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HomeMy WebLinkAbout26-125S�tMr.4, Department of Safety C run v —� Bayfield & Professional Services, Samtaty Permit Number Ike be filled in by Co.)SS. 00 %3 6 I Industry Services Division �a 5 �r i7 Smte Tnmsachon Number Sanitary Permit Application In accordance with SPS 3831;1''-1, Wis, Mm Code. submission of this form to the appropriate give ermnenml um[ is required to obraming a s:m,uuy per run Note Application forms Ibtr state -oohed Pi )WT�S are submitted to Prtyeet Address (if diticrem than mauling address) prior the Department of Safety and Pitiless on Sen•,ces I'nsonal information you Pius ' pR!eC1VG6J dam• 20670 S Siskiwit Shores Rd tposes maccordance with the Irivacs I.iv .s l rrl(i Nml. 37Catnn Inifirmaffnn — Please I rant All tfii'PMationn Proper' ,,,.n L4iItRED AUG 312026— Red Maple Rev Trust (Logan Lewis) 9 ,� ii- et d o23� -s Puipe rtc Ialcation ._ V Property Owners Mailing Address '"' Planning and Zoning Agency Turner Warnell Rd , State Zip Code Phone Number uon Lot 20 jMansfield, TX 76063 Section T 50 N R 06 E 04W1 ii, Type of Building (cheek all flint apt list'? Subdivision Name Siskiwit Shores ® I m _ Runrls Dwrllurg— Nunmb,, offedrooms 4 EhYrr,�1� 5 ---- Bloel9 O Public'Commerctal - Describe Use __. _ _ ❑City of ❑ State (honed- Describe Ilse -.. .- —---"- I��1/ Ni:lllbei 0 Villageof _ [i Lei ; i Bell ITT. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box an line B. Complete line C i a hilicabizw)— — -..-.. -- ':,, cic,n ❑Replacement Ss seem UOdmr \Indi4umon to I: si attic Scs:em iexplaint ❑ Addnunral Pretrearment tin lexpiniii) ® Holding Tnrrk ❑ In -Ground ❑ At -Grade I O Mound 0 Individual Site Design ❑ Othet Type (explain) I com'[,ltlnnal i C. ❑ Renewal Before ....Revision Revision ❑ Change of Plumber ❑ Transfer to New Ownerl.mst Previous Permit Number and Date Issued Expiration IV,_Ait��t crsaLTrcatment -Ares and Tank information:. [)--"n ", to d, Ise-sitni Sol .,p,i r� ...... Rn urpd i 1? xlc. grad Rey+u icd (,Ii C sl L Oi \,'c_- Pi r „_t rsll S+ter, r -.+alien 600 — — — — CnphciPi Iii Ilotal 4 of MattilfllClm ci Tank Information Gallons Gallons l.inn9 \ew ranks ( faunu Tattle, _ I n LZ I r it -v-U Septic reHoidmp Taus 1 2900 — 2900 --"------ Wieser r X I 1 Do -;us Chandxr V, Bespondibility Statement- 1, the undersigned,assame responsibility for installation of the POWTS showiti SMe attached plans. Plnml <.I'hunb , 1rg¢' r; MP/MPRS Number Business Phone Number - 13Fl 22 2 o 6 f 3 a l2vt/' Ut ,, p t2 xfinly' 1Tn!' nnh/De artmen 'isusing 'CpProved - D supprna d 3c nn t FCC Date Isued A ant R,enau ����„'� � Al Owner C,vn Reason for Denrn! �^ IR o (T VI - /at Conditions of Approval/Reasons for 1)bzappnsval janK to Ac eogf v(A-C1 1-O y t31Z (es04°nce/6h0rJ. &-e, Bch ed alol. Roach to i mpietc plan' fin H,.• n)a,ens said xnhmir to Out i'umire only nn paper ,.a lids Man a I2.x 11 insists in arse SBD-6398 (R. 03/22) Wisconsin Department of Safety & Professional Services t) Division of IndustryServices SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north avow, and location and distance to nearest road. Please print all Information. Personal information you provide may be used for secondary PL Property Owner Red Maple Rev Trust Property Owners Mailing Address 560 Turner Warnell Rd City, State, Zip Phone Number SOIL -TEST 1;q- zc EKIIEAED Page 1 of ? I.D. 04-010-2-50-06-20-2 00-282-05000 d by Date mlif1 lfl/Pcafll(dti I �va Property Location V v --' u Ly Govt. Lot '/, ''/ S 20 T 50 N R 06 E (or) W 311e Address or CSM and Lot #: (Lot 5 Siskiwit Shores) 20670 S Siskiwit Shores Rd ❑ city ❑ Village 12 Town I Nearest Road Bell I Siskiwit Shores Dr Q New Construction Use: 05 Residential/Numberof bedrooms 3 Code derived designtow rate 750 GPO ❑ Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable N/A ft. Parent material Sandy, outwash underlain by stratified silty, loamy, and sandy glaciofuvial deposits(Cublake-Croswell-Ashwabay complex) General comments and recommendations: Mound 1❑ Boring ❑Boring ® Pit Ground surface elev.98.3fl. Depth to limiting factor 17 in. / elev. 96.8. Soil Annliration Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPO/FP Eff#1 Eff#2 1 0-2 1 OYR 3/1 — Is 0sg ml as 2vf 0.7 1.6 2 2-10 7.5YR 6/1 — Is 0sg ml aw co/2m/lf 0.7 1.6 3 10-17 7.5YR 5/4 — Is 0sg ml cw 1m/tf/1vf 0.7 1.6 4 17-38 7.5YR 4/4 c2d 5YR 416 scl 2msbk mfi aw 11 0.4 0.6 5 38-48 10YR 5/4 f2d 5YR 4/6 Is Osg ml — — 0.5 1.0 aBoring # ❑Boring ®Pit Ground surface elev. 98.3 ft. Depth to limiting factor 19 in. / elev. 96.7 ft. Roil Annlil ration Rata Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPD/Ftz 'Eff#1 Eff#2 1 0-6 10YR 3/1 — Is Osg ml as lco/2m12 0.7 1.6 2 6-19 10YR 4/4 — Is Osg ml aw 2rr 2f2vf 0.7 1.6 3 19-58 1 OYR 5/4 c2d 2.5YR 4/8 fs 0sg ml — 1vf 0.5 1.0 Soil saturate @ 50" CST Name (Please Print) Signature T Number Keith Wiley 654921 Address Date Ev uation Conducted Number 11623 E Larson Dr. Lake Nebagamon, WI 54849 8/8/2026 218.451-2611 Effluent #1 = 800>30 5 220 mg/I. and TSS > 30 5150 mg/L ' EBluentAJ6B uJ≤ /L and TSS 5 30mg/L SBO-8330 (R03/22) Bayfield Co. Planning and Zoning Agency Page 2 of 3 3❑ Boring # ❑ Boring ® Pit Ground surface elev. 100.3 ft. Depth to limiting factor 34 in. / elev. g7,4 ft. I Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPO/Ft' •Eft#1 •EfI#2 1 0-3 10YR 3/1 — Is Osg ml as 1m/1a1 0.7 1.6 2 3-21 7.5YR 5/4 — Is 0sg ml cw 3f/2vf 0.7 1.6 3 21-34 10YR 514 — Is Osg ml Cw 1m/2f/2 0.5 1.0 4 34-60 10YR 5/4 f2d 2.5YR 4/8 is 0sg ml — If 0.5 1.0 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPO/Ft" •Eff#1 •Eff#2 ❑ Bodng # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIFI' •Eft#1 -EM#2 • Effluent #1 = BOD > 30 5 220 mg/L and TSS > 3D 5150 mg/L Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L Red Maple Rev Trust (5 bedroom) Soil Report Plot Plan North Red Maple Rev Trust 20670 S Siskiwit Shores Rd Lot 5 Siskiwit Shores S20 T50N R06W Town of Bell 04-010-2-50-06-20-2 On-'°'-ncnnn 2.040 acres c° O aco Privy to be abandoned 6 Proposed site of 5 bedroom hous Proposed site of pole bldg \ �h°tee �rRa -s Scale 1:60 AUG 2 0 2026 eaeld Co. Plannln9 and Zoning Agency 4 NOTES: X Bench Mark = Duplex nail w/orange disc in 10" DBH oak Elev= 100.0' CST 119 00002 -SP Siskiwit take - No well - Siskiwit Lake Elev = 94' Page 3 of 3 RECEIVED CONCRETE HOLDING TANK DESIGN Single Combo Tank Option AUG 312026 INDEX AND TITLE SHEET Barfield Co. Planning and Zoning Agency Project Red Maple Rev Trust - Shop Owner Red Maple Rev Trust (Logan Lewis) Address 20670 S Siskiwit Shores Rd Legal Description Sec 20 T50N R06W Township Bell County Bayfield Subdivision Name Siskiwit Shores Lot No. 5 Parcel ID Number 04-010-2-50-06-20-2 00-282-05000 Plan Transaction ID Number Index and title sheet Page 1 GONS//,°j4a�s Holding tank specifications Page 2 `t •1 Site plan Page 3 Maintenance and contingency plan Page 4 Ks'- ₹ Tank cut sheet Page 5 PSS D235 ESKO MINNESOT0. ' Designer Keith Wile Signatur wPhone No. 218-451-2611 License Number D2388PSS Date 08/27/26 Designed pursuant to: Holding Tank Component Manual For POWTS (Version 21) May 2022-2027 Version 7.1 (07/22) Page 1 of 5 HOLDING TANK SPECIFICATIONS INumber of bedrooms Non-residential estimated flow (gpd) 2000.0 Minimum holding tank volume required (gal) RECEIVED Side A Side B Total 1800.0 11000 2900.0 Proposed tank capacity (gal) AUG 31 2026 Wieser Tank manufacturer WLP1800/1100 Tank model number Bsyfield Co. SJE Rhombus Alarm manufacturer Planning and Zoning Agency Tank Alert 1 lAlarm model number Tank Dimensions and Data Tank Anchor Calculations X for round tank 27317 Jlbs Weight of tank and cover 50.0 Liquid depth below inlet invert (in) 1.50 Safety factor 8.0 Maximum depth of soil cover (ft) 36475 jlbs Weight of anchor required 62.8 Height (in) Outside 33.6 Jin Soil cover req. for anchor or 184.0 Length (in) Dimensions 9.0 yd' Concrete counterweight 102.0 Width (in) J Only HOLDING TANK CROSS SECTION Electrical complies with NEC 300 and SPS 316 optional vent pipe vent pipe manhole cover with es-"" finished location ./' locking device and grade junction c� warning label box —� J 4min 4" min. Y/ 23 in. conduit 18" min. thether I / weight Note: All tank joints, and joints - JJ I between tank openings and building sewer blind plug alarm on I piping are sealed watertight. All inlet to seal pipe and vent materials comply outlet with SPS 384. Manholes with 90% Full 36.8 in locking device are typical for each manhole opening . Side B 1100.0 I gal I I Side A 1800.0 gal 3 in. bedding under tank. Tank is anchored as necessary to negate buoyancy. Project: Red Maple Rev Trust - Shop Transaction Number: Page 2 of 5 Red Maple Rev Trust (4 bedroom) Holding Tank Plot Plan North LJ Red Maple Rev Trust 20670 S Siskiwit Shores Rd Lot 5 Siskiwit Shores S20 T50N R06W Town of Bell 04-010-2-50-06-20-2 00-""' 2.040 acres Wieser W LP18W/1100 holding. tank Within 25of all-weather road Proposed site of 4 bedroom shop 10 Proposed site of S bedroom hous C h , e x \ oZ, \ sqd NOTES: Scale 1:60 K Bench Mark = Duplex nail w/orange disc in 10" DBH oak Elev = 100.0' Siskiwit Lake DECEIVED AUG 312026 BayReld Co. Planning and Zoning Agency - No well - Siskiwit Lake Elev z 94' - All vent, observation & conveyance pipes 4" ASTM 01785 or code equivalent Page 3 of 5 HOLDING TANK — MANAGEMENT PLAN The Private Onsite Waste Treatment System (POWTS) has been designed and is to be installed and maintained according to SPS 383, Wisconsin Administrative Code, Holding Tank Component Manual for Private Onsite Waste Treatment Systems (SBD-10571-P)(R.6/99) and the Bayfield County Zoning Department Sanitary and Private Sewage Ordinance. 1. This POWTS has been designed to accommodate a maximum daily flfEtvgp ._54D _gallons of domestic wastewater per day. 2. The owner of this POWTS is responsible for system operation and AUG 312026 maintenance, locking device, alarm and access. Bayfieldco. Planning and Zoning Agency 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 Section 20 Township 50 N. Range 06 W. Town of Bell Govt. Lot Lot 5 Block Subdivision Siskiwit Shores CSM# Additional Legal Description -T kk Lt $Z 32 - Property Owners Signature u/forms/managementpIan Revised: July 2013 Date HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to SP 383, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10855-P N. 03/07, R. 01/12), and the Bayfield County Sanitary Ordinance. 1. This POWTS is designed to accommodate a wastewater flow of 80 to 580.0 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 RECEI`JFED 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 acW98 3 12026 shall comply with the county sanitary ordinance and SPS 383 and 384 Wis. Adm. Code. PlnnnBind Zo nl gg�, 5. All service events or inspections of this POWTS shall be reported to the county within 30 days. I 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 SPS 383.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons may be contacted: a. Installer ............................. Phone: b. Service Provider .................. Phone: c. Co. Zoning or Health Dept. Bayfield County Zoning Phone: 715-373.6138 11 Project: Red Maple Rev Trust - Shop Transaction Number: Page 4 of 5 WLP1 800/1100 15 -4" ------------TANK SPECIFICATIONS o 0 71„ DIMENSIONS: rr o WALL: 3' a a - - BOTTOM: 5' Y ;III Y COVER: 6" w 4" CAST —A —SEAL Ini 4" CAST—A—SEALi MANHOLE: 24' I.D. PRECAST CONCRETE RISER n HEIGHT: 62 3/4' --- Ir.I LENGTH: 15'-4" 1 mtia•Q. ,-, i(ii ,—�I WIDTH: 8'-6' �. CE ` n 1 ,y, BELOW INLET: 50' U WEIGHT: BOTTOM 18,017 LBS. 'III.-..' I COVER 9,300 LBS, FILTER OR 11115• 1 •„ ° `c3 HAFFI-F fl INLET AND OUTLET: 4' CAST —A —SEAL BOOT OR EQUAL GASKET Lr I y 111:.. INLET AND OUTLET BAFFLE AND FILTER: -- - - WISCONSIN, SEE DETAIL #10 W (OTHER STATES SEE CHART) TOP VIEW RECEIVED LIQUID CAPACITY: 41.86 GALAN (SEPTIC) 25.58 GAL/IN (PUMP) i FUG 317076LOADING DESIGN: 8'-0' UNSATURATED SOIL C r w BayfiedCo. TANK CAN BE USED AS: C3 v Planning and Zoning Agency s r.; SEPTIC/SEPTIC, SEPTIC/PUMP, too 4" VENT OR SEP11C/SIPHON `V 0 2 yo __, - COVER: MIX DESIGN ft8 (NO FIBER) r a� 1 TANK: MIX DESIGN #9 (SMALL FIBER) a -- --- -- --- -- CUSTOMIZED INLET CUSTOM TANKS: . _ _ - __ {-CUT�EI FOR TANKS CONTACT WIESER CONCRETE - I - f¢.,_._ • '.'-.' T KEY NOTES: U i - d? (0 O ui I o , Ql CONCRETE OR EZ-SNAP RISERS ' I [L . I _ 1 -r I�' OPT10NAL 2" OUTLET 16' UP FROM 9 l I II l I BOTTOM OF TANK --T ------- —J -_--_-___..i o Q REVIEWED BY m 0 REVIEW DATE w DRAWINGS SUBMITTED N ODE neW FOR APPROVAL APPROVED BY: S+EEr NO. APPROVAL DATE: 1 a� ANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS PRODUCf5 NEEDED BY: ___ BAYFIELD COUNTY Red Maple Rev Trust CHECKLIST FOR SANITARY APPLICATONS (Logan Lewis) Shop Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) 0 Check List {21 Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) 0 Index Page / title Sheet (Signed by Plumber) (383.22(2)69(c)) P1 Original Plot Plan (383.22(2)2. 3. & 4.a) 62f Cross Section, Over -Head Profile of the System asd Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) ?a 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) B Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) B Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) 0 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) ffi 2 Complete Sets of Plans (383,22(2)(2.) (Note: Sanitary Aoolication and Maintenance Agreements are to be attached to all conies) 0 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 Aoolication: (Include the following Information) IZ I Application Information must include: O 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) {G Project Address or Road Name where driveway is/will come off of) 12( (Owners Phone Number) 0 II Type of Building 0 III Type of Permit 0 IV Type of POWTS System ❑ V Dispersal / Treatment Area Information 91 VI Tank Information Cd VII Responsibility Statement (Plumber's Information) 1st *Date Stamp* Plot Plan: (To Scale or To Dimension) 0 Signature and Plumber Information IZ Surface Elevation of Body of Water Pr Direction and Percent Land Slope 0 Tank and Alter Information and Location 0 Wetlands / Navigable Bodies of Water 0 Absorption Area (Proposed and Existing) 0 Bench Mark (Location, Elevation and Description) RECEIVED AUG 312026 Bayfield Co. Planning and Zoning Agerwy 0 Address Number and Road 0 North Arrow 0 Contour Lines 0 Structures and Driveways 0 Boring Locations 0 Property Unes 0 Well Locations 10 Component Manua'. Versior, cz Legal Descriptions 0 ((e„veyance line, building sewer tine, r`nateriattype and diameter) Turn Over ► Cross -Section and Over -Head Profile of the System: O Surface and System Elevation 0 Position of Observation and Vent Pipes * Dimensions and Depths ❑ Make, Model & Number of Chamber Units in each Cell P1 How many systems will there be on this parcel of land? 1 • Has this property been split? no (Property Statement shows Property History) Property to be split Fees: ❑ Private Sewage System (Septic Tanks) $ 400.00 (a 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 9 Maintenance Agreements $ $ 30.00 (checks made out to Reg of Deeds) RECEIVED AUG 312026 Bayfield Co. Planning and Zoning Agency u/forms/checklisWchecklisuoreyn@aryapps (10/2009);(©7/2011);(()`2(2012,'V 5/2/2012 -dc) Proofed by: HOLDING TANK SERVICING CONTRACT Contract Date Ot/lo/aoaG Holding Tank Owner(s) Name(s) Red Maple Rev Trust (Logan Lewis) This contract is made between the Pumper's Name (Print) Pumper's Signature Pumpers' Registration # We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PR03ECT Legal Des t n; 1/4, 1/4, UWATT0N (Use Tax Statement) 8232 Town of: Lot Size Acreage Section 20 ,Township 50 N, Range 06 W Bell 2.18 GoVt Lot lot 4 L'SM # Vol. Page CSM Doc 4 Lots) Na. Btock(s) No. Subdhdsian: 5 Siskiwit Shores 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; 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. Name(s) (Print) Red Maple Rev Trust (Logan Lewis) Owner's Signature(s) Revised: May 2016 (®May 2018) Personal information you provide may be used for secondary purposes (Priva Subscribed and Sworn to me: on this _day of „Q2i; by: u on: Notary ID 3107188 L Drafted by Document Number/Plan I.D. No. HOLDING TANK Owner Name (s) Owner(s) Mailing Address Red Maple Rev Trust 560 Turner Warnell Rd (Logan Lewis) Mansfield, TX 76063 Parcel Identifier Number (PIN) Agreement Date (same as Notary Date) 8232 We acknowledge that application is being made for the installation of (a) holding tank( on the following property or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Stats. 1/4 of 1/4 Section 20 Township 50 N. Range 06 w Town of Bell Additional Legal Description: Gov't Lot_Lot 5 Block_Subdivision SlSkiwit Shores CSM# Lot_CSM # Vol _Page _CSM Doc# DOCUMENT NUMBER 2O26R-6 1 3562 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED O8/31/2O26 AT 2:13 PM RECORDING FEE: $30.00 PAGES: 1 Return To: Bayfield County ZoRCENED 117 E 5th Street P.O. Box 58 CEp 012026 Washburn, WI 54897 As an inducement to Bayfield County to issue a sanitary permit for a holding tank on the above described prope�.y-we a6f9dZ?8'%% fhe 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, 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. 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. State., 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 Subscribed and sworn to before me on this date: Red Maple Rev Trust (Logan Lewis) '%hd706 Notarized Owner(s) - Signature(s) Notary Public G`�•S�' US %w My Commission pires: Q Drafted by: Keith Wiley Personal Irifonnation you provide may be used for secondary purposes IPnvacy Law, s.15.04 (lilm)l jS: Adallna TlJerin 10/28/2029 xP rss Date: 8/27/2026 ullormslsenitarymold�Win�e ree n. BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): 12' check List ❑ Index Page / Title Sheet (Optional) Fa' Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) 9 Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) Red Maple Rev Trust 13' Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used Q' Property Owner's Information (no prospective buyer's name) ID' Property Location (Accurate Legal Description with Sec/Twp/Range) ID'Road Name (where driveway is/will be coming off of) REC;E VEG IX' Floodplain Elevation, Flow Rate, Comments and Recommendations 67 Complete Soil Boring / Pit Information AUG 2 0 2026 1' Date Soil Evaluation was conducted Plammnc.,a ; WCST Name, Signature, Number, Address and Phone Number 7 *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) ('Bend, Mark (Description, Elevation and Location) C�3'Contour Lines (Example = 98,0' /96.0' /94.0') ID'Property Location (Sec/Twp/Range/, Accurate Legal Description) R3' Borings (Locations and Elevations) ID' Percent and Direction of Land Slope 'Well Location (Including Neighboring Wells, if applicable) ID' Location of Wetland Areas, Floodplain and Navigable Waters ID' Buildings, Driveways, and Structures (Location and Descriptions) ID'Location of Property Lines 13' Existing System Location ID' Address Number and Road Name ID' Current Surface Elevation of Wetlands and Navigable Waters IX'CST, Owner and Property Information ID'North Arrow Fee: Ga'Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforcsts IYFIELD Bayfield County Planning & Zoning Department 117 E 5"h Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: Submission Number: RED MAPLE REV TRUST SR -00497 560 TURNER WARNELL RD MANSFIELD, TX 76063 Transaction Number: SR-00497-4CAAD Description Amount Certified Soil Tests - Review & Filing Fee $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 1116 Paid by: Coyote Septic Works LLC, 11623 E Larson Dr, Lk Nebagamon WI 54849 Payment Type: Check Transaction Date: 9/3/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. 1 -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: RED MAPLE REV TRUST SS -00836 560 TURNER WARNELL RD MANSFIELD, TX 76063 Transaction Number: SS-00836-4DB4E Description Private Sewage System (Holding Tanks) Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 1015 Paid by: Peak Excavation MN LLC Payment Type: Check Transaction Date: 9/10/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-125S STATE SANITARY PERMIT OWNER: RED MAPLE REV TRUST G OV'T LOT: 4 LOT: 5 BLK: SUBDIVISION: Siskiwit Shores 1/4 1/4 SEC: 20, T 50 N, R 6 W TOWNSHIP: Bell SOIL TEST: 129-26 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: AARON WSZALEK EMILY MACGILLIVRAY DATE: 9/10/2026 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: # 938379 Condition: Tank to be connected to 4 BR residence/shop. Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all-weather road. THIS PERMIT EXPIRES 9/10/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION