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HomeMy WebLinkAbout26-50SRequest 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 zoning(abavfieldcountv.wi.ciov Note Time Change fl Discrepancy Other Phone Number Plumber: Fax Number Homeowner: L(,( �iy� Email Address Immediate Phone Number So Zoning Sanitary Permit #: _ 50 S Dept can call you right back (if needed) Plumber's Choice Dept No Inspection(s) during this time Date: �� 1 lPlumber's Cvi Tuesday (9:30 am - 12:15 pm) (Tracy) Time: Choice g Dept �, p Township: L(.i'y , j S Address # & Road Name: C 39 ( 6 ( -I_VlR/Y _r t1(/ l lc / or Directions To Site: Comments: ** Plumbers you must verify any change(s) by fax or email ** Notes from July 2025 V } F • S n Private Onsite Wastewater Treatment „c+urnsPOVVTS .Ins Inspection Report ( ) p P JON G & BONNIE J LUMBERG (Attach to Permit) 11 28565 CHERRYVILLE RD C ASHLAND WI 54806 1ypurposes f Privacy Law, s. 15.04 1 (m F U City Village Town of. CST BM Elev: Insp BM Ele . r LAL aaiir%i;JiviisiaL;v;a TYPE MANUFACTURER CAPACITY ----- - Prop. Line J Well Buildin Air Intake Road Se #ic S 114 r 000 N/A Dosin N/A Aeration N/A Holdin nai►,nrU 'fIovti L#I ,.. County Sanitary ermit No: State Plan'Transaction ID#: Parcel Tax No: Pump! Siphon Information Pump Manufacturer _:_rump Model Demand GPM Filter Manufacturer Filter. Model TDH Lift Friction Loss Head Total Forcemain Length Dia Dist. To Well DIMENSIONS Wi th , Le t / # of Cells SETBACK FROM Prop.. Line Building Well OHWM Type of Cell Manufacturer: _ Model Number. 5,f__ Pretreatment Unit "i` - " Manufacturer: Model Number: stribution System X Pressure Systems Only Header I Manifold, Dist,ibu i e(S) X Hole Size X Hole Length Dia Length Dia - Spac Spacln Soil Cover Depth Over Depth Over Depth of Seeded / Sodded Cell Center Cell Edges Topsoil D Yes D No 1OMMENTS: (Include code discre ancles, persons present etc.) pi f&ce,tq+ 3t C4t 11 .i/4 'tA'J' DD .1 an revision required? D Yes jo 1-111 ;e other side for additional inform on. IGlevailun Wald STATION BS HI FS J__ELEV Benchmark 9 Bldg. Sewer Tank Inlet _ 6 Tank Outlet ` 3 Dose Tank Inlet Dose Tank Bottom Inst. Contour Header! Manifold - / c Distribution Pipe Infiltrative Surface)(4' '3n_3 Final Grade bservation Pipes es D No •r Mulched D Yes ❑ No V.t )) /vex e,4 :Rn-R711) rR nq»1t Date POUTS Inspector's Signature License Number Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Bayfield County Courthouse Fax: (715) 373-0114 Post Office Box 58 e-mail: zoninpCahbavfieldcountv.orn 117 East Fifth Street Web Site: www.bayfleldcountv.oro/147 Washburn, WI 54891 JON G & BONNIE J LUMBERG 28565 CHERRYVILLE RD ASHLAND WI 54806 As you know was contracted by you to install a private onsite wastewater treatment system on your property (Tax ID# above). To know when your system will be due for servicing please go to www.septicsearch.com Notes: Abandonment of Old System to meet all applicable code requirements: 1 • Tank was pumped by: C. Tank was crushed I removed and pipes disconnected by: on at AM/PM On at ( (AM / the above -mentioned plumber contacted our office to conduct a jSre-cov6r inspection as required r 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: Wfcrmsfsanitarypropertyowner-input Apri12019 . •ter°` ''�,,. "` ` E ED Industry Services Division 4822 Madison Yards Way County B Bayfield Madison, WI 53705 pS P.O. Box 7302 Sanitary PerrnitNumber to be filled in by Co.) { � '� -��� SS— u0750 Madison, WI 5302 p2(t:' _ 5c) S 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(1)(m), Stats. I. Application Information — Please Print All Information Property Owner's Ngme Jon and Bonnie Lumberg Parcel # �Q $ , , 04-002-2-48-05-34-4 00-234-14000 Property Owner's Mailing Address Property Location 28565 Cherryville Road Govt. Lot City, State I Zip Code Phone Number Ashland 54806 715-209-1756 %4, 'V4, Section S 34 T 48 N R 05 W II. Type of Building (check all that apply) Lot #8 ❑ 1 or 2 Family Dwelling —Number ofBedrooms 3 Subdivision Name Newman subd NIl2 SE Lot 8 less V.220 P.358 366 Block # ❑ Public/Commercial — Describe Use ❑ State Owned — Describe Use O Village of CSM Number X Town of Barksdale M. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if a licable. A. New System Replacement System ❑ 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) ____________________ ____________________ I C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber 0 Transfer to New Owner List Previous Permit Number and Date Issued Expiration 327403 09-23-1999 IV. DispersallTreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (sf) I 1650.4 Dispersal Area Proposed (st) I System Elevation 50 .7 I 642.86 91.5 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units v y y New Tanks Existing Tanks c y w Septic or Holding Tank 1000 1000 1 asmussen X Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown, on the attached plans. Plumber's Name (Print) I Plumber's Sign a MP/MPRS Number Business Phone Number e-- ADRIEN CADY 922139 715-373-2378 Plumber's Address (Street, City, State, Zip Code) 31160 Birch Grove Road Washburn WI 548981 VI. County/Department Use Only Approved ❑ Disapproved Permit Fee Date Issued �1 Issuing A Sign ❑ Owner Given Reason for Denial 6O^ J %` Conditions of Approval/Reasons for Disapproval REC VEF) MAY` 1 8 2026 & Bayfield £Z7tt c,'vi/���'" Plann'sng and Zoning Agency I Attach to complete plans for the system and submit to the County only on paper not less than 8112 x 11 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 N1/2 SE Lot 8 Less V.220 P.358 366 REC-iVED MAY 18 2026 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 � evvY vi C (e 12,d �q ;2$-5- a e-r/M Vi 11 kJ ktt(tc( 5-cj�'s 0 (gz, �O 9&o& `mot✓ tiC Ch f e 31±L 0o'P-3,t--1 ttca eS'w ` w wt s 5 bcUv N X 5 6 Lef 8 Les$ \L' P.352 36t -( `l ,+cv85 LEEE7 \cOUe iiiY' �d. off, o �d o So goo co o N mot• . Wick 4 Plus Standard ISA= 20.0 sq ft each quick 4 All in One End Cap ISA= 2.6 sq ft each Cross &ction of a Three I'd, IngrounelComponent Usiug Lead in Cbardbers rows of I G chambers +2 end caps LLX 20 =2OX 2 Rows= (&O X2.6 = 5.2X2 Rows= 10.4 o�tO + 10.4.= 6S0 -`proposed sq ft cell. 0 1 pahe.•sde ' bpio l Obse ratio eflt' Pipes /ch 40 pvc withl, approved caps c' ll ai Grade 'op of Chamber = . - r-- $ytemBiev. = __ Y•,1 11,11 1 1• /.� ,• e� Q 1 �► • • 1 1 .. . 1'/ •/r f'�y1y1 .1.1����,••t•�y��al1■p .'•r'+ r f J 1 d •1 ►�y�'] • • r "'rw"•M` 1/ 'Q 1 11 1 / 1 • ►1 • `- • . • • • • �' - ' y i7te,i•+D ISW�.[I Y a „�„'Yl.ro.�.� v1iMa.lACi.if'W'M.fAMt..•�W.!M 1 t /1 1 I 1 N • 1 W , .�a..rw�•C.•".= �.. / 1 A •II Q+/ ► Qy t • •• • • , .- • , o �, . 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I�+r1 tw.wrd..�.�w....^"•,�, 1•�.r„» .�. .� 1' N,.�..w. w.......A.....,... �.1 • 1 1 1 A a• il 1• 1 {r • 1 e CL CAD • b" �. c ed •��t red �ni'aa�s or the p u 'tee. 6�se��1'+ta�a to b6 conMuoed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_Lof FILE INFORMATION Owner Bo ? iOvf Permit # DESIGN PARAMETERS Number of Bedrooms 0 NA Number of Public Facility Units V NA Estimated (average) flow 3c!7 gal/day Design (peak) flow = (Estimated x 1.5) 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 ❑ NA Total Suspended Solids (TSS) ≤150 mglL Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) ≤30 mg/L Total Suspended Solids (TSS) ≤30 mg/L XNA Fecal Coliform (geometric mean) ≤104 cfu/100mI Maximum Effluent Particle Size 14 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 ❑ month(s) earls (Maximum 3 years) O NA Pump out contents of tank(s) When combined sludge and scum equals one-third () of tank volume When the high water alarm is activated 0 NA Inspect dispersal cell(s) At least once every: T ❑ month( yeaars)r(s) ) (Maximum 3 years) ❑ NA Clean effluent filter At least once every:3 ❑ month years)) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month s) ❑ year(s� %NA Flush laterals andpressure test At least once every: ❑ month(s) 0 year(s) NA Other: At least once every: 0 month(s) 0 year(s) 0 NA Other: ❑ NA SYSTEM SPECIFICATIONS Tank Manufacturer Rggw $ e vl. C—,44,12 0 NA -Septic 0 Dose 0 Holding vol. ( 000 gal Tank Manufacturer )kNA ❑ Septic 0 Dose 0 Holding vol. gal Effluent Filter Manufacturer a -NA Effluent Filter Model Pump Manufacturer ,j NA Pump Model Pretreatment Unit C..NA ❑ Sand/Gravel Filter 0 Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection 0 Other: Manufacturer Dispersal Cell(s) Qv rCK L W { j* f, 0 NA Aln-Ground (gravity) 0 In -Ground (pressurized) ❑ At -Grade 0 Mound ❑ Drip -Line 0 Other: Other: ❑ NA Other: 0 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 (!) 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 compor (DffjVLMV9t 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 eveKAY 1 8 20?@ GMW (12/02) Hayfield Co. Planning and Zoning Agency Page of ...2., 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 i► o �' C E IV E O MAY 18 Bay field Co. POWTS INSTALLER Name IYV�eLA Gd'-,' Phone 7 -;3 7 SEPTAGE SERVICING OPERATOR PUMPER) Name '3+veef- Phone -715_r 3 5 3 POWTS MAINTAINER Name v(ec1dI Phone 7c _7 --a LOCAL REGULATORY AUTHORITY Name Cj Id vziu Phone i5l-.37 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. BAYFIELD COUNTY R -C VEb CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) MAY 18 202fi ❑ Check List Bayfield 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 0 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 conies) 0 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) ❑ I Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) 0 Project Address or Road Name where driveway is/will come off of) 0 (Owners Phone Number) ❑ 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) ❑ Address Number and Road ❑ North Arrow ❑ Contour Lines ❑ Structures and Driveways ❑ Boring Locations ❑ Property Lines ❑ Well Locations ❑ Component Manual Version 0 Legal Descriptions ❑ Plping Mater al I formatlon;E o byance�lfnle building Fsewer,li e, mate alN�e _dI,c i .r e ) 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 f: Property Information MAY 18 2026 Bayfield Co. ❑ How many systems will there be on this parcel of land? planning and Zoning AgeflY ❑ 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 Ieconnection $ 50.00 and Private Interceptor ❑ Return Inspection $ 50.00 ❑ Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) u/forms/checklists/checklistfbrsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: Real Estate Bayfield County Property Listing Today's Date: 5/14/2026 +' Description Updated: 3/18/2005 Ownership Tax ID: PIN: Legacy PIN: Map ID: Municipality: STR: Description: Recorded Acres: Calculated Acres: Lottery Claims: First Dollar: Zoning: ESN: Tax Districts Property Status: Current Created On: 3/15/2006 1:14:43 PM Updated: 3/15/2006 818 JON G & BONNIE J LUMBERG ASHLAND WI 04-002-2-48-05-34-4 00-234-14000 002107606000 Billing Address: Mailing Address: JON G & BONNIE J LUMBERG JON G & BONNIE J LUMBERG (002) TOWN OF BARKSDALE 28565 CHERRYVILLE RD 28565 CHERRYVILLE RD S34 T48N R05W ASHLAND WI 54806 ASHLAND WI 54806 NEUMAN'S SUBDIV N 1/2 SE LOT 8 LESS V.220 P.358 366 P Site Address * indicates Private Road 8.690 28565 CHERRYVILLE RD ASHLAND 54806 8.735 Property Assessment Updated: 6/24/2021 Yes (R-1) Residential -1 2026 Assessment Detail 103 Code Acres Land Imp. Gl-RESIDENTIAL 2.000 16,500 190,200 Updated: 3/15/2006 G4 -AGRICULTURAL 6.690 1,200 0 1 STATE 2 -Year Comparison 2025 2026 Change 04 COUNTY Land: 17,700 17,700 0.0% 002 TOWN OF BARKSDALE Improved: 190,200 190,200 0.0% 046027 SCHL-WASHBURN Total: 207,900 207,900 0.0% 001700 TECHNICAL COLLEGE .--4 Recorded Documents Updated: 3/15/2006 Uz Property History © CONVERSION N/A Date Recorded: 490-394;767-837 R&&EJVEb MAY 18 Z0?6 Bayfietd Co. Planning and Z ,� : I.;;;d:cY Private Sewage System Maintenance Agreement Owner(s) Name SA Lu' un(oerg �owytTe t0U4b,?_!!�2 Owner(s) Mailing Address a� Ckccvvyc tle Rd 4sk 6ocL &lJ 5t?o,6 Site Address L�e✓rU1 (e Pd uW SY-806 3_4?5_65 Y Tax ID # O+00-gs-or-)N..9 O `a3 LH 'iOO As owner, I (we) do hereby certify the priva a 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 SectionTownship ______N. Range W. �Q,,�,µalr5 su bdl'v l.oAdditional Legal Description: f~ M's�WsLv rQ P 3 3�G� Town of t/ itsdqI (Acreage) S. i<! Gov't Lot Lot 8 Block Subdivision O.,w b42 f 15 11 V i S 1 OM Lot _ CSM # Vol:Page CSM Doc # DOCUMENT NUMBER 2026R -62026R-612206 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFiELD COUNTY, WI RECORDED 05/19/2026 AT 8:00 AM RECORDING FEE: $30.00 PAGES: 1 Recording Area Return To: Planning and Zonin�aED MAY 202026 gency JN 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 -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 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 rov law. A P`% 1 Yiv,v The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such��S,F'% Owner(s) Name(s) — Please Print I4Kl e C.-tawtir9 Subscribed and sworn to before me on this date: jL( P B�- ota a wner(s)—Signatures) t otaryPubl11 �,�� ••.,•. • ,.• My Cor�lmis�i n Expires: Drafted by: Date: __ ,ftclrCc4j Proofed by: Wit, — ulformsisanitary/septicmaintenceagreement Revised July 2020 vwscons;iepactment os industry, • _$( AND SITE EVWJ o Laboran Hr:. pan Relations ' : } ath 44qj ,C slo', Safety and Buildings in accordance with s. ILHR 83.09, Wis.Page AUG 0 4 1999 - Adm. Code Attach complete site plan on pager not less than 8112 x 11 inches in size. Plan must MAY _ include, but not limited to: vertical aid;?t d oitak let r9;polnt (BM), direction and Bays id co. percent slope, scale or dimensions, north arrow, and location and distance to nearestlr►ing and APPLICANT INFORMATION - Please paint all information. Personal information you Pmvide may be used for secondary pugxwm (Privacy Law, a. 15.04 (1) (m)). Prcpepwner I—tim-krf PropertyLocation & Govt. Lot Al Property Owner's Mailing Address Lot # iBiockS City State Zip Code Phone Number IEicity O }/sJ/aLd Irffo4i2/Lmza1f 400.2 -/O7, -D 3€/4.s J ` T Tl ,N•R S ) W Name or CSM# Town Nearest Road $New Construction Use: 'Residential / Number of bedrooms _S 3____ Addition to existing building 0 Replacement 0 Public or Commercial. Describe: _ 4 Code derived daily flow _ r', ?Q gpd Recommended design loading rata _�7 dU bed, gp�trench. gpd/ft2 Absorption area required bed, ft2 h, ft2 Maximum design loading rate « , 2 Recommended infr'ltraticn surface elevations a �.,� r/l bed, gl�trench . ( ) 9 ft (as referred to site plan benchma x''7.2 Additional design/siitteconsideratioons s? �� if" /� .T'4 /; y GiA4,h. d.-aZ ZS/4/ Parent material 10 7// Flood plain elevation, if applicable = A*'19. 8 S = Suitable for system Conventional I Mound I In -Ground Pressure I AT -Grade I System In Flit Holding Tank U = Unsuitable for system i Ls ❑ U ❑ S [u 1 ❑ s Qf u ❑ s ® u ❑ s W u ❑ s u SAIL DEs[!DIDTInm m=onDr Boring # f Ground fk Depth to limiting factor Boring # Ground elev. /eft. Depth to limiting fa� ?�in. Remarks: CST Name (Pleas Print) Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 Bad , Trench - 3 i 5 -�--- ----- --- c.I h,c2 s cryi w Id t :,- .- i:s- - &2i 5',� _______ Sc! ____ ___________ J _____m ______ /______ -4' 7 (g Remarks: ( u'At _:r,�a�ees���ao� 2449 Telephone No. ?/373 aoi, CST Number RECEIVED P WAFER Boring # korizon Depth Dominant Color in. Munsell !3: r Q_VA Gros nd �� f! slay /J4t —VVd2A1'1_— Depth to b�•lo limiting & o _ factor 7i... gin. Boring # Ground elev. Depth to limiting factor 4 ln. Boring # Ground elev. o�n Depth to limiting factor .,In. Boring # Ground elev. ft. Depth to ttmittng factor 4 3_!n. SOIL DESCRIPTION REPORT Remarks: Az //•} /� MAtmY 18 2026 Bayfield Co. Planning and Zoning Agency Page o'4. o�r�n�a�rr�v� Remarks: Horizon Depth In. Dominant Color Mansell Mottles Qu. Sz. Cant. Color Texttsro Structure Or. Sz. Sh. Consistence Boundary Roots Of Dill2 Bad . Trench I /2 / ' __ ./4 h m Ici Jd . s' : s 3 -7 ----- 1,i' ; .Sr ____________ cL a m1t • f� z s� % --f - .7 : �8 Remarks: nrs�er se�o■eeep ��eoee0 _ iiooeoa WINs�I -a Remarks: '%#ryj� :4d - ,330 ti'&' 74�t &n,i, irco 3L iM 8 7Yb:i j. '�€U #W,'. .??" mi4 4wiv Ii 0 sD' ro 1 t t7�tiYi z - . briA.e () 4,ebCL II'r 1 r ■ o e . x �ri� Y RPM- orid� s�d��P `� d�t� s�co►r,u�, �xo o Pi�.ewh -t- tot}' {W600) : • I - - .1 EC 1JVED i + ,ens.. ♦ + A w� MAY 18 2026 B4fieId Co.. Planning a Zoning Agency BAYFIELD COUNTY SANITARY PERMIT (#04)-26-50S STATE SANITARY PERMIT OWNER: JON G & BONNIE J LUMBERG G OV`T LOT: LOT: B LK: 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