The URL can be used to link to this page

Home My WebLink About26-157S,q 4 Department of Safety County Baytleld SS - Ooct 60L & Professional Services, ' Sanitary Permit Number (to be filled in by Co.) N Industry Services Division l 5 H e Sanitary Permit Application ____________________________1513 tate Transaction Number In accordance with SPS 383 21(2). Wis. Arlin Code, submission of ibis form to the appropriate governmental unit Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note Application farms for state-owned POWTS are submitted to the Department of Safety air) Pii,t banal Services. Personal information you provide may he used for secondary purposes in accordance wi111 die Pi l,.rc, I .m. s 1504(18m). Stars 10410 Hillside Ln i. A lication information — Please Print All Information CEIVED Pmipenc Ossnei s Same Parcel % t;Zoo E> Amy D. Kersey 04-024-2-47-08-34-1 05-002-10000 Property Owners Mailing Address UU I 09 1Q76 Property Location 2830 18th St NW Rayfield Co. Govt. Lot 2 34 City, State I Zip Code p'dthlIg`BMdtPbningAgent,]! New Brighton, MN 55112 '/a. 4 Secuon T 47 N R 08 E o R. Type of Building (check an that apply) Lot ^ Subdivision Name * I or 2 Family Dwelling— Number otHednonis 4 ; ENTERED Blocks 1pllk ❑ Public/Commercial — Describe Use ❑Cityof ❑ State Owned — Describe Use _ ❑ Village of CSM Number B rotwl of Iron River 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 i appllcahle.) '\ ❑ New System ® Replacement System ❑ Other Modification to Existing 5'stem lei lain) g P ❑ Additional Pretreatment Unit lei Win) P B' ❑ Holding Tank ® In -Ground 0 At -Grade 0 Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision 0 Change of Plumber ❑ Transfer to New Owner ist Previous Permit Number and U to Is ued Expiration A '7 V � 1/7/19 W.DbpeVFSt Area and Tank Information: Design Flow Igpd) I Design Sod Application Ratel epdisfi Dispersal \rya Required (sf I I Dispersal Area Proposed (sl) System Elevation 600 0.7 857.1 876.8 94' & 92.6' Capacity in Total s of Manufacturer e Tank Information Gallons Gallons Units 8 it U y New Tanks Eaisiing Tanks I e a,;.) 4,uI a to 9 v, .c12 � L - Septic or Holding Tank 1250 — 1250 1 Wieser X Dosing Chamber V. Responsibility Statement— 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans Plumber's Name (Print) Plan er s Si , awry MI' \II'RS Number Business Phone Number T e I 3>' ld8a- PM o?/8-393 - Alvin PI ber's Address (Street. City, State, Zip Code) 90 L hfn� N Al $S 8l wait VI. tin /De ent Use OnI Approved ❑Disapproved Permit Fee I Date Issued Issuing Agent Signature �''.�/ PISIofps & ❑ Owner Given Reason for Denial shy E SP" /0/2-3/21 (/V" 2Z 21 10 ' I it a Conditions of Approval/Reasons�for Disapproval c�'u /j /� /Q� QV'vltiif l/}d u:¢h m omgJnr plan. Ibr the' stem and submit to the (noon oniv on paper not toss than a Ina it inches in sore SBD-6398 (R. 03/22) SR- ooSdq RECEIVED Wisconsin Department of Safety& Professional Services OCT 1 22026 Division of Industry Services SOIL EVALUATION REPORTynela Planning a In accordance with SPS 385, Wis. Adm. Code Coui 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, Parc scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Re Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). Page of? TEST # /57-a Bayfield I.D. 04-024-2-47-08-34-1 05-002-10000 Property Owner Property Location ❑ Amy D. Kersey Govt. Lot 2 % % S 34 T 47 R 08 E (or) Property Owner's Mailing Address Site Address or CSM and Lot #: 10410 Hillside Ln 2830 18th St NW City, State, Zip I Phone Number El City ❑ Village ® Town Nearest Road New Briahton, MN 55112 I ( I Iron River I Hillside Ln ❑ New Construction Use: ® Residential/Numberofbedrooms 4 ® Replacement ❑ Public or commercial — Describe: Parent material Outwash Sands (Rubicon-Sayner complex) General comments and recommendations: HBoring # ❑ Boring ®Pit Ground surface elev.9`t•1 ft. Code derived designflow rate buu GPD Flood Plan elevation if applicable N/A ft. Depth to limiting factor 84 in. / elev. 87.1 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/Ft' *Eff#1 Eff#2 1 0-7 7.5YR2.5/2 — Is Osg dl Cw 1rn/1f/1 0.7 / 1.6 2 7-24 7.5YR4/4 — Is Osg dl cw 1f 0.7 1.6 3 24-43 7.5YR 5/3 — Is Osg dl aw if 0.7 1.6 4 43-64 7.5YR 5/4 — s 0sg dl aw — 0.7 1.6 5 64-84 10YR 6/4 — 10%GR) s 0sg dl — — 0.7 1.6 2 ] Boring # ❑Boring ®Pit Ground surface elev. ft. Depth to limiting factor 84 in. I elev. 88.9 ft. Soil Application Rate Horizon Depth In. Dominant Color Munseli Redox Description Qu. Az. Cont. Color TextureEStrwucotureConsistence Boundary Roots GPD/Ft' *Eft#1 •Eff#2 1 0-9 7.5YR 2.5/2 — Is dl CW 3f 0.7 1.6 2 9-19 7.5YR 3/3 — Is. dl as 3f/2vf 0.7 1.6 3 19-25 7.5YR5/1 — Is dl as 1m/2f 0.7 1.6 4 25-44 7.5YR 5/4 — Is dl aw 1co/1f 0.7 1.6 5 44-64 - 7.5YR 5/4 — Is 0sg dl aw — 0.7 1.6 6 64-84 10YR 6/4 — Is Osg dl — — 0.7 1.6 Horizon 5 firm in p ace breE cing to singlE grain loamy and CST Name (Please Print) Signature // /�' CST Number Keith Wiley v l/v 654921 Address Date Eva uation Conducted Telephone Number 11623 E Larson Dr. Lake Nebagamon, WI 54849 9/20/2026 218-451-2611 Effluent #1 = BOD > 30 S 220 mg/L and TSS > 30S150 150 mg/L * Effluent #2 = BOD. s 30 mg/L and TSS s 30 mg/L SBD-8330 (R03/22) ° r ' ❑ Boring ti3 J Boring # ® Pit Page 2 of 3 Ground surface elev. 96.5 ft. Depth to limiting factor 84 in. / elev. 89.5 ft. Soil Anolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 1 0-9 7.5YR 2.5/1 — Is 0sg dl as 2f 0.7 1.6 2 9-13 7.5YR 5/1 — Is 0sg dl as lm/2f 0.7 1.6 3 13-35 7.5YR 5/4 — Is Osg dl aw 1m/If 0.7 1.6 4 35-47 7.5YR 5/4 — s Osg dl aw 1f 0.7 1.6 5 47-84 7.5YR 4/3 — (15%) cos 0sg dl — — 0.7 1.6 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Anolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. / elev. ft. Soil Annlication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 £150 mg/L * Effluent #2 = BOO, 5 30 mg/L and TSS s 30 mg/L RECEIVED OCT 12 2026 Bayfield Co. Planning and Zoning Agency Kersey (4 bedroom) Soil Report Plot Plan North Amy D. Kersey S10410 Hillside Ln PAR IN GOVT LOT 2 IN V.788 P.1047 727F IN DOC 2023R-601263 S34 T47N R08W Town of Iron River 04-024-2-47-08-34-105-002-10000 1.560 acres Scale 1:40 Bench Mark = Top of well Elev = 100.0' 94 Hart Lake OHWM OW Septic tank & drainfield to be abandoned per SPS 383.33 ST demolished me to be house S, lsting ho bedroom & replaced `N� �� 96' Garage sauna aG ao, o� a NOTES: SWell - Property lines not shown > 50' from tested area - Hart Lake elev87' 0 0 0 CD CST 119900002 -SP Page 3 of 3 RECEIVED PAGE 1 OF 4 In -Ground Gravity Plan 0CT 092026 Index & Cover Sheet sayaeld co. Component Manual Design References: planning and Zoning Agency In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross -Section & Plan View Pg 4 of 4 Management Plan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Kersey 4 bedroom In -Ground Owner Name(s): Amy D. Kersey Phone: lS -oaLA - /0%1 Owner Address: 2830 18TH ST NW NEW BRIGHTON MN Zip: 55112 Project Address: 10410 Hillside Ln Govt. Lot: 2 1/4 of 1/4, Section 34 , T47 N -R08 Enor W ✓❑ Township: Iron River County: Bayfield Project Parcel ID #: 04-024-2-47-08-34-1 05-002-10000 Designer Information Designer Name: Keith Wiley Phone: 218 -451 -2611 Designer Address: 11623 E Larson Dr Lake Nebagamon Zip: 54849 E-mail: coyotesepticworks@gmailo.com License Number: D2388PSS Remarks: {( ylE\T %'N'4 D 27EBP55 Saffd on eacn suomioea copy. Date: 10/5/2026 Kersey (4 bedroom) Gravity In -Ground Plot Plan North Amy D. Kersey �, 10410 Hillside Ln JI PAR IN GOVT LOT 2 IN V.788 P.1047 727F IN DOC 2023R-601263 534T47N R08W Town of Iron River 04-024-2-47-08-34-1 05-002-10000 1.560 acres raj DW Septic tank & drainfield to be abandoned per SPS 383.33 5T 10AX"C gb°'°e 1q bedto r°b°uae 8, replacedwl fl co O�y N U c 111 Well O Z la ; �W 7% /Clzsonk � 2 C 3 °' w/ polylok 525 filter Three rows of 11 & one row of 10 Infiltrator Quick 4 Standard Low Profile chambers Scale 1:40 x Bench Mark =Top of well E(ev = 100.0' 94 ao \ 96' NOTES: HartLake - Property lines not shown > 50' from tested area - Hart Lake elevc+87' - All vent, observation & conveyance pipes 4" ASTM D1785 or code equivalent Page 2 of 4 Row #1-3 1 IN -GROUND GRAVITY DISPERSAL AREA Stepped Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) Low Profile SOIL COVER min. 12' (typical) $r. TYPICAL TRENCH mi depth �� CROSS SECTION VIEW () (No Scale),1.(typical).i . .. Highest Trench System Elevations = 94 ft; 94 ft; 94 ft; Septic Tank(s) Manufacturer. Wieser Septic Tank(s) Volume(s): 1250 gal gal gal gal Effluent Filter Manufacturer Polvlok Effluent Filter Model p: 525 Provide minimum 3 ft o separation between trenches. n s o co Lowest Trench (as applicable) D 2 N 0 ft' ft Quick4 Standard -W LP wl End Cap (Show location of inlet I outlet pipe connection on plan view.) (typical) L------------t--------��--- g = 46.2 ft (typical) INSTALL PER TRENCH: LP 11 Quick4 Std - 20 ff EISAIchamber = 220 ft' + 3 Pairs of end caps @4.2 ISAlpair= 12.6 ft' = Proposed EISA per trench = 224.2 ft' Observation Pipe (typical) Install per manufacturers / Instructions. TYPICAL TRENCH PLAN VIEW (No Scale) IA=3.0ft (typical) —Quick4 Standard -W chamber ILow Profile (typical) (mfd by Infiltrator Systems. Inc.) Install pursuant to manufacturers instructions. Required Infiltration Area = 857.1 ft' Distribution Method: x 3 trenches = Proposed Total EISA = 672.6 ft' branched manifold D C m W O m a ri C) rrf M a Row #4 J IN -GROUND GRAVITY DISPERSAL AREA Stepped Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) Low Profile SOIL COVER TYPICAL TRENCH CROSS SECTION VIEW (No Scale) System Elevations = min. IT (typical) $n min. encb depth (typical) (typical) ., .. Highest Trench ft; Septic Tank(s) Manufacturer Wieser Septic Tank(s) Volume(s): 1250 gal gal gal gal Effluent Filter Manufacturer Polylok Effluent Filter Model #: 525 Provide minimum 3 ft separation between trenches. Lowest Trench (as applicable) ft; ft; 92.6 ft; Quick4 Standard -W LP w/ End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) a -----------------------------f--------��--- g= 42 ft (typical) INSTALL PER TRENCH: LP 10 Quick4 Std-20ff EISA/chamber = 200 ft2 + 1 Pairs of end caps @ 4.2 ISA/pair = 4.2 ft' = Proposed EISA per trench = 204.2 ftt iT Observation Pipe (typical) Install per manufacturers / Instructions. TYPICAL TRENCH PLAN VIEW (No Scale) IA = 3.0 ft (typical) —Quick4 Standard -W Chamber Low Profile (typical) (mfd by Infiltrator Systems. Inc.) Install pursuant to manufacturefs instructions. Required Infiltration Area = 857.1 ft2 x 1 trenches = Proposed Total EISA = 2042 ft' Distribution Method: branched manifold D O m W O n POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 6 of 7 FILE INFORMATION Owner Amy D. Kersey Permit # DEVC d DARANFTFRS Number of Bedrooms 4 ❑ NA Number of Public Facility Units O NA Estimated (average) flow 400 gaVday Design (peak) flow = (Estimated )< 1.5) 600 gal/day 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 (BOD5) ≤220 mg/L O NA Total Suspended Solids (TSS) s150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) ≤30 mg/L Total Suspended Solids (TSS) ≤30 mg/L 0 NA Fecal Coliform (geometric mean) ≤104 cfu/looml Maximum Effluent Particle Size ¢ in dia. O NA Other: 0 NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: O 3 months) earls (Maximum 3 years) 0 O NA Pump out contents of tank(s) O When combined sludge and scum equals one-third ('14) of tank volume O NA ❑ When the high water alarm is activated Inspect dispersal cell(s) At least once every: 3 year(s) ❑ month( (Maximum 3 years) 0 O NA Clean effluent fitter At least once every: 3 ❑ month(s) O year(s) O NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) ® NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) 0 NA Other: At least once every: ❑ month(s) ❑ year(s) O NA Other: -- O NA SYSTEM SPECIFICATIONS Tank Manufacturer Wieser O NA 0 Septic O Dose O Holding vol. 1250 gal Tank Manufacturer 0 NA ❑ Septic O Dose O Holding vol. gal Effluent Filter Manufacturer Polylok O NA Effluent Filter Model 525 Pump Manufacturer 0 NA Pump Model Pretreatment Unit O NA ❑ Sand/Gravel Filter O Peat Filter ❑ Mechanical Aeration O Wetland O Disinfection O Other: Manufacturer Dispersal Cell(s) O NA 0 In -Ground (gravity) O In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip-Une O Other: Other: 0 NA Other: 0 NA 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 ponding 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 (!!4) 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 servicert to the local regulatory authority within 10 days of completion of any service event. GMW (12102) 0CT 0 9 2026 hayfield Co. Planning and Zoning Agency 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. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ 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. 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 MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS RECEIVED Bayfield Co. POWTS INSTALLER POWTS MAINTAINER Name ev p r' Name /) hri Phone 07/s- la - (og Phone ai 9 - SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name //-p fliuerfJ,Lj Name Bayfield County Zoning Phone 5 - .19- '-/Ootp Phone715-373-6138 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(l), (2) & (3). Wisconsin Administrative code. WLP 1250 -MR TANK SPECIFICATIONS 4" CAS 0 w tn Qa w INLET - TT y � U a 5 / 23" r I t d M DIMENSIONS: WALL 2 1/2" BOTTOM: 3" CAST -A -SEAL COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 52 1/2" LENGTH: 10'-0 1/4" WIDTH: 7'-0" BELOW INLET: 41" LIQUID LEVEL 36" WEIGHT: BOTTOM 4,945 LBS. COVER 3,865 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 34.81 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,323 GALLONS LOADING DESIGN: 8'-O" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) I OUTLET t` U J� CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE J vI i Z Q V O - U '- L 3) mN REVIEWED BY a i,g REVIEW DATE F a •w DRAWINGS SUBMITTED FOR APPROVAL a APPROVED BY: SHEET NO. APPROVAL DATE: 1 7" PRODUCTS NEEDED BY: /= OF w Wisconsin Department of Safety & Professional Services S Division of Industry Services • SOIL EVALUATION REPORT Ti, In accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information Page 1 of 3 County Bayfield Parcel I.D. 04-024-2-47-08-34-1 05-002-10000 Reviewed by I Date Property Property Owner P rtY Location '—' `-' Amv D. Kersev Govt. Lot 2 ''A % S 34 T 47 NR 08 E (or)® Property Owner's Mailing Address ' V w Site Address or CSM and Lot 1k 10410 Hillside Ln 2830 18th St NW City, State, Zip phpwoo4MMg Agency ❑ City ❑ Village ® Town Nearest Road New Briahton, MN 55112 I t ) I Iron River Hillside Ln ❑ New Construction Use: Residential/Numberofbedrooms 4 m Replacement ❑ Public or commercial — Describe: Parent material Outwash Sands (Rubicon-Sayner complex) General comments and recommendations: aBoring # Code derived designflow rate OUW GPD Flood Plan elevation if applicable N/A ft. ❑ Boring ® Pit Ground surface elev. 94_1 ft. Depth to limiting factor 84 in. / elev. 87.1 ft. I SoilAooli Horizon Depth In. Dominant Color Munsell Redox Description Ou. Az. Cont. Color Texture Structure Consistence Gr. Sz. Sh. Boundary Roots GPD/Ft2 Eff#1 Eff#2 1 0-7 7.5YR2.512 — Is Osg dl cw lntllf/lv 0.7 1.6 2 7-24 7.5YR4/4 — Is Osg dl cw 1f 0.7 1.6 3 24-43 7.5YR 5/3 — Is Osg dl aw if 0.7 1.6 4 43-64 7.5YR 5/4 — s Osg dl aw — 0.7 1.6 5 64-84 1 OYR 6/4 — 10%GR) s Osg dl — — 0.7 1.6 Boring # ❑Boring ®Pit Ground surface elev. ft. Depth to limiting factor 84 in. / etev. 88.9 ft. Snil Annlinalinn Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 Eft#1 Eff#2 1 0-9 7.5YR 2.5/2 — Is Osg dl cw 3f 0.7 1.6 2 9-19 7.5YR 3/3 — Is 0sg dl as 3f/2vf 0.7 1.6 3 19-25 7.5YR 511 — Is Osg dl as 1 m/2f 0.7 1.6 4 25-44 7.5YR 5/4 — Is 0sg dl aw 1co/1f 0.7 1.6 5 44-64 7.5YR 5/4 — Is Osg dl aw — 0.7 1.6 6 64-84 1OYR 6/4 — Is Osg dl — — 0.7 1.6 Horizon 5 firm in pace brea ing to singlp grain loamy and CST Name (Please Print) Signature nature CST Number Keith Wiley .� `� 654921 Address I Date EvaCation Conducted Telephone Number 11623 E Larson Dr. Lake Nebagamon. WI 54849 9/20/2026 I 218-451-2611 Effluent #1 = BOD > 30s 220 mg/L and TSS > 30 s 150 mg/L ' Effluent #2 = BOO, s 30 mg/L and TSS 5 30 mg/L 5BO-8330 (R03/22) Page 2 of 3 Boring # ❑ Boring ® Pit Ground surface eiev. 96.5 ft. Depth to limiting factor 84 in. / elev.69 5 ft. Soil Aoolicatlon Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sr Sh. Consistence Boundary Roots GPDIFt' Eff#1 Eff#2 0-9 7.5YR 2.5/1 — Is 0sg dl as 2f 0.7 1.6 2 9-13 7.5YR511 — Is Osg dl as 1r11/2f 0.7 1.6 3 13-35 7.5YR5/4 — Is 0sg dl aw 1m/1f 0.7 1.6 4 35-47 7.5YR 5/4 — s Osg dl aw if 0.7 1.6 5 47-84 7.5YR 4/3 — (15%) cos Osg dl — — 0.7 1.6 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. I elev. ft. I SoilAool Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' Eff#1 Eft#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I SoilAnolication Rate I Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 Ef#1 -Eft#2 ' Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 5150 mg/L RECEIVED 0CT 0 9 2026 BaYfield Gn. AgenCY Planning and Zon 9 Effluent #2 = BOD, s 30 mg/L and TSS 5 30 mg/L Kersey (4 bedroom) Soil Report Plot Plan North Amy D. Kersey J 10410 Hillside Ln PAR IN GOVT LOT 2 IN V.788 P.1047 727F IN DOC 2023R-601263 S34 T47N R08W Town of Iron River 04-024-2-47-08-34-105-002 -10000 1.560 acres DW Septic tank & drainfield to be abandoned per SPS 383.33 ST Ex�stinghome t4b ae um house & te"aced wl Ccc - N w cn Na Well / o g 7% o •'\ a //'C>// Scale 1:40 4 S Bench Mark = Top of well Elev = 100.0' 94 / 96' Garage sauna of ao NOTES: Hart Lake - Property lines not shown > 50' from tested area - Hart Lake elevz87' CST 119900002 -SP Page 3 of 3 Private Sewage System Maintenance Agreement D. 18th St NW New Brighton, MN 55112 10410 Hillside Ln " 20035 As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil testers 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 34 Township 47 N. Range 08 w Additional Legal Description: Town of Iron River Lot Block Subdivision (Acreage) 1.560 Lot _CSM#_ Vol. Page CSM Doc# ® In -ground gravity ❑ Mound Gov't Lot 2 Return To: DOCUMENT NUMBER 2O26R-6 14112 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 10/09/2026 AT 1 1 : 18 AM RECORDING FEE: $30.00 PAGES: 2 ENEDoning Department OCT 12 2026 ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ At -grade Sewage System O Other Area 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 pp rl q 1hwp,to the benefit of all current and future owners of such property. Owner(s) Name(s) — Please Print N0T .0scribed and sworn to before me on this date: •'9 Amy D. Kersey = � ''•2: Notarized Owner(s)—Signatures) LJC •Nota Publi [,(\ 'b,,%v1SC0 y Commission Expires: —i Drafted by: Keith Date: 10/5/2026 Proofed by: u/fauns/sanitary/septicmaintenceagreement Revised July 2020 EXHIBIT A Legal Description Parcel 1: Lot One (1), Certified Survey Map No. 582 as recorded in the Office of the Register of Deeds for Bayfleld County, on March 2, 1987 in Volume 4 of Certified Survey Maps, Page 176 as Document No. 368632, located in the Town of Iron River, Bayfield County, Wisconsin. Parcel 2: Including an easement 16.5 feet in width over lands to the North and East for the purpose of ingress and egress to the Town Road. AND A parcel of land in Government Lot Two (1), Section Thirty-four (34), Township Forty-seven (47) North, Range Eight (8) \Vest, Bayfield County, Wisconsin, described as follows: Commencing at an iron pipe at the intersection of the North -South 1/4 line of Section 34 and the South line of Government Lot 2. Thence S89°56'W, 1017 feet; thence N25°36'E, 91.6 feet; thence N67°05'E, 119.3 feet to the Point o;' Beginning; thence N67°05'E, 30.55 feet; thence N8S°42'E, 38.93 feet; thence N4 °20'W, 277.6 f:et more or less-to'the'water's'elige of Hart Lake (passing through an iron pipe at 227.6 feet). Thence Northwesterly and Southwesterlly along said shore 500 feet more or less, to a point on said shore wlch bears 3x144° 16'VJ; 325'8 feet from Point of Beginning. Thence S44°16'E, 325.8 feet (passing iluough an iron pipe at 44 feet) to the Point of Beginning. oci 122026 PWnmgand Zoning 4871 -I 396-02 5 911 Bayfield County Register of Deeds Document #2023R-601263 Page 3 of 3 PAY, ]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: KERSEY, AMY D 2830 18TH ST NW NEW BRIGHTON, MN 55112 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00529 Transaction Number: SR-00529-5BED7 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 1144 Paid by: Coyote Septic Works LLC, 11623 E Larson Dr, Lk Nebagamon WI 54849 Payment Type: Check Transaction Date: 10/23/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. B--YFIELLI 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: KERSEY, AMY D 2830 18TH ST NW NEW BRIGHTON, MN 55112 Description Private Sewage System (Septic Tanks) Submission Number: SS -00862 Transaction Number: SS -00862-57A44 Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 42552 Paid by: A G O'Brien, 4907 Lightning Dr, Hermantown MN Payment Type: Check Transaction Date: 10/23/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-157S STATE SANITARY PERMIT OWNER: AMY D KERSEY GOVT LOT: 2 LOT: BLK: 1/4 1/4 SEC: 34, T 47 N, R 8 W TOWNSHIP: Iron River SOIL TEST: 157-26 REPLACEMENT SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: TYREL BOTTEN EMILY MACGILLIVRAY LLIVRAY DATE: 10/23/2026 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 #: 137217 LICENSE: # PM 1082 Condition: Properly Maintain System Per Recorded Agreement. Old System needs to be properly abandoned per SPS 383. THIS PERMIT EXPIRES 10/23/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION