HomeMy WebLinkAbout25-153S^^ INBOUND NOTIFICATION : FAX RECEIVED
SUCCESSFULLY ^^
TIME RECEIVED
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November 18, 2025
at 8:04:24 AM CST 7153724159
37
1
Received
Sep 15 2025 06:13 HP Faxpol!vsld Plumbing 7153724159 page 1
Request for Sanitary Inspection (24 firs. in Advance)
Fax this form to Zoning Dept (24 Hrs,) prior to when you want an Inspection — (715) 373-0114
If you do not have a fax and must email the inspection; you must email all staff members.
Note
fJ Time Change Discrepancy fl Other
/
�FP[umbir: o by �o S
Phone Number
( o f
(
Fax Number
Homeowner:
KQ J l Z, vvt a7n ev anlq
Email Address
Sanitary
�/
C) i -z 5___— S S
Immediate Phone Number So Zoning
Dept can call you right back (if needed)
Permit #:
Plumber's Choice
Zoning Dept
Date:
11_10-zS
Time:
Plumber's Choice
Zoning Dept
,o oa Am
°9
()
Township:
l
Address#8
Road Name:
R �` R / _ f� � Ste✓
i" r �� r '�n �T �
`'('
fay A v.1 `tf 'i 'r� (_(— oy P, `e LkIcl
or
h�. 6DapitLk.tks
Directions
12� 6.v 0. r? Zoos s Tura, 1_f 2-f0 d.• ✓��4�
To Site:
re
Comments:
Plumbers you must verify any change(s) by fax or email
Notes from Zoning Dept:
Iz
u/tormalaankery/requestforinspeclon
Zoning Dept (®4/12/04); - June 2023
Ii
C
Private Ons.ite Wastewater Treatment
KEVIN K ZIMMERMAN is ( POWTS) _ Inspection Report
8500 JENSEN AVE S COTTAGE GROVE MN 55016 (Attach to Permit)
Information
City U Village
setback to:
Town of
County
Sanitary ermlt No:
State Plan'Transaction ID#:
Parcel Tax No:
TYPE
MANUFACTURER
CAPACITY
J Prop. Line
Well
j Building
Air Intake
Road
Se tic
V
N/A
Dosing
N/A
Aeration
N/A
Holdin
Pump / Siphon Information
Pump Manufacturer
Pump Model
Demand
— GPM
Fite �n cfure
FiltejoI
TDH
Lift
Friction Loss
Head
TotaL
Forcemain
Length_
Die _
Dist To Well
Dispersal Cell Information
DIMENSIONS
Wji
L th
of CBS
SETBACK FROM
Pro ..Line
Building
Well
OHWM
TypelofCell
(Q1A�(V
Manufacturer, C-
Model Number.
Pretreatment Unit
Manufacturer.
Model Number:
Elevation Data 66 1 tit
STATION
BS
HI
FS
ELEV
Benchmark
% 0•
1r 0o
Bldg. Sewer
Tank Inlet
Tank Outlet
a
q oS"
Dose Tank Inlet
Dose Tank Bottom
Inst. Contour
Header/ Manifold
,US
Distribution Pipe
Infiltrative Surface
/ c_C
Final Grade
_1
X Pressure
Observation Pipes
❑ Yes ❑ No
son .over
Depth Over Depth Over Depth of Seeded I Sodded Mulched
Cell Center Cell Edoes Toosoil ❑ Yes E7 No 0 Yes ❑ No
COMMENTS: (include code discrepancies, persons present, etc.)
al-In�tl1��5
!o 04k61 \%t6tde d 4Q L0U
It o' rL l FaUt \(ei-
4- pir s
(�clflt( jda Lid\ C44to C A -P /I CA
EnsJullyd (foci/S f cAO(los 6
�Uh t&A-t\1ri-p ca
Ian revision required9nn0`Yes N0 iii
e1 SCI
ae other side for additional information.
Date POWPS Inspectors Sig ture License Number
3RIl471n (P n1/911
Property Owner
Information
As you know
BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT
Telephone: (715) 373-61$8
Fax: (715) 373-0114
e-mail: zonino(ahbavfeldcountv.oro
Web Site: www.bayfieldcounty.orol147
KEVIN K ZIMMERMAN
8500 JENSEN AVE S
COTTAGE GROVE MN 55016
Bayfield County Courthouse
Post Office Box 58
117 East Fifth Street
Washburn, WI 54891
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:
Tank was pumped by:
:• Tank was crushed I removed and pipes disconnected by:
on
at AM/PM
On at (AM I PM) the above -mentioned plumber contacted our office to
cond ct 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.
❑ 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 $50 fee are required.
❑ System could not be inspected because County could not respond to plumber's time constraints.
1 xnc 1VGW1IPC'
Comments: L€11 tyeRic \ ((o eIl(A Y1i45 in S�GI I ?C
Uttcrms/sanitarypropertyowner-input
April 2019
/�vrRTut•yt 1 \ tie. ..
Department of Safety Count c.
& Professional Services, j ` l
NOV 14. 2025 Industry Services.Division Sanitary Permit Number (to be filled in by Co.)
°ftt.�►�¢ Bayn id Co. s2•Ob 6 v t c 5/53 S
J Sanitary ~Permit Application
State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Services. Personal information you provide may be used for secondary _ke-
I.
purposes in accordance with the Privacy Law, s. 1 S.04(I)(m), Stats. Lp le tP O .� cL V TL [ J � Application Information-- Please'Printll A -Information
Property Owner's Name ENTERED Parcel #
Property Owner's Mailing Address Property Location
g SAO O .mot r -e ✓� (� if e S Govt. Lot
City, State ) Zip Code / Phone Number
60 �cc `e. 6-v O V -e_ '"I ≤o I 6' f f- C�'f b 3 2/f '- 0 G '/4, '/,, Section 2Z.
II. Type of Building (check all that apply) Lot # T N R g '
'o
l I or 2 Family Dwelling —Number ofBcdrooms 3 Subdivision Name
i�
Block #jam
O Public/Commercial — Describe Use Y I @ OD
O City of
O State Owned — Describe Use CSM Number 0 Village of
Q1Townof
III. Type of-POWTS 'Permit: (Check'either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if
•a Iicable.
A.
New System 0 Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain)
B' 0 Holding Tank l$ In -Ground 0 At -Grade I ❑ Mound ❑ Individual Site Design 0 Other Type (explain)
(conventional)
C. ❑ Renewal Before 0 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 Ratc(gpd/sf) Dispersal Area Required (at) Dispersal Area Proposed (sfl System Elevation r
3t�d o7 4 4 3z
9'x.0
Capacity in Total # of Manufacturer
Tank Information Gallons Gallons Units iBp� ct
New Tanks Existing Tanks ti Cg t,~ ;�
C
U rn ti
Septic epHaMing Tank
ncsit:g.Casndter 7 Co -- 1sb JLI U) e.s•e. r Cc.
V. Responsibility Statement- Y, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Si re-tFP/MPRS Number Business Phone Number
Ail �� `Fo I Ar
- 22ooq d -7r6- 7,1 Ir6
Plumber's Address (Street, City, State, Zip Code)
S-2 t ' e- 4Z ≤Y'Y7
VI. County/Department Use Only..
Approved O Disapproved Permit Fec Date Issued Iss gent atu /
D Owner Given Reason for Denial73
� '— • 1 !i'a-5 L
Conditions of Approval/Reasons for Disapproval
jeL Q C,f o 17
Attach to comnleto nlane t'nr rim ----. n -.t -..k—t.....t.., n_...,._. __._. __ ___ ___ _.. - .. ........
----- ---- --- ...� ...,....y ..... u.. j..p... slut .csa utnu 0 tK X l ! 111eneS in size
SBD-6398 (R. 03/22)
PAGE 1 OF 4
tOV-1.4.2425
r- • i Co.
a:
Vic;; nr, Agee
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
Pg2of4
Pg3of4
Pg4of4
Attachments:
Index & Cover Sheet
Plot Plan —Soin N\o ()
Dispersal Area Cross -Section & Plan View
Management Plan
Enclosures:
POWTS Application for Review PcOeS
Soil Evaluation Report __ _ _ - aes
Ss� l- Sos,n;�,o�>� G_lnec.{►C,�.�S'�'-3pages
?7 Sd S� Tah � 1 p t
Project Name / Description
r it-4iIT*TX CINi1r&
Owner Name(s): . i �iy+nYli a kt w►Q M-- Phone: (.I.
Owner Address:
Project Address:
Govt. Lot: _1I
LOT
Towns sec-C3�• �qtr p: vvUIuy. y-rr
Project Parcel ID #: y "7 ~
Q � o ay ' �1 0 oo�.---.----
-rcL2cIt z� gvj
Designer Information
Designer Name: A ilc ti Fo
Designer Address: l
E-mail: kl-y C� '
License Number: Pj'1 S
Remarks:
1
k a Sk Phone:
$ 21 ten � ve k Lt
'Zod�D
7/s_z- qis%
Zip: .s '' fY 7
Si nature: f g Z�
g Date: 1Origins signature required on each submitted copy.
dad
'Soil' Evaluation Site Map - System Plot Plan
In Ground Soil Absorption for POWTS
Component Manual V_2.1 Map Coordinate Reference System:
Site Owner: Kevin Zimmerman NAD83(2011) / WISCRS Bayfield (ftUS) EPSG:7590
Site Address: 66680 Hart Lake Rd, Iron River, WI 54847
Legal Description: Lot Three (3), Bayfield County Plat of Ellenwood,
Town of Iron River, Bayfield County, Wisconsin
PIN: 04-024-2-47-08-22-2
N0V 14 2025
Bay field Co.
Panning and Zoning Agency
N
Y
J
(ti
Ll
00-323-03000 W 50 100 ft
----------------------------------------- N
Sanitary Permit Dimentions List (applicable)...
Proposed 2 bedrom home: 30' x 40'
Building to lot lines: ≥145' Building to road centerline: 192'
Septic tank to closest lot line: 134'
Septic tank to building: 15'
Drain field to closest lot line: 90'
Drain field to building: 25'
Tank- Wieser WLP750-MR
Filter- PolyLoc PL -525 Effluent Filter
BM r Pcea:
p�SB3
' Q ASB1
r
O 0' 9 II
r $
r 0�
r r
4" Pipe Material /ASTM Standard;
(Tables 384 30-3 & 384.30-5)
No Well on Property Sanitary Sewer ASTM F789
pNo Wetlands, Floodplains or Navigable Waters
Q'
r i
;' E.J Approximate Property Line
r
;' -E'?- BM - Screw in Poplar Tree - Elevation 100.00'
r+ A SB1 - Elevation 96.50
;` A SB2 - Elevation 96.81
r
� A SB3 - Elevation 96.64
r ,
r ,
CST Name & License #: To Pollcoski 11068 - ST
�� CST Signature: - a
Plumber Name & License : Allan Polk ski PMRS 220090
fir Plumber Signature: G.•-. r ii" "
r
r ,
r r
r r
IN -GROUND GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard -W Chambers
3 -ft Trench (down -sizing credit)
SOIL COVER
min. 12"
(typical)
Septic Tank(s) Manufacturer
Weser
/�
Septic Tank(s) Volume(s):
7 O gal gal gal gal
Effluent Filter Manufacturer.
Effluent Filter Model#: Pt.— 5 as
12"
rnn. trench
Lr:
door,
•tyTYPICAL TRENCH
CROSS SECTION VIEW
Fes-- 34'.
(Typical) (No Scale)
System Elevation = 9 JU ft
(typical)
Quick4 Standard -W
w/ End Cap (Show location of inlet / outlet pipe connection on plan view.)
(typical)
-f -------- ------
- - - - - - - - - - - - - - - -
►'rev%ctiZ
(typical)
Provide minimum 3 ft
separation between trenches.
Observation Pipe
(typical)
Install per manufacturers
/ Instructions.
TYPICAL TRENCH
PLAN VIEW
(No Scale)
IA=3.0ft
(typical)
"—Quick4 Standard -W Chamber
l)
INSTALL PER TRENCH: trapicSy
(,� °''� ,l (mfd by Infiltrator Systems, Inc.)
_ `t 1 OlV ft' Install pursuant to manufacturers instructions.
-r __jp Quick4 Std -W @ 20 ft' EISA/chamber =
+ Pairs of end caps @ 6 ft2 EISA/pair __¶'t_2
= Proposed EISA per trench =* a6 ft' Required Infiltration Area = 9 a9 ft2
®•C1 __ trenches = Proposed Total EISA = H3. ft'
Distribution Method:
-D
VJ
m
CA)
O
a
PAGE 4 OF 4
-'� In -ground Gravity Management Plan
IMPORT:1 4 2025
The owner dr( _90 gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requir9ffl6 3 f S�S 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall
be considered a human health hazard if not maintained in accordance with this approved management plan.
Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area Operating Limits:
Design Flow = 300 gpd; BODS ≤ 220 mgL"1; TSS ≤ 150 mgL''; FOG ≤ 30 mgL''
Inspection Checklist INSPECT EVERY 3 YEARS
type of use
'y age of system.
nuisance factors (i.e. odors, user complaints, etc.)
bt mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
material fatigue (i.e., leaks, breaks, corrosion, etc.)
solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes)
neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
extent of ponding in distribution cell prior to dosing
4 dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.)
1 electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
11 distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification)
4 surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
j6 Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. • A servicing period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company: Irc n t V'e r >'€p1- C Phone: ? ( 3 Z— S_
Local government unit: ��.
�` e- �
"�®� c ,•.
� __••_t(
�— l
Phone: � � �r � 7 3 � 3
Local government unit address:
cc S
, ✓ ✓I't
ZIP: S T4'9/
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384, Wisc. Admin. Code.
Contingency Plan
In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be
abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
.4 Z0Z5
r ayi-ie►d Co. BAYFIELD COUNTY
Planning and ZonunO CHECKLIST FOR SANITARY APPLICATONS
Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e))
j Check List
i`Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.)
Index Page / Title Sheet (Signed by Plumber) (38322(2)69(c))
[ l Original Plot Plan (383.22(2)2. 3. & 4.a)
ff Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer
ICI Pump Tank Diagram, Alarm and Pump Curve (when applicable)
Contingency Plan / Management Plan (383.22-3(2)(b)1.f.)
'[y 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)
U Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5)
E] ATU Servicing Agreement (Recorded at Reg. of Deeds)
'Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7)
I$ I Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached
to all co ies
40 Soil and Site Evaluation Report (383.22-3(2)(b)1.e.)
❑ State Plan Review (when applicable)
l Copy of Warranty/Quit Claim Deed (Optional)
Sanitary Application: (Include the following Information)
7 I Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete)
} Project Address or Road Name where driveway is/will come off of) 0 (Owners Phone Number)
P II Type of Building
)E III Type of Permit
16 IV Type of POWTS System
id V Dispersal / Treatment Area Information
'VI Tank Information
l 'VII Responsibility Statement (Plumber's Information)
l9 *Date Stamp*
Plot Plan: (To Scale or To Dimension)
i Signature and Plumber Information
0 Surface Elevation of Body of Water «r NA
Direction and Percent Land Slope
3 Tank and Filter Information and Location
0 Wetlands / Navigable Bodies of Water - N/A
Absorption Area (Proposed and Existing)
Bench Mark (Location, Elevation and Description)
$(Component Manual Version
'gyp Address Number and Road
V North Arrow
`N Contour Lines
Structures and Driveways
Boring Locations
KProperty Lines
Well Locations
Legal Descriptions
X Piping Material Information (conveyance line, building sewer line, material type and diameter)
Turn Over D
Cross -Section and Over -Head Profile of the System:
t Surface and System Elevation I Q 1 l :t. LULO
Position of Observation and Vent Pipes
uyreld Co.
Dimensions and Depths anru:► ; 4nd Zoning Agency
tt Make, Model & Number of Chamber Units in each Cell
Property Information
1, How many systems will there be on this parcel of land? ______
iJ Has this property been split?N (Property Statement shows Property History)
Fees:
1}� Private Sewage System (Septic Tanks) $ 400.00
O Private Sewage System (Holding Tanks) $ 400.00
O Mounds or Systems requiring Pre -Treatment $ 500.00
Li Sanitary Revisions $ 25.00
U Private Sewage System Reconnection $ 50.00
and Private Interceptor
O Return Inspection $ 50.00
O Maintenance Agreements + $ 30.00
(checks made out to Reg of Deeds)
u/forms/checklists/checklistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by:
WLP750-MR
TANK SPECIFICATIONS
O
01 CL
a
DIMENSIONS:
J
aI0
WALL: 2 1/2"
a a
BOTTOM: 3"
4" CAST —A -'SEAL
P" CAST —A —SEAL
COVER: 5"
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
HEIGHT: 54"
2 __j_
OUTSIDE DIAMETER: 7'-0"
BELOW INLET: 42"
a-
��
LIQUID LEVEL: 37"
WEIGHT: 6,150 LBS.
a
INLET AND OUTLET:
�y� _��• _� a�
4" CAST —A —SEAL BOOT OR EQUAL GASKET
3I 00
r!L TGR OR
INLET AND OUTLET BAFFLE AND FILTER:
ZI 0
3
WISCONSIN, SEE DETAIL #10
a a
(OTHER STATES' SEE CHART)
U a
='
W �'
� Q
LIQUID CAPACITY: 20.28 GAL/IN
TOP VIEW
HOLDING TANK:
W
OUTLET HOLE PLUGGED
ACTUAL CAPACITY: 790 GALLONS
o Un
OaC
LOADING DESIGN: 8'-0" UNSATURATED SOIL
o I
Ln
TANK CAN BE USED AS:
Qa
SEPTIC / HOLDING / PUMP OR SIPHON
o I
WHO
Li=
COVER: MIX DESIGN #8 (NO FIBER)
3 O
00
TANK: MIX DESIGN #10 (STRUCTURAL FIBER)
W
CUSTOMIZED TANKS:
R
-- - - - - - - - - FOR CUSTOM TANKS CONTACT WIESER CONCRETE
-
C
O
J •C
2�-----
_
.J
._
•u
<
PUMP A'J
a
�
J :-
SIDE VIEW
APPRov FD
By Glen Schlueter at 8:19 pm, May 30, 2022
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
REVIEWED BY
REVIEW DATE
DRAWINGS SUBMITTED
FOR APPROVAL
APPROVED BY:
APPROVAL DATE:
PRODUC"S NEEDED Bv:
Private Sewage System Maintenance Agreement
Owner(s) Name
Kevin Zimmerman
Owner(s) Mailing Address f "C `� 2025
t
8500 Jensen Ave S. Cottage Grove, MN 55016
Site Address �,. r�ju jinn Anryncy
66680 Hart Lake Road, Iron River, WI 54847
Tax ID #
20809
As owner, I (we) do hereby certify the private sewage system will be installed in
accordance with the certified soil tester's report and approved plans and specifications
on file with Bayfield County Planning and Zoning Department. The system will be
operated in such a manner as to meet the designed plans. I (we) agree to maintain said
private system at the below listed location in accordance with rules established in the WI
Adm. Code, as from time to time amended. (COMPLETE Legal Is required)
114 of 114 Section Z -Z Township `f -7 N. Range g W.
Additional Legal Description: 1. e+3 ay4 Pil at'� 1 it fM uJ0bt
Town of __ a ''� ' er (Acreage) I. i Gov't Lot
Lot Block Subdivision
Lot CSM # Vol. Page CSM Doc #
DOCUMENT NUMBER
2025R-609682
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY, Wi
RECORDED
1O/23/2O25 AT 11:O2 AM
RECORDING FEE: $30.00
PAGES: 3
Recording Area
Return To:
1rbi m.1kosk'
fc. ' O rzZ-
� r o kt + e 'o sr'f g F 7
In -ground gravity
❑ in -ground dosed
❑
In -ground pressure distribution Sewage System:
O
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 . e 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 -Grade. 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 thi ( 0
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 s1fl,J�rgs
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 p44 :. _
The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such
Owner(s) Name(s) — Please Print
Subscribed and sworn to before me on this date:
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_________________
Notarized Owner(s) — Signature(s)
on
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'Drafted by'TDP.y Pa iko.ck Date: I D 7 —ZS'
Proofed by:
State Bar of Wisconsin Form 1-2003
WARRANTY DEED
Document Number it Document Name
THIS DEED, made between Sharon M. Ahl
("Grantor," whether one or more),
and Kevin K Zimmerman
('G(aptge," whether; one or more).
Grantor, for a valuable consideration, conveys to Grantee the following described real
estate, together with the rents, profits, fixtures and other appurtenant interests, in
BAYFIELD County, State of Wisconsin ("Property") (if more space is
needed, please attach addendum):
Recording Area
Name and Return Address
Kevin K. Zimmerman
8500 Jensen Ave S
Lot Three (3), Bayfield County Plat -et 1•lelNTown of Iron River, Cottage Grove, MN 55016
Bayfield County, Wisconsin. J 18847-24
NOV 14 2025
Baytieid Co.
Plannin J and Zoning Agency
04-024-2-47-08-22-2 00-323-03000
Parcel Identification Number (PIN)
This IS NOT homestead property
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of en �rnn
BASEMENTS, RESERVATIONS AND RESTRICTIONS OF RECORD, NICOLE MARIE DIEFENDERFER
Dated /1/1 ci.rtln ZCD_________________, O 24 . Notary Public -Minnesota
My commission Expires Jan 31, 2026
(SEAL) (SEAL)
41 * Sharon M. Ahl
(SEAL) (SEAL)
41 41
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF t.M Y )
) ss.
authenticated on 1%X*C. b 4— COUNTY )
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by Wis. Stat. § 706.06)
THIS INSTRUMENT DRAFTED BY:
ATTORNEY MATTHEW F. ANICH, SB# 1017169
Anich, Wickman & Lindsey, S.C., Ashland, WI 54806
Personally came before me on Mgr[an o i aO at'
the above -named Sharon M. Ahl
to me known to be the person(s) who executed the foregoing
i sti e t and acknowledge the sam
'h1,t.0)1 RA • _J
Nofaty Public, State of
My Commission (is permanent) (expires: .31.iZ.
(Signatures may be authenticated or acknowledged. Both arc not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003
* Type name below signatures.
C-
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BAYFIELD COUNTY PLAT
8A;VIELLD C0Ii-Y IJERTIFIED SURVE+ NO. 122% ECr LLENW00D
carlFb N 595315" E 2662.06NE — NWGOOPHEnt
LOCATED IN C. K. P LOTS I AND OF
°'e ra �` " ' COV'T. LOT 2 SECTION 22. T. 47 M. R OH.. IN THE TOWN OF
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SOIL TEST o S1
• Wisconsin Department of Safety& Professional Services Page 1 of
Dj6ojln Cervices S F.- 0 0363
` 8 SOIL EVALUATION REPORT
'r•
:':.`:s Bayid Co. In accordance with SPS 385 Wis. Adm. Code County
Attach complete'si enplan on paper not less t}han 8 1/2 x 11 inches in size. Plan must include, j'� �1 /
but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. F
scale or dimensions, north arrow, and location and distance to nearest road. 0
Please print all information. Revi e y Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). t"//,Z37/3 37/3 11/47/'2. 5'
Property Owner r 3c f p y ai & *U %O%i"M Y O�P.v��ti�Ot�l
Q.
Property Owner's Mailing Address � Site Address or CS{yl and Lot #: Lcke.
City, State, Zip Phone Number ❑ City ❑ Village EWTown I Nearest Road
New Construction Use: fo Residential/ Numberof bedrooms —
❑ Replacement p� O Public or commercial-9escribe:
Parent material t e.� •t A) U In 5ot+n ��s_
General comments and recommendations:
Boring # ❑ Boring ib a �J Pit Ground surface elev. ft.
Code derived designflow rate-.�•gr� 3PD
Flood Plan elevation if applicable _ ft.
Depth to limiting fac OUin. / ele6ft.
Soil Anolication Rate
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
--
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tt,,
1O3/l
15
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4J
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ljbo
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_____
_____
—
—
. 7
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Boring #
❑Boring
NPit
Ground surface elev 'ft.
Depth to limiting fact lnd in. / el&9,!j.
Soil l Anolication Rate
Horizon
10-&10
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Si. Sh.
Consistence
Boundary
Roots
GPD/Ftz
*Eff#1
Eff#2
3/l
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s
L�
1
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1
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CST Name (Please rint
1
Signature
-r'_-
CST Number1-.s
Addresss: r 'T'( taw
"M
Date Evaluation Conducted I
nr w
Telephone Number
2.1$-3411_ 7 o c
4yef1
' Effluent #1 = BOD > 30 ≤ 220 mglL and TSS > 30 ≤ 150 mg/L " Effluent #2 = BOD, ≤ 30 mg/L and TSS ≤ 30 mglL
SBD-8330 (R03/22)
to w+r za W :t
NOV 1 4.2025 Boring
® Boring # Pit
Bayfield Co.
Planning and Z^ainj Ag ;: e i'
Page of
Ground surface eleci4(ft. Depth to limiting factin. / eie ,9_ft.
Soil Aooiication Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Si. Sh.
Consistence'
Boundary Roots
GPD/Ft'
Eff#1
Eff#2
O-6
l
l
G A)
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1.
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t
C;.
1.
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4
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❑Boring # ❑ Boring ❑ Pit Ground surface elev. ft
Depth to limiting factor in. / elev, ft.
Soil Annlicalion Rile
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Si. Sh.
Consistence
Boundary i Roots
{
GPO/Ft'
'Eff#1
Eff#2
- ❑ Boring
❑ Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft.
Soil Aooiication Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Si. Sh.
Consistence
Boundary Roots
GPDIFt`
Eff#1
Eff#2
•
l
7 ' Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 5150 mg(L ' Effluent #2 = BOD, S 30 mg/L and TSS 5 30 mg/L
Soil Evaldation Site Map - System Plot Plan
• In Ground Soil Absorption for POWTS
Component Manual V_2.1 Map Coordinate Reference System:
Site Owner: Kevin Zimmerman NAD83(2011) / WISCRS Bayfield (ftUS) EPSG:7590
Site Addrqss: 66680 Hart Lake Rd, Iron River, WI 54847
Legal Description: Lot Three (3), Bayfield County Plat of Ellenwood,
Town of Iron River, Bayfield County, Wisconsin 0 50 100 ft
PIN: 04-024-2-47-08-22-2 00-323-03000 a.
N
NOV 1.4 2025
Bayfield Co.
Planning and Zoning Agency
Ira
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Sanitary Permit Dimentions List (apr
Proposed 2 bedrom home: 30' x 40'
Building to lot lines: ≥145'
Building to road centerline: 192'
Septic tank to closest lot line: 134'
Septic tank to building: 15'
Drain field to closest lot line: 90'
Drain field to building: 25'
Tank- Wieser WLP750-MR
Filter- PolyLoc PL -525, Eff1uent Filter
�_
BM
ASB1
4" Pipe Material /ASTM Stan
(Tables 384 30-3 & 384.30-5)
No Well on Property Sanitary Sewer ASTM F789
No Wetlands, Floodplains or Navigable Waters
E.i Approximate Property Line
BM - Screw in Poplar Tree - Elevation 100.00'
A SB1 - Elevation 96.50
A SB2 - Elevation 96.81
A SB3 - Elevation 96.64
CST Name & License #: Tony Pol oski 11068 - ST
CSTSionature:, Z�Z tl�A--Da
Plumber Name & License: Allan Polkoski PMRS 220090
Plumber Signature: ���'— q: .' I I-- �_tSi I �_zS
202 BAYFIELD COUNTY
�o ,�
CHECKLIST FOR CERTIFIED SOIL TESTS
8ayt,�tci Co.
Submit�thdai�lfo"`'g (Use Permanent Ink):
l�J Check- List
'Cf.l Index Page / Title Sheet (Optional)
1 Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers)
J Original Plot Plan
0 Cross Section Soil Profile Sheet (optional)
0 Additional Information (Warranty/Quit Claim Deed) (Optional)
Soil Evaluation Report: (Include the following Information)
% Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used
Nl9 Property Owner's Information (not prospective buyer's name)
Property Location (Accurate Legal Description with Sec/Twp/Range)
l Road Name (where driveway is/will be coming off of)
D Floodplain Elevation, Flow Rate, Comments and Recommendations
10 Complete Soil Boring / Pit Information
W Date Soil Evaluation was conducted
1)0 CST Name, Signature, Number, Address and Phone Number
F *Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
Bench Mark (Description, Elevation and Location)
11 Contour Lines (Example = 98.0' /96.0' /94.0')
X Property Location (Sec/Twp/Range/, Accurate Legal Description)
CK Borings (Locations and Elevations)
Percent and Direction of Land Slope
Well Location (Including Neighboring Wells, if applicable)
IN Location of Wetland Areas, Floodplain and Navigable Waters
11 Buildings, Driveways, and Structures (Location and Descriptions)
t l Location of Property Lines
f Existing System Location r Al/A
l'Address Number and Road Name
0 Current Surface Elevation of Wetlands and Navigable Waters
tX CST, Owner and Property Information
19 North Arrow
Fee:
iI Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforests
BAYFIELD COUNTY
SANITARY PERMIT (#04)-25-153S
STATE SANITARY PERMIT
OWNER: KEVIN K ZIMMERMAN
GOVT LOT: LOT: 3 BLK:
1/4 1/4 SEC: 22, T 47 N, R 8 W
TOWNSHIP: Iron River
SOIL TEST: 145-25
NEW SYSTEM
SYSTEM TYPE: Non -Pressurized In -Ground
PLUMBER: ALLAN POLKOSKI
TRACY POOLER DATE: 1/1/2000
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: # 220090
Condition: Properly Maintain System Per Recorded Agreement
THIS PERMIT EXPIRES 1/1/2002
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION