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Home My WebLink About24-150SRRequest for Sanitary inspection (Fax this form to Zoning Dept when you want an inspection -3734114) No$e: Iii Time Change Lii Discrepancy Other c icxno.cuo...... 7jJ 7ys —2721 piumber: Dao 9 Wze,& /F Fax Number Home Owner: .` 1j/ LL Oda Q ! E RECEIVED i { Sanitary y _� �U S / aereaid co. Planning' and Zoning' Agwcy f �t>(Ettlt . Plumber's Choice ; Zoning Dept No inspection dilPing these times Date: 11:30 am — 2:30 pm Wed. (Jen) I 9:3Q am —12:30 pm Tues_ (Josh) 3-3Q am —12:30 pm Thurs. (Josfi). Time: Plumber's Choicx I Zoning Dept t Immediate Phone N -amber su Zordng 'Dept can sail you back i€ needed ; ov 3P� Township. ,�2NrS adeess # %5 1 u L n /L A o DGt lC Q. Road imarne: ar f3,9-�Z �✓!z s � W l �: Directions. To ---Site: 1 Comment8: FzrrtitAder You must confirm any change(s) that have been made prior'to or Phis inspection tadll not he scheduled aid a .memo will be sent voiding the inspection. Thank You! Plumber must verify any chaicre(sj by fax or no inspection 8411 be scheduled wfcrm tsnnda:):repr.e5iprin pe*or Zamrg Daat fs: iJ04i a6a,• 2C<5 E), Industry Services Division General Information Permit Holder's Name: Tank TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road Septic " e A 792 ea N/A N/A Dosing Aeration N/A Holding Private Onsite Wastewater Treatment Systems ( POWTS) Inspection Report Permit) WILLIAM P & HEIDI H O'BRIEN 1815 E 11TH ST 15.0a l m SUPERIOR WI 54880 Village Town of: setback to: County p /� Sanitary ermit No: L1-15oS State Plan Transaction ID#: Parcel Tax No: 3670 Pump 1 Siphon Information Pump Manufacturer Pump Model Demand GPM Filter Manufacturer Filter Model TDH Lift Friction Loss Head Total Forcemain Length Dia Dist. To Well Dispersal Cell Information DIMENSIONS Width Length # of Cells SETBACK FROM Prop. Line Building Well OHWM Type of Cell n a/` / �/� Manufacturer: Model Number. Pretreatment Unit Manufacturer: Model Number: )istribution System Header I Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes Length Dia Length Dia Spec Spacing ❑ Yes ❑ No Elevation Data STATION BS HI FS ELEV Benchmark 97 7 23 pz Bldg. Sewer i , Tank Inlet , 33 Tank Outlet 50 Dose Tank Inlet Dose Tank Bottom Inst. Contour Header I Manifold Distribution Pipe Infiltrative Surface 7 Final Grade X Pressure Svct®mc nnly bon cover Depth Over Depth Over Depth of Seeded / Sodded Mulched Cell Center Cell Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) / �9/�/( / G6MAt-14, 7r�/A- C�(.L i171�—f'Ieti/v y;Ven /eq /'l Plan other side for additional information. Date RRIl-J1n !R n2/911 POWTS Inspector's Signature License Number Property Owner Information As you know BAYFIELD COUNTY PLANNING & ZONING DEPARTMENT Telephone: (715) 373-6138 Fax: (715) 373-0114 e-mail: zoning(abavfieldcountv.wi.pov Web Site: www.bayfieldcountv.wi.gov/147 WILLIAM P & HEIDI H O'BRIEN 1815 E 11TH ST SUPERIOR WI 54880 onsite wastewater treatment system on your property described as: Notes: Bayfield County Courthouse Post Office Box 58 117 East Fifth Street Washburn, WI 54891 was contracted by you to install a private Abandonment of Old System to meet all applicable code requirements: C. Tank was pumped by: . Tank was crushed / removed and pipes disconnected by: on at AM/PM On at (AM / PM) the above -mentioned plumber contacted our office to conduct a pre -cover inspection as required under DSPS 383. One of the following applies: ❑ System 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: UHorm slsanitarypropertyowner-input April 2019 r" a, Ss o�4so� Department of Safety & Professional Services, Industry Services Division County Ba'field Sanitary Permit Number (to be filled in by Co.) - J 35 Sf2 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 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(i)(m), Sorts. Project Address (if different than mailing address) 1765 Boulder Lodge Rd, Unit 4 Property Owner's Name t William P. & Heidi H. O'Brien (ERED� Parcel # ,,/+/b 04-004-2-44-09-18-1 00-671-40000 Property Owner's Mailing Address e- Property Location 1815E 11th St GovLLot i• '4, Section 18 T 44 N R 09 E.o City, State Zip Code Superior, WI 54880 Phone Number 218-391-4427 ® I or 2 Family Dwelling— Number ofBedrooms - 2 Lot# Subdivision Name ❑ Public/Commemial — Describe Use Boulder Retreat Condo Unit 4 BI Cityof 0 Village of ❑ State Owned —Describe Use CS4aas Z026 lannin Beyfiekl Co. - ®Town of Barnes Iii A. — ,,.,/ ❑ New System 19 Re lacement System y p y !! S as ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B' 0 Holding Tank i "In -Ground ❑ At -Grade . ❑ Mound ❑ Individual Site Design I ❑ Other Type (explain) (conventional) . iI C. ❑ Renewal Before ❑ Revision Expiration Change of Plumber ❑ Transfer to Nqy Owner ist. Previous Permit Number and Date Issu -r �-- ` 50 2. .o l � i4t Design Flow (gpd) Design Soil Application Rate(gpd/st) Dispersal Area Required (sf) Dispersal Area Proposed (s� stem Elevation 300 0.7 428.6 449.9 95.0 Tank Information Capacityin .' Gallons Total Gallons #f Units Manufacturer ...ggg 2 e 0. U' y �+ tZ .2 w3 a New Tanks I Existing Tudu Septic or Holding Tank 750 — 750 1 Wieser Dosing Chunber ��ii bar's Name(Print) Plum rs ign a MP/MPRS Number 23o z Business Phone Number pis_ g Plumber's dress (Street, City, S Code) oBox 1% f T S y Approved I ❑ Disapproved Pewit Pee D Issued sic_ 6 ❑ Owner Given Reason for Denial Conditions of Approval/Reasons for Disapproval Attach to complete plow for the system and submit to the County only on paper not less then 81/2 a II Inches in size SBD-6398 (R. 03/22) Innovation, Quality and Service Since 1965 WIESEII CORCRETE �p /xvfvt J J�u �J 6,33 7,c Project. Name: Ovation: qiO +n Maiden Rock, WI Fond du Lac, WI Portage, WI Spooner, WI Roxana, IL Rosemount, MN (800) 325-8456 (800) 641-5937 (800) 362-7220 (800) 336-3416 (618) 251-9210 (800) 325-8456 �OPCH Visit Us on the Web ctwmi10 a. +x• www.wieserconcrete.com c 3.5 V RECEIVL*D AUG 252075 Bayfieid Co. Planning and Zoning Agency Computations by: Date: Checked by: Date: 9 Sheet: Of: Gravity In -Ground Plot Plan WILLIAM P & HEIDI H O'BRIEN 1765 BOULDER LODGE RD, UNIT4 BOULDER RETREAT CONDO UNIT 4 IN V.1086 P.779 • �, - _ TOG WITH AN UNDIVIDED INT IN COMMON ELEMENTS 7S18 T44N R09W ♦ e _ / Town of Barnes °f eoolq�, j 04-004-2-44-09-18-100-671-40000 RLCElyED � / ' . -AUG 252026 ► Ma v % �- T _ M / VD 5�d Co. 1OTES: Ptanntnw9 a 2oning q Na �� cabin Middle Eau Claire elev ns74' Property lines not shown > 100' from system area Verify property line, well and OHWM se)backs Weil bedroom house riot to construction Ia O ,., Septic tank & draMeld to be All vent, observation & conveyance piped abandoned per SPS383.33 " ASTM.D1785 or code equivalent . Middle Eau Claire lake •1- - filly Scale 1:40 PropertyGne - * Bench Mark = Top of Well Elev = 100.0' - JTIj 98' 96' gay W r`PMC= WLP754•Mlt w/.potytok S2S fiber Ir 16% Vi Two rows of 10 &1 rowof2 I - lnfittrator au k4 Plus Standard chambers Page 3 of 7 $i .YFIELD Bayfield County Planning & Zoning Department 117 E 5th Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-4010 Property Owner: Submission Number: O'BRIEN, WILLIAM P & HEIDI H SS -004508 1815 E 11TH ST SUPERIOR, WI 54880 Transaction Number: SS-00450R-4CD89 Description Amount Private Sewage System (Septic Tanks) PoLid (.0 [01-71;L4I'7 m tb L. $400.00 Sanitary Revisions $25.00 Total: $425.00 Payment Amount: $25.00 Reference: 4047 Paid by: MICHAEL FOAT, 49755 E SHORE RD, BARNES WI 54873 Payment Type: Check Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. warned y \"' Department of Safety & Professional Services, Industry Services Division County' Bayfield Sanitary Permit Number (to be filled in by Co.) 7� A 7 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 maybe used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Sats. 1765 Boulder Lodge Rd, Unit 4 1. Application Information —Please Print All Information Property Owner's Name Parcel # ,i11.,/ . WOO William P. & Heidi H. O'Brien 04-004-Z-44-09-18-1 00-671-40000 Property Owner's Mailing Address Property Location 1815 E 11th St Govt. Lot A, /., Section 18 City, State Superior, WI Zip Code 54880 Phone Number 218-391-4427 T 44 N R 09 E o w II. Type of Building (check all that apply) ®1 or 2 Family Dwelling— NumberofBedrooms 2 Lot # Subdivision Name ❑ Public/Commercial—DescribeUse Boulder Retreat Condo Unit 4 Block# ❑ City of ❑ State Owned—DescnbeUse 0 Village of ® Town of Barnes CSMNumber 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 y " `�/Replacement System ❑Other Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain) B. ❑ Holding Tank N In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design I ❑ Other Type (explain) (conventional) C. O Renewal Before ❑ Revision ❑ Change of Plumber O Transfer ist Previous Permit Number and Date Issued to New Owner Expiration _ wdffipenaltrreathentArea and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (st) I Dispersal Area Proposed (sf) System Elevation 300 0.7 428.6 449.9 95.0 Tank Information Capacity in Gallons Total Gallons # of Units Manufacturer u 'v c aU U $ U° ran d On y m wu u a. New Tanks I Existing Tanks Septico, Holding Took 750 750 1 Wieser Dosing Chamber V. Responsibility Statement- I, the nnderaignedhasi awe responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) rr PIp ber'SSignature t Ai:111 T.- 1 Lam/ MP/MPRS Number ;c7-- !v BusinesssiPhone Number 1 c�Ci5'"�,' P 'umbb umber's Address ��(Street, City, State, Zip Code) .may y ,! .-."' F- tl29 . . ,�4.. A ii .. *: .r ( ` ? L f .J VI, County/DepartmeatUse Only Approved 0 Disapproved ❑ Owner Given Reason for Denial Permit Fee Date Issued tfi 11 I?, Issuing Agent Signamr Conditions Approval/Reasons for Disapproval Sg 25 ot BaytWd Co. Attach to complete plans for the system and submit to the County only on paper not less than 8 Insal inches in size SBD-6398 (R. 03/22) Mr"°'"ra Wisconsin Department of Safety& Professional Services Page 1 of 3 Division of IndustryServloes SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code County Bayfield Attach complete site plan on paper not less than 81/2 x 11 inches In size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. 04-004-2-44-09-18-1 00-671-40000 Please print all information. Reviewed bL__� Date Personal Information you provide may be used for secondary purposes (Privacy Law, a. 15.04(1)(m)). Property Owner Property Location ❑ ❑ William P. & Heidi H. O'Brien Govt. Lot % ''A S 18 T 44 N R 09 E (or)® Property Owners Mailing Address Site Address or CSM and Lot # 1815 El lth St 1765 Boulder Lodge Rd, Unit 4 City, State, Zip I Phone Number ❑ City - ❑ Village Town I Nearest Road Superior, WI 54880 I( ) Barnes j Boulder Lodge Rd ❑ New Construction Use: Residential/Numberofbedrooms 2 Code derived designflow rate 300 GPD is Replacement ❑ Public or commercial —Describe: Flood Plan elevation If applicable N/A fl. Parent material Sandy outwash (Rubicon-Sayner complex) General comments and recommendations: 1❑ Boring# Boring ® Pit Ground surface elev. 98.0 ft. Depth to limiting factor 84 in. / elev. 91 ft. Soil Aoolication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDFFt2 •Eif#1 •Ef#P2 1 0-4 1OYR 2/1 — s 0sg ml Cs 1vf 0.7 1.6 2 4-29 7.5YR4/4 — 5%FGR)s 0sg ml ow 1m/1f 0.7 1.6 3 29-65 1 OYR 6/4 — 5 0sg ml ow 1vf 0.7 1.6 4 65-69 1OYR6/4 — (15%FGR)a 0sg ml aw — 1 5 69-84 1 OYR 614 — s 0sg ml — 1. r 2❑ Boring # Boring Bayfield Co. Lorhny LJSr'• ®Pit Ground surface elev. 97.8 ft. Depth to limiting factor in. / elev. 90.8 IL Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Cr. Sz. Sh. Consistence Boundary Roots GPD/Ft' •EIWl •Eff#2 0-4 10YR 3/3 — s Osg ml ab 1vf 0.7 1.6 2 4-9 10YR 2/1 — s Osg ml aw 1vf 0.7 1.6 3 9-31 7.5YR 4/4 — s Osg ml cs 1oalmnr 0.7 1.6 4 31-41 10YR 5/4 — S Osg ml as — 0.7 1.6 5 41-49 1OYR 6/4 — cos 0sg ml as — 0.7 1.6 6 49-84 1 OYR 6/4 — $ 0sg ml — — 0.7 1.6 Horizon 2 is buried A horizo CST Name (Please Print) Signatu — CST Number Keith Wiley 654921 Address Dat valuation Conducted Telephone Number 11623 E Larson Dr. Lake Nebagamon, wt. 54849 8/25/2024 218451-2611 • Effluent #1 = BOD > 30£ 220 mg/L and TSS > 30 £150 mg/L " Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L SBD-8330 (R03122) LiIJBoring # Page 2 of 3 Boring ❑ Pit Ground surface elev. 95.1ft. Depth to limiting factor 84 in. / elev. 88.1 ft. D,.{ Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Efi#1 *Effn 1 0-6 1 OYR 2/1 -- S 2 6-30 MYR 414 -- S 3 30-84 1 OYR 614 S ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Cnt1 Annliwfl+lnn De+n Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 ____ ___ _____ __________ ____ ____ ____ii)i \1 SEP 252024 Boring # ❑ Boring . O Pit Ground surface eiev. ft. Depth to limiting factor t3ayT_Irai led (,i. z _ I_ ftig Dept. Sall Annooll1i ii kon Rate Horizon Depth In. Dominant Color Munseil Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 •Eff#1 *Eff#2 * Eftluent #1= BOD > 30 5 220 mg/Land TSS > 30 51 S0 mg/L ' *Effluent= BOD, 5 30 mg/L and TSS 5 30 mg/L O'Brien (2 bedroom) Soil Report Plot Plan North LA ♦ dente / line of ' gan'de� / ` ♦ ` �°dge Rd / ��._—�+/ Q n L. q w M O a p� q V' o Well 0 bedroom house p a � a • 00 .p ST •a Op as Garag7 o N Li - 1 ,JVILLIAM P & HEIDI H O'BRIEN p765 BOULDER LODGE RD , UNIT 4 -AOULDER RETREAT CONDO UNIT 4 IN V.1086 P.779 i'TOG WITH AN UNDIVIDED INT IN COMMON ELEMENTS �18 T44N R09W own of Barnes -004-2-44-09-18-100-671-40000 cabin I7 Septic tank & drainfield to be abandoned per SPS 383.33 16% 7 Middle Eau Claire Lake III Scale 1:40 Property line 98' 96' 94' NOTES: Bench Mark = Top of Well - Middle Eau Claire elev ss74' Elev =100.0'" - Property lines not shown > 100' from tested area CST # 654921 Page 3 of 3 William P. & Heidi H. O'Brien Property Owners Name 1765 Boulder Lodge Rd, Unit 4 Property Address 04-004-2-44-09-18-1 00-671-40000 Tax Parcel Number 3,6/ Bayfield County Boulder Retreat Condo Unit 4 Legal Description 18 Section 44 Town 9 Range Page Index 1 Property Information 2 Data Entry 3 Plot Plan 4 Drainfield Cross -Section 5 Tank Information 6 Maintenance Plan 7 Contingency Plan Keith Wiley Designer's Name Designer's Signature D2388PSS Designer's License Number 218-451-2611 Designer's Phone Number 8/28/24 Date ,�p1111f11/111q�11 I � 1L �1_ A/ mow (� C L tL • o Sea ogs 2 Qs „1111 j ,c ► � � d cA s 7 Page 1 of 7 4 SEP 252 Co. Zoni g' Bayfield n- roun of Absorption for Version 2.1 Ma 2022-2027) 2.1Ma2 Component Manual Used Manual UsedVersion 2 Number of Bedrooms Number of Bedrooms16 16 Percent Slope (%) Percent Slope (%)84 84 Depth to Soil Limiting Factor in.) Depth to Soil Limiting Factor (in.)0.7 lin 0.7 Situ soil application rate Situ soil application rate200 200 Estimated Wastewater Flow (gpd) Estimated Wastewater Flowgpd)300 300 Design Wastewater Flow (gpd)1 Design Wastewater Flow (gpd) 1 Number of System Elevations Number of Sstem Elevations95 95 Proposed System Elevation #1 Proposed System Elevation #195 95 Proposed System Elevation #2 Proposed System Elevation #295 95 Proposed System Elevation #3 Proosed Sstem Elevation #398 98 Original Grade #1 Original Grade #198 98 Finished Grade #1 Finished Grade #197.5 97.5 Original Grade #2 Original Grade #297.5 97.5 Finished Grade #2 Finished Grade #296 96 Original Grade #3 Original Grade #396Finished 96 Grade #3n-unofsorptionComponent Finished Grade #3 750 750 Septic Tank Septic Tank IWieser PL -525 Polylok PL -525 Effluent FilterWieser Effluent Filter Infiltrator Quick4 Plus Standard Infiltrator Quick4 Plus Standard Chamber Type Chamber Type 12 12 Height of Chamber (in.) Height of Chamber (in.) 20 20 sq.ft. per chamber(ESIA) sq.ft. per chamber(ESIA) 3.3 3.3 sq.ft. per end cap (EISA) sq.ft. per end cap (EISA) 4 4 laying length of chamber(ft.) laying length of chamber(ft.) 1.5 1.5 length of endcap(ft.) length of endcap(ft.) 34 34 Chamber width(in.) Chamber width(in.) 3 3 Rows of Chambers Rows of Chambers 3 3 Distance Between Cells (ft. Distance Between Cells (ft.) 10 10 Number of chambers in first row Number of chambers in first row 10 10 Number of chambers in second row Number of chambers in second row 2 2 Number of chambers in third row Number of chambers in third row 22 22 Proposed Number of Chambers Used Proposed Number of Chambers Used 428.6 428.6 Minimum Distribution Cell Area Required (sq.ftJ Minimum Distribution Cell Area Required (sq.ft.) 449.9 449.9 Distribution Cell Area Proposed (sq.ft.) Distribution Cell Area Proposed (sq.ft.) Dept. Page 2 of 7 O'Brien (2 bedroom) Gravitynd Riot Plan North jflN Q, c W ♦ center// / m ne `� ofBo4/der�od / ge Rd NOTES: - Middle Eau Claire elev ss74' - Property lines not shown > 100' from system area - Verify property line, well and OHWM setbacks prior to construction - All vent, observation & conveyance pipes 4" ASTM 01785 or code equivalent Scale 1:40 Property line Bench Mark = Top of Well Elev =100.0' 11 NQ N i1 11 /G NN� a 1 q O q /1 N O�/ a N ao- Well bedroom house P �Qr '+ S Garage 98' 96' 94' WILLIAM P & HEIDI H O'BRIEN 1765 BOULDER LODGE RD. UNIT 4 BOULDER RETREAT CONDO UNIT 4 IN V.1086 P.779 TOG WITH AN UNDIVIDED INT IN COMMON ELEMENTS S18 T44N R09W Town of Barnes 04-004-2-44-09-18-100-671-40000 y �� Q 16% bin o� J� ca Septic tank & drainfield to be abandoned per SPS 383.33 Middle Eau Claire Lake Wieser precast WLP750-MR w/ polylok 525 filter Two rows of 10 & 1 row of 2 Infiltrator Quick4 Plus Standard chambers Page 3 of 7 Cross Section of a Three Cell Inground Component Using Leaching eaching Chambers Finished Grade 97.50 Original Grade 97.50 1s1�� Top of Chamber 96.00 System Elevation 95.00 Finished Grade 198 I Slope 16% -7[flC epa or Finished Grade 96.00 Feet 98.00 Original Grade ,��; 96.00 Top of Chamber __ ___ y. '_Original Grade 9fi.00 • ,; f' • • '� �' ~Top of Chamber 96.00 95.00 ISystem Elevation • ' '• • System Elevation 95.00 •: ..L •�� •`�•..••' Mme` .•±. I �• = N t• •`• lR.,�V♦ .� •:i $ Obot�lVmt Zdpes b !fo co�od and capped With spp�vad m�1o[tsb fat t>ac p�tirattEft trsa Not To 43 feet 11 feet / Vent Pipes to be located at the ends of the distribution cells. 2524 Co. Zoning Dept. 3 feet between cells Page 4 of 7 Ln y N 4" CAST -A -SEAL 4" CAST -A -SEALS i I a U) IE w a� w INLET N CL 2" in ::::1t.j; ir::::: M OUTLET I. I N0 I p D19ui0J_li I TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 RI WLP750-MR TANK SPECIFICATIONS a c o a ^ DIMENSIONS: WALL: 21/2" U BOTTOM: 3" -c3 COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER ' HEIGHT: 54" m OUTSIDE DIAMETER: 7'-0" BELOW INLET: 42" LIQUID LEVEL: 37" WEIGHT: BOTTOM 3,740 LBS. COVER 2,410 LBS. o INLET AND OUTLET: I • 3E 00 o L 4 CAST -A -SEAL BOOT OR EQUAL GASKET m o INLET AND OUTLET BAFFLE AND FILTER: ¢ a o < .9 WISCONSIN, SEE DETAIL #10 U � Q (OTHER STATES SEE CHART) LIQUID CAPACITY: 20.28 GALAN HOLDING TANK: �.7 cj OUTLET HOLE PLUGGED L() ACTUAL CAPACITY: 790 GALLONS = ce 00 LOADING DESIGN: 8'-0" UNSATURATED SOIL Q N TANK CAN BE USED AS: o M SEPTIC / HOLDING / PUMP OR SIPHON `I � 00 COVER: MIX DESIGN #8 (NO FIBER) != TANK: MIX DESIGN #10 (STRUCTURAL FIBER) 10 CUSTOMIZED TANKS: � FOR CUSTOM TANKS CONTACT WIESER CONCRETE fr Un REVIEWED BY REVIEW DATE J M Q F a w N SHEET NO. 17' OF 1 BAYFIELD COUNTY O'Brien CHECKLIST FOR SANITARY APPLICATONS Submit the Following (Use Permanent Ink) (Title 15, Section 15-1-10(e)) ffi Check List 2 Original Sanitary Application (Submitted in Deed Holders Name — not prospective buyers) (383.21(1)1.) • Index Page / Title Sheet (Signed by Plumber) (383.22(2)69(c)) 2 original Plot Plan (383.22(2)2. 3. & 4.a) 2 Cross Section, Over -Head Profile of the System and Schematic of Tank from Manufacturer ❑ Pump Tank Diagram, Alarm and Pump Curve (when applicable) * Contingency Plan / Management Plan (383.22-3(2)(b)1.f.) * Maintenance Agreement (Owner's Original Signature) (383.21(2)(c)(5),(6) (Recorded at Reg. of Deeds) 0 Holding Tank Agreement (383.21(2)(c)(5) (Recorded at Reg. of Deeds) ❑ Holding Tank Service Contract (Original Signature of Pumper and Property Owner) (383.21(2)(c)5) ❑ ATU Servicing Agreement (Recorded at Reg. of Deeds) 2 Fee (Make Check Payable to Bayfield County Zoning) (383.21(2)(c)7) 0 2 Complete Sets of Plans (383.22(2)(2.) (Note: Sanitary Application and Maintenance Agreements are to be attached to all copies) 2 Soil and Site Evaluation Report (383.22-3(2)(b)1.e.) ❑ State Plan Review (when applicable) ❑ Copy of Warranty/Quit Claim Deed (Optional) Sanitary Application: (Include the following Information) 19 I Application Information must include: 0 23 digit Parcel ID# -- (do not use 12 digits anymore --obsolete) 0 Project Address or Road Name where driveway is/will come off of) 2 (Owners Phone Number) 0 II Type of Building 2 III Type of Permit 2 IV Type of POWTS System 2 V Dispersal / Treatment Area Information 91 VI Tank Information 0 VII Responsibility Statement (Plumber's Information) ISZ' *Date Stamp* Plot Plan: (To Scale or To Dimension) 0 Signature and Plumber Information 0 Surface Elevation of Body of Water 19 Direction and Percent Land Slope 0 Tank and Filter Information and Location 0 Wetlands / Navigable Bodies of Water 2 Absorption Area (Proposed and Existing) 21 Bench Mark (Location, Elevation and Description) 0 Address Number and Road 0 North Arrow 2 Contour Unes 2 Structures and Driveways 2 Boring Locations ffi Property Lines 0 Well Locations 0 Component Manual Version Z Legal Descriptions 0 Jtioh (conveyance line, building sewer line, material type and diameter) Turn Over ► Cross -Section and Over -Head Profile of the System: 21 Surface and System Elevation 21 Position of Observation and Vent Pipes 21 Dimensions and Depths 21 Make, Model & Number of Chamber Units In each Cell Property Information 21 How many systems will there be on this parcel of land? 1 19 Has this property been split? no (Property Statement shows Property History) Fees: 21 Private Sewage System (Septic Tanks) $ 400.00 ❑ Private Sewage System (Holding Tanks) $ 400.00 ❑ Mounds or Systems requiring Pre -Treatment $ 500.00 - 0 Sanitary Revisions $ 25.00 ❑ Private Sewage System Reconnection $ 50.00 and Private Interceptor ❑ Return Inspection $ 50.00 21 Maintenance Agreements + $ 30.00 (checks made out to Reg of Deeds) O� D 2®24 Sip 2 1d G°• �°'��'9 dept. gayfie u/forms!checklists/checktistforsanitaryapps (10/2009);(®7/2011);(®2/2012)(®5/2/2012 -dc) Proofed by: BAYFIELD COUNTY O'Brien CHECKLIST FOR CERTIFIED SOIL TESTS Submit the Follow; n4, (Use Permanent Ink): Er Check List ❑ Index Page / Title Sheet (Optional) 67 Original Soil Evaluation Report (Submitted in Deed Holders Name — no prospective buyers) ' Original Plot Plan ❑ Cross Section Soil Profile Sheet (optional) ❑ Additional Information (Warranty/Quit Claim Deed) (Optional) Soil Evaluation Reoort: (Include the following Information) 1S' Parcel Identification Number (must be 23 it Tax ID#) DO NOT USE 12 digit, they are no longer being used C�'Property Owner's Information (ng.t prospective buyer's name) l'Property Location (Accurate Legal Description with Sec/Twp/Range) 1'Road Name (where driveway is/will be coming off of) ['Floodplain Elevation, Flow Rate, Comments and Recommendations li' Complete Soil Boring / Pit Information 1' Date Soil Evaluation was conducted IYCST Name, Signature, Number, Address and Phone Number 7 *Date Stamp* Plot Plan: (Include the following information drawn to dimension or to scale) L 'Bench Mark (Description, Elevation and Location) 1�'Contour Lines (Example = 98.0' /96.0' /94.0') [ 'Property Location (Sec/Twp/Range/, Accurate Legal Description) !a' Borings (Locations and Elevations) ['Percent and Direction of Land Slope Sd' Well Location (Including Neighboring Wells, if applicable) 1% Location of Wetland Areas, Floodplain and Navigable Waters 1�'Bulidings, Driveways, and Structures (Location and Descriptions) ['Location of Property Lines l' Existing System Location I 'Address Number and Road Name 7 Current Surface Elevation of Wetlands and Navigable Waters KIC TT, Owner and Property Information l'North Arrow F i 'Certified Soil Tests - Review & Filing Fee $ 50.00 \\\ SEP 252 Bayfleld Co. Zoning Dept. U/forms/sanitary/checkiist/checklistforests , 1 . Private Sewage System Maintenance Agreement Owner(s) Name. `/l `arm er Owner(s) Mailing Address ME. *~ W q0 ite Address tfs-j r 176.E Bourn, ,e 1 cc moo' JY"r i_ Tax ID # ..�46f0ly As owner, t (we) do hereby certify the private sewage system will be installed to accordance with the certified soil tester's report and approved plans and specifications on file with Bayfeld 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) •S 114 of -S'• 114 Section 7 _Township '5"/N. Range 9---w. Additional Legal Description: 9o'''De% L.aD6C tf7Z'E'/T UAL/J y (Acreage) O Gov't Lot Lot__— Bloc'sc --- Subdivision Lot CSM # Vol.. Page CSM Doc # In -ground gravity ❑ Mound 0 In -ground dosed DOCUMENT NUMBER 2024R-604760 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 09/ 18/2024 AT 1 1:01 AM RECORDING FEE: $30.00 PAGES: 1 Recording Area Return To:LeM Planning and Zont Dea1+_� 1111 SEP 19 2024 0 In -ground pressure distribution Sewage System: 0 At -grade Sewage System 0 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 (113) of the volume occupied by sludge and scum. Puma Chamber (system types B, C, D. and E): The pump chamber shall also be rinsed and pumped out when the septic lank 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, tolls. Admin. Code. Private Sewecie System Disnersal 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 (.helper wastewater or effluent from the system is pending an the ground surface. pl:ounQs. At -car de. and In -ground Pressure Svstem 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 wlth this agreement will restdl in action being taken to pay all charges and costs incurred by Baylleld County for - tnspec[ cz: nemeing,--hauler"; or etteenn+ise-servlaing-and nraintal rq-tlrs ps uasa w ago.systam.lankto..sutt, a nrrn•}nrrr rile prariaiI1 or ahale. any. hurnan health hazard caused hydra system. Baylleld County shall notify the owner of any costs which shall to paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay die costs within thirty (30) days, the o vnerspeclticaily agrees that all Ufa costs and charges maybe placed on the tax roll as a special assessment for the abatement of a human health hazarri, and the tax shall be collected as provided by lair: The tennis and cond!llons of the variance shall be binding upon and Inure to the benefit of all currant ants future owners of such properly. Owners) Name(s) — Please Print a:' Subscribed and sworn to before me an this date: 11FItfiem nom. by�o��v�y f\olarized 0vj er(s) — Signature(s) Notary . He My Commission E ! Drafted by: lIs e'2 10 C qADate: 716J4. Prcofcrd by. uohennaf ntn:ylscptic!ndntenccngraontent Rev'sed.lune 2318 SS- nOucv w' ""wv ✓ EhF El'ti u Department of Safety & Professional Services, Industry Services Division County Bayfield laid Sanitary Permit Number (to be filled in by Co.) 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)(in), Stats. 1765 Boulder Lodge Rd, Unit 4 I. Application Information — Please. Print All Information Property Owner's Name Parcel rfal.e ttr/i/O William P. & Heidi H. O'Brien 04-004-2-444-099-1.8-11 00-671-40000 Property Owner's Mailing Address Property Location 1815E 11th St Govt. Lot 1. ''/., Section 18 City, State I Superior, WI Zip Code 54880 Phone Number 218-391-4427 T 44 N R 09 E o II. Type of Building (check all that apply) Lot # ®1 or 2 Family Dwelling- Number ofBedrooms 2 Subdivision Name ❑ Public/Commercial - Describe Use Boulder Retreat Condo Unit 4 Block// ❑ Cityof ❑ State Owned - Describe Use ❑ Village of CSM Number ® Town of Barnes 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 lice le, A. ❑ New System y l`� "Replacement System p y ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B' O Holding Tank l`�In-Ground ❑ A[ -Grade ❑ Mound ❑ Individual Site Design ❑ OtherT Type (explain) yp p (conventional) C. ❑ Renewal Before O Revision ❑ Change of Plumber O Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dia enal/frea$mentArea and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) I Dispersal Area Required (st) Dispersal Area Proposed (st) I System Elevation 300 0.7 428.6 449.9 95.0 Tank Information Capacity in Gallons Total Gallons # of Units Manufacturer n - U U $ n rn New Tanks I Existing Tanks Septic or Holding Tank 750 — 750 1 Wieser Dosing Chamber V. Responsibility Statement- f, the undersigned,, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) > a,C 1P4en PI tber's Signature /' MP/MPRS Number - :a ??1 I Business Phone Number `i b o � P umber's Address (Street, CCiity, State, Zip Code) S3 Q tO J .y y-4 P iT ..r _ Good 7DepatfinentUse Only. Approved ❑ Disapproved O Owner Given Reason for Denial Permit Fee $X% Date Iss ied 101 Issuing Agcm Signalur 44/4 Conditions Approval/Reasons for Disapproval (IJI CCt ¢ su 2 52024 Bayfleld Co. Zoning Dept. Attach to complete plans for the system and submit to the County only on paper not less than a 1nx II inches in size SBD-6398 (R. 03/22) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 6 of 7 FILE INFORMATION Ownerwlliam P. & Heidi H. O'Brien Permit # DESIGN PARAMETERS Number of Bedrooms 2 O NA Number of Public Facility Units O NA Estimated (average) flow 200 gal/day Design (peak) flow = (Estimated x 1.5) 300 gal/da y In Situ Soil Application Rate 0.7 al/da /ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) ≤30 mg/L Biochemical Oxygen Demand (BOD5) ≤220 mg/L ❑ NA Total Suspended Solids (TSS) ≤150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) ≤30 mg/L Total Suspended Solids (TSS) ≤30 mg/L ® NA Fecal Coliform (geometric mean) ≤104 cfu/lo0ml Maximum Effluent Particle Size '4 in dia. O NA Other: ® NA `Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 p mean(s) (Maximum 3 years) O NA Pump out contents of tank(s) ® When combined sludge and scum equals one-third ('fa) of tank volume ❑ NA O When the high water alarm is activated Inspect dispersal cell(s) At least once every: 3 ❑ month(yeaarr(s)(s) ) (Maximum 3 years) ® O NA Clean effluent filter At least once every: 3 ❑ month(s) ® year(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) O year(s) ® NA Flush laterals and pressure test At least once every: ❑ month(s) O year(s) ® NA Other: At least once every: O month(s) ❑ year(s) ® NA Other: ® NA SYSTEM SPECIFICATIONS Tank Manufacturer Wieser O NA ® Septic O Dose O Holding vol. 75O gal Tank Manufacturer ® NA O Septic O Dose O Holding vol. gal Effluent Filter Manufacturer Polylok O NA Effluent Filter Model 525 Pump Manufacturer ® NA Pump Model Pretreatment Unit ® NA ❑ Sand/Gravel Filter O Peat Filter ❑ Mechanical Aeration O Wetland ❑ Disinfection O Other: Manufacturer Dispersal Cell(s) I In -Ground (gravity) At -Grade jlntjrt(qe*u�ej❑ M ❑ Drip-Une \Otfl3 2 52024 Other: pp l: Other: baylleld NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (14) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of ≤12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event GMW (12/02) Page 7 of 7 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. g The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESQIJJEFA PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. p ADDITIONAL COMN 5 Dept. POWTS INSTALLER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) Name Phone POWTS MAINTAINER Name S.toj.L Phone LOCAL REGULATORY AUTHORITY Name Bayfield County Zoning Phone 715-373-6138 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Private Sewage System nce Agreement DOCUMENT NUMBER 2024R-604760 DANIEL J. HEFFNER REGISTER OF DEEDS HAYFIELD COUNTY. WI Un.-ITN 1 zes BOvcDEp J #C RD. 1,OMAICs , s'y_73 As owner, I (WB) Co nereoy canny me pnvdhe aavdye ayaae,n .-.n, ve i,.a,o„�.. ,•• accordance with the certified soil tester's report and approved plans and specifications on file with 8ayfie:d 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 front time to time amended. (COMPLETE Legal Is required) $C 1!4 of -C 114 Section -7 Township 99 N. Range 9tN. Additional Legal Description: yD vLDEa: <ODE CPC?MEAT IIA11 Town of iief?A-Ct -- (Acreage)- ---d-Govttot- Lot — Slack_— Subdivision Lot — CSk1 # _ Vol.. Page _ CSM Dec # In -ground gravity O Mound RECORDED 09/ 18/2024 AT 1 1 :01 AM RECORDING FEE: $30.00 PAGES: 1 Area Return To: ttldp Planning and ZonijjdlDe�iar1S91e�1 F )II,IhII`II SEP 192024 O In -ground dosed ❑ in -ground pressure distribution Sewage System: ❑ 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 lank is found to have less than one-third (113) 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 lank is serviced as provided above. Tire s -,itches 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 manufacturers specifications. Fitter 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 pending on the ground surface. Iyounas At -grade and In -around Pressure System Laterals (system types C. D and E): Tile laterals shall be flushed out and swabbed if needed when tire wastewater distribution cell component Is inspected as provided above. Owner(s) agree that failure to comply with this agreement trill result in action being taken to pay all charges and costs incurred by Bay!laid County for lnspecliar; -pumping, hooting, or otherwiseservicing and maintaining lhe.privale sewage system lank. itt such a manner as to prev_entor abate any human health hazard caused by tire system. Hayfield 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 teims and conditions of the variance shall he 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 Ov er(s) - Signature(s) Not____ *EjI My Commi Draftedby:4h`liin rWDate: 7firs-ally Proofed by. —_ urfoanslan&tarylsepiienenlenceegreenicnt Rev:sed.lune 2318 10/7/24, 12:16 PM CarmodyTm BAYFIELD COUNTY SANITARY PERMIT (#04)-24150S STATE SANITARY PERMIT OWNER: WILLIAM P & HEIDI H O'BRIEN GOV'T LOT: LOT: BLK: SUBDIVISION: Boulder Retreat Condo 1/4 1/4 SEC:18, T 44 N, R 9 W TOWNSHIP: Barnes SOIL TEST: 145-24 REPLACEMENT SYSTEM SYSTEM TYPE: Non -Pressurized In -Ground PLUMBER: James Clements TRACY POOLER Authorized Issuing Officer DATE: 10/7/2024 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: # 222924 Condition: System to meet all setbacks. Management plan to owners. Properly maintain system per recorded agreement. Properly abandon existing/Old system per SPS 383. THIS PERMIT EXPIRES 10/7/2026 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION https://www.carmodyinc.com/PermitApp/Permit_Sign.aspx?Print=1 &permitappid=7382 1/2