HomeMy WebLinkAbout24-01S* INBOUND NOTIFICATION ; FAX RECEIVED SUCCESSFULLY **
TIME RECEIVED REMOTE CSID DURATION PAGES STATUS
• December 16, 2024 at 9;53;04 AM CST 7157983470 36 1 Received
DEC/16/2024/M0N 09:33 AM Andry Rasmussen & So FAX No.7157983470 P.001/001
Request 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 fl Other
Phone Number
Plumber:
/t pp
+ nciry 11i23n1 ssen rr - 77s
5-`7Q) —3.353—
Fax Number
%/S- 7qf-
Homeowner:
W t P1 Q ev $
orIIQ S l
Email Address
�rr�,Q rid /4SP�t
o- to ,n
rnis (�8 as,e6,,,
Immediate Phone Number So Zoning
Sanitary
Permit #:
rY D�
/�
Dept can call you right back (if needed)
Plumber's Choice
Zonin Dept
No Inspection(s) during this time
Date:
i )11�
Yk
Tuesday (9:30 am - 12:15 pm) (Tracy)
Plumber's Choice
Zo ' pt
Time:
R
Township:
-
Address # &
Road Name:
or
��cin S l [it/Yt� �Y
tr
Directions
To Site:
Comments;
** Plumbers you must verify any change(s) by fax or email **
Notes from Zoning Dept;
Wlvnns/sanitarylrequesttorinspection
Zoning Dept (04/12)04); 0 June 2023
s P�'
�'491p%��')
Industry Services Division
General Information
Personal information you prov
WINDETT REV TRUST
14852 102ND ST CIRCLE N
STILLWATER MN 55082
Ta�tlnrormanon
TYPE
MANUFACTURER
CAPACITY
Prop. Line
Well
Building
Air Intake
Road
Septic
/t700
f
N/A
Dosing
N/A
Aeration
N/A
Holding
Private Onsite Wastewater Treatment
Systems ( POWTS) Inspection Report
(Attach to Permit)
City UVillage Town of
nfl
Vutl, : Oa
setback to:
Pump I Siphon Information
Pump Manufacturer
Pump Model
Demand
GPM
Filter Manufacturer
Filter Model
TDH
Lift
Friction Loss
Head
Total
Forcemain
Length
Dia
Dist. To Well
Dispersal Cell Information
DIMENSIONS
Width
Length
# of Cells
SETBACK FROM
Prop. Line
Building
Well
OHWM
Type of Cell
/
Y/9/t€5
�// t€5
Manufacturer:
Model Number:
Pretreatment Unit
Manufacturer:
Model Number:
Distribution System
Elevation Data
STATION
BS
HI
FS
ELEV
Benchmark
Bldg. Sewer
IJ'
(y_
Tanklnlet
. 93
Tank Outlet
7 /3
___ Z
Dose Tank Inlet
Dose Tank Bottom
Inst. Contour
Header I Manifold
$,1
7y
Distribution Pipe
Infiltrative Surface
9- 55
Final Grade
X Pressure Systems Only
Header / Manifold
Distribution Pipe(s)
X Hole Size
X Hole
Observation Pipes
Length _ Dia
Length Dia Spac _
Spacing
❑ Yes O No
Soil Cover
Depth Over
Depth Over
Depth of
Seeded I Sodded
Mulched
Cell Center
Cell Edges
Topsoil
El Yes ❑ No
❑ Yes ❑ No
CO MENTS: (Include code discrepancies, persons present etc.)
/4/77 cm fr rankjusrk' j,v4wJaY
cJJA .n
Plan revision required? O Yes'`ONo '�
Use other side for additional information. '-
Date
can.a7ln tP nan1\
POWTS In ector's Signature
37
License Number
Property Owner
Information
BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT
Telephone: (715) 373-6138 Bayfield County Courthouse
Fax: (715) 373-0114 Post Office Box 58
e-mail: zoning@bayfieldcounty.wi.gov 117 East Fifth Street
Web Site: www.bayfieldcountv.wi.gov/147 Washburn, WI 54891
WINDETT REV TRUST
14852 102ND ST CIRCLE N
STILLWATER MN 55082
As you know /(J' /(( ,i&4 t1A) 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:
❑ Tank was pumped by: on at AM! PM
❑4. Tank was crushed I removed and pipes disconnected by:
On / r at 3o (AM I ?the above -mentioned plumber contacted our office to
conduct a pre -cover inspection 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:
U/forms/s anits rypropenyowner-input
April 2019
''lc;
Vi 41
er""ste+•r¢ F
Industry Services Division
County
4822 Madison Yards Way
Bafield
Sanitary Permit Nber (lo be filled in by Co.)
DEC 212023
6 t''
Madison, WI 53705
P.O. Box 7302
�r'+avnsa Bayfield
o. Madison, WI 53707
✓ D/ S
Saul nmlerm>t ppiieation
State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to
Project Address (if different than mailing address)
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. I5.04(l)(m), Stats.
66105 Co. Hwy H. Iron River, WI 54847
1. Application Information— Please Print All Information
Property Owner's Name
Parcel #
Windett Rev. Trust
19622
Property Owner's Mailing Address
Property Location
14852 102nd St. Circle N.
Govt. Lot
City, State I
Zip Code
Phone Number
Stillwater, MN
55082
651-335-4752
', Section 21
T47 N R 08 Eor
11. Type of Building (check all that apply)
Lot
❑✓ I or 2 Family Dwelling— Number of Bedrooms 3
5
Subdivision Name
❑Public/Commercial — Describe Use
Block #
—
flCityof __
❑State Owned — Describe Use
Village of
CSM Number
#235 V3 P4
0✓ Tow, of Iran River
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 i
a licable.
A.
New System
❑Replacement System
Other Modification to Existing System (explain)
❑Additional Pretreatment Unit (explain)
Holding Tank
Zin-Ground
L}At-Grade
❑Mound
Individual Site Design
Other Type (explain)
(conventional)
C.
[J Renewal Before
[]Revision
JChange of Plumber
❑Transferto New Owner
List Previous Permit Number and Date Issued
Expiration
NA
IV. Dispersal/freatment Area and Tank Information:
Design Flow (gpd)
✓
Design Soil pplieation Rate(gpd/sf)
I Dispersal Area Required (sf)
✓
Dispersal Are roposed (sf)
System Glevati
450
0.7
643
652
93.0
/;p D Capacity in
Total
# of
Manufacturer
Tank Information
Vi,
ltat d G { P Gallons
Gallons
Units
2
o
New Tanks
Existing Tanks
12
0
-o
Septic or Holding Tank
1000
1000
1
Wieser
✓
Dosing Chamber
O
V. Responsibility Statement- I, the undersigned,
assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print)
I Plumber's SignatureI
MP/MPRS Number I
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
I ❑Disapproved
Permit Fee
Date I sued
Issuing Agent m
❑ Owner Given Reason for Denial
4OLJ oW
onditions o pproval/Reasons for Disapproval
)Mo paw p\n ow'w•
Attach to complete plans for the system and submit to the County only on paper not less than 8 12 x 11 inches in size
SBD-6398 (R. 02/22)
DEC 2 12023 arc j-
Wisconsin Deparimeni o; Safety and ProfessionaiServices BaYfield Co.
Don in Depstty SeitolS Planning and Zoning Agency Page of_____
'3a SOIL EVALUATION REPORT
In accordance with SPS 385, Wis. Aidm. Code county BAYFIELD
Attach complete site plan on papa not less than 8 1/2 x 11 inches in size_ Plan must include, but not limited to: vertical and horizontal reference point (SM), direction and percent slope, Parcel I.D.
scale or dimensions, north arrow, and location and distance to nearest road. -r elt b 19 (p Z Z
Please print all information. Reviewed by Date
Property Location 1 0
e J- v + caovc rat A, i s y 7 IY R ( h e(or
Ep
roperty Owne s Mailing Address T J )
z (O2Y7 P 4. C l SiteL-Address or CSM and lot #
L S Cs 0.3 Pt # z3S
City I State Zip Code Ph2L Number ❑ City ❑ Village I5ftown Nearest Road „ r,
7I-; LI.iD4 - j I-{ 't rich' Q7 (?zc)u-7r, r__ a' - tl _ ...
NewConstrudion UseA. Residential/Numberofbedroons ?i Code derived designflow rate W50GPD
l/$ Replacement ❑ Public or commercial — Describe Rood Plan elevation r applicable $ f
Parentmatetiat Sahp t +wa.s k -
General Comments and recommendations; �-f s D 1 C
nng# O80Mg
uPit Ground surface elev. }t Depth to limiting factor gs in. / efev S$_i Ztt,
. -
Sol Application
Horizon
Depth
Dominant Color
Mhalsell
, S 3 7-
�+
Redox D
Qu_ At. Cant.pCl;n
•-
j Texture -
s
Structure
Gr. Sz. Sh.
rr
Consistence
n
Boundary
tc
Roots
Rath
GPD/Ft2
•Efl#•1
•EfFN2
z"l
G.
1
—
, b
$e�o
Ayran
ego
<','
.A
7 I Boring # Boring
it Ground surface elev. Depth tt fimiting far qb tr in. / elev SH dE
Horn
z
Lg
Depth
In.
6 -2S
tf
Dominant Color
Munsell
,�
4 3
t{ y
I Redox Description
Qu. Az Cent Color
--
Texture
r5
Structure
Gr. St Sh.
° �
1
I
Li
Consistence
tt
t(
ri
Boundary
I
i
I u
t
Roots
7'j.i
Z^C
(I,T
lI)
Sol Application
Rata
GPD/Ft2
.T
[.e
L-(,
h
.Q
y
r
j
We
D
ST Name MERTON MA19 ✓ signature
. C57 Number 224901
.ddress 1 yyB
CO T Date Evaluation Conducted (715)- 634-8719
HAYWARD
r Z — G _
' Z3 I TJephone Number
r /
fliuent#1= BOO >30≤220 mg/L andTSS ≤150 mg/L * Efuent=2=BOD, ≤ 30 mg/Land TSS ≤ 30m
92 SBD-8330 (RO4l21)
Page of
a Soring (� �-J �f
I h I Botirtg # j� i�tt Ground surface edew. Y Depth to limiting factorw tD "in. / etev. ,C)
Soil Appftc;ation
Rate
Horizon
Depth
In.
Dominant Color
Mansell
Redox Description
Qu. Az. Corr. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roofs
GPD/Ff2
'Efi#1
Eff#2
Z
3
-^T
1 --≥J
z9 — Z
-
J!
.
o -s
11 �t
7t7
q
z
t �
,�
&
t. f�
Ucf
ElBonng #
O Borg
❑ Pit Ground surface elev. ft. Depth to limiting factor in. ! elev. R
Soli Appric ort
Rate
Horizon
- ? fJ'X
Depth
In.
Dominant Color
Mansell
ts-n
Redox Description
Qu. Az. Cont Color
s o
Texture
yZ
Structure
Gr. Sz. Sh.
o; .
Consistence
6 43
Boundary
-v--
Roots
GPD/Ft2
'Eff'#1
'EfiifE2
,`j.3-3j5..)L7,4fJ___
mac.
Z T r
I,
s
__
__
__
s
do
L 1 Bering #
Q Boring
O Pit Ground surface elev. fL Depth to limiting far in. / elev. It
MApplication
Horizon
Depth
In.
Dominant Color
Mansell '
Redox Description
Qu. Az. Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
(
Boundary
Roots
GPD/Ft2
„Eff#1
*Ef2
H.
-f._
__
_
*Effluent #4 = SOD > 30 s 220 mg/L and TSS > 30 1 S0 mg/L * Etriuent 42 = BOD, s 30 mg/L and TSS 30 mg/L
RECVD
L?j: DEC 212023
w i vt d e - Re T us -�- 6 f e Cd. Co_ . y_ _ r° Vl ► .p ntn 9 1d c Agency
152 Nr ,e tJ x Iw ZZ
S•{- ,J ck - 1✓4i D eZ � �, l -r Lrr N V, O
S; &10 C d � Lo+ 5 , CS l -1 J.3 p. j Z 3S
-'L654- L-
--�-✓ ,►�,1�d•- doh � �
r- 212-4 Q0
% Jcivj
36� _
pro pp5e� I
4 .f 'u' r
' '1- � 1
L - 1.
l'
�7 So: 1.5 5cs A. S3
o
. w t *e e e+ Cod.- seek.
* sou - .�- o o
, r-} ECEIV,,„- er±.®t..-��
V 7r : -
Sys:
Bayfield Co. .i . " 3;L
Planning and Zoning Agency
Bey&Q '' e.C� cj ,►(
Cts
_4 ]{ ✓
� z
-9 J it
-_r ...»..a--..• =moao ooe. 3ci
� 1
i-ti :-E
t -- :::t:::
qo--- 3 rib--- t ---- ���-=---- 3 •3 = +3
A fo/ � Sys
LI
SSW =-_. �5 `( -7, �� 9 -?------I---- —4--- qe " 1, c
z --
W r
7 i
:ECmAQ_U1 OF 4
In -Ground Gravity Plan DEC 212023
Index & Cover Sheet Bayfield Co.
Component Manual Design References: Panning and Zoning Agency
In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg 1 of 4
Pg 2 of 4
Pg 3 of 4
Pg 4 of 4
Attachments:
Index & Cover Sheet
Plot Plan
Dispersal Area Cross -Section & Plan View
Management Plan
ures:
POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
Windett 3 Bed
Owner Name(s): Windett Rev Trust
Owner Address: 14852 102nd St Circle N. Stillwater, MN
Project Address: 66105 Co. H%
Govt. Lot: 1/4 of
Township: Iron River
Project Parcel ID #: 19622
H. Iron River, WI 54847
Phone: 651 -335 -4752
Zip: 55082
1/4, Section 21 ,T47 N -R08 E❑or W❑✓
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
s
Signature: _ Date: / 2-
Original signature required on each submitted copy.
(, tet+ Rev -crt,s+
t -Le, . 4ozPD St CL'rc-Ie l'J
54-. L( c3cc &t 1 MU SSoi�JZ
se (o&1 os Co Eiw ll-
L65+ LAC
RECEIVE®
DEC 21 zua
L e` 4� sarfiem co.
Tub lb IRr 2Z
LaES, CS N( 0.3 P. `f #23c
f: 38'
"LeAA-er t« F
6oy4 `
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
depth
(typical)
(typical) '..•� .� ..
System Elevation = 93.0
(typical)
Septic Tank(s) Manufacturer.
Wieser
Septic Tank(s) Volume(s):
1000 gal gal gal gal
Effluent Filter Manufacturer:
Orenco
Effluent Filter Model it 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)
-----------77--------77-----
L-----------t--------��---
B= 70 ft
(typical)
INSTALL PER TRENCH:
16 Quick4 Std -W @ 20 if EISA/chamber = 320 ft'
+ 1 Pairs of end caps @6 ft' EISA/pair = 6 ft2
Provide minimum 3 ft
separation between trenches.
Observation Pipe
(typical)
Install per manufacturers
/ Instructions.
TYPICAL TRENCH
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 = 326 ft2 Required Infiltration Area = 643 ft'
x 2 trenches = Proposed Total E SA = 652
RESET
Distribution
branched manifold
D
O
m
W
0
m
"P
in
C
05 m D
2 Na v
RECEIVED
DEC 212023
. S.t_C TANK CROSS SECT=0N AUD Doing Agenq '...
4" Sct4,40 PVC IPISP. Drop 6 KIN. ABOVE GRADE. O
(when tkIt+ tv�c �oe Fs burizd� P'�
APPROVED
H.4HHOLE
�*I"71HED GRADE W/ Lc�
_WAIR,�IV"_ L466L
18" NI?I .
Ip!LLOUTLET
APPR D DA•F£ E-
O FILTER)_l
APPROVED rlFG. 0KrjcO
PIPE 3'
ONTO SOLID model n T0$2.'_
SOIL
3" A.PPRt5JED BEDDING UHD�.P, TANK
SPECIFICATIONS
SEPTIC,
TANK ?'MANUFACTURE W7tSL'1 Cce-'
TANK S?LES: S??TIC (O00 GAL, UP'
NOTES:
r
Bayfield County, WI
112!2024.9:51:55 AM 1:1,827
i- - Wetlands Approximate Parcel Boundary — Town 0 0.02 0.04 0.09 ml
Rivers Road Type Building Footprint 2015 0.04 0.07 0.14 km
Lakes -- County t Building Raybee County Land Ramos Cepann,ent
Bayueld County Zoning Appll®ran
MipsIlmapabayreI4munty.wI.g v/ZonIn9WAal
1/2124, 9:53 AM Novus-Wisconsin Access rev. 12.0206
Real' Estate Bayfield County Property Listing Property Status: Current
Today's Date: 1/2/2024 Created On: 3/15/2006 1:15:34 PM
i Description Updated: 7/1/2022
Tax ID:
19622
PIN:
04-024-2-47-08-21-3 04-000-40000
Legacy PIN:
024105707000
Map ID:
Municipality:
(024) TOWN OF IRON RIVER
STR:
S21 T47N R08W
Description:
LOT 5 OF CSM #235 IN V.3 P.4 TOG
WITH SECOND PAR IN DOC 2022R-
595218 476A
Recorded Acres:
4.700
Calculated Acres:
4.688
Lottery Claims:
0
First Dollar:
Yes
Zoning:
(R-1) Residential -1
ESN:
118
''P Tax Districts Updated: 3/15/2006
1
STATE
04
COUNTY
024
TOWN OF IRON RIVER
163297
SCHL-MAPLE
001700
TECHNICAL COLLEGE
IS Ownership Updated: 7/1/2022
WINDETT REV TRUST STILLWATER MN
Billing Address:
Mailing Address:
WINDETT REV TRUST
WINDETT REV TRUST
14852 102ND ST CIRCLE N
14852 102ND ST CIRCLE N
STILLWATER MN 55082
STILLWATER MN 55082
P Site Address * indicates Private Road
66105 COUNTY HWY H IRON RIVER 54847
® Property Assessment Updated: 8/2/2012
2023 Assessment Detail
Code Acres Land Imp.
GI -RESIDENTIAL 4.700 71,300 38,500
2 -Year Comparison
2022
2023
Change
Land:
71,300
71,300
0.0%
Improved:
38,500
38,500
0.0%
Total:
109,800
109,800
0.0%
LV Property History
y. Recorded Documents
Updated: 3/15/2006 N/A
0 QUIT CLAIM DEED
Date Recorded: 6/24/2022
2022R-595218
O CORRECTION INSTRUMENT
Date Recorded: 10/29/2021
2021R-591758
0 WARRANTY DEED
Date Recorded: 4/12/2021
2021R-588041
0 LAND CONTRACT
Date Recorded: 1/13/2014
2014R-553047 1120-538
0 CONVERSION
Date Recorded:
233-485;322-162;488-236
https://novus.bayfiieldcounty.wi.gov/access/master.asp?paprpid=19622 1/1
es,""`"n•, • RECD Industry Services Division County
4822 Madison Yards Way Bafield
DEC 212023 Madison, WI Sanitary Permi` Number (to be filled in by Co.)
P.O. Box 7302
o�`'^oxws 4s Bayfield o. Madison, WI 53707
Sam ry ermit Application State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Services. Personal information you provide may be used for secondary 66105 Co. Hwy H. Iron River, WI 54847
purposes in accordance with the Privacy Law, s. 15.04(l)(m). Sats.
I. Application Information — Please Print All Information
Property Owner's Name Parcel #
Windett Rev. Trust 19622
Property Owner's Mailing Address Property Location
14852 102nd St. Circle N. Govt. Lot
City, State Zip Code Phone Number
Stillwater, MN 55082 651-335-4752 A ¼, Section 21
II. Type of Building (check all that apply) Lot # T47 N R 08 E or
I?Jl or 2 Family Dwelling— Number of Bedrooms 3 5 Subdivision Name
Block #
❑Public/Commercial — Describe Use
❑Cityof
State Owned — Describe Use CSM Number Village of
#235 V3 P4 ❑✓ Townof Iron River
111. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line Cif
app icable.)
A. ew System Ieplacement System Other Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain)
' Holding Tank ZIn-Ground EJAt-Grade Mound 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. Dispersalirfreatment Area and Tank Information:
Design Flow (gpd) Design So.1 plication Rate(gpd/sf) Dispersal Are Required (st) Dispersal Are mposed (st) System Elevati
450 ✓ 0.7 ✓ 643 652 93.0 t%
LI 1V r n 0 Capacity in Total # of Manufacturer o
Tank Information 11�ViY Gallons Gallons Units f 0 9 0
W U
New Tanks Existing Tanks
iZ d m
a`U in N rn '4U
Septic or Holding Tank 1000 I 1000 1 Wieser ✓
Dosing Chamber
V. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) I Plumber's Signamr 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 ❑ Disapproved Pe'� ^it 'Fee Date Issued Issuing Aecm . ue
jwn❑Oer Given Reason for Denial l''I-'tions Approval/Reasons for Disapproval
a)Maw%W \DS 1 ownu'
Attach to complete plans for the system and submit to the County only on paper not less than 8 iR x II inches in size
SBD•6398car02/2 6IF WM1 t ngoxamJC /t%J
RECEIVED
Private Sewage System Maintenance AgreemetfC 291
fin/1NtbtTT 1 fit.S F
Planning and
)'iB5Z yoznd Sr. ciiZCL€ /N. S'TlLLuiri-et p,,.,j
Site,Address
lo(pi0.5 (0#/."fl rrWi YY. ON It)vt/L, w.=
TaxtD#
/56 2Z
As owner, I (we) do hereby certny 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 fisted location in accordance with rules established in the WI _
Adm. Code, as from time to time amended. (COMPLETE Legal is required)
DOCUMENT NUMBER
2O23R-601 636
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY, WI
RECORDED
12/21/2023 AT 1: 1 6 PM
RECORDING FEE: $30.00
PAGES: 1
114 of 114 Section -7 t Township 4 L N. Range 00 W.
Additional Legal Description:
Town of /rZotI y'tl✓en-s
Block Subdivision
(Acreage) 4"? Gait Lot
Lot 5 CSM # z75 Vol. .7 Page 41 CSM Doc # 3M'400
Return To:
Planning and Zoning Department
Area
a
In -ground gravity
❑ In -ground dosed
❑
In -ground pressure distribution Sewage System:
❑
Mound
❑ At -grade Sewage System
❑
Other
eotic 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
statation and at least once every three (3) years thereafter unless, upon inspection by a licensed master plumber or other person authorized to make
ich inspection, the tank is found to have less than one-third (113) of the volume occupied by sludge and scum.
imo 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
Love. The switches and pump controls shall also be inspected and maintained to ensure operability of said components.
antic Tank Effluent Filter (system types A through E): The septic tank effluent filter shall be inspected and maintained as necessary and in accordance
th manufacturers specifications. Filter maintenance reports shall be submitted to the County as required by SPS 383.55, Wis. Admin. Code.
ivate Sewage System Dispersal Cell (system types A through E): The private sewage system distribution cell shall be visually inspected by a certified
•ptage servicing operator, POWTS inspector, or licensed master plumber within three (3) years of the date of installation and at least once every three
I years thereafter to determine whether wastewater or effluent from the system is pending on the ground surface.
ounds At -grade, and In -ground Pressure System Laterals (system types C, D and E): The laterals shall be gushed out and swabbed if needed when
e wastewater distribution cell component is inspected as provided above.
vner(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
rpection, pumping, hauling, or otherwise servicing and maintaining the private sewage system tank in such a manner as to prevent or abate any
man health hazard caused by the system. Bayfreld County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days
m 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
ay be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the lax shall be collected as provided by law.
e leans and conditions of the agreement shall be binding upon and inure to the benefit of all current and future owners of such property.
> AIJ tr,rt .l'tsCi
a(s)
aftedby '7"7A4 Gr_Ait< Gile: __ fs v7
and sworn to before me on this date
�is r. c _ _ `�"'�`�° Qa��'��'•`{1,�S�LIZANNE M WINDETT
i 99-00 71 It NOTARY PNSLIC
— _-�� -MINNESOTA
My Commntim E'Yn 2wMry 31. a12S
...'OA 9Q)F 4
In -ground Gravity Management Plan DEC 212023
IMPORTANT: Bayfield Co.
Planning and Zoning Agency
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 = 450 gpd; BODS ≤ 220 mgL'1; TSS ≤ 150 mgL''; FOG ≤ 30 mgL-'
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 tanks) 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 filters) 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:
Phone: 715-798-3355
Local government unit address: 117 E 5th St. Washburn, WI
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.
Deb Kmetz
From: Mckenzie Slack
Sent: Friday, January 5, 2024 2:33 PM
To: Tim
Subject: RE: 66105 County Hwy H
Got it, thanks!!
McKenzie
From: Tim <tim@andryras.com>
Sent: Friday, January 5, 2024 2:31 PM
To: Mckenzie Slack <mckenzie.slack@bayfieldcounty.wi.gov>
Subject: RE: 66105 County Hwy H
My apologies. I may have checked the wrong box there. He is completely removing the trailer and it will be a
replacement system.
Thanks,
Timothy J. Clark PE
Manager — Septic Department
Rasmussen
& Sons. Inc
"A Family Owned Business Since 19x6"
From: Mckenzie Slack <mckenzie.slack(dbayfieldcounty.wi.gov>
Sent: January 05, 2024 2:28 PM
To: Tim <tim@andrvras.com>
Subject: RE: 66105 County Hwy H
This one states new system, but we are already tracking a system on the property. Will there be two systems on the
property or is this application for a replacement system?
McKenzie
From: Tim <tim@andryras.com>
Sent: Tuesday, January 2, 2024 10:10 AM
To: Mckenzie Slack <mckenzie.slack@bayfieldcounty.wi.eov>
Subject: RE: 66105 County Hwy H
Hi Mckenzie,
They must still have it at Register of Deeds. I'm sure I hand delivered that one.
Hope all is well!
Thanks,
Timothy J. Clark PE
Manager - Septic Department
Rasmussen
A--�;
w-mw or & $ous.lnc
A Family Osmed Business Since 1946"
From: Mckenzie Slack <mckenzie.slack@bayfieldcountv.wi.gov>
Sent: January 02, 2024 10:10 AM
To: Tim Clark <tim@andrvras.com>
Subject: 66105 County Hwy H
Hi Tim,
Hope you had a good holiday season! I am missing the maintenance agreement for Windett Trust. Just so you're aware.
Best,
McKenzie Slack
Assistant Zoning Administrator
Hayfield County Planning & Zoning
117 E Fifth Street
PO Box 58
Washburn, WI 54891
P: 715-373-3511
E: mckenzie.slack rrbayfieldcounty.wi. ogv
BAYFIELD COUNTY
SANITARY PERMIT (#04)-2401S
STATE SANITARY PERMIT
OWNER: WINDETT REV TRUST
GOV'T LOT: LOT: 5 BLK:
SUBDIVISION: Csm #235
1/4 114 SEC: 21, T 47 N, R 8 W
TOWNSHIP: Iron River
SOIL TEST: 04-24
REPLACEMENT SYSTEM
SYSTEM TYPE: Non -Pressurized In -Ground
PLUMBER: JASON KUETTEL
MCKENZIE SLACK DATE: 1 4 2 4
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: System to meet all setbacks. Management plan to owner. Properly maintain per
recorded agreement. Properly abandon existing system per SPS 383.
THIS PERMIT EXPIRES 114/2026
POST IN PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION