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HomeMy WebLinkAbout24-166SRequest 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 Other Phone Number Plumber: G rl F no wL Q Fax Number Homeowner: Email Address Immediate Phone Number So Zoning Sanitary Permit #: / y "'// Dept can call you right back (if needed) f//� Plumber's Choice Zo ept No Inspection(s) during this time Date: Tuesday (9:30 am - 12:15 pm) (Tracy) Time: Plumber's Choice Z g Dept e . lk Township: Address # &3 Road Name: G T E / o-, ^� 21 or Directions Y i �`' J Gl , To Site: Comments: ** Plumbers you must verify any change(s) by fax or email ** Notes from u/fors/sanitary/req uestforinspection Zoning Dept (©4/12/04): © June 2023 �bs4�s Industry Services Division General Information Permit Holder's Name: Information Private Onsite Wastewater Treatment Systems ( POWTS) Inspection Report (At+ar'r, +n Permit) ANDREW & SUE KNUDSEN 5.04 1 m 3645 TWIN BAY RD Village Town BARNES WI 54873 SM Elev: n&14 County Sanitary er/m_ltNo. au -tus State Plan Transaction ID#: Parcel Tax No: �(Ti.t7 TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road Septic i 0 N/A Dosing N/A Aeration N/A Holding 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 Widt Lep) # of Cells SETBACK FROM Prop. Line Bthlding Well OHWMtI Type of Cell 4 % Manufacturer: Model Number: 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 0 No lion cover Elevation Data STATION BS I HI j FS ELEV Benchmark 0 Bldg. Sewer Tank Inlet 3_5 io&C Tank Outlet '1' ( 0 06.& Dose Tank Inlet Dose Tank Bottom Inst. Contour Header / Manifold Distribution Pipe Infiltrative Surface , 7 R /o z ?1 Final Grade a, /1 3" I/.Ac Pc. t' X Pressure Systems Only Depth Over Depth Over Depth of Seeded / Sodded Mulched Cell Center Cell Edges Topsoil DYes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ! o, 4// 7r'enz,/I�S /�^ %hkw/7> e/ d cAg 7 y/ {/y / Z // //'`/ �j I r 5 l GyI/ l M7o �%(.��'/L/ /G (�"'9 CK�Lt✓� Iii - Y `3 . N SLID! GS GbO✓C `•^ C /7� G //Q IL�i/IC- / Plan revision required? ❑ Yes &lo f /6! , /7 Use other side for additional Information. 7 Il / _ T Date POWTS Inspector's Signature License Number CRnR71n rR n(211 Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoning(utbavfieldcounty.wi.gov Web Site: www.bayfieldcounty.wi.gov/147 ANDREW & SUE KNUDSEN 3645 TWIN BAY RD BARNES WI 54873 Hayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know I on.-eP r'(/d t'/" 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: Tank was crushed / removed and pipes disconnected by: on at AM/PM Onat 3 (AM / e above -mentioned plumber contacted our office to condu*pre-c2oveHnspection as required un er DSPS 383. One of the following applies: flSystem 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/form srsanitarypropenyowner-input April 2019 p° �r r. ' _ Mf 1 Department of Safety County 7 r JU t & Professional Services, Ba leld yi Sanitary Permit Number (to be filled in by • a Industry Services Division Sanitary Permit Application State Transaction Number In accordance with SPS 383.21 , Wis. Adm. Code, submission of this form to the (a) appropriate Bayfiel required pent obtainingater sanitary Note: Application info fomans forstate-owned vided POW S ale ere submitted to isDepartment Project Address (if different than mailing address) al Ser the Deparhnent of Safety and Professional Services. Personal information you provide may be used for secondary we purposes in accordance with the Privacy Law. s. 15.04(l)(m), Stars. 3645 Twin Bay Rd Property Owner's Name Parcel a Andrew & Sue Knudsen 04-004-2.44-09-161 05-002-20000 Property Owner's Meiling Address Property Location 3645 Twin Bay Rd Govt. Lot City, State Zip Code Phone Number Barnes, WI 54873 847-309-5950 -i ', section 16 T 4`1 N R 09 E Lots 0 I or2 Family Dwelling—NumberofBedrooms 3 Subdivision Name p� ❑ Public/Commercial —Describe Use Block!? ❑Cityof_ 0 Village of ❑ State Owned — Describe Use CSM Number ® Town of Barnes- . .. ,,,t. .:I ..., ... ... ,. A. ❑ New stem Sy ,.,r L7 Replanemenl System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) ❑ HoldingTank 'In -Ground ❑ At -Grade ❑ Mound O Individual Site Desi gn U tsar 11'Pe (explain) (conventional) C. O Renewal Before ❑Revision ❑ Change ofPlumber O Transfer to New Owner Jet Previous Permit Number and Date Issued Expiration Design Flow (gad) Design Soil Application Rate(gpd/sl) Dispersal Area Required (st) Dispersal Area Proposed (at) System Elevation 450 0.7 642.9 669.9 103,101,99 Capacity in Total N of Manufacturer o Tank Information Gallant Gallons Units e s New Teske of iedng TaNn fl aU Septic o -Holding Taok 700/300 - 1000 1 Wieser Doming Chamber Plumber's Name (Print) PI 'sSi re MP/MPRS Number S Business Phone Number rt wb &q9s71, 7�S-2o9-v/1/ hum Address (Street, City, State, Zip Code) w 136 fl Ytut- riner— L , cg9V7 .., ., .>" was ,..r'.._...17nu1d '��"""'o,''"., �';Xl ttt111,,, Approved baire��❑OwnerGivenReasonforDenial (%CX 1� 18' Conditions o for Disapproval \/ppprovva1/Reasons ≥c CcLtck Aetarh to complete playa ror theayatem and submit to the County only on paper roe Irma then 8 m s tl lather in she 5HD-6398 (R. 03/22) Ull liii ;T 0 8 2024 J Co. Zoning Dept. .y Wisconsin Department of Safety & Professional Services Page 1 ofF � fA Division of Industry Services SOIL EVALUATION REPORT S, j-" G7 OCT 0 8 "ZD'Z4 In accordance with SPS 385, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches In size. Plan must Include, I Bayfield 8ayfie14 Co. Zoning Dept. but not limited to vertical end horizontal reference point (BM), direction and percent slope, Iparcei I.D. scale or dimensions, north arrow, and location and distance to nearest road. I 04-004-2-44 9-16-1 0 002-20000 Please print all information, F54W •1 _ , Date Property Owner Property Location U U Andrew & Sue Knudsen GoutLot Y. ''A S 16 T 44 N R 09 E(or)Qw Property Owners Mailing Address Site Address or CaM and Lot #: 3645 Twin Bay Rd PAR in Lots 2 & 3 in Doc 2022R-597125 647D City, State, Zip Phone Number ❑ City 0 Village ® Town Nearest Road Barnes, WI 54673 ( 647 ) 309-5950 Barnes 3645 Twin Bay Rd ❑'New Construction Use: ❑ Residential/Numberarbedrooms 3 Code derived designflov rate 450 GPD ®Replacement ❑ Public or commercial —Describe: Flood Plan elevation if applicable N/A A. Parent material Outwash sands (Rubicon-Sayner complex) General comments and recommendations: 1❑ Boring Boring ®Pit Ground surface elev. 102.4ft, Depth to limiting factor 96 In. / elev. 94_4 t. Horizon Depth In. Dominant Colo Munsell Redox Description Co. Az. Cont. Color Texture Structure Gr. St Sh. Consistence Boundary Roots •`YY,rvu GPDIFF •EN#i •E8#2 1 0-6 7.5YR 3/2 — s 0sg ml aw 1m13#2vf 0.7 1.6 2 6-28 7.5YR4/4 — s Osg ml cw lrn/2f/hl 0.7 1.6 3 26-44 7.5YR4/4 — 12o%GR)s 0sg ml cw 1vf 0.7 1.6 4 44-69 10YR4/3 — cos 0sg ml aw 1vf 0.7 1.6 5 69-96 10YR6/4 — i15%CR)r 0sg ml — — 0.7 1.6 2❑ Boring # ❑Boring ®Pfl Ground surface elev. 102.4 fL Depth to limiting factor 96 in. / etev._4 R Horizon Depth In. Dominant Color Munsell Redox Description Co. Az Cont. Color Texture j Structure Gr. St Sh. Consistence Boundary Roots GPD/F12 •Efi#i •Eff#2 1 0-6 7.5YR3/2 — s osg ml CW 1m/lf 0.7 1.6 2 6-16 7.5YR 4/4 — s osg m) gw 2nV2r/lv 0.7 1.6 3 16-36 7.5YR4/4 — t2eneR). Osg ml gw 1vf 0.7 1.6 4 36-51 1 0YR 4/3 — cos Osg ml aw — 0.7 1.6 5 51-95 10YR 6/4 — S Osg ml — — 0.7 1.6 CST Name (Please Print) Sig Number Keith Wiley 654921 Address Date uatlon Conducted Telephone Number 11623 E Larson Dr. Lake Nebagemon. WI 54649 I 9/22/2024 218-451-2611 •Effluent#1= BOD>305220 mglL and TSS>305150mg1L •Efluent#2= BOD, 530 mg/. and TSS S 30mg/L SBD-8330 (R03/22) 37 Boring # ❑ Boring 106.1 ® Pit Ground surfaceelev.ft. Pagegeof D Depth to limiting factor 108 in. / elev. 97 7 OCT 082024 Soil Application Rate slstence Boundary Roots spoiiytlel Co. Zoning Dept. Horizon Depth In. Dominant Color Mansell Redox Description Qu. Az. Cant Color Texture Structure Or. Sz. Sh. Con 'Eff#1 'Efl#2 1 0-10 7.5YR 3/2 — s Osg ml ow 2m/2f 0.7 1.6 2 -10-24 7.5YR 4/4 — s Osg ml ow lmnmrsr 0.7 1.6 3 2438 7.5YR4/4 — (zoxcR)s Osg ml w 2f/1vf 0.7 1.6 4 38-63 1OYR 4/3 — cos Osg ml as 1vf 0.7 1.6 5 63-108 1OYR 6/4 — s Osg ml — — 0.7 1.6 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev._ft. Depth to limiting factor n. / 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 GPDIF? 'Eff#1 •Eft#2 ❑ Boring# ❑ Boring ❑ Pit Ground surface elev.ft. Depth to limiting factor in.! elev_ft. Son Application Rate Horizon Depth In. Dominant Color Mansell Redox Description Qu. Az. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIFI' 'Eft#1 'Eff#2 EPouent#l=BOD > 30s 220 mg/L and TSS >30sl50 mg&L Efluent#2= BOD,s 30 mg/L and TSSs30mg/L cflH 1111 0CT 082024 Bayfeld Co. Zoning Dept. Knudsen (3 bedroom) Soil Report Plot Plan North V., ioa Th>or >3x 0 Andrew & Sue Knudsen 3645 Twin Bay Rd Par in Lots 2 & 3 In Doc 2022R-597125 647D Sec 16 T44N R09W Town of Barnes 04-004-2-44-09-16-105-002-20000 0.867 acres Septic tank & drainrield to be abandoned per SPS 383.33 ® Well 3 bedroom house OHWM Scale 1:40 NOTES: Bench Mark = Top of green U -Poston north property line - Upper Eau Claire Lake elev 62' • Elev =100.0' - Property lines not shwon >50' from tested area CST# 654921 �� -®� Paap 3 of 3 BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): Sr Check List Andrew & Sue Knudsen O Index Page / Tide Sheet (Optional) %'Original Soil Evaluation Report (Submitted in Deed Holders Name— r o prospective buyers) S Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) &'Parcel Identification Number (must be 23 di It Tax ID#) DO NOT USE 12 digit, they are no longer being used Gtr Owner's Information nat prospective buyer's name) El Property Location (Accurate Legal Description with Sec/Twp/Range) EX Road Name (where driveway Is/will be coming off of) id'Floodplain Elevation, How Rate, Comments and Recommendations %'Complete Soil Boring / Pit Information 7 Date Soil Evaluation was conducted WCST Name, Signature, Number, Address and Phone Number El *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) GYBench Mark (Description, Elevation and Location) &'Contour tines (Example = 98.0' /96.0' /94.0') ['Property Location (Sec/Twp/Range/, Accurate Legal Description) O' Borings (Locations and Elevations) EPercent and Direction of Land Slope 67 Well Location (Including Neighboring Wells, if applicable) [Location of Wetland Areas, Roodplain and Navigable Waters ['Buildings, Driveways, and Structures (Location and Descriptions) ['Location of Property Lines BY Existing System Location ['Address Number and Road Name 3 Current Surface Elevation of Wetlands and Navigable Waters &' CST, Owner and Property Information lD'North Arrow 1111 GEE VED OCT 082024 Bayfield Co. Zoning Dept. Fee: BY Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checklisVchecklis forays & Sue II Par in Lots 2 & 3 in Doc 2022R-597125 647D Property Address Tax Parcel Number County Legal Description Section Town Range Page Index 1 Property Information 2 Data Entry 3 Plot Plan 4 Drainfield Cross -Section 5 Tank Information 6 Maintenance Plan 7 Contingency Plan Designer's Name Designer's Signature Designer's License Number Designer's Phone Number Date A/I O/7�i/l: • 5 p on , Page 1 of 7 uflv OCT 082024 Bayfield Co. Zoning Dept. In -Ground of Absorption for POWTS Version 2.1 Ma 2022-2027 Component Manual Used 3 Number of Bedrooms 13 Percent Slope (%) 108 Depth to Soil Limiting Factor (in.) 0.7 In Situ soil application rate 300 Estimated Wastewater Flow (gpd) 450 Design Wastewater Flow (gpd) 3 Number of System Elevations 103 Proposed System Elevation #1 101 Proposed System Elevation #2 99 Proposed System Elevation #3 106 Original Grade #1 106 Finished Grade #1 104 Original Grade #2 104 Finished Grade #2 102.4 Original Grade #3 102.4 Finished Grade #3 Wieser WLP700/300-MR Septic Tank Polylok PL -525 Effluent Filter Infiltrator Quick4 Plus Standard I Chamber Type 12 Height of Chamber (in.) 20 sq.ft. per chamber(ESIA) 3.3 sq.ft. per end cap (EISA) 4 laying length of chamber(ft.) 1.5 length of endcap(ft.) 34 Chamber width(in.) 3 Rows of Chambers 3 Distance Between Cells (ft.) 11 Number of chambers in first row 11 Number of chambers in second row 11 Number of chambers in third row 33 Proposed Number of Chambers Used 642.9 Minimum Distribution Cell Area Required (sq.ft.) 669.9 Distribution Cell Area Proposed (sq.ft) Page 2 of 7 IcEii P OCT 0 8 20[4 Bayfield Co. Zoning Dept. OCT 082024 Bayfield Co. Zoning Dept. Knudsen (3 bedroom) Lift to Gravity In -Ground Plot Plan North o� Three rows of 11 infiltrator Quick4 Plus standard chambers pro line 106 104 102' _ 1396 DF Septic tank & drainfield to be 1 abandoned per SPS 383.33 Wieser WLP700/300-MR w/ polylok 525 filter 5T Andrew & Sue Knudsen 3645 Twin Bay Rd Par in Lots 2 & 3 in Doc 2022R-597125 647D Sec 16 T44N R09W Town of Barnes 04-004-2-44-09-16-105-002-20000 0.867 acres 2 forcemain ASTM D1785 NOTES: Scale 1:40 Bench Mark =Top of green U -Post on north property line Elev = 100.0' O Well 3 bedroom house Wieser precast W320 -MR w/ sewage pump capable of 22' of lift NOT Part of POWIS permit - Upper Eau Claire Lake elev a 62' - Property lines not shown >50' from system area - All vent, observation & conveyance pipes 4" ASTM 01785 or code equivalent ric 9y Qn n R Page 3 of 7 Cross Section of a Three Cell Inground Component Using Leaching Chambers Finished Grade 104.00 Original Gradel 104.00 lopofCharnberl 102.00 System Elevation 101.00 Finished Grade 106 Slope 13% C If5epaT3f jinished Grade 102.40 Feet 106.00 original Grade 104.00 Top of Chamber - .. ,__Orginal Grntle 102.40 Top of Chamber 100.00 103.00 System Elevation ,w 'y�1� @.t�� .�; System Elevation 99.00 4. fir; �':: �r i.�?"•uy.!.+{, 7.i�'... •q: li:Yf r:. +n.fyy..�rar ..y' u� •ro_ ObRnYmNaotplps lobecmYaeredaodaypedvaa ap{vwed mtlrrisb &rWepcdeulni a 47 feet 47 feet )bservation / Vent Pipes to be located at the ends of the distribution cells. 3 feet between cells Page 4 of 7 flfovE 0 082024 Co. Zoning Dept. OCT 082024 Bayfield Co. Zoning Dept. 4' CAST TANKS ARE CAST -A -SEAL WLP7OO/3OO-MR TANK SPECIFICATIONS DIMENSIONS: WALL• 2 1/2" BOTTOM: 3' COVER: 5' MANHOLE 24" I.D. PRECAST CONCRETE RISER HEIGHT: 53 1/4" LENGTH: 8'-B' WIDTH: 7'-2" BELOW INLET: 42" LIQUID LEVEL: 36 WEIGHT: BOTTOM 3,595 LBS. COVER 3,195 LBS. INLET AND OUTLET: 4' CAST -A -SEAL BOOT OR EQUAL GASKET a INLET AND OUTLET BAFFLE AND FILTER: `v WISCONSIN, SEE DETAIL 010 (OTHER STATES SEE CHART) LIQUID CAPACITY: 28.79 GAL/IN LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS SEPTIC / HOLDING COVER: MIX DESIGN /8 (NO FIBER) I TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE ■ ac O REVIEWED BY F RENEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: SHEET APPROVAL DATE: j PROWRS NEEDED BY: �OF BAYFIELD COUNTY Andrew & Sue utle�i E D CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) lulu) 0CT 08 7024 0 Check List 0 Original Sanitary Application (Submitted in Deed Holders Name —fit prospective buyers) (383.21(1)1.) hayfield Co. Zoning Dept. 0 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) 0 Original Plot Plan (383.22(2)2. 3. & 4.a) 0 Cross Section, Over -Head Profile of the System ar d Schematic of Tank from Manufacturer O Pump Tank Diagram, Alarm and Pump Curve (when applicable) 0 Contingency Plan / Management Plan (383.22-3(2Xb)1.f.) 0 Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) ❑ Holding 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'Servidng Agreement (Recorded at Reg. of Deeds) 0 Fee (Make Check Payable to Bayfeld County Zoning) (383.21(2)(c)7) 0 2 Comolete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) 0 Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ State Plan Review (when applicable) ❑ Copy of Warranty/Quit Cairn Deed (Optional) Sanitary Application: (Include the following Information) 0 I Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) 0 Project Address IL Road Name where driveway Is/will come off of) 0 (Owners Phone Number) 0 II Type of Building 2111 Type of Permit OW Type of POWTS System 0 V Dispersal / Treatment Area Information 0 VI Tank Information 0 VII Responsibility Statement (Plumber's Information) r ' 'Date Stamp' Plot Plan: (To Scale or To Dimension) 0 Signature and Plumber Information 0 Surface Elevation of Body of Water 0 Direction and Percent Land Slope 0 Tank and Filter Information and Location 0 Wetlands / Navigable Bodies of Water 0 Absorption Area (Proposed and Existing) 0 Bench Mark (Location, Elevation and Description) 0 Component Manual Version 0 0 Address Number and Road 0 North Arrow 0 Contour Unes 0 Structures and Driveways 0 Boring Locations 0 Property Lines 0 Well Locations 0 Legal Descriptions Turn Over Cross -Section and Over -Head Profile of the System: iA Surface and System Elevation 0 Position of Observation and Vent Pipes 0 Dimensions and Depths 62! Make, Model & Number of Chamber Units in each Cell fd How many systems will there be on this parcel of land? 1 {2f Has this property been split? no (Property Statement shows Property perry History) Fees: 0 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 ffi Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) u/forms/checkliswchecklistforsanitaryapps (10/2009);(®7/2011);(®2/2012$®5/2/2012 -dc) Proofed by: 1111 OCT 082024 Bayfield Co. Zoning Dept. SS, /1 V i (j Department of Safety county & Professional Services, grnajy PermitNumbyfleed rbe filled m by Industry Services Division atJ- i s o Sanitary Permit Application State TansaetionNuenber in accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Ba fiel Bayfiel required prior to obtaining a sanitary Note; Application o (bias for terowe POWTS are submitted m Project Address (if different than mailing address) st Services. in the Depertrnrnt of Safety and Professional Services. Personal information yu provide may be used for secondary you pup sin accordance wish the Privacy Law, s. IS 04(l)(m), Stets, 3645 Twin Bay Rd All 1nfinnt,onn Proper v Uwncr's Name Parcels Andrew & Sue Knudsen 04-004-2-44-09-16-1 05-002-20000 Property Owners Mailing Address Property Location 3645 Twin Bay Rd Govt. Lot City,Smte Zip Code Phone Number Barnes, WI 54873 847-309-5950 —'A ', Section 16 T 44 N R 09 Eo Lot # Olor2FamilyDwelling—NumberofBedrw= 3 Subdivision Name ❑ PubliclCommereial— Describe Use B1oUcd ❑ City of 0 Village of O State Owned — Desenbe Use CSM Number ® Town of Barnes A' O New Sstem Y Cd Re lacemenl p System O Other Modification to Existing System (explain) O Additional Pretreatment Unit (explain) B. O Holding Tank g'ln-Ground ❑ At -Grade ❑ Mound O Individual Site Design ❑ OthttType (explain) (conventional) C. ❑ Renewal Before ❑Revision ❑ ChangeofPlumber ❑ Transfertn New Owner ist Previous Permit Number and Date Issued Expiration Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (s0 Dispersal Area Proposed ('0 System Elevation 450 0.7 642.9 669.9 103,101,99 Capacity in Total ll of Manufacturer Tank Information Gallons Gallons Units a a$ ` New Taks comas Tank c N3 is o U m w U a seine in Italians Tank 700/300 - 1000 1 Wieser Dosing Ctembcr r i,iBi(, rim. n _ xtta4latfhtliedbtga/j?A�"';y'F!r3 • Plumber's Name (Print) PI fir's Si re MP/MPRS Number I Business Phone Number r---- 6R9 7 /x'209-o/Q Plumbe Address (Street, City, State, Zip Code) • UU pp C) r-iti t (ti[ r- LA) S T O 7([/� 7 Approved ❑ Disapproved Permi/[�/Py(ese/®/J Date Issue Sssu A Si re (.//n 7'7 /�z1 SI ///v// /9 ❑Owner Given Reason for Denial ID Condlnons o PprovaltReasons for Disapproval Attach to complete plans for the system and aWnis to the County only anpaper not Ins than 8 Ina I1 inches in else SBD-6398 (R. 03122) :T 0 8 2024 i Co. Zoning Dept. POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION OwnerAndrew & Sue Knudsen Permn # DESIGN PARAMETERS Number of Bedrooms 3 O NA Number of Public Facility Units 0 NA Estimated (average) flow 3OO gal/day Design (peak) flow = (Estimated x 1.5) 45O Vda y In Situ Soli Application Rate 0.7 gal/day/02 Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOD5) 5220 mg/L O NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) 530 mg/L Total Suspended Solids (TSS) 530 mg/L 0 NA Fecal Coliform (geometric mean) 510° cfWlooml Maximum Effluent Particle Size 16 in da. ❑ NA Other: NA Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condtlon of tank(s) At least once every: LI 3 0 meat h(s)(Maximum 3 years) O NA Pump out contents of tank(s) 0 When combined sludge and scum equals one-third ('h) of tank volume ❑ When the high water alarm is activated ❑ NA Inspect dispersal cell(s) At least once every: 3 ❑ month(eaarrls)(s) ) (Maximum 3 years) 0 O NA Clean effluent filter At least once every: 3 ❑ month(s) 0 earls)) O NA Inspect pump, pump controls & alarm At least once every: ❑ m) 3 0 eat(s ❑ Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) 0 NA Other: At least once every: [I month(s) ❑ year(s) 0 NA Other: 0 NA MAIM eNANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually Inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (h) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Adrnlnistrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. SYSTEM SPECIFICATIONS Page 6 of E V E Qfl D rUia OCT 082024 Tank Manufacturer Wieser O Septic O Dose ❑ Holding vol. 7OO/3OO Tank Manufacturer O NA ❑ Septic O Dose ❑ Holding vol. gal Effluent Filter Manufacturer Polylok O NA Effluent Filter Model 525 Pump Manufacturer 0 NA Pump Model Pretreatment Unit O NA ❑ Sand/Gravel Filter O Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other: Manufacturer Dispersal Cell(s) ❑ NA 0 In -Ground (gravity) O In -Ground (pressurized) ❑ At -Grade O Mound ❑ Drip -Line O Other; Other: 10 NA Other: 0 NA A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. OMW (12/02) field Co. Zoning Dept. UI V START UP u or construction, prior For new prior to use of the POWTS check treatment tanks) for the presence of painting products, soWentsI other D chemicals that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected ttfCT 082024 contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Bayfield Co. Zoning Dept. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload than resulting in the backup or surface discharge of effluent. To avoid this situation have the comet of the pump tarts removed by a Septage Servirarg Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating g the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound a al -grade soil absorption area Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sum g pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps, medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the tailed POWTS. The site has riot been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and she evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade sal absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name & f -t l.r h. Name Phone u ) $ - 2-� .Q Phone SEPTAGE SERVICING OPERATOR I Ul LOCAL REGULATORY AWHO*UTY Name NameBayfieb County Zoning Phone Phane715-.373.6138 This documed was drdted by the staffs d the Green Lake, tAagnne0a aid Washara Cam4Zaeg and Sadrrtnn agencies in compliance with chapter Comm e322(2)(b)(1Xd)a(t ard 8354(1). (2) & (3), Wasnskn Adnii6YanGode. Private Sewage System Maintenance Agreement DOCUMENT NUMBER 2024R-605104 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI 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 Bayfeld 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 )4 Township N. Range W. Additional Legal Description: COP)( DF 1i.D ,"irA-c I/ ED Town of AR hi F S (Acreage) I Gov't Lot y 3 Lot_ Block Subdivision Lot _ CSM # Vol. _ Page _ CSM Doc # In -ground gravity ❑ Mound ❑ In -ground dosed ❑ At -grade Sewage System Return To: RECORDED 10/15/2024 AT 10:06 AM RECORDING FEE: $30.00 PAGES: 3 Recording Area and Zo ' g letN V E D `1 OCT 162024 ❑ In -ground pressure distribution 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 manufacturers 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, POWiS 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 -wade. and In -around 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 by law. The terms and conditions of the agreement shell be binding upon and inure to the benefit of all current and future owners of such property. Owner(s) Name(s) — Please Print 4Nbl,EW M. KAJUDs9/J Subscribed and swom io before me on this date: QJober- /4, 1�4 SUE R• R J UD5EN — ,X,%111tlllt/111 ercirvsnrt Notarized er(s)—Signatures) Nota Public \_ )e •., Commission Expires: % °UBL�G `_; 9 5,. by:4A)D9fuJ 1U(UPSJ.J Date: 10/ 11/06,21/ 'o,;z;of r Proofed by: u/fonns/sanitary/septicmaintenceagreement Revised July 2020 State Bar of Wisconsin Form 3-2003 QUIT CLAIM DEED Document Number 2022R-597125 Daniel J. Heffner Document Number Document Name Register of Deeds Bayfield County, WI THIS DEED, made between Andrew Knudsen and Sue Knudsen ("Grantor," whether one or more), and Andrew Knudsen and Sue Knudsen, husband and wife as joint tenants ("Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in Bayfield County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): SEE ATTACHED EXHIBIT A FOR LEGAL DESCRIPTION Dated/vOVentb4- 8 ,2022 Signature(s) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat § 706.06) THIS INSTRUMENT DRAFTED BY: Atty. Carla J. Smith, SBN 1123340 Spears, Carlson & Coleman SC, Washburn WI 54891 Recorded 11/10/2022 at 2:18 PM Recording Fee: $30.00 TF Exempt #: 8M Pages: 2 Electronically recorded Recording Area Name and Return Address Spears, Carlson & Coleman SC PO Box 547 Washburn WI 54891 (Included in Attached Exhibit A) Parcel Identification Number (PIN) This is not homestead property. tiA (is not) OCT 162024 (2) Bayfield Co. Zoning Dept. SEAL) (SEAL) •Andrew Knudsen /' SEAL) /}��- (SEAL) • Knudseu ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. COUNTY) Personally came before me on ii- g - , 2022 the above -named Andrew Knudsen and Sue Knudsen to me known to be the person(s) who executed the foregoing inspuummennt an cknowledged the same. IJlwL Qtye-r Notary Publib, State of Wisconsin My commission (is permanent) (expires: la la -1 J-.oa. (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED ®2003 STATE BAR OF WISCONSIN FORM NO.3.2003 'Type name below signatures. INFO -PRO" Laaal Fon a -(800)855.2021 - bifopmfocmtcom Bayfield County Register of Deeds Document #2022R-597125 Page 1 of 2 EXHIBIT A - LEGAL DESCRIPTION Quit Claim Deed Knudsens / Knudsens Apart of Lots Two (2) and Three (3), Section Sixteen (16), Township Forty-four (44) North, Range Nine (9) West, in the Town of Barnes, Bayfield County, Wisconsin, described as follows: Beginning at an iron post on a base line which extends South from a point which is 1025 feet East ofthe NW corner of Lot 3 and extends South 1642 feet, more or less, to an iron post, set in cement, on the base line; thence running South on said base line a distance of 137-1/3 feet to a stake; thence running East a distance of 107.5 feet to a stake and the place of beginning; thence running East a distance of 225.5 feet to a stake; thence running South 68 degrees 07 Minutes East (S68° 07'E) a distance of 650 feet, more or less, to a stake on the shore of Upper Eau Claire Lake; thence running Northeasterly along the shore of said lake a distance of 75 feet to a stake; thence running approximately Northwesterly to a stake which is 25 feet North and 225.5 feet East of the point of beginning; thence running West a distance of approximately 220 feet to a stake on the East side of roadway; thence running Southerly along said roadway to the point of beginning, said distance measured North and South being 25 feet. Together with right of ingress and egress on presently existing roadway leading into said land from the North, at a distance of approximately 150 feet Northwest of the lakeshore. PIN: 04-004-2-44-09-16-1 05-002-20000 lE UflV9 OCT 1 62024 Bayfield Co. Zoning Dept. Bayfield County Register of Deeds Document #2022R-597125 Page 2 of 2 10/18/24, 8:55 AM Carmodytm BAYFIELD COUNTY SANITARY PERMIT (#04)-24-166S STATE SANITARY PERMIT OWNER: ANDREW & SUE KNUDSEN G OV'T LOT: 2 & 3 LOT: BLK: 1/4 1/4 SEC: 16, T 44 N, R 9 W TOWNSHIP: Barnes SOIL TEST: 159-24 REPLACEMENT SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: Greg Brown TRACY POOLER DATE: 10/18/2024 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: # 699374 Condition: System to meet all setbacks. Management plan to owners. Properly maintain system per recorded agreement. Properly abandon existing/old system per SPS 383. THIS PERMIT EXPIRES 10/18/2026 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION https://www.carmodyinc.com/Perm!tApp/Permit_Sign.aspx?Print=l &permitappid=7403 1/2