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Home My WebLink About26-67SSanitary Permit Application Vendor Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary \ f� purposes in accordance with the Privacy Law, s. 15.04(Ixm), Stats. 5Sct�e- C vn S �t+� L Application Information - Please Print All Information PropertyOwner's Name Parcel # O14-OOq -z -j LI - 09 ERIC + %1fHgeaU.( GILL a•a.-3-oS'-atl"-13 loo Property Owner's Mailing Address Property Location 2Ca7 G oyayr N tcP16).j';� OR S Govt. Lot CIO JJ�r'' II City, State Zip Code Phone Number f JD 83333 1503-1`13-9oa$ A, 14, Section II. Type of Building (check all that apply) l or 2 Family Dwelling - Number ofBedrooms 4 ❑ Public/Commercial — Describe Use •State Owned—DescribeUse __ ❑ City of ❑ Village of ,VTown of Rtl e hl ES otding Tank In -Ground At -Grade Mound Other Explain (conventional) B. Renewal Before ❑ Revision Change of Plumber Transfer to New ownerH Reconnection/Repair Expiration IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required (st) Dispersal Area Proposed (st) System Elevation Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units a q g New Tanks Existing Tanks °•� m u r 1 I P. I septic orHoldmglank I 3oac I 13ao I I I cx.Sle't£Q I X I I I I V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si urnMP/MPRS Number Business Phone Number Ga-a 1`ovt-+6 z319y0 7l S-39S-Z'I'ci Plumber's Address (Street, City, State, Zip Code) A brpa o'-' A .s -Q— &spct , rJ 1� lJ st 8 g0 I, lApproved ❑Ownr k'IR �Y1r71'A /��37/3 /l!/� X ❑ Owneer Give Given Reason for Denial �(�if— ` ek cdt ICVJ ea4I I :nnn'q,1.rd'Z111-gA Ba!d o.p9u to complete plans for the system and submit to the County only on pacer not less than 8 in x 1I inches in size Douglas County Planning and Zoning 4/25/2023 RgcclV to JUN 012026 Bayfieid Co. Planning and Zoning Agent/ Wisconsin Departmentof Safe and Professional Services - Page 1 of 3 Division of Industry Services TEST�5 a� SOIL EVALUATION JRNORT County BAYFIELD In accordance with SPS 38 eAttach complete site plan on paper not less than 81/2 x 11 inch i * la i Parcel I.D. L O but not limited to: vertical and horizontal reference point (BM), di percent scope, 04.0042-4409-02.3-05-00413100 .�D� ! scale or dimensions, north arrow, and location and distance to ne Please print all information. Revi w y �� Personal information you prc roperty Owner ,RIC & KIMBERLY GILL roperty Owner's Mailing Ac 65 GOLDEN EAGLE DR S City HAILEY :us`ed fof_a�ebbndary purposes (Privacy Law, s. 15.04(1)(m)). Property Location E (or) W PR U 6 2fir_' Govt. Lot /4 Y. S T -1'1 N R g O se Site Address or CSM and Lot # State Zip Code Phone Number ❑ City ❑ Village ' Town Nearest Road ID I 83333 (503)793-9028 BARNES JAMES ROAD (] New Construction UseI Residential/ Number of bedrooms Code derived designflow rate b'o'o GPD Replacement ❑ Public or commercial - Describe: .- - FQ d [Vi ratn*able-Y14—ft. Parent material OVTU4 tk S *►N QS► r'�General comments and recommendations: UN Q 1 [0L6 Boring (� Bayfield Co. Boring # Pit Ground surface elev. I FL vning and Zonlmiting factor in. / elev. ft. a 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 1 0-10 7.5YR2.5/3 FS OFSG ML 3W IF .5 1.0 --------------------- --------------- FS OFSG ML 3W IF .5 1.0 2 10-17 7.5YR4/6 3 17-28 7.5YR5/4 S OMSG ML W IM .7 1.6 4 5 28-48 48-90 7.5YR4/4 5YR4/6 S S OMSG OMSG ML ML 3W 1M 7 7 1.6 1.6 Boring Q T2. Boring # Pit Ground surface elev. ! 1 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 ----�----- FS FS OFSG OFSG ML 3W 3W IF IF .5 5 1.0 1.0 1 0-11 11-19 7.5YR2.5/3 7.5YR4/6 2 S OMSG ML 3W IM .7 1.6 3 19-30 7.5YR5/4 S OMSG ML 3W IM 7 1.6 4 30-49 7.5YR4/4 S OMSG ML .7 1.6 5 49-89 5YR4/6 ----------------- CST Name (Please Print) GREG YOUNG Address Date Evaluation ConcTuctec 6502 TOWER AVE 10-1-25 * Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 s 150 mg!L Signature CST Number 231040 Telephone Number 715-395-2929 * Effluent #2 = BOD, s 30 mglL and TSS ≤ 30 mg/L SBD-8330 (RO4/21) Page Z of 3 aBoring # ❑ Boring Pit Ground surface eiev. iq ft. Depth to limiting factor QO in. / elev. ft. I Soil Annlication 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 0-10 .5YR2.5/3 FS OFSG ML GW 1F .5 1.0 2 10-20 .5YR4/6 -- FS• OFSG ML 3W 1F 5 1.0 3 20-30 7.5YR5/4 --------------------- S OMSG ML 3W 1M .7 1.6 4 30-48 7SYR4I4 - S OMSG ML 3W 1M 7 1.6 5 48-90 7.5YR416 - S OMSG ML ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Aoclication 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 eiev. ft. Depth to limiting factor in. / elev. ft. Soil Aoalication 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 s 220 mglL and TSS > 30 s 150 mg/L JUN U Baytie;d Co. Planning and Zoning Agency * Effluent #2 = BOD. s 30 mglL and TSS s 30 mg/L 3c3 !~\IJI1 U U Z' tom_ I " v e c.s + Ord P4e , tl�+3R0 R A ' SEC 1VED JUN 012026 Bayfield Co. Planning acid Zoning Agency 6502 Tower Avenue Superior, WI 54880 June 17, 2026 Bayfield County Zoning RE: Eric Gill 5565 James Road Barnes WI I have completed a soil test for the above property, although the soils are acceptable for an in -ground system the lot size along with clear available area does not allow enough room for a conventional type of drain field, therefore lam proposing a 3000 gal holding tank. Respectfully, Greg Young HOLDING TANK SPECIFICATIONS Number of bedrooms Non-residential estimated flow (gpd) 2000.0 Minimum holding tank volume required (gal) 3000.0 jProposed holding tank capacity (gal) WIESER Tank Manufacturer WLP3000 Tank model number Rhombus SJE lAlarm manufacturer Tank Alert 101-01H lAlarm model number [.NR 062026 Bayfie!9 Co. Planning cnd Zcnicg Agency Tank Dimensions and Data Tank Anchor Calculations X for round tank 25280 Ibs Weight of tank and cover 50.0 Liquid depth below inlet invert (in) 1.50 Safety factor 8.0 Maximum de th of soil cover (ft) 37749 _ Ibs Weight of anchor required 62.0 Height (in) Outside 34.8 un Soil cover req. for anchor or 184.0 Length (in) rDimensions 9.3 yd3 Concrete counterweight 102.0 Width (in) Only HOLDING TANK CROSS SECTION vent cap vent pipe manhole cover with �— locking device and finished junction box warning label grade Ijjl T4" min. E--23 in. _f I conduit >1!!! I I Manhole and vent locations Sealed water tight blind plug to seal outlet tether weight service alarm on Electrical as per NEC 300 and SPS 316 3 in. bedding under tank. Project: GILL Transaction Number: 12.0 in. 38.0 in. Note: All tank joints, and joints between tank openings and piping are sealed watertight. All pipe and vent materials comply with SPS 384. Tank is anchored as necessary to negate buoyancy. RECEIVED JUN 012026 Sayfield Co. Planning and Zoning Agency 18" min. building sewer inlet Page 2 of 4 RECEIVED JUN 012026 JuRayfie Co. 10?6 Planning and Zoning Agency HOLDING TANK SITE PLAN Project: GILL r L P p 2 F A c1 C 1- R. L K 1- A. A d41 Scale: 1" = 40 ft I 0 IC 97 Legal Description: 02-44-09 Subdivision Name: Parcel ID: 04-004-2-44-09-02-3 05-004-1310 Lot No.: 4 5Pmt 5 Cost i C,exs'r-.-'6 ,I 1� ro Ge- AG..Koea -*T7X 3 L. Pcr 5 PS 383.33 4' t ' efZ F}7; w 3 II Eo oME 0 Use« H��sE 3M lb ►�yD -3 RECEIVED HOLDING TANK SERVICING CONTRACT cUIJ 012026 Bayfield Co. Planning and Zoning Agency Contract Date S -1M 2S0 This contract is made between the ol{I Holding Tank Owner(s)rsName(s)/'` L C J LtM•esc a t0 t 2.L- Pu per's Name (Print) Pumper's Signature Pumpers' Registration # �urs6 $v+ -Lt Sct..tCe. C7rL3� You rl6 Z� We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PR0JE I Legal Description: 1/4, t/4, LOCATION (Use Tax Statement) � 3+7 6� u 0 z �s—e 14 041 Town of. LotShe Acreage Section ,Township N, Range w Q412N1E$ f.s7o Gov't Lot I I Lott. CSM* I Vol. Page CSM Docli I Lot(s) No. I Blacks) No. Subdivision: 3 I 1823 3b8 1. The owner agrees to file a copy of this contract with Bayfield County as required in SPS 383.55, Wis. Adm. Code. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local government unit which has signed the pumping agreement required by SPS 383.55, Wis. Adm, Code, and the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank Is Installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was servIced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new 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) Name(s) (Print) Owner's Signature(s) Subscribed and Sworn to me: K: holey G:11 � onthis � dayof ' t\ T ay by: E r c G;11 Notary Public My commission expires on: \0 Z6 Revised: May 2016 (®May 2018) 44 DrafteJ Wnini RTaMP Personal Information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)j KELVET B ACERA NOTARY PUBLIC - OREGON COMMISSION NO. 1038661 MY COMMISSION EXPIRES JULY 10, 2027 RECEIVED HOLDING TANK — MANAGEMENT PLAN JUN 01 2026 Bayfield Co. The Private Onsite Waste Treatment System (POWTS) has been desi dnand4'srtc bency installed and maintained according to SPS 383, Wisconsin Administrative Code, Holding Tank Component Manual for Private Onsite Waste Treatment Systems (SBD-10571-P)(R.6/99) and the Bayfield County Zoning Department Sanitary and Private Sewage Ordinance. This POWTS has been designed to accommodate a maximum daily flow of gallons of domestic wastewater per day. 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), 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. 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 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. 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 at Township 1 N. Range o9 W. Town of_____________ s� Govt. Lot _3 Lot I Block Subdivision CSM# I8').3, Additional Legal Description / iii` Property Owners ignature u/forms / m anag a g e me nt plan Revised: July 2013 5I1u(zv _ /ir/1c TD to 6' SS-vo1sq Document Number/Plan I.D. No. HOLDING TANK D AGREEMENT 2 Owner Name �($) fit fia1Ctni1 Ru{ 6,t- t,Owner(s) Mailing Address i65•' €etbf✓+ epid'-- W3 D iti iy'z O 83333 Parcel Identifier Number (PIN) Agreement Date (same as Notary Date) B oH-a&N•7-t1-� rod: 3 5-1 K -'bb We acknowledge that application is being made for the Installation of (a) holding tank(s) 06/ on the following property or that continued use of the existing premises requires that a RE holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Stets. ��(A 1/4 of 1/4 Section OZ Township Z_ N. Range Qa W. Town of Vlr uxe$ Return To: Additional Legal Description: zer• Gov't Lot, Lot %Block_'Subb�diivision Lot CSM# 18LVo1 1 O Page.�CSMDoc# 201'Z�-Swo8T�1 OCUMENT NUMBER D26R-61 2368 ANIEL J. HEFFNER REGISTER OF DEEDS AYFIELD COUNTY. WI RECORDED 01/2026 AT 2:19PM CORDING FEE: $30.00 PAGES: 1 RECEIVED JUN 022028 Bayfield Co. riannung and Loning 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 an W,(/)6 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, Stets., 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 a. 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. 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 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. Slats., 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 property 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. Owner(s) Name(s)— Please Print Subscribed and swom to before me on this date: �:tt ')QJ%-) \`\' 202u L=r. GO1 BrcGi Notarized Ow�ne,r,(s)-mSSignature(s) Notary Public �� • -9 My Commission Expires: vi ^ Vl Drafted by: P6b /O fir► S Date: O I IA STA Pemonel Info,melbn you provide may be used for secondary purposes (Privacy Lew, 5.15.04 (n(m)] IeenlledW�E�e�OYa NOTARY PUBLIC - OREGON COMMISSION NO. 1038661 MY COMMISSION EXPIRES JULY 10, 2027 BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): F.PP 0 6 20?0 'nayflc J Co. Check List P!ecm,ir; ao! c r,irq :,g%"7 .21 ❑ Index Page / Tide Sheet (Optional) Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) RECEIVED Original Plot Plan JUN 012026 ❑ Cross Section Soil Profile Sheet (optional) arran ndZo6a yfield Co. ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) PbnnrngaaZonin gAgency Soil Evaluation Report: (Include the following Information) Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used , 'Property Owner's Information (not prospective buyer's name) Property Location (Accurate Legal Description with Sec/Twp/Range) xfRoad Name (where driveway is/will be coming off of) ❑O Floodplain Elevation, Flow Rate, Comments and Recommendations .0 Complete Soil Boring / Pit Information Date Soil Evaluation was conducted 2ICST Name, Signature, Number, Address and Phone Number 17"*Date Stamp* Plot Plan: (Indude the following information drawn to dimension or to scale) ,ZrBench Mark (Description, Elevation and Location) $tontour Lines (Example = 98.0' /96.0' /94.0') "roperty Location (Sec/Twp/Range/, Accurate Legal Description) ,flBorings (Locations and Elevations) Percent and Direction of Land Slope OWell Location (Including Neighboring Wells, if applicable) gocation of Wetland Areas, Floodplain and Navigable Waters .i2 uildings, Driveways, and Structures (Location and Descriptions) X.I Location of Property Unes Existing System Location .fAddress Number and Road Name Current Surface Elevation of Wetlands and Navigable Waters .ZICST, Owner and Property Information North Arrow Fee: ' dCertifled Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforests .CCE VED BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS t 062026 Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) fled co. Check List Pa"; a..J L ,ning Agency (Original Sanitary Application (Submitted in Deed Holders Name — gg prospective buyers) (383.21(1)1.) )KIndex Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) '0 Original Plot Plan (383.22(2)2. 3. & 4.a) 151. Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) 0 Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) 'ci, Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) ',Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) ',Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) IR2 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) 'Q Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) 0 State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary Aoolication: (Include the following Information) I Application Information must include: 0 23 digit Parcel ID# — (do not use 12 digits anymore --obsolete) Project Address gr Road Name where driveway is/will come off of) ".(Owners Phone Number) ❑ II Type of Building ❑ III Type of Permit 'I9. IV Type of POWTS System ❑ V Dispersal / Treatment Area Information "RVI Tank Information 'TS,VII Responsibility Statement (Plumber's Information) 0 *Date Stamp* Plot Plan: (To Scale or To Dimension) I Signature and Plumber Information Surface Elevation of Body of Water 1SI, Direction and Percent Land Slope 'KjjTank and Filter Information and Location Wetlands / Navigable Bodies of Water NAbsorption Area (Proposed and Existing) m Bench Mark (Location, Elevation and Description) '&Component Manual Version RECEIVED UUN 0 12026 Plannln hayfield Co. g and Zoning Agency 'Address Number and Road kNorth Arrow D -(Contour Lines Structures and Driveways ❑ Boring Locations Property Lines .Well Locations Legal Descriptions Turn Over ► Cross -Section and Over -Head Profile of the System: ECElVED 'ti Surface and System Elevation 77 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? ) 0 Has this property been split? (Property Statement shows Property History) Fees: ❑ Private Sewage System (Septic Tanks) $ 400.00 XPrivate 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) APR 0 6 2026 Bayfieid CO lV/ Planning / 7y RECEIVED JUN 0 12026 Bayfieid Co. Planning and Zening Aeenoy u/Forms/checkiists/checkiislfor anitaryapps (10/2009);(@7/2011);(@2/2012)(®5/2/2012 -dc) Proofed by: J3' 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: GILL, ERIC & KIMBERLY 265 GOLDEN EAGLE DR S. HAILEY, ID 83333 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00426 Transaction Number: SR -00426-482A0 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 21004 Paid by: Young Plumbing & Heating, 6502 Tower Ave, Superior WI 54880 Payment Type: Check Transaction Date: 6/19/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. R -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: GILL, ERIC & KIMBERLY 265 GOLDEN EAGLE DR S HAILEY, ID 83333 Description Private Sewage System (Holding Tanks) Submission Number: SS -00759 Transaction Number: SS -00759-482A2 Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 21004 Paid by: Young Plumbing & Heating, 6502 Tower Ave, Superior WI 54880 Payment Type: Check Transaction Date: 6/19/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-67S STATE SANITARY PERMIT OWNER: ERIC & KIMBERLY GILL G OV'T LOT: 4 LOT: 1 BLK: CSM: 1823 V.10 P.368 SUBDIVISION: Csm#1823 1/4 1/4 SEC: 2, T 44 N, R 9 W TOWNSHIP: Barnes SOIL TEST: 65-26 REPLACEMENT SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: GREG YOUNG TRACY POOLER Authorized Issuing Officer DATE: 6/19/2026 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 #: 2426 LICENSE: # 231040 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. Old System needs to be properly abandoned per SPS 383. THIS PERMIT EXPIRES 6/19/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION