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HomeMy WebLinkAbout26-149S"'" . Department of Safety County x 9 = &ProfessionalServices, feG Sanitary Permit Number (to be filled in by Co.) Industry Services Division , 1qS a - y / 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 are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary I'{ S IO F R y 1Ok purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. moso,n , W Z S -y 6 $6 I. Application Information —Please Print All Information Property Owner's Name Peteef# TAX Ainearew P I wetnd M Nelso 3360 Property Owner's Mailing Address Property Location I6M9 9 E eir-►'o n S -1 -tree:"- Govt. Lot SC /..r's_'/.. Section CJ S City, State I Zip Code Phone Number S -c PQt% I, M SSI 3 o ( t Z-3 sz- D 3o Z T L47 N R 7 E or II. Type of Building (check all that apply) Lot # P, I or 2 Family Dwelling — Number of Bedrooms Subdivision Name Block # ❑ Public/Commercial— Describe Use Cl Cityof ❑ State Owned — Describe Use ❑ Village of CSM Number Bayfiekl Co. Planning and Zoning Agen NgTown of Tn ; I s€ V\ III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable online A. Check one box on line B. Complete line C i a licable. A. New System ❑ Replacement SystemExisting ❑ Other Modification to System (ex lain y (explain)(explain) ❑ Additional Pretreatment Unit (ex lain B. ❑ Holding Tank In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design g ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner ist Previous Permit Number and Date Issued Expiration IV. DispersaVrreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (sf) I Dispersal Area Proposed (sf I System Elevation c)o .7 S m 85-8 9a' Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units t _ ' U New Tanks Existing Tanks '` c 2 V U, v v a Septic or Holding Tank S -O — 1.25.0 t t r T r — — Dosing Chamber _ -- — V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's S nature '9, W/MPRS Number Business Phone Number Atla of kosk; Zoo9 0 15 -2.92-Ll1S6 Plumber's Address (Street. City, State, Zip Code) ox S Z Z 10. �DKs2Z -I-f- S9897 e✓ V .County/DepartmentUseOnly Approved O Disapproved Permit Fee $ I Date Issued Issui Age Igna e /� 0 Owner Given Reason for Denial — 10 Y%' 7 �7�/ Conditions of Approval/Reasons for Disapproval cot ZcbCfrd ea - Attach to complete plans for the system and submit to the County only on paper not less than 8 lax 11 inches in size SBD-6398 (R. 03/22) �O�pARTAt . Wisconsin Department of Safety & Professional Services Page 1 of Z IDivision of IndustryServices SO u /5/ . Z SOIL EVALUATION REPORT �iC �' O County � In accordance with SPS 385, Wis. Adm. Code ac plete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, A i i d to vertical and horizontal reference point (BM), direction and percent slope, I•D. s I ensions, north arrow, and location and distance to nearest road. TAX 353 6 O Please print all information. . Reviwy Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). �J//7 I Property Owner Property Location ❑ I1 dre& P A)€1y M Nej 4 Govt. Lot SE '/4 SE "/ S T t{ N R '7 E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: t6L1c d ear Torn ee..T l B l O 2 L/\ City,. State, Zip Phone Number ❑ City ❑ Village W Town Nearest Road St- 1t, MA) .S'sI3O c (PI�) 3S 1-O3o2. P� t �e.v\ . 1=TZ �{aotl K] New Construction Use: IJ Residential/Numberof bedrooms 4 Code derived designflow rate 0OGPD ❑ Replacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material imc.10-EIVViox( Depos iTs General comments and recommendations: I t f Boring #0 Boring Pit Ground surface elev.g ft. Depth to limiting factor 95 in. / elev 7. ft. I Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 I 0-E IoYR 3l Is I r as G 3 .? _3S 3/ d► S -s -c .7 r Sy ~ s l l•0CT 067)76 oayneln t. o. I 2. 1 ❑Boring Planning and Zoning Agency Boring # ❑pit Ground surface elevgs+ 1 ft. Depth to limiting factors' L in. / elev.�7 ft. Soil Anolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 O ?.S 3/1 Is I '' cS C..$S 3y�� .,►1 1, - 7 SYR 3 GS CST Name (Please Print) 'To. Pc lkoSkt I Signatur/ e /S� CST Number Address ,S t t c C- a VA't \( 4`I i 5 ti w6.4j P3 Date Evaluation Conducted Telephone Number men.- R'v VV z S' - - 2- Zt - 3a ---7 O $ * Efflueht #1 = BOD > 30 s 220 mglL and TSS > 30 s 150 mg/L * Effluent #2= BOO, s 30 mg/L and TSS s 30 mg/L SBD-8330 (R03/22) Page of�, 3 Boring # ❑ Boring NJ Pit Ground surface elev. ft. Depth to limiting factor in. / elev.Q7• ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 o-5 . y * - �s Os as 3 Z -3, .3 Is 055 cl I 5 D s cAl. 7 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 UI 2026 Deyfie Co. Planning and Z ning Agency Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L Combined Soil Evaluation Plot Plan - System Plot Plan Page 2 of 4 Component Manual Design References: r�rr � 1 In -Ground Soil Absorption for POWTS Version 2.1 -' 1 Owner: Andrew P & Wendy M Nelson Site Address: 14810 FR 420A, Mason, WI 54856 Tax I D : 18556 Legal Description: The Southeast Quarter of the Southeast Quarter (SE 1/4 SE 1/4), Section Eight (8), Township Forty-seven (47) North, Range Seven (7) West, Town of Pilsen, Bayfield County, Wisconsin; LESS the Easterly 460 feet of the Southeast Quarter of the Southeast Quarter (SE 1/4 of SE 1/4), Section Eight (8), Township Forty-seven (47) North, Range Seven (7) West, Town of Pilsen, Bayfield County, Wisconsin, Lying South of Forest Road 420A; AND LESS the Southeast Quarter of the Southeast Quarter (SE 1/4 SE 1/4) Section Eight (8), Township Forty-seven (47) North, Range Seven (7) West, Town of Pilsen, Bayfield County, Wisconsin, Lying North of Forest Road 420A. KK r Soil Evaluated By: Tony Polkoski - 11068 -ST Plumber: Allan Polkoski - PMRS 220090 -rte--' /- 0 50 100 ftlililtillil t{ II piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 No existing wells on Pro e I I --- Approximate Property Line o Soil Test Pits: 1 - Elevation - 95' 2 - Elevation - 95.1' 3 - Elevation - 96.1' Benchmark - Screw in Maple Tree Elevation - 100' I I 3 0 3 Trenches Quick 4 Plus Standard Chambers 20 10 Tank- Wieser W1250 -MR Filter- PolyLoc PL -525 I I 1 I 2. Proposed 4 �� 1 I �z Bedroom Home RC!V � � 1 OCT 062076 Proposed Bayfield Go• Garage Planning and Zoning Agency I I I I 1 ----------------------------------------------------------� In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Page 1 - Index & Cover Sheet Page 2 - Combined Soil Evaluation -System Plot Plan Page 3 - Dispersal Area Cross -Section & Plan Page 4 - Management Plan Enclosures: Soil Evaluation Report, Sanitary Permit Application, Wieser W1250 -MR approved tank specifications, Soil Test Checklist, Sanitary Application Checklist, $450 check Project Name I Description PAGE 1 OF 4 RECEIVED OCT O620?6 Bayfield Co. Planning and Zoning Agency Owner Name(s): Andrew P & Wendy M Nelson Phone: 612-352-0302 Owner Address: 1649 Edgerton Street, St Paul, MN 55130 Project Address: 14810 FR 420A, Mason, WI 54856 Legal Description: The Southeast Quarter of the Southeast Quarter (SE 1/4 SE 1/4), Section Eight (8), Township Forty-seven (47) North, Range Seven (7) West, Town of Pilsen, Bayfield County, Wisconsin; LESS the Easterly 460 feet of the Southeast Quarter of the Southeast Quarter (SE 1/4 of SE1/4), Section Eight (8), Township Forty-seven (47) North, Range Seven (7) West, Town ofPilsen, Bayfield County, Wisconsin, Lying South of Forest Road 420A; AND LESS the SoutheastQuarter of the Southeast Quarter (SE 1/4 SE 1/4) Section Eight (8), Township Forty-seven (47) North, Range Seven (7) West, Town of Pilsen, Bayfield County,Wisconsin, Lying North of Forest Road 420A. Township: Pilsen County: Bayfield Project Tax ID #: 35360 Designer Information Designer Name: Allan Polkoski Phone: 715-292-4156 Designer Address: PO Box 522, Iron River, WI 54847 E-mail: tony@bearguidenorth.com tony@soil2septic.com License Number: PMRS220090 Remarks: PSSMA sent via USPS to Register of Deeds marked Return to: Planning and Zoning Department. Signature: G-- Date: / O-&-�� Origi ignature required on each submitted copy. Combined Soil Evaluation Plot Plan - System Plot Plan Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 Owner: Andrew P & Wendy M Nelson Site Address: 14810 FR 420A, Mason, WI 54856 Tax ID: 18556 Legal Description: The Southeast Quarter of the Southeast Quarter (SE 1/4 SE 1/4), Section Eight (8), Township Forty-seven (47) North, Range Seven (7) West, Town of Pilsen, Bayfield County, Wisconsin; LESS the Easterly 460 feet of the Southeast Quarter of the Southeast Quarter (SE 1/4 of SE 1/4), Section Eight (8), Township Forty-seven (47) North, Range Seven (7) West, Town of Pilsen, Bayfield County, Wisconsin, Lying South of Forest Road 420A; AND LESS the Southeast Quarter of the Southeast Quarter (SE 1/4 SE 1/4) Section Eight (8), Township Forty-seven (47) North, Range Seven (7) West, Town of Pilsen, Bayfield County, Wisconsin, Lying North of Forest Road 420A. Soil Evaluated By: Tony Polkoski - 11068 -ST Plumber: Allan Polkoski - PMRS 220090 Page 2 of 4 0 50 100 ft N All piping shall conform to i SPS Table 384.30-3 and SPS Table 384.30-5 Fe i No existing wells on Pro ert --- Approximate Property Line o Soil Test Pits: 1 - Elevation - 95' 2 - Elevation - 95.1' 3 - Elevation - 96.1' A Benchmark - Screw in Maple Tree Elevation - 100' slope rn m 3O 3 Trenches Quick 4 Plus —Standard Chambers o A 10 Tank- Wieser W1250 -MR _—Filter- PolyLoc PL -525 Garage Proposed 4 Bedroom Home RECEIVLo 0CT 0 6 2026 Plannin Bayfie4 Co. 9 and Zoning qgflc, IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER min. 12' (typical) Septic Tank(s) Manufacturer. Wieser Septic Tank(s) Volume(s): 1250 gal gal gal gal Effluent Filter Manufacturer: Polyloc Effluent Filter Model #: PL -525 12" min, trench { Le"%d deph (typical) . < ' TYPICAL TRENCH CROSS SECTION VIEW 34" (No Scale) System Elevation - ft (typical) Quick4 Standard -W w/ End Cap (Show location of inlet / outlet pipe connection on plan view.) t I ( ypica ) 77 ' ---- i.-�-j�-------�'�--- T1=59T2=59 H 6_.T359 ft INSTALL PER TRENCH: (typical) Trench 1: 14 I Quick4 Std -W @2082 EISA/chamber + 1280 Trench 2: 14 Quick4 Std -W @2082 EISA/chamber + 280 Trench 3: 14 I Quick4 Std -W @2082 EISA/chamber + 280 No. trenches = 0 RECEIVED OCT 0 6 2026 Bayfied Co. Planning and Zoning Agency Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturers / Instructions. A=3.0I (typical) TYPICAL TRENCH PLAN VIEW (No Scale) Quick4 Standard -W Chamber Pair of end caps @ 6 82 EISA/pair = 16 182 Pair of end caps @ 6 112 EISA/pair = 1 82 Pair of end caps @6112 EISA/pair = © 112 Required Infiltration Area = 1858 Ift2 Distribution Method: Proposed Total EISA = 1858 182 Gravity C) m W u a TOP VIEW 0 w Ui INLE1 Hr SIDE VIEW 4" CAST —A —SEAL RECEIVED 0CT 062026 Plannio BaY50d Co. 9 and Zoning Agenq, OUTLET 0 TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS W1250 -MR TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1/2" BOTTOM: SEPTIC 3" HOLDING 5" (ADD 1300 LB.) COVER: 4" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 64 1/2" O.D. LENGTH: 104" O.D. WIDTH: 86" O.D. BELOW INLET: 53' 0.0. LIQUID LEVEL: 47" WEIGHT: 7,220 LBS. INLET AND OUTLET: 4' CAST -A -SEAL BOOT OR EQUAL GASKET. CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 26.81 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,340 GALLONS LOADING DESIGN: 8 0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN(]/8, tjI� !f�B€R¢IALLY TANK: MIX DESIGN g10 S" t' Y1 J1gL 5BER) CUSTOMIZED T#&SPT OF SAFETY AND FOR CU§(6 A`� JCAESER,fONC@ETE DIVISION DE INDUSTRY SERVICE APPROVED By Glen Schlueter at 8:20 pm, May 30, 2022 DRAWINGS SUBMIT FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: J z 0 F 0 w In 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 = 600 d; BOD5 S 220 m L"�; TSS ≤ 150 m L-'; 9p 9 mgL1; Inspection Checklist INSPECT EVERY 3 YEARS o type of use 0CT 062028 o age of system o nuisance factors (i.e. odors, user complaints, etc.) Bas Co. o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) Planning and Zoning Agency 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 (Le., 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 (113) 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: Iron River Septic Phone: 715-372-4006 Local government unit: Bayfield County Planning & Zoning Phone: 715-373-6138 Local government unit address: 117 E 5th Street, 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 If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. Private Sewage System Maintenance Agreement Owner(s) Name ANDREW P NELSON & WENDY M NELSON 1649 EDGERTON ST, ST PAUL, MN 55130 14810 FR 420A, MASON, WI 54856 lax IU S 35360 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) 1/4 of 1/4 Section Township N. Range W. Additional Legal Description: St4 a,i-TtGhta Sck htiC. L Town of Lot_ Block Subdivision (Acreage) Gov't Lot Lot _ CSM # Vol. _ Page CSM Doc # DOCUMENT NUMBER 2026R-614029 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. VVI RECORDED 10/05/2026 AT 9:53 AM RECORDING FEE: $30.00 PAGES: 2 Area JIn -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ Other Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) �heli� installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person Ed td such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. ((77((++ c Pump Chamber (system types B, C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is si L Id QS r"Zfi above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Bayfield Co. Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as neceSrynalgl2ndfaca$gi ncy 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 ANDREW P NELSON & WENDY M NELSON Subscribed and sworn to before me on this date: Notarized Owner(s)—SignaWre(s) P M N PuuS /J scion pares: (2t3v Drafted by: TONY POLKOSKI Date: 9-7-26 Proofed by: AP SUSAN M GUDIM . NotaryPublic I Minnesota Yy FE*aJatlayJatwy3f,2630 u/forms/sanitary/seplicmaintenceagreement Revised July 2020 SCHEDULE C LEGAL DESCRIPTION The Southeast Quarter of the Southeast Quarter (SE 1/4 SE 1/4), Section Eight (8), Township Forty-seven (47) North, Range Seven (7) West, Town of Pilsen, Bayfield County, Wisconsin; LESS the Easterly 460 feet of the Southeast Quarter of the Southeast Quarter (SE 1/4 of SE 1/4), Section Eight (8), Township Forty-seven (47) North, Range Seven (7) West, Town of Pilsen, Bayfield County, Wisconsin, Lying South of Forest Road 420A; AND LESS the Southeast Quarter of the Southeast Quarter (SE 1/4 SE 1/4) Section Eight (8), Township Forty-seven (47) North, Range Seven (7) West, Town of Pilsen, Bayfield County, Wisconsin, Lying North of Forest Road 420A. RECEIVED OCT 0 6 [026 Barfield Co. Planning and Zoning Agency 17FIELD 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: NELSON,ANDREW P & WENDY M 1649 EDGERTON ST ST PAUL, MN 55130 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00524 Transaction. Number: SR -00524-57A99 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 2517 Paid by: Polkoski Soil 2 Septic, 5115 County Highway B, Iron River WI 54847 Payment Type: Check Transaction Date: 10/12/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. FIELD A Bayfield County �T Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: NELSON, ANDREW P & WENDY M 1649 EDGERTON ST ST PAUL, MN 55130 Description Private Sewage System (Septic Tanks) Submission Number: SS -00855 Transaction Number: SS -00855-575A5 Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 2517 Paid by: Polkoski Soil 2 Septic, 5115 County Highway B, Iron River WI 54847 Payment Type: Check Transaction Date: 10/12/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-149S STATE SANITARY PERMIT OWNER: ANDREW P & WENDY M NELSON GOVT LOT: LOT: BLK: SE1/4 SE1/4 SEC:8,T47N,R7W TOWNSHIP: Pilsen SOIL TEST: 151-26 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: ALLAN POLKOSKI TRACY POOLER DATE:10/12/2026 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: # 220090 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 10/12/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION