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Home My WebLink About25-90SRequest 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 zonincl(a bavfieldcountv.wi.gov Note fl Time Change fl Discrepancy fl Other Phone Number 715-634-8176 Plumber: Travis Butterfield Fax Number Email Address Homeowner: Daniel & Sara Joda office@butterfielddrilling.com Immediate Phone Number So Zoning Sanitary 25-90S Dept can call you right back (if needed) Permit #: 715-558-6472 Plumber's Choice Zoning Dept No Inspection(s) during this time Date: 12/10/25 Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice oning Dept Time: 1:00pm Township: Cable Address # & Road Name: Valhalla Townhouse Rd (no fire #yet) - Telemark Hills Subd or Directions To Site: Comments: ** Plumbers you must verify any change(s) by fax or email " Notes from July 2025 $" 4. Industry Services Division rf.o nnra l Infnrm atio n Private Onsite Wastewater Treatment Systems ( POWTS). Inspection Report (Attach to Permit) DANIEL JODA ATTN: SARAH JODA W328N3719 RANGE WOODS DR NASHOTAH WI 53058 Tank Infnrmnfinn TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road septic S4 Pi e✓o+y 000(33'I(l —' N/A eosin N/A Aeration N/A Holding setback to, Town of. County Sanitary ennit No: State Plan'Transaction ID#: Parcel Tax No: Pump / Siphon Information ump Manufacturer ump Model Demand GPM Filter Ma u aGtuyer C: tiC Filter Model Li -f? TDH Lift Friction Loss Head Total Forcemain Length Dia Dlst. To Well Disoersal Cell Information DIMENSIONS Wi i Len th �3y #ofCells 2, SETBACK FROM Prop.. Lire Building Well Type of Cell Manufacturer: A4' Model Number. 5 Pretreatment Unit Manufacturer: Model Number: stribution Header/ Ma ON Dia Elevation Data STATION BS HI I FS ELEV Benchmark to 3 r [.sewer S• O qt 2r Tank Inlet Tank Outlet o rr' Dose Tank Inlet Dose Tank Bottom Inst. Contour Header! Mandold S q K •� Distribution Pipe Infiltrative Surface fl,5 13 7S Final Grade c1 3 X Pressure ❑No 5o11 Cover Depth Over I Depth Over I Depth of I Seeded / Sodded Mulched Cell Center I Cell Edges I Topsoil j ❑ Yes 0 No I 0 Yes ❑ No COMMENTS: (include code discrepancies, persons present, etc.) 'ZC / stn! j �fveH DbS Pd cS (o4k� G.•� en (�tati�,it GaV�/ Ian revision required? 0 Yes D No '2 I a `Lj o se other side for additional information. Date POWTS Inspector's Signature License Number 3RnR"N n !R flqj9.fl \11 J BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-61$8 Bayfield County Courthouse Fax: (715) 373-0114 Post Office Box 58 e-mail: zonino(d)bavfieldcountv.ora 117 East Fifth Street Web Site: www.bayfieldcounty.oro/147 Washburn, WI 54891 Property Owner DANIEL JODA Information ATTN: SARAH JODA W328N3719 RANGEWOODS DR NASHOTAH WI 53058 As you know % aV, S F �.t(� F'� � 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: at AM/PM On /(O/ L i at /O / ) the above -mentioned plumber contacted our office to conduct a pre-cov r 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 respond to plumber's time constraints Comments: 111(crmsfsanilarypropertyowner-Input April2019 •s r. ��O13A�'g�r Industry Services Division General Information Personal information you prov Permit Holder's Name: Tank lnfnrmafinn TYPE 1. MANUFACTURER icn.Y Prop. Line Well'Building Jr Intake I.Road Se tic N/A Dosing N/A Aeration N/A Holdin r ` i ., Private Onsite Wastewater Treatment Systems ( POWTS).lnspection Report (Attach to Permit) be used for secondazy purposes[Privacy Law s. 15.04 (fl(m)] City Village Town of: Elev: I BM Description: setback to: County &wfiel�L Sanitary ermlt No: State PIan'Transaction ID#: Parcel Tax No: Pump I Siphon Information Pump Manufacturer JPumPump Model Demand GPM Filter Manufacturer Filter Model TiH Lift Friction Loss Head Total Forcemain Length Dia Dist. To Well Dispersal Cell Information DIMENSIONS Width Length # of Cells SETBACK FROM Prop.. Line Building Well OHWM Type of Cell Manufacturer: Model Number. Pretreatment Unit Manufacturer: Model Number: stribution System Header / Manifold j Distribution Pipe(s) Length Dia j Length Dia Spac Soil Cover Depth Over Depth Over Depth of Cell Center Cell Edges Topsoil COMMENTS: (include code discrepancies, persons present, etc.) Elevation Data STATION BS HI FS }__ELV Benchmark Bldg. Sewer Tank Inlet Tank Outlet Dose Tank Inlet Dose Tank Bottom Inst. Contour Header / Manifold Distribution Pipe Infiltrative Surface Final Grade X Pressure Systems Only X Hole Size J X Hole Seeded / Sodded ❑Yes ❑No Ian revision required? 0 Yes ❑ No 3e other side for additional information. Date POWTS Inspector's Signature Observation Pipes ❑ Yes ❑ No Mulched ❑Yes ❑No License Number ;Rn-R71 n rR ngII1 i (0Q1S,—P,3wz Department of Safety & Professional Services, Industry Services Division eS-00606 County to Sanitary Permit Numb r (to be filled in by Co.) as-goSanitary 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 purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats, v V44MA'c,o eG Rd Cno addle$$ Ytf) I. Application Information —Please Print All Information Property Owner's Name Parcel # —rhx A: 37 $3 Dance 1 4 5ara1, Tccla o4•ora->]f3- •J8 S co39b-. i Property Owner's Mailing Address Property Location W 3.S N 3'719 c,.e ewoods Dr Govt. Lot City, State V Zip Code Phone Number ggY-o4o-, Li T 53O58 4fy- a3H- bf.Gy %' i, Section T f'/3 N R 0.7 E o W II. Type of Building (check allthat apply) �1 or 2 Family Dwelling —Number ofBedrooms 3 Lot/I ` �d Subdivision Name ❑ Public/Commercial — Describe Use TcIemArXUsN� Block# O Cityof O Village of ❑ State Owned — Describe Use CSM Number Town of Cable M. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if applicable.) A. New System ❑ Replacement System p y ❑ Other Modification to Existing System (explain) y ( xp ) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank �ln-Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design I ❑ 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: 3 QuIG ! stlsofends Design Flow (gpd) Design Soil Application Rate(gpd/so ' Dispersal Area Required (sf) I Dispersal Area Proposed (st) I System Elevation 950 c-C.I '75O * 9s.so Tank Information Capacity in Gallons Total Gallons # of Units Manufacturer s o $ B �' rn 4 y 0a0� u w C7 o ,y New Tanks I Existing Tavks Septic or Holding Tads 1oo0 �_ lCoo V •or /� y Dosing Chamber V. Responsibility Statement- I, the undersigned, assum ponsibility for instalation of the POWTS shown on the attached plans. Plumber's Name (Print) I Plumb ignature MP/MPRS Number I Business Phone Number Tra.rr5 suaeocield G5�879 7i5- 3 -817ro Plumber's Address (Street, City, State, Zip Code) JY3Ybw Slat Ro,,d 77 N0. wgrdt WX S'/8Y3 VL County/Department Use Only Approved ❑Disapproved O Owner Given Reason for Denial Permit Fee S �OQ- Date Issued mijL (Q issuing ant 'gnature , Conditions of Approval/Reasons for Disapproval Qa mod. tii JUL 22 2025 Bayfield Co. Zoning Dept. Attach to complete plans for the system and submit to the County only on paper not less than 8 tQ a 11 inches in size SBD-6398 (R- 03/22) PAGE 1 OF 4 ln=Ground Gravity Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10705-P (N.01/01, R. 10/12) 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 Joda - Lot 12 Telemark Hills Phase 1 Owner Name(s): Daniel & Sarah Joda Phone: 4 1 Lf - a3y ...444& Owner Address: W328N3719 Rangewoods Dr.; Nashotah, WI Zip: 53058 Project Address: (no address yet) Vallnalla'f'o�nln ovse Rd Govt. Lot: ____ 1/4 of 1/4, Section a 8 , T 43 N -R 07 E [-]or w Ei✓. Township: Cable County: Bayfield Project Parcel ID #: 04-012-2-43-07-28-5 00-340-21000 (TAX ID: 39523) 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. 111] JUL 222025 Bayfield Co. Zoning Dept. IZA Signature: Date: OL1as/a5 Original signature required on each submitted copy. PLOT PLAN ST = 1 000gal prefab concrete septic tank made by Superior Precast w/ Lifetime LT -I/8 Filter AA = Absorption Area consisting of two cells, spaced >3ft apart, containing a total of 38 Quick 4 plus Chambers 9 Cr -f a_ 040 P4? 8' I SCALE ='1 :50 0 10 25 50 75 100 Lot 12, Telemark Hills Phase 1 Sec. 28, T43N, R07W Town of Cable Bayfield County TAX ID: 39523 Property Owners Daniel & Sarah Joda ELEVATIONS BM = 100.00 ft BI = 98.00 ft B2 = 97.00 ft B3 = 99.50 ft BM = Nail w/ Ribbon in 22" White Pine IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER 2" min, bench depth (typical) min. 12" (typical) LLI (typical) System Elevation = 79 (typical) Septic Tank(s) Manufacturer: Superior Precast Concrete Septic Tank(s) Volume(s): 1000 gal gal gal gal Effluent Filter Manufacturer: Lifetime Filter LLC Effluent Filter Model a: LT -1 /8 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) ft Quick4 Standard -W w/ End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) B= 93.50 ft (typical) INSTALL PER TRENCH: 19 Quick4 Std -W @ 20 ft2 EISA/chamber= 380 ft2 + 1 Pairs of end caps @6 ft' EISA/pair = 6 ft2 = Proposed EISA per trench = 386 ft' •)da4 6uiu07'03 plagAe0 5aoazz -ID IIII s II�I�l�I I� Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturers / Instructions. TYPICAL TRENCH PLAN VIEW (No Scale) TA=3.0ft (typical) "—Quick4 Standard -W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. Required Infiltration Area = 750 x 2 trenches = Proposed Total EISA = 772 ft2 Distribution Method: ft' branched manifold D C) rn W O -r1 a 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 = Inspection Checklist o type of use 450 gpd; BODS ≤ 220 mgL-'; INSPECT EVERY 3 YEARS TSS ≤ 150 mgL-'; FOG ≤ 30 mgL'' 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 (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 leaned 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 Phone: 715-634-8176 Local government unit: Bayfield County Planning & Zoning Phone: 715-373-6138 Local government unit address: 117 E 5th Street, PO 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 approvedff tt eprt ntinn accordance with SPS 384, Wisc. Admin. Code. l5 15 Contingency Plan 1111 JUL 2, 2 2025 In the event that any failed treatment component of this POWTS cannot be repaired, it shall b� � pmfiy"Ot. a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Su it the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) Check List Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) s ndex Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) ® Original Plot Plan (383.22(2)2. 3. & 4.a) Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer ❑ d Pump Curve (when applicable) Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) [�dMaintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) ❑ Hldi1Tg1TTlAgreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) ❑ HkftrTTTTrService Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) Dt1Svrtflreement (Recorded at Reg. of Deeds) ee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 4-comDIete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached o all coDies) EWtSoil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ en applicable) Copy of Warranty/Quit Claim Deed (Optional) Snitary Application: (Include the following Information) I ;�P'rqject ication Information must include: W23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) / Address or Road Name where driveway is/will come off of) 0 (Owners Phone Number) Y Type of Building 9 I Type of Permit VV Type of POWTS System Dispersal / Treatment Area Information /5) j' D Y'VI Tank Information If VII Responsibility Statement (Plumber's Information) JUL 2 2 L025 *Date Stamp* BaYfield Co. Zoning Dept. Plot Plan: (To Scale or To Dimension) L( Signature and Plumber Information (o+n 1w�s.cp9) 'AdelrNt1rntr and Road ❑ r C"North Arrow L/ Direction and Percent Land Slope Contour Lines Ank and Filter Information and Location CY tructures and Driveways ❑ LdBoring Locations &/Absorption Area (Proposed and Existing) Property Lines Bench Mark (Location, Elevation and Description) WV ell Locations L'Component Manual Version Legal Descriptions d'ipjng N atenal nfomia to'Y (convey nce Inie, building .sewer line, rmaterials :ear aneter.=) Turn Over ► I Private Sewage System Maintenance Agreement Owner(s) Name Daniel Joda W328N3719 Rangewoods Dr; Nashotah, WI 53058 (no address yet) ' ""' 39523 As owner, I (we) do hereby certify the private sewage system win be Installed in accordance with the certified soil tester's report and approved plans and specifications on file with Baylieid County Planning and Zoning Department The system will be operated In such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below fisted location in accordance with rules established lathe WI Adm. Code, as from time to time amended. (COMPLETE Legal Is req ilr+ d) 114 of 114 Section 28 Township ' N. Range 07 W. Additional Legal Dovcriptioru DOC 2025R-606616 Town of Cable Lot 12 Block Subdivision (As ge) 1.75 Gov't Lot TELEMARK HILLS PHASE I Lot CSM # Vol. Page - CSM Doc # DOCUMENT NUMBER 2025R-608268 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED 07/14/2025 AT 8:00 AM RECORDING FEE: $30.00 PAGES: 1 Return To: Planning and Zoning Department ® In -ground gravity ❑ In -ground dosed 0 In -ground pressure distribution Sewage System: 0 Mound ❑ At -grade Sewage System ❑ Other Area Septic Tank (system types.A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of Installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make such Inspection, the tank is found to have less than one-third (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. Filler maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sawarha System Dispersal Cep (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 -ground Pressure System Laterals (system types C. 0 and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cep component is inspected as provided above. Owner(s) agree that farltma to comply with this agreement will result In action being taken to pay alt charges and costs Incurred by Bayileld County for inspection, pumping, hauling. or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfleld County shall notify the owner of any costs which shall be paid by the owner within thhty (30) days from the date of notice. In the event the owner does not pay the costs within thfiiy (30) days, the ownerspeaficaW agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. The temrs 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: Notarized Owner(s) — Signature(s) S Notary bibc • My Commission Expires: Drafted by. RonalcTA Spreckels Jr o� ,LIL 152025 Bayfield Co. Zoning Dept. Date: 06123/25 COLLEEN MELNICK Notary Public State of Wisconsin Proofed by: . uformslsanitary/septiunalntenceagreament Revised July 2020 r r r a ARTA Page i of Wisconsin Department of Safety & Professional Services SO TEST Division of Industry Services p$. SOIL EVALUATION REPORT S� -. 00 q 8 County In accordance with SPS 385, Wis. Adm. Code 22 Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, 'JAL �i a l� but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. T1$ 1A. 395x3 scale or dimensions, north arrow, and location and distance to nearest road. �.. •'#.•t S CC - 3y Q - i Please print all information. R ew y Dat� Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). t Property Owner Property Location ❑ I • I f 5ara �do.. Govt. Lot % Y< S a$ T '13 N R 0'7 E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: 1Ra tocd.c tc L.o 4 l Ttp.vo.rY %P1c.t I City, State, Zip Phone Number ❑ City ❑ Village 1 Town I Nearest Road K AI I .l.. L h.r'l c"aricQ !/Jlt/1 1ZU../_/_/_tI VI.. _ __ n• XI New Construction User Residential/Numberof bedrooms3 Code derived designflowrate_GPD ❑ Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material Sand.. A.Jtf es h General comments and recommendations: c�!'► a Boring # ❑Boring oPit Ground surface elev. ".00ft. Depth to limiting factor 11 O in. / eleva8.83 ft. nil Annlirafinn Rata 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-8 3! 4 c.7 1. o.5 0.5 !-O (.0 Co 3 a'r .5'fA 1/ Gr rn l -T • I i T.5 R SIY �~ S a M1 �' n ® Boring # ❑Boring ®Pit Ground surface elev. CIIZC lt. De to lirri#t;r�g f4cor�i lev. ft — Qnil Annll�tinn Dab % 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 0-$ 1DYR3/ — 1 Ji o•y' it -r JYA If I c. / t. to ri3≤ 7. 0 w $ I' O7 1. t. -toy 7.5 YR /q - .S /rJ IC o.'7 i . C. ____________________ ______________ __________________ I_J ____________ __________ _______ _________ ________ CST Name (Please Print) Sign CST Number Tmvrs L*f4-er> `�a Id $t? -0 b60OWO3 Address Date Evaluation Conducted Telephone Number 1!1 y WSfQa77 Ma wxr (JX≤ y3 I /ayla 7) -- 1-R,7 * Effluent #1 = BOD > 30 ≤ 220 mg/L and TSS > 30 5150 mglL * Effluent #2= BOD, 5 30 mg/L and TSS 5 30 mg/L SBD-8330 (R03/22) � 1 � . . Boring # Page of ❑ Boring Pit Ground surface elev..5oft. Depth to limiting factor JO in. / elev.azft. I Soil AQolication 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 1 7 t 07 1b?1'!I4 1 1 v 1. 3 -f ?. Y s, �► y3- 7.5 Y/� sf 4` c f. �no�r 05 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Soil AQolication 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 S in a r r ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Soil AQolication 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 !) fl'[ Jill JUL 2:22025 Bayfield Co. Zoning Dept. `� JUL 2 2 202 RayField Co. Zoning Dept. SCALE ="1:50 0 10 25 50 75 100 Lot 12, Telemark Hills Phase 1 Sec. 28, T43N, R07W Town of Cable Bayfield County TAX ID: 39523 Property Owners Daniel & Sarah Joda Csr SP- ota �o�ao 3 ELEVATIONS BM = 100.00ft BI = 98.00 ft B2 = 97.00 ft B3 = 99.50 ft BM = Nail w/ Ribbon in 22" White Pine SOIL PROFILE SHEET OWNER: l7Gnme! 4 SQrah 55da. SOIL TESTER: Tr-a�rf„ + rTfge id SYSTEM ELEVATION: ram LOAD RATE: D• �. a SYSTEM RANGE: `�a. $O to C) 3 .� 3 1Oa i L3a 133 Io 13M oO ------ -- -- --- -- JUL 222025 -- --- --- --- ------ ytiefri Co. Zoning Dept ---- 93 ____ _____ ____ _____ ( 3 ,- ::: :: ii: 9 ) s ,'R) -- -- --- -- -- 1 L. -- --- -- -- So-- --- ------ --- 33 iii ___ __ _= 88.33 Page JL of L • Department of Safety & Professional Services, County e 1 Sanitary Permit Numbmb r (to be filled in by Co.) Industry Services Division SS -0°606 25 -SOS Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary v�.1h,.aTO1.,'•ou,e Rd purposes in accordance with the Privacy Law, s. 15.04(l)(m), Slats. cno a8dre$S yt' I. Application Information — Please Print All Information Property Owner's Name Parcel # Maix 1A! 37513 Donnie 1 4 r rctl' Tcxa ati-ora-a r3 8 s 1X1 39b-. t Property Owner's Mailing Address Property Location W 3�8 N 3"119 RC,.. eu CJO&S br Govt. Lot City, State Zip Code Phone Number g3vo1Gt Li T S. S& 9i-a3y-GGfo4 Section __ T f/3 N R 0? E o W II. Type of Building (check all that apply) Lot # 1KI or 2 Family Dwelling — Number of Bedrooms 3 Subdivision Name Tel arK I',t)s P Block# ❑ Public/Commercial — Describe Use 0 Cityof ❑ State Owned —Describe Use 0 Village of CSM Number /� Townof Cable. 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 S stem Y ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank ln-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: 3 QVicK v ! .5t&saends Design Flow (gpd) Design Soil Application Rate(gpd/sf) , Dispersal Area Required (st) Dispersal Area Proposed (so System Elevation 9SO O- t, '7s0 V7a * 93.so Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units B U o New Tanks I Existing Tanks o ` u 2 v b ra m aU ti H m ii.o a Septic or Holding Tank 1 O0 0 l/ 1 C 1 WlJ ' Or !.c X' Dosing Chamber V. Responsibility Statement- I, the undersigned, assum sponsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb .. ignamre MP/MPRS Number Business Phone Number -rr-,wf5 Gv4arcteid GS�S7,1 7/_5-(;V/-817 Plumber's Address (Street, City, State, Zip Code) 1q3YGw S4c.4c Rand 77 Ha c,rwrd, WT- 5f&'/3 County/Department Use Only Approved ❑Disapproved Permit Fee S Date Issued ni(bL Issuing ent ' nature ❑ Owner Given Reason for Denial ��Q $ 1Q d�j , Conditions of Approval/Reasons for Disapproval 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 1/2 x I1 inches In size SBD-6398 (R. 03/22) Wisconsin Department of Safety & Professional Services TEST Page 1 of �1� rF w Division of Industry Services SOIL EVALUATION REPORT 5\J R -o0,: Q 8 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, ' a Id but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. TAX It% 39Sc scale or dimensions, north arrow, and location and distance to nearest road. _ S p. Please print all information. R ew y LLDat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). I L Property Owner Property Location ❑ ER 'b,;i f5caJ Govt. Lot '/< Y. S T y3 N R O'7 E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #. L47) c Loo I� T I a City, State, Zip Phone Number ❑ City ❑ Village IJ Town I Nearest Road A{..wALl.. L l.rT C2, rQ,ul�'iu../_/_/_t.l t"'%_ VI. v_ti__.1•T..._��__ e New Construction User Residential/ Numberof bedrooms 3 Code derived designflow rate_4'S� GPD ❑ Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material General comments and recommendations: 4 Boring Boring # Pit Ground surface elev. fft(X) ft. Depth to limiting factor I 1 C) in. / eleva8.83 ft. Soil Aonlication 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 I o8 3 -- isrvr o.7 1- 8 -fib I tf 1 -- 1 0.5 1--O 3 ati , sYR YI Gr rn 1 n .s (.0 LI • I 1 ?.5 R s/Y 5 a rtc o. 7 • Ce pf� b Lf h )- CSV, Boring # ❑Boring ®Pit Ground surface elev. 97.C t. De to lirrl-g f r2O i lev.2 ft _ - • Soil Annlication 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 •$ IOYP.3/ — 1 ,C - b ► . � is Sri f.�. I • (,4 1 7. a 0 w. S 14' 0.'1 t. C. •lam 7.5YA$ Q9 )9 0., 1. C. - if, CST Name (Please Print) Signf 477 CST Number Tmvrs uf+e r�; a Id S'• �`P►0()OOob3 Address Date Evaluation Conducted Telephone Number !Ir 9 tSM4177 J/a I r t wry y ioy ,5 7)5-6 - 1? * Effluent #1 = BOD > 30 £ 220 mg/L and TSS > 30 £150 mg/L * Effluent #2 = BOD, £ 30 mg/L and TSS 5 30 mg/L SBD-8330 (R03/22) Boring # Page of ❑ Boring Pit Ground surface elev...SOfi. Depth to limiting factor JO in. / elev.w-. ft. I Soil Application 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 I c- 1cYt -- 1. I. a '13 7. YR `! -- .S I 3P1 v. >I. L► 'f -1b 7.5 YR S - r; Lt hc. s Co ono} rs Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Soil Application 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 n S n e- r � M Boring # ❑ Boring O Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Soil Application 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 5 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L D E Ob E � vy- E liii JUL 2.22025 Bayfield Co. Zoning Dept. JUL 2.2 225 Rayfield Co. Zoning Dept SCALE ='1:50 0 10 25 50 75 100 Lot 12, Telemark Hills Phase 1 Sec. 28, T43N, R07W Town of Cable Bayfield County TAX ID: 39523 Property Owners Daniel & Sarah Joda cSr vs�8Yg SP• ogO°coeo 3 a, I oK !JS ELEVATIONS B M = 100.00 ft BI = 98.00 ft B2 = 97.00 ft B3 = 99.50 ft BM = Nail w/ Ribbon in 22" White Pine SOIL PROFILE SHEET OWNER: 1 4 5cu *h ,, c)dG. SOIL TESTER: Th&yf�S 11.,.+ me Id a SYSTEM RANGE: 9a 5 to 9 3 1 3 SYSTEM ELEVATION: LOAD RATE: O• t. . o a J31 13 133 toi -- --- --- -- -- ------ --- --- - -- 6M 1 oO ---- ------ -- ------ ------ --- --- -- __ ------ 9 9. std ------ cy __ __ --- -- --- --1111 JUL 2.2.2025 -- --- -- -- --- -- 8ayfield Co. Zoning Dept. 7� --- -- ------ --- -- -- --- 3 -- --- €'1--- ------ -- S) --- ------ -- --- �T =1 =_ iii --- --------- l_ ------ So -------- -) -- --- -- ---B--- __2.33 1111__ 8g Page H of L" PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10705-P (N.01/01, R. 10/12) Pg1of4 Pg2of4 Pg3of4 Pg4of4 Attachments: Index & Cover Sheet Plot Plan Dispersal Area Cross -Section & Plan View Management Plan I POWTS Application for Review I Soil Evaluation Report & Site Map Project Name / Description Joda - Lot 12 Telemark Hills Phase 1 Owner Name(s): Daniel & Sarah Joda Phone: 41Y - N3y Owner Address: W328N3719 Rangewoods Dr.; Nashotah, WI Zip: Project Address: (no address yet) �Ja\hula-I-a,r Govt. Lot: Township: Cable Project Parcel ID #: 53058 a 1/4 of 1/4, Section D8 , T 43 N -R 07 EUor W L County: Bayfield 04-012-2-43-07-28-5 00-340-21000 (TAX ID: 39523) Designer Information Designer Name: Travis Butterfield Designer Address: 14346W State Road 77; Hayward, WI Zip: 54843 E-mail: office@butterfielddrilling.com This spaLC IT CF%,,I hr approval stamp. License Number: 652879 pp Remarks: u u222025 D [I'll JUL 2 2 2025 Phone: 715 -634 -8176 Bayfield Co. Zoning Dept. Signature: Date: O /a s /a Original signature required on each submitted copy. PLOT PLAN ST = 1000gal prefab concrete septic tank made by Superior Precast w/ Lifetime LT -1/8 Filter AA = Absorption Area consisting of two cells, spaced >3ft apart, containing a total of 38 Quick 4 plus Chambers PPP C\ cr2 'Q rl, co O , Vo- �a _ 0a 62 • 33 A BM B1 4,,pvcsch.yo \. —2' gstr?nl 3 SCALE = 1:50 0 10 25 50 75 100 Lot 12, Telemark Hills Phase 1 Sec. 28, T43N, R07W Town of Cable Bayfield County TAX ID: 39523 Property Owners Daniel & Sarah Joda ELEVATIONS BM = 100.00 ft B 1 = 98.00 ft B2 = 97.00 ft B3 = 99.50 ft BM = Nail w/ Ribbon in 22" White Pine ��cqe ate' 4 IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER MW 2" min. trench depth (typical) min. 12" (typical) I-- 34" - (typical) System Elevation =12 (typical) Septic Tank(s) Manufacturer: Superior Precast Concrete 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 (No Scale) ft Quick4 Standard -W w/End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) -----------e--------��--- Idt t------------��-------��--- H. B = 93.50 ft (typical) INSTALL PER TRENCH: 19 Quick4 Std -W @ 20 ftz EISA/chamber = 380 ft' + 1 Pairs of end caps @6 ft2 EISA/pair = 6 ft2 = Proposed EISA per trench = 386 Ida0 6wuoz '00 Play(eg x 2 slot Z Z inr Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturers / instructions. TYPICAL TRENCH PLAN VIEW (No Scale) TA = 3.0 ft (typical) "—Quick4 Standard -W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. ft2 Required Infiltration Area = 750 ft2 trenches = Proposed Total EISA = 772 ft2 Distribution Method: branched manifold D C) m G) O n a 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; BODS ≤ 220 mgL-'; TSS ≤ 150 mgL-'; FOG ≤ 30 mgL-' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (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 Phone: 715-373-6138 Local government unit address: 117 E 5th Street, PO Box 58; Washburn, WI Butterfield Inc Phone: 715-634-8176 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 approvedy t �ep@rt�ngg tin n accordance with SPS 384, Wisc. Admin. Code. IUI l5 ii U 15 II II Contingency Plan a JUL 2 2 2025 In the event that any failed treatment component of this POWTS cannot be repaired, it shall b�3f�RL�3:pRrfik�t a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) !!Check List C��Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) lWIndex Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) 9 Original Plot Plan (383.22(2)2. 3. & 4.a) ❑'Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer ❑ d Pump Curve (when applicable) —/Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) ud Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) 0 H&diTI Ta T Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) 0 Heldi TgTdrik'Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ er ig greement (Recorded at Reg. of Deeds) EI/fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) -Complete 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.) ❑% revr{ro0hen applicable) CopG7 y of War anty/Quit Claim Deed (Optional) Satiitary Application: (Include the following Information) I Ap lication Information must include: 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) I�Project Address or Road Name where driveway is/will come off of) /IJ Type of Building "III Type of Permit p Iy Type of POWTS System L_r/V Dispersal / Treatment Area Information I Tank Information 6VII Responsibility Statement (Plumber's Information) *Date Stamp* Plot Plan: (To Scale or To Dimension) dSignature and Plumber Information (on i+�p*) ❑// r C(DDirection and Percent Land Slope ❑'Tank and Filter Information and Location G/✓Absorption Area (Proposed and Existing) dBench Mark (Location, Elevation and Description) E1 Component Manual Version i Piping Material Information (conveyance line, building sewer line, 0 (Owners Phone Number) u u JUL 227025 D Bayfield Co. Zoning Dept. LWAddre551WTTt7er and Road l 'North Arrow l Contour Lines J tructures and Driveways oring Locations d.roperty Lines Well Locations Legal Descriptions material type and diameter) Turn Over ► Cross -Section and Over -Head Profile of the System: Surface and System Elevation Q Position of Observation and Vent Pipes ClDimensions and Depths d Make, Model & Number of Chamber Units in each Cell Property Information {/ How many systems will there be on this parcel of land? I H Has this property been split? Ny (Property Statement shows Property History) Fees: Q 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 ❑1 Return Inspection $ 50.00 1 Maintenance Agreements (checks made out to Reg of Deeds) u/forms/checklists/checklistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: Private Sewage System Maintenance Agreement Daniel Joda W328N3719 Rangewoods Dr; Nashotah, WI 53058 (no address yet) " " 39523 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 of 114 Section 28 Township 43 N. Range 07 W Additional Legal Description: DOC 2025R-606616 Town of Cable (Acreage) 1.75 Govt Lot Lot 12 Block Subdivision TELEMARK HILLS PHASE 1 Lot CSM# Vol._Page_ CSM Doc# DOCUMENT NUMBER 2O25R-6O8268 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED O7/14/2O25 AT 8:OO AM RECORDING FEE: $30.00 PAGES: 1 Return To: Planning and Zoning Department II In -ground gravity 0 In -ground dosed El In -ground pressure distribution Sewage System: 0 Mound ❑ At -grade Sewage System ❑ Other Area Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of Installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. Pump Chamber (system types B. C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Septic Tank Effluent Filter (system types A through E): 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, POWrS 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 whetter 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 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 Bayfeld County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. The tens and conditions of the agreement shall be binding upon and Inure to the benefit of all current and future owners of such property. Owners) Name(s) — Please Print Subscribed and sworn to before me on this data, ��ti7T ,ia42 Notarized Owner(s) Signature(s) Notary brio MY Commission Expires: /r Drafted by.. RonaktA Spreckels Jr -JL 152025 Bayfield Co. Zoning Dept. Data: 0W3M COLLEEN MELNICK COLLEEN Notary Public State of Wisconsin Proofed by. _ unorntslsenitarylseptianainlenceagreement Revised Juy 2020 FIELDBayfield 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: JODA, DANIEL W328 N3719 RANGEWOODS DR NASHOTAH, WI 53058 JODA, SARAH W328 N3719 RANGEWOODS DR NASHOTAH, WI 53058 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00298 Transaction Number: SR -00298-310A9 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 4625 Paid by: Butterfield, 14346W State Rd 77, Hayward WI 54843 Payment Type: Check Transaction Date: 8/6/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. J3-4YFIELD 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: JODA, DANIEL W328 N3719 RANGEWOODS DR NASHOTAH, WI 53058 JODA, SARAH W328 N3719 RANGEWOODS DR NASHOTAH, WI 53058 Description Private Sewage System (Septic Tanks) Submission Number: SS -00606 Transaction Number: SS -00606-310A8 Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 4625 Paid by: Butterfield, 14346W State Rd 77, Hayward WI 54843 Payment Type: Check Transaction Date: 8/6/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-25-90S STATE SANITARY PERMIT OWNER: DANIEL JODA GOVT LOT: LOT: 12 BLK: SUBDIVISION: Telemark Hills Phase I 1/4 1/4 SEC: 28, T 43 N, R 7 TOWNSHIP: Cable SOIL TEST: 90-25 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: TRAVIS BUTTERFIELD TRACY POOLER DATE: 8/6/2025 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 8/6/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION