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HomeMy WebLinkAbout26-82SI I SS—oo1 g5 Department of Safety & Professional Services, Industry Services Division County Bid Sani�ePeennit Number (to be filled in by Co.) a' gas 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 am 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(IHm), Slats. 49075 East Shore Rd Solon Springs 49105 East Shore Rd Barnes I. Application Information — Please Print All Information Property Owner's Name Parcel # Katz Pause LLC 2096 Property Owner's Mailing Address E Property Location 2304 Oliver Ave South Govt. Lot 6 i, y., Section 17 City, State Minneapolis, MN ZI 55405 Phone Number 612-940-6663 T 44 N R 09 E or W II. Type of Building (check all that apply) ® I or 2 Family Dwelling— Number of Bedrooms 1 Lot # 3 Subdivision Name Block # ❑ Public/Commercial — Describe Use O Cityof ❑ State Owned — Describe Use ❑ Village of CSM Number 254 IaTownof Barnes I11. 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 applicable.) A. New System y ❑ Replacement System p y 0 Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank ® In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Desi gn ❑ Other Type (explain) (conventional) C. ❑ Renewal Before 0 Revision ❑ Change of Plumber 0 Transfer to New Owner St Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (sf) Dispersal Area Proposed (sf) I System Elevation 150 0.7 I 214.3 226 96.7 Tank Information Capacity in Gallons Total Gallons # of Units Manufacturer B y c rt U ro $ 2 in Tn a3 to .2 iZ C7 rd P, New Tanks Existing Tanks Septic or Holding Tank 540 540 Infiltrator X Dosing Chamber V. Responsibility Statement- I, the undersigned, ass esponsi i ty or installs 'on of the POWTS shown on the attached plans. Plumbers Name (Print) Plum is Sr store MP/Iv1PRS Number Business Phone Number Doug Manthey 230722 -PM 715-739-6868 Plumber's Address (Street, City, State, Zip Code) PO Box 196 Drummond, WI 54832 VI. County/Department Use Only Approved O Disapproved I ❑ Owner Given Reason for Denial Permit Fee I $ Date Issued xa 111 7/4J21 Iss ' g A Si lure 3 z6 Conditions of Approval/Reasons for Disapproval RCIVED ≤\ O JUL 06 2026 y cct(G% thed ^4 /� V V (if/V 1 , Bayfield Co. Planning and Zoning Agency A ((arts to complete plat, for tie scslrm and submit to the County only on paper not less than 8 In x 11 inches in size SBD-6398 (R. 03/22) • y,�t.� nR7At�1T Wisconsin Department of Safety and Professional Services0 RJ G 11 NA6 Page of j" Division of Industry Services SOIL EVALUATION REPORT IL TEST #5 In accordance with SPS 385, Wis. Adm. Code County/?yr ,� c�G� Attach complete site plan on paper not less than 81/2 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, O scale or dimensions, north arrow, and location and distance to nearest road. rk X �� ��� Please print all informatip.Revie b ( Date Personal information you provide may be used for secondary rivacy Law, s. 15.04(1)(m)). �3T1 i :7,":::: Property Owner Property Location ❑ f� y sL I C Govt. Lot %4 % S /' T `Wy N R O? E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: Pay' (#1 &'! oT V1'12% 23i23ig O1 • t r �� �. $o k ft . 3r 4r 3 d,' j-, r &' 3 12.3 3 5'd City Tstate I Zip Cade Phone Number ❑ City ❑ VillageCR Town Nearest Road fP/oS l)I:�ti --__________________ cc /491' A '/ I s S Y& Aoc4 iAc roc /�_ New Construction Use: 19 Residential! Numberof bedrooms Code derived designflow rate /.S GPD ❑ Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material LSla,/ Twa c4 '2General comments and recommendations: 4) a I r '/1— .,/ ,4Q/f111 1�''� Tam p�• 7 © Boring # ❑Boring Q9 Pit Ground surface elev.! ft. Depth to limiting factor /2" in.! elev. 89 'lit. I Soil Anolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 ep—( .s` r /2 1-S sK F' t" -k/ /ec . 7 . -z o -2q .s l tf J's, ,4A- Oir 6t' .7 1.6 3 ?Y-36 ?.S- 42 yl rs a- b- L a- `tip /. Al 3 - .Z ?. c e *f . ? r2 J Boring # OBoring Pit Ground surface elev. Depth to limiting factor l in. / elev.i. I Soil Anolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 Q - 7,$� s -? r w / .ei ,- 7 /,4 Z .Zz '.. �3 4 s ,r,61c- , ', ' v.c- .7 1.44 -1z-3 $ ,S' ,p 7'q N ) m_ ,* ._ . 7 CEIVEb I. C CST Name (Please Print) Signature LYflIu CST Number Planning and Zoning Agency S� m 41GOd / li Gt kG Address 1131c! /3 a'a�c9a t> �, Date Evaluation Conducted / a Telephone Number • Effluent #1 = BOD >30 s 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS 5 30 mg/L SBD-8330 (R04/21) Page -e of.2_.._ (] Boring Boring # �� Ground surface efev.` . ft. Depth to limiting factor//0 in. / efev. ST: Ift. Anil Annul -O inn R�fa I 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 D -? 4 S -?&+i G.P kt ✓ F � tcJ At o'.r- . ? AC 2 - Jc Q yl L s' .Z m Grw f e�.� -, /. 2 -So s '' w uF .7 a -i ?.$'M s/ /• G I Boring # ❑ Boring ❑ Pit Ground surface efev. ft. Depth to limiting factor in. / elev. ft. I Soil Acolication 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 *Efi#2 Boring # ❑ Boring ❑ Pit Ground surface efev. ft. Depth to limiting factor in. / elev. ft. I Soil Annlication 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 *Efi#2 * Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 s 150 mg/L ?1s_ 6g\- il4D *Effluent #2 = BOD, 5 30 mg/L and TSS s 30 mg/L RECEIVED JUL o6 2026 Bayfield Co. Planning and Zoning Agancy i 1, 510ft Sc� !e' /" O i` 3 S I �----- N I 1 y7Iv S hasT_ / Q��• L1z ❑ �tn•�rs �o �rtc " aoX rHg9t S 4 H wa er 379•t (,4rz PauS'e 44 C 5rs , G 9G. , boo -,<' 3 e7 qD�: r.�cr► ,94' 2/ ' so�c 14 goo p A"O ilk rI MAN 2 eK Ah'S �l� ✓5-5q0[ I Tc #1u?' y�o��ae�o s� 9 9• I'H cdL tN� Town o� J,Afc SIz ryr____ � r /K (i,7 G mT 11N l z� o -Q ""3 P��� r'3sz (zT3Rd mdd k Lakes RECEIVED ' _, ao4o r JUL 66 2026 Bayfieid Co. Planning and Zoning Agency 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 Attachments: Enclosures: Tank Information POWTS Application for Review Property Information Soil Evaluation Report & Site Map Survey Project Name / Description Katz Pause Conventional Owner Name(s): Katz Pause LLC Owner Address: 2304 Oliver Ave S Min lis, MN Phone: 612 940 -6663 Zip: 55405 Project Address: 49075 East Shore Rd Barnes & 49105 East Shore Rd Solon Springs Govt. Lot: 6 1/4 of 1/4, Section 17 T44 N -R 09 ELI or W ❑✓ Township: Barnes Project Parcel ID #: 2096 County: Bayfield Designer Information Designer Name: Doug Manthey Designer Address: PO Box 196 Drummond, WI E-mail: norpines@chegnet.net This space reserved for approval stamp. License Number: 230722 -PM Phone: 715 -739 6868 Zip: 54832 Remarks: Signature: RcCERrED JUL 062026 Bayfield Co. Planning and Zoning Agency Date: 06/29/26 Scale / /9' T ohslk.� S'ioid'orevw S/QU•v — Cr) JSMI amr( P/� Page 1 N I ram,mpo{ r"4+S T'o N M cv Beet Like �r/oq,.7c� drl✓C gr 6 49.7 ®wne X398 YAT2 PaaSe «c Sysrr.,�[ 9G.7 �k� �� i� lea3o`i GLvc. R�EN�ie 5c`c , •rjrOCJ't�I € I''"c 99.7 fllist✓1C4s4v/eS v S55oS y♦oa+d @ A0 S% �jo.nc I g4YF;c(d w;. iTowyoi1 r3a.^A�5 I TQX o9G � 7 51? Tyrq go9 � . Il-7S Lacy in Go�.T Gerd l&1 A3SG (Lm T3 o1 6 3 P�3� I y9/os �QfT Slnar� Rd —\ Go`, ea'<< e P;-oJ ° be y „5e`yo fniddIe ? ti"saR35 f'C c�u 1 GKG n- Grouxr$. Se's, Absorp\.o•.. Su, ucco AJUL 062026 g aBayfield Co. ori -'Z - Planning and Zoning Agency IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) IIIJ SOIL COVER min. 12" (typical) Septic Tank(s) Manufacturer. Infiltrator Septic Tank(s) Volume(s): 540 gal gal gal gal Effluent Filter Manufacturer Orenco EfFluentFilterModelI PSCS0621-18 12" minnch depth (typ.icao 1J TYPICAL TRENCH CROSS SECTION VIEW 34" (YPhl) :.' .. (No Scale) System Elevation = 96.7 ft (typical) Quick4 Standard -W w/ End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) r------------t-------��---- _______—t B= 46 ft (typical) INSTALL PER TRENCH: 11 Quick4 Std -W @ 20 ff EISA/chamber = 220 ft2 Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturers / Instructions. TYPICAL TRENCH PLAN VIEW (No Scale) TA (typical) "—Quick4 Standard -W Chamber (typical) (mid by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. + �^ Pairs of end caps @6W EISA/pair = 6 ft2 a r = Proposed EISA per trench = 226 ft Required Infiltration Area = 214.3 ft2 Distribution Method: rr! a' x 1 trenches = Proposed Total EISA = 226 ft2 branched manifold o rr; rn Cl) RESET -0 GD m W O 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; BODr S 220 mgL"'; TSS 5150 mgL"'; FOG 530 mgL"' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) 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 (Le., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (Le., 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 (113) 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 filter(s) 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 Service 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 componegt.z @,O abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable £SAs. V� System Abandonment Bayfield Co. If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. AdMirnit f62oning Agency JUL 062026 Jr ACCESS PORT RIM 1.5 [36] co A A' FLEXIBLE LID y N ELASTO•MERIC - � � ' GASKET (TYP.) )]J co 3 5 t O N O - 14 = m r 61.7 c O. EXTERIOR TANK INLET/ i WIDTH INTERIOR OUTLET o. TEE, IF REQUIRED PIPE PENETRATION SECTION DETAIL 64.9 [1,648] EXTERIOR LENGTH LIFTING STRAP INLET (TYP.) CONNECTION TOP VIEW (TYP.) o 024 [610] ACCESS OPENING 10.6 [269] FREEBOARD WITH LOCKING LID OUTLET CONNECTION (TYP.)) © 47 11,38 54.67 11941 EXTRIOR LI�UIO DEPTH HEIGHT ISOMETRIC VIEW SECTION A- A' END VIEW NOTES: 1. ALL DRAWING DIMENSIONS IN INCHES IMILLIMETERSI OR AS NOTED. 2. EXTERIOR OR ACCESS OPENING LID INCLUDES THE FOLLOWING WARNING IN ENGLISH, FRENCH & SPANISH:'DANGER DO HOT ENTER: POISON GASES.' DRAWN BY g 3. CAPACITY, ENGLISH, FRENCH S ANISH:E: MANUFACTURINGCODE.MNOT E NAME, MODEL GAS NUMBER, LIQUID %Infiltrator P/N CAPACITY, DATE OF MANUFACTURE CODE, MAXIMUM BURIAL DEPTH, INLET, AND OUTLET. I M —Tan k 4. THE TANK MAY BE NATIVE BACKFILLED WITH SUITABLE NATIVE SOIL SEE INSTALLATION INSTRUCTIONS FOR DATE }¢8 GUIDANCE IF THE NATIVE SOIL DOES NOT NEETTHE INSTALLATiON INS1RUC11ONS Water Technologies GUIDANCE THEN BACKFILLING WITH SELECT MATERIAL WILL BE REQUIRED. Pelt of pywM 05112/2025 5. MAXIMUM BURIAL DEPTH 1348 In mm1. U/ffN SCALE TH 6. MINIMUM BURIAL DEPIS8in 1152 Hi mmj. T. TANK IS FOR NON -TRAFFIC APPLICATIONS. INFILTRATOR WATER TECHNOLOGIES, LLC IM -540 NTS S. AIRSPACE IS 13.9% 4 BUSINESS PARK RD, OLD SAYBROOK CTOS475 $ 9. INLET TEE MAY NOT BE REQUIRED BY DESIGN. WINW.WFILTRATORWATER.COM PUMP/SIPHON TANK SHEET NO. PHONE: (389)221-44361 EMAIL INFO@INFILTRATORWATERCOM CONFIGURATION 01 of 01 C' TOTAL CAPACITY 552 GALLONS WORKING VOLUME 475 GALLONS Firefox https://novus.bayfieldcounty.wi.gov/access/REAL%2OESTATE/listin... Real Estate Bayfield County Property Listing Today's Date: 6/29/2026 ' Description Updated: 5/28/2014 Tax ID: 2096 PIN: 04-004-2-44-09-17-4 05.006-90000 Legacy PIN: 004111901000 Map ID: Municipality: (004) TOWN OF BARNES STR: S17T44N R09W Description: PAR IN GOVT LOT 6 IN V.1125 P.356 (LOT 3 OF CSM V.3 P.33) 6728 Recorded Acres: 1.189 Calculated Acres: 1.189 Lottery Claims: 0 First Dollar: Yes Zoning: (R-1) Residential -1 ESN: 104 J Tax Districts Updated: 3/15/2006 1 STATE 04 COUNTY 004 TOWN OF BARNES 041491 SCHL-DRUMMOND 001700 TECHNICAL COLLEGE - Recorded Documents Updated: 3/15/2006 D WARRANTY DEED Date Recorded: 5/23/2014 JOi4R-554355 1125-356 0 CONVERSION Date Recorded: 327-279;495-105 Property Status: Current Created On: 3/15/2006 1:14:47 PM -*� Ownership Updated: 5/28/2014 KATZ PAUSE LLC MINNEAPOLIS MN Billino Address: Mailing Address: KATZ PAUSE LLC KATZ PAUSE LLC 2304 OLIVER AVENUE SOUTH 2304 OLIVER AVENUE SOUTH MINNEAPOLIS MN 55405 MINNEAPOLIS MN 55405 T Site Address * Indicates Private Road 49075 EAST SHORE RD SOLON SPRINGS 54873 49105 EAST SHORE RD BARNES 54873 Property Assessment Updated: 10/4/2016 2026 Assessment Detail Code Acres Land Imp. GI -RESIDENTIAL 1.200 243,800 38,500 2 -Year Comparison 2025 2026 Change Land: 243,800 243,800 0.0% Improved: 38,500 38,500 0.0% Total: 282,300 282,300 0.0% tf Property History N/A RECEIVED JUL 062026 Bayfield Co. Planning and Zoning Agency I of I 6/29/2026, 8:28 AM MAP OF SURVEY LOT 3 AND LOT4 OF CERTIFIED SURVEY MAP NO. 254 RECORDED IN VOLUME 3, PAGES 33 AND 34 OF CSMS AS IW CORNER DOCUMENT NO. 324760 LOCATED IN GOVERNMENT LOT 6, :OVTLOTfi SECTION 17, TOWNSHIP 44 NORTH, RANGE 9 WEST, TOWN OF BARNES, RAYFIELD COUNTY, WISCONSIN Y I1L it \ t1� \ REARINGSAREGAIDEASED ` \ WNCRS- BAYPIELD COUNTY \5 to READ 83 (20111 S\ \ \ WRNTNf EAST UNF OFTNF5Fjr SfCNON 17 ,LO ASPHALTROAD MEASURESSI'20'12'W SURFACE \,\ l \ TM I.D. / 2094 IS 89•SEE( S 88'37'27" E ` \ nGo.(S R9'52' LOT 2 149.5.5 3' 588°45'10" E (ssD. 149.4.4 LOT P 7' g0 � GAMGE CURRENT TOWN PUT RECORD MEASUREMENT. SEE NOTE WVEL ROAD \\ SURFACE LOT 4 51,627 2 SO. FT. 1.19 S ACRES INQUDING ROAD R/W LP TANK SHED W HOUSE 09 N 88'4T59" W SAUNA IN R9'52' W) z sky 49' _ / I PROPOSED I I STUDIO F~ 49' S ( FOOTPRINT I L 43'- / 53k CENTERUNEOFINGRESS EGRESSFAMMFM PFACNAB254 LOT 3 -', 51,527₹SQ. FT.; --.. 1.19 ±AOEES,' . DECK HOUSE ® HOUSE N88°44'30" VJ 115OAG') IN 89'52 W) MIDDLE EAU CLAIRE LAKE SOULE — ,W D' 4D' 8O' EASTY( CORN ER SECTION 17 FD. 2' IRON PIPE Wj SE CORNER 17 PD. D. CTON1] 4' CAPPED IRON PIPE AF O -ISO N 10.2' IRON PIPE . O 564'40'49'R-0.45' Op _.._Bs~ 4ECEIVE JUL 06Z( Bayfield Co. Planning and Zoning LEGEND O - SET Y' K 20' PLASTC CAPPED RERAR NOTES: • - POUND l' IRON PIPE PINCH TOP TISTSHORE ROAD WAS MEASURED WITH THESTART POINT BEINGTHE WESTERLY RIGHT OF WAY OFS.TH. 'Zr PER 2W9 RIGMO FOUNDY- IRON PIPE PINCNTOP WAY PLAY RSS0'16'24.02. NO: RY16.2 4.02. 2- POUND l' IRON PIPE THE ORDINARY HIGH WATER MARK OF MIDDLE UUCUIREURESHOWNONTHISMAPIAPPROXIMATEANDFORREFERENCEONLY. 0 .FROND 1Y' IRON PIPE - PASTED MAT BESUBIECT TO RECORDED AND UNRECORDEDEASEMENR,COVENANTS, RGM OFWAYSAND OTHER RESTRICTIONS. ® -FOUND -FOUNDS(4' IRON PIPE . ANY LAND BELOW THE HGH WATER MARK OF A TAKEORNAVGABLESTREAM ISSUNER TO SHEPUSIC TRUST THAT ISS ESTABLISHED 'FOUND 2'IRON PIPE UNDER ARTICLE D. SECTION I OF THE STATE CONSTITUTION. -4'PVCVENT - A COMPLETE TITLE SEARCH FOR THE SURIECT PARCEL WAS NOT CONDUCTED AS PART OF THIS BOUNDARYSURVEY. Q- SEPTIC UD . WELL SURVEYOR'S CERTIFICATE ES ' ELECTRIC TRANSFORMER I I- PREVIOUSLY RECORDED DATA 4 Re6Ey A TulnqulE, WI®min Prohsslonal land 5ulwywRAW6 herebyceNFy that I have RRrWYe4Me properly 0- PLSSCORNERMONUMENTOF RECORD rhwm Rneory w6:MMNIsmapha Weand wrtettnpEo otabon of the properly su,veytd to Mebevtormy the tlbecton"I SIew KaR and; thou have MONUMENT DIMENSIONS ARE OUTSIDE DYMFRR RnpypMCFeand HeRet, w4 Mat(Ease PRRI0HIRCdTAE- tRbMY STEVE KATZ Whby wmpuedymm the appAmb4 re4UbemennofAEa wmewDwn„n AdndMnnll.e Cole. Robby TMralgtaist 5/21/2026 SHEET I OFI DRAWNBY:RAT RobbYATIm4WR Date DAIS. 5121/2026 'wt. ,*,pIS R<ID6 ROBBY A. TURNQDIST $4005 HIDGE WI BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): /Check List ❑ Index Page / Title Sheet (Optional) Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) 'original Plot Plan O Cross Section Soil Profile Sheet (optional) O Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Reports (Include the following Information) 2<aarcel 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) l'Property Location (Accurate Legal Description with Sec/Twp/Range) O'Road Name (where driveway is/will be coming off of) O Floodplain Elevation, Flow Rate, Comments and Recommendations P1/Complete Soil Boring / Pit Information to Date Soil Evaluation was conducted 2r C Name, Signature, Number, Address and Phone Number O *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) F Bench Mark (Description, Elevation and Location) .Eontour Lines (Example = 98.0' /96.0' /94.0') 2l Property Location (Sec/Twp/Range/, Accurate Legal Description) Borings (Locations and Elevations) VWecllelLocation 1 9rcent and Direction of Land Slope (Including Neighboring Wells, if applicable) Location of Wetland Areas, Floodplain and Navigable Waters O B ildings, Driveways, and Structures (Location and Descriptions) Location of Property Lines O Existing System Location Address Number and Road Name O Current Surface Elevation of Wetlands and Navigable Waters C'CST, Owner and Property Information 1lorth Arrow RECEIVED JUL 0.6 2026 Bayfield Co. Planning and Zoning Agency Fee: I≥' rtified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforcsts BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) /'Check List O'Original Sanitary Application (Submitted in Deed Holders Name — nX prospective buyers) (383.21(1)1.) lWIdex Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) Ori final Plot Plan (383.22(2)2. 3. & 4.a) "ss Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) eContingency 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) ❑ Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) ❑ a (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) la/# Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sajjithry li t' n: (Include the following Information) I Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) CQ*oject Address or Road Name where driveway is/will come off of) D -(Owners Phone Number) Z1 II Type of Building I type of Permit Cpl IV Type of POWTS System l_a/V Dispersal / Treatment Area Information R VI Tank Information 2'GII Responsibility Statement (Plumber's Information) 0 *Date Stamp* Plot Plan: (To Scale or To Dimension) 9'Sgnature and Plumber Information 0 Surface Elevation of Body of Water direction and Percent Land Slope L�Tank and Filter Information and Location ❑0 Wetlands / Navigable Bodies of Water absorption Area (Proposed and Existing) Bench Mark (Location, Elevation and Description) p Component Manual Version l AAddress Number and Road IA4 orth Arrow Icfc�.ontour Lines p'structures and Driveways ltBBBo�orng Locations Li/Property Lines L� Well Locations ❑_Cegal Descriptions k GE1VED JUL 062026 Bayfield Co. Planning and Zoning Agency Turn Over ► Cross -Section and Over -Head Profile of the System: surface and System Elevation (IPosition of Observation and Vent Pipes V Dimensions and Depths 2' Make, Model & Number of Chamber Units in each Cell Property Information ❑ How many systems will there be on this parcel of land? ❑ Has this property been split? (Property Statement shows Property History) Fees: 2'Private Sewage System (Septic Tanks) $ 400.00 ❑ Private Sewage System (Holding Tanks) $ 400.00 ❑ Mounds or Systems requiring Pre -Treatment $ 500.00 ❑ Sanitary Revisions $ 25.00 ❑ Private Sewage System Reconnection $ 50.00 and Private Interceptor ❑ Return Inspection $ 50.00 ❑ Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) RECEIVED JUL 062026 Bayfield co. Planning and Zoning Agency u/forms/checklists/checklistforsanitaryapps (10/2009);(07/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: ]3-MFIELD 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: KATZ PAUSE LLC, 2304 OLIVER AVENUE SOUTH MINNEAPOLIS, MN 55405 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00454 Transaction Number: SR-00454-497FF Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 5476 Paid by: A -Z Enterprises, Nor -Pines Plumbing, PO Box 196, Drummond WI 54832 Payment Type: Check Transaction Date: 7/9/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. 13 'FIELD 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: KATZ PAUSE LLC, SS -00785 2304 OLIVER AVENUE SOUTH MINNEAPOLIS, MN 55405 Transaction Number: SS -00785-49800 Description Private Sewage System (Septic Tanks) Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 5477 Paid by: A -Z Enterprises, Nor -Pines Plumbing, PO Box 196, Drummond WI 54832 Payment Type: Check Transaction Date: 7/9/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-82S STATE SANITARY PERMIT OWNER: KATZ PAUSE LLC G OV'T LOT: 6 LOT: 3 B LK: CSM: 254 1/4 1/4 SEC:17, T 44 N, R 9 W TOWNSHIP: Barnes SOIL TEST: 78-26 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: DOUGLAS MANTHEY TRACY POOLER Authorized Issuing Officer DATE: 7/9/2026 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 7/9/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION