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HomeMy WebLinkAbout24-125Sxx INBOUND NOTIFICATION ; FAX RECEIVED SUCCESSFULLY xx TIME RECEIVED REMOTE CSID DURATION PAGES STATUS September 23, 2024 at 8;07;52 AM CDT 7157983470 36 1 Received SEP/23/2024/M0N 06:50 AM Andry Rasmussen & So FAX No, 7157983470 P. 001/001 V Request for Sanitary Inspection (24 "Firs. 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 r Discrepancy fl Other Phone Number Plumber: 1 00 41v *y i m--$Pn a Sans S 7QPr3355' Fax Number 7/3- 7gJ2 - Homeowner: (� Kiwi /3110n tuiseo Email Address ln(�Rnolr'yrgsdcnt MflhiSSj�rthyrpseo17 Immediate Phone Number So Zoning Sanitary Permit #; -I6 Dept can call you right back (if needed) Plumber's Choice Zoning Dept No Inspection(s) during this time Date: q 1 `ti/ OK Tuesday (9:30 am - 12:15 pm) (Tracy) Time: Plumber's Choice Zoning Dept OK Township: vt(- Address # & Road Name: or / ++•• A Ub516 Spf lab / r ?1 Directions To Site: Comments: ** Plumbers you must verify any change(s) by fax or email ** Notes from ulforms/sanitary/req uesforinspection Zoning Dept (©4/12104); ® June 2023 �nnrerp,7 s '= Industry Services Division General Information Permit Holder's Name: Tank Information TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road Septic $' (, o frcifr1 1g-tjiS5D ZC j3 N/A Dosing N/A Aeration N/A Holding Private Onsite Wastewater Treatment Systems (POWTS) Inspection Report (Attar.h to Pprmitl JUDITH M KINN 1641 S MAPLE ST OTTAWA KS 66068 Elev: I BM Description: setback to: Town of: County DD Sanitary ermltNo: 34- I2�9 State Plan Transaction ID#: Parcel Tax No: Pump I Siphon Information Pump Manufacturer ump Model Demand GPM Filter Manufacturer E NtO Filter Model O 22 TDH Lift Friction Loss Head Total Forcemain Length Dia Dist To Well Dispersal Cell Information DIMENSIONS I Width Lepglh # of Cells Z_ SETBACK FROM Prop. LJ�ne Building WeII OHWMM + Type of Cell n - (Troy-nd Manufacturer: Znti l+rcl-� Model Number. cp.,c w rovr-')' Pretreatment Unit Manufacturer: Model Number: )istribution System Header / Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length _ Dia Length Dia Spac Spacing ❑ Yes ❑ No Elevation Data STATION BS HI FS ELEV Benchmark '_ 16G ./2 Bldg. Sewer S. oo .3Z. Tank Inlet Tank Outlet O B 9 evy Dose Tank Inlet Dose Tank Bottom Inst. Contour Header I Manifold s' qg Distribution Pipe Infiltrative Surface O . Final Grade cc 6 I eG X Pressure Systems Only Soil Cover Depth Over Depth Over Depth of Seeded / Sodded Mulched Cell Center Cell Edges Topsoil 0 Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etp4 fn ®cc. Pecld aPj''cJa'.rn c/A Zc'-(��✓�/1 e�wk3c,,ItlP('. L4f4 H Sc1 ) Jny no+ obUs4�rd a/' 4)1Q rnspecO), (ft -'i5' L'nC G S f�PfP5�n j�� Ulan revisionede required? 0 YirM No / �t$ 15 a 23 I S Use other side for additional infer tot ��V O Date POWTS Inspectors Signature License Number SRn.71 n ra na/21 AS BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zonino(a�bayfieldcountv.wi.00v Web Site: www.bayfieldcountV.wi.gov/147 Property Owner _ JUDITH M KINN Information 1641 S MAPLE ST OTTAWA KS 66068 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know AnJ £CAS5;n %(SSC/) a was contracted by you to install a private onsite wastewater treatment system on your property described as: to Govt Z Abandonment of Old System to meet all applicable code requirements: Tank was pumped by: on „„ at AM / PM C. Tank was crushed! removed and pipes disconnected by: A Adr/ QGSSp I.SSc,y- On at (AM I PM) the above -mentioned plumber contacted our office to conduct a pre -cover inspection as required under DSPS 383. One of the following applies: System was inspected and appears to meet all applicable code requirements. System was inspected and appears to meet all applicable code requirements; however, a plan revision is necessary because the installation was substantially different than the original approval. System could not be inspected because plumber covered prior to scheduled time of inspection. ❑ System could not be inspected because plumber was not ready at scheduled time of inspection. County was unable to return to complete inspection. System could not be inspected because plumber was not ready at scheduled time of inspection. A re -inspection and $50 fee are required. System could not be inspected because County could not respond to plumber's time constraints. Comments: Ullotms/sanitarypropetlyowner-input April2019 FPR f2 n <S-0nul/ /xrucve V Industry Services Division County J - r AUG I 2 1014 4822 Madison Yards Way Madison, WI 53705 Barfield Sanitary Permit Number (to be filled in by Co.) rro h P.O. Box 7302 9Fcj A"'rsa,sw l ayfield Co. 7onino IF,- v Madison, WI 53707 L1 I +�� 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 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)(in), Stats. 66565 S Spider Lake Rd. Iron River, WI P I. Application Information — Please Print All Information Property Owner's Name ' I Judith M Kinn G r,"a/1 W GS(o S-1-cvc-n l.-1 SLo Parcel # 19572 . Property Owner's Mailing Address - Property Location •B 1641 S Maple St. Govt. Lot 2 City, State Zip Code Phone Number Ottawa, KS 66067 785-229-9165 A. V.. Section 20 T47 N R08 Eor Q� II. Type of Building(check all that apply) Lot [t or 2 Family Dwelling— Number of Bedrooms 2 Subdivision Name ❑PublidCommercial — Describe Use Block # City of ❑State Owned— Describe Use CSM Number Village of QTowo of Iron River III. Type of POWTS Permit: (Check either "New" or ep jiuent er applicable on line A. Check one box on line B. Complete line C i a licable. `` ❑New System L/ µreplacement System ❑Other Modificatio o Existing System (explain) ❑Additional Pretreatment Unit (explain) B. Holdin Tank g In -Ground 1%tZ ❑At -Grade ElMound Individual Site Design Other Type (explain) (conventional) C. ❑ Renewal Before _14 ❑Revision Change of Plumber Orransfer to New Owner List Previous Permit Number and Date Issued Expiration NA iV. DispersaVTreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpdist) Dispersal Area Required (sf) I Dispersal Area Proposed (st) I System Elevation 300 0.7 429 452 95.5 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units , °2' •+ u a r New Tanks Existing Tanks a,O rn rn iO a Septic or Holding Tank 760 760 1 Superior Precast ✓ Dosing Chamber O V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's SignatureI MP/MPRS Number I Business Phone Number Jason Kuettel I— 675751 715-798-3355 Plumber's Address (Street, City, State, Zip Code) PO Box 66 Cable, WI 54821 CountyiDepartment Use Only �VI. "Approved O Disapproved Permit Fee $ rm iit Fee uI[ Issu d Issuing Agent Signature Q1 1S.gZ3f5- ❑ Owner Given Reason for Denial O / r Conditions of Approval/Reasons for Disapproval • !Y)a»hdC�nw,k Plan to ounc/;. /1'YA+1&;l S7S Per m -O -ac() 40co(c - • Srsk.� , ki reef of D •Ab4akn exjs+,r SYSI-c,m per SPS 33 r• •• r•^ •+••• •••=aya•eur a••" suomrs tome county only on paper not less than a Viz II inches in size SBD-6398 (R. 02/22) Attach Soil Evaluation Report in accvdance with SPS 385, Wi8Adm Code site plan on paper not less than 8'%X 11 inches in size. Page: 1 of 6 Plan must include;but not, limitedt)biiV rtibel"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)). County: Bavfield Parcel I.D. 19572 Reviewed f6 Hal I Date: ' 3/ '2. L1 Property Owner: f6n ASCd Judith M Kinn e.Rn I.JQ5C C) Props L�oc�tion L AK LN i/oVrZ S20,T47N,R08W Property Owners Mailing Address: 12300 E 59th Terrace Lot: Block: 0 Isubdivision Name or CSM # City Kansas City State MO Zip Code 64133 Phone Number. 0 Town Iron River INearest Road: Spider Lake Road Code derived design flow rate: Number of Bedrooms: 2 r New r Residential 300 J'. Replacement r Public or Commercial - Describe: Parent Material: Flood Plain if Applicable: 85.31 General Comments & Recommendations: System Elevation: 95.5 Load Rate: 0_7 Elevation Range. 53 29 To 95_49 Borin #1 l- Bor y, Rt Ground surface Elev: Depth to Limiting Factor: g r 100.29 Ft./ 120 In. Soil Application Rate: Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/fta 'Eff#1 EfIW2 1 0-4 7.5YR2.5/3 N/A SL 2MSBK MFR CS 3F 0.6 1.0 2 4-12 7.5YR4/3 N/A LS 0SG ML CS 3F 0.7 1.6 3 12-14 7.5YR2.5/1 N/A SL 2MSBK MFR CS 3F 0.6 1.0 4 14-20 7.5YR4/6 N/A LS 0SG ML CS 2M 0.7 1.6 5 20-120 7.5YR4/4 N/A MS 0SG ML N/A N/A 0.7 1.6 6 7 Boring # 2 r, Bores Pit Ground surface Elev: / Depth to Limiting Factor: 99.24 Ft. v 120 In. Soil Application Rate: Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPDttt' *Eff#1 Eff#2 1 0-4 7.5YR4/6 N/A LS 0SG ML CS 2M 0.7 1.6 2 4-24 7.5YR4/4 N/A MS 0SG ML N/A N/A 0.7 1.6 3 24-120 7.5YR4/4 N/A MS 0SG ML N/A N/A 0.7 1.6 4 5 6 7 'Effluent #1 = BOD 5>30< 220 mg//and TS 0"< 150mg/! uent #2 = SOD 5< 30 mg// and TSS < 30 mg/I CST Name (Please Print) Mark S. Thompson Si CST Number: 877598 Address: 12006 N US Hwy 63 Hayward, WI 54843 d: Tuesday, August 6, 2024 Telephone Number 715/699-4081 SBD-8330 (R04115) i1 t J dith M Kinn AUG 12 2024 L) Parcel I.D. 19572 Page: 2 of 6 gR9ftj t C#.3'J Ground surface Elev: Depth to Limiting Factor: 97.19 Ft. 120 In. Soil App. Rate Horizon Depth in. p Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 0-4 7.5YR2.5/3 N/A SL 2MSBK MFR CS 3F 0.6 1.0 2 4-10 7.5YR4/3 N/A LS OSG ML CS 3F 0.7 .6 1• 3 10-13 7.5YR2.5/1 N/A SL 2MSBK MFR CS 3F 4 13-24 7.5YR4/6 N/A LS OSG ML CS 2M 0.7 1.6 5 24-120 7.5YR4/4 N/A MS OSG ML N/A N/A 0.7 1.6 6 7 Boring # 4 r Borr Pitt Ground surface Eiev: Depth to Limiting Factor: 0 Ft. 0 In. Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 2 3 4 5 6 7 Borin # 5 g r`" Borne Pit Ground surface Elev: Depth to Limiting Factor: 0 Ft. 0 In. Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 2 3 4 5 6 7 Borin ## 6 g r Bor v, Pit Ground surface Elev: Depth to Limiting Factor: 0 Ft. 0 In. Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 Eff#2 1 2 3 4 5 6 7 *Effluent #1= BOD 5>30 < 2 20 mg/l and TSS>30 < 150mg/I *Effluent #2= BOD 5< 30 mg/I and TSS < 30 mg/I The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777 SBD-8330(R.07100) AUG 12 [024 r 7 -inn P t Soil Profile Sheet Page: 3 of 6 Owner: Judith M Kinn Soil Tester: Mark S. Thompson System Elevation: 95.5 Load Rate: 07 System Elevation: 93.29 To 95.49 101 B1 101 B2 101 B3 100 100.29 100 100 _ - System 99 ----------• 0.7 99 ----------• 99.24 99 ----------• Elevation --------- 98.62 98 ---------• 0.7 98 98 96 96 96 0.7 95 --------------- 95 ----------- 95 ---------- 95.49 $ 94 94 94 93 ---------- 93.29 93 ---- -- 93 _ 92 92 92.24 92 Z 91 91 ------------- 91 ---- 90 - -----. 90.29 90 ---- 90 90.19 L.F. 89 89 _ 89.24 89 - _ --- 88 ----- 88 --------------- 88 ------ - 87 87 87 87.19 --------------- ------------ L.F. 86 ------------- 86 --------- 86 • 85 85 85 84 --------------- 84 --_---__ .-.__ 84 83 83 83 82 --------------- 82 -------------- 82 --------------- 81 81 81 80 - --------- 80 --------------- 80 79 79 --- 79 - Owner Information: BM=100: Nail with ribbon on the base of Power Dole near B1 Name: Judith M Kinn Location: S20.T47N.R08W B1 = Township: Iron River B2 = County: Bavfield B3 = Lot #: 0 Lake= a 1"=40Only in Tested Area 20 40 •Jj 100.29 99.24 97.19 85.31 AUG 1 2 2024 PAGE 1 OF 4 BayfieldCo. Zoning Dept. 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 Pg 2 of 4 Pg 3 of 4 Pg 4014 Attachments: Index & Cover Sheet Plot Plan Dispersal Area Cross -Section & Plan View Management Plan POWTS Application for Review Soil Evaluation Report & Site Mao Project Name / Description Kinn 2 Bed Owner Name(s): Judith Kinn Owner Address: 1641 S Maple St. Ottawa, KS Phone:785 -229 Zip: 66067 Project Address: 66565 S Spider Lake Rd. Iron River, WI Govt. Lot: 2 1/4 of 1/4, Section 20 , T47 N -R 08 E ❑ or W ❑✓ Township: Iron River County: Bayfield Project Parcel ID #: 19572 Designer Information Designer Name: Jason Kuettel Designer Address: PO Box 66 Cable, WI E-mail: tim@andryras.com License Number: 675751 Remarks: Phone: 715 -798 -3355 Zip: 54821 Signature: a — Date: &/, /z Original si a re required on each submitted copy. Owner Information: Name: Judith M Kinn Location: 820.T47N.R0SW Township: Iron River County: Bayfield Lot #: 0 flfl U AUG 122024 Bayfield Co. Zoning Dept. 161' 's" BM=100: Nail with ribbon on the base of Power Pole near B1 61 = 100.29 B2 = 9999=24 B3 = 97.19 Lake= 85.31 97 99 00 // owl N � — CZ)Ci 4L a 2 W Q�tuc 4 cL<..LvJ r s m r/lcNY 4SCMNJ 7J ?O/ pc t:ir_LD ewer a. Well wuf N W E $—J 1"=40Only in Tested Area 20 40 Mr (, 7J7S1 IN -GROUND GRAVITY DISPERSAL AREA 5)Uligl WIt vQ ion Trenches with Quick4 Standard -W Chambers u AUG 122024 Li 3 -ft Trench (down -sizing credit) Bayfield Co. Zoning Dept. SOIL COVER 12" min. Wench depth (typical) min. 12" (typical) LI 34' ; .. . (typical) System Elevation = 95.5 (typical) Septic Tank(s) Manufacturer. Superior Precast Septic Tank(s) Volume(s): 760 gal gal gal gal Effluent Filter Manufacturer: Orenco Effluent Filter Model #: FT -0822 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) ft Quick4 Standard -W w/ End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) r — ----------77--------7/-------- A114 I L-----------7�-------��--APS B= 46 ft (typical) 11 Quick4 Std -W @ 20 ff EISA/chamber = 220 ft2 + 1 Pairs of end caps @6 ft2 EISA/pair = 6 ft2 = Proposed EISA per trench = 226 ft' Provide minimum 3 ft separation between trenches. Observation Pipe (typical) TYPICAL TRENCH Install per manufacturers PLAN VIEW Instructions. (No Scale) TA=3.0ft (typical) `Quick4 Standard -W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers insimctions. Required Infiltration Area = 429 ft2 Distribution Method: x 2 trenches = Proposed Total EISA = 452 ft2 branched manifold GD m W O m a Muffin Hi uu nu) • co S=c on A �U S. Ic..rICNS Bayfield Co. Zoning Dept. 4" SCd•40PVC INSP. OTPE 6 " Kin. ABOVE GR=.DE.(cPT.) (wher, %kle+ rnc..�,,�ioke Ps buriL(I j F TNISHED GRADE 18" �1N. I NILET APPROVED PIPE 3' ONTO SOLID SD IL •APPRD &A-F•Fy-E— O FILTER MFG. O--eancn modal R FTo92z 3" APPROVED BEDDING UNDE,P, TANK SPECIFICATIOFIS SEPTIC TANK MANUFACTURER: SvP&wt Th2CCAJ7- TANK SIZES: S='TIC 7t6c GAL. NOTES: APPROVED MANHOLE WI Lccg 4 bV�fR�livc Lft8& '4" KIN. OUTLET r,IFro2nu9ncS-OOY17 Industry Services Division 4822 Madison Yards Way County Baeld AU(, 1Z 1014 Uayfield Madison, WI 53705 � Sanitary PermitNumber(to be filled inbyCo.) Co. Zoning Dept. P.O. Box 7302 Madison, WI 53707 �' ,O — 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 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(I)(m), Stats. 66565 S Spider Lake Rd. Iron River, WI p 1. Application Information -'Please Print All Information Property Owner's Name Judith M Kinn g Co-CAr1 tJcS(Q S-jcvcl Iti' SCO Parcel # 19572 l, Property Owner's Mailing Address Property Location 1641 S Maple St. Govt. Lot 2 City, State I Zip Code Phone Number Ottawa, KS 66067 785-229-9165 v., Section 20 T47 N ROB E or G) II. Type of Building (check all that apply) Lot # Subdivision Name ❑� I or 2 Family Dwelling — Number of Bedrooms 2 IIlPublic/Commercial — Describe Use Block # ❑City of ❑State Owned— Describe Use Village of CSM Number QTown of Iron River I11. Type of PO VTS Permit: (Check either "New" or"Replacement" and other applicable on line A. Check one box on line B. Complete line C i a licable.) A. New System L/ I—_IReplacement System LJJIn-Ground �ther Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain) B. Holding Tank tC IIAt-Grade Mound J Individual Site Design Other Type (explain) (conventional) C. []Renewal Before ❑Revision Change of Plumber ❑transfer to New Owner List Previous Permit Number and Date Issued Expiration NA IV. DispersaVfreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (sf) I Dispersal Area Proposed (sf) I System Elevation 300 0.7 1429 452 95.5 Tank Information Capacity in Gallons Total Gallons # of Units Manufacturer .0 v ro v y u _ New Tanks Existing Tanks 4 U in y y i+. 5 a Septic or Holding Tank 760 I 760 1 Superior Precast ✓ Dosing Chamber O V. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Jason Kuettel 675751 715-798-3355 Plumber's Address (Street, City, Stare, Zip Code) PO Box 66 Cable, WI 54821 County/Department Use Only CAD .VI. yY Approve ❑ Disapproved PPe t Fee Dat Issue Issuing Agent Signature /�� I Sg Z315"- r $ f) 5(z ❑ Owner Given Reason for Denial ° 6 o suf Conditions of Approval/Reasons for Disapproval • mnnf,per,vm Phan Fo o.-'ne_/;./no+*xn S'7S.- ^, Pec (ts`_OMC A@(r 1tn4- • Ste- )t? ref an sctbal 4: • Ab4Nlon exs+,r5 SY SI-cfn pee- SPS 33 3 Attach to complete plans for the system and submit to the County only on paper not less than S la x It inches in size SBD-6398 (R. 02/22) I�p ESE0�� Ilil PAGE4OF4 AUG 122024 In -ground Gravity Management Plan IMPORTANT• t3ayllelo uo. Zoning Dept. 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 = 300 gpd; BOD5 5 220 mgL"'; TSS S 150 mgL"'; FOG 5 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 anaerobi^ froatmnnt tanks) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (, :s, etc.) o extent of ponding in distil o o dosing irregularities - if a electrical components - if P DI / -.r CJ /G O // `. 1 �� ;, etc.) trols, timers, alarms, etc.) o o distribution lateral or latei surface discharge of efflu I V C� I,/}��J ( %o' c%cG\ •— compare to design specification) Maintenance Checklist 77 �I �� -c, ) � �� m r i necessary) o Septic and dose tank(s )perator licensed under s. 281.48 Wis. Stats. when the volume 1'G the liquid volume of the tank(s) or as required by local ordii 1 � S 113, Wisc. Admin. Code. o Effluent filter(s) shall bi ien necessary to remove any accumulated solids accc period will always be greater than 12 months. System maintenance reports ant unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component tanure ormmranmwn to: Name of individual or company: Andry Rasmussen & Sons Phone: 715-798-3355 Local government unit: Bayfield Co. Zoning Phone: 715-373-6138 Local government unit address: 117 E 5th St. Washburn, WI ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. efy SS��0417 �� Private Sewage System Maintenance Agreement \:t sin t-. INhi)PlR•r lay /bhk/ .,.narisi k,I aJ ng Address 6G'5'5 Sr bE,s'ZLAILE R'. I tze'- (2wat tai /9S7Z As owner, I (we) do hereby certury the private sewage system will be installed in accordance with the certified soil testar's report and approved plans and specifications on file wrth Bayfield County Planning and Zoning Depacment, 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 114 Section Z_ Township '17 N. Range oS 4y. Additional Legal Description: cee Town of I RON 1Z1y to - (Acreage) Govt Lot a Lot _ Block Subdivision CSM Vol._ Page CSM Doc= DOCUMENT NUMBER 2024R-604334 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED 08/12/2024 AT 2:20 PM RECORDING FEE: $30.00 PAGES: 2 Return To: II�("" pp��yy��rr (ryj Planni Q nLr5JD�pA•kr>nt I I 110 AUG 1I 3 2024 IUI Area I] In -ground gravity O In -ground dosed ❑ lo -ground pressure distribution Sewage System. ❑ Mound ❑ At -grade Sewage System ❑ Oher _ Sects Tani, (system types A through E): The septic lark shall oe pum,ped by a certif -1 s, uin3 operator it s. ins'.aila:ion and a: less: once _cry three (3) years lherea`.ar unless, uocn , specticn o a u•_: J r n,t-r plumber cr o.. e �ers .,. such inspector. the tank is found to have less than one-third (1'3) of the volume occupied by studyc and scum. Puno 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 s,wtithes 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. Fitter maintenance reports shall be submitted to the County as required by SPS 3B3.55, 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-orade 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 distnbudon 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 tar roll as a special assessment for the abatement of a human health hazard, and the tat shall be collected as provided by law. The teems and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such property. O:vnrs) Name(s) —Please Print t G�l-f21'Ur ft Kp • pr !1[? - or R'brfo n ki4ca Drf4rdh), iy,t., LLii RIt and s�,;ri to befare me on this date- 'T— . 4 •— 1- Z(P OTARY PUBLIC • State of Kansas MADELINE JEAN WOODS My Appt. ExpAppt. Exp. i 1111 AUG 1 3 2024 EXHIBIT A Bayfleld Co. Zoning Dept. Commencing at the One Quarter (1/4) corner between sections Nineteen (19) and Twenty (20), Township Forty -Seven (47) North, of Range Eight (8) West, on a bearing of N43 -00E a distance of Three Hundred (300) feet to the point of beginning; thence on a bearing of N12-28-30 W a distance of Three Hundred Thirty -Two and Eight -Tenths (332.8) feet, more or less, to the shore of Mollenhoff Lake; thence Northeasterly along the shore of Mollenhoff Lake a distance of One Hundred Seventy - Five (175) feet; thence on a beating of S39-40-30 E a distance of Two Hundred Eighty -Two and Thirty One Hundredths (282.31) feet more or less; thence on a bearing of S43-00 W a distance of Three Hundred Twenty -Five (325) feet to the point of beginning. The above described parcel of land being a part of Government Lot Two (2), Section Twenty (20), Township Forty -Seven (47) North of Range Eight (8) West. All bearings are magnetic using a declination of Four (4) degrees East. Parcel ID #:04-024-2-47-08-20-2 05-002-06000 Bayfield County Register of Deeds Document #2024R-604130 Page 2 of 2 8/27/24, 1:a3 PM , CarmodyTm BAYFIELD COUNTY SANITARY PERMIT (#04)-24r125S STATE SANITARY PERMIT OWNER: JUDITH M KINN, BRIAN & STEVEN WASCO G OV'T LOT: 2 LOT: B LK: 1/4 1/4 SEC: 20, T 47 N, R 8 W TOWNSHIP: Iron River SOIL TEST: 120-24 REPLACEMENT SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: Jason Kuettel ALESSANDRO RO HALL DATE: 8/27/2024 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: # MP 675751 Condition: System to meet all setbacks. Management plan to owner. Maintain system per recorded agreement. Properly abandon existing system per SPS 383. THIS PERMIT EXPIRES 8/27/2026 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION https://www.carmodyinc.com/PermitApp/Permit_Sign.aspx?Print=l &permitappid=7349 1/2