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Home My WebLink About23-146S REVISION Hayes•^^Sfi^l^r m Wsji'S (WAY032024 i|Saf^y and Buildings Division 201 W. Washington Ave., P.O. Box 7162 Madison, Wl 53707-7162 Sanitary Permit Application In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to ths appropriate governmental unit is required prior to obtaining a sanitary permit. Note: AppHcation forms for state-owned POWTS arc submitted to the Departmcnl of Safety and Professional Semes. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. 1. Application Information - Please Print All Information lty .r-^ -i u iry RifrmiSanitary Pj/nnit Number (to be filled in by Co.) Slate Tran^ictiAi Number ^,^5 0-^^) Project Address (if different than niailj{lg yidress) ^- !^~^\sj^. ^-un^-e.^ ^iK-cif-es L.^ ^ \)- ^0 ?<^ Property Owner's N<ur 3^-c^-A-l^ ig Mijfess Parcel#I 2.3ci0 Property Owner's Mailing Adc^essw (^^City, Stale ^i^\, ^ ^2i K Property Location Govt. Lot "^ U. Type of Building (check aU that apply) 2 Family Dwelling-Number of Bedrooms D PubIic/Cummcrcial - Describe Use D Slate Owned - Describe Use Zip Code^Ho/h Phone Number 7/^<^-22ZZ Lot # "',4, — '/<, Section 2 i? fcircfc one] .N; R 0~1 Eor; Subdivision Name Block # CSM Number D City of_ D Village of fihmvn of C^] OV-P V III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 'ew System D Replacement Systen D Trcatmcnt/HoIding Tank Replacement Only D Other Modification to Existing System (explain) D Perniil Renewal Before Expiration D Permit Revision D Change of Plumber D Permit Transfer to New Owner List P-revious Permit Number and Dale Issued IV. Type ofPOWTS System/Component/Device: (Clieck all that apply) D Non-Prcs-surized In-Ground D Pressurizcd In-Ground @^At-Grade D Mound >_ 24 in. of suitable soil D Mound < 24 in. of suitable soil D Holding Tank D Other Dispersal Component (explain)____ D Prclrcatmenl Device (cxplain)_ V. Oispersal/Trcatment Area Information:.;Design Flow (gpd)^00 Design Soil Application Ratc(gpdsf) -0^_ Dispersal Area Required (sl)^^r Dispersaj AKH Proposed (sf)V3^>~System Elevationw?VI. Tank Info Capacity in Gallons New Tanta Existing Tank-s Total Gallons Units Manufacturer ^ a•2 §'S-;g& u usS5 E 0 Seplic ur IIoltling Tank ^Ww IJ^L J_\^)i~e^er-_^Dosing Chamber VII. Responsibility Statement- I, the undersigned, assijine responsjjutjty for instnllntion of (lie POWTS shown on the attached plans. PlumbA-'s Name (Print) G-r^Sf-o^i^ MP/MPRS Number L^T7</ Business Phone Number 7^-^-Q//fc(PIumbcr't/Address (Street, City, State, Zip Code) " ^ v ' y '/' [^0 t4i^y__H , 7^^^;L-)^. ^^^^7 \rltl. County/Departmcnt Vsk Only ' / 5^ ApprovedS//&/z^D Disapproved D Owner Given Renson for Denial Permit Feq.'SB IX. Conditions of Approval/Reasons for Disapproval* ^y^e^ ^ ^\^t- o>\ ^k^\ * P^nag^O^- ^0/1 ?-o^<3l^/1^ sue/ ^ s K Issum.eAgenl Si.snatureMCTS:'^ JSgz^T n^h^ ^-^m ^ F^or^rcP C7^r<f^ •Uiaclt to complete plaiu for the system and submit to theConnfy only im paper not kss <han 8 1/2x11 inches in size SBD-6398(R. K/ll) 7 ^^-.••"— !v ^\^ ' •' v, *.t • MAY .Or 3, ZU^^-/Zj-_< Wisconsin Department of Safety and Professional San/tees Division of Industry Sennces Page.1 2of SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than.8 1/2x11 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. Personal information you prov'ide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). CountyBayfeld Parcel 1.0. 04-014-2-51.07-27-4 00-177-05000 Reviewed by Date Property Owner Jean Hayes Property LocaHon Govt. Lot %% s 27 T 51 N R 07 -D—B E (or) W Property Owner's Mailing Address 724 County Rd E Site Address or CSM and Lot #:Gitehe Gumee Shores Lot 7 in V.1140 P.58 - Tax[D:12390 City Hudson StateWl Zip Code54016 Phone Number ( ) D City Clover D Village B Town Nearest Road Bark Point Rd Use: !•! Residential/ Numberof bedrooms 2 I Public or commercial - Describe. •I New Construction Q Replacement parent material Sapdy Lacustnne and underlyinga General comments and recommendations: Q-^Q jg suitable for At-grade system Code derived designflow rate 30( Flood Plan elevaUon if applicable. 1 Boring #Qeoring 99.08 iltPit Ground surface elev._ft.45Depth to limiting factor ~ in. / etev.. Horizon A E/B c D F G Depth in. 0-3 3-9 9-30 30-45 45-52 52-65 Dominant ColorMunsell 5YR 2.5/2 5YR3/2 2.5YR 3/6 5YR5/6 5YR4/6 5YR4/6 Redox Description Qu. Az. Cant. Color m-a-p 2.5YR4/6 Texture s s s s s c Structure Gr. Sz. Sh. 0-sg-vf 0-sg-vf 0-sg-vf 0-sg-vf 0-sg-vf 3-pr-co Consistence ds ds df df wf wefi Boundary ca cw cw cw as Roots 2f-2m 2f-2m Soil Application Rate GPD/Ff2 *Efl»1 0.7 0.7 0.7 0.7 0.7 0.2 *E)St2 1.6 1.6 1.6 1.6 1.6 0.3 Boring #DBoring _ .98BgPit Ground surface elev. ~ ~ ft.48Depth to limitt'ng factor ~ ~ in. /elev.. Horizon A E/B c D F G Depth In. 0-3 3-10 10-31 31-48 48-55 55-69 Dominant Color Munsell 5YR 2.5/2 5YR 3/2 2.5YR 3/6 5YR 5/6 5YR4/6 5YR4/6 Redox Description Qu. Az. Cont Color m-a-p 2.5YR4/6 Texture s s s s s c Structure Gr. Sz. Sh. 0-sg-vf 0-sg-vf 0-sg-vf 0-sg-vf 0-sg-vf 3-pr-co Consistence ds ds df df wf wefi Boundary ca cw cw cw as Roots 2f-2m 2f-2m Soil Application Rate GPD/FP *Effiii1 0.7 0.7 0.7 0.7 0.7 0.2 *E?. 1.6 1.6 1.6 1.6 1.6 0.3 CST Name (Please Print)Tim Dykstra Address 10620 Eagle Lake Rd Iron River Wl '"""zi^S-^y Date Evaluation Conducted7/28/2023 GST Number1213855 Telephone Number 715-209-5748 * Effluent #1 = BOD > 30 S 220 mg/L and TSS > 30 s; 150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS .s 30 mg/L SBD-8330 (R04/21) / Boring it Q BoringBi Pit Ground surface elev._"LU"^n.MAY Q^L-^AQ'Depth to limiting factor. Page 2 .2of _ jn. / elev._Jt. Horizon A E/B c D F G Depth In. 0-3 3-9 9-31 31-48 48-55 55-68 Dominant Coloi Munsell 5YR 2.5/2 5YR 3/2 2.5YR 3/6 5YR 5/6 5YR 4/6 5YR4/6 Redox Description Qu, Az. Cont. Color m-a-p 2.5YR4/6 Texture s s s s s c Structure Gr. Sz. Sh. 0-sg-vf 0-sg-vf 0-sg-vf 0-sg-vf 0-sg-vf 3-pr-co Consistence ds ds df df wf wefi Boundary ca cw cw cw as Roots 2f-2m 2f-2m GPD/Ft2 *EW1 0.7 0.7 0.7 0.7 0.7 0.2 *Efi»2 1.6 1.6 1.6 1.6 1.6 0.3 Boring #D Boring D Pit Ground surface elev.-ft.Depth to limiting factor.Jn. / elev.._ft. Hon'zon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cant. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 *Ef»1 '3f#2 Boring #D BoringD Pit Ground surface etev._Depth to limiting factor._in. / elev._-ft. Horizon Depth In. Dominant Colo Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 *Efi#1 *EfiiS2 * Effiuent #1 = BOD > 30 iS 220 mg/L and TSS > 30 i; 150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS s 30 mg/L J^ySf)-y i-'^_?^— w ^ §^^^" ^J ^^I'j; r^^^s^^r (^0 §E^^ •:3=. ^J' <?"At-Grade Plan Index & Cover PAGE 1 OF 6 Component Manual Design References:Version 2^rSBB-?854^N^OT-R:Wrf2r&V^^ version 3.0, May 2022-27Index & Cover Sheet '-——Pg1of6 Pg 2 of 6 Pg 3 of 6 Pg4of6 Pg 5 of 6 Pg 6 of 6 Plot Plan Dispersal Area Cross-Section & Plan View Distribution Network Specifications Pump Tank Specifications iu Management Plan !li: MAY 0 3 '/W- Attachments: Pump Curve Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name^ Description Jean Hayes At-Grade- Plan Owner Name(s): ^ean Hayes Phone: Zip:,. 54016Owner Address: 724 County Road E, Hudson, Wl Project Address: (not assigned) _,...,,.... ^.. Govt Lot: 1/4 of 1/4, SeetiQR 27 . T 51 , N-R O7 :D or' Township: Town of Clover County: Bayfield County Project Parcel ID #: 04-014-2-51-07-27-4 00-177-05000 Designer Information Designer Name: Greg's Plumbing - Greg Brown _ Phone: 715 .209-0161 Designer Address: 13660 County Road H, Iron River,WI _ zip: 54847 E-mail: gregbrQwnplumbing@gmaji.com Tius space reserved for approval stamp. License Number: Remarks: Conditionaliy DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIViSION OF INDUSTRY SERVICES Signature: SEE CORRESPONDENCE Date: 3//y^y Origin^ fefft^s required on each submitted copy.Wj Wisconsin Department of Safety and Professional Services Division of Industry Services 4822 Madison Yards Way PO Box 7302 Madison, WI 53707 ?02i Phone: 608-266-2112 Web: http://dsps.wi.eov Email: dsos(21wisconsin.eov Tony Evers, Governor Dan Hereth, Secretary April 5, 2024 CUST ID NO.: 699374 GREG BROWN 13660 CO HWYH IRON RIVER, WI 54847 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/05/2026 MUNICIPALITY: TOWN OF CLOVER BAYFIELD COUNTY SITE: HAYES BARK POINT ROAD HERBSTER, WI 54844 Identification Numbers Plan Review No.: PWTS-042400595-C Application No.: DIS-032412363 SiteroNo.:SIT-128219 Please refer to all identification numbers m each correspondence with the Department. Conditionaliy DEPT. OF SAFETY AND PROFESSIONAL SERVICESDIVSSION OF INDUSTRY SERVICES ^ SEE CORRESPONDENCE FOR: Design Wastewater Flow Value: 300 Bedrooms: 2 Limiting Factor(s): 45 inches Maintenance Required: Effluent Filter At-Grade Component Manual - Version 3.0 (May 2022-2027) SITE REQUIREMENTS • A full size copy of the approved plans, specifications, and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. A Department electronic stamp and signature shall be on the plans which are used at the job site for construction. The following conditions shall be met during construction or installation and prior to occupancy or use: ® This system is to be constructed and located in accordance with the approved plans, and the "At-Grade Component Manual for Private Onsite Wastewater Systems — Version 3.0 a A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. » Prior to the construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a %-inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. a Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. a A state-approved affluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. » All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 Insulate building sewer beyond 30 feet per SPS 382.30 (ll)(c) |l;J ;IH Well setbacks to meet chs. NR 811 & 812 '1,1 MJ\f0^yu/" Tank Installation to follow all manufacturer's requirements. ; Verify property line(s) prior to installation. The downsiope basal area of the new planned At-grade must be > 5 ft. from the property line. Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from POWTS Dispersal Area. OWNER RESPONSIBILITIES s The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval and Wis. Admin. Code § SPS 383.5411). » In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. The submittal described above has been reviewed for confonnance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/mstallation/operadon. In granting this approval, the Division of Industry Services reserves the right to require changes or additions, should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. The Division does not take responsibility for the design or construction of the reviewed items. Inquiries concerning this correspondence may be made to me at the contact information listed below, or at the address on this letterhead. Sincerely, ^^/" "s .y-'^'.cny'WE^,/' •^ /?•' Timothy Zoromski Division of Industry Services Phone: Email: timothy.zoromski@wisconsin.gov Fee Required: $250.00 Fee Received: $250.00 Balance Due: $0.00 Refund Expected: $0.00 SITE MAP Scale: 1" = 20' 20 _40 0 ••MVMml 03?Ut PAGE 2 OF 6 Y//////////^/// Y//'////'//y///r/Vt '//y////7/7777.60 4"0 PVCSewer Pipe(typteal) P/L W840/500-MRSeptic/PumpTank(mfd by Wieser Concrete) - Install a Model 3014-S25effluent filter at septic tank ouUel (mfd by PolyLok Irx?) 2"0pvcscnctt4aForce Main(typical) Stops to pump tankfordratoback. The downslope basal areaof ii'is planned at-grade must be >5 ft. from the property line which mustbe accurately marked and located for the septic installation Proposed2BR House Wooded Proposed 43.0' x 10.0' At-Grade Dispereal Area ••L'-*' Jean Hayes Property Owner Mailing Address: 724 County Road E Hudson,Wl 54016 Parcel ID: 04-014-2-5-1-07-27-4 00-177-05000 Tax ID: 12390 Lot7inV.H40P.58 S27-T51N-R07W Town of Clover, Bayfield County Install well >50 ft from mound area and >25 ft from treatment tank(s). ..Drive :. BM= 100.0' (nail in tree) Wooded 3.88 Acres to Bark Road* co »4—00<y03coCL co St AT-GRADE COMPONENTCROSS SECTION DIAGRAM(no scale) MIN. 12" OF TOPSOIL COVER '^Qf^VSf^ ^S^fS.ffSst. ^St^S^* 0.5" TO 2.S" WASHED AGGREGATE(covered with approved synthetic fabric) PLOWeo SURFACE ~98.7»/-0.2 ft Etevatton Contour beneath distribution latera! 5.0ftPltimd ParimetBr AT-GRADE COMPONENTPLAN VIEW DIAGRAM(no scai0) 53.0ft Prohibit disturbance and vehlcular traffic within 15 ft of downelope toe. 22.0ft -k Bend as necessary to follow contours. tO n-0«tm0<Q- '-=£ PIPE SPECIFICATIONS fNo Scale) Access Box(typical)Flush AssemUy 2.0"0 PVC Level Distribution. Pipe Last Orfflce =te Oriffce Spacing [-— 2.0' First Oriffce 40.0 ft(typical) DistributlOR Plpei-ength (P) = 40.0 ft Invjsrt Elevation of DistribatiQCi Pipe = -99.2+/- 0.2 ft Bend latera! as necessary to follow elevation contour. On'fice Spacing (X) s 2.0 ft Number OrifSGBS s 21 Oriflce Diameter = 1/4 in Orffices.Equally Spaced and Located on Bottom of Pipe Qn/QI a 1.031 at 2.5 ft Distal Pressure Total Network Discharge Rate = 24.47 gpm 2.0"0 PVC Force Main(slope to pump teanKfor dralnback)' FLUSH VALVE DETAIL (by Orenco orequh/alent)No Scale CeSS^Cap ....8"0V8'^'for Head"TeaUng--^ ___ ^- with Insulated Covsi- Threaded Cap anFlush Valva 2.00° 0 Ball Valve-^"n.—-j—H I ^--Brick Suppwte PeaGravel "El" Sweeo co u-0 in UJs a. PUMP TANK SPECIFICATIONS (no scale) Approved Locking Manliotowllh Warning Label Attached(typical) \(/ \1/ 18"Mln. (typical; ^_ Intel 4° Mln.or2.0ft aboveEgtabllehed Flood Elevation 4"0 Vent Pipe>-10(tfromBuilding•t2"Mln,or2,OftabovaEatabllshed Flood eiavatlon';u"""°' "(lypFcal) \''""" r V8nl C8P Approved Joints withApproved Pipe 3 ft ontoSolid Ground(typical) sz: ^ -^k. (typical) \1/Si Finished Grade Weatterprocrf •Junction Box electrical must comply withCOMM W and NEC 300 ^k- :'- .^ -•••?.-:'. j Inlet Invert Elevation = 96,45 ft Baffle PolyU)k3014<525 ^ EffluantFlltar'W840/500 mfdbyPolYLoklnc, |Combinatiwfank (orsqulvaIBnl> • TANK MANUFACTURER: Wieser Concrete SEPTIC TANK Inside Bottom Elevation of VOt-UME = 840 gaf -Tank = 93.50 ft Outlet Invert = 97.08 PUMP-OFF ELEVATION =84.33 ft (minimum) PUMP MANUFACTURER: Goulds Pumps MODEL NUMBER; PE 31 (or equivalent)MIN. DISCHARGE RATE = 24.47 gpm CONTROL PANEL / FLOAT SWITCHES /ALARM MANUFACTURER: SJE Rhombus (or equivalent) MODEL: EZ Series Plugger (or equivalent) Anchor tank as necessan/ jayrsyant to SPS 383.43(8Va1) 3" Approved Bedding Material Beneath Tank MAX. VOLUME PER DOSE = 60.0 gal MIN. VOLUME PER DOSE = 32,1BACKFLOW VOLUME = 13.E.MAX.JOTAL DOSE VOLUME'S 73.9 ^ MIN, TOTAL DOSE VOLUME" 46.6 gaT VERTICAL HEAD = 4.9 +/. 0.2 ft+MIN. SUPPLY HEAD =2.5 +F.M. FRICTION LOSS =1,2 ft+ FITTING LOSS =0.8 ft = TOTAL DYNAMIC HEftQ_s 9.4 +/. g.g ft FORCE MAIN 0 =; 2.0 InFORCE MAIN LENGTH ° 85+/-ft PUMP TANK VOLUME = 500 gat CAPACITIES (ati 1.82 gpi) A =26.0 In or 307.3 gal B s 2.0 in or 23,6 gaF C = 5.0 In or 59.1 gal Da10.0frioM18.2-gal JotalNatori, Discharge Rate .24.47 gpm OS IMdO OIL m 05 t/ .! ; ' i ::.L-;.,....,...II ! ? I I I ! ' I i si •--^ OS'W€E"-<iN isicnra'iE.a.dmawi •*f'.&^^B™w^^aBca&^w^<tf^™<«.^^rt^^^ 4" CAST-A-SEAL 4" CAST-A-SEAL TOP VIEW 4" VENT PUMP PAD SIDE VIEW W840/500-MR TANK SPECIFICATIONS DIMENSIONS:WALL: 2 9/16" BOTTOM: 3" COVER: 5" MANHOLE: 24° I.D. PRECAST CONCRETE RISER HEIGHT: 59 1/2" L£NGTH: 9'-5 3/4" WIDTH: 7'-9" BELOW INLET: 48' LIQUID LEVEL: 43" WEIGHT: 11,150 LBS. INLET AND OUTLET:4" CAST-A-SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER:WISCONSIN, SEE DETAIL #W(OTHER STATES SEE CHART) UQUID CAPACITY: 19.61 GAL/IN (SEPT1C)11.82 GAL/IN (PUMP) LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS:SEPT1C/SEPTIC, SEPTIC/PUMP,OR SEP71C/SIPHON COVER: MIX DESIGN #8 (NO RBER)TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS:FOR CUSTOM TANKS CONTACT WIESER CONCRETE TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: -.'.WMUE^^tt ^ (£>1^ico §LO^~.fr~>0 I003: 03 w. 0010 $ <=3 u1= a,uj(75 SHEET NO. 1 OF/"' 1 Bayfield County, Wl 5/10/2024, 10:34:32AM Rivers Approximate Parcel Boundary Road Type **""* Town Late Superior Shoreline Recession Segments The average annual rate of bluff recession In this reach of shoreline is approximately 0.5 feet. The average annual rate of bluff recession In this reach of shoreline is approximately 1.0 feet. ° Flood Plain Boundaries Active Dec 16th. 2011 AE = Base floodplain where base flood elevations are provided, Lake Superior Proposed Setback Line Building Footprint 2015 Building 0 0.04 0.09 BayfieSd County Land Records Department Bayf1e!d County Zoning Appiicatlon htips://fTiaps. bayfieSdcounty.wi.gov/2onin3WAB/ 5/10/24, 9:47 AM Real Estate Bayfield County Property Listing Today's Date: 5/10/2024 Novus-Wisconsin Access rev. 12.0206 'eit Description Updated: 10/4/2017 a'Ownership Property Status: Current Created On: 3/15/2006 1:15:14 PM Updated: 10/4/2017 Tax ID: PIN: Legacy PIN: Map ID: Municipality: STR: Description: Recorded Acres: Calculated Acres: Lottery Claims: First Dollar: Zoning: ESN: Tax Districts 1 04 014 044522 001700 12390 04-014-2-51-07-27-4 00-177-05000 014112201007 (014) TOWN OF S27 T51N R07W GITCHE GUMEE P.58 4.150 4.062 0 No CLOVER SHORES LOT7INV.1140 (R-RB) Residential-Recreational Business 109 »^ Recorded Documents Updated: 3/15/2006 STATE COUNTi' TOWN OF CLOVER SCHL-SOUTHSHORE TECHNICAL COLLEGE Updated; 3/15/2006 JEAN M HAYES Billing Address: JEAN M HAYES 724 COUNTY RD E HUDSON WI 54016 Site Address * indicates N/A Property Assessment 2024 Assessment Detail Code Gl-RESIDENTIAL G6-PRODUCTIVE FOREST 2-Year Comparison Land: Improved: Total: KB Property History JEAN M HUDSON WI Mailing Address:Address: HAYES 724 COUNTS RD E HUDSON Private Road Acres 2.230 1.920 2023 76,000 0 76,000 WI 54016 i Updated: Land 74,100 1,900 2024 76,000 0 76,000 7/13/2017 Imp. 0 0 Change 0.0% 0.0% 0.0% Date Recorded: 3/27/2015 2015R-558137 1140-58 B TERMINATION OF DECEDENT'S INTEREST Date Recorded: 3/27/2015 2015R-558136 1140-54 S3 CONVERSION Date Recorded: 592-18 B WARRANTY DEED Date Recorded: 9/8/1993 407643 592-118 N/A https://novus.bayfleldcounty.wi.gov/access/master.asp?paprpid=12390 1/1 Private Sewage Systen^Mam^en Owner(s) Name 3£ANJ +IAVES i-'tl S hitV.Uw/'^ Owner(s) Mailing Address ~7Z4 COUNTY -R.a E HuoSui'J k)l S^:o?Mcu 2u"inyDepl Site Address M/ ft GT4-cHz.(qUf-t£i£ StiotLfcS S 2.7 -T^;M- R(,-7tU Tax ID #Z3-=i 0 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 specificattons 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 Wt Adm. Code, as from time to time amended. (COMPLETE Legal is required) 1/4 of 1/4 Section Zr7 TQ^Nnship 5(S(^ Additional Legal Descnpfon: ^ii'C'rE ^U)^ fcE ^.ttOi^-S .N. Range 07 w. Town of -CLo\/i=e.(Acreage)4.1 So Gov'tLot Lot _ Block Lot__7_CSM#, Subd'ivision Vol. I't^Qpage ~5^ cSMDocft. DOCUMENT NUMBER2024R-603 1 44 DANIEL. J. HEF-FNER REGISTER OF DEEDS BAYFIELD COUNTY, Wl RECORDED 05/06/2024 AT 1 0:1 5 AM RECORDING FEE; $30.00 PAGES: 1 Recording Area Return To: Planning and Zoning Department D In-ground gravity a Mound D In-ground dosed D In-ground pressure distribution Sewage System: SS At-grade Sewage System Q Other. Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servteing operator within three (3) years of the date of installation and at least once every three (3) yeare thereafter unless, upon inspection by a tfcensed 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 abo 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 sa'id components. Seotic Tank Effluent FUter (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 distributton cell shall be visuaRy inspected by a certified septage servicing operator, POWTS inspector. or Ucensed 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-arade. and In-around Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed whgn. the wastewater distribulion ceii component is inspected as provided above. Ownerfs) agree that failure to comply with this agreement will result in actton 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 shafl notify the owner of any costs which shall be paid by the owner wShin 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 (/ie (ax 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 ^<S?.^ V\^fc^Subscribed and sworn to before me on this date: |5-Zo<^.^^"11,,Notarized Owner(s) - Signature(s) ^L^s^^u f^-'y^'^ 4*- ^0,v° •.* a^^••'^BV^.-^,^g&d^..^^;?^2°E@£^^T^'''f^y^d^-'^ji ufforms/sanitaiy/septiana^lte^^^v'$>.' •"7iv '^'^^^."'.^'^^Oo'Mtf^"//////<fimiT^V ^p>— M,Management Plan wl !J3iov paaeeofe ^S^ ^Srn?St^%e3S^scsh?^^^^^^/8quS?hSh3e?R^zS ^";,n^ ,pu^altosps}§-527^sl=^^^^^ ste" bec^d^ SSSnn?SroJm.am^JSeSa^S^nSS.acvvwes sha" be performed bVaregistered"POWS*Ma1n^n^ | Wfaxi'mum Dispersal Area Ooeratjna Lnnits: Design Flow = 300 gpd; BODs ^ 220 mgL \- TSS < 150 mgL-1; FOG $ 30 mgt-1 l Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (/.e. odors, user complaints, ete.) o mechanical matfuncfion (/.e., pumps, valves, svritehes, floats, 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 negfect or improper use (f.e., exceeding design capacities, prohibited actiVfSes, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularifies (/.e., pump re-cyding, float switch settings, etc.) o electrical components (;.e., wiring, connections, switches, controls, timers, alarms, efc.) o distribution lateral or laterai orifios plugging (measure lateral distal pressure - compare to design specification) o surface discharge of effluerrt or sewage back-up into stmcture served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tankfe) 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 Kquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wise. Admin. Code. o EfBuent filteris) shat! 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. o Distribution laterals shall be f?ushed once eveiy 3 years or when necessary. 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 malftinction to; Name of individual or company; Greg's Plumbincf._L,LC Phone: Zl§s2fiSbfilfil Local government unit Bavfietd County Zoning Department Phone: 715-373-6138 Any defectfvepartofffu's system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wise. Admin. Code.Repair or replacement offaBed or maffuncfionmg components shall comply with SPS 383, Wis. Adm'in. Code. No forchemical or physical restoration of the POWTS may be used unless approved by the department in accordance witSPS 384, W?s. Admin. Code. Con&'ngencv Plan System Abandonment »^O,NSPOWTS,,^^,,,^^^^^^^^^^^^^^^^