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HomeMy WebLinkAbout26-143SDepartment of Safety County ft/s \t& Professional Services, Bayfield Sanitary Permit Number (to be filled in by Co.) IndustryServices Division 0015 � 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 Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS arc submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the PrivacyLaws. 15.04(1 xm), Stets. -' �_ -' 10245 Pine Lake Rd Property Owner's Owner's Name Parcel # Carol M. Miller 1IytIED JUN 012026 04-0242-47-08.22-305-001-21000 Property Owner's Mailing Address 1/34 Property Location J ✓ PO BOX 217 Bayfield Co. Plannln g and ZoningA Agency o Govt Lot City, State Zip Code Phone Number Iron River, WI 54847 218-940-2936 i. it, Section 22 T 47 N R 08 E ot® Lot# ® I or 2 Family Dwelling— Number of Bedrooms 3 1 Subdivision Name Block # ❑ Public/Commercial — Describe Use O Cityof ❑ State Owned— Describe Use ❑ Village of CSM Number #1666 in V.10 P.14 ® Town of Iron River 4 iN a loo t A. ❑ New System y YRe Replacement System p y ❑ Other Modification to Existing System (explain) O Additional Pretreatment Unit (explain) B. ❑ Holding Tank YIn-Ground O At -Grade ❑ Mound O Individual Site Design ❑ Other lain Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner ist Previous Permit Number and Date Issued Expiration Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) Elevation 450 1em 0.7 642.9 646.6 99 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units , New Tanks Existing Tankx `� ts , V ce wi W r7 M SepticorHoldingTank 1060 1060 1 Infiltrator XI Dosing Chamber Plumber's Name (Print) Plumber's Signature / � MPIMPRS Number Business Phone Number Chris Scharte 5— W 220717 (715) 394-7754 Plumber's Address (Street, City, State, Zip Code) 1414 )Belknap St. Superior, WI 54880 pproved ❑ Disapproved Permit Fee $ Date Issued� ry'.' Issuing ant Sign /M 1' /e t ❑ Owner Given Reason for Denial cz — �D u/ ( O Conditions of Approval/Reasons for Disapproval) Attach to complete plans for me system and submit to the County only on paper not lus than S I/1 x II inches in size SBD-6398 (R. 03/22) �}MTl4CyT �+ 1 R-OQq" S WisconsinDepartmentofSafety&ProfessionalServices� Page 1 of 3 Division of Industry Services -- SOIL EVALUATION REPOR IL TEST it �y2-ACC `5e In accordance with SPS 385, Wis. Adm. Code County Bayfield Attach complete site plan on paper not less than 8 1/2 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. 04-024-2-47-08-22-3 05-001-21000 c'S Please print all Information. R4ii(yewe} by Date ,mnnal Information you provide may be used for secondary purposes (Privacy Law, S. 15.04(1)(m)). [,t')1t.( A Ly Il 14 I /Q) "r Property Owner Property Location �) — "' u u Carol M. Miller Govt. Lot 1 % Y. S 22 T 47 N R 08 E (or)I Property Owner's Mailing Address - Site Address or CSM and Lot#: PO BOX 217 Lot #1 CSM #1666 in V.10 P.14 City, State, Zip Phone Number ❑ City ❑ Village ® Town Nearest Road Iron River, WI 54847 ( ) Iron River 10245 Pine Lake Rd ❑ New Construction Use:Residential/Numberofbedrooms 3 Code derived designflowrate 450 GPD ®Replacement ❑ Public or commercial —Describe: t t �6t3odaPTarTe vation if applicable N/A ft. Parent material Outwash sand (Sayner series) / • General comments and recommendations: (t/)'/et )JUN U 12026 ' — Bayfield Co. HBoring # NE ❑Boring Planning aid Zunm 1 Boring # ®Pit Ground surface slev.103.5 ft. Depth toglim9t g actor 96 in. / Bleu. 95_5 ft Soil Aoolicatlon Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' •Eff#1 -Eff#2 1 0-2 7.5YR 3/2 — s Osg ml as 1vf 0.7 1.6 2 25 7.5YR 4/3 — s Osg ml ow 1vf 0.7 1.6 3 5-14 7.5YR414 — Osg ml aw 1m/2f 0.7 1.6 4 14-47 7.5YR414 — 1s%OR)vn 0sg ml ow ivf 0.7 1.6 5 47-68 7.5YR 4/4 — vcos 0sg ml as — 0.7 1.6 6 68-96 5YR 4/4 — cos Osg ml — — 0.7 1.6 2❑ Boring # SW Boring 96 ®Pit Ground surface elev._1018 it. Depth to limiting factor_in. / elev.93.8 SoilAnolication Rate Horizon Depth In. Dominant Color Munseil Redox Description Qu. Az. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPO/F$ 'Efr#1 'Eff#2 1 0-10 7.5YR 3/2 — Is Osg ml aw 3f 0.7 1.6 2 10-20 7.5YR4/4 — Is Osg ml ow 2f/1vf 0.7 1.6 3 20-50 5YR4/4 — (3O%GR)cos Osg ml aw 2vf 0.7 1.6 4 50-57 5YR 4/4 — cos osg ml aw 1 m 0.7 1.6 5 57-96 1 0YR 5/4 s Osg ml — 1f 0.7 1.6 ands of lamellae in Horizon CST Name (Please Print) Signature CST Number Keith Wiley l/ 654921 Address Date E aluation Conducted Telephone Number 11623 E Larson Dr. Lake Nebagamon, WI 54849 . 8/24/2024 I218-451-2611 ' Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 5160 mg/L - Effluent #2 = ROD. 5 30 mg/L and TSS 5 30 mg/L 580-8330 (R03122) O Boring y 3 ] Boring # mid ® Pit Ground surface eiev. 101.4 ft, Page 2 of 3 Depth to limiting factor 96 In. / elev. 93.4 ft I Sail Anniication Rate Horizon Depth In. Dominant Color Munseil Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 1 0-4 7.5YR 3/2 — s 0sg ml aw 1co/1vf 0.7 1.6 2 4-10 7.5YR 5/4 — $ * Osg ml cw 1mP tl2vf o,7 1.6 3 10-57 5YR 4/4 - 0%GR) voce Osg ml aw 1 of 0.7 1.6 4 57-96 5YR 4/4 — cos Osg ml — — 0.7 1.6 I -Ill Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / eiev. ft. Soil Annilcation Rate Horizon Depth In. Dominant Color Munseil Redox Description Qu. Az. Cant. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 iUILUb Cr Planning arld Zoning A ency Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Sall Aoniication Rate Horizon Depth In. Dominant Color Munseil Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30150 mg/L * Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L Miller (3 bedroom) Soil Report Plot Plan 1 0 JUN j - ., e q .o� LOT 1 S22 T Town 04-02 M #1666 7N R08W f Iron Rive -2-47-08-2 IN V.10 P.1 -3 05-001- 1000 Pla nin9 ark; Zon;n An 4.030 cres • 01' / ____________ ++ 3 ,• %2 ,.• un Lak Ml t t __ ea Septic tank & H Irainfield to be __________________ abandoned p rSPSS83.33 Scale 1:60 NOTES: x •Bench Mark = Duplex nail w/ yellow ribbon in 11" DBH Maple tree - Lake Millicent elev ss 80' Elev =100.0' I I I I - Property lines not shown > 100' from tested area CST # 654921 Page 3 of 3 10245 Pine Lake Rd 04-024-2-47-08-22-3 05-001-21000 Bayfield LOT 1 CSM #1666 IN V.10 P.14 22 47 8 Keith WI Property Owners Ns Property Address Tax Parcel Number County Legal Description Section Town Range Page Index 1 Property Information 2 Data Entry 3 Plot Plan 4 Drainfield Cross -Section 2026 5 Tank Information ic0. 6 Maintenance Plan 7 Contingency Plan Designer's Name Designer's Signature Designer's License Number Designer's Phone Number Date Page 1 of 7 Page 2 of 7 Miller (3 bedroom) Gravity In -Ground Plot Plan r v a 0 a Well Garage Scale 1:60 4 q 0 Lake Millicent Carol M. Miller 10245 Pine Lake Rd LOT 1 CSM #1666 IN V.10 P.14 S22 T47N R08W Town of Iron River 04-024-2-47-08-22-3 05-001-21000 4.030 acres I Two rows of 16 Infiltrator Quick4 Plus Standard chambers I I Infiltrator IM -1060 tank w/ poly lok 122 filter I Septic tank & drainfield to be abandoned per SPS 383.33 W Bench Mark = Duplex nail w/ yellow ribbon in 11" DBH Maple tree Elev =100.0' NOTES: - Lake Millicent elev tt 80' - Property lines not shown > 100' from system area - All vent observation & conveyance pipes 4" ASTM D1785 or code equivalent Page 3 of 7 Cross Section of a Two Cell In Ground Compone Using Leaching ChamberseCCii�E JUN 01 2026 Observation/Vent Pipes 3QJFnished Grade Slope 8% of Chamber Y% 2...,, ______ m —E em Elevation JJ *.. 1tetri ent,pnd'Dtspgrbdt goge�. Bayfield Co. Planning and Zoning Fihishedefade,_ 101.801 ," .original Grade 101.80 3 fop of Chamber 100.00 system Elevation 99.00 Limiting Factor Observation/Vent pipes to be constueted and capped with approved materials for the particular use. 67 feet 67 feet Observation / Vent Pipes to be located at the ends of the distribution cells. Page 4 of 7 UFT1P.) STRAP(TY B c RISER CONNECTION (TYP.) A I A' RUBBERI ACCESS PORT RIM _'__, LIDDOMMUOUS TANKTOP ElASTOMEIRIC FIEIBL XEHALF OASKET pO OO GASKET UBBE .) TANK 0 e 62.2 INTERIOR SEAM CIIP OO Op EXTERIOR INIET/ \ (M A0 NMENT WIDTH TANK pOyg 4) TAW BOTTOM INTERIOR HALP LIFTING LUG B' © PIPE PENETRATION O S MID -HEIGHT SEAM (TYP.)SECTION DETAIL SECTION DETAIL 127.0 l, EXTERIOR LENGTH - WED TOP VIEW 0 4 [1021 PVC OR ABS INLET TEE JUN 01 2026 UE TNon in0la,zz61 WIDTH 62211,506 0 24.0 (6101 ACCESS OPENING Bayflelld Co. HIEGHT 54.711,3891 WITH LOCKING LID (2) Planning and Zoning Agency r 102 (2601 FREEBOARD 0 (102] PVC OR ENDOP" y S OUTLET TEE WALL 21$11X21511 FmEROlASS SUPPORT NOTES: SECTION A- A' 1. ALL DRAWING DIMENSIONS IN INCHES [MILLIMETERS] OR AS NOTED. 2. EXTERIOR OF ACCESS OPENING LID INCLUDES THE FOLLOWING WARNING IN ENGLISH, FRENCH A SPANISH: "DANGER DO NOT ENTER: POISON GASES." 3. TANK MARKINGS WILL INCLUDE: MANUFACTURER NAME, MODEL NUMBER,UQUID CAPACITY, DATE OF MANUFACTURE, MAXIMUM BURIAL DEPTH, INLET, AND OUTLET. 4. MAXIMUM BURIAL DEPTH LS 481n [1,219 mm]. 5. MINIMUM BURIAL DEPTH IS 6In [152 mm]. 6. MAXIMUM VEHICLE LOAD IS 4,500 -lb [20-kN] AXLE LOAD. 7. TANK IS FOR NON -TRAFFIC APPLICATIONS. 8. AIRSPACE 1516.5Y. 9. OUTLET TEE IS COMPATIBLE WITH EFFLUENT FILTER. 10. INTERIOR LENGTH TO WIDTH RATIO IS 2.3:1 (118.8 -INCH INTERIOR LENGTH / 51.7 - INCH INTERIOR WIDTH - 2A). SEAM CUP (Typ.) LIFTING STRAP (TYP.) SIDE INLET/ OUTLET(TYP.) LIQUID DEPTH 44.011.1181 INVERT DROP 3.0061 FREEBOARD 10.2(2601 END VIEW I A nnn MC EW SECTION B - B' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 6 of7 FILE INFORMATION Owner Carol M. Miller Permit # DESIGN PARAMETERS Number of Bedrooms 3 O NA Number of Public Facility Units ® NA Estimated (average) flow 3OO al/da Design (peak) flow = (Estimated x 1.5) 450 gaVday In Situ Soil Application Rate 0.7 gal/day/ft2 Standard Influent/Effluent Quality Monthly average` Fats, Oil & Grease (FOG) ≤30 mg/L Biochemical Oxygen Demand (BODs) ≤220 mg/L O NA Total Suspended Solids (TSS) ≤150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) ≤30 mg/L Total Suspended Solids (TSS) ≤30 mg/L ® NA Fecal Conform (geometric mean) ≤10cfu/10omi Maximum Effluent Particle Size 14 in dia. O NA Other: ® NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service a Whc}`° A2" ncv Inspect condition of tank(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ® year(s') ❑ NA Pump out contents of tank(s) ® When combined sludge and scum equals one-third ('h) of tank volume O NA O When the high water alarm is activated Inspect dispersal cell(s) At least once every: 3 ❑ month(s) 21 year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: 3 ❑ month(s) year(s O NA Inspect pump, pump controls & al At least once every: ❑ month(s)arm ❑ year(s) ® NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) ® NA Other: At least once every: ❑ month(s) ❑ year(s) NA Other: 21NA SYSTEM SPECIFICATIONS Tank Manufacturer Infiltrator O NA M Septic O Dose O Holding vol. 1060 gal Tank Manufacturer ® NA ❑ Septic O Dose O Holding vol. gal Effluent Filter Manufacturer Polylok O NA Effluent Filter Model 122 Pump Manufacturer ® NA Pump Model Pretreatment Unit ® NA ❑ Sand(Gravel Filter O Peat Filter ❑ Mechanical Aeration O Wetland ❑ Disinfection O Other: Manufacturer Dispersal Cell(s) O NA ® In -Ground (gravity) O In -Ground (pressurized) ❑ At -Grade O Mound ❑ Drip -Line cvEff® her: Other: NA Other: JUN 0 1 202 ® NA Bayfie d Co MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pending of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (%) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at Intervals of ≤12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (12(02) Page 7 of 7 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. TCIVED • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the voa space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN U ILUL6 If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provjk1%a code compliant replacement system: Plac:, m A �� 9 Agency cY O A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. l&' The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area Is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the Infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS POWTS INSTALLER Name Phone POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Private Sewage System Maintenance Agreement Owner(s) Mailing Address I P. o. Et*< zip 11Mo)3 a JSIZ,.0 L. # LL(& f'7 b I r' Tax ID# ;c-4.t. As owner, I (we) do Hereby canny me pnvate sewage system Will DO Instaneo 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) 114 of 114 Section Township N. Range W. Additional Legal Description: Lot' I GSM U144 W V.le V,14 Town of t QOM LZt1JKTL (Acreage) 4. OC Gov't Lot I Lot_ Block_______ Subdivision Lot I CSM #1(44- LVol. 1 b Page L4 CSM Doc Return To: DOCUMENT NUMBER 2026R-61 3926 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 09/28/2026 AT 1 1 : 1 0 AM RECORDING FEE: $30.00 PAGES: 1 Area RECEIVED Planning and Zoning Department SEP 29 2026 Bayfield Co. J? In -ground gravity ❑ In -ground dosed ❑ 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 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 manufacturers specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds, At -grade and In -around Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank In such a manner as to prevent or abate any human health hazard caused by the system. 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 CAsL«— (`fttt.t--' (J4. L t L -c- '1)2L4"1 Subscribed and sworn to before me on this date: l7AV Lp'i7. fxL&.L � U - .2-I-2�lCp _____________ Notarized Owner(s) — Signature(s) Notary li My Commission plres: Drafted bye f1't1µ2Date: 9 —Z`'f ' ZoZZZ,k. SONYA LONG Proofed by: NOTARY PU BUdGisanitaryl epticmaintenceagmement STATE OF WISCONSIN Revised July 2020 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: MILLER, CAROL M PO BOX 217 IRON RIVER, WI 54847-0217 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00425 Transaction Number: SR-00425-4A4EF Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 10179 Paid by: Belknap Plumbing & Heating Co Inc, 1414 Belknap St, Superior WI Payment Type: Check Transaction Date: 10/2/ 2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. E3 & 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: Submission Number: MILLER, CAROL M SS -00758 PO BOX 217 IRON RIVER, WI 54847-0217 Transaction Number: SS -00758-4753C Description Private Sewage System (Septic Tanks) Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 10179 Paid by: Belknap Plumbing & Heating Co Inc, 1414 Belknap St, Superior WI Payment Type: Check Transaction Date: 10/2/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-143S STATE SANITARY PERMIT OWNER: CAROL M MILLER FAMILY TRUST GOVT LOT: LOT: 1 BLK: CSM: 1666 1/4 1/4 SEC: 22, T 47 N, R 8 W TOWNSHIP: Iron River SOIL TEST: 142-26 REPLACEMENT SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: CHRIS SCHARTE EMILY MACGILLIVRAY LLIVRAY DATE: 10/2/2026 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: # 220717 Condition: Properly Maintain System Per Recorded Agreement. Old System needs to be properly abandoned per SPS 383. THIS PERMIT EXPIRES 10/2/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION