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HomeMy WebLinkAbout25-149SPrr.Fivrn SS_o%�6y arm°'f r = anti th Department of Safety Cn"ty DJAYF/ELp OCT 01 2025 & Professional Servic S, >,, / Indushy Services Divis Sanitary PerroitNumber(m be filled in by Co.) 4 Bayfield Co. '3gras. Planning and Zoning Agency y/ I a '— 1 9 5 Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note; Application forms for state-owned POWTS ate submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Slats. I. Application Information —Please Print An Infornwtion 377d (qKE Rd. Property Owner's Name Parcel # '7 ys iC33o[f!!iE T o%oq,IY'/o 9c9/osco y4, coo Property Ow'ner's Mailing Address Property Location 7597 r. /0. Me 9 Gore L,r City, State Zip Code Phone Number 'CLFAX .r I59734 ¼,_¼, , Section II. Type ofBuilding(c eck all that apply) - - - Lot# T `%y N Q R Ikil or 2 Family Dwelling —Number ofBedt000ss 7 Subdivision Name ❑ Public/Commeroial—Describe UseBlock# 0 Cityof ❑ State Owned —Describe Use CSM Number 0 Village of Town of ,94,f✓£5 M. Type of POWTS Permit (Check either "New" or "Replacement" and other applicable on line A. Check one box on-line B. Complete line CII applicable.) A. New System ❑ Replacement System ❑ Other Modification to Existing System (explain) El Additional Pretreatment Unit (explain) B. ❑ Hot dinTank g Win -Ground ❑ At -Grade I ❑ Mound 0 Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer m New Owner st Previous Permit Number and Date issued Expiration IV. DispersalfFreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sl) Dispersal Area Required (st) Dispersal Area Proposed (si) System Elevation Gdo .7 ss8 9oo _ Capacityin Tote) I #of Manufacturer Tank Information Gallons Gallons Units a e New Tanks Existing Tasks a rm 2E T U m r) a Septieor4ioidixg}'tmk C250 _ Dosing Chamber J /?fo �t%IESE.( Co,Je.r, El V. Responsibility Statement- I, the undersigned, a avdbllity for inetaaatIon ofthe POWTS shown on the attached plans, Plumber's Name (Print) Pltmsb Signature MPA1fltRt3iumber I Business Phone Number ENT oKE 9 7!S 9da yrsi Plumber's Address (Street, City, Stale, Zip Code) An £6 /o L 4fl4s CJI 5V730 VI.County/Department.use Only Approved ❑ Disapproved Permit Fee Date Issued h issuing S ' Erma ❑ Owner Given �— Reason for Denial ( drj IOC/(23J/3 Conditions of Approval/Reasons for Disapproval ` wl-erc-s��wl,�1 Attach to complete pins for the system end submit to theCannty only" '- . . Paper as aae mill SBD-6398 (R. 03/22) • SC!! TEST _ �cnnr,►rF 1 1 A f Jjr WisconsinDepMmeeofSafety&ProfessionaIServices D Page 1 of Division of in es o$- .• f MAY "� :� ��[� SOIL EVALUATION REPO In accordance with SPS 385, Wis. Adm. Code CO. Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. 0 - 2-' q- pq° 6q-105 -o 1- LoODOO Please print all information. Revi w b / / Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). G� i /�?3T/ 3 I /lam/'t Property Owner ] tProperty Location v� ❑ Obb) l 3) "Mt,I `��r Govt. Lot '/. Y S 9 T LI N R .L (or) Property Owner's Mailing Address Site Address or CSM and Lot #: -� i0 ���� �� N7c9-7 StA+e £110 City, State, Zip Phone Number ❑ City 0 Village Town I Nearest Road s(`I New Construction Use: Residential / Numberof bedrooms �-' _ Code derived designflow rate %y GPD ❑ Replacement L ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material 0t44u��S1�. General comments and recommendations: `. �' U 1 • 7 Boring # oring / 5 S Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Anolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 O - 75YO/. 2. `5 �- /Ytt)F/Z $ 3lyl 2 -23 7.Y,23/'-1' 5 �- !KV F S 3i. 1 3 -2.�- 5'Yrt�f to 5 c� 1 c� S ZF J. H -5 i5YL - S c� ryjj.. IV D o 'eifr l r -/)rDl.jAJ 4 Boring.# ,odng te` Pit Ground surface elev.9S 8� ft. Depth to limiting factor in. / elev._* ft. Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 1 '- -7 7g � - 1.6 mvfX- AS /3'- . /4 2 7-20 7S3/g �-' _ M /L tS 3/YL . /.l� 2 2O-41 7.`sr'YYL/ / - S �3 IY1L S 2L/ . C '�% BOO > 30 5 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L 715-4 -6 42 SBD-8330 (R03/22) P1 460 5421 5 i AS 3j Boring # 'tBoring d r ❑ Pit Ground surface elev. ft. Page L of j ((�� ((�� IP ._L....Dej toLitlMg EctIr iA it Iev._ft. �1111 MAY i3C/: U Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Cr. Sz. Sh. ConsistA�i1 k iadZ§1nl a� pL GPD/Ft2 'Eff#1 'Eff#2 I o -S ?_Srx21 d LS 2 2y -yg7,/,1 - 15 3 Z -58 g $ ❑ ❑ Boring Boring # ❑ Pit Ground surface elev. R. Depth to limiting factor in. I elev. ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' 'Etr#1 'Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Soil Anolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPD/Ft' Eff#1 Eff#2 * Effluent #1 = BOD > 30:5 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 = BOD. £ 30 mg/L and TSS ≤ 30 mg/L �ztc /N (') a,' l [r%'+ Ex 7% �e r CST -Joey Kmd rman CStRd5Fa101CeekWl 5�0�33 Gus 54742 !Z 71545 0-654 a o rt�v RECEIVED J I LUL3 OCT 01 2025 Id Co. Bayfield Co. Planning and Zoning Agency Planning and ZoningA9engy Page' of 6 Private Onsite Wastewater Treatment System Index and Title Page ProjectNamc: - BaoaiE T /`fltcc,c - y /✓�*. /nJ6naua0 /O4/ri ?'cu) Owner's Name: It e " Owner's Address: /175,7 Sr. Rv Y6 COLFAX, L)I 59730 Legal Description: St. - % 9YN ? 4) Municipality: Town, Village, City of ,Q9,W6s County: r6Ayfi_t_ Lot Number: Block Number: CSM Number: Subdivision Name: 3776 'ACE A'. Parcel I.D. Number: O900'/?Yyd po 9/a56oq6oao Page I Index and Title Page Page 2 Plot Plan with Cross -Section & Plan View Page 3 Septic Tank Specifications Page 4 POWTS Owner's Manual & Management Plan Page 5 POWTS Owner's Manual & Management Plan Page 6 Filter Information Name of Designer. KE s axr License #: n-ppgigg Signature: Date: 'E" Jo; "in -ground SoilvAbsorption Component Manual for POWTS" Version 2.1 Attachment: Soil Evaluation Report 5 corn t /36641[ Jo fi2LC(A- .3770 LAKE R4. PTOT. PLAN pp 19 yy�,�oL94J r6F /JA.c.Jrs, /IAYF/(ca a. W o lui L� 41/ESrt o o g £LtcA .E a /Ad,'osr0 SLAB -A 4AA f -n.. a� /'SC �—� To AC AHrevr6 6/44' l A/CE IT ZgYa acaaE' �AsK f' /D b n I -. o.rAEf y® .vpj4 IA 5,1 1 Qs (4floc 1145' 3o3Y IF (3f Er. L1(LL Po h6 ff,gA.JAa.rrO It 97.4 I \ 4Jf5 `V a3 3 q4.o .S EL. 95.,? qs.5 L)ooO5 ,QMJE �/ oArL R0. r 3710 L AK( 4//_ '/o ;' • L1= firs, 2.7 ALtE gar 4LL 535 ,383. y3 SEr4 4X5 NET LN (JCur IAPS(3) ��pp5L3� ,,2q11 § >/7"/a4 dcc3 /iALIUILL n/ (k- y",( I S.EL. 3I 3 3' I S 3 ` 5. EL. 1 (4655- SEcrmd CdG S(ALe) air EEFLOW /7435' ,6u.4 A(s ($ bu.JACEs X Sa.o 9r"= 9c1io iTO-orAL) fit/ J. A E4oct (n r `oa ; Jr 95S -r' 1'1449. /,J 5 r4Lcq. OEA1a' 9G Y9 /fiz4,j ctAAF 1 , 1 o 3' ,o/.3SE Av4.A'l 1(3) S` •o a Oewr //PEs`3) 15I coilI o 3 f /i /!E(J 4O S(ALE) 'a, 0 0 0 W0 N o W O N t1A U m rn Lt a 9 ¢ a w i n3' TOP VIEW in 2" I a M SIDE \AEW 4"' CAST -A -SEAL TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS WLP1250—M R TANK SPECIFICATIONS DIMENSIONS: WALL 2 1/2" BOTTOM: SEPTIC 3" COVER: 5" MANHOLE: 24' I.D. PRECAST CONCRETE RISER HEIGHT: 52 1/2" O.D. LENGTH: 120 1/4' O.D. WIDTH: 84" O.D. BELOW INLET: 41" O.D. LIQUID LEVEL• 36" WEIGHT: 8,810 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 34.81 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,323 GALLONS LOADING DESIGN: 8' 0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WESER CONCRETE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: RECEIVED OCT 012025 sayfieldco. Page Of Planning and ?eying Agency POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION Owner SCaTY flian Permit # DESIGN PARAMETERS Number of Bedrooms Number of Commercial Units Estimated flow (Ave) (100 gpd/bedmom) Yoa gpd Design flow (DWF) = estimated x 1-5'co gpd Soil Application Rate % d/fl2 Influent/Effluent Quality (O NA) Monthly Average Fats. Oil & Grease (FOG) ≤30 mg/L Biochemical Oxygen Demand (BOD,$) ≤220 mg/L Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality ($' NA) Monthly Average Biochemical Oxygen Demand (GODS) 530 mg/L Total Suspended Solids (TSS) 530 mg/L Fecal Coliform (geometric mean) ≤ 10 cfu/100mL Maximum Effluent Particle Size 1/8 inch diameter Dispersal Unit MfgJModel Number: Elf[ ) 11d3N d'a j4LEs O NA Calculations: Soil Dispersal End Cap (Dispersal Unit EISA) DWF — Application Rate = Area Required - EISA — or (Trench Width) = # Units or Total Length of Trench(s) 1006 _ % _ g5s SO. d Fr 2 = /8 /Suoete5 SYSTEM Septic Tank Ca aci gal O N Septic Tank Manufacturer /Esec ..ct.ON Effluent Filter Manufacturer OQ£d as e ❑ NA Effluent Filter Model tie I ,7 - /y6 0 N44 Pump Tank Ca aci al WNA Pump Tank Manufacturer O N Pump Manulitctvrer O NA Pump Model O NA Pretreatment Unit NA) O Sand/Gravel Filter O PeatFilter O Mechanical Aeration ❑ Wetland O Disinfection O Other. Manufacturer Model: Soil Absorption Component (0 NA) I, 'In -ground (gravity) O In -g mund(pressurized) Cl At -grade O Mound O Drip -line 0 Otter; Vertical Distance TankBottomtoServicePad: ft Horizontal Distance Tanks to Service Pad: ft --• �•••r�••=•+•+•'u••u•+s•aan.m'a- ieessure or tiravrty. Version 3.0 (May 2022-2027) "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems." Publication 9.6 (SSWMP Manual) O,("EZ Flow Mound Component Manual" Version 12/15/2017 (April 2018-2023) '"In -Ground Soil Absorption Component Manual for POWTS" Version2.1 (May2022-2027) O "Mound Component Manual for POWTS" Version 2.1 (May 2022-2027) O "Pressure Distribution Component Manual for POWTS?' Version 2.1 (May 2022-2027) O Other. 1Y1f11r11S,tJMN1,L 1VIIJIVrrl lRIIVt SCH1I' lrn F arr AW I'I2 t1A flirt. •flTfl an ---- ----� Service Event .: halts lvi LIflsr.Lflt.i 1 Service Frequency LP/inspect dispersal cells), clean filter At least once every: 13 months 3 years 0 Other: Inspect pump & pump controls, alarm, pretreatment unit At least once ev : O months Cl 3 years N NA Flush and pressure test laterals At least once every: O months O3 years NA START UP AND OPERATION: For new construction, prior to using the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the 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 startupshallnotoccur when soil conditions are frozen at the infiltrative surface. The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water -saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treauneut devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however, the disposal of food based greases, oils, vegetable/fruit peels, seeds, bones, and food solids, suchas those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non -biodegradable items, such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs, should not enter the system. Chemicals, such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents,etc., shouldnot be flushed intothesystem l>e sethey canseriously damage yourPOWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction ofsnowoverthe dispersal unitmay cause it to freeze up. RECEIVED OCT 01 2025 Bayfield Co. Planning and Zoning Agency Page _1° G . INSPECTIONS & MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer, or Septage Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and check for any backup or pending of effluent to the ground surface and test an electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks. When the combination of sludge and scum in any tank exceeds one-third (1/3) 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 Ch. NR 113, Wisconsin Admin. Code. Specific servicing mechanics must be provided if vertical is>15 feet or if horizontal is>150 feet and instructions to be provided below. The outletfilter(s) shall be inspected and cleaned to remove any accumulated solids according to manufactureesspecifications. Solids washed from the filter shall be retained in the tank Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keepthesystemoperating. Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service P OWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. ABANDONMENT: When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. SPS 383.33, Wisconsin Admin. Code: eAll 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 other 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 oQ4e 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 renders it unusable. Replacement systems must comply with the rules in effect at the time of replacement. 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. O The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. O Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructionsofsuch systems mustcomplywiththerules in effect atthattime. WAS SEPTIC, PUMP, AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN, DO NOT ENTER A SEPTIC, PUMP, OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAYRESULT.RESCUE OFAPERSON FROM THE INTERIOR OFATANKMAyBEDIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS: POWTS INSTALLER POWTS MAiNT AflJt Name: T ,,c(- N- 221/?? Name: f Phone: /i luro�Si,1G i/c JLI 5/SS [one; 7/5 ca- y/ S SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name: Ntlme: AY/i&4 Lo. Phone Phone: 7/5 373-,/3R RECEIVED OCT 0 1 2025 /G.Gsit,4 Bayfield Co. Planning and Zoning Agency _..__,, Maintenance Instructions Biotube® Effluent filter flow to Clean Your Effluent Filter To ensure your efguentfiher is functioning properly, it should be inspected every year. Under normal conditions, your clogged enough will function for several years before cleaning is necessary. The filter should be cleaned when it becomes clogged to restrict normal flows out of the septic tank At a minimum, the filter should be cleaned whenever the tank is pumped. Most people prefer to have a septic tank service providertake care of filtermaintenance and cleaning. You can find a septic tank service provider in the Yellow pages, under 'Septic Tanks & Systems.' Or you can contact your county health deparnnentfora list If you wish to inspect and/or clean your eiifuentfiheryourself, be sure to dress properly. Wear full-length pants and shirt, shoes, gloves, end goggles or glasses Then follow these instructions - 1. Remove the access lid to your septic tank by unscrew- ing the stainless steel lid bollswith hex head wrench provided. If your lid is above ground, itwiil be easy to find. If it is buried below ground, find the merkerthat indicates its location. 2 Remove the filter cartridge by grasping the tee handle and lifting it out of its housing (see photo f( 3. Spray the cartridge tubes with a hose to remove any material sticking to them (see photo 2/. Ensure the three orifices in the optional flow modulation plate inside the filter are clear of any debris. Make sure the rinse water runs back into the tank, but do not allow solids material to fall into the open filter housing. 4_ Irmly place the cartridge back into the housing. 5. Some efguentfitiOn; come with an alarm that activates when the filter needs cleaning. If you have an alarm, check to make sure it is waiting by lifting the float with a stick An audible horn should sound. The alarm panel is normally mounted an the side of the house or in the garage, Note: If your offueutfilter doesn'thave an alarm system and you would like one, call your local septic system installer. 6. Record the data that you inspected and/or cleaned yourfilter on the formthatfollows. If you checked the alarm or made.any other observations aboutthe tank orsysiem, Includethatinfomtation under°Notes° 7- Attach access lid byplacing it anthe riser matching the openings in the lid with the bolt catches. Insert lid bolts into catches and tighten with hex head wrench provided ,. neu,uve me Hirer CoWdge bylifting it out of its housing. room 4 *mYthe cartridge tubes with a hose. mN-FriFr ae°.z27 P-0so14r4 `V Bayfield County, WI w r= • > N U c TfihIDi0 DAVID P 5AN0A Tai IDR 1.754 t � . Q W y0� 3. l'SXNRffAKM&TERMF.REDEIXON1rR!JSUH ti h W x Pt' 9/25/2025, 4:41:45 PM 1:1,566 Override 1 -- Government Lot Recorded Map Existing 0 0.02 0.04 0.07 ni II Rivers =Municipal Boundary Comer 7e Sheets New 0 0.03 0.06 0.12 km Lakes All Roads U Section Corner Monument on File Unknown Meander Lines e. Town Building Footprint 2009-2015 _ Driveways Ba tl Approximate Parcel Boundary Survey Maps Ma p Changed • guiltlin s g Section Unes UnRecortled Map Demolished Boyrie]d Couay Lund Records Oepmmem hiup:Jrmaosw.,.," roomy e^.aomeoy4onWAF/ Private Sewage System Maintenance Agreement - u It' As owner, I (we) do hereby certify the private sewage system win De mswneu ill 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 opera(!(e�in such a manner as to meet the designed plans. I (we) agree to maintain said -- - private sysIbeelow listed location in accordance with rules established in the WI Adm. Code, as from area no timeamended.. (COMPLETE Legal Is required)Q( 1/4 of 1/4 Section \ Township _\�N. Range \ W. Additional Legal Description: b -.S- 0,6.-. c Town of (Acreage) Govt Lot Lot Block Subdivision Lot _ CSM # Vol._.Page__, Page _ CSM Doc # DOCUMENT NUMBER 2025R-609784 CZV.S-C DANIEL.. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 10/30/2025 AT 1:30 PM RECORDING FEE: $30.00 PAGES: 2 Return To: Planning and Zoning Department In -ground gravity ❑ In -ground dosed ❑ in -ground pressure distribution Sewage System; 0 Mound ❑ At -grade Sewage System 0 Other Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator wmmm three tat years ul ule ua.e 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 (113) 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. POWfs 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 -wade and In -ground 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 maybe placed on the tax roll as a special assessment forthe abatement of a human health hazard, and the tax shall be collected as pmvi dsylawp„r The arms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such pe 4� , -•r Owner(s) Name(s) — Please Print Subscribed and sworn to before me on this date: OK hb\e Jo \\ems-��,S�L. �7 ° ¢' r �• /o v7/ o2S: Notarized Owner(s)— Signature(s) Notary blic %.,, '• Drafted by: Fx .v Joy\. \\-r Date: \© as X35 RECEIVED z05 Proofed by: u/loans/sanitary/seplcmaintenceagreement Revised July 2020 EXHIBIT "A" Parcel 1: A parcel of land located in the Northwest corner of Government Lot Four (4), Section Nine (9), Township Forty-four (44) North, Range Nine (9) West, more particularly described as follows: Beginning at a point on the West line of Lot 4, 724 feet North of the Southwest corner; thence North on said line 300 feet more or less to the south shore of Mud Lake, now known as Birch Lake, at low waters mark; thence N. 36°32'E. along lake shore to intersect the North line of Lot 4, thence East along the North line 200.3 feet; thence South parallel with the West line of the above described Lot 4, 300 feet; thence southwesterly 476 feet, more or less, to the place of beginning. EXCEPTING THEREFROM, Outlot One (1), Certified Survey Map No. 1220 as recorded in the Office of the Register of Deeds for Bayfield County, on October 29, 2002 in Volume 7 of Certified Survey Maps on Page 316 as Document No. 476726, located in the Town of Barnes, Bayfield County, Wisconsin. Parcel 2: The East 56.73 feet of Government Lot Three (3), Section Nine (9), Township Forty-four (44) North, Range Nine (9) West, parallel with and measured at right angles to the East line of said Government Lot 3, and lying North of Lake Road, Town of Barnes, Bayfield County, Wisconsin. RECEIVED COT 3 "1 ZL:'o Bayfield Co. planning and Zoning Agency Bayfield County Register of Deeds Document # 2022R-595718 Page 2 of 2 F V F I E LD 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: MILLER REVOCABLE TRUST, SCOT M MILLER & BOBBIE JO N7597 STATE RD 40 COLFAX, WI 54730 Description Private Sewage System (Septic Tanks) Submission Number: SS -00664 Transaction Number: SS-00664-35BD8 Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 23446 Paid by: H&H Plumbing, PO Box 10, Colfax WI 54730 Payment Type: Check Transaction Date: 11/3/2025 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-25-149S STATE SANITARY PERMIT OWNER: SCOT M MILLER & BOBBIE JO MILLER REVOCABLE TRUST GOVT LOT: 4 LOT: BLK: 1/4 1/4 SEC: 9, T 44 N, R 9 W TOWNSHIP: Barnes SOIL TEST: 26-25 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: KENT HOKE TRACY POOLER DATE: 11/3/2025 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: # MP 224199 Condition: Properly Maintain System Per Recorded Agreement. Maintain setbacks. Insulate where required. THIS PERMIT EXPIRES 11/3/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION