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Department of Safety County �9 T i t �cQ C & Professional Services, Sanitary Permit Number (to be filled in by Co.) Industry Services Division �/ — s s Sanitary Permit Application State'Trannssbcttiion Number f �L') J — O�__��00?� In accordance with SPS 383.21(2). Wis. Mm. Code, submission this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application farms far state-owned PUNTS arc submitted to Project Address (if different than tailing address) the Department of Safety and Professional Services. Personal information provide may be used for secondan' 6Z(Q s CtlJ e::.• you purposes in accordance with the Privacy I .ay. s 1504(1 )(m), Stats. ^ f (J • I. Application Information — Please Print All Information l o rFhrcr 1 Property Owner's Name Parcel # 10,3a A -s W%pstr Z.21le Property Owner's Mailing Address - - � PropertyLocation S�3�•at` 4A�eI+� Govt. Lot Phone Number q�c -7 us` aW ^'�lr J� 'h, Sls' 'A, Section 3 City, Stated `O/•/fI/fr��A•f �� Zip Code �t' 21. Lot IT S'o N R E o W II. Type of Building (check all that apply) 'J or 2 Family Dwelling— Number of Bedrooms Subdivision Name ❑ Public/Commercial — Describe Use Block # ❑City of _ _ ❑ State Owned — Describe Use CSM Number ❑ Village of <Townof_ J7c( Ill. 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 Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank ❑ In -Ground ❑ At -Grade Mound ❑ Individual Site Design ❑ Other Type (explain) teons entional) C. ❑ Renewal Before i ❑ Revision Expiration ❑ Change of Plumber 'List Previous Permit Number and to Is ued ❑ Transfer to New Owner as-ays D Is IV. DispersaVr'reatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sl) Dispersal Area Required (sf1 I Dispersal Area Proposed (sf) I System Elevation 9db d, b 3°C J 3aS I lal- Z. Capacity in I Total # ; Manufacturer Tank Information i Gallons New Gallons Units O Tanks Existing Tanks t c — v -m d V V1 -' ] 4t) Septic or Holding Teak F.MZ� Dosing Chamlxr /7Oµ O (pQp V. Responsibility Statement — 1, the undersigned, assume respoasib' installation of the 'S shown on the attached plans. Plumber's Name(Print) Plumber's Si CJ�6(tl1Cr� MP, MPRS Number 6a�� Business Phone Number Z�S 6��r8��a Plum •Ys Address (Street, City, State. Zip Code) lrla !✓Cc•� �a�E�l..�t /1r �I�,.Q�GrI• iC�6 Vt. County/Department Use Only Approved V Disapproved D Owner G,, cn Reason for Denial Permit FFeere•� Dot Issued/ooc^, Is,m�tn_:I,_;n,1•mn SW'^ 7 J 2b 1 lihitaj C / �I Conditions of ApprorvVk ea,r�ns for Disapproval c_ at€O c-hPa MC!tVLD " JUL 661026 plans for the system and submit m the t ..;.1 on paper not lass than 8 I/as It inches inPnning and Zoning Agency SBD-6398 (R. -- __ Wisconsin Department of Safety.an Professional Sery ices Division of Industry Services 4822 Madison Yards Way Madison, WI 53705 July 6, 2026 CUST ID NO.: 6302 ZYGMUND JABLONSKI PO BOX 615 ASHLAND, WI 54806 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 7/6/28 MUNICIPALITY: TOWN OF BELL BAYFIELD COUNTY SITE: DOUGLAS HIPSHER 87105 COUNTY HWY C CORNUCOPIA, WI 54827 SE 1/4 SE 1/4 SEC.3 T50 N/R06 W FOR: Design Wastewater Flow Value: 450 Bedrooms: 3 Limiting Factor(s): 13" Maintenance Required: Effluent Filter Phone:608-266-2112 Web: htto://dsns.wi.eov Email: dso fii wisconsin.eov Tony Evers, Governor Dan Hereth, Secretary Identification Numbers Plan Review No.: PWTS-072600095-1 Application No.: DIS-062625276 Site ID No.: SIT -161023 Please refer to all identification numbers in each correspondence with the Department. Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE SITE REQUIREMENTS • A full size copy ofthe approved plans, specifications, and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. A Department electronic stamp and signature shall be on the plans which are used at the job site for construction. The following conditions shall be met during construction or installation and prior to occupancy or use: • The site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the Mound site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. • Components and soil removed from an existing drain field shall be properly disposed of so that there is no risk to public or environmental health. • A sanitary permit must be obtained from the countywhere this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. RECEIVEb • A state approved effluent filter is required. Maintenance information must be given to the owner of th�nl0 6 2026 explaining that periodic cleaning of the filter is required. Bayfield Co. Planning and Zoning Agency • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval and Wis. Admin. Code 5 SPS 383.54(11. • In the event this soil absorption system or any of its component parts malfunctions so as to createa health hazard, the property owner must follow the contingency plan as described in the approved plans. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In grantingthis approval, the Division of Industry Services reserves the right to require changes or additions, should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer o f the responsibility for designing a safe building, structure, or component. The Division does not take responsibility for the design or construction of the reviewed items. Inquiries concerning this correspondence maybe made to me at the contact information listed below, or at the address on this letterhead. Sincerely, Joshua Rowley POWTS Product Reviewer POWTS Plan Reviewer Division of Industry Services Fee Required: $85.00 Fee Received: $85.00 Balance Due: $0.00 Refund Expected: $0.00 JUL 062026 Bayfield Co. Planning and Zoning Agency REC3QVED -Wisconsin Department of Safety and Professional Services APR 0 5 Page 1 of 3 ENiam Division of Industry Services — 2022 SOIL EVALUATION REPORT S,aeld In accordance with SPS 385, Wis. Adm. Code P C'J[fl9 -��Zoning Agency Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, BAYFIELD 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. 7216 Please print all information. Reviewed by Date I _ / .l Property Owner Property Location / • % ❑ DOUGLAS HIPSHER Govt. Lot SE '/. SE '/. 8 03 T 50 N R 06 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 22450 SISKIWIT LAKE ROAD City State Zip Code • Phone Number ❑ City ❑ Village ® Town Nearest Road New Construction Use: 0 Residential/Numberofbedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial — Describe: Parent material SANDY OUTWASH WITH UNDERLYING CLAY DEPOSITS Flood Plan elevation if applicable NA ft. Gener comments and recommendations: SITE (TABLE FOR A MOUND SYSTEM Boring # ❑ Boring L_J ® Pit Ground surface elev. 98.6 ft. Depth to limiting factor 13 in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPD/Ft' •EN#1 •E1f#2 1 0-4 7.5YR 312 NA sl tmbk ml cs 3m 0.4 0.6 2 4-7 7.5YR 5/1 NA s Osg ml cs 2m 0.7 1.6 3 7-13 7.5YR 5/3 NA s Osg ml cw 1f 0.7 1.6 4 13-29 7.5YR 4/6 c2d 7.5YR 6/8 5 Osg ml cw 1vf 0.0 0.0 5 29-38 5YR 516 c2d 5YR 6/8 c am mfi NA 1 of 0.0 0.0 2 Boring # 0 Boring 0 Pit Ground surface elev. 99.4 ft. Depth to limiting factor 14 in. Soil l Aoolic Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Fe •Eff#1 •Eff#2 1 0-4 7.5YR 3/2 NA si lmbk ml cs 3m 0.4 0.6 2 4-7 7.5YR 5/1 NA s 0sg ml cs 2m 0.7 1.6 3 7-14 7.5YR 513 NA 5 Osg ml cw if 0.7 1.6 4 14-28 7.5YR 4/6 c2d 7.5YR 618 s Osg ml cw 1vf 0.0 0.0 5 28-38 5YR 5/6 c2d 5YR 6/8 c am mfi NA ivf 0.0 0.0 I I I IytD I!0%d3 1 I I I I 1 �� •Effluent#1=Bon >Afls92mmnf and TRR>an<15nrnnrl +cfm,e.0 fee-onn ,aneo,n.....n n_d Yee�on�.cn ._n CST Name (Please Print) natu CST Number EDWARD J WROBLEWSKI SP -72000013 Address Date Evaluation onducted Telephone Number 84805 HATCHERY RD BAYFIELD, WI 54814 I3/24/2022 I715-209-4055 SBD-8330 (R04/15) PJS J� 3 Boring # ® Boring ❑ Pit Ground surface elev. 99.6 ft. Depth to limiting factor 13 in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' •Eff#1 'Eff#2 1 0-3 7.5YR 3/2 NA sl lmbk ml cs 3m 0.4 0.6 2 3-7 7.5YR 5/1 NA s Osg ml cs 2m 0.7 1.6 3 7-13 7.5YR 5/3 NA s Osg ml cw If 0.7 1.6 4 13-30 7.5YR 4/6 c2d 7.5YR 6/8 s Osg ml aw 1vf 0.0 0.0 5 30-40 5YR 5/6 c2d 5YR 6/8 c Om mfi NA 1vf 0.0 0.0 /00.501 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor _ in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPD/Ft' 'Eff#1 Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. _ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' 'Eff#1 -Eff#2 Effluent #1 = BOD, > 30 S 220 mg/L and TSS > 30 S 150 mg/L * Effluent #2 = BOD, >30s 220 mglL and TSS >30 s150 mg/L EDWARD J WROBLEWSKI, CST #SP -72000013 SOIL TEST PLOT PLAN DOUGLAS HIPSHER S300'OFPAR INSESEWOFH IN 2022R -593084-91C S03 T50N R06 W TOWN OF BELL, WI SCALE 1'=40' = GM 12" OAK TREE, NAIL IN BASE = 100' LOT LINE rU I I-. 0 O U N T 1 3 40' SHEET 3 OF 3 A TO Z PLUMBING & HEATING, INC. 1110 LAKESHORE DRIVE WEST P.O. Box 615 ASHLAND, WI 54806 Phone: 715-682-8520 Fax: 715-682-8521 Email: Zyg@atozashland.com SEPTIC PLAN SUBMITTAL- REVISED Project: Douglas Hipsher 22450 Siskwit Lake Road Cornucopia, WI 54827 Project Site: 87105 County Hwy C — Cornucopia, WI Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE INDEX: Page 1 — Index & Cover Sheet Page 2 -4 —Soil Evaluation Report Page 5— Plot Plan Page 6— Combo Tank — Wieser WLPI000/650 Submittal Page 7 thru 11 — EZ Flow Mound Design Page 12 & 13 — Zoeller N98 Pump Submittal & Curve Page 14 & 15 — SJE Rhombus 120 -volt pump control and alarm Page 16 & 17 — Polylok Filter submittal Page 18 — Mound Maintenance Program Specifications Page 19 — Mound Management Plan Zygmund Jablonski J� 6302 June 15- /' ) JUL 002026 Planning and Zoning Agency PAGE 1 OF 6 Mound Plan Index & Cover Sheet Component Manual Design References: Mound Version 2.1 (May 2022-2027) & Pressure Distribution Version 2.1 (May 2022-2027) Pg 1 of 6 Index & Cover Page Pg 2 of 6 Plot Plan Pg 3 of 6 Mound Cross -Section & Plan View Pg 4 of 6 Distribution Network Specifications Pg 5 of 6 Pump Tank Specifications Pg 6 of 6 Management Plan Pump Curve POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Mound Owner Name(s): Douglas Hipsher Phone: 715 -209 Owner Address: 22450 Siskiwit Lake Road Cornucopia WI Zip: 54827 Project Address: 87105 County Hwy C Cornucopia, WI Govt. Lot: SE 1/4 of SE Township: Bell Project Parcel ID #: 7216 _1696 1/4, Section 3 , T 50 N -R 6 E❑or W— z County: Bayfield Designer Information Designer Name: Zygmund Jablonski Jr. Phone: 715 - 682 - 8520 Designer Address: PO Box 615 Ashland, WI Zip: 54806 E-mail: Zy9@atozashland.com l'his space reserved for approval stamp. License Number: MP6302 Conditionally APPROVED Remarks: DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES Signature: SEE CORRESPONDENCE RECEIVED Date: June 9 ? 1129? 70?6 Bayfield Co. Planning and Zoning Agency _c t Wisconsin Department of Safety and Professional Services / Division of Industry Services u �I]� SOIL EVALUATION REPORT Bavfir.fd Co. P a��it�t� id urng Agency In accordance with SPS 385, Wis. Adm. Code BAYFIELD Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, 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. 7216 Please print all information. Reviewed by Personal information you orovide may be used for secondary u oses (Pnvacv Law s. 15.04(11(m . Page 1 of 3 Date Property Owner Property Location ❑ DOUGLAS HIPSHER Govt. Lot SE 1/4 SE % S 03 T 50 N R 06 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 22450 SISKIWIT LAKE ROAD City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road CORNUCOPIA I WI I 54827 (715) 209-1696 I I BELL I COUNTY HWY C ® New Construction Use: ® Residential / Numberof bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial — Describe: Parent material SANDY OUTWASH WITH UNDERLYING CLAY DEPOSITS Flood Plan elevation if applicable NA ft. Gener comments and recommendations: SITESUITABLE FOR A MOUND SYSTEM \i I YY) ifi IW _ Cbrini % ni t �/ ( M1 Mte Nv Boring # ❑ Boring ® Pit Ground surface elev. 98.6 ft. Depth to limiting factor 13 in. Soil Application 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 0-4 7.5YR 3/2 NA sI 1mbk ml cs 3m 0.4 0.6 2 4-7 7.5YR 5/1 NA s 0sg ml cs 2m 0.7 1.6 3 7-13 7.5YR 5/3 NA s 0sg ml cw 1f 0.7 1.6 4 13-29 7.5YR 4/6 c2d 7.5YR 6/8 s 0sg ml cw ivf 0.0 0.0 5 29-38 5YR 5/6 c2d 5YR 6/8 c Om mfi NA 1vf 0.0 0.0 22 Boring # ® Boring ❑ Pit Ground surface elev. 99.4 ft. Depth to limiting factor 14 in. Soil Application 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 0-4 7.5YR 3/2 NA sI 1mbk ml cs 3m 0.4 0.6 2 4-7 7.5YR 5/1 NA s Osg ml cs 2m 0.7 1.6 3 7-14 7.5YR 5/3 NA s Osg ml cw if 0.7 1.6 4 14-28 7.5YR 4/6 c2d 7.5YR 6/8 s 0sg ml cw 1vf 0.0 0.0 5 28-38 5YR 5/6 c2d 5YR 6/8 c Om mfi NA 1 of 0.0 0.0 I ITVW 1/0.a3' I I I I I I * Fffli!pnt #1 = Rnn > 2fl s 59n mn/I 2nd TCC '2n < 1 rin mn/I * CKI, inn. W) _ inn ......n ....d -rc%c% - -jn - A en .r -n CST Name (Please Print) natu CST Number EDWARD J WROBLEWSKI SP -72000013 Address Date Evaluation onducted Telephone Number 84805 HATCHERY RD, BAYFIELD, WI 54814 I 3/24/2022 I 715-209-4055 bbU-tSi:3U (KU4/15) 1?1a( Im Boring # ® Boring ❑ Pit Ground surface elev. 99.6 ft. Depth to limiting factor 13 in. Soil Application 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 0-3 7.5YR 3/2 NA sl 1 mbk ml cs 3m 0.4 0.6 2 3-7 7.5YR 5/1 NA S Osg ml cs 2m 0.7 1.6 3 7-13 7.5YR 5/3 NA s 0sg ml cw if 0.7 1.6 4 13-30 7.5YR 4/6 c2d 7.5YR 6/8 s 0sg ml cw 1vf 0.0 0.0 5 30-40 5YR 5/6 c2d 5YR 6/8 c Om mfi NA 1vf 0.0 0.0 - loo -a Boring # ❑ Boring O Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application 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. Soil Application 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 * Effluent #1 = BOD, > 30 s 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, > 30 s 220 mglL and TSS > 30 s 150 mg/L EDWARD J WROBLEWSKI, CST #SP -72000013 SOIL TEST PLOT PLAN DOUGLAS HIPSHER S300'OFPAR INSESEWOFH IN 2022R-593084-91 C S03 T50N R06W TOWN OF BELL, WI SCALE 1'=40' = BM 12' OAK TREE, NAIL IN BASE = 100' LOT LINE NY C 2% SLOPE 3 99.6' \\ #1 98.6' #2 99.4' JLANNED HOMESITE JLANNED DRIVEWAY w z J F - o w z J F- 0 -.J LOT LINE U >- I- 2 D O O 1 2h? 30 40' I SHEET 3 OF 3 LL & O C r Ci O M o rn I7%co A. f34.,L of IZ ba+k TNm I r fI2• crcc MM—' �cz9r L£.,�U- Co. fTWLj C GSF WI MOUND DESIGN PROGRAM DATA ENTRY ation Residential or Commercial Design I 3 I Number of Bedrooms (optional) Design Flow (gpd) Site Slope (%) Installation Contour Line Elevation (ft) I 110.00 IContour Length Available (ft) Depth to Limiting Factor (in) In -Situ Soil Application Rate (gpd/ft) EFF #2 Distribution Cell Information B43 Unit Used 5 Cell Width (ft) 3, 4, 5, 6, 8, 9 or 10 I 61 = Dispersal Cell Length (ft) 2.0 Dispersal Cell Design Loading Rate (gpd/ft) 2 Influent Wastewater Quality Are the laterals the highest ooint in the distribution istribution Information network? Enter Y or N Center, End, No Manifold (Pump to Gravity), or Gravity (No Pump) Lateral Spacing If N above, enter the elevation ft Number of Laterals of the highest point. Orifice Diameter (in) (e.g. 0.25) Estimated Orifice Spacing (ft) =I 10.52 ft2/orifice Forcemain Diameter (in) Forcemain Length (ft) Does the forcemain drain back? I v l Inside Pump Tank Elevation (ft) 4.55 System Head (ft) x 1.3 6.60 Vertical Lift (ft) 1.17 Friction Loss (ft) 5 Add'I Fitting Friction Loss (ft) 17.32 Total Dynamic Head (ft) Lateral Diameter Selection in. diam. options choice 0.75 1.00 1.25 1.50 x x 2.00 x 3.00 x Septic Tank Information 10001 Septic Tank Capacity (gal) Wieser IManufacturer Dose Tank Information sooj Dose Tank Capacity (gal) 16.76J Dose Tank Volume (gal/in) [Wieser IManufacturer Project Hipsher Mound 4.59 Forcemain Drainback (gal) 26.85 5x Void Volume (gal) 31.43 Minimum Dose Volume (gal) 15.62 System Demand (gpm) Manifold Diameter Selection in. dia. options choice 1.25 1.50 x 2.00 3.00 Gallons/Inch Calculator 1000 TTotal Tank Capacity (gal) 36 Total Working Liquid Depth (in) 27. 77778 gal/in Effluent Filter Information Pol lok J Filter Manufacturer 525 IFilter Model Number Page 2 of 8 RECEIVED JUL 062026 BayfieId Co Planning and Zoning Agency GSF WI MOUND DESIGN PROGRAM GSF MOUND DRAWINGS Mound Plan \/iAw mound component Dimensions Al5.00 ft E 24.20 in HL 1.00 ft xl 10.65 ft BL 61.00 ft F 7.00 in I 9.89 ft LL 82.30 ft Dj 23.00 in CL 0.50 ft J 8.49 ft W 23.38 ft 305.00 (ft2) Dispersal Cell Area 908.51 (ft2) Basal Area Available 7.38 (gpd/ft) Linear Loading Rate 6.10 (ft) 1/10 B Obs. Pipe Placement Finished 103.10 ft Grade ( ) p�' 2❑ `iii. G H 102.10 (ft) F "r'II'I ;' I: s• Lateral Invert 101.52 ft .ea;n'� . .. DIs ersal Cell I�Fj�,j , yee ( ) —► fwd®N��,J7'Pi i ��: P t'x ' Dis ersal Cell ( tli4Nlyseo Elevation P asogu3r,+�,.'_i13 �i 1 I. I ��' Elevation ❑ �i1i I I 4 I::fi1E�N i�� Irl' iea• ii li L'Rs f�q 99.60 (ft) Contour Elevation 2% Site Slope Shading Key 1 eee Topsoil Cap 2 Subsoil Cap 3 ` y'j ASTM C33 Sand 4 Tilled Layer 5 GSF Media & Cell Header /Footer SF .o x 'n 2ft 00 c m v 0 0.5 ft Typical Dispersal Cell See Page 5 Geotextile Fabric F 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: Hipsher Mound Page 3 of 8 RECEIVED JUL 002026 Bayfield Co. Planning and Zoning Agency GSF WI MOUND DESIGN PROGRAM LATERAL AND DOSE TANK End Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below • Turn -up w/bell valve or ddeanout plug P ii Z i..F—X--J 1st onifice located at Z Laterals & force main of PVC Sch 40 Onifces poim up except every (per SPS Table 384.30-5 WAC) —Edge of distribWon cell $th one points down for drainage. Numbers of Laterals 1.00 Orifice Diameter Lateral Diameter I1.50 in Orifice Spacing (X) Lateral Length (P) 59.26 ft Orifices per Lateral Lateral End (Z) 0.74 ft Orifice Density Lateral Spacing (5) 0.00 ft Manifold Length Lateral Flow Rate I15.62 gpm Manifold Diameter System Flow Rate 15.62 gpm Forcemain Velocity 58.52 Pump Off Height Dose Tank Information .Tani oantae1 is pmpeM wmea Wieser Capacity 600 Volume 16.76 Manufacturer Gallons gal/inch Dimension Inches Gallons A 19.92 333.93 B 2.00 33.52 C 1.88 31.43 D 12.00 201.12 Total 35.80 600.00 Mn. T eeWng antler talk Alarm Manufacturer SIE 1037095 Alarm Model Number SIE 1037095 Pump Manufacturer ZOELLER Pump Model Number L. N98 Pump Must Delivery 15.62 gpm at 17.32 ft Project: Hipsher Mound woe Fpcenam uamms Z4.5 in t elevatim (It) 95.5 ab Page 4 of 8 REC€IVED JUL 062026 Bay$eld Co. Planning and Zoning Agency GSF WI MOUND DESIGN PROGRAM DISTRIBUTION MEDIA GSF Distribution Cell Media Layout Cell Width (ft) I 2.5 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements Drag appropriate drawing to space below. ASTM C33 Sand/Mound Sand r�;l Iel A42 or 843 Module II Lateral Turn -up (contained in Turn -up Enclosure) Distribution Cell Plan View Layout -Typical S Cell Width - A (ft) 61.00 Cel I Length - B (ft) 15 B43 Modules Required per Row 15 B43 Total Modules Required End Connection Later Layout Diagram Drag appropriate drawing from left to space below. Project: Hipsher Mound Page 5 of 8 RECEIVED JUL 0 6 2026 Bayfield Co. Planning and Zoning Agency 4' CAST I ^ U m iv a_ 14 0 c TJ o C) c3D Iii C Na CD rn Na O) 0 o'J 4" CAST -A -SEAL VENT OUTLET O Q WLP1000/600-MR TANK SPECIFICATIONS S DIMENSIONS: ui i WALL' 3" ¢ BOTTOM: 3' COVER: 5" MANHOLE 24I.D. PRECAST CONCRETE RISER i HEIGHT• 51' 01 LENGTH: 12'-6' I WIDTH: 7'-O' BELOW INLET: 42' LIQUID LEVEL: 36' b WEIGHT: BOTTOM 9,500 LBS. COVER 5,470 LBS. I 8 INLET AND OUTLET:i 4' CAST -A -SEAL BOOT OR EQUAL GASKET o INLET AND OUTLET BAFFLE AND FILTER: o WISCONSIN. SEE DETAIL /10 (OTHER STATES SEE CHART) H I LIQUID CAPACITY: 27.88 GALAN (SEPTIC) Ifl = 16.76 GAL/IN (PUMP) LOADING DESIGN: B'-0' UNSATURATED SOIL C C b TANK CAN BE USED AS: < sEPnc/sEPnc, SEPTIC/PUMP, ■i OR SEPTIC/SIPHON iV COVER: MIX DESIGN /B (No FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS 9 FOR CUSTOM TANKS CONTACT WIESER CONCRETE 1 Q o � Z 4 D BY p v DATE C2 a ICS SURMTTTFTI FOR APPROVAL APPROVED BY: SHEET N( APPROVAL DATE: 1 OF PRODUCTS NEEDED BY: Trusted. Tested. Tough® Product information conditions pros at time OfAiLER here info motion pr et time d of publication. Consult factory regarding discrepancies or COMPANY inca is TECHNICAL DATA SHEET FLOW -MATE SERIES Model 98 Submersible Effluent/Dewatering Pump PRODUCT SPECIFICATIONS Horse Power 1/2 Voltage 115 or 230 cc Phase 1 Ph Hertz 60 Hz Q RPM 1725 2 Type Permanent split capacitor Insulation Class B Amps 4.7-9.4 Operation Automatic or nonautomatic Auto On/Off Points 9-112" (24 cm) / 3" (7.6 cm) Discharge Size 1-1/2" NPT Solids Handling 1/2" (13 mm) spherical solids d Cord Length 9 (3m) automatic, 15' (5 m) nonautomatic Cord Type UL listed a Max. Head 23' (7 m) Max. Flow Rate 72 GPM (273 LPMI Max. Operating Temp. 130' F 154' C) Coaling Oil filled Motor Protection Auto reset thermal overload Cap Cast iron Motor Housing Cast iron Pump Housing Cast iron L9J Q Base Engineered thermoplactic Upper Bearing Oil -fed cast iron Lower Bearing Oil -fed cast iron Mechanical Seats Carbon and ceramic Impeller Type Non -clogging vortex Impeller Engineered plastic Hardware Stainless steel Motor Shaft AISI 1215 cold rolled steel Gasket Neoprene NOTE: Sea model comparison chart for specific details. e as Q ZMfY se"bs*d 5Insa'tl —bcsa Saexdr„ r b. its 3'7la'ISO mml stir (159mm) 315H6 (ID0nrr) 12 1/16" (306 nun) 450' (t77 nun) SECTION: 2.15.050 FM2779 0823 Supersedes 0123 RECEIVED JUL 062026 Bayfield Co. I and Zoning Agency 42,132',,,a mm) flaw 5/Olaf 502-778-2731 1 800-928-7867 Co 3649 Cane Run pyright 2023 o ellert Co. All rights Road I Louisville, KV 40211-1961 1 zoellerpump,com TOTAL DYNAMIC HEAD FLOW PER MINUTE MODEL 98 Feet Meters Gal. Liters 5 1.5 72 273 10 3.0 61 231 15 4.6 45 170 20 7.1 25 95 Shut-off Head: 23 ft. 7.0m uS6 14 PUMP PERFORMANCE CURVE MODEL 98 2s 20 1s 10 s GALLONS 10 20 30 40 50 60 70 60 ulens 160 240 FLOW PER MINUTE 009sn Model MODEL COMPARISON M98 N98 Seal Single Single Mode Auto Non Volts 115 115 Ph 1 1 Amps 9.4 9.4 HP 1/2 112 Hz 60 60 Lbs 36 36 Kg 16 16 Simplex 1 2or3 Duplex 4 4 E98 8N98 Single Single Auto Non Auto 230 230 115 1 1 1 4.7 4.7 9.4 1/2 112 1/2 0 600 60 38 35 37 18 16 17 1 2or3 4 4 BE9H Single --------------- Auto 230 1 9.4 1/2 60 40 18 • _ vue a cu (cm) piggyback variable level pump switch. Additional cord lengths are available In 25' (8 m) and 35' (11 m). 50' (15 m) cords are available for 230 V units only. SELECTION GUIDE 1. Integral float -operated mechanical switch, no external control required. 2. For automatic, use single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 3. See FM1228 for correct model of simplex control panel. 4. See FM0712 for correct model of duplex control panel or FM1663 for a residential alternator system. OPTIONAL PUMP STAND P/N 10-2421 • Reduces potential clogging by debris • Replaces rocks or bricks under the pump • Made of durable, noncorrosive ABS • Raises pump 2' (5 cm) off bottom of basin • Provides the ability to raise Intake by adding sections of 1'h" or 2" (DN40 or DN50) PVC piping • Attaches securely to pump • Accommodates sump, dewatering and effluent applications NOTE: Make sure float is free from obstruction. JUL b62026 2026 Bayfield Co. Planning and Zoning Agency 0 CAIJTI�1fl All InatellatIon of control.. protection devices end wiling should be done by a Qualified licensed electrician. All electrical and safety codes should be followed including the moat recent National Electrical Code (NEC) and the Occupational Safety end Health Act (OSHA). Copyright 502.778-2731 l 800-928-7867 I 3649 Cane RunoRoad I Louisville, reserved. KY 40211-1961 l zoellerpump.com 33.02 t83.9 cm 20.71 i52.6 an? -.A �) 6.5"(16.51cm) SEALED BALL MATERIAL - HOPE 4" (10.16 an) BALL TRAVEL — 5.1 14.7an7 IA HOUSING — FILTER CARTRIDGE MATERIAL- POLYPROPYLENE I MATERIAL - FILLED POLYPROPYLENE BALL PUSH ROD w°'2 FACTORY INSTALLED "aECTION A -P, MATERIAL - FILLED POLYPROPYLENE i (AND 6° FACTORY OPTIONAL BUSHING INTALLED PIPE OUTLET (FOR 4" THIN WALL PIPE) MATERIAL - PVC PART Mn V 30142-R POLYLOK FL- 525 - 625 CUTAWAY OR OPTIONAL FLOAT SWITCH (FOR 110 MM. PIPE) PART NO. 30142-EUR N CD Si C. . _ `) N OJ fin' „u 2 1(/2/2e�9 11 46 12d320420b4 LAIL Yp($ bl Report Dale., 2•JuI-0i EML Project ID....._...... 090622-PWO Your ID .................... Polytok 525 Etfiuent filter POLYLOK TEST FACIl IY 3 Fairfield Blvd Weliingtord, CT 06492 Attn: Mr. Petkr Gavin Date Sampled......_.......22•Jun.09 Date Submitted.............2JJ,Jllar-0B Values to mp/L unless athawlse need. NO " ,Nal Cetected. AIR = Abt Requited Amended Report Biochemical Oxygen Demand 044,5 38$,2 Total Suspended Solids 840. Technical Reviewer Transcript ReviewsbJ.AA £&ir. sP4 q/1 TKIe: TaaaLK aI� a9 N. PLAINS fl5fRiAL FARM WA&LINI1FQRD. CCNNEC?ICUT OC1@ JUL 062026 "°e)"`°°°` Bayfield Co. Planning and Zoning Agency The PS Patrolsystem features a built-in high water alarm and provides a convenient location to connect all wiring required for a pumping station Installation. The PS Patrol" system employs a receptacle to accept a 120 VAC pump and piggy -back style pump switch. The sleek, angled design of the clear enclosure includes a removable cover far easy access for field wiring. All internal components are sealed within the cover for protection from the elements. The red LED illuminates the cover in an alarm condition for easy 360° visual Identification, Available with or without 32" mounting post. FTLik• &n7 Controller meets Type 3R watertight standards and is designed for outdoor use • Built-in high water alarm • Removable cover provides greater access for field wiring and service • Controller can be purchased with standard 5" square plastic post or can be mounted an 4' schedule 40/80 PVC pipe or conduit (customer supplied) • Automatic alarm reset, horn silence and alarm test • 360' visual alarm; audible alarm Red LED illuminates cover In alarm condition, • Green Power On light • Auxiliary alarm contacts included for easy attachment of remote alarm Receptacle for easy connection of pump and piggy -back pump switch • Cord seal included for sealing switches and pump cable Shown with mounting post Electrical potting cavity provides easy reliable method to seal power U.S. Patent Nos. D 780,703 cables (user to provide duct seal) and 9,472,932 OPTIONS Mercury or mechanical pump switches Various cord lengths Riser assembly adapter Dual alarm (2nd alarm input - yellow LED illuminates cover In alarm condition) • Elapsed Time Meter (ETM) Pump Circuit breaker • Available with or without 32" post JUL 062026 Si E Planning Bayfield Co. R I-- I O M B US,, 9 and Zoning Agency PS PATROLS - Provides convenient wiring connection and system monitodno for Damn station nnMk 11nn.. PSP2 120V aA FJapaed Time Meter lox j Ne Mmmmnno.,. 160 Pump Breaker- Bpec!,O oil after Number 15 Followed by LatW-Fo 159 O tS Ampp Break& (07 FLA).1 •20 Arne Breaker(7.15 FLA) Example: 151P:28 Amp Breaker, 7.15 FLA For addllonal control panel options, please contact Technical Support at techaupportSajelnc.corn. ALARM VOLTAGE 120 VAC PUMP VOLTAGE 120 VAC ENCLOSURE SQE. Controller with pop 5 x 5 x 39 Inches (12.7 x 12.7x 99.06 cm) Controller without pop 5 x 5g9 8 inches (12.7 x 12.7 x 20.32 cm) PSPalrallu eptla Starting Device Level Control Application Total Options TOTAL LIST PRICE RECEPTACLE 120 VAC -NEMA type 5.15 AUXILIARY CONTACTS; 120 VAC, 0.5 amps max., 50/60 H, (circuit not supervised) ALARM HORN: 82 decibels at 10 feet ALARM FLOAT: SJE SIgnalMaster< control switch with mountinoclemp Callfemie Prop 65 repuirac aw IWbwlnp: �jWAitaN6 Cancer and Rwraducaw Harm - vnvw.P6611faMigin.pPr 8.74 W0fX 5jsrnunwus.com • email: wstomersaNl ce@s)ektc.com SEE PRICE BOOK FOR PRICING. RECEIVED JUL 062026 ©ayfield Co. Planning and Zoning Agency 4 SJE RHOMBUS GSF WI MOUND DESIGN PROGRAM SYSTEM MAINTENANCE SPECIFICATIONS Mound System Maintenance and Operation Specifications Service Provider's Name A to Z Plumbing & Heating, Inc. Phone 715 682-8520 POWTS Regulator's Name Indian Health Service Phone System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 un Estimated Flow - Average 300 gpd Maximum SODSL 30 mg/L Septic Tank Capacity 1000 gal Maximum TSS 30 mg/L Soil Absorption Component Size 305 ft' Maximum FOG 10 mg/L Maximum Fecal Coliform 10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other. 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 secured in a as shown in the Eljen mound component manual. 2. Dispersal cell media conforms to EIJen products approved for use with the Eljen Mound Component Manual approved August 2016. Eljen media is covered with the manufacturers 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 orchlsel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail 6- 8" DIAMETER LAWN SPRINKLER FlNISHED GRADE---- _ _ _ LATERAL ENDS AT LAST 4"'PERFORATED PIPE THREADED ORIFICE WHERE VARIABLE CLEANOUT PLUG LENGTH CLEANOUT BEGINS IV END CAP LONG SWEEP g0 OR SAME DIAMETER AS LATERAL y� r� DISTRIBUTION LATERAL RECEIVE �' LATERAL CLI:ANOIR JUL 06 2026 Project: HipsherMound Page 6 of 8 BaytieId Co. Planning and Zoning Agency a- DestStL.. The Double DoubleMaxTM includes two mechar,: =lay will activate and pump down co me tower Moat (reverse order for pump up 2"- 60" Pumpinci f anoe Flexible SJOOW (UL. CSA). water resistant. rubber (CPE) cable 15 Full Load Amps High impact PVC Housing Operating Temperature 0-140 F Float housing 3.25" D x 4.55" L h s'h ion 1. Determine the pumping range (Fig. 1 and Fig. 2). 2. Tighten the Relay Box on the discharge pipe at desired location, see Figure 1 for levels. 3. Tether the bottom float at 3", tighten the clamp on the discharge pipe. 4. Secure excess cable from float operation. 5. Pi. g the lc l; gy back into the receptacle, then plug the pump into the back of the piggy back. For bare lead models, see Figures 3. 4 and 5 for wiring diagrams. 6. Cycle system to ensure proper operation. Pump Down la1odel - Punip Activates on Upper Float Pump Up -Model -'-Pump Activates -on -Lower -Float - — --- (Fig. 2) Pump Up STOP) PUMP RNGE 2' to 60" (START) Down 2" to 60" (STOP) Note: To achieve minimum. pump range the hotte„n float must be mounted as nigh as possibia sad ciampet c. back side of pipe (Fig. 2) rather than 'front side' as shown (Fg. 1). Wiring (Fig. 3 - Hard Wire Installation ''0h Bare Lends or Pigoy Sane Plug Removed G N L1�=�JaJIRE USING POWER SCW0E WHICH WHITE Gar— f —RFD PUMP r 7 1TI+ _ �4 Note: To achieve minimum pump range tpe bottoryt t be mounted as high as possible and damp'of pipe as shown above (Fig. 2). JUL 0 6 2026 (Ft. 4', - Bare Leads by Remov'rg Piggy Beck Plug (Do'lhleMaxm must be 230VAC model) G t2L1 WIREUSIN(i ,J�u,� JUNCnON BOX e ACK �— WHITEIREn-- REo GG T2'' Bayfield Co. (Fig. 5) -f'latai9gMS}d�NilFOEW9TVads (�V� I�1 l�JI�LL4 "r9lderca :s„ustries • PO Box 821 Naillev, MN 511:4., P: 218-483-30311 • F:218-1883030 • alderonfd.coro Page 1 of 2 Wide-angle pump switches directly control pumps up to 3 HP at 250 VAC. Each switch features an adjustable pumping range. (,'' 'umpF736 g,, ,ran, .. _gent Range iviecnanicahy 1/2 Hr, iZUV io,v, i<uv ouA, i20V 7SJEumpMaster° WPS activated 1 HP, 230V 13A, 230V 85A, 230V SJE Pumpidast" ta Machardcally Activated 1/2 HR 120V 1 HR 230V 13A, 1207 1SA 230V LEA, 120V 85 . 230V 85A, 120V 7- 36 in (18-91 cm) 7-36 in Mechanically 3/4 HP, 120V 15A, 120V ° SJE PumpMasterPlus Ac*,.vacec 2 HP 230V :3 �.. 222V 85A, 230V 85A, 120V (18. 91 cm) 7- 36 in SJE PumpMaster'SPOT 4 Mechanically 1/2 HP, 120V 13A, 120V (single Pale, Double Throw) Activated 1 HP, 230V 13A, 230V 85A, 230V (18 -91 cm) icaiy 15 FLA 9CLRA 120'v Double F cc ' .•:ester $ MUST c - se < 7" uriiess using VerticauMaster oeioy Mechanically 11/2 HP, 125V 20A, 125V SJE Amp?Aastaractivated 3 HP, 251W 20A, 250V PCA,120V 3-48 in eCA,240V (7.6-122 cm) 120A, 125V 9- 24 in 120A, 250V (23 - 61 cm) SJE Vert !Master' M - ha^'cally 1/? HP 120V 'sA, 12CV DOA, 120V .75 - 6.5 in Activated 1 HP, 230V 12A, 230V 60A, 230V (2-17 cm) Use pep 'w.., i2. DC 1;;A, 12VDC SJE Micia:daster'AC/DC Mechanically run and iCA, 12VDC 60A, 125V 8-36 in Activated (20 - 91 cm) start current 8A. 250 VAC 6C4, 250V Use pump Mecnanically " 3A, 125V 78A, 125V 8-36 in SJE MicroMasterPlus WS ' run and Activated "2.0.. 250V 72A, 250V (20-91 cm) start current by: Sr SJE HITfmpMaster" Warn Ily - r,r cm) .. 78A, 125V 8 36 in 250V I (20-91 ir Calbmla Prop65 RgidRt iha folloriiuy: LLWARRIWG Cancer and Reproductive Harm - www.PG55ir:rrvr,gs.pa.cui ((�� Rei�i- PL-SJE (888-342-5753) 9 mer.service@sjeinc.com JUL 0 6 2026•sjerhombus.com SJE RHOMBUS Reserved. -er,Ze hayfield Co. 201e SJE, Inc. M Rights Feserve 0 Planning and Zoning Aeus is a trademark of SJE 11.1. Private Sewage System Maintenance Agreement uclk-s l -p&Lbr .212Yso stSL ,vl -- 'Tu. ar&wji 87 cgs CccsrkcjC Cot uJcQpt &t S4Y lax lus 72610 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) SC 1/4 of St 114 Section SeC``Towne Township �J N. Rang Additional Legal Description: So e A ttne_R ed 9 Town of 23t 11 (Acreage) Gov't Lot Lot_ Block Subdivision Lot _ CSM # Vol. _ Page _ CSM Doc # ❑ In -ground gravity ,Mound DOCUMENT NUMBER 2026R-612878 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 07/10/2026 AT 8:00 AM RECORDING FEE: $30.00 PAGES:2 Return To: Planning and Zo`nll�g`B ef�e(i JUL 13 2026 ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ At -grade Sewage System O 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 other person authorized to make such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. Pump Chamber (system types B, C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds. At -grade, and In -ground Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may 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. Owner(s) Name(s) — Please Print Subscribed and sworn to before me on this date: t(/ F1 -c,-- 1k 9 ac C IJ I iT/ rrrr�i' .�� �P:........... Notarized Owner(s)— Signature(s) N ryPu is ' p10T. , My Co ' sign xpires: y; Drafted by: ZV rs 9$C 1Jttasy Date: '1. 1 ?. 1'!11j11 1111%' Proofed by: u/forms/sanitary/septicmaintenceagreement Revised July 2020 *2022R-593084 1* State Bar of Wisconsin Form 3-2003 QUIT CLAIM DEED Document Number II Document Nome THIS DEED, made between Dennis Hipsher ("Grantor," whether one or more), and Douglas Hipsher ("Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, inBayfield County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): The South three hundred feet (S 300') of a parcel of land in Section 3-50-6 West, described as follows: Commencing at the NE comer of the SE'A SE'., of Section 3; thence running west along the north line of said forty a distance of approximately 337 feet to the point where said line is intersected by the center line of the highway right of way of County Trunk Highway "C", which point is the point of beginning; thence continuing West of the North line of said forty; 332.25 feet; thence south of a line parallel with the center line of County Trunk Highway "C", a distance of 906.75 feet; thence East on a line parallel with the North line of said forty a distance of 333.25 feet to the center line of County Trunk Highway "C"; thence North along the center line of said highway to the point of beginning. Dated / O - ,,2` 2 AUTHENTICATION Signature(s) authenticated on TITLE: MEMBER STATE BAR OF THIS INSTRUMENT DRAFTED BY: 2022R-593084 DANIEL J. HEFFNER BAYFIELD COUNTY, WI REGISTER OF DEEDS 01/20/2022 01:20PM TF EXEMPT #: RECORDING FEE: 30.00 TRANSFER FEE: 53.70 PAGES: 1 Recording Area Name and Return Address I) _ , T/.��� ZZy22Q,?)S;Sk r, i'a/ICI RO4a C Cfl 22ROI 5yaa� Oq-016-2--1-().oh-03-4 04-oCo4b Parcel Identification Number (PIN) d This 1S h.crJ` homestead property. (h)( CEtVED JUL 132026 BaYfield Co. PNrnning and Zoning Agency ACKNOWLEDGMENT STATE OF WISCONSIN 41 _________COUNTY) Personally came before me on / a2 2....... theabove-named,71UO/4 S ,4c ' o me known to be the person(s) who executed the foregoing t)shumg g and acknowledged the same)' , F t. -,w J'Notary Public, State of Wisconsin %..... 3'vly Commission (is permanent) (expires: O ) pip I'1'lSCON O`� '. (Slgnaturn m44teuyffiwals or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 34003 Type name below signatures. Bayfield County Register of Deeds Document # 2022R-593084 Page 1 of 1 I3- FIELD Bayfield County Planning & Zoning Department 117E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: HIPSHER,DOUGLAS 22450 SISKIWIT LAKE ROAD CORNUCOPIA, WI 54827 Description State Approved Plans (Mounds, Systems Requiring Pre -Treatment, etc.) Submission Number: SS -00761 Transaction Number: SS-00761-49D8F Amount $500.00 Total: $500.00 Payment Amount: $500.00 Reference: 30026 Paid by: A to Z Plumbing & Heating, Inc., PO Box 615, Ashland WI 54806 Payment Type: Check Transaction Date: 7/14/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-86S STATE SANITARY PERMIT OWNER: DOUGLAS HIPSHER G OV'T LOT: LOT: BLK: SE 1/4 SE 1/4 SEC: 3, T 50 N, R 6 W TOWNSHIP: Bell SOIL TEST: 15-22 REPLACEMENT SYSTEM SYSTEM TYPE: Mound 224 in. of suitable soil PLUMBER: ZYGMUND JABLONSKI EMILY MACGILLIVRAY DATE: 7/14/2026 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 #: 22-24S LICENSE: # 6302 Condition: Old System needs to be properly abandoned per SPS 383. THIS PERMIT EXPIRES 7/14/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION