HomeMy WebLinkAbout26-112S10
Department Safety of
County
��
x
& Professional Services,
Sanitary Permit (to be filled in by Co.)
1p a p, oo (XJ I
Industry Services Division
umber
/ 11A S
Sanitary Permit Application
State Transaction Number
In accordance with SPS 383.2l(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit
Project Address (if different than mailing address)
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
-1 '],SO }Cv% ft Son Or.
purposes in accordance with the Privacy Law, s. 15.04(l)(m), Sons
I. Application Information - Please Print All Information
I�
T.POh t\ t1/t(, W S 6 & y
Property Owner's Name
'Sarccl #
in ll; Fa �� ;r�Trvsrt -Jame-s ci�'illi
rax 13350
Property Owner's Mailing Address
Property Location
boa E -rh St
Govt. Lot
City, State I
Zip Code
Phone Number
S v 2f UJ w T
5 y 880
a 116 -3 H9 -3SS 1
l 1 ¼. A, Section
T 4 6 N R E o
H. Type of Building (check all that apply)
Lot #
1
10 I or 2 Family Dwelling - Number of Bedrooms Ll
Subdivision Name
❑Public/Commercial -Describe Use
Block# E VLiD
Rf� NCC
O City of
❑ State Owned -Describe Use LL
O Village of
,1 q qp
CSM NumbeAUG 04 2026
b V
I Town of Pt. ('T 0.
eaysea Co.
Plo
III. Type of POWTS Permit: (Check either "New" or "Replacement" and of er pp i QbY t1i9MWA. Check one box on line B. Complete line C i
a licable.
A.
❑ New System
y
,ay,rr
yal Replacement System
❑ Other Modification to Existing System (explain)
❑ Additional Pretreatment Unit (explain)
B.
❑ Holding Tank
IN'In-Ground
❑ At -Grade
❑ Mound
❑ Individual Site Design
❑ Other Type (explain)
(conventional)
('.
❑ Renewal Before
❑ Revision
❑ Change of Plumber
❑ Transfer to New Owner
List Previous Permit Number and Date Issued
Expiration
IV.
DispersaVrreatment Area and Tank Information:
Design Flow (gpd)
Design Soil Application Rtae(gpd/sf)
I Dispersal Area Required (so )
Dispersal Area Proposed 1sf) I
System Elevation
00
86-8
8 I
9L.j.Cf
Capacity in
Total
# of
Manufacturer
Tank Information
Gallons
Gallons
Units
s
a 'y
New Tanks I
Existing Tanks
'= =
v o
v
++
W _
m
ti
Septic or Holding Tank
I'1 GAO
_
i ro
1
�C 6f•
x
Dosing Chamber
`
—
.--.
—
V. Responsibility Statement- I, the undersigned,
assume responsibility for installation f the POWTS shown on the attached plans.
Plumber's Name (Print)
I Plu er's Signature /
MP/MPRS Number
Business Phone Number
All PoIkosk;
.
-..
ZZoo90
GIs-292-yis6
Plumber's Address (Street, City, State, Zip Code)
Po Box Si -z, Trot.- R; ue r WT S1 /7
VI. County/Department Use Only
Approved
O Disapproved
Permit Fee
Date Issued
Issui
A ign rc
❑ Owner Given Reason for Denial
Conditions of Approval/Reasons for Disapproval
dEa wed e d .
Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x I I inches in size
SBD-6398 (R. 03/22)
�a�,erR'rst��r
Wisconsin Department of Safety & Professional ServicSO8 L TEST # If'?—
(4Iato Division of Industry Services
SOIL EVALUATION REPORT
oo'-/g 3 In accordance with SPS 385, Wis. Adm. Code County
13a-�telo�
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include,
but not limited to vertical and horizontal reference point (BM), direction and percent slope, PG4GLI.D. i 33 co
scale or dimensions, north arrow, and location and distance to nearest road. TAX
Please print all information. Re ' e
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). �.
Page f of Z
(_over)
Date
Property Owner Property Location ❑ 1a
Gi r 1 IObW y C.c..i J''uST "Jctrres Cir;ll Govt. Lot /v % V. S y T 16 N R E (or) W
Property Owner's Mailing Address Site Address or CSM and Lot #:
Z E. 8-rti S -t- 97So kv�v-rsvrk Drive.
City, State, Zip Phone Number ❑ City ❑ Village 0 Town Nearest Road
su ear+ Ws S 1bCO (21 ) 3 L1 -3S5' I be.tT0. uTson v
❑ New Construction Use: I Residential/ Numberof bedrooms
&1 Replacement ❑ Public or commercial — Describe:
Parent material Saa jil G k e i h 4 l u V t a.I o S i T rj
General comments and recommendations:
( ] Boring #
u rsonng
[ Pit Ground surface elev. 1 • ft.
Code derived designflow rate 0D GPD
Flood Plan elevation if applicable ft.
(o RECEWL&D
0-`4 9MMR
Depth to limitirrin. / elev.9 ft.
Planning and Zoning Agency
Soil Annlication Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
*Eff#1
*Eff#2
I
0-
%o R3
IS
,r
L
acv
•.`7
II,
- tM
?• SY R3/'I
.
I,
tvvcbK
y4j-
C- S
.7
1.6
3
-78
S Rs
-
5.
Os3
t
_
•'7
1.6
Boring #
Boring
[Pit Ground surface elev.q 3.b ft.
Depth to limiting factor 75 in. / elev. l L• 1 ft.
Soil Aoolication Rate
Horizon
Depth
In.
Dominant Color
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary.
Roots
GPD/Ft2
*Eff#1
*Eff#2
�Munsell
101 R 3
1$
)-Cr
£3
• 7
•6
2
- I S
Y r /
_
-~
I S
C-
• "7
1.
-
7•5YRs/
S
m
1.6
CST Name (Please Print)
I Signature //
CST Number
1 i O 6 S- 5
O/ r'
Address S1 t S C.'T' " 8
I Date Evaluation Conducted
Telephone Number
o Pec. Sq q
— -1
I 2Lc-34t-7o≤
* Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 5150 mg/L * Effluent #2= BOD, s 30 mg/L and TSS 5 30 mg/L
SBD-8330 (R03122)
Payer of
❑ Boring a
3 Boring # (� Pit Ground surface elev. .7ft. Depth to limiting factor in. / elev. q ft.
I Soil Annlication Ratw_
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
*Eff#1
*Eff#2
I
0-H
iVV%5fr
G.5
3.�
7
I.
2.
- LS
. f 1Z3/
—
Is
a
w,
t. b
3
-P o
c
-.
5
I -f
t. +�
I
Boring # ❑ Boring
❑ Pit Ground surface eiev. ft. Depth to limiting factor In. / elev. ft.
Soil Annlication Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Descriptioh.
Qu. Sz. Cont. Color
Trexture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
*Eff#1
*Eff#2
I
Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft.
I Soil Aoolication Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
*Eff#1
*Eff#2
* Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 5150 mg/L * Effluent #2= BOD, 5 30 mg/L and TSS 5 30 mg/L
Combined Soil Evaluation Plot Plan - System Plot Plan
Component Manual Design References:
In -Ground Soil Absorption for POWTS Version 2.1
Owner: Cirilli Family Cabin Trust - James Cirilli
Site Address: 9750 Knutson Drive, Iron River, WI 54847
Tax ID: 13350
Legal Description: NENE SO4-T46N-R08W
PAR IN NE NE IN V.537 P.109 LESS V.738 P.234 727 (CIRILLI FAMILY
CABIN TRUST DTD 11/01/2024) IN D0C 2024R-605346
[.J Approx Property Line
o Soil Test Pits:
1 - Elevation - 96.9'
2- Elevation - 98.6'
3- Elevation - 97.7'
A Benchmark - Screw in Maple tree
Elev_L:__ A ^^I
Exis
i Stem
•�� t�n9�ar rsPet s s�JsteM
ey-O rdor,�re to revs
aga3 Pty°� �_.---
383 3at�°r
1
2
0
A
N
50 100t
1 I i i I i i I
1
1
1
2 Trenches Quick 4 Plus
Standard Chambers
to All piping shah conform to:
SpS Table 384.30-3
�° �"• SpS Table 384.30-5
o — Frost protection:
% SpS 382.30
3 Tank - Wieser
co
W1250 -MR
Filter - PolyLoc
PL -525
M
PAGE 1 OF 4
In -Ground Gravity Plan
Index & Cover Sheet
Component Manual Design References:
In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Page 1 - Index & Cover Sheet
Page 2 - Combined Soil Evaluation -System Plot Plan
Page 3 - Dispersal Area Cross -Section & Plan
Page 4 - Management Plan
Enclosures:
Soil Evaluation Report, Sanitary Permit Application,
Wieser W1 250 -MR approved tank specifications,
Soil Test Checklist, Sanitary Application Checklist, $450 check
Project Name / Description
Owner Name(s): Cirilli Family Cabin Trust - James Cirilli
Owner Address: 602 E 8TH ST, SUPERIOR WI 54880
Project Address: 9750 Knutson Drive, Iron River, W154847
Legal Description: NENE S04-T46N-R08W
PAR IN NE NE IN V.537 P.109 LESS V.738 P.234 727 (CIRILLI
FAMILY CABIN TRUST DTD 11/01/2024) IN DOC 2024R-605346
Township: Delta
Project Tax ID #: 13350
County: Bayfield
Designer Information
Designer Name: Allan Polkoski
Phone: 218-349-3551
RECEIVED
AUG 0,4 2026
seyeew cs.
Plaminy and Zoning *98f y
Phone: 715-292-4156
Designer Address: PO Box 522, Iron River, WI 54847
E-mail: tony@bearguidenorth.com
License Number: PMRS220090
Remarks: Private Sewage System Maintenance Agreement sent to Zoning
Department direct from Register of Deeds �7
Signature•( �d ' Date:
r �
Combined Soil Evaluation Plot Plan - System Plot Plan
Component Manual Design References: tN`I \\\\ N
In -Ground Soil Absorption for POWTS Version 2.1 i \
/
Owner: Cirilli Family Cabin Trust - James Cirilli / \ 0 50 100 ft
Site Address: 9750 Knutson Drive, Iron River, WI 54847 1, \I
Tax ID: 13350 i
Legal Description: NENE SO4-T46N-R08W
PAR IN NE NE IN V.537 P.109 LESS V.738 P.234 727 (CIRILLI FAMILY
CABIN TRUST DTD 11/01/2024) IN DOC 2024R-605346
i Approx Property Line
O Soil Test Pits:
1 - Elevation - 96.9'
2 - Elevation - 98.6'
3 - Elevation - 97.7'
A Benchmark - Screw in Maple tree
Elevation - 100'
Existing Well
m 2 Trenches Quick 4 I
Vase aljKlsys� SPS 0 Standard Chambers
gatX50a9�mer\Pee�sys\e
— 97'
A -- O3 �a
ns 1O
--
3_ 21
c
a0
C. N.)
> N..)
Soil Evaluated By: Tony Polkoski - 11068 -IT °'
Plumber: Allan Polkoski - PMRS 220090
C°untY Hi9hW -----
aYN
2O
i ing shall conform to'.
N
All
Table 384.30-3
a _
SpS Table 384.30-5
p Frost Protection'.
o�
SpS 382.30
3
Tank -Wieser y
W1250 -MR
Filter - PolyLoc
PL -525
IN -GROUND GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard -W Chambers
3 -ft Trench (down -sizing credit)
lltjllfl SOIL COVER
1z-
min. trench
depth
(typical)
min. 12"
(typical)
a 'e
(typical) •;e' ..
System Elevation = 94.4
(typical)
Septic Tank(s) Manufacturer:
Wieser
Septic Tank(s) Volume(s):
1 250 gal gal gal gal
Effluent Filter Manufacturer:
PolylOC
Effluent Filter Model #: PL -525
TYPICAL TRENCH
CROSS SECTION VIEW
(No Scale)
roW Quick4 Standard -W
r w/ End Cap
v (typical) (Show location of inlet / outlet pipe connection on plan view.)
o I
- --------
T1=84
Br T2=88 ft
INSTALL PER TRENCH: (typical)
Trench 1: 21 I Quick4 Std -W @ 20 ft2 EISA/chamber + 420
Trench 2: 22 I Quick4 Std -W @ 20 ft2 EISA/chamber + 440
Trench 3: II Quick4 Std -W @ 20 ft2 EISA/chamber + II
Provide minimum 3 ft
separation between trenches.
Observation Pipe
(typical)
Install per manufacturers
/ instructions.
TA = 3.0 ft
(typical)
TYPICAL TRENCH
PLAN VIEW
(No Scale)
Standard -W Chamber
Pair of end caps @6 ft2 EISA/pair =Ia I ft2
Pair of end caps @6 ft2 EISA/pair 16 I ft2
Pair of end caps @ 6 ft2 EISA/pair =I Ift2
Required Infiltration Area = 858 ft2
Distribution Method:
No. trenches = 0 Proposed Total EISA = 1572 Ift2 Gravity
O
m
U)
PAGE 4 OF 4
In -ground Gravity Management Plan
IMPORTANT:
The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall
be considered a human health hazard if not maintained in accordance with this approved management plan.
Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area Operating Limits:
Design Flow = 600 gpd; BOD5 ≤ 220 mgL"1; TSS ≤ 150 mgL"'; FOG 5 30 mgL-'
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (he. odors, user complaints, etc.)
o mechanical malfunction (Le., pumps, valves, switches, floats, etc.)
o material fatigue (Le., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes)
o neglect or improper use (he., exceeding design capacities, prohibited activities, etc.)
o extent of ponding in distribution cell prior to dosing
o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.)
o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturers specifications. A servicing period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company:
Local government unit: Bayfield County Planning & Zoning Phone: 715-373-6138
Local government unit address: 117 E 5th Street, PO Box 58, Washburn, WI Zip: 54891
Iron River Septic Phone: 715-372-4006
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384, Wisc. Admin. Code.
Contingency Plan
In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed in -ground di nt may be
abandoned and replaced by a code -complying dispersal component in a pre -determined area of ss iia5l& oils.
System Abandonment
-pumkv�nMy�ebCo.
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Nh'sTwA&** Code.
AUG 0,4 2026
4" CAST -A -SEAL
\k\\ FILTER OR BAFFLE
��[
/
co
N
—— i
—_>_
N
Iu
C'
O
4N
TOP VIEW
¢
ol
ufl
Zr
w
ZI
Cl)'
a
C
e
SIDE VIEW
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
W1250 -MR
TANK SPECIFICATIONS
DIMENSIONS:
WALL: 2 1/2"
BOTTOM: SEPTIC 3"
HOLDING 5" (ADD 1300 LB.)
COVER: 4"
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
HEIGHT: 64 1/2" O.D.
LENGTH: 104" O.D.
WIDTH: 86" O.D.
BELOW INLET: 53" O.D.
LIQUID LEVEL: 47"
WEIGHT: 7,220 LBS.
INLET AND OUTLET,
4" CAST —A —SEAL BOOT OR EQUAL
a
o
GASKET, CAST —A —SEAL BOOT OR EQUAL
INLET AND OUTLET BAFFLE AND FILTER:
m
o
WISCONSIN, SEE DETAIL #10
(OTHER STATES SEE CHART)
v
LIQUID CAPACITY: 26.81 GAL/IN
0
�
W n
HOLDING TANK:
I
OUTLET HOLE PLUGGED
ACTUAL CAPACITY: 1,340 GALLONS
LOADING DESIGN: 8' 0" UNSATURATED SOIL
C o
z cf
Oz00
=? I
a Ln
< N
TANK CAN BE USED AS:
r'7
We l
SEPTIC/ HOLDING/ PUMP OR SIPHON
CA p
COVER: MIX DESIGNQT 0Ti6€R:}I.4LLY
°J
TANK: MIX DESIGN #10 653RjU .l.bgVP, JIBER)
CUSTOMIZED TPD ,PT OF SAFETY AND
FOR Cl15SOJ.I�ftN ICO lR 70CT ,COQICETE
DIVISION OF INDUSTRY SERVICES
APPROVED
o
By Glen Schlueter at 8:20 pm, May 30, 2022 I
r
a
DRAWINGS SUBMITTED
W
FOR APPROVAL
APPROVED BY: -
SHEET NO.
APPROVAL DATE:
PRODUCTS NEEDED BY:
/OF 1
SANITARY APPLICATON CHECKLIST - BAYFIELD COUNTY
Submit the Following - (Must be original and written in ink) (Title 15, Section 15-1-10(e))
2 Check List
0 Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.)
2 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c))
0 Original Plot Plan (383.22(2)2. 3. & 4.a)
2 Cross Section, Over -Head Profile of the System and DSPS APPROVED Schematic of Tank from Manufacturer
❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable)
0 Contingency Plan / Management Plan (383.22-3(2)(b)1.f.)
❑ Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds)
❑ 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)
0 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7)
2 1 Complete Set of Plans (Note: Sanitary Application and Maintenance Agreements are to be attached)
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)
2 I S digit Tax ID - Project Address or Road Name adjoining driveway - Owners Phone Number
2 II Type of Building
0 III Type of Permit
2 IV Type of POWTS System
0 V Dispersal - Treatment Area Information
0 VI Tank Information
2 VII Responsibility Statement (Plumber's Information)
Plot Plan: (To Scale or To Dimension)
2 Signature and Plumber Information
M Surface Elevation of Body of Water
M Direction and Percent Land Slope
0 Tank and Filter Information and Location
W Wetlands / Navigable Bodies of Water
A Absorption Area (Proposed and Existing)
2 Bench Mark (Location, Elevation and Description)
2 Component Manual Version
Rtc!"b
AUG 01 ZOZb
Plannin9a�Z,, n9 ABen�7
2 Address Number and Road
2 North Arrow
50 Contour Lines
2 Structures and Driveways
2 Boring Locations
0 Property Lines
0 Well Locations
0 Legal Descriptions
2 Piping Material Information (conveyance line, building sewer line, material type and diameter)
Turn Over ►
Cross -Section and Over -Head Profile of the System:
k Surface and System Elevation
I l Position of Observation and Vent Pipes
E Dimensions and Depths
Iffi Make, Model & Number of Chamber Units in each Cell
Property Information
00 How many systems will there be on this parcel of land?
11 Has this property been split? N O (Property Statement shows Property History)
Fees:
L Private Sewage System (Septic Tanks) $ 400.00
❑ Private Sewage System (Holding Tanks) $ 400.00
❑ Mounds or Systems requiring Pre Treatment $ 500.00
❑ Sanitary Revisions $ 25.00
❑ Private Sewage System Reconnection $ 50.00
and Private Interceptor
❑ Return Inspection $ 50.00
❑ Maintenance Agreements + $ 30.00
(checks made out to Reg of Deeds)
Private Sewage System Maintenance Agreement
C011 �Gt wtr/y Ll(6r✓I I✓J ST
OZ E SrkST. Surer, o✓
7≤0 D K✓t o .S Jh ✓ i R:Jar
As owner, I (we) co nereby Certify the private sewage system will be Installed in
accordance with the certified soil testers report and approved plans and specifications
on file with Bayfeld County Planning and Zoning Department, The system will be
operated In such a manner as to meet the designed plans. I (we) agree to maintain said
private system at the below listed location In accordance with rules established in the WI
Adm. Code, as from time to time amended. (COMPLETE Legal is required)
1/4 of Al 1 /4 Section 4 Township r{/r P N. Range
fI C W.
or nNE.JJZ,1JV37 P l cq t-e✓`5 ✓• 73
Additional Legal Description:? 2 C. , r); a Lab;.n us.
DT D r tlof/t h..
borzoi iz-reo53 y
Town of /� e I �� (Acreage) 32 yb0 Gov't Lot
Lot
Subdivision
Lot _CSM#_ Vol. _ Page _ CSM Doc #
® In -ground gravity O In -ground dosed
❑ Mound ❑ At -grade Sewage System
DOCUMENT NUMBER
2026R-61 3229
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFI ELD COUNTY. WI
RECORDED
O8/O5/2O26 AT 12:46 PM
RECORDING FEE: $30.00
PAGES: 2
Area
Return To
1 �ti� font n�
❑ In -ground pressure distribution Sew�gge tern on
❑ Other HHUU �� LL
)i Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within ti?a7P M BE&P@ c�te 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 filler 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 -around 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. Bayfleld 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
maybe placed on the tax miles a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided bylaw.
The terms and conditions of the agreement shall be binding upon end inure to the benefit of all current and future owners of such property.
Owner(s) Name(s) — Please Print
AMEs L. c g i t- c,) IRu5-'E E
Subscribed and sworn to before me on this date:
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Notarized Owners) —Sig e(s)
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My Co"n�tym^issl n Expires:
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u/forms/sanitary/septicmainlenceagreement
Revised July 2020
QUIT CLAIM DEED - CIRILLI, CIRILLI, AND CLARK TO CIRILLI FAMILY CABIN TRUST PAGE 4
The Northeast Quarter of the Northeast Quarter (NE% -NE%), Section Four (4), Township Forty-six (46) North,
Range Eight (8) West, Town of Delta, Bayfield County, Wisconsin, EXCEPTING THEREFROM the following parcel
as recorded in Volume 537, Page 109, as Document No, 393840 of Bayfield County Records:
Commencing at the Northeast corner of said Section Four (4), (which is also identified as Point A for reference
purposes) run West along the North line of Section Four (4) to the shore of Twin Bear Lake, which point is
designated as the point of beginning; (there is an iron pipe monument at 198 feet, markingthe Southwest corner
of Section Thirty-four (34), Township Forty-seven (47) North, Range Eight (8) West, (which point is Identified as
Point B for reference purposes) an iron pipe marker at 296 feet, and an iron pipe marker 3 feet from the waters
edge). From said point of beginning, return to the Northeast corner of Section Four (4); thence run S0°50'W, on
the line common to Section Three (3) and Four (4), Township Forty-six (46) North, Range Eight (8) West, 185.6
feet more or less to a point In the center of the black topped road now known as Knutson Road and which was
formerly a portion of the county trunk highway, which point is marked by an iron pin driven In the ground; thence
552°14'W, alongthe center of Knutson Road 911.3 feet, more or less, to a point marked by an Iron pin driven into
the ground; thence N21°W, 365.0 feet to the shore of Twin Bear Lake running through iron pipe monuments at
37.4 feet and at 355 feet; thence Northeasterly along the shore of Twin Bear Lake to the point of beginning. (All
bearings given above assume the line between reference points A & B to be due East and West.); and
EXCEPTING THEREFROM the following parcel as recorded in Volume 738, Page 234, as Document No. 442105 of
Bayfield County Records, which is described as follows:
A parcel of land in Section Four (4), Township Forty-six (46) North, Range Eight (8) West, Town of Delta, Bayfield
County, Wisconsin, described as follows: Beginning at an Iron pipe at the Eighth corner of the center of the
Northeast Quarter (NE'/e) of said Section; thence running North a distance of 167 feet to an iron pipe which is 33
feet South of the centerline of the roadway; thence running Easterly along the road right-of-way of Highway H,
a distance of approximately 50 feet to the right-of-way of Evergreen Lane; thence South along the right-of-way
of Evergreen Lane a distance of approximately 167 feet to the point due East of point of beginning; thence West
to the point of beginning,
RECEIVED
AUG 067026
Bayfield Co.
Planning and Zoning AgalCY
Bayfield County Register of Deeds Document #2024R-605346 Page 4 of 4
BAYFIELD COUNTY
CHECKLIST FOR CERTIFIED SOIL TESTS
Submit the Following (Use Permanent Ink):
R Check List
D( Index Page / Title Sheet (Optional)
l Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers)
1 Original Plot Plan
O Cross Section Soil Profile Sheet (optional)
O Additional Information (Warranty/Quit Claim Deed) (Optional)
Soil Evaluation Report: (Include the following Information)
Tax Identification Number (must be 5 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used
J Property Owner's Information (not prospective buyer's name)
X Property Location (Accurate Legal Description with Sec/Twp/Range)
1 Road Name (where driveway is/will be coming off of)
O Floodplain Elevation, Flow Rate, Comments and Recommendations
IR Complete Soil Boring / Pit Information
1 Date Soil Evaluation was conducted
L CST Name, Signature, Number, Address and Phone Number
D( *Date Stamp*
Plot Plan: (Include the following information drawn to dimension or to scale)
R Bench Mark (Description, Elevation and Location)
t Contour Lines (Example = 98.0' /96.0' /94.0')
CR Property Location (Sec/Twp/Range/, Accurate Legal Description)
5& Borings (Locations and Elevations)
a Percent and Direction of Land Slope
X Well Location (Including Neighboring Wells, if applicable)
4a Location of Wetland Areas, Floodplain and Navigable Waters
1 Buildings, Driveways, and Structures (Location and Descriptions)
R Location of Property Lines
50 Existing System Location
X Address Number and Road Name
EA Current Surface Elevation of Wetlands and Navigable Waters
X CST, Owner and Property Information
9 North Arrow
AUG O.41;1;)
Planning and
Fee:
JR Certified Soil Tests - Review & Filing Fee $ 50.00
U/forms/sanitary/checldist/checldistforests
13A 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:
CIRILLI FAMILY CABIN TRUST,
602 E 8TH ST
SUPERIOR, WI 54880
Description
Certified Soil Tests - Review & Filing Fee
Submission Number:
SR -00483
Transaction Number:
SR-00483-4B6F6
Amount
$50.00
Total: $50.00
Payment Amount: $50.00
Reference: 6341
Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847
Payment Type: Check
Transaction Date: 8/21/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
]3 •-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:
CIRILLI FAMILY CABIN TRUST, SS -00812
602 E 8TH ST
SUPERIOR, WI 54880 Transaction Number:
SS-00812-4B6F8
Description
Private Sewage System (Septic Tanks)
Amount
$400.00
Total: $400.00
Payment Amount: $400.00
Reference: 6341
Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847
Payment Type: Check
Transaction Date: 8/21/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
BAYFIELD COUNTY
SANITARY PERMIT (#04)-26-112S
STATE SANITARY PERMIT
OWNER: CIRILLI RI LLI FAMILY CABIN TRUST
G OV'T LOT: LOT: B L K:
1/4 1/4 SEC: 4, T 46 N, R 8
TOWNSHIP: Iron River
SOIL TEST: 117-26
REPLACEMENT SYSTEM
SYSTEM TYPE: Non -Pressurized In -Ground
PLUMBER: ALLAN POLKOSKI
TRACY POOLER
Authorized Issuing Officer
DATE: 8/21 /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: # 220090
Condition: Properly Maintain System Per Recorded Agreement. Old System needs to be properly
abandoned per SPS 383.
THIS PERMIT EXPIRES 8/21/2028
v..1.I.IiIF,iI
itiI'ii
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION