HomeMy WebLinkAbout26-5SSS-oo 696
Department of Safety
CountyEF7TEREli Bayfield
V14V
& Professional Services,
ces rSani
try Pe tit Number (to be filled in by Co.)
Industry Services Division
a6-ss
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
purposes in accordance with the Privacy Law. s 15 (14(1 )(m). Stats.
66172 North Point Dr
I. A lication information— Please. Print All Information
Property Owner's Name
Parcel a
CLAUDEEN E MC AULIFFE REV TRUST RESTATED 8/3/2023
04-024-247-08-21-4 00-327-40000
Property Owner's Mailing Address
- 21351,41;e „
Property Location I/I b
1
Govt. Lot
'/., '/e. Section 21
City, Slate G / 1 Zip Code
o ul- (nt'�if 1 Wa,� SN7o3
Phone Number
T 47 N R 08 E o
II. Type of Building (check all that apply)
Lots
® I ur 2 Family Dwelling — Number of Bedrooms 1
4
Subdivision Name
Allison's Acres
Block
❑Public/Commercial — Describe Use
❑ City of
0 Village of
❑ State Owned— Describe Use
CSM Number
® Town of Iron River
III. Type ofPOWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if
a Ucable.
4.
I "New System
El Replacement System
❑ Other Modification to I \ stmg System (explain)
❑ Additional Pretreatment Unit (explain)
O Holding Tank
LJ in -Ground
O At-GradeDesign
❑ Mound
O Individual Site
❑ Other Type (explain)
(conventional)
C.
O Renewal Before
❑ Revision
❑ Change of Plumber
❑ Transfer to New Owner
ist Previous Permit Number and Date Issued
'
Expiration
IV. .Dis
rsal/freatment Area and lank Information:
Design Flow (gpd)
Design Soil Application Raie(gpd/sf)
I Dispersal Area Required (A)I
Dispersal Area Proposed (sf)
System Elevation
150
0.7
214.3
225.2
94.6'
Capacity in
Total
0 of
Manufacturer
Tank Information
Gallons
Gallons
Units
B
to v
u
New Tanks I
Existing Tarts
u p
v 2
u
a
n
a` V
rn y
rn
ii U
a
Septic or Holding Tank
840
-
840
1
Wieser
Dasing Chunber
500
-
500
1
Wieser
V. Responsibility Statement- I. the undersigned, ass me respo ility for Installation of the POWTS shown on the attached plans.
Pl anther s Name pnnil
Plw b 's ti • rteI
MP/hIPRS Number
Business Phone Number
6 3
IS-2oq -0/6
Plumbers ress (Street, City, State, Zip Code)
(3 0 C4H- . Sq8
VICourt /De artment Use Only .sic-..
Approved
0 Disapproved
PPermit Fee
I Dare Issued p)L
Issue g A t Si attire
❑ Owner Given Reason for Denial
L bD
Conditions of Approval/Reasons for Disapproval
(4W di/i4c - RECEIVED
JAN 1,4 2026
Anach to complete plans for the system and submit to the County only on paper not less than a Ills II inches in sue � � Co
Planning and Zoning Agency
SBD-6398 (R. 03/22)
(.
Wisconsin Department of Safety & Professional Services
Division of Industry Services i_._/
Count SOIL EVALUATION REPORT
rb
In accordance with SPS 385, WIs. Adm. Code Y
Attach complete site plan on paper not less then 8 1/2 x 11 inches in size. Plan must Include,
but not limited to vertical and horizontal reference point (SM), direction and percent slope, Parcel I.D.
scale or dimensions, north arrow, and location and distance to nearest road. 43 •
Please print all Information. Reviewed by •
Page 1 of'I
Planning
Personal Information you provide may be used for secondary purposes (Privacy Law, a. 15.04(1)(m)). 1 , l I g 0�a6
Property Owner I Property Location ❑ I?
1-1-GNUTf.L. ,frnLMeI- Govt. Lot Y. 'A S it T 47 N R Ob E (or) W
Property Owner's Mailing Address Site Address or CSM and Lot #:
(a Z.v S Co. 1z Col)2 jvv.e%t-eo &T- 732. I ftorr tz-1Vc7L, W.3r
City, State, Zip Phone Number Cl City ❑ Village ® Town Nearest Road' l
Poieot-t4.r
.-, T 57&'6^( ( ) i (Low, p.f1/C�•l /dunT-q poyrr pIt-
5I New Construction Use: ® Residential/Numberof bedrooms 7 Code derived designfow rate 4sb GPO
❑ Replacement ❑ Public or commercial — Describe: Flood Plan elevation tf applicable. ft.
Parent material !'(l'}t:.t/Jt.t'-
Generalcommentsandrecommendations: IDEi/G"-' ru O•7
❑Boring
{ Boring # [@Pit Ground surface elev. •7Sft. Depth to limiting factor >II p in. / elev.' .ceft.
Soil Application Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Cu. Az. Cont. Color
Texture
Structure
Gr, Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
•Eff#1
tEff#2
*-1O
7y 1st ='s�
SL
zMfl —
rhv i'
(Ot)
l ./4-
, o.G.
,.o
7-
/ a -w -t
A-"
oSG
fL.I
CU
-F)dJ
1. c
3
fl"/i0
7A.
-
Su
o16
__
r
iEn
I G
c✓ j
RECERED
3. S
JAN 14flZ6
Ddy11CIV LA.).
❑Boring Planning and Zoning Agency
96si
Z Boring # Pit Ground surface elev. ft. Depth to limiting factor) I I in. / 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/Ft2
•Eff#1
'Eff#2
6,g
7.5 YA-`.Vt
._
SL
2n3'Z.L
Mvs&
L)
zJ(u l-
/ •
8-x4
5`71-"/4
LJ
rs'
&L'
Irf
v.
1•(v
3
'1././
7 wr K/c
—
SLJAa
of G
A. I
, a.
MD
g3jf
CST Name (Please Print)
Signature
CST Number
w., CA -4R -x-
•--
,'1767r)
Address
Date Evaluation Conducted
Telephone Number
n Qo � cMc.d. W7=
/o G ZeLI
/J-7 V--7JSS
• Effluent #1 =BOD> 30 S 220 mg/L and 155>30 5150 mg1L Effluent #2 BOD, 530 mg/L and TSS530mg/L
CHECK BOX AS APPLICABLE.
CHECK BOXAS APPLICABLE.
® SOIL EVALUATION
Scale: 1 40'
❑ SYSTEM PAGE 2 OF
0
SITE MAP
40
60 80
PLOT PLAN
PROJECT N AME:
101
9
DESIGN FLOW: ! sO GPO
(10l gild)
HULA- E$
Attach design low calculations for commercial plans.
PROJECTADDRESS: 6-' )—yt. M o -TTy- PotNT c�
Pipe Material / ASTM Standard (Tables 384.30-32.3
BM Symbol: Y CM Elevation: ./0' V FT
N
Sanitary sewer: / li C
BM Descrlptlon: 1L. 9- EL% fltdM /Z " COA-K—
Face Main: /—ter_____ 202
MJO L 4
Slope Gradient (%) t (e"/. Well Symbol (If applicable): p
Indlcatonodhby
drawing anauw,
IMPORTANT:
Show ground elevation contours at suitable infbty✓thld Co.
SlopdAre
an the epproprhe line.
PlAnninn and
7nnina Ar,
4
II —
I i L r_4
)
I
I
!
SOIL PROFILE
SHEET
RECEIVEt)
OWNER:_ L1r 1+ Ehsc2>— S _ .. SOILTESTER:
) �^^. Lca2&--
AUG 2.4 2022
`� 1
SYSTEM ELEVATION: Q .:P LOAD RATE:- -
SYSTEM RANGE: g3:�g
�. 7 .5 �ayfeld Co.
1 o ► ) qq,-17s'
QE.s i
" ning Agnwj
93
q•J-rt Aete
,0O - - —
-- --
-+
-- -- --
9
-- -
--
-- —
— 97,37' —
97 -- - --
- ----RECEIVED
-- - - -
— -
-JAN 14 2026
9�
-- -- ' __
-- -__
-_ Bayfield Co.
fanning and Zoning Agency
g5-- -- ------
--
--
—
__
q0
-- --- -- ---
87 - - --
--
Page_of-
CLAUDEEN E MC AULIFFE
II 04-024-2-47-08-21-4 00-327-40000
II ALLISON'S ACRES LOT 4
U
Keith
Property Owners Name
Property Address
Tax Parcel Number
County
Legal Description
Section
Town
Range
Page Index
1 Property Information
2 Data Entry
3 Plot Plan
4 Drainfield Cross -Section
5 Tank Information
6 Maintenance Plan
7 Contingency Plan
Designer Name
Designer Signature
Designer License Number
Designer Phone Number
Date
RECEIVED
JAN 142026
Bayfield Co.
planning and Zoning AgenCY
Page 1 of 7
icy
Page 2 of 7
McAuliffe (1 bedroom)
Soil Report Plot Plan
North
/O1
@roposed site of
1 bedroom dwel
Wieser W840/500 -N
w/ polylok 525 filter
& Goulds WE05HH p
Scale 1:60
-4—
x Bench Mark = Nail & ribbon in 12" oak
Elev = 100.0'
CLAUDEEN E MC AULIFFE REV TRUST RESTATED 8/3/2023
66172 North Point Dr
ALLISON'S ACRES LOT4 IN DOC 2025R-608454 TOG W EASE
521 T47N R08W
Town of Iron River
04-024-2-47-08-21-4 00-327-40000
4.170 acres
NOTES:
- No well
- All vent, observation & conveyance pipes
4" ASTM D1785 or code equivalent
D
a
kg y m
Page 3 of 7
Cross Section of an In Ground Component Cell
Using Leaching Chambers
Observation/Vent Pipes
Finished Grade 98,70 ...............0
Slope 6% __
Original Grade 98.70
Top of Chamber 95.60
® i ) '
System Elevationr 94.60
c
°• Trootment and Dispersal Zone
a
Limiting Factor
Observation/Vent pipes to be constructed and
capped with approved materials for the particular use.
47 feet -
I Vent Pipes to be located at the ends of the distribution cells.
JAN 1420
hayfield Co.
planning and Zoning
■ LT
Page 4 of 7
Approved Manhole Covers Witn Warning Lcbe's
and Locking Device / 4" Min. Above Final Grade
Weather Proof Junction Box
Electric per NEC 300 & COMM.
4' Sch. 40 Vent / 16.28 WAC
>or= to12' 4, C
Above Final Grade n
Alternate Outlet Location
W/Approved 4' Sleeve
fon
Inlet (� A II 2 inch iph
Polyiok PL -525
n..fee eep Hde or Anti Siphon Device
C
Wieser 840/500
al Difference Between Pump Off and Inlet to Chamber
h of Forcemain(ft.) Inches Gallons
main Diameter (in.)
1n Factor per 100ft.
1n Loss
Dynamic Head
A
24.0
283.4
B
2
23.6
C
5.0
59.3
D
12.0
141.8
TOTAL 43.0 508.3
ter of Doses per Day
is per Dose (Not to exceed 20% of Daily Design Flow)
ie of Forcemain Backflow
Dose Volume
Tank Capacity (Gallons)
Tank Volume (Gallons / Inch)
Level (in)
Type
RECEIVED
JAN 142026
Bayfieki Co.
Planning and Zoning Agency
Tank Alert 1 Alarm
METERS
FOCI El
Ja
.. _..___
51g 5OlDS
in50
x
w.ft W
I 1t
120
F'
wfo>
I
0
a
�0 10 l0
i0
IYI
40 >0 If0 1 �J0 �W GrM
Gv�[m
Page 5 of 7
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 6 of 7
FILE INFORMATION
Owner CLAUDEEN E MC AULIFFE REV TRUST RESTATED 8/32023
Permit #
DESIGN PARAMETERS
Number of Bedrooms
1
O NA
Number of Public Facility Units
® NA
Estimated (average) flow
100 gal/day
Design (peak) flow = (Estimated x 1.5)
150 gal/day
In Situ Soil Application Rate
0.7 al/da /ft2
Standard Influent/Effluent Quality
Monthly average'
Fats, Oil & Grease (FOG)
530 mg/L
Biochemical Oxygen Demand (BODE)
5220 mg/L
❑ NA
Total Suspended Solids (TSS)
5150 mg/L
Pretreated Effluent Quality
Monthly average
Biochemical Oxygen Demand (BODs)
≤30 mg/L
Total Suspended Solids (TSS)
530 mg/L
® NA
Fecal Coliform (geometric mean)
510cfu/100ml
Maximum Effluent Particle Size
% in dia.
❑ NA
Other:
® NA
`Values typical for domestic wastewater and septic tank effluent.
MAINTENANCE SCHEDULE
Service Event
Service Frequency
Inspect condition of tank(s)
At least once every:
year(s) 3 month(s) (Maximum 3 years)
®
O NA
Pump out contents of tank(s)
® When combined sludge and scum equals one-third (''4) of tank volume
O NA
O When the high water
alarm is activated
Inspect dispersal cell(s)
At least once every:
3 ❑ month's) year's) (Maximum 3 years)
®
O NA
Clean effluent filter
At least once every:
3 ❑ month's)
year')
® s
O NA
Inspect pump, pump controls & alarm
At least once every:
3 ❑ month's)
® year's)
O NA
Flush laterals and pressure test
At least once every:
❑ month(s)
O year(s)
® NA
Other:
At least once every:
O month(s)
O year(s)
® NA
Other:
® NA
SYSTEM
Tank Manufacturer
Wieser
❑ NA
® Septic O Dose O Holding
vol. 840
gal
Tank Manufacturer
Wieser
® NA
❑ Septic ® Dose O Holding vol. 500
gal
Effluent Filter Manufacturer
Polylok
O NA
Effluent Filter Model
525
Pump Manufacturer
Goulds
O NA
Pump Model WE05HH
Pretreatment Unit
® NA
O Sand/Gravel Filter
O Peat Filter
❑ Mechanical Aeration
❑ Wetland
O Disinfection
O Other:
Manufacturer
Dispersal Cell(s)
O NA
® In -Ground (gravity)
O In -Ground (pressurized)
❑ At -Grade
O Mound
❑ Drip -Line
O Other:
Other:
2 NA
Other:
® NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The
dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for onding of effluent
on the ground surface. The ponding of effluent on the ground surface may indicate a failing coiR1Los the immediate
notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any treatment tank equals one-third (''4) or mpt(�pf4h trty)lypotume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordan l h h p 113, Wisconsin
Administrative Code.
f3ayfield Co.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressI�9lQtmIflPffl1qatment units,
and any servicing at intervals of ≤12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMW (12/02)
Page 7 of 7
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the
contents of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will
be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within
15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain
(sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products;
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure jisiJi�erIy
and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: R
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. JAN 1 4 2026
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
Bayfiekl Co.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the TJVtIip9@8490R4i4iP`s'r?SIY,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology
a holding tank may be installed as a last resort to replace the failed POWTS.
The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may
be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER
Name
Phone
POWTS MAINTAINER
Name
Phone
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name Name gayffeld County Zoning
Phone Phone 715-373-6138
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies in compliance with chapter
Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
BAYFIELD COUNTY Claudepn McAuliffe
CHECKLIST FOR SANITARY APPLICATONS
Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e))
19 Check Ust
ig Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1;)
0 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c))
0 Original Plot Plan (383.22(2)2. 3. & 4.a) RECEIVED
IZ Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer ' JAN 1 4 2026
0 Pump Tank Diagram, Alarm and Pump Curve (when applicable)
0 Contingency Plan Management Plan 383.22-3 2 b 1.f. ManningBardZOn gAge„ 9 cY / 9 ( ( )( ) )
0 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)
V Fee (Make Check Payable to Bayfeld County Zoning) (383.21(2)(c)7)
0 2 ComDlete Sets of Plans (383.22(2)(2.) (Note: Sanitary Aoolication and Maintenance Agreements are to be attached
to all conies)
0 Soil and Site Evaluation Report (383.22-3(2)(b)1.e.)
❑ State Plan Review (when applicable)
❑ Copy of Warranty/Quit Claim Deed (Optional)
Sanitary Application: (Include the following Information)
V I Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete)
V Project Address g_r Road Name where driveway is/will come off of)
V II Type of Building
V III Type of Permit
V IV Type of POWTS System
6d V Dispersal / Treatment Area Information
• VI Tank Information
IZ VII Responsibility Statement (Plumber's Information)
i ' *Date Stamp*
Plot Plan: (To Scale or To Dimension)
lZ Signature and Plumber Information
IZ Surface Elevation of Body of Water
V Direction and Percent Land Slope
0 Tank and Filter Information and Location
V Wetlands / Navigable Bodies of Water
19 Absorption Area (Proposed and Existing)
1a Bench Mark (Location, Elevation and Description)
iZ (Owners Phone Number)
iZ Address Number and Road
V North Arrow
V Contour Lines
0 Structures and Driveways
0 Boring Locations
V Property Unes
0 Well Locations
21 Component Manual Version 0 Legal Descriptions
Piping Material Information (conveyance line, building sewer line, material type and diameter)
Turn Over ►
Cross -Section and Over -Head Profile of the System:
IZ Surface and System Elevation
{� Position of Observation and Vent Pipes
0 Dimensions and Depths
IZ Make, Model & Number of Chamber Units in each Cell
Property Information
0 How many systems will there be on this parcel of land? 1
0 Has this property been split? no (Property Statement shows Property History)
Fees:
0 Private Sewage System (Septic Tanks)
$ 400.00
❑ Private Sewage System (Holding Tanks)
$ 400.00
RECEIVED
❑ Mounds or Systems requiring Pre -Treatment
$ 500.00
❑ Sanitary Revisions
$ 25.00
JAN 142026
❑ Private Sewage System Reconnection
$ 50.00
Ba Ccand
Private Interceptor
Planning and ZoningAgency
❑ Return Inspection
$ 50.00
0 Maintenance Agreements +
$ 30.00
(checks made out to Reg of Deeds)
u/forms/checklists/checklisforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: —
Private Sewage System Maintenance Agreement
Claudeen E McAuliffe REV TRUST RESTATED 8/3/2023
2935 Leslie Ln Eau Claire WI 54703
66172 North Point Dr Iron River 54847
Tax ID #
19631
As owner, I (we) do hereby certify the private sewage system will be installed in
accordance with the certified soil tester's report and approved plans and specifications
on file with Bayfield County Planning and Zoning Department. The system will be
operated in such a manner as to meet the designed plans. I (we) agree to maintain said
private system at the below listed location in accordance with rules established in the WI
Adm. Code, as from time to time amended. (COMPLETE Legal is required)
1/4 of 1/4 Section 21 Township 47 N. Range 08 W
ALLISON'S ACRES LOT 4 IN DOG 2025R-608454 TOG W EASE
Town of Iron River
Lot Block Subdivision
(Acreage) 4.17 Gov't Lot
Lot CSM# Vol._ Page CSM Doc#
❑ In -ground gravity ❑ In -ground dosed
❑ Mound O At -grade Sewage System
DOCUMENT NUMBER
2026R-6 10687
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY. WI
RECORDED
O 1 / 1 4/2026 AT 1 0:27 AM
RECORDING FEE: $30.00
PAGES: 1
Recording Area
RECEIVED
Planning and Zoning Department
JAN 15 2026
Ravfield Co.
• In -ground pressure distribution Sewage System:
❑ Other
Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of
installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make
such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum.
Pump Chamber (system types B, C, D. and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided
above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components.
Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance
with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code.
Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified
septage servicing operator. POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three
(3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface.
Mounds, At -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 thirty (30) days
from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges
may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law.
The terms and conditions of the variance shall be binding upon and inure to the benefit of all current and future owners of such property.
Owner(s) Name(s) — Please Print
Claudeen E. McAuliffe Trttr-1-€e
Subscribed and sworn to before me on this date:
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Revised June 2018
P YFIELD 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:
CLAUDEEN E MCAULIFFE REV TRUST
RESTATED 8/3/2023
2935 Leslie Ln
EAU CLAIRE, WI 54703
Description
Private Sewage System (Septic Tanks)
Submission Number:
SS -00696
Transaction Number:
SS-00696-3B6B0
Amount
$400.00
Total: $400.00
Payment Amount: $400.00
Reference: 37227
Paid by: Dykstra Construction, Inc., PO Box 125, Iron River WI 54847
Payment Type: Check
Transaction Date: 1/22/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
BAYFIELD COUNTY
SANITARY PERMIT (#04)-26-5S
STATE SANITARY PERMIT
OWNER: CLAUDEEN E MC AULIFFE REV TRUST
GOVT LOT: LOT: 4 BLK:
SUBDIVISION: Allison
1/4 1/4 SEC: 21, T 47 N, R 8 W
TOWNSHIP: Iron River
SOIL TEST: 117-22
REPLACEMENT SYSTEM
SYSTEM TYPE: Non -Pressurized In -Ground
PLUMBER: GREG BROWN
TRACY POOLER DATE: 1 /22/2026
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 #: 22-112S
LICENSE: # MP699374
Condition: Properly Maintain System Per Recorded Agreement. Old System needs to be properly
abandoned per SPS 383.
THIS PERMIT EXPIRES 1/22/2028
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION