HomeMy WebLinkAbout25-46Ss^ooz^?
Wisconsin Department of Safety & Professional Services
Division of Industry Services
, SO!! TEST^=-^5—.In accordance with SPS 385, Wis. Adm. Code
^glEEIIi
^—3 ill JUNO 3 ,025
Page.._of_
SOIL EVALUATION REPORT
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 Bayfield
Parcel I.D. ^l L,
04-004-2-45-09-08-3 00-153-24000
/^7/^Date
Property Owner
Bradley Sikorski
Property Location
Govt. Lot 'A y< S 08 T 45 N R 09
Property Owner's Mailing Address55600 Red Oak Drive Site Address or CSM and Lot #:2309 Birch Tree Trl
City, State, ZipSolon Springs, Wl 54873 Phone Number
(715) 969-4276
D City D Village EZ1 Town
Barnes
Nearest Road
2309 Birch Tree Trl
0 New Construction Use: 0 Residential / Number of bedrooms
D Replacement D Public or commercial - Describe:
Parent material Outwash sands (Rubicon Series)
General comments and recommendations:
Code derived designflow rate 45° GPD
Flood Plan eievation if applicable.N/A _ft.
Boring #east D BoringE2 Pit Ground surface elev. "-6 ft.Depth to limiting factor 84 in. / elev. ft.
Soil Application Rate
Horizon Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture Structure
Gr.Sz. Sh.
Consistence Boundary Roots GPD/Ft2
*Eff#1 *EfW2
0-5 10YR2/1 Osg ml cs 2vf 0.7 1.6
5-8 7.5YR 3/2 Osg ml cs 1f/1vf 0.7 1.6
8-16 7.5YR 3/4 Osg ml gs 1vf 0.7 1.6
16-47 7.5YR 4/4 Osg ml cs 1vf 0.7 1.6
47-84 7.5YR 5/4 Osg ml 0.7 1.6
Banfcfs of lamellae in holrizon 53te4-
Boring # west QBoring0Pit
w"r^\
Ground surface elev.99.6 _ft.Depth to limiting factor 84 in. / elev. 92'6 ft.
Horizon
1
2
3
4
5
Depth
In.
0-3
3-6
6-21
21-38
38-84
Dominant Color
Munsell
10YR2/1
7.5YR 3/2
7.5YR 3/4
7.5YR 4/4
7.5YR 5/4
Redox Description
Qu. Az. Cont. Color
Texture
s
s
s
s
s
Structure
Gr.Sz. Sh.
Osg
Osg
Osg
Osg
Osg
Consistence
ml
ml
ml
ml
ml
Boundary
aw
cw
gs
cs
Roots
2vf
2vf
1co/1m/2f
1f/1vf
Soil Application Rate
GPD/Ft2
*Eff#1
0.7
0.7
0.7
0.7
0.7
*Eff#2
1.6
1.6
1.6
1.6
1.6
CST Name (Please Print)
Keith Wiley
Address11623 E Larson Dr. Lake Nebagamon, Wl 54849
SIBnMU^^-^^
Dat^valuation Conducted ^5/4/2025
;ST Number 654921
Telephone Number
218-451-2611
* Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 & 150 mg/L * Effluent #2 = BOD, £ 30 mg/L and TSS <, 30 mg/L SBD-8330 (R03/22)
Page.of.
Boring # south
d Boring
El Pit Ground surface elev. 1 °^ ft. It '^ iL tile^ih t£lim|& factor 84 in. / elev. 93-6 ft.
Mi JuN ') 3AJ2^ ;L;
Horizon
1
2
3
4
5
Depth
In.
0-3
3-6
6-20
20-51
51-84
Dominant Color
Munsell
10YR2/1
7.5YR 3/2
7.5YR 3/4
7.5YR 4/4
7.5YR 5/4
Redox Description
Qu. Az. Cont. Color
Texture
s
s
s
s
s
Structure'
Gr.Sz. Sh.
Osg
Osg
Osg
Osg
Osg
Consistenee.".
ml
ml
ml
ml
ml
LBoundary
aw
aw
gw
cs
Roots
2vf
1m/2vf
2co/2m/2f
1vf
Soil Application Rate
GPD/Ft2
*Efl#1
0.7
0.7
0.7
0.7
0.7
*Eff#2
1.6
1.6
1.6
1.6
1.6
Boring #D Boring
D 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
Gr.Sz. Sh.
Consistence Boundary Roots
Soil Application Rate
GPD/Ft2
*Effi»1 *Eff#2
Boring #D Boring
D Pit Ground surface elev.Depth to limiting factor.in. / 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 s 150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS s 30 mg/L
Sikorski (3 bedroom)
Soil Report Plot Plan
North
D) I E E I J
JUN 032025
Centerline of Birch Tree Trl - . ;-———.-..___. —--^s-tytf^et-w.-^t.n^Q Uepl
BRADLEYSIKORSKI
2309 BIRCH TREE TRL
COMMANCHE ADD TO POTAWATOMJ LOT 28
DESC IN DOC 2024R- 604821 2360
SOS T45N R09W
Town of Barnes
04-004-2-45-09-08-3 00-153-24000
0.689 acres
Potential site of
3 bedroom house
Scale 1:30
<•
NOTES:
- No well
M Bench Mark = Top of green electric box
Elev = 100.0'
CST 119900002-SP Page 3 of 3
BAYFIELD COUNTY ,Bradley sik°?l? W
CHECKLIST FOR CERTIFIED SOIL TESTS ^\ ^ llu " 11 v K |!]i
Submit the Following (Use Permanent Ink): ^N °IUL
^ Check List
n Index Page / Title Sheet (Optional)
0' Original Soil Evaluation Report (Submitted in Deed Holders Name - not prospective buyers)
52' Original Plot Plan
D Cross Section Soil Profile Sheet (optional)
D Additional Information (Warranty/Quit Claim Deed) (Optional)
Soil Evaluation Report: (Include the following Information)
Sf Parcel Identification Number (must be 23 digit Tax ID#1 DO NOT USE 12 digit, they are no longer being used
E/Property Owner's Information (not prospective buyer's name)
Sy Property Location (Accurate Legal Description with Sec/Twp/Range)
E7 Road Name (where driveway is/will be coming off of)
SyFloodplain Elevation, Flow Rate, Comments and Recommendations
53'Complete Soil Boring / Pit Information
E7 Date Soil Evaluation was conducted
EycST Name, Signature, Number, Address and Phone Number
Q' *Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
sy Bench Mark (Description, Elevation and Location)
E/Contour Lines (Example = 98.0796.0794.0')
E/Property Location (Sec/Twp/Range/, Accurate Legal Description)
Q' Borings (Locations and Elevations)
S/Percent and Direction of Land Slope
S,y Well Location (Including Neighboring Wells, if applicable)
E3'Location of Wetland Areas, Floodplain and Navigable Waters
ff Buildings, Driveways, and Structures (Location and Descriptions)
5/Location of Property Lines
Q/Existing System Location
E7 Address Number and Road Name
E7 Current Surface Elevation of Wetlands and Navigable Waters
0'CST, Owner and Property Information
SV North Arrow
Fee;
Ky Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforcsts
Bradtey Sikorski
2309 Birch Tree Trl
"04^004-2-45-09-08-3 00-153-24000
Bayfield
Commanche Add to Potawatomi Lot 28
~8
45
Property Owners Name
Property Address
Tax Parcel Number
County
Legal Description
Section
Town
Range
Page Index
1 Property Information
2 Data Entry
3 Plot Plan
4 Drainfield Cross-Section
5 Tank Information
6 Maintenance Plan
7 Contingency Plan
Keith Wiley
D2388PSS
218-451-2611
5/9/25
^^Ns^^
"'YSe>-"
Designer's Name
Designer's Signature
Designer's License Number
Designer's Phone Number
Date
ID] IE g I
NAY 2 8V.^
Bayfie'dCo.Zon,nJDept
Page 1 of 7
In-Ground Soil Absorption for POWTS
Version 2.1 ^Mav 2022-2027)
3
~4.6
84
-0.7
^00
450
1
97~yr
100.6
100.6
~99:6
~9Q£~
Component Manual Used
Number of Bedrooms
Percent Slope (%)
Depth to Soil Limiting Facton;in_^
In Situ soil application rate
Estimated Wastewater Flow (gpd)
Design Wastewater Flow (gpd)
Number of System Elevations
Proposed System Elevation #1
Proposed System Elevation #2
Proposed System Elevation #3
Original Grade #1
Finished Grade #1
Originai Grade #2
Finished Grade #2
3riginal Grade #3
Finished Grade #3
WieserWOO
Polylok PL-525
Septic Tank
Effluent Filter
Infiltrator Quick4 Plus Standard
12
20
3.3
4
1.5
34
2
3
16
16
32
642.9
646.6
Chamber Type
Height of Chamber (in.)
sq.ft. per chamber(ESIA)
,q.ft. per end cap (EISA) |
aying length ofchamber(ft.)
ength ofendcap(ft.)
chamber width(in.)
?ows of Chambers
)istance Between Cells (ft.)
dumber of chambers in first row
lumber of chambers in second row
lumber of chambers in third row
Toposed Number of Chambers Used
flinimum Distribution Cell Area Required (sq.ft)
fetnbution Cell Area Proposed (sq.ft.)
/^iinl,
^28?0^
8a^Co,2on,ngDel.
Page 2 of 7
0Its -a< 3u co
Sikorski (3 bedroom)
Gravity In-Ground Septic System Plot Plan
Centerline of Birch Tree Trl
BRADLEYSIKORSKI
2309 BIRCH TREE TRL
COMMANCHE ADD TO POTAWATOMI LOT 28
DESC IN DOC 2024R- 604821 2360
S08 T45N R09W
Town of Barnes
04-004-2-45-09-08-3 00-153-24000
0.689 acres
Wieser precast WIOOO-MR
w/ polylok 525 filter
Potential site of
3 bedroom house
99
ttiiiiiiiiiiiiiii iiiiiiiiiiiiiiiiiiii iiiiitilnuuunj
HltHHiHHiliHtilHitHHIitHHHiHHHHtHUHH
s
Two rows of 16 Infiltrator Quick4 Plus Standard chambers Bay)
Property line
mm
\^262Q2S
re^ Co. Zoning Depf
Scale 1:30 NOTES:
M Bench Mark = Top of green electric box
Elev = 100.0'
- No well
- All vent, observation & conveyance pipes
4" ASTM D1785 or code equivalent
Page 3 of
Cross Section of o Two Ceil In Ground Ccmpone'i;-
Using Leaching Chambers
Obser vat io",/Vent Pipes
,/'
100.60 iFinished Grade
Stope 5%
100.60
98.00
|0riginal Grade
|Top of Chamber
n - • -
I CeH-^eperatkm
[t^-J 3 >flt
97.00 jsystem Etevation _
^<5<)^y''
/\ ^
Finished Grade
y
99.60)
•7"
v">:; .^\ ;>•' X i?figinal Grade
^'^ -/ITop of Chamber
99.60
98.00
'y^.. .\ ^. '( ____L/ System Elevation | 97.00)
•* • -• • ... ^ • '• * - -• : •'
'. -• '-Ti-eatnsent'Fnd" Dl9pe--6at .^orie . ^ .
" '" • •'• '-*..;-- ' •' " : •' :
;• ^. . - - .-—. . .'•.*- •... . • . ._._._, •_ _ ' Limiting Factor
Observation/Vent pipes to be constucted and cappeci w;th approved materials for the particular use.
Diagrams Not To Scale
67 feet
f<^^ + • - -f ^-^ ^^p>*( ' ' \~w"^, ^. ^y^w['.' •^»w*,
^^«^^'-,i^i^»teatB:<»,^^^
!
}tst
I
I
3 feet between cells
lP^^^N"^^-.1»»B^^
i!^ijpN^ii,iIi»syiNit?s»S^^
01
Bayffet
®il!fE
^ 2 8 20?5
Co. Zoning Dept.
67 feet
Observation / Vent Pipes to be located at the ends of the distribution cells.
Page 4 of 7
n>-)ri 0r]3 £T|Tl -I TIX:•n•n >y)
.-
>\J\i
•>
1 v5 v-nsrnz-It/
)v"
>
I
A
S
FR
E
Q
U
I
R
E
D
n>co
^
2
8
2
0
?
.
9a
^
C
o
2
o
r
»
i)
"
1
9
D
e
p
f
.
T3
:
>
70
-
0
0
-
0
>
70
-
V
Q
-
o
0
<
:
x
>
0
m
o
a
>
03-:
0
m
0 00-<
070
3J
Q
M
^
z
C)
>
(
/
)
-0 -o
i
n
^
c
=
Q
0
0
<
s
>MF^m0
33msm<p>^
3Dm^mi0 00
Q
3°
3
i|ONcswo^-^
^
>'
w
7;w0 >D m1/1m70 0 QTOm
-i
0
i'
§
^
v ^sx
m
Q
w
m0^
(Ac?
;=
t
f
c0?
§
tn
'
z
^°
£
-
3
3r
o
^$
31
70
mrr
i
.;
D
^3$
0
Z
-^
r
o
Im0
C
c
v
?
o
mZ
0
°>^t
"
-0c 0•J
O wTl 0
0>0 CT 0T7
?w ooI0 w vi>w0
I0
>o
5
oc
^w.
$s
lyo-
an_"
-—
m§°
Ul 0>5 w
p -u>Q M~^
1
ooOi 0>
c:
m
s
c
i
!3
o
p
g
5
!
n
j§
l
i
^
a
il
,
r
^
"
<
B
^
s
n
C
D
>
Q
Q
IH
i
Is
!
"
"
u
^?s
i-
r
o
M
t
f
l
N
^
^<0
~
s
)
un
o
0 Sow
(.
d
+
-
CT
>
N
rt
-3
0
">v>wm
4»
;
_
-0vmp w n-3
0 Fl
70y?s
1(
^E?
IS
2
1§s°
-jQz00
Ft
WL
P
1
0
0
0
SE
P
T
I
C
M
A
N
U
A
L
UI
I
E
S
E
R
c
o
n
c
i
E
T
E
W3
7
1
6
U
S
H
W
Y
1
0
,
M
A
I
D
E
N
R
O
C
K
,
W
l
5
^
7
5
0
80
0
-
3
2
5
-
8
4
5
6
SC
A
L
E
:
1
/
4
"
=
1
'
-
0
"
DR
A
W
N
B
Y
:
W
C
P
DA
T
E
:
0
0
/
0
0
/
0
0
RE
V
.
DA
T
E
:
IP
R
E
-
P
O
U
R
:
PO
S
T
-
P
O
U
R
:
FI
L
E
:
-
I
p
l
O
O
O
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _ _of_7.
FILE 1NR3RMATION SYSTEM SPECIFICATIONS
Owner Bradley Sikorski
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:
3 DNA
0 NA
300 gal/day
450 gal/day
°-7 gal/day/ft2
Monthly average*
^30 mg/L
<220 mg/L D NA
<150mg/L
Monthly average
<30 mg/L
<30 mg/L 0 NA
<104cfu/100ml
1 in dia. D NA
0 NA
"Values typical for domestic wastewater and septic tank effluent.
MAINTENANCE SCHEDULE
Tank Manufacturer Wieser
0 Septic D Dose D Holding
Tank Manufacturer
D Septic n Dose D Holding
Effluent Filter Manufacturer
Effluent Filter Model
Pump Manufacturer
Pump Model
Pretreatment Unit
D Sand/Gravel Filter
D Mechanical Aeration
D Disinfection
Manufacturer
Dispersal Cell (s)
SZI In-Ground (gravity)
D At-Grade
D Drip-Une
Other:
Other:
QNA
vol. 1000 gal
vol.
Polylok
525
D Peat Filter
a Wetland
a Other:
0NA
gal
D NA
0NA
0 NA
a NA
D In-Ground (pressurized)
D Mound
D Other:
El NA
0 NA
Service Event Service Frequency
Inspect condition of tank(s)At least once every:U month(s)EZ! year(s)(Maximum 3 years) D NA
Pump out contents of tank(s)S3 When combined sludge and scum equals one-third (16) of tank volumeD When the high water alarm is activated DNA
Inspect dispersal cell(s)At least once every:D month(s)EZ1 year(s)
D month(s)0 year(s)
(Maximum 3 years) D NA
Clean affluent filter At least once every:a NA
Inspect pump, pump controls & alarm At least once every:D month(s)
D year(s)
Flush laterals and pressure test At least once every:D month(s)D year(s)
Other:At least once every:D month(s)D year(s)
Other:Bayffeld Co, Zoning Dept.d NA
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 visuafty 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-tfiird ('4) 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 _•_ ofSTART 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 effluent.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the
affluent 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 _jpl IJ fp; |H ^Hf^1°17HT
'7-
T
'"e,
7Wlrs, I
'C; ;-,
^ !^' ''/>-
.
Name
Phone
POWTS INSTALLERINSTALLER
^/A7^ /
7YJ--7^'-
^'/^'T
-.-?^/?—
3EPTAGE SERVICING OPERATOR (PUMPER)
Name
Phone
/^-A
7y^ •
' ^^^^^
7^Y--jwy
POWTS
Name
Phone
MAINTAINER~7T^
7/-r-
s^.
-7y
^
£_
7<:
-Xi^^-
LOCAL REGULATORY AUTHORITY
NameBayfield County Zoning
Phone 715-373-6138
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.
^
8 / OZb lu'' _ __.__ _--....__ Bradley SikorskiBAYFIELD COUNFf
Bayfleid Co Zoning Dept CHECKLIST FOR SANITARY APPLICATONS
Submit the Following (Use Permanent Ink) fTitle 15, Section 15-l-10(e))
0 Check List
0 Original Sanitary Application (Submitted in Deed Holders Name - not prospective buyers) (383.21(1)1.)
0 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c))
0 Original Plot Plan (383.22(2)2. 3. & 4.a)
0 Cross Section, Over-Head Profile of the System and Schematic of Tank from Manufacturer
D Pump Tank Diagram, Alarm and Pump Curve (when applicable)
0 Contingency Plan / Management Plan (383.22-3(2)(b)l.f.)
0 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)
0 2 Complete Sets of Plans f383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached
to all copies')
0 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)
0 I Application Information must include: D 23 diait Parcel ID# - fdo not use 12 digits anymore-obsolete)
Gf Project Address or Road Name where driveway is/will come off of) 0 (Owners Phone Number)
0 II Type of Building
0 III Type of Permit
Ef IV Type of POWTS System
0 V Dispersal / Treatment Area Information
0 VI Tank Information
0 VII Responsibility Statement (Plumber's Information)
0' *Date Stamp*
Plot Plan: (To Scale or To Dimension)
Ef Signature and Plumber Information
0 Surface Elevation of Body of Water
0 Direction and Percent Land Slope
Ef Tank and Filter Information and Location
0 Wetlands / Navigable Bodies of Water
Ef Absorption Area (Proposed and Existing)
0 Bench Mark (Location, Elevation and Description)
0 Component Manual Version
0
0 Address Number and Road
0 North Arrow
0 Contour Lines
Ef Structures and Driveways
0 Boring Locations
0 Property Lines
0 Well Locations
0 Legal Descriptions
Sili:;^li^;ti?ldnig^se^6rflrie( material type and diameter)
Turn Over ^
Private Sewage System Maintenance Agreement
Owner(s) Name ^1^ S.-JArsk.
Owner(s) MaiHflg^Address ^i OGL^ Or ^ ^^ ^f^y^i\
Sits Address
^3^7 ffm^v r^c riCA-/^Qft/i^^f t^'/, 5-^7
Tax ID #•3S-/^
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 \Aflth rules established in the Wl
Adm. Code, as from time to time amended. (COMPLETE Legal Is required) .
^_G__1/4of^5'!Section V Township */J> N. Range
Additional Legal Description:
Town of /S'/^<€/<^/2"5
Lot (? 9 Block
Lot.CSM#
(Acreage) f to ST'/ Gov't Lot —
Subdivision C^flf^/^i^c/^^ A PP' /^T/ii^n-*-/
Vol. _ Page
s-o^y/eCSM Doc # 60V^^)^3&0
<E.$
. ^873
OOCUMENT NUMBER2025R-607499
OANIEL-J. HEF-FNER
REGISTER OF DEEDS
BAYFIELD COUNTS, Wl
RECOROED
05,16/2025 AT 1 2:25 PM
RECORDING FEE: $30.00&Tg s I y.
yii MAY ^•"••^
In'i
<JJIIs "
Bayfeid Co, Zoning Deot.
Recording Area
Return To:
Planning and Zoning Department
r^7te-s
^ In-ground gravity
Mound
In-ground dosed LJ In-ground pressure distribution Sewage System:
D At-grade Sewage System D Other.
Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage sen/icing 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 tess 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 ths 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.
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-flrade^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.
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 servicing and maintaining the private sewage system tank in such a manner as to prewni or ab^«W<rn,
human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thlrt^!^[^^ r^'/'i.
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 cos(^^A^Bes..;^(-^'i^
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 prov^^Cy^w. '''\.'^p\
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.^ -^ s Y*u l/^f^^ \^\
-1—i-,.— ' izl
Owner(s) Name(s) - Please Print
So^l€y s^^'
Notarized Owner(s) - Signajure(s)
Subscribed and sworn to before me on this date:
fy}c^vS ^
-Notary Public^
Lc^^Jr^^ /< <-^s^>l^
Drafted by: ?t?//<€ ^4-r' Date: .r-^'ZS-
My Commission'Expires:
^[^ 5 ;-?^7
^euc /
...•^Sgwisc^T'"nuHt»»t*kk'
Proofed by:
u/forms/sanilary/septlcmalntenceagreementRevised June 2018
P-A^FIELD
C3
Property Owner:
SIKORSKI, BRADLEY
55600 RED OAK DR
SOLON SPRINGS, WI 54873
Description
Certified Soil Tests - Review & Filing
Total:
Payment Amount:
Bayfield County
Planning & Zoning Department
117 E 5th Street
P.O. Box 58
Washburn, WI 54891
Phone: 715-373-6138
Fax: 715-373-0114
Fee
Submission Number:
SR-00257
Transaction Number:
SR-00257-2D433
Amount
$50.00
$50.00
$50.00
Reference: 1085
Paid by: Coyote Septic Works LLC/11623 E Larson Dr, Lk Nebagamon WI 54849
Payment Type: Check
Transaction Date: 6/9/2025
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit
B-^yFIELD
Pl
Property Owner:
SIKORSKI, BRADLEY
55600 RED OAK DR
SOLON SPRINGS/ WI 54873
Description
Bayfield County
Planning & Zoning Department
117 E 5th Street
P.O. Box 58
Washburn, WI 54891
Phone: 715-373-6138
Fax: 715-373-0114
Private Sewage System (Septic Tanks)
Total:
Payment Amount:
Submission Number:
SS-00553
Transaction Number:
SS-00553-2D477
Amount
$400.00
$400.00
$400.00
Reference: 4003
Paid by: MICHAEL FOAT, 49755 E SHORE RD, BARNES WI 54873
Payment Type: Check
Transaction Date: 6/9/2025
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
BAYFIELD COUNTS SANITARY PERMIT (#04)-25^6S
STATE SANITARY PERMIT
OWNER: BRADLEYSIKORSKI
GOVTLOT: LOT: 28 BLK:
SUBDIVISION: Commanche Add To Potawatomi
1/4 1/4 SEC:8,T45N,R9W
TOWNSHIP: Barnes
SOIL TEST: 46-25
NEW SYSTEM
SYSTEM T/PE: Non-Pressurized In-Ground
PLUMBER: JAMES CLEMENTS
TRACY POOLER
Authorized Issuing Officer
DATE: 6/9/2025
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: # 222924
Condition: Properly Maintain System Per Recorded Agreement
THIS PERMIT EXPIRES 6/9/2027
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION