The URL can be used to link to this page

Home My WebLink About25-143SRequest 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 zonina@bavfieldcountv.wi.nov Note Time Change Discrepancy fl Other 46/k/A/c Phone Number Plumber: NflUiyj flopISAy i hlc�iftd /b 5i i 7So S O Fax Number Email Address Homeowner: (Cc sw. tt ('es c' /, ' 'ih' (4lCm Immediate Phone umber S . om Sanitary Dept can call you right back (if needed) Permit#: J Plumber's Choice owDept hit No Inspection(s) during this time Date: /C 3,-z5 Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice ing Dept Time: �ep.y Township: u Address # & 150T 1C S�C� Or�v� Road Name: v 3335 or Directions To Site: Comments: " Plumbers you must verify any change(s) by fax or email Notes from Zoning July 2025 �b S Inc GE Pe DONN & LYDELLE BERGQUIST Pe 6988 S CLEVELAND RD LAKE NEBAGAMON WI 54849 Private Onsite Wastewater Treatment Systems ( POWTS),I•nspection Report (Attach to Permit) City Tank Information setback to: TYPE MANUFACTURER JCAPACI1Y Prop. Line J Well Building Air lntakeJ Road Se ttc i -eSCv '-I°/co 500 a` > IO (o NA- N/A DosinJIgN/A Aeration N/A Holdin s. 15.04 (1)(m)] Village Town of: County Sanitary ermi₹ No: State Plan•Transaction lD#: Parcel Tax No: 32$ • Pump / Siphon Information Pump Manufacturer ump Model Demand Filter Manufacturer Filter Model GPM TDH Lill Friction Loss Head Total Forcemain Length Dia Dist To Well Dispersal Cell Information • DIMENSIONS Width3! Length # of Cells r SETBACK FROM Prop.. Line Building Well I OHWM Type of Cell Manufacturer: -r 1 r. ^hU f Model Number. Pretreatment Unit Manufacturer. Model Number. stribution System Header I Manifold Distribution Pipe(s) C, (X Length Dia Length Dia Spac Soil Cover Elevation Data STATION Benchmark BS HI J FS ELEV Bldg. Sewer Tank Inlet 9 . O C 07 Tank Outlet j.3( 0) Jc _7C) Dose Tank Inlet Dose Tank Bottom Inst. Contour Header! Manifold — L4 , s 1j Distribution Pipe Infiltrative Surface�[� (' _i h01Cm1 2 9.o AAS lo.1 %,o Depth Over Depth Over Depth of Cell Center Cell Edges LTopsoil COMMENTS: (Include code discrepancies, persons present, etc.) a'r (e \1 0.1 ti�rr.. 'r 1, 1, °1 5 / 9 qkv s X Pressure Systems Only X Hole Size X Hole L rvation Pipes Spacing ' �Zes❑ No Seeded I Sodded . Mulched ❑ Yes ❑ No , ❑ Yes ❑ No C Imo + tocA'c ryt VeAi 1 \c1b,- Ian revision required? ❑ Yes ❑ No o 31 n_viI e other side for additional information. Date POWTS Inspector's Signature License Number RtLR71n tR ng1,11 A - Y'"T 5775-169 $42/; L. x '' PRPTD/TaxSb # 3 • _ KENNETH,L 6�SANbl PRPIDITaw b # 611' +-•I � > LUCILE R GARO R T k a' Bayfield County, WI ..�za37; is .- �,•• 'rx x. x I ID/Ta#3335 .• cI 'rb0NN & LYDELLE BER6QUI5T Y _ _ PRPIDI�__yTgx;ID�#�1617...� r t si ,• t _ 't Z x S�i5 L"k -Si 6 i R v f-- Z a _ �' =PRPID/Tax SID'#36354 • - �' ,� are y � •r• -'., ae�. _ .` 3 �. ., r I ;� _ r1eDRLr MIDDLE EAU CLAIRE L Property Owner Information As you know BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Bayfield County Courthouse Fax: (715) 373-0114 Post Office Box 58 e-mail: zonino(�bavfieldcounty.oro 117 East Fifth Street Web Site: www.bavfieldcountv.org/147 Washburn, WI 54891 DONN & LYDELLE BERGQUIST 6988 S CLEVELAND RD LAKE NEBAGAMON WI 54849 was contracted by you to install a private onsite wastewater treatment system on your property (Tax ID# above). To know when your system will be due for servicing please go to www.septiesearch.com Notes: Abandonment of Old System to meet all applicable code requirements: 0 C Tank was pumped by: Tank was crushed / removed and pipes disconnected by: on at AM/PM On at (AM / PM) the above -mentioned plumber contacted our office to conduct a pre -cover inspection as required under DSPS 383. One of the following applies: ❑/` System was inspected and appears to meet all applicable code requirements. flSystem was inspected and appears to meet all applicable code requirements; however, a plan revision is necessary because the installation was substantially different than the original approval. System could not be inspected because plumber covered prior to scheduled time of inspection. flSystem 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: Ullorms/sanlie ry prop erlyown er-input April 2919 rte`"r"F�• }"o S p j0 Department of Safety fil Si & Proessonaervces, County Bayfield Sanitary Permit Number (to be filled in by Co.) g .I Industry Services Division J Sg- Ott t9bL 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 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(1)(m), Stats. 1805 Lakeside Dr L Application Information —Please Print All Information Property Owner's Name Parcel # Donn & Lydelle Bergquist 04-004-2-44-09-07-411-118-50000 Property Owner's Mailing Address Property Location 3 G J✓ 6988 S Cleveland Rd Govt. Lot City, State I Zip Code Phone Number Lake Nebagamon, WI 54849 218-428-6983 ¼, '/,, Section 7 IL Type of Building (check all that apply) Lot # TN R 9 E o ❑ 1 or 2 Family Dwelling —Number ofBedrooms Subdivision Name �i'1 Public/Commercial — Describe Use Three 2 bedroom cabins Block # O City of ❑ State Owned— Describe Use CSM Number O Village of ® Town of Barnes IIL Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if a licable. A. Syste ❑ New m LrJ Replacement System ❑ Other Modification to Existing System (explain) O Additional Pretreatment Unit (explain) B' ❑ Holding Tank I1In-Ground ❑ At -Grade ❑ Mound O Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) IDispersal Area Proposed (sO System Elevation 585 0.7 835.7 I 850 94,92,90 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units w a U li New Tanks I Existing Tanks A. ci v] oz rs t 7 G1, Septic orxolding Tank 840/500 - 1340 1 Wieser Dosing Chamber j - -. V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber' Name (Print) Plumber's Si ature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) 737$ 5, c.(V W- �' /83 - VL County/Department Use Only Approved O Disapproved $Permit Fee I Date Issued m� Issuing A Sign O Owner Given Reason for Denial Conditions of Approval/Reasons for Disapproval / 6e7" y'P r�-� Gcu� �erw, �' (i YA God! `J! �"h�-i �,� RGEVED c#,. Ap*p4 ?/u." ' '- 4 OCT 032025 IAe TO %�eAwe Bayfield Co Planning and 2; •;.ing Aga;y Attach to complete plans for the system and submit to the County only on paper not less than 8112 x 11 inches in size SBD-6398 (R. 03/22) RECENEDS 5 OO 9""'��°°,r Wisconsiganal Services Page of 3 a Dtvisiono st Ices SOIL TEST # ��' ea 1.tdCo. SOIL EVALUATION REPORT j4'5; 5 y cn A C/ ° a planning and Zoning g ECounl,,,In accordance with SPS 385, Wis. Adm. CodeAttach complete site plan on paper not less than 8 112 x 11 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. 00-118-50000 Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04(1)(m)). / I Property Owner Property Location ❑ Donn & Lydelle Bergquist Govt. Lot 'A 'AS 07 T 44 N R 09 E (or) wQ Property Owners Mailing Address Site Address or CSM and Lot #: 6988 S Cleveland Rd 1805 Lakeside Dr City, State, Zip Phone Number ❑ City ❑ Village ® Town Nearest Road Lake Nebagamon, WI 54849 (218) 428-6983 Barnes Lakeside Dr ❑ New Construction Use: U Residential/Ndmberofbedrooms Code derived designflow rate bob GPD I� Replacement la Public or commercial —Describe: tourist rooming(6. rooms) Flood Plan elevation if applicable N/A fl. Parent material Outwash Sands (Rubicon-Sayner complex) General comments and recommendations: Boring # south ❑Poring Pit Ground surface elev. 91.9 fl. Depth to limiting factor 96 in. I elev. 83.9 fl. Snil Annlil ralinn Ratp I Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/FF Eff#1 Eff#2 1 0-6 10YR 3/1 — S Osg ml as 2m/lf 0.7 1.6 2 6-27 10YR 4/4 — s 0sg ml aw 2m12f 0.7 1.6 3 27-44 7.5YR5/6 — s 0sg ml cw 1f 0.7 1.6 4 44-57 7.5YR 4/6 — s Osg ml cw — 0.7 1.6 5 57-96 1 OYR 6/4 — s Osg ml — If 0.7 1.6 2❑ Boring # West ❑Boring ®Pit Ground surface elev. 96.5 fl Depth to limiting factor 96 in. / elev. 88_5 n. I Snil Annl Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' Eff#1 -Eff#2 1 0-16 1OYR 211 — s 0.sg ml as 1m/1f 0.7 1.6 2 16-43 1 OYR 4/6 — $ Osg ml cw 1f 0.7 1.6 3 43-61 10YR 5/6 — s Osg ml cw — 0.7 1.6 4 61-96 10YR 614 — S 0sg ml — — 0.7 1.6 CST Name (Please Print) Signatur CST Number Keith Wiley 654921 Address I Date Evaluation Conducted Telephone Number 11623 E Larson Dr. Lake Nebagamon, WI 54849 8/26/2025 I 218-451-2611 Effluent #1 = BOD > 30:5 220 mg/L and TSS > 30 5150 mg/L ' Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mgiL 5BO-8330 (R03/22) ❑ Boring Boring # east ® Pit Page 2 of 3 Ground surface elev. 96.7 ft. Depth to limiting factor 96 in. I elev. 88.7 ft. ISnil Annlir atinn Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDlFt2 *Eff#1 •Eff#2 1 0-2 1 OYR 3/1 -- s Osg ml as 1 of 0.7 1.6 2 2-9 1 OYR 416 — s 0sg ml aw lm/2f 0.7 1.6 3 9-17 7.5YR 4/4 '—' s 0sg ml cw 1 co/1 f 0.7 1.6 4 17-45 10YR 5/6 — $ 0sg ml as 1f 0.7 1.6 5 45-96 1OYR 6/4 — s Osg ml — — 0.7 1.6 Horizon 4 has tratified layers of Sind and urse sand ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. / elev. ft. Gnii annlerafinn Rata Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDlFt2 •Eff#1 •Eff#2 LIII Boring # ❑ Boring ❑ Pit Ground surface etev. ft. Depth to limiting factor in. / elev. ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Stricture Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 •Eff#1 Eff#2 Effluent #1 = BOD > 30 s 220 mglL and TSS > 30 s 150 mglL • Effluent #2 = BOD, 5 30 mg/L and TSS 5 3omglL RECEIVED �:p 262025 Bayfield Co. Planning and Zoning Agency Bergquist (6 tourist rooms) Soil Report Plot Plan North 1O/ Scale 1:30 �$ Bench Mark = Top of well Elev = 100.0' NOTES: Middle Eau Claire Lake - Property lines not shown > 50' from tested area - Middle Eau Claire Lake Elev z 71' CST 119900002 -SP Page 3 of 3 Donn & Lydelle Bergquist BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): 5d Check List ❑ Index Page / Title Sheet (Optional) Z Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) ' Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) RECEIIIEE? SEP 26 2025 eaYrkid Co. F�rrir j ai d onifl3 4, , l' Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used l 'Property Owner's Information (not prospective buyer's name) El Property Location (Accurate Legal Description with Sec/Twp/Range) El Road Name (where driveway is/will be coming off of) El Floodplain Elevation, Flow Rate, Comments and Recommendations a Complete Soil Boring / Pit Information 7 Date Soil Evaluation was conducted EX CST Name, Signature, Number, Address and Phone Number El *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) [ 'Bench Mark (Description, Elevation and Location) EYContour Lines (Example = 98.0' /96.0' /94.0') CYProperty Location (Sec/Twp/Range/, Accurate Legal Description) 9' -Borings (Locations and Elevb' Q'Percent and Direction of Land Slope E Well Location (Including Neighboring Wells, if applicable) El Location of Wetland Areas, Floodplain and Navigable Waters El Buildings, Driveways, and Structures (Location and Descriptions) GYLocation of Property Lines E Existing System Location VAddress Number and Road Name 7 Current Surface Elevation of Wetlands and Navigable Waters El CST, Owner and Property Information CYNnrth Arrow Fee: Ea' Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checkiist/checklistforests Crosswinds Resort Gravity In -Ground Project Overview The Crosswinds Resort has RV campsites, cabins and a bar. One cabin currently has a collapsed septic tank; the second cabin has a septic system of the same vintage as the one with the collapsed tank and the third is an old shower building that is being converted .into a cabin. Proposed is a gravity in -ground system to treat the wastewater from three cabins. Each cabin will have two bedrooms. There will not be any dishwashers or washing machines in the cabins. Therefore, tourist rooming house sizing will be utilized to estimate the wastewater flows. Existing Systems There are two other POWTS on the property besides the proposed system. 1. Permit # 425160 is for two cabins with a design wastewater flow of 900 gpd. 2. The bar POWTS has a design wastewater flow of 1264.5 gpd The total DWF for all systems on the property is 2749.5 gpd Sizing Calculations 6 rooms at 65 gpd = 390gpd estimated wastewater flow. 390 est gpd x 1.5 = 585gpd design wastewater flow 585 gpd /.7=835.7 sq ft. drainfield (minimum) 585 gpd x 2.088 = 1221 gallon septic tank (minimum) Proposed System Components • A Wieser 840/500 gallon septic tank with poly lok 525 filter. • A 850 sq.ft. drainfield consisting of four rows of 8 and one row of 9 Infiltrator Quick4 Plus Standard chambers. Site Specific Project Details Two of the cabins will use an external ejector pit to lift the wastewater to the septic tank. The ejector pits are shown on the plot plan but are not part of this POWTS application. The ejector pits will be Wieser filter canister set to dose 30 gallons. Because of the ejector pump usage, a two -compartment septic tank is to be used to allow the larger particles time to settle out of the wastewater before entering the drain field. The 2" force mains will increase to 4" with a Y fitting in the sewer line. A 4" building sewer will connect the septic tank to the third cabin. Areas where the 2" force main crosses walkways, driveways or any other area where snow is removed or compacted the line will be insulated as per SPS 382.30. Additional Management Plan Requirements • The drain field shall be protected via a fence or another method to keep Atv's, snowmobiles etc off the site. p sa Vq OCT 032015 Bayf'eLj Co. Punning and ?UCrtC: A,g :rry A Department -approved variance does not guarantee acceptable water quality or quantity. This variance application was evaluated based on'information provided to the Department and is assumed to be accurate. The Department has not inspected the well and water system that is the subject of this variance application. The well has not been evaluated by the Department for compliance with NR 812 requirements beyond what is addressed in the variance request. Undisclosed noncomplying features will void the variance. NOTICE OF APPEAL RIGHTS If you believe that you have a right to challenge this decision, you should know that the Wisconsin statutes and administrative rules establish time periods within which requests to. review Department decisions must be filed. For judicial review of a decision pursuant to sections 227.52 and 227.53, Wis. Stats., you have 30 days after the decision is mailed, or otherwise served by the Department, to file your petition with the appropriate circuit court and serve the petition on the Department. Such a petition for judicial review must name the Department as the respondent. To request a contested case hearing pursuant to section 227.42, Wis. Stats., you have 30 days after the decision is mailed, or otherwise served by the Department, to serve a petition for hearing on the Secretary of the Department. All requests for contested case hearings must be made in accordance with section NR 2.05(5), Wis. Adm. Code, and served on the Secretary in accordance with section NR 2.03, Wis. Adm. Code. The filing of a request for a contested case hearing does not extend the 30 -day period for filing a petition for judicial review. I€ you have any questions, please feel free to call me at (715) 416-3331 or e-mail at Jacob.Sedivy@wisconsin.gov. Sincerely, Jacob Sedivy, Water Supply Specialist Private Water Supply Section Bureau of Drinking Water and Groundwater Eccs: Keith Wiley - Septic Contractor OCT Q 3 2025 aYf7 s,j c., ':anr:nc1 ?fid c Bergquist (POWTS) 9/18/2025,6:01:32 PM Override 1 1:1,566 0 0.02 0.04 Of? run LIII] Approximate Parcel Boundary Al Roads ' ' 0 0.03 006 0.11 km sayexu Town Ill `i- H ' Driveways Buildings Bayfieid county Land Recant Oepao,nent s J6 . Crosswinds Resort Gravity In -Ground Project Overview The Crosswinds Resort has RV campsites, cabins and a. bar. One cabin currently has a collapsed septic tank; the second cabin has a septic system of the same vintage as the one with the collapsed tank and the third is an old shower building that is being converted into a cabin. Proposed is a gravity in -ground system to treat the wastewater from three cabins. Each cabin will have two bedrooms. There will not be any dishwashers or washing machines in the cabins. Therefore, tourist rooming house sizing will be utilized to estimate the wastewater flows. Sizing Calculations 6 rooms at 65 gpd = 390gpd estimated wastewater flow. 390 est gpd x 1.5 = 585gpd design wastewater flow 585 gpd / .7=835.7 sq ft. drainfield (minimum) 585 gpd x 2.088 = 1221 gallon septic tank (minimum) Proposed System Components • A Wieser 840/500 gallon septic tank with poly lok 525 filter. • A 850 sq.ft. drainfield consisting of four rows of 8 and one row of 9 Infiltrator Quick4 Plus Standard chambers. ; Site Specific Project Details Two of the cabins will use an external ejector pit to lift the wastewater to the septic tank. The ejector pits are shown on the plot plan but are not part of this POWTS application. Because of the ejector pump usage a two -compartment tank is to be used to allow the larger particles time to settle out of the wastewater before entering the drain field. A 4" building sewer will connect the septic tank to the third,cabin. Areas where the 2" force main crosses walkways, driveways or any other area where'snow is removed or compacted the line will be insulated as per SPS 382.30. Additional Management Plan Requirements • The drain field shall be protected via a:fence or another method to keep Atv's, snowmobiles etc off the site. OCT U 3 ZUL.i Flay ie!d Co. Planning and Zonk,, Bergquist (6 tourist rooms) Gravity In -Ground Plot Plan North Wieser precast W840/500 -MR a `°J w/ poly lok 525 filter Well m a > ti °� N o li! Cfl -, 52 CD 2 bedroom N r' U a' 97' robin C- 0 95' C ½ 93' 16% 2 bedroom cabin Four rows of 8 and one row of 9 infiltrator Quick 4 Standard Plus chambers ST DF m S Septictank&drainfield tobe abandoned perSPS 383.33 t Scale 1:30 4 x Bench Mark = Top of well Elev= 100.0' 2"f AST DONN & LYDELLE BERGQUIST 1805 LAKESIDE DR LOT 3 OF ASSESSOR'S PLAT EXCEPTTHAT PORTION LYING N OF LAKE RD IN V.1110 p.420 460A S07 T44N R09W Town of Barnes 04-004-2-44-09-07-4 00-118-50000 5.370 acres NOTES: - All vent, observation & conveyance pipes ® Ejector pit. Wieser filter canister 4" ASTM D1785 or code equivalent w/ ejector pump set to dose 30 gallons. (Not part of POWTS app.) - Property lines not shown > 50' from system area - Middle Eau Claire Lake Elev z 71' Page 2 of 4 State of Wisconsin DEPARTMENT OF NATURAL RESOURCES 101 S. Webster Street Box 7921 Madison WI 53707-7921 September 16, 2025 Donn & Lydelle Bergquist 6988 S. Cleveland Rd Lake Nebagamon, WI 54849 Tony Evers, Governor Karen Hyun, Ph.D., Secretary Telephone 608-266-2621 Toll Free 1-888-936-7463 TTY Access via relay - 711 0CT 032025 3,yfleld Co. Subject: VARIANCE APPROVAL for an existing well located at 1805 Lakeside Dr., in the SE 1/4 9f the SE 1/4 Sec. 7 T" N R9W; Town of Barnes, in Hayfield County; Variance ID 78245 ; WUWN 1W829. Dear Donn & Lydelle Bergquist: The Department of Natural Resources (the as reviewed your request receive bytfie-9epartrjnt on September 04, 2025 fojyarianee-to1fl�i�uirements of s. NR 812.08 (4) T— ab-fe A-'Wis-Ad . which re ires� separation di tance-6f 5O fee between a well and a(n) POWTS dispersal component less than 12,000 ga y, You hai requestcsda separation distance of 40 feet. The Department has determined that your variance meets the requirements of NR 812.43, Wis. Adm. Code, and the variance is approved, subject to the following: NDIT The o owing construction or installation features for the well and water supply system shall be complied with to protect human health and groundwater comparable to strict code compliance: 1. The well is constructed to meet all other applicable requirements in NR 812, Wis. Adm. Code. 2. A copy of this variance must be provided to any potential buyer at least 10 - days prior to the closing of any sale of this property. All subsequent owners must also comply with this condition. 3. The well must be permanently filled and sealed if it fails to consistently yield water meeting drinking water requirements for any regulated contaminant. 4. If construction of the well has not commenced within 2 years of the date on this letter, the approval is void. Failure to comply with the conditions of this variance or any other applicable requirements of ch. NR 812 voids the variance approval. Please note that groundwater flow, the surrounding land uses and the physical condition of your well will change over time. The changes can affect the groundwater quality of your well. To investigate for changes in groundwater quality, the Department recommends at least annual sampling for bacteria and nitrate. FINDINGS Your request for a variance is granted because your application demonstrates that strict compliance with the code is not . feasible. The reason that strict compliance with the code is not feasible is that Features that contribute to comparable protection include: 1. The additional well construction and/or grouting requirements specified in the conditions of this approval will help to provide additional water quality protection for the well. 2. Groundwater flow in the area is toward Lake, making the proposed drain field down gradient of the well site. 3. Well sampling requirements specified in the conditions of this approval will provide additional water quality confirmation for the well. 4. Sampling records in the area indicate that nearby water quality meets drinking water quality standards. The Department has authority under ohs. 280 and 281, Stats. and s. NR 812.43, Wis. Adm. Code, to grant a variance from ch. NR 812 requirements when strict compliance is not feasible. The Department may also require additional construction or installation features to protect drinking water and groundwater from contamination as a condition of a variance. State of Wisconsin Application for Variance Department of Natural Resources Form 3300.210 (R 06/20) Page I of 3 PO Box 7921, Madison WI 53707-7921 dnrdnr wi oovcov Notice: Information requested is required for the Department to determine if a variance can be granted, per ch. NR 812, Wis. Adm. Code. Failure to provide all requested information may result in your application for a variance being denied. Personally identifiable information on this form will be used for administration of the water supply program, and will also be available to requesters under Wisconsin's Public Records law [ss. 19.31-19.39, Wis. Scats.]. Chapter NR 812, Wisconsin Administrative Code, establishes uniform statewide standards for the construction and maintenance of water supply systems. Section NR 812.43(1), Wis. Adm. Code states in part: 'When strict compliance with the requirements of this chapter is not feasible a variance maybe requested..," Last Name First MI Email Phone Number Bergquist Donn & Lydelle (218) 428-6983 Mailing Street Address and/or PO Box City State ZIP Code 6988 S Cleveland Rd Lake Nebagamon WI 54849 Facility Name (if applicable) @ Private or O Non -Community System List complete names of all property owners as they appear on the property title. Name (Other Property Owner) Name (Other Property Owner) Donn Bergquist Lydelle Bergquist Name of Well Driller, Well Contractor or Pump Installer (if known) License # Well Contractor Email Address Richard Squires 246 (if different than owner) Code 1805 Lakeside Dr (Barnes I WI 154873 Complete legal description of property where water supply is/will be located as it is described in the property title. Gov't Lot # %'h 14 Section Township Range Q E Q City @Town Q Village County 7 44 N 9 @ W of Barnes Bayfield For what type of well are you seeking a variance? Lot Number Latitude (DD) Longitude (DD) @ Existing Well Q Proposed Well 3 4 6 305 2 5 ° N - 9!, 5 3 4 1° w For either an existing or proposed well, complete the well construction information below to the best of your knowledge. For existing wells, include a copy of the well construction report if possible. If a well construction report cannot be located, you must complete and submit a NR812 Compliance Report (Form 3300-305). Construction Type @ Drilled QDriven Point O Other Drilling Method Upper Enlarged Drillhole Diameter 8" Upper Enlarged Drillhole Depth 20' Well Depth Casing Material Casing Diameter Casing Depth Grout Material Grouting Method 45' T & C ASTM A-58 4" 41' Puddled Clay (If Existing) Name of Original Well Owner if known (If Existing) Constructed By (If Existing) Completion Date Unique Well Number Sam Wuethrich Richard Squires 05/02/1985 IW829 For what requirement (s. NR 812 Wis. Adm. Code) are you requesting this variance? NR 812.08 Table A. 50' setback to POWTS dispersal component. What is the requested separation distance or construction requirement modification? 40' separation between well and POWTS dispersal component. Why is compliance with the code requirement not feasible? The site is a campground with campsites, 5 cabins 5 accessory buildings and a bar. There is also a public road(Lakeside Dr) that is 270' long and has a 50' ROW that enters the property. With all the structures and campsites along with the associated infrastructure (roads, buried utilities, parking lots, walkways, other POWTS) there isn't another location on the property to locate the replacement drain field. The drain field is to be located parallel and downslope of the well. The well is tested yearly by the Bayfield County Health Department and the well shows no signs of contamination. OCT 032025 Baynold Co. Planning and Zoning Agency Application for Variance Form 3300-210 (R 06120) Page 2 of 3 • Include an aerial photo, map, or diagram of the property OR Sketch the property and the location of any proposed new well or existing wells. Include the scale of the drawing and direction and distance to any known contamination sources. (for example, septic systems, gas tanks, drain tiles, animal pens, etc). • Attach any additional information that may help the DNR review this variance application. (North) SITE DRAWING • DNR regional personnel may inspect this property to verify information provided and to determine comparable protection options. You may be contacted for an appointment, or if more information is needed. • NO CONSTRUCTION SHALL BEGIN UNTIL THE OWNER OR CONTRACTOR HAS RECEIVED A WRITTEN VARIANCE APPROVAL DOCUMENT. • Written notification will be provided of approval or denial within 65 business days of receipt of this application, as provided by s. NR 812, Wis. Adm. Code - I certify to the best of my knowledge the information provided in this application is true, complete, and correct. I understand that the information I provide will be used by the Department to determine if a variance can be granted and what construction specifications may be required to provide comparable protection. I further understand that in granting a variance the Department does not guarantee acceptable water quality or quantity. Keith MAIL THIS APPLICATION TO: DNR DG/5 PO BOX 7921 MADISON, WI 53707-7921 OCT 0 3 2Uii Bay5el9 ,:, . Planning and 'r.o..r,.; .:q 4" CAST -A -SEAL 9'-5j" T `�� FILTER OR IIII i�� W840/500- MR TANK SPECIFICATIONS DIMENSIONS: 4" CAST -A -SEAL WALL• 2 9/16" BOTTOM: 3' COVER: 5' MANHOLE: 24' I.D. PRECAST CONCRETE RISER a HEIGHT: 59 1/2' LENGTH! 9'-5 3/4' .. o W cnQ? v 4" VENT w rn INLET --- T°"TT a tnQ II 1 dam- I• j 4. „ a D I:. 23 - j PUMP PAD TANKS • ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 WIDTH: •7'-9"IJJ BELOW INLET: 48' LIQUID LEVEL: 43' o WEIGHT: BOTTOM 7,360 LBS. COVER 3,790 LBS. n INLET AND OUTLET: m p 4' CAST —A —SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: u, o o WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) W 0 Ln LIQUID CAPACITY: 19.61 GAL/IN (SEPTIC) U, 11.82 GAL/IN (PUMP) to LOADING DESIGN: 8'-0' UNSATURATED SOIL o to Q 00 TANK CAN BE USED AS: a Lo SEPTIC/SEP11C, SEPTIC/PUMP, II OR SEPTIC/SIPHON w COVER: MIX DESIGN #8 (NO FIBER) of Illoho TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE OCT 0320� Bav1iafd Co Planning a od Zvrrir,c; Aq :ov REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: 1 OF '1 • BAYFIELD COUNTY Donn & Lydelle Bergquist CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) Fd Check List 11 Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) 21 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) 91 Original Plot Plan (383.22(2)2. 3. & 4.a) 10 Cross Section, Over -Head Profile of the System j.�j Schematic of Tank from Manufacturer 0 Pump Tank Diagram, Alarm and Pump Curve (when applicable) 21 Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) 21 Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of heeds) ❑ 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) 21 2 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) 21 Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) 0 State Plan Review (when applicable) 0 Copy of Warranty/Quit Claim Deed (Optional) Sanitary Aoolication: (Include the following Information) 211 Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) 21 Project Address or Road Name where driveway is/will come off of) 21 (Owners Phone Number) 2111 Type of Building 21111 Type of Permit 21 IV Type of POWTS System 21 V Dispersal / Treatment Area Information 0 VI Tank Information 21 VII Responsibility Statement (Plumber's Information) 9 *Date Stamp* Plot Plan: (To Scale or To Dimension) 21 Signature and Plumber Information 21 Surface Elevation of Body of Water 21 Direction and Percent Land Slope 21 Tank and Filter Information and Location 21 Wetlands / Navigable Bodies of Water 21 Absorption Area (Proposed and Existing) 21 Bench Mark (Location, Elevation and Description) RECEIVED OCT 032025 Bayfieid Co. Piann;r Agency 21 Address Number and Road 21 North Arrow 21 Contour Lines 21 Structures and Driveways 21 Boring Locations 21 Property Lines 21 Well Locations 21 Component Manual Version 0 Legal Descriptions 21 ii�yte1aRn�tYI�dIB�s�auer�tfia�rf7a , all` :� t1di'dete) Turn Over ► C_ Sectioirr and Over -Head ' Profile of the System: S Surface and System Elevation f Position of Observation and Vent Pipes &I Dimensions and Depths 19 Make, Model & Number of Chamber Units in each Cell Pro�ertv Information 2! How many systems will there be on this parcel of land? 3 21 Has this property been split? no (Property Statement shows Property History) 21 Private Sewage System (Septic Tanks) $ 400.00 ❑ 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 2d Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) Y \.S1+i(i�1 u/farms/checklists/checkiistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: Wisconsin Department ofSafety and Professional Services Division of Industry Services 4822 Madison Yards Way Madison, WI 53705 September 23, 2025 CUST ID NO.: 654921 KEITH C WILEY 191 WILDWOOD DR ESKO, MINNESOTA 55733 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES:9/23/27 MUNICIPALITY: TOWN OF BARNES BAYFIELD COUNTY SITE: CROSSWINDS RESORT 1805 LAKESIDE DR BARNES, WI 54873 FOR: Design Wastewater Flow Value: 585 Limiting Factor(s): 96" Maintenance Required: Effluent Filter Phone:608-266-2112 Web: http://dsps.wi.goy D. ,< Email: dspsvisconsin.aov ps Tony Evers, Governor s� Dan Hereth, ��- Secretary Identification Numbers Plan Review No.: PWTS-092502244-C Application No.: DIS-092538513 Site ID No.: SIT -150759 Please refer to all identification numbers in each correspondence with the Department. Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE In -Ground Soil Absorption Component Manual - Version 2.1 (May 2022-2027) SITE REOU REMENTS • 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: • If using the existing septic tank, it must be inspected for watertightness and structural soundness, size and baffles, and must be brought into conformance with the requirements of ch. SPS 383, Wis. Adm. Code. • 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. • 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 of o . periodic cleaning of the filter is required. OCT 0 3 Z0Z6 OWNER RESPONSIBILITIES fi-,iro. • The current owner, and each subsequent owner, shall receive a copy of this letter including instructi1 ni se and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual an or owner's manual for the POWTS described in this approval and Wis. Admin. Code § SPS 383.54(1). • 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 10 1.12(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. Inquiries concerning this correspondence may be made to me at the contact information listed below, or at the address on this letterhead. Sincerely, Fee Required: $500.00 Fee Received: $500.00 CJoa4uta ,tJ, Balance Due: $0.00 Refund Expected: $0.00 Joshua Rowley Division of Industry Services Phone: Email: joshua.rowley(a)wisconsin.gov OCT 03 Bay�ieltl co.ri planntnO and "Lor;" .:. 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) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross -Section & Plan View Pg 4 of 4 Management Plan Attachments: I Enclosures: Copy of DNR variance app POWTS Application for Review Project Overview Soil Evaluation Report & Site Map Project Name / Description Crosswinds Resort (Don Bergquist) 3 2 -bedroom cabins Owner Name(s): Donn &Lydelle Bergquist Phone: 218 -428 - 6983 Owner Address: 6988 S Cleveland Rd Zip: 54849 Project Address: 1805 Lakeside Dr Govt. Lot: 1/4 of _j/4, Section 07 , T44 N -R 09 E ❑ or W ❑✓ Township: Barnes County: Bayfield Project Parcel ID #: 04-004-2-44-09-07-4 00-118-50000 Designer Information Designer Name: Keith Wiley Designer Address: 11623 E Larson Dr E-mail: coyotesepticworks@gmail.com License Number: D2388PSS Remarks: �,.• CONS/''"% KEPI H Wtt'Sy D23S8PSS Si�a°u Original signature required on each sub tt besi CE(VED Phone:218 -451 -2611 Zip: 54849 'I Ita "p;t:c reservrd for approval stamp. Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Date: 9/4/2025 OCT 032025 Gayfield Co. Planninn nn" North Bergquist (6 tourist rooms) Gravity In -Ground Plot Plan Scale 1:30 € Bench Mark = Top of well Elev = 100.0' NOTES: - All vent, observation & conveyance pipes ® Ejector pit (Not part of POWTS app.) 4" ASTM D1785 or code equivalent - Property lines not shown > 50' from system area - Middle Eau Claire Lake Elev N 71' s.n r„ c C.3 Page 2 of 4 IN -GROUND GRAVITY DISPERSAL AREA Stepped Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER TYPICAL TRENCH CROSS SECTION VIEW (No Scale) min. 12' (typical) 12' min.lranch j _________ tla.In (typical) p `. (typical) .. Highest Trench Septic Tank(s) Manufacturer Wieser Septic Tank(s) Volume(s): 840 gat 500 gal gal gal Effluent Filter Manufacturer: Polvlok Effluent Filter Model #: 525 Provide minimum 3 ft separation between trenches. Lowest Trench (as applicable) System Elevations = 94 ft; 94 ft; 92 ft; 92 ft; Quick4 Standard -W w/ End Cap (typical) (Show location of inlet / outlet pipe connection on plan view.) r--------------------�----- -------------;�-------T�--- g= 34 ft (typical) INSTALL PER TRENCH: 8 Quick4 Std -W @ 20 ft' EISA/chamber = 160 ft' + 4 Pairs of end caps @ 6 ft' EISA/pair = 24 ft' ft Observation Pipe (typical) Install per manufacturers / Instructions. TYPICAL TRENCH PLAN VIEW (No Scale) IA = 3.0 It (typical) Quick4 Standard -W Chamber (typical) (mfd by Infiltrator Systems. Inc.) Install pursuant to manufacturer's Instructions. = Proposed EISA per trench = 166 ft' Required Infiltration Area = 8357 ft' Distribution Method: x 4 trenches = Proposed Total EISA = 664 ft2 branched manifold C) m W 0 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page4_o1 of 4 FILE INFORMATION Owner Donn & Lydelle Bergquist Permit # nFCI[:IU QARARAFTFRC Number of Bedrooms ® NA Number of Public Facility Units 6 O NA Estimated (average) flow 360 gal/day Design (peak) flow = (Estimated x 1.5) 540 gal/day In Situ Soil Application Rate 0.7 gaVda /ftz Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) ≤30 mg/L Biochemical Oxygen Demand (BODs) ≤220 mg/L O NA Total Suspended Solids (TSS) ≤150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOOS) ≤30 mg/L Total Suspended Solids (TSS) ≤30 mg/L I NA Fecal Coliform (geometric mean) ≤104 cfu/100m1 Maximum Effluent Particle Size 'rs in dia. O NA Other: ® NA -Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDIIt_E SYSTEM SPECIFICATIONS Tank Manufacturer Wieser O NA l Septic O Dose O Holding vol. 840/500 gal Tank Manufacturer ® NA ❑ Septic O Dose O 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 Service Event Service Frequency Inspect condition of tank(s) At least once every: O onth(s) ears (Maximum 3 years) 3 month(s)year(s) ® O NA Pump out contents of tank(s) ® When combined sludge and scum equals one-third ('l) of tank volume O When the high water alarm is activated O NA Inspect dispersal cell(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ® year(s) O NA Clean effluent filter At least once every: 3 ❑ year(s) ) ® O NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) O year(s) ® NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) ® NA Other: At least once every: O month(s} O year(s) ® 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 (%) 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. R� E fl Page 4 of 4 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solventsr other chemicals that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed 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. 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. ❑ 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 AJoj4Luj4 - Name 4 SI Wca4 Phone 7/5—/7 -- Phone `E,77/ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name & Name Bayfield County Zoning Phone QQg._. — 2 t 1 Phone 715-373-6138 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies in corsp1l2nce wtth slater Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. OCT 0 32025 saylield Co. P!arn;ing ^i_'� �r.� Aoegcy ffl- pp1 doi o JS Private Sewage System Maintenance Agreement Owner(s) Name Mailing Site Address v /5 fed OI\ Priaiig, L41 Tax ID # ��j-00,A-2•-�y-'oy-in--90# )), -'J"®dOC3 As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil tester's report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established in the WI Adm. Code, as from time to time amended. (COMPLETE Legal Is required) 1/4 of 1/4 Section _Township N. Range W. Additional Legal Description: Ti!O r m S Town of______________________ (Acreage) • Gov't Lot Lot Block Subdivision Lot CSM # Vol. Page CSM Doc # DOCUMENT NUMBER 20258-609501 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 1O/O7/2O25 AT 1:44 PM RECORDING FEE: $30.00 PAGES: 2 Recording Area Return To: g� E C!IVED Planning and ZoningDepartment !L uT 0 8 2025 84y%ld Co. In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ Other Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. Pump Chamber'(system types B, C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds, At-c;rade. and (n -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 specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as 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 b fore me on this date: )6A// t'.LL -7 Nota ed Owner(s) — Signature(s) Notary Publi JOSEPH C EATON Ml______ My Commission Expires:NOtatf Public e State of Wiswnsiii Drafted by: Date: /o —7- Proofed by: ufforms/sanitary/septicmaintenceagreement Revised July 2020 STATE BAR OF WISCONSIN FORM I - 1999 WARRANTY DEED Document Number This Deed, made between Kevin A. Murphy, Grantor, and Donn Berepuist and Lydelle Bereguist, husband and wife, as survivorship marital property Grantees. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in Bayfleld County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): Parcel Three (3) in Assessor's Plat of Government Lot One (1), Section Seven(7), Township Forty-four (44) North, Range Nine (9) West, Bayfleld County, Wisconsin, EXCEPTING therefrom all that portion of the above lands lying North of Town Highway known as Lake Road as now located. Recording Area PATRICIA A OLSON BAYFIELD COUNTY, III REGISTER OF DEEDS 2013R-550345 07/05/2013 09:15AM TF EXEI(PT I: RECORDINC FEE: 30.00 TRANSFER FEE: 97500 RECEIVE® PAGES: I OCT 062025 Bayfield Co. Planning and Zoning Agency Name and Return Address Pioneer Abstract & Title Together with all appurtenant rights, title and interests. 004-1236-07 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Easements, Restrictions, Reservations of record. Dated: June 28, 2013 + K rphy AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. DOUGLAS County ) authenticated this day of Personally came before me this 28th day of June 2013 the above named Kevin A. Murphy TITLE: MEMBER STATE BAR OF WIS I DBERG (If not, NOTARY PUBLIC NOTARY to me known to be the person(s) who executed the foregoing authorized by §706.06, Wis. SteeATE OF WISCONSIN'' ent and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY B. Edberz " Bar Edber Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) April 13, 2014 , .) • Names arpersons signing in any capacity must be typed or printed below their signature. Inforn=ion Professionals Co., Fond du Lac. W1 STATE BAR OF WISCONSIN 800455-2021 WARRANTY DEED FORM No. 1- 1999 V1,1D P4'20 BAYFIELD COUNTY SANITARY PERMIT (#04)-25-143S STATE SANITARY PERMIT OWNER: DONN & LYDELLE BERGQUIST GOVT LOT: LOT: BLK: 1/4 1/4 SEC: 7, T 44 N, R 9 W TOWNSHIP: Barnes SOIL TEST: 129-25 REPLACEMENT SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: MATTHEW HAASIS TRACY POOLER DATE: 10/15/2025 Authorized Issuing Officer CHAPTER 145.135(2) WISCONSIN STATUTES a. The purpose of the sanitary permit Is to allow Installation of the private sewage system described in the permit. b. The approval of the sanitary permit is based on regulations in force on the date of approval. c. The sanitary permit Is valid and may be renewed for specified period. d. Changed regulations will not impair the validity of a sanitary permit. e. Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. f. The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. PREVIOUS PERMIT #: LICENSE: # 947326 Condition: Get required land use permit and other county permits for shower house conversion to a cabin. Adhere to state permit requirements. Properly Maintain System Per Recorded Agreement. Old System needs to be properly abandoned per SPS 383. THIS PERMIT EXPIRES 10/15/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION