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HomeMy WebLinkAbout26-96SIndustry Services Division County •�.� II -T 4822 Madison Yards Way 3ct ftei4 Madison. WI 53705 Sanitary Permit Number (to be filled in by Co.) Madison, WI 5302 b 1 68 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 obuainin_ 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 provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Slats /1 J Y!R G 5 !J O L,(J , -E l l L Application Information -Please Print All Information Property Owner's Name 0 Pared n Property Owner's Mailing Address Property Location 7 0 9 Gre Re lrN rcc Goa. Lot City, State Zip Code�7 Phone Number (� '/,. Section 30 r T 4 1 N R 0(0 E ore H. Type of Build' g(check all that apply) Lour k I or 2 Family Dwelling — Number of Bedrooms 3 Subdivision Name ❑ Public/Commercial — Describe Use Block II iWi4,j ❑ City or ❑ State Owned — Describe Use ❑ Village of CSM Number jg'.Towm af 'K. `/5'%fl°t-Q I11. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box: online B. Complete line C if a licable.) - - A_ News System _ y Replacement Systemp, p ❑ Other Modification to Existing System (explain) Additional AtMII B- Holdine Tank In.Ground At -Grade Mound 1�Ii'�slltir'tRJhlain) Individual Si''W.Itsi 2Qi ri'ype (explain) (conventional) C. Renewal Before ❑ Revision Change of Plumber Transfer to New Owner List Previo onmg ABaattne I sued Expiration IV.Dispersal/Treatment Area and Tank Information: - Desiignn Flow (gpd) Design Soil Application Rate(gpolsf) Dispersal Area Required (si) Dispersal Area Proposed (st) System Elevation —17 O — — —. `. Capacity in Total of Manufacturer Tank Information Gallons Gallons Units ? = 6 New Tames Existing Tanks c `t v ' a= c U n w n ScpticorHoldinaTank 3OOQ V l/ __ 3 cto ) f W� , /l AC l-0 Dosine Chamber V Responsibility Statement- I, the undersigned,assume responsibility for installation of the POWTS shown on the attachedplans. Plumber's Name (Print) Plwn s SijIyre MPIMPRS Number Business Phone Number Cs�'e 9f-owc�44Y1937Y /S X09 ofG Plumber's dress (Street, City, State, Zip Code) i3c0co c-r+H- -b?kt-et, wr. S'6q V l: Count.v/➢epartment Use Only. Approved ❑Disapproved Sea it Fee Date Issued Inmi gA St m ❑ Owner Given Reason for Denial ,l Conditions of Approval/Reasons for Disapproval S R- ooH 6 I Soil Test #Q7 Bayfield County V Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) I I1rri A,iks tc, 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 a determination. ITFR Property Owner Robe,* &Atti k 3 Contractor Property Address`PLSS6 0 Co iN Authorized Agent Agent's Telephone, Telephone 1 o2iY-- c- 6563 Written Authorization Attached: Y or N Accurate Legal Description is requested: 3k11/4 of 111W 1/4 Section 3c2 Township V?N. Range t6 W. Town of keys Additional Legal Description: Govt. Lot Lot Block Subdivision Lot CSM# Vol. 1009 Page 106 CSM Doc # 069 P - S2 '/3 y Volume Page of Deeds Tax I.D# _2/ '3 ( Acreage • O, 7 Indicate reasoning for your determination: S rrk de,e &-r t I=F A+'/ R CEIVED JUL 0 9 2026 Bayfieid Co. Planning and Zoning Agency /VmY Signature of Co my 9%ficial Signature olCertified Soil Tester 7/e/ 6 Date 42138 Certification # (Submit a Plot Plan & Fee) Date ulforms/soiltestwaiver(KLK) June 2018 . ,,�Ypl►AT11/Lyr Wisconsin Department of Safety and Professional Services Page of • 0 Division of Industry Services SPA.. SOIL EVALUATION REPORT 8�'"mvn�sYr 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. 21991 Please print all information. v y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). Property Owner Property Location LJ ✓❑ Robert Gallik JR Govt. Lot SW Y NW % S 30 T 47 N R 06 E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: 709 Crested Fern Ln City I State I Zip Code I Phone Number ❑ City ❑ Village © Town I Nearest Road Hoover I AL 135044 I Z05-475-66 Keystone I County Hwy E 07 New Construction Use: [9 Residential/Number of bedrooms 3 Code derived designflow rate 450 GPD Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material Clayey till over underlyinc stratify General comments and recommendations: Site does not meet A+4. Holding Tank suggested Boring # ❑ Boring 977 []Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Anil Annlirnfinn onfa Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIFt2 *Eff#1 *Eff#2 A 0-4 5YR 3/4 CL 3-cpr-vc dh as 1f 0.4 0.6 B 4-7 5YR 3/4 f -f -f 2.5YR 5/8 CL 3-cpr-vc dh as - 0.4 0.6 C 7-16 2.5YR 4/4 C 3- sbk-vc deh - - 0.2 0.3 Boring # ❑Boring HPit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Rnil Annliratinn Rata Horizon Depth In. Dominant Color Munseil Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 Bay eld Co. CST Name (Please Print) Signature CST Number Tim Dykstra 1213855 Address Date Evaluation Conducted Telephone Number 10620 Eagle Lake Rd Iron River WI 7/6/2026 715-209-5748 * Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS 5 30 mg/L SBD-8330 (R04/21) Page.?_......of..?...... ❑ Boring Boring # 0 Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Soil Aoolication 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 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. / elev. ft. 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 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Sail Annlicatinn RateI 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 EC I/D JUL C 9 202 Ptannin ayfi Id Co. * Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS s 30 mg/L Ro6e4 Cmitek 3R down S kcysl„rae *J,NW s so ry�,v �o6w 0 ;y A0 Sot' -r5s) )OOX) ££O L414 g rrof% �iv.@r 'V t c 9 P'2 Csr4 1a13 sec - 7/ J,26 Z q?7 05�► �a�L�"� - l' .00{', " !Q JUL 09 eon HT 6ayfietd Co. Planning and Zoning Agency ® Ba trio) 9b • S 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 IRECE1V'ED Pg 3 of 4 Holding Tank Specifications JUL 092026 Pg 4 of 4 Management Plan eayAeid Co. Planning and Zoning Agency Attachments: Enclosures: P0WTS Application for Review Soil Evaluation Report & Site Map (if ap Holding Tank Pumping Contract (if appli Holding Tank Agreement (if applicable) Project Name / Description plicable) cable) Owner Name(s): i' oL.Qt (Tu\\\' Phone: aO5 - 47S- (TO3 Owner Address: 70°i Cr—es--ed. E -e Lw Roow V, At Zip: 3 S O H H Project Address: ) Govt. Lot: — SW 1/4o1 N W 1/4, Section 3 O ,T2/1N-RAAE Q or W x�! Township: _Ice.( S+oCounty: Project Parcel ID #: 2 I c1 `1 Designer Information Designer Name: 6-s 4 gY J cam. Phone:7(5-O9- ( S -_ ao9 - o/(f l Designer Address: 13&6O L' -T4- 14- tro ti r vw- , 'E1. Zip: SY S cl 7 E-mail: License Remarks: 3 aoa≤a k.X1 This space reserved for approval stamp. Signature: Date: Odoinat siq attire required on each submitted copy. PAGE 3 OF 4 HOLDING TANK SPECIFICATIONS (No Scale) We f IZ'WorU above Junction and Esfai>�shed Flood Hevation jj Alarm Box V ihtP��4 Electrical must comply with ¢ Approved ➢ anhole SPS 316 and NEC 300 4TIVentPipe vrithy Candret >1Oiffrwn {typical) 4" fiMin. or ZO ft above Bind Established Flood Elevation (ryPic) -P_* ______ Aught S� 1 _____ Finished Grade 18°Min. Inlet Approved Joints Inletinvad - VVaterfight Plug Approved Pipe3ttonto mexlTorm%oftowvohmm ifrnon:tl>analetak _ _ RECEIVED SolidGmund r Alwva Cln JUL 092026 Bayfield Co. Planning and Zoning Agency HOLDING TANK VOLUME= 3 0 00 gala ------ 3" = e Approved Beddaig Materal Beneath Tank TANK MANUFACTURER: U)as" C-tlitic_, Anchor tank as necessary pursuant to SPS 383.43(8)(g) Ballast Weight = [(cu.fltankvol x 62.4 lbslcu.ft) - Ibs.lank Wt) x 1.5 RECEIVED JUL 092026 Planning and eon Zoning Agency 1 I LET � a N W3OOO-MR TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1/2" 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. COVER 8,350 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 58.94 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY. 3,183 GALLONS LOADING DESIGN: 8'-O" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE 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/ss) and the Bayfield County Zoning Department Sanitary and Private Sewage Ordinance. 1. This POWTS has been designed to accommodate a maximum daily flow of gallons of domestic wastewater per day. 2. The owner of this POWTS is responsible for system operation and maintenance, locking device, alarm and access. 3. The owner or owner's agent is required to submit reports as required by SPS 383.55(1), Wis. Adm, Code, to the Bayfield County Zoning Department. 4. Design approval and site inspections before, during and after the construction are accomplished by the county or other appropriate jurisdictions in accordance with SPS 383 of the Wis. Adm. Code. Maintenance Cycle. The holding tank must be serviced by licensed pumpers. An alarm system is to be installed to activate when the tank is ≤ 90% full. 6. Performance monitoring. At the time of servicing, the service provider files a report with the department of designated agent. 7. A User's Manual will accompany the component. It will include the names and phone numbers of local health authorities, component manufacturer or POWTS service provider to be contacted in the event of component malfunction or failure. B. In the event that this POWTS or a component of this POWTS 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 for such repairs. This agreement shall be binding on all assignees and heirs 1/4 of _1/4 Section 30 Township jL N. Range �6 W. Town of W% 5-kOKe- Govt. Lot Lot Block Subdivision CSM# Additional Legal Description J c/ Ny zo U ,\0t8 p, i o c ZD�1 -1Ulzc, Property Own , tire Date ulfonns/managementplan RECEIVED Revised. July 2013 JUL 14 2026 Bayfield Co. planning and Zoning Agency RECEIVED JUL 14 2026 Bayfield Co. HOLDING TANK SERVICING CONTRACT Planning and Zoning Agency Contract DateII .3o Jo l6 This contract is made between the Holding Tank Owner(s) Name(s) n�(s jj2, Pumper's Name (Print) Pumpe Signature Pumpers' Registration # We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT I Legal Descrlotion: - 7axlDg ( Z 1 1/4, LOCATION (UseTaxStatement) 1 _1>'4, O N, Range W Sect 3,Township 7 Q �j TownoftI ( h' ST'' �e 11 fZ''') e I Lotion st® s'32 Aveage q03z Gov't Lot Lot ft CM ft Vol. Page CM Dec U Lots) No. 61ock(s)No. SubdlvIsion: 1. The owner agrees to file a copy of this contract with Bayfield 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; c. The location of the property on which the 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 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 ea&nt,4Vfiange contract, the owner agrees to file a copy of any changes to this service contract or a copy ofI now r\tc4 with the local government unit and the County named above within (10) business days from thtdaf change service contract. '•_ O. OF on this I ______day of (V6✓J6v*1-. GL.� by: commission expires on: 6f%3/2026 Revised: May 2016 (®May 2018) Drafted by Personal information you provide may be used for secondary purposes [Privacy Law, 6.15.04 (1)(m)) RECEIVED JUL 14 2026 Docl,e$el p er/Plan I.D. No. HOLDING TANK anning and zoning Agency AGREEMENT Owner Name (s) Owner(s) Mailin Addy L W Q,o___ D G_LI_; k _ 7%tb u&, 4L�3tZY4/ Parcel Identifier Number (PIN) Agreement Date (same as Notary Date) o�2 24'? 663o2°30001ODOD 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. SPS 383, Wis. Adm. Code �orCh. 145, Wis Scats. //� �I 1/4 of 1//4 Section 30Township 7 / 7 N. Range o6 W. Town of Vet/h e Additional Legal Description: 5 W AW 1A) V • IQ08 P, lot Z -c'? Gov't Lot — Lot_Block_Subdivision Lot CSM # Vol Page CSM Doc# DOCUMENT NUMBER 2026R-6 1 2966 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED 07/16/2026 AT 10:38 AM RECORDING FEE: $30.00 PAGES: 1 RECEIVED Return To: Zaw JUL 17 2026 Bayfield Co. Planning and Zoning Agency 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, Scats., 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, Scats. 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) Wis. Scats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced in accordance with Ch. NR1 13, Wis. 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, W'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. 5. This agreement will remain in effect only until Bayfield County certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. SPS 383, WI's Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner 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 of the agreement to be determined by reference to the property where the holding tank is installed. Owner(s) Name(s) — Please Print Subscribed and sworn to before me on this date: CUR, Notarized Owner(s)—Slgnature(s) Nota Pry ubljq Qto N My Commission Expires: r71___________________________________ Drafted by: Y�l' Date: 0_23 ,i Personal lnrnanadon you provide may be rued forsemoda,y purposes [Privacy Law, s.15.e4 01171))Wrmma/aenkeryMaldngTenkAgreemenl 41025 __rt___it Real Estate Bayfield County Property Listing Property Status: Current `Today's Date: 7/6/2026 Created On: 3/15/2006 1:15:40 PM I Description Updated: 11/17/2020 Ownership Updated: 2/22/2021 Tax ID: PIN: Legacy PIN: Map ID: Municipality: STR: Description: Recorded Acres: Calculated Acres: Lottery Claims: First Dollar: Zoning: ESN: Tax Districts 21991 ROBERT D GALLIK JR HOOVER AL 04-028-2-47-06-30-2 03-000-10000 LAURIE B GALLIK HOOVER AL 028102703000 Billing Address: Mailing Address: (028) TOWN OF KEYSTONE GALLIK, ROBERT D JR & GALLIK, ROBERT D JR & S30 T47N R06W GALLIK, LAURIE B GALLIK, LAURIE B SW NW IN V.1008 P.106 208 709 CRESTED FERN LN 709 CRESTED FERN LN 40.320 HOOVER AL 35244 HOOVER AL 35244 40.700 * 0 Site Address indicates Private Road No N/A (AG -1) Agricultural -1 120 � Udtd•692026 1 04 028 020170 001700 4 Recorded Documents 2 WARRANTY DEED Date Recorded: 12/26/2008 ® CONVERSION Date Recorded: 3/15/2006 Property Assessment p a e 2026 Assessment Detail Updated: 3/15/2006 Code Acres Land Imp. STATE 5m -AGRICULTURAL FOREST 26.320 23,700 0 COUNTY G4 -AGRICULTURAL 14.000 2,800 0 TOWN OF KEYSTONE ASHLAND SCHOOL 2 -Year Comparison 2025 2026 Change TECHNICAL COLLEGE Land: 26,300 26,500 0.8% Improved: 0 0 0.0% Updated: 2/4/2009 Total: 26,300 26,500 0.8% 2008R-524354 1008-106 Mu Property History 433-5 N/A RE5 EIVE JUL 09 2026 Bayfield Co. Planning and Zoning Agency 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: GALLIK JR, ROBERT D 709 CRESTED FERN LN HOOVER, AL 35244 GALLIK,LAURIE B 709 CRESTED FERN LN HOOVER, AL 35244 Description Certified Soil. Tests - Review & Filing Fee Submission Number: SR -00461 Transaction Number: SR -00461-4A653 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 37503 Paid by: Dykstra Construction, Inc., PO Box 125, Iron River WI 54847 Payment Type: Check Transaction Date: 7/22/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. B- A-YFIELD Property Owner: GALLIK JR, ROBERT D 709 CRESTED FERN LN HOOVER, AL 35244 GALLIK,LAURIE B 709 CRESTED FERN LN HOOVER, AL 35244 Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Description Private Sewage System (Holding Tanks) Submission Number: SS -00792 Transaction Number: SS -00792-4A656 Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 4092 Paid by: Greg's Plumbing, 13660 County Hwy H, Iron River WI 54847 Payment Type: Check Transaction Date: 7/22/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-96S STATE SANITARY PERMIT OWNER: ROBERT D GALLIK JR G OV'T LOT: LOT: BLK: K: SW 1/4 NW 1/4 SEC: 30, T 47 N, R 6 W TOWNSHIP: Keystone SOIL TEST: 97-26 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: GREG BROWN TRACY POOLER Authorized Issuing Officer DATE: 7/22/2026 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: # MP699374 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 7/22/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION