HomeMy WebLinkAbout25-146SRequest 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@bavfieldcountv.wi.gov
Note
fl Time Change fl Discrepancy fl Other
Phone Number
715- aoq- -7Sa\
Plumber:
/\%cc W�es\c\
Fax Number
Homeowner:
Email Address
Immediate Phone Number So Zoning
Sanitary
Permit#:
S— 1ytS
Dept can call you right back (if needed)
'�15_-oq--ls.a1
l
Plumber's Choice
Zoning Dept
No Inspection(s) during this time
Date:
r I2�
l
o f as
Tuesday (9:30 am - 12:15 pm) (Tracy)
Time:
Plumber's Choice
Z n ept
■
Township:
Address # &
Road Name:
18190 3UO¼tl\\
or
` W� S�g�l
&t\
iP5J�
Directions
To Site:
Comments:
** Plumbers you must verify any change(s) by fax or email **
Notes from Zon
July 2025
WILLIAM T & KAREN M BODIN
78790 BODIN RD
WASHBURN W1 54891 LDING TANK INSPECTION REPORT
GENERAL INFORMATION
Permit Holder's Name
tYacin
I ❑ City ❑ Village giown of
w
partycldgss
Sanitary Permit No.
�S- t' -u0 S
Plan ID No.
Tax Parcel No.
od; ^at able b3
TANK INFORMATION
TYPE
MANUFACTURER/MODEL#
CAPACITY
WEi-
SETBACKS
Property Line 2
Well I0I
Water Service
Building s
All -Weather
Road
I OHWM c�
Swimming Pool
>10
jNf5
j
j>Sa
DEVIATIONS FROM APPROVED PLAN
—P3 devl�� s
fhQ ,
COMMENTS (Persons present, discrepancies, etc.)
i IAV5 Ijee
'-'s\N\1rd C\Dscv
YOacPio,.
t-rbu �} 'Y\ o\a
— Frs�" 1�\ tt`
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—IrSOli~
vvw ;F^ lntaScz
-SGhd k Q(F
N'"s t'>\ed , vevk car .or
4
I ev()'v�a- Sc>- a
sc tJ�
COMPONENTS NOT INSPECTED
Plan Revlshin Required
❑Yes No
I Dat :
t0"��1-�5
Signature of Inspector:
Cert. Number
3i-"�_
Jjcetcn on Omer side
10 of 13
DAYFIELD COUNTY PLANNING & ZONING DEPARTMENT
Telephone: (715) 373-6138 Bayfield County Courthouse
Fax: (715) 373-0114 Post Office Box 58
e-mail: zonino(o)bavfieldcounri wi.clov 117 East Fifth Street
-- - - Web Site: www.bayfieldcounty.wi.00v/147 Washburn, WI 54891
Property Owner _
WILLIAM T & KAREN M BODIN
Information _ 78790 BODIN RD
WASHBURN W154891
As you know was contracted by you to install a private
onsite wastewater treatment system on your property described as:
Notes:
Abandonment of Old System to meet all applicable code requirements:
® t c
Tank was pumped by: )> (L h " Vr� on I o A /s at A PM
Tank was crushed I removed and pipes disconnected by:
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.
fl 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:
Uttarmslsanitarypropedyowner-input
April2019
•�w����'t�I
Department of Safety
& Professional Services,
County n
t&
Sanitary Permit Number (to be filled in by Co.)
5 S 6 r7 1
Industry Services DivisJeir
Sanitary Permit Application 0
State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmen 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), Slats.
L Application Information —Please Print All Information
Property Owner's Name
\J1\\o+kONN Bcat
Parcel #
1
Property Owner's Mailing Address
Property Location
—78190 (C)\\N -
Govt Lot
'/, '/,
ciState
ZipCode
Phhone Number
WU
�7 0
`'' ^ 15 — O "7o 5S
Section o_
T N R E orQ
IL Type of Building check all that apply)
Lot #
1 or 2 Family Dwelling —Number ofBedrooms
Subdivision Name
Block#
D Public/Commercial — Describe Use
D City of
❑ State Owned— Describe Use
0 Village of
CSM Number
Town of VU1QLJ
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 'f
a licable.
A.
❑ New System
Replacement System
❑ Other Modification to Existing System (explain)
❑ Additional Pretreatment Unit (explain)
B.
,Holding Tank
❑ In -Ground
❑ At -Grade
I 0 Mound
❑ Individual Site Design
I ❑ Other Type (explain)
(conventional)
C.
❑ Renewal Before
0 Revision
❑ Change of Plumber
❑ Transfer to New Owner
List Previous Permit Number and Date Issued
Expiration
I
IV. Dis ersal/Treatment
_________________ _________________________________
Area and Tank Information:
Design Flow (gpd)
Design Soil Application Rate(gpd/sf)
Dispersal Area Required (sf)
Dispersal Area Proposed (st)
System Elevation
Tank Information
Capacity in
Gallons
Total
Gallons
# of
Units
Manufacturer
,
New Tanks I
Existing Tanks
A4
ri,
it. C7
Septic or Holding Tank
1 ! DOO
,n O
ll'
x.
Dosing Chamber
I
_
______
_____________
___
______ _________________________ _____ _____
V. Responsibility Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans.
Plumber's Name (Print)
I Plumber's
MP/MPRS Number
I Business Phone Number
Hwc-oq-s
/'c\rcAG\ Lo&ic
-C)
ii
Plumber's Address (Street, City, State, Zip Code)
LouJL i-v 1)uv C ijaskA1 5Z//
L County/DDepa : ent Use O ly
Approved
0 Disapproved
Permit Fee
I Date Issued,7
Issui A Si
0 Owner Given Reason for Denial
Conditions of Approval/Reasons for Disapproval
RECEIVED
OCT 14 2025
.
Bayfield Co.
Planning and Zoning Agency
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size
SBD-6398 (IL 03/22)
CONCRETE HOLDING TANK DESIGN
Two Concrete Tank Option
INDEX AND TITLE SHEET
Project William & Karen Bodin - Holding Tank
Owner William & Karen Bodin
Address 78790 Bodin Rd
Washburn, WI 54891
Phone: (715) 607-0194
Legal Description Par in tot 1 & N 2S of S150' of lot 1. S21, T49N, R04W
Township Bayview County Bayfield
Subdivision Name Lot No.
Parcel ID Number 6533
Plan Transaction Number
Index and title sheet
Page 1
Holding tank specifications
Page 2
Site plan
Page 3
Management & Continency Plan
Page 4
Soil Test
Page 5
Soil Test Plot Plan
Page 6
Holding Tank Agreement
Page 7
Holding Tank Servicing Contract
Page 8
Holding Tank Specifications
Page 9
Designer Michaal. froblewski
Y
Signature L4Phone No. (715) 209-7521
License Number \ Date 10/09/25
Designed pursuantto
Holding Tank Component Manual For POWTS (Version 2.0)
SBD-10855-P (N. 03(07, R. 01/12)
Version 7.0 (11/12)
RECEIVED
Pagel of 9
OCT 14 2025
Bayfield Co.
Planning and Zoning Agency
HOLDING TANK SPECIFICATIONS
Two Concrete Tanks In Series
3 j If one- or two-family, number of bedrooms
And/Or....Non-residential estimated flow per day
2000.0 IMinimum holding tank volume required
4000.0 Total holding tank capac Dpsed (gal)
2000.0 Tank 1 capacity (gal) L IX for round tanks
2000.0 Tank 2 capacity (gal)
Wieser Concrete Products Inc. Tank manufacturer
SJE hombus Alarm manufacturer
TA AB -01H Alarm model number
1.1
Anchor weight safety factor
Tank
Information
in
Exterior Dimensions (in)
lbs
lbs
in
ft
Li Level Length
Width Height Tank Wt Anchor Wt
Soil Cover
Max Bury
Tank 1
36 it
184
102 56
24827
16921
15.6
13.4 II7
7
Tank 2
36 j
164
96 I 55 II 22230 12166
HOLDING TANK CROSS SECTION
vent Manhole cover with locking device
17' min. cap 4" min. and wanking label Finished grade
Vert pipe 18" min.
Blind plug to seal
outlet opening
120 in
Service alarm on
24.C
2000.0 gal
Tank2
Note: Manhole and
vent locations may
Tether be reversed.
weight Manhole diameter is
23" min.
2000.0 gal
Tank 1
3 in. min. bedding undertanks.
Anchortanks as necessary to negate buoyant forces.
Electrical as per NEC 300 and SPS 316.
Note: All tank joints, and joints between tank openings
and piping are seated watertight.
Inlet
RECEIVED
0CT 14 2025
BayflGkt Co.
panning and Zoning Agency
Project: William & Karen Bodin - Holding Tank
Transaction Number Page 2 of 9
WILLIAM T & KAREN M BODIN
HOLDING TANK PLOT PLAN
78790 BODIN RD
WASHBURN, WI 54891
N
PAR IN LOT1ANDN25'OFS150'OFLOT1
a
IN 2016R-566731 187A
N
O
S21 T49N R04W
>
c
TOWN OF BAYVIEW, WI
= 60'
SCALEV=60'
w
O
NORTH LOT L[NE
131 4 80
SHEET 3 OF 9
HOLDING TANK MANAGEMENT PLAN
This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and
maintained according to SPS 383, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10855-P
03107, R.11i12), and the Bayfield County Sanitary Ordinance.
1. This POWTS is designed to accommodate a wastewater flow of 60.0 ' to 800.0 gpd.
2. The owner of this POWTS Is responsible for system operation and maintenance, including all provisions in
the attached Holding Tank Servicing Contract and Maintenance Agreements.
3. Each time the wastewater in the second tank reaches a level of 12" below the inlet Invert (at which time the
alarm will activate), the pumper listed In the current Servicing Contract must be called to empty the tank's
contents and dispose of them in accordance with NR 113, Wis. Adm. Code.
4. At each service event, the service provider should visually inspect the condition of the tank, risers and
manhole cover(s) and verify that the alarm system functions and manhole locking devices are present.
Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions
shall comply with the county sanitary ordinance and SPS 383 and 384 Wis. Adm. Code.
5. All service events or inspections of this POWTS shall be reported to the county within 30 days.
6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be
removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes
from this holding tank to the ground surface, including intentional discharges and discharges caused by
neglect, constitutes a failing POWTS and may result in Issuance of correction orders or a citation by the
county or state.
7. No one should enter a holding tank for any reason without being In full compliance with OSHA standards for
entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
8. In the event that this POWTS falls and cannot be repaired, a code compliant replacement holding tank may
be installed in the same location (a new sanitary permit is required for such a replacement). Connection to
municipal services would also be considered at this time if they are deemed available to the property.
9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in
accordance with SPS 383.33 Wis. Adm. Code.
10. If there is a problem with, or question about this installation, the following persons should be contacted:
a. Installer ........................... Big Lake Plumbing Phone: (715) 209-7521
b. Service Provider .................Birch Birch Street Excavating & Septic Phone: (71'5) 373-5683
c. County Zoning or Health Dept. Bayfleld County Zoning Phone: (715) 373-6138
11.
Project:
Transaction Number
Page 4 of 9
RECEIVED
OCT 14 2025
Bayfield Co.
Planning and Zoning Agency
Document Number/Plan I.D. No. HOLDING TANK I DOCUMENT NUMBER
AGREEMENT I 242SR-609378
18I0 k6o0\►n > .
�o►s11.b v-�� tai 5ysa
Aareement Date (same as Notary Date)
6s�3 I
We acknowledge that application is being made for the installation of (a) holding tank(t
on the following property or that continued use of the existing premises requires that a
holding tank be installed on the property for the purpose of proper containment of
sewage. Also, the property cannot now be served by a municipal sewer, or any other
type of private onsite wastewater treatment system as permitted under Ch. SPS 383,
Wis. Adm. Code or Ch. 145, Wis Scats.
1/4 of 1/4 Section ak Township LN. Range W.
Town of '(e1 J aMe i
Additional Legal Descr€ption: �aC't �0k I + ]v �S Q�c s ,so Cc i)
d�
Gov't Lot_ Lot Bloc k___� Subdivision CSM#
Lot CSM #,___ Vol Page = M Doc#
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY, WI
RECORDED
09/26/2025 AT 1:33 PM
RECORDING FEE: $30.00
PAGES: 2
Reti�+M�--
fBIB LAKE
PLM B I
1491 County Highway C
Washburn, WI 54891
As an Inducement to Bayfield County to issue a sanitary permit for a holding tank on the above described property, we agree to do the
following:
1. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tank installation and
maintenance. If the owner falls to have the holding tank properly serviced in response to orders Issued by Bayfield County or the
Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Stats., Bayfield County may enter upon
the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a
special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats.
2. Owner agrees to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and
maintaining the holding tank In such a manner as to prevent or abate any human health hazard caused by the holding tank. 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.
3. The owner agrees to contract with a person who is licensed pursuant to s.281.17 (3) Wis. Scats., and chapter NR 114 Wis. Adm. Code, to
have the holding- tank serviced In accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of the contract with Bayfield County.
The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within
30 days from the date of change to the service contract.
4. The owner agrees to contract with a person licensed pursuant to S. 281.48 (3) Wis. Scats., and Ch. NR 114, Wi's Adm. Code who shall
submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfield County may enter.upon the property to.
investigate the condition of the holding tank when pumping reports and meter readings may Indicate that the holding tank is not being
properly maintained.
5. This agreement will remain in effect only until Bayfield County certifies that the property is served by either a municipal sewer or a private
onsite wastewater treatment system that complies with Ch. SPS 383, WI's Adm. Code. In addition, this agreement may be cancelled by
executing and recording said certification with reference to this agreement in such manner which will permit the existence of the
certification to be determined by reference to the property.
6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this
agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a •manner which will permit the
existence of the agreement to be determined by reference to the property where the holding tank is installed.
Owner(s) Name(s) — Please Print
Subscribed and sworn to before date:
Notarized Owner(s) — Signature(s)
Notary Public _ C
My Commission Expi cn _
I r
Drafted by: ikQ. >� t6n a>.)Sf� i OCT 1 0Z5 Date: T 5
\5
Personal Information you provide maybe used for eeoondary purposes (Privacy Law. s.16.04 (1)(m)] uJtormaJsanttwy1hddingtw kagreemeat doo Mane 2018
Bayfield Co.
Planning and Zoning Agency
EXHIIBIT A
Legal Description
A parcel of land in Government Lot One (1), Section Twenty-one (21), Township Forty-nine (49)
North, Range Four (4) West, described as follows: Beginning at a point that is 1,320 feet South
and 2,053.8 feet East of the Northwest comer of the Northeast 1/4 of said Section 21; said point
being at the East right-of-way line of the public road; thence East, 475 feet, more or less, to the
high water line of Chequamegon Bay, Lake Superior; thence Northwesterly along said high water
line to a point that is 125 feet due North from the line last described; thence West, 475 feet, more
or less, to the East right-of-way line of said public road to the place of beginning;
The North 25 feet of the South 150 feet of Government Lot One (1), Section Twenty-one (21),
Township
Forty-nine (49) North, Range Four (4) West, lying East of the public road;
ALL in the Town of Bayview, Bayfield County, Wisconsin.
RECEIVED
OCT "l 4 2025
Bayfield Co.
Planning and Zoning Agency
.nv�n..� :� .-.�a..vh .we. n.r�ancw+c eRa�.aL •Ga+«x.stirs.•.+•v..waw++rnwm!wwaZM+,'�.».eat-'xn;sra.�r...;::a+v.,•.r�.--.••-anrRrsavP�ewr+a�.werrtnas+Gmsrs'+ss^.*+,e+s=wwl+ r�raac .-. .. .t�{s6:s,6�Y+T?c"!�!!.s n:....n�.+t+�nCMR.'R :T.`•.J✓� •k�;r .;r�/ v
WLP2000-MR
TANK SPECIFICATIONS
C'
a
CD
of n M
INLET
U)
M
3„
164"
4" CAST -A -SEAL
4" CAST
I
-A -SEAL I
I
I (
I
FILTER OR BAFFLE I I ,
I.
TOP VIEW
OUTLET
PUMP PAD
SIDE VIEW
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
DIMENSIONS:
WALL: 3"
BOTTOM: 5"
COVER: 6"
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
HEIGHT: 55" O.D.
LENGTH: 164" O.D.
WIDTH: 96" O.D.
BELOW INLET: 43" O.D.
UQUID LEVEL: 36"
WEIGHT: BOTTOM 14,060 LBS.
COVER 8,170 LBS.
INLET AND OUTLET:
4" CAST -A -SEAL BOOT OR EQUAL
INLET AND OUTLET BAFFLE AND FILTER:
WISCONSIN, SEE ' DETAIL #10
(OTHER STATES SEE CHART)
UQUID CAPACITY: 56.27 GAL/IN
LOADING DESIGN: 8' 0" UNSATURATED SOIL
HOLDING TANK:
OUTLET HOLE PLUGGED
ACTUAL CAPACITY: 2,138 GALLONS
TANK CAN BE USED AS:
SEPTIC/ HOLDING/ PUMP OR SIPHON
COVER: MIX DESIGN #8 (NO FIBER)
TANK: MIX DESIGN #9 (SMALL FIBER)
CUSTOMIZED TANKS:
FOR CUSTOM TANKS CONTACT WIESER CONCRETE
DRAWINGS SUBMITTED
FOR APPROVAL
APPROVED BY:
APPROVAL DATE:
PRODUCTS NEEDED BY:
au..in '
a' .I
SHEET NO.
1V
LOF
1
JV 0/ q 3b RECEIVED
ED
I RVICING CONTRACT
HOLDING TANK SE
SEP 26 202
Contrast Date P.ayfi!:!
This contract is made between the
ioiding Tank Owner(s) Name(s)
I\\\CAX\\ccess \ C,
We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions)
PROJECT LegaplPOfl I >2i
:OCanON I (Use Tax Statement)
Section _._.., ,Township . N, ado W
Gov't Lot I I Lott
Val. Page I CSM Doc #
Na.
_.__ _u4, 114,
Town aft Lot slu acreage
1. The owner agrees to file a copy of this contract with gyfieId County as required in SPS 383.55, Wis. Adm. Code.
2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have
access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain
the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner
further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by
the owner and pumper.
3. The pumper agrees to submit to the local government unit which has signed the pumping agreement required by SPS
383.55, Wis. Adm. Code, and the County, a report for the servicing of the holding tank(s) on a semiannual basis. The
pumper further agrees to include the following In the semiannual report:
a. The name and address of the person responsible for servicing the holding tank;
b. The name o€ the owner of the holding tank;
c. The location of the property on which the holding tank is installed;
d. The sanitary permit number issued for the holding tank;
e. The dates on which the holding tank was serviced;
f. The volumes in gallons of the contents pumped from the holding tank for each servicing;
g. The disposal sites to which the contents from the holding tank were delivered.
4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event o€ a change in this
contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract
with the local government unit and the County named above within (10) business days from the date of change to this
service contract.
Revised: May 2016 (®May 2018) Drafted by /9 Vl%
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (l)(m)]
BAYFIELD COUNTY
CHECKLIST FOR SANITARY APPLICATONS
Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e))
7 Check List
Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.)
Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c))
Original Plot Plan (383.22(2)2. 3. & 4.a)
Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer
❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable)
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)
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)
Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7)
I Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached
to all copies)
Soil 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)
I Application Information must include:$] 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete)
VProject Address or Road Name where driveway is/will come off of) (Owners Phone Number)
II Type of Building
III Type of Permit
IV Type of POWTS System
V Dispersal / Treatment Area Information
VI Tank Information
VII Responsibility Statement (Plumber's Information)
*Date Stamp*
Plot Plan: (To Scale or To Dimension)
Signature and Plumber Information
Surface Elevation of Body of Water
❑ Direction and Percent Land Slope
lX Tank and Filter Information and Location
9 Wetlands / Navigable Bodies of Water
❑ Absorption Area (Proposed and Existing)
0 Bench Mark (Location, Elevation and Description)
Manual Version
RECEIVED
OCT 14 2025
eayf d co.
Planning and Zoning AgencY
Address Number and Road
North Arrow
Contour Lines
j7! Structures and Driveways
Boring Locations
Property Lines
Well Locations
Legal Descriptior
Turn Over ►
Cross -Section and Over -Head Profile of the System:
❑ Surface and System Elevation
❑ 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? i
Has this property been split? -O (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
❑ Private Sewage System Reconnection
$ 50.00
and Private Interceptor
❑ Return Inspection
$ 50.00
❑ Maintenance Agreements +
$ 30.00
(checks made out to Reg of Deeds)
OCT 14 2025
Bayfeid Co.
Planning and Zoning Agency
u/forms/checklists/checklistforsanftaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by:
I Soli Test # jS0--
Bayfield 5
County
Waiver of a Thorough Soil & Site Evaluation
q y� (subject to 15-1-10(d))
EDWARD J WROBLEWSKI a certified soil tester determine that in my professional
judgment the following site (see below) is unsuitable for any treatment component other than holding
f:mks. Due to soil & site conditions, a thorough soil and site evaluation is not needed to make such a
determination.
Property Owner WILLIAM T & KAREN M BODIN
Propery Address 78790 BODIN RD
WASHBURN WI 54891
'.apficna 715-209-7821
Accurate Legal Description is requested:
Contractor EDS MECHANICAL LLC
Authorized Agent EDWARD J WROBLEWSKJ
Agent's Telephone 715-209-4055
Written Authorization Attached: V or
NE 1/4 of NE 1/4 Section 21 Township 49 N. Range 04 W. Town of WASHBURN
Additional Legal Description:_ PAR IN LOT 1 & N 25' OF S 150OF LOT 11N2016 -566731187A ( n5 3 3
Govt. Lot Lot 1 Block Subdivision
Lot CSM# Vol. Page ____ CSM Doc #
/olumme Page of Deeds Tax I.D# 6533
Indicate reasoning for your determination: CLAY SOILS & FRAGMENTED BEDROCK
Acreage__1.O
•3a
RECFJ\'ED Signature of Certified Soil Tester
SEP 262025
2025 Date
Baynela Co.
Planning and ;o.ir,;, Agency
Signal re of County Official
SP -72000013
Certification #
(Submit a Plot Plan & Foe)
u/forms/s oiitestwa iver(KLK)
June 2018
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RECE\ ED
SEP 262025
Q yre U Co.
Pannin9 2rnd : n gAgency
BAYFIELD COUNTY
SANITARY PERMIT (#04)-25-146S
STATE SANITARY PERMIT
OWNER: WILLIAM T & KAREN M BODIN
GOVT LOT: LOT: BLK:
1/4 1/4 SEC: 21, T 49 N, R 4 W
TOWNSHIP: Bayview
SOIL TEST: 130-25
REPLACEMENT SYSTEM
SYSTEM TYPE: Holding Tank
PLUMBER: MICHAEL WROBLEWSKI
TRACY POOLER
Authorized Issuing Officer
DATE: 10/17/2025
CHAPTER 145.135(2) WISCONSIN STATUTES
a. The purpose of the sanitary permit is to allow Installation of the
private sewage system described in the permit.
b. The approval of the sanitary permit is based on regulations in force on
the date of approval.
c. The sanitary permit is valid and may be renewed for specified period.
d. Changed regulations will not impair the validity of a sanitary permit.
e. Renewal of the sanitary permit will be based on regulations in force at
the time renewal Is sought, and that changed regulations may impede
renewal.
f. The sanitary permit is transferable.
History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314
Note: If you wish to renew the permit, or transfer ownership of the
permit, please contact the county authority.
PREVIOUS PERMIT #:
LICENSE: # MP 1288503
Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all-
weather road. Old System needs to be properly abandoned per SPS 383.
THIS PERMIT EXPIRES 10/17/2027
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION