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HomeMy WebLinkAbout24-149SRequest for Sanitary Inspection (24 Hrs. in Advance) Fax this form to Zoning Dept (24 Hrs.) prior to when you want an inspection — (715) 373-0114 If you do not have a fax and must email the inspection; you must email all staff members. Note fl Time Change fl Discrepancy fl Other Phone Number 715-739-6868 Plumber: Nor Pines Plumbing Fax Number Email Address Homeowner: Doreen Davis norpines@chegnet.net Immediate Phone Number So Zoning Sanitary 24-149S Dept can call you right back (if needed) Permit #: Plumber's Choice Zoning Dept No Inspection(s) during this time Date: 05/22/25 Tuesday (9:30 am - 12:15 pm) (Tracy) Time: Plumber's Choice Zo g Dept Township: Cable Address # & Road Name: or 15140 County Hwy M ,3q33 Directions To Site: Comments: ** Plumbers you must verify any change(s) by fax or email ** Notes from u/forms/sanitary/requestforinspection Zoning Dept (©4112/04); n June 2023 oee�inrtyr j3 A Industry Services Division General Information Permit Holder's Name: Tank TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road Septic O G o N/A Dosing s 3 N/A Aeration N/A Holding Private Onsite Wastewater Treatment Systems ( POWTS) Inspection Report IA++nr.k In Dnr..tit) DOREEN DAVIS 1114 MOHICAN PASS MADISON WI 53711 to: County p �e4L Sanitary ermit No: aq- Igas State Plan Transaction ID#: Parcel Tax No: 3 63 Pump! Siphon Information Pump Manufacturer Pump Model Demand GPM Filter Manufacturer liter Model TDH Lift Friction Loss Head Total Forcemain Length Dia Dist. To Well Dispersal Cell Information DIMENSIONS Widt L7tly # of Cells SETBACK FROM Prop. Line Building Well OHWM Type of Cell /t/ Manufacturer: Model Number. Pretreatment Unit Manufacturer: Model Number: )istribution System Header I Manifold Dia I Distribution Length Dia 23., X Hole Size I X Hole I I Observation Pipes Length Spac Spacing 0 Yes ❑ No Elevation Data STATION BS HI FS ELEV Benchmark D, I UD Bldg. Sewer e9Z Tanklnlet R�35 Tank Outlet R Dose Tank Inlet g, 176 Vp Dose Tank Bottom t3&e 1 �$ 3 Inst. Contour Header/Manifold y2 v Distribution Pipe Infiltrative Surface g 2- 2' y� Final Grade q Y5 X Pressure Systems Only Soil Cover Depth Over Depth Over Depth of Seeded / Sodded Mulched Cell Center Cell Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 7'a,1143 /ycveJ becaas«, l�el/ te e�p ot/cp4i�d Plan revision required?Yes 0 No �� �y Use other side for additon information. Date POWTS Inspector's Signature RRn.J1n rR ngr911 License Number Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoning(abavfieldcountv.wi.nov Web Site: www.bayfieldcounty.wi.gov/147 DOREEN DAVIS 1114 MOHICAN PASS MADISON WI 53711 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know V62> l ? ",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: :• Tank was pumped by: C. Tank was crushed / removed and pipes disconnected by: on at AM/PM On at / (AM / e above -mentioned plumber contacted our office to condu t 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: U/formslsanitarypropertyawner-input April 2019 ....... I Department of Safety c° (a �a jjj & Professional Services, Industry Services Division—Saniitary Bayfield Permiit Nuumbber (to be filled in by Co.)Sanitary Permit Application State TransactionNumber 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)(m), Stats, 15140 County Hwy M Cable Application Information — Please Print All Information Property Owner's Name parcel # Doreen Davis 39363 Property Owner's Mailing Address Property Location 1114 Mohican Pass GovL Lot City, State I Zip Code Phone Number Madison, WI 53711 608-417-0640 y1 '4, Section 16 T 43 N R E or W U. Type of Building (check all that apply) Lot # 01 or 2 Family Dwelling — Number ofBedrooms 3 2 Subdivision Nam: 1 Block # ❑Public/Commercial— Describe Use \, 1 ❑ Cityo£ O State Owned— Describe Use ❑ Village of �. CSM Number 2346 OTownof Cable III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line if applicable.) A. New System O Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. O Holding Tank ® In -Ground ❑ At -Grade I O Mound ❑ Individual Site Design O Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner ist Previous Permit Number and Date Issued Expiration IV. Dispersavrreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (sf) I Dispersal Area Proposed (sf) Elevation 450 0.7 642.9 Jtem 650 91.9 Capacityin Total #f Manufacturer Tank Information Gallons Gallons Units a m o 'g �p NewTanks I Existing Tanks W Y u Y ".0 rn ti wU Septic or Holding Tank 1000 1000 1 Wieser Concrete X Dosing Chamber V. Responsibility Statement— I, the undersigned, ass respo 'biility for installation of the POWrS shown on the attached plans. _e Plumber's Name (Print) Plu Si er' gn MP/MPRSNumber I Business Phone Number Douglas Manthey MP 230722 715-739-6868 Plumber's Address (Street, City, State, Zip Code) PO Box 196 Drummond, W 54832 VI. County/Department Use Only pproved O Disapproved Permit Fee Date Issued (0 l I� Issuin Agent r~/ ❑OwnerGivenReasonforDenial `rt 37 onditions opproval/Reasons for Disapproval ca Attach to complete plans for the system and submit to the County only an paper not less than 8 12 ill inches in size SBD-6398 (R. 03/22) $(IIL i t5 i s Wisconsin Department of Safety ar&Pr tonal Services_ '� Division of industryServices SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code ®® i� C Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, Parcel I D but not limited to: vertical and horizontal reference point (BM), direction and percent slope, r4 k scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Personal information you provide may be used for secondary purposes (Privacy Law, S. 15.04(1)(m)). Page/of 3 2 L Date Property Owner Property Location U 99 ? Govt. Lot '/. h S /6 T 'VI N R© E (or) W Property Owner's Mailing Address Site Address or CSM and Lot#: �Slea Gaaa *�11(4.7' fl S/ao co 1L� w Par '.� W +'5 w w Iv PsA J2' City State I Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road (� New Construction Use: ® Residential/ Numberof bedrooms Code derived designflow rate_ /cGPD O Replacement ❑ Public or commercial— Describe: Flood Plan elevation if applicable ft. Parent material e-/' 77' Z C//t 14/ a blow & • '? �x�1-'' � 9/' General comments and recommendations: ❑ Boring Boring # OPh Ground surface eiev. 1ft. Depth to limiting factor.'? in. / eiev.5 . ft. I?] I Sail Annfication 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 c/ 7• s- y,� 5 i C. mote w IcovF • - Si.. / S b Flt !v •6 v- t 5 o - s& n-, i- Y MO ,, $- 3i d— S 7 1• h" q Boring c� Boring # �prt Ground surface elev. ft. Depth to limiting factor /.?a in. ! eiev.• 9ft. Snit AnnIketion Rate I 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 p S- ST +t '1 7q S i/ s S b dSFr -S r_ 4 l �• /'# -'Y • ? e _ I,t o 1° a v. o CST Name (Please Print)(1 I Signature CST Number slo_ ply j ddG� Address // /3 Q IC' Date Evaluation Conducted 2.2f..2 Telephone Number •� �`� �� 6! W Srzt I * Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 S 150 mg/L * Effluent #2 = BOD, s 30 mg!L and TSS s 30 mg/L SBD-8330 (R04/21) In i'1 q T`JC)° c Boring [3I Boring # 1 Pit Page Z of Ground surface elev. 96' ft. Depth to limiting factor„n. I eiev!. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color g *-s 'i c Soil Application Rate Texture Structure Gr. Sz. Sh. Consistence Boundary Roots I*Eff#1 L GPDIFt2 *Eff#2 ./'f (, N' 6-41 )aov . Co f 9 $'s'L .y, sA APe lrft $� aBerth Boring # O Boring Depth to limiting factor _ in. / elev._� O pit Ground surface elev., ft.Depth Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots I GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. Tift#1 *Eff#2 ❑ Boring # o o Boring Pit Ground surface elev._ _ft. Depth to limiting factor in. I elev. ft. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. Soil Application Rate GPDIFt2 *Efi'#1 *EfF#2 * Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 s 150 mgIL * Effluent #2 = BOD, s 30 mg/L and TSS s 30 mglL e.= cTz� si'- o (1 co • .• • .eqot , 3 oJ3 S 0 �-Ownew 1 Sto0 CouMtY �#C*y I6 rY3 1 f w Pi, i 5 ww ;n d s�6 P.Is q s. R rrx row Tcwa '� $ /o�� of C.4 bl e • I S/vo G ovkfY llw/ Jln -Y2t 83- C46/e 6v. /ev M raJI iN 1.2",ha'Ie ` r&4c,Vt Je •1 9s9 2-q S. 9 p�o�bssd gr� .• El 4y/,,,��$-ttd �e'1�. . 6 wn..� .�JCi 10 /�ro,1d X • 12'? !iS Td 1ocu�r PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross -Section & Plan View Pg 4 of 4 Management Plan Attachments: Manufacturer Tank Specs I POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Davis EZ Flow Conventional Owner Name(s): Doreen Davis Owner Address: 1114 Mohican Pass Madison, WI 53711 Project Address: 15140 County Hwy M Cable, WI Govt. Lot: Township: Cable Project Parcel ID #: 39363 1/4 of Phone: 608 _417 _0640 1/4, Section 16 T 43 N -R 07 E ❑ or W ❑✓ County: Bayfield Designer Information Designer Name: Douglas Manthey Pho Designer Address: PO Box 196 Drummond, WI E-mail: norpines@chegnet.net License Number: MP230722 J Remarks: 715 _739 6868 L 1 :°'° urappruvalsla:ni. c7cp: 07% Signature: Date: 09/03/24 Original §i nature required on eac su mined copy. S L SEwle 1„-q°'_. Teyil©L soh 15'100 Gouty#Y'�WY%� Coble 142$Sy�2 I 516Ty3.uRo7w I" cU i Sc✓ ,vw .n ✓f46 fji i' pu rm rt Y?ZG TcwH o f ea60e I3tY,P:aU coon+Y .� - 61 Si+c [ floc Coua+y Heuy M CAd /e LU qq tt. ►tail to l2"m PJc 2` AGL . l9s9 6356.9' ytou�d Et fir, s- Efow+e`3b�r yrom"Aa&/'rof'o Y74 I?osc z cY `1 7(.9 q0S/ofe- • 43 1r' (� w orc�co ly 4 W'ese-. WLPl000 fa J 3 &d� bin SysseV. ekeu - ql-� • 2 cells coJC4i-j GSA o V jz Floa R<9u,revk ESSA _ L4Aq Cit Pmp•se..l ESA - ,so �f7 All coviOeyawct P•Pvc, �o be Ll"s-L,.4o o f SDQ :S Q' c zv Gro OX Soil Abco,p�io , ver$Jv 2•k CS/ate-S%1� 22- '313/;l t/ IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3 -ft Trench (down -sizing credit) Septic Tank(s) Manufacturer. Wieser Concrete Septic Tank(s) Volume(s): 1000 gal _ gal gal _ gal Effluent Filter Manufacturer Orenco Effluent Filter Model #: 14B TYPICAL TRENCH CROSS SECTION VIEW (No Scale) Provide minimum 3 ft separation between trenches. TYPICAL TRENCH (Show location of inlet/ outlet pipe connection on plan view.) PLAN VIEW 4„ o Observation pipe shall be Installed (No Scale) at junction between two units. Perforated Lateral Observation Pipe (typical) (typical) B= 6=ft (typical) INSTALL PER TRENCH: 6 10 -ft bundles @ 50 ft2 EISA/unit = 300 ft2 + 1 5 -ft bundles ( 25 ff EISA/unit = 25 ft2 OBSERVATION PIPE DETAIL (No Scale) Screw -Type or Sip Cap (loose) 40 PVC Pipe Top of pipe to terminate at or above finished grade (4)1/4'-1Q' X B' Slots apart Anchoring Device 5 ft (typical) A=3.0 ft (typical) `— EZ1203H Bundle (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturer's instructions. = Proposed EISA per trench = 325 ft2 Required Infiltration Area = 642.9 2 x 2 trenches = Proposed Total EISA = 65_ ft2 — Finished Grade (mulched & seeded) — Topsoil Cover (rain. 1 foot) Infiltration Surface Distribution Method: branched manifold D m W O m WLP1 000 TANK SPECIFICATIONS 8'-8" 4" CAST -A -SEAL TA KS 0 w QD car w INLET cV a. z d' % et 21" FILTER OR— /i' �T-rte.—.—. ►r. s It) N) 4" CAST -A -SEAL OUTLET cn 1 N K) PUMP PAD ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS DIMENSIONS: o WALL: 2 1/2" a n. BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 53 1/4" LENGTH: 8'-8" WIDTH: 7'-2" BELOW INLET: 42" LIQUID LEVEL: 36" WEIGHT: BOTTOM 6,790 LBS. � COVER 3,195 n 3 o INLET AND OUTLET: mo m o 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: vvi o o WISCONSIN SEE DETAIL #10 (OTHER STATES SEE CHART) IW to LIQUID CAPACITY: 27.83 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED '* ACTUAL CAPACITY: 1,085 GALLONS = a I uj LOADING DESIGN: 8'-0" UNSATURATED SOIL O TANK CAN BE USED AS: W o SEPTIC / HOLDING / PUMP OR SIPHON y = a0 cn COVER: MIX DESIGN #8 (NO FIBER) w TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE O O O REVIEWED BY REVIEW DATE J D z F w 17' /OF 1 • BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) l "Check List B Original Sanitary Application (Submitted in Deed Holders Name — ]ot prospective buyers) (383.21(1)1.) [}liidex Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) P t�riginal Plot Plan (383.22(2)2. 3. & 4.a) CYCross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer El Pump Tank Diagram, Alarm and Pump Curve (when applicable) 12 -Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) Owhar SeL. i2laintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) —le Pop :ding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) ❑ Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) 131e (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 2111 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all conies) C2'Soi1 and Site Evaluation Report (383.22-3(2)(b)1.e.) 0 State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) L'rf- Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) 13 -Project Address or Road Name where driveway is/will come off of) l Type of Building -!If Type of Permit jMV Type of POWTS System R l� Dispersal / Treatment Area Information l Tank Information [ VII Responsibility Statement (Plumber's Information) ❑ *Date Stamp* Plot Plan: (To Scale or To Dimension) nature and Plumber Information ❑ Surface Elevation of Body of Water fd'6rection and Percent Land Slope CR'fank and Filter Information and Location ❑ Wetlands / Navigable Bodies of Water ≥A6orption Area (Proposed and Existing) R1 nch Mark (Location, Elevation and Description) component Manual Version a(owners Phone Number) Address Number and Road O'North Arrow U -Contour Lines R'SY uctures and Driveways @'Boring Locations 21 Ioperty Lines i�Well Locations ❑'Legal Descriptions Turn Over ► • r' Cross -Section and Over -Head Profile of the System: [(Surface and System Elevation f Position of Observation and Vent Pipes i '6imensions and Depths lake, Model & Number of Chamber Units in each Cell iow many systems will there be on this parcel of land? 1_ O Has this property been split? (Property Statement shows Property History) Fees: C1"Private Sewage System (Septic Tanks) $ 400.00 ❑ Private Sewage System (Holding Tanks) $ 400.00 ❑ Mounds or Systems requiring Pre -Treatment $ 500.00 ❑ Sanitary Revisions $ 25.00 ❑ Private Sewage System Reconnection $ 50.00 and Private Interceptor ❑ Return Inspection $ 50.00 ❑ Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) u/forms/checklists/cheddistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(05/2/2012 -dc) Proofed by: CC-m4ur,> Department of Safety County o S & Professional Services, Bayfield Sani ary Permit Number (to be filled in by Co.) �$ ��fR�® Industry Services Division :) 1- lygc 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 Project Address (if different than mailing address) 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), Slats. 15140 County Hwy M Cable I. Application Information— Please Print All Information Property Owner's Name Parcel # Doreen Davis 39363 Property Owner's Mailing Address Property Location 1114 Mohican Pass Govt.Lot City, State I Zip Code Phone Number Madison, WI 53711 608-417-0640 r.. i, Section 16 T 43 N R 07 E or W H. Type of Building (check all that apply) Lot # ® I or 2 Family Dwelling —Number of Bedrooms 3 2 Subdivision Name Block # ❑ Public/Commercial — Describe Use O City of ❑ State Owned — Describe Use O Village of CSM Number 2346 O Town of Cable M. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable online.. Check one box on line 13. Complete line ('if a licable. A, New System O Replacement System ❑ Other Modification to Existing System (explain) O Additional Pretreatment Unit (explain) B. ❑ Holding Tank ® In -Ground ❑ At -Grade O Mound O Individual Site Design O Other Type (explain) (conventional) C. ❑ Renewal Before O Revision ❑ Change of Plumber O Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment 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 450 0.7 642.9 650 91.9 Capacity in Gallons Total Gallons # of Units Manufacturer 2 $ Tank Information 'B u `v New Tanks IExistjngTanks ; C. o O aenrn w C7 Septic or Holding Tank 1000 1000 1 Wieser Concrete X Dosing Chamber V. Responsibility Statement- I, the undersigned, ass a respon bility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) I Plu er' Sigma MP/MPRS Number Business Phone Number Douglas Manthey MP 230722 715-739-6868 Plumber's Address (Street, City, State, Zip Code) PO Box 196 Drummond, W 54832 VI. County/Department Use Only pproved O Disapproved Permit Fee r I Date Issued aAL ❑ Owner Given Reason for Denial ID In�w 37 Conditions f Approval/Reasons for Disapproval %anal, to complete mans roe bite system and suhmit to the County only on paper not less Ih an S Ina II itch" in sire SBD-6398 (R. 03/22) 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 = 450 gpd; BOD5 5 220 mgL"'; TSS 5150 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 anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served . Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit In accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: HK Septic Service Local government unit: Bayfield County Zoning Local government unit address: PO Box 58 Washburn, WI Phone: 715-798-3494 Phone: 715-373-6138 ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. _. f.:`:Gqy Private Sewage System Maintenance Agreement DOCUMENT NUMBER 2024R-604742 Site Address 15140 Cc WI 39363 As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil tester's report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established in the WI Adm. Code, as from time to time amended. (COMPLETE Legal Is required) - - 1/4 of 114 Section 16 Township 43 N. Range 07 w Additional Legal Description: Town of Cable (Acreage) 2.53 Gov't Lot Lot Lott CSM# 2346 vol. 13 Page 314-315CSM Doc# Subdivision DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 09/17/2024 AT 9:57 AM RECORDING FEE: $30.00 PAGES: 1 Return To: Planning and piing Department Bayfield Co. Area ® In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound ❑ At -grade Sewage System ❑ Other Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. Pump Chamber (system types B. C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Septic Tank Effluent 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, Ws. 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 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 bylaw. ,I I too, The terms and conditions of the agreement shall be binding ydb}r and inurgl(oR6e benefit of all current and future owners of such property. - 0 vvis,'• Owner(s) Name(s) — Please Print •• ruled and swom to before me on this date: Dorw'tE Divis WI'!.D9hn461t 3C4 zy NotarizedOwner(s)— Signature(s) -'••• Z M41t Fliblic__r J4,(/Li • r r My Comrhissioff Expires: `3-G-�ozg Drafted by: Doug Manthey Date: 09/03/2024 Proofed by: u/formstsa niterylsepticmaintenceagreement Revised July 2020 BAYFIELD COUNTY SANITARY PERMIT (#04)-24-149S STATE SANITARY PERMIT OWNER: DOREEN DAVIS GOVT LOT: LOT: 2 BLK: CSM: 2346 1/4 114 SEC: 16, T 43 N, R 7 W TOWNSHIP: Cable SOIL TEST: 154-24 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: Douglas Manthey TRACY POOLER Authorized Issuing Officer DATE: 10/7/2024 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: 1977c.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 230722 Condition: System to meet all setbacks. Management plan to owner. Properly maintain system per recorded agreement. THIS PERMIT EXPIRES 10/7/2026 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION