HomeMy WebLinkAbout26-126SDepartment of Safety
& Professional Services,
OO
Industry Services Division
Sanitary Permit Application
In accordance with SPS 383.2t(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
the Department of Safety and Professional Services. Personal information you pri�ty� v d for secondary
(`
� purposes in accordance with the Privacy Law, s. 15.04O)(m), Stats. �1[C
1. Application Information —Please Print All Information
Property Owner's Name SEP 0 9 2026
Peter Annin & Meri Annin
Property Owner's Mailing Address Bayfield Co.
87775 West Rd Planning and Zoning Agency
City, State Zip Code Phone Number
Herbster, WI 54844 608-239-4567
II. Type of Building (check all that apply) Lot #
S I or2 Family Dwelling —Number of Bedrooms 3
Block #
❑ Public/Commercial — Describe Use
❑ State Owned — Describe Use reran sr, ,..m,,
Parcel #
7270
Govt. Lot
/., ''/, Section 06
T 50 MO 06 F.A-Xh
❑ Cityof_
❑ Village of
S Town of F
III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C it
a licable.
A.
❑ New System
❑✓ Replacement System
❑✓ Other Modification to Existing System (explain)
❑ Additional Pretreatment Unit (explain)
Move Existing Tank/Replace if bra
❑ Holding Tank
❑ In -Ground
At -Grade
O Mound
❑ Individual Site Design
❑ Other Type (explain)
(conventional)
C.
O Renewal Before
❑ Revision
❑ Change of Plumber
O Transfer to New Owner
ist Previous Permit Number and Date Issued
Expiration
15-124S, 9-23-15
IV. Dispersal/fre: tment Area and Tank Information:
Design Flow (gpd) I Design Soil Application Rate(gpd/st) I Dispersal Area Required (sf) I Dispersal Area Proposed (sf) I System Elevation
Capacityin
I Total
I # of
I Manufacturer
Tank Information
Gallons
Gallons
Units
I a
U '$
u o
d
a
New Tanks
Existing Tanks
U
_
loI
Septic or I lolling Tsmk
4000
4000
2
Wieser
✓
❑
V. Responsibility Statement- I, the undersigned, assume responsi - ity for installation of the POINTS shown on the attached plans.
Plumber's Name (Print) Plumber's Si MP/MPRS Number I Business Phone Number
Dean Blakeman r-- 1092768 715-682-6050
Plumber's Address (Street, City, State, Zip Code)
44941 State Hwy 13, Ashland, WI 54806
Per it Fec Date Issued Issuing Agent Si nature
Approved 0 Disapproved MkIC90c9c
❑ Owner Given Reason for Denial 'OD— it ( (/✓0/-/00Y(0,
Conditions of Approval/Reasons for Disapproval
Attach to complete plans for the system and submit to the Counter only on saner not less than B In x 11 inches in size
SBD-6398 (R- 03/22)
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
RECEIVED
SEP 092026
Bayfield Co.
Planning and Zoning Agency
Attachments:
Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Map (if ap
Holding Tank Pumping Contract (if appl
Holding Tank Agreement (if applicable)
Project Name / Description
Annin Holdina Tank
Owner Name(s): Peter Annin & Meri Annin
Owner Address: 87775 West Rd, Herbster, WI
Project Address: 87775 West
Govt. Lot: 1/4 of
Township: Bell
Project Parcel ID #: 7270
plicable)
cable)
Phone: 608 239 _4567
Herbster, WI 54844
1/4, Section 06 , T 50 N -R 06 E ❑ or w{
county: Bayfield
Zip: 54844
Designer Information
Designer Name: Dean Blakeman Phone: 715 -682 -6050
Designer Address: 44941 State Hwy 13, Ashland, WI Zip: 54806
E-mail: dean@blakemanplumbing.com This space reserved for approval stamp.
License Number: 1092768
Remarks:
Attempting to move 1 holding tank to meet building setback for
proposed garage. Will abandon and replace if it breaks when moving.
Signature: �— Date: q __
Original signature required on each submitted copy.
CHECK Box AS APPLICABLE. CHECK BOX AS APPUCABLE.
fl SOIL EVALUATION D Scale: 100 ❑✓ SYSTEM PAGE 2 OF 4
100 150 200
SITE MAP PLOT PLAN
PROJECT NAME: (25H find) 25 DESIGN FLOW: 450 GPO
Annin Holding Tank Attach design flow calculations for commercial plans.
PROJECT ADDRESS: 87775 West Rd, Herbster, WI 54844 Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5)
Sanitary Sewer 4" PVC / D3034
BM Symbol: BM Elevation: 100 FT
Force Main: /
BM Description: Top of Building Slab
Slope Gradient (%) Well Symbol (if applicable): Q
of Tested Area:
W Lot Line
A
Wetlands
155'to 1At lot line
I
'new 4" 3034 Pvc Dips I
Indicate nosh by IMPORTANT:
drawing en arrow show ground elevation contours at suitable intervals.
on the appropdte line.
Lake Superior
for 1st Exis' _ 255to N lot line _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Ading tan 3 Bed m— —>
qpp I
Gara I
ing
ocation of 2nd
gal
on holding tank
60'to Slot line
5001 to West Rd
m
G
3
C
I
O
0
h
1
U)
r^p.
t0
Z
O
��
I Heavily Wooded Site
r
2
I
C
I
m
West Rd
RECEIVED
SEP 092026
Bayfield Co.
Planning and Zoning Agency
PAGE 3 OF 4
HOLDING TANK SPECIFICATIONS
(No Scale)
Electrical must comply with
SPS 316 and NEC 300
18" Min.
(typical)
Inlet
Approved Joints with
Approved Pipe 3 ft onto
Solid Ground
4
P
a
a
Weatherproof
12" Min. or 2.0 ftabove
—Junction and
Approved
Established Flood Elevation
Alarm Box
Vent Cap
(typical)
Approved Locking Manhole
4'0 Vent Pipe
with Warning Label Attached
Conduit
>10 ft from
(typical)
4" Min. or 2.0 ft above
Building
Established Flood Elevation
(typical)
\I/
Airtight Seal
"
Finished Grade
4 An.
l I. y.
Inlet Invert
Max. 12' 0190% of total volume RL�paGv Y
EI`,
If more than one tank
Alarm -On SEP 0 9 2i
Planning Go.
0 and Zoning
HOLDING TANK
VOLUME = 2146 gal
3" Approved Bedding Material Beneath Tank
—Waterti!
Plug
yC
J2
Ag
TANK MANUFACTURER: Wieser Concrete
Anchor tank as necessary
pursuant to SPS 383.43(8)(g)
Ballast Weight = [(cu.ft.tank.vol x 62.4 lbs/cu.ft) - lbs.tank.wt] x 1.5
Ballast Weight = [( 287 cu.ft. x 62.4 lbs/cu.ft) - 15,370 Ibs] x 1.5 = 3.808 lbs
PAGE 4 OF 4
Holding Tank Management Plan
IMPORTANT:
The owner of this holding tank(s) 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 holding tank(s)
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.
Estimated Daily Wastewater Flow =
300
gpd RECEIVED
Inspection Checklist INSPECT EVERY 3 YEARS SEP 09 2026
o type of use
o age of system Bayfield co.
o nuisance factors (i.e. odors, user complaints, etc.) Planning and Zoning Agency
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
o surface discharge of effluent or sewage back-up into structure served
SERVICING FREQUENCY
o The tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wisc. Stats.
when the wastewater in the tank(s) reaches a level of one foot below the inlet invert of the tank(s).
Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
Tank pumping reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wis.
Admin. Code. Report any component failure or malfunction to:
Name of individual or company: Blakeman Plumbing & Heating, InC Phone: 715-682-6050
Local government unit: Bayfield County Planning & Zoning Phone: 715-373-6138
Local government unit address: 117 E 5th St, Washburn, WI 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 component of this holding tank(s) cannot be repaired, it shall be replaced pursuant to a
plan submitted to the appropriate agecy for review and approval.
System Abandonment
If use of this tank(s) is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
W2000- M R
TANK SPECIFICATIONS
U
a
TOP VIEW
Wa
a �
io
TTI1 ..L.
INLET
2& a
SIDE VIEW
RECEIVED
SEP 092026
Bayfield Co.
Planning and Zoning Agency
71
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
OUTLET
0
DIMENSIONS:
WALL• 2 1/2"
BOTTOM: SEPTIC 4"
HEAW DUTY 4"
COVER: 6"
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
HEIGHT: 66" O.D.
LENGTH: 151" O.D.
WIDTH: 86" O.D.
BELOW INLET: 53" O.D.
LIQUID LEVEL• 46"
WEIGHT: 13,540 LBS. SEPTIC
15.370 LBS. HOLDING
INLET AND OUTLET:
4" CAST -A -SEAL BOOT OR EQUAL
GASKET. CAST -A -SEAL BOOT OR EQUAL
INLET AND OUTLET BAFFLE AND FILTER:
WISCONSIN, SEE DETAIL #10
(OTHER STATES SEE CHART)
LIQUID CAPACITY: 42.92 GAL/IN
LOADING DESIGN: 8' 0" UNSATURATED SOIL
HOLDING TANK:
OUTLET HOLE PLUGGED
ACTUAL CAPACITY: 2,146 GALLONS
TANK CAN BE USED AS
SEPTIC/ HOLDING/ PUMP OR SIPHON
COVER: MIX DESIGN #8 (NO FIBER)
TANK: MIX DESIGN #10 (STRUCTURAL FIBER)
CUSTOMIZED TANKS:
FOR CUSTOM TANKS CONTACT 9NESER CONCRETE
FOR APPROVAL
APPROVED BY:
APPROVAL DATE:
PRODUCTS NEEDED BY:
o Z
� z
0
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a
w
S. 1 e a
Ba; i! 1'Q1*1 County
Waiver of a ThoEGuah sew & e
(subject to 15-1-1fl( ))
a
Soil Test # 7f5 I
Evaluation
determine that In my professlona
fd'nt component other than holding
a•tlon is not needed to make such a
JUN 10 2015 `-' RECEIVED
PMupoiityOwtiot Sa.•,f d'r>'rR:f(e.Y 6a field Co ZordagtktfSctor c
---�R 092026
n • s • ;-Ad'drtess Ca:M ti c• <r'a r t Jgz Authorized Agent sayfield Co.
vna.l ow1dvcs: ioa si mmnga onin9 9
ilwctyQ , uiz. ≤'fpi 'gent'S Telephone
P1.j3lEs2F3, Written Authorization Attached: Y or N
Gm m0..t. 4,40AI Doseel�ion is requested:
9r4.of,;;,.r,^114 ae.otl�on....,�? Township ' N. Range W. Town of
;%i / dot. Block Subdivision CSM#
V`a#4ftna ...Page of Deeds Parcel I.D# - ost 00/ 1Y41V0 Acreago S
4Add111un 1Leual Dbserlption:
tnditatereaso7i'rgfor fit ourd'ett #nation: e/r s�,�s n1ev��r a✓e__4.�orrw(G,-
y' }/ `!.
ltwt. fS Oil+-JC..fsi'c SIeY v 47/ ) oK/-T_S
D�rttiY /rte tirnC F«FoY -3r`
kuvezo Ti�
ofH' cov �ectux ' 1 cIi /c'Ec ^s) O atU l7 tilled Soil Tester
0.-3 2•S`IR31t noU- ,'1 •
.3-44 a.S1gt (y n.hc o Date
County�061'a
taate
Certification.#
(Submit a Plot Plan & Fee:)
utlorrnslsolteshvelve r(KLK)
February 2006
EQ-1 fs -(
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&n'
fa5c aaF�
T
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l
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Hi
L. RECEIVE[3
I
14
SEP Q 2026..
'L
'
Bayfield Co.
Planning and Zoning Agency -
/4/
. . ..-.
.....................................:..
r\{
( SEE MAP 31516 )
RECEIVED
3/
=6
SNORES
SEP 092026
f
300.02' 3
725.02'
10200020
1020
Bayfield Co. V 71
030000 n
,P388
V 825 ,P 1
5.01 A
Planning and Zoning Agency
7A±
I'. 2
20500110000 299.51'
102000
V 446 ,P 184
V769,
4A±
16.02 '.
•ob
300.33' 161.67' LESS V825
20500120000
V677,P120
1,21 A t
In
44•
LAKE SUPERIOR
I$
250 a-
4026'
g
10200C
I.
V778
20500130000
j I I
a
5.01
V357,P23
10200040000
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V 217 ,P2
1030003001
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1.45 A
p20325'
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334.00 128,00r
446.71
10300040000
6
it I
V 62 Z,PA364
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20500140000
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20500210000
V 678,P297
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V 308 ,P377
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a.
LESS CSM
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10300020000
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G.L.205001550000
50'17A ±
II 20500240000
G.L. 2 S OF HWY
5.66 A
J I 502.41'
30200020000
V 825 ,P 243 n
3.17 A
02.41'
Ill
30100010000
NE SW
40A±
a
O
HOLDING TANK SERVICING CONTRACT
E
ntract Date
/i'/c
This contract is made between the
Holding Tank Owner(s) Name(s) / Pumper's Name
77'1&t d-- n s ) .4i✓s(/; l/
'Al., .,,.o..,.' I,,A..� N,,, i..e +ello{Inn .,f (o\ kniinn h..hlc1 .,n II; fnlinu,ion nrnnprl v' (P rnvirip tonaI rips rrintinns -1
PROJECT r.
LOCATION
_... PIN' -. /
Legaloescrintlon: (UaoTaxStatement.) 04- ijU 2-$`L) O(✓ "ctt 2 QJ'-c.oj ^ 1000 U
Town of:
tot
tot Site Acreage
114, _ ry 1/4, of Section O , Township N, Range C.) (9 w
B L2..�.
:
Govt Lot
Lot P-
CSM if
Vol. Page
Lotls) No,
Block(s) No.
Subdivision:
1
U W 319
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 I 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: RECEIVED
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.
SEP 092026
Bayfield Co.
Planning and Zoning Agency
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 Signet s
Subscribed and sworn to me on this date:
aura rtQ.1 �kN&
Owner(s) Name( (Print)
z ✓,✓„ ✓
%i .
r—'rc ��✓iN
�� o lg2oAS
Today's Date
*L4N
Pumper's Name (Print)
Pumper's Signature
(3n rck 5'f*
tary P bl c Signature
eeeeeNl
'S�'L
;Ep
G4Ge. I __�Jtg
Tq O: Commission Expiration
Pumper's Registration Number 4'
G
Revised: November2012 (Bayfield County Zoning) '%,<'• L t•. �� �� Drafted by
Personal Information you provide may be used for secondary purposes [Privacy l4y�osQf}5.0�
/hnanneeeee
Document Number/Plan I.D. No. I HOLDING TANK
AGREEMENT
me(s)
M6r4-� ! / � malcaressuwrrer r,
fay f 1� aJ /30/24?
30
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 State.
114 of 1/4 Sectonj'O&'_Townshlp N. Range R06W
Town of
aturn To; . i r.
Gov't Lot. _Lot Block Subdivision CSrmu et -Pr 4 nc( t�j,le/; slilIA,
Additional Legal Description: V, J/�fN Ae 3/ 9 too /;aX d`Aelpv (
O'1j'nacopa (cc5i 5q8 i'
PATRICIA A OLSON
0AYFIELD COUNTY, WI
REGISTER OF DEEDS
20158-560350
09/11/2015 02:45PN
IF ERENPT N:
RECORDING FEE: 30.00
PAGES: 2
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 hoidi��and
maintenance. If the owner fails to have the holding tank properly serviced in response to orders issued by the
Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, State., 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 cha IoM t as a
special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats�Cr
2. Owner agrees to pay all charges and costs incurred by Bayfleld County for inspection, pumping, hauling, or otheTrl& rRein"g�a�n�d'
maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused byRkVl1J INf&I$flR'PgBaglfela
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 low.
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 Bayfield 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. Stats., 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. Bayfield 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
properly 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.
ruAppry,
6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owns fibn1R t�tw'�tg
agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner w,& 1N bermt1 Jj
existence of the agreement to be determined by reference to the properly where the holding tank is installed. j O TA
,9',
9/..
Owner(s) Name(s)— Please Print
'4er Annl'A cwt f14c2' AAA1 \
Subscribed and sworn to before me on this data=
�. %BO
Notarfzo O ignature(s)
ub �2r 2tlL1
y ommission es:
Drafted by: PJe r j4Avi✓l rlxl and fl/)pi'/ 4nn In Date: Se o'P/ 764 e gad/S
Personal Information you pmMde may be used for secondary purposes (Privacy Law, s.15.04 D)(m)I
uflmnn/senilarymoldinglankagreemens.doc 1
v 114 8 P723
EXHIBIT A
TO
WARRANTY DEED
A parcel of land located in Government Lot One (1), Section Six (6), Township Fifty. (50)
North, Range Six (6) West, Town of Bell, Bayfield County, Wisconsin, described as follows;
Commencing at an iron pipe which is the quarter -corner of Sections 6 and 31; Thence
South 948.7 feet to an iron pipe which is the Point of Beginning;
Thence North 89°36' W. 402.8 feet to an iron pipe.
Thence North 59°01' W. 154 feet to an iron pipe on the shore of Lake Superior.
Thence Westerly along said shore 250 feet, more or less. RECEIVED
Thence South 300 feet. SEP 092026
Thence East to the North -South quarter line of Section 6. Bayfield Co.
Planning and Zoning Agency
Thence North along said line to the Point of Beginning.
Grantor reserves a permanent and perpetual easement 20 feet wide for purposes of ingress
and egress aver and across that portion of the driveway depicted on Bayfield County CSM
No. 1875 which crosses the herein -described premises, which CSM is more particularly
described in Bayfield County Certified Survey Map No. 1875 recorded in the Bayfield
County Registry on April 16, 2014 in Volume 11 of CSM on Page 107 as Document No.
2014R-553951. This reserved easement shall run with the land and be appurtenant to Lot
One (1) of said Bayfield County Certified Survey Map No. 1875.
See attached Exhibit C for further detail.
V 1148 P724
3 AYFIELD 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:
ANNIN, PETER T & MERI P
87775 WEST RD
CORNUCOPIA, WI 54827
Description
Private Sewage System (Holding Tanks)
Submission Number:
Transaction Number:
SS-00838-4DCDD
Amount
$400.00
Total: $400.00
Payment Amount: $400.00
Reference: 34671
Paid by: Blakeman Plumbing & Heating, 44941 State Hwy 13, Ashland WI 54806
Payment Type: Check
Transaction Date: 9/11/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
BAYFIELD COUNTY
SANITARY PERMIT (#04)-26-126S
STATE SANITARY PERMIT
OWNER: PETER T & MERI P ANNIN
I N
G OV'T LOT: LOT: BLK:
1/4 1/4 SEC: 6, T 50 N, R 6 W
TOWNSHIP: Bell
SOIL TEST: 67-15 (WAIVER)
TREATMENT/HOLDING TANK
SYSTEM TYPE: Holding Tank
PLUMBER: DEAN BLAKEMAN
EMILY MACGILLIVRAY LLIVRAY DATE: 9/11/2026
Authorized Issuing Officer
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 #:15-124S
LICENSE: # 1092768
Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all-
weather road.
THIS PERMIT EXPIRES 9/11/2028
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION