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HomeMy WebLinkAbout26-151SDepartment of Safety (� Count' A YI Ee''� & Professional Services, Sanitary Permit N her (to be filled in by Co.) � is I s Industry Services Division Sanitary Permit Application State Transaction Number In accordance with ST'S 383.21(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 arc submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. (o2 1'lS 1 4SCNt j)eCTA g I. Application Information — Please Print All Information Property Owner's Name €&JEE El's ?E(24 acC Parcel # Property Owner's Mailing Address ® ( U Property Location I. $, 0 " u F Govt Lot City, State Zip Clo�dee Phone Number A s H u - r) u3 c 4 84 b Y, Section �Z T N R 07 A W IL Type of Building (check an that apply) Lot # Subdivision Name l or 2 Family Dwelling — Number of Bedrooms L ❑ Public/Commercial — Describe Use BI6ck# ❑Cityof 6 ❑State Owned —Describe Use O Village of CSM Number VITown of 1) FL%A III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on Hue B. Complete Hoe C Ii applicable.) A. Mew System ❑ Replacement System ❑Other Modification to Existing System (explain) 0 Alain B' Holding Tank ❑ In -Ground ❑ At -Grade 0 Mound Lpndividual Site Design I ❑Other Type (explain) (conventional) C. Denewai Before ❑ Revision ❑Change of Plumber ❑transfer to New Owner ist Previous Permit Number and Date Issued Expiration IV. DispersaMeatmcut Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (s0I Dispersal Area Proposed (st) System Elevation Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units ,U'$ New Tanks Existing Tanks u U u Je S in rn Septic or Holding Tank oo tocaere ntt Dosing Chamber ji H H H H V. Responsibility Statement -I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si MP/MPRS Number I Business Phone Number IL&ttj-ILyriLAuy I ioo6SR3 l(T-663.0088 Plumber's Address (Street, City, State, Zip Code) 11, H I-{IU-RD &4pJ W i 5'i ir-' ounty/Department Use Only Approved O Disapproved Perm' Fee $ Date Issued Lssu' [ Si re Owner Givc¢ Reason for Dcni¢l �ioliqj2t-:,O Conditions of ApprovallReasons for Disapproval iisssaappproval t 'v✓ Ie (.{/p/� `„ Anacb to complete plain for the system sad saDmit to the county only on paper not Ina than 85/2 sit tachee In size 'O SBD-6398 (R. 03/22) RECEIVED ENT 0CT 14 2026 oO5- Baytletd Co. Soil Test # /_� Mme` ��AQw`c' Bayfield County b Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) I 1m a certified soil tester determine that in my professional judgment the fo owing 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. Property Owner kft&p. LrgspeyA Contractor Property Address 62!7S &Ago .DelIcL Authorized Agent M&90 -A ln/I , I'56 Agent's Telephone Telephone Written Authorization Attached: Y or N Accurate Legal Description is requested: 114 of 114 Section 1 oZ Township y6 N. Range 0? W. Town of Del �� Additional Legal Description: Govt. Lot Lot Block Subdivision Lot a CSM#&9Jo?Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# 3319/0 Acreage 1O Indicate reasoning for your determination: _Si \, coeS )1/DT mu -I- 4 11 Signature of ertified Soil Tester Date 6SIgnat7ure of Counjy Official 7 Date Certification # (Submit a Plot Plan & Fee) Wforms/soiitestwalver(KLK) June 2018 Wisconsin Department of Safety and Professional Services Page of 2 Division of IndustryServices SOIL EVALUATION REPORT In accordance with SPS 385, Wis, Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 Inches In size. Plan must Include, Bayfleld but not limited to: vertical and horizontal reference point (BM). direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. 04-016-2-46-07-12-4 04-000-14000 Please print all Information. Reviewed by Date Personal information you provide may be used for secondary purposes Privacy Law, a. 15.04(1)(m)). I Property Owner Property Location ❑ IZI Renee L'Esperance Govt. Lot i Y S 12 T 46 N R 07 E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: 908 6th Ave W 62175 Mason Delta Rd City State Zip Code Phone Number ❑ City ❑ Village 0 Town Nearest Road Ashland WI 54806 f Delta Mason Delta Rd Q NewConstructlon Use: [] Residential/Numberof bedrooms 2 Code derived deslgnflow rate 300 GPD ❑ Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material Loamy �jlaciofluvial deposits ovetj General comments and recommendations: Site does NOT meet A+4. Holding tank recommended. Boring # ❑Borin4 g Pit Ground surface elev. 99, 7 ft. Depth to limiting factor in.! elev. ft. nil Annftnonnn Onto 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 A 0-4 5YR 3/2 CL 2-cpr-c dh as 3f -lc -2m 0.4 0.6 B 4-6 5YR 3/2 c -2-d 2.5YR 5/8 CL 2-cpr-c dh as 3f -lc -2m 0.4 0.6 C 6-12 5YR 5/3 C 3-abk-vc dvh - - 0.2 0.3 LI] Boring # ❑Boring JPit Ground surface elev. ft. Depth to limiting factor in. / eiev. ft. .4'nll Annlirafinn Rata 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 Lin a Zoning AgenCY CST Name (Please Print) Signatur CST Number Tim Dykstra 1213855 Address Date Eval tion Conducted Telephone m er l Number 10620 Eagle Lake Rd Iron River WI g a 076 phone * Effluent #1 r BOO > 30 £220 mg/L and TSS > 30 £150 mg/L * Effluent #2 = BOD, £ 30 mglL and TSS 5 30 mg/L SBD-8330 (R04/21) L1Boring # ❑ Boring © Pit Ground surface eiev. ft. Page of.?........ Depth to limiting factor In. / elev. ft. I Soil Annllcation Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPD1Ft2 *Eff#1 *Eff#2 aBoring # ❑ Boring ❑ Pit Ground surface eiev. ft. Depth to limiting factor In.! eiev. ft. Anil AnnTInnfinn Onto Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPDIFt2 *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in.! eiev. ft. n11 Anntlonflnn Onfn Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 Effluent #1 = BOD > 30 6 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BODE s 30 mg/L and TSS s 30 mglL Bayfiela Co. Planning and Zoning Agency RECEIVED OCT 14 2026 Bayfield Co. Planning and Zoning Agency Reme G'Ep4r4zA'`e 62(7 5 idsa" Det R� ,son WX 'A'6 7�x10 3RSto Tvwn S 4eIf#.- vL ce )04.2O 6a� 444 lOj C51 ff /≥/8ds'5` EEPFARM )NSTRUCTION sdunlavy®yahoo.com SHEEPFARM Pit \Rl\G & 11%,.%(. Ilr,iItuJOR $ trk% ELECTRICAL CONTRACTOR D RESIDENTIAL MASTER ELECTRICIAN EtECIA 10108049 'arm Construction I.I.C. • 77794 Hill Rd . • Glidden, WI 54527 • Phone 715.663.0088 c AL.E 9 'i Q ti v ._/NML t t `p.0 AcRE bwlt%AsC eFC.LLa2! ntGrt R RECEIVED SEP 222026 Bay -field Co. Planning and 2oninn ,.r,rnoy AAA 251occEwEk LI#Jf I"%vLAKp G n¢e L ciµ of L tic a5ce �U-ar.�CokjCQ.ETC paobucts TAN. W, -TN R►4rmAt,, It -iEzm at.ARrh ELEcTQIIL-taAU ewtEa S,M't icC To rod of Qygsc - CtEijtLim ntcL:.S'bCWL D^ASoN DELTA [-u1'1 (nU1'i MASCaI.a'pfwf:TA(2D of Job NAIMI Es�_���A�P f3a F1161/�y�"/_T Ia_.t���,n . BayFlEw DexnpeonRer�cee L' e (i(�(✓e.. _ N, R�---- E , r. I . I Sign61uie . _ MP11006000 Dail 51'.pi It L Lb 9.r.• .: 4 HOLDING TANK — MANAGEMENT PLAN 'he Private Onsite Waste Treatment System (POWTS) has been designed and is to be nstalled and maintained according to SPS 383, Wisconsin Administrative Code. holding Tank Component Manual for Private Onsite Waste Treatment Systems (SBD-10571-P)(R.6199) and the Bayfield County Zoning Department Sanitary and Private Sewage Ordinance. This POWTS has been designed to accommodate a maximum daily flow of 30o gallons of domestic wastewater per day. 2. The owner of this POWTS is responsible for system operation and maintenance, locking device, alarm and access. 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. 5. Maintenance Cycle. The holding tank must be serviced by licensed pumpers. An alarm system is to be installed to activate when the tank is < 90% full. 6. 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 SEP 2 2 9W$hone numbers of local health authorities, component manufacturer POWTS service provider to be contacted in the event of component /`�� malfunction or failure. In the event that this POWTS or a component of this POWTS fails a be repaired the owner will find in the User's Manual the names ane numbers of property licensed individuals to contact for such repai, This agreement shall be binding on all assignees and heirs 114 of ___114 Seclton t- Tcwnsh�p9i' N. Range W. Town of DELTA Govt. Lot Lot aBlock, Subdivision _csMki!{ a1 Additional Legal Description jpl 1J r 2 c 2s12- 612 09-2PM U,c _ s_16 t _fate 77 y RMted: My 20') Sheepfarm Construction LLC. 77794 Hill Road Glidden, WI 54527 INDEX SHEET FOR HOLDING TANK SEPTIC SYSTEM PROJECT NAME: L'Esparance Holding Tank OWNER: Renee L'Esparance OWNER ADDRESS: 908 6`h Ave W Ashland, WI 54806 PROJECT ADDRESS: 62175 Mason Delta Rd Mason, WI 54856 LEGAL DESCRIPTION: LOT 2 CSM 2432 IN DOC 2025R-610480 IM DOC 2026R-610774 SEC12 T46N R07W TOWN OF DELTA 10.0a TAX ID#: 39810 PIN: 04-016-2-46-07-12-4 04-000-14000 CONTENTS 1. INDEX SHEET 2. PLOT PLAN SEP 222825 3. TANK CROSS SECTION Sayfield Co. 4. MAINTENANCE AGREEMENT Planning and ZcninaA cn�.y ®System is designed and to be installed and maintained according to In -Ground Soil Absorption Componenet Manual for POWTS Version 2.0 5BD10705-P (N.01/01) •All work is GUARANTEED to be done in workmanship quality by Sheepfarm Construction, by both Mike and Crew PLUMBER'S Michael S. Dunlavy M.P. #1006993 August 28, 2026 SHEEPFARM CONSTRUCTION msdunlavy@yahoo.com SHEEPFARM PLUMBING & HVAC ELECTRICAL CONTRACTOR CONTRACTOR & RESIDENTIAL MASTER ELECTRICIAN MP#1006993 ELECT# 1008049 Sheepfarm Construction LLC. • 77794 Hill Rd., • Glidden, WI 54527 • Phone 715.663.0088 tQ 1 S• C '1- 326 14 0 l3Ett. O1.► LcA-t1 ON PRVPOsEm adxa&Ft c —� K.IoR't H bM=&Asc nF Eclecrt.tc MnZ SEP 2 2 7.026 ApPQox 2S'0FSEwtll L,Nt I ti,SUL.A TCD G.srnte lTu O4,J. asco G.aILoti:, COMC ETE pQobucts ttNk Wrrt f{ A k mk,i. I io-tEt(oe. AC+4RIM ELL cTW c *QAN oMM Q,A&= loo' To Tod nF %45Q � %- — — — -- ecwTCl2 LINt of AccEss bt2wfc tAASotJ DELTA llD Eon- b2115 MA5olu bCLT& RD Job Name i ► SP& rr ^^ /� •• l`N n {{77 L. LCt Fire # 61-125- Town of ______F Countyof OA 16LD Description 1/4, 1/4, Sec. , T N, R E or W, Parcel ID# 202.G Signature MP#1006993 DateTl(1 Sheet o2 of RLCEIVEo SEP 222026 eaeid Co. Plannir3....J A9em_j 186.0' 7.0' 1 INLET 56.0' 3.0" 66.0" 2567 GALLONS 2567 50" so" =51.34 GALLONS/INCH LNE 50.0" LIQUID DEPTH ( N 24.0' • I 17.0' I 53.0' 1.) ALL TANKS ARE EFFLUENT FILTER COMPATABLE. 2.) OUTLET BAFFLES ONLY SUPPLIED PER REQUEST. 3.) 4" AND 6" MULTIPLE OPENINGS ARE AVAILABLE. 4.) NOTIFY WHEN DEPTH OF BURY IS GREATER THAN 72". FILE # 20070226 5.) 24AND 30" MANHOLE OPENINGS ARE AVAILABLE. WEIGHT = 18,000 LBS. 6.) NOTIFY WHEN INSTALLING IN EXTREME WET CONDITIONS. ONEIDA CONCRETE PRODUCTS HOLDING TANK - 2500 GALLON RHINELANDER. WI (800) 236-3124 02/09/10 ct.e3ocq 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-10571-P)(R.6/99) and the Bayfield County Zoning Department Sanitary and Private Sewage Ordinance. 1. This POWTS has been designed to accommodate a maximum daily flow of gallons of domestic wastewater per day. Ji:.r' L 2 2026 i lyfield Co. 2. The owner of this POWTS is responsible for system operation and Zoning Agency maintenance, locking device, alarm and access. 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. 5. Maintenance Cycle. The holding tank must be serviced by licensed pumpers. An alarm system is to be installed to activate when the tank is < 90% full. 6. 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 1/4 Section IL Township/4' N. Range d7 W. Town of DrE T4 Govt. Lot Lot a Block Subdivision CSM#& Additional Legal Description iof boC.2o'ZSR-6(Oy0© (,.n bocao1bk-G10-77y Property Owners Signature u/fortes/ma nagem entplan Revised: July 2013 Date HOLDING TANK SERVICING CONTRACT SEP 222026 Contract Date jtj>2tL 3C, 1Zo'Ltc This contract is made between the Holding Tank Owner(s) Name(s) c LEE A. L_t ESpcRANcc Baylield Co. Planning and Zoning Agency 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) PROTECT I Legal otion: Tax ID# �/ 3q$ I O 1/4, 1/4, LOCATION (use Tax Statement) /I b Town of: Lotsite I Acreage Section ,Township N, Range w DEI.Tf4 I o.o Gov't Lot I Lot # I CSM # I Vol. Page I CSM Doc # I Lot(s) No. I Block(s) No. Subdivision: 'a, Ia.y3aI I I Dt3c4 aoacfz G(o4&o ava(pR—(e(O 77 f' 1. The owner agrees to file a copy of this contract with BaVfield 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; CRAIG VISN0VEC b. The name of the owner of the holding tank; Notary Public c. The location of the property on which the holding tank is installed; State of Wisconsin 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. 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. )wner(s) Name(s) (Print) I Owner's Signature(s) I Subscribed and Sworn to me: (� on this i%t day of RENcE A. �SP�((i�i x ✓✓✓lllttt� i// by: ,NotaryPublic My commission expires on: Revised: May 2016 (®May 2018) Drafted by _______t�ytlgjJ fJ Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (I)(m)] HOLDING TANK AGREEMENT DOCUMENT NUMBER 2026R-613865 Document Number II Document Title DANIEL J. HEFFNER REGISTER OF DEEDS HAYFIELD COUNTY, WI RECORDED 09/22/2026 AT 1 1 :40 AM RECORDING FEE: $30.00 PAGES: 2 OCi U7 202 sayfPlanning eZocnn9 Aeenc! end Recording Area Name and Return Address RENEE L'ESPERANCE 908 6TH AVE WEST ASHLAND WI 54806 Parcel Identification Number (PIN) THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE. This information must be completed by submitter: document title. name & return address, and PIN (if required). Other information such as the granting clause, legal description, etc., may be placed on this first page of the document or may be placed on additional pages of the document. WRDA Rev. 12/22/2010 RECEIVED DocumentNumber/Plant.D.No. HOLDING TANK AGREEMENT Owner Name (s) Owner(s) Mailing Address REE£ A. 1- �SE'E2An1 Rob b�I^ A �! ASWA,3'a s&31 SV8n6 Parcel Identifier Number (PIN) 3, to I Agreement Date (same as Notary Date) '4 1Ur29b'tS1-%t 'Ftt+ OL,I tgax We acknowledge that application is being made for the installation of (a) holding tank(: on the following property or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Scats. 1147 of 1/4 Section 2 Township H (0 N. RangeO 1-7 W. Town of LLL'rA. Additional Legal Description: Gov't Lot _ Lot A Block Subdivision Lot CSM #2932Vo1 I Page 73 J CSM Doc# iatb a — W n —f, y OCT 072026 Bayfield Co. Planning and Zoning Agency CRAIG VISNOVEC Notary Public State of Wisconsin Return To: Rte U EsFk2A►acE ct O 6 6$' A:u E k AsiAL.awa(*3T SV$06 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 property 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. NR1 13, 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. 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 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: IZENc-g A - L`'ES?�2AwcE Al", 2bi-k4 '2O26 Notarized Owner(s) — Signature(s) Note Public My Commission Expires: 02/U/ 2.O3Q Drafted by: uN 1 G EL c V 1J Lt\'V V Date: & Q % L go r) �b Personal information you provide may be used for secondary purposes [Privacy Lew, s.15.04 (p(mll u formslsaritarylHoldingTankAgreement 4.2026 13A 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: L'ESPERANCE, RENEE A 908 6TH AVE W ASHLAND, WI 54806 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00532 Transaction Number: SR-00532-57CD6 Amount $50.00 Total: $50.00 Payment Amount: $51.95 Reference: 3881515165 Paid by: Tim Dykstra Payment Type: Credit Card Transaction Date: 10/14/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. P 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: L ESPERANCE, RENEE A 908 6TH AVE W ASHLAND, WI 54806 Description Private Sewage System (Holding Tanks) Submission Number: SS -00849 Transaction Number: SS-00849-55DC4 Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 1110 Paid by: Bear Construction Enterprises LLC, 5360 Cty Hwy B, Iron River WI Payment Type: Check Transaction Date: 10/14/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-151 S STATE SANITARY PERMIT OWNER: RENEE A L ESPERANCE GOVT LOT: LOT: BLK: 1/4 1/4 SEC: 12, T 46 N, R7 TOWNSHIP: Delta SOIL TEST: 154-26 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: MICHAEL DUNLAVY TRACY POOLER Authorized Issuing Officer DATE: 10/15/2026 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: # 1006993 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 10/15/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION