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Home My WebLink About26-118SI Industry Services Division County £� 4822 Madison Yards Way Bayfield Sanitary Permit Number (to be filled in by Co.) J (�s — O Madison, WI 53705 P.O. Box 7302 D Madison, WI 53707 J�y p — LIZ 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 Same purposes in accordance with the Privacy Law, s. 15.04(1 )(m), Seats. 1. Application Information — Please Print All Information Property Owner's Name TERED Daniel & Holly Green Parcel # 2374 AUG 18 2026 $Ejg d Property Owner's Mailing Address Property Location tl o. 1610 Lower Lake Rd. Planning and 9 Zoning nden A0 Govt. Lot City, State Zip Code Phone Number Barnes, WI 54873 815-543-3261 ¼, ¼, Section 30 T44 N R 09 E orW II. Type of Building (check all that apply) Lot # ❑✓ I or 2 Family Dwelling —Number of Bedrooms 3 Subdivision Name DBlock ublic/Commercial —Describe Use # City of State Owned —Describe Use Villageof CSMNumber �✓ Town of Barnes Ill. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i apnhicableJ A. lilNew System l., I-/ r-pceplacement System Other Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain) B. ❑Holding Tank ❑✓ In -Ground Lf`t-Grade ❑Mound Individual Site Design Other Type (explain) (conventional) C. ❑ Renewal Before ❑Revision Change of Plumber ❑Transfer to New Owner 1st Previous Permit Number and Date Issued Expiration 327271 6.22.99 IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (st) I Dispersal Area Proposed (sf) I System Elevation 450 0.7 1642 664 96.0 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units c o '0, New Tanks Existing Tanks u u d m 2 aV in iU septic orHolding Tank 1000 1000 1 Huffcut ✓ Dosing Chamber 600 600 1 Huffcut ✓ Q Q V. Responsibility Statement- I. the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Jason Kuettel I 675751 715-798-3355 Plumber's Address (Street, City, State, Zip Code) PO Box 66 Cable, WI 54821 V County/Department Use Only Approved I ❑ Disapproved Permit Fee Date Issue Issuing A t Si lure ❑ Owner Given Reason for Denial ab ,� Conditions of Approval/Reasons forDisapproval /� /��p• sc'c _ a " `.a c4 e4 e4 !G4 Attach to complete plans for the system and submit to the County only on paper not less than a 1/r x II inches in size SBD-6398 (R. 02/22) SR-oor9S 4j Wisconsin Department of Safety and ProfessionalServises Attach complete site plan on paper not less than 8'h X 11 Soil Evaluation ReportOL TEST # in accordance with SPS 386 , IMs.Adm Coda inches in size. Page: 1 of 6 Plan must include but not limited to: Vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, 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)). County: Bayfield Parcel I.D. 2374 R vi a Date: / 7 Property Owner Dan & Holly Green Property Location S30,T44N,R09W Property Owners Mailing Address: PO Box 104 Site Address or CSM and Lot # 1610 Lower Lake Road City Hayward IState I I IZip Code 54843 Phone Number. 0 Town Barnes Nearest Road: Lower Lake Road Number of Bedrooms: 3 r New IResidential Code derived design flow rate: 450 Flood Plain if applicable , it : --- (� Replacement r Public or Commercial - Descrbe: �-�L. 1 E:m �* Parent Material: Outwash Flood Plain if Applicable: 77 AUG 18 20?6 Bayfield Co General Comments & Recommendations: Planning and Zor.i ., System Elevation: 96 Load Rate: 07 . Ground surface Elev: Depth to Limiting Factor: Boring #1 r Borl✓ Pit 99.3 Ft. 110 in. Elev. 90.13 ft Soil Application Rate: Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 0-4 7.5YR2.5/3 N/A SL 2MSBK MFR CS 3F 0.6 1.0 2 4-28 7.5YR4/6 N/A LS 0SG ML CS 3M 0.7 1.6 3 28-110 7.5YR5/2 N/A MS 0SG ML N/A 1M 0.7 1.6 4 5 6 7 Boring # 2 l- Bor. �. pit Ground surface Elev: Depth to Limiting Factor: � 102 Ft. 115 in. Elev. 92.42. ft Soil Application Rate: Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 0-4 7.5YR2.5/3 N/A SL 2MSBK MFR CS 3F 0.6 9_0 2 4-30 7.5YR4/6 N/A LS 0SG ML CS 3M 0.7 1.6 3 30-115 7.5YR5/2 N/A MS 0SG ML N/A IM 0.7 9_6 4 5 6 7 *Effluent #1 = BOD 5>30< 2 20 mg/l a TS 0 < 150mg/l *Efflu nt #2= BOD 5< 30 mg/1 and TSS < 30 mg/l CST Name (Please Print) Mark S. Thompson Sa Dat va onducted: uesday, ug , 2026 CST Number: 877598 Address: 12006 N US Hwy 63 Hayward, WI 54843 Telephone Number 715/699-4081 SBD-8330 (R04/21) Property Owner: Dan & Holly Green Parcel I.D. 2374 Page: 2 of 6 Boring # 3 Bor v Pit Ground surface Elev: Depth to Limiting Factor: r- 99.07 Ft. 118 in. Elev. 89.24 ft Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 0-8 7.5YR2.5/3 N/A SL 2MSBK MFR CS 3F 0.6 1.0 2 8-36 7.5YR4/6 N/A LS OSG ML CS 3M 3 36-118 7.5YR5/2 N/A MS OSG ML N/A IM 4 5 6 7 Boring # 4 ' Ground surface Elev: Depth to Limiting Factor: r" BorryPitt 0 Ft. 0 In. Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 2 3 4 5 6 7 Boring # 5 r" Borr Pit Ground surface Elev: Depth to Limiting Factor: 0 Ft. 0 In. Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 -� 2 ID 3 4 5 Planning a )d Zoning q en 6 7 Boring # 6 r Bor r Pit Ground surface Elev: Depth to Limiting Factor: 0 Ft. 0 In. Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ftz *Eff#1 Eff#2 1 2 3 4 5 6 7 *Effluent #1= BOD 5>30 < 2 20 mg4 and TSS>30 < 150mg/1 *Effluent #2= BOD 5< 30 mg11 and TSS < 30 mg17 The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777 SBD.833O(R.o7/OO) Soil Profile Sheet Page: 3 of 6 Owner: Dan & Holly Green Soil Tester: Mark S. Thom System Elevation: 96 Load Rate: 0.7 System Elevation: 95.42 To 96.07 103 92 103 Al 102 -------------- ---- - 102 102 101 --------------- 101 --------------- 100 --------------- --------------- 9±2 100 ---------------- --------89±5 99 — 0±2 99 99 98 --------------- --------------- 98 -------------- 97 --------------- --------------- 97 96 --------------- -------------- 96 96.97 ------------- 95 ---------------99.42 95 94 --------------- --------------- 94 --------------- --------------- --------------- 93 --------------- 93 --------------- 93.13 92 --------------- 92,.42 92 --------------- L.E± --------------- T 91 --------------- 91 90 -------------- 90 --------------- 90.13 89 --------------- 89 --------------- 88 --------------- 88 --------------- 87 --------------- --------------- 87 --------------- 86 --------------- --------------- 86 --------------- 85 --------------- 84 ----------- ---- 84 83 --------------- --------------- 82 --------------- 82 --------------- 81 ---------------81 --------------- 103 83 102 101 --------------- System --------------- Elevation 100 99 ------------- 99.07 98 4,Z 97 !�Z 9±Z 96 ---------------90±02 $ 95 ------------- 94 93 92 --------------- 92.24 91 --------------- 90 --------------- 89 --------------- 89.24 88 --------------- 87 86 85 --------------- 84 -------------- ------ AUG 18 2026 83 --------------- �� Bayfield CO. --------------- Planning and Z& Agecy 82 --------------- 81 --------------- Owner Information: Name: DanDan&HolLypreen Location: S30.T44N R0SW Township: Barnes County: Bayfield Address: 1810 ow r ak Ro-d Well 82 BM 61 1"= 40Onlyin Tested Area LA @ 88.5 AUG 18 2026 BM=100: Nail wfri000n on the base of tree par el B3 Bayfield Co. planning and Zoning Agency CST: Mark 5 Thompson B1= 99.3 B2= 102 B3= 99.07 Lake= 22 PAGE 1 OF 5 In -Ground Dosed -Gravity Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10705-P (N.01/01, R. 10/12) Pg 1 of 5 Index & Cover Sheet Pg 2 of 5 Plot Plan Pg 3 of 5 Dispersal Area Cross -Section &,.P2Jan..\iQw. JkEi Pg 4 of 5 Pump Tank Specifications Pg 5 of 5 Management Plan AUG 18 2026 hayfield Co. Planning and Zoning Agency Attachments: Enclosures: Pump Curve POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Daniel &Holly Green - 3 Bedroom Drainfield Only Owner Name(s): Daniel & Holly Green Owner Address: 1610 Lower Lake Rd. Barnes, WI Project Address: Same Govt. Lot: Township: Barnes Project Parcel ID #: 2374 1/4 of Phone: 815 543 3261 Zip: 54873 1/4, Section 30 T 44 N -R 09 E for w1 County: Bayfield Designer Information Designer Name: Jason Kuettel Phone: 715 _798 -3355 Designer Address: PO Box 66 Cable, WI Zip: 54847 E-mail: Jason@andryras.com This space reserved for approval stamp. License Number: 675751 Remarks: Signature: Date: 8/ ___ Original sig ature required on each submitted copy. Owner lntorm Name: Dan & Holly re@0 Location: Township: Barnes County: Bayfield Address: 1610 Lower Lake Road Co N Co U Wu 1"= 40Only in TestedArea LA BM=100: Nail w/ribbon on the base of tree near 81 Well s 1000/400 ,}1 rrtv'f- isting Tank @ 88.5 To R@'MA1t' B3 UUUU M 3y' cl.Avc- k c c 4 a s Bhi BI 81= 89,3 B2= 102 B3= 99,47 Lake= 77 16 RECEIVED AUG 282026 Bayfield Co. Planning and Zoning Agency IN -GROUND DOSED -GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER z° mi. trench depth F;ECEIVEDrop�o AUG 18 2026 yfieid C0 Planning and Zoning Agency ly al) ( TYPICAL TRENCH bPical) CROSS SECTION VIEW (No Scale) 1• . System Elevation = 96.0 ft (typical) Quick4 Standard -W w/ End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) r- ----------77--------f---- L------------1-------7�--- B= 34 ft (typical) INSTALL PER TRENCH: 8 Quick4 Std -W @ 20 ft EISA/chamber = 160 ft2 + 1 Pairs of end caps @6 ft2 EISA/pair = 6 ft' = Proposed EISA per trench = 166 ft2 Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturers / Instructions. TYPICAL TRENCH PLAN VIEW (No Scale) I A=3.0ft (typical) `Quick4 Standard -W Chamber (typical) (mfd by Infiltrator System¢, Inc.) Install pursuant to manufacturer's instructions. Required Infiltration Area = 642 ft2 Distribution Method: x 4 trenches = Proposed Total EISA = 664 ft2 branched manifold ^D Il J m w O n O1 PAGE 5 OF 6 SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) 4"0 Vent Pipe 108 from Building Electrical must comply with 12" Min. or 2.0 ft above BPS 316 and NEC 300 Established Flood Elevation Weatherproof Extend manhole riser as necessary. (typical) Junction Box Approved Approved Locking Manhole IMPORTANT: Vent Cep with Warning Label Attached (typical) Anchor tank(s) as necessary —Conduit pursuant to SPS 383.43(8)(g) 4' Min. or 2.0It above Established Flood Elevation (typical) �AlNahl Seal ,I/ �I Finished Grade Quick Disconnect 1B" Min. CAPACITIES@ 14 gaUn �. (typical) Depth (in) Volume (gal) a l A 26 364 'k Weep ApAproved ipJe3 with B 2.0 38 A Hole Appr Solid Ground onto (typical)[C] 7 98 _Alarm D 8 112 B.on IA *Pump Tank Liquid Level = 43 in Force Main Diameter= 2 in PUMP -OFF Pump -Off ELEVATION = 83 ft concrete INSIDE BOTTOM Block ELEVATION = 82 ft Force Main Length = 50 ft 3' Approved Bedding Matonsl Beneath Tank Force Main Void Volume = 8.15 gal AUG 18 2026 Vertical Head = 13 ft Bayfiel co. + Min. Supply Head = ft [C] Total Dose Volume (TDV) = 98.15 gal/doseningand z lingAgency L + FM Friction Loss = 1.65 ft (5X total lateral void volume ≤TDV <_0.2X design flow) + (force main drainback volume) `+ Fitting Loss' = ft (min. supply head x0.3) MIN. PUMP DISCHARGE RATE = 30 gpm = TOTAL DYNAMIC HEAD = 14.65 ft PUMP TANK: Volume = 600 gal Manufacturer: Existing Huffcut Pump Manufacturer. Existing to Remain Pump Model: Existing to Remain (See attached pump curve.) Controls/Alarm Manufacturer: Existing to Remain Controls/Alarm Model: Existing to Remain Float switches containing mercury are prohibited. SEPTIC TANK(S): Total Volume = 1000 gal Manufacturer(s): Install approved effluent filter at the septic tank outlet immediately upstream of the pump tank inlet. Filter Manufacturer: Existing to Remain Filter Model: Existing to REmain PAGE 4 OF 4 In -ground Dosed -Gravity Management Plan IMPORTANT: The owner of this in -ground dosed -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 = 450 gpd; BOD5 ≤ 220 mgL-1; TSS 5150 mgL-1; FOG 5 30 mgL-' Inspection Checklist INSPECT EVERY 3 YEARS o type of use R-LE(IVED o age of system o nuisance factors (i.e. odors, user complaints, etc.) AUG 18 2026 o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) Bayfield co. o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.Elf@ffl§thbbkfdl9'P nixes) 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 (113) 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 leaned 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: Andry Rasmussen & Sons Local government unit: Bayfield Co. Zoning Phone: 715-373-6138 Local government unit address: 117 E 5th St. Washburn, WI Phone: 715-798-3355 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 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 abandoned 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. F' Effluent and Sewage Pumpr 3/4" Solids Handling Effluent Puml This economical submersible effluent pump is • Replaceable automatic float switch designed for capable of handling 3/4' solids. It is manufac- years of trouble -free pumping cycles hired of durable thermoplastic, and is ideal for • Pump starts when depth is 13-1/2' and turns mound systems, leaching fields, effluent gravity off at 5-1/2" sewers, laundry facilities, underground parking, grain storage, and construction sites. • Model requires 18' minimum diameter sump pit or basin Features • 8 ft. UL grounded power cord • Bottom suction inlet — 2' discharge • Easy disassembly after extended service • Durable thermoplastic construction ar war • Multi -vane fiberglass reinforced Vortex HP L1 \ impeller - �— Model SE2800A • 1/3HP-115 volt oil -filled motor with auto- matic overload protection a Ions per hour Performance Discharge Feet of Head 5 10 15 20 25 29 Performance GaVHour 3060 2400 192 1380 720 0 • • • • • • • • • • O • • • • • 2" Solids Handling Economy Sewage This economical submersible sewage pump is • Replaceable automatic float switch designed capable of handling 2' solids. It is manufactured for years of trouble -free pu,ping c cles__ of durable thermoplastic, and is ideal for base- • pump starts when dept�iot�itian ment installations/pumping below -grade toilet, off at 5-1/2' laundry facilities, underground parking, grain storage and construction sites. • Model requires 18°minAtOdi*I8tQ2p pit or basin Features ay • 8 ft. UL grounded ,)hfiZonCo.ingAgency • Bottom suction inlet —2' discharge • Easy disassembly after extended service • Durable thermoplastic construction • One year warranty • Multi -vane fiberglass reinforced Vortex 4/10 HP impeller • 4/10 HP -115 volt oil -filled motor with auto- Model SE3200A matic overload protection • Pumps to 4,320 gallons per hour I Performance Discharge Feet of Head 5 10 15 16 Performance GaVHour 3780 2280 720 0 Ordering Information Catalog Number UPC Number HP Construction Description Carton Dimensions Lx W x H (In.) Ship Wt. (Ibs.) FPSE2800A 0 2231510202 6 1/3 Thermoplastic Effluent Pump 10-1/8 x 7-1/8 x 16-1/4 15 FPSE3200A 022315102019 4/10 Thermoplastic Sewage Pump 10-1/8 x 7-1/8 x 16-1/4 15 • • • • • • • • • • • • • • • • • • .SS - o01IN Private Sewage System Maintenance Agreement DOCUMENT NUMBER 2026R-613397 Owners) Mailing Address DANIEL J. HEFFNER ^y "'��J ,r -r. (� REGISTER OF DEEDS "I Or yywN I'�r 1 7 BAYFIELD COUNTY, WI Site Address 1(nlo 6-t la'e 41 Wsosr 4 Sy873 RECORDED Tax ID # ;z37/08/18/2026 AT 2:48 PM RECORDING FEE: $30.00 As owner, I (we) do hereby certify the private sewage system will be installed in t PAGES: 1 accordance with the certified soil tester's report and approved plans and specifications RE: CE1 I� Yi on file with Bayfield County Planning and Zoning Department. The system will be Ev 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 _All" i_ A _ _ Adm. Code, as from time to time amended. (COMPLETE Legal is required) I �7 2026 1/4 of 1/4 Section go Township N. Range W. Bayfield Co, Planning and Zoning Age.., Recording Area Additional Legal Description: Se, 30 in SW go% Sag7/�6'Y [aI t� a0/pp'S p re turn To: Town of (Acreage) I eir kGov't L/orI1L_7 `(r Planning and Zoning Department Lot Block Subdivision Lot _ CSM # _ Vol. _ Page _ CSM Doc # _. ❑ 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 manufacturers 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 -tirade, 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 maybe 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 /1 / 6iee % �Peh % Subscribed and sworn to before me on this date: YaE �/�y Cow,t.. 0c- Snxr.teti N ed wner(s)—SI natur s) y c� Notary Public � My Commission Expires: 3 a Drafted by: i &'4Si Date: /O ac ≥�2 Beth Htft */(y CJ-fWP4 Notary Public Proofed by State of Wisvvmsimitary/ pticmaintenceagreement Revised July 2020 F I E L D 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: GREEN, DANIEL J & HOLLY J PO BOX 104 HAYWARD, WI 54843 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00495 Transaction Number: SR -00495-4D168 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 15153 Paid by: Andry Rasmussen & Sons, PO Box 66, Cable WI 54821 Payment Type: Check Transaction Date: 8/31/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. P YFIELD I E LD 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: GREEN, DANIEL J & HOLLY J PO BOX 104 HAYWARD, WI 54843 Description Private Sewage System (Septic Tanks) Submission Number: SS -00818 Transaction Number: SS-00818-4C5E8 Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 15153 Paid by: Andry Rasmussen & Sons, PO Box 66, Cable WI 54821 Payment Type: Check Transaction Date: 8/31/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-118S STATE SANITARY PERMIT OWNER: DANIEL J & HOLLY J GREEN GOVT LOT: LOT: 1 BLK: 1/4 1/4 SEC: 30, T 44 N, R 9 W TOWNSHIP: Barnes SOIL TEST: 122-26 REPLACEMENT SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: JASON KUETTEL TRACY POOLER Authorized Issuing Officer DATE: 8/31/2026 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 #: 327271 LICENSE: # MP 675751 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 8/31/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION