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Home My WebLink About26-0473CS -co IAN BAYFIELD COUNTY SANITARY PERMIT APPLICATION Zoning District Lakes Class I. APPLICATION INFORMATION Soil Test County �J 2 (Please Print All Information) ' No: Permit No: i3L o11 73 Property Owner's Name: Ryan Simula County: Bayfield Address of Property: Property Location: 21505 Old 63 S Grand View, WI 54839 % K S T N, R E (or) W Property Owner's Mailing Address: Township: Gov. Lot#: 1700 49th Ave NE City, State Zip Code Phone Number Lot# Block#: CSM#: CSM Doc# Subdivision Name Columbia Heights, MN 55421 612-964-6115 II. TYPE OF BUILDING: (Check One) ❑ State Owned Tax ID#: RECEN (E�'TERED ED ❑ Public (Explain the use/purpose ) / / / O —t ❑✓ 1 or 2 Family Dwelling - No. of Bedrooms ' b \$Lo1S' III. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) ❑✓ New ❑ Replacement ❑ County Private Interceptor Bavfield Co Planning and Zoning Agency ❑ 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) L Pit Privy ❑ Vault Privy (Vault size: gallons or _____cubic yards) ❑ Portable Privy ❑ Camping Transfer Unit Container Composting Toilets ❑ Incinerating Toilet V. ABSORPTION SYSTEM INFORMATION: 1. Gallons 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System 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'sName(s): (Print) If applying for Section c above Owner's Signature(s): (No Stamps) Ryan Leo Frost Simula Plumber's Name: (Print) If applying for Section A orB) above Plumber's Signature: (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: Issuing Agent's Signature / Date: Approved ❑ Owner Given Initial Adverse Determination IX, CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: Plot Plan on reverse side Lot Line HI Power line corridor 1 w Eighteen Mile Creek alb 398' t 14' 14' x 28Cottage Name of Frontage Road ( Old 63 S ) 1. Name the frontage road and use as a guideline, fill in the lot dimensions and indicate North (N) 2. Show the approximate location and size of the building. IMPORTANT DETAILED PLOT PLAN 3. Show the location of the well, septic tank and drain field. IS NECESSARY, FOLLOW STEPS 1-7 (a -o) COMPLETELY 4. Show the location of any lake, river, stream or pond if applicable. 5. Show the approximate location of other existing structures. RECEIVED 6. Show the approximate location of any wetlands or slopes over 20 percent. 8 2026 AUG 1 7. Show dimensions in feet on the following: Bayfield Co. a. Building to all lot lines i. Planning and Zoning Agency 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 Submit To: Bayfield County Zoning Department, PO Box 58, Washburn, WI 54891 Wforms/sanitary/bayfieldcountysanitaryapplication Revise: June 2018 Proofed by: PRIVY AGREEMENT / (ATTACHED TO THE SANITARY PERMIT APPLICATION) DOCUMENT NUMBER 2O26R-613591 Ryan Leo Frost Simula, Am3da Marquez Verity Simula 1700 49th Ave NE Columbia Heiahts, MN 55421 NW 1/4, SE 1/4, 21505 Old 63 S Grand View, WI 54839 S 21 T 45 N,R06 06 W V.951 P.844 August 28, 2026 1. NO PLUMBING will be installed in the habitable building. 2025R-607814 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED O9/O2/2O26 AT 9:5O AM RECORDING FEE $30.00 PAGES: 1 RetI Ec%,CIVED ZONING SEP Q 3 2426 planning and Zoning Agency 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 I pit shall maintain minimum setbacks as specified in Table 1. Table I Well Building Lake / Stream Additional County Setbacks OPEN PIT 50 Ft. 15 Ft. Min. 75 Ft. SEALED VAULT 25 Ft. 15 Ft. Min. 75 Ft. 4. Privies for public buildings shall comply with SPS 353.63. 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) Ryan Leo Frost Simula Amada Marquez Verity Simula Owner(s) Signature: This instrument was signed before me in the State of County of On this O JG Ha*22- . 20 by: otary Public My commission expires on: /31/3] Drafted By: August 28, 2026 (must be filled out by person submitting form) t 17*IMISIOh December 2012 u/forms/sanitary/privyform - ®October 2019 Nr Canlirine.tnmml m3l BYFIELD Bayfield County Planning & Zoning Department 117E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-4010 Property Owner: Description County Sanitary Permit: 1 Submission Number: CS -00184 Transaction Number. CS-00184-4CCAA Amount $150.00 Total: $150.00 Payment Amount: $153.57 Reference: 5664856975 Paid by: Ryan Simula 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 - BAYFIELD COUNTY PERMIT WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION No. 26-0473 Tax ID: 17460 Issued To: SIMULA, RYAN LEO FROST & AMADA MARQUEZ VERITY Location: S21 - T45N - R06W Town of GRAND VIEW Legal Description: NW SE IN V.951 P.844 (MFL-OPEN 25 YRS-YR OF ENTRY 1990) IN DOC 2025R-607814 908 Residential Structure in F-1 Zoning District For: Sanitation Permit — New [Composting Toilet] (Disclaimer): Any future expansions or development would require additional permitting. Condition(s): Maintain as required per privy agreement. 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. September 4, 2026 This permit may be void or revoked if any performance conditions are not completed or if any prohibitory conditions are violated. Date