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Home My WebLink About26-0405BAYFIELD COUNTY SANITARY PERMIT APPLICATION Zoning District Lakes Class 1. APPLICATION INFORMATION Soil Test I County a V �l J (Please Print All Information) No: Permit No: Property Owner's Name: County: Bayfield Ain t_ Addr s of Property: J Property Location: (v N i7//4S jT i N,R q E (or)W Property Owner's Mailing Address: Township:�L Gov. Lot #: 1517q eon sit- MW OPTir__ City, State I Zip Code I Phone Number Lot # I Block #: I CSM #: I CSM Doc # I Subdivision Name MN Sao 7b 3 797-l87 11. TYPE OF BUILDING: (Check One) ❑ State Owned Tax ID#: ENTERED ❑ public (Explain the use/No. osB ) 2S.�88 1 or 2 Family Dwelling - No. of Bedrooms ±— Ill. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) New - --❑ Replacement ❑ County -Private -Interceptor- - ❑ Reconnection ❑ Repair ❑ Revision " ❑ Transfer of Owner (List Previous Owner below) B) ❑ A Sanitary Permit was previously issued. Previous Permit Number. Date Issued: IV. TYPE OF NON -PLUMBING SYSTEM: (Check One) * Replacements need previous permit number and date filled out above C) ❑ Pit Privy ❑ Vault Privy (Vault size: _gallons or _cubic and Portable Privy ❑ ❑ Camping Transfer Unit Container Composting Toilets ❑ Incinerating Toilet V. ABSORPTION SYSTEM INFORMATION: 1. Gallons I 2. Absorp. Area I 3. Absorp. Area I 4. Loading Rate I 5. Perc. Rate I 6. System I 7. Final Grade Per Day Required (Sq.Ft.) Proposed (Sq. Ft.) (Gals. / Day / Sq.Ft.) (Min. Inch) Elev.(Feet) Elev. (Feet) VI. TANK Capacity Fiber INFORMATION: In Gallons Total Gallons # of Tanks Manufacturer's Name Prefab. Concrete Site Constructed Steel - glass Plastic Exper. App. New Existing Tanks Tanks Septic Tank or Holding Tank Lift Pump Tank / Siphon Chamber VII. RESPONSIBILITY STATEMENT: I the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Owner's Name(s): (Pint) If applying for Section C above Owner's Signature(s) • (No Sta s) f� Plumber's Name: (Print) If plying for Section A oral above Plumber's Signa ur (No Stamps MP/MPRSW No: Plumber's Address: (Street, City State, Zip Code) Home Phone: Business Phone: VIII. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit/Transfer Fee: Date Issued: I uing ent's Signature / Date: �� Approved [I] Owner Given Initial 60 r 7(d'6 Adverse Determination IX. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: iUL 221026 Eayheld Co. 'cninfl A9encY Plot Plan on reverse side Lot Line 1. 2. 3. Name the frontage road and use as a guideline, fill in the lot dimensions and indicate North (N). Show the approximate location and size of the building. Show the location of the well, septic tank and drain field. 4 ----=-----Show the location -of any -fake; river, stream or -pond -if applicable. - 5. Show the approximate location of other existing structures. 6. Show the approximate location of any wetlands or slopes over 20 percent. 7. Show dimensions in feet on the following: IMPORTANT DETAILED PLOT PLAN IS NECESSARY, FOLLOW STEPS 1-7 (a -o) COMPLETELY a. Building to all lot lines i. Privy to building b Building to centerline of road j. Privy to lake, river, stream or pond c. Building to lake, river, stream or pond k. Drain field to closest lot line d. Septic / holding tank to closest lot line I. Drain field to building e. Septic/holding tank to building m. Drain field to well f. Septic / holding tank to well n. Drain field to lake, river, stream or pond g. Septic / holding tank to lake, river, stream or pond o. Well to building h. Privy to closest lot line ,, Laure*. TuPY Submit To: Bayfield County Zoning Department, PO Box 58, Washburn, WI 54891 ,. = Notary Public �, Minnesota '"� • MyCcctmisslon Expires 0113112030 u/forms/sanitary/bayfieldcountysanitaryapplication Revise: June 2018 Proofed by: DOCUMENT NUMBER 2026R-613167 Document Number Ryan Tupy 15924 Xeon Street NW Andover, MN 55304 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 07/31/2026 AT 1:1 5 PM RECORDING FEE: $30.00 PAGES: 3 Recording Area Name and Return Address Bayfield County Planning and Zoning 04-036-2-49-09-01-1 01-000-10000 RECEIVED Eo AUG 032026 Bayfield Co. Planning and Zoning Agency THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE. This information must be completed by submitter: document title. name & return address, and PIN (if required). Other information such as the granting clause, legal description, etc., may be placed on this first page of the document or may be placed on additional pages of the document WRDA Rev. 12/22/2010 PRIVY AGREEMENT (ATTACHED TO THE SANITARY PERMIT APPLICATION) 1. NO PLUMBING will be installed in the habitable building. Return To: ZONING 2. NO PLUMBING includes: water closets, sinks, bathtubs or showers, laundry facilities, or any other fixture or receptacle receiving domestic waste, will be installed in the premises served by the privy unless a code compliant soil absorption system or holding tank exists, or a valid sanitary permit to install such a system has been issued. 3. A privy vault / pit shall maintain minimum setbacks as specified in Table 1. RFCEIVED Table 1 Well Building Lakeetl/t Additional County Setbacks StreaAUG OPEN PIT 50 Ft 15 Ft Min. 75 Ft 032026 Bayfield Co. SEALED VAULT 25 Ft. 15 Ft. Min. 75 Ft Planning and Zoning Ag 4. Privies for public buildings shall comply with SPS 353.63. ncy 5. Privies used for one- and two-family purposes shall be constructed in such a manner so as to exclude flies, rats and other vermin. Doors should be self -closing and vault ventilators should terminate at least one foot above the roof. 6. Privies as per SPS 391.12 (1) states as follows: (a.) The storage chamber of a vault privy shall conform with the requirements of s. SPS 384.25 relating to holding tanks and shall have a minimum storage capacity of 200 gallons or one cubic yard. (b.) The storage chamber of a pit privy shall be sited and located in soil recognized to provide treatment and dispersal in accordance with s. SPS 383.44 (4)(b). 7. The privy shall be kept clean and sanitary. The contents of the pit or vault shall be disposed in accordance with NR 113, Wis. Adm. Code. 8. This agreement shall be binding on the owner, their heirs and assignees. This document shall be recorded by the Register of Deeds in a manner, which allows its existence to be determined by reference to the property where the privy is installed. Printed Owner(s) Name(s) Owner(s) Signature: This instrument was signed before me in the State of Countyof On this day 20.(Q by: My commission expires on: Drafted ny. iL� (must be filled out by person submitting wrorms/sanilaryl 20 rivyrorm - er 19 Laure!r Tupy Notary Public ® December 2012 Minnesota My ColmJerbn F�Yes 0t/312030 . File Number: 226996 ADDENDUM/EXHIBIT A The Northeast Quarter of the Northeast Quarter (NE1/4-NE1/4), Section One (1), Township Forty-nine (49) North, Range Nine (9) West, Town of Orienta, Bayfield County, Wisconsin; EXCEPT a parcel in the Northeast Corner of the Northeast Quarter of the Northeast Quarter (NE1/4-NE1/4), Section One (1), Township Forty-nine (49) North, Range Nine (9) West, 32 rods long from East to West and 10 Rods in width from North to South. RECEIVED AUG 032026 Bayfield Co. Planning and Zoning Agency Bayfield County Register of Deeds Document #2022R-596886 Page 2 of 2 P---�YFIELD Bayfield County Planning & Zoning Department 117 E 5e, Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-4010 Property Owner: Submission Number: CS -00172 Transaction Number: CS -00172-4B490 Description Amount County Sanitary Permit: 1 $150.00 Total: $150.00 Payment Amount: $153.57 Reference: 4861809595 Paid by: Ryan Tupy Payment Type: Credit Card Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. Town, City, Village, State or Federal Permits May Also Be Required LAND USE - SANITARY - Composting Toilet SIGN - SPECIAL - CONDITIONAL - BOA - No. 26-0405 Tax ID: 25588 Issued To: TUPY, RYAN CHARLES Location: S01 - T49N - R09W Town of ORIENTA BAYFIELD COUNTY WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION Legal Description: E 1/2 N 1/2 NE LESS V.214 P.271 203 IN DOC 2022R-596886 Residential Structure in R-2 Zoning District For: Sanitation Permit — New [Composting Toilet] (Disclaimer): Any future expansions or development would require additional permitting. Condition(s): SUN -MAR EXCEL You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the department of natural resources wetlands identification web page or contact a department of natural resources service center (715) 685-2900. NOTE: This permit expires two years from date of issuance if the authorized construction Scott Roush, AZA work or land use has not begun. Authorized Issuing Official Changes in plans or specifications shall not be made without obtaining approval. This permit may be void or revoked if any of the application information is found to have been misrepresented, erroneous, or incomplete. August 07, 2026 This permit may be void or revoked if any performance conditions are not Date completed or if any prohibitory conditions are violated.