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Home My WebLink About26-97SDepartment of Safety County = • e & Professional Services, Sanitary Permit Num er (to be filled in by Co.) 1 g Industry Services Division �� OQ✓� I R (0 _Cf 7S 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. I5.04(I)(m), Stats. I. Application Information — Please Print All Information Property Owner's t .! /7 _ / Parcel # Property Owner's MailingAddress///� /� �l 2 Q Property Location e 2S / ,�j tJ141 Govt. Lot /$'" ' j (/ �Li4 NL 'A, Section 2? City, State ZipCode J T i i7CP PhoneNumber rJ L fS--I(3 i�f. / ✓ l�(/N T l " N R 06 E o II. Type of Building (check all that apply) Lot k Subdivision Name or 2 Family Dwelling— Number of Bedrooms 3 Block /i ❑ Public/Commercial — Describe Use O Cityof ❑ State Owned — Describe Use O Village of CSM Number Town of tO /'f rate t) rc(r 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 if a licable. A. 0 New System eplacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B- ❑ Holding Tank in -Ground ❑ At -Grade ❑ Mound ❑ Individual SiSi[e Design Other Type (explain) yp p (conventional) C. ❑ Renewal Before 0 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/sf) I Dispersal Area Required (sI) I Dispersal Area Proposed (si) I System Elevation YSo !o we 76 cS' fa, o Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units C, `'�° O y New Tanks I Existing Tanks c d 3 u a 0,0 n Septic or Holding T jd I QE'J a L/' Dosing Chamber V. Responsibility Statement- I, the undersigned, assume respons' ' r meta a a the PO S shown on the attached plans. Plumber's Name (Print) Jkwaroa63 I Plumber's ure MP/MPRS Number I Business Phone Number .X __ (93d CIS -(pi 1-F�S�� Plumber's Address (Street, City, State, Zip Code) ///v >=sks. .�J' , Li l w,� P qtr/. �Y VI. County/Department Use Only pproved I O Disapproved Permit Fee $ Date Issued Issuing Agen ign e ❑ Owner Given Reason for Denial Z 2S! 20 /Do5/ Conditions of Approval/Reasons for Disapproval 1 of ls- Attach to complete plans for the system and submit to the County only on paper not Is than a 112 x 11 inches in size SBD-6398 (R. 03/22) SOIL TEST # - ;titscar-sin Depanmerlt cut Safr ly a PIr:fesstuunal ServuCm e 0tvision of Iridustryr Se►vtci�s Page of 2 FS SOIL EVALUATION REPORT in arrrtrcla*Ices wilt BPS 3#3S. '.'Vrs Actin. f uxie Counly Attach .-.ompleiea Fete ptru' an p 4lper not less w ar. ii Irtchess in size Plar'= rrlulst !n%Iuido, Saytlatd but not turrtllttd to vurticat and ho zcrrial reterrsrwe point (BM. d'roctson and percent scope• Pat%& I D gC.ale nr drmenstans, nar1lt ;allow and fc,c floe and distance to neatest road 17555 Please print alt information. Review j.f jol PGrr anal mfe�rmalrsan yois provide rflo tie u15 I ft:r srr.Tsrlrt y purTYM0S� (Prrvacy Law 15 fbt<f t (Trtl! 41'.ILJ"0 (, ! • •+�..6 Property LocaIlun O Io t 6uman Govt Lot NE NE r. S 24 i' 45 N f{ 06 E furl W i Property t7' ns•r's Mauling /4dul-ecs. Suit: llc:dretily or CSM and Lot ss 24925 D dal Road - C,t' +tote. zip T'f home Nurctber ' : Gay L. V,19age Town Nearest Road -- 1MF H7 7 I $ l a1 -A '�4 rani Vtcw L7vel Redd [j New Ccunstetrcvcm Use Rt-rtcsan3:rsi Nurnt�c>r czt brttrt et35 3 Code denven detsignilow rd1v_ dpi? GPD Replacement U Pith#ic cur crarnnlsrrc33 -- t t1flbe N/A Flood Platt eievaUwl sf ap1rlr-able - ft Parent r•.ratt;ts31 Gerrrteti C:artir'wr:t.'s and iecorrtrimar 'oboes 7tsl area does havegradual nse but sods remain consuste m with no signs of seasonal saturation Bi7flRt� i# _] Littrrng _ — ._. «_......_...—.... Ground surface tslev -4jLtt. Depth 10 Irrniling faCtcr. rn ! eietJL9 1 2 _ Boring # Da.plh in Duntin$nt Color l.3unser7 Redox Descr pban ( iv Cant ColorCsr. Texture Structures Consistences Sz Sh Sod Alrpl:catrote Rate tlaunda+lr JRoots C,PDiFI -- r f 7 _— _...- . _ _._.._..� ! 'Etta •kitar I .5VR 3/2 r None SL 25t 8f m as 1-- 1 61— i 684" 7 5 R4ft3 None ISOSG ml - -J 16 :--...!7T_ __ Ueonrtg J jPrt Ground surface elev 94.1 rt• Depth to lanrttrrg factor •...,i84 in r elm, _,LL}l _—ticanxen Depth faom hint (,rAT Redox Daac rip;►on Tbxture to '.tunsttil au. ► $ Cant Color None SL None 1 g ITIL_IIirTIiiiJ Structure Gr Sz Sts _ __ Sod Agpr,c•yuarr Rt;te Conststence I Boundary Rnot 2SBK mvfr - OSG -.- ml �--•Ettfrt Erra_ as IT 1 .0 _1 i I 16 — — - - ..i.....:.i- JT:i ____ CST t3nt�y (Pltiae Pnnt1 Sityl ,, - ��- - 1 Ronald MCKuen �: CST Ncimber Add•e>ti5 - - t}r+ic+ E�vrtluu;:,sn r�uC1ed 17214 State I•}wv 13 8ultanwl„ W1 54514 0513Q/2025ava-s Tc lerpnt,ne Numtser — _71 S 661 3255 __ Effluent >l t = SOD > 30 ??0 rrtga and TSS - 30 s '50 ntg1L 'Effluent r'i'd DOD. s 30 mgit. and I SS s 30 ntglL ._ SBD-8-330 (R03t'22) Page 2 at 2- E3r)rrg �, j Bo ing i ?,t Ground Surtas:o eiev _9-5It Ueptn to Ia n"Urt9 rar rar _86 n r eiev 8L34)% 1 -Soil Appl�ca:ron Raw Kori aet Dept, ; Domunarlt Color i Mu wil Reclo.r Gescnpt:uii Qu Az Cot -1 Cntsor,- rTetletuty Stn.ccure C<rnt ctrmce C'r Sz ! F3 -unr}ary Roots GPDtt __..____. -- .... _..._;ft....._. � - -- Flat t '!: frrT'' r1',2t3'2 Nt�tte SL -•— 2SBK —--mvtr I as j if S OSG - 4 TI7i II:: Becing :S tQc BC:tnG L7f3,t Grount! surface efov It. Drapth to limiting facto t ,n r e►lev o Soil Apci;,art Rate' H:n; cn Depth D nunantt C .'tci- RV -1C Df5i:lsp, ort Textura StruCure Consislen�o Boundary Roots GPCr Ft- )'1 1.1unse;: C'7 "2 Cc:3•; C.oiof i �� L._ _ r _._ . - �•... { _ l C Sit {o 1•• IT Ehnnj i.._._.._ L„ Pit Ground suiface e!ov ____._ft. Depth sa I-mitifl factor at 1 elev -__ ft ---•------ -- Soil Apf icatlon Ra?e Horizon ' Depth i t send; Color I Re d -ox Dtspf.on lcxtwu l Struetum ; C onsi�trnce Loundry t Reaatat GPU:F! t I7 ?AuT:sel) ! Qu Az Cent Gtr Gr Sz Sly 'East' i ttp: -------L _ -- .L . 11 __ __,iii ' E!^.uent u t = 801) ' 20 220 r•tejfl. end TSS > 30:s 150 mg!L • Effluent u2 - BUD. s 30 mg I and TSS S 30 rng'i. DRoad Shed PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross -Section & Plan View Pg 4 of 4 Management Plan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Benton Replacement Septic System Owner Name(s): Ken Benton Owner Address: 24925 Dybedal Road Project Address: 24925 Dybedal Road Mason WI Govt. Lot: NE 1/4 of NE 114 Section 24 T45 N -R 06 Township: Grandview Project Parcel ID #: 1.7555 County: Bayfield Designer Information Phone: 715 -413 .0234 Zip: 54856 E❑or W❑✓ Designer Name: Zygmund Jablonski Jr. Phone: 715 -682 -8520 Designer Address: 1110 West Lakeshore Drive - Ashland, WI Zip: 54806 E-mail: Zyg@atozashland.com This space reserved for approval stamp. License Number: MP6302 Remarks: Signatu Date: June 5, 2026 IN Dybedal Road Site Location: 24925 Dybedal Road Pole Barn Well 145" Garage 81yds 3 Bdr. W 28'x42' 25' 42' Home Id ep c Elevation B 1- 94.9 B2- 94.1 B3-96.5 BM -24" Oak Spike in Tree at 100.0' Trees 64 10100 gal. Septic Tank Sewer Inv. @ House 111.9' 80' 4" CAST -A -SEAL N N. WLP1 000 TANK SPECIFICATIONS 80-8" DIMENSIONS: WALL: 2 1/2" 4" CAST -A -SEAL BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER �� 53 1/4" �i�• LENGTH: 8'-8" �� • ,/THEIGHT: WIDTH: 7'-2" BELOW INLET: 42" LIQUID LEVEL: 36" WEIGHT: BOTTOM 6,790 LBS. COVER 3,195 FILTER OR ii 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) TOP VIEW LIQUID CAPACITY: 27.83 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,085 GALLONS LOADING DESIGN: 8'-0" UNSATURATED SOIL Y.. _ _ _ _ - OUTLET -z+.r ►r In M a. 1 D st M PUMP PAD ITANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE REVIEWED BY REVIEW DATE 0 O ell 3 0 O 00 m ctii 3 Cl) 00 W U, N U c0 z tb CAW U) a N xco Wcn -I; J D Z F a w IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3 -ft Trench (down -sizing credit) min. 12" (typical) SOIL COVER Septic Tank(s) Manufacturer: Wieser Septic Tank(s) Volume(s): 1000 gal gal gal gal Effluent Filter Manufacturer. Polvlok Effluent Filter Model #: PL -525 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) Provide minimum 3 ft separation between trenches. TYPICAL TRENCH (Show location of inlet / outlet pipe connection on plan view.) PLAN VIEW Orr o Observation pipe shall be installed (No Scale) Perforated Lateral at junction between two units. Observation Pipe (typical) (typical) (typical) INSTALL PER TRENCH: 8 10 -ft bundles @ 50 ft2 EISA/unit = 80 ft2 + 1 5 -ft bundles Col 25 ft2 EISA/unit = 5 ft2 OBSERVATION PIPE DETAIL (No Scale) Screw -Type or Slip Cap (loose) 4"0 PVC Pipe Top of pipe to terminate at or above finished grade (4)1/4"-1/ " X 6" Slots @ 9 apart Anchoring Device 10 ft (typical) A=3.0 ft (typical) EZ1203H Bundle (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturer's Instructions. = Proposed EISA per trench = 255 ft2 Required Infiltration Area = 75_ ft2 = x 3 trenches = Proposed Total EISA = 765 ft2 .W Finished Grade (mulched & seeded) Topsoil Cover •i ; •(min. 1 foot) infiltration Surface Distribution Method: branched manifold m W O 11 -P 2.00 [5.1 cm] F LIt\ OUTSIDE DIAMETER ACCEPTS 4' SCHD 40 SOCKET OPTIONAL BUSHING (FOR 4' THIN WALL PIPE) PART NO. 30142-R OR (FOR 110 MM. PIPE) PART NO. 30142-EUR OUTLET BUSHING ACCEPTS 4" SCHD 40 & 6" SCHD 40 FL IAUIYl1'lV VLIl PREVENT FILTER FROM FLOATING PL -525 -625 FILTER HOUSING PART NO. - 30142-525 30142-625 11.59 [29.4 cm] [26.7 cm] 34 cm] a2 cm] 3 FAIRFIELD BLVD. Wes, C7. i MODEL MO. PL -626 0 625 EFFLUEIIT IFOLTIE PPINYN Y O. 301 a 3al4 UAW ON LDM PAT. nom.- '-J� LABEL ILLUSTRATION A TO Z PLUMBING & HEATING, INC. 1110 LAKESHORE DRIVE WEST P.O. Bog 615 ASHLAND, WI 54806 Phone: 715-682-8520 Fax: 715-682-8521 Email: Zyg@atozashland.com fi SEPTIC PLAN SUBMITTAL Project: Ken Benton J 24925 Dybedal Road Mason, WI 548567 Project Site: Same as Above INDEX: Page 1— Index & Cover Sheet Page 2-4— Soil Evaluation Report Page 5— Plot Plan Page 6— Weiser WLP1000 Septic Tank Page 7— EZFlow In -ground Gravity Dispersal Area Sheet Page 8 & 9— Septic Effluent Filter Submittal Page 10 — In -Ground Gravity Management Plan Zygmund Jablonski Jr. June 11,Z02frm /' 302 PAGE 4 OF 4 In -ground Gravity Management Plan IMPORTANT: The owner of this in -ground gravity system 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 system 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. Maximum Dispersal Area Operating Limits: Design Flow = gpd; BODS ≤ 220 mgL"1; TSS S 150 mgL''; FOGS 30 mgL"1 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 (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: /''' 2-' ?91-ot '' Phone: Local government unit: 11Ack1JU. Phone: `Z2 Local government unit address: L, fl- - 5 S4 WAA-4 L.. 9191, ZIP: 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 treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be ,bandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. Private Sewage System Maintenance Agreement Owner(s) Name �E \1 t 1� El1J IJ tiTo t� ''I Y/W cr- Q lei p 1 Owner(s) Mailing Address !1 A44e '.) 0w6' %� 4 uj rid Site Address aL(Il'{ 4 4CJAJ,( RL MA -a. GJd "vs -4 Tax ID# P7 r5•,f As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil tester's report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established in the WI Adm. Code, as from time to time amended. (COMPLETE Legal Is required) k1/4 of IrI� 1/4 Section Township _W N. Range 04 w Additional Legal Description: tin Town of CfnGrs (Acreage) &t 6iot Lot_ Block Subdivision Lot _ CSM # Vol. Page CSM Doc # DOCUMENT NUMBER 2026R-6 13021 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED 07/22/2026 AT 8:30 AM RECORDING FEE: $30.00 PAGES: 2 Return To: Planning and Zoning Department RECEIVED Area JUL Z3ZOZO In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage Syds&em: Planning and Zoning Agency ❑ Mound ❑ At -grade Sewage System ❑ Other Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. Pump Chamber (system types B, C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wiis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds, At -grade, and In -around Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall notify the 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 does not pay the costs within thirty (30) days, the owner specifically agrees that al/ 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. The terms and conditions of the agreeentsmin,jgg`,t't1 lug icQLi j tithe benefit of all current and future owners of such property. Owner e(s) ease P " '•. ribed and s om tobefore me on this date: tt z _ tAO7,q,9� zi • Notarized Owner(s) - Signature(s) : j., , tlry Publi Wis"" p V rrr.r1i1 MyCommi ion Expires: Drafted by: 7j9&/ i Date: -7IZIl Proofed by: u/fors/sanitary/septicmaintenceagreement Revised July 2020 DOCUMENT NO. 40.7£33 Volume 592 Page 93 STATE BAR OF WISCONSIN FORM 1--1988 Tl:1s RACK *U!SV® roe I1zCORmNS DATA WARRANTY DEED . This Deed, made between .Carrs R„ :Olson and ....__...... 4...-•.....................--.....«.........»...»»......»:...:....._._»... ............»_••--------................ — _._._.. ., Graatar, 'and.....REAIIS )1..Q...Ban aJl1•..�fr70.00i1e_.7JlnahnOtd...... and..r�lf+c,__x_u�v�.vQzahiR�,axi.ta].._Ius—tx--..-««............. ..-•------• .... ... ........... ...................• ..- »...------...... -_, Grantee, W1tI1esseth, That the said Grantor, for a 'valuable a naideration----.. ---------.....—.............—_-........»....»...----------.--------------..........».»_».........__».. conveys to Grantee the following described real estate in »..»..$n}cfisld__...... County, Stateof Wisconsin: VOLL L F&° PAGE REGISTER OF DEEDS ''93 SEP 8 Ra 0:14' REGISTER'S OFFICE/S:.$: .BAFIELB COk NTY, WI& r...-. rw.-ri,. /(p'Y.« Tax Parcel No: .».... The Northeast Quarter of the Northeast Quarter (NE 1/4 -NE 1/4), Section Twenty-four (24), Township Forty-five (45) North, Range Six (6) West, LESS the East 10 acres and the West 10 acres thereof. AiMSFER FEE FEE EXEMPT S o� . RENTAL WEATHERIZATION CODE YE.S O NO 'EXEMPTION i . L This ------is..... ............. homestead property. (is) (is not) Together with all and singular the hereditament'a and appurtenances thereunto belonging; And.........Gauls R. Olson and Jeanne M. Olson ......»........................._..---------------...-----...........................»......_..........,......................... warrants that the title is good, indefeasible in fee simple and free and clear of eric6mbsanep copt easements, reservations and restrictions of record and will warrant and defend the same. Dated this ...............................2.7. ........ day of ........................_._............._...:_...................... (SEAL) ...............:.............----........----........................ (SEAL). ...£ngua ................................. 19.x .... ..:._...(SEAL) • Garris R. Olson ......... .................«»...._.0. .._ (SEAL) .ie e M. Olson AUTHENTICATION ACKNOWLEDGMENT Sigastare(a)..._._----_..._..»......_»...:«................«.».. STATE OF WISCONSIN Ashland ..:County. en .._.^__._..... ........................ authenticated this .....day ai»««....«.«.«.«...:, 19»«_ Personally came before me this ....:27th .day of --:St-«----------19i...:_.:.•the above named .._...__«.............__.....«._»»....«...».._».« Garris R. Olson and Jeanne M. Olson, • husband and wife, »« TITLE: MEMBER STATE BAR OF WISCONSIN .«».....».........«....«.... _.».....».._......»....—_«»«» authorized by $ 708.96. Win. Slats.) THIS INSTRUMENT WAS DRAFTED ST ,r��L to me known to be ' the person S....-..«« who executed the foregoing inatrament and edge Ithe same. �I} Attorae_y,«Matthew P Anich : _..E`, ..«..«...« ....«....«......__ ....... . o e M. Re olds .fla1lanbach._ AAi eh..$IJs77»««.«« Notary Public «--_____. d« County, Win. (Signatures may be anthent!cated or acknowledged. Both M)T Commission Is permanent (If not, state expiration are not necessary.) date: :.. sC:rrh-�. .......» ...»..., 19.x_...) .....».«.... ...» � •Name of persons stsaing In ens capacity saoeld be typed or prinad bolos dOr stsa.eari. WAURANTr Dggy STATE.' PAR OT WTGCOi'1AtN wlRasnmin I.tust 81onk Ca Ise. romf Ba I-17°3 Vot—k.". W.- A 13FIELDBayfield 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: BENTON, KENNETH V & VALERIE P 24925 DYBEDAL RD MASON, WI 54856 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00446 Transaction Number: SR -00446-4829F Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 30015 Paid by: A to Z Plumbing & Heating, Inc., PO Box 615, Ashland WI 54806 Payment Type: Check Transaction Date: 7/28/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. P -.-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: BENTON, KENNETH V & VALERIE P 24925 DYBEDAL RD MASON, WI 54856 Description Private Sewage System (Holding Tanks) Submission Number: SS -00776 Transaction Number: SS -00776-48224 Amount $400.00 Total: $4UU.UU Payment Amount: $400.00 Reference: 30015 Paid by: A to Z Plumbing & Heating, Inc., PO Box 615, Ashland WI 54806 Payment Type: Check Transaction Date: 7/28/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-97S STATE SANITARY PERMIT OWNER: KENNETH V & VALERIE P BENTON G OV'T LOT: LOT: BLK: NE 1 /4 NE 1 /4 SEC: 24, T 45 N, R 6 W TOWNSHIP: Grand View SOIL TEST: 100-26 REPLACEMENT SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: ZYGMUND JABLONSKI SCOTT ROUSH DATE: 7/28/2026 Authorized Issuing Officer 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: # 6302 Condition: Properly Maintain System Per Recorded Agreement. Old System needs to be properly abandoned per SPS 383. THIS PERMIT EXPIRES 7/28/2028 MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION