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HomeMy WebLinkAbout26-50S" " " 1 4822 Madison Yards Way \iJ$t2Ij Madison, WI 53705 iNL ' l P.O. Box 7302 5S- 0750 Madison, WI 5302 hMrvA/ Sanitary Permit Application 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 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. I Annlirntinn rnfnrmntinn— Plnner Print A11 Infnrmaton 128565 Road :It II. Type of Building (check all that apply) ❑ I or 2 Family Dwelling — Number ofBedrooms 3 ❑ Public/Commercial — Describe Use 715-209-1756 Lot# 8 ao-5o5 Govt. Lot TagZD 'fl Section Newmans subd NI/2 SE Lot 8 less V.220 P.358 366 ❑ State Owned— Describe Use CSM Number ❑ Village of X Town of Barksdale HI. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i1 applicable.) A. New System E Replacement System y p y ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank E In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber Li Transfer to New Owner ist Previous Permit Number and Date Issued Expiration 327403 09-23-1999 IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 50 .7 642.86 650.4 91.5 Capacity in I Total I # of I Manufacturer Tank Information Gallons IGallonslUnits I I.2 '-' c O 10.0 y " y to Io Ia New Tanks Existing Tanks V. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sign amse MP/MPRS Number Business Phone Number 715-373-2378 31160 Birch Grove Road Washburn WI 548981 '$. roved0 Disapproved runt iii rue �atc tssucu r1h txswng x algn le _ O Owner Given Reason for Denial m— b Conditions of Approval/Reasons for Disapproval RECEIVED MAY 18 2026 t✓/ b�"J U!/v I j Zoning o Planning and Zoninin g Agency Attach to complete plans for the system and submit to the County only on paper not less than a I/2x Ii inches in size SBD-6398 (R. 02/22) Jon and Bonnie Lumberg 3 bedroom house replacement drainfield (gravity flow system) 28565 Cherryville Road Ashland WI 54806 Town of Barksdale PIN 04-002-2-48-05-34-4 00-234-14000 S34 T48N R05W Newmans subdiv NI/2 SE Lot 8 Less V.220 P.358 366 RECEIVE=D MAY 182075 Bayfield Co. Planning and Zoning Agency Page 1: Wisconsin sanitary application Page 2-3: Bayfield Co. checklist for sanitary applications Page 4: Tax statement (for informational purposes) Page 5: Plot plan Page 6: System elevation view Page 7-9: Soil and site evaluation Page 10: POWTS owner's manual, management and contingency plan Page 11: POWTS maintenance agreement Reference material; SPS 382-384, WI Chapter 145&160, In Ground Soil Absorption Component Manual (V 2.1 May2022-2027) These plans prepared by; Adrien Cady MP922139 31160 Birch Grove Rd Washburn WI. 54891 phone:715-373 2378 fax:715-373-0646 Wisconsin Department of industry,. .SOB. AND SITE EV L�T� .c R Labor ,aganq He. can Rndl Buildsns - �,r r.� d b' rfvfsio•.yf`Safery and amldings -, in accordance with S. ILHR 83.09, Wis. Adm. Code Y■./�_/1 AUG 041999 MAl' Attach complete site plan on pagegnot less than 8 1/2 x 11 inches in size. Plan must Coun - include, but not limited to: vertical atid.11o4 onladrefirrpoIM (SM), direction and Bays 'Ii Co. percent slope, scale or dimensions, north arrow, and location and distance to nearestRb"8tL'in'8 aflc parcel l.b. it APPLICANT INFORMATION - Please print all Information. Reviewed ded by bDate Personal intomiation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). tt'� . / r� Props7A (tar Property Location C• '/e•{r,�p/tbT 9-19fy V fiJ0 / L1f71'1 �!' Govt Lot V 1/�, JE /4,5 e�T T TO JN•R 3 j'—. )W Property Owner's Melling Address ^ Lot it Blocks Sub4. Name or CSM# City State Zip Code Phone Number ❑ City ❑ village �� Town Nearest Road At1 s-s��d6 I (7/r )Gkz-6Srl ���.l I r XNew Construction Use: KResidential I Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial • Describe: Code derived daily flow ctQ gpd Absorption area required 13 bed, it2fl ZS trench, ft2 Recommended Infiltration surface elevation(s)2 Additional design/s�iitteyconsidera�tio�ns Parent material 6740/aQ !i l/ S = Suitable for system Oonvenaonal U = Unsuitable for system I Is S ❑ U Boring # 1:: �Ground /"lest tt Depth to limiting factor -[in. Boring # Ground elev. /4fdii'ift Depth to limiting factor !Min. GST Name Recommended design loading rate...t:Z,...,bed, gpdRt2 - a trench, gpdrft2 Maxim�uilen, design loading rate _ -_7 bed, gpd/ft2________trench Rte 9� •� `� "^" m+(,Z [ • Mn (`ads referred/to site plan benchma , X ,�� Z,(' f) 4 (c)pac Zn41# t,t a rA,�/s r• aL,(1a RJ.rn Flood plain elevation, if applicable .U/4 ❑ s L? U ❑S 1$U JDsuJ ❑S CCU ❑SU Rflll ncornrn]Trn., Horizon Depth in. p Dominant Color Munseli Mottles Qu. Sz Cont Color Texture / Structure Or. Sz. Sh. Consistence Boundary Roots �• GPD/ft2 Bed , Tren ch 9 r ca a ,s� tz- c F- �•ec -& A • , 3 ? f — i aS -e- ,r .,s ii Remarks: 81 ,30 7' ea, 9_ J °least Print) Signatur � Telephone No. s /4u( 7 J1Yzo% 7/5"373 ,�, _ ,- / II ,_ J ate/ CST Number SOIL DESCRIPTION REPORT P Ptl WNER PAAAE7) I. Q - Boring # Horizon Depth Dominant Color Mottles Structure in. Mansell Qu. Sz Cont Color Texture Gr. Sz Sh / D-tf �sYQ y3 ---- s� 3 — sc Ground (1-); C)Q y� elev./V 7 / -2 — c y7 Depth to S 42-/a 2a limiting 4. D - S2 factor 7/�fLln. Remarks: Boring # Ground elev. Qft Depth to limiting factor an. Remarks: Horizon Depth Dominant Color In. Munsell RECEIVED MAY 18 2026 Bayfield Co. Planning and Zoning Agency Page _of S Boundary I Roots W vF 'HC L , , -3 :,3 r :,r o ©OMB v; Boring # I Ground elev. /Cct2ft ;' Depth to limiting factor Remarks; Boring # z Ground elev. 94ff. Depth to limiting factor ''/ Z in. 580 W-8330 ......... .. Mottles Texture Structure Qu. Sz Cont. . Sz Sh. Consistence Boundary Roots GPD Bed , Trenc jsJ14 J m-Cj Z''r rs /�/tZau�m 4 TIC¢' ,Qonni'e L' 4ew,w6d L�1/i�s�% ���� iT?J fs7u. f oc� II I � � if to �' rOg l bn'& waj, I — L i BM kVtURP> Bd4o,ebsM -Mc6 . SE corn,. eL P.� dares 45L..o� aQ2J t too , Urea da dl,. o,v - I -- I ' 4. EIVED NAY 18 2026 Ba eld Co. Planning a. Zoning Agency X�+oNk(so;l� tPnecb.-PP £ 0 o iR 0 o 4 evv � Y Li 12d a 25t5 t S Cevv v1C(e j Pry k u d l-(/1 5t2o , rowk of �r✓�Csch 0Ct-ooa-a-Ctg-o.� 3`t -Lt oo-3Utcbo 5 31t -rq8 N Re5W W€{s)t44cuty 5ub4cv N YY $5 Lo -t8 Le$ Va2o P•35a 36b -(J6 ,4cve5 p�pF05ed a- LJ + rn `l v�3 )O1'ft s a ' ocx mg N R t 1 v sC, pope✓}y /-t't e Quick 4 Plus Standard EISA= 20.0 sq ft each Quick 4 All in One End Cap EISA= 2.6 sq ft each Cross IS,s c ion of ^•I !Moe Cell Lugr°ou:rrnd Component Using Leaching Chambers 2 rows of chambers +2 end caps X20=UX2Rows=(b�t-O 2X2.6=5.2X2 Rows=10.4 J1C1 *O + 10.4 = £J�O-Proposed sq ft Typical Obser'vatio ent Pipes Top of Chantbcs . S CS1,fit I ,,/<ch 40 pvc with \ Sys Bev. _ S ✓ approved caps fl hed Grade = ' "._.... lopO % -J�. ep aatio>n' 06E bal c ade r I , ; r' 1,2 .,� y'mp of Cbmbei N� �9: � ° 4 ® ! 1 Y'.. K y . q,,,, ,ya' �Q,�[n,�.f'�0. ¶•y�yam T-i " . ii 'u' A I ( V r `. V. '"p�'dgd�i�'El'Snfl P..:�3�1 a '.4 "Q ,' ' •A•�,q, ••a, o. '9 '. .n'• �d.� '.nu: .aN' L• a .., 'I, • d',• ,• • d''o d,' ,n'y4�e., a' d:i' Pa 'v 'o • o� D .' "' �4 ,' q•' •Q , ', n$,' '', ��. .e,d •�I '• 1• . o A,.. u •Q.y.. '�• 4• dp�. a Qe' 0� 'd' • p, . , u, ' tl d' s'. �r 'B°4. a 4.e ',•'•d'��.yurtY•' '' •�a: .' '' •,, 131 u ri', .d 'o' J,A� A +„ *4 'ut dc? 4 '__ •": , u uL_J lxl .n._�r Jo c Q' ® ObaervatioWVeflt pipes to be coustucted sM capped 'vS approved materials for the paeticular use. 2 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_Lof-2 FILE INFORMATION Owner O u Permit # DESIGN PARAMETERS Number of Bedrooms 3 ❑ NA Number of Public Facility Units A Estimated (average) flow 3c!7 G gal/day Design (peak) flow = (Estimated x 1.5) j5t gal/day In Situ Soil Application Rate 7 gal/day/ft2 Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) ≤30 mg/L Biochemical Oxygen Demand (BOD5) ≤220 mg/L O 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 XNA Fecal Coliform (geometric mean) ≤10° cfu/100m1 Maximum Effluent Particle Size ¢ in dia ❑ NA Other: ❑ NA 'Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ❑ meat h(s) (Maximum 3 years) ❑ NA NWhen combined sludge and scum equals one-third ('f,) of tank volume O NA Pump out contents of tank(s) When the high water alarm is activated Inspect dispersal cell(s) At least once every: 3 ❑ year(s)s) (Maximum 3 years) 0 NA Clean effluent filter At least once every: ❑ s) year(s )) 0 NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) K NA Other: At least once every: ❑ month(s) ❑ year(s) ❑ NA Other: ❑ NA MAINTENANCE 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 inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. 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 ('f4) 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 comporGftt%ffLMg)t 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 eveMAY 182026 GMW (12/02) Bayfleld Co. Planning and Zoning Agency SYSTEM SPECIFICATIONS Tank Manufacturer Ra.7wtt,SSet.t. CXy6&t ❑ NA -Septic ❑ Dose O Holding vol. 1 000 9 gal Tank Manufacturer PLNA ❑ Septic O Dose ❑ Holding vol. gal Effluent Filter Manufacturer P5 -NA Effluent Filter Model Pump Manufacturer ,4 NA Pump Model Pretreatment Unit ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration O Wetland ❑ Disinfection O Other: Manufacturer Dispersal Cell(s) Qvtct'C'4 W tt1£1Ifga W ❑ NA j$on-Ground (gravity) O In -Ground (pressurized) ❑ At -Grade O Mound ❑ Drip -Line ❑ Other: Other: O NA Other: ❑ NA 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 fails 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 MAY 18 ZUZb Bayfield Co. POWTS INSTALLER POWTS MAINTAINER Name Vj ucTq'c/'t-Name V r e _( Phone 7 -3 78 Phone _ —a SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY NameRivcL'i S+veef Name&.yrr'e Id vz r u Phone 7f5.-373 57, 3 Phone 7f5r37((3' 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(7), (2) & (3), Wisconsin Administrative Code. BAYFIELD COUNTY R C2IVED CHECKLIST FOR SANITARY APPLICATONS MAY 18 2026 Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) ❑ Check List Bayfieid Co. planning and Zoning Agency ❑ Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) ❑ Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) ❑ Original Plot Plan (383.22(2)2. 3. & 4.a) ❑ Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) ❑ 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) ❑ 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) ❑ Fee (Make Check Payable to Bayfield 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 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) ❑ I Application Information must include: O 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) O Project Address or Road Name where driveway is/will come off of) ❑ II Type of Building ❑ III Type of Permit ❑ IV Type of POWTS System ❑ V Dispersal / Treatment Area Information ❑ VI Tank Information ❑ VII Responsibility Statement (Plumber's Information) ❑ *Date Stamp* Plot Plan: (To Scale or To Dimension) ❑ Signature and Plumber Information ❑ Surface Elevation of Body of Water ❑ Direction and Percent Land Slope ❑ Tank and Filter Information and Location ❑ Wetlands / Navigable Bodies of Water ❑ Absorption Area (Proposed and Existing) ❑ Bench Mark (Location, Elevation and Description) ❑ Component Manual Version ❑ (Owners Phone Number) ❑ Address Number and Road ❑ North Arrow ❑ Contour Lines ❑ Structures and Driveways ❑ Boring Locations ❑ Property Lines ❑ Well Locations ❑ Legal Descriptions ❑ Piping Material Information (conveyance line, building sewer line, material type and diameter) Turn Over ► Cross -Section and Over -Head Profile of the System: ❑ Surface and System Elevation ❑ Position of Observation and Vent Pipes ❑ Dimensions and Depths ❑ Make, Model & Number of Chamber Units in each Cell RECEIVED Property Information MAY 18 2026 gayfield Co. ❑ How many systems will there be on this parcel of land? planning and zoningAg cy ❑ Has this property been split? (Property Statement shows Property History) Fees: ❑ 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) u/fortis/checklists/checklistforsanitaryapps (10/2009);(07/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: Real Estate Bayfield County Property Listing Today's Date: 5/14/2026 6' Description Tax ID: PIN: Legacy PIN: Map ID: Municipality: STR: Description: Recorded Acres: Calculated Acres: Lottery Claims: First Dollar: Zoning: ESN: If Tax Districts 1 04 002 046027 001700 Property Status: Current Created On: 3/15/2006 1:14:43 PM Updated: 3/18/2005 4 Ownership Updated: 3/15/2006 818 JON G & BONNIE J LUMBERG ASHLAND WI 04-002-2-48-05-34-4 00-234-14000 002107606000 (002) TOWN OF BARKSDALE S34 T48N R05W NEUMAN'S SUBDIV N 1/2 SE LOT 8 LESS V.220 P.358 366 8.690 8.735 1 Yes (R-1) Residential -1 103 • Recorded Documents ® CONVERSION Date Recorded: Updated: 3/15/2006 STATE COUNTY TOWN OF BARKSDALE SCHL-WASHBURN TECHNICAL COLLEGE Updated: 3/15/2006 490-394;767-837 Billing Address: Mailing Address: JON G & BONNIE) LUMBERG JON G & BONNIE) LUMBERG 28565 CHERRYVILLE RD 28565 CHERRYVILLE RD ASHLAND WI 54806 ASHLAND WI 54806 11 Site Address * indicates Private Road 28565 CHERRYVILLE RD ASHLAND 54806 B Property Assessment Updated: 6/24/2021 2026 Assessment Detail Code Acres Land Imp. G1 -RESIDENTIAL 2.000 16,500 190,200 G4 -AGRICULTURAL 6.690 1,200 0 2 -Year Comparison 2025 2026 Change Land: 17,700 17,700 0.0% Improved: 190,200 190,200 0.0% Total: 207,900 207,900 0.0% I� Property History N/A R C IVED MAY 1820213 Baylfeld Co. Planning and Zoiw,i Aacy Private Sewage System Maintenance Agreement Owner(s) Name 5olA Lryua(oerg 4- )vtltie tc4L1 evq Owner(s) Mailing Address a13ts CkeivyVu1IC fFsUknacL wT s'r8% Site Address x855 Cke✓`ryyI ( � Rd 4cIi1taJ ttS't8O Tax ID#Oq..00a •�-78•o.�f 34.4 c0-≥'i-`I 'f -coo As owner, I (we) ao nereoy canny me pnvate sewage system will De instailea in accordance with the certified soil testers report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established in the WI Adm. Code, as from time to time amended. (COMPLETE Legal is required) 1/4 of 1/4 Section 34 Township N. D N. Range _W. SD Additional Legal Description: NOW 04Oh5 L. eSIfJ s5 V. Q P. 3rS`S? 3GG, Town of CI t/ dak. (Acreage) S. (79' Govt Lot Lot 8 Block Subdivision IJQu1L44a7J5 S14.13PfVi51aM CSM # Vol. Page .3CSM Doc # DOCUMENT NUMBER 2026R-61 2206 DANIEL J. HEFFNER REGISTER OF DEEDS HAYFIELD COUNTY. WI RECORDED 05/19/2026 AT 8:00 AM RECORDING FEE: $30.00 PAGES: 1 Return To: Planning and Zonir lite�el?t1'WED MAY 202025 Area gamy y� In -ground gravity ❑ 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 at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. Pump Chamber (system types B, C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds, At -grade, and In -around Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges 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 proi pM ¢y 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 N�ws+ . !j Owner(s) Name(s) — Please Print ot, VLA4 1,g pj6144te Lf,tttJ-v9 Subscribed and sworn to before me on this date: 'Y ,e '; ota a wner(s)—Signatures) J..., ,. IIot,a^ry,PPu�b6 t N a4 91F d `1k P� W4C'e MSwA My Co mi I n Expires: Drafted by: 4fTr Date: _ L fit_ a6 Aclr(ch t Proofed by: u/forms/sanitary/septicmaintenceagreement Revised July 2020 BAYFIELD COUNTY SANITARY PERMIT (#04)-26-50S STATE SANITARY PERMIT OWNER: JON G & BONNIE J LUMBERG GOVT LOT: LOT: BLK: SUBDIVISION: Neuman 1/4 1/4 SEC: 34, T 48 N, R 5 W TOWNSHIP: Barksdale SOIL TEST: 4961 REPLACEMENT SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: ADRIEN CADY TRACY POOLER 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 #: 327403 LICENSE: # MP 922139 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