HomeMy WebLinkAbout25-118SRequest for Sanitary Inspection (2Q i E1n- -
Fax or email this form to Zoning Dept (24 Hrs.) prior to when you want an inspection
Fax (715) 373-0114 or Email zoninc�bavfieldcountv.wi.00v
Note
fl Time Change fl Discrepancy fl Other
Phone Number
/� (
)
(IA) W( C=
1JS Z cy2 zd((s
Plumber:
Fax Number
Homeowner:
.sc vvwes (fit n cQ b Q r 3
Email Address
Immediate Phone Number So Zoning
Sanitary
- jf g 5
Dept can call you right back (if needed)
Permit #:
Plumber's Choice
n�t ept
No Inspection(s) during this time
Date:
jo iK z
Tuesday (9:30 am - 12:15 pm) (Tracy)
Plumber's Choice
Dept
Time:
Township:
Address # &
Road Name:
sc i v CLatIQt es J�Q
or
Directions
To Site:
Comments:
Plumbers you must verify any change(s) by fax or email **
Notes from
July 2025
,a S
OND4
Industry Servirec nhiidnn
C
JAMES S & HOLLY JOY
F LUNDBERG
PO BOX 157
POPLAR WI 54864
Information
Private Onsite Wastewater Treatment
Systems ( POWTS) Inspection Report
(Attach to Permit)
City LI Village LJ Town of.
setback to:
County
Sanitary smut No:
State Plan Transaction ID#:
Parcel Tax No:
3,63
TYPE MANUFACTURER
CAPACITY
i Prop. Line
I Well
Building
Air Intake Road
Se tic g d
MAP
4-
&'
N/A
Dosing
N/A
Aeration I
2
N/A
Holding
Pump! Siphon Information
Filter Manufacturer Filter Model GPM
TDH Lift Friction Loss Head Total
Forcemain I Length I Dia Dist To Well
DIMENSIONS
Width Le g
4 of dells
f
SETBACK FROM
Prop. Line BuJ)di g
W
OHHV
Type of Cell Manufacturer:
Quit,41 fr/g
Model Number:
Pretreatment Unit
Manufacturer.
Model Number:
stribution System
Header! Manifold I Distribution Pipe(s)
Elevation Data
X Pressure Systems Only
X Hole Size I X Hole I Observation Pipes
Dia I Length Dia Spec I I Spacing I 0 Yes ❑ No ,
3o11 Cover
Depth Over I Depth Over I Depth of I Seeded / Sodded I Mulched
; OMMENTS: (Include code discrepancies, persons present, etc.)
2¢sLye''4 /Vv%f//etL
yyR ��tR {x'7'4/ �-�'/ 'r'
'an revision required? ❑ Yes No I /
;e other side for additional info ation.
Date
❑ Yes ❑ No I ❑ Yes ❑ No
POWTS Inspector's Signature
,'9227/)
License Number
zan.7tn rR mnti
II
BAYHELD COUNTY PLANNING & ZONING DEPARTMENT
Telephone: (715) 373.6138 Bayfield County CourthousC
Fax: (715) 373-0114 Post Office Box 58
e-mail: zoning(a bavfieldcountv.org 117 East Fifth Street
Web Site: www.bavfieldcountv.org/147 Washburn, WI 54891
Property Owner
JAMES S & HOLLY JOY
Information _ LUNDBERG
PO BOX 157
POPLAR WI 54864
As you know z e I /? O rwas 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.sei3ticsearch.com
Notes:
Abandonment of Old System to meet all applicable code requirements:
❑ Tank was pumped by: on
❑ •) Tank was crushed I removed and pipes disconnected by:
at AM / PM
On v ! z`✓ at /_ (AM! M e above -mentioned plumber contacted our office to
conduct'a pre -cover inspection as required uner DSPS 383. One of the following applies:
System was inspected and appears to meet all applicable code requirements.
❑ System was inspected and appears to meet all applicable code requirements; however, a plan revision
is necessary because the installation was substantially different than the original approval.
❑ System could not be inspected because plumber covered prior to scheduled time of inspection
❑ System could not be inspected because plumber was not ready at scheduled time of inspection.
County was unable to return to complete inspection.
❑ System could not be inspected because plumber was not ready at scheduled time of inspection.
A re -inspection and $50 fee are required.
❑ System could not be inspected because County could not respond to plumber's time constraints
Comments:
U/farms/sanitarypropertyawner-input
April 2019
DCrFIVED ss_�JVV/ t
""w 4I
8 1 AUG 2 5 2
I
'b Bgnha d C.
planolni andZoni 9
Department of Safety
25 & Professional Services,
Industry Services Division
Ag_
County Bayfield
Sanitary Permit Number (to be filled inby Co.)
a S— I 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 slate -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(lXm). Stats
50180 Outlet Bay Rd
odor —
PropertyOwner'sName
Parcel# ,4414' 5937
James S. & Holly Joy Lundberg
04-004-2-44-09-09-305-010-1O000
Property Owner's Mailing Address
Property Location
PO BOX 157
GovtLat 10
''/t, u, Section 09
T 44 N R 09 EoifW1
City, State I
Poplar, WI
Zip Code
54864
Phone Number
all that apply) .
Lot#
Subdivision Name
0 l or 2 Family Dwelling— Number ofBedrooms 3
Block #
O Public/Commercial — Describe Use
O City of
❑ State Owned —Describe Use
O Village of
CSM Number
0 Town of Barnes
Permit: (Check either"New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i
A. adNew System
(3 Replacement System
D Other Modification to Existing System (explain)
O Additional Pretreatment Unit (explain)
B. O Holdin Tank
ltl In -Ground
❑ At -Grade
❑ Mound
❑ Individual Site Desig
n gn
O Other Type (explain)
(conventional)
C. ❑ Renewal Before
❑ Revision
❑ Change of Plumber
❑ Transfer to New Owner
List Previous Permit Number and Date Issued
Expiration
and Tank lnformadon:
Design Flow (gpd)
Design Soil Application Ratc(gpd/st) I Dispersal Area Required (sf) I Dispersal Area Proposed (sf) System Elevation
450
0.7 I 642.9 666.6 98.5
Tank Information
Capacity in
Gallons
Total
Gallons
It of
Units
Manufacturer
/
G
o
c
aU
v
9
rn Yn
.v..
m
iZO
P.
New Tanks
Existing Tanks
Septic orHolding Tank
1000
1000
1
1Or
Dosing Chamber
V. RnptEtM
t- 1, the undersigned,
assume responsibility for Installation of the POWTS shown en the attached platy.
Plumber's Name (Print)
CLi `�o
Plumber's Signaturs� -� ^
cc- a �J�Y�
MP/NIPRS Number
2�°$�js
Business Phone Number
?�SL422
Plumber'sAddress (Street, City, State, Zip Code)
g/ G (,�
7 vS S C-OCa 5 L to NtW a a Ytsul- �f O 1
tUaeOn
pproved O Disapproved
❑ Owner Given Reason for Denial
Permit Fee I
Date Issued (7I
rJ
Issuing Ae tSi rare
Conditions of Approval/Reasons for Disapproval
a*&t (-hPd Ctu .
Attach to complete plans for the system and submit to the County only on paper not less than 8 lax ''inches in toe
SBD-6398 (R. 03/22)
Lundberg (3 bedroom)
Gravity In -Ground Plot Plan
North
moo,
JAMES S & HOLLY JOY LUNDBERG
50180 Outlet Bay Rd
PAR IN GOVT LOT 10 LYING ELY OF OUTLET BAY RD IN V.600 P.407
S09 T44N R09W
Town of Barnes
04-004-2-44-09-09-3 05-010-10000
14.0 acres
Three rows of 11 Infiltrator Quick4 Plus Standard LP chambers
106'
104'
- 102'
\ffyP>(I�,Precast 1000 g6q,
Scale 1:50 I w/ polylok 525 filter �� x
�— 3 bedroom
x Bench Mark = Duplex nail w/ orange disc in 16" DBH pine cabin
Elev = 100.0'
sand pad elev =101.7'
Garage cabin
Pa
0aa
0 o
0
w
' s� da New home site
W cvg �' Well O NOTES:
Wr:
A sr
DF
100'
OHWM
Upper Eau Claire Lake
- All property lines > 100' from system area
- Upper Eau Claire Lake elev z 86'
- All vent, observation & conveyance pipes
4" ASTM D1785 or code equivalent
Page 3 of 7
RECEIVE®
AUG 25 2025
Lfi
planning and Zoning Agency Cmss Sermon of a Throe Cell ingl and Component
Using Leeching Chhes
Finished Grade 102.00
Original Grade 102.00
„� Top of Chamber 99.17
System Elevation 98.50
Finished Grade 1104
Slope 9% a ,, finished Gradel 100.00
Feet
104.00 Original Grade
99.17 Top of Chamber Original Grade 100.00
' Top of Chamber 99.17
98.50 System Elevation .• �:•;• l.+••1. ' • • ••.••
, , System Elevation 98.50
. ! •:M ..•. t • •�! i � ��• yt • : �. � : � • � y �.: � '•t i ' • ' •�a' i •ter: r..• � ..!• •� � • <
Ob�evatioolVaotpdpa�bbsao�ao0odoodoappod�hq�p�o�+admtieci�b ibr�ep�ctioa4enfa,
46.2 feet
46.2 feet
I
/ Vent Pipes to be located at the ends of the distribution cells.
3 feet
between cells
Page 4 of 7
WLP1 000
TANK SPECIFICATIONS
8'-8"
DIMENSIONS:
WALL: 2 1/2"
4" CAST -A -SEAL
4" CAST -A -SEAL
BOTTOM: 3"
COVER: 5"
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
HEIGHT: 53 1/4"
LENGTH: 8'-8"
WIDTH: 7'-2"
BELOW INLET: 42"
I'
LIQUID LEVEL: 36"
`�
I
I ►
WEIGHT. BOTTOM 6,790 LBS.
�
COVER 3.195
INLET AND OUTLET:
�\\ FILTER OR
iii
4" CAST -A -SEAL BOOT OR EQUAL GASKET
BAFFLE
��
�
INLET AND OUTLET BAFFLE AND FILTER:
-----
WISCONSIN SEE DETAIL #10
(OTHER STATES SEE CHART)
TOP VIEW
LIQUID CAPACITY: 27.83 GAL/IN
HOLDING TANK:
OUTLET HOLE PLUGGED
ACTUAL CAPACITY: 1,085 GALLONS
LOADING DESIGN: 8'-0" UNSATURATED SOIL
w
TANK CAN BE USED AS:
a a,
w
SEPTIC / HOLDING / PUMP OR SIPHON
COVER: MIX DESIGN #8 (NO FIBER)
u�
TANK: MIX DESIGN #10 (STRUCTURAL FIBER)
CUSTOMIZED TANKS:
INLET -
1i t1
_
OUTLET
FOR CUSTOM TANKS CONTACT WIESER CONCRETE
U
U
to c. Q.
cr D
I to
M
I
=
a= rn
d
1
'---
I
M
21"
-�'
-------.-,-�-
REVIEWED BY
PUMP
PAD
REVIEW DATE
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
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SHEET NO.
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OF
71
RECEIVED
AUG 25 2025 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 6 of?
FILE IIiI ll4TION
pFVLaflQames b. & Holly Joy Lundberg
Permit #
DESIGN PARAMETERS
Number of Bedrooms
3
O NA
Number of Public Facility Units
® NA
Estimated (average) flow
300
al/da
Design (peak) flow = (Estimated x 1.5)
450 gal/day
In Situ Soil Application Rate
0.7 al/da /ft2
Standard Influent/Effluent Quality
Monthly average*
Fats, Oil & Grease (FOG)
≤30 mg/L
Biochemical Oxygen Demand (BOD5)
≤220 mg/L
O NA
Total Suspended Solids (TSS)
≤150 mg/L
Pretreated Effluent Quality
Monthly average
Biochemical Oxygen Demand (BOD5)
≤30 mg/L
Total Suspended Solids (TSS)
≤30 mg/L
® NA
Fecal Coliform (geometric mean)
≤10° cfu/100mI
Maximum Effluent Particle Size
' in dia.
❑ NA
Other:
® NA
*Values typical for domestic wastewater and septic tank effluent.
MAINTENANCE SCHEDULE
Service Event
Service Frequency
Inspect condition of tank(s)
At least once every:
O
3 month(s) (Maximum 3 years)
® year(s')
O NA
Pump out contents of tank(s)
® When combined sludge and scum equals one-third ('4) of tank volume
❑ NA
O When the high water
alarm is activated
Inspect dispersal cell(s)
At least once every:
mon
3 ® year(s(s) (Maximum 3 years)
O NA
Clean effluent filter
At least once every:
3 ❑ month s)
® year(s�
O NA
Inspect pump, pump controls & al
At least once every:
❑ month(s)arm
❑ year(s
® NA
Flush laterals and pressure test
At least once every:
❑ month(s)
❑ year(s)
® NA
Other:
At least once every:
O y(s) ear(s)®
NA
Other:
® NA
SYSTEM SPECIFICATIONS
Tank Manufacturer Superior Precast
O NA
® Septic O Dose O Holding
vol. 1000
gal
Tank Manufacturer
® NA
❑ Septic O Dose ❑ Holding
vol.
gal
Effluent Filter Manufacturer
Polylok
O NA
Effluent Filter Model
525
Pump Manufacturer
® NA
Pump Model
Pretreatment Unit
® NA
❑ Sand/Gravel Filter
O Peat Filter
❑ Mechanical Aeration
O Wetland
❑ Disinfection
O Other:
Manufacturer
Dispersal Cell(s)
O NA
® In -Ground (gravity)
O In -Ground (pressurized)
❑ At -Grade
O Mound
❑ Drip -Line
O Other:
Other:
® NA
Other:
® NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The
dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent
on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate
notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any treatment tank equals one-third ('4) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of ≤12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMW (12/02)
RECEIVED
STAiUI J4N�8PE Page ` of '
RATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
che,m Wede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the
P emoved by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will
be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within
15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain
(sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products;
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT'
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly
and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology
a holding tank may be installed as a last resort to replace the failed POWTS.
9d The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may
be installed as a last resort to replace the failed POWTS.
O Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Chad Rochwite Name C(q, 12wA!
Phone 715-292-2415 Phone ! . �Q �.. 2..y tS
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name tflr i Name Bayfield County Zoning
Phony <JS Yrca Phone 715-373-6138
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies in compliance with chapter
Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
. f.ECEtivEO
jU .L 5 2025
James S. & Holly Joy Lundberg
BAYFIELD COUNTY
CHECKLIST FOR SANITARY APPLICATONS
Submit Med NgWjyg (Use Permanent Ink) (Title 15, Section 15-1-10(e))
iRr
i�martst
0 Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.)
0 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c))
0 Original Plot Plan (383.22(2)2. 3. & 4.a)
0 Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer
❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable)
0 Contingency Plan / Management Plan (383.22-3(2)(b)1.f.)
0 Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds)
❑ Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds)
❑ Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5)
❑ ATU Servicing Agreement (Recorded at Reg. of Deeds)
0 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7)
0 2 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached
to all conies)
0 Soil and Site Evaluation Report (383.22-3(2)(b)1.e.)
O State Plan Review (when applicable)
O Copy of Warranty/Quit Claim Deed (Optional)
Sanitary Application: (Include the following Information)
211 Application Information must include: O 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete)
0 Project Address or Road Name where driveway is/will come off of)
O II Type of Building
0 III Type of Permit
0 IV Type of POWTS System
0 V Dispersal / Treatment Area Information
0 VI Tank Information
O VII Responsibility Statement (Plumber's Information)
*Date Stamp*
Plot Plan: (To Scale or To Dimension)
O Signature and Plumber Information
0 Surface Elevation of Body of Water
O Direction and Percent Land Slope
O Tank and Filter Information and Location
0 Wetlands / Navigable Bodies of Water
0 Absorption Area (Proposed and Existing)
0 Bench Mark (Location, Elevation and Description)
Version
0 (Owners Phone Number)
0 Address Number and Road
O North Arrow
0 Contour Lines
0 Structures and Driveways
O Boring Locations
0 Property Lines
Rf Well Locations
0 Legal Descriptions
0
Turn Over ►
RECEIVED
Cross -Section and Over -Head Profile of the System„
AUG 25 2025
21 Surface and System Elevation Bayfieki Co
21 Position of Observation and Vent Pipes P ni$g aW Z 9A9wgy
21 Dimensions and Depths
21 Make, Model & Number of Chamber Units in each Cell
Propert Information
21 How many systems will there be on this parcel of land? 2
19 Has this property been split? no (Property Statement shows Property History)
Fees:
21 Private Sewage System (Septic Tanks) $ 400.00
O Private Sewage System (Holding Tanks) $ 400.00
O 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
21 Maintenance Agreements + $ 30.00
(checks made out to Reg of Deeds)
u/forms/checklists/checklistfbrsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by:
RECEIVE®
µ 1L�sconsin Department of Safety& Professional Services V K. O v __) Page 1 of 3
Division of Industry Services
' SOIL EVALUATION REPORT
Agency
Pla 6 In accordance with SPS 385, Wis. Adm. Code County
Bayfleld
Attach complete site plan on paper not less than 8 1/2 x ii Inches in size. Plan must include, 5 13
but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D.
scale or dimensions, north arrow, and location and distance to nearest road. 04-004-2-44-09-09-3 05-010-100
Please print all Information. Revlewe I Date
Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04(1)(m)).
Property Owner Property Location ❑
James S. & Holly Joy Lundberg Govt. Lot 1/. Y. 509 T 44 N R 09 E (or) W
Property Owner's Mailing Address Site Address or CSM and Lot #.
PO BOX 157 50180 Outlet Bay Rd
City, State, Zip I Phone Number ❑ City ❑ Village ® Town Nearest Road
Poplar, WI 54864 Ir 1 Barnes I Outlet Bay Rd
g NewConstruction Use: L'Residential/Numberofbedrooms 3 Code derived designflow rate 450 GPO
❑ Replacement ❑ Public or commercial —Describe: Flood Plan elevation If applicable N/A
Parent material Outwash Sands (Rubicon-Sayner complex)
General comments and recommendations:
Boring# ❑Boring
® Pit
Ground surface elev. 104.2 ft. Depth to limiting factor 108 in. I elev. 962 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
Ef1#1
Eff#2
1
0-4
1 0YR 2/1
—
s
0sg
ml
as
1vf
0.7
1.6
2
4-15
10YR 3/3
—
s
Osg
ml
gw
11f
0.7
1.6
3
15-39
7.5YR4/4
—
s
0sg
ml
cw
2m/lf
0.7
1.6
4
39-50
7.5YR 4/6
—
(5%GR) s
Osg
ml
cw
11
0.7
1.6
5
50-62
1 0YR 4/6
—
s
Osg
ml
cw
—
0.7
1.6
6
62-108
10YR5/4
—
cos
Osg
ml
—
—
0.7
1.6
2❑ Boring #
❑Boring 104 3 108 98.3
®Pit Ground surface elev.ft. Depth to limiting factorin. I elev _ft.
Soil Aoollcatlon 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
0-6
1 0YR 2/1
—
s
Osg
ml
aw
1col2M1f
0.7
1.6
2
6-37
1 0YR 3/3
—
a
Osg
ml
gw
looFlmr11
0.7
1.6
3
37-49
10YR5/6
—
s
Osg
ml
cw
1f
0.7
1.6
4
49-108
10YR5/4
—
cos
0sg
ml
—
1f
0.7
1.6
CST Name (Please Print)
Signature i
CST Number
654921
Keith Wiley
isr
Address
Date aluatlon Conducted
Telephone Number
11623 E Larson Dr. Lake Nebagamon, WI 54849
7/19/2025
218-451-2611.
' Effluent #1 = BOD > 30 S 220 mg/L and TSS > 30 5150 mg/L 'Effluent #2 = BOD, s 30 mg/L and TSS 5 30 mg/L
590-8330 (R03122)
RECEIVED
C
orinA AUG 25 2025 ® Paring
B
g
Bayfteld Co.
planning and Zoning Agency
Page 2 of 3
Ground surface elev. 99.9 ft. Depth to limiting factor 84 in. I elev. 92.9 ft.
nil Anniieatinn Rata
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
*Eff#1
*Eff#2
1
0-9
1 OYR 2/1
—
s
0sg
ml
cw
lcollvf
0.7
1.6
2
9-33
1 OYR 3/3
—
a
Osg
ml
gw
2co/2f
0.7
1.6
3
33-58
1OYR 5/6
s
0sg
ml
aw
1f
0.7
1.6
4
58-84
1 OYR 614
—
$
0sg
ml
—
1 f
0.7
1.6
Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. I elev. ft.
I Soil Anniinatinn Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Cu. 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 Anolicatlon 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 s 220 mglL and TSS > 30:9 150 mglL * Effluent #2 = BOO, s 30 mg/L and TSS s 30 mg/L
Lundberg (3 bedroom)
Soil Report Plot Plan
North
X01
� J
JAMES S & HOLLY JOY LUNDBERG
50180 Outlet Bay Rd
PAR IN GOVT LOT 10 LYING ELY OF OUTLET BAY RD IN V.600 P.407
S09 T44N R09W
Town of Barnes
04-004-2-44-09-09-3 05-010-10000
14.0 acres
Scale 1:50
Bench Mark = Duplex nail w/orange disc in 16" DBH pine
Elev =100.0'
'LrJ'�
1�
w •
LC
Q 5
2N
CU)A
C
Ui
sand pad elev =101.7'
Garage
•
a
aq
¢a"ti
as a
� ya
OJ�e� ~a44
44
•g y1`
4
'' °` New home site
fsq4
6
61
s4 Well O
ss
. 4y.
i O
sr
OF
3 bedroom
cabin
7V
cabin
CST 119900002 -SP
106'
104'
102'
8.6%
NOTES:
100'
OHWM
Lipper Eau Claire Lake
- All property lines > 100' from tested area
- Upper Eau Claire Lake Elev z 86'
Page 3 of 3
CEIVED
AUG 2 5 2025
James S. & Holly Joy Lundberg
BAYFIELD COUNTY
B,y�ld Co. CHECKLIST FOR CERTIFIED SOIL TESTS
planning and Zoning ASaY
Submit the Following (Use Permanent Ink):
[' Check List
❑ Index Page / Title Sheet (Optional)
61 Original Soil Evaluation Report (Submitted in DeedHolders Name — n1prospective buyers)
' Original Plot Plan
❑ Cross Section Soil Profile Sheet (optional)
❑ Additional Information (Warranty/Quit Claim Deed) (Optional)
Soil Evaluation Report-. (Include the following Information)
E' Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used
[' Proper Owner's Information not prospective buyer's name)
6' Property Location (Accurate Legal Description with Sec/Twp/Range)
L' Road Name (where driveway is/will be coming off of)
l' Floodplain Elevation, Flow Rate, Comments and Recommendations
67 Complete Soil Boring / Pit Information
7 Date Soil Evaluation was conducted
17 CST Name, Signature, Number, Address and Phone Number
E' *Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
['Bench Mark (Description, Elevation and Location)
['Contour Lines (Example = 98.0' /96.0' /94.0')
['Property Location (Sec/Twp/Range/, Accurate Legal Description)
9 Borings (Locations and Elevations)
C�'Percent and Direction of Land Slope
1Z Well Location (Including Neighboring Wells, if applicable)
E% Location of Wetland Areas, Floodplain and Navigable Waters
El Buildings, Driveways, and Structures (Location and Descriptions)
['Location of Property Unes
f' Existing System Location
['Address Number and Road Name
i7 Current Surface Elevation of Wetlands and Navigable Waters
('CST, Owner and Property Information
&' North Arrow
F
EX Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checkiistforests
.DECEIVE®
AUG 252025
Bayfiekf Co.
James S. & Holly Joy Lundberg Property Owners Name
50180 Outlet Bay Rd Property Address
04-004-2-44-09-09-3 05-010-10000 Tax Parcel Number
Bayfield County
GOVT LOT 10 LYING ELY OF OUTLET E Legal Description
9 Section
44 Town
9 Range
Page Index
1 Property Information
2 Data Entry
3 Plot Plan
4 Drainfield Cross -Section
5 Tank Information
6 Maintenance Plan
7 Contingency Plan
Keith Wiley Designer's Name
Designer's Signature
D2388PSS
Designer's License Number
218-451-2611
Designer's Phone Number
7/22/25
Date
••''�5CONS4"
w�Ler
p 2388 PSS
)
O
MINNS OTA
Page 1 of 7
1gCvr.e V
Page 2 of 7
BAYFIELD COUNTY
SANITARY PERMIT (#04)-25-118S
STATE SANITARY PERMIT
OWNER: JAMES S & HOLLY JOY LUNDBERG
GOVT LOT: 10 LOT: BLK:
1/4 1/4 SEC: 9, T 44 N, R 9 W
TOWNSHIP: Barnes
SOIL TEST: 115-25,91-25,19-11
NEW SYSTEM
SYSTEM TYPE: Non -Pressurized In -Ground
PLUMBER: CHAD ROCHWITE
TRACY POOLER
Authorized Issuing Officer
DATE: 9/4/2025
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; 19790.34.221; 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: # 220595
Condition: Properly Maintain System Per Recorded Agreement
THIS PERMIT EXPIRES 9/4/2027
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION