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Home My WebLink About23-190SINBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY '` • TIME RECEIVED REMOTE CSID DURATION PAGES STATUS January 9. 2024 at 10:09:07 AM CST 7157983470 36 1 Received JAN/09/7n24/TNE 09:57 AM Andry Rasmussen & So FAX No. 71E7983470 P.001/JJI Request for Sanitary Inspection (Fax this form to Zoning Dept when you want an inspection — 373-0114) Note: � Time Change Discrepancy fl Other From Zoning Dapt Phone Number Plumber: N �� % Is 7 3 3SS J j LuSs< Fax Number 71S ?58 -'3y7O HomeONmer: �or hPO.� `�0�5(�IQtU Sanitary Permit #: 13 Plumber's Choice Zoning Dept No inspection during these times Date: ' /'oI 9:30 am —12;30 pm Tues. (Tracy) 9:30 am —12:30 pm Thurs. (Tracy) Time: Plumber's Choice Zoning Dept Immediate Phone Number 00 PrA so Zoning Dept can call you right back (if needed) Township: Address # & Road Name: or (Dtla3o I l-7Qu ( f fl V Directions To Site; Comments: Reminder You must confirm any changes) that hava been made prior to this ins ecfion w1!l not be scheduled and a memo will be sent voiding the inspection. of — --- -- ---- ------ — -- — Thank Yew r.s Plumber /e1'tIj any c/;arlge s) by fax or 110 %r15Lt/on S'/lI f he scJ?ec/L//ecj "« o`I >ro� as Industry Services Division General Information Permit Holder': Tank TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road Septic N/A Dosing N/A Aeration N/A Holding Private Onsite Wastewater Treatment Systems ( POWTS) Inspection Report (Attach to Permit) :ORY M & LEAH M HOLSCLAW ?0 BOX 622 :RON RIVER WI 54847 setback to: of: 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 Manufacturer: Model Number: Pretreatment Unit Manufacturer: Model Number: Distribution System Elevation Data STATION BS HI FS ELEV Benchmark Bldg. Sewer Tank Inlet Tank Outlet Dose Tank Inlet Dose Tank Bottom Inst. Contour Header I Manifold Distribution Pipe Infiltrative Surface 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 ❑ No Soil Cover Depth Over Depth Over Depth of Seeded I Sodded Mulched Cell Center Cell Edges Topsoil 0 Yes 0 No 0 Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) oPe kcA y., S,5� c , I/, I +�, on?j7kI K W/r,%er4sd Ckar i ,vl Tis%M c v(rN9 �'°ti ` lrl5Y��t/Wry 7�G �n spy y1>So.'ls •GfG'(p3%// �yt�7d�' Plan revision required? 0 Yes 0 No / „/ Use other side for additional information. NY Date RRn_R71n /R nv0'I\ POWTS Inspector's Signature License Number Property Owner Information As you know BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoning bayfieldcountv.wi.gov Web Site: www.bayfieldcountv.wi.00v/147 CORY M & LEAH M HOLSCLAW PO BOX 622 IRON RIVER WI 54847 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: C• Tank was pumped by: 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 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/lormslsanitarypropertyowner-input April2019 C)CPFIVED ••"'"`"`vr,� Industry Services Division 4822 Madison Yards Way County Bayfield DEC 13 2023 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53705 err • Bayfield Co. I Zoning Ag' lc1 P.O. Box WI 7537 Madison, 53707 planflln and 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 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. 15.04(1)(m), Slats. 67230 N Gravel Pit Rd. Iron River, WI 1. Application Information — Please Print All Information Property Owner's Name Parcel # Cory & Leah Holsclaw 38717 Property Owner's Mailing Address PO Box 622 Property Location I 5 ry (b of y►/yry Govt. Lot I/ ✓✓✓��__✓✓��,,� City, State Zip Code Phone Number Iron River, WI 54847 715-372-8908 SW A Section 17 T47 N ROB Eo II. Type of Building (check all that apply) Lot ✓❑ I or2 Family Dwelling— Number of Bedrooms 1 SubdivisionName Sid P Public/Commercial — Describe Use Block # City of State Owned —Describe Use Village of CSM Number Town of Iron 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) flAdditional Pretreatment Unit (explain) Holding Tank ZIn-Ground ❑At -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. Dispersal/Treatment Area and Tank Information: Design Flo(pd) 150 ✓ Design Soil Appr'cation Rate(gpd/sf) ✓ I Dispersal At a Required (sf) Dispersal Area P posed (sf) System Elevation ✓ 0.7 215 ✓ 252 95.5 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units $ v g New Tanks 15 Existing Tanks 0.0 rn ti Septic or Holding Tank 320 V 320 1 Wieser ✓ Dosing Chamber V. Responsibility Statement- 1, the undersigned, assume responsibil for installation of the POWTS shown on the attached plans. Plumber's Name (Print) I Plumber's Si 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 0 Disapproved Pe it Fee $ [e Issued r�/ Issuing Agent S' lure /&'/5. a ❑ Owner Given Reason for Denial cT ` ( Conditions of Approval/Reasons for Disapproval i) SyS M 10 wiet co aIvat4fs. SPQ Quid r UM� I sipvn1 pkui fry awf Atmcn to compiese pians for Inc system and suomit to the County only on paper not less than s is z 11 inches in ,in SBD-6398 (R. 02/22) RECEIVED DEC 13 2023 Wisconsin Department of Safety& Professional Services Pa e / of 77 l " 9 s •.� S_ Division of Industry Services Bayfield Co. �$Ps Y SOIL EVALUATION REPOR nningandZoningAgen�y*`g,5 — County `+` In accordance with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches In size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by 1f�/( Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). 1 Y 1 I /a -/5.23 Property Owner Property Location ❑ EI Golt'l 9— LL j i- (jo 1jcL4W Govt. Lot Sl-1 '% St Y. S /7 T z/7 N R o& E (or) W Property Owners Mailing Address Site Address or CSM and Lot #: Po eac 62z (p723A /v (o5ZAvrt Pit IZt City, State, Zip I Phone Number ❑ City ❑ Village 1I Town I Nearest Road /2°n c2'sveu, v 5 feNj (75 )flz S4n£s iw-'ec N 62.vtV&- Qt'r J@ New Construction Use: 19 Residential/ Numberof bedrooms t Code derived designflow rate /S GPD ❑ Replacement ❑ Public or commercial —Describe: Flood Plan elevation if applicable ft. Parent material o' t ai Fb General comments and recommendations: '7tS 1 bN TO O. Boring# ❑Boring P(Pit Ground surface elev t99 ft. Depth to limiting factor %4 d in. / elev. /•°'(yt. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 -Eff#1 Eff#2 0'7 )S1t'/7 oS G /t- d --I- ,^7 /,b 3 1a-70 7,5_t4J2 - S ( BsG r f7.7 I. y_ LzJBoring # ❑Boring cc77pp [APit Ground surface ele•° Z ft. Depth to limiting factor >9Z in. / e1ev ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 'Eff#2 o -G, 5 T(- I o5G ✓f.1 t 1 I4 ) /. 2 3 re 3c 7o-rL7•S'rA 7,5 IC/f_s/1 —. S os G 6SG MI lob /4t{-. I 0•'7 7 I. 9. _s.J CST Name (Please Print/'Signature CST Number /•'^ (Yid '? / pooZj Address Date Evaluation Conducted Telephone Number t°C6& 6& estere w`3 e 7/-t Ir- 79P -73SS Effluent #1 = BOD > 30s 220 mg/L and TSS > 30 5150 mg/L • Effluent #2 = BOD, 5 30 mg/L and TSS 530 mg/L SBD-8330 (R03122) Page Z- of ❑ Boring Boring # Pit Ground surface ele . B I11 ft. Depth to limiting factor in. / elev�_h11ft. Snil Anniiratinn Rata Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 o 7 s 'c'z ½' S o.C� 6'u 4- O 1 I ❑ Boring # O Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I nil Annlinofinn 4?ofn I Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 s 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS s 30 mg/L CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. 51SOIL EVALUATION 0 Scale: 1" 13 2023 SYSTEM PAGE 2 OF 30 45 60 SITE MAP PROJECT NAME: PLOT PLAN sncy DESIGN FLOW: 15O GPO Attach design flow calculations for commercial plans. PROJECT ADDRESS: 7 Z30.' PIT 2�≥ Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) N �QD . O SanitarySewer. / BM Symbol: -4- BM Elevation: FT BM Description: -70-P Force Main: / Slope Gradient(%) Indicate north by IMPORTANT: of Tested Area: -A"� Weil Symbol (if applicable): 0 drawing an arrow Show ground elevation contours at suitable intervals. on the appropnte line. �-�''a`i1 ,S'L- 4 7230 N 6c- (2('-'(— , . Lb!: .L_S14k -'?,7tL{"J; '_° - I - -' I , — 1t !t1'/l ii-ff I tP 7. • s t — U < <cJ0 . d -to P tLIP— I, f _L.- N 1__ 1 I i I T IlILT. I F t I i1[1 I ! i_ J ' IlLI.. ;. . _ _ ,may • , , - - .zs----,- i 3 rI # E { I r i RECE )VED In -Ground Gravity Plan DEC 1 Index & Cover Sheet sayeold Co. Planning and Zoning Agoncy Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) PAGE 1 OF 4 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: POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Holsclaw Sh Owner Name(s): Cory & Leah Holsclaw Owner Address: PO Box 622 Iron River, WI Phone: 715 -372 -8908 Zip: 54847 Project Address: 67230 N Gravel Pit Rd. Iron River, WI Govt. Lot: SW 1/4 of SE 1/4, Section 17 , T47 N -R 08 E ❑ or W ❑✓ Township: Iron River County: Bayfield Project Parcel ID #: 38717 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 Signature: � Date: t z r3 z? Origins i ature required on each submitted copy. RECEIVED CHECK BOX AS APPLICABLE. DEC 1 3 2023 CHECK BOX AS APPLICABLE. ❑ SOIL EVALUATION Scale: 1"=30 ❑ SYSTEM PAGE 2 OF (Payf eld CA. _ 30 45 60 SITE MAP PROJECT NAME: pii'w'-. PI ®. PLOT PLAN DESIGN FLOW: DSO GPD Attach design flow calculations for commercial P fans PROJECT ADDRESS: b fl3o, 3o,6Rr.vCt per (2D Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) BM Symhol: 6M Elevation: /00.0 FT Sanitary Sewer: / Force Main: / SM Description: 7P IJtLC__ Slope Gradient(%) of Tested Area: Well FLA- r Symbol (if applicable): Indicate north by drawing an arrow IMPORTANT: Show ground elevation contours at suitable intervals. on the appropnte line. QW/V � c F LEE,y /-DLSCL }t J cv1saZSS : („7Z3cE6-c-: yrJ)N o 1 _ (/ZOIv z ✓cam CiczCo. 3a.5S ,4-crzeS _ 1b ' 3 nt U7lr- /JD.C ZtP uel,l 9i.d2 Thflr a�z (�G7 zv• q)..lu<L - NIT 1z/1?�z3 -12 1 W�-p ri IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard -W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER 12" min. Uench depth (typical) min. 12" (typical) Septic Tank(s) Manufacturer. Wieser Septic Tank(s) Volume(s): 320 gal gal gal gal Effluent Filter Manufacturer: Orenco Effluent Filter Model #: FT -0822 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) System Elevation = 95.5 ft (typical) Quick4 Standard -W w/ End Cap (Show location of inlet / outlet pipe connection on plan view.) (typical) r—-----------t---------t---- d � L B= 24 ft (typical) INSTALL PER TRENCH: 6 Quick4 Std -W @ 201€ EISA/chamber = 120 ft' + 1 Pairs of end caps @ 6 ft' EISA/pair = 6 ft' = Proposed EISA per trench = 126 ft' 'U =O m rn Provide minimum 3 ft separation between trenches. o a _ Observation Pipe (typical) Install per manufacturers / instructions. TYPICAL TRENCH PLAN VIEW (No Scale) IA=3.0ft (typical) `Quick4 Standard -W Chamber (typical) (mfd by Infiltrator Systems, Inc.) Install pursuant to manufacturer's instructions. Required Infiltration Area = 215 ft' x 2 trenches = Proposed Total EISA = 252 ft' Distribution Method: branched manifold O m W O m S.?TIC TA'V CROSS==TIO?I A.P+n 5. 1: 1c?.TiGPI� 4" SC114oPVC INSP. crap 6 rr MIN. P.30Vi GRD'(opt) {When cnle+ tna foie 4s buried ) J FINISHED GRADE II 18" NIN. I ILET APPROVED PIPE 3' ONTO SOLID SOIL aPPR D ?A -F —E- 0 FILTER --- M FG . OVAvtCO model Q 'T-0$ZZ 3" APPROVED BEDDING UND;eP. TAN}, SPEuFICATIOPIS SEPTIC TANK HANUtAC?LfREa: WitStiL UNC(jt7- TANK SIZES: SE?TIC 3 GAL. NOTES: RECEIVED DEC 13 2023 APPROVED BayeeidCo. MANHOLE Planning and Zoning Agency W/ L&s 4 W�IZ�iiur LABEL Orr KIN. OUTLET r Bayfield County, WI 12/15/2023, 8:12:28 AM 1:3,473 Nonmetallic Mine Lakes jrt Wetlands ,_.__._! Approximate Parcel Boundary Rivers Road Type — County Town Building Footprint 2015 • Building 0 0.04 • 0.09 • 0.17 ml •0 • 0.05 0.1 • 0.2 km Bayged County Land Records Department Baygeld Costly Zoning Application htlpa:/Maps.baylieldcountywi.govlZoningWAB/ • x2/1542":12 AM Novus-Wisconsin Access rev. 12.0206 • Real Estate Bayfield County Property Listing Property Status: Current Today's Date: 12/15/2023 Created On: 2/8/2022 8:28:43 AM Description Updated: 2/8/2022 a Ownership Updated: 2/8/2022 Tax ID: 38717 CORY M & LEAH M HOLSCLAW IRON RIVER WI PIN: 04-024-2-47-08-17-4 03-000-12000 Legacy PIN: Billing Address: Mailing Address: Map ID: CORY M & LEAH M HOLSCLAW CORY M & LEAH M Municipality: (024) TOWN OF IRON RIVER PO BOX 622 HOLSCLAW STR: 517 T47N R08W IRON RIVER WI 54847 PO BOX 622 Description: PAR IN SW SE LYING S OF HWY IN DOC IRON RIVER WI 54847 2021R-592802 Recorded Acres: 0.000 10 Site Address * indicates Private Road Calculated Acres: 30.550 67230 N GRAVEL PIT RD IRON RIVER 54847 Lottery Claims: 0 First Dollar: Yes ® Property Assessment Updated: 6/9/2023 Zoning: (AG -1) Agricultural -1 ESN: 118 2023 Assessment Detail Code Acres Land Imp. r G1 -RESIDENTIAL 1.000 6,000 26,900 V Tax Districts Updated: 2/8/2022 G5 -UNDEVELOPED 9.550 4,200 0 1 STATE G6 -PRODUCTIVE FOREST 20.000 34,000 0 04 COUNTY 024 TOWN OF IRON RIVER 2 -Year Comparison 2022 2023 Change 163297 SCHL-MAPLE Land: 38,600 44,200 14.5% 001700 TECHNICAL COLLEGE Improved: 0 26,900 100.0% Total: 38,600 71,100 84.2% yr Recorded Documents Updated: 3/15/2006 ® WARRANTY DEED Date Recorded: 12/28/2021 2021R-592802 Property History ® WARRANTY DEED Parent Properties Tax ID Date Recorded: 11/16/2018 2018R-575416 04-0242-47-08-17-4 03-000-10000 19436 ® WARRANTY DEED Date Recorded: 1/8/2016 2016R-561916 1154-757 B TRUSTEES DEED Date Recorded: 2/15/2011 2011R-537283 1057-950 0 CONVERSION Date Recorded: 464709 695-396;797-738 HISTORY ® Expand All History White=Current Parcels Pink=Retired Parcels ® Tax ID: 19436 Pin: 04-0242-47-08-17-4 03-000-10000 Leg. Pin: 024104207000 38717 This Parcel t Parents Children https:/Inovus.bayfieldcounty.wi.gov/access/master.asp?paprpid=38717 1/1 mr.e%FIVED Industry Services Division 4822 Madison Yards Way County Bayfield DEC 13 2023 Sanitary Permit Number (to be filled in by Co.) /q(2S n3� l Bayfleld Co. Madison, WI 53705 P.O. Box 7302 In and Zoning Ag na/ Madison, WI 53707 !/NJ � y 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 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. 15.04(1 )(m), Stats. 67230 N Gravel Pit Rd. Iron River, WI I. Application Information — Please Print All Information Property Owner's Name Parcel # Cory & Leah Holsclaw 38717 Property Owner's Mailing Address PO Box 622 Property Location y Yti '5, Govt.Lot (,�f City, State I Zip Code Phone Number Iron River, WI 54847 715-372-8908 Sw 'I ¼, Section 17 T 47 N R 08 E o II. Type of Building (check all that apply) Lot 4 ZI or 2 Family Dwelling — Number of Bedrooms I R r" Subdivision Name prof ❑Public/Commercial — Describe Use Block if ❑City of State Owned — Describe Use Village of CSM Number ❑Town of Iron 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 if s licable. A. ZiNew System Re lacement System n^ Cher Modification to Existing System (explain) Additional Pretreatment Unit (explain) B' ❑Holding Tank 17]In-Ground 114t -Grade Mound Individual Site Design Other Type(explain) (conventional) C. ❑ Renewal Before ❑Revision Change of Plumber JI'ransfer to New Owner List Previous Permit Number and Date Issued Expiration NA IV. DispersaVfreatment Area and Tank Information: Design Flow,(gpd) ✓ Design Soil Ap cation Rate(gpd/st) Dispersal Ate -Required (sf) ✓ Dispersal Area P oposed (s}) System Elevation ✓ 150 0.7 215 252 95.5 Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units P U E v NewTanks15 Existing Tanks o.0 rn w y Septic or Holding Tank 320 320 1 Wieser ✓ Dosing Chamber O Li E1 V. Responsibility Statement- I, the undersigned, assume responsibil' for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sin 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 0 Disapproved P�ioot 1 LC ate Issued Issuing Agent S Lure Cr- 5.a ❑ Owner Given Reason for Denial '(�� f� Conditions of Approval/Reasons for Disapproval Yv �.pr jl lit.rc i �CU'. lan1 k2 OW ) /a'�, Attach to complete plans for the system and submit to the County only on paper not less than 8 in x 11 inches in size SBD-6398 (R. 02/22) �-e� a -F �SCi7p�0N Private Sewage System Maintenance Agreement otl M HaU'c Lnu T — J vet P,T- IZt 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) ,S W 1/4 of Sc 1/4 Section I7 Township -1 N. Range O _W Additional Legal Descriptio- .S-'' of Cs'-tJ17 FrwT H Town of I Rota Aa Rt 1l e'— (Acreage) SO . S - Gov't Lot Lot_ Block Subdivision Lot _ CSM # Vol. _ Page _ CSM Doc # DOCUMENT NUMBER \ / 202 3R-60 1 548 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY, WI RECORDED 12/13/2023 AT 1: 1 2 PM RECORDING FEE: $30.00 PAGES:1 RECENbD DEC 14 2023 Bayfeld Co. Planning and ZoningAg®tlCyinq Area Return To: Planning and Zoning Department II 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 -round 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. Hayfield 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 maybe 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 p opORyt I ii, �•% CASEi, Owner(s) Name(s) — Please Print czt tst.LR' Le -f FMLJ rh t J Subscribed and sworn to before me on this date,," ��ag,a3 " - i gym: NT 1AR} A Notarized Owner(s Si ture(s) U/ Notary Public Cot yam:• DeNa� = o yC •.. .: My Commission Expires: /i 3_U -a ..,.. k/S CONS%N r//t ltitt� V Drafted by: '77t- CL640— Date: h 3 Proofed by: u/forms/sanitary/septicmaintenceagreem ent Revised July 2020 RECEIVED PAGE4OF4 DEC 1320231n -ground Gravity Management Plan IMPORTANT_:_ Bayfield Co. nmming 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 = 150 gpd; BOD5 5 220 mgL"'; TSS ≤ 150 mgL"'; FOG ≤ 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: 715-393-6138 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. BAYFIELD COUNTY SANITARY PERMIT (#04)-23-190S STATE SANITARY PERMIT OWNER: CORY & LEAH HOLSCLAW GOVT LOT: LOT: BLK: SW 114 SE 1/4 SEC: 17, T 47 N, R 8 W TOWNSHIP: Iron River SOIL TEST: 185-23 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: JASON KUETTEL MCKENZIE SLACK DATE: 12/27/2023 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 system per recorded agreement. THIS PERMIT EXPIRES 12/27/2025 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION O