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HomeMy WebLinkAbout25-33SRequest for Sanitary Inspection (24 Hrs. in Advance) Fax this form to Zoning Dept (24 Hrs.) prior to when you want an inspection — (715) 373-0114 If you do not have a fax and must email the inspection; you must email all staff members. Note fl Time Change fl Discrepancy fl Other Phone Number 715-419-0739 Plumber: Rick Brown Fax Number Address Jr.Email Henry Hendricks Jr. rickbrown2004@hotmail.com Immediate Phone Number So Zoning Sanitary 25-33S Dept can call you right back (if needed) Permit #: 715-419-0739 Plumber's Choice Dept �I No Inspection(s) during this time Date: 6/27/2025 Z ing Dept Tuesday (9:30 am - 12:15 pm) (Tracy) Plumber's Choice Time: 11:30 Township: Barnes Address # & Road Name: 54925 Dana Rd. Barnes WI or Directions To Site: Comments: ** Plumbers you must verify any change(s) by fax or email "* Notes from u/foms/sanitary/requestforinspection Zoning Dept (©4/12/04); ® June 2023 eam r� SP -^eauo.n�s Industry Services Division General Information "'HENRY HENDRICKS JR 401 FINVOLD ST WOODVILLE WI 54028 Tank Information TYPE I MANUFACTURER I CAPACITY I Prop. Line Well I Building Air Intake I Road Se tic ek N/A Dosing N/A Aeration d N/A Holding Private Ons.ite Wastewater Treatment Systems ( POWTS) Inspection Report (Attach to Permit) Li City BM D Grip setback to: Town of: County / ► CJ�I.J�—� Sanitary emit No: State Plan Transaction iD#: Parcel Tax No: 73e Pump / Siphon Information ump Manufacturer Pump Model Demand GPM Filter Manufacturer Filter Model TDH Lift Friction Loss Head Total Forcemain Length Dia Dist To Well Dispersal Cell Information DIMENSIONS Width Length # of Cells SETBACK FROM Pro. Ljpe (ccc Building, Well OHWM Type of Cell (R G k LI Manufacturer: Model Number. Pretreatment Unit Manufacturer: Model Number: istribution Header / Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length _ Dia Length Dia Spac_ Spacing ❑ Yes 0 No Soil Cover Depth Over Depth Over Depth of I Seeded I Sodded Mulched Center Elevation Data STATION BS HI FS ELEV Benchmark o ,'dfa Bldg. Sewer � 313 Tank Inlet , D Tank Outlet 9% A Dose Tank Inlet Dose Tank Bottom Inst Contour Header/ Manifold Distribution Pipe Infiltrative Surface % l5 Final Grade 6 6S X Pressure COMMENTS: (Include code discrepancies, persons present, etc.) g/ sy/n- ;/1 Veil c¢ , 451 rt'/C 7 /1"e \A'/Ovnef 'Ian revision required? 0 Yes Ql No 7 , Ise other side for additional information. (f/ ❑ Yes ❑ No ❑ Yes ❑ No 11-1A37/3 FRnJt71n tR n'(91 Date POWTS Inspector's Signature License Number Al Property Owner HENRY HENDRICKS JR Information 401 FINVOLD ST WOODVILLE WI 54028 BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Bayfield County Courthouse Fax: (715) 373-0114 Post Office Box 58 e-mail: zoning(&bavfieldcountv.org 117 East Fifth Street Web Site: www.bavfieldcountv.org/147 Washburn, WI 54891 t As you know �.G Y( Z!/9 vf/// was contracted by you to install a private onsite wastewater treatment system on your property (Tax ID# above). To know when your system will be due for servicing please go to www.septiesearch.com Notes: Abandonment of Old System to meet all applicable code requirements: :• Tank was pumped by: Tank was crushed I removed and pipes disconnected by: on at AM/PM On �/"2 ( "25 at /t319 (AJ?PM) the above -mentioned plumber contacted our office to conduct apre-cover inspection as required under DSPS 383. One of the following applies: VSystem 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: Ulformslsanitarypropertyowner-input April 2019 SS- 00146q 6, a�� -AfA YrI Department of Safety County Bayfield & Professional Services, Sanitary Permit Number (to be filled in by Co.) ,, pg Industry Services Division 3 S I c2 5 Sanitary Permit Application State Transaction Number In accordance with SPS 383.2] (2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Project Address (if different than mailing address) 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(1)(m), Stats. �925 Dana Rd. L Application Information — Please Print All Information Property Owner's Name Parcel # Henry Hendricks Jr. 04-004-2-45-09-23-2-01-000-5flfl Property Location Property Owner's Mailing Address 401 Finvold St. Govt. Lot City, State I Zip Code Phone Number Woodville WI 54028 t('!5 C,5( ]- NE y., '4, Section T 45 N R 09 E or W IL Type of Building (check all that apply) Lot # Jj�[ 1 or 2 Family Dwelling —Number ofBedrooms 3 Subdivision Name Blockfl ❑ Public/Commercial — Describe Use O City of O State Owned— Describe Use O Village of CSM Number f own of Barnes M. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i s " lie. A''es New System El Replacement System 0 Other Modification to Existing System (explain) 0 Additional Pretreatment Unit (explain) B' ❑ Holding Tank hGround ❑ At -Grade I ❑ Mound Cl Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber 0 Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) IDispersal Area Proposed (sf) I System Elevation 450 1.6 643 652 95.5 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units ';� w New Tanks I Existing Tanks c ,� " , a ,U ri en wig Septic or Holding Tank 1000 1000 1 Wieser X Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibfl for installation of the POWTS shows on the attached plans. Plumber's Name (Print) I Plumber's Signature I Business Phone Number Rick Brown 231251 419-0739 Plumber's Address (Street, City, State, Zip Code) PO Box 637 Spooner WI 54801 VL.County/Departifient Use Only Approved O Disapproved Permit Fee Date Issued IssJ7u' g A t Si tore O Owner Given Reason for Denial $ l5/2o/2 $ pp Conditions of ApprovaMeasons for Disapproval Aec/ J2( Attach to complete plans for the system and submit to the County only on paper not less than 8112 x 11 inches in size SBD-6398 (R 03/22) PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet: �_ Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg 1 of 4 Pg 2 of 4 Pg3of4 Pg4of4 Index & Cover Sheet Plot Plan Dispersal Area Cross -Section & Plan View Management Plan Attachments: Enclosures: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Hendricks Owner Name(s): Henry Hendricks Jr. Owner Address: 401 Finvold St. Woodville WI Phone: - Zip: 54028 Project Address: 549245 Dana Rd. Barnes WI 54873 Govt. Lot: NE 1/4 of NW 1/4, Section 23 , T45 N -R 09 E ❑ or W W✓ Township: Barnes County: Bayfield Project Parcel ID #: 004118209000fi7';X .7' Designer Information Designer Name: Rick Brown Designer Address: PO Box 637 Spooner WI E-mail: rickbrown2004@hotmail.com License Number: 231251 Remarks: Phone: 715 -419 -0739 Zip: 54801 This space reserved for approval stamp. Signature: Date: 10/7/23 Original signature required on each submitted copy. CHECK BOX AS APPDCABLE CHECK BOX AS APPLICABLE. ❑ SOIL EVALUATION Scale: " 40 SYSTEM PAGE 2 OF 4 0 40 60 gg SITE MAP PLOT PLAN PROJECT NAME: to DESIGN FLOW: 450 GPO (fo I gda) Henry Hendricks Jr., Attach design flow Calculations for commercial plans. PROJECT ADDRESS: 24925 Dana Rd. Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) BM Symbol: 4 BM flevatlon: 100 F7 NSanitary Sewer. 4 / Force Maln: / BM Deaodptlon: Nail In 26" norway Slope Gradient (%) 1 0 Well Symbol (If applicable): Q indicate nosh by drawing an anew IMPORTANT: Show ground elevation contours at suitable Intervals, of Tested Area: on the apprepole the 4C' 9Ay O! 9Y, ( a�= 9b'j≤ I p IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER T min. trench depth (typical) min. 1T (typical) Septic Tank(s) Manufacturer. Wieser Septic Tank(s) Volume(s): 1000 gal gal gal gal Effluent Filter Manufacturer. Polulock Effluent Filter Model#: PL -525 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) System Elevation = 95.5 ft (typical) Quick4 Standard -W w/ End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) r- ------------------��--- )-------------��-------��--- g= 75 ft (typical) INSTALL PER TRENCH: 16 Quick4 Std -W @ 20 ft: EISNchamber = 320 ft2 + 1 Pairs of end caps @6 ft2 EISNpair = 6.0 ft' = Proposed EISA per trench = 326 ft2 Provide minimum 3 ft separation between trenches. Observation Pipe (typical) Install per manufacturers / Instructions. TYPICAL TRENCH PLAN VIEW (No Scale) IA = 3.0 ft (typical) "—Quick4 Standard -W Chamber (typical) (mfd by infiltrator Systems, Inc.) Insist pursuant to manufacturer's instructions. Required Infiltration Area = 643 ft2 Distribution Method: x 2 trenches = Proposed Total EISA = 652 RESET, ft2 branched manifold -u D O m W O m PAGE 4 OF 4 In -ground Gravity Management Plan IMPORTANT: The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 450 gpd; BOD5 S 220 mgL"'; TSS ≤ 150 mgL''; FOG ≤ 30 mgL-' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution I drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids In the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Badger Septic Service Local government unit: Bayfield County Zoning Local government unit address: PO box 878 Washburn WI Phone: 715-635-7243 Phone: 715-373-6156 ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. cr 118" "1 - - t. co TOP VIEW 6 4" INLET E.- _ - - - - - :3 4" OUTLET [] d rn 2j' PUMP PAD __ AN SIDE VIEW WLP1 FDL TANK - SPECIFICATIONS DIMENSIONS: WALL' 2 1/2" BOTTOM: 2 1/2 COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 54" O.D. LENGTH: 118" O.D. WIDTH: 64" O.D. BELOW INLET: 40" O.D. LIQUID LEVEL: 36 1/2" WEIGHT: 8.000 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 LIQUID CAPACITY: 28.00 GAL/IN LOADING DESIGN: 8' 0" UNSATURATED SOIL HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,113 GALLONS TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON d z D CUSTOMIZED TANKS: FOFF NO. TANKS CAN BE CUSTOMIZED CONTACT WIESER CONCRETE TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTSo/ 0 2.00 61/2" BALL CHECK [5.1 cm] ACCEPTS 6" SCHD 40 14.34 FOR INLET EXTENSION [36.4 cm] [29.4 5cm] OUTSIDE DIAMETER - OUTLET BUSHING ACCEPTSACCEPTS 4" SCHD 40 SOCKET 4" SCHD 40 & 6" SCHD 40 8.10 OPTIONAL BUSHING [20.6 cm] (FOR 4" THIN WALL PIPE) PART NO. 30142-R OR (FOR 110 MM. PIPE) 10.52 PART NO. 30142-EUR [26.7 cm] I%" II%IIV117V VLII V PREVENT FILTER FROM FLOATING PL -525 -625 FILTER HOUSING PART NO. - 30142-525 MATERIAL - HOUSING - POLYPROPYLENE OUTLET BUSHING - PVC 6.5" BALL - HDPE D2 cm] SS 0x 454 Department of Safety County -� r '� _3 & Professional Services, Hayfield Sanitary Pe[ Number (to be filled in by Co.) ,` _ �_ . , - 1 Industry Services Division -'- � c 2s -33S 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 Project Address (if different than mailing address) 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(1)(m), Stats. !4925 Dana Rd. I. Application Information — Please Print All Information Property Owners Name Parcel # Henry Hendricks Jr. 04-004-2-45-09-23-2-01-000-5 ns Property Owner's Mailing Address Property Location 401 Finvold St. Govt. Lot City, State I Zip Code Phone Number Woodville WI 54028 ,715 -6S 1- a % NW %•.Section 23 T 45 N R 09 E or W III. Type of Building (check all that apply) Lot # XIor 2 Family Dwelling — Number ofBedrooms 3 Subdivision Name Block # ❑ Public/Commercial — Describe Use ❑ City of ❑ State Owned — Describe Use ❑ Village of CSM Number own of Barnes III. 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 lice le. A. New System y ❑ Replacement System p y ❑ Other Modification to Existing System y (explain) ❑ Additional Pretreatment Unit (explain) B' ❑ Holding Tank 4�-Grotmd ❑ At -Grade ❑ Mound ❑ Individual Site Design I ❑ Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (sf) I Dispersal Area Proposed (sf) System Elevation 450 1.6 643 652 95.5 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units o , New Tanks Existing Tanks 4? sr v 0,O y rn iz 5 P. Septic or Holding Tank 1000 I 1000 1 Wieser y( Dosing Chamber V. Responsibility Statement— 1, the undersigned, assume responsibil for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature - Number Business Phone Number Rick Brown 231251 419-0739 Plumber's Address (Street, City, State, Zip Code) PO Box 637 Spooner WI 54801 VI. County/Department Use Only Approved O Disapproved Permit Fee Date Issue Issui g A t Si tore ❑ Owner Given Reason for Denial r���it�Fe/ -IOO ^ 5 %sJ n n e ( ig Conditions of Approval/Reasons for Disapproval nn rnn Attach to complete plans for the system and submit to the County only on paper not less than a I/jr II inches in size SBD-6398 (R. 03/22) PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) Pg I 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 I Description Hendricks Owner Name(s): Henry Hendricks Jr. Phone: - Owner Address: 401 Finvold St. Woodville WI Zip: 54028 Project Address: 549245 Dana Rd. Barnes WI 54873 Govt. Lot: NE 1/4 of _N W 1/4, Section 23 T45 N -R 09 E ❑ or W ❑✓ Township: Barnes County: Bayfield Project Parcel ID #: 004118209000 A 7 3 Designer Information Designer Name: Rick Brown Phone: 715 419 0739 Designer Address: PO Box 637 Spooner WI Zip: 54801 E-mail: rickbrown2004@hotmail.com This space reserved for approval stamp. License Number: 231251 Remarks: Signature: P I,' Date: 10/7/23 Original signature required on each submitted copy. CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. ❑ SOIL EVALUATION Scale: t40 aSYSTEM PAGE 2 OF 4 D 80 SITE MAP PLOT PLAN PROJECT NAME: 10, DESIGN FLOW: 450 GPD (70 ft grid) f I@nry (i@f1C(I ICks Jr. Attach design flow calculations for commercial plans. PROJECT ADDRESS: 24925 Dana Rd. Pipe Material / ASTM Standard (Tables 384.30-3 & 384.305) BM Symbol: h BM Elevation: 100 FT Sanitary Sewer. 4 / Y Force Mein: BM Dewripdon: Nail in 26" norway Slope Gmdlem(%) Well 1.0 Symbd (If applicable): O Indicate north by drawing an snow IMPORTANT: Show ground elevation contours at suitable Intervals. or Tested Area: on the approprte lire. ottfr (1- I o1= 91,( IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) Septic Tank(s) Manufacturer: Wieser Septic Tank(s) Volume(s): 1000 gal gal gal gal Effluent Filter Manufacturer. Polulock Effluent Filter Model #: PL -525 Jitjf min. 12" SOIL COVER (bp wry 12" min. trench de plh (typical) TYPICAL TRENCH CROSS SECTION VIEW P ( l' y • . (No Scale) System Elevation = 955 ft (typical) Quick4 Standard -W wEnd Cap (Show location of inlet / outlet pipe connection on plan view.) (t ypical) r -----------------�j�— +frrttE iFnl L ------------t ------- B= 75 ft (typical) INSTALL PER TRENCH: 16 Quick4 Std -W @ 20 if EISA/chamber = 320 ft2 + 1 Pairs of end caps @6 ft2 EISA/pair = 6.0 ft' = Proposed EISA per trench = 326 ft2 Provide minimum 3 ft separation between trenches. Observation Pipe TYPICAL TRENCH (typical) Install per manufacturers PLAN VIEW / Instructions. (No Scale) IA = 3.0 ft (typical) "—Quick4 Standard -W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturers Instructions. Required Infiltration Area = 643 ft2 Distribution Method: x 2 trenches = Proposed Total EISA = 652 ft' branched manifold O m W O -P PAGE 4 OF 4 In -ground Gravity Management Plan IMPORTANT: The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 450 gpd; BOD5 5 220 mgL"'; TSS S 150 mgL''; FOG ≤ 30 mgL-' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids In the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Badger Septic Service Phone: 715-635-7243 Local government unit: Bayfield County Zoning Phone: 715-373-6156 Local government unit address: PO box 878 Washburn W1 ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc, Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. 118" TOP VIEW IO £fl 4" INLET E_ a • U) in a a 24"j_,_ PUMP PAD r ZN N SIDE VIEW 4" OUTLET m n WLP1000-FDL TANK SPECIFICATIONS DIMENSIONS: WALL 2 1/2" BOTTOM: 2 1/2" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 54" O.D. LENGTH: 118" O.D. WDTH: 64" O.D. BELOW INLET: 40" O.D. LIQUID LEVEL: 36 1/2" WEIGHT: 8.000 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 LIQUID CAPACITY: 28.00 GAL/IN LOADING DESIGN: 8' 0" UNSATURATED SOIL HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,113 GALLONS TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON CUSTOMIZED TANKS: TANKS CAN BE CUSTOMIZED CONTACT WESER CONCRETE TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS I- a d z 0 0 !n 0 a 0 0 J J W <0 z N U F. > uJJ (flit /OFD 61/2" BALL CHECK ACCEPTS 6" SCHD 40 FOR INLET EXTENSION UTLET BUSHING ACCEPTS 1"SCHD40&6"SCHD40 PREVENT FILTER FROM FLOATING PL -525 -625 FILTER HOUSING PART NO. - 30142-525 MATERIAL - HOUSING - POLYPROPYLENE OUTLET BUSHING - PVC 6.5" BALL - HDPE 2.00 [5.1 cm] 14.34 11.59 [36.4 cm] OUTSIDE DIAMETER [29.4 cm] ACCEPTS 4" SCHD 40 SOCKET 8.10 OPTIONAL BUSHING [20.6 cm] (FOR 4" THIN WALL PIPE) PART NO. 30142-R OR (FOR 110 MM. PIPE) PART NO. 30142-EUR 10.52 [26.7 cm] )2 cm'. Wisconsin Department of Safety and Professional Services Page 1 of 2 Division of Industry Services 5l2.—()02 L - SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code County Bayfield 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.D. scale or dimensions, north arrow, and location and distance to nearest road. 04-004-2-45-09-23-2-01-000-50000 Z_.___:l�— Please print all information. R )ate Personal Information you provide may be used for secondary u oses(Privacy Law, s. 15.04(1)(m)). ff��, Property Owner Property Location ❑ Henry Hendricks Jr. Govt. Lot NE %4 NW %4 S 23 T 45 N R 09 E (or) W Property Owner's Mailing Address Lot # Block # I Subd. Name or CSM# 401 Finvold St. V.1017 P.331 1184C City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Woodville WI 54028 Barnes 54925 Dana Rd. ® New Construction Use: ® Residential / Numberof bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial — Describe: Parent material Flood Plan elevation if applicable NIA ft. General comments and recommendations: conventional system 95.5 Boring # ❑ Boring ® Pit Ground surface elev. 98.1 ft. Depth to limiting factor g6 In. ISnil Anniinatinn Rate 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 1 0-3 1 Oyr 4/1 - Is osg dl cw 2fm .7 1.6 2 3-24 10yr 5/4 - s osg dl as 1 m .7 1.6 3 24-96 1 Oyr 7/4 - s osg dl - - .7 1.6 Boring # ❑ Boring ® Pit Ground surface elev. 98.2 ft. Depth to limiting factor 9fi In. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 1 0-4 1 Oyr 4/1 - Is osg dl cw 2fm 2 4-23 1 Oyr 5/4 - s osg dl as 1 m 3 23-96 1 Oyr 7/4 - s osg dl - - Soil Application Rate GPD/Ft2 *Eff#1 *Eff#2 .7 1.6 .7 1.6 .7 1.6 Rnn •An . 79n mnn and TSS > !n < 1 �n mn/l * Ff hfAnf #9 = Rffl > ,in < 97r1 mnlL and TSS > 3fl < 1.+'in mniL CST Name (Please Print) Signature CST Number Rick Brown I231251 Address Date Evaluation Conducted Telephone Number PO Box 637 Spooner WI 54801 8/10/23 715-419-0739 pc� Qov-oo�u 5� 5� s 2�S rjL Boring # ❑ Boring Pit Ground surface elev. 98.15 ft. l Depth to limiting factor 96 in. nil Annlinatinn Rate 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 1 0-3 10yr 4/1 - Is osg dl cw 2f .7 1.6 2 3-24 10yr 5/4 - s osg dl as 2f .7 1.6 3 24-96 10yr 7/4 - s osg dl - - .7 1.6 ❑ Boring # O Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Annlication Rate 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 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. I Soil Annlicatinn Rate 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 * Effluent #1 = BOD, > 30 s 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2= BOD, > 30 s 220 mg/L and TSS > 30 s 150 mg/L CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. SOIL EVALUATION Scale: 1" = 40' 60 80 F-ISYSTEM PAGE 2 OF 4 SITE MAP 0 40PLOT PLAN PROJECT NAME: z DESIGN FLOW: 450 GPD (10 ft grid) 10 Henry Hendricks Jr. Attach design flow calculations for commercial plans. PROJECT ADDRESS: 24925 Dana Rd. Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) N Sanitary Sewer. 4 BM Symbol: BM Elevation: 100 FT Force Main: BM Description: Nall in 26" norway Indicate north by IMPORTANT: Slope Gradient (%) 1.0 Well Symbol (if applicable): Q drawing an arrow Show ground elevation contours at suitable Intervals. of Tested Area: on the approprite iIns. i SANITARY INFORMATION (NEEDED) DATE: TO: RUTH DEB FRANKI MCKENZIE ERICA WHICH INSPECTOR / PERSO,N MADE THE CALL ADDT'L CALL _ DATE CONTACTED: h' PHONED IN -PERSON I(ANSWERINGMACHINE SPOKE WITH: PLUMBER OWNER CONTRACTOR _ SOIL TESTER OTHER IN REGARDS TO: AS -BUILT -.. CONTOIJjryANES '% FEE % r'a'h HOLDING TANK AGREEMENT (Recorded) JiOLWNG TANK SERVICE CONTRACT MAINTENANCE AGREEMENT (Recorded) MISSING PAPERWORK DEADLINE fJeLv % n COMMENTS PLOT PLAN SOIL TEST REINSPECTION REINSPECTION FEE REVISION REVISION FEE SOIL INFO OTHER MAIL II E-MAIL I. T NICK -SE TION 10/12123, 8:02 AM Novus-Wisconsin Access rev. 12.0206 Real Estate Bayfield County Property Listing Today's Date: 10/12/2023 Description Updated: 8/10/2009 Tax ID: 2738 PIN: 04-004-2-45-09-23-2 01-000-50000 Legacy PIN: 004118209000 Map ID: Municipality: (004) TOWN OF BARNES SIR: S23 T45N R09W Description: PAR IN NE NW IN V. 1017 P.331 1184C Recorded Acres: 7.200 Calculated Acres: 7.200 Lottery Claims: 0 First Dollar: Yes Zoning: (F-1) Forestry -1 ESN: 104 Tax Districts Updated: 3/15/2006 1 STATE 04 COUNTY 004 TOWN OF BARNES 041491 SCHL-DRUMMOND 001700 TECHNICAL COLLEGE y„ Recorded Documents Updated: 5/20/2009 0 QUIT CLAIM DEED Date Recorded: 5/13/2009 2009R-5266141017-331 U CONVERSION Date Recorded: 3/15/2006 425-97;612-111;769-241 Property Status: Current Created On: 3/15/2006 1:14:49 PM 0 Ownership Updated: 8/10/2009 HENRY HENDRICKS JR WOODVILLE WI Billing Address: Mailing Address: HENRY HENDRICKS JR HENRY HENDRICKS JR 401 FINVOLD ST 401 FINVOLD ST WOODVILLE WI 54028 WOODVILLE WI 54028 Site Address * indicates Private Road 54925 DANA RD ® Property Assessment BARNES 54873 Updated: 3/25/2022 2023 Assessment Detail Code Acres Land Imp. G1 -RESIDENTIAL 1.000 5,000 59,000 G6 -PRODUCTIVE FOREST 6.200 8,400 0 2 -Year Comparison 2022 2023 Change Land: 13,400 13,400 0.0% Improved: 59,000 59,000 0.0% Total: 72,400 72,400 0.0% 4 Property History N/A https://novus.bayreldcounty.wi.gov/access/master.asp 1/1 JA - ssOU4S Private Sewage System Maintenance Agreement r 5 Dana - As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil testers report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established in the WI Adm. Code, as from time to time amended. (COMPLETE Legal Is required) A/IT 1/4 ofiVtj 1/4 Section 233 Township _____N. Range 2w Additional Legal Description:8r 1n! Ale NWrN'64 P4?31 Town of Ba rn eS (Acreage) 7. a Oo Gov't Lot Lot_ Block Subdivision Lot _ CSM # Vol. Page f CSM Doc # / /i'/ C DOCUMENT NUMBER 2024R-604899 DANIEL.. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 09/27/2024 AT 8:00 AM RECORDING FEE: $30.00 PAGES: 3 Recording Area ReturnTo: n Planning a Zo in D3p0 2024 Bayfield Co. {?y In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage System: ❑ Mound O At -grade Sewage System ❑ Other Septic Tank (system types A through E): The septic tank shall be pumped by a certified septage servicing operator within three (3) years of the date of installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make such inspection, the tank is found to have less than one-third (1/3) of the volume occupied by sludge and scum. Pump Chamber (system types B. C, D. and E): The pump chamber shall also be rinsed and pumped out when the septic tank is serviced as provided above. The switches and pump controls shall also be inspected and maintained to ensure operability of said components. Septic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance with manufacturers specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds, At -grade, and In -ground Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such property. /endr►c js 3r. Notarized Jbscnbed and sworn to before me on 9-23-Z'( 1 1-7— 2 M Drafted by:/ /ck i_ Date: t>"9 - 1- 2 r State Bar of Wisconsin Form 3 DOCUMENT NUMBER QUIT CLAIM DEED JEFF HENDRICKS___a1k/a_JFRF'RF'_T.HFJ DPJCKS.................... quitclaim to _HENRY HENDRICKS JR________________________________________ _______________--------------.....--'---------. _.................._------------------- the following described real estate fn BAYFIELD_COUNTY ____________________ State of Wisconsin: A parcel of land located In the Northeast Quarter of the Northwest Quarter, Section 23, Township 45 North, Range 9 West, bounded and described as follows: Commencing at the Northwest comer of said Section 23; thence South 87° 51' 41" East along the Ndrth line of Section, 1409.06 feet thence South 00° 40'13" West, 553.71 feet to the point of beginning; thence South 87° 51' 41" East, 459.69 feet to the centerline of a 66 foot roadway; thence South 06' 04" East along said centerline, 367.87 feet Thence South 27° 39' West along said centerline 365.5 feet thence North 87° 51' 41" West, 337 feet thence North 00° 40' 13" East, 69420 feet to the point of beginning. PATRICIA A OLSON BAYFIELD COUNTY, WI REGISTER OF DEEDS Z®09R-52661 4 05/13/2009 1000AN TF EXERT 3: 8 REEORDIfx FEE: 11.08 PAGES: 1 Charter Bank Eau Claire 1010 W Clairemont Ave Eau Claire WI 54701 SEP 3n''/(i''/4 Property Address: 54925 Dana Road, Barnes WI 54925 Bayfield Co Zoning Dept. This .Jut---------------------homesteadnoproperty. 004118209 ( (i8 not) Tax Parcel Number Dated this �_ dayof ,_ApN________________ ___2009___ SI ned: ned: S 9 (Seal) . kJ ' \�� ✓ (Seal) " Signed: e Signature(s) * JEFF HENDRICKS ------------------------------------------------- _----_... ------------------------------------------ Signed: -----"........................ (Seal) ________________(Seal) AUTHENTICATION ---------------- - ------•---------------------- Authenticatedthis dayof TITLE: MEMBER STATE BAR OF WISCONSIN (If not, AOlhodmd oy§ 708.06, Wfe. Stale.) THIS INSTRUMENT WAS DRAFTED BY: D BAUER/CHARTER BANK EAU CLAIRE ------------•------------------------••------------------------- (signatures may be authenticated m aduieMedged. Both are not necessary.) V1017 P331 J:LLendere and Loan FornmlDeed-O,dt Claim Deed.doc ACKNOWLEDGMENT STATE OF MA )ss. COUNTY OF Si)fol_k ) +l^ Personally came before me this OS day of APRIL ' 2009 the above named - ------------------ --------------- JEFF HENDRICKS b ma born b be the person(s) who executed the fomgotr9 ins(tnxnaa and a&nowbdge the same Gy Mal - VQP (-look- — NotaryPubBc, ....�,ffoLE county Mycoomsalanls mwien4—Pfnqstet el�Neson date) Q cp, C6ttiN vomn+wrw1a�ra �rNflisets :'.'.Iy*41elunE NA**42015 BAYFIELD COUNTY SANITARY PERMIT (#04)-25-33S STATE SANITARY PERMIT OWNER: HENRY HENDRICKS JR G OV'T LOT: LOT: BLK: NE 1/4 NW 1/4 SEC: 23, T 45 N, R 9 W TOWNSHIP: Barnes SOIL TEST: 32-25 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: RICK BROWN TRACY POOLER Authorized Issuing Officer DATE: 5/30/2025 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: # 231251 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