The URL can be used to link to this page

Home My WebLink About26-77Stir Department of Safety County Bayfield & Professional Services, Sanitary Permit Number (to be filled in by Co.) Industry Services Division C7 ! _ ryr r 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 Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. the Department of Safety and Professional Services. Personal information you provide may be used for secondary 3537 Lake Rd pwpeses in accordance with the Privacy Law, s 15 0S(I Km) , Stars. " iNdn = t ki All nfultstt8ot Parcel # RECEIVED property Owner's Name E i James C. & Jean A. Mather TrusteesJUN 0 04-004-2-44-09-09-1 o5 006 60000 Property Owner's Mailing Address wn Property Location 3537 Lake Rd Bayfield Co. Govt. Lot 09 City, I Zip CodePlanning aJgfl499IFY Barnes, WI 54873 lqtZ y$6 57?i '4' %. Section Lot# T 44 N R 09 EoLWI Subdivision Name 0 I or 2 Family Dwelling —Number of Bedrooms 1 Par in Lot 6 & 9 Block # ❑ Public/Commercial — Describe Use ❑ City of ❑ State Owned — Describe Use O Village of CSM Number O Town of Barnes A. t!"New System ❑ Replacement System y p y ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) ❑ Holding Tank 'ln-Ground O At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before O Revision ❑ Change of Plumber O Transfer to New Owner 1st Previous Permit Number and Date Issued Expiration Design Flow (gpd) Design Soil Application Rate(gpdlsf) Dispersal Area Required (st) Dispersal Area Proposed (st) System Elevation 150 0.7 214.3 223.3 94' Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units ii u $ o New Tames Existing Tanks o y y gr U i5 n brn LEO SepdeurHoldingTWc 320 - 320 1 Wieser IIZI Dosing Chamber Plumber's Name(Print)a Plumber's Signature MP/MPRS Number Business Phone Number C�al.� 1 0" kJt�tL of}o �i ZiS 2`�L2fJ(T Plumber's Address (Street. City, State, Zip Code) 388 Cor w. t i≥cJS Lckc. jJelo4 aw. lvt c-i pproved I O Disapproved • Permit Fee Dam Issued Issuin A Sign re O Owner Given Reason for Denial W Conditions of Approval/Reasons for Disapproval NB {er.'1 pre/ c" ≤JI A 0 4/e 1 f& rOt3t 1k/ Cq,# 4.t. .? ^/ J2erci i ��sf'' &r) a-/+6Ck a - Attach to complete plow for the system and whmit o, the ('nunry only on paper lint Iran than S vt , 1I inches in she SBD-6398 (R. 03/22) .rR-ooy3d' cF}AR2Wa Wisconsin Department of Safety & Professional Services SOIL TEST # Page 1 3 Services Division of Industry 75^2 6 SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code County Bayfield Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must Include, Parcel I.D. but not limited to vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest mad. 04-0042-04-09-09-1 05-006-60000 Please print all Information. IRe ie d 9 /f �7 %,7 Z 146tgA / Personal Information you provide may be used for secondary purposes (Privacy Law, S. 15.04(1)(m)). I "" r iO -'if ❑ Property Owner Property Location James C. & Jean A. Mather Trustees Govt. Lot '/4 144 S 09 T 44 N R 09 E (or) WO Property Owner's Mailing Address Site address or CSM and Lot #: 3537 Lake Rd 3537 Lake Rd City, State, Zip Phone Number ❑ City ❑ Village ® Town Nearest Road Barnes, WI 54873 (928) 486-8572 Barnes Lake Rd SNewConstruction Use: LYlResidentel/Numberofbedrooms 1 Code derived designflow rate 150 GPD ❑Replacement ❑ Public or commercial —Describe: Flood Plan elevation if applicable N/A iL Parent material outwssh Sands (Rubicon-Sayner complex) JUN 252026 General comments and recommendations: Boring# ❑Boring ® Pit rijim1 Ground surface elev. 96.7 fL Depth to limiting factor 84 In. / elev. 89.7 ft. Soil Aoolicatlon Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIFt2 •Etf#1 'EJf#2 1 0-6 1 0YR 2/1 — $ Osg ml aw 2vf 0.7 1.6 2 6-18 10YR 3/3 — s 0sg ml cw 1m/tf/1vt 0.7 1.6 3 18-26 7.5YR 3/4 — s 0sg ml oyd 1m/tf/lvf 0.7 1.6 4 26-50 10YR 5/6 — s 0sg ml cs 1f 0.7 .1.6 5 50-84 1 0YR 6/4 — S Osg ml — — 0.7 1.6 Boring # ❑Boring ®Pit Ground surface elev. 97.5 ff, Depth to limiting factor 84 In. / elev. 90_5 ft, Soil Aoelicatlon Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 'Efi#1 'Eff#2 1 0-7 10YR2/1 — s Osg ml aw 1m/1vf 0.7 1.6 2 7-21 1 0YR 3/3 — S 0sg ml Cw mnf/1vf 0.7 1.6 3 21-39 7.5YR 3/4 — $ 0sg ml ow 1f 0.7 1.6 4 39.49 10YR 5/6 — $ osg ml ow — 0.7 1.6 5 49-84 10YR 6/4 — s — — — — 0.7 1.6 CST Name (Please Print) Signature ' CST Number 654921 Keith Wiley Address Date luetion Conducted Telephone Number 11623 E Larson Or. Lake Nebagamon, WI 54849 5/3/2026 & 6/13/2026 I 218-451-261.1 ' Effluent #1 - BOO > 30 5 220 mg/L and TSS > 3015O mg/L * Effluent #2 a BOO,' 30 mg/L and TSS s 30 mg/L SBD-8330 (R03!22) ❑ Boring Boring # ® Pit Page _..L of Ground surface elev. 97.2 ft. Depth to limiting factor 84 In. / elev. 80.2 ft.• RnII Annlinatlnn 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 1 0-9 1 OYR 2/1 — s Osg ml aw 1 co/2m/1 0.7 1.6 2 9-26 1 OYR 313 — s Osg ml cw imilfflvi 0.7 1.6 3 26-37 7.5YR 3/4 — s 0sg ml cw 1vf 0.7 1.6 4 37-57 1 OYR 516 — cos Osg ml as --- 0.7 1.6 5 57-84 1 OYR 6/4 -- s Osg ml -- — 0.7 1.6 Boring # ❑ Boring ® Pit Ground surface elev. 95.5 ft. Depth to limiting factor 84 in. / elev. 88.5 ft. Snfi Annllnat[nn 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 1 0-10 1 OYR 211 — s Osg ml as 2vf 0.7 1.6 2 10-29 1OYR 313 — s Osg ml gw lmlff/lv 0.7 1.6 3 29-37 7.5YR 3/4 — s Osg ml 9w 1 of 0.7 1.6 4 37-52 1OYR 5/6 -- s 0sg ml gw 1vf 0.7 1.6 5 52-84 1 OYR 6/4 — s 0sg . ml — — 0.7 1.6 DBoring # ❑ Boring 95.5 ® Pit Ground surface elev. ft. Depth to limiting factor 84 in. l elev. 88.5 ft. I Snil Annlfnatinn Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#'f *Eff#2 1 0-12 1 OYR 211 — S Osg ml as 1 of 0.7 .1.6 2 12-15 1OYR 3/3 -- s Osg ml gw 1m/tf/1vf 0.7 1.6 3 15-40 7.5YR 314 — s Osg ml gw 1 of 0.7 1.6 4 40-50 1 OYR 516 . (IO% FOR)$ Osg ml cw 1 of 0.7 1.6 5 50-84 10YR 6/4 — s Osg ml — -- 0.7 1.6 * Effluent #1 = BOD > 30 5 220 mg/L and TSS>30 30 5150 mg/L * Effluent #2= BOD, s 30 mg/L and TSS 5 30mg/L RECEIVED JUN 252026 Bayf id CO. Planning and Zoning Agency Mather (1 bedroom) Soil Reoort Plot Plan North L. . J JAMES C & JEAN A MATHER TRUSTEES 3537 LAKE RD PAR IN LOT 6 & 9 IN V.1132 P.762 509 S09 T44N R09W TOWN OF BARNES 2.245 Acres CEV JUN 25 2026 BavC. i'i Co. Planrlin ; an. .' ,..ng / j r1cy ri -1 edroom cabin 300'to lake a a Dwell DF O\Eoomhouse NOTES: 96' Shed 97` 98' .0 - Property lines not shown > 50' from tested area Scale 1:30 - Lower Eau Claire Lake elevo 68' * Bench Mark = Duplex nail w/ orange disc In 14" DBH oak Elev = 100.0' CST 119900002 -SP Page 3 of 3 & JEAN A MATHER TRUSTEES Property Owners Name 3537 Lake Rd Property Address 1-2-44-09-09-1 05-006-60000 Tax Parcel Number Bayfield County .OT 6 & 9 IN V.1132 P.762 509 Legal Description 9 Section 44 Town 9 Range Page Index 1 Property Information 2 Data Entry 3 Plot Plan 4 Drainfield Cross -Section 5 Tank Information 6 Maintenance Plan 7 Contingency Plan Keith Wiley Designer's Name RECEIVED JUN •2 5 2026 Eayfeu Co. Plannir,c Ll ,. :-, ;;g Acency // l/ Designer's Signature D2388PSS' Designer's License Number 218-451-2611 Designer's Phone Number 5/9/26 Date KE�SHW1lE1 D p9Bb Pss ° ESK� �s% N MiNNEso SA Page 1 of 7 RECEIVED JUN 252028 Bayfia!d Co. Planr,ino srd Zoning Agency In -Ground of sorption for POWTSComponent Version 2.1 (May 2022-2027 Manual Used I Number of Bedrooms 7.5 Percent Slope (%) 84 Depth to Soil Limiting Factor (in.) 0.7 In Situ soil application rate 100 Estimated Wastewater Flow (gpd) 150 Design Wastewater Flow (gpd) 1 Number of System Elevations 92 Proposed System Elevation #1 Proposed System Elevation #2 Proposed System Elevation #3 95.5 Original Grade #1 95.5 Finished Grade #1 Original Grade #2 Finished Grade #2 Original Grade #3 Finished Grade #3 Wieser 320 Septic Tank Pol lok PL -525 Effluent Filter Infiltrator Quick4 Plus Standard I Chamber Type 12 Height of Chamber (in.) 20 sq.ft. per chamber(ESIA) 3.3 sq.ft. per end cap (EISA) 4 laying length of chamber(ft.) 1.5 length of endcap(ft.) 34 Chamber width(in.) 1 Rows of Chambers Distance Between Cells (ft.) 11 Number of chambers in first row Number of chambers in second row Number of chambers in third row 11 Proposed Number of Chambers Used 214.3 Minimum Distribution Cell Area Required (sq.ft.) 223.3 Distribution Cell Area Proposed (sq.ft.) Page 2 of 7 Mather (1 bedroom) Gravity In -Ground Plot Plan North JAMES C & JEAN A MATHER TRUSTEES 3537 LAKE RD �o PAR IN LOT 6 & 9 IN V.1132 P.762 509 7.5%. 95' S09 T44N R09W TOWN OF BARNES 2.245 Acres 96' One row of 11 Infiltrator Quick 4 Plus Standard chambers 97' O w m 98 f a 90 -b Wieser W320 -MR tank shed 3 w/ polylok 525 filter 300'to lake JUN 252026 Bayfield Co. Planning and Zoning Agency dWell DF 5T 3 bedroom house NOTES: Scale 1:30 n Bench Mark= Duplex nail w/ orange disc in 14" DBH oak Elev = 100.0' - Property lines not shown > 50' from tested area - Lower Eau Claire Lake elevz 68' - All vent, observation & conveyance pipes 4" ASTM D1785 or code equivalent Page 3 of 7 Cross Section of an In Ground Component Cell Using Leaching Chambers Observation/Vent Pipes V Finished Grade1 95.50 J. .. .. Slope B% Original Grade 95.50 y j Top of Chamber 93.00 .................a 7 System Elevation .92.00 G Treatment and Dispersal Zone Limiting Factor Observation/Vent pipes to be constructed and capped with approved materials for the particular use. 47 feet servation / Vent Pipes to be located at the ends of the distribution cells. RECEIVE JUN 25 hayfield Co. Planning and Zoning Page 4 of 7 W320 -MR TANK SPECIFICATIONS 0 0 0. a I DIMENSIONS o WALL 3' a a BOTTOM: 3" COVER: 4' MANHOLE: 24" I.D. PRECAST CONCRETE RISER 58�4'-2"� WIH- LENGTH: 4'-2" 4•' CAST -A -SEAL 4" CAST —A —SEAL 4'-2"LET: BELOW INLET: 46M ,01 LIQUID LEVEL' 43" o BOTTOM 3,015 LBS. 0 I�� Ili COVER 870 LBS. I & � I r! I I INLET AND OUTLET: - m a d. ! 4" CAST —A —SEAL BOOT OR EQUAL GASKET w z on INLET AND OUTLET BAFFLE AND FILTER: U) 0 0 - U ?R" WISCONSIN. SEE DETAIL #10 (OTHER STATES SEE CHART) FILTER OR BAFFLE t•1•��=i% o to LIQUID CAPACITY: 8.00 GAL/INTOP ViEW C N JUN 25 2026 LOADING DESIGN: 8'-0" UNSATURATED SOIL C LO m Bayfield Co. TANK CAN BE USED AS: L"9 o Plznnin ) and Zcning Agency SEPTIC / HOLDING / PUMP OR SIPHON N COVER: MIX DESIGN #8 (NO FIBER) .' of o TANK: MIX DESIGN #10 (STRUCTURAL FIBER) r CUSTOMIZED TANKS: -- L FOR CUSTOM TANKS CONTACT WIESER CONCRETE M 3 INLET _ OUTLET ,.S r. N 'QU - I �U 1 :.V M2 I i7 I• 0- • 3" ILl I � Q .t 7 REVIEWED BY r7 C) REVIEW DATE IL SIDE VIEW DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: SHEET NO. APPROVAL DATE: 1 OF PRODUCTS NEEDED BY: POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 6 of? SYSTEM SPECIFICATIONS FILE INFORMATION Owner JAMES C & JEAN A MATHER TRUSTEES Permit # oARAMETCtic 1 ❑ NA Number of Bedrooms Number of Public Facility Units 0 NA Estimated (average) flow 100 paYday Design (peak) flow = (Estimated x 1.5) 150 gal/day In Situ Soil Application Rate 0.7 gal/day/ft? Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOD,) 5220 mg/L O NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mg/L Total Suspended Solids (TSS) 530 mg/L O NA Fecal Corrform (geometric mean) 510` cfu/10oml Maximum Effluent Particle Size '% in dia. O NA Other: 0 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) (Maximum 3 years) ® ear s ❑ NA Pump out contents of tank(s) 0 When combined sludge and scum equals one-third (''A) of tank volume ❑ When the high water alarm is activated ❑ NA Inspect dispersal cells) At least once every: 3 ❑ month(s) (Maximum 3 years) 0 year(s) O NA Clean effluent filter At least once every: 3 ❑ s) 0 year(s) O 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) 0 NA Other: At least once every: ❑ month(s) ❑ year(s) 0 NA Other: 0 NA Tank Manufacturer Wieser 0 NA 0 Septic O Dose 0 Holding vol. 320 gal Tank Manufacturer 0 NA ❑ Septic O Dose O Holding vol. gal Effluent Filter Manufacturer Polylok 0 NA Effluent Filter Model 525 Pump Manufacturer 0 NA Pump Model Pretreatment Unit 0 NA ❑ Sand/Gravel Filter O Peat Filter ❑ Mechanical Aeration O Wetland ❑ Disinfection ❑ Other: Manufacturer Dispersal Cell(s) 0 NA 0 In -Ground (gravity) O In -Ground (pressurized) ❑ At -Grade O Mound ❑ Drip-Une O Other: Other: 0 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 ('h) 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 s,S luding but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, Mintervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report �(I be provided to the local regulatory authority within 10 days of completion of any service event. JUN ZULU GMW (12/02) Baytd Co. Ptannin9 and Zoning Agency Page 7 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. St 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 COMMENTT,' EIVED JUN Bayfield Co. - --_. POWTS INSTALLER Name 3'r-' .S9 -t`` exn Phone —�g2 Z POWTS MAINTAINER Name q -v -'u r Phone 71 S. - iclir SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name yvtr NameBayfteld County Zoning Phone ( S Phone 715-373-6138 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. PRIVATE SEWAGE SYSTEM MAINTENANCE AGREEMENT DOCUMENT NUMBER 2O26R-6 12581 Document Number Document Title DANIEL J. HEFFNER REGISrER OF DEEDS BAYFIELD COUNTY. WI RECORDED 06/16/2026 AT 2:50 PM RECORDING FEE: $30.00 PAGES:4 Recording Area Name and Return Address Planning and Zoning Parcel Identification Number (PIN) P�D JUN 17 2026 Bayfield Co. Planning and Zoning Agency THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE. This information must be completed by submitter: document title, name & return address, and PIN (if required). Other information such as the granting clause, legal description, etc., may be placed on this first page of the document or may be placed on additional pages of the document. WRDA Rev. 12/2212010 Private Sewage System Maintenance Agreement Owner(s) Name des aiQ +n 14 W tort l2evmsLal Ii 1(71 SKf₹ 3 -3537 %)e Aea,Lo ( 973 Tax ID# /7S� As owner, I (we) do hereby certify the pdvate sewage system will be installed 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 114 Section ,_c l _______Township ______N. Range W. Additional Legal Description: GL�t.Cau-€ c2 Town of Lot_ Block Subdivision (Acreage) Gov't Lot Lot _ CSM # Vol. _ Page.._._. CSM Doc # rt3t f f, -a? cr Jae !6r 1493 Return To: Planning and Zoning Department -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ Other Area 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 ot#OE pAJtd to make such inspection, the tank is found to have less than one-third (113) 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 sept@$ i1 spr2aed ffs provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. UL Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintaingJ_as�nSi�i �Rd in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 3 �98@4cy 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 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 Smpe4iy,,,, ', Owner(s) Name(s) — Please Print L M Arr r*C rr'`ts` Subscribed and sworn to before me on this dat�:�' .-----'vj SV 1_a ZO2 L TA Y Notarized Owner(s) — Signature(s) �%LC� ,74 64 . w / Notary My Commission Expires: OFgG , V L/ �VCi Proofed by: utfonnslsanitarylsepticmaintenceagreement Revised July 2020 LEGAL DESCRIPTION A parcel in Gov't Lot 6, Section 9, Township 44 North, Range 9 West, described as follows: Commencing at a point on the South line of said Lot 6, 562 %: feet East of the Southwest comer, thence East along the South line of said Lot 6, 180 feet, thence Easterly 50.5 feet to a 1 '/4 inch galvanized iron pipe set on the North shore of Eau Claire Lake, thence in a Northwesterly direction 821 feet, more or less, to a point 455 feet South of the North line of Lot 6 and 412 4 feet East of the West line of said Lot 6, thence Southeasterly 775 feet, more or less, to the place of beginning on the South line of said Lot 6 And A parcel in Gov't Lot 9, Section 9, Township 44 North, Range 9 West, described as follows: Commencing at a point on the North line of said Lot 9, 562 %x feet East of the Southwest comer of Lot 6, thence Southeasterly direction 25 feet, more or less, to a 1 '/4 inch galvanized iron pipe set on the waters edge, thence in an Easterly direction along the waters edge 182 feet, more or less to intersect the North line of said Lot 9, thence West along the North line of said Lot 9, 180 feet, to the place of beginning. Also an easement over a strip of land twenty-five (25) feet in width through and over a part of Government Lots three (3) and six (6) in said Section nine (9), Township forty-four (44) North, of Range Nine (9) West, in Bayfield County, Wisconsin, for a roadway or driveway, said easement and strip of land being described in deed from Homeseekers Land Company to Rex E. Mather, dated June 18, 1934, and recorded in Volume 122 of Deeds on page 617 in the office of the Register of Deeds for Bayfield County, Wisconsin. RECEIVED JUN 17 2026 Bayfield Co. Planning and Zoning Agency V1132 P763 ReAl Estate Bayfield County Property Listing Today's Date: 6/15/2026 Z Description Updated: 10/10/2014 Tax ID: 1755 PIN: 04-004-2-44-09-09-1 05-006-60000 Legacy PIN: 004108905000 Map ID: Municipality: (004) TOWN OF BARNES STR: S09 T44N R09W Description: PAR IN LOT 6 & 9 IN V.1132 P.762 509 (JAMES C & JEAN A MATHER IT REV TRUST AGREE DTD 06/16/1993) Recorded Acres: 2.245 Calculated Acres: 2.245 Lottery Claims: 1 First Dollar: Yes Zoning: (R-1) Residential -1 ESN: 104 Tax Districts Updated: 3/15/2006 1 STATE 04 COUNTY 004 TOWN OF BARNES 041491 SCHL-DRUMMOND 001700 TECHNICAL COLLEGE 40 Recorded Documents Updated: 3/15/2006 ® QUIT CLAIM DEED Date Recorded: 10/6/2014 2014R-556205 1132-762 ® CONVERSION Date Recorded: 296-152 Property Status: Current Created On: 3/15/2006 1:14:46 PM 32 Ownership Updated: 10/10/2014 JAMES C & JEAN A MATHER TRUSTEES BARNES WI Billing Address: Mailing Address: JAMES C & JEAN A MATHER JAMES C & JEAN A MATHER TRUSTEES TRUSTEES 3537 LAKE RD 3537 LAKE RD BARNES WI 54873 BARNES WI 54873 P Site Address * indicates Private Road 3537 LAKE RD BARNES 54873 0 Property Assessment Updated: 10/4/2016 2026 Assessment Detail Code Acres Land Imp. G1 -RESIDENTIAL 2.200 261,100 76,700 2 -Year Comparison 2025 2026 Change Land: 261,100 261,100 0.0% Improved: 76,700 76,700 0.0% 337,800 337,800 0.0% LTotal: L"✓IQ Property History N/A RECEIVED JUN 17 2026 Bayfield Co. Planning and Zoning Agency JAMES C & JEAN A MATHER TRUSTEES BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): l ' Check List O Index Page / Title Sheet (Optional) 67 Original Soil Evaluation Report (Submitted in Deed Holders Name — jM prospective buyers) Ed Original Plot Plan O Cross Section Soil Profile Sheet (optional) O Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) l ' Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used 9 Prosy Owner's Information (Dt prospective buyer's name) E' Property Location (Accurate Legal Description with Sec/Twp/Range) I7 Road Name (where driveway is/will be coming off of) I ' Floodpiain Elevation, Flow Rate, Comments and Recommendations [l Complete Soil Boring / Pit Information 1' Date Soil Evaluation was conducted l' CST Name, Signature, Number, Address and Phone Number 6a' *Date Stamp* 1 n: (Include the following information drawn to dimension or to scale) t 'Bench Mark (Description, Elevation and Location) l 'Contour Lines (Example = 98.0' /96.0' /94.0') (YProperty Location (Sec/Twp/Range/, Accurate Legal Description) bl Borings (Locations and Elevations) IYPercent and Direction of Land Slope 11 Well Location (Including Neighboring Wells, if applicable) E Location of Wetland Areas, Floodplain and Navigable Waters E Buildings, Driveways, and Structures (Location and Descriptions) EYLocation of Property Lines I'Existing System Location lAddress Number and Road NaRECEWED g' Current Surface Elevation of Wetlands and Navigable Waters 6' CST, Owner and Property Infor+oQ 4 2026 ENorth Arrow Baylield co. Planning and ZonfgAy Fee: 9 Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistfoncsts 13,A,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: MATHER TRUSTEES, JAMES C & JEAN A 3537 LAKE RD BARNES, WI 54873 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00432 Transaction Number: SR -00432-4809F Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 1108 Paid by: Coyote Septic Works LLC, 11623 E Larson Dr, Lk Nebagamon WI 54849 Payment Type: Check Transaction Date: 7/2/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. -' 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: Submission Number: MATHER TRUSTEES, JAMES C & JEAN A SS -00762 3537 LAKE RD BARNES, WI 54873 Transaction Number: SS -00762-49216 Description Amount Private Sewage System (Septic Tanks) $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 1827 Paid by: Superior Septic Systems, 8385 S County Rd S, Lake Nebagamon WI 54849 Payment Type: Check Transaction Date: 7/2/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-77S STATE SANITARY PERMIT OWNER: JAMES C & JEAN A MATH ER TRUSTEES GOVT LOT: LOT: BLK: SW1/4 NE1/4 SEC:9,T44N,R9W TOWNSHIP: Barnes SOIL TEST: 75-26 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: CHAD ROCHWITE TRACY POOLER DATE: 7/2/2026 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: # 220595 Condition: No food prep or sink outside of bathroom w/o CUP for second dwelling upon property. Properly Maintain System Per Recorded Agreement. THIS PERMIT EXPIRES 7/2/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION