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q/\ INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY "' TIME RECEIVED REMOTE CSID DURATION PAGES STATUS -June 5, 2025 at 10:04:05 AM CDT 7153724159 39 1 Received Jun 06 2025 01:23 HP Faxpolkosld Plumbing 7153724159 page 1 Request for Sanitary Inspection (24 Hrsm 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 Discrepancy Other fl i o n ro/fr1t� / o S k Phone Number Plumber: Po/ icosI-�, ?1tJva , , Fax Number pis 3-7z-qts-� Homeowner: /mil l le K L Email Address `role' Y bearL)J Iepicr4h,c Ynberl Sc,Ci r Sanitary Permit Z 3 S Immediate Phone Number So Zoning Dept can call you right back (if needed) #: Plumber's Choice Zoning Dept Date: — ( — Z Time: Plumber's Choice Zo ept Township: Address #, Road Name: ('/ k O - �� e L f4 o v° '"` T S"t`7 or or ?�- Z� mot.({ �v -, L+° SL,4 �y Lo,,� t -.nT�+ e4 �D a �� /.( m - le � Tu r.� �zH- Directions To Site: a`` ✓mow `%' �;rc t2 [a5-- SL,a �� Ce4e Comments: lay l q I H "* Plumbers you must verify any change(s) by fax or email ** Notes from Zoning Dept: ulfonns/ser taryhequeatfaInspeaUan Zoning Dept (04112104); ®June 2023 M Private Onsite Wastewater Treatment Systems ( POWTS) Inspection Report (Attach to Permit) Industry Sarvirnc nivisinn GE Pe KELLY A TAIPALE ET AL 11271 E LINDGREN RD MAPLE WI 54854 City L I Village U Town of. / Tank Information setback to: TYPEI MANUFACTURER CAPACITY I Prop. Line Well Building Air Intake I Road Se tic 5e Bc t7 = N/A Dosing N/A Aeration N/A Holding • Pump I Siphon Information Pump Manufacturer ump Model Demand Filter Manufacturer Filter Model GPM TDH Lift Friction Loss Head Total Forcemain Length Dia Dist To Well Dispersal Cell Information DIMENSIONS Width L gth # of Cells / SETBACK FROM Prop.. Line Building Wellh OHWM Tvoe of Cell Manufacturer: County pp Sanitary ennit No: State Plan'Transaction ID#: Parcel Tax No: q � /u 6 Model Number. llll Pretreatment Unit Manufacturer: Model Number: stribution System Header/Manif Id Distribution Pi e(s) I, Length _ Dia Length Dia 3 Spec Soil Cover Depth Over I Depth Over I Depth of Elevation Data STATION BS HI FS ELEV Benchmark 97 et Bldg. Sewer s7 Tanklnlet 6 ?t 7 Tank Outlet c 9y,Y3 Dose Tank Inlet Dose Tank Bottom Inst Contour Header/ Manifold Distribution Pipe Infiltrative Surface /2 cr ', Final Grade 9 XMMMENTS: (Include code discrepancies, persons present, et:.) /, �L c GY? v/ 5/• r ©/o ` Cut K ✓'erG4 uo t, jIG�l//IH a GNAiN$ 9/a/n (('i,/d ) U5I?ut N X Pressure ❑Yes ❑ No an revision required? 0 Yes 'Jo /� seother side foraddltionalinformation. __ �Jr Date POWTS Inspector's Signature aanLa71n ra ngna\ ❑ Yes ❑ No Mulched ❑Yes ❑No 10373 License Number BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoningt(a.bayfieldcountv.wi.00v Web Site: www.bayfieldcounty.wi.gov/147 Property Owner — KELLY A IMPALE ET AL 11271 E LINDGREN RD Information — MAPLE WI 54854 As you know onsite wastewater treatment system on your property described as: Notes Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 was contracted by you to install a private Abandonment of Old System to meet all applicable code requirements: Tank was pumped by: C' Tank was crushed / removed and pipes disconnected by: at AM/PM On at /210f (AM / ' he 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: U/formslsanilarypropertyowner-input April 2019 SS�n©•.s�isl .n �l`! J�l Department of Safety & Professional Services, - U County - Q —ft 2 7 Sanitary Permit nb(`' a le '° ') , ,�1SpS � Industry Services -Division A••�,,,,�¢ ds-3qS Sanitary Permit Application State Traumatic umb In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit n Inning Dept. is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (i i e�r°nt than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary I +^ I purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. (Q C!v 5 Sna L S I. Application Information —Please Print All Information Property Owner's Name , Parcel # �'�trnD2vI -Saa✓r mac. 1b`E tinsProperty Owner's Maili g Address r� Property Location / x' 11171 E L t n. C ✓ .e r P— Govt. Lot �_ pQ V G•2 ( r ry City, State Zip Cede Phone Number � t� pp Le � Z 5'( S -I I S' Q I -f '(4'O4 %, z i o Y, Section R. Type of Building (check all that apply) Lot # T 7 N R 0 I or 2 Family Dwelling — Number of Bedrooms 3 Subdivision Name ❑ Public/Commercial — DescribeUse Block # ❑ City of ❑State Owned —Describe Use CSM Number ❑ Village of F Town of tt✓oh Rttl'Gr 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 w llcable. A, 0 New System Replacement System Y p y 0 Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) Tank In -Ground ❑ At -Grade ❑ Mound❑Individual Site Design ❑ Other Type (explain) J"'DHolding (conventional)Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dls eraalfrreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rete(gpd/sf) Dispersal Area Required (st) Dispersal Area Proposed (sf) System Elevation C n 7 _ e Y g S. L' Capacity in Total #of Manufacturer Tank Information Gallons Gallons Units 3 e New Tanks Existing Tanks g ra j 3 b U in4, o ii.O 0. Septice4h*,a Tank 1000 — 1000 J. W rs e ✓ C0 , e, ✓ mar V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' i attire �' l�% �D 1 �o �/ 9W/MPRS Number Business Phone Number - 22009 d h'Cy`7z-'u/S(o Plumber's Address (Street, City, State, Zip Code) e� e B g s n— y ✓G •-1 L— r. t/ � v' u T C `{8 Y7 VI. County/Department Use Only Approved ❑ Disapproved Permit Fec Date Issued Issuin Ag igna�•-,'n� 9 L ❑ Owner Given Reason for Denial $ 4'oO — (0133 a,5 m81- 3 �r ` Conditions of Approval/Reasons for Disapproval Attach to conmieta nlnns me nm cut mm,,,a................ r......... __... _.. ______... .. _ ... ., ., yn,.., u. ,,,s,,nn a 114 X r r 'hears in size SBD-6398 (R. 03/22) Ma/. 7. ZUl/ 1U:41AM BAYFILLU CO PLANNING & ZONING No. 9975 P. 3 Pg 1 of Pg 2 of Pg 3 of T Pg4of`l" In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10705-P (N.01/01, R. 10112) PAGE OF? RMAY 2.8 2025 Bayfield Co. Zoning Dept. Index & Cover Sheet Plot Plan I¢,c'p1t r4cassSection & Plan View Management Plan Attachments: Enclosures: Nr 5` v POWTS Application for Review 6 Sen:fc 9 ? Soil Evaluation Report & Site Map a17 Ac vetn_en Project Name I Description vyj�t rmT�r Owner Name(s): K, m a t✓ L b S c a Vi Phone: -71 S- `d I7 - t( Owner Address: 1121( E L/J,-1. - 1. g.j ✓vta;=/e vLZip: -s R.c-Y Project Address: & Slp Ss L�-, y ✓ IZ , e i �✓Z S `� i� Govt. Lot: % Ra rc.e',„114 of 1/4, Sectionn, T t/7 N -R E or W Township: ✓ o ti F_ " v - v 3 County: C y -f -e ( d Project Parcel ID #: i' K L a Designer Information Designer Name: A.]1c r 77 / ko s k Phone: '71r- 7z - y/1 SIP Designer Address: P -O. 23 DX Saz yro..,Z v�err k, J T Zip. S'V RV7 E-mail: o n / h e -c 1) cL'e_n o v 7t l. L o rvl This space reserved for approval stamp. License Number: Z2 -C Remarks: ���Z 5�/O_2S Signature: Date: riginal signature required on each submitted copy. 5/I 2Grlm 1 �! L ( 4�7. /-k'( �rvf inr.' • dl� d �'�° V,.��V•en �if:.1f� .lG° c. V, bra.,& Ey PolkpcCg:r Pi k y 5'c�Ic I No u{;•e�Ies vtehd ! f l 9 1 1lm I.O. eap C 2.F�..• 1cp o defrc oa"fi ,n r��j �+N'L Ourx �2•°v y' (i�[f3H L"LL UJ@Gm tr...K.ic.eun7'.Sdi"$7 %&'giile( JftPtlev.D®fJ,c( S43D60 Da EE'.�i/*fi 6G/dx) �u;a.u. flOO1O sysfr€ E►ewUSS.s' c Sr fzz.001G j; S'¢ptiaTank L s' IooOcja/Ion wi¢5eP ceHcn,1_/oq'f I-:-&4d'w/. n„ A i -T -lb 0 198tH W'frontbm e.,J.4.1, h,> lov °,e:n `1; ri11:1 (v:'4(. rb: f.:" $ pe'4 fl LAJ I ¢'� h -q5' Lenn} tic/2,Helg hl°_S'F.c. rnw.,t .GAIL 'tO tV6,.o-/n N4J/e cpf;cTit' k4 Zrt %l�"lrc cGHio k ! yfn.,�Ij�f!_ 12-O h:11 Iect4 a'f4?&.eu'ar&lrocanipta a w. fA SP53n S•ep>t•.o jnn.it. ooflitn-✓sr- An- c t/ •r a?P' -' 4 .c i/c. -PdC/lokrnedt/ pt..-nr £..k qc PJG 'P:nr'is A5Tri1 D) s65 _ Sch SUr23s p c p:l�e °y r157dh D33 ( tad�rast.1 P a♦¢vaft�ll zoo oiC�o� ;,ErpSyss5Ia y Lh MAY 282025 U I C t/o h X ' 1' �� •�c., If ks Sel i;c , -re ., k rtNptd aLM4L reuc'l53$9.3? rev(a —cL w//00016/Imp u,J. eScr Co. Zoning Dept. y . �r �n V e {' 'I :X N ` o- 'V'4 �Y� clfncP as q. U — a v'4 N ,vV Ji n ' qy,o 3p y!i y„ + R Y r v D' s' �_- 5 4 v 92. _ 3 • ... M n1 See oljSe ru((dfi l' 1J:(vc dC 9o,D �7 'u 3 �m3 10 M 0-s `f N IZefs•i4n 6Q.C JnT. IT raj uv � -(1 ca- ber-QckV7u-Hio e • d J M %A L u 13J ≤ <is/o d C.N-k m m ' Proper4y Otun -ro L�4f31 oi G e5CN;, ad o ��l oh -F {, ref * see.agry7N ' o IGlmb�vl Sac�vl `` Gov Loft` — pars-,eI r y ' (IZ7( n�y✓Ph Rd O Zin4h;°1-0-vaLforo� TewnG✓�.+IZcJ•e.1/ qA to In��le/ �2 S�(psY �u�Iyo,C 3cy.P:.e(I dcrmlj vlLy !3d ft�mp n i Be P Cr WLP1000- MR a TANK SPECIFICATIONS C) ,-,0 104" DIMENSIONS: C c WALL• 2 1/2" N "c BOTTOM: SEPTIC 3" ao' N HOLDING 5" (ADD 1,300 LB.) cu COVER: 4" r �--� MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: DOME COVER 61" O.D. FLAT COVER 53 1/4" O.D. / 4" CAST -A -SEAL 4" CAST -A -SEAL LENGTH: 104" O.D. WIDTH: 86" O.D. m2q" BELOW INLET: 42" O.D. LIQUID LEVEL 36" TYPE WEIGHT: 6,790 LBS. FILTER OR INLET AND OUTLET: BAFFLE/ 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL - INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 27.83 GAL/IN TOP VIEW HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,085 GALLONS LOADING DESIGN: 8' 0" UNSATURATED SOIL OPTIONAL FLAT COVER IS AVAILABLE FOR EXCHANGE { FOR DOME COVER. TANK CAN BE USED AS, SEPTIC/ HOLDING/ PUMP OR SIPHON INLET _ COVER: MIX DESIGN #8 (NO FIBER) - OUTLET TANK: MIX DESIGN #10 STRUCTURAL FIBER) a ¢ a: ¢ CUSTOMIZED TANKS: _ o FOR CUSTOM TANKS CONTACT WIESER CONCRETE M a 7 M I PUMP PAD DRAWINGS SUBMIT SIDE VIEW FOR APPROVAL APPROVED BY: APPROVAL DATE: TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS PRODUCTS NEEDED BY: W W G1 O J D Q a o 0 0 0Lu � Department of Safety County & Professional Services, � Sanitary Permit tab (t a le inl Y •) p3' / Industry Services Division Sanitary Permit Application State Tmirsactio I umb In accordance with SPS 383,2 1(2), Wis. Adm. Code, submission of this form to die appropriate governmental unit BuileId (`n Inning Dept. is required prior to obtaining a sanitary permit. Note; Application forms for state-owned POWTS are submitted to Project Address (i different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary II /I purposes in accordance with the Privacy Law, s. l S.04(I)(ni), Stars. S!P SS1 S k4 Y L 1. Appficatlon Information — Please Print All Information Property Owner's Name Sao r I Parcel # �� l m & r—rK j btt ( i 9 ,(3 Property Owner's Maili gAddress Property Location ^� t j( Z7 I E L 1 r. ,, 2 r I`Z Govt. Lot 7. City, State Zip Code Phone Number ✓k tn. to I__iJt 5`tiy-S -tic ii L(4,° , g ¼, Y., Section II. Type of Building (check ail that apply) 1 Lot!) T 9 7 N R 8' • •o I or 2 Family Dwelling - Number ofBedrooms /-7 __ Subdivision Name ❑ Public/Comntercial — Describe Use Block # ❑ City of ❑ State Owned— Describe Use CSM Number O Village of X Town of tE✓eh Rr O'e.-'- III. Type of PO�VTS Permit: (Check either "New" or "Replacement" and other applicable on fine A. Check one box on line B. Complete line C If n licable. A. ❑ 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 0 Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration s o o7 icgs &ys gg.c' Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units B o o New Tanks Existing Tanks ,+ � U 6 Cg E " a a. Sepiice 4h4& ig Tank 1OOO 1000 J. Wtesev CGn.c. ✓ V. Responsibility Statement- I, the undersigned, assume responsibility for installation or the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's i awre $ '/MPRS Number Business Phone Number A1122ooq o-1S'a4z-�{IC Plumber's Address (Street, City, State, Zip Code) �o 8o s'za y `fit kitr L4T s-`FBY7 Appmved ❑ Disapproved reimmic Pee Date Issued Issui Ag pi/g{na/jt�u/rc O Owner Given Reason for Denial S f �� Conditions of Approval/Reasons for Disapproval to complete titans ror the system and submit to the County only on paper not less than 8 'ax SBD-6398 (R. 03/22) May. h. 201/ 1U:41AM GAYEIELD CO PLANNING & ZONING No. 9975 P. 3 Pg 1 of -% Pg 2 of -7 Pg3of7 Pg4of•/ In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-1 0705-P (N.01/01, R. 10/12) PAGE 1 0F7• MAY 282025 D Bayfield Co. Zoning Dept. Index & Cover Sheet Plot Plan <r -a Section & Plan View Management Plan Attachments: Enclosures: R1 3 v POWTS Application for Review C Sun:-Ek fl Soil Evaluation Report & Site Map D I / 4 vtL.n nce A<veen.en Project Name I Description Owner Name(s): IC nA e✓ (7 S a C Vi OwnerAddress: 112'lf t; L:.. L vex zi vVLe Project Address: !o Sle SS S L.c Govt. Lot: 7 ?4r2,,1/40f 114, Section??_, T 'E7 N -R 4{ E or W Township: c✓ o ti F. v -e✓ County: 23a yC (d Project Parcel ID #: K 1- D g 19 g �(3 Lfr, LVON :ter j�erm,�ArrP') Phone: -7l S- 4S 17 - `t I° © IP e ktLCZip: 5 `f g S" Designer Information Designer Name: .Ai11 I,?,, ?v /k-0 s k; Phone: 7/C37-______ Designer Address: Po, a ©]c C2 -z-- yro lz J S Zip: S'"8{7 E-mail: -+onyabactrcjz� o/ti " o ✓✓1 This space reserved for approval stamp. License Number: 27.-C d 9 fl Remarks: Kr / 0_ 2 Signature: —" Date: riginal signature required on each submitted copy _. 4 s 5)1 S„r „ i/ p l bratn°nEyo Pb l��✓n.,y;n 5ea1c:o °��w�lo��t �e.65vF®t�d,� /Conu.entc.nG,i `Sce/ �5tar/)atS'%�/„,( Cop' :-ir.?.� I,ip a'�``artC oa'i"i twqq W' btQs•>. •251 py2 tin Ut1/ tJj<°Go IV .,., hl`•.rc uox.ri�d'r7Ii gVAP'LiIev.Yosd,m( 5!3D -)o (15t7CR5<OVAA l c/iz) sys-ren, e ev: 88 r s j s'ep+rtera„k,$1Do6gcllan wiener t6Ncara4e-°o1"L-&4"sl. Aid �mxZD : l9$ti3 Buz'°Qrb� 6a �•� h -I`, /awJ°ne:nle+ 7%`L'Chr"Scr'Spe'c• y"v+,:�a o-.-N8'"4eny! l2'1ei'ght-O""t.'�a,'; .�, �'/'otrctJ'.c,, ie+aFicTaN(dt �rl %IlrcfcFHio.P'y SfaA,l. lz"I; i, 144th;. -1 tA,t„liowawe„Atem+i;a t W: -k SP53S3 Sep{..c ° ..� 0u�lt+cr` v �5� L+at'e /.,:,, ton�e,r� c;If .✓.-Pae)�lok, eodel pt.-ta.C ) 5�hga'Pvc P.ptiy A5TY71 DliE'c- Sch SO,a35 PtIc P•le is 4$-nv, p3c3Y dpprcueetn�Fwm�/ ( i ✓r- ley -1051 Sin i Ln -ru., k n Li6-/- b•e Powt-e-1 c BayfieldCo.ZoningDept. s i.e- tutcZ w�r000q�ller ti tea. 1/ v L a 0o N� O N N 'Y+S cJy,0 3p'y„ Ly as See af.S•e rVej'�'t Ch ..._ 1 �C rm N \� ra.6G.C Pt- • • d s J nl v+ v u W N \� .---r. obSaru,4 oa p -es oe V' 94 Le �x'iouq RF.� S. A1d d•_, 'Pfoper•� OwmeY' Le. al bcsty. 4r + r Y f f i mn r i Fv ti. r; Li pov/t 1-cP 7 4 - P4rc d � � co PF J o v0 I+21! L,n�y✓eh R� rr O[i1 '{;oafarc2 �N Wta`;l•e� w -L .sL(85-y L 1 e (J sfa•, a Jak,Jcyv°w u � ��� lra _ -0e o !3m ttem o Beb -� WLP1000-MR TANK SPECIFICATIONS .r y O 104" DIMENSIONS: 00 °' a t! v a rn WALL• 2 1/2" hi 0 BOTTOM: SEPTIC 3" o CC? 0 N HOLDING 5" (ADD 1,300 LB.) o ^-^-n N ' COVER: 4" MANHOLE: 24" I.D. PRECAST CONCRETE RISER n HEIGHT: DOME COVER 61" O.D. °a FLAT COVER 53 1/4" O.D. - p Lfl CAST -A -SEAL 4" CAST -A -SEAL LENGTH: 104" O.D. '9 W o WIDTH: 86" 0.0. 024 BELOW INLET: 42" O.D. io LIQUID LEVEL• 36" °O TYPE WEIGHT: 6.790 LBS. FILTER OR INLET AND OUTLET: w m a 4" CAST -A -SEAL BOOT OR EQUAL i z' LE BAFFLE/ GASKET, CAST -A -SEAL BOOT OR EQUAL 0 C `--. - INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 W (OTHER STATES SEE CHART) LIQUID CAPACITY: 27.83 GAL/IN W TOP VIEW HOLDING TANK: �. OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,085 GALLONS 0 LOADING DESIGN: 8' 0" UNSATURATED SOIL GO.7 W OPTIONAL FLAT COVER W 2 j IS AVAILABLE FOR EXCHANGE O FOR DOME COVER. TANK CAN BE USED AS: 0 SEPTIC/ HOLDING/ PUMP OR SIPHON01 INLET _ COVER: MIX DESIGN #8 NO FIBER) 9 - OUTLET TANK: MIX DESIGN #10 (STRUCTURAL FIBER) m M ¢ CUSTOMIZED TANKS: N N a v FOR CUSTOM TANKS CONTACT WIESER CONCRETE ? a Q Q o PUMP PAD a N DRAWINGS SUBMITTED N w SIDE VIEW FOR APPROVAL ac APPROVED BY: SHEET NO. APPROVAL DATE: 1 TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS PRODUCTS NEEDED BY: ,,,OF F ' Wisconsin Department of Safety and Professional Services Reset Division of Industry Services ,1 c SR-�p230 SOIL EVALUATION REPORT 5 L:J in accordance with SPS 383, Ws. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. I tQ I percent slope, scale or dimensions, north arrow, and location and distance to nearest road. O Please print all information. R,evie,cl by j,/J Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (mp. � 7/,C. i Page of 3 property owner Property Location • Kelly Taipale, Kimberly Saari, Katherine Botten Govt. Lot 7 1/4 1/4 S 28 T 47 N R 08 E (or))W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 11271 E Lindaren Rd 1.8 acres Doc 2019R-576175 5771 City State Zip Code Phone Number Qity ®Village • Town Nearest Road Maple 1 1 54854 1 (715 ) 817-4606 Irnn Oi.,or I Shady Lane •� New Construction UseQ Residential / Number of bedrooms S Code derived design flow Replacement ® Public or commercial - Describe: Parent material f llmdal Ilrift Flood Plain elevation if applicable I ak9 leeI — ft. General comments and recommendations: The site is suitable for a conventional system. Horizon #2 in all borings is a Gravelly Course Sand D f� fN f� 11111 I� The benchmark = 100'.'' S VU IS P/ LS ® Boring MAY 0 8 ?Q , LI ❑I Boring # >90" Pit Ground surface elev. 92.0' R Depth to limitingfactor in. Pavfirlrl . ,Sov.Annl� icatinn Rate Horizon Depth in. Dominant Coloi Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots GPD/1F ' •Eff#1 *Eff#2 1 0-5 7.5yr3/2 — LS Osa ml cs 2f .7 1,6 2 5-90 7.5vr 4/6 — COs Osg ml cs 0 7 1.6 GPD 2 Boring# p�1 Boring 89.5' 90$ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/IF 'Eff#1 Etf#2 1 0-5 7.5yr3/2 LS Osa ml cs 2f .7 1.6 2 5-90 7.5vr4/4 -- COS Osa ml - 0 ,7 1.R • Effluent #1 = BOO5> 30'c 220 ng/L and TSS >30 c 150 mg/L * Effluent #2 = BOD < 30 ngIL and TSS < 30 nglL CST Name (Please Print) ignature CST Number Slecen C. Jnhnsnn L - # 227037 3620 South County Road D Poplar, WI 54864 4-11-25 218-590-6678 L' .ld � 5 o C l 0 3 rj 2A 2rvtit_ SBD-8330(Rf rm GB e !ri.;�� 17 MAY Kim Saari Property Owner '1ieIdCfl Bonn Parcel ID# 04-024-2-47-08-28-2 Bdrin # g 91.6 ti6^ V 07 _f zot " g N Pit Ground surface elev. ft. Depth to limiting factor >90" in. 2 3 Page _ of snit Annl firatinn Rafa I Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIIF 'Eff#1 Eff#2 1 0-5 7.5yr 3/2 --- LS Osg ml Cs 2f .7 1.6 2 5-90 7.5vr4/4 --- COS 0SO ml - n ,7 4] Boring # 2 Boring 94.4' >90'• Pit Ground surface elev. It. Dep01 to limiting factor in. SoilAnnHCSOn Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIIF *Eff#1 Eff#2 1 0-4 7.5yr 3/2 --- LS Osg ml cs 2f .7 1.6 2 4-90 7.5vr414 S Otis ml es 7 16 Boring # Boring 91.1' 90" O Pit Ground surface elev. ft. Depth to limiting factor in. Soil Aoolication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPD/fF 'Eff#1 'Eff#2 1 -0-4_ --7Syr3/2 --- LS --Osg - ml - cs 2f— — .7 - 16 2 4-90 7.5vr 4/4 --- S Osg mL - 0 .7 1.6 ' Effluent #1 = BOD, > 30 < 220 r g/L and TSS >30 < 150 mg/L * Effluent #2 = RODS <30 ng/L and TSS c 30 ng/L SBD-8330(R07/13) BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): -Check List ❑ Index Page / Title Sheet (Optional) K Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) aOriginal Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) J❑ Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used n Proper y Owner's Information (nnQtt prospective buyer's name) l Property Location (Accurate Legal Description with Sec/Twp/Range) S7 Road Name (where driveway is/will be coming off of) n Floodplain Elevation, Flow Rate, Comments and Recommendations fsl Complete Soil Boring / Pit Information Rt Date Soil Evaluation was conducted El CST Name, Signature, Number, Address and Phone Number M *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) ZJ. Bench Mark (Description, Elevation and Location) 5 Contour Lines (Example = 98.0'/96.0' /94.0') IZProperty Location (Sec/Twp/Range/, Accurate Legal Description) Borings (Locations and Elevations) Percent and Direction of Land Slope 19 -Well Location (Including Neighboring Wells, if applicable) N Location of Wetland Areas, Floodplain and Navigable Waters Buildings, Driveways, and Structures (Location and Descriptions) Location of Property Lines f≥PExisting System Location LWAddress Number and Road Name 'H' Current Surface Elevation of Wetlands and Navigable Waters WCST, Owner and Property Information [$9North Arrow Fee: ❑ Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checklist/checklistforests II• mot. W w3riYn Dorwt"x"`t `� "•R"h a)d r�\x1,cL)x\a1 S#rWCN Rt'sct II II E C U lS DMlien 01l1d1x^\ $.•.\�<-' Ijll'llj'�11(Jtl II s(1I1 I \niunll(1N I:I I) 'MAY 22025 U PaW_!3 at aodxrdenca wM .). n.' Aliedt wtrrpNla Ire Pbnoapugr1 $Sri nand/Ball nwhas in cr:e l'Lul rrxnl W.SJS , hR net ViSed to: Vandal aM tertto"ON taknlwa pewit (HMI. dknx'eon anti iw'a+tt slops soak adlroosias, north avow, end btarlon and dlstaance to neatest toad was. — ON Faumisttdt Pwwxt**"own TaupetAdar.ey be ta.d lot ..wary lxapoaaa(Mvary taw.• 1504 (tl IMP l Ba 4ield Co. Zoning 19'fleld Predv+l l l) 04-024.7.47-0R-2 05-007.12000 i ,'vlew h' Ikdn P, sb Oatna Property Localm Kely TBipaie, Kimberly Saan, Katherine Botten Govt Lot 7 1N 1N $ 28 T 47 N R 08 Elt® Napa OMM's WAig Address Lot S BW # Stdd. Name a CSMM 11271 E Lindgren Rd 1 8 acres Doc 2019R-576175 5771 Stele ®V11M110 • Town Nearasl Road Maple 54854 (715 1 817 - 4606 Shady Lane B New' CwwanX*on Use() Readanlal 1 Nunttier beckoats Q Code derived design flow rate 450 GPO 1 Repkcertml Pubic a cone areal - Describe: _____________— Patti maternal flit.-ud nnn Flood Plain elevation if appicabe I ak to l -Ajyjv 756ft. General COMMAS and vocony andalas: The site is suitable for a conventional system Horizon #2 in all borings is a Gravelly Course Sand The benchmark = 100.1 Barg # ® BMW 9 Pit Ground surface eiev. 92.0' ft. Depth to limiting factor >9D in. Soil Application Rate Horizon Depth in. Donirant Coioi Munsell Redox Description Qu. Sz Cont Color Texture Structure Gr. Si. Sh. Consistence Boundary Roots GPDAF 'Eff#1 •Efr#2 1 0-5 7.5yr 3/2 — LS Osa ml cs 21 .7 1.6 2 5-90 7.5vr 4/6 - me 0sq ml cs 0 7 1.6 2 Boring # Boring 895 90' pit Ground surfaceelev. ft. Depth to limiting factor m. Soil Application Rate Honzon Depth in. Dominant Colci Munsell Redox Description Qu. Si. Cont Color Texture Structure Gr. Si. Sh. Consistence Boundary Roots GPDAt' 'Eff#1 Eff#2 1 0-5 7.5yr3/2 — LS Osa ml cs 2f 7 1 6 2 5-90 7.5vr 4/4 -- COS Osa ml - 0 7 IA • Effluent #1 - BOD, '30< 220 mg/I. and 155 ' Ja < 15U mg/I. • tilluent #2 - BOD < 30 mg/I. and TSS < 30 mgt, CST Name (Please Pmtt) lure CST Number Sim en (' Jnhoam if - ---\--------- S 227337 Address Date Evaluation Conducted Telephone Number 3620 South County Road D Poplar, WI 54864 4-11-25 218.590-6678 SIfUKIN)(NUlr1i) 1111 MAY 2 8 2025 Kim Sean -024-2-47-08-28 3 Property ownea -------�__ Parcel 1D K 04 �ayFeld Co. Zoning De�_- e' — ❑ Boring __—__-- 6S_ po7r •d 3 Boring >9 91 6 0 s Pit Ground surface! elev ' ft Depth to lulling factor >9in Soil Amication Rate Horizon Depth in Dorinant Color Munsell Redox Description Qu Si Cont Color Texture Structure Gr. Si Sh. Consistence Boundary Roots GPDR( 'Efgt1 Effr 2 1 0-5 7 Syr 3/2 --- LS Osg ml Cs 21 7 16 2 5.90 7.5vr 414 --- COS Osq ml n 7 IF ❑ Boring # Bon 94.4' >yh i' Pit Ground surface elev. ft. Depth to Irnit g factor in Soil Appica^_on Rae Horizon Depth in. Dornant Color Munsell Redox Description Qu. Si. Cont. Color Texture Structure Gr. Si. Sh. Consistence Boundary Roots GPD'^ -Eff;=1 Eft I 0-4 7.5yr 3/2 --- LS (hg nil c. 2i 7 1.5 4-`A) 7.5%r4/4 S Osg ml 7 Boring 91.1' 9n-' ❑ Boring Ground surface elev. it Depth to limiting factor in Pit Sal Aocica on Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sr Cont. Color Texture Structure Gr. Si. Sir Consistence Boundary Roots GPD* ' Eft 'Efir2 1 0-4 7.5yr 3/2 --- LS hg ml CS 21 7 I fl 4-9( 7.5u 4/4 --- S lkc ml. - t1 .7 Lo Effluent #1 - BOD,> 30< 220 ngA. and TSS >30< 150 ring& Effluent #2 = SOD, <30 nvVl. and TSS ' 30 ng-1 I(l <'. G)-'. •1 e�i /1^ii. Y S I) , L7 V `� D fl MAY 2$ 2025 L t5 it /a�. sf Bafield Co: Zoning apt• / J L1 1, ,,a ; v u S 6l1i<:i, ;•s I� 1 `(z•�'� Sc h IJ ) ) /, �1 l� (1 '7 (?3 /. Fi I .S j .- �' f cc V7c c/v.y la+ y `G z, Layv POWTS OWNER'S MANUAL & MANAGEMENT LAnN flU 2,8 2,6_U of FILE INFORMATION Owner I rvt sty r< S cvcz r/ Permit # DESIGN PARAMETERS Number of Bedrooms 3 0 NA Number of Public Facility Units ;j NA Estimated (average) flow 3 00 gal/day Design (peak) flow = (Estimated x 1.5) 45_0 gal/day In Situ Soil Application Rate • % al/da /ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) ≤30 mg/L Biochemical Oxygen Demand (BODs) 5220 mg/L 0 NA Total Suspended Solids (TSS) ≤150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mg/L Total Suspended Solids (TSS) ≤30 mg/L 9 NA Fecal Collform (geometric mean) 510" cfu/100ml Maximum Effluent Particle Size %in dia. pg NA Other: [t9 NA Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) Imear At least once every:o ss) (Maximum 3 years) 0 NA Pump out contents of tank(s) N When combined sludge and scum equals one-third ('h) of tank volume 0 NA ® When the high water alarm is activated Inspect dispersal cell(s) At least once every: ❑ month(s) 3 o year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ months) year(sS 0 NA Inspect pump, pump controls & alarm At least once every: onth(s) ❑ month(s)year(s) 0 NA year s Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) ® NA Other: At least once every: ❑ month(s) ❑ year(s) ® NA Other: &INA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels In the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third ('F4) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of ≤12 months, shall be performed by a certified POWTS Maintainer. SYSTEM SPECIFICATIOI4V5eld Oct 7nninn Nant Tank Manufacturer tj.) . P Se.r Cc AL, 0 NA ❑ Septic 0 Dose 0 Holding vol. / O OO gal Tank Manufacturer 29 NA ❑ Septic ❑ Dose ❑ Holding vol. gal Effluent Filter Manufacturer FPO 1 ?! I O G 0 NA Effluent Filter Model Pi.. 52,5 Pump Manufacturer S NA Pump Model Pretreatment Unit 19 NA ❑ Sand/Gravel Filter 0 Peat Filter ❑ Mechanical Aeration 0 Wetland ❑ Disinfection 0 Other: Manufacturer Dispersal Cell(s) 0 NA C9 In -Ground (gravity) 0 In -Ground (pressurized) ❑ At -Grade 0 Mound ❑ Drip -Line ❑ Other: Other: ftq NA Other: 1 NA A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (12/02) START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) In one large dose and may overload them resulting In the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result In the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the Infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name A dkn ? Q c-ss 4C ?1kP Name A/ t d as lkcys Phone 'mil 5- Ztj 2,— &4 Q a 4 Phone '?IS- 2.9 ?,. — q I ≤-6 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name -'ncc s ?e, / k oSkrep4 '4) Name -, l L z a �► Phone 115 37 3:— At®©(o Phone 7/ This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. PRIVATE SEWAGE SYSTEM MAINTENANCE AGREEMENT DOCUMENT NUMBER 2025R-607484 Document Number Drafted By: Tony Polkoski Document Title DANIEL J. HEFFNER REGISTER OF (DEEDS BAYFIELD COUNTY, WI RECORDED 05/15/2025 AT 9:32 AM RECORDING 1 -EE: $30.00 PAGES: 3 Recording Area Name and Return Address PU� ki LS(�E��pE POOBox 522 522 Iron River, WI 5 47MAY 262075 Parcel Identification Number (PIN) THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE. This information must be completed by submitter: document title, name & return address, and PIN (if required). Other information such as the granting clause, legal description, etc., may be placed on this first page of the document or may be placed on additional pages of the document. WRDA Rev. 12/22/2010 Private Sewage System Maintenance Agreement Owner(s) Name KImb - Av Sccavl Owner(s) Mailing Address :117/ a L • � y rem /2� Site Address (pS1PSSSLdyL-1'', 2- wLS'KY As Owner, I (we) do hereby certify the pnvate sewage system will be installed in accordance with the certified soil tester's report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established in the WI Adm. Code, as from time to time amended. (COMPLETE Legal / Is required) 1/4 of 1/4 Section Township `f 7 N. Range g W. Additional Legal Description: See -('o/lor^1' "rS P"`/ e - Town of f ✓o n R t ' 'e -t' (Acreage) ) • Gov't Lot 7 Lot Block Subdivision Lot CSM # Vol. Page _ CSM Doc # Return To: -ti Area Anyfi&d Co. Zoning Dopt. ® In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ Other , Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (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. yt 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. i4 Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds, At -grade, and In -ground Pressure System Laterals (system types C. D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is Inspected as provided above. Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided bylaw. The terms and conditions of the variance shall be binding upon and inure to the benefit of all current and future owners of such property. Owner(s) Name(s) — Please Print Subscribed and sworn to before me on this date: �P 6±-_5 Notarized Owner(s) — Signature(s) Notary Publi LiJttLl. ,' {T H�N My Commission Expires: Drafted by: i• PT Date: .5`- -7 — a S Proofed by: u/fomislsanitary/septicmaintenceagreement Revised June 2018 PERSONAL REPRESENTATIVE'S DEED Kelly A. Taipale, as Personal Representative of the Estate of Thomas R. Taipale ("Decedent"), Grantor, for a valuable consideration conveys, without warranty, to Kelly A. Taipale, Kimberly R. Saari, and Katherine M. Botten, an undivided one-third (%3) interest each as tenants in common, Grantees, the following described real estate in Bayfield County, State of Wisconsin (the "Property"): A parcel in Government Lot Seven (7), Section Twenty-eight (28), Township Forty -Seven (47) North, Range Eight (8) West, described as follows: beginning at the intersection of the West line of said Lot 7 with the water's edge of Buskey Bay; thence North 0° 17' East along said west line 360.08 feet (passing through an iron pipe at 10') to an iron pipe; thence South 89° 53' East 200 feet to an iron pipe; thence South 0° 17' West 423..9 feet (passing through an iron pipe at 412.9') to the water's edge of Buskey Bay; thence North 70° 80' '%rest along said water's edge 208.34 feet more or less to the point of beginning. Located in the town of Iron River, Bayfield County, Wisconsin. Together with all appurtenant rights, title and interests. Personal Representative by this Deed does convey to Grantees all of the estate and interest in the Property which Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the Personal Representative has since acquired. This transfer is exempt from the fee per Wis. Stat. §77.25(11). AUTHENTICATION Signature(s). authenticated this _ day of 20_ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706, Wis. Stats.) This instrument was drafted by: Mitchell A. Routh Torvinen, Jones, Routh, Torvinen & Saunders, S.C. 823 Belknap Street, Suite 222 Superior, Wisconsin 54880 IIIIIIIIIIII IIIIIIIIIIIIIIIIUIIIIIII IIIIIII IIIIII II II *2019R 576175 1* 2019R-576175 DENISE TARASENICZ BAYFIELD COUNTY, WI REGISTER OF DEEDS 01/25/2019 09:55AM IF EXENPT t: 11 RECORDING FEE: 30.00 PAGES: I Name and Return Address TORVINEN,JONE SA RS, S. }.6 823 Superior, WI 0 tr [ iJ[5 t.cC_ 04-024-2-47-08-28-2 05-007-12000 (Parcel Identification Number) Dated (� - XXty k .::]:jpc&- t (SEAL) Kelly A. 11paIe, Personal Rej4esentative, Grantor ACKNOWLEDGMENT STATE OF 1111nnLC ) ) ss. DOUGLAS bolc.*c ) Personally came before me this Of U ' day of 2018, the above named Kelly A. Taipale, to me known to be the person who executed the foregoing instrument and acknowledge the same. Notary Pu lic,County, nflf S0_. L My Commission Expires- JJ3JJ aoa3 U:Wry Routh McAe/IAJS/UJ raipule Lame Personal Representmi— Deed Namzneaddaa Cross -Section and Over -Head Profile of O Surface and System Elevation O Position of Observation and Vent Pipes .fl, Dimensions and Depths OMake, Model & Number of Chamber Units in each Cell ProDertv Znformptjo ❑ How many systems will there be on this parcel of land? - ❑ Has this property been split? (Property Statement shows Property History) Fes: O 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 O Maintenance Agreements $ 30.00 (checks made out to Reg of Deeds) u/forms/checklists/checktistforsaniteryapps (10/2009);(®7/2011);(®2/2012)(®5/2/20:12 -dc) Proofed by: Ce" J fl r;av,C(I BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS [jjjj j V! Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) InMAY 282025 Id Check List Ift ti1 Original Sanitary Application (Submitted In Deed Holders Name — I?t prospective buyers) (383.21ThSfSld Co. Zoning Dept. Lv1 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) C 'Original Plot Plan (383.22(2)2. 3. & 4.a) [0 Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) @1 Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) Q Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) ❑ 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) Id Fee (Make Check Payable to Bayfeld County Zoning) (383.21(2)(c)7) ld . Co lee Set of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) 9 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 ADDllcation: (Include the following Information) Id I Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) ® Project Address of Road Name where driveway is/will come off of) Ql (Owners Phone Number) Rf II Type of Building fa( III Type of Permit ivi IV Type of POWTS System f9 V Dispersal / Treatment Area Information Id VI Tank Information ld VII Responsibility Statement (Plumber's Information) 0 *Date Stamp* Plot Plan: (To Scale or To Dimension) i2! Signature and Plumber Information t1 Surface Elevation of Body of Water ® Direction and Percent Land Slope 'Tank and Filter Information and Location LW' Wetlands / Navigable Bodies of Water I Absorption Area (Proposed and Existing) 1 Bench Mark (Location, Elevation and Description) t2 Component Manual Version O Legal Descriptions LI Piping Material Information (conveyance line, building sewer line, material type and diameter) Turn Over ► Lvf Address Number and Road L2! North Arrow Lf1 Contour Lines I' Structures and Driveways iB Boring Locations d Property Lines d Well Locations BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): E C E liV E D 0 MAY &1 Check List Bayfield Co. Zoning Dept. Qi Index Page / Title Sheet (Optional) rZ Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) l6 Original Plot Plan 0 Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) F?! Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used d Property Owner's Information (not prospective buyer's name) Property Location (Accurate Legal Description with Sec/Twp/Range) I0J Road Name (where driveway is/will be coming off of) 2 Floodplain Elevation, Flow Rate, Comments and Recommendations d Complete Soil Boring / Pit Information I21 Date Soil Evaluation was conducted d CST Name, Signature, Number, Address and Phone Number ❑ *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) l Bench Mark (Description, Elevation and Location) l Contour Lines (Example = 98.0' /96.0' /94.0') m Property Location (Sec/Twp/Range/, Accurate Legal Description) m Borings (Locations and Elevations) 16 Percent and Direction of Land Slope C�J Well Location (Including Neighboring Wells, if applicable) L6] Location of Wetland Areas, Floodplain and Navigable Waters m Buildings, Driveways, and Structures (Location and Descriptions) lii Location of Property Lines [9 Existing System Location 0 Address Number and Road Name C✓1 Current Surface Elevation of Wetlands and Navigable Waters fJ CST, Owner and Property Information 1 North Arrow Fee: 16 Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checklist/checklistforests SANITARY PERMIT (#04)-25-39S BAYFIELD COUNTY STATE SANITARY PERMIT OWNER: KELLY A TAI PALE ET AL GOVT LOT: 7 LOT: BLK: 1/4 1/4 SEC: 28, T 47 N, R 8 W TOWNSHIP: Iron River SOIL TEST: 28-25 REPLACEMENT SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: ALLAN POLKOSKI TRACY POOLER DATE: 613/2025 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: # MPRS 220090 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 6/3/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION