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HomeMy WebLinkAbout26-146St,ar�n,r Count / �4r Department of Safety County ( e I s I Og & Professional Services, '1 Industry Serviees•Division Sanitary Permit Number (to be filled in by Co.) sstiinW„a 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 Pore submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information yoR!C for secondary J purposes in accordance with the Privacy Lew, s. 15.04(i)(m), Stars. ff�� f „�,e T. Annlirattnn Tnf.r......, - urea&. 0.-C,,, All r_r .......u__ t.0 . UUl Q +-h dd v o 3 % �a4L r b 24 Y S7 Property Owner's Mailing Add ass .__ O -7 6 D Q J et Yr planning and Zoning ANncy Property Location City, State Govt. Lot pY Zip Code Phone Number l o ✓'C Lj> v^k 1/`) L j 1 4 C' -y"f/3 8 1 3 O70O 'YJ /.A'E %%,Section 2- II. Type of Building (Ch * all that apply) Lott! T S C) N R a • •o Ir$ I or 2 Family Dwelling — Number of Bedrooms 1— Subdivision Name Block p ❑ Public/Commercial — Describe Use 0 City of ❑Stott Owned — Describe Use CSM Number 0 Village of Town of.Dtt L'r.-T; III. Type of PO�VTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete fine C if a iicabie.) A. 0 New System 1yf y Ip Replacement System ❑ Other Modification to Existing System (explain) ❑ Additional Pretreatment Unit (explain) B. Holding Tank ❑ in -Ground 0 At -Grade 0 Mound ❑ Individual Site Design ❑ Other Type (explain) (conventional) C. ❑ Renewal Before 0 Revision ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration 1s o Capacity in Total fl of Manufacturer Tank Information Gallons 6 Gallons Units 8 E_ Nmv Tankx ExistinTanks 6 U 'y h rn iz U a aspawer neamg t ans Z D p "Zcoo W p •e$' •aL li Ge' n.C. Ir Becixg6hamher V. Responsibility Statement- I, the undersigned, assume responsibility for installation or the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's 'g t` re /MPRS Number I Business Phone Number Ail fth f os1Cr Looq o ciia_4/S7p Plumber's umAddress (Street, City, State, Zip Code) c� _ 1 -fi Bn)C .S ZZ 'y ✓o't Z�.t sJeV �. .-T077 Lf4pprovedI ❑ Disapproved rcnmt Fcc I Datelslssued Ill/- Issuing A nt Sign ❑ Owner Given Reason for Denial $ L(/ /o/y / � / sq/G� L to complete plans for the system and submit to the County only on paper not less then a In s is Inches In SBD-6398 (R. 03/22) Sk- ME'C+'I Soil Test # 0CT 0 8 2026 l� $ Bayfield County of a Thorough Soil & Site Evaluation Bayfield Co. (subject to 15-1-10(d)) Planning and Zoning Agency 4 / , Gk.yl J9® 1 Ko S k L 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 kekM ivi? S19 /t Property Address g'? O Q Jczr it 1` Telephone -1 1 r g 13 D`?DO Accurate Legal Description is requested: Contractor Authorized Agent Agent's Telephone, Written Authorization Attached: Y or N 1/4 of 114 Section I Township 50 N. Range W. Town of '`1 Additional Legal Description: Govt. Lot Lot Block _Subdivision Lot CSM# Vol. ____, Page CSM Doc # Volume Page of Deeds Tax I.D# �$ S 7 Acreage & D Indicate reasoning for your determination: a Q. p-g-cz_ v' rL i. -t a jc'k)iS. Signat a of County Official Date L 4r'L Signature of Certified Soil Tester Date Cf Zoo Certification # (Submit a Plot Plan & Fee). informs/solltestwaiver(KLK) June 2018 A ,a11i lr ' Mw E4 5 Nf ". 0W. W •1 a trt> ?, v� 1 1 is w d►& f c v- Z:,, z. ,"� o gallon v) e s e rr Car cv-e`k."' o I wvt 'f V ® f: ' 7 C.c y . -e C ,-e'er. e� -f v o b "[ o p?i dF z��s7I. �Rzv k -I- .I j F. sE- -��.� l�5 CsPs3� ) ��. Hb 11 cfTn k CC L j7&t � A. F = A o e �•c� ( v -a �. rv, I (�y22 27) �p �•f�.�s:�: �j vh �,.CoY•v�e✓v�'�ziv+e= � "dB`►P�,5�Z��g� 6Y1 f v P = £Ie.0 1 -7---- -- 5d/© pVc ,/ 'I 4 s rec.4r �' = r � `Ems+-C'°� kr l l tR, r�•t a v J j I"Asr� Dal#)$'CLIP'Jv-0V�?�, tom•u�' Y&LcL.-i' !/"l[doa vv I LnIV IVlIVq a LuiuIiuii No 9975 P. 2 RECEIVED OCT 082026 Bayfield Co. Planning and Zoning Agency Pg 1 of Pg 2 of Holding Tank Plan PAGE 10F8 Index & Cover Sheet cl Component Manual Design References: /TMbiss6bW.4A I �( /p arC rs)anAii (y z02 Z -oe%) Index & Cover Sheet Plot Plan Pg 3 of S` Holding Tank Specifications- z Pg 4 of 3 Management Plan Attachments: rti POWTS Application forIReviewCs4r,; F S' Soil Evaluation Report & Site Map (if ;Or ' $/ .p Holding Tank Pam in Contract if a PLl ..2 :3 t- LJ'J.1:.... T__L w i. .. _ Project Name I Description Ptr* r AP„P) :able) RQy/ cl Leeds Owner Name(s): A �a Ens 5+v o r" Phans: ISIS _ g(3 . y 7 00 OwnerAddress: g7ho C Je_vn" 4 or t l cl of w dip: SYpoS Project Address: Sc.- e c� s� Govt. Lot: 1/4 of }.S 1/4, Section z`j ,T 5o t1_R E Qor W Township: F° ' t -`s I � f county: Project Parcel ID #. c24Cy Designer Information Designer Name: A I/CL-I. � `c. c s Phone: '7�IS_ _ L,//�-4 Designer Address: J?O. ? or_ S-z_z 1 -t,. k,v•e ^ UJ- 1 Zip: _S FS17 E-mail: F .L C b •� , v c ( L Thiy space reserved for approval stamp. License Number: z z o c3 °i 0 Remarks: Signature:- / Date: ( - -Z Original signature required on each submitted copy. wrdptrty bw,1er. Ergs( Dc.scr; p+;&'n m .. Ads >;n5s+v t4uj y Stc?4tsof gS w t7&o + 1 —w,. -e SYS4SvEus n Ef 9r+ ui; v`C; _ Cewn'�yac ao<21.E 'Z8 /�/S7 c -f Btdrms:.k ff ScaJC no4e d l N Ne.u-.cs+ Rd; &oavvyRk... l5,eoga(dan v'Lcce.r Cencb-e4ctonk 6FY"t_Jol "vJ j" Prone britFense Teak to PlewL,.e inle+ 3roi jVue.v; wr- sylY7 PROPERTY OWNER: $�✓o +'vl PLUMBER: SIGNATURI DATE: It' - _z S� LICENSE #_220090 HOLDING TANK SPECIFICATIONS Number of bedrooms Non-residential estimated flow (gpd) D00.0 Minimum holding tank volume'required (gal) Manufacturer model number manufacturer fiber RECEIVED OCT 087026 Planning and Zoning Agency. Tank Dimensions and Data ""_ X for round tank Tank Anchor Calculations WfMAryLV 4CYp " " `" 18840 lbs Weight of tank and cover 5I A Liquid depth below Inlet Invert (In) 1.50 8:0 Maximum de th of soli cover (ft) m' Safety factor 40207 lbs Weight of anchor required 71,0 Height (In) 9 �_ .. Outside 40.8 in Soil cover req.for anchor or 159.8 Length (in) Dimensions 3 93.0 Width (In) Only 9.9 yd Concrete counter weight L'Y%ufI:L 1I.'WNM1 Junction box conduit blind plug to seal outlet HOLDING TANK CROSS SECTION manhole Cover with � locking device and finished warning label grade 4"min, I in. `, Manhole and vent locations cep 12"min, vent pipe ______ 18" min, service „ 12,0 In. •��_._._._�_._._._,_,_,_ alarmon Joints between tank Electrical as per openings and piping are NEC 300 39.0 In, sealed watertight. All PIPE and Comm 16 and vent materials comply wlthsps., 3 building sewer Inlet " f Sin, bedding under tank. Tank Is anchored as necessary to negate buoyancy. 183}" 4" CAST -A -SEAL 4" CAST -A -SEAL P2A 91 FILTER OR BAFFLE m o a � INLET It-) 3 " to a U. a M TOP VIEW SIDE VIEW TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS WLP2500 TANK SPECIFICATIONS DIMENSIONS: WALL• 3" BOTTOM: 3" HEAVY - 5" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 52-3/4" O.D. LENGTH: 183-1/4" O.D. WIDTH: 101-1/4" O.D. BELOW INLET: 41" O.D. LIQUID LEVEL 36" WEIGHT: TANK - 3" BOTTOM 12,560 LBS. E3 TANK - 5" BOTTOM 15.527 LBS. WEIGHT: COVER 9,300 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: ci o O N WISCONSIN, SEE DETAIL #10 111 0 o w (OTHER STATES SEE CHART) 00 LIQUID CAPACITY: 69.44 GAL/IN i'D CD m I� (J m m HOLDING TANK: c0 ILL U OUTLET HOLE PLUGGED C 8L() O "E C ACTUAL CAPACITY: 2,639 GALLONS O z c0 '� w a LOADING DESIGN: 8' 0" UNSATURATED SOIL i1 TANK CAN BE USED AS: - W I SEPTIC/ HOLDING/ PUMP OR SIPHON in g COVER: MIX DESIGN #8 (NO FIBER) W TANK: MIX DESIGN #9 (SMALL FIBER) m CUSTOMIZED TANKS: 3 3 -OUTLET FOR CUSTOM TANKS CONTACT WIESER CONCRETE N m J ^O < N Q N g 0 o D_ In DRAWINGS SUBMITTED w 5 N FOR APPROVAL w m APPROVED BY: SHEET NO. APPROVAL DATE: PRODUCTS NEEDED BY: a HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to 5f393 Wis. Admin. Code, the Holding Tank Component M4nual 45td; "flanvU.( ryp� VER2o and the .B4y-fie. (c! County Sanitary Ordinance. E{j zi) j cy Z° -Z°L7) 1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 400.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them In accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and SPS 383 ands84 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Con- nection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with CPS 983.33 Wis. Adm. Code. 10. If there is a problem with, or question about this `!installation, the following persons should be contacted: a. Installer.............................Po/IlosK; P/arnb:ny n9.P.R,S 0zgoogo Phone: 7i( 37z- NeS(o b. Service Provider ...................f,,- $ y; b 17 Phone: jig- 37z - gcaf, c. Co. Zoning or Health Dept. &y44c Cauwii Zon;ri5 Phone: 7' 3-71— 6132 11 Project Transaction Number: CEiVEC; 0ci Q82O?6 6ay6eid co. Planning and Zoning Agency HOLDING TANK SERVICING CONTRACT Contract Date q-25- zb Holding Adc�t�t Cn This contract is made between the w-. We acknowledge the Installation of (a) holding tank(s) on the following property: (Provide COMPLETE legal descriptions) PROJECT Legal Description: Taz IOk I1/4, /'t LOCATION (Use Tax Statement) I 2 g N s%fNo.SurbdivIsIom 1/4, section19N ,Townshlp , Range X w+9VGov'tLot : Lot Size Acreage Lot g CSM U. Vol. Page CSM Doc0 Lots) No. 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) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: RECEIVED a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; 0CT 0 8 2026 c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; Bayfield Co. e. The dates on which the holding tank was serviced; Planning and Zoning Agency 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 con with the local government unit and the County named above within (10) business days from the date of ch this service contract. 'c to A�� Cno s arm lhl 1 ji1 rJ d of My commission expires on: �• Revised: May 2016 (®May 2018) Drafted by )a Pu Personal Information you provide may be used for secondary purposes [Privacy Law, s.15.04 (I)(m)) uocumeni Numoertman I.U. No. I HOLDING TANK AGREEMENT Owner Name (s) I Owner(s) Mailing Address 876O Qu.y /`TCarh. En%s4rUY>1 Pn a awl A I�� a Z,S'-Z 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 [`orr( Ch. 145, Wis Scats. qq _ 1/4 of r 114 Section 1l Township � N. Range _ W, a � Town of IC) 14 L4) t '^"j Additional Legal Description: 2- O t S' L." SS4 �b 6 Gov't Lot — Lot Slock_Subdlvision CSM#_ Lot_CSM # Vol _Page _CSM Doc# DOCUMENT NUMBER 2026R-61 4099 DANIEL J. HEFFNER REGISTER OF DEEDS BAYFIELD COUNTY. WI RECORDED 1O/O8/2O26 AT 1 1 :O3 AM RECORDING FEE: $30.00 PAGES: 1 RECEI�VEtgqDC� aavreld Co. Return To: planning and Zon,n9 AgencY 7i✓lr ltCr As an Inducement to Bayfield County to Issue a sanitary permit for a holding tank on the above described property, we agree to 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 falls to have the holding tank properly serviced in response to orders issued by Bayfield County or the Capartment of Commerce to prevent or abate a human health hazard as described in s. 254.59, Scats., 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 Sayfield 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. State., 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 Bayfeld 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. Scats., 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 property maintained. 5. finis 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 Alm C sktoti. Subscribed and sworn to before me on this date: 5TM y of.&eptembty.oa Notarized Owner(s) — Signature(s) `�`�— — Nota c I ,se) otary Public My Commission Expires: nn V Drafted by: teen/ #.__c' i C+S bt l Personal information youYou provia nay be used for secondary purposes [Privacy Law, s.15.04 00lm)I Date: u/formefsmlilerymoldingtankeareemenl.doc ®June 2018 ii ]3A FIELD 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: ENGSTROM,RILEY A 1121 A E HAMILTON ST MILWAUKEE, WI 53202 ENGSTROM,ATHENA C 1121 A E HAMILTON ST MILWAUKEE, WI 53202 ENGSTROM, ADAM G 8760 QUARRY RD PORT WING, WI 54865 Description Certified Soil Tests - Review & Filing Fee Submission Number: SR -00527 Transaction Number: SR -00527-576A4 Amount $50.00 Total: $50.00 Payment Amount: $50.00 Reference: 6365 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 10/9/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. HAYFIELD 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: ENGSTROM,RILEY A 1121 A E HAMILTON ST MILWAUKEE, WI 53202 ENGSTROM,ATHENA C 1121 A E HAMILTON ST MILWAUKEE, WI 53202 ENGSTROM, ADAM G 8760 QUARRY RD PORT WING, WI 54865 Description Private Sewage System (Holding Tanks) Submission Number: SS -00859 Transaction Number: SS -00859-576A8 Amount $400.00 Total: $400.00 Payment Amount: $400.00 Reference: 6365 Paid by: Polkoski Plumbing, PO Box 522, Iron River WI 54847 Payment Type: Check Transaction Date: 10/9/2026 Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. BAYFIELD COUNTY SANITARY PERMIT (#04)-26-146S STATE SANITARY PERMIT OWNER: ADAM G ENGSTROM ET AL GOVT LOT: LOT: BLK: NW 1/4 NE 1/4 SEC: 29, T 50 N, R 8 W TOWNSHIP: Port Wing SOIL TEST: 148-26 REPLACEMENT SYSTEM SYSTEM TYPE: Holding Tank PLUMBER: ALLAN POLKOSKI SCOTT ROUSH Authorized Issuing Officer DATE: 10/9/2026 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: # 220090 Condition: Properly Maintain System Per Recorded Agreement. Must be within 25 ft of an all- weather road. Old System needs to be properly abandoned per SPS 383. THIS PERMIT EXPIRES 10/9/2028 POST IN PLAIN VIEW MUST BE VISIBLE From ROAD FRONTING THE LOT DURING CONSTRUCTION