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HomeMy WebLinkAbout25-35S" INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY TIME RECEIVED REMOTE CSID DURATION PAGES STATUS June 2, 2025 at 8:18:27 AM CDT 7153724159 37 1 Received Jun 02 2025 23:38 HP Faxpolkosk Plumbing 7153724159 page 1 Request for Sanitary Inspection Fax this form to Zoning Dept when you want an inspection — 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 Y ?orccastkr Phone Number -7ls z�2,--gls(P Plumber: o ( LZto S k ? ( u ^^ E' ° ^C Fax Number -7i s' 3 iz-- L11 9 Home Owner: 1 y Sanitary Permit #: Plumber's Choice Zoning Dept No Inspection during these times Date: Time: Plumber's Choice Zo Dept Immediate Phone Number so Zoning 0 O Dept can call you right back (if needed) ""I �1 Y Township: Address# cro Cvow (2 u-cv -f LC crr N A No Road Name: i vv ✓I Lf o✓i t1 e -(a &o or , . t k Directions / rw,(e — 4 . Je pct o, - -'3. OFo P.erortRc To Site: Comments: Reminder: You must confirm any change(s) that have been made prior to or this inspection will not be scheduled and a memo will be sent voiding the inspection. Thank You! From Zoning Dept ** Plumber must verify any change(s) by fax or no inspection will be scheduled ufarmstsani tarylrequestforinspection Zoning Dept (®!112104) ® August 2021 POWTS HOLDING TANK INSPECTION REPORT (ATTACH TO PERMIT) ANTHONY JOHN & DEBRA ANN MIDDLEMAN 73080 AIRPORT RD IRON RIVER WI 54847 TANK INFORMATION TYPE MANUFACTURER/MODEL# CAPACITY O-4.cro ax'' l lL5C Z Od0 SETBACKS Property Line Well Water Service Building All -Weather Road OHWM Swimming Pool DEVIATIONS FROM APPROVED PLAN COMMENTS (Persons present, discrepancies, etc.) .Xrt S,tiI2 � a✓i'1 TGgk I''i415 COMPONENTS NOT INSPECTED Plan Revision Required ❑Yes No Da — Signature of Inspector Cert. Number S ceICn on otner side 10 of 13 BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Bayfield County Courthouse Fax: (715) 373-0114 Post Office Box 58 e-mail: aoning(5bavfieldcounty.wi.aov 117 East Fifth Street Web Site: www.bayfieldcountv.wi.gov/147 Washburn, WI 54891 Property Owner ANTHONY JOHN & DEBRA ANN MIDDLEMAN Information 73080 AIRPORT RD IRON RIVER WI 54847 r As you know 7'2"!! /i'%)US%i was contracted by you to install a private onsite wastewater treatment system on your property described as: Notes: Abandonment of Old System to meet all applicable code requirements: C. Tank was pumped by: on at AM I PM :• Tank was crushed I removed and pipes disconnected by: Oni at r' PM) the above -mentioned plumber contacted our office to conduct apre-cover inspection as requht1 under DSPS 383. One of the following applies: ' 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/formstsanitarypmpertyowner-input April 2019 Z-00537 p/RTRt�� Department of Safety 7` jai "M; & Professional Services, Industry Services.Division Sanitary Permit Application 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 purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. L Application Iinformatlon = Please Print'All Information Property Owner's Name" c Permit Number (to be filled in by Co.) State Transaction Number __. -e- , v c j (e Property Owner's ailing Address -7ic2O f�,tr�or L Property Location L�sSa 49 Govt. Lot City, State Zip Code Phone Number Fr_ 2 / 0 {+� t .i ¼II LtJ - (� �U '�( > ,T I S^' l) "© S'L7 �J ' �' 5 '/,, Section , T 1 N 'o IL Type of Building (check all that apply) Lot # l I or 2 Family Dwelling —Number ofBedrooms R Subdivision Name ❑ Public/Commercial — Describe Use Block # ❑ State Owned— Describe Use ❑ City of ❑ Village of CSM Number ¢i Town of © J l v IIL Type of POTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C :a'' liable. A. ❑ New System 0 Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. Holding Tank 0 In -Ground 0 At -Grade ❑ Mound 0 Individual Site Design 0 Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision 0 Change of Plumber ❑ Transfer to New Owner 1st Previous Permit Number and Date Issued Expiration Design Flow (gpd) Design Soil Application Rate(gpdlsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units °' a New Tanks Existing Tanks '° I eepas Holding Tank z t- o o r z sb0 V. Responsibility Statement I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si azure r/MPRS Number Business Phone Number ill ��i Two 1 ��s��Joco {/4 Plumber's Address (Street, City, State, Zip Code) a fax s� ?- z. y V-0 P . t 1 ≤-,K8 Y7 VI County/Depa'rtmetit".Use Only Approved ❑ Disapproved Permit Fee Date Issued Issuing Agon aturo ❑ Owner Given Reason for Denial $1.100- 5/301 z5 Conditions of Approval/Reasons for Disapproval a,6L IeI CM3/ A Odd MAY 1 92O25 Attach to complete plans for the system and submit to the County only on paper not less than 8 tit x 11 SBD-6398 (R. 03/22) - �` rl64501 6 %%4 a t.VIV 4(VU NO 99/f) P. 2 I PAGE 1.OF 8 Holding Tank Pin MAY 1 9 2025 Index & Cover Sheet wield Co. Zontflg Dept Component Manuel Design References: /�I�rivLa't e i ati v c ito.y' a _oa) Pg of Index & Cover Sheet I P 2 of9 PgPlot Plan Pg 3 of 9 Holding Tank Speclftcatl ns - Pg 4 of 0 Management Plan Attachments: pcIosures: - POWT$ Application for Review CsttA yP Soil Evaluation Report & Site Ma fi a placable} 7 o. . ldin Tang Pumpin ontrac# if app1cabIe) Idin TankAgreemertjfappJjcable Project Name 1 Description Ky wt : Owner Name(s): 1>f_� v we ; ' e a Phone: 'Zis- .//3. Owner Address: "7--3 o f v A -j:-0. Project Address: S ui4 5W 1/4 of 1/4, Section _/3 T -R __EEor w Township: O O / U County: l icJ Project Parcel ID #: TL 7J '`� z, L27 (e ? --i.. Designer Information Designer Name: j4 / /cL c, a s Phone: Designer Address: R'. Ru, E-mail: 0 h L �...� �, �,- : _...,, v e de. �t C ea Thi space reserved for approval stamp. License Number; e 0 �� o Remarks: { .Signature: `� sat: s 2S--, original signature required on each submitted copy. I Pref4e.V- f Owner': Le9a I Aesrrp I ;E'tn . a 5 opecsrmse Q - Set I Bern l' oti�.`vi ilL ' etisul su y 5ecL3 T415N RI W $ccn-le: 1% N©'u , lass N 4 i�.e( ✓ot svl;��I�K.a L�5St.1 6 N i 7� N�aray+ R90 • l� 4r 73orYo P►; vror+ ) swn of: o v l % ZSbo Ilan uF eser eancue1tTnk= c.0.4. -4 A I 193 "L i'!rr� 3•r-Fvon bc.`l"I-Cwlof ..�p� ' rg 1.-e Wvt Y'�/ e�; %S aY-��/� r •Wank to �joivne inle-l; T . D z '7 �i re -`47302O t �1 -I-.Q Q old -�ce , lea ` S'C t. I e C 'rG H k rvt usf i,f f"' h-17;, d !Q et 6Gn 0v C.. a Pe✓ $ 5 383'.33 gve+�'ta CccL uJ/n.cu . o0 4 je,,1/0h w ts�v u DnllJ MAY 192025 Sayfield Co. Zoning Dept. 25'/ckQ0 26e J h 011 42S ZsO'__ , f 2w•. etn (n.0 lQ.'^.7'/ lmeiG. n[yy[CL. ,S 6�G�apl( y e, 0 junlC)rteE1-s a!l { Lcks CSPS3#S) AF.&. = ALcve •C;- ( 3tr.ctjc wlE RIr19 J 2P = Ejeu/00.0,' :Tom--, = 5ck Flo PVC; W/'8!o d. rt?.e.4//-i e-vt = 4"AsT») D3iQS"pp rtVtc p pE I ui.l tr,ctj:a O N M LO, BctV`t-;L' I -1a Id; mq'ra.t k Consj7end tvla n u.a: /!u sect 0 7/1an tta l `°8"�Jpe (t/ERZJ); C&fl&Y2az2.-Zn7) Qrcuoa $y : ►�.PP%..S'. zZeolo Palkc-5k, Plu titb;vtq Re,130K Cva rron R'vev, wr s'VRY7 a.. PROPERTY OWNER: 24fka r b • . • PLUMBER: Allan • i/ Poi sk1 PIurnbng SIGNATURE: a--. r DATE: LICENSE #22OQpo HOLDING TANK SPECIFICATIONS r'"1Number of bedrooms Non-residential estimated flow (gpd) 2D O , Minimum holding tank voiume're p quit®d (gal) Tank Dimensions and Data X for round tank TcrlLlquld depth below Inlet Invert (in) .Q iMaximum d® th of soil cover (ft) 189.3 Height (in) Outside Length (in) Dimensions 9�. Width (in) Only junction box. conduit --> blind plug to seal outset Manufacturer model number manufacturer fiber D K[flfl till MAY 1 92025 Bayfield Co. Zoning Dept. Tank Anchor Calculations C?bdb1lbs Weight of tank and cover rtri m02 " Safety factor fibs Weight of anchor required 40,8 !n Soil cover req. for anchor or a.9jJyd3 Concrete counter weight • HOLDING TANK CROSS SECTION manhole cover with locking device and tinlehad vent cap warning label grads 4" min. •I. --- < --•24 in. 12" min. Manhole and vent locations may be reversed, Vent pipe �...._... service 12.0 In, building sewer elertn on fi Note: All tank In1nim a...a1 Inlet Electrical as per NEC 300 and Comm 16 Joints between tank - openings and piping are. 39.0 in. sealed watertight. All pipe and vent materials comply with5 '. '$3 3 in. bedding under tank. Tank Is anchored as necessary to negate buoyancy. TOP VIEW E M ILL SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS WLP2500 TANK SPECIFICATIONS DIMENSIONS: hi o WALL: 3" a CL BOTTOM: 3" HEAVY - 5" COVER: 6" �- MANHOLE: 24" I.D. PRECAST CONCRETE RISER ap HEIGHT: 52--3/4" O.D. LENGTH: 183-1/4" O.D. - WIDTH: 101-1/4" O.D. W < BELOW INLET: 41" O.D. LIQUID LEVEL: 36" WEIGHT: TANK - 3" BOTTOM 12,560 LBS. V TANK - 5" BOTTOM 15,527 LBS. N WEIGHT: COVER 9,300 LBS. w N '' Ex INLET AND OUTLET: m 4" CAST -A -SEAL BOOT OR EQUAL 3 INLET AND OUTLET BAFFLE AND FILTER: o o WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) a �1 n d' t17 LIQUID CAPACITY: 69.44 GAL/IN LU1 HOLDING TANK: OUTLET HOLE PLUGGED C o LC) ACTUAL CAPACITY: 2,639 GALLONS ® z ap w LOADING DESIGN: 8' 0" UNSATURATED SOIL i j TANK CAN BE USED AS: SEPI1C/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #9 (SMALL FIBER) m CUSTOMIZED TANKS: i FOR CUSTOM TANKS CONTACT WIESER CONCRETE N J3 D N != W a cn w > U) w oC SHEET NO. OF / HOLDING TANK MANAGEMENT PLAN MAY 1 9 2025 Bayfield Co Zoning Dept. This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to f33 Wis. Admin. Code, the Holding Tank Component Aanual w.se.d" `1a.n vcL.I l /per tER2oo * and the T e (cSanitary County Ordinance. 21) ; LMT z. z°_ZC,7) � 1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 400.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and PS 383 and384 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with 66P 63.33 Wis. Adm. Code. 10. if there e 7 �.s aproblem with, n or question about this '�tallation,•� eS followa persons�Phone��' ld7 b 3 contacted: a. installer • b. Service Provider .................. 6' 4; ag,aiI Phone: 7/r 37z..- qoo c. Co. Zoning or Health Dept. j �n Phone: 7/3 3Z6R 11. 5w Sw Se -c 13 L(FAJ LESS W ( >Jw Project Transaction Number: SS- nww7 Department of Safety County 4Y f & Professional Services Sanitary Permit Number (to be filled in by Co.) Industry Services Division ur�5-35 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 (ifdiffcrent than mailing address) purposes in accordance with the Privacy Law, s. 15.04(I)(m), Sats. I.Application Information— Please Print All Information Property Owner's Name A"- -kor1 r deg✓ -ti wi;jJI Parcel N � IAk�D Property Owner's ailing Address 73o20 Ar ✓•moo✓� i21 Property Location LQs$ w Z NW Jzf City, State _ ✓ O h (� . ✓ 2 ✓ t�- -tJ d '7 `7 l S ',/ ( Zip Code Phone Number113Cityor_ Govt. Lot 1 1 1 5,1W`i/ i'A, (3 ,S' 1 Section IL Type of Building (check all that apply) Lot N T -(8 I or 2 Family Dwelling — Number of Bedrooms Z N R Subdivision Name O Public/Commercial — Describe Use Block N ❑ State Owned— Describe Use CSM Number0 Village of P Town of 0 0 O 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 livable. A. Replacement System ❑ Other Modification to Existing System (explain) ❑ NewjBefom ❑ Additional Pretreatment Unit (explain) B. Holding In -Ground ❑ At- Grade I ❑ Mound ❑ Individual Site Design I 0 Other Type (explain) (conventional) C. ❑ ReneRevision ❑ Change of Plumber ❑ Transfer to New Owner ist Previous Permit Number and Date Issued Expi IV. Dis ersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sl) Dispersal Area Required (sf) Dispersal Area Proposed (st) System Elevation 3OO -- - _ Tank Information Capacity in Gallons Total Gallons k of Units Manufacturer 2 ,5 2 in in u y New Tanks Existing Tanks Septiuux Holding Tank Dasiag.GwwWr z ≤- o — ZSoo I Wkeser GGnC, a Cg ✓ ii. C7 a — V. Respoltsibillty Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si amre bW/MPRS Number I Business Phone Number Ai(TOI V-nsk r �- 22009 O has Lgy_�{lS(P Plumber's Address (Street, City, State, Zip Code) R _ VI County/Department Use Only Approved 0 Disapproved Permit Fcc Date Issued Issuin Agen $ store ❑ Owner Given Reason for Denial %V o 5/;a/.2s - Conditions of Approval/Reasons for Disapproval J aJadied ea t4£ p d C 0 MAY 1 9 1 05 Attach to comoiete ninny for tan nxm,,, "A "°I 't t th r................ nn o c aunty only on paper not less than 8 lax II inelesn z1./ept. SBD-6398 (R 03/22) 001q Soil Test # Bayfield County Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) IA I . a '1 ?? / k'o s £ a certified soil tester determine that in my judgment the following site (see below) is unsuitable for any treatment component other than holding tanks. Due to soil & site conditions, a thorough soil and site evaluation is not needed to make such a determination. Property Owner b v Property Address? 3 o o , r lZ Contractor Authorized Agent Agent's Telephone, Telephone `7 1 '1 t 3 - D % Written Authorization Attached: Y or N Accurate Legal Description is requested: `=114 of (J114 Section 1.3 Township -/ N. Range 7 W. Town of Additional Legal Description: _-eSS t J 1'¼.J LtJ Govt. Lot Lot Block ____Subdivision Lot CSM# _ Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# 2 1e _7 l' 7 Acreage '30 Indicate reasoning for your determination: '4J -e f C 1 a s /J' i ,cjLA Signature of Coun y Offi al � 2d� Date Signature of Certified Soil Tester Date C'. S7"' 2.2o oq o / Certification # 1111 D E c EiiV E (Submit a Plot Plan & Fee) MAY 1 91025 a/forms/soiltestwaiver(KLK) June 2018 Bayfield Co. Zoning Dept. prc trtY ownero L o 1 r pf le cl 154 S" SIL0_ L3 "`i�(�N ( `A!` Le -s S t, rLtJ 7O A, yr or+ ,_, win cc jvahotoff O V J O a �erd r�r1Sd i N �'r....l e.o ! �r > Q+�'1.vi 6�E.' $"5 d! �9 -1e. 6 !�S 3 '�„� 161 '�vi f" 3 v.o!)l 't"d'F". , a r., k• -a Flow ae. i n 1 t -r ll ICY! U S £ !^t'1 '' yC ti 8604 OVIa�. Pew' J3 cos II ' i /T) L4)4eS-C.V 1111 MAY 192025 ii 33o Bayf1eld Co. Zoning Dept. C) (L 1e j 42, 25or or n k� le /o c. k:.. c.L q - r SrbZ� •Sl d. r dtc J r� i /1 ►1 se4gc.c.ks csr'5.413) He !d k cam 12avi.e-f J� C� ,� b e �. - ' �L ( g +�z c� a �v� h u. a f u s e c� a Ing A wx "r° •p 40,VC- R 2� 'Y'i�a®) 1)gP E1�.u/eO•Q,' Wr'Q,o o PJ'1JP5.2Zc'90 "' .""' .. Sck qo PVC, V /.- lb'u e i a �kes kr 'Plu.I'ti � q "A5TOI f� l "7 � ' ci,�a v -G' V � p• �7 . I+ v -c L l t �� n , .•v -on g've.vv wJ ≤ �V7 • No. 99(5 P, 2 pI Holding Tank Plan PAGE 1 oFs MAY 19 2.025 BUJ Index & Cover Sheet Bayfield Co. Zoning Dept ` Component Manual Design Refermnc'eys�:: TO1fi.buAa-I �Ciyl-e'lLr�lta'-r5ionz.i) C /llt0./ it 2-Z LOZ71 . Pg 1 of g Index & Cover Sheet Pg 2 of 9 Plot Plan Pg 3 of S Holding Tank Specifications - - �> Pg 4 of 9 Management Plan Attachments: I Ennlnanroa• 5 - POWTS Application for!Review fs4nl'4 F g Soil Evaluation Report & Site Map (if ap 2 Holding Tank Pumping Contract (if appli {— ' Holding Tank A reemetjt (if applicable) Project Name I Description PP.rm, An -'K6 K4 ✓�l CC iE v'•�c f� Owner Name(s): Dt4,v,, vet ; kd ( e ha , Phone: ' - 7/3 . o s f 7 Owner Address: -73 o 8'o {� , om, R j e 1 wL p: SY 2 F> Project Address: C 0C a L o� -c Township: C Project Parcel ID #: S W 1/4 of 5'-J,1/4, Section 13 , T t/ eN-RE ❑or w12 V County:l3c,Y,C. Y ( Designer Information Designer Name: /c K Pc fcS Ac Phone: i7/S= ,'7y _ Designer Address: "}?cam, 3 ©,r Sa27 cn /LJ' i WI Zip: E-mail: is � r da. L Thiy space reserved for approval stamp. License Number: z z 00 �9 o Remarks; Signature: Date: S Original signature required on each submitted copy. Owntr LQ a� 1ig5Gv "'o-PRtay-ols! P�mpevt�/ P�,��,. ; !. � � • = 50, 18ao°�,ng, I N j�� I �ora4 � &tA�e�ahs4J sw4 5cct3TL(SN 9W Sole: !'� t'o'ur,less no-le.d- i� •e ✓q a to : I e I�I� f y�, �I/ a Z3©20 (� vr orTn Le-SS%.l z N 7 Nectve-s+ RJr A°✓1--, r4 ra,L —c.- I. '(yY Sw n e{ v Cu Z:.zsoc cjallon i:eser cencrecTank= Cct{r1�V o , Y <<7r . (� Tank�to fl vr,te/ PNorv� bctlorsle e i n!e 1 hire 73O$0 A° rpor� !2� DID «.i M1 scf°c Tc1< n E c E U E D.. F'ecsIs363.�3 DV MAY 192025 / yc7tc.ccL i./cu coo BayfieldCo.ZoningDept. c,it 2Be�KI �p1d 12cs; a2C 7 ' , ZSO y0� t yankaie J/ociCr n4Gt.q rS r 1 e•rP qfa(✓ R 7� et �.FPr O ti Nb L'a nc Wrlkirtee4s 0.(l n1n. eJ F,I Le_e ks CP.s_3tl3) A.F.cn A6eve-(�1no.( cjv-ctJe uL a s4, -tan StCor .ev_ ' 8n1 t vgp =Elulco.o,' r W!"ASTf71 D 17QS ctjP? re vtt c F. pt YYitt.-l-ttre Ctl 11 He l d t rtl' 1 ct.o, k tan1 pe+rtei ,Y)nu.ct/ LtsCJ:maALta6 type - (VU z-�; C, t94a.Yze z2 --z®..7) brcu,o" 13y; YUK-5 z2co90 Pelkc-,k, Plant hi Re, 13 0 K s Z'2, rre r?+ve.v, wZ 5'V&Y7 PROPERTY OWNER: fit:, ��� ✓; YY1 t I e �� PLUMBER: Allan Pniknakil D„It. SIGNATURES ( '/ DATE: S—( z5 LICENSE# 220090 HOLDING TANK SPECIFICATIONS -�� Number of bedrooms I Non-residentlai estimated flow (gpd) M _____.�, Minimum holding tank volume'required (gal) Tank Dimensions and Data �.y for round tank 51.0 Liquid depth below inlet invert (in) 8:0 Maximum depth of soil cover (ft) 77;rlHeight (in) Outside 159,5 Length (in) ( Dimensions 93A Width (In) J Only Junction box conduit blind plug to seal outlet Manufacturer model number manufacturer fiber [ii i1flfl 1111 MAY 19 2025 Bayfield Co. Zoning Dept. Tank Anchor Calculations I 16840 1.50 Ibs Weight of tank and cover Safety factor 40207 lbs Weight of anchor required 40.8 in Soil cover req. for anchor or 9.9 yd3 Concrete counterweight HOLDING TANK CROSS SECTION manhole Cover with locking device and finished warning label grade ll$4" min. II E— 24 in. y Manhole and vent locations _ may be rever.MA Oservice J, 12.0 In. alarm on Note: All tank joints, and joints between tank Electrical as per openings and piping are NEC 300 39.0 in. sealed watertight. All pipe and Comm 16 and vent materials comply with5psjfl vent asp T 12"min. vent pipe T 18" min, building sewer Inlet 3 In. bedding under tank, Tank to anchored as necessary to negate buoyancy. 4" CAST -A -SEAL 183k" TOP VIEW 4" CAST -A -SEAL FILTER OR BAFFLE SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS WLP2500 TANK SPECIFICATIONS DIMENSIONS: WALL: 3' BOTTOM: 3" HEAVY - 5" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 52-3/4" O.D. LENGTH: 183-1/4' O.D. WIDTH: 101-1/4' O.D. BELOW INLET: 41" O.D. LIQUID LEVEL 36" WEIGHT: TANK - 3" BOTTOM 12,560 LBS. TANK - 5" BOTTOM 15,527 LBS. WEIGHT: COVER 9,300 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 69.44 GALAN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 2,639 GALLONS LOADING DESIGN: 8' 0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: o z a N 90 0 o_ w N 1 1I 101611 ECEoVE0. HOLDING TANK MANAGEMENT PLAN Ii MAY 1 9 2025 Bayfield Co. Zoning Dept This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to9f5393 Wis. Admin. Code, the Holding Tank Component jv1 nual µ5td; `'Ma.nvez I -r yre. VER�o and the 'Bay -Pt (c{ County Sanitary Ordinance. r sg z.1) ; cmV_y zoz..-zvt7) 1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 400.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and BPS 383 and984 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be Installed in the same location (a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with SPS 993.33 Wis. Adm. Code. 10. If there is a problem with, or question about this 'nstallation, the following persons should be contacted: a. Installer .............................Po l(osk Plarniung m,RR,s. zz0ogo Phone: 7i( 37z- Lff$(o b. Service Provider................... SGrJ-e R b z Phone: "?'��- 37z - el o®� c. Co. Zoning or Health Dept, &y44J Cau a5n Zoni�y Phone: 71S .r -z3— 61W 11. G4aI bcs 5W Sw �y Se(_ 13 Lf8n/RQtJ Less %.J' Nw (Y out') -e Project Transaction Number: HOLDING TANK SERVICING CONTRACT MAY 1 9 2025 Contract Date This contract is made between the AWNC) 4\ kThLM1 Lt -=U4 Pumper's Name (Print) PurtTper's Signature -rkc-" st5 fa(IGo5k+ 'y✓c e'faadar Bayfield Co. Zoning Dept. Registration 112.71 We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT Legal Description: Tax ION/� `Z !' 1 `� 1/4, S� 1/4, Ltcs W— N w LOCATION (Use Tax Statement) i Section 13 ,Township `[ O N, Range W Town of: Lot Size I Acreage J' J 3 ST Gout Lot Loth CSM Vol. Page CSM Dec Lot(s)No. alock(s)No. Subdivision: 1. The owner agrees to file a copy of this contract with Bayfield County as required in SPS 383.55, Wis. Adm. Code. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local government unit which has signed the pumping agreement required by SPS 383.55, Wis. Adm. Code, and the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in g. The disposal sites gallons from ` or e to which the contents from hehold holding t�nk,N ecservicing; dh 4. This agreement will remain in effect until the owner or pump m1`nuaty contract, the owner agrees to file a copy of any changes § s SiMcE with the local government unit and the County named abDO yt�hin (1t service contract. = _ t. In the event of a change in this a copy of a new service contract /s from the date of change to this My commission on: Revised: May 2016 (&May 2018) Drafted by t Jt a o f Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (I)(m)] AGREEMENT �0.xZD`sZla'7�`I � S —(o —z on the following property or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. SPS 383, Wis. Adm. Code or Ch, 145, Wis Stela. , / ,L1/4 of StO 1/4 Section i 3 Township `/gg N. Range ______W. Town of OJ I J Additional Legal Description: L e s' S W i Al W GoVt Lot — Lot Block_Subdivision CSM#_ Lot_CSM # Vol _Page _CSM Doc# DOCUMENT NUMBER 2025R-607442 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED 05/12/2025 AT 8:00 AM RECORDING FEE: $30.00 PAGES: 1 Return To: !°- ii≤oK Si_z Tve '� ✓ef(%I C I Y7 As an inducement to Bayfield County to issue a sanitary permit for a holding tank on the above described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tank installation and maintenance. If the owner fails to have the holding tank properly serviced In response to orders issued by Bayfield County or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Stets., Bayfield County may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by a. 08.0703, Scats. 2. Owner agrees to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. Bayfleld County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 3. The owner agrees to contract with a person who is licensed pursuant to s.281.17 (3) Wis. Scats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced In accordance with Ch. NR113, Wis. Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed pursuant toe. 281.48 (3) WIs. Scats., and Ch, NR 114, WI's Adm. Code who shall submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfield County may enter upon the property to Investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being property maintained. 5. This agreement will remain in effect only until Bayfield County certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that cempl!es with Ch. SPS 383, WI's Adm. Coda. In addition, this agreement may be cancoHed by executincertification to be deterand minedidby efefrence to he proon with peettt`�tS��l�rragieemant in such manner which will permit the existence of the EM,(bCO�� 6. This agreement shall be binding upon the owner� Yieirs oLHe•o �p(yand assignees of the owner. The owner shell submit this agreement to the register of deeds, and the agr. ee3of ce fy the register of deeds in a manner which will permit the existence of the agreement to be determined by r1 nce to the prot99 the holding tank is installed. 'owner(s) Name(s) — Please Print tl�t " A � or>d� ' la spa G�► 9L%o$bed and sworn to before me on this date: /4%y /JA, Zozs No r Ae wner(s — Igna (s) Nolarq-P0bf My st n E s: / 4 J Drafted by: o h 9 ?o 1 ke S k Personal Infor01allon you You prvide may he used for secondary Purposes [Privacy Law, s.15.04 (1)(01)1 Date; S' & L 5^ fl Wfornumanitery1holdingtanke ment.doe 0.Luns 20182018 't8 MAY 1 9 2025 Bayfield Co. Zoning Dept ii (I BAYFIELD COUNTY CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) p 0 t% E7 Check List IIUIr 1T Original Sanitary Application (Submitted In Deed Holders Name — no prospective buyers) (383.21 1)1MJAY 192025 Q Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) Bayfeld Co. Zoning Dept. 121' Original Plot Plan (383.22(2)2. 3. & 4.a) Rf Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer [, Pump Tank Diagram, Alarm and Pump Curve (when applicable) G7 Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) O Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) la Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) 0 ATU Servicing Agreement (Recorded at Reg. of Deeds) 19 Fee (Make Check Payable to Bayfeld County Zoning) (383.21(2)(c)7) 40 2 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) b 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 Application: (Include the following Information) 12!! Application Information must Include: ❑ 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) 10 Project Address or Road Name where driveway is/will come off of) lJ II Type of Building ® III Type of Permit 12' IV Type of POWTS System ❑ V Dispersal / Treatment Area Information 111 VI Tank Information 121 VII Responsibility Statement (Plumber's Information) ❑ *Date Stamp* Plot Plan: (To Scale or To Dimension) T Signature and Plumber Information R?'Surface Elevation of Body of Water 0 Direction and Percent Land Slope I9 Tank and Filter Information and Location Z Wetlands / Navigable Bodies of Water ❑ Absorption Area (Proposed and Existing) m Bench Mark (Location, Elevation and Description) 5 Component Manual Version G21 Legal Descriptions 121 Piping Material Information (conveyance line, building sewer line, material type and diameter) 121(Owners Phone Number) Gd Address Number and Road lI North Arrow ❑ Contour Lines 1121 Structures and Driveways m Boring Location GA Property Lines 10 Well Locations Turn Over ► BAYFIELD COUNTY CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Following (Use Permanent Ink): 0 Check List m Index Page / Title Sheet (Optional) m Original Soil Evaluation Report (Submitted in Deed Holders Name — not prospective buyers) izi Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) O Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Report: (Include the following Information) [i5 WVI 1111 MAY 1 9 2025 Bayfield Co. Zoning Dept. Z Parcel Identification Number (must be 23 digit Tax ID#) DO NOT USE 12 digit, they are no longer being used IZI Property Owner's Information not prospective buyer's name) 10 Property Location (Accurate Legal Description with Sec/Twp/Range) m Road Name (where driveway is/will be coming off of) d Floodplain Elevation, Flow Rate, Comments and Recommendations 21 Complete Soil Boring / Pit Information 121 Date Soil Evaluation was conducted I3 CST Name, Signature, Number, Address and Phone Number ❑ *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) R1 Bench Mark (Description, Elevation and Location) 0 Contour Lines (Example = 98.0' /96.0' /94.0') II Property Location (Sec/Twp/Range/, Accurate Legal Description) 7.1 Borings (Locations and Elevations) Percent and Direction of Land Slope El Well Location (Including Neighboring Wells, if applicable) L�] Location of Wetland Areas, Floodplain and Navigable Waters m Buildings, Driveways, and Structures (Location and Descriptions) i6 Location of Property Lines IS Existing System Location m Address Number and Road Name d Current Surface Elevation of Wetlands and Navigable Waters 16 CST, Owner and Property Information 161 North Arrow Fee: A Certified Soil Tests - Review & Filing Fee $ 50.00 u/forms/sanitary/checklist/checklistforests BAYFIELD COUNTY SANITARY PERMIT (#04)-25-35S STATE SANITARY PERMIT OWNER: ANTHONY JOHN & DEBRA ANN MIDDLEMAN GOVT LOT: LOT: BLK: SW 1/4 SW 1/4 SEC: 13, T 48 N, R 9 W TOWNSHIP: Oulu SOIL TEST: 33-25 REPLACEMENT SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: ALLAN POLKOSKI 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: # 220090 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 5/30/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION