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Home My WebLink About26-38SRECEIVED � Industry Services Division CountyI/3 fn� C f(, E ED 4822 Madison Yards Way Madison, WI 53705 Bayfield Sanitary Permit Number(to be filled in by Co.) �sp = 1111 KAY 0, 7 2026 P.O. Box 7302 Madison, W[ 53707 a ( — 3g s Planning aSapp ntpermit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to die appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for slate -awned 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 Same purposes in accordance with the Privacy Law, s. 15.04(1 )(m), Stats. I. Application Information — Please Print All Information Property Owner's Name Parcel # Mark Carlson & Sarah Leppien Carlson 39413 Property Owner's Mailing Address Property Location 3290 Bony Lake Rd. Govt. Lot City, State I Zip Code Phone Number Barnes, WI 54873 218-428-5123 '. `A, Section 04 T44 N R 09 E or W II. Type of Building (check all that apply) Lot # ❑� I or 2 Family Dwelling —Number of Bedrooms B 2 Subdivision Name IIIPublic/Commercial — Describe Use Block # ❑City of Village of ❑State Owned — Describe Use CSM Number #2363 Town of Barnes 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 a licable. A- IZINew System ❑Replacement System IllOther Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain) B' Holding Tank !ZlIn-Ground ❑At -Grade Mound ❑ Individual Site Design Other Type (explain) (conventional) C. []Renewal Before ❑Revision Change of Plumber Transfer to New Owner List Previous Permit Number and Date Issued Expiration NA IV. Dispersalfrrcatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/s0 I Dispersal Area Required (sf) Dispersal Area Proposed (sf) I System Elevation 450 0.7 643 678 87.5 Capacity in Total ft of Manufacturer Tank Information Gallons Gallons Units `o i — o New Tanks Existing Tanks •A P o u 2 v H at) rn y m wV c Septic or Bolding Tank 1000 1000 1 Superior Precast 1IIZJ Dosing Chamber [11O 0 V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sienamre MP/MPRS Number I Business Phone Number Jason Kuettel 675751 715-798-3355 Plumber's Address (Street, City, State, Zip Code) PO Box 66 Cable, WI 54821 County/Department Use Only Approved ❑ Disapproved Permit Fee $ Date I tied L p'b g nt ff azure 0 Owner Given Reason for Denial 5 8 4/37 Conditions of Approval/Reasons for Disapproval exlmCn to complete plans for Inc system and submit to the County only on paper not less than 8/2 x 11 inches in size SBD-6398 (R. 02/22) ►/gyp -�� SOIL TEST # 31 ��FJART�1��r " (1) ent of f rofessional Services Page I ofDivision of Industry Services n AYQ.7 ZQL6SOIL EVALUATION REPORT Bayfietd Co. In accordance with SPS 385, Wis. Adm. Code County c Attach complete si aoii e0 �r 8Pie2s than 81/2 x 11 inches in size. Plan must include, 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. R vi Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). �� I � Property Owner Property Location ❑ kA, K- QS 4JZ4& -Lfd/1 Govt. Lot %. '/+ S o'f T 4/`( N R O' E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: zy e fo N 7 u3-xL lZ� L oT- - cSM Z. 3 6 7 City I State I Zip Code I Phone Number ❑ City ❑ Village I Town I Nearest Road - A 4-pi€f trJ 5 `(8 73 (Zt 9 ) I U a, -v & S �vi✓`t L iLt' -,e--b NewConstruction Use: Residential/Number of bedrooms 7 Code derived designflow rate '/SOGPD ❑ Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material O v� w *J M— .Sv9.r-� General comments and recommendations: t 1',..J Tt) d 7 Lj1Boring # O Boring ?.,y7 Pit Ground surface elev% O . Depth to limiting factor >5 in. / elev.e ft. Soil Anolication 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 1 O.5 7 , y-4 -1 LS O S t5 ry 1 C'-' i.ft4 d' 7 / • *o Z S -18 7.514_1f&/ -� s' SG r.,. &U ,1f a.) / . GP EII] Boring # (]Boring IPPit Ground surface elev. ft. Depth to limiting factor `3 o in. /elev. I Soil Anolication Rate Horizon Depth In. Dominant Color Munseil Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD1Ft2 *Eff#1 *Eff#2 j 0.7 ?.$,,ji.Z.f — LS b.C7 /h. 661 1-11,., 0,7 1. ' Z ?^Z3 l4 y S O 6 c'I G Lv or1 , C' J L3 -qo 7 j - Y/6 — d G 1 — G 1) CST Name (Please Print) / - c1--Anr Signature r CST Number 111 0 0 ZB Address f3clC 6(o C.t!!-r3LL, r- Date Evaluation Conducted q ?o Telephone Number -77ff * Effluent #1 = SOD > 30 5 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 = BOO, s 30 mg/L and TSS 5 30 mg/L SBD-8330 (R04/21) Page Z— of ❑ Boring [[] Boring # Pit Ground surface elev., 7 ft. Depth to limiting factor�in. / elev.. Zv' tft. nil Annlicatinn 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 o 7. $ `er.i oJ6 rv\ ( lJ 07 14 z -z( .7.5Y y — s J,W. a� l._ _") ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Annlication 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 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. / elev. ft. Soil Anolication 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 * Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L CHECK BOX AS APPLICABLE. ® SOIL EVALUATION Scale: 1t1= 40' SITE MAP 0 40 60 80 PROJECT NAME: (10 ft grid) 11(0)2 A.rzzsa,� 3 a�� CHECK BOX AS APPLICABLE. -1 3 El SYSTEM PAGE- OF PLOT PLAN DESIGN FLOW: �5 o GPD Attach design flow calculations for commercial plans. PROJECT ADDRESS: S -ZAV t-3 v r *7 Lai -LE ??_ Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) N Sanitary Sewer: I BM Symbol: +- BM Elevation: FT Force Main: / BM Description: 4' '—/ 1 (s ?oiv /Z TL( Slo a Gradient (%) a indicate north by IMPORTANT: Well Symbol (If applicable): Q drawing an arrow Show ground elevation contours at suitable intervals. of Tested Area: on the approprite One. .g-i - w 3 o i7cT'�L,c f �� i7& 7& t, cj,t- 3 ` G} t � S - - ivi Of L)26 planning and Zon 9 - - 1_ rho! rr c' b , SAM t � -?. c. \. .. - - l --g 7 'J"!j 0 --- 0719ogo -8 M /'l" Q:h 0A �7l7t� ' CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. F-1 SOIL EVALUATION Scale: I" = 40' ® SYSTEM PAGE 2 OF SITE MAP 0 4o 60 8° PLOT PLAN PROJECT NAME: (10 ft grid) 102 DESIGN FLOW: LSo ,.> Attach design flow calculations for commercial plans. PROJECT ADDRESS: 3 .-'O (o ,-.'"j LA -'.E iti Pipe Material ! ASTM Standard (Tables 384.30-3 & 384.30-5) (CO o N Sanitary Sewer- C*'46 / BMsyrnbot: 9 BM Elevation: Force Main: _I_____________ IBM Description: - f J L. ( /Z " Slope Gradient %) indicate north by IMPORTANT: ( '7 Weil Symbol (if applicable): p drawing an arrow Show ground elevation contours at suitable intervals. of Tested Area: on the approprite Ene. ow." 4— ..s LJ' -E CVLLcv ,v 3c v i7'f �� .!�' w Iir LtTI..:Punning and Zonir1T :T1L::.Tr: ( Agency aI r L4I_; • '(1.9late ... _ b....- ...___. .. _. - - -• -� � -- — /� -__ -- - - __ . I - 000 wJ cs/L!rCa , �s T -it Lrfite: c Ors Cyr-ep•t�?y ; yam,. pct RECEIVED h AY o 12026 In -Ground Gravity Plan Sayfield Co. Index & Cover Sheet Planning and Zoning Agency Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Pg 2 of 4 Pg 3 of 4 Pg4of4 Attachments: PAGE 1 OF 4 Index & Cover Sheet Plot Plan Dispersal Area Cross -Section & Plan View Management Plan POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Carlson 3 Bed Owner Name(s): Mark & Sarah Carlson Owner Address: 3290 Bony Lake Rd. Barnes, WI Phone: 218 -428 - 5123 Zip: 54873 Project Address: Same Govt. Lot: 1/4 of 1/4, Section 04 , T44 N -R 09 E ❑ or W ❑✓ Township: Barnes County: Bayfield Project Parcel ID #: 39413 Designer Information Designer Name: Jason Kuettel Designer Address: PO Box 66 Cable, WI E-mail: tim@andryras.com License Number: 675751 Remarks: Phone: 715 _798 -3355 Zip: 54821 Signature: Date: S s zG Original signature required on each submitted copy. IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER 2" min. trench depth (typical) min. 12" (typical) System Elevation = 87.5 (typical) Septic Tank(s) Manufacturer. Superior Precast Septic Tank(s) Volume(s): 1000 gal gal gal gal Effluent Filter Manufacturer: Orenco Effluent Filter Model #: FT -0822 E TYPICAL TRENCH -5- CROSS SECTION VIEW n' -< (No Scale) gNa Provide minimum 3 ft c ft separation between trenches. ry o' 2 Quick4 Standard -W wl End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) r- -------------------t---- -------f--------��--- (typical) INSTALL PER TRENCH: n 11 Quick4 Std -W @ 20 ft EISA/chamber = 220 ft2 + 1 Pairs of end caps @6 ft2 EISA/pair = 6 ft' Observation Pipe (typical) Install per manufacturers / Instructions. TYPICAL TRENCH PLAN VIEW (No Scale) IA = 3.0 ft (typical) �-Quick4 Standard -W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturer's instructions. = Proposed EISA per trench = 226 ft' Required Infiltration Area = 643 ft2 Distribution Method: x 3 trenches = Proposed Total EISA = 678 ft2 branched manifold -D D G) m W O a 1i r. C) /aa 1 'ii a PAGE 4 OF 4 In -ground Gravity Management Plan IMPORTANT: The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 450 gpd; BOD5 S 220 mgL-'; TSS 5150 mg.L'';� FOG 530 mgL.1 .-:hCEIVEO Inspection Checklist INSPECT EVERY 3 YEARS o type of use MAY 0 7 2026 o age of system o nuisance factors (i.e. odors, user complaints, etc.) eayrieid co. o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) Planning and zoning Agency o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Scats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Andry Rasmussen & Sons Phone: 715-798-3355 Local government unit: Bayfield Co. Zoning Phone: 715-373-6138 Local government unit address: 117 E 5th St. Washburn, WI ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. SEPTIC TAN 053 sECT:ON =.r1U SPEc:F iCArIONs 4" Sc4•40PVC rtTSP_aror 6 " HIN. ABOVE GRAD=. (OPT) (when snlei tnc-n\ole 4s bu, iza ii FINISHED GRADE r I 18" HIN. INLET iH CC APPROVED PIPE 3' ONTO SOLID 50 IL -APPR D RA-FF1rE— O FILTER MFG. y'1CO model a c-`o9Z-z 3" APPROVED BEDDING U11De`.R TMIC EQIFICATIOHS SEPTIC TANK Y, NUFAC?UPE Svf ._Lrrz Qt - d7 TAJIN SIZES: 5E'TIC (000 CAL. NOTES: 1=:ECEIVED HAY 012026 Bayfield Co. Planning and Zoning Agency APPROVED MANHOLE W/ L«;y cE. 4" HI??. OUTLET M-OOo Private Sewage System Maintenance Agreement Owner(s) Name ^ ( Sa Sar L'qpevi-Ctzr/sorj Owner(s) Mailing Address I 3 0 r6on. Ira ►C Roar 13a(nts Wts(l5'73 Site Address 3, qo Gory Lu.kc e0a,dt�arnYc 5gg73 As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil testers 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 N. Range W. Additional Legal Description:t0+ 3. CS'M a23(;e3 -IN fipG.a,g„' 1' ^'=• J Town of 6 0.(r! e. S (Acreage) 1 t 3 S Gov't Lot ___ Lot _ Block Subdivision Lot CSM#_ Vol. 13 Page 760 CSM Doc# ?AZ41.— (e OLI lotL In -ground gravity ❑ Mound DOCUMENT NUMBER 2026R-6 1 2067 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 05/07/2026 AT 2:15 PM RECORDING FEE: $30.00 PAGES:1 Return To: E(� S! 11tT 2d Zoning Department s K1 Q V L0�U a�"' ❑ In -ground dosed ❑ In-groundpgt *Me distribution Sewage System: ❑ At -grade Sewage System ❑ Other Area 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 -around 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 agreement shall be binding upon and inure to the benefit of all current and future owners of such property. sworn to before me on mf((LcovirIsc% Sa✓a. (, L,c pp;e n - Cal !Saw! My Commission Expires: 202 D •, .. — :; Drafted b : `______ ry List t Date: a ' Z L- oC y 3 Notarial Officer by Wis. Stats. '�✓� CO.� ��` 140.10 (1) (f) and (2) Count Clerk �r�6ftzi u/fo s/sanitary/septicmaintenceagmement Revised July 2020 173M FIELD Property Owner: CARLSON, MARK TODD 3290 BONY LAKE RD BARNES, WI 54873 LEPPIEN CARLSON, SARAH A 3290 BONY LAKE RD BARNES, WI 54873 Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Description Certified Soil Tests -- Review & Filing Fee Submission Number: SR -00409 Transaction Number: SR-00409-454BB Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 15027 Paid by: Andry Rasmussen & Sons, PO Box 66, Cable WI 54821 Payment Type: Check Transaction Date: 5/8/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. 13.. FIELD 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: CARLSON, MARK TODD 3290 BONY LAKE RD BARNES, WI 54873 LEPPIEN CARLSON, SARAH A 3290 BONY LAKE RD BARNES, WI 54873 Description Private Sewage System (Septic Tanks) Submission Number: SS -00740 Transaction Number: SS-00740-454BA Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 15027 Paid by: Andry Rasmussen & Sons, PO Box 66, Cable WI 54821 Payment Type: Check Transaction Date: 5/8/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-38S STATE SANITARY PERMIT OWNER: MARK TODD & SARAH A LEPPIEN CARLSON GOVT LOT: LOT: 2 BLK: CSM: 2363 1/4 1/4 SEC: 4, T 44 N, R 9 W TOWNSHIP: Barnes SOIL TEST: 31-26 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: JASON KUETTEL TRACY POOLER Authorized Issuing Officer DATE: 5/8/2026 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: # MP 675751 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 5/8/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION