HomeMy WebLinkAbout26-75SRequest for Sanitary Inspection (24 Kra. in Advance)
Fax or email this form to Zoning Dept (24 Hrs.) prior to when you want an inspection
Fax (715) 373-0114 or Email zoninc Wbayfieldcounty.wi.olov
Note
Time Change fl Discrepancy fl Other
uc - )CkCJC oLLm
Phone Number
-IISIB
,%Nam
)3qq /7i5-9x�/�
Plumber:
Fax Number
1i5-9L/q-ooi8
Email Address
Homeowner:
k�1b '' �, ` , \ c6O \ E1^ ,
�
jbhy� t@ �} [r r Li' .Ire+
Immediate Phone Number So Zoning
Sanitary
Permit
Xp-Iss
Dept can call you right back (if needed)
itS-gj&-j3g9/7/S-9iy9-oo
Plumber's Choice
g Dept
No Inspection(s) during this time
Date:
3)J3�Zo2lp
�t
Tuesday (9:30 am - 12:15 pm) (Tracy)
Plumber's Choice
Zoning Dept
Time:
2prr
r~
Township:
Town cc I�uSS
Address # &
Road Name:
9 D-4 0 H- -&l-'- a.d
or
1 /
Directions
To Site:
Comments:
** Plumbers you must verify any change(s) by fax or email **
Notes from
July 2025
BARRY F & HEIDI J GUY
N12343 COUNTY HWY 0
( BOYCEVILLE WI 54725 )LDING TANK INSPECTION REPORT
-r v rrnv[rr)
GENERAL INFORMATION
Permit Holder's Name
I ❑ City ❑ Village ❑ Town of
Sanitary Permit No.
Property ddress if Av able
Plan ID No.
Tax Parcel No.
TANK INFORMATION
TYPE MANUFACTURER/MODEL# CAPACITY
L 3oc
SETBACKS
Property Line
Well
Water Service
Building
All -Weather
Roa�l
OHWM
Swimming Pool
DEVIATIONS FROM APPROVED PLAN
QMt9 JctVX tQ deE
COMMENTS (Persons present, discrepancies, etc.)
,,� iv o6 lac t v Q(( -e d*
Har�id� ceLr
4\ 4!'
1r\cvJ' 6JJV
COMPONENTS NOT INSPECTED
Plan Revisi Required D te• Signatur of I specto • . Numb r
❑ Yes No fr. I
Sjcetch on other side
10 of 13
BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT
Telephone: (715) 373-6138 Bayfield County Courthouse
Fax: (715) 373-0114 Post Office Box 58
e-mail: zoning(d bavfieldcountv.wi.gov 117 East Fifth Street
Web Site: www bavfieldcounty.Wi.aovl147 Washburn, Wl 54891
Property Owner
BARRY F & HEIDI J GUY
Information N12343 COUNTY HWY O
BOYCEVILLE WI 54725
As you know was contracted by you to install a private
onsite wastewater treatment system on your property described as:
Notes:
Abandonment of Old System to meet all applicable code requirements:
Tank was pumped by:
t• Tank was crushed! removed and pipes disconnected by:
on
at AM/PM
On at (AM/PM) the above -mentioned plumber contacted our office to
con ct a precover inspection as required under DSPS 383. One of the following applies:
System was inspected and appears to meet all applicable code requirements.
❑ System was inspected and appears to meet all applicable code requirements; however, a plan revision
is necessary because the installation was substantially different than the original approval.
❑ System could not be inspected because plumber covered prior to scheduled time of inspection.
❑ System could not be inspected because plumber was not ready at scheduled time of inspection.
County was unable to return to complete inspection.
System could not be inspected because plumber was not ready at scheduled time of inspection.
A re -inspection and $50 fee are required.
❑ System could not be inspected because County could not respond to plumber's time constraints.
Comments:
W(onslsanitarypropertymvner-input Apd12019
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Industry Services Division
4822 Madison Yards Way
Madison, WI 53705
County
Bayfield
Sanitary Permit Number (to be filled in by Co.)
O"
7162
FS1�oHA� {tF
Madison, WI 53707-7162
— '75 S
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
e 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(1)(m), Stats.
'7 OYao I -colt road
L Application Information — Please Print All Information
Property Owner's Name
Parcel #
Barry & Heidi Guy JUN.2 9 2026
04046251041930100020000x91 16
Property Owner's Mailing Address
Property Location
N12343 County Road O Bayfield Co.
Planning and Zoning Agency
Govt. Lot
S '/2, N '/2, in N '/2 SW in Doc. 2025r Deed
City, State
Zip Code
Phone Number
Boyceville, WI
54725
715/308-0362
607494
''A '/4, Section 19
U. Type of Building (check all that apply)
Lot #
X 1 or2 Family Dwelling —Number ofBedrooms two (seasonal cabin)
T 51 N R 4 w
Subdivision Name
O Public/Commercial — Describe Use _
Block #
O State Owned — Describe Use _
City of
Village of
CSM Number
Town of Russell
III. Type of POWTS (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B Complete line C i.
a licable.
A.
X New System
Replacement System
p y
0 Other Modification to ExistingSystem (explain)
❑ Additional Pretreatment Unit (explain)
B.
$ Holding Tank
In -Ground
0 At -Grade
Mound
❑ Individual Site Design
Other Type (explain)
(conventional)
C.
❑ Renewal Before
❑ Revision
❑ Change of Plumber
0 Transfer to New Owner
1st Previous Permit Number and Date Issued
Expiration
IV. Dis ersal4Tteaf
neatArea alzd Tank Information:
Design Flow (gpd)
Design Soil Application Rate(gpd/sf)
Dispersal Area Required (sf)
Dispersal Area Proposed (sf)
System Elevation
Capacity in
Total
# of
Manufacturer
G�
Tank Information
Gallons
Gallons
Units
v t
.-,
New Tanks
Existing Tanks
Septic or Holding Tank
3000
3000
1
Weiser Concrete
X
Dosing Chamber
V. Responsibility' Statement: 16 the undersigned, assume responsibility for installation of the POWTS shown on the attached plane
Plumber's Name (Print)
Plumb s Signature
MP/MPRS Number
Business Phone Number
Jack A. Bowman
MP222839
(715)949-0099
Plumber's Address (Street,Cit , State, Zip Code ,
N13437 490 Street, Ridgeland, WI 54763
nnty.pa'ment'Use Only
a.rApproved O Disapproved
Permit Fee
Date Issued
L
Issuing Agent
Signature
O Owner Given Reason for Denial
$
"7 ,
i( (IkLcL((fIu,4ft4
I/acr
Conditions of Approval/Reasons for Disapproval
a ed
Attach to complete plans for the system and submit to the County only on paper not less than 8112 x 11 inches in size
SBD-6398 (8.03/21)
Concrete Holding Tank Design
New Site
Seasonal Cabin
Index and Title Sheet
Project GUY
Owner Barry & Heidi Guy
Site Address Holt Rd.,
RECEIVED
JUN. 292026
PlanningBand Zoning
Legal Description S %2, N 1/2, in N Y2,SW,S 19,T51N/R4W
Township Russell
County Bayfield
Subdivision Name N.A. Lot no. N.A.
Parcel ID Number 0404625104193 0100020000
Page 1 Index and title sheet
Page 2 Site plan
Page 3 Holding tank specifications
Page 4 Management plan
Page 5 User's manual
Page 6 Servicing contract
Page Township agreement (on file at county)
Designer Loretta Larrabee
License Number 1872-007
Phone 715/664-8184 office
715/505-1628 cell
F,,
Holding Tank Component Manual for POWTS (Version 2.1)
May 2022-2027
Page 1 of 6
Site Plan
Barry & Heidi Guy
S %2, N %s, inN 1/2, SW, S 19,T51N/R4W
Russell township
Bayfield county
RECEIVED
1JUN- 2-9 2026
83y6&d Co.
Planning andZonngAg
LEGEND ciQ
Part of 20.254 A.C. - '
No DSPS 383 setback 20
problems
Scale 1'-30'
3000ga1 proposed holding tank
Wieser Concrete
SJ Rhombus manufacture or similar product
Tank Alert 101-01
pr �k
•
p
00
15{ �i scan CEO 4SiA\Z6t5
)J iatts 334
project: Guy
page 2 of 6
5'-6"
4" CAST -A -SEAL 4" CAST -A -SEAL
FILTER OR BAFFLE —"
RECEIVED
JUN .29 2026
Bayfeld Co.
Planning and Zoning Aggccy
•--- -- 41:_ __ __ OUTLET
r -J __________
cq I M l
i tn
_ I
1
i TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
W3000 -MR
TANK SPECIFICATIONS
a
v
a
DIMENSIONS:
WALL: 21/2"
a
a. e
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.
t
COVER 8,350 LBS.
n
o E
INLET AND OUTLET:
"
4" CAST -A -SEAL BOOT OR EQUAL GASKET
.t
z o s
INLET AND OUTLET BAFFLE AND FILTER:
-
a a
0
WISCONSIN. SEE DETAIL #10
(OTHER STATES SEE CHART)
n
LIQUID CAPACITY: 58.94 GAL/IN
W
HOLDING TANK:
OUTLET HOLE PLUGGED
ACTUAL CAPACITY: 3,183 GALLONS
Q I
LOADING DESIGN: 8'-0" UNSATURATED SOIL
M
TANK CAN BE USED AS:
o I
W
SEPTIC / HOLDING / PUMP OR SIPHON
o
o0
wN
COVER: MIX DESIGN #8 (NO FIBER)
____�
TANK: MIX DESIGN #9 (SMALL FIBER)
CUSTOMIZED TANKS:
FOR CUSTOM TANKS CONTACT
WIESER CONCRETE
J
1
D
C
M
F
REVIEWED BY
REVIEW DATE
3
w
`i) 2
DRAWINGS SUBMITTED
FOR APPROVAL
APPROVED BY:
SHEET NO.
APPROVAL DATE:
1
PRODUCTS NEEDED BY:
OF
HOLDING: TANK — MANAGEMENT PLAN
The Private Onsite Waste Treatment System (POWTS) has been _designed and is to be
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;
1. This.POWTS has been desig nedao accommodate a maximum daily flow of
C..:gallons of domestic wastewater per day. RECEIVED
2. The.owner of'th.. is POWTS is responsible f or',systemoperation =and 2920
N 26
maintenance,. focking.'device, alarm and access.
UN
agent is required
.. � �yltea l g a►genc�+
o.
3: The owner or owners: : to .submit :reports a requir�i�
383.55_( ), W.I. Adm. Code;: to thee. Bayfeld County Zoning: Department:
4: Design approval and site .nspectionsbefore, 'during• and: after the".construction
are.acc 'r lashed by the.:.county .or -other appropriate jurisdictions: `in
accordance with SPS 38.3 of the W s. Adm: Code.
5. Maintenance: Cycle. The holding ':tan. k.must be servicedbyl censed.put pees.
An .alarm system iS to be installed to activate when the tank is: < 90% :full.
'5. Performance monitoring: At the`:time .-of' servicing, the service: provider files a
report with the department of designated agent.
7.. .A.'Uset's Manual will accompany the component. lt.will include .the names
and phone numbers of :local health- authorities, component manufacturer or
POWTS,service provider tobe contacted in the event of.component
.
malfunction or failure.
.. In the: event,that.'this 'POTS or a component of taxis PQ'U4l`i•S :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 forsuchrepairs::
This agreement-- shall be.::binding.on-:ali:assignees and heirs
114 of -114 Section T To rns# ip N. Range - Town. of "l s 'U
Got;
Lot .: . Lo#. -+p . Block . Subdivision —1-- CSM#:
Additional: Legal Description. SY2, 'zf t' l : ®c:. - .e' .ZOr g
- 10//71 .o7 (0
Property Owsrs Sig ature: Date
vffonnS Managernentplan
Revised: July 201:3':
User's Manual
This Private Onsite Wastewater Treatment System (POWTS) has been designed and is to be installed
and maintained according to SPS383 Wis. Admin. Code, the Holding Tank Component Manual Version 2.1
and the Dunn County Sanitary Ordinance. RECEIVED
JUN 2.9 2026
Bayfield Co.
1. This POWTS is designed to accommodate a wastewater flow of 60.0 to 6000.0gning and Zoning Agency
2. The owner of this POWTS is responsible for system operation and maintenance, including all
provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements.
3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the
inlet (at which time the alarm will activate), the pumper must be called to empty the tank's contents
and depose of them in accordance with NR1 13 Wis. Adm. Code.
4. At each service event, the service provider should visually inspect the condition of the tank, risers
and manhole covers and verify that the alarm system functions and manhole locking devices are
present. Discrepancies are reported to the owner in a timely manner for corrective action. All
corrective actions shall comply with the county sanitary ordinance and SPS 383 and 384 Wis. Adm.
Code.
5. The owner may not remove any of the wastes from the holding tank (s), or cause such wastes to be
removed by any person not authorized to do so under Ch. 281 Wis. Statutes. The discharge of wastes
to the ground surface, including intentional discharges and by neglect, constitutes a failing System
and may result in issuance of correction orders or a citation by the county or state.
6. No one should enter a holding tank for any reason without being in full compliance with OSHA
standards. The atmosphere within these tanks may contain lethal gases and rescue of a person from
the interior of the tank maybe difficult or impossible.
7. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding
tank may be installed in the same location per County Ordinances.
8. If this POWTS is replaced, or its use is discontinued, components no longer in use, it shall be
abandoned in accordance with SPS 383.33 Wis. Adm. Code.
9. If there is a problem with, or question about this installation, the following persons may be contacted:
a. Installer ...................
b. Service Provider.........
c. Co. Zoning or Health Dept.
Comments:
J.B. Hydro llc
J.B. Hydro llc
Bayfield County Zoning
Phone 715/949-0099
Phone 715/949-0099
Phone 715/373-6138
project: Guy page 5 of 6
HOLDING* TANK SEf VICING: CQNTRACT
CdMmbt-Date
This .contract.�is made.- between the
HoldingTank Owner(s) Name(s)
Q'r 1i
a "
RECEIVED
JUN 2 9.2026
Bayfield Co.
Planning and Zoning Agency
Pumper's Name (Print)
Pumper's Signature
:Pumpers' Registration ..#
�; �•�,�, $�� ltd
�/�-D 3
We acknowledge the: installation.: of (a) holding tank(ss):on the following property(Provide COMPLETE legal descnptioris)
PRoiEcr
18 1 Rgscrla •.T_
4 Sya NYC t• l SyJ
i/4o
LOCATION
(Use Tax Statement)
-9 1: �'`
pa c. ao2,
t
C
Town of
Lot Size
Acreage
Section. ,Township - `'I N, Range w
•Ul5S�i
&av Lot
Lot#
GSM #
Vol. Page
CSM Doc #
Lot(s) Na..
Bloci4s) Ng. '
Sulsdlnistan:
1.. The :owners reesao. fite:a co of this: contract -with BaVf'teld _County as -required in .SPS 383.55, Wis. Adm: Code.
2. The owner agrees -to. have the htilding tank(s)::sera►iced by .the pumper. and guarantees to :permit the pumper to have
.access: and to enter upon: the property for thepurpose of servicing the holding tank(s). The owner agrees to maintain
the access road :or -drive sothat the pumper can service the holding -tank(s) with the pumping equipment. The owner
further agrees to pay the pumper for all charges iincurred in servicing the holding tank(s)- as :mutually agreeduponby
the owner andpurnper.
3 The pumper':agrees o: submit. to tide aoc, al ,government: onif:whiph: has signed the pumping agreement: required: by . SPS:
383.55, Wis. Adis: Code., and the County, a 'report for theservicingof the holding tank(s) on a semiannual basis, The
pumperfurther agrees to include the -:following: in the: semiannual .report:.
a. The name :and address of the:person responsible=for. eet icing the holdingaank;
b: The name: of - the :owner of the holding tank;`
C . The location ::of:.the property on wh ich;tha -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::;lec to which- the contents frorn-the';holding :tank-:were-deiivered:
4. This:agreetnoht will..rernain in .:efiect: urt i#the;: owner::or pumper terminates this.:con#ract::In the event of a; change in this:
contract , the owneragrees to file .a copy of any .changes tothisservice contract or.a::copy of a new service- contract
:with :thelocalgovernment unit and the -County named above: within (1 0) :business :days from the date .of :change to this
service contract.
n..:.....:ri_ RI.... nn4R !10168.... ')t14Q1
deck- : G1,
I.D. No:
_
Parcel Identifier Number (PIN)
HOLDING TANK
Rt, Cs?_V re,
Date (same as Notary
We acknowledge .that ypplication is being made,.forihe insiaiiation of (a) holding tanks
on the foilowingproperty' or, thatcontinued use of the :existing -.premises requires that a
holding tank-oe installed 'an -me property for the purpose. of`i roper cvniaiiniper t of
sewage. Also, the property cannot now be served by -a muntoipal sewer; or any other
:type of private.onsite:wasiewatertreatment system:as permitted under Ch. SPS 383,
Ws:..Adm. Code or Ch.145, WisStats.
114 of 114 Section . gwnship N. Range . W.
Town of
Additional -Legal Description:
Coov'tEot,LotBloch Subdivision Lot
0.SM fF Voi Page CSM Doer..
Return To
DOCUMENT NUMBER
2O26R-612574
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY. WI
RECORDED
O6/16/2O26 AT 1O:38 AM
RECORDING FEE: $30.00
PAGES: 2
As an Inducement to Bayfleld 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.. Adrp. Code relating, to holding` tank'.installation and
maintenanceIf- the owner fails to have the holding tankproperly serviced in response :to ordersissued by :Bayilbid. County or the.
Department of Commerce to prevent or abate a human: health -hazard as described. in; c. 2-154,59, Scats:,. BayfPid 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 asssssrr'ent for curtent serviceS rendered. The charges. ! oe assessed as prescribe# by-66,D.Tfl3 Mats:
2. Owner agrees to pay all charges and costs incurred by Baygeld County for Inspection, pumping, hauling; or: otherwiseservicing and
maintaining the- holding: tank in such a manner as to prevent ;or agate any .human health hazard: caused by the :holding tank. Bayfleld
County shall notify the ownerof` any, costs which- shall be paid by the owner within: thirty (30) daysofthe 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
roil as a special assessment #or tha abatement: of a human. heakh h .ar& and the tax snail be.cllected .as provided bylaw.
3. The owner agrees to contract With a person who is licensed pursuant to s 281.'17 (3):Wis: Stets., and chapter :NR 114 Wis, Adm: °Code;. to:
have': the:. holding tank serviced in =accordance .With Ch, NR'1:13, WIs. Adm: Code, and to file a .copy of the contract with Bayfield .County..
The: _owner- urther agrees to file -a:.copy ofany -changes to the service contract, or: a copy of a new service contract, with the comity Within
3a. days Hof the:dete of change -to the. service contract: -
4. The .owner -agrees to contract with a. person: licensed pursuantto: s. -283-: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. Bayfreld County ma atppp throperty to
:investigate the; -condition of :the holding tank when .pumping reports and meter readings may indicate that ffibdMflitWnot being
property. inaint'ained:. .
5. This -agreement'. will remain in effect only until=8.ay*ield. County certifies :that ::.the property is served by either a: l ip1al7s r a.pirivate.
onsite wastewater treatment system that complies with Ctt.:-SPS383 WI s Adm Code. In ':additions this agreernnt may -be -cancelled by
executing and :recording saidcertification with .:reference to this .agreement in such manner which: ReYl �' nee of .the
certification to -be. determined by reference to the property. in g gency
6. This agreement snail be Binding: upon .the owner, the heirs of the owner, and assignees of the owner Theowner 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 the agreement: to: be determined`.by reference to the property where -the holding tank Is installed,.
r(s).Name(s)-:P.Isase:Print `; M.
Subscribed andswomto.before-roe cn his -date:
fw O
—
hte,d,
- - - - -' - - - -
Note' " 'd:Owner(s)'=. gnatureE(s) a - ._
:Notary: P bile
Drafted -by;) 77'2 - �A !'f Date:
w��._. , ... _ ...r .:........:.:.i..:..n.. ...�...a t.. :.. ,..:..s:.:............, r.3.»..«: i ......C
File Number: 254618
ADDENDUM/EXHIBIT A
The South Half of the North Half of the North Half of the Southwest Quarter (S1/2-N1/2-N1/2-SW1/4), Section
Nineteen (19), Township Fifty-one (51) North, Range Four (4) West, Town of Russell, Bayfield County,
Wisconsin.
TOGETHER WITH an easement over and across the eadsting North -South roadway for ingress and egress, as
described in Document No. 307722.
RECEIVED
JUN 17 Z026
Bays:!d co.
Planning s:nd Agency
Bayfield County Register of Deeds Document #2025R-607494 Page 2 of 2
..e� rcc4 4f C-1_ 7/
12—
SLUIILT -
,
i% Wisconsin Department of Safety & Professional Services Page I of 3
�.�e
L. $-i Division of Industry Services
pS EI 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
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. 29186
Please print ail information. R ie ed h(q,111YA
Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). 1'4 }2�gIl(u)Jq II K S a
Property Owner Property Location ❑ El
Barry F & Heidi J Guy Govt. Lot y. 'AS 19 T 51 N R 4 E (or) W
Property Owner's Mailing Address Site Address or CSM and Lot #:
N12343 County Hwy 0 S 1/2 N 1/2 N N1/2 SW IN 2025r- 607494
City, State, Zip Phone Number Ciry LjViflage X Town Nearest Road
Bocyceville WI 54725 715-308-0362 Russe Holt
X New Construction Use: X Residential/Number of bedrooms 2 Code derived designflow rate 300 GPD
Replacement Public or commercial - Describe: Rood Plan elevation if applicable ft.
Parent material Clayey Lacustrine deposits
General comments and recommendations: Holding tank only. Clay site does not meet A+4 code.
Boring s Boring
Pit Ground surface elev. it. Depth to limiting factor in./etev. ft.
I Snit Annticatinn Rata
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description Qu.
Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPDiFt
*Eff#1
*Eff#2
1
0-8
7.5yr3/1
-
St
lmsbk
ml
cw
3co
.4
.7
2
8-16
7.5yr3/2
cmp 5yr 414
is
lmsbk
ml
cw
2f
.4
.6
3
16-60
2.5yr 4/4
N
C
3csbk
mvfi
N
.2
.3
Boring # Boring
2 Pit Ground surface etev. ft. Depth to limiting factor in.lelev. ft.
Snn Annficstinn Rata
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description Qu.
Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft
*Eff#1
*Ett#2
1
0-10
7.5yr3/1
N
st
lmsbk
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CST Name (Please Print)
Signature
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CST Number
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Ryan Van Ornum
11011
Address
Date Evaluation Conducted
Telephone Number
65907 Jolma Rd Marengo, WI
5/29/2026
(715) 413-0074
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* Effluent Iii a SOD > 30 s 220 mg/L and TSS >305150 mg/L * Effluent #2 - SOD, s 30 mg/L and TSS s 30 mg/L
SBD-8330 (R03122)
pg. 2 of 3
Soil Test #
Bayfield County
Waiver of a Thorough Soil & Site Evaluation
(subject to 15-1-10(d))
I Ryan Van Ornum a certified soil tester determine that in my professional
judgment the following site (see 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 Barry F & Heidi J Guy Contractor
Property Address,
Telephone
S1/2 N1/2N 1/2 SW
715-308-0362
Accurate Legal Description is requested:
Authorized Agent
Agent's Telephone
Written Authorization Attached: Y or N
114 of 114 Section 19 Township 51 N. Range 04 W. Town of Russell
Additional Legal Description: S 1/2 N 1/2 N 1/2 SW IN 2025r-607494 227
Govt. Lot Lot Block Subdivision
Lot CSM# Vol. Page CSM Doc #
Volume Page of Deeds Tax I.D# 29186 Acreage 20
Indicate reasoning for your determination: Clay site does not meet A+4 code.
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Signature of CountJOffici I
Date
Sign ure of Certified Soil Tester
5/29/2026
Date
11011
Certification #
(Submit a Plot Plan & Fee)
VEL)
JUN 022026
u/forms/soiitestwaiver(KLK )
June 2018
Bayfield Co.
Planning a: Z :ing AZency
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BAYFIELD COUNTY
SANITARY PERMIT (#04)-26-75S
STATE SANITARY PERMIT
OWNER: BARRY F & HEIDI J GUY
G OV'T LOT: LOT: BLK:
1/4 1/4 SEC: 19, T 51 N, R 4W
TOWNSHIP: Russell
SOIL TEST: 57-26
NEW SYSTEM
SYSTEM TYPE: Holding Tank
PLUMBER: JACK A BOWMAN
EMILY MACGILLIVRAY
Authorized Issuing Officer
DATE: 7/1/2026
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: # MP 222839
Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all-
weather road.
THIS PERMIT EXPIRES 7/1/2028
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION