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HomeMy WebLinkAbout26-78SIndustry Services Division 4822 Madison Yards Way County Bayfield `\1 Madison, WI 53705 Sanitary Permit Number (to be filled in by Co.) �•a,. t S D01'i P.O. Box 7302 Madison, WI53707 6� S Sanitary Permit Application State Transaction Number In accordance with SPS 383.2l(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 purposes i Department Personalinformation you provide may be used for secondary n accordance w with and si.0), Slats. Services. Privacy Law, Professional 47530 Cranberry Lake Rd. Solon Springs, WI 1. Application Information— Please Print All Information Property Owner's Name Parcel q Benjamin & Hannah Larson Family Trust 2382 Property Owner's Mailing Address Property Location 690 Apache Ln. Govt. Lot 3 City, State I Zip Code Phone Number Mendota Heights, MN 55120 651-247-5847 '• V, Section 30 T 44 N R 09 E or W IL Type of Building (check all that apply) Lot # ❑� I or 2 Family Dwelling — Number ofBedrooms 3 Subdivision Name Public/Commercial — Describe Use Block p Cityof State Owned — Describe Use Village of _ CSM Number Town of Barnes 111. Type of POWTS Permit: (Check either "New" or"Replacement" and other applicable on line A. Check one box on line B. Complete line (ii a licable. A. y lilNew System ❑Re lacement System(explain) p y �/ ther Modification to Existing System (explain) Additional Pretreatment Unit 2000 ht EXISTS - ADDING 2000 TANK Additional Holding Tank JIn-Ground fAAt-Grade IflMound Individual Site Design Other Type (explain) (conventional) C. ❑ Renewal Before Division Change of Plumber ❑i'ransfer to New Owner List Previous Permit Number and Date Issued Expiration 389387 11.13.01 IV. DispersaVfreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/s0 I Dispersal Area Required (sf) Dispersal Area Proposed (sf) I System Elevation 300 NA INA NA NA Capacity in Total q of Manufacturer Tank Information Gallons Gallons Units v o v• v New Tanks Existing Tanks W 'vt y a V a iz U �- Septic or Holding Tank 2000 2000 4000 2 Wieser (existing) Supedor Precast (New Dosing Chamber LI V. Responsibility Statement- 1, the undersigned, assume responsibility for installation orthe POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signatur MP/MPRS Number Business Phone Number Jason Kuettel 675751 715-798-3355 Plumber's Address (Street, City, State, Zip Code) r' IF PO Box 66 Cable, WI 54821 VI. County/Department Use Only'SJ_ Approved 0 Disapproved Permit Fee Feq $ Date IssuedM Issuing A Sign re ' /Q 7 r� ❑ Owner Given Reason for Denial (o ta(Jp1„ /%/V/(,/ Conditions of Approval/Reasons for Disapproval RECEIVED K/ v" JUN 222026 Bayfield Co. Planning and Zoning Agency Attach to complete plans for the system and submit to the County only on paper not less than s in ill inches in size SBD-6398 (R. 02/22) Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings /� /� Page of Burcau of integrated services in accordance with s. ILHR 83.09, Wis. Mm. Code /KI,f) J. Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must County t a�1i1T �� include, but not limited to: vertical and horizontal reference point (BM), direction and J7JJ( C. percent slope, scale or dimensions, north arrow. and location and distance to nearest road. Parcel I.D. # CJ • srl ( - cots. - I I4 & - o Z. APPLICANT INFORMATION - Please print all Information. Reviewed by Date et �� Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). ri &_29-9/- Property Owner Property Location 'o 0 LD i'Sro2L t Govt. Lot 1/4 1/4,S '3 o T 4LY ,N,R 09 'fl (or Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 34' L Oo .D C3el pc,- - cr. •3 V. iq3 P 33(n City State Zip Code Phone Number Cl City ❑ Village .® Town Nearest Road IACrr1CCF I 1 ( • lct.it.nl I (-I I.S )31Go'US , aAP.Klc I ❑ New Construction Use: ®Residential / Number of bedrooms Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily How ______(„__ gpd Recommended design loading rate e C) bed, gpd/R2 • D trench, gpd/ft2 Absorption area required bed, h2 — trench, ft2 Maximum design loading rate ' C) bed, gpd/ft2 ' 0 trench, gpdttt2 Recommended Infiltration surface elevation(s) I-I�'I MI ✓0 t4- TA a k ft (as referred to site plan benchmark) Additional designisite considerations t.tin c/ ' G4 /N 7*Nl- Parent material CLACA AL �lc I y- T Flood plain elevation, if applicable ft S = Suitable for system ,.,,..,,,,. ,,,-�,.,.,,,u,-,wau,e ..,tCUW ,,, r -r„ nvrv,na IMIA U = Unsuitable for system ❑ s Iu ❑ s U ❑ S (� U ❑ SSl u Es 1 u S ❑ U SOIL DESCRIPTION REPORT Boring # Ground elev. /G ? R. Depth to limiting factor /in. Boring # Ground tt Depth to limiting factor Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/tt2 Bed . Trench / C /o /oe fr'z n/oNc t.5 sE Cr -S j'V + 5 . !o z ,7 7 V si s o 5 ''1 c -•s l- .0 : ,0 2 US cc/Er S a-,Li,q not l — f -in .0 : 1 o Remarks: 6-e' " / 0-/o ,'c5'z sz WE7'- /s /-,'S4E MVO% a -s /-P ,O o-/ 7, s ,e -31' - k &)€. `l 5 o -, Cg, m / a- s I -m , O : ,O 3 ,may . GW S -,r5 ,-.j — !-m . 0 :.0 Remarks: ��� 37t24 (Please Print) 7a3 T .&r4e, D/ /'6/ 6i',, L 7%2,eaejo tot, Signature Telephone No. 7/s - 7y-aa.7 PROPERTY OWNER iS S O SOIL DESCRIPTION REPORT �j� PARCEL I.O.# � ••• , "y IITC" d? Boring # Ground elev. /aft. Depth to iimiting actor fn• Boring # El Ground glee Depth to limiting factor in. Boring # Page of Horizon Depth im Dominant Color Munseil Mottles QS Sz. Conn Color Texture Struct<re Gr. Sz. Sh. Consistante Boundary Roots Bed . Trennch t A/ O /'6 I s 12v,'r gam' �- Remarks: Gvr.GCl S�.Y-� G�.c. G-µ Remarks: Horizon Depth Dominant Color In. Munseil Ground elev. Depth to limiting factor .."..... fin' Remarks: Boring # Ground elev. Depth to limiting factor -in' Remarks: cnr+_sM�0 M. 071;a�1, Mottles I Texture 1 SttiC,tre Qu. Sz. Cont. Color Gr. Sz. Sh. 4y2- SS = �� 2c /DdCL gyro. LELIE L or GcCNE2 OF Skn ey Rio SC41 S' i 44 = T?sr 0Li: Hr Wisconsin Certified Soil Tester, LLC Thomas J. Bargeman .,.,r — Telephone 715376.2278 or 7153423 764 P.O. Box 271 � � a GLAD `^ ' � � 0141 Fax715-376-2238 Gordon, Wis. 54838 IN mo AREA EN0u9L4 -to ©N rR15 st I LA2GrG: TEST �yn1IN� 7�D, / 65 55 1p1 LASS �N y0N ALL QLOP - T � � e E'Ve,vniJC9' Less I% w4 • c & Dace `O Of 3 HOLDING TANK CROSS SECTION • (no scale) WEATHERPROOF JUNCTION BOX HIGH WATER WARNING DEVICE ON 8' POLE OR IN/ON LOCKING DEVICE AND IBUILDING SERVED WARNING LABEL AT COVER CON DU I T 12" MINIMUM L - -.� • 4" MINIMUM -'---------- I MANHOLE - MIN. 2" CAST IRON V N " ��IsT'�i MIN.24" ID GRADE RETURN BEND OR 41H ' .,� APPROVED VENT CAP. 25' MIN. ; FROM DOOR: WINDOW OR FRESH '---• • 18" MINIMUM AIR INLET LEAD JOINT AIRTIGHT SEAL p� L HIGH WATER 1` ALARM SWITCH - - - - - BLIND PVC OR CI PLUG DEPARTMENT APPROVED • JOINT WATERTIGHT JOINTS ARE. INDICATED BY UNLABELED ARROWS *PROVIDE APPROVED PIPE FROM INLET TO 3' BEYOND EDGE OF UNDISTURBED SOIL SPECIFICATIONS TANK MANUFACTURER: wtis€'C TANK CAPACITY: Zo0 O GALLONS PLUMB!R/DES'IGNER SIGNATURE: DATE: :/2 ≥ 9 LICENSE NUMBER PAGE 1 OF 4 Holding Tank Plan Index & Cover Sheet Component Manual Design References: Holding Tank Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Holding Tank Specifications Pg 4 of 4 Management Plan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map (if ap Holding Tank Pumping Contract (if appli Holding Tank Agreement (if applicable) Project Name I Description Larson Holding Tank plicable) cable) Owner Name(s): Benjamin & Hannah Larson Family Trust Phone: 651 -247 -5847 Owner Address: 690 Apache Ln. Mendota Heights, MN Zip: 55120 Project Address: 47530 Cranberry Lake Rd. Solon Springs, WI Govt. Lot: 3 1/4 of 1/4, Section 30 , T 44 N -R 09 E ❑ or W ❑✓ Township: Barnes County: Bayfield Project Parcel ID #: 2382 Designer Information Designer Name: Jason Kuettel Designer Address: 42940 US Hwy 63 S. Cable, WI E-mail: tim@andryras.com spac resir d lclap p slain i License Number: 675751 Phone: 715 -798 -3355 Zip: 54821 Remarks: RECEIVED JUN 222026 Bayfiold Co. Planning and Zoning Agency Signature: Date: 0,%is /ZG. Origin si ature required on each submitted copy. Ci 4kK C.L¼V Ck1/' ttLce C.b.r.' e „t . rye ( R CC, 4 Scwle. •3.e O-≥fre-- c3&-JAM',N 4—ISe,Ju4F} LAaJor.. j AM %¼. t CYl' tr e r -t- . aaozesi ° y7s3o G2An'Qekcz c c'-,2) SA La.-) 3 ,>1t(r Cj Leo&L,. E/00 or 70d' Guu Lo r '1 t7 2 oLDZ-sS7fl5 S v NNA) i2 09w TOW cr- i3t91L/iL$ %j 4T Pt EiVE[U JUN 222026 Bayfield Co. Planning and Zoning Agency iP �O/I5/ c. PAGE 3 OF 4 HOLDING TANK SPECIFICATIONS (No Scale) Electrical must comply with SPS 316 and NEC 300 18" Min. (typical) Inlet Approved Joints with Approved Pipe 3 ft onto Solid Ground Weatherproof 12" Min. or 2,0 ft above —Junction and Approved Established Flood Elevation Alarm Box Vent Cap (typical) Approved Locking Manhole 4"0 Vent Pipe with Warning Label Attached Conduit >10 ftfromT (typical) Bu ilding Seal Inlet Invert FitMax. 12" or 90% of total volume if more than one tank a Alarm -On HOLDING TANK VOLUME= 2100 gal a.. 3" Approved Bedding Material Beneath Tank TANK MANUFACTURER: Superior Precast (new) 4" Min. or 2.0 ft above Established Flood Elevation (typical) Finished Grade Plug Anchor tank as necessary RECEIVEL) pursuant to SPS 383.43(8)(g) JUN 222026 Ballast Weight = [(cu.ft.tank.vol x 62.4 lbs/cu.ft) - lbs.tank.wt] x 1.5 Bayfield Co. Planning and Zoning Agency Ballast Weight = [( cu.ft. x 62.4 lbs/cu.ft) - Ibs] x 1.5 = Ibs HOLDING TANK SPECIFICATIONS CYcrI�NC, Number of bedrooms __________Non-residential estimated flow (gpd) 2000.0 Minimum holding tank volume required (gal) 2000.0 Proposed holding tank capacity (gal) Weiser Concrete Tank Manufacturer WLP 2000_MR Tank model number S.J.Electro Alarm manufacturer H.W.101 lAlarni model number Tank Dimensions and Data X for round tank Liquid depth below inlet invert (in) Maximum depth of soil cover (ft) Height (in) Outside Length (in) rDimensions Width (in) Only 42.0 3.0 54.0 175.0 84.0 Tank Anchor Calculations 17070 lbs Weight of tank and cover 1.50 Safety factor 25928 lbs Weight of anchor required 26.5 in Soil cover req. for anchor or 6.4 yd' Concrete counterweight HOLDING TANK CROSS SECTION Junction box — rim' 'n conduit manhole cover with locking device and finished warning label grade n. Manhole Manhole and vent locations may be reversed. vent cap 17' min. vent pipe 18" min. blind plug service alarm on 12.0 in. building sewer inlet Note: All tank joints, and to seal joints between tank outlet openings and piping are Electrical as per 30.0 in. sealed watertight. All NEC 300 pipe and vent materials and Comm 16 comply with Comm 84. 3 tn. bedding under tank Project: Stortie Transaction Number. Tank is anchored as necessary to negate buoyancy. Page 2 of 5 REfsEd'.rELJ JUN 222026 eayfield Co. Planning and Zon fc Ar—y PAGE4OF4 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 = 300 gpd Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (Le., leaks, breaks, corrosion, etc.) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) 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: Andry Rasmussen & Sons Local government unit: Bayfield Co. Zoning Phone: Local government unit address: 117 E 5th St. Washburn, WI Phone: 715-798-3355 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. V' IC.E,IVEfS JUN 222926 Plannin Bayfield Co. 9 and Zoning Agency HOLDING TANK SERVICING CONTRACT Contract Date I i* ding Tank Owner(s) Name(s) j-iawk ltfr pct g . Scc. Scr p'nn'c._ This contract is made between the Pumper's Sic mpers' Registration # -1- We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT J Legal Description: Tax 1D# LOCATION (use Tax Statement) i�� 1/4, 1/4, %i SZ5- OVi-t-8r3 5iC41oyt go 14,1 J Roy vi Town of: LotSize Acreage Section Gwvl D Township N, Range W c vvc9 &0v✓L �a✓YVtJI I Gov't Lot Lot It CSM # Vol. Page I CSM oc # Lot(s) No. Block(s) No. Subdivision: 1. The owner agrees to file a copy of this contract with Barfield 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; RECEIt c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; JUN 22 2026 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;eayfield co. Plannin0 and ?oninO ADency 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) Owner's )4 E/( -4A L(jiV50/\ i2'/lA._ � G'1� ,,� on this ITday of .Owib 1` by: lotary Public ANDREW MICHAEL STEENS0N _________ •r -_T__ __._� f Notary Public -Minnesota MY commission expires on: —ycomrms— SW - Revised: May 2016 (' day 2018) Drafted by Personal information you provide may be used for secondary purposes [Privacy Law. s.15.04 (I)(rn)I r (( c Wisconsin oepartment Indkst' O V Fk G'TANK A iGRE ENT Labor and Human Rela 1 s SEP 1 2 2001 OCT 1 9 2001 Document No. /Plan ldentifi n No.,��; cJ,, tyv 467349 saYlieTd�20 1190Wernmen �YU'H' �rSi �il�flFlfbetank Agreement Da a owner(s) �/�fO�O Co'untv or Local Governmental Unit IHolding Tank Owner(s)/S � �� kn r Ii cafe Muni all w We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property: (Provide le al land description) E�• o `≥ . CJ / yLO7�cO 100f,� , Lod' 3 5e pi30 f ra i n hLr /fin • A] I 2, -cm © c/ (f ) ( �r9 n dE f 'Nnes Safety and Buildings Division// Bureau of Buildings and Water Systems space VOL. SOF9-er-P ,OELc un^� REGISTER OF DEEDS '01 SEP 28 API 9 48 REGISTER'S OFFICE/i..h:. BAYFIELD C0UNTY,'ii; or that continued use of the existing pre-maes requires that a holding tank be installed on the property for the purpose of proper containment 6f sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as parm.tted urdcr Ch. ...HR 33, Wis. Adm. Code, or Ch. 145, Stats. L ' a/ ,1 As an inducement to the County of 1 I l v to issue a sanitary permit for the above described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the municipality to prevent or abate a human health hazard as described ins. 254.59, Stats., the municipality 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. 66.60. Stats. 2. The owner agrees, pursuant to S. ILHR 83.18 (10). Wis. Adm. Code, to have installed in a new building or new structure a water meter approved by the county and State. The water meter shall be installed by a plumber authorized by the State to conduct such installationsrsy ,(gs$a4Wjon complying with State regulations and manufacturers specifications. The owner agrees to be financially responsible for the Jlk Mfftk�tbtn. maintenance, and repair of the water meter. and agrees to allow the municipality to enter the above described property on a regular basis to read and/or inspect the water meter. JUN 222026 3. Owner agrees to pay all charges and cost incurred by the municipality for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to preventor abate any human health hazard caused by the holding tank. The municipality sKhalbay� Q%ft 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 doePQR'#�� h& ibo%%Y thirty (30) days. the owner specifically agrees that all the costs and charges maybe placed on the tax roll as a special assessment foVthe abate e o a human health hazard, and the tax shall be collected as provided by law. 4. The owner, except as provided by s. 146.20 (3) (d). Scats., agrees to contract with a person who is licensed under ch. NR 113. Wis. Adm. Code, to have the holding tank serviced and to file a copy of the contractor the owner's registration with the municipality. 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 municipality within ten (10) business days from the date of change to the service contract. 5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the municipality on a semiannual basis a report in accordance with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code, for the servicing of the holding tank. In the case of registration under s. 146.20 (3) (d), Stars., the owner shall submit the report to the municioality. The municipality 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. - — -- 6. This agreement will remain in effect only until the local governmental unit responsible for the regulation of private sewage sy! property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83. Wis. Adm. Cc agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submj register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existenceb determined by reference to the property where the holding tank is installed. Print ission expires: The information you provide may be used by other government agency programs (Privacy Law, s. 15.04 (1)(rsQ1,, 8 0 5 P 8 �/ 6 F3!,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: GIKLING, ANDREW S & MALLORY E 3040 WILDER ST N ROSEVILLE, MN 55113 LARSON FAMILY TRUST, BENJAMIN & HANNAH 690 APACHE LN MENDOTA HEIGHTS, MN 55120 Description Private Sewage System (Holding Tanks) Submission Number: SS -00779 Transaction Number: SS-00779-486BF $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 15091 Paid by: Andry Rasmussen & Sons, PO Box 66, Cable WI 54821 Payment Type: Check Transaction Date: 7/2/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-78S STATE SANITARY PERMIT OWNER: BENJAMIN & HANNAH LARSON FAMILY TRUST ET AL GOVT LOT: 3 LOT: BLK: 1/4 1/4 SEC: 30, T 44 N, R 9 W TOWNSHIP: Barnes SOIL TEST: 4593 OTHER MODIFICATION SYSTEM TYPE: Holding Tank PLUMBER: JASON KUETTEL TRACY POOLER Authorized Issuing Officer DATE: 7/2/2026 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 675751 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 7/2/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION