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040-1118-10-080
O N O p Fn y a~ ~r c c C 0. O O I a e3 o 0 3 I _ tl) w O O N O O O o N a c- CL N moo Y.o N C " N N N N CD y .C m 3m>>C Y 0- -0 w O y m d'O o E m M C L L "o 0? E U 3- O O y O'0-)e Z! y V C O O E (n m _O 1] N m y v >t~-O a y C Kati v ~M m>•OE o y C) (D y _U) U Q. a Q N Op - to N N N a CD T) y Z Na~wa a Z ~ ~cm ~rCm E16 N-6 c Oy LL C ALL N~ ! LL C N~ ma y N a -0 3 O C U C .0 ,O > N; m 0 CD N E O d C 'O .y N m E E 'O U U :t > m UO E Q W o(°O 0 cLo Q y >m rn~ U L 3 a C v N N O y Z rn z 0 o m N O CL M v (00v II, a m a co E 4) U) M H Z 2 c O c C7 c no> v o z a m c O o w ! o ~2 O fn F' r- C 01 ca C ro U-0 m 4' a N v E rn E m C U) C a~ ~c a~ c 3 L E N U O N m 7 O- U 7 a) N co (n m r U •N U) ~ O L ~ O L N t~ N O) p a O ~a>cr Q Z Z rn Z Z rn 4i(0 N N C N C N N O) N d N m E N m E ~i I C) 12 a) m 0) CD LO LO v r > H N N C ! y d O C > G G a ° O O D a Q O w Z j vi b) (n to y ! (n N to cn N A a) ♦r~,J m F- 1 al z f° F- a z w 00 0 I~ 0 0 0 •►NV v > a a a > a a a a N N N y Fa m co N y co 0 CD C) C) a) J C.1 ! O N N Q} O N N } aO O 0) co N N Zzi~ N O Z O O E c:) c E N N C e- - ' C M ~ Q o CO c d oo M c a v M V y y V' 07 Q A (l) O Y 'C Q A (n N N 7 ii ! N 7 0 O co C co y C O O N oo v ca o co E od o E Q oa¢°ooL (D c C Sao L C C Uaoo M a) co N U y C C N cli N U y C 00 N 'O M N G r `I, p~ ( m MO s0+ 7 Cm E L m p .0.. 7 E E L 'O (O O y >1 m u 'O N o V) m m U • N O M H W (n O Z N d' a 2 U) W V' O Z N d CL 0 O 4i A'' = E V ea V~ y.Qa €a CL Z 0) m c m c v ~ c c E 7 3 A Ua~ 0UU 0cnU . Croix vvisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556395 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax Na Edge, Michael & Becki Troy, Town of 040-1118-10-080 - -7 CST BM Elev: Insp. BM Elev: qM Description: Section/Town/Range/Map No: d u U or 31.28.19.480A40 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing I G Alt. BM Aeration o~ Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet s Septic Dt Bottom .6T 30 {i~~' (J7Yf Dosing Header/Man. t ` /tl It 7O Z -7 3 `7 Aeration Dist. Pipe D R q3 • ~1 Holding Bot. System FI j Z 2 PUMP/SIPHON INFORMATION aeily 5 . D • t Manufacturer Demand St Cover GPM /0 Model Number No k~'-►` TDH Lift Friction Loss I System Head TDH Ft Forcemain Length Dia. Dist. to Well T~ SOIL ABSORPTION SYSTEM ZZ 2Z ~'h Y BED/TRENCH Width Length / No. Of Trenches~l ' PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS gI ?I I CHING SETBACK SYSTEM TO o P/L BLDG WELL LAKE/STREAM LEA O Ma ct PR ' ~C 7 INFORMATION Ty Of System: 1 I \r U Model Number: 75 IDS DISTRIBUTION SYSTEM _ sly 4t~s Oil ~S~ 49J~_' He nifold DistributionQ Q / x Hole Size x Hole S~pa/d Vent t`~o A,ir/~,~Intak/e~~ Pipe(s) ,q ~9 Length Dia Length 1 Dia 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 iftv Bed/Trench Center / / .J Bed/Trench Edges Topsoil 0 Yes [ No [ Yes ] No COMMENTS: (include code discrepencies, persons present, etc.) Inspection # I I / / f Inspection #2: / / Location: 381 Indigo Trail River Falls, WI 54022 (NW 1/4 NE 1/4 31 T28N R19W) NA Lot 1 Parcel No: 3 1.28.19 8OA40 1.) Alt BM Description = vim/jh1 I 04_~ 0 2.) Bldg sewer length = oil - amount of cover = (I`6S-2) s Plan revision Required? Z Yes No Use other side for additional information. - - - - Date Insepctors Signa ure Cert. No. SBD-6710 (R.3/97) County 8=$v~°^~~ Safety and Buildings Division 201 W. Washington a% P 4ox 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 497 X5(345 State Transaction Number Sat r ~,-'ermit Application In accordance with SPS 383.2111 is. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 I m , Stats. /N / { 1. Application Information - Please Print All Information 8 U l P/ U 4 Property Owner's Name Parcel # T a[ t lw d + 0490 re 1D C l` p 0 f/ -Z y Property Owner's Mailing Address Property Location Q /Z rq l Govt. Lot City, State Zip Code Phone Number , / Al W y, ~N 6_ Section Won ~LS J ~ Z Z_ 7~J5- T`z 5 76 T circle one) V TOW N; R Eo H. Type of Building (check all that apply) Lot # / P or 2 Family Dwelling - Number of Bedrooms / Subdivision Name 659 377 n a~ ~4t Block # I 6A-5 ~ 4 r-A c00~ ❑ Public/Commercial -Describe Use K ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of 3 22.4-Z GI-...J&e 9-Town of -f-P 4?Y III. Type of Permit: (Check onl one box online A. Complete line B if applicable) A. ❑ New System .Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal Q Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner q-2 0 73 7 -7- Z -o 3 IV. Type of POWTS System/Component/Device: Check all that a 1 XNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat ent Area Information: ,Jr- 16L Design Flow (gpd) Design Soil Application Rate(gp Dispersal Area Required (sl) Dispersal Area Propos (sf) System Elevation 10 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o New Tanks Existing Tanks ~7 A o 2 2 L-uJII- CL. U cn h v1 w' c7 a Septic or Holding Tank l Z t9 t 2 &-6 l' 5 S ( Dosing Chamber dv 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/icfiRR3Number Business Phone Number D cat ~tJ~Lz~ n/ G z Z6 ~g 7 ~ls -~73 - KXK Plumber' Address (Street, City, State, Zip Code) S 1-0072,4 A( VIII. Coun epartment Use Only Approved ❑ Permit Fee Date sued Issuing A t Signature ❑ iven Reason enial $ #75. 66 ~1 ZV Z IX. Condi9gtp'RM[Reasons for Disapproval 3 (e P D ~f i .tit 1. Septic tank, effluent filter and dispersal cell must all be servtces / maintained Goy N~ut.✓~ as per management plan provided by plumber. ~d1 r 2. All setback requirements must be maintained 7, ~t✓l G J C rs ~ ' COdB./OC • Attach to complete plans for the system and submit to the County only on paper not less than 8 in x 11 inches in size SBD-6398 (R 11/11) PLC N N fi z~3 66 zg 43 &LU VL +`~x~ m ~ cQ.Q-Q 65- OD h 8aD IZov0 c3P OrzIvC- wRY i sf' Pg~of0 Private On-Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: J//~ Project Name and System Type: Co AJ SI Location: 8 l N 1 d Z,4 /I- Street -rL~ L LS W~ s ~o z Z Address ,,rL4J NC s 3( t Z8 TZ /9w Legal Description Township /County Design Criteria (Check one): Holding Tank Component Manual: In-Ground Soil Absorption Component Manual: ❑ SBD-10571-P (6/11/1999) ❑ SBD-10567-P (R. 6/1999) ❑ SBD-10855-P (3/2007) Version 2 SBD-10705-P (N. 01/2001) Version 2 Contents: Page 1: -~f L C 4z y S Page 2: Page 3: l::> Page 4: ~ct(C `T P&V s~ ND~20 Gf~ifvu~ Page 5: ~'1/~ ~/lG ~L/~- Page 6: C o ~5-ti c 14'CA-1V Page 7: Page 8: Page 9: Attachments: Plumber/Designer: © L O `vSigned: Credential Number: ` / Z 2 /6 /4/- ~Z Date: N z~3 6 6 ~~`2f7 f c v . z ~{3 X10 00 Izvv.0 i Soil Absorption System Cross Section .~-Y• D Z ft &4" hedule 40 Final Grade Vent Pipe Vent Cap Leaching c~ Chamber 5-ft System Elevation ft Soil Absor tion System Plan View 0,9 ft 3 ft ie Leaching Trench 1 ft Vent Or Observation Pipe' p Chambers 4" Dia. Trench 2 Header Leachina Chamber Saectfications Manufacturer And Model l ti ESL Qcys K ~CUS S-f N0i4'~ F Rating ZD sq ft p~ chamber Soil Application Rate o gpd/sq ft d Design Flow + - i Soil Application Rate + EISA = t 3L z Chambers 2 rows of 2 Z chambers each. ~ 7 p . Z. Page of I Quick- Plats Standard Chamber Sk.~O'z send End 48" (EFFECTIVE LENGTH) - - - - - - - - - - a = I-34"-~ Quick4 Plus All-in-One 12 Encap Front, Side and End Views 11.2" 13" 8" INVERT ERT ~ 8" INVERT 5.3" INVERT 33" Quick4 Plus All-in-One Periscope DUICK4 PLUS ALL-IN-ONE PERISCOPEEE-------~~\ (3W' SWIVEL g" "tit 12.7 INVERT DuICKaPLUs ALL-IN-ONE 12 5n 9"~ ENDCAP h ffm ~ Quick4 Plus Standard Chamber Specifications , I Size (W x L x H) 34" x 53" x 12" (86 cm x 135 cm x 31 cm) Invert Height 0.6", 5.3", 8.0", 127" Effective Length 48" (122 cm) (1 ,5 cm, 8.4 cm, 18.5 cm, 22.6 cm) Y INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY (a) The structural integrity of each chamber, end plate, wedge and other accessory manufactured by Infiltrator ( "Units"), when installed and operated in a leachfield of an onsite septic system in accordance with Infiltrator's instructions, is warranted to the original purchaser ("Holder") against defective materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units; provided, however, that if a septic permit is not required by applicable law, the warranty period will begin upon the date that installation of the septic system commences. To exercise its warranty rights, Holder must notify Infiltrator in writing at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) days of the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty. Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units. (b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT sI TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE (c) This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty I N F I LT R AT O RO p does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including loss of production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. systems inc. Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions; failure to maintain the minimum ground covers set forth in the installation instructions; the placement of improper materials into the system containing ' 6 Business Park Road • P.O. Box 768 the Units; failure of the Units or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal, or Improper operation; or any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of the Old Saybrook, CT 06475 terms set forth in this Limited Warranty. Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any 860.577.7000 • FAX 860.577.7001 third party resulting from installation or shipment, or from any product liability claims of Holder or any third party. For this Limited Warranty to apply, the Units must be installed in accordance with all site conditions required by state and local codes; all other applicable laws; and Infiltrator's installation instructions. 800.221.4436 (d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the www.infiltratorsystems.com original Holder. The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty requirements. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in Old Saybrook, Connecticut, prior to such purchase, to obtain a copy of the applicable warranty, and should carefully read that warranty prior to the purchase of Units. U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer, Quick4 and Quick4 Plus are registered traderharks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc. is a registered trademark in Mexico. Contour Swivel Connection is a trademark of Infiltrator Systems Inc. 0 2009 Infiltrator Systems Inc. Printed in U.S.A. PLUS0510101SI-2 0 to - POWTS OWNER'S MANUAL MANAGEMENT PLAN Page Arof 1- X 152fi~ FILE INFORMATION SYSTEM SPECIFICATIONS S Owner 1PI 6 ~b Septic Tank Capacity I ZD O \Pgal ❑ NA Permit # Septic Tank Manufacturer W1 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z L ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model A `®p ❑ NA Number of Public Facility Units 21 NA Pump Tank Capacity g 0 al ❑ NA Estimated flow (average) c/ al/day Pump Tank Manufacturer t ~S ❑ NA Design flow (peak), (Estimated x 1.5) ~9 0 j, gal/day Pump Manufacturer Pyle 7L ❑ NA Soil Application Rate i al/da /fts Pump Model LE L~o ❑ NA Standard Influent/Effluent Quality I Monthly average" Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (SOD.) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD.) 530 mg/L Ain-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu/100m1 [3 Drip-Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: E3 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 eve ❑ month(s) every: 0 ear(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 3 ® year(s) Clean effluent filter At least once every: ❑ month(s) El NA r ® ear(s) Inspect pump, pump controls & alarm At least once every: 3 I❑ month(s) ❑ NA H ear(s) Flush laterals and pressure test At least once every: ❑ month(s) O NA ear(s) Other: At least once every: ❑ month(s) ❑ NA ❑ ear(s) Other: - ❑ NA MAINTENANCE INSTRUCTIONS M 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 c.611(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 arty tank equals one-third 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.servlcing•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. GMW (4/01) Page of jj~ 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 tie 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 falls 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. ❑ The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ . Mound and at-grade soil absorption systems may be reconstructed In place following removal of the b)omat 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 © & 2 CL 5o.^J Name Phone _71S_- Z 7 3 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name E LL_ tt i✓/-/ Name 5' co2o fL 2_vv ,J~ Phone Phone /S : 891 fZ6,?d This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.64(1), (2) & (3), Wisconsin Administrative Code. J Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420737 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Edge, Mike & Becki Troy Township 040-1118-10-080 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: io 4, 10 J 31.28.19.480A40 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark i .3 / LI, Ap';~ Dosing Alt. BM YQ~ / Aeration Bldg. Sewer ' Holding St1Ht Inlet s St/Ht Outlet s, TANK SETBACK INFORMATION TANK TO /L WELL BLDG. Vent Air Intake ROAD Dt Inlet C~, V / 5/ tj An "n A Septic Dt Bottom Dosing 7/b z ~ Header/Man. 4V 101 Li Aeration Bist. pipe r 9 Holding Bot. System /d. 6 1 5~'I Z Final Grade PUM HON INFORMATION U Manufacturer Demand St Cover GPM , Model Number 3~~1 1Ol j / TDH Lift Fri ion ossf System H ~ TDH Ft I Forcem~aiinn Length t, Dia. ff Dist. 16 Well SOIL ABSORPTION SYSTEM I C BED/TRENCH Width f Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS cc3JJ? 5- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufa r INFORMATION CHAMB fi • e r Type Of System: 0 NIT Model Number: DISTRIBUTION SYSTEM ncl Header/Manifold Distribution L i x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) O Lf > Length Dia t Length O I Dia_ Spacing J Q SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Centefr Bed/Trench Edges Topsoil Yes No Yes No L~ LJ LJ L ;1 COMMENTS: (I dg co a d,~e~ pencj$s, persons present, etc.) Inspection #1: / /k Inspection #2: Location: Tiudson, WI 540'g16 (NW 1/44 NE 1/4 31 T28N R19W) NA Lot 1 (1),30yy\ ,V\5~Ok,k(j 0Q Vd1 0 Parcel No: 31.28.19.480A40 1.) Alt BM Description= S+ ~VQ~' J P1 L Li Cj 2.) Bldg sewer length = lJ,l✓~J/ ~,,{o~ LIL -amount of cover Plan revision Required? es No f I Use other side for additio nfo~,ation. Date Insepctor's Si ature Cert. No. SBD-6710 (R.3/97) 5D. /A Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ,S C Q / viseonsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in b Co.) Department of Commerce (608) 266-3151 0-0 732- Sanitary Permit Application PA~IDI State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provt ~r may be used for secondary purposes Privacy Law, s15.04 Project Address (if different than mailing address) 1. Application Information - Please Print All Information ~AJPleq Property Owner's Na me r P cel N Lot # / Block 200.3 1 Property Owner's M ailing Address TL_ Location AU I City, State Zip Code Gy Phone Number Section -70 l 1 ~,t3.(f F 1 V / (circle e) 11. Type of Buildil ng (check all that apply) T N; R i or i~or 2 Family Dwelling -Number of Bedrooms Subdivision Name CSM Number / (7 r T ~7 Public/Commercial - Describe Use 6 ! L'a L /r p/ El ❑ State Owned - Describe Use ❑City_❑V illage NTownship of 2 0 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. *New 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 V 3~o IV. Type of POWTS System: (Check all that apply) T Non -Pressurized In-Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel-less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass /~]n New Existing Tanks Tanks Septic or Holding Tank Aiy Aerobic Treatment Unit ?J Dosing Chamber O 4- VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumb 's Na me (Print) Plumber's Si gnature MP/MFRS Number Business Phone Number ✓V~~ X26 2 ~f Plumber's Addre ss (Street, City, State, Zip Co ) VIII. R6unty/Department Use Only Approved ❑ Disapproved Sanitary Permit Fe (includes Groundwater Dat Issue uing Age t Signature Stamps) Surcharge Fee) ca) `7~ 63 ❑ Owner Given Reason for Denial J (J i IX. Conditions of Approval/Reasons for Disapproval Attach complete plans (to the County only) f the system on piper not less than 81/2 x 11 inches in size SBD-6398 (R. 01/03) Combination Sep•tic;Tank and PUMP CHAMBER CRO55 SECTION AMD SPZCIFICATIDJS y, VEIJT CAP WEATHC), P 0x JuuCTlc~w fo j'C.I. VENT PIPE APPROVE- LO :tll;(s .10' FROM DOOR„ P^A,~JHOLE OVE ,iiQDOW OR FRESH ~AE2 tJ; 6 l_i~. a AJK IA1T11KE coy DQIT , ~ II J P-x. I - G r, I r. GRA Dc I yy. - - J y 1>JS.~~r~or.~ ply I PROVIDE , IM LE T AIRTI[,HT SEAL I III `a, APPROVED JOIAIT A I I i ~~.PPiZGY JOI T: W/C.I. PIP fDR P I II J' .T. °II'C.>g-~c Tank construction I III shall comply with AL`~nM I *VW and 83.20 eon, ~ I I o1_ C OFCUW PUMA-, 1Z-:;EJ B L i RISER EXIT PERr1I7FED OIJLy IF TAIJY. MAIJUFAGTJFLf-R HAS SUCH A?wROVAt_ J 3E Dl, , _9_..1 SEPTIC F SPECIFICATIDKJS DOSE TAI,IK MAQUFACTURCK:~A3~ 'L-` IJUMBEK OF DOSES: T _.P~~, TA1-JK SI-7 C : OOD GALL0kJ a 1)05G VOLUME -T ALXP,n tOAQUFAAC.TUK'.P.: -7-0 S~f~T X23 II.ICLUDIIJG QA►CI"CFL0W: ( f, ( .~G,41..'.0!1~, MODEL ►JUMBER: CAPACITIES: A= y 3c0„JC}OR_` G •LLC:t. SWITCH TJPE: Iv1 ~1Ze.U~~ Y/` - I WC I-- PUMP (,IAAIUFA, CTUKFAK t 1~-l~Zs _ C=__~ uC OR ~~~//,~/•?~._L 1 5 MODEL 1JUM5 EK: SWITCH TYPE: MOTE: PU,%P AUD ALAKr~ TO 6L INSTALLED OQ 51P,RATi C; R::Ci75 M►ulMUM DISCKARGE RATE PM VEKTICA,L DIFFEREAJCE DETWLIQ PUMP OFF Au G.D15TRIpUTIC)Q PIPE., ! , 1~ ELT + MI+JIIMUM IkiETWORK SUPPLY P,R,E,SS5URE , , , . , , , , , , , FEET It tFEET OF FORCE MAI►J X v''a /ooFr.FRICt"log FACioR___~ • ,-EET Zfi c TOTAL Dy1JAMIC. HEAD _ ~.D (0 FLET Pump chamber DIAMETER IIJTE.RAIAL DIML1Jsiokj1 OF TAIJK: L_EIJOTH _,__;WID1-H BOTTOM AREA 231=~_"-36 -GAL/INCH i I ME40 Series Myers 4/10 MP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 (n 30 "Z 25 8 Z 20 6 l J -1- 15 J O 4 10 h0- 5 2 0 0 0 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805-1923 419/289-1144 FAX 419/289-6658 Telex 98-7443 K3326 7191 Printed in U.S.A. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 isconsin Madison, WI 53707 - 7162 Site Address Department of Commerce 1VD14;0 `f Iz 4fL Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 42- p 73 T ❑ Check if Revision may be used for secondary purposes Privacy Law, s15.04(1)(m) 1. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name Parcel Number `F Property Owner's Mailing Address Property Location y I /A q P U 6 Ave 1Vw'k yt--TA; S TO 8 N, R I? City, State Zip Code Phone Number Lot Number Block Number l Subdivision Name CSM Number CEIVED P C5 /W 9377 L N/`j .5J 17 4414 % H. Type of Building (check all that apply) ❑Ciry 1 or 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public/Commercial - Describe Use T ItTownship O ST. CR ~ ❑ State Owned ZONING OFFICE 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 )t New 2 El Replacement System 3 El Replacement of 6 11 Addition to For County use System Tank Only Existing System Permit Number Date Issued _ hQ B. El Check if Sanitary Permit Previously Issued S I - 1K -,IN, IV. Type of Permit: (Check all that apply) (numbering scheme is for internal use) _ , . 44*Non -Pressurized In-Ground 210 Mound 47 ❑ Sand Filter 50 El Constructed Wetlan_, ,yi, 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: v Design Flow (gpd) Dispersal Area Dispers Area p Soil Application Percolation Rate stem Elevation Final Grade Required Propos~j}-O. o Rate(Gals./Days/Sq.Ft.) (Min./Inch) EVation /6-0 VI. Tank Info Capacity in Total Number anufacturer Pre Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete onstructed Glass New Existing Tanks Tanks Septic or Holding Tank Z dO 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' Signature MP/?MFRS Number Business Phone Number ~ - a le K Z T3. Plumber's Address (Street, City, State, Zip C e) VIII. County/Department Use Only 14 Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuin Agent Signature (No Stamps) Surcharge Fee) A ❑ Owner Given Initial Adverse Determination IX. Conditions of Approval/Reasons for Disappr1ov~1 ~ S~ t~ . ar•. S~ a-btxre . I la b e-Qea.~oQi~l~i o,+ e~ Ana +~,~c,,,, s Attac comp) to plans (to the County only) for the system on paper not less than 8112 x 11 inches in size SBD-6398 (R. 05101) A Q Z..-'7.""/ r ? td ; ; Q i E i ~f 4 l x 1 q to -F ~ 3 v. J i {ter ~ ~ ~ ~ ~ 3 ti ~ = F O F i . wewn~w+wainWrY+a s.e 1 A /o rz k N t g 's i k ftconsin1?epartmentofCommerce . SOIL EVALUATION REPORT Page tof Diftion of Safety and Buildings ' in accordance with Comm 85, Wis. Adm. Code ` county st , C ro ~ K Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Rev' wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location F Iofn &-S `r &r6rc- Govt. Lot A)0114 /&1/4 S-31 Tel S N R /9 E( r) W Property Owner's Mailin Address Lot # Block # Subd. Name or CSM# 3 .9 ' C' j .0 'M C' bue Zip Code Phone Number ity ~vifiage Town Nearest Road Wl- 07 New COnMtUOtioft Use Residential /Number of bedrooms Code derived design flow rate ~ GPD Repiacement Pwic or c~mmerct Describe: Parent material elevation if applicable 7 ft General comments and recommendatkms: 411 l/ll l` 9 AUG 28 C(xyry~, ® Boring da l Boring # z ON pit Ground surface elev. /o/, ~ ft. to limiting fat~~ot d in. Rate- H6fton Daptfi Dor drat COW Redox Description Texture ° i e rice BbUiiclary Rofits GPD/fit in. MunseU Qu. Sz. Cont. CM Gr. Sz. 'Ef 1 "Eff#2 U ~2I a S G~J r `7 A2 l.. / r S D~ l - , 7 4.2 9'S •a l ;I-Cr Boring # Boring ' R Pit Ground surface elev. q / • 56 ft. Depth to limiting factor Z/9_ in. Soti Appfication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff .M nseU . > Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 d% a a.v s/ Ms k' Fr 21-- low a-~/2 - s ms m r A / 8 10 r 1 AMs / rev r A -1114 7-s(l,- 44 S 05, l, s~ " Effluent #1 = BOD > 30:5 220 mg/L and TSS >30:5 150 mg/L = D < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signa CST Number --l-h 0 P'l 4. .227 3 Address Date Evaluation Conducted Telephone Number I 3 I o S4 Yl ec~ e~c~on~ _ a I `7 I S y~-,Z Property Owner Parcel ID # Page of Boring # Boring JJ7 ❑ ON Ground surface elev. 1V ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 p-to io r Z l :2,4) 45 9 M, r r~ It 6 2 / -3 a 1V- 5"(e' ,Sri/ - Us ,7 Boring# Boring F-1 ppit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # Boring SPit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30:< 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS 130 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. SW4.130TeK (R07/00) f L. o I I 1 GO o~cae- \o b\ 06 ~ lam' ~ fl ~U Z ~~Z r 0 1 1 u 1 i S az ~ 9 , s~ 53 1 oy .3 rti I~l S o z7 387 l~ r i ' 11 Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites According to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, a soil erosion control plan needs to be submitted and approved prior to the issuance of building permits for 1 & 2 family dwelling units in those jurisdictions where the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Stan- dard Erosion Control Plan is provided to assist in meeting this requirement. Instructions: 1. Complete this plan by filling in requested information, completing the site diagram and marking appropriate boxes on the inside of this form. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time of building permit application. Site Diagram Scale: 1 inch = feet EROSION CONTROLPLAN LEGEND PROPERTY LINE EXISTING DRAINAGE TD TEMPORARY .DIVERSION FINISHED DRAINAGE LIMITS OF GRADING SILT FENCE STRAW BALES Q GRAVEL VEGETATION SPECIFICATION TREE PRESERVATIO STOCKPILEr SOIL t Please indicate r G by completing tl• arrow below. -N- ` PROJECT LOCATION E&S 1 MEAbOW r BUILDER --UNDv+ t~JliP.,~ LNG OWNER ~O WORKSHEET COMPLETED BY _T 0 0_d_ I ►L ' DATE -3 ti EROSION CONTROL PLAN CHECKLIST Check appropriate boxes below, and complete the site diagram with necessary information. ~o Site Site Characteristics % North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways. ❑ J Location of existing drainageways, streams, rivers, lakes, wetlands or wells. ❑ Location of storm sewer inlets. i $T Location of existing and proposed buildings and paved areas. The disturbed area on the lot. )9 Approximate gradient and direction of slopes before grading operations. Approximate gradient and direction of slopes after final grading operations. • ❑ Overland runoff (sheet flow) coming onto the site from adjacent areas. Erosion Control Practices ❑ Location of temporary soil storage piles. Note: Soil oil storage piles should be placed behind a sediment fence, a 10 foot wide vegetative strip, or should be covered with a tarp or more than 25 feet from any downslope road or drainageway. Location of gravel access drive(s). Note: Gravel drive should have 2 to 3 inch aggregate stone laid at least 7 feet wide and 6 inches thick. Drives should extend from the roadway 50 feet or to the house foundation (whichever is less). ❑ Location of sediment controls (filter fabric fence, straw bale fence or 10-foot wide vegetative strips) that will pre- vent eroded soil from leaving the site. ❑ Location of sediment barriers around on-site storm sewer inlets. ❑ l~f Location of diversions. Note: Although not specifically required by code, it is recommended that concentrated flow (drainageways) be diverted (re-directed) around disturbed areas. Overland runoff (sheet flow) from adjacent areas greater than 10,000 sq. ft. should also be diverted around disturbed areas. ❑ Jli Location of practices that will be applied to control erosion on steep slopes (greater than 12% grade). Note: Such practices include maintaining existing vegetation, placement of additional sediment fences, diversions, and re-vegetation by sodding or by seeding with use of erosion control mats. ❑ 51 Location of practices that will control erosion in areas of concentrated runoff flow. Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through use of such practices as in-channel fabric or straw bale barriers, erosion control mats, staked sod, and rock rip-rap. When used, a given in-channel barrier should not receive drainage from more than two acres of unpaved area, or one acre of paved area. In-channel practices should not be installed in perennial streams (streams with year-round flow.) Location of other planned practices not already noted. A/D Z--T74 17 ~o i a (vi f rt xii P 4 } ~ 5 EROSION CONTROL REGULATIONS UNIFORM DWELLING CODE (DILHR) PROJECTS AFFECTED MAINTENANCE AND WASTE DISPOSAL • All new 1 and 2 family dwellings in Wisconsin started • Sediment controls must be maintained until the site is on or after December 1, 1992, stabilized by mulching and seeding, sodding or • Additions to dwellings built after June 1, 1980. landscaping APPLICATION PROCESS • All building waste must be properly disposed to pre- vent pollutants and debris from being carried off-site • Erosion control plan must be submitted with building permit application to the local building inspector in ENFORCEMENT communities where the dwelling code is enforced • Erosion control inspections will be made during other • Erosion control plan must show: regular inspections (footing and foundation, rough con- -Location of the dwelling, other buildings, wells, sur- struction, final, etc.) face waters and disposal systems on the site with • Violations must be corrected within 72 hours respect to property lines • Stop work orders may be issued for noncompliance -Direction of all slopes on the site FOR MORE INFORMATION, CONTACT -Location and type of erosion control measures • Local building inspector CONTROLS REQUIRED • Department of Industry, Labor and Human Relations • Silt fences or straw bales along downslope sides and side (DILHR), Safety and Buildings Division, P. O. Box slopes 7969, Madison, Wisconsin 53707, (608) 267-5113. • Gravel access drive • Straw bales, filter fabric fences or other barriers to protect on-site sewer inlets • Additional controls if needed for steep slopes or other special conditions STORMWATER PERMIT (DNR) PROJECTS AFFECTED -Proposed erosion and storm water pollution control • Any construction project that disturbs 5 acres or more practices during and after construction • Smaller sites that are part of a planned development -Documentation that an erosion control and storm involving 5 acres or more of land disturbance water management plan which meets DNR standards • Effective October 1, 1992 for any new or continuing has been prepared (plan does not need to be submit- project ted with the application) • Exceptions: Indian tribal lands and work done by local -Other information related to site location and per- government staff mit holder APPLICATION PROCESS CONTROLS REQUIRED • File a "notice of intent" application (Form #3400-161) • Erosion control measures specified in the Wisconsin with the Department of Natural Resources (DNR) 30 Construction Site Best Management Practice Handbook days before construction begins • Measures to control storm water after construction • Application must include: FOR MORE INFORMATION, CONTACT -Timetable for land disturbing activities and installa- • Department of Natural Resources, Storm Water Per- tion of erosion control measures including project mits, P.O. 7921, Madison, WI 53707-7921, (608) start and completion dates 266-7078 LOCAL ORDINANCES Check with your county, and city, village or town for any local erosion control ordinances including shoreland zoning requirements. Except for new 1 & 2 family dwellings, local ordinances may be more strict than state regulations. They may also require erosion control on construction projects not affected by state or federal regulations. A publication of the University of Wisconsin-Extension, in cooperation with the Wisconsin Department of Natural Resources and Depart- ment of Industry, Labor & Human Relations, Ron Struss, UWEX Water Quality Specialist, Western Area, and Carolyn D. Johnson, UWEX Water Quality Specialist, Southeast Area. University of Wisconsin-Extension is an EEO/Affirmative Action employer and provides equal opportunities in employment and programming, including Title IX requirements. . a c `cam Indicate management strategy by checking the appropriate box: ~a Q•`~` z¢ Management Strategies ❑ 15d Temporary stabilization of disturbed areas. Note: It is recommended that disturbed areas and soil piles left inactive for extended periods of time be stabilized by seeding (between April 1st and September 151h), or by other cover, such as tarping or mulching. Permanent stabilization of site by re-vegetation or other means as soon as possible (lawn establishment). Indicate re-vegetation method: Seed;4 Sod ❑ Other ❑ Expected date of permanent re-vegetation: .584 2v>0 Re-vegetation responsibility of: Builder ❑ Owner/Buyer. Is temporary seeding )r mulching planned if site is not seeded by Scpt. 15 or sodded by Nov. 15? Yes ❑ No ❑ ❑ Use of downspout and/or sump pump outlet extensions. Note: It is recommended that flow from downspouts and sump pump outlets be routed through plastic drainage pipe to stable areas such as established sod or pavement. ❑ 1~ Trapping sediment during dewatering operations. Note: Sediment-laden discharge water from pumping operations should be ponded behind a sediment barrier until most of the sediment settles out. Proper disposal of building material waste so that pollutants and debris are not carried off-site by wind or water. Maintenance of erosion control practices. • Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to half the barrier's height. • Breaks and gaps in sediment fences and barriers will be repaired immediately. Decomposing straw bales will be replaced (typical bale life is three months). • All sediment that moves off-site due to construction activity will be cleaned up before the end of the same workday. • All sediment that moves off-site due to storm events will be cleaned up before the end of the next workday. • Gravel access drives will be maintained throughout construction. • All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized. For more assistance on plan preparation, refer to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site Best Management Handbook, and UW-Extension publication Erosion Control for Home Builders. The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available through State of Wisconsin Document Sales, 608/266-3558. Erosion Control for Home Builders (GWQ001) can be ordered through Cooperative Extension Publications, 608/262-3346 or the Department of Industry, Labor and Human Relations, 608/267-9360. 14- j ti ^1 T • IA 0 , a f V ~ } m U o D 3 CD v,'" cn Z CD " n O c N cO Q y a 5 i' D o V W O 'T1 W N O O 1 V X ~ \ ~IN 7- T-~ c Q ~ ~ 7O J n D 3 J co IJ D D r D iW ~ r Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number ~1J }3 Number of Bedrooms Desi n Flow - Peak (gpd) Estimated Flow - Average (gpd) Septic Tank Capacity (gal) 2.O , Soil Absorption Component Size (ft2) ws' 9p "VL"XiP Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) Zap N e+~ . Maximum Influent Particle Size (in) 1/8 Maximum BOD5 (mg/L) 220 Maximum TSS (m9/L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). Theoperating condition of the stfic tank and outlet fi r hall lte s be assessed at least once every 3 years by inspection. Th filte shall be cleaned as necessary to ensure proper operation. The filter cartridge sh no be removed unless provisions are made to re Yn so i sin the tank that may slough off the filter when removed from its enclosure. If the I Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 • Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. pi~ 7 3 -~-~t►J cOAj Ccz + 715 6~7 23I/ ~S C~^ 6 o .5~ CgD l K CO /L) 6, l~ Sf r 03 6 79-7 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer /Dike And .&cl✓, Eda Mailing Address 7 Z y r 11'-"d , i f Property Address (Verification required from P arming Department for new construction) City/State Parcel. Identification Number CD LEGAL DESCRIPTION Property Location V Sec. 31 , TZ LN-R_Lq_W, Town of Tro i/ Subdivision , Lot # Certified Survey Map # 65q, 7- , Volume Page # 4~~/ 9/ Warranty Deed # 4 Fq n , Volume Page # Ii~SL . Spec house ❑ yes f( no Lot lines identifiable s'Y yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the 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 by a master plumber, jounieynian plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year ex iration date. r SIG A RE OF A PLICANT- ATE OWNER CERTIFICATION I (we) 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 above, by virtue of a warranty deed recorded in Register of Deeds Office. r SIGNATURE OF APPLICANT DATE Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. Incl!ide with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed . j 2 0 5 5 P 5 5 8 6994~~ KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., MI DOCUMENT NO. RECEIVED FOR RECORD 11/21/2002 11:00AK This Deed made between THOMAS W. HILL and EMPT # BARBARA A. HILL, husband and wife, Grantors and MICHAEL R. EDGE and BECKI JO EDGE, husband TRANSEFEE: 276 00 and wife as survivorship marital property, Grantees COPY FEE: CERT COPY FEE: PAGES: 1 Witnesseth, That the said Grantors convey to Grantees the following described real estate in St. Croix County, State of Wisconsin: Part of NW 1/4 of NE 1/4 and Part of NE 1/4 of NE 1/4 of Section 31, Township 28 North, Range 19 WSt. County, Wisconsin described as follows. Lot l1 f Tax Parcel No . 040-1118-10 and 040- Croix Certified Survey filed October 17, 2001 in Vol. 15, page R1TU18-0 RN2TO: 4191, Doc. No. 659377.~t- This is homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantors warrant that the title is good, indefeasible in fee simple and free and clear of encumbrances, and will warrant and defend same. Dated thw2]~ of November, 2002. (SEAL) Thomas W. Hill (SEAL) Barbara A. Hill STATE OF WISCONSIN )SS ST. CROIX COUNTY Personally came before me tklcltay of November, 2002, the above named Thomas W. Hill and Barbara A. Hill, husband and wife, to me known t the persons o executed the foregoing instrument and acknowledged the same. Notary P blic, State of Wisconsin My Commission (expires): 1 2.~-) _ _ THIS INSTRUMENT DRAFTED BY: Attorney Barry C. Lundeen MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. 110 Second Street, P.O. Box 469 Hudson, Wisconsin 54016 I~f moo= zM0° ~ 1-6117 `J ate/ 70 ( 1 ' r III I1. 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CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF TROY COMPUTER NUMBER 040-1118-10-080 Parcel Number 31.28.19.480A-40 OWNER NAME: First MICHAEL R &BECKI JO Last EDGE PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment 381 INDIGO TRL SECTION 31 TOWN 28N RANGE 19W %160 NE 1/440 NE Line Description Line Description TOTAL ACREAGE 3.007 PLAT CSM 15/4191 LOT1 BLK 01 SEC 31 T28N R19W NE NE NW NE 15 02 LOT 1 CSM 15/4191 16 03 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, 178-History, F10-Exit Wisconsin Department of Commerce County: St. Croix Safety and Building Division Sanitary Permit No: (ATTACH TO PERMIT) 420737 0 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 Township Parcel Tax No: Edge, Mike & Becki Troy Township 040-1118-10-080 CST BM Elev: Insp. BM Elev: BM Description: Section/rown/Range/Map No: 31.28.19.480A40 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well Width ]Length No. Of Trenches No. Of Pits Inside Dia. Liquid Depth SYSTEM TO P/L BLDG WELL LAKE/STREAM Manufacturer: Type Of System: Model Number: Header/Manifold Distribution ix Hole Size ix Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing Depth Over Depth Over xx Depth of xx Seeded/Sodded Mulched Bed/Trench Center BediTrench Edges Topsoil Yes No r [C Yes No (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: 381 Indigo Tri Hudson, WI 54016 (NW 1/4 NE 1/4 31 T28N R19W) NA Lot 1 31.28.19.480A40 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ;Yes No I - Use other side for additional information. = L -j Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97)