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HomeMy WebLinkAbout24-48SRequest 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 fl Time Change fl Discrepancy fl Other ,f q ,� �S �, cq i-c Phone Number Plumber: lwI �"I, �i �" 7lS` Fax Number Homeowner: Q+ `h4,`"!1 pn1A4c&.c 1?VC, Email Address Sanitary l ' p� Q tJ� `y `-4 O J Immediate Phone Number So Zoning Dept can call you right back (if needed) Permit #: Plumber's Choice Zoning Dept t 7 a2,i I / No Inspection(s) during this time Date: OK Zoning Dept Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice Time: OK • 1/ O0 arw Township: Address # & Road Name: vl al 0 ^�� , ^, nfn t I� LG�^� I` X or Directions To Site: Comments: ** Plumbers you must verify any change(s) by fax or email ** Notes from utformstsanitary/requestforinspection Zoning Dept (©4112J04);® June 2023 oeU'�r a � �. aPs � IOMPl Industry Services Division General Information Private Onsite Wastewater Treatment Systems ( POWTS) Inspection Report (Attach to Permit) rcisuuw uuwmauuu Permit Holder's Name: City 9 Village flTown of: C ANDRE J & JODI L DRINKWINE BM Description: 3723 SCHIESS RD BARNES WI 54873 GOB Tw -TYPE MANUnvt; I urccrc unrnvi I 1 Prop. Line Well Building Air Intake Road Septic N/A Dosing N/A Aeration N/A Holding satbacicto: 1/ O 9 Sanitary Perri t No: State Plan Transaction ID#: Parcel Tax No: 3y"7 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 flicnarcal Cell Infnrmation DIMENSIONS Wid Lengt(y, # of Cells, SETBACK FROM Prop. Line iidi g Wall OHWM Type of Cell Manufacturer: Model Number: Pretreatment Unit Manufacturer: Model Number: 1icIrihn{inn Cua+am Header / Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length _ Dia Length _ Dia Spec Spacing ❑ Yes ❑ No Elevation Data STATION BS HI FS ELEV Benchmark � 1p2,SP] Bldg. Sewer 3 Tank Inlet .i4 Tank Outlet f D Ct5d .Q • Dose Tank Inlet Dose Tank Bottom Inst. Contour Header/Manifold Z _5.q5 Distribution Pipe Infiltrative Surface 5, 0 Final Grade 9 . -67 X Pressure Systems Only Soil Cover Depth Over Depth Over Depth of Seeded! Sodded Mulched Cell Center Cell Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS • (Include code discrepancies, persons present, etc,) ftg/d cr v'&l Loc 5 GiyG�i r t7 /%/f��'er/�j Plan revision required? ❑ Ye No / 7 A Use other side for additional informatio . Date RRnR71 n rR ngr91 t POWTS I spector's Signature License Number t 1V 1sr; 1 wZ (% a 1 4 Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoningf&bavfieIdcounty.wi.00v Web Site: www bavfieldcountv.wi.aovl147 ANDRE J & JODI L DRINKWINE 3723 SCHIESS RD BARNES WI 54873 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know // S i G was contracted by you to install a private onsite wastewater treatment s stem on your property described as: Notes: Abandonment of Old System to meet all applicable code requirements: LI :• Tank was pumped by: Tank was crushed I removed and pipes disconnected by: on at AM/PM On p___/jZil at PM) 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. LISystem 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: ❑llormslsanilarypropertyowner-input April2919 D ft II Department of Safety County' �, & Professional Services, u u APR 2 5 20 4 sanitary emut ber to be filled in by Co.) Industry Services Divisi�.1, amtary Pernui 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) bl�'�50)'L-� 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 �Q Cr f vt purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. ,,p� nn ! c& Information L Application Information — Please Print All Property Owner's Name Parcel # /� J / r t- I r° o` Prdperty Owner's Mailing Address Property Location Govt Lot �� q sp iAL'h, Section 3g City, State Zip,Code Phone Number /' ���)) ,, �^`�-� 1/�-l-I--� S1 O ?/5 -52t -z092 % W1 �ti T 5N R E o IL Type of Building (check an that apply) Lot # Subdivision Name i4 or 2 Family Dwelling —Number of Bedrooms Block # ❑ Public/Commercial—DescnbeUse ❑ City of_ CSMNumber ❑ State Owned —Describe Use ❑ Village of — n. ��` gTown of t f 14Q7'x- III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line e applicable.) A. $New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank $Jn-Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. 0 Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration W. DispersaVrreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required (si) I Dispersal Area Proposed (si) System Elevation ado .7 Capacityin Total # of Manufacturer B o Tank Information Gallons Gallons Units Uo Uc,O New Tanks Existing Tanks o Eil 'm m s3" on wO F4 Septic or Holding Tank 7 ' / 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 SignatureMP/MPRS Number Business Phone Number LS S5g'-17 Plumb s Address -/(S�treet, City, State, Zip Code) 5 (8 6'-&3County/Department r (.laSr W.l- Use Only ed Disapproved Perm F Date �Issued V''5' C lJ'� Iss ing at S* aattireCl ❑ Owner Gives Reason for Denial onditions f Approval/Reasons for Disapproval Attach to complete plans for the system and submit to the County only on paper not less man o vs n 11 norms 1i1 ,la SBD-6398 (R. 03/22) °`x�R "°jo„ Wi nsiq Depargr»"ntp D nd Professional Services r -.. D n In $�nYl �S` g SOIL EVALUATION REPORT APR 25 20 La In accordance with SPS 385, Wis. Adm. Code County Attach complete site plarpc�,pgp.�rypt j ,g;(� %gf2 x 11 inches in size. Plan must include, Parcel I but not limited to: vertica Htiidtf��f��n'�y oint (BM) direction and percent slope `Ft b r C o'y scale or dimensions, north arrow, and location and distance to nearest road. Tait Z Please print all information. Reviewed by Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). EL 3521 Date 'roperty Owner Property Location ❑ ❑ Anrke'Zvrh L. t)rkLe Govt.Lot 5E -SW Y. s 3t-( T t{S N R D9 E (or)® property dne?'s Maili g Address Site Address or CSM and Lot #: 2-3 Sc t -z i e5S R 1 4.c a 14ZLD E V -O t>t nsa Lk. City 54-vvleS State ( Zip Code C% -t3 Phone Number t szq zoo ❑ City ❑ Village EAown I L vyt2s o Nearest Road Ro%Ctnsovt Uc New Construction Use:Residential/Numberof bedrooms Z Code derived designflow rate .500 GPD ❑ Replacement ❑ Public or commercial —Describe: Flood Plan elevation if applicable eft. Parent material3(aGta_1 oof_wJQSIq General comments and recommendations: 1 t .Z soy s 5 SGe • 9 r&n a 9f-t_gb•zS' Boring # ❑Boring [ Pit Ground surface elev1Ri SSft. Depth to limiting factorbSin. / elev. 40 9 aL Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Ax. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 'Eff#1 -Efr#2 D -S T'5'r s — S - s (u�C .-7 Z &-ZO . 3 — S If rr rt (oi- -7 _ 3 zo-6( `t g — $ If. rt 4 ( 4 I _(a8 y 9/3 — 5 rr a — _ Boring# ❑Boring [GJ" Ptf Ground surface eievR Ct .13 Depth to limiting factor l O Zin. / elev.QO2i Soil Application 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 I D — (o .5- 3z c o -s ml 5cc) hrrc .—( t. 2 6- t tt Y -5 v rr n (,t �•� 3 (q_&b n u S ti y 1uC. `t S0 —/D l s S Y n_ _ — ,—( I•lo CST Name MERTON MAKI Signature -j4 j CST Number 224901 Address 10869N SMITH COURT HAYWARD, WI54843 Date Evaluation Conducted � t -( Telephone Number (715) 634-8719 Effluent #1 = BOD > 30 ≤ 220 mg/L and TSS > 30 ≤ 150 mg/L * Effluent #2 = BOD, ≤ 30 mg/L and TSS ≤ 30 mg/L SBD-8330 (R04/21) mi r n 9r Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az Cont Color Texture Structure Cr. Sz. Sh. Consistence alkdA L GPD/Ftz 1 'Eff#2 b -(o S_ 3i — 5s L v '( I., 6 -2Z r — �t `t B Z d e !-L L.6 3 2z -q n H — S tt 1 'f IV 1 1. Y_ n s _ 5 a 4 — —t7 1,4 ❑ Boring # ❑ Boring 0 Pit Ground surface elev. R Depth to limiting factor in. / elev. ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Cu. Az. Cont. Color Texture Structure Or. Sz. Sh. Consistence Boundary Roots GPD/Ft' 'Etf#1 ETf#2 Z 6 l = 300 d— t S i s= '-1ZR ut LIZct —2Op&tL= — ZZ rec. 1- L Z + = S r 4o G Zk4s. _i �- ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. it Depth to limiting factor in. / elev.R Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Cu. Az. Cont. Color Texture Structure Cr. 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, £ 30 mg/L and TSS 5 30 mg/L ow Andce 3 - 3adi. L. Drhw/n 3723 Sc(%lec5 R.d- T rf�es1 kit 5925-3 1:5 —Sac — _2042 cle4.reA, 2- be it ccq Leg4�; [ El� LIJ + D sytdCo• Bav✓te TluPj�252024 Twlc- SD. 352277 •vr::': Zoning Dept. sE/Sw 5' LJ TLgpJ R Iogc.J s&• z42.I0 E, l2.ob%vt,sotL Lnkce R (� • — 44.45 1 Ix slope 3 _g.53 A ScCIe: I "•_ 4d a lU ao .4 vG Stfe FS,ae s 1102 4y� IbA Yl14 C Ott %c iii H--i ro 0 iz $ca LCD �iak ko Sc4e I Tokaf 330' Rob hso4 Lake A an loo, 3cra5 c s(a b ,. bc.CAC SI. 44S£i' 2. 44.1'3' 3. e8.93` So'i I si sisfe.r eleu- q& �2r1ar r'14.k�- 1\aLL Csr zzQ9o) 4 — Iq— ZLj, Ida0B �, a? Sz'Lb (v�1S s'Lb +���' yPlg ry7k � C �k- �.j b —_��� -:scs �� ar__ s.�s r f� i;1 l�vQ—i�aVV �-emu,m�} '� PAGE 1 OF 4 In -Ground Gravity Plan IDS 6 E II V E D Index & Cover Sheet APR 2 52024 Component Manual Design References: Bavfeid Co. Zoning Dept. In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027 Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross -Section & Plan View Pg 4 of 4 Management Plan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description OwnerName(s): Pr re.5/Tod.i L1 J2n-i LWTY1rF.. Phone: lS-Sr -3oy9 Owner Address: 37075 SCtiit°5s RAt, 6myie� u)z Zip: 5'I8'73 Project Address: -] 7 /0 I!, Q`b/TScm In2s2, Govt. Lot: 1/4 of Q1/4, Section .3 , T9_N-R 057 E ❑ or W 1� -I Township:County: @__ _Q Project Parcel ID #: tA5l _Vn — 35 tU 7 Designer Information Designer Name: Designer Address: E-mail: License Number: /9�5' Q Remarks: Phone: /STh- Zip: J yL Pdnv Ytai.naU Conditloe® see 'al stamp. Signature: Date: Original signature required on each submitted copy. out 1. Andre. 3. 3zJ. . L. 377-3 Sckless Rd_ T G-fles, 1/i! syg'73 CIS -S24- Zo4CZ Lbd rr Pcor42u. L —J c14.44' o". -k•o P '11' ' A 3Vt ioa, c3cra9 c s(a b i-i bC.ck Si, 9s.�8' Z. 9c3 3. 48. R3 ,7 So'Is, S�$� eled. q(� (. ranIe 9q'-91.2.5) L CO. 8av✓1s A t %Q24 Ya \c rb. 3SzV7 sE7S i ≤3.I YcSpi R'o4l-7 S:j-. gZ1pE. P-obtvtsovtLQ.ke R1L I A Sccle l s, arji =� e 4-+rowmae 3 Si 1160 £Yrs4.wc 3 „ clef to tt4210E -rk41 3.3t= Rob esov. Lake Rd a N Ii 03 CD O \ 1;; f + ® z / Cl) a e } \ } I $ G © in m \ m $ CD c _ f f % a » [y9 ! : [ l 32j \ � � I I & ! ! � � ^ � % \ � ! 2 ! ! ® � 2 ! ! , < ! fm IT! CD \ O3 CD C- =C Co CD 1:1 C _ . _ B m C_ a % 2 9 0 % B 2 2 _ an - Iii /O® CEO trmr CL a - �! > 14/ km ?> B 2 } PAGE 4 OF 4 In -ground Gravity Management Plan U IMPORTANT: nn 0 APR 2 52024 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 shglIept. 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 = gpd; BOD5 S220 mgL 1; TSS S 150 mgL''; FOGS 30 mgL-1 Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, 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 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 (he., 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 (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 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Phone: 115 , G % Local government unit: `j( / & C, G j 2f � GC �� Phone: (A�j�j1�__ Local government unit address:U &Y' SCE L �t 7f. JIe//;1; (XE ZIP: �G �9l 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. WLP750- MR TANK SPECIFICATIONS a JJLD N DIMENSIONS: o c WALL: 2 1/2" N 'c BOTTOM: 3" No COVER: 4" N MANHOLE: 24" I.D. PRECAST CONCRETE RISER o HEIGHT: DOME COVER 61" O.D. c_ -o- FLAT COVER 53 1/4" O.D. OUTSIDE DIAMETER: 84" O.D. BELOW INLET: 42" O.D. LIQUID LEVEL: 37" CAST -A -SEAL\ 4" CAST -A -SEAL WEIGHT: 6,150 LBS. INLET AND OUTLET: III 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL FILTER OR INLET AND OUTLET BAFFLE AND FILTER: BAFFLE / WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 20.28 GAL/IN HOLDING TANK: ACTUAL CAPACITY: 790 GALLONS TOP VIEW OUTLET HOLE PLUGGED • LOADING DESIGN: 8' 0" UNSATURATED SOIL MN TANKS: WILL HAVE ONE VENT OVER OUTLET AND WILL HAVE TWO VENTS IN COVER OVER INLET OPTIONAL FLAT COVER TANK CAN BE USED AS: IS AVAILABLE FOR EXCHANGE SEPTIC/ HOLDING/ PUMP OR SIPHON FOR DOME COVER. 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(ww) ul'ans glary (89 F) E9'9 (89 t) E9'9 (ww) ul hajawep algd Jolaalla0 3 (£VE) 9'E L (EVE) S'E L (ww) ul'yawl oL lg6laq laiNO 3 (ww) ul *owetp adld 1a0n0.0 (LSt) SLYL (LSV) SLLL (ww) g'LgUlaq a6pp '0 (EES) O'LZ (t) 0 L (ww) ul jg6laq 6ulsnoH'8 (L9) L'ZZ ILLS) L'ZZ (ww) ul Yg6laq pelae0 V .. 8L-LZSOSd:)Sd 8L-LZ9OSSSd lapow }(lap 6uiuoZ 00 playAeg bZOZ S Z ddtl a 4/13/24,7:48 AM Novus-Wisconsin ATA rev. 12.0206 r, Real Estate Bayfield County Property Listing " slams;Current Today's Date: 4/13/2024 APR 2 V O 1/18/2008 12:22:55 PM Description Tax ID PIN: Legacy PIN: Map ID: Municipality: STR: Description: Recorded Acres: Calculated Acres: Lottery Claims: First Dollar: Zoning: ESN: I Tax Districts 1 04 004 041491 001700 Updated: 12/15/2023 ershi ayfield Co. Zoning Dept. Updated: 12/15/2023 35267 ANDRE J &JODI L DRINKWINE BARNES WI 04-004-2-45-09-34-3 04-000-42000 (004) TOWN OF BARNES S34 T45N R09W PAR IN SE SW IN DOC 2021R-586657 10.000 9.400 0 Yes (F-1) Forestry -1 104 Updated: 11/18/2008 STATE COUNTY TOWN OF BARNES SCHL-DRUMMOND TECHNICAL COLLEGE Billing Address: Mailing Address: ANDREJ&JODIL ANDREJ&JODIL DRINKWINE DRINKWINE 3723 SO -h ES.S RD 3723 SCI-IIESS RD BARNES WI 54873 BARNES WI 54873 Site Address * indicates Private Road 4210 E ROBINSON LAKE RD BARNES 54873 Property Assessment updated: 4/1/2023 2024 Assessment Detail Code Acres Land Imp. Gl-RESIDENTIAL 1.000 5,000 12,400 G6 -PRODUCTIVE FOREST 9.000 12,200 0 2 -Year Comparison 2023 2024 Change Land: 17,200 17,200 0.0% Improved:* 12,400 12,400 0.0% Total: 29,600 29,600 0.0% Recorded Documents Updated: 11/18/2008 © PERSONAL REPRESENTATIVES DEED'-- -- --._----- Date Recorded: 1/25/2021 2021R-586657 Property History © WARRANTY DEED Parent Properties Tax ID Date Recorded: 10/16/2008 2008R-523345 1004-516 04004-2-45-0?•34-3 04-000-40000 35247 HISTORY ®=c=_nd Ai H!stc:y White=Current Parcels Pink=Retired Parcels 12TaxI 13247 Pin G40C --_-- 35267 This Parcel ; Parents —* Children -7`s-5 P-9-goca P https:l/novus.bayfieldoounty.wi.gov/access/master.asp 111