HomeMy WebLinkAbout25-40S** INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY **
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December 18, 2025 at 8;18:12 AM CST 7157983470 36 1 Received
DEC/18/2025/TNU 07:49 AM Andry Rasmussen & So FAX No. 7157983470 P. 001/001
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 11 Discrepancy fl Other
Phone Number..
Plumber;
/ r
Fax Number ;
Home Owner:
Sanitary
_lap
Permit #:
Plumber's Choice
Zoning Dept
No inspection during these times
9:30 am —12:30 pm Tues. (Tracy)
Date:
12:00 pm -2:00 pm Wed. (Todd)
I (
- I
9:30 am —12:30 pm ThursE (Tracy)
Time:
Plumber's Choice
Zoning Dept
Immediate Phone Number so Zoning
I
'
Z /
Dept can call you right back (if needed)
Township:
J fl C_ S
Address # &
Road Name;
9 S dTw �/vc � _
��
or
Directions
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!
** Plumber must verify any change(s) by fax or no inspection will be scheduled **
ufforms/sanitary/requestforinspectlon
Zoning Dept (@4/12104) ® August 2021
0#.
LAUREL HOLM
N3409 830TH ST
HAGER CITY WI 54014
Infnrreatinn
Private Ons.ite Wastewater Treatment
Systems ( POWTS). Inspection Report
(Attach to Permit)
BM Eev:
setback to:
County pp eRetL
Sanitary ermlt No:
State Plan Transaction ID#:
Parcel Tax No:
TYPE
I MANUFACTURER
CAPACITY
i Prop. Line
I Well
Building
Air Intake Road
Se tic
3(}
N/A
Dosing
N/A
Aeration
N/A
Holdin
Pump / Siphon Information
'ump Manufacturer ump
liter Manufacturer Filter N
TDH I Lift Friction Loss
Head I Total
Forcemain I Length I Dia I Dist To Well
Tyge,o of � Manufacturer:
U Model Number:
Pretreatment Unit
Manufacturer.
Model Number:
stribution System
Header / Manifold I Distribution
Dia
Dia
GPM
Elevation Data
X Pressure
X Hole Size
❑ Yes ❑ No I
Depth Over I Depth Over I Depth of I Seeded
ed d / Sodded
0 Yes ❑ No de IMulched
Cell Center Cell Edges Topsoil
COMMENTS: (Include code discrepancies, persons present, etc.)
Ian revotheron side for additional information.
Date
3 Rn_R71n tR nYt911
POWTS Inspector's Signature
License Number
Property Owner
BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT
Telephone: (715) 373-6138
Fax: (715) 373-0114
e-mail: zoninp(Wbavfieldcountv.wi.gov
Web Site: www.bayfieldcounty.wi.gov/147
LAUREL HOLM
N3409 830TH ST
HAGER CITY WI 54014
Information
Bayfield County Courthouse
Post Office Box 58
117 East Fifth Street
Washburn, WI 54891
As you know T Q'9'G 0i) Cl ; C'2/1 C 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:
C• Tank was crushed I removed and pipes disconnected by:
FSie\i4�1�i41
On / at 175 (91W'/ PM) the above -mentioned plumber contacted our office to
conduct apre-cover inspecti n as required under DSPS 383. One of the following applies:
System was inspected and appears to meet all applicable code requirements.
❑ System was inspected and appears to meet all applicable code requirements; however, a plan revision
is necessary because the installation was substantially different than the original approval.
System could not be inspected because plumber covered prior to scheduled time of inspection.
❑ System could not be inspected because plumber was not ready at scheduled time of inspection.
County was unable to return to complete inspection.
❑ System could not be inspected because plumber was not ready at scheduled time of inspection.
A re -inspection and $50 fee are required.
❑ System could not be inspected because County could not respond to plumber's time constraints.
Comments:
Uttormslsanits rypropeeyowner-m pm
April 2019
S5 -OO55,
` rYrnnr.��F•4f,6 Industry Services Division County
l 4822 Madison Yards Way Baeld -�
�$' r•?� �� Madison, WI 53705 Sanitary Pe u r b 1 b o.
7f�a Madison, WI 53707 aS-�l a 511 ,.� A" 2fl?5
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 Bayfield Co. Zoning Dept.
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Services. Personal information you provide may be used for secondary 2990 South Shore Rd. Barnes, W1
purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats.
I. Application Information — Please Print All Information
Property Owner's Name Parcel #
Laurel Holm 2234
Property Owner's Mailing Address Property Location
N3409 830th St. Govt. Lot
City, State Zip Code Phone Number
Hager City, WI 54014 218-424-5123 NE !. sE ''A, section 20
H. Type of Bull ling (check all that apply) Lot # T 44 N R 09 E or W
IZI1 or 2 Family Dwelling — Number ofBedroo Subdivision Name
Block #
�Public/Commercial — Describe Use
❑City of
State Owned — Describe Use CSM Number Village of
IZiTown of Barnes
III:.Typeof,Vow S Peirmit (C- h&k t ith'er "New" or "Replacement" and other appl>cpble on hn A. Check ope 1 ox -on luie.:B Complete line C<i
a likable.
A.ew System IlIReplacement System ❑Other Modification to Existing System (explain) IJAdditional Pretreatment Unit (explain)
B. ❑Holding Tank ❑✓ In -Ground ❑At -Grade Mound Individual Site Design Other Type (explain)
(conventional)
C. ❑ Renewal Before ❑ Revision Change of Plumber �l'ransfer to New Owner List N n Previous Permit Number and Date Issued
Expiration A
IVDsperaJrcattiie.ntArea:aind Tank- Information:
Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) I System Elevation
300 0.7 428 452 J.0
Capacity in Total # of Manufacturer d ,
Tank Information Gallons Gallons Units w ;
o y
New Tanks Existing Tanks w
A4U rn n w0 p.
Septic or Holding Tank 750 750 1 Superior Precast ✓
Dosing Chamber E]
V Respons brltty Statement- I, the undersigned, assume responsibr for installation of the 'OW fS hoH!tt oxr tht attac ed ins.
Plumber's Name (Print) Plumber's SMP/MPRS Number Business Phone Number
Jason Kuettel 675751 715-798-3355
Plumber's Address (Street, City, State, Zip Code)
PO Box 66 Cable, WI 54821
V .. County/Department Use Only
iiii Approved O Disapproved TPermit Fee Date Issued Issuin Age igna
O Owner Given Reason for Denial
`/00 ^ �� a5 >, /Y.2.57/3 iAc
Conditions of Approval/Reasons for Disapproval
rd -7 c,zVe
&\QJ
Attach to complete plans for the system and submit to the County only on paper not less than S 112 x 11 inches in size
SBD-6398 (R. 02/22)
PAGE 1 OF 4
In -Ground Gravity Plan
Index & Cover Sheet MAY 282025
Component Manual Design References:
In -Ground Soil Absorption for POWTS Version 2.1 (May 202gd3Q�Z)Co. Zoning Dept.
Pg1of4
Pg2of4
Pg3of4
Pg4of4
Index & Cover Sheet
Plot Plan
Dispersal Area Cross -Section & Plan View
Management Plan
Attachments: Enclosures:
POWTS Application for Review
I Soil Evaluation Report & Site Map
Project Name / Description
Holm 2 Bed
Owner Name(s): Laurel Holm
Owner Address: N3409 830th St. Hager City, WI
Phone: 218 -424 - 5123
Project Address: 2990 South Shore Rd. Barnes, WI 54873
Govt. Lot: iv c
Township: Barnes
Project Parcel ID #: 2234
1/4 of NW
Zip: 54014
1/4, Section 20 , T 44 N -R 09 E ❑ or W 0✓
County: Bayfield
Designer Information
Designer Name: Jason Kuettel
Designer Address: PO Box 66 Cable, WI
E-mail: tim@andryras.com
License Number: 675751
Remarks:
Phone: 715 .798 - 3355
Zip: 54821
This space reserved for approval stamp.
Signature: Date: U
Original sign r required on each submitted copy.
Owner Information:
Name:
Laura Holm
Location:
NE1/4SE114.S20T44NR09W
Township:
Barnes
County:
Bavfield
Lot#:
2990 South Shore Road
Privy
Shed" E
ShAtI
BM=100: Nail w/ribbon on the base of tree near 63
No Well 4"}rtt B�fJ/ J
�(n eat—�—�` S•
South Shore
(z)@ y1o' AC -t(
r01
C
Co
C
K
CD
O
0
m
n
B1 = 96.6
B2 = 97_18
B3 = 97.2
,:ST-cA e. -T-1
N
W•
G
S
1"=50Only in Tested Area �o5751
0
IN -GROUND GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard -W Chambers
3 -ft Trench (down -sizing credit)
I� •r
a
ti
� o
.A
NIriIII
n =� N
SOIL COVER
Q
'MHtjiIth
o
ML
N
°�
m
min. 12"
(typical)
Septic Tank(s) Manufacturer.
Superior Precast
Septic Tank(s) Volume(s):
750 gal gal gal gal
Effluent Filter Manufacturer.
Orenco
Effluent Filter Model a: FT -0822
12'
min. trench
IL depth
(typical) • ' TYPICAL TRENCH
CROSS SECTION VIEW
34 •'
(typical) •:, ': • • (No Scale)
System Elevation = 94.0 ft
(typical)
Quick4 Standard -W
w/ End Cap (Show location of inlet / outlet pipe connection on plan view.)
ypical)
I--t--------It----
II— — — — — — — — — — — -- — — — — — — —
g = 46 ft
(typical)
INSTALL PER TRENCH:
11 Quick4 Std -W @ 20 ff EISA/chamber = 220 ft2
+ 1 Pairs of end caps @6 ft2 EISA/pair= 6 ft°
= Proposed EISA per trench = 226 ft'
Provide minimum 3 ft
separation between trenches.
Observation Pipe
(typical)
Install per manufacturers
/ Instructions.
TYPICAL TRENCH
PLAN VIEW
(No Scale)
IA=3.0ft
(typical)
`Quick4 Standard -W Chamber
(typical)
(mid by Infiltrator Systems, Inc.)
Install pursuant to manufacturers instructions -
Required Infiltration Area = 428 ftZ
x 2 trenches = Proposed Total EISA = 452
I. RESET
ft2
Distribution Method:
branched manifold
0
(7
m
G)
0
11
a
55-00552
°:�
Industry Services Division
County
tED11
4822 Madison Yards Way
Madison, W1 53705
Bayfield
'o.
P.O. Box 7302
Sanitary Pem lun r b it d bl
$ ,�
Madison, WI 53707
ZS_'lD 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
Bayfield Co. Zoning Dept
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to
Project Address (if different than mailing address)
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
2990 South Shore Rd. Barnes, WI
purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats.
I. Application Information —Please Print All Information
Property Owner's Name
Parcel #
Laurel Holm
2234
Property Owner's Mailing Address
Property Location
N3409 830th St.
Govt. Lot
City, State I Zip Code Phone Number
Hager City, WI 54014 218-424-5123
NE y,, SE 'A, Section 20
II. Type of Building (check all that apply) Lot#
T44 N R 09 EorW
❑� I or2 Family Dwelling— Number of Bedroo
Subdivision Name
Block #
Public/Commercial — Describe Use
❑City of
State Owned — Describe Use CSM Number
Village of
lilTown of Barnes
11I. 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 licable.
A.
New System
❑Replacement System
Other Modification to Existing System (explain)
❑Additional Pretreatment Unit (explain)
❑Holding Tank
ZIn-Ground
❑°.t -Grade
Mound
J Individual Site Design
Other Type (explain)
(conventional)
C.
[]Renewal Before
❑ Revision
Change of Plumber
❑Transfer to New Owner
List Previous Permit Number and Date Issued
Expiration
NA
IV.
Dispersalfrreatment Area and Tank Information:
Design Flow (gpd)
Design Soil Application Rate(gpd/sf)
I Dispersal Area Required (sf)
I Dispersal Area Proposed (st)
I System Elevation
300
0.7
428
1452
94.0
Capacity in
Total
# of
Manufacturer
Tank Information
Gallons
Gallons
Units
0 $
2
New Tanks I Existing Tanks
v o
v 2
L
0.0
in m
tin
iZ Q
Septic or Holding Tank
750
750
1
Superior Precast
Dosing Chamber
O
V. Responsibility Statement- I, the undersigned,
assume responsibiinstallation of the POWTS shown on the attached plans.
Plumber's Name (Print)
Plumber's Si
MP/MPRS Number
Business Phone Number
Jason Kuettel
675751
715-798-3355
Plumber's Address (Street, City, State, Zip Code)
PO Box 66 Cable, WI 54821
VI, County/Department Use Only
Approved
O Disapproved
Permit Fee
$ 400
Date Issued
L.
Issuin Age
igna
❑ Owner Given Reason for Denial
(ek asrb
/Y/ Z
Conditions of Approval/Reasons for Disapproval
t
'ttd 4- (/E4lete/ez' r2G urVq
so- Lid .
Attach to complete plans for the system and submit to the County only on paper not less than 8 I/2 x 11 inches in size
SBD-6398 (R. 02/22)
5R-OO2.51i
Soil Evaluation Report
? tl: �� In accordance with SPS 386 ,s.Ad
t\7 �•'$'r1 Wisconsin Department of Safety and ProfessionalServises O
Attach complete site clan on aaoer not less than 8'/ X 11 inches in size. Paae:
liii MAY 28�U23
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)).
County: tDdTIIO CO. LOnlng Dept
Bavffeld
Parcel I.D.
2234
i d
l
Date:
'm3
Property Owner:
Laura Holm
Property Location
NEI/4SEI/4,S20,T44N,R09W
Property Owners Mailing Address:
N3409 830th St
Site Address or CSM and Lot #
2990 South Shore Road
City
Hager City
lState
WI
I Zip Code
I 4014
Phone Number:
0
Town
Barnes
INearest Road:
South Shore Road
New Number of Bedrooms: 2
Residential Code derived design flow rate: 340
Flood Plain if applicable
j-- Replacement r Public or Commercial - Describe:
Parent Material: Outwash Flood Plain if Applicable: 0
General Comments & Recommendations:
System Elevation: 94.5 Load Rate: 0_7 Elevation Raror °0 2 To 94 6
Ground surface Elev: Depth to Limiting Factor:
Boring #1 Bor.' pit 96.6 Ft. 120 in. Elev. 86.6 ft
Soil Application Rate:
Horizon
Depth in.
Domm.Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr.Sz.Sh.
Consistence
Boundary
Roots
GPD/ft2
*Eff#1
Eff#2
1
0-10
7.5YR2.5/1
N/A
SL
2MSBK
MFR
CS
3CO
0.6
1.0
2
10-24
7.5YR4/4
N/A
LS
0SG
ML
CS
3M
0_7
1.6
3
24-120
7.5YR4/6
N/A
MS
0SG
ML
N/A
IF
0.7
9_6
4
5
6
7
Boring # 2 �"" Bor.jGround surface Elev: Depth to Limiting Factor:
v pit
97.18 Ft. 120 in. Elev. 87.18 ft
Soil Application Rate:
Horizon
Depth in.
Domm.Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr.Sz.Sh.
Consistence
Boundary
Roots
GPD/ft2
*Eff#1
Eff#2
1
0-4
7.5YR2.5/1
N/A
SL
2MSBK
MFR
CS
3CO
0.6
1.0
2
4-28
7.5YR4/4
N/A
LS
0SG
ML
CS
3M
0.7
1.6
3
28-120
7.5YR4/6
N/A
MS
0SG
ML
N/A
IF
007
1.6
4
5
6
7
*Effluent #1 = BOD 5>30 ≤ 2 20 mg/l and TSS> _ 50mg/l
tient #2= BOD 5< 30 mg/! and TSS
≤ 30 mgA
CST Name (Please Print)
Mark S. Thompson
igna
CST Number. 877598
Address: 12006 N US Hwy 63
Hayward, WI 54843
Date I ati Conduc d:
Tuesday, May 13, 2025
Telephone Number
715/699-4081
SBD-8330 (R04/21)
Property Owner:
Laura Holm Parcel I.D. 2234 Page: O di•• Gr t1 \fl E
1025
Boring # 3
Born% Pit Ground surface Elev: Depth to Limiting Factor:
97.2 Ft. 97.2 in. Elev. 87.2 ft
Horizon
Depth in.
Domm.Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr.Sz.Sh.
Consistence
Boundary
Roots
GPD/ft2
*Eff#1
Eff#2
1
0-6
7.5YR2.5/1
N/A
SL
2MSBK
MFR
CS
3CO
0.6
1.0
2
6-24
7.5YR4/4
N/A
LS
0SG
ML
CS
3M
0.7
1.6
3
24-120
7.5YR4/6
N/A
MS
0SG
ML
N/A
IF
0.7
1.6
4
5
6
7
Boring # 4
1 Bore' Pitt Ground surface Elev: Depth to Limiting Factor:
0 Ft. 0 In.
Soil App. Rate
Horizon
Depth in.
Domm.Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr.Sz.Sh.
Consistence
Boundary
Roots
GPD/ft2
*Eff#1
Eff#2
1
2
3
4
5
6
7
Boring # 5
Pit Ground surface Elev: Depth to Limiting Factor:
1 Bor � 0 Ft. 0 In.
Soil App. Rate
Horizon
Depth in.
Domm.Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr.Sz.Sh.
Consistence
Boundary
Roots
GPD/ft2
*Eff#1
Eff#2
1
2
3
4
5
6
7
Boring # 6
Ground surface Elev: Depth to Limiting Factor:
Bor W/ Pit
r" 0 Ft. 0 In.
Soil App. Rate
Horizon
Depth in.
Domm.Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr.Sz.Sh.
Consistence
Boundary
Roots
GPD/ft2
*Eff#1
Eff#2
1
2
3
4
5
6
7
*Effluent #1 = BOD 5>30 < 2 20 mg/l and TSS>30 < 150mg// *Effluent #2 = B0D 5< 30 mgll and TSS < 30 mg/!
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
Zoning Dept.
SBD-8330(R.07l00)
115) ll9Jfi
Soil Profile Sheet Page: 3 of,¢ _
Owner: Laura Holm ISoH Tester: Mark S. Thom so
System Elevation: 94.5 Load Rate: O7 System Elevation: 90.2 To 94.6
101 B3 101 B2 101 B1
100
--------
100 ---------------
100 ---------------
System'
99 -------
99 --------------
99----�-----
Elevation
98 ---
98 -----------
98
---
97 ------------
97.2
97 -----------
97.18
97
96.6
96
-
96 -----------
96
95 -----------
95.2
95
0_7
95 ------------
0_7
0.7
--------
---
94
94
- 0_7
94
0_7
93
93
w
93
92
92 -------
---
92 --
--
90
90.2
90
90.18
90 ------
---
89.6
89 -----------
89 ------------
89
88
-----------
88 -----------M
88 -_w---
T3'
87 ----------
87 -----------•
87.18
87---------------
L.F.
L.F.
86.6
86
--------
86 ---------------
86 _----------•
L.F.
85
--
85 ---------------
85 ---------------
84 ---------------
84 ---------------
84 ---------------
83 -------------
---
83
---
83
82 -------------
82 ---------------
82 ---------------
81 ---------------
81 ---------------
81 ---------------
80
------
80 ---------------
80 ------------
79 ----_____-----
79 ---------------
79 ---------------
Y 2*8 2025 LYJ
Co. Zoning Dept.
Owner Information
Name:
Laura Holm
Location:
NE1/4SE1/4.S20.T44N.R09W
Township:
Barnes
County:
Bayfleld
Lot #:
2990 South Shore Road
Only in Tested Area
20 60' 100'
BM=100: Nail w/ribbon on the base of tree near B3
B1=
96.6
B2 =
97_18
B3 =
97.2
Lake=
0
C
CO
C
N_
N
O
O
N
a
m
CST: Marc S orrr
715/699-4081
3Hub
PAGE 1 OF 4
In -Ground Gravity Plan B U I(i1
Index & Cover Sheet \ MAY 282025
Component Manual Design References:
In -Ground Soil Absorption for POWTS Version 2.1 (May 2024?�)Co. Zoning Dept.
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross -Section & Plan View
Pg 4 of 4 Management Plan
Attachments: Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Holm 2 Bed
Owner Name(s): Laurel Holm Phone: 218 -424 -5123
Owner Address: N3409 830th St. Hager City, WI Zip: 54014
Project Address: 2990 South Shore Rd. Barnes, WI 54873
Govt. Lot: NE 1/4 of NW 1/4, Section20 , T44 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, WI Zip: 54821
E-mail: tim@andryras.com
License Number: 675751
Remarks:
Signature: Date:
Original sign r required on each submitted copy.
Owner Information
Name:
Laura Holm
Location:
NE1/4SE1/4.S20.T44N.R09W
Township:
Barnes
County:
Ba ield
Lot #. 2990 South Shore Road
No Well
'A' BM=100: Nail w/ribbon on the base of tree near B3
Privy
Shed
Sh�
JB3
ti tt�
Sk
Driveway
(Z)@ *' Q.Act_-N
cc.S r'
'7s'O W% o z.er co ;=/
r,
C
C
CD
O
0
CD
a
B1 = 96.6
B2 = 97.18
B3= 97.2
\51M a -9N, C7
12990
m
South Shore Road
m
N
o
N IPt�
w•
E
n.
N
C
CO
N
S
TiF11
oS�5O1
1=50 Only in Tested Area
r
�-�
�✓
0 5'
IN -GROUND GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard -W Chambers
3 -ft Trench (down -sizing credit)
t
o
i
'ti
"2
1
cD
N
IV
o
SOIL COVER
m1n. 12"
(typical)
U
12"
v
min. trench
nnfl
depth
(typical)
, ••
I..�_ 34"
(typical)
..
System Elevation = 94.0
(typical)
Septic Tank(s) Manufacturer.
Superior Precast
Septic Tank(s) Volume(s):
750 gal gal gal gal
Effluent Filter Manufacturer:
Orenco
Effluent Filter Model #: FT -0822
TYPICAL TRENCH
CROSS SECTION VIEW
(No Scale)
ft
Quick4 Standard -W
w/ End Cap (Show location of inlet / outlet pipe connection on plan view.)
(typical)
r - -----------#---------f----
-------------�--------��---
B= 46 ft
(typical)
INSTALL PER TRENCH:
11 Quick4 Std -W @ 20 ff EISA/chamber = 220 ft2
+ 1 Pairs of end caps @6W EISA/pair = 6 ft'
= Proposed EISA per trench = 226 ft2
Provide minimum 3 ft
separation between trenches.
Observation Pipe
(typical)
Install per manufacturers
/ instructions.
TYPICAL TRENCH
PLAN VIEW
(No Scale)
TA = 3.0 ft
(typical)
"—Quick4 Standard -W Chamber
(typical)
(mfd by Infiltrator Systems, Inc.)
Install pursuant to manufacturer's instructions.
Required Infiltration Area = 428 ft2
Distribution Method:
x 2 trenches = Proposed Total EISA = 452 ft2 branched manifold
O
m
W
Q
m
In -ground Gravity Management PIanAE 6'Og1`E°U4
MAY 282015
IMPORTANT: R \E Irl
The owner of this in -ground gravity system shall be responsible for its perpetual operation and m2i�#LRf0'nce'pugrsuantttot
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 = 300 gpd; BOD5 S 220 mgL 1; TSS 5 150 mgL1; FOGS 30 mgL-1
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: Andry Rasmussen & Sons
Local government unit: Bayfield Co. Zoning Phone: 715-373-6138
Local government unit address: 117 E 5th St. Washburn, WI
Phone: 715-798-3355
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.
5TIC TANK C?OSS 5'1o'! 'D S?ECI:rC8rICN5
4" GCF1.4oP'IC INSP. oro_r 6 Mill. ABOVE GRAD: (opt) n [ C E � V Er' D
(When lnlei- rr&n cUt Ps louriza I�nui
MAY 28 Z0Z5 APPROVED
MANHOLE
F?Pf_SHED GRADE Bayfield Co. Zoning Dept. WI Lec,i- c}
W�fR�iivg LAB6L
4 R HIH.
18" .1N.
I
OUTLET
APPR _ D BA-FFiE—
O OR -�
AP PROVED IMFG. O{-eljcC)
PIPE 3' Ii
ONTO SOLID model n To922_
SOIL
3" APPROVED BEDDING UNDER, TMM1c
SPEZ,IFICATIONS
S EPTiC
TANK ,r, AHUFACTJRER: c f!9et .f" eet;4tr
TANK SIZE'S: S TIC 75o GA.L.
NOTES
m
N
55-oW�L
Private Sewage System Maintenance Agreement
LAu¶&L -HoL(-"-
T409 B3& ST. H,tC,&t cITY, wr 5-(o)d
LSo Sc ty $+felzc RL� (�RRrES, tj -
a, Rj
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 WI
Adm. Code, as from time to time amended. (COMPLETE Legal Is required)
Nr 1/4 of 'SE 1/4 Section Township '4'! N. Range C w
Additional Legal Description: r —
Town of /? A,QAeS (Acreage) Z /3 Gov't Lot
Lot Block Subdivision
Lot ICSM# /30 vol. L Page171 CSM Doc# 3o"1 Ito
DOCUMENT NUMBER
2025R-607641
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY. WI
RECORDED
05/28/2025 AT 2:59 PM
RECORDING FEE: $30.00
PAGES:1
Return To:
Planning
E
Area
®
In -ground gravity
❑ In -ground dosed
❑
In -ground pressure distributYdTi5La& i$gt@�,pept.
❑
Mound
❑ 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 -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 Bay#eld 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. Bayffeld 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
Subscribed and sworn to me on this date:
before
�,J, o
_ 2oz\pU
Notarized Owner(s) — SSiiignnaturre(s)
NotaryNotay c
, ```���
My Commission Expl s:
c 12c9 IaZ1 &
Drafted by: T,v. CL.4-ru` Dale: C^YV "o2S
Revised
BAYFIELD COUNTY
SANITARY PERMIT (#04)-25-40S
STATE SANITARY PERMIT
OWNER: LAUREL HOLM
G OV'T LOT: LOT: BLK:
K:
NE1/4 SE1/4 SEC:20,T44N,R9W
TOWNSHIP: Barnes
SOIL TEST: 40-25
NEW SYSTEM
SYSTEM TYPE: Non -Pressurized In -Ground
PLUMBER: JASON KUETTEL
TRACY POOLER DATE: 6/3/2025
Authorized Issuing Officer
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