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HomeMy WebLinkAbout08-180SU NOV-05-2008 09:34 ANDRY RASMUSSEN & SONS 1 715 79B 3470 P.001/001 Request 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 ''' Plumber must verify any change(s)by fax a[ no inspection will be scheduled " Phone Number Plumber: n� Fax Number gP-3(F?0 Home Owner: (Zebt-f C' ay..._tscyc\ Sanitary Permit #; Plumbers. Choice Zoning Dept No inspection during these times Date: na 11:30 am -2:30 pm Tues (Doug) 4dg > after 1:30 pm Thurs (Doug) 9:30 am —12:30 pm Tues (Mike) 9:30 am —12:30 pm Thurs (Mike) Time: Plumber's. Choice Zoning Dept Immediate Phone Number so Zoning Dept can call you back if needed ?Q8-nr( Township: nn- Address # &r Road Name: (.— Lf!^cz ≤T 4 L�� v or Directions To Site: Comments; Reminder: You must confirm any change(s) that have been made prior to or this Inspection will not be schoduled Hid a memo will be sent voiding the inspection. Thank You! I. U, Fomu,requesaorsannarynnspecbon Zoning Dept (4112)04) Revised: June 2005 Received Time Nov. 5. 9:40AM TOTAL P.001 PRIVATE ONSITE WASTE TREATMENT SYSTEMS \-*1�COI'ISII� (POWTS) Department of Commerce INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) GENERAL INFORMATION Aorrnn.�l infnrmntinn vntl nrn{77l1P m9V lip IIcM fur cpprun l ury r iirnnepc r Privnev i nw c 1 i.(14 f 1 Nm'l 1 P t Holder's ame: • 0 City ❑ Village ❑ T of: CST BM Elev: Insp BM Elev: BM Description: tOO.OO o IF_1►I:�I►1191N iFAIWZI TYPE MANUFACTURER CAPACITY Septic 7foo (41L-OJ Dosing _ Aeration ixo — - k- Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG ARI TANTAKE AiR ROAD Septic }5 ' eo` a 3o' } to ' NA Dosing NA Aeration NA Holding PUMP / SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Los System Head TDH Ft Forcemain Dia Dist. To Well ■Ill 1 R►k►L1 I1 101►`Ia@]11 \1[•]►` DIMENSIONS Width Length No of Cells SETBACK P / L Bldg Well OHWM of Nay INFORMATION Waters CELL TO ��4ZkvrII$]►111_rr=l County fL Sanitary Permit No: 044400 /801 State Plan Transaction ID#: Parcel Tax No: STATION BS HI FS ELEV Benchmark Eco.o� Bldg. Sewer St I Ht Inlet ^S. 5 St / Ht Outlet . $ Dt Inlet Dt Bottom Installation Contour Header / Man. Dist. Pipe l Infiltrative Surface o = '7.- Final Grade Type of System LEACHING CHAMBER Manufacturer: (col "y lJE 644r Model Number: X Pressure SvstAms nniv Header! Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length Dia Length Dia Spac Spacing 0 Yes 0 No OUIL t:UVI K Depth Over Depth Over Depth of Seeded I Sodded Mulched Cell Center Cell Edges Topsoil 0 Yes ❑ No 0 Yes 0 No COMMENTS: (Include code discrepancies, persons present, etc.) O)e 10 .Mof j1� ufut-( -ho�S c E 'noU 6S 0 ` 7 Auw ^ 4 r""9 C ti - 6k -J9- tam OG41M Plan revision required?❑ Yes 4 No K 7 OS Use other side for additional information Date POWTS Inspector's Signature Au- J fk + 6f 2 t Q S b Cert No Bureau of Field Operations, PO Box 7302, Madison, WI 53701-7302 SBD-6710 (R.3/01) Se eo Property Owner Address As you know BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoning(a�bayfieldcounty.org Web Site: www.bayfjeldcounty.org/zoniflg Robert / Joanna Carlson 4001 Thomas Ave Minnetonka, MN 55345 Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 City State Zip Code A Pc Aos` d + SOJS was contracted by you to install a private onsite wastewater treatment system on your property described as: 1/4 of Govt. Lot 4 Lot 1/4, Section 27 , Township 'Fl N., Range _____W. Town Block Subdivision CSM# Volume Page of Deeds Parcel I.D# 7k— 10(pLI -6 - 000 Acreage Additional Legal On t t'l*4-- b Zco4 at toy AM PM) the above -mentioned plumber contacted our office to conduct a pre -cover inspection as required under Comm 83. One of the following applies: IRS- (f&4CE tiW t" 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. flSystem 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 $40 fee is required. 'System could not be inspected because County could not respond to plumber's time constraints. Comments: U/forms/sanilarypropertyowner-input2 October 2005 KLKldak T00'd 1Y,LOL WdL5�8 L 'noN awI1g - gv pania3a� Rvic�c�t y 3oar�:� �• �.�o,� Sao?�o SCG le; !„_ ' rrt I ,AYt E 1k1 1 I N ter✓ ' :.CpI �) i,q - z qo + Lak4 (s; 40-4-+ Lake r d G,L SL7, r47N, ,C2cJ Town of Ii -o' VQ%%Jcr Ye T&. k Qln lt.1* T&k ,kLtLeL c+e . C Je 40:160 w OrF•r�c, .l , hr E1c��tkn tV4Wt'LL 11n Codf G So►'5 si F] TOO/T00'd OLirC 86L 9TL T &Q+ Noose ioo'` Th o4 WF11 (L14' ill, 6.L1) $ � + F4 . 9 , B Z; AG \ ,q: fOo. ' sT..-tnkt r gs. (&' 1 I, 0j(4gLf.qg Drjwd1 Z 84.7' \• ) gi.o' 1 ' W1eLL ♦ `� Ca1a� LCAU4 C %T ` v .. gy:s w• s rj r). q t 83 /2q% rive SNOS '8 xsssu1WSY2i A aNY 09:80 8003-LO-noN W(6tutck. '} commerce.wl.gov Safety and Buildings Division- County 201 W. Washington Ave.. P.O. Bo x162 Qe � i isconsin i n Madison. WI Sanitary Permit Number (to be tilled in by Co.) Department of Commerce Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(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 the Department of Commerce. Personal information you provide may be used for secondary Project Address (if ditl'erent than mailing address) purposesin accordance with the Pnvacv Law. s. 15.0411)(m). Stats. (" ;' - —� 1. Application Information — Please Print All Information Ii : ; } (OS ass --f- Lk Property Owner's Name i NOV! t��jH J'o ctvw Ca. -I soyi �', .f �'° ,, $ �c.c7 r�' a i r i� jj Os --o-0 Property Owner's Mailing AddressU 4001 ' 1 h.oma S iayiseki Co. Caning Dept. Property Location City, State Zip Code Phone Number �/� L iAN SS Govt. Lot 4 '/•. '/., Section 7-% V t �1 il1�.TC?Yx 3 V 9 �p1A —%/9 — a-,3 Q (circle one) t�% 'D€J 11. Type of Building (check all that apply) Lot # T N R 8 I or 2 Family Dwelling — Number of Bedrooms Subdivision Name Block # ❑ Public/Commercial — Describe Use ❑ City of ❑ Slate Owned — Describe Use CSM Number 0 Village of gown of iQ(U I11. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System 0 Replacement System � TreatmentaF4olding Tank Replacement Only ❑ Other Modification to Existing System )explain) B. ❑ Permit Renewal 0 Permit Revision 0 Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 1/9 3 7 y a —76-79 7/33 /7Sr IV. Type of POWTS System/Component/Device: (Check all that apply) Non -Pressurized In -Ground 0 Pressurized In -Ground 0 At -Grade ❑ Mound > 24 in. of suitable soil 0 Mound < 24 in. of'suitable soil ❑ Holding Tank 9Other Dispersal Component (explain) ( ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Ratelgpdst) Dispersal Area Required (st) Dispersal Area Proposed (st) I System Elevation 4 SZJ • `7 e ' -kv� eta "3'7. W kZ s -h i) u) , VI. Tank Info Capacity in TOal # of Manufac&rer Gallons Gallons Units = New Tanks Existing Tanks V u 'N 0. CJ N iA . Septic or-Woldi� Tank 1 f Ooo (ow »�,u sse�..e I I Dosing Chamberr VII. Responsibility Statement— 1. the undersigned, assume responsibility for installation of the POWTS shown on the attached plates. Pjllumbe 's Name (Print) Plumber's Signature MP/M�FIS Number Business Phone Number f7- �Si'Y4C.tS�s't� �.S _ ZZ(V � 7►S F-33.r.� Plumber's Address (Street. City. State. Zip Code) P o `3_. ( (, w z 5 f2-/ Vlll. County/Department Use Only Approved ❑ Disapproved Permit Fee Date I. ued Issu' A t4Siatur S Ii1/o6 I ❑ Owner Given Reason for Denial I IX. Conditions of Approval/Reasons for Disapproval Recd for Issuance Attach to complete pious for the system and submit to the County only on paper not less than S its a 11 inches SBD-6398 (1L 01/07) Valid thru 01/09 11 Oct 23 2008 6:49 JOE ZIRN SOIL TESTING 715 765 4608 p.1 Moorish Department of Commerce SOIL EVALUATION REPORT Page of Div cnolSsbty and Buldtngs In accordance with Comm 85.1Ms. Adm. CodeI Coutnh► Attsdr complete site plan of paper not lei than 0 112*11 11 Inches M size. Plan maust i brdude, but not imbed to: vertical and horngorttel ralremnoe point IBM). direction and Peroet I.D. - O P y oP - '/7-.O? -27-'f perdatope,eode ordmenslons, north rmwand location and distance to nearest road. oc- oo - O'700o S? Please print p 11 infontrtlon. Reviewed by Date Punossl leftmo$oa you pro t e maybe used TK escondary pwpos.s.(Pnvscy Low. s. 15.04 (1) (m)). Property Owner ; 1 Property Location 19oGtr f " 'f' �C'iv' C�tl• iSa'in Govt. Lot 114 114 S .97 T Y7 N R g W PiopeAy Owners Mating Address Lot 0 Block d Sut,d. Name or CS $ City State Zip Code Phone Number ❑ City 0'.q a2e jj Town Nearest Road min�Ie�o��4c fl21VS 3Y tGI 7/q3710 Groh IPwev� l �-f' I - c /P� 0 New Conattvution Use: ® Residential V Number of bedrooms 3 Code derived design flow rate 4'Sa GPD IN Replacement ❑ Public or c 4mrttsrdal - Describe: Pow material C _4 c,[ a / ► /// Flood Plain elevation If aopricable f'4'._ 71.0_ ft. B % Aj LIa 14.5' kv rsf - d 7Mrtt f' cSe c..'t / -4- rIP�/s 77.11 o.w. dertarsl ODlMnerBa �1n •� �� r,/ �JG6% e 9 f[ ['t �D and f ! : '.►� t �� [► +T T t s — -U e� Cs4 v't� w• «t•�•ot(o u,,1 1"1'' r . 7 jpdf s. 4 pr�►...,.�,.y • = " ' 4� 2s 9s o• I 1�r,•��,�,F- ao.r' 4.r' 4Y.o' J_]Bc1dn9* ❑ Bo tng © pit Ground aurfebeelev. "I it. Depth to inning fa tar >/`/6 in. I Cnfl A.,iZ line D Hortzon Depth In. Dominant Color Mussel Rtdox Description Out Sz. Cont. Color Texture Structure Or. Sr. Sh. Consistence Boundary Roots R '*EIIVI •EIMIu2 o-'/ -7.cYR 31 f /1b LFS grx" �nl) (r c. g 31! S l .o '1—t16 7r YR Y!'3 'WI... -.LA≤ s54 *rt0 �� GS 34-.. . 5` 1.0 3 14-7° 7SY/t yly ' rm„ L5 :d( GS 2—ee, 7 1.G Y o-1VC ZS Yl'f s Ls OS` oil -- 24 7 t'.G 2 ❑ eonng 11 8otltp t1 ® pit Ground surfs m elev. 7 ft. Depth to timtting factor._._. 11= In. Coil /►eetlr�8rr� RQtw Horizon Depth hi Dominant Color Munneel Rdox Description Ou Sr. Cont. Color Texture Structure Gr. Sr. Sh. Consistence Boundary Roots GPM -E1181 Efil2 r G-$ (bY, 3(f ; port pr- cS 2i' o ,(9 c.0 a 5-- is to YR ift'( ` /'Z° n` 4(ArZC 1, Pv- c5 241,-& s- (.o 3 1.-'I.2 10y,e'" Hg 5�- t, -P S [ -co .7 1?-uo 7SY,tYt`f /t__ S Osa .Olt -- — . 7 !4 Eauent •1 w BODE s 30 ^ ZZU era T55 X30 t 150 rugs. - Emuiertt R a BUD ≤ 30 mgrarid T55 c 30 rrprL CST Name (Pissse Print) Signature i d 3 OE zm Addmss ZDate Evalua on Conducted Telephone Number 8Q E AltamQ _ o -02- /S = Ws_ o . . I•.►1. w.�w iwwA.ww. •3 Oct 23 2008 6:49 JOE ZIRN SOIL TESTING 715 765 4608 oY- c c' Property Dwain eGy-1So y Parcel lD O 0s-o0`/10-7o00 I 3l eo'� ❑ eonna � a Pit Ground surface e . 7 c . O R. Depth to limning fe*or > (O in. P.3 Page of - Horizon Depth in. Dominant Color Murtsell Redox Description Qu. Sz. Cunt. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM= 'Ef of •Et't2 j C -ca 10IR 3 f t rl0nt SL ��'SS�C I,rt ctr GS cq (-o (L-0?2 toYR Sff( L, w+sI my ,. GS lT C9 (.0 3 X -lag r5YIe Yle( ref- S os_ c•c . .,-t .' _;;/_J BotfngC O Boring ® pit Ground surface elev. X00. 2 ft. Depth to llmlthg f fotor > !2o In. Horizon Depth In. Dominant Color Mtstsell Redox Description Qu. Sz. Cont. Color Texture Structure &. Sr. Sh. 4onsistence i Boundary Roots GPD1 •Et 1 •EI 2 I 0^S !oYP 3i!t vtvKQ_- SG & as 2 G I•o a S• -cg goy el/Y noK� L$ 2 CL c. 2f1 -e .5- t.o t to YR qtly /wt e1fc G co 7 `tQ-1b1° `1s7Rcety S c � — 1.4 Boring I_1'° oO Pu Ground surface elev. R. Depth to lrridng fa4or in. Horizon Depth In. Dominant Colo Mlmeell Redox Description Qu. Sr. Cord. Color Texture Structure Gr. Sr. Sh. Cnsistence ' Boundary Roots GP 'EI 1 'Etttt►2 • Ettluent S1 so SOD0 > 30 a 220 mg/l- and TSS >30 ≤ 150 inglL ' Eftluenj *2 a BOD1130 mgfL and TSS S 30 mg& The Department of Commerce is an equal opportunity service provider and employe. if you need assistance to access services or need material In an ahernate format, please contact the department at 601-266-3 ! S 1 of .t Y.608-264-8777. : ' IaD W (RA7AD1 Oct 23 2008 6:49 JOE ZIRN SOIL TESTING 715 765 4608 p.2 LtHVLHH\......... i 1 ' -u ue" : —: \ '' - 1 - _.t_ I 1• - I 1_ - t rilAlkG f. �. rtrf 1. :.... _ _ ....?..._ r.... .1...... _.. .. i. .. _ ....: ..... ..� _ � ..._. i ..... . ... �_ L_,__.. .. t 1. i. . � ! - � �' t � lQ4lC li ,", G•o / t i.. 8i's 100 R' 1 ! -i-- i _. ! .,. -- - I - • r L'.1. I ,Y • . .. .. •' .... ...•. * cY'1' 1 Z`4A c si14 Laic- - I -. \ —; ( •'"\ 2 - c < -• .\. ; :.. . :.. :. • :\ - . \ —ic- I I 'b.. )¼'e -- - C&iLSP4 /O!4j % ... ..__-. _ _ irdWit �: :..S ' i '.. - ...............-.. ..-L.. ...... . .:. . .......... . ............. — dis 1-t ife cSr .::≥i CCOv1 t.L i t .... Cod - c -'1.w :f/-.'._ ...• c Y w - .. .. �.✓� r....Q�":''`.°S.Z't"�..#2.234 • Y 4D-N!j ' _ .... Soil ProfleSheet Owner: t w r-+ eO.,-tSo,'\ Soil Taw: �TOe Zt r1 1b (2.o (0 8 System Elcvation. 179' Load Rate: v -7 System Rangr.1l.l3 tp gs. S7 Bt= g(, ' (taxv) EklsT1•J6- DP-YWE LL .... .... .... .... .... ...... .... .... .... s7 .... .... ...... ..._. ..... ........... ..... .... .... ...... . ........ ..... .... .... .... ....• .... ..... .M. '7$ sc4esvi..... .». ..... .... ............ .... .... ._.. ..... . 3 r .... ..... ...... ..... ..... .... ... ..... ..... ..... ..... . ..... . .... .... ..... ?4f -73 s8V g -1 ► .... ..... 5' I6 INDEX SHEET FOR POWTS PROJECT NAME -( zyj TA ce nt d NO. (o (C (v OWNER 1obe,r4 -t �o cQ.rtn& Cav-tsovn ADDRESS: Lfoo t `Thoyma S Ave. (A('%) SS3&,c PHONE: pidig- 3Lfo PROJECT ADDRESS: to s . s5 4d �-+ lulu - r'ov rK-we( , WI LEGAL DESCRIPTION: & . L ' , S -7 , T" `t7 Al, w 'Tbw✓boy R,we-1 wm PARCEL NUMBER: oq-oz4-- z -4l -og - �-7 -y1 os--ooh- o-7000 1. INDEX SHEET 2. PLOT PLAN 3. SOIL EVALUATION 4. SOIL TESTER PLOT PLAN 5. SYSTEM ELEV. VERIFICATION FORM (o. SEPTIC SYSTEM MANAGEMENT PLAN PLUMBER'S SIGNATUREox�� MP# z2 -(c((, D lo(ZsI o8 Roher# ' TmAoa '40o1 rL,nCi5 Aje-• Irn i \11 E ivr\ka, MN) (012) '19 - Z3'1 O car1s0&n * (rc:0go ---Y !ss355 40.4-f Lake Ili G.L. 41 S z7 , r 47N, ,C,?uJ Town or Iron IC rev b�cfd Co., w= u rct( 05-oot{-o7oOO "Ta k (Zep Iacew.ca bhl�� 12nmins o.- IooO w' Ore,nu, .I k r Exisr DrywtLL iH Code Compho'«+ SOILS I vkpik 2z -t sl (o Iolir(o8 8004 Meuse kale: /'=c10' �Caf<e etes• = Lt3rn-l0o'� Top 0f well (1•'1' A.G.L.) Jan k rAPIc1CUWbt+ 'B1= 8G.9' Bz.= 96 B3= 96' Eq: /00.x' A= gl.5o' �c B=93.2 � = C= 45.0' Poe Sys4 elev. P.O.W.TS s Conditionally e w Mcn A�AYFIELDPROVED DryweU. COUNTY gals . - -- I I 1 0j '-•p rnnnn ni o (3) 3 x 'F6.LL ' cec.c 5 w( Qu i cic y CkcL,6e,s (33) CSuvE s4s4e a o -p ENTE�ED CEIVED 0CT .. 2G nZ�-(nLCa_t��l commerce.wl.gov Safety and Buildings Division County iseonsin 201 W. Washington Ave.- P.O. Bu 162 Madison. WI 53707— aQ %�oo te( Q SanimyPermi Number Ito be filled in by 0) Dep o b. tie of Cntmtaero. D O Sanitary Permit Application State Transaction Number In accordance with s Comm. 8331(222). W is. 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 art Project Address (tl'ddlerent than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary purposes in accordance with the Pnvacv Law. s 15 0411)lml. Stars - - - - -- c� ,, 11 // `�^�a J� &SJaS I4.+ Wee ►2A 1. Application Information— Please Print All Information - Property Owner's Name /� - QoberT i CAriso✓) Parcel a 04--40 2Q-- 2 -'F -7-o$- 21-4 -ToaA a. - - . o S-oo 4- - O.740OO Property Owner's Mailing Address 4001 -Thorw c A)O-. _.J Property Location Govt Lot . '/., section 17 City. State n1(nf"1��arXk4 MN Zip Code 195349 Phone Number I (0ia-7/9-a31(o (circle one) T �n N; R $ 11. Type of Building (check all that apply) Lot a I or 2 Family Dwelling - Number of Bedrooms Subdivision Name ❑ Public/Commercial - Describe Use Block a 0 City of ❑ State Owned - Describe Use ❑ Village of�s—_ CSM Number ,/� ( 'own of ._s�-(rOVv (Qiti 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System ❑ Replacement System ,� TreatmenlR4oldiag Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal 0 Permit Revision 0 Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner /9 3Q4' f -76.70 IV. Type of POWTS System/Component/Device: (Check all that apply) 0 Non -Pressurized In -Ground ❑ Pressurized In -Ground 0 At -Grade Mound≥ 24 in of suitable soil 0 Mound < 24 in of suitable soil !!��❑ ❑Holding Tank 0 Other Dispersal Component (explain) �V [ Ptile LI ❑ Pretreatment Device (explain)__________________________ V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Ratetgpdsl) Dispersal Area Required (s0 I Dispersal Area Proposed 1st) I System Elevation Lf 9 e ear 1i.?' &ds Q. w. VI. Tank Info Capacity In T I M of ManufaSsrer Gallons Gallons Units ;y, a o U New Tanks Exinmg Tanks _ V el Y L 5 Septic-Hlelanig Tank (000 I ( Ow /)'1.Q Dosing Chamber VII- Responsibility Statement— I. the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumbh's Name (Print) Plumbs. is $ianature ^I MP/MPRS Number I Business Phone Number Plumber's Address (Street. City, Slate, Zip Code) P o Bax 6 & s(BZf Vlll. County/Department Use Only PCApproved 0 Disapproved j Perms Fee Date i tied Issd A t Si tors. //�� ( S ❑ Owner Given Reason For Denial EZSOoa , �� IX. Conditions of ApprovaUReasons for Disapproval ci Rudd for Issuance n••......r.a..ry.a.0 p........ Inc eymm ano auomu ro me county omy on paper not less than x iQ s i 1 inches iiN$1 U 4 LUUU 8ec/trtaflal Stall SBD-6398 (R. 0 1/07) Valid thru 01/09 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page -L of {o FILE INFORMATION Owner Robe i Carlson Permit P nFStr N PARAMETERS Number of Bedrooms: ❑ NA Number of Public Facility Units: V'NA Estimated (average) Flow: 3 DO (gaUday) Design (peak) Flow = (estimated x 1.5): ({-J) (gallday) In Situ Soil Application Rate: .'7 (palldaylft') Standard (Domestic) Influent/Effluent Monthly average Fats. Oil b Grease (FOG) s30 mgIL Biochemical Oxygen Demand (BOOS) s220 mglL ❑ NA Total Suspended Solids SS s150 m lL High Strength InfluenUEffluent Monthly average (FOG) >30 mglL (Boo,) >220 mglL )NA SS >150m ti Pretreated Effluent Monthly average (BODs) s30 mglL (SS) s30 mgfL '0 NA Fecal Cofform (geometric mean) 510` Maximum Effluent Particle Size 3 in dia. ❑ NA Other. (RNA SYSTEM SPECIFICATIONS Tank Manufacturer u.&cy2.' O NA %Septic 0 Dose 0 Holding Volume: 1000 (gal) Tank Manufacturer. O NA 0 Septic ❑ Dose O Holding Volume: (gal) Vertical Distance Tank Bottom(s) to Service Pad: 1 (ft) Horizontal Distance Tank(s) to Service Pad: 5) (ft) Provide specific servlctnp mechanics if vertical Is>15 feet or If horizontal Is >150 feet. Effluent Filter Manufacturer. Or.ei1co 0 NA Effluent Filter Model: FTo822 Pump Manufacturer NA Pump Model: Pretreatment Unit Manufacturer. ❑ Mechanical Aeration ❑ Peat Filter EV NA ❑ Disinfection ❑ Welland ❑ Sand/Gravel Fitter 0 Other. Soil Absorption System ® In -Ground (gr$vtty). ❑ In -Ground (pressure) ❑ NA ❑ At -Grade EtS`nsKJ O Mound O Drip -Line DU)- 0 Other: Other. ® NA Service Event Service Frequency ED When combined sludge and scum equals one-third (K) of tank volume Pump out contents of tank(s) ❑ When the high water alarm is activated Inspect condition of tank(s) At least once every: ?' abYe s(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: � ❑ month(s)(Maximum 3 years) ❑ NA effluent filter ❑ month(s)Clean At least once every: 3 ® yeBKs) 0 NA Inspect pump, pump controls & alarm ❑ month(s) At least once every: ❑ year(s) JR NA Flush laterals and pressure test At least once every: o month(s) NA Other. At least once every.' ❑ month(s) 0 year(s) ( 'NA Other. �NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the around surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (k-) or more of the tank volume, the enti►e contents of the tank shag be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005 (02104) v Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septege servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fin above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the fife of the POWTS: antibiotics. baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; tat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oi; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33. Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POINTS technology, a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sol and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INSTRUCTIONS: POWTS INSTALLER Name(4g. '\S Phone SEPTAGE SERVICING OPERATOR (PUMPER) Name J p -t l I Phone 7/ c -37Z - V00 (p POWTS MAINTAINER Name 11 /9 Phone LOCAL REGULATORY AUTHORITY Name Q .r7e/d p. Zoo Phone 7�s-.373-4-138 This document was dratted by the staffs of the Green Lake. Marquette and Waushara County POV%TS regulatory agencies in compliance with chapter Comm 83.22(2)(b)(1)(d)8(f) and 83.54(1). (2) 8 (3), iscons;n Administrative Code. BAYFIELD COUNTY SANITARY PERMIT (#04)-08-180S 'STATE SANITARY PERMIT OWNER: ROBT E & JOANNA CARLSON / ERIC A CARLSON (LE) GOVT LOT: 4 LOT: BLK: 0 CSM: SUBDIVISION: 1/4 1/4 SEC: 27, T 47 N, R 8 W TOWNSHIP: IRON RIVER SOIL TEST: 178-08 TREATMENT/HOLDING TANK 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 #: SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: RASMUSSEN CECE TESKY DATE: 11/4/2008 Authorized Issuing Officer LICENSE: # 221516 Condition: THIS PERMIT EXPIRES 11/4/2010 POST IN PLAIN VIEW MUST BE VISIBLE FROM ROAD FRONTING THE LOT DURING CONSTRUCTION