HomeMy WebLinkAbout26-64SI
Department of Safety
County
Bayfield
& Professional Services,
Sanitary Permit Number (to be filled in by Co.)
SS-oo7(3
Industry Services Division
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
Project Address (if different than mailing address)
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,
48745 Longview Rd
Print All Information
1. Application Information —Please
Property Owner's Name
Parcel #
Bradley L & Debra J Nelson (1)
14713
Property Owner's Mailing Address
Property Location
11855 Holly Lake Rd
Govt. Lot
City, State
I Zip Code Phone
Number
Drummond, WI
54832
715-580-0600
SE w NE y,, Section 2 3
T 44 N R 08 E or W
H. Type of Building (check all that apply)
Lot #
Subdivision Name
0 I or 2 Family Dwelling— Number of Bedrooms 1
Block #
❑ Public/Commercial — Describe Use
JUN 16 2026
DCityof
❑ State Owned — Describe Use
O Village of
CSM Number
Bayfield Go.
[a Town of Drummond
Planning and Zoning Agen
III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i
iflfllicable.)
A.
0 New System
❑ Replacement System
❑ Other Modification to Existing System (explain)
❑ Additional Pretreatment Unit (explain)
B.
❑ Holding Tank
0 In -Ground
O At -Grade
❑ Mound
❑ Individual Site Design
I O Other Type (explain)
(conventional)
C.
❑ Renewal Before
❑ Revision
❑ Change of Plumber
O Transfer to New Owner
ist Previous Permit Number and Date Issued
Expiration
IV. DispersaliTreatment Area and Tank Information:
Design Flow (gpd)
Design Soil Application Rate(gpd/sf) I
Dispersal Area Required (sf) I
Dispersal Area Proposed (st)
I System Elevation
150
0.7
214.28
226
94.0
Capacity in
Total
# of
Manufacturer
Tank Information
Gallons
Gallons
Units
B
m E
U s
New Tanks I
Existing Tanks
`
v
g
y
o
y
0..0
in
ii, V
P.
Septic or Holding Tank
500
500
1
Infitrator Systems
X
Dosing Chamber
\'. Responsibility Statement —I, the undersigned, a me
r poosi li r installation of the POWTS shown on the attached plans.
Plumber's Name (Print) I Plu is Si nature
MP/MPRS Number I
Business Phone Number
Doug Manthey
MP 230722
715-739-6868
Plumber's Address (Street, City, State, Zip Code)
PO Box 196 Drummond, WI 54832
VI. County/Department Use Only
proved
❑ Disapproved
Permit Fee I
$ LtOO
Date Issued wAt
d � Issuing Agent igrr rc D
❑ Owner Given Reason for Denial
(vli 2{,M
Conditions of Approval/Reasons for Disapproval ) o ° 1
SUL c e4 CWo{ .
Attach to complete plans for the system and submit to the County only on paper not less than 8 in s 11 inches in size
SBD-6398 (R 03/22)
S-aoyy3
OR1G1NAL,,
v�•,�RTAf�t�
' Wisconsin Department of Safety & Professional Services tt// Page l of
a i t Division of IndustryServices
SOIL EVALUATION REPORT TEST # 3-
in accordance with SPS.3$5, Wis. Adm. Code Countya n_ f/
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, t_
but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D.
scale or dimensions, north arrow, and location and distance to nearest road. 'f' c(
Please print all information. RevG j t� I Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). l�l�
Property Owner Property Location
Govt. Lot ''A 'A, S,7 3 T �f' f (N R (iJ' E (or) W
Property Owner's Mailing Address Site Address or CSM and Lot #: SJV A'6,., &-• /I Y1 P. 73$ (3?
l n f r- eel cre W"C4 , ,- 10 -j
City, State, Zip I Phone Number ❑ City ❑ Village J2 Town Nearest Road
` S f ( ) 'Yyyjs-Lo fry a £3
ig New Construction Use: Residential/Numberof bedrooms I Code derived designfiow rate GPD
❑ Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft.
Parent materialTui_ 66 s '/
General comments and recommendations: } v�G1+ y ,e, //4/ f, e >1CGJ 1 e . y y w [`j Se, It
LLL��Boring # ❑ Boring
� ®Pit Ground surface elev. I ft.
Depth to limiting factore— o in. / elev. __
Soil Annlicatinn Rate
Horizon
Depth
In.
Dominant Color
Munseil
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
*Eff#1
*Eff#2
/
j5)t'_¼
15
.2wI
iI444'fl
� oe /w
(7A
k�
/�oIVP
c �v
. ?
if G
D
7,S 3
$L
.?�s.f�,f
37:S'
21-52!.
�7�
A7
5C
K� �7
OK 0' #
9
&"
JUP,
♦ (j
/
-/Iv
zrs
$
O-5
-
146
ir- ('' t�
l
JUN _16202R fi
I_2Boring #
Boring Bayfizlci Co.
ImPit Ground surface eiev .2- ft. PannirDtii O in. / elev)R2 ft.
Snil Anniicatinn 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
d-
?.ryeZ
'5
2i*'
w'
/ova
,7
1't
2_'iL-Il
$.'M
&L.'
&
• G
ID
3
( 2
)•s,i( 4 y
$c_2'SA4'
kRR
Gw
vP
..
!,o
'1_,c/2o
7s1_'2"?
.- 5&
k•� L
--
'7
CST Name (Please Print)
Signature
CST Number
Date Evaluation Conducted
Address 3 ?O i3my � �
Telephone Number
* Effluent #1 = BOD > 30 s 220 mg/Land TSS > 30 s 150 mg/L * Effluent #2 = BOD, 5 30 mg1L and TSS s 30 mg/L
SBD-8330 (R03/22)
Page .2 of Y
❑ Boring ��tt
Boring # ® Pit Ground surface elev.PF' 7 ft. Depth to limiting facto/ 0 in. / elev. Y .
I Soil Aonlication 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
/
? )" It
y s
r
A'fA'
' t '
/dv'
7
/•
-.2 f
J.s ,t Y
c.
Z,rsifr
&("-'
1.
-S'
,,-'t yq
r4i
v
GA/
of
_
1,
Boring #
❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft.
I Soil Aonlication 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
❑ Boring #
❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft.
I Soil Aonlication 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
iv t~
W
Jul16
Planning
nd ZOninu Agc.
cy
* Effluent #1 = BOD > 30 s 220 mglL and TSS > 30 s 150 mg/L
* Effluent #2 = BOD, s 30 mg/L and TSS s 30 mg/L
Gsr' Sf'-112( acr,!
ly ,/'
sc ie: ! cfe"
9Y �
DebDebjt. Mil,O,,
11 ,0Ii Lakes o1e.
ArCA b14H, &Old WZz S'1732.
Z
Le9t1
$ , cee l w.r rce44 A rrss : L grlgtsL3ue., Qd
1 rowi't o-- t Y I
�M.l*r v�P w, w►ow�
.A3 rY'YIV ie a ir w
5 NF , , 'J. /l y3 I'. F' f13
39 1fj 4 s"ls G/osej
yr u,� -
i m ' /Co
" -ro/v -4S/QI3a7&9nfpsc10Or
rat 9f.7
J3Z 99.t
133 97.?
9r�,Nd v"a 57; 8.3
Sys jeac4k.@9'ya.? w/K yt
4
N
BAYFIELD COUNTY
• CHECKLIST FOR CERTIFIED SOIL TESTS
Submit the Following (Use Permanent Ink):
R Check List
�•dex Page / Title Sheet (Optional)
[ Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers)
12 -Original Plot Plan
❑ Cross Section Soil Profile Sheet (optional)
❑ Additional Information (Warranty/Quit Claim Deed) (Optional)
Soil Evaluation Report: (Include the following Information)
�rcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used
Property Owner's Information not prospective buyer's name)
'operty Location (Accurate Legal Description with Sec/Twp/Range)
mad Name (where driveway is/will be coming off of) RECEIVED
O Floodplain Elevation, Flow Rate, Comments and Recommendations
.< Complete Soil Boring / Pit Information
JUN 16 2026
Bayfiefd Co.
Date Soil Evaluation was conducted Planning and Zoning Agency
�ST Name, Signature, Number, Address and Phone Number
*ate Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
l ' nch Mark (Description, Elevation and Location)
ntour Lines (Example = 98.0' /96.0' /94.0')
'operty Location (Sec/Tw/Range/, Accurate Legal Description)
Borings (Locations and Elevations)
2rcent and Direction of Land Slope
9! Well Location (Including Neighboring Wells, if applicable)
❑ Location of Wetland Areas, Floodplain and Navigable Waters
(Buildings, Driveways, and Structures (Location and Descriptions)
location of Property Lines
O Existing System Location
la Address Number and Road Name
❑ Current Surface Elevation of Wetlands and Navigable Waters
SST, Owner and Property Information
2'fclorth Arrow
Fee:
•i'ertified Soil Tests - Review & Filing Fee $ 50.00
U/forms/sanitary/checklist/checklistforests
PAGE 1 OF 4
In -Ground Gravity Plan
Index & Cover Sheet
Component Manual Design References:
In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross -Section & Plan View
Pg 4 of 4 Management Plan
i=Zirc;EjV�C�
JUN 16 2026
Attachments:
Enclosures:
Septic Tank Specifications
POWTS Application for Ree+iew, tlZoningq
Soil Evaluation Report & Site Map
Project Name I Description
Nelson Cabin Conventional
Owner Name(s): Bradley L & Debra J Nelson Phone: 715 -580
Owner Address: 11855 Holly Lake Rd Drummond, WI Zip: 54832
Project Address: 48745 Longview Rd
Govt. Lot: SE 1/4 of NE
Township: Drummond
Project Parcel ID #: 14713
ency
_0600
1/4, Section 23 , T 44 N -R 08 E ❑ or WE
County: Bayfield
Designer Information
Designer Name: Doug Manthey
Designer Address: PO Box 196 Drummond, WI
E-mail: norpines@cheqnet.net
License Number: MP 230722
Remarks:
Signature:
Phone: 715 .339 6868
Zip: 54832
ins space 1cscnrd for appruwl slaini>.
Date: 06/10/26
P51 o1 Y
Pm p4 Address
i./0'79s L.O9u1& 24
OcdaC"
Deh Melsoo2
1185 s Wolf? lakes VA'.
Drun,rl,omd w.r 5YY73t
svglald lox rcwh o- - rn O r
5,3 TOW £c w
Sr4JE%, v.//Y3 P.iyx'33
39 1c0c1 Al FL .zryr5 G/osed
yr of Esrfr<av4s—)
ra y I/ ,E{
scale-, / = yo
Pro.
well'
0
J
3%Slope r
9.1. A.nc\ 11
cL bn RECE=IVED
JUN 16 2026
6L Bayfield Co.
Planning and Zoning Agency
be y " scM0
— AR cAveyo¼'-cc 2' fr
Cow, n eJ MA�^U(a1 l
7r, Cl--J Soft tl9so(p
QooTs \)ecs,.,,., 9-.l
em rico
/3u+ Yo/D-c .5 q%j 0.T&6m4? cicbr
/3l 9f'.Y
6z 99.t
133 9Y'
5ra.+„d 49 10Oa 5T, 98.3
$Y5-{crrz et Q 9' ., 7 u,l 4 •, i c('r1 t
M/2 26922
N
I
IN -GROUND GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard -W Chambers
3 -ft Trench (down -sizing credit)
SOIL COVER
12'
min, trench
depth
I
(typical)
min, 1T
(typical)
LI 34 < .. .
(typical) ':''_"\\a.. . . .
A.
System Elevation = 94.0
(typical)
Septic Tank(s) Manufacturer.
Infiltrator
Septic Tank(s) Volume(s):
500 gal gal gal gal
Effluent Filter Manufacturer
Orenco
Effluent Filter Model #: PSCS0621-18
TYPICAL TRENCH
CROSS SECTION VIEW
(No Scale)
ft
Quick4 Standard -W
w/End Cap (Show location of inlet / outlet pipe connection on plan view.)
(typical)
F— 771t-
L------------t-------yam---
INSTALL PER TRENCH:
(typical)
11 Quick4 Std -W @ 20 ff EISA/chamber = 220 ft2
+ 1 Pairs of end caps @6 ft2 EISA/pair = 6 ft'
RECEIVED
JUN 16 2026
Pbnnin Bayfield Co.
g and Zoning Agency
Provide minimum 3 ft
separation between trenches.
Observation Pipe
(typical)
Install per manufacturers
/ Instructions.
TYPICAL TRENCH
PLAN VIEW
(No Scale)
TA 3.0 ft
(typical)
-Quick4 Standard -W Chamber
(typical)
(mfd by Infiltrator Systems. Inc.)
Install pursuant to manufacturer's instructions.
= Proposed EISA per trench = 226
ft2 Required Infiltration Area =
214.28
ft2
Distribution Method:
x 1
trenches = Proposed Total EISA =
226
ft2
branched manifold
C)
m
CA)
O
m
RESET
PAGE 4 OF 4
In -ground Gravity Management Plan
IMPORTANT:
The owner of this in -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 = 150 gpd; BODS S 220 mgL"'; TSS S 150 mgL"'; FOG 530 mgL'
Inspection Checklist INSPECT EVERY 3 YEARS RECEIVED
o type of use
o age of system JUN 16 2026
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) Bayfield Co.
o material fatigue (Le., leaks, breaks, corrosion, etc.) Planning and Zoning Agency
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 (i.e., pump re -cycling, float switch settings, etc.)
o electrical components - if applicable (i.e., 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 filters) 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: HK Septic Phone: 715-798-3494
Local government unit Bayfield County Zoning Phone: 715-373-6138
Local government unit address:
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.
LIFTING STRAP
(TYPICAL)
A
0.2 (5] WALL
THICKNESS
NOTES
A'
61.7
11567]
EXTERIOR
WIDTH
64.8 (1648] EXTERIOR LENGTH
TOP VIEW
j- 0 241610] ACCESS OPENING WITH LOCKING LID
TOTALVOLUME
552 GAL (2,090 L]
SECTION A - A'
cIYu Vic"
1. ALL DRAWING DIMENSIONS IN INCHES (MILLIMETERS] OR AS NOTED.
2. EXTERIOR OF ACCESS OPENING LID INCLUDES THE FOLLOWING WARNING IN ENGLISH,
FRENCH & SPANISH: 'DANGER DO NOT ENTER: POISON GASES.'
3. TANK MARKINGS WILL INCLUDE: MANUFACTURER NAME. MODEL NUMBER, LIQUID CAPACITY.
DATE OF MANUFACTURE CODE, MAXIMUM BURIAL DEPTH, INLET, AND OUTLET.
4. MAXIMUM BURIAL DEPTH IS 48 In (1219 mm].
5. MINIMUM BURIAL DEPTH 156 In (152 mm].
6. TANK IS FOR NON -TRAFFIC APPLICATIONS.
7. NOMINAL WALL THICKNESS IS 0.20 In (5 mm).
TANKTOP CONTINUOUS
HALF GASKET
TANK
INTERIOR SEAM CLIP
(44)
ALIGNMENT
DOWEL (22) TANK BOTTOM
RECEIVED HALF
(_S MID -HEIGHT SEAM SECTION DETAIL
JUN 162076
BaYfield Co.
Planning and Zoning Agency
TRAP
I' rrmAL)
DRAINAGE
SOLUTIONS, INC
(317) 346-4110
www.drainagesolutionsinc.com
ISOMETRIC VIEW
INNFILTRATOR'
septic tanks
Infiltrator Systems Inc.
4 Business Park Rd. Old Saybrook, CT 06475
1800) 221-4436
IM -540
Pump/Siphon Tank Configuration
Firefox
https://novus. bayfieldcounty.wi.gov/access/REAL%20ESTATE/listin...
Real Estate Bayfield County Property Listing
Today's Date: 6/12/2026
L ce' Description
Tax ID:
PIN:
Legacy PIN:
Map ID:
Municipality:
STR:
Description:
Recorded Acres:
Calculated Acres:
Lottery Claims:
First Dollar:
ESN:
Property Status: Current
Created On: 3/15/2006 1:15:21 PM
Updated: 1/14/2025 `� Ownership Updated: 6/4/2015
14713 BRADLEY L & DEBRA] NELSON DRUMMOND WI
04-018-2-44-08-23-1 04-000-10000
018110305000
(018) TOWN OF DRUMMOND
S23 T44N R08W
SE NE IN V.1143 P.84 833 (39 ACRES MFL
25 YRS CLOSED YR OF ENTRY 2025)
40.000
0.000
0
Yes
3 Tax Districts
Updated: 3/15/2006
1
STATE
04
COUNTY
018
TOWN OF DRUMMOND
041491
SCHL-DRUMMOND
001700
TECHNICAL COLLEGE
a
Recorded Documents
Updated: 8/11/2011
O MFL ORDER
Date Recorded: 11/15/2024
20248-505512
O MFL TRANSFER ORDER
Date Recorded: 7/16/2015
2015R-559560 1145-621
0 WARRANTY DEED
Date Recorded: 5/27/2015
2015R-558891 1143-84
0 QUIT CLAIM DEED
Date Recorded: 8/1/2011
2011R-539578 1065-996
0 PERSONAL REPRESENTATIVES DEED
Date Recorded: 8/1/2011
2011R-539577 1065-995
O CONVERSION
Date Recorded: 3/15/2006
300-161;775-285
Billing Address:
BRADLEY L & DEBRA J
BRADLEY L & DEBRA J
NELSON
NELSON
11855 HOLLY LAKE RD
11855 HOLLY LAKE RD
DRUMMOND WI 54832
DRUMMOND WI 54832
P Site Address * indicates Private Road _
48745 LONGVIEW RD DRUMMOND 54832
® Property Assessment
Updated: 5/5/2025
2026 Assessment Detail
Code
Acres
Land
Imp.
G1 -RESIDENTIAL
1.000
10,000
6,600
W6-MFL - CLOSED AFTER
39.000
58,500
0
2004
2 -Year Comparison
2025
2026
Change
Land:
68,500
68,500
0.0%
Improved:
6,600
6,600
0.0%
Total:
75,100
75,100
0.0%
Is Property History
N/A
RECEIVED
JUN 16 2026
8ayfield Co.
Planning and Zoning Agency
I of I
6/12/2026, 6:57 AM
Private Sewage System Maintenance Agreement
Bradley L & Debra J Nelson
11855 Holly Lake Rd Drummond, WI 54832
48745 Longview Rd
Tax ID # 14713
AS owner, I (we) do hereby certlty the pnvate sewage system will De 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)
SE 1/4 of NE 1/4 Section 23 Township 44 N. Range 08 w
Additional Legal Description: V.1143 P.84 833
Town of Drummond (Acreage) 39 Gov't Lot
Lot Block Subdivision
Lot _ CSM # Vol. _ Page_._ CSM Doc #
DOCUMENT NUMBER
2O26R-61 2554
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY. WI
RECORDED
06/15/2026 AT 1 1: 1 2 AM
RECORDING FEE: $30.00
PAGES: 1
Area
Return To:
RECEIVED
Planning and Zoning Departmen
JUN 162026
0 In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System:
O 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 manufacturers specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code.
Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified
septage servicing operator. 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 Atarade 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 be 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.
NNNMINr
Owner(s) Name(s) - Please Print c$ -.// Subscribed and sworn to before me on this date:
a�bra 3' Nc Iso 7 J �i./e I S 2O2 -U
%fie%s�i .OlTdw t t
Ier(s) -Signature(s) s I .a ; ae run to
cc K ✓)1t ) w)
.'L/9
'.� .s • : CExpires: o mi ion Woaci
Drafted by: Doug Manthey Date:
Proofed by:
u/fomis/sanitary/seplicm a inten ceag ree ment
Revised July 2020
BAYFIELD COUNTY
CHECKLIST FOR SANITARY APPLICATONS
Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e))
//Check List
OrIriginal Sanitary Application (Submitted in Deed Holders Name — iZt prospective buyers) (383.21(1)1.)
Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c))
PfOriginal Plot Plan (383.22(2)2. 3. & 4.a)
CS Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer
❑Pump Tank Diagram, Alarm and Pump Curve (when applicable)
Q 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)
0 Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds)
0 Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5)
0 ATU Servicing Agreement (Recorded at Reg. of Deeds)
wee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7)
dj Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached
to all copies)
oil and Site Evaluation Report (383.22-3(2)(b)1.e.) RECEIVED
❑ State Plan Review (when applicable)
JUN 167026
❑ Copy of Warranty/Quit Claim Deed (Optional)
Bayfield Co.
Sanitary ADDlication: (Include the following Information) Planning and Zoning Agency
Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete)
Eroject Address or Road Name where driveway is/will come off of)
1i Type of Building
❑ III Type of Permit
Type of POWTS System
M Dispersal / Treatment Area Information
13 -VC Tank Information
❑ V f Responsibility Statement (Plumber's Information)
❑ *Date Stamp*
Plot Plan: (To Scale or To Dimension)
Ld51g—nature and Plumber Information
❑ Surface Elevation of Body of Water
C3' iiirection and Percent Land Slope
2'fank and Filter Information and Location
❑ Wetlands / Navigable Bodies of Water
24 sorption Area (Proposed and Existing)
6'8ench Mark (Location, Elevation and Description)
Manual Version
B -(Owners Phone Number)
l'ddress Number and Road
1North Arrow
2 -Contour Lines
.a'ltructures and Driveways
C ring Locations
Property Lines
CAlell Locations
Turn Over ►
Cross -Section and Over -Head Profile of the System:
•I�Surface and System Elevation
E Position of Observation and Vent Pipes
❑'Dimensions and Depths
fliMake, Model & Number of Chamber Units in each Cell
Property Information
a11ow many systems will there be on this parcel of land? 1
[41as this property been split? Po (Property Statement shows Property History)
Fees:
C'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 (z CEIVED
(checks made out to Reg of Deeds)
JUN 167025
hayfield Co.
Planning and Zoning Agency
u/forms/checklists/checklistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by:
1?,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:
NELSON, BRADLEY L & DEBRA J
11855 HOLLY LAKE RD
DRUMMOND, WI 54832
Description
Certified Soil Tests - Review & Filing Fee
Submission Number:
SR -00443
Transaction Number:
SR-00443-47EA2
Amount
$50.00
Total: $50.00
Payment Amount: $50.00
Reference: 5470
Paid by: A -Z Enterprises, Nor -Pines Plumbing, PO Box 196, Drummond WI 54832
Payment Type: Check
Transaction Date: 6/17/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
B=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:
NELSON, BRADLEY L & DEBRA J
11855 HOLLY LAKE RD
DRUMMOND, WI 54832
Description
Private Sewage System (Septic Tanks)
Submission Number:
SS -00769
Transaction Number:
SS-00769-47EA4
$400.00
Total: $400.00
Payment Amount: $400.00
Reference: 5471
Paid by: A -Z Enterprises, Nor -Pines Plumbing, PO Box 196, Drummond WI 54832
Payment Type: Check
Transaction Date: 6/17/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
BAYFIELD COUNTY
SANITARY PERMIT (#04)-26-64S
STATE SANITARY PERMIT
OWNER: BRADLEY L & DEBRA J NELSON
GOVT LOT: SE LOT: BLK:
NE 1 /4 1/4 SEC: 23, T 44 N, R 8 W
TOWNSHIP: Drummond
SOIL TEST: 63-26
NEW SYSTEM
SYSTEM TYPE: Non -Pressurized In -Ground
PLUMBER: DOUGLAS MANTHEY
SCOTT ROUSH DATE: 6/17/2026
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: # MP 230722
Condition: Properly Maintain System Per Recorded Agreement
THIS PERMIT EXPIRES 6/17/2028
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION