HomeMy WebLinkAbout26-71SI
Industry Services Division
County
I
4822 Madison Yards Way
Bayfield
Madison, WI 53705
Sanitary Permit Number (to be tilled in by Co.)
li— SS — t`> 0�I 1 �'
I
P.O. Box 7302
Madison, WI 53707
h'�
2 ( I
e5NaxN
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
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 pro�U s Secondary
purposes in accordance with the Privacy Law, s. 15.04(l)(m), Sla
TBD- Glacial Shores In. Bayfield, WI
Y'
I. Application Information — PleasePrint All Infor on
Property Owner's Name
6+
JUN 16 2026
Parcel #
Lichen Properties LLC
39337
Property Owner's Mailing Address Bayleld Co.
Property Location
4149 Lyndale Ave S Planning and Zoning Agency
Govt. Lot
City, State I
Zip Code
Phone Number
Minneapolis, MN
55409
612-751-3377
V %, Section 35
T 51 N R 04 E or W
H. Type of Building (check all that apply)
Lot #
❑✓ I or2 Family Dwelling - Number ofBedrooms 3
1
Subdivision Name
❑Public/Commercial - Describe Use
Block f!
Cityof
[]state Owned - Describe Use
Village of
CSM Number
2351 V13P330
❑✓Town of Russell
111. Type of POWTS Permit: (Check either "New" or"Replacement" and other applicable online A. Check one box on line B. Complete line C if
a licable.)
A.
New System
❑Replacement System
Other Modification to Existing System (explain)
❑Additional Pretreatment Unit (explain)
B,
Holding Tank
I ln-Ground
LY`t-Grade
Mound
❑ Individual Site Design
Other Type (explain)
(conventional)
C.
❑ Renewal Before
❑Revision
Change of Plumber
lI'ransfer to New Owner
List Previous Permit Number and Date Issued
Expiration
NA
IV.
DispersaVtYeatment Area and Tank Information:
Design Flow (gpd)
Design Soil Application Rate(gpd/sf)
I Dispersal Area Required (sf)
I Dispersal Area Proposed (sf) I
System Elevation
450
0.7
642
1678
94.0
Capacity in
Total
# of
Manufacturer
Tank Information
Gallons
Gallons
Units
o 's
a
New Tanks
Existing Tanks
o
y 2
d
O O
0
Septic or Holding Tank
1000
1000
1
Superior Precast
✓
Dosing Chamber
fl
V. Responsibility Statement- 1, the undersigned,
assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print)
I Plumber's Signature
MP/MFRS Number
Business Phone Number
Jason Kuettel
675751
715-798-3355
Plumber's Address (Street, City, State, Zip Code)
PO Box 66 Cable, WI 54821
VI. unty/Department Use Only
Approved
❑ Disapproved
Permit Fee
$
Date Issued
Issuing A ent Signature via 3/cG
❑ Owner Given Reason for Denial
4(2..2s( 21Odflo(
tj& — /oay
Conditions of Approval/Reasons for Disapproval
Pcatn4'tclf' MUS4 fie Q-( (Ras+ cc' d �oM (�� KS d' acJacoq i�
J
prLI'ec .
&cc� d �►d _
Attach to complete plans for the system and submit to the County only on paper not less than 8 In x I1 inches in size
IJ
SBD-6398 (R. 02/22)
SOBL TEST 7O. 1, g
Wisconsin Department of Safety and Professional Services Page I of
Division of IndustryServices
SOIL EVALUATION REPORT
gns�nxsIfi In accordance with SPS 385, Wis. Adm. Code County
Fl
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, parcel I.D. 3
but not limited to: vertical and horizontal reference point (BM), direction and percent slope,
scale or dimensions, north arrow, and location and distance to nearest road. q 7
Please print all Information. RRU
d by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). c11J I '/
t?/c2
Property Owner Property Location ❑
Li G iEN p rL P etir1 ±S «-L.. Govt. Lot '/e % S S T 51 N R O'.( E (or) W
Property Owner's Mailing Address Site Address or CSM and Lot #:
q 1q L'(N AL Ve-• L.uT I Lai LS) `V l3 P 33a
City I State I Zip Code I Phone Number ❑ City ❑ Village ® Town I Nearest Road
t -Al NN t c Lt S M !J SS '(0 ¼ — X?77 ' ' S S t LL 62.CS
New Construction Use: I Residential/Number of bedrooms 3 Code derived designflow rate (-.15O GPD
❑ Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. E 'E
Parent material O 'TvJ f1 14- S"%i- Dl
General comments and recommendations: c S is f TV v �?
ELI Boring #
❑ Boring
g Pit Ground surface elev. 7 - /eft.
Depth to limiting factor >1 U' in. / elev. 7./bit.
Sell Anoilcation 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#1
I
O- :
--
L..S
a St
/ki
G w
11 i(-
D ,7
I . (o
Z
-3-7-O
7.5 Y,c- ' 13
--
S
o SG
(,>/V
J1 r
O
1('
3
Zo
7rS Y4- V6
--
S
oSC,
/. C,
JUN -I -S
2026
Bayneld Co.
F�—] Boring # ❑Boring Planning and Zoning Agency
❑Pit Ground surface elev�� • 6i ft. Depth to limiting factor>II6 in. / elev.85 _ _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
GPD/Ft2
*Eff#1
*Eff#2
/ .
o-
.-Yti3/
^'
0_
(v
o'?
6
(v 7J
7, S lei. V3
S
o SC'
M
t
a .�
3
v1 - /i
.S rti $16
--
S
D f G
_ 1
1f
l
,
CST Name (Please Print)
Signature
CST Number
-
O 00 O Z -S
Address
'o
6iivatin Conducted I
Telephone Number
Qa )c (a &' c. ? , w �'
y /oo Z-1�
7 � - 7 S 8 77 5
* Effluent #1 = BOO > 30 5 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L
SBD-8330 (R04/21)
Page Z of
Boring•
3 Boring # Pit Ground surface eIev/9_W'3ft.
Depth to limiting factor�)U in. / elev.8?• tralFt.
Snit Annlinatinn Rate
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
dZ
7.5�
L.S
aSC�
Ml
Gw
(v
o.)
Z
Z
7'S' rA /?
--
$
i4 -tit
O..1
3
(-?Z
5`( -sly
SG
V
)4
7
Y
Z Z- tz
, S �,s-
--5
r
a Boring # H Boring
Pit
Ground surface elev. ft. Depth to limiting factor in. / elev. ft.
Sall Annlicatinn RateI
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPDlFt2
*Eff#1
*Eff#2
oZs
Bay''
..rd Zon1fl Agency
Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor 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
* Effluent #1 = BOD > 30 ≤ 220 mg/L and TSS > 30 s 150 mglL * Effluent #2 = BOD, 5 30 mglL and TSS ≤ 30 mg/L
CHECK BOX AS APPLICABLE CHECK BOX AS APPLICABLE.
SOIL EVALUATION Scale: 1"=40' SYSTEM PAGE 2 OF 3
SITE MAP 0 ao 60 80
PLOT PLAN
PROJECT NAME: (10 ft grid) 102 DESIGN FLOW: L! 50 GIRD
Li c-i'.J 3 i3 eft Attach design flow calculations for commercial plans.
PROJECT ADDRESS: 'Tt'S ib Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5)
N Sanitary Sewer. /
BM Symbol: BM Elevation: / O0 FT
• Q
t Force Main: _____________/_____________
BM Description: (7" A ,e
Indicate north by IMPORTANT:
Slope Gradient (%) 5 Well Symbol (If applicable): 0 drawing an arrow Show ground elevation contours at suitable Intervals.
of Tested Area: on the approprite line.
SS`f T b - (Xa Ec-c
t a LS?' 3 S 1 i3 33' 0 2 S S� s S 1 N ( oL )
17 C
L RECVED
(1 ap. a
IL JUN -4-6-1-02-6
Say i 7 Co---
A
Planning and Zoning Agency (lj C1
I_ ! N &C 9t. 96 TV Y5.1"
LIIIIiI
L / -TCQ
' l
I. ' 5%
\__.X33
'
f3M
2JC�R �
1/1'/Z6
PAGE 1 OF 4
In -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
Pg 2 of 4
Pg 3 of 4
Pg 4 of 4
Attachments:
Index & Cover Sheet
Plot Plan
Dispersal Area Cross -Section & ngJVD
Management Plan
JUN 16 2026
Bayfield Co.
Planning and Zoning Agency
POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Lichen Properties 3 Bed
Owner Name(s): Lichen Properties LLC
Owner Address: 4149 Lyndale Ave. S Minneapolis, MN
Phone: 612 -751 -3377
Project Address: TBD - Glacial Shores Bolder Pt. Bayfield, WI
Govt. Lot:
Township: Russell
1/4 of
Project Parcel ID #: 39337
Designer Name: Jason Kuettel
Zip: 55409
1/4, Section 35 , T 51 N -R 04 E ❑ or w121
County: Bayfield
Designer Information
Designer Address: PO Box 66 Cable, WI
E-mail: tim@andryras.com
License Number: 675751
Remarks:
Phone: 715 -798 -3355
Zip: 54821
I'hie sp!.e resorved ( it approval stomp.
Signature: . Date: 6/411A
Original si at a required on each submitted copy. ____
CHECK BOX AS APPLICABLE.
CHECK BOX AS APPDCASLE.
fl SOIL EVALUATION
Scale: l'•=40
O
SYSTEM PAGE 2 OF
SITE MAP
0
40
60
80
PLOT PLAN
PROJECT NAME:
DESIGN FLOW: GI SO GPO
a
(t0 ghd)
0,
(,1 Cti-r=-N 3 L3 e�
Attach design flow calculations for commercial plans.
PROJECT ADDRESS; 1 t�S
Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5)
AM Sym ado . D
BM Symbd: � BM Elevation: F7
El
Sanitary Sewer. /
Farce Main: /
BMDescripuon: N4i1.% l.tr7Sc.v f7"
Slope GradfeM (%) n
of Tested Area: S �o Well Symbol (if applicable): 0
Intlicala north by
drawing an arrow
IMPORTANT:
Show ground elevation contours at suitable intervals.
on the approprite line.
Q WN t'K -. Uc �'cr4 ?(Loec4--n €t C_LC-
fla�,t.4SP Tab- i3 6-D E I -9r. 6 Lttc. S t' o2.2s
LQ,sz COT t CSr^ 2351 V 13 P73a 2.5 ?S RC41i
77aK L7 3933
l?m ei cz-o C.O.
RECErvEu
JUN 16 2026
Bayfield Co.
-. Planning and Zoning Agency
fv
6)S7St
b/4 I zc
l /Vu Wt?c-l_
ON S rtE
7
F
1
3'-(&r -. c:z v 01H.o
(ZA'Jbc ql . eG
/moo W3/ a Ik'N�u F�ssa'l..
ctra .
P�
«)C rt"
4 ctd+at,3tNt.f
r N�
//A"S 3Z
97
/
tf 9','- Tt 5 d�d a +
133 i3M too•-
95
i OL ' Stn21
IN -GROUND GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard -W Chambers
3 -ft Trench (down -sizing credit)
min. 12'
SOIL COVER (tvFlcel)
12"
min. trench
depth
(typical) �'.
(typical) 4... •
System Elevation = 94.0
(typical)
Septic Tank(s) Manufacturer:
Superior Precast
Septic Tank(s) Volume(s):
1000 gal gal gal gal
Effluent Filter Manufacturer.
Orenco
Effluent Filter Model#! FT -0822
TYPICAL TRENCH
CROSS SECTION VIEW
(No Scale)
ft
Quick4 Standard -W
w/ End Cap (Show location of inlet / outlet pipe connection on plan view.)
(typical)
FR -1 �t----------t--------- ----i s —
I------------__-------��----
B= 46
(typical)
INSTALL PER TRENCH:
11 Quick4 Std -W @ 20 fe EISA/chamber = 220
+ 1 Pairs of end caps @6 ft= EISA/pair = 6
ft
ft2
ft2
Provide minimum 3 ft
separation between trenches.
Observation Pipe
(typical)
Install per manufacturers
/ instructions.
TYPICAL TRENCH
PLAN VIEW
(No Scale)
TA
(typical)
R���I��� `Quick4 Sta Idard W Chamber
(typical)
(mfd by Infiltrator Systems, Inc.)
JUN 16 2026 Install pursuant to manufacturers instructions.
Bayfield Co.
Planning and Zoning Agency
= Proposed EISA per trench = 226
ft2 Required Infiltration Area =
642
ft2
Distribution Method:
x 3
trenches = Proposed Total EISA =
678
ft2
branched manifold
7
GD
m
W
O
ii
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"'; FOG ≤ 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.) JUN 16 2026
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.) Bayfield Co.
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance''8. "Vision` nLW(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 (i.e., 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.
Scats. 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: Andry Rasmussen & Sons Phone: 715-798-3355
Local government unit: Bayfield Co. Zoning Phone: 715-373-6138
Local government unit address:
117 E 5th St. Washburn, WI
ZIP: 54891
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384, Wisc. Admin. Code.
Contingency Plan
In the event that any failed 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.
?li TA%IV
CROSS STOH JF) S?EC;%iCATICNS
4" So11,4o PVC INSP. PTO- 6 " MIN. ABOVE
(when cnle+ rna� o\e Fs buried
APPROVED
MANHOLE
FINISHED GFADE WI Lccy,•�p
W�FRui,u� cRBe(.
II - 4" MIN.
18" NIN.
I FILET
OUTLET
APPR_•D
� O FILTER
APPROVED MFG. 04�nco
PIPE]'
ONTO SOLID model s T082Z- RECEIVED
SOIL
I JUN 16 2026
Bayfield Co.
Planning and Zoning Agency
3" APPROVED BEDDING UHDR TANK
SPECIFICATIONS
S EPTdC
TANK Y MUtACTiRER: ___IL'+� __ __
TANK 5"IZE51 SE'TIC (b00 GAL
NOTES:
Private Sewage System Maintenance Agreement
.,c1 Winn/ L1 C i1,
911°1 1 iv//, Ct Ave S M,OIs MAI 55`t0°(
Site Address
e6t55d Turn)etr kr,, Q✓SSeI I Ws, 59I9
Iax lD tF 3935"r
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)
5E. 1/4 of IJW 1/4 Section 35 Township St N. Range 9 W
Additional Legal Description:
Town of RV(Acreage) , _ Gov't Lot
Lot_ Block Subdivision
Lot�CSM#Z3SI Vol. (7 Page770 CSMDoc#76x"12-607aq�(
DOCUMENT NUMBER
2026R-6 1 2580
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY. WI
RECORDED
06/16/2026 AT 2:49 PM
RECORDING FEE: $30.00
PAGES: 1
Recording Area
Return To:
Planning and Zoning Department
kfIn -ground gravity El In -ground dosed ❑ In -ground pressure distribution Sewage System:
❑ Mound El 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 manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code.
rivate Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be 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. JUN 1 7 2026
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. Bayfield Co.
Planning and Zoning Agency
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 lank 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
maybe placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provid #j$M r ^ ,
The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such prope41�� "'• ;rl
TAR),
Owner(s) Name(s) — Please Print C noc�sl
Gi-��cyr Ncl1o1�,5
Subscribed and sworn to before me on this date: S
p
MSG Clpe5cQu6cr)
'9
1'tA(
No rized O er(s) Slgnature(s)
ry Public
My Co icon Expires:
Drafted by: ' V N pate: 5. l d6
j7nA CZrFJJLLL
BUG e
Proofed by:
utforms/sanitarylsepacmalnlenceagreement
Revised July 2020
I3MFI E LD 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:
LICHEN PROPERTIES LLC
4149 LYNDALE AVE S
MINNEAPOLIS, MN 55409
Description
Certified Soil Tests - Review & Filing Fee
Submission Number:
SR -00444
Transaction Number:
SR -00444-4804D
Amount
$50.00
Total: $50.00
Payment Amount: $50.00
Reference: 15041
Paid by: Andry Rasmussen & Sons, PO Box 66, Cable WI 54821
Payment Type: Check
Transaction Date: 6/23/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
P-YFIELD Bayfield County
Planning & Zoning Department
117 E 5t1, Street
P.O. Box 58
Washburn, WI 54891
Phone: 715-373-6138
Fax: 715-373-0114
Property Owner:
LICHEN PROPERTIES LLC
MINNEAPOLIS , MN 55409
Description
Private Sewage System (Septic Tanks)
Submission Number:
SS -00772
Transaction Number:
�*-UslIIy"MF-1:1177
Amount
$400.00
Total: $400.00
Payment Amount: $400.00
Reference: 15041
Paid by: Andry Rasmussen & Sons, PO Box 66, Cable WI 54821
Payment Type: Check
Transaction Date: 6/23/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
BAYFIELD COUNTY
SANITARY PERMIT (#04)-26-71 S
STATE SANITARY PERMIT
OWNER: LICHEN PROPERTIES LLC
GOVT LOT: LOT: 1 BLK:
CSM: 2351 V13P330
1/4 1/4 SEC: 35, T 51 N,R4
4
TOWNSHIP: Russell
SOIL TEST: 70-26
NEW SYSTEM
SYSTEM TYPE: Non -Pressurized In -Ground
PLUMBER: JASON KUETTEL
EMILY MACGILLIVRAY DATE: 6/23/2026
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: # MP 675751
Condition: Drain field must be at least 50 feet from wells or adjacent properties. Properly Maintain
System Per Recorded Agreement
THIS PERMIT EXPIRES 6/23/2028
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION