Loading...
HomeMy WebLinkAbout26-75Sis Industry Services Division County 4822 Madison Yards Way Bayfield 1 _ -7 Madison, WI 53705 in O / P.O. Box 7162 Sanitary Permit Number (to be filled by Co.) =bfctwo. Madison, WI 53707-7162 — 75 S Sanitary Permit Application State Transaction Number I�oses ccordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit quired prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) Department of Safety and Professional Services. Personal information you provide may be used for secondary in accordance with the Privacy Law, s. 15.04(txm), Stars. J o�rao Holt road L Application Information — Please Print All Information Property Owner's Name Parcel # Barry & Heidi Guy 04046251041930100020000 -_. Owner's Mailing Address 2343 County Road O W1 II. Type of Building (check all that apply) X I or 2 Family Dwelling — Number of Bedrooms ❑ Public/Commercial — Describe Use _ ❑ State Owned — Describe Use 1 II1 Bayfield Co. Planning and Zoning Agency Phone Number 715/308-0362 Lot # Govt. Lot S '/a, N '/:, in N '/ SW in Doc. 2025r Deed 607494 ¼, ¼, Section 19 T 51 NR4 w Cityof Village of CSM Number Town of Russell III. Type of POWTS Permit. (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if applicable.) A. X New System y Replacement System ep y ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. Holding Tank In -Ground ❑ At -Grade Mound 0 Individual Site Design Other Type (explain) (conventional) C. 0 Renewal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration Capacityin Total #ofManufacturer Tank Information Gallons Gallons Units S New Tanks Existing Tanks I i20...L12 'i Septic oHolding Tank 3000 3000 I 1 I Weiser Concrete X V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. I WI 54763 l "Approved I ❑ Disapproved rcrnn'— uIt_ ruc umc Issucu issuing agent g/nonrre /y/ r/��/✓i ) rn ❑ Owner Given Reason for Denial $ / W -7Il 1 / f t 1 i Iff kt (l/l IIII )//M COYI/nr7 CT"--�(" s(e. Oa Pd to complete plans for the system and submit to the County only on paper not less than 81/2x SOIL TEST#S%-C ( Sa�oO rsconsin Department of Safety & Professional Services Page 1 of 3 '..8 $ = Division of Industry Services p$ b3 SOIL EVALUATION REPORT "'i•^?' In accordance with SPS 385, Wis. Adm. Code County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must Include, Bayfield 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. 29186 Please print all information. R ieyved by� Date Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04(1)(m)), l III/c%' LS Property Owner Property Location ❑ Q Barry F & Heidi J Guy Govt. Lot V1 '45 19 T 51 N R 4 E (or) W Property Owner's Mailing Address Site Address or CSM and Lot M: N12343 County Hwy O S 1/2 N 1/2 N N1/2 SW IN 2025x- 607494 Bocyceville WI 54725 715-308-0362 Russell I Holt S New Construction Use: Y Residential/Number of bedrooms 2 Code derived designflow rate 300 GPD Replacement Public or commercial -Describe: Flood Plan elevation if applicable h. Parent material Clayey Lacustrine deposits General comments and recommendations: Holding tank only. Clay site does not meet A+4 code. Boring Ii RBoring 1 Pit Ground surface elev. It. Depth to limiting factor in./elev. It. Soil Ann81 cat Horizon Depth In. Dominant Color Munsett Redox Description Qu. Az. Cont. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPD/Ft •Eff#i EffM2 1 0-8 7.5yr3/1 -. st lmsbk ml cw 3co .4 .7 2 8-16 7.5yr3/2 cmp5yr4/4 is lmsbk ml cw 2f .4 .6 3 16-60 2.5yr4/4 - C 3csbk mvfi .2 .3 Boring r4 Boring 2 Ph Ground surface etev. ft. Depth to limiting factor in./elev. ft. SoilAnnii Horizon Depth In. Dominant Color Munselt Redox Description Qu. Az. Cont. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPD/Ft •EfUMl -Eif#2 1 0-10 7.5yr3/1 - St lmsbk ml cw 3co .4 .7 2 10-16 7.5yr3/2 cmp5yr4/4 is lmsbk ml Cw 2f .4 .6 3 16-50 2.5yr 4/4 - c 3csbk mvfi - - .2 .3 RC Ell CST Name (Please Print) Signature a CST Number ! V "--� Ryan Van Ornum 11011 Address Date Evacuation Conducted Telephone Number 65907Jolma Rd Marengo, WI 5/29/2026 (715) 413-0074 T ncy Effluent M1 -BOO >30 s 220 mg/L and TSS >30 s 150 mg/L • Effluent M2- BOO, s30 mg/L and TSS s 30 mg/L SBD-8330 IR03/22) pg. 2 of 3 Soil Test # Bayfield County Waiver of a Thorough Soil & Site Evaluation (subject to 15-1-10(d)) I Ryan Van Ornum a certified soil tester determine that in my professional judgment the following site (see below) is unsuitable for any treatment component other than holding tanks. Due to soil & site conditions, a thorough soil and site evaluation is not needed to make such a determination. Property Owner Barry F & Heidi J Guy Contractor Property Address S 1/2 N1/2 N 1/2 SW Authorized Agent Agent's Telephone Telephone 715-308-0362 Written Authorization Attached: Y or N Accurate Legal Description is requested: 1/4 of 1/4 Section 19 Township 51 N. Range 04 W. Town of Russell Additional Legal Description: S 1/2 N 1/2 N 1/2 SW IN 2025r-607494 227 Govt. Lot Lot Block Subdivision Lot CSM# Vol. Page CSM Doc # Volume Page of Deeds Tax I.D# Indicate reasoning for your determination V11LI thu/ Signature of Count\jJOfficia,l i Date 29186 Acreage 20 site does not meet A+4 code Sign ure of Certified Soil Tester 5/29/2026 Date 11011 Certification # (Submit a Plot Plan & Fee) Cam �. e] i '✓ k_ L JUN 02 Z'i?d u/forms/soiltestwaiver( KLK) June 2018 C a CO. - a I I 14LJ+. H itii i II1III :g' EHP' FEE# EEl :H±t:: tH' Y .- - " d Cal aaI 1iTr rrrr I I I 1 Concrete Holding Tank Design New Site Seasonal Cabin Index and Title Sheet Project GUY Owner Barry & Heidi Guy Site Address Holt Rd., RECEIVED JUN 292025 P+anni Bayd,&d Co. 9 and Zoning Agony Legal Description S %, N''A, in N'A,SW,S19,T51N/R4W Township Russell County Bayfield Subdivision Name N.A. Lot no. N.A. Parcel ID Number 04046251041930100020000 ��'. Page 1 Index and title sheet ,�`� t�tR� • , `� a• � �� Page 2 Page 3 Site plan Holding tank specifications F - Page 4 Page 5 Management plan User's o manual ,,'�' •.. �� Page 6 Servicing contract Page Township agreement (on file at county) Designer Loretta Larrabee License Number 1872-007 Phone 715/664-8184 office 715/505-1628 cell Jack Bowman MP222839 Holding Tank Component Manual for POWTS (Version 2.1) May 2022-2027 Page 1 of 6 Site Plan Barry & Heidi Guy S'/2,N'/2, inN'/2, SW, S19,T51N/R4W Russell township Bayfield county LEGEND Part of 20.254 A.C. No DSPS 383 setback problems Scale 1'-30' 3000ga1 proposed holding tank Wieser Concrete SJ Rhombus manufacture or similar product Tank Alert 101-01 RECEIVED JUN 292026 eareeid Co. Planning and ZoningAgaw t4 sue, k� �S�ma665_... - '-1 l (� /o``-C�\\e -ct 'su� 33 ro f v vu` 0 carcrcJct c o/I f 00.0L QJ project: Guy page 2 of 6 I RECEIVED JUN 292026 Bayfield Co. Planning and Zoning Agency 1 INLET C N 'ANKS ARE MANUFACTURED TO MEET OR W3000 -MR TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1/2" BOTTOM: 4' COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 71" LENGTH: 15'-6" WIDTH: 7'-9" BELOW INLET: 57" LIQUID LEVEL 50" WEIGHT: BOTTOM 12,260 LBS. COVER 8,350 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 58.94 GALAN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 3,183 GALLONS LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: 0 cx O O 3 i OF HOLDING TANK — MANAGEMENT PLAN The Private Onsite Waste Treatment System (POWTS) has been designed and is to be installed and maintained according to SPS 383, Wisconsin Administrative Code, Holding Tank Component Manual for Private Onsite Waste Treatment Systems (SBD-10571-P)(R.6/99) and the Bayfield County Zoning Department Sanitary and Private Sewage Ordinance. 1. This POWTS has been designed to accommodate a maximum daily flow of �zoc> gallons of domestic wastewater per day. RECEIVED 2. The owner of this POWTS is responsible for system operation and HIM 29 2026 maintenance, locking device, alarm and access. Rayfleld Cong g AgencY 3. The owner or owner's agent is required to submit reports as requirIfliS t ' 383.55(1), Wis. Adm. Code, to the Bayfield County Zoning Department. Design approval and site inspections before, during and after the construction are accomplished by the county or other appropriate jurisdictions in accordance with SPS 383 of the Wis. Adm. Code. Maintenance Cycle. The holding tank must be serviced by licensed pumpers. An alarm system is to be installed to activate when the tank is ≤ 90% full. 6. Performance monitoring. At the time of servicing, the service provider files a report with the department of designated agent. 7. A User's Manual will accompany the component. It will include the names and phone numbers of local health authorities, component manufacturer or POWTS service provider to be contacted in the event of component malfunction or failure. 8. In the event that this POWTS or a component of this POWTS fails and cannot be repaired the owner will find in the User's Manual the names and telephone numbers of property licensed individuals to contact for such repairs. This agreement shall be binding on all assignees and heirs _1/4 of 1/4 Section 'ii _Township5t_N. Range 4- W. Town of U sse 1 l Govt. Lot Lot --t- Block - - Subdivision'—"--- CSM#, Additional Legal Description S yz . N Yz, tJ '/z} swk n 0 ec, i eeaoz 5 r /e' i 4 G4 Property Ovlrfiers Sig ature u/forms/managemenip lan Revised: July 2013 1 �c \e.Jt- v,� La //?/o7 o Date t0 User's Manual This Private Onsite Wastewater Treatment System (POWTS) has been designed and is to be installed and maintained according to SPS383 Wis. Admin. Code, the Holding Tank Component Manual Version 2.1 and the Dunn County Sanitary Ordinance. RECEIVED JUN 292026 Bayfiem co. 1. This POWTS is designed to accommodate a wastewater flow of 60.0 to 6000.0gpwinmg and zoning Agency 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper must be called to empty the tank's contents and depose of them in accordance with NR113 Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole covers and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and SPS 383 and 384 Wis. Adm. Code. 5. The owner may not remove any of the wastes from the holding tank (s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281 Wis. Statutes. The discharge of wastes to the ground surface, including intentional discharges and by neglect, constitutes a failing System and may result in issuance of correction orders or a citation by the county or state. 6. No one should enter a holding tank for any reason without being in full compliance with OSHA standards. The atmosphere within these tanks may contain lethal gases and rescue of a person from the interior of the tank maybe difficult or impossible. 7. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location per County Ordinances. 8. If this POWTS is replaced, or its use is discontinued, components no longer in use, it shall be abandoned in accordance with SPS 383.33 Wis. Adm. Code. 9. If there is a problem with, or question about this installation, the following persons may be contacted: a. Installer ................... b. Service Provider......... c. Co. Zoning or Health Dept. Comments: J.B. Hydro llc J.B. Hydro llc Bayfield County Zoning Phone 715/949-0099 Phone 715/949-0099 Phone 715/373-6138 project: Guy page 5 of 6 Contract Date Cp/)7/aozk HOLDING TANK SERVICING CONTRACT This contract is made between the Holding Tank Owner(s) Name(s) I •`-fir �d&di Gw RECEIVED JUN 292026 Bayfiakl Co. Planning and Zoning Agency Pumper's Name (Print) Pumper's Signature Pumpers' Registration # 7J;r•ah S -Free! ?,a''G �/1_M _ (/�-0.7 We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT I Legal Desulotion: I Tax ID# 1/s, 1/0. Sya P1yz. 4 Qy s W LOCATION (UseTaxstatement) LL a5f )S`e Qoc-.flacA aoa r - (t ,ggg Town of Lot Size I Acreage Section ! i—_ ,Township `�' i N, Renge w uS e -t I )' 2) Gov't Lot Lot # CSM # Vol. Page CSM Doc # Lot(s) No. I elockis) No. Subdivision: vo.A, f4'R, 1. The owner agrees to file a copy of this contract with Bayfield County as required in SPS 383.55, Wis. Adm. Code. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local government unit which has signed the pumping agreement required by SPS 383.55, Wis. Adm. Code, and the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local government unit and the County named above within (10) business days from the date of change to this service contract. f—ooa-90 Document Number/Plan I.D. No. HOLDING TANK AGREEMENT Owner Name (a) Owner(s) Mailing Address I Barr'., HetckN 1i Gu .3x-13 G tnY P'Zc A cev M S s4� asJ Parcel Identifier Number (PIN) I Agreem nt Date (same as Notary Date) t-InuL,,SIOLi I4cIOcoaoc5c0 _ on the following property or that continued use of the existing premises requires that a holding tank be installed on the property for Hie purpose ui propel wnieinu ant of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. SPS 383, Wis. Adm. Code or Ch. 145, Wis Stats. 1/4 of 1/4 Section _Township N. Range W. Town of Additional Legal Description: Gov't Lot — Lot_ Block_ Subdivision Lot GSM ii Vol Page CSivi Doc# DOCUMENT NUMBER 20268-61 2874 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED O6/16/2O26 AT 10:38 AM RECORDING FEE: $30.00 PAGES: 2 Return To: 2©rj;NG As an inducement to Bayfield County to issue a sanitary permit for a holding tank on the above -described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. SPS 383, Wis. Adm. Code relating to holding tank installation and maintenance. If the owner fails to have the holding tank property serviced in response to orders issued by Bayfield County or the Department of commerce to prevent or abate a human health hazard as described in a 2.54 59, Stets Reyfield County may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stets. 2. Owner agrees to pay all charges and costs Incurred by Bayfield County for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. Bayfield County shall notify the owner of any costs which shall be paid by the owner within thirty (30) days of 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. 3. The owner agrees to contract with a person who is licensed pursuant to s.281.17 (3) Wis. Scats., and chapter NR 114 Wis. Adm. Code, to have the holding tank serviced in accordance with Ch. NR1 13, Wis. Adm. Code, and to file a copy of the contract with Bayfield County. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the county within 30 days of the date of change to the service contract. 4. The owner agrees to contract with a person licensed pursuant to s. 281.48 (3) Wis. Scats., and Ch. NR 114, WI's Adm. Code who shall submit to the county within 30 days a report detailing the servicing of the holding tank. Bayfield County may. ,ent roperty to investigate the condition of the holding tank when pumping reports and meter readings may indicate that f1bZ�MMCIJnot being property maintained. di II dfitr�tf qq 5. This agreement will remain in effect only until Bayfield County certifies that the property is served by either a diV&l1ills9v 6r a private onsite wastewater treatment system that complies with Ch. SPS 383, Wi's Adm. Code. In addition, this aig��ree nt may be cancelled by executing and recording said certification with reference to this agreement in such manner which VrdnRlPNg a mini gene of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is Installed. Owrtar(s) NamPlease Subscribed and sworn to before me on this date: Nota*Owner(s)— gnature(a *x �`''-My i°oF NotaryP bifc Commission Expires: ic,u .li....lM1..:/....—:.....i.....RLbGs.T....i�..........A 1'Jli9R File Number: 254618 ADDENDUM/EXHIBIT A The South Half of the North Half of the North Half of the Southwest Quarter (S1/2-N1/2-N1/2-SW1/4), Section Nineteen (19), Township Fifty-one (51) North, Range Four (4) West, Town of Russell, Bayfleld County, Wisconsin. TOGETHER WITH an easement over and across the existing North -South roadway for ingress and egress, as described in Document No. 307722. RECEIVED JUN 17 2026 Bayfield Co. Planning and Zoning Agency Bayfield County Register of Deeds Document #2025R-607494 Page 2 of 2 R YFIELD Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: Submission Number: GUY, BARRY F & HEIDI J SR -00429 N12343 COUNTY HWY O BOYCEVILLE, WI 54725 Transaction Number: SR -00429-47A00 Description Amount Certified Soil Tests - Review & Filing Fee $50.00 Total: $50.00 Payment Amount $50.00 Reference: 106 Paid by: Northwoods Soil & Site, 659 Jolma Rd, Marengo Payment Type: Check Transaction Date: 6/16/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. I3 A YFIELD Bayfield County Planning & Zoning Department 117 E 5"h Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: GUY, BARRY F & HEIDI J N12343 COUNTY HWY O BOYCEVILLE, WI 54725 Description Private Sewage System (Holding Tanks) Submission Number: SS -00782 Transaction Number: SS -00782-4900C Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 3770 Paid by: Barry Guy, N12343 County Rd O, Boyceville WI 54725 Payment Type: Check Transaction Date: 7/1/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-75S STATE SANITARY PERMIT OWNER: BARRY F & HEIDI J GUY G OV'T LOT: LOT: B LK: 1/4 1/4 SEC: 19, T 51 N, R 4 W TOWNSHIP: Russell SOIL TEST: 57-26 NEW SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: JACK A BOWMAN EMILY MACGILLIVRAY Authorized Issuing Officer DATE: 7/1/2026 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 222839 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. THIS PERMIT EXPIRES 7/1/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION