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HomeMy WebLinkAbout24-183S"' INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY •^ • TIME RECEIVED REMOTE CSID DURATION PAGES STATUS Deceatler 23. 2024 at 12;20;04 PM CST 7157983470 37 1 Received DEC/23/2024/M0N 12:00 PM Andry Rasmussen & So FAX No.7157983470 P.001/001 Request 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 me Change fl Discrepancy fl Other Phone Number Plumber: iliidrq &?JYtliiS3Pn T . k Y7S `7 S- —,335. Fax Number 7is- ff- Homeowner: �P �0fl(k Lynn Sh%fn 1 Emall Address �' ti Yfl4SFLrirt 11 Ussardr sr �� Immediate Phone Number So Zoning Sanitary Permit#: 49- /83 Dept can call you right back (If needed) Plumber's Choice Zoning Dept No Inspection(s) during this time Date: `- 14?Plumber's Tuesday (9:30 am - 12:15 pm) (Tracy) Time: Ch Zo Dept 8:36a.m Township: Address # & Road Name: or 5/Q3 w,f cAs j3Gt� �O Directions To Site: Comments: Plumbers you must verify any ciiange(s) by fax or email Notes from u formslsanitaryfrequesifofinapection Zoning Dept (4/1VO4); c7 JUn9 2023 Private Onsite Wastewater Treatment Systems ( POWTS) Inspection Report (Attach to Parrnit) Industry Services Division General Information JEFFREY & DONNA LYNN SIMENSEN Personal information you provide ms 241 1 m BO BOXa Permit Holders Name: BRIDGEPORT CA 93517 9 Town of: CST BM Elev: Insp BM Elev: BM Description: Nck is, Wa-t'1 r on base of t( . r tcxY 61 ank Information setback to: County p� //'�� � k elerm�it Sanitary q- No. 1 IQRS State Plan Transaction ID#: Parcel Tax No: TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road Septic N/A Dosing N/A Aeration N/A Holding Pump I Siphon Information Pump Manufacturer ump Model Demand GPM Filter Manufacturer ilter Model TDH Lift Friction Loss Head Total Forcemain Length Dia Dist To Well Dispersal Cell Information DIMENSIONS Width Length # of Cells SETBACK FROM Prop. Line Building Well OHWM Type of Cell Manufacturer: Model Number. Pretreatment Unit Manufacturer: Model Number. )istribution System Header I Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length _ Dia Length Dia Spac _ Spacing ❑ Yes 0 No Elevation Data Plumber pro, tcka STATION BS HI FS ELEV Benchmark too' 10 Bldg. Sewer L .SS ' g8.09' Tank Inlet (,o� Tank Outlet ' 9:S' Dose Tank Inlet Dose Tank Bottom Inst. Contour Header/ Manifold 81 Distribution Pipe Infiltrative Surface 8.8' 3 (�1 t Final Grade X Pressure Systems Only Soil Cover Depth Over Depth Over Depth of Seeded / Sodded Mulched Cell Center Cell Edges Topsoil 0 Yes ❑ No ❑ Yes 0 No COMMENTS: (Include code discrepancies, persons present, etc.) Ss, sta rT'dt 2 fett Flow or I e\eV oc _ 3C t4 o H 6o\ (etDO (* -h-1s Ghc n �t e is c Zc&1 J. DCp� *rY'QM nod prQser\# fi' t1lSf-a\\ , P\umber SgnkJ pr M- Zle G%o (\S, Plan revision required? ❑ Yes,No Use other side for additional information. ►aoiS-PI Date POWTS Inspector's Signature SRn171n !R n4l911 License Number i 4 Property Owner Information As you know BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715)373-0114 e-mail: zonine(&bayfieldcountv.wi.00v Web Site: www.bayfieldcounty.wi.00v/147 JEFFREY & DONNA LYNN SIMENSEN PO BOX 241 BRIDGEPORT CA 93517 onsite wastewater treatment system on your property described as: Notes: Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 was contracted by you to install a private Abandonment of Old System to meet all applicable code requirements: ❑ Tank was pumped by: on at AM/PM ❑ C. Tank was crushed / removed and pipes disconnected by: On 12)2(4 2'-1 at :o A( I I / PM) the above -mentioned plumber contacted our office to conduct a pre -cover inspection as required under DSPS 383. One of the following applies: ❑ System was inspected and appears to meet all applicable code requirements. ❑ System was inspected and appears to meet all applicable code requirements; however, a plan revision is necessary because the installation was substantially different than the original approval. System could not be inspected because plumber covered prior to scheduled time of inspection. ❑ System could not be inspected because plumber was not ready at scheduled time of inspection. County was unable to return to complete inspection. System could not be inspected because plumber was not ready at scheduled time of inspection. A re -inspection and $50 fee are required. System could not be inspected because County could not respond to plumber's time constraints. Comments: Peehok-os on c� e\cvc<FiaY�S k b�-+ pK rnoer Suctxr .tn *c \�aa \Lj324 bCk Ye SI Akj≥�¼Yec)11OV� Uttormslsanilarypropertyowner-input April 2919 n I 1 I "i_f r t. I � S x " I �� ;✓>j i.. t•'� t ))F .-l� � '. . I � Iva c i , ' � It X41 1, !�l li. i.. v, ! v'a� i I�;S a �t vF vy, .@.' ;j'�J ,N. I. 'i. id fit' ,S.,, fag ; (r rJ «rte jft p ,• Wd � 1 F Ruth Hulstrom From: Ruth Hulstrom Sent: Monday, December 23, 2024 11:18 AM To: tim@andryras.com; missy@andryras.com Cc: Savannah Piff; Trent Wiesner Subject: RE: Andry Rasmussen & Sons - Jeffery & Donna Lynn Simensen Coverup Good morning, If you install today, please be aware that the system will need to be left open until Thursday, December 26`h given that Bayfield County offices are closed for the Christmas holiday tomorrow and Wednesday. State regulations allow the department 24 hours to complete an inspection on the system before it is covered, which does not include holidays or weekends. Thanks, Ruth Hulstrom, AICP I Director Planning and Zoning Department 117 E 5th Street, PO Box 58 Washburn, WI 54891 Phone: 715-373-3514 Fax: 715-373-0114 Email: mth.hulstromi(a.bavfieldcoun y.wigov B*YFIELD From: Savannah Piff <savannah.piff@bayfieldcounty.wi.gov> Sent: Monday, December 23, 2024 11:11AM To: Ruth Hulstrom <ruth.hulstrom@bayfieldcounty.wi.gov> Subject: FW: Andry Rasmussen & Sons -Jeffery & Donna Lynn Simensen Coverup Savannah Piff I Clerk II Planning and Zoning Department 117 E. 5th Street, PO Box 58 Washburn, WI 54891 Phone: 715.373.3510 From: tim@andrvras.com <tim@andrvras.com> Sent: Monday, December 23, 2024 10:19 AM To: Savannah Piff <savannah.piff@bavfieldcounty.wi.gov>; missv@andrvras.com Cc: Zoning <zoning-internal@bayfieldcountv.wi.gov> Subject: RE: Andry Rasmussen & Sons - Jeffery & Donna Lynn Simensen Coverup Good Morning, Our crew is working tomorrow and will provide an adequate as -built and pictures. Merry Christmas. Timothy J. Clark PE Manager —Septic Department Rasmussen & sue. me ":A Family (fined Busiaess Since 1946" From: Savannah Piff <savannah.pill@bayfieldcountv.wi.sov> Sent: December 23, 2024 8:51 AM To: tim@andrvras.com; missy@andrvras.com Cc: Zoning <zonina-internal@bayfieldcounty.wi.gov> Subject: Andry Rasmussen & Sons - Jeffery & Donna Lynn Simensen Coverup Good Morning, The request fora sanitary inspection for the Simensen Property cannot be completed today as we need a 24 hour advance notice to schedule. Because of the upcoming holidays, the soonest we can schedule appointments is 12/26/24. Please resubmit for a different date with the following guidelines to get this scheduled in. Thank You & Happy Holidays, -Savannah Savannah Piff I Clerk II Planning and Zoning Department 117 E. 5th Street, PO Box 58 Washburn, WI 54891 Phone: 715.373.3510 -`i• r Industry Services Div ision County 41(22Madi n r(s a r Bayfield \Itlll lino r�4' 3'tlJ5� V 1 S;niulimn Number (to he tilled ml+)Co) zoz4 .sPf �. I)�ox 77350y2� 1r� Jn-'-i y I,I x1rtU41 -LI L D - IC3S Sanitary Permit Application p ( State Tmnseiion Number In accordance milt SI'S 353 21(2). Wi Allot ('ode. suhmisston of this ilinu Rrinvl�((�ra(�riut pril�rrr�nlirPtlittitimit is required prior Co obuining a saniu0y permit. Note Application Toros for state owned POWTS are submitted to Protect Address (if dulirent than mailing address) the Ikpartment oiSald) and I'rofessnm;d Seniccs Personal mlimnation von provide may he used fm setrnukm Pursues in accordance lwth the lkn;w% l.au. s 1504(11(111). Slate 51920 Witchs Bay Rd. Barnes, W I Jeffrey & Donna Lynn Simensen Copy Property Owner's Mailm_ : W dress PO Box 241 ('a<. Slate Zip Code Phone Number Bridgeport, CA 93517 715-450-6011 II. Type of 13uiWing (check all that apply) Lot a aI or 2 Pamdl Duelling - Number ol'lledrooms 1 2 ❑I'uhle/Conunercial - Describe Use t3lock if I'lSL•ne Owned - Ikscrde tlx• r�., .,.._�.. 3175 I'ropertl Location (jolt Lot '. 5. &ttinn 35 •,45 e n 09 #1177 V7 P228 0lrnlnof t3annes Ill. Type orlOW'TS Permit: (Check either"New" or "Replacement" and other applicable on line A. ('heck one box on line B. Complete line C i u livable. A r t �J ew Sm ❑ t steReplacement System ❑they \hWilieation lu I :fisting System (ecplaml ❑Addntunal Pretreatment amt (septum B. I D id' JIn-Ground ❑\t -Grade ❑\lmmd jlndividualSiteflesig,t Other Tlpe (ecplam) (conlentionulI C. Renewal Before ❑Revts,on lchange orilum(er [Jfratster to New Owner List Previous I'emut Number and Dane Issued Ecpuauon NA IV. Dis ersadTl'rcalment .\ren and Took Infnrmatiun: Design Flow (epd) I Design Soil Application Ita(elupd/sll Dispersal Area Required (s0 Dispersal Area Proposed (sl) System Elevation 150 0.7 214 1226 198.0 Capacnl in I Total I P of I ManuIwturer Gallons (ialhuw IhuLs * � _ F5- rank Infomtatimn 'L Lwwnp Tanl. .� G c 1.2- z n v. IaL ... r nxm rtolmnp mss 320 Dnunp ('lumber V. Responsibility Statement- 1, (he undersigned, Plumber's Name I Print) Phr. Jason Kuettel Plumber's Address (Street, ('ny. State. Yip Code) PO Box 66 Cable, WI 54821 V. ('ounly/Drpartmenl Use Only Approved O Oisalppioved /T'- ❑ (klner tin en itr.nnn nix 1 )curl Conditions of,�,proval/1(ensons Ihr I)isappnn of 320 1 Wieser I J 1 I Ill III C assume responsibility for installation of tire POWT'S shown on the attached plans nher's Sienmurc MP/MPRS Number Business IMnnlc Numhc 675751 715-798-3355 to tire ( uunI, not' m, Inner not te.. dun x I S13D-6398 (R. 02122) N:aPW flU o5elety snG7 d ;-�— Soil Evaluation Report OC 2 2 nw„pa�,athr se �e, 2('14 ,n attomance wren SPS Jos,VA, nam coax Attach complete site plan on paper not less than 6% X 11 inches in size. Plan must include but not limited to: Vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, location and distance to nearest road. Please Print All Information Personal information you provide may be used for secondary purposes. (privacy Law,s.15.04(1)(m)). County: Ba field Parcel I.D. 3175 R Yi we By: 6 LL� ' . {t Date: 1 0) 3i (2j - Property Owner: Jeffery B 8 Donna Lynn Simensen Property Location S35,T45N,R09W Property Owners Mailing Address: PO Box 241 Lot: Block: ISubdivision 0 Name or CSM # City Bridgeport State Zip Code jPhone CAI Number: 0 Town INearest Barnes Road: Witches Bay Road Number of Bedrooms: 1 Code derived design flow rate: ( New r Residential 150 (J Replacement r Public or Commercial - Describe: Parent Material: Flood Plain If Applicable: General Comments & Recommendations: System Elevation: 95 Boring #1 I Bor f� Fit Ground surface Elev: Depth to Limiting Factor: 97.22 Ft. 120 In. Soil Application Rate: Horizon Depth in. Domm.Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPO/ft' 'Eff#1 Eff#2 1 0-4 7.5YR2.5/1 N/A SL 2MSBK MFR CS 3M 0.6 1.0 2 4-12 7.5YR416 N/A LS OSG ML CS 3M 0.7 1_6 3 12-120 7.5YR4/4 N/A MS OSG ML N/A N/A 0.7 1.6 4 5 6 7 (^ Bor (� Fit Ground surface Elev: Depth to Limiting Factor: Boring #2 100.25 Ft. 130 In. Soil Application Rate: Horizon Depth in. Domm.Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft' 'Eff#1 Eff#2 1 0-6 7.5YR2.5/1 N/A SL 2MSBK MFR CS 3M 0_6 1.0 2 6-10 7.5YR4/6 NIA LS OSG ML CS 3M 0_7 1.6 3 10-130 7.5YR4/4 N/A MS OSG ML N/A N/A 0.7 1.6 4 5 6 7 'Effluent #1 = SOD 5130 < 2 20 mgi7 and TSS>30 < 150mgA _ 'Effluent #2 = 8OD 5 < 30 mgi and TSS < 30 mg/1 CST Name (Please Print) Mark S. Thompson 5 gnature \ CST Number: 877598 Address: 12006 N US Hwy 63 Hayward, WI 54843 Date Evalua ondu ted: Wednesday, October 16, 2024 Telephone Number 715/699-4081 I SBD-8330 (R04/15) Bayfleid Co Znnlnn Dr -r,, Page: 1 of 6 - ,e `1&A4..t C. Property Owner: Jeffery B & Donna Lynn Simenser Parcel I.D. 3175 Page: 21 I EaVE OCT 2 2 2024 D Boring # 3 Ground surface Elev: Depth to Limiting Factor: f Bores At 98.59 Ft. 120 In. Soil App.:Rate Horizon Depth In. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft' 'Eff#1 Eff#2 1 0-8 7.5YR2.5/1 N/A SL 2MSBK MFR CS 3M 0.6 1.0 2 8-14 7.5YR4/6 N/A LS 0SG ML CS 3M 0.7 1.6 3 14-120 7.5YR4/4 NIA MS 0SG ML N/A NIA 0.7 1.6 4 5 6 7 Boring #4 Rt Ground surface Elev: Depth to Limiting Factor: r Borr t 0 Ft. 0 In. Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft' -Eff#1 Eff#2 2 3 4 5 6 7 Boring #5 r Borr Fit Ground surface Elev: Depth to Limiting Factor: 0 FL o In. Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh, Consistence Boundary Roots GPD/ft' •Eff#1 Eff#2 2 3 4 5 6 7 Boring #6 r Bor7 Pt Ground surface Elev: Depth to Limiting Factor: 0 Ft. 0 In. Soil App. Rate Horizon Depth in. Domm.Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr.Sz.Sh. Consistence Boundary Roots GPD/ft' Eft#1 Eff#2 2 3 4 5 6 7 'Effluent #1 = BOD 5>30 < 2 20 mg4 and TSS>30 . 150mg/I Effluent #2 = BOD 5< 30 mg11 and TSS < 30 mg/I The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777 Dept. SBm8130{R 07!00) OCT 2 2 2fi 024 Soil Profile Sheet Page: 3 led Owner: affery B & Donna Lynn Simens Soil Tester: Mark S. Thompson System Elevation: 96 Load Rate: 0.7 ISystom Elevation: 92.42 To 96.22 101 B2 101 83 101 BI 100 100.25 100 -- 100 0.7 System 99 — 99.42 $ 99 — 99 • Elevation 0.7 98_59 98 98 98 0.7 97 97 97_42 $ 97 97_22 -- .7 0.7 96 96 96 96_22 — _ — 0.7 95 95 ------ 95 94 94 -- --- 94 93 93 --- 93 92 92.42 92 ------ 92 91.59 91 91 91 — rT 90 90 -tT 90 90.22 89 89_42 89 89 -- L.F. 88_59 r3' 88 88 L.F. 88 87 87 87 87.22 86 86 --- 86 85 85 85 84 84 84 83 83 83 82 82 82 - 81 81 81 80 80 80 ----- 79 79 79 Zoning Dept. Owner Information: Name: Jeffery B & Donna Lynn Simensen Location: S35.T45N.R09W Township: Barnes County: Bayfleki Lot #: 0 To Wit hes B_ Only in Tested Area 'pBM=100: Nail with ribbon on the base of tree near 81 B1 = 97.22 B2 = 100.25 B3= 98_59 Lake= 77.43 m m O u CST: f k S. Tho son-\ C a N uti X N N o # 598 . 715/699-0081 �O O N ' G In -Ground Gravity Plan Index & Cover Sheet OCT 2 22024 D Component Manual Design References: Bayfield Co. Zoning Dept. In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Pg 2 of 4 Pg 3 of 4 Pg 4 of 4 Attachments: Index & Cover Sheet Plot Plan Dispersal Area Cross -Section & Plan View Management Plan F Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Simensen 1 Bed Owner Name(s): Jeffrey & Donna Lynn Simensen Phone: 715 Owner Address: PO Box 241 Bridgeport, CA Zip: Project Address: 51920 Witchs Bay Rd. Barnes, WI Govt. Lot: Township: Barnes Project Parcel ID #: 3175 1/4 of Designer Name: Jason Kuettel -450 -6011 93517 1/4, Section 35 T45 N -R 09 E ❑ or W ❑✓ County: Bayfield Designer Information Designer Address: PO Box 66 Cable, WI E-mail: tim@andryras.com License Number: 675751 Remarks: Phone: 715 -798 -3355 Zip: 54821 //' Signature: Date: __ Original signa)CirWrequired on each submitted copy. Owner Information: BM=100: Nail with ribbon on the base of tree near B1 Name: Jeffery B & Donna Lynn Simensen Location: S35.T45N.R09W B7 = 97.22 Township: Barnes B2 = 100.25 County: Bavfield B3 = 98.59 Lot#: 0 Lake= 77.43 - - - - / / / No Well rcr0 / M+� nttnrc Fir_TL" BM Propesed House 'A" 98' To WitTo Wit he� 100' N WE 1"=40Only in Tested Area I L1 B3 r m (t7 c► y6` qcy-4 C"I.Gc"t3 a Zr C-) —i c= o N .. O � N N � /AP (pic75 i a I*(tc/Cr IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER 2" min. trench depth (typical) Septic Tank(s) Manufacturer. Wieser Septic Tank(s) Volume(s): 320 gal gal gal gal Effluent Filter Manufacturer. Orenco Effluent Filter Model #: FT -0822 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) System Elevation = 96.0 ft (typical) Quick4 Standard -W w/ End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) r- -----------752---------7----- ------------ --------; `_ B= 46 ft (typical) INSTALL PER TRENCH: 11 Quick4 Std -W @ 20 ft' EISA/chamber = 220 ft' + 1 Pairs of end caps @6 ft2 ElSNpair = 6 ft' = Proposed EISA per trench = 226 ft2 Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturers / instructions. TYPICAL TRENCH PLAN VIEW (No Scale) IA=3.0ft (typical) C) m `Quick4 Standard -W Chamber W (typical) 0 (mfd by Infiltrator Systems, Inc.) -n Install pursuant to manufacturers Instructions. Cu Required Infiltration Area = 214 x 1 trenches = Proposed Total EISA = 226 TP ft2 Distribution Metho t N branched manifold ft2 IC T?JIK CROSS SECTION AND LI Sct(.40PVC INSP. DT E 5 HIN, ABOVE JGR;.D'.(op ) (when nlF te+ i+.a.�.�o�e s burl _(I ) 1/FINISHED GRADE • 18" HIN. I jILET cj APPR D BA•Ff3—E— I OR APPROVED INEC. O%enCto PIPE 3' DUTO SOLID model a To$Z,z SOIL 3" APPROVED BEDDING UND�.P, TAN); SPECIFICATION$ SEPTIC TANK HANUFACTURER: WiES_ .. CcNc, rE TANK SIZES.' SE'TIC 7th GAL. — NJOTES " DBa le/d Co. 2024 00n/ogAq* 0V ED MANHOLE W/ Lc4. lN/fR✓lNE LABEL 4" HIII. OUTLET I Industry Services Division ('ring 4R?? adi,n����{a s n Pit it mtLy4'n3IS11w Ba field tiara Box 7302 tare Perm itNumber(to be tilled mby ('o1 - 1r� r1 L „IlellsmlUt.l r - l 32 LI L Lo24 Sanitary Permit ApplicatioIl Stale Transaction Number 11 In acciirdanw ce nh SI'S 3s3 2112Mm). Wt m ('tide suhnussion ol't is li+m1 i+`�BeP'pprlll(or�a MnlvPpmnt is required prior to obutimng a sonitary permit. Note Application Totals ('r sine+owned POWI' are submitted to Project Address (il'dl0ircnt than marling address) the Ikpanment ofSafel) :aid Professional Senices Personal ndbnn:nion you provide nu y he used lie SettnlJary 51920 WitChs Bay Rd. Barnes, WI purposes in accordance tdlh the I'rivay I.rn'. S l UAI I pmt. S1ais I. Application Information — ('lease Prinl All Information Properly Owner's Name Parcel q Jeffrey & Donna Lynn Simensen 3175 Property Owner's Mailing Address Property Location PO Box 241 cwt, lot City. Sege I Zip ('ode phone Number Bridgeport, CA 93517 715-450-6011 -% ti. Sccliol 35 T45 N R09 for \V II. Type ofBuilding (check all that apply) Lot a ❑✓ l m 2 l'amdy Dwelling - Number nl'Bedroonis 1 2 Sulido ision Name �ekII PuhhelCmnnicreial - Describe Use Bl ❑Cnc of State Owned - I h:scnbe Use _ Viilageol' CSM Number #1177 V7 P228 p✓ Iownof Barnes Ill. Type of PO\\'TS Permit: (Check either "New" or "Replacement" unit outer applicable on line A. ('heck one box on line 11. Complete line C it n licable. '\ ew System ❑Re lacemem System p hher \Itidika11t, t.. ISISIIng System ev lain) I' P' Wdntunal I'retratn ent unit es Mal O 1 p. U. 'lank In•Ground ❑\t.Grade IDMotmnd Individual Site Deslpn Other'1ype lesploml (eomenmmul l C. Renewal Belbre [3Revlsiun 'hanae of l'Iumter ❑frmtsli•no Sew t hree list l'revious Permit Number and Date Issued P.ypiration NA W. Dis ersulffreatment Area and lank Information: Design Flow (gp.) Design Soil Application Itate(gpd/sn Dispavd Area Required (s0 I Dispersal Area Proposed jsf I System lilevotion 150 0.7 1214 226 96.0 Cupaap in 'loud h of Ma utitcturer 'funk Information Gallons Gallons Itnas r• a' u v dew looks I•liemp Tank, sep cotllolding'Imtk 320 320 1 Wieser ✓ D"Unp('nan+1w, O O V. Responsibility Statement- I, the undersigned, assume responsibility for installation or the POWYS shown on the attached plans. Plunder's Name (print) Plumber's Signature MPMPItS Number Business Phone Number Jason Kuettel 1675751 715-798-3355 Plumber's Address (Street. City. State, Zip Cork) PO Box 66 Cable, WI 54821 P' ('ounty/Oeparlment Ise Only Approved C Disapproved Per c F oit Pre y Date Issued Isss og A •nt ' tore <�/1 O� L ❑ Darer flown Iteacon for Donal IllO \ IZ-k-IL— C'onJilio ol'Appmyal/Rensons rr Diappmyal Anon . Io rnmpleie plan. for the s '-t m and suhmh in Ihr ('m,mr "nl, on VaPer n"I In, than 8 14 e II lobe, In OLr SBDdi398 (R. 02122) E op�(�f4�o 4 In -ground Gravity Management PIa0CTL�0 IMPORTANT: 222 .02q BaYfield Co. Zo The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance Lftdptto 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 = 150 gpd; BOD5 ≤ 220 mgL''; TSS ≤ 150 mgL''; FOG ≤ 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: Andry Rasmussen & Sons Local government unit: Bayfield Co. Zoning Phone: 715-373-6138 Phone: 715-798-3355 Local government unit address: 117 E 5th St. Washburn, WI ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. Private Se -Vale System Maintenance Agreement DOCUMENT NUMBER 2024R-6051 97 E facr S /Ann -Je" 9-- tbON S)A,\cNSaN Owner(s) Mailing Address Po go f. z•it ;fie v36te02; crt 9351? SiflU 1/t'TZfl L2•Ty ZV, ?AR -`J, NL Tax ID# �17S 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 1/4 Section 35 Township `1S N. Range 09 W. Additional Legal Description: Town of QAZNCS Lot_ Block Subdivision (Acreage) Z• Cl i Gov't Lot Lot Z CSM# Iti7 Vol.�Page ZB CSM Doc# 80973 I DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 10/22/2024 AT 1:10 PM RECORDING FEE: $30.00 PAGES:2 Return To: Area Planning and Zon � D4 allfdldf�t II V r D OCT 232024 �f 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, 0, 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. I�Ont'�qStr'Y1�nS �[\ N . Signature(s) Qtr j7e 4 Draflea by. '/f.& Ltalttt Date: to/IS/ti Subscribed and sworn to before me on this date N Public. tme& Pat lG My Comn-i ND ✓ i �/ 2021 Proofod by ulfomls!sa nil aryl septicmainlenceagreemenl OCT 237024 CALIFORNIA ACKNOWLEDGMENT Bayfield Co. Zoning Dept CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of CaliforniaMt�`` tt County foff1`MONt C On uCl s�i�►" I. 1 Z4 before me, 4 IV D e r Here Insert Name personally appeared Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capac'Ity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument DANIELLE S. PATRICK Notary Public' California 4 Mora County Commission r 2471685 My Comm. Expires Nov 14, 2027 Place Notary Seal and/or Stamp Above I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature Signature of Notary Public OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document Description of Attached Title or Type of Documel Document Date: /y//5/5/fI Signer(s) Other Than Named Above: Capacity(les) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Individual ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer is Representing: ©2019 National Notary Association of Pages: Signer's Name: o Corporate Officer — Title(s): o Partner — O Limited O General ❑ Individual ❑ Trustee ❑ Other: Signer is Representing: ❑ Attorney in Fact ❑ Guardian or Conservator 5)MP,�1Sr� 1214/24, 9:41 AM CarmodyTM BAYFIELD COUNTY SANITARY PERMIT (#04)-24183S STATE SANITARY PERMIT OWNER: JEFFREY B & DONNA LYNN SIMENSEN ENSEN GOV'T LOT: LOT: 2 B LK: SUBDIVISION: Csm #1177 1/4 1/4 SEC: 35, T 45 N, R 9 W TOWNSHIP: Barnes SOIL TEST: 181-24 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: jas CECE RUDNICKI DATE: 12/4/2024 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: # 675751 Condition: System to meet all setbacks. Management plan to owners. Properly maintain system per recorded agreement. THIS PERMIT EXPIRES 12/4/2026 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=7423 1/2