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HomeMy WebLinkAbout25-43Sss-mw'7 Department of Safety & Professional Services, Industry Services Division ^- County ',a<-/ -(-'-€. I 'ermiit.I^umber (to be filled in by Co.)^7'"iTrrryf'>j! ifiSanitary Permit Application In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. I5.04(l)(m), Stats. State Transacti<)tn!NuiNNU'mY 2 8 2025 I. Application Information - Please Print All Information Project Addressl^f'iiti®rent,thaiun8i|>ng at|d|;e»s) (e^Q 10 ^.^+1^1^^ Property Owner's Name , .. L u^ ke. uJ'i ^ ( ^ Parcel# ^T^c Tb^3 S~<ff~f^ Property Owner's Mailing Address ^i?/ /3^<i S-/-. A^L^ City, State 'Z.l^i y^-^V M-LQ^ A/H AY Zip Code &~^S e?l ^ II. Type of Building (check all that apply) pt I or 2 Family Dwelling -Number of Bedrooms a Public/Commercial - Describe Use D State Owned - Describe Use Phone Number ^/Z_ 5^0 /(/^ Property Location Oovt.Lot_ fi.XY^-tl l ^^^^ ^^'^ s£ S^f'/,', ^'^ ''/<. Section -r^-t Lot # Section T ^ N R _^__Xo<® Subdivision Name Block # CSM Number a City of__ a Village of 9 Town of '^ '- £> ^ ^ ' ^e-^ III. Type ofPOWTS Permit; (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if| applicable.) A.IS New System D Replacement System D Other Modification to Existing System (explain)D Additional Pretreatment Unit (explain) B.D Holding Tank B In-Oround (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/Trcatment Area and Tank Information; Design Flow (gpd) 3oo Design Soil Application Ratc(gpd/sf) .-7 Dispersal Area Required (sf)^•^Dispersal Area Proposed (sf)^^^'cn,^' Tank Information Capacity inGallons New Tanks Existing Tanks Total Gallons # of Units Manufacturer l!Is s sE 0 Septiu ur Holding Tank ~7€~0 -?£~0 J^LOt'e.s.e.K C.c'^d.^- .DaangChambn- V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print)Alt^ Te\^-^^u^^^:NP/MPRS Number 2.2- GOC! 0 Business Phone Number ~?tS~ ^^-^l'S~(ft Plumber's Address (Street, City, State, Zip Code) J^o. Bc-y. .$'2-2^ ^r^o^i^^^r ^0 2T ^~^8^7 VI. County/Department Use Only Approved D Disapproved a Owner Given Reason for Denial Permit Fee Date Issued^- \H^~^L U/^7/-^ Conditions ofApprovaI/Reasons for Disapproval C^LoJ^Oueko^L Uyy^ Attach to complete plans for the system and submit to the County only on paper not less than 81/2x11 inches in size SBD.6398 (R. 03/22) S?1 SOll TEST Wisconsin Department of Safety and Professional Services Division of Industry Services ^ !? !1: S? Si ^ !^ •In'lU; :; 1:: '- \\\\ lli! ^AV •; I; --,'-.. il.;Page.-of_ SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 81/2x11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, 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)). f:.;,;,';-.,-; County •^Y^/<L Parcel I,D, <3-^ZL^ 3^^^~7(e Date,^^-,^^5 IJS^^e^^tl ^ t^<n<, •• L^ k«_ L^J - • ^ /^Property Location ^, id.; -!a vcl" t''t l < ^ Govt. Lot ^ ^ A-^'% S 33 T y? N R ^ E(or)@ Property Owper's Mailing Address ;^y^r^^ng^ares^ ^ ^,ite Address or-CSM oncHset-ftIf^'oiO 'i^-u-t^ LA K-e. City ^ -^ , i/l '^ •£-« ^2^<;*1 State/^A/Zip Code^-6-37f Phone Number^^}3^D City D Village ^1 Town "J^ v o >->. /S- 11 ^ -e- •^ Nearest Roadg.j4 L, L^k^ ^ New Construction Use: [Xl Residential/Numberofbedrooms 2- [Replacement . I_| Public or commercial - Describe: Parent material 6- lci.€. n <Si. I "TH if General comments and recommendations: Code derived designflow rate_GPD Flood Plan elevation if applicable_ft. Boring #Q Boring Ipit Ground surface elev,M. Oft.Depth to limiting factor ^n./ elev. Horizon / -?- ^_ Depth In.~^=T31^-[^ Dominant Color Munsell rs-y^/l ^^ sr/^, $-<rX S-/f Redox Description Qu. Az, Cont. Color /d c. /V < /J o /v<z. (J f/v-e Texture ^^~T5~ _^_ Structure Gr.Sz. Sh. /-?^i^k 0 Consistence /H \J^v (.VI ^-f-1/ \A^.\^ Boundary ^<> ^s Roots 3^^FT^F Soil Application Rate GPD/Ft2 *Eff#1~T .7 _z. *Ef?27T(^~TT Boring #DBoringIPit Ground surface elev...y'/.pft.Depth to limiting factor ^3in./ elev. Horizon / ^ ^- Depth In. D-^~^r7T /^- §3 Dominant Color Munsell •^ crf^/i 7.s-r^,^r\^ ^ Redox Description Qu. Az. Cont. Color /\J o^e. /A/ c ,v^ /J p ,^1(» Texture ~^L~ L$ .5_ Structure Gr. Sz. Sh. 1-^K 0 D Consistence ^ l/^ ^A L-^L Boundary c^ ^5 Roots j^~ z ^~7^T Soil Application Rate GPD/Ft2 *Effff1~T .7 .7 *Eff»2IE~TVTV CST Name (Please.Print).» ..^., , ,A'Kn^'TS'YTo l^^l€i_ Address '(30, B&f^ S'2-2.^^R<uw'a-,;r s^f^7 Signature^ ^ / ^^.^3> 7 ;on Conducted'iTT^^C CST Number tZ.Q€sclO Telephone Number , ^ ^7^5"" Z'E?2.- ^^S~(^ * Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 S 150 mg/L * Effluent #2 = BOD, S 30 mg/L and TSS s 30 mg/L O^U^^[% f^d t^D ^[^\SBD-8330(R04/21) 'o W- Boring # D Boring Ground surface elev,.^'C ft. Page €» of Depth to limiting factor~-7 .in. / elev.__TI. Horizon T •2- _i_ Depth In. D - ^ ^-1^ ^-cll Dominant Color Munsell\^^s-r&r/^ S-^^Z S-/^ Redox Description Qu. Az. Cont. Color /J o A^€ /v'<?;v^ /^Ir-^-c Texture ^L 2.S s Structure Or. Sz. Sh. y^jc .0 0 Consistence n/i j\-^ 1^.1^ w/^ Boundary ^ts' ^s Roots ~3^ Zl^\~7^P Soil Application Rate GPD/Ft2 *Eff#1~r -7 _2_ *Effff2 ~^_1SLIM Boring #D BoringD Pit Ground surface elev._-ft.Depth to limiting factor.in. / elev._ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Or.Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 *Eff#1 *Eff#2 Boring #Q BoringD Pit Ground surface elev._Depth to limiting factor.Jn. / elev.. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 *Eff#1 *Eff»2 * Effluent #1 = BOD > 30 £ 220 mg/L and TSS > 30 & 150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS < 30 mg/L ^ ^ ^ 7 ~ • - - ^ S C _ e ' <rS ^ 7 ^ ~ ^ ? w " ^ ' ' ? I - ^ ' " 4 " ^•s ;^f?', -^^ L . ? Ov i ~ * . "• - ^ ? ; ( " f ? y ^ - ' - t£ <. .^^w~&00 ?5 * 5>u-r ^ - &T^%: ' ^ 6 -c . s -^ ^ ~ / - ' ^ k - ( 6 (S - ^ . ^" z - r s < F ls < ^ •^ - t " ^ s: « 7^ ? ?? i Lp ? . -— O u ' • - ' .y > 5 ~ 1 ^ - -^ ^ ^? . l- ^ OQ l It , <?•v e . - t t e ' n e ?, > & • C l ^ f - e . ? / e I & ^ t f f , / . . . I U . ~ I c . - ^ / ' & n d ' s s f t s I y - 1 / ' I i. s ? L t W t : s l s f t P & Q i f K i . - . a " • • • e- f e s H s ' ' J c . A ? W ^ c - S Q Q t Q- f c e . S s s - ^ n e ' - . ^ e a ^ g ^ f& e o a - , ;i | t f f- ^ - i : s f. S . c S T .s ' f f - S 9 HN - P N§ f 1 ^^ "? £ •^^'> y^ c ^ y' l ^ ' 0? - P ; ^ t\ ^ f f ?- * ' l - s ^ a- ' - p - ? e ' "g & - ? » , . ^ I^ H ^ n ^ y o £ y' F ? ' i A % ' . A n s ' ? * co -< fM ? ? (A 5 & - ^N K ^ l r , L ' . (i ^ S ? 3 ~ U i{ T ^i J ' ^ ^ -.. * • •- S ^? ^ >i J ^ i^ j - T» 1 I t ^ ^ ' e@(A ' * t . '. ' s - . A 'T ^ ?^ f ^. l ^ t ? . ! Rj ; ^ ? ^ t ^ & ~3 K. S ? * •U t r=? ' "• < - S - L - i * » > ~? - a • ) ^ " 5 i iB I ?¥ 1 ^ ' S ^ - j ^ . t * ! i: i l s 4 1 ^— ; %^ -l ^ i ?? ?<y•? (A05cyi 7< ° : ^ << • < • ; $- ^ S ? ' ® •^ f & • s 3' f l I A ^ v 6 - . ? _ & ^l £ ^C ! : : S - ^ ' ^ € ^ ^+- —^ ^+ - j R 'a - m. Us BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS !i)'l K i ft P n r,I fe !^1 Wl^ /n11)1 ...'~'!": "I }-; ,', r,^•'' ' ,i . / .Or^C: Oan.: II Submit the Following (Use Permanent Ink): 0 Check List ^ 0 Index Page / Title Sheet (Optional) E] Original Soil Evaluation Report (Submitted in Deed Holders Name - not prospective buyersy' -:' ^ ,',';,- H E? Original Plot Plan ''•£:vr!eici ,' D Cross Section Soil Profile Sheet (optional) D Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) 0 Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used 13 Property Owner's Information (not prospective buyer's name) 0 Property Location (Accurate Legal Description with Sec/Twp/Range) Ei Road Name (where driveway is/will be coming off of) 0 Floodplain Elevation, Flow Rate, Comments and Recommendations 0 Complete Soil Boring / Pit Information El Date Soil Evaluation was conducted 13 CST Name, Signature, Number, Address and Phone Number a *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) 0 Bench Mark (Description, Elevation and Location) 0 Contour Lines (Example = 98.0' ,96.0' ,94.0') El Pioperty Location (Sec/Twp/Range/, Accurate Legal Description) El Borings (Locations and Elevations) ^ Percent and Direction of Land Slope 0 Well Location (Including Neighboring Wells, if applicable) 6 Location of Wetland Areas, Floodplain and Navigable Waters E] Buildings, Driveways, and Structures (Location and Descriptions) £l Location of Property Lines Ef Existing System Location 0 Address Number and Road Name [2 Current Surface Elevation of Wetlands and Navigable Waters El CST, Owner and Property Information North Arrow Fee: B5 Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checklist/checklistforcsts May. 5. 2017 10:41AM BAYFIELD CO PLANNING & ZONING No. 9975 P, 3 PAGE 1 OF 7 In-Ground Gravity Plan Index & Cover J E(r t?'i f r ^ • Component Manual Design References: |;jj ^,,.,.,,,,, 1^?Version 2.0, SBD-10705-P(N.01,01, R. 10/12) l;i! fW ^ 5 20?!) /u PQ 1 of 1. Index & Cover ShssQt Pg 2 of 7 Plot Plan Pg 3 of "7 St. f '^IC.'TG, n ^ << os Section & Plan View Pg 4 of 7 Management Plan Attachments: Pf fct7^^f '^ -7 ^ ^1 Enclosures:I. POWTS Applicsmn for Review ^<>A^a^p^m.t/W.^ Soi! Evaluation Report & Site Map f^\^' ^4-e-'^ ^ <--e'- A ci ^c -^ yt-l-^/i'^- Project Name / Descriptior? Owner Name(s): ^ ke i^Jii^^l^ _ FBEoraa: ^^2- - 3^.- /Y'2- / Owner Address: 2.7^5, ,53^ ^-/-A/^'^-<^^&^^<r^.^(/ZiD: ^s'3ci^-^—. —_^-...-y— - I ^ Project Address: ^S~o i o J^^-^-L, L^ l^-e •^^ -^^o^ /^/^^^- ^- M^</ ^-V £ $i^ 1/4 of ^'1/4. Section^ 3 .T ,7 N-R ^ EUor w]^<l Township: ^y'^^ °/2j~^-^'-- • County: BA^-A/€ / Project Parcel ID #: -^T^ K ^ D ^ 3^L?~7^ _,„,„„„ Designer Information Designer Name: A//^ /^o/^os-^/ __ Phona: 7/<T'3%- '// ^'^ Designer Address: P.o. 3 ^ .S-2.-Z- rr^o.. ^ > ^-ec- ^ / X Zip: ^Y<?(/~7 E-mail: -j'ont/^.jb^-ci.^^ U.-^'^-'«-^^01^~^-" C—Q_^^_^ This space r&served for approval Stamp. License Number: "z-"2-00*^ Remarks: Signature: ^%^— / ^y^^ ^^ <^(-^5' Original signature required on each submitted copy. ^ ^ ^ " y - • " ^ i C f (*^ ^US f wOv i <5 (^L -H » .z . <s i ( / \ -~ u - I ' <^A ,^ ? - w-^00 ^ ^£ -1 - ^ p~ ? • ^ (^ . ^ a & ^' - ^ ^. ^ ?i *pi, ^T^ ^v : . ' 5 ( ' ; ^ £^" / ^ r. ^ ^ ^ !^ ^s. ^ -^ « - ^ -s - t • ~ - £: • 5 : -^ ? ^ s ?mr^ s ' 5 - i ^ - -^a rf . \ ^^ OQ ?-f lf -h ! ag j il Ok s < & . T W & v ' t « 1 ^ ® p^ & ' & ^ & ? / ' " HI r :i i ^ - ^. — - » yr a 3 - f p 1° § ^ ^3 w^0 ff s f ^— I & » 4 < J C . ^ ^ . n n e s f Q S^ e . i ' y / d ' , s 3 p i ^ C i ' 3 , f c e a ' i s s H . " s . ^ ~ 3 ~ k c- f e a / J s " ^ n y y . ^ ^ Q e u f . ~ 5 w - ~ ^i i Q- f a Q . S l s - e y t & R i c s . ^ s , ' ^ y \^- \ n_ Iw .^ 0 :t y 0 «.t ff l ,p^ p i^". w (S - ( ? f? % < S - ? 7 ! f* . S t 9? o 4v w(L U J '^ ' l •e . ^ ' + . ' ^T ~ { ? ; t 4 ^^ e ? ^r . ^ as T r a « -V A ~ » * . . ' ^ ^ H ^ ^ ' < . ^ ' e ; ' - ?-s CD sU - ^ ^ Q p. ~ f ; o 3 . 7 W3 o - e - ^ ^ ^ ^ ^ 1 i~ ^ . ^:L^ ^ (i ^ ^ ^ ~ Q ^S j ^ f &O Hm^ ' - S •- S s»s s- i t - t o - ^^ ^ . —<«? « r rl ^ s ^ S i . ^ ?^ F ^ ^' 5 - 1 5 ^ - t ? ? S^ i l ^ ^ j * ^ — : ?j ^ ? ? 5 ? r ^ 1 S T tS i - K S S ^l i ^ ^ 'P ^ P ^ m a ' <6 ^ 2 : » ^ t ^ ' £ ^¥ £ ? I S T H i & . « <f & ' K ^ 2 ; . S^ T - U T i ^^ • ^ ^y ^ i tt - a - £ . i e ^B 3 ^ ^ j^ ^ ? ' f f i i =; : ^ ' , f s : : ? c f e -^ C ! : ^ r t.1y.7 " •^.^(A3a cy . { ^e- §Q? $4- If ~t > &f ^K 1, ^ 4" CAST-A-SEAL TOP VIEW OPTIONAL FLAT COVERIS AVAILABLE FOR EXCHANGEFOR DOME COVER. WLP750-MR TANK SPECIFICATIONS DIMENSIONS:WALL: 2 1/2" BOTTOM: 3" COVER: 4"MANHOLE: 24" 1.0. PRECAST CONCRETE RISERHEIGHT: DOME COVER 61" O.D.FLAT COVER 53 1/4" O.D. OUTSIDE DIAMETER: 84" O.D. BELOW INLET: 42" O.D.LIQUID LEVEL: 37" WEIGHT: 6,150 LBS. INLET AND OUTLET:4" CAST-A-SEAL BOOT OR EQUALGASKET, CAST-A-SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER:WISCONSIN, SEE DETAIL j?10(OTHER STATES SEE CHART) LIQUID CAPACITY: 20.28 GAL/IN HOLDING TANK:ACTUAL CAPACITY: 790 GALLONS"OUTLET HOLE PLUGGED LOADING DESIGN: 8' 0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #6 (NO FIBER)TANK: MIX DESIGN #t0 (STRUCTURAL FIBER) CUSTOMIZED TANKS:FOR CUSTOM TANKS CONTACT WIESER CONCRETE PUMP PAD SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: ^1d] g cog in6. ^- z 00Eda I$ ins CM1^)° I >- 0t 03: 00 CMs §I 52 ^ u p^- uQ-LU(7)QL w SHEET NO. 1 .OF r IT' FILE INFORMATION POWTS OWNER'S MANUAL & MANAGEM^fpLAN SYSTEM SPECIFKSATIol^ " - In; .of. Owner i- ^ ^~-€_ ^ • ' ~i ^ I c\ Permit # 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 (BODs) Total Suspended Solids (TSS) Pretreated Effluent Quality Biochemical Oxygen Demand (BODs) Total Suspended Solids (TSS) Fecal Coliform (geometric mean) Maximum Effluent Particle Size Other: 2. DNA NA "Z^ c ° gal/day '3^0 gal/day t '7 gal/day/ft2 Monthly average* <30 mg/L <220 mg/L @ NA <150mg/L Monthly average :£30 mg/L <30 mg/L B NA <104cfu/100ml ^ in dia. E NA PNA Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Tank Manufacturer; yj» &.S<6 D Septic D Dose H Holding Tank Manufacturer D Septic D Dose D Holding Effluent Filter Manufacturer Pi 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) gj In-Ground (gravity) D At-Grade D Drip-Line Other: Other: .r &.! 'z D D D D D D C&A^ vol. -7$"0 vol. 1.&C. € Peat Filter Wetland Other; D D a a B B D NA gal NA gal NA NA NA ISIA In-Ground (pressurized) Mound Other: ^ s NA NA Service Event Inspect condition of tank(s) Pump out contents of tank(s) Inspect dispersal cell(s) Clean effluent filter Inspect pump, pump controls & alarm Flush laterals and pressure test Other: Other: Service Frequency At least once every: • 3 jgj m^^s) (Maximum 3 years) D NA S When combined sludge and scum equals one-third (14) of tank volumeB When the high water alarm is activated At least once every: ^ § !^nt(s) (Maximum 3 years) D NA At least once every: ^ g Ss()s) D NA At least once every: ^ | ^^ D NA At least once every: g Sneoanrt(5{s) B NA At least once every; g ^S)s) ® NA SNA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Ma$ter 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 (16) 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. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (12/02) Page <C- 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). 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 efduent. 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. 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. D 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 ^ |j^ '] Phone "7 if ^ s 2— iC€>5^C.\ ^^S~(c CP^lk^ld pltJoyiPuf POWTS MAINTAINER Name A 1. (& ^ S s» I kw'S id ( pc. / k.c.S, 1c, '?lij "-J^ ^ Phone -7/S~ 2-^'i- SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name -T^s,o<vi&5 T&liCQ Phone fIS' 3" Name 15 ei^-4-. ^ I i C&^tf-i^- "2-o^ ^ Phone -71 5~ 3-7 ^-(USg This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies In compliance with chapterComm 83.22(Z)(b)(1)(d)&(() and 83.54(1), (2) & (3), Wisconsin Administrative Code. Private Sewage System Maintenance Agreement Owner(s) Name t-^t^e- ^(\ R^^.-^-v YOv^^^a^A Ownsr(s) Mailing Address "Z.^7<c"^-l <y>^ <^'A/^ Z.-uUt<J?i<</W^'3'<tf| Site Address . 'SiteActdress ^ . f ~~^c\o ^U^^\ ^o^ R^-cVT^W TaxlD# ^^.^-7^ 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 specificationson file with Bayfield County Planning and Zoning Department, The system will beoperated in such a manner as to meet the designed plans. I (we) agree to maintain saidprivate system at the below listed location In accordanca with rules established in the Wl Adm. Code, as from time to time amended. (COMPLETE Legal is required) ^k^h'^^S^an ^ Township^.N. Range,-w. A^toua! Legsi Doaa-ipitou./^S ?l>r ^^ t ^ 2^ fr-5^^7<?4' 7' ^A Town of~^--rt> -i "R • 'J^- ir (Acreage)Gov'tLot. Lot..CSM#. . Subdivision Vol..CSMDocff. DOCUMENT NUMBER2025R-6075 1 5 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 05, 1 9/2025 AT I 1:1 5 AM RECORDING FEE: $30.00 PAGES: 4 Recording Area Return To: l€>^ ^4^p;f^ i, ^^f^^'B-£in'£ I. ^ro^ •fC^^^^^W'7 El In-ground gravity D Mound C3 In-ground dosed D In-ground pressure distribution Sewage System: D At-grade Sewage System d Other. .^ Seulte Tsnk (systci-i-i typss 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 makesuch Inspection, the tank is found to have less than one-thlrd (1/3) of the volume occupied by sludge and scum. Pump Chambsr (system types B, C, D, and E): The pump chamber shall also be rlnsed and pumped out when the septlc tank is serviced as providedabove. The switches and pump controls shall also be Inspected and maintained to ensure operabillty of said components, •*. Septic Tank Effluent Filter (system types A through E): The septlc 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. Admln. Code, ->• Private Sewage System Dispersal Cell (system types A through E); The private sewage system distribution cell shall be visually Inspected by a certified septage servicing operator, POWTS Inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds. At-arade. and In-around Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbedif needed when the wastewater distribution cell component Is inspected as provided above, Ownerfs) 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 sewlclng and maintaining the private sewage system tank In such a manner as to prevent or abate anyhuman health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. The terms and conditions of the agreement shall be binding upon and Inure to the benefit of all current and future owners of such property, Owner(s) Name(s) - Please Print ^ ^ ^_ kjj ^^ \-^\^ /fe^'^2 ^'//r?i^ Notarized Owner(s) - Sfgnature(s) ^.^W^ ^Uu -/^L/^ Subscribed and sworn to before me on tl s-^'^^< , JIULSONNotary F^ubtteMinnesjote any Commission 6(plres|Januarr31,2027 Notar jbllc My Commission Expires: Drafted bvFTe^ /% / ^^ k < Date: .3"-/^-^ 5">p \^\^o'y\ "l^;^_,rProofed by; J^/'/^?/; ' u/forms/sanltaiy/SBpticmalntenceagrBBmentRevised July 2020 ^ L^5P^^^S5H^ Document Number State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Name THIS DEED, made between SCOTT MAGAW, VJCKI MAGAW AND FRANK MANN, .("Grantor," whether one or more),and UJKER. WHTALA AND REBECCA J. WUTALA, HUSBAND AND WISE, AS JOINT TENANTS, .("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, m BAYPIELB County, State of Wisconsin ("Property") (if more space is needed, please attach addendum); See the annexed Exhibit A which is incorporated herein by reference. i K lra I E ^ ••\ El [I MAY '^^[ ^ .^ ^.. ..^.. g,..,^.. ..^..,^..,,.^.,..^,,,^..g,.,g .„, .^, ^ 2016R-565796 PATRICIA A OLSONBAYFIELD COUNTY, HIREGISTER OF DEEDS10/19/2018 01:10PM TF EXEMPT 8: RECORDM8 FEE: 30.00 TRflHSFER FEE: 75.00 Pfl8ES: 3 Recording Area Name and Return Address %<; -^ Q,. _ L^i'ifQ.lc*. 9n(aZ^ !^rci Sk AJt^J Z.-'m/>/l<^(M&<-< , f\Ahf S?3£?S n IQ4-024-2-47-08-33-2 02-000.11000 Parcel Identification Number (PIN) This IS NOT homestead property. t^W^ CO :.0nitig USri (<s) (is not) Ct 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. Dated DPjhoi^r /t/ ^0/fe» .(SEAL).AL) .(SEAL). AUTHENTICATION (SEAL) Signature(s) ^,,fl""»»»,,^ AGKSP STATE OF WISCONSIN authenticated on ^S^£^i ) )ss.COUNTY ) TITLE: MEMBER STATE BARS?F WISQONSIN (If not, ^' ..•"• —t..^^-^ \/V\\^-^\ f^CoTA/?.v^J/ ^ rrT7~\ "p|-sonally came before me on ^0 / IH t^-,t^^^-=— I thSabove-named SCOTT MAGAW AND VICia tpX°^l<<Blil\0 /..W^GA.W. HUSBAND AND WIFE '•^ 'w 0 h» ' ^_-~r—^7- n._, c ^^"^\. ff ..*/<?1^me known to be the person(s) who executed the foregoingauthorized by Wis. Stat. § ^^.....^Q^/^^^^^<ppwisyTHIS INSTRUMENT DRAFTED BY; '"^•«..ur«1 ATTORNEY MATTHEW F. ANICH. SB#101716? UALLENBACH, AJNICH & WCKMAN, S.C., ASHLAND, Wl + Qc^i^c. \-^c<^^ Notary Public, State of Wisconsin My Commission (iypcra»Bea4 (expires: ~7— Ce- ' ?'0?0 ) (Signatures may bo authcnflcntcd or acknoirledged, Botll are not necessary.)NOTE; THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY 1DENTIFI ED.WARRANTY DEED . © 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures. EXHIBIT A TOWARRANTY DEED A parcel of land located tn the Northwest Quarter of the Northwest Quarter (NW*4 NW%) and in the Southwest Quarter of the Northwest Quarter (SW'/ii NW/), Section Thlrty-three (33), Township Forty-seven (47) North, Range Eight (8) West, Town of Iron River, Bayfield County, Wisconsin, described as follows: Commencing at the Northwest corner of Section 33, Township 47 North, Range 8 West, which is known as the place of beginning; thence East along the North line of Section 33 a distance of 1316.6 feet to an iron pipe, thence angle to the right 89° 39' a distance of 1329.0 feet to an iron pipe, thence angle to the right 90° a distance of 538.8 feet to an iron pipe, thence angle to the right 90° a distance of 210,2 feet to an iron pipe, tlieace angle to the left 98° a disfsnce of 748.0 feet to an iron pipe, thence angle to the left 90° a distance of 1530.0 feet to an iron pipe, thence angle to the right 90° a distance of 42.0 feet to the West line of Section 33, thence North along the section Une a distance of 2640.0 feet to the place of beginning; LESS A parcel of land located in the Northwest Quarter of the Northwest Quarter (NW14 NW/i) and the Southwest Quarter of the Northwest Quarter (SW% NW'/<), Section Thirty-three (33), Township Forty-seven (47) North, Range Eight (8) West, Town of Iron River, Bayfield County, Wisconsin, described as follows: Commencing at the Northwest corner of said Section 33 and run South on the West Section line, 2640.0 feet to a point; thence proceed East parallel with the North boundary line, 42.0 feet to a point, thence proceed North parallel with the West section line to a point on the North section line; thence proceed West on said North section line to the point of beginning; AND LESS A parcel of land located in the Northwest Quarter of (lie Northwest Quarter (NW% NW/() and in the Southwest Quarter of the Northwest Quarter (SWy< NW%), SecUon Thirty-three (33), Township Forty-seven (47) North, Range Eight (8) West, Town of Iron River, Bayfield County, Wisconsin, described as follows: Conunencmg at the Northwest corner of said Section 33 and thence East along the North line of Section 33 a distance of 1316.6 feet to an iron pipe, thence angle to the right 89° 39' a distance of 998.8 feet to a point known as the place of beginning, thence continuing South on the same line a distance of 330.2 feet to an iron pipe, thence angle to the right 90° a distance of 538.8 feet to an iron pipe, thence angle to the right 90° a distance of 210,2 feet to an iron pipe, thence angle to the left 90° a distance of 740.0 feet to a point, thence angle to the right a distance of 120.0 feet to a point, thence angle to the right 90° East to the point of beginning. WiIni[II !? M< IP1!;-n w [;-> ' J n 6 ^1 L^Zs ? fT!1' o^r.1; K.S.K F lili ^ ^ C o 'A ^ 'e-^- T »c^r' "-i BAYFIELD COUNTYCHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-l-10(e)) ET Check List Bf Original Sanitary Application (Submitted In Deed Holders Name - not prospective buyers) (3^.2^1)1.) I Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) ;^ !| ^ „ ; ,; n ^ Ef Original Plot Plan (383.22(2)2. 3. & 4.a) ISi Cross Section, Over-Head Profile of the System and Schematic of Tank from Manufacturer D Pump Tank Diagram, Alarm and Pump Curve (when applicable) St Contingency Plan / Management Plan (383.22-3(2)(b)l.f.) ST 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) Ef Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) Ef. Complete Set. of Plans (383.22(2^2.} Mote: Sanitary Application and Maintenance^sire@m@nts are to be attached to all copies) ET 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) I Application Information must include: D 23 digit Parcel ID# - (do notuse 12 digits anymore-obsolete) El Project Address or Road Name where driveway is/will come off of) (3 (Owners Phone Number) ^ II Type of Building Q III Type of Permit Ef IV Type of POWTS System Ef V Dispersal / Treatment Area Information Tank Information Ef VII Responsibility Statement (Plumber's Information) a *Date Stamp* Plot Plan: (To Scale or To Dimension) Ef Signature and Plumber Information Ef Address Number and Road ET Surface Elevation of Body of Water Ef North Arrow 0 Direction and Percent Land Slope Ef Contour Lines Ef Tank and Filter Information and Location Ef Structures and Driveways [3f Wetlands / Navigable Bodies of Water H Boring Locations M Absorption Area (Proposed and Existing) Ef Property Lines 0 Bench Mark (Location, Elevation and Description) Ef Well Locations Ef Component Manual Version Ef Legal Descriptions Sr l^!®^^@^!]!^S^^iP9?^ Turn Over > Cross-Section and Over-Head Profile of the S¥S!teni; EO Surface and System Elevation El Position of Observation and Vent Pipes 0 Dimensions and Depths P Make, Model & Number of Chamber Units in each Cell Property Information D How many systems will there be on this parcel of land? _A a Has this property been split? ?tJ s (Property Statement shows Property History) Fees; E3 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 D Return Inspection $ 50.00 E3 Maintenance Agreements f $ 30.00 (checks made out to Reg of Deeds) u/forms/checklists/checkllstforsanitaryapps(1.0/2009);(®7/2011);(®2/2012)(®5/2/2012-dc) Proofed by: RAyFIELD Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: WIITALA, LUKE R & REBECCA J 27634 133RD ST NW ZIMMERMAN, MN 55398 Submission Number: SS-00547 Transaction Number: SS-00547-2C330 Description Private Sewage System (Septic Tanks) Amount $400.00 Total: Payment Amount: $400.00 $400.00 Reference: 6196 - ($50 soil/ $400 sanitary) Paid by: Polkoski Plumbing/ PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 6/4/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit BAYFIELD COUNTf SANITARY PERMIT r#04)-25-43S STATE SANITARY PERMIT OWNER: LUKE R & REBECCA J WIITALA GOVTLOT: LOT: BLK: 1/4 NW 1/4 SEC: 33, T 47 N, R 8 W TOWNSHIP: Iron River SOIL TEST: 43-25 NEW SYSTEM SYSTEM TYPE: Non-Pressurized In-Ground PLUMBER: ALLAN POLKOSKI TRACY POOLER Authorized Issuing Officer DATE: 6/4/2025 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: # 220090 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 6/4/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION