HomeMy WebLinkAbout26-35Sp
Department of Safety
& Professional Services,
County p r
Da i
Ito
Sanitary Permit Number be filled in by Co.)
a�3
'
'6•cm,x,.o�'
Industry Services Division
a�-ass
O D �3I
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
Project Address (if different than mailing address)
Rd
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to
Professional Services. Personal information be for secondary
the Department of Safety and you provide may used
8-7 oo LcxrV ic-K.
purposes in accordance with the Privacy Law. s. 15 04(l)(m), Stats.
Po IA) i kit s'J9GS
Print All Information
I. Application Information —Please
ri 43,
Property Owner's Name
RECEIVED
Parcel ll
Kc P No.be-r
ox ID: a 8583
Property Owner's Mailing Address APR 302076
Property Location
O I S
Govt. Lot
_ _
. Secuon
City, State I
T W S
?br W1h
Zip Code
Sfi96SPIa °h)
Phgwyfly(yltyfo,_
_ I Agen
I
,
T 0 N R E W
If. Type of Building4check all that apply)
�
Lot H
Subdivision Name
!!
❑ I or 2 Family Dwelling—Nnmbencf Badeanlus o'4r4 a
❑ Public/Commercial — Describe Use
Block N
0 City of
❑ State Owned — Describe Use
CSM Number
0 Village of
-
VI Town of f' r i.v;nj Ti-
III. Type of POWTS Permit: (Check either"New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if
applicable)
A.
qN New System
❑ Replacement System
❑ Other Modification to Existing System (explain)
❑ Additional Pretreatment Unit (explain)
B.
Holding Tank
❑ In -Ground
❑ At -Grade
❑ 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
IV. Dispersal/Treatment Area and Tank Information:
Design Flow (gpd)
Design Soil Application Rate(gpd/sf)
Dispersal Area Required (sf)
I Dispersal Area Proposed (sf)
System Elevation
Capacity in
Total
9 of
Manufacturer
Tank Information
Gallons
Gallons
Units
°-
`o
..
`
New Tanks
Existing Tanks
2
—
�v.
H
s m
n
n`U
H
u. V
a
`BYWt - Holding Tank
-1 S'�.x,+�
01 Vim/
sM
{!�
1
S,
Dosing Chamber
—
V. Responsibility Statement- I, the undersigned,
assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print)
PoIkosk
Plumber's S- ature
-MP/MPRS Number
Business Phone Number
Ailcw
o
IS -292-915(v
Plumber's Address (Street, City, State. Zip Code)
Po l3ox Szz Iron River. wt S'17
VI. County/Department Use Only
Approved
❑ Disapproved
$ennit Fee I
—
Date Issued
5L
Issuing A [ Si re
'f
0 Owner Given Reason for Denial
Conditions of Approval/Reasasonnssrfor Disapproval l ���,e�
S%1%!!g er6 /�ovl lIZ fleoli�f O'Z/12�i til/!� 4{ii)7� v" HH.v/nl/
J.
Attach to complete plans Inr the system and .submit to the County only on paper not less than 8 1/1 x II inches in size
SBD-6398 (R. 03/22)
RRECE1VED
APR 302026
SR- oOZ[o) Soil Test#O7q_a .
Bayfield Co. Bayfield County O
E RED Planning and Zoning Agency
Waiver of a Thorough Soil & Site Evaluation
(subject to 15-1-10(d))
,
I �O V\PO S LC. $ 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 1.. V kC P 4/c 6e, &( Contractor
Property Address 8?oO L t&ir.vick... Re) Authorized Agent
S i I
Agent's Telephone
Telephone I S-' 13 " 1 I Cl 1 Written Authorization Attached: Y or N
Accurate Legal Description is requested:
/Jti 1 /4 of S E 1/4 Section__Township Sy N. RangeW. Town of rflt7ivy
Additional Legal Description:
Govt. Lot Lot Block Subdivision
Lot CSM# Vol. Page CSM Doc #
Volume Page of Deeds Tax I.D# 72 5 13 3 Acreage 4 O
Indicate reasoning for your determination: Redoximorphic features are present within 4
inches of the A horizon. SPS 385.30(2)(b)1
Signature of County Official
Date
Signature o Certified Soil Tester
Date
11068 - ST
Certification #
(Submit a Plot Plan & Fee)
u/forms/soiltestwaiver(KLK)
June 2018
PAGE 2 OF 4
System Plot Plan - Holding Tank Version 2.1 0 10 20 ft
Owner: Luke P Naber
Site Address: 8700 Larvick Rd, Port Wing, WI 54865
N
Legal Description: NWI/4 OF THE SE1/4, Section 32,
Township 50N, Range 8W, Town of Port Wing, Bayfield County,
" ;
WI'
Property boundaries are approximate and for reference only
3 U 2026
Bayfield Co.
Planning and Zoning Agency
Pipe Material / ASTM Standard
(Tables 384.30-3 & 384.30-5)
(J;
r«
o
Wieser
Z
S
WLP 500 Proposed
Addition
m
SB2 . Existing BM - Top of existing garage
Garage —concrete floor. Elevation 100'
CD
SB1 +
f
3B3
Driveway Larvick Road
a)
O)
w
I
o
o
C
o
CD
`C
1
I—
5.
I
I
CD
I
U
I
Well so
Existing ,-
5O
Home -0
'a
Sr
lm
IC)
IN
O
-
.--------------------------------------------- South Property Line 1320'------:
BAYFIELD COUNTY
CHECKLIST FOR CERTIFIED SOIL TESTS
ECE1VED
Submit the Following (Use Permanent Ink):
APR 30 2026
j�l Check List Bayfield Co.
QJ Index Page / Title Sheet (Optional) Planning and Zoning Agency
R7 Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers)
V�'J Original Plot Plan
❑ Cross Section Soil Profile Sheet (optional)
❑ Additional Information (Warranty/Quit Claim Deed) (Optional)
Soil Evaluation Report: (Include the following Information)
T S
'J -I ePIdentifiication Number (must be digit Tax ID#) DO NOT USE 12 digit, they are no longer being used
.X Property Owner's Information (not prospective buyer's name)
Jul Property Location (Accurate Legal Description with Sec/Twp/Range)
fA Road Name (where driveway is/will be coming off of)
❑ Floodplain Elevation, Flow Rate, Comments and Recommendations
Pl Complete Soil Boring / Pit Information
l Date Soil Evaluation was conducted
[E CST Name, Signature, Number, Address and Phone Number
M *Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
I Bench Mark (Description, Elevation and Location)
❑ Contour Lines (Example = 98.0' /96.0' /94.0')
l Property Location (Sec/Twp/Range/, Accurate Legal Description)
l Borings (Locations and Elevations)
0 Percent and Direction of Land Slope
l$ Well Location (Including Neighboring Wells, if applicable)
❑ Location of Wetland Areas, Floodplain and Navigable Waters
Pl Buildings, Driveways, and Structures (Location and Descriptions)
l Location of Property Lines
❑ Existing System Location
'$ Address Number and Road Name
❑ Current Surface Elevation of Wetlands and Navigable Waters
f CST, Owner and Property Information
LW North Arrow
Fee:
'� Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checklist/checklistforests
PAGE 1 OF 4
Holding Tank Plan
Index & Cover Sheet
Component Manual Design References:
Holding Tank Version 2.1 (May 2022-2027)
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
Enclosures: kolJ,nu T0.v,k IwreaYnGnT. Noldin, TF.nk
r- ;/%' v -D
/PR 302026
Bayfield Co.
Planning and Zoning Agency
J ��/ J
Cov,Trs.xX1 S�vv.rtrnry Per,n t "PitW cc..Tiyn, b.,r iv2c 0.
Thal-, Sot I .'jt Site E�4yan ov., Wieser wLP 2.SCO
Sp2Cic',cam.onS1 Scy\&'t`ory App liwtCon cktcJCli5T
45-0 c heclt , Sod Te%'r GkeC,k. Ucr
Project Name / Description
OwnerName(s): Lu k e. 'P Nolb c.r Phone: Zc -'R -J of
Owner Address: PO (3 ox I eS, Port k) ivtQ W 2 Zip: S`IB6r
ProjectAddress: 8700 Lo.ryic.K Rc\ , PorT W itia WS Sy86.f
Govt. Lot: N (A) 1/4 of S E 1/4, Section_, TAN -R 8 E ❑ or W
Township: Por'T (4)in County: Qa.y
ProjectID #:
T4X
Designer Information
Designer Name: A I Ic&v-. Pc, I I- os k'i Phone: 71S -2`12 -9/
Designer Address: Po I3oX 52.2, =rov- R.;Ve✓' WT Zip: S`i 8'I -7
E-mail: TO bear5uicienCo [his .I,.iccrr.c,v Ilural,Lnualslumi.
License Number: PM R E a a CEO 9 O
Remarks:
�^ �7�Zlo
Signature: Date: 7 Z
riginal signature required on each submitted copy.
PAGE 2 OF 4
System Plot Plan - Holding Tank Version 2.1 0 10 20 ft
Owner: Luke P Naber N
Site Address: 8700 Larvick Rd, Port Wing, WI 54865
Legal Description: NW1/4 OF THE SE1/4, Section 32, CtIVED
Township 50N, Range 8W, Town of Port Wing, Bayfield County, bPR 302026
WI BayfieldCo,
Planning and Zoning Agen '
Property boundaries are approximate and for reference only
Pipe Material / ASTM Standard
(Tables 384.30-3 & 384.30-5)
0
Z
0
Wiesemiz
?
WLP�
\
0
CD
CD
S62BM - Top of existing garage
Concrete floor. Elevation 100'SB3
Driveway Larvick Road
rn
rn
w
�
o
o
c
T
�
�
o
m
r
5
CD
,
Well
�N
Existing
,^'
Home
'-U
Co
It
go
'r
'C
$5
im
Ik
'N
'O
--------------------------------------------- South PropertXLine 1320'______,
REGE WED
t,PR 307076
Bayfield Co.
Planning aid Zoning Agency
HOLDING TANK SPECIFICATIONS
(No Scale)
PAGE 3 OF 4
Weatherproof
12" Min. or 2.0 ft above
Junction and
Approved
Established Flood Elevation
Alarm Box
Vent Cap
(typical)
Electrical must comply with
Approved Locking Manhole
SPS 316 and NEC 300
4"g Vent Pipe
with Warning Label Attached
Conduit
>10 ftfrom
(typical)
4" Min. or 2.0 ft above
Building
Established Flood Elevation
(typical)
\I/
"_ Airtight Seal "
Finished Grade
18" Min.
(typical)
a.
..
Inlet
Inlet Invert
Approved Joints with J
Watettight
Plug
Approved Pipe 3 ft onto
Max. 12" or 90% of total volume
Solid Ground
if more than one tank
a
a
Alarm -On
n
•
HOLDING TANK
VOLUME =
2500 gal
3" Approved Bedding Material Beneath Tank
TANK MANUFACTURER: Weiser
Anchor tank as necessary
pursuant to SPS 383.43(8)(g)
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 = L -_ Q gpd
RECEIVED
Inspection Checklist INSPECT EVERY 3 YEARS I PR 30 7026
o type of use
o age of system Bayfield Co.
o nuisance factors (i.e. odors, user complaints, etc.) Planning a,;d Zoning Agency
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 (Le., 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. Stats.
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: Iron River Septic
Phone: 715-372-4006
Local government unit: Bayfield County Zoning Phone: 715-373-6138
Local government unit address: 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 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.
Document Number/Plan I.D. No. HOLDING TANK
AGREEMENT
r Owner Name (s) Owner(s) Mailing Address
LUKE P NABER
04-042-2-50-08-32-4 02-000-10000
?O QX1%C)
Agreement Date (same as Notary Da
We acknowledge that application is being made for the installation O1(a) nolaing 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.
N%_1/4 of S E 1/4 LA)
Township _____N. Range _____W
Town of Pr71PT u) 11na
Additional Legal Description:
Gov't Lot Lot_ Block_ Subdivision CSM#_
Lot_CSM # Vol _Page CSM Doc#
DOCUMENT NUMBER
2026R-61 1594
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY. WI
RECORDED
03/31/2026 AT 1 1 :02 AM
RECORDING FEE: $30.00
PAGES: 1
Return To:
Tony Polkoski
5115 County Highway B
Iron River, WI 54847 Bayfield Co.
planning and Zoning Agency
APR 302028
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, 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. 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 reJtWMUftO41 property where the holding tank is installed.
Owner(s) Name(s) — Please Print $' • , V 1% Subscribed and sworn to before me on this date:
OT
LUKE P NABER )�•;•• 4�• •. i.
y y i /i1 )�j Ir1 aJ ) aD'-(P /� It
/ Notarized Owner(s) -Signatures) Notary l` Public �liV r Qte T7 WI
Drafted by: Tow.( _(6toski Date: 3-r 6- 2 6
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (n(m)] uftorms/saniiwymoidingtankegreementdoc ®June 2018
: IVED
HOLDING TANK SERVICING CONTRACT
LPK
302026
Contract Date Sayfield Co.
Inning arid zoning Agency
3-18-26 This contract is made between the
Holding Tank Owner(s) Name(s)
LUKE P NABER
Pumper's Name (Print)
I Pumper's Signat��
Pumpers' Registration #
Thomas Polkoski
River Septic
81271
Iron
{{
/
We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions)
Or
Legal
Ta><ILM •�
AiM! 1/4,SE 1/4,
LOCATION
(use Statement)
Tax Statement)
el
Q B S S J
— g
Section ,Township N, Ran e w
Town of:
f or -r Witn
Lot Size
Acreage
0
Gov'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:
Ill fa. The name and address of the person responsible for servicing the holding tank; `\`�o������(t,4%,,?
b. The name of the owner of the holding tank;
c. The location of the property on which the holding tank is installed; �0TA4;
d. The sanitary permit number issued for the holding tank; - :
e. The dates on which the holding tank was serviced; • -o
f. The volumes in gallons of the contents pumped from the holding tank for each servicing; y� '. GBL\G
g. The disposal sites to which the contents from the holding tank were delivered. �''ir`OF turcC.O��``�``
4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event df"d't'R&Hi a 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. teO�' w 1a1�5 to / 13a e d (OU
Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed and Sworn to me:
on this DJC day of I I o G
LUKE P NABER
by:
)totar9 Public/
My commission expires on: -) )14i'3'
Revised: May 2016 (®May 2018) Drafted by Tr..n>< pelkosk;
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)] _ f
WLP2500
TANK SPECIFICATIONS
183k"
- - - - - - - - - - - - - - - - -
4" CAST -A -SEAL 4" CAST -A -SEAL �I
FILTER OR I
BAFFLE I
- -
-----------------
TOP VIEW
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
DIMENSIONS:
WALL: 3"
BOTTOM: 5"
COVER: 6"
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
HEIGHT: 55 1/4" O.D.
LENGTH: 183-1/4" O.D.
WIDTH: 101-1/4" O.D.
BELOW INLET: 43" O.D.
LIQUID LEVEL: 36"
WEIGHT: TANK - 15,527 LBS.
COVER 9,300 LBS.
INLET AND OUTLET:
4" CAST -A -SEAL BOOT OR EQUAL
INLET AND OUTLET BAFFLE AND FILTER:
WISCONSIN, SEE DETAIL #10
(OTHER STATES SEE CHART)
LIQUID CAPACITY: 69.44 GAL/IN
HOLDING TANK:
OUTLET HOLE PLUGGED
ACTUAL CAPACITY: 2.639 GALLONS
LOADING DESIGN: 8' 0" UNSATURATED SOIL
TANK CAN BE USED AS:
SEPTIC/ HOLDING/ PUMP OR SIPHON
COVER: MIX DESIGN #8 (NO FIBER)
TANK: MIX DESIGN #9 (SMALL FIBER)
CUSTOMIZED TANKS:
FOR CUSTOM TANKS CONTACT WIESER CONCRETE
J
Q
DRAWINGS
TED
APPROVAL FORII
APPROVED BY:
APPROVAL DATE:
PRODUCTS NEEDED BY:
0 Z
0<
EL I-
0
a
U)
U)
gwil01rw u[Ne1ro]a[y:I* IN=--Y_vdaI 4ire1uJ II"
Submit the Following - (Must be original and written in ink) (Title 15, Section 15-1-10(e))
0 Check List
0 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))
0 Original Plot Plan (383.22(2)2. 3. & 4.a)
* Cross Section, Over -Head Profile of the System and DSPS APPROVED Schematic of Tank from Manufacturer
❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable)
0 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)
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)
0 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7)
0 1 Complete Set of Plans (Note: Sanitary Application and Maintenance Agreements are to be attached)
FZf Soil and Site Evaluation Report (383.22-3(2)(b)i.e.)
RECEIVED
❑ State Plan Review (when applicable)
❑ Copy of Warranty/Quit Claim Deed (Optional)
APR 302026
Bayfield Co.
Planning and Zoning Agency
Sanitary Application: (Include the following Information)
2 I 5 digit Tax ID - Project Address or Road Name adjoining driveway - Owners Phone Number
2 II Type of Building
0 III Type of Permit
0 IV Type of POWTS System
2 V Dispersal - Treatment Area Information
2 VI Tank Information
0 VII Responsibility Statement (Plumber's Information)
Plot Plan: (To Scale or To Dimension)
2 Signature and Plumber Information
❑ Surface Elevation of Body of Water
❑ Direction and Percent Land Slope
0 Tank and Filter Information and Location
❑ Wetlands / Navigable Bodies of Water
❑ Absorption Area (Proposed and Existing)
2 Bench Mark (Location, Elevation and Description)
Q( Component Manual Version
0 Address Number and Road
2 North Arrow
❑ Contour Lines
0 Structures and Driveways
2 Boring Locations
0 Property Lines
0 Well Locations
0 Legal Descriptions
19 Piping Material Information (conveyance line, building sewer line, material type and diameter)
Turn Over ►
Cross -Section and Over -Head Profile of the System:
❑ Surface and System Elevation
❑ Position of Observation and Vent Pipes
❑ Dimensions and Depths
❑ Make, Model & Number of Chamber Units in each Cell
Property Information
❑ How many systems will there be on this parcel of land?
$3 Has this property been split? (Property Statement shows Property History)
Fees:
❑ Private Sewage System (Septic Tanks) $ 400.00
9 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)
_ - - _ Bayfield Gount3�.
a � FIELD
Planning & Zoning Department
117E5th Street
P.O. Box 58
Washburn, DWI 54891
Phone: 715-373-6138
Fax: 715-373-0114
Property Owner:
NABER, LUKE P
PO BOX 185
PORT WING, WI 54865
Description
Certified Soil Tests - Review & Filing Fee
Submission Number:
SR -00401
Transaction Number:
SR -00401-45393
Amount
$50.00
Total: $50.00
Payment Amount: $50.00
Reference: 6302
Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847
Payment Type: Check
Transaction Date: 5/7/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
13 YTFIELD 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:
NABER, LUKE P
PO BOX 185
PORT WING, WI 54865
Description
Private Sewage System (Holding Tanks)
Submission Number:
SS -00731
Transaction Number:
SS-00731-44EAF
Amount
$400.00
Total: $400.00
Payment Amount: $400.00
Reference: 6302
Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847
Payment Type: Check
Transaction Date: 5/7/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
BAYFIELD COUNTY
SANITARY PERMIT (#04)-26-35S
STATE SANITARY PERMIT
OWNER: LUKE P NABER
GOVT LOT: LOT: BLK:
NW1/4 /4 SE1/4 /4 SEC: 32, T 50 N, R 8
TOWNSHIP: Port Wing
SOIL TEST: 29-26
NEW SYSTEM
SYSTEM TYPE: Holding Tank
PLUMBER: ALLAN POLKOSKI
TRACY POOLER
Authorized Issuing Officer
DATE: 5/7/2026
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: # MPRS 220090
Condition: Structure not for sleeping or habitation without additional zoning & UDC permits.
Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all-weather road.
THIS PERMIT EXPIRES 5/7/2028
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION