HomeMy WebLinkAbout26-95SI
Industry Services Division
County
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(III' ,_ j t S'S- Oo7 q a
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4822 Madison Yards Way
Madison, WI 53705
P.O. Box 7302
Bayfield
Sanitary Permit Number (to be filled in by Co.)
/� /y
fi�
Madison, WI 53707
),6 — 9 5 - 1
V
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(1 )(m), Slats.
Same RECEIVED
I. Application Information — Please Print All Information
Property Owner's Name
Parcel #
JUL 092026
Martha Ole (�7&7N/l
19605
0
Property Owner's Mailing Address
Property Location Bayfield Co.
66285 Co Hwy H
Planning and Zoning Agency
Govt. Lo[
City, State I
Zip Code
Phone Number
Iron River, WI j54847
218-393-7319
NE ,, SW y,, Section 21
T47 N R 08 E org/
II. Type of Building (check all that apply)
Lot #
❑✓ 1 or2 Family Dwelling —Number ofBedrooms 3
Subdivision Name
UPublic/Commercial — Describe Use
Block #
City of
Village of
State Owned — Describe Use
CSM Number
Town 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 if
a licable.
A.
❑New System
Replacement System
lijOther Modification to Existing System (explain)
❑Additional Pretreatment Unit (explain)
B.
Holding Tank
Z In -Ground
LIAAt-Grade
Mound
Individual Site Design
Other Type (explain)
(conventional)
C.
[]Renewal Before
❑Revision
Change of Plumber
j1'ransfer to New Owner
List Previous Permit Number and Date Issued
Expiration
404343 7.2.2003
IV. Dispersal/freatment Area and Tank Information:
Design Flow (gpd)
Design Soil Application Rate(gpd/sf)
I Dispersal Area Required (sf)
I Dispersal Area Proposed (sf) I
System Elevation
450
0.7
642
678 195.24
Capacity in
Total
# of
Manufacturer
Tank Information
Gallons
Gallons
Units
V
o'er
New Tanks
Existing Tanks
o
u
r 2
v
r,
ii o
a
Septic or Holding Tank
320
750
1070
1
Wieser (ex) Superior Precast (new)
Lu
Dosing Chamber
D
C
o
V. Responsibility Statement- 1, the undersigned,
assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print)
Plumber's SignatureI
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
7VI. unty/Department Use Only
Approved
0 Disapproved
Permit Fee
Date IssuedI
Issuin" Agent Signatft}fy�It
, / / /1
l"
I
I❑
Owner Given Reason for Denial
—'
l '�,.Q 2 �
r l i .� I
ll
I/!1 / r L J y/
lLC l 1 f
Conditions of Approval/Reasons for Disapproval
/
SBD-6398 (R. 02/22)
MRY-25-2003 08 16 JOSEPH ZIRN SOIL TESTING 1 715 765 4608 P.01
warm Doparbnent of comnarm SOIL EVALUATION REPORT
Division of Sy and Buldbgs
in uocordmwe with Comm e5. Wa. Mm_ Code //�J
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MRY-25-2003 08 17 JOSEPH ZIRN SOIL TESTING 1 715 765 4608 P.03
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The Deparnnem of Commerce is an equal Opportunity scrvice provider and employer. If you netdassistuce to access services or
need material in an altemate format, pleam contact the department at 608.2663151 or TTY 608-264$177.
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T0TRL P.03
PLOT PLAN
6VNrt-: JAAn-n O.e
o1Jts nf-" b z 6 S ow1'1 4 hriJ'l f'ti'
TICK (l7 iS o s
N/Su S Z1 TN7,'' 12o64)
Lot Line
Scale: 1= 40'
Symoos ew -1s.eh ec-� 9S.z�
System= Mlle. z 1 N S
B1=99.3 I' F3c�ow �.ISnN6
B2=10RECEIVED
63=101.1. 0
BM= Top of well casing ?RN6e Ta 9sNeoe6
100:00 JUL 092026
Planning anted Zoning AgenBaeld c0.
cy
StiPt21UA- PRCc'1 3Z0 (37 e y6' Q� c)t N c1tsMBescj
/ aze Ncc r'1'—TtL-10011 ft /
1 GX1fri/v& .Ct,
Wieser 750 gal SeptIc Ti
IN l2•ennMN
NC.N
Home
Lost Lake v' 1z5 ' 7c' =c -
1
Well I IApprox. 180 Ft to road
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MRY-25-2003 08:16 JOSEPH ZIRN SO1L TESTING 1 715 765 4608 P.02
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RECEIVED
JUL 092026
Bayfield Co.,
Planning and Zoning Agency
r
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)
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross -Section & Plan View
Pg 4 of 4 Management Plan
Attachments: Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Map
RECEIVED
Project Name / Description JUL 09 2026
Oie - 3 Bed Barfield co.
Owner Name(s): Martha Oie
Owner Address: 66285 Co Hwy H Iron River, WI
Project Address: Same
Phone: 218 -393 -7319
Zip: 54847
Govt. Lot: NE 1/4 of SW 1/4, Section 21 , T47 N -R 08 E
Township: Iron River County: Bayfield
Project Parcel ID #: 19605
Designer Information
or W❑✓
Designer Name: Jason Kuettel Phone: 715 - 798 -3355
Designer Address: PO Box 66 Cable, WI
E-mail: tim@andryras.com
License Number: 675751
Remarks:
Zip: 54821
Signature: _ Date: ___26
Original sig u required' 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
min. french
depth
(typical)
min. 17
(typical)
Septic Tank(s) Manufacturer.
Wieser (ex) & Superior 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
w/End cap llvoicah (Show location of inlet / outlet pipe connection on plan view.)
r:--------�--------ylf-----
1 o
L•L—....__..rki-----:9-------.77.. ---
B= 46 ft
(typical)
INSTALL PER TRENCH:
11 Quick4 Std -W @ 20 ft EISA/chamber = 220 ft'
+ 1 Pairs of end caps @6 ft' EISA/pair = 6 ft'
= Proposed EISA per trench = 226 ft'
RECEIVED
JUL 0 9 2026
Provide minimum 3 ft
separation between trenches.
Observation Pipe
(typical)
Install per manufacturers
/ Instructions.
TYPICAL TRENCH
PLAN VIEW
(No Scale)
TA = 3.0 ft
(typical)
"—Quick4 Standard -W Chamber
(typical)
(mfd by Infiltrator Systems, Inc.)
Install pursuant to manufacturers instructions.
Planning and Zodntcg A
Required Inftl ratron Area = 642 ft2 Distribution Method:
x 3 trenches = Proposed Total EISA = 678 ft' branched manifold
C)
m
W
O
a
SEPTIC TANK
OSS S?CT=ON AND S?E I:ICATIcrra
4" GC4.'IOP'iC INSP. DTnr 6 " M_N. A3OVE GRADE (opt)
(Whe.Y1t2+ fn0. 0C FS J
FINISHED GRADE
ff
18" 1iN.i
I ?ILET
APPRQ3LE'D BA-P-CrE-
O FILTER
APPROVED MEG. Ol et1Co
PIPE 3'
ONTO SOLI0I I model e To$2.-z-
SOIL
3" APPROVED BEDDING U)1Di R, TAN1's
SPECIFICATIONS
S E pfrC
TANK N ANUFACTuRE:: ______'___ (_� c.9r—
TANK SIZES. S='TIC 3LO GAL.
NOTES:
APPROVED
MANHOLE
W/ Ltx.g4
W%f"I'Vc' 1J48&L
4" MIN.
OUTLET
RECEIVED
JUL 092075
BaYfield Co.
Planning and 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 5 220 mgL-1; TSS ≤ 150 mgL''; FOG ≤ 30 mgL-1
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
Local government unit: Bayfield Co. Zoning
Local government unit address: 117 E 5th St. Washburn, WI
Phone: 715-798-3355
Phone: 715-373-6138
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.
to-o03o7
Private Sewage System
Owner(s) Name
t gThA O(C
U
62`bS-Coo
Iq(,OS
DOCUMENT NUMBER
2026R-6 1 2853
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY. WI
RECORDED
�� H 07/08/2026 AT 11:32 AM
RECORDING FEE: $30.00
PAGES:2
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)
L1/4 of 1/4 Section ______Township 117.N. Range _K6
Additional Legal Description: o . S-QJL-a r
1 k
Town of t-Dvv R 1 vt..f (Acreage) Gov't Lot
Lot Block Subdivision
Lot _ CSM # Vol. _ Page _ CSM Doc #
Area
Return To:
Planning and Zoning Dal�trrleEIVED
JUL 09Z026
CO.
lanni g and Zoning q
In -ground gravity ❑ In -ground dosed ❑ In -ground pressure distribution Sewage nSystem:
❑ Mound ❑ At -grade Sewage System ❑ Other
AQ 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. Atarade. 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) Names) — Please Print
Subscribed and swom to before me on this date:
Notarized �Owner(s)—�signature
\[(\�\\�
NotaryPublic
A
My Commission Expires: 0'
,
/(,,1GL13.\)a —r
l./ V
Drafted by: V ita+rt net Q≥ e- Date: 7 -IV oa'a ,
'. -
r:li':. Proofed by:
u/forms/sanitary/septicmaintenceagreement
Revised July 2020
Real Estate Closings 885 W. Broadway Avenue
GOWEY Title Titlelnsurnce 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°3636" 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
RECE WED
.;1. 09 2026
Bayfield Co.
Planning and Zp°ine C
Bayfield County Register of Deeds Document #2026R-612107 Page 2 of 2
P-`-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:
OIE, MARTHA C SS -00790
66285 CO HWY H
IRON RIVER, WI 54847 Transaction Number:
SS-00790-4A3D6
Description
Private Sewage System (Septic Tanks)
Amount
$400.00
Total: $400.00
Payment Amount: $400.00
Reference: 15102
Paid by: Andry Rasmussen & Sons, PO Box 66, Cable WI 54821
Payment Type: Check
Transaction Date: 7/20/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
BAYFIELD COUNTY
SANITARY PERMIT (#04)-26-95S
STATE SANITARY PERMIT
OWNER: MARTHA OIE
G OV`T LOT: LOT: BLK:
NE 1 /4 SW1/4 /4 SEC: 21, T 47 N, R 8 W
TOWNSHIP: Iron River
SOIL TEST: 79-03
REPLACEMENT SYSTEM
SYSTEM TYPE: Non -Pressurized In -Ground
PLUMBER: JASON KUETTEL
EMILY MACGILLIVRAY 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
ondition: Properly Maintain System Per Recorded Agreement
THIS PERMIT EXPIRES 7/20/2028
POST IN PLAN HIV
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION