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HomeMy WebLinkAbout23-136SRequest for Sanitary Inspection (Fax this form to Zoning Dept when you want an inspection — 373-0114) (Vote: 1'fl Time Change C Discrepancy Other From Zoning Dept ie^ C Phone Number v t Z3 Fax Number Home Owner. sanitary Permit #: 2 3 G, 5 Plumber's Choice Zoning Dept No inspection durinct these times Date: 9:30 am —12:30 pm Tues. (Tracy) 9:30 am —12:30 pm Thurs. (Tracy) Time: WnOK pt Immediate Phone Number so Zoning Dept can call you right back (if needed) Aaaress # & Road Name: 84ate' g . Nerbs�er or Directions To Site: Comments: Reminder. You must confirm any changes) that have been made prior to or this inspection will not be scheduled and a memo will be sent voiding the inspection Thank You! ** Plumber must verify any change(s) by fax or no inspection will be scheduled u/fonnslsanitarylreque-IdWnspection Zoning Dept (®4112104) Julie 2016 £'d 9b90ELE9lL oil DVAHPue 6ulquanld Apes d lZ:£0'£Z 9Z deg POWTS HOLDING TANK INSPECTION REPORT (ATTACH TO PERMIT) ALISON F GILLESPIE 84950 LENAWEE RD HERBSTER WI 54844 TANK INFORMATION TYPE MANUFACTURER/MODEL# CAPACITY RITRAfVC Property Line Well Water Service Building All -Weather Road OHWM Swimming Pool DEVIATIONS FROM APPROVED PLAN COMMENTS (Persons present, discrepancies, etc.) f9 hut077r'b pljN y l cr y fir COMPONENTS NO INSPECTED Plan Revision Required ❑ Yes ❑ No Dte•A Signature of Inspecto . Ce Number Sketch on other side 10 of 13 BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoninganbavfieldcountv.wi.gov Web Site: www.bavfieldcountv.wi.gov/147 Property Owner ALISON F GILLESPIE 84950 LENAWEE RD Information HERBSTER WI 54844 As you know onsite wastewater treatment system on your property described as: Notes Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 was contracted by you to install a private Abandonment of Old System to meet all applicable code requirements: r Tank was pumped by: Tank was crushed / removed and pipes disconnected by: on at AM/PM On at (AM / PM) the above -mentioned plumber contacted our office to conduct a 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: Ulform slsanitarypropenyowner-input Apri12019 Department of Safety CormIP-�itNufmber ?<>,��, = & Professional Services, is Ps Services Division/3 Sanit(ro he filled byCIndustry s Sanitary Permit Application State Transaction Number 6 In accordance with SPS 383.21(2), Wis. Mm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note: Application forms for slate -owned POWTS Project Address (if different than mailing address) Co L.GrLe..LJCQ- ?c&. ��� t _r S are submitted to the Department of Safety and Professions( Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Smts. LA plication Information- Please Print All Information Progeny Owner's Name 1 ' �Sr�fy E. i'CCckLlVs.s 11 Parcel#Gy-Ols(-],-So-C7-ZI-Z O Pi-tiscr, F. Gtllc \ Pro Perry Owner's Mailing Address ozc»o-(oaop X34 trU LGne.,y.,3ere R4.- P petty Location Govt. Lot City, State Zip Code Phone Number Nef�s\e(; (]J I 5 i'-f -7 NL4Lr4 NI i..section ZL is•'14-3K IL Type of Building (check all that apply) Lot u I or 2 Family Dwelling — Number ofBedroorns T U N R Eo Subdivision Name ❑ Public/Commereial — Describe Use Block # ❑ State Owned —Describe Use ❑ City of ❑ Village of CSM Number t/ Town of L M. Type of POWTS Permit: (Check either "N"or "Replacemenr' and other applicable on line a licable A. Check one box on line B. Complete line C' A. ❑ New System ,Replacement System j 0 Other Modification to Existing System (explain) I 0 Additional Pretreatment Unit (explain) � q Holding Tank ❑ In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) jC-D =Rr=cwaiBcfom❑ Revision ❑ Change ofPlumbr ❑ Transfer to New Owner ist Previous Pcoult Number and Dafe Issued IV. DispersaVTreatment Area and Tank Information: Design ©w (gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required (ODispersal Area Proposed (at) System Elevation Tank information Capacityin Gallons Total Gallons I #of Units Manufacturer :: c New Tanks Existing Tanks m e oo Fi � y � u SF ZInditiOns Holding Tankn�= U N m M O 4 hembcr --`.HoL� )eSe - onsibilityt- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. 's Name (PPlumber's Si re MP/MPRS Number Business Phone Number ten �(z 's Address ( State, Zip Code) I fl!3'13-23 S txf G R L. LJ eS Lr nty/Depae Onlyved ❑ d Permit Fee Date Issued Lss❑n Reason for Denial J /1 /%3;,' ns Apptoval/ReasonnssforDisapproval Attach to complete plans for the system Una submit to the County only an paper not less than 8 In_ s I 1 relies in size SBD-6398 (R- 03/22) 4°Wisconsin ``••""'' \ sconsin Department of Safety and Professional Services \� 1 Division of Industry Services SPA ' SOIL EVALUATION R "z.9� M'TFaxrvn�%"� In accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizorQjtpal-Deference point (BM), direction and percent slope, scale or dimensions, north arrow,+antl location and distance to nearest road. !JUL IUL 10 2023 County _ BAYFIELI I Parcel I.D. 4-014-2-50-07-21-2 pknc Please print all information. 1P We Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). roperty Owner Property Location ❑ ❑ Jison Gillespie & Gregory Highlands Govt. Lot NW 34 NW % S 21 T 50 N R 07W roperty Owner's Mailing Address Site Address or CSM and Lot#: 4950 Lenawee Rd. 950 LENAWEE RD HERBSTER WI 54844 City I State I Zip Code Phone Number City Village X Town I Nearest Road Herbster WI 54844 I 715-774-3447 TOWN OF CLOVER I HALF MILE RD New Construction Use: Residential / Numberof bedrooms _2 (two) Code derived designflow rate 300 GPD XI Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. >arent material Sandy Outwash 3eneral comments and recommendations: HOLDING TANK (or continue soil test for a suitable mound site) , / w r 1 I Boring# ❑Boring 1 ❑X Pit Ground surface elev. 96.4 ft. Depth to limiting factor 20 in. / elev. ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPD/Ft' •Eff#1 •Eft#2 1 04 5YR/4/3 SL 1CR MVRF CW 3M 0.6 2 4-20 7.5YR/3/3 LS OSG MVRF CW 2M 0.7 3 20-30 7.5YR/4/2 SL OSG MVRF CW IM 0.6 4 30-48 7.5YR/3/3 1F (spots) 7.5YR14/6 LS OSG MRF GS IF 0.7 5 48-78 7.5YR/3/4 2D (streaks) 5YR/7/1 LS OSG MRF AS - 0.7 6 78-86 SYR/4/4 C 3PL MVFI - - 0.0 2 I Boring # Boring ❑X Pit Ground surface elev. 95.6 ft. Depth to limiting factor 14 in. / elev.ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPD/Ft' *Eff#1 •Eff#2 1 0-4 5YR/42 LS ICR MVFR CW 3M 0.7 2 7.5YR/62 SL OSG MVFR CW 2M 0.6 3 14-40 5YR/4/4 F2D (spots) 5YR/4/6 LS OSG MVFR GW IF 0.7 4 JY56 5YR/4/4 M2P (streaks) 5YR/7/I LS 0SG MRF AW IF 0.7 5 56-66 5YR14/4 C 3PL MVFI - - 0.0 2ST Name (Please Print) S' re CST Number 4DRIEN CADY 922139/SP-112200036 I Telephone Number Sddress Date Evaluation Conducted 31160 BIRCH GROVE ROAD WASHBURN, WI I 07/07/2023 715-373-2378 ' Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 s 150 mg/L • Eff^lue t #2 - OD, 5 30 mg/L and TSS s 30 mg/L e l�� $ 7' -4'2 30(R0421) pvoeV� < ≤vle C°(f MCR) R) 75'\ e d s S 37 JUL 10 2023 o2 ofd, I i � V Gov* P° AL 150A G-i LLesfie gcfc75,L'� era e Pc/ Hev-bsftrWj 'qt 7A7� 1/74(6 PIN oa-eoo-!Dodo Nw NV 52! 1 5bN Ro7V `fo caves Tom u otC(ovev- ♦BM m p of uiet( case1 (00' ft0pev/ LI ve &Oo ` 1 93 Gregory Highlands & Alison Gillespie (Holding Tank) 84950 Lenawee Road Herbster WI 54844 S21 T50N R07W Town of Clover RECEIVED PIN 04-014-2-50-07-21-2 02-000-10000 Pavfir.l." r0_ P! nn ..__ pncy page 1-2: Bayfield county checklist page 3: Tax statement (for informational purposes) page 4-5: Soil and Site Evaluation page 6: Plot plan page 7: Holding tank details page 8: Holding tank management plans page 9: Holding tank servicing contracts page 10: Holding tank agreements page 11: Wisconsin sanitary application Reference material; SPS 381-387 POWTS component manual (Version 2.1) (May 2022-2027) These plans prepared by; Adrien Cady MP922139 31160 Birch Grove Road Washburn WI. 54891 phone:715-373-2378 fax:715-373-0646 a s 40 1 G-ve9ovy E/- ralczmaS * 14Cisok g 9- ct L e Llcc c ,ee Rd S02l TsaN Ro7ry TSc PTN of -pl -a- G;llesp1e so1-al oa-000-coma Dviytyu 'f ofCteV'L well S 5eptc 4ow K .�- P7, t(ed- tA w7&Ri Sind CAST -A -SEAL 4" CAST -A -SEAL FILTER OR BAFFLE c(na us r teoK S (WoVN i uq (•a.bC.j TOP VIEW o *Nevcv"y Etee H qrL kkef-ev ltealw Flcaf- Nz O K INLET Q � V 2" 0 i------------L " W3000 -MR TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1/2" BOTTOM: 4" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 71" o LENGTH: 15'-6" 111 WIDTH: 7'-9" Q BELOW INLET: 57" 2 LIQUID LEVEL: 50" WEIGHT: BOTTOM 12,260 LBS. COVER 8,350 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN. SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 58.94 GAL/IN ft > 311gaud becU u% OUTLET � a � HOLDING TANK: OUILET HOLE PLUGGED - ACTUAL CAPACITY: 3 GALLONS LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE REVIEW DATE - DRAWINGS SUBMITTEDII FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: 1 Z OF 1 Department of Safety Count.., & Professional Services, IS�tti t 9 Industry Services Division Sanitary Permit Number��((ttoJJ�}y�eflu lledinb dL3Sanitary Permit Application State Tmnmotion Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permitNote: Application forms for state-owned POWTS are submitted to project Address (if different than mailing address; the Department of Salbry and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. s�I �I Sn LG�'�Q, ea. I. Application Information — Please Print All Information !i-ce '*'(' L$E- $Zi.g4� Properly Owner's Name of E. Parcel # `( et�l4r.�5 I a�l-OIs(-2-tSo rrl-zl -Z A laor, F. G:tla t ' 41/17:13 ozaoo.,O Property Owner's Mailine, Addrn e ire i ai ro Ltnc s ec Ra.. City, State Zip Code 6r wc 4L( II. Type of Building (check all that apply) \ I)( I or 2 Family Dwelling - Number ofBedrooms I � ❑ Public/Commercial—DescriheUse ❑ State Owned —Describe Use ID. Type Of POWTS Permit: (Check either "New" or annlicable.l Govt. Lot Phone Number IN IS'-ll4-34 - . -`.V-"/, Section _ ZI Lot# ... ❑ City of O Village of k/Townef_CLoJt r applicable on line A. Check one box on line B. CComnlete line C' A. ❑ New System YsReplecement System ❑ Other Modification to Existing System (explain) I ❑ Additional Pretreatment Unit (explain) B. Holding Tank ❑ In -Ground ❑ At -Grade 0 Mound 0 Individual Site Desi ❑ Other Type (explain) (conventional)gn C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Tmnsferto New Owner Prevrous PemritNumber and Date Issued Expiration IV. DispersaVTreatment Area and Tank Information, mow (gpd) I Design Tank Information Gallons I Units .O. D u p u m RG U jw ii C7 p. V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si MP/MPILS Number Business Phone Number Iac-ler, 922.139 IS 3'13-L318 Plumber's Address (Strut. Ls& Stata Tin r dnl 3lttoo l3 to C-tnwt RL. lvl VI. County/Department use Only Approved I El Disapproved I P is ❑ Owner Given Reason for Denial Attach system and r-' the County only on piper nit less than 8 1125 11 inches SBD-6398 (K 03/22) HOLDING TANK — MANAGEMENT PLAN The Private Onsite Waste Treatment System (POWTS) has been designed and is to be installed and maintained according to SPS 383, Wisconsin Administrative Code, Holding Tank Component Manual for Private Onsite Waste Treatment Systems (SBD-10571-P)(R.6/99) and the Bayfield County Zoning Department Sanitary and Private Sewage Ordinance. 1. This POWTS has been designed to accommodate a maximum daily flow of cDO gallons of domestic wastewater per day. 2. 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. 4. Design approval and site inspections before, during and after the construction are accomplished by the county or other appropriate jurisdictions in accordance with SPS 383 of the Wis. Adm. Code. 5. Maintenance Cycle. The holding tank must be serviced by licensed pumpers. An alarm system is to be installed to activate when the tank is < 90% full. 6. Performance monitoring. At the time of servicing, the service provider files a report with the department of designated agent. 7. A User's Manual will accompany the component. It will include the names and phone numbers of local health authorities, component manufacturer or POWTS service provider to be contacted in the event of component malfunction or failure. 8. In the event that this POWTS or a component of this POWTS fails and cannot be repaired the owner will find in the User's Manual the names and telephone numbers of property licensed individuals to contact for such repairs. This agreement shall be binding on all assignees and heirs hi LLI1/4of NUI114 Sectional TownshipSy N. Range o7 W. Town of Ct-cy6. Govt. Lot Lot Block Subdivision CSM# Additional Legal Description flu5 (11.3 T..1J V. Wjto - IZZ 't(.4 Tnn2cn`IR-�l9zl(.S '7-zc zoz3 Pro a Owners Signature u/forms/ma nagementpla n Date Revised: July 2013 HOLDING TANK SERVICING CONTRACT Contract Date 7 2s- 2O23 This contract is made between the Holding Tank Owner(s) Name(s) �ce or C 6l ��ws ►�l;�o., 1=: G; tlesp1c Pumper's Name (Print) Pumper's Signature Pumpers' Registration # -cl /c7 p j We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT Legal Description: Tax ID# 1/4, IV It 1/4, LOCATION (Use Tax Statement) I ), t� l3 Town of: I lot Size Acreage section 2.t ,Township So N. Range o -I IN Gov't Lot Lout CSM # I Vol. Page CSM Doc # I Lops) No, I Block(s)No. Subdivision: 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 t ev5 a change in this contract, the owner agrees to file a copy of any changes to this service contract or a c099 of a e contract with the local government unit and the County named above within (10) business days fr m the d®te o'frit h' this service contract. 8ate,,, kpIIA„ NG Il0wner(s) Name(s) (Print) I Owner's Signature(s) I Subscribed and Sworn to rn,9f-.'ons Ill on this ^ / by: 1 4L1.S0N CtLL€5fl( of My commission expires on: /0 " % c Revised: May 2016 (®May 2018) Drafted by Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)) , G Y RECEIVED 3reS.r�E.t {xgt,La,y t� m Ati3mn F Cttevpla I ao-o HOLDING TANK / 20`" I DOCUMENT NUMBER AGREEMENT 2O23R-6OO247 Owner(s) Mailing Address e yfe:ICo. 8H,SU Le ci t.3e� & nm6 rr ,:ency DANIEL J. HEFFNER Hefbaef^r wZ �18Y,( REGISTER OF DEEDS BAYFIELD COUNTY. WI Agreement Date (same as Notary Dat el a..r.rruwmuge mac application is being made for the installation of (a) holding tank( 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 Scats. tJ ti 1/4 ofhi (4) 1/4 Section 2.. t Township Lb N. Range C12W. Town of LLo./ r0 Additional Legal Description: NOJ f40 all V. E`Ita P (22 4V4 .flN 2�f� `'t 92.8 �J Gov't Lot Lot Block_ Subdivision CSM# Lot CSM # Vol _Page _CSM Doc# Return To: RECORDED O8/28/2O23 AT 1:O5 PM RECORDING FEE: $3O.OO PAGES: 1 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, Scats., 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. 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. 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 ermit 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 own . ThgA all submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds ' a many existence of the agreement to be determined by reference to the property where the holding tank is inst d. $' 04^ u1) ermit the. I nwnnr,' Ara...dh4 n,____ nom_. LA 'Ya Li._ f>p9 111c�44L s ,bct-trc,J CtLLESfSE a ana sworn to before me on thii isslon Drafted by: J Personal inkxmation you provide nay be used for semtmry pltrwses (Privacy law, 5.15.04 ()(m)) Date: 7J,$ cPG&3 uMonTtslmn0ary/soldrnglankagmementdw ®.tune 2018 BAYFIELD COUNTY SANITARY PERMIT (#04)-23-136S STATE SANITARY PERMIT OWNER: GREGORY E HIGHLANDS GOVT LOT: LOT: BLK: NW 1/4 NW 1/4 SEC: 21, T 50 N, R 7 W TOWNSHIP: Clover SOIL TEST: 81-23 REPLACEMENT SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: ADRIAN CADY TRACY POOLER Authorized Issuing Officer DATE: 9/19/2023 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 #: 10963 LICENSE: # MP 922139 Condition: System to meet all setbacks. Management plan to owner. Properly maintain per recorded agreement Old system to be abandoned per SPS 383. THIS PERMIT EXPIRES 9/19/2025 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION