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HomeMy WebLinkAbout26-152SDepartment of Safety & Professional Services, Industry Services Division Sanitary Permit Application In accordance with SPS 383.2l(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary numoses in accordance with the Privacy Law, s. 15.04(1)(m), Stats. County Sanitary Permit tumber (to be fi abH sa S State Transaction Number 'reject Address (if different than in S42Z0 Sck'll -✓' �A/rteS_ u)_L S' Je.-F-Fr l T T'k" 2.665 Property Owner's Mailing Address C.O Bayfield Co. Property Location Govt. Lot S A' 3 /., Section T f i S N R gE o W City, State P;h L. M I Zip Code Sso 6 3 Phone Number 6 12 - _! 6 S- L L 2S H. Type of Building (check all that apply) IZ I or 2 Family Dwelling —Number of Bedrooms Z 0 Public/Commercial — Describe Use Lot 4 Subdivision Name Block 4 ENTERED O I 0 City of 0 State Owned- Describe Use CSM Number ❑ Village of XTownof Barre S III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if a l'cable. A. New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding rank M In -Ground ❑ At -Grade ' ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before 0 Revision ❑ Change of Plumber ❑ Transfer to New Owner lst Previous Permit Number and Dale Issued Expiration Design Flow (gpd) Design Soil Application Kate(gpd/st) Dispersal Area Required (st) Dispersal Area Proposed (st) System Elevation o •'7 L{32- q .6 Capacity in _2 Total # of Manufacturer Tank Information Gallons Gallons Units a o v B New Tanks Existing Tanks u c u a U Septic or Holding Tank coo — i root ` 1t11 Dosing Chamber ..... - V. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) llal.1 col lock: Plumber' nature --- 7t * I -MP,'vlPR5 Number 22osQn Business Phone Number Its-Zq2-gt►S6 Approved I ❑ Disapproved Permit Fee I Date Issued )' Iss ng A t Sig mre l��r� ❑ Owner Given Reason for Denial $JOD /0/lb /2 r,; Conditions of Approval/Reasons for Disapproval �y 4QI d. Attach to coinplete otans for the system and submit to the Counts' only on saner not less than 8 1/2x SBD-6398 (R. 03/22) S pi- ooS3Lf °.,Meyer P SOIL TEST # /SS-2�,Pa e of 2. Wisconsin De artment of Safety& Professional Services 9 �o S Division of IndustryServices (p V ear') SOIL EVALUATION REPORT county In accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, I> G( but not limited to vertical and horizontal reference point (BM), direction and percent slope, itttD. Is — scale or dimensions, north arrow, and location and distance to nearest road. Z. 6 Please print all information. Re e b y /Date ,I -rsnnal Information you orovlde may be used for secondary ourooses (Privacy Law. s. 15.04(1)(m)). 7 71-i I �6/z Property Owner Property Location u P L I n LL.r ..t C .L Q . r., 1 L--; Govt. Lot`{ SWAB .$ W/i S ZU TS s N R C( E (or) W Property Owner's Mailing Address I Site Address or CSM and Lot #: II T h t: Road C 1220 Scl,'.II e.✓ Re'o. City, State, Zip Phone Number ❑ City ❑ Village M Town Nearest Road Rhe Ci M Sob (612)965-1125 bar tzS .S k;Ile✓ Rd M NewConstruction Use: 'Residential/Numberofbedrooms 2 Code derived designflowrate 3 OOGPD ❑ Replacement ❑ Public or commercial —Describe: Flood Plan elevation if applicable ft. Parent material C7 u T W cask Sand s General comments and recommendations: ENTERED ❑ Boring © Boring # ®Pit Ground surface elev 6.Oft. Depth to limiting factor 110 in. / elev.96.TJft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 •Eff#1 •Eff#2 -IL ID'1t3 — s o CS 3cc' . Ir 2 —I10 R`f — /. ® Boring # ❑Boring QQ [ Pit Ground surface elev. .Oft. Depth to limiting factor 11 Z in. / elev. 7ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GRID/Ft' *Elf#1 •Eff#2 o -lo !oY12.3/'( — Is 0cg di C_S 3coIr( z mot / - s — -7 1.6 0CT 15 2026 Byflctd Co. PL nning and Zoning Agen CST Name (Please Print) T P 1tcosk' Signature CST Number Address S i t S <—V J n'nl W WY $ Date Evaluation ConductedI 6-1�-Z6 Telephone Number Z10 -3q1 Ir.,,, wrs 00� Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 = NOD, 5 30 mg/L and TSS S 30 mg/L SBD-8330 (R03/22) T3 Boring # ❑ Boring ® Pit Ground surface elev l J • oft. Page 1 of 2 Depth to limiting factor 1 [ S in. I elev. "h7•�tft. I Soil Annlication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 o -Lo 10?f3/3 - Is LS •'7 l,6 'Z t s O S r • 7 if Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Soil Aonlication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS s 30 mg/L RECEIVED OCT 15 2026 Bayfield Co. Planning and Zoning Agency Combined Soil Evaluation/System Plot Plan Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 Owner: Jeffrey & Rita Lahti Site Address: 54220 SCHILLER RD, BARNES, WI 54873 Tax ID: 2665 Legal Description: A piece or parcel of land in Government Lot Four (4), Section Twenty (20), Township Forty-five (45) North, Range Nine (9) West, Town of Barnes, Bayfield County, Wisconsin, described as follows: Commencing at the Southwest corner of said Section 20 and from said Southwest corner along the west section line in a northerly direction a distance of 1300 feet to the one sixteenth (1/16) line for a place to beginning; thence North along the west section line of said Section 20 a distance of 225 feet; thence at right angles East and parallel to the One Sixteenth (1/16) line a distance of 200 feet to the shore of Little Tomahawk Lake; thence in a Southwesterly direction along the shore of Little Tomahawk Lake to the sixteenth line of said Section 20; thence in a westerly direction along the one sixteenth (1/16) line a distance of 138 feet to the place of beginning. --- Approximate property Line o Soil Test Pits: 1 - Elevation - 96.0' 2- Elevation - 96.0' 3- Elevation - 95.8' A Benchmark - Screw in oak tree Elevation - 100' Soil Evaluated By: Tom Polkoski -11068-ST. Plumber: Allan Polkoski - PMRS 220090 0 50 100 ft (P 3O %\\\ N II I II 2ii 0 N -� Gcfl ii 10 1 I Tank - Wieser WLP1 000 -MR Filter - PolyLoc PL -525 Existing Cabin II to be j Removed i All piping shall conform to SPS Table I j 384.30-3 and SPS Table 384.30-5 I I Proposed 2 Bedroom Home a C r 0 r a c O rn r r No existing wells on Property a r i C, Q r r r . ---- -- -- - - - - - - -- - - - - - - .�- -- - - - - - - - - - - — —r WLP1000-MR TANK SPECIFICATIONS 4" CAST - TANKS ARE MANUF _I DIMENSIONS: WALL: 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: 6,790 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: rwg WISCONSIN. SEE DETAIL #10 a ® ---1 �� (OTHER STATES SEE CHART) Cr - LIQUID CAPACITY: 27.83 GAL/IN o N rn n'1 HOLDING TANK: O 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) I OUTLET I I N R_ m P PAD CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE SIDE VIEW APPROVED By Glen Schlueter at 8:20 pm, May 30, 2022 ;EED ASTM C-1227 REQUIREMENTS w 0 W` U, r N U = z G.76 1 w a N r7 0 1 O H r00 W_ a 0< Q REVIEWED BY REVIEW DATE n. 3 F w N DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: SHEET NO. APPROVAL DATE: 1 PRODUCTS NEEDED BY: OF In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Page 1 - Index & Cover Sheet Page 2 - Combined Soil Evaluation -System Plot Plan Page 3 - Dispersal Area Cross -Section & Plan Page 4 - Management Plan Enclosures: Soil Evaluation Report, Sanitary Permit Application, Wieser WLP1 000 -MR approved tank specifications, Soil Test Checklist, Sanitary Application Checklist, $450 check Project Name / Description PAGE 1 OF 4 RECEIVED OCT 15 2026 Bayfield Co. Planning end Zoning Ag*nW Owner Name(s): Jeffrey & Rita Lahti Phone: 612-965-1125 Owner Address: 23276 TUNNEL RD, PINE CITY, MN 55063 Project Address: 54220 SCHILLER RD, BARNES, WI 54873 Legal Description: A piece or parcel of land in Government Lot Four (4), Section Twenty (20), Township Forty-five (45) North, Range Nine (9) West, Town of Barnes, Bayfield County, Wisconsin, described as follows: Commencing at the Southwest corner of said Section 20 and from said Southwest corner along the west section line in a northerly direction a distance of 1300 feet to the one sixteenth (1/16) line for a place to beginning; thence North along the west section line of said Section 20 a distance of 225 feet; thence at right angles East and parallel to the One Sixteenth (1/16) line a distance of 200 feet to the shore of Little Tomahawk Lake; thence in a Southwesterly direction along the shore of Little Tomahawk Lake to the sixteenth line of said Section 20; thence in a westerly direction along the one sixteenth (1/16) line a distance of 138 feet to the place of beginning. Township: Barnes County: Bayfield Project Tax ID #: 2665 Designer Information Designer Name: Allan Polkoski Phone: 715-292-4156 Designer Address: PO Box 522, Iron River, WI 54847 E-mail: tony@bearguidenorth.com tony@soil2septic.com License Number: PMRS220090 Remarks: PSSMA sent via USPS to Register of Deeds marked Return to: Planning and Zoning Departure t. Signature: � Date: f _ Original signature required on each submitted copy. Combined Soil Evaluation/System Plot Plan Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 Owner: Jeffrey & Rita Lahti Site Address: 54220 SCHILLER RD, BARNES, WI 54873 Tax ID: 2665 Legal Description: A piece or parcel of land in Government Lot Four (4), Section Twenty (20), Township Forty-five (45) North, Range Nine (9) West, Town of Barnes, Bayfield County, Wisconsin, described as follows: Commencing at the Southwest comer of said Section 20 and from said Southwest corner along the west section line in a northerly direction a distance of 1300 feet to the one sixteenth (1/16) line for a place to beginning; thence North along the west section line of said Section 20 a distance of 225 feet; thence at right angles East and parallel to the One Sixteenth (1/16) line a distance of 200 feet to the shore of Little Tomahawk Lake; thence in a Southwesterly direction along the shore of Little Tomahawk Lake to the sixteenth line of said Section 20; thence in a westerly direction along the one sixteenth (1/16) line a distance of 138 feet to the place of beginning. 0 50 8,i Sao m 3O As Existing Cabin to be 100 ft A H N Tank - Wieser WLP1000-MR Filter - PolyLoc PL -525 All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 --- Approximate property Line o Soil Test Pits: 1 - Elevation - 96.0' proposed 2 Bedroom Home 2 - Elevation - 96.0' i C 3 - Elevation - 95.8' i d O ' A Benchmark - Screw in oak tree i v Elevation - 100' I o N No existing wells on Property m I � I 2 Soil Evaluated By: Tony Polkoski - 11068 -ST Plumber: Allan Polkoski - PMRS 220090 mo CD 3 C O Q) v � Cr X CD IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers II 3 -ft Trench (down -sizing credit) SOIL COVER min. trench depth (typical) min. 12" (typical) — (typical) System Elevation = 92.0 (typical) Septic Tank(s) Manufacturer. Wieser Septic Tank(s) Volume(s): 1000 gal gal gal gal Effluent Filter Manufacturer: Polyloc Effluent Filter Model #: PL -525 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) ft Quick4 Standard -W w/ End Cap (fYPICaI) (Show location of inlet / outlet pipe connection on plan view.) T1=47 B=12=43 ft INSTALL PER TRENCH: (typical) Trench 1: 11 Quick4 Std -W @ 20 ft2 EISA/chamber + 220 Ift2 Trench 2: 0 Quick4 Std -W @ 20 ft2 EISA/chamber + 200 Trench : I Quick4 Std -W @ 20 ft2 EISA/chamber + fl2 Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturers I instructions. ®I A = 3.0 ft j (typical) TYPICAL TRENCH PLAN VIEW (No Scale) v 6 Quick4 Standard -W Chambeg Pair of end caps @6 ft2 EISA/pair = 16 I ft2 D� Pair of end caps @ 6 ft2 EISA/pair = 16 I ft2 2 Pair of end caps @ 6 ft2 EISA/pair =I Ift2 Required Infiltration Area = 1429 ft2 CD Cr rC cm N C" CPi rti z rn a Distribution Method: No. trenches = 12 I Proposed Total EISA = 1432 1ft2 Gravity 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 = 300 gpd; BOD5 5 220 mgL"1; TSS 5150 mgL"'; FOG ≤ 30 mgL-' Inspection Checklist INSPECT EVERY 3 YEARS - t L o typeofuse .LIVCb o age of system o nuisance factors (i.e. odors, user complaints, etc.) COT 15 2026 o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) in treatment tank(s) distribution Bayfield Co. 98sir lioni�� ro�%es) o solids volume anaerobic and any appurtenance(s) (i.e., 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 Wlsc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Iron River Septic Local government unit: Bayfield County Planning & Zon Local government unit address: Phone: 715-372-4006 Phone: 715-373-6138 117 E 5th Street, 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. (l.-00350 Private Sewage System Maintenance vwneg) rvanle The Jeffrey Francis Lahti and Rita -May Sparks=Lahti Revocable Living Trust Dated July 6, 2018 23276 TUNNEL RD, PINE CITY, MN 55063 54220 SCHILLER RD, BARNES, WI 54873 Tax ID # 2665 As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil tester's 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) 1/4 of 1/4 Section Additional Legal Description: Town of Township _N. Range _W. See attached Schedule C Lot_ Block Subdivision (Acreage) Gov't Lot Lot _ CSM # Vol. — Page _ CSM Doc # DOCUMENT NUMBER 2026R-61 4030 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 1O/O5/2O26 AT 9:53 AM RECORDING FEE: $30.00 PAGES: 2 Area Return To: z,Oni '5 De partmc-n Or ii+r. yr COIL 2 C P I r% � } In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ Other Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (+$per of installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other peamiEdrtt'Wake such inspection, the tank is found to have less than one-third (1/3) 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"s`�Ivir' d b' Acted above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Bayfield Co. Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessnAl98R9 te&PdR8 with manufacturers specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Was. 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 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 bylaw. The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such property. Owner(s) Name(s) — Please Print Subscribpd and sworn to before me on this date: Jeffrey Francis Lahti, Trustee eft Q i f gI Z07Zj Rita May Sparks -Lahti, Trustee U Notarized °�j'ne�r(�s)—Signature ) _ Notary Public _ - My Commission Aires: i 3'- ZZ30 ------------------------------- Drafted by: TONY POLKOSKI Date: 9-14 6 ---------'C NOTARY PUBLIC S tNESOTA My Corn. Exp. Jan 31,2030 Proofed by: AP u/Forms/sanitary/septicmaintenceagreement Revised July 2020 SCHEDULE C LEGAL DESCRIPTION A piece or parcel of land in Government Lot Four (4), Section Twenty (20), Township Forty-five (45) North, Range Nine (9) West, Town of Barnes, Bayfield County, Wisconsin, described as follows: Commencing at the Southwest corner of said Section 20 and from said Southwest corner along the west section line in a northerly direction a distance of 1300 feet to the one sixteenth (1/16) line for a place to beginning; thence North along the west section line of said Section 20 a distance of 225 feet; thence at right angles East and parallel to the One Sixteenth (1/16) line a distance of 200 feet to the shore of Little Tomahawk Lake; thence in a Southwesterly direction along the shore of Little Tomahawk Lake to the sixteenth line of said Section 20; thence in a=vesterly direction along the one sixteenth (1/16) line a distance of 138 feet to the place of beginning. RECEIVED OCT 067026 Bayfield Co. Planning and Zoning Agency Vw-AYFIELD Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: Submission Number: LAHTI TRUSTEE, JEFFREY F SR -00534 23276 TUNNEL RD• PINE CITY, MN 55063 SPARKS-LAHTI TRUSTEE,RITA M 23276 TUNNEL RD PINE CITY, MN 55063 Description Certified Soil Tests - Review & Filing Fee Transaction Number: SR -00534-58089 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 6369 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 10/16/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. HAYFIELD Property Owner: LAHTI TRUSTEE, JEFFREY F 23276 TUNNEL RD PINE CITY, MN 55063 SPARKS-LAHTI TRUSTEE,RITA M 23276 TUNNEL RD PINE CITY, MN 55063 Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Description Private Sewage System (Septic Tanks) Submission Number: SS -00866 Transaction Number: SS -00866-57E67 $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 6369 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 10/16/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-152S STATE SANITARY PERMIT OWNER: JEFFREY F LAHTI TRUSTEE GOVT LOT: LOT: BLK: SW 1/4 SW 1/4 SEC: 20, T 45 N, R 9 W TOWNSHIP: Barnes SOIL TEST: 155-26 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: ALLAN POLKOSKI TRACY POOLER Authorized Issuing Officer DATE: 10/16/2026 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: # 220090 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 10/16/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION