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HomeMy WebLinkAbout26-135SRequest for Sanitary Inspection (24 Hrs. in Advance) Fax or email this form to Zoning Dept (24 Hrs.) prior to when you want an inspection Fax (715) 373-0114 or Email zoning�bavfieldcounty.wi.gov Note fl Time Change fl Discrepancy fl Other Phone Number Plumber: Po I k05k( h152Cl,t/5 Fax Number Homeowner: P�4-f'/V J (III Email Address Immediate Phone Number So Zoning Sanitary91 Permit#: .y `/ 35 Dept can call you right back (if needed) p`6 Plumber's Choice Zoning Dept No Inspection(s) during this time Date: l r�(� (Choice 6 Q Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Zoni pt Time: /0:30 Township: ref Address # & Road Name: _ U S GS O i2 U y t�ll)�/ J or / Directions `f552- To Site: Comments: ** Plumbers you must verify any change(s) by fax or email ** Notes from Zoning Dept: July 2025 MARLENE PETERSON REV LIVING TRUST 3330 HAYMEADOW RD RHINELANDER WI 54501-8538 . __.--.-...iOLDING TANK INSPECTION REPORT (ATTACH TO PERMIT) GENERAL INFORMATION Permit Holder's Name O City ❑ Village ❑ Town of t I Sanitary Permit No. Plan ID No. Tax Parcel No. Property ddress if Av able SETBACKS Property Line Well Water Service Building All -Weather OHWM Swimming Pool DEVIATIONS FROM APPROVED PLAN COMMENTS (Persons present, discrepancies, etc.) ,' �5 /l COMPONENTS NOT INSPECTED Plan Revl Io Required E Yes o Date: Signatyre of Inspector Cert. N be SJcefctyon other side 10 of 13 Property Owner Information DAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373.6138 Fax: (715) 373-0114 e-mail: zonino(�bayfieldcountv.wi.gov Web Site: www.bayfieldcountv.wi.cl0V/147 MARLENE PETERSON REV LIVING TRUST 3330 HAYMEADOW RD RHINELANDER WI 54501-8538 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know b /frI s, ` f, was contracted by you to install a private onsite wastewater treatment system on your property described as: Notes: Abandonment of Old System to meet all applicable code requirements: 1 .• Tank was pumped by: Tank was crushed I removed and pipes disconnected by: on at AM/PM On pr at l ' ,{ AM PM) the above -mentioned plumber contacted our office to conduct a cover inspection as requ under 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: Ulforms/sanitarypropertyowner-Input Apol 2019 Department of Safety County . & Professional Services, sa . rotary Permit Number {to be filled in by Co.) Industry Services.Division 135 State Transaction Number Sanitary Permit Application 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 Project Address (if different than mailing address) 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), Stats. ((u I. ApplicationInferinatio`n—Please,PrintAil-Information. c� 'tt/� Property Owner's Name M(4r j i.�✓ i: -'-- Parcel # Property Owner's Mailing Address ] Property Location 333 0 ` vl4ecL OtiJ Govt. Lot ,, �� % 1�/ E ySection 1 Z T .Sa N R • 'o City, State l r - ` • vt -� �• �7[ 4— W Zip Code s/ 5 1r Phone Number / % J ≤ T II. Type of Building (check that apply) Lot # Subdivision Name I or 2 Family Dwelling — Number of Bedrooms O Public/Commercial — Describe Use Black # NTF EO O City of O State Owned — Describe Use 1J Village of CSM Number Town of_'' - F� ''e L. III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C If a lleable. ,.,. A. New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) 19 Holding Tank 0 In -Ground ❑ At -Grade I ❑ Mound ❑ Individual Site Design I ❑ Other Type (explain) (conventional) C. 0 Renewal Before ❑ Revision ❑ Change of Plumber 0 Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dis ersailTreatment Area and Tank Information:' Design Flow (gpd) t r�� Design Soil Application Ratc(gpd/st) Dispersal Area Required (at) Dispersal Arcs Proposed (st) Jtcm Elevation Tank Information Capacity in Gallons Total Gallons # of Units Manufacturer New Tanks Existing Tanks w �. '40 SopiLl are Holding Tank O p _ Bee!»�Ctittmber V: Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown an the attached plans. Plumber's Name (Print) Plumber's i ture P/MPRS Number Business Phone Number Al l v. To l d -vs kc', ' ID) ji Plumber's Address (Street, City, State, Zip Code) . Ird. S'? -Z yvoW1 Z2� LJEtr i,i .L ≤-'8Y7 VI. n 1Depa'rtment Use Only Approved O Disapproved Permit Fee Date Issued Issuin Agent ' nature O Owner Given Reason for Denial ? O Conditions of Approval/Reasons for Disapproval 1 eL tLC/) ec. cv REcEntD A.1nwt..w ....... _,.. _ ! ..._ . - - - - SP 0e2026 2026 ----•--•- .--•....�..... r .... \..V Y,q\f.U\ NUN o..uuni w auu a.uuu(y only on paper ROT leSS inaa a 112X 11 inehes in size Bayflehi CO. Planning and Zoning Agency SBD-6398 (R. 03/22) U V I Lnivivllvu of LUNU No.. 9975 P. 2 1 Holding PAGE 1� 4F $ Tank Plan Index & Cover Sheet 11 Component Manna! Design References: , 1'Yir��uta. �� YF " Vr % PVty? — zoa-7) Pg 1 of 8 Index & Cover Sheet 1 Pg 2 of 9 Plot Plan Pg3of9 Pg4of Attachments: Pcj7 o4' Holding Tank Spealficatid'ns- z Management Plan Lnciosures: POWT$ A plica- Soil Evaluation F Holding Tank Pu Holding Tank Aa Project Name I Description n forlReviewCSc ►� port & Site Map if g Ding contract (if aai t (If applicable 1plicable) lcable) ef Des, Owner Name(s): I K 'e o ✓ . Phone: i/.S - o owner Address: 3 33 o ct cl eL./ J ....,_______.. Lr {per. Project Address: 3 IP S c P t#,r T_ ; j rr 'IV tF4, vine. Govt. Lot: �, tJ VJ 1 /4 of /' ,1/4, Section-, T I -R E M or W Township: cy-P. Q County: i3 c Project Parcel ID #: (S≤z. _j.. Designer Information Designer Name: A //C +-t Flo /c": a s Phone: fry S" Designer Address: '? b n Qi. :Zip: S`Y�' fl7 E-mail: _t hy cay _ L Thi space resell for approval stamp. License Number: 7- 2. d o 'I 0 Remarks: S I ,Signature: ( Da1e: Orfgfnal signature required on each submitted copy. RECEIVED SEP 08 2026 Bayfield Co. Planning and Zoning Agency L�g cd r; p+� v\ 1''e.4evsoii t*JE4 S.lz i`s'N p& w tZe.'i Li, Js vS! y4. 4 b 3330 � c-yPvLe JocJ T ew h oo f a 434Yr,,e �� •'��I.i K'� � � K � +E: i/ ����s`�1 C..�^ �t.vl T o I� rt � id ;r€ -34e4' C-1-Lr H 'y i o -f St,u rus; 1- S Sc�..1e.o I'= /a'a i 1e s n Ls4f,� R9 ; C -t— y !-f y . ZS �o e� 1 av vJ esev c�ncrre4 .1j k= lr jew Lt II)) 13zo 11.S Sn a `t S t4 53 lL.a�y n3 i45, r: v . +v c• 2? , loo 7 ?vied A.1=& = Above. -crnck ret j e 9�vi U-kP'=-E1 e.0 ioo o, 4"AsT1ry1 D 17Ips- «,�l� V -o Ve 4 F: P AL4.+e.&rf ( ! i 13 z n, RECEIVED SEP 082026 Bayfield Co. Planning and Zoning Agency H D l ! 1q ) cin Ce..l j7vt eTt J IY� n Ltid/ Lz5c( 4 /netAIU. L L 1 pi~ V� R 2 ° Y Y1�lct 2e z2 Z®Y7 Arab, $y:M.P 5.2tco e ?®lkos kf Pl a ivt bf vic:j P. a, !3 o K ≤2.2. J- on R. ve.v, w2-TV;FY7 PROPERTY OWNER: PLUMBER: Allan Po SIGNATURE: f Y / DAVE: I - z LICENSE # 220Q90 HOLDING TANK SPECIFICATIO Ns Number of bedrooms Non-residential estimated flow (gpd) 00,0 Minimum holding tank volume'required (gal) Tank, Dtmens1ons and Data X for round tank a .0 8.0 ` Liquid depth below inlet Invert (in) Maximum de th of soil cover (ft) 71.0 Height (in) 169.9 ' Outside Length (in) Dimensions Width (In) Only Manufacturer model number manufacturer Iber Tank Anchor Calculations 0lbs Weight of tank and cover q'1;Mr1lbs Safety factor Weight of anchor required 40.8 in Soil cover req. for anchor or 8.8 yda Concrete counterweight HOLDING TANK CROSS SECTION manhole cover with Junction box ..� locking device and ffntahed warring label grade vent cep !r 4" min, 4-- `j' <--.24 In. 12" min. conduit ---- 0 Manhole and vent locations may be reversed. vent pipe 18" min. r••.-•.ww•r•.w.r•�.�..wr.�..w.w.r.--•w•y. ______________ �.r... r..•.w. wr. �..�. �.•M. P•.� '12.0 r. service in, building sewer blind plug alarm on Note: All tank joints, and Inlet to seal outlet joints between tank Electrical as per openings and piping are NEC 300 39.0 in. sealed watertight. All pipe and Comm 'le and vent materials comply �C50EIV D w1thSFsjrS3 SEP 08 2026 3 In. bedding under tank. Tank Is anchored as necessary to negate buoyancy. Hayfield Co. Planning and Zoning Agency 7A adi IC C 1831" 4" CAST -A -SEAL 4" CAST -A --SEAL X24 / FILTER OR • BAFFLE TOP VIEW Q ix INLET __ OUTLET U M M U SIDE VIEW I TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS WLP2500 TANK SPECIFICATIONS DIMENSIONS: o WALL: 3" °- BOTTOM: 3" HEAVY -5" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER =p HEIGHT: 52-3/4" O.D. LENGTH: 183-1/4" O.D. WIDTH: 101-1/4" O.D. L) BELOW INLET: 41" O.D. cn o LIQUID LEVEL• 36" WEIGHT: TANK - 3" BOTTOM 12,560 LBS. TANK - 5" BOTTOM 15,527 LBS. N WEIGHT: COVER 9,300 LBS. W cn '- INLET AND OUTLET: m 4" CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: o o WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) W BAN LIQUID CAPACITY: 69.44 GAL/IN L HOLDING TANK: co OUTLET HOLE PLUGGED C o d�- ACTUAL CAPACITY: 2.639 GALLONS ® Zap W LOADING DESIGN: 8' 0" UNSATURATED SOIL < uj = TANK CAN BE USED AS: N) SEPTIC/ HOLDING/ PUMP OR SIPHON O COVER: MIX DESIGN #8 (NO FIBER) c TANK: MIX DESIGN #9 (SMALL FIBER) m to CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: N J5 N U 1= W W N w SHEET NO. 1 OFD 1 2 c C C a HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according tof393 Wis. Admin. Code, the Holding Tank Component Ilanual.,5eda 6` 6-h l Typo tER 2,o and the 11 County Sanitary Ordinance. \f J) j L Y } 1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 400.0 gpd. • 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed In the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. Al! corrective actions shall comply with the county sanitary ordinance and 'PS 383 and 84 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with 5P5 963.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer ............................. 1 rJ vv s.it .2: oogO Phone: ,,,� 37z-� Lll �i m.P1J. S. b. Service Provider................... Sp4; a Phone: zi,-. c. Co. Zoning or Health Dept. a e'u ni-m Phone: 7/3 y. �i drLo.c: c e wi4o4a ?a - ?a -I Th a 1C Dtj3S z_ Project Transaction Number: RECEIVED SEP 08 2026 Bayfield Co. Planning and Zoning Agency HOLDING TANK SERVICING CONTRACT Contract Dzii ate This contract is made between the Holding Tank Owner(s) Name(s) YM � t n .e `�� � v s rev L� vi vi r v S Pumper's Name (Print) 1kw.@3?'1kc.skd Signature Pumpers' Registration•# 7PuZrls (2Q71 - We acknowledge the Installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT I LOCATION Legal Description; Tax IOU z----�1't= ,� f•� JT 1 4 1 (Use Tax Statement) -------- , Section Z(� ,Township N, Range W Town of: Lot Size Acreage r r I ,.,c Gov't Lot Lot # CSM # Vol. Page CSM Doc # Lot(s) No. Block(s) No. Subdivision: 1. The owner agrees to file a copy of this contract with Be field County as required in SPS 383.55, Wis. Adm. Code. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred In servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local government unit which has signed the pumping agreement required by SPS 383.55, Wis. Adm. Code, and the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following In the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; RECEIVED d. The sanitary permit number Issued for the holding tank; e. The dates on which the holding tank was serviced; SEP 0 8 2026 f. The volumes In gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. Bayfield Co. Planni and Zoning Aency 4. This agreement will remain in effect until the owner or pumper terminates this contract, in the event't a c ange�in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local government unit and the County named above within (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner's Signatures) Subscribed and -Sworn to me: on this _____day of Gtrb, ♦ y: • •q NotaryPublic NO Tq �•.� 14y commission expires on: Revised: May 2016 (®May 2018) ; '\ ��$ L t G I Drafted by Pz Personal information you provide may be used for secondary purpoaq�s p'v cy Law, s.15r01 )J ec 00. Document Number/Plan I.D. No. bLDING TANK AGREEMENT Owner Name ( � ���� Owner(s) Mailing Address YYI a , 333 O [�e.V LJlyL IOq(j 42 - We acknowledge that application is being made for the installation of (a) holding tank(I on the following property or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. SPS 383. Wis. Adm. Code or Ch. 145, Wis Stats. 1/4 of 1/4 Section Township �b N. Range _ W. Town of f -e 1 r t o Additional Legal Description: l 0 r 2 XK b&CZL Z3 A— S Gov't Lot_ Lot Block ubdivision CSM# Lot CSM # Vol Page CSM Doc# DOCUMENT NUMBER 2026R-613704 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 09/09/2026 AT 2:59 PM RECORDING FEE: $30.00 PAGES: 1 RECEIVED SEP 10 Return To: Planning and Zon'ng g9ency Zo ki r vl As an inducement to Bayfleld County to issue a sanitary permit for. a holding tank on the above described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. SPS383, Wis. Adm. Code relating to holding tank installation and maintenance. If the owner falls to have the holding tank properly serviced in response to orders issued by Bayfield County or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Stats., Bayfield County may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats. 2. Owner agrees to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. 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 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. 3. The owner agrees to contract with a person who is licensed pursuant to s.281.17 (3) Wis. Stats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced in accordance with Ch. NR1 13, Wis, Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed pursuant to s. 281.48 (3) Wis. Scats., and Ch. NR 114, WI's Adm. Code who shall submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfleld County may enter upon the property to Investigate the condition of the holding tank when pumping reports and meter readings may Indicate that the holding tank is not being property maintained. 5. This agreement will remain In effect only until Bayfield County certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. SPS 383, WI's Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement In such manner which will permit the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds In a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is Installed. Owner(s) Name(s) — Please Print vtf_.s&iv Notarized Owner(s) — Signature(s) �.� P�rcU°► S:,ry Drafted by: © e 1 9� & s k e N �'% Av0 L\G' , Personal information you prov de may be used for secondary purposes (Pdvacy. i1b,WI (Um)). - - - q 1r W�SG sworn to uetore me on 22 /l/Zz L9 g- 3i --z to ulformslsantlarylholdingtankagreement.doc ®June 2018 llo _ ( �o Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 'of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Count y BAYFIELD Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel E.D. 4552 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 7 jj A,r wv i/C - 6 -- ac Property Owner Property Location ■ MARLENE PETERSON Govt. Lot NW 114 NE 1/4 S 12 T 50 N R 4 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 3330 HAYMEADOW RD City State Zip Code Phone Number ity f Village ■Town Nearest Road RHINELANDER WI 54501 ( 715) 369-1127 CTY HWY J 19 New Construction Use Residential! Number of bedrooms I Code derived design flow rate 150 GPD ® Replacement ® Public or commercial - Describe: Parent material GLACIO TILL Flood Plain elevation if applicable ft. General comments HOLDING TANK D U YE and recommendations: SEP 2.9 2020 1 Boring # 11 Boring rj pit Ground surface elev. N/A _ft. Depth to limiting factor 4 ipatetd CO. onn.g Dept Anil Annliratinn Ratp Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft= *Eff#1 *Eff#2 1 0-4 5YR3/2 LS 0SG MVFR CW 3M .7 1.6 2 4-10 • 5YR6/4 C2D 7.5YR 6/6 LS 0SG MVFR AW 3C .7 1.6 3 10-19 5YR4/4 M2P 5YR 6/8 S 0SG MVFR GW 2F .7 1.6 4 19-60 5YR4/4 M3P 5YR 6/4 S 0SG MFI - IF .7 1.6 2 Boring # (3Boring N/A 9 El Pit Ground surface eiev. ft. Depth to limiting factor in. Snil Annftratinn Ratty Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft *Eff#1 *Eff##2 1 0-9 SYR3/2 LS 0SG MVFR CW 2M .7 1.6 2 9-11 5YR6/4 C2D 7.5YR 6/6 LS 0SG MVFR AW 2F .7 1.6 3 11-24 5YR4/4 M2P 7SYR 6/8 LS 0SG MVFR GW IF .7 1.6 4 24-60 5YR4/4 M3P 5YR 6/4 S 0SG MFI - - .7 1.6 * Effluent #1 = BOD > 30 < 220 mg/t. and TSS >30 < 150 mg/L * Effluent #2 = BODS ≤ 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signa CST Number BRUCE W BLAKEMAN ti 708148 Address Date Evaluation Conducted Telephone Number 64903 CHARLES JOHNSON ROAD ASHLAND, WI 54806 09/21/2020 715-209-2569 4m /O -g-8O... Property Owner PETERSON Parcel ID # 3 Boring # Ci Boring N/A 19 Pit Ground surface elev. ft. 4552 Depth to limiting factor 4 in. 2 3 Page of Anil Annlirafinn Rata Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 1 0-4 5YR3/2 LS 0SG MVFR CW 3M .7 1.6 2 4-10 5YR6/4 C2D 7.SYR 6/6 LS 0SG MVFR AW 3C .7 1.6 3 10-19 5YR4/4 M2P 5YR 6/8 S 0SG MVFR OW 2F .7 1.6 4 19-60 5YR4/4 M3P 5YR 6/4 S OSG MFI - IF . .7 1.6 Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. Snfl AnnFrratien Rafe Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff *Eff#1 *Eff#2 Boring # (1 Boring © Pit Ground surface elev. ft. Depth to limiting factor in. Cnff Annr; ffnn Rata Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fF *Eff#1 *Eff#2 * Ef uent #1 = BOD5 > 30:5 220 mg/L and TSS >30 ≤ 150 mg/L *Effluent #2 = BOD5 30 mglL and TSS 30 mglL The Department of Commerce is an equal opportunity service provider and employer. Ifyou need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD•8330Ten (R.07100) BAYFIELD COUNTY SANITARY PERMIT (#04)-26-135S STATE SANITARY PERMIT OWNER: MARLENE PETERSON REV LIVING TRUST G OV'T LOT: LOT: B LK: NW 1/4 NE 1/4 SEC: 12, T 50 N, R 4 W TOWNSHIP: Bayfield SOIL TEST: 166-20 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: ALLAN POLKOSKI EMILY MACGILLIVRAY Authorized Issuing Officer DATE: 9/17/2026 CHAPTER 145.135(2) WISCONSIN STATUTES a. The purpose of the sanitary permit Is to allow installation of the private sewage system described in the permit. b. The approval of the sanitary permit is based on regulations in force on the date of approval. c. The sanitary permit is valid and may be renewed for specified period. d. Changed regulations will not Impair the validity of a sanitary permit. e. Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. f. The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221;1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. PREVIOUS PERMIT #: LICENSE: # 220090 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 9/17/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION