Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
25-86S
xH INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY A4 TIME RECEIVED REMOTE CSID DURATION PAGES STATUS Il// October 17, 2025 at 8:08:27 AM CDT 7153724159 40 1 Received Sep 13 2025 04:47 HP Faxpo➢osld Plumbing 7153724159 page 1 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 jJ Time Change Discrepancy fl Other ont� (Fey1`<vSkl Phone Number -7tS 292.-"t(�b Plumber: I / �' 6' ?e' os r1 cwt y Fax Number Homeowner: Nt t so n ce c iY .' te- i ( ( Email Address I 1ny b ac ✓y u �evte r i ti•C P4 v �,ers . D a n i IJ c_ soti Immediate Phone Number So Zoning Sanitary Z S g 5 Dept can call you right back (if needed) Permit #: i S-- 1`i z—q(s`(o Plumber's Choice i ept Date: Y Plumber's Choice Z Sept Time: J 3o p rn Township: ✓o e i Address #& Name: !r v i ,= u-er t o L`e u s ff L F& J czV Road his An o✓ iZ wc. ie. C ✓h or R L:. 6 D A7 iY u .C 1 .� r -- Directions [ t75, ","L g'c(. S �.-� o .., f'� 6o A Pr (C 1 _ To Site: v:)a Comments: o Lj ** Plumbers you must verify any change{s) by fax or email +,K Notes from Zoning Dept: uHonTaisenitery/requeatfCAnspectlon Zoning Dept (04/12)04); ® June 2023 Industry Services Division General Infnrm.Knn NELSON FAMILY LIMITED PARTNERS 27691 HACIENDA E BLVD APT 320 D BONITA SPRINGS FL 34135 Private Onsite Wastewater Treatment Systems ( POWTS) Inspection Report (Attach to Permit) Rlbbt>-, on &k +Ike,,. Tank Infnrmatinn setback to: TYPEI MANUFACTURER CAPACITY I Prop. Line I Well I Building Air Intake Road Se tic t 7 U N/A Dosin 1 1 N/A Aeration N/A Holdin of: County Sanitary ermlt No: State Plan'Transaction ID#: Parcel Tax No: Pump / Siphon Information Pump Manufacturer rump Model Demand L GPM Filter M nuf cturer Alter Model 7'D Li 1 FridUonLos Head Total Forcemain Length Diatr Dist To Well b0 4 - Pretreatment Unit Manufacturer: Model Number. Elevation Data STATION BS HI FS ELEV Benchmark ) i�[ Bldg. Sewer Tank Inlet I 1 Tank Outlet ?. co Dose Tank Inlet Dose Tank Bottom Inst. •ontourPt( RISC Header/ Manifold a Distribution Pipe jfjj33 q Infiltrative Surface Final Grade v ?.K' X Pressure Header / anifold I ( Distribution Pipe(s) t (�ayrlgty) 1 X Hole Size X Hole Observation Pipes Length _ Dia •_ Length Dia Spac i I Spacing LJ'Yes ❑ No $oil Cover Depth Over Depth Over Depth of Seeded I Sodded Mulched P P P Cell Center Cell Ednes Topsoil ❑ Yes ❑ No 0 Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.)y I Try �ui1h�1L {si& Of> . joc I t4 o n I "; -4 w�6htvinupI"UL006PW'V\dot _ I CX.uc�Iiuw-t to r✓� an revisi6rti'3 ❑ Yes ❑ No se other side for additional information. — cWPW )wfilar\ !IcI /_tV<ki t*Thzzp2lj Date POWTS Inspectors Signature t - (&J-(, License Number 22 2Rn12]1n rR nZ/911 II Property Owner Information As you know BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoninoMbavfieldcounty.oro Web Site: www.bavfieldcounty.ora/147 NELSON FAMILY LIMITED PARTNERS 27691 HACIENDA E BLVD APT 320 D BONITA SPRINGS FL 34135 Bayfield County Courthous6' 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.septicsearch.com Notes: Abandonment of Old System to meet all applicable code requirements: LI LI Tank was pumped by: Tank was crushed / removed and pipes disconnected by: on at AM/PM On at (AM! PM) the 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. ❑ 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 Lrespond to plumber's time constraints. Comments: JJQ(� C� K (j (D ck 'Vi &AI j 6 Iusr(:�1� 4 a OwAvc r) rA(A(�nq �l2 (�i r- Wforms/sanitarypropertyowner-input April 2019 rtpA�rst( �r ' - f e)5 — Department of Safety County E?c - I �..; & Professional Services, Sanitary Permit Number (to be filled in by Co.)Industry Services.Division y�SxkMu �� S V/ 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 purposes in accordance with the Privacy Law, s. 15.04(l)(m), Slats. i I ! 5•-- . ( �c I. Application Infoi oration - Please Print Ail Information T tN • - Property Owner's Name Parcel # Is c. v w%, j E, -#-.E,1 a i et ors lb4 n`i e t / i e ismi -k s a !C13 io 4 Property Owner's Mailing Addr s Property Location iluA, Ar+' Zc b Govt, Lot 2- PCI V C. f- `s , k €. City, State / Zip Code Phone Number 4- 5a✓+, c` f., � rL I 3t I 3.S S"Zs7 3�Z_tf 777 /. F,, ¼, Section H. Type of Building (check all at apply) Lot # T N R l I or 2 Family Dwelling —Number of Bedrooms Subdivision Name Block # 0 Public/Commercial— Describe Use O City of O State Owned — Describe Use CSM Number 0 Village of Q1 Town of 1YC-' -'y�-fr 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 0 Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) ❑ Holding Tank In -Ground ❑ At -Grade ❑ Mound 0 Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration .IV. Dis ersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Ratc(gpd/sf) Dispersal Area Required (at) Dispersal Area Proposed (sf) System Elevation 1)45 ' •7 _ 2 I Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units s' New Tanks Existing Tanks a I U -g �, •�—, 04U #1t Septic ar[ioldixt is y$b � icg ill 2 W b '�S •e- Ir Cc, �'f. e., t� Dosing Chamber $ fl QC b I I I t V. Respoesibillty Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) r Plumber's Signature --� 3�P/MPRS Number Business Phone Number AlIaLii 7v �osk-, Plumber's Address (Street, City, State, Zip Code) s- •y i D'-, t 1 tc ≤ '8 Y7 VI. County/Department Use Only :. Approved 0 Disapproved JF$pc� mit Fee Date Issued Issuing nt Si attire O Owner Given Reason for Denial d 5 ;(i'j Conditions of Approval/Reasons for Disapproval JL 172025 ,.I Bayfield Co. Zoning Dept. Attach to complete plans for the system and submit to the County only on paper not less than S tit x 11 Inches in size SBD-6398 (R. 03/22) May. 5. •2017 10:.41AM BAYFIELD CO PLANNING & ZONING No. 9975 P. 3 Pg 1 of 9 Pg2of$ Pg3of $' Pg 4 of i Attachments: In -Ground Gravity Plan Index & cover Sheet Component Manuel Design References: Version 2.0, SBD-1 0705-P (N.01`/01, R. 10/12) PAGEIOFr Index & Cover Sheet Plot Plan Se phc. nk. 4-'4 Section & Plan View- 2 p j �I Management Plan tnciosures: POWTS Application for Review 4 Soil Evaluation Report & Site Me A we K p v rn.t S s- 3 p 4 5 s Project Name / Description cw 1re,i/rV11�fi, r ��Y„�r e.lsbn Owner Name(s): t o- L s o n -ra m l 1 L, rrn 4 e 1L Pa v4kteKPhone: 37 ...3SZ- 4/777 OwnerAddress: z749 ! £uof l.EvGv A Zip: Syr3s .4 1., coa v 2� " • J f- v c.J-L s y� Project Address: 5J�A 'Jo J fl� ��� 2 Pa ice I5 v + L e, s61/4 of 1f4, Section, T tf7 N -R ? E E 1 or MR Township: IR �-e County: i� f i e ,I I y Project Parcel ID #: e i �D 13 4 r Designer Information Designer Name: A 1 o 70-1kos-k Phone: 7/ST .- 7z - / f �P Designer Address! ?-&. 3 aK S'zz yr `(� v-er J2 Zip: _SV"7 "7 E-mail: . a A'e..z-t o r --L This Space reserved for approval Stamp, License Number; 27-O ci'0 Remarks: JUL 17 2025 • Bayfield Co. Zoning Dept. Signature: Date: g na signature require en each submitted copy. ' 3-1fZS BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): 0 Check List f6 Index Page / Title Sheet (Optional) 1l Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) 121 Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) m Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used 23 Property Owner's Information (not prospective buyer's name) m Property Location (Accurate Legal Description with Sec/Twp/Range) E6 Road Name (where driveway is/will be coming off of) 11 Floodpiain Elevation, Flow Rate, Comments and Recommendations 56 Complete Soil Boring / Pit Information Ii Date Soil Evaluation was conducted d CST Name, Signature, Number, Address and Phone Number O *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) CI Bench Mark (Description, Elevation and Location) 2I Contour Lines (Example = 98.0' /96.0' /94.0') m Property Location (Sec/Twp/Range/, Accurate Legal Description) Ql Borings (Locations and Elevations) l?i Percent and Direction of Land Slope U Well Location (Including Neighboring Wells, if applicable) 16 Location of Wetland Areas, Floodplain and Navigable Waters l Buildings, Driveways, and Structures (Location and Descriptions) 21 Location of Property Lines 19 Existing System Location f1 Address Number and Road Name Ll Current Surface Elevation of Wetlands and Navigable Waters El CST, Owner and Property Information 16J North Arrow JUL 172025 13ayfield Co. Zoning Dept. Fee: El Certified Soil Tests - Review & Filing Fee $ 50.00 . . u/forms/sanitary/checklist/checkiistforests fL! O; 4, J ° � di vSF •�v1 r car, tt ( S�S( ( ! CC ce % p vatv h Ey o o l ka.: te, P1�u,.M 4 ,,, ���I ! "-- qoc;c#I' ' �PJ• .0it a 2w. '� v ct s L��P•r,��,� �' O2ax uci r IJ$ a • , x?v, U)2rr Y gm+ ,:IZ +J643b--iv ''O$'�. 8. / LLic/ia) G 5 r �' �Z�a 0 S�is*wn EI'eV,,, `l \''o4 0 •�' 4 o eP.c,Task ► `75? a «o„ W; ever "Oco .- 3+ a "r " L: -93" V1. a vk d yb ° r ' a',,� `�"�iID191 bea`�'��� ©-�• '�'r.�� -�- 161y1,�4 y�, J. �1 CAr,.:;Z�. S p c 4� : �W '' �`� 1, " � " .�►,q� � 12 l� 8ff'� kp-� FG. man r • c �'o '1'raw� , -'..1'i k g �n �% 1 f��.f�r i ok 5 H v ! 1 i 4 '.�c+���i•�w ��f425^ PS 3$ 3 .5 r— �p "� (a.e� DvP'��. '�-�✓S��-Q c.ppr.r av,"�� v, r,-Pdf lokmod .( PL~ I 5LM qo PVC ?� p� i� A r'fl 'D3`79r51A -SbA3 P 1C P.pf� es ASTM D303 �r����rc► J�.� ?Pc�� '"dt•�d �� ti A- , 47 00 \\\ "i G ` � a i t ►► f,S � � � 11#1 �," `� ' �. �► Bayfield Co. Zoning Dept. i fNM-�•av ��re�e� Ce,. , • y ti • pro edy owp%er. L1 t vl rot dvl ! �.1 �'�-�. fyl E it `� G '� /V w sC' J Y ?N !I N f'.. I S © '1L P4 VC Ls s ( & ` V. 'f G� L f •l''. Y'i^ l I •.T®1..� t� © f/ C Y1 �, v �i `� n� W j P III� d�•�. v.� o f -•�/ e t�tt dC /P ►��s v G ©rt 'a"" Gj' v'. v►,.5 ,f= L 13c5 WLP750- M R TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1/2" BOTTOM: 3" COVER: 4" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: DOME COVER 61" O.D. IIIIDFLAT COVER 53 1/4" O.D. OUTSIDE DIAMETER: 84" O.D. BELOW INLET: 42" O.D. 4" CAST-A-SEALLIQUID 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 p (OTHER STATES SEE CHART) o c LIQUID CAPACITY: 20.28 GAL/IN HOLDING TANK: ACTUAL CAPACITY: 790 GALLONS TOP VIEW s OUTLET HOLE PLUGGED m, LOADING DESIGN: 8' 0" UNSATURATED SOIL Co 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) INLET TANK: MIX DESIGN #10 (STRUCTURAL FIBER) - _ OUTLET CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE b " PUMP PAD I. SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: N_ O Q N a M' I <Z N a cf) W5 N Ix Ii, [,,.OF 1 • r W CSC a UI U z 8 w W H r0 to N la u-i N N 66 N 113" C TOP VIEW 4 lil oc 4" CAST -A -SEAL ti rn znfl 0' > r 4" VENT SIDE MEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS W840/500 -MR TANK SPECIFICATIONS 0IMENS DNS: a WALL• 2 1/2 N BOTTa : a' oovER: 5" MANHOLE: 24" [.D. PRECAST CONCRETE RISER HEIGHT: 59 1/2" O.D. LENGTH: 113 3/48" 0.0. V D7H: 93" O.Q. BELOW INLET: 48" O.1} LIQUID LEVEL.: 43" WEIGHT: 11,150 LBS. 3 ! a INLET AND OUTLET-. 4" CAST -A -SEAL BOOT OR EQUAL . GASKET, CAST -A -SEAL BOOT OR EQUAL c INLET AND OUTLET BAFFLE AND FILTER: VASCONSIN, SEE DETAIL #10 (OTTHER STATES SEE CHART) o LIQUID CAPACITY: 19.81 GALAN (SEF'BC) a 11.82 GAL/AN (PUMP) LOADING DESIGN: 8' 0" UNSATURATED SOIL C If) 41 TANK CAN BE USED AS: 2 SEP'11G/SEPTIC, SEPUUCfUMP OR SEPTIC/SIPHON I COVER MIX DESIGN I 8NO FIBER) TANK: MflC DESIGN (STRUCTURAL _ aQ #10 FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT V ESER CONCRETE � 1 Q Z o Q DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: SHEET NO, APPROVAL DATE: 1 le PRWUCTS REED O BY: ' ... SEPTIC TANK AND PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS Vent Pope a 12° above grade Looking cover with warning label and locking device and sealed Weather Proof Junction Box. Electrical as per NEC 300 and Comm 16.28 WAC Disconnect1t d In 18 "min. Alternate outlet r�r Force Main , Diameter. Z Approved effluent filter :`�J �`� f Length ) Q 0 Bwler sewer<to1/8" particle size A 'o Weep hole or anti B siphon device. C • , s �- � Pump Off Elev. __ - - D Bed Tank Anchor tank as necessary to negate buoyant forces. Tank Manufacturer: t,1,)' e,ser Co-sc . Tank Sizes: Septic !Z Gallons Pump s00 Gallons I I H Dose Tank Elev. Note: All pipe and vent materials comply with &33 I Doses Per Day: GPD/ # of Doses: 15' gallons tac K -1k3= Backflow: I iP gallons Gallons Per Inch: I! - Z Total Dose Volume: 1 gallons Liquid Level: �3 Required GPM: 3 ' Pump Manufacturer: &o o.1 1 Pump Model: F, P.O. '11 1. . Alarm Manufacturer. 1' Alarm Model: S -°.I Dimensions Inches Gallons A 17 ado C 1.7 D J �3 igc Total r Vertical Difference between pump off and distribution pipe — 13 1 I1MiJIFi/I! V Minimum Required Supply Pressure (0 for dosed conventional) = o Bayfiefd Co. Zoning Dept. "d�awi jzO Feet of force main x 3,30 friction factor / 100 = ✓ Total Dynamic Head = 1 3 awr►er ; e.15on 1' , .� i Lirn; `�� �ar414e p!; lla.� zzoo 0 tr,'I Sam MGOULDS PUMPS Submersible Effluent Pump � Fr EP04 & EP05 Series APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance, construction. heat transfer. ■Casio and Rugged • Homentrystems thermoplastic design provides AGENCY LISTING • Fomss man a l o per operation. Auto- tand superior strength and corrosion • Farms manual opemtian.Canadien standards Association • Heavy duty sump matic models include resistance. s . Ale #11138549 • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron • Dewatering assembled and preset at the for efficient heat transfer, factory, strength, and durability. ��/)1�� SPECIFICATIONS ■ Motor Cover: Thermoplastic UU u U capability: FEATURES cover with Integral handle and • Solids handling P ty: float switch attachment points. JUL 1 / 2025 '/a° maximum. ■ EP04 Impeller. Thermoplas- • Power Cable: Severe duty • Capacities: up to 60 GPM. tic semi -open design with rated oil and water resistant PP •Total heads: up to 31 feet pump out vanes for mechanical Bayfield Co. ZOnln0 - • Discharge size: 11/2• NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. •Temperature: 104°F (40%) continuous 140°F(60%) intermittent METERS FEET --_.__ . __..,..—__.._ _r_.__— • Fasteners: 300 series 70 , - ,.L... - . _ ` —, stainlesssteel. 9 30 - - __-- • Capable of mooing dry without damage to a ! i_ - components. zsFr , 7 j • EP04 Single phase: 0.4 HP, u 6 2a�--------- - 1-------- 115or230V,60H41550 RPM, built in overload with > s automatic reset. • EP05 Single phase: 0.5 HP, c 4 i - EPos RPM, built in overload with I EP04 automatic reset 2 • Power cord: 10 foot sr ------- ------r— --' standard length,16/3 t --' - ... .. ........ _ - _ .__. . SITW with three prong i ( .------"_ _------ grounding plug. Optional 20 0 00 - __ -"__._10 20 30 40 50 GPM foot length, 16/3 SJTW with three prong grounding plug p 2 4 6 8 10 12 m4h (standard on EP05), CAPACITY Goulds Pumps ITT Industries 18 Table 6 FRICTION LOSS (FOOT/100 FEET) IN PLASTIC PIPE Flow in Nominal Pipe Size GPM' 3/4 1 1-1/4 1-1/2 I 2 J 3 I 4 1 6 1 2 •• 4 5.52 V 5 8.34 6 11.68 2.88 Velocities in this area 7 15.53 3.83 are below 2 feet per second 8 19.89 4.91 9 24.73 6.10 10 30.05 7.41 2.50 11 35.84 8.84 2.99 12 42.10 10.39 3.51 13 48.82 12.04 4.07 • 14 56.00 13.81 4.66 1.92 15 63.62 15.69 5.30 2.18 16 71.69 17.68 5.97 2.46 17 80.20 19.78 6.68 2.75 18 21.99 7.42 3.06 19 24.30 8.21 3.38 20 26.72 9.02 3.72 25 40.38 13.63 5.62 30 56.57 19.10 7.87 1.94 35 25.41 - 10.46 40 32.53 . 13.40 .30 45 40.45 16.66 4.11 50 49.15 20.24 4.99 60 28.36 7.00 0.97 70 37.72 9.31 1.29 80 11.91 1.66 90 Velocities in this area 14.81 2.06 100 exceed 10 feet per second, which is 18.00 2.50 0.62 125 too great for 27.20 3.78 0.93 150 various flow rates and 5.30 1.31 175 pipe diameter 7.05 1.74 200 9.02 2.23 250 13.64 3.36 0.47 300 4.71 0.66 350 6.27 0.87 Note a: Table is based on - Hazen -Williams formula: h = 0.002082L x (100/C)'•e5 x (gpm`•ss d486") Where: h = feet of head L = Length in feet C ; Friction factor from Hazen for 1 -Williams (145 plastic pipe) p gpm - gallons per minute d = Nominal pipe size J J L i 770 Bayfield Co. Zoning Dept. 19 of 28 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_Lot of FILE INFORMATION Y L � �,ti.. - f �. 1:6 Permit # DESIGN PARAMETERS Number of Bedrooms .. ❑ NA Number of Public Facility Units NA Estimated (average) flow a O gal/day Design (peak) flow = (Estimated x 1.5) O Zg gal/day In Situ Soil Application Rate 7 ggal/day/ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) ≤30 mg/L Biochemical Oxygen Demand (BOD5) ≤220 mglL 51 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 lI NA Fecal Coliform (geometric mean) ≤104 cfu/100mI Maximum Effluent Particle Size '/a in dia. NA Other: I NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Tank Manufacturer U e5e.tr (^C., ❑ NA ]1 Septic O Dose ❑ Holding vol. 7$b+ / O gal Tank Manufacturer L NA ❑ Septic l Dose ❑ Holding vol. 5t'0 dal Effluent Filter Manufacturer PG 1 y 10 C. O NA Effluent Filter Model P L. SZ S Pump Manufacturer t≤ is v I d. O NA Pump Model p o i.// I Pretreatment Unit J@ NA ❑ Sand/Gravel Filter 0 Peat Filter ❑ Mechanical Aeration O Wetland ❑ Disinfection ❑ Other: Manufacturer Dispersal Cell(s) O NIA In -Ground (gravity) O In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip -Line O Other: Other: 1 NA Other: NINA Service Event Service Frequency Inspect condition of tank(s) At least once every: mear s s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) i1 When combined sludge and scum equals one-third ('f6) of tank volume PM When the high water alarm Is activated O NA Inspect dispersal cell(s) At least once every: ❑ month(s) year(s) (Maximum 3 years) ® O NA Clean effluent filter At least once every: ❑ month s) ON years) O NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ® year(s) O NA Flush laterals and pressure test At least once every: months) ❑ year(s) ® NA Other: At least once every: ❑ month(s) ❑ year(s) I1 NA Other: IR 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 efflient 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 (4) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurize mmor(ntt 4e&aLeinits, and any servicing at intervals of ≤12 months, shall be performed by a certified POWTS Maintainer. IJ A service report shall be provided to the local regulatory authority within 10 days of completion of any se ce e4tit. 172025 Bayfield Co. Zoning°'p'02 .. , .-p.. rwiY_Y Tax Parcel NoA • .. arced. of land located in the SE1/4-NW1/4, Section 16, Township Ock P •bed as f ollows • Commencing at the 47 No'x:'��11 PS."'KI 8 Wort r ( C'sG •a. West r •, 47 Nox:t]1, Ranee 8 We Nw LI1t ( riitt . LO]4flW'. Of �ioc;1 :tca��....0 ( WnfJh:�. -... : 1 o er : of road, t1once 4 South along the Section Line a c�:�..� acne of x;622:`5 feet to an ironpipe; thence angle . to the left 87 deg gees 26' a distance of 1,178.6 feet to an iron.pipe; thence angle to the left 14 degrees 19 distance 8 de rees 15 a dis 2 • O to an iron pipe; thence angle to the • left g tance of 9.25.7 feet to an iron pipe; thence angle to the right g 90 degrees a distance of 1,011.7 feet to an iron pipe which is . first point of determination; thence angle • to . the ence ht 9 0 degrees a distance. of 1,035.2 .afeet to distance n of 45 p5 pfeet to an iron angle to the left 27 degrees o4 pipe located on. the water's edge of Peterson Lake which is known thence retracing on the same line to as place of beginning;thence angle to the right 9.0 first point of determination; degrees a distance of 67.5 feet to an iron pipe; thence angle to the right •0 . degrees a distance of 980.8 feet to an iro33nOpipet thence' angle. to the left 46 degrees 04 a distanceof to .an iron pipe located on the .water's edge of Peterson Lake; thence 'in a Southwesterly direction along' the water's edge of Peterson Lake a distance of 100 feet more or less to the point.of beginning • JUL Bayfield Co. Zoning Dept. ... '"i" 'J . .�.?.=;it:`:•eY;T7Y.F :�::: a•..;1',rr'.tj3tiJ.•y::`wlW?';:•Y_:`.°`..:. Y..•:t;, viii .: •`•. '•:' - ., .. purpose only) on Peterson Lake, located in -the i4 Parcel L (for reference North, Range $ West,. as follows 3 SE_Nw Section 16, Township 14.7,North, Range C�-<n enc-i ng at the Northwest corner of 'Section 16 , Township 4+7 , --•` ° _ distance. of 2,622.5 feet to once S�-,�t a, �n the Section line a �s_s.. _ ut..� _along the cente _ �.. =�- �7 degrees 26 minutes r �' ."�+.. w S:" -r - :r '� - ...� rr degrees _ t r r:, T •_ `y;_ n air Z... r. �. s• �. ,:.�, :ri: •fie! .:� o;.. '-a. t!t.` "" .�. ••t. ' •- �,��:a.i.. a. r..s .iw, fi- V. r"!. 1DD 'rte? Y C � di.s: a � ... ::.::: . - feet ru• o aa..: t� €#'i'1 •p_ .. x u G `? r � f'.'•,:�+� :����':.:,y^�:: x`O.�"� .w... 6.3�•+�.r'i�'•Ja...�v,.. S�.....� . i: ...;..:. :.. a: distance::::of ::9 5.17 feet to an .iron: pipe, thence ::ankle : to theright ::.40.. - degrees ::a distance of..:946.0 :f:ee.t to an iron p i e which is first point of determination, thence ankle to the right 90 r• degrees a distance of 1,035.2 feet to an iron pipe , thencea� located the lth eft 04. decrees 09 minutes a distance of 95.0 feet. to an iron pipe shore of PetersonLake which is known as place of beginning; thence retrac- ing on the same line to first point of determination, thence angle t.o the. I right 90 degrees a distance of 65.7 feet to an iron pipe, thence angle to i the right 40 degree -s a distance of 1,035.2 feet to an iron pipe, thence - anle to the left 27 degrees -04 minutes a distance of 45 .7 feet to an iron .axce io_f tc w a:-iaa.Itie f. cent in;,red on other side) `T; .w .„•ice . .w.d�T'� .o'. r s:.� :�Q :t� ....�_-�..r..r..r p S� y D 1i JUL 17 2025 f3ayfield Co. zoning Dept. 0 024103608000 o V 477..,P.51 12.5A 4 ti �11 1343.30' 284.90' ` 197.50' 65.20' 65.7D' b7.50' 143.40' N l 1�4�4 - M oaa rN Ii1P1 a aCova OCL-< 0 024103706000 { 02410370100.0 V 4f2 ,P 377 n { N> { o V513,P325 5.0A o 6.6A v I .n o 0 J° ryf I N> >- 3 • 1 • 024103707000 I V384,P17 c { 1.64 A• n' LOT I CSM V3, ?'308 M iq p J:*i!* ( SEE MAP 16478C ) Private Sewage System Maintenance Agreement L. I AA . %a.J a r' fifyCJ J /I�.XJ� Tic w4 Owner(s) Mailing Address a��/i % . 39135 Site Address R V_ Oo y/aZh7op//JO(, may.),1_) te,xig3� I Ms owner, i twe) eo nereoy certiry the private sewage system will be Installed 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) ,5 1/4 of N &114 Section ��Township 4"7 N. Range 2W. Aadltional Legal Description: , .5 a t /9'+ /= Lc.tl_ _ Town of L ✓d41 RIP' (Acreage) Cov't Loi Lot _ Block Subdivision Lot _CSM #_ Vol. _ Page _ CSM Doe # UO UMEri r N'JMeER 2024R•-604490 Area Return To; >. /S'it IPIsy jts(� o / ©,+I'i3°K Szz Eros 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 manufacturers 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-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. Owners) agree that failure to comply wlth this agreement will result in action being taken to pay all charges and costs incurred by Sa}Teld Crunty 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 miles 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: Thnte) E. NelsovL A-lcc3t.�s t 19, 20 zq Notarized Owner(s) — Signature(s) 1c::j.LLA:2$;k;I:'- �€s4..3 Notary Public My Commisslo spires: Jxrnuary 3t,°2 Drafted by S trio t(d1 1 ffiV II Proofed by. 4, 1 q S JUL 1720L5 Pr sanitary/sepdcmalntenceagmement V,=NotWyPubIIc-Mi�nnes6ffPr 26 Revised July 2020 Bayfield Co. Zoning Dept. 6)Z - o O21 &t SDI �'E5 ARTAI �r "`,"''� • Wisconsin Department of Safety and Professional Service Page_ of Division of Industry Services SOIL EVALUATION REPORT '`ssc 4 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, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. D Et /, 3 1p scale or dimensions, north arrow, and location and distance to nearest road. 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 b4 h' er E,/ e S 0 h Property Location 7, P4 v t'E .( n ie D 11 gelSo" ."vi Iv L • ry c 'i -0- c f �a Y, f Govt. Lot sE V. jj W'/a S ! ( T L(7 N R if E or Property Owner's Mailing Ad4ess .r Site Address or CSM and Lot #: 2.741�' %Iete ten .9IV cis- i; `J ,,,rso �� �r 1's .J �� City State I Zip Code I Phone Number O City ❑ Village Town I Nearest Road ! ® New Construction Use: ® Residential/ Numberof bedrooms 2• Code derived designtiow rate30 D GPD JReplacement l . ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material at"S-144— a S t • d I General comments and recommendations: a Boring # ❑Boring (SPit Ground surface elev. 95, S ft. Depth to limiting factor _731n. 7 in. I elev. ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 1 0-.5- i o Y R 3 /1- jJosJe 4 L 1--l= 4 k lei! V --y a 5 3(c Z f- is S o /V C' LS c we v -v S Z w, .7 /. 3 ID -� 3 s s/ S 0 A4 L -- / ✓- . 7 I2. I Boring # [IBoring j1Pit Ground surface eiev. 1'0. Depth to limiting factor in. / elev. ft. C:l Annlinfl4lnn 0/Jid Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 D- Jo'?_2/.L a - S L I -f `vt V v iq .r . 4 r !i7� -1e oiJe L CJ d / WL 1 �( S j3o.. I ni .I • / L• ( )3-13 s Yom. s owe o wt CST Name (Please Print) All 9 YI I +Doi i>0 / -as A� , Signature. ,. CST Number Address • 0. BE, k SZ2.. I Date Evaluatio Can c Telephone Number Yeti * Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 50 mgt 1 7 nt =•BOD, 5 30 mg/f.and TSS 5 30 mg/L A SID -8330 (Ri4121) Bayfieid Co. Zoning Dept Page_of S a Boring # Ground surface cloy. _9 ,eft. Depth to limiting factor ' in. / alev._(t. c..0 w....I Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/FN Elf#1 'Efd12 oe-4 'oi'R3/ O"f St. I-1ci IC lVltl-'✓ 4S 3to •(o -ly c%-Z≤'/L jciosie L.S 4GAk vnv-Fv 4 s z .y t it -/of i 7-z S/ o N- $ o WI L — v .7 ❑ Boring it ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. I elev. ft. cnil hnnlir,dlnn Pta I Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPD/Fh Eff#1 Eff#2 fl Boring it 0 coring 0 Pit Ground surface elev. ft. Depth to limiting factor In. / elev. ft. sna A-11-1lnn P.I. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont Color Texture Structure Or. Sz. Sh. Consistence Boundary Roots GPDIFt2 Eff#1 Eff#2 ' Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 5150 mg1L ' Effluent #2 = BOD, 5 30 mg/I. and TSS s30 mg/i. JUL 177025 Bayfield Co. Zoning Dept. p r ir&. J Y o h $ 1 4 f ►Li .. 110"F : 1 l �IrY!'J � /1� gcAL l Q.o 1" j V f� �i-�iV1 4 t v' iIi t� 1 J� ! • (J �E:+!/'t7 .. u 6. a�' ® �'-�.. r Pi L �Ye 4vs/1 j�? 4it UCL I V e2 �' ✓•e ✓ w� v l% ? ` y 6!Cl 5 T' z.z,raoyo r 5 J4k Task as `70 ` /len w;ese4 t4NGve.4ee ? a j, o �, � o P� 11 !.. q3 �✓. a � d �o' y "�ON1 bta`�•c+.-� o• 'ij..i ••% 18trtJ, rt �� �ic�`►i t �• ,, A� �•� °o 3N 4 tA, �4 t, •-PT . 8•h 'j ' 1 'r iy �J'g jr►{p L.. rMaki �•o trameA •w• ` 1 { •.SP.I .=i 17aE. Qo k 5-a a( -a9 v1'�� '�� k.4 atctvsa•e,�cr a-4rra (�a �+ip as w , �r.3� s•EPr,e- r R.t d V �4 fN S r Ae Gr-e-•/f.C! a �M1-p�,'r.�✓c,L . , (i-PO IokrtodeI �i.•-sox •-• , . 5) q, pvc. Ppe. A5Ti'n b!�$5 «- Se.h SS0R32r p%K= p p . 'S AS-rm o303Y "PP'- ?.pe w w 4 Imo. r '/1 Q ; u k 0 `J. ,tr L- J_ S4` 0 tt -i �r N N l' a ` V 'L .N cm �JJ Far 1a/1 tIll JUL 172025 �G tlj� .:.i 1 b C -,r, 6'icL / � w:T •tvv b 30 t."\ r /ft\ ynVa+ G J, \T -T, hV'O - 3 1 ci u O (I kN b r 'O pro ;es.ect 1:1k a°• Bayfle)d Co. Zoning Dept Perape.4y ©uvV .ro Cr;r+vter5 )& A I ld .. b --i,[.5©11 •7 qj -, f4aZe-enc4 1I�4 A ion 44 ' fi�► $ g x113 r S .V • 3 a '3S `Sc� ( ^•d S a Jrcl r p 00 L a s64"; p -k11•0- SE MU 6 -C-'Ip T 47N R r w of Z P4 v c. e IS art `i-i t Q •4` -T'aw w. 0) 'Z r 'j J Cu?4-4f 4 i BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) [ Check List 9 Original Sanitary Application (Submitted in Deed Holders Name — no prospective buyers) (383.21(1)1.) C6 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) i' Original Plot Plan (383.22(2)2. 3. & 4.a) f6 Cross Section, Over -Head Profile of the System a.�.d.. Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) E1 Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) L1 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) i1 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) I. mp1etg Set of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached_ to all copies Iii!' Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary A a� licaIon: (Include the following Information) i7 I Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) ® Project Address or Road Name where driveway is/will come off of) i1 (Owners Phone Number) II Type of Building iI III Type of Permit 56 IV Type of POWTS System i9 V Dispersal / Treatment Area Information ix' VI Tank Information 9 VII Responsibility Statement (Plumber's Information) 0 *Date Stamp* Plot Plan: (To Scale or To Dimension) Signature and Plumber Information iV Surface Elevation of Body of Water l0 Direction and Percent Land Slope E'Tank and Filter Information and Location 9 Wetlands / Navigable Bodies of Water II' Absorption Area (Proposed and Existing) r Bench Mark (Location, Elevation and Description) Nf Component Manual Version JUL 17 2025 Bayfield Co. Zoning Dept. (9 Address Number and Road [f North Arrow [1 Contour Lines [i' Structures and Driveways l Boring Locations d Property Lines C ( Well Locations 9 Legal Descriptions Turn Over ► .t5tJlii i, Department of Safety County .fie -e- & Professional Services, Industry Services,Division Sanitary Permit Number (to be filled in by Co.) v4l�NMt�Nr (D 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 Project Address (if different than mailing address) submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stets. C7 LI 15 I 1 CW op� —I W I. Application Information Print —Please All Information - . Property Owner's Name e�I sbn �awt. �r •. fed 1 a tTvters DG ,e /eso Parcel # f-)<1 D Property Owner's Mailing Addr •s Z7&11 0 Halite-KCct 84Jd 1'r 67. Property Location ' l Z-� b I Govt. Lot � �Q vL•2 l$rH+ City, State / 50✓ Zip Code i Phone Number sE N'W , T� rat n S I'-- 34 35 S^D7 3gZ-q-177 ¼. %, Section T 3[ 7 9 II. Type of Building (check all hat apply) Lot # I or 2 Family Dwelling — Number of Bedrooms N R Subdivision Name Block # ❑ Public/Commercial — Describe Use ❑ City of ❑ State Owned— Describe Use CSM Number ❑ Village of 09 Town of S✓a... 72�vC1r III. Type of POWTS Permit; (Check either "New" or "Replacement" and other applicable on line A. Check one box online B. Complete line C If a livable. ._.. A. New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) ❑ Holding Tank in -Ground ❑ At -Grade 0 Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration Dis ersal/Treatment Area and Tank Information: IV. Design Flow (gpd) ADD Design Soil Application Rate(gpd/sf) Dispersal Area Required (st) j Dispersal Area Proposed (sf) t137 Sysicm Elevation .7I q2 93.5 Capacity in Total # of Manufacturer Tank Information Gallons.. Gallons Units c .� O New Tanks Existing Tanks 6U mPa rn ii:U a septic u'fifuldng5,ak 1 '�DT gyO Ico 2' Wp�'$tV CGt'1. �, r Dosing Chamber OO -- Soo L t t l r V. Responsibility Statement- I, the undersigned, assume responsibility for Installation or the POWTS shown on the attached plans. Plumber's Name (Print) t Plumber's Signature Ali�o �%—Os �--� / $ '/MPRS Number Business Phone Number ��c�r//jti� �h � 22009 O 71SL4a-�i/,S7o Plumber's Address (Street, City, State, Zip Code) VI. County/Department Use Only Approved 0 Disapproved Permit Fee Date Issued y'Issuing nt Si ature $ ❑ Owner Given Reason for Denial yoo— 1 as 2�m''' Conditions of Approval/Reasons for Disapproval 112025 JL Bayfield Co. Zoning Dept. Annex to mmnln,n f...m.,e.....,........a ..e....u._.,._r_.._... __.__ .. _ _ ...p ....p on I.nyv nu, lea mnn a ."x i r Inenes In 51Fe e_ SBD-6398 (R 03/22) I • SSh� j I 5 � p � ART1Ug�� Wisconsin Department of Safety and Professional ServicJ Pa e ` of 3 Division of IndustryServices g 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, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. T scale or dimensions, north arrow, and location and distance to nearest road. ! . t b f 3 Please print all information. Reviewed by i Date Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). Property Owner is 4 h' e- > I f- S O n iI Property Location 7- F4 or z * '1 C. ( Soh Yt'1 i w e c .j -Q. �v -t k Q y Govt. Lot $ '/. W% S / ( T 7 N R E (or)) Property Owrrner's Mailing A ress 1.� Site Address or CSM and Lot #: r Z71i1 G. Q C i 2 n j V A -1 3'2G f/ trt� i t •-J o< < �r r� u �c i� d City /I State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road tq S �� n L 3 13 Sr (5�7) 3 ��� .L ✓ h P--& 'j -e r ' w"c4- C g] New Construction Use: 4M Residential/ Numberof bedrooms 2 Code derived designflow rate30 0 GPD 7 Replacement , ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material 6-14_4 C "1e I I General comments and recommendations: a Boring # ❑Boring [RPIt Ground surface elev. 95.5 ft. Depth to limiting factor 7 73in. / elev. ft. CI -11 A __II_ -at-_ T -a - Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cent. Color Texture Structure Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 D-3 ll//jj to t'i.3iL 0/ e C f 4+ L /��G�/r. • 1 4 k �,/ -��! kt V i✓ /� 4 J .36o f 2 S --JO 5-Y-9 s- a N e LS j4c1,L `vc v-Fy IS Z *n .7 /. 3 It' 3 S s t'1 S o ML- - i,42 •7 I a Boring # ❑Boring JIPit Ground surface elev.IZZ0ft. Depth to limiting factor )3 in. / elev. ft. c -t1 A __11_ -at-- d -a - Horizon Depth in. Dominant Color Munseli Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 JO -.2/,L a . 5 L I. f 4 J Je 3--g3 sY -s 1Jie o wt -- / ✓ 7 CST Name (Please Print) �� r (1,i/) s�e k Signature ,. CST Number Address .2 O. BE, yc £2.2. Date Evaluatlo Con c Telephone Number * Effluent #1 = BOO > 30 s 220 mg/L and TSS > 301_x50 mfr 7 2K9nt Y)=.BOD,:g 30 mg/L and TSS 530 mg/L J �. SBD-8330 (R04/21) Ycjv Xa ► )ayfietd Co. Zoning Dept. sI ;s",. hvan4-ra,�.'c.I So< < Ap6sae���i a !Dtr&v.J h Eye Po l kOS11 Pl v►•" 4 /A1 5c�a.l t'��'I�" �(h t�c.$s M® ��. f t'� p , l�• �e ✓ � �! ? Y -X am. P= E%v. p.m!=tz /*J6S 3 a ' & 001 Q $' 54% ...� Y Ta'e�� 97-5. ��ir,� C5i' �' Zz•�o�o � `l0 o t' • z: Sep+ c, nk ► %7y"� gilt'L:- 93j/ii✓. a v� d � � 0 1 1 y-Fr'ovn ba ��• c• (• YL ?��:��Nv i w� k .- ' .e*5 4 l "/ ! l f'•-��� �. yYla �o lit �-p 'iv Kc.L, t�f /fir► f 1)_7)�'�7ul k '1 5�Q►, .av i;'.-"h;9 je�cl=i �y `dcltca�p ^a/ is aCLO�+�n4s�+.f/paij w; '�t� SPS 3.03 $e -p' 'T.sk.. Y ¢}'�v �'7GdLf•C �/ F C4�`')P.,T✓(.��, sl Q 6 f�cs Y • r/ •0ki/i�V! pf+~ Zo7 5•4h qo Ai•ri 1D!5 - as Ppe- .s 4sTI 3'i eLPP"- pd�� ,v►a�-e�rd ��l 4 o ` a_ • . -. A... C1-. LL N1 (+ td vl N :s j' • t c, ya r. s �JJ-c•+ •.._ X • a.. - o jIi 11 ++ Uh•;c� w �� 1 'Fte� ` _fl ' • t r•E I L/I.`J W t( !.) t,e% w[io� +L S dpi 1 •1 �a' � ��uy IjQ L44� J�y ea '\� 4; jy\36'_..� � j � •, ASS s, O (/ cs �i � O v'.• + s 8 gore$ �ti6tr� C@vLee o v C � U l�1 U d '•\ a. JUL 172025 U 3ayfield Co. Zoning Dept. Piro p e r4y O .0 t e. y' .. Ca. K r EM. ! Y ra 7c.. =7&9[ Gs.c`ia -taci4 ©r1 i 4 3(13I 5 0+ L� j a SE 9M/.4sce.H 17N RrW v VSO+' - Cc. p e v �..-�.� p64•erun�id�• •des @Q"AfG. VC.t•F lo, jolt.$ : flU�cj 1-� • a. a.�r�_ •., oft O -F m i7 (.o✓y )€nt'®vtcii BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) (9 Check List 121 Original Sanitary Application (Submitted In Deed Holders Name — not prospective buyers) (383.21(1)1.) Rf Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) [if Original Plot Plan (363.22(2)2. 3. & 4.a) 21 Cross Section, Over -Head Profile of the System n4 Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) 6if Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) 67 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) 21 Fee (Make Check Payable to Bayfleld County Zoning) (383.21(2)(c)7) 9 . Comolete Set of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) I�' Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary licati n• (Include the following Information) 211 Application Information must include: ❑ 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) ® Project Address or Road Name where driveway is/will come off of) [6 II Type of Building ® III Type of Permit i9 IV Type of POWTS System Rf V Dispersal / Treatment Area Information Ef VI Tank Information 55 VII Responsibility Statement (Plumber's Information) ❑ *Date Stamp* Plot P • (To Scale or To Dimension) 21 Signature and Plumber Information it Surface Elevation of Body of Water ® Direction and Percent Land Slope lr'Tank and Filter Information and Location E11' Wetlands / Navigable Bodies of Water l9 Absorption Area (Proposed and Existing) Q Bench Mark (Location, Elevation and Description) (Owners Phone Number) JUL 17 2025 Li Bayfield Co. Zoning Dept 2f Address Number and Road lS North Arrow C7 Contour Lines 9 Structures and Driveways [21 Boring Locations d Property Lines 1121 Well Locations 21 Component Manual Version 6 Legal Descriptions ❑ Piping Material Information (conveyance line, building sewer line, material type and diameter) Turn Over ► Cross -Section and Over -Head Profile of the System: Surface and System Elevation ®'Position of Observation and Vent Pipes 1' Dimensions and Depths V Make, Model & Number of Chamber Units in each Cell PronePronerty Information CI How many systems will there be on this parcel of land? L ❑ Has this property been split? 7- O (Property Statement shows Property History) e s: Ed Private Sewage System (Septic Tanks) $ 400.00 O Private Sewage System (Holding Tanks) $ 400.00 11 Mounds or Systems requiring Pre -Treatment $ 500.00 ❑ Sanitary Revisions $ 25.00 ❑ Private Sewage System Reconnection $ 50.00 and Private Interceptor ❑ Return Inspection $ 50.00 tS Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) u/forms/checklists/checkllstforsanitaryapps (10/2009);(®7/2011);(®Z/2012)(®5/2/2012 -dc) Proofed by: May. 5. 2017 10:41AM BAYFIELD CO PLANNING & ZONING No, 9975 P. 3 PAGE 1 OF V In -Ground Gravity Plan Index & Cover Sheet Component Manuel Design References: Version 2.0, SBD-1 0705-P (N.01/01, R. 10/12) Pg 7 of S Pg 2 of g Pg3of$ Pg4ofI Attachments: a D Index & Cover Sheet Plot Plan ept_T 4Cy&&Section & Plan View- Z i CJ J Management Plan POWTS Applicatioi Soil Evaluation Rel Pu A -p S'?..td s _ 3 Project Name I Description for Review ( S4nf4 rr pe v:% ,rt&Site Map-tpcsel rein-c.tD-pC54) L'1 I>anic ( � /J'e.,lsan Owner Name(s): 14Json (a ni, l c.-: m'. 4€i P v4kersphone: S°7 - 38 z - 1/777 OwnerAddress: Z7e91 h;€ -d. £ $oJ ucvJ Ja } iP 3y� ue' rS PL Project Address: '7t/ / S , I w cno GA ✓n�q ✓o J vec[ �. 1� '4O"?l i • J �v �Jl S Y�y, ZIarceI5'n +Le, -5'r_1/4 of /J /1/4,S n llv1 T WY N -R' E❑or W® Township: jIv s, „ iZ I J -C r County: i34r 7 e e l ci Project Parcel ID #: i c 1 Lb 1 '134' & Designer Information Designer Name: A1(4 n ?o / ko s k; Phone: 7/C-37-______ Designer Address: P -a. 3 ©)c Szz_ J ro.-, `Z , ices ' tJ i Zip: SV 8L17 E-mail: o n y & b ec rcj u.' C o r f I Co a'i'l This space reserved for approval stamp, License Number: Z2- C 0 90 Remarks: JUL 17 2O25 • �� Bayfield Co. Zoning Dept. t _____________ Signature: Date: 3` 2 f .- Z S ginal signature required on each submitted copy. BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): k'1 Check List l Index Page / Title Sheet (Optional) [97 Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) 21 Original Plot Plan O Cross Section Soil Profile Sheet (optional) O Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) m Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used El Property Owner's Information (rLot prospective buyer's name) m Property Location (Accurate Legal Description with Sec/Twp/Range) A Road Name (where driveway is/will be coming off of) 121 Floodplain Elevation, Flow Rate, Comments and Recommendations 21 Complete Soil Boring / Pit Information 121 Date Soil Evaluation was conducted El CST Name, Signature, Number, Address and Phone Number ❑ *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) d Bench Mark (Description, Elevation and Location) R1 Contour Lines (Example = 98.0' /96.0' /94.0') m Pioperty Location (Sec/Twp/Range/, Accurate Legal Description) m Borings (Locations and Elevations) 0 Percent and Direction of Land Slope 0 Well Location (Including Neighboring Wells, if applicable) 16 Location of Wetland Areas, Floodplain and Navigable Waters 121 Buildings, Driveways, and Structures (Location and Descriptions) Ed Location of Property Lines 121 Existing System Location IZf Address Number and Road Name d Current Surface Elevation of Wetlands and Navigable Waters d CST, Owner and Property Information 1 North Arrow ECEoVE 0 JUL 172025 Bayfield Co. Zoning Dept. Fee• III Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforests Cs $tJI i &p;_ jvJ pranJ' 8y i�oi(Co ic: lei✓.ly;, S'cn1I"=Ha'un(ecsMWO-4 Cnue.t�iu�c/ ScI bsvr�{ipnv�, P0.E;.+auz2o.-1�'tuct�_ Ynpan�.n•%74i:nucd USedo 1'V 'tr"., K-je-. U�2:r/'r ' * ex r ✓Apse%v. /mo.m!cta/+k'≤ab—Io OS= .oa/oltjticjiz) C 5 T O y mom c 5ysd em El ev: 93.6' 4 o ak.1T31&/ $o se?+rc.rc,k170trgaltonwtesercbncre-4e �"L_13/',L and t€..x1sb . L I 't from bn/f.,...-f't.•' a le�✓I°,e�,de� `✓y(J'i"/C lan �t y'l �il{'✓GTc1=Q ili ��'.::Y<...w epc/.: 3'1 'vJi vlt�;r��/+�:@.ny !�"N'61y�Y-B'FL. ✓/1a.li �o 1�'hn tren��n iimi; /l 1 / )�/12 h:yL, k.tc4��✓/�iG.�tn)e>jba..rav�2/snton�f�7:aN w; --h .sP53.$3 Sep i'.G /q.trc OUrl� 4N✓$(- /,oV€ TQ '.pp 7✓./. 4: "r; jis". +•`. "POI£,/Ie kYYLoad. 3 pC�Zc• MQ•�@Na tal ap 5wh1 0 p✓c �:P�i's Ann1 b; U— 55oh 50,135 PVC p:p.. /s A5 -m i p e3 ( pr ?.i ran' t v1 )� i t7 1 1Ac-k-.' i s (-I- o, Cl. •' N t) N 1` '1 ci Z ° •G S/ 1"tropedy ©WneV`o. / f 1'(is 'ceort Cann. IY t.;r.7f.C n�r.r{-vlQrs iDG.rt6.1 0. a.E ls0ri -7491 C. 14at/ )eI4 A Til ✓� C) G Yrapnsct e Std k•* Atsl trice. TJ cn<1 'un ISY" ICI fI -F ad ce,t Lct � c - i klla )° J .+ —30 f\A P l' \. -, 4° q , �Eay '�S�R�cld --tnn.rr uI°I�D JJL 17 ZU25 Bayfield Co. Zoning Dept L!N\. tl r6E A J 'I Leg b ¢3tv p' '; en SE pA "4 sec4 Ty/jN R 5'Ur Z tvCe Is ,tLe-5 —5 TOWN OT l✓c.� .�. J E✓ Q.u4l.y4 E<iy/'E C rj iou p.- aorY�c Ora or4(•1 xTT 2 r±li'.F4{'d 'r Lpl �7 p as WLP750- MR TANK SPECIFICATIONS 4" CAST -A -SEAL BAFFLE C� 0, �N1 N 01 O o TOP VIEW nm Cr' m ^^n V , @ 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. LIQUID 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 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 � U M U PUMP PAD SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: N < O N z I < a n U � a in U45 W 0 SHEET NO. 1 V Go GoGo W CD a 0 W w n: V `0 W w IC N Go ,-a u� Co in N rn 0 "a 1131" 4"` ST -A -SEA II t� III FILTER OR IIII BAFFLE IIII TOP VIEW SIDE VIEW W840/500 -MR TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1/2" BOTTOM: 3" COVER: 5" MANHOLE: 24" LD. PRECAST CONCRETE RISER HEIGHT: 59 1/2" 0.0. LENGTH: 113 3/48" 0.0. WIDTH: 93" O.D. 4" CAST -A -SEAL BELOW INLET: 48" O.D_ LIQUID LEVEL: 43" WEIGHT: 11.150 LBS. %t/f (/j Vi t� v C) fl, '0 INLET AND OUTLET: 44 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: 19.61 GAL/IN (SEPTIC) 11.82 GAL/IN (PUMP) Y ll oII E o Q € E W r—_ `J NiLOADING DESIGN: 6' 0" UNSATURATED SOIL C v u7 C� __ o0 TANK CAN BE USED AS: 4" VENT SEPTIC/SEPTIC, SEPTIC/PUMP OR SEPTIC/SIPHON W 2 I COVER: MIX DESIGN #8£N0 FIBER) TANK: MIX DESIGN � #10 (STRUCTURAL FIBER) Lu . b _ OUTFT CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WESER CONCRETE TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS J a I I 2 o ; N � 00 WINGS SUBMITTED 13 N FOR APPROVAL APPROVED BY: SHEET N0. PROVAL DATE: 1 DDUCTS B N / NEEDED BY: AF _ 1 SEPTIC TANK AND PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS Vent Pipe Locking cover with ≥ 12" above grade warning label and locking device and sealed Weather Proof Junction Box. Electrical as per NEC 300 and ,✓� cg �� Comm 16.28 WAC 2.uc.nt!cclp Disconnect 4 in 4,F . I 18" min. Alternate outlet 1 Force Main �� Diameter. 1 Approved Building effluent filter Length 1OO sewer ≤to 1/8" particle size A S o C �4j Weep hale or anti siphon device. B 9O 4! 1 u.� C Pump Off Elev. _ - D i If Dose Tank Elev. 8 ' Bed Tank Anchor tank as necessary to negate buoyant forces. Tank Manufacturer: ui, eser Cone.. Tank Sizes: Septic 4D +15Gallons Pump S�0 Gallons Note: All pipe and vent materials comply with $??5-383 Gallons Per Inch: I / -8-- Liquid Level: `l3 Pump Manufacturer: 66c o I d Pump Model: E.PPC), q I I A Alarm Manufacturer: 5ef4- " ' `-S Alarm Model: Srf ZSc J Doses Per Day: g GPD/ # of Doses: 1≤ gallons 1004.143_ Backflow: I b gallons Total Dose Volume: '11 gallons Required GPM: 3' Dimensions Inches Gallons A 17 a co B z 2 C 1.7 / D R,3 IS5` Total Vertical Difference between pump off and distribution pipe I Minimum Required Supply Pressure (0 for dosed conventional) Z "d,4m la0 Feet of force main x 3.3C friction factor/ 100 Total Dynamic Head ©Wrn,e..r. tko"1 �c.mi y Li 4 f«✓tnev5 Pa..trL ( t-e/s° 13 X161 Bayfield Co. Zoning Dept. = 3.3 P/ow 1sr`(\/(aI oskt LzooO NGOULDS PUMPS �w- d� y, APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet • Discharge size: it/r° NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°f (40%) continuous 140°F(60°C)intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor. • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V or 230V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 SJTW with three prong grounding plug. Optional 20 foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ■ EP04 Impeller: Thermoplas- tic semi -open design with pump out vanes for mechanical seal protection. Submersible Effluent Pump 11 EP04 & E PO 5 Series ■ EPOS Impeller Thermoplas- ■ Bearings: Upper and lower tic enclosed design for heavy duty ball bearing improved performance, construction. ■ Casing and Base: Rugged thermoplastic design provides AGENCY LISTING superior strength and corrosion resistance. Canadian standards Assodalion sp'File #1838549 ■ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. • M Motor Cover: Thermoplastic cover with integral handle and float switchattachmentpoints. JUL 1 j 2025 ■ Power Cable: Severe duty rated oil and water resistant Bayfield Co. Zoning pepL METERS FEET —_.. ..__ _ ___.. to T--,-. a ; O ' i EPOS l 2 . sF------.___.. 1• a• 0-------- 0 2 4 EP04 IIL1E'EI±h 30 40 50 GPM 6 8 10 12 m'/h CAPACITY Goulds Pumps 18 ITT Industries Table 6 FRICTION LOSS (FOOT/1 00 FEET) IN PLASTIC PIPE' Flow in Nominal Pipe Size GPM' 3/4j 1 1-1/4 1-1/2 2 3 4I 6 1 2 3 3.24 4 5.52 5 8.34 6 11.68 2.88 Velocities in this area 7 15.53 3.83 are below 2 feet per second 8 19.89 4.91 9 24.73 6.10 10 30.05 7.4] 2.50 11 35.84 8.84 2.99 12 42.10 10.39 3.51 13 48.82 12.04 4.07 14 56.00 13.81 4.66 1.92 15 63.62 15.69 5.30 2.18 16 71.69 17.68 5.97 2.46 17 80.20 19.78 6.68 2.75 18 21.99 7.42 3.06 19 24.30 8.21 3.38 20 26.72 9.02 3.72 25 40.38 13.63 5.62 l �9 30 56.57 19.10 7.87 1.94 35 25.41 - 10.46 40 32.53 . 13.40 3.30 45 40.45 16.66 4.11 50 49.15 20.24 4.99 60 28.36 7.00 0.97 70 37.72 9.31 1.29 80 11.91 1.66 90 Velocities in this area 14.81 2.06 100 � exceed 10 feet per second, which is \ 18.00 2.50 0.62 125 too great for k 27.20 3.78 0.93 150 various flow rates and \ 5.30 1.31 175 pipe diameter 7.05 1.74 200 9.02 2.23 250 13.64 3.36 0.47 300 4.71 0.66 350 6.27 0.87 Note a: lame is oases on - rtazen-wuuams tormula: n = U.UU2082L x (100/C)"' x (gym's - d4.8655) Where: h = feet of head L = Length in feet pp C = Friction factor from Hazen -Williams (145 for plastic pipe) D C U gpm - gallons per minute d = Nominal pipe size JUL 172025 Bayfleld Co. Zoning Dept. 19 of 28 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pagel of 2. FILE INFORMATION . erlso h fc, r.t, i L..14 f e P4 r f-r�evj Permit # DESIGN PARAMETERS Number of Bedrooms j. 0 NA Number of Public Facility Units ;( NA Estimated (average) flow a o 0 gaVday Design (peak) flow = (Estimated x 1.5) 3 O r9 aVda y In Situ Soil Application Rate 1 aVda /ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) ≤3O mg/L Biochemical Oxygen Demand (BODs) ≤220 mg/L (9 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) ≤10cfu/10oml Maximum Effluent Particle Size 14 in dia. 07 NA Other: (l 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(Maximum 3 years) 0 NA Pump out contents of tank(s) 09 When combined sludge and scum equals one-third (114) of tank volume 0 NA ® When the high water alarm is activated Inspect dispersal cell(s) At least once every: 3 l year(s) (Maximum 3 years) 0 NA Clean effluent filter At least once every: ❑ month s) � year(s) ❑ NA Inspect pump, pump controls & al At least once every: ❑ month(s)arm year(s) ❑ NA Flush laterals and pressure test At least once eve ry month(s) ❑ year(s) ® NA Other: At least once every: ❑ month(s) ® NA ❑ year(s) Other: 5Q 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 (4) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurizes f�b mWor{ntE rOe1i4atbtepk)(tflits, and any servicing at intervals of ≤12 months, shall be performed by a certified POWTS Maintainer. liUn(J U A service report shall be provided to the local regulatory authority within 10 days of completion of any sece gy+ytit.1 7 2025 SYSTEM SPECIFICATIONS Tank Manufacturer W., eStr C° ce'1C- ❑ NA IM Septic 0 Dose ❑ Holding vol.7519.f8 O gal Tank Manufacturer L NA ❑ Septic ISI Dose 0 Holding vol. gal Effluent Filter Manufacturer PC I Y 1O C- ❑ NA Effluent Filter Model FL. S2 S' Pump Manufacturer -o u DNA Pump Model E po &// I Pretreatment Unit W NA ❑ Sand/Gravel Filter 0 Peat Filter ❑ Mechanical Aeration 0 Wetland ❑ Disinfection ❑ Other: Manufacturer Dispersal Cell(s) 0 NA IS In -Ground (gravity) 0 In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip -Line 0 Other: Other: 54 NA Other: p@ NA W 12/02) Bayfield Co. Zoning Liept. 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 falls 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 falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ 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. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER `� e,, d POWTS MAINTAINER -. Name I to ', ? , I te, Q S � d C Po 11 v5 k 11`�1e3ba�d&?n � Name 1 tca , mss ka ! kc.� , ?L . ✓d5� Phone ?d 5" 15` Phone 11S 2 °cf z . q d ≤ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 5 ?c,IkLosk, ( r ecq4g Name Ba ; ra Phone uS 372..- Phone "7/ ;�'i �•-(s f � 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. _- - - Tax Parcel No_ c -z I A parcel of land located in the SE1/4-NW1/4, Section 16,'Township��� l 47 Nni-11) Panne 8 West, described as follows: Commencing at the Nut Cllw,rcf. L(ruwr U1; e;oc11cm 16, Town;:ha.p 47 North, Range 8 West in canter oL road; thence South along the section Line a dis- tance of 2,622.5 feet to an iron pipe; thence angle to the left 87 degrees 26' a distance of 1,178.6 feet to an iron pipe; thence angle to the left 14 degrees 19' a distance of 162.0 feet to an iron pipe; thence angle to the left 78 degrees 15' a dis- tance of 925.7 feet to an iron pipe; thence angle to the right 90 degrees a distance of 1,011.7 feet to an iron pipe which is first point of determination; thence angle to the right 90 degrees a distance.of 1,035.2 feet to an iron.pipe; thence angle to the left 27 degrees 04' a distance of 45.5 feet to an iron pipe located on the water's edge of Peterson Lake which is known as place of beginning; thence retracing on the same line to first point of determination; thence angle to the right 90 degrees a distance of 67.5 feet to an iron pipe; thence angle to the right •90 . degrees a distance of 980.8 feet to an iron pipe; thence angle, to the left 46 degrees 04' a distance of 33.0 feet to an iron pipe located on the water's edge of Peterson Lake; thence in a Southwesterly direction along the water's edge of Peterson Lake a distance of 100 feet more or less to the point of beginning. JUL 1 71025 Bayfield Co. Zoning Dept. •' ` or reference purpose on on Peterson Lake, located in the Parcel L (fNorth Range $ West described as follows : SEA.-Mlt ) Section 16, Township 47, > ,.. • enc n� at the Northwest corner of Section 16, Township 47, North, Range :er�••�- 2 622 feet to ,tee S _t alcz the Section line a distance of . 5 - - _ _ _ _ _ - -•- x^ erack 26 minutes along the cente :e '� �a �. ^ e a n i e t. c t e left ft _a �-, -- C feet +-�. p pr' the^'ce angle .► * .r ti..r �..� .. f + � L- . �.' C` G . o , 6 2 • al' 1 �. iLr i o an....rot'x o the left 78 degrees 15 °minutes a distance of p25.7 feet to an iron pipe, thence ?:angle to the. right 40 degrees a distance of 946.0 feet to an iron pipe which is first point of determination, thence angle to the right degrees a distance of 1,035.2 feet to an iron pipe, thence angle to the lefi l04 degrees 09 minutes a distance of 95.0 feet to an iron pipe located on th( i known as place of beginning; thence retrac- ing shore of Peterson Lake which is on the same line to first point of determination, thence angle to the I right 90 degrees a distance of 65.7 feet to an iron pipe, thence angle to the right 90 degrees a distance of 1,035.2 feet to an iron pipe, thence ie do tre left 27 degrees 0L. minutes a distance of 45 .7 feet to an iron cont_nued on other side) H. JUL 177025 bayfleld Co. Zoning Dept 024103608000 V 477.,P51 12.5 A N 'C 1343.30' 0- )3607000 '4 ,P336 -34O 1.6A f .1 J LJUO' I o on �I x MTcp O I p , < O° o 0 ttoont�a 0 O 24 0. o - 'g MM ^ I OQ ; O j > M 0_ N I > ONE 024103701000' 024103706000 a O V 513 ,P325 / V 462 ,P377 I N> ; 6.6 A S.O A o a I D O o O T 'po-, 1 N UI Uwi I Uri O n _I'—_ / a< C. I— My �i" � � ONE 6.0, j v �> Yi 3 a / / i 38 23 024103707000 / y V V 3844 ,P ,017 17 m' 1.64 A L / 1.07 1 CSM V3, 0308 N I c a c� I PETERSON >� LAKE ( SEE MAP 16478C ) Private Sewage System Maintenance Agreement gyis Li; h1k4,rCR nGroJ.ac/ ._..... Yo7g ?VYo7/620yoam7voa it% 193 4 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) —1/4 ofN &114 Section _Township 5/'7 N. Range W Addltkma', l.nLegal Descrntlon: t f}'f lt'-Z= Town of 1 ✓d4'1 /f ['eV^ (Acreage) Gov't Lci Lot _ Block Subdivision Lot_CSM#_ Vol._Page_ CSM Doc# Return To: lt7✓L'r ttsjlt$'kr r ©, �B6g S22 yrt , cur t,J L S-YB"7 ® In -ground gravity ❑ In -ground dosed 0 in -ground pressure distribution Sewage System: ❑ Mound 0 At -grade Sewage System 0 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 (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. 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 I aterals (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. Owners) agree that fa!,um to comply with this acreemeat will result In action being faker to pay ell chs, gas and costs Cacurred by Be dleld 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 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 bylaw. The terms and conditions of the agreement shall be binding upon and inure h1 the benefit of ell current and future owners of such property. Owner(s) Name(s)—Please Print Subscribed and sworn to before me on this date: ,angel S. 1Jelsorl. ,cgus f (9, 2-0- q Notarized Owner(s) — Signature(s) Notary Public My Commissio plres: 70th 1 3!,W2/o Drafted by S r(a (}�tdl ( Z l� q JILL M. CONTRERAS Froored by: ICE jiiu l)L 172025 Notary Public-Minnese(Pr rsenitery/sepYaneinlenceagreement .MY Commlukn Ekpiraa Jan 31, 2026 Revised July 2020 Bayfield Co. Zoning Dept. V,AYFIELD 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: NELSON FAMILY LIMITED PARTNERS 27691 HACIENDA E BLVD BONITA SPRINGS, FL 34135 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00291 Transaction Number: SR-00291-313CA Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 6219 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 7/29/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. A FIELD 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: NELSON FAMILY LIMITED PARTNERS BONITA SPRINGS, FL 34135 Description Private Sewage System (Septic Tanks) Submission Number: SS -00604 Transaction Number: SS-00604-30C6D Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 6219 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 7/29/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-25-86S STATE SANITARY PERMIT OWNER: NELSON FAMILY LIMITED PARTNERS GOVT LOT: LOT: BLK: SE 1/4 NW 1/4 SEC: 16, T 47 N, R 8 W TOWNSHIP: Iron River SOIL TEST: 81-25 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: ALLAN POLKOSKI TRACY POOLER DATE: 7/29/2025 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: # 220090 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 7/29/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION