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HomeMy WebLinkAbout24-111SRequest for Sanitary Inspection (24 Hrs. in Advance) Fax this form to Zoning Dept (24 Hrs.) prior to when you want an inspection — (715) 373-0114 If you do not have a fax and must email the inspection; you must email all staff members. Note fl Time Change fl Discrepancy fl Other Phone Number 715-739-6868 Plumber: Douglas Manthey Fax Number Email Address Homeowner: Triangle J LLC norpines@chegnet.net Immediate Phone Number So Zoning Sanitary Dept can call you right back (if needed) Permit #: 24 -ills Plumber's Choice Zo Dept No Inspection(s) during this time Date: 08/18/25 C Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice g Dept Time: 1:00 Mason Township: Address # & Road Name: or �J 357/ 20095 Peterson Rd Directions To Site: Comments: * Plumbers you must verify any change(s) by fax or email ** Notes from u/fonns/sanitary/requestforinspection Zoning Dept (©4/12104); ® June 2023 r � WAY Industry Services Division General Information Permit Holder's Name: Tank TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road Septic I 7W f d N/A Dosing e N/A Aeration N/A Holding Private Onsite Wastewater Treatment Systems ( POWTS) Inspection Report (Attarh to PPrmlt) TRIANGLE) LLC 62675 CO HWY E MASON WI 54856 W I ►t o c/ setback to: of: County p /� Sanitary ermitNo. State Plan Transaction ID#: Parcel Tax No: 15/71 Pump I Siphon Information Pump Manufacturer ump Model Demand GPM Filter Manufacturer Filter Model TDH Lift Friction Loss Head Total Forcemain Length Dia Dist. To Well Dispersal Cell Information DIMENSIONS Width Length # of Cells l SETBACK FROM Pro . Line 97p e I 0 Type of Cell ov/r L C // Manufacturer: Model Number: Pretreatment Unit Manufacturer: Model Number: )istribution System Header I Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length _ Dia Length Dia Spec Spacing ❑ Yes ❑ No Elevation Data STATION BS HI FS ELEV Benchmark (0/, Bldg. Sewer :c Tank Inlet 93 g,2 Tank Outlet Z 6 Dose Tank Inlet Dose Tank Bottom Inst. Contour Header/ Manifold Distribution Pipe 3 - Infiltrative Surface I 3 Final Grade - S.Y X Pressure Systems Only Soil Cover Depth Over Depth Over Depth of Seeded / Sodded Mulched Cell Center Cell Edges Topsoil ❑ Yes 0 No ❑ Yes 0 No COMMENTS: (Include code discrepancies, persons present, etc.) /( 5y tM, ;h /ltMs¢ c4ks cj d,,'fc1 t A-trit-z Plan revision required? ❑ Yeso /> /g' S Use other side for additional inform l 17 Date POWTS Inspector's Signature CRn-R71n /R ngi911 License Number 411 BAYRELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoninciAbayfieldcountv.wi.00v Web Site: www.bayfieldcounty.wi.00v/147 Property Owner TRIANGLE I LLC Information 62675 CO HWY E MASON WI 54856 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know 8157 / r4#/(fc was contracted by you to install a private onsite wastewater treatment system on y ur property described as: Notes: Abandonment of Old System to meet all applicable code requirements: ❑ :• Tank was pumped by: C. Tank was crushed / removed and pipes disconnected by: ['11 at AM/PM On _____ at / (AM / ?the above -mentioned plumber contacted our office to conduct a pre -cover inspection as required under DSPS 383. One of the following applies: System was inspected and appears to meet all applicable code requirements. System was inspected and appears to meet all applicable code requirements; however, a plan revision is necessary because the installation was substantially different than the original approval. System could not be inspected because plumber covered prior to scheduled time of inspection. ❑ System could not be inspected because plumber was not ready at scheduled time of inspection. County was unable to return to complete inspection. System could not be inspected because plumber was not ready at scheduled time of inspection. A re -inspection and $50 fee are required. System could not be inspected because County could not respond to plumber's time constraints. Comments: UHorms/sanEta rypmpertyawner-input April 2019 Department of Safety County Ylg Ba eld & Professional Services, Industry Services Division Sanitary Permit Nu bar( be 1 in by ��Mnuy JULt2 5'1074 4 ermit Application State Transaction Number '3.2l(2), In accordance ti? 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 Project Address (if different than mailing address) 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), Slats. Peterson Rd Mason, WI I. Application Information — Please Print All Information Property Owner's Name Parcel # Triangle J LLC 35172 Property Owner's Mailing Address Property Location 62675 CO HWY E Govt. Lot City, State I Zip Code Phone Number Mason, WI 54856 203-560-7144 NE Y. SE i, Section 07 T 46 N R 06 E or EL Type of Building (check all that apply) Lot # ® t or 2 Family Dwelling — Number ofBedrooms 2 Subdivision Name ❑ Public/Commercial — Describe Use Block # , ❑ City of ❑State Owned —Describe Use O Village of CSM Number o Town of Mason III. Type of POWTS Permit: (Check either "New" or"Replacement" and other applicable online A. Check one box online B. Complete line Cif applicable.) A. I@ New System y ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B' ❑ Holding Tank ® In -Ground ❑ At -Grade I ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumberist ang ❑ Transfer to New Owner Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (st) I Dispersal Area Proposed (sf) I System Elevation 300 0.7 428.6 452 91.2 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units e o ' U New Tanks Existing Tanks a d 0,O tiva w i:. 0 Septic or Holding Tank 750 750 1 Wieser Concrete X Dosing Chamber V. Responsibility Statement- I, the undersigned, a me responsibility for install tion of the POWTS shown oa the attached plans. Plumber's Name (Print) I MP/MPRS Number I Business Phone Number Douglas Manthey MP 230722 715-739-6868 Plumber's Address (Street, City, State, Zip Code) PO Box 196 Drummond, WI 54832 LCounty/Department Use Onlypproved r!onditions ❑ Disapproved Permit Fee Dayu' g nt Si luree❑ Owner Given Reason for Denial ofA proval/Reasons for Disapproval Amch to complete plans for me system and submit to the County only an paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 03/22) 001119 � I1 �y�rnw•r-M- ,B�F �7 Wisconsin Department of Safety and Professional Services ." Uj Page of D ivision of industryServices JUL 2 E 2074 SOIL EVALUATION REPORT In accordance with SPS 385, Ws. Adm. Code County dQBBYf Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, F Parcel ID. scale or dimensions, north arrow, and location and distance to nearest road. 0421)( %q�C , Please print all information. dt IRe edrrsonal information you provide may be used for secondary purposes (Privacy La , s. 1m .. Property Owner Property Location El I' T/qn !e- T' LL C � Govt Lot % % S p -7 T 76 N R O(q E (or) W Property Owner's Mailing Address 62670 GD f/w7E Site Address or CSM and Lot #: ire s t rK •?O? (.(— 3-9 2 r4 $ /2? City I State Zip Code Phone Number ❑ City ❑ Village ® Town I Nearest Road filason L lys's- ( ) sd ® New Construction Use: Residential/Numberofbedrooms _ Code derived designflow rate 3MA-.PD ❑ Replacement ❑ Public or commercial- Describe: Flood Plan elevation if applicable ft. Parent material (T/acaa ) MN.Tivt5 General comments and recommendations: SYS 4 an ..fG. - 4Q 7/.,l & /j '/.e .e r/ enc4 $ w/ c' y - Boring# ❑Boring ®Pft Ground surface elev. ! ft. Depth to limiting factor' in. / elev.S.≤ Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 ,Eff#1 ,ETf#2 / 0Y 74r34 LS e9 slr 'e`?L bw fm a .? /•6 .Z •, S OS&r 'r /✓< .7 /14 3 -zz h y/ s CDS& 'r tr •1 /.� Y -o y y S o s6 e, .? l.6 FBoring # []Boring ®Pit Ground surface elev.`/y2 ft. Depth to limiting factor/d8 in. / elev?5.2 ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 Etf#1 •Eff#2 I. O - s' ),$)r,P l t5 o SG vh< Gov lNFF .'7 /-F .n -/o , sT S rt .r .— r? 1._a CST Name (Please Print) Za4 Signature CST Number s/'Owl000d c : t Address /1340 o`"°be54alp Date Evaluation Conducted Telephone Number CG6! lc/ . C- z r I — /— Effluent #1 = BOO > 30 '220 mg/L and TSS > 30 5150 mg/L • Effluent #2 = BOD, s 30 mg/L and TSS 5 30 mg/L SBD-8330 (R04/21) ❑ 9cg# IIIL'JQPit il ,IiiL L 620Y4 Page 2 of Ground surface eiev. 6ft. Depth to limiting factor'Ogin. I elev.W £ at. Horizon epth In. O-% Dominant Color Munsell ?.r7 s Redox Description Qu. Az. Cont. Color Texture G S Structure Gr. Sz. Sh. os c Consistence Boundary 64' Roots /v,, uUll npp11UCYUn Rate GPD/Ft2 •Eff#1 •Eff#2 i.6 3 8-39 3, -log '//y S s u w K a 9 /.C !. L ❑ Boring # o Boring Pit Ground surface elev. R. 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 son Appllcaiian Rate GPD/Ft2 •EI1#2 ❑ Boring# ❑ Boring . ❑ Pit Ground surface eiev. ft Depth to limiting factor n. / elev_ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Or. Sz. Sh. Consistence Boundary Roots Jvll /{ppllUauun Rare GPD/Ft' •Eff1 •Eff#2 Effluent #1 = SOD > 30 ≤ 220 mg/Land TSS > 30 ≤150 mg/L K llrt-cC �ct 'sT ' s,"- ot21 0000f * Effluent #2 = SOD, ≤ 30 mg/L and TSS £30 mg/L 3I3 ,"°6 fe T LLB JUL 2 UZ024 6016 ys to Hwy € Masoti W -r --q ps,6 Bayfield Co. Zoning Dept. Town of hgcon /&7g,() cat 507 r46NRoow /l/E St liZ ?DZlg'- s9.ztb 8 S i is # C t'er $OMM %L! /w rtddre sr /7oCi / %st V" as,' t, eC vh 5oit44 5%c% e/ 9'.z is 9q2 83 91fG yroK• eL) Ec � /t %,G cja; SYSt,., eL 102 I.' a I 3'/i 5/°l'6 7 fr/r., tc/ i4uel, cS'T* s/'o/zlmoanl woe! .2 Bd le h om e d E l In -Ground Gravity Plan _JJL z t -UUJ/ Index & Cover Sheet Bayfield Co Zoning Depi Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Pg 2 of 4 Pg3of4 Pg4of4 Attachments: PAGE 1 OF 4 Index & Cover Sheet Plot Plan Dispersal Area Cross -Section & Plan View Management Plan Wieser Tank Specifications I POWTS Application for Review Soil Evaluation Report & Site Map Project Name I Description Triangle J/DiNino Conventional Owner Name(s): Triangle J LLC Phone: 203 560 _7144 Owner Address: 62675 CO Hwy E Mason, WI 54856 Zip: 54856 Project Address: Peterson RD Mason, WI Govt. Lot: NE 1/4 of NE 1/4, Section 07 , T46 N -R 06 E ❑ or W ❑✓ Township: Mason Project Parcel ID #: 35172 County: Bayfield Designer Information Designer Name: Douglas Manthey Designer Address: PO Box 196 Drummond, WI E-mail: norpines@chegnet.net License Number: MP 230722 Remarks: Phone: 715 -739 6868 Zip: 54832 nce t -g approval Conditt��'D APPGR COUNTY Signature: Date: 07/18/2024 Origi al signature require o each submitted copy. Par 2o 49 Sc4e I ", 90 Owner Ti'rliny(e S LLG O 4� c.2'7rColfwyE Ma5ov/ WT Sg85,6 - }.kw Sysew. - Town of Theoh 7gjj tot Soft r46,(v Koi w OUE sir r yi ,Zd.2 r /2- 5-92 lb 8 /z Pcterso+t go�reSf /3t lOo �a 9ya 13 9t 5s'.z 5YSleo, ei 9/•.2 2 cells t\ Qt ck / CLxw .6ecs Earl, bt 4"Sc-1.4o oc SDQ 35 PUC 3'/o 5Idle rr �%'laanuo. I _ Gcounck Sa;l A sarPp;ot- }ar PDWT5 Vecsto. 2.1 /VP 23D92z 9/S,5' 5octf4l 5 %C% JUL 2 6?0z4 Bayfield Co. Zoning Dept. ' ;v- wecl lot m 9- IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER 2" min. trench depth typical) min. 12" (typical) r 34" (typical) System Elevation = 91.2.2 (typical) Septic Tank(s) Manufacturer: Wieser Concrete Septic Tank(s) Volume(s): 750 gal gal gal gal Effluent Filter Manufacturer. Orenco Effluent Filter Model #: 14B TYPICAL TRENCH CROSS SECTION VIEW (No Scale) ft Quick4 Standard -W w/ End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) L--------------------��--- B= 46 ft (typical) INSTALL PER TRENCH: 11 Quick4 Std -W @ 20 ff EISA/chamber= 220 ft' + 1 Pairs of end caps @ 6 ff EISA/pair = 6 = Proposed EISA per trench = 226 x2 ft2 ft2 d fi]i CD n C_ r- C-) r P N n1i N c Provide minimum 3 ft g. c separation between trenches. E a C In co Observation Pipe (typical) Install per manufacturers / Instructions. TYPICAL TRENCH PLAN VIEW (No Scale) TA= (typical) "—Quick4 Standard -W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. Required Infiltration Area = 428.6 ft2 trenches = Proposed Total EISA = 452 ft2 Distribution Method: branched manifold C) m W 0 m a 4" CAST -A -SE WLP750-MR TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1/2" BOTTOM: 3" CAST -A -SEAL COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 54" OUTSIDE DIAMETER: 7'-0" BELOW INLET: 42" LIQUID LEVEL: 37" WEIGHT: BOTTOM 3,740 LBS. COVER 2,410 LBS. 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) LIQUID CAPACITY: 20.28 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 790 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) tTOUThT r U I a= o PUMP PAD CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL, DATE: PRODUCTS NEEDED BY: 0- ) VI ' 1 1 ARE MEET U) ( JUL U 3 CERTIFICATE OF AUTHORITY The undersigned, being duly sworn, and in his capacity as Co -Manager, hereby certifies that the following information is true and correct: 1. Triangle -J, LLC (the "LLC") was created on October 18, 2021, with the Wisconsin Department of Financial Institutions. 2. The members of the LLC are Theodore Jay Jones and Rachel Floran. 3. The Co -Managers of the LLC are Theodore Jay Jones and Rachel Floran. 4. Section 7.2 of the LLC Operating Agreement indicates that the Co -Managers may act independently. 5. Attached to this certification are true copies of the Articles of Organization of the LLC and pages of the Operating Agreement designating the Co -Managers of the LLC and the authority of the Co -Managers to act independently. This instrument is signed on July 02, 2024. Theodore Jay Jones, Co -Manager ,,���M APP/?/ "°•,s. Subscribed and sworn to before me by ��Q; 4 ,'• Theodore JayJones on July 02, 2024 = `,O�ARr '18 /Zft/frkJi Print Name: Tara M. Apprill State of Wisconsin County of Ashland My commission expires: 08/26/2025 shall take account of any variation between the asset's adjusted basis for federal income tax purposes and its Asset Value as so adjusted in the same manner as under Section 704(c) of the Code and the Regulations thereunder. (e) Elections. Any elections or other decisions relating to the allocations shall be made by the Manager(s) in any manner that reasonably reflects the purpose and intent of this Agreement. (f) )mnuted Interest. To the extent the Company has interest income or deductions with respect to any obligation of or to a Member pursuant to Section 483, Sections 1271-1288, or Section 7872 of the Code, the interest income or deductions shall be specially allocated to the Member to whom the obligation relates. ARTICLE 7- MANAGEMENT OF THE COMPANY Section 7.1 Management. Except to the extent otherwise provided in this Agreement, management of the Company is vested in its Manager(s). No Member shall have any right or power to take part in the management or control of the Company or its business. Except as such authority may be limited under this Agreement or by Majority Consent, the Manager(s) shall have full and complete authority to manage the business of the Company, to make all decisions regarding those matters, and to perform all other acts customary or incidental to the management of the Company's business. Members have the right to vote only on those matters expressly set forth in this Agreement or as required by the Act. Except for the initial Manager(s), the Manager(s) shall be elected by the Members in accordance with Section 7.3. Section 7.2 Identity of Initial Manayer(s) and Number of Manager(sl. The initial Manager(s) shall be Theodore Jay Jones and Rachel Floran. The number of Manager(s) shall be determined by the Members. Whenever two or more Managers are serving, such Managers may act independently. Section 7.3 Term of Managers) and Election of Successor. (a) Unless otherwise provided by Majority Consent, a Person shall cease to be a Manager upon the earliest to occur of any of the following: (a) the Manager's voluntary resignation effective as of the prospective date provided in a written notice from the Manager to the Company; (b) the Manager's removal as such by Majority Consent; or (c) the Manager's (i) death or (ii) incompetency as set forth in Section 183.0802(f)(2) of the Act. (b) At any time no Manager is acting, a new Manager shall be selected by Majority Consent. If a Manager is removed by Majority Consent pursuant to the provisions of Section 7.3(a) above, the Members shall at the time of such removal appoint a successor Manager by Majority Consent. {W2927s75.nocwi) -15- Sec. 18§.0202 Wis. Stats. State of Wisconsin Department of Financial Institutions ARTICLES OF ORGANIZATION - LIMITED LIABILITY COMPANY J U L 0 82 u /4 Executed by the undersigned for the purpose of forming a Wisconsin Limited Liability Company under Chapter 183 of the Wisconsin Statutes: Article 1. Name of the limited liability company: Triangle -J, LLC Article 2. The limited liability company is organized under Ch. 183 of the Wisconsin Statutes. Article 3. Name of the initial registered agent: T. Jay Jones Article 4. Street address of the initial registered office: 62675 County Highway E Mason, WI 54856 United States of America Article 5. Management of the limited liability company shall be vested in: A manager or managers Article 6. Name and complete address of each organizer: Melissa S. Kampmann 500 N. First Street Suite 8000 Wausau, WI 54403 United States of America Other Information. This document was drafted by: Melissa S. Kampmann Organizer Signature: Melissa S. Kampmann Date & Time of Receipt: 10/18/2021 1:29:57 PM ARTICLES OF ORGANIZATION - Limited Liability Company(Ch. 183) Filing Fee: $130.00 Total Fee: $130.00 ENDORSEMENT State of Wisconsin Department of Financial Institutions EFFECTIVE DATE 10/18/2021 FILED Entity ID Number 10/18/2021 T093533 BAYFIELD COUNTY n 0 0 0 CHECKLIST FOR SANITARY APPLICATONS JUL 262024 Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) Check List Bayfield Co. Zoning Dept. 2"6riginal Sanitary Application (Submitted in Deed Holders Name — ngtt prospective buyers) (383.21(1)1.) ❑"index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) I- Original Plot Plan (383.22(2)2. 3. & 4.a) ss Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) -contingency Plan / Management Plan (383.22-3(2)(b)1.f.) IT Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) k ety_)Ne r- 0 Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) ❑ Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) pFe (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) Cr3.1 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) L 'soil and Site Evaluation Report (383.22-3(2)(b)1.e.) 0 State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) [WI Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) 0-rroject Address or Road Name where driveway is/will come off of) ❑jDwners Phone Number) alt Type of Building U41/ Type of Permit f-iV Type of POWTS System R V Dispersal / Treatment Area Information a' % Tank Information l VII esponsibility Statement (Plumber's Information) Pl *Date Stamp* Plot Plan: (To Scale or To Dimension) Signature and Plumber Information ❑ Surface Elevation of Body of Water Jrection and Percent Land Slope nk and Filter Information and Location 0 Wetlands / Navigable Bodies of Water 2' bsorption Area (Proposed and Existing) ❑Bench Mark (Location, Elevation and Description) ff Component Manual Version V ❑ Address Number and Road 11Gorth Arrow ['Contour Lines B'Structures and Driveways Boring Locations t$roperty Lines �' 'ft C] Well Locations IJC) l Q,Legal Descriptions Turn Over ► Cross -Section and Over -Head Profile of the System: ps&Urface and System Elevation C_L,Position of Observation and Vent Pipes VDi�Dimensions and Depths Cd'Make, Model & Number of Chamber Units in each Cell Property Information It flflfl JUL 2 b 2024 Bayfield Co. Zoning Dept. plow many systems will there be on this parcel of land? B'Has this property been split? Jo (Property Statement shows Property History) C3 Private Sewage System (Septic Tanks) $ 400.00 ❑ Private Sewage System (Holding Tanks) $ 400.00 ❑ Mounds or Systems requiring Pre -Treatment $ 500.00 ❑ Sanitary Revisions $ 25.00 ❑ Private Sewage System Reconnection $ 50.00 and Private Interceptor ❑ Return Inspection $ 50.00 ❑ Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) u/forms/cheddists/check stfrsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: _ BAYFIELD COUNTY SANITARY PERMIT (#O4)25-ItQS a�- Ills STATE SANITARY PERMIT OWNER: ORTMAN, MONTE L & OLSON, ROSEMARY S GOVT LOT: LOT: 63 & 64 BLK: SUBDIVISION: Namakagon Lake Shore Subdiv 1/4 1/4 SEC: 15, T 43 N, R 6 W TOWNSHIP: Namakagon SOIL TEST: 109-25 OTHER MODIFICATION SYSTEM TYPE: Mound > 24 in. of suitable soil PLUMBER: DOUGLAS MANTHEY TRACY POOLER DATE: 8/20/2025 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: THIS PERMIT EXPIRES 8/20/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION