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HomeMy WebLinkAbout26-16ScRFd I Department of Safety Countyp n3' \ DA. 4 Z s 3/y & Professional Services, Number be filled in by Co.) -, -�/� Indrustry Services Division Sanitary Permit (to ^l 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 Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. {� T R T COi1D R. I. Application Information— Please Print All Information .Lf Is K'✓1. 1 - ,f q Property Owner's Name MAR 0 4 2026 J ol.meS L. S okn soy-\. Parcel # 3989 Property Owner's Mailing Address Bayfield Co. Property Location / 102_S 7 0o e -c. i Lot ke Drive. Planning and Zoning Agency Govt. Lot S w '/•, '/,' SectionZ City, State I W T Zip Code S S Phone Number 7'S-61 y• 6 2s vn \ n,o e - T N R E o W II. Type of Buil mg (check all that apply) Lot # e I or2 Family Dwelling—NumberofBedrooms 3 Subdivision Name Block # ❑ Public/Commercial — Describe Use ❑ Cityof __ ❑ State Owned— Describe Use O Village o£ CSM Number I Town of O o I. y Ill. 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. iS New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. M Holding Tank ❑ In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design In OthcrTypc (explain) (conventional) C. ❑ Renewal Before ❑ 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 Rate(gpd/sl) Dispersal Area Required (so I Dispersal Area Proposed 1st) System Elevation Capacity in Gallons Total Gallons # of Units Manufacturer E u Tank Information $ New Tanks I Existing Tanks 2-U u i� „ v h A i2- O W a S•'Fe�r HoldingTank ^O0 JL / riff f t,t✓v `ehc Pixiing Rsonbar .�. �- — V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) /�'" / ' Plumber's Si atutr r MP /MFRS Number Business Phone Number AI a n pet- lit � ZZ o o o Plumber's Address (Street. City. State, Zip Code) f o. . [o h (22 C."t ✓ -1 CVJY7 VI. County/Department Use Only Approved ❑ Disapproved $ Permit Fee Date Issued M Iss g t Si rare O Owner Given Reason for Denial17/3 Conditions of Approval/Reasons for Disapproval CeeG-a�,U 0 . Attach to complete plan for the system and submit to the County only on paper not less than 8 1/2 x 11 Inches in size SBD-6398 (R. 03/22) RECEIVED Elk- 00 917 MAR 0.4 2026 Soil Test # Bayfie Co. Bayf ie1thcounngASency Waiver of a Thorough Soil & Site Evaluation ENTERED (subject to 15-1-10(d)) I©v •j Pc a certified soil tester determine that in my professional judgment the following site (see below) is unsuitable for any treatment component other than holding tanks. Due to soil & site conditions, a thorough soil and site evaluation is not needed to make such a determination. Property Owner 3&,mty, L• JekMK6Y\ Contractor Property Address Warne. — 1i%a..vsj 5 Te... Authorized Agent W Cc i by Rey Zrov RI' vet, w Agent's Telephone, Telephone `l /S - 1s l g - 6 2. S I Written Authorization Attached: Y or N Accurate Legal Description is requested: S W 1/4 of 1/4 Section -Z O Township N. Rangeg_W. Town of 0 u/ u Additional Legal Description: Govt. Lot Lot Block Subdivision Lot CSM# Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# 3l G 9 Acreage 'f v Indicate reasoning for your determination: csS I C) G G. c,;L L nn -V- S u i 'c& L -? cat. v J o TI e,/ 5 V S+e. wv O . Signature of Co my Official Date Signature of Ckrtified Soil Tester 11-/ -as Date 11()(0S --3T Certification # (Submit a Plot Plan & Fee) u/forms/soiltestwaiver(KLK) June 2018 Page 2 of 4 System Plot Plan - Holding Tank Version 2.1 0 50 100 ft Owner: James L. Johnson Legal Description: SWI/4 of the SWI/4, Section 20, Township N 48N, Range 9W Town of Oulu, Bayfield County, WI Pipe Marerial /ASTM Standard (Tables 384.30-3 & 384.30-5) RECEIVED MAR 0.4 2626 Bayfield Co. Planning and Zoning Agency No wells on Prooerty W Colby Road Wieser proposed WLP2500 saa 3 Bedroor Home sat O CD CD m y t 3 D 3. 3 D s a ri D PAGE 1 OF 4 Holding Tank Plan Index & Cover Sheet RECEIVED Component Manual Design References: Holding Tank Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Holding Tank Specifications Pg 4 of 4 Management Plan MAR 047026 Bayfield Co. Planning and Zoning Agency Enclosures: Nld�tc vik Agrecrherti, 41olL1;IAti tavik_ Gt4.tcJL (i r.71 ISU Ghe.c.k, SCI resr checks IiS-r Project Name / Description OwnerName(s): JG.mes L. Jo nScv, Phone:7/S -1`/- 69S Owner Address: I Ua S-1 13pbcoi L k. Dr.g M el toca lI Zip: 5 5'S'f B_ Project Address: —Aliont -WC( =A , Iton �iv2r c,: tggq7 Govt. Lot: 51.3 1/4 of kJ 1/4, Section,T'/13 N-RcTE[II]or w Township: Oulu County: F u FiQ Project Parcel ID #: Designer Information Designer Name: A / ( A n ?c / A s t Phone: i's- 27L- WI S Designer Address: /3cS2-21- ✓o i , I . u'e.- LiZip: ____ I E-mail: To Y� c� E'_Ci V CcrYI License Number: 1 'V1.R S 7 Z o 0 9O Remarks: Signature: / ` Date: L ______ Original signature required on each submitted copy. W Colby Road Page 2 of 4 System Plot Plan - Holding Tank Version 2.1 0 50 100 ft Owner: James L. Johnson Legal Description: SWI/4 of the SW1/4, Section 20, Township N 48N, Range 9W Town of Oulu, Bayfield County, WI Pipe Marerial /ASTM Standard (Tables 384.30-3 & 384.30-5) RECEIVED MAR 042026 Bayfield Co. Planning and Zoning Agency Wieser sQ proposed I O Proposed Well m WLP2500sB2 g Bedroom I Location I m Home ----II- I a r CD CD rn 0 RECEIVED MAR 042026 Sayfield Co. Planning and Zoning Agency HOLDING TANK SPECIFICATIONS (No Scale) I7_[ol*fl rI Weatherproof 12" Min. or 2.0 ft above Junction and Approved Established Flood Elevation Alarm Box Vent Cap (typical) Electrical must comply vrith Approved Locking Manhole SPS 316 and NEC 300 40 Vent Pipe with Warning Label Attached —Conduit >10 It from (typical) 4" Min. or 2.0 it above Building Established Flood Elevation (typical) Airtight Seal Finished Grade 18" Min. (typical) ITT Inlet/ Approved Joints with J Inlet Invert Watertight Plug Approved Pipe 3 ft onto Max. 12" or 90% of total volume Solid Ground if more than one tank a P Alarm -On HOLDING TANK VOLUME _ , coo gal 3" Approved Bedding Material Beneath Tank TANK MANUFACTURER: (A) ieS2✓ Anchor tank as necessary pursuant to SPS 383.43(8)(g) PAGE 4 OF 4 Holding Tank Management Plan IMPORTANT: The owner of this holding tank(s) 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 holding tank(s) 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. Estimated Daily Wastewater Flow= Inspection Checklist INSPECT EVERY 3 YEARS MAR 042026 o type of use aayfield Co o age of system Planning and Zoning Agency o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (Le., leaks, breaks, corrosion, etc.) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o surface discharge of effluent or sewage back-up into structure served 300 RECEIVED SERVICING FREQUENCY o The tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wisc. Stats. when the wastewater in the tank(s) reaches a level of one foot below the inlet invert of the tank(s). Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. Tank pumping reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wis. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Iron River Septic Local government unit: Bayfield County Zoning Phone: Local government unit address: Washburn, WI Phone: 715-372-4006 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 component of this holding tank(s) cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agecy for review and approval. System Abandonment If use of this tank(s) is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. HOLDING TANK SERVICING CONTRACT RECEIVED Contract Date This contract is made between the MAR 0 4 2026 Bayfield Co. Planning and Zoning Agency We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT Legal Description: Tax ID# I CC,, X1/4, CU )) 1/4, LOCATION (Use Tax Statement) Q Town of: Lot Size Acreage Section ; , Township N, Range 1 W Oulu HO Gov't Lot Lot# 6M# Vol. Page CM Dec Lot(s) No. Block(s) No. Subdivision: 1. The owner agrees to file a copy of this contract with Bayfield County as required in SPS 383.55, Wis. Adm. Code. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local government unit which has signed the pumping agreement required by SPS 383.55, Wis. Adm. Code, and the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; Jordan Gabler d. The sanitary permit number issued for the holding tank; Notary Public e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each serving; State of Wisconsin g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local government unit and the County named above within (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed and Sworn to me: �� �on this 2nd day of �G��,^Z0ZCo by: rdan G- cA- ��s Notary Public JameS L i My commission expires on: cR Zo ZOZ- Revised: May 2016 (®May 2018) Drafted by Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)] WLP2500 TANK SPECIFICATIONS 1834" 4" CAST -A -SEAL 4" CAST -A -SEAL II ZYP / \ I FILTER OR l I BAFFLE tr•JYA*?4 RECEIVED MAR 0 4 2026 Bayfield Co. Planning and Zoning Agency DIMENSIONS: WALL: 3" BOTTOM: 5" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 55 1/4" O.D. LENGTH: 183-1/4" O.D. WIDTH: 101-1/4" O.D. BELOW INLET: 43" O.D. LIQUID LEVEL: 36" WEIGHT: TANK - 15,527 LBS. COVER 9,300 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 69.44 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 2,639 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 #9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE DRAWINGS SUBMITTEDII FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: W wn r N W e C8ui Ln Oa s N 9i H o 1w M 00 11 o z 0 a o F- 0 w N WARRANTY DEED This deed, made between William). Brandi a/k/a William I ( rECEIVED Brandt, by Carol L. Topp, his Attorney -in -Fact, Grantor, and MAR 0 4 2026 Barfield Co. James L. Johnson, Grantee, Planning and Zoning Agency Witnesseth, That the said Grantor, for a valuable consideration conveys to Grantee the following described real estate in Bayfleld County, State of Wisconsin: As Described in Attached Addendum/Exhibit A Return to: James L. Johnson 10257 Bobcat Lake Drive Mlnocqua, WI 54548 This is not homestead property. File No. 257395 Together with all and singular the hereditaments and appurtenances thereunto belonging; And the said grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except exceptions, reservations, easements and restrictions of record, and will warrant and defend the same. Dated this 16th day of September, 2025. Ci Po Z 7g1AA Carol L. Topp, as Attorney -in -Fact for RACHEL KROENING William J. Brand) Notary Public - State of Michigan County of St Clair State of Michigan ) My Commission Expires Feb 4, 2029 ) S.S. St. Clair County ) Personally came before me this 16th day of September, 2025, the above named Carol L. Topp, to me known to be the person(s) who executed the foregoing instrument and hereby acknowledge the same. This instrument drafted by: Michael S. Brandner Gowey Abstract & Title Company Inc. Rachel Kroening Notary Public, State of Michigan My Commission Expires: 02/04/2029 Completed via Remote Online Notarization using 2 way Audio/Video technology. ufam hnn in cArhh?IA-rf9A-Aa4R-R'%fr-.Q�,QI777hrI ADDENDUM/EXHIBIT The Southwest Quarter of the Southwest Quarter (SWi/4-SW1/4), Section Twenty (20), Township Forty-eight (48) North, Range Nine (9) West, Town of Oulu, Bayfleld County, Wisconsin. For Informational Purposes Only, the above described lands are designated with the following: Tax ID Number(s): 04-038-2-48-09-20-3 03-000-20000 04-038-2-48-09-20-3 03-000-10000 Property Address(s): Vacant Land on Oulu Rock Road RECEIVED Brule, WI 54820 MAR 0 4 2026 Bayfield Co. Planning and Zoning Agency RECEIVED BAYFIELD COUNTY MAR 04 2026 CHECKLIST FOR SANITARY APPLICATONS Bayfield Co. Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) Planning and Zoning Agency 't1 Check List fa Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) i I Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) Original Plot Plan (383.22(2)2. 3. & 4.a) t)if Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) W Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) IF Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) l Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) a Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) O ATU Servicing Agreement (Recorded at Reg. of Deeds) Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) I )(1 ! Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ State Plan Review (when applicable) l Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the followin Information) ci I Application Information must include: 'Ql $digit Parcel ID# -- (do not use 12 digits anymore --obsolete) ❑ Project Address or Road Name where driveway is/will come off of) J II Type of Building 'I III Type of Permit IV Type of POWTS System ❑ V Dispersal / Treatment Area Information P VI Tank Information JU VII Responsibility Statement (Plumber's Information) i(y *Date Stamp* Plot Plan: (To Scale or To Dimension) N Signature and Plumber Information El Surface Elevation of Body of Water 19 Direction and Percent Land Slope '6 Tank and-Fllter Information and Location ❑ Wetlands / Navigable Bodies of Water ❑ Absorption Area (Proposed and Existing) bi Bench Mark (Location, Elevation and Description) Component Manual Version I� Piping Material Information (conveyance line, building sewer line, material type and diameter) ❑ (Owners Phone Number) ❑ Address Number and Road North Arrow Contour Lines 7 Structures and Driveways El Boring Locations j(J Property Lines Pq Well Locations (A Legal Descriptions Turn Over ► Cross -Section and Over -Head Profile of the System: ❑ Surface and System Elevation RECEIVED %] Position of Observation and Vent Pipes MAR 0 4 2026 ❑ Dimensions and Depths ❑ Make, Model & Number of Chamber Units in each Cell Bayheid Co. Planning and Zoning Agency Property Information 0 How many systems will there be on this parcel of land? I f] Has this property been split? Alp (Property Statement shows Property History) Fees: ❑ Private Sewage System (Septic Tanks) $ 400.00 $J Private Sewage System (Holding Tanks) $ 400.00 ❑ Mounds or Systems requiring Pre -Treatment $ 500.00 ❑ Sanitary Revisions $ 25.00 ❑ Private Sewage System Reconnection $ 50.00 and Private Interceptor ❑ Return Inspection $ 50.00 ❑ Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) Wfonns/checklists/checklistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: HOLDING TANK 10IZ51 15,4ocwsf Lakc, Dr. James L Joknsofn ►In„noc %)o, t. T. r45*4g Parcel Identifier Number (PIN) Agreement Date (same as Notary Date) 39689 We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Stats. .5 VJ 1/4 of SW 1/4 Section O Township N. Range ______W. Town of QutU Additional Legal Description: gA'14teIJ COunSj, U);SrnnSir% Gov't Lot _ Lot_ Block_ Subdivision CSM#_ Lot_CSM # Vol _Page _CSM Doc# DOCUMENT NUMBER 2026R-61 1124 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 02/20/2026 AT 1 1 :01 AM RECORDING FEE: $30.00 PAGES: 1 Return To: Tony RlKoski S11S Got,hty Niyhway B Irvin R% e,r, '..us Sygy7 As an inducement to Bayfield County to issue a sanitary permit for a holding tank on the abFtElCEIQerty, we agree to do the following: MMa�pp nn 99��9� 1. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. CotlE�ff?I2fin4j ZV? Iding tank installation and maintenance. If the owner fails to have the holding tank properly serviced in response to orders issued by Bayfield County or the Department of Commerce to prevent or abate a human health hazard as described in s. 459 ,,1,CAay fiield County may enter upon the property and service the tank or cause to have the tank to be serviced and charge the'oWIY@4Cf i f7 rges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats. 2. Owner agrees to pay all charges and costs incurred by Bayfeld County for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 3. The owner agrees to contract with a person who is licensed pursuant to s.281.17 (3) Wis. Stalls., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced in accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed pursuant to s. 281.48 (3) Wis. Stats., and Ch. NR 114, WI's Adm. Code who shall submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfield County may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being property maintained. 5. This agreement will remain in effect only until Bayfield County certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. SPS 383, WI's Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will per ' the existence of the agreement to be determined by reference to the property where the holding tank is installed. Owner(s) Name(s) — Please Print J 0. m e .s L. J AN n$ o h Subscribedand sworn to before me on this date: 0t v 4 Owner)— Signature(s) Nota Pu tLNotarized O4 My Commission Ex ires: p� ol 20 Z -o2- 1 Drafted by: To v%1 Po t kas 11 Date: I — 2l rn — a G Personal information you provide may be used far secondary purposes (Privacy Law, s.1 5.04 (I)(mlj ulformslsanitarylholdingtankagreement.doc ®June 2015 BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS CEWD Submit the Following (Use Permanent Ink): MAR 0 4 2026 '0 Check List Bayfield Co. 10 Index Page / Title Sheet (Optional) planning and Zoning AgencY ❑ Original Soil Evaluation Report (Submitted In Deed Holders Name — not prospective buyers) ,O Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) Additional Information (Warranty/Quit Cairn 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 Property Owner's Information (OQ.t prospective buyer's name) `J Property Location (Accurate Legal Description with Sec/Twp/Range) 'J Road Name (where driveway is/will be coming off of) ❑ Floodplain Elevation, Flow Rate, Comments and Recommendations f!] Complete Soil Boring / Pit Information Date Soil Evaluation was conducted iji CST Name, Signature, Number, Address and Phone Number V *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) IM Bench Mark (Description, Elevation and Location) ❑ Contour Lines (Example = 98.0' /96.0' /94.0') JO Property Location (Sec/Twp/Range/, Accurate Legal Description) l Borings (Locations and Elevations) ❑ Percent and Direction of Land Slope I Well Location (Including Neighboring Wells, if applicable) 0 Location of Wetland Areas, Floodplain and Navigable Waters I I Buildings, Driveways, and Structures (Location and Descriptions) I Location of Property Lines ❑ Existing System Location ❑ Address Number and Road Name 0 Current Surface Elevation of Wetlands and Navigable Waters [ CST, Owner and Property Information 09 North Arrow Fee: Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checkllst/checklistforests AFIELD 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: JOHNSON, JAMES L 10257 BOBCAT LAKE DR MINOCQUA, WI 54548 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00387 Transaction Number: SR-00387-3FC91 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 2503 Paid by: Polkoski Soil 2 Septic, 5115 County Highway B, Iron River WI 54847 Payment Type: Check Transaction Date: 3/6/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. L1! YFIELD Barfield County Planning & Zoning Department 117 E 5w Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: Submission Number: JOHNSON, JAMES L SS -00710 10257 BOBCAT LAKE DR MINOCQUA, WI 54548 Transaction Number: SS-00710-3FA95 Description Amount Private Sewage System (Holding Tanks) $400.00 Total: $400.00 Payment Amount $400.00 Reference: 2503 Paid by: Polkoski Soil 2 Septic, 5115 County Highway B, Iron River WI 54847 Payment Type: Check Transaction Date: 3/6/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-16S STATE SANITARY PERMIT OWNER: JAMES L JOHNSON GOVT LOT: LOT: BLK: SW 114 SW 1/4 SEC: 20, T 48 N, R 9 W TOWNSHIP: Oulu SOIL TEST: 14-26 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: ALLAN POLKOSKI TRACY POOLER Authorized Issuing Officer DATE: 3 2026 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. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 3/6/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION