HomeMy WebLinkAbout26-62S/r•^"*vnr
Industry Services Division
Yards Way
County
i \�\1
4822 Madison
O. C,
0 1 '�
pS tJ
Madison, WI 53705
Sanitary PeriSt Number (to be filled in by Co.)
_.,. —l/6
.• �.;F;;�„�,��,/ SS��7
P.O. Box 7302
Madison, WI 5302
Q- a S
Sanitary Permit Application
State Transaction Number
In accordance with SPS 38321(2). Wis. Adm. Code, submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to
Project Address (if different than mailing address)
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
7zSt d �pHJ
purposes in accordance with the Privacy Law, s 15.04(I)(m), Stats.
1�4
L Application Information - Please. Print All Information RECEIVED
Property Owner's Namc
(�q e M e e f°° JUN 052028
Parcel #_
3 f
9
Property Owner's Mailing Address
Property Location
Z \ %0 kGI/V Rd
PtanninoBand Zoniiin0 A
9urrcy
Govt Lul
City, State
Zip Code
Phone Number
yA tic ,,^ (,,
54 '1(
?lS 29i98>es
A Section 19
T - y$ N R For
: pe.of Building(check all that apply). -
L.ot #
Subdivision Name
I or 2 Family Dwelling— Number of Bedrooms I
❑ Public/Commereial -Describe Use
Black #
0 City of
❑ State Owned - Describe Use
0 Village of
CSM Number
XTownof Ti., PT
In. 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 jicable.)
A.
N v yslem
Replacement System
❑ Other Modification to Existing System (explain)
Additional Pretreatment Unit (explain)
B.
ding
In -Ground
At -Grade
I Mound
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: -
Design Flow (gpd)
Design Soil Application Rate(gpd/st)
Dispersal Area Required (so
Dispersal Area Proposed (so
System Elevation
Capacity in
Total
# of
Manufacturer
Tank Information
Gallons
Gallons
Units
a
NewTanks
ExistingTanks
e c
u
.x
0,Q
rn g,
rn
is o
A,
Septic or Holding Tank
3 o00
-
3DGo
Weiser Conrtr,ta
Dosing Chamber
V. Responsibility Statement- I, the -undersigned, assn resspn, i ility for installation of the POWTS shown on the attached. plans.
Plumber's Name (Print) Phan tI MPMIPRS Number Business Phone Number
Plumber's Address (Stoat, City, State, Zip Code)
I�G ( c1y Vsmy If ..� _ w 5-y
VI. County/Department Use Only
Approved
0 Disapproved
Permit Fee
I Date Issued OL I
Issuing Agentof P�IJ Siggnature o '
tO
✓
❑ OwnerGivenReason for Denial
(p !�P ,
o
A
Conditions of Approval/Reasons for Disapproval
d44].
:51L, 0()Lq�- i
SOiI Test #
Bayfield County
Waiver of a Thorough Soil & Site Evaluation
2b (subject to 15-1-10(d))
MAY 2 6 2u6
fm tyk4. a certified soil tester determine that in my profproferpal
judgment the following site (see below) is unsuitable for any treatment component otherrthgn o1 kQg a
tanks. Due to soil & site conditions, a thorough soil and site evaluation is not needed to make such a
determination.
Property Owner &* /(ei esof4o Contractor
Property Address 712520 6€�r3t /yi 'A Authorized Agent
Er -ran 1nl,I4/8g7 Agent's Telephone,
Telephone
�t57-aqa-QM5-
Accurate Legal Description is requested:
Written Authorization Attached: Y or N
5 W 114 of/1/14/ 1/4 Section19Township 9' N. Range OS W. Town of
Additional Legal Description: 1C C tO
Govt. Lot Lot Block Subdivision
Lot .1 CSM# 161a Vol. 9 Page 30' CSM Doc # _X ≥ 5-k— 60c2 a 3 Q 6
Volume Page of Deeds Tax I.D# 3O€G'( Acreage 7. 6'f
Indicate reasoning for your determination: 'ik ,'u i- t A 1y
tmmis I1t c/i::;c
Signature of C u ty Offici
O(o/I6'i /c9D1g
Date
Signature of Certified Soil Tester
Date
/a/3scc
Certification #
(Submit a Plot Plan & Fee)
u/forms/soiitestwaiver(KLK)
June 2018
�orrx�RTer�yrG� Wisconsin Department of Safetyand:ProfessionAservices Page of
Division of IndustryServices
SOIL EVALUATION REPORT
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. 04-048-2-48-08-19-2 03-000-40000
Please print all Information. R viewed by Dynte
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). t1 I G6,b OO
Property Owner Property Location ❑ ✓❑
Gage Meierotto Govt. Lot SW % NW r S 19 T 48 N R 08 E (or) W
Property Owner's Mailing Address Site Address or CSM and Lot #:
72520 Range Line Rd
City State Zip Code Phone Number ❑ City ❑ Village ❑i/ Town Nearest Road
Iron River WI 54847 71529298&I Tripp Rang Line Rd
_.! New Construction Use: [] Residential/ Numberof bedrooms 2 Code derived designflow rate 300 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
Boring # ❑ Boring 100.8
[]Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft.
nil Annlinafinn D f
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 3/4
SIC
2-sbk-c
mfi
as
1f
0.2
0.3
B
5-15
2.5YR 4/4
f -1-f 2.5YR 5/8
C
1-pr-vc
dh
-
-
0.0
0.0
C
L U"b
Bayfe{;i
Co.
v
inning and Zc
ling Age,-
y
Boring # ❑Boring
[]Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft.
nil Anniin,lin l?1n
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
12-20-26
I 11213855
Telephone Number
Address I
Date Evaluation Conducted I
10620 Eagle Lake Rd Iron River WI
1715-209-5748
* Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 S150 mg/L * Effluent #2 = BOD, 5 30 mglL and TSS 530 mg/L
SBD-8330 (R04/21)
t t
Page a of 2
❑ Boring
Boring # Q Pit Ground surface eiev. ft. Depth to limiting factor in. I elev. ft.
I Soil Anolication Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPDIFt2
*Eff#1
*Eff#2
fl Boring # ❑ Boring
O Pit Ground surface elev. ft. Depth to limiting factor in. ! elev. ft.
Cnil Annliroiinn Dofn
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
MI
Yd`(J6
Planning
and Zcnin
; Agen
❑ Boring #
❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft.
Cnil Annlin.�finn
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPO/Ft2
*Eff#1
*Eff#2
* Effluent #1 = SOD > 30 5 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOO, s 30 mglL and TSS 5 30 mg/L
7aS0 O 2_ t L he RA
S„x, Q.a wz Sy8y7
I wn v0 T°,
?P
Talc Sh 30026'
SuJc I = So
Ace'- Soil Tesf,n
I 06ao Cakc Lttkt Pd
Isar 2cvtir wt �'/5q7
csr3 j (3Sss
S/i9/a6
zv),4z5
U ZUL6
Bayfielo Co.
Panning and Zcning Agency
PAGE 1 OF 4
Holding Tank Plan
Index & Cover Sheet
Component Manual Design References:
Holding Tank Version 2.1 (May 2022-2027)
RECEIVED
Pg 1 of 4 Index & Cover Sheet JUN 05 2026
Pg 2 of 4 Plot Plan BaYfield Oo
Planning and Zoning Agency
Pg 3 of 4 Holding Tank Specifications
Pg 4 of 4 Management Plan
Attachments:
Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Map (if ap
Holding Tank Pumping Contract (if appli
Holding Tank Agreement (if applicable)
Project Name I Description
plicable)
cable)
Owner Name(s): C e c c W,, P f ( o i t c, Phone: T 15 -2°12 -_ (r
Owner Address: Z°l`6 `ko 'f ° l`<!IL Zip: 5 I `6 `I I
Project Address: ? 1C)
Govt. Lot: 1/4 of 1 /4, Section, TES N -R 8 E ❑ or W
Township: County: Sc J } c (cj
Project Parcel ID #:
Designer Information
Designer Name: G f r f r c.'J.' r, Phone: 15 - 10�,, - Cr
Designer Address: 13 GG c 1 •, vjr��, ,i t ler , U• ; Zip:
E-mail: (n eq5 aivtyb P on)- lock
License Number: M P. ( c 31 `l
Remarks:
This space reserved for approval stamp.
Signature: /TipDate:
Original signature required on each submitted copy.
PAGE 3 OF 4
Electrical must comply wvilh
SPS 3i6 and NEC300
HOLDING TANK SPECIFICATIONS
(No Scale) RECEIVED
JUN 052026
ea�a Co
Planningand Zoning Agency
—Junotton and ESIabI1 Flood EFevalion
Armmio VetiGad (tvcao
a[f rap
Approved iodd is Armhole
pV
evith Wanaag Labe! Attached
.Conduit >10 i from fpMcat) 4° Min. or2.0 ft above
E'jufJ Established Flood Elavation
-- _ _ / (typical)
(typic 7I
Approved Join'S with --/
ApprovedPipe3ftonto Met i2=arg0';5affatalvohcta
Solid Ground if >a then ox lSc
a
' AiaatOn
HOLDING TANK
VOLUME _ 3 0 o v gal
3°Argiaraa Es i fg Mafedal E{.ir:ath Tan:
TANK MANUFACTURER: V3 { S e ( Lov) c +c4 ti
Finished Grade
1.
Plug
Anchor tank as recess-3ry
ptasuant to SPS 383.43(8)(g)
Ballast Weight = j(cu,₹Ltankvoi x 62A Ibs/cu t) - lbs la .wg x 1.5
l€6\\? s T9 - MANAGEMENT PL Ai i
The Private Onsite !waste Treatment System (POW'TS) has been designed and is to be
ris: o ►sin Administrative Code,
installed and rrtainiasted according G =5 3&8_
P=vat Oft rev-- T a1me t -Systems
Holding Tank Component.= Manual fir . _v -. +-A=s5?.. �.• -� °_ '• "-
(SBD =u571-P)(i'._61 ) and the Bay"eld County honing Depf ®ry and Private
Sewage orainance. JUN 052026
i. This POWTS has been designed to accommodate a TI i Lom daily flow of
Ga gallons o₹ domestic wastewater per danning and Zoning Agency
2. The owner of this POWTS is responsible for system operation and
maintenance, locking device, alarm and access -
3. The owner or owner's agent is required to submit reports as required by SPS
383.55(1). lnris_ Adm. Code, to the Sayfield 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 h SPS 383 of the Wis. Adm. Code.
5. 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
repot with the department of designated agent.
7. A Users Manual will accompany the component It will include The names
and phone numbers of local health authorities, component manufacturer or
POWTS seats pr c•vide: to be contacted in the event of component
malfunction or tailure.
8. In the event that this POINTS or a competent of this POINTS fails and cannot
be repaired ₹he owner find in the Users Manual the names and telephone
numbers of proper} licensed individuals to contact for such repairs_
This agreement shall be binding on all assignees and heirs
+Ah t:t So t! \ s L N _ Range D W. Town ' i 'P
Il
:. of 7,- 4c rn T _ r= himRune _ _ e_ or
Govt. i c r ?
Lot Lot / Block Subdivision GSI!%r 7vv x -0. 51 n 3�2
Additional Legal
,j' 4J2Lc7i
PropeztylOwness Signature
4/./z G
Date
RECEIVED
HOLDING TANK SERVICING CONTRACT
Contract Date
US/� \ /o&
Holding Tank Owner(s) Name(s)
Gate J. hilttroPrO
This contract is made between the
JUN 052026
Bayfield Co.
Planning and Zoning Agency
Pumper's Name (Print)
Pumper's nature
Pumpers' Registration #
�ILca,la��J,c,
We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions)
PROJECT
LOCATION
Legal Description:
(Use Tax Stattemeeent)/
Tax ION
(
",,Oj(o '4
1/4, 1/4,
Section 5 1
'Y'9S't N, Range
IZTJt.J w
Town of: I
Lot Size I
Acreage
,Township
Gov't Lot
I
Lot p
CSM If
I Vol. Page
CSM Dec # I Lot(s) No.
I Block(s) No.
Subdivision:
Yooti: )3-Jao3ba k
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. s
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 fbr 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
contract, the owner agrees to file a copy of any than
with the local government unit and the Counti narifN
terminates this contract. In the event of a change in this
us sprvira ct or a copy of a new service contract
IeNHPaTsineLs days from the date of change to this
service contract. NOTARY PUBLIC
me:
on thisC- I day of 1
hM 1Afl/7 )Q1
My commission expires on:
Revised: May 2016 (®May 2018) Drafted by
Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (I)(m)]
15'-6
4" CAST -A -SEAL 4" CAST -A -SEAL
c e�
FILTER OR
e
CEIVED
JUN 052026
Bayfield Co.
Planning and Zoning Agency
1
OUTLET
C- ,
alU
W3OOO-MR
TANK SPECIFICATIONS
DIMENSIONS:
WALL: 2 1/2"
BOTTOM: 4"
COVER: 6"
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
HEIGHT: 71"
LENGTH: 15'-6"
WIDTH: 7'-9"
BELOW INLET: 57"
LIQUID LEVEL: 50"
WEIGHT: BOTTOM 12,260 LBS.
COVER 8,350 LBS,
INLET AND OUTLET:
4" CAST -A -SEAL BOOT OR EQUAL CASKET
INLET AND OUTLET BAFFLE AND FILTER:
WISCONSIN, SEE DETAIL #10
(OTHER STATES SEE CHART)
LIQUID CAPACITY: 55.94 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
SS- 0o76K
AGREEMENT
Cry J. me;ero +o a48 o,e�JTy
rno or•, wt S-{Ss49
Parcel Identifier Number (PIN) Agreement Date (same as Notary Date)
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.
1/4 . J Q of 1/4 Section Township N. Range �SW.
4r Town of f t' pp
Additional Legal Description: - -
Gov't Lot_ Lot�Block_Subdivision Lot
CSM#ibla Vol q Page 3�D _CSM Doc# aC*b)9-5a0 ba
DOCUMENT NUMBER
2O26R-6 1 2478
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY. WI
RECORDED
06/08/2026 AT 1: 19 PM
RECORDING FEE: $30.00
PAGES: 1
Return To:
ZoZt
JUN 09
Bayfield Co.
I and Zoning Agency
As an inducement to Bayfield County to issue a sanitary permit for a holding tank on the above -described propertyw4 agree to do the
following:
1. Owner agrees to conform to all applicable requirements of Ch. SPS 38.3r 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 Qpscribed in s. 254.59, Slats., 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 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. Slats., 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. 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. Bayffeld 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 reference to the property where the holding tank is installed.
ITrr., \ • flr,.,, ,1T
Owner(s) Name(s) — Please Print
ed aid sworn to before me on this date:
NOTARY Pt.
BLIC
STATE OF WIS
O IN
Notarized Owner(s) — Signature(s)
Note Public
iTzt IX
4Mq Commission Expires:
4-
Drafted by: J n e I\ z a K Date: 6-62) - (� la
ll
Personal inrormetion you provide may be used for secondary purposes lPnvacy Law, x.15.04 (I)(m)l uHom,e/sanitary/HaldingTanMgreement 4.2026
]FIELD 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:
ZAK, JASON A SR -00421
29840 KELLY RD
MASON, WI 54856 Transaction Number:
MEIEROTTO, GAGE J SR -00421-47008
29480 KELLY RD
MASON, WI 54856
OGILVIE ZAK, JENELL R
29840 KELLY RD
MASON, WI 54856
Description Amount
Certified Soil Tests - Review & Filing Fee $50.00
Total: $50.00
Payment Amount: $50.00
Reference: 3371
Paid by: Timothy Dykstra, 10620 Eagle Lake Rd, Iron River WI 54847
Payment Type: Check
Transaction Date: 6/16/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
]34YFIELD 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:
ZAK, JASON A
SS -00764
29840 KELLY RD
MASON, WI 54856
Transaction Number:
MEIEROTTO, GAGE J
SS -00764-47644
29480 KELLY RD
MASON , WI 54856
OGILVIE ZAK, JENELL R
29840 KELLY RD
MASON, WI 54856
Description Amount
Private Sewage System (Holding Tanks) $400.00
Total: $400.00
Payment Amount: $400.00
Reference: 4067
Paid by: Greg's Plumbing, 13660 County Hwy H, Iron River WI 54847
Payment Type: Check
Transaction Date: 6/16/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
BAYFIELD COUNTY
SANITARY PERMIT (#04)-26-62S
STATE SANITARY PERMIT
OWNER: GAGE J MEIEROTTO
GOVT LOT: LOT: BLK:
SUBDIVISION: Csm #1612
1/4 1/4 SEC: 19, T 48 N, R 8 W
TOWNSHIP: Tripp
SOIL TEST: 59-26
NEW SYSTEM
SYSTEM TYPE: Holding Tank
PLUMBER: GREG BROWN
EMILY MACGILLIVRAY
Authorized Issuing Officer
DATE: 6/16/2026
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. Must be within 25 ft of an all-
weather road.
THIS PERMIT EXPIRES 6/16/2028
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION