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HomeMy WebLinkAbout25-29SMolly Larson From: Allan Polkoski <bearguidenorth@icloud.com> Sent: Friday, May 23, 2025 11:31 AM To: permits Subject: Rutschow inspection [You don't often get emailfrom bearguidenorth@ictoud.com. Learn why this is important at Request for Sanitary Inspection Far di s fDnn :o Zonrrg :a,t Naen yoJ want an iaspec.ion- 373-0Ne tl ypu de na•hey a(ek Dnd r:eto...al: tie nepecean: you must omen an flair men,.n ho •� f o f :C a S t<, oee Number I Plumber: `! �' 5 zi 2— `•` I S /r l iz,o 5 r'� I 'la .r n.. . nG _ 1/5` 372--rrrl5�`r � +�- �L_.., -_•---ICI Home Owner: tit y, ST • 1n { t ( S c 1_ R� Sanitary^^ G.• t `� 5 -_—.____..__�j PormN 1: Date: I a 2 Plumbers choice apt 77rpp; :mmedInto Phone Numbe. so Zoning Pr(� M poet oen call you light beck Qrnandeal ff Iv„Co ` Township: {�05 �cS i �� 1 A9droaall: r-, C. s-t:.,cr fjt'- Cl l"I' S-Vez y. Reed Name: rr l or o o-I�'%• I w.. E L Directions Itj f-,.. !`u 41:..,.�.�a f,=t &z,u Ln To Sgo: % ` — Comments: Mm;ndor..Yv+a must con.4,maoytire.•:gd. sj cea; wrs ttwi mace p.Y.•rro ______at t lbls fnanscVon will not be cqhedut& a rnrn,o Miji oo sent tgdrra rhn,ncpotL rz `1 Thank Yord ;9 From2an4q arol "Plumber must verily any change(s) by fax or no lnspacNon will be schedufod ubrraO ttChe.et...,-rap+ Sent from my iPhone 1 Private Onsite Wastewater Treatment En Systems ( POWTS) Inspection Report ROBERT N & CHRISTINE (Attach to Permit) Ind RUTSCHOW GE 503 W ROBERTS Pet u oses [Privacy Law, s. 15.04 1 m Pe SPENCER WI 54479 - City 9 village 9 Town of: CST BM Elev: map BM Elev: BM Descripti Tank Information setback to: TYPE MANUFACTURER CAPACITY Prop. Line We I Building Air Intake Road Se tic p N/A Dosing N/A Aeration N/A Holding County Sanitary ennitNo: State Plan, Transaction ID#: Parcel Tax No: S Pump / Siphon Information ump Manufacturer ump Model Demand GPM Filter Manuf tur r K Filter Model TDH Lift Fdction Loss Head Total Forcemain Length Dia Dist To Well istribution Header/Me Dia Elevation Data STATION BS HI FS ELEV Benchmark /Otr Bldg. Sewer Tank Inlet Tank Outlet Dose Tank Inlet Dose Tank Bottom Inst. Contour Header) Manifold , cf Distribution Pipe Infiltrative Surface gi Final Grade i ?5 X Pressure X Hole ❑ Yes ❑ No Soil Cover Depth Over I Depth Over '3 Depth of P Seeded! Sodded T Mulched ❑ Yes ❑ No I ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) /07jII/t Il sy an Vea4 Jo �N5�% �.�jP/�s vllm /t 4149 9 Ol I i< x"1"1' `� 'Ian revision required? O Yes No �� ,�S Jse other side for additional inform io . Date POWTS Inspector's Signature License Number RRMA71n rR n4M11 a Property Owner Information BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373.6138 Fax: (715) 373-0114 e-mail: zoning(&bavfieldcountv.org Web Site: www.bavfieldcounty.org/147 ROBERT N & CHRISTINE RUTSCHOW - 503 W ROBERTS SPENCER WI 54479 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 As you know O' /) *C/ was contracted by you to install a private onsite wastewater tre,tIent system on your property (Tax ID# above). To know when your system will be due for servicing please go to www.septicsearch.com Notes: Abandonment of Old System to meet all applicable code requirements: 1 Tank was pumped by: o Tank was crushed / removed and pipes disconnected by: on at _ AM/PM On c' /,, '- at _ PM) the above -mentioned plumber contacted our office to conduct a pre -cover inspection as requ ed 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/farms/sanitarypropertyowner-input April 2019 ss - o0528 (( 'Pa Department of Safety & Professional Services, Industry Services.Division County s 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 are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address) purposes in accordance with the Privacy Law, s. lS.04(I)(m), Stats. �7 L�.� A t��- eK- r�_L I: Application Information _ Please Print All Information �• Property Owner's Name CLv'� s -I- 1111 MAY 1 3 2025 Parcel # 1aa lb 3S1 I Property Owner's Mailing Address 3 l 3 �o ,� s Ba eld Co. Zoning De t Property Location 2 Palr •�' f' p Govt. Lot City, State Zip Code Phone Number rr t 9'4 'C q '? 1 $ �'�— t0 Z 77 _— —V4, '/, Section Z 5 II. Type of Building (ch�c1 all that apply) Lot # T �'? N RCf • 'o I or 2 Family Dwelling — Number ofBcdrooms 21 Subdivision Name O Public/Commercial — Describe Use Block # O State Owned — Describe Use CSM Number 0 City of ❑ Village of -- 11 Town of III. Type of PO�VTS.Permit: (Check either "New" or "Replacement" and other applicable on line A. Check' one' box on line B. Complete line C if a ilcable. li A. ❑ New System Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. ❑ Holding Tank 'In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design 0 Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration I7 —•—,-----• _ .. .vj.wva. �oaJf'o Iu! L4VdLIVli f 7 Z Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units aIa New Tanks Existing Tanks acs U La p 13 A Septic o�iok3 .Tank .? $-o a U IZ C7[II V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Siture�� lr G/ i![twP/MPRS Number Business Phone Number Ai/1 7o I— o s k i .-••• D O ci C)�,.._ " 1 c Plumber's Address (Street, City, State, Zip Code) r-` Vox .Syo.' /€-v' ,L "•`' L 7 ,1VI. CouOty/Department. Use Only Approved 0 Disapproved Permit Fcc Data Issued M Signa 1J Owner Given Reason for Denial $ h2 5124 2S 4r /f;37,' Conditions of Approval/Reasons for Disapproval Attach to complete plans for time system and submit to the County only on paper not less than 8 1/2 x I1 Inches in size SBD-6398 (R. 03/22) 5�2 oa A�p"ruk,�G� Wisconsin Department of Safety and Professional Services MAY '( 32025Page______ c _ ', Division of Industry Services SOIL EVALUATION REP(�feld Co. Zoning Dept. In accordance with SPS 385, Wis. Adm. Code County j3 yr'e I vL Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D.r scale or dimensions, north arrow, and location and distance to nearest road. i a -� 3 '� / Please print all information. a is y Date Personal information you provide may be used for secondary purposes Privacy Law, s. 15.04(1)(m)). l_._/9231/3 I.4'*5 Property Owner 1 Property Location !� r tS44VtQ J l S 0 Govt. Lot L( '/• Y. S Z,c T "7 N R /' E (or 1 Property Owner's Mailing Address Site Address or CSM and Lot #: 1.3 % I 3O r S + S� rL r1 City // (�'+ State Zip Code / Phone Number ❑ City ❑ Village Town Nearest Road I` y✓�Q YS �t`t'i l.rJ_ .c�{ / T / i 7fS. ¶7 t-./�i L' 5 j4 k -e K New Construction Use: Residential/Numberof bedrooms 2- Code derived designflow rate GPD El Replacement * ! ❑ Public or - Describe: Flood Plan elevation if applicable ft. Parent material �-[4(.i 4 & 1Iiommercial General comments and recommendations: I__J Boring # ❑Boring IPit Ground surface elev. `T?3 ft. Depth to limiting factor / elev. ft. Horizon Depth In. Dominant Color Munseli Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots •rr•• GPD/Ft2 *Eff#1 *Eff#2 1 D— 7,5 31.1 ,¼J)1 L. l �.i T e C w, ..7 Z /-Z' 4i//, v o N L5 / AV ni L 7 /. 3 wo-- 9 S sY .s ,Jof' 5 0 -' r . c Boring # ❑Boring JJPit Ground surface elev. ft.. Depth to limiting factor in. / elev. ft. _tl A__[t__.f__ r ..a_ Horizon Depth In. Dominant Color Munseil Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 _ s iO' _ L A3o Y' -'f $1.- I4iJki �IL 65 3 . V 15/ 1J0,u, L5 . vvrL 5 3 ,7 /• (, Zi.-9 cc/S s Jo&e 5 a •� 1. CST �ame (Please s'd SignatureL-� CST Number Y� din ! �1 n9O Address j� Bc 4. e"2.L ri Ro tier v „,d ct`t(? I I Date Evaluation Conducted 5- tP — S Telephone Number '7I. ai20 t I _ Effluent #1 = BOO > 30 5 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L Sc' sd 1 4e't f n! SBD-8330 (R04/21) 1,SOe4i25rvLI°� IL O Boring A Boring # (J Pit Ground arf elev. .,Page ol• Depth to limiting factor 7 n. / elev. ft. Horizon Depth in. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots oou i ppucation mate GPD/Ft2 *Eff#1 *Eff#2 — — — — — 7 3'g • __ LS Jrqk iVI L- G. S 1-F .7 1, 3 2 —7 S 5"8' ors $ _ -- /v .- /c, 01L/t' ,f -;( � ______ ______ _____ ___ ____ • ❑ Boring Boring # ❑ Pit Ground surface eiev. 11111 MAY Ce18h Mtin ctor in. / elev. ft. Horizon Depth In. Dominant Color Munseil Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Qnil D,4.-. Horizon Depth In. Dominant Color Munseil Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 s 150 mglL * Effluent #2= BOD, 5 30 mg/L and TSS 5 30 mglL Fy 3 of 3 v g sc, i Qoriog y i , (Q� O ll kt� t{yy . rl • t /1 RA C.s.n u.en -�•a a:c l Sae. b uc^�%' 0`t . �rn.Nlhl ✓Ye �01 K.oSlf, I"'u/m �0 �n4 scale: J •� VG G'c6$ {'10Ye•dL 1 !t • p q� Pci.. ay CV&. j4cO11 ZO"Mcnrv1cc jv+•v }C.ucr-• w�:Wyq;i J' gin. q Jsr=E1eV. Orb,efriz Ad6rsl3b-•d® JStRa/f' od'd7•� bl SIC S T a• yaaoI G System �•CJ,: J .�{''' 7� �-^ 9 a; Sa p�'Pc-md< -I.S b ga l%n r ui esov eoncvs4 �� " Lr5r ed/ a w d plY sbae° 3≤!I.? qZ-"gU"o✓v, h44e..4 w4?-!*, ';r. -!'c y^lewi,%°Mf'/fdfG1N! '' ?1d%' C,',f�e,.a f.e. a• t pce ": �'Id"4+A'a'"-Y8' 40�nq'I'N; !'�.'fq ltf'^ '�GvYlw.ti ,�o lI '!'ve„e.t�r/m7r Bpi Ta i o, Arl .a ox`.k'fd5�a uifvsc �.rCh:1`11IoLc8ti�ycAd 16.t 'o okrfe ,e/" pW;sad w53� Se h qo hit Ppt As7rv! 49ygS'- Se.h SUR3a e7JG p: ¢ rs f SYM b3a3y 8AproIe_u PpQ ,ncdltvo rh 1 _ 1' F' v e a o !. w k•e }t ti ,e e.le kd _ ,,_.,,r--�. yyo� ^�N�/ �•�1 i. r N U 1 P .40 3 d a J 4 q4a 1;,, plus"��a ' Sb "sDoo h S a"e-4 lt3' r ,,! z5, s I , 3 d3 zS . W a I ids � ,a 2'.q,.,' •'sue ylof ,/n,P/a o a SE ggeGiR Y_ 'taf� ` Cci wj n n EcEiv D IJP�j MAY 1 3 20 s Bayfield Co. Zoning Dept. �4zgft�' 7J i.K?-cl /et zeeI( eS.8F•&7's ccpS=y31 yo4CZ Ck' z r 'FEZ e. Zi 5 fft Gefllcreehxi@.+t,��.8 , _.0_I/Z.;:GZek'ae.F'i'`e�l+S.�f%lcndce.py Ze•----• lf:Wr mot ! Les�f�.4 Tetul= alaeff Cell a : (Dcf+kN'/e' /'/e durS" qi' ,roppa'v`>L1y LOW Vi Par 2-3a( *13 o v.e.5 t S I Vl a vSLrf t LI 2 Ltya1 Dtsrr;p raq '4 4 5'ae Wfl'7N R Uo 60atLef214( -e 2P4 I -r°WK of Nt &y 11t5 CpU.41 of OY.,. 4 Id ti BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TT U Submit the Following (Use Permanent Ink): 1111 MAY i 3 Bayfieid Co. Zoning Dept Q'1 Check List I Index Page / Title Sheet (Optional) m Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) E Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) 10 Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used { l Property Owner's Information (not prospective buyer's name) m Property Location (Accurate Legal Description with Sec/Twp/Range) I Road Name (where driveway Is/will be coming off of) d Floodplain Elevation, Flow Rate, Comments and Recommendations t?1 Complete Soil Boring / Pit Information iizl Date Soil Evaluation was conducted d CST Name, Signature, Number, Address and Phone Number 0 *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) 17i Bench Mark (Description, Elevation and Location) 9 Contour Lines (Example = 98.0' /96.0' /94.0') m Property Location (Sec/Twp/Range/, Accurate Legal Description) II Borings (Locations and Elevations) 21 Percent and Direction of Land Slope 0 Well Location (Including Neighboring Wells, if applicable) l! I Location of Wetland Areas, Floodplain and Navigable Waters m Buildings, Driveways, and Structures (Location and Descriptions) 21 Location of Property Lines E1 Existing System Location i21 Address Number and Road Name d Current Surface Elevation of Wetlands and Navigable Waters 21 CST, Owner and Property Information 16J North Arrow Fee: 21 Certified Soil Tests - Review & Filing Fee , $ 50.00 u/forms/sanitary/checklist/checkiistforests may. 5. 201/ 1U,41AM I3AYFIELD CO PLANNING & ZONING No.9975 P. 3 PAGE 10F7 7 In -Ground Gravity Plan Index & Cover Sheet Component Manuel Design References: F Version 2.0, SBD-1 0705-P (N.01/01, R. 10/12) MAY 13 0 Pg 1 of I Index & Cover Sheet Bayfield Co. Zoning Dept. Pg 2 of -7 Plot Plan Pg 3 of T �phiik. CUB. Section & Plan View Pg 4 of "7 Management Plan Attachments: Enclosures: P .5f 7 POWTS Application for Review C San: ,4 I Soil Evaluation Report & Site Map aI ,yAc, v,e K. Project Name I Description r Owner Name(s): Ch r ' s +, tR J +S c L0i Phone: 7!.5-- 877 77 Owner Address: 23/1 3=o ves t'≤+t/i/1a v5I , -e I1 it Zip: ≤ L( i4 L7 Project Address: Z70 L€k€ AL -'-e. w T s P ?'7 Govt. Lot 114 of 1/4, Section T '17 N -R J E Ocr W 'cifr is : �c - Township: t( �� County: -e (cL. Project Parcel ID #: 2c T t 3 S'1 1 S`_ Designer Information Designer Name: A if't4sx Fo Lko Phone: 7/if 7z -/ ! Designer Address: 1O. v arc Sze_ Lrc ; `R ty'ev LtJ.: Zip; 817 E-mail: o n V e b ems. v -q it o v+l. " L o M This space reserved for approval stamp. License Number: ?Z- C o 9 O Remarks: Signature: Date: • Original sinaturo required an each submitted copy. ,, 0. TOP VIEW J o C) t0 I� m `rI cn co < 01 CV 01... p4)0 22" •• I') ID SIDE VIEW 4" CAST--A-SEAL WLP 750- MR TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1/2" BOTTOM: 3" COVER: 4" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: DOME COVER 61" O.D. FLAT COVER 53 1/4" O.D. OUTSIDE DIAMETER: 84" O.D. BELOW INLET: 42" O.D. LIQUID LEVEL: 37" WEIGHT: 6,150 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 20.28 GAL/IN HOLDING TANK: ACTUAL CAPACITY: 79O GALLONS OUTLET HOLE PLUGGED LOADING DESIGN: 8' O" UNSATURATED SOIL OPTIONAL FLAT COVER TANK CAN BE USED AS: IS AVAILABLE FOR EXCHANGE SEPTIC/ HOLDING/ PUMP OR SIPHON FOR DOME COVER. COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) OUTLET CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE PUMP PAD TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS 0 N J O N Q O n Q U w DRAWINGS SUBMITTED DCfl FOR APPROVAL � w a! APPROVED BY: SHEET NO. APPROVAL DATE: PRODUCTS NEEDED BY: /OF 1• • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page L of ' FILE INFORMATION Owner C • re S+1 ry a -1-S C- a Permit # f)irt 1! 1111 DESIGN PARAMETERS AY 1 3 Z( Number of Bedrooms foal Number of Public Facility Units j NA Estimated (average) flow Z d o gal/day Design (peak) flow - (Estimated x 1.5) ' 0 0 gal/day In Situ Soil Application Rate - 7 aVda /ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) ≤30 mg/L Biochemical Oxygen Demand (BOD5) ≤220 mg/Li NA Total Suspended Solids (TSS) ≤150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) ≤30 mg/L Total Suspended Solids (TSS) ≤30 mg/L Il NA Fecal Coliform (geometric mean) ≤104 cfu/100ml Maximum Effluent Particle Size 14 in die. II NA Other: �] NA "Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Tnk4anufacturer o e,5�-Y C.c./C., 0 NA Sc 0 Dose ❑ Holding vol. '7 ≤0 gal Sjan anufacturer ER NA O Septic ❑ Dose 0 Holding vol. gal Effluent Filter Manufacturer ?I Y !o C. 0 NA Effluent Filter Model P L 52.5' Pump Manufacturer 59 NA Pump Model Pretreatment Unit 1 NA ❑ Sand/Gravel Filter 0 Peat Filter ❑ Mechanical Aeration 0 Wetland ❑ Disinfection ❑ Other: Manufacturer Dispersal Cell(s) ❑ NA In -Ground (gravity) 0 In -Ground (pressurized) ❑ At -Grade 0 Mound ❑ Drip -Line 0 Other: Other: J4 NA Other: NINA Service Event Service Frequency Inspect condition of tank(s) At least once every: O month(s)3 onth(s) ears (Maximum 3 years) 0 NA Pump out contents of tank(s) 10 When combined sludge and scum equals one-third ('4) of tank volume IN When the high water alarm is activated ❑ NA } Inspect dispersal cell(s) At least once every: ❑ month(s) year(s) (Maximum 3 years) 3 ® ❑ NA Clean effluent filter At least once every: ❑ month(s) ® year{s� ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ® ear{s ❑ NA Flush laterals and pressure test At least once every: ❑ month(s) 0 year(s) ® l4A Other: At least once every: ❑ month(s) ) ❑ear s II NA Other: M NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank Inspections must Include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or le4ks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels In the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may Indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third ('f3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wlscorjsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment. units, and any servicing at intervals of ≤12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (12/D2) START UP AND OPERATION Page a of a For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals that may Impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) In one large dose and may overload them resulting In the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to Insure that the system Is properly and safely abandoned In compliance with chapter Comm 83.33, Wisconsin Administrative Code: 0 - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result In the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 14 The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the blomat at the Infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name 1( Pd4) Name A Q Q / kcg ka o l k�,s k,' L Phone •-71 5- 2.1j B So Phone 11S / SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name `'d" �a 5 Po l k-osk; Name j3� `�s e ' 0OL �Z©.'t Phone u S 37 Phone II .c 3'7 'S•— d(13 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies In compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. SS -00535 Department of Safety County s t us � s � & Professional Services, Industry Services Division Sanitary Permit Number (to be filled in by Co.) ?S- a 9 s 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 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, s. 15.04(1)(m), Stars. 2% t-4sc'c��-"'CCC .l I. Application Information —Please Print All Information s�f j Property Owner's Name Parcel # CLA41 XLd-ccLow MAY 132025 U aK Ibd3s1IS Property Owner's Mailing Address Property Locution 2 3 3 O �) Co.Co. Zoning 2 n F r-� S+e pt Govt. Lot . __ _ _- City, State `/ Zip Code /ode (PhoneNumber `'%�(a✓ck c/ k ws = Sr`t 7 q 7/ S- $'q7 Z77 /. /. Section ZS II. Type of Building (checl all that apply) Lot# T �? N R o �Ior2 Family Dwelling — Number ofBedrooms 2 Subdivision Name O Public/Commercial — Describe Use Block # ❑ City of ❑ State Owned — Describe Use CSM Number ❑ Village of 19 Town of �; �'2S III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box online B. Complete line C if a licable. line A. ❑ New System Replacement System y F Y ❑ Other Modification to Existing System (explain) 0 Additional Pretreatment Unit (explain) D' ❑ Holding a�( Tank CJ 1a -Ground ❑ At -Grade I ❑ Mound ❑ Individual Site Design I 0 Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber List Previous Permit Number and Date Issued 8 ❑ Transfer to New Owner Expiration /( 59 �P IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Ratc(gpdtsf) Dispersal Area Required (a I) Dispersal Arco Proposed (sQ System Elevation Do 7 Z 3 910. O Tank Information Capacity in Gallons Total Gallons # of Units Manufacturer dl Now Tanks Existing Tanks Septic sM1ol4ingTank 9aeiag.CNw,abes .7 SO _ 7 SO ll)4F-Sat✓ Go✓LC 0. ✓ r v2 iZ C7 L V. Responsibility Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Pluunib/er's Name (Print) Ir '/ Plumber's Si ore �� '!fF/MFRS Number Business Phone Number A �h �� I l r�5 R—� 22009 0 7'SL9y_L{/S4 Plumber's Address (Street, City, State, Zip Code) 8 f`,, , .-UT 8o)C S'2-7VI. County/Department Use Only Approved 0 Disapproved Permit Pee Date Issued su' rg A Signs t� /3 ❑ Owner Given Reason for Denial �Q'} `- 6/2a Ze / f .3 '7 Conditions of Approval/Reasons for Disapproval �ia,fn!4 a 9 T,GJcc C °u" of Attach to com"Icte oleos tar an. sysmn. -1111 ...," t th r................................- o e aunty only an paper not less than a 1/2 x I t Inches In size SBD-6398 (R. 03/22) :; 5QOOTh3 4��uriuki,� Wisconsin Departmentof Safetyand Professional Services MAY 1 3 1025 Page__ Division of IndustryServices 30 r. SOIL EVALUATION REPQjeld Co. Zoning Dept. In accordance with SPS 385, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 Inches In size. Plan must Include, but not limited -to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I , fret . b 3 ≤/ /5 scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. S le y Date Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). 3 I/jrF • Property Owner Property Location r r s v 4 S od1J Govt. Lot Lf'/a % S ST '"7 N R E (or) 1) 23 Property Owner's Mailing Address 1 Site Address or CSM and Lot #: r S City I State I Zip Code Phone Number ❑ City ❑ Village 11 Town I Nearest FRgad 1vta vs t4 1 c-i/. -`1 y1( (151 ', JL4 ke A k wL•e -,e kC ❑ NewConstruction Use: Residenilal/Numberof bedrooms 2- Code derived designflow rate -3C3 b GPD Replacement i ❑ Public or commercial — Describe: Flood Plan elevation if applicable ft. Parent material 4[ eLt Q I 'lTi j I General comments and recommendations: Boring # ❑Boring VPit Ground surface elev. ??3 ft. Depth to limiting factor In. / elev, ft. Anil Annlln.�linn �nln Horizon Depth in. Dominant Color Munsell Redox Description- Qu. Az. Cant. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 o-- i./1 w 5L / /i. f r ct 3 ( •.7 3 zo-- B? .Y S f 6 nJ e p -- ,. ? ! . _ I_2.1 Boring # []Boring lJ JPit Ground surface elev. �7 _ Sft. Depth to limiting factor in. / eiev. ft. Anil Annilms=inn Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 ( -≤ 1D r3ia / NdV-1' 5L- /-(4M L 65 3h V ,$ fJ o WP L 5. o Ykl L $ *rt . 7 14 CSTJ'ame (Please Print) • Signature ,, CST Number 90 Address •f? ©. Bci it S22. �.� ga a e �.0 c / W 7 I Date Evaluation Conducted ^ .g (e — Z Telephone Number i1 ' z a� z -- 41: 4 * Effluent #1 = BOO > 30 5 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 BOD, 5 30 mg/L and TSS 5 30 mglL I SBD-8330 (R04/21) �¢� o� `oo C�(QZ�� 5c Sol .� L ❑ Boring Boring # � Pit Ground garface eiev. Page of Depth to limiting factor �in. I eiev. ft. Horizon Depth In. Dominant Color Munseil Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots oon t ppncaaon Kate GPD/Ft2 *Eff#1 *Eff#2 z 1 - �.� 3''gY awe Ls 4 r4bk 1141- L$ 1- . 7 1, 3 2 -7 s iz $ 10f" $ . -7 ! 6 ____ ____ o—i/"-1I_-(--( _____ _____ ____ ___ ____ D LLBYJL J) ❑ Boring # O Boring ❑ Pit Ground surface elev. MAY r .P,Zq)tin ctor in.! elev. ft. W--1-- GM___k A_.. • _ .._ .. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture p . Structure Gr. Sz. Sh. - Consistence Boundary Roots v.. I.`+f.1.vM4vl1 I1W lei GPD/Ft2 *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface eiev, ft. Depth to limiting factor in. / elev. ft. Qnil D.1.. Horizon Depth In. Dominant Color Munseil Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. -Consistence Boundary Roots GPDIFt2 *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 s 220 mglL and TSS > 30 s 150 mg/L * Effluent #2= BOD, s 30 mglL and TSS s 30 mg/L a ?oIkasse.: PJupm4:,nl $k: l�lW Yt*'u / � u��► l �a� aaa � I4CU 1 ! N ,i l ?_O " w`'4fraz'44'csa/iQQO-►r9 . J @ d wdad 7g7 .+ g�/!td J p" Irv.�' . ®„ O `.' 9�!' /t4i p®/�az o o £s+' Cf -ev✓: to• c tj r .i( C 5't 2: gI+i41.L,k' -.S''b c3a11 w,►Jeser c:�H v .-,� .. n �, 1b: 3≤�') I „�'" q�-�' f ir//.dyyym ba ,. m -�• �� - e �. ( ae�'. ah d + el vtlt.t"„dw ,�'j (; r$ 0 7 ry a •►�� i IAe le. e�► ' t� k� .sl� Ip w� SPS t .�.z 4c,. ® r� a�� ,. - �•,� s - v�e I �� a jfl�.��.� ' � d r� ,� �. —�'o� !'© wed 1`� &f o PAC. 'Po��i. a6 A S'i-rn 3f plc s .4$'r D3'3 Y ppV.&+ ' e.. Pap ttj t ,�bs��aef a11S rt?Ic 4v �r' r En) �'Qt(II11 MAY 13 20 Bayfiefd Co. Zoning bept. .79Pd 7.pt� a,. I c1, iC2.,4j.f aLt+c.e!I.L: 11 C.1i lD4*'/t& k v5lr 1J. w, �.5 /tf`(% 2&/I GatI • w t )9f ;t, --� �p0da Y 0 0 Y -P I4 BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TT I Submit the Following (Use Permanent Ink): 1111 MAY i 3 ?Ulh Dayfield Co. Zoning Dept. f1 Check List iF Index Page / Title Sheet (Optional) 9 Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) fig Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) ® Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used l I Property Owner's Information not prospective buyer's name) ® Property Location• (Accurate Legal Description with Sec/Twp/Range) t Road Name (where driveway is/will be coming off of) I1 Floodplain Elevation, Flow Rate, Comments and Recommendations 21 Complete Soil Boring / Pit Information 0 Date Soil Evaluation was conducted IZI CST Name, Signature, Number, Address and Phone Number O *Date Stamp* Plot Plan; (Include the following information drawn to dimension or to scale) 51 Bench Mark (Description, Elevation and Location) L�l Contour Lines (Example = 98.0' /96.0' /94.0`) l0 Property Location (Sec/Twp/Range/, Accurate Legal Description) m Borings (Locations and Elevations) A Percent and Direction of Land Slope ICJ Well Location (Including Neighboring Wells, if applicable) 16 Location of Wetland Areas, Floodplain and Navigable Waters m Buildings, Driveways, and Structures (Location and Descriptions) 0 Location of Property Lines Ci Existing System Location I Address Number and Road Name Rl Current Surface Elevation of Wetlands and Navigable Waters fJ CST, Owner and Property Information 06 North Arrow Fee: Ed Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checkiist/checjciistforests May, h. /01I 10:41AM BAYbILLD CO PLANNING & ZONING No. 9975 P. 3 PAGE 1OF7 In -Ground Gravity Plan Index & Cover Sheet p C d Component Manual Design References: D Version 2.0, SBD-1 0705-P (N.01/01, R. 10/12)IPi MAY 13 c0'lh Pg1of% Pg 2 0t7 Pg3ofi Pg 4 ofi Index & Cover Sheet Bayfield Co. Zoning Dept. Plot Plan el�t ) tG Ciro Section & Plan View Management Plan Attachments: Enclosures: Pr s- o POWTS Application for Review (, S4n -k fl - ? Soil Evaluation Report & Site Map a" -7c1 Mc. \, ✓r42,.. Ln cZ A vetwn Project Name / Description Owner Name(s): ah v S 4[ , , ,e R J ±S c L O j Phone: 7/S _ g77 - &a7 -7 Owner Address: 2311 3 roye5fcf pt'14vshf - lcL '-4-' Zip: $ q4t{7 Project Address: 6270 Lc-<ke A 11 �-cICt1. e w = S1'8 Y7 Govt. Lot: '-4 1/4 of 1/4, Section S , T 117 N-R2E ❑ or W ` R«r��(s kJ Township: Z County: F -c LL Project Parcel ID #: ! x I D 35/ I S Designer Information Designer Name: A I /u r` ?o /kO s /c Phone: '71r- 7y - y l cKo Designer Address: l? c', c3 ©K C -a 1ro.. `R , v-er -1j.Z Zip: SV8V7 E-mail: -f o n r/ a h e.G v j u,', d.e - o r-/-4_ - e_ o r'v1 This space reserved for approval stamp. License Number: 27C -C70 Remarks: Signature: S Date: Original sionature required on each submitted copy. CO WLP750-MR TANK SPECIFICATIONS 23„ TOP VIEW t V M Q SIDE VIEW 4" CAST -A -SEAL DIMENSIONS: WALL 2 1/2" BOTTOM: 3" COVER: 4" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: DOME COVER 61" O.D. FLAT COVER 53 1/4" O.D. OUTSIDE DIAMETER: 84" O.D. BELOW INLET. 42" O.D. LIQUID LEVEL• 37" WEIGHT: 6,150 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 20.28 GAL/IN HOLDING TANK: ACTUAL CAPACITY: 790 GALLONS' OUTLET HOLE PLUGGED LOADING DESIGN: 8' 0" UNSATURATED SOIL OPTIONAL FLAT COVER TANK CAN BE USED AS: IS AVAILABLE FOR EXCHANGE SEPTIC/ HOLDING/ PUMP OR SIPHON FOR DOME COVER. COVER: MIX DESIGN #8 NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) OUTLET a PUMP PAD TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: W W . C � U = z C OAF O J5 It D M Z I Q U 0 V)) w 5 1n w It SHEET NO. 1OF POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page L of FILE INFORMATION Owner C r S 1 e u is c o p Permit ft 1! DESIGN PARAMETERS AY 13 2f Number of Bedrooms M fS( Number of Public Facility Units JK NA Estimated (average) flow Z C O gal/day Design (peak) flow = (Estimated x 1.5) 3 D O gal/day In Situ Soil Application Rate • 7 al/da /ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODS) ≤220 mg/L 5 NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mg/L Total Suspended Solids (TSS) ≤30 mg/L ® NA Fecal Coliform (geometric mean) 5104 cfu/100ml Maximum Effluent Particle Size kin dla. j NA Other: jt9 NA Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: p month(s s) (Maximum 3 years) 0 NA Pump out contents of tank(s) Ihl When combined sludge and scum equals one-third ('k) of tank volume Q9 When the high water alarm is activated 0 NA Inspect dispersal cell(s) At least once every: d ® year(s) (Maximum 3 years) 0 NA Clean effluent filter At least once every: ® yeonth ar(s)(S) 0 NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ® year(s) 0 NA Flush laterals and pressure test At least once eve ❑ month(s) ry ❑ year(s) ® NA Other: At least once every: ❑ month(s) ❑ year(s) ® NA Other: 9( NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must Include a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (15) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at Intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. SYSTEM SPECIFICATIONS anufacturer *' e5e ir Cc.r►C, 0 NA In S is 0 Dose 0 Holding vol. 7C0 gal �an anufacturer IPl NA Septic 0 Dose 0 Holding vol. gal Eff vent Filter Manufacturer PO 1 y I c' L 0 NA Effluent Filter Model P L S 2 S Pump Manufacturer Q NA Pump Model Pretreatment Unit R NA ❑ Sand/Gravel Filter 0 Peat Filter ❑ Mechanical Aeration 0 Wetland ❑ Disinfection ❑ Other: Manufacturer Dispersal Cell(s) ❑ NA 09 In -Ground (gravity) 0 In -Ground (pressurized) ❑ At -Grade 0 Mound ❑ Drip -Line 0 Other: Other: R NA Other: $I NA GMW (12/02) START UP AND OPERATION Page + of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals that may Impede the treatment process and/or damage the soil dispersal cell(s). if high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resulting In the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system Is properly and safely abandoned In compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Setae Servicing Operator. P p Y P Septage P • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result In the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be Installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed In place following removal of the biomat at the Infiltrative surface. Reconstructions of such systems must comply with the rules In effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name A i1' ?. Ikoskr P� I kck PQh�aName l tei l 1 kof k 0v l 6CcS k ?L3 .4 I1 Phone 11 a 2,ci 2 'I 1 Si Phone II S� 9 ?.. - ? 574 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY EName'rh0 ?,Itc�skd Name z Qu 1 Phone 1/ 3'7 . ( (39 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. I Private Sewage System Maintenance Agreement DOCUMENT NUMBER 2025R-607387 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI ono numaaa Marsh -Q .\� , W i 5y414 q r two) w assay canny me 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. Cade, as from time to time amended. (COMPLETE Legal is required) 1/4 of 1/4 Section Township N. Range 9W. Additional Legal Description: . fc lS i Yb Town of a /r r. S (Acreage) V�a Gov't Lot______ Lot _ Block Subdivision Lot __ CSM # _ Vol. SW 0qy 3(° CSM Doc # RECORDED 05/06/2025 AT 8:22 AM RECORDING FEE: $30.00 PAGES:3 Recording Area Return To:tY ,_..f��� �ODSIYI , D o )CZ 025 D Berri! D`f S i''7 In -ground gravity ❑ in -ground dosed ❑ in -ground pressure distribution Sewage System: O Mound ❑ At -grade Sewage System ❑ Other ,I- 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 S, 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 Pilfer (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 ae required by SPS 383.55, Wis. Admin, Code. i 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 -around Pressure System terals (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 a/i chs. nos and costs k,curred by Sayi'eid Couniy 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. Sayfleid 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 chq@@ges 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 prov(d@ytNii 19W. till, The terms and conditions of the agreement shall be binding upon and Inure to the benefit of all current and future owners Owner(s) Name(s)—Please Print e Subscribed and sworn to before me on this date: Vj`• . r sfne t2uis��a� /lay5�i,5Z�'• GB Notarized Owner(s) — Signature(s) No ill! r' My Co lea( xpl uranea 0y: LOQ,$f?L K"? $- ( Date: ) 5 Proofed by: Wforms/sanits ry/septicmalnlenceagreemenI Revised July 2020 T r v �� -2 PLATOFSURVEY A9EC L M. TOw9LflO Li&�M DCO(A.RATED IV MATiSCOV&N4 IRON MI nFJ rowxDPxuDNEa enwmOcwvTr. W4CW&N JH! O C 3 _ o FFARMGSARF GRID U9FD ,,[�BINTNM AEASIAEO o Ch N SHED ® SEPTIC 7'+I[TTr'",�� NAr w.n x _n R— O ryI dPl'•F�y✓CIJ E�cL ^ n 10 VENT ® �® POLE I r �� ' 0 ® - Ern N LINE TABLE /�� >0, 3 m LINE -t"w I Mj LI •0714W n.u' a ROW ENEWAY •\ LEGAL DESCRIPTN)N: CGNE88AYFIELO COUNTA PARCEL OF LAHOLOCATEOEVOOVTLOTI, SECTION 15 TI>N,.WW TORNOF y,` MS.•G._ `�� V. LNSCON&N. AP pl1E ARTICULNN.Y DESCPoEED AS $ V( PAMELLFOLLOI: L 8)O figT oly RO• �".�� �D• COT EEKIM AT THE WEST V. CDRNERCF SAID SECTNN MENCENFR•RTIB'E ALpA MEEWW LINEA 015TANCE OF [J19.1TREET THEACERITI'I2M'A ^ 92 p9TA OF I. TUBS FEET, INFM':EAOI'M'MEA OTMCE p°®TM FEET MA 57' `— jCjI MEANDER COIMR 8M0 COMFREINS ANNMEA p91AN(YSFESTMOFE OR LESS FROM TIE OINMM[RY MiR WIDER YMR OF IRON La,; THENCE SU'19WE HONG A MEANDER LINE A DISTANCE OF 21598 FEET TO A MEANDER (4 CORNER 9HDCORNER DEIAG TERM I Ap9/MCFCF 19FEET 11LOFE OR ZIYWALESS FROMTNE ORM.WRFEETRwENCE511OF Thea g' yy PARCiELf p8/MCFEGINIll UiEFi; INENCFN9e'ODCeWAp9/ARCS Cf 116RFEF1lO ME LA IITIlLTll6 OAMMEIOITIIS WlR PDINIDF BEpNMNO. COAANW01nMWOM1lIn MPMEe4w 153,423 rest DaxAMCTax WTN NSAIwW MLIXA/Ip19f O1' 3.52 Acres 3 y DIE ABOVE DESCRIBED PMCEL OF LAM) CCNIAN9 IFSW EgMREFEET MOPEOR SIN959751117lDWNII[EMIDreCMpFOW Y LESS MM'JII9IUALK8 M0/R W(EH9 /A6LpAU RM1NROL1WiBFMEFN lEST LEE OF MUPHCIL MLgNRIRIIDId'AMWr K �' TIE MEANDER LINE AND THE ORDIMMWMOM WATER AWE OF IRONUNE. NATMMTOH LOCATION OR SIC LEE.[IxMR J MRe MBEMSTO W IMORTREMIC[Nnlxx s IBL WEW M REST LIE OF ODVFAMMT LOTS I SO NOT ACCWT M W GUSTO R!S ILCMYNIMO M MIITIME[/ CpxIR OF CW OATH TINT BYE GG CgIWR NH MONIAEMEO BY'MINNNEROW( 8� [ 81/flVE1,OF8G£/111FGiE M II[R lAS FLAT 091MV[Y MTED EWIMI WI[E - R I 1050 EITHIDNNO M REST LIE OF GOVT LOfA TO Neal 1599 SCOOPS M K GMED RIYRPLIITIEA AAT CA MCR'UEN WISCONSIN PROFESSIONAL LEND SUN YEYOR 9'Yro], DO HEREBY EAST HYOVMOx MHIuiHOINS EON �RTEYTHAT MBNdP WAS MADE AT DIE DIRECIIONOFCNRISTITl0NMCNLWA OWNER OF HLIPTET(TN sno(wwnvlvaxe.IMcvTED - ,x TIE MOW DESCROEOAIA IMP -FED PARCELS, MO THE IEOEDRATIDN&IOWN DR THIS MAPS TN[rWNOWNMENTAMNII, MOWIWiIWT'E 19 CCRPAEOIA40 ACCURATETOTIC BEHICF MY DONEEDGEAND SEC EFAND MEETSiNE MTHOOxEOlAF TIE LOCIMI, PIE 11[M[vuvM SIO[ReNL118S 11 MLOGONlCOM[E CODE. STANDARD REOIAREMFNi8F0R SURVEYS UNDER AF.IOFWIBCgISINAD.tbN19TFOTIVE wRYexISIML2 SelLIxOLVRMHpRetEOTO LODE, g / NTAOCN[YJ WOOMIEPS y� wr D J ra .SFr Zo2 1 twrERMwE.rrmRxArzxo r n E F a ((11 rORHH[EEDIAr. R11, , ME INTO ELOxTN[OROYNRYIIR111WT(R WR1{CF CI TA ' i yyy SLAVE OR NICIMS ITRLWEIVIECT IOM 1af FYEM: r11WrxIMNOMIYxIOE Mn E. u. ,E®ALIBI rOl '0599.51* MR[ 0 PINE RI LARD BURVEYMO LLC. li eIrHLAeD IRaRHIRv aacnanlaM •-2 j0p'1 PATEICI(A KWUEN WI I/Al[CONBTURMCDMlRCpI1W rwRlgnYw RIFLE. 8.2902 N 00490MAO �, rwygNE MLDIA'MMxV! rol'M]IM IOS C15UN•f nr+sxnl ,Rvmxe-IW IaTN.IS RNIIYfNOHExr� FwNlamw T n------ nM (.j J LEGEND ; NBWBo'58RW 248.760NBD•50'55'W 51°.73' CIF g �p°1 D -SET 1 1/4. 0.0. N IC IRON PIPE RESTYUVFEIBE • -FD. MONUMENT AS NOTED SECS T 0. A ( )-PRENOUSLY RECORDED AS 1.326.27' ________--- SEC. 4 i��RE C . 3 lfl 80' 0 80' 160' 240' wtrwreD_eF.R _ 3,°30.78_ _�-_-� (SBB'5B'45•E) nxwrMREw f 4257377 F SCALE FEET x,, OSII;x fS257.377 OF 11 I MAY 132025 Bayfield Co. Zoning Dept LEGAL DESCRIPTION: A PARCEL OF LAND LOCATED IN GOVT LOT 4, SECTION 25. T47N. ROW, TOWN OF HUGHES, BAYFIELD COUNTY, WISCONSIN. ,WORE PARTICULARLY DESCRIBED AS FOLLOWS: PARCEL 1: COMMENCING AT THE WEST% CORNER OF SAID SECTION; THENCE N88'58'48'E ALONG THE E•WZZLINE ADISTANCE OF 1,326.27 FEET; THENCE NOf•21'12'4VA DISTANCE OF 1,153.56 FEET; THENCE NOO.20-38' E A DISTANCE OF 597,22 FEET TO A MEANDER CORNER, SAID CORNER BEING N00'20'38't A DISTANCE OF 0 FEETMORE OR LESS FROM THE ORDINARY HIGH WATER MARK OF IRON LAKE; THENCE S88'28'03'E ALONG A MEANDER LINE A DISTANCE OF 245,68 FEET TO A MEANDER CORNER, SAID CORNER BEING S0002'19"W A DISTANCE OF 48 FEET MORE OR LESS FROM THE ORDINARY HIGH WATER MARK OF IRON LAKE, THENCE 50002'19W4 DISTANCE OF 595.58 FEET,' THENCE N89'50'56'W A DISTANCE OF 248.75 FEET TO THE POINT OF BEGINNING. THE ABOVE DESCRIBED PARCEL OF LAND CONTAINS 153,423 SQUARE FEET MORE OR LESS, WHICH /5 3.52 ACRES MORE OR LESS INCLUDING THAT LAND LYING BETWEEN THE MEANDER LINE AND THE ORDINARY HIGH WATER MARK OF IRON LAKE. BAYFIELD COUNTY � M D CHECKLIST FOR SANITARY APPLICATO L5 15 U Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) MAY 1 3 2025 Gd Check List Bayfield Co. Zoning Dept 661 Original Sanitary Application (Submitted In Deed Holders Name — n t prospective buyers) (383.21(1)1.) i6 Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) ' Original Plot Plan (383.22(2)2. 3. & 4.a) M Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) 121 Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) 121 Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(S),(6) (Recorded at Reg. of Deeds) ❑ Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) ❑ Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) 21 Fee (Make Check Payable to Bayfeld County Zoning) (383.21(2)(c)7) Gd . Comolete Set of Plans (383.22(2)(2.) (Note: SanItarY Application and Maintenance Agreements are to be attached to all copies) l r Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary li do • (Include the following Information) 9 I Application Information must Include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) 0 Project Address or Road Name where driveway is/will come off of) d II Type of Building l9 III Type of Permit d IV Type of POWTS System Of V Dispersal / Treatment Area Information 9 VI Tank Information * VII Responsibility Statement (Plumber's Information) ❑ *Date Stamp* Plot Plan: (To Scale or To Dimension) 121 Signature and Plumber Information ' Surface Elevation of Body of Water ® Direction and Percent Land Slope I 'Tank and Filter Information and Location if Wetlands / Navigable Bodies of Water 9 Absorption Area (Proposed and Existing) Ld Bench Mark (Location, Elevation and Description) l Component Manual Version E Legal Descriptions ❑ Piping Material Information (conveyance line, building sewer line, material type and diameter), Turn Over ► ® (Owners Phone Number) Address Number and Road 21 North Arrow 5 Contour Lines l2fStructures and Driveways Q Boring Locations L4 Property Lines (a Well Locations Cross -Section and Over -Head Profile of the S,y teat: El Surface and System Elevation O Position of Observation and Vent Pipes o Dimensions and Depths O Make, Model & Number of Chamber Units in each Cell Property Information 1111 MAY Bayfield Co. Zoning Dept ❑ How many systems will there be on this parcel of land? _L ❑ Has this property been split? _ (Property Statement shows Property History) Fees: El 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 O Return Inspection $ 50.00 El Maintenance Agreements ® $ 30.00 (checks made out to Reg of Deeds) u/forms/checklisis/checklistforsanIWryapps (10/2009);(®7/2011);(®2/2012)(®5/Z/2012.dc) Proofed by: r� /I) p e a sar / Qor;n .5 f a / ®vn..nlnB`rm ia1/CnpG4', l�'.,.v.�4inq $Gct�6o ,a•�A'iO'Mnlegsn167Y'fd,[�,l ��+.nU•en�toti9n/J�©/ �Scru'/ld^aN P.O.G.•Oy :'�24. J Na�0.t ( a`a Zo"N ry i'$a� ' 6 LPi MM1 eGao •N•w� ('�6 cTis lrcll U•�°�o li ' rnn lt:r, ✓ w'i."'Wd>7 m am. ( VAP=EIev. D®b,®!"z"A SS DI '-/o O t'?('4Ai/�&f'�t.,9odd). fo'k S. LZc,o1R0 S'ys+" Elul o •• CS •zzfl.ago ... .•�' y"7� 1! a p4fc -r .k �;,5� 1$-b jet l%n wi esev tbncvc4e - �`i " Lr,Sr�g,A; o, n d • 3•� i l.s �Z "(J'.M boT7'mn�. er i' e' • `%'e IBVd f vne , M �P't' -r^ I' 1t`T%� �`G,/G.:, i.f,J• u C hEi �y"4+A, G1'•a•t, .. a l'He1 h.vY7 1, e rJS.17"i'IG /can C -P 1III ii.k'{�5•�6i,: fS�' �S �pY19 4 t -A'. a••.F '/b'1'ra+li /roi' d svl r h,e/�ti stcaineCGnuabm,.ravei,�caa>7, /,o w;�lh SP538:3 5ep/ic /ant-- Her- set 4nv.e /e"'c a.pp..T�Y � •fb/>tr..r.-t'olj�/okAver�d/"` pL-s2 A, Sa.Ga ys hit. P:p t, A5Trvl D;ifl — Sabi 50a°.3a pP'C Pp as F1STM Q33 ( ctjrprG se.a rope ;vlatT�vi fjP F, ve (0270 .a ic•f. A4tiYn•�ede kd . _..�--•''_"... woYt t.4 €, .,. icJ: <4o g !& � t i •Je"-n be 4.atILat 5�?ibc�. /ijrth 1^�I� yer emu' 1 1 ln�pll ks p/ra a i_ •2 a 2 •1ylcf / k o• o u E 2d3 Y a✓.e`Y6 f in1{fit ( e„la 4y# ss till MAY 1 3 2025 Bayfleld Co. Zoning Dept zl Ch cel(s S≤g /c c4 S `43l 2a•F t'Z EL, c!/l: it mhK ae /(Gl + h t2/ Zccps c 2G5-fI� GeI/2: loch g"ze .F•d'/I Ct: +S. It �tT�•c`,4ce. r tGl= a zl ff Cclll . IIC-Lt e!+ k 3'J'a�%feu S: %7' —. Ge1I1 lbc4r k't a/Ch {'3,/e vr�Ga)v5'•. cf=r Pd'opepyi ©whew; Ckrsf' gUtsLl,oL..) 2311 -C3 Fcy4i tSt L j �l v sLrF: e (d w.X Stl ti"( z49' N /ilk°- �wad• a a Lq .( Desc.v1#ton a waa se.e.31tV7N 9 `1 W �c 61T if tl£-+. 17,/ •—rcw kt of k 1'4 k e /'�Y+ ic'a' /•y e{ l aY-F' < /14 Sti BAYFIELD COUNTY SANITARY PERMIT (#04)-25-29S STATE SANITARY PERMIT OWNER: ROBERT N & CHRISTINE RUTSCHOW GOVT LOT: LOT: BLK: 114 1/4 SEC: 25, T 47 N, R 9 W TOWNSHIP: Hughes SOIL TEST: 30-25 REPLACEMENT SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: Allan Polkoski TRACY POOLER Authorized Issuing Officer DATE: 5/22/2025 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: # 220090 Condition: Maintain setbacks. Properly Maintain System Per Recorded Agreement. THIS PERMIT EXPIRES 5/22/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION