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HomeMy WebLinkAbout24-60S McCarver^n'^'- ?7">r-i1 xy^W/s/c '' (^.. •^-v*'<(^^^''.i^:^''- ^M M/V' Department of Safety & Professional Services, Industry Services Division^ County Bayfield Sanitary Permit Number (to be filled in by Co.)'^6>G£ Sanitary Permit Application In accordance with SPS 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 are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. State Transaction Number I. Application Information - Please Print All Information Project Address (if different than mailing address) 45145 Sugar Bay Drive Property Owner's Name Thomas A & Jeannie L McCarver Parcel# Tax ID: 24324 Property Owner's Mailing Address 11443 Zachary Lane N Property Location 4Govt. Lot City, State Maple Grove, MN Zip Code 55369 H. Type of Building (check all that apply) 0 1 or 2 Family Dwelling-Number of Bedrooms D Public/Commercial - Describe Use D State Owned - Describe Use. Phone Number 612-382-2026 _'/4,I4, Section 02 Lot #T 43 N R 06 EorW 1 Subdivision Name Block # CSM Number 723 D City of. D Village of 0 Tcnvn of Namakagon m. Type ofPOWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if| applicable.) New System Replacement System Other Modification to Existing System (explain)D Additional Pretreatment Unit (explain) B.D Holding Tank B In-Ground (conventional) D At-Grade D Mound D Individual Site Design D Other Type (explain) c.D Renewal Before Expiration D Revision D Change of Plumber D Transfer to New Owner List Previous Permit Number and Date Issued IV. Dispersal/Treapnent Area and Tank Information: Design Flow (gpd)^ 600 ^ Design Soil Application/Rate(gpd/sf) 0.7 v^ Dispersal Area Required 857.1 Dispersal Area Proposgd^sf) 900 System Elevati(g^ ^^ A:88.45 B:87.6 Tank Information Capacity in Gallons New Tanks Existing Tanks Total Gallons # of Units Manufacturer si!&s Its GO ~S -s sE 0 •G Septic or Holding Tank 1000 & 800 1800 Andry Rasmussen Dosing Chamber V. Responsibility Statement- I, the undersigned, a^an\c responsibility forjnstallation of the POWTS shown on the attached plans. Plumber's Name (Print) Douglas Manthey Plumber MP/MPRS Number MP 230722 Business Phone Number 715-739-6868 Plumber's Address (Street, City, State, Zip Code) PO Box 196Drummonct,WI 54832 VI. County/Department Use Only aApproved ^•5o-M d Disapproved D Owner Given Reason for Denial Permjt Fee;rmjtFee \, f\ Rate Issued /| Issuing Agent Signature;^J ^K'^^IJFiy'/S^ 74^o? conditions ofApproval/Reasons for Disapproval 'WN pia^ to ^w fii^ Ca^i:JT~"w\KT^ Wpa^- 3>)^sm) ^w ^ ^ ^^^my P^r ^PS 3^. Attach to complete plans for the system and submit to the County only on paper not less than 81/2x11 inches in size SBD-6398 (R. 03/22) VV's^-f'i ') Private Sewage System Maintenance Agreement Owner(s) Name Thomas A & Jeannie L McCarver Owner(s) Mailing Address 11443 Zachary Lane N Maple Grove, MN 55369 Site Address 45145 Sugar Bay Drive Cable, Wl Tax ID #24324 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 Wl Adm. Code, as from time to time amended. (COMPLETE Legal is required) JMof Additional Legal Description: Town of Namakagon Lot _ Block. .1/4 Section 02 Township 43N N. Range 06 W. (Acreage) 2.07 Gov't Lot 4 Subdivision Lot 1 ww-CSM # 723 Vol. 5 Page 98 CSM Doc # -8086^=589943 DOCUMENT NUMBER2024R-60337S DANIEL. J. HEFFNER REGISTER OF DEEOS BAYFIELO COUNTY, Wl RECORDED 05/28/2024 AT 1 1 :06 AM RECORDING FEE: $30.00 PAGES: 1 Recording Area Return To: "^ Planning and Zoning Department ^ ,-.!/0^ J<| In-ground gravity Mound In-ground dosed D In-ground pressure distribution Sewage System: D At-grade Sewage System D Other Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make such inspection, the tank is found to have less than one-third (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 serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds. At-arade. and In-around 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 by law. The terms and conditions of the agreement shall be binding upon and inure ^of all cCHVWt^iWrMfnre own fs of such property." Notary" Public Owner(s) Name(s) - Please Print J(2^n^l<i ^lc CArv'e* "n^ ^ M^ ^^^:. Flhdwy?Jan 31, 2028 iQli thi^date: ('^5 ' 1-5^0^1 Nptarized Owner(s) - Signature(s)Notary Public\[^^£^{{c^ My Commission Expires: ' 30L^_^1_W^ Drafted by: Douglas Manthey Date:05/10/24 Proofed by: u/forms/sanitary/septicmaintenceagreementRevised July 2020 and frontage along either side of Washington Avenue South and Cedar Avenue South between 14th Avenue South and 2 1/2 Street Southl and on Interstate 35W/State Highway 62 west of Nicollet Avenue, IMPORTANT: PAGE 4 OF 4 In-ground Gravity Management Plan j'''f;'i" ,' ,; ^ The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wise. Admin. Code. Pursuant to SPS 383.52 (2), Wise. 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), Wise. Admin. Code. Maximum Dispersal Area Operatina Limits: Design Flow = 60° gpd; BODg $ 220 mgL-1; TSS S 150 mgL-1; FOG <. 30 mgL-1 Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (/.e. odors, user complaints, ete.) o mechanical malfunction (/'.e., pumps, valves, switches, floats, etc.) o material fatigue (/.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (/.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (/".e., pump re-cycling, float switch settings, ete.) o electrical components - if applicable (/".e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or tateral 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, Wise. Admin. Code. o Effluent filterfs) 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 Wise. Admin. Code. Report any component failure or malfunction to: Name of individual or company: HK SeptlC _ phone: 715-798-3494 Local government unit: Bayfield County Zoning _ phone: 715-373-6138 Local government unit address: PO BOX 58 Washbum, Wl _ ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wise. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wise. 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, Wise. 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, Wise. Admin. Code. BAYFIELD COUNTS SANITARY PERMIT f#04)-24-60S STATE SANITARY PERMIT OWNER: THOMAS A & JEANNIE L MCCARVER GOVTLOT: LOT: 1 BLK: SUBDIVISION: Csm #723 1/4 1/4 SEC:2,T43N,R6W TOWNSHIP: Namakagon SOIL TEST: 48-24 REPLACEMENT SYSTEM SYSTEM TYPE: Non-Pressurized In-Ground PLUMBER: Douglas Manthey MCKENZIE SLACK DATE: 5/31,2024 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 230722 Condition: System to meet all setbacks. Management plan to owner. Existing Field to be abandoned per SPS 383. Properly maintain system per recorded agreement. THIS PERMIT EXPIRES 5/31/2026 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION ^-^ Wisconsin Department of Safety & Professional Services Division of Industry Services ;^|!;\t! j\^ ! L,l!iii:'''r I'^'i^ '••^y LL li'_^-'i.;i'Z.3 Page./-of_ SOIL EVALUATION REPORT MAY In accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 81/2x11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and percent slope, seals or dimensions, north arrow, and location and distance to nearest road. Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1 )(m)). County ^y//^.^ Parcel l.D.T^j./>^ ^vs^y Reviewed by Date Property Owner 7'^.o^as 4 oLt^l ^d/i, Property Owner's Mailing Address//^/3 2ea.c.^y ^<^ A/ Property Location iivt. Lot VA "D - W % s <^» T y^ N R o <o E (or) W I Site Address or CSM and Lot #: ^ 'S~/*^ S^ ^<A^r- &^Y D^. iy e'SAtf^^ ^ ^ r A n(''^ j^ ^r ^ City, State, Zip /^fa/s J^^ts- ^^ !y3<» Phone Number !_) D City D Village ^^1^1Q{^€L Town ^CZ^L. Nearest Road^^^<}Y P< Code derived designflow rate €*°C> GPD Flood Plan elevation if applicable. Q New Construction Use: B" Residential/ Numberof bedrooms 0 Replacement D Public or commercial - Describe:. Parent material ^& e,^ I T^V/ ft. General comments and recommendations:^-^>rr^t<^W/^/TY^^ ^ ^^^ /f f?'/-r^«=A /! ?t!' €> Boring #a BoringBP't Ground surface ele'J?./^L Depth to limiting facto/^^ in. / e\w^¥Yf~ Horizon Depth In. Dominant Color Munselt 2 y^ ^ Redox Description Qu. Az. Cont. Color Texture Structure Or.Sz. Sh. Consistence Boundary Roots 0-6 ^/-<^<^^^/^JL^-/*'/=r/?l ^^-^m ^L -?-XJ^y^^B\ /^-yy -yy.r^S/¥c^ $-y< 0'A,^ pr /^0 ^/t^r •</I/F. \ys~-/o%J£^5_0-.?^-0(< H-- s-\ 5,^ ji^.i/ -f\€^^ y-l/^<ste=^ ^Boring #QBoring 0Pit Ground surface elev,^ft _in. / elev.S^.Cft. Horizon _/__^3_~SL Depth In. e>-^ ^-^ ^0-Y^ ^-/oy 7f-/ Dominant Color Munsell 7^)y ^^^/T- w// ^ / ^s Redox Description Qu. Az. Cant. Color ^>/ r^. Texture s/ 1L. <§</ ^r-S J^•of Structure Gr.Sz. Sh. <L^^^56^/^wO.J<^ ^ -f- e-cf Consistence ^l/^ K M/^Z ^4<L »y ^o^- Boundary <fto h ».» &c- Roots •?w? )^^ /<^ fv/j 'C Soil Application Rate GPD/Ft2 *Eff»1~^~ <:<?3: *Effl»2 /•o /<?TTTT~& CST Name (Please-SR o( Alfct^w^^^^CST Number7S'a Yo^c> Address // 3 rl0 6e.H^c ^ Q.^ &<,C.ctf,/^ Wj: "s^f^'t "^Date Evaluation Conducted7,,^,.?^Telephone Number;^$--<-^7-//^ •' Effluent #1 = BOD > 30 S 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, & 30 mg/L and TSS £ 30 mg/L SBD-8330 (R03/22) Boring # D Boring0 Pit Ground surface elev. Paae-o?. of 3 .%/'^ft. Depth to limiting factor/^Lln./elev.^![/$~- Horizon -/ -23~ _i_ Depth In. <^ ^-?<s» 3b-^ ^»-/oS ~7T^ Dominant Color Munsell ^s-v<^ ft ^ -< ^- w y 5^.5 Redox Description Qu. Az. Cont. Color u^/ f^ Texture SJL!LScjL S^J J"^ MAY Structure Gr. Sz. Sh. -?At<^ ^ Mf sA^ /^.<A/^ <s>^^ y rf~ << Consistence /f^7< « «t^2- ^^ ^ ^ . Boundary ? t*!> (I t1 ffi<^~~ Roots •jyff ^F< tv A A^& Soil Application Rate GPD/Ft2 *Ef?1~^~ -<T » -^~r~ *Eff»2~f^~ -/^~ -*T ~m. Baring #D BoringD Pit Ground surface elev..-ft.Depth to limiting factor._in. / elev.__ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 *Ef?1 *Eff#2 Boring #D BoringD Pit Ground surface elev..-ft.Depth lo limiting factor.Jn. / etev._Jt. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft" *Eff»1_.*Ef»2 * Effluent #1 = BOD > 30 e. 220 mg/L and TSS > 30 & 150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS & 30 mg/L (ic'^ve^ /<xu^ ^^7- ^ /^ Voy^ p$<^C25/ ^-J.^ T^^ f^^r^ JS", ^ ..^ 5",^ ^ -^6 I? >ffS l&>m >f9 Y^^<o -=?-»<s»^i? ^"h 3>;<^>^ ^ vft ^ ^ ff<y/ = W^ '^a ^3 ^m ^sht-sh ^'S- ^c>$^ ^\^>/y ^-o i^/^o/ hV!hi' ^ <!-T ^Ji <^^o^ fl~a1^^y E7»'!7£^J-yc^o<>- 'X>Q ^" (/vJ.ft7 ^°^ vi.f f^^yj^ jgk ^ J5"/7 ^/ £^-^ ^J7 ,^.07 pi ?<3-y y^f^a. ^03 }te£37- ^S.-S^S /V\^f •9^^<9 ^/of)yw /V -aw7 ^^^->i>^ g^// ^>/»(/\!><>-»(y •7-s>,»wu>^ f^'y S.\>^r<?^J, 'ji~9i/rf)o ^ Sftk ^ h ,6»^5,.;' '.^/v^jr •^ ^^w<y\/ ^7 N 7 "' -' I \f Li s^£ w ^Q )9 ~W~s PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet M/i Component Manual Design References: In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg1 of 4 Pg2of4 Pg3of4 Pg4of4 Index & Cover Sheet Plot Plan Dispersal Area Cross-Section & Plan View Management Plan Attachments:Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description McCarver Replacement Cells Owner Name(s): Thomas & Jeannie McCarver _ Phone: 612 -382-2026 Owner Address: 11443 Zachary Lane N Maple Grove, MN _ Zip: 55369 Project Address: 45145 Sugar Bay Drive Govt. Lot: _ 1/4 of Township: Namakagon 1/4, Section_02_, T 43 N-R06 _E . County: Bayfield or W / Project Parcel ID #: Tax ID:24324 Designer Information Designer Name: Douglas Manthey _ Phone: 715 .739 -6868 Designer Address: PO Box 196 Drummond, Wl _ Zip: 54832 E-mail: norpines@cheqnet.net This space reserved for approval stamp. License Number: MP230722 Remarks: Signature:r^L^i f L^-^ Or^ir)$fl signature required on eacWTubmitted copy. 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Wt^ f^'y S- b^<?>/j \^'9um0 ^ -?'1t?sr^ ^ ,C>/»C,./' ~:»1^ ^^Wf^ 5^7 b •: ft IN-GROUND GRAVITY DISPERSAL AREA Stepped Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down-sizing credit) SOIL COVER Septjc Tank(s) Manufacturer: Andrv Rasmussen & Sons 1000 gal Septic Tank(s) Volume(s): 800 gal _ gal Effluent Filter Manufacturer: gal Orenco Effluent Filter Model #: 14B 12° min. trench depth(typical) Highest Trench TYPICAL TRENCHCROSS SECTION VIEW (No Scale) Lowest Trench (as applicable) System Elevations = 88.15 ft;87.6 ft;ft;ft; Provide minimum 3 ft separation between trenches. OBSERVATION PIPE DETAIL (No Scale) Screw-Type orSlip Cap (loose)Finished Grade(mulched & seeded) 4"0 PVC Pipe TYPICAL TRENCH PLAN VIEW (No Scale) (Show location of inlet / outlet pipe connection on plan view.) ff----f----m 4"0 Perforated Lateral (typical) -y/- Observation pipe shall be Installed at junction between two units. Observation Pipe(typical) 10 J- (typical) J. .ft Top of pipe to terminate at or above finished grade (4)1/4"-1/2"X6"Slots @ 90 apart • Anchoring Device Topsoil Cover(min. 1 foot) |L h- INSTALL PER TRENCH: -//- B= 90^ (typical) ft ^ T 10-ft bundles @ 50 ff EISA/unit = 450 5-ft bundles @ 25 ff EISA/unit =, ft2 ft2 h-A=3.0 ft J_ (typical) EZ1203H Bundle (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturer's instructions. -u>0m 000 = Proposed EISA per trench = 450 ft2 Required Infiltration Area = ^^-^ ft2 x trenches = Proposed Total EISA = 90° ft2 Distribution Method: branched manifold Bayfield County, Wl 5 PRPIO/Tax I&X LA KEFNttWWW imw/jTw;i6y,if32yi•WonMsmffje'A?)ieiyHiiccAfi 5/30/2024,10:56:57 AM ::-iM.~- Wetlands — Town pj Flood Plain Boundaries Active Dec 16th, 2011 ^gg AE = Base floodplain where base flood elevations are provided. -J Approximate Parcel Boundary Bu"din9 FootPrint 2015 0.01 1:1,313 0.03 0.06 mi Road Type ~^~ County Building 0.03 0.05 0.1 km Bayfleld County Land Records Department Bayfleld County Zoning ApplicationhUpsrf/maps.bayfleldcounty.wi.gov/ZoningWAB/ 5/30/24, 10:56 AM Novus-Wisconsin Access rev. 12.0206 Real Estate Bayfield County Property Listing Today's Date: 5/30/2024 m.Description ^ 1 04 034 041491 001700 Updated: 2/8/2022 Tax ID: 24324 PIN: 04-034-2-43-06-02-3 05-004-30000 Legacy PIN: 034104010001 Map ID: Municipality: (034) TOWN OF NAMAKAGON STR: S02 T43N R06W Description: LOT 1 CSM #723 IN V.5 P.98 (LOCATEDIN GOVT LOT 4) IN DOC 2020R-583043 Recorded Acres: 2.070 Calculated Acres: 1.963 Lottery Claims: 0 First Dollar: Yes Zoning: (R-l) Residential-1 ESN: 123 Tax Districts Updated: 3/15/2006 STATE COUNTY TOWN OF NAMAKAGON SCHL-DRUMMOND TECHNICAL COLLEGE m Ownership Property Status: Current Created On: 3/15/2006 1:15:47 PM Updated: 2/8/2022 THOMAS A & JEANNIE L MCCARVER MAPLE GROVE MN Billing Address: THOMAS A &JEANNIEL MCCARVER 11443 ZACHARY LANE N MAPLE GROVE MN 55369 Mailing Address: THOMAS A &JEANNIEL MCCARVER 11443 ZACHARY LANE N MAPLE GROVE MN 55369 y Site Address * indicates Private Road 45145 SUGAR BAY DR Property Assessment CABLE 54821 Updated: 3/25/2021 2024 Assessment Detail Code Acres Land Imp. Gl-RESIDENTIAL 2.070 330,800 276,100 2-Year Comparison 2023 2024 Change Land: 330,800 330,800 0.0% Improved: 276,100 276,100 0.0% Total: 606,900 606,900 0.0% « Recorded Documents Updated: 3/15/2006 S TRUSTEES DEED Date Recorded: 7/9/2020 B CONVERSION Date Recorded: 2020R-583043 565-274;603-101 Property History N/A https://novus.bayfieldcounty.wi.gov/access/master.asp?paprpid=24324 1/1 BAYFIELD COUNTS CHECKLIST FOR SANITARY APPLICATONS ! I ' '• . • "I Submit the R)llowina (Use Permanent Ink) (Title 15, Section 15-l-10(e)) p _ , ,;„ 1;;MA'. if •' ^'i/;i 'Check List B'-Onginal Sanitary Application (Submitted in Deed Holders Name - not prospective buyers) (383.21(1)1.) 0'lndex Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) B^riginal Plot Plan (383.22(2)2. 3. & 4.a) J3^Cross Section, Over-Head Profile of the System and Schematic of Tank from Manufacturer D Pump Tank Diagram, Alarm and Pump Curve (when applicable) B"Contingency Plan / Management Plan (383.22-3(2)(b)l.f.) D Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) D Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) D Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) D ATU Servicing Agreement (Recorded at Reg. of Deeds) (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) ^Comfi.tete Set» of Plans (383.22(2)(2.) (NoteLSanitary Application and Maintenance. Agreements are to be.attachect to all copies') B^oifand Site Evaluation Report (383.22-3(2)(b)l.e.) D State Plan Review (when applicable) D Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) I Application Information must include: d 23 digit Parcel ID# - fdo not use 12 digits anymore-obsolete) B'Project Address or Road Name where driveway is/will come off of) ^(Owners Phone Number) Q-TT Type of Building arfn Type of Permit B^fV Type of POWTS System Dispersal / Treatment Area Information D-VI Tank Information Responsibility Statement (Plumber's Information) D *Date Stamp* Plot Plan: (To Scale or To Dimension) &-5ignature and Plumber Information ZfAddress Number and Road Q^Surface Elevation of Body of Water Q^North Arrow C<M5irection and Percent Land Slope -flContour Lines Tank and Filter Information and Location ET Structures and Driveways /etlands / Navigable Bodies of Water Q^Boring Locations [yAb§orption Area (Proposed and Existing) 0 Property Lines C3^6ench Mark (Location, Elevation and Description) Q^Well Locations Manual Version Ofcegal Descriptions 'iping Material Information (conveyance line, building sewer line, materia! type and diameter) Turn Over > Cross-Section and Over-Head Profile of the System: ^TSurface and System Elevation ' O^osition of Observation and Vent Pipes M,A Q^imensions and Depths B^Make, Model & Number of Chamber Units in each Cell Property Information How many systems will there be on this parcel of land? J_ D-tias this property been split? ^ (Property Statement shows Property History) Fees: 'rivate Sewage System (Septic Tanks) $ 400.00 D Private Sewage System (Holding Tanks) $ 400.00 d Mounds or Systems requiring Pre-Treatment $ 500.00 D Sanitary Revisions $ 25.00 D Private Sewage System Reconnection $ 50.00 and Private Interceptor D Return Inspection $ 50.00 D Maintenance Agreements ^ $ 30.00 (checks made out to Reg of Deeds) u/forms/checklists/checklistforsanitaryapps (10/2009);(®7/20ll);(®2/2012)(®5/2/2012-dc) Proofed by: