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HomeMy WebLinkAbout25-84SRDepartment of Safety Go"°ry �� & Professional Services,, Perini „artier (to be filled in by Co.) S SS o O S 1 R Industry Services Division D Sanitary Permit Application RECEIVEDState Transaction Number 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 fS1ai544)&d to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary SI 230 Lrl� pp�7• Purposes in accordance with the Privacy Law, a. 15.04(t)(m), Stab. L Application Information —Please Print AB Information Planning and Zoning Agency Property Owner's Name Parcel!! 1 y 13 0l0txj farare1iwn ENTER d OOl-Z-vv-O-owl o500$ Property er's Mailing Address j' �/ OO PropertyLocative tJ I (a t ' r ° F IVY S I44ry 2t�Zl Aa..i„ S�. In a�z,ya) r 2oava6ov9g1 Govt Lo[ N '- City, State I Zip Code Phone Number L aCl oils lMi 5'-/ OI (QA9--738- 91V& •,, v., Section T [.l 1 N R gB or U. Type of Builhing (check all that apply) Lot P 1 or 2 Family Dwelling — Number ofBedrooms ,'3 Subdivision Name O Public/Commercial — Describe Use Block it ❑ City of ❑ Village of ❑ State Owned — Describe Use CSM Number W Town of l3nny≤ 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 Y ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) & ❑ Holding Tank ® In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision Cbange of Plumber ❑ Transfer to New Owner ist Previous Permit Number and Date Issued Expiration — q§ 7/3•1/� l IV. DispersaUTreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required (sI Dispersal Area Proposed (s( System Elevation 0 0. I_& i I_(-1G.G' I 99 Capacity in Total U of Manufacturer Tank Inforrvation Gallons Gallons Units °' New Tanks Eusting Tacks o °7 �p u at .0 m CJ rn m Septic mHolding Tank _ ld°n l wit X _ — Dosing Chamber — — V. Responsibility Statement— I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Nan, (Print) Plumber's Signature MP/MPRS Number Business Phone Number T/l S 3Z i7 !7- Z/ Plumber's Address (Street, City, State, Zip Code) Si bre County/De artmentU Only ved Cl Disapproved Permit Fee $ Date Issued Iss 'till A t Si ❑ Owner Given Reason for Denial I l�_J � �/ Np Conditions of Approval/Reasons for Disapproval d u sen to complete plans or we system and submit to the County only on paper not less than 8 5/2x l l inches in size SBD-6398 (IL 03/22) Tracy Pooler From: Petzel, Katie - DSPS <katie.petzel@wisconsin.gov> Sent: Wednesday, April 22, 2026 4:26 PM To: Tracy Pooler Subject: RE: change in plumber - intelectual property? Hi Tracy, A new plan is required unless a designer designed the system. I'm not a lawyer, and it doesn't say this directly in the code anywhere, but unless they have permission or something like that to use another plumber's design, it's unethical. It's also just really bad practice as the submitting plumber is taking responsibility for the system. I wouldn't want to submit someone else's design (without them taking some responsibility like a designer would) for liability reasons. Thank you, Katie Petzel I POWTS Plan Reviewer - Field Division of Industry Services Department of Safety and Professional Services Field Office —District 4 POWTS hJAJlLIsIKI The information and response presented above is a general code answer based on the question submitted. This response should not be construed as a formal code interpretation. To view approved plumbing product listings, search underthe Products" tab using this link: https://est .wi.. v/apex-publiclookup From: Tracy Pooler <tracy.pooler@bayfieldcounty.wi.gov> Sent: Wednesday, April 22, 2026 11:17 AM To: Petzel, Katie - DSPS <katie.petzel@wisconsin.gov> Subject: change in plumber - intelectual property? Katie, I have a request for a change in plumber. I may be confusing Wi and MN laws as to intellectual propertyfor septic design. Aside from the cover sheet (SBD-6398) is there more that needs to be done? ���� .. • Private Onste Wastewater Treatment P°s K Systems (POWTS). inspection Report Y p p (Attach to Permit) Industry Services Division - -__I LARRY R& JULIANN M MCMAHON lazypu oses Pxiva Law, s. 15.04 (1)(m)] 2021 MAIN ST City fj Village Town of: LACROSSE WI 54601 BM Description: Tank Infnrrnafinn sefbeckfa- TYPE MANUFACTURER CAPACITY Prop. Line Well Building r Intake Road Se tic N/A Dosing N/A Aeration N/A Holding County Sanitary ermit No: State Plan'Transaction ID#: Parcel Tax No: Pump 1 Siphon Information Pump Manufacturer Pump Model Demand GPM Filter Manufacturer Filter Model TDH Lift Friction Loss Head Total Forcemain Length Dia Dist. To Well Dispersal Cell Information DIMENSIONS Width Length # of Cells SETBACK FROM Prop.. Line Building Well OHWM Type of Cell Manufacturer: Model Number: Pretreatment Unit Manufacturer: Model Number: stribution System Header / Manifold Distribution Pipe(s) Length Dia Length Dia Spac Soft Cover Depth Over Depth Over Depth of Cell Center Cell Edges Topsoil COMMENTS: (Include code discrepancies, persons present, etc.) Ian revision required? ❑ Yes ❑ No 3e other side for additional information. Date Elevation Data STATION BS HI I FS ELEV Benchmark Bldg. Sewer Tank Inlet Tank Outlet Dose Tank Inlet Dose Tank Bottom Inst. Contour Header / Manifold Distribution Pipe Infiltrative Surface Final Grade X Pressure Systems Only X Hole Size I X Hole Seeded 1 Sodded ❑ Yes Ci No Observation Pipes ❑ Yes ❑ No Mulched ❑Yes ❑No I I. I POWTS Inspector's Signature License Number '.RMA71n lR n1/711 Property Owner Information As you know BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoninp(a bavfieldcountv.ora Web Site: www.bayfi*eldcounty.oro1147 LARRY R & JULIANN M MCMAHON 2021 MAIN ST LACROSSE WI 54601 Bayfield County Courthou' Post Office Box 58 117 East Fifth Street Washburn, WI 54891 was contracted by you to install a private onsite wastewater treatment system on your property (Tax ID# above). To know when your system will be due for servicing please go to www.senticsearch.com Notes: Abandonment of Old System to meet all applicable code requirements: 1 4- Tank was pumped by: • Tank was crushed I removed and pipes disconnected by: on at AM/PM On at (AM I PM) the above -mentioned plumber contacted our office to conduct a pre -cover inspection as required under DSPS 383. One of the following applies: ❑ System was inspected and appears to meet all applicable code requirements. ❑ System was inspected and appears to meet all applicable code requirements; however, a plan revision is necessary because the installation was substantially different than the original approval. ❑ System could not be inspected because plumber covered prior to scheduled time of inspection. ❑ System could not be inspected because plumber was not ready at scheduled time of inspection. County was unable to return to complete inspection. System could not be inspected because plumber was not ready at scheduled time of inspection. A re -inspection and $50 fee are required. System could not be inspected because County could not respond to plumber's time constraints. Comments: URormslsanitarypropertyowner-input April 2019 ~� S C _ oosy eL. ✓ V E �y. iii Department of Safety & Professional Services ' Industry Services Division County Bayfield Sanitary Permit Number ((o be filled in by Co.) - anitary Permit Application Stater an action Number In accordance with SPS 38321(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 's sanitary permit. Note Application forms for state-owned POW is are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with il'tePrivacyLaw, s. 15.04(l)(ni). Stats: 51230 Birch Lake Rd I. Applleadofl Information — Please Print All fotormatiOif Property Owner's Name Parcel # I413 LARRY R AND JULIANN M MCMAHON 04-004-2-44-09-04-3 05-008-01000 Property Owner's Mailing Address 2021 Main St Property Location N ,fife OFNSSHWY IN LOT 8(2.4A) IN 2024R4°4949 411 Gm2. Lot City, State Zip Code Phone Number LaCrosse, WI 54601 %.__'A, Section 4 r 44 N R 9 Eo w II. Type.ofBuilding (cheek all that apply) Lot ® log 2 Family Dwelling—NumberofBedrooms 3 - _ SuhdivisconName Block # ❑Public/Commercial —Describe Use O State Owned —Describe Use DCityof 1(].,i _ J, ❑ Village of CSM Number ®Town ofBarnes • IlL Type -90,0 S PerWiC (Check_eMker "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C l A. � / I]'1 New System ❑ Replacement System p ❑ Other Modification to Existing System (explain) 0 Additional Pretreatment Unit (explain) B. 0 Holding Tank ,-f NJ In-Gr d ❑ At -Grade 0 Mound ❑ Individual Site Difl Other Type (explain) C. ❑ Renewal Before 0 Revision ❑ Change of Plumber ❑ Transfer to New Otwtcr(ast 1revious P it Number and Date Issued Expiration iWDMpenaVTsnt Ant and Tank Informatio' r Design Flow (gpd) I Design Soil Application Rate(gpdisfi - ersaLArea Required ts4 Dispersal ca Proposed tsf1 System Elevation 450 0.7 642.9 646.6 94 Tank Information Capacity in Gallons T Gallon # of Units Manufacturer • t `9 � 0 `o ' v y � o j L ,� N a New Tanks Existing'Ianks sepec nr rloldiug rynk 100O - 1000 Wieser Dosing Chamber V DctpllaibflM$em.ot I, the ®derMgned, asame respond for imtaWttloo of the shown on the attached plans. Plumber's Name (Print) Plumber's Signature .Ml'RS Number Business Phone Number Plumber's Address tStreet, City; State, Zip Code) .. J f5)60 S ee at.s. LL- 87 .. Use On .. proved. ❑Dtsapproied Reason for O Ovmer GirenDeni Per�mibFtG s �( U Datclssued n l'f ( � `� ]sswtiv: nt ' nature ��/ Conditions of Approval/Reasons for Disapp val I ( / Vii /! 7 ) 7/ Attach in complete plans for the system and submit to the County only on paper not less. than 8 in x I I inches in size SBD-6398 (R. 03/22) 1 2 J ,KEITH WILE D 2388 PSS ESKO MINNESOTA Property Owners N� 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's Name Designer's Signature Designer's Lice e Number _� Designer's Phone Number Date Page 1 of 7 EWier.' n0a.: _ Septic Tank::: k PL -525 Effluent Filter North +91 Two rows of 16 Infiltrator Quick4 Plus Standard chambers Property line Wieser W1000 -MR w/poly lok 525 filter 450' Fcabin well and septic Existing on seperate mac.. •.••.. __N* Proposed site of 3 bedroom ho 4y �yy .s- Driveway to Birch Lake Rd. 4¢sssasssss_ Property line KEITH wILEY � w • D 2388 PSS ws ESKO MINNESOTA Scale 1:50 Larry McMahon (3 bedroom) Gravity In -Ground Plot Plan O Neighbors sand point well 98' 96' 94' ck 12.5'0 Bench Mark = Duplex nail w/orange disc in 10" DBH Oak Elev =100.0' NOTES: OHWM TB1rth Lake Larry R. & Juliann M. McMahon 51230 Birch Lake Rd N 161'EOFN & S HWY IN LOT 8 (2.4A) IN 2024R-604949 411 SO4 T44N R09W Town of Barnes 04-004-2-44-09-04-3 05-008-01000 2.735 acres - Existing well serves cabin near Birch Lake Rd - Existing cabin near Birch Lake Rd on seperate septic system - Birch Lake Elev N 68' - Property lines not shown > 100' from system area - All vent, observation & conveyance pipes 4" ASTM D1785 or code equivalent Page 3 of 7 -A=-SEAL 8`-8" • FILTER OR BAFFLE f 4" PORTS OWNER'S '. MANUAL & MANAGEMENT PLAN Page 6 of -7 FILE:iNFURMATIoN Owner LARRY RAND JULIANN M MCMAHON Permit: DES$GN-PARAMETERS Nurritier bf Bedrooms 3 : C7 Number of Public Facility Units NA Estimated (average) :flow 300 gal/day Design (peak) flow =. (stitnated )C .1:5} 450 gallday In Situ -Soil Application Rate 0.7 anda lftz Standard nfluent/Effiuerit-Quality Monthly :average' Fats, Oil :& Grease, (FOG) X30 mgft. Biochemical Oxygen Demand.. (BOD5) X20 mg/L 0 NA Total Suspended Solids (TSS) ≤150 mg/L Pretreated Effluent Quality : ` Monthly average Biochemical Oxygen Demand (B0D5) ≤30 mgfL Total . Suspended Solids (TSS) -≤30 mg/L ® NA Fecal.Coliform {geometric mean} s10a ctu/100ml -Maximum Effluent Particle Size in dia. O NA. i?ttier:J -NA Values: t +plcai .tcr domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Sere%e Event ervf ce I`rguency Inspect condition of tank(s) At. least once every; 3 ear s (Maximum 3. years) . U NA contents of tank(s) When When combined sludge and scum equals one-third (') of tank volume O When thehighwater alarm inactivated. ; p NA: s) cell s) Inspect dispcell( - ... At least once every: 3 C] r onth(s} (Maximum 3 years) gi years) . DNA Clean .effluent -filter At least once every. C! r#ior�th s� 3 4 O NA - Inspect pump, pump controls: & alarm .:: At least once :every::: Li rriorith{s} . D year(s}- NA Flush laterals and pressure test : p At least once eve !�' [� nionth(s) �..aar(s.. Other: least: once: every: D month(s)At �. year(s : ®. NA Other ::NA SYSTEM --SPECIFICATIONS Tank Manufacturer Wieser CI NA �. Septic D Dace O Holding vol.. 1000 .gal Tank Manufacturer.. NA. . D Septic O Dose 0 Holding vol. gal Effluent Filter..Manufacturer PCtlyi k NA • Effluent Fitter Model 525 PumpManufacturer : 0 :NA . Pump::Model_ Pretreatment Unit NA El Sand/Gravel Fllteir O Peat_ Filter O Mechanical Aeration C Wetland p Disinfection Q Other , u i ?025 Manufacturer - Dispersal Cell(s) : O NA . •®' 1n -Ground (gravity) O In-Ground`(pressurized) O, At -Grade Cl Mound: 0 : Dnp:-Use : C. -Other. Other:. : NA: other: �: Nq MAINTENANCE INSTRUCTIONS CIS ections .of tanks and dispersal cellsshall be made:. by anJrdividua l carrying, one ofthe following licenses or certifications Master Plumber, . Master. Plumber Restricted Sewer; POWTS inspector;:- POWTS- Maintainer: Septage: 5iyrvraing Operator pumper). Tank. inspections must .include a visual inspection of the ::laink(s)'to identify any missing or broken hardware, .Identify any cracks or -leaks, measure the volume of combined sludge: and, .scum and a cheek for .any; back -up or pondrng of :effluent' on, the ground surface : The dispersal :.shall: be visually inspected to check the effluent levels in the :observation .pipes and to check for ,any ponding of effluent onthe ground surface: The; pending of:;effluent :on: the ground :surface may -indicate, a failing condition and requires :the immediate -notification-of the local -regulatory :authority. When ;the -combined ..accumulation of sludge and scum in-. any treatment tank equals one -third :(f)- or more of the: tank 'volume, :the entire contents :of the task shall be removed by :a Septage: Servicing Operator anddisposed of in :accordance with chapter NR 113, Wisconsin = Administrative Code. All other services, including but not limited to:tl theservicingof effluent filters, :mechanical or pressurized components; pretreatment -units and any servicing- at intervalsofG i2 months, shallbeperformed by a -certified POWi'S Maintainer A service report shall be provided to the local regulatory authority- within 10 days of. -completion of any service event . GMW (1. Jo2} P. of START .UP AND OPERATION For new construction, prior ;to use of the -POWYS; check treatment tank(s) ° for the presence of painting products, solvents or other chemicalsthat may impede the treatment process and/or damage the :sail :dispersal cell(s) : If high concentrations are detected have the contents .of the tank(s) removed by a-sepfage. servicing operator prior .to - use . System start up shall not occur whensoil conditions'are frozen at the infiltrative surface During :extended power outages pump .tanks ;may : fill -.above normal -higliwater.levels . When power is restored the ..excess ::wastewater --will be discharged to the dispersal cell(s) in.one .large dose and may overload them resulfirng in the backup +or:;surface discharge effluent To avoid this situation have .the contents :of the -pump tank removed by a Septage Serviding operator prior to restoring power to the effluent : pump or contact aPlumber= or PANTS Maintainer :to assist ing manually operating the pump :controls .to: restore normal levels within- the, pump tank.. Do: not drive: or ark vehicles over tanks and dispersal cells. Do not drive er-- park over or... otherwise. disturb or compact, the: area :within p.. R l p. 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- he performance :and prolong the life of the P ?l 1FT' antibiotics, :baby wipes,, cigarette .butts; condoms, cotton swabs, .degreasers, dental floss, diapers,, disinfectants, fiat, foundation drain (sump pump) discharge :fruit and vegetable peelings gasoline,: grease, herbicides, :meat. scraps, :medications, oil,, palrltirlg products pesticides; sanitary napkins, tampons water softener brinE. ABANDONMENT. When :the > OWTS- fails and/or is permanently taken out of. service the following steps shall :be taken to insure tttai the system is properly andsafely abandoned in compliance with chapter Comm 8x:33, Wisconsin Administrative.Code.: • All piping to tanks and pits shall be disconnected andthe.abandoned pipe openings sealed. JUL 012025 • The contents: of all tanks and pits shall be: removed aridproperly :disposed of by a Septage Servicing Operator: •: After pumping, all tanks andpitsshall be excavated and removed or their covers removed and the void spacefiilledwith soil;: gravel or another inert solid material CONTINGENCY' PLAN If the. - POWYS. fails` and cannot .be repaired the :following measures have been, or .must :: be .₹alien, to provide a ode compliant replacement system; 1 1 A suitable replacement- area has been evaluated and: may sae- 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 welts 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 O A suitable replacement area is not available due to setback and/or soil limitations Barring advances: in POWYS technology a .holding tank may: be installed .as a last resort: to replace the failed POWT The site has nofi.been evaluated to identify a:suitable replacement area Upon -.fail ire:of:the POVif'f'S a soil andsite evaluation must be performed to locate asuitable -replacement `area , :lf :no'replacement area is available:e holding :tank .:may = be installed as a last resort to replace the -failed PO TS Q and a d air rade soil absorption tion systems maybe reconstructed in Lace:follo following removal of the biarnai at the infiltrative: surface:. Reconstructions of'such :systems 'must.comply with the hales iri_:effect :at:that time <elfll.ARNMNta SEPTIC, PUMP AND OTHER: TREATMENT ' TANKS MAY :CONTAIN LETHAL: GASSES AND/OR : NS FFICIENT OXYGEN DO .N 3T ENTER A:SEPTIC, .PUMP Oifi:OTHER TREATMENT TANK .UNDER ANY C[RCUMSTANCES DEi T MAY RESULT : RESCUE OF A. PERSON FROM THE INTERIOR- 3F: A Ai K MAY BE DIFRCULT OR IMPOSSIBLE -ADRlT14NAL• MMEAITS POViITS INSTALLER :POWT$.t 1AINTAiNER, Name .. :Name:. Phone 7/75— 92 2 Phone: . . . SERTAGE SERVICING OPERATOR °(PUMPER :: LOCAL: REGULATORY -AUThORITY Dame : Ste �'N atneSayfieki'County Zoning:.,. Phone _ .4. :: ne-715-37S-6138 This:clr�cur document was drafted by the>st s.of the'Gre n Lake :Marquette•and.Waushara:Cou Zoning and Sanitation agencies in compliance c with chapter i...:.. y O......:.. . Oah t 1, la kh l�. Comm :83:22(2) (9), d)&(t) and 8354(1) 2 & (3)Wisconsin Administrative Code Larry R. & Juliann M. McMahon BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) t Check List 2 Original Sanitary Application (Submitted in Deed Holders Name - nt prospective buyers) (383.21(1)1) Index Page I Title Sheet (Signed by Plumber) (383.22(2)69(c)) 0 Original Plot Plan (383.22(2)2. 3. & 4.a) O Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer 0 Pump Tank Diagram, Alarm and Pump Curve (when applicable) 21 Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) m 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) O ATu Servicing Agreement (Recorded at Reg. of Deeds) Sd Fee (Make Check Payable to Bayfleld County Zoning) (383.21(2)(c)7) 0 2 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all cooled 21 Soil and Site Evaluation Report(383.22-3(2)(b)1.e.) State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) JLIi 0 1 [;l Sanitary Application: (Include the following Information) Pl I Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) 2 Project Address or Road Name where driveway is/will come off of) 19 (Owners Phone Number) O II Type of Building Our Type of Permit 21 IV Type of POWTS System 21 V Dispersal / Treatment Area Information • VI Tank Information (21 VII Responsibility Statement (Plumber's Information) I ' *Date Stamp* Plot Plan: (To Scale or To Dimension) 21 Signature and Plumber Information 0 Address Number and Road 21 Surface Elevation of Body of Water QI North Arrow • 2, Direction and Percent Land Slope 2 Contour Lines • 0 Tank and Filter Information and Location 0 Structures and Driveways 0 Wetlands / Navigable Bodies of Water 21 Boring Locations 2 Absorption Area (Proposed and Existing) Id Property Lines • Bench Mark (Location, Elevation and Description) 0 Well Locations 0 Component Manual Version 21 Legal Descriptions 21 line, building sewer line, material type and diameter) -- - Turn Overt Private Sewage System Maintenance Agreement Owner(s) Name tar + i.L{i clrI (0LLazu ite / ACAO'�^"' Owner(s5 Mailing Address 202.1 a,in Sk- Cn�s5e rill i !o V —uZ Site Address /� / 51Z3O g& LL ��, s L)t S -c73 Tax ID# 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 Township Lid N. Range ______W. Additional Legal Description: A 161 r L bt N+ S 1 k .V Town of__________________ (Acreage) -Zo-7 3 S Gov't Lot - Lot Block Subdivision Lot CSM # Vol. Page CSM Doc # Return To: DOCUMENT NUMBER 2025R-608363 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED 07/16/2025 AT 1 1 :02 AM RECORDING FEE: $30.00 PAGES: 1 Recording Area Planning and Zoning Department 1. In -ground gravity El In -ground dosed El In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ Other Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. Pump Chamber (system types B, C, D, and E): The pump chamber shall also 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, POWi"S 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 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 properly. Owner(s) Name(s) — Please Print 1CW07 L Subscribed and sworn to before me on this date: Mti4 3u1 fr-I ! 2025 %3Vlic�nn (ait i -TvliL Mc Notarized Owner(s) — Signature(s) c�f Nota ublic Notary Public. State of Wi My Commission Expires: _ It-i ^ZozB v Drafted by: z vt Date: ;onsin ) t1Fll1 �. J U L 2:1 Phi' u/forms/sanitary/septicmaintenceagreement Revised Ravfiotr C'.-. 7,• -......,,rd . ; 2020 Wiscons n IZepartinen °.vfS fetj+:•& Prc fe sfor t e rires 9 & : ' Page Dlvlslon of lndusf rySer�Vl a � Q:EVAUJAT+r# Sfl TEST •' In accordance with SPS 38$ Wis. ?dm::Code : Attach .complete site plan :on. paper not less than t/2X 11 cctiestas . Plan '-must :i dud B2yfietd I ut:notli if tdvartical and f on2ontal.teferencepoir SNI)direction and piers entsiope; ::':.::: :Parcel ID i s scab or duieflsiens,: Hotta an o1 .; and location and 'dlstancie IQ nearest r0act... • ::. :: 04-O : x-:44=09 944 0 4Q8 1 QDD Please prtntali %frn'mati'o»: ed Data' Per$_P Information-yciu'provide'may. be used fay'secQnd rry:pufpe .-JPrivacS►:Law;:A 4& 'f)( at)lr/?3,42 Property : .PropertyLocatldn , LAC . -D:: Lany R & Juliann M McMahon Govt. tht � � S 04 T 44 t4 R 09 E(or) •:Praparty': wnet'$:Ni�til ng Address ':: SrteA dr sft ar:CSM and Lot #. . Q2'i:Main St 512.30 Birch Lake Rai. State ' Pt .e Number C3: P • y ElVillage • 'Town :.Nea►rest`Road LaCrosse7 WI 5461)1 ( ) Barnes Birch Lake Rd Ne.1Ar: .nr1 �Ctiotf' •' :i ' ':�' use., Rd tdentiailN�irnberaf edr ii MA : Cc?.de•dei d:clgsigt�tld i4o:gip© Replacement e,nt: Q 1 Zia cat -commercial—Describe F.Flobd Plan '•e e [ if A Parent •mat Outwasi :Sands' Rub1 on=:Sa. nef'cbmplex) eta "ersIcqrnmentaalidrecommen�lations 119 - rsYrriii:surface 'ele'_ft Depth .to 1'inlbn ' factor : r: i� 8 f :Qr�i1►niYni+t:S�Li�ia I. Harr is: Depth": ' !n, ''•DomInat <✓oloc'• Ntuitsr U . '.' Redoc Descripiop Clti:Az CentColor. '. Texture Structure ' -fir-, SzSh, :Doitsistertce' Bounda Roots GPDIFt '� . - .. . _ � fi••.•:. .�•'1tlYR•2fi: • . - :�.:: •� • ". � `s •: • � :0s � � •' �' � r�l[� •a$ • ' 1. '1 2:: •28 .:: 7.5Yi 4f :: "'' : =s Osg ml:: : :112#: 4 3 ::: 847 ' : ?:5 R 8/8-::: : Qs ml : cw : ' s'!: 1_6 47.84:': •'IOYR 514 , 0sg tnt:" •''. lvf 0,7 16 P'q Grounct:st#rface! eiev: ft • : Depth ' limiting lr facto4 : tr : :88 9__ • •.HowA."..••:`pe...• n Depth Iri.. o .' e .. � rnln*nt:f� !br'• :MUhstt :U.:iz:otit:: �.:. '-.. '. R. o Oesorlptkai Color ,. ...• Texture ' - " . Structure • "fir $:':t: D#nsistei ae . 8ourtdo ry' Roots ..' - . . P fft ': 5-2 : 7�SYR. SI :' . � l R) : : ' s9:: ` ' 'fit.`'' ::8 ''':' ' :3 :i'C.. °. :28�# ' : Y ....: ( %F 3s . ml a+�ti 'If G7 t 6 . ' . 4' - 'T ° ' '1 :0YR: 41 Q g . : ml aw : Address : : Date: aluslltai Conducted Tell hone:ls umber.' '°1s23 E E.aisotrt D: i a) e N tia amont Wi .≥ 54849 6/14/2U2 :218-451-2$I i Effluent I:. '$.OTh? S0≤ 220 mgft: a d'ASS : M. f5 mg/L ' °'Effluett#Z BOIL, s3O mg/i. anLtTSS:a ;3am8 i1.. SD -833O :SRO 12) '. ' . ..0*ge .. -2 of '3.:— :(;Bari# . Pit Ground suF 3t a :elev,___ _;_ft . ' . Depth to :Urnit1ng factor in 1' elev tt' c 'zotr.' H rt • Depth''..': in z: '. Dominant'! r ` color • `-Munseti` ' 9 Redo Description'. ...r 'Qu. Az. Cont.:Cotor •7ektttre.: . ' Structure ' -Gr, 8z Sh::.-.. st t ' ota . s srit+e 2 Via. ,. + o °Ito. . GPDIJ t2 .' :, *E. . :. ' ::0» ' �'YR 31 11 at rial . .s.: 0s • .. . ,:.mI:.. ::c v: ' ..l .: ' 07 : 1..6, . 3-7 t#Y'`4 fill m t nal .:.. $.:: - 4s9:' . : ml as ,' :f/ivI`' ::D 7 : :1;6 ` :' 1O?R I '.. :. '..'::. : $: ,: ' - : sg" ml• . ' Cw • ' v1Yrlvt' . a;7 .::'.: ..6 VV . .' ••' Y7 .' '..{Y 4/4 -'•' -. I : • ...' 0s'• •...•\I ••'., cw ..• 'if• ••.0 {6- ' :6': • 8 . IOYR 614 • . ' '-': ' :. :f&.. '. fist. ' :• -.'- Q $':': fl Honig • . . goring :# Pfit: _'- : : Ground su actecieu : . .' [j .... -rft•. ' . . . fept i;to limiting fctor_. in 1 •elev: ft• . . .. . . . . . . . . . . • . : I:Aeialtc atiitn:Raia' •.1-ior on: ' -Depth In ' DomlnantColor utunseU' • Redax'Desx` tlon tau: Az;. Wit. Colot' :.. .'Text'uM.: • `Structure.- Gr' Sz: $h:: Consistence •*°BO nda : Roots : -` . 'GP. ' : ":'. :j(1 ::Q 2: . : Q: Put' . Ground av ft': . •'Dept t ic.timltinI h. I-elev: - .". - ft .. .. .. .. . - .•. .. - - - • - .•.. •S'n1!'.Atist�lEc •R�le t#ozazon O .': omltlaht C.t?tol- : Mun eti'::. Redox Desiiphon. "QU.:P C nt:.Colo .` Te ttire : ' . Stw tote .' Gr. Viz: Sid` :Consistence Boundaly Rom' • CPD/Ff?`. . ; •ffluent#1`= Bt D:? 30:S...22Q'rttgIL end T$$> -3.0 5l.ri3gL.. *Effluent#2 $Ob,.5 D.n3$IL and T.SS 5:30►ngli:. . North Property line c m 45 Existing cabin on seperate well and septic. Proposed site of 3 bedroom ho y1i '4¢ may. �L. Driveway to Birch Lake Rd saesaassessaazras=' Property line Larry McMahon (3 bedroom) Soil Report Plot Plan O Neighbors sand point well 98' 96' 94' VO ' �W . oHWM . Cam! 12.5% ti �, : . do Birch Lake Larry R. & Juliann M. McMahon 51230 Birch Lake Rd N 161' E OF N & S HWY IN LOT 8 (2.4A) IN 2024R-604949 411 SO4 T44N R09W Town of Barnes 04-004-2-44-09-04-3 05-008-01000 2.735 acres NOTES: Scale 1:50 - Existing well serves cabin near Birch Lake Rd - Existing cabin near Birch Lake Rd on separate septic system $ Bench Mark = Duplex nail w/orange disc in 10" DBH Oak - Birch Lake Elev z 68' Elev =100.0' - Property lines not shown > 100' from tested area CST 119900002 -SP Page 3 of 3 Larry & Juliann Mr .I eMah n. BAYFIELD .. : ubmittheFoftowui (Use Pelmanent Ink) ck List I:index :Page : Je 5etional Z 0rginal' oil Ezra uat os : Report (Submitted in Deed:fit dLaName —g prospective buyers) rtgirzai :1lot:Plan °.. 1=i':Cross for: Soil Profile Sheet (optional) O Additional Information (Warranty/Quit Claim Deed) : ioP pil Evaluation Report (Include the fIIoWsng Information) =C `-fiarcel •dMti ft atlon ,Number 'bust be 3 a i it Tai 'Ip' :i d NOT : .::. . ' .:. .- -... #..dt�ttheX are no longer :being used l'Propertv Owners Thformatior not'prospectiveb is name) IProperty :to n:(Accurate aLegal I scrip on wi 5 ` rp/Range3 •Paad: Name: (where :."" s/wjll;-be: coming off f 1 fl ad p ain'Elevation, Row pf � Rate; : Comments and Recommendations jCom '-let Soi1 Boring I:PitThformabon: JUL 01 7tate::Soil Evaluation was conduct i'csr Nazi e; :Signature,; Number;: Address :and: Phone Number Date .:5ta p* Plot Plan: (Include the following information drawn to dimension orto scale) C` Bo Mark ecrpao and Location) ; t Coat r Uries a:=::9$ Qw /96J)' /9 o : I P opery:Location (S /Twp•#on a Accurate Legal : Description) Borings Lc attons' and Elevations) • . lYPercentand Direction of La d dope • 6 'Wei# Lo on = d diizg:Neighboring: #ts ..# applicable) >` catlon:of WetlandsAreas toodplairi:and Naviga1e Waters.. ; tBuilding,'Driveways, and:Structutes (Location ran and s+eri dons: l'Locatiop of Property Lines bdsEintsfier°.�acat%on ••• • t ctdres :Number .and Road Marne : " Current Surface` levatLon of Wetlands and Nauigai le:Waters. I1STJ Owner and Property:Thiori afipn : e,° IQ'Certified t'Tests Review &:l n fe$ 5000 U/rosan/hec1thstItheckHstyorcsts 19 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: MCMAHON, LARRY R AND JULIANN M 2021 MAIN ST LACROSSE, WI 54601 Description Sanitary Revisions Submission Number: SS -00588R Transaction Number: SS -00588R -4463A Amount $25.00 Total: $25.00 Payment Amount: $25.00 Reference: 187 Paid by: Northwest Plumbing and Heating LLC, 7378 S Pelkey Rd, Foxboro WI 54836 Payment Type: Check Transaction Date: 4/29/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-25-84SR STATE SANITARY PERMIT OWNER: LARRY R AND JULIANN M MCMAHON GOVT LOT: LOT: BLK: 1/4 1/4 SEC: 4, T 44 N, R 9 W TOWNSHIP: Barnes SOIL TEST: 79-25 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: MATTHEW HAASIS TRACY POOLER DATE: 4/29/2026 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 #: 25-84S LICENSE: # 947326 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 4/29/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION