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HomeMy WebLinkAbout26-72SDepartment of Safety County Bayfield 0s & Professional Services, Sanitary Permit Number be filled in by Co.) SS -co -17 Industry Services Division (to a - 7&tS ' 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 Project 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 be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Slats. 62135 County Hwy E I. Application Information — Please Print All Information Property Owner's Name Parcel # Chase Hoven ©23375 Property Owner's Mailing Address Property Location 63770 Franciskovich Rd Govt. Lot City, State I Zip Code Phone Number Ashland, WI 54806 715-209-5097 SW 1, SE 1, Section 09 T 46 N R 06 E oec II. Type of Building (check all that apply) Lot # •l or 2 Family Dwelling —Number of Bedrooms 2 RECEIVED Subdivision Name Block ❑ Public/Commercial — Describe Use JUN 17 2026 DCityof ❑ State Owned — Describe Use 0 Village of CSM Number Planning Bayfield Co. and Zoning Agency ® Town of Mason 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 i a licable. A. El New System ❑ Replacement System ❑ Other Modification to Existing System (explain) Cl Additional Pretreatment Unit (explain) ❑✓ Holding Tank ❑ In -Ground ❑ At -Grade ❑ 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/s Dispersal Area Required (st) I Dispersal Area Proposed (st) I System Elevation 300 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units s d c r0 ' is New Tanks I Existing Tanks o it U M Septic or Holding Tank 2105 2105 1 Superior Precast ✓ ❑ Dosing Chamber ❑ V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) tuber's Signal MP/MP12S Number Business Phone Number Dean Blakeman _ 1092768 715-682-6050 Plumber's Address (Street, City, State, Zip Code) 44941 State Hwy 13, Ashland, WI 54806 VI County/Department Use Only Approved ❑ Disapproved Permit Fee $ Date Iss ed Al �G .>•/� Issui Age igyna��ty/�¢ ❑ Owner Given Reason for Denial I v- W a� b1„ 2 CAG��'� Conditions of Approval/Reasons for Disapproval e(ij Attach to complete plans for the system and submit to the County only on paper not less than 8 IR x 11 inches in size SBD-6398 (R- 03/22) Soil Test m 56_ 2(O / Bayfield County Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) [3. 'V?2Ja certified soil tester determine that in my professional judgment the following site ee below) is unsuitable for any treatment component other than holding tanks. Due to soil & site conditions, a thorough soil and site evaluation is not needed to make such a determination. Property Owner L,4pSP JlO✓e/l Contractor .& Property Address_ ≤213r eo. iX t Authorized Agent 3'eraar;r ?w n6 1w /4 Agent's Telephone 2zf W - 6/i Telephone 7/3 77 Written Authorization Attached: Y or N Accurate Legal Description is requested: �1/4 of ≤F 1/4 Section_ 9 Township N. Range W. Town of a o Additional Legal Description: Govt. Lot Lot Block Subdivision Lot CSM# Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# c3.37S)) Acreage 4'O reasoning for your determination: ?n Mar, /;i (1/y 50 �S an (Z ./l, / L / Signature of Certified Soil Tester Date EHTEfi 6/�6 22/�39 Certification # Signature of County Official (Submit a Plot Plan & Fee) Date 0 202 u/form s/soiltestwaiver(KLK) Bpytold r P0enCi June 2018 panON 2nd Za' SUPERIOR PLUMBING MECHANICAL (715) 278 3456 S'3 CST# 221939 l PINPIN.2 375 No 7e jC4If 40 Acres SW SES9 T46N R6W Town of Mason Bayfield Co. Customer Name: Chase Hoven 4 Adress: 63770 Franciskovich Rd. Ashland. WI 54806 N SITE: 621335 co Hwy E Mason Phone#: 715-209-5097 Email: @chaseh1486@amail.com No Well on site 0 0 V q6'- rep..PL, o � � v I 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 Pg 2 of 4 Plot Plan JUN '172026 Pg 3 of 4 Holding Tank Specifications p aayfieid Oo. Planning and Zoning Agency Pg 4 of 4 Management Plan Attachments: Enclosures: Tank Specs POWTS Application for Review Soil Evaluation Report & Site Map (if ap Holding Tank Pumping Contract (if appl Holding Tank Agreement (if applicable) Project Name / Description Hoven Holdina Tank Owner Name(s): Chase Hoven plicable) cable) Phone: 715 209 -5097 Owner Address: 63770 Franciskovich Rd, Ashland, WI Zip: 54806 Project Address: 62135 County Hwy E, Mason, WI 54856 Govt. Lot: SW 1/4 of SE Township: Mason Project Parcel ID #: 23375 1/4, Section 09 , T 46 N -R 06 E ❑ or W C county: Bayfield Designer Information Designer Name: Dean Blakeman Phone: 715 -682 -6050 Designer Address: 44941 State Hwy 13, Ashland, WI Zip: 54806 E-mail: dean@blakemanplumbing.eom This space reserved for approval stamp. License Number: 1092768 Remarks: Signature: _� �<"7! Date: Ii ( I l 2D2(o Original signature required on each submitted copy. CHECK BOX AS APPLICABLE. CHECK BOX AS APPLCABLE. fl SOIL EVALUATION Scale: 10 40 60 80 ❑✓ SYSTEM PAGE 2 OF4 0 40 SITE MAP PLOT PLAN PROJECT NAME: , DESIGN FLOW: 300 GPD (10 ft grid) 10 Hoven Holding Tank Attach design flow calculations for commercial plans. PROJECT ADDRESS: 62135 County Hwy E, Mason, WI 54856 Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) D3034 4" PVC Sanitary Sewer. / BM Symbol: BM Elevation: 100 FT Force Main: / BM Descdption: Top of well casing Indicate nosh by Slope Gradient (% ) of Tested Area: Well Symbol (if applicable): 0 drawing an arrow on the approprite Ilne. 'I' I, 1,1 L I 645'to N lot line (line not to scale) 2,000 -gallon holding tank O 1 2 Bedroom Mobile IMPORTANT: Show ground elevation contours at suitable intervals. RECEIVED JUN 17 2026 Bayfleld Co. Planning and Zoning Agency 62135 Driveway 1,775' +/- to County Hwy E \_825'+/-toWlot line______ 462'toElotline _ -------\ (line not to scale) (line not to scale) .1 ,' 4- 0 Well Woods 575' +/- to S lot line (line not to scale) \ 1 I 1, I 6 I Open Field PAGE 3 OF 4 HOLDING TANK SPECIFICATIONS (No Scale) Weatherproof Junction and Alarm Box Electrical must comply with SPS 316 and NEC 300 Conduit Seal RECEWED JUN 172026 Bayfieki Co. 12" Min. or 2.0 ft above Planning and Zoning Agency Approved Established Flood Elevation Vent Cap (typical) Approved Locking Manhole 40 Vent Pipe with Warning Label Attached .10 ftfrom (typical) 4" Min. or 2.0 ft above Building I Established Flood Elevation 1 _ / (typical) 18"Min. v (typical)• .: a InletInlet Invert Approved Joints with Approved Pipe 3 ft onto Max. 12" or 90% of total volume Solid Ground if more than one tank P1 Alarm -On e HOLDING TANK VOLUME= 2105 gal 3" Approved Bedding Material Beneath Tank TANK MANUFACTURER: Superior Precast Concrete Finished Grade Plug Anchor tank as necessary pursuant to SPS 383.43(8)(g) Ballast Weight = [(cu.ft.tank.vol x 62.4 lbs/cu.ft) - lbs.tank.wt] x 1.5 Ballast Weight = [( 281.4 cu.ft. x 62.4 Ibs/cu.ft) - 16,216 Ibs] x 1.5 = 2,015 Ibs PAGE 4 OF 4 Holding Tank Management Plan IMPORTANT: The owner of this holding tank(s) 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 holding tank(s) 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. Estimated Daily Wastewater Flow = 200 Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system ttLt1VED o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) JUN 17 2026 o material fatigue (i.e., leaks, breaks, corrosion, etc.) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) yfield co o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) Planning an Zoning AQency o surface discharge of effluent or sewage back-up into structure served SERVICING FREQUENCY o The tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wisc. Stats. when the wastewater in the tank(s) reaches a level of one foot below the inlet invert of the tank(s). Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. Tank pumping reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wis. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Blakeman Plumbing & Heating, InC. Phone: Local government unit: Bayfield County Planning & Zoning Phone: Local government unit address: 117 E 5th Street, PO Box 58, Washburn, WI 715-682-6050 715-373-6138 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 component of this holding tank(s) cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agecy for review and approval. System Abandonment If use of this tank(s) is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. SUPERIOR I 2100 1 -Compartment Tank 'SUPERIOR PRECASTCONCRETE `\-eieht (in lb s) Tame: 9,427 Lid: 6,7S9 Total: 16,'16 Value of Concrete Total : 4.1 Yd' Gallons Per Inch: 46.5 Iii Aral Enlarged Detn$ Coodhi.sally APPROVED/ DEPT. OF SAFETY AND PROFESSIONAL T lot SERVICES DIVISION OF INDUSTRY SERVICES O`a'r 5(r SEE CORRESPONDENCE Manhole Openings 3" Taper Polyethylene Baffle Mastic Rope TOP VIEW 165" 'Sr RECEIVE© JUN 17 2026 Bayfield Co. f Planning and Zoning Agency ` 21015 Gallons SIDE VIEW 'Sr, I, �a'TCi3 ss S" Aar Space ,,. ;I9" •fir, T qp... d 62- ( 48"I Produced by Superior Precast Concrete, LLC PO Box 1390 Hayward, WI 54843 4M SUPERIOR PRECAST CONCRETE Design conforms to ASTM C1227, 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 shall be verified bythe purchasers licensed professional engineer for suitability of use. Configuration may change from drawing, consult with SPC. Product FlleNo: I This is proprietary information, and remains the property olsuperior Precast concrete,LLC. I 8.305-1N-20241 HOLDING TANK SERVICING CONTRACT RXEGF- ED Contract Date JUN 172025 This contract is made between t6 Bay tcico. Plgnning and Zoning Agency Pumper's Name 1 Pumpers Sign re Pumpers' Registration # To tin HI CJv orsoh .:e ad1"Jwledge It n5tallatlon Of (a'' hok;i:ly ta''IK, �.; ';,1 the N -I us'•ii g p'C,perI, I H_:vi:Je COMPLETE �r_.ii r 111:hpil,.I PPO1, rT - u: . r,ipnn�' s Air/aq: T•s•10= fl 1:4 �� t;: LONUT1O+.i ��•' 337 � Sett r,n D NI:dnee ©(p w ivrrrt vl. Lc: Su_ .tCtt2liI .T,„m%Np y V _ 1C.SGvt Gov t lot Las CSM a '.nl Paga (SM Oat Ioils) Nc. fuadlsi No. SUMntrsirns I. The owner agrees to flile a copy of thys contract w:'i Bayfield County as required in SPS 333 55. Wis Adm. Code. 2. The owner agrees to have the holding tankis) serviced by the pu!itper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding lank(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 lank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local government unit wh ch bas signed the pumping agreenrrl r-u.nred by SPS 383.55. Wis. Adm. Code. and the County, a report for the servicing of the holcing tank(s) on a se M,,,,,, �sts. The pumper further agrees to include the following in the semiannual report r`` p TApq'%,� a. The name and address of the person responsible for servicing t+ t' _+Ir_ Ir rt a1 •., /'.' h. The name of the owner 01 the hokiing tank, O1ARy •: _ c. The location of the property on which the holding tank is ntsiall+ I. d The sanitary permit number issued for the holdng tank, e_ The dates on which the holding tank was serviced. pUB�,Y c ,3 I. The volumes in gallons of the contents pumped from the holding tank for each ,ervicinq, - ; .......O g. The d:sposai sites to which the contents from the holding tank were delivered. -p OF "t(yys�,�+` 4. This agreement will remain in effect until tree owner o' pumper terminates this contract to the ever,! .i 1 r:. contract, the owner agrees to file a copy of any chances to this service contract or a copy of a new service contract with the local government unit and the County named above within (10j business days from the date of thange to this service contract. Owner(s) Name(s) iPnnri Owners Signatureist Subscribed and Sworn to me* ton..' C �nG4't_, uueh Ilf��/ /J Q_ h,• ysY� T" __ t0 . tc t /" Nutar:':.I'. My commission expires cr. O' —..11 — L_O May :?' n .. -My :9' FI Dratted by P'-v-Olfrmat Y.ln ): 11:;tn'. ule may t*.:led ice Snoanrt.'-yp.,''orri51P6:;3Cy. au. ?.1. i4 .5i1•nn Document Number/Plan I.D. No. HOLDING TANK AGREEMENT Owner Name (s) Owner(s) Mailing Address (ed C Lm - N0ver1 /0 witA o0 ht .ni W) 7q&o(, Parcel Identfiej9umber (PIN) r;23375 Agreement Date (same as Notary Date) (p/J7/o34 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. PS 383, Ws. Adm. Code or Ch. 145, Wis Scats. !t Ce, 1/4 of 1/4 Section Township N. Range W. DOCUMENT NUMBER 2026R-61 2601 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED O6/17/2O26 AT 1:49 PM RECORDING FEE: $30.00 PAGES: 2 Town of D n Return To: /� 1 Ja`'t"�.1 /O°h Additional Legal Description: � 0�wj� Ca^'h I Y G vu Gov't Lot — Lot_ Block_ Subdivision Lot (l? C � ST, `e7 CSM # Vol Page CSM Doc# Pro. 9 a)( 5,10 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 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 described in s. 254.59, Stats., 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) Ws. Stats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced in accordance with Ch. NR113, Ws. 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. Scats., 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 properly maintained. �11111111/r 5. This agreement will remain in effect only until Bayfield County certifies that the property is served by either a municipdl onsite wastewater treatment system that complies with Ch. SPS 383, WI's Adm. Code. In addition, this agreerrteh Thee oa ll d'$y executing and recording said certification with reference to this agreement in such manner which will peter nit Th 6Ne)<,(s e d"&4h;_ certification to be determined by reference to the property. r U ,q 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. Thv Nner 3 Ml -submit this = agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a mana8r.wfi altyillpermirthe: existence of the agreement to be determined by reference to the property where the holding tank is installed. c' °L i.' Owner(s) Name(s) - Please Print Subscribed and sworn to before me on this dMe;,4 isco'\\ �� rrrrrll11111\\ OV4C 4koVen J uhe 11t Zoz4 Notarized Owner(s) - Signature(s) Notary Public A^doE x TbZ�1373 i'��/ • My Commission Expires: �i✓ amti2� 2 Drafted by: C,�1GSL `HOJ•Gfx Date: 7r1a0?c Personal intormaton you provide maybe used for secondary purposes [Privacy Law, s.15.04 (p(m)) uIormslsanlferyMoldingTankAgreemanj We 18 2028 Bayfield Co. Planning and Zoning Agency State Bar of Wisconsin Form 1-2003 WARRANTY DEED Daar=XN=ba I DoaunmtName one or mote), ('Grantee," Whether one a more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in BAYFIELD County, State of Wisconsin (Property") (if more space is needed, please attach addendum): Parcel 1: The Southwest Quarter of the Southeast Quarter (SWV.SEy.), Section Nine (9), Township Forty-six (46) North, Range Six (6) West, Town of Mason, Bayfield County, Wisconsin. (NOTE: Includes that portion of Lot One (1), Certified Survey Map No. 2091 recorded in the Office of the Register of Deeds for Bayfield County, on August 2019 in Volume 12 of Certified Survey Maps on Page 196 as Document No. 2019 578581, located in the Town of Mason, Bayfield County, Wisconsin.) Parcel 2: A non-exclusive easement for the benefit of Parcel 1, for ingress, egress and utilities over, under and across the North 30 feet of the North Half of the Southeast Quarter of the Southeast Quarter (N%cSEY..SEY.), Section Nine (9), Township Forty-six (46) North, Range Six (6) West F: vrdicg A,cs Chase Hovea 63770 Fraciskovich Road Ashland WI 54806 20437-25 Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except EASEMENTS, RESERVATIONS AND RESTRICTIONS OF RECORD. ,/ Dated .1(1370,1YVU.t!/t AO, , n /� tl/ AUTHENTICATION Signature(s) authenticated on TIMLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENTDRAFTED BY: ATTORNEY MAX T. LINDSEY, SB#1112865 Anich, Wickman & Lindsey, S.C., Ashland, WI 54806 Public STATE OFpWISCONSIN __ COUNTY�t^�srs� Personally came before me on the above -named Marc T. Bichanich &Wa Marc Bichanich to me known to be the person(s) who executed the foregoing instrument and acknowledged the same, a Notary Pubic, State of Wisconsin My Commission (is permanent) (expires: — ) (Stgoatutes maybe authenticated or acknowledged. Both arc not necemty.) . NOTE: ITUS IS A STANDARD FORM. ANY MODIFICATION'S TO TIM FORM SHOULD BE CLEARLY IDENTIFIED. WARRANIYDEED O2003 STATE BAR OF WLSCONSLN FORM NO, 14003 • Type name below sigoatwec {{ECElVED JUN 18 2026 Scanned with CamScanner l Bayfield Co. Planning and Zoning Agency 13 -4 -AFIELD 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: HOVEN, CHASE SR -00427 63770 FRANCISKOVICH RD ASHLAND, WI 54806 Transaction Number: SR-00427-47CFC Description Certified Soil Tests - Review & Filing Fee Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 10756 Paid by: Superior Plumbing & Mech Inc, 1015 11th Ave E, Ashland WI 54806 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. ]3-4Z\ 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: HOVEN, CHASE 63770 FRANCISKOVICH RD ASHLAND, WI 54806 Description Private Sewage System (Holding Tanks) Submission Number: SS -00774 Transaction Number: SS -00774-48D72 Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 34559 Paid by: Blakeman Plumbing & Heating, 44941 State Hwy 13, Ashland WI 54806 Payment Type: Check Transaction Date: 6/29/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-72S STATE SANITARY PERMIT OWNER: CHASE HOVEN GOVT LOT: LOT: BLK: SW 1/4 SE 1/4 SEC: 9, T 46 N, R 6 W TOWNSHIP: Mason SOIL TEST: 56-26 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: DEAN BLAKEMAN TRACY POOLER Authorized Issuing Officer DATE: 6/29/2026 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: # 1092768 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 6/29/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION