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HomeMy WebLinkAbout25-43Su"' INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY TIME RECEIVED REMOTE CSID DURATION PAGES STATUS June 16, 2025 at 7:51:44 AM CDT 7153724159 39 1 Received Jun 16 2025 23:11 HP Faxpollrosld Plumbing 7153724159 page 1 Request for Sanitary Inspection (24 I-Irs. 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 sta₹€ me•mhare Note Time Chanfl Discrepancy fl Other l e n t ro/fros Phone Number Plumber: I/ 1- / / ?c Y�eS{� jet v We b n Fax Number -7/S 3-7z-4(s�� Homeowner: L i/ G Email Address Sanitary Permit Z - L(3 S Immediate Phone Number So Zoning Dept can call you right back (If needed) #: I 7rS--Z9z Y(S Plumber's Choice Zoning Dept Date: -j 5 Time: Plumber's Choice Zoning Dept i0`30 j � ��ii 1�i Township: �voh � ✓e _______ -l. Address #& & Road Name: ✓ o` ` ' V0 ` ` `i'e ,- k e £T or sOO+C1 /T- 4-11 Lsr ire gA 4o a Z (e s -I a h L Directions To Site: oK e-ase warn # �v v. jv-,-i4 �' %o L{ : i e �s R i-geec !ct Jib Comments: f Plumbers you must verify any change(s) by fax or email notes from m U/fonna/sa niteryhequesror)nsoecdon Zoning Dept (e411 2/04); ® June 2023 Y PS. Industry Services Division P -' --' I..s....,,atinn Private Onsite Wastewater Treatment Systems ( POWTS) Inspection Report (Attach to Permit) LUKE R & REBECCA J WIITALA Li 27634 133RD ST NW ZIMMERMAN MN 55398 BM Descrip Urtl to Tank Infnrmafinn setback to: TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake 1 Road Se tic c SQL D 5G I N/A Dosing N/A Aeration N/A Holding Town of: County &ui'AeJdLil Sanitary molt No: State Plan' Transaction ID#: Parcel Tax No: Pump I Siphon Information rump Manufacturer ump Model Demand GPM l er c rer Filter Model TDtf Lift Friction Loss Head Total Forcemain Length Dia DIst. To Well Cell Type of Cell O�vgTtLS Pretreatment Unit Manufacturer: Model Number: Distribution Dia UGII.7 1 Iv OHWM r. Dia Elevation Data STATION BS HI FS ELEV Benchmark — Q 6O Bldg. Sewer — Tank Inlet — g710& Tank Outlet (,�G 4/ Dose Tank Inlet Dose Tank Bottom Inst. Contour Header/ Manifold Distribution Pipe Infiltrative Surface t�Q ql 9 Final Grade qS f X Pressure Systems Only X Hole Size I X Hole Observation Pipes ❑ Yes ❑ No Depth Over P Depth Over P Depth of P Seeded I Sodded Mulched Cell Center I Cell Edges J Topsoil I ❑ Yes ❑ No ❑ Yes 0 No DOMMENTS: (Include code discrepancies, persons present, etc.) _ Ceti 5how� � Tbn =Utn1b/Ub5e�v0a6^. ptai '�rnati 4 Ian revision required? O Yes�'i okx I� � for information. ?&°�1(l I /'t Jet !00 r r I4/1 ' 1 ae other side additional Date POWTS Inspector's Signature License Number t3 Is ,Rn.fi71n rR n'ir911 Property Owner Information As you know BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoning(abayfieldcounty.wi.nov Web Site: www.bayfieldcounty.wi.gov/147 LUKE R & REBECCA J WIITALA 27634 133RD ST NW ZIMMERMAN MN 55398 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: 1 •> Tank was pumped by: Tank was crushed / removed and pipes disconnected by: on at AM/PM On at (AM I PM) the above -mentioned plumber contacted our office to condu t 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: kQ �% s'/ c I (24 I LtXA in <1 k//PO' / r U/formslsanitarypropertyowner-input April 2019 55-ooq7 y�trnxrtk y Department of Safety County t...,v �� ;• � & Professional Services, Sanitary Perm um er (tq be filled in by Co.) Industry Services.Division ��) 11 t Sanitary Permit Application State TransacNu 'SAY 2 8 2025 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 Project Addres (IIfi0104 a1E1 pff f Ojj{s) the Department of Safety and Professional Services. Personal information you provide may be used for secondary 11- I purposes in accordance with the Privacy Law, s. 1S.04(1)(m), Stats. 4 ≤ / O v TL L I:.Appllcation Information — Please Print All Information - . •- Property Owner's Name Parcel # Lu kle �I Property Owner's Mailing Address Property Location 27&3 1 d s N� Cit , State Govt. Lot ?at Y L. e [ l'1 '' —L`� Y Zip Code Phone Number iYc vvl- e tr � rL(2.(N t,J � �� �( �360 t; 3 m S b �Z tP 4 i t1 % '/+, Section II. Type of Building (check all that apply) Lot # T 117 N R g • 'o Ior2Family Dwelling — Number ofBedrooms '2.. Subdivision Name Block # O Public/Commercial — Describe Use O City of O State Owned — Describe Use CSM Number O Village of Q9 Town of _ r D k 1/C-✓ III. Type of POWTS Permit: a (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete lineCif if licable. A. New System 0 Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank R9 In -Ground ❑ At -Grade 0 Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Int'nrmnfinn•- 3300 __________ __ J - q ljc. Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units Now Tanks Existing Tanks U H U v� w o7 w C7 a.. Septic a okli g Tank -7 ?O nesiag.Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) r Plumber's atu 3�/MPRS Number Business Phone Number A/14L11hD 1 -r,5kI Plumber's Address (Street, City, State, Zip Code) _ O, Box .s~z.� y �a t✓ m J .L ≤Y7 VI. Count'/Department Use Only. Approved 0 Disapproved $Permit Fee Date Issued Issui g A I 0 Owner Given Reason for Denial I *V 41H115 / �S Conditions of Approval/Reasons for Disapproval I n SBD-6398 (R. 03/22) May. 5. 2017 10:41AM BAYFIELD CO PLANNING & ZONING No. 9975 P. 3 Pg 1 of 7 Pg2of7 Pg3of-1 Pg4of-' Attachments: In -Ground Gravity P'an Index & Cover Sheet D . Component Manual Design References: Version 2.0, SBD-1 0705-P (N.01101, R..10/12) PAGE 1OF7 MAY 2..8 ?U?J Da.YField Co. Zoning Dept Index & Cover Sheet Plot Plan C.: ads Section & Plan View Management Plan c ■ciosutl es: POWTS A piicatson for Review ( San Soil Evaluation Rekort & Site Mao Project Name I Description t� / i Owner Names : i- u ke 1 1 -�bo�ae:Z)�. ��� _ ..mod - /'� owner Address: 2 7 !v 3 133 r 5+ AI tc� �� ,�,s�e -rr/Zip: 5' Project Address: / k -e 2 k-" w ' Y 5;v/ 1/4 of _. N1w1/4, Section, T N -R S E nn or W Township: J-. v D h '-'-L SOounty: ≥ c y :€ ( Project Parcel ID #: K 1 y 3 ≤ to 7 . r Designer Information Designer Name: A 1 / ko s k - Phone: 7/ S- _ 7 -VI Designer Address: ?-& &. 2 © S2, -z- . (� v-e.��- J . f zip; { . 'f 7 E-mail: -1�'t y b € . roc w l'e_ii o v+1&." C- © i This space reserved fo approval stamp. License Number: Z7 -O o 9 Remarks: Signature: Date: -- z S Original signature required on each submitted copy. ____________________ 5 g; I 4 � J n o ?a t : 1 !►�ayr fc ;.� f 'c.�t � ' !" z!o` rri j� r� ��, �'�e� v.e.n �r c��► �z a: � / �D r� �' n;J, e.6? v 2.'� J r r1 h + l'.. •_ a�J1•i �Q,li: j��i.�i�i �dl ! J csr Z.Zdmdb'7 3p+f .ie k 7SO Pa l %1 wi ese r c6sc e4e w " �,,..g j�,,�,►, ra �, d �� a•� j07 ,-lt' 6'M ba�� �, „ .. , ti ¢. viLS' � v (�C �. : V 'b44l4 t l� '� '' L.Q,p1 '� Man r f o it . fo `¢•war.t.Ge bO* 9 !j, l�feyq i` » G� � !ro:k 'fl5 w ' � /` "tip l, ?4 4 SpS irioVD i® VM ,p 'e,�� Atlr'1 .h S^DP"U •P/\o rope `s ASI cv sa3Y MAY 2 ?U k i 4 4 PlrOper4y O ter G,, %� w !� 2 7 7' 13 3 r d..c+ / " iv' e v Yvt r /Z? "≤ 3 Cl g• hayfield Co. Zoning Dept. .. ja'+ __ i i �� � nf�4vd. � rrt• r Tt��lt'rsv' ' ' L►, Zr e1c ur r �.,•+� a� f . (� ti J . d k N' t t! / i �1 ''I ≤ Q' 2::c • C a13ec R't Zes14e.zct /32-D L�.q $ec 33`rWN R S W -TOWa o1 Cvclti . J' e*OvJy 04 18 c-tY` ' -e. / h 1' a u TOP VIEW PUMP PAD SIDE VIEW 4" CAST -A -SEAL L FLAT COVER ABLE FOR EXCHANGE IE COVER. TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS WLP 750- M R TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1/2" BOTTOM: 3" COVER: 4" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: DOME COVER 61" O.D. FLAT COVER 53 1/4" O.D. OUTSIDE DIAMETER: 84" O.D. BELOW INLET: 42" O.D. LIQUID LEVEL: 37" WEIGHT: 6,150 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 20.28 GAL/IN HOLDING TANK: ACTUAL CAPACITY: 790 GALLONS OUTLET HOLE PLUGGED LOADING DESIGN: 8' 0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: 0 N a � N_ J O Q N I <Z � U w N w SHEET NO. 1 OF/ Department of Safety County 4'_ s e & Professional Services, Sanitary ' Pennum r( b Bled�' ryby Co.) Industry Services Division D `( U / _ l5 U tlAMYI\J'" Z- S Sanitary Permit Application State Transact Nailav 2 g 2025 In accordance with SPS 383.2](2), Wis. Adm. Code, submission of this form to the appropriate governmental unit N is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Addres o Ipa ) the Department of Safety and Professional Services. Personal information you provide may be used for secondary 'y/ - purposes in accordance with the Privacy Lew, s. I5.04(1)(m), Stats. (p,$ b I a R v -EL/ � Let 1' F C I. Application Information — Please Print All Information Property Owner's Name Parcel # Lu_Q ;; 4I a.,Eib'sr Property Owner's Meiling Address Property Locution 17(e3 133rd S-{- Al(,jJ Cit , State Govt. Lot i Zip Code G Phone Number '/ p(�i Ijw y./ E �,n-t vrtie V I'I't-4 v! ✓vI /) S $-3 6 6/Z- 340 !t/ 2( SW 1 �./td/ �/a, Section 3' IL Type of Building (check all that apply) Lot # T q 7 N R g o i or 2 Family Dwelling— Number of Bedrooms ' Subdivision Name Block # ❑ Public/Commerelal — Describe Use ❑ City of ❑Slate Owned — Describe Use CSM Number ❑ Village of X Town of lr0r ii 4tle1 DL Type of PONTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line Cif a livable. A. ® New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank In -Ground 0 At -Gorda 0 Mound (] Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration 300 ` 7 yes ..-._._.._.� I'�9 yes Capacity in Total IF of Manufacturer Tank Information Gallons e Gallons Units New Tanks Existing Tanks ,m` U E aepnc ernaawnsrank —zSQ _-_J-1_i-_f W 6 GSt ✓ Ga nC, ✓ V. Responsibility Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber'sName(Prin0 Plumber's namr r tEp/MFRS Number Business Phone Number Ail0.h J�o �o5%Cr i-"L009d 7[Sygy_ r{lS(oo PIIu�.nther's Address (Sued, City, Stale, Zip Code) 9 G VI. County/Department Use Only Approved ❑ Disapproved Permit FeJe� Date Issued mgL Issui g A lg ❑ Owner Given Reason for Denial �"�t /— LIN$ Attach system and submit to the County only on paper not less than S to x Is Inch, In size SBD-6398 (R. 03/22) sal TEST Wisconsin Department of Safety and Professional Services age of Division of Industry Services MAY 2 8 1(� !_ •) falr1 n 7nni Ilion, In accordance with SPS 385, Wis. Adm. Code County `/ SOIL EVALUATION REPORT 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 percent slope, Parcel I.D. , f b 3c6-7scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. MIwe Date -� Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). I •� Property Owner f Property Location ,jCi ' '.t( < et t 'e v w' ' I � Govt. Lot NW 's A)b)% S3 j T y% N R E (or) Property Owner's Mailing Address Site Address Z 1 33 r L S -f x (p e/ O Lc 'Rc City State I Zip Code Phone Number ❑ City ❑ Village Town I Nearest Road -� , we w• �v '4'i !yj i4l S"S3 'j (10/ L) r o h `!Z e. - Ji.-(-1, L€ke R New Construction Use: Residential/ Numberof bedrooms 2- Code derived designf1ow rate GPD Replacement ❑ Public or 9ommerciai — Describe: Flood Plan elevation if applicable ft. Parent material g' d. a 1 t '1s I General comments and recommendations: a Boring # ❑Boring IPit Ground surface elev. 4.0 ft. Depth to limiting factor "'°31n. / elev. ft. Q.lI A...It....al..- r_s� Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Corit. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 •, S Y R S L- 1 g L L /nL/-(; v et $ 3 .r 7- -13 cr1e- s- ,U ,vQ LS €1 k £'v+ v G S Z -F • °7 ___ lJ 3 n VOL, - l • 7 /- ® Boring # []Boring Pit Ground surface elev. ____ft. Depth to limiting factor 793ln. / elev. ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont.(Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots •rr•• GPD/Ft2 *Eff#1 *Eff#2 1 i' V -C i. 9-7 l / ©�` s j I 7, • r l . Y ' - S -!g 7. `tom LS o wi t_ er S Z .7 - �Y s o �Q 5 p YL4L v 7 CST L Name (Please Print) , Irk s Signatur - CST Number 2Z0 Address ? o. Bo e. t2;. v�y Re%AJ„! -T4(TV7 Date E lu/atJon Condycted 7 �ZS Telephone Number 7i.- Zq�— I S'1p 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 SBD-8330 (R04121) Ch9,-JcCe1°L" ac,d 50 4'i/- m�- Boring # ❑ Boring Pit Ground surface elev. 1''-' ft. Page 2 of 3 Depth to limiting factor 7 'in. / elev. it. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont.ov/Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots vv11 I1�JFJIIt IlV1 I I\Qla GPD/Ft2 *Eff#1 *Eff#2 i hh V ]� I� 1 1- .� Jo/¼J e S L J4d'ki YVl (iY CL _5 3 . r 'Z S -/yy� s i 1�-% -7't' /v){ o ,A�tl` LS O yyl L 4S z � _ 7 . // )-9( 1 lz s !� env S _r / 7 L 1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. P L1_11 A Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots rr GPD/Ft2 *Eff#1 *Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in.! elev. ft. 0..11 A....11....I1.... C..a.. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz, Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 5 220 mg1L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS s 30 mg/L . , Q j/�^.J�,/t� t. f(✓'� 1 Jt +� 1 l oj�f �o(�•; �••,,�►`/n{ a jj,, .. J �1 C./ O 1 �++ r 1M/�u G4.. ! / IJVYi 4 /.�tl:' �C�.iL � YO i t'•�u• !O�/i II i'e s� �4�� �,d r36bo f7�{!��� Q3 N ui • e�A k o �ri�,.. "� JlP �� r h l '� r�l G� v'r.� i �i• w4k� l� r c ✓ �M .� d : Om f' JA r s;/eV. y [,®(:eZ°.4LG�: 5 a bI ® O.T . Klu/41; 8qf d2) csr 2: sq+i4rcuiks 75 R /(o tj we ee�H�V'�,$� M a ��-$1�►J', a h v qAt1x H gif'..� ,�. .. , N, 1. � h �. ,. b a r A + is � �h ��' G �ytan �� '��, "�'va�;.n I• � 1 � o:k see �• .�, , Qp a • ' �� sr 11 w ; w-�A 5i's 3 0 3 ✓�•le.pi ! ', e. r 6 °Z � o u �9 crY 4. 6+0 S - d11� c.' a :/.:e '4 r .Ttio ` 'f C'•l'c `4 J%STM D3 MAY 2.3 lO '►�e. 45`01 Ca Rv+'t' Lci k i< L Bayfield 1 y e d Co. Zoning Dept 1t--_______ 1317 G'4 � o.[J �;( c )#loper4y OUJ i erap' j € Wit tc4/Gt zf' 133Lsi-NW yvtP -e vpLrv1 ll?1� ≤ 3C1g- ,• . P, 14 e-'er to vb y rt 7' 23€c Knt rReSi4e►ic,e we11 L&I 1�W Mv* S .331 '7N R S W 5Jk, �,, WW1 �e 5 K ih G�i''�waa�ov ��e�rs� t'.ea• 't,�.@ ierl�. ...�jiQtif `rl pu6s d u BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): l J Check List luyeNy 11 Index Pa a Title Sheet O tional L9 I ( P )m Original Soil Evaluation Report (Submitted in Deed Molders Name — not prospective 2.8 1015 l6 Original Plot Plan Bayfield Co Z9 onin Dept ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report; (Include the following Information) ® Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used l) Property Owner's Information (not prospective buyer's name) i Property Location (Accurate Legal Description with Sec/Twp/Range) 11 Road Name (where driveway is/will be coming off of) I?l Floodplain Elevation, Flow Rate, Comments and Recommendations I?. Complete Soil Boring / Pit Information E1 Date Soil Evaluation was conducted d CST Name, Signature, Number, Address and Phone Number 0 *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) 06 Bench Mark (Description, Elevation and Location) l?i Contour Lines (Example = 98.0' /96.0' /94.0') I Piz perry Location (Sec/Twp/Range/, Accurate Legal Description) f0J Borings (Locations and Elevations) RI Percent and Direction of Land Slope 0 Well Location (Including Neighboring Wells, if applicable) U Location of Wetland Areas, Floodplain and Navigable Waters 11 Buildings, Driveways, and Structures (Location and Descriptions) Ed Location of Property Lines tEl Existing System Location 0 Address Number and Road Name I: l Current Surface Elevation of Wetlands and Navigable Waters CI CST, Owner and Property Information 0 North Arrow Fee: RI Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checklist/checklistforests May. 5. 2017 10:41AM BAYFIELD CO PLANNING & ZONING No.9975 P. 3 PAGE 1 0F7 In -Ground Gravity Plan Index & Cover Sheet p d D Component Manual Design References: MAY 2 Version 2.0, SBD-10705-P (N.01/01, R. 10/12) 8 2025 Pg 1 of 7 Pg 2 of I Pg3of7 Pg 4 of r Attachments: Bayfleld Co. Zoning Dept. Index & Cover Sheet Plot Plan 4.l -f is (r. Cco-wSection & Plan View Management Plan POWTS Application for Review ( S4� Soil Evaluation Report & Site Map 411&,K4-c.,cKce A�,veeh en Project Name I Description Owner Name(s): t I TG I R Phone:/z -. D - Owner Address:'a7/c3 /33 rd S+tjtJ W+slerw�c 4NZip: 5 5350 Project Address: �So 1 a 72 f / L G jc ! a R; e e w7 (YY7 t ` S1/40f Nwi/4, Section 33 ,T N-RE❑or W Township: I r on �` t- -e County: gay e (c{ Project Parcel ID #: _fie K i Designer Information Designer Name: A I (a r 7o /k0 s k " Phone: 7/S - 7y - y / r4P Designer Address: P -a, 3cn i✓o...7 , y er U�Jfj Zip: S-VRL17 E-mail: -i-o n / f j eae o v L o rv. _ This space reserved for approval stamp, License Number: 2.2-0 o 90 Remarks: Signature: &%L l Date: - ( - Z S Original signature required on each suhmitleo copy. __`.. jp� r r� ,k1� p f b2 s01 scrim jg� .. ®Ira.�nlBy: Po1kn,tf. P'vm�0rnr. ,• p ' r AA %.LYIV(t.n`Ftt:al/e5� 5©a�C1 ust {-r�N p.6. f1,,�1 C24. �'cct�r et/o ldNn..J( Y1¢aEt. �.0 Rn tJ✓..+dw d 6/H�avn7.ot f USE '�,',n,.y le. {� ✓ W'' :."'"r'!d:'A amu ' 1/fP:l(@V. FO90rQ9(_dZ WA r, sj b+^/®"�'0$-t�'e�'//lJ �nl@�Qx') I`t'.f' t' i`b,m.��,'ZPo'W 5�5`I' In GIeJ,: 9°I.C SrC'tz.00go 2: s'¢pc-rak 1$� TSo Id IfO11 w;eser coecve•$e-et 9 � ,J7J 7�Z' ✓°'M 644x.., o-i' `i':.:' -ie y Ss.r�*n&L• - T+rl'�'Ifvefar- i4:�r{ l .�'e`,•tti.Gr �('c - :5�/°Ndre�•Fl.- r �n'l /� 2 °f8 +`c�l,rf'f�; Ig,�ilel'q N� �%•�./•yylani pa l�l .fp'}'Yenih nS r Q oM n 7w/s„ I'.3."r1:9h I +NCcldi�+y ilnac:7(11�_w avPtlwco n (• n w, •M 52p rt. //� n� aut�Aed vv usPC heiv< b,<gfe aF7ur,rom,�4(� .F;;/y'r.✓,-Pe�Y(ortlSY de/~ /���331.. Sys (d Sa.Cy®'Pjt'P• wry Art- Su.h SDR3S PVC Pp�, is A$T1'VI D?n 3t ®315 ly LS r1 7MAY 2.8 2U25 I°' ° C S v + k L" k4 1 % 1. Bayfield Co. Zoning Dept. 13171 `Q1 M �I ?. �� -__ loOpr M SCE o1.5�' ✓da r. nn ti C'{". I N II rr''I✓4�-er 1L S`lan�a vd L r,,t' �V. a wH f •t r,j . Q u . [ 1C d r 1 $ !+' /O Slei( 1 }a Gr.,s Ray v�ti�`✓! 1 t0 i' Za4P N�viE_ Ib�rl"cclt t/d +�_ 23ft1 lCnt Properly ©Whop`:' . 1 io ke 27ft3/ 133: SfNIN , bbl •'l'. V vvt C. ri / 3L0 •/ VyN% Gap itt4 proe1$ Gt O"b4.t 4:.,.Vm.tt IG C C Leya!° µtSC4 fpk Ah V a a 1JQ* v Sec33 WNR81�i' b_ or N ,mows? $ w;rr 7`IW'r%fa v Lt'. I t "r I"{' 'T "1 .0 0, ff. C604 -f 0Y `i T t �f ( Y 4 r� Ari c5 1 P IaY kk41'r++bcw .13P•9'$onn a f7o ,Jb ......w........� C WLP750- MR TANK SPECIFICATIONS n ^ n 0. p DIMENSIONS: o m WALL• 2 1/2" BOTTOM: 3" o n ^ n _, N N COVER: 4" MANHOLE: 24' I.D. PRECAST CONCRETE RISER o HEIGHT: 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" / 4" CAST -A -SEAL\ 4" CAST -A -SEAL WEIGHT: _.=� 6,150 LBS. O24 INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL FILTER OR INLET AND OUTLET BAFFLE AND FILTER: BAFFLE WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 20.28 GAL/IN HOLDING TANK: ACTUAL CAPACITY: 790 GALLONS TOP VIEW OUTLET HOLE PLUGGED LOADING DESIGN: 8' 0" UNSATURATED SOIL OPTIONAL FLAT COVER TANK CAN BE USED AS: IS AVAILABLE FOR EXCHANGE SEPTIC/ HOLDING/ PUMP OR SIPHON FOR DOME COVER, COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) OUTLET U M U PUMP PAD SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: W Iu' W U D] O n K 00 Q I Q l n � N £191 O N Do SHEET NO. POWTS OWNER'S MANUAL & FILE INFORMATION I/ Owner j, 1c- L. - J h --c/ cc Permit # DESIGN PARAMETERS Number of Bedrooms Z ❑ NA Number of Public Facility Units NA Estimated (average) flow Zoo gal/day Design (peak) flow = (Estimated x 1.5) 3 OO gaVday In Situ Soil Application Rate gaVda /ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) ≤30 mg/L Biochemical Oxygen Demand (BOD5) ≤220 mg/L 59 NA Total Suspended Solids (TSS) ≤150 mgfL Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) CO mg/L Total Suspended Solids (155) ≤30 mg/L ISI NA Fecal Coliform (geometric mean) ≤10° ofu1100ml Maximum Effluent Particle Size '.6 in dia. 09 NA Other: K NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ;] 0 monear ss) (Maximum 3 years) O NA Pump out contents of tank(s) ® When combined sludge and scum equals one-third ('h) of tank volume ® When the high water alarm is activated ❑ NA Inspect dispersal cell(s) At least once every: month ® year(s)s) (Maximum 3 years) 0 NA Clean effluent filter At least once every: ❑ (s) ® yeearar((ss) 0 NA Inspect pump, pump controls & alarm At least once every: onth(s) ❑ month(s)year(s) year s 0 NA Flush laterals and pressure test At least once every: ❑ month(s) O year(s) ® NA Other: At least once every: ❑ month(s) ❑ ear(S) ® NA Other: 5aNA 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 (h) 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 512 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. MANAGEM MJF. I of Z. SYSTEM SPECIFI I�1&Y 252025 Tank ManufacturerBc U''. Moffonmyf�etn. ❑ NA ❑ Septic ❑ Dose 0 Holding vol. '79-0 gal Tank Manufacturer Iffi NA ❑ Septic ❑ Dose 0 Holding vol. gal Effluent Filter Manufacturer PG 1 y ioG O NA Effluent Filter Model Pt.. 525 Pump Manufacturer 4 NA Pump Model Pretreatment Unit F1 NA ❑ Sand/Gravel Filter 0 Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other: Manufacturer Dispersal Cell(s) 0 NA 0 In -Ground (gravity) O In -Ground (pressurized) ❑ At -Grade O Mound ❑ Drip -Line ❑ Other: Other: C7 NA Other: O NA 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 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: ❑ 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. 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. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the blomat 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 /1jet, ?� 1 Ce ' 1k zsk j?jj Kba � Name 4/( ? /kas kd(c,/ kc$k4?LO. 11) Phone '7l 1- 2,dj L— d s Phone `? I S- SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name �" o�/a e4 ?� ke�S ; ac46) Name -1r.tl J. e'd�,•z ✓Q Phone IlS 37 2w-'- •. J Phone 7 A 3 37 10 13k 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 -I N 6500 R>ak LU.M 4 ,""„a '356-76 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 Bayfeld 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) JW4Nw4£s'u4MuJfrSectlon 33 Townshlp`,% N. Range g W. „ ddlL'cna; Legal DascriptiotL ¢55 Far Dcs< I n 201p R—S(rS'jc)/p -7l {f A Town of it o n R Ut r (Acreage) Gov't Lot Lot ______ Block Subdivision Lot _ CSM #_ Vol. _ Page _ CSM Doc # DOCUMENT NUMBER 2025R-60751 5 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI —4. RECORDED 05/ 1 9/2025 AT 1 1: 1 5 AM RECORDING FEE: $30.00 PAGES: 4 Return To: Iort rc In r. , E'�'FIVE a}1JJ e0. DningDept ® In -ground gravity ❑ in -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ Other ., Septic Tani: (syate a 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 end pump controls shall also be Inspected and maintained to ensure operability of said components. j. 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. r 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 of 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 around Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewaterdistribution cell component Is Inspected as provided above. Owner(s) agree that (allure to comply with this agreement will result In action being taken to pay all charges and costs Incurred by Bay!lald County for Inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system lank in such a manner as to prevent or abate any human health hazard caused by the system, Bay/laid 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 agreement shall be binding upon and inure to the benefit of all current and future owners of such property. site)rvamwts)- rreaserant Iru't-.lrJ \��rq Subscribed and izedOwner(s)-signatures) _Z //_/"�. Note ubllc Z/ ��.`�-"'-_ My Commission Drafted Date: sworn to before me on Notary Proofed by: u/forms/senitary/sepacmaintenceagroe menI Revleed July 2020 Document Number State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Name THIS DEED, made between SCOTT MACAW, VICKI MACAW AND *FRANK " whether one or more), 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, in BAYFIELD County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Seethe annexed Exhibit A which is Incorporated herein by reference. 11111 MAY 2820 IIII Ifl IIIIIIIIIIIIfill IIIIIIIflil IUI lilhifi IIIIIIIIII *2016R-565795 3* 2016R-565796 PATRICIA A OLSON BAYFIELD COUNTY, WI REGISTER OF DEEDS 10/19/2016 01:10PM IF EXEMPT R: RECORDING FEE: 30.00 TRANSFER FEE: 75.00 PAGES: 3 Recording Area me and Return Address rased-` _ ( C, iitQl(. 7(o3y 133rd 5i-. !Jw m.vterwta.a r MN SS39S Parcel Identification Number(PIN) Bayfleld Co. Zoning De This IS NOT homestead pmpeChol0®B9tls Yf p (�) 320 Main Street West Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Ashland, WI 54606 EASEMENTS, RESERVATIONS AND RESTRICTIONS OF RECORD. Dated flQ&ee- /N (SEAL) AL) (SEAL). (SEAL) * * VICKI MAGA AUTHENTICATION ACWOMPLEDGMENT Signature(s) „grrr.Hrr„r STATE OF WISCONSIN ≥ss. authenticated on ,asRO...:_Fn≥,k RA c, COUNTY *TITLE: MEMBER ST (If not, OF wtSG;,t THIS INSTRUMENT DRAFTED BY: ATTORNEY MATTHEW F. ANICH, SB#1017169 * EPt.ta4it C - I-le.dt'CAY NotaryDALLENBACH, ANICH & WICKMAN, S.C., ASHLAND, My Commission o s State of Wisconsin My Commission (ispenaeHent} (expires: %— Ce - 1Ua0 ) (Signatures maybe authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures. before me on known to be the person(s) who executed the foregoing EXHIBIT A D C l5TO fl) WARRANTY DEED MAY 28 2025 Bayfield Co. Zoning Dept A parcel of land located in the Northwest Quarter of the Northwest Quarter (NW'''% NWY%) and In 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 Section 33, Township 47 North, Range S 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 01 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, thence angle to the left 90° a distance of 740.0 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 line 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 (NW''/, NW%) and the Southwest Quarter of the Northwest Quarter (SWY< 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 the Northwest Quarter (NW'% NW'/.) and in the Southwest Quarter of the Northwest Quarter (SW% NWI/), 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 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 900 a distance of 210.2 feet to an iron pipe, thence angle to the left 900 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. % AA\ Q_✓1"(av uI BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) liii Check List ���111 pp I2 it Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (3p2.2E1t)I 0 U tg D 9Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) 1111 MAY 2.8 ZQZ`J 9 Original Plot Plan (383.22(2)2. 3. & 4.a) i0 Cross Section, Over -Head Profile of the System and_ Schematic of Tank from Manufacturer Bayfield Co. Zoning Dept 0 Pump Tank Diagram, Alarm and Pump Curve (when applicable) g Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) 5if 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) 121 Fee (Make Check Payable to Bayfeld County Zoning) (383.21(2)(c)7) 99 . Complete Set of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) @ Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) d I Application Information must Include: Cl 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) ® Project Address Qt Road Name where driveway is/will come off of) g11 Type of Building ii III Type of Permit iid IV Type of POWTS System Rf V Dispersal / Treatment Area Information 5d VI Tank Information f7 VII Responsibility Statement (Plumber's Information) 0 *Date Stamp* Plot Plan: (To Scale or To Dimension) 21 Signature and Plumber Information 9 Surface Elevation of Body of Water ® Direction and Percent Land Slope N'Tank and Filter Information and Location t( Wetlands / Navigable Bodies of Water * Absorption Area (Proposed and Existing) Q Bench Mark (Location, Elevation and Description) © (Owners Phone Number) I Address Number and Road 56 North Arrow ( Contour Lines t7 Structures and Driveways © Boring Locations d Property Lines ii Well Locations t� Component Manual Version El Legal Descriptions Q Piping Material Information (conveyance line, building sewer line, material type and diameter) Turn Over ► Cross -Section and Over -Head Profile of the Sera �Q El Surface and System Elevation it Position of Observation and Vent Pipes Df Dimensions and Depths 0 Make, Model & Number of Chamber Units in each Cell Prone y. Information O How many systems will there be on this parcel of land? O Has this property been split? YJ (Property Statement shows Property History) Fe s: 0 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/checkllstfersanitaryapps (1a/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: B!-YFIELD 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 Description Private Sewage System (Septic Tanks) Submission Number: SS -00547 Transaction Number: SS -00547-2C330 Amount $400.00 Total: $400.00 Payment Amount: $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 COUNTY SANITARY PERMIT (#04)-25-43S STATE SANITARY PERMIT OWNER: LUKE R & REBECCA J WIITALA GOVT LOT: 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 DATE: 6/4/2025 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: # 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