HomeMy WebLinkAbout25-52Sss- oos^
Department of Safety
& Professional Services,
Industry Services Division
County Bayfield
Sanitary Permit Number (to be filled in by Co.)
55-5^
Sanitary Permit Application State Transaction Number
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. 15.04(1 )(m). Stats.
I. Applicatt<>ri Information—Please Print All Information
Project Address (if different than mailing address)
2150 South Shore Rd
Property Owner's Name
Benjamin Morse etal
Parcel # ""f/,^ Ai^'^. a:-"
04-004-2-44-09-20-2 05-004-14000
Property Owner's Mailing Address
4177GothenbergRd
Property Location
Govt. Lot
City, State
Duluth, MN
Zip Code
55803
D. Type of Building (check all that apply)
0 1 or 2 Family Dwelling-Number of Bedrooms
D Public/Commercial - Describe Use
D State Owned - Describe Use
Phone Number
^iy-^/3 L13^_'/<
Lot #
_'/4, Section 20
T 44 N R 09 EoifWI
Subdivision Name
Block #
CSM Number
000770V.5P.192
D City of.
D Village of
0 To^vn of Barnes
ffl:.3Cy|M!,su?0WrS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if
is^£iSII^^:lll:lmlK ;1".;:11:^111--
A.D New System Efpi.eplacement System D Other Modification to Existing System (explain)[-] Additional Pretreatment Unit (explain)
B.D Holding Tank [n-Ground
(conventional)
D At-Grade D Mound D Individual Sit^sigJ?
c.D Renewal Before
Expiration
D Revision D Change of Plumber D Transfer to New Owner!List Previous Perrtii(fNumb.er .and Date Issued'W7ii;o% IUf
rV.DiS^rsalTreatnitntArra and Tank Information:°aytield r-nSystem Elevaii6hc'l"'l'ly Dep;
94',93'
Design Flow (gpd)450 Design Soil Application Rate(gpd/sf)
0.7
Dispersal Area Required (sf)
643
Dispersal Area Proposed (sf)
646.6
Tank Information
Capacity in
Gallons
New Tanks Existing Tanks
Total
Gallons
# of
Units
Manufacturer
£ 0
lls gai •S
VIs iE 5
Septic or Holding Tank 1000 1000 Wieser xDosing Chamber
V.Re8[»oilsibi]ity Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Signature'rmil I numrers signamre^-^^ G. i^^n- OK^^SA^S y^ f.^ ^i ^^^B-^uMT/MPRS Number Business Phone Number
Plumber's Address (Street, City, State, Zip Code)
-^^-(^ 5'7S
^
Lfct 1-7 A"-^^^, aj/. ^ytS-rs
^^ftSiiUi'ai^arfaneiitiIJse^Dly.
pproved D Disapproved
D Owner Given Reason for Denial
Permit Fee
$ t f - ^ ——^)0
DMeIssuec^
(p|/3/.lS
iture
/^/3 ^-^i
Conditions ofApproval/Reasons for DisapprovalPff ^1 ^H ^/7 e^ c^/7^ ^/f£^ ff^o^ P^/t^ e/
<SL^ ^M~aet\s4 (L^.
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2x11 inches in size
SBD-6398 (R. 03/22)
^- 002^
Wisconsin Department of Safety & Professional Services
Division of Industry Services
SOIL EVALUATION REPOI
SO" TEST
i~5.-S_^ IS iR I? fl f II 1^ >-~'^-p E^£ y w is?\ liH Page '' ofIll MAY 0 9 2025 ^
in accordance with SPS 385, Wis. Adm. Code ^WH-6- zonlr1u,w,.BayfieldAttach 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)).
Parcell.D. ._ _ ._ w^t04-004-2-44-09-20-2 05-004-14000^LA^V^/^
Property Owner
Benjamin Morse etal Property Location
Govt. Lot 'A Y< S 20 T 44 N R 09
D
E (or)
D
Property Owner's Mailing Address4177 Gothenberg Rd Site Address or CSM and Lot #:2150 South Shore Rd
City, State, ZipDuluth, MN 55803 Phone Number
(218) 393-4395
D City D Village Q Town
Barnes
Nearest Road
South Shore Rd
Q New Construction
EZ Replacement
Use: [^Residential/Number of bedrooms 3
Public or commercial - Describe:
Parent material Sandy and loamy till (Keweenaw-Sayner-Vilas complex)
General comments and recommendations:
1 Boring #D Boring
0 Pit Ground surface elev. »'-o ft.
Code derived designflow rate.
Flood Plan elevation if applicable
Depth to limiting factor "" in.
450
(EL
/ elev,
^D.1128) ft.
89-6 ft.
Horizon
1
2
3
4
5
Depth
In.
0-14
14-32
32-42
42-54
54-96
Dominant Color
Munsell
10YR 3/2
7.5YR4/4
7.5YR 4/6
7.5YR 5/6
10YR6/4
Bands
Redox Description
Qu. Az. Cont. Color
of lamellae in hori;
Texture
Is
s
(GR 5%) s
s
s
)n5
Structure
Or. Sz, Sh.
Osg
Osg
Osg
Osg
Osg
Conslstence
ml
ml
ml
ml
ml
Boundary
aw
_gs_
cs
cs
Roots
2m/2f/2v
2m/2f/1vl
1f
1vf
Soil Application Rate
GPD/Ft2
*Efii»1
0.7
0.7
0.7
0.7
0.7
*EffiK
1.6
1.6
1.6
1.6
1.6
Boring #QBoringEJPit Ground surface elev. 94.3 ft.Depth to limiting factor 96 in. / elev. 86'3 ft.
Horizon
1
2
3
4
Depth
In.
0-6
6-22
22-48
48-96
Dominant ColorMunsell
7.5YR 2.5/1
7.5YR 4/4
7.5YR 4/6
10YR6/4
Bands
Redox Description
Qu. Az. Cont. Color
of lamellae in hori2
Texture
Is
s
s
s
)n4
Structure
Gr. Sz, Sh.
Osg
Osg
Osg
_0^_
Consistence
ml
ml
ml
ml
Boundaiy
cw
_gs_
cs
Roots
2vf
lco/2m/1
If
Soil Application Rate
GPD/Ft2
*Ef?1
0.7
0.7
0.7
0.7
*Efl*2
1,6
1.6
1.6
1.6
CST Name (Please Print)Keith Wiley
Signature^-^^-tsT Number 654921
Address11623 E Larson Dr. Lake Nebagamon, Wl 54849
Dat^^aluatlon Conducted4/27/2025 Telephone Number
218-451-2611
* 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
:R^c'4 ^0 (Uv.c^ ^ ,0^] 5M25 W1-
SBD-8330 (R03/22)
Boring #
D Boring0 Pit TF MAY U 9 2025 B
Page 2 pf 3B F IR!I II I i^
Ground surface elev. 9^ ft Depth to li^i<i|ig factor 96 in. / elev.87-5 ft.
ii u ?n?(; 1^
Horizon
1
2
3
4
Depth
In.
0-13
13-16
16-55
55-96_
Dominant Color
Munsell
7.5YR 2.5/1
7.5YR4/4
7.5YR 4/6
10YR6/4
Bands
Redox Description
Qu. Az. Cont. Color
of tamellae in hori;
Texture
Is
s
s
s
?n4
•iTjfin.l-i r.- 7-.ninn ;''c
Stmfiture
Gr. Sz. Sh.
Osg
Osg
Osg
Osg
u. A. vi HUM ;-•Consistence
ml
ml
ml
ml
Boundary
cs
cs
cw
Roots
co/1m/2
1m/1f
2f
1f
Soil Application Rate
GPD/Ft2
*Ef?1
0.7
0.7
0.7
0.7
*Effitf2
1.6
1.6
1.6
1.6
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
Gr. Sz. Sh.
Conslstence Boundary Roots
Soil Application Rate
GPD/Ft2
*Efl#1 *Efl#2
Boring #D Boringa pit Ground surface elev..-ft.Depth to limiting factor.in. / elev._ft.
Horizon Depth
In.
Dominant ColorMunsell
Redox Description
Qu. Az. Cont. Color
Texture Structure
Gr. Sz. Sb.
Conslstence Boundary Roots
Soil Application Rate
GPD/Ft2
*Eff#1 *Efi#2
* Effluent #1 = BOD > 30 £ 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, & 30 mg/L and TSS s 30 mg/L
Morse (3 bedroom)
Soil Report Plot Plan
North Benjamin Morse etal
2150 South Shore Rd
LOT 1 OF CSM #000770 V.5 P.192
S20 T44N R09W
TownofBarnes
04-004-2-44-09-20-2 05-004-14000
9.120 acres
Septlc tank & drainfield to be
abandoned per SPS 383.33
Scale 1:50
<•NOTES:
X Bench Mark = Duplex nail w/ orange disc in 14" DBH pine
Elev = 100.0'
- Property lines not shown > 50' from tested area
- Middle Eau Claire elev " 86'
CST 119900002-SP^?^-i2 Page 3 of 3
Benjamin Morse etal
BAYFIELD COUNTYCHECKLIST FOR CERTIFIED SOIL TESTS
Submit the Following (Use Permanent Ink):
53/Check List
D Index Page / Title Sheet (Optional)
0' Original Soil Evaluation Report (Submitted in Deed Holders Name - nfii prospective buyers)
52'Original Plot Plan
D Cross Section Soil Profile Sheet (optional)
D Aaditional Information (Warranty/Quit Claim Deed) (Optional)
Soil Evaluation Report: (Include the following Information)
3 ii» m i
MAY 0 9 20?b W
yayfield Co, Zoning Dept.
5^ Parcel Identification Number (must be 21digiS Tax ID#) DO NOT USE 12 digit, they are no longer being used
Of Property Owner's Information (not prospective buyer's name)
CT'Property Location (Accurate Legal Description with Sec/Twp/Range)
Q" Road Name (where driveway is/will be coming off of)
Q'Floodplain Elevation, Flow Rate, Comments and Recommendations
Gf Complete Soil Boring / Pit Information
y Date Soil Evaluation was conducted
E7CST Name, Signature, Number, Address and Phone Number
E7*DateStamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
Q/'Bendh Mark (Description, Elevation and Location)
Sf Contour Lines (Example = 98.0' ,96.0' ,94.0')
lyproperty Location (Sec/Twp/Range/, Accurate Legal Description)
Of Borings (Locations and Elevations)
S/ Percent and Direction of Land Slope
0'Well Location (Including Neighboring Wells, if applicable)
Ey Location of Wetland Areas, Floodplain and Navigable Waters
Q Buildings, Driveways, and Structures (Location and Descriptions)
sy Location of Property Lines
13'Existing System Location
E7 Address Number and Road Name
E7 Current Surface Elevation of Wetlands and Navigable Waters
K^CST, Owner and Property Information
E/North Arrow
Fee:
E7 Certified Soil Tests-Review & Filing Fee $ 50.00 U/forms/sanitary/checkllsVchecklistforcsts
Benjamin Morse etal
2150 South Shore Rd
04-004-2-44-09-20-2 05-004-14000
Bayfield
TOT 1 OF CSM #000770 V.5 P. 192
20
44
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
4/29/25
,>,|HHI"IH,,,,^£°^\KEITH WLEV
D 2388 PSS
ESKO_MINNESOTA
.<. ^\^s^"""^i7ui'r!'>*l>*
Designer's Name
Designer's Signature
Designer's License Number
Designer's Phone Number
Date ^ i ® i ill
^y .^
:-iyngiQ .•-.Or) I
w ^
J/" i1
l^ni
Page 1 of 7
n-Ground Soil Absorption for POWTS
/ersion2.1 (May 2022-2027)3
15
96
0.7
300
450^^4
^3
97
97
~96^^
Component Manual Usei
slumber of Bedrooms
:>ercent Slope (%)
Depth to Soil Limiting Factor (in.)
n Situ soil application rate
Estimated Wastewater Flow (gpd)
Design Wastewater Flow (gpd)
slumber of System Elevations
3roposed System Elevation #1
3roposed System Elevation #2
3roposed System Elevation #3
original Grade #1
:inished Grade #1
)riginal Grade #2
:inished Grade #2
)riginal Grade #3
:inished Grade #3
VieseMOOO
•olylok PL-525
Septic Tank
Effluent Filter
ifiltrator Quick4 Plus Standard^2
20
3.3
4
1.5^2
3^^
32
642.9
646.6
Chamber Type
leight of Chamber (in.)
q.ft. per chamber(ESIA)
q.ft. per end cap (EISA)
lying length of chamber(ft.)
sngth of endcap(ft.)
;hamber wicfth(in.)
!ows of Chambers
>istance Between Cells (ft.)
lumber of chambers in first row
lumber of chambers in second row
lumber of chambers in third row
'roposed Number of Chambers Used
linimum Distribution Cell Area Required (sq.ft.)
ijstribution Cell Area Proposed (sq.ft.)
!D) fe' ?: f n^
!nf
';[| M^V •/ ^ ');,.',; '"1 / f\ '^\7'
'-lyn^i;; ;'
-w;l,t.; i
/ni
w
Page 2 of 7
Morse (3 bedroom)
Gravity In-Ground Septic Systemi
North Benjamin Morse etal
2150 South Shore Rd
LOT 1 OF CSM #000770 V.5 P.192
S20 T44N R09W
Town of Barnes
04-004-2-44-09-20-2 05-004-14000
9.120 acres
Middle Eau Claire Lake
To be connected to seperate septic system
Wieser W1000-MR w/ polylok 525 filter
in place of old tank Two rows of 16 Infiltrator Quick4 Plus Standard chambers
Scale 1:50
<-NOTES:
X Bench Mark = Duplex nail w/ orange disc in 14" DBH pine
Elev = 100.0'
Property lines not shown > 50' from system area
Middle Eau Claire elev " 86'
Page 3 of 7
Cross Section of a Two Cell In Ground Component
Using Leaching Chambers
Observotion/Vent Pipes
97.00 | Finished Grade
Slope 15%
97.00
95.00
Original Gcack
Top of Chamber
Cejl-Seperation
-^ I 3 jfejqt^X->L
Finished 9-ada ,_[_ 96.001
94.00 |System Elevation !_/_________. \^i. :. , „ ., <
•'•. •.-
96.00
--x./' \~X' X)
-^< >^ j5rfginal Grade
^ ^ /^Top of Chamber|
t^-" System Elevation I 93.00|
94.00
r.«' •
:\T'"eQtnient'pnd4:Dt9peredl' ,?orie. / . :;
"^ •' •<* • ^ ' • . : < ' - •' ' '•"--''•,•*
" ..':'• -'•'•..:.'.'..
•:"•.• ••' . .< \ • • ' • '•. . • •••Limiting Factor
Observation/Vent pipes to be constucted and capped with approved materials for the particular use.
Diagrams Not To Scale
67 feet
i ill
^y 2.\
ff=f1 eayffe/d Co. 7
?
nfn9 Dept
67 feet
Observation / Vent Pipes to be located at the ends of the distribution cells.
Page 4 of 7
4" CAST-A-SEAL
TOP VIEW
PUMP PAD
SIDE VIEW
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
WLP1000
TANK SPECIFICATIONS
PENSIONS:
^ WALL: 2 1/2"
S BOTTOM: 3"
COVER: 5"
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
HEIGHT: 53 1/4"
LENGTH: 8'-8"
WIDTH: 7'-2>>
BELOW INLET: 42"
LIQUID LEVEL: 36"
WEIGHT: BOTTOM 6.790 LBS.COVER 3.195
INLET AND OUTLET:
4" CAST-A-SEAL BOOT OR EQUAL GASKET
INLET AND OUTLET BAFFLE AND FILTER:WISCONSIN SEE DETAIL #10(OTHER STATES SEE CHART)
LIQUID CAPACITY: 27.83 GAL/IN
HOLDING TANK:OUTLET HOLE PLUGGEDACTUAL CAPACITY: 1,085 GALLONS
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
REVIEWED BY
REVIEW DATE
DRAWINGS SUBMITTED
FOR APPROVAL
APPROVED BY:
APPROVAL DATE:
PRODUCTS NEEDED BY:
^ tOB22 ^t-00^ T§ln^£ 100I 00
in=>
000
a,
<=)
uF
a,LJen
SHEET NO.
1 OF 1
FILE INFORMATION
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
SYSTEM SPECIFICATIONS
Page 6 of _L
Owner Benjamin Morse etal
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 (BOD5)
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 D NA
0NA
300 gal/day
450 gal/day
0.7 gal/day/ft2
Monthly average*
<30 mg/L
<2.2.0 mg/L D NA
$150mg/L
Monthly average
^30 mg/L
$30 mg/L D NA
<104cfu/100ml
% in dia. D NA
0 NA
'Values typical for domestic wastewater and septic tank effluent.
MAINTENANCE SCHEDULE
Tank Manufacturer Wieser
EZI Septic D Dose D Holding
Tank Manufacturer
D Septic D Dose C 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)
B In-Ground (gravity)
D At-Grade
D Drip-Line
Other:
Other:
vol. 1000
vol.
Polylok
525
D Peat Filter
D Wetland
D Other:
D NA
gal
EZINA
gal
D NA
0NA
0 NA
D NA
D In-Ground (pressurized)
D Mound
D Other:
0 NA
0 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 ^ ^r(s) (Maximum 3 years) D NA
E When combined sludge and scum equals one-third (16) of tank volume ^ ^^D When the high water alarm is activated
At least once every: 3 § ^eTr^)(s) (Maximum 3 years) D NA
At least once every: 3 g ";S^) | ^sii
At least once every: _H ?S|) ^ ^-^
DNA
EZINA
At least once every: H I"eTrt(s) — ^^
D month(^vr!eici [AS. /:.oning ueprAt least once every: g vearfsr7'"""" "" """ "a '"" 0 NA
0NA
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 affluent levels in the observation pipes and to check for any ponding of affluent
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 (%) 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 Z_ of Z_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 affluent.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to theeffluent 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.
Of 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. DEAT^PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
9nAtTfTI 'Wf^f
"1 ill!ili NAY ^bZU^ '^
FA
yavneiu L,a /.onina UOD'!
POWTS INSTALLER POWTS MAINTAINER
Name /t^ / ^ ^ ^ €>^- /"
Phone ^/S~ 7f^ <-Z ^^-Z-
Name ^-l<-s^^r^
Phone ~7/^ 7$^ 3 V 9^
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name /^./< S^^r/£
Phone -7/<S-^ ^ f ^ 3 9 f y
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.
^5 -oos^n^
Private Sewage System Maintenance Agreement
Owner(s) Name
s ^^ ^Jud^-h nnc
Owner(s) Mailing Address3^ Pi-\c^c L<^^<2-b-sla 55^
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Tax ID #^.^2. H
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 specificab'ons
on file with Bayfield County Planning and Zoning Department. The system will be
operated in such a manner as to meet the designed plans. I (we) agree to maintain said
private system at the below listed location in accordance with rules established in the Wl
Adm. Code, as from time to time amended. (COMPLETE Legal is required)
•su^ 1/4 of A/j^ 1/4 section ^ ° Township _9^_N. Range 9 _w.
Additional Legal Description:
Town of Ofir^'U/S._S (Acreage)Gov'tLot_H
Lot---.-Block:.Subdh/ision
CSM*<W^Voi..Page ^2. CSM Doc#'3^#^-£t£yLfOl^j^
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DOCUMENT NUMBER2025R-607763
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY, WI
RECORDED
06/09/2025 AT 8:00 AM
RECORDING FEE: $30.00
PAGES: 1
Recording Area
Return To:Ini i£ ^ j^1!! 1^ ^ in;Planning and ZoiJing Depaftment ' !!=
!!lj JUNIOR p
^;l":,-l! f,IU Ufji.r
In-groun^-gravity
D Mound
D In-ground dosed
D At-grade Sewage System
D In-ground pressure distribution Sewage System:
D Other
Septic Tank (system types A through E): The sepfc 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 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 the septic tank is serviced as provided
above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components.
Septic Tank EffIuerrtFiitej_(systern 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 sen/icing 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 detennine whether wastewater or effluent from the system is ponding on the ground surface.
Mounds, At-arade. and In-around Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when
the wastewater distribution cell component is inspected as provided above.
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 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 fax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law.
The terms and conditions of the variance shall be binding upon and inure to the benefit of alt current and future owners o/suc/i property.
Owner(s) Name(s) - Please Print
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^N'9fari2ed owner(s) - Signature(s)
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Subscribei^nd sworpto before me on thHAitft
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/ / ^Notary Publro^S -^ ^t^"?'j
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ELLIOTTWAYNEHOUpH
Notary Public
State of Wisconsin]
My Commissioivexpii
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Drafted by: /°^//^?~ ^^T' Date: -^:-^?'~2/'^~
Proofed by:
ufforms/sanitary/septicmaintenceagreementRevised June 2018
Benjamin Morse etal
BAYFIELD COUNTSCHECKLIST FOR SANITARY APPUCATONS
Submit the Following (Use Permanent Ink) 0'itle 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)
0 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7)
0 2 Complete Sets of Plans f383.22(2')f2.') fNote: 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)
0 Project Address or Road Name where driveway is/will come off of) El (Owners Phone Number)
0 II Type of Building
Ef III Type of Permit
0 IV Type of POWTS System
Ef V Dispersal / Treatment Area Information
0 VI Tank Information
0 VII Responsibility Statement (Plumber's Information)
*Date Stamp*
Plot Plan: (To Scale or To Dimension)
0 Signature and Plumber Information
0 Surface Elevation of Body of Water
0 Direction and Percent Land Slope
0 Tank and Filter Information and Location
Ef Wetlands / Navigable Bodies of Water
0 Absorption Area (Proposed and Existing)
B Bench Mark (Location, Elevation and Description)
'Q! m (r E
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ul'"'!-; IXipt
0 Component Manual Version
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0 Address Number and Road
0 North Arrow
0 Contour Lines
0 Structures and Driveways
0 Boring Locations
0 Property Lines
0 Well Locations
0 Legal Descriptions
ssewgrirhe, maiterteil type arid diam^tei-)
Turn Over ^
""-I J^ J.Jl^.Bayfield County
Planning & Zoning Department
117 E 5th Street
P.O. Box 58
Washbum, WI 54891
Phone: 715-373-6138
Fax: 715-373-0114
Property Owner:
MORSE/ BENJAMIN
4177 GOTHENBERG RD
DULUTH/ MN 55803
MORSE/DANIELL
4177 GOTHENBERG RD
DULUTH/ MN 55803
MCLEOD/TIMOTHY L & JUDITH L
38 ALDER LN
ESKO, MN 55733
Submission Number:
SS-00549
Transaction Number:
SS-00549-2D99E
Description
Private Sewage System (Septic Tanks)
Amount
$400.00
Total:
Payment Amount:
$400.00
$400.00
Reference: 4004
Paid by: MICHAEL FOAT/ 49755 E SHORE RD/ BARNES WI 54873
Payment Type: Check
Transaction Date: 6/13/2025
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
BAYFIELD COUNTY SANITARY PERMIT (#04)-25^2S
STATE SANITARY PERMIT
OWNER: BENJAMIN MORSE ETAL
GOVT LOT: 4 LOT: 1 BLK:
CSM: 000770V.5P.192
1/4 1/4 SEC: 20, T 44 N, R9 W
TOWNSHIP: Barnes
SOIL TEST: 31-25
REPLACEMENT SYSTEM
SYSTEM TYPE: Non-Pressurized In-Ground
PLUMBER: JAMES CLEMENTS
TRACY POOLER
Authorized Issuing Officer
DATE: 6/13/2025
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. Do not park atop or plow snow off
of drainfield.
THIS PERMIT EXPIRES 6/13/2027
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION