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HomeMy WebLinkAbout25-14SRequest for Sanitary Inspection (24 HPso in Ae9vamce) 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 J Time Change Discrepancy Other Plumber: oe S 1;;�k' Phone Number Fax Number Homeowner: \ ti\t �- /Mt Dq V\ o it (` 0 S &\ .0 Email Address 1 ` Sanitary Permit #: � ' E Immediate Phone umber o Zoning Dept can call you right back (if needed) Plumber's Choice Zoning Dept No Inspection(s) during this time Date: J 5 "aD Tuesday (9:30 am - 12:15 pm) (Tracy) Time: Plumber's Choice Zoning Dept ' () 00ve Township: Address # & Road Name: 90&TO 2���S �o i �+, 1 or I (8/ Directions To Site: Comments: * Plumbers you must verify any change(s) by fax or email Notes from Zoning Dept: u/fomts/sanitary/nquestfodnspectlon Zoning Dept (@4/12(04); ® June 2023 POWTS HOLDING TANK INSPECTION REPORT (ATTACH TO PERMIT) GENERAL INFORMATION _ Permit Holder's Name Sanitary Permit No. LUKE W & M[RANDA M iss if Ava able Plan ID No. GROSSKREUTZ property dd 1128 167TH ST HAMMOND WI 54015 TANK INFORMATI TYPE MANUJFACTURER/MODEL# CAPACITY ui�uc a' Jg Lam( S&CSr134&O - -- - - OOA a roO OS- , LIAV,v Property Line Well Water Service Building All -Weather OHWM Swimming Pool Road DEVIATIONS FROM APPROVED PLAN COMMENTS (Persons present, discrepancies, etc.) ctANE n : EAIriYJC� kkf a Son is�- .Anaw'at'1�. y'4 ouAuj r 9 band 4lQiMon a"kaA h ��Wdcl ty'natl linkskkctt S , 7 � ' I N► kaAtr' W%%A 9-Io b°I °d dfwtwuc� S t ci J C PONENT NOT INSPECTED Plan Revislo squired Dyes o Date: Signat a tor: In C�t 7umber.y Sketch on other side v V C '- r - r — 10 of 13 411 Property Owner Information As you know BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoning(aibayfieldcountv.wi.gov Web Site: www.baVfieldcounty.wi.gov/147 _ LUKE W & MIRANDA M GROSSKREUTZ 1128 167TH ST HAMMOND WI 54015 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 Aba donment of Old S stem to meet all applicable code requirements: •o Tank was pumped by: f),tf c 1 \ 4A on ❑ . Tank was crushed I removed and pipes disconnected by: _ at AM/PM On at (AM / 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: saliW I(151(at(ed fay pIyln Ulforms/sanitarypropedyowner-input April2019 SS -00S21 „r. i Department of Safety county t �S '! & Professional Services, G Po p,,i)k 1 12025 Industry Services Division SwitaryPcrmitNumbcrpnbeEllcdinbyCnJ 2S -HS Sanitary Permit Application State Transaction Number In accordance with SI'ti 383.21(2), Wis. Adm. Code. submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted In the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than m 'tin mss) lQm UU C'U < a 15.04(l)(m). 1-L f t; t r purposes in accordance with the Privacy Law, s. Slats. " \ � 1 �{ Yb \\ I. 5LI L Ll 1. Application Information Please Print All Information — ll Property Owner's Name Parcel H L $ce - f\c- Goskre $- a;\' Property Owner's Mailing Address Property Location 16 W\ >-1. GovLl.01 _____ ' %., Section City, State I Zip Cade igwnc Number `!7 t>R'. t3JL svoi S -7 S— 6 (t -7 `t{t' T ` N It 1 E o 11. Type of Building check allthat apply) Lot B Subdivision Name or2 Family Dwelling— Numberofledrooms 4 I Block a ❑ Public/Commercial — Describe Use ❑ City of ❑l Village of ❑ State Owned — Describe Use CSM Number �UvI townof Clatj,'r 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 a licable. A, ❑ New System i Replacement System 0 Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) I bolding Tank ❑ In -Ground ❑ At -Grade I fl Mound ❑ individual Site Design I ❑ Other Type (explain) (conventional) C, ❑ Renewal Before ❑ Revision n Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. flbpersnliTreatment Area and Tank Information: Design Flow (g,d) Design Soil Application Ratclgpd/sf) I Dispersal Alen Required (si) Dispersal Area Proposed (sp System Elevation Goo 'rank Information Capacity in Gallons Total Gallons if of Units Manufacturer o v New Tanks I•aislinulanks �- e C u e+ ,rdr aU in ''" it i'm—.O a aedicorlloldin Tant 1 a q 50U 4560 a- L\'&&'r u IsC d Dosing Chamber V. Responsibility Statement— 1, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's ' amiNc MPJMPRS Numbers Business Phone Number 7( - '�/ /5 (�n8sc 3 s/lc'" Plumber's Address (Street. CI y. Slate. Zip Code) _ L. 4' FL L Ic,I\L t� J-� 5L( VI. Court /De rtment U Only Approved I ElDisapproved Permit Fec I Date Issued SA i' Issuing Age} I Signature O Owner Given Reason for Denial "�� C ,�'7 Conditions of Approval/Reasons for Disapproval V pjp si 12 5 9.94 sw c_o\ra Attach to complete plans for tin• system and submit Is the County only on paper not lei, than S'in II inches in size S13D-6398 (It. 03/22) S'(Z— co 0221 Soil Test# Bayfield County Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) R 17 2Qz I EDWARD J WROBLEWSKI a certified soil tester determine that in my professional judgment the following site (see below) is unsuitable for any treatment component otherthan? holding tanks.. Due to soil & site conditions, a thorough soil and site evaluation is not needed to make such a determination. Property Owner LUKE W & MIRANDA M GROSSKREUTZ Contractor ED'S MECHANICAL LLC Property Address 90530 BARK POINT RD Authorized Agent EDWARD J WROBLEWSKI HERBSTER, WI 54844 Agent's Telephone 715-209.4055 Telephone 715.607.0194 Written Authorization Attached: Y or NO Accurate Legal Description is requested: 114 of 1/4 Section 24 Township 51 N. Range W. Town of CLOVER Additional Legal Description: LOT 1 CSM #2097 (LOCATED IN GOVT LOT 3) IN DOC 2020R-583483 Govt. Lot Lot Block Subdivision Lot CSM# Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# 38084 Acreage 1225 Indicate reasoning for your determination: CLAY SOILS & EVIDENCE OF SEASONAL HIGH GROUNDWATER Signature of Certified Soil Tester IH( /y.L Date SP -72000013 v �Is j2 z. Signature f County Official Certification (Submit a Plot Plan & Fee) Date Wfonnslsoilleslwalye r(KLK) Qqt So , oo L(12°I 12S Rt June 2018 EDWARD J WROBLEWSKI, CST #SP -72000013 SOIL TEST PLOT PLAN LUKEW & MIRANDA M GROSSKREUTZ 90530 BARK POINT RD LOT 1 CSM #2097 (LOCATED IN GOVT LOT 3) IN DOG 2020R-583483 S24 T51 N R07W TOWN OF CLOVER, WI SCALE 1 ° = 50' LOT LINE LOT LINE If LAKE SUPERIOR II It 2tI 3 41 5J SKEET 2 OF 2 BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): U ( V E n )7 Check List 2025 L�J� Index Page / Title Sheet (Optional) saylield Co. Zoning Dept. Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) O Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) }�7 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) Property Location (Accurate Legal Description with Sec/Twp/Range) Road Name (where driveway is/will be coming off of) Floodplain Elevation, Flow Rate, Comments and Recommendations ❑ Complete Soil Boring / Pit Information Date Soil Evaluation was conducted CST Name, Signature, Number, Address and Phone Number *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) ❑ Bench Mark (Description, Elevation and Location) ❑ Contour Lines (Example = 98.0' /96.0' /94.0') Property Location (Sec/Twp/Range/, Accurate Legal Description) Borings (Locations and Elevations) O Percent and Direction of Land Slope Well Location (Including Neighboring Wells, if applicable) Location of Wetland Areas, Floodplain and Navigable Waters Buildings, Driveways, and Structures (Location and Descriptions) Location of Property Lines Existing System Location Address Number and Road Name Current Surface Elevation of Wetlands and Navigable Waters l( CST, Owner and Property Information North Arrow Fee: ❑ Certified Soil Tests - Review & Filing Fee $ 50.00 U/forms/sanitary/checklist/checklistforests V 1 , ) Ar'it I /2025 D Bayfield Co. Zoning Dept. CONCRETE HOLDING TANK DESIGN Two Concrete Tank Option INDEX AND TITLE SHEET Project Luke & Miranda Grosskreutz- Holding Tank Owner Luke & Miranda Grosskreutz Address 1128 167th St. Hammond, WI 54015 Phone: (715) 607-0194 Legal Description Lot 1 CSM #2097 (Located in gwt lot 3) S24 T51N R07W Township Clover County Bayfield Subdivision Name Parcel ID Number 38084 Plan Transaction Number Designer Michael Wroblewski Lot No. Index and title sheet Page 1 Holding tank specifications Page 2 Site plan Page 3 Management & Continency Plan Page 4 Soil Test Page 5 Soil Test Plot Plan Page 6 Holding Tank Agreement Page 7 Holding Tank Servicing Contract Page 8 Holding Tank Specifications Page 9 Signature.— ( / --& Phone No. (715) 209-7521 License Number as'as 0) Date 04/15/25 Designed pursuant to: Holding Tank Component Manual For POWTS (Version 2.0) SBD-10855-P (N. 03/07, R. 01/12) version 7.0(YV12) Page 1 of 9 APR 1? 2025 HOLDING TANK SPECIFICATIONS Ii Co. Zoning Dept, Two Concrete Tanks In Series 4 If one- or two-family, number of bedrooms _ And/Or....Non-residential estimated flow per day 2000.0 IMinimum holding tank volume required 4500.0 Total holding tank capacity_, proposed (gal) 2500.0 Tank 1 capacity (gal) ',X for round tanks 2000.0 Tank 2 capacity (gal) Wieser Concrete Products. Inc. Tank manufacturer SJE Rhombus !Alarm manufacturer TAAB-01H rm model number HOLDING TANK CROSS SECTION Vent cap 12" min. 4" min. Vent pipe HI Blind plug to seal outlet opening -I- 12.0 in Service alarm an 24.C i 2000.0 gal Tank2 Manhde cover with locking and warning label box Note: Manholeand vent locations may Tether be reversed. weight Manhole diameteris 23" min. 2500.0 gal Tank 1 3 in. min. bedding undertanks. Anchortanks as necessaryto negate buoyant forces. Electrical as per NEC 300 and SPS 316. Note: All tan kjoints, and joints between tank openings and piping are sealed watertight. Finished grade 18" min. Inlet Project: Jim Marsh - Holding Tank Transaction Number. Page 2 of 9 LUKE W & MIRANDA M GROSSKREUTZ HOLDING TANK PLOT PLAN 90530 BARK POINT RD LOT 1 CSM #2097 (LOCATED IN GOVT LOT 3) IN DOC 2020R-583483 S24 T51N R07W TOWN OF CLOVER, WI SCALE 1" = 50' LOT LINE o gun# Dl � APR 1 7 2025 C- B yi:ekl Co. Zoning Dept. LOT LINE N i LANE SUPERIOR i 3 qp So SHEET 3 OFP [b CHU APR 1 7 2025 Bayfield Co. Zoning Dept. HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to SPS 383, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10855-P 03/07, R.11112), and the Bayfleld County Sanitary Ordinance. 1. This POWTS is designed to accommodate a wastewater flow of 80.0 to 900.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the second tank reaches a level of 12" below the inlet invert (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and SPS 383 and 384 Wis. Adm. Code. 5. All service events or Inspections of this POWTS shall be reported to the county within 30 days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes from this holding tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required forsuch a replacement). Connection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with SPS 383.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer ...........................Big Big Lake Plumbing Phone: (715)209-7521 b. Service Provider ................ Birch Street Excavating & Septic Phone: (71'5) 373-5683 c. County Zoning or Health Dept. Bayfield County Zoning Phone: (715) 373-6138 11 Project: Transaction Number. Page 4 of 9 WLP2000-MR TANK SPECIFICATIONS C) N m o E N �C � ^ N o 0 < a INLET 164' II 4" CAST -A -SEAL 4" CAST -A -SEAL I� mg ≤o in FILTER OR BAFFLE J �� TOP VIEW SIDE MEW OUTLET PUMP PAD TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS DIMENSIONS: WALL• 3" BOTTOM: 5" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 55" O.D. LENGTH: 164' O.D. WIDTH: 96" O.D. BELOW INLET: 43" O.D. LIQUID LEVEL 36" WEIGHT: BOTTOM 14,060 LBS. COVER 8.170 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL X10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 56.27 GAL/IN LOADING DESIGN: 8' 0' UNSATURATED SOIL HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 2,138 GALLONS TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN /8 (NO FIBER) TANK: MIX DESIGN /9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE II DRAWINGS TED APPROVAL FORII APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: E x Co N J ¢ Q D IQ o CSJ U F w U) zOF 1 -� I E. jaaa LCD 15-3' N O p; ry ( o Y °J j ' CAST -A -SEAL 4' CAST -A -SEAL >. •II c o FILTER OR BAFFLE O w v 1 2 INLET --- - — - — - - ....... ---- OUTLET I d I WLP2500 TANK SPECIFICATIONS DIMENSIONS: WALL• 3" BOTTOM: 5' COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 55 1/4' LENGTH: 15'-3 1/4" WIDTH: B'-51/4' BELOW INLET: 43" LIQUID LEVEL 36" WEIGHT: BOTTOM 15,527 LBS. COVER 9,300 LBS. INLET AND OUTLET: 4' CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL /10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 69.44 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 2,639 GALLONS LOADING DESIGN: 6'-0' UNSATURATED SOIL TANK CAN BE USED AS: SEP11C / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN {/6 (NO FIBER) TANK: MIX DESIGN /9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE KEY NOTES: O CONCRETE OR EZ-SNAP RISERS O2 (2 EA.) MANHOLE EACH END OR (1 EA.) MANHOLE & (1 EA.) 4' COUPLER OPPOSITE ENDS REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: rc 0 C J Q O 0 Q N 7 a a w rn 1 V OF 1 SS- 00521 I Department of Safety count. 0 - 1 I & Professional Services, C�C Smlitery Pcrmil Nl !\ I' 17 2025 �-� Industry Services Division mbcr(to be filled in by Co.) 2-S- IBS 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 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS arc submitted to Project Address (if diff rent than m 'tin ad MU) die Department of Safety and Professional Services. Personal information you provide may be used for secondary O rj S'&.o (?i C k pt; �(Z• purposes in accordance with the Privacy Law, s. 15.04(I)(m), Stars. r `t fl ��C` � r \p U 1. Application Information Print All information -Please u J Property Owner's Name Parcel X /�i Lv&rt / \ro;.c\' Gcosskfet($z 3�'os'LI Property Owner's Mailing Address Property Location \k9 i b 1 th 5 E. Govt l.ot 14 y., Section �-` City, State Zip Code Phone Number svoi s 1jS6LThOk9L T • \ N R 07 E IL Type of Building check all that apply) Lot p j[f I or 2 Family Dwelling— Number of Bedrooms _______ Subdivision Name ❑ Public/Commercial — Describe Use Block a ❑ City or O village of O State Owned — Describe Use CSM Number __ XTownof.:Ink).ar 111. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line Cif a licable. A• ❑ New SystemReplacement ys System } ❑Omer Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain) B' I Iolding Tank ❑ In -Ground 0 At -Grade ❑ Mound 0 Individual Site Design ❑ Other'Iype (explain) (conventional) C. ❑ Renewal Before ❑ Revision 0 Change of Plumber 6 ❑Trmsfcrm New Owner' ist Previous Permit Number and Date Issued Expiration IV. Dis ersaVrrestment Area and Tank Information: Design Flow (bpd) Design Soil Application Ratc(gpdfs1) Dispersal Area Required tut) Dispersal Area Proposed (so System mementionUnF o Capacity in Total a of Manufacturer Tank Information Gallons Gallons Units ' Now Tonks Existing Trmks v '> o - •n fl j 6 U in i= U a SeprieorlluldingTaak Lfcoo I 4SCo a- 'L=S UI'C Dosing Chamber V. Responsibility Statement- 1, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) ,, Plumber's jm 1 �� PRNumber MP/MS Num Business Phone Number ►�: 8�l 7i - Dc:, -75a Plumber's Address (Street Cry. Stale- Zip Code) ILH\ C; Nom:. ( t VI. County/DepartmentU Only 1 Approved O Disapproved Permit unit Fee I Date Issued I �.. `� I Issuin, Agent Signature & ❑ Owner Given Reason for Denial Z 1. Z`� Conditions of Approval/Reasons for Disapproval a i a SI 112 S R sew cars Attach to complete plans for Chess stem and submit to the Count) only on paper not less thin R '/2x 11 inehe, in sire SBD-6398 (R. 03/22) SR-oo221 Soil Test # I (r 25 Bayfield County Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) PR I ( EDWARD J WROBLEWSKI a certified soil tester determine that in my professional judgment the following site (see below) is unsuitable for any treatment component other than: holding tanks. Due to soil & site conditions, a thorough soil and site evaluation is not needed to make such a determination. Property Owner LUKE W& MIRANDA M GROSSKREUTZ Contractor ED'S MECHANICAL LLC Property Address 90530 BARK POINT RD HERBSTER, WI 54844 Telephone 715-607-0194 Accurate Legal Description is requested: Authorized Agent EDWARD J WROBLEWSKI Agent's Telephone 715-209-4055 Written Authorization Attached: Y or NO 1/4 of 1/4 Section 24 Township 51 N. Range 07 W. Town of CLOVER Additional Legal Description: LOT 1 CSM #2097 (LOCATED IN GOVT LOT 3) IN DOC 2020R-583483 Govt. Lot Lo₹ Block Subdivision Lot CSM# Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# 38084 Acreage 1.225 Indicate reasoning for your determination: CLAY SOILS & EVIDENCE OF SEASONAL HIGH GROUNDWATER jt Signature �f County Official 't)? iI).::� Signature of Certified Soil Tester I Date SP -72000013 Certification # (Submit a Plot Plan & Fee) Date u/(orms)soiIIestv+aiver(KLK) Qu\ So OO 2 1q 2S Rt June 2018 EDWARD J WROBLEWSKI, CST #SP -72000013 SOIL TEST PLOT PLAN N. LUKE'W & MIRANDA M GROSSKREUTZ 90530 BARK POINT RD LOT 1 CSM #2097 (LOCATED IN GOVT LOT 3) IN DOC 2020R-583483 S24 T51N R07W TOWN OF CLOVER, WI SCALE 1" = 50' LOT LINE LOT LINE LAKE SUPERIOR 0 10 2 3 40 50 SHEET 2 OF 2 BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): / 2025 7 Check List Index Page / Title Sheet (Optional) saytield Co. Zoning Dept. Original Soil Evaluation Report (Submitted in Deed Holders Name — nrntt prospective buyers) Original Plot Plan O Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) }VO 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) Property Location (Accurate Legal Description with Sec/Twp/Range) Road Name (where driveway is/will be coming off of) Floodplain Elevation, Flow Rate, Comments and Recommendations ❑ Complete Soil Boring / Pit Information Date Soil Evaluation was conducted CST Name, Signature, Number, Address and Phone Number *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) ❑ Bench Mark (Description, Elevation and Location) ❑ Contour Lines (Example = 98.0' /96.0' /94.0') Property Location (Sec/Twp/Range/, Accurate Legal Description) 4 Borings (Locations and Elevations) ❑ Percent and Direction of Land Slope Well Location (Including Neighboring Wells, if applicable) Location of Wetland Areas, Floodplain and Navigable Waters Buildings, Driveways, and Structures (Location and Descriptions) Location of Property Lines Existing System Location Address Number and Road Name Current Surface Elevation of Wetlands and Navigable Waters CST, Owner and Property Information North Arrow Fee: ❑ Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checklist/checklistforests LL V Jll An 1/2025 Bayfieud Co. Zoning Dept CONCRETE HOLDING TANK DESIGN Two Concrete Tank Option INDEX AND TITLE SHEET Project Luke & Miranda Grosskreutz - Holding Tank Owner Luke & Miranda Grosskreutz Address 1128 167th St. Hammond, WI 54015 Phone: (715) 607-0194 Legal Description Ld I CSM #2097 (Located in gwt lit 3), 524, T51N, R07W Township Clover County Bayfield Subdivision Name Lot No. Parcel ID Number 38084 Plan Transaction Number Index and title sheet Page 1 Holding tank specifications Page 2 Site plan Page 3 Management & Continency Plan Page 4 Soil Test Page 5 Soil Test Plot Plan Page 6 Holding Tank Agreement Page 7 Holding Tank Servicing Contract Page 8 Holding Tank Specifications Page 9 Designer Michael Wroblewski Signature" ( / Phone No. (715) 209-7521 License Number 1aS5 Date 04/15/25 Designasuant to: Holding Tank Component Manual For POWTS (Version 2.0) SBD-10856-P (N. 03/07. R. 01/12) Versim7.0(YV12) Page 1 of 9 151 Hfl APR 177075 HOLDING TANK SPECIFICATIONS 3:d Co. Zoning Dept. Two Concrete Tanks In Series if one- or two-family, number of bedrooms And/Or....Non-residential estimated flow per day 2000.0 Minimum holding tank volume required 4500.0 Total holding tank capacit ro osed (gal) 2500.0 Tank 1 capacity (gal) X for round tanks 2000.0 Tank 2 capacity (gal) Wieser Concrete Products, Inc. Tank manufacturer SJE Rhombus Alarm manufacturer TAAlI Alarm model number 1.1 Anchor weight safety factor Tank Information in Exterior Dimensions (in) lbs lbs in ft .Lig Level Length Width Height Tank Wt Anchor Wt Soil Cover Max_ Bury .,. Tank 1 36 184 102 56 24827 16921 15.6 7 Tank 2 36 164 96 55 22230 12166 13.4 HOLDING TANK CROSS SECTION Vent rap Manhde cover with locking device 12" min. 4" min. and warning label Finished grade �i ,IincUon box f� 1 Vert P� 18" mimin. Blind pug to seal outlet opening Note: Manhole and R_ T vent locations may Inlet 12.0 in T be reversed. IIservice alarm on weigh Manhole diameteris 23" min. 24.C ip 2000.0 gal 2500.0 gal Tank2 Tank 1 3 in. min. bedding undertanks. Anchortanks as necessary to negate buoyant forces. Electrical as perNEC 300 and SPS 316. Note: All tank joints, and joints between tank openings and piping are sealed watertight. Project: Jim Marsh - Holding Tank Transaction Number. Page 2 of 9 LUKE W & MIRANDA M GROSSKREUTZ HOLDING TANK PLOT PLAN 90530 BARK POINT RD LOT I CSM #2097 (LOCATED IN GOVT LOT 3) IN DOC 2020R-583483 S24 T51 N R07W TOWN OF CLOVER, WI SCALE 1" = 50' LOT UNE [Dl is c H n Y E n 0 APR 1 7 2025 aayfield Co. Zoning Dept. LOT UNE LAKE SUPERIOR 1b 2) 3hmSJT SHEET 3 OF 9 ll APR 1 7 2025 Bayfield Co. Zoning Dept. HOLDING TANK MANAGEMENT PLAN This Private Onslte Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to SPS 383, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10855-P 03/07, R.11112), and the Bayfield County Sanitary Ordinance. 1. This POWTS is designed to accommodate a wastewater flow of 80.0 to 900.0 gpd 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the second tank reaches a level of 12" below the inlet invert (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and SPS 383 and 384 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 30 days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes from this holding tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit Is required for such a replacement). Connection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with SPS 383.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer ........................... Big_Lake Plumbing Phone: (715)209-7521 b. Service Provider ................Birch Birch Street Excavating & Septic Phone: (71'5) 373-5683 c. County Zoning or Health Dept. Bayfield County Zoning Phone: (715) 373-6138 11 Project: Transaction Number. Page 4 of 9 o� o N G o c N C o ' INLET to d 3" 164" I Ir 4" CAST -A -SEAL 4" CAST -A -SEAL ml m II FILTER OR BAFFLE—' 1 TOP VIEW i_s I-- OUTLET PUMP PAD TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS WLP2000-MR TANK SPECIFICATIONS DIMENSIONS: WALL• 3" BOTTOM: 5" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 55" O.D. LENGTH: 164" O.D. WIDTH: 96" O.D. BELOW INLET: 43" O.D. LIQUID LEVEL 36" WEIGHT: BOTTOM 14,060 LBS. COVER 8,170 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 56.27 GAL/IN LOADING DESIGN: 8' 0" UNSATURATED SOIL HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 2,138 GALLONS TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN a8 (NO FIBER) TANK: MIX DESIGN #9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: J a oI4 0 F w U) jOF 1 Cow om p 15-31" ('-4 p) O � nn flnn INLETc i_T 1 a1 -- T --------J------•----- Y --.--- in 2 i OUTLET a ' WLP2500 TANK SPECIFICATIONS DIMENSIONS: WALL• 3" BOTTOM: 5" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 55 1/4 LENGTH: 15-3 1/4" WIDTH: 8'-5 1/4" BELOW INLET: 43" LIQUID LEVEL• 36* WEIGHT: BOTTOM 15,527 LBS. COVER 9,300 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL /10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 69.44 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 2,639 GALLONS LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN /8 (NO FIBER) TANK: MIX DESIGN /9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE KEY NOTES: O CONCRETE OR EZ-SNAP RISERS O (2 EA.) MANHOLE EACH END OR (1 EA.) MANHOLE & (1 EA.) 4" COUPLER OPPOSITE ENDS REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: rc J O 0< N N U F a liii 1 Z OF V BAYFIELD COUNTY fd U CHECKLIST FOR SANITARY APPLICATONS IS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) APR 1/2025 Check List Zoning Dept. Original Sanitary Application (Submitted in Deed Holders Name — pot prospective buyers) (383.21(1)1.) Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) Original Plot Plan (383.22(2)2. 3. & 4.a) Cross Section, Over -Head Profile of the System it Schematic of Tank from Manufacturer 0 Pump Tank Diagram, Alarm and Pump Curve (when applicable) Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) ❑ Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) 'Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) 0 ATU Servicing Agreement (Recorded at Reg. of Deeds) Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 8 Complete Sets of Plans (383.22(2)(2.) (Note_ Sanitary Aoolication and Maintenance Agreements are to be attached all cpDies Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) 0 State Plan Review (when applicable) 0 Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) I Application Information must include: )l 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) Project Address or Road Name where driveway is/will come off of) 4] (Owners Phone Number) II Type of Building III Type of Permit IV Type of POWTS System V Dispersal / Treatment Area Information VI Tank Information VII Responsibility Statement (Plumber's Information) I� *Date Stamp* Plot Plan: (To Scale or To Dimension) Signature and Plumber Information A�\J Surface Elevation of Body of Water ❑ Direction and Percent Land Slope Tank and Filter Information and Location Wetlands / Navigable Bodies of Water ❑ Absorption Area (Proposed and Existing) ❑ Bench Mark (Location, Elevation and Description) ] Address Number and Road North Arrow l Contour Lines Structures and Driveways Boring Locations Property Lines Well Locations Component Manual Version Legal Descriptions .Piping Material Information (conveyance line, building sewer line: material type and diameter, Turn Over ► D UUHHVE ❑ Surface and System Elevation p I APR 172075 ❑ Position of Observation and Vent Pipes ❑ Dimensions and Depths Sayfield Co. Zoning Dept. O Make, Model & Number of Chamber Units in each Cell How many systems will there be�on`this parcel of land? Has this property been split? ( (Property Statement shows Property History) Fees; ❑ Private Sewage System (Septic Tanks) $ 400.00 Private Sewage System (Holding Tanks) $ 400.00 ❑ Mounds or Systems requiring Pre -Treatment $ 500.00 ❑ Sanitary Revisions $ 25.00 ❑ Private Sewage System Reconnection $ 50.00 and Private Interceptor ❑ Return Inspection $ 50.00 ❑ Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) u/forms/checklists/checklistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: HOLDING TANK Uwner ivalrle la7•� LvCtt %A I t .8 i6 as 30&L -I on the following property or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Slats.. 1/4 of 114 Section a4__Township 5 N. Range 0, W. Townof lover Additional Legal Description: Gov't Lot 3 Lot_Bbdc_Subdivision CSM# LotJ_CSM# bcfl Vol ,Page dd I_CSM Doclf-�b 1G &" 113 Retur. T DOCUMENT NUMBER 2025R-607083 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED O4/O7/2O25 AT 8:O6 AM RECORDING FEE: $30.00 PAGES:1 BIG PLMBING n 1491 County Highway C Washburn, WI 54891 As an inducement to Bayfield County to issue a sanitary permit for a holding tank on the above described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tank installation and maintenance. If the owner fails to have the holding tank properly serviced in response to orders issued by Bayfield County or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Slats., Bayfield County may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats. 2. Owner agrees to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. 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. 3. The owner agrees to contract with a person who is licensed pursuant to s.281.17 (3) Wis. Stats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced in accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed pursuant to s. 281.48 (3) Wis. Stats., and Ch. NR 114, WI's Adm. Code who shall submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfield County may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 5. This agreement will remain in effect only until Bayfield County certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. SPS 383, WI's Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. Owner(s) Name(s) — Please Print `9ros/,�/v_CJft- Subscribed andswom to before me on this date: )' b I o a //y tt4 e o 1\0\��UttuDIK A r.ui/ CYGc' c ,, Notarized Owner(s) — Signature •)— Nota Pubilt n My Commission Expires: Drafted by: M r\tee. U% '{3 • lb{C` Date: ' k \1L, a.S fill I Int`t"\\ personal informafon you provide may be used for aecandary purposes [Privacy L. 5.15.04 Pxmi] Wonnslsanimry,Toldirglankagreemenl.doc Qlune 2018 HOLDING TANK SERVICING CONTRACT IUJ E G E 1 VI �unu� APR 1 7 2025 Contract Date Bayfield Co. Zoning Dept. This contract is made between the Holding Tank Owner(s) Name(s) Pumper's Name \(Print) Pumper's�S,iggnat�ure Pumpers' Registration # We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT Legal Descriotbn: LOCATION (UseTaxstatement) 1l� Town of•. Lotsire Acreage Section _____ , Townsbip S I N, Range O1 w C to uo f- ) • a;� Gott Lot _Lot # CSM# Vol. Page CSM Doc# Lot(s)No. abde(s)No. Subdivision: 3 i a0V1 1. The owner agrees to file a copy of this contract with Bayfield County as required in SPS 383.55, Wis. Adm. Code 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local government unit which has signed the pumping agreement required by SPS 383.55, Wis. Adm. Code, and the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local government unit and the County named above within (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed and Sworn to me: Lc& 6 �� on this abt" day of '', 2oa 6 ii // II� \\\\pUi nll IN111/p/ by: I Q,"wL ,�.r�rti (j7vl,sl(ryb ',l ��\��\oIKEM,q� Notary Public TARy•commission expires on: ht1 _ t _ aoa 6 ,c. - U • 25 Revised: May 2016 (®May 2018) Dratted by _ Personal infopurposes (P,r ,3�yLsw, X5.0 �ri1 //I,,, OFVA ,ipO V tAG\\\\\ 5/1/25, 12:11 PM Carmody'"" BAYFIELD COUNTY SANITARY PERMIT (#04)-25-14S STATE SANITARY PERMIT OWNER: LUKE W & M I RAN DA M GROSSKREUTZ G OV'T LOT: LOT: 1 BLK: CSM: 2097 1/4 1/4 SEC: 24, T 51 N, R 7 W TOWNSHIP: Clover SOIL TEST: 16-25 REPLACEMENT SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: Michael Wroblewski CECE RUDNICKI Authorized Issuing Officer DATE: 5/1/2025 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: # 1288503 :ondition: Properly Maintain System Per Recorded Agreement. THIS PERMIT EXPIRES 5/1/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION httnc•//www rnrmnr1vinn rnm/ParmitAnn/PArmit Sinn acny?Print=1 Rnarmitnnnir1=7dcR 117