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HomeMy WebLinkAbout24-67S9? Request for Sanitary Inspection (24 Hrs. in Advance) Fax this form to Zoning Dept (24 Hrs.) prior to when you want an inspection — (715) 373-0114 If you do not have a fax and must email the inspection; you must email all staff members. Note Time Change fl Discrepancy fl Other Phone Number Plumber: Ckc,a 'O W, kz 292- a iS Fax Number Email Address Homeowner: vxe shy -C .arm Tcl^t^rc,^ 2� .,s Immediate Phone Number So Zoning Sanitary Dept can call you right back (If needed) Permit#: 2 G7S —1(5 z9Z 2-4(C Plumber's Choice Zoning Dept No Inspection(s) during this time Date: t• Z7 OK Tuesday (9:30 am - 12:15 pm) (Tracy) Time: Plumber's Choice Zoning Dept OK Township: Address # & Road Name: (1(/2c Warn&r or Directions To Site: Comments: 5i l 2O ** Plumbers you must verify any change(s) by fax or email Notes from Zoning Dept: u/forms/sanitary/requestforinspection Zoning Dept (©4/12/04); ® June 2023 arv^ar'ug r !o Private Onsite Wastewater Treatment SPS' Systems ( POWTS) Inspection Report (Attach to Permit) Industry Services Division General Information Personal information you provide may beused for secondarynumoses I Privacy Inw .c. 15.n4 l m Permit Holder's Name: ge LI Town of: TIMOTHY & LAURA JOHNSON TRUST OF 2012 CSTBM Elev: 3333 EMERALD VALLEY DR ONALASKA WI, 54650 •ank Information setoacKto: TYPE MANUFACTURER CAPACITY Prop. Line Well Buildin Air Intake Road Septic ltd a N/A Dosing OW N/A Aeration N/A Holding County Ba 'field Sanitary hermit No: State Plan Transaction ID#: Parcel Tax No: 36 Pump! Siphon Inform�fion 1 Pump Manufacturer Pump Model Demand GPM Filter Manufacturer Filter Model TDH Lift Friction Loss Head Total Forcemain Length Dia Dist. To Well Dispersal Cell Information DIMENSIONS Width Length # of Cells SETBACK FROM Pr,re Ire U B 'I iqg el /yj OHWM Type of Cell 9' 7 Ow/ M nufacturer: Model Number: Pretreatment Unit Manufacturer: Model Number: Distribution System Elevation Data STATION BS HI FS ELEV Benchmark 7 p 117 Bldg. Sewer 3� 103,71 Tank Inlet iQ$ Tank Outlet ..1..1..! (o3 ,3 Dose Tank Inlet Dose Tank Bottom Inst. Contour Header / Manifold Distribution Pipe Infiltrative Surface S. 1oi, 3S" Final Grade 0,2 ,1 X/ 7 X Pressure Systems Only Header I Manifold I Distributio Pipe(s)I X Hole Size I X Hole I Observation Pipes Length Dia Length Dia Spac Spacing ❑ Yes 0 No Depth Over I Depth Over I Depth of I Seeded I Sodded I Mulched Cell Center Cell Edges Topsoil 0 Yes ❑ No 0 Yes ❑ No C MME TS: (Include cr discrepancies, persons present, etc.) 7ul4 ,< w/ Oct/ki 'GrG%s�r/S���� / t �a d uy i 5%ar7�dd 1��� I 1r"' .1 / li (/ r n f U Plan revision required? ❑ Yes 0 No ( 1 y 2 Use other side for additional information. Date POWTS spectors Signature 1z3�3 License Number SBD-6710 (R.03121) S. V r, '. BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT _ Telephone: (715) 373-6138 Bayfield County Courthouse Fax: (715) 373-0114 Post Office Box 58 e-mail: zonina@bayfieldcounty.org 117 East Fifth Street Web Site: www.bayfieldcounty.org/147 Washburn, WI 54891 Property Owner - TIMOTHY & LAURA JOHNSON TRUST OF 2012 Information - 3333 EMERALD VALLEY DR ONALASKA WI, 54650 As you know C/j ¢ J Ro L iy, tr was contracted by you to install a private onsite wastewater treatment system on your property described as: Notes: Abandonment of Old System to meet all applicable code requirements: 1 o Tank was pumped by: o Tank was crushed / removed and pipes disconnected by: on at AM/PM On T/"? 7/2 t/' at 2 (AM I the above -mentioned plumber contacted our office to conduct a pre -cover inspection as required under DSPS 383. One of the following applies: System was inspected and appears to meet all applicable code requirements. System was inspected and appears to meet all applicable code requirements; however, a plan revision is necessary because the installation was substantially different than the original approval. System could not be inspected because plumber covered prior to scheduled time of inspection. ❑ System could not be inspected because plumber was not ready at scheduled time of inspection. County was unable to return to complete inspection. System could not be inspected because plumber was not ready at scheduled time of inspection. A re -inspection and $50 fee are required. System could not be inspected because County could not respond to plumber's time constraints. Comments: U/lormslsanitarypropertyowner-input April 2019 RECEIVED Industry Services Division 4822 Madison Yards County- rQ. Thai'{'it J /0',L fi; .�S ` ,. Pi SAP L Q 20 Way Madison, W1 53705 3 Sanitary Permit Number (to be filled in by P.O. Box 7302 63. `-"v�"" tpvict� Madison, WI 5302 ' @Iar�� e JZtt tt1to limit Application State Tra suction Number 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 stateowned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stals. mor a V 1.Application Information - Please Print All Information Property Owner's Name Parcel 4 T -41C 2 D 130 f� afi%4 N11 7 t4u14 J'riecw1Oknscm L OT BIZ o1•cr6.2•NG•n1.24.14 no_.enn.fin. rwperty V.rucr s ,vmwng Aauress Property Location 5333 EMQfatd VaUe.,r Govt. Lot City, State 1 , Zi Code /� Phone Number /' ^� `/ r� q O11Qr t 4 s kA W.Z l & S , fl6'33W - 337 'A,. —%, Section ^ 1 II. Type of Building (check all that apply) of # T 6 N R 07 SW R I or 2 Family Dwelling — Number offedrooms & Subdivision Name Block # ❑ Public/Commercial — Describe Use O City of ❑ State Owned - Describe Use CSM Number O Village of - inc IATownof 'hCLI+4, 111. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i a licabte. A. New System y ❑ Replacement System 0 Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B, 0 Holding Tank In -Ground 0 At -Grade ❑ Mound 0 Individual Site Design ❑ Other Type I(explain)(conventional)C• ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ist Previous Permit Number and Date Issue Expiration Goo I lopwa- Capacity in Total # of I Manufacturer Tank Information Gallons Gallons I Units u o v U & o New Tanks Existing Tanks w u o dl U in Ic, lOIa. Septic or Holding Tank I2SO 1 Inllco! nn V. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached olans. /1 1 8385 S County Road S, Lake Nebagamon, WI 54849 g.Approved O Disapproved E_"" =c W� uace mssuea su ng A ma re /- 0 Owner Given Reason for Denial b'�.�pl'1,y / /9257/7 Sacs- C GCr c Attach to complete pines for the system and on paper not lass than 8 IA x tl inches in SBD-6398 (R_ 02/22) RECEIVED 5`" 2 0 2023 Wisconsin Department of Safety and Professional Services 1 of Page Division of Industry Services Bayfield Co. SOIL EVALUATION REPrYRrlhing and Zoning Agency In accordance with SPS 385, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, Bayfield but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. 04-016.2-46-07-29-3 02-000-50000 Please print all information. Reviewed bb/yr Date �1A 3ersonal information you provide may be used for secondary ourooses (Privacy Law. s. 15.04(IVm11. � /7�'7 - Property Owner Property Location ❑ ❑ Timothy M. & Laura A. Johnson Trust of 2012 Govt. Lot '% Y. S 29 T 46 N R 7 E (or) W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 3333 Emerald Valley Dr 2 CSM# 1425 in V.8 P.316 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Onalaska I I 54650 Delta 14125 Warner Rd New Construction Use: ® Residential/ Numberof bedrooms 4 Code derived design flow rate 660 GPO ❑ Replacement ❑ Public or commercial - Describe: Parent material Sandy outwash Flood Plan elevation if applicable N/A ft. General comments and recommendations: System elevation 98.9' - 102.0' 1❑ Boring # ❑ Boring 0 Pit Ground surface elev. 103.0 ft. Depth to limiting factor 20 in. c..a e....n,...r..., o..u. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 •Eff#1 E f#2 1 0-2 7.5YR 3/2 -- Is Osg ml cw 2vf 0.7 1.6 2 2-6 10YR513 — Is Osg ml cw 1m/1f 0.7 1.6 3 6-23 7.5YR4/4 — GR5% osg ml cW 1m/2f 0.7 1.6 4 23-90 7.5YR 3/4 — cos osg ml — 1vf 0.7 1.6 2❑ ❑ Boring Boring # 0 Pit Ground surface elev. 103.4 ft. Depth to limiting factor QQ in. 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 1 0-3 7.5YR 3/2 — Is Osg ml cb 2vf 0.7 1.6 2 3-5 10YR5/3 — Is Osg ml cw if/1vf 0.7 1.6 3 5-21 7.5YR4/4 — 5 Osg ml ow 1m/3f 0.7 1.6 4 21-32 7.5YR 414 — (15% GR, 1% ST) osg ml cw 1f 0.7 1.6 5 32.90 7.5YR414 — s osg ml — If 0.7 1.6 Emunnt s1 = HOD > 3n 5 7sn molt, and TSS > 3n s 150 molt - Emuwnt sz = ROD > 3n 5 7?n mnn and rss > 3n < 1 sn mnn CST Name (Please Print) Sig CST Number Keith Wile 'l 654921 Address I Date Evaluation Conducted I Telephone Number 11623 E. Larson Dr. Lake Nebagamon, WI 54849 I 7/30/2022 I 218451-2611 SCU-I1J3u (KU411 b) RECEIVED 3❑, Boring # ❑ Boring Sr? 20 202 ® Pit Ground surface elev. 103.3 ft. bepth to limiting factor 90 in. Bayfield Co. Planning and Zoning Anencv Soil Annliratinn 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 -ER#2 1 0-3 7.5YR 3/2 — Is Osg ml cw 2vf 0.7 1.6 2 3-5 10YR 5/3 — Is Osg ml cw 1f/2vf 0.7 1.6 3 5-32 7.5YR 4/4 — Osg ml cw 1m/3f 0.7 1.6 4 32-90 7.5YR 4/4 - 5 0sg ml — 1vf 0.7 1.6 ❑ ❑ Boring Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor _ in. Sail Anolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 •ER#1 •Etf#2 ❑ Boring ❑ Boring # — ❑ Pit Ground surface elev. R. Depth to limiting factor _ in. Coil Aenfil ration Re/> Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 •Eff#1 •Eff#2 Effluent #1 = BOD, > 30 S 220 mg/L and TSS >305150 mg/L • Effluent #2 = BOD, > SOS 220 mg/L and TSS > 30 S150 150 mg/. Johnson Trust of 2012 Soil Report Plot Plan North Pm 0 O cn W N ml a J O ti U�8 @ y N N CM UF9 N it• a mT 0 IIL � C1CL CT a n C. Scale 1:40 195.50' 3.4% O Proposed 40' x 40building site 4 bedrooms n Bench Mark = Top of iron property stake Elev = 100.0' Timothy M. & Laura A. Johnson Trust of 2012 #### Warner Rd Lot 2 CSM # 1425 in V.8 P.316 Sec 29 T46N R07 W Town of Delta 4-016-2-46-07-29-3 02-000-50000 .520 Acres OHWM % 102' \ Bellevue Lake •.ate 299.22' autl Auadmd NOTES: - No well - Property line not to scale, see dimension ® - Survey stake - Bellevue Lake elev. = 55' CST # 654921 Page 3 of 3 RECEIVED PAGE 1 OF 4 SEP 202023 In -Ground Gravity Plan Barfield Co. Index & Cover Sheet Planning and Zoning Agency Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Pg 2 of 4 Pg 3 of 4 Pg 4 of 4 Attachments: Index & Cover Sheet Plot Plan Dispersal Area Cross -Section & Plan View Management Plan POWTS Application for Review Soil Evaluation Report & Site Map Project Name I Description Johnson Trust of 2012 Owner Name(s): Timothy & Laura Johnson Owner Address: 3333 Emerald Valley Dr Zip: 54848 Project Address: Warner Rd Govt. Lot: NW 1/4 of SE 1/4, Section 29 T46 N -R 7 E ❑ or W 0 Township: Delta County: Bayfield Project Parcel ID #: 04-016-2-46-07-29-3 02-000-5000 Phone: - - Designer Information Designer Name: Keith Wiley Phone: 218 -451 -2611 Designer Address: 11623 E Larson Dr Lake Nebagamon, WI E-mail: s.shoreseptic@gmail.com Zip: 54849 n a rl rc.,l'talnl,. icMN Number: D 2388 PSS Condit ovally N jwpROVED ,�W"Ey = EFY E D COU2NTTZY p 2�e ps5 _ II n7 E`'ESOtP —'` Date: 2 5 ?� Original signature required on each submitted copy. Johnson Trust of 2012 Septic System Plot Plan North Timothy M. & Laura A. Johnson Trust of 2012 X01 #### Warner Rd �JI Lot 2 CSM #1425 in V.8 P.316 t�0I N Pro ertline Sec 29 T46N R07W 195.50' m_ ••. \•trown of Delta 9 "-' Z o ≥ N dp Iii l� d N o iii n-• I.Li mm C' • Scale 1:40 8 N auti Auadad 3.4% 40 x 40' building site ns It Bench Mark = Top of iron property stake Elev = 100.0' 4-016-2-46-07-29-3 02-000-50000 .520 Acres \ 2 rows of EzFlow 9 units each (90) \ 102' `` Bellevue lake Wieser 1250 gallon tank \ w/ polylok 525 filter \ Jam. 299.22'iJ NOTES: - No well - Property line not to scale, see dimension(s) ®- Survey stake - Bellevue Lake elev. = 55' - All vent, observation and conveyance pipes 4" ASTM D1785 Page 2 of 4 IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3 -ft Trench (down -sizing credit) Geotextie Cover SOIL COVER 12' min, trench depth (typical) System Elevation = 00 ft. (typical) min. 12' (typical) Septic Tank(s) Manufacturer. Wieser Septic Tank(s) Volume(s): 1250 gal gal gal gal Effluent Filter Manufacturer: Polylok Effluent Filter Model ft: 525 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) Provide minimum 3 ft separation between trenches. TYPICAL TRENCH (Show location of inlet / outlet pipe connection on plan view.) PLAN VIEW 4.. 0 Observabon pipe shall be *staled (No Scale) Perforated Lateral atiunpion between two units Observation Pipe —\ (typical) (typical) --------- ----7.1--------- r- F B= 90 ft (typical) INSTALL PER TRENCH: 9 10 -ft bundles @ 50 ff EISA/unit = 450 ft2 + 5 -ft bundles @ 25 if EISA/unit = ft2 OBSERVATION PIPE DETAIL (No Scala) Screw -Type or Finished Grade Sp Cap (loose) (mulched & seeded) 4-0 PVC Pipe Top of pipe to teminate at orabove finished grade (4) 1/4'-112•X 6'Sbts 9b apart Anchoring Device , 10 ft A=3.0 -ft (typical) i Bundle (typical) (mid by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. = Proposed EISA per trench = 450 ft` Required Infiltration Area = 857 ft' x 2 trenches = Proposed Total EISA = 900 r — Topsoil Cover (min. t foot) N 0 J cc r' i lnfilbalonm -.0 SudaEy N N ca fV 0 2D C) W O TI .A Distribution Method: branched manifold m C) IT! m a 0 iw—o5ZLdjm :3n1� 9S-b8—SZc-008 :anod—IS0d 00/00/00 :3140 09Li'S IM 'N30a N3o1Vw '0l AMH Sn 9IL£M 'lyf1N'dW OLLd3S z\ r 313eouoo dOM :A9 NMb�10 w • 21nod-3ad :31Wa 'AM „0-, l = „* L :31d0S 2iW-05Z ld�M NIlISIlIN I r \ w D: N ce U z N J 6 O _ m 0 0 0 0 _ IL 05 w 0 U -J ti O a O ,� I- mm opzQ J Ix a. W U F. Q to H S Q Q = -�v <�w Q c� td) N Wes; Z a f5 zv O a ' * �`O � a= M J mom 4 O I Q\ 0 O 0 Y �Mz ..Q m wcn Q M dV Q �— CZZ 9 !e 0 O HMO IZ) �g mV I O1 OWN Q jo. Z O= m� W 0 Q� N "3p= Za z�W Q Q=U ~ W 0 ZU X0 �X 0() NU U,���'z0zos�2 w3 Q� <(1)U z 0 z <a w9mvmi93m: �' �Fo ov go< Q z >Z NO C Z Z S OJ la- U H U J w N 1 Q U) U 0 1 I I I ii I e f 1 w N U U d' w L 0 „L do I1!1 N „9 do -..I4 m a W IJ m0 D IY In d d co (I) < in 1-10 W z t J J (A Q 0 d a o < a a Z w W W - N N N gU N 0 w w U X w O F - Iii 2 0 0 w Ir R U lL Li z w N Y z IQ - -. V II_ SEP 202023 Salloidco.CoPAGE 4 OF 4 icy In -ground Gravity Management'I51�n IMPORTANT: 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 shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 600 gpd; BOD5 5 220 mgL"'; TSS 5 150 mgL''; FOGS 30 mgL-' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o 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 (i.e., 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: Superior Septic Systems Phone: 715-292-2415 Local government unit: Bayfield County Zoning Phone: 715-373-6138 Local government unit address: 117 E 5th St Washburn, WI ZIP: 54891 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. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION ownerTimothy M. & Laura A. Johnson Trust of 2012 Permit # DESIGN PARAMETERS Number of Bedrooms 4 O NA Number of Public Facility Units 0 NA Estimated (average) flow 400 gal/day Design (peak) flow = (Estimated x 1.5) 600 gal/day In Situ Soil Application Rate 0.7 al/da /ft2 Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mg/L Total Suspended Solids (TSS) 530 mg/L 0 NA Fecal Coliform (geometric mean) 5104 cfu/100ml Maximum Effluent Particle Size '4 in die. ❑ NA Other: 0 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: 3 ❑ month(s) years') (Maximum 3 years) 0 ❑ NA Pump out contents of tank(s) 0 When combined sludge and scum equals one-third ('b) of tank volume ❑ NA O When the high water alarm is activated lnspect dispersal cell(s) At least once every: 3 ❑ month(s) year(s) (Maximum 3 years) 0 ❑ NA Clean effluent filter At least once every: 3 ❑ month(s) 0 year(s) ❑ rt Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) ® NA Flush laterals and pressure test At least once every: ❑ ❑ month() 0 NA Other: At least once every: O m❑ year(s) ® NA Other: 0 NA SYSTEM SPECIFICATIONS Tank Manufacturer Wieser \\ O NA / 0 Septic O Dose ❑ Holding vD. al Tank Manufacturer ❑ Septic O Dose O Holding vol. APR 12 Effluent Filter Manufacturer Polylokgaeld Co. Zoning D Effluent Filter Model 525 Pump Manufacturer 0 NA Pump Model Pretreatment Unit 0 NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection O Other: Manufacturer Dispersal Cell(s) ❑ NA 0 In -Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade O Mound ❑ Drip -Line O Other: Other: 0 NA Other: 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. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. pt. GMW (12/02) Page of START UP AND OPERATION 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 k at the1system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: (ID) J • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. APR 12t, • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing 6091tht.Co. Zoning Dept. • 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: ❑ 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. I$ 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 Name Superior Septic Systems Phone 715-292-2415 POWTS MAINTAINER Name Superior Septic Systems Phone 715-292-2415 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Mr. Biffy Name Bayfield County Zoning Phone 715-395-4000 Phone 715-373-6136 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. q M ' ,� � `�� 34YFIELD Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-4010 Property Owner: Submission Number: JOHNSON TRUST, TIMOTHY M & LAURA SS -00347 A 3333 EMERALD VALLEY DR Transaction Number: ONALASKA, WI 54650 SS -00347-F132 Description Amount Private Sewage System (Septic Tanks) $400.00 Total: $400.00 Payment Amount $400.00 Reference: Tax ID 13088/Check #1657 Paid by: Superior Septic Systems - Chad Rochwite Payment Type: Check Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. •12/15/23, 8:28 AM Real Estate Bayfield County Property Listing Today's Date: 12/15/2023 Novus-Wisconsin Access rev. 12.0206 Property Status: Current Created On: 3/15/2006 1:15:16 PM 11_ t>�' Description Tax ID: PIN: Legacy PIN: Map ID: Municipality: (016) TOWN OF DELTA STR: S29 T46N R07W Description: LOT 2 CSM #1425 IN V.8 P.316 (LOCATED IN NW SW & SW NW SEC 29 & NE SE SEC 30) IN V.1154 R170 Recorded Acres: 1.520 Calculated Acres: 1.800 Lottery Claims: 0 First Dollar: No Zoning: (R-1) Residential -1 ESN: 110 Updated: 2/18/2021 0 Ownership 13088 TIMOTHY M & LAURA A JOHNSON TRUST 04-016-2-46-07-29-3 02-000-50000 OF 2012 016106004002 i'1 Tax Districts Updated: 3/15/2006 1 STATE 04 COUNTY 016 TOWN OF DELTA 041491 SCHL-DRUMMOND 001700 TECHNICAL COLLEGE Billing Address: TIMOTHY M & LAURA A JOHNSON TRUST OF 2012 3333 EMERALD VALLEY DR ONALASKA WI 54650 Updated: 2/18/2021 ONALASKA WI Mailing Address: TIMOTHY M & LAURA A JOHNSON TRUST OF 2012 3333 EMERALD VALLEY DR ONALASKA WI 54650 P Site Address " indicates Private Road N/A ® Property Assessment 2023 Assessment Detail Code GI -RESIDENTIAL Updated: 8/29/2011 Acres Land Imp. 1.520 25,600 0 2 -Year Comparison 2022 2023 Change Land: 25,600 25,600 0.0% Improved: 0 0 0.0% Total: 25,600 25,600 0.0% va Recorded Documents Updated: 12/21/2010 i property History ® WARRANTY DEED N/A Date Recorded: 12/22/2015 2015R-561774 1154-170 © QUIT CLAIM DEED Date Recorded: 10/14/2015 2015R-560794 1150-450 ® TERMINATION OF DECEDENT'S INTEREST Date Recorded: 9/27/2010 2010R-534806 1047-775 ® QUIT CLAIM DEED Date Recorded: 4/25/2006 2006R-506310 942-815 © CONVERSION Date Recorded: 3/15/2006 503306 B CERTIFIED SURVEY MAP Date Recorded: 11/17/2005 2005R-503306 B-316