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Home My WebLink About26-0305SANITARY PERMIT APPLICATION CS- oo 63 .,.t."kw Cfeu Soil Test County osOC a / U t7 J No No: Permit : P�ppertyC,4?,e Trll h 1SP �Yn� vi County: Bayfield letq cLsPr Address of Property: Property Location: l7O old Kenry / lr^&4 Y ½,S T N, R E (or) W Property Owner's Mailing Address: Township: Gov. Lot #: t3os P ; r) e '-A/ City, State Zip Code Phone Number Lot # Block #: CSM #: CSM Doc # Subdivision Name OZ`4 7t,' SEA Z75 2 � 1V 1CDING `-(Check One) . ' Tax ID#: JUN ❑ State Owned ❑ Public (Explain the use/purpose ) 39 6 P- 112026 [!} 1 or 2 Famil Dwellin - No. of Bedrooms _E 9RPERMIT:: Cheigr onl y one box on line A:;: Check boioon.tlne'B,ilIfA livable '4ar> >n A) rsNew ❑ Replacement ❑ County Private Interceptor ❑ Reconnection ❑ Repair ❑ Revision " ❑ Transfer of Owner (List Previous Owner below) B) ❑ A Sanitary Permit was previously issued. Previous Permit Number Date Issued: PE OF NON -PLUMBING SYSTEM: (Check One) ' Replacements need previous permit number and date filled out above ❑ Pit Privy ❑ Vault Privy (Vault size: _gallons or _cubic yards) Portable Privy ❑ Camping Transfer Unit Container ❑ Composting Toilets ❑ Incinerating Toilet ?WC ORPTION SYSTEM=INFORMATION: ons 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System 7. Final Grade ay Required (Sq.Ft.) JN Proposed (Sq. Ft.) (Gals. / Day / Sq.Ft.) (Min. Inch) Elev.(Feet) Elev. (Feet) K ATION: Capacity In Gallons Total # of Fiber Manufacturer's Prefab. Site Steel - Plastic Expe Gallons Tanks Name Concrete Constructed glass APF New Existing Tanks Tanks ank or Tankp Tank /Si hon hamber VII. RE5_FVIV,tl7lLft;�u?,rt?J cnr v:: :. I the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Owner's Name(s): (Print) If applying for Section C above Owner's Signature , (No Stamps) ne ¶r ( fr SArr.A Gc5 l= P/umber'sN�ame: (Print) Ifapplying forSectionAorB)above Plumber's urn: (No Stamps) MPIMPRSW No: 'lumbers Address: (Street, City State, Zip Code) Home Phone: Business Phone: DESSE,ONLI'i 1 P ❑ Disapproved Sanity Permlt/Transfer Fee: Date Issued: Issuin� Agent's Signature I Dal Approved ❑ Owner Given Initial1l/ Adverse Determination V d il�J� MFQMUflA!QNS FQR ISAP,FRQYAfi k ,. k: us (eOutff C� Plot Plan on rf fn�ooa.Y RECEIVED Contract Date: M ronaoie Kesrroom uwnerts) Names): I Pumpers (Service Provider) Name: II Sam Carp s� AruJ�ri>c vv��re ELxr�tvrtiaJ#( Ii We acknowledge the placement of a Portable Restroom on the following property: PROJECT LOCATION Legal Description: (Use Tax Statement) Tax1De 3 Z ) 1/4, of Section 9) N, Range I Town of: r` •L(f I Lot Size I Acreage _1/4, __[_ ,Township _____ w 13" c. c Gov't Lot I Lot *4 I CSM N I Vol. Page I CSM Doc I Lot(s) U Block(s) k Subdivision: q ;q- IVHe4 L'ca≤g-onl 1. The owner agrees to file a copy of this contract with the Bayfield County Planning and Zoning Dept as required in Title 15 of the Bayfield County Zoning Ordinance. 2. The owner agrees to have the Portable Restroom 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 Portable Restroom. The owner agrees to maintain the access road or drive so that the pumper can service the Portable Restroom with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the Portable Restroom as mutually agreed upon by the owner and pumper. 3. The pumper whom has signed the pumping agreement agrees to submit the agreement to the local government unit (Bayfield County Planning and Zoning Dept.) as required by Title 15 of the Bayfield County Zoning Ordinance, a report for the servicing of the Portable Restroom on an annual basis. The pumper further agrees to include the following in the annual report: a. The name and address of the person responsible for servicing the Portable Restroom; b. The name of the owner of the Portable Restroom; c. The location of the property on which the Portable Restroom is installed; d. The dates on which the Portable Restroom was serviced; e. The volumes in gallons of the contents pumped from the Portable Restroom for each servicing; f. The disposal sites to which the contents from the Portable Restroom 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 and/or a copy of a new service contract with the local government unit (Bayfield County Planning and Zoning) named above within (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) e( Owner's Signatur9(s)` Subscribed and sworn to me on this date: arn.Capsper z I �� ao2(� W U z oday's Date 0 m U Qd - No ryPublic Signature Pumpers Name Print) Pumper nature o I yr E o W 1 f ?5/902 Pumpers Registration Number `� �(� Z Commission Expiration U rQ Created: Nov2011 (Bayfield County Zoning.rnf) €6/7/201 B Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (i)(m)) Proofed by; ILK PRIVY AGREEMENT (Yl - o o a 6 9 (ATTACHED TO THE SANITARY PERMIT APPLICATION) DOCUMENT NUMBER 2026R-6 1 2083 ?t.J'fce,-i 1 .St /3t5 #m,rie (A1iy 33970 oral k-ervwt7 /Zd Legal Description: Section, Township, Range 1/4, 1/4, S cR2T 5_D N, R V Return To: 7Z I 1. NO NO PLUMBING will be installed in the habitable building. DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 05/08/2026 AT 11:45 AM RECORDING FEE: $30.00 PAGES: 1 ZONING MAY 112026 Planning and Zoning Agency 2. NO PLUMBING includes: water closets, sinks, bathtubs or showers, laundry facilities, or any other fixture or receptacle receiving domestic waste, will be installed in the premises served by the privy unless a code compliant soil absorption system or holding tank exists, or a valid sanitary permit to install such a system has been issued. 3. A privy vault / pit shall maintain minimum setbacks as specified in Table 1, Table 1 Well Building Lake/Stream ake / Stream Additional County Setbacks OPEN PIT 50 Ft. 15 Ft. Min. 75 Ft. SEALED VAULT 25 Ft. 15 Ft. Min. 75 Ft. 4. Privies for public buildings shall comply with SPS 353.63. ENTERED' 5. Privies used for one- and two-family purposes shall be constructed in such a manner so as to exclude flies, rats and other vermin. Doors should be self -closing and vault ventilators should terminate at least one foot above the roof. 6. Privies as per SPS 391.12 (1) states as follows: (a.) The storage chamber of a vault privy shall conform with the requirements of s. SPS 384.25 relating to holding tanks and shall have a minimum storage capacity of 200 gallons or one cubic yard. (b.) The storage chamber of a pit privy shall be sited and located in soil recognized to provide treatment and dispersal in accordance with s. SPS 383.44 (4)(b). 7. The privy shall be kept clean and sanitary. The contents of the pit or vault shall be disposed in accordance with NR 113, Wis. Adm. Code. 8. This agreement shall be binding on the owner, their heirs and assignees. This document shall be recorded by the Register of Deeds in a manner, which allows its existence to be determined by reference to the property where the privy is installed. Printed Owner(s) Name(s) This Instrument was signed before me in the State of W r County of IK . rLc T2f 11jen ccj%f r On this a2 day 20 a6 Owners) Sa otary Public My My commission expires on: 7/ aS/ O9 Drafted By. Sotvo.,k rl4SIXtlmust be filled out by person submitting form) u/fmms/sanitry/privyform�®O a eret b 20a ercl b 2019 CHRISTINA A. SIREK1 NOTARY PUBLIC STATE OF WISCONSIN O December 2012 D =YFIELD Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-4010 Property Owner: Description Portable Restroom Submission Number: CS -00163 Transaction Number: CS -00163-482E1 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 79-998/918 Paid by: Sarah Gasper Payment Type: Check Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. Town, City, Village, State or Federal Permits May Also Be Required LAND USE - SANITARY - Portable Privy SIGN - SPECIAL - CONDITIONAL - BAYFIELD COUNTY PERMIT WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION No. 26-0305 Tax ID: 39672 Issued To: TRUHLSEN, DWAYNE K & GASPER, SARAH L Location: S27 — T50N — R04W Town of BAYFIELD Legal Description: LOT 4 CSM 2417 V14 P46 IN DOC 2025R-608823 IM 2025R-608921 Residential Structure in R-RB Zoning District For: Sanitation Permit — Portable Privy (Disclaimer): Any future expansions or development would require additional permitting. Condition(s): Maintain as required. You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the department of natural resources wetlands identification web page or contact a department of natural resources service center (715) 685-2900. NOTE: This permit expires two years from date of issuance if the authorized construction work or land use has not begun. Changes in plans or specifications shall not be made without obtaining approval. This permit may be void or revoked if any of the application information is found to have been misrepresented, erroneous, or incomplete. This permit may be void or revoked if any performance conditions are not completed or if any prohibitory conditions are violated. Emily Macgillivray, AZA Authorized Issuing Official June 29, 2026 Date