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HomeMy WebLinkAbout25-111S^-ffO^'O ^•'^ffps.^^^/ Department of Safety & Professional Services, Industry Services Division County Bayfield Sanitary Permit Number (to be filled in by Co.) Sanitary Permit Application 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 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. State Transaction Number PWTS-072501377-C I. Application Information - Please Print All Information Project Address (if different than mailing address) 43970 County Hwy D Cable, Wl Property Owner's Name Monte L Ortman & Rosemary S Olson Parcel # 38075 Property Owner's Mailing Address 1339 Star School Rd Property Location Govt.Lot City, State Stoughton, Wl Zip Code 53589 II. Type of Building (check all that apply) 0 1 or 2 Family Dwelling-Number of Bedrooms D Public/Commercial - Describe Use D State Owned - Describe Use. Phone Number 608-332-1251 _•/<,_14. Section 15 Lot #T 43 N R 06 EorW 63 & 64 Block # Subdivision Name Namakagon Lake Shore Subdivision CSM Number D City of. a Village of 0 Town of _Namakagon III. Type ofPOWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if| applicable.) D New System D Replacement System B 0(^e?Modlficatj^n to Existing System (explain) // Recorp^f existing Mound D Additional Pretreatment Unit (explain) B.D Holding Tank D In-Ground (conventional) ^(^QfttO^B Mound D Individual Site Design D Other Type (explain) c.d Renewal Before Expiration Revision D Change of Plumber D Transfer to New Owner List Previous Permit Number and Date Issued FV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd)300 Design Soil Application Rate(gpd/sf) 1.0 Dispersal Area Required (sf) 300 Dispersal Area Proposed (sf) 300 System Elevation 98.7 Tank Information Capacity in Gallons New Tanks Existing Tanks Total Gallons # of Units Manufacturer ^p GIIa: U 51 is "3E U Septic or Holding Tank 800 800 Rasmussen x Dosing Chamber 500 Rasmussen V. Responsibility Statement- I, the undersigned, ^/sum|i respyisibilityjyr instal^og/ut'the POWTS shown on the attached plans. Plumber's Name (Print) Douglas Manthey iber'sl MP/MPRS Number MP 230722 Business Phone Number 715-739-6868 Plumber's Address (Street, City, State, Zip Code) POBox196Drummond,WI 54832 yi^County/Department Use Only pproved D Disapproved D Owner Given Reason for Denial Pennit Fee $600- Date Issued ^LO/15 /\^T//^, ^j Conditions ofApproval/Reasons for Disapproval S-o^ oMacfLdj ^^ ^ i e n n ^!n) ' " ~ M f II 9 0 omr Attach to complete plans for the system and submit to die County only on paper not less than 8 1/2x11 inches in size ~'3Vt}w: SBD-6398 (R. 03/22) l-F i- >-J L 'J O.^r;^ Fip- BAYFIELD COUNTfCHECKLIST FOR SANITARY APPLICATONS Subonit the Following (Use Permanent Ink) (Title 15, Section 15-l-10(e)) ' Check List Sanitary Application (Submitted in Deed Holders Name - ngt prospective buyers) (383.21(1)1.) iTTdex 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 Tank Diagram, Alarm and Pump Curve (when applicable) [^Contingency Plan / Management Plan (383.22-3(2)(b)l.f.) O^iaintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) D Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) D Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) D ATU Servicing Agreement (Recorded at Reg. of Deeds) BTee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) D ^ Complete Set( of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to_alLcoeiesJ I^Soil and Site Evaluation Report (383.22-3(2)(b)l.e.) B^State Plan Review (when applicable) D Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) flT Application Information must include: D 23 diait Parcel ID# - fdo not use 12 digits anymore-obsolete) B'Project Address or Road Name where driveway is/will come off of) B^Owners Phone Number) zfll Type of Building S^IlI Type of Permit Q^fV Type of POWTS System 0^7 Dispersal / Treatment Area Information !u; 11 Tank Information '! !i JUL 2 8 20Z5 [*KfI Responsibility Statement (Plumber's Information) -„,:,-.,-, ,...:-.-\'''6iL1 ;..;.\ ,';"""i.i^0 i Ji a *Date Stamp* Plot Plan: (To Scale or To Dimension) B^ignature and Plumber Information 0"Address Number and Road D Surface Elevation of Body of Water [ZT^Jorth Arrow O'Oirection and Percent Land Slope [yGontour Lines 0'Tank and Filter Information and Location B^Structures and Driveways D Wetlands / Navigable Bodies of Water B'Boring Locations 0-Absorption Area (Proposed and Existing) [ifproperty Lines B'Bench Mark (Location, Elevation and Description) Ef Well Locations O'tomponent Manual Version Q-Legal Descriptions 'iping Material information (conveyance line, building sewer line, material type and diameter) JOi Turn Over > Cross-Section and Over-Head Profile of the System: B"5urface and System Elevation Q^osition of Observation and Vent Pipes QDimensions and Depths D Make, Model & Number of Chamber Units in each Cell Property Information S^How many systems will there be on this parcel of land? Has this property been split? Tc\ (Property Statement shows Property History) Fees: D Private Sewage System (Septic Tanks) $ 400.00 D Private Sewage System (Holding Tanks) $ 400.00 or Systems requiring Pre-Treatment $ 500.00 D Sanitary Revisions $ 25.00 D Private Sewage System Reconnection $ 50.00 and Private Interceptor D Return Inspection $ 50.00 D Maintenance Agreements ^ $ 30.00 (checks made out to Reg of Deeds) «m! JUL 2 8 2025 "ytielc.;.;, .:.of,m,j Qooi u/forms/checklists/checklistforsanitaryapps(10/2009);(®7/2011);(®2/2012)(®5/2/2012-dc) Proofed by: Wisconsin Department of Safety and Professional Services Division of Industry Services 4822 Madison Yards Way Madison, WI 53705 Phone:608-266-2112 Web: http'//dsps.wi gov Email: dsDsffl'wisconsin eov Tony Evers, Governor Dan Hereth, Secretary July 3, 2025 GUST ID NO.: 230722 DOUGLAS E MANTHEY P.O. BOX 196 DRUMMOND, WI 54832-0196 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/03/2027 MUNICBPALITy: TOWN OF NAMAKAGON BAYFIELD COUNTy SITE: ORTMAN/OLSON MOUND REPLACEMENT 43970 CTY HWY D CABLE, WI 54821 S15T43NR06W FOR: Design Wastewater Flow Value: 300 Bedrooms: 2 Limiting Factor(s): 17 inches Maintenance Required: Effluent Filter Identification Numbers Plan Review No.: PWTS-072501377-C Application No.: DIS-062526299 SiteroNo.:SIT-147061 Please refer to all identification numbers in each correspondence with the Department. ConditionallyAPPROVED DEPT. OF SAFET/ AND PROFESSIONALSERVICESDiViS'QN OF iNDUSTRY SERVICES /t^-^ SEE CORRESPONDENCE Mound Component Manual - Version 2.1 (May 2022-2027) Pressure Distribution Component Manual - Version 2.1 (May 2022-2027) SITE REQUIREMENTS • A full size copy of the approved plans, specifications, and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. A Department electronic stamp and signature shall be on the plans which are used at the job site for construction. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for POWTS (Version 2.1), (May 2022-2027)". • The pressure network is to be constructed in accordance with publications "Pressure Distribution Component Manual for POWTS (Version 2.1); (May 2022-2027)" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Prior to the construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 'A-inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A state-approved effluent filter is required. Maintenance information must be given to the owner (^f-.,the^n^e^)liini^jg ^at periodic cleaning of the filter is required. All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 JUL 2 8 20'^|LI! • Insulate building sewer beyond 30 feet per SPS 382.30 (1l)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacturer's requirements. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per the approved plan. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the POWTS Dispersal Area must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • Any tail grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from POWTS Dispersal Area. • Abandon Existing System per SPS 383.33 Recore • The following must be completed in addition to any comments made from the County inspector: a. Remove excess/overgrown vegetation from mound, mow and remove clippings. b- Pump out any standing wastevvater through observation pipes. c. Permit dispersal area to dry out. d. Pump out septic and dose tanks. e. Remove and stockpile topsoil from the mound system. f. Remove cap soil and stockpile. g. Remove aggregate from absorption area(s) and dispose of in approved manner. It cannot be re-used. h. Remove distribution pipes and observation pipes. Dispose of properly. i. Remove end cap markers if present and dispose of properly. j. Remove clogged sand plus an additional 3 inches of clean sand and dispose of properly. This sand cannot be re-nsed. k. Sample remaining sand at several locations to assure it meets ASTM Specification C-33 for fine aggregate. If the sand does not meet ASTM Specification C-33 for fine aggregate, it must be removed down to the natural soil. Install rep!acement mound system using procedure outlined in the approved mound system component manual. • Ensure the existing septic tank and pump tank are watertight structural'.y sound and baffles are in place. Any changes made to the tank must be approved by the manufacturer. OWNER RESPONSIBILITIES • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval and Wis. Admin. Code § SPS 383.54C1'). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval, the Division of Industry Services reserves the right to require changes or additions, should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. The Division does not take responsibility for the design or construction of the reviewed items. Hi?,D) ISSI S I JUL 2 8 2025 Lu' ti^vf'eki Cn. Zo'iinq !.-ien] Inquiries concerning this correspondence may be made to me at the contact information listed below, or at the address on this letterhead. Sincerely, ^^-fw'y^,^' Fee Required: $250.00 Fee Received: $250.00 Balance Due: $0.00 Refund Expected: $0.00 Timothy Zoromski Division of Industry Services Phone: Email: timothy.zoromski@wisconsm.gov [i ^ U I ^ JUL 2 82025 L--.- Bsvfieid Co, Zoning Dep^ 0 }Z ^ Wisconsin Department of Safety and Professional Sel Division of Industry Services SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code SOti TESTpggej_-of 3_ IProperty Owner: ORTMAN, MONTE L & I OLSON,ROSEMARYS ^/~';"'Sw0?' Attach complete site plan on paper not less than 81/2x11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1 )(m)). Property Location Govt. Lot ,4 Parcell.D. TAX I.D. #38073 % S 15 T 43 N R 06 Property Owner's Mailing Address;1339 STAR SCHOOL RD Site Address or CSM and Lot # NAMAKAGON LAKE SHORE SUB DIV PAR IN LOT| g3 &64 IN DOC 2017R-571123 LESS PAR DOC 2019R-579399 777E City STOUGHTON State Wl Zip Code 53589 Phone Number ( )D City H NAMAKAGON Village Q Town Nearest Road 43970 COUNTY HWY D CNew Construction [X) Replacement Parent material_ Use:Residential / Nu mber of bedrooms Q Public or commercial - Describe: GLACIALQUTWASH. Code derived designflow rate 300_GPD Flood Plan elevation if applicable_ft. General comments and recommendation: RECORE ORIGINAL MOUND Boring #Boring APit Ground surface elev.97.16 ft. {^"" j \ Depth to i|(nitina^&rlizl—Jn. &le^{]&5.74Jt. Horizon 1 2 3 4 Depth In. 0-6 6-17 17-36 36-38 Dominant Color Munsell 7.5 YR 3/2 7.5 YR 4/4 7.5 YR. 5/4 7.5 YR 5/4 RedoK Description Qu. Az. Cont. Color P1F SPOTS 2.5 YR 4/6 SAT SOILS Texture LPS LS s s Structure Or. Sz. Sh. 2FGR 0-SG 0-SG 0-SG i Consistence MVTR ML ML ML II JUL . -^9I1SB''";n GW GW GW ,8 ZW. Pools/ornna 2COVFF 1COVF 1VF -luL S6il/Application Rate GPD/Ft2 yi%?1 s .7 .7 .7 *EfR,t2 1.0 1.6 1.6 1.6 .2 Boring #QBoring'it Ground surface elev. 97.16 ft.Depth to limiting factor 17 in. / elev._95.74_ft. Horizon 1 2 3 4 Depth In. 0-6 6-17 17-34 34-38 Dominant Color Munsell 7.5 YR 3/2 7.5 YR 4/4 7.5 YR 5/4 7.5 YR 5/4 Redox Description Qu. Az. Cont. Color C1D SPOTS 2.5 YR 4/8 SAT SOILS Texture LFS LS s s Structure Gr. Sz. Sh. 2FGR 0-SG o-so 0-SG Consistence MVPR ML ML ML Boundary GW GW GW Roots 2COVFF 1COVF 1VF Soil Application Rate GPD/Ft2 *Effi»1 .5 .7 .7 .7 *Efl»2 1.0 1.6 1.6 1.6 CST Name (Please Print) RICHARD RAUCH Address 11370 BONDEGARD DR. CABLE Wl. 54821 Signature ^- / --; ^.^"••^y x-"s^' Date Evaluation Conducted 7/18/2022 CST Number SP-012100001 Telephone Number 715-681-1190 ' Effluent #1 = BOD > 30 £ 220 mg/L and TSS > 30 S 150 mg/L ' Effluent #2 = BOD, s 30 mg/L and TSS s 30 mg/L SBD-8330 (R04/21) Boring # Q Boring©Pit Ground surface elev. 97 _ft. Page _2_of 3 Depth to limiting factor 17 in. / elev_95.58__ft. Horizon 1 2 3 4 Depth In. 0-6 6-17 17-36 36-38 Dominant Color Munsell 7.5 TO 3/2 7.5 YR 4/4 7.5 YR 5/4 7.5 YR 5/4 Redox Description Qu. Az. Cont. Color C1 D SPOTS 2.5 YR. 4/6 SATSOIL.S Texture LFS LS s s Structure Gr.Sz. Sh. 2FGR 0-SG 0-SG 0-SG Consistence MVFR ML ML ML Boundary GW GW GW Roots 2COVF 1COVF 1VF Soil Application Rate GPD/Ft2 *Eff»1 .5 .7 .7 .7 *Ef?2 1.0 1.6 1.6 1.6 Boring #D Boring D Pit Ground surface elev..-ft.Depth to limiting factor..in. / etev._ Horizon Depth In. Dominant ColorMunsell Redox Description Qu. Az. Cent. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 *Ef»1 *Effi»2 Boring #D BoringD Pit Ground surface elev..-ft.Depth to limiting factor._in, / elev._ Horizon Depth in. Dominant ColorIVIunsefl Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz.Sh. Consistence Boundary Roots Soil Application Rate GPD/Ftz *Eff#1 *Eff»2 ' Effluent #1 = BOD > 30 £ 220 mg/L and TSS > 30 s 1 SO mg/L * Effiuent #2 = BOD, s 30 mg/L and TSS & 30 mg/L I Hi ^ IIIJj 's 'IS ill sc^u^ ^<yt-u^ ^ ^ 7~^: 5-^ ^ c^ I Ocw( --y JUL.282025 ID' •^f^H-^f- 3^3 A'(W% V* -o^n^e-i^ Mfmc^^ , ^ |B3<? 5^~W ^ef. \^^kf^ u/f!-^[ ^(->^ £>€- A^^.t^e^^ja^. ^y-^U co^^y \r^.r^-3Bo)?^ S^T^Af^^t^ rt/s^l^./^'^^h £-^.^€tf-f^/^ •fu^ G>t^/f^r- fn tff/y 6y ^ ^y /"^ o^c ^c3/^~^~r//^3 L&ss /Ar,,'% pe,^ ^/f^^-?fS^ 77? f ^^f-^_ ^ Wo &&t^-y ^ ^ 'D ^^ie .,60 /S/^. Ta/° oft- ^e-/^ €1 ^t7./6 ns. ^l.ic ^, ^ 5.F /n ^g IT ^7/r- <?/,. ^/Te fz. J.? ^.^ r-^- s-^-ffr^ l^ifwf 7/<-.^f~/7^ ^ s.T •f7...p /l(^y P :5<;4^ I-/ " S. /(?7—i Ini 1111iUj ^ JUL 2.8 1025 UJ^l1 •Aft^ 1^\p/i DEPARTMENT OF INDUSTRY, LABOI.! & HUMAN RELATIONS P.O. BOX 796° ,V)ADISON,WI 53707 INSPECTION REPORT FOR PRIVATE SEWAGE SYSTEMS D CONVENTIONAL DALTERNATIVE D Holding Tank D In-Ground Pressure JEStjVlound ,6/y:ggrs< BUILD IN 'ftS^ ': . DIVISIj BJJREAU-OF PLUMBI: State Plan I.D. Number;(If assigned) NAME OF PERMIT HOLDER: /HlW^.U, /-^7/rZ ADDRESS OF PERMIT HOLDER: y^r^/ 6^^ /^-r W^/ BENCH MARK IPnii»antnl reler.ncc poinll OESCniBE IF DIFFERENT FROM PLAN:' •/ ./).'"•• ••.' ^/ft^'f-f Namuol Plumber; ^7?r/n/ /(7^/?tV/^e77 MP/MPRSW No.^f3^^^/£^.£> INSPECTION DATE; ,; • • . • .' /<?- 11 .^ REP.PT.ELEV.: ^-' n CSTREF.PT.ELEV. Sannary Permit Numbcf:jr;%> |maeme-T/<i\IK/HOLDtNG TANK: MANUFACTURER /r^:-!^< LIQUID CAPACITY;TAMK-INl.ETELgV,. 1.1. TANK OUTLET EkEV;; ,.|[WARNING LABEL[PROVIDED: DYES a NO IMCKING COVERIPROVIBED- D^ES ~Qn DYES" DNQ VBDTDIA.'~WS VENTMATL.HIGH WATERALitnM _QYEs2 [NUMBEROF"IFEET FROMINEAREST- RQAD;IPHOPEHTYILINE.I'D vetn TO BAimNi.gji <SIG CHAMBER: MANUFACTURER M BEDDI|MG -} DYES 'DNO GALLONS PER CYCLE:(DIFFERENCE BETWEENPUMP ON AND OFF) LIQUID CAPACJTY 5^ 3 PUMP MODEL ^ ft a PUMP/SIPHON MANUFACTURER tfl'3t ^ E?^ > ^ PUMP AND CONTROLS OPERATIONAL. DYES INO ll^gflllllaABSpRPTIpN SYSTEM. Check the soU moisture at the depth of plcwtfingor excavation. (If soil can be rolled into a wire. construction shall cease until the soil is dry enough to continue.) CONVENTIONAL SYSTEM; FORCEMAIN NUMBER OFFEET FROMNEAREST- ll_ WARNING LABELPROVIDED: 1-YES D NO LOCKING COVER !'PROVIDED; ' DYES DNUUILDINp MATERIAL AND MARKfNG s nw '' l&i'.S si.'i' ' liiDTfR-eNeu-JDIIUENStONS NO, OFTRENCHES DISTH.PIPE SPACINQ ICOVfcH ..itOKTCRIXL:PIT LIQUIDDEPTH! GRAVEL DEPTHBELOW PIPES |F ILL OESJM--—IftBOW COVER O'lSTR PIPF IDISTR. PIPE -ID1STH-1»IP6~MlU[ERIAL:ELEV. INLET ]ELEV. END I ~ ~INO. DISTR. IPIPES- -. _,NUMBEROFwNEAREST- PROPERT-.LINE;VENT T0:AIR INLF IUNDSYSTEIVI; Mound site plowed perpendicular to slope and furrows thrown upslope: . ••,,..,•i£.y^-£i DYES DNO Check the texture of the fill material for mound systems to make certain that it meets the criteria for medium sand. PROVIDE A DIAGRAM OFSYSTEM ON REVERSE SIDE. SHOW ELEVA- TSONS MEASURED. ;SOJL COVER ITEXTURE PERMANENT MARKERS DYES _ D NO OBSERVATION WELLS DYES DNO ; DEPTH OVER TRENCH.'BEDCENTER DEPTH OVER TRENCH/BEDEDGES [DEPTH OF TOPSQIL^[SEEDED DYES DNO DYES__,JEI?_DYES '0t PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCHDIMENSIOMS |i>ie-of! _. ,ITBENISHES; -LATERAL SPACING GRAVEL DEPTH BELOW PIPE IDISTR.PIPEIDIA.: FILL DEPTH ABOVE^QVER: iOrSTRIBUTION PIPE MATERIAL 6'MftRKING. ELEVATION ANflDISTRIBUTION '*•!INFORMATION 'ELEV^ f/~^h.A 'PUMF 6LEV.,,j-nH». [MANIFOLD MATERIAC '•/.4 " IHOLE SPACING IORILL6D CORRECTLY I YES ONQ^COMMENTS:TERMANENT MARKERS: DYES DNO iCOVER MATERIAL: "fyyLH • VERTICAL LIFT CORRESPONDS TO APPROVEDPLANS. DYES OBSERVATION WELLS: DNO NUMBER OF |PR5PERTYFEETFROM \u?':WEAREST- 'wjaT /^5 3^o BUILDIMO; t.6 if!/ •Tfff /\-^ l .|J P,/..H r-'-7 '-M.?-'^. rf"'''lu ,. ]"} [t f /1 r' IU; //"'••'I »j il? ri il JUL 2^82025 1^ ^avfeld /;o /lor,ina Uenr Sketch System on Reverse Side. DILHRSBD 6710 (R. 01/82) !lt: Retain rWtibunty file for audit. PAGE 1 OF 6 Mound Plan Index & Cover Sheet Component Manual Design References: Mound Version 2.1 (May 2022-2027) & Pressure Distribution Version 2.1 (May 2022-2027) Pg1 of 6 Pg 2 of 6 Pg 3 of 6 Pg4of6 Pg 5 of 6 Pg 6 of 6 Index & Cover Page Plot Plan Mound Cross-Section & Plan View Distribution Network Specifications Pump Tank Specifications Management Plan Attachments: Pump Curve Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Ortman/Olson Mound Replacement Owner Name(s): Monte L Ortman & Rosemary S Olson phone: 608 .332 .1251 Owner Address: 1339 Star School Rd Stoughton, Wl _ Zip: 53589 Project Address: 43970 Cty Hwy D Govt. Lot: _ 1/4 of Township: Namakagon 1/4, Section 15_, T 43 N-R . County: Bayfield 06 orWL Project Parcel ID #: 38075 Designer Information Designer Name: Douglas Manthey _ Phone: 715 .739 .6868 Designer Address: P0 Box 196 Drummond, Wl E-mail: norpines@cheqnet.net Zip: 54832 License Number: MP230722 Remarks: This space reserved for approval stamp. CondftionallyAPPROVED DEPT. OF SAFEPr AND PROFESSIONALSERVICESDIVISION OF INDUSTRY SERVICES ^ Isi" H--' Irt Signature: ]!!! JUL 2 8 2025 iRESPONDENCE >^vile!o ^l.i. 7o!'"-lg !JePLDate: 05/28/25 Origina)4ynature required on each j . A/iv% V. -otu^e-i^ ^ti^c^^ /^-he i. f <?/<»»,/ ^o$e ft^Tf ^ f??1 ST^r r^^l ^. r^t^^, h/I s~3fg<f -^.1 J^e^h. ^^- /V^l^^.^jo^. ^y^'^f^ cck^y r^ r^ 3^ot?s~- ^/-T'r'^^/f^i^ ft/e^^^'^oh L-e^t^e. ^l^re. S^b t>^ f<^r i'y\ L<f^ ^ <^ <^v /^ ^^ ^01 ~?H '-^~~/?/U 3 Ztfs-.r iPa.r.i'tt t5<!>^ ^e>^y-S"?fi^ \77HE~ -s-''^ ~L^^O &6i^-y ti ^ £> ^^a yoc7 ^/x r^o^t^e.// \/3l <?r7./6 |r32 ^.ic \S}. ^ I 5.T ,\ V.-S> 1^ w 9/^^ K^e ^.^ fif.r yxfi: y.i(. ^^^ h :$^As' /"s ¥<?' ^tt •Aftth BM c£Moe^cv<^ ^'i^^'^z? ^>^ ^c. ^ ^/^\ 0^ ^1< S^t-/o Vt^ i ^p/i ffu^y ^\\!1 I'i^"1}W^ E 1 I JUL 2 8 2025 IJayfie!d Cu Zoning Oeut u CROSS SECTION VIEW (No Scale) 0.5" TO 2.5" WASHED AGGREGATE (min. 6.0" beneath distribution pipe - min.2.0"over distribution pipe and covered with approved synthetic fabric) MIN. 6.0- OF TOPSOIL COVER min. 1.0 ft D- 1.6 ft System Elevation = 98.7 ft Lateral Invert Elevation = 99.2 ft Plowed Surface Surface ContourElevation = 97.1 ft PLAN VIEW (No Scale) MOUND DISPERSAL AREA (Show force main, manffold, and flush valve locations on plan view.) w= 25.2 ft 1.0 °0Schdl40 PVC Lateral . (typical) j= 8.6 ft 3.8 (typical) Dispersal Cell Observation JLPipe (typical) B= 37.5 f, 1= 8.6 L= 57.6 ft ; Reset Page| K= 10.05 f, (lypiral)T3>G?muQ-n 0) m i ig I n i I ^i !ill JUL 2 8 2025 !u? ^yfieiij C'^ zoning Deot:. DISTRIBUTION NETWORK SPECIFICATIONS (No Scale) Orifice in ^ Center of Threaded Cap for Head Testing (optional)/IBall Valve (optional)\\ Orifices equally spaced:[check a) OR b) below] a) LiLI along bottom of lateral ill with every_th hole facing down FLUSH VALVE DETAIL (No Scale) Valve Box (insulation optional) Lateral Spachg S= 4.0 ft Shield orifices forgravelless applications _J_2S_"0Schdl40PVC Manifold 2.0 ..CX.CSchrilAn PVC Force Main (slope to pump tankfor drain-back) Lateral Length (P) = _18_ft First Orffice(typical) Laterals to be level - Schdl 40 PVC Lateral 0 = _1.25 .in (typical) Number of Orifices per Lateral = 9 Flush ValveAssembly (typical - see detail) LATERAL INVERT ELEVATION -• (typical) 99.2 Last Orifice (typical) Oriflces equally spaced along bottom of lateral Orifice Spacing (X) = 25.5 in(typical) Orifice Diameter = 0. "188 in (typical) Oriflce Discharge Rate = 0.66 gpm Number of Laterals = 4 Lateral Discharge Rate = 5.94 gpm TOTAL DISCHARGE RATE = 23.76 GPM OBSERVATION PIPE DETAIL (No Scale) Screw-Type orSlip Cap (loose) 4"0 PVC Pipe Top of pipe to terminate at or above finished grade (4)1/4"-1/2"X6"Slots @ 90 apart Anchoring Device Finished Grade(mulched & seeded) Topsoll Cover(min. 1 foot) First Oiffice Check applicable box. X-(typical) First Orifice (typical)-^ END MANIFOLDCONNECTION Manifold(riser pipe optional) Manifold (riser pipe optional)z CENTER MANIFOLD CONNECTION -0>0m •^0-n a> ! JUL 2 8 2025 f3:3vf?e(d Co Zoninq Deof. PAGE 5 OF 6 SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) 4"0 Vent Pipe >10 ft from Building 12" Min.or2.0ft aboveEstablished Flood Elevation(typical)ApprovedVent Cap Anchor tank(s) as necessary pursuant to SPS 383.43(8)(g) IMPORTANT: \1/ \^ Finished Grads Electrical must comply withCOMM 16 and NEC 300 Weatherproof-Junction Box Extend manhole riser as necessary. Approved Locking Manhole with Warning Label Attached(typical) 4" Min. or 2.0 ft above Established Flood Elevation(typical)^k_\l/ CAPACITIES 10.5 gal/in A B [C] D Depth (in) 28 2.0 6 12 Volume (gat) 294 21 63 126 Pump Tank Liquid Level = Force Main Diameter = 2 48 18"Min. (typical) Approved Joints withApprovad Pipe 3 ft ontoSolid Ground(lyplcal) Install and maintain pursuant to manufacturer's instructions. PUMP-OFF ELEVATION =92.7 INSIDE BOTTOMELEVATION = 91 •7 70Force Main Length = ""' ft Force Main Void Volume = 11-4 gal [C] Total Dose Volume (TDV) = 63 gal/dose (5X total lateral void volume <, TDV <. 0.2X design flow) + (force main drainback volume) 3" Approved Bedding Material Beneath Tank MIN. PUMP DISCHARGE RATE =25.1 _gpm ft ft + Min. Supply Head - + FM Friction Loss = + Fitting Loss* =. '([min. supply head x 0.3] + filter loss) = TOTAL DYNAMIC HEAD =. 6.5 2.5 .97 1.55 11.52 jt _ft ,ft _ft Volume = PUMP TANK: 500 gal Manufacturer:Andry Rasmussen SEPTIC TANK(S): Total Volume = 800 gal Manufacturers):Andry Rasmussen Pump Manufacturer: Pump Model: EP0411 Goulds (See attached pump curve.) Controls/Alarm Manufacturer: SJE Rhombus Controls/Alarm Model: SJE1025830 Install approved force mainjilter pursuant to manufacturer's instmGtions. ^ E \\ %;; E^ £ U ^ I? Filter Manufacturer. Filter Model: SII^TECH GSFSTF100A2" Float switches containing mercury are prohibited.•vt'eid Co. Zonmq Dep PAGE 6 OF 6 Mound Management Plan IMPORTANT: The owner of this mound system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wise. Admin. Code. Pursuant to SPS 383.52 (2), Wise. 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), Wise. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 300 gpd; BODs $ 220 mgL-1; TSS S 150 mgL-1; FOG S 30 mgL-1 Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (/.e. odors, user complaints, ete.) o mechanical malfunction (/.e., pumps, valves, switches, floats, eto.) o material fatigue (/,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 (/.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities (/.e., pump re-cycting, float switch settings, etc.) o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure laterat 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(sl 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, Wise. Admin. Code. o Efftuent filterisl 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. o Distribution laterals shall be flushed once every 3 years or when necessary. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wise. Admin. Code. Report any component failure or malfunction to: Name of individual or company: HK SeptJC _ phone: 715-798-3494 Local government unit: Bayfield County Zoning _ phone: 715-373-6138 Local government unit address: PO BOX 58 Washbum, Wl _ ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wise. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wise. 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, Wise. 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 appropriate agency for review and approval. A failed mound dispersal component may be re-constructed within the originally approved area after removal of all failed components. System Abandonment r\ ^ W F il % If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wise. A(lfViin.LC(^e[£ " n ,JUL282025 ^weio i\,^ /^on!nq Depi ^GOULDS PUMPS Submersible Effluent Pump MODEL EP04EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS •Solids handling capability: 3/4" maximum. • Capacities: up to 60 GPM. •Total heads: up to 31 feet. • Discharge size; WNPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. * Temperature:104°F(40°C) continuous 140°F(60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components, Motor: • EP04 Single phase: 0.4 HP,115or230V,60Hz,1550 RPM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP,115Vor230V,60Hz,1550 RPM, built in overload with automatic reset. •Power cord: 10 foot standard length, 16/3 SJTOW with three prong grounding plug. Optional 20foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). © 2002 Goulds Pumps Effective September, 2002B3871 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES • EP04 Impeller: Thermoplas- tie Semi-open design with pump out vanes for mechanical seal protection. • EP05 Impeller: Thermoplas- tie enclosed design for improved performance. • Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. • Motor Housing: Cast iron for efficient heat transfer, strength, and durability. • Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. • Power Cable: Severe duty rated oil and water resistant. • Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING '. Canadian Standards Association Goulds Pumps is ISO 9001 Registered. US JUL 2 8 2025 ggvfieici (;o Zonmq Depi METERS 10 9 8 § 7LUa6 5 4 3 2 1 0 y < £ 3C 2C 2C 15 1C 5 f ,- '~1 I 7' I i 1±-<—3 ami •2.5FT St. - EP04 1—1 .-...^. 10 20 30 40 50 GPM CAPAClTf 10 12 mVh Goulds Pumps iITT Industries Private Sewage System Maintenance Agreement Owner(s) Name Monte L Ortman & Rosemary S Olson Owner(s) Mailing Address 1339 Star School Rd Stoughton, Wl53589 Site Address 43970 County Hwy D Cable, Wl TaxlD# 38075 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 Wl Adm. Code, as from time to time amended. (COMPLETE Legal is required) .1,4 of _1 ,4 Section 15 Township _43_N. Range _06_W. Additional Legal Description: see Attached Additional Description Townof_Namaka90n^ (Acreage) -859 GoVtLot_ Lot _ Block_ Subdivision Lot _ CSM # _ Vol. _ Page _ CSM Doc #. DOCUMENT NUMBER2025R-60S06S DANIEL J. HEF-F-NER REGISTER OF- DEEDS BAYFIELD COUNTY, Wl RECORDEDOG/30/2025AT 1 1:28 AM RECORDING FEE: $30.00 PAGES: 3 Recording Area Return To: Planning and Zoning Department jiii :i i /nz^ D In-ground gravity 0 Mound D In-ground dosed At-grade Sewage System In-ground pressure distribution Sewage System: D 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-arade, 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 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 specificaUy agrees that all the costs and charges may be placed on the fax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such property. Owner(s) Name(s) - Please Print Monte L Ortman Rosemary S Olson Subscribed and sworn to before me on this date: Ofc/SO/30^ ^"1""11^""*1';^^'^'t^A^,^r^:f 1//% [^. r^'Notarized Owner(s) - Signcfture(s;Notary Public ?/IUIW^\ ff\'I*: My Commission Expires:07/17/3097 ^;^BCfw^ '.*! ^.•w "^ss^ Proofed by: y Drafted by:Date: 06/19/25 u/forms/sanitary/septicmaintenceagreementRevised July 2020 Documeni Number STATE BAR OF WISCONSFN FORM 1 - 2000 WARRANTY DEED This Deed, made between Earl G. Manthev. Jr. and Sharon J. Manthev. husband and wife Grantor, and Monte L. Ortman and Rosemary S. OIson, as tenants in common, and undivided one-half interest each^ Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in Bayfield County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): (SEE EXHIBIT A FOR LEGAL DESCRIPTION) J LI I 0 1 ^3 I!Ill2 Recording Area IMUt7"R in•_--5 I' 1 M wr^g-^Ill 2017R-571123 DENISE TARASEWICZBAYFIELD COUNTY, WIREGISTER OF DEEDS12/08/2017 02:35PMTF EXEMPT 8: RECORDING FEE: 30.00 TRIWSFES FEE: 600.00 POSES: 2 Name and Return Address Spears, Carlson & Coleman, SC PO Box 547 Washburn, WI 54891 "1 Together with all app.urtenaiit rights, title and interests. 04-034-2-43-06-15-1.00-227-68000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Grantor warrants that the title to the Property is good, uidefeasible in fee simple and free and clear of encumbrances except subject to easements, reservations and restrictions of record. - 1 1^» ^ » Dated this ^W day of I ^<2/r «W^T?>^. 2017. i/^^-^TC.6^J?^A^ * EarlG,Manthey,Jr.v * Sharon K. Manthey AUTHENTICATION Signature(s) authenticated this __ day of .»<•<*""*"""'»«./0^su?s ACKNOWLEDGMENT STATE OF WISCONSIN . ) )ss. BAYFIELD _ County ) Personally came before me this f&At^c'.C' __, 2017 the above named day of THIS INS Attv.JackA.Cai 122W.BavfieldSt.PO Earl G. Manthev, Jr. and Sharon K. Manthev TITLE: MEMI afnot.i^?-\0' ^ ^ authorize to me kni to be the person(s) who executed the foregoing id acknoiyjedged the same. Washburn, WI 54891 (Signatures may be authenticated or acknowledged- Both are not necessary.) Notary Public, State of Wisconsin My Commission is permanent, (i/lI£iA* <?i*n<-a aunSwa+mn /ln*-ia. * Names oFpersons.signjng in any capacity must be typed or printed below their signature.WARRANTVDEED FORM No. 1 - 2000 INFO-PRO (800)655-2'02T www.mfoprofomis.comSTATE BAR OF WISC< D(mBn-"An Parcel 1: All that portion of Lots 63 and 64 plat of Namakagon Lakeshore Division, Bayfield County Wisconsin included within the following metes and bounds descripUon: To locate the point of beginning commencing at an Iron Pipe on the N. line of See. 15, Township 43N, Range 6W, at a point 321' E. of the meander corner E. shore of Namakagon Lake thence S. 13 deg. 40 min E. a distance of 217.5' to an Iron Pips thence S 43° 00 rriinutss' E. a distance of 481.2' to an Iron Pipe thence S. 55° 26 min. W. a distsncfi of 343.3' to an Iron Pipe thence Gpntinuing S, 5? 26 min. W. a distance of 10' more or less to the said point of beginning thence by metes and boundsi N 55° 26 rriin. E. 10' more or less to an Iron Pipe thence continuing N. 55° 26 mm. E. 343.3' to an Iron Pipe thence N 49° 00 min. W. a distance of 183,2' to an Iron Pipe thence S. 52° 36 itiin. W. 172.3' to the center of County Highway D thence S. 37° 24 min. E. 20.0' thence S. 64° 28 min. W. 30' more or less to an Iron Pipe thence continuing S. 64P 28 min. W. 62.7 to an Iron Pipe Uience continuing S. 64" 28 min. W. 10' more or less to the waters edge of the Namakagon Lake thence South Easterty along side waters edge to the point of beginning. LESS the parcel described in the Certified Survey May #000279, filed in Volume three (3) of Certified Sunrey Maps on Page Seventy (70) and being a part of Government Lot Two (2), Section Fifteen (15), Township Forty-three (43) North, Range six (6) West, Town of Namakagon, Bayfield County, Wisconsin. Parcel 2: A parcel of land located in part of Lot 63 of Namakagon Lake Shore Subdivision and in part of Gov't Lot 2, Sec. 15-T43N-R6W, Town of Namakagon, Bayfield Cbunty, Wiscpnsin, bounded and described as fpllpws; Commencing at the NE comer of said Sec. 15; thence S 0°-07'W along the East line of the See., 190.76 feet; thence N. 86q-15'-20n W, 138.98 feet; thence S 4P-44'-39" W, 586,82 feet; thence N 40P-28--09" W, 132.57 feet; ftence N 46°-00' W, 5.80 feet to the point of beginning; thence S 58P-29' W, 100.00 feet; thence N 46°-00' W, 14.00 feet; thence N 58°-29' E, 100.00 feet; thence S 46°-00' E, 14.00 feet to the point of beginning. M 0 1 7025 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: ORTMAN/ MONTE L 1339 STAR SCHOOL RD STOUGHTON/ WI 53589 OLSON REV LIV TRUST/ROSEMARY DTD 6/4/2025 1339 STARR SCHOOL RD STOUGHTON/ WI 53589 Submission Number: SR-00324 Transaction Number: SR-00324-334E1 Description Certified Soil Tests - Review & Filing Fee Amount $50.00 Total: Payment Amount: $50.00 $50.00 Reference: 5327 Paid by: A-Z Enterprises/ Nor-Pines Plumbing, PO Box 196, Drummond WI54832 Payment Type: Check Transaction Date: 8/20/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. RAyFIELD 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: ORTMAN, MONTE L 1339 STAR SCHOOL RD STOUGHTON, WI 53589 OLSON REV LIV TRUST/ROSEMARY DTD 6/4/2025 1339 STARR SCHOOL RD STOUGHTON, WI 53589 Submission Number: SS-00610 Transaction Number: SS-00610-312EO Description State Approved Plans (Mounds/ Systems Requiring Pre-Treatment, etc.) Amount $500.00 Total: Payment Amount: $500.00 $500.00 Reference: 5313 Paid by: A-Z Enterprises, Nor-Pines Plumbing/ PO Box 196, Drummond WI 54832 Payment Type: Check Transaction Date: 8/20/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit BAYFIELD COUNTS SANITARY PERMIT (#04)-25-110S STATE SANITARY PERMIT OWNER: ORTMAN. MONTE L & OLSON, ROSEMARY S GOVT LOT: LOT: 63 & 64 BLK: SUBDIVISION: Namakagon Lake Shore Subdiv 1/4 1/4 SEC:15,T43N,R6W TOWNSHIP: Namakagon SOIL TEST: 109-25 OTHER MODIFICATION SYSTEM JVPE: Mound > 24 in. of suitable soil PLUMBER: DOUGLAS MANTHEY TRACY POOLER Authorized Issuing Officer DATE: 8/20/2025 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 ip 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: # MP 230722 Condition: THIS PERMIT EXPIRES 8/20/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION