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HomeMy WebLinkAbout24-165SRequest for Sanitary Inspection (24 Hrs. in Advance) Fax or email this form to Zoning Dept (24 Hrs.) prior to when you want an inspection Fax (715) 373-0114 or Email zoninc ( avfieldcounty.wi.gov Note Time Change fl Discrepancy Other Phone Number Plumber: TCZPoV1s 11u t CERF,cLft] Fax Number Email Address Homeowner: I�ayr «,d 144 Lee Ta51t45 o9- ;ce\'cc1.cm Immediate Phone Number So Zoning Sanitary \\ L) _ 15 C .3 Dept can call you right back (if needed) Permit #: d Plumber's Choice yet • No Inspection(s) during this time Date: 07/ y / a 5' Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice Dept Time: Township: N Address # & Road Name: M , cl cn 13�-y Ra or JJ Directions To Site: Comments: u � 0 0' ** Plumbers you must verify any change(s) by fax or email ** Notes from July 2025 aF' Industry Services Division General Information Permit Holder's Name: Tank TYPE MANUFACTURER CAP ITY Prop. I,141e Well Building Air Intake Road Septic N/A Dosing N/A Aeration N/A Holding Private Onsite Wastewater Treatment Systems ( POWTS) Inspection Report (Attarh to Permit) RAYMOND H & MICHELE K LEE TRUSTEES m 727 MARTIN AVE ge flTownot HUDSON WI 54016 ,/ r setback to: County Sanitary ermft No: aw - I L05S State Plan Transaction ID#. Parcel Tax No: J.q7Og' Pump I 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 Width Length ft of Cells / SETBACK FROM Pro ne Budin% Well(J 0 U Type of Cell 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 Soil Cover Elevation Data STATION BS HI FS ELEV Benchmark 0e Bldg. Sewer 6 z Tank Inlet S Tank Outlet Dose Tank Inlet Dose Tank Bottom 3j Inst. Contour Header/ Manifold 4-96;,- Distribution Pipe Infiltrative Surface Final Grade ?..O .GrJ X Pressure Systems Only Depth Over Depth Over Depth of Seeded I Sodded Mulched Cell Center Cell Edges Topsoil 0 Yes 0 No ❑ Yes 0 No COMMENTS: (Include ?ode discrepancies, persons present etc.) � `r Qr4 n`(, /,i //ca " 9'f ?�G (itoH4 F.zia���S���/ 'j7/,/e(/���� �QYrf acre..' 6t'- S to - TQ4k /r'1/y€,1A/ icfX1{4,tl9fti4—v'l 'ff 6ec Plan revision required? Yes O No Use other side for additional information. /a Date RRn_R71n (P M/91 POWTS Inspector's Signature License Number Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoning(a�bayfieldcounty.wi.00v Web Site: www.bayfieldcounty.wi.gov/147 — RAYMOND H & MICHELE K LEE TRUSTEES — 727 MARTIN AVE HUDSON WI 54016 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know ��b�� itr ii e/d' 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: n d• Tank was pumped by: on at AM / PM Tank was crushed I removed and pipes disconnected by: OnXct at 7 AMyF�M) the above -mentioned plumber contacted our office to core -cover inspecti n as req 'eff 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 $50 fee are required. System could not be inspected because County could not respond to plumber's time constraints. Comments: U/forms/sanitarypropertyowner-input April 2019 D of Safety :• 95 Professional Services, County 1 n 024JIDepartment Sanitary Permit Number (to be filled in tv Ps OCT ustry Services Division �6cRxns�$e �O-ILQ5S 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), Stars. /�-I ((�� Rd 39 ( 5 / I �.1 iC i GG n {7Gy JJ All I. Application Information — Please Print Information Property Owner's Name Parcel # TAsr 10: ZH7O5 Pbo ,niond H + MJche Ile K Lee Trus4ce o'-o3y.a.y3•oo•w-y 05.4.0 OO Property Owner's Mailing Address Property Location 7a 7 Mpr4r,r, A.je Pro Govt. Lot 51 City, State I Zip Code Phone Number Hudsora WZ Syo1(i (r5)- a(.o- 547, ¼' /•,Sections T Y3 N R tG II. Type of Building (check all that apply) Lot # I 2 Family Dwelling Number Bedrooms a Subdivision Name )C or — of o1 Block # ❑ Public/Commercial — Describe Use ❑ City of O Village of ❑ State Owned — Describe Use CSM Number C 4 XTown of manse Kaa oo n vM p 3I III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if applicable.) A.ew System y ❑ Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank am -Ground �% ❑ At-GradeI ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (convention l) W 1L i C'} C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber g ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. ' Dispersal/Treatment Area and Tank Information: SOf ea.wi 00 :.. 0.4. a5 r A r 1 Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (sf) Dispersal Area Proposed (so System Elevation 30o ho /Z.O 3o6/iso 931a.5 Ilaa.5 9Y. a5 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units o a ' Bo New Tanks Existing Tanks CO M$D / o a U rn E u ti TAwi K " Septic or Holding Tank p y O — y 0 Dosing Chamber .roo — 5-0o V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's azure MP/MPRS Number I Business Phone Number Trv15 &++crrr:e 1d GSaB'79 715-G 3'/ •817 Plumber's Address (Street, City, State, Zip Code) /y3YGW 5+ak Road H4 ward, LiZ S'1f8V13 VI. County/Department Use Only Ca Approved O Disapproved PermitFee ate Issued Issui g Agent Sign ❑ Owner Given Reason for Denial Conditions ofpprorovval/Reassonnsss for Disapproval fp OVA c Attach to complete plans for the system and submit to (he County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 03/22) SR. DO i Lp° SU,LTLSL, cvr^'tF Wisconsin Department of Safety&ProfessionalS-- c_ Division of IndustryServices InS SOIL EVALUATION REP T OCCno Tty 1 01024 In accordance with SPS 385, Wis. Adm. Cod 1210 G. ZO(}I� 4xnm�n�g L7 DI? t 1,4 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. 'fA, scale or dimensions, north arrow, and location and distance to nearest road. OY• pay- p-M3.04-lq-Y 6 Please print all Information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). lfi7flf/- Property Owner Property Location ❑ O__ _ _ . .. ►A• ��_11.. L# 1 1.._.� i._� Govt. Lot Lf 14 %5 141 T /3 NR 0(o E(or) W Owner's Mailing Address Site Address or CSM and Lot #: City, State, Zip Phone Number U City U Village Rfl Town Nearest Road 1.1.>AeA... r.i-r 44n1J_ (GS) ) J(,p0. 597a Nama.Kaae,n 5rNewConstruction Use: Residential/Numberof bedrooms Code derived designflowrate Orb GPD ❑Replacement ❑ Public or commercial —Describe: Flood Plan elevation if applicable — ft. Parent material Sn^o4y Te I, General comments and recommendations: ❑ Boring # KPit Ground surface elev. 97.soft. Depth to limiting factor! in. / elev.9aaSft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 'Eff#2 O•/e 10Y0.-7/ — .1R5bK v r54 0.(. 1.0 G.'≥l bY0.'fl or r SCa¼ O. ). 3 )'7.63 7.svi% 414 "- i5 I6 O.6" 1.O (.3.7$ ' . YAi . Y Y 5Yar/, 0 r ^— r tIciq. i,, u L 1 etIo Boring # Boring Fit Pit Ground surface elev. 97.08 ft. Depth to limiting factor 43 in. / elev. 9J $aft. SoilAnoli Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots • GPD/Ft2 "Eff#1 'EN#2 1 O-6 090.'3/ —" sl )F zn 1.0 G• oYa`) _- IC 50.5 1. 2 . 3 y -Y y&I g r95 Ii OS I. 710 S`/R 91 SY Y 5YR6,.Jr n'. a Y 1 PIr.nl .pieCe" n Gl CST Name (Please Print) '5r Signature CST Number F`�6.na1a A rcc cI Address Dat9.4valuation Cond ted Telephone Number FY3YIMSRIII P&vw4ers118s3 0 63 /a4 7,5 -43Y -&I'7 Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 5150 mg/L ' Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L �,�,( Q� SBD-8330 (R03/22) ec( 1 11') I2y Page ei of Bo Boring # Boring Pit Ground surface elev.9V•Q of ft. Depttj �[q lirr naSr I,./� v.9f•7JSft. I��JI^I�{JI OCT 1 02024 Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. ConsistencBa flei'I€@rZO IRQ p GPD/Ft2 *Eff#1 *Eff#2 O.4 JPSb .. D.C. 1.0 G- YR H — i /n..95 SL 0.5 1.0 3 J6•G, 7.5YRY — ra.jCr 55 if 0.5 1.O Y -4-75 7.5YR`I 3S1Ry SYR6/1 1r5 t — — — — 11 .,-, 1 a ry i'nc oilerS t- ct 1 el SI ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / 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 GPO/Ft' *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' *E#1 *Eff#2 * Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L O IV ^Rr r U � U � to m o 98.00ft 3/0 Slope 81 a ABM A B3 S B2 97.00ft 23965 Michigan Bay Rd P/O Govt Lot 4 Sec. 14, T43N, R06W Town of Namakagon Bayfield County Lot 2 CSM #1031 v.6 p.349 Pcl. 04-034-2-43-06-14-4 05-04-06000 BM = Nail w/ Ribbon in 21" Maple Owner: Raymond H & Michelle K Lee Trustees 727 Martin Ave. Hudson, WI 54016 v SCALE = 1: 50 1 1 I 1 I 1 A. 0 10 25 50 75 100 ELEVATIONS BM = 100.00 ft B 1 = 97.50 ft B2 = 97.08 ft B3 96.92ft Lake = 79.75 ft ,?rN6 We�L t6/63iy CST: Ronald A Spreckels Jr 14346W State Road 77 Hayward, WI 54843 (f GARDEN f LAKE Page 3c L/ OWNER: Sc1yrnontl N t N:ck SYSTEM ELEVATION: SOIL PROFILE He K ,Lee Trams —c SOIL SHEET 1111 TESTER: t�m.a \d A 0 SYSTEM RANGE: OCT 102024 4w44�a4fe,;F pt to LOAD RATE: 6.5 ,. ----1J D1Z 133 93 --- -- ------ 7 S O ------ -- -- 9� -- - 9�.o8 --- --- 96.9a -- 9G ----- - - --- -- --- -- -- -- ------ 95 ------ --- -- - ------ --- - ------ -- ------ 43 ------ - ------ -- 9a.a5 - --- --- --- ------ -- - - -- - re ox --------- _ Iim.}rn5&c3ar\ --(L:v...}+v.gFacler� l 9� -- --- -- - rt alc --- ----- - e erx cde'' So --- --- -- -- --- --- -- -- --- --- -- ------ ------ Sc? ------ ------ --- -- --- --- -- -- --- -- -- 88 -- --- -- -- ------ --- -- --- --- -- ------ -- 27 ------ -- ------ ------ -- -- -- 8�-- --- -- - --- -- --- - --- --- 36 Page _1Lof iL 51 ECE0VH Real Estate Bayfield County Property Listing Today's Date: 10/8/2024 I#l3+ Description Updated: 10/21/2019 Tax ID: 24708 PIN: 04-034-2-43-06-14-4 05-004-06000 Legacy PIN: 034107304002 Map ID: Municipality: (034) TOWN OF NAMAKAGON STR: S14 T43N R06W Description: LOT 2 CSM #1031 V.6 P.349 (LOCATED IN GOVT LOT 4) IN DOC 2019R-579513 (LEE FAMILY TRUST DTD 12/06/2017) Recorded Acres: 2.600 Calculated Acres: 2.625 Lottery Claims: 0 First Dollar: Yes Zoning: (R-RB) Residential -Recreational Business ESN: 123 Tax Districts Updated: 3/15/2006 1 STATE 04 COUNTY 034 TOWN OF NAMAKAGON 041491 SCHL-DRUMMOND 001700 TECHNICAL COLLEGE Recorded Documents Updated: 10/21/2019 0 WARRANTY DEED Date Recorded: 10/14/2019 2019R-579513 1111 OCT 1 02024 U Property Status: Current Created On: 3/15/2006 1:15:48 PM Bayfield Co. Zoning Dept. dW Ownership Updated: 10/21/2019 RAYMOND H & MICHELE K LEE TRUSTEES HUDSON WI Billing Address: Mailing Address: RAYMOND H & MICHELE K LEE RAYMOND H & MICHELE K TRUSTEES LEE TRUSTEES 727 MARTIN AVE 727 MARTIN AVE HUDSON WI 54016 HUDSON WI 54016 IV Site Address * indicates Private Road 23965 MICHIGAN BAY RD CABLE 54821 19 Property Assessment Updated: 4/1/2020 2024 Assessment Detail Code Acres Land Imp. G1 -RESIDENTIAL 2.600 205,800 5,800 2 -Year Comparison 2023 2024 Change Land: 205,800 205,800 0.0% Improved: 5,800 5,800 0.0% Total: 211,600 211,600 0.0% Property History N/A BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): l Check List uflfl 1111 OCT 10Z024 Bayfield Co. Zoning Dept. o InthexPapEmttCStmeOpti1t1y Lf/Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) C rlglnal Plot Plan Cross Section Soil Profile Sheet (optional) PI Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) 19'Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used ❑ Property Owner's Information (not prospective buyer's name) F"Property Location (Accurate Legal Description with Sec/Twp/Range) f/Road Name (where driveway is/will be coming off of) ❑ F atfans Soil Boring / Pit Information C3 DD/ate Soil Evaluation was conducted C3' T Name, Signature, Number, Address and Phone Number 8 *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) Q Bench Mark (Description, Elevation and Location) LB/ontour Lines (Example = 98.0' /96.0' /94.0') l p�roperty Location (Sec/Twp/Range/, Accurate Legal Description) C4'Borings (Locations and Elevations) LM/'ercent and Direction of Land Slope SWell Location (Including Neighboring Wells, if applicable) H Location of Wetland Areas, Floodplain and Navigable Waters "Buildings, Driveways, and Structures (Location and Descriptions) Eq Location of Property Lines EKAddress Number and Road Name f3/Current Surface Elevation of Wetlands and Navigable Waters f9 CST, Owner and Property Information "North Arrow Fee: [9 Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforests GeoMat IN GROUND AND DOSING DISTRIBUTION COMPONENT Residential Application lUn) l U G 0 INDEX AND TITLE PAGE U U OCT 10 2024 All Water Treatment Systems To Be Removed From System Owner Info Zoning Dept. Project Name: Lee - 23965 Michigan Bay Rd Owner's Name: Raymond H & Michelle K Lee Trustees Owner's Address: 727 Martin Ave. Hudson, WI 54016 Property Info Property Address: 23965 Michigan Bay Rd Legal Description: S 14 T 43 N R 6 W Township Namakagon County: Bayfield Subdivision Name: Lot Number: 2 Block Number: CSM#: 1031 Parcel I.D. Number: 04-034-2-43-06-14-4 05-004-06000 TAX ID:24708 Plan Transaction No.: n e ages Page 1 Index and title Page 9 Plot plan Page 2 Data entry Page 10 Pump Curve Page 3 GeoMat dist. cell drawings & calculations Page 4 Lateral and cell cross section Page 5 Management & contingency Page 6 Maintenance & specifications Page 7 Tank cross sections Page 8 Distribution media Travis Butterfileld Date: 10/08/24 Signature: Designer S License Number: 652879 Phone Number: 715-634-8176 State of Designed Pursuant to the GeoMat In Ground Component Manual lar tce...a� Laeeh�n95y�}ym Wisconsin Approval Stamp: Golf 'r '',.J 2019 V o r/v Page 1 of 10 In Ground and Dosing Distribution Component D" All Water Treatment Systems To Be Removed From System Site Information UO"�'� R Residential or Commercial Design _________N ISD Required? 200.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 300.00 Design Flow (gpd) 3.00 Site Slope (%) 94.25 Prop. System Elevation (ft) Sand & Native soil Contour 63.00 Depth to Limiting Factor (in) 1.00 In -situ Soil Application Rate (gpd/1t2) 96.92 Lowest Original Grade Ele. In System Area (ft) 97.50 Highest Original Grade Ele. In System Area (ft) 92.25 Limiting Factor Elevation (ft) 1.75 Depth Below Grade Distribution Cell Information 3.25 Cell Width (ft) 1 Number of Cells 2.00 Dispersal Cell Design Loading Rate (gpd/ft2) 2 Influent Wastewater Quality (1 or 2) Distribution Information Center or End Manifold, Dist. Box or Drop Box Number of Laterals Lateral Spacing (ft) Forcemain Drainback (gal) Forcemain Filter Loss (ft) Forcemain Diameter (in) Forcemain Length (ft) Inside Pump Tank Elevation (ft) System Head (ft) x 1.3 Vertical Lift (ft) Friction Loss (ft) Total Dynamic Head (ft) Designer must enter friction loss and system demand (gpm) Minimum Dose Volume (gal) System Demand (gpm) System dosed Y Does the forcemain drain back?I Y Manufacturer Information Treatment Tank Information Effluent Filter Information 840.001 Septic Tank Capacity (gal) Lifetime Filter LLC Filter Manufacturer Wieser Concrete Products, Inc. Manufacturer LT 1/8 Filter Model Number Dose Tank Information Gallons/Inch Calculator (optional) 508.26 Dose Tank Capacity (gal) 508.26 Total Tank Capacity (gal) 11.82 Dose Tank Volume (al/in) 43.00 Total Working Liquid Depth (in) Wieser Concrete Products, Inc. jManufacturer 11.82 galrin (enter result in cell DoseTankVolume) Project: Lee - 23965 Michigan Bay Rd Page 2 of 10 1 IC ® cCefl O©oM t OCT 1 12124 4 9e1d Co. Zoning Dept. Ba • • • • • • • •: °o c°o c ° °o°o°o° ,,p o 00°0 0 0 0 0 0 o o OO0O o c coop �o o°o°o° �a � 0 00°000 0 0 o°,.p�o c o° �: °o°o cro°000° : �bo00cg0�°,°000° Calculations I 1.50 K 1 S 0.00 ft ft ft A 3.25 B 50 L 52 W 6.25 Basal Area Calculation GPD Loading Rate 300 1 gausq ft/day Totall 300 ft2 Number of Cells 1 Cell Length 50.00 Min. Cell Length 46.2 Cell Spacing 0.00 ft ft ft I I I 1 Basal Area Required 300 Basal Area Proposed 312.5 [e]J]] ft2 ft2 Calculation Lineal Feet of GeoMat Required 46.2 Lineal Feet of GeoMat Proposed 50 System Elevation 94.25 Limiting Factor 92.25 Separation 2 NOTE: Min S dimension = T ft ft ft 2'Min gal/sq ft/day ft2 ft2 ft Directions: Play with cell length to get desired cell spacing, length and width. Remember system SHOULD be longer than it is wide. It must also Satisfy basal loading rate and GeoMat cell loading rate. Project: Lee - 23965 Michigan Bay Rd Page 3 of 10 ption Lateral Layout Dia OCT 1 01024 //,-00700�0000000000000000000°o°o°000°o°o° Ba�eld Co. De t0000000000000000000000000000000 Zoning P• Hole spacing is every 12" , 1/2" hole at 4 & 8 O'clock, starting 4 O'clock 6" from end and 8 O'clock Holes at 12" from end. 4" Perforated pipe may be used. Pipe Length = GeoMat Length Lateral Spacing I o.00 ft Pipe Diameter I 2.00 in Distribution Cell Cross Section Finished Grade e � � emLnc ° lamdl+evd "•� '"_42 +' 1.75 ft f'°'°°e'4 e 2in —� pipeDii . I>�v _-Ft A Rpe I.__ Top of geomat to be at or • . - - ,..0 GF0MA3 below original grade III III 2?_ASTM 33 Eaa III , I, I; I°� __ Y infiltcetiv° S°r5 -_WIVE.SOFiiJi Lrtatmp Fear sain Observation Pipes 12" Min. 42" Max. Od p6 Project: Lee - 23965 Michigan Bay Rd Page 4 of 10 In Ground System Maintenance and Operation Specification Service Provider's Name POWTS Regulator's Name Design Flow - Peak Estimated Flow - Average Septic Tank Capacity Soil Absorption Component Size Type of Wastewater Phone IL5�Phie D (715) 634-8176 7 7 1 Travis Butterfield Bayfield County SPIA - Zoning Department System Flow and Load Parameters 300 gpd Maximum Influent Particle Size 200 gpd Maximum BOD5 840 gal Maximum TSS 162.5 ft2 Maximum FOG Domestic Maximum Fecal Coliform 102024 in Dept. mg In9 p mg/L cfu/100 mL /8 0 10 10E4 Service Frequent Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System In Ground Inspect and/or service once every 3 years Inspectandcleanasnecessaryatleastonceevery3years Test once every 3 years Should test periodically Lateralsshouldbeflushedandpressuretestedevery3years Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap and are secured in as shown in the GeoMat In Ground Component Manual Ver. April 2019. 2. Dispersal cell media conforms to GeoMat products approved for use with the GeoMat In Ground Component Manual Ver April 2019. Media is covered with an approved geotextile fabric. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Scarification of basal area is accomplished with a rake or other tool. 5. All disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Diameter i Sprinkler Lateral Ends at Last Orifice Where Lateral Turn -up Detail 94.25 Feet Threaded Cleanout Plug or Ball Valve Vent if mot Dosed Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Lee - 23965 Michigan Bay Rd Page 6 of 10 GRAVITY -DOSED Page 7 of 10 SEPTIC / PUMP TANK SPECIFICATIOTEC1 0 kV f D 40 Vent Pipe (No Scale) 0CTcc102024 -10 fl from Building 12" Min. or 2.0 ft above Established Flood Elevation (typical) Approved IMPORTANT: Vent Cap Anchor tank(s) as necessary pursuant to SPS 383.43(8)(g) Finished Grade CAPACITIES @ 11.82 gal/in � a Depth (in) Volume (gal) A 27.1 320.32 B 2.0 23.64 [C] 3.9 46.10 D 10.0 118.20 *Pump Tank Liquid Level = 43 in Force Main Diameter = 2 in C Force Main Length = 133 ft Force Main Void Volume = 21.68 gal [C] Total Dose Volume (TDV) = 46.10 L (< 0.2X design flow + force main void volume) Vertical Lift = 9.5 ft PUMP TANK: Volume = 508.26 gal Wieser Concrete Inc Manufacturer: Pump Manufacturer: Champion Pump Mode: CPS5 l(See attached pump curve.) Controls/Alarm Manufacturer: SJE Rhombus Electrical must comply with COMM 16 and NEC 300 Extend manhole riser as ,y�fL� Co. Zoning Dept. Weatherproof e i t --Junction Box �I-ILtI Approved Locking Manhole with Warning Label Attached (typical) 4" Min. or 2.0 ft above Established Flood Elevation (typical) �Ainight Seal ' Quick Disconnect 18" Min. • (typical) * Approvetl Joints viN Liquid Weep Hole Approved Pipe 3 ft onto Solid Ground A Depth Force Main (typical) Filter* Alarm * Install and maintain pursuant B On to manufacturer's instructions. PUMPOFF Pump oft ELEVATION = 86.83 ft 3" Approved Bedding Material Beneath Tank gal/dose COMBINATION TANK Controls/Alarm Model: PS Patrol Float switches containing mercury are prohibited. INSIDE BOTTOM ELEVATION = 86.00 ft SEPTIC TANK(S): Total Volume = 840 gal Manufacturer(s): Wieser Concrete Inc Install approved force main filter pursuant to manufacturer's instructions. Filter Manufacturer: Sim -Tech Filter Model: STF-100 ll OCT 102024 GeoMat Distribution Cell Media Layout yfield Co. Zoning Dept. 3.25 ICell Width (ft) I 2.63 ISidewall to Lateral (ft) Distribution Cell Cross-section Arrangements 0 Distribution Pipe GeoMat is covered with approved geotextile fabric as per the their product approval. Distribution Cell Plan View Layout - Typical 3.25 Cell Width - A (ft) I 50.00 ICell Length - B (ft) End Connection Lateral Layout Diagram Typical Dispersal Cell -. Finished Grade 'N" N v r W Y ;i._�: •:`-;. v...:: .;._.`, >�... _ a- Diem . 12 42 BaLrfl jataQpyyd Ifbrcteo®eaded` F `'! mstc.tiwe pipe Dia . I:s F�brie GEOPipe'lMAT •tl III 2"jTM33S Ifllrlll 6ffw>wn Sur�te J J J� JNA7'IVB-SOIL. =__� � -- - Lcirtma FKtN See details on page 4 for number, size, and spacing of laterals. Project: Lee - 23965 Michigan Bay Rd Page 6 of 10 PLOT PLAN -� -- - O N mnn c- O � U v CD `s. 0 98.00ft 3% Slope 31 8 M e A — 63 2" PVC Force Main ASTM D1785 t 4" PVC SCH 40 ASTM F891 23965 Michigan Bay Rd P/O Govt Lot 4 Sec. 14, T43N, R06W Town of Namakagon Bayfield County Lot 2 CSM #1031 v.6 p.349 Pcl. 04-034-2-43-06-14-4 05-04-06000 BM = Nail wl Ribbon in 21" Maple Well is to meet all setback requirements `Ao� Ga N a9 ELEVATIONS BM = 100.00 ft B 1 = 97.50 ft B2= 97.08 ft B3 = 96.92 ft Lake = 79.75 ft ca cw� b%3 SCALE = 1:50 0 10 25 50 75 100 CT= 840/500 gal prefab concrete combination septic/pump tank made by Wieser Concrete wl Lifetime LT - 1/8 Filter, Sim -Tech STF-100 Filter and Champion CPS5 Pump AA= Absorption Area consisting of 50ft of Geomat 3900 arranged in a 6.25ft x 52ft cell Property Owner: Raymond H & Michelle K Lee TrustE 727 Martin Ave Hudson, WI 54016 Plumber: Travis Butterfield 14346W St Rd 77 Hayward, WI 54843 r( I 1GARDEI ( LAKE 1I1� Page 9 of 10 a 1 FEATURES/BENEFITS PERFORMANCE Heads up to 28' TDH Flows up to 85 GPM MOTOR High efficient, 115v or 230v, oil filled, permanent split capacitor motor with upper and lower ball bearings and thermal overload protection - Constant bearing lubrication - Maximum motor cooling - Runs cooler and lasts longer - Internal overload protection - Quiet operation - Fasteners and shaft made from rugged, corrosion resistant stainless steel SEAL DESIGN Type 21 inboard seal design with secondary exclusion seal - Rotating components of seal are in the motor housing, being lubricated by the motor oil preventing foreign matter from wrapping around the seal components - Seal will last longer if the pump runs dry - Secondary exclusion seal keeps debris from entering the seal cavity PERFORMANCE CURVE IMPELLER DESIGN Non -clog style, cast-iron vortex impeller - Designed to help reduce clogging by foreign material POWER CORD Sealed entry quick disconnect power cords - Prevents water from entering the motor housing through a cut cord - Easy to replace in the field -Available in lengths up to 100' SWITCH Piggy -back switch design - Defective switches can be diagnosed over the phone - Pump can be operated manually or supplied with other piggy -back switches -Switch can be replaced without having to replace the pump APPLICATIONS Basements, dewatering, septic systems and truck docks E 102024 Zoning Dept. 1/2 HP submersible pumps that handle up to 11/4" solids with 2" discharge 0 10 20 30 40 so so 70 so Yo Gallons perMinute, GPM Champion Pump Company, Inc • P.O. Box 528 • Ashland, OH 44805 Page 10 of 10 Phone 419-281-4500 • Fax 419-616-1100 • www.championpump.com ND W840/500 -MR 113" TANK SPECIFICATIONS DIMENSI W 2 1/2" r\ IIII 4"\ ST -A -SEA IIII III FILTER 0 `� BAFFLE TOP VIEW INLET — 23' 1 U nI SIDE VIEW ANHOLE: 24" I.D. PRECAST CONCRETE RISER EIGHT: 59 1/2" O.D. LENGTH: 113 3/48" O.D. WIDTH: 93" O.D. 4" CAST -A -SEA BELOW INLET: 48" O.D. LIQUID LEVEL: 43" WEIGHT: 11,150 LBS. w ET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL INLET D OUTLET BAFFLE AND FILTER: m o WI CONSIN, SEE DETAIL #10 (0 ER STATES SEE CHART) o LIQUID CAPA ITY: 19.61 GAL/IN (SEPTIC) o 11.82 GAL/IN (PUMP) W ~ LOADING DESIG 8' 0" UNSATURATED SOIL W C D na (C) LU C8LU z DD G7 TANK N BE USED AS: a LC) 4" V T S /SEPTIC, SEPTIC/PUMP N OR S SIPHON W I O COVER: MIX DESIG 0 FIBER) W co TANK: MIX DESIGN UCTURAL FIBER) OUTLET CUSTOMIZED TANKS: —I- b FOR CUSTOM TANKS NTACT WI E�CONCRETE PUMP PAD TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: SHEET NO. %F1 850/520 2 -COMPARTMENT TANK LID 143" 83-112" 2" 51-1/2" -{ -----------------\ /-------- / \ / ( 1( 1 I II I II I 1 II 1 I II I II II I GALLONS ii 520 24.55 GPIJ \ GALLONS 14.86 GPI / \ / \---------------_/ ------ JOINT DETAIL 6" LID �t 40" 8"AIR SPACE 4" INLET 35" LIQUID DEPTH I--2-112" TAPER 3" FLOOR TOP VIEW SIDE VIEW 028" TYP. 024" TYP. I 4" OUTLET - (BAFFLE OR FILTER PER INSTALLER REQUEST) 73" 7' 52" 38" -3" WALL Ss-ou-ic.S... 1 p of Safety County X a Cte 1 d yTE// JIDe=ent Ponal Services, a Sanitary Permit Number (to be filled in OCT 10 .024 ustry Services Division rb�x`�r . 1 _ 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. 3Q(5 [1 iC 1't+pGn ) O.y Rd I. Application Information — Please Print All Information ./ Property Owner's Name Parcel # retr ,o: )YloB 'Ro. ,ntond N • M;che Ile K Lee Tru 4eE Oar-03Y-a-Y3.04'/Y•V 05-64f,0&600 Property Owner's Mailing Address Property Location 7 a V Pie Govt Lot Y City, State I Zip Code Phone Number W= SyO/(, (a51- oleo- 547 'A, '/.,Section T 9,3 N R O H. Type of Building (check all that apply) Lot # )C I or 2 Family Dwelling — Number of Bedrooms ela Subdivision Name Block # ❑ Public/Commercial — Describe Use ❑ City of ❑ State Owned — Describe Use ❑ Village of CSM Number CSM +� 103 1 r'fown of A/a»Yakaa o n v.4 p.3Yy Ill. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if applicable.) A. talvew System y ❑ Replacement System 0 Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank aln-Ground GecYr'tsf ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other I' a yp (explain) ppLL (conventional)WIGi rT C. ❑ Renewal Before Revision ❑ Change of Plumber ❑ Transfer to New Owner ist Previous Permit Number and Date Issued Expiration IV.Dispersal/Treatment Area and Tank Information: $( so(� 6ecrreJ JWO /a n 4. 5 ' . S t Ce II Design Flow (gpd) Design Soil Application Rate(gpdist) I Dispersal Area Required (st) Dispersal Area Proposed (st) System Elevation 300 Soo/,so tt(31D.5/1f.a.5 9Y.aS Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units 2 o -B u New Tanks Existing Tanks CO'rAAtK '� a a v" y s U Chm Cl) u, O P. Septic or Holding Tank p 3Y0 Dosing Chamber 500 — g0U V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's amre MP/MPRS Number Business Phone Number T-M,rs (3,hier%e Id G5a8'79 7,5-L 3Y Br7 Plumber's Address (Street, City, Slate, Zip Code) /Y3Y6W 54&4t• Read 1/11 Word, WX 59893 VI. County/Department Use Only Approved ❑ Disapproved Permit Fee Issuedh�'Issui g Agent Sign re❑ Owner Given Reason for Denial y(/(/Sate Conditions ApApproval/Reasons for Disapproval Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 Inches in size SBD-6398 (R. 03/22) OCT 102024 Notes/ Maintenance Requirements Bayfield Co. Zoning Dept. MANAGEMENT PLAN This private onsite wastewater (POWTS) has been designed, and is to be installed and maintained in accordance with SPS 383, Wis. Admin. Code, the in -Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0 SPS-1 0705-P (N.01/01). GeoMat in ground Component manual April 2019 Version . 1. This POWTS has been designed to accommodate a maximum daily flow of 30QiPRons of wastewater per day. The quality of influent discharge into the POWTS treatment or dispersal component shall be equal to or less than all of the following. A monthly average of 30 mg/L fats, oil and grease A monthly average of 220 mg/L BOD5 A monthly average of 150 mg/L TSS Wastewater shall not discharge to the POWTS in quantities or qualities that exceed these limits or that result in exceeding the enforcement standards and preventative action limits specified in ch. NR 140Tables I & 2 at a point of standards application, except as provided in DSPS 383.03 (4), Wis Admin. Code. 2. The owner of this POWTS is responsible for system operation and maintenance. 3. Defects or malfunctions identified during maintenance described above shall be repaired in conformance with SPS383 Wis. Admin. Code, and the pertaining county Private Sewage Systems Ordinance. The users manual, provided to the owner of the POWTS includes the names and telephone numbers of the properly licensed individuals to contact for such repairs. 5. No product for chemical or physical restoration or chemical or physical procedures for POWTS may be used unless approved by the Dept. of Commerce in accordance with SPS. 384, Wis. Admin. Code. 6. If the POWTS is replaced, or its use discontinued, it shall be abandoned in accordance with SPS 383.33, Wis. Admin. Code. NOTES Two Effluent Filters to be installed where possible 1 to be installed in ST, and or 1 in pump tank in order to insure particle size less than or equal to 1/8". Filters should be cleaned once in spring, and once in fall. Also, strainers in sinks in the building shall be maintained, so that solids and fats are minimized to flow into system. A minimum of 2 observation pipes per cell shall be installed. These pipes shall be located approximately at the end of each cell. The plumber, or county shall see to it that a copy of these plans including this page, maintenance folder, and maintenance agreement is given to the homeowner. This system may contain a dose chamber. If a pump, float, electrical outage causes the dose tank to fill, the homeowner should see to it that the effluent level in the tank is brought down gradually and not all dosed to the system at once. One large dose could cause damage. Contact a pumper or your installer if this problem occurs. The homeowner is responsible for formulating a water conservation plan that will ensure the system is rarely overloaded. I.E. spread laundry out over time, not 6 loads in 2 hours, while everybody showers, and uses the toilet, ETC. CONTINGENCY PLAN FOR COMPONENT FAILURE A. Septic Tank. Any structural failure resulting in cracks or leaks in the tank must be corrected by replacement of the septic tank component. Leaks in the joints between manhole risers or covers shall be repaired by replacing faulty seals with approved materials to make joints water- tight. B. Outlet Filter. The outlet filter shall be replaced or repaired when it is either no longer capable of preventing the discharge of particles larger than 1/8 inch or when it has become permanently degraded by clogging so as to interfere with the design flow out of the septic tank. C. Dosing chamber and pump. The dosing chamber shall be replaced if any structural failure is found. Leaks in joints between manhole risers or covers shall be repaired by replacing faulty seals with approved materials to make joints water -tight. The pump and controls shall be replaced when they are no longer capable of functioning according to the design plan. D. Pressure Distribution Piping. Partial clogging of the distribution network may result in unduly long dosing cycles. The ends of the distribution laterals may be exposed and the threaded end caps removed. The piping can be disconnected on the outlet end of the pump. The distribution piping may then be back flushed to cleanse any accumulated matter from the piping. It is recommended that the dosing chamber then be pumped by a licensed plumber. E. Soil Absorption Cell. The discharge of sewage or wastewater to the ground surface is strictly prohibited due to the human health hazard created by the effluent. All failures created by surface discharge shall immediately be reported to the appropriate county. The pump shall then be immediately disconnected to prevent further discharge to the ground surface via the soil absorption cell. The existing septic tank and dosing chamber shall be used as a temporary holding tank until the necessary repairs to the soil absorption cell can be achieved. The replacement shall be initiated only after any necessary plan approvals have been obtained from the appropriate plan review authority and the required sanitary permit is obtained from the county. Project: Lee - 23965 Michigan Bay Rd Page 5 of 10 Private Sewage System Maintenance Agreement )Name H Lee Trustees 727 Martin Ave. Hudson, WI 54016 23965 Michigan Bay Rd 24708 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 W� Adm. Code, as from time to time amended. (COMPLETE Legal is required) 1/4 of 1/4 Section 14 Township 43 N. Additional Legal Description: LEE FAMILY TRUST DTD 12/06/2011 Town of Namakagon (Acreage) 2.6 Gov't Lot 4 Lot_ Block Subdivision Lot 2 csM # 1031 vol. 6 Page 349 CSM Doc #-47 c3 DOCUMENT NUMBER 2O24R-6O5O57 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 10/10/2024 AT 1 1:27 AM RECORDING FEE: $30.00 PAGES:1 Return To: Area Planning and I g Qe%lrtle�t V E D 15 (OTT L1 11 ?n?4 ❑ 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, Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds, At -grade, and In -ground Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall 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 shall be binding upon and inure to the benefit of all current and future owners of such property. Owner(s) Name(s) — Please Print Subscribed and sworn to before me on this date: ►Zoyrnend H Lee 2a"STS Ocitbe ✓ t o 2024 `,,,N��rnuurnugr ,����HEYF , _, Notarized Owner(s) — Signature(s) ptary Publi -Heys 5 i > a-.— , PWCommission Expires: N•° ., `: Drafted by: F nald Spreckels Jr Date: 10/08/24 Proofed by: ulfomis/sanitary/septicmaintenceagreemen l Revised July 2020 10/17/24, 3:19 PM CarmodyTM BAYFIELD COUNTY SANITARY PERMIT (#04)-24.,-165S STATE SANITARY PERMIT OWNER: RAYMOND H & MICHELE K LEE TRUSTEES GOVT LOT: LOT: 2 BLK: CSM: 1031 SUBDIVISION: Csm #1031 1/4 1/4 SEC: 14, T 43 N, R 6 W TOWNSHIP: Namakagon SOIL TEST: 164-24 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: Travis Butterfield TRACY POOLER Authorized Issuing Officer DATE: 10/18/2024 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: 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: # 652879 Condition: System to meet all setbacks. Management plan to owners. Properly maintain system per recorded agreement. THIS PERMIT EXPIRES 10/18/2026 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=7402 1/2