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HomeMy WebLinkAbout25-98SV Request for Sanitary Inspection (24 Hrs. in Advance) Fax or email this form to Zoning Dept (24 Hrs.) prior to when you want an inspection Fax (715) 373-0114 or Email zoning(atbavfieldcountv.wi.pov Note Time Change Discrepancy Other Phone Number Plumber: Fax Number Homeowner: I k)a t Ly eI+- Email Address c Sanitary Permit #: q G / 0 Immediate Phone Number So Zoning Dept can call you right back (if needed) Plumber's Choice Zonin Dept Date: 01 o I A �> � u No Inspection(s) during this time Tuesday (9:30 am - 12:15 pm) (Tracy) Time: Plumber's Choice Zo Dept Township: s�r)e Address #& & Road Name: or // // `` cc � SS // // n� /�J7�J v�n�rlll/ l� i) On Directions ff To Site: Comments: ** Plumbers you must verify any change(s) by fax or email ** Notes from Zoning Dept: July 2025 ?ezrM Industry Services Division Tank TYPE MANUFACTURER CAPACITY ' llTfl Weil Air Intake Road Be tic 1 hest✓ Goo0 ga\ 'SD -IQ N/A Dosing N/A Aeration N/A Holding Private Ons.ite Wastewater Treatment Systems ( POWTS). Inspection Report (Attach to Permit) HALEY L WALLER PITTS ET AL 2005 ROYALE DR EAGAN MN 55122 enrt of setback to: of. County MeicL Sanitary ermlt No: a5-tes State PlanTransaction ID#: Parcel Tax No: aa'i%o-j Pump I Siphon Information ump Manufacturer Pump Model Demand GPM IlterManufacturer Filter Model TDH Lift Friction Loss Head Total Forcemain Length Dia Dist. To Well Dispersal Cell Information RtMENSION9r 'UP1 ? ,. I of CeIt " 3 0 SETBACK FROM 9pt® 44 j 6eth Manufacbrer.S.�, l Tcch Model Number. Qv�ck 9 Pretreatment Unit Manufacturer: Model Number: \v stribution System 3oi1 Cover Depth Over I Depth Over I Depth of I Seeded / Sodded I Mulched Cell Center Cell Edges Topsoil j ❑ Yes ❑ No 0 Yes 0 No 30MMENTS: (Include code discrepancies, persons present, etc.) �Hc w lryCfs YV*J Vm- }rze otec- 4c,, L 0 irw.or — iV'&c k each ce\1 D in Qat"1 ll-1el�S f C'M�nl d� Pf� �� — V t Ak% N I c be I r t n� 1�<C� P� D105G✓vd ten qt?,o I SGty a 1wl We✓ !an revision required? ❑ Yes ,No I p 3t isi 1 \OO�9-pr is other side for additional info m kHon. 6 0� Date POWTS Inspector's Signature License Number Elevation Data STATION BS HI FS ELEV lenchtae s S , (o O ( O5. (O loo O Bldg. Sewer 3.1 l0 I. 1 nkInlet ( t110 Wank Outlet to 9Z.9 Dose Tank Inlet Dose Tank Bottom Inst. Contour header/Manifold g g 9& Z Distribution Pipe °I.1 s 9s.sa Final Grade X Pressure ❑ No 1 :Rn-.71n /R ngf911 BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT a; Property Owner Information As you know Telephone: (715) 373-6138 Bayfield County Courthouse Fax: (715) 373-0114 Post Office Box 58 e-mail: zoning(a)bavfieldcountv.ora 117 East Fifth Street Web Site: www.bayfieldcounty.org/147 Washburn, WI 54891 HALEY L WALLER PITTS ET AL 2005 ROYALE DR EAGAN MN 55122 was contracted by you to install a private onsite wastewater treatment system on your property (Tax ID# above). To know when your system will be due for servicing please go to www.septiesearch.com Notes: Abandonment of Old System to meet all applicable code requirements: 1 3 Tank was pumped by: Tank was crushed! removed and pipes disconnected by: on at AM/PM On at (AM / PM) the above -mentioned plumber contacted our office to conduct a pre -cover inspection as required under DSPS 383. One of the following applies: System was inspected and appears to meet all applicable code requirements. 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 could not be inspected because plumber covered prior to scheduled time of inspection. ❑ System could not be inspected because plumber was not ready at scheduled time of inspection. County was unable to return to complete inspection. System could not be inspected because plumber was not ready at scheduled time of inspection. A re -inspection and $50 fee are required. System could not be inspected because County could not respond to plumber's time constraints. Comments: U/forms/s anitarypropertyown er-input April 2019 r � EIVE Industry Services Division 4822 Madison Yards Way County s $ �' •,_ .� 5YMadison, WI 53705 �b � Sanitary ermit Number (to be filled in by Co.) pS. /< AUG • 0 5 2025 P.O. Box 7302 Madison, WI 5302 � c `'C rs Planr�iS i . ��+ rz it 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 thap ipai 1inttsdd f `` 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 in Privacy Law, 1.5.04(l)(m), Stats. j l0 �+V' purposes accordance with the s. CtS a g�j I Application Information— Please Print All 1h1 anon _' Propertyr-,,Yncr's Name Parcel # w 0;L/ Property Owner's Mailing 4ddress Property Location a 'oLtttkct Govt. Lot f___ ` 1 City, State I Zip Code Phone Number ssI 2 Z 15—ya9—o b '/+. '/., Section T M N R LE or SIT:= I '.of-Buildtng (checkall that apply) ;:.... Lot # Ll or 2 Family Dwelling —Number of Bedrooms D !t Subdivision Name Block # ❑ Public/Commercial — Describe Use O City of ❑ State Owned — Describe Use O Village of CSM Number 6LTown of Kee j VIP _ Ill Type of POWTS Permit. Check either "New" or "Replacement" and ;other: -applicable on lint; �4::. Check one. "ox on in rr YP (Check Pb e B. Complete line G if li ble. A. New System Replacement System ❑ Other Modification to Existing System (explain) Additional Pretreatment Unit (explain) B. Holding Tank In -Ground At -Grade Mound Individual Site Design Other Type (explain) (conventional) C. Renewal Before ❑ Revision Change of Plumber Transfer to New Owner ist Previous Permit Number and Date Issued Expiration isprialatliintArea and nah"on' Design F v(gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required (sf) Dispersal Area Proposed (st) System Elevation ofd © v bSo Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units -a Ne%v Tanks Existing Tanks Septic or Holding Tank 0 2 Ood I Dosing Chamber Y Responsibility.Statementi-. I the undersigned, assume r nsi for Installation fifth :OWTS ' g �4 itY' shown Q the attached she a n e.at Plumber's Name (Print) Pt is a MPIMPRS Number Business Phone Number dbw 6��37 2 q -�t6 Plumber' Address (Street, City, State, Zip Code) T �7 r v��Y q0 p 4 7 Ci+oun��Depar�,e4s Approved O Disapproved O Owner Given Reason for Denial Fee $e UC ` Date Issued ���L I ssui A t Si /?32'13 Conditions of Approval/Reasons for Disapproval CL LC C f C\ RECEIVED AUG05 5 2025 Sayef 1 CO. Planning ageicy PAGE 1 OF 4 PRIVATE SEWAGE SYSTEM PLAN INDEX r_Ownees,Name: Haley L. Waller Pitts Town: Town of Keystone (Bill Waller site) Coun : Bayfield Countyy 005 Royale Drive, Eagan, MN 55122 Legal Description: S22-T47N-R07W Tax ID: 22167 Lot 19, Spider Lake Shores Property Address: 16425 Sand Hill Road Mason, W l 54856 Page •Number CONTENTS 1 of 4 PLAN INDEX 2 of 4 SYSTEM PLOT PLAN 3 of 4 DISPERSAL AREA X -SECTION & PLAN VIEW 4 of 4 MANAGEMENT PLAN Attachments: SOIL EVALUATION REPORT For Office Use Only COMPONENT MANUAL NO.: Version 2.0, SBD-10705-P (N.01I01) I, the undersigned, hereby certify that the plans and specifications submitted herewith were prepared under my direction and control Greg Brown Greg's Plumbing, LLC. 13660 County Hwy H Iron River, WI 54847 715-209-0161 Signature: Date: ,� L License No: z SEC "iWED AUG 052025 PAGE 2 OF 4 SPIDER LAKE O1 I Prop tine — — SPIDER LAKE SITE MAP 7N ; Scale: 1" = 40' / 0 40 80 120 1 \ Proposed 'ZOO O 5BR House Site �' - t Il a Modal 3t aW l (wM Ey Mow c�awete) aXL=t Eilor at capc ruoi a" / N (eafd dY PWYlaktna3 / athta=Srbm S o Su Proposed of Well Location ,b? •1. 100. mat rw t- Saar Design Flow = 5 BRs x 100 gaYBR/day x'1.5 = 750 gaVday Minimum Inflltratlon Area 750 gpd 10.7 gpd/sq 4 =1,072 sq-ft . •- . System Elevation = 96.00' Instal! 3 trenches with • 100.0 18 "Quick -4 Standard" ' :: _ 82 gravelleas chambers per trench. ; • .. (mfd by Infiltrator Water Technologies) ` PtMW 97.8 tt.. BM. 100.00' /(nail In White Pine) a •: Bill Waller Site .• -: a� Haley L. Waller Pitts (owner) - SIM Address: Lot 19, Spider Lake Shores a, 16425 Sand Hill Road Sec 22, T47N-R47W Mason, WI 54856 Town of Keystone, Bayiield County Tax ID#22167 •.i: ' •+�- �' -,b' .;... ••• •� �•' r •.=•sue••: •�•••-•� •s ,-,7's•ti.•+.-'r'•,. �.. `.-• . . .....v ., �.; •t.�,.•s, .. .- • SAND HILL EASEMENT ROAD � , .�... ,:: .:.... ; - •., - ` d' LL O M W CD End Cap (typical) Observation—) Pipe (typical) DISPERSAL TRENCH CROSS-SECTION VIENV SCHEMATIC (No Scale) SOIL COVER F!N!Slig0 GRADE min. 12' min. 12'-•� (tyPl} (typo 1 Geotextde Cover 36' rR _ ' min. trench 12• • a4paration distance Endcap s m depth 8' : y (typical) Inle96.67d e ; • (typical) {tyPtcal) '. F'-- 86'----} • . ; ' e Standard Qulck-4 + Chamber •. ; a '• (typical) A• • • t (mfd by Infiitrator Systems. Inc.} System Elevation = 9800 •. .� °• ; • t (typical) , . (typical) Install pursuant to manufacturers instructions.. L • •.' Required Dispersal Area = (750 gpd) / (0.7 gpd/sq-ft) = 1,072 sq-ft EISA = (18 chmbrs/trnch x 3 trnchs x 20 sq-ft/chmbr) + 5.8 sq-ft/end cap pair x 2 prs = 1,092 sq-ft DISPERSAL TRENCH PLAN VIEW SCHEMATIC (No Scale) Standard Quick -4 + Chamber I..4 h., r...iira...a... Q....a......... P..... 3.0 ft 401 PVC Conveyance Pipe (typical) icap Invert 3.67 ,ical) REC NE AUG 05 2025 Page 4 of 4 Management Play ea�►�i;� �° IMPORTANT: The owner of this in -ground dispersal 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 = 750 gpd; BOD5 5 220 mgL"'; TSS ≤ 150 mgL"'; FOGS 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 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 o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic 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 Wis. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Greg's Plumbing (Greg Brown) Phone: 715-209-0161 Local government unit: Bayfleld County Zoning Department Phone: 715-373-6138 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, Wis. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wis. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the Department of Safety and Professional Services for review and approval. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wis. Admin. Code. AUG 0 5 2025 ;.. _ Piann nc a .d Zcu` A?enf . ii- cu. to 1iE W.M SIX ft l9%flE:, MTAEBamtuaAFFi.E�@s! U i^' �n����'y�Cv1 riry:r t ..: ,.. `.' o h Alts tR s"@j kiR QSMFu11CS (7RMEM r _ +POBfACf Q ... w 1 7 CC)! 30 Private Sewage System Maintenance Agreement Owne s) Name V 1 TT > f Q I e. L VfC t' RH- Owner(s) Mailing Address 40S !o7k Pes C4f ei'I MAJ SS/2 7 - Site Address f6`f2S .<4AJd 001 1A Tax ID# A21 b"7 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 1/4 Section 2 Z. Township N. Range 7 W. Roe ! •v W Additional Leal Description:.2 02.1 iZ .. 5'9l %G Z. ke 4c i.Lt Town ofIce,s Tot, 9 (Acreage) • Gov't Lot Lot I -/ Block Subdivision 3'Pi q.cc J h o r&S Lot CSM # Vol. Page CSM Doc # DOCUMENT NUMBER 2025R-608639 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 08/05/2025 AT 9:00 AM RECORDING FEE: $30.00 PAGES: 3 Recording Area Return To: Planning and Zoning Department Et' In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ Other Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. Pump Chamber (system types B, C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds. At -grade, and In -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 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 a# 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 teens and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such property. h C E i C L. Owner(s) Names) — PleasetiG{r jtr4} 4 fey ��I I.« i�'Hr fj" W KJ Subscribed and swam t�� before ate: A Notarized Owners — Signature(s) — otary lic My Commission Expires: - . (k/i - .3/ 3C7 Drafted by: M " VJA 19 y` r 5 Date: a 1 S 12 S ;0626/:, 3ayfiuld Co. c._ ...r r, ..• .. Proofed by: XItG OT J 80 � Fewft-Ild j��y sans ry epticmalntenceagreement M� Revised July 2O2O 10r1 �T.l �i, zec30 EXHIBIT "A" A parcel of land located in the Northwest Quarter of the Northeast Quarter (NW'/NE'/a) and the Southwest Quarter of the Northeast Quarter (SW'/NE%4), Section Twenty-two (22), Township Forty-seven (47) North, Range Seven (7) West, Town of Keystone, Bayfield County, Wisconsin, described as follows: To locate the Point of Beginning, commence at the East Quarter (EI/a) corner of Section Fifteen (15), Township Forty-seven (47) North, Range Seven (7) West, and run N. 88°04'51" W., 2622.29 feet along the monumented East-West'/4 line of said Section Fifteen (15) to the center of said Section Fifteen (15); Thence continue along said monumented East-West/4 line, N. 88°14'21" W., 655.39 feet to the Northwest corner of the E%2NE'/4SW%a of said Section Fifteen (15); Thence S. 00°42'32" W., 2626.08 feet along the West line of the E%2 of said NE'/SWI/4 and the SE'/aSW%4 of Section Fifteen (15) to the South line of Section Fifteen (15); Thence S. 0°43'26" W., 1813.44 feet to the Northerly right-of-way of the Tri-County Corridor; Thence along said Northerly right-of-way line, S. 88°43'52" E., 967.64 feet to a 1 inch iron pipe which is the Point of Beginning.. Thence from said Point of Beginning by metes and bounds: Continue along said Northerly right-of-way line, S. 88°43'52" E., 400.00 feet to a 1 inch iron pipe, Thence leaving said Northerly right-of-way line, N. 00°48'43" E., 145.00 feet to a 2'/2 inch iron pipe; Thence S. 89°13'04" E., 5.03 feet to a 2'/2 inch iron pipe which is N. 89°13'04" W., 25 feet, more or less, from the water's edge of Spider Lake; Thence along a meander line, N. 01°13'53" E., 119.38 feet to a 2%2 inch iron pipe; Thence N. 20°48'09" E., 197.22 feet to a 2%2 inch iron pipe; Thence N. 09°10'13" W., 402.46 feet to a 2Y2 inch iron pipe; Thence N. 69°50'28" W., 221.60 feet to a 2%2 inch iron pipe; Thence S. 39°34'35" W., 327.84 feet to a 2%2 inch iron pipe; EC ;v.:D Thence S. 37°11'40" E., 371.72 feet to a 2'z inch iron pipe; AUG 0 6 l O1b Thence S. 21°42'36" E., 197.72 feet to a 2%2 inch iron pipe; Bayfield c . nninand Zc:- Thence S, 57°28'00" W., 172.19 feet to a 2%2 inch iron pipe; Plag , ... „0enc Thence N. 57°36'54" W., 176.00 feet to a 2%2 inch iron pipe which is S. 00°49'24" W., 35 feet, more or less, from the water's edge of Spider Lake; Bayfield County Register of Deeds Document # 2021 R-591662 Page 2 of 3 Thence leaving said meander line, S. 0004912411 W., 182,65 feet to the Point of Beginning. Also known as Spider Lake Shores, Lot Nineteen (19), as recorded in File 1 of RLS, Page 37. Together with and subject to an easement for ingress and egress as shown on the Registered Land Survey recorded on March 20, 1997 in File 1 of Registered Land Survey on Page 37 as Document No. 432692. RF.CE ED AUG -0 6 2025 Bay ieid co. Planning and 'cuing Agency Bayfield County Register of Deeds Document # 2021 R-591662 Page 3 of 3 - ...Fro - _. --- ..�•. AUG 05 2025�a� ' e wnscansin Department of Commerce eayfid Co. SOIL EVALUATION REPORT Division of Safety and Agency in ac conianca with Comm 85. WIS. Adm. Code County Attach complete site plan an paper not loss than 8112 x 11 Inches In Size. Plain must •C , include.. but not limped to: vertical and horizontal reference point •(BM) dtrtictlan and Parcel t.D. percent slope, scalp or dlmansla�s, north arTnw. and location and distance to nearest road. P2.8- Jo'-! `/ — b 3 a 1 Please print a/i information. Reviewed by Date pam*nW tLttonnation you ptav₹do may be uaed for ac0cndary iPosu L s.LQ4 (1Hm)eL) .IZ ' . Propcsw Owner ]] L '� ' j Pt y Lacs an I I'Y)L. r " e l �t /cJ\ 1 oo44ot 114 1/4 8 ZZ—T Y7 N R 7• ar W properly owners MaWn9 Address J M 2&8 , Block is SuDd. Name i t 3L17 53 O $ oof $p, J-.��. L ke City State ZiP Cade P • ' City jV1Iin9e Town NeArost Road New ODhetroction . Use: g Residential I Number of bedrooms Code derived design: flow rare__ - GPD Q Replacement dPublic or c omin rc l • D1 Parent`matsnal /4 C T; I _ Fl p aln evatlon 11 applicable (#; _ t3enetal cDrnmcnts r . _ - - and roaamniandatians:•1 a # . p Bonng Pit Ground surtaoo elay. / ft. Depth to limiting factor In. Soil Appllcatlon Rate Hainan Depth f?cminant Cdor in. Mansell Redac Desalpt'an Texture Structure Consistence Qu. Sr- Cont. Color Gr. Sz. Sh. Boundary Roots GPD/K3 'Effiyl *Eff 2 Z 3-2i 75Y, } 0AJ-f L..S i4k mL- aS /7 /2- 5// vim' j I�. S - ow b ; �'7L..- — , •7 !, z. solcadan li Ap Race I3aniRaisl Coicnr' . Rsdox Desciipiian . Texture:: In. Mansell Qu. Sz. Cont. Color Struchue Cr. Sz. Sh. Conslstence ' socuidary •Roots GP!)lft= "Eff#1 -Eff42 L L e, —.c i z1A a e S 1 -AS Z m v(r.- 4 S 3 1 5 1 f iI "\ 5.viz __- s/ f.o -t 1 / 2— - • ►� r cca+tcn! In M auuS. 30 < 220 mglL and TSS '3D< 150 mgiL. ' Etltuent 02 = t3QDs < 30 mail and TSB < 30 mg/L. CST Nams tPLeae Prtrtt) CST Number /J11a • o I bask; ,_._. as 6o Cs Address Data Evaluation Conducted Telephone Number t. Box .S doh AVr. i,irz ,5$'8'/7 II" —a3 7/5-39/ �ECIEVED AUG 052025 . _ `, Parcel ID#OZsf_ /o'-fY-03!0d "Page of ..3 Boring - odng ® pit Ground surface oleo, / 7 e ft. Depth to limiting factor 7�� in. c„a n...r._. -- ^ .,d1 Depth Dominant Color' Redox Description Texture In. Munsell - Qu. Sz Cont. Color Structure Sr. Sz. Sh. Consistence Boundary Roots GPD/tl' Eti#S 'tf i2 I o4 io', 311 SL tjz,Lk rv-ct- es 3Cc ,� .Z <23 Y& 94 /)ow65 Osq mv.fr e5 Sr" .7 !.z — /.Z Bodng # ❑ Boring n pit Ground surface oleo. R Depth to Ilmitine factor In. SOIi Application Rate Horizon Depth Dominant Color Redox Desaipion Texture Structure In. Mansell Qu. Sz. Cont Color Sr. Sz. Sh. Consistence Boundary Roots GPDRIZ 'EfffY 'Eff#2 ( I L -H J90 # ❑ eortng n ou Ground surface elev. ft Depth to limiting factor In. 'Effluent M:GOD, >30<220 mg/L and TSS >30<150 mg/I. •Effluent#2= SOD,<30mg&and TSS <30 mg/L The DepaiTinent of Commerce is an equal opportunity service provider and employer. If yon need assistance to access services or -need material in an alternate fotmat, please contact the department at 608-266-3151 or TTY 608-264-8777. Soaa3D (115100) @alfiyld c s' iIiLI �i { i r I s. � I qzS i I I I - RL o 5 G1 u l I 1 {a i I ii f 1 1 j Q ! i •t l'l fri I j;;srv� Vi:w>I ! I 1 j 1 hl�^✓� •� i I 1 i � i � I � I .I { ' �� f'F s,I C l 5/'e'v A lah Peplos � t� 377 �, zl e S� i,eb / 1S t-hk f Le4e z , S z + �7 N Rfr 4✓ i D c u rattan tgTi 3 6 l I i ! I I j d�a�' elL of i i GST yzzoo90 RECEIVED Indus Services Division 4822 Madison Yards Way County - [. }I p 1 —Gobi lvtadison WI 53705 � E SS ( v Sanitary ermit Number (to be filled in by Co.) AUG05 5 2025 P.O. Box 7302 Madison, WI 5302 — Bojficti Co. PWnnifr� a4Ag it 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 thanm ddr 1=vJs) I is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS arc submitted to the of Safety and Professional Services. Personaltr information you provide may be used for secondary in Privacy Law, 15.04(O(m), Slats. _ y Z I Ip purposesDepartment accordance with the s. m 4t43a S'9 gs.$ T. Application Information - Please Print All Information Property wner's Name Parcel # q / q (Jr/hr / Property Owner'sMailing dress Property Location ( t Govt. LotI 0t -7 _ `� Z City, State Zip Code Phone Number I V S -r 2. Z '/•_ '/y Section T 91 N R E or II. Tyi of Building (check all that apply) Lot # or 2 Family Dwelling — Number of Bedrooms A U Subdivision Name Block # ❑ Public/Commercial — Describe Use O Cityof ❑ State Owned — Describe Use O Village of CSM Number S'ownofe4Acer Kcuc+,ne Ill. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Checkone boxon line B. Complete line C if a licable.) A. New System ySystem Replacement ❑ Other Moditic:uimt to Existing System (explain) Additional Pretreatment Unit (explain) Holding Tank In -Ground At -Grade Mound Individual Site Design I Other Type (explain) (conventional) C. Renewal Before ❑ Revision Change of Plumber 't'ransfer to Nov Owner ist Previous Permit Number and Date Issued Expiration IV.Dis ersal/Treatment Area and Tank Information: Design Soil Application Rate(gpd/sf) I DispersaArea egquiirred (st) Dispersal Area Proposed (st) System Elevation S V [ //" v l/0 sl Capacity in Total N of Manufacturer Tank lnfomation Gallons Gallons Units 2 o o New Tanks I Existing Tanks v $ .00 m a U iii v7 k. Ci R. SepdcorHoldingTank t 0 — 2Coo I �S/' l [)osine Chamber V. Responsibility Statement- 1, the undersigned, assume responsi city for installation of the POWTS shown on the attached plans, ['lumber's Name (Print) �CDw Plm is 'i a MP/MPRS Number Business Phone Number 16 69/37 2-61 Plumber' Address (Street, City, State, Zip Code) Q TK - q8 VI. County/Department Use Only Approved I 0 Disapproved ❑ Permit Fee I Date Issued gL Issui A t Si tare Owner Given Reason for Denial onditions of ApprovaUReasons for Disapproval /� taQ C4G{ OA 1O- AUG 0 5 2025 Wisconsin Department of Commerce Bavfiald Co. SOIL EVALUATION REPORT Division of Safety and Buildingsf„3n,,;,,. ;d Loning Agency in accordance with Comm 85, Wis. Aden Code County Attach complete site plan on paper not lass than 8 1/2 x 11 Inches in size, Plan must Include, but not limited to: vertical and horizontal reference point (SM), direction and Parcel percent slope, scale or dimensions. north snow, and location and distance to nearest road. Please print all information. t Review Portorul iNwmsGm you pmvioe may be used for xmMarY putpases (Pnva IaW, s. (hl l(n)). Property Owner J� - . PrIpArty Location �i� L 1 t Ge L''1 � J/ ,. e" Go k� l t 1/4 property Owners Melling Address' 'c 8 LOU3Block P Subd. t, U1.37 5 3L/�90 $tl <,% Su,< 6a r I 55 ; City state Zip Code P 8 City U Village S a5 h -tan I W'IIc3 1 1 1 1( 2GZi c foc Dxt1 -/tf L oLd- JOyd-630/t 1 by Data !s'[. f Z =- -twUe-- I fe' moo' u3 114 S-ZT 1{7 NR 7 or( me GM $6t tref Town Nearest Road I FFR, tfy/9 New Cohstrucffon Use: p=+ Residential / Number of bedrooms V Code derived design flow rate /o 9 GPD ❑ Replacement 0 PublIc or commercial- Descrilup, Parent material (,' /4 C i a I ( I - . j Flood Plain elevation If applicable }t. General comments and recommendations: I] Boring, � # ® Pit Ground surface elev. 104,6 r f. Depth to limiting factor 7 / / In. Horizon I Depth in. Dominant Color Munsell Redw Description Ou. Si. Cont. Color Texture Structure Gr. Si, Sh. Consistence Boundary Roole GPD/f' •Eff#1 Eff#2 o-3 3% Pie.ve s, /.�c SV lvnv-1- as 3G. Y .Z 3-il ',cy A) v 1,4bt m v -C,- aS 3i , ? /.2- 3 27%4 rt- 5 6 jVory vsf - ✓. /7 /,2_ __ ® sofatg o ❑ Boring ® pit Ground surface alev. 1 oE, d ft Depth toihn ing factor "/ / V in. Soil Application Rate Horizon J Depth In. I Dominant Calocj jMunsall Redox Description Ou. Sz Cons Color Texture Structure Gr. Sz Sh. Consistence i Boundary I Roots i GPD/ftP 'Eff61 I EU#2 r✓5 /2 z/1 St I34 Z z sri 14A tS /- z 2/ !l ail= ^-'p S .mG ✓ /2- - cmuentel-Duo,>30 _<220mOL and TSS >30< 150 mg/L - Emuentp2a BOD,< 30 mg/L and TSS< 30 mg/L CST Name _ (PI a Print) CST Number Alta- Address Date Evaluation Conducted Telephone Number o- BoX 5o Tor .Vrf 2 5i/K7 s— / h-03 7/5-37-y/54 RECEIVED AUG 0 5 2025 Bayfield Co. Parcel ID # Ot — !o Ll' 1— 03 EQ�11% and z�ang Ag ' of Boring- �;oring�l� Q C FA Pit Ground surface elev. / 7, a R. Depth In Ilmilnn Udnr 790 1n -" Soil Application Rate .,d Depth in. Dominant Color Munsell - Redox Description Qu. Sr. Cont. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPD/fl 'Eff#1 'ER#2 Q -Y to 'u 3 c,--Jc .Si- l li%C tnv-Fr qS 3Co tl , (P Z -Z5 `l b �s✓t GS Osq mvfr c5 3-' 7 /.z 23 -fl S /ZA u ( D f�7 L -- / tl f ,y /. H - - Boring # Q Boring 1 I nn rT.N e,ntro.lev a n.nr6 k. u...n4... Soil Application Rate Horizon Depth Dominant Color In. Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence I Boundary Roofs GPO/fi' 'Eft#1 Eff#2 H___. ___ -Li Baring* ❑ Boring 1-1 n„ Ground surface elev. R Depth to Ilmitino factor in. Soil ApplIcation Rate Horizon Depth Dominant Color Redox Description Texture In. Munsef Cu. Sz. Cont. Color Structure Cr. Sz. Sh. Consistence Boundary Roots GPDIflr 'EffSi 'Eff#2 - ____ H H H. ' Effluent f1 = BOD, > 30 .C220 mg/Land TSS 5.30-f 150 mg/I. • Effluent #2 = 8OO,.c30 30 mg/Land TSS 30 mg/I. The Departiaent of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. sandl]o re "M r I i f l i j I j i i t r t ' ali j I r , A V 1 ' I ° i I I I I I i i 11 : �' i j' I i r !� // 5/' 1 i /t I Ij I1'iH � I ` Y 9 o%'tll ✓( �.pes 0.✓i 1's•�' n' r. i j(7y ci [m;J-4 O t; !aA ' i o f'� 9 F S .g377: 5. E¼t° S4k4/�S�-f%er%o v,; S iza� • dOousm.an,, t,utL1 513!! I ;T9 -tio. EC%ED: Pla4ning i Co. Mq i ads Allahftikuc N Ri?L i✓ Via. a•k Szz awn N vze wZs th ! I SST�za0o90 RECEIVED AUG 052025 Bayfield Co. Planning and Zoning Agency PAGE 1 OF 4 PRIVATE SEWAGE SYSTEM PLAN INDEX Town: Town of Keystone Owner's Name: Haley L. Waller Pitts (Bill Waller site) County: Bayfield County 2005 Royale Drive, Eagan, MN 55122 Legal Description: S22-T47N-R07W Tax ID: 22167 Lot 19, Spider Lake Shores Property Address: 16425 Sand Hill Road Mason, W 154856 Page Number CONTENTS 1 of 4 PLAN INDEX 2 of 4 SYSTEM PLOT PLAN 3 of 4 DISPERSAL AREA X -SECTION & PLAN VIEW 4of4 MANAGEMENT PLAN Attachments: SOIL EVALUATION REPORT For Office Use Only COMPONENT MANUAL NO.: Version 2.0, SBD-10705-P (N.01/01) 1, the undersigned, hereby certify that the plans and specifications submitted herewith were prepared under my direction and control Greg Brown Greg's Plumbing, LLC. 13660 County Hwy H Iron River, WI 54847 715-209-0161 Signature: License No: L� RECEIVED SPIDER LAKE AUG 052025 Bayfeld Co. Planning and Zoning Agency OHWM IProp Line — — — SITE MAP Scale: 1"= 40' / 0 40 60 120 PAGE 2 OF 4 Proposed 2 D O O 5 BR uAasK4__ House Site s roren. -uormauma:o,a5 lmmM'v%sarcanverel emwea a,.apk lala.o,Jiol1 o a ^ (n(e by PNrICF Fq a{ e.w=wm a Proposed Well Location 0 Mme' 61 ioatffmJrucrstr Design Flow = 5 BRs x 100 gaIBR/day x 1.5 = 750 gallday Minimum Infillralbn Area = 750 gpd 10.7 gpolsq-fi = 1,072 sq-ft Install 3 trenches with 18 "Quick -4 Standard" gravelless chambers per trench. (mid by Infiltrator Water Technologies) Bill Waller Site ,M1 SPIDER LAKE II 100.0 System Elevation =96.0(1 B2 97.8 I B3 BM =100.00' /(nail in White Pine) / I Haley L. Waller Pitts (owner) Site Address: Lot 19, Spider Lake Shores m ' 16425 Sand Hill Road Sec 22, 147N-R47W Mason, WI 54856 Town of Keystone, Bayrield County Tax ID # 22167 .,.- '-:':SAND HILL EASEMENT ROAD' 74 TRENCH CROSS-SECTION VILvV SCHEMATIC (No Scale) SOIL COVER tFINISHE0G P,1 min. 1T min. tT IgplmP' Gakxttlo _ min.lmncn ' tr T S aoparalion aeI'. Endlap n min. french 1 (typlwp Inlet Inved nopm B' =96.67 6.' (Mgrab (Npi(a9 36' '=i' i, •' '' b Standard Quick -4• ChxMer e. • (tyc+ml) s^. I (nya by Infiltrator Systems, Inc.) .': System Elevation= 96.00' ts t (typist) (typical) e.. Install pusuant to manufacturees instmct'am. • Required Dispersal Area = (750 gpd) / (0.7 gpd/sq-ft) = 1,072 sq-ft EISA = (18 chmbrs/trnch x 3 trnchs x 20 sq-ft/chmbr) + 5.8 sq-ftlend cap pair x 2 prs = 1,092 sq-ft DISPERSAL TRENCH PLAN VIEW SCHEMATIC (No Scale) 4•�PVC Standard Quick -4 + Chamber 3.0 ft Conveyance Pipe End Cap (mfd by Infiltrator Systems, Inc.) (typical) (typical) (Iy*all ervation 75.0) 'ipa (typical) (Ii O System Elevation = 96.00 ft (typical) min. 3.0 ft p Inlet dcaert (Nplm) = 96.67 n n (typical) RECEIVED AUG 052025 Page 4 of 4 eayfield Co. Management Plaanningandzomng Agency IMPORTANT: The owner of this in -ground dispersal 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 = 750 gpd; BOD5 5 220 mgL''; TSS 5150 mgL"1; 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 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 (Le., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic 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 filters) 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 Wis. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Greg's Plumbing (Greg Brown) Phone: 715-209-0161 Local government unit: Bavfield County Zoning Department Phone: 715-373-6138 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, Wis. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department In accordance with SPS 384, Wis. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the Department of Safety and Professional Services for review and approval. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wis. Admin. Code. @CEIVED AUG 052025 Bayfield Co. planning and Zoning Agency ta" asQ '2004 -MR _ CA-GON.S CIS. mar F TIE. . die RISER n. we Oat > na 4r at tmm CST@_ W, fa" KTlu In -e star In L mtEC AM WRFC BAffi.E MID FUTt3t Szk HME P"' Acmai CEWAM zu3R cntLms -'6� SEme} tam cl pt l at s" mt ! _��f -.&-. 'jtt4Er der — �. — — _ tmT�.y� ss EO4 M=M Yuan$ CONTACT WESM CONCRETE a , r i ^f e o C_ i i f7 - _ --- --� ItBB OMEti C 10-00/30 Private Sewage System Maintenance Agreement Owner(s) Name frLIit-L. S.wt f Owner(s) Main Address o°S 1O 4k Pr. C4 4S it -MM 15/21 - Site Address l6V25 $6rvd W11 Tax ID# - _ _ 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) ��1rr 1/4 of 1/4 Section 22. Township N. Range % w. ?o" Irvry W Ale i S ^/E Irr pc, Additional L�e/Qal Description: .2 g021 — Sgt 66 2- c 5e ai4a ,Ll - Town of M1cV57UHL a (Acreage) 1r 3 Gov't Lot Lot I'? Block Subdivision 'l 4c' LcM1t ≤I1oeei Lot _ CSM # Vol. _ Page CSM Doc # DOCUMENT NUMBER 2025R-608639 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED O8/O5/2O25 AT 9:OO AM RECORDING FEE: $30.00 PAGES: 3 Return To: Planning and Zoning Department Area I In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ Other Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. Pump Chamber (system types B, C. D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds. At -grade, and In -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 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 providedRECEIVE law. The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such property. ` `E C EIVE CJ TIQ Owner(s) Please Pip. Wa_ -r ,,15 Is. W f ' K14 Subscribed and sworn to before 'this date: A � Or� �L 5 $l"evcrJ P(T"1 Plannin Notarized Owners — Signature(s) / — glary is My Commission Expires: 3/ 3C7 Drafted by: Tl `^ \ i V V A I S Date: B (c/2c U 0626i:- Bayfield Co. and Zonirc . •,. ,I„y ANGELA .J BGETTCNEf� Proofed by; ♦ NOTARYp l.'ICsani ryepticmainlenceagreement MIMffSolA Revised July 2020 Mr L�M1111131 n EKpkm im 01,1030 A parcel of land located in the Northwest Quarter of the Northeast Quarter (NW'/4NE'/.) and the Southwest Quarter of the Northeast Quarter (SW'/NE%,), Section Twenty-two (22), Township Forty-seven (47) North, Range Seven (7) West, Town of Keystone, Bayfield County, Wisconsin, described as follows: To locate the Point of Beginning, commence at the East Quarter (E'/a) corner of Section Fifteen (15), Township Forty-seven (47) North, Range Seven (7) West, and run N. 88°04'51" W., 2622.29 feet along the monumented East-West Aline of said Section Fifteen (15) to the center of said Section Fifteen (15); Thence continue along said monumented East-West 'A line, N. 88°14'21" W., 655.39 feet to the Northwest comer of the E%2NE'/4S W'/4 of said Section Fifteen (15); Thence S. 00°42'32" W., 2626.08 feet along the West line of the E%2 of said NE'/<S W'/, and the SE%SW'/< of Section Fifteen (15) to the South line of Section Fifteen (15); Thence S. 0°4326" W., 1813.44 feet to the Northerly right-of-way of the Tri-County Corridor; Thence along said Northerly right-of-way line, S. 88°43'52" E., 967.64 feet to a 1 inch iron pipe which is the Point of Beginning. Thence from said Point of Beginning by metes and bounds: Continue along said Northerly right-of-way line, S. 88°43'52" E., 400.00 feet to a 1 inch iron pipe, Thence leaving said Northerly right-of-way line, N. 00°48'43" E., 145.00 feet to a 2',' iron pipe; Thence S. 89°13'04" E., 5.03 feet to a 2'/2 inch iron pipe which is N. 89°13'04" W., 25 feet, more or less, from the water's edge of Spider Lake; Thence along a meander line, N. 01°13'53" E., 119.38 feet to a 2%2 inch iron pipe; Thence N. 20°4809" E., 197.22 feet to a 2%2 inch iron pipe; Thence N. 0901013 W., 402.46 feet to a 2%2 inch iron pipe; Thence N. 69°50'28" W., 221.60 feet to a 2%2 inch iron pipe; Thence S. 39°3435" W., 327.84 feet to a 2%2 inch iron pipe; Thence S. 379 11'40" E., 371.72 feet to a 2%2 inch iron pipe; Thence S. 21°42'36" E., 197.72 feet to a2'/ inch iron pipe; Thence S. 57°28'00" W., 172.19 feet to a 2'/2 inch iron pipe; RECEIVED AUG 0 6 2OZ5 Bayfield C Planning and Zero, " Thence N. 57°36'54" W., 176.00 feet to a 2%2 inch iron pipe which is S. 00°49'24" W., 35 feet, more or less, from the water's edge of Spider Lake; Bayfield County Register of Deeds Document # 2021 R-591662 Page 2 of 3 Thence leaving said meander line, S. 0004924" W., 182.65 feet to the Point of Beginning. Also known as Spider Lake Shores, Lot Nineteen (19), as recorded in File 1 of RLS, Page 37. Together with and subject to an easement for ingress and egress as shown on the Registered Land Survey recorded on March 20, 1997 in File 1 of Registered Land Survey on Page 37 as Document No. 432692. RECEIVED AUG 062025 Bavrield Co. Planning and Zoning Agency Bayfield County Register of Deeds Document # 2021 R-591662 Page 3 of 3 T3 -•Y F I E LD Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: Submission Number: WALLER PITTS, HALEY L SS -00618 2005 ROYALE DR EAGAN, MN 55122 Transaction Number: PITTS,STEVEN G SS-00618-31FA1 2005 ROYALE DR EAGAN, MN 55122 WALLER,HARRIS W & DIANE 2980 PINE CREEK RD LA CRESCENT, MN 55947 Description Amount Private Sewage System (Septic Tanks) $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 3869 Paid by: Greg's Plumbing, 13660 County Hwy H, Iron River WI 54847 Payment Type: Check Transaction Date: 8/12/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-25-98S STATE SANITARY PERMIT OWNER: HALEY L WALLER PITTS ET AL GOV'T LOT: 19 LOT: 19 BLK: NW 1/4 NE 1/4 SEC: 22,T47N,R7W TOWNSHIP: Keystone SOIL TEST: 98-03 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: Brown, Greg TRACY POOLER DATE: 8/12/2025 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: # MP699374 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 8/12/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION