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HomeMy WebLinkAbout24-74S Gottschalk-Rein.^•^V *£vx '^^" Industry Services Division 4822 Madison Yards Way Madison, WI 53705 P.O. Box 7302 Madison, WI 53707 County Bayfield Sanitary Permit Number (to be filled in by Co.)w-1^ Sanitary Permit Application State Transaction 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 state-owned POWTS are submitted to 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. Project Address (if different than mailing address) 48745 Clearwater Rd. Barnes, Wl I. Application Information - Please Print All Information Property Owner's Name Lorilyn Gottschalk Co-trustee & Stanley Rein Co-trustee Parcel # 4194 Property Owner's Mailing Address 5156 Newton Ave. S Property Location Govt.Lot. City, State Minneapolis, MN Zip Code55419 II. Type of Building (check all that apply) 1 or 2 Family Dwelling-Number of Bedrooms _3. 'ublic/Commercial - Describe Use IState Owned - Describe Use . Phone Number 612-578-2752 .',4, Section 09 Lot # 19&20 r 44 _N R 09 .EorQy Block # CSM Number Subdivision Name Clearwater I|cityof_ ^Village of r7lTownofBarnes III. Type ofPOWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if applicable.) Few System (.eplacement System (her Modification to Existing System (explain)|Additional Pretreatment Unit (explain) B.lolding Tank In-Ground (conventional) I|At-Grade DMound Individual Site Design [Other Type (explain) c.Renewal Before Expiration I Revision [Change of Plumber transfer to New Owner ,ist Previous Permit Number and Date IssuedNA IV. Dispersal/Treatment Area and Tank Iiitformation: Design Flow (gpd)450 Design Soil Application Rate(gpd/sf) 0.7 Dispersal Area Required (sf)642 Dispersal Area Proposed (sf)678 System Elevation 93.0 Tank Information Capacity in Gallons New Tanks Existing Tanks Total Gallons # of Units Manufacturer o: 0 31 s£ 0 Septic or Holding Tank 760 760 Superior Precast Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Jason Kuettel Plumber's Signature 7 ^^^MP/MPRS Number 675751 Business Phone Number 715-798-3355 Plumber's Address (Street, City, State, Zip Code) PO Box 66 Cable, Wl 54821 VI. County/Department Use Only m ^7 ^ Approved D Disapproved n Owner Given Reason for Denial Permit Fee4^Date Issued 11112^/1 Conditions ofApproval/Reasons for Disapproval ^ a-^J^A ij?ir^t^ ^d Attach to complete plans for the system and submit to the County only on paper not less than 81/2x11 inches in size SBD-6398 (R. 02/22) n\ Wisconsin Department of Safety and Professional Services Division of Industry Services Soil Evaluation Report in accordance with SPS 385 , Wls.Adm Code v attach complete site )lan on paper not less than 8% X 11 inchei n size. 'lan must include but not limited to: Vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, 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)). 'roperty Owner: Gottschalk Lorilvn J & Rein Stanley M 'roperty Owners Mailing Address: 5156 Newton Ave S City Minneapolis tateMN Zip Code55419 hone Number:0 r New j7 Residential Number of Bedrooms: 3 |7 Replacement f Public or Commercial - Describe: Parent Material: Outwash Flood Plair Seneral Comments & Recommendations: System Elevation: 93 Load Rate: 0.7 Boring #1 F Bor.F m G^ndsu^Ele^ Horizon 1 2 3 4 5 6 7 Depth in. 0-12 12-30 30-120 3omm.Coloi Munsell 7.5YR2.5/3 7.5YR4/4 7.5YR5/6 Redox Description Su. Sz. Cont, Colo N/A N/A N/A exture SL LS MS Structure Gr.Sz.Sh. 2MSBK OSG OSG Ground surface Elev:Boring #2 F Bor.jy ra "—^"^ Horizon 1 9 3 4 5 6 7 Depth in 0-10 10-30 30-100 Domm.Colo Munsell 7.5YR2.5/3 7.5YR4/4 7.5YR5/6 Redox Description 3u. Sz. Cont. Colo N/A N/A N/A 'extun SL LS MS "Effluent #1 = BOD 5>30<. 2 20 mg/l and TSS>39-^TSOmg/l CST Name (Please Print) Marks. Thompson I Address: 12006 N US Hwy 63 Hayward,WI54843| Structure Gr.Sz.Sh. 2MSBK OSG OSG X/"s^^y.^-late pfraWQtiaa<B&"duct9d: "Wednesday, June 12, 202 Page ounty: arcel I.D.^froperty Location Lot: Block: 0 Town Barnes 1 aft L ^ /.."' Bavfield 4194•" w^ ^t^T^y^lf19,T44N,R09W ubdivision Name or CSM # earest Road:Clearwater Road Code derived design flow rate: 450 \pplicable: 87 Elevation.BaO.ae;. 'pth to Limiting Factor: 120 ;onsistence| MFR ML ML Boundary cs cs N/A ipth to Limiting Factor: 100 insistence I MFR ML ML Boundar cs cs N/A ~*RG[uert#2=60D5<2: 9J_02 To 9o02 1. Roots sco 2M 1F n. Roots 3CO 2M 1F Soil Application Rate: GPD/ft2 *Efl»1 &6 n 07 Eff#2 1.0 1.6 L6 Soil Application Rate: GPD/ft2 *Ef?1 0.6 03. J=Z- Ef?2 M-1£ L6 ?0 mg/1 and TSS <. 30 mg/1 =ST Number: g^ggg Felephone dumber 715/699-4081 SBD-8330 (R04/1S, P<^A ^^° TH^A (UH Property Owner: ittschalk Lorilvn J & Rein Stanley Parcel I.D.4194 Page:2of6 Boring # 3 -lorizonl 1 2 3 4 5 6 7 lepth in 0-10 10-35 35-95 Boring # 4 Horizon) 1 2 3 4 5 6 7 )epth in Boring # 5 Horizon] 1 2 3 4 5 6 7 3epth in Boring # 6 Horizonl 1 2 3 4 5 6 7 3epth ir Bor 17 Pit Ground surface Elev: | Depth to Limiting Factor: 95.94 Ft. 95 In. )omm.Color| Munsell 7.5YR2.5/3 7.5YR4/4 7.5YR5/6 Redox Description 2u. Sz. Cont. Coloi N/A N/A N/A extun SL LS MS Ground surface Elev:pj^ _.—..„»-,,„„„„.. 0 Ft. 3omm.Color| Munsell Redox Description 2u. Sz. Cont. Colo extun Ground surface Elev:~ Borp Pit "•""••"•••"•.•""••--— 0 Ft. 3omm.Color] Munsell Redox Description 3u. Sz. Cont. Colo 'extur Ground surface Elev: 0 Ft. Domm.Colorl Munsell Redox Descriptior Qu. Sz. Cont. Cole Fextur Structure Gr.Sz.Sh. 2MSBK OSG OSG ;onsistence MFR ML ML loundari cs C5 N/A Roots sco 2M 1F Depth to Limiting Factor: 0 In. Structure Gr.Sz.Sh.;onsistenci ioundan Roots Depth to Limiting Factor: 0 In. Structure Gr.Sz.Sh.Sonsisteno Boundar Roots Depth to Limiting Factor: 0 In. Structure Gr.Sz.Sh.Consistenc Boundar Roots ioil App. Rate GPD/ft2 •Eff#1 M QJ. 0.7 :ff#2 1.0 LS M- ioil App. Rate GPD/ft2 *Eff#1 ;fW2 Soil App. Rate GPD/fP *Eff#1 Eff»2 Soil App. Rate GPD/ft2 *Ef»1 EffiK affluent #1 = BOD 5>30;< 220 mg/1 and TSS>30 5 150mg/l "Effluent #2 = SOD 5 < 30 mg/1 and TSS <. 30 mg/1 The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access sen/ices or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777 SBM330(R.07/00) ..i Z024 Soil Profile Sheet Page:3 of 6 Owner: ttschalk Lorilvn J & Rein Stanle|SoirTester Mark S. Thompson System Elevation:93 Load Rate:•5T System Elevation:91.02 To 93.02 »» 97 96 95 94 93 92 91 90 89 88 87 86 85 84 83 82 81 80 79 78 77 U1 97.45 0.7 94.95 $ OJ. 90.45 ±3: 87.45 L.F. 98 97 96 95 94 93 92 91 90 89 88 87 86 85 84 83 82 81 80 79 78 77 76 OZ 90.71 ±y 87.71 L.F. ±y 88.02 L,F, Owner Information:BM=100:120 I Name: I Location: I Township: [County: I Lot #: Gottschalk Lorilvn J & Rein Stanley M S19.T44N.R09W Barnes Bavfield _Q_ 95 ^ ' 5-AprJstina System 96 V -^BM^B1^ B1= B2= B3= Lake= 97.45 96.04 95.94 87 Driveway 48745 +/-150 Lower EauClare Lake Well CST:/Mark S. Thompson x Only in Tested Area 715/S3T-3139 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) Pg1 of 4 Pg 2 of 4 Pg3of4 Pg4of4 Index & Cover Sheet Plot Plan Dispersal Area Cross-Section & Plan View Management Plan Attachments:Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Gottschalk 3 Bed Owner Name(s): Lorilyn Gottschalk Co-Trustee Owner Address: 5156 Newton Ave. Minneapolis, MN Phone: 612 .578 -2752 Zip:. 55419 Project Address: 48745 Clearwater Rd. Barnes, Wl Govt. Lot:1/4 of Township: Barnes 1/4, Section^9, T 44N-R^SEQor W [/l County: Bayfield Project Parcel ID #: 4194 Designer Information Designer Name: Jason Kuettel _ Phone: 715 .798 .3355 Designer Address: po Box 66 Cable, Wl . 54821 E-mail: tim@andryras.com License Number: 675751 Remarks: Signature: Original signature required on each submitted copy. <s/^/^y I Name: I Location: [Township: I County: I Lot #: Owner Information: Gottschalk Lorilvn J & Rein Stanley M S19.T44N.R09W Barnes Bavfield 0 \^yjJTlL i^T^tt? BM=100:120 ^•^•^^ c^^^ B1 = B2= B3= Lake= 97.45 96.04 95.94 87 Driveway 148745 Lower EauClare Lake Well 1 "=50'Only in Tested Area j^p G7^<>^ (.H^ IN-GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard-W Chambers 3-ft Trench (down-sizing credit) SOIL COVER ri--^ \— mm. 12"(typical) Septic Tank(s) Manufacturer: Suoerior Precast 760 gal Orenco Septic Tank(s) Volume(s): gal _ gal Effluent Filter Manufacturer: gal Effluent Filter Model #:: FT-0822 12" min. trench depth(typical) ^B-' •^':< 34"-<—\-^ ., •• •• •(typical) TYPICAL TRENCHCROSS SECTION VIEW (No Scale) Quick4 Standard-W w/ End Cap (typical) System Elevation = 93.0 f( (typical) (Show location of inlet / outlet pipe connection on plan view.) Provide minimum 3 ft separation between trenches. —: _____^ _______ ^_-__: B= ^6_ ft INSTALL PER TRENCH: (typical) Observation Pipe(typical) Install per manufacturer's instructions. TYPICAL TRENCH PLAN VIEW (No Scale) A =3.0 ft (typical) 11 Quick4 Std-W @ 20 ff EISA/chamber = 220 Pairs of end caps @ 6 ft2 EISA/pair = ^. ft2 ft2 -Quick4 Standard-W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturer's instructions. n>0m GO0 = Proposed EISA per trench = x3_ Required Infiltration Area = °^ ft2 Distribution Method: trenches = Proposed Total EISA = ^_ ft2 branched manifold 5Z:?TIC TAJ-1;<CROSS 5 ACTION .-hT> S?;:CIFlCATrn,'ti^ 4" ScH^OPV-C IMSP. pi:?.: 6 " MI.Y A30VZ GRADZ.(opT.) GbJ^e^ inle-4- Tr-\c^vY\o\& (^- \3u.(-ile-d.y FINISHSD GRADE APPROVED PIPE 3' ONTO SOLIDSO [L -APPRfiXED B-A-FCfcE Of FILTER. MFG. OK.^CO model ;F PT082-"2- 3" APPROVED BEDDING Uh1)£R TAh'K SPECIFICATIONS SEPT-AC^TANK-MANUFACTURE?: S^Pt^^0^ PC<X^fr' TAW SIZE:S; SE?TIC ~7^0 GAL. APPROVEDHANHOLE W/ La/t<4. WWw^ U^Q^_ -^" HIM. OUTLET NOTES: PAGE 4 OF 4 In-ground Gravity Management Plan 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, 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. Admin. Code. Maxi mum Dispersal Area Operating Limits : Design Flow = 45° gpd: BODs$ 220 mgL-1; TSS ^ 150 mgL-1; FOG $ 30 mgL-1 Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (/.e. odors, user complaints, etc.) o mechanical malfunction (/.e., pumps, valves, switches, floats, etc.) o material fatigue (/.e., leaks, breaks, corrosion, ete.) 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, ete.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (/.e., pump re-cycling, float switch settings, etc.) o electrical components - if applicable (/.e., wiring, connections, switches, controls, timers, alarms, ete.) 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, 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 Wise. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Andry Rasmussen & Sons _ phone: 715-798-3355 Local government unit: Bayfield CQ. Zoning _ phone: 715-373-6138 Local government unit address: 117 E 5th St. Washbum, Wl _ Zip: 54891 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, Wise. 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, Wise. 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, Wise. Admin. Code. • n:33 AM Novus-Wisconsin Access rev. 12.0206 . : 31'Estate Bayfield County Property Listing Today's Date: 6/5/2024 Property Status: Current Created On: 3/15/2006 1:14:53 PM tion Tax ID: PIN; Legacy PIN: Map ID: Municipality: STR: Description: Recorded Acres: Calculated Acres: Lottery Claims: First Dollar: Zoning: ESN; ''•f Tax Districts 1 04 004 041491 001700 Updated: 11/17/2021 4194 04-004-2-44-09-19-2 00-150-18000 004134007000 (004) TOWN OF BARNES S19 T44N R09W CLEARWATER (PART OF GOVT LOT 3)LOTS 19 & 20 IN V. 1006 P. 391 719R 2.330 2.333 0 Yes (R-l) Residential-1 104 Updated: 3/15/2006 STATE COUNTi' TOWN OF BARNES SCHL-DRUMMOND TECHNICAL COLLEGE o Recorded Documents Updated: 7/8/2009 B PERSONAL REPRESENTATIVES DEED Date Recorded: 11/20/2008 Ownership Updated: 11/17/2021 LORILYN 3 GOTTSCHALK CO-TRUSTEE MINNEAPOLIS MN STANLEY M REIN CO-TRUSTEE MINNEAPOLIS MN Billing Address: GOTTSCHALK, LORILYN J & REIN, STANLEY MATTN: DEBRATING5156 NBA/TON AVE SMINNEAPOLIS MN 55419-1029 Site Address * indicates Private 48745 CLEARWATER RD Property Assessment 2024 Assessment Detail Code Gl-RESIDENTIAL 2-Year Comparison Land: Improved: Total! £B* Property History Mailing Address: GOTTSCHALK, LORILYN 3 & REIN, STANLEY MATTN: DEBRA TING5156 NEWTON AVE SMINNEAPOLIS MN 55419-1029 'rivate Road BARNES 54873 Updated: 10/4/2016 Acres Land Imp. 2.330 343,100 114,400 2023 2024 Change 343,100 343,100 0.0% 114,400 114,400 0.0% 457,500 457,500 0.0% B QUIT CLAIM DEED Date Recorded: 5/5/2006 2006R-506566 943-783 N/A 7 ?nJL https://novus.bayfieldcountv.wi.aov/access/master.asD?DaDrDid=4194 1/1 Private Sewage System Maintenance Agreement Owner(s) Name L.o?-i<-'r^ .1 (3oTT-/c i-*^^c- (^_<3 r^^'re^ Owner(s) Mailing Address 5 \s & ^^rzi^/^-'e.>, A^I $-;s-mc) Site Address tT'67MS CL-6.y^J^ ^r^^. (Z>^ _ rj^fLrt^, i->3T Tax ID S t^H 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) i 1/4 of 1/4 Section / ? Township ^/ N. Range _OC7_W. Additional Legal Description: Town of /!^-^^S Lot /9 ^-1° Block (Acreage) 'Z--7J Go'/'t Lot -37 Subdivision C.LC.^^ftT^— Lot CSM#Vol..Page.CSM Doc # OOCUMENT NUMBER2024R-603633 DANIEL. J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. Wl RECORDED 06,14/2024 AT 1 :35 PM KF-CORUiNG FEE: $30.00 PAGES: 1 Recording Area Return To: Planning and Zc(hJ.hg Department l'il jUN 1 8^J^ fn-ground gravity [_] Mound D In-ground dosed Q In-ground pressure distribution Sewage System: D At-grade Sewage System D Other. Septic Tank (system types A through E): The sepiic tank shall be pumped by a certified septage servicing operator within three (3j 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 privale sewage system distribulion 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 wastewatsr or effluent from the system is ponding on the ground surface. Mounds, Al-qrade. and In-qround Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbeci 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 lav/. The terms and conditions of the agreement sha!l be binding upon and inure to the benefit of all current and future owners of such property. Owner(s) Name(s) - Please Print ^oe.\i_^'VJ 6orr-i<-< Notanzed Owne'(s) - Signatursfs) ^. Subscribed and^ sworn to before me on This date; "^ ^ '\ ^^ i'\twiASS^<W^^^A^^^^^A<vwwwwwM ^fo<^W^ Drai-dby J~,^\. L^A^.<^_ D?'.^ 'C'lc^ DAVID GEORGE 8ERGH;Notary PuUto-MlnnNor I /3-. /-z-oZ-3 BAYFIELD COUNTY SANITARY # STATE SANITARY PERMIT I TRANSFER/RENEWAL PREVIOUS NO. OWNER: Lorilyn J Gottschalk Co-Trustee & Stanley M Rein Co-Trustee PROPERTY LOCATION: Town of Barnes Lots 19 & 20, Clearwater SEC 19, T44N, R9W PLUMBER: Jason Kuettel LIC. #: 675751 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 im pair 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. Tracy Pooler AUTHORIZED ISSUING OFFICER 7/1/2024 DATE 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 7/1/2026 UNLESS RENEWED BEFORE THAT DATE POST IN FLAW VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION