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HomeMy WebLinkAbout040-1061-95-110 N ~ O 60 1� Odp O n O w � � O O N O � U � I y I to > � c o � � a i . v LL c y p T 0 O Q Z I 3 � _rn Z O 6 Z co G 0 d N E a� c y o T O Z a O w N y M v o E o 0 N N U y 1 � C O O N O t O_ CL O y `� @ v Q d Z Z o N .. Z N cc 1� N d a —_ ++ � H d L d O D O a E bap ZN a w a y Z •mil _4.; L L a a a N CL 7 p fq M M (n J V O O Z N N � y O N Y O O cl O O O q E M 0 •0 O o ° U) a c W o d =o O W V O O N O N c c ` N a N U w F L y 3 N 14 ' co T ' O O O c c O �I O CD � O o I� 2 o Z Y rn w M a ^. at EL d �, CL A o u a 2 1 0 V U � r . r 0 0 � $����f� e ■ ( - .D E z \ # O M w o $ , , . U) o , : @- I E [& g 8< f e _ / K / E Q 9 = 0 § 2 ® � J " 2 2 a§ i k a? e 8 o ° ® 0 k§ O co o § � [ 2 m , ■ � E E U) : ƒ C 0 ° K/- G 2 F E c 2 o o —. o Z , (D 0) 3 C 0 z co ; o ~ 0 r ■ 0 0 (n CD q w@ ca c cr . k "0 T < ■ . 0 0 o m .. m 2 ■ ■ ■ C L � w � � �� < N) z > Or o / M a § R� � � � E J D -n i I k'S � � •. I ; I \ E q 0 ' ~: / I cn k Oro � � [ / k e (D U) // B/ z ) � .. ®� & co CL z G F . � # CD CCD CCD & ® 0 . ? / /g3 z % �2 E2 ( k ! .k \E % CDa3» co / a,; 9.0 it &E I0, � �J2 i iro 2 � E qb 0 o 10 � � < t tA A o § 8 I \ l �T Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430026 0 GENERAL INMRMAtION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Halverson Homes I Troy Township 040 - 1061 -95 -110 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map a0 -0 /O a �} 'kn / 15 19.2234E10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ) Z Septic Benchmark S• Dosing Alt. BM r 7 —3 •� � Its . �� � Aeration Bldg. Sewer �• c� [ Holding St/Ht Inlet • 4F• ft TANK 9ETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic , I I Dt Bottom 12 . $ l2 / Dosing Header /Man. S Aeration Dist. Pipe $•1 Holding Bot. System Final Grade P P /SIPHON INFORMATION Manufacturer Demand Demand St Cover . GPM / Model Number c? - 5 10S, o TDH Li Friction ss System Head TDH Ft Q a Forcemain Length t Dia. I I I Dist.toWell �� 2-% - /�S•� 15 SOIL SORPTION SYSTEM f -. J'A'I �S E CH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L JBLDG WE LAKE /STREAM LEACHING T ut r r: _ /I INFORMATION CHAMBE ` Gt' Type Of Syste / �.�09 '^ T Model Number: 12 it DISTRIB M Hr anif d Di tribution x Hole Size x Hole Spacing Vent to Air Intake Pi a s) L Dia engt Dia Spacing S x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil L .. Yes L] No 51 Yes E] No C0 T lud code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: _ !/n � Location: 10 Glover d River Falls, WI 54022 (SW 1/4 SW 1/4 15 Unknown) NA Lot Par l No p� 1.) Alt BM Description = ' 5 2.) Bldg sewer length = ��/ j� � ��3 �j • f e �g'�� - amount of cover 14 _dap, �. = 9�•a� � -- -- ,- - - -- -- �- Plan revision Required? i f Yes o Use other side for additional information. SBD -6710 (R.3/97) Date n pct or's Signatur Cert. No. Safety and Buildings Division County ` , 201 W. Washington Ave., P.O. Box 7082 5T 61 Y sc Onsin Madison, WI 53707 - 7082 Sanitary P it Number (to be filled in by Co.) Department of Commerce (608) 261 -6546 3 OQo1 Sanitary Permit Application State Plan I.D. Nqm / r In accord with Comm 83.2 1, Wis. Adm. Code, perso Fn, o /0 ' may be used for secondary purposes Privacy s 1 i V E Project Address (if different than mailing addr-ess), 1. Application Information - Please Print All Informatio / Q MA �7 Owner's Name Parcel # Lot # a Ole" l/ HAI I d iU 140 15 ST. CROIX COUNTY b/0 1061 Property Owner's Mailing Address Property Location IL - 703 V. /n /L) 97 e 23LIE! _vy _ City, State / Zip Code Phone Number section (� � /1J 2 I"1QLGS W I S�ro �3-/ p�0 (cviceo T N; R> II. Type of Building (check all that apply) n p I or 2 Family Dwelling - Number of Bedrooms L� Subdivision Name CSM Number T yy f�3 ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use O / /e �-s� ❑City ❑Village'JATownship of T�Q Y III. Type of Permit: (Check only one box on tine A. Complete line B if applicable) A. _g New System ❑ R Replacement System ep y ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑Permit Renewal ❑Permit Revision ❑Change of 11 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that a 1 K l _ ewe ❑ Non - Pressurized In- Ground ❑ Mound 2:24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand ❑ Constructed Wetland 'V Pressurized In-Go olding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Syntheti c Media Filter thing Chamber Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Inform Design Flow (gpd) Design Soil Applicati n Rate( Dispersal Area Required (sf) Dispersal Area Proposed (sq y�c erg Eleva Goo . 5 ,� 1 ) �aDO le ✓ io0 qq 9q.0 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units A` I �D Concrete Constructed Glass New Existing Tanks I Tanks Septic or. ;Zack Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement I , the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number c,vic� l >m ), �nLI 60) ;0 /33ga a S3 6 Plumber's Address (Street, City, State, Zip Code) 4dz' VIII. Coun /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued ssuing Age t Signature S mps) Surcharge Fee) S 9 11 Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval �2 3 � f� compte / plan the County only) f r t, sysfe aper not less t � 81/2 ' : 11 Inc h�j in si ! (lire (7A �J /� / UG / v 0 BD -6398 ( 2) i rLUT PLAN Scale 1 "_ LI 0 ' - Pale l of 3 VS J 1 ,�`P���4 CH�I�IB�S }�Z - C�'1� _ --�t7' � � P►- �'�ZUP� ��G U1=_ C e11 l00 R4 1 d ,s` of 63 10 r y Put 1 _ — �`�lrJ �Z` CvU S rP t �QuG �T \ N C ) +M :W1 - -_LL. JOa O, oN .8 `'MU cq" :DlA-_ P\JC V-1pE NOTES 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. (_ required). 3. Septic tank to be\t lean gallon capacity manufactured by lzm /ba) r, � w/ A-- 1$ zYMLi.. C1L 4. Bench marks Ste' pr$oVE �. Divert surface water around system to prevent ponding at the uphill side PLOT PLAN Scale 1 "_ LI D 'Page of 3 J w `t OF Juft 100 0, °tq.S, 4Q .p 6S tti� Y` 1{rJ X12 "WU vG v Bx t1 -_Xi - )Oaz�_o1V 8"M(- Sty" D1fl:: vC_i? P ►1L13'12 NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( - _ required). 3. Septic tank to be \Z 1800 gallon capacity manufactured by 4. Bench mark S s Q "OVE 5. Divert surface water around system to prevent ponding at the uphill side N EAT'iAf6 /AIC $ peC tool 4E Fa 2 w► zs t - 7 695 fil, WOO-5� fto i» ES PQ,CSC.d Wt. SYOa1 7v3 iV. ol.4) V ST 715 5 3 3 ,: H ,2 I L/ 4 5 , ctrl 5 �� ?t5 -gg69 G (715) 262.5336 EARLY PLUMBING & HEATING BILL EARLY W12517 695TH STREET PRESCOTT, WI 54021 20 m TiQN k W iese Evo °X ( 4 ) T 2�N�N 1 YSi 0 /d0, v . GK Jf V e Y5T �✓ ��� 9 �� t � �-�s1A L 0ZAOt IOI 1 7 2so ' 4 YST I w i 3 ors per. T QED cam - 3 Hl - CA P c.T2� - WjCSC WA/C-&&T' ,0121) 6�X Du )qC. dar -&j" II Combination Sep,t4c:Tank and PUMP CHAMBER CROSS SECTION AUO SPECIFICATIONS' PAGE 2. OF 3 NEWT CAP � WEATHER PROOF JUUCTIOW BOX . `I C.Z. VENT PIPE APPROVED LOCKIWG 110' FROM OOOR, MAWHOLE COVER A01 :i WOOW OR FRESH u'ARIJIWG LA.6EC.. w ?�t1fiU PIPE AJ� R IWTAKE S corapu�r 11 t>•7 a-rt•P r to_ A GZ� 18 Ml IAJLET PROVIDE _ • '' — TAIRT16HT SEAL i 8 APPLE I III V APProved Zt'atn- r-i`�t A I 11I Approved joint w/ �_ I I I joint w/ PVC pip � b _� ALARM PVC pipe I I ! oW C i 1 LLEY. FT I OFF D - C OIJC BETE . �-�V- gb.00 ' .. e�oc►c Y - RISER EXIT PERMI TTED oQLy IF TAWK MAL;UFACTURER HAS SUCH APPROVAL ,.Ep � "Wko BED�IN4 SEPTIC F 5PEC- IFICAT10US DOSE TAUKS MAWUFFACTUREit: W� CUh1L1�`'T�r QUM15ER OF DOSES• y• • PER DAB TAWK JIZC : QL�pL'OO1boD - MR CALLOUS DOSE VOLUME r ALARM MAUUFACTURCR; S•S �0 St- 37etl I.MCLUDING 6ACKFLDW: `33'� („ALLONS MODEL I.►UMBER: l01 FdA) CAPACITIES: A= L qb.'� SWI TyPC: �L��R -kJ - IuCHCS OR .�_ GALLOys B = Z WCHES'OR ��y' S G(�LtO►JS PUMP MAWUFACTURCR: C. IUC+1E5 OR 13, S lZ h') GALLOWS MODEL IJUMHER: l p= 11 INCHES OR Z ..Z.Z, GALLOAIS SWITCH TYPE: DOTE: PUMP A)JD M ARE T aE _6 MIMIMUM DISCKARGE INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEU PUMP OFF A PIPE.. FEET + M METWORK SUPPLY PRESSURE , ; , , , , N A- FEET + rS FEET OF FORCE MA IM X 1 3.0'7 FT 1 �0 fCFRICTIO►I FACTOR.. q L FEET TOTAL ayWAMIC HEAP - �?' 1 3 FEET As. per manufacturer 22. Zy gal /in. Liquid depth 3 6'�' i �y�^'1� l��Q FC�1Zri'1 A JJCL Gu4.yE TOTAL HEAD IN FEET V 9 G£" O ul O Ul O c O o 0 N O m O D - 0 D W H N O D C7 -P H G) ° D o f r Ul H 0 O Z N CO — 0 rn M ° .LJ N H � Z � O C H v m Z o I � - w m m o m O W N O cD O W n _ O O ° Ul W v m cD TOTAL HEAD IN METERS Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach cdmplete.site plan on paper not less than 8 112 x 11 inches in size. Plan mus t ounty t ST• C� i include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. © ( 4 0 _1 b _ q S —) I Please print all in Re wed y Date Personal information you provide may be used for se ndary Arr(njdvy�b" j>. 15.0 (1) (mp. 2 2 Property Owner Prope Location Q �y of S1" 1 14SkJ 1/4 S 1S T Z-8 N R lq E (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# O-S y'! V 0 L , ZO City State Zip Code Phone um ity []Village � Town Nearest Road 122 :'Jj'rl w i Sq o Za 1 (71 t S) LL ZS -Z �q 6 6l.o X- t� IL New Construction Use: [a Residential / Number of bedrooms —L 4 Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material LO S pU�R'1L.l. OV (hJ`P SH Flood Plain elevation if applicable )Q ft General comments , and recommendations: — : >-- 3 - D SEA Ct?Z-.(-S � L4 = 's X e L . — Z - S / L O KJG kv 13 UN 1 OF:- 71 Boring # ❑ Boring ® pit Ground surface elev. q . S ft. Depth to limiting factor '71 0S in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 � 0 -9 1��trZZt — St 1 "zfRh w)v� �� 1� -1 •S - 3 yq Sy - ).sLf2 311 q -N tio-i V- VA -- S g 1 c)•v - , S •9 �,SLy 2y/ — S o `fr1 U` — • 3 • S Boring # ❑ Boring ® pit Ground surface elev. ti00• S ft Depth to limiting factor �� S in— Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0-9 2 Zl z - s z( Z m \A-- st ( Z vn c �„�, •S -$ 3 LA40 l O'l R Yn \JTl — , 3 , S rL3 sl ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS _< 30 mg& CST Name (Please Print) Z N ' nature CST Number Arthur L. Wegerer D Z Y — Z 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Bain St. River Falls, WI 54022 tp_3p_pZ -,715 -425 -0165 Property Owner E Parcel ID # c) q C) - ! u L )- q 5--) j U Page Z ' of Boring # ❑ Boring 3 ® pit Ground surface elev. -s ft. Depth to limiting factor -7 lUJ in, Soil Application Rate Horizon Depth Domlpant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 f Z I' — s l Z '�- �-- nr? V o -` toy fZ 316 - S r'I ZJI& 1: Y-0 - 3 �[S -1 pti2 y!b -� ov►t 'MV ft- , 3 .s R- 31 s a b r _ 2 <, F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 • Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.6/00) l PLOT PLAIT Page 3 of Scale 1'= SO' loo a N N N _ IN SU t�3�L F�tZ� ao m 3 - 1�3L eA 5 1 �- SL, y D1fl. PUC PZA6`C - L. �0 -3u -oZ 715- 425 -0165 220254 o t -Z CST Signature g e Date Telephone No. CST No: Job P10. I Wisconsin Department of Commerce SOIL EVALUATION REPORT 3 Division of Safety and Buildings Page of in accordance with Comm 85, Ws. Adm. Code Attach Complete. site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County S ` CTZ'0 I include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. © _1 ob1- qs -1 io Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, S. 15.o4 (t) (m)). Property Owner t�om,, Property Location � �'pt C�V�QE 6eu4 -dot S 1/4SW 1/4 S 1S T Z,3 N R Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# Kv - 1 1 4 Zs l 1 O `�} ST'. Z - I Cs" v 0 L 7 z0 City State zip Code Phone Number E) City ❑ Village f � Town Nearest Road ������ w i s�.o�I c��s) �tzs _z��16 �z- s IL New Construction Use: Residential / Number of bedrooms 1 4 Code derived design flow rate _ 60 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Lp t'7.S OU '11L1, O General comments \ j -IJ 3 ft N Flood Plain elevation if applicable 1V . and recommendations: DU SAD C�ZLS, l 3 x V l •�-S (p (j !)/ l 1 3 UN VTg OF- HG JJ L - �C�� i Sl ��JI/V17Qi� L l'F Cr1'Pr�1 j3EMZ F Boring # ❑ Boring ® Pit Ground surface elev. �t q ft. Depth to limiting factor i U$ in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Applica / tion Rate ti in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 o�� Zc - s i 7 - rn v"�.- 3 16 - s) 2�sb k r2 e,,,� �, • S , 3 yy SY -�.s 31 Y lcsvn \m \)+ CS - . q b q-V lulP-Vj6 o gq 1 ci,v - "S •9 - 7,-S LY [?-Y/ a Gron Boring # ❑ Boring d surface elev. LSO. ® Pit u _ S ft. Depth to limiting factor S in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 ° 'Eff#2 1 0-9 1-0y R- zl Z - S ( Z m \A- V4 •s • b G -4 q 1 0`'1 2316 — Sl b ` C 1nt 0`2 R — rE,S 1 — • 3 • _S I IPIrL -3 sI Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) nature CST Number Arthur* L'. Wegerer 220Num Address W e g e r e r Soil Testing & Design Service Date Evaluation conducted Telephone Number 421 N. 1 St. River Falls, WI 54022 1p_3p_p .,715- 425 -0165 Property Owner V „' `"u Parcel ID # �I 1 �� "l S —)� u Page �' of a Boring # ❑ Boring ® Pit Ground surface elev. l 3 S ft. Depth to limiting factor ' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 p _l0 14`11- Z( - s)) Z r m V c'w if -1 • S - 8 JO`s 231 - '30 Z�-Ps k Y)? C►ti) �"� • S - Y 3 its -1 iotirZ v/6 - �sl owt rnv�h — , 3 •s ❑ Boring # E] Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistencq Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 `Eff#2 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L • Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity P q pp ty 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. SM69330 (R.6/00) PLOT PLAIT Page 3 of 3 Scale 1' w a N � " ftx„D RM 715- 425 -0165 220254 p2 -Zy) -Z CST Signature Date Telephone ITo. CST No: Job NO. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner L 1/S0 41QTn Septic Tank Capacity a l ❑ NA Permit # 3a0� to Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units NA Pump Tank Capacity �� J a l ❑ NA Estimated flow (average) 41/00 al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) &00 al /day Pump Manufacturer ❑ NA Soil Application Rate - S gal/day/ft' Pump Model ❑ NA Standard Influent /Effluent Quality Month_ I�erage* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland T otal Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (g ravity) I Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L X NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) ,, 10 cf Om ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 2 — 3 ❑ month Y ls) (Maximum 3 ears) ❑ NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: Z- 3 ❑month(s) (Maximum 3 ears) ❑ NA years) Y month(s) ❑ NA Clean effluent filter Xl� At least once every: ( ❑ year(s) ' > months) ❑ NA Inspect pump, pump controls &alarm At least once every: ❑ year(s) Flush laterals and ressure test At least once eve month(s) ❑ NA P ever ❑ year(s) Other: ❑ month(s) ❑ NA At least once every: ❑ year(s) Other. ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page Z of 2 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replacement system: • A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. • A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T alua ' a o ing ank 0 0 Mound ai e 8 Tim CDR- N/>61�✓ CflNS7Rt1C�Tl b R Del l ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name 7B ILC- E"nop—L:y Name Phone '71 2 _3 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY / Name Name ST', ( d V N Z011�l N Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1 &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. vuiliivv rxi iJ:iz ran tia joo 4000 Ji %1AA VV Lvlvliw 'j�Lj"v� ST CROIX CO'tTN'r SEPTIC TANK MAINTENANCE A01EME14T ARID OWNS 'TION FORM OwnertBuyer RTIFTCA RSHIP CE 4 Address �C� �' . - .0111 � - � 11 M � Glovo r Q, PropertY Address reification required from Planning Dcpart rent for new construction) V — umber -- r ty/State 7 l=' Parcel Identification N EGAY• DESCRIPTION ° Z 3 qe /U _ PJ _ W Town of : ts✓ � � T �- R Property Location L W _ /•, /�, Sec. 1 Subdivision Certified Survey Map # _ 7,s�/ j Volume _ — 7 . Page # f�9� Warranty Deed # - Volume _ 2 Lr Page # Spec house Lot lines identiifiable)X yes [] no yes Q no gySTEM MAINTENANCE improper use and maintenance of your septic systemcould result i its premature failure to ,_r. Wba aste o u p �� syden' consists of pumping out the septic tame every three years or sooner, if needed by a licensed psuupe , Y P can affect the function of the septic tank as a treatment stage is the waste disp oral system. t a certification focus, signed by the owner and by a 'Ilse property owner agrees to submit to St: Cruiz Zoning peen drat (1) the oa site wastewaterdisposal system mastcrpluniber, jotungt=plumber, restrictedplumber or a l cezased pumPa , the septic an tank is less th 113 full of sludge - is in proper operating condition and/or (2) after inspection and pumping (if necessary). meats and agee to maintain sal system with the standards the private sewage dispo � Certification Ilwe, the undersigned have read the above require artmcnt of Natmral grsourees, State of Wisconsin set forth, hcrcin, as set by the Deparimcnt of Commerce and the plep Office within 30 se ptic system has been maintained must be completed and returned to the St. Croix County Zoning stating bat our ep sys g Y days ofYear expiration date. DATE OF APPLICANT OWNER CERTIFICATION our knowledge. I we RID (arc) the owncr(s) of I (we) certify that all statements on this form are arse to the best of my (our) e . ( ) warren deed recorded in Register of needs Office P b virtue of a ty the property desen'bed above, . y _ _ ....._ _ _ _ DATE SIGN,k OF APPLICANT • «r•.f. ...•.* represented may result in the saa'stary permit bring revoked by the Zoning DepartmeIIt. Any i that is atis •• Include with this application: a stamped warranty deed, from the Register of Deeds office J copy of the certified MUVey map if refcrenoe is made in the warranty decd J 2193P 439 1 5 � 7 7 7 9 DOCUMENT ,NUMBER , KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD Debra T. Enloe, a single woman, by her Power of Attorney, Frederick G. 94/03/2 M 09:30AN Tegeler, II, Grantor, conveys and warrants to Halvorson Homes, Inc., Grantee, the following described real estate in St. Croix County, State WARRANTY DEED of Wisconsin: EXEW7 # REC That part of SW 1/4 SW 1/4 Sec. 1S- T28N -R19W described as follows: Lot TRA FEE: 11.00 TRANS FEE: 135.00 2 of Certified Survey Map recorded in volume 7 of certified Survey COPY FEE Maps, page 2093, as Document No. 447519. Together with a 66 foot wide CC FEE: private road easement as shown on the subject Certified Survey Map. PAGES 1 NAME AND RETURN ADDRESS WESTCONSIN CREDIT UNION PO BOX 308 RIVER FALLS WI 54022 040 - 1061 -95 -110 Parcel Identification Number This is not homestead property. Exception to warranties: All easements, restrictions and rights -of -way of record, if any. Dated thi day of 2003. O // (SEAL) (SEAL) Frederick G. Tegeqr, II, as Power of Attorney for Debra T. Enloe (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ss. ... }..�: - � C /d; fC COUNTY ) authenticated this day of 2003 Personally came before me this ( day of ` 2003, the above named Frederick G. Tegeler, LI. •� (signature) to known to be the persons(sl who executed-the re oing instrument and dge he sa. * (Name Printed or Typed) • i ge TITLE: MEMBER STATE BAR OF WISCONSIN C. ( Signa ture ) (If not, :_A y�i C� authorized by 5706.06 Wis. State.) • FF M MCCARDLE -, `printed or ea THIS INSTRUMENT WAS DRAFTED BY: Notary Public ST CROIX County, Wis. Leo A. Beskar, Attorney at Law My commission is permanent. (If not, expiration date:) Rodli, Beskar, Boles & Krueger, S.C. P.O. Box 138 MY COMMISSION EXPIRES: 02 -15 -04 Rivet Falls, WI 54022 jEFFM M. O N( -an 447519 Z ,, MAY p „ E ES 01 o 198 g a NNELL. 3 CDITIFIEO SURVLY MAP ' RICHARD 0. MLAE _ ' Part of Uie Southwest 1/4 of the Soutt,wes 1 of Seetivn 1.5, 'Cownyhip 23 North, N Range 19 West, Town of Troy, St. Croix County, Wisconsin. h e Owner's Address: Route 1 W Prescott, b1I } , •Indicates 1" iron pipe found. � •. • . • e h 01ndicates 1" x 24" iron pipe = t ' • IAURENCE` ; weighing 1.13 lbs. /iin. ft, set. -_ m W MU 3 : � Indicates 3/4" iron pipe N O fo d. RIM 4 A / z C •;P BLS, \ A'% vii N \ wls 9 "J UN% E I �� LAND 0. N6;•4B OG Na0 ,,, � 4 . / D . Laurence W. Mxrphy i0 6y, fl S•59'` /µp !E R 0 o ,I B o_ 3 00 \ \� Registered Land Surveyor %� aE 3B � LpE P71DN 5N6 L4� 2 ...\� - .. N �� U� DOt BD J r P / 01� 2 2 2 BB Revised: 3 -21 -87 'Lo a ' O Dated: 2 -9 -87 6 1 r o 3 . ,..'�. »..L O 20 Ar 4�£�5656Z. ql, , 76 RFS p - N W N NFT + Z.JDe ACRfS �' IOC, 34J SO, Fr. a UNP�A/ z m - c _ 2 01• 0 �1 \ O cn 6 ;' ;' 3 00 V \ � - \ Q p lu 3 g6 to a uo 0 ' B 5 6 n c h �. N 63.1 •1165 3801 92, 437 SO, Fr, _ 3 41 40 , N• ,,6 N °o 48 56/95• ENT \ • \ /VOTE. LOrS 1,2 ti .+'� 66a s6 0 pSE AND 3 MUST b w /6'' 4B 0AP No \ i ACCESS OFF / 5 t E R L.OVER,ROAD Ar'P,R /V•ArE Lo r 3 H ~ ROA D; E,4SEME1 ✓r ~ 07f /RON PIPE IN P •J */ ACRES ~ .. rrUNP Nor DR, veN / /O, 667 SO, fT, \ \ _ K FL L/SH Arr + P,006 ACRES es e. 17 ' \ 89 C./7' 200.00' 460.00' S er 58 1 /7 "W r , S L /A'E SW 1.�4 SI14 COR. Sec. I. r2I N, R /9W, SIY COR, SC C. 15, r2BN, R79 W, UNPLA rTE L1 6 NDS ICOURrr SURVEYOR'S AION,/ f CoL HrY sLIRVFroR'S AION,J SCALC / "+ /00' Vol. 7 — : ?a'ue 209 o co too' ISO' Zoo, Jvo' Certified Survey Maps St. Croix County, Wisconsin APR0Vr-r> SHEET / of 2 MAY 0 3 mg f. CROIx COLmy DOCUMENT NUMBER WARRANTY DEED Debra T. Enloe, a single woman, by her Power of Attorney, Frederick G. Tegeler, II, Grantor, conveys and warrants to Halvorson Homes, Inc., Grantee, the following described real estate in St. Croix County, State of Wisconsin: That part of SW 1/4 SW 1/4 Sec. 15 T28N - R19W described as follows: .Tot" 2 of Certified Survey Map recorded in Volume 7 of Certified Survey page as Documen er with a 66 foot wide private road easement as shown on the subject Certified Survey Map. NAME AND RETURN ADDRESS WESTCONSIN CREDIT UNION PO BOX 308 RIVER FALLS WI 54022 040- 1061 -95 -110 Parcel Zdentificatio Number This is not homestead property. Exception to warranties: All easements, restrictions and rights -of -way of record, if any. Dated this day of 2003. D I/ (SEAL) (SEAL) Frederick G. Tege r, IT, as Power of Attorney for Debra - T. Enloe (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. Ci 1� COUNTY ) authenticated this day of 2003 Personally came before me this ? day of -400�4-9!n 2003, the above named Frederick G. Tegeler, II (signature) to known to be the persons (s) who executed the re oing instrument and dge the same. * (Name Printed or Typed) e �'7 TITLE: MEMBER STATE BAR OF WISCONSIN C (Sig nature) (If not, authorized by 9706.06 Wis. Stats.) EFFR M MCCARDLE (Name Printed or ed) THIS INSTRUMENT WAS DRAFTED BY: Notary Public ST CROIX County, Wis. Leo A. Beskar, Attorney at Law My commission is permanent. (If not, expiration date:) Rodli, Beskar, Boles & Krueger, S.C. P.O. Box 138 MY COMMISSION EXPIRES: 02 -15 -04 River Falls, WI 54022 N OWY p of Ww=r }tin / 0 r ' ° 2 J $ , 5 n § (D � $ i c m §f . # § / { / / ° \ a) / § �- > i/ , E 8$ \ \» \ CD 0) @ 0 ° P � 0) , \ \ ) / / / \ § 3 3 M � - EEe e & g a co © 7 / § £ \ 2 \ § p) g g qE2. CL z o o ° S S z A\ 7 "w, CD 2 -n , r . [ � kkk� 7 m L CA co [ � k ~ I � & \� �(D � N) g 7 \ z 2 :3 > \ j k $ J \ 0 @ ° k k - % N CD �3 / / � £ ; § E /® E , CD CL _ / — ) � a n R [ CD � Cl) [ & < CD CL a ; 0 § c k z / % l f k \ 0 § c z \ƒ { m X. ° 7 $ � \ a 2 � 2 0 / , � � I k ) J / _o §� �2 Wisconsin Department of Commerce (/AGE SYSTEM County: St. Croix Safety and Building Division IN REPORT Sanitary Permit No: 430026 0 GENERAL INMRMAf ION - O PERMIT) State Plan ID No: Personal information you provide may be use Permit Holder's Name: X Township Parcel Tax No: Halverson Homes oy Township 040- 1061 -95 -110 CST BM Elev: Insp. BM � Section/Town /Range /Map N Ia 15. 19.2 34E10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 12 1 7 Septic Benchmark 1.�.� �1�� S• w 1 m0.O Dosing Alt. BM A 3 Aeration Bldg. Sewer Holding St/Ht Inlet Q � Y rZ TANK ETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ' t 1 6z I Dt Bottom 1 12•S Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System P P /SIPHON INFORMATION Final Grade Manufacturer G� Demand St Cover GPM Model Number S� Ilti — T' TDH Lift Friction Loss System Head TDH Ft �i r,otE c (o •I Forcemain Length t Dia. j 1 Dist. to well /Q� 2 • l -- -i : A 4!�� 2 ` r SOIL SORPTION SYSTEM MEWTR ENCI-I'lWidth Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING INFORMATION CHAMBER OR ` Type Of System: I UNIT Model Number: 12 DISTRIB M Header anif d Di tribution x Hole Size x Hole Spacing Vent to Air Intake _ Pi a s) Lev 9th Dia `�� engt Dia Spaci ng S&M-COVER x Pressure S ystems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil B Yes [-] No 51111 Yes No CO UN T�: d code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / Location: 10 d River Falls, WI 54022 (SW 1/4 SW 1/4 15 Unknown) NA Lojt /' ( Parcel No: 15, 0.19.2/34E10 1.) Alt BM Description = 2.) Bldg sewer length = 7 .s a .O + amount of cover = f O ` I** Plan revision Required? i�! Yes u No i �_�� Use other side for additional information. _ � __. _ _ _ i SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division County N Visc ' onsin 201 W. Washington Ave., P.O. Box 7082 5 d ) Madison, WI 53707-7082 Sanitary P it Number (to a filled in by Co.) Department of Commerce (608) 261 - 6546 T3OD� Sanitary Permit Application State Plan I.D. Ngmb r In accord with Comm 83.2 1, Wis, Adm. Code, perso m o A may be used for secondary purposes Privacy w, sl 'r _ D Project Address (if different than mailing addret S. G WOt 2 ) 2 I. Application Information - Please Print All Informatio 3 / 0 MAY P - Owner's Name Parcel # Lot # a Ott H,4 tyor 5 e � O YY1 s� 5 ST. CROIX ., COUNTY 6C1 1061 T Property Owner's Mailing Address zz Property Location City, State Zip Code Phone Number SIAL 'K _; $A) %, Section _ T d fJl N; R II. Type of Building (check all that apply) L Q n O ,� 1 or 2 Family Dwelling - Number of Bedrooms i4l Subdivision Name CSM Number [y ❑ PubliclCommercial - Describe 86 ibe Use y� ❑ State Owned - Describe Use ❑City ❑Village�1Township of - rRo Y_ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. - V New S tem ys ❑Replacement System ❑ Treatment/Holding Tank Replacement Only C1 Other Modification to Existing System B• ❑ Permit Renewal 11 Permit Revision El Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) 1 K / ❑ Non - Pressurized In -Ground ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand �0 Constructed Wetland ' V Pressurized In-Ground okling Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter 4n-.- hing Chamz Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersaVrreatment Area Inform Design Flow (gpd) / Design Soil Applicati n Rate Dispersal Area Required (sQ Dispersal Area Proposed (sf) Vey Eleva /, r / °� , s 1x layy ✓ goo qq� qA.o VI. Tank Info Capacity in 4Gallons mber Manufacturer Prefab Site Steel Fiber Plastic Gallons Units Concrete Constructed Glass New Existing ankTanks Septic or r,,,r_JdWoX nk l')7 � Aerobic Treatment Unit Dosing Clamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) I Plumber's Signature MP/MPRS Number Business Phone Number 60 C lAY11 0, t,4n,) w.z. O. 1 3 3 90 q a S3 Plumber's Address (Street, City, State, Zip Code) s� 7 z - / 4 / - ' 44 X01 sl d� VIII. un /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Age )t Signature S mps) Surcharge Fee) f 0 h ❑Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval 93 r2 pie plan o the County only) f tlye sysfenyfifi paper met less t4p? 1/2 x 11'ach7 in si BD -639 (R08/02) Z YL�.ly Scale 1 "_ LI -P age of I l J ! l I. vNQ Or- J;jm Cvivem F 0 � - 6S D t= 4 PUC a .� L- - ►`'J' X1 z, -S _ t vG - V- "Mu = - - - �l�c— x_ ``---- ��- - - - ".. -_" - -- - -'�- -- �---- - - - - -" --- '---- .— ..- �------- - - - - -- NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. (_ required). 3. Septic tank to be\Z /Bon gallon capacity manufactured by C W CRS CA LP t zwle v PI 2 w/ A-180 Z.rraeL F, ' 4. Bench marks SQ 1'rROVE �. Divert surface water around system to prevent ponding at the uphill side