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HomeMy WebLinkAbout26-140SRequest for Sanitary inspection (24 Hrs. in Advance) 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 all staff members. Note Time Change fl Discrepancy fl Other Phone Number Plumber: pp •a11Ufy h%1Sli!U5/n .T r _____ Fax Number 7/i- 77:V - 7n Homeowner: �/ -, (li /%i% /1 _3Y Email Address -Tio-Olntliy,u3S,&>,t l 1e ('1ISiJtJ e,� Qlt�jl i (6Th Sanitary Permit #: a r) & _,qO Immediate Phone Number So Zoning Dept can call you right back (if needed) Plumber's Choice Zoning Dept Date: q I rl No Inspection(s) during this time Tuesday (9:30 12:15 �1 p am - pm) (Tracy) Time: Time: Plumber's Choic Dept (joning Township: Address # & Road Name: or , Q3LotO LI 1' I Q(,n/ f Directions To Site: 3%S$(n Comments: 63. Pd 4 9/dq i2i I� S LL ii l — h�1 �� Tf I Q ' *" Plumbers you must verify any changes) by fax or email "k Notes from u/forms/sanitary/reques tforinspectinn Zoning Dept (@4/12)04): _ ®June 2023 ,Private Onsite Wastewater Treatment -lams ( POWTS). Inspection Report PAUL L & VICTORIA TRIBOVICH (gttach to Permit) 93600 LITTLE SAND BAY RD BAYFIELD WI 54814 TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road Se tic N/A 151ng. N/A Aeration N/A Holding Pump I Siphon Information ump Manufacturer ump Model Demand GPM Filter Manufacturer Filter Model TDH Lift Friction Loss Head Total Forcemain Length Dia Dist To Well ❑isnersal Ceti Information DIMENSIONS Width Ler�gt I # of Cells SETBACK FROM I Prop.. Line IB it ing Well 0 Type of Cell Manufacturer' H(14 Model Number. Pretreatment Unit Manufacturer: Model Number: Dia Elevation Data STATION BS HI FS ELEV Benchmark p to Bldg. Sewer Tank Inlet Tank Outlet Dose Tank Inlet Dose Tank Bottom Inst. Contour a:8 i Header/ Manifold Distribution Pipe /0-6? It. I Infiltralve Surface Final Grade X Pressure Systems Only ❑ No I sou cover • Depth Over Depth Over Depth of Seeded / Sodded Mulched Cell Center Cell Edges Topsoil ❑ Yes 0 No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) � , r Ian revision required isMo ap S� ;s other side foraddldon�infa flan. ✓ Date POWTS Inspector's Signature License Number iRn.A71n rR nvg1i Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zonino(a!bavfieldcounty org Web Site: www.bayfieldcounty.org/147 PAUL L & VICTORIA TRIBOVICH 93600 LITTLE SAND BAY RD BAYFIELD WI 54814 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know R. t Pta5t}S tV) 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.septicsearch.com Notes: Abandonment of O/d System to meet all applicable code requirements: Tank was pumped by: on :• Tank was crushed / removed and pipes disconnected by: _ at AM/PM On \ at Z (AM /A) the above -mentioned plumber contacted our office to conduct a pre- over inspection as required untrer DSPS 383. One of the following applies: 1�2 System was inspected and appears to meet all applicable code requirements. (/fl 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/farms/sanitarypropertyowner4nput Apri12019 ,,a�A"7"err Industry Services Division County 4822 Madison Yards Way Bayfield Da` ``� Madison, WI 5370S Sanitary Permit Number (to be filled in by Co.) J v t P.O. Box 7302 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 PWTS-082601846—C 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 Same purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. I. plication'Information—Please PnatAll Information' Property Owner's Name Parcel # Paul & Victoria Tribovich I TERED 37586 Property Owner's Mailing Address Property Location 93600 Little Sand Bay Rd. Govt. Lot City, State Zip Code Phone Number Bayfield, WI 54814 715-779-5546 SW ,,,, NE 'V,, Section 04 IT Type of Bwlding (clleck all that apply) Lot # 151 N R 04 E or lId' I1 or 2 Family Dwelling — Number ofBedrooms 3 Subdivision Name Block # 11pubi ic/Commercial — Describe Use Cityof ❑State Owned — Describe Use CSM Number Village of IZiTown of Russell ni.,ly, `ofPU SPc�riniit Cfieck 'therj Newtt.ox"Re-'lacement"andothera 1icatile.o U *.:Check:orieboa:o IineB.Con letel%rie:Ci A. ❑New System replacement System ❑Other Modification to Existing System (explain) Additional Pretreatment Unit (explain) B. ❑Holding Tank ❑ In -Ground It -Grade ✓ ❑DesignType (explain) Mound Individual Site Other (conventional) C. ❑ Renewal Before ❑Revision hange of Plumber ❑Transfer to New Owner List Previous Permit Number and Date Issued Expiration NA IV D.lis etsaV;rreN .time It Airea:and-Tank;Infojrmatiun: _' . Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 450 . 0.4 450. 450 J.88 Capacity in Total # of Manufacturer , Gallons Gallons Units o b Tank Information 'B U N New Tanks Existing Tanks w i? a U rn �, rn w C7 a Septic or Holding Tank 1000 1000 1 . Superior Precast ✓ Dosing Chamber 600 600 1 Superior Precast ❑ ❑ ❑ V: Responsll nlity S�tatepteriE-- , the undersstigned, assumes e�potis3b iity, for Installation olthef 01 ?S s i%wa on the attached peas Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Jason Kuettel 675751 1715-798-3355 Plumber's Address (Street, City, State, Zip Code) PO B 66 Cable, WI 54821 VI: unty/Degaartam.."ep iJse U_ n_ 1y- r l Approved O Disapproved $Permit Fee I Date Issued Issui Agent Sign /\J I� O Owner Given Reason for Denial 500--fei (15 (a Conditions of Approval/Reasons for Disapproval () t C E Lt aiocha jJy)�J SEP 1 12026 Bayfield Co. Planning and Zoning Agency Attach to complete plans for the system and submit to the County only on paper not less than 8112 x 11 inches in size SBD-6398 (R. 02/22) Wisconsin Department of Safety and Professional Services Division of Industry Services 4822 Madison Yards Way Madison, WI 53705 August 20, 2026 CUST ID NO.: 1476757 TIMOTHY J CLARK 42940 US HIGHWAY 63 CABLE, WI 54821 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/20/2028 MUNICIPALITY: TOWN OF RUSSELL BAYFIELD COUNTY SITE: TRIBOVICH MOUND 93600 LITTLE SAND BAY RD. BAYFIELD, WI 54814 SW NE SO4 T51N R04W FOR: Design Wastewater Flow Value: 450 Bedrooms: 3 Limiting Factor(s): 15 Inches Maintenance Required: Effluent Filter Phone: 608-266-2112 Web: http://dsps.wi.gov Email: dsps(�wisconsin.gov Tony Evers, Governor Dan Hereth, Secretary Identification Numbers Plan Review No.: PWTS-082601846-C Application No.: DIS-082632488 Site ID No.: SIT -163118 Please refer to all identification numbers in each correspondence with the Department. CONDITIONALLY APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES V Eldchxmvn. 08120/2026 SEE CORRESPONDENCE Mound Component Manual - Version 2.1 (May 2022-2027) SITE REQUIREMENTS • A full size copy of the approved plans, specifications, and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. A Department electronic stamp and signature shall be on the plans which are used at the job site for construction. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from POWTS Dispersal Area. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • Abandon Existing System per SPS 383.33 • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. • Divert surface water from POWTS Area. RECEIVED • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (1 1)(c) SEP 11 2026 • Tank Installation to follow all manufacture's recommendations. Bayreld Co.. Planning and Zoning Agency • Verify property line(s) prior to installation. CONDITIONALLY APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DMSIOI OF INDUSTRY SERVICES �n!_ SEE CORRESPONDENCE MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Tribovich Mound Owner's Name: Paul & Victoria Tribovich Owner's Address: 93600 Little Sand Bay Rd. Bayfield, WI Legal Description: SW/NE SO4 T51 N R04W Township: Russell County: Bayfield Subdivision Name: Lot Number: Block Number: Parcel I.D. Number: 37586 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Page 9 Soil Evaluation Page 10 Soil Tester Plot Plan Designer: Jason Kuettel License Number. 675751 Date: 07/29/26 Phone Number: 715-798-3355 Signature: Designed Pursuant to the Mound Compose OWTS Version 2.0 SDB-10691-P (N. 01101), and both SSWMP Publication 9.6 Design of Pressure arks for ST -SAS (01181) and Pressure Distribution Component Manual Ver. 2.0 SBD-107 - Version 7.0 (R. 03/2012) Page 1 of 10 Updated manuals to be used RECEIVED CED 1 1 ?ne)q Piancu �.as,�y e� 8ilpy Mound Plan and Cross Section Views 11 450.40 (ft2) Dispersal Cell Area 1341.36 (ft2) Basal Area Available 5.63 (gpd/ft) Linear Loading Rate 8.00 (ft) 1110 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 92.67 (ft) Dispersal Cell 4.0 % Site Slope G IH 91.38 (ft) Lateral Geotextile Fabric Cover Shading Key d a 1Q ® Topsoil Cap cI ❑2 "" Subsoil Cap ya Z © O ASTM C33 Sand " ° �, ar © O Tilled Layer c © Aggregate a o I I 1.5 ft 0.5 ft Dispersal Cell See lateral details on Page 4 for number, size, F and spacing of laterals. Laterals are equally spaced from the distribution cell's centerline in the Lii ,. ::. O ' Typical Lateral O. distribution cell (AxB). �--- A Project: Tribovich Mound Page3of of 10 REC EI VED SEP 112025 Hayfield Co. Planning and Zoning Agency Mound System Maintenance and Operation Specifications Service Provider's Name ANDRY RASMUSSEN & SONS Phone 715-798-3355 POWTS Regulator's Name BAYFIELD CO ZONING Phone 715-373-6138 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450.4 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic I Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Inspect and/or service once every 3 years Should inspect and clean at least once every 3 years Test once every 3 years Should test monthly Laterals should be flushed and pressure tested every 1.5 years Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished • ............ • • Grade .. 6-8" Diameter Lawn :. Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution . ._._:•._. Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Tribovich Mound Page 5 of 10 SEP 1 12026 Bayfield Co. Planning and Zoning) Agency FE 1 FEATURES/BENEFITS PERFORMANCE Heads up to 37' TDH Flows up to 72 GPM MOTOR High efficient, 115v, oil filled, permanent split capacitor motor with upper and lower ball bearings and thermal overload protection -Constant bearing lubrication -Maximum motor cooling Runs cooler and lasts longer Internal overload protection Quiet operation - Fasteners and shaft made from rugged, corrosion resistant stainless steel SEAL DESIGN Mechanical with secondary dynamic lip seal -Provides added leakage protection IMPELLER DESIGN Hon -clog style vortex impeller -Designed to help reduce clogging by foreign • material P�ocnpiviAhi FriiFt1/F 0 41 41 C 01 POWER CORD Sealed entry quick disconnect power cords - Prevents mater from entering the motor housing through a cut cord • Easy to replace in the field -Available in lengths up to 100' SWITCH Piggy -back switch design - Defective switches can be diagnosed over the phone - Pump can be operated manually or supplied with other piggy -back switches - Switch can be replaced without having to replace the pump APPLICATIONS Basements, dewatering, septic systems, residential and commercial developments and elevator pits 1G Wide -Angie Float 1/3-1/2 HP submersible pumps that handle up to 3/4" solids with 2" discharge with 11/2" adapter i 1n.,,,a p,rbIlnu.s Champion Pump Company, Inc > P.O. Box 523 , Ashla.nd, OH = 4305 Phone 419-28L-4500 . FaL9-616-LLOO + ;v;r,v.champion2 :mp»rr SR-OaS09 " �,�nxreieyr Wisconsin Department of Safety and Professional Services Page of Division of IndustryServices SOIL EVALUATION REPO IL TEST #13'- O? (, In accordance with SPS 385, Wis. Adm. Code County 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. scale or dimensions, north arrow, and location and distance to nearest road. 3 7 5 8 G O e$_zci Please print all information. ' Reviewed , by Date tt nn Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). E i 49Kt'' Property Owner Property Location ❑ Govt. Lot SO Y, N 6 Y4 S O `{ T S 1 N E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: 3 ( 00 L. rr' w S' Z7')`( 2, , �O �. rii'L>� SjQ.�✓ � i� a 7 /� City I State I Zip Code I Phone Number ❑ City ❑ Village IJ Town I Nearest Road S'f l (7fS ) sY G S� �� L�7�-�.�= SA rTT ❑ NewConstrucciion Use: Residential/Numberof bedrooms Code derived designflow rate SO GPD ❑ Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. ENTERED Parent material 6 L. 1 ac.— T7 LL(q �G General comments and recommendations: lb E S 1 b "� ��'� �-- O / o'-' OS • l C o C,)-roy t--- 1 Boring # ❑ Boring M Pit Ground surface elev$ 8•73ft. Depth to limiting factor).3 in.! elevlU�. 8ft. Soil Annlication Rate Horizon Depth In. Dominant Color Munsel€ Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 `Eff#1 `Eff#2 j 0 .S'r,L's SL-- zj )L fvf w f.4.i4 Jo 1 —s, I'5 Z •5'tec— /"1 S; C. c b)C M t4. O. L pGo 4-Z.•S Y2 Z EIi1 Boring # ❑Bor€ng �8 pPit Ground surface elev5�. ft. Depth to limiting factor 5 in.! elev !Zbft. 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 o -4 ).sZ , L p)L u 1 Z� o.(o 1, v "Z :CJ S}- /v.4r !- o'1 O -!o IS - Zn Z, 5 %t- t [= . 5 YiLf ,S;c. 4N. o b �,.. , z.. O . G'- 1 CST Name (Please Print) Signature CST Number PEanning and Zoning Agen 1! 4 oUZ. Address Date Evaluation Conducted Telephone Number 9u 3o≥c, 6 C. 3i:. W' I I -'9 -?YS " Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 5150 mg/L " Effluent #2 = BOD, s 30 mg/L and TSS 5 30 mg/L SBD-8330 (R04/21) Page Z , of 3 IIII ❑ Boring Boring # P Pit Ground surface elev.S • 5t. Depth to limiting factor 1 O) - in. in., elev ?% 55t. Soil Aoolication 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 o" 5 '7. S `t -t S s b u_ w ]-f'4 D. G 1.O Z l? - ti ,CJ & 6iL- _ M k e3,Li Li 04 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Aoolication 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 LIII Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. nil Annliratinn Rat, Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Efl'#2 * Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 c 150 mg/L * Effluent #2 = BOD, ≤ 30 mg/L and TSS ≤ 30 mg/L SEP 1 12026 Bayfield Co. planning and Zoning A•nenc-Y M CHECK BOX AS APPUCABLE. CHECK BOX AS APPLICABLE. ® SOIL EVALUATION 0 Scale: 1=4O' 60 80E SYSTEM PAGE 2 OF SITE MAP PLOT PLAN PROJECT NAME: (to ft grid) 102 DESIGN FLOW: �-I SO GPO p Attach design flow calculations for commercial plans. PROJECT ADDRESS: dZC 0 C) L 17-ru 1- SA•S'� 3?'( Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) N Sanitary Sewer. / BM Symbol: 4 BM Elevation: /OO ' O FT Force Main: / BM Description: ID? W (Z —L.- t � Slope Gradient (°%j �Indicate north by IMPORTANT: of Tested Area: y .< ` Well Symbol (if applicable): O drawing an arrow Show ground elevation contours at suitable Intervals. on the approprite line. rji,a N Kati.° '. • cL u&.t r9=- cc ICY C C�a4Z -cm %top ca to csc �•r-�+� r� jc P ___ j __ _ s'T oa, .zg SP .1 12026 j 7/ �1 ^-iield planning and zoning Private Sewage System Maintenance Agreement Owner(s) Name ,} v L ' iZ 113 C1 I LI-i--- Owner(s) Mailing Address ?.7 6 0 L i ;T -L SA -N L7 A7 tZ1:. U 4'ir'6M Site Address � Tax ID# 37s��c 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) S W 1/4 of ./Ij 1/4 Section 0 4 Township 5 t N. Range W Additional Legal Description: Town of /Z- SfELL. (Acreage)'7 Gov't Lot Lot Block Subdivision Lot CSM # Vol. Page CSM Doc # DOCUMENT NUMBER 2O26R-61 3844 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED 09/22/2026 AT 8:00 AM RECORDING FEE: $30.00 PAGES: 4 Recording Area Return To: RECEIVE® Planning and Zoning Department SEP 2 3 2026 Bayer t o. El In -ground gravity El In -ground dosed El In -ground pressure distribution Sewage System: (� Mound El 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 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 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 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. 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) — Please Print Subscribed and sworn to before me on this date: 4i is-: 2c2( Notarized Owner(s) — Signature(s) No Public My Commitsi Expires: Drafted by: / l^ C. L/9 -/Z— Date: , �_� Provof,d►W, SCO`\`` Real Estate Bayfield County Property Listing Today's Date: 9/15/2026 1 ' Description Updated: 7/15/2026 Tax ID: 37586 PIN: 04-046-2-51-04-04-1 03-000-12000 Legacy PIN: Map ID: Municipality: (046) TOWN OF RUSSELL STR: SO4 T51N R04W Description: SW NE LESS V.410 P.388 & LESS V.601 P.245 & LESS V.981 R 41 & LESS DOC 2017R-568092 ALL IN DOC 2026R- 612679 37 Recorded Acres: 35.897 Calculated Acres: 35.987 Lottery Claims: 1 First Dollar: Yes ESN: 128 Tax Districts Updated: 7/27/2017 1 STATE 04 COUNTY 046 TOWN OF RUSSELL 040315 SCHL-BAYFIELD 001700 TECHNICAL COLLEGE Property Status: Current Created On: 7/27/2017 1:59:50 PM i Ownership Updated: 7/15/2026 PAUL L & VICTORIA TRIBOVICH BAYFIELD WI Rifling Address: Mailing Address: PAUL L & VICTORIA PAUL L & VICTORIA TRIBOVICH TRIBOVICH 93600 LITTLE SAND BAY RD 93600 LITTLE SAND BAY RD BAYFIELD WI 54814 BAYFIELD WI 54814 Site Address * indicates Private Road 93600 LITTLE SAND BAY RD BAYFIELD 54814 0 Property Assessment Updated: 7/20/2026 2026 Assessment Detail Code Acres Land Imp. G4 -AGRICULTURAL 33.897 2,600 0 G7 -OTHER 2.000 9,100 382,700 2 -Year Comparison 2025 2026 Change Land: 11,300 11,700 3.5% Improved: 329,800 382,700 16.0% Total: 341,100 394,400 15.6% 4 Recorded Documents Updated: 7/27/2017 Is Property History © QUIT CLAIM DEED Parent Properties Tax ID Date Recorded: 6/24/2026 2026R-612679 04-046-2-51-04-04-1 03-000-10000 28936 © QUIT CLAIM DEED 04-046-2-51-04-04-1 03-000-20000 28937 Date Recorded: 6/16/2026 2026R-612579 © WARRANTY DEED Date Recorded: 4/24/2017 2017R-568092 ® WARRANTY DEED Date Recorded: 4/24/2017 2017R-568092 HISTORY ® Expand All History, White=Current Parcels Pink=Retired Parcels 0 Tax ID: 28937 Pin: 04-046-2-51-04-04-1 03-000-20000 Leg. Pin: 046100406000 ® Tax ID: 28936 Pin: 04-046-2-51-04-04-1 03-000-10000 Leg. Pin: 046100405000 37586 This Parcel Parents 1 Children RECEIVED SEP 231016 BarfdCc. Planning and Zoning AgenCY Legal Description The Southwest Quarter of the Northeast Quarter (SW' NE'h), Section Four (4), Township Fifty-one (51) North, Range Four (4) west, Town of Russell, Bayfield County Wisconsin. LESS The North 150 .feet of the West 400 feet of the Southwest • Quarter- of. the Northeast Quarter (SSk NE}), Section Four (4) , Township Fifty-one (51) North, Range Four (4) T?est.. AND LESS A parcel of land in the Southwest Quarter of the Northeast Quarter (SW i NEJ), Section 4, Township 51 North, Range 4 West, described as follows: commencing at a point in the center of the town road which runs along the north and south quarter section line of said Section 4 at a point ,150 feet south of the north line of said SW NE l; thence east on a line parallel with. the .north• l i rye of -said , ti. forty a distance of 400 feet; thence south'oh a l i ne' paral l hi with the center line of said town road a distance of ?00 feet; thence west on a line parallel with the north line of said forty a distance of 400 feet to the center of the town road; thence north along the center'of the town road, which is also the north and south quarter section line 200. feet to the point of beginning. AND LESS A parcel of land located in the SW '/ of the NE '/4 of Section 4, 1.51 N., R. 4 W., in the Town of Russell, Bayfield County, Wisconsin, described as follows: Beginning at a point in the center of the Town Road which runs along the North South 1/4 line of said Section 4 at a point 350 feet South of the North line of said SW % of the NE '/4, run East, 400 feet on a line parallel with the north line of said SW '/ of the NE '/4. Thence South, 30 feet on a line parallel with said N -S line. Thence West, 400 feet, parallel with the north line of said SW '/4 of the NE %4, to said N -S '/4 line. Thence North, 30 feet along said N -S '/ line and the centerline of said Town Road, to the Point of Beginning. (CONTINUED ON THE NEXT PAGE) RECEIVED SE P 2 3 2026 ptamtn9 and ZonM9 AgeflGl AND LESS A parcel of land located in the Southwest Quarter of the Northeast Quarter (SW1/4 NE1/4), Section Four (4), Township Fifty-one (51) North, Range Four (4) West, Town of Russell, Bayfield County, Wisconsin more particularly described as follows: Commencing at the Northeast corner of said section; Thence North 89°25'37" West along the north line of the Northeast /4 a distance of 2,633.98 feet to the North /4 corner of said section; Thence South 00°23'43" East along the North -South %4 line a distance of 1,701.67 feet to the -Point of Beginning; Thence South 89°54' 16" East a distance of 400.00 feet; Thence South 00°23'43" East a distance of 392.50 feet; Thence North 89°54'16" West -a distance of 400.00 feet to the North -South % line; Thence North 00°23'43" West along said '/4line a distance of 392.50 feet to the Point of Beginning. 23 2426 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: TRIBOVICH, PAUL L & VICTORIA 93600 LITTLE SAND BAY RD BAYFIELD, WI 54814 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00509 Transaction Number: SR -00509-562A9 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 15176 1 Paid by: Andry Rasmussen & Sons, PO Box 66, Cable WI 54821 Payment Type: Check Transaction Date: 9/25/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. ]3A 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: TRIBOVICH, PAUL L & VICTORIA 93600 LITTLE SAND BAY RD BAYFIELD, WI 54814 Description State Approved Plans (Mounds, Systems Requiring Pre -Treatment, etc.) Submission Number: SS -00840 Transaction Number: SS -00840-563B8 Amount $500.00 Total: $500.00 Payment Amount: $500.00 Reference: 15176 & 10382 Paid by: Andry Rasmussen & Sons, PO Box 66, Cable WI 54821 ($400) & Paul Tribovich ($100) Payment Type: Check Transaction Date: 9/25/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-140S STATE SANITARY PERMIT OWNER: PAUL L & VICTORIA TRIBOVICH G OV'T LOT: LOT: B LK: SW 1/4 NE 1/4 SEC: 4, T 51 N, R4 TOWNSHIP: Russell SOIL TEST: 138-26 REPLACEMENT SYSTEM SYSTEM TYPE: Mound 224 in. of suitable soil PLUMBER: JASON KUETTEL EMILY MACGILLIVRAY LLIVRAY DATE: 9/25/2026 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 675751 Condition: Old System needs to be properly abandoned per SPS 383. THIS PERMIT EXPIRES 9/25/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION