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HomeMy WebLinkAbout26-30SDepartment of Safety County & Professional Services, Sanitary Permit umber (to be filled in by Co.) .S'S o o% 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 Addres (if different than mailing address) the Department of Safety and Professional Services. Personal intoormation you pro l a secondary %6C/O Slone N w j 13 purposes in accordance with the Privacy Law_ s 15.04(1)(m), Stats. ((ter C p �\�� ' 1= g // 7' I. Application Information — Please Print All Information h70. W ` Property Owner's Name APR 102026 Parcel # knce t Le mks S9 9 y EHiEREn Property Owner's Mailing Address eayneto w. Planning and Zoning Agency ?\kCaut,-� RNt� ��- Property Location Govt. Lot `SF /.,NW '/,, Section ao T 5/ N R OS E o City, State W x I Zip Code J`��{ �I 11-► Phone Number °\ao -13-T - U ag 1 I1. pe of Building (check all that apply) I or 2 Family Dwell ing — Number o f Bedrooms ❑ Public/Commercial — Describe Use Lot # Subdivision Name Block # ❑ City of O State Owned — Describe Use CSM Number O Village of rr 11 XTownof ITI C'O. III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line Cif a licable. A. yyyy ❑ New System t(l Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ,Holding Tank ❑ In -Ground ❑ At -Grade g ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner ist Previous Permit Number and Date Issued Expiration Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units o 'g `m u New Tanks Existing Tanks a o 'v v a aU cc, N ri O d Septic or Holding Tank 600 o aka ( t e&o rJ Dosing Chamber V. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumbe`('s Name (Print) Plumber'" yore MP/MFRS Number Business Phone Number /1A \ col<; (j�e �a8o3 71s-aoa- 7s\ Plumber's Address (Street, City, State, Zip Code) H! /oµniv NC1 SLL�nt 11= EL/RC( VI. County/Depart ent Use dnly %Approved O Disapproved O Owner Given Reason for Denial Permit Fee $ //60 — I Date Issued M� Issuing A Sig re i to complete olans for the system and submit to the County only on naner not less than 8 1/2 x SBD-6398 (R. 03/22) Soil Test# 4/_�(i; Bayfield County RECEIVED O Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) APR 10 2026 I EDWARD J WROBLEWSKI a certified soil tester determine that in m X� yF i w Agency 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 KOREY J LEMKE Property Address 3124 COUNTRY RUN DR Telephone, APPLETON, WI 54914 920-737-4287 Accurate Legal Description is requested: SE 1/4 of NW 1/4 Contractor ED'S MECHANICAL LLC Authorized Agent EDWARD J WROBLEWSKI Agent's Telephone 715-209-4055 Written Authorization Attached: Y or ND Section 20 Township 51 N. Range 05 W. Town of BAYFIELD Additional Legal Description: PAR IN SE NW & NE NW N OF HWY 13 IN V.112 P.907 LESS PAR FOR HWY IN V.515 P.384 806A Govt. Lot Lot Block Subdivision Lot CSM# Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# 5494 Indicate reasoning for your determination: CLAY SOILS �G /7/ � Signature of Cou Off ial Date Acreage 5.26 Signature of Certified Soil Tester Date SP -72000013 Certification # (Submit -a Plot Plan & Fee) u/forms/so i itestwa iver(KLK) June 2018 RECEIVED APR 10 2026 Bayfield Co. Planning and Zoning Agency EDWARD J WROBLEWSKI CST #SP -72000013 SOIL TEST PLOT PLAN KOREY LEMKE 26510 STATE HIGHWAY 13 BAYFIELD, WI 54814 PAR IN SE NW & NE NW N OF HWY 13 S20 T51 N R05W TOWN OF BAYFIELD, WI SCALE: 1" = 40' Existing Septic Tank Lot Line Lot Line>100' 100' T RECEIVED CONCRETE HOLDING TANK DESIGN Single Tank Option APR 10 2026 INDEX AND TITLE SHEET Bayfieki co Planning and Zoning Agency Project Korey Lemke - Holding Tank Owner Korey Lemke Address 26510 State Hwy 13 WI 54814 737.4287 Legal Description Par in SE NW&NW&NE NWNofHwy 13inV.1142P.907less Parlor Hwy inV.515P.384S20,T51N,R0W Township Bayfield County Bayfield Subdivision Name Parcel ID Number 5494 Plan Transaction ID Number Index and title sheet Holding tank specifications Site plan Maintenance and contingency plan Soil test Soil test plot plan Holding tank agreement holding serviicing contract Holding tank specifications Designer Michael Wroblewski Sign ature/f� /(_� (�� ' License Number 1288503 Lot No. Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Phone No. (715) 209-7521 Date 12/11/25 Designed pursuant to: Holding Tank Component Manual For POWTS (Version 2.0) SBD-10855-P (N. 03107, R. 01/12) version7.0(11/12) Page 1 of 9 HOLDING TANK SPECIFICATIONS Number of e bedrooms Non-residential estimated flow (gpd) 2000.0 Minimum holding tank volume required (gal) 2000.0 Proposed holding tank capaci ty Wieser concrete Tank Manufacturer WLP2000-MR' Tank model number SJElectro systems manufacturer WH101 Alarm model number RECEIVED APR 10 2026 Piannln BaYfiekt do' B and Zoning Agency limensions and Data Tank Anchor Calculations X for round tank 22230 lbs Weight of tank and cover 0 Liquid depth below inlet invert (in) 1.1QJ Safety factor I Maximum de th of soil cover (ft) 12166 lbs Weight of anchor required 0 Height (in) Outside 13.4 in Soil cover req. for anchor or 0 Length (in) OnlyDimensions 3.0 yd3 Concrete counterweight 0 Width (in) junction box. conduit HOLDING TANK CROSS SECTION manhole cover with locking device and finished I vent cap warning label grade T4" mn. 1 12" min. 23 in. Manhole and vent locations may be reversed. vent p pe o tether weight service alarm on Electrical as per NEC 300 and SPS 316 3 in. bedding under tank. 12.0 in. 31.0 in Note: All tank joints, and joints between tank openings and piping are sealed watertight. All pipe and vent materials comply with SPS 384. Tank is anchored as necessary to negate buoyancy. 18" min. building sewer inlet Project: Korey Lemke - Holding Tank Transaction Number. Page 2 of 9 RECEIVED APR 10 2026 Plannin and Co' 0 nd Zoning Agency KOREY LEMKE HOLDING TANK PLOT PLAN 26510 STATE HIGHWAY 13 BAYFIELD, WI 54814 PAR IN SE NW & NE NW N OF HWY 13 S20 T51 N R05W TOWN OF BAYFIELD, WI SCALE: 1"= 40' Existing Septic Tank Power P LI Well 4" pvc cleanout House Lot Line > 100' Lot Line> 100' T 2000 Gallon Holding Tank Garage Driveway L O T PAGE 3 OF 9 RECEIVED APR 10 2026 HOLDING TANK MANAGEMENT PLAN BaYaeklCc Planning and Zoning Apanly This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to SPS 383, Wis. Admin. Code, the Holding Tank Component Manual (SBD-1 0855-P N. 03/07, R. 01/12), and the Bayfield County Sanitary Ordinance. 1. This POWTS is designed to accommodate a wastewater flow of 40.0 to 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 Service 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 SPS 383 and 384 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 30 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 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 .........................Big Big Lake Plumbing Phone: 715-209-7521 Service Provider........ c. Co. Zoning or Health Dept. 11 Birch Street Sepiic Service Bayfield County Planning & Zoning Phone: 715-373-5683 Phone: 715-373-6138 Project: Korey Lemke - Holding Tank Transaction Number. Page 4 of 9 W2000 -MR TANK SPECIFICATIONS 12'-7" DIMENSIONS: a WALL: 2 1/2" a BOTTOM: 4" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 66" O.D. LENGTH: 12'-7" O.D. 4" CAST -A -SEAL 4" CAST -A -SEAL �� �� WIDTH: 7'-2" O.D. w BELOW INLET: 53" O.D. Ni LIQUID LEVEL• 46" `o I I I WEIGHT: BOTTOM 9,430 LBS. COVER 5,940 LBS. n $ E 2 FILTER OR BAFFLE INLET AND OUTLET: 3 m o c g �� ii 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: w m o o ysW i< ------------- WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) W I RECE%VED LIQUID CAPACITY: 42.92 GAL/IN WW, TOP VIEW APR 1 0 20Th HOLDING TANK: c OUTLET HOLE PLUGGED O o Co ACTUAL CAPACITY: 2,126 GALLONS C.7 Z BaYb Zoning Agent' a 04 Planning and LOADING DESIGN: 8'-0" UNSATURATED SOIL r,r)) o, w TANK CAN BE USED AS: 1 o0 J SEPTIC / HOLDING / PUMP OR SIPHON CIs ro ---- ---- - COVER: MIX DESIGN #8 (NO FIBER) INLET _� TANK: MIX DESIGN #10 (STRUCTURAL FIBER) T __ ___ ___ OUTLET CUSTOMIZED TANKS: < m U FOR CUSTOM TANKS CONTACT WIESER CONCRETE IL iD a e I a N 2' L4 0 f 2 z - o f REVIEWED BY 0 0 REVIEW DATE 3 a U, SIDE VIEW DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: SHEET NO. APPROVAL DATE: 1 Z 1KS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS PRODUCTS NEEDED BY: OF HOLDING TANK SERVICING CONTRACT Contract Date This contract is made between the Holding Tank Owner(s) Name(s) RECEIVED APR 10Z026 Bayfield Co. Planning and Zoning Agency 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) Tax ID# PROJECT I Legal Description: (� Sy 1/4, 1/4, LOCATION (Use Tax Statement) 9 / Town of: Lot Size Acreage c Section �o ,Township ) I N, Range CC w ��11 Go✓t Lot Lot# CSM # vol. Page CSM Doc # Lot(s) No. Block(s) No. Subdivision: 1. The owner agrees to file a copy of this contract with Bayfield County as required in SPS 383.55, Wis. Adm. Code 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees 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 serv(g g contract with the local government unit and the County named above within (10) business days from the dates this service contract. on this 1_day of Koc lam - 4 by: My commission expires on: _ w'a'ry ()t /" (s(,C Drafted by Revised: May 2016 (®May 2018) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (p(m)] TANK DOCUMENT NUMBER 2025R-610054 owner Name ts) ?) 1j Rvc 3V Koce� Lemke A \QAo� W� s149I ti Parcel Identifier Number (PIN) Agre ment pa e (same as Notary Date) 51199 �i�la� a� 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. 114 of 1/4 Section aC) Township cj N. Range OS W Town of 1�"�aTt'21C� Additional LegalDescription:Pc&( ir\SFNW+NFM0 4ok\kwy13 Gov't Lot _ Lot Block_Subdivision CSM# Lot__CSM # Vol _Page _CSM Doc# DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 1 1 /2O/2O25 AT 8: 1 5 AM RECORDING FEE: $30.00 PAGES: 2 (BIG LA��E PLMBING A 4g1 County Highway C Washburn, W1 54891 As an inducement to Bayfield County to issue a sanitary permit for a holding tank on the above described propREEQdo the following: pppp 11 pp 1. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holdARa4Q1ZNlJo 07rtrt99�� n 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, Slats., Ba �g1dCgenter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing tidRmeii�IlNas 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. 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. agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a existence of the agreement to be determined by reference to the property where the holding tank is installed. Owner(s) Name(s) — Please Print r K''�n1 din VV Subscribed and sworn to before me on thi an 08e F, 9J' NCly2M btn )°5 Notarized Owner(s) — IgnatureW Notary Public It,t a ( My Commission Expires: Drafted by: f1\ce CA©\e�1JSICDate: I'ZI1. uxo5uwt� Personal information you provide may be used for secondarypurposes IPrivaoy Law. s15.04 (l)(n,fl utlorrrwisanilary/holdingrarhagmemem.doc 3W ne 2018 RECEIVED APR 102026 EXHIBIT A TO QUIT CLAIM DEED 6aYfield Co. Mueller to Lemke Planning and Zoning Agency A parcel of land in the East %3 of the NW '/4 of Section 20, Township 51 North, Range 5 West, in the Town of Bayfield, Bayfield County, Wisconsin. To locate the point of beginning, commence at a 2" iron pipe, which is the South '/4 corner of said Section 20, and run N.00°03' 17"W. along the N -S '/4 line, 3721.38 feet to a 1-1/4" iron pipe on the North right-of-way line of Wisconsin State Highway 13, which is the point of beginning. Said point of beginning is 1582.40 feet South, 00°03'17"E. of the North '/4 comer of said Section 20. Thence from said point of beginning by metes and bounds: N.00°03' 17"W. along the N -S '/4 line, 450 feet to a 1-1/4" iron pipe; Thence S.89°56'43"W. 400.00 feet to a 1-1/4" iron pipe; Thence S.00°03' 17"E. parallel to the N -S '/4line, 741.28 feet to a 1" iron pipe on the North right-of-way line of said Highway 13; Thence N.53°53'00"E. along said right-of-way line, 494.82 feet to the point of beginning; LESS the following described parcel: A parcel of land in the East %3 of the NW %4 of Section 20, Township 51 North, Range 5 West, in the Town of Bayfield, Bayfield County, Wisconsin, described as follows: Commencing at the SW comer of Section 20 which is marked with a 2-1/2" Brass Cap Iron Pipe; thence Nl°30'18"E, 1581.34 feet, along section line to the South R/W line of STH 13 as laid out and traveled January 1, 1990. Thence N1°30'18"E, 138.97 feet; to a point on a curve, concave to the north whose long chord is 136.08 feet and bears N67°56'49"E; thence 140.02 feet along the arc of said curve; thence N47°34'13"E, 293.21 feet; thence N62°03'57'3 , 203.89 feet; thence N62°34'47"E, 189.55 feet; thence N50°23'51"E, 700.00 feet; thence N46°06'30"E, 200.56 feet' thence N64°26'02"E, 103.08 feet; thence N50°23'51"E, 280.06 feet; thence N51°29'50"E, 221.84 feet; thence N45°34'48"E, 244.90 feet; thence N54°59'34"E, 360)42 feet; thence N62°35'14"E, 302.66 feet; thence N54°59'34"E, 143.51 feet; thence S0°59'33"W, 55.62 feet; thence S0°59'33"W, 181.18 feet; thence N61°51'15"W, 80.22 feet; thence S54°59'34"W, 168.09 feet; thence $63°31'25"W, 101.12 feet; thence S54°59'34"W, 200.00 feet; thence 533°11 '29"W, 107.70 feet; thence S54°59'34"W, 60.42 feet; thence 563°24' 14"W, 239.58 feet; thence S51°29'50"W, 217.62 feet; thence S50°23'14"W, 1080.06 feet; thence S42°16'24"W, 389.19 feet; thence S55°7'6"W, 333.29 feet; thence S74°56'26"W, 214.35 feet; to a point of a non -tangent curve, concave to the north whose long chord is 196.43 feet and bearsS68°40'56"W; thence 196.51 feet along the arc of said curve; to the point of beginning. Said parcel contains 0.21 acres more or less exclusive of lands previously acquired or now used for highway purposes. V 1142 P908 BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS RECEIVED Submit the Following (Use Permanent Ink): APR 1 0 2026 '1] Check List /❑\Index Page / Title Sheet (Optional) ❑ Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) ' Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) Bayfield Co. Planning and Zoning Agency 'Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used \JJProperty Owner's Information not prospective buyer's name) Property Location (Accurate Legal Description with Sec/Twp/Range) Road Name (where driveway is/will be coming off of) O Floodplain Elevation, Flow Rate, Comments and Recommendations O Complete Soil Boring / Pit Information JDate Soil Evaluation was conducted )(.C5T Name, Signature, Number, Address and Phone Number *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) O Bench Mark (Description, Elevation and Location) O Contour Lines (Example = 98.0' /96.0' /94.0') J Property Location (Sec/Twp/Range/, Accurate Legal Description) Borings (Locations and Elevations) El Percent and Direction of Land Slope Well Location (Including Neighboring Wells, if applicable) ❑ Location of Wetland Areas, Floodplain and Navigable Waters Buildings, Driveways, and Structures (Location and Descriptions) Location of Property Lines Existing System Location Address Number and Road Name O Current Surface Elevation of Wetlands and Navigable Waters ACST, Owner and Property Information G North Arrow Fee: A7"Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checkl ist/checkl istforests BAYFIELD COUNTY RECEIVED CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) APR 10 2026 Check List Bayfield Co. Planning and Zoning Agency Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) Original Plot Plan (383.22(2)2. 3. & 4.a) Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer O Pump Tank Diagram, Alarm and Pump Curve (when applicable) l 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) )Q Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) X$ Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) 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 ADDlication: (Include the following Information) I Application Information must include:23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) v' Project Address or Road Name where driveway is/will come off of) n❑ (Owners Phone Number) II Type of Building Q.III Type of Permit IV Type of POWTS System V Dispersal / Treatment Area Information VI Tank Information VII Responsibility Statement (Plumber's Information) *Date Stamp* Plot Plan: (To Scale or To Dimension) r\ Signature and Plumber Information Address Number and Road ❑ Surface Elevation of Body of Water North Arrow ❑ Direction and Percent Land Slope O Contour Lines ❑ Tank and Filter Information and Location O Structures and Driveways ❑ Wetlands / Navigable Bodies of Water ❑ Absorption Area (Proposed and Existing) ❑ Bench Mark (Location, Elevation and Description) Component Manual Version 5 Boring Locations 9Q Property Lines )i'S Well Locations Legal Descriptions Turn Over ► Cross -Section and Over -Head Profile of the System: ❑ Surface and System Elevation ❑ Position of Observation and Vent Pipes RECEIVED ❑ Dimensions and Depths APR 10 2026 ❑ Make, Model & Number of Chamber Units in each Cell Bayfield Co Planning and Zoning Agency Property Information How many systems will there be on this parcel of land? i Has this property been split? N (Property Statement shows Property History) Fees: ❑ Private Sewage System (Septic Tanks) $ 400.00 )I 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 ❑ Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) u/forms/checklists/checklistforsanitaryapps (10/2009);(®7/2011);(02/2012)(05/2/2012 -dc) Proofed by: VWXY--IFIELD 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: LEMKE, KOREY J 3124 COUNTRY RUN DR APPLETON, WI 54914 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00395 Transaction Number: SR-00395-43C3E Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 2954 Paid by: Ed's Mechanical, 1491 County Hwy C, Washburn WI 54891 Payment Type: Check Transaction Date: 4/27/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. 13- 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: LEMKE, KOREY J SS -00723 3124 COUNTRY RUN DR APPLETON, WI 54914 Transaction Number: SS-00723-43C7F Description Private Sewage System (Holding Tanks) Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 2955 Paid by: Ed's Mechanical, 1491 County Hwy C, Washburn WI 54891 Payment Type: Check Transaction Date: 4/27/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-30S STATE SANITARY PERMIT OWNER: KOREY J LEMKE G OV'T LOT: LOT: BLK: SE 1/4 NW 1/4 SEC: 20, T 51 N, R 5 W TOWNSHIP: Bayfield SOIL TEST: 24-26 REPLACEMENT SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: MICHAEL WROBLEWSKI TRACY POOLER Authorized Issuing Officer DATE: 4/27/2026 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: # MP 1288503 Condition: Old System needs to be properly abandoned per SPS 383. Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all-weather road. THIS PERMIT EXPIRES 4/27/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION