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HomeMy WebLinkAbout038-1033-40-000 :Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safet, and Building Division INSPECTION REPORT Sanitary Permit No: 487962 0 + (ATTACH TO PERMIT) GENERAL INFORMATION tate PI n you provide may be used for seconds purposes Priva Law, s.15,04 1 m 6TI No: Personal information a S3 r " - - s -I b. � Y Y secondary p P I cY ()( )1 Z Permit Holder's Name; i Village X Township Parcel Tax No: C ty g p Van Dam, Gerald I Star Prairie, Town of 038- 1033 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: / I Section/Town /RangetMap No: tJ� -p dD •D �,xrG 08.31.18.150E TANK INFORMATION ELEVATION DATA TYPE t� MANUFACTURER `�' � CAPACITY STATION BS HI FS ELEV. Septic , n! 2 Benchmark Dosing � Alt. BM �'�� � O • �1 Aeration Bldg. Sewer %0 VA&W Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION 1242 R/•.SY TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic >,SO 33 ,�� �- Dt Bottom 41 - Dosing 4 u �� / Header /Man. 3 l `(! Aeration Dist. Pipe - � - Z' (m Holding Bot. System L[- hl pp- � Final Grade ,t 7!7! PUMP /SIPHON INFORMATION '"' ` JO It -v Manufacturer u ' - GPm St Cover ti � GL- s-f— P1i�e. • `O d Number Qtj (J 2 — TDH Lift Friction Loss System He d TDH Ft / /• } 12 -`F1' 2.9 -t 9 • 3iP . (0 Forcemain Lei I Dia. rl Dist. to Well ' p p • 7 r SOIL ABSORPTION SYSTEM .q� - 1•� iRK.�/' The -,a REN Width r Length 1 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Dept DIMENSIONS O 1 ') SETBACK SYSTEM TO P/L J BLDG WELL LAKE /STREAM LEACHIN Mamf jjrel . INFORMATION I CHAMBER OR Type Of System: , 5V laz ! 2 l UNIT Mode er. DISTRIBUTION SYSTEM Header /Manifo d Distribution x Hale Size a x Hole Spacing u Vent to Air Intake rr Pipe(s) tt / Length Dia 2 Lengt Dia Z • O Spacing !3 2 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil Yes No Yes No p COMMENTS: (Include code discrepencies, persons.present, etc.) Inspection #1: Inspection #2, d0 Location: 2251 95th Street Star Prairie, WI 54026 (SW 1/4 NE 1/4 8 T31 R1 8W) NA Lot Parcel Noli 0 E � 1.) Alt BM Description = s • it • wKMkaL CKW 2.) Bldg sewer length = ... 10 r ale AV - amount of cover= > 3 vLk «x- � V-zi- Plan revision Required? ? i ', Yes No � P � ;- Use other side for addit information. i • J toes signature Cert. No. to � -J o SeFyF SBD -6710 (R.3/97) "���'C �, �• S II Safety and 8't *@li Division County 201 W. Washing Ave. P. , � r o f lvi sc ons r n Madis � itary Permit Number (to be filled in by Co.) f Depa rtment of Commerce 8)266R@' i,�,ftED S Plan I.D. D. Number �q� to Sanitary Permit Applic: In accord with Comm 83.21, Wis. Adm. Code, personal info dide' S • r'� may be used for secondary purposes Privacy Law, P je t Address (if different than ma iling address) I. Application Information — PleasePrintAllInformation ZONING OFFIC * 225_J Property Owner's Name e^^ Parcel # Lot # Rlnrk # ti7 rc� l4 u n �t n► kV'` -9 '/03 -� -c - cco Property Owner's Mailing Address Property Location �V , �V.., Section _ City, State Zip Code Phone Number c II. Type of Building (check all that apply) S Subdivision Name CSM Number J1 or 2 Family Dwelling — Number of Bedrooms �vl � u ❑ Public/Commercial — Describe Use ❑ State Owned — Describe Use ❑City_❑ Village own ip of � � ,V , �— III. Type of Permit: (Check only one box on line A. Complete line B if applicable) V A ' XNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) vi O' Non — Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil AAt -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland El Pressurized In- Ground ❑Holding Tank ❑Peat Filter El Aerobic Treatment Unit ❑Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Cham r ❑ Drip Line ❑ Grayfl -less P'Rq ❑ Other (explain) V V. Dis eirsal/!'reatment Area Information: 10 K l a � — - ke Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation ` / I VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Uni fYJ�� j Qi'J Concrete Constructed Glass New Existing W Tanks Tanks ptic Holding Tank 'X / K Aerobic Treatment Unit Dosing Chamber C l( VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum is Name (Print) ! _ Plum s ignature MP/MPRS Number Business Phone Number Plu is Address (Street, Ctty, State, Zip Co VIII. Countyfflevartme Use Only Approved ❑ Disa Sanitary Permit F (includes Groundwater Date Issued Issuin Agent Signature Stamps) Surcharge Fee) 3/ � ❑ O ven Reason for Denial IX. Condition Approva n SYSTE R: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained _ �p as per management plan provided by plumber. .d. 6-" VkoC 2. All setback requirements must be maintained kto, —S l� 'f t5_ as per applicable code /ordinances. � S vuo�� Attach complete plans (to the County only) for the system on paper not less than 8112 :11 inches in si i S r2 La k l U SBD -6398 (R. 01/03) S� _ CAJs.` I CLX i /CONVENTEIONAL PLOT PLAN ' Gerald Van Darn ADDRESS 2251 95th St. New Richmond Wi 54017 NE 1i4S 8 iT 31 N/R 18 W TOWN Star Prairie COUNTY ST.CROIX M ELEVATION 99.0' 4 BEDROOM . AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # of chambers none BENCHMARK V.R.P. Top of Power Box ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark 600' Property Line Scale = 1 /4" = 10' 350' Pro 4 Bedroom House .M. 130' Grading is to be done to divert run -off away from Well system B-1 100' B -2 98 , Huffcutt Combo Tank >100' to Tank is to be properly 95th St. 97' bedded and provided with lockdown covers B- with approved 8% Slope I warning labels Area 15' below system is Squaw Lake 230' to remain undisturbed Proiaerty Line not to scale ~ Safety and Buildings 4003 N KINNEY COULEE RD coi'nmerce.wi.gov LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 i scons i n www.commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary October 25, 2005 CUST ID No. 220527 ATTN: POWTS Inspector BYRON BIRD ZONING OFFICE BYRON BIRD JR. PLUMBING, INC ST CROIX COUNTY SPIA 896 68TH AVE 1101 CARMICHAEL RD AMERY WI 54001 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/25/2007 Identification Numbers Transaction ID No. 1208453 SITE: Site ID No. 706390 Gerald Van Dam Please refer to both identification numbers, 2251 95 Street above, in all correspondence with the agency, Town of Star Prairie, St Croix County SWI /4, NE1/4, S8, T3 IN, RI 8W FOR: Description: Four Bedroom At -Grade System Object Type: POWTS Component Manual Regulated Object ID No.: 1046791 Maintenance required; 600 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade; System: At -grade Component Manual, SBD- 10570 -P (R.6/99), Pressure Distribution Component Manual, SBD - 10573 -P (R.6/99); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the approved plans, and with publication SBD - 10570-P (R. 6/99) "At -grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems ". • The pressure network is to be constructed in accordance with publications SBD- 10573 -P(R. 6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ". C ondit • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area.` m Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and p s PTMENT I k I dispersal are prohibited. CF • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption SEE uORRE area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county project where this ro'ect is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. ' BYRON BIRD JR Page 2 10/25/2005 • Inspection of the POWTS 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. Stat • Comm 83.22(7) A copy of the approved -plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 U Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789-7893, 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 I I Cover Page Byron Bird Jr. Byron Bird Jr. Plumbing Inc. 896 68th Ave Amery Wi 54001 715- 268 -7616 Date: 10/12/05 Owner:Gerald Van Dam Location:SW1 /4 NE1 /4 S8 T31 N,R18W 95th St. Star Prairie System type: At -Grade Manuals Used: At -Grade Component Manual version 1.0 SBD 10570 -P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01 /81) Page# RErr=n rr_ r� 1. Cover Page OCT 2. At -Grade Plot Plan 2005 3. At - Grade Cross Section SAF 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -8. Maintance and Contigency plan 9 -11. Soil test Byron Bird Jr Signature License number 22527 �PONDENCE PLOT PLAN PROJECT Gerald Van Dam ADDRESS 2251 95th St. New Richmond Wi 54017 SW 114 NE 1 /4s 8 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 99.0' 4 BEDROOM CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1 255 LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # of chambers none IL BENCHMARK V.R.P. Top of Power Box ASSUME ELEVATION 100' Filter Zabei A -100 ❑ BOREHOLE U WELL *H.R.P. Same as Benchmark 600' Property Line AL Scale= 1/4" = 10' 350' Pro 4 Bedroom House .M. 130' Grading is to be done to divert run -off away from Well system B-1 100' B -2 98 , Huffcutt Combo Tank >100' to III Tank is to be properly 95th St. 97' bedded and provided with lockdown covers B- with approved 8% Slope warning labels Area 15' below system is Squaw Lake 230' to remain undisturbed Property Line not to scale y3. . =;a — Dui rjt B > cJ M f TUP w— UPS �— �tSTRi�Ttcrwt LIk ?�RAt 1(Y STA$tLiZ` 0= `cltrt�r� Y 5' 1/6 B � ll6B 112 B A : l- L FAL. —CELL Of v+l = Ft. Fabric Distribution Lateral �.-- -Soil Cover We 1 1 Zr� 1't.av+tEty LaUX 5` A "2c ' 5 , Plan View and Cross saection Unit with a Single Absorption Area on a Sloping Site �tiL,�it�YuR� Page Of Distribution Pipe Detail for Lateral Metwork C �9 to sC- • TuRM -UP CLERT -IOu ) PVC Force Ma PVC Distribution Pipe P * Last hale Should Be Next To R Hole Diameter L/22 l Diameter Inch(es) Inches Latera - X �-`'� Iirfc J/ Y Inches Force Bain Diameter Inches `� j of moles /Pipe �2 Invert E ievation Of Laterals >> Ft. Signed; License der: Date: j . S£PTZ£ TANK =�31�1P CliM gt'.R CR�}SS SEC1'IG;� ANTI SPECI'FICRTIt3Ke ATWRPRWF APPROV VENT PIPE IZ" '� aBD�£ GRADE jUNCTII14 $OTC MANHOLE COVER ? j `1tOM DOOR. WINDOW OR WITH coNDUIT 1d/ gAD'j,I3CK 6 FRESI= AIR INTAKE �� �mr ^ e� — WAF,biING i NEU r GRADE 6 V �,' ' ,,,, - -..4 MIN- ............. le INLET � GAS- WATER TIGHT S£ALS � SAL � ` - Jt INTS VIT PE APPROM $ SOLID SOIL APPROME gIPE 31 C. FF Off, SOLID FT. --�--- SOIL PUMP O E-f- EL - � a APPROVED ZEDIDING UNDER TANY, comcRE'TE P AD SPErZFIC.tiTIONB � - ssEPTIC DOSE f - CA 2+ DflS£S PER DAY iANX MAbrtjrACTUP_f_' :: ,.r.� DOSE v owmE �NC�DI3�G / 7 5 GAL - GAL. F LOWBACIC : GAL _ � K SIZES: DOSE � . O?SE ��dJ �NCHE$ s V61 � :� �.���„ �PACIT�F:B mxwjrAC = � z INCHES T�3RER AI.A MODEL USER : ` �' l3� , l � L 7 SJ �L. SWITCH / C IiCMES c MOD EL I 1IR 15.23 SWITCH TYPE:-- � ALARM wI'RING AS PER � FEET REQUI�tE 3 DI SCHPiR�aE RATE !' i�NB DI S'�I MJ - ON ;?IP£ - - �_ FEET pump of F - r C� �' FEET VERTICAL DjFE�LiRC PP Y PRESSURE`�t1Qi3 -� I _ - FRICTIf3N CA E ' MINIM` '�j`I'�`i1, pY f f �.E'T FtIR��MRI� � �� . � �� WIDTH DI�ET� LENGTH � f � INTERNA Dlt4ENSION PUMP T�� K : LI� U I D LICENSE MBE ", 318s ' - TOTAL DYNAMic;r.ERD/CAPAC!lY PER MINUTE ~ HLAD CAPACITY CURVE EFFLUENT AND OEWATER r „ MODEL 152/153 MODEL 152 1 53 j � g i 50 Feet Meters GOT Lifers Gn!. 1 Liters 14 5 1.5 6y { 261 t 77 291 153 14 3.1 61 231 70 1 265 71 12 - 40 1 52 15 4.6 i 53 201 61 231 20 _ 6.1 1 44 167 52 197 s 30 7 z5 7.6 34 129 4 159 v z 8 30 9.1 2 87 33 125 t ! r n { 35 1 0.7 -- _.. 22 85 s 40 12.2 -- 42 O r i ; � loam 4 Lock Valve: 8.0 F.. t.6m 4;.0 Ft. ( .. ) o�.saa 10 t 0 80 100 �� • 20 40 60 {� t i` GALLONS LITERS 0 80 1 fiD 240 320 - 3 27/32 V FLOW PER MUTE 27J32 l J CONSULT FACTORY FOR SPECIAL APPLICATIONS s available. 3 27/32 — - Timed dosing panel ' Elearical alternators, for duplex systems; are available and supplied with an alarm. ! ! - Variable level control switches are available for controlling single phase systems. _�____ -- DouDlepiggyback variable level float switches are available for variable E ! � level long and short cyde controls. Sealed Qwilt -aax available for'outdoor instal lations. See FM1420. • Over 130 °F. (54 °C.) special quotation required. i 19?t953'Serses " ! n t 53 1) Cants Se! � t Model Yofts Ph tdoda Am Stm lex Duplex Mod M 1 N O 8.5 1 2 or 3 115 1 i ^ —L SN152 _ 115 1 _ &R _ 15 laduded 2 or 3 — 1 E152 230 1 Non 4.3 1 2 or 3 SE152 230 1 Auto 43 1 S 2 or 3 M153 115 1 NO 10.5 1 2or3 SELECTION GUIDE 8N153 115 t Auto t0.5 lndu ied 2 or 3 E153 230 t Non 53 1 1 -- Tor 3 1. Single piggyback variable level float switch or double Ptilybadk variable level float 86153 230 1 Aum 5.3 lnduded 2 or 3 switch. Refer to FM0477. n 65AUMN71 2. See FM0712 for correct model of Ele'lclrical Aitemator E-Pak. All insta Won of controls, protection devices and wking should be done by a qualified 1 Variable level control switcb 10.10225 used as a contr01activator. Sped' duplex (3) ucomW e*01cian. All atactricai and safety codes should be followed including the most" or (4) float system. recent National Electric Code (NEC) and t oOccupatioaa l$W* and Health Act (05HA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. b+1AlL To: P.O. BOX 16347 Louisviae,KY 40256 AteU�dmof.. SMP M. 3649 Cane Run Road _ Q LouiWfe, KY 40211 -1961 AMU Aff 1502) 778 - 2731.1(800) 928 -PUMP frtt�rJlnvtrwxaelter cnm j ll"W rAa. FAX {502} 774 -3624 @ Copyright 2000 Zoeller Co. All rights reserved. - UAL & MANAGEIVtE PLAN N Pa4e w POWTS O �ER'S � SYSTEM SPEG[FtCAT1014S $eptic Tank 03110* aZ s s'' at II NA F" INFURMA!!0N n� s Tank Mangy fl l rA oar - , Petrie- Efllue d Filter Maw PµRA Q NA o i�G�� �Itenf �f D M OO' �� � NA CapaC jiuumbber of BedM0ff* r NA Manu Number of Comma Units p Tank WC.OR � Q Esdrtr d taw (�) C : all - t'umt? '� 2 - a NA !fin t oar (P� 0. (striated x t- , d Pump Model Una d NA Prey p Peat Faber Soli sOt Monthly average' C SaridrGrB+� t� D Wetland m fl u uent Quaff inch 53U rn9n p iutechantcat Aeraf on Cl ether_ FWF, G} On & Grease Deemand (ODs) 15220 mg/- Q Disinfeol)on soSfds {t'SS3 S1 S0 m m e" is o Ge(g a tn-ground (pressur¢ed) PEffl B ODs) M91L 9 L] t -gre ad {gravrfY) um, p Mound abchemit l O ( and So {�SS} 530 Mg/L p pn 'ne D Other Total Susp X10` cfuf4 Wml �wastewamr Few CoQform (geom etric mean) varaes ty pr�i for doMBWC ( Y . �ameter tan kelrtuea t,Aaxin► truer pa�ide Sire .� va lues rp�'wr wash Servlc$ Frequency MMNgNCE SCHEDULE s) (Ma yjrnurn 3 yis -) Servitx Event c C1 month At least once every uaTs an ird (ys) of tank volume inspect condition of tanks) a anti scum eA When combined sludge c - mn 0 oths ) (Maximum 3 yts PUMP contents of tanks) At least once every 9 r(s) inspect dispel cel!(s) At least once every ! E3 man s} O NA r � rt7Ontl� Clean o fnuent Mar At least once every s) p NA nvtals & alarm p Mon inspect t ip PUMP as At least once every Q m onths E3 Year(s) II NA Flush tats 2md pressure test At least once every Q rn0J 13 Y��s) p NA Cowr At least once every older= one of the fcltoarin<J lioertses or MAINTENANCE IMMUCTIONS c�eris shalt be made by an individual Carrying pector; POWTS Mainta"mer; SePtVe for broken is Of txa S plumber, r Plumber Restricted Sewer; O of WK {S) toI � � an beck up ns Master ns mu st include a visual Inspecfl Ser'ddnS ' Tank ins ur a the volume of combined stu �� �� to �� me eftfue,nt levels hamfwaM i Y ally cracks "or teaks. Ttie dispel Ott {s) st►aii be of effluent on the round surface, The pandin9 cu g of effluent to check air the BondQe- ding of effluent on life g �. piles and for any P� tian of the bwi regu� in the obseiva condMOfl and regrsues the Immediate notifx� or more of ft tank volvMe, the ground sum May indCate a lb ing min any tank eci�s ane -third f� � m ac�cordanae With CM NR r #ion of s ludge acrd sx to eitft and disposes When the combined axon' removed by a Septage Servicing opefa t n� of the tank shall be r+em - t t�P°n�ts and any 113. tn Administrative Code comp onents, pretr� POWTS Maintalnet. of effluent rlltets. meChanic� °r PreSSUrized pOWT S comp r r ned by a � nt. Efts s at intervals of 12 months or less shall be A� o f campleetion of any Service e v en t other maintenance or trwfftring regu l a tory allthOdty within 1() d ays A report shag be Pf�� to the Io�al t'e<3 Of oil products IN other START UP AM3 OPE ZA71ON PONS check.treatment tank(S) for thO Qr�� c�ncerlbat� � For ttsw constlIC f to use Of the damage the dispet5ai cell(S). If high chiefs that may impede the treabnent proces $and/or Tabor prior to use - � l�Ye the pOntsnis of the tariic(s) removed hY a septage servicing o � - l - Page s - 1 , condit ons are frozen at the ineitrainre surface is resorted theSys � up shall not s�cwr�� � � awe rYOrm t n9 the a3 hFghwatez �etirets. n Power excess Dui 9 Per ies pump to the ds � y l ce 9s) in one large dose. over co p � m � by a e �rwrt�i tie -r avoid this situation have the cxo PUVIt M3ltrtairtecb� badoW or - power to 3tae effluent pump Sep ge g D1 Pd '6 . � to restore normal levels lrin ifie pump tank mist in ff=ul tlY r'g and drsp this. Do not drive Or park over, fu oftrwtse dlsb�ub or compact, Do ditye or park v over Wks mound or at -grade sal abssdsrp 4n area - Do area � 15 feet down slope 'of a� rfoffnanC a and pig ft � Red or erunlnatratl of the follow ng from the wasWW*er sttz?aln may improve #hem. dot fi)s cotton s� �garette butts condomsswabs, r tlerbitides; meat Of the POltifr5 arltz6rlo6GS;Y1 ; fruit and vegetable Qee�ngs: B d . � dt'an {scanP pump) . scram rttedrens: sanry napkins; tatriPons arm r bt3ne ASAN004MENT gn out o f service the fdifaw steps strati $e taken to insure that the WWn the POVVrS fails Wwor is petmaner c orn a with ch - Comm 83 -33. Wrsoonsin Admin�tive Cale system is .otter abandoned ned in Q nnec: d t t tanks and pits shall be disconnected and abandoned pipe g Servicing Operator Alt piping tits shall be r emoved and properfy disposed removed "and the vaed space The of an tank s end P After pumping, a ll labia and P shall be excavated arYQ removed or their oov e Bred Wfth Solt, gravel or encoder inert $olid rmateriaL C ©iQTINGENCY PIANI the f measures have been, or must be taK ' tta Pie a code if the POWTS tans and cannot be rePai compfant repbeement system t area has been evaluated and may be utB:zed for the location of a reP[aoem�t should not sod 0 A suitable fe� a repiacerrsent area should tae protected from disturbance � compa absorPWn � ii ed setbas ks from e)dsting and Proposed srrucfure, tat Fines and _ Failure to ablLs be infringed upon try Diu protect the replacement area jnrrll result in the need pt with the rul if] effect at that time tablish a suitable replacement aired Replacement systems must corrzply the advances in POWTS p A suitable replacement area is not available due to setback a il ridlor soli funit s_ Barri logy a holding tank may be installed as a last resort to replace fa--- f P01N1 S_ to identify a suitable repiacernert area Upon a'Iure Of the POWTS a so"-m'vd has not been evaluated t area is available a site Upon must be � to locate a suitable replacement area If no rem n tdirtg tank mazy be installed $s a last resort to replace the faired POtI'+rl S_ removal of the bkmvt at " Mound and at -grade $ort absotpWn �s may be reconstructed in place following the such , Recxmstn ns of such systems must comply with the rules in etfii at that time <<VVARN[NG>> GAS N SES ADdOR iNISUFFICIENT OXYGENt. SE "C. PUMP AND OTHER T T ENTER A SEPTIC, PUMP REATMENT TANKS HCAI GOI�rTAtNi LETHAL CIRCUMSTANCES. DEATH MAY OR OTHER TREATMEN'E TANK UNDER ANY RESULT_ NO RESCUE OF A PERSON THE INt'r'ERIOR OF A. TANK MAY BE DiFFICUI.T OR IMPQSSIBd.E. ADOMOMAL CCIlllOWEEKTS poW S I.N1STALLER POWTS NLPJNTAINER 1 ~� game , c� I I/ . Name t i �t �1 Phone Phone ) J = c i - ' Z SEPTAGE SERVICING OPERATOR LOCAL. RE1;ULATC}KY AU7N4RU Y Name / l� �, 6 ' Phone 7) s t�' Ptlone Tti was araaedr Cry ttre st>its of the geed Lane. Marquette and wausham County Zc1ntng aril S aru't ZM i This doartmt meets u mk"w» mq+i m0enft of cit_ (door 83M ( jXdj gt) aM 83- 54(1}. fzl & (3). Wisconsin Ada*115*3M a Cede the of this doaowt does M guarantee the perfwnance of the POWrS. " GUnrcriotl N :.sMnsin Department of Commerce SOIL. EVALUAI&N R Page of Dr Asior: of Safety and Buildings in accordance with Comm 85, Wis. Aga Code Coun nfBC, complete site plan on gaper not less than. 8 'ill x 11 inches' include, but not lim !ed to: vertical and horizontal r @ference point (B ), din Parcel J.D. percent slope scale or dimensions, north arrow, and location and d' lance to nearest road. Please Prat all W, onnation. �; C A ' ev' Date Personai infcmatior: you provide maybe used for secondary purposes (Priva Law, s. (m) . U ©�, 3 j s--- t - vYerty Owner ; iC riev C of 3G1; S T N R /'E (. °Ar roperby Owners Mailing Address � Lot # I Block # Subd. Name or CSM# , } l St Zip Code Phone Number p City Q Village ,T own Nearest Road e ,N Co - :stru io: �� Use: ; , Residential /Number of bedrooms Code derived design flow rate 15:: G2 S2 GPD epiacer. Beni { Public or co nercial - Describe: 5 =r'nf raesial i G. ! Lal it Flood Plain elevation if applicable R. ire :�': com ents or and r=cemmendations: � 5 1 --e m L_ 6 f Boring BC3n� P Ground surface elev.ft. Depth to i'smring factor in. Soil Application Rate Horizon I Depth Dominant Color Redox Desorption Texture Structure Consistence Boundary Roots GPD/fF I` in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 1 ¢Eff;:2 I f 1,6 ` e : Boning # Boring Pit Ground surface elev. ' lP a ft. Depth to limiting factor in. Soil 8Mlicatlon Rate Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff Yunsei! Qu. Sz. Cont, Color Gr. Sz. Sh. Eff#1 'E02 s le vwl f t ; -� l : i € i i " Effluent #1 = BOO > 30 < 220 mg/L and TSS >30 < 150 mg1L " Effluent #2 = BOD < 30 mgt and TSS _< 30 mg/L CST ftiare se Frtnt) t / Lure CST Number F Address Da t valuation Conducted Telephone Number Proper Owner ' r I-e 600 e � f AV Parcel 1D # Page or r 1 3oring # R: Boring 1 ❑ Pit Ground surface etev. E.L ft. Depth to limiting factor in. Soil lication Rate 1 Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots l GPDlti? € in. i Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. l *Eff#? *Eff#2 F 1 E Bari ig # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soli Application Rats Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary l Roots GP D/fF i 1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ! *Eff#1 *trff#2 l ) ' i f l 1 ' ❑ Boring Boring # l' I Ground surface elev. ft. Depth to limiting factor in. :.i Pit Solt Application Rate ona Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDffF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 i *Eff#1 *Eff#2 i l I 1 Effluent #>~ i = BOB > 30 220 mgA- and TSS >30 5 i 50 mg& * Effluent #2 = BOO < 30 mg/L and TSS < 30 mgrs he eparimert 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 T T Y 608- 264 -8777. Sari -8330 (R.07m) % Soil Test Plot Plan Project Name Gerald & Jodene VanDam Byron Jr. Address 2251 95th St. NewRichmond %4017 C S ' TiW#220527 Lot Subdivision Date 1 0/10/1905 County CROIX S w 1 M N E 1 /4S 8 T 31 N /A W TownshipStar Prairie [� Boring Q Well PL Property Line# Alt. BM ,BM or VRP Assume Elevation 100 ft Top of ElecTransformer Box System Elv H.R.P Same as BM SCALE 1" = 40' Unless otherwise Noted 600' PL 350' arag vewa 4 Bed Hou B > 100' to PL 55' 55' 100' 30' 100' B2 70 25' 40' Well 40 Sgau 00' Lak 100 99' 12 'of lift 98' 8 % slope 97, ---�-' B3 230' r ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer P r lc1 l/ a vz �Gi 17 Mailing Address Property Address (Veri f ication required from la a artment for new construction.) Neujj h&�- � /oil c �o City /State Parcel Identification Numb r - 14 �✓ $ LEGAL DESCRIPTION Property Location � /a , �/a , Sec. N R ,Town of Subdivision , Lot # Certified Survey Map # , Volume , Page # r Warranty Deed # C9 7 41' 3 , Volume 2 3 7 , Page # Spec house yes no Lot lines identifiable yes ) no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 113 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described abo , by virtue of a warranty deed recorded in Register of Deeds Office. l�?sros" SIGNATURE OF APPLICANT(S) DATE * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 7436 6 WALSH STATE BAR OF WISCONSIN FORM 1 - 1999 REGIST O DEEDS Docu ment Number WARRANTY DEED ST. CROIX GO., WI RECEIVED FOR RECORD This Deed, made between Frank Stater and Patricia Stater, husband and wife and each in their own right 10/14J2003 09:45A1i WARRANTY DEED _ EXEMPT 4 i' Grantor, and Gerald l- Van Dam and Jodene R. Van Dam, husband REC FEE: 13.00 and wife as survivorship marital property TRAITS FEE: COPY FEEL CC FEE: PAGES: 2 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix _ _ County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area SEE ATTACHED EXHIBIT "A" Nanx and Retum Address i - FC 6 This deed is given in satisfaction of land contract between parties dated November 12, 1999 and recorded November 18, 1999 in Volume 1471, page 561 as Document No. 614037 038 -1031- nd 038 - 1033 -40 ficatlot Number (PIN) Together with all appurtenant rights, title and interests. This is not homestead property. ,(#0 (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and ordinances of record and will warrant and defend the same Dated this 3rd day of October _ ' 2003 * * frank Slater * * Patricia Stater AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. Polk County ) authenticated this day of Personally came before me this 3rd day of October , 2003 the above named Frank Slater and Patricia Slater TITLE: MEMBER STATE BAR OF WISCONSIN (If not, tome known]" -- >son(s) who executed the foregoing authorized by § 706.06, W is. Stats.) instru .... en' - ed the same. THIS INSTRUMENT WAS DRAFTED BY Priscilla R Dorn Cutler, Attorney at Law N' Q�. f cQnsin Osceola, Wisconsin 54020 M'=Gp' " r' Rnt. (If not, state expiration date: �� • 4 (Signatures maybe authenticated or acknowledged. Both are not necessary.) 4 £ ) * Names of persons signing in any capacity must be typed or printed below their signaiurer jj :, +`' ' mtormacion Prorasaionala company. fonduu t ac 1M WARRANTY DEED STATE BAR OF WISCON3 �' G``r., W0455 -202t Oi of FORM No. t - I499 ':� �•��� ,.• U 2435 P 188 EXHIBIT "A" Part of SW' /, of NE' /., Part of NW'1. of SE' /. and Part of NE' /. of SW' /. of Section 8 -31 -19 described as follows: 1. Part of SW' /, of NE' /, and Part of NW' /. of SE'/, of Section 8 -31 -18 described as follows: Commencing at the S'' /. comer of said Section 8; thence S88'40'50 "E on Section line 32.35% thence NO'07'32 "W 2435.01' to Point of Beginning; thence NO'07'32 "W 192.24% thence A'21'37'38 "E 117-76% thence S89'23'40 "E 1481.33' to meander line on Squaw Lake; thence S8'41'32 "E on said meander line 38.92'; thence S32'5 1'28"W on said meander line 408.48; thence S24'46'28 "W on said meander line 52.6; thence N80'27'14 "W 898.93' to Point of beginning. Together with all land between said meander line and water's edge of Squaw Lake. Subject to 33.0' strip for ingress and egress in NW comer of said described parcel. ' f Section 8 described as follows: Commencing Also part of NE /. of SW /. and part of NW'/4 of SE /. o sand S g at the S' /. corner of said Section 8; thence S88'40'50 "E on S line of said Section 8, 32.35% thence NO'07'32 "W 2185.01' to Point of Beginning; thence S57'3228 "W 172.48% thence S60'40'28 "W 139.96% thence NO'07'32 "W 499.95% thence N76'50'28 "E 275.0% thence SO'07'32 "E 401.44to Point of Beginning. Subject to roads over My 33.0' and Sly 33.0' thereof and Subject to 33.0' strip for ingress and egress described as follows: Commencing at the S'/. comer of said Section 8; thence S88 *40'50"E on S line ofsaid Section 8, 32.3 5 ; thence NO'32W 2185.01; thence N55' 18'28 "E 37.8' to Point of Beginning of centerline of said 30' easement; thence N61 *46'32"W 115.14'; thence N30' 57'32 "W 54.2% thence NO' 12'28 "E 256.5' to the end of easement. Also part of SW' /. of NE' /, of said Section 8 described as follows: Commencing at the N'!, comer of said Section 8; thence SO'27'50 "E along the %. Section line 2680.33' to the center of said Section 8; thence S88'38'40 "E 47.82; thence N21'37'28" B 117.76' to the Point of Beginning; thence N23' 10'48 "E 200.75% thence N89'4728"E 989.33' to the beginning of a meander line; thence S3'42'12 "E 200.0'to the end of said meander line; thence N89'23'40 "W 1081.33' to the Point of Beginning. Including all land lying between the meander line and the water's edge of Squaw Lake. Together with easements as described in Warranty Deed in Vol. "537, page54. 2. A 30 foot wide easement for ingress and egress in the NE %4 of SW' /. and NW %, of SEA of Section 8-31 - 18 described as follows: Commencing at the Northwest corner of said NW' /. of the SE' /.; thence S88'38'40 "E, along the North line of said NW% - SE %4, 47.82 feet to an iron stake; thence S00'07'32 "E, 30.80 feet to an iron stake; thence S76'5028 "W, 98.88 feet to an iron stake and the beginning of said 30 foot wide easement; thence S00' 1228"W, 256.50 feet to an iron stake; thence S30' 5732 "E, 54.20 feet to an iron stake; thence S61'46'32 "E, 115.14 feet to an iron stake; thence S71'54'30 "E, 396.25 feet; thence N24'40'30 "E, 113.00 feet; thence N49' 16'00 "E, 114.60 feet; thence N24' WOVE, 64 feet more or less to the north line of the Chris Johnson lot and the end of the above described easement. 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