Loading...
HomeMy WebLinkAbout26-49SRLC iJVED EHTER D Industry Services Division County Bayfield .er�� 4822 Madison Yards Way 2b P -I " Madison, WI 53705 Sanitary Permit Number (to be filled in by Co.) MAY "I l' 2026 SS P.O. Box 7302 _ 'P1 5 W / Madison, WI 5302 Plannlns, ttt9P?ermlt 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 numoses in accordance with the Privacy Law, s. 15.04(I)(m), Stats. James Duclon Property Owner's Mailing Address Property Location 64805 County HWY H Govt. Lot City, State Zip Code Phone Number Iron River, WI 54847 715-372-8290 NW' /4, NE%, Section 33 11. Type of Building (check all that apply) Lot # 147 N R 8 E o® ,I I or 2 Family Dwelling — Number of Bedrooms 2 Subdivision Name 0 Public/Commercial — Describe Use Block # O Cityof ❑ State Owned — Describe Use CSM Number O Village of IN Town of Iron River 111. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line Cif a licable. A. ❑ New System X Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before List Previous Permit Number and Date Issued ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner Expiration IV. Dispersal/Treatment Area and Tank Information: 7 "pn aty ,. Tank Information Gallons Gallons Units $ 9 New Tanks Existing Tanks v 2 ' , 0,0 in y rn iL O C Septic or Holding Tank 750 750 1 Wieser Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's ignature MP/MPRS Number Business Phone Number Allan Polkoski &._ r 220090 715-292-4156 Plumber's Address (Street, City, State, Zip Code) PO Box 522, Iron River, WI 54847 VI. County/Department Use Only Approved O Disapproved SPermit Fee Date Da'Issue% Issuing Agent Si naature �� & ❑ Owner Given Reason for Denial Oar- 7/27 /% thi i i4 4 M /al /1i,/ti 11,y)4&—,OJ �cA- Cv�a CQ�ed C a✓� . to complete plans for the system and submit to the County only on paper not less than 8 t2 x II inches in size SBD-6398 (R. 02/22) R—oowct •:•. of Safety & Professional ServicesSOIIL TESTL1t O Page1 of 2 J%Msar1ment tySvices (over) ) ,► SOIL EVALUATION REPORT " f AY 13 202 57$2& accordance with SPS 385 Wrs. Adm. Code County Bayfield complete it lMr'8a er bs an 8 1/2 x 11 inches in size. Plan must include, not limits �� I reference point (BM), direction and percent slope, Parcel I.D. 19973 kale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by //0 Date Personal Information you provide may be used for secondary purposes (Privacy Law, s: •15;04(1)(m)). I Property Owner Y Property Location '1'fi❑ (:?&c James Duclon Govt. Lot. NW14 NE% S33 T 47 N R 8 E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: 64805 County Highway H 64805 County HWY H LCity, State, Zip Phone Number ❑ City ❑ Village ® Town Nearest Road Iron River, WI 54847 715-372-8290 j Iron River County. HWY H O New Construction Use: I Residential/ Numberof bedrooms 2 Code derived designflow rate 3_ 0_0GPD ® Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material: Sandy and gravelly outwash General comments and recommendations Avi s C y r esv %res Paressvve : A A 1 F i. fl _ — 0 _ a . w — — _ , L 1 Boring # ❑ Boring ® Pit Ground surface elev. 96.4 ft. Depth to limiting factor 105 in. / elev. 87.7 ft. Horizon Depth Dominant Color . Redox Description Texture In. Munsell Qu. Az. Cont. Color O- 9 7$YR I Si -ao 3/'- 3 -S L4 J•IiC 'VDLJ//_ Boring # Soil Application Rate Structure Consistence Boundary Roots GPD/Ft2 Gr. Sz. Sh. *Eff#1 *Eff#2 rnsbk_Pr_S5_34'_.4 /7 -S f.1,r It v 4 . '7 I . P� ❑Boring ®Pit Ground surface elev. 96.3 ft. Depth to limiting factor 102 in. / elev 87.8 ft. Horizon Depth In. Dominant Color Redox Description ITexture I Munsell Qu. Az. Cont. Color 1 o-4 . [ t4.9 `` r gkc 3 s- I y S1.1,7 cvP a// - CST Name (Please Print) Signao.7-7 tur Tony Polkoski 4ddress Date Evalua(fon Con ucte 1115 County HWY B, Iron River, WI 54847 I 5-2-26 Structure I Consistence I Boundary I Roots Gr. Sz. Sh. Soil Application Rate GPD/Ft2 *Eff#1 *Eff#2 ps .s - CST Number 11068 - ST Telephone Number * Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 5150 mg/L * Effluent #2= BOD, s 30 mg/L and TSS 5 30 mg/L SBD-8330 (R03/22) Boring # ❑ Boring ® Pit Ground surface elev. 96.2 ft. Page 0 or 2 Depth to limiting factor 100 in. / elev 87.9 ft. I Snil Annlication Rate Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence- _ Boundary Roots GPD/Ft2 Horizon *Eff#1 *Eff#2 o 3J '- ,m4( S -c c, $ 1 Q .c .c t 1 C f ref R r- GS i-F' .S" Boring # ❑ Boring O Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Soil Annlication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence . Boundary Roots GPD/Ftz *Eff#1 *Eff#2 •t ' L____I Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I 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 EVNED > 30 s 220 mglL and TSS > 30 s 150 mg/L MAY 13 2026 Bayfield Co. Planning and Zoning Agency * Effluent #2= BOO, s 30 mg/L and TSS•s 30 mg/L . 1 � i,C �VED BAYFIELD COUNTY f:�AY 132026 CHECKLIST FOR CERTIFIED SOIL TESTS aayfield Co. Saibi#Pdrin4 (Use Permanent Ink): X Check List ($ Index Page / Title Sheet (Optional) f Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) D( Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) Tax Identification Number (must be 5 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used 18t Property Owner's Information (not prospective buyer's name) [ Property Location (Accurate Legal Description with Sec/Twp/Range) Z Road Name (where driveway is/will be coming off of) O Floodplain Elevation, Flow Rate, Comments and Recommendations IX Complete Soil Boring / Pit Information X Date Soil Evaluation was conducted I $ CST Name, Signature, Number, Address and Phone Number CK *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) R Bench Mark (Description, Elevation and Location) X Contour Lines (Example = 98.0' /96.0' /94.0') I,R Property Location (Sec/Twp/Range/, Accurate Legal Description) X Borings (Locations and Elevations) a Percent and Direction of Land Slope. I Well Location (Including Neighboring Wells, if applicable) Location of Wetland Areas, Floodplain and Navigable Waters CK Buildings, Driveways, and Structures (Location and Descriptions) Location of Property Unes Existing System Location Address Number and Road Name I Current Surface Elevation of Wetlands and Navigable Waters 1 CST, Owner and Property Information X North Arrow Fee: X Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checidist/checldistforests MAY 13 2026 gayfietd co. In-Onaand ndSoil Absorption for POWTS Version 2.1 Owner/Site Address: James Duclon 64805 County HWY H Iron River, WI 54847 Tax ID: 19973 Legal Description: Combined Soil Evaluation - System Plot Plan A parcel of land located in the Northwest Quarter of the Northeast Quarter (NW'/4 NE'/.), Section Thirty-three (33). Township Forty-seven (47) North, Range Eight (8) West, Town of Iron River, Bayfield County, Wisconsin, described as follows: Commencing at the quarter comer between Sections 28 and 33; thence West along the section line a distance of 359.5 feet to an iron pipe; thence angle to the left 90°21' a distance of 222.6 feet to an iron pipe; thence angle to the left 41°40' a distance of 307.1 feet to an iron pipe; thence angle to the left 02°48' a distance of 571.0 feet along the South side of new Highway "H" to an iron pipe located on the water's edge of Bass Lake,. which is known as the place of beginning; thence continue on the same line a distance of 162.7 feet to an iron pipe; thence angle to the left 05°22' a distance of 157.7 feet to an iron pipe; thence angle to the left 07°30' a distance of 648.7 feet to an iron pipe; thence angle to the right 147"20' a distance of 340.3 feet to an iron pipe; thence angle to the right 44°35' a distance of 302.0 feet to an iron pipe located on the water's edge of Bass Lake; thence Southwesterly and Northerly along the water's edge, a distance of 977.0 feet to the place of beginning. Absorbtion Area o Soil Borings: 1 - Elevation - 96.4' 2 - Elevation - 96.3' 3 - Elevation - 96.2' Q Benchmark - Screw in Birch tree Elevation - 100' __- Approximate Property Line Note: Existing system abandonment per SPS 383.33 prior to new system installation. Completed Bayfield County Abandonment form available during inspection of new system. r 98' 1 Pipe Material: ASTM Standard (Tables 384.30-3 & 384.30-5) Existing Well Page 2 of 4 .. wnn ri A Drainfield . " .� Soil Evaluated By: Tony Polkoski -11068-ST Plumber: Allan Polkoski - PMRS 220090 PAGE 1 OF 4 �_;C�IVED In -Ground Gravity Plan I,Al 132026 Index & Cover Sheet �ynetd cc. e� Component Manual Design References: pianninga�Zo"'"g� In Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Page 1 - Index & Cover Sheet Page 2 - Combined Soil Evaluation -System Plot Plan Page 3 - Dispersal Area Cross -Section & Plan Page 4 - Management Plan Enclosures: Private Sewage System Maintenance Agreement, Soil Evaluation Report, Sanitary Permit Application, Wieser WLP750-MR approved tank specifications, Soil Test Checklist, Sanitary Application Checklist, $450 check Project Name / Description Owner Name(s): James Duclon Phone: 715-372-8290 Owner Address: 64805 County HWY H, Iron River, WI 54847 Project Address: 64805 County HWY H, Iron River, WI 54847 Legal Description:Lon plcrC it3a( cleSCt'ipTi()v\ o.TCac,ked o%s SckcJQ!e.C Township: Iron River County: Bayfield Project Tax ID #: 19973 Designer Information Designer Name: Allan Polkoski Phone: 715-292-4156 Designer Address: PO Box 522, Iron River, WI 54847 E-mail: tony@bearguidenorth.com License Number: PMRS220090 Remarks: Signature: — Date: z c Original signature required on each submitted copy. RECEIVED MAY 1 3 2026 Bayfield Co. SCHEDULE C PWnning aril Zoning Agency LEGAL DESCRIPTION A parcel of land located in the Northwest Quarter of the Northeast Quarter (NWT/a NEl/a.), Section Thirty-three (33), Township Forty-seven (47) North, Range Eight (8) West, Town of Iron River, Bayfield County, Wisconsin, described as follows: Commencing at the quarter corner between Sections 28 and 33; thence West along the section line a distance of 359.5 feet to an iron pipe; thence angle to the left 90°21' a distance of 222.6 feet to an iron pipe; thence angle to the left 41°40' a distance of 307.1 feet to an iron pipe; thence angle to the left 02°48' a distance of 571.0 feet along the South side of new Highway "H" to an iron pipe located on the water's edge of Bass Lake, which is known as the place of beginning; thence continue on the same line a distance of 162.7 feet to an iron pipe; thence angle to the left 05°22' a distance of 157.7 feet to an iron pipe; thence angle to the left 07°30' a distance of 648.7 feet to an iron pipe; thence angle to the right 147°20' a distance of 340.3 feet to an iron pipe; thence angle to the right 44°35' a distance of 302.0 feet to an iron pipe located on the water's edge of Bass Lake; thence Southwesterly and Northerly along the water's edge, a distance of 977.0 feet to the place of beginning. Attached hereto and made part of the sanitary permit application. ECE JVED MAY 13 2026 gayfield Co. ing fl I n-I0P2i?Mnd1SolilAbsorption for POWTS Version 2.1 Owner/Site Address: James Duclon 64805 County HWY H Iron River, WI 54847 Tax ID: 19973 Legal Description: Combined Soil Evaluation - System Plot Plan A parcel of land located in the Northwest Quarter of the Northeast Quarter (NWY NE'''A), Section Thirty-three (33), Township Forty-seven (47) North, Range Eight (8) West, Town of Iron River, Bayfield County, Wisconsin, described as follows: Commencing at the quarter corner between Sections 28 and 33; thence West along the section line a distance of 359.5 feet to an iron pipe; thence angle to the left 90°21' a distance of 222.6 feet to an iron pipe; thence angle to the left 41 °40' a distance of 307.1 feet to an iron pipe; thence angle to the left 02°48' a distance of 571.0 feet along the South side of new Highway "H" to an iron pipe located on the water's edge of Bass Lake, which is known as the place of beginning; thence continue on the same line a distance of 162.7 feet to an iron pipe; thence angle to the left 05°22' a distance of 157.7 feet to an iron pipe; thence angle to the left 07°30' a distance of 648.7 feet to an iron pipe; thence angle to the right 147°20' a distance of 340.3 feet to an iron pipe: thence angle to the right 44°35' a distance of 302.0 feet to an iron pipe located on the water's edge of Bass Lake; thence Southwesterly and Northerly along the water's edge, a distance of 977.0 feet to the place of beginning. Absorbtion Area o Soil Borings: 1 - Elevation - 96.4' 2 - Elevation - 96.3' 3 - Elevation - 96.2' A Benchmark - Screw in Birch tree Elevation - 100' LII Approximate Property Line Note: Existing system abandonment per SPS 383.33 prior to new system installation. Completed Bayfield County Abandonment form available during inspection of new system. —"9 co / t7) 'o, 98' 1 °om Pipe Material: ASTM Standard (Tables 384.30-3 & 384.30-5) Existing Well - N Page 2 of 4 A Soil Evaluated By: Tony Polkoski - 11068 -ST Plumber: Allan Polkoski - PMRS 220090 IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER min. trench depth (typical) min. 1T (typical) (typical) System Elevation = 91.2.2 (typical) Septic Tank(s) Manufacturer: Wieser Septic Tank(s) Volume(s): 750 gal gal gal gal Effluent Filter Manufacturer. Polvloc Effluent Filter Model #: PL -525 S TYPICAL TRENCH 3 ' v rf; CROSS SECTION VIEW O (No Scale) go. C.,, roa ^' Provide minimum 3 ft o rn ft separation between trenches$ rn IC 3 Q Quick4 Standard -W w/End Cap (t(Show location of inlet / outlet pipe connection on plan view.) ypical)J lakinmlnH. B= 47 ft (typical) INSTALL PER TRENCH: 11 Quick4 Std -W @ 20 ft' EISA/chamber = 220 ft' + 2 Pairs of end caps @6 ft2 EISA/pair = 6 ft' = Proposed EISA per trench = 226 ft' Observation Pipe (typical) Install per manufacturers / Instructions. TYPICAL TRENCH PLAN VIEW (No Scale) TA (typical) "—Quick4 Standard -W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. Required Infiltration Area = 429 ft2 x 2 trenches = Proposed Total EISA = 452 ft2 Distribution Method: Gravity D C m C)) O m RESET WLP750-MR TANK SPECIFICATIONS 4" CAST -A -SF" TANKS ARE TOP VIEW C w Li ao INLET - 21" 4" CAST -A -SEAL I .xv� it PUMP PAD DIMENSIONS: o WALL: 2 1/2" a a BOTTOM: 3" COVER: 5" w MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 54" OUTSIDE DIAMETER: 7-0" BELOW INLET: 42" LIQUID LEVEL: 37" WEIGHT: 6,150 LBS. INLET AND OUTLET: n 0 4" CAST -A -SEAL BOOT OR EQUAL GASKET - 3 0 m o INLET AND OUTLET BAFFLE AND FILTER: o WISCONSIN, SEE DETAIL #10 a w (OTHER STATES SEE CHART) N o 0 LIQUID CAPACITY: 20.28 GAL/IN HOLDING TANK: LIJ OUTLET HOLE PLUGGED v 0 n ACTUAL CAPACITY: 790 GALLONS 0 0 Ip LOADING DESIGN: 8'-0" UNSATURATED SOIL G7w TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON o I O COVER: MIX DESIGN #8 (NO FIBER) ma, m 00 TANK: MIX DESIGN #10 (STRUCTURAL FIBER) V, CUSTOMIZED TANKS: R FOR CUSTOM TANKS CONTACT WIESER CONCRETE SIDE VIEW APPROVED By Glen Schlueter at 8:19 pm, May 30, 2022 TO MEET OR EXCEED ASTM C-1227 REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: � OF 1 CEIVED PAGE 4 OF 4 In -ground Gravity Management Plan HA'( 13 2026 IMPORTANT: saved ro. n _ The owAeanei4flRfS 7n -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 = 300 gpd; BOD5 ≤ 220 mgL"1; TSS ≤ 150 mgL"'; FOG ≤ 30 mgL"' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (Le. odors, user complaints, etc.) o mechanical malfunction (Le., pumps, valves, switches, floats, etc.) o material fatigue (Le., 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 (Le., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (Le., 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. Stats. 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: Iron River Septic Phone: 715-372-4006 Local government unit: Bayfield County Planning & Zoning Phone: 715-373-6138 Local government unit address: 117 E 5th Street, PO Box 58, 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. Private Sewage System Maintenance Agreement Owner(s) Name Ductbfl JAMES R& LORRAINE J DUCLON 64805 COUNTY HWY H, IRON RIVER WI 54847 64805 COUNTY HWY H, IRON RIVER WI 54847 19973 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 _N. Range W. Additional Legal Description: 5€-c.a'rtc c. aec) Sc-ked., to L Town of Lot_ Block Subdivision Lot CSM # Vol._ (Acreage) Gov't Lot Page _ CSM Doc # DOCUMENT NUMBER 2026R-612156 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED O5/14/2O26 AT 8:OO AM RECORDING FEE: $30.00 PAGES:2 RECEIVED 11AY T5 2026 Bayfield Co. Planning and Zoning Agency Recording Area Return To: PIO.P%blfny and 'RitafrPtsikoskivi In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound O 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, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds, At -grade. and In -ground Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. 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 maybe placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided 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 sworn to before me on this date: 9u,tlo� JAMES RP& LORRAINE J DUCLON TAR` otarized Owner(s)— Signature(s) N Ylig 4 U My Com 'ssio Expires: ���rriOF WISE Drafted by: Tony Polkoski Date: 5-1-26 Proofed by: AP u/fo mi s/sa n itary/septi cm a intencea g reement Revised July 2020 SCHEDULE C LEGAL DESCRIPTION A parcel of land located in the Northwest Quarter of the Northeast Quarter (NWra NEra.), Section Thirty-three (33), Township Forty-seven (47) North, Range Eight (8) West, Town of Iron River, Bayfield County, Wisconsin, described as follows: Commencing at the quarter corner between Sections 28 and 33; thence West along the section line a distance of 359.5 feet to an iron pipe; thence angle to the left 90°21' a distance of 222.6 feet to an iron pipe; thence angle to the left 41°40' a distance of 307.1 feet to an iron pipe; thence angle to the left 02°48' a distance of 571.0 feet along the South side of new Highway "H" to an iron pipe located on the water's edge of Bass Lake, which is known as the place of beginning; thence continue on the same line a distance of 162.7 feet to an iron pipe; thence angle to the left 05°22' a distance of 157.7 feet to an iron pipe; thence angle to the left 07°30' a distance of 648.7 feet to an iron pipe; thence angle to the right 147°20' a distance of 340.3 feet to an iron pipe; thence angle to the right 44°35' a distance of 302.0 feet to an iron pipe located on the water's edge of Bass Lake; thence Southwesterly and Northerly along the water's edge, a distance of 977.0 feet to the place of beginning. Attached hereto and made part of the sanitary permit application. R�Ce vv MpV 51028 M Go. encl and Z p'annin9 a SANITARY APPLICATON CHECKLIST - BAYFIELD COUNTY Submit the Following - (Must be original and written in ink) (Title 15, Section 15-1-10(e)) Check List RECEIVED 2 Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) 2 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) MAY 132026 2 Original Plot Plan (383.22(2)2. 3. & 4.a) PlanningBand oning Agency • Cross Section, Over -Head Profile of the System and DSPS APPROVED Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) 2 Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) 0 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) ❑ ATLI Servicing Agreement (Recorded at Reg. of Deeds) 0 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 2 1 Complete Set of Plans (Note: Sanitary Application and Maintenance Agreements are to be attached) 2 Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) 0 State Plan Review (when applicable) 0 Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) 2 I 5 digit Tax ID - Project Address or Road Name adjoining driveway - Owners Phone Number 2 II Type of Building 2 III Type of Permit 0 IV Type of POWTS System 0 V Dispersal - Treatment Area Information 2 VI Tank Information 0 VII Responsibility Statement (Plumber's Information) Plot Plan: (To Scale or To Dimension) 2 Signature and Plumber Information Surface Elevation of Body of Water Direction and Percent Land Slope 2 Tank and Filter Information and Location 14 Wetlands / Navigable Bodies of Water N Absorption Area (Proposed and Existing) 2 Bench Mark (Location, Elevation and Description) IZ Component Manual Version 0 Address Number and Road iZ North Arrow Contour Lines 0 Structures and Driveways 2 Boring Locations 2 Property Lines to Well Locations 2 Legal Descriptions 2 Piping Material Information (conveyance line, building sewer line, material type and diameter) Turn Over ► Cross -Section and Over -Head Profile of the System: 10 Surface and System Elevation RECEIVED 1l Position of Observation and Vent Pipes MAY 13 2026 R Dimensions and Depths Planning and Zionin8,g� I$j Make, Model & Number of Chamber Units in each Cell Property Information How many systems will there be on this parcel of land? I. 1I Has this property been split? Nb (Property Statement shows Property History) Fees: Ii7J 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 ❑ Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) a 17Q-nck oaertc�;1 S - dv�vmelr-re� on Pa9e3 04 The Sorito.rY Qe4vvti1" Svbwn3t'ru-I K 693989.23E 430694.444 -693993325 430605. . i�3;,uT}� a3070k'8� Total Cartesian a Ellipsoidal 57.9381t feet Segments Ifeetl Absorbtof\ wreck dlnThe. ortyiic4 S4ni-tb.q PIoT phew- is dCc fl to 7,he- eXoCT aittewriois aye IO.689ee-r X y7.$ -ceei-' w1\;A flcC aJes r`o�nis e -E' Qvik-( PIv5 r-W%m6teirS will be �nS lleci-k rotj b. 3' k y7' 1„)i -W 0. 3' Se"do bcrwecrt r erc4s GtS doc vm.ervred en Pa5e 3 ©-C ---w c.PPI,cc4*?et— IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) :iii7iil� min. 12" (typical) Septic Tank(s) Manufacturer. Wieser Septic Tank(s) Volume(s): 750 gal gal gal gal Effluent Filter Manufacturer: Polyioc Effluent Filter Model #: PL -525 12" min. tench depth (typical) _ TYPICAL TRENCH I 34" CROSS SECTION VIEW (lyplcal) .. (No Scale) System Elevation = 91.2 ft (typical) Quick4 Standard -W w/End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) (typical) INSTALL PER TRENCH: 11 Quick4 Std -W @ 20 ft2 EISA/chamber = 220 ft2 + 2 Pairs of end caps @6 ft2 EISA/pair = 6 ft2 = Proposed EISA per trench = 226 ft' Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturers / instructions. TYPICAL TRENCH PLAN VIEW (No Scale) IA=3.0ft (typical) "—Quick4 Standard -W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. Required Infiltration Area = 429 ft2 Distribution Method: x 2 trenches = Proposed Total EISA = 452 ft2 Gravity -t7 C) W O n a V�IFPIELD Bayfield County Planning & Zoning Department 117E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: DUCLON, JAMES R & LORRAINE J 64805 COUNTY HWY H IRON RIVER, WI 54847 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00414 Transaction Number: SR-00414-45AF6 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 6311 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 5/27/ 2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. 13 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: DUCLON, JAMES R & LORRAINE J 64805 COUNTY HWY H IRON RIVER, WI 54847 Description Private Sewage System (Septic Tanks) Submission Number: SS -00749 Transaction Number: SS-00749-45AF8 Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 6311 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 5/27/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-49S STATE SANITARY PERMIT OWNER: JAMES R & LORRAINE J DUCLON G OV'T LOT: LOT: B LK: NW1/4 /4 NE1/4 /4 SEC: 33, T 47 N, R 8 W TOWNSHIP: Iron River SOIL TEST: 42-26 REPLACEMENT SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: ALLAN POLKOSKI EMILY MACGILLIVRAY LLIVRAY DATE: 5/27/2026 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 #: LICENSE: # 220090 Condition: Old System needs to be properly abandoned per SPS 383. Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 5/27/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION