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HomeMy WebLinkAbout25-39S^Department of Safety & Professional Services, Industry Services .Division 55-o^^y ''S^.^-fi-c / ^County Sanitary Permitj^jBmb^: (tf^e ^lle^ in^y (;».) ^-SfS |r<|l&Y ? b '/.0'Z5iumffi?m~ •- - -"-Sanitary Permit Application In accordance with SPS 383.21(2), Wis. Adm, Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note; Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary puiposes in accordance with the Privacy Law, s. 15.04(1 )(m), Stats. State TransactiotflUumW* ;:';S»/fe!,-i ;; I. Application Information - Please Print All Information Project Address (ifdifferent than mailing address) ie^^~~S^^YL^ Property Owner's Name K) <v\l><-^ ill ^Ctd. V I Parcel #^T^^^ (°1?^ Property Owner's Mailiilg Address I 12--7/ ^ L» ^<LQ ^^^4City, Stale ^Uct'pl.-e <-<j1-J Zip Code^^^ II. Type of Building (check all that apply) ^- -^ 1 or 2 Family Dwelling - Number ofBcdrooms /—5 / 0 Public/Commercial - Describe Use D State Owned - Describe Use Property Location _ i t' pclK €.-€-/ l^ Govt. Lot /Phone Number ^ii^ g/-r ^(^o(p .'/•>,.Vs, Section 2^ Lot #T l/^ N R ^ ^o<^ Subdivision Name Block # CSM Number a City of. a Village of I? Town of '"LrQ^ /^I'O-e^ III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line S. Complete line C if| applicable.) A,D New System 8 Replacement System D Other Modification to Existing System (explain)D Additional Pretreatment Unit (explain) B.D Holding Tank ^In-Ground (conventional) D At-Grade D Mound D Individual Site Design D Other Type (explain) c.D Renewal Before Expiration D Revision D Change of Plumber D Transfer to New Owner,IList Previous Permit Number and Date Issued IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd)YS"O Design Soil Application Ratc(gpd/sf) -7 Dispersal Area Required (sf)^Y3'Dispersal Area Proposed (sf)4'ys-System Elevation ^g-s-' Tank Information Capacity in Gallons New Tanks Existing Tanks Total Gallons # of Units Manufacturer £0 I? GO <%II Septic-ui Hulllhy, Tank / D 00 1000 A U) tC-S-e-ir ^o,n^.^ .DamisCFunniier V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print)All^ Te\^-^ic, Plumber's-SiadatureW7^ f^^•WP/MPRS Number 2.2. Q0cl 0 Business Phone Number •^tg~ ^2.-^ i'S~(s Plumber's Address (Street, City, State, Zip Code) ^ ,r^ B^ £:^ ' :r^ <^^^ •^)^ ^-^,7 VI, County/Department Use Only Approved D Disapproved D Owner Given Reason for Denial Permit Fee$^)0 Date Issued^ ; m6L^1^ Issuidg AffSfl^ei]gna /^?J7/3 ~^£: Conditions ofApproval/Reasons for Disapproval Se^ ff^r^ d}^ (IAJT^ Attach to compietc plans for the system and submit to the County only on paper not less than 8 1/2 x 11 Inches In size SBD-6398 (R. 03/22) Wisconsin Department of Safety and Professional Services Division of Industry Services Reset SOIL EVALUATION REPORT in accordance with SPS 383, Wis. Adm. Code ^-00230 '/Page.of Attach complete site plan on paper not less than 81/2x11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). County Bayf(®^—-^,i^- Parcel I.D.im 2sc^. /w/?Datec////^ Property Owner Kelly Taipale, Kimberly Saari, Katherine Botten Property Location Govt. Lot 7 1/4 1/4 S28T 47 NR 08 lT^r)W Property Owner's Mailing Address 11271 ELindarenRd Lot #Block #Subd. Name or CSM# 1.8 acres Doc 2019R-576175 5771 City State Zip Code Phone Number Maple ^ 54854 j(715) 817-4606 QCity QViilage BgTown Irnn Riv<=»r Nearest Road Shady Lane W New Repls Parent rr General i and reco 1 Horizon w fe rr Ill w E n 1 2 2 Horizon E n 1 2 instruction UseQ Residential / Number of bedrooms ement Q Public or commercial - Describe: iterial ninpinl nrift a F imments imendations: -^. ...The site is suits Horizon #2. in alt b The >""g# SBOring ® pjt Ground surface elev. Depth in. 0-5 5-90 Dominant Colo Munsell 7.5yr 3/2 7.5vr 4/6 Boringiring#[S) pjt Ground surface elev. Depth in. 0-5 5-90 Dominant Coloi Munsell 7.5yr 3/2 7.5vr 4/4 id surface elev. 92.0 Redox Description Qu.Sz. Cont Color 89.5' id surface elev. Rectox Description Qu. Sz. Cant. Color Code derived design flow iod Plain elevation ifapplicafc ale for a conventional s' irings is a Gravelly Cou lenchmark = 100'.' t. Depth to limiting Texture LS cos Structure Gr. Sz. Sh. Osa Osg :. Depth to limiting Texture LS cos Structure Gr. Sz. Sh. Osa Osa ite _450 _ GPD > Lake level -- Approx 75.6' ^ stem. >e Sand. actor >9° in. Consistence ml ml Boundary cs cs 90" [actor in. Consistencel ml ml Boundary cs Roots 2f 0 Roots 2f 0 Soil Application Rate GPD/ff *Efl#1 .7 7r *Effi?2 1,6 1.6 Soil Application Rate GPD/ff *Ef(#1 .7 .7 *Eff#2 1.6 1.R * Effluent #1 = BOD,, > 30 ^ 220 mg/L and TSS >30 ^ 150 mg/L EfRuent #2 = BOD, .2 30 mg/L and TSS ^ 30 mg/L CST Name (Please Print) Steven C. Jnhnsnn iSignature CST Number #227037 Address 3620 South County Road D Poplar, Wl 54864 ~Date Evaluation Conducted 4-11-25 Telephone Number 218-590-6678 ^CL/d ^50 (jlk^^O-^lO^^ ^|Z^>|2^ M<_SBD-8330(R07/13) Property Owner Kim Saari ParcellD#04-024-2-47-08-28-2 Page of 3 Horizon B m 1 2 .ring # Depth in. 0-5 5-90 Boring B Pit Groi Dominant Color Munsell 7.5yr3/2 7.5vr 4/4 91.6' id surface elev. Redox Description Qu.Sz. Cont. Color o<r-c> :. Depth to limiting Texture LS cos Structure Or.Sz. Sh. Osg Osa >/-) 2_0-'.> >90" ,_factor - ~ in. Consistence ml ml Boundary cs Roots 2f n Soil Application Rate GPD/ff *Eff»1 .7 ,7 *Eff#2 1.6 1 fi 4 Horizon B n 1 1 5 Horizon B n 1 9. iring# Depth in. 0-4 4-90 Boring ») Pit Groi Dominant Color Munsell 7.5yr 3/2 7.5vr4/4 Boringring#l®pF ^ Depth in. 0-4 4-90 Dominant Color Munsell 7.5yr3/2 7.5vr4/4 94.4' nd surface elev. Redox Description Qu.Sz. Cont. Color 91.1' nd surface elev. Redox Description Qu. Sz. Cont. Color t. Texture LS s Depth to limitini Structure Gr. Sz. Sh. Osg Qsa ft. Depth to limiting Texture LS s Structure Gr. Sz. Sh. Osg Osg >90" factor in. Consistence ml ml Boundary cs C'i 90" factor in. Consistence ml mL Boundary cs Roots 2f Roots 2f 0 Soil Application Rate GPD/ff *Eff#1 .7 -7 *Efi#2 1.6 i.n Soil Application Rate GPD/fl? *Eff#1 .7 .7 *Eff#2 1.6 1.6 * Effluent #1 = BOD, > 30 5 220 mg/L and TSS >30 $ 150 mg/L * Efftuent #2 = BOD, ^ 30 mg/L and TSS 5 30 mg/L SBD-8330 (R07/13) t- T »( 1 r- t } tL 1 > £ f t x 1 > < ^ it^ sc». hi E ^^ •>! 1 1 p 4 / { K L 3 ^s ? >3 '< x ^ 1~ z k- I ^ f.c. <£ 2 z & '< ^ 7 4 /' <? • < >, ' ^ i f. ? ( /* ^J ^ r ? ^» &> Li / BAYFIELD COUNTYCHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): •^-Check List D Index Page / Title Sheet (Optional) JB: Original Soil Evaluation Report (Submitted in Deed Holders Name - nat prospective buyers) '& Original Plot Plan D Cross Sectton Soil Profile Sheet (optional) D Additional Information (Warranty/Quit Qaim Deed) (Optional) Soil Evaluation Report: (Include the following Information) JH Parcel Identification Number (must be 23 didt Tax ID#1 DO NOT USE 12 <Sgit, they are no longer being used & Property Owner's Information (not prospective buyers name) S Property Location (Accurate Legal Description with Se</Twp/Range) S Road Name (where driveway is/will be coming off of) & Floodplain Elevation, Row Rate, Comments and Recommendations ® Complete Soil Boring / Rt Information St Date Soil Evaluation was conducted B CST Name, Signature, Number, Address and Phone Number 'B * Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) %L Bench Mark (Description, Elevation and Location) B' Contour Lines (Example = 98.0796.0794.00 !S03roperty Location (Sec/Twp/Range/, Accurate Legal Description) "^B> Borings (Locations and Elevations) ^Percent and Direction of Land Slope TS-Well Location (Including Neighboring Wells, if applicable) 5 Location of Wetiand Areas, Floodplain and Navigable Waters i. Driveways, and Structures (Location and Descriptions) 12PLocation of Property Lines \S Existing System Location iy Address Number and Road Name & Current Surface Elevation of Wetlands and Navigable Waters lEPcST, Owner and Property Information [^North Arrow Fee: E3 Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checkfist/checklistforcsts V^vw Dctwhwt k>» Sf^ »n(t P^«»»WHMM»I S«>nk'»B CtMWic o»n>k«!«tr> StWiO.-w Reset SOIL EVALUATION REP|yT|^Y 2.8 2025 li»u»of m ftivmtona? wW> SPS Wst Wte Artm Cotte A(t»rti wnv*rtf 9»» ptw on p<y« n<l< hw* th*" 8 <<3x 1 < inchw hi »ul» Pton munt irxk»*» Mt w< »(rt<»« to witicat »(»< hcwwtnl r»»w»w peint (BM), dii»v<l«w <mt1 r*»wm s*w w<»i» o< Anwwon? mirth iwmiif. ml tawlkw Rnd d»ti>tK« h> mNknwit loud Ptew priht •» tntornNrtton. S><>-»kV*' »**.Tift»(W> 1W Iu^'**t ?»» tt uiKl fc* »w?on<t»r> pirpor* (Pnwcy t»», • 15 04 (1) (mH cfiff^ield Co. Zoning DgB^ield PNiwt 10 04-024-2.47-08.2 05-007' 12000-1^-^/9«t/3 Rcytwwfl by-? Dat*^7P ife^^l P»Qp«t»Ow»w Ke»y 75a<pa»e. Kimberty Saari. Katherine Botten Property Locrtton Govt Lot 7 1/4 1M S 28 T 47 N R 08 ;(o0 Propwty Owner's Mantnsi AcMncs 11271 EUodorenRd Lotd iBtockt | Sutri NnmBorCSM* Cfc State flpCode _L ±54854 |(715 ^ Phone Mur^rn 817.4606 1 8 acres Doc 2019R-576175 5771 |V»W BflTown Imn Rivfir NearwtRoed I Shady Lane B N»¥| Consfrudkm UseQ R«sidBrtM/Nurtbwo» bedrooms. QRaptoowwnt Q Puhfc or comnnKart - DwcribK Parent mNeml _ rstn.'Ml nril^ ^Code dertwd design (tow rate.450 OPD Ftood Ptam etovaUon H •pptcabte i nk-a louol - Ar>orox 75 6' ft General oonwnarte and reccxnmntnlrtuns:The site is smtabte for a conventional system. Horizon 92 in all borings is a Gravelly Course Sand The benchmark = 100'.1 1 Horo-on E n 1 2 2 Honzon ( n 1 2 Boringrtngt® Pit <»" Depth in. 0-5 5-90 Dominant Cok Munsel 7.5yr3/2 7.5vr4^5 ringt QBOrin9 W pit Gra Depth in. 0-5 5-90 Dominant Cok Munset 7.5yr3/2 7.5VT4/4 dsuiteceetev. 92.0' RedoK DescripBon QaSz. ContCokN' 89.5- d surface etev. Redax Description Qu. Sz. Cont- Color Depth to inntux; Texture LS nn?; Structure Gr.Sz. Sh. Osa Osg Depth to bntim Texture LS cos Sbucture Gr. Sz. Sh. Osa Osa actor >90" in. Consistence] ml ml Boundan cs cs Off actor _ h. Consistence) ml ml Boundary cs Roots 2f 0 Roots 2f 0 Sofl Appfcation Rate GPDflP *EffM .7 7 •Efl»2 1,6 1.6 Soil Apptcation Rate GPDW •EW1 7 7 •Emc 1.6 1 fi ' EffluentOl "B0t\> 30^220m((/L nndTSS >30^ 150mo/L * Eflkjcnt #2 - BOP,; 30 n^/L and TSS ^ 30 rr^/L CST Name (Ptease PnrQ Str.vcn F Johnson ^. CSTNurrtx»r r 227CU7 Addiess 3620 South County Road D Poplar, Wl 54864 y Date Evaluation Conducted 4-11-25 Telephone Number 218-590-6678 smmw(Ro7 r>» GIIW NAY 2.8 2025 fmpprty C 3 B Hon Ton 1 2 -. _ ,Kimsaan. Parcel ID » 04-024-2- ,^. OB.^';"". . 916' . ..ZT' pjl Ground surface etev _______ ft Depth to imilinB Depth tn 0-5 5-90 Dominant Cotoi Munselt 7 5yr 3/2 1 .SVT4/4^ Redox DesCTipdon Qu Sz Cont Cotor Texture LS cos Structure Gr. Sz Sh Osg OSQ 7.08.28-gayfieldCo, >7- tT-pt'^ >90- ,Factor in Consfetence] ml ml Boundary cs lcm^ De(5t ai Roots 2» n 3 Soil Apptcafion Rate GPD/flf 'EfW 7 7 'EM2 16 1 fi 4 Horizon B n 1 •> 5 Horizon E n 1 I ring » Depth in. 0-4 4-90 Borir^ D Pit Grol Dominant Cotoi Munsell 7.5yr3/2 7.5VT4/4 Boring Depth in. 0-4 4-90 Dominant Cotoi Munsell 7.5yr3/2 7.5vr4/4 94.4' id surface etev. Redox Description Qu.Sz. Cont Color 91.1'nd surface etev. Redox Description Qu.Sz. Cont-Cotor t. Texture LS _s^ 5epth to imitin Structure Gf. Sz. Sh. Osg Osg t Depth to fimi1in$ Texture LS s Structure Gr. Sz. Sh. Osg Osg >90"(actor hi. Consistence ml ml Boundar) cs Ft 90"(actor_in. Conststsnce ml mL Boundary cs Roots 2f Roots 21' 0 Soil Apptcabon Rate GPOffF *Efl»1 .7 7 •ESC 1.6 I 6 Soil Appicabon Rate GPDfflF *EW1 .7 .7 •EftR 1-6 1.6 Effluent<»1 .BOO.>30;220rrcA.andTSS>30;150mo/L • Eflluent #2 • BOO. 5 30 mgA. and TSS ; 30 n^t Mn^.ai.Wid'nM f; •;-^?4£ ......i'^iS-if-^-:L:^?^3£------L-----^^IN-^ trr>L !S-ii?!s-^;CT> i>^ May. ^. 2U1/ 1tJ:41AM BAYhlhLD CO PLANNING & ZONING No. 9975 P. 3 In-Ground Gravity Plan Index & Cover Sheet Component Manual Design References. Version 2.0, SBD-10705-P (N.01/01, R. 10/12) PAGE J. OF 7!^ f? ^ ^ it? fnl ill MAY 9 ^ 70'^ !L;;! li i'lAT </ U /'J/.O ^.1 ::V-msS!i:1 J;:\ <_C;i.;'iQ lm5';., Pg1of^ Pg 2 of 7 Pg 3 of -I: Pg 4 of 7 Index & Cover Sheet Plot Plan S€f^i^"T^nk- ('-tr0^ Section & Plan View Management Plan Attachments: P.i 5^t 7 f'c, ^ ^ -! ^•^7^ Enclosures: POWTS Application for Review ^^•-f-c^ ^m.tArP; Soil Evaluation Report & Site Map //y\^i 1^.4-^^s. ^ <~^- )\ c/ vre.'e.v^e.i\ Project Name / Description Owner Name(s): Ktiw^^K^ ^ ^<q. Vl Phone: -7t<T-W- <^°^ Owner Address: {[-i-H ^ L/^<L<s ^-c^ ^1 iM^^l-e i^-Zip: ^'/ ^ ^~ ^ ^^~ ^ ^ ^-^ ^Project Address: (£^leS~^~ ^^-^i^ L<-i "j/i^^^ /S.\/<-^ <-^'L ^H yY^ Govt Lot: -7 y^^^t/4 of _1/4, Section ^ . T ^~7 N-R ^ EDor W Township: -'C^o^ ^\/-e-^ _ County: T^^^-f^ ( <J Project Parcel ID #: -<^^ ^ £> tf lct^^3 Designer Information Designer Name: A//^ ^o/^os:^/ _ Phone: 7/F^3^-L// ^^ Designer Address: P-o. 3 o/c S-z-z- ^"^o^ IR • ^-er \^J X- ZID: J"/<?/7 ^E-mail: -hs^'/€-^<^-^^ ^l '^--e-i^.o^L - ^-o^^v License Number: _^o^c?0 RemarKs: This space 1-e.served for approval ^tamp, Signature: ^ /f./ inal sisnature required oh each submitted copy. Date:^/^_^J' ^ ^ ? N - ' _ 0 ' ^ L \ s ^ ~s ^ 1 ^ 0- ^ (k , W ( a ^ r^ ? 5' ^ ? ^ . ^ - 1 / \ s "F ^ ' ^ ^ i ^<» 0 ? (6 p 5 ^ ^s ^Ot s S ' a . ' r u e i A ' i ' s ^ « P/ p f c & < < - h e . f ' / e > 1- a " ^ r ^ ^ |S •u p ~ t " l ^ <? ~ " t < > s ~ ^? ^ ^ f s s - I f y^ i ?- | D L j ^ •^ " ^ . ^ f i l ? Et ' 0 « ? K A U, ( i - ^ , "' ^ ^ . ^ : '^ y ~ ' ^ ' \ 11 • i Q ^ ? - . o^ c ? ; H J n ^ O F ^• i j ^ & ' ° { S - ® e •V s - k . C7 SS ,>3 t- 0 ~<s v 's g U - c - o •• e ' F ' H T 0 f ^ ) s ? ^ f f t ^ ' ° $ I A ? 1 ^ c ^ - r ^ ^ ^ : \ ^ i r^ > P4 % / ^ . .' s < fS ® C > ' S - ^ \ <5 1 f j ' 5: > S - « S :'- 3 1 ' c 5 ~ r " %I P ~i 3 ^ 9 Q'f f C . r y e d i p f l • p i v ^ G . b ^ ' i f , » i " s Sr ^ - W l ' K ' < J r f l Y ^ y ' C i ^ e - S S / o- f c e . l i s - ^ n & n t i c a . p s . U '• ' s r c •~ 0 >^ 5 : ^e f S ^" ? ^ il l ^ ^ «© > . • T' ^ . ». ? ^ < ^J l ^ \ & ~ 1 M N ' '< . 'a : n ? r ; f\ (A ^ S p j ^ 0 ^f i2 8 ^ *? ^ 3 ' ; ' 0° ^ ^ ~> . l m^ j s ^ r f ^ - s " r . F 0 6 f t 1 ? ? l ^ < f f 1 " - 1 °. s ^ ? - ^ ? ^ ? r » ^ ^ ^ S U < ? I $ S ~ ^ ^ * UU " . ^ ^ ^ - ^ ^ „ _ l - ^? ^ t i ' S ( ? T ? ^ yH - E l i ? ? ^ - no i " h ^ ^ ^ - ' cl n ^ l l i ' s 0 T^ ? ^ t - ^ w m . + > s ^ ^ ' ^^ . . ^ s ? o ^ < r s ; r ^ ' S . . - T - ^ ^ - r . ' S - . . ? tN § ^ $ ' ° £ i ^i ' ^ t ^n rf ^ f ^ Tr ^ i f i ^^ , c ^ 5 - ^ + " ^ < ' ^• : ^ - ^ e ^ ^ ^ y ^ + i ^ ' ^ ^ ^ / ^ i ^ -£ / C . ^ 1 " zs ^ p / ^ ^b d l ^ s d ^ . , / , , ^ ^ , . . , ^ t / \ ^ U e / e - ^ ^ ^ ' / ^ i - < ^ ? S ^ ^ l l ^[ [ i : S z . e . ^ ^ ¥ y f c ' ' ' • - ^ " - - " r •3 - ; -^f^ M ^^ i m ^i ^ f 1^ 1 is i S I ?i N ^ s ^ - i ^ . r i S2 t f . l l i^ l i t H j$ ? ? ^ ? - ^ ;, ^ ' ^ ^ i ' ? '- ; ] < ^ - 7 > ~ t ; L^ pi . " -^ ^ e^ tf tOs or . s s it I ?I i <$ w / ^ 'i=:rrr=3 S=n-i.l ••,- ^.i ^J ^. ^ ^rLfL_. 'i ^-~ ra'£'=~, WLP1000-MRTANK SPECIFICATIONS (000 104" ^"^^^FILTER__OR.\^_jy DIMENSIONS:WALL: 2BOTTOM: 4" CAST-A-SEAL TOP VIEW 1/2"-...SEPTIC 3"HOLDING 5" (ADD 1,300 LB.)COVER: 4"MANHOLE: 24" 1,0. PRECAST CONCRETE RISERHEIGHT: DOME COVER 61" Q.D.FLAT COVER 53 1/4" O.D. LENGTH: 104" O.D. WIDTH: 86" O.D.BELOW INLET: 42" O.D.LIQUID LEVEL: 36" WEIGHT: 6.790 LBS. INLET AND OUTLET:4" CAST-A-SEAL BOOT OR EQUALGASKET, CAST-A-SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER:WISCONSIN. SEE DETAIL #10(OTHER STATES SEE CHART) LIQUID CAPACITr: 27.83 GAL/IN HOLDING TANK:OUTLET HOLE PLUGGEDACTUAL CAPACir/: 1,085 GALLONS LOADING DESIGN: 8' 0" UNSATURATED SOIL OPTIONAL FLAT COVERIS AVAILABLE FOR EXCHANGEFOR DOME COVER.TANK CAN BE USED AS:SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER)TANK: MIX DESIGN jji10 (STRUCTURAL FIBER) CUSTOMIZED TANKS:FOR CUSTOM TANKS CONTACT WIESER CONCRETE PUMP PAD SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS DRAWINGS SUBMITTEDFOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: ->^ S co8m£ ^-coI T^tps CM100 iQ01 00w3 'I <=) <2Qi= a,sc/i C>4 SHEET NO. Ip 1 R IS P E " ^; ir POWTS OWNER'S MANUAL & MANAGEMENT^L/W 2 b ^J_o< FILE INFORMATION Owner \/'~I V^\ Permit # <&«J^-~r _!eSL a r ( DESIGN PARAMETERS Number of Bedrooms Number of Public Facility Units Estimated (average) flow Design (peak) flow = (Estimated x 1.5) In Situ Soil Application Rate Standard Influent/Effluent Quality Fats, Oil & Grease (FOG) Biochemical Oxygen Demand (BOD5) Total Suspended Solids (TSS) Pretreated Effluent Quality Biochemical Oxygen Demand (BOD5) Total Suspended Solids (TSS) Fecal Coliform (geometric mean) Maximum Effluent Particle Size Other: J DNA ^INA 3 00 gal/day _^5~0 gal/day _L"7 _ga!/day/ft2 Monthly average* <30 mg/L <220 mg/L @ NA <150mg/L Monthly average ^30 mg/L <30 mg/L 121 NA <104cfu/100ml \ in dia. jg] NA PNA 'Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS^! 3; Tank Manufacturer yj i e/Se-if D Septic D Dose D Holding Tank Manufacturer D Septic D Dose D Holding & if Effluent Filter Manufacturer P€> I Effluent Filter Model p L S' Pump Manufacturer Pump Model Pretreatment Unit D Sand/Gravel Filter D Mechanical Aeration D Disinfection Manufacturer Dispersal Cell(s) IS In-Ground (gravity) D At-Grade D Drip-Line Other: Other: r& D D D D D D c-&^DNA vol. /C700 gal vol. /l<c-£- € Peat Filter Wetland Other: EINA gal DNA BNA @NA DNA In-Ground (pressurized) Mound Other: m NA ^ NA Service Event Inspect condition of tank(s) Pump out contents of tank(s) Inspect dispersal cell(s) Clean effluent filter Inspect pump, pump controls & alarm Flush laterals and pressure test Other: Other: Service Frequency At least once every: ^ ^ ^r(s)s (Maximum 3 years) D NA IS When combined sludge and scum equals one-third (14) of tank volumeB When the high water alarm is activated At least once every: ^ ^ ^nr^)(s^ (Maximum 3 years) D NA At least once every: ^ g ^r(s)s [:1 NA At least once every: ^ g my^ D NA At least once every: g Ss) B NA At least once every: g ^^ m NA SNA 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 affluent on the ground surface. The ponding of effiuent 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 (!6) 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 <\1 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (12/02) Page &» of,START UP AND OPERATION 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). 1( 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 infiltratlve 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 fails 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: D 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. D 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. j^, 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. a 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 NOTENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF APERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER • Name /\ ifeih '? Phone '-st f yj; SEPTAGE SERVICING Name -Tl^c'n^.e. Phone •r/lS~ 3- & I k^k.'t CP^i^i^' ^ Z.^1 S~(ft OPERATOR(PUMPER) ^ TefltCQslCi ^J"r&^Ae T 2-- '^•oo(e ItJoWl&Bi .irS&pf POWTS MAINTAINER Name ^H&i^. fW^oS i^frb Phone -US' 2.9^-y^S" LOCAL REGULATORY AUTHORITY Name t5 (0.</-f-, € I A. C& u ^ f^- "2. o ^ < ^ < Phone "71 5" 5'7'5--( 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. Document Number PRIVATE SEWAGE SYSTEMMAINTENANCE AGREEMENT Document Title Drafted By: Tony Polkoski DOCUMENT NUMBER2025R-6074S4 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, Wl RECORDED 05, 1 5/2025 AT 9:32 AM RECORDING FEE: $30.00 PAGES'- 3 Recording Area Name and Return Address Tony Polkoski ^ ^ ^ ^ p ^PO Box 522 ^ E^ £ !i 0 Iron River, WI 5|J47^ 9 8 2025 }-;-a\/'hAi/-; ,''•',. -/'/-,...,^^ rj,^^M Parcel Identification Number (PIN) THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE. This information must be completed by submitter: document title, name & return address, and PIN (if required). Other information such as the granting clause, legal description, etc., may be placed on this first page of the document or may be placed on additional pages of the document. WRDARev. 12/22/2010 Private Sewage System Maintenance Agreement Owner(s) Name |^ i i^\ b '€-^^C3<^<^V Owner(s) Mailing Address HZ71 ^ L'iri c-i r«^ /^^[^i^^lj ^y^-v Site Address ^5~^S'S'$'^^^-Ay ^^ lc?g'^5 C <-l Tax ID # As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil tester's report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established in the Wl Adm. Code, as from time to time amended. (COMPLETE Legal is required) _1/4 of _1/4 Section '2-^' Township _^/_Z_N. Range ^ W. s&& ^C.HSLJ,^^ T'a^ e-Additional Legal Description: Town of Lot -^on K^-^(Acreage)/'.^Gov't Lot 7 Block_Subdivision Lot CSM#Vol.Page.CSM Doc # y Recording Area Return To: •--fc ^ '^ pc^ fS- c ^ v d i--i /^. / pc^^^' -j Lb U vl ^mf'^^S HavfiiaM f';n ';';iCo, Zoning Dopt. In-ground gravity Mound D In-ground dosed At-grade Sewage System D In-ground pressure distribution Sewage System: Other y Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. Pump Chamber (system types B, C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. ^ Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. fe Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds. At-arade. and In-around Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. The terms and conditions of the 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 k-lrr)6E^i^ Sp\fi^\ Subscribed and sworn to before me on this date: "- T^o^S Notarized Owner(s) - Signature(s)Notary Public My Commission Expires:L/5.A«/\^ Drafted by: ~T" F Date: _ S--^-^ 5 Proofed by:-rr u/forms/sanitary/septicmaintenceagreement Revised June 2018 Document Number PERSONAL REPRESENTATFVE'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 (Vs) 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 ofBuskey 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° SO' West 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 appurtenarit 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 pnor 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). Kelly '*" 2 -0 f' 9'R -"57-6-1 • -7-5 - • -J -i- 2019R-576175 DENISE TARASEWICZ BAYFIELD COUNTY, WIREGISTER OF DEEDS01/25/2019 09:55AMTF EXEMPT »: 11 RECORDIN6 FEE: 30.00 POGES: 1 Name and Return Address fpTORVINEN, JONE3SAUT^ 823 Belknapl ERS; S.t.»^ II^e^-^.. iUj Superior, WI 54880 Bgyfield Co, ZonEna DeDi. 04.024-2-47-08-28-2 05-007-12000 (Parcel Identification Number) DAVID JASON NEUDECK^R NOTWW PUBUC-MINNESOTA My Comnwsion Expires Jan. 31. 2023 i I3-|3-ft|lft ^ ."T FATO^e fSEAL) pale, Personal Representative, Grantor 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, Roiith, Torvineh & Saunders, S.C. 823 Belknap Street, Suite 222 Superior, Wisconsin 54880 ACKNOWLEDGMENT STATE OF fYMnrA-bC^ DOUGLAS bo^<- -) ) ss.J Personally came before me this pl's ' 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 Public, fc^dSAk . County, ^>^rUS6^. My Commission Expu-es; I / ^\ f 9oa^ U:\AttyRouihMitche!lA\t8l04TciipaleEstale\Persona{ RepreseniafivesDeeJHGmesiewi.docx Cross-Section and Over-Head Profile of the m Surface and System Elevation El Position of Observation and Vent Pipes 0 Dimensions and Depths 0 Make, Model & Number of Chamber Units in each Cell Property Information 1' D How many systems will there be on this parcel of land? _J_ D Has this property been split? _!^L___ (Property Statement shows Property History) El Private Sewage System (Septic Tanks) $ 400.00 D Private Sewage System (Holding Tanks) $ 400.00 D Mounds or Systems requiring Pre-Treatment $ 500.00 D Sanitary Revisions $ 25.00 D Private Sewage System Reconnection $ 50.00 and Private Interceptor a Return Inspection $ 50.00 El Maintenance Agreements f $ 30.00 (checks made out to Reg of Deeds) u/forms/checklists/checMistforsanit8ryapps(10/2009);(®7/2011);(®2/2012)(®5/2/20:l2-dc) Proofed by: C 0 A ^ €-^ T « 0 ^ c<- i BAYFIELD COUNTYCHECKLIST FOR SANITARY APPLICATONS I ; Submit the Followino (Use Permanent Ink) (Title 15, Section 15-l-10(e)) ^ Check List Sf Original Sanitary Application (Submitted in Deed Holders Name - noS prospective buyers) (383.21(1)1.) Ef Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) Ef Original Plot Plan (383.22(2)2. 3. &4,a) @i Cross Section, Over-Head Profile of the System and Schematic of Tank from Manufacturer D Pump Tank Diagram, Alarm and Pump Curve (when applicable) Ef Contingency Plan / Management Plan (383.22-3(2)(b)l.f.) Ef Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) D Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) D Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) D ATU Servicing Agreement (Recorded at Reg. of Deeds) EZT Fee (Make Check Payable to Bayfleld County Zoning) (383.21(2)(c)7) El. Complete Set. of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies! BT Soil and Site Evaluation Report (383.22-3(2)(b)l.e.) D State Plan Review (when applicable) D Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) S I Application Information must include: D 23 diait Parcel ID# - (do not use 12 digits anymore-obsolete) E] Project Address or Road Name where driveway is/will come off of) 0 (Owners Phone Number) II Type of Building Q III Type of Permit /--X G3 IV Type of POWTS System V Dispersal / Treatment Area Information Tank Information VII Responsibility Statement (Plumber's Information) D *Date Stamp* Plot Plan: (To Scale or To Dimension) 0 Signature and Plumber Information Bf Address Number and Road 0 Surface Elevation of Body of Water 0 North Arrow G3 Direction and Percent Land Slope Ef Contour Lines [gf Tank and Filter Information and Location E3" Structures and Driveways ST Wetlands / Navigable Bodies of Water OH Boring Locations EZf Absorption Area (Proposed and Existing) [if Property Lines 0 Bench Mark (Location, Elevation and Description) Bl Well Locations Ef Component Manual Version Ef Legal Descriptions ® !Si^[!^a^l'^!JIT^TOa^&^^ type and diameter)1 Turn Over > BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS B ^i[" ^!: ";:: IT Submit the Following (Use Permanent Ink): ;^( ji; II HAY '^ ^:/: 0 Check List _.,.,.,. .,..;.. ;->p-DgvpejG ^, \'JW% !-?F- 10 Index Page / Title Sheet (Optional) 13 Original Soil Evaluation Report (Submitted in Deed Holders. Name - not prospective buyers) El Original Plot Plan a Cross Section Soil Profile Sheet (optional) D Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) El Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used Q Property Owner's Information (not prospective buyer's name) EZI Property Location (Accurate Legal Description with Sec/Twp/Range) El Road Name (where driveway is/will be coming off of) IZI Floodptain Elevation, Flow Rate, Comments and Recommendations El Complete Soil Boring / Pit Information \Z Date Soil Evaluation was conducted 0 CST Name, Signature, Number, Address and Phone Number D *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) @1 Bench Mark (Description, Elevation and Location) 0 Contour Lines (Example = 98.0796.0',94.0') 12 Pioperty Location (Sec/Twp/Range/, Accurate Legal Description) 10 Borings (Locations and Elevations) \S Percent and Direction of Land Slope 0 Well Location (Including Neighboring Wells, if applicable) \6 Location of Wetland Areas, Floodplain and Navigable Waters [Z3 Buildings, Driveways, and Structures (Location and Descriptions) £1 Location of Property Lines Ef Existing System Location 0 Address Number and Road Name [3 Current Surface Elevation of Wetlands and Navigable Waters ^ CST, Owner and Property Information ^ North Arrow Fee: E3 Certified Soil Tests - Review & Filing Fee . $ 50.00 . u/forms/sanitary/checklist/checklistforcsts BAYFIELD COUNTS SANITARY PERMIT f#04)-25-39S STATE SANITARY PERMIT OWNER: KELLY A TAIRALE 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 Authorized Issuing Officer DATE: 6/3/2025 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 #: 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