HomeMy WebLinkAbout24-52S Heche^Wi
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s.MAY 1^?0?4
City, Stale
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Safety and Buikfings Division
201 W. Washington Ave., P.O. Box 7162
Madison, Wl 53707-7162
Sanitary Permit Application
In accordance with Sl'S 383.21(2), Wis. Ailm. Code. submission onhis fonn to the appropriate governmental unitis required prior lo obtaining a sanitary permil. Note: Application forms for sliile-owncd POWTS arc submillcd to
llic Department of Safely and Proftssional Semcs. Personal infonnnlion you prondi; may be used for sccuntlaq'
purposes in accordance witli the Privacy Law, s. 15.U4(l)(m), Slats.
1. Application Inforinafiou - Please Print All Information
Property, Owner's Nnmc
IQ^l'i^^ t t<i
Property Owner's Mailing Address
UA^H^ /-r€^L&
css4%3S- fc IAJYYJ (AM, M
:ily. Stale J I Zip Code
II. Type of Building (chcikall that apply)
or 2 Fumily Dwelling —Number oi'Budrooms
Zip Code
^ 3H1
Phunu Number
l"7/S~-^^-^i(/,i
D I'ublic/Commcreial - Describi; Use
D State Owned - Describe Use
Lot»
Block#
CSM NumberA\^%
""W-fX
Sanitary Pemii/Number (lu be fiiSanitary Pi.'rmi/Number (lo be filled in by Co.)^.^S
Slate Transaction Number
Project Address (if different tlmn niniling address)
N>|i^^FarJc;FurJclS 0^-611-' •i.-H'J-OS
O^i •j?C'~21Z.^(UOQ
Property Locution
Govt. Lot
•A,'4•i. Section t-/ "
:ircn:onc]TtH N: R<3^'E^
Subdivision Name
D: Ciiy of__
D Villagi: of
"^faown of '¥ iTtl tv 'R i y<|/—
HI. Type of Permit: (CIieck only one box on line A. Complete Imc B if applicable)
B.
^.NewSys
a Pennit Renewal
BervreExpimlion
D Replacement System
D Permit Revision
D Trcatmcnt/Holding Tank Reptacemcnl Only
D Change of Plumber D Permit Transfer to New
Owner
D Other ModiGcalion la Existing System (explain)
Luit Previous Permit Number and .Date-Issued
IV. Type of" POWTS Systeni/Coniponent/Device: (Check an that apply)
.Non-Pruysurized In-Ground D Pressurixed In-Ground D At-Gradc Q Mound ^ 24 JIL ofsuitabli; .soil D Mound < 24 in. of suitable i>ui)
D Holdiny Tank D Otliur Dispersal Component (explain)_^___ . ^___, _ D PnUrcatmcnt Device (cxpiain)
V. DispersaVTrcatigent Area Information:
Design Flow (^p<3)^SQv
VI. Tunk Info
Design Soil Appticalion ga(?(gpdsf)0.^
wScptic w Uultfing Tank
Positti: Chamher
^L
Capacity inGallons
Dispersal Area Rcquij^xTtsl)'w
New Tanks
IQOOV^
Existing Tanks
Total
Gallons
Soa
# ofUnits
Dispersal Area Proposed (sf)^-'System Elevation^^[^\ 'n.^
Manufacturer
U'IT? *>•;/- G£>^<- ,X.
3?fe •&£i ^E 0
VIL Responsibility Statement- I, thjMrndcrsigned
Plumber's Numc (Print)
{:yr-?A^>~"t^^L^_Plumber's ^(Jreffi (Street, City, Stale. Zip Code)
KjN^JTiility for installatian oftbe POWTS shuwn on llic attaclied plans.
MP/MPRS Number Business Phone Number
ii<5-im-c^{
\Z^6_c^ ^, H ^ ^^^^,U^. ^^-7VIII. County/Dupartincrf Use Only •' ' J)
Approred^
s^-an
D Disapproved
yvncr Given Reitspn for Denial
'Date Issued
IX. Conditions nf.^iprovaVRcasnns for Disapproval
3'^^
^swno wri aB-jnw^ ^^
/5n?7^/c2
IP 6U)WAUach <<» cofcplctc plans furthc system and submit tnlhcConnty only on paper not fcss than 81/2 TC lI-inchcshinK
SHD-»?8(R. 11711)
' I -7,' •(•<:<;:).-.'^'ffl
Private Sewage System Maintenance Agreement
Owner(s) Name\?^ ^ f^MW^ ^-c/a^
Owner(s) Mailing Address
^ojito ^ lo^y ^{^ ^.b -T^fc^^v* 6^^
Site Address
<p6tG35 ^ ^ LWa ^ .J-ro^12^&^ uvi 5^^
Tax ID #3<U4l
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 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 Wl
Adm. Code, as from time to time amended. (COMPLETE Legal is required)
'o<6._1/4of 1/4 Section oz Township M_N.Range _w.
Additional Legal Description:
Town of ^-r&Vy ^L \\TC,r>
Lot Block Subdivision
(Acreage)^0 Gov't Lot
Lot \ CSM # Zl<pgvol. IZ Page Sfc^ CSM Doc # _Z07AH8i%'?
DOCUMENT NUMBER2024R-603259
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY, WI
RECORDED
05,16/2024 AT 1 0:45 AM
RECOFSDING FEE: $30.00
PAGES: 1
Recording Area
Return To:
Planning anqiZonjng Pepartment -n^'z~^l
;1!; MAY '! 7^i)2'l
In-ground gravity
D Mound
D In-ground dosed D In-ground pressure distribution Sewage System:
D At-grade Sewage System D Other
Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of
installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make
such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum.
Pump Chamber (system types B, C, D,and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided
above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components.
Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance
with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code.
Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified
septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three
(3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface.
Mounds. At-arade, and In-around Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when
the wastewater distribution cell component is inspected as provided above.
Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfield County for
inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any
human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days
from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges
may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law.
The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such property.
Owner(s) Name(s) - Please Prir^t ^U)^u^n H^-l^
^irf}hr/<^ l^cc^C^-
Subscribed and sworn to before me on this date:
y-/^-^o^c/
Notarized Owner(s) t- Signaty[e(s)(< ^
'nk^'^/^^T \
•
^i.l\ff-^o^"». y —9s-i — 4 —<!r
Drafted by !.'-U. ^/ . /- .;i ^,9/2^Date:
\^u81-Kyi i''^^—^./ ' /^lywff€y /
Proofed by:
u/forms/sanitary/septicmaintenceagreement
Revised July 2020
"s.K^sa^'^'S.^a.'*?
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, Wise. Admin. Code. Pursuant to SPS 383.52 (2), Wise. 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), Wise. Actmin. Code.
Maximum Dispersal Area Operating Limits:
MAY ' ': /!;/.,
Design Flow = 450 gpd; BODs$220 mgL-1; TSS ^ 150 mgL-1; FOG$30mgL-1
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (/.e. odors, user complaints, ete.)
o material fatigue (/.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 (/.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 Seotic tankfs) 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, Wise. 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: Grea's Plumbing (Grea Brown) Phone: 715-209-0161
Local government unit: Bayfield County Zoning Department Phone: 715-373-6118
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wise. 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.
BAYFIELD COUNTY SANITARY PERMIT f#04)-24-52S
STATE SANITARY PERMIT
OWNER: WILLIAM & KIMBERLY HECHE TRUST
GOVTLOT: LOT: 1 BLK:
CSM: Csm #2168
1/4 1/4 SEC:2,T47N,R8W
TOWNSHIP: Iron River
SOIL TEST: 41-24
REPLACEMENT SYSTEM
SYSTEM TYPE: Non-Pressurized In-Ground
PLUMBER: Brown, Greg
MCKENZIE SLACK DATE: 5/24/2024
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. 1 68; 1979 c. 34,221 ;1981 c. 31 4
Note: If you wish to renew the permit, or transfer ownership of the
permit, please contact the county authority.
PREVIOUS PERMIT #: 06-21 ST
LICENSE: # MP699374
Condition: System to meet all setbacks. Management plan to owner. Properly maintain system per
recorded agreement.
THIS PERMIT EXPIRES 5/24/2026
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION
JM\'otM
Wisconsin Department of Safety and Professional Services
Division of Industry Services Page.1 .2of
SOIL EVALUATION REPORT
In accordance with SPS 385, Wis. Adm. Code
Attach complete site plan on paper not less than 81/2x11 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 provide may be used for secondary purposes (Privacy Law, s. 15.04(1 )(m)).
CountyBayfield
Parcel I.D.
04-024-2-47-08-02-1 00-212-11100
Reviewed by Date
D [3
E (or) W
Property Owner
Bill+Kim Heche
Property Location
Govt. Lot 1/4 % s 02 T 47 N R 08
Property Owner's Mailing Address
1091 OS Long Lake Rd
Site Address or CSM and Lot #:
69635 E Long Lake Rd
City
Iron River
StateWl Zip Code54847 Phone Number
715-410-66
D City
Iron River
D Village H Town Nearest Road
E Long Lake Rd
Code derived designflow rate 4i
Flood Plan elevation if applicable.
•I New Construction Use: [•] Residential/Numberofbedrooms 3
Public or commercial - Describe:
Parent material OutWSSh Sands
General comments and recommendations: site Suitable for Conventional System with Gravity feed
Boring #DBo"ng 95.58
• |Pit Ground surface elev._ft.Depth to limiting factor..in. / elev..
Horizon
A
B
c
Depth
In.
0-3
3-18
18-96
Dominant Color
Munsell
5YR 2.5/1
5YR 4/6
5YR 5/6
Redox Description
Qu. Az. Cont. Color
Texture
LS
s
s
Structure
Gr. Sz. Sh.
0-sg-f
0-sg-f
0-sg-f
Consistence
dl
ds
ds
Boundary
aw
cw
Roots
2f-2m
2f-2m
Soil Application Rate
GPD/Ft2
*Eff#1
0.7
0.7
0.7
*Ef?2
1.6
1.6
1.6
Boring #DBoring 1 00
[•]Pit Ground surface elev._ft.Depth to limiting factor.in. / elev.
Horizon
A
B
c
Depth
In.
0-4
4-27
27-98
Dominant Color
Munsell
5YR 2.5/1
5YR 4/6
5YR 5/6
Redox Description
Qu. Az. Cant. Color
Texture
LS
s
s
Structure
Gr. Sz. Sh.
0-sg-f
0-sg-f
0-sg-f
Consistence
dl
ds
ds
Boundary
aw
cw
Roots
2f-2m
2f-2m
Soil Application Rate
GPD/Ft2
*Eff#1
0.7
0.7
0.7
*Efi#2
1.6
1.6
1.6
CST Name (Please Print)
Tim Dykstra
Address
10620 Eagle Lake Rd Iron River Wl
Signature^
~yDate Evaluation Conducted7/28/2023
CST 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 £ 30 mg/L
SBD-8330 (R04/21)
2 ,2Page "^ __ of.
Boring #
D BoringPit 97.75Ground surface elev._ft.Depth to limiting factor_in. / elev._ft.
Horizon
A
B
c
Depth
In.
0-6
6-30
30-100
Dominant Color
Munsell
5YR 2.5/1
5YR 4/6
5YR 5/6
Redox Description
Qu. Az. Cont. Color
Texture
LS
s
s
Structure
Gr. Sz. Sh.
0-sg-f
0-sg-f
0-sg-f
Consistence
dl
ds
ds
Boundary
aw
cw
Roots
2f-2m
2f-2m
Soil Application Rate
GPD/Ft2
*Effiff1
0.7
0.7
0.7
*EfW2
1.6
1.6
1.6
Boring #D BoringD Pit Ground surface elev.-ft.Depth to limiting factor.jn. / elev.__ft.
Horizon Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture Structure
Gr. Sz. Sh.
Consistence Boundary Roots
Soil Application Rate
GPD/Ft2
*Ef?1 *Ef?2
Boring #D BoringD Pit Ground surface elev.__ft.Depth to limiting factor.Jn. / elev.__ft.
Horizon Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture Structure
Gr.Sz. Sh.
Consistence Boundary Roots
Soil Application Rate
GPD/Ft2
*EfW1 *EfW2
Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 s 150 mg/L Effluent #2 = BOD, £ 30 mg/L and TSS S 30 mg/L
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PAGE 1 OF 4 ^!\\•i;y.
PRIVATE SEWAGE SYSTEM PLAN INDEX
1 Town: Town of Iron River
Owner's Name: William & Kimberly Heche
69635 E Long Lake Road, Wl54847
Bayfield County
Parcel ID:
04-024-2-47-0802-1 00212-11100
Legal Description:
S02-T47N-R08W
Page
Number
1 of 4
2 of 4
3 of 4
4of4
Attachments:
CONTENTS
PLAN INDEX
SYSTEM PLOT PLAN
DISPERSAL AREAX-SECTION & PLAN VIEW
MANAGEMENT PLAN
SOIL EVALUATIONREPORT
For Office Use Only
COMPONENT MANUAL NO.: Version 2.0, SBD-10705-P (N.01/01)
Signature;:
License No:
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.
13 660 County HwyH
Iron River, WI 54847
715-209-0161
-^~7"•A^m^i
Date
\\
0
CM
LUQ<CL
William & Kimberly Heche
•~-.-— property
69635 E Long Lake Road
Iron River, Wl 54847
SITE MAP
Scale: 1"= 20'
20'////////////^7y y///////////7/.y//////////^,
— • — —. Apgroxj=>/L
PIN#: 04-024-2-47-08-02-1 00-212-11100
S02-T47N-R08W
Town of Iron River, Bayvield County
LONG
LAKE
BM= 100.00
(screw in 10"—\ ^
dbh pine)
I--. --..___ 95.
Proposed
3 BR House
Min. Buildng Sewer Invert
at house foundation = 98.30'
40 60
Install 2 trenches with
16 "Quick-4 Standard"
gravelles chambers per trench.
(mfd by Infiltrator Water Technologies)
System Elevation @ 96.50'
Well0
Proposed ;.
. ..Drive ,.'.
WLP1000-MR
Septic Tank(mfd by Wieser Concrete)
- Install a Model 3014-525
effluent filter at septic tank outlet(mfd by PolyLok Inc)
E Long Lake Road
~ • -~ -~ . APBLOX__P/L
PAGE 3 OF 4
DISPERSAL TRENCH
CROSS-SECTION VIEW SCHEMATIC
(No Scale)
l>/iA';/ ••: i '1
SOIL COVER
• min. trench
^ . separation distance
>. ... (typical)
36"-
(typical)Standard Quick-4 + Chamber-
(mfd by Infiltrator Systems, Inc.)
(typical) •• .
Install pursuant to manufacturer's instructions.
Endcap
Inlet Invert
=97.17(typical)
. System Elevation = 96.50'
(typical)
Required Dispersal Area = (450 gpd) / (0.7 gpd/sq-ft) = 643 sq-ft
EISA = (16 chmbrs/trnch x 2 trnch x 20 sq-ft/unit) + 5.8 sq-ft/end cap pair x 2 pr^= 651.(
DISPERSAL TRENCHPLANVIEWSCHEMATIC
(No Scale)
3.0ft
(typical)
ObservationPipe
(typical)
0
p\
Standard Quick-4 + Chamber
(mfd by Infiltrator Systems, Inc.)
'S7
3.0 f1(typical End Ca|
(typical)^
System Elevation = 96.50 ft (typical)
4"0 PVC
Conveyance Pipe
(typical)
67.0 ft
(typical)^-I
EndcapInlet Invert
=97.17
(typical)
1" CAST-A-SEAL
TOP VIEW
Lo&V-^ctziSti't^s^ n's.-es-S' per-Ga d&
^fy(oi<- 5TZ-S- P:!-|--£V-.
OPTIONAL FLAT COVERIS AVAILABLE FOR EXCHANGEFOR DOME COVER.
WLP1000-MRTANK SPECinCATIONS.
DtMENSIOMS;WALL; 2 1/2"BOTTOM: SEPTIC 3"HOLDING 5" <ADD 1,300 LB.)COVER; 4"MAWHOLE; 24" 1.0. PRECAST CONCRETE RISERHEIGHT: DOME COVER .61" Q.D.FLAT COVER 53 1/4" 0,0.
LENGTH: 104" 0,D,
WIDTH; 86" 0.0. .. ,BELOW INLC'r: 42" O.D.LIQUID LEVEL; 36"WEIGHT; 6.790 LBS.
INLET AND OUTLET:4" CAST-A-SEAL BOOT OR EQUALBASKET, CAST-A-SEAL BOOT OR EQUAL
IMLET AND OUUET SAFFj-E MD RLTERtWISCONSIN, SEE OlETAIL #\0(OTHER STATES StE CHART)
LIQUID CAPACITC: 27.83 GAL/IN
HOLDING TANK;OUTLET HOLE PLUGGEDACTUAL CAPACITY; 1,085 GALLONS
LOADING DESIGN: 8' 0'rUNSATURATED SOIL
MM TAMKS:WILL HAVE OWE VENT OVER OUTLETAND WILL HAVE TWO VENTS IM COVER OVER INLET
TANK CAN BE USED AS;SEPTIC/ HOI.DING/ PUMP OR SIPHON
COVER; MIU DESIGN fS (NQ FIBeR)TANK; MIX DESIGN |?10 (STRUCTURAL FIB?)
CUSTOMIZED TANKS:FOR CUSTOM TANKS CONTACT VWESEfi CONCRETE
PUMP PAD
SIDE- VIEW
3fr b-sJcll'dtej
3 ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
I '^.'•:;0
JOB INFORIVIATIOM:
CUSTOMER: UteS'fer-J
308 MAME;
DATE NEEDEDi
APPROVED BY;
APPROVAL DATE:
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