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HomeMy WebLinkAbout21-121SRequest for Sanitary Inspection (Fax this form to Zoning Dept when you want an inspection — 373-0114) Note: Time Change fl Discrepancy Other From Zoning Dept I I Phone Number Plumber: Fax Number HomeOwner: Sanitary Permit #: �} C7 / — i S Plumber's Choice Zoning Dept No inspection during these times 9:30 am —12:30 pm Tues. (Tracy) Thurs. Date: 9:30 am —12:30 pm (Tracy) Time: Plumber's Choice Zoning Dept Immediate Phone Number so Zoning Dept can call you right back (if needed) Township: D�v)\ Address # & Road Name: 2/2g��� bJe 7� Q /j �' o Directions I` Y ��� c To Site: Comments: P\ n /r ;.,c n v r A x., '_ ' Lit V �, t\_)((\ k' '-'%�- lull Reminder: You must confirm any change(s) that have been made prior to or this inspection will not be scheduled and a memo will be sent voiding the inspection. Thank You! * Plumber must verify any change(s) by fax or no inspection will be scheduled ** utfors!sanitary/repuestfonnspection Zoning Dept (@4/12104) n June 2018 Request for Sanitary Inspection (Fax this form to Zoning Dept when you want an inspection - 373-0114) From Zoning Dept Plumber: I Home Owner: -Qf Sanitary ' ^a l / S Permit #: I _ Plumber's Choice I Zoning Dept Date: Plumber's Time: �AA Township: Zoni t O� Phone Number Fax Number tts- 9:30 am —12:30 pm Tues. (Tracy) 9:30 am —12:30 pm Thurs. (Tracy) Immediate Phone Number so Zoning Dept can call you right back (if needed) Address #& & ' Road Name: �n �T� S ac or v �� Directions To Site: n Comments: Vi \ P k of Reminder: You must confirm any change(s) that have been made prior to or this inspection will not be scheduled and a memo will be sent voiding the inspection. Thank You! ** Plumber must verify any change(s) by fax or no inspection will be scheduled ** u/fortns/sanitary/reguestforinspection Zoning Dept (©4112104) © June 2018 Vic'onsin PRIVATE ONSITE WASTE TREATMENT SYSTEMS c POWTS) Department of commerce INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION .._-_. .. _._.. Pe it Ider'a N p City II ge T C Elev: Insp BM lev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG TO AIRRIINrAKE ROAD Septic I i I I NA Dosing I NA Aeration NA Holding PUMP! SIPHON INFORMATION Manufacturer Model Number TDH Lift I Friction Loss System Head TDH Ft Forcemaln Length Dia J Dist To Well DISPERSAL CELL INFORMATION DIMENSIONS Width I Length No of Cells SETBACK P / L Bldg Well WH WM of Nav INFORMATION CELL TO )ISTRIBUTION SYSTEM leader/Manifold I Distribution Pipe(s) annth Dia I Length Dia Sox Center ELEVATION DATA County 6MF,�fd Sanitary Permit No: State Plan Transaction ID#: STATION BS HI FS ELEV Benchmark Bldg. Sewer St / Ht Inlet St / Ht Outlet Dt Inlet Dt Bottom Installation Contour Header/ Man, Dist Pipe Infiltrative Surface Final Grade Type of System I I Manufactuter:.' LEACHING CHAMBER IModel Number: X Pressure X Hole Size ❑ Yes 0 ❑ Yes ❑ No 1 ❑ Yes ❑ No DMMENTS: (Include code discrepancies, persons present, etc 3��q�j ,tl � to l K /' ' c/ MOW eAck = yre/ ?21/2V At // ,�tt Mitanid was in l/V4t ca4v fM/• !oi 7'4sk n revision required?❑ Yes 0 No !Q 7 / ; 3 1 other side for additional Information Date POWTS Inspector's Signature Cert No reau of Field Operations, PO Box 7302, Madison, WI 53701-7302 //� /a if/BVst7o.nl A evtf real«j ? &C 4o'se N ,Ue4v Property Owner Information As you know onsite wastewater treatment system on your property (Tax ID# above). To know when your system will be due for servicing please go to www.seoticsearch.com HAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zonlna( bavneldcountv.orn Web Site: www.bavfleldcoufltV.0rg/147 Clarence Pratt 27220 S Pratt Rd Bayfield WI 54814 ID# 37154 21-121S (73-21) Tony Brown Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 was contracted by you to install a private Notes: Abandonment of Old System to meet all applicable code requirements: S• Tank was pumped by: C. Tank was crushed / removed and pipes disconnected by: on at AMIPM PM On at (AM / 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: tllformslsanllarypropartyownar-Input April 2019 :t�►�'q\ Industry Services Division County ' ' t=• 1400 E Washington Ave P.O. Box 7162 SanitaryPermNumber (to be filled in by Co.) �i� ` : Madison, WI 53707-7162 Sanitary Permit Application State Transaction Number In accordance with SPS 38321(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), m , Stats. I. Application Information — Please Print All Informs 2 Property Owner's Name L Le Parcel # c Property Owner's Mailing Address LI ' I- 6 .=' - Property Location 22 O ftft ,J._ Govt. Lot 5 '1.. 5 '/., Section ' City, State Zip Code J "`' " '-Pb'ofrt Nitinb c N i T Sly N• R D S rE oiL�bf/ II. Type o mitring (check all that apply) Lot # Subdivision Name 1 or 2 Family Dwelling —Number of Bedrooms3 Block # ❑ Public/Commercial — Describe Use 0 City of ❑ State Owned — Describe Use ❑ViVillage of 0Townof CSM Number III. TYPef Permit: (Check only one box on line A. Complete line B if applicable) A' New System ys ❑ Replacement System I ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. 0 Permit Renewal 0 Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: (Check all that apply) ❑ Non -Pressurized In -Ground ❑ Pressurized In -Ground 0 At -Grade 0 Mound? 24 in. of suitable soil Mound <24 in. of suitable soil ❑ Holding Tank 0 Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) I Design Soil Application Ratc(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) I System Elevation qs I Aso Wd' • o 0 . VI. Tank Info Capacity in Total # of Mamsfbcturer e , Gallons Gallons Units , '$ c' y _B New Tanks Existing Tanks a U rZ y iw V tt. Septic or Holding TankI O ! + X Dosing Chamber " D ____ VII. Responsibility Statement- I, the undersigned, assume respo pity for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's a MP/MPRS Number Business Phone Number 33 I 7r -oW Plumber's Ad (Street, City, State, Zip Code) -- Grp" VIII. County/Department Use Only -Approved J❑ 0 Disapproved Permit Fee $ 5)C) Date IssuedIssuing ~G Ja Agent Signature g- ! - 2' Owner Given Reason for Denial V 1 IX. Conditions of Approval/Reasons for Disapproval - -) p (- Attach to complete plans for the system and submit to the county only on paper not less than 8112 x 11 Inches an size SBD-6398 (R. 08/14) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County BAYFIELD Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM). direction and Parcel I.D. 37154 percent slope, scale or dimensions, north arrow. and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (ml). Property Owner Property Location ❑ TARA ALBERT / PRATT Govt. Lot SE 1/4 SE 1/4 S 8 T 50 N R 5 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 27220 S PRATT ROAD City State Zip Code Phone Number Ocity ❑ Village -Town Nearest Road BAYFIELD WI 54814 ( 715 )BAYFIELD I 779-985-5 S PRATT 0 New Construction UseEj Residential! Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material TILL Flood Plain elevation if applicable ft. General comments I-IOLDING TANK OR MOUND and recommendations: SYSTEM ELEVATION AT 100.4 ON 98.3 CONTOUR DESIGN LOAD RATE = .4 GPD/SQ. FT. SOME TREES TO BE REMOVED STUMPS LEFT IN PLACE I Boring # �0 Boring t' 1 Pit Ground surface etev. 98.3 ft. Depth to limiting factor 12 in. Snil Annlicatinn Rafe Horizon Depth in. Dominant Color Munsell Redox Description Qu. Si. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPO/if 'Eff#1 Eff#2 1 0-5 5YR3/4 SL 3MGR DL- CW 3M .6 1.0 2 5-12 5YR4/4 SCL 3MSBK DL AW 3F .4 .6 3 12-16 2.5YR4/4 CII' .`YR b'R SC 3CSBK DS AW 2F .2 .3 4 16-20 2.5YR4/6 t:2n 5YIt t»x SIC 2MSBK DSI I - 2F 2 .3 Boring # ❑ Boring 98.3 10 E] Pit Ground surface elev. ft. Depth to limiting factor in. Snit Arsnlication Rale Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff 'Eff#1 'Eff#2 0-5 5YR3/4 SL 3MGR DL CW 3M .6 1.0 2 5-10 5YR4/4 SCL 3MSBK DL AW 3F .4 .6 3 10-12 2.5YR4/4 CIf 51'8 'K SICL 3CSBK DS AW 2F .4 .6 4 12-18 2.5YR4/6 C't1 SYR i';;t SICL. 2MSBK DSl-I - 2F .4 .6 Effluent #1 = BOD > 30 a 220 mg1L and T55 >30 ≤ 150 mg/L - tmuent ii[ = tsuu < Ju mgrL ono + a.7 JU mgrL CST Name (Please Print) Signature CST Number BRUCE W BLAKEMAN I w /5� 708148 Address Date Evaluation Conducted Telephone Number 64903 CHARLES JOHNSON ROAD ASI (LAND. WI 54806 05'2712021 715-209-2569 Property Owner ALBERT/PRATT Parcel ID # ❑ Boring # Barrng Pit Ground surface elev. ft. Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff 'Eff#1 Eff#2 1 0-5 5YR3/4 SL 3MGR DL CW 3M .Ci 1.0 2 5-10 5YR4/4 SCI. 3MSI3K DL AW 3F .4 .6 3 10-12 2,5YR4/4 CIF5YR6/K SJCI. 3CSBK OS AW 2F .4 .6 4 12-18 2.5YR4/6 CCU 5YR 6/8 SICL 2MSBK DS1.1 - 2F .4 .6 37154 2 3 Page of 10 Depth to limiting factor in. Sniff Annlicatinn Rate Boring # D Boring a Pit Ground surface elev. ft. Depth to limiting factor in. Snil Annlinntinn Ratp Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDNf 'Eff#1 Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDfff 'Eff#1 Eff#2 'Effluent #1 = BOD, > 30 ≤ 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOO, < 30 mg/L and TSS < 30 mg/L The Department ofCormnerce is an equal opporlunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-315I or TTY 008-204-8777. SRD•R:?ATat IR 07 Ong -�.ART/PR4rT 3d3 �1 7r)L, of 3iyc4 C.-tV, k/zr 2c qcs `/ A --t - "A-13c'Vc— &RouN4 ' Rzc,vi f." f'rPLc lee'. A/C lItA.tL 47 Zs 7 . S/,2 7/2c 7c/V? N RTh- PROP. L x w . / 0/t S LL - � • uPc fYL LLB +1c E x � kkLL L, A '/d c,4 •otirT�•� DIVISION OF INDUSTRY SERVICES . - o� 2850 MIDWEST DR STE 104 v : des f4:;. D ' ONALASKA ONALASKA WI 54650 Contact Through Relay 9 3 $ p w �ROS5IONA�•5 www.wisconsin.gov Tony Evers - Governor Dawn Crim - Secretary July 27, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2023-07-27 Plan Review: PWTS-072101724-C ANTHONY PATRICK BROWN 315 Sanborn Ave Ashland WI 54806 SITE: Tara Albert 27220 S. Pratt Road Town of Bayfield Bayfield County SE, SE, S8, T50N, R5W Total Amount: $250.00 Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE FOR: Description: Three Bedroom Mound System 1 Sloping site Mound Component Manual — Ver. 2.0, SBD-10691-P (N.01/01, R 10112), 450 GPD, 10" depth to limiting factor, Maintenance required, Effluent filter, New construction The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Owner Responsibilities The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M Swim POWTS Plan Reviewer, Division of Industry Services (608)789-7892 — voice \ (608)785-9330 — fax ierry.swim(�wi.gov MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Indian Health Services Owner's Name: Tara Albert Owner's Address: Legal Description: Township: County: Subdivision Name: 27220 S. Pratt Rd Bavfield WI 54814 Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES SE SE S8 T50 N R5W DIVISION OF INDUSTRY SERVICES Bayfield Bayfield SEE CORRESPONDENCE Lot Number: Block Number: Parcel I.D. Number: 37154 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications * all design corrections were approved by the system designer Designer: Tony Brown Signature: ate_ i Credential No. 664303 I Phone: 715-292-0029 Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01). and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 7.0 (R. 03/2012) Page 1 of 7 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) RI Residential or Commercial Design 3000pj Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 450.00 Design Flow (gpd) 98.301 Contour Line Elevation (ft) 0.40 In -situ Soil Application Rate (gpd/ft2) Distribution Cell Information 80.00 Dispersal Cell Length Along Contour (ft) _ 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Pressure Disribution Information (C or E) E Center or End Manifold 2.82 Lateral Spacing (ft) 2 Number of Laterals 0.156 Orifice Diameter (in) 3.00 Estimated Orifice Spacing (ft) _ 1.50 Forcemain Diameter (in) 55.00 Forcemain Length (ft) 89.00 Pump Tank Elevation (ft) 4.55 System Head (ft) x 1.3 11.22 Vertical Lift (ft) 4.08 Friction Loss (ft) 19.85 Total Dynamic Head (ft) Project: Lateral Diameter Selection in. dia. options choice 0.75 1.00 1.25 1.50 x x 2.00 x 3.00 x Gallonslinch Calculator (optional) Treatment Tank Information 1600.00 Total Tank Capacity (gal) L i000.00l Septic Tank Capacity (gal) Total Working Liquid Depth (in) 1.R weiser Manufacturer gal/in (enter result in cell B49) Note: Sand fill (D) calculations assume a Table 383-44-3 in -situ soil treatment for fecal coliform of <= 36 inches. 5.63 Cell Width (ft) Are the laterals the highest point in the distribution Y network? Enter Y or N If N above, enter the elevation (ft) of the highest point. 8.34 ft2/orifice Does the forcemain drain back? I Y Enter Y or N 5.05 Forcemain Drainback (gal) 5x Void Volume (gal) Minimum Dose Volume (gal) System Demand (gpm) 72.04 77.09 29.08 Manifold Diameter Selection in. dia. options choice 1.25 x 1.50 x x 2.00 3.00 Dose Tank Information Effluent Filter Information 600 Dose Tank Capacity (gal) PolyLok Commercial Filter Manufacturer 16.76 Dose Tank Volume (gal/in) 525 Filter Model Number weiser IManufacturer Indian Health Services Page 2 of 7 Mound Plan and Cross Section Views 1 L Mound Component Dimensions A 5.63 ft E 30.73 in B 80.00 ft F 9.50 in D 26.00 in G 0.50 ft 450.40 (i2) Dispersal Cell Area 5.63 (gpd/ft) Linear Loading Rate H 1.00ft i 14.63 ft J 8.57ft K 12.47 ft L W 104.93 ft 28.83 ft 1620.76 (f9) Basal Area Available 8.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.26 (ft) --> H I ..__........_ Dispersal Cell 100.9 7 (if) Lateral 100.47 (ft) — ► — Invert Dispersal Cell [37 .. D Elevation 98.30 (ft) Contour Elevation 7.0 % Site Slope r' Geotextile Fabric Cover Shading Key a Dispersal Cell 1Q Topsail Cap c 1.5 ft ©" Subsoil Cap rn °4 O j2 kb ASTM C33 Sand 9 2 F LAJ Tilled Layer c IJ TVP�cal Lateral 5 ID y G] Aggregate v o .. —A Project: Indian Health Services See lateral details on Page 4 for number, size. and spacing of laterals. Laterals are equally spaced from the distribution cell's centerline in the distribution cell (AXB). Page 3 of 7 End Connection Lateral Layout Diagram atora s centerod o�rer r ? x B dim,rien 0 = Turn -up v, ball value or eleanoutplug to Ali laterals .are identical I<- x -4I Holes drilled on tho bottom 01 tho taterAl equally spaced Force mam connection via tee or cross to mantbld at anu eoint Laterals & forcemain Sch 40 PVC per S P S Table 384.30-S Number of Laterals 2 Lateral Diameter 1.50 in Lateral Length (P) 78.52 ft Lateral Spacing (S) 2.82 ft Lateral Flow Rate 14.54 gpm System Flow Rate 29.08 gpm Total Dynamic Head L 19.85 Ift Orifice Diameter Orifice Spacing (X) Orifices per Lateral Orifice Density Manifold Length Manifold Diameter Forcemain Velocity 0.156 in ft ft2/orifice ft in ft/sec 3.02 27 8.34 2.82 1.50 5.28 Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 SPS 316.300 WAC Disconnect . 4 in. min. Tank component is properly vented E- Alternate outlet location weiser tank Manufacturer Forcemain diameter 1.5 in. Capacity 600.00 Gallons Volume 16.76 gal/inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 20.40 341.90 C B 2.00 33.52 �_PumQ off elevation (ft) C 4.60 77.09 1 89.75 D 9.00 150.84 D Total 36.00 603.36 Dose tank elevation (It) 3" Bedding un er tank. 89.00 Alarm Manuafacturer SJE-Rhombus (or equal) Note: Switches Alarm Model Number I Tank Alert (or equal) equal) containing mercury may not be used in Pump Manufacturer 610 ,�, d!; ' this system. Pump Model Number - Pump Must Deliver I 29.08 gpm at [19.85 Ift TDH Project: Indian Health Services Page 4 of 7 Mound System Maintenance and Operation Specifications Service Provider's Name J Phone 7,5 373 s�Z1 POWTS Regulator's Name Phone 7 s " 138 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450.4 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Inspect and/or service once every 3 ears Should inspect and clean at least once every 3 years Test once every 3 years Should test monthly Laterals should be flushed and pressure tested every 1.5 years Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished e..•,......... N 6-8" Diameter Lawn Sprinkler Valve Box Distribution •...........s.. Threaded Cleanout Plug or Ball Valve g Sweep 90 or Two 40 Jegree Bends Same Diameter as Lateral Project: Indian Health Services Page 5 of 7 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01 /01)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33. Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 -inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under S. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113. Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment. maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October -February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5. 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu!100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. if the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. if the mound component falls to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. 7 Project: Page 6 of ITT RATINGS COMPONENTS Total Head (ft. of water) Gallons Per Minute EP04 EP05 5 53 - 10 46 62 15 36 55 20 21 46 25 0 33 30 - 11 Item No. Description I Impeller 2 Base 3 Pump Casing 4 Mechanical Seal 5 Ball Bearings 6 0 -Rings 7 Power Cord 8 Oil Filled Motor 9 Motion Housing/ Stator Assembly 10 Motor Cover 1 GOULDS PUMPS Wastewater METERS FEET 10 — —1 9 30—��.. _► F5 GPM._. 8 2.5 FT 7 6 20 a 5 2 4 EP05 O EP014 0 Op --- -10 20 30 40 50 GPM 0 2 4 6 8 10 12 m7h CAPACITY ra qq u .. ,'. LQ2RT pR#rrr � ..3Cf3 SC 5E 59 7 -S -C AIRS-kI 7l vN �1 4W c Uj 13Ay4cL4 7Y, h/ O2e ncs - / Ld ` P £oV/ L A - J1 -j (o u M3oVc C- oc,wv4 iN R 3aviV&4 /2" AFPGf. _ /DO, A/ (.tic[. ,47' Tss3ra_ .S-/a7/tea r (�s7 a� 7o 8/g �R-r* PROP. L -x Nc ,3%1 4I7j Aggregate cell of mound shall be staked out at a slightly higher elev. along the 98.3' contour (see page 3). 3 q 45fqO 41l'3 .240 3 BR 5chh1O'/ „pile /Q9.r1 o400 nt weiser combination tank tv 09 LE. 1cfE h WAJ khLL I /nr / 6m► .url 74? P/re's V.. 2x? SDB10M10 C2 o,'/o,) 4e/ , fA , &uiiip Pu.6i w >, . Adc fn q & cswre 2I/Ss Ivifwn ST -j,ts `al/&,me/ tsw �o� � Lr o 0 -tom-P 4", o i/o ) I ���,, Industry Services Division I County n =� •I 1400 E Washington Ave P.O. Box 7162 _ Senitary Peml' umber (to be filled in by Co.) Madison, WI 53707-7162 .qx..o./ i— GiI Sanitary Permit Application State Transaction Number In accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prim 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 Seats. I. Application Information - Please Print AB Infornra Property Owner's NameParcel # %GiuL C re ?10_ c 27I wnS-' Property Owner's Mailing Address = Property location 2 522o nI. Lot t f/z Sc ;i, sc '/., Section oY city, state Zip Code fleldGovt. ltmbNcNi. (�✓% __ 7/.1`'j-G14-oo Le -1 r (cireleon SD N: R OS Eow D. Type o ullding (check all that apply) Lot # WI or 2 Family Dwelling -Number of Bedrooms 3 Subdivision Name Block # ❑ Public/Commercial - Describe Uu ❑ City of ❑ State Owned - Describe Use ❑., Village of q ,J t.7 Town of ___ CSM Number ID. Type Permit: (Check only one box on line A. Complete line B If applicable) A. Ncw System ❑ Replacement System ❑ Treatment/Holding Tank Rcplacernent Only 0 Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: (Check all that apply) ❑ Non -Pressurized In -Ground 0 Pressurized In -Ground ❑ At -Grade ❑ Mmmd≥ 24 in. of suitable soil Edound <24 in. of suitable &oil ❑ I bolding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) I Design Soil Application Rate(gpdsi) I Dispersal Area Required (II) I Dispersal Area Proposed (at) I System Elevation I'7 SO I ySo. • o -9n� too .4"i VI. Tank Info Capacity in Gallons Total Gallons ;i of Units Manufacturer U '� C c New Tanks Existing Tanks 6U in rn V Septic err Holding Talc .t?GCI h4ot" L pars Dosing Chamber hot' VII. Responsibility Statement- I, the undersigned, assume res o Rity for Installation of the POWIS shows on the attached plans. Plumber's Name (Print) I Plumber' a MP/b1PRS Number Business Phone Number Plumber's Ad (Street, City, State, Zip Code) 3/s- 4ct. .70dcd VIII. County/Department Use Only -Approved I 0 Disapproved Permit Fee S I Date Issued 8-ia I Issuing Agent Signature ff-7—it ❑ Owner GivenReason fm Denial >N 14 4 a -7 v IL Conditions of Approval/Reasons for Disapproval Ct S s k-4fp,-o,/) P(c - / V mot • ,� � N Sy ( 4a 1 N t C V YK-a-.. 4— Anseb to complete plain for the system and submit to the County only an paper not less than 8 In x 1 I incite, to size SBD-6398 (R. 08/14) III ilili II I IIIII III III! INIIMIII I MI IIIil IUhi *2021R 590240 1* Private Sewage System Maintenance Agreement L•/r*K *ccc.C 1, r'a. vner(s) Mailing Address 7c90 o S . rl As owner I (we) do hereby certify the private sewage system will be Installed in accordance with the certified soil testers 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 SC 1/4 Section ______Township 50 N. Range 5 W Additional Legal Description: Town of .v'e (Acreage) Kul — Gov't Lot Lot_ Block Subdivision Lot _ CSM # Vol. _ Page _ CSM Doc # 2021R-590240 DANIEL J. HEFFNER BAYFIELD COUNTY, WI REGISTER OF DEEDS 08/10/2021 01:23PM TF EXEMPT #: RECORDING FEE: 30.00 PAGES: 1 Return To: Planning and Zoning Department Area ❑ 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 manufacturers 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 swam to me on this date: fO Z L�rFcr.Jc'� Ar1?r -- �2 before PiAL4jA; c Notarized Owner(s)— Signature(s) Notary P lic My Co nissio Ex Tres: G! fr Q Vic; p Drafted by-415ytict d r FmJ7 Date: RID -a'l A. ulfomis/sanitarylsepticmaintenceagreement Revised July 2020 BAYFIELD COUNTY SANITARY PERMIT (#04)-21-121 S STATE SANITARY PERMIT OWNER: CLARENCE D PRATT GOV c LOT: CSM: LOT: BLK: SUBDIVISION: SE 1/4 SE 1/4 SEC:08,T50N,R5W TOWNSHIP: Bayfield SOIL TEST: 73-21 NEW SYSTEM .� E -MAILED 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. a 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 #: SYSTEM TYPE: Mound < 24 in. of suitable soil PLUMBER: Tony Brown Todd Norwood DATE: 8/12/2021 Authorized Issuing Officer LICENSE: # 664303 Condition: Conditions per State approved plan. Maintain system per recorded document. THIS PERMIT EXPIRES 8/12/2023 POST IN PLAIN VIEW MUST BE VISIBLE FROM ROAD FRONTING THE LOT DURING CONSTRUCTION