HomeMy WebLinkAbout26-95SRequest 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 bayfieldcounty.wi.gov
Note
Time Change fl Discrepancy fl Other
Phone Number
Plumber:
%I,,,,,1 �( ^q r��—
LJ 1 i I( ��Y1S
Fax Number
[ �1 R7 0
Email Address
Homeowner:
)'y�)5SL/ JG.ndt'gazsafbm
m aY
Immediate Phone Nu ber So Zoning
Sanitary
Dept can call you right back (if needed)
Permit #:
(p —
Plumber's Choice
Zoning Dept
1s
w
No Inspection(s) during this time
Date:
n �/)
4
a
Tuesday (9:30 am - 12:15 pm) (Tracy)
Plumber's Choice
j ing Dept
Time:'
Township:
r
Address # &
Road Name:
or
'1 �/
bums
^jj
W LAw!
H
'4O5
Directions
(
To Site:
Comments:
* Plumbers you must verify any change(s) by fax or email **
Notes from Zoning Dept:
July 2025
��nnrn,
MARTHA C OIE
66285 CO HWY H
Indu IRON RIVER WI 54847
Gel
Pets
Permit Holder's Name:
lnfnrmnfinn
Private Onsite Wastewater Treatment
( POWTS),Inspection Report
(Attach to Permit)
setback to
fo1° of kve V
TYPE
MANUFACTURER
CAPACITY
Prop. Line
Well
Building
Air Intake
Road
Se tic
S,
G
'7/O0
7
N/A
c
N/A
Aeration
+ ,
N/A
Holding
Pump! Siphon Information
um p Manufacturer
ump Model
Demand
GPM
ilterManufacturer
O ✓e-iGO
tPilterModel
PJ Z— 2
TOH
Lift
Friction Loss
Head
Total
Forcemaln
Length
Dia
Dist. To Well
Disnersal Cell Information
DIMENSIONS
Width Length ,
0o
# of Cells
cJ
SETBACK FROM
Prop_ Line Building
Well
OHWM
Type of Cell
Pretreatment Unit
Manufacturer
Model Number.
Manufacturer:
Model Number.
Elevation Data
X Pressure Svstems Only
Length Dia Length Dia, Spac_ j Spacing ' es ❑ No
Soil Cover
Depth Over Depth Over Depth of Seeded / Sodded . Mulched
Cell Center Cell Edges Topsoil DYes ❑ No 0 Yes ❑ No
COMMENTS: (include code discrepancies, persons present, etc.) j � /
G�,t-J)"(c'S Vail 1
Ian revision required? ❑ Yes ❑ No
3e other side for additional information.
Date
9RnlJ1n in 09/)11
License Number
Property Owner
Information
BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT
Telephone: (715) 373-61$8
Fax: (715) 373-0114
e-mail: zoning(aTbavfleldcounty.org
Web Site: www.bavfieldcountv.org1147
MARTHA C OIE
66285 CO HWY H
IRON RIVER WI 54847
Bayfield County Courthouse
Post Office Box 58
117 East Fifth Street
Washburn, WI 54891
As you know �L1 d . ( Jc 141C. cc�,.1 was contracted by 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.sei3ticsearch.com
Notes:
Abandonment of Old System to meet all applicable code requirements:
1
Tank was pumped by:
• Tank was crushed / removed and pipes disconnected by:
on
at AM/PM
On ` at Z{AM &) the above -mentioned plumber contacted our office to
conduct a pr -cover inspection as required under DSPS 383. One of the following applies:
System was inspected and appears to meet all applicable code requirements.
flSystem 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/sanilarypropenyowner-input
Apri12019
rYT"ST•"`E+r
Industry Services Division
County
Ps- fw
$
4822 Madison Yards Way
Madison, WI 53705
P.O. Box 7302
Bayfield
Sanitary Permit Number (to be filled in by Co.)
Madison, WI 53707
—
9.5 3
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
is required prior 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 l m , Stats.
Same r�
I. AppliicationInformation — Please Print All Information
Property Owner's Name
Parcel # # o, 9 2026
U
Martha Ole
19605 �!
0
Property Owner's Mailing Address
Property Location Bayfield Co.
66285 Co Hwy H
Planning and Zoning Agency
Govt. Lot
City, State I
Zip Code
Phone Number
Iron River, WI 154847
218-393-7319
NE %, SW ''A, Section 21
T 47 N R 08 E or AV
IL Type of Building (check all that apply)
Lot #
Subdivision Name
Jl or 2 Family Dwelling — Number of Bedrooms 3
Dublic/Commercial — Describe Use
Block #
❑City of
❑State Owned — Describe Use
Village of
CSM Number
QTown of Iron River
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 i
a livable.
A.
New System
Replacement System
z
❑Other Modification to Existing System (explain)
Additional Pretreatment Unit (explain)
13
Holding Tank
IJIn-Ground
❑At -Grade
fllMound
Individual Site Design
Other Type (explain)
(conventional)
C.
❑ Renewal Before
❑ Revision
Change of Plumber
I1"ransfer to New Owner
List Previous Permit Number and Date Issued
Expiration
404343 7.2.2003
IV.
Dispersal/Treatment
Area and Tank Information:
Design Flow (gpd)
Design Soil Application Rate(gpd/sf)
I Dispersal Area Required (sf)
Dispersal Area Proposed (sf) I System
Elevation
450
0.7 1642
678 95.24
Capacity in
Total
# of
Manufacturer
Tank
Gallons
Gallons
Units
u
•Information
s,
o
New Tanks
Existing Tanks
e. U
cn H
w C7
a
Septic or Holding Tank
320
750
1070
1
Wieser (ex) Superior Precast (new)
T7J
Dosing Chamber
V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print)
I Plumber's Signature
MP/MPRS Number I
Business Phone Number
Jason Kuettel
675751
715-798-3355
Plumber's Address (Street, City, State, Zip Code)
PO Box 66 Cable, WI 54821
VL unty/Department Use Only
Approved
I O Disapproved
$Permit Fee
'/Oo�—
Date Issued
Issuin Agent Signal I�y/ 4
(W� 10 iol
O Owner Given Reason for Denial
`i '� 2
/� lit l't
(,� V
Conditions of Approval/Reasons for Disapproval
$�Wfaed eMJ
naacn Co complete plans for inc system anu submit to the County only on paper not less than 111/2 x 11 inches in size
SBD-6398 (IL 02/22)
PAGE 1 OF 4
In -Ground Gravity Plan
Index & Cover Sheet
Component Manual Design References:
In -Ground Soil Absorption for POWTS Version 2.1 (May 2022-2027)
Pg1of4
Pg2of4
Pg3of4
Pg4of4
Index & Cover Sheet
Plot Plan
Dispersal Area Cross -Section & Plan View
Management Plan
Attachments: Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description JUL 09 2026
Oie -3 Bed Bayfield Co.
;'fanning and -Zoning Aggncy
Owner Name(s): Martha Oie
Owner Address: 66285 Co Hwy H Iron River, WI
Project Address: Same
Govt. Lot: NE 114 of SW
Township: Iron River
Project Parcel ID #: 19605
Designer Name: Jason Kuettel
Phone: 218 .393 .7319
Zip: 54847
1/4, Section 21 , T 47 N -R 08 E LJ or w WJ
County: Bayfield
Designer Information
Designer Address: PO Box 66 Cable, WI
E-mail: tim@andryras.com
License Number: 675751
Remarks:
Phone: 715 .398 .3355
Zip: 54821
This space reserved fur approval stamp.
Signature: Date: 7A___ '
Original sig u require n each submitted copy.
IN -GROUND GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard -W Chambers
3 -ft Trench (down -sizing credit)
SOIL COVER
2'
min, trench
depth
(typical)
min. 12'
(typical)
Septic Tank(s) Manufacturer.
Wieser (ex) & Suoerior Precast (new)
Septic Tank(s) Volume(s):
750 gal 320 gal gal gal
Effluent Filter Manufacturer:
Orenco
Effluent Filter Model #: FT -0822
TYPICAL TRENCH
CROSS SECTION VIEW
(No Scale)
System Elevation = 95.24 ft
(typical)
Quick4 Standard -W
wl End Cap (Show location of inlet / outlet pipe connection on plan view.)
(typical)
N
-----------0-------------------f--------7�---
B= 46 ft
(typical)
INSTALL PER TRENCH:
11 Quick4 Std -W @ 20 fl' EISA/chamber = 220
+ 1 Pairs of end caps @6 ft2 EISA/pair= 6
ft2
ft2
= Proposed EISA per trench = 226 ft2
JUL 0 9 2026
Provide minimum 3 ft
separation between trenches.
Observation Pipe
(typical)
Install per manufacturers
/ Instructions.
TYPICAL TRENCH
PLAN VIEW
(No Scale)
IA=3.0ft
(typical)
"—Quick4 Standard -W Chamber
(typical)
(mfd by Infiltrator Systems. Inc.)
Install pursuant to manufacturers instructions.
Plannin Bayeld Co.
9 andflZoning Aoan
Required Infiltraon Area = 642 ft2
x 3 trenches = Proposed Total EISA = 678
ft2
Distribution Method:
branched manifold
D
O
m
C))
O
I. RESET
S� T C TANK C?OSS S:cT=on AE S?ECU iCATIO ,S
t.r` SCtl14Q PVC rrrsP. PIPE 6 U M• ?U. ABOVE GRAD (OPT.
(whe_ % 6n1 e.+ Ma ll- D�e Ts 6ur(e d
c TNISHED GRAD."
• 18" HiN.
I p1LET
AP PRO'1EO
PIPE 3'
OFUTO SOLID
SOIL
3" APPROVE BEDDING U)7! EP, 1Fi}s
SPECIFICATIONS
SEPTIC
TANK i c AW1J F AC TU R E R :TAN? S 4ZES., SE'TIC Z. GAL.
['TOTES:
APPROVED
HIHO LE
WI
VIIIR,vi,v� LA.g�L
4" Kill
OUTLET
R v
JUL 0.92026
Planning�� Id Co.
Zoning Agency
PAGE 4 OF 4
In -ground Gravity Management Plan
IMPORTANT:
The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. 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 Dispersal Area Operating Limits:
Design Flow =
450
gpd; BOD5 S 220 mgL''; TSS S 150 mgL''; FOGS 30 mgL-'
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
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, etc.)
o extent of ponding in distribution cell prior to dosing
o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.)
o electrical components - if applicable (i.e., 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
as 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: Andry Rasmussen & Sons
Phone: 715-798-3355
Local government unit: Bayfield Co. Zoning Phone: 715-373-6138
Local government unit address:
117 E 5th St. Washburn, WI
ZIP: 54891
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 may be used unless approved by the department in
accordance with SPS 384, Wisc. Admin. Code.
Contingency Plan
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
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.
f'1-0030'7
Private Sewage System Maintenan
Owner(s) Name .� fl-iA
f
Owner(s) Mailing Addres
66owi? ;cty 11
Site Address
Ca o NTH ti $\ ? L
Tax ID# I n / O5
As owner, I (we) do hereby certify the private sewage system will be installed in
accordance with the certified soil tester's 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)
NC 114 of S'&) 114 Section ,Township _____N. Range __9
Additional Legal Description: SLQ—aAcar V\Q
Town of I'f-Dy . R (Acreage) Gov't Lot
Lot Block Subdivision
Lot CSM # Vol. Page CSM Doc #
DOCUMENT NUMBER
2O26R-612853
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY, WI
RECORDED
07/08/2026 AT 1 1 :32 AM
RECORDING FEE: $30.00
PAGES: 2
Recording Area
Return To:
Planning and Zoning DsjiJ IVED
JUL.. 0.9 2026
Co.
Manning and Zoning
lI, In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sege 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 manufacturer's 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 sworn to before me on this date:
Notarized Owner(s) — Signature
Notary Public
C! e ,f22J
= t, a t
_ •r
My Commission Expires:
Drafted by: (tbrrk Date: l `I
i3.00fed by:
u/forms/sanitary/septicmaintenceagreement
Revised July 2020
Titlel
Real Estate Closings 885 W. Broadway Avenue
GOV #/ E�/ / Title insurance Medford, WI 54451
www.goweytitle.com
File No, G-2603753
ADDENDUM/EXHIBIT A
A parcel of land in the Northeast Quarter of the Southwest Quarter (NE1/4-SW1/4), Section Twenty-one (21), Township
Forty-seven (47) North, Range Eight (8) West, Town of Iron River, Bayfield County, Wisconsin, described as follows:
Commencing at the Southeast corner of said NE1/4-SW1/4; thence North 00°36'36" West, along the East line of said
NE1/4-SW1/4, a distance of 395.00 feet to a point; thence South 88°00'00" West, a distance of 56.41 feet to a point on
the West boundary of the right-of-way of Country Trunk Highway H and the Point of Beginning; thence from said Point of
Beginning by Metes and Bounds: South 88°05'00" West, a distance of 635.00 feet to a point; thence South 40°05'00"
West, a distance of 50.00 feet to a point on the shore of Lost Lake; thence South 26°55'43" East, a distance of 372.96
feet along said lake shore to a 1 inch iron rod on the South line of said NE1/4-SW1/4; thence South 89°46'03" East, along
said South line to a 1 inch iron rod on the West boundary of the right-of-way of County Trunk Highway H; thence
Northerly along said boundary of said highway right-of-way to the Point of Beginning.
Tax ID Number(s): 04-024-2-47-08-21-3 01-000-80000
09 2026
Bayfieid Co.
piannina and Vic►►n9 Agency
Bayfield County Register of Deeds Document #2026R-612107 Page 2 of 2
MAY -25-2003 0816 JOSEPH ZIRN SOIL TESTING 1 715 765 4608 P.01
woemoa+nw�e SOIL EVALUATION REPORT peg. 3
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TOTAL P.03
PLOT PLAN
o -'- ' a.gS Ccurl-T4 !- '• 1 r 2fv k la N
-rr�x r17 ; 1S605
Lc - N J Sl) s -' T L1?"f f2n8 iJ
Scale: "= 40'
Lot Line
Elea ions S 9 z.
System=cy&, aLJ
81=99.3 1' �3 `��•� L�� N (,
B2_ 98.5 .. _.. R&CEI�y'D
B3= 101.0
BM= Top of well casing gAPJ �
100:00 JUL *9 2026
Bayfleld Co.
Planninand Zoning A en
9 cy
Lot
3zoll
t,) /_ 101 f
100 ft .A►
' 98 ft. to =
CX/sr(/U�TIi
V11�eser 750 ga! Sep c Ta
""4ry \) II
Hom
•c
Well, Approx. 180 Ft to road
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BAYFIELD COUNTY
SANITARY PERMIT (#04)-26-95S
STATE SANITARY PERMIT
OWNER: MARTHA OIE
GOV'T LOT: LOT: B LK:
NE1/4 SW1/4 SEC:21,T47N,R8W
TOWNSHIP: Iron River
SOIL TEST: 79-03
REPLACEMENT SYSTEM
SYSTEM TYPE: Non -Pressurized In -Ground
PLUMBER: JASON KUETTEL
EMILY MACG I LLIVRAY DATE: 7/20/2026
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 #: 404343
LICENSE: # MP 675751
Condition: Properly Maintain System Per Recorded Agreement
THIS PERMIT EXPIRES 7/20/2028
POST N PLAIN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION