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HomeMy WebLinkAbout25-27S-` INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY TIME RECEIVED REMOTE CSID DURATION PAGES STATUS June S'. 2025 at 8:03:53 PM CDT 7153724159 38 1 Received Jun 09 2025 23:23 HP Faxpolkosla Plumbing 7153724159 page 1 Request 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 Other fl onL/ o) fosk; Phone Number 7tS zqz—LFiS6 Plumber: Fax Number !S j 3-72-41-5; Email Address Homeowner: I tih AnCr c Dzi'•5 /—/ r o5"!1 j�o. Y�bear��� �e�cr{ •c immediate Phone Number So Zoning Sanitary ` -7 5 ( _ - Dept can call you right back (if needed) Permit#: `� 7 ! S -7-C, LE(5-iv Plumber's Choice Zoniiinn• Dept Date: jrp - ( 3 _ Z Plumber's Choice ZonDept Time: ii'oof�� Township: D ( Address#8'�� ra /ce t.l 5 1( Road Name: ✓ + )> ri r o , or�o �.�f ✓oK. �.s r Directions Lt ^ f �l ✓ )e.Jc - 71 c3S Dur� o`(C y r ye-. To Site: Comments: * Plumbers you must verify any change(s) by fax or email Notes from Zoning Dept: I u/forms/sa nitary/requestfadns pactlon Zoning Dept (®4/12104); ® Juno 2023 POWTS HOLDING TANK INSPECTION REPORT (ATTACH TO PERMIT) GENE ANDREW F FROSTMAN a ❑ Town of Sanitary Permit No. rPermit F 71035 OULU ROCK RD - Plan ID BRULE Wl 54820 Property ddress If Avat able TANK INFORMATION TYPE MANUFACT RER/MODEL# CAPACITY p 4OO JG 1 Oft JL J Property Line Well Water Service Building All -Weather OHWM Swimming Pool Road 0Dk- DEVIATIONS FROM APPROVED PLAN COMMENTS (Persons present, discrepancies, etc.) SARa beddl / W� Q UU �p � 6utUy pfuj Q`1mved rnat (ILArc — ✓ w %MtS ha„�Q�d q locl'sfcha, - ry( vtvrc —v a14'w)— ry 6 0 COMPONENTS NOT INSPECTED Plan Revislo equired ❑ Yes o I Date: Signature of fns ector: r ✓/ Ce7. Number Sketch on other side 3 10 of 13 ELEVATION DATA Point Backsight Height of Instrument Foresight Elevation Comments Bench mark Bldg. sewer •ritJJaL Tank inlet Tank outlet Tank inlet Tank outlet Bottom of furthest tank Top of all- weather road SKETCH OF COMPONENT & ADDITIONAL COMMENTS n 11 of 13 BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT IjTelephone: (715) 373-6138 Bayfield County Courthouse Fax: (715) 373-0114 Post Office Box 58 e-mail: zonino�bayfieldcountv.wi.gov 117 East Fifth Street Web Site: www.bayfieldcounty.wi.00v/147 Washburn, WI 54891 Property Owner — ANDREW F FROSTMAN Information 71035 OULU ROCK RD BRULE WI 54820 As you know was contracted by you to install a private onsite wastewater treatment system on your property described as: Notes: Abandonment of Old System to meet all applicable code requirements: Tank was pumped by: k on A(U?1 (0k C on iihil�IaGRc at AM/PM Tank was crushed I removed and pipes disconnected by: ' �� Ql)! On at (AM / PM) the above -mentioned plumber contacted our office to condu 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 Ibecause County could not respond to plumber's time constraints. Comments: II1\IL �1��rCa,{Il��((r. U/forms/sanitarypropertyowner-input April 2019 f t Department of Safety & Professional Services county C)O ,�r��jStaryPermit Industry Se s, 1 ,tsi ni� i,1 { Ntuber(to be filled in by Co.) Sanitary Permit Application U T A � UL State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to dioapproria a governlnental.Uttlt is required prior to obtaining a sanitary permit. Note: Application forms for state-owned D5 lre submfitted� to 9Nbject Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary paws in accordance with the Privacy Law, s. 1S.04(1)(m), Slats. `� 3 O 7 k ,c • .A ' IIeatio.Information •— Please. Print All Information L/ Property ]Owner's Name n Gr v e tj £ e b rrCt tc,51-LCTL7 Parcel # Property Owner's Mailing Address 1/ C'35 D��� �� P' i Property Location Govt. Lot i City, State f Zip Code Phone Number ✓'v l •� f ,— 2 Ca '71,S- rT Z 9O %4 Y ¼, ¼, Section 3/ T ' c' N R • 'o U. Type of Bu lding (check all that apply) Lot # l or 2 Family Dwelling —Number of Bedrooms Subdivision Name O Public/Commercial — Describe Use Block # O City of D State Owned — Describe Use CSM Number 0 Village of FTownof IiL Type of P0WTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C a licable. A. ❑ New System • Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B' H ld' T o ing ank ❑ In -Ground ❑ At -Grade [] Mound 0 Individual Site Design ❑ Other Type (explain) (conventional) I ____________________________________________ C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber 0 Transfer to New Owner ist Previous Permit Number and Date Issued Expiration IV. Dis ersal/Treatment Area and Tank Information: Desigtl Flow (gpd) Design Soil Application Ratc(gpd/sf) Dispersal Area Required (sf) IDisperaa1 Area Proposed (sf) System Elevation Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units .d New Tanks Existing Tanks a d chi V au tit d ii. C7 Septic-er Holding Tank -2 C' p-7 . I j - �r� 6 �5 G r Cc' l . C, V:'Responsibility Statement- I, the undersigned, assume responslblltty for Ilotto 4 of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb is Si lure 3P/MPRS Number I Business Phone Number oo A/lt 7I1( -k, Plumber's Address (Street, City, State, Zip Code) , �• f� a X Sr Z. y rr ca •-i ` < t~I €_ tr LtJ L 9-'K9 Y7 VI: County/DepartmentUse Only . . Permit Fe o0 Date Issue Approved D Disapproved $Issuin AgentSi atomO Owner Given Reason for Denial t 1,/,-,/2.,hlrbL A'3?/ ? Conditions of Approval/Reasons for Disapproval $4 Attach to complete plans for the system and submit to the County only on paper not less than 8 In x 11 Inches in size SBD-6398 (R. 03/22) • + 6 V vv I Lnniv i ivu Oi LVit l IVU No. 9975 P. 2 Pg I of Pg2of Pg3of Pg4of Attachments. Holding Tank Plan PAGEIOF8 lrl�iex D is hover' bneet APR282025 8 2025 L' Component Manuel Design References: I t1 �P10b 1AC1. '�' Vre" . Jr i �vt y.o� Q- �O r inl*Z�o ing Dept Index & Cover Sheet I - Plot Plan Holding Tank Speelficati ns -- 2. ? f �s Management Plan I- I UJOUL V4dIJIr uescripuon ble) Owner Name()e: A d r w f Owner Address: 71 o 3.S'� V C R' `P Br J I e Jr *lp: S —Y P 2 v Project Address: 5a e aS' G CLie ; Govt. Lot: jJz /111/4 of 1i E ,, X14, Section_, T ' N..R E E or w E Township: © J County: Project Parcel ID #: C4 : D !1:27-Z3 Designer Information //yy L I Designer Name: f 1 G. i Fo / K o S k Phone: i7/S --qjrc Designer Address:_. S�-a.. - � �� i eU `�" Zip; '7 E-mail: `�'i� � � � L -ems; �- v � �. � � �-- � .--'--------- ..�..., L ® "'�. Thi≥ space reserve4 for approval stamp. License Number: Z. CP O ej O Remarks; ,Signature: L Da O nel signatum requlr on each submitted copy. I H r is - i ��- �►- ' BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS D 1 f Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) l� Check List APR 2 a 2025 E Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) 0 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) V Original Plot Plan (383.22(2)2. 3. & 4.a) 21Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer 10 Pump Tank Diagram, Alarm and Pump Curve (when applicable) V Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) ❑ Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) V Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) 21 Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) 2 Fee (Make Check Payable to Bayfleld County Zoning) (383.21(2)(c)7) if 2 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) 59 Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) 21 I Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) ® Project Address o: Road Name where driveway is/will come off of) lid (Owners Phone Number) 211I Type of Building 21111 Type of Permit 011V Type of POWTS System 0 V Dispersal / Treatment Area Information [ii VI Tank Information R1 VII Responsibility Statement (Plumber's Information) 0 *Date Stamp* Plot Plan: (To Scale or To Dimension) 2f Signature and Plumber Information E. 'Surface Elevation of Body of Water ® Direction and Percent Land Slope iJ Tank and Filter Information and Location Z Wetlands / Navigable Bodies of Water 0 Absorption Area (Proposed and Existing) iI Bench Mark (Location, Elevation and Description) C' Address Number and Road 10 North Arrow ❑ Contour Lines [ Structures and Driveways 21 Boring Location 01 Property Lines [j Well Locations L Component Manual Version Cif Legal Descriptions Piping aI iform;ation coriveyacelin, buildingsew¢line, material type and diameter) Turn Over ► Cross -Section and Over -Head Profile of the System: J , ❑ Surface and System AElevation }'j. PR ?_ 8 �1 ® Position of Observation and Vent Pipes BViie1d (;c, ❑ Dimensions and Depths ❑ Make, Model & Number of Chamber Units in each Cell Property Information ❑ How many systems will there be on this parcel of land? ❑ Has this property been split? (Property Statement shows Property History) Fees: O Private Sewage System (Septic Tanks) $ 400.00 1 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 O Return Inspection $ 50.00 ❑ Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) u/fork s/checklists/checklistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: 'rcj' rt tJwnero L1 1Jescr; p+iosv o 'vt1 eLr� � 11 4v err :ecycicI. +�X n) 27 ZZ 3 }-.� Fri -7 1 o3c o1 oLl� ,r�. F. C Mb e ve. ";emu. ( v -a 'i n ASIA) % 3 7 ✓e^ Gv...pp V �+ i� • ,7 �. v►.LCt,'1 �. Fr [ CC l 1 a 0* secs rmst 3 • osI 8or;1 I `r 'S+Or►1 fd,.• 1 `� �Q 'L�s•1 less L. N-•Fri+ RJ; E v ! iZ oc R4 Z- . O ¶$ jlon VJ tce�.v- L�ncv-e ank; '3 "Lv !oi » " 4 Fro, b fo of to ow L,,te i n 1 tJ L '& C-[1 4 - FV)c 't t,iI L.SC( :m (vR ad); r Y �� 3y F©/kc+s k, P/L 1 t bf nl ,Tro I P.' v ee � w r PROPERTY OWNER: PLUMBER: Allan Piki SIGNATURE: I c' DATE: 3-2-Z- Zsr LICENSE 22OQ9p HOLDING TANK SPECIFICATIO NS rT1Numbsr of bedrooms Non-resldential estimated flow (gpd) r6oMInrmum holding tank volume'required (gal) Tank •- Dimensions and Data xufm�yrr• _.. X far round tank wcrlLiquid depth below Inlet Invert (in) .D Maximum depth of soil cover (ft) Height (In) 1 Outside 189.8 '.O Length (in) r Dimensions Width (In) Only junction conduit y blind plug to seal outlet Manufacturer model number manufacturer iber APR 28U2.5 Li Bayfield Co. Zoning.Dept. Tank Anchor Calculations Ibs Weight of tank and cover .so Safety factor 020 lbs Weight of anchor required 40.8 in Soil cover req. for anchor or 9.9 yde Concrete counterweight • HOLDING TANK CROSS SECTION manhole cover with locking device and finished warning label grade 4"min. 24 In. Manhole and vent locations may be reversed. vent cap min. vent pipe , 1O' min. eetvice 0 In. building sewer alarm on � Note: All tenk�oint inlet Electrical as per NEC 300 and Comm 16 s, and joints between tank openings and piping are• 39.0 in. sealed watertight. All pipe and vent materials comply w1thS�. gg3 s, s 3 In. bedding under tank. Tank 1s anchored as nwcessaiy to negate buoyancy, P CD O fl:flcs 183k" cc i\ TOP VIEW CD et U d' M Q r) SIDE VIEW I TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS M- OUTLET vs M WLP2500 TANK SPECIFICATIONS DIMENSIONS: W T cn WALL: 3" aa.. a BOTTOM: 3" HEAVY - 5" o COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER � HEIGHT: 52-3/4" O.D. LENGTH: 183-1/4" O.D. WMDTH: 101-1/4" O.D. BELOW INLET: 41" O.D. °C Q LIQUID LEVEL: 36" to WEIGHT: TANK - 3" BOTTOM 12,560 LBS. TANK - 5" BOTTOM 15,527 LBS. N WEIGHT: COVER 9,300 LBS. a INLET AND OUTLET: m a 4" CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: o a WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 69.44 GAL/IN HOLDING TANK: Y CO OUTLET HOLE PLUGGED = o to ACTUAL CAPACITY: 2.639 GALLONS z LOADING DESIGN: 8' 0" UNSATURATED SOIL TANK CAN BE USED AS: r 71 SEPTIC/ HOLDING/ PUMP OR SIPHON OI COVER: MIX DESIGN #8 (NO FIBER) O TANK: MIX DESIGN #9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: N J 0 0 Z Q w EL N w > cn w ar SHEET NO. F ' r f1i APR 2 8 2Q?5 HOLDING TANK MANAGEMENT PLAN Bayfield Co. Zoning Dept. This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to x' 383 Wis. Admin. Code, the Holding Tank Component nual w� .cU ``+i4.n iQ l and the ' U County Sanitary Ordinance. �'2` )1 L -° ..Z )V7 �E'R�o �c�,y��. � 1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 400.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and O'PS 383 and384 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with .OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with PS p83.33 Wis. Adm. Code. 10. If there is a problem with, or question about this 'nstallation, the following persons should be contacted: a. Installer.............................r©1 hs'k Mawr EAq .P1��SV7,Z0cg0 Phone: ?1S' 372 'rc(O b. Service Provider ...................f1 • ' 4.. a 2 Phone: `'yc 3- - 41004, c. Co. Zoning or Health Dept. i3a.y4s.LJ Phone: 7/, f 3Z- 'I + 11. L eJ? AJy f-5 L4AJ� ` 5ems- / I.) ) "ro w vI a -c © J t J r`,jx-11b Z`7Z - Project Transaction Number: F Department of Safety & Professional Services County on Permit N mbcr (to be filled in by Co.) p 55 `l�2 �, 9 Industry Sery sI 4 n �cj .2 —� 95 Sanitary Permit Application II U A /IIn S e Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the apprpriaJe gqv nmcptal unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owner to' '-Project Address jtI12,8kMEbbaiittbd (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(1)(m), Sluts. I. Application lnfortnatton— Please Print All Information 7/0.( Q4/G oc Property (Owner's Nam;. Parcel t! ptJV"Et.J £ btl,r4t 1OS4''CL 'h,C 2T Z 7? 3 Property Owner's Mailing Address / Property Location 71035 £)4,J g t, ICL Govt. Lot City, State Zip Code Phone Number � ✓t, `�2 Ai ji .S- V ? Z Q. -7i.s- z 9 z 9o41 40 % 1/4, Section 31 II. Type of Building (check all that apply) Lot 0 T xE ! •o N R _ I or 2 Family Dwelling — Number of Bedrooms 3 Subdivision Name ❑ Public/Commercial — Describe Use Block t✓ ❑ City of ❑ State Owned — Describe Use CSM Number Cl Village of �Townof tR%J J 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 applicable.) A. ❑ New System ReplaceJ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. Holding Tank ❑ In-GronAt-Grade ❑ Mound ❑ Individual Site Design ❑ Other T e ex lei(conven)P ( P n) C• ❑ Renewal Before ❑ Revision Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Information: Des•151jn Flow (gpd) Design Soil Application Ratc(gpd/st) Dispersal Area Required (at) Dispersal Area Proposed (af) System Elevation Capacity in Total 4 of Manufacturer Tank Information Gallons Gallons Units a .� New Tanks Existing Tanks Cgs o 21 2 g a `nfr U n „ h izU grlxieer Bolding Tank Z5 b O — ZSco •Dasixg•6hmmFar V. Responsibility Statement- I, the undersigned, assume responsibility for I judo of the POWYS shown on the attached plans. Plumber's Name (Print) Plumb is Si lure /� JO/MPRS Number Business Phone Number �'J0.� J�D P—D$Gr 22OOry O 7l S'ZcJZ—ai l,s� Plumber's Address (Street, City, State, Zip Code) SC,)C szv y✓o 1 t .tiev t.-i CY'8V7 VI. County/Department Uso Only Approved O Disapproved Permit Fee Date Issued Issutn' Agent SI nature /y/ s 00 M2L /�/� O Owner Given Reason for Denial W — Jr 2( �/3 Conditions of Approval/Reasons for Disapproval &C d-24 QLrc Attach to cotnaleto nlans for tiro svxten, and cWunit m,a.. r•,...... • , •.••y .•.. ,.apart nut uas man a in x Iimature In size SBD-6398 (R. 03/22) nry rliuV a cviuciuu No, 9915 P. 2 PAGE 10F8 8 Holding Tank Plan Index & Cover Sheet j D u I APR 2 8 2025 Component Manual Design References: j Mr�nva l type°°� Jens oy zap`' L.l'i'l0.i Zo �ji=i�c�p �ing Dept. Pg 1 of S Index & Cover Slheet - Pg 2 of 9 Plot Plan Pg 3 of S Holding Tank Specifications -2- p of Qf Pg 4 of 9 Management Plan Attachments: Enclosures: 5" -IL S POWTSApplication forrReviewcsttn°laryPc.rm� ,4 g Soil Evaluation Report & Site Map (!if applicable) as c4- g Hojqj9 Tank Pumin Contract if alicable) 9 of- j Holding Tank A reemeryt if applicabje Project Name / Description Owner Name(s): Ak, 1,rew £ l,eL ✓c, rvosi-2 h Phone: '•7!s _ z5z l 0 4� Owner Address: 7! o3S7Du(u R ckj' L Bru (e t-.JT Zip: .s 4'22 C) Project Address: Sc .n e GS c b c. c'e Govt. Lot: N4 Nt1/4 of N'C 1/4, Section 3/ , T• Township: £ 1 County: _ Project Parcel ID #: i G y- I' 1) z-7 2-2-3 Designer Information or W Designer Name: /-} //«s- P, !c o s Phone: %x'72 _ y'/s% Designer Address: "/? a. 3 aK S7- L c. k, , i WI Zip: S^S✓Sfl7 E -mall' :E!' ti tr L • cs -c L , dL b This space reserved for approval stamp. License Number: z z b o 0 Remarks: Signature: v- �u'/ i/ Date: 0 ' nal signature requir on each submitted copy. 3+CD11. - 9 '-r-- t' BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS j Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) IIIIIIIII111�000III APR 252025 1 Check List IH' Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) e 1x)i4)Oning Dept. 0 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) 9 Original Plot Plan (383.22(2)2. 3. & 4.a) 'Cross Section, Over -Head Profile of the System an Schematic of Tank from Manufacturer I0 Pump Tank Diagram, Alarm and Pump Curve (when applicable) IK Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) ❑ Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) Gd Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) 91 Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) 9 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 10 2 Corr llete Sets of Plans (383.22(2)(2.) (Note: Sanitary Anolication and Maintenance Agreements are to be attached to all conies) Ill Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary Aoolication: (Include the following Information) 211 Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) l Project Address or Road Name where driveway is/will come off of) 21!! Type of Building ® III Type of Permit El IV Type of POWTS System ❑ V Dispersal / Treatment Area Information m VI Tank Information Gd VII Responsibility Statement (Plumber's Information) ❑ *Date Stamp* Plot Plan: (To Scale or To Dimension) 19 Signature and Plumber Information 'Surface Elevation of Body of Water ® Direction and Percent Land Slope fd Tank and Filter Information and Location 0 Wetlands / Navigable Bodies of Water ❑ Absorption Area (Proposed and Existing) 56 Bench Mark (Location, Elevation and Description) d Component Manual Version 10 Legal Descriptions Gl Piping Material Information (conveyance line, building sewer line, material type and diameter) I' (Owners Phone Number) [if Address Number and Road i0 North Arrow ❑ Contour Lines 4 Structures and Driveways IZ Boring Location l Property Lines 1j3 Well Locations Turn Over ► Cross -Section and Over -Head Profile of the System: 2 C � � U \ n 0 Surface and System Elevation APR 26 ?(j/� Il���yyyIJJJI ® Position of Observation and Vent Pipes Bayfield Go lo ❑ Dimensions and Depths �!{i ( ❑ Make, Model & Number of Chamber Units in each Cell Property Information ❑ How many systems will there be on this parcel of land? ❑ Has this property been split? (Property Statement shows Property History) Fees: ❑ Private Sewage System (Septic Tanks) $ 400.00 Cdf 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/checkOsts/checklistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012.dc) Proofed by: Prsp.ev-1'y owner: /�nctvewJ E Dekrq 6-ost' 71©3S®uti'FZoc`Ccl Taa, 't 27 aZ3 t.o-+ Bearn�s3 Le w l Darr-rP , +cah , : � 9 • e.Soi 18or;„J6 N:. NG• 9cin N6--rl scc3l i'k$4K9&sa, I t; /'. Nc'un, less na4e.d I N Rockpd. Town e f; o u i u x'ifr3 oo,4I:on u/.eser C encv- tt k: lre t.t.vt4y cc kJ �Lti/•�i'� [ .'i'a "L -jot "d wV.t".Pvorr1 btt-ton.i.of to e !n/e-}; 1 t=ire '7 Fo3,e- colt Floc-kP— 1 �LL r t..)oTe� �G.,'�v,I £4;s -r t,i5 Seloi-a< a bey on'c L✓cple cce .J/I-J'euuZsto�cl/ov, J,tSev Lc,4c.-e-le 6o1A,^,5; ` APR 2 8 Z0Z5 U •i m, l t Bayfield Co. Zoning Dept. 1 Y. 3L� 3 3D vi 2, S5 - 59, gD 7sb i vJ s1o�G s• 500 - l'Jzn t�, KC} ,Qry jLIeCT$ 0./t ni;n. SC4LaCC.ks CsPS.383) AF.&; ,4t�ove -c'.cc( ( 9 v-v.je • = well B f ugP=.E/ev/co.o.' .-j 4"A5Tfl1 D17Q$'0.ppvCVI'.c( lo•(ai.ltil<L"l"LV•tCL .1 L 0 E He /d Yty rLYi k cofL1 7.ne-� u � rn n"dc/ usec�:mvsu�Ld j e «vf.r?2I)i Cwayzeza-Z0 0) brcuon. JSy: MYRS z2eo70 Fe l(co,s k, 1 ea YYI b; %-lit Xren R.'due-� wT C/47 PROPERTY OWNER: PLUMBER: Allan Pniki SIGNATURE:/ DATE: 3 - 2- Z - 2- s LICENSE #•_220090 HOLDING TANK SPECIFICATIONS Numberofbedrooms 0 U D iIL�W1,X.ILYL.LLYy ull Non-residential esidential estimated flow (gpd) ul 2D00,� Minimum holding tank volume'required (gal) APR 2 8 2uZ6 Dimensions and Data X for round tank 4�. .0 Liquid depth below Inlet Invert (in) Maximum depth of soil cover (it) Height (in) Outside 45..... Length (in) r Dimensions 40 Width (In) J Only Bayfieid Co. Zoning.Dept. Manufacturer model number manufacturer iber Tank Anchor Calculations pfYplyLLYLYp 16840 libs Weight of tank and cover 1.50 jSafety factor 4020U lbs Weight of anchor required 40.8 Jin Soil cover req. for anchor or 9.9 Jyd3 Concrete counter weight HOLDING TANK CROSS SECTION manhole cover with Junction .f-- locking device and finished vent cap box warning label grade box : 4' min. I =24 Y 12" mm. conduit ---� Manhole and vent locations blind plug to seal outlet ii may oe reversed. vent pipe 1 18" min. servIce W on _ 12.0 in, ~ — — — — ^ r ^ _ building sewer servo Note! All 1nnir i.a..■.. .sm Inlet Electrical as per NEC 300 and Comm 16 Joints between tank openings and pipIng are - 39.0 in, sealed watertight. All pipe and vent materials comply with,{, jws $33 i, J 3 in. bedding under tank. Tank is anchored as necessary to negate buoyancy. =� N o) 183}" co N ci TOP VIEW n 0 INLET 3" < a 0- N) SIDE VIEW N 10 a TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS fl OUTLET M WLP2500 TANK SPECIFICATIONS DIMENSIONS: WAIL 3" BOTTOM: 3" HEAVY - 5" COVER: 6" MANHOLE. 24" I.D. PRECAST CONCRETE RISER HEIGHT: 52-3/4" O.D. LENGTH: 183-1/4" O.D. WIDTH: 101-1/4" O.D. BELOW INLET 41" O.D. LIQUID LEVEL • 36" WEIGHT: TANK - 3" BOTTOM 12,560 LBS. TANK - 5" BOTTOM 15,527 LBS. WEIGHT: COVER 9,300 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 69.44 GALAN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 2.639 GALLONS LOADING DESIGN: 8' 0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #5 (NO FIBER) TANK: MIX DESIGN #9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: I 1111 APR 282025 HOLDING TANK MANAGEMENT PLAN Bayfield Co. Zoning Dept. This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to 9(5393 Wis. Admin. Code, the Holding Tank Component M§nual wscd; "flfl&nuu l t yr� VER2o and the 'Bul"e— (4 County Sanitary Ordinance. `V VIR zi) j % '� Z° 'ao� 7) 1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 400.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and BPS 383 andk4 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with SP$ 993.33 Wis. Adm. Code. 10. If there is a problem with, or question about this +'nstallation, the following persons should be contacted: a. Installer.............................PO/ a5JG Plumbun9 M.S.S. zZoo90 Phone: 7/S 372._. L/(C b. Service Provider................... • £e A:; Rg L y Phone: ' 7a jig- 3 - 4a®yz c. Co. Zoning or Health Dept. &zy4e.lJ Gauvt5n Zon:rub Phone: 7/5 3-73 6l39 11. Le_nnr L1m.ce_." fZ Y -J y Nt$ems / 7Th/I9 Lc.) rCJ Lto Project Transaction Number: HOLDING TANK SERVICING CONTRACTCHV D Contract Date II L APR 2 8'L0'� 3 Z 5' This contract is made between the -,eid Co. Zoning Dept Holding Tank Owner(s) Name(s) £ �2 P per's Name (Print) " s i 1 flvt o f� L � PumJper's ignature Pumpers' Registration # 1 �'�� y✓on �r✓+e✓ SeF3'[ We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT I Legal Description: Tax 104* , f k It's v q & f 1/4, N LOCATION (Use Tax Statement) /1 7rl 3 O( ff X1/4, Section 31 LI� N, Range W Town of: I Lot Size I Acreage ,Township ___ fof.)lu jio Gov't Lot Lot If CSM # Vol. Page CSM Doc # Lot(s) No. Block(s) No. Subdivision: 1. The owner agrees to file a copy of this contract with Bayfield County as required in SPS 383.55, Wis. Adm. Code. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local government unit which has signed the pumping agreement required by SPS 383.55, Wis. Adm. Code, and the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; 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. 4ylarew frosfman d t? bra >�r+o57Jman DJ -11 ._- O�Ppti Pue Revised: May 2016 (®May 2018) HAAN Personal information you provide may be used for secondary purposes [P w, s.15.04 Subscribed and Sworn to me: on this , day of 2�1tU[1lLF,oX1a5 by: ._efN--rYZLC-�.W Notary Public expires on: L 15&O;1, Drafted by'P .. 3377 Document Number/Plan I.D. No. HOLDING TANK AGREEMENT Owner Name (s)_ Owner(s) Mailing Address 7ndeew Froolman J/033 Duly Aoek Akd i54 o' Froetvnao b(vIe W1 s4Sao Parcel Identifier Number (PIN) -T- j Agreement Date (same as Notary Date) 033-1obg-o*-o00 ZDZZ3 2-3-zS 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. SI'S 383, Wis. Adm. Code or Ch. 145, Wis Scats. 3 of P 1/4 Section ) Township u c7 _ �¢ N. Range . f��1 W. Town of —0(j) 0 _._ I I To: DOCUMENT NUMBER 2025R-606662 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 02/25/2025 AT 1 1 :45 AM RECORDING FEE: $30.00 PAGES: 2 Additional Legal Description:{_±1_ .-V}d,_ J.t$ J. ?Yb t377 $ ¶2 or 5,5E Gov't Lot Lot Block Subdivision___-..__ CSM# a'Z 3 p I ea n d er b r Lot CSM;t__Jol__Jage_--_.—C3MDucn"_ 7 ,...s _ I —lam 2S As an inducement to Bayfield County to issue a sanitary permit fora holding tank on the above descrii d jopWUoEhe following: II u u 1. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tank installation and maintenance, lithe owner fails to have the holding tank properly serviced in response to orders >3oy 7'')6 { ayf)){)„Gppnly or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Scats., ayflel 'o 9 ter 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, Scats. 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 mauler 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 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. 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. NRI 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 from 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 tcrtificai on io be determined by reference to the properly. - 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. ro5+-lm4� Drafted by: Ion o 1k05 k Personal inlorrnation you provide may be used for secondary purposes IPrivacy Law. s,1504 (II(mll Subscribed and sworn to before me on this date: P1J AI . SANDRA. Notary-i,3,,Ids HAAN My Commission Expires: Date: 3 z S ulimms/san,taryholdinglankagreemenl.doc dune 2018 6 L$ ft6L STATE BAR OF WISCONSIN FORM I - 2000 Document Number WARRANTY DEED This Deed, made between Andrew F. Frostipan and Debra E. Frostman, husband and wife, Grantor, and Joseph A. Merila, a single er n Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in Bayfleld County, State of Wisconsin (the Property") (if more space is needed, please attach addendum): South One-half of North One-half of Northeast Quarter of Northeast Quarter (51/2 N12 NEI/4 NE1/4) and South One-half of North One-half of Northwest Quarter of Northeast Quarter (51/2 N12 NW 1/4 NE1/4), all in Section Thirty-one (31), Township Forty-eight (48) North, Range Nine (9) West, Town of Oulu, Bayfeld County, Wisconsin. PATRICIA A OLSON BAYFIELD COUNTY, WI REGISTER OF DEEDS 2004R-492844 07/09/2004 9:30 AM TRANSFER FEE 30.00 RECORDING FEE 11.00 Pages I Name and Rehm Address Attorney Matthew F. Anich 220 Sixth Avenue West P.O. Box 677 Ashland, WI 54806 APP I Together with all appurtenant rights, title and interests. 038-1069-07' 038 1069 09 PacelldenuaceoonNumber(PM) Bayfield Co. Z ning Dept. This 111121 homestead property (is/is nnot) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, reservations and restrictions of record. v! dayo7vt_Y Dated this IFL, 2004. AUTHENTICATION Sitptawre(s) authenticated this_ day of OTAHY STA authonzed by 6706.06, THIS INSTRUMENT WAS DKMMIIBUIIWI° ATTORNEY MATTHEW F. ANICH, SBe1017169 DALLENBACH & ANICH, S.C., ASHLAND. WI 54806 (Stgsatmes may be authenticated or acknowledged Both are not necessary) x.c.�x DREW F. FROSTMAN C. F ..z • DEBRA E. FROSTMAN ACKNOWLEDGMENT STATE OF WISCONSIN ) as. ____________County ) Personally came before me this day of JMNE ,%y/y - 229L the above named ANDREW , FROSTMAN AND DEBRA E. FROSTMAN, HUSBAND AND WIFE to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. (rLtt�Gr.cw�//1 Notary Public. State of WISCONSIN My Commission is permanent. (If not, state expiration date: store. MFO.FRO (ana)655.2021 www mfopeoamu corn V896 P377 - - in accordance with SPS 383, Wis. Adm. Code - - County Bayfleld Attach complete site plan on paper not less than 81/2 x 11 inche include, but not limited to: horizontal si4aL� 9�@@njq} uyyt V Lb ,. vertical and reference point ( ). dijedithitendl U Itiacet I.D. 04-038-2-48-09-31-1 percent slope, scale or dimensions, north arrow, and location and lance to nearest road. IH O 1 _ Ot t>- Please print all information.Dli APR 282025 eviewed by Date Personal information you provide maybe used for secondary purposes (Pri c . 5.0 it (m)). /7 _Z Property Owner Property Lo lion Andrew Frostman Govt. Lot NE 1/4 NE 1/4 s 31 T 48 N R 8 E(r))W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 71035 Oulu Rock Road North 1/2 10 acres City State Zip Code Phone Number Qcity ® Village • Town Nearest Road Brule W( 54820 1( 715 ) 292-9040 Di ih Oulu Rock Road New Construction Uses Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ® Public or commercial - Describe: Parent material Flood Plain elevation if applicable NA ft. General comments and recommendations: The site is suitable for a Mound system. The benchmark =100' I` I I Boring# Boring S Pit Ground surface elev. 94.4' ft. Depth to limiting factor 21 in. r---� Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots OUJI nppivauu Rare GPD/ff 'Eff#1 Eff#2 1 0-5 7.5yr 3/2 -- SL 2fsbkrrnfr cs 2f .6 1.0 2 5-21 7.5vr 4/4 - CI 2fsbk cs 0 6 1.0 3 21-29 7 5vr 4/4 C2D Syr Ere SL lfsbkcs - 0 n 4 29-50 7 Svr4/4 C2DSyr 6,8 SCL lfsbk - 0 0 0 2 I Boring # Boring L -I 94.6' 26" Pit Ground surface elev. ft. Depth to limiting factor in. i— Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Oun Nppucaiion Rate GPD/ff' 'Eff#1 Eff#2 1 0-5 7.5yr 3/2 - SL 2fsbk mvfr cs 2f .6 1.0 2 5-26 7.5vr4/4 — SL 2fsbk mvfr cc 0 6 1,0 3 26-31 7.5yr 4/4 C2D Syr 6/8 SL 2fsbk mfr rc 0 n n 4 31-50 7.5yr4/4 — SCL Ifsbk mfr - n n n uyyLano wasourr®,L CST Name (Please Print) ignature CST Number Steven C. Johnson �. # 227037 Address ate Evaluation Conducted Telephone Number 9111 East Potter Road South Range, W1 54874 United States 10-18-24 218-590-6678 DropertyOwner , Andrew Frostman 04-038-2-48-09-31-1 Parcel ID# Boring# Boring 92.7' _ 21„ oi. Ground surface elev. ft. Depth to limiting factor in. Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fF 'Eff#1 Eff#2 1 0-6 7.5yr 3/2 --- LS Osg mvfr Cs 2f .7 1.6 2 6-21 7.5vr 4/4 --- LS Osa mvfr r..a if .7 1.8 3 21-30 7.5yr 4/4 C2D 5vr 6/8 SL 2fsbk mfr i's 0 0 n 4 30-50 7.5yr4/4 CID5vr6/R CL tI'sbk Si - 0 0 0 2 3 Page of_ Snit Annii� ratinn Rat QQQ��� P 9t l5 0 PI Lb Boring # Boring • Pit Ground surface elev. ft. Depth to limitinIor Op rn. I snu nnnij" �ratinn Rarer Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence "3 field Cr Boundary �. - Roots GPD/fF E11#1 'Eff#2 ® Boring ❑ Bodng # Ground surface elev. ft. Depth to hitting factor in. ® Pit Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fF 'Eff#1 Eff#2 Effluent #1 = BOD5> 30 <220 mg/L and TSS >30 ≤ 150 mg/I.. Effluent #2 = @OD5 < 30 rng/L and TSS ≤ 30 mg/L SBD-8330(RO]ir3) ay, Op _Z-yff-69 3r , 7/635 Duly Rock- /21 T3,vlc / L. ,f Sti 82a Oi $31 -T' -raw R g• t v G c tj it) '%z rh c4 t� J;nCA- Kv' c fr dt- csOo-j &Ooo unu} APR 2 f3 "0', r E/avUTi,n3 hayfield Co. Zoning bep jig ,,„ . r 1= ffY' (gz. 9y6. qK1 ltZ v.Li N U S' 'L q i4' JSdf Iru b nGdrbbN' fir• $^? // .� d►r� S96 £ %s(L pcc< n .t/C /-u TI 4 7To- - 61C �/ /6-rsZy Sea. t A / /Orer fy 4 -n e- BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): d Check List m Index Page / Title Sheet (Optional) m Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) 10 Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) liii APR 287075 Bayfiela Co. Zoning Dept m Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used lZ Property Owner's Information (not prospective buyer's name) 10 Property Location (Accurate Legal Description with Sec/Twp/Range) m Road Name (where driveway is/will be coming off of) RI Floodplain Elevation, Flow Rate, Comments and Recommendations LI Complete Soil Boring / Pit Information m Date Soil Evaluation was conducted LI CST Name, Signature, Number, Address and Phone Number ❑ *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) d Bench Mark (Description, Elevation and Location) 21 Contour Lines (Example = 98.0' /96.0' /94.0') m Property Location (Sec/Twp/Range/, Accurate Legal Description) m Borings (Locations and Elevations) i6 Percent and Direction of Land Slope l� Well Location (Including Neighboring Wells, if applicable) LZJ Location of Wetland Areas, Floodplain and Navigable Waters m Buildings, Driveways, and Structures (Location and Descriptions) i4 Location of Property Lines i9 Existing System Location IZf Address Number and Road Name d Current Surface Elevation of Wetlands and Navigable Waters GJ CST, Owner and Property Information 1 North Arrow Fee: 16 Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checkllst/checkllstforests 5/21/25, 1:27 PM CarmodyTm BAYFIELD COUNTY SANITARY PERMIT (#04)-25-27S STATE SANITARY PERMIT OWNER: ANDREW F FROSTMAN GOVT LOT: LOT: BLK: NE1/4 NE1/4 SEC: 31,T48N,R9W TOWNSHIP: Oulu SOIL TEST: 174-24 REPLACEMENT SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: Allan Polkowski TRACY POOLER Authorized Issuing Officer DATE: 5/21/2025 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 #: 389456 LICENSE: # MPRS 220090 Condition: Properly maintain system per recorded agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 5/2112027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION https://www.carmodyinc.com/PermitApp/Permit_Sign.aspx?Print=l &permitappid=7472 1/2