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HomeMy WebLinkAbout26-83SS Industry Services Division 4822 Madison Yards Way Madison, WI 53705 P.O. Box 7162 Madison, WI 53707-7162 County Sanitary Permit Number (to be filled in by Co.) (— 3 S 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 prior to obtaining a sanitary permit Note: Application forts 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 Xm), Slats. 41175 ✓dil a wy I. Application Information — Please Print All Information _ w 'w Property Owner's Name fames b. pj5L on •,, Parcel # Property Owner's Mailing aiAddress _ 7 07 LU 4M g/ . .. / Property Location Govt. Lot_____ 1VIY'i Section t4 T N R 01 E o City, State Rea Zip Code Phone Number (05/-38o-s93y H. Type of Building (check all that apply) q lq1 or 2 Family Dwelling — Number of BedroomJ s Lot # Subdivision Name ❑Pubite/Commercial — Describe Use Block # ❑City of ❑State Owned — Describe Use Villageof Town of era CSM Number M. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C 11 applicable.) _ _ A. IlNew System I nReplacement System I rlDlher Modification to Existing System (explain) (❑Additional Pretreatment Unit (explain) ullolding Tank fIn-Ground ukt-Grade UMound Individual Site Design Other Type (explain) (conventional) C. ❑ Renewal Before Revision a of Plumber ❑fmusfer to New Owner Previous Permit Number and Date Issued Expiration IV. DispersaliTreatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/st) I Dispersal Area Required (sf) I Dispersal Area Proposed (sf) System Elevation ¢50 17 1,43 GSZ 99. s Capacity in I Total #of I Manufacturer Tank Information Gallons IGallons Units a U New Tanks Existing Tanks c al m cc n,u 'm u, rn I c7 SepticorHokbngTank /.._ I S'lf fdtC,ieio r' rGGs 1f' Dosing Chamber I Em Q UL V. Responsibility Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu 's Signature MP/MFRS Number Business Phone Number 6ed/)tS �Sm4.t,.S�.rl 22/5/6 "7er-sBooZS¢ Plumber's Address (Street, City, State, Zip Code) 4zws 4w'enaegh Pd-. C$b/ 1UJ/ 5982 ,Approved ❑ Disapproved rermtt tee irate Issued INp tssumg Ag bl t a ❑ Owner Given Reason for Denial LJni) — % 1 f f1 I � /'�I1 Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x SBD-6398 (R. 03/21) OBETEST ... Wisconsin Department of Safety $ Professional Services S Page of ;�8� . Division of lndustryServices SOIL EVALUATION REPORT tax . d, ,31.1I In accordance with SPS 385, IMs. Adm. Code County &zoe// Attach complete site plan on paper not less than 8 112 x 11 Inches In size. Plan must include, tJ but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. ©4-d/2 " -4:3 -cS .. lQr Z scale or dimensions, north arrow, and location and distance to nearest road. 5/ d Please print all iniormaBon. Rev e y Date Personal Information you provide may be used for secondaryI purposes (Privacy Law, s. 15.04(1)(m)). Property Owner Property Location 0Is rc ai v b. Pi Govt Lot 44j% ,g X S /9 T 43 N R E (orW Property Owner's Mailing Addres 00 Site Address or CSM and Lot#: W Z'775 k v4NAW-1i fib, City, State, Zip a Phone Number ❑ City ❑ Village M Town Nearest Road l' y /"Ili% (6 1)366-. "v 4f A 3 l�:�i ✓l� ►SIG# i@ NewConstruction on Use: ❑ Resldential/ Numberof bedrooms 3 Cade derived doslgnflow rata 4 O GPD ❑ Replacement ❑ Public or commercial —Describe: p-; ' C E iV tan elevation if applicable NR ft. Parent material,, General comments and recommendations: J U L 08 2026 ' Bayfield Co. Boring # ❑Boring Il6 • `Henning and Zoning Agency UUU Pit Ground surface eiev. It. Depth to limiting factor �` r I p g in. I elev. 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 *Ef 2 )VA 5 % . 5bk '7't _t4 2- F . S • 1 f6 2 7Z€ ' yg f s 2M � W -e Zi . .c7 1.2. Za-3i 5y '1 d NA Is C3. i� — , 7 ! •Z 31- 44 ,5 Y 54 Nd s cis .1 i. z. IT 44-44 gYkr s /VA l�s n,j -- ._ ,7 ' ! j Z. ❑Bad 94.414 0 Pit Ground surface elev.it. Depth to limiting factor ,8 in. l elev. ft. e.,t, e.,.s►...a.... o - Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr Sz. Sh. Consistence Boundary Roots GPD/Ft2 * 1 *E % j ,ly ,�. s 5 - y 1/4 NQ k r rn .7 !•2 % 4 A WA 7. n/ W -- g1 - o y 6 AIQ S s• •- 7 /.Z CST Name (Please PrInL l ,u,s i # e'. Signet CST Number SP- �S a�i083 Address 4 Z4,Z5 KAYANX00X kD• Date Evaluatlo Conducted _ Telephone Number * Efduent #1= BOD > 30 s 220 mg/Land TSS >30 s 150 mglL * Effluent #2 = BOD, s 30 mglL and TSS s 30 mg/L SBD-8330 (RO3122,` Boring 94 , Y5 Boring # ❑ Pit -Ground surface elev._,_,_, t Page Z of 6 yomL$. Depth to limiting factor 7 tn. ! elev._.,_„_ft. Horizon Depth In. O -7 7- zZ Dominant Color Munsell 5YR I TY 4 Redox Description Qu. Az. Cont. Color AM N Texture t s' Structure Gr. Sz. Sh. 1 sb Consistence mfr l'1?V 1'n Boundary Roots — Soil Appilcatlon Ra GPD/Ft2 *Etff#'i 2 *Eff#j 1, 3 4 Z1' 5 -% y y 4 /S s w L1 Boring # ❑Boring I ❑ Pit Ground surface elev..ft Depth to limiting factor _In. / elev. ft Horizon Depth In. Dominant Color Mansell Redox Description Qu. Az. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Zoiiiippncavon Rat GPD/Ft2 *Eff#1 'Eft LiiBoring # ❑ Boring ❑ Pit Ground surface elev.% Depth to limiting factor / elev..It Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots COJIAppHcatton RatF GPD/Pt2 - ,Eff *E Effluent #1= SOD > 30 s 220 mg/L end TSS > 30 s 150 mg/L RECEIVED JUL 082026 Bayfield Co. Planning and Zoning AgefCY * Eftent#2 = BOD. s 30 mg1L and TSS s 30mg/L p A � \ Q F ECE JULY o 0 2026 gayneld Co. Planning and Zoning Agency --s Y AQ V It 3/� r Soil Profile Sheet __- Soil Tester: �nY� S2syytli.��� System El eY ati on: �� Load Rate: - Z System mange: 4 to g3 •,r CJ'/ 4 .. ..... 47415 • .... .... .... .... e ...... ---_.......---� ::::::::::: •J :::.i::::::: 9 .... .... .... . .... J:::: .... ... ..._. 8 9 ... __... • .. . ........... ... .... ._.. ...._ .... ..... .... ..... .... ..... • jLO8ZOZ6 .. .... ... :.:.. AgenCY planning and Zon 9 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design References: In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027) /Pg 1 of 4 'Pg2of4 /Pg 3of4 /Pg 4of4 Attachments: Index & Cover Sheet Plot Plan PAGE 1 OF Dispersal Area Cross -Section & Plan View Management Plan POWTS for Review Soil Evaluation Report & Site Map Project Name / Description Owner Name(s): wires Pd ' VOI 1 Phone: is/.. 3S0- 73 Owner Address: /907 Ii/ 41t 6 6/ • Zip: t§Ga(a Project Address: 4z 77_c k z! vajn,Uvh 1d. (z bi. Ul/ Govt. Lot: MU 1/4 of 0 1/4, Section Al ,T 4.3 N -RAE U or W g Township: CASce County: (34,y7t-it2D Project Parcel lD #: C74 -e/2- z fr d •07 /9• 2 ccx� - 54nc o Designer Information Designer Name: __-nets R2-sh < eh Phone: 7/f -stc-ozs4 Designer Address: _ 4z4z5 k dan .ztyA Rd Zip: 54S2./ E-mail: olcnn u'ra s tnQ G .may /94L �gme '/. Con1 This space rc,cr -cd for approval stamp. License Number: Remarks: RECEIVED JUL 062026 Bayfield Co. Planning and Zoning Agency Signature: Date: o%l____ • Original signature required on each submitted copy. S s/aMES D. Pfl7E7k.Sd)V — /Sd 9 w girt 5r RFb !X/'A/f, tIN 4277g KAve.'vAo&4'S N Nw y/ r�F' l -. /!L' /9, 43,7w i''T%rV O'L CALD: V p ' ��; � R too' TOw Fpu/?c�at/o/I .veDos�G W P2 944i' e� Po 5 rr'tii L -try. 94,50 �a lam `16��oAFCet7L 5,7 ≥ N �� g U 012 NSA PRcpery { IN -GROUND GRAVITY DISPERSAL, AREA Uniform Elevation Trenches with Qulck4 Stendard.W Chambers 3 -ft Trench (down -sizing credit) SOIL COVER 12" min, trunch dnppih (lyplonq mm, 12" (lyploal) 8eptla Tanic(s) Man feature✓: nrrr Sepllo 'rank(s) Valume(e); pgal „.,.a,.,.w„ gal .s..,..„.,., gal ,.�..�..,,�.-w gal Effluent Filter Manufacturer: Effluent Filter Model VAIyi„R„m „ m J 0 a, < TYPICAL TRENCH Si'CROSS SECTION VIEVV l) ,•" a' •' (No Scale) System Elevation= y' Sft (typical) Quloic4 Standard„W w/hnd Cap (Show location of Inlet / outlet pipe connection an plan view,) (lyploal) III IiIii/II R = _._ ft (typical) INSTALL PER TRENCH: , /& Qulol<4 Std -W @ 20 f� EISA/chamber= 32c ft° I Pairs of end caps @ 6,Ct2 EISA/psir = = Proposed EISA per trench = 3 „ ft2 Provide minimum 311 W o separation between trenol'>, ILI ra Observation Pipe (typical) [all per mmnufacluraee / Inalrucllona, r.0 TYYPICAL4REN( PLAN VIEW (No Scale) JA = 3.0 ft (typical) "—Qulok4 Standard -W Chamber (typical) (mid by Infiltrator ByoIema, Inc.) Install purausnlde manulaplumr's inatnictlana, Required Infiltration Area = t ,,, ft2 x —_.2 trenches = Proposed Total EISA - „642,. n2 Distribution Method: 9 s O, C 0. in O "T9 masureu�c,mmvg� In -ground Gravity Management Plan PAGE 4 OF 4 IMPORTANT: The owner of this in -ground gravity system shall be responsibleior its perpetual operation and maintenance pursuant to requirements of SPS 362-384, Wisc- Admin- Code. Pursuant to SPS 383.52 (2), Wise. 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 DISDArSal Area Operating Limits: Design Flow = gpd; BODE 5 220 mgL"1; TSS 5150 mgL"1; FOG 30 mgL-' Ins ection Checklist INSPECT EVERY 3 YEARS RECEIVED o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) JUL 08 2026 o mechanical malfunction (f_e., pumps, valves, switches, floats, etc.) yfield Co. o material fatigue (i.e., leaks, breaks, corrosion, etc.) Panning and Zoning Agency 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, ettc-) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i-a-, pump re -cycling, float switch settings, etc.) o electrical components - if applicable (La., 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 a; 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: L)enni S �c3 S'Pt )Li S e,) Phone: 7/c - S 'o -Q Local government unit �zy�e O. ZarriJy Phone: 37.? - Local government unit address: 10 <2S/, bQVF, (41/ ZIP: 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 maybe used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. ContIngncy Plan In the event that any failed treatment component of this POWTS canno₹ 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- 1,3M FIELD 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: PATTERSON REV TRUST, JAMES D 1509 W 4TH ST RED WING, MN 55066 PATTERSON REV TRUST, JENNIFER J 1509 W 4TH ST RED WING, MN 55066 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00456 Transaction Number: SR-00456-499BC Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 6026 Paid by: James Patterson, 1509 @ 4th St, Red Wing MN 55066 Payment Type: Check Transaction Date: 7/10/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. iT kYFIELD 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: PATTERSON REV TRUST, JAMES D SS -00787 1509 W 4TH ST RED WING , MN 55066 Transaction Number: PATTERSON REV TRUST, JENNIFER J SS-00787-499BB 1509 W 4TH ST RED WING, MN 55066 Description Amount Private Sewage System (Septic Tanks) $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 6026 Paid by: James Patterson, 1509 W 4th St, Red Wing MN 55066 Payment Type: Check Transaction Date: 7/10/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-83S STATE SANITARY PERMIT OWNER: JAMES D PATTERSON REV TRUST GOV'T LOT: LOT: B LK: 1/4 1/4 SEC: 19, T 43 N, R 7 W TOWNSHIP: Cable SOIL TEST: 81-26 NEW SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: DENNIS RASMUSSEN SCOTT ROUSH Authorized Issuing Officer DATE: 7/10/2026 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: # 221516 Condition: Properly Maintain System Per Recorded Agreement THIS PERMIT EXPIRES 7/10/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION