Loading...
HomeMy WebLinkAbout042-1076-80-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ` a & INSPE&ION wR�PORT sanitary Permit No 453402 0 GENERAL INFORMATION (ATTACH TQ PENT) 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: Nutting, Kari I Warren Townshi CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 16b Cs- 166 1 28.29.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3, Sg X03, Dosing Alt. BM }CErBt10� Bldg. Sew r 1 9,_7 `13.� Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 25 1 111 i Z 5 i Z6� i Dt Bottom 15 Dosing 7 i / f' i 2,5 / Z� _ Header /Man. (I / % 97 Aeration Dist. Pipe (, 7 Holding Bot. System s5 `I(0 Final Grade PUMP /SIPHON INFORMATION 1 3. Manufacturer Z mand St Cover p GPM - 2.6 Model Number Gpq S / TDH Lift � Friction ` L , o + si System ead TDH � F t r Forcemain Lengtb- i Dia. Dist. to well SOIL ABSORPTION SYSTEM D DITRENCH Width Length �� No. Of Trenches PIT DIMENSIONS No. Of P't`S Inside Dia. Liquid epth d O d D ' SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer,'� // INFORMATION CHAMBER OR �/h� !1 Type Of System: ' i ! J� UNIT }� Model Number. { DISTRIBUTION SYSTEM - Z- Header /Manifold / � Distribution x Hole Size I x Hole Spacng Vent to Air Intake r Pi i d Lengt Dia Length \ Dia \ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over / Depth Over xx Depth of T eeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil \ [Ye "`s L] No 7 Yes ` ?i No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 777 112th St Unknown (NW 1/4 NW 1/4 28 T29N RI 8W) NA Lot 2 ff Parcel No: 28.29.18. 1.) Alt BM Description = - °J �'�" C1, a �� d- 2.) Bldg sewer length = T5 - amount of cover = S! Plan revision Required? Yes No I J x -7 1 �i a Use other side for additional informatio ��u� SBD -6710 (R.3/97) Date Insepct s Sig re Cert. No. J Safety and Buildings Division County NVisconsin 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Dep artment of Commerce ( 2 � '' ' � , n A • °" Sanitary Permit Application .: Plan I.D. Number In accord with Comm 83.21, Wis. Ado. Code, personal information you provide t maybe used for secondary purposes Privacy Law, so.04(1 xni)' 1 " Project Address (if diffmvotthan mailing address) 1. Application Information - Please Print All Information Owner's Name . Parcel # Lot # Block # Property Owner's Mailing Property Location � '/4, b W — ' /4, Section A df CA aAwle Zip Code Phone Number ea irs o X8 T AZ N , R /Y E'e ° e) II of Building (check all that apply) eft o�J ar 2 Family Dwelling - Number of Bedroo rns 1,�diEp Ali! Subdivision Name CSM Number ❑ Public/Coommial - Describe Use ❑ State Owned - Describe Use ❑City_ ❑village Township o 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A New System ❑ Replacement System ❑ Twatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. [I Permit Renewal Permit Revision ❑Change of ❑ Permit Transfer to New list Previous Permit Number and Date Issued Before Expiration Plumber owner 1,053 AIA �. IV. Type of POWTS stem: Check all that a pply) k Nan - Pressurized In -Ground ❑ Mound?: 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At-Orade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Preasunzed In-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ - Recirculat i ng Synthetic Media Filter ❑ Leaching Oita nber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Desi Flow (gpd) Design Soil Application Rate(gpdsfj Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation boo • 7 1 Y s7 1 Fl /. I %,o VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks IWO ' Tr k Aerobic TmaMrcm Unit Dosing Chambcr ilia / VII. Respo nsibility Statement- 1, them ed, ass 1 nWHty for installation of the POWTS shown on the attached plans. Pl Name (Print P Si MP/MPRS Number Business Phone Number I�lo/ 39 1v Z Zb Plumber's Address (Street, City, State, Zi ) ,SZD 9 OF E ,✓dill/?? /,� Al-r Sy7r -, VIIL Conn /De partment Use Only ❑ Approved ❑ Disapproved Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Reason for Denial IX. Conditions of Approval/Remons for Disapproval Attack easuplite plaw (to the Cou so only) for the system an paper not km tkaa 81/2 111 look" Is size SBD -6398 (R. 01/03) POWTS OWNER'S MANUAL at MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner dlTN Septic Tank Capacity gal ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent F ilter Manufacturer p T04 ❑ NA Number of Bedrooms ❑ NA. Effluent Filter Model ZN ❑ NA Number of Commercial Units X 43 NA Pump Tank Capacity S- gal ❑ NA Estimated flow (average) gal /day Pump Tank Manufacturer �?' ❑ NA Design flow (peak), (Estimated X 1.5) D gal /day Pump Manufacturer NA Soil Application Rate 7 gal /day /ft' Pump Model ❑ NA Influent/Effluent Quality Monthly average* Pretreatment Unit ZN Fats, Oil 81 Grease (FOG) :530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter <_220 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) ❑Disinfection ❑Other: Total Suspended Solids (TSS) :5150 mg /L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average ** Dispersal Cell(s) Biochemical Oxygen Demand (BODs) _ <30 mg/L Aon- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) s30 mg /L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) s10' cfu /100m1 1 ❑ Drip -line ❑ Other: Maximum Effluent Particle Size A inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect c onditio n of tank(s) At least once every 9,otv -S ❑ months years) (Maximum 3 yrs. ) Pump out conte of t ank(s) When combined sludge and scum equals one -third (Ys) of tank volume Inspect dispersal cell(s) At least once every .2,�* 3 ❑ months years) (Maximum 3 yrs.) Clean effluent filter At least once every / ❑ months *war(s) DEC Inspect pump, pump controls 81:alami At least once every ❑ months q0earw ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) NA Other: At least once every ❑ months ❑ year(s) NA Other: At least once every ❑ months ❑ year(s) 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 (Ys) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less 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. 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 ^F r{,n 3 cnnr3aa carvirina nnarntnr nrinr to nca. Page of 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 perfonmance 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. ABANDONEMENT 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 ch. 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 repla ent 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 ?;unable 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 blomat 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 iMPMURt - ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name li llv7/ 494"' 111L— Name - 71 NZ Le�Pd� Phone ? ,S— 23 Zb V Phone 71�� 2 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL RE AUTHORITY Name Agency eldl X ep Phnna Phone 7 /•r" a=r- 3" — 4/6^ FROM L.ERT I F I ED SO I L TEST I NG FAX NO. 715 2 7398 Jun. 14 2002 05: 52RM P2 __ � W E 7►T'N � 0. PRt7 K W41CK atit�vttT�""ti IL r �y f'ti` �.'� $ �ij7ti7lT.7 0 - NDtS ! I w �� 40 MAALLOLE I v� PUJ%LP r i CrT iM - b P ttG 4 t I � car�z�rc 1 �`' bcoCjC j r SEPT,C E t _._ PEC P1tAT107j5 }6 Doss i �G�.'f' T�Q MAUU FA, CTU4QR: tJU&NbV.R OF DOSGS: TA.�K S02K: I GALLOQS DOSC VOLUME �1 0 ALAT%^ mAS 4wFALTUKLIt: S 1 Lpt,4.�v„� IAltLllfllfaG OACXPi.C�N: /�`� ���,��5 ^00W ►.►UK�lCR: 1 e t t-� „a CAPACITIES: A = 30 WCRU OK 5 C -L�: == w -Sw..• bwl� SWITCH TJPG' 52L 0A 34.t�L �A:.0 ; PUP''•F MAkJUFALTUFtrK _ -_ ` 9 *fN7' 2Q SWITCH TtIPC: %A4 u T E: PUAP A►JD AL Ail1•� ARC TO 5L t1i�lIMUM CiS r.MAVtfsE RATC GPM INSTALLED Ok. SEPARATC CJKCL- '� V7KTICAL DIFFEUW(.[ &CTWCLAI PUMP OFF Auo 0J6TRl4UT10U PIPE.. t Z FE 1:7 f Mlkll)'%UM riCTWORX SUPPi.! PAC&SUPt£ . . . . . . . . . O -- FGC + _ 6d CCET of iPRG( 1'MIb1 X� 3 4 f p /�FKICTIO►3 FXCTQ14.,�' TOTAL. O`SWA,M {G I'IE&O 12 .. —;.� FEET h A liiTE l.T .t r. g A►.lAk DiMlL►JislO�f. OF TAQK: LEkACvTN 'H -.- _ ; t IQti1l0 OCP7 s-� — 1 4 A— 9EH SERIES SUMP /EFFLUENT PUMP 8.96 n specifications MDDEI CAT, LIST111D HP VOLTS SOUPS %RE Rt1wmo KNORMAA6EFPM 4a KUD) M10" PWII' WEIGHT afumtous 10• NO, (Na. In,) AMPSIWA y 17 1b' !P (rytil (Ft I Lb4.1 IN x r w) 1 9fH-GM 509330 UUCSA 4 / U) 115 .3'4 13,0 1000 71 68 DO 49 32 13.5 20' 27 9.1 t x t1,64 x B 9a HH -01M 509340 UL/C5A 4/10 290 I4 6.5 1000 T1 68 60 49 32 116 20' 27 911 M 1 1.65 x B94 9EH•C IA-RFS 509350 UUCSA CO 114 y4 13.0 1000 71 68 60 40 32 13.5 211` 27 911 0164 x 6.95 9 H CIA RFS 699360 UUCSA 410 230 3 65 1000 71 68 00 a 32 13,8 A0 27 9.11 x I l 4 194 FLOW- LITERS /1.011 C onstruction. 1000 2000 3000 Motor 1 Dousing -�� Fipoxy ('mated G ul Iron I. � Pot Material Y Carbon- t !rn clicr Typ Closed crane Volute ABS 7,5 Power Cord SJTW -A W Lt �o Mechanical Shaft Seat Nitrilt with cdrbcuz mid � ceramic f�� Gt•S r'as teners Stainless Ste :4 1 u _. z.s Shaft Stainless Ste41 B I Upper 5lr;cvc and Lower 0 13a11 Bearings 711 lit till it I Pill rr .. u o 20 4o 60 a�1 FLOW- GAI, r,ONS /MINUTE PUMP PFRF CURVE I15V 60H4 Little GA2nt PUMP Co. PU Box () Phone: 405.9 47.25 Okla, Ci ty, I (�K 731.57 Fax: 405,9 � F 4pS.9 :Sb74 1VWW.Lit0eCdantPlrMP -CC' ISO 9001 CE RTIFIED ti Form 99523:5 — 0 1 J 1 abed r YVd ld £ z0 - AON . `- age Z99 91L ` - -OOZE ;af Jasel eH : �9 l_ e T.L. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 235 -2644 Menomonie, WI 54751 �� 7Nq �j T �� Fax: (715) 235 -2592 // www.tisinzplumbing.com ,A/U) NA) 99 owe/ r" V a t 13EDPct 1 /� L€ 1R�r/ r 0 a U 1 �DD.v A ��G4 �f�,� -d�2S � S -c w, Ft-r'✓ ��,D 4 get =i < ST��L Safely and B ddinip Divisicao C 201 W Wasbingioo Ave., P.O. Box 7162 � Vios, ���� Madison, Wl 53747 - 7162 Sanitary Peamit Number (to be fed in by Co.) De artment of Commerce () 266 -3151 Z Sanitary Permit Application) Stme Pl a 'LD. Numhes in aacurd with Comm 83 -21, W is. Ad i Code. permal itat>astr ion you p—idg ma be used Sea sevolaty p vpows Privacy Low, addM) I. Application la wmaden - rimse Phut All Information Prapatf Owmes Name 1 - / • Pa¢oel 1i hat N Blatt ,/(J�17 Ne .�- Ptopedy Ownes Mailing CA /f/d/1 zip Code Phone Number t�/.t S B i.8 , N; RAM90 i Bttlldtag (tbmk all that apply) ? IB7 or 2 Family >*dliag - Number of Se ltovmm ❑ AtbGdGnmmeedal- Dmesibe Use o Sram t3wned - Deaeribe fhe Q 3 of ' k Z ❑cA ❑� �p . 11L Type of reraalt: (Cbeclt ady one box oa Itae A, C ampine lone B if a New sysem ❑ Replooemettt s ystem ❑ Tksmed/lioid'atg T alk ikpiacemeaa only ❑ 0&ffModification to Faistiag Synam, B. ❑ Pemit Raaeeral Permit Ravi a im ❑Change of ❑ Permit 7hmfar m New list Pteviaus Permit Number and Date Jssued Ba= Eaprmtim Plumber o� l53 IY, of OWN ftskom- tchick all that o - E4 k N®- Piesaaized hi -drama 0 aaotxd >_ 2a;a. ofsdr.ble ❑ M..d - u m. .fsuh&bfo w0 ❑ Au.� 0 stnpk Pan, sand 1Filter 11 Comcttuatea Wethmd ❑ Ptaaswwxd ln- (lromtd ❑ Ho>dir6 Txok O P= Fl,& ❑ Ant Me Tn9ement unit ❑ Beoiee+dedag Sand Fdh ❑ Rmiseds ftMc Media F9tcr 01.eachM C) Dip L1W . - QChZvel-lW?e ❑ oa>a ( W V. DisparselfErmtomwat Area ltaformdon: Daai 1•lou� (gPd) Daign Sol App4 Dispe►ad A:ra R�and ( Dispeoal Axes l4aposed (sf j system FJpyatioa �o . 7 �s? FIA * .o VI. Took Info Capacity is Tad) Number lyaaifiaehasr ft Site Smet Fiber Plastic Gallo" Gi Uaos of units to/ O tr $ ` Coacate Coped�d Glens NOW Pairing Taolea I Tadu �e•cr+r o rr Aerobic TmxWw t Unit Doin Clumber re r � VIL Beepoodbid Statement 4 tha ad, sdtiSty for lasft9adoa of riot PCMIS shwa oa the sdadwd pleas. PI N=w P $i 1►tPft"Pd N—Jaw Busmaas Ph®e Number Z00 i. ,O-L._ Pl 6lelddte65 vim co me ttmeot v.e ❑ Disepp:ovad �Pa (midudea Groundwo f Dift ha77ued Sipohaz ShmWS) [] Owner C>ivm Rr>asm Edf Denial !ice► C IlXCanditloae fApprova0asvns 1 < SYSTEM OWNER: '�° '^`' 4O 1 Septic tank, effluent filter and r— dispersal cell must all be serviced / maintained as per management plan provided by plumber. I 2. All setback requirements must be maintained V f as per applicable code /ordinances. Atardl aamnYe Naas ins +ue c-aer ..b) for dw q paten' at tea sae nn s Is tw ai. W atas wt. SBD -639$ 01/03 /mod s (��,�lL`� u�.n (�,�,,� �D G� ✓inn = c0o OKI DNI'MMId ZKIS Z Z Z69Z2VZ2TL %Vd T5 :9T POOZ /CZ /LO T.L. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 255 -2644 Menomonie, W1 54751 � � �iv �� T Fax: (715) 235 -2592 www.tlsinzplLLmbing.com i✓w AM) ar p 9 oele4d 7' � /w- s% OF pi e., Awf r 14 Wes- p ,$. o Td�E ice. / p lip � c° r�s sST .w 6L�'✓ 9L, / 60o OKI 9KIMMIM MI5 Z Z Z65Z5CZ5TL %V3 T9:9T 6002 /CZ /L0 T.L. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 255 -2644 Menomonie, WI 54751 7r �� T ' Fax: (715) 255 -2592 ww.u.tLsinzp [umbing.com ,A/U) ,vX) ar a �Dwmj dF Gv4)a'6✓ ® 7 Z r� q� Q M+f r 915' W hy ��,� +- ,t�a T ✓�E f-!!/�z a 6 1- .2, X'Fr ✓ 91v b ee too fn DHI DNIMMId MI5 Z Z ZOSUCUTL XVd T5 :9T VOOZ /CZ /Lo FROM ': CERTIFIED SOIL TESTING FAX No. ` Y : [ � 233 0398 Jun. 14 2002 05: 52AM P2 1 'M A n '` Wl:�'1 LD C jei wc' C Ova R { h1 a.t:T c N 1 6c j'w' m'0j' d ff6FL . QUir-14 OraCJ�r1�CT� j - p taDt5SU91S3E13 f ! I � i I \� +." Solt.'' Z.17. ) �� ' ` y f 4° GAT 3DsdrrJ BAFFLE 4 J f 3' ow c ?rE�'T'tCtis { - - �^�c -' `"./ �t .� � �.Q � - \ J'C� � V:.:�►:G r_ T P' o ' i I LGFn.¢tYt 4 I SfPTtG E PEC. IF.1.'GA.T'10kis Doss � Tc -..41" U To%w - -.5 hAhau�ACIr r', g. 1 � �Jl;l+r6LA OF vascv k T^xJK SJZZ; vizi 0 %Ai -L0S15 0 0 5C vot`uhE p A L � k ki� � P 9iFA6LTU&r.x1. S 1_°l,� v 4L]CL3SOI�IG 6AtKPl,G�1; �� /'e7 fiA'tit�Ais AOIDCL 1.it4k roER \ • t 1� CAPALiTIES: A I1JLHiU bK $1 Z C ." L I v y SWITCH YSPC: �•��• bWl�, _JAtiCKE53A 3 �' 1a r '.l.CC:, Pull-.p MA1JU FACT Witicit �� QQ `� N� La 7 _ iuLKfS 09 r tkoDE: NL mbC.U; [ 00 iu� HE5 GR \a2�Z.4��,.,��. SWIT T1d PF ' �,�, LIQT:: PUAP AWO ALAP.JA ARC TC bC t111!IMIJK pISCMARGE RATS- .�.. —FPM INSTALLED 0►> >EPP-RATL Co9(: s WiLT1CAL DIFFELCUCE SETWECU PU^P OFR Akio 016TILMUTJOW PIPE.. Z FECT %w1AUA k1LT+d0jty( SJPP.LY FAJ;rbujkC . _ _ . . . . , , . . FECT + PCET QF ro &C[ r'nnlW X 1r3 f 3r.opLFKIcT10►1 FACYam.. ' 8 ., F PET � TOTAL OUWAPUr. ►LEAD i FEET 03TERWAi. D^LUslous of T'AUK: L.E►,I&TH `.,, ;'_ TOTS - -� g -- ; LIg Di ?T N - - Z :Q VOOZ /CZ /LO goo [A alQI JKISw11'Id Z1QI5 Z 1 Z69Z5CZ5TL %�13 ZS :QT 4A t / • ' 9EH SERIES SumRIE1= FLUENT PUMP 4- ' 0�- specifications IIODm CAL L13Tpi0 HP "Us SO1106 S?b NYNtpllti P' FOPMCPCE tGPII ®A AD) 9HMOR PB I "m, CAE, WFJOHT GIMEN'StOttS Yo, 110, (dE la) INPryWIM 5' Td Y6' I I►+d 1Fl I�•1 IM Y L / W) 9EH-GM 100330 UIJt SA C0 115 3/4 13 0 1000 TI 68 50 44 32 15.6 20' "1 T B, t t k 11.5+ x F 9� i N -CIM 500340 UUCSA y10 230 314 6.6 1000 71 W 60 49 32 1 3.6 .01 2T s.l t 1 11.54 x 0.�1 68 W 40 J2 1J,1 NY 27 911 x 116a = 8.91 9EH•51A-R 560356 UUCSA 4'10 116 >/i 13.0 1D00 T1 4 32 13 0' 27 9.11 xll. •94 9E Glk Rf5 609360 ULMS1+ d10 230 y4 65 1000 1 66 FLOV- LITERS / Cons truction u 1000 Mo 3000 P. 4x C:r>aszJ C aul Iron �lcttnr llnucin �..... -I ' Irnpcllcr Material P C:aTbonat to a C)atced `Jane volute 7,5 Powor Cord S JTW - A Mec,hanicUl Shah Seul Nitl'ile with carbon 81"01 crr�mic 1Aces _ t astt�rs Str�i>7leya Stc Shaft _ Stainless Steol 8earia s upper Sic ce and Lowe r 13&11 Rearing% 0 20 (0 6c FLOV- Gay I,13NE /nINUTE PUmP PFRF IIRMANCE CURV Little Giant PUmP I LSv 6oHi 5t.7 PO Sax 12010 Phoue; 405.947.2SII pk)e. C} 73 137NS Fa:: doS.941._567d WWW.L1tt1eCdantPU P-cQm ISO 9001 CERTIFIED 6 FvtrI1 49523.5 — 0 MO Y loco �'n al I `,0 L£ �arjaSPJ 6H :!i9 ;ua 900 ^ �lsI� 1QISilf1'Id ZZ1I5 Z ,L Z65Z5 ML %�d Z5:9T VOOZ /CZ /LO POWTS OWNEWS MANUAL a MANAGEMENT PLAN FILE INFORMATION SYSTE SPECIFiICATIONS Owner � � ✓� i/ Septic Tank Capacity tt'p gal ❑ NA Permit # Septic Tank Manufacturer /fi" ❑ NA DESIGN PARAMETERS Effluent Filter M anufacturer WO ❑ NA Number of Bedrooms ❑ NA. Effluent Filter Model O Q NA Number of Commercial Units O �TNA Pump Tank Capacity �D gal ❑ NA Estimated flow (average) gal /day Pump Tank Manufacturer �T ❑ NA Design flow (peak), (Estimated x 13) gal /day Pump Manufacturer f,� , NA Soil Application Rate gal /day /ft' Pump Model ❑ NA influent/Effluent Quality Monthly average' Pretreatment Unit Te A Fats, Oil az Grease (FOG) 530 mg/L ❑ Sand /Gravel Filter O Peat Filter Biochemical Oxygen Demand (BODs) :5220 mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) s 150 mg/L Q Disinfection © Other: Pretreated Effluent Quality ❑ NA Monthly average ** Manufacturer Dispersal Cell(s) Biochemical Oxygen Demand (BODs) 530 mg/L AIn- ground (gravity) ❑ in- ground (pressurized) Total Suspended Solids (TSS) <30 mg/L ❑ At -grade ❑ Mound Fecal Colifonn (geometric mean) _ <10' tits /100m1 ❑ Drip-line ❑ Other: rax!mum Effluent Particle Size )6 inch diameter * Values typical for domestic (non- commerclal) wastewater and sepTic tank effluent. * * Values typlcal for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of rank(s) At least once every A 3 ❑ months years) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third ($h) of tank volume Inspect dispersal cell(s) At least once every . 3 ❑ months years) (Maxilnum 3 yrs.) Clean effluent filter At least once every ❑ months #year(s) d C Inspect pump, pump controls BC : - alarm At•least once every ❑ months ear(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) NA Other. At least once every ❑ months ❑ year(s) NA O` At least once every ❑ months ❑ year(s) 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 nodficadon of the local regulatory authority. When the combined accumulation of sludge and scum in any rank equals one -third (PS) 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 ch. NR 113, Wisconsin Administrative Code_ The servicing of effltrent mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitcting at Intervals of 12 months or less shall be performed by, a ckrtlfled POWTS Maintainer. A service report-shall be provided to the local regulatory authority within 10 days of completion 'of any service, event. 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 .. •• Lod[A DR •.. .� ._..� 5555 _, J•1::- J. --.- r6- J:....... —�1 x..11/.\ (C Li.-L �,...�nnr�.�7..nr tirA �arar•YaA I+�rc YF+a rnnrGr'IYc I J�HIS3 lcl MIS 1 1 Z69ZSCZSTL XVd Z5 :9T t00Z /9Z /L0 r T.L. Sinz .plumbing Inc. E5609 708th Avenue Phone: (7 IS) 235 -2644 Menomonie, Wi 54751 Fax: (7 IS) 235 -2592 FAX TRANSAUTrAL Date: �� �7' �T _ No. of Pages: (including cover) Attn: From: Subject: ,zr4< / Z Message: y l/�✓S �i(/ 7F��IOiN c ��� Alnow 6w '&'oo-4 it/1 /�✓�f� � r� F��GId +mil EdijE� ��vs � � G �• �. Signature: TOO(n DNI 9miaxilId MIS Z Z Z89Z9CZ9TL %Vd T9 :9T b00Z /CZ /LO 5 .G 2 d 0 s a f � CO if L Z Ira. 0 0- 1 SUM F! t a o LU i 5 z b- eF��cs s�s t� z CL s = s W m > W O z 0 iz W O noo W L o w .�. w I z Q 2 CL 0 - 0 ca Lulil C� ca �1 J J W r- Q Q N z CO LL 2 - a 0 z - o O j z C/) cr to 0 W �l � 2 uJ F- M CL W w CC J LL 1�- W 4 ce w W m O J S j ��o CL 0Luz >9 O a rm ca a r... n nnns. non PTI Ti:X OC_PT TK.d ffl %1LQ ZoOl j aHI 1�I I zuis Z Z Z65Z5£ZSiL XV3 i5.9i i� Safety and Buildings Division Cry 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707 — 7162 Sanitary P Numb (to be N ftc�nsin (608)266-301 ' Department of Commerce S 02 Sanitary Permit Application see Plan l D. Number In accord with Comm 83.21, Wis. Aden. Coda, personal inEoamrdion you provide t may be used for secondary purposes Privacy " WEE I _- Project Address (if different than mailing addross) L A.pplicatbn Information - Please Print AU Information - ' z `� r 7- owrar's Name , c L, , # ` # Block # P t/rKi� ✓STN FAI ` 2 Property Owner's Mailing Address ; \� P,apecty on AV 98' City, State / Zip Code Phone Numbs �OVQ(/GL1 �G ff�l �(cucle ) IL Type of Building (cbeck all that apply T N; iso _E o p�� f �e f .,Sutadivisiee•Nama CSM Number r 2 Family Dwelling - Number of Bedrooms 7 /� �+- / �o ❑ Pubh'c/Conmteaeial - Describe Use s. ` P T %39S ❑ State Owned - Desaibe use 2 'K n1 ocity Eiv' ownship of Alhvzdw Ill. Type of Permit: (Chock only one box u A. omplete line B if apps ) A ew System ❑ Replacement System ❑ ding Tank J Only ❑ m to Existing System B. ❑ Pennit Renewal ❑ P=h Revision ❑ ch. of ❑ t Transfer to New Issued Before Expiration Plumber 1V. of POWTS tem: Check all that a m - Pressuriaod htd3muod ❑ Monmd > 24 is of suitable soil �&F < 24 in. of suitable soil ❑ A"hade Q Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized hrGround ❑ Holding Tank Fester D Aerobic Treatiment Unit D Rwaculatiag Sand Filter ❑ Reciroula ' s Media Faber D Leacbing Cbamba ❑ Drip ❑ Gravel -leas Pipe ❑ other lain V. Din sdfl' rwtmeat Area Information: Design Flow (gpd) Design Soil Applitsttan Rabdat) Di Area oiled (at) Dispersal Area P pn>4ed (st) System Elevation Vi. Tank Into Capacity is Total Number Mao ns of Uni Prefab Site Steel Fib- Plastic Gallons Gallo nr l O , o Concrete Conatnwrted Glass New I Existing Tanks Tads Scpdc Of liewing TIM 1,740 16 Acmbic Tccatmcan Unit Dosing Clumba /_� Djj Q� VII. Respo Statement- 1, the zmdep6 for installation d the S shown on the attached Plumber's Name (Print) P 'a MP /S RS Number Business Phone Number Plumber's Address (Street, City, State, ) s 0 9 VuL Co /De t Use Only Approved ❑ D; Fee (includes Groundwater Date Issued Signature Stamps) D 2,� - 2 1 , 70 4 ven for Denial 1X. Conditions of Approval/Reasons for Disapproval 3) a� y SYSTEM OWNER) x,71 1 Septic tank, effluent filter and .� -o;,°' , dispersal cell must all be serviced / maintained ---- -- as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Atlae4 complete plans (to the Comaay only) forum rystem am paper mot bar them 8117 all laeha lo dee SBD -6398 (R. 01/03) T.L. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 235 -2644 Menomonie, WI 54751 Fax: (715) 235 -2592 www.tlsinzplumbing.com Nw IvA) A8 '7 , fowl vF 40A 4o r y -r MAW cfo, wr � „ �13F.�egpµ'1 � w , f� llyo�owc�G ._S�,3o SySTt ✓ qq,g Q T.L. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 235 -2644 Menomonie, WI 54751 � � rrl Nq T �' Fax: (715) 235 -2592 www.tlsinzplumbing.com Nw / vim a� a 9 ;���� owl vF GtJ e ,LB r Z loo /Y ?0I 40LC IQ�D tortff/ 2' 2 74 &9 n lE�rr -d��s s,� O a`✓ qq, g 'V r ORlCIOL� i 2069 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 2.66 acre CSM pending Please print all information. v' ed�By D Personal information you provi m aX .beused,for_secowaw-pucpococ(B' aw, s. (1) (m)). 21 Property Owner t R arty Location Nutting, Ben & Carrie Go . Lot NW 1/4 NW 1/4 S 28 T 29 N R 18 W Property Owner's Mailing Add r j f ,(IL of # Block # Subd. Na a or CSM# �� C/o Great American Homes 1915 Wilson 2 ( w3lrl ( P' d City 3tate Zip Code Phmme:Number � City id Village 16 Town Nearest Road Menomonie r 1x'`e_':::235.48 0 Warren 1 112Th St. New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe Parent material loess over sandy /loamy outwash Flood plain elevation, if applicable NA General comments and recommendations: install "conventional" in ground trench system @ system elevation of 96.0 w/ 0.7 gpd /sq ft loading FT] Boring # - I Boring Pit Ground Surface elev. 100.1 ft. Depth to limiting factor > 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 ff#2 1 0 -10 7.5YR 312 - sil 2 f sbk mvfr dsh cs • l m" • .6 2 10 -18 10YR 4/4 - sil 2 m sbk dsh cs 1m .6 .8 3 18 -32 7.5YR 4/4 - s 0 sg ml cs 1 m .7 1.6 4 32 -96 10YR 4/4 - s 0 sg dl - - .7 1.6 oct- 6 •o� occasional gr & cob below 16" Boring # Boring YJ Pit Ground Surface elev. 99.5 ft. Depth to limiting factor > 96 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 1 'E 2 1 0 -14 7.5YR 3/2 - sil 2 f -m sbk mvfr dsh cs 1 m . 2 14 -24 10YR 4/4 - sil 2 m sbk dsh cw 1 m .6 .8 3 24 -42 7.5YR 4/4 - s 0 sg ml cs 1 m .7 1.6 4 42_96_ 10YR 4/4 - s 0 sg dl - - .7 1.6 Z Effluent #1 = BOD 30 < 220 mg /L and TSS >30 150 mg/ " Effluent #2 = BOD < 30 mg /L and TSS _< 30 mgL CST Name (Please Print) Signatu e: CST Number Henry F. Grote - 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 7/2/2004 715- 233 -0398 Property Owner Nutting, Ben & Carrie Parcel ID # 2.66 acre CSM pending Page 2 of 3 a Boring # Boring 16 Pit Ground Surface elev. 100.1 ft. Depth to limiting factor > 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots = in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 7.5YR 3/2 - sil 2 f sbk mvfr dsh Cs 2 12 -26 10YR 4/4 - sil 2 m sbk dsh cs 1M .6 .8 3 26 -40 7.5YR 4/4 - s 0 sg ml cs 1 m .7 1.6 4 40 -96 10YR 4/4 - S 0 sg dl - - .7 1.6 ' 2—/9t7- 2 very occasional gr & cob F Boring # .j Boring j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 ❑ Boring # Boring _,j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#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.07 /00) Certified Soil Testing }. ( y f , rri C _,�. v ` `✓� d bo Ll ►1" n$ t � S X �a s I d 1 �1 fl �; `�°� c FROM.,: C:ERT I F I ED SO I L TEST I NG FAX NO. 715 233 03% .Jun. 14 2002 05 : 52AM P3 W S AYf{ E � PROJ K LoCI(i 4.a Co,4r&R .3LNCY►ON ► lr/�0�ittltJb ,t ��•� . � du�tiC Plac.cwK�.GY ---� c. 4't 1'Y� s�� _ I /7�� i%7 T 4'm 41 P C 3 F.sc R I p saOlbTuRf3EQ y '`., SOIL. ! e 4 o SOIL. % -D. ` Vi NT /A"I- CET ="r'3 �AFFL.E Q� 3' ova c Jl A 6r �GV. a4o G+C f SEPTIC a _ Pt I F 1',CAT1 Q JS Dose r r AW,.S N^AJUFACTQIkCK� � WwAsER of 004ES: J PEK DAZ TANK S I ZE : S 002 " L' G ALLOWS • .00SG VOLUME pp ALA0.N MA►.JLJFAGTtJfi ST INCLUO)MG 5ACKr"0w: -! /' 7 � ' C 0NS ^0OCL WWA4CK: 1 ° ``' tkP A 40 WC14CS OK _ 7 C� o Z \-',� s .�... �G �" lA1GH1:5OR A O p G�LLvUJ PWMP AAWUFACTURc r �/ Cr Oil 740 (,A�. L0I:S MODEL. ►JUFIDCIt: 4No:HES09, left 6A',L�,�L bwITCH TLiPc: ` ••.v L _ PUMP AW ALARM ARC YO 9(: MIW1I�I�I1 G1bC►i�.1lC.+L R ATL �� INSTALLED 01.1 5EP4 C."Kc: � G�1h VERTICAL D FFcxctucc bETW[=W PGS" OIL/ A1J0 QISTRIWYIOJJ PIPE 1'2 FEET + 'kjAlIKUM AII:YWORK SUF'PL! mtssuKe .. . . .. . D FEET + j<i.9 FEET OF FORtt MAIN X 2� FACTOJk.._,.'f— FEET � 30 9"OTAL ObWAMIG MEAD 2 'g F LE r !UTERX)AL D)MEWi4slic Of TA&jK: L.LkJCPTH .,;W,pTN `:.. ; i`IQUsD DEPTH " Pe rfor m ance w holesale Products Page: 6350 -1 Data ' Section. Performance Data RPM: 1550 Discharge: 1 -R/2" lids: 3/4" Dated: January 2001 12 40 9 30 o 6 ° 20 SH � - 3 10 0 0 Capacity -U.S. G.P.M. 10 20 30 40 50 liters /Second 0 1 2 3 The curves reflect maximum performance characteristics without exceeding full load (Nameplate) horsepower. All pumps have a service factor of 1.2. Operation is recommended in the bounded area with operational point within the curve limit. Performance curves are based on actual tests with clear water at 70° F and 1280 feet site elevation. Conditions of Service: HYDROMATIC GPM: TDH: " POWTS OWNER'S MANUAL ar MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner 1 41771;41 Septic Tank Capacity 14y gal ❑ NA Permit # Z Septic Tank Manufacturer / ►'i? ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms j ❑ NA. Effluent Filter Model NA Number of Commercial Units ,�9'NA Pump Tank Capacity e' gal ❑ NA Estimated flow (average) � gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5)0 gal /day Pump Manufacturers ❑ NA Soil Application Rate gal /day /ft' Pump Model 14 ❑ NA Influent/Effluent Quality Monthly average* Pretreatment Unit &NA Fats, Oil st Grease (FOG) _ <30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter <_220 mg /L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) ❑Disinfection ❑Other: Total Suspended Solids (TSS) :5150 mg /L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average ** Dispersal Cell(s) Biochemical Oxygen Demand (BODs) <_30 mg/L ,fin- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) s30 mg/L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) s10' cfu /100ml ❑ Drip - line ❑ Other: Maximum Effluent Particle Size A inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every hj ?j ❑ months years) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (>5) of tank volume Inspect dispersal cell(s) At least once every OU ❑ months A61'year(s) (Maximum 3 yrs. ) Clean effluent filter At least once every ❑ months A& year(s) D� Inspect pump, pump controls 8t:alarm At least once every o''fz, ❑ months 4ear(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) IQ NA Other: At least once every ❑ months ❑ year(s) A Other: At least once every ❑ months ❑ year(s) NNA 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 ()i) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less shall be perfonned 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. 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 i _e-i__ .__L/_X 4... - .....t.,.... -A An m nnnr�tnr nrinr to ma Page of 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. ABANDONEMENT 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 ch. 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 replac ment 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 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 IMP(1.C.tIR1.F. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name �G Z �i it/L— Name L //l!L Phone /,57-1 _ Phone rf� — u SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Agency 1 D; n . Phone 71. r-OVL — 449b 07/16/ 2004 11ct6 FAX 7151352592 T L SXNZj1PING INC 1 4 00 t. n CROIX COMM $$p nc TANK MAWIT KANCS AQRM OZONT AM oVIxr✓RSKM cKKCATsarr POW t?wflacfF3uyar � 177? l Mai13n Add,reas --- - � ---- Property Adder -- (Veritlea000 roquued from P4tusing )COI O M rot ntia centtr0°rroet) CirylStale pawl Identification Ntanber Lag �I. property (,bcaona . ��, Jmi %, S= %8 T a�r7 -R. R'. Town of �N sv��;oa o cerofled SurveY MaP # -- Warranty Deed # Gt{7e� , Volume 2 Page # Spec house Q yet Lot tines ideadtittble d C7 U0 �.,t...•Q,ur >Vr �tNTFNAN orrw aePft � =e�u�d a1ea�3tis lb ttat fitl�t to E ItAPRaP°r ter# ft tepielc tud; avaq' e6sea yatmc er +�e< ut irits0 Cite ecm cau fuaaaoa of the sepda unk as ti ttaetsnenc sa60 •sa tlse d;apessl a eet�e�m f0rt4 � by the ot�rtaetr sad b1' a Ids pt°Perq' o�r°es •bre a to subsist oo St cot: Zeaiug Depottis mut �teC (1) tt.0 �, rvastlra+t+brdisQo� sytetm m rptombepy Plumber ,tt:sttk•+�li�bav+atit�sodP � &0 wpti0 as k Im tlt a 1/3 AM of sludF, coaditiew andlar C2) *Am wrecoan sod PUMP4 Of t�mY� is to p� �°� • with thin �� thm the aodt:t bave Tvd the above sogau b 06 48 W vsamca[a � yd`*w i.�ua9s � aronatSen of ldmtsrai 30 "t (ort0. bnsia. a set by the bepsrtmad of CGUMMt vtt t�+ed z eeRt>:md in the SL t�oitc t:OM1iatl► Zoa�B dp6ea wig g *,,,t yoer moo system Do boo maw4io� so b0 �' days of �c O:zec yc catpinttyoa dsto. —7 PATE $A'RjRFs tiu�wt�re H beat e lac w (am) th �l� e awticds) n{ o rhit all SatCps=ts vu dLis or fond s U-0 t 0 tba RM tf D� O m car Me d ( ' cry d bo by vizWc of a �t Im y & reaatdoo is Ago I prep Y �A� s atiA OF ...,., •.. Aor;a{o,u 601 that is m!s- tooscscntedmay result to tbo $40drszy' Pub g nw A °P ea4 of Doc& oft" •+ joclude vAth tWI0 +tpplleali0es h a sod wyawmty Hood bunt t1JG a is ow wusaseh' dcod a tApy at 04 eardw tbrey Mp it is load ZD 3 Jbd d31VM NNIC)I63INV 08609LZT99 ZT :TT b0 0Z /9T /L0 07/16/2004 06:37 7152354641 GREAT AMERICAN HOMES PAGE 02 2 5 8 8 P 2 3 ?'6�+���+r�l STATE BAR Of WISCONSIN FORM 1 - VOW= KATHLEEN H. MbLSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX Co., MI This DeW, made between David D. .Coyer and Carol J. RECEIVED rOR RECORD Comer, husband and wife 06/03/2984 01:�PM Grantor, WARRANTY D EED and GtN_ cuter C. Nutting and X&ri L N%ittina t_ hugb*nd FXW 4 and wife as sumr_*vorab$,A marital prgp Ety PIC Pa: 11.09 TRANS FEE: 156.90 Grantee. COPY FEE: ur a valuable consideration conveys to Grantee tfe following CC E S Grantor, s � f � eY � PAGfiSa 1 described real estate i .. St. Cr County, State of W131jou in (the "Property') (if more space is needed, please attach addendum): Lot of Certified Survey Map recorded in Volume 1 8 on page 4760 as Document: No. 763951 being a part Of the Northwest Quar r o e clot sreat Quarter (NNi't Recording Area Of 100%) , Government Lot 1, Section 28, Tovnship 29 Name and Return Address North, Range iB Pest, Town of,warren Title t$e Premier Group, Inc. 706 19th Street South Hudson, WI 54016 part of 042- 1076--90 -05 part of 042- 1076 -60 -05 Parcel Idernificatiort Number (PIN) Together with all appurtariantt rights, tide and interwrts. This is not homestead property. 09) (is not) Grantor wanauts that the title to the Property is good, hAefbesible in The simple and free and clear of encumbrances except Roadways, laaementa, and Restrictions of Record. Dated s 1 .Tune , .2004 1 "David D. C : Carol C s rt AU'1 MMUCATION ACKNOWLEDGMENT STATE OF WISCONSIN ) 6ignature(s) _ ) ss. _ Croix Conrrty, ) authenticated this da Personally came before me this l ot day of V L at W�SC011S ,r s 4 the above named e _ David D. 9mmr and �ar2l J. gaygr TITLE: 1'Vi>~MBF;R STATE BAR OF WISCONSfit (If not, to isle known to be the person s Who executed authorised by §706.06, Wis. Stan.) the fo wiedged the ae¢rte. THIS INSTRUMENT WAS DRAFTED BY ' � Ica V 1 Michael H. e] oreeski, Attaimey 'Not6ry Public, State of Wisconsin Eau t:3 AJAe, WinacknaIn My Commission is permanent. (If not, state expiration date: S i res me, be authenticated or acJtttouded .Hoch sro net naoess Dec 20 Na mes of pe30as signing in any capacity must be typed or printed below their signature. . WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 -2000 Attorney Micheal H Forcoki 3492 Oakwood 4ills Pkwy Sts I, Eau Claim WI 54701 -7928 �Phonc: (715) 935 -3020 Fax: (71S) 635.4112 T10o Ons.Premicr Group 7'5740356,ZFx Prumeadvota ZWFgrMW by Refgttttapiet, LLG %ut rvtam Aft Rwfi. Vioft) Towrfahyp, lRr<Yiryran 48033, (bttU)'A4_W00 *fflE1i2kML om 1 10 7/16/2004 06:37 7152354641 GREAT AMERICAN HOMES PAGE 01 7tE>.Z 1 VOL 18 PA13E 4760 NATMMN H. ALSR REGISTER W D1tIEDS FtRCI� O kBCORD CERTIFIED SURVEY MAP a m/20" 04; LOCATED IN PART OF THE NW1 /4 OF THE NW1 /4 CERTIFIED SURVNY MAP AND IN PART OF GOVERNMENT LOT 1 OF REC FEE: 13 COPY PRE: 3.00 SECTION 28, T28N, R1 8W, TOWN OF WARREN, PAGES% 2 ST. CROIX COUNTY, WISCONSIN. '3BLr°41 "E NORTH LINE OF THE NWi /4 N1/4 CORNER 1.1 1 SECTION 28 r VNPL_ATTE� LANOS g z 0 13Y PLATTER OWNER 3.2 sa,oa DAVID COYE y 1122 76TH AVENUE i P p ROBERTS, WI 54023 ' SOIL P BO S V RVEYOR ; � EDWIN C FLANUM ` Q NORTHLAND SURVEYING, INC. - � 656 A HWY "65• 1 ROBERTS. WI 64023 1 , LOT 2 ' 2.9 ACRES INC. F tiW 129,364 SQ. FT. . 7. 2.66 ACRES EXC. R/W a le 115,697 SO. FT. ` � W G �+ �)CISTING ; FI l0 DRIVE - Z _ I F $ l C `q A_ O LOT I APPROVED ti � - 2.76 ACRES INC. RAN � 9T. CROIX COUNTY 119,697 SO. FT. PlannU 604 and Perks Committee 4� • 2.45 ACRES EXC. RJVJ Y 2 6 2004 ` N ' sPROPOSE� 10t3,599 SO. FT. If not recorded within 30 days of ' - approval date approval shall lie mull and void { 7 X ST. CROIX COUNTY SECTION CORNER /\' ` AA*. I UMENTS OF SS RECORD MONUMENTS 1 V 1 °� �Q� rG�� 0 1 "Y. 24 IRON PIPE SET WEIGHING ` r{ 1• / �. 1.13 LBS, PER LINEAR FOOT 1 5/16" O.O. IRON PIPE FOUND y I 1% • 100' ROADWAY SETBACK LINE 33 1 33' SCALE IN FEET I" 100' 1 11100 0 100 200 SHEET 1 OF 2 SHELrrS Vol 16 Page 4760 PUMP PERFORMANCE CURVE •- •� PUMP PERFORMANCE CURVE T EFFLUENT MODELS /8", 314" SOLID PASSING CAPACITY • ■ ■ ■ ■ ■ ■ ■�� ® ■ ° e ° ee ■ ■see ° eases ° ee ° ° ° a ■e ■ ■ ■ ■■ ■gym ° °0e ° ° ° °emee °sasses °° ° ®seem ° ° °m °° °see °eaves . ■ ■ \ \1 \ ■ ■I ° °e °e0 °a °e °ease °eases° . .' . \` \■ \II ■ ■I�� v ° °° � ° �� ° . �°�� °��°�°� ■■■11►�■■■■■ ■ ■■■ OWN O\\ \11 ■I■\\■■■■■■ 111N20,5i■■►►i■■■■■ SEEM pS V, \IIa \\■■■■\ \■■ , O'SINISCSW weH■■■olo■ ■\0011L, ON bil \\■■■\■ ■ ■■ ■�� ■� \�■ \ \■ ■ ■ ■■■ H. '- ;explosion proof pump, se SEWAGEAND DEWATERING o less than 15 feet TO ®msomm ®m ®00A ® ® ©mmmmommmomm ® ®osmm0 ®omos ®mam ®m ®0omm ®mm ®mm0mmommmsms0mmmmm ®yam ®m ®m ®mm0smm_mssmasmamm ® ®0mmomm 0 ®msaommmmsma0mm0m ®�ea0mmo ®m �a ®asmama�smsmmammsmomasoa ®® ®m0mmmmmsssss0mm0ms0ss ®m ®® ® ®smsmosmssmmsso0m0amamm ®0 SUGGESTED METHODS OF•FWAT INSTALLATION On some installations it may be desirable to install an independent hanger for the level control switches to avoid possible hang ups on the pumps, piping, valves, etc. Float hangers are available from Zoeller Company on Catalog Sheet FM0526 or can be fabricated from standard pipe and fittings. ACCESS COVER STANDARD PIPE FLANGE ' 10 -1457 FLOAT TREE ` WITH 3 FLOATS SHOWN 0 PVC OR LIGHT WEIGHT PEAGRAVEL STAINLESS STEEL PIPE SK1217 TYPICAL FLOAT HANGER ON CONCRETE PITS SK1218 TYPICAL FLOAT HANGER ON STEEL COVER PITS OR SEPTIC TANK RISERS i "EXTRA PROTECTION SYSTEMS" TWO PUMP SYSTEM ALARM The "Extra Protection" Two Pump system is an economical solution to the costly duplex alternating UUNCTION UG NOTINCLUDED) pump system and it's easy to install. The "Extra Protection" Two Pump Systems consists of: a. The two nonautomatic pumps with VLFS of your choice b. One Alarm System c. Two Unicheck Valves as required ADVANTAGES (1) The Two pump systems offers high pump performance without the high price. It is a system that DMA EL fits your needs and your budget. (2) Delivers more dependability than a single pump system and greatly reduces the chance of costly and time consuming problems associated with wear out or damages and the resulting system failures. ,% ALARM ON PUMP 20N PUMP ON (3) Affords greater satisfaction and peace of mind to all concerned by providing state of the art protection \ LM- 2 OFF for costly and expensive surroundings. ® PUMP 1OFF VARIAHLE LEVEL FLOAT SWITCH (4) Ability to change lead and lag positions by changing pump plug connection. ® ® ® ' A `" ftM) SK878 (5) Easy and economical to install. 'MINIMUM DISTANCE 2 "BETWEEN PUMPS THE BASEMENT SENTRY 12 Volt backup sump pump system model 507 & model 510 a Application - For Clear Water, emergency backup usage when power is off or primary pump fails. Extra Protection - When the primary AC pump fails due to power outages or system problems. • Storms • Brownouts • Wiring or electrical problems Extra Protection - When the primary pump fails to keep up with excessive water due to rain or overloading. Includes: Pump and control MODEL 507 MODEL 510 Charger Fittings TDH (ft) Flow (GPM) TDH (ft) Flow (GPM) Battery Case 5 23.2 5 33.8 (Battery Not Included) 10 12.5 10 21.6 14 Shut -off Head 15 10.6 For submersible or pedestal installations. 19.9 Shut -off Head See FM 1311 (507) or FM 1139 (510) for information. Suitably sized basin required, © Copyright 2004 Zoeller Co. All rights reserved. 5 Wisconsin uepartmeni of (-ommerce Qt-/ 1 L- C V f'1L V h 1 1 v v 1 \L- v 1 \ I rage _�_ 01 -+ ti Division of Safety and Buildings in accordance with Comm 85. Wis. Ad . Co) Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan minty include but not limited to: vertical and horizontal reference point (BM). direction nd Parcel I. percent slope. scale or dimensions. north arrow. and location and distance to nea y1 Q 76 - J V -- Please print all information. b Date r Personal 7MOmraWn you provide may be used for secondary puqxwAs {Hnvacy 1504 (1) (m)). 2 0 Property Owner a perry Location . Govt. Lot SW 1/4 114 'S T N R Z E (ory� Property Owner's Mail' g Address _J k # Block # Subd. Name or CSM# rew City State Zip Code Phone umber ❑ City ❑ Village own Neare t Roa ([3 N Construction Use: Q,Residential / Number of bedrooms _ Code derived design flow rate zoo GPD ❑ Replacement �c ❑ Public or commercial - Describe: Parent material 1 !.�`Gf/r1T/% r Flood Plain elevation ff applicable General comiments and recarrtrtmWadons: Boring # ❑ Boring ❑ Pit Ground surface elev. ?/_ ft. Depth to limiting factor 7 f9 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 •Eff#2 Z .w.s F • H L — L 2• -- L t 7 A 2 /s - 2 l a B oring # [] Boring ❑ Pit Ground surface elev. Q70 ft. Depth to firni ing factor in. Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 *Eff#2 _ a : :4/ z 7- O -S i�- — — • Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 _< 150 mg/L uent = BOO,:! 30 mg/L and TSS < 30 mg/L - PST tipme (Please Print) 0---% CST Number A 1 - 2 2 � Fogerty Plumbing & Perk T sting Date Evaluation Conducted Telephone Number Address 28288 McKenzie — /j_O3 S - 9�� P owner A MC 10 � Parcel ID # ®5� `gym 76 — �3' Page O f 3 F —1 Boriry El eormg # V Pit Gr,,w surface elev. _? 7 tt. Dep th �? n Spy Rate Horizon Depth Dominant Color Redox Description Texture SVuchre Consistence Boundary Roots GPDJIf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff111 '101#2 �� 3 sG S =S F-1 Boring # ❑ Bo'nu's Pit Ground surface elev. ft- Depth to V boor Soil rule Horizon Depth Dominant Color Redox Description Texture Structure C onsistence 8ourndary Roots GPDIff in. Munsell Qu. Sz. Cont. color Gr. Sz. Sh. 'EtT#1 '100#2 ❑ Boring in. Bain9 # tr. Depth to Nm6rx� factor Pit Ground surf" elev. Spy F] O Rate Horizon Depth Dominant color Redox Description Texhxe Structure Roots GPON in. Murnsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 'Efr#2 • EfllueM #1 = BOD > 30 < 220 mg& and •TSS >30 1150 mglt. ' Effluent 92 =• BQD, 30 ffQ& and TSS 5 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 3151 or T- TY 608 - 264 -877 sao-uw ca•�t � c♦ 4 Fogerty Plumbing �' e-eplo x #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 635 - 96009 sr '� f3 b \ w? mAp 1 x I 70' 3�L A 1- l /or * . l /BD•O y��' \ ' t wT 1 .dw ter toA4v yd•,7 it = ,de crr vL • _ ICAW'O LOT Gq/ --VXA cxze rw 'fc#461 L CERTIFIED SU RVEY MAP 0 LOCATED IN PART OF THE NW1 /4 OF THE NW1 /4 AND IN PART OF GOVERNMENT LOT 1 OF SECTION 28, T29N, R1 8W, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN. NORTH LINE OF THE NW1 /4 N1/4 CORNER S89 °41'48 "E SECTION 28 O 531.10' 2118.04 M $ UN_PLAT T_ED LANDS �o �A BY PLATTER o >, � M' S89 °0 '32 "W 329.32' c OWNER .28 2 ss.0a' z DAVID COYER ° o 1122 76TH AVENUE 1 C ROBERTS, WI 54023 SOI P OR A ILG S 1 r�i • 1� Paw SURVEYOR 1 m EDWIN C FLANUM : I NORTHLAND SURVEYING, INC. Z 856 A HWY "65" Q ® I v ROBERTS, WI 54023 Ni 1 c LOT 2 0 t 11 '{ 9) 2.97 ACRES INC. R/W I m w •. m 129,354 SO. FT. Z 1 v n w 2.66 ACRES EXC. R/W � I N w0 � 115,697 SO. FT. I O at X Z 1 C) Cn EXISTING 0 I C � FIELD DRIVE : M 6 6' : 11 m O Mn 0 I o C : 301.85 4.85 1 "� O A M o II Z 33.01 r" •N80 2420 E 1 •� m o 1� cn 1 m I Im 10 LOT 1 APPROVED C j : 2.75 ACRES INC. R/W ST. CROIX COUNTY I Y 119,897 SO FT Plannina 7_oninq and Parks Committee I z w 2.45 ACRES EXC. R/W 10 a o 106,589 SO. FT. MAY 2 6 2004 1 1 N PROPOSED 1 � pFtIVE : OO If not recorded within 30 days of O I approval date approval shall be null and void I Z 1 m •. � LEGEND I I -G 3 3 y oo* Q5 1 I � ,yZa X ST. CROIX COUNTY SECTION CORNER O POSITIONED FROM WITNESS 1 0 MONUMENTS OF RECORD I I 6 1" X 24" IRON PIPE SET WEIGHING 0 1.13 LBS. PER LINEAR FOOT i 1 1 5/16" O.D. IRON PIPE FOUND • I 1 00' ROADWAY SETBACK LINE 33 33 SCALE IN FEET 1 100' 1 100 0 100 200 SHEET 1 OF 2 SHEETS �--M NOR UB ®IVI 1 N APPLICATION ST. CROIX COUN Y RECEIVED The submittal deadline for certified survey maps is the 4 Tuesday of the month t o moe"pirr7o ftTo f p ntation for approval by the Planning, Zoning & Parks C mmift�e. Property owner NVIL 624CR- Agent (if not owner) ST. CROIX COUNTY 117-7- 11G ME Mailing address Ca 3t_tZ U Lit S4oa.3 Mailing address Daytime phone Daytime phone Surveyor C� OLi I r-- C.J�tt•�lt t"\ Address NORTHLAND SURVEYIMG INC r-0. IJOX 14 Phone - 1 - 4 t - C - 1 l FAX 7 41 - 1 712 ROBERT-S, m .w23 66 ,j7 - to 7 ( r+ l ' Property location 1/4 1/4 Section v T �'I N -R I f - W, Town of 4A zeEit/ No. of lots 2 _ Total acreage of lots -7Z Size of original parcel /1" A f Parcel Identification rio(s). -0 - t9- / f'- 43c: Zoning District of parcel 4C -eee MAKE A SKETCH IN THE BOX SHOWING HOW THE NEW LOT(S) FIT WITHIN THE ORIGINAL PARCEL so - , W ,04 Y40 PROM In ST, CRW OUW1''f' 9 Zvol and Par'* NW44a MAY 2 6 2004 t It not raoorded within 30 d ays Of approval data appro* atW be nuN and void 1 certify by my signature that all information presented herein is true and correct to the best of my knowledge. I hereby request the St. Croix County Zoning Depart nt to process thi application according to Chapter 18 of the St. Croix Zoning Ordinance. Signature 00wner 6QA uthorized Agent Eight (8) copies of a "concept " map are to be submitted for staff revie%A avisions. Once the "concept" corrections are made, an official minor subdivision NOTE: ONLY COMPLETE SUBMITTALS WILL BE ACCEPTED. - f vzuI (AIL 5 C S1vt , plated Submittal deadline is the 4 n Tuesday of the month - SUBMITTALS MUST INCLUDE THE FOLLOWING: One (1) copy of the preliminary certified survey map ❑- Applicable fees (noted below) J !� SP- O , X Township approval (a copy of the map signed by the Town Chj CXr ;V'l ,a A copy of the soil test for all proposed lots not having a residence General Zoning Notice Statement (see attached for wording) AA DOT certification letter if the proposed lot(s) abut(s) a state highw Ak Road plans (if new roads are proposed) S e Check list from County Surveyors Office Disturbance of slopes 20% or greater are to be avoided or at the -/ eater are present, the attached slope statement must appear on the map. If required, wetland delineation is to be done by a pro`essional ar Applicant shall flag all property /project corners and mark flags ac , A final map, reflecting all requested revisions, as well as town approv V`e ✓ YeL�U�d �SH� )rior to presentation to the Planning, Zoning & Parks Committer for pr Reww AeA 4" V «sl y � °rou � o, I * Application Fee $200 _ _ — * County Surveyor Review Fee - $50 per lot or outlot *Escrow for parks $250 per vacant buildable lot * These fees are mandatory at time of submittal TOTAL FEES PAID dQQ I fA � DATE PAID q o' Applica ion accepted and complete: / / By Zoning Map number �- �gu 3W X PLANNING, ZONING & PARKS COMMITTEE ACTION X Approves Rejects Conditionally approves Conditions 5 -as -0 Si nature o Corn n Chairman Date Revised April, 2002 a- • FILED Ol JAN 2 8 1997 ► � DL KATHLEp H. W ASH RegislerotD S /1 554947 c0 St Croix 00, p ya _ /076 - q•S,� 14 1. r This instrument drafted n leskacek Proj. No. 96 -6 7 En 0 Bearings are referenced to the east -west <n E 1/4 line of Section 28, assumed to bear 0 . N90 ° 00'00 "E. 0o H qj . z co ' 8 ,� JAN 2 8 ']' o C:J 3 '' ° 0 % L=J v c < A� H . Ci�G�IX COUNTY 0__* * n rt K N (;Otct lz'L ?c�nS1Y8 Plannis $ n M 00• ¢' '. wring and 5. 90 N N• Parks Committee Z � � � � to - 1.3 >y I� not recorded ? n 0 c Wr al.n 30 days of 8 ° �04.w Aval data O 0o " 101'oval shad be �" .4 W M void U1 H 0 O ___- Q311dn G SQNd� o - � fi W • r 0 ft ° HiZtT 13321 W co x > > t d 0 3 o au } — f _ 0 c� G omi W Peoj UM�� } a c 3 c Q' ct 0 —��— 0 o 80N IC 0 v 0 H co ( o m (D IZ - <n � fi fi - T7 W co W -'. r Ir— _+1 ct 7 w m o Q Ia et M L7 ® I—i 2 co IM S C . ,\ R1 IC A 7 O C CD rt M o \ \ Z IC7 N 3 \ 1 N \ \ W o IC/) o a ° w 5% (0 1 M m \� O - ,.G 0 \ CC) Q G t� Q, IC ri \!� ` \ �' O o w c_n —I o Co 0 vi 0 v+ II to r" -n � Ia 7 'Af \ \ rF N � _ I C7 0 /� L O x a \ \ 00 O -�C r �► c'c c �� ' ®c Q.� - c X'E t" 6Z' £SZ H U Q °v n Z a °_:W 3ub+►'5£o50S .£3 3 s w }••S. y -4� sQ Nd� Q�iid�d ,R O� � �� o 0 o a rn <. E "C 3I��1t���t _ 14 no 0 K R -n a rt M ? c c Vv N co 0 c 0 -n o VOL. 11 Page 3206 l - LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF WARREN COMPUTER NUMBER 042 - 1076 -95 -120 Parcel Number 28.29.18.438A -02 OWNER NAME: First DAVID D & CAROL J Last COYER PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment SECTION 28 TOWN 29N RANGE 18W 1 /4160 1 /440 Line Description Line Description TOTAL ACREAGE 40.966 PLAT LOT BLK 01 SEC 28 T29N R1 8W PT GOV LOT 15 02 EXC CSM 11/3206 & EXC AS 16 03 DESC IN WD- 1952/257 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, F8- History, F10 -Exit LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF WARREN COMPUTER NUMBER 042 - 1076 -90 -400 Parcel Number 28.29.18.437D OWNER NAME: First DAVID D & CAROL J Last COYER PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment SECTION 28 TOWN 29N RANGE 18W 1 /4160 1 /440 Line Description Line Description TOTAL ACREAGE 1.450 PLAT LOT BLK 01 SEC 28 T29N R18W PT GOV LOT 15 02 1 & 2 BEING OUTLOT 1 16 03 CSM 11/3206 1.45AC 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, F8- History, F10 -Exit x LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF WARREN COMPUTER NUMBER 042 - 1076 -95 -000 Parcel Number 28.29.18.438 OWNER NAME: First RETIRED NUMBER Last COYER PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment SECTION 28 TOWN 29N RANGE 18W 1 /4160 1 /440 Line Description Line Description TOTAL ACREAGE 42.090 PLAT LOT BLK 01 SEC 28 T29N R18W GOV LOT 2 15 02 45AC EXC CSM 11/3206 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, F8- History, F10 -Exit