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HomeMy WebLinkAbout26-53SDepartment of Safety & Professional Services, Industry Services Division SS - o O1 S Sanitary Permit Application 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 slate -owned POWTS are submitted to the Department of Safety and Professional Services. Personal informauun you provide mac he used (in secondary purposes in accordance with the Privacy Law, s. 150411 II m I. Stats !All Information Property Owner's Name DANIEL G & JENNA K VERNON uqE31 I Property Owner's Mailing Address 25810 COZY CORNER RD City, State Zip Code Phone Number ASHLAND WI 54806 Q.Typ.OrD l4cbeekalltb.t apply) Lora ® I or 2 Family Dwelling — Number of Bedromns 1 bathroom Block A ❑ Public/Commercial — DescribeUsc ❑ Cityof ❑ State Owned— Describe Use__ — ❑ Village of .. CSM Number B Town of Barksdale IIL T ,$ i (Check either r "Replacement" and other appliabte on H A. Check one box online 8e Copy line C ' A New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit(explain) B. ® Holding Tank ❑ In -Ground ❑ AtGrade ❑ Mound O Individual Site Design gn ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner wn ist Previous Permit Number and Date Issued Expiration Bayfield by Co.) MAY 282026 eject Address (if different than mailing address) Planning and Zoning Agency eel q ^ 04-002-2-48-05-19-4 04-000-50000 Govt Lot SE j SE j., section 19 IV. U lntormadoa: Design Flow (gpd) Design Soil Application Ralel gpd:stl Dispersal Area Required (st) Dispersal Area Proposed (si) System Elevation 150 - - - - Capacityin Total Hof Manufacturer Tank Information Gallons Gallons Units �y o f , V L N S x q yu, q NCw Tanks Existing Tllnks U H " rn ii 5 a of the POWTS shown / 5 36115`0 C T TAI 1Z/J2. s f' Approved ❑ Disapproved Permit Fee Date Issued g A t Lure ❑ fhvner Given Reason for Denial 5 Sit /t/,R37/3 b JG Conditions of Approval/Reasons for Disapproval ku—h inn nuilen. nI.— fur the—, and —limit titthe('nunm only �.. nine. eat 1—th.n x to. iI ineh-ei.•i- SBD-6398 (R. 03/22) SZ-Oogd Soil Test# Bavfield County Waiver of a Thorough Soil & Site Evaluation R CiVED (subject to 15-1 -1 0(d)) VA? 28 2026 I im a certified soil tester determine that in my professional judgment the following site (see below) is unsuitable for any treatment component ot02F ^ 'ol tir 9 j d Bonin en�r tanks. Due to soil & site conditions, a thorough s nd site evaluation is not needed to ma a such a determination. S Property Owner )ae\, Vernon Contractor UyAstr JiL. n Property Address 6'1O '10 Cozy Cn 'ntr QA Authorized Agent 7i Oy&6it &We -4J j ii c+'s'6 Agent's Telephone %5- 6J.2. 9Sf f Telephone '7, S -CP09 Written Authorization Attachedc3or N Accurate Legal Description is requested: S j6 1/4 of _ 1/4 Section_ Township y8 N. Range Uc W. Town of &rh5�cIe Additional Legal Description: Govt. Lot Lot Block Subdivision Lot CSM# Vol. Page CSM Doc # aoIgR -5770 Volume Page of Deeds Tax I.D# 3 �l 9 Ct ( Acreage 1y. y/ Indicate reasoning for your determination: 51 k pots IUDT lfleLf A fy —z- Signature cSf Certified Soil Tester Date /z/(3 Signature of Co my Official Date /�I38sg;" Certification # (Submit a Plot Plan & Fee) u/forms/solltestwaiver(KLK) June 2018 RCVED �'� 8yr4 • Wisconsin Department of Safety and Professional Services ! L 1(i.6 Page of Division of Industry Services .si' • Bayfeld Co. SOIL EVALUATION REPORTPianning and zoning, Agency In accordance with SPS 385, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, Bayfield County 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. 04-002-2-48-05-19-4 04-000- 0000 Please print all Information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). I Property Owner Property Location ❑ ❑✓ Daniel+Jenna Vernon Govt. Lot AS E % 6 , Y S 19 T 48 N R 05 E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: 25810 Cozy Comer Rd 25810 Cozy Comer Rd City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road Ashland WI 54806 715209256 Barksdale Cozy Comer Q New Construction Use: 0 Residential/ Numberof bedrooms 1 Bath Code derived designflow rate 150 GPD ❑ Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material Clayey Till General comments and recommendations: Site does not meet A+4. Holding tank recommended a Boring # ❑Boring ❑■Pit Ground surface elev. ` 6 ft. Depth to limiting factor in. / elev. ft. Anil Annlirat'inn Qua I Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 A 0-5 5YR 3/1 SIL 2 -pr -c mvfr as 1f 0.6 0.8 B 5-9 5YR 5/3 f -1-f 2.5YR 5/8 SL 2-sbk-c mfr as - 0.6 1.0 C 9-18 2.5YR 4/6 C 3-cpr-vc dh - - 0.2 0.3 Boring # ❑Boring OPit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Anil Annliratinn Rat= Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 CST Name (Please Print) Signature CST Number Tim Dykstra Z-r3ti5 11213855 Address Date Evaluation Conducted I Telephone Number 10620 Eagle Lake Rd Iron River WI 5-20-26 • 1715-209-5748 * Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2= BOD, s 30 mg/L and TSS s 30 mg/L SBD-8330 (R04121) Page 2 of 2 O3. Boring # ❑ 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 GPD/Ft2 *Eff#1 *Eff#2 Boring # ❑ 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 GPD/Ft2 *Eff#1 *Eff#2 ► I<4 C .�. Ii�.I � ihI L O`LU �6 LJQ Planning al 1 V d Zoning ,gency ❑ Boring # ❑ 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 GPD/Ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS s 30 mg/L Dance' Vernon aS7810 Cozy Ccsnr PA A-sk+ 4 wj: 5Wa6 Twn o� ( +-lksLk 1 K DD 369415- N 5t0k RLICEiVED MAY 262026 Bayfield Co. Planning and Zcning Agency RD o yr' RECEIVED CONCRETE HOLDING TANK DESIGN MAY 282026 Single Tank Option INDEX AND TITLE SHEET Bayfield Co. Planning and ZoningAgency Project Vernon Holding Tank Owner DANIEL G & JENNA K VERNON Address 25810 COZY CORNER RD ASHLAND WI 54806 Legal Description PAR IN SE SE DESC IN DOC 2019R-577032 19-48-05 Township Barksdale County Bayfield Subdivision Name Parcel ID Number 04-002-2-48-05-19-4 04-000-50000 Plan Transaction ID Number Index and title sheet Holding tank specifications Site plan Maintenance and contingency plan Tank cut sheet Designer Keith Wile Signature_. License Number D2388PSS Lot No. Page 1 Page 2 Page 3 Page 4 Page 5 Phone No. 218-451-2611 Date 05/21/26 Designed pursuant to: Holding Tank Component Manual For POWTS (Version 2.1) May 2022-2027 Version 7.1 (07/22) Page 1 of 5 HOLDING TANK SPECIFICATIONS Number of bedrooms Non-residential estimated flow (gpd) 2000.0 Minimum holding tank volume required (gal) 3000.0 IProposed holding tank capacity (gal) Wieser Tank Manufacturer W3000 -MR Tank model number Rhombus SJE Alarm manufacturer Tank Alert 101-0IH lAlarm model number Tank Dimensions and Data X for round tank 50.0 Liquid depth below inlet invert (in) 8.0 Maximum depth of soil cover (ft) 71.0 Height (in) 1 Outside 186.0 Length (in) rDimensions 93.0 Width (in) J Only F ECEIVEEO MAY 2 8 2U2ri Plannin aaNeld Co. 9 I'd Zoning Agent, Tank Anchor Calculations 20610 Ibs Weight of tank and cover 1.20 Safety factor 32610 lbs Weight of anchor required 32.6 in Soil cover req. for anchor or 8.1 yd3 Concrete counter weight HOLDING TANK CROSS SECTION manhole cover with locking device and finished vent cap junction warning label grade 4" mm. 12" min. � 23 in. Manhole and vent locations conduit vent pipe 1 B" min. A. tether weight - / service blind plug alarm on to seal outlet Electrical as per NEC 300 and SPS 316 3 in. bedding under tank. 12.0 in. &I:I'Il 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. building sewer inlet Project: Vernon Holding Tank Transaction Number: Page 2 of 5 (1 bathroom) Holding Tank Plot Plan Property line DANIEL G & JENNA K VERNON 25810 COZY CORNER RD PAR IN SE SE DESC IN DOC 2019R-577032 S19 T48N R05W Town of Barksdale 04-002-2-48-05-19-4 04-000-50000 10.414 acres House •c Wieser precast tank W 3000 -MR I 0: �° REcEIVED Proposed ≥' MAY 2 8 2026 60': 70'shop : p` w/ bathroom PlanningBand ZYfieon ni g Agency 11 att. Bldg Garage acc. Bld Pole Barn' ❑: Centerline of Cozy Coarner Rd — i Scale 1:60 NOTES: * Bench Mark = Top of well Elev = 100.0' - All vent, observation & conveyance pipes 4" ASTM D1785 or code equivalent Page 3 of 5 W3000 -MR TANK SPECIFICATIONS 5•-6" N. INLET I _ a e U i a, N -1 o a t 21" 4" CAST -A -SEAL 4" CAST -A -SEAL FILTER OR RECEIVED MAY 282026 Bayfield Co. Planning and Zoning Agency 1 L .1 J------.-.-----.L-----_----- Ifs OUTLET I• O� U d - DIMENSIONS: WAIL 2 1/2" BOTTOM: 4" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 71' o LENGTH: 15'-6" WIDTH: 7-9" BELOW INLET: 57" LIQUID LEVEL: 50" WEIGHT: BOTTOM 12,260 LBS. COVER 8,350 LBS. i INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET e INLET AND OUTLET BAFFLE AND FILTER: a WISCONSIN, SEE DETAIL /10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 58.94 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 3.183 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 a a 0 0 k. J O n i REVIEWED BY REVIEW DATE 3 F 0- w N DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: SHEET NO. APPROVAL DATE: 1 PRODUCTS NEEDED BY: or HOLDING TANK SERVICING CONTRACT ttiECtyit/EIS Contract Date Holding Tank Owner(s) Name(s) Pumper's Name (Print) p` oTWDSGPfc/ ,P0sWtut MAY 28 Z0?6 Bayfleld Co. This contract is made between the Panning and Zoning Agency �/ �'1 •lJ"J� ir's Signat e Pumpers' Registration # d•P/uti.. /I IAlJl4 4 L S SZ We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT LOCATION Legal Description: J (Use Tax Statement) Tax ID# 37Y5 6 X 1/4, 5( 1/4, q Section L ,Township 9 N, Range o c W of:th'" r7 TOW . J/ ` 9 _ tL.. P'� 11n Ac, Acreage Io y14 Gov't Lot Lot# CSM # Vol. Page CSM Doc ft Lot(s) No. Block(s) No. Subdivision: 1. The owner agrees to file a copy of this contract with BaVfield 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. Owner(s) Owner's Revised: May 2016 (®May 2018) Personal information you provide may be used for secondary purposes [Privacy Subscribed d Swom to me: on thisay of •.,:�� Notary Public pARY s Mycommissien expires on: 5 14 P \- U Drafted bythY IIJ Iii it HOLDING TANK — MANAGEMENT PLAN The Private Onsite Waste Treatment System (POWTS) has been designed and is to be installed and maintained according to SPS 383, Wisconsin Administrative Code, Holding Tank Component Manual for Private Onsite Waste Treatment Systems (SBD-1 0571 -P)(R.6/99) and the Bayfield County Zoning Department Sanitary and Private Sewage Ordinance. 1. This POWTS has been designed to accommodate a maximum daily flow of L`ED I Co gallons of domestic wastewater per day. MAY 282026 2. The owner of this POWTS is responsible for system operation and Bayfield co. maintenance, locking device, alarm and access. 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. 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 __TownshipY3 N. RangeC75 W. Town of Govt. Lot Lot Block Subdivision CSM# Additional Legal Description?4?-. iA) 5L .5 $c IA, ocG Property Owners Signature u/forms/ma nagementplan S - a - Date Revised: July 2013 SS- o o7S N IOLDING TANK AGREEMENT owner Name (s) 5 a Owner(s) Mailing Address p 8 b ..cc�G """ 25'8ro e0zy A' p /~D1 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 Scats. p L p 5 E 1/4 of SF" 1114 Section 1 Township ! O N. Range W. Town of L-KS,JA.rr��1 Pi II $EC= Additional Legal Description:Vff 1N D C ZN I) cc6 in I ii 51/03 - Gov't Lot_ Lot Block Subdivisiory7 Lot CSM # Vol Page CSM Doc# Return To: DOCUMENT NUMBER 2026R-6 12301 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 05/28/2026 AT 1 l:Q2 AM RECPI IN D3O.OO PAGES: MAY 29 Z026 Planning and Zoning Agency 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, Scats., 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, Scats. 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 of 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. Scats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced in accordance with Ch. NR1 13, 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 of 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. Scats., 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 I()gp 1t the existence of the agreement to be determined by reference to the property where the holding tank is installed. ``\% �A O Owner(s) Name(s) - Please Print DA n; ! V -e rn o n Subscribed and swornto before me on this datc, .' C�� �- =_ _•_ Notarized Owner(s)— Vv Signature(s) V'� Nota Iic i '•... .••'Q My Commission Expires: \ rr r r t l i l i t+ltd / Drafted by: � �Jia � Date: Penwnal infomation you provide may be used for secondary purposes (Privacy Law, s.15.04 Q)(m)I u/forms/sanitary/HoWingTant greement 4.2026 File Code: ASH-BayLR File Number: 130702 ADDENDUM/EXHIBIT A A parcel of land located in the Southeast Quarter of the. Southeast Quarter (SE1/4-SE1/4), Section Nineteen (19), Township Forty-eight (48) North, Range Five (5) West, Town of Barksdale, Bayfield County, Wisconsin, more particularly described as follows: Commencing at the Southeast comer of said section;; thence N89°25'36"W along the South line of the SE1/4 a distance of 661.97 feet to the Point of Beginning; thence N89°2536"W and continuing along said South line a distance of 661.97 feet to the South 1/16 Southeast comer of said Section; thence NO2°40'37"E along the West line of the SE1/4 of the SE1/4 a distance of 664.29 feet; thence 589°27'36"E a distance of 664.47 feet; thence 502°53'28"W a distance of 664,77 feet to the South line of the SE1/4 of the SE1/4 and the Point of Beginning. For Informational Purposes Only, the above described lands are designated with the fob wing: Tax ID Number(s): 04-002-2-48-05-19-4 04-000-30000 (Parent) 04-002-2-48-05-19-4 04-000-20000 (Parent) Property Address(s): 25810 Cozy Comer Road Ashland, WI 54806 RECEIVED MAY 292026 Beyfeld Co. Planning and Zoning Agency A-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: VERNON, DANIEL G & JENNA K 25810 COZY CORNER RD ASHLAND, WI 54806 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00422 Transaction Number: SR-00422-46B8B Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 3370 Paid by: Timothy Dykstra, 10620 Eagle Lake Rd, Iron River WI 54847 Payment Type: Check Transaction Date: 5/29/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. I3AYFIELD 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: VERNON, DANIEL G & JENNA K 25810 COZY CORNER RD ASHLAND, WI 54806 Description Private Sewage System (Holding Tanks) Submission Number: SS -00754 Transaction Number: SS-00754-46B8D Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 4064 Paid by: Greg's Plumbing, 13660 County Hwy H, Iron River WI 54847 Payment Type: Check Transaction Date: 5/ 29/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-53S STATE SANITARY PERMIT OWNER: DANIEL G & JENNA K VERNON GOVT LOT: LOT: BLK: SE 1/4 SE 1/4 SEC: 19,T48N,R5W TOWNSHIP: Barksdale SOIL TEST: 46-26 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: GREG BROWN TRACY POOLER Authorized Issuing Officer DATE: 5/29/2026 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: # MP699374 Condition: Properly Maintain System Per Recorded Agreement. THIS PERMIT EXPIRES 5/29/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION