HomeMy WebLinkAbout26-99SDepartment of Safety
Coun
gaty
& Professional Services,
Sanitary Permit Number (to be filled in by Co.)
Industry Services Divisionfield
oo8b
a' -g g 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(l)(m), Stats.
61210 Andrew Anderson Rd Mason, WI
L Application Information — Please Print All Information
Property Owner's Name
Parcel #
Erik and Mary Treba
23503
Property Owner's Mailing Address
Property Location
W188 S1 0411 Kelsey Dr. BayfieldCo.
Piani,lno and Zoning Aganry
Govt. Lot
SW SW 15
City, State I
Zip Code
Phone Number
Muskego, WI
53150
%, /, section
T 46 N R 06 S❑or W
II. Type of Building (check all that apply)
Lot #
0 I or 2 Family Dwelling— Number of Bedrooms 2
Subdivision Name
Block #
O Public/Commercial — Describe Use
U City of
❑State Owned —Describe Use
O Village of
CSM Number
a Town of Mason
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.
New System
❑ Replacement System
❑ Other Modification to Existing System (explain)
❑ Additional Pretreatment Unit (explain)
B'
0 Holding Tank
❑ In -Ground
❑ At-GradeDesign
❑ Mound
❑ Individual Site
❑ Other Type (explain)
(conventional)
C.
❑ Renewal Before
❑ Revision
❑ Change of Plumber
❑ Transfer to New Owner
List Previous Permit Number and Date Issued
Expiration
IV.
DispersaliTreatment
Area and Tank Information:
Design Flow (gpd)
Design Soil Application Rate(gpd/sf)
Dispersal Area Required (st)
I Dispersal Area Proposed (sf)
I System Elevation
450
Capacity in
Total
# of
Manufacturer
Tank Information
Gallons
Gallons
Units
a
o
L
v
New Tanks
Existing Tanks
w G
y
m
m
B
a
au
in
Septic or Holding Tank
❑
2000
1
Wieser
❑✓
❑
❑
❑
❑
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
Business Phone Number
Edward B. Redinger
��
221939
715-292-6670
Plumber's Address (Street, City, State, Zip Code)
1015 11th Ave. E. Ashland, WI 54806
VI. County/Department Use Only
bL
Approved
❑ Disapproved
Permit Fee
DateIssuuedIF
Is Agen ature 7 �/
O Owner Given Reason for Denial
400 �
8 l J �l0D
Conditions of Approval/Reasons for Disapproval
ass°- mod.
Attach to complete plans for the system and submit to the County only on paper not less than 8 to x 11 inches in size
SBD-6398 (R. 03/22)
Soil Test #
Bayfield County
Waiver of a Thorough Soil & Site Evaluation
(subject to 15-1 -1 0(d))
I EDWARD J WROBLEWSKI 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 MARY K TREBA
Property Address XXXXX ANDREW ANDERSON RD
MASON, WI 54856
Telephone 414-465-6403
Accurate Legal Description is requested:
Contractor
ED'S MECHANICAL LLC
Authorized Agent EDWARD J WROBLEWSKI
Agent's Telephone 715-209 4055
Written Authorization Attached: Y or
Sw114 of Sw 114 Section 15 Township 46 N. Range 06 W. Town of MASON
Additional Legal Description: IN V.845 P.115 256 RECEIVED
JUL 29 2026
Govt. Lot Lot Block Subdivision
Bayfield Co.
Lot CSM# Vol. Page CSM Doc # finning and Zoning Agency
Volume Page of Deeds Tax I.D# 23503 Acreage 40
Indicate reasoning for your determination: CLAY SOILS
l
Signature of Certified Soil Tester
7/,y /Z. zr
Date
SP -72000013
Certification #
Signature of County Official
(Submit a Plot Plan & Fee)
Date
u/forms/soiltestwaiver(KLK)
June 2018
EDWARD J WROBLEWSKI, CST RSP-72000013
SOILTEST PLOT PLAN
MARY KTflEBA
XXXXX ANDREW ANDERSON RD
SWI14OFSWIA
IN V605.115266
615 T46N R06W
TOWN OF MASON, WI
SCALE 16U
aftl TAIPEWa1ffJYlRfC
10 Loist
RECEIVED
JUL 292026
Bayfiekt Co.
Plannin
g and Zoning Agency
m
i nr V!
O
�w IT
O �SfiFC
WRM]it KJ
TbO•TO LOT Ur
p.
•W ICWTLIT&
FJEElR6n
PAGE 1 OF 4
Holding Tank Plan
Index & Cover Sheet
Component Manual Design References:
Version 2.0, SBD-10855-P (N. 03/07; R 01/12)
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Holding Tank Specifications
Pg 4 of 4 Management Plan
RECEIVED
JUL 2.9 2026
Bayfield co.
PianMng and Zoning Agency
Attachments:
Enclosures:
POWTS Application for Review
Soil Evaluation Report & Site Map (if ap
Holding Tank Pumping Contract (if apph
Holding Tank Agreement (if applicable)
Project Name I Description
2 Bedroom Holding tank
Owner Name(s): Erik and Mary Treba
Owner Address: W1 88 S1 0411 Kelsey Dr. Muskego,Wl
Project Address: 61210 Andrew Anderson Rd. Mason,WI
Govt. Lot: SW 1/4 of SW
Township: Mason
Project Parcel ID #: 23503
Phone:
Zip: 53150
plicable)
cable)
1/4, Section 15 , T46 N -R 06 E U or W
County: Bayfield
Designer Information
Designer Name: Edward Redinger Phone: 715 -292 6670
Designer Address: 1015 11th Ave. W. Ashland, WI
E-mail: ed@superiorpmw.com
License Number: 221939
Remarks:
Zip: 54806
Ibis space reserved for approval stamp.
Signature: ZGDate: 7/28/2026
Original signature required on eac submitted copy.
Page 2 of 4
CONTACT INFORMATION
PHONE:
EMAIL: hdiet@aot.com
n Plot Plan
1- = 100'-0"
4kSUPERIOR
PWMBING MECHANICAL
(715)292.6670
ER
D
TO BE
/ELL
.L
V
r
PARCEL #:23503
40 ACRES
TOWN OF MASON
SWI/4 SW1/4515 T46 N R06W
ERIC t MARY TREBA I Plot Plan
61210 ANDREW ANDERSON RD. Date 7/28/2026 C1 00
MASON, WI Drawn by JCR
Checked by ED REDINGER, CST#:221939 Scale 1" = 100'-0"
PAGE 3 OF 4
HOLDING TANK SPECIFICATIONS
(No Scale)
Electrical must comply with
SPS 316 and NEC 300
18" Min. v
(typical)
e ;
Inlet
Approved Joints with
Approved Pipe 3 ft onto
Solid Ground c
a
a
Weatherproof
12" Min. or 2.0 ft above
—Junction and
Approved
Established Flood Elevation
Alarm Box
Vent Cap
(typical)
Approved Locking Manhole
4`0 Vent Pipe
with Warning Label Attached
Conduit
>10 ft from
(typical)
4" Min. or 2.0 ft above
Building
I
Established Flood Elevation
j
(typical)
\/
Airtight Seal
•
Finished Grade
Inlet Invert
RECEIVED
Max. 12" or 90% of total volume _F ' if mom than one tank
JUL 29 2026
Alarm -On
Bayfieki Co.
Planning and Zoning Agency
HOLDING TANK
VOLUME = 2000 gal
3" Approved Bedding Material Beneath Tank
TANK MANUFACTURER: Wieser
Anchor tank as necessary
pursuant to SPS 383.43(8)(g)
Ballast Weight = I(cu.ft.tank.vol x 62.4 Ibs/cu.ft) - lbs.tank.wt] x 1.5
Ballast Weight = I( cu.ft. x 62.4 lbs/cu.ft) - Ibs] x 1.5 =
Plug
lbs
PAGE4OF4
Holding Tank Management Plan
IMPORTANT:
The owner of this holding tank(s) 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 holding tank(s)
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.
Estimated Daily Wastewater Flow = 450 gpd
RECEIVED
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system JUL cL,9f,0 2026
o nuisance factors (i.e. odors, user complaints, etc.) BayCo.
o mechanical malfunction (Le., pumps, valves, switches, floats, etc.) planing and Zoning Agency
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
o electrical components (Le., wiring, connections, switches, controls, timers, alarms, etc.)
o surface discharge of effluent or sewage back-up into structure served
SERVICING FREQUENCY
o The tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wisc. Stats.
when the wastewater in the tank(s) reaches a level of one foot below the inlet invert of the tank(s).
Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
Tank pumping reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wis.
Admin. Code. Report any component failure or malfunction to:
Name of individual or company: Superior Plumbing & Mech. Inc.
Local government unit: Bayfield Co Zoning
Local government unit address: 117 5th St. E. Washburn, WI
Phone: 715-292-6670
Phone: 715-372-6138
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 component of this holding tank(s) cannot be repaired, it shall be replaced pursuant to a
plan submitted to the appropriate agecy for review and approval.
System Abandonment
If use of this tank(s) is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
164"
v-4'1 CAST -A -SEAL 4" CAST -A -SEAL
I�I
1Yp
FILTER OR BAFFLE J II
TOP VIEW
RECEIVED
JUL a9 2026
N S Bayfield Co.
a planning and Zoning Agenl.Y
INLET TL
`� 11QMEJ
PUMP PAD
n
SIDE VIEW
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
WLP2000—MR
TANK SPECIFICATIONS
J
O
DIMENSIONS:
o
a
WALL: 3"
a
o
BOTTOM: 5"
a
a
COVER: 6"
o
C
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
��
HEIGHT: 55" O.D.
a
d
LENGTH: 164" O.D.
Z
WIDTH: 96" O.D.
BELOW INLET: 43" O.D.
z
LIQUID LEVEL: 36"
o
WEIGHT: BOTTOM 14,060 LBS.
COVER 8,170 LBS.
a
o
INLET AND OUTLET:
4" CAST -A -SEAL BOOT OR EQUAL
INLET AND OUTLET BAFFLE AND FILTER:
m
�
�
WISCONSIN, SEE DETAIL #10
(OTHER STATES SEE CHART)
o
o
0
r N
LIQUID CAPACITY: 56.27 GALAN
LOADING DESIGN: 8' 0" UNSATURATED SOIL
HOLDING TANK:
C o Ln
OUTLET HOLE PLUGGED
C
ACTUAL CAPACITY: 2,138 GALLONS
�a to
N
Ws l
H�o
TANK CAN BE USED AS:
W N oo
SEPTIC/ HOLDING/ PUMP OR SIPHON
0
COVER: MIX DESIGN #8 (NO FIBER)
TANK: MIX DESIGN #9 (SMALL FIBER)
CUSTOMIZED TANKS:
FOR CUSTOM TANKS CONTACT WIESER CONCRETE
-1
a
z
Z
O
U
DRAWINGS SUBMITTED
FOR APPROVAL
APPROVED BY:
CUcCT
APPROVAL DATE:
PRODUCTS NEEDED BY: /OF 1
HOLDING TANK SERVICING CONTRACT
Contract Date
This contract is made between the
Name(s)
Ee,k
of
I ✓e
Pumper's Name (Print)
i-IaLv o rg o>1�flovy, g
Pumper's Signature
Pumpers' Registration #
s
33
We acknowledge the installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions)
PROJECT
Legal Description:
Tax log
LOCATION
(Use Tax Statement)
Q 3 S03
1/4, 1/4,
B
Section �H
Town of:
Lot 5¢e
Acreage
,Township N, Range W
M0 --s
L1O
Gov't Lot
Lot U
CM U
Vol. Page
CSM Doc g
Lot(s) No.
Slack(s) No.
Subdivision:
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) onRE�RIEIt>(/Dsis. 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; JUL 29 2026
b. The name of the owner of the holding tank;
c. The location of the property on which the holding tank is installed; Rayfiekt Co.
d. The sanitary permit number issued for the holding tank; Planning and Zoning Agency
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.
Owner(s)
✓,k )rtLC
,yavy Treb0
vi'Q,�,'fn�'
M. REINHART
to me:
on thist'r day of
commission expires on:
Revised: May 2016 (®May 2018) STATE OF WISCONSIN 1 Drafted by
Personal information you provide may be used for secon an' purposes nvacv'L^aw. S"T5�rt�lmhV
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-1 0571 -P)(R.6/99) and the Bayfield County Zoning Department Sanitary and Private
Sewage Ordinance.
This POWTS has been designed to accommodate a maximum daily flow of
750 gallons of domestic wastewater per day.
2. The owner of this POWTS is responsible for system operation and
maintenance, locking device, alarm and access.
3. The owner or owner's agent is required to submit reports as required by SPS
383.55(1), Wis. Adm. Code, to the Bayfield County Zoning Department.
4. 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.
5. 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 A i9pa
report with the department of designated agent. JUL 292026
7. A User's Manual will accompany the component. It will include ttaoaes
and phone numbers of local health authorities, component �t�4Pi99213e"-'
POWTS service provider to be contacted in the event of component
malfunction or failure.
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 r r Township L?6N. RangeQ(, W. Town of (Oc S oy
Govt.
Lot Lot Block Subdivision CSM#
Additional Legal Description Sw S j y ✓ rL/S 1° '1.,c '7&C
-7- )V -
Property Owners Signature
u/forms/managementplan
Date
Revised: July 2013
(s)
r.k O%h2 Mary "Tick
HOLDING TANK
8€ S/O411 t#<t / ( ) 1%r
1171 ✓t'1J
cement Date (same as Notary Date)
- on - z —Q& —c &- tS-3"'aao-/t)m1l - 7&) - � (0
We acknowledge that application is being made for the installation of (a) holding tank(:
on the following property or that continued use of the existing premises requires that a
holding tank be installed on the property for the purpose of proper containment 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.
DOCUMENT NUMBER
2O26R-613126
DANIEL J. HEFFNER
REGISTER OF DEEDS
BAYFIELD COUNTY. WI
RECORDED
O7/29/2O26 AT 12:56 PM
RECORDING FEE: $30.00
PAGES: 1
1/4 of 1/4 Section I S Township yb N. Range O (v W.
Townof m0.SOV1
Additional Legal Description: St.' SW X" V. 8 yS ✓''• i/.{ 2G" Return To:
RECEIVED
Gov't Lot._ Lot_ Block_ Subdivision CSM#
Lot _
__
CSM# VolPageCSMDoc# JUL 302026
As an inducement to Bayfield County to issue a sanitary Planning and Agenq
permit for a holding tank on the above described property, we agree tto o 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 properly 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 s. 254.59, Stats., Bayfield 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, Stats.
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 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.
3. The owner agrees to contract with a person who is licensed pursuant to s.281.17 (3) Wis. Stats., and chapter NR 114 Wis. Adm. Code, to
have the holding tank serviced in accordance with Ch. NR113, 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 from 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. Stats., 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 enter upon the property to
investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being
properly maintained.
5. This agreement will remain in effect only until Bayfield County certifies that the property is served by either a municipal sewer or a private
onsite wastewater treatment system that complies with Ch. SPS 383, WI's Adm. Code. In addition, this agreement may be cancelled by
executing and recording said certification with reference to this agreement in such manner which will permit the existence 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.
Owner(s) Name(s)—Please Print
/-r, k Tr -
Subscribed and sworn to before me on this date:
Mo.+'/ lrP PC-
—o�
r
Notarized Owner(e}—Slgnature(s)
TINA M. REINHAR
ry P c _
!?tnt. 'tZ
NOTARY PUBLIC
STATE OF WISCONS
.
My
N
ommission xpires:
3�9
Drafted by: r. W'1 7)4 Date:
Personal information you o'de may be used for secondary purposes (Privacy Law, 5.15.04 (I)(m)I
ullorms/sanilary1holdingfankagreerrentdx ®June 2018
B ! 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:
TREBA,MARY K
W188 S10411 KELSEY DR
MUSKEGO, WI 53150
Description
Private Sewage System (Holding Tanks)
Submission Number:
SS -00807
Transaction Number:
SS-00807-4AFDD
Amount
$400.00
Total: $400.00
Payment Amount: $400.00
Reference: 10854
Paid by: Superior Plumbing & Mech Inc, 101511th Ave E, Ashland WI 54806
Payment Type: Check
Transaction Date: 8/3/2026
Receipt of payment does not guarantee eligibility of
permit and is not proof of issuance of a permit.
BAYFIELD COUNTY
SANITARY PERMIT (#04)-26-99S
STATE SANITARY PERMIT
OWNER: MARY K TREBA
G OV'T LOT: LOT: B LK:
SW 1/4 SW 1/4 SEC: 15, T 46 N, R 6 W
TOWNSHIP: Mason
SOIL TEST: 115-21 WAIVER
NEW SYSTEM
SYSTEM TYPE: Holding Tank
PLUMBER: EDWARD REDINGER
TRACY POOLER
Authorized Issuing Officer
DATE: 8/3/2026
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: # 221939
condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all-
ieather road.
THIS PERMIT EXPIRES 8/3/2028
POST IN VIEW
MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION