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HomeMy WebLinkAbout26-109Soe""TMw,� Industry Services Division 4822 Madison Yards Way Cowry qled Madison, WI 53705 Sanitary ermit ! m er (to be in by Co.) 1 J P.O. Box 7302 Madison, WI 5302 `& - /0 q 5 O —CJ Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental wit Project Address (if different than mailing address) q, I St_._t4' Ca02.40 _ . ^,.}'� . fl\otn U. 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 in accordance with the Privacy Law, s. I5.04(l)(m), Stats. I. Application Information — Please Print All Information Property Owner's Name Parcel # ENTERED 0��.s �fl.oj-&Do-/o6A Property Own 's Address Property Location 6 3Z 3t OO4 t.cat.Govt. Lot '/.. '/4, Section 2.2. T 44a N R E or® City, Sta�tten Y• uy_61n. µyy Zip Code gs� Phone Number Ics' !. U. Type of Building (check all that apply) MI or 2 Family Dwelling — Number ofBedrooms Lot # Subdivision Name ❑ Public/Commercial — Describe Use Block # O Cityof ❑ State Owned —Describe Use r age wn of CSM Number III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line Cif applicable.) A. New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design gn 0 Other Type (explain) (conventional) C. ❑ Renewal Before ❑ 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 (sf) I Dispersal Area Proposed (sf) I System Elevation �bo es I Ito I$ o j . S Tank Information Capacity in Gallons Total Gallons # of Units Manufacturer t 6 U d $ in to in ii: U P. New Tanks I Existing Tanks Septic or Holding Tank jco I Woo 2 V , 11111 11111 Dosing Chamber ___ V. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) I Plumber's SiI MP/MPRS Number I Business Phone Number GAF ts- ?-oa29 Plumber's A mess (Street, ity, State, Zip Code) 31S oG VI. County/Department Use Only ❑ Approved O Disapproved ❑ Owner GivenReason for Denial PermitFee $ D to Iss ed Issuing Agent Signature Conditions of Approval/Reasons for Disapproval VZ'c RECEIVED Cb _ AUG 1 1 2026 Bayfield Co. Planning and Zoning Agency Attach to complete plans for the system and submit to the County only on paper not less than 81/2x 11 Inches in size SBD-6398 (It 02/22) SR- o�H�9 SOIL ,.,PAST„ry '� Wisconsin Department of Safety and Professional Services 0 '1 Division of Industry Services s�= SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). TEST #/13-�P ge1 of5 Reviewed by Date 8/1/26 rapeny owner r -CL-I Li Vernon Property Location Govt. Lot SWy. SE 14522 T 46 N R 5 E (or) W roperty Owner's Mailing Address Site Address or CSM and Lot #: 60240 Stuart Road, Mason WI 60240 Stuart Road, Mason, WI City State Zip Code Phone Number U City U Village NJ Town Nearest Road Stuart ( ) Kelly Stuart © NewConstruction Use: © Residential/Numberofbedrooms 4 Code derived designflow rate 600 GPD ❑ Replacement ❑ Public or commercial —Describe: Flood Plan elevation if applicable NA It. CHI Parent material Glacial Lacustrine g/ld.R�D6 General comments and recommendations: BM is 100' at base pf Steal T post Painted Orange System Elevation range from9l if located near B3 or 95.25 If located near BI and 62 El Boring # ❑ Boring ®Pit Ground surface elev. 101.25 ft. Depth to limiting factor 120 in. / elev._91.25 8. SoilAonilcation Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' •Eff#1 •Eff#2 ] -12 10yr3/1' is JVFS SG AL s F 4 6 12-29 yr3/2 Ia S SG AL A .5 1.0 3 9-00 .5yr4/4 IC MPR AVFI JA .2 3 0-120 5yr4/4 vfs ISO AL JA 4 6 112026 Boring # ❑Boring Bayfield Co. 2 ®Pit Ground surface elev. 101.25 ft. P anniny p{h 1p.gtrWhWMctor 120 in. / elev._91.25 4. Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPD/Ft' •Eff#1 •Eff#2 1 -12 I0YR3/1 LVFS SG L S F 4 6 12-54 .5YR3/4 31C !MPR 1VFI JA 2 3 4-120 .5YR4/4 yES SG A .4 6 CST Name (Please Print) Signature ln,.• CST Number Calvin Rowley l SP -072400025 Address Date Evaluation Conducted Telephone Number 69710 Island Blvd, Iron River, WI 54847 7/27/26 715-979-1042 Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 s 150 mg/L • Effluent #2 = BOD, 30 mg/L and TSS s 30 mg/L SBD-8330 (R04/21) Paget of5 ❑ Boring fIIJ Boring # ® Pit Ground surface elev. 96.334 ft. Depth to limiting factor 120 in. / elev.-86.334 ft. Soil Application 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 1 -1G 5YR3/3 ..VFS SG ilL CS F 4 6 16-60 .5YR4/4 A VFS SG ilL W A 4 6 3 0-120 .5YR4/4 4A S SG ilL A .4 .6 LIII Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Application 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 JG 112)26 Plan yne o Cc ingand_Zonin 'Agency LIII Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Application 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 * Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 = BOD, S 30 mg/L and TSS 5 30 mg/L Bayfield County, WI S 1 ,:..�' yy�.4`_ vKAL R. 1pj/ I1 �� ly`itlL 1 Q4• * � i li 1{1x If ,,{4' ty'rb6 1 (, i; iil' aj 14 Kry, Irf h 1 L1 r '. 7 t ♦} t00s �1 , a Piv • 1; 1 '1a IL 1 ,_� ! R 1._.' ,� "'t , J I• I I lea I t 1 •• j 4 i..I 6(7/2026, 9:43:45 AM Approximate Parcel Boundary Section Lines 0 Municipal Boundary Building Footprint 2009-2015 New W >A .2 I. 1:500 No property line setback issues. 0 30 60 12011 10 20 40m bayfield9ls.SDE.T_Kelly North AUG 1 YCL.: e'nl`a IndexCo T 12026 Intermediate I BaWeld Planning and Zing Agency edynaa county Inm a.�ra otwnn»M nlrodmmo� b.yrodoounmwso.re,yre1dwAe, Bayfield County, WI 8/7/2026, 9:43:45 AM Approximate Parcel Boundary 0 Section Lines Municipal Boundary bayfield_gIs.SDE.T Kelly Building Footprint 2009-2015 Index New Intermediate tCo AUG 112026 Plannin Sayfield Co. 9 and ZoningAgenc, 1:500 0 30 60 120ft 0 10 20 4 9aylew BaYllald County Land Ruwda oacadaem MWl/maaabayfia'dramrywtgovIayfS tr RECEIVED GSF WI IN -GROUND DESIGN PROGRAM AUG 1 1 2026 INDEX AND TITLE PAGE Bayfield Co. Planning and Zoning Agency Project Name: Vernon Owner's Name: Tyler and Molly Vernon Owner's Address: 7 (,AMA QG( / rr cn, tar G,o24o Shad i Ncgsn kll Legal Description: S22 T 46N SW SE Sub] to E V.642 P.411 485 In Doc 2025R-606201 Township: Kelly County: Bayfield Subdivision Name: Lot Number: Block Number: Parcel l.D. Number: 21332 2111 - Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 GSF system views Page 4 Lateral and dose tank Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Designer: Date: License Number: (o p Phone Number: Designed Pursuant to the GSF In -Ground Component Manual (N. 11/19), and SSWMP Publication 9.6 Design Pressure Distribution Networks for STSAS (01/81) GSF In -Ground Version 3.1 Page 1 of 8 GSF WI IN -GROUND DESIGN PROGRAM DATA ENTRY Site Information R Residential or Commercial Design 900 Design Flow (gpd) 0.5 In -Situ Soil Application Rate (gpd/ft2) Trench Information B43 Unit Used 10 Cell Width (ft) 3. 4. 5.6. 8, 9 or 10 __________Additional Units per Row or Trench Number of Bedrooms (optional) Original Grade EFF #2 181 1= Length (ft) Are the laterals the highest point in the distribution Distribution Information network? Enter Y or N Center, End, No Manifold (Pump to Gravity), or Gravity (No Pump) Lateral Spacing If N above, enter the elevation ft Number of Laterals of the highest point. Orifice Diameter (in) (e.g. 0.25) Estimated Orifice Spacing (ft) = Oftr/orifice Forcemain Diameter (In) Forcemain Length (ft) Does the forcernain drain back? 0 Inside Pump Tank Elevation (ft) System Head (ft) x 1.3 Vertical Lift (ft) Friction Loss (ft) Add l Fitting Friction Loss (ft) Total Dynamic Head (ft) Lateral Diameter Selection in. diam. options choice 0.75 1.00 1.25 1.50 2.00 3.00 Septic Tank Information 2100/1000 Septic Tank Capacity (gal) )Superior Precast IMfg. Manufacturer Dose Tank Information Dose Tank Capacity (gal) Dose Tank Volume alAn) Mfg. Forcemain Drainback (gal) 5x Void Volume (gal) Minimum Dose Volume (gal) System Demand (gpm) Manifold Diameter Selection In. dia. options choice 1.25 1.50 2.00 3.00 Gallons/Inch Calculator Total Tank Capacity (gal) Total Working Liquid Depth (in) gagin Effluent Filter Information Polylok Filter Manufacturer PL -122 Filter Model Number Project: Vernon Page 2 of 8 I RECEIVED AUG 1 1 2026 Bayfield Co. Planning and Zoning Agency GSF WI IN -GROUND DESIGN PROGRAM GSF IN -GROUND DRAWINGS Plan View 2 cells each 10x91 In -Ground Component Dimensions A 10.00 ft B®ft D 0.50 ft F 7.00 in H 1.00 ft Excavation Depth 2.08 ft From Grade I_1810.001(R2) Basal Area Available Finished Grade Lateral Invert Elevation Dispersal Cell Elevation Bottom of Excavation Typical Cross Section Trench View tiCi . - ��mravne SOIEATtl£ *1 993 843 �_CBnEItW 03i 6EM1W ml uMo wo Into see BorTW CF `—FYN'MTAI Typical Dispersal Cell rn See Page 5 0 � 2 It Geotexlile o Fabric —► A .W F a 00 0.5 ft + A A See details on page 4 for number, size and spacing of laterals. Laterals are located In the 4" gravity distribution pipes as shown on page 5. Project: Vernon Page 3 of 8 RECEIVED AUG 112026 Hayfield Co. Planning and Zoning Agency ul6lu NO TN*( f Wfi96CMl® S/iFFPT Fl55NG YBCCIIYItCfl1 PIPE 51RBUTO'IBG% VNTm PIEsaEO PFf ��� GGFSULYE I.MKeca W latml YYnp5Yamtla N YIMleiMlpl 50.01 P h Y1mItMo mltahi9151 5.00 It Ianlllw'R%e pn SYvaam MRa¢ dm RECEIVED AUG 1 1 2026 Bayfield Co. Planning and Zoning Agency Pct V✓nm PY.a. OSf WI PLRWRO OlS MPRO A o5TR®UfgN MEOW 4Y q[Nnulim Rll WJIR apW Qio huwmn rypEiii5dtW.NISLIWIZWI O4Nullu Call 4uaiwkn Rm nwn4 OM 4PMM 6yNN le—M1w. fOR V.LL ABi3 Eli RSM 61LrvUMwM5aM m 4I MMuk II D= nmw lamtYKJ a Tunyp EPlwel dtlrbunun fall flan vwv' IapN-Typical Ii -Rrn l.RpW.RIRI 43 IWnN ®NWMaJP1Rays b4l frysalMyds.ys,qaas Punplo Snryypyan ux apPMal. eaNvaMn WIm W 5d. RECEIVED AUG 1 1 2026 Bayfield Co. Planning and Zoning Agency each aPna Pp Rids GSF WI IN -GROUND DESIGN PROGRAM SYSTEM MAINTENANCE SPECIFICATIONS System Maintenance and Operation Specifications Service Provider's Name Phone POWTS Regulator's Name Bayfield Cou yZoning Phone 715-373-6134 System Flow and Load Parameters Design Flow - Peak 900 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average fi0Ogpd Maximum BODS 30 mg/L Septic Tank Capacity 2100/10 gal Maximum TSS 30 mg/L Soil Absorption Component Size 1810 ft' Maximum FOG 10 mg/I. Maximum Fecal Coliform 10E4 cfu/100 mL Service Frequency Septic and Pump Tanl Effluent Filter Pump and Control! Alarm Pressure System In -Ground System Other Inspect and/or service once every 3 years Should inspect and dean at least once every 3 years Test once every 3 years Should test monthly Laterals should be flushed and pressure tested every 1.5 years Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards RECEIVED AUG 1 1 2026 Bayfield Co. Planning and Zoning Agency 1. Observation pipes are slotted and materials conform to the standards, have a watertight cap, and are secured in a as shown in the Eljen In -Ground component manual. 2. Dispersal cell media conforms to EIJen products approved for use with the most recent Eljen In -Ground Component Manual. Ellen media Is covered with the manufacturer's geotextlle fabric. 3. All gravity and pressure piping materials conform the requirements in the state code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The system structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail 6-& DIAMETER LAWN SPRINKLER FINISHED GRADE — — — — — \ — a LATERALENDS AT LAST 4"PERFORATED PIPE CLEANOLT PLUG ORIFICE WHERE VARIABLE 4" END r— J—ILJJF—� LENGTH CLEANOUT BEGINS CAP LONG 5WEGR EE OR TWO 45 DEGREE BENDS a. Project: Vernon Page 6 of 8 SUPERIOR I 2100 1 -Compartment Tank 'SUPERIPRECASTCOIItOR TOP VIEW Weight tin lb s) Tank.:9,4:7 Lad:,d;789 Total: 16.216; l olmne of Concrete Total': 41 Yd' Gallons Per Inch: 46.8 WaL Enlarged Detail 24" SIDE VIEW 2S" Cone;rennur ,,F S O Air Space I - --- I APPROVED d^ 2 d DEPT. F SAFETY ROFESSIONAL SERVICES I{ - DIVISION OF INDUSTRY SERVICES 1 I 45., 1 6r O 4$" SEE CORRESPONDENCE III I I Manhale Openings. J C 3 raper Produced by Superior Precast Concrete, LLC PO Box 1390 Hayward, WI 54843 Itclene a Baf 1e . SUPERIOR PRECAST CONCRETE Design conforms to ASTM C1227, Specification for Precast Elastic Concrete Septic Tanks and WI SPS 384:25, POWTS Holding Rope Components or Treatment Components. The information provided on any Superior Precast Concrete (SPC) drawing or document shall be verified by the purchasers licensed professional engineer for suitability of use. Configuration may change from drawing, consult with SPC. I Product FIle No: I This IS proprietary mtormaron, and remains the property of Superior Precast Concrete, LC. P.J 05-19-20241 O SUPERIOR I 1,000 1 -Compartment Tank SUPERIOR PRECAST CONCRETE PRECAST CONCRETE TOP VIEW ►I`eieht fin lbs) Tank: m,83: Lid: 3,683 Total: 9.493 S3 -1t2" -`' t'oiof Concrete RECEIVED Total : 3,4 I d' Gallons Per Inch::4.4 AUG 112076 Bayfield Co. 73" 79'' Planning and Zoning Agency I I lair r•_u.._. tin SIDE VIEW ConC; APP DEPT. OF SAFETY 5ER DIVISION OF INO 'm SEE CORRE R V6E5 =s° Fularged Detail I? IIPImny �° e� A1ET OVED �u 9" fist Spaces ND PROFE5510NA1 ti1l2L US'�TR-YvS/E_RVICES S �—•-1 ""`✓ 47e 60n 471'45" 5PONDENLE 7 1-- I [anhole Opeuiags __1 [ A Tager Produced by Superior Precast Concrete, LLC PO Box 1390 Hayward, WI 54843 hyiene r Baffle SUPERIOR PRECAST CONCRETE Design conrorms to AS I M U122/, Specification for Mastic Precast Concrete Septic Tanks and WI SPS 384.25, Rope POWTS Holding Components or Treatment Components. The information provided on any Superior Precast Concrete (SPC) drawing or document shall be verified by the purchasers licensed professional engineerfor suitability of use. Configuration may change from drawing, consult with SPC. IPtoduct File No: I This is pmpnetary Information, and remains the propeM of Superior Precast Concrete, ILL. I 8.305-19-20241 Bayfield County, WI Superior Precast 1000 gal Polylok PL -122 Superior Pr st 2100 Gal ≤-q°Pt/G �tatJ tract All 2-10'x91' B43 Eljen Cells Center feed 3cell separation 8/7/2026, 9:43:45 AM O Approximate Parcel Boundary No property line setback issues Section Lines All piping to comply with SPS 384 Municipal Boundary bayfeldjis.SDE.T_Kelly Building Footprint 2009-2015 Index New Intermediate 1:500 CENED RE 0 30 60 ion 0 10 20 40 m AUG 112026 North Bgftw DiiYfi01d anti pionnino ana ,zgn,ing „� aeyfip Cowlr R Dapm M h"JM P.bayfieWm nryxoi.g ffiaybtlMW TOWN OF KELLY TREASURER LORRI MATTES 60050 ROY ANDERSON RD MASON WI 54856 Phone: (715) 718-1638 E -Mail: lmattesl@live.com CALEB & LAURA WALKER 925 18TH AVE CUMBERLAND WI 54829 STATE OF WISCONSIN - BAYFIELD COUNTY REAL ESTATE PROPERTY TAX BILL FOR 2025 Please include self-addressed, stamped envelope for return receipt. Please inform your treasurer of any billing address chances. CALEB & LAURA WALKER TOWN OF KELLY PAYMENTS should reference: Tax ID: 21332 DOCUMENT RECORDING, or anything Else should reference: PIN: 04-026-2.46-05-22-4 03-000-10000 Alternate/Legacy ID: 026-1046-10 000 Ownership: CALEB & LAURA WALKER Important: Be sure this covers your property. Note that this description is for tax bills only and may not be a full legal description. See reverse side for important information. Property Description / Location of PropeE! r. Site Address: 60240 STUART RD Description: Sec 22 Tn 46 Rg 05 SW SE SUB] TO E V.642 P.411 485 IN DOC 2025R-606201 Acreage: 40.000 Document! 7n7Sg-6n67n1 Assessed Value Average Net Assessed Value Real Estate Tax: 1,610.42 Lan Improved Total Assessment Ratio Rate First Dollar Credit: -27.81 (Does NOT reflect lottery Lottery Credit: -0.00 $11,000 $88,100 $99,100 0.65085 or first dollar credit) Net Real Estate Tax: 1,582.61 0.016250386 Total Due: 1,582.61 Estimated Fair Market Value An "X" means unpaid School taxes reduced by Idad ImpJQy IQt1.prior year taxes. school levy tax credit. For payment in full See Reverse $154.37 Pay to TOWN OF KELLY TREASURER by (Use Value Assessment) January 31, 2026 Estimated State Aids Sb Tax Allocated Tax District Net Tax Change Warning Taxinci Jurisdiction COUNTY 2024 2025 024 2025 If not paid by due dates, installment 1 9,116 9,120 1 458.79 533.30 16.2 TOWN OF KELLY 181,031 191,403 665.59 725.91 9.1 option is lost and total tax is delinquent SCHL-DRUMMOND 4,540 4,631 304.89 316.17 3.7 and subject to interest and if applicable, TECHNICAL COLLEGE 29,413 31,470 32.09 35.04 9.2 penalty. (See reverse) Totals 234,100 246,624 1,461.36 1,610.42 10.2 First Dollar Credit 31.95 27.81 -13.0 Lottery & Gaming Credit 0.00 0.00 0.0 Net Property Tax 1,429.41 1,582.61 10.7 FOR INFORMATIONAL PURPOSES ONLY - Voter -Approved Temporary Tax Increases Total Total Addni Taxes Year Taxing Jurisdiction Addnl Taxes Applied to Property Increase Ends 6,464 11,135 75.24 129.61 2027 RECSCHL-DRUMMOND EIVED 2045 RECEIVED Pay 1st Installment Of: 791.31 Or Pay Full Payment Of: 1,582.61 by January 31, 2026 Amount enclosed: CALEB & LAURA WALKER Tax ID: 21332 (026) Make payment payable and mail to: TOWN OF KELLY TREASURER LORRI MATTES 60050 ROY ANDERSON RD MASON WI 54856 Include this stub with your payment AUG 112026 Pay 2nd Installment Of: 791.30 Bayfield Co. Planning and Zoning Agency by July 31, 2026 Amount enclosed: CALEB & LAURA WALKER Tax ID: 21332 (026) Make payment payable and mail to: BAYFIELD COUNTY TREASURER JENNA GALLIGAN PO BOX 397 WASHBURN WI 54891 Include this stub with your payment Or to Pay Online see Online/Credit Card Payments on back BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) NJ/C heck) ist LRf/Original Sanitary Application (Submitted in Deed Holder's Name — not prospective buyers) (383.21(1)1.) l Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) RECEIVED 1/Original Plot Plan (383.22(2)2. 3. & 4.a) AUG 1 1 2026 iW Cross -Section, Overhead Profile of the System and Schematic of Tank from Manufacturer Bayfield Co. EPump Tank Diagram, Alarm and Pump Curve (when applicable) Planning and Zoning Agency Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) Iv6Maintenance Agreement (Owner's Original Signature(s)) (383.21(2)(c)(6) (Recorded at Reg. of Deeds) E( Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) H ATU Servicing Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) 06 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 11 1 Complete Set of Plans (Note: Sanitary Application — Maintenance Agreement & Service Contract are to be included in the copy packet) f Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) llState Plan Review (when applicable) C� Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) I Application Information must include: E'(4 or 5 digit) Tax ID# -- (do not use 12 digits anymore --obsolete) IiProject Address or Road Name where driveway is/will come off of) L (Owners Phone Number) 0 II Type of Building VIII Type of Permit IV Type of POWTS System Vv Dispersal / Treatment Area Information ltd VI Tank Information II Responsibility Statement (Plumber's Information) *Date Stamp* Plot Plan: (To Scale or To Dimension) Signature and Plumber Information gSurface Elevation of Body of Water l/"Direction and Percent Land Slope R1 Tank and Filter Information and Location M'Wetlands / Navigable Bodies of Water Absorption Area (Proposed and Existing) I�J/Bench Mark (Location, Elevation and Description) l Component Manual Version ❑ Address Number and Road ❑ North Arrow ❑ Contour Lines O Structures and Driveways ❑ Boring Locations ❑ Property Lines ❑ Well Locations ❑ Legal Descriptions EM' Piping Material Information (conveyance line, building sewer line, material type and diameter) Turn Over ► Cross -Section and Overhead Profile of the System: E Surface and System Elevation Position of Observation and Vent Pipes Dimensions and Depths ErMake, Model & Number of Chamber Units in each Cell Property Information M How many systems will there be on this parcel of land? 0 IMIHas this property been split? N/A (Property Statement shows Property History) Fees: rfteCCiVED ❑ Private Sewage System (Septic Tanks) $ 400.00 AUG 1 1 2026 I$rivate Sewage System (Holding Tanks) $ 400.00 sayfield Co. ❑ Mounds or Systems requiring Pre -Treatment $ 500.00 planning and Zoning Agency ❑ Sanitary Revisions $ 25.00 ❑ Private Sewage System Reconnection $ 50.00 and Private Interceptor ❑ Return Inspection $ 50.00 ❑ Maintenance Agreements V $ 30.00 (check should be made out to Reg of Deeds) n (A full legal description is required at the Register of Deeds Office). If you have a legal description that states "parcel in or part of you must attach a copy of your deed showing the metes and bounds description in order to be recorded. Examples: located in part of Gov't Lot 4, Section 1, Township 23 N, Range 4 W, Town of Bayfield, described as a parcel in the NE 1/4 of the SE 1114, Section 1, Township 23 N, Range 4 W, Town of Bell u/forms/checkllsts/checklistforsanitaryapps (®8/5/2026) Private Sewage System Maintenance Agreement AS owner, I (We) do hereby certity the pnvate 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) of 1/4 Section Township _____N. Range S W. Additional Legal Description: 22 .. Town of K`e. (Acreage) gGov't Lot Lot _ Block Subdivision rc½1"a.C.ytc\ Lot _ CSM # Vol. _ Page _ CSM Doc # DOCUMENT NUMBER 2026R-61 3302 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED OS/1 1/2026 AT 10:44 AM RECORDING FEE: $30.00 PAGES: 2 Area Return To: RECEIVEDPlanning and Zoning Department AUG 12 2026 In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ 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, Wis. 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 -ground 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 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. The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such property. Owner(s) Name(s) — Please Print y1� V f u f\ S/Ia/a& lI Subscribed and sworn to berg KAMEgAE ZINNECKER Notary Public state of Wisconsin Notarized (Ownnner(s)—�Signature(s$ Note P is My Commis 'lo spires: :�1 a arJ�� Drafted byy Cyn w .. Date: X11 U 9 Proofed by: u/forms/sanitary/septicmaintenceagreement Revised July 2020 GOtA/CY Title Real Estate Closings V V C 1 I t Title Insurance File No. G-2606510 ADDENDUM/EXHIBIT A 885 W. Broadway Avenue Medford, WI 54451 www.goweytitle.com The North 660 feet of the West 660 feet of the Southwest Quarter of the Southeast Quarter (SW1/4-SE1/4), Section Twenty-two (22), Township Forty-six (46) North, Range Five (5) West, Town of Kelly, Bayfteld County, Wisconsin. Tax ID Number(s): 04-026-2-46-05-22-4 03-000-10000 (Parent) RECEIVED AUG 12 2026 Bayfield Co. Planning and Zoning Agency Bayfield County Register of Deeds Document #2026R-613191 Page 2 of 2 Bayfield County ]3L,AAFIELD Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: VERNON, TYLER 24360 LUND RD MASON, WI 54856 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00489 Transaction Number: SR-00489-4C43C Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 10556 Paid by: Brown Plumbing & Heating, 315 Sanborn Ave, Ste A, Ashland WI 54806 Payment Type: Check Transaction Date: 8/17/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. B-LYFIELD Bayfield County Planning & Zoning Department 117 E 5e, Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: Submission Number: VERNON, TYLER SS -00815 24360 LUND RD MASON, WI 54856 Transaction Number: SS-00815-4C43F Description Private Sewage System (Septic Tanks) Total: Payment Amount: Amount $400.00 $400.00 $400.00 Reference: 10556 Paid by: Brown Plumbing & Heating, 315 Sanborn Ave, Ste A, Ashland WI 54806 Payment Type: Check Transaction Date: 8/17/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-109S STATE SANITARY PERMIT OWNER: TYLER VERNON GOV'T LOT: LOT: BLK: K: 1/4 1/4 SEC: 22,146 N, R 5 W TOWNSHIP: Kelly SOIL TEST: 113-26 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: TONY BROWN SCOTT ROUSH Authorized Issuing Officer DATE: 1 1 2000 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: # 664303 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 1/1/2002 MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION