding tank. 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' my be cancelled by executing and recording said certification with reference to this agreement in such manner which willp�II;iF�rce of the certification to be determined by reference to the property. ............'<'s' 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the own%r,a'rite o II•5 t this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds irfzkgg2nnlMQt1Itl1t tiill per4Bt the existence of the agreement to be determined by reference to the property where the holding tank is installed. — • — prrn,\G i ? ₹ Owner(s) �N_ameI(lls,,)), _—�P-l^e�as-e Print M�+1V)rw lJs w� Subscribed landrswom to before me I� ILQ- cqo&� '•sedate: ��9TF'n.. •.••'` ••.. F W .. 44444444rr444444 Sigryture - Notarized Owner(s) —/4 Not ,i(P blic _ FWtL24 y Commission Expires: �a-Jy oa Drafted by: M4r A 6+,totock ' Date: Personal Information you provide may be used for secondary purposes lPnvacy Law. s.15.04 (I)(m)l offormVeanBarymmoldingtankegreement.doc ®June 2018 HOLDING TANK SERVICING CONTRACT Contract Date This contract is made between the Holding Tank Owner(s) Name(s) ` S Pumper's Name (Print) Pumper's nature Pumpers' Registration # aSs2. We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT Legal Description: Tax ID# S W ,,, s W 1/4, LOCATION (Use Tax Statement) I_/_5 B Town of: Lot Size I Acreage section , Township 4 N, Range w x '� M. 5 tex� Gov't Lot Lot # CM # Vol. Page CM Doc if Lot(s) No. Block(s) No. 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; b. The name of the owner of the holding tank; DEC 15 2025 c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; Bay#okJ Co. e. The dates on which the holding tank was serviced; Planning and ZoningAgency 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. Ownerr(/I'r1 eS Owner(s) Name(s) (Print) Owner's Signatture(( Subscribed and Sworn to me: STUJrJ M/°f( c /'t on this _day of ��........., • Jam'. pRY pit ct * . NoTaryPublie� cc -' :y My commission expires Revised: May 2016 (®May 2018) Drafted by Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (I)(m)] �FIELD Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: MILANOWSKI, MATT G & TIA M 66040 US HWY 63 MASON, WI 54865 Description Private Sewage System (Holding Tanks) Submission Number: SS -00691 Transaction Number: SS -00691-39F48 Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 3955 Paid by: Greg's Plumbing, 13660 County Hwy H, Iron River WI 54847 Payment Type: Check Transaction Date: 12/16/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-25-161 S STATE SANITARY PERMIT OWNER: MATT G & TIA M MILANOWSKI LANOWSKI GOVT LOT: LOT: BLK: 114 1/4 SEC: 20, T 47 N, R 5 W TOWNSHIP: Eileen SOIL TEST: 53-23 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: GREG BROWN TRACY POOLER Authorized Issuing Officer DATE: 12/16/2025 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: # MP699374 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 12/16/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION