Loading...
HomeMy WebLinkAbout25-87SRequest for Sanitary Inspection (24 Hrs. in Advance) Fax or email this form to Zoning Dept (24 Hrs.) prior to when you want an inspection Fax (715) 373-0114 or Email zoning(abayfieldcountV.wi.gov Note fl Time Change Discrepancy fl Other Phone Number 715-634-8176 Plumber: Travis Butterfield Fax Number Email Address Homeowner: Taylor Fay office@butterfielddrilling.com Immediate Phone Number So Zoning Sanitary Dept can call you right back (if needed) 25-87S Permit #: 715-558-6472 Plumber's Choice Zoning Dept No Inspection(s) during this time Date: 06/15/26 1i6 Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice Zoning Dept Time: 2:30pm Township: Cable Address # & Road Name: 41590 Nordic Way or 20 > Directions To Site: Comments: * Plumbers you must verify any change(s) by fax or email ** Notes from Zoning Dept: July 2025 8 s Industry Services Division r TAYLOR FAY 4338 45TH AVE S MINNEAPOLIS MN 55406 Private Onsite Wastewater Treatment Systems ( POWTS). Inspection Report (Attach to Permit) of: BM Description: GC setback to: County I Sanitary No: TYPE MANUFACTURER CAPACITY Prop. Line Well , Building Air Intake Road Septic .0✓ / JZ Q N/A Dosing N/A Aeration N/A Holding Pump! Siphon Information lump Manufacturer Pun Filter Manufaur �i/� 41 Filter Model GPM TOH Lift Friction Loss I Head Total Forcemain Length Dia Dist To Well Dispersal Cell Information DIMENSIONS Width / gth, f�of Cells SETBACK FROM Pr :.Lind I wilding 7ts Well I OHWM Type of Cell L c LtK tf CfModel Ma cturer: Number. Pretreatment Unit Model stribution Soil 3OMMENTS: (Include code discrep�ncles, persons present, etc.) jL"l f tic)e4 1oC-KJ, Elevation Data STATION BS HI FS ELEV Benchmark £�ji0 Bldg. Sewer L vo pd t3.23at Tank Inlet Tank Outlet Dose Tank Inlet Dose Tank Bottom Inst. Contour Header/ Manifold r ,o .o Distribution Pipe Infiltrative Surface 6. o c Final Grade X Pressure ❑ Yes ❑ No O) ?I1 CA F w,'ll cuter 1 991 U e �S . ele„i{ r.,�tc GeJPrv, Ian revision required? O Yeso If f� .� 3e other side foradditionalinfinn on. O I Date POWTS Inspector's Signature 2Rn-n79n rR nci911 ❑No ' I ❑ Yes ❑ No 2 77rrVatu3 u6%si.M Y18 W J L j ti %aD a - License Number S S eve /a Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-61$8 Fax: (715) 373-0114 e-mail: zoninpnabavfieldcountv.org Web Site: www.bavfieldcountv.org/147 TAYLOR FAY 4338 45TH AVE S MINNEAPOLIS MN 55406 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know tV U,S 0 C-(G� 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.septiesearch.com Notes: Abandonment of Old System to meet all applicable code requirements: Tank was pumped by: Tank was crushed I removed and pipes disconnected by: on at AM/PM On b 26 at 2 32 (AM the above -mentioned plumber contacted our office to conduct a pre-o6ver inspection as required un er DSPS 383. One of the following applies: ;NJ 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 $50 fee are required. ❑ System could not be inspected because County could not respond to plumber's time constraints Comments: U/rormslsanitarypropertyowner-input April 2019 S_ Department of Safety County & Professional Services, a Sanitary Permit Number (to be filled in by Co.) Pa Industry Services Division Sanitary Permit Application StateTransactlonNumber In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Project Address (if different than mailing address) ( *sa f c eC 4. yet' V1ha.11at Tawnke�ie R d is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. I. Application Information — Please Print All Information Property Owner's Name Parcel # TA'1c tfl: 3i 530 To i l:Mf O Property Owner's Mailing Address Property Location £./33 li ^ er ) L S 4 h X6 S Govt. Lot City, State I Zip Code Phone Number M 4 '4, ' ,Section �$ T y N R _!7E o U. Type of Building (check all that apply) Lot # )k1 or 2 Family Dwelling —Number of Bedrooms 3 Subdivision Name Block # ❑ Public/Commercial — Describe Use O City of ❑ State Owned — Describe Use O Village of CSM Number %Crown of C tb 1 e. 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 applicable.) A. X New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank K1n-Ground ❑ At -Grade ❑ 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 IV. Dispersal/Treatment Area and Tank Information: Ore' At P?uC 4VWhErSLee �,1Se t.S 0iCl Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation Y a o. ( '7so 7'7 I I• s0 fk Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units U Uo I_ti New Tanks Existing Tanks a B C% U to t/. Septic or Holding Tank 1 OO ,_ 00O r V v C-1 Q C t ctedt Dosing Chamber V. Responsibility Statement- I, the undersigned, assu responsi ility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb Sigma MP/MPRS Number I Business Phone Number Tr.sjs au4-+er .-e Ie! Plumber's Address (Street, City, State, Zip Code) /'/ /(, W 4@.-e Road '77 /4 W4.rd , w Z S 18 13 VI. County/Department Use Only Permit Fee Date Issued mpJ L Iss ' g nt Si ature Approved O Disapproved O Owner Given Reason for Denial 7/o/j �5JVc;, 3 Conditions of Approval/Reasons for Disapproval ll JUL 2 2 2Q25 Rayfielii Co. Zoning Dept. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 03/22) PAGE 1OF4 F 4 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg1 of4 Pg2of4 Pg3of4 Pg4of4 Index & Cover Sheet Plot Plan Dispersal Area Cross -Section & Plan View Management Plan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name I Description Fay - Lot 19 Telemark Hills Phase 1 Owner Name(s): Taylor Fay Owner Address: 4338 45th Ave S; Minneapolis, MN Project Address: Govt. Lot: _ Township: Cable Project Parcel ID #: Phone: 612 _840 9711 Zip: 55406. 1/4 of 1/4, Section 28 , T 43 N -R 07 E [:1 or W IIEi County: Bayfield 04-012-2-43-07-28-5 00-340-28000 (Tax ID: 39530) Designer Information Designer Name: Travis Butterfield Designer Address: 14346W State Road 77; Hayward, WI E-mail: office@butterfielddrilling.com License Number: 652879 Remarks: Phone: 715 634 _ 8176 Zip: 54843 This space reserved for approval stamp. JUL 22202' t!i Bayfield Co. Zoning Dept. Signature: Date:�7//5/ Original signature required on each submitted copy. 1� u \ \ 22 L�Z5 Co Zo��ng �epr. gay�ield SCALE = 1:50 a $o as so 7s 1oc Lot 19 Telemark Hills Phase 1 Section 28, T43N, R07W Town of Cable Bayfield County TAX ID: 39530 5 I o CS 0ga► %. p ce Fb Corc re k 5LP}:C +A^ 4%+&e &y SupeKor Pr eas,'w/eh-n►� L.T •'/8 f11 -k r A A : Abs crprccri Pi' & Gers3�'S1vr� a41voCellb, spacedi3CJ. o►Po.rl., car,arn.A •! off' 32 0-: ck y P/vs G'jl 47+. be cc 5 BM = Nail w/ Ribbon in 24" Red Pine ELEVATIONS BM = 100.00 ft B1 = 94.33 ft B2 = 98.00 ft B3 = 94.08 ft Wetland = 81.17 ft IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER 12" min. trench depth (typical) JUL 22 2025 min. 12" (typical) Septic Tank(s) Manufacturer: Superior Precast Septic Tank(s) Volume(s): 1 000 gal gal gal gal Effluent Filter Manufacturer: Lifetime Filter LLC Effluent Filter Model #: LT -1 /8 LL( ° ' TYPICAL TRENCH CROSS SECTION VIEW 34" (typical) ? ° ^ ... (No Scale) System Elevation = 91.50 ft (typical) Bayfield CQ ZoIjirlQ Dept GtUlcK4 `J"tandard-W w/ End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) r 77 INIi---------------7�--- B= 79 ft (typical) INSTALL PER TRENCH: 19 Quick4 Std -W @ 20 fl? EISA/chamber = 380 ft2 + 1 Pairs of end caps @6 ft2 ElSNpair = 6 ft2 Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturers / instructions. TA=3.0ft (typical) TYPICAL TRENCH PLAN VIEW (No Scale) `Quick4 Standard -W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. = Proposed EISA per trench = 386 ft2 Required Infiltration Area = 750 ft2 x 2 trenches = Proposed Total EISA = 772 ft2 Distribution Method: branched manifold C m C;) O m PAGE 4 OF 4 In -ground Gravity Management Plan IMPORTANT: The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 450 gpd; BOD5 ≤ 220 mgL"1; TSS ≤ 150 mgL"1; FOG ≤ 30 mgL"1 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 (113) 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: Butterfield Inc P Y� Local government unit: Bayfield County Planning & Zoning Phone: 715-634-8176 Phone: 715-373-6138 Local government unit address: 117 E 5th Street P.O. Box 58 Washburn, WI ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by t p rtment in accordance with SPS 384, Wisc. Admin. Code. ` 1 Contingency Plan JUL 2 2 cOC In the event that any failed treatment component of this POWTS cannot be repaired it shall be replac ci pursuant to a plan submitted to the appropriate agency for review and approval. A failed in-grod / fir%�lQ nt 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. Real ,Estate Bayfield County Property Listing Property Status: Next Year Today's Date: 6/25/2025 Created On: 2/18/2025 4:47:01 PM Description Updated: 3/12/2025 al Ownership Updated: 3/12/2025 Tax ID: 39530 TAYLOR FAY MINNEAPOLIS MN PIN: 04-012-2-43-07-28-5 00-340-28000 JASMINE MASTEL-LIPSON CABLE WI Legacy PIN: Map ID: Billing Address: Mailing Address: Municipality: (012) TOWN OF CABLE TAYLOR FAY TAYLOR FAY STR: S28 T43N R07W 4338 45TH AVE S 4338 45TH AVE S Description: LOT 19 TELEMARK HILLS PHASE 1 IN MINNEAPOLIS MN 55406 MINNEAPOLIS MN 55406 DOC 2025R-606333 Recorded Acres: 1.840 t� V Site Address * indicates Private Road Calculated Acres: 0.000 N/A Lottery Claims: 0 First Dollar: No Property Assessment Updated: N/A Zoning: (R-RB) Residential -Recreational Business ESN: 108 2025 Assessment Detail Code Acres Land Imp. Tax Districts Updated: 2/18/2025 N/A 1 STATE 2 -Year Comparison 2024 2025 Change 04 COUNTY Land: 0 0 0.0% 012 TOWN OF CABLE Improved: 0 0 0.0% 041491 SCHL-DRUMMOND Total: 0 0 0.0% 001700 TECHNICAL COLLEGE ' Recorded Documents Updated: 2/18/2025 �. Property History ® WARRANTY DEED Date Recorded: 2/26/2025 2025R-606665 Parent Properties Tax ID 04-012-2-43-07-28-101-000-14000 39511 © CORRECTION INSTRUMENT Date Recorded: 2/19/2025 2025R-606597 ® WARRANTY DEED Date Recorded: 1/28/2025 2025R-606344 © PLAT Date Recorded: 1/27/2025 2025R-606333 HISTORY ® Expand All History White=Current Parcels Pink=Retired Parcels ® Tax ID: 9100 Pin: 04-012-2-43-07-28-1 04-000-10000 Leg. Pin: 012107406000 ® Tax ID: 9095 Pin: 04-012-2-43-07-28-1 01-000-10000 Leg. Pin: 012107401000 fax ID: 9097 Pin: 04-012-2-43-07-28-102-000-10000 Leg. Pin: 012107403000 ® Tax ID: 39400 Pin: 04-012-2-43-07-28-1 02-000-12000 © Tax ID: 39455 Pin: 04-012-2-43-07-28-102-000-16000 © Tax ID: 9099 Pin: 04-012-2-43-07-28-1 03-000-10000 Leg. Pin: 012107405000 ® Tax ID: 39398 Pin: 04012-2-43-07-28-103-000-12000 ® Tax ID: 39511 Pin: 04-012-2-43-07-28-1 01-000-14000 39530 This Parcel 1Parents Children JUL Bayfield Co. Zoning Dept. SUPERIOR 1,000 1 -Compartment Tank SUPERIOR PRECASTCONCRETE PRECAST CONCRETE TOP VIEW 89-112" Weight (m lbs) S3-Lr?" Tank -812 ,81: Lid: 3,683 f U 20 5 onin [ ts. by iai )ept. Product File No: This Is proprletaryInformation, and remains the property of Superior Precast Concrete, LLC. R.3 05-19-2024 BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) ', heck List "Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) g' Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) m Original Plot Plan (383.22(2)2. 3. & 4.a) o Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer ❑ P Pump Curve (when applicable) Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) O Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) ❑ k,Aeement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) ❑ I1 ii ' e Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ement (Recorded at Reg. of Deeds) L'Fee (Make Check Payable to Bay field County Zoning) (383.21(2)(c)7) ' omplete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ an evi when applicable) ' Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the followi9g Information) L9' I Appli ation Information must include: LY23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) /1, Project Address or Road Name where driveway is/will come off of)(Owners Phone Number) E1Type of Building I�I Type of Permit H�IV Type of POWTS System ®'V / DispersalTreatment Area Information JUL 2 2 20L5 P �VI Tank Information Bayfield Co. Zoning Dept l /II Responsibility Statement (Plumber's Information) oQ *Date Stamp* Plot Plan: (To Scale or To Dimension) Signature and Plumber Information ON l^ ('9 dress Number and Road lurface Elevation of Body of Water EY4Jorth Arrow "rection and Percent Land Slope ['Contour Lines @'Tank and Filter Information and Location E1S ructures and Driveways &Mpe,dt�� l Wetlands / Navigable Bodies of Water B ring Locations l Absorption Area (Proposed and Existing) P operty Lines [9'Bench Mark (Location, Elevation and Description) ell Locations 7Legal 8 mponent Manual Version (o Iiq. Descriptions Piping ing Material Information (conveyance ance� line, building sewer line, material type and diameter) P ( Y 9 Yid Turn Over ► (// I Private Sewage System Maintenance Agreement Owner(s) Name Taylor Fay 4338 45th Ave S; Minneapolis, MN 55406 (no address yet) Tax ID # 39530 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 Bayfleld County Planning and Zoning Department. The system will be operated In such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established in the Wi Adm. Code, as from time to time amended. (COMPLETE Legal is required) 114 of 114 Sectinn 28 To"sp 43 N. Range 07 w. Additional Legal Description: Town of Cable (Acreage) 1.84 Gov't Lot Lot 19 Block Subdivision TELEMARK HILLS PHASE I Lot CSM # Vol. Page CSM Doc # DOCUMENT NUMBER 2025R-608440 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 07/23/2025 AT 8: 15 AM RECORDING FEE: $30.00 PAGES: 1 Return To: Planning and Zoning Department ❑X In -ground gravity 0 In -ground dosed 0 In -ground pressure distribution Sewage System: 0 Mound ❑ At -grade Sewage System 0 Other Area Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of installation and at feast 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, POWI'S 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. Aberade. and tn-ground Pressure System Laterals (system types C, O 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 Baytield 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. Baytreld County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days the owner specifically agrees that all the costs and charges maybe placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. The terms and conditions of the agreement shall be binding upon and inure to the benefit of all cument and future owners of such property. !ttri7P_[M nwnP_r1SI — Sil Drafted by. Ronald A Spreckels Jr ( Date: 06/23/25 JUL 2 4 2025 1) Bayfield Co Zoning Dept. r and sworn to before me on this date: WC I Je1n d b' mission Expires: %'j- e)C %%%tlililt/�1, /'sisantanpucmaenceag reesnem • Revised Ady 2020 NOTARy•'�: 1 11� � - r " OFwSGG�`` iii 'rrfflt�l�,` JUL 2.2 2025 F3ayfield Co. Zoning Dept. 5C)D2JL ARTIf "N Wisconsin Department of Safety & Professional Services age 1 of L- xt- °s Division of IndustryServices TEST f SP3 SOIL EVALUATION REIN 1? IS In accordance with SPS 385, Wis. Adm. Code County (3 a ( h e 1 Attach complete site plan on paper not less than 8 1/2 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. •f'e %D'. 3953 0 scale or dimensions, north arrow, and location and distance to nearest road. _ .c o o..gp. Please print all information. Re)IieWl by Date Personal information you provide may be used for secondary purposes (Privacy Law, S. 15.04(1)(m)). Property Owner I Property Location ❑ •ra r Fy Govt. Lot '/4 ' S $ T y3 N R b'1 E (or) W Property Owner's Mailing Address j Site Address or CSM and Lot #: City, State, Zip Phone Number ❑ City ❑ Village RI Town Nearest Road I1innpI.'≤.MN Sy (Gt ) 8'fo•9711 Cfa�bl \1&1W114ri R New Construction Use: Residential/ Numberof bedrooms .3 Code derived designflow rate �/SO GPD ❑ Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material nd v O u+t .i& Ih General comments and recommendations: 'U fLr e M csY. Pde Boring # ❑ Boring IN Pit Ground surface elev. W. 33 ft. Depth to limiting factor 9 _in. / elev. f(,•17ft. 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 a 6-Z % y Os 3 y y --- 0 M 1 w y '• .SYR S/ S IV% 1 o • '7 i . r:z H ,. Boring # ❑Boring 1 u JUL 2:2 2025 IgPit Ground surface elev. 9Q•oob ft. Depth to limiting factor in. I elev. 87.U3rt. Bayfield Co. Zoning Dept. 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 O• 1O'fR-3/ -- 1 uk a44 o.7 1.4 7.5`t S rK 1 e�. 7 1. CST Name (Please Print) l Travl• BVt+er-PC )Q Signat a CST Number o 03 Address Date valuation Conducted Telephone Number 193%W 34& (o77 77 h4 war WI O G /4' /J 1 - • 1 * Effluent #1 = BOD > 30 ≤ 220 mg/L and TSS > 30 ≤ 150 mg/L * Effluent #2= BOO, ≤ 30 mg/L and TSS ≤ 30 mg/L SBD-8330 (R03/22) r 1 'Boring Page of Ll ❑ Boring Pit Ground surface elev.4m.0 ft. Depth to limiting factor % in. / elev., 9S,7Sft. Soil Aoolication Rate 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 O•$ y N -- o. 1. s'• 1c y 4 5 0.7 1. £. IOD 7.10.% — S F o. %.G h -reF, o + 4' 1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Soil Aoolication Rate 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 VE.' te 4 1reca '/ o 7 L3ADIAI 2 3. r e de Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Soil Anolication Rate 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 * Effluent #1 = BOD > 30 ≤ 220 mg/L and TSS > 30 ≤ 150 mg/L * Effluent #2 = BOD, ≤ 30 mg/L and TSS ≤ 30 mg/L 1111 JUL 2:??025 2025 Bayfield Co. Zoning Dept. SCALE = 1:50 sp IS 10O Lot 1.9 Telemark Hills Phase 1 Section 28, T43N, R07W Town of Cable Bayfield Coun TAX ID: 3953 ci 3 s � C.ST &.CZ B79 59.O 500000033 oto /oSr/aS BM = Nail wl Ribbon in 24" Red Pine ELEVATIONS BM = 100.00 ft BI = 94.33 ft B2 = 98.00 ft B3 = 94.08 ft Wetland = $1.17 ft O.9e 3c.c ±I SOIL PROFILE SHEET OWNER: �a�i o c SOIL TESTER: Trcu'. u . $ % v#k r C i c I d SYSTEM ELEVATION: LOAD RATE: Oh,/I. SYSTEM RANGE: D to 9 a • o'd 99 -C CELLS AAA aESTCPPjF7 -- -- —_ __ TO PRO s DE 6(EATE f� EL EV.,._J E• Ar N a -- lq8 --- --- -- -- ------ --- M sw+i- 9g.co --- PTH O)= CELL -- ------ ------ ------ -- -- -- --- --- --- --- --- --- -- -- ______ S- -- --- --- -- --- -- ------ 93 ------ ------ -- --- --- -- -- 9� --- -- --- ------ ------ cli 90 OO ------ ------ D C E C �� -- -- -- --- 3 FT __ -- _- --- -- ------ --- JUL 2�.2 `1UCb __ __- I N TV =_ —__ __ __- hayfield Co. Zoning Dept) 1 30L _____ _____ -2,1.00---- -. _-_ __ 9s.'75 Page It of JL • r ` BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): C; Check List ❑ Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) �/Original Plot Plan ross Section Soil Profile Sheet (optional) Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) P Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used Property Owner's Information (not prospective buyer's name) VProperty Location (Accurate Legal Description with Sec/Twp/Range) (9' Road Name (where driveway is/will be coming off of) ❑ Fions Complete Soil Boring / Pit Information Date Soil Evaluation was conducted :�*DTate Name, Signature, Number, Address and Phone Number Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) Lg' Bench Mark (Description, Elevation and Location) L9oContour Lines (Example = 98.0' /96.0' /94.0') 4f Property Location (Sec/Twp/Range/, Accurate Legal Description) Borings (Locations and Elevations) LPercent and Direction of Land Slope e' Location of Wetland Areas, Floodplain and Navigable Waters Buildings, Driveways, and Structures (Location and Descriptions) l 1 cation of Property Lines ", d ess-Number and Road Name Current Surface Elevation of Wetlands and Navigable Waters Owner and Property Information 3 North Arrow JUL 2.270Th Bayfield Co. Zonili9 Dept- Fee: L9"Certified Soil Tests - Review & Filing Fee 550.00 U/forms/sanitary/ch eckl ist/checkl istforests i ��- --no loo.00-L i3.a5 = 93 as Sys. li9oa C1�.6a 17wr'� l N y0� La rc�- G`> o g „�..,v„ ..-� 55. O&oa Department of Safety County a Cr & Professional Services, Industry Services Division ra Sanitary Permit Nu nber (to be filled in by Co.) ^ 4�t 1 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 Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary (ns f; •c k3 ye t) purposes in accordance with the Privacy Law, s. 15.04(l)(n[), Stats. UG•thott4 TONMhouse Rd I. Application Information — Please Print All Information Parcel TA -a it 39530 Property Owner's Name T'a ►or Fa 1e . .fb_ y c Property Owner's Mailing Address Property Location '-/33S ySati A4e S Govt. Lot City, State I Zip Code Phone Number Mtnnea ol�s. MN S5'/bL Gl�•8Y0-9711 Y., '/., Section T '13 N R O1 E o II. Type of Building (check all that apply) Lot # �1 or 2 Family Dwelling— Number of Bedrooms 3 Subdivision Name Block # ❑ Public/Commercial — Describe Use O City of ❑ State Owned — Describe Use O Village of CSM Number /� i�fown of Ca.blt 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 applicable.) A. ' New System ❑ Replacement SystemExisting ❑ Other Modification to System (explain) ❑ Additional Pretreatment Unit (explain) B' ❑ Holding Tank In -Ground � ❑ At -Grade ❑ 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 IV. Dispersal/Treatment Area and Tank Information: _&UCCI4'IPlusChe.a.hcrss.ulaSe#sa$nds Design Flow (gpd) Design Soil Application Rate(gpd/sf I Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation y b o.c. 7So 117 4I. SO FE Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units a o o New Tanks Existing Tanks o ,° m . a 0.0 m rn 4,V 4 Septic or Holding Tank OO _ 0 l u Pi O r Pnec k Dosing Chamber V. Responsibility Statement- I, the undersigned, assuyfresponsi ility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb Sigma r MP/MPRS Number Business Phone Number TrAvf l3ul er e IS C<Sa87 7/S'-!.3 - 1 Plumber's Address (Street, City, State, Zip Code) /Y3y(oW Si i Rotd 77 NG ward I w .9/893 VI.County/Department Use Only Approved O Disapproved $enni[ Fee Date Issued t rn Iss g nt Si ature �,t8r'zS O Owner Given Reason for Denial //IIM�/� 'f W ' 7 3� .2-5 Conditions of Approval/Reasons for Disapproval D C C, CAM.1111 JUL 222025 Bayfield Co. Zoning Dept. Attach to complete plans for the system and submit to the County only on paper not less than 8 I/E x II inches in size SBD-6398 (R 03/22) Wisconsin Department of Safety & Professional Services /age _ of_ - o i Division of IndustryServices SCI TEST SOIL EVALUATION REIN County In accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 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. 1'?O %D' 39530 scale or dimensions, north arrow, and location and distance to nearest road. O - Please print all information. Reyiew1 by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). I.'''5 Property Owner Property Location ❑ to Taylor a Govt. Lot '/ '/4 S $ T Lj3 N R d'1 E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: City, State, Zip I Phone Number ❑ City ❑ Village Town Nearest Road 9711 Cabl W .l6rownhevse 46 New Construction Use: ®. Residential/ Numberof bedrooms .3 ❑ Replacement ❑ Public or commercial — Describe: Parent material .ScLnd y O u+t,.,& h General comments and recommendations: Code derived designflow rate so GPD Flood Plan elevation if applicable ft. ❑ Boring Boring # IN Pit Ground surface elev. 99'33n. Depth to limiting factor gin. / elev. (i.1% ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots WW41 r%J J'IUHauUJI I%aLc GPD/Ft2 *Eff##1 *Eff#2 b•S iO'aPQ31;,-- 1 a� 0. !. 1 a. i. (.. t'm T Boring # ❑Boring U U JUL 2. 2 2025 Pit Ground surface elev. f9. ft. Depth to limiting facto a'� p factor _I3 in. / elev. ?8 •C�Ft. Bayfield Co. Zoning Dept. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots vv1 � FF41VQ L4 J1 I 1 \a LG GPD/Ft2 *Eff#1 *Efi##2 64 1 O`1' 3 _. 4r- JC O.7 1'(o G.- 1 '! 0.7 fi. G Lj 7.Sf $ q `— 5 rK a r '1 h ,'• n 'I CST Name (Please Print) Tnave'6 Qvt+e e M Signat a CST Number .a _o�OcO3 Telephone Number Address Date valuation Conducted 13'�G w R 77 Na Wier wt 04 /O Y / 7i-4331 Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 5150 mg/L * Effluent #2= BOD, 5 30 mg/L and TSS 5 30 mg/L SBD-8330 (R03/22) Page a of Ll [] Boring P3Boring # ® Pit Ground surface etev.qq.OPj ft. Depth to limiting factor 10O in. I elev.2575ft. Soil AoDlication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIFt2 *Eff#1 *Eff#2 O• )(, •q i�"a9, —fr s CO) .7 1. 3 a9• 7. ti y — s 1e a. I.L h .�. note I Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Soil ADDlication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIFt2 *Eff#1 *Eff#2 jt 1t srepr Se'`'/o1 , f / 3irt5 7 hftDiiJ R r e4 -6e Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Snil Annlicatinn Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIFt2 *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 s 220 mg1L and TSS > 30 5150 mg/L * Effluent #2 = BOD, 5 30 mg/L and TSS s 30 mglL Ilfi JUL 2 2 2025 Bayfield Co. Zoning Dept. SCALE = 1:50 I ----T o 1D as sb 75 loa Lot 19 Telemark Hills Phase 1 x Section 28, T43N, R07W Town of Cable and Bayfield Coun TAX ID: 3953 0 r� o tc5 CC C.ST !o.CQ a79 5P-os0000003 O4 fo'1 / S BM = Nail w/ Ribbon in 24" Red Pine ELEVATIONS BM = 100.00 ft BI = 94.33 ft B2 = 98.00 ft B3 = 94.08 ft Wetland=81.17ft aye 3a SOIL PROFILE SHEET OWNER: ¶a l o e 14y SOIL TESTER: Tray : 5 I ,*4cc' e l d SYSTEM ELEVATION: LOAD RATE: O. SYSTEM RANGE: 9 0. CJ Cto_ 99 -c C ELLS A (AV !3E 3 re pEO TO PRO r OE 6RE,TE R -- -- -- _-- EL Etc. 6E A N U -- qg --- -- --- M j � - 9g.� -&E DEPTH Or GF LL G-- --- -- -- --- -- ------ -- q Sc ------ -- --- ------ -- --- --- --- --- --- -- -- _= -_= ' I.3 =_ ___ ------ 93 ------ --- 9� ------ 91 -- ------ --- -- --- --- -- 90 _ _- 9000 ----- -- --- - ===_=i I) t I 11 \IJ t 8� 3 FT JUL 2.2 ZUZ� __ =_ ___ _— __= Bayfield Co. Zoning Dept. 301L -- 87 --- ------ --- oo � ___ 8 __$r. Page IfL. of JL BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): C Check List ❑ I nal) Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) �/Original Plot Plan ross Section Soil Profile Sheet (optional) E2 Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used "Property Owner's Information (not prospective buyer's name) VProperty Location (Accurate Legal Description with Sec/Twp/Range) lg' Road Name (where driveway is/will be coming off of) ❑ F ions Complete Soil Boring / Pit Information ZDate Soil Evaluation was conducted EST Name, Signature, Number, Address and Phone Number *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) I Bench Mark (Description, Elevation and Location) "Contour Lines (Example = 98.0' /96.0' /94.0') t Property Location (Sec/Twp/Range/, Accurate Legal Description) Borings (Locations and Elevations) EY Percent and Direction of Land Slope L� u VLocation of Wetland Areas, Floodplain and Navigable Waters Er'Buildings, Driveways, and Structures (Location and Descriptions) t 'Location of Property Lines er and Road Nary, 2' Current Surface Elevation of Wetlands and Navigable Waters G CST, Owner and Property Information L/ North Arrow \\"\\ JUL 2 2 ?1`� Bayfield Co. Zoning Dept Fee: "Certified Soil Tests - Review & Filing Fee 550.00 U/forms/sanitary/checklist/check) istforests PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross -Section & Plan View Pg 4 of 4 Management Plan Attachments: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Fay - Lot 19 Telemark Hills Phase 1 Owner Name(s): Taylor Fay Owner Address: 4338 45th Ave S; Minneapolis, MN Project Address: Govt. Lot: Township: Cable Project Parcel ID #: Phone: 612 840 _9711 Zip: 55406. 1/4 of 1/4, Section 28 , T 43 N -R 07 E ❑ or W ❑✓ County: Bayfield 04-012-2-43-07-28-5 00-340-28000 (Tax ID: 39530) Designer Information Designer Name: Travis Butterfield Designer Address: 14346W State Road 77; Hayward, WI E-mail: office@butterfielddrilling.com Phone: 715 634 8176 Zip: 54843 This space reserved for approval stamp. License Number: 652879 Remarks: n� lun}u JUL 22 2025 )Si3Bayfield Co. Zoning Dept. Signature: Date: 07//5 /ac Original signature required on each submitted copy. �Ut 2 2 zoz gay6eld Z°�e90ePti Co.. 4� 9 SCALE = 1:50 o ,o as ro -is ioo Lot 19 Telemark Hills Phase 1 Section 28, T43N, R07W Town of Cable Bayfield County TAX ID: 39530 55',. 1060a. pvFab cantre Sef,}tc +cv.0 rno.de by Sup en'or Precasfw/4:Fcl:mc LT -+/3 f/I-kr AAr Abssrp}can Arc.. Ge„si5}rn9 cr ocr//s, sratedt3Ci a.parl., ce+s+arnc1 a+ola,/ of 320vtcic 4 Pl.rs Cha...&er$ BM = Nail w/ Ribbon in 24" Red Pine ELEVATIONS BM = 100.00 ft B 1 = 94.33 ft B2 = 98.00 ft B3 = 94.08 ft Wetland = 81.17 ft Pad a .of :/ IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER 2" min. french depth (typical) DII JUL 222025 min. 17 (typical) Septic Tank(s) Manufacturer: Superior Precast Septic Tank(s) Volume(s): 1 000 gal gal gal gal Effluent Filter Manufacturer: Lifetime Filter LLC Effluent Filter Model #: LT -1 /8 TYPICAL TRENCH CROSS SECTION VIEW aa' (tyal) (No Scale) pic':.� �� .. System Elevation = 91.50 ft (typical) Bayfield CO.Zo i Dent. UUIcKC4ztanaard-W w/ End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) ----------v7--------��--- --------------- B= 79 ft (typical) INSTALL PER TRENCH: 19 Quick4 Std -W @ 20 fly EISA/chamber = 380 ft2 + 1 Pairs of end caps @6 ft2 ElSAipair = 6 ft2 = Proposed EISA per trench = 386 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) (mid by Infiltrator Systems, Inc.) Install pursuant to manufacturer's instructions. Required Infiltration Area = 750 x 2 trenches = Proposed Total EISA = 772 ft2 ft2 Distribution Method: branched manifold D G) m W O m a 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; BODS ≤ 220 mgL''; TSS ≤ 150 mgL"'; FOG 530 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 (Le., pumps, valves, switches, floats, etc.) o material fatigue (Le., 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: Local government unit: Bayfield County Planning & Zoning Butterfield Inc Local government unit address: Phone: 715-634-8176 Phone: 715-373-6138 117 E 5th Street P.O. Box 58 Washburn, WI ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by t p ent in D accordance with SPS 384, Wisc. Admin. Code. I U D In Contingency Plan JUL 22'101 In the event that any failed treatment component of this POWTS cannot be repaired it shall be replac lRRp�rsuant to a plan submitted to the appropriate agency for review and approval. A failed in-gro� ger t 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. Real .Estate Bayfield County Property Listing Today's Date: 6/25/2025 S Description Updated: 3/12/2025 Tax ID: 39530 PIN: 04-012-2-43-07-28-5 00-340-28000 Legacy PIN: Map ID: Municipality: (012) TOWN OF CABLE SIR: 528 T43N R07W Description: LOT 19 TELEMARK HILLS PHASE 1 IN Recorded Acres: Calculated Acres Lottery Claims: First Dollar: Zoning: ESN: DOC 2025R-606333 1.840 0.000 0 No (R-RB) Residential -Recreational Business 108 I Tax Districts Updated: 2/18/2025 1 STATE 04 COUNTY 012 TOWN OF CABLE 041491 SCHL-DRUMMOND 001700 TECHNICAL COLLEGE -a Recorded Documents Updated: 2/18/2025 © WARRANTY DEED Date Recorded: 2/26/2025 2025R-606665 © CORRECTION INSTRUMENT Date Recorded: 2/19/2025 2025R-606597 © WARRANTY DEED Date Recorded: 1/28/2025 2025R-606344 © PLAT Date Recorded: 1/27/2025 2025R-606333 Property Status: Next Year Created On: 2/18/2025 4:47:01 PM at Ownership Updated: 3/12/2025 TAYLOR FAY MINNEAPOLIS MN JASMINE MASTEL-LIPSON CABLE WI Billing Address: Mailing Address: TAYLOR FAY TAYLOR FAY 4338 45TH AVE S 4338 45TH AVE S MINNEAPOLIS MN 55406 MINNEAPOLIS MN 55406 P Site Address " indicates Private Road N/A ® Property Assessment Updated: N/A 2025 Assessment Detail Code Acres Land Imp. N/A 2 -Year Comparison 2024 2025 Change Land: 0 0 0.0% Improved: 0 0 0.0% Total: 0 0 0.0% Is Property History Parent Properties Tax ID 04-012-2-43-07-28-1 01-000-14000 39511 HISTORY © Expand All History White=Current Parcels Pink=Retired Parcels ® Tax ID: 9100 Pin: 04-012-2-43-07-28-1 04-000-10000 Leg. Pin: 012107406000 © Tax ID: 9095 Pin: 04-012-2-43-07-28-1 01-000-10000 Leg. Pin: 012107401000 rax ID: 9097 Pin: 04-012-2-43-07-28-1 02-000-10000 Leg. Pin: 012107403000 © Tax ID: 39400 Pin: 04-012-2-43-07-28-1 02-000-12000 u Tax ID: 39398 Pin: 04-012-2-43-07-28-1 03-000-12000 O Tax ID: 39511 Pin: 04-012-2-43-07-28-1 01-000-14000 39530 This Parcel t Parents Children JUL Bayfield Co. Zoning Dept. PREC AS ERIOR 1 SUP0NCRETE 1,000 1 -Compartment Tank 'SUPERIOR TOP VIEW 89-112„ Weight (in lb-) 83-1p. Tank $,812 Lid: 3,683 Total: 9,495 Volume of Concrete Total : 2.4 Yd' Gallons Per Inch: 24.4 73" 79" Yi7L Lid 102$ Gallons Wall SIDE VIEW 28" I Enlarged Detail 24" Conditionally 4" Outlet APPROVED DEPT.OF SAFETYVPROFESSIONAL ,.. 9" Air Space SERVICES DIVISION OF INDUSTRY SERVICES I Th later J60 ;- __ Denth fl 4I 45" SEE CORRESPONDENCE I 3 Manhole Openings 4 I1 - Taper Polyethylene i Baffle Mastic Rope Gasket (Poured in Place) Produced by Superior Precast Concrete, LLC PO Box 1390 n 2 fN LS I� O Hayward, WI 54843 IS In JUL 222 Bayfield Co. Zon SUPERIOR PRECAST CONCRETE Design contorms to AS I M C1227, Specification for Precast Concrete Septic Tanks and WI SPS 384.25, POWTS Holding Components or Treatment Components. The information provided on any Superior Precast Concrete (SPC) drawing or document shall be verified by the purchasers licensed professional engineer for suitability of use. Configuration may change from drawing, consult with SPC. )ept. Product File No: I This Is proprletmylnlormation, and lemainsthe properlyofSupedorPrecasl Concrete, LLC. I 8305.1920241 BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) heck List Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) 13/Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) 9 /Original Plot Plan (383.22(2)2. 3. & 4.a) C�Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer ❑ and Pump Curve (when applicable) Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) * Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) ❑ U ,k- gieement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) ❑ Htfdirig Tank -Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑`°TI ct.o- w44flgrement (Recorded at Reg. of Deeds) L 'Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) t mplete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ 'State-IaRevie when applicable) f°' Copy of Warranty/Quit Claim Deed (Optional) Sanitary A lication: (Include the followi9g Information) I Appllii ation Information must include: Q'23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) L'YProject Address or Road Name where driveway is/will come off of) `" (Owners Phone Number) ltjJ Type of Building /Iw Type of Permit Lg1IIV Type of POWTS System Lo"V Dispersal / Treatment Area Information 4�VI Tank Information NII Responsibility Statement (Plumber's Information) *Date Stamp* Plot Plan: (To Scale or To Dimension) EV gnature and Plumber Information "^'" p-7 c ol1, urface Elevation of Body of Water GYD/irection and Percent Land Slope Tank and Filter Information and Location @Wetlands / Navigable Bodies of Water tf/Absorption Area (Proposed and Existing) Bench Mark (Location, Elevation and Description) M Component Manual Version (o- lndq.r.•te) ESfnU D JUL 222025 Bayfield Co. Zoning Dept. dress Number and Road ❑''North Arrow Contour Lines C9' Structures and Driveways (pcxrst oN) Q" B%ring Locations Ef Property Lines 7'ell Locations 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: QAurface and System Elevation u' Position of Observation and Vent Pipes WDimensions and Depths CMlake, Model & Number of Chamber Units in each Cell Property Information C'How many systems will there be on this parcel of land? L Y 3 Has this property been split? N 6 (Property Statement shows Property History) Fees: Private Sewage System (Septic Tanks) $ 400.00 ❑ Private Sewage System (Holding Tanks) $ 400.00 ❑ 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 ,I& Maintenance Agreements + 30.00 M (checks made out to Reg of Deeds) R. o. D. u/forms/checklists/checklistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: 11/1 00//I Private Sewage System Maintenance Agreement Taylor Fay 4338 45th Ave S; Minneapolis, MN 55406 (no address yet) 39530 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 hayfield County Planning anj 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) 114 of 1/4 Section 28 Tnwnlr ,io 43 N. Range 07 W Additional Legal Description: Town m Cable (Acreage) 1.84 Gov't Lit Lot 19 Black Subdivision TELEMARK HILLS PHASE 1 Lot CSM# Vol._Page_ CSM DoeIt DOCUMENT NUMBER 2O25R-6O844O DANIEL.. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 07/23/2025 AT 8: 1 5 AM RECORDING FEE: $30.00 PAGES: 1 Rehm To: Planning and Zoning Department ❑X In -ground gravity O 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 seplage 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 manufacturers specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, We. 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 pending on the ground surface. Mounds At -grade and In -ground Pressure System Laterals (system types C, D and E): The laterals shall be rushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. Owner(s) agree that /allure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Wield 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 ownerspeabcally 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 shag 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. Iov, Drafted Subscribed and swum to beforeme frets Jr Data. (!6123125 111111111 `,fit �ytLUONNs OUe Pmolal by Q O ` P ••••• tiryfofjpslsarNaryheptirniantvisiW July 20 ;` p10TAgy Reyisaa.lylyzom Ur' 6 u U \-%/ TPUBLIC 9.`� Illll !I`ll JUL 242025 .9"lttt�OFWrSCC Bayfield Co. Zoning Dept. 0 JUL 222025 Bayfield Co. Zoning Dept. ]E3L7 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: MASTEL-LIPS ON, JASMINE TELEMARK HILLS CABLE, WI 54821 FAY,TAYLOR 4338 45TH AVE S MINNEAPOLIS , MN 55406 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00295 Transaction Number: SR -00295-31465 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 4623 Paid by: Butterfield, 14346W State Rd 77, Hayward WI 54843 Payment Type: Check Transaction Date: 7/30/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. P YFIELD Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: Submission Number: MASTEL-LIPSONJASMINE SS -00605 TELEMARK HILLS CABLE, WI 54821 Transaction Number: FAY,TAYLOR SS-00605-30EFB 4338 45TH AVE S MINNEAPOLIS , MN 55406 Description Amount Private Sewage System (Septic Tanks) $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 4623 Paid by: Butterfield, 14346W State Rd 77, Hayward WI 54843 Payment Type: Check Transaction Date: 7/30/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-25-87S STATE SANITARY PERMIT OWNER: TAYLOR FAY GOVT LOT: LOT: BLK: 1/4 1/4 SEC: 28, T 43 N, R 7 W TOWNSHIP: Cable SOIL TEST: 87-25 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: TRAVIS BUTTERFIELD TRACY POOLER DATE: 7/30/2025 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: # 652879 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 7/30/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION