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Home My WebLink About23-43SRequest for Sanitary Inspection Fax this form to Zoning Dept when you w PAld' ant an inspection — 373-01 14 If you do note a fax and must email the inspection; you must email all stae €f members� _ t� Time Change ®° iscrepancy Other fZ QS Phone Hu Plumber: Lr�SizliC« L ✓ � his—ci3 � 9f Fax Num Horne Dwreer: 5 {A�ff� pVrl(JG'0 Sanitary j perm tg: �_• wevece zoning Dept (-W/ j Aso inspection during iheea Dc I v�Bdl ® 9:30 am —12.30 pm Tues. (Tracy) 12.00 pm-2:00 Dm Wed. (Todd) 9:30 am —12:30 pm Thurs_ (Tracy) Time: Plumber's Choice Zoni t 10.106 --) 0; ?) a-1K ®A immediate Phone dumber so Zoning Dept can call you fight back (ia needed) Township: c dreas $ & Road Name: or Directions Comments: Reminder: You must confirm.any changes) that have been made prior to ih)s insoa on will not be scher"JI211 and a memo trill be sent voiding fhe inspection. or 1=rara shank You! PlUmbermusf eser'fy any change(s) by fax or $ cgs®n wi/I be cchedralsci u1'"-sanHary/n:quesfrorinspactton Zoning r)W (®4/121Q4) 0 August 2021 w - SP Industry Services Division General Information Pomnnal infnm fitm_vo jdde.=) be STALTER PROPERTIES LLC E4063 STATE RD 72 MENOMONIE WI 54751 Private Onsite Wastewater Treatment Systems ( POWTS) Inspection Report (Attach to Permit) City Tank Information satbackto, Town C&41ejd__) Sanitary ermit No: a3- �3S State Plan Transaction ID#: Parcel Tax No: TYPE MANUFACTURER CAPACITY Prop, Line Well Building Air Intake Road Septic 01 7 S` 716, N/A Dosing N/A Aeration N/A Holding Pump / Siphon Information Pump Manufacturer Pump Model Demand Filter Manufacturer b a I Filter Model �� DO GPM TDH Lift Friction Loss Head Total Forcemain Length Die Dist. To Well Disnersal Cell Information DIMENSIONS Width3. Length i tole #of Cells a SETBACK FROM P%Line Building Well I OHWM ' Type of Cell Manufacturer: W 1Y). Wft Model Number: Pretreatment Unit Manufacturer: Model Number: Distribution Svstem Elevation Data STATION BS HI FS ELEV Benchmark 0.0 100 IW Bldg. Sewer Tank Inlet Tank Outlet 3 -� Dose Tank Inlet q Dose Tank Bottom Inst Contour Header / Manifold 5 Distribution Pipe Infiltrative Surface v ND Final Grade old out ,a 9 . a Oldili'aW W X Pressure Svstems Onlv Header / Manifold Distribution Pipe(s) X Hole Size X Hole 1 Ob ation Pipes Length _ Dia Length _ Dia _ Spac _ Spacing ffYes ❑ No Boil Cover Depth Over Depth Over Depth of Seeded / Sodded Mulched Cell Center Cell Edges Topsoil es ❑ No 1 1.121yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 11 i VI lei d'YM* Ile CIA Ylgff Plan revision required? ❑ Yes 911110 1 3 Use other side for additional information. 0 Date POWTS Inspectors Signature qRn-R71n to m/911 License Number _4W Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Bayfield County Courthouse Fax: (715) 3734114 Post Office Box 58 e-mail: zonino(a).bayfieldcounty.wi.aov 117 East Fifth Street Web Site: www.bayfieldcounty.wi.gov/147 Washburn, WI 54891 STALTER PROPERTIES LLC E4063 STATE RD 72 MENOMONIE WI 54751 As you know �Qi h�� 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: on at AM / PM ❑ Tank was crushed I removed and pipes disconnected by: On _ Q 13 at 10�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: U/forms/saniterypmpeayowner-input April 2019 C p.\n\if Department of Safety County BAYFIELD 9= MAY 19 2 23 & Professional Services, ENiEitE 'in 1 �t Industry Services Divisio 5-a ni� Permit Number( be filled Co.) /t%� Sanitary Pennit Application State Transaction Number NA In accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes m accordance with the Privacy Law, s. 15.04(1)(m), Slats. 46375 CRYSTAL LAKE RD I. Application Information - Please Print All Information Property ownc's Name Panel # STATLER PROPERTIES LLC I14A 11 Property Owner's Mailing Addre Property Location E4063 S.T.H. 72 Govt Lot 5 City, State Zip Code Phone Number MENOMONM, W1 54751 a-Ja- a y. v, section 32 T 44 N R 06 XXO W IL Type of Building (check all that apply) Lot # CXor2 Family Dwelling-NumberofBedroo5ms 1 Subdivision Name ❑ Pubtim c/Conercial-DescnbeUse NA Black# NA ❑ City of ❑ State Owned -Describe Use ❑ Village of CSMNumber #1000; V6, P284 GRANDVIEW IIL Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C applicable.) A" New System ys Replacement ep System X Other Modification to Existing System ❑Additional Pretreatment Unit (explain) (explain) upgrading to a 5 bedroom system B. ❑ Holding Tank 7XIn-Gmmd ❑ At-Gmde ❑ Mound ❑Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration 298259/08-25-1998 IV. DispersaVrreatment Area and Tank haformation: Design Flow (gpd) 450 Design Soil plication (gpd/sf) � Dispersal Area Required (sf) ✓ Dispersal Area Propos sf) System Elevation 642.86 652 .� 93.40 FT.I/ Capacity in TOW # of Manufacturer Tank Information Gallons Gallons Units w C u tS y �u v a New Tanks Exisfivg Tanks 10 Septic crHoldmg Tank 760 1000 17601 1 1 RASMUSSEN Dosing Chamber V. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plama. Plumber's Name ( ' t) PI s Signs MP/MPRS Number Business Phone Number Plumb ssJAdddreess (Street, City, State, Zip Code) r�,t Part --a, / �- � / I � I— U (T� Z w!i� 5Q&q VL Comity/Department U�see Only Approved ❑ Disapproved Date Issued Issuing p t Signature �• ❑Owner Given Reason for Denial $ IPqonWutFN- 5� / R Conditions of roval/Reasons for Disapproval b rn fi a1� Jaw& a) YYu� g Dta� Dow. SBD-6398 (R- 03/22) Attach to complete plans for the system and submit to the County only on paper not less than 8 1R x Il Inches in size isconsm. Department of Indust ,�j �� Fr_-••ng�� AND SITE EVALUATION tbor and Human. Relations 3i i 1__ ; • . vision of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code Lr lath complete site plan on Pape • lesss tFian 8 1/2 x t t inches in size. Plan must County ^U clude, but not limited to: ve rBfereoc%ppjnt,(BM), direction and 1 scent slope, scale or dimensions��. ndioralnn and lance to nearest roatl. '�P � j.�'0 :- Parcel l.D. N 04 Paget of 3 PPLICANT INFORMATION - Please print all information. Re eAedby I Da rrsonal mlormation you provide may be used for secondary purposes (Privacy Law, s. 15o4 (1) W). ' —� 'operty Owner Property Location l ) Govt. Lot 1/4 1/4,S 3-Z T ,N,R 'operty Owns Mailing Address Lot Blocks Subd. Name or CSMN I - -IF -177 �. �r %. VOL, iP mfG C SN►1 9 Phone ❑ city J New Construction Use: 06Residential / Number of bedrooms %3 Addition to existing building ] Replacement ❑ Public or commercial - Describe: :ode derived daily now gpd kbsorption area required bed, ft2�' trench, n2 t aecormnended infiltration surface elevati n(s)z I-3-S gZ.(e3 4dditionaldesign/sitew.,----.—,J�,sy Q�S 11lF parent material W Tu�As Recommended design loading rate bed, gpd/ tzy trench, gpdtW Maximum design loading rate bed, gpd/ttz_trench, gWt2 2,-3-q 92•("r ft (as referred to site plan benchmark) Flood plain elevation, if applicable Suitable for system "'"' ^-��'w Treasure nr-uraue aysremm rill notaing la = Unsuitable for system 0 S ❑ U iS ❑ U I" S ❑ U ❑ S 06 U ❑ S VU ❑ S U �aund ,v. 22fl. )pth to lifing -t in. bring # Z ound 3V._ olt SOIL DESCRIPTION REPORT Horizon Depth in. Dominant Color Mussels Mottles Cm Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 Bed . Trench / -� Z 8 -S / — 5� S MIMFAWA i ia� AI[� .f /I'11f wing Tam QIMr MId. -:,A.rraM59M rMF ME ETAMWVI"I VM/.I ap(h to siting �( 7 -or ;Qin. R2TTta�1(S-�• •�y� �O S 7AAA6r[ A1�.-7 .S ST Name (F{♦laAHtM L. HISDAHL to J YWXO 4 A/Al/ // --7. ✓ Telephone No �7 LAX.-F, 4J. I i rs'.a -r� f � w I � C� t4i, 7 ar47 x eAI�D E5 1! is A P, 0' $A go dIV : 5�.�� t �! � � i i `xis 77W e�v VIVA III L. HISDAHL 7w P.O. k 231 � � � � � �9�• gI Af able .11, 101, 7 PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross -Section & Plan View Pg 4 of 4 Management Plan Attachments: Enclosures: FRe\Jakseu,u s POWTS Application for Review TAY- Soil Evaluation Report & Site Map Project Name / Description Owner Name(s): 5TATLE�R PRCt'ERT/ES t_LL Phone: Owner Address: i✓Ll"3 SX44,i2-, "it C_NcA,\r.vtEILVi Zip: Project Address: 46375 CRYSTAL LAKE ROAD Govt. Lot. Na 5 1/4 of M 1 /4, Section 32 , T 44 N-R 06 E ❑ or W ❑✓ Township. GRANDVIEW County: BAYFIELD Project Parcel ID #: ZI - i0 7Z f -7,-)n 1 Fax 2D:: k4l / Designer Information Designer Name: MARY JO HUPPERT Phone: 715 - 426 - 1775 Designer Address: 25720 FIREFLY LANE, WEBSTER, WI E-mail: hollisterdesign@outlook.com License Number: 1859 - 007 Remarks: Lf)7 / � eyvl _f iaoG VE, P, Signature: 0riqinaHi4qn&ture required dnAach submitted copy. Zip: 54893 IAA•• .1a)POVIE �( WI^ Date: 05 - '�i �2023 STA7LFIR _I00J. -r' P100-1 "IKonl-PiP�- M FLLVA-7- 0&1,. -' 45, 3-S 9z.63 %SAr'/! CsModvoo I � RtJtt l S.Td«.Ic Albo I � � PR'oPos� Lou�sid� •�'bU � C� gc��rceoM} 59 Kl?z' s La X E< RoAi) (jell �z� g3.4aY • � XSY �' � JO I+v`�'tiC ' �'-`L#op�� KASM�SSE/J 7�DaAudl SEp►�C "Tr1� �E��', PD CXisn�llo ARV WAl--� �___ �✓ �91. sV. IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard-W Chambers 3-ft Trench (down -sizing credit) Septic Tank(s) Manufacturer adding: RASMUSSEN Septic Tank(s) Volumeis): 760 gal gal gal gal Effluent Filter Manufacturer: EXISTING: ZABEL Effluent Filter Model #: A100 min 12" SOIL COVER (typical) 12' mintrench depth (typical) _ _ _ TYPICAL TRENCH CROSS SECTION VIEW , (ypical) --- (No Scale) • •' Provide minimum 3 ft System Elevation = 93.40 It separation between trenches. (typical) Quick4 Standard-W wl End Cap (Show location of inlet / outlet pipe connection on plan view.) Obse(tyPcal) ion Pipe (typical) Install per manutsdurets instructions. l t w'�'� t tr v ►Irt�gy'/ �� e I I A=3.Oft L_r.0acaa taaratWtWikf — — — — t�caa/LLYt410ILtt.tWJ (typical) 7�----------------- B = 66 ft (typical) INSTALL PER TRENCH: 16 Quick4 Std-W @ 20 ftz EISA/chamber = 320 ft' + 1 Pairs of end caps @ 6 ftz EISA/pair = 6 ftz = Proposed EISA per trench = 326 ft' TYPICAL TRENCH PLAN VIEW (No Scale) ,4D;Jink�: 'i q_C;0 C,FD Qu1ck4 Standard-W Chamber 4tiZ. 3G�i. .20 Ef5!t fA,ti (typical) VA' (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions. Z5 i7 To7fl' Ey' 7rbn0ih" Required Infiltration Area = 642.86 ftz x 2 trenches = Proposed Total EISA = 652 W Distribution Method: branched manifold D 0 m W 0 A RFGFT qUG 110 1&1 NKiAhY PERMIT APPLICATION �5COD5% Deowtmert o, Commer 17 icird with ILHR 83 05, Wis. Adm Code Safety and Buildings Division 201 E. Washington Ave. P.O. Box 7969 Madison. WI 53707-7969 Attach complete tIlQccApiC OD*15bly) for the system, on paper not less than 8 vz x 11 inc n size. County F lei See reverse side for instructions for completing this application �# state Sa itary Permit Number C4 98I5'9 information you provide may be used by other government agency programs Check.1 revismn to prevxxu appecaiwn ivacy Laws 15.04(1)(m)l. State Plan I D. Number APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N ipertyOwner Napsa, . u l 'r D c T��u (( Property Location v4 114,S _,.2T V C1 , N, R (o �r) W iperty Owner's Miibn dress Vic/ K Lot umber Block Number ce N,E• V.5(�atg Zip Code �13'U Phone Nu m bar Subdivision Name or CSM Number 1rKltul a ( %frJl-S= CO I TYPE OF : (check one) ❑ State Owned D City Nearest Road Public 1 or 2 FamilyDwelling- No. of bedrooms ❑ To age Town OF G Li.. C!` "t RA, BUILDING USE: (If building type is public. check all that apply) Parcel Tax Number(s) ❑ Apartment/Condo ❑ Assembly Hall 6 ❑ Medical Facility / Nursing Home 10 Q Outdoor Recreational Facility ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining ❑ Church / School 8 ❑ Mobile Nome Park 12 ❑ Service Station / Car Wash ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ® New 2. Q Replacement 3. Q Replacement of 4. Q Reconnection of 5. Q Repair of an System System Tank Only ExistingSLstem Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued TYPE OF SYSTEM: (Check only one) Ion -Pressurized Distribution Pressurized Distribution Experimental Other I ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank 2 (Seepage Trench 22 ❑ In -Ground Pressure 42 ❑ Pit Privy 3 6 Seepage Pit 43 ❑ Vault Privy 4 ❑ System -In -Fill . ABSORPTION SYSTEM INFORMATION: Gallons Per Day 2. Absorp. Area 13. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade _ Required (sq. ft) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation L1 —%. �% �/ Feet Feet I. TANK Capacity INFORMATION in gallons Total Gallons # of Tanks Manufacturer's Name Prefab Concrete Site Con- Steel Fiber glass plastic Exper App New Existin Tank T nk strutted Sic Tank oraieldrixg Tail, jOd C r o (. i1 / El1 11 Pump Tank /Siphon Chamber El Ej ❑ II. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. m is Name: (Print) mber's Sign e: Stamps) MPAN►Rswfilo : Business Phone Number [1y u e. -► Cvc % c ��Gi7� 7tJ.. � 75/ -ji"3 J mber'sA ess (StreT 4ity, State, Zip Code): 6. COUNTY / DEPARTMENT USE ONLY El Disapproved Sanitary Permit Fee uivwee. G,o nd.Av Sunhwge tee) ate s ue Issuin /agent Signal e(No (Approved Q Owner Given InitiallP 12i• t c r4 6?, �' ?wfI' Adverse Determination (1Q -�itt CONUI I IONS OF APPROVAL / REASONS FOR DISAPPROVAL: ,aiv � ? 77 MZ = ice J0L 3' f-2' 4" SM 3034 PVC M L 4" SM 2-M PW Dom- 4'• al . PIPE -3 ,�� .. L NAL M OTf SIDE . .s 4" SO! 40 PVC • +...iE TI ... disw_• .pip fRr':}77 �i�i to • j r *° �e min. 6� C;' � '�1 ,. •. err.. Yi " z yz 4:a LZCL.,, c stt- Dice 2 y, t S __o�i�e to p.Ltch @ 2" _4�� per 100' Ofrc. Cl r�3s fc otui.Z .craves Cv tcD Of " -S�'—• I � jam' -'"' ic% sycthet c C=t. ��r: 1 �.%pipe. s`aw. -z- Or g o= is - � ma 'Sh iav Q(i. to — 13. Lb 'PW L 1Z/('26 l��j Niscor;inDepartmentofCommerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) .................. y..,. P.,,.. ...oy w...�wa,y pvrpuses lrnvacy Law. s.U.U4 (1)(m)1. Permit Holder's Name: ❑ City ❑ village la Town o Up �e nods N '.ST BM v : I M Elev : M Description OD A50a r Aw. IIvtUKMAI IUN TYPE MANUFACTURER CAPACITY Septic of Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Ventto An Intake ROAD Septic lbisfadt> S' 3a' NA Dosing NA Aeration NA Holding PUMP / SIPHON INFORMATION a Ter Demand !TDH odel Number GPM Lift Friction Sy TDH Ft Ms ead Forcemain Length Dia. H Ost To well SOIL ABSORPTION SYSTEM ELEVATION DATA County 25Uy7 /'e 1 d e Sanitary Permit No ;) 9 S�S9 State Plan ID No: Parcel Tax No STATION BS I HI FS ELEV Benchmark a.( Bldg. Sewer St/Ht Inlet 7.ay 9 .PG St/ Ht Outlet -7. y 9y, -, Dt Inlet Dt Bottom Header / Man -1 qAi 4/ Dist Pipe -7 94.3 Bot System g 7 "! Final Grade BED/ V**NEN Widthl 7 Lengt s6, No Of Trenches PIT MEN I No Of Pits inside Dia Liquid Depth SETBACK SYSTEM TO P/ L I BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR UNIT rype0 System n S Q 7 S� Mo el Number: UIS I KIBUTION SYSTEM if / Mam old D,swbuliun P.pe(s) I x Hole Size I x Hole Spacing vent To Au Inta e / u Length _SL Did Length 53' Did y_ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over dp Depth Over xx Depth Of xx Seeded (Sodded xx Mulched Bed r Trench Center O Bed! Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Igo We11�. wv'v) 'R.eai -rYcvn R&S MO-Uen WWfFRE ON51-1'E jAOJ¢ .INSPECTION A W wcw imii-aked Lmui'e¢d °� ,;tin 4u moo. � ac sQs Plan revision required? Yes 0 No Bayfield County, WI 5/11/2023, 3:10:39 PM 1:500 Rivers 7� Section Lines All Roads Town Lakes -- Government Lot Survey Maps Meander Lines LEI Municipal Boundary 0Recorded Map Approximate Parcel Boundary Building Footprint 2009-2015 Existing Driveways Buildings 0 0.01 001 0 001 0.01 wyf� 0.02 mi 0.03 km Wy1+io� C�W.I.�.4�La.n N ft O hi"'m W�M� vng "S-YM1 Real Estate Tax Statement BAYFIELD COUNTY, NR.SCONSIN Printed: 5/11/2023 3:01:53 PM Ownership STALTER PROPERTIES LLC, Tax ID: 16911 Legacy PIN:021107207001 PIN: 04-021-2-44-06-32-4 05-005-03000 Property Description Site Address: 46375 CRYSTAL LAKE RD Municipality: TOWN OF GRAND VIEW Description: (Not for use on Legal Documents) SE S32 T44N-R06W GOUT LOT 5 Plat Name: GOVT LOT 5 LOT 1 OF CSM #1000 V.6 P.284 (LOCATED IN GOVI LOT 5)IN DEED DOC 202211-596716 STALTER PROPERTIES LLC Document: 2022R-596716 E4063 STATE RD 72 Acreage: 1.590 MENOMONIE WI 54751 2022 Assessments 92ft Acres Land ImRi: Total G1- RESIDENTIAL 1.590 161,200 203,700 364,900 Total Values: 1.590 161,200 203,700 364,900 Estimated Fair Market Value: 371,900 STALTER PROPERTIES LLC E4063 STATE RD 72 MENOMONIE WI 54751 TAX RECORDS - KEY TO CODES RE = Real Estate SA = Special Assessments PF = Private Forest LC = Lottery Credit SC = Special Charges MFLO = Managed Forest Land Open `FD = First Dollar Credit DU = Delinquent Utilities MFLC = Managed Forest Land Closed NNN THERE ARE NO PRIOR DELINQUENT PAYMENTS DUE NNN 2022 TAXES GRE (FD) (LC) RE SA SC DU PF MFLO MFLC TOT Tax Due: 2,822.12 (19.84) (0.00) 2,802.28 0.00 0.00 0.00 0.00 0.00 0.00 2,802.29 Tax Paid: 1,401.14 0.00 0.00 0.00 0.00 0.D0 0.00 1,401.14 Balance: 1,401.14 0.00 0.00 0.00 0.00 0.00 0.00 1,401.14 Ta. m r65n Total Due For 2022 Tax: 1,401.14 Tax ID 16911 Total Due if paid on or beforethe last day of: May, 2023 1,401.14 If paid after 3uly 31 contact the County Treasurers Office or Print a new statement from www.bayfieldcounty.wi.gov Sayf dd County Treasurer JENNA GALLIGAN, PO BOX 397 WASHBURN W154891 Phone: (715) 373-6131 Credit Card Pay Site httos: //www.tayfleldcounty.wi.gov/ 151 /Treasurer 1. w Department of Safety County BAYFIELD _ MAY '19 2 23 & Professional Services, ENiENE Permit Number he filled in by r, �f Bayfield Cc. Industry Services Divisio y'-a - nil tary ( Co.) Sanitary Permit Application State Transaction Number NA In accordance with SPS 3832Aden Code, Wis. AdCode, submission of this farm to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for stale -owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, a. 15.04(ixm). Slats. 46375 CRYSTAL LAKE RD I. Application Information Please Print All — Information Property Owner's Name Parcel # STATLER PROPERTIES LLC Property Owner's Mailing Addre Property Location E4063 S.T.H. 72 GOVL Lot 5 City, State Zip Code Phone Number MENOMONIE, W1 54751 a- a a % '/«Section 32 T 44 N R 06 now W IL Type of Building (check all that apply) Lot # EXor2 Family Dwelling— Number ofBedmoms 5 1 Subdivision Name NA Block # ❑ Public/Commercial — Descnbe Use NA ❑ City of ❑ Village of ❑ State Owned — Describe Use CSM Number #1000; V6, P284 °GRANDVIEW III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box online B. Complete line C i applicable.) `` New System y Replacement S ep System X Other Modification m Existing System g y ❑ Additional Pretreatment Unit (explain) (explain) upgrading to a 5 bedroom system B. ❑ Holding Tank X}n-Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration 298259/08-25-1998 IV. DispersaVY'reatment Area and Tank Information: Design Flow (gpd) 450 Design Soil A lication st) "� �fgp� Dispersal Area Required (sf) ✓ Dispersal Am Pro sf) System Elevation 642.86 652 93.40 FT.V--� i Capacity in Total #of Manufacturer Tank Information Gallons Gallons Units a C o $ u New Tanks Faistmg in Hfo6 U Septic or Holding Took 760 1000 1760 1 RASMUSSEN Dating Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu s Signal MP/MPRS Number Business Phone Number Pl (Street, City, State, Zip Code) mj'sfAdtd�reess �//i �r /'�/ �/�y1 / �j- Q{/ V� / r `Y V W r l Vic GfA F -a, �!-- 5Q L VL CountyMepartment Use Only 4 Approved ❑ Disapproved Pe it Fee Date Is ed Issuing A t Signature ❑ Owner Given Reason for Denial S 15,2 a Conditions of A roval/Reasons for Disapproval b "i air Jab" - port) a) yY1u�1 DlGN1 bow. Anach to complete plans for the system and submit to the County only on paper not less (hang 12 x it inches in sae SBD-6398 (R- 03/22) RECEIVED Private Sewage System Maintenance Agreement MAY 116 2023 'I e.\r- Pro'Qe rA-if-5 LLC Planning &M- As owner, 1 (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 3Z Township -14 N. Range ODD W, Additional Legal Description: Townof61v-14,10\ ieW (Acreage) -5'7 Gov't Lot J Lot Subdivision :40 Return To: Lot CSM# 1600vo1. & Page214 CSMDoc# Zo2Z-L-$7%%1(o DOCUMENT NUMBER 2023R-598968 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 05/ 1 5/2023 AT 8:00 AM RECORDING FEE: $30.00 PAGES: 2 Planning and Zoning Department [a 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 Bayfreld 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. Sayffeld 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 c sts 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��}}b1Yt(pf a human health hazard, and the tax shall be collected as provided by law. The terns and conditions of the agreement shall be benefit of all current and future owners of such properly. Owners) Name(s) -Please Print r if ,%b''Pbed and swom to before me on this date: SOtiti� W. '5i: by Lf�ry i 5fia key Pra�e�� '� ;=.��J la 2023 � � Expires: Drafted by^(I Date: W tt� Proofed by: _ u/forns/sanitary/sepgcmaintenmagmement Revised July 2020 . ; PAGE 4OF4 In -ground Gravity Management Plan IMPORTANT: The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = Inspection Checklist o type of use 300 gpd; BOD5 S 220 mgL"; TSS 5150 mgL"; INSPECT EVERY 3 YEARS FOGS 30 mgL" 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 (113) 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 manufacturers 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: Phone: Local govemment unit: BAYFIELD COUNTY ZONING Phone: 715 - 373 - 6138 Local government unit address: 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. BAYFIELD COUNTY SANITARY PERMIT (#04)-23-43S STATE SANITARY PERMIT OWNER: STALTER PROPERTIES LLC GOV7 LOT: LOT:1 BLK: SUBDIVISION: Csm #1000 1 /4 1 /4 SEC: 3Z T 44 N, R 6 W TOWNSHIP: Grand View SO I L TEST: 4644 OTHER MODIFICATION SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: Strand, Ryan MCKENZIE SLACK DATE: 5/31 /2023 Authorized Issuing Officer CHAPTER 145.135M 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.1 68;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 #: 298259 LICENSE: # MP 798301 Condition: System to meet all setbacks. Management plan to owner. Properly maintain system per recorded agreement. THIS PERMIT EXPIRES 5/31 /2025 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION