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HomeMy WebLinkAbout25-131SRequest for Sanitary Inspection (24 Hrs. in Advance) Fax or email this form to Zoning Dept (24 Hrs.) prior to when you want an inspection Fax (715) 373-0114 or Email zoning(adbayfieldcounty.wi.gov Note Time Change fl Discrepancy fl Other Phone Number 715-739-6868 Plumber: Doug Manthey Fax Number Email Address Homeowner: Tom Gibbons norpines@chegnet.net Type text nere Immediate Phone Number So Zoning Sanitary Dept can call you right back (if needed) Permit #: 25-131S Plumber's Choice Zoning Dept Type text here No Inspection(s) during this time Date: 08/19/26 Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice ing Dept Time: Township: Cable Address # & Road Name: 45455 E Cable Lake Rd or Directions _n ��(Y� To Site: Comments: ** Plumbers you must verify any change(s) by fax or email ** Notes from July 2025 THOMAS J & ANN L GIBBONS e Onsite Wastewater Treatment S373 VALLEY VIEW ESTATES LN ns ( POWTS). Inspection Report COON VALLEY WI 54623 (Attach to Permit) ACountyPermit No: State Plan'Transaction ID#: Parcel Tax No: TYPE I MANUFACTURER CAPACITY I Prop. Line Well Building Air Intake Road Se tic tv;255.. /704 ^ N/A Dosing N/A Aeration J J I I I I N/A Holding Pump I Siphon Information ump Manufacturer ump Model Demand GPM Filter Manufacturer Filter Model TDH Lift Friction Loss Head Total Forcemain Length Dla Dist To Well Disnersal Cell Information DIMENSIONS Width Length # of Cells SETBACK FROM Prop.. Line Building Well OHWM Type of Cell Manufacturer: Model Number. Pretreatment Unit Manufacturer. Model Number: Distribution Die Elevation Data STATION BS HI FS ELEV Benchmark 7. Ui (p L( Bldg. Sewer Lt, 2-c 1 Tank Inlet Tank Outlet Dose Tank Inlet Dose Tank Bottom \) p tt' Inst. Contour Header/ Man fold Distribution Pipe Infiltrative Surface Final Grade ❑ Yes ❑ No son cover • Depth Over I Depth Over I Depth of I Seeded / Sodded I Mulched Cell Center I Cell Edges I Topsoil ❑ Yes ❑ No j 0 Yes 0 No ; OMMENTS: (Include code discrepancies, persons present, etc.) G�Q.bS Ian revision required? ❑ Yes O No F se other side for additional information, Date QRn_R71n rR ❑4/711 POWTS Inspector's Signature License Number Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zonino(o7bavfieldcountv.org Web Site: www.bavfieldcounty.org/147 THOMAS J & ANN L GIBBONS S373 VALLEY VIEW ESTATES LN COON VALLEY WI 54623 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know 9 ©t) k Td t. �Gfj'' 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: ❑ Tank was pumped by: on at AM/PM ❑4 Tank was crushed / removed and pipes disconnected by: On at (AM PM he above -mentioned plumber contacted our office to conduct a pre -cover inspection as required un er 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/forms/sanitarypmpertyowner-input April 2019 r::.. k !C!tVE ° EtI�E�Et Department of Safety & Professional Services, County Ba eld 4 �S (;,)�. Sanitary Permit Number (to be filled in by Co.) Rat =- `� 2 Q2 Industry Services Division r— nitar?PJMf1t Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 1S.04(1)(m), stats. 45455 E Cable Lake Rd I. Application Information — Please Print All Information Property Owner's Name Parcel # 39004 Thomas J & Ann L Gibbons Property Owner's Mailing Address Property Location S373 Valley View Estates Ln Govt. Lot City, State Zip Code Phone Number Coon Valley, WI 54623 608-317-4167 ¼. ¼, section o i T 43 N R 08 E or W II. Type of Building (check all that apply) Lot # Subdivision Name ® 1 or 2 Family Dwelling —Number ofBedrooms 2 1 & 2 Block # D Public/Commercial — DescribeUse O City of ❑ State Owned — Describe Use O Village of CSM Number 761 ® Town of Cable III. Type of POWTS Permiti (Check either "New" or "Replacement" and other applicable on.line A.: Check one box online B. Complete line:C ' a Iicable. A. O New System O Replacement System ® Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) Tank Replacement O Holding Tank ® In -Ground O At -Grade O Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner ist Previous Permit Number and Date Issued Expiration 9877410/08/87 IV. Dis - ersalfrreatmeat.Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) Dispersal Area Proposed (st) System Elevation 300 0.7 / Perc rate <10 428.6/410 sf Exstg Bed 410 sgft 91.8 Capacity in Total # of Manufacturer s, Tank Information Gallons Gallons Units `'" o c _ s New Tanks Existing Tanks U rncow E5 A, Septic or Holding Tank 1000 1000 1 Wieser Concrete X Dosing Chamber 600 600 V. Responsibility Statement-. I, ttie undersigned, a me lro malt f lusts ;of the POWTS shown on the attached plena. Plumber's Name (Print) PIu er's S gnature MP/MPRS Number Business Phone Number Doug Manthey MP 230722 715-739-6868 Plumber's Address (Street, City, State, Zip Code) PO Box 196 Drummond, WI 54832 Vi County/Departmet tUse,Only �(Approved O Disapproved $Permit Fee Date Issued L Issu g store zy O Owner Given Reason for Denial aa. s Conditions of Approval/Reasons for Disapproval Attach to complete plans for the system and SUDmzt to me ounty only on paper not Less man a 114111 zacuca m aao SBD-6398 (R. 03/22) PAGE 1 OF 1/ In -Ground Dosed -Gravity Plan RECEIVED Index & Cover Sheet SEP 17;2 Component Manual Design References: 25 In -Ground Soil Absorption for POVVTS Version 2.1 (May 2022-2,027) sayfieid co. Panning and Zoning Agency Pg 1 of / Index & Cover Sheet Pg 2 of y Plot Plan Pg 3 of Y Pump Tank Specifications Pg `1 of y Management Plan Attachments: Enclosures: Pump Curve POWTS Application for Review Wieser Tank Specs Soil Evaluation Report & Site Map Property Data Project Name I Description GIBBONS TANK REPLACEMENT Owner Name(s): THOMAS J & ANN L GIBBONS Phone: 608 -317 -4167 Owner Address: S373 Valley View Estates Ln Coon Valley, WI Zip: 54623 Project Address: 45455 E Cable Lake Rd Govt. Lot: ___ Township: Cable .1/4 of 1/4, Section 01 , T 43 N -R 08 Project Parcel ID #: Tax ID: 39004 County: Bayfield Designer Information Designer Name: Douglas Manthey Designer Address: PO Box 196 Drummond, WI E-mail: norpines@cheqnet.net License Number: MP230722 Remarks: E ❑or W E✓ Phone: 715 - 739 -6868 Zip: 54832 This space reserved for approval stamp. Signature: Date: 09/10/25 Origin signature required on ch submitted copy. liii SEP 19 2025 Rayfield Co. Zoning WJe ew • Pe_la' t rOCO �lov 1h 45 GTa+p ¢!fl fit��� ! �i! b � �t •�� � rCL L e l C� eve, l -L iI 3ra�c,� JVew ov.,e A � {{ J l Neon ��ope l�ls liii SEP 19 2025 Bayfield Co. Zoning Dept. MP 3&?z PAGE j OF y • GRAVITY -DOSED 11 SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) 4"0 Vent Pipe p 1 2 >10 ft from Building 12" Mn. or 2.0 fl above Established Flood Elevation P�nriM9 af4 i (typical) Approved IMPORTANT: Vent Cap Anchor tank(s) as necessary pursuant to SPS 383.43(8)(g) Finished Grade CAPACITIES @ 11.82 gal/in Depth (in) Volume (gal) A 31 366.42 B 2.0 23.64 [Cl 6 70.92 D 12 141.84 4 ..4 A '[CJ * Pump Tank Liquid Level = 51 in D Force Main Diameter = 2 in •- ; 3" Approved Bedding Material Beneath Tank Electrical must comply with SPS 316 and NEC 300 �2Juencjioatherproof n Box Conduit Airtight Seal Extend manhole riser as necessary. Approved Locking Manhole with Warning Label Attached (typical) 4° Mn. or 2.0 fl above Established Flood Elevation (typical) Quick Disconnect :• 18" Mtn. (typical) Force Main Length = 75 ft Force Main Void Volume = 12.2 gal [C] Total Dose Volume (TDV) = 70.92 gal/dose L ( 0.2X design flow + ford main void volume) Vertical Lift = 15.8 ft PUMP TANK: Volume = 600 gal Manufacturer Wieser Concrete Pump Manufacturer. Goulds Pump Model: EPO 411 (See attached pump curve.) Controls/Alarm Manufacturer. SJE Rhombus Controls/Alarm Model: 1025830 Float switches containing mercury are prohibited. Pump Weep Approved Joints with Hole Approved Pipe 3 fl onto Solid Ground (typ€cal) On __off' PUMP -OFF 4-. ELEVATION = 76.5 ft INSIDE BOTTOM ELEVATION = 75.5 ft SEPTIC TANK(S): Total Volume = 1000 gal Manufacturer(s): Wieser Concrete Install approved effluent filter at the septic tank outlet immediately upstream of the pump tank inlet. Filter Manufacturer: Orenco Filter Model: PSCS0621-18 • RPRG BF 4 In -ground Dosed -Gravity Management Plan SEP 17 2025 IMPORTANT: Planning •and Zoning Agency The owner of this in -ground dosed -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 POINTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 300 gpd; BODs 220 mgL 1; TSS 150 mgL'1; FOG ≤ 30 mgL"1 Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tanks) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Local government unit HK Septic Service Bayfield County Zoning Local government unit address: PO Box 58 Washburn, WI Phone: 715-798-3494 Phone: 715-373-6138 ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless 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 soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. GOULDS PUMPS APPLICATIONS Submersible Effluent Pump RECEIVED 3 871 EP05 SEP 17202 WJV 1.-..__ BaCo. planning and Zoning Agency Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: '/a" maximum. • Capacities; up to 60 GPM. Total heads: up to 31 feet. • Discharge size: 11/4' NPT. • 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, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V or 230V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: l0 foot standard length, 16/3 SJTOW with three prong grounding plug. Optional 20 ,,—..foot length, 16/3 S1TW with three prong grounding plug (standard on EP05). • 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 •i EP04 Impeller. Thermoplas- tic Semi -open design with pump out vanes for mechanical seal protection. METERS ,FEE 7 Ui 6 S 4 r 2 1 ■ EP05 Impeller: Thermoplas- tic endosed 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 $I' Canadian Standards Association Goulds Pumps is 150 9001 Registered. .._. --- _ ._. H__Hscnj -4....................__ --- ....— E'': 2 _ ....... 10 ; s v 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m3/h CAPACITY Goulds Pumps @2002 Goulds Pumps <& ITT Industries Effective September, 2002 83871 4" CAST -A TOP VIEW W1000/600 -MR TANK SPECIFICATIONS DIMENSIONS: 4" CAST -A -SEAL WALL: 2 1/2" BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 69 1/2" w a 4" VENT w oc __ :iL::4::::_ I LETTJ TI Dn _ OUTLET to I'I I 2k" I ' II PUMP PAD 0 0. _I LENGTH: 9'-6 7/8 WIDTH: 7'-9" BELOW INLET: 57" LIQUID LEVEL: 51" c E WEIGHT: BOTTOM 8,540 LBS. r' o o COVER 3,840 LBS. U $ o 1 INLET AND OUTLET: . m 0o a o 4" CAST -A -SEAL BOOT OR EQUAL GASKET Q INLET AND OUTLET BAFFLE AND FILTER: N oac o o ii 4" 0 WISCONSIN. SEE DETAIL #10 SEE CHART) (OTHER STATES LIQUID CAPACITY: 19.61 GAL/IN (SEPTIC) 11.82 GAL/IN (PUMP) Co _ a LOADING DESIGN: 8'--0" UNSATURATED SOIL 00 p i TANK CAN BE USED AS: SEPTIC/SEPTIC, SEPTIC/PUMP, o I OR SEPTIC/SIPHON '" p COVER: MIX DESIGN #8 (NO FIBER) 0 m x 00 TANK: MIX DESIGN #10 (STRUCTURAL FIBER) _ ID CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE REVIEWED BY REVIEW DATE 0 Co I 0 0 0 3 J z U a w U) SHEET NO. 1 � OF T ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS Real Estate Bay field County Property Listing Today's Date: 9/10/2025 Description Updated:/15/2023 Tax ID: 39004 PIN: 04-012-2-43-08-01-4 05-002-21000 Legacy PIN: Map ID: Municipality: (012) TOWN OF CABLE STR: SO1 T43N R08W Description: LOTS 1& 2 IN CSM NO 761(LOC IN GOV LOT 2) IN DOC 2023R- 599060 Recorded Acres: 3.600 Calculated Acres: 4.015 Lottery Claims: 0 First Dollar: Yes ESN: 108 �4 Tax Districts Updated: 6/15/2023 1 STATE 04 COUNTY 012 TOWN OF CABLE 041491 SCHL-DRUMMOND 001700 TECHNICAL COLLEGE L• Recorded Documents .-Updated: 6/15/2023 O WARRANTY DEED Date Recorded: 5/19/2023 2023R-599060 © QUIT CLAIM DEED Date Recorded: 2/4/2015 2015R-557627_ W QUIT CLAIM DEED Date Recorded: 5/18/2007 2007R-513917 © CONVERSION Date Recorded: 3/15/2006 ® QUIT CLAIM DEED Date Recorded: 1/5/2004 2004R-488480.881-309 ® CERTIFIED SURVEY MAP Date Recorded: 7/22/1992 40034 Property Status: Current Created On: 6/15/2023 1:02:16 PM ' A _� Ownership__ T_� .. - ... _ Updated: 6/15/2023 THOMAS J & ANN L GIBBONS COON VALLEY WI Billing A dress: Mailing Address• THOMAS J & ANN L GIBBONS THOMAS J &ANN L GIBBONS S373 VALLEY VIEW ESTATES LN S373 VALLEY VIEW ESTATES LN COON VALLEY WI 54623 COON VALLEY WI 54623 Site Address * Indicates Private Road 45455 E CABLE LAKE RD CABLE 54821 Proper hem --` - — Updated: 3/18/2024 2025 Assessment Detail Code Acres Land Imp. G1 -RESIDENTIAL 3.600 132,600 29,600 2 -Year Comparison 2024 2025 Change Land: 132,600 132,600 0.0% Improved: 29,600 29,600 0.0% Total: 162,200 162,200 0.0% aProperty History -- ---..__ . . __ ... Parent Properties Tax ID 04-012-2-43-08-01-4 05-002-20000 HISTORY LL pand All History White=Current Parcels Pink=Retired Parcels ® Tax 1D: 9179 Pin: 04-012-2-43-08-01-4 05-002-200 Leg. P€n: 012108304000 39004 This Parcel Parents Children Srr I / L1J15 Planning and Zoning Agcy RECEIVED SEP i 72025 Plannin BaYfield Co. 9 and Zoning 4 BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) O'Check List rl5riginal Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) a1ndex Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) Original Plot Plan (383.22(2)2. 3. & 4.a) 2Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer l2'�ump Tank Diagram, Alarm and Pump Curve (when applicable) E'Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) ❑ Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) t" 6e 5 0 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) lee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 5y har%eowhcr omolete Set%of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) I and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) .1 Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) erect Address or Road Name where driveway is/will come off of) all Type of Building 13111 Type of Permit I SV Type of POWTS System a -t Dispersal / Treatment Area Information �VI Tank Information 2Vh Responsibility Statement (Plumber's Information) lL *Date Stamp* Plot Plan: (To Scale or To Dimension) P -Signature and Plumber Information 0 Surface Elevation of Body of Water ,direction and Percent Land Slope ank and Filter Information and Location tlands / Navigable Bodies of Water 1orption Area (Proposed and Existing) wench Mark (Location, Elevation and Description) 948wners Phone Number) RECEIVED SEP 17 2025 Bayfleh Co. Planning and Zoning Agency dress Number and Road 2 N&th Arrow contour Lines a/tructures and Driveways siring Locations 1J�Property Lines Well Locations ❑ Component Manual Version E] _k ggal Descriptions Limping Material Information (cur Turn Over ► Cross -Section and Over -Head Profile of the System: ❑ Surface and System Elevation O Position of Observation and Vent Pipes ❑ Dimensions and Depths ❑ Make, Model & Number of Chamber Units in each Cell Property Information ❑ How many systems will there be on this parcel of land? ❑ Has this property been split? (Property Statement shows Property History) Fees: ❑ Private Sewage System (Septic Tanks) $ 400.00 ❑ Private Sewage System (Holding Tanks) $ 400.00 ❑ Mounds or Systems requiring Pre -Treatment $ 500.00 ❑ Sanitary Revisions $ 25.00 O Private Sewage System Reconnection $ 50.00 and Private Interceptor ❑ Return Inspection $ 50.00 ❑ Maintenance Agreements i $ 30.00 (checks made out to Reg of Deeds) RECEIVED SEP 17 2025 Bayfield Co. Planning and Zoning Agency u/forms/checklists/checkflsttorsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: -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: GIBBONS, THOMAS J & ANN L S373 VALLEY VIEW ESTATES LN COON VALLEY, WI 54623 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00336 Transaction Number: SR -00336-3528C Amount $50.00 Total: $50.00 Payment Amount $50.00 Reference: 5344 Paid by: A -Z Enterprises, Nor -Pines Plumbing, PO Box 196, Drummond WI 54832 Payment Type: Check Transaction Date: 9/22/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. VwA--Y--.F1ELD Property Owner: GIBBONS, THOMAS J & ANN L S373 VALLEY VIEW ESTATES LN COON VALLEY, WI 54623 Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Description Private Sewage System (Septic Tanks) Submission Number: SS -00654 Transaction Number: SS -00654-3528A Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 5345 Paid by: A -Z Enterprises, Nor -Pines Plumbing, PO Box 196, Drummond WI 54832 Payment Type: Check Transaction Date: 9/22/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. , q iQ Page.. -of 2— � I �,r ' — }��, Wisconsigb4cal Wety and Professional Services :� ' t i Division of Industry services �\ t. .1 "( G25 SOIL EVALUATION REPORTS rZ-oo33SOIL TEST #/5- �t County B�vbeld Co. In accordance with SPS 385, Wis. Adm. Code BAYFIELD Attach complete site plan k1. pijt; less"fx 11 inches in size. Plan must include, parcel I.D. but not limited to: vertical and horizontal reference point (BM), direction and percent slope, TAX ID # 39004 scale or dimensions, north arrow, and location and distance to nearest road. Date Please print all Information. Rev' ed Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). Property Owner Property Location THOMAS J & ANN L GIBBONS Govt. Lot % % S 01 T 43 N ROB E (or) W Property Owner's Mailing Address Site Address or CSM and Lot # LOTS 1& 21N CSM NO 761 (LOC IN GOV LOT 2) $373 VALLEY VIEW ESTATES LN IN DOC 2023R- 599060 (45455 E CABLE LK RD City State I Zip Code Phone Number ❑ City ❑ Village ❑ Town Nearest Road COON VALLEY I WI 54623 ( ) E CABLE LK RD ❑ NewConstruction Use: 1 Residential/Numberofbedrooms 2 Code derived designflow rate 300 GPD ❑ Replacement ❑ Public or commercial —Describe: Flood Plan elevation if applicable ft. Parent material GLACIAL UIW SH General comments and recommendations: BI SOIL VERIFICATION ON EXISTING SYSTEM IS GOOD Boring # ❑ Boring 0a pit Ground surface elev. 94_?ft. Depth to limiting factor 120 in. / eiev _84.7„it. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlFt2 *EfF#1 *Eff#2 In. Munsell Qu. Az. Cont. Color S z. Sh. 1 0-8 7.5 YR 312 S 2MGR MVFR GW 1CQVF .7 1.6 2 8-20 7.5 YR 413 S 2MSBK MVFR GW 1 VFF .7 1.6 3 20-40 7,5 YR 414 GRS O -SG ML GW 1'/F .7 1.6 4 40- 120 7.5 YR 4!4 S 0 -SG ML ----- .7 1.6 H32% GRAV & COB F-1Boring # (]Boring On Ground surface elev..ft. Depth to limiting factor_.___.,_in. l elev. It. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlFtz *Eff#2 in. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. ' * Effluent #1 = BOD > 30 s 220 mglL and TSS > 30 s 150 mglL * Effluent #2 = BOD, s 30 mglL and TSS s 30 mglL SBD-8330 (804121) I Qc Q 12'7O~��r' 1st 71 7lI V wg �9N If C! 2•r 4,h& pis yP'o s Joe -a _t •p mss• sof 23f may',, h1 w,' /.'ta '��► i l a SS's' --Sly ,, , (≥ Q49 24? / yZ Ow-s�r7 vt "'� gad+ AIE-sj. 1oS o oy 6uluoz Pus 6uluueld b oPh 00 �I i -A sov9rf."9 7 v0p, PI sb�,o ,a ��s• O/ BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): I Check List ❑ Index Page / Title Sheet (Optional) I�'(Sriginal Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Gaim Deed) (Optional) Soil Evaluation Report: (Include the following Information) cel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used 1perty Owner's Information not prospective buyer's name) ' Property Location (Accurate Legal Description with Sec/Twp/Range) .HName (where driveway is/will be coming off of) ❑ Floodplain Elevation, Flow Rate, Comments and Recommendations ®'Complete Soil Boring / Pit Information Soil Evaluation was conducted 'Name, Signature, Number, Address and Phone Number ❑.0rate 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') O4roperty Location (Sec/Twp/Range/, Accurate Legal Description) I"rings (Locations and Elevations) O Percent and Direction of Land Slope ell Location (Including Neighboring Wells, if applicable) O Location of Wetland Areas, Floodplain and Navigable Waters L'iidings, Driveways, and Structures (Location and Descriptions) ration of Property Lines xisting System Location Address Number and Road Name O Current Surface Elevation of Wetlands and Navigable Waters Lf GST, Owner and Property Information [ North Arrow RECEIVED SEP 17'2025 hayfield Co. Planning and Zoning Agency Fee: Otertified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforcsts BAYFIELD COUNTY SANITARY PERMIT (#04)-25-131 S STATE SANITARY PERMIT OWNER: THOMAS & ANN GIBBONS G OV'T LOT: LOT: 1 & 2 B LK: CSM: 761 1/4 1/4 SEC: 1, T 43 N, R 8 W TOWNSHIP: Cable SOIL TEST: 125-25 OTHER MODIFICATION SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: DOUGLAS MANTHEY TRACY POOLER DATE: 9/22/2025 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 #: 98774 LICENSE: # MP 230722 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 9/22/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION