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HomeMy WebLinkAbout26-117SI Request for Sanitary inspection ai Fax this form to Zoning Dept (24 Hrs.) prior to when you want an inspection —(715) 373-0114 if you do not have a fax and must email the inspection; you must email a? s a_mGmbers. Mote jJTime Change Discrepancy Other G;,o (�J ids ✓ v 1 T Phone Number Plumber: Fax Number Homeowner: cl I e Ve n L t'n fltx (cxf l6 o (, Email Address Sanitary Permit #: /) / — j /V Immediate Phone Number So Zoning Dept can call you right back (if needed) d/� Plumber's Choice ig ept Date: 93 r No lnspeciloEn fa(s du g this time Tuesday (9:30 am -12:15 pm) cy) Time: Plumber's Choice Zoning Dept Township: Address#� Road Name: I� ®IT` ft� or Directions To Site: G Comments: > 1�SC 4a `4.i'1+5'5 you m€4st varM, any ohange(s)by fax Or /n.-, E t• Notes from Zoning Dept u/forms/sanitary/requesforinspection Zoning Dept (@4112104); ® June 2023 Private Ons.ite Wastewater Treatment s ( POWTS). Inspection Report STEVEN P & ANNA M CARLSON (Attach to Permit) Ind 1240 S 2ND ST, UNIT 501 MINNEAPOLIS MN 55415 GE pwposes[Privacy Law, s. 15.04 1 1m Pe. _ _ _ City 9 Village 9 Town oft Tank TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road jJ€ I Oo f 6 N/A N/A r N/A • Pump! Siphon Information ump Manufacturer ump Model Demand Filter Manufacturer Filter Model GPM Ocktico 6•a�y8e— r. T0H Lift Friction Loss Head Total Forcemain Length Dia Dist To Well Dispersal Cell Information DIMENSIONS Wil / j Length # of Cells setback to: County Sanitary ermltNo: State PlanTransaction lD#: Parcel Tax No: Type of Cell IManufacturer: Model Number. Pretreatment Unit Manufacturer: Model Number: Distribution Elevation Data STATION BS HI FS ELEV Benchmark g ;� Bldg. Sewer Tank inlet '(662. Tank Outlet y� `,Y Dose Tank Inlet Dose Tank Bottom Inst. Contour Header/Manifold g.. 4S 16.3 Distribution Pipe Infiltrative Surface 9 , 3 Final Grade L " X Pressure Systems Only Length Dia I Length_ Dia _ Spac_ i Spacing ' il`es ❑ No Soil Cover Depth Over i Depth Over I Depth of j Seeded / Sodded I Mulched Cell Center I Cell Edges I Topsoil ❑ Yes ❑ No 0 Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) (tek (Ucs} ��,r� �, r j 40 f )� t.i Veti Ian revision required? ❑ Yes No IY wothersideforadditionalinfban lion. Date WTS Inspector's Signature License Number %RRR]1n 7R fhr911 Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoninoa(1bavfieldcounty.oro Web Site: www.bavfieldcounty.oro/147 STEVEN P & ANNA M CARLSON 1240 S 2ND ST, UNIT 501 MINNEAPOLIS MN 55415 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know &5 Sall C was contracted by you to install a private onsite wastewater treatment system on your property (Tax ID# above). To know when your system will be due for servicing please go to www.septiesearch.com Notes: Abandonment of Old System to meet all applicable code requirements: LI r Tank was pumped by: • Tank was crushed I removed and pipes disconnected by: on at AM/PM On , 3 ,2 cat (AM / the above -mentioned plumber contacted our office to pre - conduct a cover inspection as a wired un er DSPS 383. One of the following applies: System was inspected and appears to meet all applicable code requirements. ❑ System was inspected and appears to meet all applicable code requirements; however, a plan revision is necessary because the installation was substantially different than the original approval. ❑ System could not be inspected because plumber covered prior to scheduled time of inspection. ❑ System could not be inspected because plumber was not ready at scheduled time of inspection. County was unable to return to complete inspection. System could not be inspected because plumber was not ready at scheduled time of inspection. A re -inspection and $50 fee are required. System could not be inspected because County could not respond to plumber's time constraints. Comments: U/forms/sanitarypropertyowner-Input April 2019 -Industry Services Division County Sp . , 4822 Madison Yards W Madison,. WI 53705 Sanitary Permit Numb (to be ad m Co.) $ -% l.� S''S O b ` P.O. Box 7162 Madison, W1 53707-7162 — t Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), 1A. Adm. Code, submission of this form to the appropriate govermnental unit is required prior to obtaining a sanitarypermit Note: Application forms for state-owned PONES are submitted to the Dcpartm tof Safety and Professional Services. Personal information you provide may be used for secondary Project Address Cif different than mailing ) purposes in accordance with thePrivacy Laws. lS.04(IXa:), Scats- Q k.1 -r / `"I T. Application Information - Please Print All Information Property Owner's Name Parcel CC CwisrnqqI Property Owner's Mailing Address �"�'� ��• Property Iaeazion �� v s-1 aI Govt. Lot City, State Zip Code _________ Phone Number 1155,41 Y Section _ T N R .IL Type of Building (check alt that apply) .. Lot # or2 FamilyDwelling—NumberofBedmoms SubdivisionName [jublidComraercial—DescribeUse Block # City of State Owned— DescrllbeUse CSM Number �, ' o Jvillagcof ��N E ' V, Ij(Q ? own of Tr la III. Type of.POWTS Permit Check either "Pew" or 6'Replacemeut" and other applicable on line A. Check oneboo ox oiliac B. Complete line C if a` likable..). A. 4ew System R�PlaceznentSystem f Other Moddification to Existing System (explain) jAdditional Prat Unit (explain) B. []H.oIding Tank Ob-Gmund DAt-Grade QMonnd individual SiteDesign Other Type (explain) (conventional) C. [jRenewal Before DR evision hangeofPhunber Drransfcrio New Owner.ist Previous Pe Number and Date Issued Expiration IV DispersaVTreatinent Area and TankInIormation: Design Flow (gpd) Design Sort Application Rate(gpolsf) DispersalAreaRequired (sf) Dispersal Area Proposed (sf) System Elevation capacity in Total # of Manufacturer Tank Information, Gallons Gallons Units a r, Nets Tanks Erthtlug Trmdcs chi U It w v R. U r✓o 0o V3 L � fss Spine orliol rmS Tack; DosmgCtraa;Iber x Q 13 fl V. Responsibthty Statement— I, rice undersigned, assume respons by for instaltatlon of the POWTS shown on the attached plans. Plumber's Name (Print) Pin ac's MPIMPRS Number Business Phone Number I7o PI A rty State, Zip Code) ww ++ (U1J /V T&i lid. uiZ 6 Y•L Connty/Department IIse pulp "raved Q Disapproved Permit Fee Date Issered Issuing igna4¢re D Owner Given Reason for Denial Conditions of Approval lRedsons for Disapproval RECEIVED Sz€- (?� -a)e4ied(ULio.AUG 072026 Barfield Co. Planning and Zoning Agency Attach to complete plans for the system and submit to the County only on paper not toss than 8 Viz 11 inches hi size SBD-6398 (R 03/21) PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross -Section & Plan View Pg 4 of 4 Management Plan Attachments: Enclosures: POVVTS Application for Review Soil Evaluation Report & Site Map Project Name I Description Owner Names:5+%w7. (fJJ6Q) 1 Phone: L19 - Owner Address: Zip: 55(1/5 Project Address: `7 Govt. Lot: ___ 1/4 of 1/4, Section 5 , TN-R (5? E nor wk] Township:' County: Project Parcel ID #: ` Cti 99I" Designer Information Designer Name: Designs E-mail: License Remarks: ECEVV!D AUG 0 72026 Bayfield Co. �`— Planning and Zoning Agency Signature: Date: 0 gin na re requ€red on each subrnlfted copy. OW • S+ev K�a. M • Caw sow y.c eJcJ. co. a bbe cp. T x sb . 3S- T L13)U- R OgW 2w33O N£tJE ii 'I. ii1? i?. toy AUG 072026 . .Uyslyd cn:..: Planning and Zoning Agency ' t o' b %. cl, . `iq•.3.[ I irs'j . ..:. •. . . .. . . oL.& fit... _R_ -�ro_... -*-- , --� 2 IN- AC)UND GRAVITY DISPERSAL, AREA Uniform EllevatkMi Trenches with Quick4 Standard.„w Chambers 3 -ft Trench (down-slzlrig credit) P ' 5Q11, covEfq nil fl (ranch rlapp111 (typltint) ni01.12" (lypinoll Septic TanK(s) Munutaaturer; ,vumi awxmnrurrmna,w•wenmumemnewmew �.mi�.n� �>+�-so.v Septic 'I'7nk(s) Valurnm(s); iLQ ai :; m ,u,n gal flftI,M Sal �,.,.. gel Effluent f•I • r Mmnupmolursr, Effluent t^"Ilfep Mndml014,,,,,,, 4 , ' TYPICAL TRENCH �;I•' ; ",� " CROSS SECTION VIEW (Ialaaq r I p (No Scale) Systafrl L"-lavatlan = "zS Provide minimum a ft (typical) .""• g Tt separation between trenches, Culok4Stancfaram w/hnd cap rvation Pips (typloaf) (Show location of Inlet / outlet pips confleatlon on plan view,) abn°(typ al hlotnll pr ninnufmnunoPn hnlrualfonn, @.)��1'�lAu3oft hjgijLI I (typical) (typlasl) INST��, ALL 161 °rr�ENCI-I; clulalc4 Std -W @ 20 ft' EISA/ohambei' _ •ftn + ,. Pairs of end caps @ SV EISA/pair = w ftu proposed EISA per trench c vin o s o. _A N C v TYPICAL TRENCH PLAN VIEW (No Scale) • Qulalc4 Atanclard•W Chambor (typlaml) (mh1 by Inflm for 6yntama, ins,) (rlsteH purnuanI la niah(Ifnntu 3S inatmotlana, Rsqulrsci Infiltration Anna �ft" Distribution Method: ox trenches = Proposed Total EISA: 7 82 • wD PAGE 4 OF 4 In -ground Gravity Management Plan IMPORT: The owner•of this in -ground gray system shalt be responslbte yr its perpetual operation and maintenance pursuant to', requirements of SPS 382-384, Wisc Admin. Code. Pursuant to SPS 383.52 (2), , Wisc. be considered a human health hazard if not maintained in accordance with this approved ement plan. )Admin. Code, this system shall Furthermore, all inspection and maintenance activities shall be performed by a registered managP� i Maintainer accordance with SPS 383.52 (3), yiWisc.Admin. Code. in Maximum Dispersal Area 0peratina Limits: Design Flow — O 9Pd; OD5 220 mgL'1; TSS S 150 L ;. 1 FOG 3'O _ rng�. inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (Le.,, pumps, valves, switches, floats, etc,) o material fatigue (Le., leaks, -breaks corrosion etc.) o solids volume in anaerobic treatment tank(s) and any drstribution`appmtenance(s) (i.e., distribution ! dro o neglect or iri poper use (i.e-, exceeding design capacities, prohibited activities, etc.) P boxes) o extent of pending in distribution cell priorto dosing o dosing irregularities - if applicable (Le., pump re -cycling, float switch settings, etc.) o electrical components - ifapplicable e4e4 wiring, (Lee, 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 effluentor sewage back-up into structure served $P coon) Maintenance Checklist MAINTAIN EERY 3 YS (or when necessary) o Sepik and dose tanictsl shall be pumped by a certified septage servicing operator licensed under s. 281.48 Stats, when the volume of solids in the tank(s) exceeds one-third (113) the liquid volume of the� Wis.as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc.Admits. Code. tank(s) or o ffIuent filter[) shall be inspected every 3 years and shall be cleaned when necessary to remove ay accumulated solids according to manufacturer=s specifications. A servicing period will always be greater than 12 months. System Maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 disc. Admin. Code, Report any component failure or malfunction to: Narne of individual or company: j4f1 3cftr2iiOPh one: Local government unit" P)1Lf4(?(I L)1114L1 Phone: i1j;-';3i— �43) Local government unit address:f,['it- OEdt)u'z& uJi- ZIP: 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 wiled or malfunctioning cots No. product for chemical or physical restoration of the Pa rep mayb shall comply with SPS 383. ism Admin. Code. accordance with SPS 384, Wise. Adnun. Code. maybe used unless approved by the department in Connnatencv Plan In the. event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced a plan submitted to Me appropriate agency for review and approval. A failed in -ground -abandoned and replaced by a code-complyingdis dispersal component in a dispersalarof Lfftb � A A P P eten'n red area of suitable soils. AUG 0.7 ?fl?R System Abandonment Bavfiid co Planning and Zoning Agency If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wlse Admin. Code. Opi_onal float s -'ch Orenco PSC-Serrgs rvurbe SYlaenf R7e:r Applicaftons Ha odic O,erco PSG Biotuog Uiiuenffl.js ar dw tined oremfl w ; Snlidc i,pm efllnE(tileaviving Y�.n Orancn's pair esnds PSO Se acme fluentRifers a usedin Improve the quality of ofi uent from 'v ewateriarka imp ate[! elfluent quatry extandi maimield life fn onsite dspstsai the perfmfnatc2 of dov systems and 3mp{eyps vma lentil eMnerl s m Toe 9ioiuhsdt rears dge j>, tiuJiljffi the housing while being easy ; of t6s :< . to mm nve for malnQna� maintenance. lhenasstl, s sei₹ nlPa g deaon et,ON, arefdae ycle �,�ei rvals. flUermeji is available in ir✓ n nr 9li8in {3.2rnm or 1.6m'rS mesh opening sin me handle can be exIei tided M Plttpipe (not inr,>udeQ) tr 6e - access to thec silig .A 3Abi CBmm} ' eW t hen3te is includsd. Pafodafs PSCSOL21-18 and PSCWCG2I--}8 are NSF=S certi;iej Sidi aM Mee PSCS052111 PsctiN.t167-78PSC-FSG62T-iS PSGt=lyf i o" act node tgrj feu� elan '$`+STlss c 1nn_a n.p15111=9.444g o V11VpfaiaACQ.Ca113 I HiT ` aAa.-mL�E.xN_is'--cr�.3 1 t fj T='i8'aFs I i ic'.nlMiz i- lID[lirj I id-is{qrr I ant-mme we Tom. _ ., .. P nc'aclv iL, AUG 072026 Bayfield Co. Planning and Zoning Agency SIame TErcazLidQe P'JC A5,S odeQneofs Nf4TmpSleQe DDD Dvlacar :SIC sfainle�l ABS a�FFra2 aH! 3®Q@/17 Pagel af2 k ttfi6del PSCS0621-18 PSCPSO621-18 x Doemu Neigh`s in (mm) 217(571) 227 (577) 0. Housing Neigh , in (mm) 21.0 (5a 21.O(53 C. Cadridge Neigh₹, in (mm) 17.75 (451) 17.75 (461) D. Ouget Pipe diamew,, in (mm) A514' 4.5(114) E Ouget he ght� irt, in (mm) i3.5 (3431 1a c MAM r. Mjectorplate daanet r, in (mm) 6.63(168) 6.63(168) Mesh st, ht (tam) 118(3.2) 1/16(1.6) Ft(ersaniace aM-W . 6.3(0.59} 6.3 (0.59) . FoW area, Y (mr i 9 (O.ISj 19 `fw-ctifl'wasS 1mdkmar9ef=1tia 1&,o �5 aG'cn B�Iatr rnCge.---- yy�� ,•RPP2re7Gd�tQ'irx�Q (',wa=s BLr�"`c rQE a!^.yiR'1fd�15'eflyMfiPd 65V¢i'S'u'Nlill da l:/gyp �4.i(i�� AUG 07 2026 Bayfield Co. ivvu-ro-rjs-Q - _ — Orenco 9ency Bev.3@08!2t Sysiems�=80Et-9-08-9&13 2541-459-,449 mytyorecce.cam Fa9e2 oft il W1250 -MR TANK SPECIFICATIONS mI O 8'-8" W o DIMENSIONS: a O 'fi"• a 4" CAST -A -SEAL 4" CAST-A-E&L ~ BOTTOM: 3" fi" Jp ,11r` g COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER ¢ HEIGHT: 64 1 /2" LENGTH: 8'--8" ♦�� °' WIDTH: 7'-2" w i ��'--'� ��lQ . ���`�A t BELOW INLET: 53" LIQUID LEVEL: 47" N I WEIGHT: 7,220 LBS. -' ��--' -' 7� INLET AND OUTLET: E O � FILTER OR 4" CAST -A -SEAL BOOT OR EQUAL GASKET } L -. > O N J S ``` BAFFLE 57' INLET AND OUTLET BAFFLE AND FILTER: a a ___._ r�� WISCONSIN, SEE DETAIL #10 N o c (OTHER STATES SEE CHART) 1.1.1 p LIQUID CAPACITY: 26.81 GAL/INIQEIYL W HOLDING TANK: OUTLET HOLE PLUGGED 0 If) ACTUAL CAPACITY: 1,340 GALLONS A a ado z LOADING DESIGN: 8'-0" UNSATURATED SOIL C■� ' If) < N TANK CAN BE USED AS: o s I SEPTIC / HOLDING / PUMP OR SIPHON W 300 "'COVER: MIX DESIGN #8 (NO FIBER W _ _ - j 00 TANK: MIX DESIGN #10 (STRUCTURAL FIBER) INLET - 4:::::i a g - OUTLET CUSTOMIZED TANKS: 3 cn I. FOR CUSTOM TANKS CONTACT WIESER CONCRETE N V I _ a0 Q CO xr M = U) efi O I U)I. jJ: ______ ______________ z - - it REVIEWED BY N c) PUMP PAD REVIEW DATE 3r w DRAWINGS SUBMITTED C', °E FOR APPROVAL • APPROVED BY: SHEET NO. APPROVAL DATE: 1 v" PRODUCTS NEEDED BY: OF TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS 7/7/26,7:43 AM Novus-Wisconsin Access rev. 12.0206 Real Estate Bayfield County Property Listing. Property Status: Current Today's Date: 7/7/2026 Created On: 3/15/2006 1:15:08 PM `& Description Updated: 1/9/2024 Ownership Updated: 1/9/2024 Tax ID: 9918 STEVEN P & ANNA M CARLSON MINNEAPOLIS MN PIN: 04-012-2-43-08-35-1 01-000-10000 Legacy PIN: 012115404000 Ril ing Address: Mailing Address: Map ID: STEVEN P & ANNA M STEVEN P& ANNA M Municipality: (012) TOWN OF CABLE CARLSON CARLSON STR: 535 T43N R08W 1240 S 2ND ST 1240 S 2ND ST Description: N 1/2 W 330- NE NE IN V.1162 8107 UNIT sol MINNEAPOLIS MN 55415 UNIT 501 MINNEAPOLIS MN 55415 1100 Recorded Acres: 5.000 19 Calculated Acres: 4.999 Site Address * indicates Private Road Lottery Claims: 0 11795 OLD MILL RD CABLE 54821 First Dollar: Yes Zoning: (R-2) Residential -2 M) property Assessment Updated: 6/17/2020 ESN: 108 2026 Assessment Detail Code Acres Land Imp. Tax Districts Updated: 3/15/2006 Gi-RESIDENTIAL 5.000 21,000 15,100 1 STATE 04 COUNTY 2 -Year Comparison 2025 2026 Change 012 TOWN OF CABLE Land: 21,000 21,000 0.0% 041491 SCHL-DRUMMOND Improved: 15,100 15,100 0.0% 001700 TECHNICAL COLLEGE Total: 36,100 36,100 0.0% ,4 Recorded Documents Updated: 3/15/2006 ® SPECIAL WARRANTY DEED M Property History Date Recorded: 6/17/2016 2016R-564016 1162-107 N/A ® SHERIFFS DEED Date Recorded: 12/14/2015 2015R-561643 1153-752 • ® CONVERSION Date Recorded: 426-354;510-322;649-386 RECEIVED AUG 0.7 2026 Bayieid Co. Planning and Zoning Agency httnc•/lnrnn ra havfiatr1nnu into wi nnvlarraaa/maatar non 111 Private Sewage System Maintenance Agreement Owner(s) Name t'tL *W. ? (YW. I Owner(s) Mailing Addres t-goS•Z&d,4 LKn Pdlis, r'3_ Site Address L1 -1q 5 dlc( 1 'IL �"4d 64It-i w c&02l Tax ID# Qq, Q4 Pin: D�-D12•Z►• i vi M V 'g'3 08 35_ 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. (COMPLETE Legal is required) 14 Y2 ii4i of fl3L i'4� NtcllQn ) 7 Township N. Range _0, Haria w Description: _ 5t d 3S li 0 > 4 2 W 3�' Town of Cab L2 (Acreage) S Gov't Lot Lot BlockSubdivision Lot CSM # Vol. Page CSM Doc # DOCUMENT NUMBER 2026R-612941 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED O7/15/2O26 AT 11:O5 AM JODOO RECORDING FEE: $30.00 PAGES: 1 /0 Z T ?ecording Area Return To: Planning and Zoning Department RECEIVED In -ground gravity Yfieid co. ❑ In -ground dosed ❑ In -ground pressure distribution S F'�a�pte ,n(j Agee ❑ 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 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 ma such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. RED 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 pro above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds. At -grade. and In -ground Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that a!1 the costs and charges maybe placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shag 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) — PleasePrint Pk)l. Subscribed and sworn to before me on this date: Notarized Ownerf— £ na e(s) Notary Public , My Commission Expires: cTAVx 31729 Drafted by: _i)1Z ✓'l≤ in. —Date: v +. ELIZABETH FERNANDEZ ♦ Notary Public Minnesota My Commission Expires U17 4 . • Jan 31, 2029 Proofed by. Revised July 2020 • r AIR I. p Page of � Wisconsin Department of Safety and Professional Services TEST #?r 2j, r, Division of Industry Services LN8i SI2._ QOM r1 v SOIL EVALUATION REPORT o c� ty ''►�r�,�.� � In accordance with SPS 385, Wis. Adm. Code Coun BAYFIELD Altam�"et ite plan �on paper not less than 81/2 x 11 Inches in size. Plan must Parcel [.D. but not limited to: vertical and horizontal reference point (BM), direction and percent slo D 9q l8 scale o`lr, �lmeTsip th arrow, and location and distance to nearest road. uL 1 Please print all information. Reviewed y Personal infon tiac8i psov may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). SJ €'t rope „ W ode. t . A h d1.0. Ca v- O Property Location Govt. Lot % Y. S 3S' T L13 N R O E (or) Property 1 Owner's Mailing Address S -r s i Site 2dress or CSM and Lotr 1 - P t O 7 W 330 Nt • City State I Zip Code IPhone Number O City 0 Village &Town Nearest Road New Construction User Residential/Numberof bedrooms 4 Code derived designflow rate 0 GPD ❑ Replacement ❑ Public or co mercial — Des ibe: Flood Plan elevation if applicable ft. Parent material V Gt. S General comments and recommendations: -T S©� 1, c/ S+ ?S.25' C Q. -S- r ❑ Boring Cf� 101[tI Boring # i .S'� ( Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Application Rate Horizon Depth In. 0___-G' _-G' Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD!Ft2 •Eff#1 •Eff#2 i. Y 3 1 s b _,s C •1 I'•& 6_..3(' •� 3 r 115 '� c� it it ,cc _ t•� Y _ -- s+ '� << <, t v .--� t . ,� ro()f s+b 4S't Boring # 1W . Boring f1ci .31 1�� wit D 3,>' f limiting in. / ft. [pit Ground surface elev. ft. Depth to factor elev. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIFt2 •Eff#1 'Eff#2 0--I '13.j-3/ - — 1S O-5 �J hi .1 L.6 •Z- —i-'40 rf .r %. „ ' h,f4 • f L. l7 } —!0 r 4 ccr5 . i is - , .(o V ''oo 5 .52 - CST Name MERTON MAKI Signature 3 CST Number 224901 Address 10869N SMITH COURT HAYWARD, WI 54843 Date Evaluation Conducted I 11 -2-br Telephone Number (715) 634-8719 Effluent #1 = SOD > 30 5 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L SBD-8330 (R04121) ❑ Boring &�3 Boring # ( 2S+ JO Pit Ground surface elev. ft. Page of 109 Depth to limiting factor in. / elev. ft. Soil Application Rate Horizon Depth In. Dom inan Color. Munsell Redox Description Qu. Az. Cont. Color Texture Structure Or; Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 O ~� rr/� • I Z �� 's -s Dt CO �{ /�l/� Z Y � '1 .7 l /I L ( t• Z-1 3 .... 3(e -tO ' [� 1t y. T IS 11/c4 - .-'.- _____ 1l ________ t 1 -.-- Vh j 4 •1 t . (. 1oct-Zr aBoring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Horizon Depth In. 4 . k is e_ Dominant Color Munsell r �.,. oN T Redox Description Qu. Az Cont. Color od :�. . e� t- Texture :-l5- K Structure Gr. Sz. Sh. c .r � 0 t Consistence Boundary Roots �, . Soil Application. Rate GPD/Ft2 'EfI##1 *Eff#2 Boring # ❑• Boring 1 O Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture J Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 ■ w * Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 s 150 mg/L *Effluent #2= BOO, < 30 mg/L and TSS s 30 mg/LAUG 07 2026 Bayfleld Co. Planning and Zoning Agency • $+ 3evl kKv�a. M • ClSO Sa rn . L22.Y-r .t. jJ..S5lSS__. t• c-7 q 5' o IS �-� L aayc LJ Co. e 6w 3g rt3J R. 0P.W W l2 W 33a N£ i vt q - t {'7. 10 7 • !, (r _. , . _ � .. .. �.. _ .. • .. .... � .... ....Words • .•. off-._ .. .. . ... - •. ... ... V��.��C�+ .._ . - •. . . - .. v. .. .. .. .. n t.. .. _ ��• .YY 1W .M1... Yt�Y....^•KS.aw�...�.I�. J. �i_. _ .. .. t _. Caq-3t` 3 X8.$3 :. _ .....:... • .. •. • . ••L/i • .. .... .TTh •L. •1!U.fl1z026 . .,.... Bayf�ld. C,o, Planning and Zoning Agency _ 0� [trsi . ... . . .__• • . • _ . - • e • _ � ..«� w+ iow� l_.if � • c1alco il±i "' • qc73/ two a��rr paoo• /�a { :�� � oo•ovo �ssae e � � E - I a � s _ • •ono. / .� 5T IIi _ : S • i T 1 i 11• -h-- \ " lx?, TEE.. • � 000 __ •t f R3 rte...' � �� oaoop000 S t oo.000E�mc+m �-- - BEGET i L-. f3 AUG 07 2 43 rev •• Plannerr• PnvfielJl • 90• qD BAYFIELD COUNTY SANITARY PERMIT (#04)-26-117S STATE SANITARY PERMIT OWNER: STEVEN P & ANNA M CARLSON G OV'T LOT: LOT: B LK: CSM: v.1162 p.107 1/4 1/4 SEC: 35, T 43 N, R 8 W TOWNSHIP: Cable SOIL TEST: 93-26 REPLACEMENT SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: RYAN STRAND SCOTT ROUSH DATE: 8/31 /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 798301 Condition: Properly Maintain System Per Recorded Agreement. Old System needs to be properly abandoned per SPS 383. THIS PERMIT EXPIRES 8/31/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION