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HomeMy WebLinkAbout042-1079-20-140 o o / e % ® E ƒ rr r t oƒ 0 J 3 ® - j/\ o E 2 2 c �fj§ \� / o� § ° ; 90 ! -4 r- *(2 a & o E § 4 © g / § £ 7 R = co 7 i / � 8 2 CL � U $ , CD o o- g E c 0 / M M E; Oro { o o o - 2 � § § § � 0 7§ Ch�■ a 7 ° § » g E -0 o v c o" / , g 0 § _ & , 7 = \ > E � ~ CD q (4 C. § a a @ � E / { / § { / \ N 2 2 ) ] 2 I § E § } ` ( C.) / 0 k E / % 0 � I r / � [ ' z � 2 0 » � < § / 4A �$ Wisconsin Department Commerce Count Safety and Building Divi.,;on PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT sanitary Permit No: 463150 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: Maier, Gary & Gail Warren Townshi CST BM Elev: Insp. BM Elev: BM Descr' tton: Se ion/Town /Range ap No: 100'o '00 -� '5 29.29.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer 3 Holding St/Ht Inlet 7 p. 07 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet �— ; �k) S�Oic � / / r _ Dt Bottom qn Dosing Header /Man. L ��3 Aeration Dist. Pipe Holding / B Syste Final Grad $ PUMP /SIPHON INFORMATION Q Manufacturer Demand St Cover GPM Model Number TDH Friction L ss Systeny He TDH `, Ft f� /_7 31 Forcemain Len th , Dia. Dist. I loo � 2 y 1 r SOIL ABSORPTION SYSTEM' BED/TRENCH Width Length No. Of Trenches PIT DIM NS No. Of Pits Inside Dia. Li uid Depth DIMENSIONS -7S , SETBACK SYSTEM TO P/ BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHA T O �"� Ty Of System i YP Y f T Model Number: DISTRIBUTION SYSTEM Header/Main' H Fistribution S" H x Hole Size x Hole Spacin Vent to Air Intake iPe(s) // U Length Dia ength / 3 ` Dia ` Spacing 3 r 216, ` - 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 Bedrrrench Center Bed/Trench Edges ITopsoil g [K] Yes 0 No 0 Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: ( ( / 21 / 0 Location: 786 103rd Street Roberts, WI 54023 (NW 1/4 NW 1/4 29 T29N R18W) NA Lot 3 Parcel No: 29.29.18. 1.) Alt BM Description = ' c P � wAV -I"- nA� &S - 2.) Bldg sewer length - amount of cover => Plan revision Required? [J Yes Use other side for additional information. No SBD -6710 (R.3/97) Date Insepctors Signature Cert . o. T I I 1 i r/ " " Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463150 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information ou p rovide may be used for seconds p urposes [ Privacy Law, s.15.04 1 m Y p Y second p p i cY O( )1 . Permit Holder's Name: City Village X Township Parcel Tax No: Maier, Gary & Gail I Warren Townshi CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 29.29.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 6�- Dosing Alt. BM Aeration 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 Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number (o.Zj` D 2.- TDH J iLift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length 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 Bed/Trench Center Bed/Trench Edges Topsoil Q Yes [F No [] Yes `.] No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / t// /-W Inspection #2: / / Location: 786 103rd Street Roberts, WI 54023 (NW 1/4 NW 1/4 29 T29N R1 8W) NA Lot 3 l U/ /pu ow Parcel No: 29.29.18. o 1.) Alt BM Description 2.) Bldg sewer length - amount of cover = Plan revision Required? J Yes [J No Use other side for additional information. SBD 6710.(R.3l97) Date Insepctor's Signature Cert. No. Safety and Buildings Division 2 County 201 W. Washington Ave., P.O. Bo �� Madison, WI 53707-716 ry Permit Number (to be filled in by Co.) s - "-n NV (608) 266 -3151 J CJ Department of Commerce umber Sanitary Permit Application G `' In accord with Comm 83.21, Wis. Adm. Code, personal information you de may be used for secondary purposes Privacy Law, st 5.04(1 xm) O , Ptdlest Address (i 'di rent than mailing address) L Application Information —Please Print All Informatiol► O O �- '_ ' ` 79(o /03 Sir Property Owner's Name I # Lot it Block # Property Owner'h Mailing Address Property Location 2y 003 f � l."/ ��., section City, State Zip Code Phone Number c < < I) ; , circle one) ��t L ✓' /i �`[ /�� T l N. R EorW II. Type of Building (check all that apply) L L subdivision Now CsM Number Quor 2 Family Dwelling - Number of Bedrooms 3 / ❑ Public/Commercial - Describe Use ❑ State Owned - Describe use 1 " 1 62 �d x 7 S �'1 �n _ ❑villagewnship of R� G� III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A• L4 New g rem Replacement System ❑ Treatment/Wding 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 n IV. Type of POWTS System: (Check all that "Pl ❑ Non - Pressurized In- Ground 9KMouod ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground U Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sad Filter ❑ lain —-. Recirculating Synthetic Media Fitter ❑ Leacfii Chamber ❑Drip Line ❑Gravel -I Pi pe Other (exp ) V. Dis tsaUt'reatment Area Inf matio Design Flow (gpd) Design Soil Appli Rate(gpdsO Dispersal Area aired st) Dispersal Area (sf) System Elevation 4 0 G V/ 2 0 Z, 6, 0 /2f'3 /0 3. 9 5 — V1. Tank Info Capacity in Total Number Manufacturer b Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank I •�� (�/ ,' e L 1 Aaobic Tratmem Unit / Dosing Chamber �� r VH. Responsibility Statement- 1, the dad tgaed, assume remondblUty for Witallation of the POWTS *Gwm on the attached Plumber's Name (Print) P Si h4PVMPRS Number Business Phone Number it x Plumber's Address (Stroctj City, State, Zi ode) P C, 13, Ltil� o c� I (t _ 5 Z(c - z -- VIII-County/ e rtmentUseOnl Approved 11 Disapproved Sanitary Permit Fee (i =�� � sued ssuin Si to o tames) Surcharge Fee) e�L R n f r Denial 2 R 0 IX. Conditions o❑ Owner Given f Approval/Reasons for Disapproval 3 I ] , 1'3, ' 1 eptic tank, effluent filter and spersal cell must all be serviced /maintained (DOW �N� - as er management plan provided p g p a p ovlded by plumber. - f� 2. All setback requirements must be maintained Tk a pim (ter Ara Coma e*) far ale °8 paper net ksa than 51/2 X11 haminsho � C gs SBD -6398 (R. O1/03) 0 c�v��r : Gary G'a M P F Top Exc s 1"rorC�r L I i1 � ` (3aq ,off ,v /02.7S' 796 a il 8(� io3, �. Si aP�. poc o �,osea� I a8 olsoo o 7� PrpPC CL �s1ed( 3y y BJ 146me-- Wc�l ff -� j Ocatr L b to-e I3,M. Ib�•09 rr -r6f o� L6+ S1elc, Safety and Buildings commerce.wi. �OV 4003 N KINNEY COULEE RD g LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 i sco n s i n w ww.coe.wi.gov/sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary October 15, 2004 CUST ID No.223475 ATTN.- POWTS Inspector ZONING OFFICE JOE STANG ST CROIX COUNTY SPIA PO BOX 263 1101 CARMICHAEL RD WOODVILLE WI 54028 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/15/2006 Identification Numbers Transaction ID No. 1068115 SITE• Site ID No. 690708 Gary and Gail Maier Please refer to both identification numbers, 103RD Street L above, in all correspondence with the a enc . Town of Warren St Croix County NW1 /4, NW1 /4, S29, T29N, R18W Lot: 3, FOR: Description: Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 985584 Maintenance required; 600 GPD Flow rate; 33 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual, SBD- 10572 -P (R.6/99), Pressure Distribution Component Manual, SBD - 10573 -P (R.6/99); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, COrtrl.�d stats. APP R( The following conditions shall be met during construction or installation and prior to occupancy or use: DEPARTMENT OF .. ,OF .Wl'EY General Approval Requirements: SEE CORREF • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. TOE STANG Page 2 10/15/2004 • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • _Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 r INDEX SHEET tlivz' J''� ocr � � 4 ? ��� B1 to PROPERTY OWNER: GARY & GAIL MAIER 794 103RD STREET ROBERTS, WI 54023 PROJECT NAME: GARY & GAIL MAIER PROJECT LOCATION: NW 1/4, NW 1/4, S 29, T 29 N, R 18W MUNICIPALITY: TOWN OF WARREN COUNTY: ST. CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD- 10573- P(R/99) MOUND COMPONENT MANUAL SBD- 10572 -P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank Pump Chamber Cross Section & Specifications Page 5: W1280/800-MR Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan - Pg. I D Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 ComltERce B GS C- / ONDENCE Name: Joe Stang Signed -t. 1�;� M Address: PO Box 263 i Woodville, WI 54028 Credential Number: 223475 Date: October 1, 2004 , kA- ( 1 M CL Cr P � S T -t,,C 7'b ��� �B� 5l �P� Poc a P n5�� 1x80/goo 6,J F,lf�b- o� S, CL rs��1 14ome- Wc r b IJ-e i(�3•O r c7' r — - ► Page u � Synthetic Covering Distribution Pipe AST�t C 33 _Be 1DS, Medium Sand -- _ � - - - -- F Topsoil - " -- N p E �l 3 b C o % Slope plowed CaLLOf Z'_ 2,Z Force Main Aggregate From Pump Loyer D 5- Ft. E /. ©C, Ft. Cross Section Of A Mound F Ft. G Ft. A _� Ft. H _ / Ft. Signed: — B Ft. Qf�,QG•- K Ft. �2�2 License Number: L Ft. 2- Date: � Ft U,l1,e� ,� ic I c Ft. r �� -St Fo rce. W L7- Ft. L —_ —_— Observation Pipe K A - -- - - -- - - - - - - - - - -- ----------- - - - --� _ _ Distribution C �t-i- Of 2 2 Pipe Aggregate ( Observation Pipe (3asa A rea- = 1 -Z 2 0- Plan View Of Mound I (Dour 3 0 S C ) e o �, o•- fi Porloto -- hip,. C) .1011 ll C .; �c rs - - - — Ca" 0 / End V111 Porloralyd �" PVC P; p C `ll .4 Holes Located on Bottom are Equally Spaced F., rC c M c r TL n ./ Q Pip, Distri buri__on 1D lje L_aY P 7�) p f r R c' X � Y Hole Diameter Inch Signed:" Lateral " — Inch (es) License Number: Manifold Inches Date: Force Main " Inches 1,� ?UE�`� tle�. � a 3 �`� •S I - lo�es �er La�'era - 3y .. �,►�� ber d �- _ A les 6-w4ex G& i Page g SEPTIC TANK E 'PU CHAM BER CRO SEC TION AND SPECIFICATIONS 4" PA-VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER � ►-o L,, 6 teu IC) C3 W1 PADLOCK E WARNING LABEL {__ .__- 4 " MIN. ......... �l . Zyp 18" IN. ��� 18 INLET I WATER TIGHT SEALS GAS- TIGHT o /APPROVED F ILT ER — A SEAL JOINTS WITH APPROVED 7A WE 1- �' (00 —f--- � ALM APPROVED PIPE PIPE 3' P " x '' B 3 ONTO ONTO SOLIO ` 6 ' ON SOLID SOIL SOIL C i PUMP OFF ELEV . 9 L.s FT. -- OFF D 3" APPROVED BEDDING -UNDER TANK CONCRETE PAD SPECIFICATIONS `f"ota ( (To 1 S =v. Lai' r�LS SEPTIC / DOSE TANK MANUFACTURER: (,� ese►- X S z. Ie o. 7 , 5 7 - (5cx I . TANK SIZES SEPTIC IDAL GAL. DOSE VOLUME INCLUDING DOSE CS GAL. 6, /S_ 6 - >FLOWBACK: GAL. . ALARM MANUFACTURER: EleJ o CAPACITIES: A = I9 INCHES = </C)/,7 GAL. - MODEL NUMBER: / SWITCH TYPE: B = 2 INCHES = �� GAL. PUMP MANUFACTURER: I� C = INCHES = AL. MODEL NUMBER: P S - � R7 l SWITCH TYPE: c oa�" D = J- � INCHES = J6• GAL. REQUIRED DISCHARGE RATE 1,8a GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . 7•a FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . f FEET + $O FEET FORCEMAIN X 3.6,) FT /100 FT. FRICTION FACTOR . l ► A 1 FEET TOTAL DYNAMIC HEAD = $; FEET INTERNAL DIMENSIONS 'OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID DEP'IFr �hc 'le ase c - raV, ( s�•�c . h e e� SIGNED: LICENSE NUMBER: DATE: 1/88 r CL a Z � \ i W fLJLQ U Or luni F= w U O F0 Fm N F Lu O I °� 2 M �NF F— Y0 Lu ,`Oj = O Z U p I O U W 0 00 M OB �� ~ � NaN o G m pQ ZZ U Oa ZQJV 47 Q 0� O U FLrL'1�� 3 N 0 x N II� - - J� 0 o vi a V) t�. � W LLI (30 Z � O w '° W 00 W 0 0 0 ;.� 00 � N Q It C) V) � C) j > � v 0 Q O V N I nOw_i0 ~Q f N Q m 0= U 00 Z M iCl�j m ��ZW - W U Q� W N NM�0 &0 ~� ..3 �OY 0 0w Q w = * YZ Q w -i zz m a zzv00io < YJ z za �QOOaWW Wc3 < < 0 Q�.. Z�Q H 0 3.mUm2JS`�mJ O Z Q N Y Z Z O O Z N O H N D U W O N ' M W H Z,, S . U Q - r ( I W � 1 F U- mom ; II S „£ W .n d _LI ,- > W U _ N N z i `. �g O „lti l 3 O Gc ° M OD E L DVP M OD EL Vertical . Pump P0' •0 Su bmersible Effluent Pump , t,Y r ol Ai Ira to I I ' I Pump Specifications 73 HP Up to 40 GPM to i MODEL: 3871 Discharge size 1'/4" NPT 9 3 0 ' Solids: W maximum e Motor 7 25 I i Single phase: 115V o 9 p 6 20 — — -- – ; Materials of Construction v 5 , Brass /thermoplastic ,5 — -- - - -- -- — EPOS Features and Benefits 4 ` ' _ h... • Top suction eliminates a Impeller clogging. 2 5, _, �.' _ �_.._._ . eroa • Corrosion resistant , construction. + ° o r i -- __L__._.l_-- !_...__�.._.__ p 10 20 00 40 SO USITM -Float actuated switch. 0 2 4 6 • ,0 u CA 4GItV METERS - -. - - Pump Specifications Features and _Benefits 25 5 .. .. MODEL DVP03 I ' /to and 72 HP • EPO4 impeller- semi -open design b t0 ' I Up to 60 GPM with pump out vanes to protect a ,5 Maximum head to 32' mechanical seal. Discharge size 1'h "NPT • EP05 impeller - enclosed design Z 3 10 Solids '/4" maximum for improved performance. 2 Motor • Rugged glass - filled thermoplastic 5 casing and base design provides All motors feature ball °I ° o s ;o t5 20 25 L - - - -` -- .. - -- i bearing construction. superior strength and corrosion 00 35 40 U.S.CPM resistance. Single phase: 115V 0 2 4CAPACITY 6 a lortI Materials of Construction *Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. • CSA listed-models available. All Models are designed for continuous operation and feature stainless steel hardware. 1788 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Crob( include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 042 - 1079 -20 -000 0 J� 61 Please print all information. A bat Personal information you Lew, s. 15.04 (1) (m)). / 6 7 . 7/„ Property Owner z - Property Location Y ✓ C Gary &Gail Maier Govt. Lot NW 1/4 NW 1/4 S 29 T 29 NR 18 W Property Owner's Mailing Addrf ss APR R t () 200 Lot # Block # Subd. Name or CSM# 794 103rd Street Prop. 3 7 ...8wpawd CSM City Stag Zibde Ahbq dumber J City Village J Town Nearest Road Roberts iJFr 42 Warren 103 Rd Street 0 New Construction Use: 601 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Install mound system at elev. 103.25' at 6" above 102.75' contour. a Boring # Boring Pit Ground Surface elev. 103.19 ft. �jn. Soil Depth to limiting factor Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence, Roots GPD/ffs in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 1 0 -11 10yr3/3 none sil 2fsbk mvfr as 20 m 0.6 0.8 2 11 -20 10yr5/4 none sicl 2fsbk mfr cW 1f 0.4 0.6 3 20 -25 10yr4 /4 none sl 2msbk mfr cW 1f 0.6 1.0 4 25 -33 10yr5/6 none gr Ifs 1 msbk ds cW 1 vf,f 0.5 1.0 5 33 -58 5yr4/4 f2f 7.5yr5/8 sl 1 csbk mfi - 1 of 0.4 0.7 a Boring # J Boring 6el Pit Ground Surface elev. 102.52 ft. Depth to limiting factor 40" in. Sal 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 1 0 - 12 10yr3 /3 none sit 2fsbk mvfr cs 2fm 0.6 0.8 2 12 -24 5yr4/4 none sl 2msbk mfr es 1fm 0.6 1.0 3 24-40 7.5yr4/6 none Ifs 0 sg ml cW 1vf,f 0.5 1.0 4 40 -46 7.5yr4/6 f2f 7.5yr5/8 ffs 0 sg ml cw - 0.5 1.0 5 46-60 7.5yr4/6 f2d 7.5yr5/8 sl/fs 1csbk mvfr - - 0.4 0.7 -- T i i - H#5 con ' fan unsorted mature of 1 csbk 7.5yr4/6 sl & 10yr5/6 Is. * Effluent #1 = BOD ? 30 < 220 mg/L and SS >30 < 1 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS <30 mg/L CST Name (Please Print) Signatur . CST Number James K. Thompson 5. 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, 1 54020 4262004 715- 248 -7767 Property Owner Gary & Gail Maier Parcel ID # 042 - 1079 -20 -000 Page 2 of 3 3 ] F Boring # Boring 01 Pit Ground Surface elev. 100.24 ft. Depth to limiting factor 42" 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 -11 10yr3/3 none SO 2fsbk mvfr cs 2fm 0.6 0.8 2 11 -33 10yr5/4 none sl 2fsbk mfr cs 1fm 0.6 1.0 3 3342 7.5yr4/6 none sl/Ifs 1msbk mvfr cw 1vf,f 0.4 0.7 4 42-61 7.5yr4/6 f2f 7.5yr5/8 sws 1 msbk mvfr - - 0.4 0.7 I I H #3 & 4 consist of an unsorted mxture of 1 csbk 7.5yr4/6 sl & 10yr5 /6 Is. Redox. concentrations located within coarser textured Is. F-1 Boring # I Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F- F-1 Boring # I 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ' Effluent #1 = BOD 5 > 30 < 220 mg1L and TSS >30 < 150 mg/L ' Effluent #2 = BOD <30 mg/L and TSS a 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. i 1766 . l]e -►1C� l'YtaY� � Tja o,��o�S�R�•JC.[t /e: /�_ �, �{SSum2c✓ elegy` _ /�. �' .3 VA g9, ♦ E,r gee elev � _ � 63 - � • /o card Prod. S�z�E'e T � e - i 00, D' con mar- /o 1 3 - O ,f ,- OOOS -�•d io W �o ?op or lot' sba�e. Elcir = /03, 09 ZSit. 73' /03 L d 541-,e e �P5. 3 0{3 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of S -FILE INFORMATION SYSTEM SPECIFICATIONS Owner GARY u" GAIL NAIEk Septic Tank Capacity 1280 gal ❑ NA Permit # Septic Tank Manufacturer 3 WIESER CUi`iCItE3'E E3 NA DESIGN PARAMETERS Effluent Filter Manufacturer GAEL ❑ NA Number of Bedrooms 4 ❑ NA Effluent Filter Model A -100 12" x 20" ❑ NA Number of Public Facility Units J7 NA Pump Tank Capacity 600 ga l ❑ NA Estimated flow (average) 400 g al/day Pump Tank Manufacturer WIESER CONCRETE ❑ NA Design flow (peak), (Estimated x 1.5) 600 gal /day Pump Manufacturer GOULDS MIPS INC ❑ NA Soil Application Rate 0,5 al /day /ftz Pump Model 3871 EPOS ❑ NA Standard Influent /Effluent Quality Monthly average` Pretreatment Unit IA NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD :!9220 mg /L 14 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 IBOD 530 mg /L ❑ In- Ground (gravity) ❑ In - Ground (pressurized) Total Suspended Solids (TSS) S30 mg /L d NA ❑ At -Grade It Mound Fecal Coliform (geometric mean) :510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 2 ❑ month(s) y (Maximum 3 ears) ❑ NA � ear(s) M Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Ins Inspect dispersal cell(s) At least once eve ❑ month(s) (Maximum 3 years) ❑ NA P P every: 2 IX year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA 13 ❑ year(s) Inspect pump, pump controls & alarm At least once every: 13 M mon ❑ NA Flush laterals and p ressure test At least once eve 11 m ye ar(s) ❑ NA P ever 3 ®year(s1 Other: ❑ month(s) ❑ NA At least once every: ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of :512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) PWNERS: GARY & GAIL MAIER Page 8 of _ ` 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 Pklmber 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 degreasers; pro the We of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degres; dental Aoss;' disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings, gasopne; grease ;• herbicides; meal scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONOMENT 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 Vold space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: • A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compacdoitand should not be infringed upon by required setbacks from existing and proposed structure, lot Imes 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. WTS a g# and Th site not been ev to id Itable repla nt area. Upon sit ev ado must performe locate a I placeme ea replacement area available n hol i tank ma a Installed as a last resort to replace the failed POWTS. C�} 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. -VVARMNG>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFIGIBNT 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 STANG PLUMBING & ELECTRIC Name ABC SEPTIC SERVICE — MENOMONIE Phone 715/684 -5166 -Phone 715/235 -1666 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name ABC SEPTIC SERVICE 2 "MENOMONI ' Agency ST CROIX COUNTY ZONING Phone 715/235 -1666 Phone 715/386 -4680 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencipa. This dowrtent awels the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)3(Q and 83.54(1), (2) & (3), Wisconsin Administrative Coda Use of this dowmd does ad guarantee the performance of the POWTS. 68AMf(2/01) 10/19...'211104 04:40 715622 PRECISE QUALITY BLDR N16E 01 A14D CERTWICATION FORM Mailing p (%- ftom pl D 90w coxtstnacttotil - -'1tVfS1AM,/ )DI Towit OZ J w - v" Sec. Subdivisior a::,' SnrV�y map 4 Vaiump- Page v 'Warranty Deed v - 30 Jot lines identifiablexyes 1 0 no Ej 4 WaStCS '112 lb jj 10 J33j2LjjC C S cool d rcsu pjj 1h E jW. e 7 ! b'Properm if neede Pumpittg But >Iv' 5('TfiU tw* cycry tbx— as a trCatguerd ib Ov wwe eau aff6�( the function Of The mr f sigutsd by t ow=j and by The pfopow- 13wntf Agmes to sa to St emix. 7momA DcPtwellt $ C ' " was te- wi tler disposal s than III full of mastcr, plumbcy, j0U=e-3'D=P1wmbtT' Te LTy), 02! Gf-Mic t,�M�P- is 't Ind plunpiuy , is iu Prop- opememe omdftim AnNor (2). Afwr 65Pnval sys with the qtmd-7-1� - t7 i oma, tbc A& Tequ'r=tUL and " o f NZI(EIMI 171effOU�r-"- Stake' tilt herciw as set by 4ir. DVPftrtD1ent Of C' lmd the Dapa —ed to thr St - mix CollutY 7, vzdug Off '" V -)UX septic sN jjastc mo i n titki:dmmt be COUTIettdand rctt of the threr LI- /I . (p doic Z DATE '�PPLICANT (alc� the L C C A'ffGN (md. I ce llif� that an statalicnL� or this a4 2tyr, cc record i Register r-f Dee& t decd I 1i!e I perty a T)A OF APPLICANT A-ry W fDymmi4a "I is mis-represwit'-d may result to (ac smitz fiv, .-All this a pplieattan� a staraprd wamaty deed from. tht Rf1t - L in thr- Include - 1rfctr ;I'Gopy o f t h e ccr dftcd surwy inhi) if C y 1()-19-04 05:43 TO: FROM:7156883361 P01 j I[ ` DOCUMENT NO !I WARRANTY DEED � s[RV CD VOR 11EroNutNa DATA A �� cO ,(STATE BAR OF WISCONSIN FORTH 2 -1982 b V I a•• R EGISTER 'S OFFICE L. Koshe ST. CROIX CO., WI Anthony n i n : and Alice A . Rec'd for Record Kosfieni11 a, husband and wife ......... ... ......... . . . .. NOV 01199 _ ............... ... ..... 11:05 A. �M ........... .......... . ....... .... conveys and warrants to .. ..G_ary- W.,_ Maier • ..an d - .Ga,i.l. Maier, husband. -and.. wife.. _klal- ding..as...... R�plsfMofl� .... surviv orshiP ..mar.itat- .property .......... ........ ............ . .... .... ................. ............. . .. .. ............................ .. .... ••-- ........ .... . .......... .... .. ................ .... - RETUPN TO -.. .... .... .. ......... .... .•-- --- . - - - -.. ...... ... .... .... ...... ..... -.... ............. . -... .. .. . ......................... . ..... ....... ...... .. ....... . ....................... . the following described real estate in ........St. Croix ...... county, State of :Wisconsin: Tax Parcel No: .. North Half of Northwest Quarter (N2 of NW4), except that part thereof lying north of the Highway, AND FURTHER EXCEPTING that part of the North Half of the Northwest Quarter (NZ of NW4) of Section Twenty -Nine (29), Township Twenty -Nine North (T29N), Range Eighteen West (R18W), lying Southerly of 80th Avenue (Badlands Road) and Easterly.of 103rd Street (Ross Drive). This parcel contains Thirty -fire (35) acres, more or less. AND FURTHER XCparcel of land located in the Northwest Quarter of the Northwes r (NA of NW4) and the Northeast Quarter of the Northwest Quarter (NE4 of NW-) of Section Twenty -Nine (29), Township Twenty -Nine North (T29N), Range Eighteen West R18W Town of Warren, St. Croix County, Wisconsin as follows: ClinV olume 1) of Certified Survey Map filed the 19th day of October, 1990, 8 of Certified Survey Ma ps, Page 2284 as Document 81 , office of the Register of Deeds for St. Croix County,+ . This is not homestead property. XCK (is not) S W.160. E xception to warranties: Easements and restrictions of record. Dated this - _ - 71 � _. _ _ _ day of . . -... � I �_ 1990 _ ... (SEAL) �,p;,�Ti / •s`LC:v+v/71't' _ (SEALo Anthony L. Koshenina G G L - c --r - .j- _ _ . .. _ - ._(SEAL) �(- GC . � � `._ - - -- -- - - - - -- ---- -.Alice A. Koshenina AUTHENTICATION ACKNOWLEDGMENT Signature(s) .............. . .................... •.._-----------------­- STATE OF WISCONSIN ----------- - - - - -- St. Cro i x ss. - - - -- ----------------- -------- authenticated this - - - - - -- -day of ....................... . ... 19.•.... Personally came before me this ...... .---. ..... day of -- --- -- 19.9 -0-. tt , above named ......................... •- • - -• - -- -- •-- •------------- • - -...- --- ---- - - - - -- Anthony L. Koshenina and Alice A. E.oshen i na TITLE: MEMBER STATE BAR OF WISCONSIN (If not . .............................. ............................ - ........ - -- -------- _ --..-..__.__--- -- authorized by § 706.06, Wis. Scats.) to me known to be the person _S. -_- who executed the forekoin, "strum / ent and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY '��/ Thomas A. McCormack tf Baldwin, .. ........................... WI 54002 - - - - -- N otary Public ._ St. Croix _ __- County, Wis. (Signatures may be authenticated or acknowledged. Both MY Conim:sinn is per manent. (If not, state expi ation are not necessary.) ;'I f 'j P/ ' - / / --- 19 '� •) date: �-.._ *Names of ver+ons sitninQ in any capacity should be typed or Urintr,l below their siKn,w.rc.. WAtRANTT DEED STATE BAR OF WISCONS7V Wis—­..;in 1 -g.1 Mw-, I'­ I��r FORM No. 2 — Pjs'z ,; ,.. h,... %% -1, 10 -19 -04 16:49 ID= P92 3 b -c O i 1 ' I y 1 y 1 AT 1 Ol _ �^ r•w � 1 t • 1 'w► 1 a 1 1 ww p 1 1 1 1 ■ .ra 1 x n i I �• 10 -19 -04 16:50 ID= PO4 1 1 1 1 ' , 1 1 i 1 � 1 � 1 1 1 � , 1 1 , , 1 1 � 1 , 1 , , 1 1 w r ' � 1 7 1 1 * Z 1 t Itri� • /N P 1 J 1 1 1 1 1 � 1 � � 1 � 1 Ara i t t t 1 t , 1 1 ` � 1 1 1 1 , 1 1 1 1 1 1 L ---- A PJ . = s s t rr Ga I t i s i ti✓ � i s i s = i t L _ ` s L L L 3 L ..a It Ame �-.r 71 €i _ ___ c-4 L ! i .r, a •'� AJS; cod 610:9T ti9 -6T -0T r - 4 .. STAIIIG'S 50 6 vfd)ow D� Wo d iUe, VA 540 Fax (71 604- Fax- Trag.uenitw Fom C'R c , h 0 A" 7 �a? (� • 3 - 0 tio:• Review 0 Please Cnmm�� T9d =QI 6tr:9T tp0 -6T -0T a; ' ? 6 3 9 4 9 VOL 18 PAGE 4759 KATHLEM H. W KLSH REGISTER OF DEEDS ST. CROIX CO., wI CERTIFIEn SVRVEV MAP RECEIVED FOR RECORD 85/26/2004 03:30PM LOCATED IN PART OF THE NW1 /4 OF THE NW1 /4 AND IN CERTIFIED SURVEY MAP PART OF THE NE1 /4 OF THE NW1 /4 OF SECTION 29, T29N, REC FEE: 13.00 R18W, TOWN OF WARREN, ST. CROM COUNTY, WISCONSIN COPY FEE. 3.00 INCLUDIN(3 PART OF LOT 7 OF CERTIFIED SURVEY MAP PAGES: 2 RECORDED IN VOLUME 8, PAGE 2284. m BEARINGS ARE REFERENCED TO THE ST. CURVE DgTq n CROIX COUNTY GPS NETWORK. LOCgTEp ON / /p 0 S00 °00'41 'E 1322.87 p'- �� Ln' m SHEET2 S00`0041 "E 33. z 800 °00'41 "E 1289.81' _ WEST LINE OF 1255.41' 34.401 n a THE NWi /4 =j n � r { � � 0. APPROVED _ ST. CROIX 00uKrY i o � 4 Planting Za+kq and Psrks Committee � MAY 2 6 2004 kD 1 ,lam c T { 1 t r K not r000rded within 30 days of r l = m appoval daft apWavai shag be M P ruwg and void r "I Ic�t� m a� , lr�J r J I 33' 331 1 m w� 0 I i C, L � V ' m —{ tp� m � o cf) Z 00 A 7, : n z I I I r�l �I �I 16 0 NOO °42'36'E 1243.48' 352.84' 33.001- c° I 289.5 ' f p 5 p 284.701 283.40' NOO °42'36 "E r- 1 ///�� 385.84' I i ' m 110- N �j Z W t0 t� { 3 Z E8 8:1. III.. Z s D D iv _ a i f p : m 1"' W y� Yd m , O a n c11� I W °® ' 1� I i� �t�' ` O m I � O cn ^'cn p y pr" C_n ...I n rom �m01 N g ® .�; I itn �� �W � AV ° I z''S -i liC 0o c ) m - o f "� ' ...'.. '-1 n ..'-7 ' 1 ❑ ° '1� m 4. ml o I o NO1 °03'47 "E ! 852.96' ^1 , +284_81' _ __ ♦264.73' 128 - 284.73' -- _ N01 °03'47 "E 852_50' i s D STRI =ET 1 ( G 1CPi�GJSr_�?_C D &WRM n v m -0 z m -4 l ;« f LEGEND ➢x =Op Q 0 Ov� w I I I O• �� C W ]o I 1 B ALUMINUM COUNTY SECTION CORNER m 0 Z Z w MONUMENT FOUND x T m� D Z t d p 3/4'X 18" IRON REBAR SET, WEIGHING 1.50 A T — Z m I i qq I LBS PER LINEAR FOOT. 1 p -" * O Z — - !q 1 t I � coa C� grn ! 1 5/8"0.0. IRON PIPE FOUND co j o N I ` N �O W li -0 EXISTING POWER POLE PROPOSED DRIVEWAY L I — ' L SOIL BORING z n THIS INSTRUMENT DRAFTED BY EDWIN FIANUM SHEET i OF 2 SHEETS JOB 04 -36 DATE 4 -7 -04 Vol 18 Page 4759