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HomeMy WebLinkAbout25-95SRequest for Sanitary Inspection (24 Hrs. in Advance) Fax this form to Zoning Dept (24 Hrs.) prior to when you want an inspection — (715) 373-0114 If you do not have a fax and must email the inspection; you must email all staff members. Note jjChange fl Discrepancy fl Other Phone Number 715-634-8176 Plumber: Travis Butterfield Fax Number Email Address Homeowner: Ben Christensen & Jennifer Folsom office@butterfielddrilling orn Immediate Phone Number So Zoning Sanitary Dept can call you right back (if needed) Permit #: 25-95S 715-558-6472 Plumber's Choice Zoning Dept No Inspection(s) during this time Date: 08/25/25 ■ a �� Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice Zoning Dept Time: 2:30-3:00 pmi Township: Barnes Address # & Road Name: or 50210 Point O Pines Rd �� p Directions To Site: Comments: ** Plumbers you must verify any change(s) by fax or email ** Notes from u/forms/sanitary/requestforinspection Zoning Dept (©4/12104); ® June 2023 Industry Services Division • CHRISTENSEN, BEN M & FOLSOM, JENNIFER J 735 WOODCREST DR N HUDSON W154016 Tank TYPE MANUFACTURER CAPACITY J Prop. Line Well Building Air Intake Road Se tic yr r p` p N/A Dosing . N/A Aeration I,,iC4 N/A Holding Private Onslte Wastewater Treatment Systems ( POWTS). Inspection Report (Attach to Permit) City LJ Village U Town of: setback to: County itary QQ VicL Sanermlt No: State Plan'Transactlon ID#: Parcel Tax No: 37p - Pump! Siphon Information Pump Manufacturer ump Model Demand GPM Titer Manufacturer Filter Model TON Lift Friction Loss Head Total Forcemain Length Dia Dist To Well Dispersal Cell Information • DIMENSIONS Width Length, # of Cells SETBACK FROM Pr o5 Bui((I��'��ng Well OH� Type of Cell Manufacturerfl<: Model Number. Pretreatment Unit Manufacturer: Model Number. Elevation Data STATION BS HI I FS ELEV Benchmark a0a Bldg. Sewer D Tank Inlet 6 0 Tank Outlet b Dose Tank Inlet Dose Tank Bottom Inst. Contour Header/ Manifold Distribution Pipe Infiltrative Surface p T/9.Z Final Grade 3 76 O stribution System X Pressure Systems Only Header / Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length Dia Length _ Die _ Spec Spacing O Yes O No 3o11 Cover . i Depth Over Depth Over Depth of Seeded / Sodded . Mulched Cell Center Cell Edges Topsoil Q Yes O No ❑ Yes ❑ No COMMENTS: (Include code discreppancf ies, ersons present, etc.) ' Pia flail 9ro/6L I Gres/ o:~ S 9 Ian revision required? O Yes,1fNo g _ 2 — ;e other side for additional inforniatio__n. 7 Date :Rn-A71n !R OR/91', POWTS Inspector's Signature License Number Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-61$8 Fax: (715) 373-0114 e-mail: zoning(d bavfieldcountv.org Web Site: www.bavfieldcounty.org/147 CHRISTENSEN, BEN M & - FOLSOM, JENNIFER J 735 WOODCREST DR N - HUDSON WI 54016 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know P�rner ?Z P 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: 1 Tank was pumped by: Tank was crushed / removed and pipes disconnected by: on at AM/PM On �5 S at 3 (AM /he above -mentioned plumber contacted our office to conduct a pre -cover inspection as required under DSPS 383. One of the following applies: N _WOK -8VjIeni was inspected and appears to meet all applicable code requirements. flSystem was inspected and appears to meet all applicable code requirements; however, a plan revision is necessary because the installation was substantially different than the original approval. System cold not be inspected because plumber covered prior to scheduled time of inspection. pty'! Sysstem 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 $50 fee are required. System could not be inspected because County could not respond to plumber's time constraints. Comments: Ulforms/sanilarypropertycwner-input April 2019 T;s4}or O° .�' 4` Department of Safety & Professional Services,°` Industry Services Division County �,. 1d 'e Sanitary Permit Number (to be filled in by Co.) - E Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. S0ZA 0 i%O; n' 0 P1 c s t I. Application Information — Please Print All Information Property Owner's Name Parcel # "'A� S 37 O''1 14 r t Cet04- .► 00- C.)�C) Property Owner's Mailing Address Property Location 'y35 jc�dc reSrr Govt. Lot 1$ City, State I Zip Code Phone Number w z qq ti 7/Jr'a c�a - Oho l 1 ''4, '/., Section O T Lf "I N R V E.erf) II. Type of Building (check all that apply) Lot # 1 or 2 Family Dwelling — Number ofBedrooms 3 1 Subdivision Name ❑ Public/Commercial — Describe Use Block # 0 City of ❑ State Owned — Describe Use 0 Village of CSM Number C.}1 43 187M 7 4 v. 11 ,163 ):Town of &GM C 5 M. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if a licable. A. )New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B' ❑ Holding Tank SIn-Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design I ❑ Other Type (explain) (conventional) C. ❑ Renewal Before Expiration ❑ Revision El Change of Plumber Li Transfer to New Owner ist Previous Permit Number and Date Issued d I (O0 1/l ;-O) O IV. Dispersal/Treatment Area and Tank Information: _(i K J,S Ch m r wl al S of t rd Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (sf) Dispersal Area Proposed (sf) I System Elevation 950 O.7 (,y3 (Sa A SO4 Tank Information Capacity in Gallons Total Gallons # of Units Manufacturer a a 0 A.0 , o m y CO .c 2 w0 a New Tanks Existing Tanks Septic or Holding Tank O ` 1 Dosing Chamber 'reCh1 6)C5'e j V. Responsibility Statement- I, the undersigned, assu responsibil fo i sta labor of the POWTS shown on the attached plans. Plumber's Name (Print) I Plumb Signature MP/MPRS Number I Business Phone Number Trn►v�s 13v��-crf�� W (sa�d79 7/S-G3H - $17(0 Plumber's Address (Street, City, State, Zip Code) 3 1 L13NfoW $#AM (44646% '77 l4s y ward, LUX ',fi3 VI, County/Department Use Only Approved 0 Disapproved 0 Owner Given Reason for Denial Permit Fee Date Issued 15 L Issuing nt nature Conditions of Approval/Reasons for Disapproval selc aka AUG 042025 Sayfleld Co. Planning and Zoning Agency Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 03/22) PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg1 of4 Pg2of4 Pg3of4 Pg4of4 Index & Cover Sheet Plot Plan Dispersal Area Cross -Section & Plan View Management Plan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Christensen/Folsom - 50210 Point 0 Pines Rd Owner Name(s): Ben M Christensen & Jennifer J Folsom Owner Address: 735 Woodcrest Dr; Hudson, WI Phone: 715 222 _8619 Zip: 54016 Project Address: 50210 Point O Pines Rd Govt. Lot: 11 1/4 of 1/4, Section 09 , T 44 N -R 09 Township: Barnes County: Bayfield Project Parcel ID #: 04-004-2-44-09-09-3 05-011-06100 (TAX ID: 37044) Designer Information Designer Name: Travis Butterfield Designer Address: 14.346W State Road 77; Hayward, WI E-mail: office@butterfielddrilling.com License Number: 652879 Remarks: EUor Wu Phone: 715 _ 634 .8176 Zip: 54843 This space reserved for approval stamp. FEE �.� �_ ' �`�-;IVED AUG 042025 Bayfiela Co. planning and ?orting Agency Signature: Date: o� / a_ ___ Original signature required on each submitted copy. SCALE = 1:40 II 1 It o to o PLOT 50210 Point O Pines Rd RIO Govt Lot 11 ' L Lot 1 CSM#1874 v.11 p.103`'II Sec. 09, T44N, R09WN Town of Barnes y Bayfield County y 31 B1 ,o� TAX ID: 37044 ,? �� g� o y ,y•p��s aao I w .? B2 SS ,Gic ct a D%-"z%%;� Well7 ELEVATIONS BM = 100.00 ft BI = 95.83 ft B2 = 96.25 ft • B3 = 95.42 ft BM = Nail w/ Ribbon in 18" Red Pine .I A o, tir v A� STu 10loOya t. pa$hc. Se? t c- 4,c nK (4de 6y 1 nos % ro r wJ L� I e h, .e L1'1S S'1 kt r /-�A= Abs&p4i m �4c+ca GansSSi F`'� e9)to tef 5, �+�o► ' S Paoed 3ce t n, ci' •�. tea.) of 3b Ou c lc '! PIu s CJ,4t be -. IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER roE.c�'Wa��i3 AUG 04 2025 Planning and Zonin g 9 Agency min. 12" (typical) Septic Tank(s) Manufacturer Infiltrator Water Technoloqies Septic Tank(s) Volume(s): 1060 gal gat gal gal Effluent Filter Manufacturer: Lifetime Filter LLC Effluent Filter Model #: LT -1 /8 12" min. trench depth (typl�i) TYPICAL TRENCH °Q. <: CROSS SECTION VIEW � 34" •'. .. . (ypical) . • , I .. (No Scale) System Elevation = 92.50 ft (typical) Quick4 Standard -W w/ End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) I------------------��---- t i �-------------------7�---- F B= 67 ft (typical) INSTALL PER TRENCH: 16 Quick4 Std -W @ 20 ff EISA/chamber = 320 ft' + 1 Pairs of end caps @6 ft' EISA/pair = 6 ft2 = Proposed EISA per trench = 326 ft' 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. Required Infiltration Area = 643 ft' x 2 trenches = Proposed Total EISA = .652 ft2 D GD m W O m Distribution Method: branched manifold El PAGE 4 OF 4 In -ground Gravity Management Plan IMPORTANT: The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 450 gpd; BOD5 ≤ 220 mgL''; 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 (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: Butterfield Inc Local government unit: Bayfield County Planning & Zoning 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 approvqqjtment in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan AUG 0.4 2025 In the event that any failed treatment component of this POWTS cannot be repaired, it syd�{{'uant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. IM -1060 General Specifications and Illustrations The IM -1 060 is an injection molded two piece mid -seam plastic tank. The IM -1 060 injection molded plastic design allows for a mid -seam joint that has precise dimensions for accepting an engineered EPDM gasket. Infiltrator's gasket design utilizes technology from the water industry to deliver proven means of maintaining a watertight seal. The two-piece design is permanently fastened using a series of non -corrosive plastic alignment dowels and locking seam clips. The IM -1 060 is assembled and sold through a network of certified Infiltrator distributors. Must be backfilled and installed in accordance with Infiltrator Water Technologies, Infiltrator IM -Series Septic Tank General Installation Instructions and for shallow ground water conditions reference the Infiltrator IM - Series Tank Buoyancy Control Guidance. Please visit www.infiltratorwater.comrimages/pdf/ ManualsGuides/TANKoi.pdf for the latest information. ITVPICAL 1 UMNG5R45P Working Capacity 1094 gal (4141 L) (1WKAU Total Capacity 1287 gal (4872 L) END VIEW Airspace 16.5% Length 127" (3226 mm) 041104 42416f01Acc555cPENINcswIn,L°cNGu°5fll Width 62.2" (1580 mm) Pa OR ABS '"LRrT� 041104PVCOR 1"WlfR®CARP PB$a TEE Length -to -Width Ratio 2.3 to 1 INut 63/II 163% 166% u Height 54.7" (1389 mm) PEA 34 _ PER Liquid Level 44" (1118 mm) 44.6 Invert Drop 3" (76 mm) f®ERGLA55 WPPoRT 11tIB] 1WID FlBBIGLA55 SUPPORT ITVPKAU is mrlrAu OFPIH WITH BAFFLE Fiberglass Supports 2 REQUIRED � REoulaEo Compartments 1 or 2 Maximum Burial Depth 48" (1219 mm) SIDE VIEW Minimum Burial Depth 6" (152 mm) Maximum Pipe Diameter 6" (152 mm) TANKTOP HALF CONTINUOUS GASKET n Weight _________________________ 320 lbs (145 kg) _________________________-I INFILTRATOR" water technologies 4 Business Park Road P.O. Box 788 Old Saybrook, CT 06475 860.577-7000 - Fax 860-577-7001 1-800-221.4436 www.Inflltratorawater.con, AUG 0 4 2025 TANK INTERIOR ALIGNMENT DOWEL SEAM CLIP TANK BOTTOM HALF MID -HEIGHT SEAM SECTION U.S. Patents: 4,759,661; 5,017,041;5,156.488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,183; 5,588,778; 5639,644 Canadian Patents: 1,329,959; 2,OOg564 O9wpatents pending. exictrator, Equalizer, Culck4, and SldeWlnder are registered trademarks of Infiltrator Water Technologies. Infiltrator Is a registered trademark in France. Infiltrator Water Technologies Is a registered trademark In Mexico. Contour, a trademark PW&TV6, Chamberspacer, MaePat tLocl , ark of T , CuId lay, SnapLock and StraiehtLock are trademarks of Infiltrator Water Technologies. POtyLok Is a trademark of Poytok, Inc. TUF-TITS is a registered trademark of NF-TnE, INC. Ultra -Rib Is a trademark of P0< Inc. 02016 Infiltrator Water Technologies, LUC. All rights reamed. Printed in U.S.A. IMD2 1116 ontact Infiltrator Water Technologies' Technical Services Department for assistance at 1-800-221-443t * y Real Estate Bayfield County Property Listing Property Status: Current Today's Date: 7/23/2025 Created On: 2/9/2015 9:50:08 AM tam' Description Updated: 12/30/2015 49 Ownership Updated: 12/30/2015 Tax ID: 37044 BEN M CHRISTENSEN HUDSON WI PIN: 04-004-2-44-09-09-3 05-011-06100 JENNIFER J FOLSOM HUDSON WI Legacy PIN: Map ID: Billing Address: Mailing Address: Municipality: (004) TOWN OF BARNES CHRISTENSEN, BEN M & CHRISTENSEN, BEN M & STR: S09 T44N R09W FOLSOM, JENNIFER J FOLSOM, JENNIFER J Description: LOT 1 CSM #1874 IN V.11 R103 735 WOODCREST DR N 735 WOODCREST DR N (LOCATED IN GOVT LOT 11) IN V.1154 HUDSON WI 54016 HUDSON WI 54016 R4 Recorded Acres: 0.900 r� 0 Site Address * indicates Private Road Calculated Acres: 0.900 50210 POINT 0 PINES RD BARNES 54873 Lottery Claims: 0 First Dollar: Yes Property Assessment Updated: 5/3/2024 ESN: 104 2025 Assessment Detail Tax Districts Updated: 2/9/2015 Code Acres Land Imp. G1 -RESIDENTIAL 0.900 21,000 49,300 1 STATE 04 COUNTY 2 -Year Comparison 2024 2025 Change 004 TOWN OF BARNES Land: 21,000 21,000 0.0% 041491 SCHL-DRUMMOND Improved: 49,300 49,300 0.0% 001700 TECHNICAL COLLEGE Total: 70,300 70,300 0.0% Recorded Documents Updated: 2/9/2015 ® WARRANTY DEED Property History Date Recorded: 12/21/2015 2015R-561726 1154-4 Parent Properties Tax ID 2 CERTIFIED SURVEY MAP 04-004-2-44-09-09-3 05-011-06000 3320 Date Recorded: 3/19/2014 2014R-553642 11-103 HISTORY ® Expand All History White=Current Parcels Pink=Retired Parcels ® Tax ID: 3320 Pin: 04-004-2-44-09-09-3 05-011-06000 Leg. Pin: 004123503000 37044 This Parcel Parents 3 Children cvw AUG 04 2025 Bayfield Co. Planning and Zoning Agency PRIVATE SEWAGE SYSTEM T ' MAINTENANCE AGREEMENT Document Number Document Title Lot 1 CSM #1874 Vol. 11 Page 103 CSM Doc #2014R-553642 DOCUMENT NUMBER 2025R-608609 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 08/04/2025 AT 8:00 AM RECORDING FEE: $30.00 PAGES: 2 Recording Area Name and Return Address Planning and Zoning Department Parcel Identification Number (PIN) AUG 05 2025 Bayfield Co. Planning and Zcnj A-?ancy THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE. This information must be completed by submitter: document title, name & return address, and PIN (if required). Other information such as the granting clause, legal description, etc., may be placed on this first page of the document or may be placed on additional pages of the document. WRDA Rev. 12/22/2010 Private Sewage System Maintenance Agreement Owner(s) Name Ben M Christensen Owner(s) Mailing Address 735 Woodcrest Dr N; Hudson, WI 54016 Site Address 50210 Point O Pines Rd Tax ID # 37044 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 Section 09 Township 44 N. Range 09 W. Additional Legal Description: Iny.1154 p.4 Town of Barnes Lot Lot 1 (Acreage) 0.900 Gov't Lot 11 _ Block Subdivision CSM # 1874 vol. j.L.Page 103 CSM Doc # Return To: Recording Area Planning and Zoning Department ® In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ 0ther________________________________ Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) yea ;t atk oC 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 aasprovided (Y YP ) P P P above. The switches and pump controls shall also be Inspected and maintained to ensure operability of said components. Planning Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds. At -grade, and In -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 Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner �lAR►� 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 Va es maybe placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collectd as0VdJedbefyP�. The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of Owner(s) Name(s) — Please Print r Subscribed a sworn to before me on this dat4 02� • o• PUBLIC �® =� �• eQ �Vf�7iJ� Notariz d Owner( — Ignature(s) Nota ublic My C�� fifes: /5 Drafted by: Ronald A Spreckels Jr Date: 07/16/25 Proofed by: u/forms/sanitary/septicmaintenceagreement Revised July 2020 BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Su it the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) eck List Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) rdex 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 ❑ 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) ❑ FjnldinTink Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) ❑ H (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ AELLS 4e green,nt (Recorded at Reg. of Deeds) [Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) �1Complete 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.) ❑ n applicable) Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) 1I Application Information must include: L"3 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) @/Project Address or Road Name where driveway is/will come off of) L9' (Owners Phone Number) I'II Type of Building C C7 III Type of Permit L�IV Type of POWTS System AUG 0.4 2025 dV Dispersal / Treatment Area Information Planning as d did Co. onjr.•g AgenCY C�VI Tank Information ES' VII Responsibility Statement (Plumber's Information) z*Date Stamp* Plot Plan: (To Scale or To Dimension) t9 Signature and Plumber Information (� Qc) [N/Address Number and Road 0 r C" North Arrow -rection and Percent Land Slope Contour Lines Tank and Filter Information and Location W Structures and Driveways ❑ r Boring Locations I/ Absorption Area (Proposed and Existing) l roperty Lines @/Bench Mark (Location, Elevation and Description) ell Locations Q omponent Manual Version ��+,c> Legal Descriptions Piping 11 terra fo xsatiol� (+ponveyance llfle, ,building sewe 1line, seater a pe gnd diajn er) Turn Over ► 5Z-0050 TEST •a�c'� 7" `� Wisconsin Department of Safety& Professional Services O — Page 1 of 1 Division of IndustryServices SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code County , n Attach complete site plan on paper not less than 8 1/2 x 11 inches in size, Plan must Include,C` F'e Id but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. ?I4,Icila: 3'70'i y scale or dimensions, north arrow, and location and distance to nearest road. yy.Q .q9- o ,011- o iota Please print all information. Revie ed Da�tt Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). Property Owner Y Property Location ❑ Be M C r i 54e en + Tey nt(er 3 Govt. Lot 1 t '/4 Y< S O9 T W N R 09 E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: •F � J 1 CMtJ I274 v.11 City, State, Zip I Phone Number ❑ City ❑ Village Town Nearest Road 5b 10 4'cI, LJX s''oit. I (')S) a)- &l01°1 r I P ' v 0 ;4%e5 P1 n X New Construction Use: Residential/N umber ofbedrooms Code derived designflow rate 'ISO GPO ❑ Replacement 0 Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material O.j ph Sd c General comments and recommendations: Boring # ❑ Boring MPit Ground surface elev.95.8 ft. Depth to limiting factor 10$ 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 O- 5 Y -E/ A ai1 O.7 I.G - 5-`1 Y/3 -- S t 3� aM. 1- 3 1J•7 yYj% 7. w iii / __ aI`Ce .s ^ v • I 1 • 7.SYR 5"/'! — 5 ,rv► - 1 c'.'7 1 - • Boring # []Boring cgPit Ground surface elev.9 ft. Depth to limiting factor in. / elev. ft. 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 (3_S 10 YR3/ r' ., c 0 •'7 -' J S'-% 10 R " 13 S 5 a-� 1. mot- 7. Y'IN ^' S 3 t7'l 1. 3.l1 7.'YR5/�,1 — J%1 - 1� o. CST Name (Please Print) Signature CST Number 1dA pckeIsT/ .A'J 6(.88 5P -10L14.56000 Address Date aluatlon Con cte Telephone Number I.4 9 R 7 I7 �c� cd £4 / 071 ill / 7/f- 43V — 8/ 7 * Effluent #1 = BOD > 30 ≤ 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 = BOD, ≤ 30 mg/L and TSS ≤ 30 mg/L SBD-8330 (R03/22) Page of __L ❑ Boring ® , Boring # 'RPit Ground surface elev.' S'f ft. Depth to limiting factor 110 in. / elev. ft. 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 YP'/13 -- ��.. 1. - 1, rn M --- s p.7 7.5Yj T/q --' CQ rv► v. 1. Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. 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 I ! ❑ Boring Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. 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 * Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS ≤ 30 mg/L SCALE = 1:40 0 I i � .—_--f aS '0S6 so 50210 Point O Pines Rd P/O Govt Lot 11 Lot 1 CSM#1874 v.11 p.103 Sec. 09, T44N, R09W Town of Barnes Bayfield County TAX ID: 37044 �-� BI ?16 h g�.00 B3 ABM B2 ELEVATIONS BM = 100.00 ft B1 = 95.83 ft B2 = 96.25 ft B3 = 95.42 ft BM = Nail w/ Ribbon in 18" Red Pine C$T SP- o Y4sa�T ti& s SOIL PROFILE SHEET OWNER: enii Cr;+enset,¢ jet &'j Fold SOIL TESTER: Ra id A Sra re c�G,C 1 s 'S'r-• SYSTEM ELEVATION: LOAD RATE: 0.711- (o SYSTEM RANGE: $ q. 1 to 9 �•" oc 9s ___ _____ 93.4 __ ___ 93 ------ -- --- ------ -- ---ISys^' ---carnrnenc'� --- ------ -- -- -- -- 9) 5 0 ___) -- --- __ -- __ --- $9 -- -- 3 - --- ------ gg --i -- --- 5°�� --- -- --- -- Page _!L of BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): C/ Check List ❑ I onal) Woriginal Soil Evaluation Report (Submitted in Deed Holders Name — not prospective. buyers) Original Plot Plan L1 ross Section Soil Profile Sheet (optional) 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) Property Location (Accurate Legal Description with Sec/Twp/Range) CZ Road Name (where driveway is/will be coming off of) ❑/F d D1 Complete Soil Boring / Pit Information V Date Soil Evaluation was conducted I (CST Name, Signature, Number, Address and Phone Number Q *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) VBench Mark (Description, Elevation and Location) c ' ontour Lines (Example = 98.0' /96.0' /94.0') Property Location (Sec/Twp/Range/, Accurate Legal Description) 7rings (Locations and Elevations) 0ercent and Direction of Land Slope Well Location (Including Neighboring Wells, if applicable) ❑L , Q' Buildings, Driveways, and Structures (Location and Descriptions) I Location of Property Lines ❑ n Address Number and Road Name ❑/ ion o e rs Owner and Property Information North Arrow 7Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforests 65 _ �� Department of Safety County & Professional Services, )& ye Id Sanitary Permit Number (to be filled in by Co.) Industry Services Division - q 5 S 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 purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. So a t 0 P6; n* o Pi rte s i I. Application Information — Please Print All Information Property Owner's Name Parcel # rJ%Jr t D t 37 OM 4 r 1" C r; a oca1 Property Owner's Mailing Address Property Location 735 ts3cec&crese hr Govt. Lot I I City, State Zip Code Phone Number Nudsov+, W X `-401 (e 7/s-aaa- plrst9 /. %, Section CA T I'I tf N R U E-er II. Type of Building (check all that apply) Lot # I or 2 Family Dwelling — Number of Bedrooms 3 1 Subdivision Name Block # 0 Public/Commercial — Describe Use 0 City of 0 State Owned — Describe Use 0 Village of CSM Number C-5 H i4 I B 74 ($r Town of l4M e 4 'V.11 .163 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. KNew System ❑ Replacement SystemExisting ❑ Other Modification m System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank ln-Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design I Type (explain) ❑ Other (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued / Expiration / —r71(I0 i// `)-000 IV. I lspersal/Treatment Area and Tank Information: ut KW(iasCha..tberswia S of a wd Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) Dispersal Area Proposed (sl) System Elevation 950 Ofl 413 6Sa 4 9a.so4Y Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units 2 U y 'a New Tanks Existing Tanks a p; 6 o 0.0 in w in [i C7 6. Septic or Holding Tank 10� 1 1 Dosing Chamber Teeh not ojte 5 f the POWTS shown on the attached plans. V. Responsibility Statement- 1, the undersigned, assn responsibly fo i stallation Oft Plumber's Name (Print) Plumb Signature MP/MPRS Number Business Phone Number Tftxv;s Q"+}er1Ce Id GS879 7/S-G�Jd 817(0 Plumber's Address (Street, City, State, Zip Code) 143y6W Skate Read 77 Nayww�d, ws 5`/SN3 VI. County/Department Use Only Approved 0 Disapproved Permit Fee s Date Issued L Issuing nt lure 0 Owner Given Reason for Denial ���- r^6 $ '�(j Conditions of Approval/Reasons for Disapproval e -c acl C -lied Camel _ AUG 04 2025 Bayfield Co. Planning and Zoning Agency Attach to complete plans for the system and submit to the County only on paper not less than 8 In x II Inches In size SBD-6398 (R. 03/22) TESt �RTlfg�. scsi Wisconsin Department of Safety & Professional Services g — a-Jr�— Page 1 of y Division of Industry Services iii �:.:• . -� $p' SOIL EVALUATION REPORT rnr4s� In accordance with SPS 385, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, / Sa 1' but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. 1A)(11): 3/O's y scale or dimensions, north arrow, and location and distance to nearest road. pgy. YY. .p9- O •,pil- 06100 Please print all information. Revie ed Dayt%� Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). Property Owner Property Location ❑ Sen r'I G r S4C erg + Jern,fer S Folsom Govt. Lot 1% '/ 1h S O T L,1;/ N R 09 E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: Lba-1 CM 127'4 v.11 City, State, Zip I Phone Number ❑ City ❑ Village Town I Nearest Road S0a 1 ('IS) W4- Wat r e P i O P:4% New Construction Use: Residential/Numberofbedrooms 3 Code derived designflow rate O GPD ❑ Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material Crud-Lj&sk SdLnd s General comments and recommendations: Boring # ❑ Boring Do Pit Ground surface etev.95.g3 ft. Depth to limiting factor 108 in. I elev. ft. Soil ADolication 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 -s Vs/ — f•C4.. a 0. I -C. � -g tbW4./3 -- S t 3� o . 1.C. 3 19.47 7. YR y/ -- S c)' 1. -IO 7.SY s/ — S p n% 1 c Q. -> 1 . Poring Boring # Pit Ground surface elev.9G..�5 ft. Depth to limiting factor lain. / elev. ft. Soil ADDlication 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 v-5 10Y13/ — f. s 0.7 •_ lt• S ( 3 i t.7 1.6 3•I1 . "YR S/N �• 1 — 1 c cs 1. CST Name (Please Print) Signature CST Number cavci3 A pciec.ktIs5i / 11410 S sP. ogQs6doo Address Date aluation Con cte Telephone Number 1"94w77 U*vc.1t £4 o7/ 1y /S WS -63W--817 * Effluent #1 = BOD > 30 ≤ 220 mg/L and TSS > 30 ≤ 150 mg/L * Effluent #2 = BOD, ≤ 30 mg/L and TSS ≤ 30 mg/L SBD-8330 (R03/22) Page a of __ Lr Boring # ❑ Boring IRPit Ground surface elev.�S I ft. Depth to limiting factor 11 O 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 1 - 3/-A ."_ .r YR`II3 — 55J.• 1. o-1 7, YR 5 1 4 p.7 ).C. -11 O 7.5 YR S/y —" �6 r+n 1f C'., 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 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. 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 * Effluent #1 = BOD > 30 ≤ 220 mg/L and TSS > 30 ≤ 150 mg/L * Effluent #2 = BOD, ≤ 30 mg/L and TSS ≤ 30 mg/L SCALE = 1:40 II I It 010 as S056 so 50210 Point O Pines Rd P/O Govt Lot 11 Lot 1 CSM#1874 v.11 p.103 Sec. 09, T44N, R09W Town of Barnes Bayfield County TAX I D . 37044 n o� Iq7 B1 Q' B3 ABM B2 0) (kovt ELEVATIONS BM = 100.00 ft BI = 95.83 ft B2 = 96.25 ft B3 = 95.42 ft BM = Nail w/ Ribbon in 18" Red Pine CST SP•oY4$CbO 5 A� b7 / ,Y/,≤ SOIL PROFILE SHEET OWNER: Gen M Chri.5 nStn,# -enn: ' J FolS. SOIL TESTER:Rcccid A S�recK�! s fir' SYSTEM ELEVATION: LOAD RATE: O/%- Co SYSTEM RANGE: to 9 3. 99 -- --- -- --- --- -- --- --- -- -- ------ --- --- ---_ -- -- ------ q7 ------ --- -- -- --- --- --- --- -- 9� --- -- 95.93 --- -- --- -- ------ -- --- - - -- 9s 93 IC�r(TeV%& --- 77 -- Sr5 __ --- --- -- -- 90____)__ ___ _____ ________ __ ___ 89 ------ -- 3 --- ---- -- Q -- -- �� 51-TQ -- --- -- --- --- 8G23 -- --- -- --- Page 4i of �_ BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): E/Check List ❑/I onal) L� Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) Original Plot Plan WCross Section Soil Profile Sheet (optional) Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) C9 Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used WR=&_Owner's Information (not prospective buyer's name) 11Property Location (Accurate Legal Description with Sec/Twp/Range) [; Road Name (where driveway is/will be coming off of) ❑F lZ Complete Soil Boring / Pit Information CY Date Soil Evaluation was conducted LS/CST Name, Signature, Number, Address and Phone Number Q *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) VBench Mark (Description, Elevation and Location) Contour Lines (Example = 98.0' /96.0' /94.0') V,property Location (Sec/Twp/Range/, Accurate Legal Description) E9 rings (Locations and Elevations) /7ercent and Direction of Land Slope Well Location (Including Neighboring Wells, if applicable) ❑L Cg' Buildings, Driveways, and Structures (Location and Descriptions) Q` Location of Property Lines ❑ n Address Number and Road Name ❑ ion o e rs "CST, Owner and Property Information L!i North Arrow 7Ce ified Soil Tests - Review & Filing Fee $ 50.00 U/farms/sanitary/checklist/checklistforests PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross -Section & Plan View Pg 4 of 4 Management Plan Attachments: POWTS Application for Review I Soil Evaluation Report & Site Map Project Name I Description Christensen/Folsom - 50210 Point O Pines Rd Owner Name(s): Ben M Christensen & Jennifer J Folsom Owner Address: 735 Woodcrest Dr; Hudson, WI Project Address: 50210 Point O Pines Rd Govt. Lot: 11 1/4 of 1/4, Section 09 , T 44 N -R 09 E ❑✓ or W ❑✓ Township: Barnes County: Bayfield Project Parcel ID #: 04-004-2-44-09-09-3 05-011-06100 (TAX ID: 37044) Phone: 715 222 8619 Zip: 54016 Designer Information Designer Name: Travis Butterfield Designer Address: 14346W State Road 77; Hayward, WI E-mail: office@butterfielddrilling.com License Number: 652879 Phone: 715 _634 8176 Zip: 54843 ['his space reserved for approval stamp. Remarks: RECEWED AUG 042025 Bayfield Co. Planning n^A_onln g Agency Signature: L Date: o-7la2___ Original signature required on each submitted copy. SCALE = 1:40 P T O to as yo 56 90 L O 50210 Point O Pines Rd P/O Govt Lot 11 Lot 1 CSM#1874 v.11 p.103 a n n Sec. 09, T44N, R09W Ifs Town of Barnes � r° Bi Bayfield County y Ay TAX ID: 37044 ?� y•PJtS R5n'nFBA L.4O B3 `BM qt 82 wed ST ,`to utt; ""� ELEVATIONS Well BM = 100.00 ft B1 = 95.83 ft B2 = 96.25 ft B3 = 95.42 ft BM = Nail w/ Ribbon in 18" Red Pine ST= I0tobep-t. ptaSFcc Sae%ie- 4an1C n.c4e o•t'J a}u In{tl}�r w/ L4+W" Lt/8 F:lkr A .� We el��.i� A% iab5o4.w+ AR0. Gen$:,$�i�_+7 1ir SPa•ed 3Ft ? ' CO tni n) fin) 1O of 3cl SU1CK 9 P/us Cho.-.bar3 ?c @ '1u IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER PECE;VED AUG 042025 i Co Planning ��lon Zoning Agency min. 12'• (typical) Septic Tank(s) Manufacturer: Infiltrator Water Technoloqies Septic Tank(s) Volume(s): 1 060 gal gal gal gal Effluent Filter Manufacturer: Lifetime Filter LLC Effluent Filter Model a: LT -1 /8 12"TI rHiC min. trench deph (typical) TYPICAL TRENCH ':a •. CROSS SECTION VIEW ('' ') (No Scale) System Elevation = 92.50 ft (typical) Quick4 Standard -W w/ End Cap (fypIC81) (Show location of inlet / outlet pipe connection on plan view.) r- ------ --t--------f----- I t L--------------- -�--- INSTALL PER TRENCH: B= 67 ft (typical) 16 Quick4 Std -W @ 20 ff EISA/chamber = 320 + 1 Pairs of end caps @6 ft2 EISA/pair = 6 ft2 ft2 Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturers / Instructions. A=3.0ft (typical) TYPICAL TRENCH PLAN VIEW (No Scale) '—Quick4 Standard -W Chamber (typical) (mid by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. = Proposed EISA per trench = 326 ftZ Required Infiltration Area = 643 x 2 trenches = Proposed Total EISA = 652 C m W O m ft2 Distribution Method: ft' branched manifold El PAGE 4 OF 4 In -ground Gravity Management Plan IMPORTANT: The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 450 gpd; BOD5 ≤ 220 mgL"1; TSS ≤ 150 mgL'1; FOG 5 30 mgL-1 Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (Le. 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 Local government unit address: 117 E 5th Street P.O. Box 58 Washburn, WI Butterfield Inc Phone: 715-634-8176 Phone: 715-373-6138 ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approvedsbythetlejfgltment in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan AUG 042025 In the event that any failed treatment component of this POWTS cannot be repaired, it si (I,j�n,9gruant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. IM -1060 General Specifications and Illustrations The IM -1060 is an injection molded two piece mid -seam plastic tank. The IM -1060 injection molded plastic design allows for a mid -seam joint that has precise dimensions for accepting an engineered EPDM gasket. Infiltrator's gasket design utilizes technology from the water industry to deliver proven means of maintaining a watertight seal. The two-piece design is permanently fastened using a series of non -corrosive plastic alignment dowels and locking seam clips. The IM -1 060 is assembled and sold through a network of certified Infiltrator distributors. Must be backfilled and installed in accordance with Infiltrator Water Technologies, Infiltrator IM -Series Septic Tank General Installation Instructions and for shallow ground water conditions reference the Infiltrator IM - Series Tank Buoyancy Control Guidance. Please visit www.infiltratorwater.comAmages/pdf/ ManualsGuides/TANKO1.pdf for the latest information. ir1 muu umNG smAP Working Capacity 1094 gal (4141 L) rTV° Total Capacity 1287 gal (4872 L) END VIEW Airspace 16.5% Length 127(3226 mm) 0411021 e24161DIACCESSOPENINGSWIINLOCI'INGUD5(2) Width 62.2" (1580 mm) P/C OR ASS w"r'� 10212601 FREE60ARD ms10 2ui nit Length -to -Width Ratio 2.3 to 1 u&rr AIRSPACE 01 n Height 54.7" (1389 mm) ffR I',°, PER C WE CODE Liquid Level 44" (1118 mm) „a L Invert Drop 3" (76 mm) SUPPORT S LgUID LOA SUPPORT SUPPO T f11PIULl DEPTH WINBL) Fiberglass Supports 2 W LLw�`1E REWIRED Compartments 1 or 2 Maximum Burial Depth 48" (1219 mm) SIDE VIEW Minimum Burial Depth 6" (152 mm) Maximum Pipe Diameter 6" (152 mm) TANKTOP__Ji CONTINUOUS Weight 320 Ibs (145 kg) HALF GASKET n INFILTRATOR® water technologies 4 Business Park Road P.O. Box 768 Old Saybrook. CT 06475 860-s77-7000 - Fax 860-577-7001 1.800.221.4436 www.inflltratorswater.com TANK INTERIOR SEAM CUP nECE IVED ALIGNMENT AUG 04 2025 DOWEL TANK BOTTOM HALF Bayfield Co. MID -HEIGHT SEAM SECTION Planning and Zoning Agency U.S. Patent: 4,759,661; 5,017,041; 5.156.488:5,336.017:5.401,116; 5,401,459; 5,511,903; 5,716,163; 5.586.776; 5,839.844 Canadian Patents: 1,329,959; 2,004,564 Omar patens gentling. Infilustor, Equalizer, 0uick4. and Sidewinder are registered trademarks of Infik2tor WaterTechnobgiea. Infiltrator is a registered trademark in France. Infilbetor WateTechnobgies is a registered trademark in Mexico. Contour. MicroLeachirg, PoyTufi, ChamberSDacer, MultiPort, PoaiLock, OuickCub OuickPty, Snaptock and ShalghtLock are trademarks of Infiltrator Water Technologies. PotyLok Is a trademark of PoyLok, Inc. TUF-TITE is a registered trademark of TUF-TITE, INC. Ultra -Rib is a trademark of IPE< Inc. O 2016 Infilvetor Water Technologies, LLC. NI rights reserved. Printed in U.S.A. IM02 1116 Real Estate Bayfield County Property Listing Today's Date: 7/23/2025 Ill Description Updated: 12/30/2015 Tax ID: 37044 PIN: 04-004-2-44-09-09-3 05-011-06100 Legacy PIN: Map ID: Municipality: (004) TOWN OF BARNES STR: 509 T44N R09W Description: LOT 1 CSM #18741W V.11 P.103 (LOCATED IN GOVT LOT 11) IN V.1154 P.4 Recorded Acres: 0.900 Calculated Acres: 0.900 Lottery Claims: 0 First Dollar: Yes ESN: 104 �'S Tax Districts Updated: 2/9/2015 1 STATE 04 COUNTY 004 TOWN OF BARNES 041491 SCHL-DRUMMOND 001700 TECHNICAL COLLEGE 4 Recorded Documents Updated: 2/9/2015 O WARRANTY DEED Date Recorded: 12/21/2015 2015R-561726 1154-4 0 CERTIFIED SURVEY MAP Date Recorded: 3/19/2014 2014R-553642 11-103 Property Status: Current Created On: 2/9/2015 9:50:08 AM 93 Ownership Updated: 12/30/2015 BEN M CHRISTENSEN HUDSON WI JENNIFER] FOLSOM HUDSON WI Billing Address: Mailing Address: CHRISTENSEN, BEN M & CHRISTENSEN, BEN M & FOLSOM, JENNIFER J FOLSOM, JENNIFER 3 735 WOODCREST DR N 735 WOODCREST DR N HUDSON WI 54016 HUDSON WI 54016 11 Site Address * indicates Private Road 50210 POINT 0 PINES RD ® Property Assessment BARNES 54873 Updated: 5/3/2024 2025 Assessment Detail Code Acres Land Imp. G1 -RESIDENTIAL 0.900 21,000 49,300 2 -Year Comparison 2024 2025 Change Land: 21,000 21,000 0.0% Improved: 49,300 49,300 0.0% Total: 70,300 70,300 0.0% Is Property History Parent Properties Tax ID 04-004-2-44-09-09-3 05-011-06000 3320 HISTORY 0 Expand All History White=Current Parcels Pink=Retired Parcels O Tax ID: 3320 Pin: 04-004-2-44-09-09-305-011-06000 Leg. Pin: 004123503000 37044 This Parcel t Parents 4 Children ztCVED AUG 0 4 2025 Bayfield Co. Planning and Zoning Agency Document Number PRIVATE SEWAGE SYSTEM MAINTENANCE AGREEMENT Document Title Lot 1 CSM #1874 Vol. 11 Page 103 CSM Doc #2014R-553642 DOCUMENT NUMBER 2025R-608609 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 08/04/2025 AT 8:00 AM RECORDING FEE: $30.00 PAGES: 2 Recording Area Name and Return Address Planning and Zoning Department Parcel Identification Number (PIN) RECr-- HD AUG 057025 6afcld Co. Planning and Zoning Agency THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE. This information must be completed by submitter: document title, name & return address, and PIN (if required). Other information such as the granting clause, legal description, etc., may be placed on this first page of the document or may be placed on additional pages of the document. WRDA Rev. 12/22/2010 Private Sewage System Maintenance Agreement Ben M Christensen Owner(s) Mailing Address 735 Woodcrest Dr N ; Hudson, WI 54016 50210 Point O Pines Rd """ " 37044 As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil testers report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated In such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established in the WI Adm. Code, as from time to time amended. (COMPLETE Legal Is required) 1/4 of 1/4 Section 09 Township 44 N. Range 09 W. Additional Legal Description: Iny.1154 p.4 Town of Barnes (Acreage) 0.900 Gov't Lot 11 Lot_ Block Subdivision Lot 1 CSM # 1874 vol. 11 Page 103 csM Doc # Return To: Area Planning and Zoning Department ® In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ Other _ Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) yeafs fFtly aa}�, E D 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 8, C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is semiAUG i9o1ded 2025 above. The switches and pump controls shall also be Inspected and maintained to ensure operability of said components. S, Planning a: Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturers specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, WIs. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is pending on the ground surface. Mounds. At -grade. and In -around Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. _ Owner(s) agree that failure to comply with this agreement will result In action being taken to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner 'fr14A) 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 �g6Et61eBQ gr� as maybe placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collecf4tl as pMtljded`bp - `4A_ The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners C7 Owner(s) Name(s) — Please Print Subscribedynl sworn to before me on this dot /JU /7 2o2$ ____________ ,44/7 X40 yyISCO ________ Notadz d Owner( — ignature(s) Note ublic S' A ,S'._— My Co Is ' n 6rpree: My /s /hare L. Drafted by: Ronald A Spreckels Jr Date: 07/16/25 Proofed by: u/forms/sanitary/septicmaintenceagreement Revised July 2020 BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Subfnit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) eck List iloylginal Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) �rdex Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) GV%riginal Plot Plan (383.22(2)2. 3. & 4.a) Q' Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer ❑ 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) ❑ I-4nlrling Tank Agent (383.21(2)(c)(5) (Recorded at Reg. of Deeds) ❑ H (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ (Recorded at Reg. of Deeds) dFee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) !I7.Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached Lto all copies) s Soil and Site Evaluation Report (383.22-3(2)(b)1,e.) ❑ n applicable) ['3/ Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) 1'I Application Information must include: 19/23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) dProject Address or Road Name where driveway is/will come off of) l (Owners Phone Number) VII Type of Building C/ �/III Type of Permit C9/IV Type of POWTS System UV Dispersal / Treatment Area Information AI Tank Information 4VII Responsibility Statement (Plumber's Information) u1 *Date Stamp* Plot Plan: (To Scale or To Dimension) S Signature and Plumber Information FTarnk tion and Percent Land Slope and Filter Information and Location ❑/ r V Absorption Area (Proposed and Existing) Bench Mark (Location, Elevation and Description) Ci�omponent Manual Version (VAadr> F`ECE1VEO AUG 042025 Planning and fling Agenoy C9'/Address Number and Road QNorth Arrow "C ontour Lines M'Structures and Driveways Boring Locations Lgroperty Lines ❑ a+Vell Locations L9/Legal Descriptions Piping Material Information (conveyance line, building sewer line, material type and diameter) Turn Over ► 4 .. Cross -Section and Over -Head Profile of the System: � l rface and System c'i y m Elevation ❑ P sition of Observation and Vent Pipes Dimensions and Depths IY'Make, Model & Number of Chamber Units in each Cell Property Information SHow many systems will there be on this parcel of land? 1 (� Has this property been split? S (Property Statement shows Property History) Fees: CNiPrivate Sewage System (Septic Tanks) ❑ 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 (checks made out to Reg of Deeds) u/forms/checklists/checklistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: ]3'F ii E LD Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: CHRISTENSEN, BEN M 735 WOODCREST DR N HUDSON, WI 54016 FOLSOM,JENNIFER J 735 WOODCREST DRIVE N HUDSON, WI 54016 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00309 Transaction Number: SR -00309-32421 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 4608 Paid by: Butterfield, 14346W State Rd 77, Hayward WI 54843 Payment Type: Check Transaction Date: 8/11/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. R.4 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: CHRISTENSEN, BEN M 735 WOODCREST DR N HUDSON, WI 54016 FOLSOM,JENNIFER J 735 WOODCREST DRIVE N HUDSON, WI 54016 Description Private Sewage System (Septic Tanks) Submission Number: SS -00615 Transaction Number: SS-00615-31EB9 Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 4608 Paid by: Butterfield, 14346W State Rd 77, Hayward WI 54843 Payment Type: Check Transaction Date: 8/11/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-25-95S STATE SANITARY PERMIT OWNER: CHRISTENSEN, BEN M & FOLSOM, JENNIFER J GOVT LOT: 11 LOT: 1 B L K: CSM: 1874 V.11 p.103 1/4 1/4 SEC: 9, T 44 N, R 9 W TOWNSHIP: Barnes SOIL TEST: 98-25 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: TRAVIS BUTTERFIELD TRACY POOLER Authorized Issuing Officer DATE: 8/11/2025 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 #: 16-0160 LICENSE: # 652879 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 8/11/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION