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Home My WebLink About26-108SSBD-6398, Sanitary Permit Application 7/10/2026 6:33:40AM Introduction SS -o0 Wisconsin Department of Safety and Professional Services (1 In accordance with Wis. Admin. Code sec. SPS 383.21(2), submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Upon completion, you will be emailed a copy of the completed form for submittal. Include a complete plan on paper not less than 8 1/2 x 11 inches. Check with your local POWTS authority about additional requirements and fees. Note that applications for state-owned POWTS are submitted to the Department via esla.wi.gov. (Rev. 02/26/2026) General Information Applicant Name: Mike Wroblewski Email: mike@biglakeplumbing.com Owner Name: Christopher Bergren & Rebecca Levoir Email: Phone Number: Mailing Address Address Line 1: 1421 Carriage Road Address Line 2: City: Woodbury State: Minnesota Zip: 55125 Project and Site Parcel ID: 4313 RECEIVED AUG 0 3 2026 Baybeid co. Planning and Zoning Agency 15co- Iss ue I I3l2o2J ihll a d0 State Transaction Number: PWTS- Project Address Address Line 1: 36499 County Highway J Address Line 2: City: Bayfield State: Wisconsin Zip: 54814 CSM and Lot Number: Subdivision: Block and/or Lot: Legal Description: Government Lot X PLSS 1/4 of: SE 1/4 of: NW Section: S01 Township: TSON Range (E or W): R04W Municipality Type: City X Town Village Municpality Name: Bayfield County: Bayfield Building Type: X 1- or 2 -Family Dwelling Public/Commercial State -Owned Number of Bedrooms: 3 POWTS Permit (.,J ) 3 LLU Bayheld co. Planning and Zoning Agency Permit Type: X New System Replacement System Other Modification to Existing System Additional Pretreatment Unit POWTS Type: Holding Tank In -Ground (conventional) X At -Grade Mound Individual Site Design Other Is there a previously issued permit?: Yes X No Dispersal/Treatment Area and Tank Design Flow: 450 GPD Design Soil Application Rate: 0.7 GPD / SF Dispersal Area Required: 642.86 Dispersal Area Proposed: 642.86 Square Feet System Elevation System Elevation: 101.00 Feet Tank Information Type: X Septic Holding Dosing New or Existing: X New Existing RECEIVED AUG 032026 Bayfieki Co. Plannin g and Zoning Apeno). Material: X Prefab Concrete Site Constructed Steel Fiberglass Plastic Manufacturer: Wieser Concrete Septic Tank Capacity: 1000 Gallons Type: Septic Holding X Dosing New or Existing: X New Existing Material: X Prefab Concrete Site Constructed Steel Fiberglass Plastic Manufacturer: Wieser Concrete Dosing Tank Capacity: 600 Gallons Total Capacity of Septic Tanks: 1000 Gallons Total Capacity of Holding Tanks: 0 Gallons Total Capacity of Dosing Tanks: 600 Gallons Total Capacity of All Tanks: 1600 Gallons Total Number of Tanks: 2 Responsibility Statement Signature Plumber Name: Michael Wroblewski RECEIVED AUG 032026 Bayrteid co. Planning and Zoning Agency Plumber Email: mike@biglakeplumbing.com Phone Number: (715) 209-7521 Plumber Credential Type: X Master Plumber Master Plumber Restricted Service Credential Number: 1288503 - PM Address Address Line 1: 1491 County Highway C Address Line 2: City: Washburn State: Wisconsin Zip: 54891 RECEIVED HWO 03 Z026 Bayfield Co. Planning and Zoning Agency By inserting my typed signature below, I attest that the information provided is complete and accurate to the best of my knowledge and belief. I, as the licensed plumber, assume responsibility for installation of the POWTS shown on the submitted plans. Electronic Signature of Plumber: Michael Wroblewski Date: 7/10/2026 Wisconsin Department of Safety and Professional Services Division of Industry Services 4822 Madison Yards Way Madison, WI 53705 July 31, 2026 CUST ID NO.: 1288503 MICHAEL J WROBLEWSKI 1491 COUNTY HIGHWAY C WASHBURN, WI 54891 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/31/2028 MUNICIPALITY: TOWN OF BAYFIELD BAYFIELD COUNTY SITE: BERGREN/LEVOIR AT GRADE 36499 COUNTY HIGHWAY J BAYFIELD, WI 54814 PAR IN SE NW & SW NEW OF CO HWY J IN 2022R-595061 SOI, T50N, R04W RECEIVED AUG 032026 Bayfield Co. Planning and Zoning Agenq Phone: 608-266-2112 Web: ht•p://dsps.wi.gov Email: dspsldnvisconsin.eov Tony Evers, Governor Dan Hereth, Secretary Identification Numbers Plan Review No.: PWTS-072601648-C Application No.: DIS-072629648 Site ID No.: SIT -162315 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 Design Wastewater Flow Value: 450 At -Grade Component Manual - Version 3.0 (May 2022-2027) Bedrooms: 3 Limiting Factor(s): 37 inches Maintenance Required: Effluent Filter SITE REQUIREMENTS • A full size copy of the 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: • This system is to be constructed and located in accordance with the approved plans, and the "At -Grade Component Manual for Private Onsite Wastewater Systems — Version 3.0" • The pressure network is to be constructed in accordance with publications "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.1 and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81). • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Prior to the construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a'/. -inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • 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. Scats. • A state -approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30(1O(c) RECEIVED • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacturer's requirements. AUG 0 3 2026 • Verify property line(s) prior to installation. • Pump Floats to be set and verified per the approved plan. sand z Co. planning and Zoning Age • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the POWTS Dispersal Area must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from POWTS Dispersal Area. • Provide surface water diversion around the treatment tanks and at -grade dispersal component. OWNER RESPONSIBILITIES • 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 6 SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a 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 granting this 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 of 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 may be made to me at the contact information listed below, or at the address on this letterhead. Sincerely, Timothy Zoromski Division of Industry Services Phone: Email: timothy.zoromski@wisconsin.gov Fee Required: $250.00 Fee Received: $250.00 Balance Due: $0.00 Refund Expected: $0.00 F! CEIVED j;,; 032026 Bayfield Co. Planning and Zoning Agelwy RESIDENTIAL AT -GRADE DESIGN Pressurized - Sloping Site INDEX AND TITLE SHEET Project Christopher Bergren & Rebecca Levoir - At Grade Owner Christopher Bergren & Rebecca Levoir Address 1421 Carriage Road Woodbury, MN 55125 Phone: (651) 276-6652 Legal Description Par in SE NW & SW NEW of Co Hwy J in 2022R-595061 501, T50N, R04W Township Bayfield County Bayfield Subdivision Name Lot No. Parcel ID Number 431 Plan Transaction Number Index sheet Calculations At -grade drawings Laterals and dose tank Specifications Management & contingency plan Pump curve & specifications Site Plan Soil Test & Plot Plan Maintenance Agreement Designer Michael Wroblewski License Number Signature ( /,L !i! Phone Number Date 07/10/26 Page 1 Page 2 Page 3 Conditionally Page 4 APPROVED Page 5 DEPT. OF SAFETY AND PROFESSIONAL SERVICES Page 6 DIVISION OF INDUSTRY SERVICES Page 7 Page 8 l Y Page 9 Page 10 SEE CORRESPONDENCE 1288503 (715) 209-7521 Designed pursuant to: 3.0, May 2022 -end May 2027 At -grade Component Manual Ver. ), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) and Pressure Distribution Component Manual Ver. 24SBD-10706-P (N. 01/01) 2.1 May 2022-27 Version 7.0(03/12) Page 1 of 10 Wisconsin Department of Safety and Professional Services SOIL TEST I �{ # Page 1 of 3 Division of Industry Services Sn �� Std, �� SOIL EVALUATION REPORT �•J t0 I` b In accordance with SPS 385, Ws. Adm. Code County BAYFIELD Attach complete site plan on page ess 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. 4313 Please print all information. Reviewe '/ Date Property Owner Property Location , ❑ CHRISTOPHER L BERGREN & REBECCA L LEVOIR Govt. Lot SW % NE V. S 01 T 50 N R 04 E (or) W Property Owners Mailing Address Lot # I Block # Subd. Name or CSM# City State Zip Code Phone Number I ❑ City ❑ Village ® Town Nearest Road WOODBURY I MN 55125 I (651) 276.6652 I BAYFIELD I COUNTY HWY J ® New Construction Use: ® Residential/Numberof bedrooms 3 Code derived design flow rate 450 GPD RECEIVED ❑ Replacement ❑ Public or commercial — Describe: Parent material SANDY OUTWASH -- Flood Plan elevation if applica a NA ft. General comments and recommends ens: SITE SUITABLE FOR AN AT -GRADE SYSTEM _ --- APR 10 2026 ''yfieId Co. � — — Planning and Zoning Agency 1 I Boring # ❑ Boring LJ ® Pit Ground surface elev. 97.1 ft. Depth to limiting factor 37 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/Ftl •Eff#1 'Eff#2 1 0-8 7.5YR 3/2 NA Is Osg dl cs 2f 0.7 1.6 2 8-15 5YR4/6 NA s Osg dl gs 1f 0.7 1.6 3 15-37 5YR 7/6 NA s Osg ds cs 1vf 0.7 1.6 4 37-46 5YR 7/6 c2d 5YR 5/8 s Osg dsh NA 1vf 0.0 0.0 2❑ ❑ Boring Boring # ® Pit Ground surface elev. 100.4 ft. Depth to limiting factor 38 in. Soil Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' Eft#1 -Eff#2 1 0-3 7.5YR 3/2 NA s Osg dl cs 2f 0.7 1.6 2 3-6 7.5YR6/3 NA 5 Osg dl cw 1f 0.7 1.6 3 6-15 5YR4/6 NA s Osg dl cs lvf 0.7 1.6 4 15-38 5YR7/6 NA s Osg ds cs lvf 0.7 1.6 5 38-45 5YR 7/6 c2d 5YR 5/8 s Osg dsh NA tvf 0.0 0.0 . Fff"pnr Rl=Rnn >sn<99mmnn and TAC> nn<icmmnn-Fmuenl C9e Rhn > 3n<99mmnll nA TCQ. nc un m,.n CST Name (Please Print) Signatu CST Number EDWARD J WROBLEWSKI Z SP -72000013 Address Date Evaluation Conducted Telephone Number 84805 HATCHERY RD, BAYFIELD, WI 54814 11/14/2025 715-209-4055 eau-aasu tnuana7 3❑ ❑ Boring Boring # Z Pit Ground surface elev. 101.9 ft. Depth to limiting factor 37 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/F1' 'Eff#1 'Eff#2 1 0-3 7..5YR 3/2 NA Is Osg dl cs 2f 0.7 1.6 2 3-6 7.5YR613 NA s 0sg dl cw if 0.7 1.6 3 6-14 5YR4/6 NA s Osg dl cs 1vf 0.7 1.6 4 14-37 5YR 7/6 NA s Osg ds cs 14 0.7 1.6 5 37-46 5YR 716 A $ Osg dsh NA 1vf 0.0 0.0 Boring # ❑ Boring �J ❑ 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 GPO/F1' 'Eff#1 Eff#2 APR 1 0 0Z6 Bayfield C o. Pla g and on p Agency 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/Ft2 'Eff#1 Eff#2 Effluent #1 = BOD, > 30S 220 mg/L and TSS > 30 ≤ 150 mg/L ' Effluent #2 = BOD, > 30 ≤ 220 mg/L and TSS > 30 ≤ 150 mg/L EOWARC J.:JROBLEWSKI. CST #SP -72000013 SOIL TEST PLOT PLAN CHRISTOPHER L BERGREN AND REBECCA L LEVOIR 36499 COUNTY HWY J BAYFIELD, WI 54814 PAR IN SE NW SW NE W OF CO HWY J IN 2022R-595061 S01 T50N R04W TOWN OF BAYFIELD. WI SCALE 1" = 60' APPROX 750TO WEST LOT LINE APPROX 750 TO' NEST LOT LINE FUTURE 3 EEOROOM HOUSE 11% SLOPE 97.1' EXISTING MANMADE POND O EXISTING GARAGE RECEIVED APR 102026 Barfield Co. Planning and Zoning Agency APPROX 600' TO EAST LOT LINE AND COUNTY HWYJ FUTURE DRIVEWAY A EM 10' O. NAIL IN BASE - ISO 0 JO d0 LLOCIT SOUTH LOT LINE SHEET 3OF3 WLP1000/600-MR TANK SPECIFICATIONS o 12-6" DIMENSIONS: a 0 WALL 3" 4" CAST -A -SEAL 4" CAST -A -SEAL BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER o '5-----------------�� ----TI HEIGHT: 51" jui j I LENGTH: 12'-6" 11 v I r WIDTH: 7'-0" w a I, 0tid i — 7 i BELOW INLET: 42" o LIQUID LEVEL 36" I - II I I I I 1 WEIGHT: BOTTOM 9,500 LBS. IL o ow COVER 5,470 LBS. o I� j�Ij II INLET AND OUTLET: m o a ! I FILTER OR 11'11 I 1 4" CAST -A -SEAL BOOT OR EQUAL GASKET w BAFFLE III I: 11 111 — INLET AND OUTLET BAFFLE AND FILTER: 00 b. 'r--'--- —'^----'—'-- WISCONSIN, SEE DETAIL #10 Lu N (OTHER STATES SEE CHART) TOP VIEW LIQUID CAPACITY: 27.88 GAL/IN (SEPTIC) C 16.76 GAL/IN (PUMP) 'v' i CO LOADING DESIGN: 8'-0" UNSATURATED SOIL O z Ib TANK CAN BE USED AS: acv SEPTIC/SEPTIC, SEPTIC/PUMP, ND OR SEPTIC/SIPHON .1 m C 4" VENT COVER: 0 ¢ x t0 TANK: MIX IXDESIGNN 8 (NO FIBER) Lii #10 (STRUCTURAL FIBER) V+ fl ____ CUSTOMIZED TANKS: ---- FOR CUSTOM TANKS CONTACT WIESER CONCRETEINLET !'n: OUTLET--�-1��-- O¢aio I.I'�v 1' mD in i 3..L ------' -----� L�.7 _� p �i I s W rn REVIEWED BY 00 T PUMP PAD c REVIEW DATE w C DRAWINGS SUBMITTED SIDE VIEW FOR APPROVAL APPROVED BY: SHEET NO. APPROVAL DATE: 1 OF PRODUCTS NEEDED BY: / j TANKS ARE MANUFACTURED TO MEET OR EXCEED AS TM C-1227 REQUIREMENTS RECEIVED AUG 032026 PRESSURIZED AT -GRADE DESIGN sy ol,co At -grade Design Worksheet - Sloping Site Planning and Zoning Agency Flows and Site Data to . (r or c) El rj Residential or commercial? 300.0 I Estimated wastewater flow (gpd) 450.0J Design wastewater flow (gpd) 11.00 % Site slope 101.00 Contour elev. below lateral (ft) 37.00 Depth to limiting factor (in) 0.70 In -situ soil application rate (gpd/ft^2) Distribution Cell Information (1 or 2) 1 Influent wastewater quality 10.00j Linear loading rate gpd/ft 10.00 Effective absorption width (ft) io.00j Max. effective width permitted (ft) 65Qpj Aggregate length (ft) Pressure (core) Not a final calculation Designer must select one lateral diameter Entry enter or end lateral connection Vumber of laterals Orifice diameter (in) e.g. 0.25 Estimated orifice spacing (ft) Forcemain diameter (in) Forcemain flow velocity (ft/sec) Forcemain length (ft) Pump tank elevation (ft) System head (ft) x 1.3 Vertical lift (ft) Friction loss (ft) In -line Filter Loss (ft) Total dynamic head (ft) Lateral Diameter Selection L_Pice diameter Design options Design choice 1 in 1.25 in 1.5 in 2in X X 3in x y or n L Does forcemain drain back? y or n y Are laterals at highest point? NA 8.2 Forcemain drainback (gal) 51.0 5x Lateral void volume (gal) 59.2 Minimum dose volume (gal) 21.7 System demand (gpm) Gallons/Inch Calculator (optional) (Total Tank Capacity (gal) Total Working Liquid Depth (in) Gal/in (enter result in cell G46) Treatment Tank Information LIIioo Iseptic tank capacity (gal) Wieser ConcreteTli Manufacturer Effluent Filter Information Dose Tank Information Pol lok Filter manufacturer L0.0 Dose tank capacity (gal) 1525 Filter model number 16.8 Dose tank volume (gal/in) Wieser Concrete J Manufacturer Project: Christopher Bergren & Rebecca Levoir - At Grade Page 2 of 10 Transaction Number. RECEIVED AUG 032026 AT -GRADE PLAN VIEW D —"+ L__ 1/6 B Observation pipes (cal) o W Tc B L 1 _= Total aggregate cellAxB 0 = Plowed areaLxW Bayfield Co. Planning and Zoning Agency A B 1/6 B C D E L W AxB 4__� Cap Typical abs. pipe. Slotted in the lower 6", and anchored securely. 6" T AT -GRADE CROSS SECTION Synthetic fabriccover 102.83 ft Finished grade elevation Lateral invert elev. 101 .50 ft Observation pipe at aggregate toe E Surface contour 101.00 ft and system elevation A CA _ = 12 in. topsoil and subsoil over aggregate and tapered to toes. _ = 6 in. aggregate below pipe(s), and 2 in. above pipe. Project: Christopher Bergren & Rebecca Levoir-At Grade Transaction Number: 1oSlope � Plowed layer below Lx W Page 3 of 10 RECEIVED hid 032026 PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram - End Connection Bayfleld Co. Planning and Zoning Agenq It x—+ Laterals S force main of PVC Sch 40 Last hole drilled next to end oap per SPS Table 384.30-6 Holes drilled on the bottom of the lateral equally spaced • =Turn-upwtballvalveor cleanoutplug Lateral Specifications o.ioBj Orifice diameter (in) 150.00 Lateral connection point X I 1.961 Orifice spacing (ft) 14 Number laterals 331 Orifices/lateral P j 62.74 Lateral length (ft) 21.71 Lat. discharge rate (gpm) Lateral diameter (in) Forcemain diameter (in) 21 71 Sys. discharge rate (gpm) Forcemain Length (ft) 13.25 TDH (ft) Typical Pump Chamber Layout Approvedla manhole cower with warning label arid locking device Weather -prod junction box 4.. Find discomixct Tank component is properly vented Electrical as per NEC 300 and SPS 316.300 WAC o C B E C c D Totals Inches Gallons 20.2 339.2 2.0 33.6 3.5 59.2 10.0 168.0 35.7 600.0 Tank full A Alarm on Pump on 92.03 ft Pump off D Goulds Pump manufacturer EP05 Pump model number Alternate 1 outlet location 18" min. cutlet outlet joint Provide 1/4" weep hole or antisiphon device. .4 91.20 ft SJE Rhombus Alarm manufacturer HW101 Alarm model number Project: Christopher Bergren & Rebecca Levoir-At Grade Transaction Number. Page 4 of 10 Service Providers Name Big Lake Plumbing POWTS Regulator's Name Bayfield County Zoning System Flow and Load Parameters At grade System Maintenance and Operation Specifications 0 032026 Phone 715-209-752 Phone 7153736138IT19and Zoning Agency RECEIVED Design Flow - Peak 450 jgpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 300 gpd Maximum BOD5 220 mg/L SepticTankCaPacitYL 1000 4ga1 Maximum TSS 150 mg/L Soil Absorption Component Size L6429 ft2 Maximum FOG 30 mg/L Type of wastewaterl Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Service Frequency Inspect/or service once eve 3 eas clean at least once eve 3eve 3 earst month)ould be flushed and ressuretd 15 ears ponding and see a e once every 3 years —� Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1,have a watertightcap, and are secured in as shown in the at -grade component manual. 2. Dispersal cell aggregate conforms to SPS 384.30(6)(1), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board orchisel plow. 5. The at -grade structure and otherdisturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downslope toe will be protected from compaction. 7. All other construction details are as perthe at -grade component manual SBD-1 0854-P (N. 03/07). Lateral Turn -up Detail Finished ............... Grade ` �I 6-8" Diameter Lawn SprinklerValve Box Distribution Lateral 101.50 ft Threaded Cleanout Plug or Ball Valve Long Sweep 90 orTwo 45 Degree Bends Same Diameter as Lateral Project: Christopher Bergren & Rebecca Levoir - At Grade Page 5 of 10 Transaction Number. At -grade System Management Plan RECEIVED Pursuant to SPS 383.54, Wis. Adm. Code AUG 032026 General This system shall be operated in accordance with SPS 382-384 Wis. Mn. Cade, and shall maintained in accordance with It component gaP,ey ld Co. manuals [58D -10854-P (N. 03/07), SSWMP Pub. 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706 (N.0{ipganp Zoning Agency local a state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic a pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, a subject to failure must be replaced. Exposed access openings greater than 8 -inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry Into a tank or component Seotin Talk The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated contintnmly. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its cements removed when the volume of sludge and scum in the tank exceeds 1/3 the liqud volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shalt advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required However, if such products are used they shall be approved for septic tank use by he Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3yeers. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be Inspected and serviced as necessary. At -grade d Prassnra Distribution System No trees or shrubs should be planted on the at -grade. Plantings may be made around the at -grade's perimeter, and the at -grade shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the at -gale Is not recommended since sill compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October -February) dictate that the at -grade be heavily mulched as protection from freezing. Influent quality into the at -grade system may not exceed 220 mglL BOOS. 150 mgt TSS, and 30 mglL FOG for septic tank effluent or 30 mg/L 8OO5. 30 mgt TSS, 10 mg/L FOG, and 104 cfW10o mL for highly treated effluent. influent flow may not exceed maximum design flaw specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the Initial test when the system was installed todetermine if aificeclogging has occurred and If orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent pending. Pending levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent moitoring. ontinoencv Plan If the septic tank or any of its components become defective the tank a component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank. pump, pump controls, alarm or related wiring becomes detective the detective components) shall be Immediately repaired a replaced with a component of the same or equal performance. If the at -grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, itwill be repaired a replaced in itq present location by Increasing basal area if toe leakage occurs or by renovating the biologically clogged absorption and dispersal media, installing new piping, and replacing other components as deemed necessary to bring the system into props operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Christopher Bergren & Rebecca L Transaction Number: Page 6 of 10 TECHNICAL BROCHURE B3871 R1 RECEIVED AUG 032026 Bayfield Co. Planning and Zoning Agency EP04 & EP05 Series Model 3871 SUBMERSIBLE EFFLUENT PUMPS •GOULDS a xylem brand Wastewater FEATURES EP04 Impeller: Thermoplastic semi -open design with pump out vanes for mechanical seal protec- tion. EP05 Impeller: Thermoplastic enclosed design for improved performance. Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resis- tance. Motor Housing: Cast iron for efficient heat transfer, strength, and durability. APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: a/4" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'h" NPT. • Mechanical seal: carbon-rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40° C) continuous 140° F (60° C) intermittent. • Class B Insulation • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. Power Cable: Severe duty rated oil and water resis- tant. Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTINGS CTested to UL 778 and CSA 22.2 108 Standards S• By Canadian Standards Association c us File #LR38549 RECEIVED AUG 032026 Bayfield Co. Planning and ZoningAgency Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V or 230V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 SJTW with three prong grounding plug. Optional 20 foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Automatic models include Mechanical Float Switch assembled and preset at the factory. PERFORMANCE RATINGS Total Head (ft. of water) Gallons Per Minute EP04 EPOS 5 53 - 10 46 62 15 36 55 20 21 46 25 0 33 30 - 11 Wastewater METERS 1 ET 30 25 2C 1( Li t 5 GPM —� ��— - - - EP05 r— —.. — — - — _ __ _ H I �- FHf_H -- - � 00 L 0 MODEL INFORMATION Order No. HP Volts Amps Minimum Circuit Breaker Phase Float Switch Style b Cord Length Discharge Connection Minimum On Level Minimum Off Level Minimum Basin Diameter Maximum Solids Size Shipping Weight lbs/kg EP0411 .4 115 12 20 1 Plug / No Switch 10' 1h" Manual Manual 15" '/" 20/9.1 Piggyback! W,dngle 10 1'h" 12' 6" 15" 21!9.5 EP0411A Plug! NoSwitch 20 1'/d' Manual Manual 15" 20 / 9.1 EP0411 F Piggyback/ Wide -Angle 20 ih" 12" 6' 15 21/9.5 EP0411AC EP0412 230 6 10 Plug/ No Switch 70 1h" Manual Manual 15" 20/9.1 Plug! NPlug /o Switch 20 172" Manual Manual 15" 20/9.1 EP0412F Plug / No Switch 20' 1W Manual Manual 15" 22/10 EP0511 F .5 115 13 20 Piggyback! Wide -Angle 20 ih 12" 6" 15" 23/10.4 EP0511AC EP0512F 230 66.5 10 Plug! No Switch 20 1W Manual Manual 15" 22 / 10 10 20 30 4t1 JU '41 .I 2 4 6 8 10 12 m'/h RECEIVED CAPACITY AUG03 3 2026 Bayfield Co. Planning and Zonkp Agency PAGE 3 DIMENSIONS (All dimensions are in inches. Do not use for construction purposes.) 10'% MAX. COMPONENTS Item No. Description 1 Impeller 2 Base 3 Pump casing 4 Mechanical seal 5 Ball bearings 6 O -rings 7 Power cord B Oil filled motor 9 Motor housing/stator assembly 10 I Motor cover FJ 11ar.IPT 10 E] 6 9 S 4 3 1 2 RECEIVED AUG G 32Q26 a. xylem � �c Xylem, Inc. Pynnin0 aM Zoning P.gencY Let's Solve Water 2881 East Bayard Street Ext., Suite A Seneca Falls, NY 13148 Phone: (866) 325-4210 Fax: (888) 322-5877 www.gouldswatertechnologY.com Goulds is a registered trademark of Goulds Pumps, Inc. and is used under license. O2012 Xylem Inc. 53871 RI April2013 Wide-angle pump switches directly ccncm, pu,„ND '-r •- - - - - Mechanically : 1/2 HP 120V 13A, 120V 85A, 120V ! 7 - 36 in SJE PumpMaster WPS Activated - 1 HP. 230V 13A 230V 65A, 230V (18 - 91 cm) U , Mechanically j 1/2 HP, 120V 13A, 120V 85A, 120V ' 36 in `s.i PpmPMasteY' 1 Activated 1 HR 230V 13A, 230V 85A, 230V (18-91 em). Mechanically 3/4 HP, 120V 15A, 120V 85A,1 0V 7 38 in q : SJE PumpMastarPlus Activated 2 HP 230V i5A, 230V 85A, 230V (1B - 91 cm) { tspa�epmp teyter'BP�T i Mechanically ( 11 IP, 1 0 V 13A, 120V 1 85A, 230V ` cw ndo: peuygThiav) ' Activated 1 HP 230V 130. 230V t S5A, 230V (18 - 91 cn1) Mechanlcally a 15 FLA, 90LRA 15A, 120V 90A, 120V -3- 48 in Oauble Rost' Master + Activated E 120 or 240V 15 240V 900. 240V (7.6 12^_ cmj MUST use if dose c 7" unless using VerticaiMasier below - Mechanically 1 1/2 HP, 125V ;, 20A, 125V S 120A, 125V '9 - 24 `^ SJE AmpMirster' Activated 3 HP, 250V 1 20A, 250V 120A, 25DV t23T- 01 crrt) Eye ticalt4 1/2 HP, 120V 13A, 120V 60A, 120V .75 - 6.5 in SJE YerticalMastar' Mechanically ki ,wrActivated 1 HP 230V 12A, 230V 600. 230V (2-17 cm) ACIDIC Use pump 10A Activated , 12V0C 100A, 12C - �Mechanically run end � 10A, 12V0C t 60A, 125V (20' 91 cm)- SJE MloroMaster' ` start currant 8A, 250VAC 60A, 250V Use pump 13A, 125V 78A, 125V 8 - 36 in Mechanically run and SJE MicroMaster' Plus WS Activated 12A, 250V • 72A, 250V (20 - 91 cm) start current Use pump 13A, 125V 78A, 125V 2 - 36 io Mechanically run and sJE HiTempMaster'" WARNI Activated y 12A. 250V 7?A, 250V (20 91 cm) start current .... _ California Pmp 65 requires the tosowing: ® NG Cancel and Reproductive Harm - www.peswamiogs.ce.gov SS8 D1AL-SJE (888-342-5753) custamer.service@sjeinc.com RECEIVED wwwsjerhomhus.com 0e001369 07/40 J RHOMBUS. AUG o � �O�[� SJE RHOMB vselea e.mGn ruen,sp areJ. g,�i pNOMBU5 isa Vodcmdh of SJE, lnc Bayfield Co. Planning and Zoning Agency N AT GRADE SEPTIC SYSTEM PLOT PLAN CHRISTOPHER L BERGREN AND REBECCA L LEVOIR 36499 COUNTY HWY J _ RECEIVED BAYFIELD, WI 54814 PAR IN SE NW & SW NEW OF CO HWY J IN 03 2026 2022R-595061 MUG 501 T50N R04W TOWN OF BAYFIELD, WI Bayfizld Co. SCALE 1' 60' Planning and Zoning Agency EXISTING MANMADE POND north O APPROX, 750 TO NEST LOT LINE EXISTING GARAGE SOUTH LOT LINE A• EM 10OAK. NAIL IN 845E=100' a16 I 14 5 6OT 5HEETSOFID Private Sewage System Maintenance Agreement C_hets '2,614 Tax IOU L As owner, I (we) do Hereby cerary me private sewage system win oe Insanea in accordance with the certified soil testers report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established in the WI Adm. Code, as from time to time amended. (COMPLETE Legal is _Trequired) _114 of ___1/4 Section1 ownship SC N. Range Ott• W. t'St= (�1,f ct' Additional Legal Description: �c.P S� K � CO ({ t.SYIu� C„) Town of i`= i ____ _ (Acreage) 1�? Gov't Lot Lot Block Subdivision Lot _ _ CSM # Vol. _ _ Page __ CSM Doc # Rs' DOCUMENT NUMBER 2026R-61 2868 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 07/09/2026 AT 8:20 AM RECORDING FEE: $30.00 PAGES: 2 '(BIGGLAKE1 R PLUMBING n 1491 County Highway C Washburn, WI 54891 Area ❑ In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound At -grade Sewage System ❑ Other Septic Tank (system types A through E: The septic tank shall be pumped by a certified septage servicing operator within t 3 yg rs I date of installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or othe fro 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, 0, and E): The pump chamber shall also be rinsed and pumped out when the septic to 6 s412e�l &rovided 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 �eld J?nce with manufacturers specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383. , is. Admin. Cote. 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 it 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 rot/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. r( kphev- L lie. r�jrc•. • iubscnbeC and sworn to before me on this date: awly I, 202&V Mcru3 Gown+" ^ N e "PC Z'l. 203 iH Drafted by: `�Stilk+`.Sk. Date: 6 I'-'cProofed by: by: uIlormsisanitarylsepticm ainfenceagreomenl Revised July 2020 File Number: 222512 ADDENDUM/EXHIBIT A A parcel of land located in the Southeast Quarter of the Northwest Quarter (SE1/4-NW1/4), and the Southwest Quarter of the Northeast Quarter (SW1/4NE1/4), West of County Highway "]", Section One (1), Township Fifty (50) North, Range Four (4) West, Town of Bayfield, Bayfield County, Wisconsin, described as: Commenting at the corner common to Sections 35 and 36, Township 51 North, and Sections 1 and 2, Township 50 North, Range 4 West; thence S00°22'03"W, 2589.76 feet along a line common to Sections 1 and 2; thence S89°29'08"E, 1316.63 feet to the SW comer of the SE1/4 of the NW1/4 of said Section 1, which is the Point of Beginning; thence N00°22'00"E, 540.00 feet; thence S88°38'44"E, 1295.73 feet to a point located in the Westerly right-of-way line of County Highway "3"; thence 520°04'34E, along said Westerly right-of-way line 160.04 feet thence continuing along said Westerly right-of-way line on a curve to the right, having a long chord bearing and distance of 516°26'50"E, 388.06 feet; thence N89°29'08"W, 1463.69 feet to the Point of Beginning. RECEIVED AUG 12 2026 Bayfield Co. Planning and Zoning Agency Bayfield County Register of Deeds Document # 2022R-595061 Page 2 of 2 p TFIELD Bayfield County Planning & Zoning Department 117 E 5e, Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: BERGREN, CHRISTOPHER L 1421 CARRIAGE RD WOODBURY, MN 55125 LEVOIR, REBECCA L 1421 CARRIAGE RD WOODBURY, MN 55125 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00394 Transaction Number: SR -00394-43C20 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 2956 Paid by: Ed's Mechanica1,1491 County Hwy C, Washburn WI 54891 Payment Type: Check Transaction Date: 4/24/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. P AFIELD 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: BERGREN, CHRISTOPHER L 1421 CARRIAGE RD WOODBURY, MN 55125 LEVOIR, REBECCA L 1421 CARRIAGE RD WOODBURY, MN 55125 Description State Approved Plans (Mounds, Systems Requiring Pre -Treatment, etc.) Submission Number: SS -00809 Transaction Number: SS -00809-4B526 Amount $500.00 Total: $500.00 Payment Amount: $500.00 Reference: 3062 Paid by: Ed's Mechanical, 1491 County Hwy C, Washburn WI 54891 Payment Type: Check Transaction Date: 8/13/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-108S STATE SANITARY PERMIT OWNER: BERGREN, CHRISTOPHER L & LEVOIR, REBECCA L G OV'T LOT: LOT: BLK: SE 1/4 NW 1/4 SEC: 1,150 N, R 4W TOWNSHIP: Bayfield SOIL TEST: 23-26 NEW SYSTEM SYSTEM TYPE: At -Grade PLUMBER: MICHAEL WROBLEWSKI EMILY MACGILLIVRAY DATE: 8/13/2026 Authorized Issuing Officer CHAPTER 145.135(2) WISCONSIN STATUTES a. The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. b. The approval of the sanitary permit Is based on regulations in force on the date of approval. c. The sanitary permit is valid and may be renewed for specified period. d. Changed regulations will not impair the validity of a sanitary permit. e. Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. f. The sanitary permit Is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. PREVIOUS PERMIT #: LICENSE: # MP 1288503 Condition: THIS PERMIT EXPIRES 8/13/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION