Loading...
HomeMy WebLinkAbout26-66SRequest 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 zoninca(a?bavfieldcounty.wi.gov Note fl Time Change fl Discrepancy fl Other Phone Number Plumber: PcIo5o5 Fax Number Homeowner: �uS�Q-r5o N Email Address Immediate Phone Number So Zoning Sanitary Permit #: an / C r J Dept can call you right back (if needed) of Plumber's Choice Zoning Dept No Inspection(s) during this time Date: 1 jp � 0 Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice Z Dept Time: tilt Township: T 1 tAD) n Address #& & Road Name: or /l� f3U 3 Ywl / f 3 Directions To Site: S Comments: *' Plumbers you must verify any change(s) by fax or email "* Notes from Zoning Dept: July 2025 . r • CLENDON W GUSTAFSON 7830 STATE HWY 13 PORT WING WI 54865 GENERAL INFORMATION ►.DING TANK INSPECTION REPORT Permit Holder's Name ❑ City ❑ Village ❑ Town of Sanitary Permit No. Plan ID No. Tax Parcel No. Property ddress if Av able TANK INFORMATION TYPE MANUFACTURER/MODEL# CAPACITY '24o0 Property Line I Well Water Service I Building % I All -Weather Road I OHWM Swimming Pool I 1 /00 1 I O DEVIATIONS FROM APPROVED PLAN EV,7Lt' COMMENTS (Persons present, discrepancies, etc.) ,i.)o) COMPONENTS NOT INSPECTED Plan Revision Required Da/1 Signature of Inspect Cart. umber ❑ Yes 0 No . I to IN Sketch on other side 10 of 13 Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoning(a)bavfieldcountv.wi.gov Web Site: www.bavfieldcoufltv.Wi.UoV/147 CLENDON W GUSTAFSON 7830 STATE HWY 13 PORT WING WI 54865 Hayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know 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: :• Tank was crushed / removed and pipes disconnected by: on at AM/PM On _ 4 26 at 2 (AM / the above -mentioned plumber contacted our office to conduct a e -co r 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: Ulforms/sanilarypropertyowner-Input April 2019 ' c' -•r • Department of Safety County (([ a ag' :� K JUN 16 2026 & Professional Services, Sanitary Permit Number (to be filled in by Co.) Industry Serviees.Division Bayf eld Co•Agency onln9 3S-00773 — \Q 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 are submitted to Project Address (if different than mailing addre. the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, a. 15.04(1)(m), Stats, ' vt,` I. Applictation Information— Please Print All -Information. Property Owner's N o CI� � do h q (S C Fir. Property Owner's Mailing Address 7 3 o S1cz 7--e- 4 3 Property Location Govt. Lot Z 8 O City, State Y,Q F0 Zip Code Phone Number V C,J ! +'t L.J g3 7 ZD ¼, CE ¼, Section 3 0 T s O N R ' o IL Type of Building (check all that apply) Lot # I; I or 2 Family Dwelling —Number ofBedrooms -3 Subdivision Name D Public/Commercial — Describe Use Block # ❑ City of 0 State Owned— Describe Use CSM Number Village of 9I Town of' t £ 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 a Iicable. A. ❑ New System Replacement System ❑ Other Modification to Existing System (explain) ( plain ) ❑ Additional Pretreatment Unit (explain) B' tW Holding Tank ❑ In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber J 0 Transfer to New Owner List Previous Permit Number and Date Issued Expiration W'DispersaUTreatment Area and Tank Informntinnc DesDcsigx1 Flow (gpd) Design Soil Application Ratc Capacity in Tank Information Gallons Z.r10 i sal Area Required (at) Dispersal Area P Total # of Manufacturer Gallons Units o 1 -1- I W r s�e r Cc. ne,, d1L y U 7 -1 .1 1 1 V; Respons'ibllIty Statement- I, the undersigned, assume responsibility installation of the POWTS Shown on the`attaehed plans. Plumber's Name (Print) Plumber's i attire /MFRS Number I Business Phone Number Allah `tlIG- sk-, 17 716- ?19 71 1%5-4 Plumber's Address (Street, City, State, Zip Code) VI. County/Department Use Only `Approved ClrC3 Disapproved Permit Fee tozssI1L.j Issuing Agent gn . Owner Given Reason for Denial Conditions of Approval/Reasons for Disapproval I 1)0qz #c4,e4 cad'. Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x 11 inches In size SBD-6398 (R. 03/22) • i i •_ t MFj g Sta 2026 SR . -.6 o LjLj5" Soil Test # Bayfield Count �� 3aY� planntnandZan►nS� Waiver y aiver of a Thorough Soil & Site Evaluation (subject to 15.1-10(d)) I u.i4 I*,/.. o s i £ a certified soil tester determine that in my professional ?udgment 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 Pro ert Address1 3 a ≤+c +-e /.3 c Jd0 Ga{ -Fso1 Contractor Authorized Agent Agent's Telephone Telephone `7 ' g 13 '7- bd Written Authorization Attached: Y or N Accurate Legal Description Is requested: 1/4 of 114 Section 3 0 Township b N. Range g W. Town of )1' r 7L Additional Legal . Description: zoo Govt. Lot Lot Block Subdivision Lot____ Vol. _____Page____ CSM Doc # VolumePage of Deeds Tax I.D# Acreage Indicate reasoning for your determination:-- 5� 1 /1) C u �'r4 c4 m,4s-i-L4 Signatur,� of Count Official Z(Z 6 Date Signature of Certified Soil Tester Date Certification # (Submit a Plot Plan & Fee) Wforms/solltestwaiver(KLK) June 2018 ���;,p.e�►'-�-/ Owner.o eks AJ0: US a!SDfri 793b s+'+ I-E'/O F"v + cfi ttr≤Y 1,c • L I 1E SGrrs s-47≤4 SO -00 TON R S �r W z 0 ff _wtt cc : IL 6j�io,w iemkotef.'�s (Y Il eb ;#1, 4kctcks C5'Ps ) Ar& Abe -c i d, ( j race. er iJt 7 1 = 5ck q® PvC v1,/$ o us :'¢. /"A5Ta'1 D1zIPScc.pfav-e h A 1 8 4 N Iv r + .s t�'z & w y ;3 '— Io,jI®vt U)v cse-r c a tyre'. a.aik "-j2f #3-Fv-®vi bo,'t ®f cut b oL 1 1 1J' T.1 Ic Cep, t� tt cvg R a7i); c B12.01z._ a 7) L)ra.t.,v'l 3y: P.I3Ou zz . ...'.. �,,,� •L.6V vu I LrUV1V11Vka 41 LUIVUIVU o..9975 P. 2 Holding Tank Plane 1 OF8 IJUN T fi ndex &'over tineet LULD Bayfeid co. tit Component ManUal Design Rafemnces: Planning and Zoning Age y Vr&' ! &i24) ftkL Zaz,2._Z©Z7 PgIof$ Index & Cover Sheet I P'� 2of9 Plot Plan Pg 3 of 9 Holding Tank Speclficatldns - z ?' S S Pg 4 of 8 Management Plan Attachments: nclosures: POWTs Application for Review Cs'aK $4C .r-yP`v-m a 1 Ate m 4 ' Soil Evaluation Report & Site Map f applicable) P 7 f ' Holding Tank Pum In ontra.ct (if doable) ° Holding Tank. A regime t (ifpplicablej Project Name I Description Owner Name(s) Cllevu Phonrs. ! 7/s .. 13 7 z o a Owner Address: .S` e 'Z"a ( J 1J Apr __ Project Address: S,a a ctL o u e 1 Govt. Lot: ii 2./v E1/4of -.5 1/4 Section OT R E yr w � ' Township: .'-t aC� .� County: 4 " p Project Parcel ID #: 1Ta i Z.$' -s o 7' ________________ Designer In formation nforrnation Designer Name: A f Pc . a s Phone: Designer Address: ' ..t. "'.z-�. � ��� i ' . E-mail: +tS M7.L- '- v ; E4!. � '.� c� � .�. "L. Thij spy reserved for approval stamp. License Number: - 2 O Remarks: e 1 ,signature: Dane: 3 Original signaturequfred on each submitted copy. "---' h'rcre v-tt uw#1erro , L ga, I icscr; A+s*@�vt ® ' OkAJ601 g-u'd 4-flokI £7 5Ei7 Ste3vT$0N 99 w 73t sf cde/4t-)'/13 Cvt4y c: 2.od , r 7 3 d S-i-ctf l- wy t3 1 gECV JUN 162026 �� Q Bayftd Co. a� 5 Planning and Zoning Agency 'ill, °. 33, 2Z.5 6 I0'LJ 1em kits9-e4s c .1I 4Lck5 CJ?) 4 o( ritJ e it v rgp - £leiv /00-0.' - -.- 5CL '/O PvC A21 -NOW J. i v -' -w L/"A5Ta'1 D 17 19S t j' p v - F P Ptq.+. tr ct I ! i Jzr H Ic!; T k �o&i.€1- ,ykPtcL/ sct:n1.cJiVp i/9R a3i), PW)O. ZaZZAZO . t)re y: fl5.''7o 'F4kesk, n3 Ra, a a c va rr- n A've,� w2 srVf?y7 PROPERTY OWNER:C L PLUMBER: Allan Pnikneiril SIGNATURE: _i24'( ^--'--� DATE: -F-Z4 LICENSE #_ 220 90 HOLDING TANK SPECIFICATIO IBS r Number of bedrooms ikon- residential estimated flow (gpd) 00.0 Minimum holding tank volume'requlred (gal) Tank Dimensions and Data —�"•X for round tank 6 .0 a.Q Liquid depth below Inlet Invert 71.0 Maximum depth of soil cover (ft) Height (in) 169.8 Outside Length (In) r Dimensions .0 Width (in) Only Manufacturer model number manufacturer iber JUN 16 2026. Bayfield Co. Planning and Zoning Agency Tank Anchor 6040 Calculations lbs Weight of tank and cover d20 Safety factor lbs Weight of anchor required 40.8 In Soil cover req. for anchor or 9.9 yds Concrete counterweight HOLDING TANK CROSS SECTION manhole cover with junction 4 locking device and finished box ....a warning label grade X24 ln. W conduit hole and vent locations maybe reversed. vent cep 12=' min, vent pipe .I- ........,.,, 18"min. 11 service 12.0 In. blind plug toautietl a grt" on Note: All tank joints, and joints between tank Electrical as per NEC 300 openings and piping are• 39.0 in. sealed watertight. All pipe and Comm le and vent materials comply Ia with 5 P. *,3 building sewer inlet 3 In. bedding under tank. Tank Is anchored as necessaryto negate buoyancy. c 163k" 4" CAST -A -SEAL 4" CAST -A -SEAL FILTER OR BAFFLE TOP VIEW yV e:?a SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS _ � t WLP2500 TANK SPECIFICATIONS 0 a � DIMENSIONS: WALL: 3" - a BOTTOM: 3" HEAVY - 5" COVER: 6" MANHOLE: 24" I.Q. PRECAST CONCRETE RISERHEIGHT 52-3/4" O.D. Im 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. N WEIGHT: COVER 9.300 LBS. w y a INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) L LIQUID CAPACITY: 69.44 GAL/IN L HOLDING TANK: C7 Y CD OUTLET HOLE PLUGGED C o d�- ACTUAL CAPACITY: 2,639 GALLONS O 00 LOADING DESIGN: 8' 0" UNSATURATED SOIL TANK CAN BE USED AS: M o SEPTIC/ HOLDING/ PUMP OR SIPHON O COVER: MIX DESIGN #8 (NO FIBER) W N 00 TANK: MIX DESIGN #9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: N J O J N N I= W w S N w W SHEET NO. 1" /1 HOLDING TANK MANAGEMENT PLAN JUid1 b 2026 Bayfield Co. This Private Onsite Wastewater Treatment System (POWTS) has been designed, andlaite4at,and maintained according to 33 Wis. Admin. Code, the Holding Tank Component Anual C.4Se.dv" ``WG.rI ve l -49R 2do and the I1 County Sanitary Ordinance. E1 2J) L.� `? 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 iS'PS 383 and384 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with 5PS 9$3.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer ............................. r©1 ask f 1uw f??.F,A,S.. ZE.ao i Phone: -n( 37z.- LIl$(i b. Service Provider .................. cep4 Rb I2 Phone: `7/g 4oaaf c. Co. Zoning or Health Dept. Phone: 7/3 3-y , 6I3 11. L� o ! t€ 2 0 a' 5 JL/ S F Jw S ic 30 Project Transaction Number: JUN 16 2026 HOLDING TANK SERVICING CONTRACT Bayfield Co. Planning and Zoning Agency contract Date This contract is made between the Holding Tank Owner(s) Name(s) fon Cl i\ i.ii C Pumpees Name (Print)Signature Pumpers' Registration # S �Z.71 We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) .RojE� Wry L�._'CK �T" � _;. 't• j`. f � 1� 4i,i1 . C' %l_ R 1. �r � u.-.• �-. -.:r- � Jr _`v..'' `�y -�1ex � ti i•]�`r ,•9 _ ~ g' � � v a 'r s` °'i F',�+•. .y E.r r_tf�•+C 1rp W i�'=, �+ --��: rtIa 41,"5 '� +� �} 1�•,�,t� �J.• �,'�ix:4,•.a •f.E M ). %a.:.+a�iv}I 'wi•1.7 (!�,�I.L 1•.:1.ti l`"NsJir..r.... L-!+ 1. !.- 1 ..} F� wt. f• i�'f-+ i"A. ''1 / Yi. 4i:. -r ri�1La.+r-.. �•i.✓ail.. -.� >r.:,r J i '�i' �.I _i . !• ,Scl'!-(* T'' ✓ '' r� 4.v YAW.•. SPi-a..•.e..'11�� ��fw y. .7. �� f .f' -1.- i:, Yi'� �:1 � 5"•�:;'• 'f J. . Q�i r�ii� w ��.:�f;" }'9 ��i�,'��"r'rr` ,i '-. r• r'.+-�._..s�. _O'i�i�1h-�'� �r�l f .�.'� .. .. .. •.....:.. Y. - >•'• x--"-- •,,.: . r*rr—_: 't' . ate.. 1'^r •-'x�'•'.'*^F' •.. ... .� . . �,�.r_ � .."-: ,.___-�.r,-...::.���..�:� .:.-.,,, . . ' � .... 'ry' L'=- {�:r�: ,r ,•, r. Y+s . r . '=fin•/� t..s? �.s�:iV:�_ :•l: i�uL,:.s�•;.�•: GQ t LQt': ,LQt } NT s P ,.... �.r ,vo�f�.fY a a : �. ;CSIVI Dac 6 ;tit s Na �.. 1. •.Blae s GHQ.: uaawtaro . P:'r' ' rs> r•, -nom.. �t••.� ' T �...._ 7 � .� .:n..-, .� i. Y � .t..,... _ .. .. .. r: . �: r .ir .�1 'a ..... ? ' S r".i'z .i�':�--.7 - r "�ti'�I.' i ;�:Fn '�' r . ;i'::,: .�•: • ..r,.: S; r : f?:^::' i"�� :,'��..::�...1:, 1; i'�•y:•:'rr .. . .2� • � . � �'=::-.'.�::.',%:.�:-:._ s.. :. f � ?. .•a' �.� rj:..s.r:c'""':..3�= ::i �� I.lrL"k.���. ...... ...� .-. i.-., .. i. -.. Y � ..� .. 4r�r.L -'Lr. .•.. r r —ti. . �.�r�iN.`.t�w ..J Jr1.�.i�i:��L - -i ,.a" � ..r':.:s�. �'::ak�: .Gii'Y3.,•- wa.+rrri'�irvr.:+:�.S'r: 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; = • N o •''.. A c. The location of the property on which the holding tank Is installed; �„ q d. The sanitary permit number issued for the holding tank; _ 9 A, • ' e. The dates on which the holding tank was serviced; ,► '•. 'j f. The volumes in gallons of the contents pumped from the holding tank for each servicing; %� p.,,••..••• •,..•\�a`��•� g. The disposal sites to which the contents from the holding tank were delivered. ''i,,, "11111 1 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change In this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local government unit and the County named above within (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed and Sworn to me: on this `1 day of ________,____ )J$Jt kndor by: Notary ubiic My commission expires on: ly cJ Revised: May 2016 (®May 2018) Drafted by If rc Personal Information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)] Document Number/Plan I.D. No. HOLDING TANK AGREEMENT Owner Name (s) Owner(s) Malty,g Address I€iot W GttqRofl al I ► S 065 Parcel Identifier Number (PIN) Agreement Date (same as Notary -Date) o o! 2- Z-3 D O' '- 30- Yfl'i- ono•' 5_7J 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 asp�n itte under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Stats. tt/LpSy a y7 OP _S1/4 of 1/4 Section ,3) Township S 0 N. Range -W. Town of Polt1 W n Additional Legal Description: zoo . f a (€AIitJSc)a.iv)5 Gov't Lot_ Lot Black Subdivision CSM#. Lot CSM # Vol Page CSM Doc# DOCUMENT NUMBER 2026R-612470 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED O6/O8/2O26 AT 1 1 :O3 AM RECORDING FEE: $30.00 PAGES: 2 R(; E1VEtJ JUN 16 2026 Bayfield Co. 3 and zprling Agency Return To: , c' (O) ) 5 zz_ 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 falls to have the holding tank properly serviced In response to orders Issued by Bayfieid 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. 68.0703, 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. 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. Bayfieid 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 Bayfieid County certifies that the property is served by either a munlcipal.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 thi existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds In a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank Is installed. .�t� i N i�Ni���"/, .�i Owner(s) Name(s) -- Please Print Gsko�y' Subscribed and sworn to before me on this date: ""••.. : NOT Notarized Owner(s) — Si ure(s) No Public �: 1C My Cc la on Expires: CO` 'h l$I``, Drafted by: 1 O h f'o 1 k0 S t Personal Information you pro de may be used for secondary purposes [Privacy Levi. x.15.04 (I)(m)) Date: ulformslaaniteryfioldinglanksgreement,doc dune 2018 fMD7CUMENT NO. DOCUMENT NO. 388474 WARRANTY DEED STATE BAR OF WISCONSIN FORK 2-1882 WARRANTY DEED STATE BAR OF WISCONSIN FORM 2.— 1982 Signed H. York .............. ....................................._....._..................._.......... conreys and «arrants .to -..._. n .. g7 E' man .......................................................................... ..............................................--........--...--.....-...................................... �..... ..................•-.........---•_•.............................._.......... the following described real estate in ............Bae .. y...f i ................ ...::..County, State of Wisconsin: �- THIS SPACE RESERVED FOR RECORDING DATA THIS SPACE RESERVED FOR RECORDING DATA FXCIST �s OFFICE f ayfle1d Couniy, Wis. RECORDED AT t • L' G i -'1990 I� 1E'rE$-�E RETURN M ."o7�.TTX coo TaxParcel No :.............................. H The West Two -hundred (200) feet of the Southeast one -quarter of the Southeast quarter (SEA SEA) of Section Thirty 0ne.. (8) West. (30), Township Fifty (50) Worth, Range a: rn a ur riuc `ar.S.: Doc No Cou�� , �r�388510 TRANSFER FEE FEE EXEMPT FADED AT/I•laA. M. :I 4J c cT s 1990 i� 4� ° _ RENTAL - __.. ATHERIZATION COQ gJQJrExEMpnoN .# _'j, This ......................homestead property. p . (is) (is not) Exception to warranties: easements and reservations of prior rec rd' hereto. Datedthis ..........4+k)........................day ....................... • . day of ........ N8FEar - ...EEEXEMPr._.�.... ..(SEAL) .•Y��{�.z�-rq r .... ... (SEAL) ta-r p. ..:...�!...... .................. (SEAL) • Sigri ed -j York .C, BAYFIELD COUNTY SANITARY PERMIT (#04)-26-66S STATE SANITARY PERMIT OWNER: CLENDON W GUSTAFSON GOVT LOT: LOT: BLK: SE 1/4 SE 1/4 SEC: 30, T 50 N, R 8 W TOWNSHIP: Port Wing SOIL TEST: 64-26 REPLACEMENT SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: ALLAN POLKOSKI SCOTT ROUSH Authorized Issuing Officer DATE: 6/19/2026 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: # 220090 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. Old System needs to be properly abandoned per SPS 383. THIS PERMIT EXPIRES 6/19/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION