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HomeMy WebLinkAbout25-40SSS -00 5 S 2^ ,^s:v'^,,./^>" ~"'''<^. . \rs .^^^T^fi?-'''~r!vwKrtf:'' ^wF.ZA.1^ Industry Services Division 4822 Madison Yards Way Madison. WI 53705 P.O. Box 7302 Madison, WI 53707 County Bayfield un r-3Sanitary Pemi^ ^unfc (to b^fil(<:d ^ b^So.J '^''. ^-^S| ^ 9ti/fi7S !^ 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(l)(m), Stats. State Transaction Number ^-iy1!eld';u. i'ywv Project Address (if different than mailing address) 2990 South Shore Rd. Barnes, Wl I. Application Information - Please Print All Information Property Owner's Name Laurel Holm Parcel# 2234 Property Owner's Mailing Address N3409 830th St. Property Location Govt.Lot. City, State Hager City, Wl Zip Code 54014 II. Type of Building (check all that apply) 11 or 2 Family Dwelling - Number ofBedrooi 'ublic/Commercial - Describe Use IState Owned - Describe Use . Phone Number 218-424-5123 NE ,/,SE _^ section 20_ Lot #.44 _N R 09 _EorW Subdivision Name Block # |City of. CSM Number Qvillage of r7lTownofBarnes 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.^ p^Tew System [Replacement System )ther Modification to Existing System (explain)[Additional Pretreatment Unit (explain) B.[aiding Tank IIn-Ground (conventional) I[At-Grade DMound Individual Site Design [Other Type (explain) c.Renewal Before Expiration Revision 'hange of Plumber ransfer to New Ownerl ,ist Previous Permit Number and Date Issued NA IV. Dispersal/Treatment Area and Tank Information: Design Flow (gpd)300 Design Soil Application Rate(gpd/sf) 0.7 Dispersal Area Required (sf) 428 Dispersal Area Proposed (sf) 452 System Elevation 194.0 Tank Information Capacity in Gallons New Tanks Existing Tanks Total Gallons # of Units Manufacturer Septic or Holding Tank 750 750 Superior Precast Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibijjty for installation of the POWTS shown on the attached plans, Plumber's Name (Print) Jason Kuettel Plumber's Si:MP/MPRS Number 675751 Business Phone Number 715-798-3355 Plumber's Address (Street, City, State, Zip Code) PO Box 66 Cable, Wl 54821 V^ County/Department Use Only Approved d Disapproved D Owner Given Reason for Denial Permit Fee $ tio0 ' Date Issued .^}-<c^>/A5 Issuing Agegt^ignaj ^^- //;??7/3 j^.^ Conditions ofApproval/Reasons for Disapproval ^r^ftcT ^y^f^i^ ^^^ Vs ^^^ a^.^ Sej^ ^fcfo<^JL (La^r&l. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 02/22) W-OO'L^ ~\°F Soil Evaluation Report in accordance with SPS 385 , Wis.Ac ^'^ Attach complete site plan on paper not less than 8% X 11 inches in size. -"Page: inH 'ii@fc-^^'?^/ wlsliconsin Department of Safety and Professional Servises [ill NAY 2 Szu. 1 of 6 Plan must include but not limited to: Vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, 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)). Property Owner: Laura Holm Property Owners Mailing Address: N3409 830th St City Hager City |s7 New Seneral System r Replacement Parent Material: I acement Vlaterial: ;omment levation: StateWl Zip Code [Phone Number:54014 | 0 Number of Bedrooms:Residential .—..--. - —.—...-. |— Public or Commercial - Describe: Outwash ii Recommendations: 94.5 Load Rate: 2 Flood Plair 07 ^unty^" wynein (.:o Zonmq Dep Bavfield :>arcel I.D. 2234 i\^s6J^i:H^w% ^A^~ 3roperty Location NE1/4SE1/4,S20,T44N,R09W Site Address or CSM and Lot # 2990 South Shore Road Town Barnes Nearest Road: South Shore Road Flood Applicable: Eleyat Code derivedderived design flow rate: Plain if applicable 0 wp,.Ran,qe; 90_2 Ground surface Elev: Depth to Limiting Factor:Boring #1 r Bor. ^ n "' uu"u '"•gg'e "7^ ^ 2o^pl" lEilelv"IUIIa r°'86.u6 ft Horizon 1 2 3 4 5 6 7 Depth in 0-10 10-24 24-120 Domm.Colo Munsell 7.5YR2.5/1 7.5YR4/4 7.5YR4/6 Redox Description Qu. Sz. Cont. Coloi N/A N/A N/A Texture SL LS MS Structure Gr.Sz.Sh. 2MSBK OSG OSG ;onsistence MFR ML ML Boundary cs cs N/A Roots 3CO 3M 1F r Bor.ff Rt Ground surface Elev: Depth to Limiting Factor: 97.18 Ft. 120 in. Elev. 87.18 ft Horizon 1 2 3 4 5 6 7 Depth in 0-4 4-28 28-120 Domm.Coloi Munsell 7.5YR2.5/1 7.5YR4/4 7.5YR4/6 Redox Description 3u. Sz. Cont. Color N/A N/A N/A Texture SL LS MS •Effluent #1 = SOD 5>30< 220 mg/l and TSS>30-<^50mg// ;ST Name (Please Print) Mark S. Thompson] Address: 12006 N US Hwy 63 Hayward, Wl 54843| Structure Gr.Sz.Sh. 2MSBK OSG OSG insistence MFR ML ML Boundary cs cs N/A Roots 300 3M 1F 300 To 94.6 Soil Application Rate: GPD/ft2 *Eff#1 0.6 0.7 0.7 Ef(S2 1.0 L6 L6 Soil Application Rate: GPD/ft2 *EfW1 M OJ. OZ Eff#2 1.0 1^ L6 ^tffhi^nt #2 = BOD 5 < 30 mg/1 and TSS 5 30 mg/1^/L4^^)ate^al u'ation" Conducted: Tuesday'May 13,2025 ^ =ST Number: g^gg Felephone Number 715/699-4081 SBD-8330 (R04/21) Property Owner:Laura Holm Parcel I. D.2234 Page: | Hi 2^fl'J -025 Boring # 3 Horizonl 1 2 3 4 5 6 7 Depth ii 0-6 6-24 24-12C Boring # 4 Horizonl 1 2 3 4 5 6 7 Depth ir Boring # 5 -lorizonl 1 2 3 4 5 6 7 3epth ir Boring # 6 Horizonl 1 2 3 4 5 6 7 )epth in p Ground surface Elev: Depth to Limiting Factor: 97.2 Ft. 97.2 in. Elev. 87.2 ft Domm.Colorl Munsell 7.5YR2.5/1 7.5YR4/4 7.5YR4/6 Redox Descriptior Qu. Sz. Cont. Cole N/A N/A N/A Textur SL LS MS Ground surface Elev:- Bor 1^ Pit t 0 Ft. 3omm.Color| Munsell Redox Descriptior Qu. Sz. Cont. Colo Fextun Ground surface Elev:Bar 1^ Pit 0 Ft. Domm.Colorl Munsell Redox Description 3u. Sz. Cont. Colo Fexturs Ground surface Elev:Bar |V Pit 0 Ft. )omm.Color| Munsell Redox Description 3u. Sz. Cont. Coloi 'exture Structure Gr.Sz.Sh. 2MSBK OSG OSG Consisteno MFR ML ML Boundar cs cs N/A Roots sco 3M 1F Depth to Limiting Factor: 0 In. Structure Gr.Sz.Sh.Sonsistena Boundan Roots Depth to Limiting Factor: 0 In. Structure Gr.Sz.Sh.Sonsistence Boundary Roots Depth to Limiting Factor: 0 In. Structure Gr.Sz.Sh.insistence Boundary Roots Soil, ^pg,, Rate GPD/ft2 *Ef?1 M oz 0.7 Eff#2 LO L6 1.6 Boil App. Rate GPD/ft2 *Eff#1 Eff#2 3oil App. Rate GPD/ft2 *Eff#1 =ff#2 Soil App. Rate GPD/ft2 *Eff#1 Eff#2 affluent #1 = BOD 5>30<. 220 mg/l and TSS>30 <. 150mg/l "affluent #2 = BOO 5 < 30 mg/1 and TSS ^ 30 mg/1 The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777 SBD-8330(R.07/00) !ni i? 'f? i? fl 1^irt Owner: System Elevation: Laura 94.5 Soil Profile Holm Load Rate: Sheet I Soil 0. Tester: 7 I System Elevation: Page: ^Vlark S. 90.2 3 of 6 Thompsortr " ' 1! To 94.6 HAY z b zo^ 101 100 99 98 97 96 95 94 93 92 91 90 89 88 87 86 85 84 83 82 81 80 79 B3 97.2 ='95.2 $ 0^ 90.2 87.2 L.F. 101 100 99 98 97 96 95 94 93 92 91 90 89 88 87 86 85 84 83 82 81 80 79 B2 Owner Information: Name: I Location: |Township: [County: I Lot #: Laura Holm NE1/4SE1/4.S20.T44N.R09W Barnes Bavfielc 2990 South Shore Road No Well BM=100: Nail w/ribbon on the base of tree near B3 B1 = B2= B3= Lake= 96.6 97.18 97.2 0 Proposed 2 bed house 2990 South Shore Road > <QcwQ-. (D?0MQ. CST: Mark SJftt&mps^rf^x ^^^f98 ' " Only in Tested Area 715/699-4081 co£U'§? CB> Q. ?'">»0 ii v0 CQQtK-0 3:&> r\_- ec ^* .;/ .^=r t'ruT] <S=3) iKFO C5§ [nn] 20'60'100' PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet H;n\ ^ t, l|il MAY 26ZQ2" Component Manual Design References: In-Ground Soil Absorption for POWTS Version 2.1 (May 2022-aQ^T'); c ^un«!5 i-'&n' Pg 1 of 4 Pg2of4 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 Holm 2 Bed Owner Name(s): Laurel Holm phone: 218 .424 .5123 Owner Address: N3409 830th St. Hager City, Wl Zip:. 54014 Project Address: 2990 South Shore Rd. Barnes, Wl 54873 Govt. Lot: _ NE 1/4 of Nw 1/4, Section^0, T 44 N-R09 E \_\ or W [/] Township: Barnes _ County: Bayfield Project Parcel ID #: 2234 Designer Information Designer Name: Jason Kuettel _ Phone: 715 .798 -3355 Designer Address: PO Box 66 Cable, Wl _ Zip: 54821 E-mail: tim@andryras.com •'L'n^i! ^>iniL" License Number: 675751 Remarks: Signature:.^L^. Original sign^ftrsf required on each submitted copy. Date: $A 8/2^ Owner Information: I Name: I Location: [Township: I County: I Lot#: Laura Holm NE1/4SE1/4.S20,T44N,R09W Barnes Bavfield 2990 South Shore Road No Well BM=100: Nail w/ribbon on the base of tree near B3 Cz) €. ^' <?^c»- M ^y-AJ^Qe«.^ ^ <^^?(^-fi<:^~ <<-s-<sJ r~ Proposed 2 bed house Driveway ~7^0 1^y o.ze^co <^^ 2990 South Shore Road B1 = 96.6 B2= 97.18 B3= c\J-nrA^ &- ~^^L ° > (Qcwf-t-3(D ~n§ Only in Tested Area $•"' ^><s^) ^/^/^- 0 i>i0 (00,CD13 -^.~^3- -^< i^o •co r~~oCDI'OU-l CnJ=i! [Tim IN-GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard-W Chambers 3-ft Trench (down-sizing credit) 1;L"^! !f-n=Q .'£-=) iZJT-li^ ;\J <1 Q-S300-; 0*0 <t> '^^wiM SOIL COVER Septic Tank(s) Manufacturer: Suoerior Precast 750 gal Orenco Septic Tank(s) Volume(s): gal _ gal Effluent Filter Manufacturer: gal Effluent Filter Model #:FT-0822 12" min. trench depth (typical) 34 °.^ :< i4"-<—V—J ... •• •• '(typical) TYPICAL TRENCHCROSS SECTION VIEW (No Scale) Quick4 Standard-W w/ End Cap (typical) System Elevation = 94-° ft (typical) (Show location of inlet / outlet pipe connection on plan view.) Provide minimum 3 ft separation between trenches. wnms INSTALL PER TRENCH: _^-_____ B= i6_ ft (typical) --^- Observation Pipe(typical) Install per manufacturer's instructions. TYPICAL TRENCH PLAN VIEW (No Scale) 11 Quick4 Std-W @ 20 ff EISA/chamber = 220 Pairs of end caps @ 6 ft2 EISA/pair = ^. ft2 ft2 A =3.0 ft (typical) -Quick4 Standard-W Chamber(typical) (mfd by Inflltrator Systems, Inc.) Install pursuant to manufacturer's instructions. :u>CDmGO 0 = Proposed EISA per trench = 226 ft2 Required Infiltration Area = 428 trenches = Proposed Total EISA = 452 ft2 ft2 Distribution Method: branched manifold MM4^ irr^p^In-ground Gravity Management Plar^',ini MAY '/y^;^" ^"IMPORTANT: The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wise. Admin. Code. Pursuant to SPS 383.52 (2), Wise. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wise. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 30° gpd: BODs^ 220 mgL-1; TSS ^ 150 mgL-1; FOG ^ 30 mgL-1 Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (/".e. odors, user complaints, 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, ete.) o electrical components - if applicable (/.e., wiring, connections, switches, controls, timers, alarms, eto.) 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 tankfs) 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: Bayfield CD. Zoning _ phone: 715-373-6138 Local government unit address: 117 E 5th St. Washbum, Wl _ ZIP: 54891 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wise. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wise. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wise. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wise. Admin. Code. 5 ~L?T 1C TAJ-IK CROSS SECTION ANT' S?ZCIriCATIONS 4" Scri^oPrciNSP. p;:?s 6^ "^i?^ A30VZ GRADZ.CopT) 1 I G IE H Cbjha^ i,nle-+ r^c-v^o\& t^ ou.n'&d.y - ----^p-'-./ !u<'Cujhe^p. i.nle/t- r^c-t.\V\o\& t^' ou-ri'e-d.^ FINISHSD GP^ADZ T^ APPROVED PIPE 3' ONTO SOLID SO [L MAY ^H^n^ ^ APPROVED' u ''-"•' '" M^/HOLE ^qyiijajd (^ ^O^ij-ji, ijapi W/ LcCk.4- • WW/,^ ^fiQ^_ -4" HIM. -APPROVED. &A-F%:E Of( FILTER. NFG. OKnco model S -pTOSZ"^ 3" APPROVED BEDDING UKliSP, TAfl'K SPBCIFICATIONS SEPTAC- TANK HA-WFACTURE?.: <^/'e'<-jt<<- ptZ-c^^T- TAW SIZE:SJ SSPTIC ^5'^ GAL. _ OUTLET NOTES: 55-?t Private Sewage System Maintenance Agreement Owner(s) Name ^\U-i2-fc^_ h^^/^. Owner(s) Mailing Address ^?40°t 83or<"ST. HrtGi^ CIT^^ST 5-yo)t/ Site Address ^.^lo ^c^n-<- ^hte.ze |2-^>. (2>.^a^e3, i^^~ Tax ID #2-ZJL/ As owner, I (we) do hereby certify the private sewage system will be installed in accordance with the certified soil tester's report and approved plans and specifications on file with Bayfield County Planning and Zoning Department. The system will be operated in such a manner as to meet the designed plans. I (we) agree to maintain said private system at the below listed location in accordance with rules established in the Wl Adm. Code, as from time to time amended. (COMPLETE Legal is required) 1^€ 1/4 of '$>£ 1/4 Section "2_c-' Township '-/'-/ N. Range Oc? W. Additional Legal Description: ^^i: i'^ I "I ^t*^t. Town of /?/=sh«^CS (Acreage)Gov't Lot Lot Block Subdivision Lot CSM # / 3 o Vol. ^- Page i ~7 '2- CSM Doc # "Jo'-l I Z-0 OOCUMENT NUMBER2025R-607641 DANIEL J. HEF-F-NER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 05/28^2025 AT 2:59 PM RECORDING FEE: $30.00 PAGES: 1 Recording Area Return To: Planning andL Zoning Degar^^iR 0 MAY 9 y ?n?h iy: [3 In-ground gravity D Mound In-ground dosed Q In-ground pressure distribuficj 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 manufacturer's specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code. Private Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified septage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three (3) years thereafter to determine whether wastewater or effluent from the system is ponding on the ground surface. Mounds. At-arade, and In-around Pressure System Laterals (system types C, D and E): The laterals shall be flushed out and swabbed if needed when the wastewater distribution cell component is inspected as provided above. Owner(s) agree that failure to comply with this agreement will result in action being taken to pay all charges and costs incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any human health hazard caused by the system. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. The terms and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such property. Owner(s) Name(s) - Please Print ^Au'Z-tt- /-(-Z5CA- Subscribed and sworn to before me on this date: fv^u-), Ma^jj l^vi, 2^-7-5 \\\\"r '"^^Notarized Owner(s) - Signature(s) My Commission ExpFI'gs:C^ /-ZLP toZ^ "I"'///, Drafted by: ~T7^w^^--^^^0^?u/forms/sanitary/septicmaintenci Revised July 2020 BAYFIELD COUNTS SANITARY PERMIT (#04)-25^0S STATE SANITARY PERMIT OWNER: LAUREL HOLM GOVTLOT: LOT: BLK: NE1/4 SE1/4 SEC: 20, T 44 N, R 9 W TOWNSHIP: Barnes SOIL TEST: 40-25 NEW SYSTEM SYSTEM T/PE: 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. Protect system from vehicular activity. THIS PERMIT EXPIRES 6/3/2027 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION