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HomeMy WebLinkAbout24-68SRequest 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 Phone Number 715-685-4330 Plumber: QUINN GRANGER Fax Number Email Address Homeowner: DAVID & KATHRYN HAWBAKER quinn@gspmllc.com Immediate Phone Number So Zoning Sanitary Dept can call you right back (if needed) Permit #: 24-68S 715-685-4330 Plumber's Choice Zoning Dept No Inspection(s) during this time Date: 7/02/2024 OK Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice Zoning Dept Time: 1:00 PM OK Township: WASHBURN Address # & Road Name: 600 W WOODLAND DRIVE WASHBURN, WI or Directions To Site: Comments: TANK TO BE SET AT 9:30 AM ** Plumbers you must verify any change(s) by fax or email ** Notes from u/forms/sanita ry/req uestfo rinspection Zoning Dept (©4/12/04); 0 June 2023 3�,rnxnpvr4. Industry Services Division General Information Permit Holder's Name: Tank Information -- TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road Septic I E, SFi O 6 O Z O N/A Dosing N/A Aeration N/A Holding Private Onsite Wastewater Treatment Systems ( POWTS) Inspection Report (Attach to Permit) may be used fnr rernnn.-" '- '- DAVID & KATHRYN HAWBAKER 600 W WOODLAND DR WASHBURN, WI 54891 setback to: J Village LJ Town of: CdtaPG 'Qde3�C4 County Sanitary nit No: jy -(vas State Plan Transaction ID#: Parcel Tax No: Pump 1 Siphon Information Pump Manufacturer amp Model Demand GPM Filter Manufacturer liter Model TDH Lift Friction Loss Head Total Forcemain Length Dia Dist. To Well Dispersal Cell Information DIMENSIONS Width Length # of Cells 3 SETBACK FROM P p. Lin Buildin Well OH M S Type of Cell SIJ &6v,nnqQiclC Manufaac�turer: t! COnvc+f4la",aI ryryLj M Napier( /C%Grf_'J Pretreatment Unit Manufacturer: Model Number. Elevation Data STATION BS HI FS ELEV Benchmark 44.05 S.Zo Jd8,$ Bldg. Sewer Tank Inlet 3 rs $OS Tank Outlet 36$. Dose Tank Inlet Dose Tank Bottom Inst. Contour Header / Manifold ii. Distribution Pipe Infiltrative Surface g3 -S stj.7o Final Grade istribution System X Pressure Systems Only Header / Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length Dia Length Dia Spac Spacing 0 Yes 0 No Soil Cover Depth Over Depth Over Depth of Seeded I Sodded Mulched Cell Center Cell Edges Topsoil 0 Yes 0 No 0 Yes 0 No COMMENTS: (Include code discrepancies, persons present, etc.) too dci %4-o n ≤ ..F? plan. dft'XJI o &/) I -O V k Plan revision required? 0 Yes'�No Use other side for additional info ation. is�z3r�— s4 Date POWTS Inspectors Signature SBD-6710 (R.03121) License Number Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoning(atbayfieldcountv.org Web Site: www.bayfieldcountv.org/147 DAVID & KATHRYN HAWBAKER 600 W WOODLAND DR WASHBURN, W1 54891 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know q ✓f " Il V Tti 6)C r was contracted by you to install a private onsite wastewater treatment system on your property described as: At / `v Ut S 32 7c/ Abandonment of Old System to meet all applicable code requirements: Tank was pumped by: on at AM / PM Tank was /crushed I removed and pipes disconnected by: GIc On /Z/ z—\ at_ (AM the above -mentioned plumber contacted our office to conduct a pre -cover inspection as required un er 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: Ulformslsanitarypropertyowner-input April 2019 S5' - oo:3 2 (e) Department of Safety & Professional j U l County. IBAYFIELD nit p mit Number (to be filled in by Co.)rvi \ .�! � Industry Sec ivision� 2N "b 2204 Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Ada,. Code, submission f his form to the approp Btdgoveremmeento. ll unI I I_GQ(. is required prior to obtaining a sanitary permit Note: Application forms for slate -owned 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), Stats. 1. A lleation Information — Please Print All. Information . . Property Owner's Name Parcel # DAVID & KATHRYN HAWBAKER 32519 Property Owner's Mailing Address Property Location 600 W WOODLAND DR Govt. Lot City, State Zip Code Phone Number WASHBURN, WI 54891 262-515-2989 SW v., NW v., Section 32 T 49 N R 4 E II.Type of Building (check all that apply) Lot# q1 or 2 Family Dwelling — Number ofBedruoms 3 Subdivision Name ❑ Public/Commercial — Describe Use - Black # Xcityof WASHRIIRN O State Owned —Describe Use O Village of _ CSM Number ❑Town of III. Type of POW TS Permit: (Check either'New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if A. New System 7 Replacement System P Y ❑ Other Modification to Existing System (explain) ❑ Additional Rretrcatman Unit (captain) B. D Holding Tank .GI In -Ground V'z ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventionalfl �u C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transferto New Owner Ass Previous Permit Number and Date Issued Expiration IQ.Dla rsaUTreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(epd/sfl Dispersal Area R auitvd (:.i) Dkpu.al Area Proposed (s System Elevation 450 0.6 750 798 J100.5 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units °o ' New Tanks Existing Tanks w B Z 8 a S F5 m rC V in rn it a Septicnr Holding Tankloon 000 WIESER CONCRETE X Dosing Chamber V. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the,attachedplans. Plumber's Name (Print) PlumnePs Si�amre MP/MPRS Number Business Phone Number QUINN GRANGER � 987826 715-685-4330 Plumber's Address (Street, City, State, Zip Code) 39860 JENSEN RD, MARENGO, WI 54855 VI. Countv/De arlment Use Onty. Approved ❑ Disapproved Permit �tLL�-((ll/p/ Date Issued 6 Issuing Agegn[Signawm 11 ❑ Owner Given Reason for Denial ' 1 21 = 158131s Conditions of Approval/Reasons for Disapproval 4b i-sk#0 . ref a f w1jacks % {+5rne53meM (Mn j ol,.fnecS . m ?'4tl,n s'ys+evn f'reec, ec)l ag eeemcvui- d pfOp&Iy awrdun c,cPer cps 383 ma .ye,eau nuu ]uomr to Inc County only an paper not less loan a i2 i II inches in sae SBD-6398 (R. 03/22) 3� 2y Wisconsin Department of Canmerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code County BAYPIGLD Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 32519 percent slope, scale or dimensions, north arrow, and location and distanceto nearest road, Please print all Information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (111)1. eroperty Owner Property Location ❑ E' DAVID & KATHRYN FIAWBAKER Govt. Lot SW 1/4 NW 1/4 S 32 T 49 N R 4 E (or) W eoperty Owner's Mailing Address Lol # I Block # I Subd. Name or CSM# 600 W WOODLAND DR LW tree zip woe rnone rvumoer I Lpity O Village LTown Nearest Road WASHBURN WI l 54891 ( 262) 515-2989 ASH8UN I WOODLAND DR New Construction usefj Residential / Number of bedrooms Code derived design flow rate 450 GPO Replacement 0 Public or commercial - Describe: Parent material FLUVIAL Flood Plain elevation if applicable ft General comments CONVENTIONAL and recommendations: SYSTEM ELEVATION RANGE 98,2 TO 101.4 DESIGN LOAD RATE _ .6 GPO/SQ. FT. TANK & GRAINFIELD WILL NEED REPLACEMENT I Boring # ❑ Boring 9 Pit Ground surface elev, 103.2 ft. Depth to limiting factor >96 in. ant of nl;iinn Rnr I Horizon Depth in. Dominant Color Munseli Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPO/1F Eff#1 Eff#2 1 0-8 7.5 YR3/3 SL 3MGR MVFR CW 3F .6 1.0 2 8-36 7-5YR4/4 SL 2FSBK MVFR AW 2F 6 1.0 3 36-96 5YR4/6 S 0SG ML _ 2F .7 1.6 ❑Boring# ❑ Boring 103.2 >96 El Pit Ground surface elev. ft. Depth to limiting factor in. Sot Annhir.tinnRAte 1 Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPO/if *Eff#1 -EH#2 1 0-8 7,5YR3/3 SL 3MGR MVFR CW 3F .6 1.0 2 8-36 7.5YR4/4 SL 2FSBK MVFR Aµr 2F .6 1.0 3 36-96 5YR4/6 S 0SG ML 2F .7 1.6 Effluent #1 = SOD > 30 < 220 mgr. and TSS >30 < 150 mg&L ' Ef tuent #2 = BOD < 30 mg,t and TSS < 30 mg4 CST Name (Please Print) Signature / CST Number BRUCE W BLAKEMAN 708148 Address Date Evaluation Conducted Telephone Number 64903 CHARLES JOHNSON ROAD ASHLAND, WI 54806 05/29/2024 715-209-2569 Horizon Depth in. Dominant Color Munseil Retlox Description Qu. Sz Cant. Color Texture Structure Gr. Sz. Sh, Consistence Boundary Roots GPD/ *E i#1 " Etf#2 7.SYR3L3 SL 3MGR MVFR CW 3M 6 10 2 9-30 7.5YR4/4 SL 2FSBK MVFR CW 2M .6 1.0 3 30-100 3YR4/6 OSG ML _ 2F .7 1.6 Boring 0 boring Pit Ground surface elev. ft. Depth to limiting factor. in. SoLlLpphcatIon Rate : Boring Baring # Pit Ground surface elev. ft. Depth to limiting factor in. lStAnthIinn Rate " t ittuemt #1 SOD, > 30 220 mg/L'and TSS >30 150mgIL Effluent #2 5 BOD,130 mg& and T'SS ≤ 30 mgIt The Department of Commerce is an cqual.opportunity service provider and employcrr1f�you need assistance to access services or need material in an alternate format, please contacts the department at 608-266-3151 or TTY 608-264-8777. ssaa)i a (R.o7roo) CHECK BOX AS APPLICABLE. CHECK BOX AS APPIJCABLE fl SOIL EVALUATION Scale: 1"=40'❑ SYSTEM PAGE 2 OF 4 SITE MAP 0 40 60 80 PLOT PLAN PROJECT NAME: to, DESIGN now: 450 GPD DAVID & KATHRYN HAW BAKER Attach design flow calculations for commercial plans. PROJECT ADDRESS: BM Symbol: BM Description: Slope Gradient (%) of Tested Area: 600 W WOODLAND DR. BM Elevation: 100 ET TELEPED 19" ABOVE GROUND Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) N Sanitary Sewer 4" PVC D3034 Force Main: NA / NA Indcete north by 3 Well Symbol (If applIcable): Q drawing an arrow on the eppropnte Itie /O3. 1D3. Z - at suitable intervals. u JUN12 2 avfield C ii "0 J —C IC n Yv . Fie. of 4!2 6/1f =ro0 rit e PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: 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 DAVID & KATHRYN HAWBAKER CONVENTIONAL Owner Name(s): DAVID & KATHRYN HAWBAKER Phone: 262 515 2989 Owner Address: 600 W WOODLAND DR., WASHBURN, WI Zip: 54891 Project Address: SAME Govt. Lot: SW 1/4 of NW 1/4, Section 32 , T 49 N -R 4 E ❑ or W ❑✓ Township: WASHBURN CITY County: BAYFIELD Project Parcel ID #: 32519 Designer Information Designer Name: QUINN GRANGER Phone: 715 _685 4330 Designer Address: 39860 JENSEN RD, MARENGO, WI Zip: 54855 E-mail: quinn@gspmllc.com This space reserved for approval stamp. License Number: 987826 Remarks: Signature: i— Date: 6/12/2024 Original 'signa�ta a required on each submitted copy. ffft L L1m 1L44m jL _ H a - - 4 E i Lt k I i i HF 1k 0*1 -H-Fv 'L S ...,4. t s t ' JHH\LHW+t1 .. 1Ij11j11j t i , f i; V _f E t E HTI, I , . _ f S w P�o� i—�£f I i IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER 2' min. tench depth (typical) min. 12" (typical) Septic Tank(s) Manufacturer: WIESER CONCRETE Septic Tank(s) Volume(s): 1000 gal gal gal gal Effluent Filter Manufacturer: POLYLOK Effluent Filter Model a: PL -525 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) System Elevation = 100.5 ft (typical) Quick4 Standard -W w! End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) a-------------- A'---- -----------t--------�c---- B= 56 ft (typical) INSTALL PER TRENCH: 13 Quick4 Std -W @ 20 fF EISA/chamber = 260 ft2 + 1 Pairs of end caps @6 ft2 = 6 ft2 Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturers / Instructions. TYPICAL TRENCH PLAN VIEW (No Scale) TA (typical) "—Quick4 Standard -W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. = Proposed EISA per trench = 266 ft' Required Infiltration Area = 750 ft x 3 trenches = Proposed Total EISA = 798 ft2 Distribution Method: branched manifold D C) m W O m w 0) CD 0- C) CD C— i39 WLP1 000 TANK SPECIFICATIONS 4" CAST - CA a TANKS ARE TO CAST -A -SEAL OUTLET NO 0-Dt n MP PAD DIMENSIONS: WALL 2 1/2" BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 53 1/4" LENGTH: 8'-8" WIDTH: 7-2" BELOW INLET: 42" LIQUID LEVEL• 36" WEIGHT: BOTTOM 6,790 LBS. COVER 3,195 INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 27.83 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,085 GALLONS LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE L U C REVIEWED BY z - REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: OF� /wa///d//�%%//// I�I������iI����� �������������������������I�����I������I����1,.tlIIJLY,R7:aJlllli�idlil"l�4'.I I.H. O BALL PUSH ROD SECTION A -A FACTORY INSTALLED MATERIAL - FILLED POLYPROPYLENE H 6.5" (16.51cm) SEALED BALL - � 4" AND 6" FACTORY OPTIONAL BUSHING -/ MATERIAL - HDPE INTALLED PIPE OUTLET (FOR 4" THIN WALL PIPE) MATERIAL - PVC PART NO. 30142-R OR OPTIONAL FLOAT SWITCH POLYLOK PL- 525 - 625 CUTAWAY PART NO. RT (110 02EU) 30142-EUR PAGE4OF4 In -ground Gravity Management Plan IMPORTANT: 0 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. JUN i 2 ZIUL4 Maximum Dispersal Area Operating Limits: Design Flow = 450 gpd; BODS S 220 mgU1; TSS 5150 mgL 1; FOG ≤ 30 mgL-1 Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (Le. odors, user complaints, etc.) o mechanical malfunction (Le., 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: QS PLUMBING & MECHANICAL LLC Local government unit: BAYFIELD COUNTY ZONING Local government unit address: 117 E 5TH ST, WASHBURN, WI Phone: 715-685-4330 Phone: 715-373-6138 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. 1R FIELD 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: HAWBAKER, DAVID C & KATHRYN M SS -00362 600 WOODLAND DR WASHBURN, WI 54891 Transaction Number: SS-00362-F21A Description Amount Total: $0.00 Payment Amount: $400.00 Reference: Tax ID 32519/Check #1964 Paid by: QS Plumbing and Mechanical Payment Type: Check Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. Real Estate Bayfield County Property Listing Today's Date: 6/12/2024 lP Description Updated: 7/18/2013 Tax ID: 32519 PIN: 04-291-2-49-04-32-2 03-000-03000 Legacy PIN: 291100607000 Map ID: Municipality: (291) CITY OF WASHBURN STR: 532 T49N R04W Description: PAR IN SW NW IN V.1110 8.195 2449K Recorded Acres: 1.656 Calculated Acres: 1.656 Lottery Claims: 0 First Dollar: Yes ESN: 102 I Tax Districts Updated: 3/15/2006 1 STATE 04 COUNTY 291 CITY OF WASHBURN 046027 SCHL-WASHBURN 001700 TECHNICAL COLLEGE Recorded Documents Updated: 3/15/2006 O WARRANTY DEED Date Recorded: 7/1/2013 2013R-550289 1110-195 O TERMINATION OF DECEDENTS INTEREST Date Recorded: 7/1/2013 2013R-550288 1110-191 O WARRANTY DEED Date Recorded: 4/11/2006 2006R-506071 941-867 O CONVERSION Date Recorded: 298-252;663-195 Property Status: Current Created On: 3/15/2006 1:16:10 PM 40 Ownership Updated: 7/18/2013 DAVID C & KATHRYN M HAWBAKER WASHBURN WI Billing Address: Mailing Address: DAVID C & KATHRYN M DAVID C & KATHRYN M HAWBAKER HAWBAKER 600 WOODLAND DR 600 WOODLAND DR WASHBURN WI 54891 WASHBURN WI 54891 I* Site Address * indicates Private Road 600 W WOODLAND DR WASHBURN 54891 ® Property Assessment Updated: 8/28/2023 2024 Assessment Detail Code Acres Land Imp. G1 -RESIDENTIAL 1.656 23,300 194,500 2 -Year Comparison 2023 2024 Change Land: 23,300 23,300 0.0% Improved: 194,500 194,500 0.0% Total: 217,800 217,800 0.0% a Property History N/A SS -00'3(2 sat' Department of Safety & Professional rvices, Counry- BAYFIELD SanitaryPennit Number (to be filled in by Co.) v�CY,Y/ aI� Industry Serviceisbivision �u- bps Sanitary Permit Application State Transaction Number In accordance with BPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit J(;_(. Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS TS are submitted to tire 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), Slats. " pn - I'least Print All Information Property Owner's Name Parcel # DAVID & KATHRYN HAWBAKER 32519 Property Owner's Mailing Address Property Location 600 W WOODLAND DR Govt. Lot City, State I Zip Code Phone Number WASHBURN, WI 54891 262-515-2989 SW v., NW v., Section 32 T 49 N R 4 E ofl Type of Building (check all that apply) Lot if Subdivision Name JII. tTl or 2 Family Dwelling — Number of Bedrooms 3 Block # 0 Public/Commercial — Describe Usc Xl Chyof WASHRURN ❑ State Owned —Describe Use 0 Village of CSM Number ❑ Town of ❑l. Type of POAVTS 1'crnlit: (Check either "New" or "Replacement" and other applicable on line A. c:Iteck one box on line B. Complete line C' it applicable.) A. New System y Re lacemert S tem p ys ❑ Other Modifcation to Existing System (explain) ❑ Additional I'-clmnunent Lnit Irsploin) B' ❑ Holding Tank In -Ground V tt ❑ At -Grade ❑ Momd ❑ Individual Site Design ❑ Other Type (explain) (conventioaal{i W C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner in Previous Permit Number and Date Issued Expiration IV.Dispersal/Treatment Area and Tank Information: ;. Deslen Flow (epd) Design Soil Application Rate(gpd/sq I Dispersal Area Required (ii) Dispersal Area Proposed (s System Elevation 450 0.6 750 798 100.5 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units y 3 $ u Nee Tanks I Existing Tanks d9 o p; Z 'm u 2 "� 6U G rn itO Septic or Holding Tank 000 WIESER CONCRETE X Dosing Chamber V. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the 1'OW l S shown on (he attached plans. Plumber's Name (Print) Plumber's Signature MPdvMPRS Number Business Phone Number QUINN GRANGER 87826 715-685-4330 Plumber's Address (Street, City, Suite, Zip Code) 39860 JENSEN RD, MARENGO, WI 54855 \'I, County/Department Use only Appmvcd 0 Disapproved r�� Permit Fee Rfe $ y a o Date Issued �p11I2.4 Issuing Agent Signatre "_. /19/211A' ❑ Owner Given Reason for Denial = IS823Sb Conditions of Approval/Reasons for Disapproval ® ¢tom tic'!- at) vi - aCks ksrslern . fnAWW nee* Plan o�nerf . Mw„i 4„n Sys ef' at ceeirnwi- , grope-ly a)so+dun cyc/flfl pr Si's 383. Attach to complete plans for the system and submit to the County only on paper not less Than 8 rn x I I inches in size SBD-6398 (R. 03/22) 5S-�p3b�,�Fo Private Sewage System Maintenance Agreement 2C? `- tp:7 > (too — Woe'�j4tnok 5%fl u2 00 r WOraL. 4np(- 0rwel 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 WI Adm. Code, as from time to time amended. (COMPLETE Legal is required) 1/4 of ______1/4 {Section -------Township ------N. Range _____W. Additional Legal Description: SLz1'_!�_5�'`_yl_Nw i� _ V� �!_I_o t� 19S_24�Iq k Town of ---------------------- (Acreage) L , te7 Gov't Lot Lot ______ Block----___ Subdivision __.v e___�. Lot _____ CSM # ------Vol -----Page _____ CSM Doc # Recording Area Return To: Planning and Zoning parDnent U JUN 132024 E In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ 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 Fitter (system types A through E): The septic tank effluent fifer 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-grade,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 Prirt,t ba,Ker Subscribed and sworn to before me on this d \Nj YllIlsi C< ',',' 661Io sots o: Notarized Owner(s) - Signature(s) Notary P lic SEAL Drafted by: __0AA _ b*A k kr1'Date: --_ G - - Iljj II Proofed by: Dept. Wtorms/sanitary/septicmaintenceagreement Revised July 2020 PATRICIA A OLS0N BAYFIELD COUNTY, WI REGISTER OF DEEDS State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number H Document Name THIS DEED, made between MARGARET A. SCHLEITWILER, AN UNREMARRIED WIDOW, ("Grantor." whether one or more), "whether one or Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in BAYFIELD County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): See the annexed Exhibit A which is incorporated herein by reference. 2013R-550289 07/01/2013 02:50PM IF EXEMPT I: RECORDING FEE: 30.00 TRANSFER FEE: 457.50 PAGES: 2 Recording Arta JUN 1 3'[U'L4 Name and Return AdH as . Id Co. Zoning Dept. k1JiCt (fl\L, Choice Title Lll)WJDuA.R UJl S4-? 1320 Main Street 1 J+a98-6 Ashland, WI 54 04-291-249-04-32-2 03-000-03000 Parcel Identification Number (PIN) This IS homestead property. (is) (iseer) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: EASEMENTS, RESERVATIONS AND RESTRICTIONS OF RECORD. Dated , 90i3 AUTHENTICATION Signature(s) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN ACKNOWLEDGMENT STATE OF WfSC-9NSR3 l� ) aa^vv )ss. ____________________COUNTY ) Personally came before me on_________________ �lg the above -named MARGARET A. SCHL ILER, (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: ATTORNEY MATTHEW F. ANICH, SB#1017169 Notary Public, late of Wisconsin p �/ DALLENBACH, ANICH & WICKMAN. S.C., ASHLAND, WI My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledg . o ar NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO S FORM AALVII) WARRANTY DEED O 2003 STATE BAR OF CONSIN SHERYL GUILL RM NO.1-2003 • Type name below signatures. NOTARY PUBLIC • STATE OF IWNOIS V 1110 P 19 5MY COMMISSION EXPIRES:o821/13 .t� A parcel of land in the Southwest Quarter of the Northwest Quarter (SW'/..NW'/4, Section Thirty-two (32), Township Forty-nine (49) North, Range Four (4) West, City of Washburn, Bayfield County, Wisconsin, described as follows: Commencing at the Northwest corner of said SW'/.NW'/.; thence South 89°05' East, a distance of 512.92 feet; thence South 00°40West, a distance of 16.5 feet, to the point of beginning; thence South 89°05' East, a distance of 229.93 feet; thence South 00°40' West, a distance of 313.64 feet; thence North 89°05' West, a distance of 229.93 feet; thence North 00°40' East, a distance of 313.64 feet to the point of beginning. I� rya I4 I� n L5l�LS��U.� U I�n5u JUN 132024 Bayfield Co. Zoning Dept. V111O P196 BAYFIELD COUNTY SANITARY PERMIT # 24-68S STATE SANITARY PERMIT El TRANSFER/RENEWAL PREVIOUS NO. OWNER: DAVID & KATHRYN HAWBAKER PROPERTY LOCATION: CITY OF WASHBURN SW '/a NW'/a SEC 32, T49N, R4W PLUMBER: QUINN GRANGER LIC. #: 987826 ALESSANDRO HALL AUTHORIZED ISSUING OFFICER 6/26/2024 DATE 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 a 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. Condition: System to meet all setbacks. Management plan to owner. Properly maintain per recorded agreement. Properly abandon existing/old system per SPS 383. THIS PERMIT EXPIRES 6/26/2026 UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R. 06/23)