Loading...
HomeMy WebLinkAbout26-56SRequest for Sanitary Inspection (24 Hrs. in Advance) Fax or email this form to Zoning Dept (24 Hrs.) prior to when you want an inspection Fax (715) 373-0114 or Email zoning(g)bavfieldcounty.wi.gov Note fl Time Change fl Discrepancy fl Other Phone Number Plumber Z gb�S�c I Fax Number �s Homeowner: 0�d� ��� M Email Address 3@ �zp.slLc.S. C Sanitary Permit A / � S oL (p _ J Immediate Phone Number So Zoning Dept can call you right back (if needed) M Plumber's Choice Zoning Dept Date: / / `c{w 66 No Inspection(s) during this time Tuesday (9:30 am - 12:15 pm) (Tracy) Time: Plumber's Choice Zoning Dept r6d Pm Township: Address # & Road Name: 34 /3 0OAJr o /lC J or ' 225 Directions 7 To Site: Comments: ** Plumbers you must verify any change(s) by fax or email ** Notes from Zoning Dept: July 2025 VERONICA ARTHUN-MADAY 56130 ONDRIK RD MASON WI 54485 HOLDING TANK INSPECTION REPORT (ATTACH TO PERMIT) GENERAL INFORMATION Permit Holder's Name ❑ City ❑ Village 0 Town of Sanitary Permit No. Plan ID No. Tax Parcel No. Properly ddress if Av able TANK INFORMATION TYPE MANUFACTURER/MODEL # CAPACITY 2 icJV / 7f 0 SETBACKS Property Line Well Water Service I Building I All -Weather OHWM I Swimming Pool Road s, , I I I I )5' DEVIATIONS FROM APPROVED PLAN J57hi9 /)" COMMENTS (Persons present, discrepancies, etc.) ii( Felt/ fLkSeil Lo c, K 3 & L)"- �i D�✓e,s�i� COMPONENTS NOT INSPECTED Plan Revision Required ❑ Yes ❑ No Sketch on other side 10 of 13 Signature of Inspp6 . BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Bayfield County Courthouse Fax: (715) 373-0114 Post Office Box 58 e-mail: zoningCa�bayfieldcountv.wi-nov 117 East Fifth Street _--_ - Web Site: www bavfieldcounty wi.gov1147 Washburn, WI 54891 Property Owner VERONICA ARTHUN-MADAY Information 56130 ONDRIK RD MASON WI 54485 As you know t1't' J4 b ` 0 4 5 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: 4- Tank was crushed! removed and pipes disconnected by: on at AM/PM On Z = at ❑— (AM I� the above -mentioned plumber contacted our office to conduct a pre -cover inspection as required unZSer DSPS 383. One of the following applies: 7_ 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: Wforms/sanitaryprope tyowner-Input April 2019 Department of Safety County Ay4 r 1 J,. p. R • � -� & Professional Services, Sanitary Permit Number (to be filled in by Co.) 7 $ Industry Services Division 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 Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. I: Application Information -Please Print All Information Property Owner's Name U Ef 'J�tj A\ Parcel # 2 2 3 5 Property Owner's Mailing Address /� f , c Property Location (a t&< 1i r I `L Govt. Lot S %,, SLr %,, Section — City, State / U✓ Zip Code / 57Y V 5-b Phone Number / "- Fr5 ' Q' o 4 Q b T 5 N R S E pe ofBdilaing (check'all :that apply) Lot # 2 Family Dwelling — Number ofBedrooms Irl Subdivision Name ❑ Public/Commercial — Describe Use Block # O City of O State Owned — Describe Use O Village of CSM Number `Town of___________________ III.:Type. of POWTS'Permit: (Check either "New" ar "Replacement" and other applicable:on hne:A. Check one boz-on lizie B:_Com0lete' Iine, C t A. ❑ New System Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B.AHoldingTank ❑ In -Ground ❑ At Grade ❑ Mound ❑ Individual Site Design ❑ 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:,Dls PeirsalL k,eatmerlt.Area and Tank1nforAtioai : . Design Flow (gpd) Design Soil App1iation Rate(gpd/sf) Dispersal Area Requ'7 A (sf) Dispersal Area P posed (sf) System Elevation 74 50 '/ X Tank Information Capacity in Gallons Total Gallons # of Units Manufacturer 2 New Tanks Existing Tanks U vi y Septic or Holding Tank 2 s�S €e^ Dosing Chamber V. Respoaa blltty ta#emend .I, the nad_erslgned, assume respa for ins one the POWT$4wla oa thealttsclied glans. Plumber's Name (Print t Plumber's Sjgnf�re MP/MPRS Number Business Phone Number Plumb Address (Street, City, State, Zip Code) i . L,. $ L. Lit Jo G -County/De sitmcaflJse Only - - _ . Approved O Disapproved Permit Fee $ lfrj) Date)/ssu Iss g A ent Signature J o 1t O Owner Given Reason for Denial ?„� loo 5S 6 100 V2 Conditions of Approval Reasons for Disapproval R 12,12b T EflED MAY 29 2026 ._._.�. jj Bayfield Co. Planning and =ruing Agency 'p) ct*E-ct c4e4 , Attacn to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 03/22) A TO Z PLUMBING & HEATING, INC. 1110 LAKESHORE DRIVE WEST P.O. Box 615 ASHLAND, WI 54806 Phone: 715-682-8520 Fax: 715-682-8521 Email: Zyg@atozashland.com SEPTIC PLAN SUBMITTAL Project: Veronica Maday 56130 Ondrik Road Mason, WI 54856 Site: SW 1/4, SE 'A, Sec. 8, T 45 N/R 5 W Town of Lincoln INDEX: 1 —Table of Contents 2— System Plot Plan 3- Holding Tank Cross Section 4— Holding Tank Management Plan 5 — Holding Tank Agreement 6— Holding Tank Servicing Contract 7— Tank Specifications 8 & 9— SJE Rhombus Alarm 10 — Email allowing Holding Tank 11-13— Original Soil Test Zygmund Jablonski Jr. MP6302 May 29, 2026 MAY 292012 Bayfield Co. Planning and Zoning Agency Veronica Maday 56130 Ondrik Rd. i 100ft II L 9N (14Y 292026 Bayfield Co. Planning and Zon;ng Agency n Above Ground .E. Corner rn --Well 150ft >100ft pl- 250/750 olding Tank PVC Sewer from House Tank Alert HW141 Locking Cover w/label Wire to Home 4" PV� Sch. 40 I T9p cL-Float 1250 750 Gallon Tank 6" Approved bedding material Approved Vent Cap Grade Used As 2000 gal holding tank with Conversion to Tank & Pump Chamber for future mound. RECE1VED 1AY 292026 Bayfield Co. Planning and Zoning Agency PAGE 4 OF 4 Holding Tank Management Plan IMPORTANT: The owner of this holding tank(s) shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this holding tank(s) shall be considered a human health hazard If not maintained In accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS MaIntainer In accordance with SPS 383.52 (3), Wisc. Admin. Code. Estimated Daily Wastewater Flow = 450 gpd Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o neglect or Improper use (i.e., exceeding design capacities, prohibited activities, etc.) o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o surface discharge of effluent or sewage back-up into structure served SERVICING FREQUENCY RLC IIVEO f'1AY 29 2026 Bayfield Co. Planning aid Zoning Agency o The tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wisc. Stats. when the wastewater in the tank(s) reaches a level of one foot below the Inlet Invert of the tank(s). Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. Tank pumping reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wis. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Zygmund Jablonski Jr. Local government unit Bayfied County Zoning Local government unit address: 117 E. 5th. Washburn, WI Phone: 7156828520 Phone: 7153735489 ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department In accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed component of this holding tank(s) cannot be repaired, It shall be replaced pursuant to a plan submitted to the appropriate agecy for review and approval. System Abandonment If use of this tank(s) is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. s , HOLDING TANK SERVICING CONTRACT Contract Date jVO 29, v6S Holding Tank Owners; Vern lj i c Name(s) MAJAJ This contract is made between the Pumper's Name t We acknowledge the Installation of (a) holding tank(s'i on the following nrnnArty- (Pmvidra 1pnnl rlaer�rintinne •1 PL:CT LOCATION Legal Des_: (UseTaxStatement) _ 04 0307 �"` S " r' 0; '-C?6d — /bod —^' 4, S 1/4, of Section ,Township l _ N, ttae W To of w c -d, .1 Lotskm AcreogB Govt Lot Lot # CSM# Vol. Pegs Lot(s)No.' Biock(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 t 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 agreeme4ee PS 383.55, Wis. Adm. Code, and the County, a report for the servicing of the holding tank(s) on a sem� �'he 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; MAY 2 9 202b b. The name of the owner of the holding tank; Bayfield co. c. The location of the property on which the holding tank is installed; Planning and Zoning Agency 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. —••••�•.•► IIII / .#wviw a olyr:aturets) subscribed and sworn to me on this date: Jetov.ca. L V4ocJ 74 t a �. ,e oday's Date Pumper's Name (Print) Pumper's Signature %S%GIA ER® Notary Public Signature ..rd Pumper's Registration Number PS!.� •�y� Commission Expiratic;cc on Revised: November2012 (Bayfleld County Zoning) Drafted by ____ Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)] 0 w ¢3 Or w I 2'-11" 4" CAST -A-SEAL 4" CAST -A -SEAL .✓ice, 1 E1 /� 1111 a �� IF41 U \\ Ikll ��� FILTER OR I �.I I BAFFLE I tl C JVED TOP VIEW MAY 29 ZU26 Bayfield Co. Planning a,ld Zoning Agency 4" VENT TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS W1250/750 -MR TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1/2" BOTTOM: 3" COVER: 6" MANHOLE 24" I.D. PRECAST CONCRETE RISER HEIGHT: 66" LENGTH: 12'-11" WIDTH: 7-2" BELOW INLET: 53" LIQUID LEVEL: 48" WEIGHT: BOTTOM 8,740 LBS. COVER 6,120 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: 27.66 GAL/IN (SEPTIC) 16.12 GAL/IN (PUMP) LOADING DESIGN: 8'-O" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/SEPTIC, SEPTIC/SIPHON, OR SEPTIC/SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: w SIEA Rhombus TANK ALERT® I Alarm installation Instructions This alarm system monitors liquid levels in lift pump chambers, sump pump basins, holding tanks, sewage, agricultural, and other non -potable water applications. The Tank Alerts I indoor alarm system can serve as a high or low level alarm depending on the float switch model used. The alarm horn sounds when a potentially threatening liquid level condition occurs. The horn can be turned off, but the warning light remains on until the condition is remedied. A green "power on" light indicates power to the alarm panel. ® 120 VAC Model Voltage - (circuits not supervised) Primary: 120 VAC, 50/60 Hz, 5 watts maximum (alarm condition) Secondary: 12 VAC 230 VAC Model Voltage - (circuits not supervised) Primary: 230 VAC, 50/60 Hz, 5 watts maximum (alarm condition) Secondary: 12 VAC NEMA 1 enclosure rated for indoor use. Red warning light, green "power on" light, alarm test switch, and horn ,sl(enbe''sv(rithf,Y e •. 0 1 a v ® Alarm horn sounds at 86 decibels at 10 feet (3 meters). eayeeld Co. 6 foot 1.8 meter Planning and Zoning Agency ( ) power card. Can be used with any switching mechanism rated to indude 1 amp, 12 VAC load. / Maximum line impedance for initiating device: 5 ohms. Alarm system (when installed on separate circuit) operates even if the pump circuit fails. Complete package includes standard Sensor Float° control switch with 15 feet (4.57 meters) of cable (other lengths available) and mounting clamp. Switching mechanism operates on low voltage and is isolated from the power line to reduce the possibility of shock. Three-year limited warranty. When ordered with the alarm, this system is available with: ■ alternate float switch models for high or low level warning. 8 120 VAC primary voltage or 230 VAC primary voltage. ® splice kit. ° CE Periodically inspect the product. Check that the cable has not PREVENTATIVE won oEmaatt the housinghas not been damaged so as to Impair the protection of the product. Replace the product immediately if any damage is found or suspected. ° Periodically check to see that the float is free to move and operate the switch. • Use oNy SJE-Rhombus's replacement parts. SJE-RHOMBUS® warrants to the original consumer that this product shall be free of manufacturing defects for three years after the date of consumer purchase. During that time period and subject to the condi- tions set forth below, SJE-RHOMBUS° will repair or replace, for the original consumer, any component which proves to be defective due to defective materials or workmanship of SJE-RHOMBUS®. THIS EXPRESS WARRANTY DOES NOT APPLY TO THE MOTOR START KIT COMPONENT. SJE-RHOMBUSsMAKES NO WARRAN- TIES OF ANY TYPE WITH RESPECT TO THE MOTOR START KIT. ELECTRICAL WIRING AND SERVICING OF THIS PRODUCT MUST BE PERFORMED BYA LICENSED ELECTRICIAN. THIS WARRANTY DOES NOTAPPLY: (A) to damage due to lightning or conditions beyond the control of SJE-RHOMBUS'; (B) to defects or malfunctions resulting from failure to properly install, operate or main- tain the unit in accordance with printed instructions provided; (C) to failures resulting from abuse, misuse, accident, or negligence: (D) to units which are not installed in accordance with applicable local codes, ordinances, or accepted trade practices, and (E) to units repaired and/ or modified without prior authorization from SJE-RHOMBUST. Some states do not allow limitations on how long an implied warranty lasts, so the above limitation may not apply to you. Some states do not allow the exclusion or limitation of Incidental or consequential damages, so the above limitation or exclusion may not apply to you. This warranty gives you specific legal rights, and you may also have other rights which vary from state to state. TO OBTAIN WARRANTY SERVICE: The consumer shall assume all responsibility and expense for removal, reinstallation, and freight. Any item to be repaired or replaced under this warranty must be returned to SJE-RHOMBUS, or such place as designated by SJE-RHOMBUS®. ANY IMPLIED WARRANTIES OF MERCHANTABILITY ORFITNESSARE LIMITED TO THE DURATION OFTHIS WRrTTEN WARRANTY. SJE-RHOM- RUSTSHALL NOT, INANYMANNER, BE LIABLE FORANYINCIDENTAL OR CONSEQUENTIAL DAMAGES AS A RESULT OF A BREACH OF THIS WRITTEN WARRANTY ORANYIMPLIED WARRANTY. Disconnect power before installing or servicing this product. A qualified service person must install and service this product according to applicable electrical and plumbing codes. •a„M,�. w oa,uw u'use precautions could result in serious Injury or dei or severed. Keep these Instructions with warranty after Installation. This ANSI/NFPA 70 so as to prevent moisture from entering or accumula Do not use this product with flammable liquids. Do not install in hazardous locations as defined by National Electrical Code, ANSIJNFPA 70. wy,u..c pi uuuta Immeoateiy It switch cable becomes damaged Juct must be installed in accordance with National Electric Code, within boxes, conduit bodies, fittings, float housing, or cable. For detailed specifications on this product, or for the complete line of SJE-Rhombuso panel, alarm, and switch products, visit our web site at www.sjerhombus.com 1. Determine indoor mounting location for alarm panel. 2. Insert screw (supplied) at desired wall location. Note: Screw is to be located over wall stud or used with a wall anchor sized for a #8 x 1.25 self tapping screw. 3. Make sure power to alarm panel is disconnected. 4. Hang alarm panel using keyhole on panel back. Install second screw between tabs located on bottom of panel. 5. Mount the cord by placing the cord into the damp as shown in Figure A. 6. Locate the clamp at the desired activation level and secure the clamp to the discharge pipe as shown In Figure A. Note: Do not install cord under hose damp. 7. Tighten the hose damp using a screwdriver. Over tightening may result in damage to the plastic clamp. Make sure the float cable is not allowed to touch the excess hose clamp band during operation. 8. Bring cable leads back to alarm device and wire according to Figure B. Note: All hose clamp components are made of 18-8 stainless steel material. See your SJE-Rhombuse supplier for replacements. Note; When used with a pump application, connect alarm to a circuit separate from the pump circuit. This allows the alarm to operate if the pump circuit fails. 9. Plug the panel in to apply power. The green "power on" light should come on. 10. Check installation by manually tipping the float. The hom and warning light should come on. 11. Move the hom silence switch to silence, the horn should silence while the red light stays on. 12. You must manually reset alarm after activation. Push hom button back to hom position and press "push to test" button. The light and hom should activate. 13. Test unit once per week to ensure proper operation. 14. Using the provided cable clasp, secure cord to outlet as shown in Figure C. Use existing receptacle faceplate screw and supplied washer. RECEIVED MAY 292026 hayfield Co. Planning and Zoning Agency Figure A Wi ogre B wvoltage screw rminals connection to ntactaxkthno xhmalpo)Br Source) W NOTapply power powerwire size cord22 AWG mo tabs switch here Figure C Slhombus Z2650 County HlQhway 6 JJg P-0. Box 1708 Al Detroit lakes, Minnesota 56502 USA 1-888-DIAL-SJE (1-888-342-5753) / Phone: 218-847_1317 ® fax: 218-847-4617 ® E-mail: sje€sjerhombus.com Itsa.Insir. pN 10119780 @SJE-Rhombus MadeITAlOJ 04/08 Zygmund Jablonski From: Tracy Pooler <tracy.pooler@bayfieldcounty.wi.gov> Sent: Friday, September 19, 2025 8:16 AM To: Zygmund Jablonski Cc: Michelle Kainz Subject: FW: Emailing: 22535 SOIL EVALUATION REPORT.pdf Attachments: 22535 SOIL EVALUATION REPORT.pdf Zygmund, Yes, a holding tank can be the system of choice when soils are limited such as this one. Tracy -----Original Message ----- From: Zoning <zoning@bayfieldcountywi.gov> Sent: Thursday, September 18, 2025 10:46 AM To: Tracy Pooler <tracy.pooler@bayfieldcounty.wi.gov> Subject: FW: Emailing: 22535 SOIL EVALUATION REPORT.pdf Tracy - can you help Zyg with this one? Michelle -----Original Message ----- From: Zygmund Jablonski <zyg@atozashland.com> Sent: Thursday, September 18, 2025 10:29 AM To: Zoning <zoning@bayfieldcounty.wi.gov> Subject: Emailing: 22535 SOIL EVALUATION REPORT.pdf [You don't often get email from zyg@atozashland.com. Learn why this is important at https://aka.ms/LearnAboutSenderidentification ] Hello, RECLINED MAY 2 9 ZU26 Bayfield Co. Planning aid Zonfic Gency Veronica Maday owns this property and has orders on her septic system. Will Bayfield Co allow holding tanks on this site even though a Mound could be installed? Please note my new email address: Zyg@atozashland.com Zygmund Jablonski Jr. A to Z Plumbing & Heating, Inc. 1110 West Lakeshore Drive Ashland, WI 54806 715-682-8520 715-292-8503 cell ('ENTERED) -�-Li rn - o a a-oq Document Number/Plan I.D. No. HOLDING TANK AGREEMENT Owner Name (s) VL1 Owner(s) Mailing Address C7nACC& 1 Vvs,y UV.Y Parcel Identifier Number (PIN#�..t ement Da (same as Notary Date) J y -• ut13-•ot - "1a L1 J UO 1 I 1 1 / 1 V1 1 Cu VL.4 J We acknowledge that application is being made for the thstallation 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 Stats. S W 1/4 of 2)1/4 Section Township N. Range _W. Town of L l L i 1 Gov't Lot — Lot Block Subdivision CSM# Additional Legal Description: L40 DOCUMENT NUMBER 2025R-609946 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 11/12/2O25 AT 2: 14 PM RECORDING FEE: $30.00 PAGES: 1 Return To: 7t\r NOV 13 2025 la Hinz, 4ri ?o :ing 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. Scats. 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. Scats., 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 submi: 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 Print Y Subscribed and sworn to before me on this date: I \ 1 p -I 025 .. ... Nota ' Owner(s) — Signature(s) fl/flOeL& (islres: Notary Public ./ Ot ' G y C ' iIr)i)���inir»illt»►��� Drafted by: Date: i cJ ! 5 Personal information you provide may be used for secondary p [Privacy Law. s.15.04 (I)(m)J ulforms/sardtary/hotdngtankagreementdoc .. Wisconsin Department of Commerce SOIL EVALUATION REPORT a of 3 Division of Safety and Buildings in accordance with Comm 85, Ws. Adm. Code County BAYFIELD Attach complete site plan on paper not less than 81/2 x 11 Inches in size. Plan must Include, but not limited to: vertical and horizontal reference point (SM), direction and Parcel I.D. 22535 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewe y Date Personal Information you provide may be used for secondary purposes (Privacy Lew, s. 15.04 (1) (m)). Property Owner Property Location MARC ARTHUN TRUST Govt. Lot SW 114 SE 114 S 8 T 45 N R 5 _E(orEl )Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 245 KUNJIE BLVD y State Zip Code Phone Number Ulty ®Village [•Town Nearest Road MANHATTEN MT 59741 ( 406 ) 580-1775 ONDRIK L Q New Construction UseEl Residential / Number of bedrooms 3 Code derived design flow rate 450 G 0 Replacement El Public or commercial - Describe: Parent material TILL Flood Plain elevation if applicable 1E ii General comments HOLDING TANK OR MOUND and recommendations: SYSTEM ELEVATION AT 101.75 ON 100 CONTOUR AUG 2 7 2020 DESIGN LOAD RATE = .4 GPD/SQ. FT. Additional pump tank will be needed. Long grass to be mowed. Old tank ® doles iZoning Dept. Boring # U oonng 0 Pit Ground surface elev. 1O0 ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color 1 0-5 SYR3/2 2 5-18 5YR3/4 3 18-40 5YR4/4 c i F SYR 5/8 4 40-50 SYR4/6 C2D SYR 6/4 Boring# © Boring 100 El Pit Ground surface elev. ft. Depth to limiting factor _ in. Soil Application _Re Texture Structure Consistence Boundary Roots G Dlft' Gr. Sz. Sh. *Eff#1 *Eff#2 SL 3MGR MVFR CW 3F ,6 1.0 FS 0SG MVFR AW 2F .5 1.0 FS 0SG MVFR CW 2F .5 1.0 SCL 3MSBK MFR , tt4 .6 fIAT 29 dayfield nine and Zof I5 Death to ilm€tins factor in Horizon 1 Depth In. 0-4 Dominant Color Munsell SYR3/2 Redox Description Qu. Sz. Cont. Color Texture SCL Structure Gr. Sz. Sh. 3MGR Consistence MVFR ' Soil Application Rate Boundary CW Roots 3F GPD/f *EW1 .4 *Eff#2 .6 2 4-15 5YR3/4 SCL 3MSBK MVFR CW 2F .4 .4 .S .6 .6 1.0 3 I5-20 5YR4/4 CIF SYR 5/8 SCL 2CSBK MFR AW 2F 4 20-42 SYR4/6 C2D SYR 6/8 FS 0SG ML - 1F * Effluent ai = Rnn a qn "A &"-n ww.1 7@O -en --- CST Name (Please Print) QUIUMrl # ; euus 5 sU mgn. and TSS S 30 J. 1 771I 1 CSTNurr 64903 CHARLES JOHNSON ROAD ASHLAND, WI 54806 08/19/2020 715-209-2569 emm n+hn,n Property Owner MARC ARTFIUN TRUST Parcel ID # 3 Boring # Boring 99 1 S pit Ground surface eiev. tt. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIft2 *Eff#1 *Eff#2 1 0-4 5YR3/2 SCL 3MGR MVFR CW 3F .4 .6 2 4-15 SYR3/4 SCL 3MSBK MVFR CW 2F .4 .6 3 15-20 5YR4/4 C1F 5YR 5/8 SCL 2CSBK MFR AW 2F .4 .6 4 20-42 5YR4/6 C2D 5YR 6/8 FS 0SG ML - IF .5 1.0 22535 Depth to limiting factor 15 In. 2 3 Page of • I Snil Anntin.4rnn Rnfc Boring # 9Bcring Pit Ground surface eiev. ft. Depth to limiting factor In. an Annliru4rnn Ra4 Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD& *Eff#1 *Eff#2 06 Bay ield Co. air coning ;envy Boring # Boring Pit Ground surfaceelev. ft. Depth to limiting factor In. Anil Annlir_alinn Pnfm Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots G D/ft' *Eff#1 *Eff#2 * Effluent#1 BODE > 30 220 mg/L and TSS >30 ≤ 150 mg/L * Effluent #2 = BODE ≤ 30 mg/!. and TSS 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SSD.8330TCSI is mrocl :.. 7s 1 of j (Veo[r. z qv t- _ /' 41O1 &Z°s Lt sa0vu, i w sE 60,toxg POST of ALI , Loo $`t p 6 laOao r jz7O/q8 REC1 JVED MAY 2 9 ZU26 Bayfield Co. Planning acid Zoning Agency Pksc 3 f3 jJ Li Fkc. tb qq,i ?3' BAYFIELD COUNTY SANITARY PERMIT (#04)-26-56S STATE SANITARY PERMIT OWNER: VERONICA ARTHUN-MADAY G OV'T LOT: LOT: B LK: SW 1/4 SE 1/4 SEC: 8, T 45 N, R 5 W TOWNSHIP: Lincoln SOIL TEST: 138-20 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: ZYGMUND JABLONSKI SCOTT ROUSH Authorized Issuing Officer DATE: 612L2026 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: # 6302 Condition: Properly Maintain System Per Recorded Agreement. THIS PERMIT EXPIRES 6/2/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION