The URL can be used to link to this page

Home My WebLink About26-58S,; Department of Safety County 0. C t 1 6 � xYjls & Professional Services, $p - ' g Industry Services Division Sanitary Permit Number (to be filled in by Co.) o o� b 6 — _____ 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 Proiect Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may he used for secondary purposes in accordance with the Privacy Law, s. 15.04(t)(m), Stars. 46 1 a s Twh ode h Id i 1 -6 Rd I. Application Information — Please Print All Information Property Owner's Name Parcel # TIaX I bt 39 H4 1 M0..trecc. - r 1 E OY-O/ -a1-4 07 - 0-oco-IJ Property Owner's Mailing Address Property Location U3 O 1 ' J S Govt. Lot City, State I Zip Code Phone Number For Con;6s , CO $OSa 1 3o-i-7v≤- 9M%Y ¼, 1A, Section T N R 07 4o69 II. Type of Building (check all that apply) Lot # AGor2Family Dwelling — Number ofBedruoms -3 3 Subdivision Name Block # ❑ Public/Commercial — Describe Use 0 City of ❑ State Owned — Describe Use ❑ Village of CSM Number Ch#31'/ Z3'7'/ $xjbwnof nrtr yrnond v. 13 p.333 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 a licable. A. ;New System ❑ Replacement System ❑ Other Modification to Existing System (explain)(explain) ❑ Additional Pretreatment Unit B' ❑ Holding Tank Kin -Ground k�l ❑ At -Grade ❑ Mound El Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Information: 38 4...': c,K • u rs t../ . sets of cm Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (sf) I Dispersal Area Proposed I System Elevation 17 O 0.7 I G Y3 cosa 93.5O Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units 2 a v New Tanks Existing Tanks 2 c 0 V .0 0.0 w, rn ii C7 Septic or Holding Tank 1000 000 — rO� 5pe e%&r Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb i store MP/MPRS Number Business Phone Number is r :e d G53879 7/S -e31/ -8i7. Plumber's Address (Street, City, State, Zip Code) /y3YeiW Sfal-r o-tad7 /•i1ti,,,ard u.s S�/8L/3 VI. County/Department Use Only pproved 0 Disapproved Permit Fee $ Date Issued mnL Iss g ent Signature 0 Owner Given Reason for Denial sj2„6 5Co ]� o(. I oO Conditions of Approval/Reasons for DisapprovalL..._- 6cc ail ckcd C"O. RECEIVED JUN 022026 Attach to complete plans for the system and submit to the County only on paper not less than 8 lox 11 inches in size Planning and Zoning Agency SBD-6398 (R. 03/22) S R- O03 Ilei aArkI &IL Wisconsin Department of Safety& Professional Services V Page I of4Division of Industry Services 10A/SOIL EVALUATION REPOR TEST#qg -% In accordance with SPS 385, tMs. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, 6a �: e 1 but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. TAX 1W. 3I4 N I scale or dimensions, north arrow, and location and distance to nearest road. - 7- O3-(!6 Please print all information. Reviewed by D to Personal information you provide may be used for secondary purposes (Privacy Law, a. 15.04(1)(m)). p /ic )N :4 Property Owner Property Location 0..+r [ n + d ' r St/u.'3 Govt. Lot %. %535 T WW1 NRO7 E (or) W Property Owners Mailing Address Site Address or CSM and Lot #: W O l i r 1"1 v. / City, State, Zip I Phone Number ❑ City ❑ Village Town Nearest Road 4 1 F,t+ CsI1ca4 _ C.n 90!01 f 3o4)7y5-7'174 fL....•.-^.....A Ta1.Ka.kh NJfls 24 g[ NewConstruction Use:®Residential/Numberof bedrooms 3 Code derived designflow rate 4' 'O GPD ❑ Replacement ❑ Public or commercial —Describe: Flood Plan elevalicable ft. Parentmaterial Sandy g1sa to t1...r:al CItpos:1.5 General comments and recommendations: .3 c :2c ro Boring Boring# ❑ Pit Ground surface elev.9l,.83 ft. Depth to limiting factor I a0 In. / elev.Sb.83ft. Soil Aoolicatlon 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 06 St 4 mvGs• 0.6 1.0 of 6. fl Y H S cc n+ C.7 I . Ce 3 JS• Y 5 ,, 0.7 ).4 yR-/ac 7.SVAr - I�.0.. 7. �4•Co Boring # ❑Boring F=-- Zc-Vr A.nency �QPit Ground surface elev.9(A.4J ft. Depth to limiting factor 1O in. / elev. &.S 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 0-S '. 3/a i M.r1 iCaC o.C. 1.6 -a3 O' Y — IS S s 14. o. -I I -C. 3 y 5 45 C.7 ).c. L/ .34-)a0 .5Y S v — ' 0.7 1. CST Name (Please Print) i CST Number Trnv:s 8.++.FordIt3P-0 0000 Address D valuation Conducted Telephone Number Iy3V&W SfRd 77 11a marol 4.T]'54 CS //9/�G 7/5-C'3Y--817C, Effluent #1 = BOO >305220 mg/L and TSS > 30 5150 mg/L • Effluent #2 = BOO, 5 30 mg/L and TSS s 30 mg/L SBD-8330 (R03/22) Page a1 of _, ❑ Boring Boring # SPit 3 Ground surface elev.98* 13 ft. Depth to limiting factor ) lC, in. / eiev.2L 23 ft. I Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 1 p. $ �! L ..fir O.C. 1.0 R Y '-' 6�6 r• . 7 1.6 3 .I-4% `.SYRY l -. / 7v .. 1 j /Onom O. I.G, w1-tao 7*$S/ 5 - C O.7 r.(. Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 5150 mglL * Effluent #2= BOD, s 30 mglL and TSS 5 30 mg/L JUAN 0 2 ZU`0 BayflQ'Id Co. Planning and 'cl!ny r1g� cy r rA l/ Lake 7/ / / Tahkodah Proposed Well Proposed • Garage r / Proposed / 3 Bdrm �� Dwelling l/ / // / / % v �oe �h ≥(N' hoe" BM B2 aq° ay M I SCALE = 1:40 0 40 N46185 Tahkodah Hills Rd Lot 2 CSM #2374 v.13 p.383 Sec. 35, T44N, R07W Town of Drummond Bayfield County TAX ID: 39441 BM Nail w/ Ribbon in 24" Pine ELEVATIONS BM - 100.00' B 1 - 96.83' B2 - 96.92' B3 - 98.83' Lake >17ft below BM ROW Tahkodah Hills Rd tlCEV JI0t4 022020 Bayfield Co. Planning and Zoning Agency t 90600,003 /, 9 /-%C► 1&9e - '-1 e • SOIL PROFILE SHEET OWNER: _ta.a r e e+n ie Q; ar1 v 4 SOIL TESTER: Trc,, v krA SYSTEM ELEVATION: LOAD RATE: 0.7 J. C,. SYSTEM RANGE: g 1 .8 3 to c,5 .83 BM_ 10d 133 `� --- -- ------ --- -- .8 3 ------ ------ --- -- ISy.s r• q9 ---I ') eJ�}.c�. -- --- 3 f'r --- -- -- --- cm s -----J - ---- So L -- --- --- -- -- -- -- --- -- --- It U L LUL0 87 -- -- -- —_ -- -- Planning and ZoninryAgcncy Page of PAGE 1 OF 4 On -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross -Section & Plan View Pg 4 of 4 Management Plan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Selvig 46185 Tahkodah Hills Rd Owner Name(s): Maureen & Bjorn Selvig Owner Address: 828 W Olive St. ; Fort Collins, CO Project Address: 46185 Tahkodah Hills Rd Govt. Lot: 1/4 of 1/4, Section 35 , T 44 N -R 07 EUor W L!1 Township: Drummond County: Bayfield Project Parcel ID #: 040182440735003000 11000 (TAX ID: 39441) Phone: -_ Zip: 80521 Designer Information Designer Name: Travis Butterfield Designer Address: 14346W State Road 77; Hayward, WI E-mail: office@butterfielddrilling.com License Number: 652879 Remarks: Phone: 715 634 Zip: 54843 This space reserved for approval stamp. RLCE1ED JUN 022025 sayfiefd Co. Planning and Zoniuy Ageyy Signature: Date: Q5 /aiJ anal signatur required on each submitted copy. PLOT PLAN /7 Lake Tahkodah ,/// / Rio / ST slope 6% 4rP BM B2 oV'" I ft AA I is Proposed proposed Well � Garage Proposed 3 Bdrrn Dwelling B 1 4"PVC Sch40 ASTM F891 slope 4% SCALE = 1:40 0 40 11 46185 Tahkodah Hills Rd Lot 2 CSM #2374 v.13 p.383 Sec. 35, T44N, R07W Town of Drummond Bayfield County TAX ID: 39441 BM = Nail w/ Ribbon in 24" Pine ROW Tahkodah Hills Rd ELEVATIONS BM - 100.00' B1 - 96.83' B2 - 96.92' B3 - 98.83' Lake >17ft below BM ST = 1000gal prefab concrete septic tank made by Superior Precast w/ Lifetime LT -1 /8 Filter AA = Absorption Area consisting of two cells, spaced >3ft apart, containing a total of 32 Quick -4 Plus Chambers RECEI'V'ED JUN 0 2 202x; Bayfield Co. Planning and Zoning Agency Page 2 of 4 IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER min. 12" (typical) Septic Tank(s) Manufacturer: Superior Precast Concrete Septic Tank(s) Volume(s): 1 000 gal gal gal gal Effluent Filter Manufacturer: Lifetime Filter LLC Effluent Filter Model #: LT -1 /8 12" min. trench depth (typical) •' TYPICAL TRENCH CROSS SECTION VIEW 3 (typical) ^'a .. (No Scale) a System Elevation = 93.50 ft (typical) Quick4 Standard -W w/End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) L--- I---------j�---------�--- B= 67 ft (typical) INSTALL PER TRENCH: 16 Quick4 Std -W @ 20 ff EISA/chamber = 320 ft2 + 1 Pairs of end caps @ 6 ft2 EISA/pair = 6 ft2 RECEIVED = Proposed EISA per trench = 326 ft' JUN 022026 Bayfietd Co. Planning and Zoning Agency Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturers / Instructions. TYPICAL TRENCH PLAN VIEW (No Scale) IA = 3.0 ft (typical) '—Quick4 Standard -W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. Required Infiltration Area = 643 x 2 trenches = Proposed Total EISA = 652 C m W O m ft2 Distribution Method: ftz branched manifold 0 PAGE 4 OF 4 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 = 450 gpd; BOD5 ≤ 220 mgL"'; TSS ≤ 150 mgL-'; FOGS 30 mgL-' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) 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 (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (Le., 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: Butterfield InC Phone: 715 634 8176 Local government unit: Bayfield County Planning & Zoning Phone: 715 373 6138 Local government unit address: 117 E 5th Street P.O. Box 58 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, W)k/�Oe. 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. ,!UN 0 2 2U26 Contingency Plan Bayfield Co. Planning and Zoning Agency 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. SUPERIOR I 1,000 1 -Compartment Tank SUPERIOR PRECAST CONCRETE I PRECAST TOP VIEW - Weight (in lb s) Tank 5,812 Lid: 3,683 Total 9,495 Volume of Concrete Total: 2.4 Yd' Gallons Per Inch: 24.4 'iii Wail Enlarged Detail Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL 1 SERVICES DIVISION OF INDUSTRY SERVICES 4!!/ 4 $1 R44, 47" SEE CORRESPONDENCE I Manhole Openings I CIE) SIDE %'IEV4T 228„ 2_1'2" Taper Polyethylene Baffle AL2stic Rope 4n 9" Air Space 424Liqthd 73"" 79' 45" 1O11 Produced by Superior Precast Concrete, LLC PO Box 1390 Hayward, WI 54843W. SUPERIORP�°°'° �iQ p 9pyfe, Co. Planning and Zoning Agency PRECAST CONCRETE Design conforms to AS I M C122/, Specification for Precast Concrete Septic Tanks and WI SPS 384.25, POWTS Holding Components or Treatment Components. The information provided on any Superior Precast Concrete (SPC) drawing or document shalt be verified by the purchasers licensed professional engineer for suitability of use. Configuration may changefrom drawing, consultwith SPC. Product File N. This is proprietary Information, and remains the property of Superior Precast Concrete, LLC. I 8805.19-20241 BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) Ch ck List I4iginal Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) B' Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) 6'Oyiginal Plot Plan (383.22(2)2. 3. & 4.a) CW/Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer :/Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) Ig Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) a -H t (383.21(2)(c)(5) (Recorded at Reg. of Deeds) (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) (Recorded at Reg. of Deeds) la Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) Co I fete 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.) ❑"Copy of Warranty/Quit Claim Deed (Optional)- (1+/Sa'lTc stF") Sanitary Application: (Include the following Information) 3 Application Information must include: El 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) pl�8'Project Address or Road Name where driveway is/will come off of) [/(Owners Phone Number) 'I I Type of Building Ig IIIII Type of Permit E V, Type of POWTS System NV/��Dispersal / Treatment Area Information Tank Information 7I Responsibility Statement (Plumber's Information) *Date Stamp* Plot Plan: (To Scale or To Dimension) Signature and Plumber Information h�'Surface Elevation of Body of Water Y%D'rection and Percent Land Slope L9'Tai k and Filter Information and Location CLNf��etlartds / Navigable Bodies of Water GLA�bsorption Area (Proposed and Existing) C04ench Mark (Location, Elevation and Description) C� Component Manual Version (on )-A P 6f > dAddress Number and Road E14 orth Arrow "/Contour Lines Q"Structures and Driveways ['/Boring Locations I5Property Lines [5/ell Locations N'Legal Descriptions RECEIVLb JUN 022026 Bayfield Co. Planning and Zoning Agency 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 l 'Position of Observation and Vent Pipes ZE imensions and Depths 19 Make, Model & Number of Chamber Units in each Cell Property Information 11 Fjow many systems will there be on this parcel of land? Has this property been split? Ye S (Property Statement shows Property History) Fees: CPrivate Sewage System (Septic Tanks) $ 400.00 ❑ 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 L9�Maintenance Agreements (checks made out to Reg of Deeds) $ 50.00 $ 30.00 — %c4 40 (.o.t. JUN 0 'L 2023 BaYfield Co. Agency Plynning and Zoning Ag u/forms/checklists/checklistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: f1-oo -7& Private Sewage System Maintenance Agreement Owner(s) Name N,\c.J(-4.Q-V, Wt,'mC\A/t Di1Je S+ I Ockcoll;ris.CO 805x1 y6185 To.h kod&h LAkt R AlikE As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil testers 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 1/4 Section 35 Township ggN. Range O7W. Additional Legal Description: Townof Drummond (Acreage) 0.900 Gov'tLot Lot Block Subdivision Lot a CSM # a37V Vol. 13 Page jfl CSM Doc # alO tk-Go5431 DOCUMENT NUMBER 2026R-61 2332 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 05/29/2026 AT 1 1 :48 AM RECORDING FEE: $30.00 PAGES: 1 Return To: Plarg M#Pdn�Repa rtme nt JUN 012026 Area umr RED ZorhO Agency PKIn -ground gravity ❑ In -ground dosed ❑ pJng and In -ground pressure distribution Sewage System: 0 Mound ❑ At -grade Sewage System ❑ Other 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, Wis. Admin. 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 every 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 if 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 County 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 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. The terms and conditions of the agreement shall be binding upon and inure toottthhe 4enefit of 11 cumen and future owners 4f such property. Owner(s) Name(s) — Please Print M crctv�: 1� . Sz�./i�1 Subscribed and sworn to before me othis date: rna'y i3' anvt LJ- 1N5 ) Notarized Owner(s) — Signature(s) Notary Public CSF,q„�r J� /v�ff/l//7r My Commission Expires: os-/J--a Drafted by: Ra.r Sp.tls.ti7r Date: 0 0 : bL AWJR I NOTARY NRLIC STATE Of COLORADO NOTARY ID 9974006451 Ml' COMMISSION E*PIR S APRIL 19, 2029 Proofed by: u'iorms/sanitary/septicmaintenceagreement Revised July 2020 , • Real Estate Bayfield County Property Listing Property Status: Current Today's Date: 5/29/2026 Created On: 11/21/2024 1:27:52 PM Description Updated: 3/12/2025 at Ownership Updated: 3/12/2025 Tax ID: 39441 MAUREEN M & BJORN W SELVIG FORT COLLINS CO PIN: 04-018-2-44-07-35-0 03-000-11000 Legacy PIN: Billing Address: Mailing Address: Map ID: MAUREEN M & BJORN W MAUREEN M & BJORN W Municipality: (018) TOWN OF DRUMMOND SELVIG SELVIG STR: S35 T44N R07W 828 W OLIVE ST 828 W OLIVE ST Description: LOT 2 CSM 2374 IN DOC 2024R-605437 FORT COLLINS CO 80521 FORT COLLINS CO 80521 P13 V383 417 Recorded Acres: 0.900 Site Address * indicates Private Road Calculated Acres: 0.000 46185 TAHKODAH HILLS RD * CABLE 54821 Lottery Claims: 0 First Dollar: No Property Assessment Updated: 5/5/2025 Zoning: (R-1) Residential -1 ESN: 112 2026 Assessment Detail Code Acres Land Imp. Tax Districts Updated: 11/21/2024 Gi-RESIDENTIAL 0.900 193,500 0 1 STATE 2 -Year Comparison 2025 2026 Change 04 COUNTY Land: 193,500 193,500 0.0% 018 TOWN OF DRUMMOND Improved: 0 0 0.0% 041491 SCHL-DRUMMOND Total: 193,500 193,500 0.0% 001700 S TECHNICAL COLLEGE 048020 TAKODAH LAKE Property History Recorded Documents Updated: 9/1/2010 Parent Properties Tax ID ® TRUSTEES DEED 04-018-2-44-07-35-3 03-000-70000 39438 Date Recorded: 2/21/2025 2025R-606622 04-018-2-44-07-35-3 03-000-80000 39439 ® CERTIFIED SURVEY MAP Date Recorded: 11/8/2024 2024R-605437 13-383 ® QUIT CLAIM DEED Date Recorded: 6/9/2023 2023R-599313 ® CORRECTION INSTRUMENT Date Recorded: 8/6/2020 20208-583532 2 TRUSTEES DEED Date Recorded: 12/22/2014 2014R-557209 1136-494 ® QUIT CLAIM DEED Date Recorded: 6/11/2010 20108-533103 1041-341 ® QUIT CLAIM DEED Date Recorded: 4/30/2007 2007R-513561 969-83 ® QUIT CLAIM DEED Date Recorded: 4/30/2007 20078-513560 969-82 2 CONVERSION Date Recorded: 3/15/2006 457218 335-174;780-328 HISTORY ® Expand All History White=Current Parcels Pink=Retired Parcels ® Tax ID: 14282 Pin: 04-018-2-44-07-35-3 03-000-30000 Leg. Pin: 018105708001 ® Tax ID: 39439 Pin: 04-018-2-44-07-35-3 03-000-80000 2 Tax ID: 14281 Pin: 04-018-2-44-07-35-3 03-000-40000 Leg. Pin: 018105708000 ® Tax ID: 39438 Pin: 04-018-2-44-07-35-3 03-000-70000 39441 This Parcel 1 Parents Children JUN 02 ?1J 6ayfili Co. Panning and Zc• :in;; Agency L3MFI ELD 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: SELVIG, MAUREEN M & BJORN W 828 W OLIVE ST FORT COLLINS, CO 80521 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00431 Transaction Number: SR -00431-47217 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 5309 Paid by: Butterfield, 14346W State Rd 77, Hayward WI 54843 Payment Type: Check Transaction Date: 6/5/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. B 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: SELVIG, MAUREEN M & BJORN W 828 W OLIVE ST FORT COLLINS, CO 80521 Description Private Sewage System (Septic Tanks) Submission Number: SS -00760 Transaction Number: SS -00760-47086 $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 5309 Paid by: Butterfield, 14346W State Rd 77, Hayward WI 54843 Payment Type: Check Transaction Date: 6/5/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-58S STATE SANITARY PERMIT OWNER: MAUREEN M & BJORN W SELVIG G OV'T LOT: LOT: 2 B LK: CSM: 2374 Vi 3,P383 1/4 1/4 SEC: 35, T 44 N, R 7 TOWNSHIP: Drummond SOIL TEST: 48-26 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: TRAVIS BUTTERFIELD SCOTT ROUSH DATE: 6/5/2026 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: # 652879 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 6/5/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION