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HomeMy WebLinkAbout24-79SRequest 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 715-413-0122 Plumber: Superior Plumbing & Mech. Inc. Fax Number Email Address Homeowner: Jason Baldwin ed@superiorpmw.com Immediate Phone Number So Zoning Sanitary Dept can call you right back (if needed) Permit #: 24-798 Plumber's Choice Zoning Dept No Inspection(s) during this time Date: 8/22 OK Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice Zoning Dept Time: 2prn 12-1230PM OK Township: Delta Address # & Road Name: 63745 Evergreen Ln. Iron River or Directions To Site: Comments: Conventional system 1 bedroom ** Plumbers you must verify any change(s) by fax or email `* Notes from u/forms/sanitary/requestfori ns pection Zoning Dept (©4/12/04): ' June 2023 vrrnanfC I i11,S i H ��SSInN�V: Industry Services Division General Information Permit Holder's Name Tank Infnrmafinn • TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road Septic /L/&44A 1,1 T /� N/A Dosing N/A Aeration N/A Holding Private Onsite Wastewater Treatment Systems ( POWTS) Inspection Report (Attach to Permit) provide may be used for secondary pumoses r Privacy JASON A & AMY C BALDWIN 4017 MANTI RD FARRAGUT IA 51639 s�Iback fo: C yp_ty Sanitary Pe No: 9J4 - 7q. State Plan Transaction ID#: Parcel Tax No: Pump / Siphon Information ump 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, Ley. # of Cells / SETBACK FROM Prop. Line Building We OHWM Type of Cell Manufacturer: Model Number: Pretreatment Unit Manufacturer: Model Number: Distribution System Elevation Data STATION BS HI FS ELEV Benchmark Bldg. Sewer Tank Inlet 4 6 Tank Outlet Dose Tank Inlet Dose Tank Bottom Inst. Contour Header I Manifold Distribution Pipe Infiltrative Surface Final Grade '6 X Pressure Systems Only Header / Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length _ Dia Length Dia Spec _ Spacing ❑ Yes ❑ No Soil Cover Depth Over Depth Over Depth of Seeded / Sodded Mulched Cell Center Cell Edges Topsoil ❑ Yes ❑ No O Yes El No COMMENTS: (Include cpde discrepancies,'persons present, etc.) � a 44 M(IQL � l "Z. D 4',li like tee s�c�v °U ,lS / tej Plan revision required? ❑ Yes ® No d 2 Z z( Use other side for additional infor1ation. O Date POWTS Inspector's Signature License Number can-s»n ra ngnr\ Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zonina(a�bavfieldcountv.wi.aov Web Site: www.bayfieldcounty.wi.00v/147 JASON A & AMY C BALDWIN 4017 MANTI RD FARRAGUT IA 51639 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 l As you know - 4 o'z- mss.o, n -j was contracted by you to install a private onsite wastewater tceatment system on your pf�erty described as: Notes: Abandonment of Old System to meet all applicable code requirements: Tank was pumped by: on at AM / PM Tank was crushed / removed and pipes disconnected by: On at A (AM 1iRhe above -mentioned plumber contacted our office to conduct a pr -cover inspection as required under DSPS 383. One of the following applies: }�` System was inspected and appears to meet all applicable code requirements. fl 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: Ulformslsanitaryproparty ownar-input April 2019 SS-, J1370 ` -. Department of Safety c°n"ry 1� � Professional Services I a Bayfleld S ,J [' I Za _Industry Services Division Sanitary Permit Number (to be filled in by Co.) `i•. - 9 S P�it Application Sm[e Transaction Number sanitary In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Project Address (if different than mailing address) is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS am 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(I)(m), Stats. 63745 Evergreen Ln. Iron River, WI 1. Application Information - Please Print All Information Property Owner's Name Parcel If Jason & Amy Baldwin 13392 Property Owner's Mulling Address Property Location 4017 Mantl Rd. Govt. Lot____ City, State I Zip Code Phone Number Farragut, IA 51639 712215-0123 SW v, NE '/v Section 4 T 46 N R 8 Ear II. Type of Building (check all that apply) Lot If ® I or 2 Family Dwelling - Number ofBedrooms 1 Subdivision Name Block If ❑ Public(Commercial - Describe Use ❑ Ciryof ❑ Village of iR ❑ State Owned - Describe Use CSM Number l Town of Delta 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 if s Bcable A. © New System ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B' ❑ Holding Tank ® In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber I❑ Transfer to New Owner ist Previous Permit Number and Date Issued Expiration IV. Dispersai/Tratmeat Area and Tank Information: Design Flow (gpd) Design Soil Application Ratc(gpd/sf) Dispersal Area Required (s0 Dispersal Area Proposed (sf) I System Elevation 150 .7 214 246 95.5' Capacity in Total If of Manufacturer Tank Information Gallons Gallons Units, o v New Tanks Existing Tanks m S icc ti u pp , a _ U in 4a rn Septic or Holding Tank R 750 Wieser Concrete R Dosing Chamber V. Responsibility Statement- 1, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) I Plumber's Signature I MP/MPRS Number Business Phone Number Edward B. Redinger 221939 715-292-8670 Plumber's Address (Street, City, State, Zip Code) 1015 11th Ave. E. Ashland, WI 54806 VI. County/Department Use Only - - - Approved Cl Disapproved Pemt 1 Fee Date Issued Issuing Agc ign m �z ❑ Owner Given Reason for Denial lit Conditions of Approval/Reasons for Disapproval s pe..s-mi+ card Attach to complete plans for the system and submit to the County only on paper sot less than 5112 ill inches in size SBD-6398 (R. 03/22) ]ARiN( Wisconsin Depertmentof Safety and Professional Services E Division of IndustryServices SOIL EVALUATION REPORT -'/!rJJ In accordance with SPS 385, Wis. Adm. Code Attach complete site pleat less than 8 12 x 11 inches in size. Plan must include, but not limited to: vertical a ho ' ntal 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 maybe used for secondary purposes (Privacy Law. s. 15.04(1)(m)). Parcel I.D. 13392 • _ Page 1 3 of_____ Property Owner Property Location LJ Jason & Amy Baldwin GovL Lotsw ' NE ,'A s4 T 46 N R 8 E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: 4017 Manti Rd 63745 Evergreen Ln. Iron River, WI city State Zip Code Phone Number ❑ City ❑ Village IN Town Nearest Road Farraaut IA 51639 215-Q123 Delta Everareen Ln Q New Constmction Use: O Residential! Numberofbedrooms 1 Code derived deslgnflow rate 150 GPD ❑Replacement ❑ Public or commercial —Describe: Flood Plan elevation if applicable ft. Parent material Sandy Glaciofluvial Deposits General comments and recommendations: Conventional System elevation 95.5' 1 Boring # m oring ■ PIt 99.7 84 92.7 Ground surface elev.ft. Depth to limiting factor In. f elev ft. I SellAool Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Or. Sz. Sh. Consistence Boundary Roots GPD/Ft2 'Eff#1 'Eff#2 1 0-6 Syr 4/2 - Is 0 ml ow 2co .7 1.6 2 6-24 5yr4/4 - Is 0 ml gw 3m .7 1.6 3 24-72 Syr 5/3 - s Osg ml - 1co .7 1.6 Boring # Boring 97.52 65 92.1 QPII Ground surface elev. ft. Depth to limiting factorin. / elev. ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Flz 'Eff#1 'Eff#2 1 0-7 Syr 4/2 - sl 0 ml cw 3f .7 1.6 2 7-20 5yr4/4 - sl 0 ml gw 1vf .7 1.6 3 20-65 Syr 5/3 - s Osg ml - - .7 1.6 CST Name (Please Print) Signature CST Number Edward B. Redinger 221939 Address Date Evaluation Conducted Telephone Number 1015 11th Ave. E. Ashland, WI 54806 6/5/24 715-292-6670 Effluent#1=BOO> 305220ng/L and TSS>305150mg/L ' Efluent#2= BOO, 930mg/L and TSS530mgfL P0.1 d t 5 O -1 1 12M .per $DD -8330 (R04121) Page 2 of ❑Boring 99.62 L bl i LU! I :' 60 94.6 3 Boring # ® Pit Ground surface elev. & Depth to limiting factorin.! elev.ft. Soil Aool Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Or. St Sh. Consistence Boundary Roots GPD/Ft2 Eff#1 Eff#2 1 0-6 Syr 4/2 - sl 0 ml cw 3f .7 1.6 2 6-20 5yr414 sl 0 ml gw 1vf .7 1.6 3 20-60 5yr 5/3 - s Osg ml - - .7 1.6 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor —in. I elev. ft. SoilAnol 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 fl Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factorin. / elev. ft. Soil Application 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 'E1f#2 • Effluent #1 = BOD > 30 s 220 mg/Land TSS > 30 5150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS s 30 mg/L Customer Name: Jason & Amy Baldwin Adress: 4017 Manti Rd. jjj Farragut, IA 51639 SUPERIOR SITE: 63745 Evergreen Ln, Iron River WI PLUMBING MECHANICAL Phone #: 712-215-0123 (715) 278-3456 Email: lasonabaldwin@hotmail.com 61s1p y CST# 221939 Scale: 1" = 40' PIN: 13392 3.19 Acres SW NE S4T45N R8W Town of Delta Bayfield Co. Yt� l �Ir' (\oQ �v/__ _ H — re red Pn �7'� �L `` la I N 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 New 1 Bed gravity @.7 loading Owner Name(s): Jason & Amy Baldwin Owner Address: 4017 Manti Rd. Farragut, IA Project Address: 63745 Evergreen LN. Iron River, WI Govt. Lot: SW Township: Delta Project Parcel ID #: 13392 /4 of NE Designer Name: Edward B. Re Designer Address: 1015 11th Ave. E. Ashland, WI E-mail: ed@superiorpmw.com rhisspace,.c ,. urar License Number: 221939 P' itionally Remarks: Cond D c:nls Phone:712 -215 £123 Zip: 51639 1/4, Section4 , T45 N -R8 E❑or W Q County: Bayfield Designer Information Phone: 715 -292 -6670 Zip: 54806 stamp. Signature: Date: Original signature required on each s miffed copy. i SUPERIOR PLUMBING MECHANICAL (715) 278.3456 CST# 221939 Scale: 1" = 40' PIN: 13392 3.19 Acres SW NE 54 T45N R8W Town of Delta Bayfield Co. Customer Name: Jason & A rnv Adress: 4017 Manti Rd Farragu�1639 /V SITE: 63745 Evergreen Ln Iron River WI Phone #: 712-215-0123 Email: �onabaldwin�hotmail.com o.,: k / •nr/Jft TOc- s-ac Pa ry c A c,'! J, PI � i 2 'In -1 / C c IN -GROUND DOSED -GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) in. 12" TYPICAL TRENCH SOIL COVER (tyocao rz CROSS SECTION VIEW trench (No Scale) depth (typical) (typical) °' . ' Provide minimum 3 ft A separation between trenches. System Elevation = ft (typical) Quick4 Standard -W w/ End Cap (typical) (Show location of inlet / outlet pipe connection on plan view.) t------ �'�-------��--- g= 48 ft (typical) INSTALL PER TRENCH: 12 Quick4 Std -W @ 20 ft' EISA/chamber= 240 ft2 + 1 Pairs of end caps @6 ft2 EISA/pair = 6 ft' Observation Pipe (typical) Install per manufacturers / instructions. TYPICAL TRENCH PLAN VIEW (No Scale) TA=3.0ft (typical) `Quick4 Standard -W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. D G) m W O m (Si = Proposed EISA per trench = 246 ft2 Required Infiltration Area = 214 ft2 Distribution Method: x 1 trenches = Proposed Total EISA = 246 ftz branched manifold 0 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, 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 = 150 gpd; BOD5 5 220 mgL-'; TSS 5150 mgL"1; FOG ≤ 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 (to., 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 (Le., 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 Plumbing & Mech. Inc. Phone: 715-292-6670 Local government unit: Bayfield Co. Zoning Phone: 715-372-6138 Local government unit address: 117 5th St. E. 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. WLP750- MR TANK SPECIFICATIONS 4" CAST -A -SEAL DIMENSIONS: WALL 2 1/2" BOTTOM: 3" COVER: 4" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: DOME COVER 61" O.D. FLAT COVER 53 1/4" O.D. OUTSIDE DIAMETER: 84" O.D. BELOW INLET: 42" O.D. LIQUID LEVEL 37' WEIGHT: 6,150 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 20.28 GAL/IN HOLDING TANK: ACTUAL CAPACITY: 790 GALLONS OUTLET HOLE PLUGGED LOADING DESIGN: 8' 0" UNSATURATED SOIL MN TANKS: WILL HAVE ONE VENT OVER OUTLET AND WILL HAVE TWO VENTS IN COVER OVER INLET OPTIONAL FLAT COVER TANK CAN BE USED AS: IS AVAILABLE FOR EXCHANGE SEPTIC/ HOLDING/ PUMP OR SIPHON FOR DOME COVER. COVER: MIX DESIGN /8 NO FIBER) TANK: MIX DESIGN #10 .,STRUCTURAL FIBER) TN- OUTLET CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT NIESER CONCRETE 0j j < '°' PUMP PAD JOB INFORMATION: CUSTOMER: SIDE VIEW 108 NAME: DATE NEEDED: APPROVED BY: TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS J O Q U N 1OF Tracy Pooler From: Ed Redinger <ed@superiorpmw.com> Sent: Monday, August 4, 2025 12:18 PM To: Subject: ason Baldw' Attachments: Bal wirr≤nitary Permit 24-79S w revised st and plot plan.pdf Here is a copy of the permit, looks like I have the extra soil boring on there. Let me know if you need anything more. Ed Redinger Superior Plumbing & Mech 715-278-3456 ed@superiorpmw.com E5 Oi37O I Department of Safety County Ba eld & Professional Services, Sanitary Permit Number be filled in by Co.) J U;4, Industry Services Division (to ``` % anitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forks for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may he used for secondary purposes in accordance with the Privacy Law, s. 15.04(t)(m), Seats. 63745 Evergreen Ln. Iron River, WI 4 Application Information —Please Print AU Information Property Owner's Name Parcel # Jason & Amy Baldwin 13392 Property Owner's Mailing Address Property Location 4017 Manti Rd. Govt. Lot City, State I Zip Code Phone Number Farragut, IA 51639 712215-0123 SW A. NE Y.. Section 4 T 46 N R 8 E orw II. Type of Building (check all that apply) Lot tt O I or2 Family Dwelling —Number of Bedrooms 1 Subdivision Name Black Y. ❑ Public/Commercial — Describe Use ❑ City of ❑ Stale Owned— Describe Use ❑ Villageof CSM Number 0 Town of Delta Ill. Type of POWI'S Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i s licable A. I NewSystem ❑ Replacement System r rr� ❑ Other Modification to Existing System lex l hin) ❑ Additional Pretreatment Unit (explain) ( r ) A ❑ Holding Tank ® In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner rst Previous Permit Number and Date issued Expiration IV. Dispersavrreatment Area and Tank laformation: Design Flow (gpd) Design Soil Application Ratc(gpd/st) I Dispersal Are. Required (s0 I Dispersal Area Proposed (so I System Elevation 150 .7 214 246 95.5' Capacity in Total #of Manufacturer Tank Information Gallons Gallons Units ii E c $ p New Tanks J Existing Tanks e e S $ 2 6 U N x N 4. V t Septic or Holding Tank x 750 Wieser Concrete X Dining Chamber V. Responsibility Statement- 1, the undersigned, assume responsibility- for installation of the POWTS shown on the attached plans. Plumber's Name (Print) I Plumber's Signature MP/MPRS Number I Business Phone Number Edward B. Redinger 221939 715-292-6670 Plumber's Address (Street. City, State, Zip Code) 1015 11th Ave. E. Ashland, WI 54806 VI. County/Department Use Only _ Approved 0 Disapproved Per t t Fee bF(/`(/ Dale Issued 11 1(211 (211 Isuing Age i gn ❑ Owner Given Reason forDenai Conditions of Approval/Reasons for Disapproval G1\l1 0. pee care\ Attach to complete pima for the system and submit to the County only on paper not less thin X i/it It inches in sae SBD-6398 (R. 03/22) iJ4r JUN u'IU24 U 1 3 Wisconsin Department of Safety and Professional Services Page of / R %1 Division of Industry Services 4,'? EVALUATION REPORT ����((JJ In accordance with SPS 385. Wis. Adm. Code Co nt Attach complete site plari�urKpWldlhft less than 8 112 x II inches in size. Plan must include, Bayfleld but not limited to: vertical and hopzontai reference point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. 13392 Please print all information. r fewe i 1)5pj , Personal information you provide may be used for secondary purposes (Privacy Law, & 15A4(1 m)). / ( i( I or, Property Owner Property Location C a Jason & Amy Baldwin GovL Lot sw %NE i s 4 i46 NRB E (or) W Property Owners Mailing Address Site Address or CSM and Lot P. 4017 Manti Rd 63745 Evergreen Ln. Iron River, WI City Slate Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Farragut IA 51639 215-0123 Delta Evergreen Ln Q New Construction Use: O Residential/Numberofbedrooms 1 Code derived designflow rate 150 GPO ElReplacement ❑ Public or commercial — Describe: Flood Plan elevation if applicable R Parent material Sandy Glaciofluvial Deposits General comments and recommendations: Conventional System elevation 95.5' Liii Boring# ❑Boring ❑j Plt 99.7 84 92.7 Ground surface elev.ft. Depth to limiting factor in.! elev.ft. I Soil Anil Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIFt2 Eff#1 'Eff#2 1 0-6 5yr4/2 - Is 0 ml ow 2co .7 1.6 2 6-24 5yr 4/4 - Is 0 ml gw 3m .7 1.6 3 24-72 5yr 5/3 - s 0sg ml - 1co .7 1.6 2] Boring # []Boring 97.52 65 92.1 ®Pit Ground surface elev. ft Depth to limiting factor in. r elev.ft Sall Application Rate Horizon Depth In. Dominant Color Mansell Redox Description C u. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIFtt Eff#1 'Elf#2 1 0-7 5yr 412 - sl 0 ml cw 3f .7 1.6 2 7-20 5 r4/4 - sl 0 ml gw 1vf .7 1.6 3 20-65 5yr 5/3 - S Osg ml - - .7 1.6 CST Name (Please Print) Signature CST Number Edward B. Redinger 221939 Address Date Evaluation Conducted Telephone Number 1015 11th Ave. E. Ashland, WI 54806 615/24 715-292-6670 • Effluent #1 = BOD > 30 5 220 mgIL and TSS > 30 5150 mg/L ' Effluenyqtt�#2 = BOD, 530 mg/L and TSS 5 30 mg/L t- 1 a t s O -t III 2H g4 D-8330 (R04121) Pago 2 _ of 3 ❑Boring 99.62 b. 60 94.6 HBoring ft ®Pit Ground surface elev. ft. Depth to limiting factorin./ elev. ft. Soil A pilratlon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az Cont. Color Gr. Sz Sh. 'Eff#1 E11#2 1 0-6 5yr 4/2 - sl 0 ml cw 3f .7 1.6 2 6-20 5yr4/4 - sl 0 ml 9w 1vf .7 1.6 3 20-60 5yr 5/3 - s 0sg ml - - .7 1.6 HBoring # ❑ Boring ® Pit Ground surface elev.984_�t. Depth to limiting factor 84 in. I elev _91.46fl. I BellAuo Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/FR In. Munsell Qu. Az Cont. Color Cr. Sz Sh. E0#1 -Eff#2 1 0-8 5yr 4/2 - sl 0 dl gw 3f .7 1.6 2 8-84 5yr 5/3 - s Osg dl - - .7 1.6 H Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in.l elev. ft. Soil Aodication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/FtZ In. Munsell Qu. Az Cont. Color Cr. Sr. Sh. 'Eff#1 •Eff#2 Effluent#1=BOD> 30s 220mg/L and TSS>30s150mg/L Effluent#2= BOD,S 30mg/L and TSS530mg/L Department of Safety County 6 & Professional Services, Bayfield S P S J )Ul Industry Services Division Sanitary Permit Number (to be filled in by Co.) n _ 7 unitary 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 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. I5.0411)(m), Stals. 63745 Evergreen Ln. Iron River, WI 1. Application Information — Please Print All Information Property Owner's Name Parcel # Jason & Amy Baldwin 13392 Property Owner's Mailing Address Property Location 4017 Manti Rd. Govt Lot City, State I Zip Code Phone Number Farragut, IA 51639 712-215-0123 SW V4, NE �'/., Section 4 T 46 N R 8 E or IL Type of Building (check all that apply) Lot # i9 I or 2 Family Dwelling — Number offedrooms 1 Subdivision Name Block # ❑ Public/Commercial — Describe Use ❑ City of ❑ State Owned— Describe Use 0 Village of CSM Number O Town of Delta III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if a licable. A. © Ncw System Y � Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank I In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design gn ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dispersalll'reatmeat Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/st) I Dispersal Area Required (st) Dispersal Area Proposed (so System Elevation 150 .7 214 246 95.5' Capacity in Total #of Manufacturer Information Gallons Gallons Units ETank . oo $ v a 2 u H e t .0_ c' New Tanks I Existing Tanks d ow, H ti. a P. Septic or Holding Tank 7t 750 Wieser Concrete % Dosing Chamber V. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) I Plumber's Signature I MP/MPRS Number Business Phone Number Edward B. Redinger 221939 715-292-6670 Plumber's Address (Street, City, State, Zip Code) 1015 11th Ave. E. Ashland, WI 54806 VI. County/Department Use Only Approved O Disapproved ❑ Pemi t �Feee� S�(/"r/ Date Issued 1 I I I Issuing Age ign m ` Owner Given Reason for Denial (�� Z Conditions of Approval/Reasons for Disapproval y�. o1 �o4----k � \\� GaCt0.C,,�aQ - " —c CA' -3 Attach to cnnspleto plans for the system and submit to the County only on paper not less than 8 in x 11 inches in size SBD-6398 (IL 03/22) ss-co7\o C ERFD� Private Sewage System Maintenance Agreement y0/r /'loll Ti (zd • / rr-4qu , /1 S/G 39 3 79 CV raid 4A• '11a n ICr{Ki As owner, I (we) do hereby candy the private sewage system will be installed in accordance with the certified soil testers report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established in the WI Adm. Code, as from time to time amended. (COMPLETE Legal Is required) 1/4 of /� 1/4 Section �/11 Township ______N. lN. Range 11W. Additional Legal Description: S� 4L_cL j Town of 1) C 1 (Acreage) '3. /9 Gov't Lot Lot_ Block Subdivision Lot _ CSM # Vol. _ Page _ CSM Doc # DOCUMENT NUMBER 2024R-603694 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, VVI RECORDED O6/2O/2O24 AT 11:55 AM RECORDING FEE: $30.00 PAGES: 2 Return To: Planning and Zoning Department Area 0 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 he 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, Wls. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator. POWTS inspector, or licensed master plumber within three (3) years of the date of Installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is pending on the ground surface. Mounds. At -grade, and In -ground Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. Owner(s) agree that failure to comply with this agreement will result in action 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 maybe 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 Print 4mK /3'61d1/Fj 8 ( Subscribed and sworn to before a da(e• _--2Y-Z miss r l '- Commission hJuna 702061 My Comms:;.on Elygires owp Notarize )—Slgnature(s) Notary Public My Commission 6tpires: 27 ? Drafted by: JaSa n 7A IcJ,✓r1n Da m 2 Y I . JUI'i .I AVI Proofed by: uiforms/sanitary/septicmalntenceagreement Revised July 2020 File Number: 240075 ADDENDUM/EXHIBIT A A parcel of land located in the South One-half of the Northeast Quarter (S1/2-NE1/4), Section Four (4), Township Forty-six (46) North, Range Eight (8) West, Town of Delta, Bayfield County, Wisconsin, described as follows: Commencing at the Northeast corner of the SW1/4-NE1/4, Section 4, Township 46 North, Range 8 West; thence West a distance of 216 feet to an iron pipe on the East lake shore of Muskellunge Lake; thence South along the East lake shore a distance of 301.5 feet, which is the Place of Beginning; thence East along the South line of Parcel 20 a distance of 947.7 feet to the Southeast corner of said Parcel 20; thence North along the East line of said Parcel 20 a distance of 150.75 feet; thence West on a line parallel with the South line of said Parcel 20 to the East shore line of said Muskellunge Lake; thence South along said East shore line to the Place of Beginning. Intending to describe herein the South 150.75 feet of Parcel 20 of an unrecorded Plat of the area, called Map of Section 4-46-8 West; EXCEPT a parcel described as follows: To locate the Point of Beginning, commence at the Northeast one -sixteenth corner of said Section 4, and run South 83°11'31" East, 660.04 feet to a 1 1/4 rebar; thence South 09°21'23" West, 124.04 feet; thence North 84°24'10" West, 715.97 feet to a 1 inch iron pipe, which is the Point of Beginning; thence from said Point of Beginning by metes and bounds; continue North 84°24'10" West, 144.00 feet to a 1 inch iron pipe; thence South 05°35'50" East, 8.00 feet to a 1 Inch iron pipe; thence South 76°53'06" East, 145.25 feet to a 1 inch iron pipe; thence North 05°35'50" West, 27.00 feet to a 1 inch iron pipe. Bayfield County Register of Deeds Document #2023R-601652 Page 2 of 2 BAYFIELD COUNTY SANITARY PERMIT # 24-79S STATE SANITARY PERMIT 1:1 TRANSFER/RENEWAL OWNER: Jason & Amy Baldwin PROPERTY LOCATION: Town of Delta SW'/a NE '/a SEC 4, T46N, R8W PREVIOUS NO. _________ PLUMBER: Edward B. Redinger LIC. #: 221939 Tracy Pooler 7/1/2024 AUTHORIZED ISSUING OFFICER DATE Condition: Management plan to owner. Properly maintain per recorded agreement. System to meet all setbacks. 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. (I) 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. THIS PERMIT EXPIRES 7/1/2026 UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R. 06/23)