Loading...
HomeMy WebLinkAbout26-41SI Department of Safety County 3 0.Y c 05 & Professional Services, Sanitary Permit Number (to be filled in by Co.) P 4 ^ Industry Services Division -�, .,0s SS -00-730% Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Is required prior to obtaining a sanitary permit. Note; Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. 1 1 7O•rI[D 1 I. Application Information — Please Print All Information Property Owner's Name RECEIVED 3r k, I4a- b•e✓ RGV Pereea•a Properly Owl is Meiling Address � MAY 0 1 Z 2- C t 7J ,,� N/ Properly Location / Govt. Lot tP / '/., h, Section Y ' 'o }C,ity, State 1 A n C(h Cet E'e. L /J Zip Code S -S3 D Z Phone � °�p Z z qAgency q 'o II. Type of Building (c eck all that apply) Lot # I or 2 Family Dwelling — Number of Bedrooms 3 T N R • Subdivision NameO Public/Commercial— Describe Use Block NOCityof tj ❑Smte Owned — Describe Use CSM Number O Village of 1 X Town of__V I -•es III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line applicable.) A. Check one box on line B. Complete line C if A. I New System Replacement System y ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank In -Ground ❑ At•Grade ❑ Mound ❑ Individual Site Design I ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration / ry 7c 7—.2O_ /Qco / ,7 I ! l IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (of) Dispersal Area Proposed (st) System Elevation �__ .7 lt'f3 toll 9z.o' Capacity in Total II of Manufacturer Tank Information Gallonsc Gallons Units II New Tsid;.s Existing Tanks Cwt p o G „a W o u k3 C 0.5 �3 v Ja in 7n ii. U w Septic ur.ReMilrg Tank I Cdb /OOD AL W ecset' Ce,nC, ✓ Dosing Chamber DD hoc f. t V.Responsibility Statement- I, the undersigned, assume responsibility for Installation or the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sig orate lrP/MPRS Number Business Phone Number Ail Th I os k I 22009 U iIszg4/c4 Plumber's Address (Street. City, State, Zip Code) Pb aC.x s z- yrort ,t'j r i IKEv'7 VI ounlymepartntent Use Only Approved ❑Disapproved Permit Fee -Date is L Issuing Agent SignatSignature❑ S Owner Given Reason for Denial ^^sued�i aK7/ I aFt 0 l 1(/ 4 4p Conditions of Approval/Reasons for Disapproval aed Attach to cmnalete alma far the ay.ma, a,w a,d...,t th C',.......-'.................................. o ze SBD-6398 (R. 03/22) trreruk% Wrsc Safety & Professional Services L5s-- a L Page y� Divis ces 1 of Z.. O V e.,r` $p$ MAY 0 ,12026 SOIL EVALUATION REPORT yf� In accordance with SPS 385, Wis. Adm. Code County q _ QiI cL Attach complete site plan on 112 x 11 inches in size. Plan must include, % p ��1� Peree� I.D. but not limited to vertid�l�1IR�� a ence point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Tb..X I $6 7 2_ Please print all•information. Reviewed by4&(w11V I DatePersonal z information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)).4 Property Owner g 14 bQ.r Property Location ii3❑ Govt. Lot '/. '/ S a T � N R Q ❑ E (or ('sj r o Property Owner's Mailing Address a89lCGVr S 1N Site Address or CSM and Lot #: G7OSK.oIU1 Rc� =rc,v River wI Sy94 City, State, Zip Anh�ll �1tn1N ., SS3 r22 I Phone Number y -! (3 aa14 0 ❑ City ❑ Village MTown I4 Vq ties Nearest Road ko l U,n icl X3 New Construction Use: 1 Residential/ Numberof bedrooms ❑ Replacement ❑ Public or commercial — Describe: Parent material 1' General comments and recommendations: Boring # ❑ Boring [ jPit Ground surface elev�_ft. Code derived designflow rate ! ) V GPD Flood Plan elevation if applicable ft. Depth to limiting factor 1 00 in. / eiev8s9.j 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 I s -cab Tnv-� Y,r • s i t% 3 -- r.• •S l - 'r 3 �Is b k mvcr s • S I Ha -t S' - 5 wt -' 1 Boring # ❑Boring loPit Ground surface elev _ i•5 ft. Depth to limiting factor in. / eleB _pft. I Soil Anaiication 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 — -'FI cabk t .5 2 C0- 11' 5YR 31 - -c Is iobk yv', v4 S 3w • S t J " S 'I/ - Is abk s -c . 1• (o W '1 `- S o. IM t - ✓'Q • . CST Name (Please Print) � Tory ?o I Ko s k � Signature � CST Number r Address $'1 IS GTI t}wY 6 ivcr w '%q Date valuation Conducted q--?%I-a6 Telephone Number Z19 -3q - r opS' o * Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L SBD-8330 (R03/22) Boring # []Boring Pit Ground surface elev���ft. Page of Depth to limiting factor I 00in. / elevfi. Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 o-( ?,S -c i c& • 5 1 Z .. 5 a 9S 3 -z q / r IS o2IMOI k v �' S �! '!' . �o ( a -ice &'i/6 - 1 I( rrtl -- k'- II Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. AE,,gont.G)or Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOO, s 30 mg/L and TSS s 30 mg/L r,' T• toIC": l�l.: Sear Ii/o, fs• l , %u✓ueant. c..l Se !e46s°^l�{%a;{ uY1 taS5 vies a Co m ew ° td �YJLnr w Z-'y—gcvew°RaglGTree_ P•'+ 't" N3'ja/aVr. t fJ�Llu ^..,, �� . ;.,,.. , �F ant vgz P=riley. tecx( C S r �' 7 amot�G wriy5'�`P"6{� �'@a0.ol%°O boo '. t: Sep4 .`r"ank is ioo°l gallon wleser ttncra4e- i5o" Lr8 i'✓. as' d IT 'fib o r$lo1Z- !.,F� lewY�°,e: ap( -�' �" .r 4'I/n: staN\ e°✓ SAc c.G®°,9y°Wet{•#t,..E/$r.' y97A-I,r/�gYa A1"-�°F6. 6rtn°i°.cnl1f� io mtrtc.,°.� Cp*/G IuNY Y/'I -TG{�4'•;O gS4't uJ.�Rvn. lir.�Nii911 Iact•7r•' Corv,caulill•C.r ar 6s coni,I;a. jaew;..r.1 SPS3$3 5•ep�°c F ., a a''€tn��'.n ,c,:..e s/,:r �:�..V�',-..•:.,.y ':/*r-p4jjek,nede.l'1FpL-sas - - £..k qo Pvt P;pt. s A5TNr➢ Diifl — $cr, 5a/23'S PJe ip;p°c es A57m 3c,3 j ap/�ro. t P ,tee'�9 MCENED MAY 012026 Baykld Co. (i1aflBllig and Zoning Ag I I M ff7 �1veto7osKo115 q`fj1� �qn„F y0� — dra:�5.F.et 77.6-fl'4 3 Rei,�eacz TZ'wi.an ho l; Si U1 i no i r4 ban�o�ed-rev 'sps3&a+33 si'§n�,avi1• •, ers- ✓iC k y p 3 (.� -o r iN V _ v ip fit' 4 1 —Ii d `I N d X 0 N u 9 N V) v V 1I it C. /J cJ v J ISDr ''// �_• t2J = 73. qS- eb .i;<.._\: „�i.°acs rfoper4y owner: Legal bst, p -;Oh « `a - fi,�.._.. B r i/ h f et � c v, �yj H * S�7' r7c f.q �,co ka S art V.i 1 n -i a -t --y rid s'YJ W _ u c t 7 O �ltinatit�4�2vvINS. Z. I 6w K o# !'r J L.c. ? �/ C. . (J xp : AN'✓4r; ✓ u a p'r' �i.�' /5/�` a oc.y-R'e 1. a Soil Evaluation Site Map Owner: Bryn Hagberg Site Address: 6705 Kolling Rd, Iron River, WI 54847 Tax ID: 18672 Legal Description: A part of Government Lot Six (6) in Section Twenty-four (24), Township Forty-seven (47) North, Range Nine (9) West, 'Town of Hughes, Bayfield County, Wisconsin, more particularly described as follows: Commencing at the 1/16 section corner in the SE 1/4 of the aforesaid section; thence South on the 1/8 section line, 8.685 chains to iron pipe driven in the North side of large white pine stump; (herein designated as point A); thence continuing South on the 1/8 section line, 6 chains to the shore of Iron Lake, the point of beginning; thence return to Point A; thence East 1/5 chains; thence Southeasterly on deflection angle of 11"18', 1 '/2 chains; thence Southwesterly on deflection angle of 85"27', 5.68 chains to Iron Lake; thence Westerly along the shore of Iron Lake to the point of beginning. 0 25 50 ft N ng Road A Benchmark: Screw in oak tree Elevation 100' o Soil Borings: SB 1 - Elevation 96.65' SB2 - Elevation 94.46' SB3 - Elevation 96.48' EJ Property Line Soil Evaluated By: Tony Polkoski - CST #11068 R CE%VED 11 -Ay 0.1 ZON BAYFIELD COUNTY Bayfield Co. CHECKLIST FOR CERTIFIED SOIL TESTS Planning and Zoning AgenCY Submit the Following (Use Permanent Ink): Qj Check List ❑ Index Page / Title Sheet (Optional) Al Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) J1 Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) TAK MaPareel Identification Number (must be & digit Tax ID#) DO NOT USE 12 digit, they are no longer being used W Property Owner's Information (not prospective buyer's name) N Property Location (Accurate Legal Description with Sec/Twp/Range) NI Road Name (where driveway is/will be coming off of) ❑ Floodplain Elevation, Flow Rate, Comments and Recommendations NI Complete Soil Boring / Pit Information 10 Date Soil Evaluation was conducted l�l CST Name, Signature, Number, Address and Phone Number 56 *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) 6(1 Bench Mark (Description, Elevation and Location) M Contour Lines (Example = 98.0' /96.0' /94.0') bpi Property Location (Sec/Twp/Range/, Accurate Legal Description) 4 60 Borings (Locations and Elevations) II Percent and Direction of Land Slope• l Well Location (Including Neighboring Wells, if applicable) i Location of Wetland Areas, Floodplain and Navigable Waters 14 Buildings, Driveways, and Structures (Location and Descriptions) tjl Location of Property Lines K1 Existing System Location Fl Address Number and Road Name Current Surface Elevation of Wetlands and Navigable Waters CST, Owner and Property Information North Arrow Fee: �I Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforests May. D. 201/ 1U:41AM BAYbIbLD CO PLANNING & ZONING No, 9975 P. 3 RECEIVED MAY 01 2026 Bayfield Co. Planning and Zoning Agenq Pglot 42 Pg 2 of 8 Pg3of� Pg4ofg PAGE 1 OFS In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-1 0705-P (N.01/01, R. 10/12) Index & Cover Sheet Plot Plan 5 e. f t,Ic-,! «f/ C4rc s Section & Plan View — as Management Plan Attachments: Enclosures: �r Y c , 4 POWTS Application for Review (, Srrnfc S Soil Evaluation Report & Site Map ?c o ftl4, rl4t C. e A2✓e.e mQn PJY,n' :Iy-o z s k.e..e.4S Project Name I Description ry pernns Afl'� Owner Name(s): v "r ' c5 L v `7 Phone; 3z D Zz go Owner Address: 24 f 7 COY K Ls A ck i A hrtc nda Ae Lyl Zip: S 5_3 e .L Project Address: (P 05 fLo / /, l }Z •,-✓ ev �✓1 S Y Govt. Lot: (P 1/4 of 1/4, Section Z'/ , T7 EQor W ER Township: i-/ U( ^ e 5 County: &cyf Project Parcel ID #: X 7J d / Designer Information Designer Name: A 7 ( 1 ?© / ko s k - Phone: 7 / S - 7y - Designer Address: P -O, t3 ©K Saz J ro `(z v e J Zip: _6V8V7 -7 E-mail: :to n / a iJ eG V `) ccAtv10 l L e- o ✓✓1 This space reserved for approval stamp. License Number: fl -s 0 9 C Remarks: Signature: Date: 7 - Z%' Z ?iginai aigndwro required on each submitted copy. — RECEIVED MAY 012026 Bayfield Co. Planning and Zoning Agency MGOULDS PUMPS APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: 3/°" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/i' NPT, • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. •Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset • EP05 Singlephase: 0.5 HP, 115 V or 236V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 SJTW with three prong grounding plug. Optional 20 foot length, 16/3 SJTW with three prong grounding plug (standard on EP05), • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ■ EP04 Impeller: Thermoplas- tic semi -open design whh pump out vanes for mechanical seal protection. METERS FEET - - —. ..... 10 G 7 Submersible Effluent Pump E PO4 & E P05 Series ■ EPOS Impeller: Thermoplas- tic enclosed design for improved performance, ■ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ■ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ■ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ■ Power Cable: Severe duty rated oil and water resistant. H I 151"_.__._.__.. �..... .........L_ .�_.__.. _ 2 i 0` 00 _...._ o 20 30 0 2 4 6 8 CAPACITY 18 ■ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING Sp, Canadian Standards Association File # LR38549 11� EPOS 1 EP04 40 50 GPM 10 12 m'/h Goulds Pumps tITT Industries Table 6 • FRICTION LOSS (FOOT/100 FEET) IN PLASTIC PIPE' Flow in Nominal Pipe Size GPM• 3/4 1 1-1/4 1-1/2 I 2 3 I 4 I 6 2 3 3.24 4 5.52 5 8.34 6 11.68 2.88 Velocities in this area 7 15.53 3.83 are below 2 feet per second 8 19.89 4.91 9 24.73 6.10 10 30.05 7.41 2.50 11 35.84 8.84 2.99 12 42.10 10.39 3.51 13 48.82 12.04 4.07 14 56.00 13.81 4.66 1.92 15 63.62 15.69 5.30 2.18 16 71.69 17.68 5.97 2.46 17 80.20 19.78 6.68 2.75 18 21.99 7.42 3.06 19 24.30 8.21 3.38 20 26.72 9.02 3.72 25 40.38 13.63 5.62 1-z9. 30 56.57 19.10 7.87 1.94 35 25.41 - 10.46 I 2.58 40 32.53 . 13.40 3.30 45 40.45 16.66 I 4.11 50 49.15 20.24 4.99 60 28.36 7.00 0.97 70 37.72 9.31 1.29 80 11.91 1.66 90 Velocities in this area 14.81 2.06 100 exceed 10 feet per second, which is 18.00 2.50 0.62 125 too great for k 27.20 3.78 0.93 150 various flow rates and 5.30 1.31 175 pipe diameter 1 7.05 1.74 200 9.02 2.23 250 13.64 3.36 0.47 300 4.71 0.66 350 6.27 0.87 Note a: Table is based on - Hazen -Williams formula: h = 0.002082L x (100/C)185 x (gpm' 85 - d4.86ss) Where: h = feet of head L = Length in feet C = Friction factor from Hazen -Williams (145 for plastic pipe) gpm = gallons per minute RECt1t a1 pipe size MAY 0 12026 Bayfield Co. Planning and Zoning Agency 19 of 28 WLP1000/600-MR TANK SPECIFICATIONS 150" TOP VIEW in IOcC II 4" CAST -A -SEAL DIMENSIONS: WALL 3" BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 56" O.D. LENGTH: 150" O.D. WIDTH: 84" O.D. BELOW INLET: 42" O.D. LIQUID LEVEL 36" WEIGHT: 14,970 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 27.88 GAL/IN ) 6.76 GAL/IN ((PUMP) LOADING DESIGN: S' 0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/SEPTIC, SEPTIC/PUMP 4" VENT OR SEPTIC/SIPHON COVER: MIX DESIGN #8 NO FIBER) TANK: MIX DESIGN #10 STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE PUMP PAD TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: �OF 1 A SEPTIC TANK AND PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS Vent Pipe Locking cover with ≥ 12" above grade warning label and locking device and sealed Weather Proof Junction Box. Electrical as per NEC 300 and ,,.•` Comm 16.28 WAC n,ac:nlesifp Disconnect 4 In 4.F. H 1 � 18" min. . Alternate outlet Force Main ,eCEIVED Diameter: 2. Approved Building effluentfilter Length sewer j.:;;f {) 2026 ≤to 1/8" A particle size (pn0 0�q((oa1 Weep hole or anti planning and Zoning Agency a P � � siphon device. lcoo9allu� C pP mumU Off Elev. D I. Dose Tank Elev. ISO Bed Tank Note: All pipe and vent materials comply with $'5.383 Anchor tank as necessary to negate buoyant forces. Tank Manufacturer: W. tsar Cone.. Doses Per Day: It Tank Sizes: Septic /.OOO Gallons 1160O141101% GPD/ # of Doses: S gallons LF Lci 6� 17Sx. 1103= Pump bPto Gallon -<°" IL Backflow: l gallons Gallons Per Inch: Liquid Level: 3(P Pump Manufacturer: be 1 Pump Model: 1P.©. ,-/ ( A Alarm Manufacturer: s,/ e d vs Alarm Model: 1 011 1-( Vertical Difference between pump off and distribution pipe Total Dose Volume: 79 gallons Required GPM: � 1 Dimensions Inches Gallons A 300 B 2 33 C .5 -79 D I I I Total 3(p 6DO Minimum Required Supply Pressure (0 for dosed conventional) /rcf Z ,amt_ /7SFeet of force main x I �q friction factor/ 100 = o Total Dynamic Head 13vyYt 4g�e✓?(�.,,ber. A/(a- 1 "1k1D i % Zzc, 0df1ft215 sZlf=CtNED POWTS OWNER'S MANUAL & MANAGEMENT PLAN FlUN bN Own , ,i 4 t1 �l I-ev, Yom" A� 'M DESIGN PARAMETERS Number of Bedrooms 0 NA Number of Public Facility Units P4 NA Estimated (average) flow 3 d'a gaVday Design (peak) flow = (Estimated x 1.5) 7 .SD gal/day In Situ Soil Application Rate % aVda /ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) ≤30 mg/L Biochemical Oxygen Demand (BOD5) ≤220 mg/L CM NA Total Suspended Solids (TSS) ≤150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) ≤30 mg/L Total Suspended Solids (TSS) ≤30 mg/L ® NA Fecal Coliform (geometric mean) ≤10° cfu/100ml Maximum Effluent Particle Size in dia. 91 NA Other: (d) NA EYPjuw ,u, uuuwsuc wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Page b of Z Tank Manufacturer W , eSer [' C✓►( ❑ NA !1 Septic 0 Dose 0 Holding vol. 1 D 0 0 gal Tank Manufacturer DNA ❑ Septic pg Dose 0 Holding vol. 10 o� gal Effluent Filter Manufacturer Po 1 �/ It C.. O NA Effluent Filter Model P1_ 525 Pump Manufacturer �ov DNA Pump Model E ' O S/f A Pretreatment Unit 19 NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration 0 Wetland ❑ Disinfection ❑ Other: Manufacturer Dispersal Cell(s) ❑ NA ® In -Ground (gravity) 0 In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip -Line ❑ Other: Other: 59NA Other: J9 NA Service Event Service Frequency Inspect condition of tank(s) At least once every: S ❑ myear(ss) (Maximum 3 years) O NA Pump out contents of tank(s) M When combined sludge and scum equals one-third ('%) of tank volume 9 When the high water alarm is activated ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) .3 ® year(s) (Maximum 3 years) 0 NA Clean effluent filter At least once every: ® yeonth Inspect pump, pump controls & alarm ar(n)s) At least once every: ❑ month(s) ❑ NA .3 ® year(s) 0 NA Flush laterals and pressure test At least once every: Other: ❑o year(sjs) ® NA At least once every: O Other: year(s) li NA I9 NA MAINTE NANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank measurtons must e the volume of combined slue a visual dgetion of the and scum tand(a)to checkefoir any back any sup orrbroken po ding of effluent on identify grou d surface.leaks, The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding 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 tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of ≤12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (12/02) Page ?, of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals that may Impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the Infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power Is restored the excess wastewater will be discharged to the dispersal cell(s) In one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to Insure that the system Is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area Is available a holding tank may be Installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER d , POWTS MAINTAINER .4 • Name 1 lct,in ?� 1 � S s(P�d) Name Mt d� a I kc$ Phone .1 / 5' 2cj 2,— &1 1 .5 Phone II 5 3~ ≤ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ?,l kcSks arGAkeuer,* �� Name 'Z�.� e ' Phone u J S~ 37 7, ®0 (v Phone II c ' 138" This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Emily Macgillivray From: Emily Macgillivray Sent: Tuesday, May 5, 2026 1:33 PM To: 'tony@bearguidenorth.com' Subject: 6705 Kolling Rd Hi Tony, As we talked about on the phone, can you confirm that you are goingto be replacing the current system at 6705 when you do the install of the new system? Thanks! Emily Macgillivray (she/her) Assistant Zoning Administrator Planning and Zoning Department Bayfield County 117E 5th Street, PO Box 58 Washburn, WI 54891 Phone: 715-373-3511 emily.mac illivray cr,bayfieldcounty.wi.gov Fraudulent Billing Alert: Be aware that individuals submitting applications to our department have received scam emails. Bayfield County will NOT ask applicants to wire any funds. Please contact our office atzoning@badfjel I oumty.wi.gov or 715 373-6138 with any questions or concerns. O I ( Al 0 1 2026 BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Bayfield Co. Submit t1elkso&M QuaecPermanent Ink) (Title 15, Section 15-1-10(e)) III Check List 9 Original Sanitary Application (Submitted in Deed Holders Name — r14# prospective buyers) (383.21(1)1.) El Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) E' Original Plot Plan (383.22(2)2. 3. & 4.a) M Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) El Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) [9 Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(S),(6) (Recorded at Reg. of Deeds) ❑ Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) ❑ Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) 9 Fee (Make Check Payable to Bayfeld County Zoning) (383.21(2)(c)7) L. Com 1p ete Set 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) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary ADDlication: (Include the following Information) i2(I Application Information must Include: 0 23 digIt Parcel ID# -- (do not use 12 digits anymore --obsolete) ® Project Address o[ Road Name where driveway is/will come off of) L II Type of Building I9 III Type of Permit El IV Type of POWTS System [C+9 V Dispersal / Treatment Area Information S VI Tank Information S VII Responsibility Statement (Plumber's Information) 0 *Date Stamp* Plot Plan: (To Scale or To Dimension) 0r Signature and Plumber Information is Surface Elevation of Body of Water ® Direction and Percent Land Slope rt'Tank and Filter Information and Location [ ' Wetlands / Navigable Bodies of Water 05 Absorption Area (Proposed and Existing) Q Bench Mark (Location, Elevation and Description) El Component Manual Version O Legal Descriptions Q Piping Material Information (conveyance line, building sewer line, material type and diameter) Turn Over ► I@ (Owners Phone Number) [if Address Number and Road El North Arrow @1 Contour Lines Gr7 Structures and Driveways (0 Boring Locations d Property Lines GI Well Locations Cross -Section and Over -Head Profile of the Svstem: &T Surface and System Elevation E' Position of Observation and Vent Pipes Ca! Dimensions and Depths l Make, Model & Number of Chamber Units in each Cell Pr ooerty Information O How many systems will there be on this parcel of land? ❑ Has this property been split? :. (Property Statement shows Property History) es: Private Sewage System (Septic Tanks) $ 400.00 ❑ 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 l Maintenance Agreements , $ 30.00 (checks made out to Reg of Deeds) u/Forms/cheddtsts/checklistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: Emily Macgillivray From: Emily Macgillivray Sent: Tuesday, May 5, 2026 1:33 PM To: tony@bearguidenorth.com' Subject: 6705 Kolling Rd Hi Tony, As we talked about on the phone, can you confirm that you are going to be replacing the current system at 6705 when you do the install of the new system? Thanks! Emily Macgillivray (she/her) Assistant Zoning Administrator Planning and Zoning Department Bayfield County 117 E 5`h Street, PO Box 58 Washburn, WI 54891 Phone: 715-373-3511 emily.macgillivrav nbavfieldcounty.wi.gov Fraudulent Billing Alert: Be aware that individuals submitting applications to our department have received scam emails. Bayfield County will NOT ask applicants to wire any funds. Please contact our office at zoningCdbayfieldoQunty.w'gov or 715 373-6138 with any questions or concerns. RECEIVED MAY 01 2026 Bayfield Co. Planning and Zoning Agency Private Sewage System Maintenance Agreement BRYN HAGBERG 2847 COUNTY RD 5 NW, ANNANDALE, MN, 55302 6705 KOLLING RD, IRON RIVER, WI, 54847 1 laxluo 18672 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 fisted 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 / Townshi _N. Range W. Additional Legal Description: Set o -it o-Lhtd s�ir2IAr1I-Q, I - Town of (Acreage) Govt Lot_ Lot _ Bloch Subdivision Lot _ CSM # _ Vol. _ Page CSM Doc # DOCUMENT NUMBER 2O26R-€1 1 793 DANIELJ. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 04/15/2026 AT 1:44 PM RECORDING FEE: $30.00 PAGES: 2 Return To: Polkoski Soil 2 Septic Attn: Tony Polkoski 5115 County Highway B Iron River, WI 54847 ❑ In -ground gravity 2 In -ground dosed ❑ 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 et 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 8, 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, POWrS 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 -tirade. and Inaround 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 Bayfleld 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 nobly 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 ownerspeciflca/y agrees that all the costs end charges maybe placed on the tax roll as a special assessment forthe abatement of a human health hazanf, 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. Owner(s) Name(s) — Please Print Subscribed and swoon to before me on this date: 'yh I�u9� ro 1+/I I 7)1)r? O Notary Public E. yy� K� �� tYz My Commission Expires Drafted by: Tony Polkosld Date: 03-28-26 Proofed by: AP ,', EMMY LEE LARSON NOTARY PUBLIC - MNNESOTA MY COMMISSION EXPIRES 01/31/30 RECEIVED MAY 012026 Schedule C Bayfield co. Planning and Zoning Agency The land is described as follows: A part of Government Lot Six (6) in Section Twenty-four (24), Township Forty- seven (47) North, Range Nine (9) West, Town of Hughes, Bayfield County, Wisconsin, more particularly described as follows: Commencing at the 1/16 section corner in the SE 1/4 of the aforesaid section; thence South on the 1/8 section line, 8.685 chains to iron pipe driven in the North side of large white pine stump; (herein designated as point A); thence continuing South on the 1/8 section line, 6 chains to the shore of Iron Lake, the point of beginning; thence return to Point A; thence East 1/5 chains; thence Southeasterly on deflection angle of 11"18', 1 %z chains; thence Southwesterly on deflection angle of 85"27', 5.68 chains to Iron Lake; thence Westerly along the shore of Iron Lake to the point of beginning. IM AFIELD $ayfield 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: HAGBERG, BRYN 2847 COUNTY RD 5 NW ANNANDALE, MN 55302 Description Certified 'ed Soil Tests - Review & Filing Fee Submission Number: SR -00402 Transaction Number: SR -00402-457D8 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 6304 N Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 5/12/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. 34-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: Submission Number: HAGBERG, BRYN SS -00732 2847 COUNTY RD 5 NW ANNANDALE, MN 55302 Transaction Number: SS -00732-457E0 Description Amount Private Sewage System (Septic Tanks) $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 6304 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 5/12/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26,41 S STATE SANITARY PERMIT OWNER: BRYN HAGBERG GOVT LOT: 6 LOT: BLK: 1/4 1/4 SEC: 24, T 47 N, R 9 W TOWNSHIP: Hughes SOIL TEST: 35-26 REPLACEMENT SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: ALLAN POLKOSKI EMILY MACGILLIVRAY LLIVRAY DATE: 5/12/2026 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: 19770.168; 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 #: 137179 LICENSE: # MPRS 220090 Condition: Old System needs to be properly abandoned per SPS 383. Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 5/12/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION