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HomeMy WebLinkAbout24-49S** INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY TIME RECEIVED REMOTE CSID DURATION PAGES STATUS May 21, 2024 at 10:54:15 AM CDT 7153724159 37 1 Received May 22 2024 02:10 HP Faxpolkosk Plumbing 7153724159 page 1 Request for Sanitary Inspection Fax this form to Zoning Dept when you want an inspection — 373-0114 If you do not have a fax and must email the inspection; you must email all staff members 1 I Note Time Change Discrepancy ri Other Phone Number ' Fax Number Plumber: 7 : ? c 3.7 LI1 S 9 Home Owner: f , v i Sanitary Permit #: Plumber's Choice Zoning Dept No inspection during these times Date: S f 2 �' OK Time: Plumber's Choice Zoning Dept Immediate Phone Number so Zoning � O� OK Dept can call you right back (if needed) Township: Address& Road Name: v-� '� vtr ft ire c r '"r` f ```` a..� L (� or Lt s K f ra Directions �- ✓ e ld Coo Q �. ,, -�- L, [..ca IC, To Site: Comments: Rem: You must confirm any change(s) that have been made prior to or this ►nsAgctlon will not bescheduledggjj a memo will be sent voiding the Inspection. Thank You! From Zoning Dept ** Plumber must verify any change(s) by fax pr no Inspection__be scheduled ** uKcrmelsanitary1requssttadnspedon Zoning Dept 04112(04) ® August 2021 o�"ar"wr T Private Onsite Wastewater Treatment $P Systems Industry Services Division General Information Personal infnrmAKnn 'mu "•..a RICHARD A & ANDREA D WIITALA 65000 RUTH LAKE RD IRON RIVER WI 54847 T..n4 InFnrn� i+inn TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road Septic )� r N/A Dosing N/A Aeration N/A Holding POWTS) Inspection Report (Attach to Permit) oses [Privacy Law, s. 15.04 (D(ra o City U Village M Town of.. Vim Vu BM Description: e i cothnrk tn• Pump I Siphon Information Pump Manufacturer Pump Model Demand GPM Filter Manufacturer Filter Model a TON Lift Friction Loss Head Total Forcemain Length Dia Dist. To Well Dispersal Cell Information DIMENSIONS Width Length #of Cells 31 SETBACK FROM Prop, Line Building1 Well OHWM 7 — Type of Cell Manufacturer: \ft\ Model Number. Yo ,,VJI 1lX Pretreatment Unit Manufacturer: Model Number: Distribution System Elevation Data STATION BS HI FS ELEV Benchmark loo Bldg. Sewer Tank Inlet so .so Tank Outlet'j.-ic o Dose Tank Inlet Dose Tank Bottom Inst. Contour Header/ Manifold — Distribution Pipe - Infiltrative Surface (Q 7 (o gg Final Grade . C C_g Qrj X Pressure Systems Only Header/Manifold Distribution Pipe(s) X Hole Size X Hole gbservation Pipes Length _ Dia Length _ Dia Spac _ Spacing f] Yes ❑ No Soil Cover Depth Over Depth Over Depth of Se ded / Sodded Mulched Cell Center Cell Edges Topsoil 1 Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Plan revision required? 0 Yes No Use other side for additional inform lion. % 2rfl Date - POWTS Inspector's Signature /so?7gfa License Number CRn-A71n !R ngni\ h i i U 1 1 Department of Safety County �s & Professional Services, a` -c 0 San itary Permit Number(to be filled in by Co.) Industry Serviees.Division Sanitary Permit Application In accordance with SPS 383.21(2), Wis, Adm. Code, submission of this form to the appropriate governmental unit 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 Proposes in accordance with the Privacy Law, a. 15.04(1)(m), Stets. ,rLke,rI W 1, 1'-[4l, 'arty Owner's Mailing Address f Sfi00 P,J — L4 C State Zip Code Phone Number cur 1 jcfgy, 718 z 54Ob Paroal # y� -i��K 1 T .D Property Locution • /' / Govt. Lot FQrC_-e l 9: ul '5 • '/�3, Section 3 I or 2 Family Dwelling— Number ofBedrooms .....e T 'ti si N R o Subdivision Nome ❑ Pubilc/Con,n ,' ,l —Describe Use Block# 0 State Owned — Describe Use ❑ City of CSM Number (J Village of r �Townof S -e ?.Ll-c.. IIL Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B.Complete line C a licable a New System ❑ Replacement System 0EEEW Existing System S(explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holdin 8 Tank In -Ground ❑ Mound (conventional) ❑ Individual Site Design 0 Other Type (explain) C. ❑ Renewal Before ❑ Revision 0 Change of Plumber List Previous Permit Number and Date Issued Expiration S ❑ Transfer to New Owner -SNu� ) Dispersal Area Proposed (s System Elevation Capacity in Total #of Manufacturer Tank Iafonnation Gallons Gallons Units Nov Tanks Existing Tanks' 5i _ h .� UG L' a $ u SeptieG aWsliin®Tsnk D„ g� mnbn 7D W p e5 e Ir 6C. rL V. Responsibility Statement- 4 the undersigned, assume responsibility for Inetollatloa of the POWTB shown on the attached pions. Plumber's Name(Print) Plumber's Sigma re I'0.h 1t) I �n51C1 ]rt4MPRS Number Business Phone Number ,. Plumber's Address (Street, City State, Zip Code)�.r (`(, t, 2� OO 9 C7 7 ! C L�j Z. 1J tp 73C.x - yyor � t ✓�U � .L J T O 7 % I( Approved I U Disapproved � e /I./.c94 ❑ Owner Given Reason for Denial Conditions of Approval/Reesons for Disapproval i M t allS- a) SU1QC�C.v QNit pkuv. 10 for tiro system SBD-6398 (IL 03/22) on paper not ten than a I/t x �gxncruq.�`+ Wisconsin Department of Safety anQrdrejonHfsINs L Page ! of 3 s0 ; ; r DlvisionoilndusttyServices MAY U b YU24 s�� SOIL EVALUATION REPORT Attach complete site plan on paper not less than 8 112 x 11 Inches in size. Plan must include, I - but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. K scale or dimensions, north arrow, and location and distance to nearest road. 1 r� )` = D Please print all information. Reviewed by Date I ar Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). .a Proarty Owner ha' Property Locatiaon ('✓ c ( e cu a r h r L L a✓ I W r I 't Govt Lot SUP'. 3V%533 T LIt N R E (or)& Property Ownees Mailing Address 11� Site Address or CSM and Lot #: SOOO J1 k Ke /2 1eScoo pvtti LewIC-e 72L . city,7 • State Zip 1` y'Code Phone Number ❑ City ❑ Villllaage ® Town Nearest Road O,t'Krt/•e.✓ W= Sod i�O T7%/SLS/)L✓G .l ✓C. LA NewConstruction Use: ®Residential/Numberofbedrooms .1— Code derived designfow rate i.co GPD Replacement♦/ , ❑ Public or commercial —Describe: Flood Plan elevation If applicable _It Parent material { -1) 4t. ,Cc t I II General comments and recommendations: Boring # ❑Boring IPil Ground surface elev.9 S ft. Depth to limiting factor Win. / elev_ft e,.n A...m,..,w.., o.,.., Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Si. Sh. Consistence Boundary Roots GPD/Ft2 •Ef#t tEffii2 i 0"lP ,DYr_3 / tJc,QP L 1 4 k At v cs C. •7 Z- -I 7.n -z. AJ , n 5 2 -n -,LS w. 1.1O 3 1`-1 S- ≤ . Ne.*.i1 S o 1'(L - 1J� 1_ ® Boring # paPit Ground surface elev. 1 a • Sft. Depth to limiting faclor7 //Oin. / elev._R Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 •Eff#i •Eff#2 0-i s tz? !'°"k L≤ / 4 )C M ✓ Q S 3. r .7 1- (o Z -7-ze SY/z / DNS LS 0 wtL CS Z,+. .7 _6 Z4^ //O S`"iZS e w2 S a Iv! L — v .7 I. !e CST Name 1 nPte se I Print) TO/kLSSIO SignalureC CSTNumber fl009c, Address ►?O. Bo R S'2.Z j `r sn R;Yev' WI: 5`14 Date Evaluation Conducted `f-ZS=Z`F Telephone Number I'7Is 2¢lL- 41 S(p • Effluent #1 - BOD > 30 s 220 mg/L and TSS > 30 s 150 mg/L • Effluent #2 = SOD, 5 30 mg/L and TSS s 30 mg/L SBD-8330 (804/21) Page 2 cci. 3 ❑ Boring ❑ nA 3 Boring # (]Pit Ground surface elev. I d -S {t, Depth to limiting faclorZL�ln. / elev._ft. Solt Annlll nntlnn Ratw I Horizon Depth In. Dominant Color Munsell Redox Description Ou. Az. Cont Color Texture Structure Cr. St Sh. Consistence Boundary Roots GPD/FP •Ef#1 •Ef#2 O— 7.Sip3/ oruq S L- 1 ch rM v- c<S 3(o if .7 2- ID -1 -7r t�Z tJt' LS C /6(L G$ 2 .7 Ii' s"Ytz S /J o.Nt 5 C' jLI L . _ . {, ❑ Boring # ❑ Boring ❑ Pit Ground surface elev.ft. Depth to limiting factor in. / elev. ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. At Cont Color Texture Structure Cr. St Sh. Consistence Boundary Roots GPD/FP •Eff#1 •Efl#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factorIn. / elev.ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont Color Texture Structure Cr. St Sh. Consistence Boundary Roots GPD/FP ¶f#1 •Eff#2 Effluent #1=BOD> 305220 mg/L and TSS> 305150 mg/L • Effluent #2 = BOD. S 30 mglL and TSS s 30mg/L PV (] • Sol Bar"w y { i✓IXulhBYe Palko3dL'; PI"n�O:nn 5ealQ: ltS/o'uhle nuenw�a Soil Qf`sorp�ip�( P.o• C Pu saa. Bem n C!� pc s lu G,mPo„awl $ar+unl DSeM Al es• O ✓ WZ 9 . = 8.A7, c VRPxfilev. $eo.o. 5 38—/o,i"0SrcM.41®tlif P.,gaz) fi r"zaoatIC. S'ysia«n EI•e+�:93.3 #. j; ¢p+Ycnk' 75Dga/►bniesavccwc✓a� i" r. 'raxIb . 3s'/9zufre.w bo G p t c7aH%c / 71+' ar"bar Spcay, �H°w .a4h_ F a4. -1,1.ne. nla.(- 91' 7Z Halght-�' •rvlani.co7J uric, t hoi P+"Sep/ Znfr 11/47/D7.Aylie�N 5fa., 'vA Md.`h.'* 1 e 4;i 1i�ac:74e.ravaimc�m w; r11 SP5 � 3 ie674oNuL'P: ,Li 5 If7DIvtr�— saA50r.3�pvC /rcr pedp/okrve�de�"pL-1zaSo 'H T' s T ppo- ,5 AsT"» 3o3f aPPe6%)Q Pope na4�Cleaa..• R� La 64 •- d,., ✓e MAY 067024 1 Qi7ia• isti _ ISP e --35r � Q:a�°gyp /L L4C5 -a,rct ��s.�.a f 16 a a�, X Zo 1rt2re�,+� & ftx/e„leapf: z S Z• 'y ' }° 7 L,srl1=ltctiYzo¢+''�akFS:frtt''��,idcaPs:zz.� a \ iNQWt . `i I . rap e3 I! i�y�°s ZYJ` cc[� l y`7' LI 1 s, "EGG lr.�nL�IE-�I 0(25/- V * -- 1jVk c U.Q.P. U Pf*rer" Owner' fRL4 tAi,7..t"alq J Soon u1' 6cke g '1.,o -b? !z, ✓.✓ vJ-7'- Scl rM7 L.gal baser; p .ton o ≤WW*sul4l Stc 33T"l7N K ' A?c. e Ion-IQArK -LE Town of Crr., tR--vcs e.ns.41o4 ac.y-�; c !1 ..• 132-c' Vah+ tap ar "'—wx4avprme c ca to ; F d 1p� a `a r r 7S A? .� < 6va1u6 m d 1__ raPp ^ d - tca Le. ,c,.4 lie•+#1 t alP Ba _f May, h. 201/ 10:41AM BAYFIELD CO PLANNING & Z0NI`NG No. 9975 P. 3 s5 PgIof- Pg2of7 Pg3of1 Pg 4 of In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-1 0705-P (N.01/01, R. 10112) PAGE 1 OF7 fl MAY062024 6 2024 IiJ Pa'vf .ld C: 7 Wing Dept Index & Cover Sheet Plot Plan epfcT k. C.I' Sys Section & Plan View Management Plan Attachments: Enclosures: Pc,, Y v POWTS Application for Review ( Son- r 9f 7 Soil Evaluation Report & Site Map i o AI Z, t4c c - ce A, vr- e en Project Name / Description Owner Name(s): 7 - c- �c 1 t J r 1 fiu ( Phone: -7/S = 7/g _ t 5 a ( OwnerAddress: feSaoo F, -H-, Lc, ce R 1y J:kt,., P-veu, IZip: S Project Address: Sc -,mac c S -, .' o " f Govt. Lot: trc'E'n 5 w' 114 of S ti' 1/4, Section 33 ,T q7 N -R ? Eor W Township: y _ E. County: °'( F' e I Project Parcel ID #: k T 0 36 L( Designer Information Designer Name: A i (u r J?o /k0 s k" Phone: 7/C-372-______ Designer Address: P.M. 3 oK Saz 1'ro , Iz i.ier UJl: Zip: fl'8`{7 E-mail: -+ or n y (j ezt v u. ) Al n o 1+k L o ✓✓l This space reserved for approval stamp. License Number: 2.2000 Remarks: Signature: �` Date: Original signaWre required on each submitted copy. p) p� R /y� /� {] 11 • a Soil Bop • y�i dJ ✓L4N/%" e I "IkaciC. Pl�rv..0.n • rl ,� w nV•L'n` ce a Sc.'!�bv y su�►e< cWo uni*es$ 1vt��c yy l�dsor�� C24. ✓ '� fl -o p' PeSfC( LCs bt41J8w•&w (�gt4H ll t1� �Jf•.�oN Al dh�J+Fd,� u�aooYea .S am, v1eP=Elev.0oo,®! k3D-t®o fzN4 l��tj�wt®fie$)Pi CS T °r zzaogo S�S►1ar+1 �i e,/. 43. 3 .r77�� j„ cj *Yc7 K flV ga/I°'i u4eser cc.+crs4 ' E.:'� ?% Fd eY" " f SUS: 35-t/9HZ'/ J'.ee*rA boY'1'nc+ a• ••1^O %YW, �n4C in � ?1vt rnbceSpc'w:flb+e.ddh-tf8"E+Prt¢ 12'/#st �i4' Y-L.man;4-11J-lmta,.f,eb�' zp 4 nkE tnf�llrc rQaa%i ky 5%ac. ' vJ, /3."h r Li It c4;n7 f�luNlba . .nce / o w:4�A SP53nn 5•e f•, 1 ) to ro. p c 4n� OY TY �•.I YNJi�• Go<.f a�.<.'r nplo <.•.M ,� .��/y,^.•%-j+ne�(o �C Yye�de%�p L-Sab' S�.h yo ,VC P.psly 71YI V 7fl"- 5th 5DR3a !� IoYjae rS AS -us 3u 3�( opPva1ew P•pc ,nctaP2tpaiJft ta �e. /o 5'dot7 v h4, 4c. e ped. MAY 062024 The Bayfield•co. Zoning Dept. 1 ✓Z.o yen C4lG5 = i7 t, y =ZI S•F''I' d"S.aw l 4-35 ' p lot a ' 9P a� hopk'5�;kf� a 'I, - to ftr(ch=l1 c1,Xzo�+?�c�+:.&�tYr`e y• ti�;��'.��'r' c�.l(1:tictiuLO•�+''�c�l+s:$ft���KdGaps za S e! c,etE 1 i„e�j-fr,c!(cl,K'(r�ch+3'�e dcer•sW7' I //L. mIC-4, "it �r Properly ®weer; ji:Lar€L W.1 -►-,,14L (p Soo0 flu+h l aliel2d- -Z✓ay R. viz cqp / to c-. y� 6•� Lel d bssc.r p•ioh u sec23t4'TN Rg w4 cl /}acv Q ivCaleArntlE—nd r O •q• I<,ro(t In/ell e a p Pgoo, TOP VIEW 4" CAST -A -SEAL WLP750- MR TANK SPECIFICATIONS DIMENSIONS: WAIL 2 1/2" BOTTOM: 3" COVER: 4" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: DOME COVER 61" O.D. FLAT COVER 53 1/4" O.D. OUTSIDE DIAMETER: 84" O.D. BELOW INLET: 42" O.D. LIQUID LEVEL• 37" WEIGHT: 6,150 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 20.28 GAL/IN HOLDING TANK: ACTUAL CAPACITY: 790 GALLONS OUTLET HOLE PLUGGED LOADING DESIGN: 8' 0" UNSATURATED SOIL OPTIONAL FLAT COVER TANK CAN BE USED AS: IS AVAILABLE FOR EXCHANGE SEPTIC/ HOLDING/ PUMP OR SIPHON FOR DOME COVER. COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) INLET - OUTLET CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE n 2 7 Q PUMP PAD DRAWINGS SUBMITT FOR APPROVAL SIDE VIEW APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS 1 I Lu M1 W U u,Lo C8 �Q00 N Ws l C1� 00 < o w D Cl o a a N � � 2c a ( Nw Low 1 r Bayfield County, WI 5/14/2024, 8:00:48 AM 1:2,629 Wetlands --i Approximate Parcel Boundary Building Footprint 2015 • Building 0.03 0.07 0.13 m1 0.05 0.1 0.2 km Bayadd County Land Rams Oaparimont Baytwld County zoning Applicallan helps:llmaps.bayfaMrountyvd.gov2oningWAB) 5/14/24, 8:00 AM Novus-Wisconsin Access rev. 12.0206 aeal Estate Bayfield County Property Listing Today's Date: 5/14/2024 Lam' Description Updated: 2/28/2017 Tax ID: 35496 PIN: 04-024-2-47-08-33-3 03-000-12000 Legacy PIN: Map ID: Municipality: (024) TOWN OF IRON RIVER STR: 533 T47N R08W Description: Recorded Acres: Calculated Acres Lottery Claims: First Dollar: Zoning: ESN: PAR IN SW SW DESC IN V.1000 P.879 30.228 30.228 0 Yes (R-1) Residential -1 118 Tax Districts Updated: 4/9/2009 1 STATE 04 COUNTY 024 TOWN OF IRON RIVER 163297 SCHL-MAPLE 001700 TECHNICAL COLLEGE 4' Recorded Documents Updated: 4/9/2009 0 QUIT CLAIM DEED Date Recorded: 8/8/2008 2008R-522275 1000-879 Property Status: Current Created On: 4/9/2009 10:36:10 AM a Ownership Updated: 2/28/2017 RICHARD A & ANDREA D WIITALA IRON RIVER WI Billing Address: Mailing Address: RICHARD A & ANDREA D RICHARD A & ANDREA D WIITALA WIITALA 65000 RUTH LAKE RD 65000 RUTH LAKE RD IRON RIVER WI 54847 IRON RIVER WI 54847 11 Site Address * indicates Private Road 65000 RUTH LAKE RD 11 Property Assessment IRON RIVER 54847 Updated: 7/28/2022 2024 Assessment Detail Code Acres Land Imp. Cl-RESIDENTIAL 1.000 6,000 72,700 G6 -PRODUCTIVE FOREST 29.228 43,800 0 2 -Year Comparison 2023 2024 Change Land: 49,800 49,800 0.0% Improved: 72,700 72,700 0.0% Total: 122,500 122,500 0.0% 6a Property History Parent Properties Tax ID 04-024-2-47-08-33-3 03-000-10000 2 Q12 HISTORY 0 Expand All History, White=Current Parcels Pink=Retired Parcels O Tax ID: 20012 Pin: 04-024-2-47-08-33-3 03-000-10000 Leg. Pin: 024109401000 35496 This Parcel t Parents 4 Children https://novus.bayfieldcounty.wi.gov/access/master.asp?paprpid=35496 1/1 Con k)�' rfl±e 0t1 BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) C$ Check List MAY 062024 Bayfield Co. Zoning Dept. &.I Original Sanitary Application (Submitted in Deed Holders Name — no prospective buyers) (383.21(1)1.) 06 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) 9 Original Plot Plan (383.22(2)2. 3. & 4.a) 1( Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) RI Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) RI Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) ❑ Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) ❑ Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) RI Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) if . ]plea Set of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all coples) 47 Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary ADDlication: (Include the following Information) 9 I Application Information must include: ❑ 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) ® Project Address or Road Name where driveway is/will come off of) i21 (Owners Phone Number) g II Type of Building d III Type of Permit [9 IV Type of POWTS System 9 V Dispersal / Treatment Area Information RI VI Tank Information RI VII Responsibility Statement (Plumber's Information) 0 *Date Stamp* Plot Plan: (To Scale or To Dimension) [if signature and Plumber Information if Surface Elevation of Body of Water ® Direction and Percent Land Slope 09 Tank and Filter Information and Location 'Wetlands / Navigable Bodies of Water * Absorption Area (Proposed and Existing) Q Bench Mark (Location, Elevation and Description) lComponent Manual Version 9 Address Number and Road RI North Arrow C7 Contour Lines 9 Structures and Driveways RI Boring Locations l Property Lines d Well Locations 5d la Pi__Gi>rol ((a flrafortriat(0ionv9yance;nneepur_itiplgsewaraRe/ma_rariarypeano alarn erery Turn Over ► Cross -Section and Over -Head Profile of the System: 9 Surface and System Elevation l 'Position of Observation and Vent Pipes Od Dimensions and Depths l Make, Model & Number of Chamber Units In each Cell Property Information 0 How many systems will there be on this parcel of land? ❑ Has this property been split? Jio (Property Statement shows Property History) Fees: 21 Private Sewage System (Septic Tanks) $ 400.00 ❑ Private Sewage System (Holding Tanks) $ 400.00 ❑ Mounds or Systems requiring Pre -Treatment $ 500.00 ❑ Sanitary Revisions $ 25.00 ❑ Private Sewage System Reconnection $ 50.00 and Private Interceptor ❑ Return Inspection $ 50.00 66 Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) u/Forms/cheddists/check tforsartitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: MAY 0 6 202 1 Department of Safety County sP Bayfield Co. Zoning & Professional Services, Sancta Permit apt. Indust Services.Division Number//(to befllled in by Co.) Sanitary Permit Application State Transaction umber In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different then mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary ores in accordance with the Privacy Law, a. IS.04(I (m), State. p lication Information— Please Print All In ormation �P 5o 0 C, Xv7 t-1 �erty O ner's Nama Parcel # rl. erty Owner's Mailing Address 7� yl f Propany Locution S fi O p i` J l n't (�c ti � .n C Stale Govt. Lot ?QfL`I l t7CcT�cL _ Zip Code Phone Number y✓o t�,Vel� 1 tJ L 5`t�%. 5":%s,Section ___ 7'c,-1�z ( 33 II. Type of Building (check all that apply) Lot # q7 II T N R I or 2 Family Dwelling —Number ofBedrooms L ° Subdivision Name ❑Public/Commmcint— Describe Use Block# ❑ City of ❑ State Owned — Describe Use CSM Number O Village of FTOwm Of .1—r° rt III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete Use C if applicable.) A. 11 Now SystemgReplacement0TD Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B' 11 Holding Tanknde ❑ Mound ❑ Individual Site Deli n ❑ Othor p ) 8 Type(ex lainC• ❑ Renewal Befoe of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date issued Expiration IV. Dlspersaltrreatq,ent Area and Tank I formation: Design Flow (gpd) Design Soil Applicati ate(gpd/st) Dispersal Area Dispersal Area Proposed (a ✓ System Elevation 1 .So � z S.� Capacity in Total #of Manufacturer Tank Information Gallons Gallons Units Nov Tanks Existing Tanks �m m vi W Ci 0. Seplle eciialdins Teak i Sp -- 7�0 DesklgEhmmher td) 6 eS e ✓ Cc [4L', ✓ V. Responsibility Statement— I, the undersigned, assume responsibility for installation of the POWTS shown on the attached pions. Plutnber•a Name(Print) Plumber's Signs re Al 7 ikG5%G 1 If�P/MPRS Number Business Phone Number 220090 7lsZ,z_'i/, Plumber's Address (Street, City, State, Zip Code) PO, L3esX $ z7- y✓on t✓e.tr^ L L S-tF8` 7 VI. County/Department Use Only/fyr� Approved ❑ Disapproved Pc It Pao at is d� Issuing Ag°nt nature O Owner Given Reason for Daniel I22 �,j�%/l/!ten _ Conditions of Approval/Reasons for Disapproval �S ►�) s(PYWl io Mt all Setba(X- ") r .wwtt phut fo ouim.. Attach to complete plans for the systenr and submit to font,,..., ....u. _.. _..__.. __..__._ .. ... ._. "floe us x ,, I°enes In size SBD-6398 (R. 03/22) EC IV[�1� MAY 0 6 2024 LPrivate Sewage System Maintenart�C?fAg9ement laxlus 35 qq 1P - - 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) t1/1i4 of /4 Section, 3 Township LJ7 N. Range ______W. 4rf!9c r :•rr' ^ascrip.Licn: Lot _ Block Subdivision 1000 (Acreage) Govt Lot _CSM #______ Vol. _ Page _ CSM Doc# DOCUMENT NUMBER 2024R-603077 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 04/29/2024 AT 8:45 AM RECORDING FEE: $30.00 PAGES:2 Recording Area Return To: ny/ j ® /( trkt ©- o K -2Z- Erc ® In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: D Mound ❑ At -grade Sewage System O Other_ _ Seotic 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. Seotic 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, Wls. 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 iha 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 bolrc falcon c pay all ci:a: y..:: and vests incurred by Bayfreld County for i^.scion, pwrrpLrg, hauling, or ornerwise 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. Bayfleld 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 bylaw. The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners Owner(s) Name(s) — Please Print Subscribed and sworn to before me on this date •aO�L7g9 L r/ R'BL J � * : • T Notarized Owner(s Sfg atu (s) Note Public ��, •• (yeL • tG My Commission Expires: ISCO yU rr�ItlNlllt�it Drafted by: f OYt t7 KOS K r Date: 4--4ZZ_y _ Proofed by: :z!:T' wforms/sanitary/seplicmaintenceagroe monI Revised July 2020 DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3-1982 QUIT CLAIM DEED Richard B. Wiitala and Jennifer L. Wiitala, husband and wife, as joint tenants quit claims to Richard A. Wiitala and Andrea D. Wiitala, husband and wife, as joint tenants the following described real estate in BAYFIELD County, State of Wisconsin: A parcel of land located in the Southwest Quarter of the Southwest Quarter (SW% SW%) of Section Thirty-three (33), Township Forty-seven (47) North, Range Eight (8) West, Town of Iron River, Bayfield County, Wisconsin, described as follows: Commencing at the Southwest corner of the said SW% SW'/.; thence North along the West line of said SW'/. SWY., a distance of 990 feet to a point; thence angle to the right 90° a distance of 1311.06 feet to a point; thence angle to the right 90° a distance of 990 feet to a point; thence West along the South line of said SW% SW% a distance of 1311.06 feet to the place of beginning. This is not homestead property. PATRICIA A OLSON BAYFIELD COUNTY WI REGISTER OF DEkDS 2008R-522275 08/08/2008 09:15AM IF EXEMPT t: 8 IEORDING FEE: 11.00 RETURN TO Richard A. Wiitala /.3Ac Aivy jan4' /Y7N Ss%2t x"'10 1 ! U [ I_I ( L' Tax Parcel No: 024-1094-01 000 Dated this 9''/ iay of July, 2008. (SEAL) / (SEAL) Richar B;iila ` ennifer dtala AUTHENTICATION Signature(s) lh' ti a 8 C,J u/ 7Ja_ G^ d authenticated this X73 day of 20Q. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis, Stats.) THIS INSTRUMENT WAS DRAFTED BY WERNER LAW OFFICE Attorney Richard Wehner (Signatures may be authenticated or acknowledged. Both are not necessary.) 'Names of persons signing in any capacity should be typed or printed below their signatures rt ACKNOWLEDGMENT STATE OF MINNESOTA OUNTY OF I } ss. Personally came before me thi& ., day of July, 2008, the above named Richard B. Wiitala and Jennifer L. Wiitala, husband and wife to me known to be the person(s) who executed the foregoing instrument and acknowledge tjte same. Notary blicblic jqc(,y County, MN. My Commission's expiration date: TERESA ANN KANADA Notary Public —Minnesota My Comm. Expires Jan. 31,2010 vt000 P879: QUIT CLAIM DEED POWTS OWNER'S MANUAL & FILE INFORMATION I L,i Owner D J L 4 r G t l fi4 Q Permit # l�� DESIGN PARAMETERS Number of Bedrooms 1 O NA Number of Public Facility Units J( NA Estimated (average) flow / c' o al/da Design (peak) flow = (Estimated x 1.5) / SO gal/day In Situ Soil Application Rate ..7 al/da /ft2 Standard Influent/Effluent Quality Monthly average` Fats, Oil & Grease (FOG) ≤30 mg/L Biochemical Oxygen Demand (BOD5) 5220 mg/L 59 NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) 530 mg/L Total Suspended Solids (TSS) 530 mg/L IS NA Fecal Coliform (geometric mean) ≤10° cfu/100ml Maximum Effluent Particle Size k in die. p NA Other: F61 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: mont :3 ❑ years (Maximum 3 years) O NA Pump out contents of tank(s) ® When combined sludge and scum equals one-third ('fa) of tank volume ❑ NA ® When the high water alarm is activated Inspect dispersal cell(s) At least once every: 3 ® year(s)s) (Maximum 3 years) O NA Clean effluent filter At least once every: ❑ month(s) ®yeas ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month s) 3 f31 year(s� ❑ NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) ® NA Other: At least once every: ❑ month(s) ❑ year(s) ( ) ® NA Other: IR 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 512 months, shall be performed by a certified POWTS Maintainer. L MANAGEMEIIT P tq 6 ZOZ4'ag of 2 SYSTEM SPECIFICATIONS Tank Manufacturer W J Eo ' O NA ❑ Septic 0 Dose O Holding vol. 7 SU gal Tank Manufacturer X NA ❑ Septic O Dose O Holding vol. gal Effluent Filter Manufacturer Pt. 1 10 G O NA Effluent Filter Model P Z- 5"2, S Pump Manufacturer El NA Pump Model Pretreatment Unit Q NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration O Welland ❑ Disinfection 0 Other: Manufacturer Dispersal Cell(s) O NA In -Ground (gravity) 0 In -Ground (pressurized) ❑ At -Grade 0 Mound ❑ Drip -Line O Other: Other: NA Other: J31 NA A service report shall be provided to the local regulatory authority within 10 days of completion of any service event GMW (12102) START UP AND OPERATION Page Z of 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: O 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 POWTS INSTALLER I, POWTS MAINTAINER •F ame i a, h l�� ! fr. o S dC r 1'c l kc k �ba4$; � Name A (ca h ?l ! koS k§ 0v l kGS"hone '1/ S Z-- I S Phone / / s� SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY / . V • Name '�Aa w9. �s ? I k os kr (, soh tZ•de�- C Name 13 -� ,C' v- 2 ,, i ✓+ Phone -7 / S 3�7 2— s oo C, Phone ii .S 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(1), (2) & (3), Wisconsin Administrative Code. BAYFIELD COUNTY SANITARY PERMIT (#04)-2449S STATE SANITARY PERMIT OWNER: RICHARD A & ANDREA D WIITALA GOVT LOT: LOT: BLK: SW 114 SW 1/4 SEC: 33, T 47 N, R 8 W TOWNSHIP: Iron River SOIL TEST: 50-24 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: Allan (Tony) Polkoski MCKENZIE SLACK DATE: 5/16/2024 Authorized Issuing Officer CHAPTER 145.135(2) WISCONSIN STATUTES a. The purpose of the sanitary permit Is to allow Installation of the private sewage system described In the permit. b. The approval of the sanitary permit Is based on regulations in force on the date of approval. c. The sanitary permit is valid and may be renewed for specified period. d. Changed regulations will not impair the validity of a sanitary permit. e. Renewal of the sanitary permit will be based on regulations In force at the time renewal is sought, and that changed regulations may Impede renewal. f. The sanitary permit Is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. PREVIOUS PERMIT #: LICENSE: # MPRS 220090 Condition: System to meet all setbacks. Management plan to owner. Properly maintain system per recorded agreement. THIS PERMIT EXPIRES 5/16/2026 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION