HomeMy WebLinkAbout25-48SRequest for Sanitary Inspection (24 Hrs. in Advance)
Fax this form to Zoning Dept (24 Hrs.) prior to when you want an inspection - (715) 373-0114
If you do not have a fax and must email the inspection; you must email all staff members.
Note
Time Change
fl Discrepancy Other
Phone Number
' p
I11* &1S111US3Pn
r� 7S
5 9 —3:355
Plumber:
Number
r� pFax
/lg yq —
Homeowner:
5t I `10.h1 1JQ✓i
Q 0.
Email Address
-74Ardr`P a&tocryt
)
M SS £1 txi j ps. x o,77
Immediate Phone Number So Zoning
Sanitary
#:
/
5 — '`f �
Dept can call you right back (if needed)
Permit
Plumber's Choice
Zoning Dept
No Inspection(s) during this time
Date:
'_7 I g'a
g
Tuesday (9:30 am - 12:15 pm) (Tracy)
Plumber's Choice
Zoning Dept
Time:
RR
IV •VD
Township:
4fttt31 f I
Address # &
Name:
Road
5q(O IYIan/n
r
or
Directions
To Site:
Comments:
** Plumbers you must verify any change(s) by fax or email *k
Notes from
u/farms!sanitary/requestforinspectlon O June 2023
Zoning Dept (/12/04);
WILLIAM D VAN ATTA JF
710 S 3D ST
LA CRESCENT MN 55947
Tank Information
I TYPE MANUFACTURER
CAPACITY
Prop. Line
Well
Building
Air Intake
Road
[peptic 31pen0r
7
N/A
Dosing
N/A
Aeration
N/A
Holding
Private Ons.ke Wastewater Treatment
Systems ( POWTS) Inspection Report
(Attach to Permit)
City
setback to:
Village U Town of:
"Parmlt
State Plan'Transaction ID#:
Parcel Tax No:
Pump/ Siphon Information
Pump Manufacturer
Pump Model
Demand
GPM
Filter Manufacturer
liter Model
- o ea7—
TDH
Lift Friction Loss
Head
Total
Forcemain
Length
Dia
Dist To Well
Dispersal Cell Information's(+.n 1A --
DIMENSIONS
LengiJ�1 `
1�
# of Cells
SETBACK FROM
Prdo Line
I Building
ell OHWM
Type of Cell
(9r`5' — 'k
Manufacturer:
Model Number:
Pretreatment Unit
Manufacturer:
Model Number:
Dia
Over
Distribution
ZOMMENTS: (Include code discrepancies, persons present, etc.)
Elevation Data %S.l I e v
STATION
BS
HI
FS
ELEV
Benchmark
.4111
. 7
00.c
Bldg. Sewer Rft0,00
Tanklnlet -
5.�u
Tank Outlet -
/o≤
Dose Tank Inlet
Dose Tank Bottom
Inst. Contour
Header/ Man fold
Qra
Distribution Pipe
Infiltrative Surface
pp 7
4(.
Final Grade _
4i11
❑ Yes ❑
❑ Yes ❑ No 1 ❑ Yes ❑ No
-FMK Inthifltd wJ (oc(4S 6-
ehatAS
c n (fro.. rcw o p r' IJ -
; Vtn� CUPS U4 0" s�Ci`
Ian revision required? ❑ Yes 'I o I �1 Mkiipi!ItJ
>e other side for additional information.
Date POWTS n ector's Signature
License Number
:Rf1.FTln (P nq/991
Property Owner
Information
As you know
BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT
Telephone: (715) 373-6138
Fax: (715) 373-0114
e-mail: zoning(a)bayfieldcounty.wi.00v
Web Site: www.bayfieldcounty.wi.gov/147
WILLIAM D VAN ATTA JR
— 710S3DST
LA CRESCENT MN 55947
onsite wastewater treatment system on your property described as:
Notes:
Bayfield County Courthouse
Post Office Box 58
117 East Fifth Street
Washburn, WI 54891
was contracted by you to install a private
Abandonment of Old System to meet all applicable code requirements:
Tank was pumped by:
C. Tank was crushed I removed and pipes disconnected by:
on
at AM/PM
On at (AM I PM) the above -mentioned plumber contacted our office to
con7t a pre -cover inspection as required under DSPS 383. One of the following applies:
IPElSystem was inspected and appears to meet all applicable code requirements.
fl 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 obecause County could not respond to plumber's time constraints.
Comments: ((� S n • Vf11� rou <�Ve(PC.1 I Il O47"-( SG 2t -4.
Cuffs
Ullormslsanilaryproperlywmer-input
April2019
ss-005-6 F
1 '1
r�Rl•�
Industry Services Division
4822 Madison Yards Way
Madison, WI 53705
P.O. Box 7302
Madison, WI 53707
County
Bayfield
Sanitary Permit Number by Co.) be filled in (to b
5 " L.J $
Sanitary Permit Application
State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit
Project Address (if different than mailing address)
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats.
8891O Mariner Mile. Bayfield, VVI
I. Application Information -Please Print All Information
Property Owner's Name
Parcel #
William D Van Atta Jr
39310
Property Owner's Mailing Address
Property Location
710 S 3rd St.
Govt. Lot
¼, ¼, Section 35
City, State I
La Crescent, MN J55947
Zip Code
Phone Number
540-460-6922
T51 N R 04 E or W
II. Type of Building (check all that apply)
Lot #
Subdivision Name
a1 or 2 Family Dwelling— Number ofBedrooms 2
1
Block #
UPublic/Commercial — Describe Use
City of
State Owned — Describe Use
Villa a of
CSM Number
g
#2342 VI 3 P304 Townof Russell
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 licable.
A. New System IliReplacement System Other Modification to Existing System (explain) Additional Pretreatment Unit (explain)
B' ❑Holding Tank JJIn-Ground ❑At -Grade Mound Individual Site Design JOther Type (explain)
(conventional)
C. ❑ Renewal Before Revision JChange of Plumber Transfer to New Owner List Previous Permit Number and Date Issued
Expiration NA
IV. Dispersalfrrea_tnlent Area and Tank Information:
Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (sf) Dispersal Area Proposed (sf) I System Elevation
300 0.7 1429 452 i945
Capacity in 1 Total # of Manufacturer
Tank Information Gallons Gallons Units U y
New Tanks Existing Tanks
wU !n0 C
Septic or Holding Tank 750 750 1 Superior Precast ii
Dosing Chamber
V. Responsibility $tatement- 1[, the undersigned, assume responsibi ' or instal lion of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's a MP/MPRS Number Business Phone Number
Jason Kuettel 675751I 715-798-3355
Plumber's Address (Street, City, State, Zip Code)
PO Box 66 Cable, WI 54821
V . County/Department Use Only
Approved 7Droved Permit Fee Date Issued Issuin Age ign re
Given Reason for Denial
Conditions of Approval/Reasons for Disapproval
c≥_c7QzwIQ4 &'z
till JUN o 5 ZO?5
Bayfield Co. Zoning Dept.
Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 inches in size
SBD-6398 (R. 02/22)
PAGE 1 OF 4
In -Ground Gravity Plan
Index & Cover Sheet
Component Manual Design References:
In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg1 of4
Pg2of4
Pg3of4
Pg4of4
Attachments:
Index & Cover Sheet
Plot Plan
Dispersal Area Cross -Section & Plan View
Management Plan
POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name I Description
Van Atta - 2 Bed
Owner Name(s): William Van Atta
Owner Address: 71 OS 3rd St. La Crescent, MN
Project Address: 88910 Mariner Mile. Bayfield, WI 54814
Govt. Lot: 1/4 of
Township: Russell
Project Parcel ID #: 39310
Phone: 540 _460 .6922
Zip: 55947
1/4, Section 35 , T 51 N -R 04 E Ll or W U
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 _3356
Zip: 54821
This space reserved for approval stamp.
IIH
1111 JUNG 5 20'i�
Bayfield Co. Zoning Dept.
Signature: Date:
Original gn ure required on each submitted copy.
uwner inrormatlon:
Name:
William D Van Atta Jr
Location:
S35.T51 N,R04W
Township:
Russell
County:
Bavfield
Lot #:
88910 Mariner Mile
I-aT I CS, -% Z W?.
V
9'
'1,/I
97 B1 /
?t-- Woodline ,' o
/ •//7
paw
Only in Tested Area
BM=100: Nail W/ Ribbon on the base of tree near B1 & woodline
BI= 97.2
B2 = 96.9
B3 = 96.55
(a) e qr' 9viru- 4t CH t,
-.
',(
TTTTTT
teep Slope
No 3₹LL i
oN prtls rY ` Empty lot
Mariner
Mile
Mp , ?S7S
J4 Zs
`= yr PL.
IN -GROUND GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard -W Chambers
3 -ft Trench (down -sizing credit)
min. 12"
SOIL COVER (typical)
12"
min. trench
j ______________
depth
(typical) �'.
(typical) •., ..
System Elevation = 94.5
(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
wl End Cap (typical) (Show location of inlet / outlet pipe connection on plan view.)
I-s..•i i-(Trwrwir --- --------1f----
I. B= 46 ft
(typical)
INSTALL PER TRENCH:
11 Quick4 Std -W @ 20 ft EISA/chamber = 220 ft2
+ 1 Pairs of end caps @6 ft= EISA/pair = 6 ft'
= Proposed EISA per trench = 226 ftZ
P O trir
Provide minimum 3 ft s o
separation between trenches.
Observation Pipe
(typical)
Install per manufacturet's
/ Instructions.
-) o
cc, r-,) o i iF6
CS.
TYPICAL TRENCH
PLAN VIEW
(No Scale)
TA=3.0ft
(typical)
'—Quick4 Standard -W Chamber
(typical)
(mfd by Infiltrator Systems, Inc.)
Install pursuant to manufacturers instructions.
Required Infiltration Area = 429 ft2
x 2 trenches = Proposed Total EISA = 452 ft2
Distribution Method:
branched manifold
D
GD
m
(1)
O
m
a
RESET
PAGE 4 OF 4
In -ground Gravity Management Plan
IMPORTANT:
The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall
be considered a human health hazard if not maintained in accordance with this approved management plan.
Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area Operating Limits:
Design Flow =
300
gpd; BOD5 ≤ 220 mgL"'; TSS ≤ 150 mgL"1; FOG ≤ 30 mgL"'
Inspection Checklist INSPECT EVERY 3 YEARS nn E c E II U L�
o type of use
o age of system j LI JUN 05? O?5
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) Bayfield Co. Zoning Dept.
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
Local government unit address:
117 E 5th St. Washburn, WI
Phone: 715-798-3355
Phone: 715-373-6138
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.
'V 3
TC 9'1K C.,US- ST0H .ANDJ S?-CTF ICA TI0H-13
y" SC4,40 p'ic INSP. oToE 6 " MIN. A3OVL G R:DE.(�oP;,} r&Vto1e. ?cAPPROVED
MANHOLE
c TN SHED GR.aDE
in.
ItILET
OUTLET
TT I
APPR D BA -F -F E
O FILTER- •1
APPROVED MFG.
PIPE 3' D LE�
ONTO SOLID model TO$Z"Z-
so rL JUN 0 r, w,
'Ii
3" APPROWE BEDDING UN-DEF, TIc'1J
SPEC.IFICtiTI0NS
S EPT-s�C
TANK ? 1 AHU ACTVP ER : ,S��P�123► t�2.� -.pI_
TANJX S 1 ZES. SEDTJC )So'
MOTES:
25 LI
Bayfield Co. Zoning Dept.
{
- T.
Nr
Wisconsin Deparlm¢ni nisaleryand PmlessienalseNlsen
Attach complete site plan on paper not less than 8Y, X 11
SR-oQa o
Soil Evaluation Report
in acromance withSPS 385,LNs Adm Code +
inches in size. Page: 1 of 6
Plan must include but not limited to: Vertical and horizontal reference
County:
point (BM), direction and percent slope, scale or dimensions, north arrow,
Bayfield
Parcel I.D.
location and distance to nearest road.
Please Print All Information
39310
Personal information you provide may be used for secondary purposes.
v'
Date:
(privacy Law,s.15.04(1)(m)).
Property Owner:
Property Location
William D Van Atta Jr
S35,T51N,R04W
Property Owners Mailing Address:
Site Address or CSM and Lot #
710 S 3D St
88910 Mariner Mile
City
State Zip Code
Phone Number:
Town
Nearest Road:
La Crescent
MN 55947I
0
Russell
Mariner Mile
New, Number of Bedrooms: 2
Residential Code derived design flow rate:
��
Flood Plain if applicable D fl Replacement fl Public or Commercial - Describe:
IPI
JUN 052025
Parent Material: Outwash Flood Plain if Applicable: 0
Bayfield Co. Zoning
General Comments & Recommendations:
System Elevation: 94.5 Load Rate: 07
� Ground surface Elev: Depth to Limiting Factor:
Boring #1 r Bor.At
Soil Application Rate:
97.2 Ft. 120 in. Elev. 87.2 ft
Horizon
Depth in,
Domm.Color
Redox Description
Texture
Structure
Consistence
Boundary
Roots
GPD/ft'
Munsell
Qu. Sz. Cont. Color
Gr.Sz.Sh.
'Eff#1
Eff#2
1
0-2
7.5YR3/1
N/A
LS
0SG
ML
CS
3F
0.7
1.6
2
2-8
7.5YR5/2
N/A
SL
oSG
ML
CS
N/A
0.7
1.6
3
8-30
7.5YR4/3
N/A
MS
0SG
ML
CS
N/A
0.7
1.6
4
30-120
7.5YR4/6
N/A
MS
0SG
ML
N/A
N/A
0.7
1.6
5
6
7
Boring #2 r- Bore PR Ground surface Elev: Depth to Limiting Factor:
Soil ApplicajRate:
96.9 Ft. 120 in. Elev. 86.9 ft
Horizon
Depth in.
Domm.Color
Redox Description
Texture
Structure
Consistence
Boundary
Roots
GPD
Munsell
Qu. Sz. Cont. Color
Gr.Sz.Sh.
*Eff#1
1
0-4
7.5YR3/1
N/A
LS
0SG
ML
CS
3F
0.7
1.6
2
4-12
7.5YR5/2
N/A
SL
0SG
ML
CS
N/A
0.7
1.6
3
12-26
7.5YR413
N/A
MS
0SG
ML
CS
N/A
0.7
1.6
4
26-120
7.5YR4/6
N/A
MS
0SG
ML
N/A
N/A
0.7
1.6
5
6
'Effluent #1 = SOD 5>30< 220 mg/l and S>30 < 150mg/I
'E t #2 = SOD 5 < 30 mg4 and TSS < 30 mg'/
CST Name (Please Print)
signs re
CST Number:
Mark S. Thompson
877598
Address: 12006 N US Hwy 63
Date lu tion onduc ed:
Telephone Number
Hayward, WI 54843
Thursday, May 29, 2025
715/699-4081
SBD-8330 (R04/21)
;pi
Property Owner: William D Van Atta Jr Parcel I.D. 39310 Page: 2 of 6
Boring #3
F Barr Fit Ground surface Elev: Depth to Limiting Factor:
96.55 Ft. 96.55 in. Elev. 86.55 ft
Soil App. Rate
Horizon
Depth in.
p
Domm.Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr.Sz.Sh.
Consistence
Boundary
Roots
GPD/ft2
"Eff#1
Eff#2
1
0-2
7.5YR3/1
N/A
LS
0SG
ML
CS
3F
0.7
1.6
2
2-10
7.5YR5/2
N/A
SL
0SG
ML
CS
N/A
0.7
1.6
3
10-24
7.5YR4/3
N/A
MS
0SG
ML
CS
N/A
0.7
1.6
4
24-120
7.5YR4/6
N/A
MS
0SG
ML
N/A
N/A
0.7
1.6
5
6
7
Boring # 4
F 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
II
�� (i.
4
Ir.
5
NJ
JLJ
1T
7
Boring #5
r- Bor r Pit 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#i
Eff#2
1
2
3
4
5
6
7
Boring #6
r Bor P Plt 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
"Effluent #1 = BOD 5>30 < 2 20 mg/I and TSS>30 < 150mg/1 *Effluent #2 = BOD 5 < 30 mg/I and TSS < 30 mg/I
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
VND2025
ping Dept.
SBD-3330(R.07100)
100 100 ---- 100
— -- --- System
99 99 99 -- Elevation
98 98 98
97 97 ----
96.9 96_55
96 96 — 96
:E1EE:
0.7 950.73 $ .I 94 0_7 94 0_7
93 ---- 93 -- 93 —
92 ---- 92 92
91 -------- 91 — 91 ---
90 90.2 90 90 -------
89.9 ---------- 89_55
89 - 89 - - 89 --------------
t3' --- ----
88 — 88 T3' 88 *3'
87 87.2 87 - 87 — -
L.F.. 86.9 86.55
86 86 L.F. 86
85 85 85 -----
84 84 — 84
83 83 83 EE -
82 82 — 82 — - Ii JUN 0 5 2025 D
81 — 81 81 BaY(ield Co. Zoning Dept.
80 - 80 80 -------
79 79 79
('I N OI
m a m au
rn
II II Ii II
d
m m m
Dl U9HHfl
[II! JUN 052025 U
9ayfield Cu. Zoning Dept.
SS-Dc5__
Industry Services Division
County
�s� �'
4822 Madison Yards Way
Madison, WI
Bayfield
Sanitary Permit Number (to be filled in by Co.)
PS - �`
53705
P.O.Box
Madison, WI53707
C25 —y SS
Sanitary Permit Application
State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit
Project Address (if different than mailing address)
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
88910 Mariner Mile. Ba leld WI
purposes in accordance with the Privacy Law, s. 15.04(t)(m), Stats.
Y' r
1. Application Information— Please Print All Information
Property Owner's Name
Parcel #
William D Van Atta Jr
39310
Property Owner's Mailing Address
Property Location
710 S 3rd St.
Govt. Lot
City. State I
Zip Code
Phone Number
La Crescent, MN
55947
540-460-6922
V '4, Section 35
T51 N R04 EorW
II. Type of Building (check all that apply)
Lot#
Subdivision Name
❑� I or 2 Family Dwelling— Number of Bedrooms 2
1
Opublic/Commercial — Describe Use
Block #
City of
IliState Owned — Describe Use
jvillage of
CSM Number
#2342 V13 P304
M✓ Tam of Russell
111. Type of POW'I'S Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C i
a licable.
A.
IZiNew System
❑Replacement System
I1Other Modification to Existing System (explain)
❑Additional Pretreatment Unit (explain)
Holding Tank
Zln-Ground
Jt-Grade
IJMound
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,
Dispersal/Treatment Area and Tank Information:
Design Flow (gpd)
Design Soil Application Rate(gpd/st)
I Dispersal Area Required (sf)
I Dispersal Area Proposed (sf)
I System Elevation
300
0.7
429
1452
94.5
Capacity in
Total
# of
Manufacturer
Tank Information
Gallons
Gallons
Units
9
to
New Tanks I
Existing Tanks
'- a
o.
2u
,fl
0
H
n
iZU
Septic or Holding Tank
750
750
1
Superior Precast
✓
Dosing Chamber
V. Responsibility Statement- 1, the undersigned,
assume responsibior instal Lion of the POWTS shown on the attached plans.
Plumber's Name (Print)
Plumber's e R
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
V . County/Department Use Only
Approved
0 Disapproved
Permit Fee
S
I Date Issued
Issuin Age ign re //�
❑ Owner Given Reason for Denial
(O 6I !i. ej
Conditions of Approval/Reasons for Disapproval C WY
�D�n c4 /�
1 D IS LS U
liii JUN 052025
Bayfield Co. Zoning Dept.
Attach to complete plans for the system and submit to the County only on paper not less than 8 in x It inches in size
SBD-6398 (R. 02/22)
�R-001-6yo
Wisconsin Department of Safety and Professlonal Servlses
Attach complete site plan on paper not less than 8% X 11
Soil Evaluation Report TEST
In accordance with SPS 385,ws.Adm Code
inches in size. Page: 1 of 6
ED
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:
Bavfield
Parcel I.D.
39310
v, Date:
,3 __ 7
Property Owner:
William D Van Atta Jr
Property Location
S35,T51N,R04W
Property Owners Mailing Address:
710 S 3D St
Site Address or CSM and Lot #
88910 Mariner Mile
City
La Crescent
State
MN
I Zip Code
55947
Phone Number.
0
Town
Russell
Nearest Road:
Mariner Mile
Number of Bedrooms: 2
New J Residential Code derived design flow rate: 00�
Flood Plain if applicable D
Replacement r Public or Commercial - Describe:
Iii] JUN 052025
Parent Material: Outwash Flood Plain if Applicable: 0
Bayfield Co. Zoning
General Comments & Recommendations:
System Elevation: 94.5 Load Rate: 0_7 Elevation Ranae. 9002 To 9455
Boring #1 r Bor.r' pit Ground surface Elev: Depth to Limiting Factor:
97.2 Ft. 120 in. Elev. 87.2 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
0-2
7.5YR3/1
N/A
LS
0SG
ML
CS
3F
0.7
1.6
2
2-8
7.5YR5/2
N/A
SL
0SG
ML
CS
N/A
0.7
1.6
3
8-30
7.5YR4/3
N/A
MS
0SG
ML
CS
N/A
0.7
1_6
4
30-120
7.5YR4/6
N/A
MS
0SG
ML
N/A
N/A
0.7
1.6
5
6
7
Boring # 2 Ground surface Elev: Depth to Limiting Factor:
�"" Bor. Pit
96.9 Ft. 120 in. Elev. 86.9 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/ftz
*Eff#1
Eff#2
1
0-4
7.5YR3/1
N/A
LS
0SG
ML
CS
3F
0.7
9_6
2
4-12
7.5YR5/2
N/A
SL
0SG
ML
CS
N/A
0.7
1.6
3
12-26
7.5YR4/3
N/A
MS
0SG
ML
CS
N/A
0.7
1.6
4
26-120
7.5YR4/6
N/A
MS
0SG
ML
N/A
N/A
0;7
1.6
5
6
7
*Effluent #1 = BOD 5>30 ≤ 2 20 mg/1 and S>30 ≤ 150mg/1
*E t #2 = BOD 5 < 30 mg/l and TSS
< 30 mg4
CST Name (Please Print)
Mark S. Thompson
Signa r
CST Number: 877598
Address: 12006 N US Hwy 63
Hayward, WI 54843
DateDatequ do on ed:
Thursday, May 29, 2025
Telephone Number
715/699-4081
SBD-8330 (R04/21)
apt.
- 1 :Property Owner. William D Van Atta Jr Parcel I.D. 39310 Page: 2 of 6
Boring # 3
iBorrV Pit Ground surface Elev: Depth to Limiting Factor:
96.55 Ft. 96.55 in. Elev. 86.55 ft
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
0-2,
7.5YR3/1
N/A
LS
0SG
ML
CS
3F
0.7
1.6
2
2-10
7.5YR5/2
N/A
SL
0SG
ML
CS
N/A
0.7
1.6
3
10-24
7.5YR4/3
N/A
MS
0SG
ML
CS
N/A
00.7
1.6
4
24-120
7.5YR4/6
N/A
MS
0SG
ML
N/A
N/A
0.7
1.6
5
6
7
Boring #4
Ground surface Elev: Depth to Limiting Factor:
r Bores t
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
Ii)
li[
4
____
______
_________
___
______
______
____
5
U
6
)ayfieH�
I
7
Boring # 5"`
Ground surface Elev: Depth to Limiting Factor:
Bores At
0 Ft. 0 In.
Soil A
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:
r Bores PitApp.
0 Ft. 0 In.
Soil 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/I and TSS>30 < 150mg/l *Effluent #2= BOD 5< 30 mg/! and TSS < 30 mg/I
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
2025
ling Dept.
SBD-8330(R.07100)
Soil Profile Sheet Page: 3 of 6
Owner: William D Van Atta Jr jSoil Tester: Mark S. Thompson
System Elevation: 94.5 Load Rate: System Elevation: 90.02 To 94.55
101
B1
101
B2
100
---
100
---------
99----------
99
----- ----
98
98
97
97.2
97
---------------
------------ 96.9
95
0_7
95
94
----------- 0.7
94
------------
93
-----------
93
92
92
91
91
90
90.2
90
---
89.9
89
-----
89
T3'
88
88
------------ T3
87
87
L.F.
86.9
86
----------
86
------------ L.F.
85
--
85
---
84
84
83
83
-----------
82 -----------
82
81 ---------------
81
---------------
80
_
80
---
79
79
101 B3
100 -
Svstem
99-------�--- Elevatioi
98 -------------
------- 96.55
,796
0.7 95 0_7
94.55 $
0.7 94 ------------ 0.7
93
92 -------
91
89.55
88 T3'
87 --------------
86.55
86 ---------------
84
83 ___ : Ull U
82 --------------1111 JUN 05 2025
81 ---- ----- Bayfield Co. Zoning Dept.
79 ---
B1 & woodline
B1=
97.2
B2 =
96.9
B3 =
96.55
Lake=
0
Only in Tested Area
PAGE 1 OF 4
In -Ground Gravity Plan
Index & Cover Sheet
Component Manual Design References:
In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of4
Pg2of4
Pg 3 of 4
Pg4of4
Attachments:
Index & Cover Sheet
Plot Plan
Dispersal Area Cross -Section & Plan View
Management Plan
res:
POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Van Atta - 2 Bed
Owner Name(s): William Van Atta
Owner Address: 710S 3rd St. La Crescent, MN
Project Address: 88910 Mariner Mile
Govt. Lot:
1/4 of
Township: Russell
Project Parcel ID #: 39310
, WI 54814
Phone:540 _460
Zip: 55947
6922
1/4, Section 35 T51 N -R 04 E❑ or W FV
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
ECHH
1111 JUN 052025
Bayfield Co. Zoning Dept.
Signature: Date:
Original gn ure required on each submitted copy.
Owner Information: BM=100: Nail WI Ribbon on the base of tree near B1 & woodline
Name: William D Van Atta Jr
Location: S35.T51N.R04W B1 = 97.2
Township: Russell B2 = 96.9
County: Bayfield
Lot #: 88910 Mariner Mile J
X e . ? 171O
LoT I cS+-' 2342 I l3 ?'d'L
.51 rrteeS
B1
?.I Woodline
n
No WeI.L
oN ?rtDtewt /i
(2) e Y6'ytvtGc V
•.................
.........
O,2.,
• it
tttttt
• teep Slope
F„wlte
4 Sc4 Yo Z. I7t-)
Empty lot
Maryner
A,ji/e
N
C
W E
C)
z
O
C
0
Q
S
=
S.fl
O G
1"=40Only in Tested Area Mp ,S7S S
`" rt�u
jy Jz5
o
U
IN -GROUND GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard -W Chambers
3 -ft Trench (down -sizing credit)
SOIL COVER
12"
mirt trench
depth
(typical)
min. 12"
(typical)
X34:•. ...
System Elevation = 94.5
(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
a) G�
TYPICAL TRENCH = t�
CROSS SECTION VIEW
(No Scale) o o lrvu
Provide minimum 3 ft o U,
ft separation between trenches. _. N
o
Quick4 Standard -W
w/ End Cap (Show location of inlet / outlet pipe connection on plan view.)
(typical)
I-----------��--------��----
L — — — —
B= 46 ft
(typical)
INSTALL PER TRENCH:
11 Quick4 Std -W @ 20 ff EISA/chamber = 220
+ 1 Pairs of end caps @6 ft' EISA/pair = 6
ft2
ft2
Observation Pipe
(typical)
Install per manufacturers
/ Instructions.
u
CD
TYPICAL TRENCH U
PLAN VIEW
(No Scale)
TA= 3.011
(typical)
`Quick4 Standard -W Chamber
(typical)
(mfd by Infiltrator Systems, Inc.)
Install pursuant to manufacturers instructions.
= Proposed EISA per trench = 226
ft' Required Infiltration Area =
429
ft'
Distribution Method:
x 2
trenches = Proposed Total EISA =
452
ft'
branched manifold
D
GD
m
W
O
m
PAGE 4 OF 4
In -ground Gravity Management Plan
IMPORTANT:
The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall
be considered a human health hazard if not maintained in accordance with this approved management plan.
Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area Operating Limits:
Design Flow =
300
gpd; BODS S 220 mgL'1; TSS 5 150 mgL-1; FOG 5 30 mgL-'
Inspection Checklist INSPECT EVERY 3 YEARS [I11 L5 G E I] U l5
o type of use IF4I I
o age of system 1111 JUN 05 2025
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) Bayfield CO. Zoning Dept.
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 (Le., 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 Phone: 715-798-3355
Local government unit: Bayfleld Co. Zoning Phone: 715-373-6138
Local government unit address:
117 E 5th St. Washburn, WI
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.
Sr JTIC TAI CROSS S=CTIOti .ND SPZ 7'!CATIGti5
4" GC4,4OPVC INSP- PTE 6 " MI?!. ABOVE GRAD (np'
(whun kk+ Ps buried
FINISHED GRADE
28" dl?!.!
I TILET
APPROVED
PIPE 3'
ONTO SOLID
SOIL
DA-EfUzE
OR
MFG. OrncL
model R TO$12
3" APPROVED BEDDING UNDER. TA.KK
SPECIFICATIONS
SEPTIC
TANK HA,}NUcACTIIRER: SuP&2t 0L..r72tCAfi
TANK SIZES: S=?TIC 7S Q'
NOTES:
APPROVED
H.4NHOLE
W/ Lec:iZ4
vlllp'JI,V/' [ABEL
4" HIH.
OUTLET
1111 JUN 052025
Hayfield Co. Zoning Dept.
- !-
$ - 00
Private Sewage System Maintenance Agreement
DOCUMENT NUMBER
)Name ///%� 2025R-607740
;/ice v ' �', , 1p `4 DANIEL J. HEFFNER
Mailing Address 1 REGISTER OF DEEDS
C 3c.
G4 f p.�.L J 4Gt��Q�-� a 4 !'<b(r BAYFIELD COUNTY. WI
ress �J "CC r1 v. pa ..7t> ! 7
dIn
RECORDED
fct�Irk-e Milt g'!�7i-iaZD, r;y S48IL( 06/05/2025 AT 10:47 AM
RECORDING FEE: $30.00
3931 D PAGES: 1
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)
1/4 of 1/4 Section Township _N. Range W.
Additional Legal Description:
Town of
L!`
(Acreage)
I. Cy Gov't Lot
___L_-�t
Lot_
Block Subdivision
17oLbtk?T"
Lot 1
CSM # L34Z Vol. /-7
Page'°`(
CSM Doc# Lo74 Z -6orma.
Recording Area
Return To: UjD�
Planning ggllfyyll,II'511)tt,", Zoning Department
JUN OtZUUH
Bayfield Co.
In -ground gravity
❑
In -ground dosed
❑
In -ground pressure distribution Sewage System:
❑
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 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
Subscribed and sworn to before me on this date:
tt4AtPd�®®ejii
Notarized Owner(s) — Signature(s) /'
Not ry P tic
• ,-..
Drafted by: % 7 !_C,}r21L Date: _ 9/I1 /?.S
Gr iY,
Proofed by:
u/forms/sanitary/sep ticm aintencea greeme/t
Revised July2020
I3--YFIELD Bayfield County
Planning & Zoning Department
117 E 5th Street
P.O. Box 58
Washburn, WI 54891
Phone: 715-373-6138
Fax: 715-373-0114
Property Owner: Submission Number:
VAN ATTA JR, WILLIAM D SR -00260
710 S 3D ST
LA CRESCENT, MN 55947 Transaction Number:
SR-00260-2DODA
Description
Certified Soil Tests - Review & Filing Fee
Amount
$50.00
Total: $50.00
Payment Amount: $50.00
Reference: 14712
Paid by: Andry Rasmussen & Sons, PO Box 66, Cable WI 54821
Payment Type: Check
Transaction Date: 6/11/2025
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
13 '(FIELD Bayfield County
Planning & Zoning Department
117 E 5th Street
P.O. Box 58
Washburn, WI 54891
Phone: 715-373-6138
Fax: 715-373-0114
Property Owner:
VAN ATTA JR, WILLIAM D
710 S 3D ST
LA CRESCENT, MN 55947
Description
Private Sewage System (Septic Tanks)
Submission Number:
SS -00565
Transaction Number:
SS -00565-2D686
Amount
$400.00
Total: $400.00
Payment Amount: $400.00
Reference: 14712
Paid by: Andry Rasmussen & Sons, PO Box 66, Cable WI 54821
Payment Type: Check
Transaction Date: 6/11/2025
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
BAYFIELD COUNTY
SANITARY PERMIT (#04)-25-48S
STATE SANITARY PERMIT
OWNER: WILLIAM VAN ATTA JR
GOVT LOT: LOT: 1 BLK:
CSM: 2342 V1 3 P304
NW 1/4 NE 1/4 SEC: 35, T 51 N, R 04 W
TOWNSHIP: Russell
SOIL TEST: 48-25
NEW SYSTEM
SYSTEM TYPE: Non -Pressurized In -Ground
PLUMBER: JASON KUETTEL
TRACY POOLER DATE: 6/11/2025
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
THIS PERMIT EXPIRES 6/11/2027
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION