Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
034-1004-95-000
Wisconsin Department of Commerce PR S EWAGE SYSTEM County: St. Croix Safety and Building Division R VA7E E WA G x INSPECTION REPORT Sanitary Permit No: 147 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be u - ed for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Kessler, Mic hael & Sandra Springfield, Town of 034- 1004 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 03.29.15.38E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ; I l `h Benchmark Dosing � Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet 7 U !� • a5 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing t ^ Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover t GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO t I BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Di ent to Air Intake stribution x Hole Size x Hole Spacing V Pipe(s) Length Dia Length Dia Spacing SOIL COVER f /� x Pressure Systems Only xx Mound Or At - Grade S ystems O nly Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes F,-� No 0 Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: I I Inspection #2: / / Location: 1181 Highway 128 Glenwood City, WI 54013 (NW 1/4 NW 1/4 3 T29N�R NA Lot 1 Parcel No: 03.29.15.38E / 1.) Alt BM Description = / 5 � Y- �'� 4i C 2.) Bldg sewer length = O J n - amount of cover = �� JY2 a� C OJC.r`. an Plan revision Required? Yes X No Use other side for additional information. Date In pctor s ature Cert. No. SBD -6710 (R.3/97) County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT Personal information you provide may be used for seq�a ur ses ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)( r 1101 Carmichael Road � Hudson, WI 54016-7710 (715)386 -4680 Fax (715)386 -4686 Attach complete plans for the system on paper not less than 8 -1/2 x 11 inches in size. County Sanitary Permit # ❑ Check if revision to previous application o /#7 1. Application Information - Please Print all Informatio Location: T tion: Property Owner Name C 1/4 W 1/4, Sec 1 416 1 S,) �( p 6 Z�09 N, R E (or) Property Owner's Mailing Address �� i;rzU� �NtNG %G Lot N / Block Number ! City, Stat Zip Code Phone Numer Sub 179 Name or CSM Number Av C� r a - cam, II Type of Building: (check o ) amity ❑ Village Town of ❑ 1 or 2 Family Dwelling - No. of Bedrooms: ® Public /Commercial (describe use): 'y" CvTT /ry� SA� I/d /�Lv ❑ State -owned Neares oad / A I. Type of Permit: (Check only one box on line A. Check box on line B if applicable) d ]Parcel Tax Nu ber(s) A) 1 1.0 Repair [ JoReconnection 3.❑Non- plumbing 4. []Rejuvenation 6 giJ Sanitation I 1 ? T 4 Permi ber Date Is 91/ , 0 B) y J State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ❑ Non - pressurized In- ground ❑ Mound ? 24 in. suitable soil A-Mound <_ 2� 4 in. stable soil ❑pound A +O ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line • Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Other • At -grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required n � Proposed �� (Gals.ldaylsq .) (Min. /inch) �[/� Elevation VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks X /256 ❑ ❑ ❑ So Go ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement I, the undersigned, assume responsibility epair /recon dTion/rejuvenation /installation of non - plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair r the ' stallati of non -pl bing sanitat' n system. PI tier's Name (print) lumber' ignat MP /MPRS No. Business _ Ph n Number miow, r �J Plumbe' Ad r ss (Street, ity, Stat i Code) ff u1 VIII. County Use Only isap d Sanitary Permit Fee D lssue9 Issuin gent Signatur o sta s) Approved Owner G' eLed`rse ation IX. Conditions of Approval /Reasons for Disapproval: D 3 Pep,,, .� �� 4 1 y, SYSTEM OWNER: 1. Septic tank, effitlnt fiker and 5v►�.� �oC t"�u -�'• ^� ``''`�'" dispersal cell must all be services/ maintained ^ I ( � Go t 1 A ��� C f AA-o as per management plan. provided by plumtw. �t R ` 7 I J 2. AN setback requirements must be maintained 4 � P {�d A3 ¢o w � - as pat aR* able code / wdirnnces. Rev: 8/05 K :`mss w \'L X3 1v�4 -�L,' l7.'�r lbw - - \S w C-A Lt1� 4 t OV A Q arc � 1( 1 l\ (1 .'1 C p S ( r f I U Yt /w Lq�t•b) a` '� {l L.'`S > ltro j 15.E a. S:ia s `'jL \ �� PvC- \ \ Sj, YUvK�n DD.4K \ 7 � SAM Soi� e` -VC D \ lea X u,a y srw Y0 Pr's- � v AP b'L r" O S •.v �i�o Stu, i I Illlll Illll 11111 i{i!I IIl11 {lilt Ills lill[i 1111 {I1{ Document Number Document Title 903187 BETH PABST REGISTER DEEDS St. C County ST. CROIX , WI RECEIVED FOR RECORD Occupancy Affidavit for a single POWTS 09/02/2009 02 :15PM servicing Two Dwellings via PIMS AFFIDAVIT M ` e.� � / K -- EXEMPT i ul, " !5Lce REC FEE: 11.00 Name – (Owner) Typed or printed PAGES: 1 being duly sworn, states, under oath, that: 1. He/she is the owner /co -owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume //o Page elol Document Number 5253Sg Croix County Register � l/ of Deeds Office: Recordin Area A parcel of land located in the N� '/< of the Nw '/ of Sec ion 3 Name and Retu� +d fs� T z _ N – R l5 W, Town of_ _5� _��. ��i cl � FA %k\1 kLS St. Croix County, Wisconsin, being duly described as follows Cn._toA G% *% L�; S NO t (include lot number and subdivision/CSM or detailed legal p gi _ /Qp tt _ J r _ L'17a description): C . C_ , y , , # (oz$ QS �XGSC -�'• b e� t rl Parcel Identification Number (PTN) Vo As owner of the above described property, I acknowledge thrdt a Privlite On-site Wastewater Treatment System (POWTS) serving the primary residence is sized for -�/ bedroom(s) with a design wastewater flow of � gallons /day. (DWF calculation based on 150 gpd /bedroom @ 2 persons/bedroom). Two dwellings will be connected to the POWTS via Private Interceptor Main Sewer (PIMS) in compliance with Comm 82.30(12). A maximum of occupants are permitted. There are currently a total of S occupants in these residences, therefore the POWTS can be considered code - compliant at this time. However, I understand that if the number of occupants exceeds the maximum for POWTS design, the system will be undersized to accommodate any increased wastewater flows and/or contaminant loads and may be subject to premature failure. I also acknowledge that I will disclose this information to any parties interested in purchasing this property in the future. Dated this ' _ day of 6e___iN4 e_r 100 i O AUTHENTICATION STATE OF W ISCONSIN Signature(s) )ss. St. Croix County. ) authenticated this day of Pers nally came before me this day of G he above named Per TTHIT MEMBER STATE BAR OF WISCONSIN to me known (If not, to be the person(s) who executed the foregoing instrument and acknowledge the same. authorized by § 706.06, Wis. Stats.) , -, t R 0, " . THIS INSTRUMENT WAS DRAFTED BY O � I Notary Public, State o ll (Signatures may be authenticated or acknowledged. My Zr 0 M "C Both fare not necessary.) •d ate- � C �' l T*D Date: "THIS PAGE IS PART OF THIS LEGAL DOCUMENT — DO NOT REMOVE" This ln;6rmation must be completed by submitter: document title. name A return address, and eM (1f required). Other information such as the granting clauses. legal description, etc. maybe placed on this first page of the document or may be placed on additional pages of the document. Note: Use of this cover pTg6 fdf/s one page to your document and S2.00 to the recording fee. Wisconsin Statutes. 59.517. ST CROIX COUNTY PLA �,taw -. nzsn. - ..+.aa« - :ra :aw.. - omaw .. ^:taus»•. -. �;ne ,vain afire ., 4v_ -ms:, a, s •_ K ...«c�+sz„- rami,,. _.e . r� ra. .Q � sacs,.; . ra,..... ✓u:+n«e.m*amw, . �.:ara�mw. a _ .�.ra�... <.rw .. ti ....zxi re �S August 3, 2009 k v Mr. Mike Kessler 1181 Hwy. 128 In � . G e wood City, W RE: Request to combine domestic and non - domestic wastewater in a DNR Code Adminisrrarr' approved holding tank at 1181 Hwy 128 Glenwood City, WI 54013. Parcel #034- 715- 386 -4680 1004 -95 -000. Land Information Dear Mr. Kessler: Planning 715 - 386 -4674 ' This department has received and reviewed the WDNR letter dated July 2, 2009 Real Properr� addressing your request to co- mingle domestic wastewater from a new restroom 715-3p, and non - domestic wastewater from your meat processing business. Re 7, As per St. Croix County Sanitary Ordinance Chapter 12 .1 (F) (5), holding tanks for 386 -4675 domestic wastewater are not allowed for new construction. The new restroom would be considered new construction and therefore could not be allowed to enter the WDNR approved holding tank. After consulting with the State Wastewater e. Specialist it is agreed that a private interceptor main from the new restroom could be connected into the existing building sewer mound system serving the house. Your licensed plumber would be required to complete a County sanitary permit application and include the following information: 1. County Sanitary Permit Application $225 permit fee 2. Plot plan of the site with all applicable setback information ;= 3. Statement from plumber that system is working properly ,- An b inspection de 24 hr notice) is required at the time the new p Y this department ( r , building sewer is connected to the existing system by the licensed plumber. If you have any questions concerning the required information, please contact me at 715- 386 -4680. Sincerely, Ryan Yarrington Zoning Technician ST. CROIX COUNTY GOVERNMENT CENTER 1 10 1 CARMICHAEL ROAD HUDSON, W/ 54016 715- 386-4686 FAX PZ@CO. - A/NT-CROIX. W1. US WWW.CO.SAINT- CROIX. WI.US Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ,. INSPECTION REPORT Sanitary Permit.No: 395253 OENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 5% - r q. m.*) Permit Holder's Name: City Village X Township Parcel Tax No: Kessler, Mike Springfield 034 - 1004 - 95-000 CST BM Elev: Insp. BM Elev: BM Description: 1�, D CST' Bw�� - ( z TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 5� 6S• 1 LV «� Dosing v, l.( Alt. BM I.40 �03 •� Aeration Bldg. Sewer ( j b2 k Holding SVHt Inlet O$ St/Ht Outlet TANK SETBACK INFORMATION TANK TO P /L. WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ? A I DtBottom p aO r s. 1 Dosing i l 1�� y �� / Header /Man. - 7-10 9 O f l/O ' Aeration Dist. Pipe 3, C 93 1 Holding Bot. System • r} f PA • 3 Final Grade PUMP /SIPHON INFORMATION G;_u_A *;�- la Manufacturer f� �( Demand St Cover rJ�6,n.LC, GPM Mo, Number *30 ti �• D Lift Friction Loss I System Head TDH Ft 11 0.S{r 3 -Tv 1.5tp Forcemain Length Dia. Z L Dist. to Well f 1p I SD SOIL ABSORPTION SYSTEM BED/TRENCH Width f Length I No. 0 Trenches PIT DIMENSIONS No. Of Pits Inside Dia. ILIquid Depth DIMENSIONS SETBACK SYSTEM TO P/L DG� WELL LAKE /STREAM LEACHING of rer. INFORMATION Type Of System: f I / CHA UNIIT OR Model } e . Zoo > Zoa = DISTRIBUTION SYSTEM Q Header /Manifold Distribution nt to Air Intake ` �t x Hole Size /� x Hole Spacing Ve Length K� Dia Length Dia Spacing 3� 3 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over IDepth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ® No Fjv� Yes ® No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: l ° / I / D I Inspection #2: Location: 1181 Hwy 128 Glenwood City, WI 54013 (NW 114 NW 114 3 T29N R15W) NA L t 1 Parcel No: 03.29.15.38E f q 4 1.) Alt BM Description = �j`� ` �+''V 1 LLW �'�^•* 2.) Bldg sewer length = Ip t vs f C^.k ......q Y -4/•Il 15 I,�UIZ+tlL,i1•/ - amount of cover = CJ t ) Contour = 99.6,0 (. s -a S 4 a k i /ox Cb revision Required? U Yes ® No o / 9 O/ •-S r ' Z se other ide f r a dition I ' formati _ '[� \,c:o5 �� L Insepctor's Signature Cert. No. Safety and Buildings Division County G 201 W. Washington Ave., P.O. Box 7162 sr_ N) Pisconsin Madison, WI 53707 - 7162 Site Address De artment of Commerce I // Sanitary Permit Applicati ;,,7'U - p ov ide Sanitary Permit Number `' 39�z�3 In accord with Comm 83.21, Wis. Adm. Code, personal info r 11 Check if Revision may be used for secondary purposes Privac Law, m I. Application Information - Please Print All Information '© Elk f State PI�D. Numbe Property O W/,/ ' Name L PazceI Number � � S� L, �iZ. ,QUG 10 2001 � � z f, 4s Property Owner's Mailing Address i p . ST U Property Location C� I �v / ` r'"' / iitl 0► !4 Ik ; S .3 T N, R �� City, State Zip Code 1 P 'one Number Lot N er Block Number J g Subdivision Name CSM Number II. Type of Building (check all that apply) \ ❑City grr or 2 Family Dwelling - Number of Bedrooms C ❑Villa e g ❑ Public/ Commercial - Describe Use R , 'ownship _ ��/� A �� ❑ State Owned Nearest Road 0 �/ L� M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 ❑ New 2t Replacement System 3 ❑ Replacement of 6 ❑ Addition to 71 7� use System Tank Only Existing System B • ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply) (numbering scheme is for internal use) 44 ❑ Non - Pressurized In- Ground Mound & X /Sd 47 ❑Sand Filter 5011 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. Dispersal/Treatment Area Information: r / 3 S 3 Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade ✓ Require / Proposr ✓ Rate(Gals./Days /Sq.Ft.) (Min./Inch) Elevation C93(� /Ply Y3 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks I Tanks Septic o ..uoia - �T 2 a Dosing Chamber 1 7 2 „i C 1;V VII. Resgonsibil.ity Statement I, the and ' ed, assume ponsibility for inA.Usitim of the POWTS shown on the attached plans. PI r s Name (Print) Pl r' Si MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Z' e 6 e �Ib� VIII. Column /De artment Use Onl Approved ❑ Disapproved Sanitary Pernik Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse . Determination $ . co IX. Conditions of Approval/Reasons for / Disapprovval r r`µ f�/ 5r4, ?l /�� Q�JQw�i ip2 r �pS�� 1n V 3 �, cv �a �K S�oe.��� �G�f � �u 7`��G�ee� ��r f.� -q"a a'(•a ��u rev 5 Attach complete plans (to the County only) for the system on paper not less than 81/2 it 11 inches In size a SBD -6398 (R. 05101) _ i STO CROIX COUNTY • . i ... ZONIN PLANNING & „" .;.;?^,A33: \- //9.;A.., ✓„ A v.. v.: �.%w . z.. .. .. y� �r�r ✓, eeYec ',IH'/x f' .xa. i y FAx MEMO DATE: -71, 7/4>`i TO: � Code Administratz 715 - 386 -4680 117 FAX NUM tBs R: 71 - 7 2 (o - 2 1 Land Information fr Planning FROM: 715- 386 - 4674, FAx NUMBER: 715 - 386 -4686 A Pro 8 715 , '4677 PHONE NUMBER: 7/5 38( 'yw$0 Re cling - 386 -4675 NUMBER OF PAGES, INCLUDING COVER SHEET: RE: • ke essl� t' o w.�.,.. b vs. b- f ceJ �a �''�'a ♦`' fr. rb+ 6,6 sue. Sd` 1 ti 1, 10.1-- �r a �. OA- � .... prate; �./ov `r�te� d��6` D Y w.�..- �.e_ �Oa.�tL..('onw�, C J ei d-�► -e_, he��►5� Mo�+� ST. CRO /X COUNTY GOVERNMENT CENTER 1 10 1 CARM/CHAEL ROAD HUDSON, Wi 54016 71 X386- -4686 FAX RZ @CO.SAINT- C ROIX.WI _QS WWW. CR0IX.W 07/1512009 22:35 7152657448 ORMSONS SUPERUALU PAGE 01 6 -25 -09 a Dear Steve, I'm writing to you about modifying my permit for a holding tank for non - domestic wastewater. I spoke with you on Thursday, June 25th, I received this permit in June of 2005. I worked with Duane Schuettpelz at that time. I have a 2000 gallon tank currently in use which is being pumped by ABC Septic l'Isc. # 227548. I use this tank for wastewater in my business where I custom cut beef, pork, venison lisc. # 1655. 1 also process related products. I currently have the tank pumped 4 -5 times a year. In the course of developing my business, it has been brought up (by my state meat inspectors) to put in a bathroom. It is mainly my wife and 1 who work in my sroall shop, which is approxim,$,ely 70 feet from. - my hou'sR. We use house bathroom when needed. I also have 2 -3 part -time employees for my busy time of year, which is the gun deer season. I am asking permission to modify my holding tank permit..l would like it to include combined use of my current load of wastewater along with the additional small amount of waste that would be generated by this bathroom. My holding tank is directly behind my shop, about 15 from the building. Connecting the bathroom waste fine into my holding tank would be much less expensive Ulan other options. I am a small operation and cannot afford to spend a lot to accommodate this request from my meat inspectors. If you have questions I may be reached at 715 - 265 -4248. Sincerely, Mike Kessler 'Kessler Prxxessing 1151 Hwy 128, Glertwood City, wl.5 4,013 State of Wisconsin 1 DEPARTMENT OF NATURAL RESOURCES 101 S. Webster St. Jim Doyle, Governor Box 7921 Matthew J. Frank, Secretary Madison, Wisconsin 53707 -7921 WISCONSIN Telephone 608 - 266 -2621 DEPT. OF NATURAL RESOURCES FAX 608- 267 -3579 TTY Access via relay - 711 July 2, 2009 FILE CODE: 3420 Mr. Mike Kessler Kessler Processing 1181 Hwy. 128 Glenwood City, WI 54013 Subject: Request To Modify Original WDNR Plan Approval For Non - Domestic Wastewater Holding Tank At Kessler Meat Processing Shop -- Glenwood City, WI Dear Mr. Kessler: I have received and reviewed your transmittal dated June 25, 2009 in reference to your proposal to modify the original WDNR approval (dated 6/30/05) for your existing non - domestic holding tank to allow connection of a proposed new restroom wastewater source. According to your transmittal, your existing holding tank is located at your business / property (1181 Hwy. 128 in Glenwood City, WI) and is currently used to store non - domestic wastewater associated with your meat processing business. The stored wastewater is currently and will presumably continue to be hauled in the future to the City of Menomonie municipal wastewater treatment facility for ultimate treatment / disposal. Based on this review, your request to modify the original plan approval to allow the proposed restroom wastewater connection to your existing holding tank is hereby approved. Since your holding tank will be used to store combined domestic and non - domestic wastewater with the proposed restroom connection, please also forward a copy of this acceptance letter to the Wisconsin Dept. of Commerce and / or their local County zoning designee for their comment / approval. If any questions concerning this acceptance notice, please contact Steve Smith, WDNR Madison office, 608/266 -7580. Sincerely, Stephen J. Smith, P.E. Wastewater Section Bureau of Watershed Management dnr.wi.gov wisconsin.gov PAMed on Recycled 63�-► /Qo�- 4 � Pepe h A y ip v 'z w v " 7 O U d 5 4i � L M G i O,f`30 aC C C 12 Ey O'U O) C �o L U V ` N O N (p C U � N U x CERTIFIED SURVEY N0. 628 ` Part of the Northwest 1/4 of the Northwest 1/4 of Section 3, Town 29 North, Range 15 West, Town of Springfield, County of St. Croix, State of Wisconsin, described in Volume 3 of Certified Survey maps, page b28 as Certified Survey No. 628 349708 SHEET 1 of 2 — — 8 9 If 1 m F;F'1 ED JUN 27 ~' APPROVAL OF THIS MINOR SUBDIVISION A%" 00 DOES NOT MEAN APPROVAL FOR ■eaw 46 M BUILDING SITE OR SEPTIC SYSTEM. as ���+r, REFER TO H62.i0. p '��►��,, Z APPROVED va ima JUN 2 2 1978 5-1315 = ST. CROIX C -ou iY O o COMPREHENSIVE PARKS PLAN .ING 9 ,A a AND ZONING COMMITTEE EARIN 0 0 S 6T° 29 08 W �♦ h�t P 128.08 f �o z UNPLATTED LAND \ 2 FD 4 �: � � m CD rn �C� S LOT I \ / 15.6 ACRES t " EAST LINE, N.W. 1/4 / f OF THE N.W. 1/4 SEC 3 x goo/ UNPLATTED LAND s °o EXISTING I" O ,y9 eB0 IRON PIPE /8EAZNG 2 Ag d O 247.06 al � S 88 42" E 1065.88' ` - SOUTH LINE, N.W. I/4 UNPLATTED LAND OF THE NW. 11q SEC 3 CURVE 1 -2 L.C. BEARING S 46 39" W ;U 0D M z L.C. 1314.15 D z RAD. 18 3C.08 _ '{ I. A. 44 08' I8" M Z ARC, LENGTH ' TAN BEARING S 6 W N m C n w 3 \M rn �m ca CNn N mom ' - mom- D OO WEST .LINE z? + NW 1/4 SEC 3 C) W M LEGEND Z :E 3/4 "X 30" ROUND IRON � ID U) ROD WEIGHING 1.502 LB. /L.F. z z rn W. 1/4 - COR.SEC3 T29NR15W R/R SPIKE r SCALE ' I"= 300 I 0 150 300 '600 Volume 3 Page 628 1 839 90Ed 8UM10A �a1.iNVPO� OVANOZ ONV no O � dld 5�1add ?A�SN3H38dW0� � Xl f' vop D '1S O� • `. �V . .. , vim :)I1d3S Z;O KIWI �ddd � a i1�OH1 "'' " A Addb Nd3W ION S3 I DISIAMuris SONNY SIHI JO 1VAObddb MNNq{N�� I �. '8L6L —w .30 Ava yt .YZ SIHl 031VG • awes a4i 6U L dde tu pup 6U LP LA Lp ' 6u LRanans UL X LOa3 • j.S 10 4j uno9 044 pue pLaLj6uLadS 3.o uMOl a44 JO SUOL4eLn6aa uOLsLALpgns a43 pup sa ;nlpq S uLSUO3sLM a44 JO 9£Z aa;de49 jo SUOLSLAoad 84q 43LM paLLdwoo RLLnj anp4 14p41 •appi.0 Joaa044 uoLsLALpgns 844 pup P@kO Aans pueL a44 Jo saLappunoq aoLae4xa LLp Jo uOL4p4u8saadaa 4Oaaaoo p SL 4P Ld 4ons ;e41 •ua6eH 44LP3 Pup uaLLH JO uoL40aaLP 844 Sq 4eLd pup UOLSLALP pupL °4@A 4ons appw ane4 I 4e41 •ssaL aO aaow °saaOe 9 SULP4uO3 LaOaed pLPS •6uLuuL6aq 3.0 4ULod a44 off. 4aaj 9L *tL£`L "M „6£ ,9Z 09t 'S 6uLaeaq p.Ao4O 'anano e jo oan a44 6UOLe aoue4l °Paj 80'8ZL "M .,80 ,6Z oL9 'S aOUa41 !4aaJ ZZ'L86 "3 .8Z 18L 000 'N a3ua41 !490J 88'590` L "3 .,Zb ,VL 088 'S -6uLnuL'4UOO 0OUa41 `.6uLuuL6aq 10 gULod a44 osLe `8ZL RPM4 juna1 a4p4S Jo f'pM J O 44 A'Laa ;sea 844 0 a aaj 90'ZVZ "3 net '.VL 088 'S aOUa41 !V /L ;S@m4;JON a44 10 auL L ;saM a44 6uoLp 49aj LS'LL£` L 44JON a3ua41 !£ uOL4oaS pLes 10 aauaoo th ;saM a44 4e 6ULOUawwoB i :sMOLLOJ se pagLaosap kLaeL noLZapd aaow °uLsuoosLM 40 a4p4S 'XLOXI '4S 4o R4uno9 `p LaL46ULAS j0 uMol `MSIb `N6Z1 `£ UOL408S 40 IMN a44 10 i MN a44 jo 4apd a paddew pup papLALp `paSanans anp4 I ;e44 kjpaao kgaaau 'JORananS pue3 paaa4sL6ab `b31S3m '9 SHWOHI `I Z jo Z 133HS 80V31 9 • ON f'ananS pe LJ L4aao sp gz9 a6pd `sdew ;CananS pa LJ L4aa) jo --- C — awn LOA UL pagLaosap `uLsuoosLM 10 a4e4S 'XLOa9 4S jo k4 uno9 `pLaLj6uLadS jo uMol 1 1saM 51 a6ueb `44aON 6Z UmOl `£ UOLj3aS JO t/L 4saM43aON a44 1 b/L ;SBM44aON a44 40 4aed �,. - 7Z'; — 'ON A3Abns 03IJI M Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 395253 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)]. m = T ID. Permit Holder's Name: City Village X Township Parcel Tax No: - 7 Kessler, Mike Springfield Townshi 034 - 1004 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: 3-2- t S t 3gE^ 00 .1b 100.1b C5c gw- ( �akt -!cam TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark M ` Dosing `_ L Alt. BM -}O lto � Aeration Bldg. Sewer aZ q Holding SUHtlnlet EW �CO�Os St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic i Dt Bottom n/ I Dosing I r y 2QD / Header /Man. Aeration Dist. Pipe 3. 1 o • S�- Holding _ Bot. System .S � -- . eo • 3 Final Grade PUMP /SIPHON INFORMATION o * Ib� Manufacturer; Demand St Cover L, GPM A4� Number x 3o ti N �� D Lift Friction Loss r System Head TDH Ft O - N-9 0, 0 .S� 3•S'0 (• 3 Forcemain Length 1 Dia. a Dist. to Well f S 2- 1 > so SOIL ABSORPTION SYSTEM S,`► S . BEDITRENCH Width f Length I No. Wrenches PIT DI ENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS \ SETBACK SYSTEM TO P/L DG WELL LAKE /STREAM LEACHING r: of re I INFORMATION K CHAMBER OR Type Of System: ! i > Z�(?D UNIT Model N er. N � f c� DISTRIBUTION SYSTEM Header /Manifold Distribution t t x Hole Size x Hole Spacing Vent to Air Intake 1 J f Pipe(s) I 1 (l 32. 3 .O �---' Length Dia i l_engt � is Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched BedtTrench Center Bed/Trench Edges Topsoil J� Yes FMI No FS Yes A No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: 1 Inspection #2: --* 0 (��a� t 1 vw.�— Parcel No: 03.29.15.38E Location: 1181 Hwy 128 Glenwood City, WI 54013 (NW 1/4 NW 1/4 3 T29N R15W) NA Lot I 1.) Alt BM Description =^ 7�'� 4 b 2.) Bldg sewer length = I p us ` ,K„ 4#w - amount of cover = / ^ n 3. Contour = 99•(ab Swrr&°# TA ak 401 ° � an revision Required? ❑Yes [� No c / 9 0/ — S e other ' srde f r a ditiona 1132 -- C t i Insepctor's Signature Cart. No. t 11 -6 10 ( 7) � & Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 �r ` Madison, WI 53707 - 7162 Site Address , seonsin De artment of Commerce Sanitary Permit Applicatio Sanitary Permit Number . 3 1-5 5_3 In accord with Comm 83.21, Wis. Adm. Code, personal info n op provide ❑Check if Revision may be used for secondary purposes Privacy Law, to I. Application Information -Please Print All Information State PI I.D. Ntmnber EKED �E 74, Property Owner' Name Parcel Number 63- -400Y- 4S - 0Ci6 �1 s `� L -c. ��G 1 �1 ?_001 X_ 7- Property Owner's Mailing Address ST OK Property Location c� 12,e ",. 0NOW� �� �• % A �ti , S T 7 1. N, R I� City, State Zip Code 1 V 'one Number Lot Nu er Block Number g Subdivision Name CSM Number � Z II. Type of Building (check all that apply) ❑City ` or 2 Family Dwelling - Number of Bedrooms f �- ft9Ci- ❑Village El Public /Commercial - Describe Use Ri'ownship _� [4 A L.0 ❑ State Owned Nearest Road III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 ❑ New 2, Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use System Tank Only Existin g System B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply) (numbering scheme is for internal use) 44 ❑ Non - Pressurized In- Ground 2O'Moundry X /Sd' 47 El Sand Filter 50 El Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 44 ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area Information: ✓ _ / 33 S 7 3 Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposyd ✓ Rate(Gals. /Days /Sq.Ft.) (Min./Inch) Elevation t1"Itl (( � VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New I Existing Tanks Tanks Septic o ark Dosing Chamber 5 i ) I ! l 15V VII. Res nsibility Statement- I, the and ed, assume ponsibility for of the POWTS shown on the attached plans. Pl s Name (Print) PI r'is Si MP/MPRS Number Business Phone Number 1 V,�o L Plumber's Address (Street, City, State, Zi rge d Ad- VIII. Coun /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse . 3 ? d� Determination 4 �,. IIC. Conditions of Approval/Reasons for Disapproval `� - •- o, �.` r r,':��� �"✓ �� �K S�allr�r'� G�GI -OI / H OC✓ (,K��ctktoC_�6tr�li J� Attach complete plans to the County o n not less than 81/2 x 11 Inches In size d for We stem o P P ( h Y) system PsP�' _` SBD -6398 (R: 05101) _ . . , 1'\ t l � �crs` ov .. 1� 4 0 � ��� �. ,, 1 � � 1 l� w \' �-•� � Ewa s� � �a�l��•,..� rte,,,, ( -6) moo\ � (l Ll L is �lL 4' v %Vv' ip \ C4- a•} \ < �•.�w.. �� tt V Q ( \ �lFlo X `--,5 ` b r I'1 MS i C w,` T \ ' bZ © S•�. v�.o n Ar L ,. a �: •. t3 2 1 CQ q, b k � 3 0� $ ti I N O O~ "r O O a c (D 0 0 o N m /. H m� •�� I � I p y p p c C d '•� co � � m � .€ I I c c� y O ., M w _ O V N � �E�v`ON U u a) 3: 3 wco E YE m �� U) I f0 f Y O N 7 f6 C U) C m OO ' 2 7 N a f6 M l6 t!) C T LL C co LL p N 0,2 O O O T' C U N N "O C C w C p N fC N O Q J aJ 2 O_ E Q N O M M N ql Z E E O '.I O O` Z € v O M C\l Z a m a m I c t7 O z _ c I o m z � c cnr� m m I � I a� E E 0) a� m I � m � 'S w w o 0 o CD :. ( - o a U M C U U O z r z O Z Z Z Z O N C C � `N° M R C U sir d o o ►� v C - ° v a y O Q .�4 .. r co LO H d i O O d N O DOa c 30aCL • d d m d d a N a ° o m _� 3 3 o Cl) (1) } rn rn Y I °rn o °o CC QN\i O T 0 0 0 0 0 N O - N 0 _ Z O O N N N N N p) ! 00 O T O O .� .O O .� 00 S (0 m a O) N O) _d Q Z (n N 'O _� Q A (n N O 0 f S U 7 a� O 0) H O O 3 � N C N N C O O O O @ O N 7 y 7 V 0 O .- N N � N U r ��, N C U N c a 0 0 0 0 0 0 0 U O O N s = N N N N N N y W m a I C c c d rn o M cp co W 4= N �''� O d O M N C 0 0 C N ap y N p Z m N y N N C O 0) M I• �' N m M ++ O 4) U) a+ 7 C j L •- Cl) M O- fd co 0 O U M O N O O to O N U 0 0 fn 2 Z '� S I- Y M o z Y r L fn l V d R a d CL 3 u a L a r`N Q o = M 3 2 o !; o `� 1 A U a m 0 N U 0 0) U CROIX COUNTY PLANNING & ZONING August 3, 2009 Mr. Mike Kessler 1181 Hwy. 128 aTT Glenwood City, WI RE: Request to combine domestic and non - domestic wastewater in a DNR Code ad nsst :arrw4 approved holding tank at 1181 Hwy 128 Glenwood City, WI 54013. Parcel #034- 715- 386 -4680 1004 -95 -000. , Land Information & Dear Mr. Kessler: Planning 715- 386 - 4674' ` This department has received and reviewed the WDNR letter dated July 2, 2009 Real Property addressing your request to co- mingle domestic wastewater from a new restroom 715 -3.6 677 and non - domestic wastewater from your meat processing business. Re cling As per St. Croix County Sanitary Ordinance Chapter 12 .1 (F) (5), holding tanks for 386 -4675 domestic wastewater are not allowed for new construction. The new restroom would be considered new construction and therefore could not be allowed to enter the WDNR approved holding tank. After consulting with the State Wastewater Specialist it is agreed that a private interceptor main from the new restroom could be connected into the existing building sewer mound system serving the house. Your licensed plumber would be required to complete a County sanitary permit application and include the following information: A 1. County Sanitary Permit Application $225 permit fee 2. Plot plan of the site with all applicable setback information 3. Statement from plumber that system is working properly An inspection by this department (24 hr notice) is required at the time the new building sewer is connected to the existing system by the licensed plumber. If you have any questions concerning the required information, please contact me at 715- 386 -4680. �_. Sincerely, �n Ryan Yarrington . Zoning Technician ST. CROIX COUNTY GOVERNMENT CENTER 110 1 CARMICHAEL ROAD HUDSON, Wi 54016 715 - 386 -4686 PAX PZ @CO.SAINT -CROIX WI. US WWW.CO.SAINT- CROIX.WI.US • DOCUMENT NO STATE BAR OF WSCONSIN FORM 2— '982 THIS SPACt: RESERVED FOR RECORDING DATA WARRANTY DEED 525338 ST. C 0 CO.. WI � Allen L. Hagen and Edith H husband and wife PAWd for Record JAN Q 3 1995 Michael Kessler an Sandra Kessler St 9:30 A.M I t Conveys and warrants to r � husband and wife as survivorship marital prope a404", *. (,c 4'j,,, +f Regtater of Deeds 4 RET" 91MCAflS1N CREDIT 17Ni0N ' Poet OfAce Box 160 the following described real estate in St. Croix County, �— MNbDQ1 *, * 6 4:x51 _ %, State of Wisconsin: Tax Parcel Me. Part of the Northwest 1/4 of the Northwest 1/4 of Section 3, Tow 29 North, Range 15 West, Town of Springfield, County of St. Croix, State of Wi3consin, described in Volume 3 of Certified Survey maps, page 628 as Certified Survey No. 628. This homestead property. (is) 'r Exception to Warranties: j h Dater+ this 5th day of ig 95 (SEAL) 7zm - -- (SEAL) Allen L. Hagen c (SEAL) (SEAL) • Edith Hagen AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN as. d DUNK County. authenticated this--day of 19 Personally came before me this St h day of January ,19_ 9% the above named husba and wife TITLE: MEMBER STATE BAR OF WISCONSIN _ (If not, to me known to be the perso ti tdhcd ; authorized by § ?O6.D8, Wls. S!ats.) foregoin +nstrument nd Ac owledgethe n0: THIS INSTRUMENT WAS DRAFTED BY �• (• 7 MUZA S MUZA Ca 541 Broadway, P.O. Box 408 James Lockie Menomonie- Notary Public ' A '• (Signatures may be authenticated or acknowledged. Both My Commisslon $kwiWYA. (it no ,w h ! '':• are not necessary.) date: 7' 7 ife. ? ffa ,4' � - J 8432 NrF ota+ ' ' Narnta of parsons signing In any capacity should be tyPOTOr printed below their apnalurat WARRANTY DEED STATE BAR OF WISCONSIN Nelco Tax Forms. P.O. Box 10206,t)rW Bay. N SUOT -0209 Form No.2 — 1982 Safety and Buildings 4003 N KINNEY COULEE RD Nvisconsin LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 www.commerc ons www.wis .wisconsin.gov n.gov Department of Commerce Scott McCallum, Governor Brenda J. Blanchard, Secretary August 06, 2001 CUST ID No. 139462 A7TN: POWTS Inspector TODD L SINZ ZONING OFFICE ` T L SINZ PLUMBING INC ST CROIX COUNTY SPIA E5609 708TH AVE 1101 CARMICHAEL RD MENOMONIE WI 54751 -5520 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/06/2003 Identification Numbers Transaction ID No. 664576 SITE: Site ID No. 633859 Mike Kessler - STH 128 Please refer to both identification numbers, St. Croix County, Town of Springfield L above, in all correspondence with the agency. NW1 /4, NW1 /4, S3, T29N, R15W FOR: Description: Mound System for Three Bedroom Residence & Day Care Service - Individual Site Design Object Type: POWT System Regulated Object ID No.: 805219 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with sections of the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01/0 1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10706 -P (N.01/01). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. The owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound manual, and section VI of the pressure distribution component manual are complied with. A copy of this letter including instructions and information regarding proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • 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. Slats. • 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. Slats. • Comm 83.52(2), Wis. Adm. Code - 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. • Comm 83.52(3), Wis. Adm. Code - The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. TODD L SINZ Page 2 8/6/01 • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /instal lation/operation. In granting this approval the Division of Safety & Buildings reserves the right tb 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. Sincerely, ! FEE REQUIRED $ 300.00 FEE RECEIVED $ 300.00 BALANCE DUE $ 0.00 GerarM. Swim POWTS Plan Reviewer - Integrated Services 608 - 789 -7892 Mon - Fri 7:15 AM to 4:30 PM WiSMART code: 7633 jswim @commerce.state.wi.us cc: Mike Kessler 1 Mike Kessler - Mound Transaction # Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manual: Pressure Distribution, SBD- 10706 -P (01 /O1) Mound is Individual Site Design Location: NW 1/4, NW 1/4, Sec. 3, T 29 N, R 15 W Town: Springfield County: St. Croix Date: July 25, 2001 p V.T.S. C Owner: Mike K ler ?%0VED Address: 1181 128 A ENT OF COMMERCE DEPART iia"a Glen od City, 54013 j\f N Plumber: T Sinz SEE CORR D Signature: License # P 39462 Attachments: 6748 -Plan Approval Application SBD -8330 ri page 1: cover f��,��� 2: design criteria & calculations Z�p1 3: plot plan ,1111 2 011' 4: system cross section & BLDUD 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management page 1 of 8 r a I Design Criteria Residential Wastewater Contaminant Load: 30 mg /L < BOD < 220 mg /L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L Bedrooms x 100 gal/bedroom/day x 1.5 6, cy gallons /day hydraulic load Design Calculations In situ designed loading rate •3 gallons /sq. ft. per day Depth to estimated high ground water Tr Z in. Depth to bedrock in. Cross slope at system % `^� '• X Force main length ft. of Z• in. Manifold /header length ft. of — in. Drain -back `'( • o gallons Lateral length 2 @ 3 ' ft. of �� �- in. Lateral elevation l ° \A4 ft. @ bottom of lateral Lateral hole size 5- /SZ- in. @ 31.•o in. ( Z ° ft.) Spacing holes %lateral holes total Lateral volume 2- gallons Total lateral discharge rate 2'�' o gallons /minute @ ft. head Network pressure compensation losses k ` ° _� ft. Elevation difference 1 ft. Friction loss ft. @ Za gallons /minute Total dynamic head 2' Z ft. Pump /siphon gpm @ (( 3 ft. of head Manufacturer \4 ' '"° "°•°" C_ Model # SVyTr - 3 0 Dose volume ` �'�' gallons Lift /sip)aon tank `� M•� �w ``�O'�'�� �-O�� ° �� gallons Septic tank �L gallons Effluent filter Measurement pump on and off d t in. Height alarm from tank bottom in. Reserve capacity s L 4 � gallons specs,calcs.res Page Z of FROM CERTIFIED SOIL TESTING FAX NO. 715 233 0398 Aug. 06 2001 02:07PM P2 re �.�t fir•' � �o.,../ Z.. 4VoVt \ 0 2 .01' . . . . . . . T•�f � � I f 1 ba •o ' . Q C- � o o .,... o � Y o C- IL b U - Vo t.5� 1., T•o I � «T QJ. tG.�J+W 1 \ o \ .a- �, b • C7 1 3 . ci , a IV o3 �7va -Fa.c4 ��.�`. �.. ("� lral�e boh ti Engineering Details - SHEF30 Pump Characteristics Performance Data Rleta Eld, Sfbeaetdmo Aetoetotk hfodols SNIF30Ai t i - Norrpewer •30 I + Fell Load Asks i.0 e 2D . INota T)tpo ShWW Peb 14 ) 1 R.M. 1 S50 _. _ _ -..- KIM 0 1 Yak I1S Hat: 40 I f G 17 10 t0 as 10 H >�psrtMero 0'F Ate�oet r,�r,us•e�r,r �•..,....__�.._.•�...,. , .._ —. .- ,.�..__...._... , . , - --t• -- NER1A Da1Se A LI%wi"14 a 1 = b .O haaktioe Leas A Total NOW 06 t 12 6 20 24 Fudwp She ) ^i/2" NFT lun4 0'N (V .=.y 44 26 29 2= !2 sous Nang 3/4" 09222) {Mit Wright 3011x. Pew Cad 18/3, SnW, 20' std. Dimensional Data Materials o Const ruction 0) ' ►A � 471{ (���� P K) 2. (0a"Wt &Vft s MY No�411e StsAldsss Sta>,1., my tlt fi� �t ,,.. •.n 3. NN (« arokuRan ptepaa Ldx* oR W46trk 01 Rletor "Oft cast koe pig c,etaw <oe qn ,b,,,,. Cmbg t.� on 1 �ffoh RIO epttibl" AM Mikas, Mledtaeldll Sal feat. Celiop /Gram ��' ° ••� Shoff 5941 Sod Mdr Aso" Stal Sprier WNW wss leas -N (3011 g Can 0 Slow Lower Row MN lowull -7� INdten Moto E ( ) Pl logs Eeg(ItaoTOd lltetatePfestk Fastolllri Stwwkts Seel Q 1999 Hydromak' Pumps, Ashirand, Cato. A! R' ti Ranved. I F L I'? O HYDROMATIC - YourAuthorizedlordDistributor - W-707" e 1840 Barr Rood AsWwd, Oho 44185 lol: 419.289.3041 Pox: 419.261 4011 f Web Sao: www.p ntuIrpwp.tom SALES OFFICES IN ALL MAJOR CITIES AND COUNTRIES Rem x: W- 02.8350 1208 6M� r • 'System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, T.L. Sinz Plumbing, 715- 235 -2644, or the St. Croix County Zoning Office, 715- 386 -4680, should be contacted for assistance. General Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1 . If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2 Install water- saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any.solids in the bottom of the pump tank must be pumped, and the filter must be back - washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area. 11. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and /or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 "ORIGINAL ' 1335 • Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 5 Division of Safety and Buildings in accordancg,with Comm 85, Wis. Adm. Code Certified Soil Testing C oun ty Attach complete site plan on paper not less thaff 8'/: x 11 inches in sk �a�I must St. Croix include, but not limited to: vertical and horizontal reference point (BM"irection and Parcel I.D. percent slope, scale or dimensions, nortlr�arrow, and lor�yp a distance tp'n0rest road. 034 - 1004 -95 Y . Please print`all inforp#� wed 8 y Date Personal information you provide may be'used for secondary purposes (Priv , s. 15.04 n - P roperty Owner i ;`� c rop Location Kessler, Mike S �Y 064 lot NW 1/4 NW 114 S 3 29 N R 15 W P roperty O wner' s M ailing Address ` " _ G OF Lot Block # Subd. Name or CSM 1181 HW 128 city State Z ip C 61ts r', Cit Village Town Nearest Road Glenwood City WI 54013 a'" 1 15265` -4248 Springfield WSHW 128 New Construction Use: ® Residential / Number of bedrooms 3 Code derived de ' flo rra GPD jj Replacement If Public or commercial - Describe: ; a a , �, wr2 ti *�G► v� s o Parent material till Flood plain elevation, if applica a NA General comments and recommendations: see page 5 a Boring # ® Boring a Pit Ground Surface elev. ft. Depth to limiting factor 28 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. 1 0 -3 10YR 3/2 - sl 2 m gr mvfr cs 1f /m .5 r 9 ✓ 2 3 -7 10YR 3/2 - sl 2 f sbk mvfr cs if .5 .9 3 7 -17 10YR 4/3 - sl 2 f sbk mvfr cs 1M .5 ✓ .9 ✓ 4 17 -28 10YR 4/4 - sl 1 m sbk mfr cs if .4 i .6 ✓ 5 28 -41 10YR 5/4 - scl /gr 0 m mfr - - 0 0 Boring # 0 Boring in 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/ t' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -3 10YR 3/2 - sl 2 m gr mvfr CS 1f /m .5 ✓ 9 ✓ 2 3 -12 10YR 3/2 - sl 2 f -m sbk mvfr gw if .5 .9 ✓ 3 12 -18 10YR 4/3 - sl 2 f sbk mvfr gw Inn .5 .9/ 4 18 -32 10YR 4/4 - sl 1 m sbk mfr cs 1 m .4 ✓ 6 ✓ 5 32 -36 10YR 4/4 f2d 7.5YR 4/6,5/8 sl 0 m mfr cs - .3 a .4 6 36 -42 10YR 5/4 - scl /gr 0 m mfr - - 0 ✓ 0 ✓ pr s Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L N ame ease Print) ig u um er Henry F. Grote 222774 Address Certified Soil Testing ate Evaluati�onucte Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 6/25/2001 715- 233 -0398 f Fu Property Owner Kessler, Mike Parcel ID # 034- 1004 -95 Page r2 of 5 ° • ` a Boring # Boring Pit Ground Surface elev. 99.6 ft. Depth to limiting factor 34 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. IEffWPDqE r• 1 0 -3 10YR 3/2 - sl 2 m gr mvfr Cs 1 f/m .5 ✓ 9 ✓ 2 3 -9 10YR 3/2 - sl 2 f sbk mvfr CS 1M .5 .9 V 3 9-15 10YR 4/3 - sl 2 f -m sbk mvfr Cs if .5 v 9 4 15 -22 10YR 4/4 - sl 2 f -m sbk mfr cw if .5 ✓ 9 ✓ 5 22 - 34 7.5YR 4/4 - sl 1 m sbk mvfr cs if .4 .6 6 34 -39 7.5YR 4/4 f2p 7.5YR 5/8,5/3 sl 1 m sbk mvfr CS - .4 V .6 7 39-49 10YR 5/4 f2d 10YR 6/2 scl 0 m mfr - - 0 ✓ 0 ❑ Pit Ground Surface elev. 99.6 g Boring 4 Boring # ft. Depth to limiting factor 16 in. $al Application Rate Horizon Depth Dominan Color Redox Description Texture Structure Consistence Boundary Roots in. Mu Qu. Sz. Cont Color Gr. Sz. Sh. 1 0-4 7.5� m gr mvfr Ft 3/3 - sl 2 cS 1f /m .5 V .9 2 4 -16 7.5YR 3/3 - sl 2 f -m sbk mvfr cw 1m .5 l .9 3 16 -31 7.5YR 3/3 - sVgr 2 m gr mvfr - if 0 0 0 ✓ > gr ❑ Borin g # Boring rj Pit Ground Surface elev. 96.2 ft. Depth to limiting factor 42 in. Soil Applicator Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 1 0-4 10YR 3/2 - sl 2 m gr mvfr Cs 1f /m .5 ✓ 9 ✓ 2 4 -12 10YR 3/2 - sl 2 f -m mvfr Cs if 5 9 ✓ 3 - 12 -21 10YR 4/3 - sl 2 m sbk mfr Cw if .5 .9 4 - 21 -30 10YR 4/4 - sl 2 m sbk mvfr Cw if .5 ,/ 9 ✓ 5 - 30-42 7.5YR 3/4 - scl 0 m mvfr Cs - 0 0 6 42 -52 10YR 5/4 - scl /gr 0 m mfr - - 0 ✓ 0 ✓ R gucowac on 5 is near 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 /00) Certified Sod Testing • Ploperty Owrfer Kessler, Mike Parcel ID # 034 - 1004 -95 Page 3 of 5 Fil g Boring Boring # � Pit Ground Surface elev. 99.6 ft. Depth to limiting factor 20 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz Sh. 1 0 -3 10YR 3/2 - sl 2 m gr mvfr cs 1f /m .5 ✓ .9 ✓ 2 3 -9 10YR 3/2 - sl 2 f -m mvfr cs if .5 ✓ .9 ✓ 3 9 -20 10YR 4/4 - Is 1 m sbk mvfr cw if .7 ✓ 1.2 4 20 -31 10YR 5/4 f2p 10YR 6/2 scl /gr 0 m mfr cs - 0 0 ✓ 5 • 31 -38 10YR 4/6 - scl /gr 0 m mfr - - 0 r 0 ✓ are s ❑ Boring # 2 Boring Pit Ground Surface elev. 99.6 ft, Depth to limiting factor _ 24 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 1 i 0 -3 10YR 3/2 - sl 2 m gr mvfr cs 1f /m .5 ✓ .9 ✓ 2 3 -9 10YR 3/2 - sl 2 f -m mvfr cs if .5 ✓ .9-/ 3 9 -18 10YR 4/3 - sl 2 m sbk mvfr cw if .5 .9 4 18 -24 10YR 4/4 - sl 1 m sbk mvfr cw if .4 ✓ .6 ✓ 5 24 -40 10YR 5/4 f2d 10YR 6/2 scl /gr 0 m mfr - - 0 ✓ 0 ✓ hotizon ►not ,m,m w < gr ❑ g $ Borin # 2 Boring pit Ground Surface elev. 97.4 ft. Depth to limiting factor 31 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -4 10YR 3/2 - sl 2 m gr mvfr es 1f /m .5 r .9 ✓ 2 4 -8 10YR 3/2 - sl 2 f -m mvfr cw if .5 ✓ .9 ✓ 3 8 -19 10YR 4/3 - sl 2 m sbk mfr cs if .5 .9 ✓ 4 - 19 -31 10YR 4/4 - sl 1 m sbk mvfr cw if .4 ✓ .6 ✓ 5 31 -40 10YR 5/4 f2f 10YR 6/2 scl /gr 0 m mfr - - 0 0 wwwo wa s * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD s < 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 /00) CertlfiEd Soil Testing �l VL t 44 two s� S c 0A = v � j,,a.r. aX4 Zo X wsµ.. / --h .4? jl.. n e .. ct- Ao %J1 Q6 � � i.WQ.. 0 1 $.S�! \ �•y�� o 1 r Kessler Sizing Recommendations Site has a three bedroom residence which also serves as a day care center; plus there is a seasonal butcher shop which is nominally in operation about 3 months of the year for deer processing. Estimated Daily Flows: 3 br residence = 3 x 100 gpd = 300 gallons /day , ¢� ID day care = 6 x 16 gpd = 96 butcher shop — 60 gpd* = 60 " Total daily flow = 456 gallons /day Design flow = 1.5 x 456 gpd = 684 gallons /day * Butcher shop flow is seasonal, 3 months /year, estimated by owner as 3 x 20 gallon sinks per day, and is presumed to be high strength effluent requiring treatment. System Recommendations: If total and design flows remain as descri bed, a septic tank should be installed for the butcher shop; septic tank effluent from the residence and the shop could then be combined and treated with an aerobic treatment unit giving a foot of soils credit for the dispersal system. The northern portion of the proposed system area has at least 20 inches of suitable soil between B -6 and B -7; with the foot of credit for treated effluent a 5' x 140' rock unit mound could be installed to accommodate all flows with 0.5' sand fill. If day care and butcher shop are discontinued, a 4' x 112.5' rock bed mound on 16 inches of sand fill could be installed to accommodate the residence with untreated effluent. If the butcher shop could be put on a holding tank system and the high strength effluent pumped and hauled off site — county board approval likely necessary — effluent treatment is unnecessary. If the butcher shop is discontinued or put on a holding tank, and the day care is retained, a 4' x 150' rock bed mound on 16 inches of sand fill could be installed to accommodate the residence plus the day care with untreated effluent. Without the butcher shop, using treated effluent, the residence and day care options above could be installed using six inches of sand fill. Theoretically, the butcher shop effluent could be treated seasonally with an aerobic unit and the lower strength, household effluent could be taken to a mound system without treatment. Greater depths of sand fill would then be needed. Page 5 of 5 i 06.02.00 FRI 10:71 F.4-1 715 386 4686 ST CRl CO ZONING 0 n1 r� . ST CRO COUNTY 4 SEPTIC TANK MAINTENANCE A GRBEM13Nr AND OWNERSHIP CERTIFICATION FORM owner/Buyer �' ` h T K Mailing Address I I Z' Property Address 4 (Vcrificatioa required from PlifininiDepartment for new construction) City/State %� c9 . LJ� Parcel Identification Number - S - p d 3 . Z LEGAL DESCRIPTION 1 Property Location MW .%, V1, Sec. T�N- R ',2._W. Town of " N Subdivision Lot # 1 Certified Survey Map # Volume __ . Page # Z Warranty Deed # _ __ Volume _ _ , Page # Spec house 0 yes © no Lot lines identifiable t yes 13 no SYSTE1Vi NANCE Improper use and mainterranceof 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 The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and b masterplumbor, joumcyman plumber, restdctedplamber or a licensedpumper verifying that (1) the on -situ wastewaterdispos s 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards sat forth, herein, as set by the Department of Commerce and the epartmcot of Natural Resources, State of Wisconsin. Ce� ti3n stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning days of the three year a . ration date. r 1 DATE SIGNAT F APPLICANT OWNER CERTIFICAnQN owacr(s) of I (we) certit� that all statements on this form are true to the best of my (our) Lvowledge. I (we) am (arc) the the property described above, by virtue of a warranty decd recorded in Register of Deeds office. � SIGMA F APPLICANT DATE 0.6•rt0 Any information that is mis- represented may result in the sanitary perarit being revoked by the Zoning Department. it00 « •+ include vYith thEs application: a oyof the f survey certified suey map if rcfemnce s man op in the warranty deed o p °� p M 4 ° ° I a D N @d �� m m� d 6• c o m C v � °? CL tn rn 'B j r_ '0 o 0 I I M N U N U) E .x d E ° in U) 0 LL d E T c 7 O T'D U) N y O c Z C Ul C ') 2 I c f0 LL c M U) M U) O C LL C co O N D O O 'D O` € N c c a cc c < d d O N N O d a Q J O.J ... 1.2 E Q N M d Cl) N z y a y E E L 2 Z p p N a m N d CL m M F- Z I 0 z :! t c a U) i N in I m m d d c U) cn o o a • d M O w O d O Y _o o Q ° ° v g z z O o zF-z LO z zo Y C d � io E C w m M U! }y Q — .° — d •D I V O d d � N 3 o 0 a 0 o a • � a a a I� co a a a a 0 m =3 c co d d w U .i U rn rn } rn oo oo > O = rn rn Z ° o 0 0 0 0 00 �l N O W N d N N N N N 0 0 - •O d o 0 .—.. O� = O M N co j O _M _ _ 3 m O - ;5 - 6 m m d 0 0 Cl) Q z to m p Q n U) m CD o = 3 :°+ U) 3 y O c N C y C I v O O ° O E -t P- O N N © �� LO W F" � c u a�i c m cs d o 0 0 0 0 o °) M U Ul (6 0 Vl C N N N N N N O O O M O O O ems-- W ` m d M C c0 O M N 1 = x,1 O N ,C Q W 2 a) O E N a j C > C= 0 W m M • O O Co = N 2 F Y M O Z '!l Y U) O V1 d R a d a �x6 a `ate L: IL CL 0) _1 A 00.x 0UU)0 0 UU)U I - - o O c 3 m c d L T A CD o V i o o� um, 0 m o m o W 00 m o C4 ° O' p CD �' n CD A N N CD M 3 O CD H OD N j CL G m � N W W n a 7 M p ° t0 d Co r :K N fl. d Q d N d d W v = w co 0 J� e c M o CD l C o CD C m b 3 n g 3 0 CD y m y N ao C Q� C D CD 4 co °' v> z I �p �p a CD CD m d s CD CO O a S se o m' a) _ f v m o N 3 n ° 0 00 3 O CL 0 Como Q O z CO CCD 0Np CD = 00 i p i N N o $Faa T n 0000 CL T z 000 o l I � o z 0) 3 0 s N N N Q D O O C� v O N CAD C�TD 0 W Cn 7 a °_'' A O-� tD O N IN A OD CL 7 n z .. z O D D o m O D m O C l�l Q CD n E5, CD �. :3 m c� CD C v � w w a a. 3 o 3 5 z CD z CD C6 y o m v oa p 6Zj 0 z N W W T W M cc o 3 C 3 z o o z cn cn I y z v a C.0 v I w c� D 3 o --rvrD a CD m 7 O CD CD a - n cD Oa,wu;n`� „ Z d O N C 7 C Z d o R � o CD CS N N 63 CD I N 3� m 01 N c n 0 m a a s m 0 fi S n °7 C,) d cCD 3. y a ° ?� C ,K CD p C 0 o C w p c 'm cj, o r m to a I C x 0 CD (n n C, N v cn o� ° o a j = b a CD q o c tA a I °o a. I ° o i ,�, REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEK Sanitary Permit_ &� State Septic NAME TOWNSHIP St. Croix County LOCATION " At Section # _ Subdivision SEPTIC TANK j Size = gallons Number of compartments Distance from: Well 41' fjO Building s 12% slope Highwater ..... PUMPING CH AMBER Size gatt s ump anu ac ure Model Number HOLDING TANK Size gallons Numbe.., f "' Pumper Alarm em Distance from: Well Building 12% slope Highwater ABSORPTI SITE Bed Trench Distance from: Well Building 12% slope Highwater — ABSORPTIO SITE DIMENSIO Width of trench S — ft Required area ft. Length of each line , ft Depth of rock below tile in. Number of lines j Depth of 'rock over tile in. Total length of lines �G� _ ft Depth of tile below grade in. Distance between lines ft Slope of trench in. per 100 ft. Total absortption area ft Type of Cover: PI D IMENSIONS Number of pits Gravel around pits yes no Outside diameter ft Depth below inlet _ft Total absorption area ft Area required - -- "! ^ ^ ^�, ft INSPEC Y TITLE APPROVED _ DATE_ - -- REJECTED DATN:_ _ _ -- - - - -- - 198_ REASON FOR REJECTION V * • �, �"�.. ` I •yi � r ! � ' � *} + ' ., `1 . ,,, ., Wisconsin Department of Industry, PLR -1" - INSPECTION REPORT_ _ Labor & Human Relations Safety & Buildings Division Bureau of Plumbing, Platting & Fire Protect on ame of remises Date Plan i.P. No. -lb - <g street_ oun ria a ary Permit OWY-1. N M aster um er Name laress t l�)A NE t L- e Nt7 Journeyman Plumber Address Owner t✓pt�' � �'tJ Add ress . r I €Ff TI C ' (A t,) k d it) Fir L - 3 32o T iscusse wi g ure )See Attached. DILM-- SBD= 6192(N.09/80) Si gnature of s . um ing Sap. U - Spec r?ifRf White- Inspector Yellow -Local Inspector Pink - Plumber or Responsiblff Party Green ner �. i lo , ' ; l X • vC, 1a A,- ... off.. , -._- rte..... _ ,.. .._ a. ...:- ...,.. TRANSFER FORM SANITARY PERMIT r� c PLB 6 7 — State Permit # Sanitary Per it County Sanitary Permit Transfer Date Original Permit Issuance Date A. Property Location: 46L '% 1 /,, Section , T Z --; R . E (o W Lot # City Subdivision Name, Nearest Road, Lake or Landmark BLK # Village Township ds� B. TYPE of Occupancy: ,Commercial Industrial Other (Specify) Single Family L- Duplex No. of Bedrooms Variance C. SEPTIC TANK CAPACITY —O c ° Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab Concrete Poured -in -place Steel Fiberglass Other(Specify) New Installation ✓ Replacement LIFT PUMP TANK /SIPHON CHAMBER Total gallons Prefab Concrete Poured -in -place Other(Specify) D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate aA 'Total Absorb Area 5 sq. ft. New Replacement Alternate (Specify) Seepage Trench: No.Lineal Ft. Width — Depth 3 Tile Depth(top) d No.'Trenches Seepage Bed: Length Width Depth Tile Depth(top) No. of Lines Seepage Pit: Inside diameter Liquid Depth No. Seepage Pits Percent slope of land Distance from critical slope E. WATER SUPPLY: rivate ❑ Joint ❑ Community ❑ Municipal Present Sanitary Permit Holder Phone No. Sanitary Permit Transferred To: Phone No. y Name �- Name 7A) ct.e4 Address 1lQo 1 Address Zip Zip I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with section H 62.20., Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH -115 prepared by the Certified Soil Tester and /or any additional soil tests that may have been required. Plumber's Signature ,�{,/ MP /MPRSW # , Phone Plumber's Address Information obtained from (owner or agent) PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh- bor's Prooert . If well has a r' I indicatp- Signature of Issuing Agent 1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH 2. State (White copy) 4. Plumber (Green copy) P.O. BOX 309, MADISON WI 53701 : APPLICATION . 1 PA[�7I4ENT OF SAFETY &BUI LDINGS !sTRY, FOR SANITARY Dlvlslo LABOR AND PgRMIT PX6. BOX 7969 HUMAN RtLATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawr}twscale, Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by s Mastdr Plumber, the date, signature and license number must,be shown. The owners copy or a legible reproduction of the soil test report `must -be included. Property Owner. Mailing Address: Property Location: Siij I .... p.or Township: County: '/4 ' /aS i T N/ R IW1 W — /i° c✓ S G Lot Number: Blk No.: Subdivision Name: Nearest RodK, Lake or Landmark: State PIAIL LD, Number: (if ate,) . TYPE OF BUILDING Nu mber of Public F7 Variance El Other (specify)* f 'Belfaooms :. 1 or 2 Family * State Approval Required. TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLA$+S NEW n,JLJEPLACt ER GALLONS OF TANKS CONCRETE PLACE INSTALLATIO cify) SEPTIC TANK CAPACITY . HOLDING TANK CAPACITY LIFT PUMP TANK /SIPHON CHAMBER MANUFACTURER: � gi 4 EFFLUENT DISPOSAL S3fSTEM PERCOLATION R • E ABSORPTION AREA (Minutes per inch; PROPOSED (Square feet): 29 New ❑ Replacement ❑ Experimental ❑ Seepage Bed d .Seepage Pit ❑ Alternative (specify) Same Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint. ❑ Public I, the undersigned, hereby assume responsibility`for installation of the private sewage system shown on the attachec(iplarts ' Name of Plumber: Signature:RSW No.: PI Number. Plumber's Address: Name of Designer, COUNTY /DEPARTMENT USE ONLY ; Zan ur of Issui A nt: Fee �} Date: y� APPROVED San itart+ amnit�Nymber: ❑DISAPPROVED " f ; 'for Disapproval• 'Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- `' stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White- County, Canary- Bureau of Plumbing, Pink- Owner, Goldenrod- Plumber DILHR -SBD -6398 (N.03/81) i , h c _ f G `TiGa 3 M' Im - a ft4 ;',� a,r4� , •.� ''.f , .fit.# z , . Y: i r TRANSFER FORM �� SANITARY PERMIT State Permit it Sanitary Permit # County Sanitary Permit Transfer Date Original Permit Issuance Date A. Property Location: ' /, /,, Section , T N,R E (or) W Lot # City Subdivision Name, Nearest Road, Lake or Landmark BLK # Village Township B. TYPE of Occupancy: Commercial Industrial Other (Specify) Single Family Duplex No. of Bedrooms Variance C. SEPTIC TANK CAPACITY Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab Concrete Poured -in -place Steel Fiberglass Other(Specify) New Installation Replacement LIFT PUMP TANK /SIPHON CHAMBER Total gallons Prefab Concrete Poured -in -place -Other (Specify) D. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No.Lineal Ft. Width Depth Tile Depth(top) - No.'Trenches Seepage Bed: Length Width Depth . Tile Depth(top) No. of Lines Seepage Pit: Inside diameter Liquid Depth No. Seepage Pits Percent slope of land Distance from critical slope E. WATER SUPPLY: ❑ Private ❑ Joint ❑ Community ❑ Municipal Present Sanitary Permit Holder Phone No. Sanitary Permit Transferred To: Phone No. Name Name Address Address r Zip Zip I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with section H 62.20,, Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH -115 prepared by the Certified Soil Tester and /or any additional soil tests that may have been required. Plumber's Signature MP /MPRSW # Phone Plumber's Address Information obtained from (owner or agent) PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord with H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigh- bor's ro ert . If well has of been r'll indirate i 1 1 TT 1 Signature of Issuing Agent 1. County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH 2. State (White copy) 4. Plumber (Green copy) P.O. BOX 309, MADISON WI 53701 DEPARTMENT OF APPLICATION SAFETY &BUILDINGS INDUSTRY FOR SANITARY DIVISION LABOR AND PERMIT P .O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: " e w a/G /1 Property Location: Ci+M/g4or Township: 'County: '/a ' /aS /T,2 NCR 1W) W -/� s7,� Lot Number: Blk No.: Subdivision Name: Nearest Ro , Lake or Landmark: State Plan I.D. Number: 5 r2-2 » (If assigned) TYPE OF BUILDING Number of ❑ Public ❑ Variance* ❑ Other (specify)* Bedrooms: 06 1 or 2 Family * State Approval Required. TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK /SIPHON CHAMBER MANUFACTURER: IV I e. 4, EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): A New ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) 0 Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): 0 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signature: 41119MPRSW No.: Phone Number: G S 1-6-Ifo d' Plumber's Address: Name of Designer: L o 0 COUNTY /DEPARTMENT USE ONLY ign tur of issuing A nt: Fee• Date: Sanita Permit N ber: Q`� APPROVED D _ �O ❑ DISAPPROVED ea n for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White - County, Canary- Bureau of Plumbing, Pink - Owner, Goldenrod - Plumber DILHR -SBD -6398 (N.03/81) I r .1'15 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES 8 �� DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALT @� f P.O. BOX 309 � MADISON, WISCONSIN 53701 �(.' �F It% REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: Nk' /4, /vim /4, Section , TAfN, RZ�2_1111W) W, Township or Lot No. , Block No. County d �� Subdivision Name Owner's Name: .�., p Mailing Address: N 940 TYPE OF OCCUPANCY: Residence — No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW G ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS y — .- 7 -d PERCOLATION TESTS SOILMAPSHEET �_b SOIL TYPE Ax� ••�- PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE OLE AFTER INTERVAL NUM- INCHES THICKNESS IN INCHES SINCE HOLE H MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 E 3O AL O / iV SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) d'T ' 8' r '/,L, s y s / y ., c, V .� S /i Ii G , p "L PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. Indicate scale or distances. Give horizontal and vertical reference points. Indicat sl . D ;VC It a - o a ll W / I p ' i N fy 2 D �8 I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct . to the best of my knowledge and belief. Name (print) fit- e / Certification No. +� Address �- GG N O e, / f✓ �v/ Name of installer if known e / CST Signature l" -- LOCAL AUTHORITY i .� .� �. �, _, ', � - . ,, - �. _ •� , ,� .3 -, . _ . ,. � � , ,� i r ". i a;,. i 1 � t �� � If � . _ .. I � � `� �� I - .� 1 • Y\ - ; - ,- -� / 0� - H r /y Mobile HJoMe y y Z V %0 0� pi p e - TNve,gt r Mp3'�90 I - t _0) LU m w L 7 Q. c o 0 o m Y a o f m o e— o m ° Q 7 N 7 m 00 �n E E d E E 00� W E Y C F cu H = dr = c a 3 = E Q '� O O ` O U O C 0 com -(u ILI" O ` C C > -0 N Q y N O ui 0 O a U E a o N o .° .Z ' 3z m •- E ._ /Y Z Ln a Cc F O Q CL > 20 7 E EL d-f � O l. _ � N ~ O a 7 W m y m Ln YO = C m O L C O �. p`\ LO H N H \ w ui r yQ 3 �_ �u dQ c o " ui Ema `_• H3 EY �d t u �— OC ' o E o ° LtJ o 0 o y a o m a3 o f Q O ID d m p > = 7 = `• L m Q ay °� `s o M w 3= w J Q a� � o F'.. c m o ` U m ° - m =E a I m Qm W L y L L O L N L Q w a y ui ~ O ~ a 7 V" cr m m H y ., __ _ Z d E > O O O d w Z � �- H r Q � U w Z U — C) Z LL � f-- - O O o w Z F-- U C/) z z rr LL Ir D Cl) Cr) p� o Q Z" o O ) C-3 Ljj z a: ( I Lj F— o w L� Q - _ Z) Z � U U < � F- oC O O D cr LL sox w w U) w m — U) CL x 2c F- w 2c O O ` — F— M L 2 p m 0 W co (o w 2 Z o- Cn F- Q �F F