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Request for Sanitary Inspection (24 Hrs. 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 Time Change fl Discrepancy Other Phone Number Plumber: N -\p- o\Xe aO Fax Number Email Address Homeowner: `\ cnT1�C5c 1 dh �����J G�c� IuvV��l (C Immediate Phon Number So Zoniri Sanitary �1 S a S Dept can call you right back (if needed) Permit #: 71-� 7S\ Plumber's Choice Zoning Dept No Inspection(s) during this time Date: a 16 I a� ,� M e it Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice Zo ept Time: Township: Address #& & Road Name: )c\'\Q1 \ ' \ey \\ or Lcns�`°uC \ Directions To Site: Comments: ** Plumbers you must verify any change(s) by fax or email ** Notes from iu u/forms/sanitary/req uestfori nspection Zoning Dept (©4/12/04); ®June 2023 Industry Services Division General Information Permit Holders Name: Private Onsite Wastewater Treatment Systems (POWTS) Inspection Report (Attach to Permit) BRIAN P & PATRICIA A ,5.04 1 PATTERSON Village Town of: 76205 MCKINLEY RD WASHBURN, WI 54891 y VAti oil t ' setback to: County QQ VaJ Sanitary ermlt No: 2S-I"IS State Plan Transaction ID#: Parcel Tax No: flTYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake I Road Se tic S,e N/A Dosing N/A Aeration N/A Holding Pump! Siphon Information Pump Manufacturer ump Model Demand Ma facturer 1 r . Filter Mo¢✓L �,I c c GPM TDH Lift Friction Loss Need Total Forcemain Length Dia Dist To Well Dispersal Cell Information DIMENSIO Width Lenj�gth CYl1tr4 # of Cells SETBACK FROM ine B it i Well OHWM Type of Cell Qu��K LA M darer: Model Number. Pretreatment Unit Manufacturer: Model Number: )istribution System Header / Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length _ Dia Length Dia Spac_ Spacing 0 Yes 0 No N Elevation Data STATION BS I HI IFS ELEV Benchmark s ( oO Bldg. Sewer t0 gtA Tank Inlet a Tank Outlet q,41f, g71�) Dose Tank Inlet Dose Tank Bottom Inst. Contour Header/ Manifold Q._06' Distribution Pipe Infiltrative Surface _________ 6.44' 4-c._� Final Grade _________ L X Pressure Systems Only Soil Cover Depth Over Depth Over Depth of Seeded / Sodded Mulched Cell Center Cell Edges Topsoil 0 Yes 0 No 0 Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Gn Plan revision required? 0 Yes EL j_ Use other side for additional information. __ Date 2 Loc6I ckvis + f -a64 Fa(lx &K Ce ( S Sh(OLA V1 - X rcu)5 c-6 UFVt�'S(cib≤e VVIAW^ ql(4 'in, !- end (a($ PO S Inspector's Signature License Number RRn-R71n rR n4(911 Property Owner Information As you know onsite wastewater treatment system on your property described as: BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373.6138 Fax: (715) 373-0114 e-mail: zonina(&bayfieldcounty.wi.pov Web Site: www.bayfieldcounty.wi.gov/147 BRIAN P & PATRICIA A PATTERSON 76205 MCKINLEY RD WASHBURN, WI 54891 Notes: Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 was contracted by you to install a private Abandonment of Old System to meet all applicable code requirements: Tank was pumped by: on at AM / PM o Tank was crushed / removed and pipes disconnected by: On at (AM! PM) the above -mentioned plumber contacted our office to a pre -cover inspection as required under DSPS 383. One of the following applies: conduSystem 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 pp��be inspected because County could not respond to plumber's time constraints. Comments: UtW 4\ ey k%l aI(ed o r id 1/i £2-e/7C ((•tKG in U/formslsanitarypropertyowner-input April 2019 SS- ooS2S IP :' Department of Safety & Professional Services, Industry Services Division CO 11 q Sanitary Peimit Number (to be filled in by Co.) �J� ( fi� •. 'f Ill' Sanitary Permit Application Stale Transaction Number In accordance with SPS 383.21(2). Wis. Adm. Code, submission of Ihis form to the appropriate governmental unit is required prior to obtaining a sanitary pemra. Note: Application forms forstatc-owned POWTS arc submitted to tire Department of Safely 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. Project Address (if different than mailing address) 1. Application Information — Please Print All Information Property Owner's Name Parcel # Property Owner's Mailing Addrvss 16 ' .G s ('ic Ic; f.\e �ck' Property Location Govt Lot 5F Y...S!< %.. Section '` J T Ll t N R C 5 L' or City. State • rJ V-i Zip Code, it "L, ` Phone Number / 12& y •��.0 ��s1...1. Type of Building (chec all that apply) gp l or2 Family Dwelling- Number of Bedrooms 1.01W Subdivision Name ❑ Public/Commercial — Describe Use Block N O City of O Village of v Town of .IGS 4,r,xrn O State Owned — Describe Use -. CSM Number Ill. a licabie Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i A' New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B' n Holding Tank 8 In -Ground 9 ❑ At -Grade ❑ Mound 0 Individual Site Design ❑ OlherType (explain) (conventional)I C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber I❑ Transfer to New Owner .rst Previous Permit Number and Date Issued Iixpiration 1VD)ispersailTre*tnient Area and Tank Information: Design Flow (gpd) /SO Design Soil Application Ratc(gpdhf) i C).S Dispersal Area Required (al) 3 _ Dispersal Arco Proposed (s0 System Wavor n� Tank Information Capacity in Gallons Tout Gallons Hof Units Manufacturer. a d? e v 73 in 3 v: g a tJ L Now Tanks I Existing Tank% seMicwaolding'rank ) o (> p� /—rs1.: LSC- f1CP yes /\ Dosing Clusuber V. Responsibility Statement— 1, the undersigned, assume s itnsihllity for Installation of the POWTS shown on the attached plane, Plumber's Name (Print) I Plumber' ' alufy t,c �� e� ''�c≥wsl`¼ Cam/ MP/MPRS Number Iide a Business Phone Number 7i5--3uj-75�) Plumber's Address (Sucel, City. State, Zip code) l\cA.1 Hw. G V11.Vl.Connty/Depdrtment Use Only APpmwrd l7 Disapproved ❑ Owner Given Reason for Denial Pc it Fee ri Dale Issued z J 1.`) Issuin g t Si ature ' /rC�G--�•--�_ Conditions of Approval/Reasons for Disapproval elovrlOi" 5 ck � t� , 00 S) ,� RAN 15 35, See- c.it Act A c"r Attach to comptele plans far the,ystem and submit to the Count' anton paper not Irss Than a @ % II inches in sue SBD-6398 (R. 03/22) & Professional Services, Department of Safety County sanitary t er o e I b o.> Industry Services Division - " APR 21 2025 State Transaction Number Sanitary Permit Application Bayfield Co. Zoning De;: In accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forts 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 numnses in accordance with the Privacy Law. s. 15.04(l)(m), Scats. � 31 � 18 a ec&rte I Ib &-O5 I ICI\.\K e C&Ck" GovcLot City, State Zip Code ( , Phone Number t�p,[ � 1t6- IaOP�10O SS ',.4E , Section s H. Type of Building (chec all that apply) Lot# 1 T N R _0S Eon) or �IXl or 2 Family Dwelling - Number ofBedrooms Subdivision Name Block # O Public/Commercial — Describe Use ❑ Cityof ❑ State Owned— Describe Use CSM Number ❑ Village of Town of t. Kh�Y� lA(�•(� Ill Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on fine A. Check one box on line B. Complete line C if e Iicable. A. ,XNew System ���rrr,,,❑l Replacement System ❑ Other Modification to Existing System (explain) 0 Additional Pretreatment Unit (explain) B' 0 Holding Tank 7(J In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. 0 Renewal Before 0 Revision ❑ Change of Plumber ❑ Transfer to New Owner mat Previous Permit Number and Date Issued Expiration IV. Die ersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation SO o -S 300 33a 91.5t' Capacity in Total # of Manufacturer Tank Information Gallons Gallo, Units o ' o New Tanks Existing Tanks vU SepticorHolding Tank lcc0 d %SQ r i'ieSc(--/r1ACls /� V. Responsibility Statement- I, the undersigned, assumepsyQnslblilty for i taladon of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' a MP/MPRS Number Business Phone Number � C�e��•• Plumber's Ad (Scree City, Stale, Zip Code) G kH,A\ C ,,j Hwy, C ( LJc( ,.ouzo I 11Jr s `� I ❑ Approved I ❑ Disapproved rc,uur rec L'@W "'"w ,s "6`..` .n.o.W Is I ❑ Owner Given Reason for Denial Conditions of Approval/Reasons for Disapproval to camuiele plans far the system and submit to the County only on paper not less than S I2 z SBD-6398 (R. 03/22) PAGE 1, OF 4 In -Ground Gravity Plan & C Sh t APR ; I oc! Index over ee 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: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Maintenance Agreement Septic Tank Specs Project Name / Description Owner Name(s): Brian & Patricia Patterson Phone: 715 _928 9526 Owner Address: 76205 McKinley Road, Washburn, WI Zip: 54891 Project Address: Govt. Lot: 1/4 of 1/4, Section 35 , T 49 N -R 05 E ❑ or W I✓E Township: Washburn County: Bayfield Project Parcel ID #: 37918 Designer Information Designer Name: Michael Wroblewski Designer Address: E-mail: mike@biglakeplumbing.com 1491 County Highway C, Washburn, WI License Number: 1288503 Remarks: Phone: 715 _209 _7521 Zip: 54891 ibis space I: tr' (i! L'd lii'j�i Cn'.!I .Ln1 Signature: Date: wi Original signatu required on each submitted copy. rReset Page l Wisconsin Department of Safety and Professional Division of Industry Services In accordant Attach complete site plan on paper not less than 8 1/2 x 11 Inc but not limited to: vertical and horizontal reference point (BM), scale or dimensions, north arrow, and location and distance to Please print all Information APR Pagelof$ ,I. I [025 )IL EVALUATION REPORT with SPS 385, Wis. Adm. Code County In size. Plan must include, Hayfieldas Irection and percent slope, Parcel I.D. 04-050-2-09-05-35-4 04-000.20000 Reviewed by Date Property Owner Property Location ❑ Brian Patterson Govt. Lot SE Y. SE V. S 35 T 49 N R 05 E (or) W Property Owner's Mailing Address Lot Block # Subd. Name or CSM# W8490 530°1 Ave City State Zip Code PhonelNumber ❑ City ❑ Village ® Town Nearest Road ® New Construction Use: ® Residential/Numberol ❑ Replacement ❑ Public orcommerciai— Parent material TIL General comments and recommendations: Boring # ❑ Boring ®Pit y Code derived design flow rate QQ GPD Flood Plan elevation if applicable Wa ft. Ground surface elev. 97.02 fL Depth to limiting factor in. Horizon Depth In. Dominant Color Munsell Redox Description) Qu. Az. Cont. Colof Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' Eff#1 •Eff#2 1 0-6 5YR2.5/2 - SL lmsg mvfr cs 2vf 0.5 1.0 2 6-10 SYR 512 - I LS Osg ml ow 2vf 0.7 1.6 3 10-46 7.5YR6/8 - I S lmsg ml gs lm 0.7 1.6 4 46.62 5YR5/6 - S lmsg ml gb lm 0.7 1.6 5 62-72 5YR5/8 - S Omsg ml - Ico 0.7 1.6 ❑ Boring0 ❑ Boring ® Pit Ground surface elev. 97.28 ft. Depth to limiting factor fl In. e.,n n...l l.,..n,.., o.,... Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 •Eff#1 •E0#2 1 0-7 5YR2.5/2 - SL lmsg mvfr cs 2vf 0.5 1.0 2 7-11 5YR5/2 - LS lsg ml ow 24 0.7 1.6 3 11-52 7.5YR 518 - I S lmsg ml gs 1m 0.7 1.6 4 52-67 5YR 516 - I S lmsg ml gb lm 0.7 1.6 5 67-72 SYR518 - S Omsg ml - leo 0.7 1.6 CST Name (Please Print) Signe 1 ` u CST Number Edward Wroblewski / 8718 Address Date E wjiakon Conducted Telephone Number 1210 5h Ave W, Washburn W1 54891 7/12/19 (715)373-5808 SBU-8330 (R04/15) # Boring Boring ® Pit Ground surface elev. QB 844 R Depth to limiting factor >72 in. Horizon Depth In. Dominant Color Munsell Redox Descdptiori Qu. Az. Cent Col r Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPO/F1' •Eft#1 Eft#2 1 0-7 5YR2.5/2 - I SL lmsg mvfr cs 2vf 0.5 1.0 2 7-11 SYR 5/2 - I LS omsg ml cw 2vf 0.7 1.6 3 11-41 7.5YR5/2 - S lmsg ml gs 1m 0.7 1.6 4 41-84 5YR 518 - S lmsg ml gb ice 0.7 1.6 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. _ ft. Depth to limiting factor_ in. Horizon Depth In. Dominant Color Munsell Redox DescdptiorI Qu. Az. Cont. Colo) Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/FIF 'Elf#1 E0#2 ❑ Boring if ❑ Boring ❑ Pit Ground surface elov. _ ft. Depth to limiting factor_ in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/FP Eft#1 Eff#2 Effluent #1 = BCD, > 30 5 220 mglL and TSS>30 30 5 150 mgly' Effluent #2 = BCD, > 30 5 220 mg/L and TSS >30S 150 mgJL Brian Patterson Soil Test Plot Plan Edward Wroblewski, CST Legal Description: N 1/2 N1/2 SE SE in Doc 2018R-575731 S35149N 1l 0". R05W, Town of Washburn, Bayfield County, WI. Scale: 1" = 50' Lot Line> 100' I Proposed Well Location Privy Boring 99.0' Pitv3 House Site Elv. - 98.66' Lii O 98.0' T 97.50' L Pit #2 I O/ Dv. -97.28' N Eii Pd&1 97.0' Ell. -97.02' p BM&H&VRP Nail in base of 12° Pine Slope 3% W P Elv. - 100.0' Lot Line> 100' Comer Post McKinley Road Page 2 of 2 Brian Patterson Septic System Plot Plan t I� �S ` ( !� Edward Wroblewski, CST (�1 Legal Description: N 112 N1/2 SE SE �!� APR 2 1 2ui5 in Doc 2018R-575731 S35 T49N R05W, Town of Washburn, Bayfield Baylield Co. Zoning Dep! County, WI. ' �1 Scale: 1"=50 Lot Line> 100' I Well Location 99.0' Garage 1 I 750 Gallon Seplic Tank L O T L N E Corner Post McKinley Road 018 Infiltrator Quick 4 chambers tiller — 98.0' 97.50' 97.0' o BM&H&VRP R Nail in base of 12" Pine Slope 3% 1 Ely. - 100.0' V E W A Y Lot Line> 100' Page 2 of 4 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) Manttg{tacturec ( r'C c-k� Septic Tank(s) Volume(s): gal gal gal gal Effluept Filter Manufacturer. V'C\\I p 1\ Effluent Filter Model #: 12' min. trench dopth (teal) TYPICAL TRENCH ^— 34. CROSS SECTION VIEW (typical) (No Scale) System Elevation =, 95.5' (typical) Quick4 Standard -W W/End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) 8= ft (typical) INSTALL PER TRENCH: Quick4 Std -W @ 20 ft' EISA/chamber = 16Cm ft' + 1_ Pairs of end caps @6W EISA/pair = _______ ft2 = Proposed EISA per trench = I 66 ft' Provide minimum 3 ft separation between trenches. Obser �)ipe TYPICAL TRENCH Install per manufacturers PLAN VIEW / Instructions. (No Scale) IA=3.0ft (typical) `-Quick4 Standard -W Chamber. (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions: Required Infiltration Area = 'C ft' x trenches = Proposed Total EISA = 3� ft' D a ° G) m v W p G Distribution Method: Rfur'c\\Qd /u\G;lt$��C\ PAGE4OF4 In -ground Gravity Management Plan IMPORTANT: The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 150 gpd; BODS ≤ 220 mgL-'; TSS ≤ 150 mgL-'; FOG ≤ 30 mgL-' Inspection Checklist INSPECT EVERY 3 YEARS , a� o type of use f 1? if i,! IS o age of system h.iI o nuisance factors (i.e. odors, user complaints, etc.) 7075 o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution] drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing Irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure —compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose 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. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Local government unit: Bayfield County Zoning Phone: 715-373-6138 Big Lake Plumbing Phone: 715-209-7521 Local government unit address: 117 E 5th S, Washburn, WI ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. Reset Page 4" CAST -A -SE C-1 227 WLP750-MR gp TANK SPECIFICATIONS DIMENSIONS: WALL• 2 1/2" BOTTOM: 3" CAST -A -SEAL COVER: 5" MANHOLE 24" I.D. PRECAST CONCRETE RISER HEIGHT: 54" OUTSIDE DIAMETER: 7'-0' BELOW INLET: 42' LIQUID LEVEL• 37' WEIGHT: BOTTOM 3,740 LBS. COVER 2.410 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL 010 (OTHER STATES SEE CHART) UQUID CAPACITY: 20.28 GAL/1N HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 790 GALLONS LOADING DESIGN: 8'-0' UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN 08 (NO FIBER) TANK: MIX DESIGN 010 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WESER CONCRETE D BY DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: O Lii 0 � 3 OF /�I calculated by taking a backsight the turning point. Now, all measurements are a foresight to this new height of instrument. In this manner, any number of turning points can be established and therefore an infinite number of data point collected; all tied back to the original benchmark. See FIGURE 6.6 Bid. Lvi. J] Benchmark Bid: LA. Position 2 Turning Point Boring 1 Boring 2 Station F.S.(-) H.I. B.S. (+) Elevation Benchmark 100.00 Builder's Level 1 101.80 1.80 Turning Point 5,02 96.78 Builder's Level 2 :97.33 0.55 Boring 1 1.88 95.45 Boring 2 4.74 92.59 FIGURE 6.6 — Turning Point Diagram Contour Lines A contour line is a line on a map representing an imaginary line on the land surface, on which all points are at the same elevation. Visual interpretation of contour lines on a map can quickly give insight as to the landscape found on a site. Here are some helpful rules concerning contour lines. Since they are the same elevation, lines can never cross. Close contour lines indicate a steep slope while far apart lines indicate flatter areas. Lines in concentric circles indicate a hill (or possibly a depression). Lines that take the form of a "V" indicate a valley with the upslope towards the point of the "V". Contour lines should be indicated at whole numbers and at an interval suitable to the site. One- or two -foot contours work best for most sites. DETERMINING CONTOURS Mapping contours can be accomplished by a couple different methods. The first method involves interpolation of data between points. Elevation data is obtained in either a grid pattern or random points. Although both require the same calculations, the grid method is easier to locate on the plot plan. The second method plots each contour separately. The interpolation requires the collection of many data points across the area. Using a grid, data 76 ELEVATIONS Complete this form Fax (715) 373-0114 to Zoning Dept Was Inspector Present for Sanitary Installation: 0 Yes 0 No Property Owner �G C Township G -S Sanitary Permit # o- 5 — 1-7 Benchmark � = I OC) ,Q Septic Tank #1 Holding Tank Inlet 11 II // I _ —1 1 `1 �o outlet t-\,6) .-a Septic Tank #2 Holding Tank Inlet Outlet Building Sewer i System Elevation b • Header •. / 66' Finish Grade H O 1 ' Pump Tank Inlet Top of Block Comments ufforms/elevations Ss- ooS25 Department of Safety County I & Professional Services, Sanitary Permit Number Permit b $ Ps Industry Services Division (to be filled in by Co.) ,_ Sanitary Permit Application State Tmn uclion Number In accordance with SPS 383.21(2), Wis. Adm. Code. submission of this two to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms forstateowrled POWTS arc submitted to Project Address (if different th:m mailing address) the Department of Safely and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. I5.04(l)(m), Stats. 1. Application Information — Please Print All Information Property Owner's Name � - Pared a •� �i 118 a- u (c( c c�t'�, Property Owner's Mailing Address Property Location 1(5 �o5- ML less\e 1≥` Govt. Lot SE Y., SC Y.. Sauion eJ City, State , Zip Code CJl8jt� Phone Number X15 9u �-ati r U t N R Li S E err Il. Type of Building (theA all that apply) Lot a XI or 2 Family Dwelling— NumbcrofHcdraoms Subdivision Name Block a ❑ Public/C'ommercial — Describe Use O City of ❑ State Oumcd — Describe Use O Village of CSM Number Town of 1 \GSW(lt AP{'\ I11. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i .applicable.) A. ,XNcry System n ❑ Rc 5 P laccmcnl System n Other Modification to Existing System (explain) 0 Additional Pretreatment Unit (explain) 0' ❑ Holding Tank y, In -Ground ❑ AtGrade ❑ Mound ❑ Individual Site Design I❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision 0 Change or Plumber ❑'I'mnsfer to New Owner List Previous Permit Number and Date Issued fapiration IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) So Design Soil Application Rate(gpdfsl Dispersal Area Required (sly I Dispersal Area Proposed (s0 SysicLlcv n �` o.s 30O 33a Capacity in Total a of Manufacturer 'lank Information Gallons Gallon Units •o T, v New Tanks Lsisting Tanks a a.L' in ,s In iZ (J C orltoldin ScryicTant p l J O (� 7 c� O I ernc x lyosing Chamber V. Responsibility Statement- 1, the undersigned, assumeprasIbllIty for installation ofthe POWTS shown on the attacked plans. Plumber's Name (Print) Plumber' � � MMMPRS Number l�S"SSG3 I Business Phone Nwnbcr I 715-Cq-75 ( \ce\ 1c`�ewS�C� ) Plumber's A (Strcct City. State. Zip Code) \\ c.1 Hwy C1 (va4J�v;e i✓J= 6L18 k VI. County/DepIrtment Use Only Approved ❑ Disapproved I P dt Fee 5 -ro Date Issued f� ! 7 _ `J Issufn 115i ature At C O Owner Given Reason for Denial L l Conditions of Approval/Reasonsfor Disapproval 6 / tci J•1 oo.ao �) r R£N S p 1 51.,5- f" ��czt-in s 35. nise'i C r� Ste_ oik Attach to complete plan for the system and submit to the County only on paper not less than a In a II inches in size SBD-6398 (R. 03/22) 7\eiW> Q Department of Safety County & Professional Services, Sanitary it m er a e 'le ' b o.) ( SPs Industry Services Division liLt APR 2 1 2025 Sanitary Permit Application State T anB yfleld Co.saction Zoning Dept. In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental wit 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 purposes in accordance with the Privacy Law, s. 15.040(m), Stats. I. Application Information — Please Print All Information Property Owner's Name Parcel # \?� r\ a- Mc' cec 19\8 Property Owner's Mailing Address Property Location i6'.o s P1 c. k; t.\e & • GovL Lot City, State . Zip Code Phone Number 1Ic7-1 1ff .SI? '/..-SE %a Section S ���I....., Type of Building (chec all that apply) Lotfl T N R 5 E or qp I or 2 Family Dwelling— Number ofBedrooms Subdivision Name Block # ❑ Public/Commercial — Describe Use O City of ❑ State Owned— Describe Use CSM Number O Village of Town of_____________________ 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 applicable.) A. New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank U1n-Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. O Renewal Before 0 Revision ❑ Change of Plumber ❑ Transfer to New Owner ist Previous Permit Number and Date Issued Expiration Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) Dispersal Area Proposed (st) System Elevation SO o.S 300 �3a; gi.St Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units r New Tanks Existing Tanks U c 0.0 n h a V P I SepticarHoldingTank I 150 1 O 1 -7301 1 1 �k1tes�( <oncre�c� I X I I I I V. Responsibility Statement— I, the undersigned, assume usibility for in tallation of the POWTS shown on the attached plans. Plumb is Name (Print) 11 Plumber' MP/MPRS Number Business Phone Number ,c e\ CMe oc*,. �:�pl " 1 �8sS03 X15 �ocl-75a� Plumber's Ad (State City, State, Zip Code) 1 lyq\ C, I�Wu C ( �c(��tn 1 l Jt 5�!Sot ❑ Approved O Disapproved rv...,n rev ,.nw ia"w .aa"n,g frsn. "s„a,m. O Owner Given Reason for Denial Attach to complete plans for the system and submit to the County only on paper not less than 8 in x 11 inches in size SBD-6398 (R. 03/22) In -Ground Gravity Plan D ( G I �P t EjOF4 ' Index & Cover Sheet APR 212015 Component Manual Design References: ;! -'c Co. Zoning Dept 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: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Maintenance Agreement Septic Tank Specs Project Name / Description Owner Name(s): Brian & Patricia Patterson Phone: 715 - 928 - 9526 Owner Address: 76205 McKinley Road, Washburn, WI Zip: 54891 Project Address: Govt. Lot: 114 of 1/4, Section 35 T49 N -R 05 E ❑ or W ✓❑ Township: Washburn County: Bayfield Project Parcel ID #: 37918 Designer Information Designer Name: Michael Wroblewski Designer Address: 1491 County Highway C, Washburn, WI E-mail: mike@biglakeplumbing.com License Number: 1288503 Remarks: Sig Phone: 715 - 209 - 7521 Zip: 54891 This space reserved ror approval stamp. nature:z JY Date: le as Original signatu required on each submitted copy. gReset Page l 01- i9 Wisconsin Department of Safety and Professional Services - Page 1 of 3 Division of IndustryServices SOIL EVALUATION REPORT In accordantith wSPS 385, Wis. Adm. Code County Attach complete siteplan on paper Bayfield p not less than 8 112 x 11 krcfjres in size. Plan must include, but not limited to: vertical and horizontal reference point (BM),fraction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to iearest road. 04-050-2-49-05-35-404-000-20000 Please print all informatlon. Reviewed by Data Property Owner Property Location ❑ Brian Patterson Govt Lot SE Y. BE '/. 5 35 T 49 N R 05 E (or) W Property Owner's Mailing Address Lot it Block # Subd. Name or CSM# W8490 530°1 Ave City Slate Zip Code Phone1Number ❑ City . 0 Village 0 Town Nearest Road New Construction Use: ® Residential/Numberol ❑ Replacement ❑ Public or commercial — Parent material TIL General comments and recommendations: 1 Boring # Code derived design flow rate QQ GPO Flood Plan elevation if applicable WA ft. ❑ Boring ® Pit Ground surface elev. 97.02 R Depth to limiting factory in. Horizon Depth In. Dominant Color Mansell RedoxDescription Du. Az. Cont Colo Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft° 'Eti#1 'EB#2 1 0-6 5YR 2.52 - SL lmsg mvfr cs 2v1 0.5 1.0 2 6-10 5YR 52 - LS Osg ml cw 2vf 0.7 1.6 3 10-06 7SYR 5/8 - S lmsg ml gs 7m 0.7 1.6 4 48-62 5YR516 - I S lmsg ml gb lm 0.7 1.6 5 62-72 5YR 518 - S Omsg ml - 1co 0.7 1.6 2❑ Boring H lIBoring Pit Ground surface elev. 97.28 ft. Depth to limiting factor In. nato CST Name (Please Print) Signs _ CST Number Edward Wroblewski Il 8718 Address Date E uabon Conducted Telephone Number 1210 5^ Ave W Washburn WI 54891 7/12/19 (715)373-5808 JUU-ti W (It04ns) C [ii V l ❑Boring # ® ❑ Boring ,. 3 pit Ground surface elev. 96.84 tL APR 21 207 Depth to limiting factory in. n I en,r..au.... fare Horizon Depth In. Dominant Color Munsell Redox Descripti Qu. Az. ConL Coidr Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPO/Ft' -Eif#1 -Eff#2 1 0-7 SYR2.512 - SL lmsg mvfr cs 2vf 0.5 1.0 2 7-11 51R 512 - LS Omsg ml ax 2vf 0.7 1.6 3 11-41 7SYR52 - S lmsg ml gs 1m 0.7 1.6 4 41.84 6YR6/8 - S lmsg ml gb 1c0 0.7 1.6 ❑ Boring# ❑ Boring ❑ Pit ' Ground surface elev. _ ft. Depth to limiting factor_ in. Horizon Depth In. Dominant Color Munsell Redox Descriptfor Qu. Az. Cont. Coloi Texture Structure Cr. Sz. Sh. Consistence Boundary Roots ^ flaw GPDIFP •Eff#1 •EO#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. — ft. Depth to limiting factor _ in. Horizon Depth In. Dominant Color Munsell Redox Oescriptionl Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots a.rr n nwuun new GPO/fl' E0#1 •E6#2 ' Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 5150 mg/4 - Effluent #2 = BOD, > 30:9 220 mglL and TSS > 30 5150 mg/L Brian Patterson Soil Test Plot Plan Edward Wroblewski, CST (� L C (5 �� f Legal Description: N 1/2 N1/2 SE SE �Uf� in Doc 2018R-575731 S35149N APR 21 2025 R05W, Town of Washburn, Bayfield i N Bayfield Co. Zoning Dept. County, WI. Scale: 1 " = 50' L O T L N E Comer Post Lot Line> 100' T McKinley Road Proposed Well Location Privy Boring Pit House Site Ely. - 98.86' 98.0' 97.50' 97.28' Pit 0 1 97.0' Ely. -97.02 BM & H & VRP Nail in base of 12' Pine Slope 3% Ely. - 100.0' Lot Line> 100' Page 2 of 2 Brian Patterson Septic System Plot Plan Edward Wroblewski, CST IfVtu(I Legal Description: N 1/2 N1/2 SE SE APR 2 1 ZUZ5 in Doc 2018R-575731 S35 T49N 1w� R05W, Town of Washburn, Bayfield 1\ Bayfield Cu. Zoning Depl. County, WI. ' Y Scale: 1" = 50' Lot une> 100 T Well Location 99.0' Garage i 750 Gallon Septic Tank L O T L N E Post McKinley Road 525 effluent filler 98.0' 97.50' rows of 8 Infiltrator Quick 4 chambers 97.0' D SM&H&VRP R Nail in base of 12" Pine Slope 3% 1 Ely. - 100.0' V E w A Y Lot Line> 100' Page 2 of 4 IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER min. 1Y (typical) Septic,Tank(s) Man acturer W1�5 (nrcr Septic Tank(s) Volume(s): gal gal gal gal E uept Filter Manufacturer Effluent Filter Model IS: [a a tY min, trench depth (lYpical) • TYPICAL TRENCH CROSS SECTION VIEW I (tyvcan (No Scale) System Elevation =• 95.5' (typical) Quick4 Standard -W w/ End Cap (typical) (Show location of inlet / outlet pipe connection on plan view.) tlr. ttr+l++e7}(par:: -------------- I B= ft (typical) INSTALL PER TRENCH: 4 Quick4 Std -W @ 20 fe EISA/chamber = c' ft' + �_ Pairs of end caps @ 6 ft' EISA/pair = L//ft' = Proposed EISA per trench = I L 6 ft' Provide minimum 3 ft separation between trenches. ObservationPipe TYPICAL TRENCH (typical) Install per manufacturors PLAN VIEW / Instructions. (No Scale) TA= soft ujl 1 INPInq m "—Quick4 Standard -W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers Instructions. Required Infiltration Area = ft2 x trenches = Proposed Total EISA = 3 ft' O m (A) ii Distribution Method: aru,�h1"\uiit�oL\ PAGE 4 OF 4 In -ground Gravity Management Plan IMPORTANT: The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 150 gpd; BODS ≤ 220 mgU'; TSS ≤ 150 mgL-'; FOG ≤ 30 mgtP Inspection Checklist INSPECT EVERY 3 YEARS rr o type of use ![)� •L c I 35LS o age of system o nuisance factors (i.e. odors, user complaints, etc.) 2025 o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution] drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose 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. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Big Lake Plumbing Local government unit: Bayfield County Zoning Local government unit address: 117 E 5th S, Washburn, WI Phone: 715-209-7521 Phone: 715-373-6138 ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. Reset Page j 4" CAST -A -SE -j INLET IOU In Y j • WLP750-MR AP TANK SPECIFICATIONS DIMENSIONS: WALE 2 1/2" BOTTOM: 3' CAST -A -SEAL COVER: 5" MANHOLE 24' I.D. PRECAST CONCRETE RISER HEIGHT: 54" OUTSIDE DIAMETER: 7-0" BELOW INLET: 42' LIQUID LEVEL• 37" WEIGHT: BOTTOM 3,740 LBS. COVER 2,410 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL /10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 20.28 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 790 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) I OUTLET na U II 0 - PUMP PAD CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE REVIEWED BY REVIEW DATE DRAWINGS SUBMITTEDI FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: 1/ OF BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS n Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) II l APR 211075 Check i Ist 1,1 Co. Zoning Dept x Original Sanitary Application (Submitted in Deed Holders Name — jio 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 drld Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) ji 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) f6 1 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached t��Ilco igsl I Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) O State Plan Review (when applicable) O Copy of Warranty/Quit Claim Deed (Optional) SanitaryADDlication, (Include the following Information) I Application Information must include: ,23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) &Project Address Q 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 Address Number and Road Surface Elevation of Body of Water l North Arrow 11 I Direction and Percent Land Slope �p Contour Lines k�❑ Tank and Filter Information and Location y� Structures and Driveways O Wetlands / Navigable Bodies of Water Boring Locations Absorption Area (Proposed and Existing) Property Lines Bench Mark (Location, Elevation and Description) Well Locations Component Manual Version Legal Descriptions .::conveyance line, building sewer line m Turn Over ► Cross Section and Over -Head Profile of the System; l5 C �c � V9 L Surface and System Elevation �J U APR 2 12023 1PJ Position of Observation and Vent Pipes Bayfield Co. Zoning Dept Dimensions and Depths Make, Model & Number of Chamber Units in each Cell Property Information 'How many systems will there be on this parcel of land? Has this property been split? ND (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 El Return Inspection $ 50.00 ❑ Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) u/forms/checkilsts/dieckll5tforsaNmryapps (1012009);(®7/2011);(®2/2012)(®5/7/2012 -dc) Proofed by: Private Sewage System Maintenance Agreement DOCUMENT NUMBER 2025R-606938 Owner(s) Name AC\Gt� Qte(c50 ,Address 1 111 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 03/25/2025 AT 8:05 AM RECORDING FEE: $30.00 Owner(s) Mailing 0 K W 8 �/�jo S ua s yo/l She Address —16a0 - `^le p , y l „ 'f pp SL( p I PAGES: 1 Tax ID # l p 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) rj L4 of 114 Section Township 4 N. Range OS W. Recording Area Rehire To: D I} (� Ij I� . Iss vv 0u L5 D Additional Legal Description: - Town of (p36kSV i\V.t�1N (Acreage) /O Govt Lot Lot _Block Subdivision Lot_ CSM#_ Vol._Page_ CSM Doc# .)"y (-G r Q �1VQ'025 jib W jC (yt_(�L L.avfiPlnt/r17 ra R In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ Other Septic (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. Fitter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sewaue 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 Bayfleld 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. Bayfietd 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 mll as a special assessment for the abatement of a human health hazard, and the tax shalt be collected as provided bylaw. 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 swom to before me on this date: 3I )91 as' `ttt 11111111111 rnn r Notarized Owner(s)— signatures) Notary lic �;j\G�JY��— My G remission Expires: t Drafted I Ott Date: y 01 u formslsenbarylsepticmaintenceegreement Revised July 2020 5/6/25, 11:54 AM Carmody'm BAYFIELD COUNTY SANITARY PERMIT (#04)-25-17S STATE SANITARY PERMIT OWNER: BRIAN P & PATRICIA A PATTERSON GOVT LOT: LOT: B LK: SE1/4 /4 SE1/4 /4 SEC: 35, T 49 N, R 5 W TOWNSHIP: Washburn SOIL TEST: 103-19 & 151-19 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: Mike Wroblewski CECE RUDNICKI Authorized Issuing Officer DATE: 5/6/2025 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: System elevation is 95.5'. Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 5/6/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION httnc•//www p:;rmnrivinr• rnm/ParmitAnn/Parmit Sinn acnx7Print=f &narmitnnniri=7dcQ 117