The URL can be used to link to this page

Home My WebLink About26-134So q H N Ps Department of Safety & Professional Services,Bayfield Industry Services Division County Sanitary Permit Number (to be filled in by Co.) 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 purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 26842 Cherryville Rd I. Application Information — Please Print All Information Property Owner's Name r- t Thousand Pines Properties LLC TE ED Parcel # 37315 Property Owner's Mailing Address Property Location 9169 W State St No 2202 Govt. Lot City, State I Zip Code i idflnmn t'lokIliring Agency Garden City, ID 83714 612-225-8940 SE -A, NE y. Section 32 T 48 N R 05 E or W 11. Type of Building (check all that apply) Lot # Subdivision Name 0 I or 2 Family Dwelling — Number of Bedrooms 3 1 ❑ Public/Commercial — Describe Use Block/I ❑ City of ❑ State Owned — Describe Use ❑ Village of CSM Number 1943 0 Town of Barksdale 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 a licable. A. ® New System y ❑ Replacement System ❑ Other Modification to Existing System (explain) O Additional Pretreatment Unit (explain) B. ❑ Holding Tank N In -Ground O At -Grade O Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revisiong O Change of PlumberList O Transfer to New Owner Previous Permit Number and Date Issued Expiration 24-113S 08/08/2024 IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (si) I Dispersal Area Proposed (sf) I System Elevation 450 0.7 642.6 678 95.5 Tank Information Capacity in Gallons Total Gallons # of Units Manufacturer , u e cC U o T y in m u rn `u ii. a v P. New Tanks lExisdngTanka Septic or Holding Tank 1000 1000 1 Wieser Concrete X Dosing Chamber V. Responsibility Statement— 1, the undersigned, a respon bility for 'nstalla ' a of the POWTS shown on the attached plans. Plumber's Name (Print) PI ber Sigma a MP/MPRS Number I Business Phone Number Douglas Manthey MP 230722 715-739-6868 Plumber's Address (Street, City, State, Zip Code) PO Box 196 Drummond, WI 54832 VI. County/Department Use Only Approved ❑ Disapproved Owner Given Reason for Denial Permit Fee Date Issued /17/2/a Iss g nt nature �❑ /'/2j,7[3 Conditions of Approval/Reasons for Disapproval &g a aIed end. Attach to complete plans for the system and submit to the County only on paper not leas than 8 12 i II inches in size SBD-6398 (R. 03/22) PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Pg 2 of 4 Pg 3 of 4 Pg 4of4 Attachments: Index & Cover Sheet Plot Plan Dispersal Area Cross -Section & RMLVD Management Plan SEP 15 2026 Bayfield Co. Planning and ZWn9A9anw Wieser Tank Specifications POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Thousand Pines Conventional Owner Name(s): Thousand Pines Properties LLC Owner Address: 9169 W State St No 2022 Garden Cif Project Address: 26842 Cherryville Rd Washburn, WI Govt. Lot: SE 1/4 of NE Township: Barksdale Project Parcel ID #: 37315 ID Phone: 612 225 -8940 Zip: 83714 1/4, Section 32 , T 48 N -R 05 E ❑ or w71 County: Bayfield Designer Information Designer Name: Douglas Manthey Designer Address: PO Box 196 Drummond, WI E-mail: norpines@chegnet.net License Number: MP230722 Remarks: Phone: 715 .739 6868 Zip: 54832 H (pa, C reserved Hr approval stains,. Signature: Date: O9 Oq Origins nature required on each submitted copy. Tost4 lanes PeoeeAies LLC _ 1 Scoaa =�a SC .'-ytw �2o5w Pose 2099 rowh o9 3ar¼sc%oa(e yo cot,, 1 ,Z4 Sy 2 c -Leery � , l\e Rci lax 3O: 331r era G��s�ruz,�rian Os. 4M )00- B3: 101 Qy = )01.(0 sys' eM : Q5,S` . Naa i%" AG -L )O1 RECEIVED SEP 15 2026 Bayfield Co. Planning and Zoning Agency q6 99.1 lC0 r loot e /N \'Vu _ s cells cov 0tW \ A Qu,\ck 1 ckoii.�bers )p\lo \�o - A11 CDnoeyaaee D 9 E0b� 'a y° s�.ky0 or 3SjNc Q- cbq" Na I`�d�nNw a - MN -GCOUNd Se; 1 A6sorP-ac ii C.�ecc� U•��e ROD a3 o c) X2, IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER min. 12" (typical) Septic Tank(s) Manufacturer. Wieser Concrete Septic Tank(s) Volume(s): 1000 gal gal gal gal Effluent Filter Manufacturer. Orenco Effluent Filter Model #: 14B 12" min.aench depth (typical) < ' TYPICAL TRENCH CROSS SECTION VIEW Fitypl> (No Scale) System Elevation = 95.5 ft (typical) Quick4 Standard -W wcal) End Cap It (Show location of inlet I outlet pipe connection on plan view.) ypi r------------t-------��---- LI-------------------;�_ I. B= 46 ft (typical) INSTALL PER TRENCH: 11 Quick4 Std -W @ 20 If EISA/chamber = 220 ft' + 1 Pairs of end caps @6 ft= EISA/pair = 6 ft' = Proposed EISA per trench = 226 ft' Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturers / instructions. TA=3.0ft (typical) TYPICAL TRENCH PLAN VIEW (No Scale) "—Quick4 Standard -W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. Required Infiltration Area = 642.6 ft2 x 3 trenches = Proposed Total EISA = 678 ft' 1p1 ra D nO Cm Na �_.o cn W iv C O m rn m Distribution Method: branched manifold RESET PAGE4OF4 In -ground Gravity Management Plan IMPORTANT: The owner of this in -ground 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; BODs ≤ 220 mgL"'; TSS S 150 mgL"'; FOG 5 30 mgL"' Inspection Checklist INSPECT EVERY 3 YEARS R�CCIv�Ci o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) 5EP 1 52026 o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (Le., leaks, breaks, corrosion, etc.) Bayfleid Co. n A envy o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) q.�"Pb%iA6bg'or�I &rop boxes) 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 (1/3) 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 cleaned 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: HK Septic Service Phone: 715-798-3494 Local government unit: Bayfield County Zoning Phone: 715-373-6138 Local government unit address: PO Box 58 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 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. t Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed Personal information you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)). he ._L. of BAYFIELD 37315 Date PropertyOwner -__ Property Location ❑ ❑, JAMES & SUSAN JACOBSON Govt. Lot SE 1/4 NE 1/4 S 32 T 48 N R 5 E (or) W I Prnnerty Owner's Maitino Address Lot # I Block # I Subd. Name or CSM# 26975 CHERRYVILLE ROAD r, r7 Ciy State Zip Code Phone Number I f_J"ity Village UTown Nearest Road ASHLAND i WI i 54806 If 715 1 209-5320 n A nvCfA I C I CIIERRYVILLE Q New Construction Uses Residential / Number of bedrooms S Code derived design flow rate 'f " GPO lo Replacement O Public or commercial - Describe: Parent material GLACIOFL(!VIAL Flood Plain elevation ifapplcable iL5 fl. General comments CONVENTIONAL e and recommendations: SYSTEM ELEVATION FROM 2 FEET TO 5 FEET IN GROUN/G 'a?OZ0 1 DESIGN SOME TREES REDES TO BE REMOVED FT. Sa YBci _ ❑ Bo ❑ Boring wnin9 I dng # El pit Ground surface elev. 99.1 ft. Depth to limiting factor >9G in. Rate I Soil Aoolication Horizon Depth in. Dominant Color Munsell Redox Description Cu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fF 'Eff#1 'Ef##2 I 0-8 7.SYR3/2 LS 0SG DS AW 3C .7 1.6 2 8-34 7.5YR4/6 LS 0SG DS CW 3M .7 1.6 3 34-96 5YR4/6 S 0SG DL - 2F .7 1.6 Ba e nning and Zoning Agency 2 Boring # ❑ Boring 100.1 >96 Q Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Fe 'Eff#1 -Eff#2 1 0-c 7.5YR3/2 LS 0SG DS CW 3C .7 1.6 2 9-32 7.5YR4/6 LS 0SG DS CW 3M .7 1.6 3 32-96 5YR4/6 S 0SG DL - 2F .7 1.6 ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mgr. - tmuent #z = uUU, a Ju mg,L ano I bb < iv mgrL CST Name (Please Print) Signa�W�r�e �� /i /� CST Number BRUCE W BLAKEMAN W `-�— 708148 Address Date Evaluation Conducted Telephone Number 64903 CHARLES JOl-INSON ROAD ASHLAND, WI 54806 08/05/2020 715-209-2569 1Property Owner JACOBSON Parcel ID # s I Boring# Boring n pa Ground surface elev. I0I ft. Horizon Depth in. Dominant Color Munsel) Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIIF 'Eff#1 'Eff#2 1 0-9 7.5YR3/2 LS 0SG DS AW 3C .7 1.6 2 9-32 7.5YR4/6 S 0SG DL CW 2M .7 1.6 3 32-96 5YR4/6 COS 0SG DL - IF .7 1.6 37315 >96 Depth to limiting factor in. 2 3 Page _of_ cnil Af rrann R 4 Boring # fl Boring 101.6 >96 Pit Ground surfaceelev. ft. Depth to limiting factor in. Soil Annlir.atinn Rate I Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fF 'Eff#1 Eff#2 1 0-7 7.5YR3/2 LS 0SG DS AW 3C .7 1.6 2 7-27 S 0SG DL CW 3M .7 1.6 3 27-96 5YR4/6 COS 0SG DL - IF .7 1.6 1520 og field Co. ncl ❑ Boring# Boring Pit Ground surface elev. ft. Depth to limiting factor in. Snit Annlf nn Ratw1 Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPO/IF 'Eff#1 'Eff#2 Effluent#1= = BOO, > 30 5 220 mg/L and TSS >30 5 150 mg&L - Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L The Department ofCommerce 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. SBD833OTcu (ROM) oBs3,✓ 5E NFs3arygw/en / � Twer of ?,,44ZKSbPrcE, BtyF#ce Cif; 41 4<7 ,4c€5 5M-cL- /"= S'b` /&rs u./frAck?F'OE A-Thvt- NA-sL- 7"48o t cauAiA .r. j13104l J g" J 4e C5 ro7d8/4% Fro 4} g $S 02 IU0 1/J"CLL i1T Tss &mC Jol ReCr-iWE® SF? 15t7- L-° punning and Zoning A9ecG 73 �CE- 3 of 3 0gg^' tr1V1 o 9'? Qi-r-- SLoP � y 4 FR WLP1 000 TANK SPECIFICATIONS 4" CAST - INLET N Y U SIDE VIEW A TANKS ARE MANUFACTURED TO DIMENSIONS: WALU 2 1/2" 4" CAST -A -SEAL BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 53 1/4" LENGTH: 8'-8" WIDTH: 7'-2" BELOW INLET: 42" LIQUID LEVEL: 36" WEIGHT: BOTTOM 6,790 LBS. COVER 3,195 N v $J C �g () ''U 5 C- T OUThET N0 0) In 'AD INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 27.83 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,085 GALLONS LOADING DESIGN: 8'-0" UNSATURATED SOIL 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 WESER CONCRETE REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: - I Q 0 D 0 Z o_ 910 w In 1 BAYFIELD COUNT* CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) L3'Checklist 13"6riginal Sanitary Application (Submitted in Deed Holder's Name — not prospective buyers) (383.21(1)1.) C1index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) EI"Original Plot Plan (383.22(2)2. 3. & 4.a) E"Cross-Section, Overhead Profile of the System an Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) la'Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) Maintenance Agreement (Owner's Original Signature(s)) (383.21(2)(c)(6) (Recorded at Reg. of Deeds) ❑ 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) 0 ATU Servicing Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) Pltee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 24 Complete Set of Plans (Note: Sanitary Application - Maintenance Agreement & Service Contract are to be included in the copy packet) R"5`oil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ State Plan Review (when applicable) 0 Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) 0"I Application Information must include: 2or 5 digit) Tax ID# -- (do not use 12 digits anymore --obsolete) p -Project Address or Road Name where driveway is/will come off of) '(Owners Phone Number) 0'II Type of Building III Type of Permit RECEIVED ≥IV Type of POWTS System LTV Dispersal / Treatment Area Information {] VI Tank Information 2'TII Responsibility Statement (Plumber's Information) 0 *Date Stamp* Plot Plan: (To Scale or To Dimension) signature and Plumber Information ❑ Surface Elevation of Body of Water a Direction and Percent Land Slope C'Tank and Filter Information and Location ❑ Wetlands / Navigable Bodies of Water E6bsorption Area (Proposed and Existing) lflench Mark (Location, Elevation and Description) SEP 151026 Bayfield Co. planning and Zoning Agency 2'Address Number and Road [Borth Arrow rd'tontour Lines Structures and Driveways Loring Locations l"roperty Lines ❑ Well Locations Component Manual Version ta'Cegal Descriptions wiping Material Information (conveyance line, building sewer line, material type and diameter) Turn Over ► Cross -Section and Overhead Profile of the System: 7(Surface and System Elevation rJ Position of Observation and Vent Pipes Dimensions and Depths rd Make, Model & Number of Chamber Units in each Cell Property Information iiow many systems will there be on this parcel of land? I O Has this property been split? (Property Statement shows Property History) Fees: HDrivate Sewage System (Septic Tanks) ❑ Private Sewage System (Holding Tanks) ❑ Mounds or Systems requiring Pre -Treatment ❑ Sanitary Revisions ❑ Private Sewage System Reconnection and Private Interceptor ❑ Return Inspection $ 400.00 $ 400.00 $ 500.00 $ 25.00 $ 50.00 $ 50.00 ❑ Maintenance Agreements ♦ $ 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 '/< of the SE '/4, Section 1, Township 23 N, Range 4 W, Town of Bell RECELVED SEP 15 2026 u/forms/checklisis/checkllstforsanitaryapps (®8/5/2026) Bayfield Co. Planning and Zoning Agency Private Sewage System Maintenance Agreement Owner(s) Name Thousand Pines Properties LLC Owner(s) Mailing Address 9169 W. State Street NO 2202 Garden City, ID 83714 Site Address 26842 Cherryville Rd Ashland, WI 54806 Tax ID # 37315 As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil testers 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) SE 114 of NE 1/4 Section 32 Township 48 N. Range 05 w. Additional Legal Description: Town of Barksdale (Acreage) 4.73 Gov't Lot Lot_ Block Subdivision Lot 1 cSM # 1943 vol. 11 Page 265 CSM Doc # 2021R-589636 DOCUMENT NUMBER 2024R-604083 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 07/24/2024 AT 10:01 AM RECORDING FEE: $30.00 PAGES: 2 Recording Area (�[ Pf3ning"anld Zoning artment ,':L 2 .i'UZ4 ® 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 (113) 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 specification. 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 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 properly. Owner(s) Name(s)—Please Print Michael Maciosek authorized official, Thousand PinesProperties LLC Subscribed and swom to before me on this date: 7` J 2 I,' 1(15 9 a t/ O Notarized Owner(s) — Signature(s) Nola IL My4dlImisslon Expires: C t / -3 1 20'fl- Drafted by: Dou M Date: 07/01/2024 t: DULCE VANESADSOLIS Proofed by: Notary Minnes/sanitary/septicmaintenceagreement SEP 15 2026My Commissi` Revised July 2020 Jan 31, Baytteld Go. Agency Planning and zoning B &YFIELD Bayfield County Planning & Zoning Department 117 E 5"h Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: THOUSAND PINES PROPERTIES LLC 9169 W STATE ST NO 2202 GARDEN CITY, ID 83714 Description Private Sewage System (Septic Tanks) Submission Number: SS -00844 Transaction Number: SS -00844-55879 Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 5535 Paid by: A -Z Enterprises, Nor -Pines Plumbing, PO Box 196, Drummond WI 54832 Payment Type: Check Transaction Date: 9/17/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-134S STATE SANITARY PERMIT OWNER: THOUSAND PINES PROPERTIES LLC G OV'T LOT: LOT: 1 B LK: CSM: 1943 SUBDIVISION: Csm #1943 SE 1/4 NE 1/4 SEC: 32, T 48 N, R 05 W TOWNSHIP: Barksdale SOIL TEST: 131-20 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: DOUGLAS MANTHEY TRACY POOLER DATE: 9/17/2026 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 €n 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 #: 24-113S LICENSE: # MP 230722 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 9/17/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION