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HomeMy WebLinkAbout26-43SV Request for Sanitary Inspection (24 Hrs. in Advance) Fax or email this form to Zoning Dept (24 Hrs.) prior to when you want an inspection Fax (715) 373-0114 or Email zonino anbavfieldcounty.wi.gov Note fl Time Change fl Discrepancy fl Other Phone Number Plumber: kos Q , Fax Number ) Homeowner: . l i x Email Address Immediate Phone Number So Zoning Sanitary Permit #: Dept can call you right back (if needed) Plumber's Choice ng Dept ,� No Inspection(s) during this time Date: ff Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice g Dept Time: llam r Township: 0 y I Address # & Road Name: / or I ��� R� son ((( Directions To Site: Comments: ** Plumbers you must verify any change(s) by fax or email ** Notes from Zoning July 2025 FAIX MILY LAND TRUST LLC 13882 85TH ST NE OTSEGO MN 55330 GENERAL INFORMATION ,DING TANK INSPECTION REPORT Permit Holder's Name ❑ City ❑ Village ❑ Town of t Sanitary Permit No. Plan ID No. Tax Parcel No. Property ddress if Av able TANK INFORMATION TYPE MANUFACTURER/MODEL# CAPACITY SETBACKS I Property Una I Well Water Service I Building I All -Weather Road I OHWM I Swimming Pool Oo Y° 1 DEVIATIONS FROM APPROVED PLAN 'Po C,Lt ak1, c COMMENTS (Persons present, discrepancies, etc.) o1 Pit -k f1 o� COMPONENTS NOT INSPECTED Plan Revision Required Dyes Duo D " YItnei Signature o pe Cert. Number Sketch on other side 10of13 l Property Owner Information HAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Bayfield County Courthouse Fax: (715) 373-0114 Post Office Box 58 e-mail: zoningCa bayfieidcounty.wi.gov 117 East Fifth Street Web Site: www.bayfieldcountv.wi.gov/147 Washburn, WI 54891 DONALD & CAROLINE FELIX FAMILY LAND TRUST LLC 13882 85TH ST NE OTSEGO MN 55330 As you know 1 .1X0f ,` 1• was contracted by you to install a private onsite wastewater treatment system on your property described as: Notes:i)'l1/AQ'f -1 6' 5 i �aHt/l'P Abandonment of Old System to meet all applicable code requirements: C• Tank was pumped by: :• Tank was crushed / removed and pipes disconnected by: on at AM/PM On at (A IPM) the above -mentioned plumber contacted our office to conduct a p e -co er inspection as req - 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: U/formslsanilarypropettyowner-input April 2019 �a►'tV^""'``r,•R Department of Safety County . L t.. h MAY 1 12426 e Lc & Professional Services, P - Sanitary Permit Number (to be filled in by Co, Industry Services.Division Banfield in �� — O 0-7 � I pnnand Zoning AgencyQ( L(� Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are, submitted to Project Address (if different than mailing addn 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(1)(m), Stars, j I.'Abnllce tInn'Inforinattnn — Phw. . Prof* A1I rnfnwmoMtr.n s�� u rroperry uwner-s71MI Pc&7L 1 � Property Owner's Mailing Address 13 Z • �" ' S� /! City, Stated Zip Code 6>l eD.�1.5-r.3 3o H. Type of Building (check all that apply) lP I or 2 Family Dwelling —Number of Bedrooms O Public/Commercial— Describe Use h RED Parcel # Tcc t. jj z S g 7 S^ Property Location Govt. Lot Phone Number 7 L " 3 7 i d ���r--'/ u k% y,, Section 1 3 Lot # .r L/ 4 -. .. c .� a O City of O State Owned — Describe Use CSM Number ❑ Village of Q1 Town of D ✓, III. Type of PO�'VTS Permit; (Check either "New" or "Replacement" and other applicable on line A. Cheek one box on line B. Complete line C a licable. A. New System ❑ Replacement System 0 Other Modification to Existing System (explain) ( plain ) ❑ Additional Pretreatment Unit (explain) B. Holding Tank 0 In -Ground 0 At -Grade ❑ Mound 0 Individual Site Design 0 Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision 0 Change of Plumber 0 Transfer to New Owner List Previous Permit Number and Date Issued Expiration LV. DIs ersal/Treatment Area and Tank Information: Desi7.5-0 Flow (gpd) Design Soil Application Ratc(gpd/sf) Dispersal Area Required (at) Dispersal Area Proposed (sl) System Elevation L� Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units Now Tanks Existing Tanks '° •rs V w Sepe'esHoldingTunk 2.So Z S"DO L tdJ i �5•e r �G h. C � V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) tJ Plumber's Si ature tt�/MPRS Number I Business Phone Number A11Th1G-O 1�; �--� 22 ao7 p 171 {/s4 Plumber's Address (Street, City, State, Zip Code) s- t,) .L ≤-'K8 Y7 t Si TO l Approved 0 Disapproved remur rcc Date Issued L Issui g A /`$ y ❑ Owner Given Reason for Denial -- 5 i,3 Conditions of Approval/Reasons for Disapproval 4fEE1fiirJ Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x ii Inches in size SBD-6398 (R. 03/22) . . . .• ..r'•I I +V1.N VV I Lf11VIVLIVJ ct LVIVtiVU No,. 9975 P. 2 Pg 2 off Pg3off Pg4of9 MAY 112Q26 Bar4 Zoning pgencY p�,nn+n9 PAGEIOF9 Holding Tank Plan Index & Cover Sheet Dorn onent Manual Design References: ►' 1Yir�rtiu�o�. yp'j.i �si� i i) czo2Z _o�7 Pg I of t - Index & Cover Sheet Plot Plan Holding Tank Speclfica#i ns �-z.. 74 y e- Nlanagament Plan Project Name I Description )le) ', te..ej Owner Name(a): 1 o ta jcL -e" X Ph 7 3- 7 b D. Owner Address: I3 q9Zr t i E D•f 5 M tii p; 3c-3 30 Project Address: S l4 (7 r*c,.i: J (;≤— Gov#, Lot: 1/4 of U) 914, Section 3 ► T i -R E Q or W Township: f4 ��� County: __ _ Project Parcel ID #: v -e ! Z f53 Designer Information Designer Name: A / /& Pc, Ile -I 0 S htPhone: 7/S't S4 Dear nerAddress: _�. �---- 9 ©X S`z-z e %firy �e_r' W,1 :dip: SV._7 E-mail: `f " AIL L rrj; d am. .. G;.' �•,'r,.� Thi Spate reserved for approval stamp. License Number: - 2 Q o �) O Remarks; •Signature: Dat6: 6 — / z+� Original signature required on each submitted copy. I .tli4'-'i BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) If Check List L? Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) Z Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) ®' Original Plot Plan (383.22(2)2. 3. & 4.a) I Cross Section, Over -Head Profile of the System an Schematic of Tank from Manufacturer 1J Pump Tank Diagram, Alarm and Pump Curve (when applicable) it Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) ❑ Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) IT 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) i' Fee (Make Check Payable to Bayfleld County Zoning) (383.21(2)(c)7) 2 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be atta hie to all copies) i�1 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 ARp ation: (Include the following Information) L I Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) ® Project Address gr Road Name where driveway Is/will come off of) E1' (Owners Phone Number) i1 II Type of Building ®III Type of Permit ii' IV Type of POINTS System ❑ V Dispersal / Treatment Area Information L VI Tank Information 121 VII Responsibility Statement (Plumber's Information) ❑ *Date Stamp* Plot Plan: (To Scale or To Dimension) Of Signature and Plumber Information t 'Surface Elevation of Body of Water 0 Direction and Percent Land Slope 121 Tank and Filter Information and Location ill Wetlands / Navigable Bodies of Water 0 Absorption Area (Proposed and Existing) 19 Bench Mark (Location, Elevation and Description) ti CEIVED MAY 112026 Bayfield Co. Planning and Zoning Agency if Address Number and Road 10 North Arrow ❑ Contour Lines Structures and Driveways @i Boring Location I�' Property Lines I Well Locations i9 Component Manual Version 1O Legal Descriptions 19 Piping�Maierlai,,information (conveyance line, building sewer line, material type and diameter) Turn Over ► rcp - r°t� Vwdl€YA0 ' . Dv�4c/:::e,x t38z.'fig+15 jJ1 D5e50 44 IJ5533 FM tc4?t4U34 SJ3TV7N F 1 ecopt C6 Jwvt 4V a f i4 I nor Utz f,DytSn J e'/i..X�rk 6 ,"„"i dyl lcs 4t + R : 41 3 oa 1! kt - / 1AY .I 12026 Say1ie{d Co. '�ro r5 �. Planning and Zoning Agency' PN Z≤b 27, sr�A ale+ ,R, tJf i 1't� 1'e&6-.- V1'SGhj0F/K#— ` L..c k5 C Ps . v!) /3Z0 Ar 1 6'.P a t c: y U -et e. + � 5ck Io PvC vi/4?cs vi 1 q"ASTM D7'5- ct,pp V-0 ve-J F. P d��e;,- t�• � ct l ! H II M k Cep t' &45t ova P1L a:1 R F3 ° ≤z; Z d'a►i n►'vt..�°, t&2 ≤'� W7 Icc 1834" 4" CAST -A -SEAL 4" CAST -A -SEAL FILTER OR • BAFFLE TOP VIEW io a v„� w M (� RI N) SIDE VIEW WLP2500 TANK SPECIFICATIONS DIMENSIONS: WALL: 3" BOTTOM: 3" HEAVY - 5" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 52-3/4" O.D. LENGTH: 183-1/4" O.D. WIDTH: 101-1/4" O.D. BELOW INLET: 41" 0.0. LIQUID LEVEL: 36" WEIGHT: TANK - 3" BOTTOM 12,560 LBS. a =U U o a TANK - 5" BOTTOM 15,527 LBS. WEIGHT: COVER 9,300 LBS. N a INLET AND OUTLET: m 4" CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 0 e.f� (OTHER STATES SEE CHART) LIQUID CAPACITY: 69.44 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED C d�- ACTUAL CAPACITY: 2.639 GALLONS z 00 W LOADING DESIGN: 8' 0" UNSATURATED SOIL j TANK CAN BE USED AS: raj SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) c TANK: MIX DESIGN #9 (SMALL FIBER) 0 m CUSTOMIZED TANKS: 3 �- OUTLET FOR CUSTOM TANKS CONTACT WIESER CONCRETE M �^ N �c � . •re N ,3 ..l:t ', a. DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: N J3 N o Q N 5 != W W 5: V) W 0: SHEET NO. / OF lI • PROPERTY OWNER: b o v.q PLUMBER: AlLan Polkoski! 12.olk s l Plumbing SIGNATURE: ---.. •DATE: 5 -- / _— Z (P AICENSE # 220 90 Yk(..p mss. HOLDING TANK SPECIFICATIONS ZT I Number of bedrooms Non-restdentiel estimated flow (gpd) Minimum holding tank vofume're lid (gal) Tank k Dimensions and Data X for round tank 51 Liquid depth below Inlet Invert (in) ,Maximum de th of soil cover (ft) 10 f'91 Height (in) Outside 6 sus o'° Length (in) Dimensions Width (in) Only Manufacturer model number manufacturer iber y-:rC .iVED MAY 112026 Bayfield Co. Planning and Zoning Agency Tank Anchor Calculations MYd4 Ibs Weight of tank and cover Safety factor lbs Weight of anchor required In Soil cover req. for anchor or Concrete counter weight HOLDING TANK CROSS SECTION msnnola coverwith junction 4 locking device and finished vent clip box ,,...� warning label grade min, -- H--24 in. t it min. conduit -.--a Manhole and vent locations may be reversed. Yent pipe r.........,,, 18"min. serolce '12.0 In. building sewer blind plugalarm on '"""'"""' inlet Note: All tank jolnts, and to sees Joints between tank outlet o enin s Electrical as per openings and piping are NEC 300 39.0 in. sealed watertight. All pipe and Comm 1 s and vent materials comply with 5I 4TS3 's 3 In. bedding under tank. Tank is anchored as necessary to negate buoyancy. r y Document Number/Plan I.D. No. I HOLDING TANK I DOCUMENT NUMBER I AGREEMENT I 2426R-612120 ri�o u fir✓ O� ,r -'s Parcel Id ntifier Number (PIN) Agreement Date (same as Notary -Date) Oq- o3tu ��ly - t7ct- i 'a uoa iu� o �! ..-Z - on the following property or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Slats. Al if 1/4 of " IA/ 1/4 Section 13 Township j t9 N. Range O� W. TownoLPOt` Additional Legal Description: Gov't Lot Lot Block Subdivision CSM# Lot CSM # Vol Page CSM Doc# DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED O5/12/2O26 AT 1 1 :O2 AM RECORDING FEE: $30.00 PAGES: 1 RECEIVE® tiAY 3 2026 13f BaYfield Co. Return To.....'-" "^ ""a 'Agency As an inducement to Bayfield County to issue a sanitary permit for a holding tank on the above described property, we" agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tank Installation and maintenance. If the owner falls to have the holding tank properly serviced in response to orders Issued by Bayfield County or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Slats., Bayfield County may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the chargQg.,on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats. 2. Owner agrees to pay all charges and costs Incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may beplaced 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 IaW, . 3 3. The owner agrees to contract with a person who is licensed pursuant to s.281.17 (3) Wis. Slats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced In accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of the contract with Bayfieid County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed pursuant to s. 281.48 (3) Wis. Scats., and Ch. NR 114, Wi's Adm. Code who shall submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfleld County may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may Indicate that the holding tank is not being properly maintained. 5. This agreement will remain in effect only until Bayfield County certifies that the property Is served by either a municipal sewer. or a private onsite wastewater treatment system that complies with Ch. SPS 383, WI's Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall ;submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds In a manner which will'permit the existence of the agreement to be determined by reference to the property where the holding tank is Installed. Owner(s) Name(s) — Please Print Sub o ry u c to b Minnesota re me on this date; Notarized wner(s) Notary Public My Commission Expires: .�' �, 4—Z7 -7- Drafted by: 1O `t a 5 Date: Personal Information you pro de may be used for secondary purposes tPdvacy Levi, s.15.04 (l)(m)i ulformalsanitarylholdingtankegreemenLdea dune 2018 HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and f, maintained according tof533 3 is. Admin. Code, the Holding Tank Component nual ttis -cJve t-soo n vc. ! typ f Eo and the ` J e. I J County Sanitary Ordinance. z.1) j LM' Z° zn.`� R2oc.N 1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 400.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and PS 383 and384 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or Its use discontinued, components no longer in use it shall be abandoned in accordance with CPS 963.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer ............................. P csJ PA.g zZOog! Phone: -71( 37 Lj ,' b. Service Provider .................. • ' g,z71 Phone: 'vs- 3-ra. - 400pg, c. Co. Zoning or Health Dept. a.y4e4d C,upf Phone: 7/3 -yam f 6tM 11. a P�Wt 10 Project Transaction Number: /+J 5ec /y 1-' IJ R4 U HOLDING TANK SERVICING CONTRACT Contract Date a4 / qt ) & This contract is made between the Holding Tank Owner(s) Name(s) ca^4J r e\io� Pumper's Name (Print) - kovvL•4s Fo lkosk. Pu edrs Signature Pumpers' Registration # We acknowledga the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT I Legal Description: Tax ION I / A. 1/4, V" 1/4, LOCAT1ON (Use Tax Statement) 5 f1 Section., Township 4/ 1 N, Range D_t W Town of: I Lot Size I Acreage Gov't Lot Lot# rSM N Vol. Page CSM Doc N Lot(s) No. Block(s) No. Subdivision: 1. The owner agrees to file a copy of this contract with Bavfield County as required in SPS 383.55, Wis. Adm. Code. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges Incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local government unit which has signed the pumping agreement required by SPS 383.55, Wls. Adm. Code, and the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: Z Cn �VED a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; MAY 11 2026 c. The location of the property on which the holding tank is Installed; d. The sanitary permit number Issued for the holding tank; sayeea Co. e. The dates on which the holding tank was serviced; Planning and Zoning Agency f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local government unit and the County named above within (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner's Signatur (s) Subscribed and Sworn to me: t -1 � C �e 11.x � J� on this oZ( day of ✓L k by: GINA M LYONS tary Public Notary Public 1 I Minnesota My commission expires on: 6 I O2 Revised: May 2016 (®May 2018) Drafted by �If V. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)) • ' 12026 E 1� �6 S !Z - O o q`( soli rest # �7 / Ra�ifielrl CnimY4� /' � b Saflieta co. p{8nning a,dzon%n9A9�'�Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) I cu/I 19 / lo(�o s A £ a certified soil tester determine that in my professional judgment the following site (see below) is unsuitable for any treatment. component other than holding ' tanks. Due to soil & site conditions, a thorough soil and site evaluation Is not needed to make such a determination. IIj Property Owner 2' I—`- "X Pro pert Address �.i 5'0" i v Contractor Authorized Agent Agent's Telephone, Telephone 7 t'3 7.4' d Z Written Authorization Attached: Y or N Accurate Legal Description is requested: IV 1114 of 1001/4 Section t3 Township N. Range7 W. Town of Additional Legal Description: Govt. Lot Lot Block Subdivision Lot CSM# Vol. Page CSM Doc # VolumePage of Deeds Tax I.D#_ _ S �`7 S Acreage 'o '- Indicate reasoning for your determination: kJcr C t(cLy.e75 Is .— o r cj h y G -f Li, 7 0 Signature of Count Official Date tire of Certified Soil Tester Date C,�; ' 2to1y Certification # Submit a Plots Plate"& -Fee) Wforms/sotitestwaiver(KLK) June 2018 r,r.rt �W✓1 11'o Dam c to .13fgz f +�sfiIJ o�"s�wyo� i44fJ SS3�D Tic 7� L 4 L1 r;pvt J44 S x.1,3 T 'fYN ' r �� �� v►e f v Err i `€ mot. Cct1 -pensa�t L 3 1 jU6 1t vC. `I - C4 5cir;3 Ska 1 ' s/ 1s s, -fit Ncsir,-t' R gws a s� d�D,,t;IJt// ?r o__i,j o52G l.GJ 2�a o J' RECEIVED �Y� �L� k�,,� / 1 ® G tie ,,� N1 MAY 1 12026 �!� a6 n S��$�sw Bayfield Co. Z "A J.planning and Zoning Agency I•• rx3 d 1 a�.r j m dC yyt ee4s ot,1 ! A$ i r d'1. , e.44a ru k (-5;P.5.383) l 3 ° . e=# b e'e. 4 lac: ( y Ott c k -• = we-) t .-�► 2 5c� i1O PVC vj/"F t o q"AS�7-09) i s 7 �'5 �c, � v-� 1%( ��:` r�«z.-1' w� ct ( 11 1H,R !d v oiq ccal k Cc hi p aA ,y� t, iu/ se c�q (V i 4.1 cPA a.7) .7 �-1 3 o Y cz:z. r 'i F' u e, BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): C E�VEO MAY 112026 Bayfield Co. 11 Check List Planning and Zoning Agency 10 Index Page / Title Sheet (Optional) 9 Original Soil Evaluation Report (Submitted in Deed Holders Name — n® prospective buyers) if Original Plot Plan G Cross Section Soil Profile Sheet (optional) • Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) © Parcel Identification Number (must be 23 di it Tax ID#) DO NOT USE 12 digit, they are no longer being used 91 Property Owner's Information (n .t prospective buyer's name) O Property Location (Accurate Legal Description with Sec/Twp/Range) Ed Road Name (where driveway is/will be coming off of) iI Floodplain Elevation, Flow Rate, Comments and Recommendations i1 Complete Soil Boring / Pit Information i0 Date Soil Evaluation was conducted l CST Name, Signature, Number, Address and Phone Number 0 *Date Stamp* Plot Plan (Include the following information drawn to dimension or to scale) ld Bench Mark (Description, Elevation and Location) i Contour Lines (Example = 98,0' /96.0' /94.0') 0 Pi operty Location (Sec/Twp/Range/, Accurate Legal Description) 9 Borings (Locations and Elevations) Ei Percent and Direction of Land Slope �f Well Location (Including Neighboring Wells, if applicable) E Location of Wetland Areas, Floodplain and Navigable Waters IZI Buildings, Driveways, and Structures (Location and Descriptions) C Location of Property Lines C1 Existing System Location fZI Address Number and Road Name I1 Current Surface Elevation of Wetlands and Navigable Waters !�J CST, Owner and Property Information North Arrow Fee 16 Certified Soil Tests - Review & Filing Fee . $ 50.00 u/lbrms/sanitary/checklist/checklistforests 1. Tracy Pooler From: Tracy Pooler Sent: Wednesday, May 13, 2026 9:22 AM To: 'tony bearguidenorth.com' Subject: RE: Tax 25875 - Felix soil test ? Thanks, In the future please do it on a soil profile form. Tracy Pooler - AZA Planning and Zoning Department 117 E 5th Street, PO Box 58 Washburn, WI 54891 Phone: 715-373-3512 Fax: 715-373-0114 Email: tr� . poote bayfieldcounty.wi. ov C O U H r r 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 zoningbayfieldcounty.wtgov or 715373-61 38 with any questions or concerns. From: tony bearguidenorth.com <tony@bearguidenorth.com> Sent: Wednesday, May 13, 2026 8:23 AM To: Tracy Pooler<tracy.pooler@bayfieldcounty.wi.gov> Subject: Re: Tax 25875 - Felix soil test ? A few inches of black topsoil and the rest clay Sent from my iPhone On May 13, 2026, at 8:02 AM, Tracy Pooler <tracy.poolerc bayfieldcounty.wi.gov> wrote: Tony, What is the soil profile of the soil test that you did at Felix ? Tracy Pooler - AZA Planning and Zoning Department 117 E 5th Street, PO Box 58 Washburn, WI 54891 1 BAYFIELD COUNTY SANITARY PERMIT (#04)-26-43S STATE SANITARY PERMIT OWNER: DONALD & CAROLINE FELIX FAMILY LAND TRUST LLC GOVT LOT: LOT: BLK: NE 1/4 NW 1/4 SEC: 13, T 49 N, R 9 W TOWNSHIP: Orienta SOIL TEST: 37-26 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: ALLAN POLKOSKI TRACY POOLER Authorized Issuing Officer DATE: 5/13/2026 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: # MPRS 220090 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 5/13/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION