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HomeMy WebLinkAbout24-44SRequest 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 Discrepancy Other Phone Number Plumber: ,,,- (p Li — Fax Fax Number Email Address Homeowner: Immediate Phone Number So Zoning Sanitary Permit #: �' S Dept can call you right back (if needed) Plumber's Choice Zoning Dept Date: -77/.7 No Inspection(s) during this time Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice Zonin Dept Time: Township: Address # & Road Name: or Directions To Site: Comments: ** Plumbers you must verify any change(s) by fax or email ** Notes from Zoning Dept: u/forms/sanitary/requestfori ns pection Zoning Dept (O4/12/04); ® June 2023 In Industry Services Division Private Onsite Wastewater Treatment Systems ( POWTS) Inspection Report (Attach to Permit) RUSSELL E AND CHERYL L CHAMPINE REVOCABLE TRUST 634 200TH AVENUE SOMERSET WI 54025 _I_ ._L_L:_._ City t Town of: e Sanitary Pern1R No: State Plan Transaction ID#: Parcel Tax No: l Olin nuv'uiauvu TYPE MANUFACTURER CAPACITY Prop. Line Well BuiIdin9 Air Intake Road Septic W; e5 Q N/A Dosing N/A Aeration N/A Holding ' Pump I Siphon Information / Pump Manufacturer Pump Model Demand GPM Filter Manufacturer Filter Model TDH Lift Friction Loss Head Total Forcemain Length Dia Dist. To Well nienarcal rail Infnrmatlnn DIMENSIONS I Width Louth # of Cells SETBACK FROM Pr. Line Building Well UMWM Type of Cell Manufacturer: ott'n1w � Model Number, Pretreatment Unit Manufacturer: Model Number: tievation uata STATION ,, BS c HI FS ELEV Benchmark?4 ________ lot .7 Bldg. Sewer q(g •q Tank Inlet P ct(o .9 Tank Outlet r ctla Dose Tank Inlet Dose Tank Bottom Inst. Contour Header/ Manifold °Ito .`7 Distribution Pipe Infiltrative Surface ,cl Final Grade Q8 ,$ listribution System X Pressure Systems Only Header! Manifold Distribution I (s) X Hole Size X Hole Observation Pipes Length Dia Length I Dia ' Spac Spacing ❑ Yes ❑ No Soil Cover Depth Over Depth Over Depth of Seeded I Sodded Mulched Cell Center Cell Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) .4 Cfl'r/ O -v 9,9e ls� �C d chi s ,r /ac t �d Plan revision required? 0 YessNo I ✓i / j n Use other side for additional Informa on. / /+ Date CRn.R71 n !R nRl911 POWTS nspector's Signature License Number ya j BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Bayfield County Courthouse Fax: (715) 373-0114 Post Office Box 58 e-mail: zoning(&bayfieldcountv.wi.gov 117 East Fifth Street Web Site: www bayfieldcounty.wi.gov1147 Washburn, WI 54891 Property Owner 'USSELL E AND CHERYL L CHAMPINE EVOCABLETRUST Information X34 200TH AVENUE ;0MERSET WI 54025 As you know r ki/A) was contracted by you to install a private onsite wastewater treatment system on your property described as: Notes: Abandonment of Old System to meet all applicable code requirements: •'r Tank was pumped by: Tank was crushed I removed and pipes disconnected by: on at AM/PM On at / (AM /'?the above -mentioned plumber contacted our office to conduct a pre -cover inspection as required under DSPS 383. One of the following applies: Y System was inspected and appears to meet all applicable code requirements. ❑ System was inspected and appears to meet all applicable code requirements; however, a plan revision is necessary because the installation was substantially different than the original approval. ❑ System could not be inspected because plumber covered prior to scheduled time of inspection. ❑ System could not be inspected because plumber was not ready at scheduled time of inspection. County was unable to return to complete inspection. System could not be inspected because plumber was not ready at scheduled time of inspection. A re -inspection and $50 fee are required. ❑ System could not be inspected because County could not respond to plumber's time constraints. Comments: Ulformslsanitaryproperlyowner-input April 2019 ,ate Department of Safety County A. & Professional 3ervict:y. _ ,' Industry Services Diviaion Sanitary ermitNumber (to filled in by Co.) Sanitary Permit Application State Trurt action Number In accordance with SPS 383 21(2), Wis. Adm. Code, submission of this form to the appropriate govemmentgl unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned P0WTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. l5.04(l)(m), Stats. 1 I l t0 I. Application Information —Please Print All -Information Property Owner's Name ��- /r ( Parcel ? % - (L,sS C � Property Owners Mailing A ress Property Location IY 4, ZZpoo 3 Govt Lot 2Z. �OC.2-0231 (oO% Z —_'A. %, Section City, State Zip Code Phone Number S O W 2,5 •L5 __- T N R E ortj IL TypapfBnihimg.(eheck allhint apply). Lot N SubdivisionNeme t+' or 2 Family Dwelling —Number ofBedrooms v 7 z Block? o PubliefCommercial —Describe Use ❑ Cityof ❑ State Owned — Describe Use 0 Village of CSM Number $.-Town of • g0..V'0t•0 5 1n. Type of POWTS'Permitp (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i. . a' livable.) . - __ A. Abl ew System 0/// Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B' ❑ Holding Tank In -Ground fl At -Grade 0 Mound - ❑ Individual Site Design ❑ Other Type (explain) r (conventional) C. 0 Renewal Before 0 Revision 0 Change of Plumber 0 Transfer to New Owner st Previous Permit Number and Date Issued Expiration r.-Ditperaal/r eatmentArea mid Tank. Information: .. :.. .. .. _. Design Flow (gpd) Design Soil Amp-p-lication Rate(gpolsf) Dispersal Area Required (st) Dispersal �A�rea Proposed (st) System Elevation Capacity in Total N of Manufacturer 'rank Information Gallons Gallons Units m e o m New Tanks Txisrwg Tanks y 3 u h a 't: U rs �.. Septic orHolding Tank fffl _ Dosing Chamber °'"a ' affhe l?OwWSshatvamfheattaehed V.I2esppnsibtlity $pittgmen[- T, the undersiwed, � Pleas. Plumbers Name (Print) Plumber' Si MP/MPRS Number Business Phone Number Plumber Address (Street, City, State, Zip Code) artment-U.eOuly:;,. 9•-Copnty!De dODha:mVed - Permit Fce $� arc Issued Is uing A Sig e 7 �J �.7! �� Owner Given Reason for Denial onditions of Ap vah'Reasons for Disapproval µ, AR 2 "i LO a°' �'�, Nfisconsin Oepertmenl of Safety&Professional ServicesMPage 1 of 3 Division of IndustryServices SOIL EVALUATION REPORT county In accordance with SPS 38.5. Wis. Adm. Code Bayfield Attach complete site plan on paper not less than 8 112 x 11 Inches in size. Plan must include, Parcel I.D. 3 -T but not limited to vertical and horizontal reference point (BM). direction and percent slope, D4-004-2-05-09-1 00-14rr22000 scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). Property Owner Property Location O ❑ Russell E. & Cheryl L. Champine Revocable Trust Govt. Lot i % S 18 T 45 N R 09 E (or)( Property Owner's Mailing Address Site Address or CSM and Lot #: 634 200th Ave CHEROKEE ADD TO POTAWATOMI LOT 221N DOC 2023R401217 City, State, Zip Phone Number ❑ city ❑ Village ® Town Nearest Road Somerset WI 54025 (612) 366-4197 Barnes 1630 Lynx Rd 2New Construction Use: ®Residential/Numberofbedrooms 2 Code derived designfowrate 300 GPD ❑ Replacement ❑ Public or commercial —Describe: Flood Plan elevation if applicable ft. Parent material Sandy outwash (Rubicon Series) General c mxrlents and recortmendations. Keep system elevation above 93.5' a Bori # ❑Boring 9780 90.3 n9 West ® pit Ground surface elev._ft. Depth to limiting faUer_in. / elev._ft. Soil Application 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 1OYR 2N s Osg ml cw lm/2vf 0.7 1.6 2 7-14 10YR 3/3 — s Osg ml cw 2m/21 0.7 1.6 3 14-40 7.5YR 4/4 — s Osg ml gw 1vf 0.7 1.6 4 40-73 10YR 5/4 — s Osg ml cs — 0.7 1.6 5 7360 1OYR 5/4 — cos Osg ml — — 0.7 1.6 ❑ Boring # East oB°d°g .8 ®Ps Ground surface elev. 97_ft. Depth to limiting fador60in. / elev. 91_1 ft. Sol] Annll ication Rate 1 Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPO/Ft' 'Eff#1 'Eff#2 1 0-4 1 OYR 2/1 — s Osg ml cw 2vf 0.7 1.6 2 4-8 10YR 3/2 — s 0sg ml cw if/lvf 0.7 1.6 3 8-31 7,5YR414 — S Osg ml aw 1m/1f 0.7 1.6 4 31-37 7.5YR 4/4 — 10% GR) s Osg ml aw lvf 0.7 1.6 5 37.85 10YR 5/4 s 0sg ml Cw 1vf 0.7 1.6 6 65-80 1OYR 5/4 — cos Osg ml — — 0.7 1.6 CST Name (Please Print) Signature, - `CST Number 654921 Keith Wiley >/ .� Address Date ifvaluiation Conducted Telephone Number 11623E Larson Dr. Lake Nebagamon, W 54849 2/6/2024 218-451-2611 • Effluent #1 = 130D > 30 5 220 mg/L and TSS > 30S 150 mg/L ' Effluent #2 = SOD. £ 30 mg/L and TSS S 30mg/L 580-8330 (R03/22) ' page 2 of 3 MAR?• 7 (4 Boring 90.2 Boring # ® Pit Ground surface elev. 97.2 ft. Depth to limiting factor 84 In. I elev. �_,fl•— CnAnnll ll maiion RalTe Horizon Depth In. Dominant Color Munsell 1 OYR 2/1 10YR 312 7.5YR 414 10YR 5/4 10YR 5/4 Redox Description Ou. Az. Cord. Color — — — — — Texture s s s $ cos Suc Se Gr. 0sg 0 osg Osg Osg Consistence ml ml ml ml ml Boundary cw cw as — Roots 2vf 2m/2f 2f 1vf Vrurrr •Eft#1 0.7 0.7 0.7 0.7 0.7 'ER# 1.6 1.6 1.6 1.6 1.6 1 O-5 2 5-1O 3 1O-42 4 42-80 5 80-84 ❑ Boring # o Boring o Pit Ground surface cloy. ft. Depth to limiting factor_____ in. I eetev. _____ ft. cnii er.dl I anm Rate Horizon Depth In. Dominant Color Munsell Redox Description Ou. Az. Cont. Color Texture Structure (Sr. Sz. Sh, Consistence Boundary Roots GPD/Ft2 •Eff#1 • Eft#2 fl 0 swing Boring # 0 Pit Ground surface clew. ft. Depth to limiting factor _in./ clew. _fl. Sail Aonlication Rate Horizon Depth In. Dominant Color Munsell Redox Description Ou. Az. Cont. Color Texture Structure Or. Sz. Sh. Consistence Boundary Roots GPO/Ft' •EfT#1 •Efh%2 - Effluent #1 = SOD > 30 5 220 mg/I. and TSS > 30:5150 mg/L • Effluent #2 = SOD. 5 30 mg/L and TSS 5 30 mg/L Champine (2bedroom) Soil Report Plot Plan North R S. centerline of Lynx Rd__----- _---- RUSSELL E AND CHERYL L CHAMPINE REVOCABLE TRUST 1630 Lynx Rd CHEROKEE ADD TO POTAWATOMI LOT 22 IN DOC 2023R-601217 Sec 18 T45N R09W Town of Barnes 04-004-2-45-09-18-4 00-146-22000 2.101 acres Scale 1:50 NOTES: Bench Mark = Nail w/orange ribbon in 8" DBH aspen Elev = 100.0' h^Ai. _ .I1Yn_ -No well - Lake elev = 89.8' - wetland elev a 89.8' rrr crate„ GV MAR 217024 U PAGE 1 OF 4 Bavfieirl Co. Zoning Dept. PRIVATE SEWAGE SYSTEM PLAN INDEX ime: Russell & Cher Revocable 634 200'" Ave, Sam, Parcel ID: 04-004-2-45-09-18-4 00-146-22000 WI 54025 Page Number CONTENTS 1 of 4 PLAN INDEX 2 of 4 SYSTEM PLOT PLAN 30f4 44 DISPERSAL AREA X -SECTION & PLAN VIEW 4 of 4 MANAGEMENT PLAN Attachments: SOIL EVALUATION REPORT County: Bayfield County Legal Description: S18-T45N-HO Lot 22, Cherokee Add to Potawatomi Doc 2023R-601217 1630 For Office Use Only COMPONENT MANUAL NO.: Version 2.0, SBD-10705-P (N.01/01) Signature: License N I, the undersigned, hereby certify that the plans and specifications submitted herewith were prepared under my direction and control Greg Brown Greg's Plumbing, LLC. 13660 County Hwy H Iron River, WI 54847 o: 715-209-0161 �--- Date: 3 2lO Z. ., 7 / ?� �@ I..,/ / ,\ 2 o a ',II °|�! / f!#� �/ co \ C) 2((} / / -4R3 . a- I! _ m . Z §( C / \359 n f ) / flu ( �f ' © E o m / )\{ O o \ 3�\�\ \— }}a{ {/E/ f (0 /5 (\ t&q$77 / ° J : (0 ({{} \ f, (- -.n c \ ° &« ' , o CD -- � k 0) CD > 0 NJ 0 / PAGE 3 OF 4 Li r, DISPERSAL TRENCH a MAR 212024 CROSS-SECTION VIEW SCHEMATIC `elc C. Z?i°Jna Dept. (No Scale) SOIL COVER c Ijl FINf5HED GRADE min. 12' (typical) Geotextile Cover W. 12- _ A. a min. Irench soperation distance Endcap mi^depthd,j tba�0 In1e9647d 8 '. , (typical) . (typical) ' " �. ' " r, Standard Quick -4 + Chamber . , System Elevation = 95.80' (typical) N. " •r t (mfd by Infiltrator Systems, Inc.) . (typical) ' (typical) Install pursuant to manufacturers instructions. Required Dispersal Area = (300 gpd) / (0.7 gpd/sq-ft) = 429 sq-ft EISA = (11 chmbrs/tmch x 2 tmch x 20 sq-ft/unit) + 5.8 sq-ft/end cap pair x 2 prs = 451.6 sq-ft DISPERSAL TRENCH PLAN VIEW SCHEMATIC (No Scale) Standard Quick -4 + Chamber 3.0 ft End Cap 4"0 PVC (mfd by Infiltrator Systems, Inc.) (typical) (typical) Conveyance Pipe (typical) o 3.0 ft System Elevation = 95.80 ft (typical) Observation (typi�) Pipe (typ O 47.0 f (typical) Inlet Invert = 96.47 (typical) 9 Page 4 of 4 Management Plan IMPORTANT: The owner of this in -ground dispersal 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 = 300 gpd; BOD5 ≤ 220 mgL-'; TSS ≤ 150 mgU'; FOG ≤ 30 mgL-' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) 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 o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic 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 (1/3) 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 Wis. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Greg's Plumbing (Greg Brown) Phone: 715-209-0161 Local government unit: Bayfield County Zoning Department Phone: 715-373-6138 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, Wis. 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, Wis. 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 Department of Safety and Professional Services for review and approval. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wis. Admin. Code. 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Indianapolis, IN 46278 1 Customer Service: 1-888-604-7888 MAR 2 LUL4 Payment Confirmation Your successful payment to AllPaid constitutes payment to the Payment Destination(s) and discharges your obligation to pay the Payment Destination(s) below in the amount specified by "Payment Amount" for the following matter(s). Your next statement will display this transaction as ALLPAID* followed by the name of the paid party. Contact AllPaid at 1-888-604-7888 with any questions about the processing of this payment. Transaction Information Status: Approved Please take a moment to give us feedback on your payment experience by clicking HERE. APD Reference #: TX_12738194 Date: 03/21/2024 11:39 AM CDT Approval#: 07672D Pay Amount: $400.00 Service Fee: $14.00 Total Amount: $414.00 Payment Information Property Owner: Gregory M Brown Tax ID#: 3437 Payment Amount: $400.00 Billing Information iI Ending in 2157 Gregory M Brown 13660 County Rd H Iron River, WI 54847 us (715) 209-0161 gregbrownplumbing@gmail.com Please take a moment to give us feedback on your payment experience by clicking HERE. © 2007-2024 AllPaid. Inc. All Rights Reserved. (NMLS ID #1434636: Licensed by the Georgia Department of Banking and Finance #61205) An Aventiv Technologies Company 4110/24. 11:48 AM E Reul Estate Bayfield County Property Listing Today's Date: 4/10/2024 Novas -Wisconsin Accesslrev. I'12.I0[[206II I, L LS U Pr; perry Status: Current APR 30 f,LeatedJOi: 3/15/2006 1:14:51 PM Description Updated: 11/14/2023 Tax ID: 3437 PIN: 04-004-2-45-09-18-4 00-146-22000 Legacy PIN: 004124802000 Map ID: Municipality: (004) TOWN OF BARNES STR: 518 T45N R09W Description: CHEROKEE ADD TO POTAWATOMI LOT 22 IN DOC 2023R-601217 (RUSSELL E AND CHERYL L CHAMPINE REVOCABLE TRUST) Recorded Acres: 2.101 Calculated Acres: 2.101 Lottery Claims: 0 First Dollar: No Zoning: (R-1) Residential -1 ESN: 104 Tax Districts Updated: 3/15/2006 1 STATE 04 COUNTY 004 TOWN OF BARNES 041491 SCHL-DRUMMOND 001700 TECHNICAL COLLEGE Recorded Documents © WARRANTY DEED Date Recorded: 11/13/2023 © WARRANTY DEED Date Recorded: 5/15/2020 Updated: 6/19/2020 2023R-601217 2020R-582129 ja Ownership..;%fleld CO. Zoning Dept. Updated: 11/14/2023 RUSSELL E AND CHERYL L CHAMPINE SOMERSET WI REVOCABLE TRUST RUSSELL E AND CHERYL L CHAMPINE SOMERSET WI REVOCABLE TRUST Billin9_Address: Mailing Address: RUSSELL E AND CHERYL L RUSSELL E AND CHERYL L CHAMPINE REVOCABLE CHAMPINE REVOCABLE TRUST TRUST 634 200TH AVENUE 634 200TH AVENUE SOMERSET WI 54025 SOMERSET WI 54025 "- Site Address * indicates Private Road 1630 LYNX RD BARNES 54873 .-' Property Assessment Updated: 10/4/2016 2024 Assessment Detail Code Acres Land Imp. G1 -RESIDENTIAL 2.100 31,800 0 2 -Year Comparison 2023 2024 Change Land: 31,800 31,800 0.0% Improved: 0 0 0.0% Total: 31,800 31,800 0.0% Lf Property History N/A https://novus.bayfieldcounty.wi.gav/access/master.asp 1/1