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Home My WebLink About26-119S>• "a `"rrI Industry Services Division County _ 4822 Madison Yards Way P I', 1 Madison, W153705 Sanitary Fermi tber (to be filled in by Co.) ,\ �� P.O. Box 7302 Madison, WI 5302 6 -119 S 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 obtaining 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 5.04(t)(m). Stats. I. Application Information -Please Print All Information Prop�ertytner' N e v !cl TAh1 F G parcel# owl-ol8-a-y7-o1-zs� 1 Props er's Mailing Address 'Js Property Location ' OoO ^Cl.0'o0 Govt. Lot Y. City, tale 1 Y,L ' ; p�JCo� c umla ,r—. 0sc� I >�ID' - L IVED Section T_N R P E or�— II. Type of Building (check all that apply) 1 or 2 Family Dwelling — Number ofBedraoms Subdivision Name Blo ❑ Public/Commercial— Describe Use ❑ City of ❑State Owned —Describe Use It�rgljjfQ{mj(� A9eo ' 0 Village of ❑ Town of Ili. Type of POWTS Permit: (Check either "New" or " lacement" and other applicable on line A. Check one box on line B. Complete line C if a Gcable. A. New System Repla inert System Other Modification to Existing System (explain) Additional Pretreatment Unit (explain) B. Holm Tank ,_ `` In -Ground (conventional) At -Grade Mound Individual Site Design Other Type (explain) C. Renewal Before Expiration Revision Change of Plumber Transfer to New Owner List Previous Permit Number nd ate Issued I5—//3 31/1/20/5 IV. Dis ersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required (aft I Dispersal Area Proposed (sf) I System Elevation Tank Information Capacity in Gallons Total Gallons is of Units Manufacturer Prefab7S,1,Sice1er Plasi Con c New Tanks Existing Tanks Crete/t Septic or Nolding Tank O O 0- IbD� W Dosing Chamber V. Responsibility Statement— 1 the undeni ed, assume responsibility for installation of the POWTS shown on the attached plans. Plu her's Name (Print) Plu r s ign tore MP/MPRS Number ukR mo n V;sue as 3s Business Phone Number 15 69 -0fi3 PlumbeAddresslb Sire rate, ode) ,(/�� tY� C L Q VI. Coon /De artment Use Only`+/1 pproved ❑ Disapproved Permit Fee D e 1s ued Issu' g A Si Lure 0 Owner Given Reason for Denial 6U— 3'7 .b c1yV,i- ,q'1773 Conditions of Approval/Reasons for Disapproval /% ` ,p •" ,...p.1.1 r'lnn' 'U' till system one suomn 10 me a.ounly only on paper not less than a so x ii inches in size SBD-6398 (R. 02/22) 0 TEST Wisconsin Department of Safety & Professional Services %. /D\ • Division of Industry Services SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code County Bayfield Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include. 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. 137690 Please print all information. ei b� yid SR- 00305 Page 1 of 2 Personal information you provide may be used for secondary purposes (t•nvacy law, s. lb.u4(rfim8. l f i Property Owner Property Location ❑ William Gallik Govt. Lot NE % NE Y,, S 25 T 47 N R 07 E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: 18925 US HWY 2 18925 US HWY 2 City, State. Zip Phone Number ❑ City ❑ Village ® Town Nearest Road Mason WI 54856 / 715 1746-2204 Keystone US HWY 2 ❑ New Construction Use: IN Residential/ Numberof bedrooms ® Replacement ❑ Public or commercial — Describe:, Parent material Glacial Till 3 General comments and recommendations: Water Is present at 15" below grade. Mound Design Required ❑1 Boring# ❑Boring S Pit Ground surface elev. 93.4 ft. Code derived designfow rate 450 00 GPD Flood Plan elevation if applicable ft. Depth to limiting factor 11 in.! elev. 92.55 ft. Anil ennl lirarinn Rato I Horizon Depth In. Dominant Color Munsell Redox Description Ou. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPO/FP •Eff#1 'Eff#2 1 6" 5YR 2.5/2 None SIL 2SBK mvfr as 3m .6 .8 2 4"-11" 10YR3/2 None SICL 1SBK mfr aw 2f .2 .3 3 11"-36" 2.5YR 4/4 c2d7.5YR6/3 6/3 C 0M mvfi - - 0 0 ❑2 Boring # ❑Boring ®Pit Ground surface elev. 92.7 ft. Depth to limiting factor 10 In. / elev.9187 ft. Snil Annlirafinn Rate Horizon Depth In. Dominant Color Munsell Redox Description Ou. Az. Cont. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPD/FP •Eff#1 'Eff#2 1 5" 5YR 2.5/2 None SIL 2SBK mvfr as 3m .6 .8 2 5"-10" 10YR 3/2 None SICL 1SBK mfr aw 2f .2 .3 3 10"-32" 2.5YR 414 c2d 7.5YR6/3 C OM mvfi - - 0 0 CST Name (Please Print) Signature CST Number Ronald McKuen Roxa2d Mc#&ca . 1553740 1111 q 'I 2025 Address Date Evaluation Conducted Telephone Number 17214 State Hwy 13 Butternut WI 54514 07/19/2025 (715) 661-3255 Co Planning end Zoning Agency Effluent #1 = BOO > 30 s 220 mg/L and TSS > 30 s 150 mg/L 'Effluent #2 = BOO. s 30 mg/L and TSS s 30 mg/L SBD-8330 (R03/22) Page 2 of 2 Boring # ❑ Boring ® Pit Ground surface elev. 93.9 ft. Depth to limiting factor 72 in. / elev. 92.9 ft. 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 1 5" 5YR 2.5/2 SIL 2SBK mvfr as 3m .6 .8 2 5'-12" 10YR3/2 SICL 1SBK mfr aw 2f .2 .3 3 12-32' 2.5YR 4/4 c2d 7.5YR6/3 C OM mvfi - - 0 0 FBoring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Anolicalion Pale 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. SoilAnolicalion Pate 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 s 220 mg/L and TSS > 30s 150 mg/L ' Effluent #2 = BOO. 5 30 mg/L and TSS 5 30 mg/L RECEIVED JUL 3 2025 Bayfield Co. Planning and Zoning Agency 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 Pg 3 of 4 Holding Tank Specifications Pg 4 of 4 Management Plan RECt=i-V-:G AUG 2/2026 Pbnni 8aYfiea C°' ng and Zoning Agency Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map (if ap Holding Tank Pumping Contract (if appF Holding Tank Agreement (if applicable) Project Name / Description plicable) cable) Owner Name(s): W Cl) Phone:1(S -/ / 1 -(135 Owner Address: I $ ¶S '3s \444. D- mocwv-.) \1 Zip: _$ Project Address: S }.MK. Govt. Lot: Township: Project Parcel ID #: OM— O". q ..` Lr? -Cl 45 "1 I 0 � Ott ca-toOQ '141 "90 (� Designer Information Designer Name: Y\ O Iii 3; SO Q �-QP one1h S -9-1_ Designer Address: �0 QSt$k. Samna (ML'' Zip: S 1 E-mail: VW) V sold CV t�9.4$3 . Gow r, This space reserved for approval stamp. License Number: '3t' 13Q Remarks: 1/4 of 1/4, Section -S ,T7 County: 07 E❑orW Signature: Date: 8 Z4 Original signature requ ed on each submitted copy. CHECK BOX AS APPLICABLE. ❑ SOIL EVALUATION SITE MAP PROJECT NAME: PROJECT ADDRESS: BM Symbol: .4 - BM Description: Slope Gradient (%) of Tested Area: _ SM Elevation'. CHECK BOX AS APPLICABLE. Scale: 1" = 20 ❑ SYSTEM PAGE 2 OF 0 20 30 40 PLOT PLAN LA jS0k3 ^y S0 DESIGN FLOW: GPO Attach design flow calculations for commercial plans. Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) Sanitary StaSewer: / FT Force Main: / Well Symbol ( if applicable): 0 Indicate north by IMPORTANT: drawing an arrow Show ground elevation contours at suitable intervals. on the approprite line. N S. o 1I s IXS us l6.a 5.1 D -feufry Iyy� fob'? item ei�a.iiaja 1 " a we 4 1S00._1100 ,3.AW-) JCetT4 SG 4b l33k1ac AUG L:f Zun Pig and d Co. P 15'-4" C so, C U 4" VENT INLET -- fl t° Li___ o' � a I M u� a 3 ' � I a i(1 TANKS ARE MANUFACTURED TO MEET WLP1800/1100 TANK SPECIFICATIONS DIMENSIONS: WALL• 3" BOTTOM: 5" COVER: 6" MANHOLE: 24* I.D. PRECAST CONCRETE RISER HEIGHT: 62 3/4" LENGTH: 15'-4" WIDTH: 8'-6" BELOW INLET: 50" LIQUID LEVEL 43" WEIGHT: BOTTOM 18,017 LBS. COVER 9,300 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL CASKET AND OUTLET BAFFLE AND FILTER: ICONSIN, SEE DETAIL #10 rHER STATES SEE CHART) *ID CAPACITY: 41.86 GALAN (SEPTIC) a 25.58 GAL/IN (PUMP) LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/SEPTIC, SEPTIC/PUMP, OR SEPTIC/SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE KEY NOTES: CONCRETE OR EZ-SNAP RISERS O OPTIONAL 2" OUTLET 16" UP FROM BOTTOM OF TANK REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: u 1 V OF /1 RECEIVED AUG 2:7 2026 HOLDING TANK — MANAGEMENT PLAN Bayfield co: Pw e nvMAeg 4{site 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/s9) and the Bayfield County Zoning Department Sanitary and Private Sewage Ordinance. Tl is POWTS has been designed to accommodate a maximum daily flow of �b 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. 5. Maintenance Cycle. The holding tank must be serviced by licensed pumpers. An alarm system is to be installed to activate when the tank is 5 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. 8. 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 Sectior Township P_RangPR_W. Town of_____________ Govt. Lot Lot Block Subdivision GSM# Additiona egal Description Property Owners Signature Date u/fomis/managementplan Revised: July 2013 Contract D 1 aate i i`t HOLDING TANK SERVICING CONTRACT This contract is made between the 0qC RECEIVE ,.-- AUG 2:12026 Bav5eld rn P1annug and ZonLno Holding Tank Owner(s) Name(s) Pumper's Name FCeANOF\ c IA/n on4nnurtarina the Inotnllnfinn of (o\ hnirfinn fanlr(c1 nn the fnanwinn nrnnrrty (Provide Ienai descrinnOnS :) PROJECT Legal Qescrlotion: (Use7ax statement( PI 04-[Ja �.—��y y..� /—O / SOn "/o00O LOCATION C1/ �� Rango� W Townof totslze A5rebe ^I/4;'T 1/A, of Section ,Township N; Gov't Lot Lot II CSM R V.I. Page tot(s) No. 'Block(s) No. Subdi ion: 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 t 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 event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local government unit and the County named above within (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed and sworn to me on this date: /Q y (te1 u .y1 a. t tt,,t,l ltrlrfr„/,, �, / �N <Sii f/ Co.( / �\ :``�' ecenibr J` oi6/ 7 OTA5 O�/• Today's Date 'mot M�-'-- Notary Public Signature Pumper's Name (Print) (� 'T7smcS PumQper' Sign _ * : •"�C//// 'Td/%%t1 \ S Raw t¼.- SepdLs anefLtt� ( ,u /' 2O/7 Number Pumper's Registration Commission Expiration ?1tII Revised: November2012 (Bayrield County Zoning) Drafted by Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)I ° (7 ;mss �;,,f ..��I�E� 1 =i- `i _______________________ Safety and Buildings Division 201 W. Washington Ave., P.Q. Bo Madison, WI 53707-7162 County Sanitary Pert «moor (to be oiled in by Co.) )51IS 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 obtaining a sanitary permit. Note: Application forms for te-owned POWTS arc submitted to the Department of Safety and Professional Servies. Personal information y4piroc (iy, ictr1coi purposes in accordance with the Privacy Law, s. 15.04 1 m Stats. (5 Project Address (if different than mailing address) ••'j L Application Information -- Please Print All Information Property Owner's Name JAN 1 5 2n 15 J U 1 CoitdthOoa Parcel # 0 .,'� w 1, ,, �1 .� .— 01 °l •-' 0B) Property Owner's Mailing Address QCo. Zoning Dept. 1917�-rs• - Property Location Gt /, 25 /+, Section circle one 7N; R Eor 2 City, State W J 7„s� Zi Code 7 ,�.so Phone Number 7 /S:-� ,�• L1 II. Type of Building (check all that apply) or 2 Family Dwelling — Number of Bedrooms Lot # Subdivision Name ❑ Public/Commercial-Describe Use Block It 0 Cityof ❑ State Owned —Describe Use ❑ Village of CSM Number Town of III. Type of Permit: (Check only one box on line A. Complete line B If applicable) A. ❑ New System ❑ Replacement System XTreatmerittRolding Tank Replacement Only 0 Other Modification to Existing System (explain) B. 0 Permit Renewal 0 Permit Revision 1 ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV.Type of POWTS S temlCom onent/Device: (Check all that apply) ❑ Non -Pressurized In -Ground ❑ Pressurized In -Ground 0 At -Grade ❑ Mound ≥ 24 in. of suitable soil ❑ Mound <24 in. of suitable soil f Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersallTreatment Area Information: Design Plow (gpd) I Design Soil Application Rate(gpdst) Dispersal Area Required (at) Dispersal Area Proposed (si) System Elevation VI. Tank Info Capacity in Gallons Total Gallons # of Units Manufacturer 0) 51 o i U Now Tanks t3xisting Tanks Septic or Holding Tank '1 , Eti 1E Ti Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) y Plumber' i tI MPIMPRS Number / I Business Phone Pone Number I7/$i3L/../7t Plumber's Address (Street, City, State, , Code) j 2.. ,44. e A 99J ' re-, g Lj VilkCounty/Department Use Only Approved 1 0 Disapproved ❑ Owner Given Reason for Denial Permit Foe $ 1"�X100 Date Issued Issuing Agent �• IX Conditions of Approval/Reas n for Disapproval ..;...n w curninclu pram tar ling syuum ana suomu wino county omy on paper nor toss man a uz x ii raertes in size SBD-6398 (R. 11/11) RECEIVED AUG 212026 Bayfieid Co. Planning and Zoning Agency I- LaeTiSt& A ells, Vi139 P194 PATRICIA A OLSON BAYFIELD COUNTY, WI REGISTER OF DEEDS 2015R-557929 03/09/2015 08:45AM IF E%ENPT It: RECORDING FEE: 30.00 PAGES: 2 QL�WN!(`ye, t Zri I sN •G .47 -U-25 - /-o /- Parcel JduQ/Icatlon Number (PIN) Onb /DO" OLDING TANK AGREEMENT )89;S US /r" 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 or Ch. 145, Wis Scats. (yV� � y -114 of 114 Section Township N. Range 7 W. Town of Gott Lot! Lot — Block Subdivision CSM#_ Additional Legal Description: 1111 MAR 042015 RECEV?Wo. Zoning Dept. AUG 2.1 2026 Bayfield Co. I and Zoning Return To: '.i1.c g 4t u nf1 r71C (rill •1- ii i1 I 1 al 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 falls 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, Slats. 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 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. 3. The owner agrees to contract with a person who is licensed pursuant to s.281.17 (3) Wis. Stats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced in accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of the contract with Bayfleld 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 from 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, WI's Adm. Code who shall submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfleld 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 property 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. 8. 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 catJa( Ara` t K Scribed and sworn to before me on this date: __ Notarized Owner(s) — Signature(s) Notary' ublic Q0V'-' MOR41%ti'h My Commise n Expires: Drafted by: for secondary vvinn 7 _..._ 9 _..._ V, 39 P195 I3-' 3TFIELD Bayfield County Planning & Zoning Department 117 E 511, Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: Submission Number: GALLIK, WILLIAM F SR -00305 18925 US HWY 2 MASON, WI 54856 Transaction Number: SR -00305-32230 Description Certified Soil Tests - Review & Filing Fee Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 1057 Paid by: Ronald McKuen, 17214 State Hwy 13, Butternut WI 54514 Payment Type: Check Transaction Date: 8/8/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. 13 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: GALLIK, WILLIAM F 18925 US HWY 2 MASON, WI 54856 Description Private Sewage System (Holding Tanks) Total: Payment Amount: Reference: 6222 Submission Number: SS -00824 Transaction Number: SS-00824-4CF72 Paid by: Visocky Plumbing, 16222 US Hwy 63, Hayward WI 54843 Payment Type: Check Transaction Date: 8/31/2026 Amount $400.00 $400.00 $400.00 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-119S STATE SANITARY PERMIT OWNER: WILLIAM F GALLIK GOVT LOT: LOT: BLK: 114 1/4 SEC: 25, T 47 N, R 7 TOWNSHIP: Mason SOIL TEST: 96-25 REPLACEMENT SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: RAYMOND VISOCKY 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 #: LICENSE: # 230236 Condition: Properly Maintain System Per Recorded Agreement. Old System needs to be properly abandoned per SPS 383. THIS PERMIT EXPIRES 8/31/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION