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HomeMy WebLinkAbout032-2156-60-000 n ■ o ■ -0 n e ' § 7 § § ; § ° # , E rr 0 M 2 E 7 ° t 9 $ G S Q - � G / $ \ m § E / E § ) § a,= E¥ i 9 E 7 ° § % } ( S. R \ 0 OD ¢ $ ° / U { 0 8 c r g 3 § / ¢ g § \ § 2 I \ (D @ a § E / a o o r co � W E ; (n 0 g T co fu 0 0 0 C CD $ § / CO) @ (0 _ % Or o � \ ■E2 / , . 0 § ¥ % f \ 7 ( g ;o k K k § § E / E @ §\& m g PL S§ (D ° i in Oro i e � ® 3 2 z I CA & + § % .. e w m (D m § / z 0 /_ k 7 z E � -n 7 % $ � f � � ƒ o / � K 0 s t \ \ � \ i , 4 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Croix Safety and Building Division f 0 , INSPECTION REPORT sanitary Permit No: 420422 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)j. Permit Holder's Name: City Village X Township Parcel Tax No: Grand Properties L.P. I Somerset Township 032- 2156 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: P VC - PAI TANK INFORMATION ELEVATION DATA ,c3 jp / 2 • o S TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. /a/d- S•3 Septic ,� /000 Benc ark si I 4 /06j3 Dosing Alt. BM Si�eyl Aeration lti/ — Idg Sew r - 6. jU o. Holding St/Ht Inlet •7 , St/Ht Outlet � 7 - 1 TANK SETBACK INFORMATION 7 � B 1 TANK TO P/L ELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic � � � � � C � Dt Bottom / r 2 Dosing � -S zz) f 2o S am cf Z Aeration J Dist. Pipe , pg. �/� Holding Bot. System . PUMP /SIPHON INFORMATION Fin I Grade Manufacturer Demand I St ver �7 GPM .� / 1 Model Number /3 1 p •' 4 . TDH Ufa arI Friction Loss Sys Forcemain Dia m H� TDH ,,Ft f b- & 0 Z�f Leng� Dist. to Well v SOIL ABSORPTION SYSTEM "lC BED /TRENCH Width Length No. Of PIT DIMENSIONS No. Of Pits Inside Dia. th DIMENSIONS SETBACK SYSTEM TO P/L BLDG WEL j LAKE /STREAM LEAC anufacturer: INFORMATION CHAMBER Typ ystem: � O`s / Mode DISTRIBUTION SYSTEM o Header /Manifol Distribution x Hole Size x Hole Spacing Vent to Air Intake • I� Pipe(s) a ` O 3/'` ,t Length 3 Dia b Length Dia Z' Spacing n' 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 Bed/Trench Edges Topsoil Yes No [, Yes 1 ,j, No \ C ` OM NT :ode ( Include c di �ep ricies, persons present, etc.) Inspect' Cj� #1:��1 2 � l � Inspection #2: / 0 � �J G) V / v Location: g89 167th A en Somert, WI 54025 se t, 1/4 NE 1/4 12 T30N R19W) NA Lo 6 4 � ` l Par el No 9 f Ir 1.) Alt BM Description =R n � / - b� � � `, �� Y V 2.) Bldg sewer length = / 5 j 4 - amount of co = > j jS ,7 n a X 4,,r � S:P 3.) Contour — L " Plan revision Required? Yes Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor' Signature Cart. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 5r • CP O/ c N V&Ic onsi aw n Madison, WI 53707 - 7162 Site Address 3 , Department of Commerce �i � 0—O Z ci W 1 6 r7 LJv�e Sanitary Permit Application Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 11 Check if Revision �� may be used for secondary ses Privacy Law, s15. 1 m I. Application Information - Please Print All Information State Plan I.D. y ber Property Owner's Name Parcel Number 03 a1 - / ' �+ O 'P roperty Owner's Mailing Address Property Location t 3 d "-A-. S ZI T 0 N. R / City, State Zip Code Phone Number Lot Number Block Number x Subdivision Name CSM Number O LY acs II. Type of Building (check all that apply) i._ I' m% '' n J ? ❑City 1 or 2 Family Dwelling - Number of Bedrooms 3 ❑Village ❑ Public/Commercial - Des cribe Use JfTownship - ❑ State Owned 1 1 q R(-A0( fit// G t �C � �/ �µ 9 1, - 6 Neatest Road M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A For County use 1 R New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to System Tank Onl Exis ' stem � B. ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that a ring scheme is for internal use) 44 El Non - Pressurized In- Ground 1� Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 Holding Tank 48 ❑Single Pass 51 ❑Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. D' rsal/'IYeatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) Elevation q5'o �D 60 P T E �/ 2 ✓ iV!,f 00 40.6 3 VI. Tank Info Capacity in Total Number Manufacturer pp Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks ��� !I Z� ?7' �7� Y Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank DO 000 Dosing Chamber VII. Responsibility Statement- I, the un ed, assume responsibility for installation WTS shown on the attached plans. Plumber's Name (Print) PI 's Signature MP Number Business Phone Number TT is .S _ Plumber's Address (Street, City, State, Zip Code) /�, � Y O ` 5 6 2 � VIII. ount /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Da Issued i ature Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse ✓ ) °? / vim Determination f Q IX. Codr�t Approval/Reasons fo oval pft` - ` Z Att6ff complete plans (to the County only) or the system on paper not ess than Sl x 11 inches in size 0 3 /�Q v2t�6ar. vG =�stvn ax / �"` u// 6wi /+i J�3• - SBD -6398 (R. 05101) T N E N 6 NLAAJS Z- o7 ' - -- i i ©A ' „ = qo - Zk. ` W OUL 4 t I PRo Pry's e p - 3 g�OBoom 1, Hous q 8,� /Ooo 6 A L S. - q 8 x Z Z•8 Z -- � c m eu N.n 20 /00 oe'cE M Itj - ' -- v� b'"- 8 n1 1 z"o-P o 3�� Piv C P�P� �[. / " Pc 4 a vc Ape S6 06. � rn . �� - 'T P o �= ' 3 lY � ' - cou o!uk c lNIC c. y7. 0o _--- -- : i ! I 1 ! i Jpff .5cfFN1r�T GkA D P90 P ER T iES ' - - N ` - -- 7/ a R,� i It o sr, s4, rc- - /oa - i ! /(, l -- A - .SSO rf/ om t ET_ i wl -qa .� S7 _ - 141 PR-s Ad-3760 ! - loL TN E /4)'691-4/us /-o7 6 - L IO , i oc - CA 3 8�D200 14C � .Bma -Z CONTOUR LiAig ho S . Ir lOoo GAL s- em I - _- 00 R g�� F110"E R gZ•88 x , h1euN _ La or 3 Y Q V c P� P� L. X00.40 - - e)m 0o ' f : i couT oiLtP L iNlc_I G. X 17 00 —' — i l.W i- ���N -- -- _ ott�J ! r'T i R �� ASE Z/ � �v��d sr� 'S4� rr .ion i - -_: ; l� oT�r iht�2SET 1/il �' <SLfo S - i ! Som teSET - 141 Pr-s A d-3760 i j Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TD #: (608) 264 -8777 erc isconsin www w ww.commerce.state.wi.us/sb ons .wisonsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary September 06, 2002 CUST ID No.223760 ATTN: POWTS Inspector JOHN F SCHMITT ZONING OFFICE SCHMITT & SONS EXCAVATING ST CROIX COUNTY SPIA 616 150TH AVE 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/06/2004 Identification Numbers Transaction ID No. 784348 SITE: Site ID No. 649687 Grand Properties / Mike Germain Please refer to both identification numbers, 170th Avenue above, in all correspondence with the agenc Town of Somerset St Croix County SE1 /4, NE1 /4, S12, T30N, R19W Subdivision: The Highlands - lot 6 FOR: Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 868164 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19 Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. P.O.W.T.S. Conditionally APPROVED n..oecTU►cuT M PnUUr-0P9 e JOHN F SCHMITT Page 2 9/6/02 Owner Responsibilities Continued: • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633 j swim @commerce. state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 RECEIVED ScHmI s E vATING AUG 1 9 2002 Soemem -4 WI 54025 715- 549 -6651 SAFETY & BLOGS 01V4 MEND SYSTEM For: r Rn p � RaP E,2 TiFS f�� h E �t,�l�p�nl Address: P? W q-2 0 57' S U /T,E goo S om CP2s 6 r Legal: Township-- tV 15e !5,6:7 - County: -57 CP O) k C Page 1 Plot Plan Page 2 System Cross Section Page 3 Pipe Lateral Layout Page 4 Dosing Chamber Page S Pump Curve Page 6 Management Plan Attachment I Soil Evaluation Report Attachment 2 V 0 N' Mound Component Manual (Version 2.0) SBD -10691 P(N. 01101) Pressure Distribution Component Manual (Version 2.0) SBD - 10706 -P(N 01 /01) By: MPRSW a - 3 7 6 o Date: S / 3 O a DIVISiQNOf Af ETY ND BUILDINGS SEE CORRESPUNIENCE Page 3. Cf .� t Straw, Marsh Hay, Or Synthetic Covering A$TM C33 Distribut Pipe Medium $end 6 Topsoil , a E R sy sixv.q 3 ? .�a % Slope Bed Of !fi a Force Main Plowed Aggregate foyer t 61 , Below PIP*) �� ii�- Cross Section Of A Mound System Using E • (o Ft. A Bed For The Absorpt Ar ea F ° Ft. Q _ Ft. A (p Ft. H 1_ 0 Ft. Signed: 8 Ft. ` license "Um 3 ...�... K � q Rt . r : � -�3 _o t �SFt. Da to : , r��.r. a 3 Ft. Alternate Position T !� 3�Ft. of --- Wa S3 Ft. Force !Main ��► rr L ' 1l6 To 1t10 S "mod of de0 K 6 rm .g. ,,,,, •.� �.. •.nr. �� �r r: �r �� F — — r....r .rr.rw.rrrrr..urr....r♦ r•�. �r r..�r rrr •�• � A Force Main •• rr..rrrrrrrr+rrMrrro rrr� t••' rrr r..�r�r.w r.arr.. rr �� �r� r �r rrr w. Distribution Bad Of 2 P Aggregate Permanent Markers Observation Pipe . 110 To 1H011 Front 6td of Bed Plan V1ew 0 f Mound Utzina A Bed For The Absorption Area P4&e .j o r Turn-up with Cleanout Acoesa Bqx Plug or GO Valve �--..► PVC Force Main E -- pVC Distribution Lateral •s i fold .� P X x x l X12 Distribution Lateral Layout p — .5:Ft. . 3 x I nchom Hole Diameter �/ Inch Signed: Lateral " �, �, t, Inch(es) License ri ber : a a 3 o Manifold " `/a Inch Force Ma 1 n " _a Inches Hate: # of holes /pipe Invert Elevation of Laterals'. PA6 pUMp CKp M?,e..R CROSS SEC ?OsJ A 10 SPCCIF'►CAT►OA.'S ' VC WT CAP '1 "C. Z. VCIJT' I►JPC CATlitlt PROD/ APPROVED LOCKING W PkAFIHIOL.0 COVRR { .IuMCT1014 BOX ./INU(�W I,JN / It4t;ll 41•'Mi� /• t Alu iki TAKC { t GRADC I 4 MIN. %r IlY .A1. cowouIT — r -.ror le•MJu. ��`$ . PROVIDE JULET —.�.. AIRTte.A47 WAL f t APPIlOVEO JA4t1'f / A 1 4 w1 c. . ri tig JI)IWZi s:KTCAlau6 a' t ALARM E 3 0 auYO %0419 %OIL. T I ONTO AMA lieu. � � I j/ ON LLCk ,. 7 +. OFF 0 COwCKETE BLULII (r 1 AMCK CJIIT FCKMITTCG WJLy IF TANK MAUUFACTURCR HAS SUCH APPADVA6 3 "J1PPA�YJ10 SEPTIC SPECii= S 0059 ZAN" N►AUU�wcrua�r�: eE K Wur+�cJr OF aoscs: �tR 1 TANK LIZ1C GALLOWS 0049 VOLiJMC &A-FA MMIumcrupmR �'�'PTi2oN�C T�- UK 7'f Is+cLUOluc. oACKr4ow: g ��, �r�«owt AONCL MUTA I1CR: m — CAPACITICS. A luclic! CIA...,. 3 �Wi.LONJI swiTCM' rope:.. ru..�.�._... Sa a,lucliEs<on . %%Lou$ L MP Ahmurm-TURCR: Z© e• L G !2 C ■ _..,� ►uCNCs OR � � � � ,• � / � � : 646cu1 ^00CL WulAstitt �.3 I) s - 1W."ES Olt 6ALLOWC SWITC T11PC: . elz c WJ.X_� PUMP ^NO ALARM ARE TO OL MWIFUM DISC) ARGC RA r /M ssNSTAs.L�rG 0 � CIRLU VERTICAL OIPFEJlEM& bCTWEE1J PUMP OFF AUD.D►STRIpUTION PIPC.. —w— FEC r � 9P t MloilO N4 ' WETWORA SUPM PILC14SiUILC .... ..... 3 ...D s- IMET /00 + FC E T OF FORC9 MAIM X 1 r o FtF K1c (lam fALTO01 3 •a y T TOTAL DISNAMIC HEAD F I#ITF -RUA4 DIMLWSil7 Qt OF TAWK: LENC l'K —...,WIDTH --..; LlQulo OEPY M �,+......:�.,.,., siawco: LiCEUSE WUMISCit; -�?� _ D�►`fC: �.�..�o( • .. . r ■ ■ld�t� i�� �imems® 0 ti © © ® . _® \E\■■ ■ NEMESES ■MEN IM ■VENEEME ■ ■■ME ■E MIREVEMEEMEMEME ORM■ME MEMEMEME 70— EMEEMEEMEM ■ \ ■ \I\ \ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ . \1� \Ili\ \��E ■ ■ ■MMME 1 \11■ I■\ ■EMM■■ ' R i m RENNES \� ■ \`� 1111\ MM\\\SEMME■ ■ . `E19V IEEE LINES ■■ M\MEM\' !E■ \M■ \ MEMEM EMME MEMEWMEME ■MMUN I■ I \M\MMEMER 0 MENUMMEE ■ ■■ ■SEEM■ . .........:............. :. .. •. . •.. :. .. .. . Wisconsin Department of, Commerce SOIL EVALUATION REPORT Page of 3 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 -S t include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 0 32 - percent slope, scale or dimensions, north arrow, and location and distance to nearest road. yp� Please print all information. ew by Date l Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner I Property Location ►'C' a. r� S A c Govt. Lot 5 1/4 ,U I S Z T N R 19 E (or)(g Property Owner's Mailing Address Lot # I Block # I Subd. Name or CSM# S iV � e -c- 4 r- � 1 4dS City State Zip Code Phone Number ❑ City ❑ Village S Town Nearest Road ® New Construction Use: Residential / Number of bedrooms 3 - y Code derived design flow raft�`Z? T? GPD ❑ Replacement // ❑ Public or commercial - Describe: AL Parent material 1`m Flood Plain elevation if applicable General comments $y vVi G (,.Q, U , 951, U o and recommendations: n;r C0A -6in" 2t-e d% g7,00 ti All loos ox- 4A'�d fv F Boring # ❑ Boring Ldjw ,30 / ox ® pit Ground surface elev. 70 ft. Depth to limiting factor Z S ``: Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft i n. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 zs -3o 0 2 L-FS r —1, Ir— y 6 a Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor Z (P in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o- 3/E S,' Zrrtub G - 5 ✓ 1 -5 Z 9 - -4- /a wl.'r CS c ' 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) Signature / CST Number Address Date Eva ua ion Conducted Telephone Number -So - rte!_ s ozs /�` 30 -o/ /-57)z-1:; SBD -8330 (R07 /00) l r � Property Owner y Parcel ID # O Page z of ^' 1 -31 Boring # Boring ?, ® pit Ground surface elev. ' `e ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 I L -it 1 6 , lr3lZ- S,'/ zwvb6 W 4� S Ll — 2 I I-ZS l `�i`/ S L/ Zm.56 I r c 5 C- Z p 7. .s i / L �'S 1 s1 N'�� — F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. SAiI Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 F I I F-1 Boring # [] ❑ Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L 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. SBD -8330 (R.07 100) PAGE 3 OF � NAME LOT# LEGAL DESCRIPTION SF X0 X . S fZ T 30 ,N,R, Z `f E(o� SCALE: I"= � I BM 1 ELEVATION BM 1 DESCRIPTION Svc, fJ1 4z i + BM 2 ELEVATION AU • 0 BM 2 DESCRIPTION 4c9 a� - " p ���e_ C ' Z SYSTEM ELEVATION 4 j$, O U ALTERNATE ELEVATION A1 1 , 14 CONTOUR ELEVATION ( 77,60 v .o° � Z- 8 n'l l � • 6 C� ur q �. y SIGNATURE DATE N! '" Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 Visconsin www.commerc .wis ons Department of Commerce _ _,_� ._..�� www•wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary September 06, 2002 CUST ID No.223760 ATTN: POWTS Inspector JOHN F SCHMITT ZONING OFFICE SCHMITT & SONS EXCAVATING ST CROIX COUNTY SPIA 616 150TH AVE 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/06/2004 Identification Numbers Transaction ID No. 784348 SITE: Site ID No. 649687 Grand Properties / Mike Germain Please refer to both identification 170th Avenue numbers, above, in all Town of Somerset correspondence with the agency. St Croix County SE1 /4, NE1 /4, S12, T30N, R19W Subdivision: The Highlands - lot 6 FOR: Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 868164 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. i JOHN F SCHMITT Page 2 9/6/02 • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. Owner Responsibilities Continued: • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101. 12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Gerard M. Swim Balance Due $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim @commerce.state.wi.us WiSMART code: 7633 cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 �. POWTS OWNER'S MANUAL & MANAGEMENT PLAN page G of FILE INFORMATION SYSTEM SPECIFICATIONS I Septic Tank Capacity l G` al ❑ NA Owner ! 11 QAl /N Septic Tank Manufacturer w e6 C ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Zq.d,CL ❑ NA Number of Bedrooms :3 [3 NA Effluent Filter Model — /00 ❑ NA Number of Commercial Units g NA, Pump Tank Capacity ga l ❑ NA Estimated flow (average) 0 O gal/day Pump Tank Manufacturer EE iC O NA Design flow (peak). (Estimated x 1.5) 5� aVd Pump Manufacturer a Le O NA I S Sop Pump Model l3 O NA Application Rate � aVda /ft Month average' Pretreatment Unit _ @tNA InfluentlEffluent Quality p Sand/Gravel Filter ❑ Peat Filter Fats, Oil & Grease (FOG) 530 mg/L O Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD 5220 mg/L ❑ Disinfection ❑ Other. Total Suspended Solids (TSS) 5150 mg/L Manufacturer Pretreated Effluent Quality M NA Monthly average" Dispersal Cell(s) .❑ In (pressurized ) Biochemical Oxygen Demand (BOD :530 mg/L ❑ In -ground (gravity) In-ground Total Suspended Solids (TSS) 5 ❑ At -grade t% Mound 30 mg/L ❑Other. Fecal Coliform (geometric mean) 510 cfu/100ml ❑ Drip-line Maximum Effluent Particle Size Y Inch diameter Values typical for dornesfic (non - commercial) wastewater and septic tank effluent. •+ Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Frequency Service Event Inspect condition of tank(s) At least once every 3 ❑ months OJyear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume Inspect dispersal cell(s) At least once every ❑ months ® year(s) (Maximum 3 yrs.) Clean effluent filter �S r��� least once every ❑ months . [3 years) Inspect pump, pump controls & alarm At least once every 1 ❑ months dFyear(s) ❑ NA Flush laterals and pressure test At least once every ❑ months Gcyear(s) ❑ NA Oftr. At least once every ❑ months ❑ year(s) ❑ NA other. At least once every ❑ months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS n one of the following licenses or Inspections of tanks and dispersal cells shall be made by an Individual carryi or, POWTS Maintainer, Septage certifications: Master Plumber; Master Plumber Restricted Sewer, POWTS Inspect Servicing Operator. 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 to 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 tank equals one -third (Y) 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 ch. NR 113, Wisconsin Administrative Code. retreat ment components, and any The servicing of effluent filters, mechanical or pressurized POWTS components, p other maintenance or monitoring at intervals of 12 months or less 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 STARTUP AND OPERATION For new construction, prior to use of the POWTS heck treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the 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 pp shall not occur when soil'conditions are frozen at the infiltrative surface. Pa ge of -During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal call(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of eff1pent To avoid this situation have the contents of the pump tank removed by a j Septage Servicing Operator prior Wrlestoring 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 soli 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; diaper;; disinfectants; fat; foundation diain'(sump pump) water; fruit and vegetable peelings; gasoline; grease;: herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener trine. ABANDONMIMENT When the POWTS falls and/or Is permanently. taken out of service the following steps shall the taken to Insure that the system Is properly and safely abandoned In compliance with ch. 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 faits 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. IP 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. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Tpom SCl4inrn Name QWsJ6PS C14 0f(6 Phone 7�5 _ S y9 —� 6 J Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name O W tJ & 8 3 C Aoe-O lC E Agency 5T Cao l COu AfrV Z oaf�N 6 Phone Phone 71,5 3 9 " y6a 80 This document was drafted by the staffs of the CCt w Laka. Marquette and Waushara County Zoning and sanitation agencies. This document meets the minimum requirements of ch. Comm 8322(2)(bX1)(d),(r) and 83.54(1), (2) d. (3), Wisconsin Adminlstradva Code. Use of this document does not guarantee the perforrnanoe of the POWTS. GMW ( 1) ST CROIX COUNTY SEPTIC "TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerfBuyer 6Rf�, fl Mailing Address 2) R\yaROD <:fR_ Sar 100 36MRL� (_\v I � - Property Address g 9 (Verification required from Planning Department for new construction) 0 3.z - 0 y y- is -000 City /State Snn STT Parcel Identification Number A 03,1 - 460 -. LEGAL DESCRIPTION Property Location .5t ! /4, ' 4, Sec. , T,70 N -R_/ W, Town of _'QI1n tf Se I Subdivision Certified Survey Map # , Volume , Page # `Warranty Deed # C ��?� s ,2 Volume , Page t+ Spec house yes ❑ no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the syster can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the t ree year expt (ion date. `7 dUl - dZ S NATURE y APPLICANT DATIi OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) ant (are) the owner(s) of the pro rty descri ed above, by virtue of a % deed recorded in Register of Deeds Office. // /0z' 8IdNATURE OF APPLICANT DATE « * « * ** Any information that is nits- represented may result in the sanitary permit being revoked by the Zoning Department. •* Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 07/11/02 TKU 14:24 FAX 713 083 4887 REGISTER 9F DEEDS Q002 I 'i STATE BAR OF WISCONSIN FORM 2 - 1698 1 t6839Z5 z WARRANTY DEED XAT131.Eu H. VALSH `ER b j ST CO., VII Doctanwnt Number R8C&IYSD Fit RECORD t This Deed, made between 07 -11 -2802 2x15 PH �j ]RIC - • s wnrirw a,ttrtr A T 1 c TOUT - Ij WWA NE Grantor, _... REC FEE t 11.8® � I and GRAN - RWRERTIES, T R ji COPT S�j 182.38 i __...... .__ CERT COPY FEEL Grantee. PAGES: 1 ' Grantor, for a valuable consideration, conveys and warrants to Grtrae the following dascri�eal e` to in St C roix County, State of Wisconsin: I� Lot 6, lat of The highlands, Town of ��,R`"° nlnv,aw Berner t, St. Croix County, Wiscongin• jr�i fC2. !�l ii 032- 2044 -10 -000 �� Fseal tdenaneatton Number N) !, i� ' This j az ++^+ homestead properly. I i ' (18) (a not) li r 'I r� li i 1 t I I II I . li ; I li Exceptions to warranties: casements, restrictions, rights - of -W and covenants 1, i {, of record, 'I Dated this ., ._ day of ____�Z• 1 1 i-h „Ja +T }r li , ' I I (SAL) j +_Ri chard 0. Stout r + Janet P. S tout I _ (SEAL) (SEAL) S t iI AUTHENTICATION ACKNOWLEDGMENT j ' Statue of Wisconsin, I i! Rt_ Crni x authenticated this day of Pantonally came More me this 1 1 th day of tf3L}f . the above named ;i Janet. MEMBER i ji T1TLL: STATE BAR OF WISCONSIlV ;j of (104 me known to be the person -&— who executed the foregoing 'I +iA instrument and acknowledge tht same. authorized by 5708.03. Wis. Stara.) , I� ;I THIS INSTRUMENT WAS GRAFTED BY :i Janet. P. stout �� 4 it 1353 n wat l ke 5AU16 NoteryPubltc,S Hudson, W ate of W censor j+ My commission is permanent. (If nn J gI, s y expiration datz j ! (Signinu es may be authenticated or acknowledged. Bath ate not i ry) i MC0.�Sa ....- , Names of pmwn *VIna in any cop+a!aY mum b• typed w prtnud bvl w dwb ataMCure I j 1 1 STATE BAR OF WISCONSW w""n taw awes Co., Inc. I, �� WARRANTY DUD FORM Na, 2 - toga W+wa'I'r• W'. j, Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. d 32 - 2-4V11 —/O percent slope, scale or dimensions, north arrow, and location and distance to nearest road. — ya —zx�o Please print all information. rew " by Date Personal inforrnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner I Property Location r Q rA S J4 Govt. Lot 5 114,V la1 /4 S T e N R cL E ( or)(g Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# S � e -e_ r h City State Zip Code Phone Number ❑ City ❑ Vi llage 0 Town Nearest Road ® New Construction Use: Residential / Number of bedrooms 3 _ y Code derived design flow faf� GPD ❑ Replacement ❑ Public or commercial - Describe: `' ` Parent material Flood Plain elevation if applir,3ble General comments $or c vVl G ( u U' 0 0 and recommendations: Ca Y��o u r et e J. qT0 Alt Y4 L v %- . X,44 �Wa'4- Boring # F I ❑ Boring le,��yu 38 � • . � `• ® pit Ground surface elev. • 70 ft. Depth to limiting factor _ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 O-f D oy r Z S' Zwlabt'C W V+ • - 5 - ' 9 - ef, /o '- , c ( Z v►� Sit r- c S _ i_57/ 0 Z •s . L-FS 1 m.5,6 lc a Boring # ❑ Boring G EA pit Ground surface ewv. ft. Depth to limiting factor 2 (y in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z - / • ins war ' 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) Signature CST Number -'�c -e z s o Address Date Eva ua on Conducted Telephone Number z !/3 o7611 SoWLQ C.,/ I- s -/ 0'- S /4' 3a - o t KOZ /7 -f2�FO SBD -8330 (R07 /00) i Property Owner s� y Parcel ID # LO� Page of_� F31 Boring # Boring Boring � .S ® Pit Ground surface elev. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2 C.S rl 1,5 -a 1 :4 ,-V111 111 - Zmsb /c I r C5 ❑ Boring # Boring pit Ground surface elev. ft Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2 Boring # Boring pit Ground surface elev. ft Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 - Eff#2 ` Effluent #1 = BOD > 30 < 220 mg/l- and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L 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. SOD-030 (X07/00) Y r PAGE 3 OF NAME 5i6Q t- LOT# (, LEGAL DESCRIPTION SF X tiE 1 4,S f T '56 ,LI,R, Z 4 E(ol6ip SCALE: I"= y0 I BM I ELEVATION /0Q . 0 BM I DESCRIPTION - eve BM 2 ELEVATION /,OCR • U BM 2 DESCRIPTION , loQ OX : 4 SYSTEM ELEVATION Ta l O U ALTERNATE ELEVATION A1 ,1 14 CONTOUR ELEVATION 1 7 7- 00 a loo Tr3 L1 a . 2. �n Z SR'►� ,� r � , b d ur SIGNATURE DATE