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HomeMy WebLinkAbout26-91SDepartment of Safety S S o ©--1 q / & Professional Services, D Industry Services Division Sanitary Permit Application In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this farm to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary nurnoses in accordance with the Privacy Law, s. 15.04(1)(m), Slats. Richard & Paula Thompson RECEIVED Property Owners Mailing Address N9658 Say Hi Rd JUL 13 2026 City, State Zip Code P�r Springbrook, WI 54875 Plan ing and Zoning Agency Lot// ®1 or 2 Family Dwelling— Number of Bedrooms 3 Block # l O Public/Commercial — DescribeUse ❑ State Owned — Describe Use CSM Number y Bayfield ry Permit Number (to be aG-g,s Kaufman Rd 04-004-2-45-09-23-2 02-000-40000 Property Location PAR IN NW NW IN DOC 2028R-811195 Govt. Lot NW Y. NW %, Section 23 T Ar ., s 09 ❑ Cityof _ ❑ Village of U Town of Barnes A- New System ❑ Replacement System O Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B' ❑ Holding Tank ® la -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision O Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration 'at'' - - - - 642.9 646.6 98' (available range 96.8-98.9) 450 0.7 Capacity in Total # of Manufacturer Tank Information - Gallons Gallons Units New Tanks Existing Tanks a [g rn rn C7 a 1000 1 - I1000II :r's Name (Print) Cory J. Jackson 124884 State Rd 35 Siren, WI 54872 Approved I O Disapproved /� ❑ Owner Given Reason for Denial nditions of Approval/Reasons for Disapproval G �l. cal ,n emmnlete nlanz for the ivete x and submit to the County only en paper not 824339 I 715-566-2786 Inc SBD-6398 (IL 03/22) Sk-oaf67 SOIL TEST# $�-aL >drµ,vr'r o Wisconsin Department of Safety & Professional Services j'� tr i Division of IndustryServices SOIL EVALUATION REPORT In accordance with SPS 385. Wis. Adm. Code County Bayfield Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must include. but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. A 7 # scale or dimensions, north arrow, and location and distance to nearest road. 04-004-2-45-09-2 Please print all information. R e etl � L:(/V v ,,// -rsanal information you provide may be used for secondary oumoses (Privacy Law. s. 15.04(1)(m)). /9 1 „f 3 Property Owner Property Location u u Richard & Paula Thompson Govt. Lot NW ' NW 'h S 23 T 45 N R 09 E (or) wp Property Owner's Mailing Address Site Address or CSM and Lot #: #### Kaufman Rd N9658 Say Hi Rd S`/YYO 4 Man, 42 City, State, Zip Phone Number ❑ City ❑ Village is Town Nearest Road Sprinqbrook, WI 54875 ( I Barnes Kaufman Rd ® New Construction Use: ® Residential/Numberofbedrooms 3 j o ved designfow rate 450 GPD ❑Replacement ❑ Public or commercial —Describe. n elevation if applicable N/A ft. Parent material Outwash Sands (Rubicon Series) General comments and recommendations: JUL 1 O ZO26 VMREU Boring # ❑ Boring 101 n twinning and Zoning A9uN' 96 Pit Ground surface elev. 8ff. Depth to limiting factor_in. I away. 93.8 it. 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 10YR 2/1 — s 0sg ml as lvf 0.7 1.6 2 3-21 10YR 3/4 — S Osg ml gw tco/lml2 0.7 1.6 3 21-28 10YR 4/4 — s Osg ml gw 1f/1vf 0.7 1.6 4 28-38 10YR 4/4 - io . FGRK° Osg ml cw l of 0.7 1.6 5 38-53 10YR 4/4 — Is Osg ml cw 1vf 0.7 1.6 6 53-96 10YR 5/4 — Is Osg ml — — 0.7 1.6 Horizon 5 has bans of lam llae 2❑ Boring # ❑Boring ®Pit Ground surface elev. '__ft. Depth to limiting factor 96 in. I elev. 91_9 fl. Sail Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 E##1 •Eff#2 1 0-2 10YR 2/1 — s 0sg ml as corlalvf 0.7 1.6 2 2-5 10YR3/3 — s 0sg ml CS 1m/1f 0.7 1.6 3 5-17 10YR4/4 — s Osg ml gw 1f 0.7 1.6 4 17-33 7.5YR 4/4 — S 0sg ml 9W if 0.7 1.6 5 33-55 1 0YR 5/4 — S Osg ml cw 1f 0.7 1.6 6 55-63 10YR 5/4 — (5 FOR) cos Osg ml cw — 0.7 1.6 7 63-96 10YR 5/4 — s 0sg ml — — 0.7 1.6 CST Name (Please Print) Signatur CST Number 654921 Keith Wiley Address Date E aluation Conducted Telephone Number 11623 E Larson Dr. Lake Nebagamon. WI 54849 6/13/2026 218-451-2611 Effluent #1 = BOD > 30 s 220 mglL and TSS > 30 5150 mg/L - Effluent #2 = BOD. 5 30 mg/L and TSS 5 30 mg/L SBD-8330 (R03122) 3❑ Boring # Page 2 of 3 ❑ Boring ® Pit Ground surface elev.100.3 ft. Depth to limiting factor 96 in. I elev. 92.3 ft. Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Cu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPO/Ft' Eft#1 Eff#2 1 0-4 10YR 2/1 — s Osg ml as 1M201vf 0.7 1.6 2 4-20 10YR4/4 — s Osg ml cw 1f/1W 0.7 1.6 3 20-30 7.5YR 4/4 — s Osg ml gw if 0.7 1.6 4 30-50 10YR 5/4 — s Osg ml cw if 0.7 1.6 5 50-96 10YR 5/4 — S Osg ml — 0.7 1.6 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev.ft. Depth to limiting factor in. I elev._It. I Soil Soil Aooli Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPO/Ft' Eff#1 'Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev.ft. Depth to limiting factor in. I elev._ft. SoilAooli Horizon Depth In. Dominant Color Munsell Redox Description Cu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Fl2 Eff#1 'Eff#2 Effluent #1 = BOD > 30' 220 mg/L and TSS > 30 s 150 mg/I. ' Effluent #2 = BOD, s 30 mglL and TSS s 30 mg/L RECEIVED JUL 10 2026 Bayfield Co. Planning and Zcning Agency Thompson (3 bedroom) Soil Report Plot Plan North \ t------------ Centerline of CFR 167A a C IC Iir It It \ Scale 1:60 1C Proposed site of 3 bedroom hous pole bldg Qa / mJ 3 NOTES: * Bench Mark = Duplex nail in 8" DBH Jack Pine Elev = 100.0' ProPert y fine Richard & Paula Thompson #### Kaufman Rd PAR IN NW NW IN DOC 2026R-611195 S23 T45N R09W Town of Barnes Tax ID 2742 15.4 acres RECEIVED JUL 13 2026 Bayfield Co. Planning and Zoning Agency - No well - Property lines not shown > 50' from tested area Page 3 of 3 Richard & NW NW in F7 Keith II 218-451-2611 )mpson Property Owners Name Rd Property Address -000-40000 Tax Parcel Number County RECE VED ≥026R-61195 Legal Description Section JUL 1 3 2026 Town Bayfield Co. Range Planning and Zoning Agency Page Index 1 Property Information 2 Data Entry 3 Plot Plan 4 Drainfield Cross -Section 5 Tank Information 6 Maintenance Plan 7 Contingency Plan Designer's Name Designer's Signature Designer's License Number Designer's Phone Number Date Page 1 of 7 RECEIVED JUL 13 2026 Bayfield Co. Planning and Zoning Agency In -Ground of Absorption for POWTS Version 2.1 (May 2022-2027) Component Manual Used 3 Number of Bedrooms 3 Percent Slope (%) 96 Depth to Soil Limiting Factor (in.) 0.7 In Situ soil application rate 300 Estimated Wastewater Flow (gpd) 450 Design Wastewater Flow (gpd) 1 Number of System Elevations 98 Proposed System Elevation #1 98 Proposed System Elevation #2 Proposed System Elevation #3 101.8 Original Grade #1 101.8 Finished Grade #1 99.9 Original Grade #2 99.9 Finished Grade #2 Original Grade #3 Finished Grade #3 Wieser 1000 Septic Tank Polylok PL -525 Effluent Filter Infiltrator Quick4 Plus Standard I Chamber Type 12 Height of Chamber (in.) 20 sq.ft. per chamber(ESIA) 3.3 sq.ft. per end cap (EISA) 4 laying length of chamber(ft.) 1.5 length of endcap(ft.) 34 Chamber width(in.) 2 Rows of Chambers 3 Distance Between Cells (ft.) 16 Number of chambers in first row 16 Number of chambers in second row Number of chambers in third row 32 Proposed Number of Chambers Used 642.9 Minimum Distribution Cell Area Required (sq.ft.) 646.6 Distribution Cell Area Proposed (sq.ft.) Page 2 of 7 Thompson (3 bedroom) Septic Plot Plan North �-------------------- �o J -- Wieser W1000 -MR w/ polylok 525 filter — Centerline of CFR 167A -- ------------► Property line Richard & Paula Thompson #### Kaufman Rd PAR IN NW NW IN DOC 2026R-611195 523 T45 N R09 W Town of Barnes Tax ID 2742 15.4 acres 100 1 RECEIVED \ P roposed site of 3 bedroom house JUL 13 2026 S 4.4% Scale 1:60 pole bldg n Bench Mark = Duplex nail in 8" DBH Jack Pine Elev = 100.0' Bayfield Co. Planning and Zoning Agency I Two rows of 16 Infiltrator Quick4 Plus Standard chambers I NOTES: - No well - Property lines not shown > 50' from system area - All vent, observation & conveyance pipes 4" ASTM D1785 or code equivalent Page 3 of 7 Cross Section of a Two Cell In Ground Compon t Using Leaching Chambers RECtN Observation/Vent Pipes 7 101.80 Finished Grade Slope 3% of Chamber f7<'Y em Elevation %e. ,; r .. :r.'' .'1•reatrenf :pnd Dtsperstlf'.Zoge. f e II JUL 13 2026 Banff Z and oning Agency ptynnln9 Finished -Glad 99.901 3gtginal Grade 99.90 4op of chamber 99.00 System Elevation I 98.00 Limiting Factor Observation/Vent pipes to be constucted and capped with approved materials for the particular use. 67 feet 67 feet Observation / Vent Pipes to be located at the ends of the distribution cells. Page 4 of 7 4" CAST (n TANKS ARE 4" CAST -A -SEAL C cc d Lu `" o cr 0€ o Mi o � c a I WLP1000 TANK SPECIFICATIONS 0 a d I DIMENSIONS: WALL: 21/2" a BOTTOM: 3' COVER: 5' MANHOLE. 24' I.D. PRECAST CONCRETE RISER HEIGHT: 53 1/4' , LENGTH: 8'-8" WIDTH: 7-2" BELOW INLET: 42" LIQUID LEVEL: 36" WEIGHT: BOTTOM 6,790 LBS. COVER 3,195 INLET AND OUTLET: m 0 G 4CAST-A-SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN SEE DETAIL #10 (OTHER STATES SEE CHART) IW LIQUID CAPACITY: 27.83 GAL/IN HOLDING TANK: Lfl C g OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,085 GALLONS c LOADING DESIGN: 8'-O" UNSATURATED SOIL a 1� TANK CAN BE USED AS: W o SEPTIC / HOLDING / PUMP OR SIPHON = ro W 0 COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) 9 CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE II Up 1 a N f n U J 7v 1 n I' I' O REVIEWED BY F PUMP PAD REVIEW DATE 1L DRAWINGS SUBMITTED SIDE VIEW FOR APPROVAL APPROVED BY: APPROVAL DATE: LSHEFT PRODUCES NEEDED BY: URED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page m? FILE INFORMATION owner Richard & Paula Thompson Permit # nPSIr:N PARAMETERS Number of Bedrooms 3 ❑ NA Number of Public Facility Units ® NA Estimated (average) flow 300 galiday Design (peak) flow = (Estimated x 1.5) 450 gavday In Situ Soil Application Rate 0.7 aWda /it2 Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) ≤30 mg/L Biochemical Oxygen Demand (BODs) <220 mg/L O NA Total Suspended Solids (TSS) ≤150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) ≤30 mg/L Total Suspended Solids (TSS) 530 mg/L 3 NA Fecal Cofrform (geometric mean) ≤10° cfu1100mI Maximum Effluent Particle Size k in dia. ❑ NA Other: ® NA `Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ® me°y"rt h(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) ® When combined sludge and scum equals one-third (r%) of tank volume O NA O When the high water alarm is activated Inspect dispersal cell At least once every: 3 ❑ month( ) (Maximum 3 years) ® yearar(s)s) ❑ NA Clean effluent filter At least once every: 3 ❑ month(s) ® year(s ❑ NA Inspect pump, pump controls & alarm At least once every: ❑❑ year(s()s) ® NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) ® NA Other: At least once every: O month(s) ❑ year(s) ® NA Other: ® NA SVSTFM SPECIFICATIONS Tank Manufacturer Wieser ❑ NA ® Septic ❑ Dose ❑ Holding vol. 1000 gal Tank Manufacturer ® NA ❑ Septic O Dose O Holding vol. gal Effluent Filter Manufacturer Polylok ❑ NA Effluent Filter Model 525 Pump Manufacturer ® NA Pump Model Pretreatment Unit ® NA ❑ Sand/Gravel Filter O Peat Filter ❑ Mechanical Aeration ❑ Weiland ❑ Disinfection ❑ Other: Manufacturer Dispersal Cell(s) ❑ NA ® In -Ground (gravity) O In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip-Une ❑ Other: Other: ® NA Other: ® NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may Indicate a failing condition and requires the Immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (116) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, Including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of ≤12 months, shall be performed by a certified POWTS �VMaintainer. A service report shall be provided to the local regulatory authority withi f GFW�er iQletion of any service event. 13MW (12/02) JUL 13 2026 Bayfield Co. planning and Zoning Agency Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other • chemicals that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the • contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. 0 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS RreriVEG JUL Bayfield Co. POWTS INSTALLER Name Phone POWTS MAINTAINER Name IJ O aWAJCM -EP PhonEq j S--ry-i 3 -(%6 i s a3 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name No vv4sij Namegayfield County Zoning Phone l j5. j43. (,5D Li a3 '9 Phone715-373-6138 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Piivate Sewage System MgatOfiance Agreement Richard Thompson N9658 Say Hi Rd Kaufman Rd r ux ru x* 2742 As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil testers report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established In the WI Adm. Code, as from time to time amended. (00111PLETE gbi, ;tegpic tl) NW. 1/4 of NW 1/4 Section 23 Township 45 N. Range 09- w. Additional Legal Description: PAR IN NW NW IN DOG 2026R-611195 Town of Barnes Lot Block Sub Lot_ CSM #_____ Vol. (Acreage) 15.4 GoVt Lot Page_ CSM Doc Ii DOCUMENT NUMBER 20268-61 2930 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED 07/14/2026 AT 2:30 PM RECORDING FEE: $30.00 PAGES: 2 Return To: Planning and Zoning Department DECEIVED ® In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution S q $yytem: planning and Zonm9 Agency ❑ Mound ❑ 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 (113) of the volume occupied by sludge and scum. Pump Chamber (system types B, C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and In accordance with manufacturers specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sewage System Disoersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWrS 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 roil 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: Richard Thompson f'1✓f ( dit 7-try-2az Notarized Owner(s) — Signature(s) NotaryPublic My Commission Expires: •/ Pi Keith Wile "r "' `— Drafted by: Y Date: 6/28/2026 Rc JUL 13 2026 Plpofed by:_ Bayfield Co. Planning and Zoning Agency u/formssanitary/sspticmainteceegreemenf RevvedJt2n2O Document Number State Bar of Wisconsin Form 2-2003 WARRANTY DEED Document Name THIS DEED, made between Julie A. Keene, Jill C. Marten, Jeffrey D. Marten, and Jennifer L Marten ("Grantor," whether one or more), and Richard Thompson and Paula Thompson, husband and wife, as survivorship marital property ("Grantee," whether one or more). Grantor for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in Bayfield County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): A parcel of land located in the Northwest Quarter of the Northwest Quartet and in the Southwest Quarter of the Northwest Quarter, of Sectiob 23, Township 45 North, Range 9 West, Town of Barnes, Bayfield County, Wisconsin, bounded and described as follows: Beginning at the Northwest corner of said Section 23; thence S87°Sf'41"E along the North line of the Section, 709,06 feet; thence SO°40'13"W, 851.02 feet to the centerline of a roadway; thence N81°22'W along said centerline, 399.94 feet; thence 552'44'W along said centerane, 257.00 feet; thence 51894W along said centerline, 549.93 feet to the West fine of the Section, thence N2'48'35"E along said west line, 1497.13 feet to the NW corner of Section 23 and the point of beginning. DOCUMENT NUMBER 2026R-6 11195 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED O2/26/2O26 AT 8:23 AM RECORDING FEE: $30.00 TRANSFER FEE: $180.00 PAGES: 1 ELECTRONICALLY RECORDED Recording Area Name and Return Address iependable Title of Wisconsin 021 N. Superior Avenue, Suite 9 omah. WI 54660 04-004-2-45-09-23-2 02-000-40000 Parcel Identification Number (PIN) This Is not . homestead property. (l5) is not) RECEIVED Exceptions to warranties: Covenants, conditions, restrictions, easements and rights of record. JUL 152026 Dated 1e %' 'd Q'(1Q (SEAL) * J ie A. Keene _(SEAL) * Jill C. Marten —ifA'tJ.o AUTHENTICATION Signature(s) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Shudlick Law Office LLC Joshua D. Shudlick, Attorney Bayfield Co. Planning end Zoning Agency I (SEAL) *J64`6. larten i�1 0.� (SEAL) * nnifer L Marten ACKNOWLEDGMENT STATE OF WISCONSIN ss. _________________COUNTY) Personally came before me on o _ the above -named Julie A. Keene. Jill C. MaAen, to me known to be the i t:Y;'J-P( :'11`:34.417 Notary Public, State of My commission (is permanent) (expires: (Signatures may be authendcated or acknowledged. Both are not necessary.) NO'T'E: THIS IS A STANDARD FORM. ANY MODIFICA'T'ION TO THIS FORM SHOULD HE CLEARLY IDENTIFIED. WARRANTY DEED 02003 STATE BAR OF WISCONSIN FORM NO. 2-2003 ~Type name below signatures. NFOFRQ'"wwwiMopofoms.mm Bayfield County Register of Deeds Document #2026R-611195 Page 1 of 1 BAYFIELD COUNTY Richard & Paula Thompson CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) 671 Check Ust 0 Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) 21 Index Page / Tide Sheet (Signed by Plumber) (383.22(2)69(c)) 0 Original Plot Plan (383.22(2)2. 3. & 4.a) 21 Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) 21 Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) 21 Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) ❑ 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) 671 Fee (Make Check Payable to Bayfeld County Zoning) (383.21(2)(c)7) 0 2 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) 0 Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) 0 I Application Information must include: O 23 digit Parcel ID# — (do not use 12 digits anymore --obsolete) 0 Project Address or Road Name where driveway is/will come off of) 21 II Type of Building 9f III Type of Permit 0 IV Type of POWTS System 621 V Dispersal / Treatment Area Information 0 VI Tank Information 21 VII Responsibility Statement (Plumber's Information) F *Date Stamp* Plot Plan: (To Scale or To Dimension) 621 Signature and Plumber Information 21 Surface Elevation of Body of Water 21 Direction and Percent Land Slope to Tank and Filter Information and Location 21 Wetlands / Navigable Bodies of Water 21 Absorption Area (Proposed and Existing) 21 Bench Mark (Location, Elevation and Description) 0 Component Manual Version 21 (Owners Phone Number) RECEIVED JUL 13 2026 eayfield Co. Planning and Zoning Agency 21 Address Number and Road 2 North Arrow 21 Contour Unes iJ Structures and Driveways 21 Boring Locations 0 Property Lines 0 Well Locations 0 Legal Descriptions Cross -Section and Over -Head Profile of the System: • Surface and System Elevation RECEIVED S2f Position of Observation and Vent Pipes • Dimensions and Depths JUL 132026 O Make, Model & Number of Chamber Units in each Cell Bayfield co. planning and Zoning AgenCY Property Information 0 How many systems will there be on this parcel of land? 1 0 Has this property been split? no (Property Statement shows Property History) Fees: Cd 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 0 Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) u/forms/checklists/checklistforsanitaryapps (10/2009);(®7/2011);(O2/2012)(®5/2/2012 -dc) Proofed by: BAYFIELD COUNTY Richard & Paula Thompson CHECKLIST FOR CERTIFIED SOIL TESTS RECEIVED Submit the Following (Use Permanent Ink): JUL 13 2026 Ea' Check List Bayfield co. ❑ Index Page / Title Sheet (Optional) Planning and Zoning Agency lX Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) 9' Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) LL' Parcel 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) R% Property Location (Accurate Legal Description with Sec/Twp/Range) l2' Road Name (where driveway is/will be coming off of) El Floodplain Elevation, Flow Rate, Comments and Recommendations E Complete Soil Boring / Pit Information 1 Date Soil Evaluation was conducted EX CST Name, Signature, Number, Address and Phone Number F *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) El Bench Mark (Description, Elevation and Location) IContour Lines (Example = 98,0' /96.0' /94.0') GYProperty Location (Sec/Twp/Range/, Accurate Legal Description) EX Borings (Locations and Elevations) WPercent and Direction of Land Slope la' Well Location (Including Neighboring Wells, if applicable) EYLocation of Wetland Areas, Floodplain and Navigable Waters EY Buildings, Driveways, and Structures (Location and Descriptions) CQ'Location of Property Lines E Existing System Location l 'Address Number and Road Name L' Current Surface Elevation of Wetlands and Navigable Waters El CST, Owner and Property Information I 'North Arrow Fee: Er Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checldist/checldistforests P--�YFIELD Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: Submission Number: THOMPSON, RICHARD & PAULA SS -00796 N9658 SAY HI RD SPRINGBROOK, WI 54875 Transaction Number: SS-00796-4A14C Description Amount Private Sewage System (Septic Tanks) $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 6084 Paid by: Jackson Plumbing, 24884 State Rd, Siren WI Payment Type: Check Transaction Date: 7/ 17/ 2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-91 S STATE SANITARY PERMIT OWNER: RICHARD & PAULA THOMPSON GOVT LOT: LOT: BLK: NW 1/4 NW 1/4 SEC: 23, T 45 N, R 9 W TOWNSHIP: Barnes SOIL TEST: 82-26 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: CORY J JACKSON TRACY POOLER Authorized Issuing Officer DATE: 7/17/2026 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: # 824339 'ondition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 7/17/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION