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HomeMy WebLinkAbout26-76SReque t for Sanitary Inspection (24 Hrs. in Advance) Fax or emit this form to Zoning Dept (24 Hrs.) prior to when you want an inspection ax (715) 373-0114 or Email zoningAbayfieldcounty.wi.gov Note Time Change fl Discrepancy fl Other Phone Number z)8 3Ljg 2 �go Plumber. � Ya�.-s(o Fax Number Homeowner: Br r Email Address Immediate Phone Number So Zoning Sanitary Permit#: ! QL7 Dept can call you right back (If needed) F lumber's Choice Zoning Dept Date: No Inspection(s) during this time cC Tuesday (9:30 am - 12:15 pm) (Tracy) lumber's Choice Zoning Dept Time: ll � 3D Aw, o Township: Address # &S Road Name: $/ e,- �o or Directions a\ a� To Site: Comments: ** P umbers you must verify any change(s) by fax or email ** Notes from Zoning Dept: July 2025 Private Onsite Wastewater Treatment "-'-s ( POINTS). Inspection Report (Attach to Permit) n SMITH JOINT REV TRUST FI 1885 SMART RD u oses Privac Law s. 15.04 1 m GORDON WI 54838 City vlliage Town of: C b ✓✓I2✓ o P 4�U, County nn Sanitary ermit No: State Plan' Transaction ID#: Parcel Tax No: ink Information TYPE MANUFACTURER CAPACITY .awau^ RI. Prop. Line Well BuildingA r Intake I N/A !2 tic e)•v 000 Ih N/A )osin N/A leratlon ioldln 'ump I Siphon Information imp Manufacturer 1%' ,Puml GPM 'DH Lift Friction Loss Head Total Forcemain Length Dia Dist To Well DIMENSIONS Width # of Cells 3E HACK FROM Prop.. neWell fMancturer: 0 OHV UO ype of Cell � t Model Number a, { Lh retreatment Unit Aanufacturer: lodelNumber. I, )MMENTS: (Include code discrepancies, persons present, etc.) ✓e') ,Lst, PVeial r'r Ce�� C`•vn revision fed9 0 Yes 17 No other side for or additional information. I IGYFIIVII ✓QOM STATION BS HI I FS ELEV Benchmark 2. /o27 Bldg. Sewer Tank Inlet Tank Outlet 6.s-�¶h¶h. i Dose Tank Inlet Dose Tank Bottom Inst. Contour Header / Manifold ' j Distribution Pipe Infiltrative Surface W9 °1 cc, Final Grade 7i q , X Pressure X Hole Size soil ❑ Yes ❑ No 6 "/ 2 Date POINTS Inspector's Signature n -71n in nzr21i ❑ No Mulched ❑Yes ❑No 3.Y01,% I_joey(/ License Number Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-S138 Hayfield County Courthouse Fax: (715) 373-0114 Post Office Box 58 e-mail: zonincanbavfieldcountv.oro 117 East Fifth Street Web Site: www.bavfleldcounty.org/147 Washburn, WI 54891 SMITH JOINT REV TRUST 1885 SMART RD _ GORDON WI 54838 As you know (<i/es) ctuyl q was contracted by you to install a private onsite wastewater treatment systa4 on your pfperty (Tax ID# above). To know when your system will be due for servicing please go to www.septicsearch.com Notes: cl, J elavoe� Abandonment of Old System to meet all applicable code requirements: Tank was pumped by: on ❑ 4. Tank was crushed! removed and pipes disconnected by: — at AM/PM On 2 6 at (�(�/ PM) the above -mentioned plumber contacted our office to conduct p e -over inspection as regwr under DSPS 383. One of the following applies: 7 System was inspected and appears to meet all applicable code requirements. fl 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: W farms/sanitarypropertyownerinput April 2019 V�ynRTx�ev, , 50i 9r Industry Services Division 4822 Madison Yards Way County rt--� - p Madison, WI 53705 Sanitary Permit Number (to be filled in by Co.) j SS- O O� 6 3 * �°aYoxn►�' P.O. Box 7302 Madison, WI 5302 O2 J 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) eeysubgmiittted to is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are the Department of Safety and Professional Services. Personal information you provide RpLPC `i E!� dart' ( purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. i gam"" s tv\' T Ic!:) I. Application Information — Please Print All Information - Property Owner's Name J U N 0 8 2026 Parcel # '797'..- t , �A1f� • d �' V i Bayfl&d w��MM—� di d�r7 c. Property Owner's Mailing Address Planning and Zoning Agency Property Location 1 P' S s Govt. Lot City, State I Zip Code Phone Number gjj ' Z '/4, '/., Section T yL N R d'1 E orQ Ii. Type of Building (check all that apply) Lot # Subdivision Name or 2 Family Dwelling — Number ofBedrooms 3 NT Block # ❑ Public/Commercial — Describe Use O City of O State Owned — Describe Use O Village of CSM Number 'Town of d�Nes 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 a licable. A. ❑ New System ' eplacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B' ❑ Holding Tank "In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design I ❑ Other Type (explain) (conventional) I I C. ❑ Renewal Before. Expiration ❑ Revision ❑ Change of Plumber 0 Transfer to New Owner ifst Previous Permit Number and Date Issued Oy37 �a aa63 IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (sf) I Dispersal Area Proposed (sf) I System Elevation ysc7 l,16I 2.PI 33r� X3.`7 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units 0 o New Tanks I Existing Tanks w as u u 0.0 v c, w C7 E Septic or Holding Tank 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 SignatureI MP/MPRS Number I Business Phone Number I(c-t0 Plumber's Address (Street, City, State, Zip Code) county/Departnient Use Only pproved O Disapproved PPermit Fee 9(> I Date Issued L u' g Si ature O Owner Given Reason for Denial 7/1/2 /3 Conditions of Approval/Reasons for Disapproval S& cV(a thed dcr Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x 11 inches in size SBD-6398 (R. 02/22) GSF WI IN -GROUND DESIGN PROGRAM • INDEX AND TITLE PAGE Project Name: SMITH Owner's Name: SMITH JOINT REV TRUST Owner's Address: 1885 SMART ROAD GORDON WI 54838 Legal Description: 18-44-09 Township: BARNES County: BAYFIELD Subdivision Name: Lot Number: 2 Block Number. Parcel I.D. Number: 04-004-2-44-09-18-1 05-002-14000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry RECEIVED Page 3 GSF system views Page 4 Lateral and dose tank JUN 0 8 2026 Page 5 Distribution media Page 6 System maintenance specifications Bayfieid co. Page 7 Management and contingency plan Planning and Zoning Agency Page 8 Pump curve and specifications eR%GoIpa-ftL S- T iT =`sf t L. It4b Ito i t•.&T £i 4A C E' �e5:�+ Mei►•'i" Designer. GREG YOUNG License Number: 231040 Date: 6/5/2026 /%Phone Number: 3952929 Signature: Designed Pursuant to the GSF In -Ground Component Manual (N. 11!19), and SSWMP Publication 9.6 Design Pressure Distribution Networks for STSAS (01/81) GSF In -Ground Version 3.1 Page 1 GSF WI IN -GROUND DESIGN PROGRAM DATA ENTRY Site Information R Residential or Commercial Design. 3 Number of Bedrooms ( 30 IDesign Flow (gpd) i F � 99.6 Original Grade 1.6 u In -Situ Soil Application Rate (gpd/ftz) EFF #2 Trench Information B43 � Unit Used 10 Cell Width (ft) 3, 4, 5, 6, 8, 9 or 10 Additional Units per Row or Trench Are the laterals the highest oint in the distribution [_N_._j Pressure Distribution Information network? Enter Y or I' G i Center, End, No Manifold (Pump to Gravity), or Gravity (No Pump) 5 Lateral Spacing If N above, enter the elevation 2 Number of Laterals of the highest point. Orifice Diameter (in) (e.g. 0.25) Estimated Orifice Spacing (ft) = ftz/orifice Forcemain Diameter (in) Forcemain Length (ft) Does the forcemain drain back? _j Inside Pump Tank Elevation (ft) 2 33 1= Length (ft) System Head (ft) x 1.3 Vertical Lift (ft) Friction Loss (ft) _ Add'I Fitting Friction Loss (ft) Total Dynamic Head (ft) Lateral Diameter Selection in. diam. options choice 0.75 1.00 1.25 1.50 2.00 1 3.00 Septic Tank Information 1000_ Septic Tank Ca acity (gal) (WIESER Mfg. Manufacturer Dose Tank Information Dose Tank Capacity (gal) Dose Tank Volume (gal/in) Mfg. Forcemain Drainback (gal) 5x Void Volume (gal) Minimum Dose Volume (gal) System Demand (gpm) in. dia. options Icholce _ 1.25 1.50 2.00 3.00 RECEIVED JUN 082026 gand eld Co. oni g PlanningZoning Agency Gallons/Inch Calculator r Total Tank Capacity (gal) _ETotal Working Liquid Depth (in) galrn Effluent Filter Information fl POLYLOCK Filter Manufacturer 525 Filter Model Number Project: SMITH Page 2 GSF WI IN -GROUND DESIGN PROGRAM GSF IN -GROUND DRAWINGS Plan View In -Ground Component Dimensions Al10.00 ft B 33.00 ft D 0.50 ft F 7.00 in HI 1.004ft Excavation Depth 5.90 ft � From Grade 660.00 (ft2) Basal Area Available Finished Grade q ._ Lateral Invert Elevation 94.78 Dispersal Cell Elevation 94.2 Bottom of Excavation 93.7 Typical Cross Section Trench View MIN it OF GEDIE MLE --fIM5FEDGiADE CLEAN FILL" FABRIC LA7EJiAL I IOIT 7 (F� B43 DISPERSALCELL �ELEVAnoN ( 1 MO(JLDSNO I BOTroa+oF `-EKCAVAiION L Ur �CL 2 ft o � o �Z 0 0.5 ft Typical Dispersal Cell See Page 5 Geotextile Fabric --- F L 1 A See details on page 4 for number, size and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. Project: Page 3 of 8 -2 GSF WI IN -GROUND DESIGN PROGRAM DISTRIBUTION MEDIA GSF Distribution Cell Media Layout ipj Cell Width (ft) 2.5 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements Drag appropriate drawing to space below. nd ASTM C33 Sand/Mound Sand • • • A42 or B43 Module Lateral II [J Turn -up (contained in Turn -up Enclosure) Distribution Cell Plan View Layout - Typical 10 Cell Width - A (ft) I 33.00 Cell Length - B (ft) 8 B43 Modules Required per Row 16 B43 Total Modules Required Pump to Gravity Diagram Drag appropriate drawing from left to space below. RECEIVED JUN 0 8 2026 Bayfield Co. planning and Zoning Agency 4 � gE;;•g�. ri •• 5z'�es� �.ii�� • •n•. ��`! -�''C �; • •( .s,( 2r a�iiu,:,(♦ v,�CS ? 1�+.}s7'� M� :°i�.,), � �,1.��.t -?:• •� '�T{' .niyf+ +.,t , . � � f'? �i'•fl*��'!••+.%d s�7j..;,''Rcr`,r'F, . �.�,•�,t�-'� � x � • • e v! A pC, . . ..e.!'+•�' :4 f . •.k .7 1:�' ?Yr:.A�j�-' j e' a. _ • •,• . •r �• w�'i• . �fs1 '� • .. � � t��.yV� •'�y. , {,,�.�� •yes; �::"• . •, '�;� • �•,..,,,,.'� `Y��-'�}�.��. ,���,;.-�' �,`i�5' ..j „j. •i. 1 . , +F,'.f`j19�f 'T�'.y/T�:.•�i.'.. �•t: r ,' •7'r t.., ••�••~ Z 7f �• • S�F� . LY M;gt�`' n��"s'�`wsr. • "! .3 .•sk••i i.. .k. tk� � .i'.satr _ 7SL. ..:� _ w ♦ •.•A + Q'•' a ia..• J !e }i.r•�?• J7v :N 3 . �• t .'Ma�v:� f yF "!"e t i SN i fM..,a.. s °"t ! �� • nt 'S. •. �^i•�!,'•'•`.rt �` ` y 'N r..'..��Ut L Project: SMITH Page 5 GSF WI IN -GROUND DESIGN PROGRAM SYSTEM MAINTENANCE SPECIFICATIONS System Maintenance and Operation Specifications Service Provider's Name YOUNG PLUMBING ,jjPhone POWTS Regulator's Name BAYFIELD COUNTY —Phone System Flow and Load Parameters (715) 395-2929 71 5 373-6156 Design Flow - Peak 300 gpd Maximum Influent Particle Size 1/8 Estimated Flow - Average 200 gpd Maximum BOD5 30 Septic Tank capacityL 1000 gal Maximum TSS 30 Soil Absorption Component Size I330 Ift2 Maximum FOG 10 Maximum Fecal Coliformi 10E4 Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System In -Ground System Othei Service Frequency Inspect and/or service once every 3 years Should inspect and clean at least once every 3 years Test once every 3 years Should test monthly Laterals should be flushed and pressure tested every 1.5 years inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to the standards, have a watertight cap, and are secure shown in the Eijen In -Ground component manual. 2. Dispersal cell media conforms to Eijen products approved for use with the most recent Eijen In -Ground Coml Manual. Eijen media is covered with the manufacturer's geotextile fabric. 3. All gravity and pressure piping materials conform the requirements in the state code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The system structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help penetration. RECEJVED Lateral Turn -up Detail JUN 0 8 2026 6- 8" DIAMETER Bayfield Co. LAWN SPRINKLER Planning and Zoning Agency FINISHED GRADE - - THREADED LATERAL ENDS AT LAST 4" PERFORATED PIPE THREADED LATERAL ENDS AT LAST 4!'PERFORATED PIPE CLEANOUT PLUG ORIFICE WHERE VARIABLE 4" END LENGTH CLEANOUT BEGINS CAP LONG SWEEP 90 OR TWO 45 DEGREE BEI .... .. _ ___ _ __ SAME DIAMETER AS LATERAL +- TTJ]j DISTRIBUTION LATERAL LATERAL CLEANOUT Project: SMITH Page 6 GSF WI IN -GROUND DESIGN PROGRAM MANAGEMENT AND CONTINGENCY PLAN System Management Plan General This system shall be operated in accordance with SPS 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals Eljen in -Ground Component manual November 2019 and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 - inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entryRECEIVED tank or component. Septic Tank JUN 082026 The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The d Co contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operatOmoninqAgency � of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pumn Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as In -Ground and Pressure Distribution System No trees or shrubs should be planted on the system. Plantings may be made around the system's perimeter, and the system shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the system is not recommended since soil compaction may hinder aeration of the infiltrative surface within the system and snow compaction in the winter will promote frost penetration. Cold weather installations (October -February) dictate that the system be heavily mulched as protection from freezing. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continaencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the in -ground component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project SMITH Page 7 f QObE E,'s C �i (≥E kF (egCE'$i r+ fbb RECJJ' JUN 08 2026 Bayfield Co. Planning and Zoning Agency pg, s.t —�Es oa ���- �-N --tea c�; s�e.c �' r.� , r--* C'�'•M� � �`' � a � h O f%41 r i END L4?r rt-eV 8Z AO ALU�Ti®NPA►�T�1 ��a WisoQns#nDepertmen#oiCcmm JUL 200Ij\ • Young's Sol DMaaon of SaMy and gulldltigs U Uin accordance with 85r.lMs. Adm. Code. County Ba�+ileld Co. Toni, Bsyfle d Attayc�h oa Iota site pt l on Peger no lass then 8 x n n stce plea must �1Q u:YIY�iPI l₹�itot ln911181C0�nd�, an0M wmv4 eaddloaat3an tIJUL �eucsit.Dpercentstops, Please Print ell fir> vrrrretlon.}. eviewed By to Laka l�• irnn• MLA Fropw V ph owner OR (51 Pkt iot 114 114 3 18 i 44 NR Frdman, Mats LA # Biock # 8ubd. Name or CSM# Property Owner's Mailing Address 2911 Rd Oak Dr C Village Town Nearest Road qty Etate Zip Cade Phone Nurhber 9tiL ft, v* %?� Harvard i IL OW331T 0— M80 e 3 9W Uses ResidenUal / Number of bedrooms i cope aeriv� dsst8n haw mta 300 ate New Ccnetr ctlori Pubilo of aommailtl = D irTbb: Rep#acem� N/A mutedel till FlOod pietn option, l[ eppticabt� general comments end rscornmondations: * .ffiusrst#1 = BQD j3O c 220 mgLL end TSS>30 s 15Q wr JL ,afo'g:84#ttu ., f..8Tidumt Oita 'Props ty owner Effluent•#'•= BOQ � •30 <�0•m�lE.- * Etfttreni� �•BOD •�,�0•mgfl: and T98•c;,�0 maR and TSS � �'I�•mgfL � ThoDepaft1ttitdfC01tli11�8 an equo oppott;mity sercrxc° pm er and empiIoyer. ff you need as9ief anoa•M aooes9 serviceor •,1'1AneIs X2,6/vi4Ir / $ 8 57 .S,wrr /ntt O (. i /4 iLo 1ov S' J' l3' 1lJ rn1t $4'e at (1- . ��cISTtN c Lever (Wi) - N WE 1?Jl =/DO L Ec.1/-A-1 r 6ICJ cc i • 1 r ' Qrarpz`iy 1-i NE 5 (2 fi2z /ji4 b'/ 11 ©AWE -r Ave 17t J1oL/ 00' RECEIVED JUN 08 2026 Bayfietd Co. Planning and Zoning Agency SS-oo'763 Private Sewage System Maintenance Agreement Owner(s) Name ' U � Srv% I" �.s- Si"�'i1� :,%%t -rim •50ar-S t` GeV TRYST Site Address fs?95- Tax ID # 04 -coot« Z -Ham• o4 —t$ —t OS'«ODD 1�-{se o As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil tester's report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established in the WI Adm. Code, as from time to time amended. (COMPLETE Legal Is required) 1/4 of 1/4 Section / g Township 414 N. Range oq W. Additional Legal Description: S' ' Town of e►+hI2t. S (Acreage) Gov't Lot Lot Z Block Subdivision Lot CSM # Vol. Page CSM Doc # DOCUMENT NUMBER 2O26R-612479 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED 06/08/2026 AT 1:58 PM RECORDING FEE: $30.00 PAGES: 2 Recording Area Return To: pp++ Planning and Zoning D �unerw � JUN 0 9 2026 In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ Other IF L-4mg7lJ 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 (113) of the volume occupied by sludge and scum. Pump Chamber (system types B, C, 0, 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 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. Name(s) — Plea a Pri t Subscribed and sworn to before me on this date: r z c Jw*U. y ) aC acs r ' 7 . • Owners) — na No ry Public "b'"i n n 1 i My Corn scion Expires: - 1') I Drafted by: Date: b" Proofed by: utforms/sanitary/septicmaintenceagreement Revised July 2020 File Code: HAY-BayFA File Number: 154564 ADDENDUM/EXHIBIT A That part of Government Lot Two (2), Section Eighteen (18), Township Forty-four (44) North, Range Nine (9) West, Town of Barnes, Bayfield County, Wisconsin, described as follows: Commencing at the Northwest comer of said Government Lot 2; thence running South, on the West line of said Government Lot 2, 1290 feet to a point; thence running East, parallel with the East-West quarter line of said Section 18, 2190.9 feet, to a point; thence North variation 18° East 114 feet to the Point of Beginning; thence running North 18° 00' East, 105 feet to a point; thence running South 89° 30' East, 216 feet to a point; thence running South, 100 feet along shore of Middle Eau Claire Lake to a point; thence running West 228 feet to the Point of Beginning. sW E1VED JUN 092076 Bayfield Co. Planning and Zoning Agenv/ ` �c Rriu�yr Wisconsin Department of Safety and Professional Services SOIL TEST # _____ Page 1 of 2 • �" 'r�Y''' Division of Industry Services p$ SOIL EVALUATION REPORT G�satm�•4s�¢ In accordance with SPS 386, Wis. Adm. Code CountyBAYFILD Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but,not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel . north arrow, and location and distance to nearest road. 21 j &J -Do . 4y._Q-tg- scale or dimensions,os'-oo ______ Please print all information. Y Datejt Personal information you provide may be used for seconda acy Law, s. 15.04(1)(m)} Za / ,j I 771 Property Owner Property Location SMITH JOINT REVOCABLE TRUST Govt. Lot Z % % S I$ T $ N R E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: 1886 SMART ROAD I1Ma S fbA?T- gc p.o City I State I Zip Code I Phone Number ❑ City ❑ Village XTown Nearest Road GORDON WI 54838 ( ) BARNES .0 NewConstruction Use: Residential/Numberofbedrooms 3 Code derived designflow rate_'1≤D_GPD RReplacement ❑ Public or commercial -- Describe: Flood Plan elevation If applicable N /Aft. EIIT Pa rent material 6� 21 General comments and recommendations: Boring # [Boring �f Pit Ground surface elev. ft. Depth to limiting factor in.! elev. ft. I Sail Annlication Rate Horizon Depth In. Dominant Color Munsell Redox Description • Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 1 -6 ----- S OMSG 4L 1F .7 1.6 -45 7.5YR6/4 ---- S OMSG W IF .7 1.6 5-70 7.5YR4/4 ---- S OMSG v1LW .7 1.6 0-184 .5YR4/6 ---- S OMSG W .7 1.6 r Boring # ❑Boring []Pit Ground surface elev. ft. Depth to limiting factor in. I elev. ft. I Sail Annl!eatinn 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 ECE V D 2026 Plan ng and Zc ing Agency CST Name (Please Print) Signature CST Number GREG YOUNG 231040 Address Date Evaluation Conducted Telephone Number 6502 TOWER AVE I 6-3-26 I 3952929 * Effluent #1 = BOD > 30 s 220 mglL and TSS > 30 5150 mg/L * Effluent #2 = BOD, s 30 mglL and TSS 30 mg/L SBD-8330 (R04/21) /� QOL4r� L�P►� C' lam, (≥E 1 W CAo,ria.mssL- 5 Zaps' ---------------------------------------- tb C F 3-n pies t e� �•. �., 1 s�.•�.r�z- �r►fl 9, vat-t;�r� a s���''►�t ,ck ate • , etc . � + qqi E L`I i I5 statt �-� I f-..& Lea a,'ii1 s ni As eycctiti-. 14fa siP+V rL4W eV 82' 1 JUN 082026 Planafngand Zonhj q9e BAYFIELD COUNTY SANITARY PERMIT (#04)-26-76S STATE SANITARY PERMIT OWNER: SMITH JOINT REV TRUST GOV'T LOT: 2 LOT: BLK: 1/4 1/4 SEC: 18, T 44 N, R 9 W TOWNSHIP: Barnes SOIL TEST: 74-26 REPLACEMENT SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: GREG YOUNG TRACY POOLER DATE: 7/1/2026 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 #: 404375 LICENSE: # 231040 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 7/1/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION