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Home My WebLink About26-84Sof Safety County Department Bayfield eI & Professional Services, S P Sanitary Permit Number (to be filled in by Co.) 4 a_ 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 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal informationyo}lylQvj4rplty be used for secondary Property Owner's Name O 226 Parcel N Stephen and Patricia Vork JUL 6 38873 Property Owner's Mailing Address Bayfeld Co. Property Location 541 24th St. Plarcwtg tarW Zoru"Ay Govt. Lot 2 City, State I Zip Code Phone Number Chetek, WI 54728 715-237-2911 7.. '/., Section 27 II. Tvne of Building! (check all that aonly) Lot # T 51 N P 06 p nr p I or 2 Family Dwelling —Number of Bedrooms 2 suomtvisron Name Block/I ❑Public/Commercial — Describe Use •rasftsq/ ❑City of () ❑ State Owned— Describe Use CSM Number O Village of ® Town of Bell IQ. 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 applicable.) A. New System ❑ Replacement SystemExisting System (explain) (explain) ❑ Other Modification to ❑ Additional Pretreatment Unit B' ® Holding Tank ❑ In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ist Previous Permit Number and Date Issued ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner Expiration IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) I Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) I Dispersal Area Proposed (sf) I System Elevation Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units , o'Z V o New Tanks Existing Tanks ' c o. U v j ,`uo m rn rL C7 a Septic or Holding Tank x 2000 1 Wieser Concrete X Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Edward B. Redinger - 221939 715-292-6670 Plumber's Address (Street, City, State, Zip Code) 1015,11th Ave. E. Ashland, WI 54806 Approved O Disapproved Permit Fee Date Issued fIJ — Issuing Agent Signature $4n0— 7I/b!u• i'mi / 6 4 ❑Owner Given Reason for Denial 1f. /IIm �L///�'I (%,r_, i97/....!IIq cam -a c&4Caid Attach to complit. plans for the system and submit to ti,. County only nn nsmr not Ieat than R lily 11 inrhet ins. SBD-6398 (R. 03/22) 5R_o0yy2- Soil Test# �r Bayfield County KJ �liE Gp Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) Edward B. Redinger 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 Stephen & Patricia Vork Contractor Superior Plumbing & Mech. Inc. Property Address 89605 W Sunset or. Authorized Agent Cornucopia, WI Telephone 715-237-2911 Accurate Legal Description is requested: Agent's Tele Written Authorization Attached: Y or N 114 of 1/4 Section" 7 Township5I N. Range W. Town Additional Legal Description: Govt. Lot I Lot Block Subdivision Lot 2 CSM# 313 Vol. Page CSM Doc # Volume 3 Page 135 of Deeds Tax I.D# 38873 Acreage 2.84 Indicate reasoning for your determination: Mottled Sand over Clay with limited space on Lot Date UII(((4 gc III u c3 Signature of ounty O�tcial Date JUN ii ZUzu 2x/939 Certification # (Submit a Plot Plan & Fee) ulformslsoiltestwaiver(KLK) June 2018 Bayfiald Co. Planning and Zoning Agency N O O111 1 80'-0" Pagelofa RECEIVED PARCEL #:38873 2.84 ACRES JUN 1 12026 TOWN OF BELL LOT 2 527 T51 nB yflelcj o. Agency YORK, STEPHEN AND PATRICIA Plot Plan / SUPERIOR 89605 W SUNSET DR. Date _ 6/12/2026 Cl 00 (715)292-6670 CORNUCOPIA,WI Drawnby JCR Checked by I Scale 1"=8( J_Cel:Ri irmn Holding Tank Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10855-P (N. 03/07; R 01/12) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Holding Tank Specifications Pg 4 of 4 Management Plan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map (if ap Holding Tank Pumping Contract (if appl Holding Tank Agreement (if applicable) Project Name I Description 3 Bedroom Holding tank Owner Name(s): Stephen and Patricia Vork Owner Address: 541 24th St. Chetek, WI plicable) cable) Phone: 715 273 2911 Zip: 54728 Project Address: 89605 W Sunset Dr. Cornucopia, WI 54827 Govt. Lot: 2 1/4 of 1/4, Section 27 , T_51 N -R 06 E ❑ or W ❑✓ Township: Town of Bell County: Bayfield Project Parcel ID #: 38873 Designer Information Designer Name: Edward Redinger Designer Address: 1015 11th Ave. W. Ashland, WI E-mail: ed@superiorpmw.com License Number: 221939 Remarks: Phone: 715 278 3456 Zip: 54806 This space reserved for approval stamp. RECEIVED JUL 08 2026 Bayfleld Co. planning and Zoning Agency Signature: ,t yes Date: 8/25/2022 Original signature required one ch submitted copy. NPage 2 of 4 O LAKE SUPERIOR PROPERTY LINE --------------------------------- PROPOSED HOUSE PROPOSED WELL PROPOSED HOLDING TANK ------------------- ----------------- ---------------- PROPERTY LINE RECEIVED ;IUL 0 8 2026 PARCEL #:38873 PLOL Plan gayfietd Co. 2.84 ACRES Zoning Agency 1' 80'-0-0" planning and TOWN OF BELL LOT 2 527 T51 N R06W YORK, STEPHEN AND PATRICIA Plot Plan SUPERIOR "°"""` """""` 89605 W SUNSET DR. C 4 I OQ Date 6/12/2026 Drawn b JCR (715) 292- 6670 CORNUCOPIA, WI Checked by Scale 1" = 80'-0" 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 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 o The tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wisc. Scats. 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: Superior Plumbing & McCh. Inc. Phone: 715-292-6670 Local government unit: Bayfield Co Zoning Phone: Local government unit address: 117 5th St. E. Washburn, WI 715-372-6138 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. {�GECE%VED AL 082026 Bayfield Co. Planning and Zoning Agent/ W1250/750 -MR TANK SPECIFICATIONS Cl a •1/LL" Cl) C 'C Lii DIMENSIONS: WALL: 2 1/2" BOTTOM: 3" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 66" O.D. LENGTH: 155" O.D. WIDTH: 86" O.D. BELOW INLET: 53" O.D. LIQUID LEVEL: 48" 4" CAST -A -SEAL WEIGHT: 14,860 LBS. SEPTIC INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL 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' 0" UNSATURATED SOIL 4" VENT CD OUTLET V N ° N n__ __ rr \- PUMP PAD NH SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS MN TANKS: WILL HAVE ONE VENT OVER OUTLET AND WILL HAVE TWO VENTS IN COVER OVER INLET TANK CAN BE USED AS: SEPTIC/SEPTIC, SEPTIC/PUMP OR SEPTIC/SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE JOB INFORMATION: CUSTOMER: JOB NAME: DATE NEEDED: APPROVED BY: iPPROVAL DATE: 0 J 0 Q N 0 Z Z 0 0 p W N N 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-1 0571 -P)(R.6/99) and the Bayfield County Zoning Department Sanitary and Private Sewage Ordinance. This POWTS has been designed to accommodate a maximum daily flow of 3OO gallons of domestic wastewater per day. The owner of this POWTS is responsible for system operation and maintenance, locking device, alarm and access. 3. 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 _1/4 of _1/4 SectionXl TownshipS!_N. Range V o W. Town of Govt. Lot Lot Block Subdivision CSM# Additional Legal Description LUT 2. C5M X313 W Vi P. i35 AS Do(, 3; ` -3 9q 1 /N 5 1/3 &cJ'T Lot r) jN DEED 'Doc 2-oilR-59St155 y` a &2'i . A. f . i S, Property Owners Signature Date uRorms/managementplan RECEIVED Revised: July 2013 , uL 082026 CA7ED Bayfield Co. Planning and Zoning Agency HOLDING TANK SERVICING CONTRACT RECEIVED Contract Date JUL 082026 This contract is made between the Bayfieki oning Agency Holding Tank Owner(s) Name(s) Sr r%PN5N Di ah t PfrrRI CIA /}. VCtzZ Lot We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT LOCATION I Legal Description: (Use Tax Statement) Ta 1DN 3 gg73 1%4• 1/4, Section ,Township N, Range�� W Town of: Bell Lot Site . 25$5OO Acreage eoret Lot 1 Lot # 2 CSM # 313 . P V age 35 CSM Doc # Lot(s)No. I Blocks) No. Subdivisioon: 2. GSM * 313 /N V.3 P, 135 *5 DC 3343dr9 CLocf# p iN 3 %/3 Gov? 1.v7 f) IN DEED 0Cc. 2.02-ZR- 6g545 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, Wiis. 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 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) ST'E'PHEN D. 1/o Rii' PAr7R/C-rA- A.VoRK and Sworn to me: on this %i day of by: Revised: May 2016 (®May 2018) Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (I)(m)] commission expires on: 121Z5!201 Drafted by m-OO3)D owner name s) Owner(s) Mailing Address STEP EN D. VoRK syl 2qi S7 PRTRlC1, n. Vofflc cifercx WI5 2e Parcel Identifier Number (PIN),,,- #gZOO Agreement Date (same as Notary Date) oq-dfo-2-5l-6L-fl , At We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Stats. 1/4 of 1/4 Section 27 Township _L N. Range O6W. Town of Gel.! Lot t CS'i3) j'/S I Additional Legal Description:33f(LaC4r�p rn S V# eatr Lrof 1) in p Wray L -622r Z -"gg55 Gov't Lot Lot Block u vision CSM# Lot CSM # Vol Page 135 CSM Doc# DOCUMENT NUMBER 2026R-61 2862 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 07/08/2026 AT 2:36 PM RECORDING FEE: $30.00 PAGES: 1 RECEIVED 92026 Return To: r� `` 'Bayfield Co. "S.yCPlenh�and 7Ahing Agency Zen; 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, State., 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. Slats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced in accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service contract 4. The owner agrees to contract with a person licensed pursuant to s. 281.48 (3) Wis. Stats., and Ch. NR 114, WI's Adm. Code who shall submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfield County may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 5. This agreement will remain in effect only until Bayfield County certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. SPS 383, WI's Adm. Code. In addition, this agreement 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 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 Print ST5Pt/Eni D. YORK Subscribed and sworn to before me on this date: ,JUYI,C 15011 2o2(J PRTRIC,4 A. Vo2K Notarized Owner(s) - Signature(s) � UtT Notary Public i Notary Public, State O{ g fir- ✓'` Pth;f 1 My Commission Expires: uv l 21 Z5 1A2°I Drafted by: cr-rc11 ''nk Date: __�a6 Personal inforne8on you provide awry be used for secondary purposes [Privacy Lav,. s15.04 (p(m)] Wlomtsanidtrymoidinglankagreementdoc ®,lure 2018 I3 `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: Submission Number: VORK JOINT REV LIVING TRUST, SR -00442 STEPHEN D & PATRICIA A 541 24TH ST Transaction Number: CHETEK, WI 54728 SR -00442-47D12 Description Amount Certified Soil Tests - Review & Filing Fee $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 10786 Paid by: Superior Plumbing & Mech Inc, 1015 11th Ave E, Ashland WI 54806 Payment Type: Check Transaction Date: 6/22/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. 13 1YFIELD 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: VORK JOINT REV LIVING TRUST, STEPHEN D & PATRICIA A 541 24TH ST CHETEK, WI 54728 Description Private Sewage System (Holding Tanks) Submission Number: SS -00789 Transaction Number: SS-00789-49B5B Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 10822 Paid by: Superior Plumbing & Mech Inc, 1015 11th Ave E, Ashland WI 54806 Payment Type: Check Transaction Date: 7/10/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-84S STATE SANITARY PERMIT OWNER: STEPHEN D & PATRICIA A VORK JOINT REV LIVING TRUST GOVT LOT: 2 LOT: B LK: 1/4 1/4 SEC: 27, T 51 N, R 6 W TOWNSHIP: Bell SOIL TEST: 66-26 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: EDWARD REDINGER EMILY MACGILLIVRAY DATE: 7/10/2026 Authorized Issuing Officer 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: # 221939 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 7/10/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION