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HomeMy WebLinkAbout25-64SRequest for Sanitary Inspection (24 Hrs. in Advance) Fax this form to Zoning Dept (24 Hrs.) prior to when you want an inspection — (715) 373-0114 If you do not have a fax and must email the inspection; you must email all staff members. Note Time Change fl Discrepancy Other Phone Number 715-413-0122 Plumber: Superior Plumbing & Mech. Inc. Fax Number Craig Kelm Email Address Homeowner: ed@superiorpmw.com Sanitary �� Immediate Phone Number So Zoning Dept can call you right back (if needed) Permit #: Plumber's Choice Zoning Dept 07/10/2025 No Inspection(s) during this time Date: (Eat) Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice Dept Time: 2:00 PM q Township: Lincoln Address # & 26725 Marengo River Rd Road Name: Mason, WI 54856 or Directions To Site: Comments: Septic Tank I j I� aag8� ** Plumbers you must verify any change(s) by fax or email "* J Notes from Zoning Dept: \ 4 Gil Wfonns/sanitary/requestfonnspection ®June 2023 Zoning Dept (®4/12104); 1 Industry Services Division General Information CRAIG H KELM PO BOX 233 SO ST PAUL MN 55075 ' e Private Ons.ite Wastewater Treatment Systems ( POWTS) Inspection Report (Attach to Permit) City Tank Information setback to: TYPE MANUFACTURER I CAPACITY Prop. Line Well Building Air Intake Road septic l4g 52 7p /0O AC N/A Dosing N/A Aeration N/A Holdin • Pump I Siphon Information Pump Manufacturer Pump Model Demand Filter Manufacturer Filter Model GPM TDH Lift Friction Loss Head Total Forcemain Length Dia Dist To Well Dispersal Cell Information DIMENSIONS Width Length # of Cells SETBACK FROM Prop. Line Building Well OHWM d0 32 P4 4O Town of. Countyj, , Sanitary !1tN0 State Plan'Transactlon ID#: Parcel Tax No: Type of Cell Manufacturer: &1R Model Number: Pretreatment Unit Manufacturer: Model Number: Dia I Lenoth Dia Elevation Data STATION BS HI FS ELEV Benchmark g x t Bldg. Sewer 13 99/ 7z Tanklnlet Tank Outlet 6. (9/ 6, o Dose Tank Inlet Dose Tank Bottom Inst. Contour Header / Manifold Distribution Pipe Infiltrative Surface 7 3 iS Final Grade '(,o X Pressure Systems Only X Hole Size X Hole Spacing Observation Pipes ❑ Yes ❑ No ❑ Yes ❑ No i ❑ Yes ❑ No 3OMMENTS: (Include code discrepancies, persons present, etc.) !an revision required? Yes 6 No O teother side for addition linformation. / 7 Date POWTS Inspectors Signature License Number zi;mr7in iR nA/9ii Ii Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoninp(a�bavfieldcounty.oro Web Site: www.bavfieldcountv.ora/147 CRAIG H KELM PO BOX 233 SO ST PAUL MN 55075 Bayfield County CourthouW Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know��G/•� �tc s was contracted by you to install a private onsite wastewatertreatment system on your property (Tax ID# above). To know when your system will be due for servicing please go to www.septicsearch.com Notes: Abandonment of Old System to meet all applicable code requirements: • Tank was pumped by: Tank was crushed / removed and pipes disconnected by: on at AM / PM On G 23 at 2 (AM / tie above -mentioned plumber contacted our office to conduct a pre -cover inspection as required under DSPS 383. One of the following applies: System was inspected and appears to meet all applicable code requirements. 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/farms/sanitarypropertyowner-input April 2018 S —d U5 `t Rid Industry Services Division County 4822 Madison Yards Way Ba�eld " $ '� WI 53705 Sanitary Permit Number (to be filled in by Co.) _ A. Madison, p$ P.O. '� P.O. Box 7302 Madison, WI 53707 (p H $ 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 Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary 26725 Marengo Lake Rd. Mason purposes in accordance with the Privacy Law. s. 15.04(l)(m). Stats. T_ Annliratinn Tnfnrmntinn — Planca Print All TnfnrmnHnn Property Owner's Name Craig Kelm Property Owner's Mailing Address 2426 Sough Shore BIv. D ?C 2.33 City, State Zip Code Phone Number White -Bear -Lake, MN 551101651-226-7907 II. Type of Building (check all that apply) Lot # JJ1 or 2 Family Dwelling — Number ofBedrooms 2 Opublic/Commercial Block # — Describe Use State Owned — T'.4k. U Parcel # 22984 Property Location Govt. Lot NW y,. NW %. Section 28 T45 N R 5 E or W Subdivision Name of r se CSM NumberVillage of E✓ Town of Lincoln 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 if a livable. A. ✓{]New System replacement System aother Modification to Existing System (explain) Additional Pretreatment Unit (explain) PIndividual ❑Holding Tank aIn-Ground [JAt-Grade Mound Site Design Other Type (explain) (conventional) C. ❑ Renewal Before DRevisiou JChange of Plumber Transfer to New Owner ist Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 300 .7 428 492 98' Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units B o g g a cn New Tanta Existing Tanks U iII ii C7 0, Septic or Holding Tank X 750 1 Wieser Concrete ✓ Dosing Chamber (� V. Responsibility Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans, Plumber's Name (Print) I Plumber's SignatureI MP/MPRS Number Business Phone Number Edward B. Redinger 1221939 715-292-6670 Plumber's Address (Street, City. State, Zip Code) 1015 11th Ave. E. Ashland, WI 54806 ,Approved O Disapproved Permit Fee Date Issued Issuing t Si hue O Owner Given Reason for Denial '1 I/.25≥ Conditions of Approval/Reasons for Disapproval i,�l� JUN 202075 Bayiiek Co. Zoning Dept. e►uucu wo compute plans sor inn sysaem nun suomir to We county ou iy on paper not less than a in x 11 inches in size SBD-6398 (R. 02/22) PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross -Section & Plan View Pg 4 of 4 Management Plan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description 2 Bed Home .7 laoding Owner Name(s): Craig Kelm Owner Address: 2426 South Shore BIv. White Bear Lake, MN Phone:651 -226 -7907 Zip: 55110 Project Address: 26725 Marengo River Rd. Mason, WI Govt. Lot: NW 0114 of NW 01 /4, Section 28 , T45 N -R 5 E ❑ or W Z✓ Township: Lincoln County: Bayfield Project Parcel ID #: 22984 Designer Information Designer Name: Edward B. Redinger Designer Address: 1015 11th Ave. E Ashland, WI E-mail: ed@superiorpmw.com License Number: 221939 Remarks: Phone:715 -292 Zip: 54806 -6670 This space reserved for approval stamp. ,L.►`Z 0 ?025 (. 2.ortflg Dept. Signature: Date: 6/20/25 Original signature required on each sub fitted copy. SUPERIOR PLUMBING MECHANICAL (715) 278-3456 Customer Name: Craig H Kelm Adress: 2426 South Shore Rd White Bear Lake, MN 55110 SITE: 26725 Marengo Rvr Rd. WI Phone #: 651-226-7907 Email: kelmoroo@yahoo.com CST# 221939 I NO WELL Scale: 1" =40' y6 I PIN: 22984 8 ACRES NW NW 528 T45N R5W TOWN OF LINCOLN Bayfield Co. 4 ,v I e.S A' llti JUG 202025 Ba held Ch _7mind Deel IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers z c c 3 -ft Trench (down -sizing credit) f;Eflu1 SOIL COVER T11 . 1 ira 12' min. trench depth (typical) F!\':;i 34: (typical) .•. System Elevation = 98 (typical) OVU Quick4 Standard -W w/ End Cap (typil) (Show location of inlet / outlet pipe connection on plan view.) �•ca (---------------------f----- Septic Tank(s) Manufacturer Wieser Concrete Septic Tank(s) Volume(s): 750 gal gal gal gal Effluent Filter Manufacturer. Poly Lock Effluent Filter Model #: 525 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) ft INSTALL PER TRENCH: g= 48 ft (typical) 12 Quick4 Std -W @ 20 ff EISA/chamber = 240 ft' + 1 Pairs of end caps @6 ft2 EISA/pair = 6 ft2 Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturers / Instructions. TYPICAL TRENCH PLAN VIEW (No Scale) IA = 3.0 ft (typical) '—Quick4 Standard -W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers Instructions. = Proposed EISA per trench = 246 ft2 Required Infiltration Area = 428 ft' x 2 trenches = Proposed Total EISA = 492 ft2 D (7 m w O m a Distribution Method: distribution box El PAGE 4 OF 4 In -ground Gravity Management Plan IMPORTANT: The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 300 gpd; BOD5 5 220 mgL'1; TSS 5150 mgL''; FOGS 30 mgL'' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (/.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Superior Plumbing & Mech. Inc. Phone: 175-292-6670 Local government unit: Bayfield Co Zoning Phone: Local government unit address: 117 5th St. E. Washburn, WI 715-373-6138 ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by �he,pdeR,artm n , n accordance with SPS 384, Wisc. Admin. Code. i , • j ii Yj kjj Contingency Plan ,)UN U 2025 In the event that any failed treatment component of this POWTS cannot be repaired, it shall be a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal c mponen maybe abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. cii rct C 1N ¶hrt c C Cr N N CJ A 1:1 6.5" (16.51 cm) SEALED BALL MATERIAL - HDPE POLYLOK PL- 525 - 625 CUTAWAY 33.02 [83.9 cm] 20.71 [52.6 cm] (10.16 cm) BALL HOUSING TRAVEL FILTER CARTRIDGE J - r MATERIAL - POLYPROPYLENE I-- 5.7 [14.7 cm] MATERIAL - FILLED POLYPROPYLENE BALL PUSH ROD ILl FACTORY INSTALLED SECTION A -A MATERIAL - FILLED POLYPROPYLENE 4" AND 6" FACTORY OPTIONAL BUSHING INTALLED PIPE OUTLET (FOR 4" THIN WALL PIPE) MATERIAL - PVC PART NO. 30142-R OR OPTIONAL FLOAT SWITCH (FOR 110 MM. PIPE) PART NO. 30142-EUR a a WLP 750- M R TANK SPECIFICATIONS a CD v •' 2j" - M U Q 4" CAST -A -SEAL OPTIONAL FLAT COVER IS AVAILABLE FOR EXCHANGE FOR DOME COVER. OUTL______ ET OT - PUMP PAD LTA.NKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS CNti�I p .ti DIMENSIONS: a a WALL: 21/2N Q I - BOTTOM: 3" COVER: 4" 0. a MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: DOME COVER 61" O.D. FLAT COVER 53 1/4" O.D. .° OUTSIDE DIAMETER: 84" O.D. BELOW INLET: 42" O.D. LIQUID LEVEL: 37" WEIGHT: 6,150 LBS. INLET AND OUTLET: 4" CAST -A --SEAL BOOT OR EQUAL 2 N GASKET, CAST -A -SEAL BOOT OR EQUAL 2 >- INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN. SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 20.28 GAL/IN c a c W n HOLDING TANK: ACTUAL CAPACITY: 790 GALLONS OUTLET HOLE PLUGGED I tn LOADING DESIGN: 8' 0" UNSATURATED SOIL MN TANKS: WILL HAVE ONE VENT OVER OUTLET © '* AND WILL HAVE TWO VENTS IN COVER OVER INLET j L TANK CAN BE USED AS: ____ 0 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 JOB INFORMATION: CUSTOMER: JOB NAME: DATE NEEDED: APPROVED BY: APPROVAL DATE• 0 0 N 0 C U ac,, W Si SHEET NO. 17 1 (Parcel Identification Number) A 'parcel of land located in the Northwest Quarter of the Northwest Quarter (NW3( NW%) and the Southwest Quarter of the Northwest Quarter (SW3( NW() of Section Twenty-eight (28), Township Forty-five (45) North, Range Five (5) West, in the Town of Lincoln, Bayfield County, Wisconsin, described.as follows: To locate the point of beginning, commence at the N3( corner of said Section 28, and run N. 87° 27' 21" W., 1664.96 feet along the north line of said Section 28 to a 1W' iron pipe, which is the point of beginning. Thence from said point of beginning by metes and bounds: 3 4 Continue N. 87° 27" 21" W., 330.00 feet along said north line, to a 13(" iron pipe; Thence S. 02° 32' 39" W., 1230.50 feet, parallel with the west line of said Section 28, tb a 13(" iron pipe near the water's edge of the Marengo• • River; Thence along a meander line near said water's edge, N. 60°04' 44" E., 391.13 feet, to a 13(" iron pipe; Thence leaving said, meander line, N. 02° 32' 39" E., 1020.55 feet, parallel with the west line of said Section 28, to the point of beginning. Intending to include that land lying between the meander line and the water's edge of the Marengo River and the east and west lot lines extended to said water's edge. (Known as Lot 10 on survey map by NelsonSurveying and Engineering, Inc.) JUN 2 3'1025 Bayfielci Co. Zoning Dept. *4 (f)iy)c v►r"T Y Wisconsin Department of Safety and Professional Services Division of Indust Services • SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code 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, scale or dimensions, north arrow, and location and distance to nearest road. Please print alt Information. Personal information you provide may be used for s"- Property Owner Craig H Kelm Property Owner's Mailing Address 2426 South Shore BIv City State Zip Code White Bear Lake IMN 155110 MAY , r_; ZU24 Page � of 3 Parcel I.D. Reviewed by ry purposes (Privacy Law, S. 15.04(1)(m)). Property Location Govt. Lot NW r4 NW %s28 Site Address or CSM and Lot #: 26725 Marengo River Rd. Phone Number O City ❑ village ❑■ Town ( ) Lincoln Date 15--68- T45 N R 5 E (or) W Nearest Road Marengo River Rd ❑■ New Construction■ Code derived designfiow rate GPD Use: ❑ Residential/Numberofbedrooms 2 ❑Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material Sandy Alluvium General comments and recommendations: Conventional Trench system as shallow as possible .7 loading @ / starting at 98` a Boring # ❑Boring 99.55 ■Pit Ground surface elev. ft, 92.5 ❑ Depth to limiting factor � in. / eiev. ft. Boring # ❑Boring 100.25 84 []Pit Ground surface elev.ft, 93.25 Depth to limiting factor In. / etev.�it. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture I Structure Gr. Sz. Sh. 1 0-3 5yr 4/2 - sl 2mabk 2 3-36 5yr 5/6 - Is 0sg 3 36-84 5yr 5/3 - ms 0sg as CST Name (Please Print) SI nature Edward B. Redinger Address Date Evaluation Conducted 101511th Ave. E. Ashland, WI 54806 I 5/15/24 * Effluent #1 = BOD > 30:5 220 mg/L and TSS > 30 5150 mg/L Soil Application Rate Consistence Boundary Roots GPD/Ft2 *Eff#1 'Etf#2 ml cw 3co .6 1.0 ml gw 3co .7 1.6 ml - - .7 1.6 CST Number �.. 221939 Telephone Number 715-292-6670 * Effluent #2 = BOD, 5 30 mg/L and TSS S 30 mg/L SBD-8330 (R04121) OA (4!5L 671) ,J,I Boring # Paget of3 ❑ Boring 99.85 R ® Pit Ground surface eiev. ft. ;A?ejthi�ii�g factor"' in. I elev. 92�8�ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIFt2 *Eff#1 *Eff#2 1 0-6 5yr 417 sl 2mabk ml cw 3co .6 1.0 2 6-60 5yr 5/6 - Is Osg ml cw 2m .7 1.6 3 60-84 5yr 4/2 - co S Osg ml - - .7 1.6 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. I eiev. ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots I 1 Boring # Soil Application Rate GPD/Ft2 *Eff#1 I*Eff#2 ❑ Boring ❑ 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 Soil Application Rate Roots GPDIFt2 *E *E * Effluent #1 = BOO>30 30 s 220 mglL and TSS > 30 s 150 mglL * Effluent #2 = BOO, s 30 mg/L and TSS s 30 mg/L SUPERIOR PLUMBING MECHANICAL (715) 278.3456 CST# 221939 L� Scale: 1"=40' L PIN: 22984 8 ACRES NW NW 528 T45N R5W TOWN OF LINCOLN Bayfield Co. A 4.A?, =,ea' jLsesE ,6/u. Cors./ i-ian, / Sys • i ,. /+t 11 S1.J/4 as Customer Name: Craig H Kelm Adress: 2426 South Shore Rd White Bear Lake, MN 55110 SITE: 26725 Marengo Rvr Rd. WI Phone #: 651-226-7907 Email: kelmprop@yahoo.com NO WELL 9 4/ foa aSI 6 iQ Tracy Pooler From: Ed Redinger <ed@superiorpmw.com> Sent: Monday, August 4, 2025 12:11 PM To: er Subject: Craig Kelm sed ST Attachments: Revised - Craig Kelm.pdf Here Is the revised ST, I think that was all you needed for this site? Ed Redinger Superior Plumbing & Mech 715-278-3456 ed@superiorpmw.com SUPERIOR PLUMBING MECHANICAL (715) 278-3456 CST# 221939 Scale: 1" =40 `/6' PIN: 22984 8 ACRES NW NW 528 T45N RSW TOWN OF LINCOLN Bayfield Co. lns lr !! ≤L. /laz , as err. Ti Customer Name: Craig H Kelm Adress: 2426 South Shore Rd 1 White Bear Lake. MN 55110 1, SITE: 26725 Marengo Rvr Rd. W1 Phone #: 651-226-7907 Email: kelmoropto?vahoo.com NO WELL lizf • I �.S qq g, M Wisconsin Department of Safety antl Professional Services Pagel of_____ 6 Division oflndustryServices SPg SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include. Sayfield 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. 22984 Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). Property Owner Property Location �✓ Craig H Keim Govt. Lot NW Y. NW r s 28 i45 N RS E (or) W Property Owners Mailing Address Site Address or CSM and Lot #: 2426 South Shore BIv 26725 Marengo River Rd. city State Zip Code Phone Number ❑ City ❑ Village I9 Town Nearest Road White Bear Lake MN 55110 ( ) Lincoln Marengo River Rd New Construction Use: Residential/Numberofbedrooms Z Code derived design0ow rate 300 GPD JReplacement Public or commercial —Describe: Flood Plan elevation if applicable R. Parent material Sandy Alluvium General comments and recommendations: Conventional Trench system as shallow as possible @ .7 loading / UBoring # UBoring 99.55 4 92.5 l!JP1t Ground surface elev._f. Depth to limiting factor in. - in. / elev.ft. Horizon 1 2 Depth In. 0-7 7-60 Dominant Color Munsell 5yr 3/1 5yr 5/6 Redox Description Ou. Az. Cont. Color - - Texture SI Is Structure Cr. Sz. Sh. 2mabk Osg Consistence ml ml Boundary cw cw Roots 3co 3m Doll Application Rate GPO/Ft2 •Eff#1 .6 .7 •EB#2 1.0 1.6 3 60-84 5yr 4/2 - coS 0sg ml - - .7 1.6 2 I Boring # ❑Boring 100.25 84 93.25 ®Pit Ground surface elev.ft. Depth to limiting factorin. / elev.ft Horizon Depth 0-3 3-36 36-84 Dominant Color Munsell 5yr 4/2 5yr 5/6 5yr 5/3 Redox Description Ou. Az. Cont. Color - - - Texture sl Is ms Structure Gr. Sz. Sh.#21 2mabk Osg Osg Consistence ml ml ml MPDIn. Soil Application Rate 02 63 6 CST Name (Please Print) Si nature CST Number Edward B. Redinger 221939 Address 1015 11th Ave. E. Ashland, W 54806 Date Evaluation Conducted j 5/15/24 Telephone Number 715-292-6670 Effluent #1 = SOD' 30 5 220 mg/L and TSS > 30 5150 mg/i. • Effluent #2 = SOD. S 30 mg/L and TSS S 30 mg/L SBD-8330 (R04/21) Page 2 of Boring # [Pit Ground surface eiev. ft. Depth to limiting.in/ elev. 92.85 factor 84 . ft. ❑ Boring 99 Horizon 1 Depth In. 0-6 Dominant Color Munsell Syr 4/7 Redox Description Qu. Az. Cont. Color Texture si I Structure Gr. Sz. Sh. 2m bbk Consistence ml Boundary cw Roots 3co Soil Application Rate GPD/Ft2 'Eff#1 .6 .7 .7 Eff#2 1.0 1.6 1.6 2 6-60 5yr 5/6 - Is 0sg ml cw 2m 3 60-84 5yr 4/2 - co s 0sg ml - - QBoring # ❑ Boring Pit Ground surface elev.______ t Depth to limiting factor_it_in. / eiev. 9Ja7 Horizon Depth Dominant Color Redox Description Texture I Structure Soil Application Rate Consistence Boundary Roots GPD/Ft2 I— In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. a S� 3 'Eff#1 'EffQ -' '6 *6 (Y / J el) /c fii ya - �L -j w 1, d s4 .�, — ii Boring # 0 Boring 0 Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30:S 220 mg/L and TSS > 30 s 150 mg/L • Effluent #2 = BOD. s 30 mg/L and TSS 5 30 mg/L s—dUs Pk 'a' Industry Services Division \�:, �!v� 4822 Madison Yards Way ij 1_'_��; 'I� Madison, WI 53705 VVV i P.O. Box 7302 Madison, WI 53707 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 ourmoses in accordance with the Privacy Law. s. 15.04( Dim). Scats. Craig Kelm Property Owner's Mailing Address 2426 Sough Shore Blv. PO v< 23'3 City. State Zip Code Phone Number White --Bear- Lake, M N 55110 651-226-7907 II. Type of Building (check all that apply) Lot # [at or 2 Family Dwelling - Number ofBedrooms 2 Block N [IP11bhid/Comme1nt1— Describe Use 11 tatanwns,I_n...rihatmo r,J sn t.umoct r wage of ZI'own of Lincoln III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if annlicable.) 05 -(NHS Marengo Lake Rd. Mason 22984 Govt. Lot NW Iv.,NW v., section 28 A5 M U5 4. I�ew System I nReplacement System I Other Modification to Existing System (explain) iDAdditional Pretreatment Unit (explain) n. Holding Tank EIn-Ground l�t-Grade ❑Mound Individual Site Design Other Type (explain) (conventional) C - ❑ Renewal Before Revision hange of Plumber ❑Transfer to New Owner rst Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (sfl I Dispersal Area Proposed (sfl I T6Sysmmevation 300 .7 1428 j492 Capacityin Total N of Manufacturer Tank htfontmton Gallons Gallons UnitsNew Tanks Existing Tanks6 rn ii c "e'" I x I 1750 I 1 I Wieser Concrete ✓ III Ilf—1 I —I II I V. Responsibility St atuineut- I. the nudes signed, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) I Plumber's Signature MP/MPRS Number I Business Phone Number Edward B. Redinger 221939 1715-292-6670 Plumber's Address (Street, City. State, Zip Code) 1015 11th Ave. E. Ashland, WI 54806 ,Approved 0 Disapproved 3cI"»l rev mate usue(l L rsswug r as are b/ ❑ Owner Given Reason for Denial "7 1 25 / Conditions of Approval/Reasons for Disapproval D JUN 2 0 2025 Bayfield Co. Zoning Dept. Allan h to romaine oram fee the seetrm and athmlr to II... carman ena.. ..n .,o.... nn. Isa ran., u u,.e..�.- SBD-6398 (R. 02/22) • an �'-' Wisconsin Department of Safetyand ProfessionelServices Division of Industry Services SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code 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 @M), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. MAY 1.2024 ?age of3 I.D. Reviewed by Date Property Owner Property Location O a Craig H Kelm Govt. Lot NW i NW i. s 28 T 45 N R 5 E (or) W Property Owner's MaIling Address Site Address or CSM and Lot #: 2426 South Shore Blv 26725 Marengo River Rd. City State Zip Code Phone Number ❑ City ❑ Village 0 Town Nearest Road White Bear Lake MN 55110 ( ) Lincoln Marengo River Rd ---. ..--•-�...`.......,u_v. `auruo'r's c Code derived designflow rate 300 GPD C] Replacement Public or commercial -Describe: Flood Plan elevation If applicable ft. Parent material Sandy Alluvium General comments and recommendations: Conventional Trench system as shallow as possible @ .7 loading / starting at U Boring Ljuonng 99.55 92.5 aPit Ground surface elev. It, Depth to limiting factor 4 in.! elev. R. Horizon Depth 0-7 7-60 60-84 Dominant Color Munsell 5yr 3/1 5yr 5/6 5yr 4/2 Redox Description Qu. Az. Cont. Color - - - Texture sl Is cos I Structure Gr. Sz. Sh.1 2mabk Osg 0sg Consistence ml ml ml Boundary cw cw - RootsIn. 3co2 3m3 - eSollAnffR 2 florin Boring # ❑ 9 100.25 R4 A A 93.25 ---- -- --- -•-•• uepm to ummng factor in. / elev. ft. Nlynant Color unsell r4/2 r 5/6Is r 5/3 Redox Description Qu. Az. Cont Color - Texture sl ms Structure Gr. Sz. Sh. 2mabk Osg Osg Consistence ml ml ml Boundary cw gw - Roots 3co 3co - Soil Application Rate GPD/Ftz 'Eff#'1 .61.0 .7 .7 'Efl#2 1.6 1.6 CST Name (Please Print) / Si nature CST Number Edward B. Redinger �/ 221939 Address Date Evaluation Conducted Telephone Number 101511th Ave. E. Ashland, Wi 54806 5/15/24 715-292-6670 ` Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 s 150 mg/L Effluent #2 = BOD, s 30 mg/L and TSS s 30 mg/L nn SBD-8330 (R04121) IVc 4c6o _5-aU Aiol1 • j,,. .. J Page2 of!.L Boring 99.85 gtp92.85 3 Boring# Pit Ground surface elev. ft. MA�LQ[Qg factdr84 in. / elev.ft. 1_. — I Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Cr. Sz. Sh. Consistence - Boundary Roots aun r+ppncauon Kate GPD/Ft2 'Eff#1 'EfF#2 1 0-6 5yr4/7 sl 2mabk ml cw 3co .6 1.0 2 6-60 5yr 5/6 - Is 0sg ml cw 2m .7 1.6 3 60-84 5yr4/2 - cos Osg ml - - .7 1.6 y�y gss. ❑ Boring # ❑ Boring ❑ 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 Cr. Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 •Eff#1 •Etr#2 ❑ Boring # ❑ Boring ❑ 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 Cr. Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 Etf#1 •Ef#2 •Effluent#1=BOD> 305220 mglL and TSS > 305150 mg/L " Effuent#2= BOD, s30 mg/Land TSS 530mg/L SUPERIOR PLUMBING MECHANICAL (715)278-3456 CST# 221939 Scale:1"=40' LI PIN: 22984 8 ACRES NW NW 528 T45N R5W TOWN OF LINCOLN Bayfield Co. Customer Name: Craig H Kelm Adress: 2426 South Shore Rd White Bear Lake, MN 55110 SITE: 26725 Marengo Rvr Rd. WI Phone #: 651-226-7907 Email: kelmpropPyahoo.com NO WELL 4ZM /Oa' 44tdF E/e, 4c_. -r Sy SI cn- ✓// i 5 /1 ≤i-0 J1a as rb(zr roa• I /\ acv K Y t:. r d x r' T 1 kilt' } '� ��� + ��} F' 'i� i �. :.:t% t*'4j Y q'"L' ♦y _ ` si' it ,fix f <} �4 t * a i \ fl� �t t akf:Z '�'y 4 Vin. ✓-�' _tC=) t " J`, , 'a * s tl. .may as :.�f )c[* e " __ r.] rk. �" .. r � '�r nidwY:y 1{i fi .C ��7 �r}' �'q �`� �q �rl`l,w � ��,-� w" ""c 4 7 r � s � iFa. // ! S � '� rl T S i A A 3 �' JY ,f � 'j PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross -Section & Plan View Pg 4 of 4 Management Plan Attachments: POWTS Application for Review I Soil Evaluation Report & Site Mao Project Name / Description 2 Bed Home .7 Owner Name(s): Craig Kelm Phone: 651 226 Owner Address: 2426 South Shore Blv. White Bear Lake, MN Zip: 55110 Project Address: 26725 Marengo River Rd. Mason, WI Govt. Lot: NW U1/4 of NW Township: Lincoln Project Parcel ID #: 22984 -7907 1/4, Section28 , T45 N -R5 E❑or WE County: Bayfield Designer Information Designer Name: Edward B. Redinger Phone: 715 -292 -6670 Designer Address: 1015 11th Ave. E Ashland, WI Zip: 54806 E-mail: ed@superiorpmw.com License Number: 221939 Remarks: Phis spaec reserved Iiir approval stamp. DJUN 'L 0 2025 Bayeld Co_ Zoning Dept. Signature: c&' -n_ _..,,__ Date: 6/20/25 Original signature required on each sub itted copy. Customer Name: Craig H Kelm SUPERIOR PLUMBING MECHANICAL (715)278-3456 CST# 221939 Scale: 1" = 40' PIN: 22984 8 ACRES NW NW S28 T45N RSW TOWN OF LINCOLN Bayfield Co. 4 15, ?. -- it %4 sF G/a. Adress: 2426 South Shore Rd White Bear Lake, MN 55110 SITE: 26725 Marengo Rvr Rd. WI Phone #: 651-226-7907 Email: kelmprop@vahoo.com NO WELL .D a I ri [-mss Y?' � c f��s Q,.; ck / e V 5� 1 1q5 3•a JUN 202025 Bayfield Co. Zoning Dept. IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) min. 12" SOIL COVER (typical) 12" min. trench dept (typical) O o System Elevation = 98 o Q (typical) Septic Tank(s) Manufacturer: Wieser Concrete Septic Tank(s) Volume(s): 750 gal gal gal gal Effluent Filter Manufacturer Polv Lock Effluent Filter Model #: 525 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) ft 0 Iry Quick4 Standard -W w/ End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) ------ --------- �j�---- -------------------��--- B= 48 ft (typical) INSTALL PER TRENCH: 12 Quick4 Std -W @ 20 ff EISA/chamber = 240 + 1 Pairs of end caps @6 ft2 EISAlpair = 6 = Proposed EISA per trench = 246 x2 ft2 ft2 ft2 Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturers / Instructions. TYPICAL TRENCH PLAN VIEW (No Scale) IA=3.0ft (typical) "-Quick4 Standard -W Chamber (typical) (mid by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. Required Infiltration Area = 428 ft2 trenches = Proposed Total EISA = 492 ft2 D G) m W O m a Distribution Method: distribution box 0 PAGE 4 OF 4 In -ground Gravity Management Plan IMPORTANT: The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 300 gpd; BOD5 S 220 mgL"'; TSS 5 150 mgL"'; FOGS 30 mgL"' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats, when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Superior Plumbing & Mech. Inc. Phone: 175-292-6670 Local government unit: Bayfield CO Zoning Phone: Local government unit address: 117 5th St. E. Washburn, WI 715-373-6138 ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by -he de a n n, accordance with SPS 384, Wisc. Admin. Code. H J Contingency Plan JUIJ 2 U 2025 In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replpp (i pursya� tDept. a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component rtiayte abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. O3 CD o O O G o 2 N O __ (0 N act' m (D a -A H 6.5" (16.51cm) SEALED BALL MATERIAL - HDPE 33.02 [83.9 cm] 20.71 [52.6 cm] 4" (10.16 cm) BALL HOUSING TRAVEL FILTER CARTRIDGE MATERIAL- POLYPROPYLENE �--- 5.7 [14.7 cm] MATERIAL - FILLED POLYPROPYLENE POLYLOK PL- 525 - 625 CUTAWAY BALL PUSH ROD SECTION A -A FACTORY INSTALLED MATERIAL - FILLED POLYPROPYLENE 4" AND 6" FACTORY OPTIONAL BUSHING -� INTALLED PIPE OUTLET (FOR 4" THIN WALL PIPE) MATERIAL - PVC PART NO. 30142-R OR OPTIONAL FLOAT SWITCH (FOR 110 MM. PIPE) PART NO. 30142-EUR O C 0 TOP VIEW WLP750- MR TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1/2" BOTTOM: 3" COVER: 4" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: DOME COVER 61" O.D. FLAT COVER 53 1/4" O.D. OUTSIDE DIAMETER: 84" O.D. BELOW INLET: 42" O.D. 4' CAST -A -SEAL UQUID LEVEL 37" WEIGHT: 6,150 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN. SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 20.28 GAL/IN HOLDING TANK: ACTUAL CAPACITY: 790 GALLONS OUTLET HOLE PLUGGED LOADING DESIGN: 8' 0" UNSATURATED SOIL MN TANKS: WILL HAVE ONE VENT OVER OUTLET AND WILL HAVE TWO VENTS IN COVER OVER INLET OPTIONAL FLAT COVER TANK CAN BE USED AS: IS AVAILABLE FOR EXCHANGE SEPTIC/ HOLDING/ PUMP OR SIPHON FOR DOME COVER. COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) _ OUTLET =n CUSTOMIZED TANKS: m a ¢ m FOR CUSTOM TANKS CONTACT WIESER CONCRETE N n u C� Q Q Z o f ¢ cn PUMP PAD a = . JOB INFORMATION: o G W n= ^ ,v N CUSTOMER: W N o S SIDE VIEW___ a JOB NAME: LU 2 DATE NEEDED: SHEET N0. APPROVED BY: L -- m �1 TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS APPROVAL DATE: OF (Parcel Idemifiealion Number) A parcel of land located in the Northwest Quarter of the Northwest Quarter (NW;( NWM) and the Southwest Quarter of the Northwest Quarter (SW',( NW%) of Section Twenty-eight (28), Township Forty-five (45) North, Range Five (5) West, in the Town of Lincoln, Bayfield County, Wisconsin, described.as follows: To locate the point of beginning, commence at the NU corner of said Section 28, and run N. 87° 27' 21" W., 1664.96 feet along the north line of said Section 28 to a 1W" iron pipe, which is the point of beginning. Thence from said point of beginning by metes and bounds: Continue N. 87° 27" 21" W., 330.00 feet along said north line, to a 1%" iron pipe; 12 Thence S. 02° 32' 39" W., 1230.50 feet, parallel with the west line of said Section 28, to a 1%" iron pipe near the water's edge of the Marengo. River; Thence along a meander line near said water's edge, N. 60°04' 44" E., _ 391.13 feet, to a 12" iron pipe; Thence leaving said, meander line, N. 02° 32' 39" E., 1020.55 feet, parallel with the west line of said Section 28, to the point of beginning. Intending to include that land lying between the meander line and the water's edge of the Marengo River and the east and west lot lines extended to said water's edge. (Known as Lot 10 on survey map by Nelson Surveying and Engineering, Inc.) JUN 232025 Bayfield Co. Zoning Dept. Ss`d0571' Private Sewage System Maintenance Agreement ✓Pv(CeL. As owner, I (we) ao hereby certlty the pnvate sewage system will oe installee In accordance with the certified soil testers 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 with rules established in the WI Adm. Code, as from time to time amended. (COMPLETE Legal is required) . [j1/4 of �.i U1/4 Section 31 Township N. Range ,� W Additional Legal Description: Town of F.:tCo IA (Acreage) Lot_ Block Subdivision Gov't Lot Lot _ CSM # Vol. _ Page __ _ CSM Doc #_______ _ DOCUMENT NUMBER 2025R-60793 1 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED O6/2O/2O25 AT 1O:36 AM RECORDING FEE: $30.00 PAGES: 2 Return To: Planning and Zoning Department In -ground gravity O In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ Other Area Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. Pump Chamber (system types B, C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Septic Tank Effluent Filter (system types A through E): T' ie septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturers 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 license^. 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 etlluent from the system is pending on the ground surface. D (! c SIn E )I (� D Mounds, At-orade. and In -ground Pressure System Laterals (system types C, D and E): The laterals shall be flushed out an webbed if needed when the wastewater distribution cell component is inspected as provided above. 1111 JUN 232025 Owners) 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 ffrfp( thiaPept. human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner {v'ifh'in tK1rty�2 s from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such property. Owner(s) Name(s)— Please Print Subscribed and sworn to before me on this date: c<J^f' R y Commission Ef7, BB L. OLSON pabHo-rylinnes0l Drafted by: Date: l asluExplrsa Jan. 31, 2C _"pfdbfed by: ulfonnstsanitary/septicmaintenceagreement Revised July 2020 B- YFIELD Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: KELM, CRAIG H PO BOX 233 SO ST PAUL, MN 55075 Description Private Sewage System (Septic Tanks) Submission Number: SS -00579 Transaction Number: SS-00579-2ECC1 $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 10330 Paid by: Superior Plumbing & Mech Inc, 1015 11th Ave E, Ashland WI 54806 Payment Type: Check Transaction Date: 6/30/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-25-b4S STATE SANITARY PERMIT OWNER: CRAIG H KELM GOVT LOT: LOT: BLK: NW 1/4 NW 1/4 SEC: 28, T 45 N, R 5 W TOWNSHIP: Lincoln SOIL TEST: 55-24 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: EDWARD REDINGER TRACY POOLER DATE: 7/1/2025 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: # 221939 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 7/1/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION