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HomeMy WebLinkAbout25-125S*'" INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY ** TIME RECEIVED REMOTE CSID DURATION PAGES STATUS November 17, 2025 at 8:17:42 PM CST 7157983470 45 1 Received N0V/17/2025/M0N 07:49 AM Andry Rasmussen & So FAX No.7157983470 P.001/001 Request for Sanitary Inspection (24 Hrs. in Advance) Fax this form to Zoning Dept (24 Hrs.) prior to when you want an inspection -- (715) 373-0114 If you do not have a fax and must email the Inspection; you must email all staff members. Note fl Time Change Discrepancy ri Other Plumber: 'f Ii d V QJIM53An •r •.� nsfr/15gQg_33sr Phone Number Fax Number Homeowner: a/�erie ' Email Address '1�;q� ecty.t .,S i a- l- n rl Y) I S Q 11YY//r roe, c Sanitary Immediate Phone Number So Zoning Dept can can you right back (If needed) Permit #: _ 15" Plumber's Choice 7 opt pw No inspection(s) during this time Date: ) tl Tuesday (9:30 am - 12:15 pm) (Tracy) Time: Plumber's Choice Zoning Dept Township: Q� Address # & Road Name: or j7S(} Directions To Site: Comments: "Plumbers you must ver/fy any change(s) by fax or email Notes from U/faims/sanitary/reques&orinspaction Zoning Dept (@4/12/04); ® June 2023 •o Onsite Wastewater Treatment JAMES F & ANNE MARIE D is ( POWTS). Inspection Report KANICKY (Attach to Permit) In 1750 LOWER LAKE RD c BARNES WI 54873 Information City U Village L f Town of: setback to: 5 1 County MLL Sanitary ermlt No: State Plan Transaction ID#: Parcel Tax No: 237 TYPE MANUFACTURER CAPACITY Pro . Line I Well Buflding r Air Intake Road Se tic © 3 6 N/A Dosing N/A Aeration N/A Holding Pump! Siphon Information Pump Manufacturer Pump Model Demand GPM Filter Manufacturer Filter Model TOH Lift Friction Loss Head Total Forcemain Length Dia Dist To Well Length I # of Cells Building Well Manufacturer: Model Number. Pretreatment Unit Manufacturer: Model Number: Elevation Data STATION BS HI FS ELEV Benchmark 3 Bldg. Sewer Tank Inlet 3 9to Tank Outlet t6, L p y i Dose Tank Inlet Dose Tank Bottom Inst. Contour Header/ Manifold Distribution Pipe Infiltrative Surface Final Grade - stribution System X Pressure Systems Only Header! Manifold Disbrbution Pipe(s) X Hole Size X Hole Observation Pipes Length Die Length _ Die _ Spec_ Spacing ❑ Yes ❑ No Soil Cover Depth Over Depth Over Depth of Seeded / Sodded Mulched Cell Canter Cell Edoes Toosoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discr pancles, persons present, etc.) Ian revision hers i e required? Yes t10 . /�117 I 2511 S /'/23 7 Z to other side for additional infor tfon, t Date POWTS Inspector's Signature License Number iRn-i71n rR nV7c, Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoninola bavfieldcountv.oro Web Site: www.bavfieldcountv.oro/147 JAMES F & ANNE MARIE D KANICKY 1750 LOWER LAKE RD BARNES WI 54873 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know C(�i ups //l / ' ' 9 was contracted by you to install a private onsite wastewater treatment system on your property (Tax ID# above). To know when your system will be due for servicing please go to www.septicsearch.com Notes: Abandonment of Old System to meet all applicable code requirements: 1 • Tank was pumped by: Tank was crushed / removed and pipes disconnected by: on at AM/PM On at 279 (AM / e above -mentioned plumber contacted our office to conduct'a pre -cover inspection as required under DSPS 383. One of the following applies: ISZI' 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: W forms/sanitarypropertyowner-input April 2019 �,,r"Rt�rryr ? Y $S Industry Services Division 4822 Madison Yards Way County Bayf eld �s S p$ Madison, WI 53705 • Sanitary Permit Number (to be filled in by Co.) �' P.O. Box 7302 Madison, WI 53707 p —� / c25 Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary Same purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. I. Application Information — Please Print All Information Property Owner's Name Parcel # James & Anne Kanicky 2372 Property Owner's Mailing Address Property Location 1750 Lower Lake Rd. Govt. Lot City, State Zip Code Phone Number Barnes, WI 154873 715-376-4457 %, ¼, Section 30 II. Type of Building (check all that apply) Lot # T 44 N R 9 E or W a1 or 2 Family Dwelling — Number ofBedrooms 2 Subdivision Name Block # ❑Public/Commercial — Describe Use ❑City of ❑State Owned — Describe Use CSM Number Village of QTown of Barnes III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i a licable. A. IINew System Replacement System ❑Other Modification to Existing System (explain) Additional Pretreatment Unit (explain) B. aHolding Tank IJIn-Ground ❑At -Grade IIlMound Individual Site Design Other Type (explain) (conventional) C. ❑ Renewal Before Revision JChange of Plumber Transfer to New Owner List Previous Permit Number and Date Issued Expiration 665 5.28.70 IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (sf) Dispersal Area Proposed (sf) I System Elevation 300 0.7 Existing Existing Existing Capacity in Total # of Manufacturer Tank Information Gallons New Tanks Gallons Units $ 0 Existing Tanks u :2ca a U v) cn in t C7 a Septic or Holding Tank 1000 1000 1 Infiltrator I. Dosing Chamber J ______ _____ _______________________ V. Responsibility Statement- li, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number I iness Phone Number Jason Kuettel I 1675751 Plumber's Address (Street, City, State, Zip Code) PO Box 66 Cable, WI 54821 VI. County/Department Use.Only KApproved O Disapproved Permit Fee Date Issued y . Issui Age gnatu O Owner Given Reason for Denial �(Q Conditions of Approval/Reasons for Disapproval RECEIVED e1 d. SEP 05 2025 Bavfield Co. Planning and Zoning Agency Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x 11 inches in size SBD-6398 (R. 02/22) PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg1of4 Pg2of4 Pg3of4 Pg4of4 Index & Cover Sheet Plot Plan Dispersal Area Cross -Section & Plan View Management Plan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Kanicky Steel Tank Replacement Owner Name(s): James & Anne Marie Kanicky Owner Address: 1750 Lower Lake Rd. Barnes, WI Project Address: Govt. Lot: 1 Township: Barnes Same Project Parcel ID #: 2372 1/4 of Designer Name: Jason Kuettel Phone: 715 Zip: 54873 -4457 1/4, Section 30 , T44 N -R 09 E ❑ or W County: Bayfield Designer Information Designer Address: PO Box 66 Cable, WI E-mail: tim@andryras.com License Number: 675751 Remarks: Phone: 715 -798 .3355 Zip: 54821 This space reserved for approval stamp. RECEIVED SEP 052025 Bayf►e;i Co. Planning and curt r.g , c ncf Signature: Date: Original Si re required on each submitted copy. Owner Information: Name: James & Anne Marie Kanickv Location: S30.T44N.R09W Township: Barnes County: Bayfield Address: 1750 Lower Lake Road wen 9R' 95, BM=100: Bottom of siding on the SE corner of house 93' �p r \m ru R3 T NZ.L•1 �Ntr�.rhh'nr�1M Ioi+C i ting.0pn ell -9455 $y,t m I vation ,2 RCM.9W RI As'b `N LCH) CQ""1r0"N Driveway ® To Lower Lake Road+ v n N �= b C _l� b J i ' �? N < 1"=40' Only in Tested Area B1 = 95_15 B2= 96.05 B3 = 93.65 Lake= 70_85 'T �C ''1( COS S ST'! N.�`tJ SPEC.7; ICATFONS y'` GCI.1,LfOPVC INSP. PTE 6 11 Mi'!. ABOVE GAD (OPT.) whe.c� �nl �f tnco\' FINISHED GRADE 18" HiN. IHHLETI IC AP PROVED PIPE 3' ONTO SOLID SOIL 3" APPROVED BEDDING UNDER T/!J SPECIFICATIONS E P-Fzc TA1n� H ANU F AC!UP. E R : j j� f -71 i J -T .. TIIC SIZES.' SEDT1C (YO GAL. NOTES: APPROVED MANHOLE WI Lam, 4. W0,41" U 6 L Li" Hill. OUTLET R CEIVED SEP D 5 2025 Bayfield Co. P:anningnd Z nrg Aency PAGE 4 OF 4 In -ground Gravity Management Plan IMPORTANT: The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc., Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 300 gpd; BOD5 5 220 mgL"'; TSS ≤ 150 mgL"'; FOG ≤ 30 mgL'' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Scats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Andry Rasmussen & Sons Phone: 715-798-3355 Local government unit: Bayfield Co. Zoning Phone: 715-373-6138 Local government unit address: 117 E 5th St. Washburn, WI ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. 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 in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable s `s c p , System Abandonment SEP 052025 If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Codlqyfietd Co. Planning and Zc,nina Agency • Application No. Date ------------ APPLICATION FOR PERMIT BAYFIELD COUNTY, WISCONSIN BUILDING SANITARY WELL L. 'D USE O Name %� .,s ,'fjr, r/'I Address a �, h¢ j� Telephone Land: may` ¼ of i(/,c= y Sec. i j T. yff N. I R. 9' W. I Acres_I Town of / BUILDING - STRUCTURE Construction Contractor (Describe) PLUMBING - WASTE DISPOSAL — WELL of Installation To be installed by CHANGE OF LAND USE: Present Planned Zoning Dist. Remarks: e's Note: Submit completed application and fee to: Zoning Administrator, Courthouse, Washburn, Wis. 54891 Do not purchase or install a septic tank, do any plumbing, or start any building, until a permit has been issued. A permit may be revoked if misrepresentation of any of the information conveyed herewith is found to exist. Changes in plans or specifications shall not be made without approval of the Zoning Administrator. Fees: Alterations, additions ----- _-- $ 1.00 New residential $ 3.00 Applicant ___________________________________________ Commercial $10.00 Address ____________________________________________ Permit issued (date Reason for denial: Permit No. Permit denied Appealed Appeal No. ..— .�._ (date) Variance: Signed Zoning Administrator Condition: _ ^-- ---- -. ------_. Inspection Record :iLII .---W--- By I Date _ __ - (See reverse side) TiCTAwAA �.T�w. �IA..0 i. i Lw I S a....I A A4.. i I V 4oiw - Distance from drainfield or seep pit to ] I . wen ---------------------- 100 ft. 1 Shoreline ---------- 50 ft. Dwelling _ ---_ - 25 ft. Lot line --------_ _ --_ - - 1 .10 ft. - -- - - Groundwater LOT PLAN tar« tvomg YR a • — — .. .. aw. — 1 . 1 i I i s1pr YARD S DE y cRb o � I I •! I I - - --- !.__.._.. i -- -- - - T f R.4y L:atar t j f Fill in dimensions on this plat, locate any accessory buildings, and indicate "North". Show location of sanitary installations with distances in feet from wells, streams, lakes and property lines. SPUD MESSAGE SUBJECT .$ • c 51f/A1 _ DATE 1-7 19 ��c-- pp y -r SIGNED Gm Into "SNAP•A.WAY" FORT! 44.900 2 • PARTL WIL9OU JONES CON PANE • ' I9G! _ • PRIIITEO IN U.S.A. SPEED MESSAGE TO t FROM _'9 ,� r "7 - /;' / /.1• i,sT�� �a r , ,6c Yip . � /fad 4 .1 5* , r' I7 �rCJi J SUBJECT _DATE 3 —/ 19-r ,,d .-"'rte►+i/ %/fF 7r •fir +/' ic/ f► / � / , i'/�goze 7 rW/010 .h j� ( /7Gronrr'/icr /� �455/ca►ru iru .6' ,v /(?e '2 , p ,,s T;// f ey s / ', /91/i/sy 4P'r- An uS ! Ssr h.or 1/l Se /XP ,;1'r f�r/ - ��S� • Tom• / r NI / l �C� • / O)_ - i •�!/d rLJ,p_s' 7.rv�r . 'erers7r�� c Ti�r�• t we eA.4rI �,L ,, f % /o, d44mss 1r o / / is i-��'/urrr�c� A- C flQlS�' C® /7I? 39 SIGNED 2 G 1Jne "St1AP•A-WAY" FORM 44.900 2. PARIS WILSOtt JONES COMPANY • (C) 1961 • PRINTED IN U.S.A. e c// V ! (2- _- : r' y 7 D GN l � A it k f Ti 9/10/25, 9:49 AM Novus-Wisconsin Access rev. 12.0206 Real Estate Bayfield County Property Listing Today's Date: 9/10/2025 Description Updated: 7/16/2015 i0 Ownership Tax ID: 2372 PIN: 04-004-2-44-09-30-1 05-001-10000 Legacy PIN: 004114501000 Map ID: Municipality: (004) TOWN OF BARNES SIR: S30 T44N R09W Description: N 150' OF GOVT LOT 1 IN V.575 P.32 848C Recorded Acres: 4.966 Calculated Acres: 4.966 Lottery Claims: 1 First Dollar: Yes Zoning: (R-3) Residential -3 ESN: 104 i Tax Districts Updated: 3/15/2006 1 STATE 04 COUNTY 004 TOWN OF BARNES 041491 SCHL-DRUMMOND 001700 TECHNICAL COLLEGE Property Status: Current Created On: 3/15/2006 1:14:47 PM Updated: 7/16/2015 JAMES F & ANNE MARIE D KANICKY BARNES WI Billing Address: Mailing Address: JAMES F & ANNE MARIE D JAMES F & ANNE MARIE D KANICKY KANICKY 1750 LOWER LAKE RD 1750 LOWER LAKE RD BARNES WI 54873 BARNES WI 54873 ;r Site Address * indicates Private Road 1750 LOWER LAKE RD BARNES 54873 Property Assessment Updated: 10/4/2016 2025 Assessment Detail Code Acres Land Imp. G1 -RESIDENTIAL 4.800 252,300 61,600 2 -Year Comparison 2024 2025 Change Land: 252,300 252,300 0.0% Improved: 61,600 61,600 0.0% Total: 313,900 313,900 0.0% Recorded Documents Updated: 3/15/2006 Property History ® CONVERSION N/A Date Recorded: T308-43575-32 AmUi /(44I/� f�/dr`GV-77 54J /775' 7/ZPa96� J�n � Sys a' Mc,,��ef-ayA� / https://novus.bayrieldcounty.wi.gov/access/master.asp?paprpid=2372 1/1 rn..OOI5Lf Private Sewage System Maintenance Agreement DOCUMENT NUMBER Name 2025R-609060 Y -C _ JK4 e , W k S`) t; 73 Tax iD # 177'l_ 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) 114 of 1/4 Section -7a Township '1`i N. Range O')W. Additional Legal Description:i -Tttc..t4 Town of ,6Ar . S (Acreage) 'I'9 ( Gov't Lot Lot Block Subdivision Lot CSM # Vol. Page CSM Doc# DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 09/05/2025 AT 1:56 PM RECORDING FEE: $30.00 PAGES: 2 Recording Area Return To: Planning and Zoning Department ] In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ Other Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) 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 septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at lea�t . (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. G�rrpp p �9� Mounds, At -grade, and In -ground Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbet ifneQI J A05% the wastewater distribution cell component Is Inspected as provided above. Sayffeld Co. Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurredF 9k}leferi2&wi4 fogency 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 maybe 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 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 Subscribed and sworn to before me on this date: ALWST J9, 3A And K-1-IsN % C it-i 2oZS-' Notarized Owner(s) — Signature(s) Notary Public kCQi(c _____ 9 My Co miss an Expires. •••.......,•• �1 01 •. ., I .•' •• r _________________ Drafted by: / lM LLtbZ— ---- .. r Wis. Slats. �.� • �- �!otarial Officer by 1 Praafed by: i and (2) County Clerk �• • • 4 �l . } i ` 3 lf� ��..� •., t�/forr�T i�lajlsepticmainienceagreement � ••••••M••• ` `� R�vicart Ielu 7A7A V5'5P32 DOCUMENT NO. • TMS SPACE RESERVED i cA RECOROUVO DATA WARRANTY DEED 403512 STATE BAR OF'WISCONSIN FORM 2- 182 VbLF / d:PACE••3A2 Linn S. Larson and Jeanne H. Larson, husband �y""t'Ql and wife as joint tenants REGISTER OF DEEDS conveysandwarrantsto James F. Kanicky and Anne Marie '93 JAN' 26 fm 1159 D. I;anicky, husband and wife as joint tenants REGISTER'S OFFICE/S.S. BAYFIELD COUNTY,. WIS. , yp, ° s��r� F KrnJ,e a ' r the to lowing described real estate to Ba y f i e l d Courtly. # FpO e6 p 90 $' 29Gk5• State of WLecons(n: The North 150 feet of Government Lot One (1) Tax Parcel No: in Section Thirty (30),.Tpwnship Forty Four (44) North of Range Nine (9) West, subject to reservations of record. • . IJLfJ RENTAL WEATHERIZ'ATION COOO YES a NO 'EXEMPTION id'! •ham i s not homestead property (is) . (!s nat) • Ezceptlan to warranties: Dated thl day of Aj11 L'Yn. 'a€.!' i 9 q Z?����EALJ (SEAL) •Lysin S. Lalrson * 6 (SEALS (SEAL) *Jeanne H. Larson AUTHENTICATION ACKNOWLEDGEMENT Signature(s) STATE OF WISCONSIN • ss: CSw ty •rscn ally c me before me this day at autherdicated this day of .19 .19 above named Lqnn 5. r'` Lal TITLE: MEMBER STATE BAR OF WISCONSIN (if ndt. ' • to me known to be the person authorized by 1706.06. Wis. State) foregoinginstrument and ackn THIS INSTRUMENT WAS DRAFTED BY 7i eJ h; e.. oe is Notary Public (Signatures may. be aiithenfic (ed or acknowledged. Both • My Commisal are not necessary) date: I Name.i of pwaeu afyntng in any aapadCy shmdd be Iy$d crprkded bafo* thu& 4&fU es. WARRANTS' DEED V 5 7 5 IP 3 2 STATEFFORM N F I 0B2WISCONSIN WISC0NSK.REALTORS ArSSOCtATION 4801 wryes Road. Madison. Wisconsin 53704 FIELD 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: KANICKY, JAMES F & ANNE MARIE D 1750 LOWER LAKE RD BARNES, WI 54873 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00332 Transaction Number: SR -00332-34900 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 14797 Paid by: Andry Rasmussen & Sons, PO Box 66, Cable WI 54821 Payment Type: Check Transaction Date: 9/16/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. ,A FIELD 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: KANICKY, JAMES F & ANNE MARIE D 1750 LOWER LAKE RD BARNES, WI 54873 Description Private Sewage System (Septic Tanks) Submission Number: SS -00645 Transaction Number: SS-00645-348FE Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 14797 Paid by: Andry Rasmussen & Sons, PO Box 66, Cable WI 54821 Payment Type: Check Transaction Date: 9/16/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. • f • � (js) 5 O .�, Soil Evaluation Repel �, in accordance with SPS 385,Kls.Adm Code �. sl .�`••z!0)WisconshDeparunentetSaterysndProfesslonalServises Attach complete site plan on paper not less than 8'/ X 11 inches in size. Page: Plan must include but not limited to: Vertical and horizontal reference County: point (BM), direction and percent slop€, scale or dimensions, north arrow, location and distance to nearest road. Parcel I.D. Please Print All Information TEST # i23 -d5 Personal information you provide may be used for secondary purposes. i Date. (orivacv Law.s.15.04(1)(m)).t�- Property Owner. James & Anne Marie Kanicky Property Location S30,T44N,R09W Property Owners Mailing Address: 1750 Lower Lake Road Site Address or CSM and Lot # 1750 Lower Lake Road City Barnes 1State WI I Zip Code 54873 tPhone Number. 0 Town Barnes Nearest Road: Lower Lake Road "" New 3 Residential Number of Bedrooms: 2 Code derived design flow rate: 3Q0 Flood Plain if applicable Replacement r Public or Commercial - Describe: Parent Material: lilt Flood Plain if Applicable: 70.65 General Comments & Recommendations: System Elevation: 91.5 Load Rate: 0.77 Elevation Range. 98.88 To 91.65 , Ground surface Elev: Depth to Limiting Factor: Boring #1 Bor.pit 95.15 Ft. 120 In. Elev. 85.15 ft Soil Application Rate: Horizon Depth In. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 0-4 7.5YR2.5/3 NIA SL 2MSBK MFR CS 3M 0.6 1,0 2 4-24 7.5YR4/4 N/A LS 0SG ML CS 3M 0.7 1.6 3 24-120 7.5YR4/6 N/A MS 0SG ML NIA IF 1.6 4 5 6 7 Ground surface Eiev: Depth to Limiting Factor: Boring # 2 r B°fj F 96.05 Ft. 110 in. Elev. 86.88 ft Soil Application Rate: Horizon Depth In. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 0-6 7.5YR2.5/3 N/A SL 2MSBK MFR CS 3M 0.6 1.0 2 6-20 7.5YR4/4 N/A LS 0SG ML CS 3M 0.7 1.6 3 20-110 7.5YR4/6 N/A MS 0SG ML N/A IF 0.7 1.6 4 5 6 7 *Effluent #1 = BOD 5>30< 2 20 mg/I and 7≤S>30 < 150m ffluent #2 = BOD 5< 30 mg/I and TSS < 30 mg/l CST Name (Please Print) Mark S. Thomps sign CST Number: 877598 Address: 12006 N US Hwy 63 Hayward, WI 54843 D)3t Eva uati cted: Tuesday, August 26, 2025 Telephone Number 7151699-408'fr, `'J«r~ SBD-8330 (R04/21) SEI U � LUL5 Bayfield Co. P!a nning and Zoning Agency 13roperty Owner: James & Anne Marie Kanickv Parcel I.D. 2372 Page: 2 of 6 Boring # 3 1" Bork Pit Ground surface EIev: Depth to Limiting Factor: 93.65 Ft. 100 in. Elev. 85.32 ft Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 0-4 7.5YR2.5/3 N/A SL 2MSBK MFR CS 3M 0,_6 1.0 2 4-24 7.5YR4/4 N/A LS 0SG ML CS 3M 0.7 1.6 3 24-100 7.5YR4/6 N/A MS 0SG ML N/A IF 0.7 1.6 4 5 6 7 Boring # 4 "` ' Pit t Ground surface Elev: Depth to Limiting Factor: l3or 0 Ft. 0 In. Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 2 3 4 5 6 7 Boring # 5 r Bor17 Pit Ground surface Elev: Depth to Limiting Factor: 0 Ft. 0 In. Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 2 3 4 5 6 7 Boring # 6 r Bores Pit Ground surface Elev: Depth to Limiting Factor: 0 Ft. 0 In. Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 2 3 4 5 6 7 *Effluent #1= BOD 5>30 < 2 20 mg/! and TSS>30 < 150mg/ *Effluent #2 = BOD 5< 30 mgil and TSS < 30 mg/l The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777 seas�o�R.onao� SEP 05 ZOZ5 Bayfiejd Planning and Zor; CO. Ao;:ncv Owner: James & Anne Marie Kanic Soil Tester: Mark S. Thompson System Elevation: 91.5 1 Load Rate: 0.7 System Elevation: 98.88 To 91.65 101 B2 101 B1 101 B3 100 ------------- 100 ------------- 100 99 99 ---- - 99 --------- 98 - --------- --------- 98 --- --------------- 98 --- -------____-- -- ----_ System 97 97 97 Elevation _ 96 ----- 96.05 96 _______________ 96 ----------- 95 95 --- 95.15 95 -------- _ 94 ----------• 94.38 00.7 ----------- 0 ----------- 93.65 93.15 93 ----------- 0.7 --------------- ----- _ ____" ____.91.65 91-----�----- 91 ---- 91 0.7 ------------ 89.88 89 ------------ 89 89 88 - -S T31 88 ----• 88.15 88 -----------• 88.32 87 ----•-------- 87 -------�--- 87 86.88 T3' �- T3' 86 L.F. 86 --------------- 86 --------------- 85 --------------- 85 85.15 85 -95.32 L.F. L.F. 84 -- 84 - 84 83 ---------- 83 83 --------------- 82 -- 82 82 ------�---- 81 -------------- 81----_�_____ 81 80 - 80 ______________ 80 79 --------------- 79 _ --- 79 ___________'_ SEP 0 5 z0zb hayfield Co. P1anf:ing and Zoning Agency N Owner Information: Name: James & Anne Marie Kanickv Location: S30.T44N.R09W Township: Barnes County: Hayfield Address: 1750 Lower Lake Road vvee • 96' Shed BM=100: Bottom of siding on the SE corner of house Driveway Lowed Road+ B1 = 95.15 B2 = 96_05 B3 = 93.65 Lake= 70.65 "' _ N CST S. Th^om s C rn 1'40' Only in Tested Area 715/699-4081 ,,. cNn BAYFIELD COUNTY SANITARY PERMIT (#04)-25-125S STATE SANITARY PERMIT OWNER: JAMES F & ANNE MARIE D KANICKY GOVT LOT: 1 LOT: BLK: 1/4 1/4 SEC: 30, T 44 N, R 9 W TOWNSHIP: Barnes SOIL TEST: 123-25 REPLACEMENT SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: JASON KUETTEL TRACY POOLER DATE: 9/16/2025 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 #: 665 LICENSE: # MP 675751 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 9/16/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION