HomeMy WebLinkAbout25-37S^'" y$;,./^.^ Y^''.
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Industry Services Division
4822 Madison Yards Way
Madison, \Y^37(@5 rp j-i; jlP.O.Bo^3o£ ^ I" '!
Madison, V^,53707
K
-^izm^
County
Bayfield
^litary Permit Number (to be filled in by Co.)5^~57S
Sanitary Permit Application TTT •'-
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the app^igi^^lg|@3y)gnig^tghigi(t)i
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.
STate Transaction Number
J3t_Project Address (if different than mailing address)
88850 Mariner Mile. Bayfield, Wl
I. Application Information - Please Print All Information
Property Owner's Name
Wagner Family Liv Trust
Parcel #38235
Property Owner's Mailing Address
5510 MahoneyAve
City, State
Minnetonka, MN
Zip Code
55345
II. Type of Building (check all that apply)
1 or 2 Family Dwelling - Number of Bedrooms 4
IPublic/Commercial - Describe Use
IState Owned - Describe Use
Phone Number
970-333-0424
Property Location
Govt. Lot
_'/4,_'A, Section _35_
Lot #
2
.51 _N R °4 E or ^
Subdivision Name
Block #
ICity of _
CSM Number
#2127
IQvillage of
1 yf Russell
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.Jew System I (Replacement System )ther Modification to Existing System (explain)[Additional Pretreatment Unit (explain)
B.DHfolding Tank In-Ground
(conventional)
I|At-Grade Mound Individual Site Design [Other Type (explain)
c.Renewal Before
Expiration
I Revision ;hange of Plumber 'ransfer to New Owner-,ist Previous Permit Number and Date IssuedNA
IV. Dispersal/Treatment Area and Tank Information:
Design Flow (gpd)600 Design Soil Application Rate(gpd/sf)
0.7
Dispersal Area Required (sf)857 Dispersal Area Proposed (sf)892 System Elevation
92.0
Tank Information
Capacity in
Gallons
New Tanks Existing Tanks
Total
Gallons
# of
Units
Manufacturer
Septic or Holding Tank 1250 1250 Superior Precast
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 Signature
..^L.
MP/MPRS Number675751 Business Phone Number
715-798-3355
Plumber's Address (Street, City, State, Zip Code)
PO Box 66 Cable, Wl 54821
/ t-:f f
VI. County/Department Use Only^ApprovedA D Disapproved
D Owner Given Reason for Denial
Permit Fee
' ^O.oo
Date Issued \^•/is" '/y
Issuing AgentJSignatup
,^23^w^
Conditions of Approval/Reasons for Disapproval ^e^a^-^4\^cf O^rd:
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x II inches in size
SBD-6398 (R. 02/22)
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Wisconsi n Department of Safety & Professional Services
Division of Industry Services /SQiiAiT
SOIL EVALUATION REPORT
nc^crvCD
NOV0120Z3 _ ^;
BayfieM Co. Page' •'• of
Ptannfng and Zoning Agency
—0
-/
In accordance with SPS 385. Wis. Adm. Code
Attach complete site plan on paper not less than 81/2x11 inches in size. Plan must include,
but not limited to vertical and horizontal reference point (BM), direction and percent slope,
scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information.
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1 )(m)).
County /S^Ti^i^'^
Parcel I. D.J8<^T<S
Reviewed by w^Dat4lte.Property Owner
^en?/^ f- 3~^<-iA- i^//3-6A/tr'<~
Property Location
Govt. Lot 'A 1/< SfS T S'/ N R e>^
T] ' ^B"
E (or) W
Property Owner's Mailing Address
SS/Q /^./vt+o^ei ^£
Site Address or CSM and Lot #:
T0'K> - LOT- Z_ cfA-^ "Z.)?~7
D City D Village 0 Town
,'ZvSsc^
City, State, Zip
A^t/'/^ery/^^-/^^ SS~^\
Phone Number
(770 )JJJ' 0^
Nearest Road
Mfi^\r/cn- /^>»-£
New Construction Use: E0 Residential / Number of bedrooms
Replacement D Public or commercial - Describe:
Parent material /^I-TI-VJftSf^-
General comments and recommendations:
Code derived designflow rate '/^o GPD
Flood Plan elevation if applicable •— ft.
'bfcJ/S/^ To 0 .'~t
Boring #D Boringla pit Ground surface elev,-f-^A ft.Depth to limiting factor^ZZjn. / elev.^j'?- ^ft.
Horizon
I
z_
J~T
Depth
In.
0-2.
2. -<?
?'??
?J-^
Dominant ColorMunsell
-7.5 u-?-y(
?.S V^ V-i
7-r^^
-? ,S tA^/h
Redox Description
Qu. Az. Cont. Color
Texture
<-s
s ^
_s^s "
Structure
Gr. Sz. Sh.
^56
H^l 0,^6
^1 of C
^ cS<.
Consistence
/v\.v^^}
_/hL
Boundary
_6t^_
6(->^
Roots
\f\^
\f^zf^
Soil Application Rate
GPD/Ft2
*EfW1
rf.7
o.~)
Q.-7
0,~?
*Eff#2
/.^
I.C
l.(^
I.C-
Boring #[Boring
?Pit Ground surface elev,%77 ft.Depth to limiting factor;> HO jn. / elev.le^feft.
Horizon
t
^_3
^
Depth
In.
~o^T
3^9 -^
?^ -//»
Dominant Color
Munsell
~?JtA.--/f
7 S -^^
7.^1^/7
7. S •^-UI/C.
Redox Description
Qu. Az. Cont. Color
Texture
LS
^M/ffSA^ft
Structure
Gr.Sz. Sh.
eS6
^fosG^rc:
hSC
Consistence
^\
/M
^{
Ml
Boundary
_^__2?±-^L
Roots
iMi
(A.I-F~^~
Soil Application Rate
GPD/Ft2
*Eff#1
_^_j?Q^L
c.~?
*Eff#2
AA_
_f^_
1. <.
/. (-
CST Name (Please Print)
~T7^ CLrt^-X-
Address
Po ff"f- ('(, C^€^,v€^
Signature
Date Evaluation Conducted
^/^/-z/7
CST Number
/y?^s"?
Telephone Number?^~^5^-?J'$^
* Effluent #1 = BOD > 30 < 220 mg/L and TSS > 30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS 5 30 mg/L SBD-8330 (R03/22)
^ ^SD ll-? M
Boring #
^ Q Boring
japit,,,,Ground surface elev.2^ft.
Page 2- of
Depth to limiting factor.? ^^ in. / elev6?.'':3ft.
Horizon
i
z.~T
Depth
In.
6' jE?
^-Z-7
z?- 77
Dominant Color
Munsell
7-f^-t/S
7 's-^/3
7St^'t/(.
Redox Description
Qu. Az. Cont. Color
Texture
^
5:
s
Structure
Gr. Sz. Sh.
*SG
oJ'6
oJG
Consistence
Ml
^.v
/w(
Boundary
6^6^
Roots
1/1^TT
Soil Application Rate
GPD/Ft2
*EfW1
0.-?
o.~f
0<-~>
*Eff#2
/.<.
,.6
l.c-
Boring #D Boring
D Pit Ground surface elev._ft.Depth to limiting factor.in. / elev.
Horizon Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture Structure
Gr. Sz. Sh.
Consistence Boundary Roots
Soil Application Rate
GPD/Ftz
*Eff#1 •EffiK
Boring #D Boringa pit Ground surface etev._ft.Depth to limiting factor.In. / elev.ft.
Horizon Depth
In.
Dominant Color
Munsell Redox Description
Qu. Az. Cont. Color
Texture Structure
Gr. Sz. Sb.
Consistence Boundary Roots
Soil Application Rate
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 mg/L and TSS £ 30 mg/L
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PAGE 1 OF 4
In-Ground Gravity Plan
Index & Cover Sheet
D) »i! i SE
ili MAY 21 Z025 ^
Component Manual Design References: BaviifiM /nninn r^n?In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-202f)ltt'u '^' /-o""ly L'^'
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
Wagner Family Trust
Owner Name(s): Wagner Family Liv Trust _ Phone: 970 .333 -0424
Owner Address: 5510 MahoneyAve. Minnetonka, MN _ Zip: 55345
Project Address: 88850 Mariner Mile. Bayfield, Wl54814
GovtLot:_ 1/4 of 1/4, Section35 ,T^1 N-R04 E|_|orw[/
Township: Russell _ County: Bayfield
Project Parcel ID #: 38235
Designer Information
Designer Name: Jason Kuettel _ Phone: 715 .798 .3355
Designer Address: PO Box 66 Cable, Wl _ Zip: 54821
E-mail: tim@andryras.com
License Number: 675751
Remarks:
1 his SPLI^
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Signature: _'~ ' - .-/ "~ _ Date: 6 / '^/^5
Original signature required on each submitted copy.
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"SOIL EVALUATiON
SITE MAP
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on ?2 3ppr3.crili lir.s.
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Pipe iU3:sr;3!; A.3TM acsndsrd rablss 334 3C-3 -i 334.30-3;
33";t3,-/ 3-!',-'3- -4~ ^t\l HU <?''/<t
F:r:3?,'3in:_/^Q ./.
IMPORTANT:
Show ground eis'/aaon contours at suitasie intsr/als.
Loy^&e; P'&.T^ ^-^r^L-i^ ^j.-^6^ei<— '
I :..'_!.' ; ; ! , ' : ;i-A-T^VsQ '• T2?b - fr^^.^'&^-j/i^i'-iT: _j__
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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:
Suoerior Precast
1250 gal
Orenco
Septic Tank(s) Volume(s):
gal ^____ gal
Effluent Filter Manufacturer:
gal
Effluent Filter Model #: FT-0822
12"
min. trench
depth(typical)
ts'E=" . .M- • • .-" •• .' '".4 •».
3;t" — —^—) ., •• •• •(typical)
TYPICAL TRENCHCROSS SECTION VIEW
(No Scale)
Quick4 Standard-W
w/ End Cap
(typical)
System Elevation = S^--'J ft
(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)
A =3.0 ft
(typical)
(typical)
INSTALL PER TRENCH:
22
+ 1
Quick4 Std-W @ 20 ff EISA/chamber = 440
Pairs of end caps @ 6 ft2 EISA/pair = ^.
ft2
ft2
-Quick4 Standard-W Chamber(typical)
(mfd by Infiltrator Systems, Inc.)
Install pursuant to manufacturer's instructions.
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= Proposed E ISA per trench = 446 ft2 Required Infiltration Area = 857 ^Distribution Method:
x ^_ trenches = Proposed Total EISA = 892 ^ branched manifold
ipj g=ygq^qF^In-ground Gravity Management Plan |r| u " f|jjijlj i-IAy / 'i /[jZb lujIMPORTANT:
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 = 60° gpd; BOD5^220 mgL-1; TSS $ 150 mgL-1; FOGS 30 mgL-1
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (/'.e. odors, user complaints, etc.)
o mechanical malfunction (/.e., pumps, valves, switches, floats, etc.)
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, etc.)
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 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 _ phone: 715-798-3355
Local government unit: Bayfleld Co. 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.
Continaency 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.
S^PTIC T.^iK CP.OSS SZCTION ^FD SPECIFICATTi1 HITTFR
4" SC^OPVC^ INSP. p^rps 6^ " ^I^, A30VZ G^DI, (/op^ U i! MAY 7. \ •^
CljJheo ^nle/t- ^c-i,\V\Ci\& ^ ^ou.n'&d '^
Sayfieid &. Zonina DSDI ADPROV ED"'"'"'" •—":iy-?^ HA^/HOLE"
W/ La-klc^
• W^'WS- ^Q^_
-^" HIM.
APPROVED
PIPE 3'
ONTO SOLID
SOIL
-APPRp^LED. &ft-F"EfcE
Off FILTER,
MFG. OH^C'O
model if -jPTOl_2,~2--_
3" APPROVED B£DDIH£ Uh1>£P TAh'K
SPECIFICATIONS
SEPTiC
T^IK M ANU FACTURE?,: S ^ ^0po(^'?/t-^0<9rr-
T.-N?^ SIZES.' SS?TIC /"2-5'Ci GAL.
OUTLET
NOTES:
$5-^0
Private S@wag® System 6»8aint®nanc® Agreement
Ownor(s)Name (^^fitd^t9- F'9^7L~i TA^'^J_fe^7^A ^4^W^ ^ " T^-^
Owne^Maiiing Address ^^5%> ^-^^SL^ ^t .^^^/7a«/^L.^/^5~3'<?>Tf
Site Address ^
X^-s-Tax ID #~
As owner, I (we) do hereby certify the private sewage system wilt be installed in
accordance with the certified soil tester's report and approved prans and specrRcations
on file with Bayfield Couniy Piannsng and Zoning Department. The system will be
operated in such a manner as to meet the designed plans. ) (we) agree to maintain said
private system at the below listed location in accordance with rules established in the W!
Adm. Code, as from time to time amended. (cOIWIPLerie Legal is required)
J/4of.-1/4
Additional Legal Description:
Town of j^^SJi/
Lot _ Block, Subdh/ision
Lot.
-Z^'Township _4"/_N. Range 0^ W.
^y^^O /^4^/A UK ^/^
DOCUMENT NUMBER2025R-60756 1
DANIEL J. HEF-FNER
REGISTER OF DEEDS
BAYF1ELD COUNTY, Wl
RECORDED
05/21,2025 AT 1 2:47 PM
RECORDING FEE: $30.00
PAGES: 1
I
/.6/^~Go^ Lot
Recording Area
Return To:
. CSM # (2^?<7Vol. f^. Page c%7^ CSM Doe #^?&-?d /^ S9/TSS'
iinfhg'Def^rt^frit
MAY 2 2 2025 1^
r^
Bayfield Co, Zoning Dept.
I'fcS in-ground gravity
a Mound
D fn-ground dosed D in-ground pressure disiribution Sewage System;
a At-grads Sewage System D Other
>tic Tank (system types A through E): The septic tank shall be pumped by a certified septage ser/icing operator within three (3) years of the date of
installation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make
such inspection, the tank is found to have less than one-ihird (1/3) of the volume occupied by sludge and scum.
Pumo Chamber (system types B, C, D, and B): The pump chamber shall also bs rinscd and pumped out when the septic tank se serviced as provided
above. The switches and pump controls shall also be inspected and maintained to ensure operabiltty of said components,
Septic Tank Effluent Fiiier (system types A {hrcugh E): The septte ta^;< efflusr.S fiiter shall bs inspected and maintained as necsssa.'y and in accordance
wth manufacturer's specifications. Filter maintenance reports shall be submMed to the County as required by SPS 383.55, Wis. Admin. Code.
Private Sewade System Dispetsal Cell (system types A through E): The private sewage system distribution cell shaU be visualiy inspected by a certified
septags servicing operator, POWTS inspector, or licensed master piumber within three (3) years ot the date of installatior. an<! at least ones every thras
(3) years thereafter to determine whether wastewater or effiuent from the system is poncfing on the ground surface.
Mouods.Atotade^atKLtn_^roynclPtes$Mre..Sy_sternLaterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when
;he wastswater distribution ceil componenS is inspsctad as proviGcd above.
Ownerfs) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfie'd County forinspection, pumping, hauling, or othwwise 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. aayfieM County shall notify the owner of any costs which shall be pak! tsy the owner within thirty (30) cfays
from the date of notice. In the went the owner does no? pay the costs with'n 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 tarms and conditions of the agreement shall be tmding upon and inure to the benefit of aU current and future owners of such property.
Owneris) Name(s) - Prsne
^/^ ^J^-^^^-
Sfgfiaturs(s$
CTi^svt'?^
Notarized Owner(s) - Sfgfiaturs(s$
Subscribed and sworn to before me on this date:
^/^^
Notary P]
1y Commission ESpffgs:
6/-S/-^<^<&
Orafted by: T|/"\ Cl--yl-<~- Date: 5^1^ /tS>
Proofed by;
MARKA BAL^TEJ?.L......SL-_-,-N07ARY"PUBUC^Imi^tarytp*i<:<ntS^To?Q
' My Commission Expires Jan. 31,2028
Revised July 2Q2Q
BAYFIELD COUNTS SANITARY PERMIT (#04Y25-37S
STATE SANITARY PERMIT
OWNER: WAGNER FAMILY LIV TRUST
GOVT LOT: LOT: 2 BLK:
CSM: 2127
1/4 1/4 SEC: 35, T 51 N, R04W
TOWNSHIP: Russell
SOIL TEST: 172-23
NEW SYSTEM
SYSTEM JVPE Non-Pressurized In-Ground
PLUMBER: JASON KUETTEL
TRACY POOLER
Authorized Issuing Officer
DATE: 6/3/2025
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: # MP 675751
Condition: Properly Maintain System Per Recorded Agreement
THIS PERMIT EXPIRES 6/3/2027
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION