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HomeMy WebLinkAbout25-80S** INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY ** TIME RECEIVED REMOTE CSID DURATION PAGES STATUS November 17, 2025 at 3:06;27 PM CST 7157983470 36 1 Received N0V/17/2025/M0N 02:38 PM Andry Rasmussen & So FAX No, 7157983470 P.001/001 Request 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 flume Change 1Discrepancy fl Other Plumber: at1J'ry IIyp�/ rtSfiwe(1 S Phone Number r ' 3355- Fax Number 16- %`'1,)p Homeowner: S Q artbu]Sr Email Address f nclr' /QS, trerrt 1 ( Yh)S52at i' S1P Sanitary Permit #: 5 RD Immediate Phone Number So Zoning Dept can call you right back (if needed) Plumber's Choice (3 Dept No Inspection(s) during this time Date; Tuesday (9:3o am - 12:15 pm) (Tracy) Time: Plumber's Choi a ning Dept ! e '. It O V Township: Address # & Road Name: or / / iSS t1t m !►t lW ,� -J q '� 2/3t7 Directions To Site: Comments: ** Plumbers you must verify any change(s) by fax or email ** Notes from Zoning Dept: u/formslsanitarylrequastonnspection Zoning Dept (i&J112104); ® June 2023 Industry Services Division General Information JAMES G DRAGANOWSKI 2256 18 7/8 AVE RICE LAKE WI 54868 Private Onsite Wastewater Treatment Systems ( POWTS),Inspection Report (Attach to Permit) setback to: County Sanitary ermlt No: State Plan'Transaction ID#: Parcel Tax No: TYPE MANUFACTURER CAPACITY I Prop. Line Well Building Air Intake Road Se tic s G 'av lct' N/A N/A Z N/A Pump I Siphon Information Pump Manufacturer um p Model Demand GPM Filter Manufacturer Filter Model TDH Lift Friction Loss Head Total Forcemain Length Dia Dist To Well Disnersal Cell Information DIMENSIONS Width Length II of Cells SETBACK FROM Prop Line Building Well OHWM Type of Cell Pretreatment Unit Manufacturer: Model Number: Manufacturer: Elevation Data STATION BS HI FS ELEV Benchmark Bldg. Sewer 71 0 7/f Tank Inlet 3 Tank Outlet 7 9G,& $' Dose Tank Inlet Dose Tank Bottom Inst. Contour Header I Manifold 7 7 Qc, Distribution Pipe Infiltrative Surface €3.79,r g Final Grade stribution System X Pressure Systems Only Header / Manifold Distributi Pipe(s) 2 X Hole Size X Hole Observation Pipes Length Dia _ Lennth I Dia / Spac Spacing ❑ Yes ❑ No Over ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 1(1 9r , ,tt 1'cks� 5 Ian revision required? ❑ YessNNo I/ ' 5 to other side for additional Inform n. ❑ Yes ❑ No Date POWTS Inspector's Signature 3Rn-R71❑ rR nal91) License Number A' Property Owner BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Bayfield County Courthou' Fax: (715) 373-0114 Post Office Box 58 e-mail: zoninp(�bavfieldcountv.orp 117 East Fifth Street Web Site: www.bavfieldcounty.org/147 Washburn, WI 54891 JAMES G DRAGANOWSKI Information 2256 I8 7/8 AVE RICE LAKE WI 54868 As you know /'/C(y/[ W ls/i/� 4- �G'YG % was contracted by you to install a private onsite wastewater treatment system on your property (Tax ID# above). To know when your sirstem will be due for servicing please go to www.septicsearch.com Notes: Abandonment of Old System to meet all applicable code requirements: ❑G Tank was pumped by: on at AM / PM ❑ •) Tank was crushed / removed and pipes disconnected by: On 7/9/ atM M) the above -mentioned plumber contacted our office to co,klct a pre -cover inspection as requited under DSPS 383. One of the following applies: System was inspected and appears to meet all applicable code requirements. ❑ System was inspected and appears to meet all applicable code requirements; however, a plan revision is necessary because the installation was substantially different than the original approval. ❑ System could not be inspected because plumber covered prior to scheduled time of inspection. ❑ System could not be inspected because plumber was not ready at scheduled time of inspection. County was unable to return to complete inspection. ❑ System could not be inspected because plumber was not ready at scheduled time of inspection. A re -inspection and $50 fee are required. ❑ System could not be inspected because County could not respond to plumber's time constraints Comments: W forms/sanitarypropertyowner-input April 2019 `Rru� Industry Services Division County 4822 Madison Yards Way Bayfield i( $ p' S S — 00 (; j - Madison, WI 53705 Sanitary Permit Number (to be filled in by Co.) Z $ P.O. Box 7302 Madison, WI 53707±ji` l s�tovn�- 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 TBD - Jim Miller Rd. Barnes, W purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. I. Application Information — Please Print All Information 1 55 Property Owner's Name Parcel # James G Draganowski 2139 Property Owner's Mailing Address Property Location 2256 18 7/8 Ave. Govt. Lot City, State I Zip Code Phone Number t` '/Z. C1 N I/i... Rice Lake, WI 54868 715-296-8127 SW ¼. sw ¼, Section 18 II. Type of Building (check all that apply) Lot # T 44 N R 09 E or O II1 or 2 Family Dwelling —Number of Bedrooms 3 Subdivision Name ❑Block # PublCommercial — Describe Use (City of Owned — Describe Use CSM Number e of of Barnes III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check;one'box on line B. Complete line Cif a `!cable. A. New System DReplacement System ❑Other Modification to Existing System (explain) Additional Pretreatment Unit (explain) B. ❑Holding Tank a In -Ground ❑At -Grade ❑Mound jlndividual Site Design Other Type (explain) (conventional) C. ❑ Renewal Before ❑Revision JChange of Plumber ❑Transfer to New Owner List Previous Permit Number and Date Issued Expiration NA IV. DispersaVTreatment Area_and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (st) l Dispersal Area Proposed (sf) I System Elevation 450 0.7 1642 1652 96.0 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units o New Tanks Existing Tanks a 0.0 cis y w v Septic or Holding Tank 1000 1000 1 Superior Precast LJ✓ Dosing Chamber ❑ ❑ V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS-shown on theattached plans. Plumber's Name (Print) I Plumber's Signal MP/MPRS Number 1 Business Phone Number Jason Kuettel 675751 J715-798-3355 Plumber's Address (Street, City, State, Zip Code) PO Box 66 Cable, WI 54821 VI County/Department Use Only Approved O Disapproved Permit Fee I Date Issued Issuing t Sature l O Owner Given Reason for Denial D�' as 5 � a Conditions of Approval/Reasons for Disapprovalj C ,e_ d7fa,12i! C1 d_ JUL 1 52025 Bayfield Co. Zoning Dept. Attach to complete plans for the system and submit to the County only on paper not less than 81/2 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 POWYS 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 Draganowski 3 Bed Owner Name(s): James G Draganowski Owner Address: 2256 18 7/8 Ave. Rice Lake, WI Project Address: TBD - Jim Miller Rd. Barnes, WI Govt. Lot: SW 1/4 of SW Township: Barnes Project Parcel ID #: 2139 Designer Name: Jason Kuettel Phone: 715 Zip: 54868 1/4, Section 18 , T 44 N -R 09 County: Bayfield Designer Information Designer Address: PO Box 66 Cable, WI E-mail: tim@andryras.com License Number: 675751 Remarks: JUL 1 52025 R�yiI Id co, Zoning Dept. - 8127 E❑or W ❑✓ Phone: 715 - 798 - 3355 Zip: 54821 This space reserved for approval stamp. Signature: Date: *7/1;%s Original si ature required on each submitted copy. Owner Information: BM=100: Nail with ribbon on the base of tree between 618 B3 Name: lames O Oragonowski Location: SWt/4SW1/4S18.T44N.R09W B3= 99.92 Township: Barnes B2 99.9 County: Baytield B3= 99,35 Address: lim Miller Road Jim Miller Road d 1"=40Only in TestedArea LA /p 6�S�S1 p 1 Is)zs 7V tau I C\1 /000 a2rc° F/t.rrti IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) mm. n1T SOIL COVER (typical) 12" min. trench depth (npican TYPICAL TRENCH ' a •. CROSS SECTION VIEW — (No Scale) cr 96.0 o rr� System Elevation = ft (typical) l ✓ Quick4 Standard -W w/End Cap (Show location of inlet / outlet pipe connection on plan view.) t I (yplca ) -----------;�--------;j//_ L— — — — — — — — — — — —t -------It---- Septic Tank(s) Manufacturer. Superior Precast Septic Tank(s) Volume(s): 1000 gal gal gal gal Effluent Filter Manufacturer. Orenco Effluent Filter Model #: FT -0822 B= 66 ft (typical) INSTALL PER TRENCH: 16 Quick4 Std -W @ 20 ff EISA/chamber = 320 ft' + 1 Pairs of end caps @6 ft' EISA/pair = 6 ft2 = Proposed EISA per trench = 326 ftZ Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturer's / Instructions. A = 3.0 ft (typical) TYPICAL TRENCH PLAN VIEW (No Scale) `Quick4 Standard -W Chamber (typical) (mid by Infiltrator Systems, Inc.) Install pursuant to manufacturer's instructions. Required Infiltration Area = 642 x 2 trenches = Proposed Total EISA = 652 ft2 Distribution Method: ftz branched manifold GD m W O RESET S�FTrC T.AJIK _ C.0SS Ste'.. 1 l O r.tF-j S?.rrI ; C TIG1'1S U" Gc,., .o P'TC INS.P. PTPF 6 f1 MIN{, A30'/L when tnl e.+ s ur►zd APPROVED t jHOLE F IN SH D GP4a.DE W/ Lac. l, 18" 1'ilN. I rl LET I AP PAC PIPE ON TO SO IL 3" APPR€W D BEDDING UHD�P, Thi{K SPECIFICATIONS �EP'F'DG TANK H A1U FAC' RED:: T11( S !iES. SE'T1C bob GAL. [DOTES: JUL 1 52025 Bayfieltl Co. Zoning Dept. OUTLET • PAGE4OF4 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 = 450 gpd; BOD5 ≤ 220 mgL"1; TSS ≤ 150 mgL4; FOG ≤ 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: Andry Rasmussen & Sons Local government unit: Bayfield Co. Zoning Local government unit address: 117 E 5th St. Washburn, WI Phone: 715-798-3355 Phone: 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 tIP"s"Y'le Ss nless approved by the department in -accordance with SPS 384, Wisc. Admin. Code. Contingency Plan ij u JUL 1 52025 In the event that any failed treatment component of t jgy� �S3 i1u Dbptrepaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be 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. - 1 ,wt-i',2ntL t:,i9 f ��� 57'\7 ,C'�'Soil Evaluation Report Nin accordance with SPS 385.1Ms.Adm Code SDI TEST Wisconsin Department of Safety and Professional Servlses Attach complete site plan on paper not less than 8'Ya X 11 inches in size. Page: 1 of 6 Plan must include but not limited to: Vertical and horizontal reference County: point (BM), direction and percent slope, scale or dimensions, north arrow, Bavfleld location and distance to nearest road. Parcel I.D. Please Print All Information 2139 Personal information you provide may be used for secondary purposes. R v'ew y: Date: (privacy Law,s.15.04(1)(m)). Property Owner: Property Location James G Dragonowski SW1l4SW114,S18,T44N,R09W Property Owners Mailing Address: Site Address or CSM and Lot # 225618 718 Ave Jim Miller Road City IState I Zip Code Phone Number: Town Nearest Road: Rice Lake WI I 54868 0 Barnes I Jim Miller Road Number of Bedrooms: 3 • New Residential Code derived design flow rate: 450 Flood Plain if applicable fJ Replacement r Public or Commercial - Describe: Parent Material: Outwash Flood Plain if Applicable: 0 General Comments & Recommendations: System Elevation: 86 Load Rate: 00.7 Elevation Range; 9'1.95 70 96.4 Ground surface Elev: Depth to Limiting Factor. Boring #1 Bor. Pit Soil Application Rate: 98.67 Ft. 120 in. Elev. 88.67 ft Horizon Depth in. Domm.Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 Munsell Qu. Sz. Cont. Color Gr.Sz.Sh. 1 0-6 7.5YR2.5/1 N/A SL 2MSBK MFR CS 3F 0.6 1.0 2 6-24 7.5YR4/4 N/A MS 0SG ML CS IM 0.7 1.6 3 24-120 7.5YR4/6 N/A MS 0SG ML N/A N/A 0.7 1.6 4 5 6 7 Boring # 2 r Bor.F Pit Ground surface Elev: Depth to Limiting Factor: Soil Application Rate: 98.9 Ft. 120 in. Elev. 88.9 ft Horizon Depth in. Domm.Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 Munsell Qu. Sz. Cont. Color Gr.Sz.Sh. 1 0-8 7.5YR2.5/1 N/A SL 2MSBK MFR CS 3F 0.6 1.0 2 8-30 7.5YR4/4 N/A MS 0SG ML CS 1 M 0.7 9_6 3 30-120 7.5YR4/6 N/A MS 0SG ML N/A N/A 0,.77 1.6 4 5 6 7 *Effluent #1 = BOD 5>30 < 2 20 mg/l and TSS> < 150mg/l "Effluent #2 = BOD 5< 30 mg/1 and TSS < 30 mg/l CST Name (Please Print) Si natur CST Number: 877598 Mark S. Thompson Address: 12006 N US Hwy 63 Date E lug o Telephone Number Hayward, WI 54843 ue a J f 1� 25 E 7151699-4081 SBD-8330 (R04/21) 1111 JUL I U LUL:J Bayfield Co. Zoning Dept. Property Owner: James G Draaonowski Parcel I.D. 2139 Page: 2 of 6 Boring # 3 r- Bor.W Pit Ground surface Elev: Depth to Limiting Factor: 98.95 Ft. 120 in. Elev. 88.95 ft Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ftz *Eff#1 Eff#2 1 0-4 7.5YR2.5/1 N/A SL 2MSBK MFR CS 3F 0_6 1.0 2 4-28 7.5YR4/4 N/A MS 0SG ML CS 1 M 0,._7 1.6 3 28-120 7.5YR4/6 N/A MS 0SG ML N/A N/A 0.7 1.6 4 5 6 7 Boring # 4 'Ground surface Elev: Depth to Limiting Factor: r" eor. Pit t 0 Ft. 0 in. Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ftz *Eff#1 Eff#2 1 2 3 4 5 6 7 Boring # 5 Ground surface Elev: Depth to Limiting Factor: " Bor.P Pit 0 Ft. 0 In. Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ftz *Eff#1 Eff#2 1 2 3 4 5 6 7 Boring # 6 Ground surface Elev: Depth to Limiting Factor: r Bony' Pit 0 Ft. 0 in. Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ftz *Eff#1 Eff#2 1 2 3 4 5 6 7 *Effluent #1 = BOD 5>30 < 2 20 mg/l and TSS>30 < 150mg/i *Effluent #2 = BOD 5< 30 mg/! and TS Anj The Department of Commerce is an equal opportunity service provider and employer. If you need assists to 2�fe�ss services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777 Bayfield Co. tuD52025 Zoning Dept. SBD.8330(R.07l00) Soil Profile Sheet Page: 3 of 6 Owner: James G Dra onowski ISoil Tester: Mark S. Thom son System Elevation: 96 Load Rate: Oliystem Elevation: 91.95 To 96.4 101 B3 101 B2 101 B1 100 ---------- 100 --------------- 100 ------------ System -- --- Elevation 98.95 98.9 98.67 98 --------------- 98 --------------- 98 --------------- --- -te 97 -----------. 0_797 97 ______--_• 96.62 $ 0.7 96.67 $ 96 ------------ 007 96 -----------• $ 96 ------0,_7 --- 0.7 --- 95 -----_-- 95 --------------- 95 94 94 94 ----- 93 -------- 93 --------------- 93 - 92 92 92 --------- - 91.95 -----------• 91.9 ------------ 91.67 91 --------------- 91 --------------- 91 --------------- 90 ----------- T3' 90 -----------• T3` 90 -----------• T3' 89 ---------- 89 ------------- 89 ------- - ------ 88.95 -----------• 99.9 -------�--- 88.67 88 ------------ L.F. 88 ------------ L.F. 88 ------------ L.F. 87 --------------- 87 _____ _w 87 86 --------------- 86 ----- 86 -------�_.._.._ 85 85 --------------- 85 ---- 84 84 84 ------------ 83 ----- 83 _-------- 83 --------------- 82 ---------- 82 --------------- 82 ------------- 81 ------ 81 --- 81 ---------- 80 --------------- 80 --------------- 80 --------------- 79 ------- 79 79 ------ 79 -- E-- - VU O U �5 Dayfield Co. Zoning Dept. Owner Information: Name: James G Dragonowski Location: SW1/4SW1/4.S18,T44N.R09W Township: Barnes County: B €eld Address: Jim Miller Road Jim Miller Road BM=100: Nail with ribbon on the base of tree between B1 & B3 B1= 98.67 B2 B3 = Lake= Q 1"=40Only In TestedArea 71 6 99 1 77598 \t\ JUL Private Sewage System Maintenance Agreement pwner(s) Name I& ≥ C�• -b,7. C,A1�OW Er-; Ora r(s) Mailing Address ?.zS is/ft A\ile jzt L4 -i.:, i'I ,gS6t3 Site Address tLt TaxrD# Zti 3� As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil tester's report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below fisted location in accordance with rules established in the Wi Adm. Code, as from time to time amended. (COMPLETE Legal is required) StrV ,'Z OF N 1/'t. 1/4 of S W 114 Section./,Township !Z ( N. Range C0 W. Additional Legal Description: Town of 9 4 ZN t S Lot Block Subdivision (Acreage) /O ° Gov't Lot Lot CSM # Vol. Page CSM Doc # Bayfield Co. Zoning Dept. DOCUMENT NUMBER 20258-6083 p DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED O7/15/2O25 AT 1:47 PM RECORDING FEE: $3O.OO PAGES: 1 Recording Area Return To: Planning and Zoning Department © In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: O Mound ❑ At -grade Sewage System ❑ Other 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): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55. Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS Inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter todetermine whether wastewater or effluent from the system is ponding on the ground surface. Mounds, At -grade, and In -around Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the 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 Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges' may be placed on the 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: }, A M SS j CG A -Vows 1(: ��'+•� ��'�r 2028 Notarized Owner(s) — Signature(s) My Commission Expires: ' 2.. � ALEX VAN J Drafted by:77A-► Jiiz Date: 7—� Ada c State of Wisconsin Industry Services Division County 4822 Madison Yards Way Bayfield S S —00 6d I SF, ' Madison, WI 53705 Sanitary Permit Number (to be filled in by Co.) tA (�P.O. Box 7302 Madison, WI 53707 a„S— O S 'bmcny 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 TBD-Jim Miller Rd. WI purposes in accordance with the Privacy Law, s. 15.04(l)(m), Scats. Barnes, 1. Annlication Information — Please Print All Information I i CiCi James G Draganowski Property Owner's Mailing Address 2256 18 7/8 Ave. City, State Zip Code Phone Number Rice Lake, WI 54868 715-296-8127 II. Type of Building (check all that apply) Lot i3 JI or 2 Family Dwelling —Number of Bedrooms 3 Public/Commercial — Describe Use Block/I State Owned — Describe Use CSM Number 2139 Govt. Lot E I/L cF N 'ft. SW ¼ SW y,, Section 18 T44 xi o 09 of Town of Barnes 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 a licable. A. New System ❑Replacement System ❑Other Modification to Existing System (explain) DAdditional Pretreatment Unit (explain) B. �Holdmg Tank �In-Ground ❑At -Grade Mound Individual Site Design Other Type (explain) (conventional) C. ❑ Renewal Before ❑Revision Changc of Plumber Transfer to New Owner List Previous Permit Number and Date Issued Expiration NA IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) I Dispersal Area Proposed (sf) System Elevation 450 0.7 642 652 96.0 Capacity in I Total I # of Manufacturer Tank Information Gallons I Gallons I Units I I a II I u .. 2tt u 2 `u lr2_ New Tanks Existing Tanks o.U rn o li.oI I sepucorttomingIank I 1000 I 11000 1 1 I Superior Precast II ✓ IIIhInInInI V. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) I Plumber's Signal MP/MPRS Number I Business Phone Number ,:.r Jason Kuetteli 675751 715-798-3355 Plumber's Address (Street, City, State, Zip Code) PO Box 66 Cable, WI 54821 Approved 0 Disapproved I $_.......Mgt s ,. ,, In,mC %lR" 0 Owner Given Reason for Denial 7vv ��aaa5 Conditions of Approval/Reasons for Disapproval irecvtfa mod_ o[ flY JUL 152025 Bayfield Co. Zoning Dept. to complete plans for the system and submit to the County only on naoer not less than a to x II inches in size SBD-6398 (R. 02/22) Si _ C(Z i - •°`�x`w�r � Soil Evaluation Report Pi in accordance with SPS 385.Ms.Adm Code SOI1 TEST 73--x5 tittirrs i —/� Wisconsin Department of Safety and Professional Sewises Attach comolete site olan on caner not less than 8% X 11 inches in size. Paae: 1 of 6 Plan must include but not limited to: Vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, location and distance to nearest road. Please Print All Information Personal information you provide may be used for secondary purposes. (privacy Law,s.15.04(1)(m)). County: Bavfield Parcel I.D. 2139 R v'ew y: Date: iZ Property Owner: James G Dragonowski Pro erty Location SW1/4SW1/4,S18,T44N,R09W Property Owners Mailing Address: 225618 7/8 Ave Site Address or CSM and Lot # Jim Miller Road City Rice Lake State WI I Zip Code J Phone Number: 0 Town Barnes Nearest Road: Jim Miller Road New Residential Number of Bedrooms: 3 Code derived design flow rate: 450 Flood Plain if applicable fv- Replacement ;— Public or Commercial - Describe: Parent Material: Outwash Flood Plain if Applicable: 0 General Comments & Recommendations: System Elevation: 96 Load Rate: 00.7 E�evatiar� Rar 9 95To iG ? Borin #1 Bor. Pit Ground surface Elev: Depth to Limiting Factor: g 98.67 Ft. 120 in. Elev. 88.67 ft Soil Application Rate: Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 0-6 7.5YR2.5/1 N/A SL 2MSBK MFR CS 3F 0.6 1.0 2 6-24 7.5YR4/4 N/A MS 0SG ML CS IM 0.7 1.6 3 24-120 7.5YR4/6 N/A MS 0SG ML N/A N/A 00.7 1.6 4 5 6 7 Boring # 2 1- Bor. , pit Ground surface Elev: Depth to Limiting Factor: 98.9 Ft. 120 In. Elev. 88.9 ft Soil Application Rate: Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 0-8 7.5YR2.5/1 N/A SL 2MSBK MFR CS 3F 0.6 1.0 2 8-30 7.5YR4/4 N/A MS 0SG ML CS 1M 0.7 1.6 3 30-120 7.5YR4/6 N/A MS 0SG ML N/A N/A 0.7 1.6 4 5 6 7 *Effluent #1= BOD 5>30< 2 20 mgA and TSS> < 150mg// *Effluent #2= BOD 5< 30 mg/l and TSS < 30 mg/1 CST Name (Please Print) Mark S. Thompson Si natur CST Number: 877598 Address: 12006 N US Hwy 63 Hayward, WI 54843 Date E lua ue a J 1 2 5 Telephone Number 715/699-4081 SBD-8330 (R04/21) 1111 JUL I .a LULJ Bayfield Co. Zoning Dept Property Owner. James G Draaonowski Pa:cel I.D. 2139 Page: 2 of 6 Boring # 3 Ground surface Elev: Depth to Limiting Factor: �" Bor.� Pit 98.95 Ft. 120 in. Elev. 88.95 ft Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 0-4 7.5YR2.5/1 N/A SL 2MSBK MFR CS 3F 2 4-28 7.5YR4/4 N/A MS 0SG ML CS IM 3 28-120 7.5YR4/6 N/A MS 0SG ML N/A N/A 0.7 1, .6 4 5 6 7 Boring #4 1'"' Bore' Pitt Ground surface Elev: Depth to Limiting Factor: 0 Ft. 0 In. Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 2 3 4 5 6 7 Boring # 5 Ground surface Elev: Depth to Limiting Factor: r Bore 0 Ft. 0 In. Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 2 3 4 5 6 7 Boring # 6 Ground surface Elev: Depth to Limiting Factor: i Bor.P' It 0 Ft. 0 In. Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 2 3 4 5 6 7 E *Effluent #1 = BOD 5>30 < 220 mg,1 and TSS>30 < 150mg/I *Effluent #2= BOD 5< 30 mg// and TS 3 The Department of Commerce is an equal opportunity service provider and employer. If you need assistar to amass 1 52025 services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777 Bayfield Co. Zoning Dept. SBD•8330(R.07100) Soil Profile Sheet Page: 3 of 6 Owner: James G Dra onowski Soil Tester: Mark S. Thompson System Elevation: 96 Load Rate: 0.7 System Elevation: 91.95 To 96.4 101 B3 101 B2 101 B1 100 --------------- 100 --------------- 100 ------------ System - Elevation 99 -- 99 -------- 99 EEEE- . 98.9 ---------- 98.67 98 ------ 98 ------------ 9__-'_________ 97 ------------ 0_7 97 --------------- 97 ------------ 0_7 96.62 $ 0.7 96.67 $ 96 ------------ 0_7 96 ------4 $ 96 -�------� 0_7 0.7 95 --------------- 95 --------------- 95 --------------- 94 94 --------------- 94 93 --------- 93 --------------- 93 --------------- 92 __ 92 __ 92 -----_--- ------------ 91.95 ------------ 91.9 ------------ 91.67 91 ------ 91-----____� 91 90 T3' - 90 _ T3' _ 90 _----- �_ N T3' 89 - 89 --- --- 89 ----- - 88.95 99.9 88.67 88 -----------• L.F. 88 ------------ L.F. 88 -----------• L.F. 87 87 87 86 --------------- 86 --------------- 86 --------------- 85 85 85 ------ 84 84 84 83 --------------- 83 --------------- 83 ------_____---_ 82 82 - - 82 81 --------------- 81 --------------- 81 --------------- 80 80 80 ------------- -------- 79 --------------- 79 -479 ------ c E 0 V l5 JUL i 5 1 U'L`� Bayfield Co. Zoning Dept. Owner Information: Name: James G Dragonowski Location: SWi/4SW1 /4,S1B,T44N Rpgw Township: Barnes County: Bayfield Address: Jim Miller Road lim Millar Rnori 1"=40Only in TestedArea 7i699-4l&.g775gg BM=100: Nall with ribbon on the base of tree between R1 & B3 B1= 98.67 B2= RU B3= 98.95 Lake= 0 ji 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: closures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description nowski 3 Bed Owner Name(s): James G Draganowski Owner Address: 2256 18 7/8 Ave. Rice Lake, WI Project Address: TBD - Jim Miller Rd. Barnes, WI Govt. Lot: SW 1/4 of SW Township: Barnes Project Parcel ID #: 2139 Designer Name: Jason Kuettel Phone:715 -296 -8127 1/4, Section 18 , T44 N -R 09 E ❑ or W ❑✓ County: Bayfield Designer Information Designer Address: PO Box 66 Cable, WI E-mail: tim@andryras.com License Number: 675751 d E D Remarks: JUL 1 52025 Peyfiold Co. Zoning Dept. Phone: 715 798 -3355 Zip: 54821 hi, , '.ac rc,c'r ccd lur approval ;lamp. Signature: I Date: 7 /Is %zs Original si ature required on each submitted copy. Owner Information: Name: lames G Dragonowski Location: SWI/4SW1/4.S18.T44N.RO9W Township: Barnes County: Bayfield Address: Jim Miller Road [Nu 1°=ao� Empty Lot Lot is realativly flat Onlyin Tested Area r r fl1R7RTi1iZTiLTiifT-iThti:TTflhi div iTil:ifl:k Driveway B2 7 BM B1 I�10 * Nv IAGkt F Ier:.r art CSrt /doo W/ 02,C° CE)a66' c ci' Y )Ap 6�5�S1 )11:5 B1= 98.67 B2= 99.9 B3= 98,95 IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) min. 12" SOIL COVER (typical) 2" min.trench depth �_ try (:cap it V I— 3c •• .. (typical) •• .. N e try System Elevation = 96.0 (typical) Septic Tank(s) Manufacturer. Superior Precast Septic Tank(s) Volume(s): 1 000 gal gal gal gal Effluent Filter Manufacturer: Orenco Effluent Filter Model #: FT -0822 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) ft Quick4 Standard -W w/ End Cap (typical) (Show location of inlet / outlet pipe connection on plan view.) r------------------��---- II i ! i ------------- B= 66 ft (typical) INSTALL PER TRENCH: 16 Quick4 Std -W @ 20 ff EISA/chamber = 320 + 1 Pairs of end caps @6 ft2 EISA/pair = 6 ft2 ft2 Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturers / Instructions. TYPICAL TRENCH PLAN VIEW (No Scale) TA = 3.0 ft (typical) `Quick4 Standard -W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. D 6) m co O m = Proposed EISA per trench = 326 ft' Required Infiltration Area = 642 ft2 Distribution Method: x 2 trenches = Proposed Total EISA = 652 ft2 branched manifold SEPTIC TANK CROSS S?CT.01I AND S?EC I: ICaTiO1iS 4" Gci1,4OPVC INSP. PTor 6 " MIN. ABOVE G?;.D'.('opT,� (when %nle+ rra.e .6o�4s l7uried i J FINISHED GRADE 18" �IN. I }HLET APPROVED PIPE]' ONTO SOLID SO IL -APPR D BA -e -e -E — O FILTER —� MFG. ON?anco model n .F_O$ __ 3" APPROVED BEDDING UHDEP, TMK PECIFICATIONS S EPTaC TANK MAMNtACTJRE3:: rt c - TANK SIZES. S=?TIC (boo GAL. NOTES: JUL 1 52025 Bayfield Co. Zoning Dept. APPROVED MANHOLE W/ Lam, c}. woAllNE- L 46gL 4" HIH. OUTLET PAGE4OF4 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 = 450 gpd; BOD5 ≤ 220 mgL-'; TSS ≤ 150 mgL''; FOG ≤ 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 (Le., 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: Andry Rasmussen & Sons Local government unit: Bayfield CO. Zoni Local government unit address: 117 E 5th St. Washburn, WI Phone: 715-798-3355 Phone: 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 tPQW�S($nay��seRnless approved by the department in I¼!D IS with SPS 384, Wisc. Admin. Code. IUI IS SS 88 Ev IIII IIII Contingency Plan 1111 JJL 152025 In the event that any failed treatment component of tWi T3Ry.JDbptrepaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be 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. Private Sewage System Maintenance Agreement 1r> OAroW SK: ZZS(a t8% AVE fatnS L4ke, vc SW8613 Site Address //f / yy� c7 urn / r r t /Y� c '°' 2135 As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil tester's report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established in the WI Adm. Code, as from time to time amended. (COMPLETE Legal is required) C 1/t- of N I/L SW 1/4 of S W 114 Section' Township Q'i N. Range 0'21' W. Additional Legal Description: Town of ,4g,N t S (Acreage) /O. o Gov't Lot Lot_ Block Subdivision Lot CSM # Vol. — Page CSM Doc # 'V Lb JUL 'I t gut ) Li Bayfield Co. Zoning Dept. DOCUMENT NUMBER 2025R-608317 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 07/15/2025 AT 1:47 PM RECORDING FEE: $30.00 PAGES: 1 Return To: Planning and Zoning Department Area ® In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ Other 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): The septic tank effluent filter shall be Inspected and maintained as necessary and in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55. Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS Inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface, Mounds, At -grade, and In -around Pressure System Laterals (system types C. 0 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 Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shalt be collected as provided by law. The terms and conditions of the agreement shall be binding upon and inum to the benefit of all current and future owners of such property. Owper(s) Name(s) — Please Print Subscribed and sworn to before me on this date: TA ES tb 4C,RNoNS)c' 3l./ 7 th 2 °2 Nol4rized Owner(s) — Signature(s) No ublic ate____ My Commission Expires: c z —] Drl�ted by'77A-' ,t- C.tt iZ.K_ Date: 7—%2De"2 S' ALEX VAN HEUK M Notary u c State of Wisconsin P ulfurmslsnibrv!cnnrirmanbnro.: imnmoo, Bayfield County r /1 II LI T V Property Owner: DRAGANOWSKI, JAMES G 225618 7/8 AVE RICE LAKE, WI 54868 Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00287 Transaction Number: SR -00287-30B84 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 14760 Paid by: Andry Rasmussen & Sons, PO Box 66, Cable WI 54821 Payment Type: Check Transaction Date: 7/22/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. F Y F I E LD 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: DRAGANOWSKI, JAMES G SS -00601 225618 7/8 AVE RICE LAKE, WI 54868 Transaction Number: SS -00601-30530 Description Amount Private Sewage System (Septic Tanks) $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 14760 Paid by: Andry Rasmussen & Sons, PO Box 66, Cable WI 54821 Payment Type: Check Transaction Date: 7/22/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-25-80S STATE SANITARY PERMIT OWNER: JAMES G & JUDY DRAGANOWSKI G OV`T LOT: LOT: B LK: 1/4 1/4 SEC: 18, T 44 N, R9 W TOWNSHIP: Barnes SOIL TEST: 73-25 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: JASON KUETTEL TRACY POOLER DATE: 7/22/2025 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: # MP 675751 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 7/22/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION