HomeMy WebLinkAbout25-52S'< INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY '
TT'1E RECEIVED REMOTE CSID DURATION PAGES STATUS
September 12, 2025 at 3:36:46 PM CDT 7157952324 32 1 Received
912212025 14:3S57 PJs Cablm Store 7157952324 1/1
(Fax this form to Zoning Dept when you went an inspection — 4(a-9114)
1 Ll Time change Discrepancy [] Other
I Phone Number
7/i C79r2y2 2
Plumber:
j9 C ��M `ti'r S
Fag Number
Home
M t -S
Santtary
2,$`� -S
Pturnbar's Choice
Zoning Dept
tdo ineeection during $hne times
i
11:30 am — 2:30 pm Wad. (Jan)
f
9:30 am —12:30 pm Tues. (Josh)
I9.30
am —12:30 pm Thurs. (Josh).i
^:
Time
Plumber's Choice
'ng Dept Immediate Phone Number so aon)ng
piLl
Dept can aslt you back If needed
Township:
j
)3 'tJE
Address ti &
Road warnG ZjSO . so ry SHse( � z)
or
Directions
Tn GRd-
Comments;
Bpmin : You must conTnn any ehen9e(s) that have been made pdorto or
mis hissneciiog y not h� i a memo wiff be sent voiding /he inspee1ion
Thank You! ,I
Plumber must verify any change(s) by fax or no lnspecWas, wi(Lb®scheduled'*
Ldiccnamenwjicsgs.co9wlntpe*or
iomrq bSDt;A:1J94i ggtry]C{6
Private Onsite Wastewater Treatment
o
Systems ( POWTS) Inspection Report
(Attach to Permit)
Industry Services Division
Onneral Information
F U City U Village U Town of:
BENJAMIN MORSE ET AL
4177 GOTHENBERC RD
r DULUTH MN 558033 BM Description: Nq,1 \� frees
Y\n)c# +o 'iY21nca
Tank Information setback to:
TYPE
MANUFACTURER
CAPACITY
Prop. Line
Well
Building
Air Intake
Road CIJ
Se tic
W e .e. r
loco 4.
I Q O'
0t'
10. k'
N/A
Dosing
N/A
Aeration
N/A
Holding
County
Sanitary ennit No:
25- 52-S
State Plan Transaction ID#:
Parcel Tax No:
Pump / Siphon Information Elevation Data
stribution System X Pressure Systems Only
Header / Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes
Length Dia Length Dia Spac Spacing ❑ Yes 0 No
Soil Cover
ueP in uver I iiepin uverI ue in oT I eeaeo I 000aea I Muicnea
Cell Center I Cell Edges I Topsoil I ❑ Yes 0 No j ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) M tt2 FoA* + 2, p{ S#q ck ;•1c.(CS 4
lcilnS cri +°fl D icd 110-f'tns pec} altar rr
!an revision required? ❑ Yes No I 5 Q .i 25 loots — P
,e other side for additional information. 1
Date POWTS lnspectol's Signature License Number
;an_a71n rR n4/911
Property Owner
Information
As you know
BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT
Telephone: (715) 373-6138
Fax: (715) 373-0114
e-mail: zonino(dbayfieldcounty.ora
Web Site: www.bavfieldcounty.org/147
BENJAMIN MORSE ET AL
4177 GOTHENBERG RD
DULUTH MN 55803
Bayfield County Courthou$'
Post Office Box 58
117 East Fifth Street
Washburn, WI 54891
was contracted by you to install a private
onsite wastewater treatment system on your property (Tax ID# above). To know when your system will be due
for servicing please go to www.seoticsearch.com
Notes:
FiUtc\ \n blocice cgrt( weld
Abandonment of Old System to meet all applicable code requirements:
1
Tank was pumped by:
o Tank was crushed I removed and pipes disconnected by:
on
at AM/PM
On I (2Sf 2-S at 200 (AM P the above -mentioned plumber contacted our office to
conduct a pre -cover inspection as required un er DSPS 383. One of the following applies:
System was inspected and appears to meet all applicable code requirements.
flSystem 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:
U/forms/sanitarypropetlyowner-Input
Apri12019
sS- oosgq
'.� ENIIpEp
( I
L2j
Department of Safety
& Professional Services,
Industry Services Division
County
Bayfield
Sanitary Permit Number (to be filled in by Co.)
s- 5aS
Sanitary Permit Application
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats.
State Transaction Number
Project Address (if different than mailing address)
2150 South Shore Rd
I.Application Information—. Please Print All Information
Property Owner's Name
Benjamin Morse etal
Parcel # A)4
04-004-2.44-09-20-2 05-004-14000
Property Owner's Mailing Address
4177 Gothenberg Rd
Property Location
GovL Lot
'4 %, section 20
T 44 N R 09 E o W
City, State
Duluth, MN
Zip Code
55803
Phone Number
Il -393
II. Type of Building (check all that apply) i
® I or 2 Family Dwelling —Number ofBedrooms 3
❑ Public/Commercial — DescribeUse
❑ State Owned — Describe Use
Lot#
1
Subdivision Name
Block #
❑ City of
❑ Village of
® Town of Barnes
CSM Number
000770 V.5 P.192
M. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i
111111Iica le.
A.
O New System
y
NJ Replacement System(explain)
p y
❑ Other Modification to Existing System (explain)
❑ Additional Pretreatment Unit (ex lain
B'
❑ Holding Tank
M In -Ground
(conventional)
O At -Grade
❑ Mound
❑ Individual Sit idd
n RRRSSS
(i� lrery
loJ V. If
(gapla
lS}
),
C.
❑ Renewal Before
Expiration
❑ Revision
❑ Change of Plumber
Transfer to New Owner
( d Date Iss!u1ed
ist Previous Per i u fH yar ?u?Issued
2❑
I U
IV,
Dispersal/Treatment
Area and Tank Information: dayfl&p
Design Flow (gpd)
450
Design Soil Application Rate(gpd/st)
0.7
Dispersal Area Required (sf)
p 643
I Dispersal Area Proposed (sf) I
646.6
System Elevati0fl1 1w Depi.
94,93'
Tank Information
Capacity in
Gallons
Total
Gallons
# of
Units
Manufacturer
d9 8
wV
U'5
g
in 3
V
m
m
s .E
wU
New Tanks
Existing Tanks
Septic or Holding Tank
1000
-
1000
1
Wieser
Dosing Chamber
V. RespoAsibility Statement- 1, the undersigned, assume responsibilityfor installation of the POWTS shown on the attached plans.
Plumr's Name (Print) Plum er's Signature
► 4 l�
MP/MPRS Number
3t
Business Phone Number
`ass -3s ca
Plumber's Address (Street, City, State, ZipCode
[[ ..rrte� G S
VI. Co'rmty/Department Use Only
p -Approved
❑ Disapproved
❑ Owner Given Reason for Denial
Permit Fee I
Date Issuedm,
Issuin A Si lure / S
/1232/3
Conditions of Approval/Reasons for Disapproval n
-P Mn' &k ?6f 96 sAO'PG af /�r4 /I
aeAcf e.
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/Is 11 inches in size
SBD-6398 (R. 03/22)
Benjamin Morse etal - Property Owners Name
2150 South Shore Rd Property Address
04-004-2-44-09-20-2 05-004-14000 Tax Parcel Number
Bayfield County
LOT 1 OF CSM #000770 V.5 P.192 Legal Description
20 Section
44 Town
9 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 Designer's Name
/ Designer's Signature
D2388PSS Designer's License Number
218-451-2611 Designer's Phone Number Q
? UII
4/29/25 Date
Go+ SMAY 28 p;
,,,.��'����' ��••.,,, Bayfield Co. Zo
n �g
KEITH WILEY
D2388
PSS
ESKO
MINNESOTA
�esig�e,%
'/flllll►11
75
Dept.
Page 1 of 7
1111 MAY 2 8 ZO2;.
gayfield Co. Zoning
I..p
n- I'round SoilAbsorption f�fPOWTS
Version 2.1 (May 2022-2027)
Component Manual Used
3
Number of Bedrooms
15
Percent Slope (%)
96
Depth to Soil Limiting Factor (in.)
0.7
In Situ soil application rate
300
Estimated Wastewater Flow (gpd)
450
Design Wastewater Flow (gpd)
2
Number of System Elevations
94
Proposed System Elevation #1
93
Proposed System Elevation #2
Proposed System Elevation #3
97
Original Grade #1
97
Finished Grade #1
96
Original Grade #2
96
Finished Grade #2
Original Grade #3
Finished Grade #3
1000
Septic Tank
EWieseer
k PL -525
Effluent Filter
Infiltrator Quick4 Plus Standard
I Chamber Type
12
Height of Chamber (in.)
20
sq.ft. per chamber(ESIA)
3.3
sq.ft. per end cap (EISA)
4
laying length of chamber(ft.)
1.5
length of endcap(ft.)
34
Chamber width(in.)
2
Rows of Chambers
3
Distance Between Cells (ft.)
16
Number of chambers in first row
16
Number of chambers in second row
Number of chambers in third row
32
Proposed Number of Chambers Used
642.9
Minimum Distribution Cell Area Required (sq.ft.)
646.6
Distribution Cell Area Proposed (sq.ft.)
"1
Page 2 of 7
Morse (3 bedroom)
North
Middle Eau Claire Lake
O�
Wieser W1000 -MR w/ polylok 525 filter
in place of old tank
Wetland
a
ell
cabin
Gravity In -Ground Septic System t)1
cabin
a
a)
a
C
N
O
a
m
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
To be connected to seperate septic system
Scale 1:50
4 NOTES:
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 N 86'
Page 3 of 7
Cross Section of a Two Cell In Ground Component
Using Leaching Chambers
Observation/Vent Pipes
V N
97.00 Finished Grade ...j Finisd•Gheade._ 96.00
Slope 15% Cej eperation
3 t >
97.00 Original G ?:t' <; itiginal Grade 96.00
95.00 Top of Chamber ./\/ _r f: prop of Chamber 94.00
94.00 System Elevation.. :' _ , System
= , ., _ � stem Elevation I 93.00
1'reatn3ent'.'pnd':Dtspersot ,Zone . '- '
...�.__��._' �_'•'=:•. _,.ti, _�� - Limiting Factor
Observation/Vent pipes to be constucted and capped with approved materials for the particular use.
s Not To Scale
_ I 67 feet ^
67 feet
Observation / Vent Pipes to be located at the ends of the distribution cells.
If1) MAY 2.1 2025
BaYf7eld C0. Z nin
g Dept.
Page 4 of 7
4" CAST -A -SEAL 4" CAST -A -SEAL a a
j
4r
FILTER OR ii"
BAFFLE ,
w
<
Or
w
41
INLET — — — _ OUTLET
�cn 1-- I fi
t -- j to I a r
23"-
PUMP PAD
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
WLP1000
TANK SPECIFICATIONS
a
1ENSIONS:
o
a
o
a, WALL: 2 1/2"
a
a
•= BOTTOM: 3"
N COVER: 5"
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
a
a HEIGHT: 53 1/4"
o
LENGTH: 8'-8"
WIDTH: 7'-2"
w
m BELOW INLET: 42"
LIQUID LEVEL 36"
o
WEIGHT: BOTTOM 6,790 LBS.
COVER 3.195
R
O
o
INLET AND OUTLET:
rQ
m
o
a
4" CAST -A -SEAL BOOT OR EQUAL GASKET
W
o
INLET AND OUTLET BAFFLE AND FILTER:
¢
o
W
WISCONSIN SEE DETAIL #10
(OTHER STATES SEE CHART)
I� N
LIQUID CAPACITY: 27.83 GAL/IN
Lai
HOLDING TANK:
00 Lo
Ir
OUTLET HOLE PLUGGED
®
ACTUAL CAPACITY: 1,085 GALLONS
U)
LOADING DESIGN: 8'-0" UNSATURATED SOIL
j N
TANK CAN BE USED AS:
_o
W
0
SEPTIC / HOLDING / PUMP OR SIPHON
0
= a0
COVER: MIX DESIGN #8 (NO FIBER)
WD
co
TANK: MIX DESIGN #10 (STRUCTURAL FIBER)
R
CUSTOMIZED TANKS:
FOR CUSTOM TANKS CONTACT WIESER CONCRETE
0
0
O
REVIEWED BY
REVIEW DATE
J
D
Z
U
F
a
w
17
OF
1
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 6 of 7
FILE INFORMATION
Owner Benjamin Morse etal
Permit #
DESIGN PARAMETERS
Number of Bedrooms
3
O NA
Number of Public Facility Units
® NA
Estimated (average) flow
300 gal/day
Design (peak) flow = (Estimated x 1.5)
450
al/da
In Situ Soil Application Rate
0.7 al/da /ft2
Standard Influent/Effluent Quality
Monthly average*
Fats, Oil & Grease (FOG)
≤30 mg/L
Biochemical Oxygen Demand (BOD5)
≤220 mg/L
O NA
Total Suspended Solids (TSS)
≤150 mg/L
Pretreated Effluent Quality
Monthly average
Biochemical Oxygen Demand (BOD5)
≤30 mg/L
Total Suspended Solids (TSS)
≤30 mg/L
❑ NA
Fecal Coliform (geometric mean)
≤104 cfu/100ml
Maximum Effluent Particle Size
in dia.
❑ NA
Other:
® NA
*Values typical for domestic wastewater and septic tank effluent.
MAINTENANCE SCHEDULE
SYSTEM SPECIFICATIONS
Tank Manufacturer Wieser
O NA
® Septic O Dose O Holding
vol. 1000
gal
Tank Manufacturer
® NA
❑ Septic O Dose O Holding
vol.
gal
Effluent Filter Manufacturer
Polylok
O NA
Effluent Filter Model
525
Pump Manufacturer
® NA
Pump Model
Pretreatment Unit
® NA
❑ Sand/Gravel Filter
O Peat Filter
❑ Mechanical Aeration
O Wetland
❑ Disinfection
O Other:
Manufacturer
Dispersal Cell(s)
O NA
® In -Ground (gravity)
O In -Ground (pressurized)
❑ At -Grade
O Mound
❑ Drip -Line
O Other:
Other:
® NA
Other:
® NA
Service Event
Service Frequency
Inspect condition of tank(s)
At least once every:
onth(s) ears (Maximum 3 years) O NA
3 ❑ month(s)year(s)
®
Pump out contents of tank(s)
® When combined sludge and scum equals one-third (1) of tank volume
❑ NA
O When the high water
alarm is activated
Inspect dispersal cell(s)
At least once every:
3 ❑ month(s) year(s) (Maximum 3 years) O NA
®
Clean effluent filter
At least once every:
3 ❑ mont
® year
}
U
fi \
O NA
Inspect pump, pump controls & alarm
At least once every:
❑ mont()
❑ year
® NA
Flush laterals and pressure test
At least once every:
❑ mont ( )
❑ year(s
® NA
Other:
At least once every:
O
O years) Y ie 0. Lonln
-
® NA
Other:
® 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 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 (%) 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 ` of
'START UP AND OPERATION
• For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the
contents of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will
be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of 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:
O 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.
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 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 NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATI{ IAl TB Tst
UF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. AIL)) IIfl
ADDITIONAL COMMENTS
BayneBayneld Uo. Loning Dept.
POWTS INSTALLER
Name ,g PQf- /-
Phone /5 7 f J—
SEPTAGE SERVICING OPERATOR (PUMPER)
Name 441�- ,c,°T1�
Phone 9' 3
POWTS MAINTAINER
Name Sll Y7
Phone .$ 79 s, 3
LOCAL REGULATORY AUTHORITY
Name Bayfield 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.
SS- oosgq
(j,j)
Department of Safety
& Professional Services,
Industry Services Division
County Bayfield
Sanitary Permit Number (to be filled in by Co.)
as -sus
Sanitary Permit Application
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form Lathe 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(I)(m), Scats.
State Transaction Number
Project Address (if different than mailing address)
2150 South Shore Rd
1. Application Information - Please Print All Information
Property Owner's Name
Benjamin Morse etal
Parcel #
04-004-2-44-09-20-2 05-004-14000
Property Owner's Mailing Address
4177 Gothenberg Rd
Property Location
Govt. Lot H
'G, Z, Section 20
T 44 N R 09 E o
City, State
Duluth, MN
Zip Code
55803
Phone Number
118-393 - `/39r
II. Type of Building (check all that apply)
® I or 2 Family Dwelling — Number of Bedrooms 3
❑ Public/Commercial — Describe Use
❑ State Owned — Describe Use
Lot #
1
Subdivision Name
Block #
❑ City of
0 Village of
® Town of Barnes
--
CSM Number
000770 V.5 P.192
111. Type ofPONVTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i
a livable,
A.
❑ New System
y
,--/
p • y
LvJ Replacement System
❑ Other Modification to Existing System (explain)
y p )
(explain)
❑ Additional Pretreatment Unit (ex lain
B.
❑ Holding Tank
M In -Ground
(conventional)
❑ At -Grade
❑ Mound
p
❑ Individual Sit sig
9 ller(jI'yr (gapla
UU IISS
C.
0 Renewal Before
Expiration
❑ Revision
❑ Change of Plumber
Transferto New Owner
❑ Tr
ist Previous Per i u d Date Issued
I
Nr 28 q �025
IV.
Dis ersaUfreatment Area and Tank Information; a ie
Design Flow (gpd)
450
Design Soil Application Rate(gpd/sf)
0.7
Dispersal Area Required (0Dispersal
643
Area Proposed (st)
646.6
System Elevalio Dept
94',93'
Tank Information
Capacity in
Gallons
Total
Gallons
# of
Units
Manufacturer
::
v c
a` V
U $
= 2
rn H
y
m
.o
ii O
u
Os
New Tanks I
Existing Tanks
Septic or Holding Tank
1000
—
1000
1
Weser
Dosing Chamber
n on the . attached plans.
V. Responsibility Statement— I, the undersigned, assume responsibility for installation of the shown
Plum1iLr's Name (Print)
� tC l
Plum er's Signature r
WP /MFRS Number
3,�?3'j3s
Business Phone Number
,-3 s 41
Plumber's Address (Street, City, State, Zip Code)
VI. Corsnty/Department Use Only
.Approved
0 Disapproved
❑ Owner Given Reason for Denial
$ermit Fee
- (V
Date Issued
% 1 3 �j
Isaain A Si rare
/1<732/)
Conditions of Approval/Reasons for Disapproval
Po ll d P4 �k atop 6`1�/R/ rd riAPtsr 07�0� �/ O•N Fj e/m
Attach to complete plans for the system and submit to the County only on paper not less than a 12 x 11 inches in size
SBD-6398 (It 03/22)
Sal TEST
,) to) ' , 31--
Wisconsin Department of Safety & Professional Services Pageof____ 3
Division of Industry Services MAY 092025
SOIL EVALUATION REPO
'►,,�,, in accordance with SPS 385, Wis. Adm. Code C• Zoning
Bayfield
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.
scale or dimensions, north arrow, and location and distance to nearest road. 04-004-2-44-09-20-2 05-004-14000
Please print all information. a ewe /i/Date
Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). _,_//•J/4_ -
Property Owner Property Location ❑ ❑
Benjamin Morse etal Govt. Lot % %% S 20 T 44 N R 09 E (or)
Property Owner's Mailing Address Site Address or CSM and Lot 2150 South Shore Rd
4177 Gothenberg Rd
City, State, Zip Phone Number ❑ City ❑ Village Town I Nearest Road
Duluth, MN 55803 I (218 ) 393-4395 Barnes South Shore Rd
❑ New Construction Use: (Residential/ Numberof bedrooms 3 Code derived designflow rate pD
Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable (EL 1128) ft,
Parent material Sandy and loamy till (Keweenaw-Sayner-Vitas complex)
General comments and recommendations:
Boring # ❑ Boring
® Pit
Ground surface elev. 97.6 ft. Depth to limiting factor 96 in. / elev. 89.6 ft.
anti Annitratinn Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft3
*Eff#1
*Eff#2
1
0-14
1OYR 3/2
—
Is
Osg
ml
aw
2m12f12v
0.7
1.6
2
14-32
7.5YR 4/4
—
s
Osg
ml
gs
2m/2f/1vf
0.7
1.6
3
32-42
7.5YR 416
—
(GR 5%) s
Osg
ml
cs
If
0.7
1.6
4
42-54
7.5YR 5/6
—
S
Osg
ml
cs
1vf
0.7
1.6
5
54-96
1OYR 614
—
s
Osg
ml
—
--
0.7
1-.6
Bands
of lamellae in hori
n__5
[II1
Boring #
❑Boring 86.3
®Pit Ground surface elev. 94.3 ft. Depth to limiting factor 96 In. / elev. ft.
Snil Annliratinn Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Cr. Sz. Sh.
Consistence
Boundary
Roots
GPDIFt2
*Eff#1
*Eff#2
1
0-6
7.5YR 2.5/1
—
Is
Osg
ml
cw
2vf
0.7
1.6
2
6-22
7.5YR 4/4
--
$
0sg
ml
gs
1co/2m/1
0.7
1.6
3
22-48
7.5YR 4/6
—
s
0sg
ml
cs
If
0.7
1.6
4
48-96
1 OYR 6/4
—
s
Osg
ml
—
—
0.7
1.6
Bands
of lamellae in hori
)n4
CST Name (Please Print)
Signatu
Number
654921
Keith Wiley
Address
Dat aluatlon Conducted
Telephone Number
11623 E Larson Dr. Lake Nebagamon, WI 54849
4/27/2025
218-451-2611
* Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 s 150 mglL * Effluent #2 = BOD, S30 mglL and TSS s 30 mg/L
SBD-8330 (R03/22)
ecd X50 io/i25 n�n-
(� (� Page 2 of 3 _
❑ Boring 9 . U 96 87.5
F Boring # ® Pit Ground surface eiev. ft. Depth to Il i I g factor In. I eiev. 87.5
MAY 092025
Sail Aenilcatlan Rate
Horizon
Depth
In.
Dominant Color
Munseil
Redox Description
Qu. Az. Cant. Color
Texture
Stru lure
Gr. Sz. Sh.
Consists ce
Boundary
Roots
GPDIFt2
•Eff#1
`Eff#2
1
0-13
7.5YR 2.5/1
--
Is
Osg
ml
cs
lcollml2
0.7
1.6
2
13-16
7.5YR 4/4
—
s
0sg
ml
cs
Im/1f
0.7
1.6
3
16-55
7.5YR 4/6
—
s
0sg
ml
cw
2f
0.7
1.6
4
55-96
10YR 6/4
—
$
0sg
ml
—
1f
0.7
1.6
Bandt
of lamellae In hori
n 4
aBoring #
❑ Boring
❑ Pit Ground surface eiev. ft. Depth to limiting factor in. / elev. ft.
Sall Annitcation Rate
Horizon
Depth
In.
Dominant Color
Munseil
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
*Eff#1
•Eff#2
F1 Boring #
❑ Boring
❑ Pit Ground surface eiev. ft. Depth to limiting factor in. / eiev. ft.
I Snil Anniiratinn Rata
Horizon
Depth
In.
Dominant Color
Munseil
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPDIFt2
•Eff#1
*Eff#2
Effluent #1 a BOD > 30 s 220 mg/L and TSS > 30:9 150 mg/L • Effluent#2 = BOD, s 30 mg/L and TSS s 30 mg/L
Morse (3 bedroom)
Soil Report Plot Plan
North
Middle Eau Cairo Lake
Septic tank & dralnfleld to be
abandoned per SPS 383.33
Wetland
I
e0
cabin
I
Scale 1:50
4
It Bench Mark = Duplex nail w/ orange disc in 14" DBH pine
• Elev = 100.0'
cabin
Benjamin Morse etal
2150 South Shore Rd
LOT 1 OF CSM #000770 V.5 P.192
S20144N R09W
Town of Barnes
04-004-2-44-09-20-2 05-004-14000
9.120 acres
I To be connected to separate septic system I
NOTES:
CST 119909002 -SP
- Property lines not shown > 50' from tested area
- Middle Eau Claire elev n 86'
Page 3 of 3
Benjamin Morse etal
BAYFIELD COUNTY
CHECKLIST FOR CERTIFIED SOIL TESTS
Submit the, Following (Use Permanent Ink):
i�' Check List
O Index Page / Title Sheet (Optional)
5' Original Soil Evaluation Report (Submitted in Deed Holders Name — got prospective buyers) �o
' Original Plot Plan ID f( EII U M O Cross Section Soil Profile Sheet (optional) 1111 MAY 0 9 202`i
O Aaditional Information (Warranty/Quit Claim Deed) (Optional)
Bayfield Co. Zoning Dept
Soil Evaluation Report: (Include the following Information)
l' Parcel Identification Number (must be 23 digit Tax ID#) Do NOT USE 12 digit, they are no longer being used
E'Property, Owner's Information (mit prospective buyer's name)
I' Property Location (Accurate Legal Description with SectTwp/Range)
GI Road Name (where driveway Is/will be coming off of)
i 'Fioodplain Elevation, Flow Rate, Comments and Recommendations
I 'Complete Soil Boring / Pit Information
1' Date Soil Evaluation was conducted
['CST Name, Signature, Number, Address and Phone Number
6�' *Date Stamp*
Plot 1 n: (Include the*following information drawn to dimension or to scale)
[ 'Bench Mark (Description, Elevation and Location)
E 'Contour Lines (Example = 98.0' /96.0' /94.0')
('Property Location (Sec/Twp/Range/, Accurate Legal Description)
EZ Borings (Locations and Elevations)
['Percent and Direction of Land Slope
EZ Well Location (Including Neighboring Wells, if applicable)
EZ Location of Wetland Areas, Floodplain and Navigable Waters
i' Buildings, Driveways, and Structures (Location and Descriptions)
('Lccatlon of Property Lines
Q' Existing System Location
i�'Address Number and Road Name
' Current Surface Elevation of Wetlands and Navigable Waters
ii' CST, Owner and Property Information
l 'North Arrow
Fee:
R1 Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checId st/checidistforcsts
i Morse etal
Property Owners Name
th Shore Rd
Property Address
20-2 05-004-14000
Tax Parcel Number
yfield
County
X000770 V.5 P.192
Legal Description
20
Section
44
Town
9
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 Designer's Name
>1-C--- Designer's Signature II
D2388PSS - Designer's License Number
218-451-2611 Designer's Phone Number D
4/29/25 Date D
MAY 2 8
B oNS/N°-,, Bayfeld on
Co. Z
KEITH WILEY " Dept.
ESKO II
D 2388 PSS __
NIINNE 0TA
IT
Page 1 of 7
Page 2 of 7
North
Middle Eau Claire Lake
Wieser W1000 -MR w/ polylok 525 filter
in place of old tank
Wetland
Scale 1:50
ell
cabin
Morse (3 bedroom)
Gravity In -Ground Septic System
NOTES:
It Bench Mark = Duplex nail w/ orange disc in 14" DBH pine
Elev = 100.0'
non
0
c4
ctD
>--
Benjamin Morse etal
2150 South Shore Rd
LOT 1 OF CSM #000770 V.5 P.192
520 T44N R09W
Town of Barnes
04-004-2-44-09-20-2 05-004-14000
9.120 acres
I To be connected to seperate septic system I
- Property lines not shown > 50' from system area
- Middle Eau Claire elev z 86'
Page 3 of 7
Cross Section of a Two Cell In Ground Component
Using Leaching Chambers
Observation/Vent Pipes
97.00 Finished Grade --------_— — -- " Finished Grade._ 96.00
Slope 15°/a Cej operation /
t,.
97.00 Original Grade_ _ ,X[ i' > 3 rg i final Grade 96.00
95.00 Top of Chamber '\ , ` e ; Top of Chamber 94.00
Y �
94.00 system Elevation i. System Elevation 93.00
! �• •i. Treatrnentpnd Dispersal zone. -
-- - - - Limiting Factor
Observation/Vent pipes to be constucted and capped with approved materials for the particular use.
67 feet
rn
3 feet between cells
IE 67 feet
Observation / Vent Pipes to be located at the ends of the distribution cells.
MAY 212025 D
BaYfeld Co. Z
ning Dept.
Page 4 of 7
4" CAST -
In
a
ITANKS ARE
WLP1 000
0 TANK SPECIFICATIONS
mn
1ENSIONS:
o
+a WALL: 2 1/2"
CAST -A -SEAL o
N
BOTTOM: 3"
Co
o COVER: 5"
N
N
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
>
a HEIGHT: 53 1/4"
LENGTH: 8'-8"
7'-2"
mWIDTH:
BELOW INLET: 42"
_
*0
OUTLET
I
1
IU
D t
tN
I M a I as M
2} "
4 � -
PUMP PAD
SIDE VIEW
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)
n
W
u"i
m
a
o
o
o
�
o
o
o
0
w
1.1.1
LIQUID CAPACITY: 27.83 GAL/IN
HOLDING TANK:
3 in
OUTLET HOLE PLUGGED
ACTUAL CAPACITY: 1,085 GALLONS
o
`n
LOADING DESIGN: 8'-0" UNSATURATED SOIL
a
I,Nj
TANK CAN BE USED AS:
W S
SEPTIC / HOLDING / PUMP OR SIPHON
C ro
W
COVER: MIX DESIGN #8 (NO FIBER)
TANK: MIX DESIGN 110 (STRUCTURAL FIBER)
R
CUSTOMIZED TANKS:
FOR CUSTOM TANKS CONTACT WIESER CONCRETE
Q
O
D
O<
O
IL
m
REVIEWED BY
REVIEW DATE
F
w
In
DRAWINGS SUBMITTED
FOR APPROVAL
APPROVED BY:
SHEET NO.
APPROVAL DATE:
1
7"
PRODUCTS NEEDED BY:
/
OF
)
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 6 of 7
FILE INFORMATION
Owner Benjamin Morse etal
Permit #
DESIGN PARAMETERS
Number of Bedrooms
3
O NA
Number of Public Facility Units
® NA
Estimated (average) flow
300 gal/day
Design (peak) flow = (Estimated x 1.5)
450 gal/da
y
In Situ Soil Application Rate
0.7 gal/da /ft2
Standard Influent/Effluent Quality
Monthly average'
Fats, Oil & Grease (FOG)
≤30 mg/L
Biochemical Oxygen Demand (BOD5)
≤220 mg/L
O NA
Total Suspended Solids (TSS)
≤150 mg/L
Pretreated Effluent Quality
Monthly average
Biochemical Oxygen Demand (BOD5)
≤30 mg/L
Total Suspended Solids (TSS)
≤30 mg/L
❑ NA
Fecal Coliform (geometric mean)
≤10° cfu/10oml
Maximum Effluent Particle Size
,6 in dia.
O NA
Other:
® 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:
3 ❑ month(s) ears (Maximum 3 years) O NA
®
Pump out contents of tank(s)
® When combined sludge and scum equals one-third ('f4) of tank volume
O NA
O When the high water
alarm is activated
Inspect dispersal cell(s)
At least once every:
3 ❑ month(s) year(s) (Maximum 3 years) O NA
®
Clean effluent filter
At least once every:
3 ❑ mont
® year
)
�ju
c
jd
E
Ilp
U
❑ NA
Inspect pump, pump controls & alarm
At least once every:
❑ mont
❑ yearjpl
)
MAY 28 ZU?5
® NA
Flush laterals and pressure test
At least once every:
❑ mont ( )
❑ year(s
NA
Other:
At least once every:
❑ month y le o. onin
O year(s)
® NA
Other:
® NA
SYSTEM SPECIFICATIONS
Tank Manufacturer Wieser
❑ NA
® Septic O Dose O Holding
vol. 1000
gal
Tank Manufacturer
® NA
❑ Septic O Dose O Holding
vol.
gal
Effluent Filter Manufacturer
Polylok
O NA
Effluent Filter Model
525
Pump Manufacturer
® NA
Pump Model
Pretreatment Unit
® NA
❑ Sand/Gravel Filter
O Peat Filter
❑ Mechanical Aeration
O Wetland
O Disinfection
O Other:
Manufacturer
Dispersal Cell(s)
O NA
® In -Ground (gravity)
O In -Ground (pressurized)
❑ At -Grade
O Mound
❑ Drip -Line
O Other:
Other:
® NA
Other:
® 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 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 ('f6) 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 7 of 7
'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 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:
O 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.
f' 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 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 NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATFJ A?e[ U.TB $*SFU*F A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. IL)) Lb U lb uu III
ADDITIONAL
POWTS INSTALLER POWTS MAINTAINER
Name e POSY f Name /I-i<-- S t77e-
Phone /„f - 7/-,f' ,Z 9Z -L Phone 7jS' 79g 3
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name 4j� s.c-Pr/c Name Bayfleld County Zoning
Phone `,%6" 9¢ 3 '/7 y I 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.
Private Sewage System Maintenance Agreement
Owner(s) Name
w-lr (�/�
l I -no' \ L fJ ud t.tk \ 1
Owner(s) Mailing Address
78 (Aria(-
,2Aaoress
l
As owner, I (we) CO nereby ceruty the private sewage system will be Installed in
accordance with the certified soil tester's report and approved plans and specifications
on file with Bayfleld 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)
S W 1/4 of IV dU 1/4 Section a O Township 'Vt' N. Range 9 W
Additional Legal Description:
Town of Lilbe kviss (Acreage) q, 12 Gov't Lot
Lot-=Bfoak - Subdivision
bat, CSM #�o 'ol.SL Page 1"a CSM
ENTERED
%- I Ov?J
DOCUMENT NUMBER
2025R-607763
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY. WI
RECORDED
06/O9/2O25 AT 8:00 AM
RECORDING FEE: $30.00
PAGES: 1
Area
Retum To: - C
Planning and Zo �� . g Dep n
JUN '1 0 2025
"'��� In-group cavity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System:
❑l Mound ❑ At -grade Sewage System ❑ Other
Septic Tank (system types A through E): The septic tank shell 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 (113) of the volume occupied by sludge and scum.
Pump Chamber (system types B, C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided
above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components.
Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be Inspected and maintained as necessary and in accordance
with manufacturer's specifications. Fitter 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 whetherwastewater or effluent from the system is ponding on the ground surface.
Mounds, At-orade, and In -ground Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when
the wastewater distribution cell component is inspected as provided above.
Owner(s) agree that failure to comply with this agreement will -result in action being taken to pay all charges and costs incurred by Bayfleld County for
inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any
human health hazard caused by the system. Bayfleld 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 ,.
maybe placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law.
The terms and conditions of the variance shall be binding upon and inure to the benefit of all current and future owners of such property.
Owner(s) Name(s) me — Please Print ntt� �, p
I J 1 \cLe.O Q
Subscribbeec and swo to before me on th
s/ /ZO
ELLI HOU
M ,[�1 �y cOt+
2-y Zs-
Notary Public
State of Wisconsin
rized Ovmer s) — Signature(s)
/
Notary Public
A
My Commissf ire.
D-7 Il ZbZ
Drafted by: /WA2T Ptt4r Date: —5L2 3'
Proofed by.
u/rormstsanitary/septicmalntenceagreement
Revised June 2018
Benjamin Morse etal
BAYFIELD COUNTY
CHECKLIST FOR SANITARY APPLICATONS
Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e))
19 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
❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable)
0 Contingency Plan / Management Plan (383.22-3(2)(b)1.f.)
0 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)
0 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7)
0 2 ComDlete Sets of Plans (383.22(2)(2.) (Note: Sanitary AODlication and Maintenance Agreements are to be attached
to all copies)
IZ Soil and Site Evaluation Report (383.22-3(2)(b)1.e.)
O State Plan Review (when applicable)
❑ Copy of Warranty/Quit Claim Deed (Optional)
Sanitary Aoolication: (Include the following Information)
0 I Application Information must include: O 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete)
0 Project Address or Road Name where driveway is/will come off of) IZ (Owners Phone Number)
O II Type of Building
9 III Type of Permit
ffi IV Type of POWTS System
0 V Dispersal / Treatment Area Information
0 VI Tank Information
O VII Responsibility Statement (Plumber's Information)
9 *Date Stamp*
Plot Plan: (To Scale or To Dimension)
O Signature and Plumber Information
O Surface Elevation of Body of Water
0 Direction and Percent Land Slope
0 Tank and Filter Information and Location
0 Wetlands / Navigable Bodies of Water
0 Absorption Area (Proposed and Existing)
0 Bench Mark (Location, Elevation and Description)
❑ Component Manual Version
EA9milFF
�IJ MAY 2.8 2025
0 Address Number and Road
O North Arrow
O Contour Lines
0 Structures and Driveways
O Boring Locations
0 Property Lines
® Well Locations
* Legal Descriptions
Mayfield Co. Zoning Dept.
V Piping Material Information (conveyance line, building sewer line, material type and diameter)
Turn Over ►
B A-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: Submission Number:
MORSE, BENJAMIN SS -00549
4177 GOTHENBERG RD
DULUTH, MN 55803 Transaction Number:
MORSE,DANIELL SS-00549-2D99E
4177 GOTHENBERG RD
DULUTH, MN 55803
MCLEOD,TIMOTHY L & JUDITH L
38 ALDER LN
ESKO, MN 55733
Description Amount
Private Sewage System (Septic Tanks) $400.00
Total: $400.00
Payment Amount: $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)-25-52S
STATE SANITARY PERMIT
OWNER: BENJAMIN MORSE ET AL
GOVT LOT: 4 LOT: 1 BLK:
CSM: 000770V.5 P.192
1/4 1/4 SEC: 20, T 44 N, R 9 W
TOWNSHIP: Barnes
SOIL TEST: 31-25
REPLACEMENT SYSTEM
SYSTEM TYPE: Non -Pressurized In -Ground
PLUMBER: JAMES CLEMENTS
TRACY POOLER DATE: 6/13/2025
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: # 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
u r' '
Timothy L. & Judith L. Mcleod etal
BAYFIELD COUNTY
CHECKLIST FOR CERTIFIED SOIL TESTS D E a t E
Submit the Followin4 (Use Permanent Ink): tIll JUN 0 42025
9 Check List Beyfleld Co. Zoning Dept.
O Index Page / Title Sheet (Optional)
&d' Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers)
6 ' Original Plot Plan
O Cross Section Soil Profile Sheet (optional)
O Additional Information (Warranty/Quit Claim Deed) (Optional)
Soil Evaluation Reaort (Include the following Information)
�' Parcel Identification Number (must be 23 dial Tax ID#) DO NOT USE 12 digit, they are no longer being used
VProperjr Owner's Information (nQt prospective buyer's name)
(1 Property Location (Accurate Legal Description with Ser./Twp/Range)
Q' Road Name (where driveway is/will be coming off of)
E? Floodplain Elevation, Flow Rate, Comments and Recommendations
L' Complete Soil Boring / Pit Information
E7 Date Soil Evaluation was conducted
11 CST Name, Signature, Number, Address and Phone Number
6' *Date Stamp*
PlotPlan: (Include the following information drawn to dimension or to scale)
('Bench Mark (Description, Elevation and Location)
E'Contour Unes (Example = 98.0' /96.0' /94.0')
I�YProperty Location (Sec/Twp/Range/, Accurate Legal Description)
6d' Borings (Locations and Elevations)
Q'Percent and Direction of Land Slope
j Well Location (Including Neighboring Wells, if applicable)
51 Location of Wetland Areas, Floodplain and Navigable Waters
V Buildings, Driveways, and Structures (Location and Descriptions)
Q' Location of Property Lines
i1 Existing System Location
i'Address Number and Road Name
�' Current Surface Elevation of Wetlands and Navigable Waters
Q' CST, Owner and Property Information
Q' North Arrow
Fee:
61 Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checkiist/checkiistforests