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032-2177-11-000
Parcel #: 032 - 2177 -11 -000 03/24/2005 03:24 PM PAGE 1 OF 1 Alt. Parcel #: 11.31.19.1515 032 - TOWN OF SOMERSET Current X! ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 07101/2004 00 0 Tax Address: Owner(s): ' = Current Owner " RICHARD L PLOURDE PLOURDE, RICHARD L 624 220TH AVE SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 640 222ND AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 3.560 Plat: 10 /13- HIDDEN HILLS 032/04 4/15 SEC 11 T31N R19W PT NE SW HIDDEN HILLS Block/Condo Bldg: LOT 11 04 LOT 11 (3.56AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 11- 31N -19W NE SW Notes: Parcel History: Date Doc # Vol /Page Type 07/01/2004 767565 10/13 PLAT 12/31/2003 750406 2483/200 EZ -U 09/03/2003 738643 2398/532 EZ -1 1209/341 TD more 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 02/25/2005 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ,onsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ;ety and Building Division INSPECTION REPORT Sanitary Permit No: a 463001 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: Strobeen, Ray Somerset Township / " CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: T CST BM Elev: Insp. BM Elev: f�'�j lCt� tea C'� 11.31.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �JJ '' Benchmark �. �,� -- / Z�z3 7.75 ip'7�°1� fae Dosing � Alt. BM Aeration 7 ^ Bldg. Sewer Z 1 Holding St/Ht Inlet -- 4,61 97- Iq . St/Ht Outlet TANK SETBACK INFORMATION 11 � TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7/M A n i ! Dt Bottom ht' 3a �y. X13 3 Dosing - 7/60 AJ IT' 1 1 Header /Man. I Z ZS 15, Aeration J Dist. Pipe lz.zs 95 1 5 Holding Bot. System 13 Z-5 Final Grade C17 C PUMP /SIPHON INFORMATION , V 6 . 6 j Manufacturer za r1 11 GPM Dema St Cover 5 . 7 )�Z �j Model Number TDH Li$ Friction Loss System ead I T 7 6 Ft Forcemain Length , Dia. Dist. to Well (Do Z SOIL ABSORPTION SYSTEM ength No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth BEDITRENCH Width L DIMENSIONS �; SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR r✓\C�t' �f c)tL Type Of System: `' / J� . Ifl UNIT G bfhV CV/_� ® � 7 !VA- Aunt Model Number; DISTRIBUTION SYSTEM cL 1 4 T�� Header /Manifold P Distribution x Hole Size x Hole Spacing Vent;to AV Intake Pipe(s) Length �+� Dia Length \ Dia Spaci SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only , a`5 Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center /' Bed/Trench Edges Topsoil Yes [N No es � No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / 1 Inspection #2: / / Location: 640 222nd Avenue Somerset, WI 54025 (NE 1/4 SW 1/4 11 T31 R19 ) Hid en Hills Lot 11 Parcel No: 11.31.19. 1 .) Alt BM Description = ���� " �' ��""�5LCG'� fib- QA Bldg sewer length = — 3o 5� . Go J� 1I5 amount of cover = 1+Z 'ision Required? I ] Yes o r side for additional information. ' ._ Date Insepct s Signa r Cert. No. `.3/97) 4UdU ST LKA (:U LUPIl1VV LVj uu fety and Buildings Division County t �,� f 201 W. Washington Ave-, P.O, Box 7162 �j Madison, WI 53707 - 7162 Sanitary Perm k Numbs (to be fdkd in by Co.) (608) 266-3151 7 00 Dep artment of Commerce Sanitary Permit Application Sate Plan J.D. Number in stead with Comm 83.21, Wis. Aden. Code, personal information you provide maybe used fa aWndaly purposes privacy Dew, 315.04(1 Xm) Project Addre 6 y if diffarart than co ?Z_ 2_- ` L. Application Information - Please Print All Information Pro wner's Narmx PSI +I Lot x Block M 14PP A Pro O ^ is Mailing Address Propeety Loetien /Sn e ���L" ` y., S� Y+, Section City. State Z ip Code Ph tine Number IL Type of Building (check all that apply) u 'vi Name CSM Number I or 2 Family Dwelling - Number of Btelroans L'` C ❑ PublWCommacial - Describe Use � J ❑City DYillage Ys" ownship of ❑ Starr: Owned - Dcm use AA dt r LiI. Type of Permit: (Check only one bar en line A. C omplde line 0 R ttpplieAbie) A. New S�,tern ❑ Repiacemmmt Syflxm ❑ Tr atmpmwolding Tank Repintenteiu Only ❑ Other Modification to Existing Sysran List Previous Permit Number and DU E Issued B. ❑ Permit Rawal ❑ Permh Revision ❑ Che V of ❑ Permit Transfer to New nm EL-Fort Fxpirstii Plumber Owner IV. Tyjx of POW S stein ' Leek that a Non - ?=urued Its -Gw% and ❑ Mound > 24 in. of sttirabk soil ❑ Mound < 24 hen. of sukWc soil ❑ Atddade ❑ Sing)* Psse Sand Fists' ❑ Corsertvcted wetland ❑ pmoutiaed wourotmd ❑ Roldilte Tank ❑ Peat F1ker ❑ Aaobie Treatment Unit ❑ Rocitrsaladng Sand t 111er ❑ Reeinulatinrg Synthetic Medi F1tter V 1 2 ingamb-w Q Dri Line ❑gavel -kss P' ❑ Otltex ) V. A er=VTrv*tenmt Area Iafortaa ' Design Flow (gpd Design Soil Application te(gpd3t) Dispersal Area Roqutmd (SO pispaset Ara Proposed (af) yaw Fa°v° r � VI. Tank Info pat ley in Total Number Man utacturar prefab Site Sled Fiber Plastic erallons Total of Units Concrete • Constructed Glass New ne Ta Tanks T tent ' NOI g AaGb Ttatmnew U [?esi Vli. Rees nslbi[' Statstneot- 1, the arrd asstttue r iratanatiaa of qte PgVY[S s6awu ea ttte arched plaits. Plumber's Name (print) P! •s iga,otu RS Number B usiness Phone Numbs ym Pium s Add s (Street, City,! ip ) Vill. Count /D artment Use 00 ❑ L)isaPProYlA Sanitary Pamir Fee inc ludes GrourmdH+atcr Date Issued AEglt Sig e o Stamps) ,Approved r 9usetmrpe Pat) 03 , ` \..� ❑ Owner Civer► Rewoem far Denial UL Canditions of Approval/Rasons for Disapproval SYSTEM QWNER: 1 Septic Unk, effluent hiker and dispersal cell must all 2 S r a* Per mattrpeme p1 2. All oftapk require �ed!>> Ibaintain ) & i as per applicable co�anG10. ,� Al�Chewt +reeetsl..s(uttoC.attT«mtr} a /�� awersparaaesealQ,awslll� .. t//i �`r "'\ SBD -634$ M 01/03) Vi cam 11 Crow C0UWV 1101140MOCHAEL ROAD r lL, ofJ,kR 4. ` , HL06%; VVISCONOW WS _if ,_ Cbn S erl a i i r y 0 KEN SCHMITZ INC. Septic Systems Design & Installed / MPRS /CSTM 224173 6� P.O. Box 160 SHELL LAKE, WI 54871 ", eex (715) 468 -2434 r , ( c ME wla C 4'2 #4o4w 1P /F 'me 5� �5 t 9 4 0 No °2 c- �plo C OPY AAx JUe Tlq � �h • �� �� �' �I � ' to � ' I� 1� I � I �I KEN SCHMITZ INC. Septic Systems Design & Installed MPRS /CSTM 224173 - P.O. Box 160 SHELL LAKE, WI 54871 O (715) 468 -2434 Private On -Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: Project Name-and System Type: Location: Street A d ss /::�J2 L / Z ZYI - Legal Description �c Township /County Contents: Pagel: Page 2: Page 3: 6�� Page 4:. Page 5: ./ �i�/1A ��< ///tt°� ��AA Page 6: Page 7: ��oss P�- /���d` Page 8: Page 9: Attachments: Plumber/Designer: �I �G4V7 i �Z Signed: i Credential Number: Date: { I` 'I I KEN SCHMITZ INC. Septic Systems Design & Installed A- MPRS /CSTM 224173 P.O. Box 160 c SHELL LAKE, WI 54871 .Q h Pe-ic (715) 468 -2434 ter/ l rU Ak% r- No °-7r He o 417 I T01) WW(MMM Qepartmont of CoMMWce SOIL EVALUATION REPORT Page of Division of Safety and Buildings In soomdenos with Comm 85, Wis. Adm. Code Attach complete site plan on psper 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. Reviewed by Date Personal information you provide maybe used for secondary purposes (Privacy Low,*. 15.04 (1) (m)). Property 0 Property Location Govt. Lot 1/4 S T N R (or& Property is Mailing Lot # Block # Subd. Na or-G" city Stat ZJp Code Phone Number ❑ City ❑ Village _g Town Nearest Road New Construdlon Use;ffResidential / Number of bedrooms Code derived desi n flow rate _ GPD ❑ Replacement !! ❑ Public or Commercial - Describe: � .. Parent material F} /rt, pit sue/ Flood Plain elevation if placable ft. Gememl comments and on,: S�E.�f,C yes APR 16 2004 t ST. CROIXCOUNT' a ZONINGOFFICE Boring # _ ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Mtmseli Qu. Sz. Co nit. Color Gr. Sz. Sh. •Eff #1 •Eff#2 7 eorlrg # I ❑ Bor1n0 Y3 Pit Ground surface elev. 1,rS. J3 ft. Depth to limiting factor r//5 In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. t. Color Gr. z. Sh, 'Eff#1 •Eff#2 zz 7 4 4 • E#jent #1 ■ SOD > 30 S 220 ng1L and TSS 40 < 150 nV = 800 . : 5 30 mp/L and TSS < 30 ngtL CST j. Signatu CST tVtxriber 3 'Vore / ' Oate Evaluatbn Conducted Telephone Ntxnber 'R� X le t Property Owner Parcel 10 # Page of D Boring # ❑ Boring ® Pit Ground surface elev. ft. Depth to limiting factor >f S_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 S/ , f F-1 Ong C:] Borin ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lica tion 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 F-1 Boring # Boring a ❑ Pit Ground surface elev. ft. Depth to ilmiting factor kt. Soil icatiao Raw Horizon Depth Dominant Color Redox Description. Texture Stricture Consistence Boundary Roots QP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = 8O0, > 30.< 220 nV/L and TSS >30 < 150 rngj • Effluent #2 = SO0 _ 30 m t and TSS 5 30 rnWL 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. sso-aw QLA000l 1 -16 Ole I� y� y° s /` \ 1 D ,� D II II � U k rA Cd G it w � `� ♦ � .'.::..• , - � k Q • \ \ .o. . U CA cis •a NO �: •� W gy p, II II II O N W H � SYSTEM SPECIFICATIONS In- ground Soil Absorption Component Component Manual # Project Name: & '� 409 ,o�e i Distribution Cell Type +� Septic Tank Aggrega on - egate to NAggr p ❑ Min. Septic Tank Vol. Req. 1,2 eq gal. Type of Non - Aggregate Component Septic Tank Volume 57 a ga. Manufacturer 1 /� 2 Manufacturer i L �i',� - /d' Model Effluent Filter ,,pp Manufacturer Number of Bedrooms Model Soil Application Rate (DLR) gpd /ft (Designed Loading Rate) Pump Tank Wastewater Quality Manufacturer GC e Treated ❑ Untreated Volume 5 ' Model Combined wastewater: Number of bedrooms _ Distribution Componen gal /day /bedroom LI4 Distribution B Daily Wastewater Flow (DWF) Hydro er ❑ Oth Clear and graywater only: nufacturer Number of bedro s gal /day /be m2Q Daily W ewater Flow (DWF) _ Cross section of distribution cell(s) Blackwater Number of be ooms gal /day /b oomQ. Daily astewater Flow (DWF) _ Dispersal Area (A egate) T = ft (D PLR) Dispersal Area (Non -A egate) . EISA Rating ..ft System sizing = DWF + DLR i EISA ( _ � + chambers PWF) PLR) Diverter valve ❑yes 91no Manufacture i POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner kPl�l Tank Manufacturer `lu f e& 7` ❑ NA Permit i I Septic ❑ Dose ❑ Holding Vol. 112 .50 gal DESIGN PARAMETERS Tank Manufacturer Cl t 17 ❑ NA Number of Bedrooms ❑ NA ❑ Septic P6 Dose ❑ Holding Vol. — 1S gal Number of Public Facility Units NA Effluent Filter Manufacturer �j+f,�r ❑ NA Estimated (average) flow g al/day Effluent Filter Model / eI Design (peak) flow = (Estimated x 1.5) �L� © g al/day Pump Manufacturer ��j,E ~ L1°� ❑ NA In Situ Soil Application Rate , �p al /da M4 Pump Model 3 Standard Influent/Effluent Quality Monthly average' Pretreatment Unit NA Fats, Oil & Grease (FOG) s30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Manufacturer Biochemical Oxygen Demand (BOD5) • 530 mg /L Dispersal Cell(s) ❑ NA Total Suspended Solids (TSS) 530 mg /L NA 0 In- Ground (gravity) ❑ In- Ground (pressurized) Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ At -Grade ❑ Mound Maximum Effluent Particle Size X in dia. ❑ NA ❑ Drip -Line ❑ Other. Other: ❑ NA Other: ❑ NA Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) Maximum 3 ears NA Inspect condition of tank(s) At least once every: El ears (Maximum ❑ Pump out contents of tank(s) When combined sludge and scum equals one -third ('h) of tank volume ❑ NA ❑ When the high water alarm is activated At least once eve ❑ month(s) (Maximum 3 years) ❑ NA inspect dispersal ce11(s) ry: years) ❑ month(s) ❑ NA ffl Clean effluent . filter At least once every: y ear (s Li month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: v2 ear(s) ❑ month(s) �NA El laterals and pressure test At least once every: year s) Other: At least once every: p year(s)s) O NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: M as t er Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator (pumper). inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and.scum and a check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one -third ('h) 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 Vith chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be,performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GNM (12/02; START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals that may impede the treatment process and /or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within l 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater Stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products, pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines , and weirs. 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. ❑ 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�� L Phone 6 $ SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name C />� lei;' CD �► �.w Phone Phone This document is in compliance with chapter Comm 83.22(2)(b)(1)(d)8(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. W W 3 15/16 6 5/32 HEAD CAPACITY CURVE 4 1 7/32 5 zs ' - "59 "SERIES 1 1/2 -11 112 NPT 3 15/16 6 0 w 4 1/16 x v 15 + z 4 TOTAL DYNAMIC HEADIFLOW r PER MINUTE EFFLUENT AND DEWATERING CAPACITY o HEAD UNITS/MIN 2 � 5 1.5 43 163 5 10 3.05 34 129 19.25 5.67 0 0 0 10 1/16 U.S. GALLONS 10 20 30 40 50 LITERS 1 1 313/32 80 ts0 0 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Piggyback Variable Level Float Switches • Available with special cord lengths of 15', 25', available. 35' and 50'. • Variable Level long cycle systems •Alarm systems available. available. • Duplex systems available. Standard cord length - automatic 9 ft. Standard cord length - non - automatic 15 ft. SELECTION GUIDE 57159 Series Control Sele l0 1. Integral float operated 2 pole mechanical switch, no external control required. Model volts -Ph Mode AM D$ - simplex Duplex 2. Single piggyback wide angle variable level float switch or double piggyback variable M57/59 115 1 Auto 8.0 1 or 1 & 7 _ level float switch. Refer to FM0447. 3. Mechanical alternator 10 -0072 or 10 -0075. 4. See FM0712 for correct model of Electrical Alternator "E -Pak ". E57/59 230 1 Non 4.0 2 or 2 & 6 3 or 4 & 5 5. Variable level control switch 10 -0225 used as .a control activator, with "E -Pak' duplex (3) or (4) float system. No molded plug 6. Four (4) hole "J -Pak', junction box, for watertight connection or wired -in simplex or 2 pump operation, 10.0002. 57 Series - Wt. 27 - .3 H.P. 59 Series - Wt. 30 -.3 H.P. 7. Two (2) hole "J - Pak ", for watertight connection or splice, 10 - 0003. CAUTION For information on additional Zoeller products refer to catalog on Combination starter, All Installation of controls, protection devices and wiring should be done by a qualified FM0514; Piggyback Variable Level Float Switches, FMO477: Electrical Alternator, FMO486; licensed electrician. All electrical and safety codes should be followed Including the most MechanicalAltemator, FMD495; Alarm Package, FMO513; and Sump /Sewage Basins, FMO487. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 ® Louisvile, icy 40256-0347 Manufacturers of .. . SHIP 3280 Old Millers Lane Lo F1 � Louisville, KY 40116 QLGlUTY P UMP9 , - /iNC �,S`.1�./ E 79 " ® (502) 778.1731 928 -PUMP FAX (502) 774.3624 IPA ��Ipa i-e Combination Tank Component Cross Section Approved Manhole Covers With Warning Labels and Locking Device / 4" Min. Above Final Grade Weather Proof Junction Box Electric per NEC 300 & COMM. 16.28 WAC I Disco Alternate Outlet Location j W /Approved 4" Sleeve I Inlet ., Approved Force Main Diam. Effluent Filter Baffle < or = to 1/8" Weep Hole or Anti Siphon Device Particle Size A B Pump Off Elev. �, 5 C Tank Mfr, Q &,C D $ Dose Tank Elev. Vertical Difference Between Pump Off and Distribution Pipe = 1 0 1 Minimum Required Supply Pressure ........................ ............ _ �_ FT. of Force Main x j� Friction Factor /100FT. ,.. _ Total Dynamic Head ....... I.......... — Number of Doses ... _ — Lr er Day Gal. Per Day/ #of Doses = al. Volumeof Backflow ..................................... ............................... = Gal. TotalDose Volume ...................................... ............................... Gal. i Pump Tank Capacity �Gallons Dimensions Inches Gallons Pump Tank Volune /ri5,Gal/Inch A Pump Mfr. GL B� Pump Model D �0 Minimum Discharge Rate = GPM '3D Alarm Mfr. S IT /,Pr /10 C Total = Alarm Model J,2/ Bed Tank per COMM. 83.45(5) Anchor Tank as necessary to negate buoyant forces per COMM. 83.43(8)(g). wn V Department of Commeroe SOIL EVALUATION REPORT Page —/— of L`�tb of Safety and Buildirrgs M aoowdMW with Comm 85, Wls. Adm. Code County Attach complete site pan on paper not leas than 81/2 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. Re wed by Date Personal Information you provide may be used for Secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Property Location Govt. Lot 1/t::5 1/4 S T N R (or)ffl Property is Maillng /4ddrgas Lot # Block Subd. oF66M# / 1 City stat p e Phone Number ❑ City ❑ Village Town Nearest Road S - - - _ 7• 0 New Construction Use Residential / Number of bedrooms Code derived des n flow ra Z&2 GPD ❑ Replacement ❑ Public or commercial - Describe: n 1 Parent material � � Flood Plain elevation If pliC I General conments�s toC �/s' APR ? 6 2004 t / ,ST. CROIX COIJNT1 21 ` g ,,,,, ZONING OFFICE FT Pit Ground surface slev. ft. Depth to limiting factor Zll� in. SoA Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Co . Color Gr. Sz. Sh. •Eff#1 •Eff#2 o 36. ro /� � • 1 # IS 0 Pit Ground surface alev. 1-i9A. 15 ft. Depth to limiting factor S r in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' In. Munsell Qu. Sz. Qont. Color Gr. $z. Sh. 'Eff#1 'Eff#2 '4 4 4 R • E t #1 = SIM > 30 220 mglL and TSS , 30 1 160 mglL uent #2 = SOD 1 30 mg/1- and TSS 1 30 mg1L CST Signatu CST Number ss Date Evaluation Conducted Telephone Number Property Owner Parcel 10 # Page of L n 1 1 Boring # ❑ Boring — ® pi Ground surface elev. � � h. Depth to limiting factor >,/� S in. �I Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munseli Qu. Sz. P ont. Color Or. P z. Sh. •Eff#1 •Eff #2 S / 7 9 S — ' F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Str Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr- Sz. Sh. •Eff#1 •Eff#2 Boring # ❑ Boring ❑ Pit Ground surface eiev. ft. Depth to limiting factor In. Soil Application Raw Horizon DWM Dominant Color Redox Description • Textuns Stnxxure Consistence SOUndary Roots Gp Dff in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 •Eff#2 Effluent #1 800, > 30:S 220 mglL and TSS >30 S 150 mg/L • Effluent #2 ■ BOD 130 mgll. and TSS 1 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. S804330 (UM) /91V I i �4 0 Jzz 9� i 08/13;04 FRI 09;07 FAX 715 386 4686 ST CRg CO ZONING W002 ST. CROIX COUNTY SEPTIC TANK MAIN'T'ENANCE AGREEMENT AND 4WNER.SFU CERTIFICATION FORM Owner/Buyer Mailing Address # 6 '/o Property Address 40 P ��5 �U 2 z 2 "� Ave . (Verification required from Planning Department for new construction.) tf R - /40 3/ - 95 City /State %,,, Ag c Parcel Identification Number ,Z,,)32_ LEGAL DESCRIPTION y� Property Location V4 , ui % a , Sec. T �� N R_W, Town of $P / Subdivision r+i /JA Lot #_. Certified Survey Map # Volume — Page # Warranty Deed # - 7 / S 2 , Volume ,M Page # Ll Spec house yes no Lot lines identifiable yes no SYSTEM ENANCE 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 system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St Croix County Sanitary Ordinaneo. The property owner agrees to submit to St. Croix County 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 wastewater disposal 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. Ilwe, 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 systems has been maintained must be completed and returned to the St. Croix County Zoning De t within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the prop ribed abo e, by YkU n i deed recorded in Register of Deeds Office - /S IGNATURE OF APPLICANT DATE *• *'s' * Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Deportment. • *" "` Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified su vcy map if reference is made in the warranty deed. V 2.(o:Y7 P 11 Cp 7? 1 X25 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS j Document Number ST. CROIX CO., WI This Deed, made between Richard Plourde a/k /a Richard L. RECEIVED FOR RECORD Plourde. Grantor, 08/12/2094 10: 35AN and Raymond A. Strohbeen and Cynthia J. Strohbeen, husba an d wife WARRANTY DEED Grantee. EXEMPT if Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.00 the following described real estate in St. Croix County, State of Wisconsin TRAITS FEE: 177.00 if ingre space is needed, please attach addendum): COPY FEE: �Jsconmsiniat of Hidden Hills in the Town of Somerset, St. Croix County, CC FEE . PAGES: 1 Together With Driveway Easement over Lot 12 as shown on the Plat of Hidden Hills. Recording Area Name and Return Address -ta Part of 032 - 1031 -95: 032- 1032 -10 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Excepti ns to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of Aug , 2004 * * Richard Plourde a/k/a R ichard L. Plourde AUTHENTICATION eC —A CKNOWLEDGMENT Signatures) -- ------- • --..- -------------- STATE OF ) — - - -•-•----------•----- County ) authenticated this _ day of h !� `t' _ Personally came before me this day of August 2 _ the above named Richard Plourde a/k/a Richard L. Plourde, s TITLE: MEMBER STATE BAR OF WISCONSIN (If not, _ _ to me known to be the person(s) executed the foregoing authorized by § 706.06, Wis. Stats.) inst tnent and acknowle ed s t THIS INSTRUMENT WAS DRAFTED BY Atto Kristina O gland_ Hudson, W154016 No Public, State f - - -•------- •--- -- - - -- - ---- - •-- --- ----------- ---- • - - - - -- ..---------------- My Commission is permanent. (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 Profcasionais Co., Fond du Lac, W 1 STATE BAR OF WISCONSIN 80)- 655 -2021 WARRANTY DEED FORM No. 2 -1999 H/D D Et (A COUi Located to part of the Northwest Ouarter of Si the Southwest Quarter, and port of the Southwe i1, Townahfp 31 North, Range 19 West, T, j I 60st -8bst 114 /Are VOL. 538. PAC 531 I -- 38833'39£ 1 SB8'33'59 "E 1256.94' -- — ' ' 296.55 474.74 I 485.E 939.5 951.50 I 1. LOT 14 I ' N TOTAL AREA: -j T ff a' " �,OT 12 260, 442 sq. ft. p 4�6 147,622 sq. ft. N 5.98 acres v! LBO acres �' 7.39 acres a � \ \ I LBO a 937.5' o" LBO D� ,gepIOL6Y IroI T, 'zo5 f ...... �I>I`rI o ,- /f 947. Sas71� LBO o I ., I Z � - I 5138 24'11'E 353 28 vile 5 ¢' m cif ,R ,�' LOT lE / 93J. 58 �� n' ^ TOTAL AREA: ry 145,051 Sq. h. I y i QL .es/ A33 acres _/ . - / at/1xrE `N Lill •l'7�"'•••..• LBO 919.8' • jgl/ a r5' i /'' '•• I ` + ^ �•• x" � j� /ts -rte � ' '• 924. 06 Lao = 929 0'., 1 I :' \ - � " � � � \� , f! �,..: �'�• LOT AIlr ' £ TOTAL AREA: r ^N1 o bJ`j C �" +k } ,/ ^�; �+`�,h�l`y • -.._ 267,172 sq. ft. �s5- nor• "�M •�' 6.13 ocres,........1 I A NU =RSaDr t}/t ".L��+.ry LBO 5 h LEGEND \ 1 • �,:.F, Section Corner Monument of Record ��Np� �S ,.• •5'S p Found 1" Iron Pipe •' Fj.\ y' Set 1 -1/4" x 18" Rabor �3 �� \\ / (weighing 4.303 lbs. par linear fool) Bull Setback Llne � \ ' J j " " " " " " " "' (100' from Right of Way, 75 from Navigable Waters) ?> , Proposed Driveway Location _ ss, q IT Utility Easement Lp+s \ —OVA— Ordinary High Water Mork of Navigable Waters \ L.B.O. Minimum Lowest Building Opening (2' above 25 -your High- Water - Level) \ H.W.L. 25 year High Water Line Elevation Drainage Easement Areas 99.99 Benchmark (Top of Iron Pipe) ALL OTHER LOT CORNERS ARE MONUMENTED WITH LINEAR x R IRON UNLESS OTHERWISE 3 LBS. PER ERWISESHOWN- LINEAR FOOT) A special exception use permit Is required for the disturbance of Scopes 80 20% or greater not Identified on the approved plot or CSM. This permit ad -de -s a — Is applied for through the zoning office and Is reviewed through a public (to be ej 4 _ '4 hnorin rocess b the St. Golz Caynt Board of Ad atmen6 sXtOTIJ/an r GRA.. SCALE CURVE TABLE SCALE IN FEET: 1 Neh = +oo. f"' CURVE RADIUS DELTA ARC CHORD CHORD BEARING TANGENT BEARINGS Prepared for and at C5 167.00 37 °33'3 " 109.49 107.54' 8 36"E N 6 °56 3 19°22'40'E NOTES the request of: c6 233. fi 435.89' 375.05' N72 °58'18 "E N 9°22'40"E 53-26'04"E OWNER: LOT2 233. 18346' 178.76' 1441 °56'03 "E Rick Plourde LO 11 233.00 159.27' 156.19' N84 °04' 4 "E ELEVATiD, 624 - 220th Avenue LO 12 233.00 66.22' 66.00' 368° 2'06 "E CONTOUR Somerset, WI 54025 LOT 13 233.00 26.94' 26.93' S56 °44'49 "E BEARING 715- 247 -3162 C7 167. 101.92' 100.35' S70° 5' 7 "E S 2604 °" SECTION 88 °24'11 "E A31� 167. 34.51' 34.45' SS °2 '15 "E THE PAR JOB WI0575D25 233 . 34 °38'07 14 .20' 140.01' 70 °55'07 "W N88 4'1 "W 53 °26'0•+ "W COUNTY I C9 167 107 °11' 6" 312.42 268.81 72 °513' "W N53 °26'04 "W 319°22'40' WETLAND P repared by. 152.76' 150.04' S3 "W 519 '40 "W 356 °56'33 "W PURCHA: �-!/'� 233.00 37 °33'5 " COUNTY I+A J COggul(S�� C10 ADVICE. 15) 246-4319 IN OWNf Phone No. (7 A LEGAL TERkeNUS FOR ALL ! THE WITH NAVIGABLE WATER, HAS BEEN O RDI NA RY N RY HIG FOR ER ARK OF NA AND E 47 INTERFEI Fox No. (715) 2A6 -3830 p�pHICALLV HEREON. IT D 7IiE INTENT HEREON THAT SHOULD 7HE ORDINARY HIGH WATER MARK OF NA VIGABL E WATERS RECEDE COMPREI P.O. Box 325 THAT THE L.OT UNES WOULD EXTEND AS SHOMN. IF THE ORDINARY NIGH WATER MARK RISES THE LOT LINES WOULD ALSO HOLD AS THIS PU New Richmond, WI 54017 THE UNES OF EACH LOT WITH THE ORDINARY HCH WATER MARX BEINC THE TERMINUS OF USABLE LOUD FOR 1HE L. MAR K. IN THE STATE OF WISCONSIN HAS ALL RIDHIS M VIGABLE WATER BELOW THE ORDINARY HIGH WATER MARK. ALL ANY DR, SHEET 2 OF 2 SHEETS agn* NAVIGABLE TER ARE SUBJECT TO THE LMSCON9N THE TRUST NA DOCTRINE. RUNWAY ILL— fey aid Buildings Division County 201 ty, Wailtington Ave., P.O. Box 7162 e� I vis � Mad'tspp, WI 53707 — 7162 Sanhar Pem►it Number (to be ft led in by Co.) (ON) 2664 151 3 00 De artmerit of Commerce Sanitary Permit Application sate P1an,.Q Number In accord with Comm 93.21, Wis. Adm. Code, personal infasmstion You P-Vi44 may be used for sawndwy purpose Privacy Law, s 15.040 Wm) Project /14dresa (if ditfuatt then nailing address) 1. Appilcation Information - Please Print All Idot [nation Pro wner's Name i i Pereel M Lot x Block N Pro 's Maims Addrms f l ti: y Pmp' -Y Location yV 5W /. Section City. State Zip PhoLnFNhtplr( J i.. _ nrcle one Oil' l�l/ /�7� D� T N. R Bar W M Type of Building (cheek all that apply) q vie ame CSM Number 1 or 2 Family Dwelling — Number of Bodrooms �` ❑ PublWComm=W — Desaibc Use or 0 state Owned — Dewn'bc Use OCity OYill� i� sh4 III. Type of Permit: (Check only one box on line A. Cotoplett tide 0 if appiitttble) A ' New System ❑ Repta System ❑ Tnatr MVHolding Tank Replacement Only ❑ Other Modifrcation to Existing Syslan B. l,if[ Previous Permit Number tltrd a Issued 0 Permit Rmcml ❑ Permit Revision 0 ClWV of 0 Psmtit Transfer to New Befom F�cpinttbn Plumber Owner IV. of FO W tS stem: Cheelk a!1 that a pply) Non — Pttuurmed in.Groats ❑ Mot nd ? 24 in. of suitable soii ❑ Mwnd < 24 hL of sukabic soil ❑ A"bv& ❑ Singk Pass Said rdorr ❑ Constructed Wetland 0 Pturiwd bn Ground 0 H AW& Tank ❑ Pest Fika 0 Anal* Treatment Unit 0 Rv*cuiadrig Sand F11W El Recirculating synthetic Media Filter VleaehingChwbcr 0 Drip Line avel -less PBE 0 Ot ) V. A ersaVrrestment Area Infortnutioq: t Area Proposed (sf) yatcm Des ign Flow (gpd) Design soil A icatioo Wgpdst} D totted (sq pespaEe HOC ' Vi. Tank Info Capacity in Total Nwnber M Concrete ConS S t Stad G Piastic Gallons Gallons of Units New . IIa reeks r C go nc NoldarX Taatt � �/ Aerobia rea(Mat Unit _ VII. Resp6asimity Statement 1, odic mdersigned, assttote r insealiatioa of the POVnS shawo ea the attached plans pl bet's Name (Print) Pt •s igtmtu R$ Number Busituace Phone Number Flume's Add (Street, City. State. Zip ) ✓'D /6D `�4 G �� d 7/ YI11. Coact /D artment Use Oa Sanitary Pamnt Fee indes clu Groundwater Date l"ad Agent Sig e o Stamps? X Aouroved ❑ Disapproved suretmrw Pee) 03 ?Op ❑ owner Given Reason for Denial " �- , IX Conditions of ApprovaVReasons for Disapproval 31 �o I�- ty Q, cul� SYSTEM OWNER: l / 1 Septic tank, effluent filter and aJSO S �• l s dispersal cell must all be serviced I maintained 2Sr as per management plan provided by �!t plumb r n 2. All setback requirements must be maintain) as per applicable code /ordinances, M-W-h rwptese plan (N t!s CoaW 4ob) on (acme uet tac than s trAX11 'a Zo SBD -6398 (R. 0 1/03) "M DEPART11111W Cft= 7LKrY OWERIWi ENT R r45 101�CMM1CK ROAD '� C. ,Bunk- -�. _ ..�. ��.�• AL Ilv Vou 4000 01 WtA I'.0 LU1NIiNu g uul and Buildings Division Cmm(y 201 W. Wa9hinjton Ave., P.O. Box 7162 vis cons i n Madhoa, WI 53707 - 7162 San: Pamh Nu era be tilled in by Co.) (60) 266-3151 Department of Commerce Sanitary Fermat Appffcation Sure Plan I. D. ta In accord with Comm 97.21, Win. Adm. Code, personal information you provide may be usod for secondary purposes Privacy law, 05.M() xm) Project Address (if diffesart than mailing address) 1. Application Information - Please Print All Idonnation Pro wner's Name Parcel M Lot a Block N P� s Maim Address Proper radon /yt J �� C e Y., Y., Section City, State Zip Code Phone Number R rek one) T� N; � W IL Type of Building (check all that apply) u 1 or- Family Dwelling - Number of Bedroom$ vivame CSM Number 13 PublWC:otttmaaial - Desaibc Use �t ❑ State Owned - Describe Vsc 00ty ❑-Village grownship of Ill. Type of Permit: (Check only oac box as line A. CoM plete line g It appikollile) A. New S _ ystan ❑ Replaoetsrmst System ❑ TrptmgttAiolding Tank Replscememt Only Other Modification to Existing System B. ❑ Permit Renomil ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New —07— previous Permit Number and Date Issued Before axpiratkb Plumber Owner IV. Type of PQWTS SystcvL, Ebeck sM that a Non - p=,urbme ltt✓Gtoand ❑ Mound 224 in. of wintbk soil 0 Mound < 24 la of sukabl, soil ❑ At -Orsdc ❑ Single Past+ Sand Filter ❑ Coreauaed Wetland ❑ Pr ewunwil ln4anxind ❑ Fielding Tank ❑ Peat Filter 0 Aerobic Trartncne Unit ❑ Rtairmtlatiog sand Flier ❑ Recircutating synttretk Mafia Filter WLMehing Chamber Q I)fip Line 0 QMV40W s Pie ❑ Other V. A er nVTrelttn►ent Area lafv n: Des Flow (gpd) Design Soil A tcatron Dbponal Aron Requited DispalM Area Proposed ( :!) System F,tcvatien �Da / 9 1 7' , VI. Tank Info Capacity in Total Nornber Manufacturer Prciab Site Steel Fiber Plastic Gallons Gallons of units Concrete Constructed Glass Nov Ekirling Teaks t" a Trait Gera - `�• L VII. Ra ttslb[li Statement 1, the assatne r loataltatiaa of rtes pQt9YCd sh.wo ea the amched as. 1 bee Name (Print) PI 's lgnsatt RS Number &U Pitons Number Plum s Add CW (Street, City. StaW Zip ) 7/ \'Ili. Cottat /D a arat Use Qa ❑ l 1, CQ ed l t tlne me ro U Sanitary Penn it (Includes Grou ter Date Issued Issuing Agent ignatum (No Stamps) sureharse Pee) ❑ Owner Given Roawn For Daniel TY- Conditions of Approval/Ratsoas for Disapproval ,r Att>� earNttt Naas (N tW «rbl rK der sy7fd err pat+k oar Isar Nora t t!i x t s M doe SBD -6398 (R- 01/03) kT. CNOQ� COUNTY milli p!!M►RTi�l1T 9r, Ckm COUNTY MiVARMWMAELL ROAD HL080141 WISC 61N 51018 I KEN SCHMITZ INC.. Septic Systems Design & Installed MPRS /CSTM 224173 P.O. Box 160 SHELL LAKE, WI 54871 (715) 468.2434 Private On -SIte Wastewater Treatment System (POWTS) Index and Title Sheet Owner: Project Name -and System Type: i1J�Gl/ mo b/ ��i•o ,��� Location: Street Addr ss Legal Description ` Township /County I Contents: Page 1: Af A�All / Page 2: 7e / Page 3: Page 4: Page 5: �1f�N Page 6: Page 7: Page 8: Page 9: Attachments.: Plumber/Designer: �°�/ �GXV7 / 7 Signed: !� _ Credential Number; fi LZ4A � Date: d L �I KEN SCH M ITZ INC. Septic Systems Design & Installed �^ / MPRS /CSTM 224173 P.O. Box 160 SHELL LAKE, WI 54871 PCB (715) 468 -2434 OiXA 1 WIC G G' Aw W k % f & 7 r /vo U -75 Hre c " r T� A" 0 4& rll-1 ev g3 I 1 �S/•n No �. � gr^ T o YAl A A0 V+Moonsin Pepartmont of Commerce SOIL EVALUATION REPORT Page or Division of So" and Buildings In aootxdsna with Comm e5, Wis. Adm. Code qty Attach complete she plan on papK not lea thane 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 Reviewed by Date Personal Infomutlon you provide may be used for saoondary purposes (Privacy Law, 1. 15.(W (1) (m))• Property _ Property Location Govt. Lot 1/4-5 1/4 S T N R (or Property es Ma ling Addpas Lot # Block Subd. or-GSW / 7-7 _ s City tat p e one Number , ❑ City ❑ Village JO Town Nearest Roa4 4L New Cortstruction. Use Residential / Number of bedrooms Code derived desion GPD ❑ Replacement ❑ Public or convyierclal - Describe: Parent material Flood Plain elevation if icable ft. come and rec ndationr.: ��E;•• j ";Vs APR 16 200 ! ST CROIX COUNT') ZONING OFFICE a BMngt w y Pit � elev. �� Depth to limiting factor _ (n. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD In. Mtmsell Qu. Sz. Col. Color Gr. Sz. Sh. •Eff#1 'E(f #2 23 Pit Oround surface Slay. "145 ft. Depth to limiting factor Y//!5 In. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munaell Qu. Sz. Cont. Color Gr. $z. Sh. 'Eff#1 'Eff#2 ,Q 4 • E #1 = BCC > 30 S 220 nVIL and TSS >30 150 mgfl. = 800 30 mg/L and TSS < 30 nv& CST Signstu CST Number J-7 ate Evaluation Conducted Te phone Number Page r7 of Property Owner � Parcel 10 # D ❑ Boring �..L Boring # �� J ®Pit Ground surface elev. _ ft. Depth to limiting factor �. . - in. Soil Applicatiion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMf In. Munsell Qu. Sz. Pont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 i Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor I^• Soil Application Rate Horizon Depth, Dominant Redox Description Texture Structure Cor>slstance Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # C] Boring Ground surface elev. ft. Depth to Ilmitirg factor in. ❑ Pit Soli Application Raw Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots f In. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. 'Eff #1 'Eff#2 n, • Effluent #1 : 800 > 30 <_ 220 mg/L and TSS >30 _< 150 mg& ' Effluent #2 = BOD, 130 mg& and TSS < 30 mp/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 609- 266.3151 or TTY 608.264 -8777. SOD4330 (x6AO) I ' ` 5 _2> � f I � t _ o � T i r `C,� O v � v b o � II II 0 U w � � c II w w Q4 S� 04 V U . 4� O U :� U ; co :' b Cd rA CIS 0 • . II II II O W • o a � � O H � At • SYSTEM SPECIFICATIONS In- ground Soil Absorption Component Component Manual # �Xg�' M S� 1 Project Name: Distribution Cell Type Septic Tank Aggregate ❑ Non- Agg'regate(g Min. Septic Tank Vol. Re q. LSO 9 g ai . Type of Non - Aggregate Component Septic Tank Volume / gal. Manufacturer 0 Manufacturer Mod Effluent Filter ,,pp Manufacturer /Jll Number of Bedrooms Model 0 Soil Application Rate (DLR) ^ gpd /ft (Designed Loading Rate Pump Tank �J Wastewater Quality Manufacturer "O* Treated ❑ Untreated Volume 7 5 Model � Combined wastewater: Number of bedrooms _ Distribution Componen gal/day/bedroom Distribution B a Daily Wastewater Flow (DWF) _ _�Q_C 1 Hydro -s er ❑ Oth Clear and graywater only: nufacturer Number of bedro s gal /day /be mQ Daily W ewater Flow (DVM = Cross section of distribution cell(s) Blackwater ,tL TTI Number of be ooms gal /day /b oom( Daily astewater Flow (DIVM _ Dispersal Area (A egate) ft (D V PLR) s, Dispersal Area (Non -A egate) . EISA Rating ft System sizing = DWF + DLR =- EISA i — J r �� �J chambers (DWF) PLR) 7 Diverter valve ❑yes Eno Manufacture POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner , hoe-,i Tank Manufacturer {{tv 7 ❑ NA Permit # Septic ❑ Dose ❑ Holding Vol. ��? S gal DESIGN PARAMETERS Tank Manufacturer C! Go, ❑ NA Number of Bedrooms ❑ NA ❑ Septic 0 Dose ❑ Holding Vol 7S gal Number of Public Facility Units NA Effluent Filter Manufacturer ;�,,fle� ❑ NA Estimated (average) flow B gal/day Effluent Filter Model �- Design (peak) flow = (Estimated x 1.5) ®Q g al/day Pump Manufacturer �G ~ L�� ❑ N In Situ Soil Application Rate , al /da /ft2 Pump Model 5 Standard Influent/Effluent Quality Monthly average' Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Manufacturer Biochemical Oxygen Demand (BOD5) • 530 mg /L Dispersal Cell(s) ❑ NA Total Suspended Solids (TSS) 530 mg /L NA 0 In- Ground (gravity) ❑ In- Ground (pressurized) Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ At -Grade ❑ Mound Maximum Effluent Particle Size k in dia. ❑ NA ❑ Drip -Line ❑ Other: Other: ❑ NA Other: ❑ NA 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency ❑ Inspect condition of tank month s () s) At least once every: month(s) (Maximum 3 years) Q NA Pump out contents of tank(s) When combined sludge and scum equals one -third (') of tank volume ❑ NA ❑ When the high water alarm is activated - 3 m th Inspect dispersal cell(s) At least once every : C] ea (s) (s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ earts(s) ❑ NA Inspect pump, pump controls & alarm At least once every: P 0 earts(s) ❑ NA Flush laterals and pressure test At least once every: p ear(sj Other: ❑ month(s) ❑ NA At least once e y ear (s Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator (pumper) Tank, inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or (ears measure the volume of combined sludge and.scum and a check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one -third ('h) or more of the tank volume, the ent re and disposed of in accordance ith chapter NR 113. Wisconsin n tank shall be removed 'by a Se to a Servicing sp � P contents of the " Y R 9 _ 9 Operator a Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment un.t and any servicing at intervals of 512 months, shall be,performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW t 2 C START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the Presence Page or chemicals that may impede the treatment process and /or damage the soil dispersal cell(s). If high con centrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. p e of painting products, solvents or other System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effl To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring p will effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore nor uens within t pump tank. 9 P wer to the Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or mat levels ' 15 feet down slope of any mound or at -grade soil absorption area, compact, the area within Reduction or elimination of the following from the wastewater Stream may improve the performance and prolong the life of the P antibiotics; baby wipes; cigarette�,butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation d ps; medications; oil; aintin Product OW (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scra pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT painting When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is Properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: Y • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to replacement system: provide a code compliant 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 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. O 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. ❑ 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 Name POWTS MAINTAINER Name Phone Phone SEPTAGE SERVICING OPERATOR PUMPED Name LOCAL REGULATORY AUTHORITY Name C� C Phone Phone This document is in compliance with chapter Comm 83.22(2)(b)(1)(d)b(1) and 83.54(1), (2) 6 (3), Wisconsin Administrative Code. Cr 3 15/16 6 5/32 Cr UJ W w HEAD CAPACITY CURVE 4 1 / 32 25 "57" - "59" SERIES 1 1/2 -11 1/2 NPT 3 15/16 6 0 w 4 1/16 L) 15 i f a q Z TOTAL DYNAMIC HEAD/FLOW >_ -- PER MINUTE J EFFLUENT AND DEWATERING CAPACITY HEAD UNITSIMIN 2 E19.25 1 5 43 163 5 3.05 34 129 5.87 0 0 0 10 1/16 1 1 1 U.S. GALLONS 10 20 30 40 50 LITERS 1 3/32 80 160 0 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS - Piggyback VSriable Level Float Switches • Available with special cord lengths of 15', 25', �\ available. 35' and 50'. • Variable Level long cycle systems • Alarm systems available. available. • Duplex systems available. Standard cord length - automatic 9 ft. Standard cord length - non - automatic 15 ft. SELECTION GUIDE 57159 series Control Selection 1, Integral float operated 2 pole mechanical switch, no external control required. Model Volta -Ph Mode AnnDs simplex Duplex 2. Single piggyback wide angle variable level float switch or double piggyback variable M57159 115 1 Auto 8.0 1 or 1 a 7 level float switch. Refer to FM0447. 3. Mechanical alternator 10 -0072 or 10.0075. D57/59 230 1 Auto 4.0 Joil&7 4. See FM0712 for correct model of Electrical Alternator "E -Pak'. E57159 230 1 Non 4.0 2 or 2 8 6. 3 or 4 & 5 5. Variable level Control switch 10 -0225 used as a control activator, with "E -Pak" duplex (3) or (4) float system. No molded plug 6, Four (4) hole "J -Pak', junction box, for watertight connection or wired -in simplex or 2 pump operation, 10.0002. 57 Series - M. 27 -.3 H.P. 59 Series - Wt. 30 -.3 H.P. 7. Two (2) hole "J -Pak ", for watertight connection or splice, 10 -0003. CAUTION For information on additional Zoeller products refer to catalog on Combination starter, All Installation of controls, protection devices and wiring should be done by a qualified FMO514; Piggyback Variable Level Float Switches, FMO477: Electrical Alternator, FMO486; licensed electrician. All electrical and safety codes should be followed including the most Mechanical Alternator, FMO495;Alarm Package, FMO513; and SumplSswageBasins, FMO487. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL To: P.O. BOX 16347 ® Louisville, KY 40256-0347 Manufacturers of ... -- OLL�� SHIP TO: 3280 Old Millers Lane / p Louisville, KY 40216 Q/JAUTY P UMP9 ,JINCE /���7 77 31 • 800 9 502 8 27 1 8 -PUMP ? FAX (502) 774 -3624 l 7 Combination Tank Component Cross Section Approved Manhole Covers With Warning Labels and Locking Device / 4" Min. Above Final Grade Weather Proof Junction Box Electric per NEC 300 & COMM. - � 16.28 WAC Disco n t' I Alternate Outlet Location W /Approved 4" Sleeve Inlet ., Approved Force Main Diam. = o� Effluent Filter Baffle < or -to 1/8" Weep Hole or Anti Siphon Device Particle Size A B Pump Off Elev, _ 5 C Tank Mfr. Q &+cv D Dose Tank Elev. Vertical Difference Between Pump Off and Distribution Pipe = �_ Minimum Required Supply Pressure ....... _ �Q FT, of Force Main x� Friction Factor/ 100FT, ... _ Total Dynamic Head Number of Doses ... _ —f- Day Gal. Per Day/ #of Doses = al. Volume of Backflow ...... ............................... = Gal. Total Dose Volume ....... ............................... Gal. ` Pump Tank Capacity Gallons Dimensions Inches Gallons Pump Tank Volune %��GaVInch A " 15 .31 Pump Mfr. a t 01 B ?• 7 Pump Model C D D Minimum Discharge Rate = GPM '511 Alarm Mfr. IT e/l-�/Jo 6 Total = Alarm Model I I Bed Tank per COMM. 83.45(5) Anchor Tank as necessary to negate buoyant forces per COMM. 83.43(8)(g), X23 I N IAO I