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HomeMy WebLinkAbout26-129S"eld u = , SS o0`6 a'S Department of Safety & Professional Services, Industry Services Division gee�,Ft3' Sanitary Permit Number(to be filled in b Co.)SP by aC-1z9S Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2). Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. Project Address (if different than mailing address) I. Application Information —Please Print All Informal i n Property Owner's Name Melissa Giesregen E 2/2026 Parcel # 10657 Property Owner's Mailing Address Property Location 16895 Stone Pine Dr SariaZZd Co Govt. Lot City, State Zip Code Phone Numbern Cable, WI 54821 715-828-8073 NE ,, SE y, Section 15 T 43 N R 07 E or W II. Type of Building (check all that apply) ® I or2 Family Dwelling —Number ofBedrooms 1 Lot # Subdivision Name O Public/Commercial — Describe Use Stone Pine Subdivision Block# ❑ Cityof ❑Village of ❑ State Owned —Describe Use CSMNumber 12 Townof Cable M. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete fine C if a licable A. New System Y ❑ Replacement System p y ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank ® ln- round GO O At-GradeTyp Mound 0 Individual Site Design 0 Other a lain (explain) (conventional) C. ❑ Renewal Before ❑Revision O Change of Plumber ❑ Transfer to New OwnerList Previous Permit Number and Date Issued Expiration IV. Dis ersaVfreatment Area and Tank Information: Design Flow (gpd) 150 Design Soil Application Rate(gpd/st) 0.7 I Dispersal Area Required (sf) 214.3 I Dispersal Area Proposed (sf) 226 System Elevation 95.4 Tank Information Capacity in Gallons Total Gallons # of Units Manufacturer 8 a B v. d o $ y i'n 05 " 4v _ 0sc3 a New Tanks Existing Tanks Septic or Holding Tank 540 540 1 Infitrator Sstems X Dosing Chamber V. Responsibility Statement— I, the undersigned, a i respo ' ility f r i Ratloa of the POWTS shown on the attached plans. Plumber's Name (Print) Plu bar's ignaI MP/MPRS Number I Business Phone Number Douglas Manthey 230722 -PM I 715-739-6868 Plumber's Address (Street, City, State, Zip Code) PO Box 196 Drummond, WI 54832 VI. County/Department Use Only proved Cl Disapproved ❑ Owner Given Reason for Denial Permit Fee Date lssu 9' Pv Issui A ignature Conditions of Approval/Reasons for Disapproval i 0 C $ f <' Q *d da or rile system and suamrt to me Lounty only an paper not less than 8 in s Ii inclies in size SBD-6398 (R. 03/22) S R- ooso t Wisconsin Department of Safety and Professional Services OR! GIN AL Page 1 of 3 Division of IndustryServices SOIL EVALUATION REPORT -- ps y SOIL TEST # 13& In accordance with SPS 385, Wis. Mm. Code County BAYFIELD 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, Parcel I.D.. TAX ID # 10657 scale or dimensions, north arrow, and location and distance to nearest road. Please` lon. Reviewed by Date 1/Personal Information you provide may be�hjirr on�ary purposes (Privacy Law, s. 15.04(1)(m)) p _ Property Owner: Property Location ❑ MELISSA S GIESREGN PUG 212026 Govt. Lot N _ ' g E % S 15 T 43 N R 07 E (or) W Property Owner's Mailing Address BayfeldCo. Site Address or CSM and STONE PINE SUBDIVISION LOT 25 IN DOC 16895 STONE PINE DR. nd Zoning cy { a annin9 2020R-582067 1265 City State I Zip Code I Phone Number ❑ City 0 Village Town Nearest Road 16895 CABLE W 54821 (•1 jy` $ ' lme STONE PINE DR. pa New Construction Use: Residential/ Numberof bedrooms ! Code derived designflow rate /SD GPD ❑ Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material GLAICIAL OUTWASH General comments and recommendation: '/"1 f OF S Ysf e.�.. �L �•f'y Boring # Boring ���� Pit )C Ground surface elev 98.4 ft. Depth to limiting factor 120 in. / elev.88.4 ft. I Soil Annlication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 1 0-7 7.5 Y/R 3/2 LS 2MGR MVFR GW 2COVFF .7 1.6 2 7-16 7.5 Y/R 4/3 S OSG ML GW 1COVF .7 1.6 3 16-40 7.5 Y/R 4/4 GRS OSG ML GW 1VF .7 1.6 4 40-120 7.5 Y/R 514 S OSG ML ---- 1W .7 1.6 Boring # Boring JPit Ground surface elev. 98.1 ft. Depth to limiting factor 120 in. / elev._88.1 ft. I Soil Anolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 1 0-8 7.5 Y/R 3/2 LS 2MGR MVFR GW 2COVFF .7 1.6 2 8-16 7.5 Y/R 413 S OSG ML GW 1COVF .7 1.6 3 16-42 7.5 Y/R 4/4 ORS 0SG ML GW 1W .7 1.6 4 42-120 7.5 Y/R 5/4 S OSG ML - 1VF .7 1.6 CST Name (Please Print) Signature CST Number SP -012100001 RICHARD RAUCH Address 11370 BONDEGARD DR. Date Evaluation Conducted Telephone Number CABLE WI. 54821 6/3/2026 715-681-1190 * Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOO, 5 30 mg/L and TSS s 30 mg/L SBD-8330 (R04/21) Page 2_ of _3` O Boring Boring # ` J Pit Ground surface elev. 98.4 ft. Depth to limiting factor 120 in. I elev 88.42. I Soil ADolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 1 0-7 7.5 Y/R 3/2 LS 2MGR MVFR GW 2COVFF .7 1.6 2 7-14 7.5 Y/R 4/3 S OSG ML GW 1COVF .7 1.6 3 14-48 7.5 Y/R 4/4 GRS OSG ML GW 1VF .7 1.6 4 48-120 7.5 Y/R 5/4 S OSG ML ----- 1VF .7 1.6 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Soil Anolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Soil Annlication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 £ 220 mg/L and TSS > 30 £150 mg/L csl �c O/1(9f * Effluent #2 = BOD, £ 30 mg/L and TSS £ 30 mg/L RECEIVED AUG. 2::7 2026 • Bayfleld Co. J RECEIVED 2 l 2026 AUG fi Ba wCo planning and Zoning Agency StiQ� nskI4 `" p'� ____ L 03 ��L ssQ S%mss tg6e1 ,is` 5 ,Lcvre J i to D/A. Cq b i U i• ,V /9I t 4e&1 lS.Y ASq V ict� 1jj:. towam-i�.61� 7•x tc/a7 $/ � 1 �I3A' RO7 $,tone fr n .e S K j d•' ise' l — s'fd i- o6 A6 $` 4 0 T .T S" >" F30 G .2 Li s' ,&S146 rdOob 11 1$A' 133 q.q L. fro 13 ;l ci'i5 e 7t/ 3 043 GS1`� 2,2J 0000 7'c -6S (- Jt9' PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: RECEIVED In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) AUG 271026 Pg 1 of 4 Index & Cover Sheet BayBeid Co. Pg 2 of 4 Plot Plan wing and Zoning Agency Pg 3 of 4 Dispersal Area Cross -Section & Plan View Pg 4 of 4 Management Plan Attachments: Enclosures: Infiltrator Tank Specs POWTS Application for Review Property Listing Soil Evaluation Report & Site Map Project Name / Description Altmann/Giesregen Conventional Owner Name(s): Melissa Giesregen Owner Address: 16895 Stone Pine Drive Cable, WI Project Address: 16895 Stone Pine Drive Govt. Lot: NE 1/4 of SE Township: Cable Project Parcel ID #: 10657 Phone: 715 828 8073 Zip: 54821 1/4, Section 15 T43 N -R 07 E ❑ or W ❑✓ County: Bayfield Designer Information Designer Name: Douglas Manthey Designer Address: PO Box 196 Drummond, WI E-mail: norpines@chegnet.net License Number: 230722 -PM Remarks: Signature Phone: 715 .339 6868 Zip: 54832 .- <racc resvnrJ k r stain H. Date: 08/25/2026 Original ature4redeach miffed copy. PA5c z o c y �-- 'Si RECEIVED AUG 272026 sayfield co. Planning and Zoning Agency Tank' Ed/Ore.co �ASalaFel.p'y+` \ . g��sc • \\l__ it O„,cL4 cLo...-.Lcr, 63 SI0Pt '6� o Y \ �T 'ReL,;sSQ 5 G/c5PtGeit DA \ 5Yt //oS9e- Sfavre //rte \ Cgb(e W.i• ryg�t y8.� vawT Le_i SS.Y IOWIi G!T �'C — �T�I C�KJLy QNL� PDNg lza ,�lV ��'/ T4x *0("IL06✓G- 7 5! i> 7' q 3Al R o l +-.- bt Lt” `A LiO er5D(Z3S PUG $foNe t;nc S46d.✓ise'oe-r 4orgS /O Oct Zozo5 F2o6'� CO OKe4 (Vo¼�a Q WI A = !C o 5e.\ 1��0<orO on c,. Q0 ZctS /36h TO Io O - S iq �j eFlt S !'44oOh 4ZA Uers, ,1l �S/�� - IS! UN 133 Q.N t?L. G' Yv. y fro l� l�t+s $2 9B•`� 230 022- — P1c1 IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER 2' min. trench depth (typical) -'I' 34, (typical) System Elevation = 95.4 (typical) Septic Tank(s) Manufacturer: Infiltrator Septic Tank(s) Volume(s): 540 gal gal gal gal Effluent Filter Manufacturer. Orenco Effluent Filter Model a: PSCS0621-18 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) ft Quick4 Standard -W w/ End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) ---------- — — — — — — — --f--------��---- L— — — — t — — — — — — — B=46 ft (typical) INSTALL PER TRENCH: 11 Quick4 Std -W @ 20 ff EISA/chamber = 220 ft2 + 1 Pairs of end caps @6 ft2 EISA/pair = 6 ft2 = Proposed EISA per trench = 226 ft2 Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturers / Instructions. TYPICAL TRENCH PLAN VIEW (No Scale) -- —� T zwininitaLl I A=3.0ft i (typical — — — — J �I d� "—Quick4 Standard -W Chamber N (typical) 5 (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. Required Infiltration Area = 214.3 ft2 m C) m m a Distribution Method: x 1 trenches = Proposed Total EISA = 226 ft2 branched manifold GD m C)) O 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 = 150 gpd; BOD5 5 220 mgL'1; TSS S 150 mgL-'; FOG 530 mgL Inspection Checklist INSPECT EVERY 3 YEARS RECEIVED o type of use o age of system AUG 27 2026 o nuisance factors (Le. odors, user complaints, etc.) Bays o mechanical malfunction (L.e., pumps, valves, switches, floats, etc.) pinkq and zorting Agerwy o material fatigue (i.e., 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 (i.e., 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 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 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: HK Septic Local government unit: Bayfield County Zoning Phone: 715-373-6138 Phone: 715-798-3494 Local government unit address: PO Box 58 Washburn, WI ZIP: 54891 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 dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment f use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. ACCESS PORT RIM 1.5 [38] A A' FLEXIBLE LID ELASTO-MERIC GASKET (TYP.) O 61.7 O. 1,56 TANKF'TREQUIRED NLET/ E WIDTH R INTERIOROUTLET WIDTH EE, IF PIPE PENETRATION SECTION DETAIL 64.9 [1,648] EXTERIOR LENGTH LIFTING STRAP INLET (TYP.) CONNECTION TOP VIEW (TYP.) o 024 [610] ACCESS OPENING WITH LOCKING LID 10.6 [269] FREEBOARD OUTLET CONNECTION C) (TYP.) ¶t N [1,38 O L9477 f` " EXTERIOR DEPTH I N 'g HEIGHT �® ISOMETRIC VIEW SECTION A -A' END VIEW NOTES: 1. ALL DRAWING DIMENSIONS IN INCHES (MILLIMETERSI OR AS NOTED. 2. EXTERIOR OR ACCESS OPENING LID INCLUDES THE FOLLOWING WARNING IN IQDRAWN DV ENGLISH, FRENCH & SPANISH:'DANGER 00 NOT ENTER: POISON GASES. - L 3. TANK MARKINGS WILL INCLUDE: MANUFACTURING NAME, MODEL NUMBER, LIQUID infiltrator P/N CAPACITY, DATE OF MANUFACTURE CODE, MAXIMUM BURIAL DEPTH, INLET, AND OUTLET. ' -Tan k 4. THE TANK MAY BE LLED WITH SUITABLE NATIVE SOIL. SEE INSTALLATION INSTRUCTIONS FORTHEN DATE ITH GUIDANCE. IF THE NATIVE SOIL DOES NOT MEET THE INSTALLATION INSTRUCTIONS Water Technologies 05/12/2025 5. GUIDANCE MUM BURIALDEKPTH IS 4FILUNG9In (1219 mEm MATERIAL WILL BE REQUIRED. ppR o(A" fLV SCALE S. MINIMUM BURIAL DEPTH IS S In (152 mmL 7. TANK IS FOR NON -TRAFFIC APPLICATIONS. INFILTRATOR WATER TECHNOLOGIES. LLC IM -540 NTS S. AIRSPACE IS 13.9% 4 BUSINESS PARK RD. OLD SAYBROOK. CT W75 SHEET NO. 9. INLET TEE MAY NOT BE REQUIRED BY DESIGN. PUMP/SIPHON TANK W WW.INFILTRATORWATER.COM PHONE: 18001221-4438! EMAIL INFO®INFILTRATORWATER.COM CONFIGURATION 01 of 01 C. TOTAL CAPACITY 552 GALLONS WORKING VOLUME 475 GALLONS Firefox https://novus.bayfieldcounty.wi.gov/access/REAL%20ESTATE/l istin... Real Estate Bayfield County Property Listing Today's Date: 8/25/2026 Imo' Description Updated: 7/31/2020 Tax ID: 10657 PIN: 04-012-2-43-07-15-4 00-289-22000 Legacy PIN: 012122801000 Map ID: Municipality: (012) TOWN OF CABLE STR: S15 T43N R07W Description: STONE PINE SUBDIVISION LOT 25 IN DOC 2020R-582067 1265 Recorded Acres: 0.680 Calculated Acres: 0.681 Lottery Claims: 1 First Dollar: Yes Zoning: (R-1) Residential -1 ESN: 108 Tax Districts Updated: 3/15/2006 1 STATE 04 COUNTY 012 TOWN OF CABLE 041491 SCHL-DRUMMOND 001700 TECHNICAL COLLEGE Property Status: Current Created On: 3/15/2006 1:15:10 PM a Ownership Updated: 7/31/2020 MELISSA S GIESREGEN CABLE WI Billing Address: MELISSA S GIESREGEN 16895 STONE PINE DR CABLE WI 54821 Mailing Address: MELISSA S GIESREGEN 16895 STONE PINE DR CABLE WI 54821 P Site Address * indicates Private Road 16895 STONE PINE DR CABLE 54821 91 Property Assessment Updated: 7/27/2026 2026 Assessment Detail Code Acres Land Imp. G1 -RESIDENTIAL 0.680 6,800 219,600 2 -Year Comparison 2025 2026 Change Land: 3,400 6,800 100.0% Improved: 134,000 219,600 63.9% Total: 137,400 226,400 64.8% 56 - Recorded Documents Updated: 3/15/2006 — O WARRANTY DEED N/A Date Recorded: 5/11/2020 20208-582067 © QUIT CLAIM DEED Date Recorded: 8/28/2015 2015R-560162 1148-96 © QUIT CLAIM DEED Date Recorded: 8/9/2013 2013R-550831 1112-301 © CONVERSION Date Recorded: 437-83;758-84 History RECEIVED AUG 2 7 70z6 Bayfield Co. Planning and Zoning Agency I of 1 8/25/2026, 8:30 AM BAYFIELD COUNTY RECEIVED CHECKLIST FOR SANITARY APPLICATONS AUG 27 2026 'Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) BayRea Co. planning q and Zoning Agency Original Sanitary Application (Submitted in Deed Holder's Name — not prospective buyers) (383.21(1)1.) CX'lndex Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) &iginal Plot Plan (383.22(2)2. 3. & 4.a) 2 -cross -Section, Overhead Profile of the System and Schematic of Tank from Manufacturer ❑Pump Tank Diagram, Alarm and Pump Curve (when applicable) L3 Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) ❑ Maintenance Agreement (Owner's Original Signature(s)) (383.21(2)(c)(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 (383.21(2)(c)(5) (Recorded at Reg. of Deeds) ❑ Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 21 Complete Set of Plans (Note: Sanitary Application — Maintenance Agreement & Service Cr to be pp � included in the copy packet) t' ..exAv.c.. w i U akdCaew- Iota, tecoaur t re --\-�(1 v Fr j ❑ 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) tat Application Information must include: or 5 digit) Tax ID# -- (do not use 12 digits anymore --obsolete) L2 -Project Address or Road Name where driveway is/will come off of) B -(Owners Phone Number) ?1 11 Type of Building aII Type of Permit Type of POWTS System L? V Dispersal / Treatment Area Information CSI VII Tank Information �I Responsibility Statement (Plumber's Information) 2 *Date Stamp* Plot Plan: (To Scale or To Dimension) O'Signature and Plumber Information 0 Surface Elevation of Body of Water C4tlrection and Percent Land Slope l"1'cnk and Filter Information and Location 0 Wetlands / Navigable Bodies of Water isorption Area (Proposed and Existing) e Bench Mark (Location, Elevation and Description) dress Number and Road f'Crth Arrow atontour Lines dructures and Driveways Wiring Locations f ' perty Lines aWell Locations 'omponent Manual Version ❑-Legal Descriptions C -"Piping Material Information (conveyance line, building sewer line, material type and diameter) Turn Over ► Cross -Section and Overhead Profile of the System: surface and System Elevation c'Position of Observation and Vent Pipes @timensions and Depths ❑-Make, Model & Number of Chamber Units in each Cell Prooertv Information ❑ How many systems will there be on this parcel of land? I O Has this property been split? (Property Statement shows Property History) Fees: PlPrivate 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 RECEIVED AUG 212026 Bayfield Co. Planning and Zoning AoenCY ❑ Maintenance Agreements • $ 30.00 (check should be made out to Reg of Deeds) a (A full legal description is required at the Register of Deeds Office). If you have a legal description that states "parcel in or part of you must attach a copy of your deed showing the metes and bounds description in order to be recorded. Examples: located in part of Gov't Lot 4, Section 1, Township 23 N, Range 4 W, Town of Bayfield, described as a parcel in the NE % of the SE ''%, Section 1, Township 23 N, Range 4 W, Town of Bell u/fortes/checklists/checkllstforsanitaryapps (08/5/2026) . ' BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS RECEIVED Submit the Following (Use Permanent Ink): AUG .272026 Wheck List sayfieid Co. Planning and Zoning Agency O Index Page / Title Sheet (Optional) C"Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) l2-riginal Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) larcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used 2 -Property Owner's Information not prospective buyer's name) (Property Location (Accurate Legal Description with Sec/Twp/Range) ❑ Road Name (where driveway is/will be coming off of) ❑ Floodplain Elevation, Flow Rate, Comments and Recommendations ❑'Complete Soil Boring / Pit Information [ Date Soil Evaluation was conducted <ST Name, Signature, Number, Address and Phone Number ❑ *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) (Bench Mark (Description, Elevation and Location) Contour Lines (Example = 98.0' /96.0' /94.0') a -Property Location (Sec/Twp/Range/, Accurate Legal Description) fa'Borings (Locations and Elevations) [percent and Direction of Land Slope 11Well Location (Including Neighboring Wells, if applicable) O Location of Wetland Areas, Floodplain and Navigable Waters Buildings, Driveways, and Structures (Location and Descriptions) D'tocation of Property Unes 13" Existing System Location 11Address Number and Road Name O Current Surface Elevation of Wetlands and Navigable Waters C!CST, Owner and Property Information CiNorth Arrow Fee: U'Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checkiist/dieckiistforests 13�-A�FIELD 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: GIESREGEN, MELISSA S 16895 STONE PINE DR CABLE, WI 54821 Description Certified Soil. Tests - Review & Filing Fee Submission Number: SR -00501 Transaction Number: SR -00501-55548 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 5519 Paid by: A -Z Enterprises, Nor -Pines Plumbing, PO Box 196, Drummond WI 54832 Payment Type: Check Transaction Date: 9/15/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. Private Sewage System Maintenance Agreement Melissa Giesregen 16895 Stone Pine Dr 10657 As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil tester's report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established in the WI Adm. Code, as from time to time amended. (COMPLETE Legal is required) NE 1/4 of SE 1/4 Section 15 Township 43 N. Range 07 w Additional Legal Description: Town of Cable (Acreage) .68 Gov't Lot Lot 25 Block Subdivision Stone Pine Subdivision Lot_CSM#_ Vol._ Page_ CSM Doc# DOCUMENT NUMBER 2026R-6 1 3742 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 09/14/2026 AT 1 1:03 AM RECORDING FEE: $30.00 PAGES: 1 Return To: Planning and Zoni p" 't r }�QApattmer SEP 15 2026 Area la In -ground gravity ❑ In -ground dosed O 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 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 maKt such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. Pump Chamber (system types B, C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wiis. 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 pending on the ground surface. Mounds At -grade. and In -ground Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. ,1 till d inure to the benefit of all current and future owners of such property. Owner(s) Name(s) — Please Print • • •9,,0' • • •e, y s'c Subscribed and sworn to before me on this date: •• Notarized Owner(s) — Signature(s) %: ��0%(S11�`�```` '" My Commission Expires: bY) I z Drafted by: Oe key Date: 08/25/26 Proofed by: u/forms/sanitarylseptcmaintenceagreement Revised July 2020 LYFIELD 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: GIESREGEN, MELISSA S 16895 STONE PINE DR CABLE, WI 54821 Description Private Sewage System (Septic Tanks) Submission Number: SS -00825 Transaction Number: SS-00825-4D28D Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 5520 Paid by: A -Z Enterprises, Nor -Pines Plumbing, PO Box 196, Drummond WI 54832 Payment Type: Check Transaction Date: 9/15/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-129S STATE SANITARY PERMIT OWNER: MELISSA S GIESREGEN GOVT LOT: LOT: BLK: SUBDIVISION: Stone Pine NE 1/4 SE 1/4 SEC: 15, T 43 N, R 7 W TOWNSHIP: Cable SOIL TEST: 132-26 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: DOUGLAS MANTHEY SCOTT ROUSH DATE: 9/15/2026 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 230722 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 9/15/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION