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HomeMy WebLinkAbout25-32SINBOUND NOTIFICATION ; FAX RECEIVED SUCCESSFULLY TIME RECEIVED 3u1y 7, .2025 at 8:00:14 AM CDT REMOTE CSID7157983470 DURATION PAGES37 1 STATUS Received JUL/07/2025/MON 06:35 AM Andry Rasmussen & So FAX No.7157983470 P, 001/001 Request for Sanitary Inspection (24 Mrs. in Advance) Fax this form to Zoning Dept (24 Mrs.) prior to when you want an inspection - (715) 373-0114 If you dojiot have a fax and must email the inspection; you must emgil all staff members. Note Plumber: Time Change Discrepancy -Qndfij ^'mss^n ^ .S&77; Other Phone Number H7/5-/7^-33.S:^_ Fax Number 7/5-- W- ^ Homeowner;^cuwm LCozfti^ Email Address r / ry^^n^'q^^ fcyy.^ m;^/^(Ww^,^777 [mmsdiate Phone Number So Zoning Depf can calf you right back (If needed)Sanitary Permit #;<^-33 Date: Plumber's Choice 11^ ing Dept No Inspection (s) during this time Tuesday (9:30 am -12:15 pm) (Tracy) Time: Plumber's Choice 10:30 Township:toAddress # & Road Name: or Directions To Site: ^;?? ^rry ^ ^ Comments: **Plumbers you must verify any change(s) by fay or emal! Mates from Zoning Dept: u/forms/Baniiary/requestforinspection Zoning Dept (©4/12/04);iS>Juns2023 BAYFffiLD COUNTY PUNNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715)373-0114 e-mail: zoninaObavfieldcountv.orq Web Site: www.bavfieldcountv.oro/147 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn.WI 54891 Property Owner Information As you know ROBERT F & KAREN J WOZNIAK 44185 PERRY LAKE RD CABLE WI 54821 ^.ASl4cl<(<-CM ^.was contracted by you to install a private onsite wastewater treatment system on your property (Tax \D# above). To know when your system will be due for servicing please go to www.septicsearch.com Abandonment of Old System to meet all applicable code requirements: •:* Tank was pumped by: _ on at AM/PM Tank was crushed / removed and pipes disconnected by: on i/ y / ^ ^ at 1° '• ^ 0 (AMY PM) the above-mentioned plumber contacted our office to conduct a'pre^cbver inspection as requiiWIinder DSPS 383. One of the following applies: VI System was inspected and appears to meet all applicable code requirements. System was inspected and appears to meet all applicable code requirements; however, a plan revision is necessary because the installation was substantially different than the original approval. System could not be inspected because plumber covered prior to scheduled time of inspection. System could not be inspected because plumber was not ready at scheduled time of inspection. County was unable to return to complete inspection. System could not be inspected because plumber was not ready at scheduled time of inspection. A re-inspection and $50 fee are required. System could not be inspected because County could not respond to plumber's time constraints. Comments: U/forms/sanitarypropertyowner-input April 2019 ^ssss"^ rtas. l^ap.^A^/ Private Onslte Wastewater Treatment Systems ( POWTS) Inspection Report (Attach to Permit) Industry Services Division General Information Perso Perrr ROBERT F & KAREN J WOZNIAK 44185 PERRY LAKE RD CST CABLE WI 54821 rposes [ Privacy Law, s. 15.04 (l)(m) ] Q City ^ Q Village rown of: 0\<Qb^ BM Description: f^ Co^^l/ itO^C State Plan-Transaction ID#: Parcel Tax No:^SS-7 rank InformationTYPE Septic Dosing Aeration Holding "MANUFACTURER c - r- :-:^%^^ , fpi^y-r CAPACITY '?f^ .y •setback to: Prop. Line -Wef ~g^_ Building^Air Intake Road N/A N/A N/A Pump / Siphon Information Elevation Data Pump Manufacturer |Pump Model Filter Manufacturer Filter Model TDH Lift Friction Loss Forcemain | Length | Dia Head Demand GPM Total Dist. To Well Dispersal Cell Information DIMENSIONS SETBACK FROM Width £. Prop. Li; Type of Cell ^^l '^^•\^/A^\ iengVn,"Cj'if Builejtnc # of Cells ^ Wej^OHWM Manufacturer: 0c,/^ -/-7'. -' Model Number:i-^/\_[Mi^ Pretreatment Unit Manufacturer: Model Number: STATION Benchmark Bldg. Sewer Tank Inlet Tank Outlet Dose Tank Inlet Dose Tank Bottoi Inst. Contour Header/Manifolc Distribution Pipe Infiltrative Surface Final Grade -BS- 3r2 ZLli 7-<f^ s.^ T7= ^~3~ ss- ~RT Jd FS -ELEV tiS:7: LT- /^ 79 r; Uf •Mr 7 -i.r istribution System Header/Manifold Length .. Dia. Soil Cover Depth Over Cell Center Distribution Pipe(s) Length , Dia. Depth Over Cell Edges Spac. Depth of Topsoil X Pressure Systems Only X Hole Size X Hole Spacing Observation Pipes D Yes D No Seeded / Sodded D Yes D No Mulched D Yes D No CCWfMENTS: (Include code discrepancies, peHuiUUHHnrent, etc.) ^ T^/S ^.^^ ^ ^^a'u^A i : ^'^^ Sc^e^ 6^A^ICC 'lan revision required? D Yes/E^No Jse other side for additional infornYation. c;Rn_fi7-in /R n'!/31^ '^_^y ---N-^/oo5-l -^ Date POWTS Inspector's Signature License Number 55-0(95r0 t€-2^2sf Indusby Services Division 4822 Madison Yards Way Madisot^jWIffE37^5 j'c;' f.dMoxfSO^" iL 11 s NWI53707 j^AV ^) Q '}n'/i(irt i t~T County Bayfield '.Sanitary Permit Number (to be filled in by Co.)! Sanitary Pennit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to thj'appropnatggoyejni^entatjgi^^ is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. Project Address (if different than mailing address) Same I. Application Information - Please Print All Information Property Owner's Name Karen Wozniak Parcel # 8537 Property Owner's Mailing Address 44185 Perry Lake Rd. Property Location Govt. Lot 1 City, State Cable, Wl Zip Code 54821 II. Type of Building (check all that apply) |1 or 2 Family Dwelling - Number ofBedrooms 2 'ublic/Commereial - Describe Use IState Owned - Describe Use . Phone Number 715-798-5028 •/4. Section 08 Lot #T43 N R °7 E onW 1 Subdivision Name Block # |City of. CSM Number #851 V5 P351 jVillage of lTownofcable III. Type ofPOWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if| applicable.) A.few System leplacement Systen )ther Modification to Existing System (explain)(Additional Pretreatment Unit (explain) B.QHolding Tank I In-Ground (conventional) IJAt-Grade D.'Mound Individual Site Design [Other Type (explain) c.Renewal Before Expiration I Revision ;hange of Plumber transfer to New Ownerl ,ist Previous Permit Number and Date Issued fJft IV. DispersaI/Treatment Area and Tank Information: Design Flow (gpd) 300 Design Soil Application Rate(gpd/sf) 0.7 Dispersal Area Required (sf) 428 Dispersal Area Proposed (sf) 452 System Elevation 93.5 Tank Information Capacity in Gallons New Tanks Existing Tanks Total Gallons # of Units Manufacturer il1" §S 0 stis GO '55 f=) (dE U Septic or Holding Tank 750 750 Superior Precast Dosing Chamber ^a ] V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Jason Kuettel MP/MPRS Number 675751 Business Phone Number 715-798-3355 Plumber's Address (Street, City, State, Zip Code) PO Box 66 Cable, Wl 54821 VI. County/Department Use Only Approved D Disapproved D Owner Given Reason for Denial Permit Fee Date Issued me ^/^ Conditions ofApproval/Reasons for Disapproval Attach to complete plans for the system and submit to the County only on paper not less than 81/2x11 inches in size SBD-6398 (R. 02/22) ^ ;y ,|?^GE|,qF^ Bn-Ground Gravity Plan | ' " '" 1" £ Jj Index & Cover Sheet !!!j MAY/890% IL<; Component Manual Design References: c' In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross-Section & Plan View Pg 4 of 4 Management Plan Attachments:Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Wozniak 2 Bed Owner Name(s): Karen Wozniak _ Phone: 715 -798 -5028 Owner Address: 44185 Perry Lake Rd. Cable, Wl _ Zip: 54821 Project Address: Same Govt. Lot: _ 1 /4 of 1 /4, Section °8 , T43 N-R 07 E |_j or W [/ Township: Cable _ County: Bayfield Project Parcel ID #: 8537 Designer Information Designer Name: Jason Kuettel _ Phone: 715 .798 -3355 Designer Address: PO Box 66 Cable, Wl _ Zip: 54821 E-mail: nm(Qt)c3nQryras.com This space reserred for approval stamp, License Number: 675751 Remarks: '--snifey--'"'Signature: __ Date: 5v/^/~s^~on each submitted CODV. / / m^ c » t<,0 Nt J< ^.0 LM~^ co ^ ~ S . 0 - Q ^ ~ I 7 < J .^ rt o . , s; t - > ^\ ^ T ° ^ [^ r - ° ^ (/ W A> r . ^ ^TO?00 cy 1=^^T t &- .???(^T ( ^- y " A •t > T^ . .^ ^ce € : •s l f t ? . ^ ^ ^ °, \ i ^ t? J ^ ^v — - kV rv l ? J i s s! . t ? e - :i s £ IN-GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard-W Chambers 3-ft Trench (down-sizing credit) i—i—L-J SOIL COVER Septic Tank(s) Manufacturer: Suoerior Precast Z50_ga Orenco Septic Tank(s) Volume(s): gal — gal Effluent Filter Manufacturer: gal Effluent Filter Model #: FT-0822 12" min. trench depth (typical) (typical) TYPICAL TRENCH CROSS SECTION VIEW (No Scale) Quick4 Standard-W w/ End Cap (typical) System Elevation = 93.5 ^ (typical) (Show location of inlet / outlet pipe connection on plan view.) Provide minimum 3 ft separation between trenches. instr -^-------7^---- B= 46_ ft Observation Pipe (typical) Install per manufacturer's tructions. A =3.0 ft (typical) (typical) INSTALL PER TRENCH: 11 + 1 Quick4 Std-W @ 20 ff EISA/chamber = 220 Pairs of end caps @ 6 ff EISA/pair = ^. ft2 ft2 -Quick4 Standard-W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturer's instructions.? TYPICAL TRENCH PLAN VIEW (No Scale) ^—1..r^;i 3: "•u-!; •3> ,-._= er .- r'-,;- i:^ ^r~ -u>(Dm 00 0 = Proposed EISA per trench = 226 ft2 Required Infiltration Area = 428 ff Distribution Method: trenches = Proposed Total EISA = 452 ^ branched manifold ^ g ^q^|P|4In-ground Gravity Management Plartl [c " 'L b |||| IMPORTANT: The owner of this in-ground gravity system shall be responsible for its perpetual operation and msiirit@nahee pursuant'to requirements of SPS 382-384, Wise. Admin. Code. Pursuant to SPS 383.52 (2), Wise. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wise. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 30° gpd: BODs ^ 220 mgL-1; TSS ^ 150 mgL-1; FOG^30mgL-1 Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (/'.e. odors, user complaints, ete.) o mechanical malfunction (/.e., pumps, valves, switches, floats, etc.) o material fatigue (/'.e., leaks, breaks, corrosion, ete.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (/,e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (/".e., pump re-cycling, float switch settings, eto.) o electrical components - if applicable (;".e., wiring, connections, switches, controls, timers, alarms, ete.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats, when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wise. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wise. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Andry RasmUSSen & Sons _ p^, 715-798-3355 Local government unit: Bayfleld CQ. Zoning _ phone: 715-373-6138 Local government unit address: 117 E 5th St. Washbum, Wl _ ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wise. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wise. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wise. Admin. Code. Contingencv Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wise. Admin. Code. ^'^-. A 00^ 0 ^ m ; ' y9 ! ' • o0 C ^ 00 - - J [J ^ <'^PT * \i oS cf 0 I ^ ; (( ' &o ^^• ' c &Q ^a J3 X. I I I » I I I -Q £, ~\ h s li t I I I ( I • I l • i « r l c? ^ cP^ 4- 1^ ^%0Kf ^»J L , u\ <s ~ - .- I I . w•? ^> -J t I I I I ' i i ' i i i < _ . J _ i J _ i — 0<0 ~- J A ,^ )0 ^r^ - i <A J i j •n -c t> 0 vJ 5' 0 -r ~ <3 X?J ^1 ^! Wt n> .0 -0 (^^1 -J D ~c u- t ^ ft l '? ' ;^Ci V. -+ - • •Q^0 -f l ^T . w Q 1 < (n ^ S- ' ^ ^0 cQ <s ~6- 4~ OJ J? -^ G - s" ~s -n N' Y\ ) v • I ! I I I 4. , U . j I • ( I <T ^) -^ ^^. :' a c > = • = : = ; - - : = = 1- : ? ~ r £l - r J i i ' . :^ = < t e j" N ^ ec w 0.^-S ) -, - / .f -' - £ J^ -? : V" ! -^^J B • • 1. i I >^ * J r" i- - i - ~ - r yf . ^ , ^ ^ W , « ^ M . - . , . j W < , . . > ^ . < i I M i i i rr r w0{• " II _1 ^J Ii [ ^ -0Mj V} D -J 0 %: - -^_/0 -\ . T^rs ^\cpv 5r ^~ - 0 ^ L f < -^ \M v\ F3 C5 £<5 r; / ,&7" - .. ( / i 0 (4 ^«K) )i " ' I Q •t ~i I .0 •4 ^.y -0 jj ~J^ l^ sK R- 1^7^ ~ ir . S^PTZC T^IK _C? OS 3 SZCTION At\'D S ? ZC I F I CATI 0^(': 4" Scrt^OPV-C INS P. p^ps 6^ "^MI,V. A30yS GR.iD.Z.^ Cuhe-n i,nle-+ TrM^\\\o\& \£' lou.y-i'e-dy 1^ ;•-, li" frH'tl 1? !L'! l[i il ^ i&y /6'/OZ'. FINISHED GRADS n AP PRO'/ED PIPE 3- ONTO SOLID SO [L. -APPRQXED Q-A-E-eSzE Ot FILTER. MFG._OKnco_ model ^ -PT08^2- 3" APPROVES BEDDING U}-(Dgp, TA^JC SPECIFICATIONS SEPTJC TAN;< MANUFACTURE?: ^^<St_iov&_ ^/Z^c-Qd'r— TAW SIZSSJ SZ?T1C ^?5C) GAL. APPROVED HANHOLE W/ Lcc^4- WWw^ ^Q^ -H" HIM. OUTLET NOTES: /-tAT"'"^,, ^ "<!'>.S^J\y.\ \ 9 /,>/%y'=^r'^•'^.sy /tHTERED^^25t ^S-oo^rO Industry Services Division 4822 Madison Yards Way Madisotji^WIIP.ojlt^xM !t;I ! |WI53707 | li I! MAV •") ft •;ln';,.;-MA^- County Bayfield ^Sanitary Permit Number (to be filled in by Co.)^-^s Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to th^iapprpppate.gov.emiTteff^at nnft is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. Project Address (if different than mailing address) Same I. Application Information - Please Print All Information Property Owner's Name Karen Wozniak Parcel# 8537 Property Owner's Mailing Address 44185 Perry Lake Rd. Property Location City, State Cable, Wl Zip Code 54821 II. Type of Building (check all that apply) 1 or 2 Family Dwelling-Number of Bedrooms _2. D''ublic/Commercial - Describe Use [State Owned - Describe Use . Phone Number 715-798-5028 Lot # Govt. Lot r 43 1 ',4. Section 08 _N R 07 1 _E or® Subdivision Name Block # [||cityof. CSM Number #851 V5 P351 |Village of Townofcabte HI. Type ofPOWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if applicable.) Jew System [Replacement System )ther Modification to Existing System (explain)[Additional Pretreatment Unit (explain) B.QHolding Tank I In-Ground (conventional) I|At-Grade I Mound Individual Site Design [Other Type (explain) c.Renewal Before Expiration Revision ;hange of Plumber List Previous Permit Number and Date Issued'ransfer to New Owner! !jft IV. DispersaI/Treatment Area and Tank Information: Design Flow (gpd) 300 Design Soil Application Rate(gpd/sf) 0.7 Dispersal Area Required (sf) 428 Dispersal Area Proposed (sf) 452 System Elevation 93.5 Tank Information Capacity in Gallons New Tanks Existing Tanks Total Gallons # of Units Manufacturer i i?S 3^3 sE 0 Septic or Holding Tank 750 750 Superior Precast r: Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Jason Kuettel Plumber's Signatm ^_ MP/MPRS Number 675751 Business Phone Number 715-798-3355 Plumber's Address (Street, City, State, Zip Code) PO Box 66 Cable, Wl 54821 VI. County/Department Use Only Approved D Disapproved n Owner Given Reason for Denial Permit Fee Date Issued ^/5o^ /\ Issuing Ag^ySigngture ^7/3 ^^- Conditions ofApproval/Reasons for Disapproval 5^ oC^~c(ch?c{ (l^rji. Attach to complete plans for the system and submit to the County only on paper not less than 81/2x11 inches in size SBD-6398 (R. 02/22) ^ ii- ipAGIW^In-Ground Gravity Plan | ^ jj Index & Cover Sheet "AS Component Manual Design References: ' In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Index & Cover Sheet Pg2of4 Plot Plan Pg 3 of 4 Dispersal Area Cross-Section & Plan View Pg 4 of 4 Management Plan Attachments:Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Wozniak 2 Bed Owner Name(s): Karen Wozniak _ Phone: 715 .798 .5028 Owner Address: 44185 Perry Lake Rd. Cable, Wl _ Zip: 54821 Project Address: Same Govt. Lot: _ 1 /4 of 1 /4, Section °8 , T 43 N-R 07 E |_| or W [/| Township: Cable _ County: Bayfield Project Parcel ID #: 8537 Designer Information Designer Name: Jason Kuettel _ Phone: 715 .798 -3355 Designer Address: PO Box 66 Cable, Wl _ Zip: 54821 E-mail: tim@andryras.com i;,- „;,„ „, ,^n.:-,! ,„ ippiu.ni s, ,;n License Number: 675751 Remarks: (' Signature: ^/^W _ Date: ^A?/-^ Originaf signature required on each submitted copy. / / Ir ^ ,1p k- a rt ^ 1- s V* . s>^.0 \M '^ aa » • ?^ ^ N r ' ^ ^0 s - ° : ° ^ -J ^ 6 tt ^ - 5 S 3 J; v » (^ — ?^^JQ L> ^ i^ 03 °t 0•hr^j~r &-???1^T ^•s2 f^^0- <»Cn 0 0. -^ - I r> - II s -c f\ ^ ? ^ S ^^ - f - ^ - 11 ^ N? s ^ r\ ^<? -£ ~ <3 - -S i . c.V-r -E . ^4;^ ' f 1^rA -T 7° 0~ I Aft <>^5 n £^(^3 r » pr r ^ ^ ? & ^ p j n ^3 V< 1 0 ,J •t 2 £ fr ^Vl 1&0- I} . I ? ? : ~^ . 2£ f^ o co 1^ 0 c= > 1~ 0 CJ - , IN-GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard-W Chambers 3-ft Trench (down-sizing credit) SOIL COVER Septic Tank(s) Manufacturer: Superior Precast 750 gal Orenco Septic Tank(s) Volume(s): gal — gal Effluent Filter Manufacturer: gal Effluent Filter Model #:.. FT-0822 12" min. trench depth(typical) 3'4 .4 '-, (typical) TYPICAL TRENCH CROSS SECTION VIEW (No Scale) Quick4 Standard-W w/ End Cap (typical) System Elevation = 93.5 f( (typical) (Show location of inlet / outlet pipe connection on plan view.) •^- Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturer's instructions._/; -^ ------- ^---^——-— TYPICAL TRENCH PLAN VIEW (No Scale) =3.0 ft (typical) ^1,.' vs ^^^J (typical) INSTALL PER TRENCH: JJ_ Quick4 Std-W @ 20 ff EISA/chamber = 220 Pairs of end caps @ 6 ft2 EISA/pair = ^. = Proposed EISA per trench = 226 ft2 ft2 ft2 -Quick4 Standard-W Chamber '^ (typical) ;,, (mfd by Infiltrator Systems, Inc.) ^ Install pursuant to manufacturer's instructions,^ 3>-< CF-Lf; ln-n.1 n>0m GO 0 Required Infiltration Area = ^zo ft2 Distribution Method: trenches = Proposed Total EISA = ^ _ ft2 branched manifold ^ ;, ,pAq^,p^4In-ground Gravity Management Plar^j j|! IMPORTANT: The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wise. Admin. Code. Pursuant to SPS 383.52 (2), Wise. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wise. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 30° gpd: BODs^ 220 mgL-1; TSS < 150 mgL-1; FOG ^ 30 mgL-1 Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (/.e. odors, user complaints, eto.) o mechanical malfunction (/.e., pumps, valves, switches, floats, ete.) o material fatigue (/.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (/'.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (/'.e., pump re-cycling, float switch settings, ete.) o electrical components - if applicable (/.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Seotic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats, when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wise. Admin. Code. o Effluent filterfs) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wise. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Andry RasmuSSGn & Sons _ phone: 715-798-3355 Local government unit: Bayfield CQ. Zoning _ phone: 715-373-6138 Local government unit address: 117 E 5th St. Washbum, Wl _ ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wise. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wise. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wise. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wise. Admin. Code. ^-^ \ ^)^ &Q -A - f t . . ^1 • I I • I \\ L n ! ' • ' • { ) ! ! 1 I I I I • I I I I -Q £. . . <M ^oQ 00 r~ . J '. 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OUTLET NOTES: >k:/ ^AWisconsin Department of Safety and Professional Service's'</,^</^, Division of Industry Services *s > ori-5 Page.-of_ _nAv 2^/u^SOIL EVALUATION REPORT In accordance with SPS 3£[^WiJ:; 'flf^n|'[Cc Attach complete site plan on paper not less than 81/2x11 inches in size. Pla^Aiust include. but not limited to: vertical and horizontal reference point (BM), direction and p^jent scale or dimensions, north arrow, and location and distance to nearest road. [! ii •26z0^ Please print all information. ^ ^ , Personal information you provide may be used for secondary purposes (Privacy Lawfs. t^b4(T)(m^. NLTKT /g BAYFIELD-^^/7" .D.Vajc XO g>53~7 f^7^\ [Property Owner ?L^+ F.,k^r€-«^J' Cjo^ni'^^ Property Location Govt.Lot I %1/, sog» T 4.3 N R o~l [Property Owner's Mailing Address 44 I BS' ^er<~^ L-^ E-d Site Address or CSM and Lot #:'UaTV'C^^"^'^^^( ^ <ss City C^\€. State LJl Zip Code S'H^z.f Phone Number ( ) D City D Villageu Town <^b(e Qy\ Nearest Road Lte P^. New Construction Use: (S Residential/ Numberof bedrooms 2— Q2 Replacement D Public or commercial - Describe: Parent material CUa.C.ic. I _+'1 Code derived designflow rate ?CQ GPD Flood Plan elevation if applicable —" ft. General comments and recommendations:.-7 $^. S^e-i cf^' L ^^e. c'^- c?^t) Boring #D Boring Ground surface etev.'£LO(.Depth to limiting factor f05> in. / elev. ?^-^%- Hon'zon I 2, 3_ &f/z.^ Depth In. -o-TT ~-r-3Z ?2.-(o< in L.a.L^^. Dominant Color Munsell T^^ ^ ., c//y - 'f ^ ~r A-\r<^ Redox Description Qu. Az. Cont. Color Texture <? -^5_ Structure Gr.Sz. Sh. <£»-: 'I lt Consistence nj •( H_ Boundary y_IL Roots T7T~^~ Soil Application Rate GPD/Ft2 <Eff#1 .-X .-7 n •Eff#2 \.^ J^_u^ "^J Boring #QBoring ]Pit Ground surface elev.(l7-2-^. Depth to limiting factor IC> ^ in. / elev.^^fe Horizon ( 1T Depth In. 0-~1 -7-?5 3?'U Dominant Color Munsell -t^^ ^ ./ ^ $ f ^A Redox Description Qu. Az. Cont. Color Texture [^ 5r^- ^ Structure Or.Sz. Sh. (3 -^ •( l(_ Consistence 1^ ( 1 •I Boundary \t0 t( Roots JK (J^ Soil Application Rate GPD/Ff •EfW1 •~l ~l .-I •Eff»2 _v_ 1.^ i.(, CST Name MERTON MAKI Signature ^^fc pU<-CST Number 224901 Address 10869N SMITH COURT HAYWARD, Wl 54843 Date Evaluation Conducted ^r-(^' z-7 Telephone Number (715) 634-871 /^II^U ' Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 < 150 mg/L • Effluent #2 = BOD, S 30 mg/L and TSS < 30 mg/L u y)c_x-/ _^r//^7, SBD-8330(R04/21)/ Boring # D Boring |,?P!t Ground surface elev.^^Gt. Page..of_ Depth to limiting factor'00 in. / elev. <^^< Honzon t z ~^_ Depth In. 0-~L -)-^1 3 (-too Dominant Color Munsell l^f^~v~^ k y? Redox Description Qu, Az. ConL Color f Texture T^ y5 3£Li. Structure Or. Sz. Sh. 0-^ '( JL Consistence Jh. 1( JL Boundary t£> >( Roots to-^ \^(- I Soil Application Rate GPD/Ff *Ef»1 .-T <1 •I *EW2 \.^JLE JL4- Boring #D Boring D Pit Ground surface elev..-ft.Depth to limiting factor.Jn. / elev._ Redox Description Qu. Az. Cent Color fQ^A =- ^~~ - 2-C Tlr^_<LU [\fie\ Boring #Boring a pit Ground surface elev..-ft.Depth to limiting factor..In. / etev.__ft Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. ConL Color Texture Structure Gr.Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 *Eff#1 *Efl»2 • Effluent #1 = BOO > 30 S 220 mg/L and TSS > 30 S 150 mg/L * Effluent #2 = BOD, S 30 mg/L and TSS S 30mg/L r\-1p?-art ^\ nS^s> t4 . 1 .0 \N m<<f \ 0^J7 J ^0 tA C^ — T 3 w-^£> OA .0 .J ~^ «0 N .0 -js 03 -Q -< J3 v; , u^ (/ L ><0?0<5 031^?0•t - >^^i"T 0~???t\T (? ^ ^ ^^*\^-c -I ^s ft0 ^^ 0I- .s J !> _ '? Tr to "<;?[^^0- <» in ?. 0 c. £.t -^ If>-c0 h» .n ^ ?' ^^» •?>?+ '. y . cs f; - . i. ^ J i '1 0 0(. : ' i > "; " > • \ M A•J D • N i^ = 3 ^ s . rn j = t ' ~K - - . . = = „ :' < . i s - ^ s U- U T i 0: - = = r^ - ! _ — r< - •' - ' " ' F m l 0 "Y -pv\J c.^ ~r 7 3 ^^fr ^Vl r\ /»0- r\ s. s 4^f. CD \A ^-) u! ^ s£ ^(U . 0 CP -1 rC (A ) ?>p 0J£ 7°0- I ?p-b t>(9 \s \u -J p\ 0p .^ "^ AA ^5 n £<& (M 3 r •^'T - a> , 4 t> I <f c ' p-n»0 c\ ,a u- rT ?"^ s i^1^ p» X- - :* - s r~ ~ s » -- . r^ ~ -0 . S5-W) Private Sewage System Maintenance Agreeme ~y Owner(s) Name t^i^N T ^OZ.^1 i ^Y^. Owner(s) Mailing Address f/<//85 P££&.T C^K.€ ^ CArri-e, 1^33 Site Address 5A^<c Tax ID #6S 3-7 As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil tester's report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established in the Wl Adm. Code, as from time to time amended. (COMPLETE Legal is required) 1/4 of _1/4 Section 0(f Township 4 3 N. Range 0 *7 W. Additional Legal Description: Town of C.A.(3<_<=. _ (Acreage) Lot , Block Subdivision Gov't Lot Lot_I CSM#85l Vol. -$ Paae?^"'' CSM Doc # 4l5"7C?S DOCUMENT NUMBER2025R-607639 DANIEL J. HEF-KNER REGISTER OF OEEDS BAYFIELD COUNTY. Wl RECORDED 05/28/2025 AT 2:59 PM RECORDING FEE: $30.00 PAGES: 1 Recording Area Return To: Planning 0 a In-ground Mound gravity D D In-ground dosed At-grade Sewage System a In-ground Other pressure Dgyrje distribution 'ia (;.;. /d Sewage mrulltent System: Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of installation and at.least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. Pump Chamber (system types B, C, D, and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds, At-qrade. and Inoround Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such property. '.^'^ '! •' •' Owner(s) Name(s) - Please Print KA(Ze;i^ J~ ^ OZ^t(\»^ Notarized Owner(s) - Signature(s) ^ "^/U^ IA/^ Subscribed and sworn to before me on this date: ^••~'c.'^ ,'•"•'• ! •'.'.;•-•',-' ;-\.^'' '"y /%^ ^R ^rf^' ij •••?;;:>• Notary Pub^ ", ', fs;f-u ;C ^ 7&^ '^;,."/ """...i-t I^Con^missip.n Empires: _ ^<,''-';~'^'_^-';.^;5V'"TK^.A.^';W^\^•»' Drafted by: T~i (^ <.LAP-^ Date: S/^-T-/^ Proofed by: u/forms/sanitary/septicmaintenceagreement lnlu BAYFIELD COUNTS SANITARY PERMIT (#04)-25^2S STATE SANITARY PERMIT OWNER: ROBERT F & KAREN J WOZNIAK GOVTLOT:1 LOT: 1 BLK: CSM: 851 V5 P351 1/4 1/4 SEC:8,T43N,R7W TOWNSHIP: Cable SOIL TEST: 70-24 REPLACEMENT SYSTEM SYSTEM TYPE: Non-Pressurized In-Ground PLUMBER: JASON KUETTEL CHAPTER 145.135(2) WISCONSIN STATUTES a. The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. b. The approval of the sanitary permit is based on regulations in force on the date of approval. c. The sanitary permit is valid and may be renewed for specified period. d. Changed regulations will not impair the validity of a sanitary permit. e. Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. f. The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 C. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. PREVIOUS PERMIT #: LICENSE: # 675751 TRACY POOLER Authorized Issuing Officer DATE: 5/30/2025 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 5/30/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION