Loading...
HomeMy WebLinkAbout24-87SRequest 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 flTime Change flDiscrepancy flOther Phone Number Plumber: 77a4? %���yrJi�, °S-852-7oY7 Fax Number rIPR5 Vtz2W734 iyiey.Q Email Addr ss Homeowner: 7Z4+. Immediate Phone Number So Zoning Sanitary �U��-24 v 7S Dept can call you right back (if needed) Permit #: Gob- 5'62-7097 Plumber's Choice Zoni ept Date: n A 2 �d No Inspection(s) during this time Q{ Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice Dept Time: 3:0o Wh .S Township: Address # & Road Name: /396'5 9u%L_n / 2. or Directions To Site: Comments: ** Plumbers you must verify any change(s) by fax or email ** Notes from u/forms/sanitary/requestfod nspection Zoning Dept (O4/12)04); ® June 2023 o£Mar loPrivate Onsite Wastewater Treatment SP Systems ( POWTS) Inspection Report (Attach to Permit) MARK H & DENISE A PALMER W16623 LINDSTR0M RD UTPOSCS[Privacy Law, s. 15.04 (1 m)] BLAIR WI 54616 City Village Town of: Tank Information iIT MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road Septic Od Q ,j N/A Dosing N/A Aeration p , N/A Holding setback to: Sanitary Pe No: O) V gig State Plan Transaction ID#: Parcel Tax No: Pump I Siphon Information 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 Lens h # of Cells SETBACK FROM PoLine B9 ing W ( OHW Type of Cell cc7t1.,r/2 y p/u( Manufacturer: Model Number: Pretreatment Unit Manufacturer: Model Number: Distribution System Elevation Data STATION BS HI FS ELEV Benchmark 00 h 5. / 2 Bldg. Sewer Tank Inlet jQ Tank Outlet $ 3 Dose Tank Inlet Dose Tank Bottom Inst. Contour Header/Manifold Distribution Pipe Infiltrative Surface Final Grade X Pressure Systems Only Header / Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length _ Dia Length _ Dia Spac Spacing ❑ Yes O No Soil Cover Depth Over Depth Over Depth of Seeded! Sodded Mulched Cell Center Cell Edges Topsoil ❑ Yes El No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) C%.�gYaiM) l/MC5 yG S�'� -7u� Plan revision required? ❑ Yes No Use other side for additional infor lion. 7 /44 rn- Date POWTS Inspector's Signature CRn_R71 n /R flw fl License Number Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zonina(a bayfieldcounty.wi.gov Web Site: www.bayfieldcounty.wi.gov/147 MARK H & DENISE A PALMER W16623 LINDSTROM RD GLAIR WI 54616 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know �t /4tf2 e /? 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: I On 7% 2✓ at 3 (AM he above -mentioned plumber contacted our office to co,Iuct 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. 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. .• Tank was pumped by: .r Tank was crushed / removed and pipes disconnected by: on at AM/PM 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/forms/sanits ryproperlyowner-inpul April 2019 SS'-Ofl�35 (� Industry Services Division �3°Qrenuryta "�' �') 4822 Madison Yards Way,.. D '^( Madison, WI53705 F/ ` III] MAY 022024 P.O. Box 7162 JJ '°o ,1f' fJ`g'-005Z(,�sdadison, W153707-7162 \.__ ayfie emit Application In accordance with SPS 363.21(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 oation you provide maybe used for secondary purposes in accordance whir the Privacy Law, s. 15 04(I)(), norm- _.,. _�_...,.. nfi.:d1L'enaAlt i)(mimatidn -. retry Owner's Mailing Address W/6GZ3 State Zip Code 7&et >,, G>/ S5'6 /6 Type of Building (check all that apply) or 2 Family Dwelling — Number of Bedrooms 3 'ublic/Commercial — Describe Use itate Owned — Describe Use /3985 Parcel 4 /2578 Govt. Lot Phone Number t�pD9-625 %Z3 '4, Section - of IIm.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 f e 'livable. ,.. I L, ... A. ew System I L�Replacement System ❑0ther Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain) B' Holding Tank In -Ground ❑&t -Grade ❑Mound Individual Site Design Other Type (explain) (conventional) C. ❑ Renewal Before ❑Revision flChange of Plumber ❑1'mnsfer to New Owner is[ Previous Permit Number and Date Issued Expiration Ila�"Glla'iei ht`Meaaoa.Tank Iuf'drmiition Design FlowDe gn Soil Application Rate(gpd/sf) Dispersal Area Required (s0 Dispersal Area Proposed (sf) System Eleva tion So 960 9/'/.4 _ Capacity in Total I! of Manufacturer Gallons Gallons Units .�' _r Tank Information Ga New Tanks Edsting Taals _p ,°J_ g a ps 4G V m Septic or Holding Tank Dosing Chamber /O66 /d6Q &i IL.HI .V..RepponsibiiityStatement-1, the undersigned,pasumerepoquomry3or{auuuu._u.os.. -•-----.-- -- - Plumber's Name (Print Plumber's Signature +.&/MPRS Number Business Phone Number ,uff736 6o8-8S.z-7oY7 Plumber's Address (Street, City, State, Zip Code) ` / S' e �� /)/66 -3 �zt.>^doGioza-� J ..VL Couaty/.Depactmeut)V*Onl vek 4 .. :a zal, Permit Fee ued suing nt S re Approved O Disapproved _/ �� ❑ Owner Given Reason for Denial Attach to complete plans for the system and submit to the County only on paper not less than 8112 X 11 inches SBD-6398 (R. 03/21) .IITYE , /3%\ . � Wisconsin Departmentof Safety and Professional Services .'V —Ur O� Bayfie!Co. Page / of�3 > , Division of IndustrySarvices / V PlanninO and ZoZoning Agency SOIL EVALUATION REPORT 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, 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. Please print all information. - vi D.attee Personal Information you orovlde may be used for secondary numoses /Prwacv I aw. a 9.c, nd/ I /mu ���� ;9/? I /✓li/0 Property Owner r Property Location I Govt Lot Nw +/, 56 y, S r -, T 944 NR 7 E (or) W PropertyOwner's Mailing Address d77 Site Address or CSM and Lot #: City State 4J/ Zip Code '/6/6 Phone Number ❑ City ❑ Village own c� o -37a Nearest Road it -- New wnsuucuon Use:C Residential/Numberofbedrooms Code derived deslgnflow rate y,5 V` GPD -� Replacement ❑ PubjiF or commercial — Describe: Flood Plan elevation if applicable ft. Parent material General comments and recommendations: j4_ v ^ a Boring # r C�' ❑Boringz. 8' O ���c" 9a,,s b lt Ground surface elev. - Y Depth to limiting factor 90 in. / elev. D S II ion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenct=In. Munseil Qu. Az. Cont. Color Gr. Sz SSh.•Eff#2b- O C, WRootsGPD/Ft2 D- 7 7,SYR Gh =D, 7 q ❑ Borin # []Boring 4,z. t/ g Ground surface elev. 9Q Depth to limiting factor 76 in. / elev. 7 yam, cull nppucauon nuts Color Redox Description Texture4Sz. Consistence Boundary Roots GPD/Ft. PHtorIzonTDepthDominant Munseil Qu. Az. Cont. Color 'Eff#i R Z f,0 J&q'a t']$4(! z*/avdcfdtaJ O._al .,L - ___ v-0 -1 1 CST Name (Please Print) Signature CST Number Mark Palmer 224736 Address W16623 Lindstrom Rd Blair WI 54616 Date Evaluation Conducted 5— /5t- oZ - Telephone Number 608-525-3723 ' Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 5150 mg/L • Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L Pd so- (n 30 Q dais gs tRoa/2,, Page cZ of Boring %DD, Boring # ❑ Pit Ground surface elev.__ k.. Depth to limiting factor 77 in. / elev. 13 . Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots -rr- GPD/Ft2 *Eff#1 *Eff#/ 5i'eW23/≥ 2, -- 3`f 7►45 k3fz/ _________ ______ ____ ___ ___ ___ 3 y- 7 7 SYR (f ______ _____ ___ ____ ____ L ] Boring # O Boring ❑ Pit Ground surface elev. 1.t. Depth to limiting factor in. / eiev. I Soil Annliratlen Rats 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 • Boring # ❑ Boring ❑ Pit Ground surface eiev_ ► Depth to limiting factor In. / elev. , I Soil Anolication 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 *Eff#2 * Effluent #1 = BOD > 30 s 220 mglL and TSS > 30 s 150 mglL * Effluent #2 = BOD, 5 30 mg/Land TSS 5 30 mg/L Site Plan M /q4 f %7o 6 NO WELL ON S!TE WELL SITE MUST COMPLY WITHNR811 &NR812. J rr r SO >5a' +o Graphic S ( in feet) 1 inch = 30 ft. aUcn 3 a gal -�0 3 o e 0O z o r v v o Z o p v EU 0. U Ce w j_ c Ma e a ; b � K I lcNiI orc4i O z. r El Oi h v? e c hI L• `m 3 z /� V N E Z bI1 " d - Q o fC E1 ZnI x F- CI O N u p �L�f5�Uf� ��. MAY L 2 2024 BUJ IN -GROUND ABSORPTION SYSTEM COVER j,ingDept. SHEET In -Ground Soil Absorption Component Manual for POWTS Version 2.1 (May 2022-2027) SBD-10705-P (N.01/01) LOCATION:NW 1/ SE 1/ SS T fl N R 7w TOWN: COUNTY: OWNER NAME/ADDRESS: ____ . __, ✓t1/ J/Le23 A.a r w / 1i S`f6 1, PLUMBER NAME/ADDRESS: 72/ w/e≤2 3 L .'I 0/ S9S /� LICENSE #: o2, _ L/ 736 SIGNATURE: DATE: 4't.z 92 7< ATTACHMENTS: PAGE 1: PLOT PLAN PAGE 2: PLAN VIEW CROSS SECTION PAGE 3: TANK SPECIFICATIONS �3 PAGE 4: MAINTENANCE /� 1 n00 a73QA bV c,aJ�t ,ems DESIGN By HIGH CLIFF CONSULTING LLC =� High Cliff Consulting LLC Phone: 608-582-2205 PO Box flL Copyright © 2021 High Cliff Consulting LLC Galesville, WI 54630 em >Sao' 2L0s 'V y -Z9 a 4' X N 6 Site Plan /62.f' Ct. Clams I 0 NO WELL ON SYFE WELL SITE MUST COMPLY WITE[NR I �ntt.Fc mld.ivffl� 2-3'x 13 aka) DPI at S a'_ 0' Graphic Scale o (in feet) 1 Inch - 30 It VJ a0 b '1)o 3a� b tn�h 3 G C A p 7. e =az Ey 3 c o ago- N d m b S � m 9 m i a m 0 U d i R p C H V 0 0 E >( V 3 . O z < a } 211 IN -GROUND DISPERSAL AREA Quick4 Plus Standard Chamber TYPICAL TRENCH CROSS SECTION VIEW (no scale) Ge C Provide minimum 3 ft separation between trenches On. 12" (typical) OBERVATION PIP DETAIL (no scale Slip cap 4" PVC pipe Top of pipe to terminate at or above finished arad or ,—Finished TYPICAL TRENCH DIMENSIONS Trench 1 Trench 2 Trench 3 Trench 4 Trench 5 Installation Contour = 9 'ft ft q fio ft ft ft ft System Elevations = 9t€ v ft ft ft ft ft Trench Length = 93 ft 93 ft ft ft ft TYPICAL TRENCH PLAN VIEW (no scale) Quick4 Plus Standard Chamber Required Infiltrative Area 966 sq. ft. Proposed Total EISA sq. ft. seeded) Topsoil cover (minimum 12") Observation pipe (typical) installed In end cap L C �uL p N 2.N O I k0 N v © High Cliff Consulting LLC 2021 I. 1 LIFTING STRAP (TYPICAL) 04(1021 PVC OR ABS INLET TEE B 0; O `► B' 127.0 P2261 EXTERIOR LENGTH - TOP VIEW RISER CONNECTION (TYPICAL) A' ACCESS PORT RIM FLEXIBLE ELASTO- MERIC GASKET (TYPICAL) / 62.2 TANK [1250] INTERIOR EXTERIOR WIDTH PIPE PENETRATION SECTION DETAIL TANK EXTERIOR LENGTH 127.013226] WIDTH 62.2[1580] HEIGHT 54.7(1388] 024 (610) ACCESS OPENINGS WITH LOCKING LIDS (2) 0 41102] PVC OR 10.2 (260] FREEBOARD r / ABS OUTLET TEE 30 DE [76f } PER 44 0215] WALL BAFFLE CODE THICKNESS COMP ENT WALL A 940 S [1118] LIQUID 2[51)X2(51) X 2 (51) DEPTH FBASTENER (TYP ) FIBERGLASS BAFFLE COMPARTMENT SUPPORT SLOT B (TYPICAL) -38.1(988] -.- _ 41.5(1054) 38.11968)- 2/3 TOTAL VOLUME 1/3 TOTAL VOLUME SECTION A -A' SEAM CLIP (TYPICAL) LIFTING STP, (TYPICF_, NOTES: 1. ALL DRAWING DIMENSIONS IN INCHES [MILLIMETERS] OR AS NOTED. 2. EXTERIOR OF ACCESS OPENING LID INCLUDES THE FOLLOWING WARNING IN ENGLISH, FRENCH & SPANISH: 'DANGER DO NOT ENTER: POISON GASES.' 3. TANK MARKINGS WILL INCLUDE: MANUFACTURER NAME, MODEL NUMBER. LIQUID CAPACITY, DATE OF MANUFACTURE, MAXIMUM BURIAL DEPTH, INLET, AND OUTLET. 4. MAXIMUM BURIAL DEPTH IS 481n [1219 mm]. 5. MINIMUM BURIAL DEPTH IS 6 in 1152 mm]. 6. TANK IS FOR NON -TRAFFIC APPLICATIONS. 7. AIRSPACE IS 165%. 8. OUTLET TEE IS COMPATIBLE WITH AN EFFLUENT FILTER. SIDE INLET/ 9. INTERIOR LENGTH TO WIDTH RATIO 152.3:1(118.8 -INCH LENGTH /51.7 -INCH WIDTH = 2.3). OUTLET (TYP.) 10. FREE VENT AREA BETWEEN TOP OF BAFFLE WALL AND BOTTOM OF TOP BAFFLE SLOT IS 39.7 In'. 11. BAFFLE WALL THICKNESS IS 0.31 In (8 mm). 1.51381 LID TANK TOP OUS HALF GASKET GASKET TANK INTERIOR SEAM CLIP (64) r—loNLET/ ALIGNMENT DOWEL (34) TANK BOTTOM TLETHALF E LIQUID DEPTH 44.0 (1118] INVERT DROP 3.0(76) FREEBOARD 10.2 (260) END VIEW OS MID -HEIGHT SEAM SECTION DETAIL AL CAPACITY 1287 GAL 14872 L) RKING VOLUME 1094 GAL (4141 L) MPARTMENT A VOL I 733 GAL 12775 LI MPARTMENT B VOL. 361 GAL (1366 LI 6.0 BAFFLE I7 BAFFLE SLOT_LII TOP 1 = tJF 16.0 49.4 14D�^[1255) 3] 'mil BAFFLE IOR HEIGHT 4T SUPPORT BEHIND BAFFLE SECTION B - B' BAFFLE DETAIL INFILTRATOR WATER TECHNOLOGIES o QUICK4 PLUS STANDARD CHAMBER N N PRODUCT SPECIFICATIONS p a (NOT TO SCALE) C TOP VIEW SIDE VIEW sU : 1•1:�PF,li 11 i;:nCJ1•J PJ':�il� INSPECTION PORT 2" diam. QUICK4 PLUS ALL -IN -ONE 12 END CAP O® INSPECTION PORT 4" diam. r- PRESSURIZED PIPE DRILL END VIEW 12" 34" POINTS LOCATIONS (2 PLACES) 33" 8" INVERT r INFILTRATOR' INFILTRATOR WATER TECHNOLOGIES 4 BusInev Pert R. ON Saydaok CT 051]5 (800)2214435 QUICK4 PLUS STANDARD CHAMBER PRODUCT SPECIFICATIONS DFH Ir 1of1 rvpv„r rc �a xru::ar 1. t' i 1i Industry Services Division 13 IS I U l5 4822 Madison Yards Way County /3-C Sanitary Permit Nu�i rftb be filled m by Co.) -;.. Madison, WI 53705c A liiiP.O.Box 7162 MAY 022024 r, gC,r)�-t![�adison, WI 53707-7162 a\/tl 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 Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. the Department of Safety and Professional Services. Personal information you provide may be used for secondary / p purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. / 98 L Application Information —Please Print All Information '- Property Owner's Name ,/ Parcel # 57 /� /2 /8 Property Location Property Owner's Address i% /6 �a ,Z 3 Govt Lot City, state Zip Code Phone Number N '/.. Sect on ___ —6z5-5723 Type (check all, that apply) Lot# T 6 N R Eo II;TYR BuildingSubdivision Name 1 or 2 Family Dwelling — Number ofBedrooms Block # ablic/Commercial — Describe Use ❑City of ❑State Owned — Describe Use CSM Number 1Village of ®Town of IILType of POWTS Permttr(Check either "New" or "Replacement" and other applicable on line A{Check one box online B. Complete line C i A. ew System []Replacement System ❑Other Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain) II B. ❑Holding Tank �I1n-Ground EM -Grade ❑Mound Individual Site Design lijOther Type (explain) (conventional) ❑Transfer to New Owner ist Previous Permit Number and Date Issued C. ❑ Renewal Before ❑Revision hange of Plumber Expiration IV Dis ersal/Treatmeat-Area Design Flow (gpd) and Tank Information: Dispersal Area Proposed s S stem Elevation Design Soil Application Rate(gpolst) Dispersal Area Required (st) pe a(t) System /T) 946.61 So S Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units E �ee c g New Tanks Existing Tanks iL V P. U S rn rn Septic or Holding Tank /O66 /a b D ! a'v- [TIED Dosing Chamber V_ Responsibility Statement -:I, the undersigned, assume responsibility forinstafation of the POWTS shown oa the atracned plena, Number Business Phone Number Plumber's Name (Prin Plumber's Signature 7 f vX ,gt/n7er +.4P/MPRS 22Y736 6o8-8S2-7oY7 Plumber's Address (Street, City, State, Zip Code) I /✓l / ��6 /6 � v� It)/6623 a o7` ` :VL County/Department Use Only Permit Fee Date Issued suing at Si ure Approved ❑ Disapproved S 1D I l I ❑ Owner Given Reason for Denial onditions Approval/Reasons for Disapproval o �C' to the County only on paper not less than a lit x SBD-6398 (R. 03/21) In -ground Gravity Management pi4ii l C li d IMPORTANT: killMAY 02 '[024 The owner of this in -ground gravity system shall be responsible for its perpetual operation and 1 ihti iaho p(lI% Q 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 = S/SO gpd; BOD5 5 220 mgL''; TSS 5150 mgL''; FOG ≤ 30 mgL_1 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 (he., 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. Scats, 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 SPS 383.55 Wisc. Admin. Code. Report any componer Name of individual or company: Local government unit: local government unit in accordance with s or malfunction to: Phone: 10O $Z$ -37z 3 Phone: 7/5-373- 6135/ 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. Private Sewage System Maintenance Agreement Owner(s) Name ..0 Owner(s) Mailing Address Wi6623 tt.>..af ot—tr. Ia ,4&, S9 I6 Site Address /3 98S t r.y�` .Q As owner, I (we) do nereby certify 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) rtW 1/4 of SE 1/4 Section ______Township 96 N. Range 7 W Additional Legal Description: —4tL'_ Town of Cit.) (Acreage) 3o Gov't Lot Lot Block Subdivision Lot_CSM#____ Vol. _Page _ CSMDoc# DOCUMENT NUMBER 2024R-603693 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 06/20/2024 AT 1 1 :00 AM RECORDING FEE: $30.00 PAGES: 2 Return To: Planning and Zoning Department Area Ain -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 Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds, At -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 nobly 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 prrqjp1t E 1 ms.', \P1 I Owner(s) Name(s) — Please Print Subscribed and sworn to before me on this date: `\ .. L0 A.2024 Denise- AL/mar . Notarized Owner(s) — Signature(s) Notary Public � 'ti.J �I"7'�'•........ \ M h ' r. My Comm on Expires: 1111111 1 �� 0 m`,�T \b.\\, J25. Drafted by: I'1Q.C K Palmer Date: 6-8-zo _ Proofed by: u/fortis/sanitary/septicmaintenceagreement Revised July 2020 p Property Description: The Southwest Quarter of the Southeast Quarter (SW+ SE' ), LESS the South 860feet thereof; AND the South Half of the Northwest Quarter of the Southeast Quarter (S+/aNWiSE¼), LESS the West 150 feet thereof; all located in Section Six (6), Township Forty-six (46) North, Range Seven (7) West, Town of Delta, Bayfield County, Wisconsin. BAYFIELD COUNTY SANITARY PERMIT (#04)-24-87S STATE SANITARY PERMIT OWNER: MARK H & DENISE A PALMER G OV'T LOT: LOT: B LK: NW 1/4 SE 1/4 SEC: 6, T 46 N, R 7 W TOWNSHIP: Delta SOIL TEST: 43-22 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: Palmer, Mark TRACY POOLER DATE: 7/15/2024 Authorized Issuing Officer CHAPTER 145.135(2) WISCONSIN STATUTES a. The purpose of the sanitary permit Is to allow Installation of the private sewage system described in the permit b. The approval of the sanitary permit Is based on regulations In force on the date of approval. c. The sanitary permit is valid and may be renewed for specified period. d. Changed regulations will not impair the validity of a sanitary permit. e. Renewal of the sanitary permit will be based on regulations In force at the time renewal Is sought, and that changed regulations may impede renewal. f. The sanitary permit Is transferable. History 1977 c.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. PREVIOUS PERMIT #: LICENSE: # 224736 Condition: System to meet all setbacks requirements. Management plan to owner. Properly maintain system per recorded agreement THIS PERMIT EXPIRES 7/15/2026 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION