HomeMy WebLinkAbout26-29S�'""�vr•z
Industry Services Division
County
,a
4822 Madison Yards Way
Bayfield
= GGG
Madison, WI 53705
P.O. Box 537
Sanitary Permit Number (to be filled in by Co.)
Madison, W153707
i_Xl
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 information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats.yf
RECEIVED
TBD - Mariner Mile. BaleldWI
,
I. Application Information — Please Print All Information
Property Owner's Name
Parcel #
Ryan & Carrie Headley APR 082026
39312
Property Owner's Mailing Address
Barfield Co.
5012 Falling Leaves Ln. Planning and Zoning Agency
Property Location
y��o�
Govt. Lot
City, State I
Zip Code
Phone Number
Mcfarland, WI
53558
608-286-4568
. Section 35
T51 N R04 Eor*
I1. Type of Building (check all that apply)
Lot#
lil or 2 Family Dwelling — Number ofBedrooms2
3
Subdivision Name
❑Public/Commercial — Describe Use
Block #
Cityof
State Owned —Describe Use
JVillage of
CSM Number
#2342 V13 P304
OTnxm of Russell
Ill. 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
applicablej
A.
�✓ New System
❑Replacement System
ljlOther Modification to Existing System (explain)
Additional Pretreatment Unit (explain)
B.
❑Holding Tank
ZIn-Ground
1t -Grade
fl Mound
Individual Site Design
Other Type (explain)
(conventional)
C.
❑ Renewal Before
Revision
jChange of Plumber
fiTrans(er to New Owner
List Previous Permit Number and Date Issued
Expiration
NA
IV.
Dispersalffreatment Area and'fank Information:
Design Flow (gpd)
Design Soil Application Rate(gpd/sf)
Dispersal Area Required (st)
I Dispersal Area Proposed (st)
System Elevation
300
0.7
428
452
94.0
Capacity in
Total
# of
Manufacturer
Tank Information
Gallons
Gallons
Units
o
o
New Tanks
Existing Tanks
�
Vv.
—y
L U
N
at
ti U
G
Septic or Holding Tank
750
750
1
Superior Precast
✓
Dosing Chamber
0
V. Responsibility Statement- I, the undersigned,
assume responsibili for installation of the POWTS shown on the attached plans.
Plumber's Name (Print)
Plumber's SignatI
MPIMPRS Number
I Business Phone Number
Jason Kuettel"r;;
675751
715-798-3355
Plumber's Address (Street, City, State, Zip Code)
PO Box 66 Cable, WI 54821
VI, County/Department Use Only
pproved
O Disapproved
�Permit Fee
$VV—
Date Issued (Y1
lss 'neL[Snature
�5jq
❑ Owner Given Reason for Denial
7 7 e y�
Conditions of Approval/Reasons for Disapproval
are tea. etiaA, 7// tt
717/
ie c -A ,!/ firs 7
e 4acbdWd.
•� •w•••e•••v ,.... ...=sp.en, am. suumn wine county omy on paper not less then a lax 11 inches in size
SBD-6398 (R. 02/22)
U
_
'Q' Wisconsin De artmentof Safety &Professlo al Services / of
Division ofIndusby services MAY 1 6 ZOZ4 Page
SOIL EVALUATION REPq1 Oct flel Cb. Zcnhip Ueut. #62-24
In accordance with SPS 385, Wiis. Adm. Code County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,
j?rWFltr_�
but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. 2 j 1
scale or dimensions, north arrow, and location and distance to nearest road. 3 C% ) 7 C] 39 J l f�
Please print all Information. Reviewed i1byd) /t r] Diane
Personal information you provide may be used for secondary purposes (Privacy Lew, s. 15.04(1)(m)). l t454 nH Ql 1 I p/ 2 VA
Property Owner Property Location ❑ IjI
p n ?oN i [ lL Govt Lot pt✓Y. tvty. s21 T Si N R OY E(or) W
Property Owner's Mailing Address Site Address or CSM and Lot #:
gSo O t_Co. w Y 1- )J
City, State, Zip I Phone Number ❑ City ❑ Village c�A
?/liF/C--t2), t —r 5 9 L/`I (bob ) -H 6 $6 6 J1zL `—' Town Nearest Road
/wn,Rt .-'Et /L, IL f-
OI NewConstruction Use: ® Residential INumberofbedrooms TO b Code derived deslgnflow rate TO D GPD
❑ Replacement ❑ Public or commercial —Describe: Flood Plan elevation if applicable ft.
Parent material O"f'l'lt?if—
tsaepd recommendado s: G'' 7V 0.i
Cvhl General comyl/CL-Cr&cs-fel\ A91w4 1y
Boring# ❑Boring
[Pit
Ground surface elev2 . V) ft. Depth to limiting factor 10 l in. I elev. aK Nlf .
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Cr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ftr
•Eff#1
•Eff#2
6--L
7'yJ
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—
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—
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J,
aBoring #
❑Boring cc��
RPit Ground surface elev.77.22 ft. Depth to limiting factor≥ 101 in. / elev.8-•v ft.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPDIFt2
•Eff#1
'Eff#2
a -z
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I. 6
CST Name (Please Print)
7 (-4-CO
I Signature ^
CST Number
oat
Address
O '?u' 6.6 CA+he IT'
I Cate E alu tlon Conducted I
I $ -
Telephone Number
-_7 S
Effluent #1 = BOD > 305 220 mg/L and TSS > 305150 mglL • Effluent #2 = BOO, 5 30 mg/L and TSS 5 30 mg/L
SBD-8330 (R03122)
RECEIVED
APR 082026
Wisconsin Department of Safety & Professional Services BaY5eM CA
Co.
Division of industry Services Planning and Zoning Agency
SOIL EVALUATION REPORT
In accordance with SPS 385, Wis. Adm. Code County 17A"IF,€C
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include,
but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D.
scale or dimensions, north arrow, and location and distance to nearest road. 3Q/ )7 S
Please print all information. Reviewed by
Personal information you provide may be used for secondary purposes (Privacy Law s 15 04(1)(m))
Page / of
Date
Property Owner Property Location ❑ ry
t-i. f_rt- ?0,N i USC— GovLLot ( it '/. /ut'/. 525' T 5 / N R O r -f E (or) W
Property Owner's Mailing Address Site Address or CSM and Lot #:
SSo pima co. -fl -r iJ
City, State, Zip Phone Number ❑ City ❑ Village (� Town Nearest Road
ilfrilic-t2 1 -Jr 5V/'1 (°W) t.JJi2tL J ftlr'€C /l. ILL
New Construction Use: ® Residential/Numberofbedrooms 7'/] b Code derived designflow rate 717 D GPO
❑ Replacement ❑ Public or commercial- Describe: Flood Plan elevation if applicable ft.
Parent material O' -fl --'pc 2r-
General comments and recommendations: 'bEJ / 0r 7v O' i
Boring # Boring
JPit
Ground surface elev%. t> ft. Depth to limiting factor l0 ( in. / elev.b8''lfff.
Horizon
I Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPF��-
Eff#1It
d -Z
'rn-o
3
;9-f/
5 pn
—
S
3 5
—
f
o7
J,
Pq Boring #
❑Boring
QaPit Ground surface elev.7 7.12 ft. Depth to limiting factor> /ot in. / elev.$%.13 ft.
c.m e....r......:..., c..,,.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft°
•Eff#1
*Eff#2
o- Z
7J'< —'A
—
CJ
o-16
/".I
v1
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OS≤
ml
rJ
tFs
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7
/T • /d/
S Yet.
S
_
,, !
—
1
o.')
/, 6
CST Name (Please Print)
I Signature
CST Number
_
Address
Iate E alu tion Conducted
I Telephone Number
O %Try[ ,6.G %11-aLE y
S 'Z
•»S
Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 s 150 mg/L' Effluent #2 = SOD, 5 30 mg/Land TSS 5 30 mg/L
SBD-8330 (R03/22)
Page Z of
Boring #
❑ Boring
Pit Ground surface elev. .Z5ft.
Depth to limiting Factor 111 in. / elev. O.J ft.
Soil Application Rate
Horizon Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ftr
'Eff#1
'Eff#2
O-&
,f-r1.3/z
_
Lf
e G
(
w
I
a.7
1G
Z y- z
sy1r —
Sr
c,S6
s'-'
pi4
0.7
(;
3 zS n
mss/ —
s
osG
I
I —
(
o.)
i. G
❑ Boring #
❑ Boring
❑ Pit Ground surface elev._Ft. Depth to limiting Factor in. / elev.ft.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. RECEI Eb
Soil Application Rate
GPD/Ft2
Eff#1
'E##2
R 08
026
P
nning and Zoni
g Agency
OBoring #
❑ Boring
❑ Pit Ground surface elev._ft. Depth to limiting factor in. / elev.ft.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
son Application Rate
GPO/Fir
•Eff#1
•Eft#2
Effluent #1 = BOD > 30 s 220 mg/L and TSS >30s 150 mg/L ' Effluent #2 = BOD, 5 30 mg/L and TSS s 30 mg/L
! 5/AIL c' -LU—TsD _--
- SYSTEM F- _ % OF
SITE MAP
1
:,
PLOT PLAN
PT C RYi+*-J trn≥tI r
717
_70t_c1
c?7;E0; ro?5 i 3 �.}21 v _
.
�orrn001 GI„s.
-
dMCj:'p^O A i&- P'a- PRINT IN eP(Nc
O(T9xlAra} �?, a'/^'G I(.13 C:K3S+) Q c 3 - a na::
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v 19.::I;; r:194l9 S
'i S�%�J^:� - I. f .]q wJrs ]- i�Jib3 !e !1!_!'AJa
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RECEIVE
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-5 s
-
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CSY 07Ioot
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PAGE 1 OF 4
In -Ground Gravity Plan
Index & Cover Sheet RECEIVED
Component Manual Design References: APR 0 8 2026
In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Bayfied Co.
Planning and Zoning Agency
Pg 1 of 4
Pg 2 of 4
Pg 3 of 4
Pg 4 of 4
Index & Cover Sheet
Plot Plan
Dispersal Area Cross -Section & Plan View
Management Plan
Attachments: Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Man
Project Name / Description
Headlev 2 Bed
Owner Name(s): Ryan Carrie Headley
Owner Address: 5012 Falling Leaves Ln. Mcfarland, WI
Phone: 608 -286 -4568
Zip: 53558
Project Address:
TBD - Mariner Mile.
Bayfield, WI
Govt. Lot:
1/4 of
1/4, Section 35
, T51 N -R04 E❑or W
Township: Russell County: Bayfield
Project Parcel ID #: 39312
Designer Information
Designer Name: Jason Kuettel
Designer Address: PO Box 66 Cable, WI
E-mail: tim@andryras.com
License Number: 675751
Remarks:
Phone: 715 -798 -3355
Zip: 54821
Signature: Date: H G�L6
Original s gna ure required on each submitted copy.
5''L c'VALU, TIJ;.; scALti-4p
SITE MAP - - I�JfJ=r,.l L0r
i ur: a
r•.. 9r "/////i7;; ,' — PLOT PL
C4LIo'- Pr : _ _y�0 V
C RYA vizna�� Y //
r .,or I' 3
°rte haa�_rL lL /
3: /�_;I f !I enL� .. - .
jNh1� 1--r%1NL PPr N'' -- -
N e,1pNf``
't!syr,ca j:fo_=lcn.'�7 p I:a_a:: cr ISp, o-ap-
or:n3 3'3w yruc+. 9; gj ;n ca^ol,ry a•: sui[ah inknals
y�WNclL•; IZIAa`f Hv A:rZLt:7 ��
I
LE A 1'' 4—/"t/NL
�' i �3 5 TSPn) I lZo4 L� ' i �' , �—C2i--�M-G---6�.ns•'+[��c tH►r.dnc,!
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i:; T -
wry /1
i=vvat pa a
p?¢e.c'1rt �S� w P
-. ::Y--- H
JI1III11)--'\ -/iJ7<-rTT:---/
/_ /
a -- /
'• 1ti
APR 0 8 2026
1 sayteld co. ��� ��tRls�
P° lK' CC -LL: 21ZeN f L Y Planning aM Zoning Agenq
P'tsptr7
IN -GROUND GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard -W Chambers
3 -ft Trench (down -sizing credit)
SOIL COVER
RECEIVED
APR 082026
min. 12"
(typical)
Septic Tank(s) Manufacturer.
Superior Precast
Septic Tank(s) Volume(s):
750 gal gal gal gal
Effluent Filter Manufacturer:
Orenco
Effluent Filter Model #: FT -0822
12"
min.bench
depth (tyMca TYPICAL TRENCH
9 . '
"•a ;•: CROSS SECTION VIEW
(typical) dal) .. (No Scale)
System Elevation = 94.0 ft
hayfield Co. (typical)
Planning and Zoning Agency
Quick4 Standard -W
w/ End cap (Show location of inlet / outlet pipe connection on plan view.)
(typical)
(- Z ------- - - - - - - - -�----
iI'•bt•ahl+tH!lltlUtluttk
B=46 ft
(typical)
INSTALL PER TRENCH:
11 Quick4 Std -W @ 20 ff EISA/chamber = 220 ft'
+ Pairs of end caps @6 ft' EISA/pair = 6 ft'
= Proposed EISA per trench = 226 ft'
Provide minimum 3 ft
separation between trenches.
Observation Pipe
(typical)
Install per manufacturers
/ Instructions.
TYPICAL TRENCH
PLAN VIEW
(No Scale)
TA=3.0ft
(typical)
'—Quick4 Standard -W Chamber
(typical)
(mfd by Infiltrator Systems, Inc.)
Install pursuant to manufacturer's instructions.
Required Infiltration Area = 428 ft'
x 2 trenches = Proposed Total EISA = 452
RESET
ft2
Distribution Method:
branched manifold
D
G)
m
W
O
PAGE4OF4
In -ground Gravity Management Plan
IMPORTANT:
The owner of this in -ground gravity system 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 system 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.
Maximum Dispersal Area Operating Limits:
Design Flow = 300 gpd; BOD5 ≤ 220 mgL-'; TSS ≤ 150 mgL-'; FOG ≤ 30 mgL'
Inspection Checklist INSPECT EVERY 3 YEARS RECEIVED
o type of use
o age of system APR 08 2026
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) Barfield Co.
o material fatigue (i.e., leaks, breaks, corrosion, etc.) Planning and zoning Agency
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes)
o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
o extent of ponding in distribution cell prior to dosing
o dosing irregularities - if applicable (Le., pump re -cycling, float switch settings, etc.)
o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats, when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company: Andry Rasmussen & Sons Phone: 715-798-3355
Local government unit: Bayfield Co. Zoning Phone: 715-373-6138
Local government unit address: 117 E 5th St. Washburn, WI
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 treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be
abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
SEPTIC T
CROSS SECTION AND S?EC', ICA.TIOP7S
4" Gc4•4oPVC INSP. DTPE 6 " M_ii. ABOVE G?-.D'.(opT,�
(when tnle+ me dole Yc buried ) J
FINISHED GRADE
r I
18" HIN.
I pi LET
IC
APPROVED
PIPE 3'
ONTO SOLID
SOIL
-APPR D &&&E-
0 FILTER
MFG. OK4,)En
model rt T0912
3" APPROVED BEDDING UNDER TMJC
SPECIFICATIONS
SEPTIC.
TANK JIAWUFACTURER: VPL'LIca Pt-ec4cr
TANK S?LES: Sa?TI_C %sd CAL.
NOTES:
APPROVED
MANHOLE
W/ LccK4
WARu1,UL4. LAB6L
4" KIN.
OUTLET
RECEIVED
APR 08 ZUZ6
Barfield Co.
Planning and Zoning Agency
rVL- ootR
Private Sewage System Ma enance Agreement
Owners) Name ,
Owner(s) Mailing Address / II �,�C[
50(a S>q//,? Lcwyrs !,h- '4€, ,QL(ANQ , WL .�"3SSi3
As owner, I (we) do hereby certify the private sewage system will be installed in
accordance with the certified soil tester's report and approved plans and specifications
on file with Bayfield County Planning and Zoning Department. The system will be
operated in such a manner as to meet the designed plans. I (we) agree to maintain said
private system at the below listed location in accordance with rules established in the WI
Adm. Code, as from time to time amended. (COMPLETE Legal is required)
114 of 114 Section 35 Township S I N. Range _y W
Additional Legal Description:
Town of SSEL-L
Lot_ Block Subdivision
Lot? CSM# ZJy1-vol. /3 Page 3"It CSMDoc# toT'ti2-&x3631
(Acreage) / , s ( Gov't Lot
DOCUMENT NUMBER
2026R-6 1 1712
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY. WI
RECORDED
O4/O8/2O26 AT 2: 1 O PM
RECORDING FEE: $30.00
PAGES: 1
Return To:
Planning and Zoning Department
P] in -ground gravity ❑ In -ground dosed ❑ in -ground pressure distribution S$R9®0yj@2fi
❑ Mound ❑ At -grade Sewage System ❑ Other Bayfield co.
Area
Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of
installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make
such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum.
Pump Chamber (system types B, C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided
above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components.
Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance
with manufacturers specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wiis. Aclmin. Code.
Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified
septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once ever; three
(3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface.
Mounds, At -grade, and In -ground Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed It needed when
the wastewater distribution cell component is inspected as provided above.
Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfield Cer:nty for
inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any
human health hazard caused by the system. 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 c'rarges
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 provldecby hlw.
The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such property.
y4
Drafted by:
r:_)9ble-y
Date:
Subscribed and sworn to before me on this
3
llv 4.
Proofed by _:__
utformslsanitary/sepdcmaintenneattrnem enl
Revised ,My 2020
I34YFIELD 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:
HEADLEY, RYAN L & CARRIE A
5012 FALLING LEAVES LN
MCFARLAND, WI 53558
Description
Private Sewage System (Septic Tanks)
Submission Number:
SS -00722
Transaction Number:
SS -00722-43A70
Amount
$400.00
Total: $400.00
Payment Amount: $400.00
Reference: 15008
Paid by: Andry Rasmussen & Sons, PO Box 66, Cable WI 54821
Payment Type: Check
Transaction Date: 4/24/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
BAYFIELD COUNTY
SANITARY PERMIT (#04)-26-29S
STATE SANITARY PERMIT
OWNER: RYAN L & CARRIE A HEADLEY
GOVT LOT: LOT: 3 BLK:
CSM: #2342 V1 3 P304
1/4 1/4 SEC: 35, T 51 N,R4
4
TOWNSHIP: Russell
SOIL TEST: 62-24
NEW SYSTEM
SYSTEM TYPE: Non -Pressurized In -Ground
PLUMBER: JASON KUETTEL
TRACY POOLER DATE: 4/24/2026
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: # MP 675751
Condition: Properly Maintain System Per Recorded Agreement. Affirm that if trenches are at
different elevations, that the uphill trench fill first.
THIS PERMIT EXPIRES 4/24/2028
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION