HomeMy WebLinkAbout26-83SRequest for Sanitary Inspection (24 Hrs. in Advance)
Fax or email this form to Zoning Dept (24 Hrs.) prior to when you want an inspection
Fax (715) 373-0114 or Email zoning(�bavfieldcounty.wi.00v
Note
fl Time Change fl Discrepancy Other
Phone Number
�'f p
500 —
Plumber:
S �,n I / 5 S-
ia/ I I Vl
``6—
Fax Number
Email Address
Homeowner:
r SO
Immediate Phone Number So Zoning
Sanitary
Permit #:
(p— g 3 5
Dept can call you right back (if needed)
Plumber's Choice
Zor( Dept
Date:
l2 T
No Inspection(s) during this time
Tuesday (9:30 am - 12:15 pm) (Tracy)
Plumber's Choice
ip ept
Time:
Township:
Address # &
Road Name:
or
/ / /�
Ll� /r7S Vt Vq l�(� Rd
Directions
3'1y(-7
To Site:
Comments:
** Plumbers you must verify any change(s) by fax or email **
Notes from Zoning Dept:
July 2025 ..�
Private Onsite Wastewater Treatment
POWTS. Inspection Report
PATTERSON REV TRUST, JAMIS ES (POWTS).
D & PATTERSON REV TRUST, (Attach to Permit)
it JENNIFER J
' 1509 W 4TH ST
RED WING MN 55066 ypuiposesfPrivacyLaw,s.15.04 1 m
F DC Vlilage Town of.
Fi c v /*/ per !i�'3'e
Tanis 1nfnrmnfinn setbackfo-
County
PJ ,.
Sanitary ermit No:
State Plan•Transaotlon ID#:
Parcel Tax No:
TYPE
MANUFACTURER
CAPACITYJ
Prop. Line
Well J Bufldijj Air Intake JRoad
Se tic
?cj/o v
/.0D
'7 7 d N/A
Dosin .
N/A
Aeration
N/A
Holding
• Pump! Siphon Information
Pump Manufacturer jPurnP Model Demand
liter Manufacturer Filter Model GPM
O"tWCp
TDH Lift Friction Loss Head Total
Forcemain Length Dia Dist. To Well
Elevation Data
STATION
BS
Hl
I FS
ELEV
Benchmark
lo).
Bldg. Sewer
Tank Inlet ?. 1
I ELM vuUej
Dispersal Cell Information
Dose Tank Inlet
DIMENSIONS
Width Length, 1 of Cells 3
Dose Tank Bottom
SETBACK FROM
Prop.. Lint I Bu !ding Well OHW1
/o c
Inst. Contour
! I7�J
Header 1 Manifold
...
-�,
Type of Cell
Manufacturer;
Q �• �k �
Distribution Pipe
•
1 Model Number.
Infiltrative Surface J
. 9
Pretreatment Unit
Final Grade
Manufacturer:
Model Number:
z..
• 4
stributlon System
X Pressure Systems Only
'.
Header / Manifold
Distribution Pipe(s)
X Hole Size I X Hole
Pipes
Length Dia
Length Dia Spac
Spacing •
Jbservation
es ❑ No .,
Soli Cover
•
Depth Over
I
Depth Over I Depth of
Seeded I Sodded
Mulched _
Cell Center
1
Cell Edges f To soil
❑ Yes ❑ No
❑ Yes ❑ No
)OMMENTS: (Include code discrepancies, persons present etc.) 2. cj l w/ /3 c� 6 .,.-j
ft. b.k., .&bLv.,>v ?JJJ d. .t "it "1e
M &t 'Q?V /e, h0} v.e�e'
!an revision required? des ❑ No1 1 I ��rLto 1
3e other side for additloml information.
Date POWTS Inspector's Signature License Number
4Rn-R71n !R nqI 1'%
BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT
Telephone: (715) 373-6138 Bayfield County Courthouse
Fax: (715) 373-0114 Post Office Box 58
e-mail: zonino(a)bavfieldcountv.oro 117 East Fifth Street
Web Site: www.bavfieldcountv.org/147 Washburn, WI 54891
Property Owner
PATTERSON REV TRUST, JAMES
D & PATTERSON REV TRUST,
Information
JENNIFERJ
1509 W 4TH ST
RED WING MN 55066
n i
As you know 1 a Y'f,. ( ®r i was contracted b
� y you to install a private
onsite wastewater treatment system on your property (Tax ID# above). To know when your system will be due
for servicing please go to www.septicsearch.com
Notes:
Abandonment of Old System to meet all applicable code requirements:
Tank was pumped by:
• Tank was crushed / removed and pipes disconnected by:
on
at AM/PM
On t r (AM I M the above -mentioned plumber contacted our office to
conduct a pre-co>0 r i ispection as required un er DSPS 383. One of the following applies:
PSystem was inspected and appears to meet all applicable code requirements.
System was inspected and appears to meet all applicable code requirements; however, a plan revision
is necessary because the installation was substantially different than the original approval.
❑ System could not be inspected because plumber covered prior to scheduled time of inspection.
System could not be inspected because plumber was not ready at scheduled time of inspection.
County was unable to return to complete inspection.
System could not be inspected because plumber was not ready at scheduled time of inspection.
A re -inspection and $50 fee are required.
System could not be inspected because County could not respond to plumber's time constraints.
Comments:
U/farms/sani tarypropetlyowner-input
Aprf2019
'
Industry Services Division
4822 Madison Yards Way
County
Madison, WI 53705
P.O. Box 7162
Sanitary Permit Number (to be filled in by Co.)
Madison, WI 53707-7162(19
3 S
Sanitary Permit Application
State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit
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), Stats.
4 y-7 75 trans iv/
I Application Information — Please Print All Information _ .
Property Owner's Name
T� �%7 +�_ t2�d)1'1
Parcel #
S I
eS 1
Property Owner's Mailing Address
Property Location
f,<Q9 4/ 41z4) 5/.
Govt. Lot
City, State
Zip Code
Phone Number
R/ kj- //7
:sS
(p5/ - 3, S 93Y
NW ¼. /V _` 1 Section
T N R 01 E o
H. Type of Bnilding (check all that apply)
Lot #
Subdivision Name
®1 or 2 Family Dwelling —Number of Bedrooms 3
ablietCommercial — DescribeUse
Block #
of_____________________
DState Owned —Describe Use
Village of
CSM Number
!!
D e
Town of (?,sib/e.
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
a livable.
JNew System
[]Replacement System
❑Other Modification to Existing System (explain)
❑Additional Pretreatment Unit (explain)
B'
M[lolding Tank
joln-Ground
ft -Grade
❑Mound
Individual Site Design Other Type (explain)
(conventional)
C.
[]Renewal Before
❑Revision
JChange of Plumber
Transfer to New Ownerr
Previous Permit Number and Date Issued
Expiration
IV.
Dispersal/Treeatment Area and Tank Information:
Design Flow (gpd)
Design Soil Application Rate(gpd/sf)
Dispersal Area Required (sf)
Dispersal Area Proposed (sf)
System Elevation
¢moo
,7
(43
&5Z
.'
Capacity in
Total
#of
I Manufacturer
Tank Information
GallonsI
Gallons
Units I
a
a�
g
New Tanks
Existing Tanks
_rz�zsf
o.O
in &,
ca
w C)
Septic or Holding Tank
Dosing Chamber
V. Responsibility Statement -I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print)
Pi�r's SignatureSignature
MP/MPRS Number
Business Phone Number
j a//
J 7/t -0Z54
Plumber's Address (Street, City, State, Zip Code)
17-1025. '-d'I q h - e L t 1' 542 (
VL County/Department Use Only
App roved
0 Disapproved
Permit Fee
Date Issued
Issuing Age Si
0 Owner Given Reason for Denial
I
?
Conditions of ApprovalMeasons for Disapproval
CAAJ.,ai*cte,ie4
Attach to complete plans for the system and submit to the County only on paper not less than 8112111 inches in size
SBD-6398 (R. 03/21)
PAGE 1 OF
InwGround Gravity Plan
Index & Cover Sheet
Component Manua! Design References:
In -Ground Soil Absorption for POWTS Version 2.1 May 2022-2027)
/Pg1of4
'Pg2of4
I
iPg3of4
/Pg4of4
Index & Cover Sheet
Plot Plan
Dispersal Area Cross -Section & Plan View
Management Plan
Attachments: Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site MaD
Project Name I Description
Owner Name(s}: �T &s' P/Of Phon : � j _-
e
Owr er Address: X5O Al. 4 A Zip: 66
Project Address: ? vIp1 A'c. bL, wli
Govt. Lot: 114 of
Mj/ 114, Section ,q , T j¢3 N-R!E Dor W
Towlnship: 4 (Ate County: 8b yi-b
Project Parcel ID #: d¢ - y/2- 2-43 .d7 -i9•-:2 lea
Designer Information
Desljgner Name: Ji n Phone: 7/f -o- - 4'a54
Designer Address: 4z z k Uri,gg 4 R 1 Zip: 54b2/
E -mil: o�� nn�s roc s .nus. i, /9y�- } Q:ii2 � � • Ca /yj This space reserved for approval stamp.
Licepnse Number: 2 2j-5/ 4
Remarks: RECEIVED
JUL 0.8 2026
• Bayfield Co.
Planning and Zoning Agency
Signature: Date: o �z
Odg€nal signature required on each submitted copy.
s,2 7ES D. P 7"T7Sa�SI
/59W X7`1 Sr.
RE r C"A/f, /'IN S"Sa
4Z 75 /(V444//( , .
41 k , NW, /43,7w
1f4 P 1 o' 7v /Qflda4'iJ
K �f -. P Vl
fI r
x �e PC -,K- 17 S I / c r
Ev. qp s
, LLJ
4, $6'pc Preis7L.
N A PRoPEP7y
cco
QAJ
a0 20
43
IN -GROUND GRAVITY DISPERSAL, AREA
Uniform E ovation Trenches With WOW Standard•„W Chambers
3 -ft Trench (down -Sizing credit)
SOII. OV614
min, Iranuh
rfn ib
(Wprnnl)
mlm 1?
(lyplual)
,
1411q
'�'
5
, ,
,41
(lypinaq
'�°' • I v
esptlo Tanit(n) Man fanturerl
seplla'iank(e) volumo(e)I
gal L _._.., gal .__..'b., gal Taw and
stnusnt miter Manufaatursrl
Effltiant Filler Model 01
TYPICAL TRENCH
CROSS SECTION VIEW
(No Scale)
System tEil vatiol) = ft
(typical)
!1 Qulok4 Stendard,W
w(ypd inaljp (Show location of Inlet / outlet pipe connection on plan view,)
I3
(typical)
INSTALL PER TRENCH;
Qulok4 Std -W @ 20 ff EISA/ahember = ,J2 f
�?ys
+ ___Pairs of end caps @ d'{rtnEISA/pair =
= Proposed EISA per trench = ? 2 ,'�ft2
Provide minimum 8 ft w cc
separation between trencl
lit o
Observation(�Ipa
((ypleol)
TYPICAL'fEN
PLAN VIEW
(No Scale)
TA = :a,o rt
(lyPloal)
'-Qulcic4 Standard•W chamber
(typloal)
(mfd by Infiltrator alien, ma,)
nut all purauanl to mehufaplonsee instmotionn,
Required Infiltration Area S9L*n ftl
x .,2. trenches = Proposed Total EISA - ft
Distribution Method:
�zv,f
m
O
m
PAGE 4 OF 4
In -ground Gravity Management Plan -
r :
The owner of this 1n- ground gravity system shall be responsible -for its perpetual
requirerrfenfs of SPS 382-384, Wise Admin. Code. Pursuant o SPS 8(2), Wise. Adm n Code maintenance
ce pursuant to
it
be considered a human health hazard if not maintained in accordance with thiss system sl3all`
Furthermore, all inspection and maintenance activities shall be approved management plan.
accordance with SPS 383.S2 (3), Wise. Admin. Code. performed by a register POWTS ntainer, in
E dmui fDfsooreat .Area Operating Limits:
DesignPOW — gpd, 60D5 S 220 mgL 1; TSS 5151 mgL ; FO E 30 rngL1
tyn GnecKUS t INSPECT EVERY 3 YEARS RECEIVED
o &caofuse.
o ge o€ system
o nuisance factors (i.e. odors, user complaints, etc.) JUL 0.8 2026
o mechanical malfunction Le:; pumps,switches, floats, etc 3 6ayfie�d co.
o aterial fatigue (i.e., leaks; breaks corrosion, efC) Planning and Zoning Agency
o .solids volume in anaerobic treatment tank(s) and any distribution'appvrtenance=s) (Le., die button !drop boxes)
o neglect or improper use (Le.., exceeding design capacities, prohibited activities, etc) o extent of ponding in distribution cell priorto dosing
o o dosing
irregularities
— If applicable (i_e., pump re -cycling, float switch settings, etc.)
components - if applicable (Le., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure— compare to d ec i o
o sufface discharge of effluent or sewage back-up into structure served � SP � n
Maintenance Cheer MAINTAIN EVERY 3 YEARS (or when necessary)
O 5ettfc and dosed shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
stafs. when the volume of solids in the tank(s) exceeds onethird (113) the liquid volume of the tanks or
ai required by local ordinance. Disposal of contents shad be pursuant to NR 113, Wisc. Admin. Code. tank(
)
o Fffluent f s r(s; shall be inspected every 3 years and shall
cumulated solids according to manufacturer's specifications. e A sere serned vicing will necessary remove any
months.9 period always be greater than 12
System Maintenance reports shall be submitted to the proper local government unit In accordance with SPS 383.55 wlsc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company: /a 0 S a. Phone: 1/ S "�� -ate
Local government unit S� Je C4_
Phone. 7/S 373
Local gov mment unit address: f s/ f ct1, • l i/i ZIP: S18?/
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383-51(1), Wise. Admin.
Code. Reiircr replacement of failed or malfunctioning components shalt comply with SPS 383, Wisc. Admin. Code.
No, pmduat for chemical or physical restoration of the POWTS maybe used unless approved by the department in
accordance with SPS 384, Wlsc. Admin. Code.
contljcy Pbii
In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be
"abandone l and replaced by a code -complying dispersal component to a pre -determined area of suitable soils.
System Abandon# r gnt
if use of this PCWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wise. Admin. Code.
. 4
YW'`►'r ' Wisconsin Department of Safety & ProfessionalServices TEST " Page ot!
SOIL
Divrslon of IndustrySenfices
•1 ; o.qs
SOIL EVALUATION REPORT -tax A S f 111
In accordance with SPS 385, WIIs. Adm. Code County
Attach complete site plan on paper not less than 8 112 x 11 Inches In size. Plan must include, '&z/d
but not limited to vertical and horizontal reference point (BM), direction and percent slope, ParcelED. O4 -d/ -2.4 =19
scale or dimensions, north arrow, and location and distance to nearest road. _►
Please print all information. R e y Date
Personal Information you provide may be used for secondary purposes (Privacy Low, S. 15.04(1)(m)).
Property Owner Property Location
JaM b• /'7GoutLot i /}/ /. 3/ S lQ ' T NR �7 E (er 1N
Property Owner's Mauln�, Addres Site. Address or CSM and Lot#.
ILL/ 2'775 kAv , X16hl rib,
City, State, Zip 366 I Phone Number ❑ City ❑ Village II Town Nearest Road
NewCeonstructlor3 Use: 0 Realdentlal/Numbsrof bedrooms_S Code derived deslgnflowrate 450 GPO
❑ Replacement ❑ Public or commercial --Describe: i�':E IV ian elevation if applicable WA ft.
Parent material.�„�,
General comments and recommendations: J U L 4 8 2026
Bayfield Co.
Q Boring # ❑Boring 4 canning and Zoning Agency
spit Ground surface elev.. , „ft Depth to limiting factor in. / elev� ft.
Horizon
Depth
In.
Dominant Color
Munsell•
Redox DoscripfIon
Qu. Az. Cent Color
Texture
Structure
Cr. Sz. Sh.
Consistence
• Boundary
Roots
GPD/Ftz
6-7
5 yRi 2 'p4'
6/
% h). Sik
%+ri
_I
2-F
S
o '
2
7'
StIR 4e;
7'L S
VAK.
w.
zn •
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—
3.44
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s
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nil
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S'
44—
£ yR•
>V4
Cis
...
,7•
❑B°
o
sPitt Ground surface also ft. Depth to limiting factor �in. / elev. ft.
Cnll arrnliratlnn Raid
Horizon
. Depth
In.
Dominant Color-
Munsell
Redox Description
Qu. Az. Cant Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPDIFtx
1
0-(
ffyk 2
1
!r» Sk
-zf
,s
�•
gf ¢j
Nd
k
r
C.LLS
2w
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CST Name (Please Print Sign CST Number`
b 7YN/S &5,% r.J p- 40674190 '.�
Address 4 2625 KKY4N UOK kb • Date Evaivafo Conducted _ Telephone Number
A 54 z :.�3?. 7/p- 58 "6254(
* Effluent #1 = BOD > 30 s 220 mglL and TSS > 30 150 mglL ` Effluent #2 = SOD, s 30 mglL and TSS s 30 mglL
SBD-8330 (R03122,'
LIIBoring # •0 P •Ground surface elev. It.
Page --Z�� tt•. of
ya dTr�% •
Depth to limiting factor in. I elev.__tt.
Horizon Depth
In.
•Ti c-Y-yg91
ZZ
4 54 -79
Dominant Color
Mansell
5Y
, s1R
Redox Description
Qu. Az. Cont. Color
AM
iv
/.�
Texture
s1
is
,s
Structure
Gr. Sz. Sh.
_/,,,hk
fK ,..
Consistence
jifr
nyyi
Boundary
w
Roots
T1
Jv.
--
Solt Appilcatlonj
GPD/Ft2
2
__
1 Z
r Z
OBoring
D Pit Ground surface elev. . ft. ..Depth to limiting factor In. / elev IL
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Cr. Sz. Sh.
Consistence
Boundary
Roots
oo„ ppucairon Km
GPDJFt2
*Eff#1
*Ef 2
Liii] Boring #
Q Boring
o Pit Ground surface elev._ ft Depth to limiting factor in. I elev. ft.
Horizon
Depth
In.
Dominant Color
Munson
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
oou f! pu uuon Kai
GPDIFt2 -
*E
*Efl#2
*Effluent #1 = SOD > 3O s 220 mg/L and TSS a_ 30 s t 5O mg/L
RECEIVED
. JUL 082026
Bayfield Co.
Planning and Zoning AgepcY
* Bmuent#2 = SOD, S30 mg/L. and TSS s 30mg/L
D. PTT .,Sv4C
R Wrn/f, /'IIV N
4277'
4 VP lod Thp #dho ,
• L',1B/N
' ter•
N Q
! ! o.
•1
NA PRo f ,0T1' //j/E L.
s � .
' t
Soil Profile Sheer
Owner: t��J��siz��
Soil Tester: �n h .S2Sy Lt .S�
S Ys tem El ev ati an: 56' load Rate:
? System Range. ! 5 toif
s-
p (?�')
; gam .... .... ..... .....
..I . .
9�,�
.. .... ...::
.....1 4.....3' ::::::.::::•'
S9 ... _... ... . .
. ......... .... ....
s_. .... . .....
JUL a 2026 .. .
BaYtd Co•
ng Agency
plane ing and Zoni
a�-s3s
R Wm/f, frM1 c5 -o6
42 77$ K V4,VAt1 ' ,'.a-
r p ! +%' ��•i1r ' ire ` 317 8'u
SGT: l ar
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BAYFIELD COUNTY
SANITARY PERMIT (#04)-26-83S
STATE SANITARY PERMIT
OWNER: JAMES D PATTERSON REV TRUST
G OV'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 DATE: 7/10/2026
Authorized Issuing Officer
CHAPTER 145.135(2) WISCONSIN STATUTES
a. The purpose of the sanitary permit is to allow installation of the
private sewage system described in the permit.
b. The approval of the sanitary permit is based on regulations in force on
the date of approval.
c. The sanitary permit is valid and may be renewed for specified period.
d. Changed regulations will not impair the validity of a sanitary permit.
e. Renewal of the sanitary permit will be based on regulations in force at
the time renewal Is sought, and that changed regulations may impede
renewal.
f. The sanitary permit is transferable.
History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314
Note: if you wish to renew the permit, or transfer ownership of the
permit, please contact the county authority.
PREVIOUS PERMIT #:
LICENSE: # 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