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HomeMy WebLinkAbout26-43S'_, rriVED '4------, Department of Safety County ii 1 MAY 112026 a NtePS & Professional Services, Sanitary Permit Number (to be filled in by Co.) / Industry Services Division e BandZonin. .i'' and A0enr.Y ;;t.=` " Zoning SS_oo7q O�YJ' l 3s Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note; Application forms for state-owned POWTS am submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address) purposes in accordance with the Privacy Law, s. l S.04(1)(m), Stnts. �'E.vl5 1c_ I. Application Information Print All Information —Please ✓t Property Owner's tam I Parcel # Pona[�' �2(t� ENiERED tcKZDZS�-7,$ Property Owner's Mailing Address Property Location 13fl'y S�'STNC Govt. Lot City, State Zip Code Phone Number I ` ©tf≤ e. D i tJ ,sf3 3 O 7 &v 3 740'z -'f'57 1�'/4, N w'/'/, Section 13 II. Type of fluildin (check all that apply) Lot # T t 9 'o N R I I or 2 Family Dwelling —Number of Bedrooms Subdivision Name ❑ Public/Commercial — Describe Use Block # O City of ❑ State Owned — Describe Use CSM Number O Village of Q9 Town of D V. efz ct 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 lI iicable. A. K New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. S Holding Tank ❑ in -Ground El At -Grade 0 Mound Individual Site Design 0 Other Type (explain) (conventional) C. ❑ Renewal Before 0 Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dis ersal/Treatment Area and Tank Information: Design F�� pd) Design Soil Application Rate(gpolsf) Dispersal Area Required (aQ Dispersal Area Proposed (st) System Elevation ,Tl Tank Information Capacity in Gallons Total Gallons ft of Units Manufacturer '$ a E B G V U New Tanks Existing Tanks Sepriweslielding Tsnk Z 3 o 0 — z Sod I Wr.GSLV GGKC, ✓ — — 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 nture l�/MPRS Number Business Phone Number Mild." folk-oskr ,,-- 22000 7'Sziz-/St'o Plumber's Address (Street, City, State, Zip Code) ump /.-b B ,c .$ZZ y✓on Cif ✓e✓L4J c`f8v'% Use Only KVIounty/Department roved O Disapproved gennit Fec Dale Issued ft Issui g A t Si urn O Owner Given Reason for Denial �/ Conditions of Approval/Reasons for Disapproval Attach to eoamlete nlans fir elm .v.roi, ,n1 .m...n .. ,k. n......... tar paper nor less than a In x I1 Inches in size SBD-6398 (R. 03/22) E E0 Soil Test # Bayfield Count 3 • - a � Say6eld Co. County planning nd Zoning AgencyWaiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) !3 A /1 u.V1 ? 11�os k £ 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 D© &`- X Property Address _vi Sc'-, j L N v LJ Contractor Authorized Agent Agent's Telephone Telephone 7123 7.120 Z L 7/ Written Authorization Attached: Y or N Accurate Legal Description is requested: 1/4 of N O1/4 Section _ Township N. Range7 W. Town of Additional Legal Description: Govt. Lot Lot Block Subdivision Lot CSM# Vol. Page CSM Doc # Volume. Page of Deeds Tax l.D# ,A 5'7 S Acreage Sr r .• Indicate reasoning for your determination: vJe.f IS C �o s , /c q / -f L -e ? 0 73 Signature of Count Official Date ature of Certified Soil Tester Date C:c;r ' 2 2 0 9 0 Certification # Submit a Plot Plan & Fee) ufforms/soiltestwaiver(KLK) June 2018 .rt ®wrlero Do4L /,X t fgzs1 IJ i2 K� pow` l stc..13' '/9N Py W j �u�c� �� C�v�•eti. �L ``Y 8 rvs; 3 Sc1 t0 1 ®r'.i�.� leas -le '"orr j4lon w e se.r umc rdC.. .nk� .�, e� L 107- W i f3 -f r- a� b e-j--I"c, �.1 Of %'C to eatisa1 l 3 1ucv- ' T.. , Flo ≤a RECEIVED j P MAY 1 12026 ���a�•�� s N '°'' Bayfiaid Co. I Z "A . ≤:. Planning and Zoning Agency L I. I d «r f k j L I.IF-4T 4, /1 Yb i i n. :r e`t' ke-.c k5 C s P5 . � , l 3 4 • HH 1d r vi , ttbi k �c'�1)2 t (v1 ai); 1ZLdZ7) PlLt 11 n� Pa 13oK s 2. -Trr o' R v r � w Z ≤'Y Pc!? i A L ®vim -� tic: �d+Yl V RP - £lr�ule0.o : 4 5cl' q® PvC j/-�10 w a `rem • -"% 1/h A5T� D 3•1 IPS c%.p7�� t1'E' 1%' .c F.,: fr CL BAYFiELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS SuAbmit the Following (Use Permanent Ink): MAY 1 12026 Bayfield Co. RI Check List Planning and Zoning Agency 10 Index Page / Title Sheet (Optional) I1 Original Soil Evaluation Report (Submitted in Deed Holders Name -- not prospective buyers) I6 Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Cleo.,= (Include the following Information) ® Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used Ci Property Owner's Information (nat prospective buyer's name) ® Property Location (Accurate Legal Description with Sec/Twp/Range) 10 Road Name (where driveway is/will be coming off of) m Floodplain Elevation, Flow Rate, Comments and Recommendations �i Complete Soil Boring / Pit Information Gil Date Soil Evaluation was conducted d CST Name, Signature, Number, Address and Phone Number O *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) ii Bench Mark (Description, Elevation and Location) i Contour Lines (Example = 98.0' /96.0' /94.0') m Pi operty Location (Sec/Twp/Range/, Accurate Legal Description) m Borings (Locations and Elevations) C'1 Percent and Direction of Land Slope 56 Well Location (Including Neighboring Wells, If applicable) l Location of Wetland Areas, Floodplain and Navigable Waters 0 Buildings, Driveways, and Structures (Location and Descriptions) d Location of Property Lines IZI Existing System Location Ili Address Number and Road Name @I Current Surface Elevation of Wetlands and Navigable Waters U CST, Owner and Property Information Cdl North Arrow Fee: It Certified Soil Tests - Review & Filing Fee . $ 50.00 U/forms/sanitary/checklist/checkilstforests Tracy Pooler From: Tracy Pooler Sent: Wednesday, May 13, 2026 9:22 AM To: 'tony bearguidenorth.com' Subject: RE: Tax 25875 - Felix soil test ? Thanks, In the future please do it on a soil profile form. Tracy Pooler-AZA Planning and Zoning Department 117 E 5th Street, PO Box 58 Washburn, WI 54891 Phone: 715-373-3512 Fax: 715-373-0114 Email: tracy.ppoolercbayfieldcounty_wi.gov c O v a r r Fraudulent Billing Alert: Be aware that individuals submitting applications to our department have received scam emails. Bayfield County will NOT ask applicants to wire any funds. Please contact our office at cning�bayfjeldcounty.wLgov or 715373-61 38 with any questions or concerns. From: tony bearguidenorth.com <tony@bearguidenorth.com> Sent: Wednesday, May 13, 2026 8:23 AM To: Tracy Pooler <tracy.pooler@bayfieldcounty.wi.gov> Subject: Re: Tax 25875 - Felix soil test ? A few inches of black topsoil and the rest clay Sent from my iPhone On May 13, 2026, at 8:02 AM, Tracy Pooler <tracy. o� oler@bavfieldcountvwi.gov>wrote: Tony, What is the soil profile of the soil test that you did at Felix? Tracy Pooler - AZA Planning and Zoning Department 117 E 5th Street, PO Box 58 Washburn, WI 54891 1 •...� ., LU w I Lnmvinu OC LVIV[IVU Pl o. 9975 P. 2 PAGE 1 OFg Holding Tank Plan t1m 112426 Index & Cover Sheet BaYfield �• A ency planning and Zonm9 g �t Component Manuel Design References: me nual -tatiZed C Vl�l0.ri zezZ-az7) Pg 7 of g Index & Cover Sheet Pg 2 of I Plot Plan Pg 3 of I Holding Tank Speclfications--z rci e f Pg 4 of j' Management Plan Attachments: I FNr lnenrnc• 1's S F P0WTS Applic —_►' �' 601 E✓alu0.#on Psi aHolding Tank Project Name I Description Owner Name(s): Dv vta 1 I €/: Owner Address: 13Qpz g5 STIJE Dts�go t/ project Address: t3 QK S .:, o Iz � 70 r i [cable) Phone: 763_7bD_ Zc(9( Zip: 3533o JrS-'VcLr Govt. Lot: i f E 114 of /J W 114, Section L3 ,T __N -R y E ❑ or w C Township: count �ar-e( c Project Parcel ID #: •Tu1c Pc ( Z s 5173• Designer Information Designer Name: �-t / /_L h P / K- S hc, Phone: 1%/S -.171- / S(a DesignerAddress:.E o, a aX Sze ! ten, k , e r WJZT zip; •S YRV'7 E-mail: fr ti q t� L e-<< �_ _ J �_ �, /� This space reserved for approval stamp. License Number: Z'L ) o Remarks: Signature: C��--�`�✓ `— Dat�c: Original signature req nred on each submitted copy. P/ d� ( anj . BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) Gn Check List [I' Original Sanitary Application (Submitted in Deed Holders Name — ngs prospective buyers) (383.21(1)1.) 0 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) &r Original Plot Plan (383.22(2)2. 3. & 4.a) id Cross Section, Over -Head Profile of the System Schematic of Tank from Manufacturer 10 Pump Tank Diagram, Alarm and Pump Curve (when applicable) 65 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) I1 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) 9 Fee (Make Check Payable to Bayfleld County Zoning) (383.21(2)(c)7) Wr 2 ComIete Sets of Plans (383.22(2)(2.) (Note: Stitt1{pnlication and Maintenance Agreements are o be attached to all conies) fib 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 AnDlication: (Include the following Information) 101 Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) ® Project Address gr Road Name where driveway is/will come off of) 21!! Type of Building l31 III Type of Permit - Li IV Type of POWTS System ❑ V Dispersal / Treatment Area Information fd VI Tank Information C,3 VII Responsibility Statement (Plumber's Information) ❑ *Date Stamp* Plot lan: (To Scale or To Dimension) M'Signature and Plumber Information Ld'Surface Elevation of Body of Water ❑ Direction and Percent Land Slope 59 Tank and Filter Information and Location fib Wetlands / Navigable Bodies of Water ❑ Absorption Area (Proposed and Existing) IJ Bench Mark (Location, Elevation and Description) f+I Component Manual Version d Piping Material Information (conveyance line, building sewer line, material type and diameter) 12( (Owners Phone Number) ::tcE➢VED MAY 112026 Bayfield Go. Planning and Zoning Agency Lif Address Number and Road l l North Arrow ❑ Contour Lines of Structures and Driveways Eff Boring Location G[f Property Lines ii?! Well Locations IM Legal Descriptions Turn Over ► Cross -Section and Over -Head Profile of the System: ❑ Surface and System Elevation ® Position of Observation and Vent Pipes ❑ Dimensions and Depths ❑ Make, Model & Number of Chamber Units In each Cell Prop, erty Information ❑ How many systems will there be on this parcel of land? 1- ❑ Has this property been split? loo (Property Statement shows Property History) ees: ❑ Private Sewage System (Septic Tanks) $ 400.00 lei Private Sewage System (Holding Tanks) $ 400.00 ❑ Mounds or Systems requiring Pre Treatment $ 500.00 ❑ Sanitary Revisions $ 25.00 ❑ Private Sewage System Reconnection $ 50.00 and Private Interceptor ❑ Return Inspection $ 50.00 ❑ Maintenance Agreements $ 30.00 (checks made out to Reg of Deeds) u/forms/checidists/checklist orsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: Ircptrt Owoer: i388,_ otde5D( vYrlJ c33& VAX tip 2Sg 7.5 tJE 4t4w y Stci3 "i Q*I Ry ur I noun eew.L4y aF: 0t -c; / c Pewsowl t32-0 ti jL(e I ✓�� T f 3 a z,. oi- iycarnns. -• Sol I gev'�ner°%, i N SceJ e. ! r- ; U!o u., less n e -fit. Nttv�s+ RJ 8a.wscn - 2s oc yallan W.Eser Cencrdtt&nk= i n(k to((vif 0•(•Fvon1 6e{ For.1ofl Flcwt;.°e, in/rh ;ft •Q. IAIt r /CciVED ,, MAY 112026 10 Bayfield Go. P APnning and Zoning Agefl I °* act a I� n�,tiaLt y'(cctc, m �ba.n r a ularw�.5S-'� 4IItjnc•. jee.,leir tds .1I 12ir/�, .ScI-L L5 CSP.53� ) IAdeve r .c. c� vale t = ue1l 7--'r—'a-'r = J5ch Wo i'Vc W/ -•SLOW d. r@. 6h = Y"ASTJ') p 1 is 'cpp ve yr p. pc (tic I r Ct! ll He ii ncj I nt k L)vI 1 �0i1jj7 K�/ (4 Q/eLS$l �a rth�V64A.c69J`� a vfl2JdJ cWIay/inL-z® 7) hra&on t/5ysl✓)�P�f%ZZcolo Fa+/F•6$Kfy , 11u r�.b•n1 �?2�. t3 a c cia J rrevl R•Vve. w:v 5'V&Y% WLP2500 TANK SPECIFICATIONS 183*' 1 C` p 4" CAST -A -SEAL 4" CAST -A -SEAL FILTER OR BAFFLE TOP VIEW SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS DIMENSIONS: WALL: 3" BOTTOM: 3" HEAW - 5" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 52-3/4" O.D. LENGTH: 183-1/4" O.D. WIDTH: 101-1/4" O.D. BELOW INLET: 41" O.D. LIQUID LEVEL• 36" WEIGHT: TANK - 3" BOTTOM 12,560 LBS. TANK - 5" BOTTOM 15.527 LBS. WEIGHT: COVER 9,300 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 oI 0 (OTHER STATES SEE CHART) Lu N LIQUID CAPACITY: 69.44 GAL/IN HOLDING TANK: G7 x c0 OUTLET HOLE PLUGGED C in ACTUAL CAPACITY: 2.639 GALLONS C i 0D v LOADING DESIGN: 8' 0" UNSATURATED SOIL < u1 TANK CAN BE USED AS: M W SEPTIC/ HOLDING/ PUMP OR SIPHON 0 COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #9 (SMALL FIBER) (- CUSTOMIZED TANKS: B FOR CUSTOM TANKS CONTACT WIESER CONCRETE N J E; Q N S z o < z !J N N � O _ DRAWINGS SUBMITTED F w v w FOR APPROVAL APPROVED BY: SHEET NO. APPROVAL DATE: 1 PRODUCTS NEEDED BY: OF 1 n PROPERTY OWNER: PLUMBER: SIGNATURI DATE: -/ o -z 4 LICENSE #' 220090 mP rzs. HOLDING TANK SPECIFICATIONS Number of bedrooms �qMI,W...itµV.YYpyq Non-residential estimated flow (gpd) q 2Dt)0!jMinimum holding tank volume'required (gal) Junction box —•-a conduit blind plug to seal outlet ;Ions and Data for round tank quid depth below Inlet Invert (in) aximum depth of soil cover (ft) Bight (in) Outside ingth (in) r Dimensions Idth (in) Only LCVED MAY 11 2026 Bayfield Co. Planning and Zoning Agency Manufacturer model number manufacturer iber Tank Anchor Calculations .W,IMwIy4gUNq 0 1884 Ibs Weight of tank and cover .50' Safety factor 40207 Ibs Weight of anchor required 40.8 in Soil cover req. for anchor or 9.9 yd3 Concrete counterweight HOLDING TANK CROSS SECTION manhole cover with looking device and Onlahed warning label grade fJ 4" min, in. V Manhole and vent locations may be revercart bservice y 12,0 in. alarm on Note: All tank Joints, and Joints between tank Electrical as per NEC 300 39.0 In. openings and piping are sealed watertight. All pipe and Comm 16 and vent materials comply with 5 pS, *83 / vent cap 12" min. vent pipe T 18" min, building Bawer Inlet s; 7 3 In, bedding under tank, Tank is anchored as necessary to negate buoyancy. HOLDING TANK `I'Z U ''Y&2. fir' S+, K If&nw'/u Tr✓ Oa o MN SS33o Parcel ld ntlfier Number (PIN) Agreement Date (same as Notary• Date) 04-o3fo-a-gq-O4 Ise DI-oeu Iw b z./_- z4 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 Stets . N 1/4 of I" W 1/4 Section t L.Townshtp N. N. Range O` W. Town of Pork Additional Legal Description: Gov't Lot_ Lot Block_Subdivision CSM#_ Lot_CSM # Vol _Page _CSM Doc# DOCUMENT NUMBER 20268-6 12120 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 05/12/2O26 AT 1 1 :02 AM RECORDING FEE: $30.00 PAGES: 1 RECENED -------MAA.1L9 ✓ LU26 r�- i C,- to/ti ,1J7 PQP-t. As an Inducement to Bayfeld County to Issue a sanitary permit for a holding tank on the above described property, w(agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis, Adm. Code relating to holding tank installation and maintenance. if the owner falls to have the holding tank properly serviced in response to orders issued by 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, Scats. p` 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 IaW. 3. The owner agrees to contract with a person who is licensed pursuant to s,281.17 (3) Wis. State., and chapter NR 114 Wis, Adm. Code, to have the holding tank serviced In accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed pursuant to a. 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 shal6,submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds In a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is Installed. Owner(s) Name(s) — Please PrintIS 1 c vn1eML'Cr %P Sub lob oor u c Minnesota MyCammi55imExpiresJaalay31,2029 re me on this date; Cy'/a -7� �>•,�In / r b O"�P Notarized wner(s)-5 gnatu (s) Notary Public My Commission Expires: 's Drafted by: 1 C Pt,' (?o I K h 5 t� r Date; Personal Informetlon you pro may be used for secondary purposes [Privacy Levi, s.15.04 e)(m)i r-/-Z7-Z WtomsisanitaryR,ddingtenkagreemenl.doc ®June 2018 lECE1VE® MAY 112026 BaYfieb Cn Agency panni9 and Zon 9 HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to 5(5393 Wis. Admin. Code, the Holding Tank Component pAnual µstd; `Ma n v.I -t"yre VER2vo and the '$ay -fie• IA County Sanitary Ordinance. ` Vk 2i) 1 cly y zoz7,_Zpz.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 SP5 383 andi84 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 SP5 363.33 Wis. Adm. Code. 10. If there is a problem with, or question about this (installation, the following persons should be contacted: a. Installer.............................poi ocK+ PIamb;n5 M,PR,S,oZZoowo Phone: 7/S 3az qes( b. Service Provider.................. , 6 J.. - R n g,a7, Phone: '7/t 3n7, - 4cm�, c. Co. Zoning or Health Dept. $a y ycn;,Phone: 7i,y ?-fl- 61R2 11 ni Project Transaction Number: n N w%a Sec 13 T\1 `i N '-9 L) HOLDING TANK SERVICING CONTRACT Contract Date d11 /a ql 2i 2 , This contract is made between the Holding Tank Owner(s) Name(s) We acknowledge the installaticn of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT Legal Description: Tax Op1/4, LOCATION (Use Tax Statement) j `f 7.j ''1/4, [� I o't Town of: Lot Size Acreage Section ,Township 1 N, Range w - - )/ Gov't Lot Lot 0 CSM U Vol. Page CSM DocU 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: RECF 1VED a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; MAYI .I 2026 c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; Bayfield Co. e. The dates on which the holding tank was serviced; planning and ZoningAgecY 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. Revised: May 2016 ®Ma 2018) (®May Drafted by it l o Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)] 13A 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: DONALD & CAROLINE FELIX FAMILY LAND TRUST LLC 13882 85TH ST NE OTSEGO, MN 55330 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00411 Transaction Number: SR -00411-458A1 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 6308 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 5/13/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. B YFIELD 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: DONALD & CAROLINE FELIX FAMILY LAND TRUST LLC 13882 85TH ST NE OTSEGO, MN 55330 Description Private Sewage System (Holding Tanks) Submission Number: SS -00746 Transaction Number: SS -00746-458A6 Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 6308 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 5/13/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26,43S STATE SANITARY PERMIT OWNER: DONALD & CAROLINE FELIX FAMILY LAND TRUST LLC GOVT LOT: LOT: BLK: NE 1/4 NW 114 SEC: 13, T 49 N, R 9 W TOWNSHIP: Orienta SOIL TEST: 37-26 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: ALLAN POLKOSKI TRACY POOLER Authorized Issuing Officer DATE: 5/13/2026 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: # MPRS 220090 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 5/13/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION