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HomeMy WebLinkAbout26-17Sl ,>r Department of Safety a I IJ' 1 & Professional Services, Industry Services ' on EMERED Sanitary Permit Application 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 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. 15.040)(m). Stats. P'! &# A/wuiva.soM DE Property Owner's Mailing Address L. y� 4lTo5 ft '6L5 &AD Bayfield Co City, State Zp Code 0 -ate, W/ Sya2 7/$'53�—ovrp/ II. Type of Building (check an that apply) Lot # 0 1 or 2 Funnily Dwelling — Number of Bedrooms 3 Block # ❑ Public/Conmemial—Desribe Ux ❑ Cityof ❑ State Owned — Describe UseCSM Number V. P244 0 Village of CJTownof CAt3LIE III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C 11 a hirable. A. r Mew System ❑ Replacement System Other Modification t Existing System (explain) ;[]A .❑B.HldingTank ®In -Ground ❑At-Grde ❑ Mound rdivitalal Site Design QOther Type (expleiu) (conventional) Qtenewal Before ❑Revision QChange of Plumber flflnsfert New Owner .tiPrevious Permit Number and Date Issued Expiration IV. Dispersal/treatment Area and Tank Information: Design Flow (gpd) Design Sol? Application Ita[e(gpd/st) Dispersal Area Required (st) Dispersal Area Pro 450 17 (9.43 &So I der System Elevation Capacityin Total # of Manufacturer Tank Information Gallons Gallons Units Ie New Tanks 5xisdog Tsal¢ 1 G u u C aU 'm� r5 iLU n. Septicortleidmg Took /'vwtconT LSA y'/'/ C/ -b unitary Perth Number (to be fill :3000 'mot, GovtLot .Lor/'CSKV.fo 5 Siq y. NW y,, Section 24 1vd. V. Responsibility Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MPIlv1PRS Number Business Phone Number Q�vNls �Zmsrau s�v , — asps/I 7'c -5$o-0254 Plumber's A,idress (Street, City, state, zip Code) 426.r:S iAv,wuO/I lib. CAlit r h/I Syt3Z/ St County/Department Use Only Approved 0 Disapproved Per,/miit,Fee Date Issued L g Si Lure / , / 9 Q ❑ OwnerGiven Reason for Denial 7TY/ — �i IG' / /1/ !'Y 2 371 2 aka 4 Attach to complete plans for the system and submit to the County only on pnper not lass Than 8 in x 11 inches In tine SBD-6398 (R. 03/22) " Wisb6nW gpa1 §S[fe S& Professional Services _ Page of 0037 . Division 7�7 eniroes s p w SOIL EVALUATION REPORT *XI.O. %&e In accordance with SPS 385, Wis. Adm. Code County Attach complete site plan of paper not less than 8112 x 11 Inches in size. Plan must include, - 01'22 9t.z Zd 3©�'a but not limited to vertical and horizontal reference point (BM), direction and percent slope, parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Rev a DateQ Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m))./fr'71/JL"9t Property Owner RECE1® Property Location s Z ❑ P ( $ ON P1° 4 M u,1,aso,! Govt. Lot .5'vl1 i SW 'i S 4 ' 143 N R og E (or) W Property Owner's Mailing Address DEC 08 20Z5 Site Address or CSM and Lot #. Loll VC p244 V I D5 FRA5..s / OA1) City, State, Zip PPhon O.Agency❑ City ❑ Village Town Nearest Road ui S4yg21 ( LA arm _ 41INScr ® NewConstruction Use: ❑ Residential/Numberofbedrooms Code derived deslgnflow rateGPD 0 Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material j6 Ai. oU7W4s./ General comments and recommendations: 4 vR/° /ate TDp / "5d • 4tDpt plo(sdu ", ? /N 7 Boring # ❑Boring y8. 5500 s �I , ZZ spit Ground surface elev. ft. Depth to limiting factor 1/2. in. / elev. ft. Q_:1 A....I?..a:_.. s_a_ Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. S Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 I Q � 7414. $) 41 _� +Sf CAD 1h.. j1s1,k CW TJ �r s 2 a -Zs Y/! 3 iV4. ,s s my r et I '7 3 ?-37 S Y 5' /o 6/4 Cs P d M I - , 7 /. Z 4 3775YR NA S rn W •7 /.7 S -74 5Ya A e5 . 0. M I W , 7 A 74- 78 S f Nh S s m UU •7 i, 2 7 78- //2 SY/? �o /YA C.5 DS n I Boring # Boring Q 007 ®Pit Ground surface elev. ft. Depth to limiting factor` __in. / eiev.q__s ft. *,.Ii AwMlins4iww 0 -6 - 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 I °-q s YR z. �- IVd 5 cV1 3vf = 5 '7 Z 9-2 (,qt !- mv,Cr CVJ Z -P , 7 1, 2 3 9--g8 4 S c,o& p5'rn I !{' : 7 /. Z 4_4Z_ 4S � r 5 R At ml 1�1 • 7 1, Z 5_6c-7 • �GQ 5Y/?V �J ivA O s j m • Mf/ - .7 /I z to 7? -$4 SVR s N4 G Os m v — .7 7 4-° 5YR 4'& /VA 5 O7 in ., II2. CST Name (Please Print) �S/�IUSsC-•/ SIgnatu . CST Number 7 ovo83 Address _I_2/5/y/5;c.(.58 Date Evaluation Conducted . I Telephone Number 7/r-5-06-6254 ' Effluent #1 = BOD > 30 s 220 mglL and TSS > 30 s 150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS s 30 mg/L SBD-8330 (R03/22) Page, Z ,of¢ Boring �fo 2 _ �.. ® Boring # ® Pit Ground surface elev. It. Depth to limiting factor in. I elev Sniff Annl!ni inn Rata Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *EIi#1 *Eff#2 a —q SYR a. ivA 5 Deb 2 4s?ic r w . 5 --35 5i '`f /5c4, 2,i sE,k incr W 24' , 2 35g 5Ya 4/4 IVA sc Os , ...:. .m 7 1.Z 68y s 5 YR ` NA Os v41 ,7 1.2 So14i sY 54 Nd S •- 1.6 ❑ Boring # ❑ Boring [,j Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Snl1 Annitntinn Rata Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ftz *Eff#1 *Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. / elev. ft. Sn11 Annifnatinn Rata Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIFt2 *Eff#1 *Eff#2 Effluent#1 = SOD > 30 s 220 mg/Land TSS a 3D:6 1 S0 mg/L *Effluent #2 = BOO, s 30 mg/L and TSS 30 mglL d 4/Ao5 ROAb WI 54$2 Tzez.'b2. Lor / off' sfr! V4 P z44 ' Sw)',N // ,SZ4T43NA'6 W PZZ 1 4 s A vi p /oo 'C To , " pvt pl pe Ar 84$ oP &1,d 0-E /3 igd L ' coo/ 1°/T / 4&S3' fr J `O z %3 S1�r"1 V 9s ,sa N ) Pe)v, __ L16 Foss SP - r�87�Bpv8.3 'w' c/4 ' Vj✓ 3� 202 S t 14MAA 1/4 Soil ProfleShest Owner: ,°eE rD4' i4/'WA/D&/ Soil Tester: i/ //$ AS/'14IS5AI S ►stem EIevat+on: 9 Load Rate: System Ran e-. 9 Gf 1p r � S�o /ao F rH:: - . << r' • ..... .... :: __ :.::: It04L5 x:;:1 J [U1� Bayfeld co. Planning and Zoning Agency REGENED In -Ground Gravity Plan DEC u 2025 Index & Cover Sheet ea a cO Component Manual Design References: FUnn;ng and zonin 9e fi1Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Pg2of4 r'9 3014 Pg4of4 Attachments: Index & Cover Sheet Plot Plan PAGE 1 OF Dispersal Area Cross -Section & Plan View Management Plan POWTS Applic Soil Evaluation Project Name I Description for Review & Site Owner Name(s): PU src3w A quNpsoN Phone: 7/5 .SS$ - OOla/ Owner Address: 4/b5 FREED, Ri. CA&L WZ' Zip: 54848 Project Address: 42 -co SUN9C-7' ROAD Gor►t. Lot: L 5' SW 1/4 of �y(1/4, Section 2 4 ,T 43 N -R o 8 E ❑ or W Township: CABLE County: L3AVP/ELO Project Parcel ID #: �`f a /P243o82¢z0 �© {ogpp lax Z.D. 9Gfl Designer Information Designer Name: JJENN/S A.Stc'ssay Phone: 7/ S -5.90 -o254 DessignerA))ddress: 42425 k°AVANAu46/ PD fa&E, 4WZip: 51S2/ E -m.311: L7C1117/kl.ZSmlIC {F17 /(/4G Q/1i71d'/. caei r6s oyucc rcocr - u for approval stamp. License Number: 22/574 Remarks: Signature•.. ----Date: ii J2S a Original signature required on each submitted copy IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Washed Aggregate Cover SOIL COVER iL\1 12 i min, trends ) depth L (typical) TYPICAL TRENCH CROSS SECTION VIEW (No Scale) 4'0 Perforated Lateral (typical) — s System Elevat(on = 7s5 ft (typical) #: min. 12" (typical) Septic Tank(s) Manufacturer: SypaAloR Co/yc,kleTa Septic Tank(s) Volume(s): %D0Q gal gal gal gal Effluent Filter Manufacturer: Effluent Filler Model#: OR 4e / ,TS 4444 0.5" TO 2.5" WASHED AGGREGATE ," (min. 6.0 beneath distribution pipe - min. 2.0" over distribution pipe and covered with approved synthetic fabric) I. Provide minimum 3 ft separation between trenches. OBSERVATION PIPE DETAIL (Nc5w e) Saex-Type or Sip Cap Qoose) "LJ- Flnlshad Grade (mulched 8 seededi 49 PVC Pipe ,'� ' j; TopeaQ Cover Top of pipe to terminate , '., • (ruin. 1 fool)at orabove fmished grade (4)1 f4" -1/2-X 6" Sbls - TYPICAL TRENCH (Show location of inlet / outlet pipe connection on plan view.) @9° apart s PLAN VIEW AnchoringDevke— % 4" 0 'r' (No Scale) Perforated Lateral (typical) Observation Pipe ft W (center lateral in trench) (typical) (typical) ol-- ------------------•-------- L -------------------------------------J 1_ B= Cos ft -i (typical) Required Infiltration Area = Gsb ft2 Proposed Total Infiltration Area = ,3Z 5 ft2 per trench x 2 trenches = GSTJ ft' IA s ft M (typical) W O m Distribution Method: cwtV. RECEIVED II�Pt�R�dl�'i: DEC 08 zozgn-cg ound Gravity Managemr ant Plan PAGE 4OF A Sayrea co. wo nOtng and Zpning A9 The owneraf is to -gamed gravhy system shall be res requir�xideris of SPS 382-384, Wise Admin. Code Pursuant S 388352 ! aeon and- -nainterrance pursuant to be considered a harrier: heaidt hazard if notmaintained in accordance (2)` Wises Adrltrtgeme,, this Fufihemrrtre all inspection and maintenance activvities shall be performedd by in in sha11 accordance with SPS 383.62 (3), aPPMvedrtanagemenipiarl ( 1. Wise Admin. Code Y registered POWTS en tntatrter in Zli&i4$+m MI Area QpLraniirn f fay`• , - Design Flow= 4SD gpdi RODS S 220 trial.ji 3Sl`≤15o mgL'; FOG 1 i y g Bat3pE_c.Flon GMMIS1 INSPECT 38 r o type of use YEARS o age o€ system o nuisance factors (La odors, user complaints, eta) o o n e anic malfunction (; a, pumps valves, switches, floats, etc.) al fugue (La, leaks, breaks, corosfoq etc.) o o SOlidseagle or voturrie in anaerobic treat[nent tank(s) and any distribution apptrrt„nan (s) fr-e•, distribvGon I drop o extent of panning distribution ceyp ng des g capjtj M prohibited acfirites, e A boxes) o ,dosing agulangin-ifa ort dosing ) o -decnicat components - tFaopcabte(La.., � re -cycling, float switch settings, o distrtruUon oareral or lateral orifice i- ..wiring, connections, switches, contrni ) o durface discharge of lateral or sewage gg� (measure lateral dislat pressure_ timer afarign etc.) back-up into structure sewed t° design spedtiea, on) l�l2trttE!rlance NTEVERY 3 YEARS (or when necessary) o ;teptic anr€ dose tankfsl shalt be pumped by a certtfjed septage servicing operator licensed under & 28?_48 Wis. ::hats. wltgtt the volume of solid's In the tanks) exceeds one-fbirr.! (9faj file liquid volume of the s) or es required by local ordinance_ Disposal of contents shall be pursuant to NR 113$ Wise. Admin_ Code. ac p ° a`t%lu°rt- `rtfsi shall be ins sccumulated solids a tact every 3 year3 and shall be cleaned when n sion-uts ccording to mantfiaciurer`s specificaFions A servicing eCesszry to r °rra any 9 period will always be greater than 12 System raair¢ertartce reports shall be submitted to the proper local goverttma r unit in accorrian Swith fl 38E.55 Wise. Admitt. Cate. l sport arty camponetp I j.,ure °r maifurciion 20: Name of fidividual or company: .Octtows RASM (IS(Eg----- Phone' 7/S'SS0'OZS4 Local gon3mment unit QaY2 '? y Local govr;runerrt tell: address: / / iE S rn IC' o Any defej,tnve part orthis system shall be wlZIPS'169/ Code. Repairer ce repaired, replar� f or removed purauarri to SpS 3835? ? , W No Beet formenc of urea or malfunctioning coriponenis shall comply witrt SP$ 383, Visa A de. accordanus chemical or physical restoration of the POWs S may be used unless approved by the d watt SPS 3K Wise. Admin. Code.eparimerrt in Contin®rincu Platt Infh2overt that any hailed freatmentcomponent4fthisPOIrUTScannotberepairedrtshallbereplacedpursuantis a plan sutnttified io the apprapdafe agency for review and approval. A failed In -ground dispe,mai component maybe abandoned and replaced by a code.complying dispersal component in a Pre-detarmrned orao of suitable soils. System /_+taandonnae If use ofthf> POW'ts is discontinued, it shall be abandoned in accordance with Spg3$3_83 Wsc Admrn Code SUPERIOR I LP10001-Compartment Tank SUPERIOR PRECAST CONCRETE PRECAST CONCRETE DEC 06 2025 TOP VIEW R"eiekt (in lb41annl �nd Z S9_ Tank: g. ,1S Lid: 3.340 cast ding rete tyof ;PC. Product File No: I This Is proprietaryinformatIon. and remains the Property ofsupenor Precast Concrete, LLC. I 11,305.19-MM41 DEC 06 2025 eayreb Co. planning and Znning Age Optanal float switch bracxt Orenco PSC-Series Srotube Effluent filter ppiicalcops. Handle Orenco PSC-SBIies Bioiuba elluent Flt lets are designed to rem solids from affluent leaving wastevafer tat Omn o s patent -pending PSC-Sedes 3ioiune E Event Filters are used to Improve the quality of effluent from wastewater tanks imp Quad effluent quatfi; extends rltainaetd life in onsde dispersal systems and imaroves the performance of dclmstieam tteatmemin effluent sewers_ The Siotuhe titer cariddge tits iighily in the housing While being easy 8?ohtha niter to rerove for maintenance. The passively self-cieardng design extends ca'6idae maintenanm cycle intervals. Filter mash is available in itBin or 116h (S _2mm or 1.6mm) mesh opening sizes The handle can be extended with PVC pipe (not indud6d} for belie access to the car6idge. A 31din (l9nun) diameter tee handle is included, Models PStSOb-21-18 and PSCW0621-18 are NSF 48 certined. Stamlard V ocie s PSCS0621-18,PSCW0621-18,PSCPS0621-18,PSCPWOo2i-18 rodugg Code Diagram 7eilec -plate Housing Pse Fe3MSftSI 0,- oka= /ataa 16{1. P = iri6nal aterIa of ConsM- O PVG. A8S Biaebe filter txr6idoe �� ��� Puiypmpyiene, D(.'P7i Deflector PVC• swnbN s steel ABS - 'r! C wrm:orsrtco.cam. rl--Fr-Frs-2 0621 Page 1 N 2 P F I U r 8.Ovarall " PSGPS0621-18 0- Heusin9 height in (mm) 7 r5 T 227 (SM C. Cartridge height in (mm) 21-0 (533) 21.0(533) 0.Oufet pipe ffiameter, in {mrr� i7.7a (-".51) 17.75 {451) E Oullet height to invert in (mm) 35(714) 4.5(114) F. t)egeCtOr plate diameter, m (mmj 735 (343) 135 (343) Mesh site, in lmm) 6.53 (168) 6.53 068) f71�surfacea ;tz(mkt1/16(1.6) 1/6(3.2) Rovi area, jr (mr 6.3 j0.59j 6.3 (0.59) a a., era is d�rk'Gat ge5 isrrtfr�sta r'1ra+�- + faG_ .,_-- 1.9 .78) -- 1.9 NTtB-Pr-FfsY R3 ® Owl Orence Systems® a 88-348-8843 a .r.1 941-459-4449° Wv W.oMeacem Paget gf2 OFFICE Sayflefd County, WIS. 5 43t3709 AT/'�apM. ON JAN 19 1998 INI _99T s ,o BAYFIELD C�uN iy cERTI1D SURVEY MAP #&22 CERTIFIED SURVEY MAP FOR A LOT IN THE SOUTH 1/2 OF THE SW 1/4 OF THE NW 1/4 LESS THE NORTH 165 FEET, SECTION 24-43-8W MAP LEGEND & KEY TO SYMBOLS SCALE' 1 INCH - 100 FEET 11111111111 I I 49. 50"3 0 60 100 200 300 RODS O 1-1/4 I. D. IRON PIPE SET, U. N. O. MO I I I O AL. SURVEY MONUMENT IN PLACE -I d DEGREES(ANG. MEAS.) BASED ON BRO. _ __WESTR. O. W. LINE OF C. L. OF STH W. 1/4 fL----------WEST --- --- - -- -- 8 rA. 239- COR. , 24 24 1' X I C. L. OF SUNSET41= !_...1p09 2aw 30' Lg. AL. I --- aM sl3s, .76' .76' ALW MONUMENT N Od 4841' W. 499. 065' MASONR j W/AL. CAP P. O. B. STAMPED W/ EAST R. O. W LINE NAIL LOCATION I 48 170'+/ - (SEE MON. ! 527-6' 7' RECORD) I LONG EXISTING I I 30'-3' T DWELLING -3' ZV I w 01 1 c I IL Z 4.59 A. w /PRIVATE 28 A RD. R. O. W. } U) E � 1 ACCESS I DRIVEWAY KATHLEEN Z U) I RASMUSSEN < j 19257' z �;ei:•�'i ry S 6 48' 2a' w. 498 43► J = pE5Aa pg F.�RS �' I j Q ASKI f Ri 24•_4., X56'6. ` ` OQ. HOUSE & GAI 0s i IN I S I KATHLEEN RASMUSSEN I Y I Q I.D. I.P. 1. Arthur J. Desrosiere. Wisconsin Registered Land Surveyor, hereby certify that in full compliance with the provisions of Chapter 236.34 Wisconsin Statutes, and under the direction of Kathleen Rasmussen. Owner. Route 1. Box 174. Cable, Wisconsin 541. that I have surveyed. mapped and divided the land herein described and that this map correctly represents the exterior boundaries of the land surveyed which is boated in the south one-half less the north 155 feet thereof of the Southwest One -Quarter of the Northwest One -Quarter of Section 24 Township 43 North, Range 8 West of the Fourth Principal Meridian. Town of Cable. Bayfield County. Wisconsin and described as follows, Commencing at the Aluminum Bayfield County Survey Monument marking the One -Quarter Corner common to Sections 23 and 21-T43N-RBW; Thence N 69d 0 W E. on the East-West One -Quarter Line of said Section 24-43-8W. 24.75 feet to a 1-1/4' L D. Iron pipe on the east right-of-way One of Sunset Road. which is the Point -of -beginning) Thence N Od 48 41' W. 499.07 feet. along said East right-of-way to a 1-1/4 ID. Iron pipes Thence N 60d 44' 21. T E. 430.84 feet to a 1-1/4' I. D. Iron pipes Thence S 6d 46. 29' W. 495 43 feet to a 1-1/4' I. D. Iron pipes Thence 8 89d 0W 49' W. 370.02 feet. following back along the E -W One -Quarter Line. to the 1-1/4' 1. D. Iron pipe which Is at the Point -of -Beginning. Parcel consisting of 4 60 acres •I- and subject to all easements and reservations of record. o ` CERTIFIED SURVEY FOR A LOT IN THE SW i /4, NW 1/4, SECTION 24-43-8W Sheet 1 of i �f ss- 0o qo Private Sewage System Maintenance Agreement m (S w2 SE!] 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 Hayfield 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 Township 143 N. Range $w Additional Legal Description: Town of ( _QAlt (Acreage) 4gl Govt Lot Lot Block Subdivision Lot! CSM#q o Vol. h Page CSM Doc#. g3g70c In -ground gravity O Mound DOCUMENT NUMBER 2O26R-61 1 328 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 03/06/2026 AT 1 1 :26 AM RECORDING FEE: $30.00 PAGES: 1 Return To: RECEIVED Planning and Zoning Department MAR 092026 O In -ground dosed ❑ In -ground pressure distribution Sewage System: D At -grade Sewage System ❑ Other Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. Pump Chamber (system types B, C, D, and E): The pump chamber shall also 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 manufacturers 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. Hayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges maybe placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall 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 "PYCFSTaN M , /}wllrJC$oti Subscribed and sworn to before me on this date: 63I o3�L2ip %IACYtL4 ,C. --t--._ Notarized Owner(s) — Signature(s) ignattu Notary Public N4 M. t\J y�N$j-EN tMy Commission4k*F r iS �EI2tvtAT�EN"i— l.1/'////7 ,4Z: _ t111111 Date: _________Tl� =of "sm�:. AU13L)I 21Z Proofed by: _ u/formslsanitary/septicmalntenceagreement Revised July 2020 13M FIELD Bayfield County Planning & Zoning Department 117 E 5th Sheet P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: AMUNDSON, PRESTON M 41905 FRELS RD CABLE, WI 54821 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00372 Transaction Number: SR-00372-398FD Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 2794 Paid by: Red's Septic Service & Repair, 41855 Namakagon River Rd, Cable WI 54821 Payment Type: Check Transaction Date: 3/9/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. 13AYFIELD 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: AMUNDSON, PRESTON M 41905 FRELS RD CABLE, WI 54821 Description Private Sewage System (Septic Tanks) Submission Number: SS -00690 Transaction Number: SS-00690-398FE Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 2794 Paid by: Red's Septic Service & Repair, 41855 Namakagon River Rd, Cable WI 54821 Payment Type: Check Transaction Date: 3/9/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-17S STATE SANITARY PERMIT OWNER: PRESTON M AMUNDSON GOVT LOT: LOT: 1 BLK: CSM: V.6 P244 1/4 1/4 SEC: 24, T 43 N, R 8 W TOWNSHIP: Cable SOIL TEST: 15-26 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: DENNIS RASMUSSEN TRACY POOLER DATE: 3/9/2026 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 €n 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: # 221516 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 3/9/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION