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HomeMy WebLinkAbout26-136SIndustry Services Division County - 4822 Madison Yards Way Bayfield Madison, WI 53705 P.O. Box 7302 Sanitary Permit Number (to be filled in by Co.) Madison, WI 5302 (t a�j� 136S u ` 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 provid f ondary purposes in accordance with the Privacy Law, s. 15.04(1)(m). Scats. 1[C 23555 State Hl )1Wa 13 Cornucopia WT�54817 I. Application Information — Please Print All Information Mark Halvorson SEP 0 2 2026 Parcel# 04-010-2-51-06-35-1 02-000-10000 Property Owner's Mailing Address tsaylleld GO. Planning and Zoning Agenq Property Location 1005 b 88395 Huron St. Govt. Lot City, State I Zip Code Phone Number Corucopia WI 54827 715 -2O9 -O679 NW /,NE_'G Section 35 U. Type of Building (check all that apply) Lot!! ❑ I or2 Family Dwelling — Block # X Public/Commercial— Describe Use Bathroom 2 employees ❑ State Owned — Describe Use CSM Number Name ❑ Village of X Town of B I11. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if a livable. A. New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B' Holding Tank In -Ground ❑ At -Grade I❑ Mound ❑ Individual Site Design In Other Type (explain) (conventional) ❑ Change of PlumberList Previous Permit Number and Date Issued C. ❑ Renewal Before ❑ Revision ❑ Transfer mNew Owner Expiration IV. DispersaUTreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (so Dispersal Area Proposed (sf) System Elevation Capacityin Total # of Manufacturer Tank Information Gallons I Gallons I Units I I o cI I Iv New Tanks Existing Tanks m op v m aU I I IoIL V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. ADRIEN CADY 922139 715-373-2378 Plumber's Address (Street, City, State, Zip Code) y� 31160 itch Grove Road Washburn WI 548981 it I1 12.-b m p L VI. ounty/Department Use Only Approved ❑ Disapproved Permit ''// Fee Date atIssued /1 Issuing Agent Signat/urre1I/,�' /� ❑ Owner Given Reason for Denial $AD r H/ h/%tai /. - Y111l I f , rl i I V i// ,f1 1 rl / Su ovt4jed to complete oleos for the system on caner not less than 8 t/2 x - ' SOIL TEST # /a5- Wisconsin Department of Safety & Professional Services Page / of , \ Division of IndustryServices J') se Ov7O 14 SOIL EVALUATION REPORT J in accordance with SPS 385, Wis. Adm. Code Y Count / Attach complete site plan on paper not less than B 112 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I.O. scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. RMe.e9 by Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). I we; Property Owner 7 f �CAXi✓OW%bbr-ri I Go t. LotProperty LA location Y. N E V. S Property Mailing Address ^Property Owner's Site Address or CSM and Lot #:Site Addressor CSM and Lot #: State, Zip Phone Number I U City Town Date c/ T_5/ NR (p E (or) W Nearest Road ,3$'iewConslmdion Use: Qa4r Residential/Numberofbedrooms Code derived designflow rate 17� GPO ❑Replacement Allobwie or commercial—DDesscrib%: 6_ax Flood Plan elevation if applicable_ ______ R. Parent material________________________________________________ "- C�w(+l..oA'iiR. A. rJ �o-t a. •�c.1.d�C' General comments and recommendations: �Bodng Boring if Dpit Ground surface elev. 94V 'V F} Depth to limiting factor O in. / elev. 9 4_"_Ff 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 6-1 o A Lit ' R F Boring # 4boring Pit Ground surface eiev. �01 / F+ Depth to limiting factor_C in. I elev. F} Cdr A...a o.� Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistency CC @p� t �` tots GPD/Ft2 •Eff#1 Eff#2 / -/ 1 IO 3 z /_ y MG 21Z(6 ISayfield Co. aQt€ L4 y & Lx -(.a GEC. L,,iQ,Q�.C Q% CST Name (Please Prints I SignatureI CST Number Mark Palmer - High Cliff Consulting 224736 Address Date Evaluation Conducted Telephone Number P.O. Box 176 Galesville, WI 54630 7—/$_z G, j 608-582-2205 • Effluent #1=800>30 '220 mg/I, and TSS> 305150 mg/L Effluent #2 = BOO, 530 mg/L and TSSs 30mg/L SBO-8330 (R03/22) III Pag° of ❑❑ Boring Boring # ❑ Pit Ground surface elev. Ff Depth to limiting factorin. I elev. F -F Soil Anolicalion Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' *Eff#1 •Eff#2 ❑ Boring # ❑ Boring O Pit Ground surface elev. F7- Depth to limiting factor In. / elev. F} SoltAooli Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPO/Ft' E##1 F_ff#2 Boring # ❑ Boring J ❑ Pit Ground surface eiev. F¢ Depth to limiting factor in. / elev. FP Soil Annliratinn Rata Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/F1' •Eff#1 •Eff#2 Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 s 150 mg/L ' Effluent #2 = BOD. s 30 mg/L and TSS 5 30 mg/L PUG 212026 A gencY ptannl 0: nd ZM Mark Halvorson State Hwy 13 NW 1/4- NE Y4, Section: 35 T51N R6W Town of Bell, Bayfield County, WI Tax ID: 8005 23555 State Hwy 13, Cornucopia, WI 54827 HIGH CLIFF CONSULTING LLC 0 I e:CEIVED AUG 21 2026 Bayfield Co. Planning and Zoning Agansy 098.3 J aofdi 58.9 ° °fler P.O. Box 176, Galesville, WI 54630 608.582-2205 service@highcliffconsulting.com www.hlghcllffconsulting.com Drawn SJS I D715-2026 'J HALVORSON I .Z- Notes: • Undergmund utlilities not located as of this date. Funher research is recommended before any construction or excavation. • boundary inlbrmation is based on apparent property fines. A survey is recommended to determine hue property lines. • Location and elevation of building sewer(s) Is beyond the scope of Its report. • Pemal&za :37acesc Graphic Scale ( In feet) . Inds. 30 rt. Pibpo.,bmk 94.7: P2 Legend unnnn•In•tnl = Property line ........ ® = Pit . = BM (grade @ corner conc) �� Watsrnu, ® = Well (BM elev. at top) =Edge of fill Mark Halvorson (Holding Tank) 23555 State Highway 13 Cornucopia WI 54827 NW NE S35 T51N R06W Town of Bell 39.09 Acres PIN 04-010-2-51-06-35-1 02-000-10000 page 1-2: Bayfield county checklist page 3: Tax statement (for informational purposes) page 4-5: Soil and Site Evaluation page 6: Plot plan page 7-8: Holding tank details page 9: Holding tank management plans page 10: Holding tank servicing contracts page 11: Holding tank agreements page 12: Wisconsin sanitary application Reference material; SPS 381-387 POWTS component manual (Version 2.1) (May 2022-2027) RECEIVED SEP 022026 sayfied Co. Planning and Zoning Agency These plans prepared by ; Adrien Cady MP922139 31160 Birch Grove Road Washburn WI. 54891 phone:715-373-2378 fax:715-373-0646 8/13/26. 8:29 AM 1206.png 4.1 1 - FILTER LE 9AFRE � I ___________�1 t'Tyi,g7I T i WLP3000 TANK SPECIFICATIONS DIM ENSION5: WALL: 3' BOTTOM: 5' COVER: 6' MANHOLE: 24' I.D. PRECAST CONCRETE RISER ' HEIGHT: 62 .3/A' c LENGTH: 15•-A' WIDTH: B'-6' BELOW INLET: 50' LIOUID LEVEL: U' HEIGHT: BOTTOM 15,980 LBS. COVER 9.300 LBS. INLET AID OUTLET: $ A' CAST -A -SEAL BOOT OR EQUAL GASKET m $ INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAR #10 S o (OTHER STATES SEE CHART) W LIQUID CAPACITY: 69.77 GAL/IN HOLDING TANK: a OUTLET HOLE PLUGGED Y % ACTUAL CAPACITY: 3,140 GALLONS C i LOADING DESIGN: B•-0' UNSATURATED SOIL Y J TANK CAN BE USED AS SEPTIC / HOLDING / PUMP DR SIPHON COVER: DESIGN 98 (NO FIBER) " TANK: MIX I% DESIGN 99 (SMALL FIBER) eLVII jjH L n CUSTOMIZED TANKS: LIII FOR CUSTOM TANKS CONTACT WIESER CONCRETE �� +• KEY NOTES., (' CONCRETE OR E2 -SNAP RISERS (2 (A.) MANHOLE EACH END OR (I EA.) MANHOLE & (I EA.) i COUPLER OPPOSITE ENDS a AS RENEWED BY RENEW DATE IRAWINGS SUBMITTED FOR APPROVAL APPROVED IV: _ YQL' •• 'EAD"LL DATE: ) m'ETs REIDED Fr' - RECEIVED SEP 022026 Bayfield Co. Planning and Zoning Agency hftps://mall.google.com/mail/WO/?tab=rm&ogbl#inbox/FMfcgzQhVrFzxpkxdNtMwLkGshjXDHJG?projector-1&messagePartld=0.1 1/1 Page 2 HOLDING TANK SIZING CRITERIA BEDROOMS/COMMERCIAL DESCRIPTION I (3€LDRtJOt1h -4 8&-tntn w/ -� £r ,Pu�Yr-ss = (i(- GPD ESTIMATED DAILY FLOW X 5 MINIMUM REQUIRED PROPOSED 3a00 cr%u SV vwo• and Z HOLDING TANK SERVICING CONTRACT Contract Date This contract is made between the Holding Tank Owner(s) Name(s) Z2a.iA, Lc -mot - We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROTECT Legal Description: I!&IPit 't �1/4, NE 1/4, LOCATION (Use Tax statement), `it Ej�:�' Section .3 b ,51 N,Range 1, W Town of: •13 J Lot Size I Acreage ,Township ) Gov't Lot tons CSM # Vol. Page CSM Doc# Lot(s) No. Block(s) No. Subdivision: 1. The owner agrees to file a copy of this contract with Bayfield County as required In SPS 383.55, Wls. 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 servit tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the ti1kp sWith the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. SEP 0 2 2026 3. The pumper agrees to submit to the local government unit w,bich I ralgaed the pumping agreement required by SPS 383.55, Wis. Adm. Code, and the County, a report for the s lE°%a81 "ABRfliS7 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; RECEIVED b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; AUG 2 8 2026 d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; abnninpsandld Co. 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. Subscribed and Sworn to me: `�Fz.K NALVORt'c,nf >67 on this 9s11iday of ,o_; My commission expires on: "Tenn Revised: May 2016 (®May 2018) Drafted'by Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)I HOLDING TANK — MANAGEMENT PLAN The Private Onsite 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-1 0571 -P)(R.6/99) and the Bayfield County Zoning Department Sanitary and Private Sewage Ordinance. CEIVED This POWTS has been designed to accommodate a maximum aaaily BOW of I 7b gallons of domestic wastewater per day. SEP 0 22026 2. The owner of this POWTS is responsible for system operatioia %d co. maintenance, locking device, alarm and access. Planning and Zoning Agency 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. Maintenance Cycle. The holding tank must be serviced by licensed pumpers. An alarm system is to be installed to activate when the tank is c 90% full. 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 /4 Section Township N. Range b W. Town of_P., P (! Govt. Lot Lot Block Subdivision CSM# Additional gal iption N LJ NC Less Pay' fo ✓ Hwy 11i b0 - a,Ol7R-56964p Si? '3 (9_h Prope Owners Signature Date u/fonns/managementplan Revised: July 2013 S Document Number/Plan I.D. No. HOLDING TANK AGREEMENT Owner Name (a) Owner(s) Mailing Address 183 9.5 Nwt.s-n. /.eL&4i' f Q� vso-,tI � ti �'( sy 8x7 Parcel Identifier Number (PIN) Agreement Date (same as Notary Date) We acknowledge that application is being made for the Installation of (a) holding tank(! 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 onslte wastewater treatment system as permitted under Ch. SPS 383, WIs. Adm. Code or Ch. 145, Wis Scats. rV W' 1/4 of NI! G 1/4 Section S$ Township 5) N. Range �! W. Town of 0 f 1 Additional Legal Description: PaJw 2 4f OD$ Gov't Lot — Lot_ Block Subdivision CSM#_ Lot_CSM # Vol _Page _CSM Doc# DOCUMENT NUMBER 2026R-61 3523 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED O8/31/2O26 AT 8:OO AM RECORDING FEE: $30.00 PAGES: 1 Return To: RECEIVED SEP 012026 As an inducement to Bayfeld 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 fails 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 a. 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, Scats. 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. Scats., 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. 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. 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 affect 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. 6. 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 Subscribed and sworn to before me on this date: zV&rk (%4/✓rrsCrw ��1luunrrr, !�u us-i- , )-OaL . Notarized Owner ) — Signature(s) Notary Public ;t SEAL Ex My mmission Expires: „�, • Drafted by: /lg i /' cjI voi y / Date: "I rL'Oi I fl fl Personal Informeton you provide may be used for secondarypurposes (Privacy Law, e.15.04 (e(m)l ulfarnn/sanitarymoldingtankagmamonl.doc ®.tune 2018 Real Estate Bayfield County Property Listing Today's Date: 9/1/2026 2t Description Tax ID: PIN: Legacy PIN: Map ID: Municipality: SIR: Description: Recorded Acres: Calculated Acres: Lottery Claims: First Dollar: Zoning: ESN: Property Status: Current Created On: 3/15/2006 1:15:03 PM Updated: 9/5/2017 'a't Ownership Updated: 9/5/2017 8005 MARK HALVORSON CORNUCOPIA WI 04-010-2-51-06-35-1 02-000-10000 010108306000 (010) TOWN OF BELL S35 T51N RO6W NW NE LESS PAR FOR HWY IN DOC 2017R-569640 519 39.090 36.965 0 Yes (R-1) Residential -1 107 I Tax Districts Updated: 3/15/2006 1 STATE 04 COUNTY 010 TOWN OF BELL 044522 SCHL-SOUTHSHORE 001700 TECHNICAL COLLEGE Billing Address: Mailing Address: MARK HALVORSON MARK HALVORSON 88395 HURON AVE 88395 HURON AVE CORNUCOPIA WI 54827 CORNUCOPIA WI 54827 P Site Address * indicates Private Road 23555 STATE HWY 13 CORNUCOPIA 54827 ® Property Assessment Updated: 7/15/2025 2026 Assessment Detail Code Acres Land Imp. G1 -RESIDENTIAL 2.000 30,000 89,000 G6 -PRODUCTIVE FOREST 37.090 32,600 0 2 -Year Comparison 2025 2026 Change Land: 62,600 62,600 0.0% Improved: 89,000 89,000 0.0% Total: 151,600 151,600 0.0% , Recorded Documents Updated: 3/15/2006 a. Property History © TRUSTEES DEED N/A Date Recorded: 8/21/2017 2017R-569640 ® QUIT CLAIM DEED Date Recorded: 4/7/2014 2014R-553852 1123-372 © CONVERSION RECEIVED Date Recorded: 569-25 SEP 0 2 2026 Bayfield Co. Planning and Zoning Agency BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) ❑ Checklist ❑ Original Sanitary Application (Submitted in Deed Holder's Name — not prospective buyers) (383.21(1)1.) ❑ Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) ❑ Original Plot Plan (383.22(2)2. 3. & 4.a) ❑ Cross -Section, Overhead Profile of the System and Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) ❑ 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) ❑ ATU Servicing Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) ❑ Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) ❑ 1 Complete Set of Plans (Note: Sanitary Application — Maintenance Agreement & Service Contract are to be included in the copy packet) ❑ Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) 0 State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary ADolication: (Include the following Information) ❑ I Application Information must include: 0 (4 or 5 digit) Tax ID# -- (do not use 12 digits anymore --obsolete) ❑ Project Address or Road Name where driveway is/will come off of) ❑ II Type of Building ❑ III Type of Permit ❑ IV Type of POWTS System 0 V Dispersal / Treatment Area Information ❑ VI Tank Information ❑ VII Responsibility Statement (Plumber's Information) ❑ *Date Stamp* Plot Plan: (To Scale or To Dimension) ❑ Signature and Plumber Information ❑ Surface Elevation of Body of Water ❑ Direction and Percent Land Slope ❑ Tank and Filter Information and Location ❑ Wetlands / Navigable Bodies of Water ❑ Absorption Area (Proposed and Existing) ❑ Bench Mark (Location, Elevation and Description) ❑ Component Manual Version ❑ (Owners Phone Number) REceiveo SE? 022026 Bayeea co. Punning and Zoning Agency ❑ Address Number and Road ❑ North Arrow 0 Contour Lines ❑ Structures and Driveways ❑ Boring Locations ❑ Property Lines ❑ Well Locations ❑ Legal Descriptions ❑ Piping Material Information (conveyance line, building sewer line, material type and diameter) Turn Over ► Cross -Section and Overhead Profile of the System: -O Surface and System Elevation ❑ Position of Observation and Vent Pipes ❑ Dimensions and Depths ❑ Make, Model & Number of Chamber Units in each Cell Property Information ❑ How many systems will there be on this parcel of land? ❑ Has this property been split? (Property Statement shows Property History) Fees: ❑ Private Sewage System (Septic Tanks) $ 400.00 ❑ Private Sewage System (Holding Tanks) $ 400.00 RECEIVED ❑ Mounds or Systems requiring Pre -Treatment $ 500.00 ❑ Sanitary Revisions $ 25.00 SEP 0 22026 ❑ Private Sewage System Reconnection $ 50.00 Bayfield co. and Private Interceptor Planning and Zoning Agency ❑ Return Inspection $ 50.00 ❑ Maintenance Agreements • $ 30.00 (check should be made out to Reg of Deeds) a (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 4W, Town of Bayfield, described as a parcel in the NE'/ of the SE 1/i, Section 1, Township 23 N, Range 4 W, Town of Bell u/forms/checklists/checklistforsanitaryapps (®8/5/2026) 1 A-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: Submission Number: HALVORSON, MARK SR -00498 88395 HURON AVE CORNUCOPIA, WI 54827 Transaction Number: SR-00498-4CADB Description Certified Soil Tests - Review & Filing Fee Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 5514 Paid by: High Cliff Consulting LLC Payment Type: Check Transaction Date: 9/1/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-136S STATE SANITARY PERMIT OWNER: MARK HALVORSON G OV'T LOT: LOT: BLK: 1/4 1/4 SEC: 35, T 51 N, R 6 W TOWNSHIP: Bell SOIL TEST: 125-26 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: ADRIEN CADY EMILY MACGILLIVRAY Authorized Issuing Officer DATE: 9/17/2026 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: # MP 922139 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 9/17/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION