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Home My WebLink About26-139SSS- bc,%qI SBD-6398, Sanitary Permit Application 9/14/2026 6:45:31 AM E TERFD 1 9� l Introduction Wisconsin Department of Safety and Professional Services In accordance with Wis. Admin. Code sec. SPS 383.21(2)., submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Upon completion, you will be emailed a copy of the completed form for submittal. Include a complete plan on paper not less than 8 1/2 x 11 inches. Check with your local POWTS authority about additional requirements and fees. Note that applications for state-owned POWTS are submitted to the Department via esla.wi.gov. (Rev. 02/26/2026) General Information Applicant Name: Mike Wroblewski Email: mike@biglakeplumbing.com Owner Name: Carolyn Sneed Email: Phone Number: (715) 373-2537 Mailing Address Address Line 1: 78650 Bodin Rd Address Line 2: City: Washburn State: Wisconsin Zip: 54891 Project and Site Parcel ID: 34069 RECEIVrEO SEP 14 2026 I SSuud 91a4\oa6 Bayfield Co. Planning and Zoning Agency @4 108(46-01 State Transaction Number: PWTS- Project Address Address Line 1: 78650 Bodin Road Address Line 2: City: Washburn State: Wisconsin Zip: 54891 CSM and Lot Number: Lot 1 CSM #1640 Subdivision: Block and/or Lot: Legal Description: X Government Lot PLSS Gov. Lot: 1 & 2 Section: 521 & 22 Township: T49N Range (E or W): R04W Municipality Type: City X Town Village Municpality Name: Bayview County: Bayfield Building Type: X 1- or 2 -Family Dwelling Public/Commercial State -Owned Number of Bedrooms: 3 POWTS Permit RECEIVED SEP 14 2026 Bayfield Co. planning and Zoning Agency Permit Type: New System X Replacement System Other Modification to Existing System Additional Pretreatment Unit POWTS Type: X Holding Tank In -Ground (conventional) At -Grade Mound Individual Site Design Other Is there a previously issued permit?: Yes X No Dispersal/Treatment Area and Tank Estimated Flow: 300 GPD Tank Information Type: Septic X Holding Dosing New or Existing: X New Existing Material: X Prefab Concrete Site Constructed Steel Fiberglass Plastic Manufacturer: Wieser Concrete Holding Tank Capacity: 2000 Gallons RECEIVED SEP 14 2026 Bayfield Co. Planning and Zoning Agency Type: Septic X Holding Dosing New or Existing: X New Existing Material: X Prefab Concrete Site Constructed Steel Fiberglass Plastic Manufacturer: Wieser Concrete Holding Tank Capacity: 2000 Gallons Total Capacity of Septic Tanks: 0 Gallons Total Capacity of Holding Tanks: 4000 Gallons Total Capacity of Dosing Tanks: 0 Gallons Total Capacity of All Tanks: 4000 Gallons Total Number of Tanks: 2 Responsibility Statement Signature Plumber Name: Michael Wroblewski Plumber Email: mike@biglakeplumbing.com Phone Number: (715) 209-7521 Plumber Credential Type: X Master Plumber Master Plumber Restricted Service Credential Number: 1288503 - PM Address Address Line 1: 1491 County Highway C RECEIVED SEP 14 2026 Bayfield Co. Planning and Zoning Agency Address Line 2: City: Washburn State: Wisconsin Zip: 54891 By inserting my typed signature below, I attest that the information provided is complete and accurate to the best of my knowledge and belief. I, as the licensed plumber, assume responsibility for installation of the POWTS shown on the submitted plans. Electronic Signature of Plumber: Michael Wroblewski Date: 9/14/2026 RECEjvED SEP 14 2026 Plannin Yn'ekd Co. 9 and Zoning ;i:,;F,-,}, SR.- oOt0- K Soil Test # J 7 4 Bayfield County Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) I EDWARD J WROBLEWSKI a certified soil tester determine that in my professional judgment the following site (see below) is unsuitable for any treatment component other than holding tanks. Due to soil & site conditions, a thorough soil and site evaluation is not needed to make such a determination. ENTERED Property Owner CAROLYN SNEED Contractor ED'S MECHANICAL LLC Property Address Telephone, 7$(5 0 -78664-BODIN RD WASHBURN, WI 54891 715-373-2537 Accurate Legal Description is requested: SE 1/4 of NE 114 Authorized Agent EDWARD J WROBLEWSKI Agent's Telephone 715-209-4055 Written Authorization Attached: Y or Q Section 21 Township 49 N. Range 04 W. Town of BAYVIEW Additional Legal Description: LOT I CSM #1640 IN V.9 P.368 (LOCATED IN GOVT LOT 2 SEC 21 & GOVT LOT 1 SEC 22) Govt. Lot 1 Lot Block Subdivision Lot CSM# 1640 Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# 34069 Acreage 3.15 Indicate reasoning for your determination: CLAY SOILS .14 2026 Signature of Certified Soil Tester n,4 Agency Date SP -72000013 l Signature of C u ty Offi ' I ti V$ I(oC Date Certification # (Submit a. Plot Plan & Fee) u/forms/soiitestwaiver(KLK) June 2018 EDWARD J. WROBLEWSKI. CST #SP -72000013 SOIL T CAROI 78650 WASH LOT 1 2 SEC S21 T4 TOWN SCALE N i 0 0 0o a� T SHEET 3 OF 3 CONCRETE HOLDING TANK DESIGN Two Concrete Tank Option INDEX AND TITLE SHEET Project Carolyn Sneed - Holding Tank Owner Carolyn Sneed Address 78650 Bodin Rd Washburn, WI 54891 Phone: (715) 373-2537 Legal Description Lot 1 CSM #1640 in V.9 P.368 (Located in govt lot2 sec 21 &govt loll sec 22) Sec 21, T49N, R04W Township Bayview County Bayfield Subdivision Name Parcel ID Number 34069 Plan Transaction Number Lot No. RECEIVED Index and title sheet Page 1 Holding tank specifications Page 2 SEP 1 4 2026 Site plan Page 3 Management & Continency Plan Page 4 Bayfield co. Planning and zoning Agency Soil Test Page 5 Soil Test Plot Plan Page 6 Holding Tank Agreement Page 7 Holding Tank Servicing Contract Page 8 Holding Tank Specifications Page 9 Designer Michael l p blewski Signature Phone No. (715) 209-7521 License Number �aEB So 3 Date 09/14/26 Designed pursuant to: Holding Tank Component Manual For POWTS (Version 2.0) SBD-10855-P (N. 03/07, R. 01/12) Version 7.0(11/12) Page 1 of 9 HOLDING TANK SPECIFICATIONS Two Concrete Tanks In Series 3 If one- or two-family, number of bedrooms And/Or....Non-residential estimated flow per day 2000.0 Minimum holding tank volume required 4000.0 Total holding tank capacit proposed (gal) 2000.0 Tank 1 capacity (gal) IIX for round tanks 2000.0 Tank 2 capacity (gal) Wieser Concrete Products G, Inc. Tank manufacturer SJE Rhombus j Alarm manufacturer TA AB -01H IAlarni model number Tank lbs ICCLi t+LI) 4 Z026 Fa'rfeld Co. r-.. . ,and Zoning Agency lbs in Anchor Wt Soil Co, 12166 13.4 12166 13.4 HOLDING TANK CROSS SECTION iR Vent cap Manhole cover with locking device 122' min. 4" min. and warning label Finished grade Q� unction box T V pip 18min. 4 Blind plug to seal outlet opening Note: Manhole and vent locations may Inlet 12.0 in Tether be reversed. Service alarm on weight Manhole diameter is 23" min. 24.C i 2000.0 gal 2000.0 gal Tank2 Tank1 3 in. min. bedding undertanks. Anchortanks as necessary to negate buoyant forces. Electrical as per NEC 300 and SPS 316. Note: All tank joints, and joints between tank openings and piping are sealed watertight. Project: Carolyn Sneed - Holding Tank Transaction Number. Page 2 of 9 CAROLYN SNEED HOLDING TANK PLOT PLAN 8650 BODIN RD WASHBURN, WI 54891 LOT I CSM #1640 IN V.9 P.368 (LOCATED IN GOVT LOT 2 SEC 21 & GOVT LOT 1 SEC 22) S21 T49N R04W TOWN OF BAYVIEW, WI ere. c 4•-Rm RECEIVED SEP 14 2026 GARAGE COTTAGE FEXISTING SEPTIC SYSTEM PCNaroM 2' PVC &h 40 Pipe �T LAKE SUPERIOR BayfieldCO. W 2- Gelbn Ho rg Tanks 320 calbnp T� Planning and Zoning ggen WELL o `Ot HOUSE 0 1D 20 30 10 50 SOFT SHEET3OF9 HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to SPS 383, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10855-P 03/07, R.11/12), and the Bayfield County Sanitary Ordinance. 1. This POWTS is designed to accommodate a wastewater flow of 60.0 to 800.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the second tank reaches a level of 12" below the inlet invert (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and SPS 383 and 384 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 30 days. SEP 142025 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be saya_id Co removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes arming and zc,l;no Agency from this holding tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Connection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with SPS 383.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer ........................... Big Lake Plumbing Phone: (715) 209-7521 b. Service Provider ................Birch Birch Street Excavating & Septic Phone: (71'5) 373-5683 c. County Zoning or Health Dept. Bayfield County Zoning Phone: (715) 373-6138 11 Project: Transaction Number. Page 4 of 9 EDWARD J. WROBLEWSKI, CST#SP-72000013 SOIL TEST PLOT PLAN CAROLYN SNEED 78650 BODIN RD WASHBURN, WI 54891 LOT 1 CSM #1640 IN V.9 P.368 (LOCATED IN GOVT LOT 2 SEC 21 GOVT LOT I SEC 22) 521 T49N R04W TOWN OF BAYVIEW. WI SCALE 1" = 60' SEP 14 2026 e Planning and Zoning Agency 4 \ PO 0 SOIL BORING WELL o AGE EXISnN SCPTIC SYSTEM EXISTING 1000OOONSEPTIC TANKS LAKE SUPERIOR SHEET 3OF3 0 0 0 466 B0T WLP2000-MR TANK SPECIFICATIONS 164" 4" CAST -A -SEAL 4" CAST -A -SEAL ---� I a C — wI— INLET N N 3" FILTER OR BAFFLE—' TOP VIEW R1GEiVEU SEP 14 2026 Bayiield Co. Planning and Zoning Agency OUTLET iD c M I. SIDE VIEW PUMP PAD TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS DIMENSIONS: WALL: 3" BOTTOM: 5" COVER: 6" -� MANHOLE: 24" I.D. PRECAST CONCRETE RISER !' HEIGHT: 55" O.D. LENGTH: 164" O.D. WIDTH: 96" O.D. BELOW INLET: 43" O.D. LIQUID LEVEL: 36" WEIGHT: BOTTOM 14,060 LBS. COVER 8,170 S. a INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 56.27 GAL/IN S o o LL W 0 r N LOADING DESIGN: 8' 0" UNSATURATED SOIL Lu ca HOLDING TANK: C LI) OUTLET HOLE PLUGGED C ACTUAL CAPACITY: 2,138 GALLONS G.7 aU) < N M Ws o TANK CAN BE USED AS: W� SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE M z I Q o 0 0- D_ DRAWINGS SUBMITTEDI FOR APPROVAL APPROVED BY: SHFFT APPROVAL DATE: 1 PRODUCTS NEEDED BY: /OF 1 W320 -MR TANK SPECIFICATIONS 4-2' 4" CAST -A -SEAL I FILTER OR INLET _ pp N U I U) +v C.2 I i7 in I I 3" Li_ I _TJI r) CAST -A -SEAL RECEIVCU SEP 14 2026 Bayfield Co. a Planning and Zoning Agency L1 OUTLET D a OR EXCEED ASTM C-1227 DIMENSIONS: WALL 3"...°iL BOTTOM: 3" COVER: 4" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 58" LENGTH: 4'-2" WIDTH: 4'-2" BELOW INLET: 46 1/2" LIQUID LEVEL 43" WEIGHT: BOTTOM 3,015 LBS. COVER 870 LBS. u 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) bII W` r LIQUID CAPACITY: 8.00 GAL/IN N C ₹ LOADING DESIGN: 8'-0" UNSATURATED SOIL C 8 x TANK CAN BE USED AS: v o SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) c CUSTOMIZED TANKS: .. FOR CUSTOM TANKS CONTACT WIESER CONCRETE 3 J Q a O Z O M � F REVIEWED BY REVIEW DATE 3 w N DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: SHEET NO. APPROVAL DATE: 1 PRODUCTS NEEDED BY: / OF BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) Checklist �J 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)) 4 Original Plot Plan (383.22(2)2.3. & 4.a) Cross -Section, Overhead Profile of the System and Schematic of Tank from Manufacturer 0 Pump Tank Diagram, Alarm and Pump Curve (when applicable) Contingency Plan / Management Plan (383.22-3(2)(b)l.f ) ❑ Maintenance Agreement (Owner's Original Signature(s)) (383.21(2)(c)(6) (Recorded at Reg. of Deeds) AHolding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) J�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) \ packet Soil and Site Evaluation Report (383.22-3(2)(b) I.e.) 0 State Plan Review (when applicable) 0 Copy of Warranty/Quit Claim Deed (Optional) RECEiVEOL SEP 14 2026 Bayfield Co. Planning and Zoning Agency SanitaryApplication: (Include the following Information) I Application Information must include: (4 or 5 digit) Tax ID# — (do not use 12 digits anymore --obsolete) ttProject Address or Road Name where driveway is/will come off of) YQ (Owners Phone Number) II Type of Building 14 III Type of Permit IV Type of POWTS System V Dispersal / Treatment Area Information WWW f,t VI Tank Information \ II Responsibility Statement (Plumber's Information) *Date Stamp* Plot Plan: (To Scale or To Dimension) ] Signature and Plumber Information )Address Number and Road t� Surface Elevation of Body of Water ,qt North Arrow 0 Direction and Percent Land Slope ❑ Contour Lines Tank and Filter Information and Location X� Structures and Driveways Wetlands / Navigable Bodies of Water Boring Locations ❑ Absorption Area (Proposed and Existing) I Property Lines ❑ Bench Mark (Location, Elevation and Description) Well Locations Component Manual Versionegal Descriptions Piping Material Information (conveyance line, building sewer line, material type and diameter) T. Over ► Cross -Section and Overhead Profile of the System: ❑ Surface and System Elevation ❑ Position of Observation and Vent Pipes htips://www.bayfieldcounty.wi.gov/DocumentCenter/View/329/Checklist-for-Sanitary-Apps?bidld= 9/14/26, 6:16 AM Page 1 of 2 ❑ Dimensions and Depths ❑ Make, Model & Number of Chamber Units in each Cell Property Information VHow many systems will there be on this parcel of land? ,Has this property been split? t'3t) (Property Statement shows Property History) Fees: ❑ Private Sewage System (Septic Tanks) $ 400.00 Private Sewage System (Holding Tanks) $ 400.00 RECE!VC V ❑ Mounds or Systems requiring Pre -Treatment $ 500.00 1'� ❑ Sanitary Revisions $ 25.00 SEP 142076 ' 2026 ❑ Private Sewage System Reconnection $ 50.00 and Private Interceptor Bayfield Co. Planning and Zoning Agency ❑ Return Inspection $ 50.00 ❑ Maintenance Agreements I $ 30.00 (check should be made out to Reg of Deeds) I --I (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 %, Section 1, Township 23 N, Range 4W, Town of Bell NfonnslchecWitlelrherWinlfonanilan'appa (®d/513036i https://www.bayfieIdcounlywi.gov/DocumentCenter/View/329/Checklist-for-Sanitary-Apps?bided= 9/14/26, 6:16 AM Page 2 of 2 HOLDING TANK SERVICING CONTRACT Contract Date \ 3 \a6 Holding Tank Owner(s) Name(s) CGro\ Sneed This contract is made between the Pumper's Name (Print) Pumper's Signature Pumpers' Registration # We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT I Legal Description:O Tax ID# 1/4, 1/4, LOCATION (Use Tax Statement) U/ ` II JJ section ` LI N, Range `I Town of: Lot Size Acreage ,Township W Lxn` I Q ) Gov't Lot I I Lot It CM # I Vol. Page CM Doc # I Lotls) No. Block(s) No. Subdivision: 16/-1O 1 36B 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 to 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; SEP 142026 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; Planning,_,,'„r n9 A4encY f. The volumes in gallons of the contents pumped from the holding tank for each servicing; stills g. The disposal sites to which the contents from the holding tank were delivered. `S" NN Sg 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of. taft+Qe in thTs contract, the owner agrees to file a copy of any changes to this service contract or a copy of a nesic'&k44qtt with the local government unit and the County named above within (10) business days from the dateiange to this service contract. V: AV ��% BLIC Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed and Sworn to me: ii�h R "SSG on this LJ d y of S 11 S : byL) &JL Notary Public My commission expires on: 1 Revised: May 2016 (®May 2018) Drafted by Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (0(m)) Document NumbenPlan I.D. No. HOLDING TANK AGREEMENT JO -u 1o41N <O y W�,� buM Wrsye�(� Parcel Identifier Number (PIN) Agreement Date (same as Notary Date) 390A 9 I k a6 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 Stats. 1/4 of 1/4 Section -, Township -l-1 N. Range OH W Town of Additional Legal Gov't Lot _ Lot_ Block_ Subdivision t� csM #_ __Q vol 9 Page 368 CSM Docri �008i2 — DOCUMENT NUMBER 2026R-61 3637 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED O9/O4/2O26 AT 9:44 AM RECORDING FEE: $30.00 PAGES: 1 i BIG G r49r County Highway C L PLMBING n Washburn,WI 54891 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 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 s. 254.59, Stats., 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, Stats. 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 of 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 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 of the date of change to the service contract. SEP 1 4 2026 4. The owner agrees to contract with a person licensed pursuant to s. 281.4L8 (3) Wis. Stats., and Ch. NR 114, WI's Adm. Code who shall submit to the county within 30 days a report detailing the servicingof the holding tank.yfield 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. 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: 93 (ro L 1 P tS ��tttunni�,� Notarized Owner(s) — Signature(s) Notary Pubr �� ,,.»»•,.,, My Commi Ion Expires: /-� = -(/9,1: 7— �— 3O �7: At/ A� \- 1l - C Drafted by: /'A �P.II�COll\PI�1SI\t Date: QI'3 c�� 4O�• ,�r15�`� Personal information you provide may be used for secondary purposes (Privacy taw, s.15.04 (1I(m)] Wforms/sanitary/HOWingTenkAgreement' BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Followin4 (Use Permanent Ink): Check List 0 Index Page / Title Sheet (Optional) KOriginal Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) Original Plot Plan 0 Cross Section Soil Profile Sheet (optional) 0 Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) \7 Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used Property Owner's Information not prospective buyer's name) Property Location (Accurate Legal Description with Sec/Twp/Range) Road Name (where driveway is/will be coming off of) 0 Floodplain Elevation, Flow Rate, Comments and Recommendations Complete Soil Boring / Pit Information Date Soil Evaluation was conducted CST Name, Signature, Number, Address and Phone Number *Date Stamp* SEP 14 2026 Bayfield Co. rlanni!,g and Zoning Agency Plot Plan: (Include the following information drawn to dimension or to scale) 0 Bench Mark (Description, Elevation and Location) 0 Contour Lines (Example = 98.0' /96.0' /94.0') Property Location (Sec/Twp/Range/, Accurate Legal Description) Borings (Locations and Elevations) ❑ Percent and Direction of Land Slope Well Location (Including Neighboring Wells, if applicable) Location of Wetland Areas, Floodplain and Navigable Waters )I Buildings, Driveways, and Structures (Location and Descriptions) 'Location of Property Lines Existing System Location L Address Number and Road Name ❑ Current Surface Elevation of Wetlands and Navigable Waters ,1 CST, Owner and Property Information ,North Arrow Fee: Certified Soil Tests - Review & Filing Fee $ 50.00 U/farms/sanitary/checkiist/checkiistforests 13M FIELD 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: SNEED, CAROLYN 78650 BODIN RD WASHBURN, WI 54891 Description Certified Soil Tests -- Review & Filing Fee Submission Number: SR -00512 Transaction Number: SR -00512-5622F Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 3102 , Paid by: Ed's Mechanical, 1491 County Hwy C, Washburn WI 54891 Payment Type: Check Transaction Date: 9/24/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. B---,►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: SNEED, CAROLYN SS -00841 78650 BODIN RD WASHBURN, WI 54891 Transaction Number: SS -00841-56231 Description Private Sewage System (Holding Tanks) Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 3103 Paid by: Ed's Mechanical, 1491 County Hwy C, Washburn WI 54891 Payment Type: Check Transaction Date: 9/24/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-139S STATE SANITARY PERMIT OWNER: CAROLYN SNEED GOVT LOT: LOT: BLK: 1/4 1/4 SEC: 21, T 49 N, R 4 W TOWNSHIP: Bayview SOIL TEST: 137-26 REPLACEMENT SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: MICHAEL WROBLEWSKI EMILY MACGILLIVRAY LLIVRAY DATE: 9/24/2026 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 #: LICENSE: # MP 1288503 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. Old System needs to be properly abandoned per SPS 383. THIS PERMIT EXPIRES 9/24/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION