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Wisconsin Departip, ent of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 429922 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Eder, Tim I So merset Townshi 032 - 2128 -10 -000 CST BM Elev: Insp. BM Elev: BM D scription: _ Section/Town /Range /Map No: 09.30.19.1143 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic D � Benchmark 2 7 Dosing VV Alt. BM o Aeration Bldg. Se S ccl7 /S /ob. , Holding -- b t Inlet (/ 91. O ?i TANK SETBACK INFORMATION S HtOutlet ���/ y�✓ 5� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet � l Septic / St i gj Dt Bottom ' Dosing -- — Header /Man. j ?j Aeration 8 1 /02.7 Holding Bot. System ( / 3• PUMP /SIPHON INFORMATION Final Grade 9 0fl G Z, Manufacturer Demand St Cover 3s D • f •Z GPM Model Num TDH Lift ion Loss System Head T H Ft Forcemain Length Dist. to SOIL ABSORPTION SYSTEM ( ,d Q1vy BED/TRENCH Width / Len th� No. Of Trenches PIT DIMENS S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS + / /Y SETBACK SYSTEM TO / P/ BLDG IWELL LAKE /STREAM LEACHING Man uf c r r � INFORMATION CHAMBER O M l r Ty a Of System: 7 -- ( �/ d0 / % U Model Number: DISTRIBUTION SYSTEM e� Fleader /Manifold Distribution x Hole Size x Hole Spacing Ve to Air Intake :kj I u Pipe(s) u / 1 !t Length Dia Length 7 Dia j p cing S !1� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center t Bed/Trench Edges Topsoil 9 p [] Yes No Yes No COMMENTS: (Inclu e c de discrepencies, persons present, etc.) Inspection #1:/ / �� Inspection #2: Location: 535 164th Avenu Some et 1 54025 NE 1/4 SW 1/4 9 T30N R19W Wagner Estates 5 Parcel No: 09.30.19.1143 ottyk 1.) Alt BM Description = (ga t ( /'Ltaued BH 1 i 5 a �r� 2.) Bldg sewer length = 3 �J >�C��GG —� Sys %c� � use , 61 Ile - amount of cover Plan revision Required? Yes o Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. T.L. Sinz Plumbing Inc. C OP )i E5609 708th Ave. Phone: (715) 235 -2644 Menomonie, WI 54751 \ Fax: (715) 235 -2592 www.tlslnzplumbing.com IT o- d \^�' ��v T l o°O °► ►wf'1 m S'ePi c j ,4,� l� L � a I Safety and Buildings Division City p 201 W. Washington Ave., P.O. Box 7162 VISCOnsin Madison, WI 53707 - 7162 Sanitary Permit N (to be filled in by Co.) V (608) Z Z Department of Commerce Sanitary Permit Application State Plan LD. Numbe)' In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(I &M1 Project Address (if Brent than mailing address) 1. Application Information - Please Print All Information Property Owner's Name r, si' „: �� �] arcel # Block # Property Owner's Mailing Address ert location V,'/4, Section City, State �^ Zip Code Phone Number �+ �{ T N; RL ( Il. Ty of Building (check all that apply) ✓ Subdivision Name CSM Number 1 or 2 Family Dwelling - Number of Bedrooms _ 5 El Public/Co - Describe Use El State Owned - Describe Use ❑City_ ❑Village/ Township of 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) ` , New System ❑ Replacement System g Replacement Y g y ❑ Treatment/Holding Tank R lacement Onl Other Modification to Existing System B list Previous Permit Number aued ❑ Permit Renewal a nit Revision a of ❑ Permit Transfer to New Before Expiration Plumber Owner 1; q9 G S9 / ndF/s : , 2 _Z__ 1V. T c of POWTS System: Check all that a 1 Non - Pressurized In- Ground El Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter El Constructed Wetland ❑ Pressurized In- Tank ❑ Peat Filter El Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Fithing C ^e ❑ Gravel less P ( lain V. Dis ersalrFreatment Area mation: Design Flow (gpd) Design Soil Application n Dispersal Area Propos sf) System FlevatiQrl, to o5o q33 qti VI. T Info Capacity Prefab Site Steel Fiber Plastic Gallons Concrete Constrocted Glass Tanks Tanks � /1! Septic q6AsMft1R71 l/i V ol Aerobic Treatment Unit Dming Chamber L VII. Responsibility Statement - I, the and ne u responslbili to. tallation of the POWTS shown on the attached plans. f PI s Name (Print) PI t MP/MPRS Number Business Phone Number �` Plumber's Address (Street, City, State, ) �S” O VIII. unt /De artment Use Onl proved El Disapproved Sanitary Permit Fee (includes Groundwater .DC,att sued Issuing Ag Signatur ( s) Surcharge Fee)�O / o El Owner Given Reason for Denial DL Conditions of Approval/Reasons for Disapproval W 1 Attach complete plans (to the County only) for the system on paper oot Icsa Wan 1/2 : t t incbet in stzc '7 V�Z�� Y3. SBD -6398 (R. 01/03 � GQ.�LGGt� SQ/I Q'�v''t S -' da no��/j► ��� G� -. 04/25/2003 08:19 FAX 7152352592 T L SINZ PLUMBING INC IM 001 T.L. Sinz Plumbing Inc. E5609 708th Avenue Phone: (715) 238 -2644 Menomonie, W154751 Fax: (715) 235 -2592 FAX TRANSMITTAL Date: Rio_ of Pages: 9 (including cover) To: Attn: 7 �'VI 1 „fin From: 1Li n Subject: AU` -kA Message; . u Signature: ,-�AI^ LNA= T.L. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 235 -2644 Menomonie, WI 54751 \ Fax: (715) 235 -2592 I www.tlslnzplumbing.com fA l0 GFG17 i ow ,&a S'efi 7;441- f"" ZM3 LE A I uU r-i f 4 -VL �v wl \ P139`�O� Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. e y Date Personal information ids be used for seconds c you provide may secondary purposes (Privacy Law, s. 15.04 (1) (m)). 63 Property Owner Property Location 71 1A Govt. Lot V 1/4 VO 1/4 S C( T_�O N R 19121E (or) Property Owner's Mailing Addrns Lot # I Block # Subd. Name or CSM# Cfly State Zip Code Phone Number ❑ City ❑ Village [g T Nearest Road Q New Construction Use: [51 Residential / Number of bedrooms Code derived design flow rate G/ S 16 o d GPD ❑ Replacement 1 ❑ Public or commercial - Describe: - -- T Parent material 1 i ` Flood Pla' elevation if ap tfld y U X-1 r4 ft. General cormrents S -e/-e 1/, 7Z; 6o GGwei R / - a o and recommendations: t 5 ? 0 3 f; q tr' S T F Boring # d ng I Pit Ground surface elev. ft. Depth to limiting factor �� 0 d in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 0-1 r3 — Sr'I mSb zM-< vyl-r'- c , 3 40 loo 3/ l� TY4 1 Z Boring # 0 Boring ® Pit Ground surface elev. gd ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 3 �� mss m�� �S - r 5� Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) — 2s CST Number 3 3 Date Evaluation Conducted Telephone Number i Property Owner Parcel ID # 1 � >� / S /.Ua Page Z of 3 F%] Boring # ❑ Boring U ® Pit Ground surface elev. /� oQ ft. Depth to limiting factor 74° in. Sol Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. r 'Eff#1 TIM C - IO 3�Z — S r -� Z M Sb ` � m / S V t �r E # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. F 91 — Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F Boring # Boring ❑ Pit Ground surface elev, ft Depth to limiting factor in. Sa'I Applkabon Rate Horizon Depth Dominant Color Redox Description. Texture Structure Lure Consistence Boundary Roots GPD/fF In. Munsell Qu. Sz. Cont. Color Gr. Sz- Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 1220 mg1L and TSS >30 1 150 mgA- ' Effluent #2 = BOD 130 mgA- and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. ssu4330 (RAM) COPY PAGE-"> OF NAME: LOW /5 LEGAL DESCRIPTION:_1 /4_1 /4,S_T E(Or)W SCALE: 1"= 6 ELEVATION: /OO- k BM 1 DESCRIPTION: ,6Q o l I �U_e 124'e- BM 2 ELEVATION: 9(0, /O s, BM 2 DESCRIPTION: - led 4 4 j P e SYSTEM ELEVATION: y "'L t �Zi d q/, Oo SYSTEM TYPE: COY► u ovi - act I 'O i \ 1 ,- i SIGNA / : ` DATE: PAGE 51 OF� NAME: LOT# 45 LEGAL DESCRIPTION:_1 /4_1/4,S_T ,N,R, E(or)W SCALE: 1 "= L/(� ELEVATION: /OO• r BM i DESCRIPTION: �Q o 1 4 �IfC p,10, BM 2 ELEVATION: q&, /D f: T BM 2 DESCRIPTION: �P 4 SYSTEM ELEVATION: P SYSTEM TYPE: (' a xl v V�� o'✓ V'r ° o � l � r SIGNAT RE: DATE: Wisconsin Departmentpf Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety aFd Building Division i INSPECTION REPORT Sanitary Permit No: 399659 0 uENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Eder, Tim Somerset Township 032 - 2128 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding SUHt Inl Ht WtIe TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake Dt Septic Dt Bo Dosing ASystem Aeration Holding PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover i GP Model Number TDH Lift Friction Loss System Head I fD V Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIME 10 S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Yes No � Bed/Trench Center Bed/Trench Edges Topsoil 1" Yes B� :N]o j ] �__ COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: Location: 535 164th Avenue Somerset, WI 54025 (NE 1/4 SW 1/4 9 T30N R19W) Wagner Estates Lot 15 Parcel No: 09.30.19.1143 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No E T . Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) 08%28/01 TUE 15:11 FAX 715 886 4686 ST CRX CO ZONING �d 2 r , POWt"S OWNER'S MANUAL EL MA14^uaintf`e rLAry -+-- - FILE INFORMATION SYSTEM SPECIFICATIONS I Owner A; ;f— Septic Tank Capacity gal ❑ NA p emy { t # 9 �.7� Septic Tank Manufacturer FGdv� D NA DESIGN I'ARAMETF.RS Effluent Filter Manufacturer f�¢$L� ❑ NA CI NA, Effluent Fitter Model 00 C] NA Number of Bedrooms Number of Commercial units A Pump Tank Capacity gal .@HlA Estimated flow (average} �d gal /day Pump 'tank Manufacturer .ra -3 Design flow (peak), (Estimated X 1.5) ,s gal/day Pump Manufacturer •tea Soil Application Rate , s aal/day /W Pump Model PIMA lnfluentt£ffluent Quality Monthly average* Pretreatment Unit ANA C3 Sand /Gravel Filter a Peat Filter Fats, Oil 8t Grease (FOG) s30 mg/L p Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) <220 mg /L ❑ Disinfection p Other: Total Suspended Solids ( T55) s 150 mg /L Manufacturer Pretreated Effluent Quality - ❑ NA Monthly average* * persal Cell(s) Biochemical Oxygen Demand (BODs) s30 mg/L 71n- ground (gravity) Q in- ground (pressurized) Total Suspended Solids (TSS) s30 mg/L ❑ At -grade ❑ Mound Fecal Collform ( mean ) 510 cfu /100mt ❑ Drip-line ❑ Other. Maximum Effluent Particle Size 1 Inch diameter * Values typlCdl for domestic (non- commercial) wati@w2ter and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Strvice Event Sarvice Frequency Inspect condition of tank(s) At least once every c3 months years) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equais one -third (h) of tank volume Inspect dispersal cell(s) At least once every ©months ,Plyear(s) (Maxirntttst 3 yrs.) Clean effluent filter At least once every ❑ months years) D Inspect pump, pump controls ax.alarm At least once every ❑ months L2 year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months O year(s) O NA Cher: At least once every ❑ months ❑ year(s) 13 NA others At least once every ❑ months ❑ year(s) 0 NA MAINTENANCE INSTRUCTIONS ade Inspections of antis and dispersal �l shall POWTS b nspector PO M Intalner f S ptage Servicing operator, Tan Inspection Plumber; Master Plumber Restrict d Sewer leaks, measure th must include a visual Inspection of a an (s) w identi any ba missinn go or ha dwar , Ide the ground surface. The dispersal volume of combined sludge ft and to check for any pending of effluent on ce ll(s) shall be vWaliy Inspected to check the effluent levels In the observation pipes the ground surface. The pending of effluent on the ground surface may Indicate a failing condition and requires the immediate notification of the local regulatory authority. . the entire When the combined a all be lation of a Septage Servicing Operator an disposed o in accordance with ch. 1 13, WlScons( contents of the tank shall Administrative Code. The servicing of effluent filters, mechanical or pressurized PO WTS components, pretreatement components, and any other maintenance or monitoring at Intervals of 12 months or less shall be performed by a certified POWTS Mafntalner. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPRIKATION For new consrrucdon, prior to use of the POWTS check treatment tank(s) for the presence of palncin$ products or other chemtc that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the conten nr rho rankfsl rpmcvpd by t tentage servicing oporztor prior to use. 08/28, TUE 15:11 FAX 715 386 4686 ST CRX CO ZONING i�002 Pap �� v System start up shall not occur when soil conditions are frown at the InfEuative WrWv. During povmr outages pump tanks may till above nonnal highwaw kvets. When powttr Is resitMd the exCeu wastewater will tie discharged to the dispersal cell(l) in One large dose, overloading the cells) and may result kr the backup or surface dttchargr v! effluent. To ivold this situation havt the tantsnu of d w pump tank removed by a Septage Servktng Operator •prior to rtswrtng power to the effluent pump or contact a Pwmber or POWTS Maantalner to assist an manually operating the pump control, to restore normal levels within the pump tank. Do not drlve or park vehicles over tsnks and dispersal cells. Do not drtve or park ovrr, or otherwise dbwrfs or compact, the area within 15 feet down slope of any mound or at-grade $oat absorption aria. Reduc0on or etlminadon of the following from the wastewater stream may Improve the performance and Prolong tht We of the POWTS: antibiotics; bacy wipes; clgaretW butts; condoms; cotwo swats; degreasen; dental Aosa; diapers; dWn(40MU; tat; foundation dratn (sump pump) water; fruit and WOuble peeUnes; Cato m grea5t; herbittdes; meat scraps; mtrdicatwrrs; oil paintlnR vroducts: oesticides: san n.) o kins: um Dons: ind wetter sofu brMe. A ;ANDON EM iEN'T When the POWTS fails and /or is permanently taken out of strvlce the followink surps shall be taken to Insure that the system is property and safely abandoned In compliance with Ch. Comm 83.35, Wisconsin Adrntnlstrative Codes • All piping w tanks and plts shall bt 41sconnocted and Ole abandoned 0104 "OrAnO scaled. The contents of all tanks and pits stud be removed and property. disposed of by a Septage Servicing Operator. • After pvrnping, all tanks and pin shall be excavated and removed or their covers removed and the void Space filled with soil, gravvi or another Inert fond matrrial. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the toiiowing mea>sturts haW iseen, or must be taken, W provide a code compliant replacem jystem: A suitable replacement area has been tvaauated and may be utifized for the location of a replaeemsnt soil aWOrptlOn system. The replacement arcs should be protected from disturbance and Compaction and should not be infringed upon e, reQUlred setbacks from existing and ptoaosed strucwM, tot lines and wells, failure to protect the replacement area will result in the need for a new soli and sett evaluation to establish a sultaNe replacernom area. Replacement systems must comply with the rules In effect at that true. Q A s Die replacement area is not available due w stuck an or soil timit:atio UrMntls advances in POWTS wchrQ1QKi a yt-" nk maY be Ir>staA =s a latst re9vrt to play fa PO 0 e as not n cvalu tat tffy a s w alt f re f a d s al us t r'o ed I a w We oc If pia • nt ar ♦ anal ab a ng may t d last eso w r e t f' 414 PO E) Mound and at•grode absorption sysurru may be recottstruc-wd in place following removal of the biomat at the lnnIV30ve suriace. Reconsv ualoru of such systems rnust.cvtn* wath the rules In sifect at ttlat dme. < < WARNING > a• SEPTIC, PUMP AND OTKER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. 00 NOT ENTER A SEPTIC, PUMP OR OTHjR TREATMENT TANK UNDER ANy CIRCUMSTANCES. DEATH MAY RESULT, RECCE OF A PERSON FROM TKE IKTgRIOR OIL A TANK MAY BE DIFFICULT OR 1MPn F. ADD ITIONA L COMMENTS POWTS INSTALLER POWTS MAINTAINER Name G• e�t12 /� �- Na me /C�i 60 . 4 - Phone Phone Adf SEPTAGE SERVICING OPERATOR ( PVMPf!j WCAL RS0 V AUTN QUff- N'aM4 l ncy Phnna 5.5 om COUP MENT TASK %Lh' iT9N^?4 ACRD 5�l'T AND OWNERSHIP cettT1ltCATtON FO L�J� Msilinf i %ddrertt -= P• Pwt•I Addrew � tpttcett rat =40 4 ywItiC811on required tretn P6tRaieK Awpf [fit {OA W11isFAW '� City/St; e , rrne�8� ' Lys Ted o743s A e3-:7 - �� ner!ItCQ lp'Y"EON prop . L4cadan Sec. W Tower of Subdiv , ion L , Lot 0 COMIM d Survey Map N , Volume , Psgt., �► . wer"I ty Deed N d Volume . Page e Spec b ; are CI yes no L*I ium ideadt"Is Yes 0 no if HAMMANCE �tpeeltwt we end tfWi»tape�:aaf your septic syNwm could tesuk in off premsturt; fa�tti V tt; t:ottti csns+w + ' pwaj tt ing out ohs n' twtk every thtce ywan or seer, if naw4d by a tie�wttsedr pumptt, % ha• y eats Me the &"two of the septic tank so a tramtew><W iu %b* vwetw dispWI vivo . be Ple"Ry ewer wfts to subettit to 8t. Croat Zones DtpsIWARt a oerlt ikvion town, : Merer0 a 4414, jer MYttrasplumber. ratricudpi wbgfero livw +ed iR in PftI t optn ting condit►wt and+or (2) alto inspectitrn told po P vidiy� am {i) tht radar #rttoeattwy),tbe feptte Ywc, UK ttdews"d haw wad the above retluktene w tad Met to r"lemur dew pnvew rw+►iPe ti $P: b& R, suet lastGir, I!*L% as oaf by dew Doparttwat of COWMA a art! tart w a r Pow Optic system kigs +n.it+taincd due stpidelrttl lktsaorare:, Ststc .•f 'x da t ! o eewPkud oats ewrtrewd 40 tits St. Ceotx t ATI , atS 4!' APPLICANT _ r t the , a � � oft�a rut tY�u !roan aft true t e r dwibwd att�'L th e rear of t�pr (ow) lcue+s�ts�iha. e of a % firrerr: bred eaeartt d in iteshw of Wwda 01r i ce. A' Y ttt OMISOM drat is this fepretteeted tttsy tosttlt Is 60 eenihry ttstterit be toroked by ON `• Yt;elyd ,itlr grit epprlieetisw sate »tpte "fregfjr need lfem file i'�wds s rutty or tM eettlfbd Sygr Mow it foraftow M wad* in the wornolity 14 . I� Safety and Buildings Division County r • - 201 W. Washington Ave., P.O. Box 7162 - Madison, WI 53707 - 7162 Site Address I( Dep a r tment ,sCOt � s erce / (9a0 jk K �.�5 - /� Sanitary Permit Application Sanitary 1 e ts9 in accord with Comm 83.21, Wis. Adm, Code, personal information you provide ❑ Check if Revision may be used for socondgy purposes Privacy Law, s15. 1 m - I. AppUcadon Information - Please Print All Information State Plan I.D. Number Owner's Name «• 4 ., arcel Number 03z - 2/2- Pro - O -r700 Pent ?30./9•/ % /3 Property Owner's Mailing Address n, f Piro [ty Location s f n f2 11. w f u t4.S T N,R City, State Li Ccxic one Num y ... Number Block N bee t Zip �' ti : bUrJY 1 J �N "IGQFI=t ubdivision Name CSLt- U. Type of Building (check all that apply) "" ❑City I or 2 Famdy Dwelling - Number of Bedrooms ^ �'� a S ��i A_ '� S Dvillage Q Public /Conuncrcial - Describe Use S -5�T'owruhi ❑ State Owned Nearest Road I M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 0 0 New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addidon to For County use S sum Tank Only Exis System B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 tZ Non - Pressurized In- Ground 21\0 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wodand 22 ❑ s In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Dui Line Pic surized dutg tng P 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirquiating 30 JD Other V a n Area Information: f t S . D' ersa!/Tre tme t A rm .3 - - Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals,/Days /Sq.F(,) (Min./Ineh) Elevation V , Tunk Info Capacity ut Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Cotuuucwd Glass New Existing Tanks Tanks Septic or Holding Tank Dosing Chsmber VII. Respo nsibility Statement- I, the undersigned, aswme responsibility for installation of the POWTS shown on the attached plans. Plumber' am (P ' X Plumbers Si , MP/MPRS Number Business Phone. Number 1 r s Address (Street, City, State, ip Code) VIII, Count /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given initial Adverse Z Z s ZOOZ _ Determination _ IX. Conditions of Approval /Reasons for Disapproval k�4iV\ et4 Atlacb caoptdc plaits (to the County only) for the qucm oa paper not test that $V2 x 11 caches to size SBD -6398 (R. 05101) /L ✓/ Jam. - 4-C , e'AF�J��a _ Q _ n 3 AT -*JIf _ -- - / - I l e - wr6$ - ' Zio Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 ~ Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code A-C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8'/2x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference nt (BM), direction and St. Croix percent slope, scale or dimemsions, north arrow istance to nearest road. parcel I.D.# \ " 032- 2034 -95 ID#9.30.19.606 eAnnt 9ll inform on APPLICANT INFORMATION - . R iew By Date Personal information you provide may be us or`' cond r pu"ses F frivacyLavr s. 15.04 (1) (m)). NM . s L Property Owner Property Location lin , Bu er: Gr ohnsQU s; ovt. Lot NE 1/4 SW 1/4 S 9 T 30 N,R 19 W Gaylen Schil Property Owner's Mailing Address t f Lot # Block # Subd. Name or CSM# 498 150th Avenue 15 1 Plat Of Wagner Estates City Stat -ZipCoc Ply''Ourn er City Ll Village ZTown Nearest Road Somerset WI 025 715- 549 -6173 %� Somerset 50Th Street New Construction N R kGal / Num4" fiedrooms 4 ❑Addition to existing building Use: - -_- ❑ Replacement [-] Public or commercial describe Code Derived daily flow 600 gpd Recommended design loading rate .4 bed, gpolft .5 trench, gpd/ft Absorption area required 1500 bed, ft 1200 trench, ft Maximum design loading rate .4 bed, gpd/ft .5 trench, gpd/ft Recommended infiltration surface elevation(s) 95.0, 94.0, 93.0' ft (as referred to site plan benchmark) Additional design I site considerations htstall 3 trenches at 3 x 81.25 using high capacity infiltrators. Parent material Glacial till Flood plain elevation, if applicable NA ft S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ® S ❑ u N S El ® S ❑ u ❑ S 11 U ❑ S ®U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPDIft Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consisten Boundary Roots Bed ;Trench n2 W code 1 1 0 -9 10yr3 /2 None sil 2fcr mvfr as 2fin 0.5 0.6 2 9 -24 10yr5 /4 None sil 2fsbk mvfr es if .05 0.6 Ground 3 24 -42 7.5yr4/4 None sl 2msbk mfi gw if 0.5 0.6 S 98.39 ft 4 42 -107 7.5yr4/6 None A 2msbk mfr - - 0.5 0.6 Depth to limiting factor >107" �2• Remarks: - - -- - -- - -- - -- - - - - -- - - -- 2 1 0 -9 10yr3 /2 None sil 2fsbk mvfr as 2 fin 0.5 0.6 S 2 9 -16 10yr4/3 None sil 2fsbk mvfr cs if .05 0.6 5� Ground 3 16 -22 7.5yr4/6 None sit 2msbk mfr aw if 0.5 0.6 S elev - 98.75 ft 4 22 -38 5yr4/4 None sl 2msbk mfi gw - 0.5 0.6 Depth to 5 38 -112 5yr4/4 None sl lcsbk mfi - - 0.4 0.5 limiting factor - >112" R'3" Remarks: CST Name (Please Print) Signature: Telephone No. James K. Thompson �— 715- 248 -7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref# 340 Paulson Lake Lane, Osceola, WI 54020 5/8/00 3602 1234 PROPERTY OWNER: Gaylen Schilling, Buyer: Greg Johnso SOIL DESCRIPTION REPORT t2sa Page 2 of 3 AARCEL I.D.# 032- 2034 -95 IDk9.30.19.606 A.C.E. Soil & Site Evaluations Horizon Depth Dominant Color Mottles Texture Structure nsistence Boundary Roots GPD/ft2 Le- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0 -10 10yr4 /2 None sill 2fcr mvfr as 2f 0.5 0.6 - S' 2 10 -18 10yr4 /4 None sil lthinpl mvfr cs if NP 0.3 L Ground elev 3 1 -38 10yr5 /4 None sil 2msbk mfr cw if 0.5 0.6 94.70 ft 4 38 -93 7.5yr4/4 None sl 1csbk mfr cs - 0.4 0.5 Depth to limiting factor 04 , ,-s >93" +r Y N Remarks: 4 1 0 -14 10yr3 /2 None sit 2fsbk mvfr as 2fm 0.5 0.6 2 14 -21 10yr4/4 None sil 2fsbk mvfr cs if 0.5 0.6 Ground elev 3 21 -33 7.5yr4/4 None sl 2msbk mfr aw 1f 0.5 0.6 S 91.75 ft - 33 -61 7. 5yr4/4 None its Om mfr gw 0.4 0.5 D m mg 5 61 -83 5yr4/4 f2f7.5yr4/6 fsl Om mfi - - 0.4 0.5 3 factor 61" Remarks: 5 1 0 -10 10yr3/3 None sil 2fcr mvfr as 2f 0.5 0.6 S 2 10 -18 10yr4 /3 None sil 2fsbk mvfr cs if 0.5 0.6 Ground S elev 3 18 -40 10yr4/4 None sil 2msbk mfr cw if 0.5 0.6 92.22 ft 4 40 -82 7.5yr4/4 None sl 1csbk mfr cs - 0.4 0.5 Depth to limiting factor >g2" i Remarks: Ground elev Depth to limiting factor Remarks: z LOt /S P lad ortJagnerCi ta.:&5, o; on Pr op. :t�taai'2 �f e- XiSi /ence /ne J c�e / " -yo U 32 a . 6- of a. n C—< ■ 5cyp I�h� . E le.tp- = 46.33 N O p e `�'` ■ B 37'` w Q� kr � Br Q � !3s 82 " PUre: Top o "rebal- Assu mzd } yf1' W)Pri 4 71 66 EN 13AL STATE BAR OF WISCONSIN FORM 2 -1 KATHLEEN H. ARLSH Document Number WARRANTY DEED FEGISTER OF DEEDS 51'. CROIX CO.. WI This Deed, made between Nottingham D LLC, RECEIVED FOR RECORD b yGre g Johnson, its sole memb er, iP -14 :001 11:30 AM _ - WARRANTY DEED Grantor, and Tim Eder and Julie Eder, husband and wife, cy.E4PT N _ CERT COPY FEE: COPY FEE: - TRANSFER FEE: 149.70 -- - RECORDING FEE: 11.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix _ County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot 15, Wagner Estates, St. Croix County, Wisconsin Name and Return Address Jennings State Bank + 1715 Tower Drive West Stillwater, I•IN 55082 -7580 032 - 2034 -95 & 032 - 2035 -10 Parcel Identification Number (PIN) This is not homestead property. QE) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this `gyp -fit, day of October - 2001 2 � Nottingham Develop LLC • Greg Jo hnson, its embe AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) )ss. County ) authenticated this day of „ _ - -- Personally came before me this 'Jay, of October 2001 <, ers�lried Notting Development, LL C, by G 1e; . - - - -_ ... - ---- - --- -- member, TITLE: MEMBER STATE BAR OF WISCONSIN - -- ` (1f not, to me known to be the person(s) who��kkecged th ocegomg authorized by 0 706.06, Wis. Slats.) - in trument and acknowledge the saalLr. ' y .., THIS INSTRUMENT WAS DRAFTED BY � iiA I Attorney K ristine Ogland — Notary Public, State of Wisconsin Huds WI 54016 _ _ My Co�mm erm 's,,on i artt!Rt. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ____� .- __.,__ ) ' Names of persons signing in any capacity must be typed or printed below their signature. information vrofasaionals company, Fond du Lac, vin STATE BAR OF WISCONSIN e�ssaort WARRANTY DEED FORM No. 2 - 1999 X . . . . . . . . . . . . . ...... z . . . . . . . . . . . . . . . . . . . . m + . . . . . . . . . . ... . . . . m 1 ..................... Z ....... . .... ............... ............. .................. ............... ............... .......... R) ...... ....... ........ c OZ E3 m ................. ... .......... m ....... m ........... .......... ......... ... ... 0 m ........... ........ ' Fr, C m .......... ................ ..... . % ................ ............. ............ 5 ................. ............... .............. ................... ...................... ................... rn (B ................ c ................. ca c" 0 m /' �\ cp .............. .5 mm Co— ........... .......... --4 01 ............ Z C 0 / �. —.Mg ........ c . .. . Z m 0 ........... m m OD <>— i 70 m 0 > M -n z m . ......... • _0 M m M X Z02 c: --i Z - u 2 C - 1 4 , 0 A> Z> m m -- I 0 0 —4 z z m — u r C-) 100, 0,,00':: > m .......... ........... mm 0 C z > r C 73 PAC E; ......... z '00 . . . . . . . CA ..... . ... ....... X rk 0.01 M r— ....... ........ .............. ....... ...... . ... ..... .. . . . . . . . . . . . . . .. . . ......... . .. ........... ............... Z 10 ........... Sol W" WIM i co ............ ........... ............ ........... ........... ........... 0 C) q ........... c ............. ............ . ............... .......... ..... ............. ...... . . . . . . . ....... ............. .............. ........ ....... ...... ............ ............. ................. ................ ............ .... ................. .................... .................... ............. ................... ....... ......... .................. . . . ............ ................... ......... ............. ....... ........ ...... . .......... . .... ............... ....... ........... .... ................... .... ....... . ......... .... m ........... L .... 1305.6 0 ........ ............. ...................... nff 575.71' x -------- (A (4 x x M — SOO*43'57"W C-) 0 r) SOO*4, z 0 m 04/25/2003 08:19 FAX 7152352592 T L SINZ PLUMBING INC Z002 - Safay atfd Budding is Div COU IN 201 W. Washington Ave., P.O. Box 7162 [� I visconsi n Madison, WI 53707-7162 Sanitary Pemtit Number (to be filled is by ) (608) 266-3151 Department of Commerce State Pin LD.Numb- Sanitary Permit Application In accord with Comm 83.2 1, Wis. Adm. Code, Personal information you Pluvidc may be usod for srmndaty purDases Pavacy Law, 615.04(1 XW) Prq= Addttas (if difikent than marring addrm) 1. Application Information - Ple*lc Rrinl An linforaoatloe Pared Property Owrltr's Name Property owns s Malang Aad r r Am c y., y., secrion City, State Zi �Code .! Phone Number 'Q Il. Type of Building (check all that apply) - dui N CSM Number k�or 2 Family Dwelling - Number of Bedrooms J t/ ��S ❑ Public/Commacial - r--dbc Use OCity_ ❑vdLbeleJ foWGShip of ❑ State Owed.. Describe Use - Ill. Type of PertnR: (Check only one box on lime A- Complete line B if applicable) A. NtW System ❑ lieplaoeonrrtt Symm ❑ Tl utnwet/Hcldlng Tank Rcplacemmt Only Q OtherModifioatim to E;d0 +g System ljst Ps -v6d Aint Number and Date Issued B. [I Permit Rcocwal ❑ Permit Rcvisieo or ❑ Permit Trarnsta to New �Q! G ✓ ` Scibre Expiration PIS a" 7 IV, Type of POVVTS S stem: Check all that a l ❑ Noa _ Yressurized m un - Grod ❑ Mound > 24 4t of suitable soil ❑ Mound = 24 at. of suitable soil ❑•fit 1de ❑Single Pass Sand Conswicted wetland ❑ Pressurized In -Grmmd ❑ Holding Task ❑ Peat Filter ❑ Aambic T'"' nmt Unit ❑ Renhoelating Sand Filter ❑ R-irculadng Synthc6c Mccia Cribs ❑ L®chmg chamber ❑ Dap Line ❑ Caavel-kaa P" ❑ Otla M aln) V. Dis rsal/TrcutuacutArea Information: Design Flew ( Q Atd ��� ( � Elevati ( Design � G eatim Ratn(gpdsn ; Di ° � Info f epmKy m Tom Nu Matr.nfacuuer Site Steer Fiber Plastic V1. Tank Gallons Gallons of . Concrete CamLhretnd Glass New Eawryt Tanks Taakil Accublc Trcommd Unit Dwiug Chcmhcr V11 Responsibili S[atement 1, the tmd n '- pousibitl for tnstathntioo of the POWTS slwwrn on the attached plans. Plu s Nart+e (Print) YI MP/MPRS Numb= B ••atne+ce pyp Nutnba Plumber's Address (Stxca t. City, State ) VILL Coup /1)c artment Use Unl Sanitary Permit Fee (includes Crtonmd+wtcr Date Issued Issuing Agent Si6oanna (No Snunps) ❑ AW cr cd ❑ Disapproved I Sutrhary Fee) ❑ Owner Giv,pn Ramon lbr banal 1X Conditions of Approval/Reasoos for Disapproval Aurae► ®mplefe plans pe the County poly) Aw lac sydeen ea paper dot In$ thin W1 1% it 11 ;o is Ohre SBD -6398 (R. 01/03) 04/25/2003 08:20 FAX 7152352592 T L SINZ PLUMBING INC 0 003 T.L. Sinz ,Plumbing Inc. E5609 708th Ave. Phone: (715) 235 -2644 Menomonie, WI 54751 Fax: (715) 235 -2592 .ww wAsirizplumbing -coin o a , N Ot I Tod of ) 11 ply- , B �DD,o er v j , + Zr�►3 �.E y4 - � by F=i f �-w. '77/ C. 9 Z o 5 Dw z it I /allot- 04/2552009 088:21 FAX 7 'N--- T L SINZ PLUMBING - INC 1 007 s2r.:ty ana $ulldings Dtvisiun 201 W. Washington Ave- P,O. Dow 7162 - I�Q�S�� Madison, w l 63707 7162 Sim 1( Dep artment of Commerce or�S``r� � Sanirary Pcrsnit Ntustber Sanitary Permit Application Ln accord widt Corran 89,21. Wis. Adm, Code, personal ia(onrwaoa jy 0 Choak if Xavision _ L^9 ti3tld (ur ssiO ses Privac LA s ( Ak [. Ayplicatiora Lnfottataeltao - FItan PHnt A4 lntormaUon ` Sots Plsst l.D. Nur rber Owner's NYne �- .' • 1iat+iel lVUtmber I3 Pro prr v `�. `� t 3o - T Prupntty Owner's Mailitlg /►d�ress r j r i -� • t '`' ° � O ° 4Rt w � " qj kj / / C11Y. sou "ltF one Nu►n UWN r �t Ngmber Block N bGr �, $i"71liN grFIC,c 'awivision hlarua ;oe 1,417 j 'rte LI, Type or Building (check all Ghat apply) Ocim, I or Z Family Dwelling - Number of lkdreianus di CIVIJUse 1 D Puutu /Gomt nctcial - taesl:ritw Ute 4ti�la i t'1� ---`— �Tawitslti D State o—atrd Nearat Road III, Tjpe of Permit; (Cder-k only one b" oa lino; A (alsrstbcrittg tie fur iaternail arse). complew line 8 If applicable) A ' 10 New 2 0 Repl■mtmnt S�Freatl 3 D Replaccumni or 6 ❑ ^wdon w For Corla4 me Symm I cra sy stem B. E] sta Cb=k if Sanitary Peit Reviously Issued Permit Number mare tsmod 1V. Type of PwvLitt (Check *0 that apply)(numbering scheme is; for internal tie) as Nen - Presatri 1n- Orow*1 alto Mouaa 47 ❑ Sand Filrer So 0 Coasauawd Wvdattd I zz ❑ P'MWU to L2- QMtutd 41 ❑ H044 T&;* 48 D S"lc PM Sl ❑ Drip lit= 41 q At -Gr,dr Ad u Aarobie Tretim'lent Unit 49 O Reci atieg 30 Otber V. D ersal/TreaUnenL Area Inrormation: t S' Caasisn Flow (gpd) Cispersal Arco Dispersal Arco Sell Applie>,don Pcrecla4en WE System Elevation Final dude Requircd Proposed Rate(Oals. /Days/Sq.M.) (Min./W4 Elevation 1. _ , �/ 4(Z j V . TarJt Ittfu cApaclry itt Total Numtwr rtauuhlource /reran site 5tael Fits► Plastic GaJloes Conner of Tanks Concrete coo9cnlerad ows Free. t;r:stllu Tana Trolls :cpoC or Halrting Tom Dosing Chatnbcr i YA. RcspodsibWzy StatettImt- I, the understand, asi& rtspoMWIt for -% la Uoo of the POWTS shown no the 4Ractat11 P)amm Plumksr' tttn (P ' Plttmbcr 4 SI , FRPMrPR3 Ntttaher Swittess PhoQhltlmber I T A44re s (Smut, Clry, Stare, Ip e i YQX, Count /Dc srmcat us; Cal „ Approved Q 1](sappY6�ed F"—,.r Pet -nit Fee (includes G�oundwater Dane tesuad lrnviryt Agar. Siggaatn (No swnps; Fee) Owner Givca Wail Adefst Dctttminatiun 1 � LX. Conditions or Approval/Ftcuans for Alvapprovul nn -1 r r 1 d aid �a�. vl&A � 4 r( 4P �+ �'ke,r� i ��C r � �r r.t.5 � f e TQ r tr► (4� seer ..+� a►C t. re t 1r (LOht ArClt� QTr"--jC oww"A eampkre ptw (w the Cwaq edsl r: u►e Wza i16 popor "Iwo tW 4111 s A3 here, IN aft SBD-6398 (R. 05101) 04/25/.2003 08 :22 FAX 7152352592 MB T L SINZ PLUMBING INC fa009 lidf !ul IUn 1J. t1 wile PJLW ..,• Systems start up shall not occur when soil eondlvo are fro>rm at Ow In191111'ad" st r"- During Do�nllr ou;ages pump tanks may 1111 above no mtal hiehwater levels. Who pm*r h tutored the "c" wastewater will be discharged W the d13CerW 0011(1) In one lalpe lose, OverlOading dw COU(s) and may resYta In the badtlrp or ltstfate dlt resr to effluent 'to avoid this situation nave the Corltancs er d" putttp sink rerrW4vd bl► a $Wup Servidng OWrator•ptl e or to resrrsctn� power to t w eftluerrt purnP or contact a Plumber or poy/TS 1'taitlttJfler to as#Ist In r+►arwafy ooetrigrti ON GOntrols to restpre ncrenal levels within the pump lank. Do not OrIve or Park vehicles over tins and dispersal cells, Do not drive or yark vvrr, Or othen�Ylse dlswrb or compact, the area wtchlrt 15 feet down slope of any mound or at - grade sal asssorptloh AMA- s MO Ufa Of t' Reduction or ellnslnatlon of the foli0wi11>: (10111 the vlasur�aterstrtaltt maY ln`° else per6°mu rrsee aril pYOlon rolon ectiants; fat: POWTS: antibiotics; ba'vtr wipes; m clgarvtu butts! condos; Comm swabt; defMaNTS; dental Voss; dlape R j foundation 413th !sump Dump) water; fruit and vq"uble pee{hrcq pwq ml creasers herfsit3414111; treat scraps; mrdicatons; psi; paindriR croductst t,?%dcldes: sanitary na0lns: tan cons; and water soltitsner br111e, ARANDONEM EN1 When the POW'T5 fails and/or Is permanentlY Mien out of sarvlte the rollowt% steps shall be takers to kIS11re that the system is properly and safely abandoned to caerlpllance wKI't ch. n*! . Con d3.33, W3scarWa Adrrllnbtradw Cocks. • AIt ploMs to tanks aril Olw shall be dIsconrtoCted and tM abandoned pipe epWno • The comencs of aA tanks and plts shall be removed acrd proper► . d proper? of by s 5e~ $erwktrst Operator, Afirr pumpire„ all v, nki and pltr shall be excyvated and removed or their covers rettwve4 and the veld space filled with soil, travei yr another Inert solid matcri.l. CONTINCZNCY PLAN or must be taken, provide a code catrspllant If t w he Po r$ falls anti cannot be repaired We (allowlnt mrasuRS hary hewn, 11► replacetn yseetn 4Wt soil apsorDUon A $V ubic reptecerncrt area has been evaluated and may be udAnd /Ot the faagon of a reQtiaeln sysrern. The rovlac�er"ent are should be prvttcud from dl wftance and Compaction and shoWd not be Infrlrteed upon Dv reQuirtd setbacks from existing and proposed'RUCtaue, toe llnes•and fib• fa moo dw cemen t rent S (Mus ll result M the need for a new $oft and sfk evaluariP>t to esumish a sultame 1011 comply with the+ rulas In 0((009 as that OM9, Q A 314tta41e replactrnertt area is CW; available due us w0ack- and/or soli 11mil:30ons. Wrig advances In POWTS ccchnoloifi' a holdin =.Cart maY be IMUPW as ill laws resort tO refer dw l ilted POMrT><. O The site his not beet) ewluaetd 14 I a suit M r8PbCWq &,M' up" hdinre of the POWi'S a soil and site evaluation must be performed to lope a svlubie replaeewrent ilea• If no tetili<ernent area b available a holding tank MaY b. Insulled as a last resort to replace the railed POWT$. ❑ Hound and at -erad e sots absorpdon sYST -orm maY be rvcQrJt wd ��?I� following K �� a�i �ebiomat at the Inflitrattve surface. RleconMvaloris of such systems rnust•oompgr < < WrAN1NG > SEPrr%C, I►uNP AND OJUER TREATMLWT TANKS MAY C iIETNAt GASSES A111Dl0R MSLIFFICILNIT DEATH SAY R RESULT, X IKU6 OF A FltOV4 yKS IMTE IOR OVA TANK MAY E DIFFICULT Olt ES. eT.tprSCC1R) C. ADDITIONAL COMMENTS POWYS INSTALLER ' owes ly/AINTAIT49K A" Phone � • �lfwrly � "�iri SEPTAGE SgIVICINO OPERA P "PER 11A eav_ OV-CULAT01111Y AUTH 'W i n 04/25/,2003 0t• 21. FAX 7152952592 T L SINZ PLLW- ING. INC 1�00 U8; ZO Ul 1 L 1J. 11 a s.i #A.+ Jvv `� -�• POIARS OWNER'S R"tAN�1A1r ►clef rtp►t�f�►vEfcrfr rim FILE INF OlirlATlotN 51(STllH SPECIFICATIONS Septic Tank Capadty GsOAD I O NA Owner l M D NA Per # Septic Tank Manufacturer Effluent Filter Manuracturer 2 "$L.E ❑ NA DESlG3+ll PARAiNE'>iE>itS ❑ NA Number of Btdrooms Cl NA. Effluent Filter Model AD q Psnnp Tank tawny Number of Ec ercial Units average) B� $aVday Estimated flow ( Pump 'Tank ManufacaarQr' ANA Design now (peak), (Estimated x 1.5) 5O gaVday Pump Manufacturer EaVday /ft Pump Model �A Soil Application Rate ' e pretreatment Unit Inguent/Ef'luent Quality Monthly average C) Sand/Gravel Filter ❑Peat filter Fats, Oil at Getase (FOG) s30 mg/L Cl Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD%) ! =0 mg /l, O Disinfecti ❑ Other: Total Suspended Solids (T55) 5 i SO ma }L Manufacturer Pretreated Effluent Quaft ' p NA� Monthly average" ED52 Cel nd (gravity) Q in Around (pressurized) Biochemical Oxygen Demand (BODY) 530 m¢/L At-Wade p Mound Total Suspended Solids (TSS) 530 mVL G Othet_ Fecal CoRform (eomeaic mean) x10 cfull00ml I6 inch diameter * Yilues tuDka1 for domestic (norKommertlal) „ waxer end septic Mazlmum Effluent Particle Size tame effluent, * +► values$ typical for prtrraatsd wastewater. MRINTlHANCE SCHEVULE S F ropeeey Service Tsvent inspecrt condition of ra n k(s) At least once every C3 months year (maximum 3 yrs.) Pump out contents or tanks) When combined sludge and scum equals one-third (A) of tank volume Inspect dispersal MKS) At least once every ❑ months 0 yemr( S) (Ma�k+kkkk 3 YT S.) Clean effluent filter At least once even► Q months year($) um controls 8z:alartn At (s!35t once curry O Rlontfls ❑ Yew(s) Q NA . Inspect pump, pump ❑months D year(s) ❑ NR Flush laterals and pressure test At least once every At least once every o months [I year(s) DNA op At least once every C3 Months ❑ yea r(s) M NA 14AINTENANCF INSTRUCTIONS one of the following licenses or cer[iflCations: Mast, Inspections of tanks and dispersal cells shwa be made by a e individual retrying Plumber; Master Plumber Restricted Sewer-, POWTS Inspector; POWTS Malntalnet; SePv Id en any cracks or Waks, ch must include a visual inspection of thg rank($) to identify any missing or broken of effluent de the Bound surface. The dispersal volume of combined sludge and scum and to check for any backup or Ponding to check ror airy ponding of effluent on cell(s) shall be visually inspected to check th e a fftuenc levels 6, the observation Pipes and wires the Immediate the ground surface The ponding of effluent on the ground surface May I n di cate a f condition and req notification of the local rrniatory authoritY• th entire When the combined accumulation of sludg and s e Servicing n tank equals one disposed e volume, of in accordance ch. 14 13 � , Wons' contents of the tank shall be removed by Administradve Code. The servktng of ef11 tent flitec$ rnerhankal or pressurized ppy�r7'S components, pretreacemenc comp onents, S Ma npiner. a ny ocher maintenance or rr+onitoring at Intervals of 12 months or less shall be performed by a cercifl k � of a service event. of com A service report shall be Provided to the local resulacory a within t 0 drys p START Up AND OPS ATION For new consmtalon, per to use of the pOWTS chec dtre atment Ce %) f o 1 he PresQ concentrations are de have t he conre chat nuy impede the treatment process and/or damage ,+r r1■n rnhrr(Sl rpmourd by a senwe servidnsr aperssor p4ar to use 04/25/2003 08:20 FAX 7152352592 T L SINZ PLUMBING INC [a 004 : . —: �Plw 23 03 04.22p Honta Excavati 1715)796 -2519 p _1 04/E3/02 16:07 Fn& 247 5 185 —, S & C 0,09 SOMERSET tbooi waoerdn oweMumm df CO^+YOME° SOIL EVALUATION REPORT Page d --Z Cjjw*Wn of Sa%ty and Bulielkvs Ih aCtafdtlncs. w ah Comm 35, VYa. Adm. Wx Atirh iz,SgtN the AM, a p not wm Iron a 112 x 11 Irrhee in 4&0 Plan rnuat IhduOe, Mr1 qer tsued go: vert cM and huNtonW MMMM; , Ookx (CM). chm% iv^ and Pmael I.D. paoanl alopw. Beale Or Oirnanalanx, rora wroer. ana locaaior ano diaunae to r.eareat luxe. Oeta i hm" print on 1 -nftf nawbn. O dY Prntond i7aorlP■rlen pf vO-d �! �aa0re• ■■eal.aaf7 dy��i fo+�xr �'�• ■. ' S-04 fi) un1). P►y Ct+R+sr progeny Localism ( (o W rK C,*,t L X �LJ vs 1d 5 1 T N R P O.nora Mlaltin0 A dd a roc 81ad� f Sutd warns ar CSw C. y T k A u e I s L/w ,u .-c 54- cr; T t:eee e O cir 0 V lwaa Q T a kin An" Now GontiYJdlon Use: ® Re�denYar / Ntarmer a bo peQRr4 Cana aerirvd dlaelgn day rule L� Cta fG o b GPD te ❑ Reytimrr�nr ; 1 `[� Public or wmfno►CI31. 0e110fbW Porum MAWW Flood Plain eravadun If wDY ®his 1L clonr f11R q alt10sm s ✓� ej-4 !7 60 G6 Wcr Qf•a ,and remnn+enA.Eerrs y m^^9 tl Pit 0-.-d auAata etas. l.,�_ �� K, Depin m fNrsti)p lealor / „• 5bl t� Nnlaflrt Dtr�1Qr 0tatrf narfl G's# Redu: Doswiptlan TaNk" SVLWMNar Corvistanca Beundaq RWU GP011p In. Mufad Ott 3z Cdx. Maw Of. 92- SIL VOW 'ER52 i o- �3 - 5, okab `1 s .�( d0L C _ a p, 31r, a Ba ring P ® t3orhp Pit Greur,0 arshae ems, s- d R QPrr 1e w6wig 1 cm In- $Qe AWN20dm Race t Iview� C1e;rp1 pernhwe Cdor Rotas Daatdpdon r odum Sbuftim ConalslMra Boundertl Root GPM IrL MreleeN CU. SL Cal. CAW Of. g• Sh. 'EMI •ERIr2 Z►�tsbf rm.(� eAue o Al - DOD > 30 1 220 nWL anfF Wx; 150 rnayi • EEMtord 02 = WD 1 30 and TSS :5 30 111911 - csf nerve Print) gnmwe CST ttlurr� AW 4ja w, ` �s a Addmov; 10- gas Evatte kin Gara idea Te"MW Numbr 04/25/2003 08:20 FAX 7152352592 T L SINZ PLUnING INC, [a 005 Pr 23 03 04:22P Honte Excavating �i����o - c�ta f-' o4/23/02 18:.0 W .715 247 $195 S & C BhNx SOMERSET tatopart�r ��._1! Pa.� 10 V e f— � �c � _ Peps Z of [j boring to t� �. 9r �a I t Depth 12 1e10t+ns � �+• �, watt: ® p h Grwmd fir• �� Fiormort �� Darr+4>mt C4ar Deww"ott TaeM�v � Con[Imtce 9surdilry Raott Nuteetl Qa GanL Eats: Cir. sz Slt 'EHNr 1 'EJN� � O'• 1 t D 3� — 5 ^f Z�rSb /+'� -�� � S / l/l Z III- / rc— ; ql 0 '1 OWN V Pk Gsysr.re aurWae dew. tt Drpllt b I'KritL+p hder � an Rare RH&W bat atptlQt Tarauue SOedura GenrJsletr� Hotrtder7 Aoaet +roPR! ttarsmn DuDtlt, �tottsitettst •EtU1, 'E� In Mtati+el� Cu. fit= Caro CAM rx. SA Cl Be" Dattnp t► Grourr►msbm elan. ti Dsvot r. rq+.mu 5oaliors P.O. pit GPM ►aar®n tma Darr:rtarttcoi Radv = Dotobrb'• Ysxf>ns sa.sirro Ce�m"° HQ.raary R°'° ; 1lrnse0 Gu. U mat. color or, sz srt • &fii1, "EHp¢ • EMU WA Sh DOD > 30 = nO w#L and TSS -,9D 1150 erg& ' EAR" DOD, 30 D9 WW TSB a 3D The DePaMnesr erCatmmMe it on OW&I upper® iiy &=.vice XVvider <d entployet. if you Red llmd3 not to arse iotrices or aea0 trwrndal in m %,Wmle Cenmtr p1mm mnLma the dep�at at tiG�2116.3I51 or TTY 008- Z6d87 =oasto n sar 04/25/,2003 08:21 FAX 7152952592 T L SINZ PLUMBING INC [a 006 .� Apr 23 03 04:22p Bonte Excavating rtajiab - c;Dia r - 04/19/02 FAX 715 237 5155 5 & C BANK SOMERSET 002 PAGE 3 Off NAME_ ► M (5XM lt)Tlf /9' LEGALDESCRUM ON:_1 / / 4,5 _T � N.R _ E(or)W SCALE: 1 �_ . BLE VATION:/0 BM I DESCR1rnON: jme HM 2 FI.EVATION' Ql r <D DM 2 DESCRIPTION: a G.NJ SYSTEM a F VA_nGN: ' jof ! Z. d ql• ° SYSTEM T e.a *► y +. r. �-' c.ra�c.� ap r SJGXA E: DATE: 23 03 04:22p Bonte Excavating (715)796 -2519 p.1 04/29/02 16:07 FAX 715 247 5 185 S & C DANK SOMSET tool Wiscomn Deperonem of Commerce SOIL EVALUAT REPORT Page � of D)vhtlon of safety and Buildings In accordance ..nth Came+ tl5, Wis. qdm. Code �Y ,Busch oompialo stte plan on paper not less than a 112 x 11 Inches in pize. Plan must Include. but not Ibnved to: vertical and horizontal referenw point (BM), dirediun and Parcel I.D. percent stop*. scale or dimensions, north snow. and IoGation and distance to nearest road. Please print 1111 infonnaHon. Revtowed try Onto peraonai jMOnealw+ V" to * .;" may be urod too seranAny Purposes (Pmracy Law. s. 15.04 lit (m))• Properly Owner L/ Property Location T i G Lot 14 Lj 114 1/4 S C� J T N R I� E (or) W Per's Mai 1g� idr�i 6 Lnt� Blodt lU 5u6d.tt1 p C S r r S CAy l� 7 yp CWo a C) C;W ❑ Village [9 T&Wn Nearest Road scy c` �. �. 5 ` )( T - '75'I 4 �rmR'r Sat New Cone Wcaon Use: (jI Residential / Number of Dettoorrts Coda derived design flour rate G 6 o d GPD ❑ Repiacernent ; `[� Public or commercial - Describe: — — - -- Parem material 1 T Flood Plain elevation it appUcable fL General come+ates s �c ►•'� e!� U� Z" 60 Gdw e r q I a e and reax,rnandabom "� Borin Pit Ground surfara elev. -!5- ft, Depth to tlrttilirig Fedtx / tj h. Soil AWkbw FZ Horizon Depth Dandnent color Radox Description Texh" Souculm Consistence Boundary Roots l in. Munsell Chi Sz. Cant. Color Gr. SL 8h 'Ertpt 'E"2 i a-Ir �3 — 5h'I .►tdb rr�� c 5 1 � '� � Z y) ►e / y Bori ng 0 ❑ Boring ® pit Ground suftceelev. 7S 96 ft Depth to Iimiling fader U In. Sol Appicolion Rate Horcm Depth OnnUraWC.olor Redox Description facture Slrucium Consistence Boundary Raub GPOAP In. Munaeil Qu. Sz- Cont. Color Gr. SL Sh. 'Effp1 'Efft2 1 6 A� 3/2 - S,'J ZIn�F r � Iu4 s` iL 3 Y i >r 3 - �i rr C 3 ro SL ZbE , Effluent At = 130D > 30 c 720 mgA and TSS >3D < f60 ntg1L " Effluent 62 = BOD = 30 mg/L and TSS < 30 mg(L C5T Name 1pllw oe Prrd) 9^ p - CST Number `" _ S 3 o Add ma Date Evaluation Condud ld Telephone Number Zl� O �' vrvr 1• S'>b2 y�`o - 71 5 -Z1- / -yooF pr 23 03 04:22p Honte Excavating 17151796 -2519 p.2 04/25/02 18:,09 FAX-715 247 5185 S & C BANK SOMERSET Q1001 PropertyownerrS IC �r Parcel ID PdfA-Y' er' page z or 3 ❑son oo ®Pit Ground 8urfacealev. OQ R. Depth to limiting hour in. Sod A Rote jknwn Depth Dominant Color Redos Deaviphon Texhae Structure Consimame Boundary Room GPCIM in. kkamell Qu Sz Cord. Color Gr. Sz Sh. 'ENM1 't W i o- i V IC N - 5. zo►Sb l /Q Q t3on+►+e ❑ Boring ❑ P8 Ground surface also, ti Depth to {inviting factor in. 551 Utm Rate Horimn Depth Dominant Cdw Radcm Deiorlpdm Tamura Structure CnnsWimme Boundary Roots GPDRf IR Munscil Q+1 &z- Coa Color Gr. Sz. Sh. 'EtW1 - ERY.2 Dre ° �°'° ❑ pit Gtoundaurlatx also. R Depth to tirrr6r,g t>DCtor in. . Sat ApPlication Rate Horizon Depth Dotrdrtant Color Redox Oetoiption. Takit" struawra Co- lstenee owndary Roots GPI in. MnnseO cu. Sz Cain Color Gr, Sz Sh. 'EftN1 'Efld2 Efauant In BOD, 30 1220 nWL and TSS >30 =150 mglL ' Ef lijend 12 = SOD, 1 30 OIS& arb TSS 5 30 nWL The Department of commerce io on equal opportunity service provider and employer. ]f you need assistant: to aceest: services oz need material in an alternate (am -At. please contact the dtpetbiu at 608 -266 -3151 or TTY 608 -264 -6777. r�araaawts -eraor 'Rpr 23 03 04:22p Bonte Excavating 17151796 -2519 p.3 04/29/02 18:0 FAX 715 247 5185 S & C BANK SOMERSET Zo02 -� PAGE .S OF NAME. � _ ,\ LOT1# 1�� LEGAL DESCRIPi70N :_i /4 _T _1 /4,5 SCALE: I"- EL£VATION:L O BM 1 DESCRIPTION: o - � j ~ _ � � BM 2 FLEVATION: /O DM 2 DESCR. PTION: -1 --iP PVC O . p e SYSTEM ELEVATION SYSTEM TYPE: C.a yr j- o � i r DATE: SIGMA 1�7irE- , 04/23/03 1i'ED 10:24 FAX 715 386 4686 ST CRT CO ZONING 2001 J — V�h sconsin Saru- s ki ailui siun ldings Divi County 201 W, Washington Ave., P.a. Dox 7162 Maaiwn, W1 53707 - 7162 Site A s - 1( De art rnent of Commerce pp eav g J. Sanitary Permit Nt►tstbcr ~� Sanitary Permit Application 3 90 ri -T-? In accord with Comm 83,21. Wis. Adm. Code, personal infomudon y V. {] Cheek if Revision rna be used for mcordaxy p urposes Privacy Law, 05. I. Application Information - Please Prim ALI Information t \ Sate Plan I.D. Nwnber Property Owner's Nurse tarrsl Number 03 —2tz O - dip r Properly Owner's MaUittg Address P' M Location 4Z J11/Z r 'A u S T N•R City Stye One Nurn UN Lo, Number Block N her Z1NiNGO C-FICE Udivision Name CSbI Nutrt�ct IJ, Type of Build.i.ag (cbcck pil that apply) — ❑City 1 or 2 Family Dwelling - Nutnper of Bedrooms �� e S �� f � ❑villa e � ❑ Punite /Conuucmial - Dc scribe Usc — �� �,E4 .2 ovmstu ❑ State Owned NoLrest Road ff -I M. Type of Permit. (Check only out box on line A (aumbcri4 scheme fur internal use). Complete flue B If applicable) A ' 10 New 2 ❑ Replacement System 3 ❑ Rcplaoemont of 6 ❑ AddidOn ID For Cote 7 we S stew I Ttok Ordy I Ewd System B • ❑ Cbeck if Sanitary Permit Prtvia sly Issued Permit Number Date Issued -T IV. Type of Permits (Check all that apply)(aumbering scheme is for internal tae) 44 19 Non - 'FT0L%WLied ln Ground 24 M QW 4 47 ❑ S" Filter So ❑ Cousevetrd Wed" 22 ❑ Pmuurisad lirmund 41 ❑ Held4 Tack 48 0 S4 Pass 51 ❑ Drip line 45 ❑ At -Grade 46 ❑ Aerobic Trc.tment 'Unit ag ❑ Reei sting 30 JJ Other V - DisPeruLUTreatment Area Informations Design Flow LurA) DJ srursal Arc* Dispersal Arca SOU Applicktion Percolation Irate System Elevation Fusal Grade Required Proposed L2ata(0als /Days /Sq.Ft.) (T~lin./lnch) Elevation V , Tank lttfu Capacity ut Total Numt,cr Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tartics Concrete. Conswcted Glair New EaisdiU Tanks TW.c Septic or Hvlairrg 'rgnk ' Dozing Chamber VQ. Responsibility Statement- 1, the tmidersigned, a rtspoaslbitity for irutallation of the POWTS shown on the attached plate. PlurnbGr' am T ?,� � plumber s Si � MPlMPRS Ntsurber ettsiaess Phom.Ntunber 1 Address (SnYSer, Clry, State, ip todo VM' County 1De artment Use Onl l Approvcd ❑ Disapproved Sanitary Pcrnut Fee (includes Groursdwater Date Issued Issuing Agra. Signature (No Sump,; Surcharge Fee) ❑ Owner Givco I us) Adverse _ Determination Z 0 IX. Con or Ap /Reason; for Disapproval i ( l # + nI( 4 CI"r'(v bl t�s cl�cf 4, h.Q�sT4(rslt:' rper uy�6t+.ut0.CIa(fCS Ttr-O e"erLlJa4 d6-'s. AU—h edmpise Phan 04 the coutty oplyl for the Matem an paper" 1Lao gill a 11 Loops m stns . SBD -6398 (R. 05/01)