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HomeMy WebLinkAbout042-1079-20-150 o N 0 ' 3 c d r 0 ) c l 3 0 3 M m w G • CD I " � S N A !� =1 CD CD N y N y v y 3. tc O p a 3 m N ? g y CD o pC c o _ .. a v�z m ca D y 0. CD W N 3 O a) ODD O O N ° I I o W r. < z cn a M v a co o S w d CD cc N 3 C z O D O 0 S 00 d PO I c � � m o I � 3 0 z m ai -� N 0 Q p z O D cu ,� c 0 o_ z N 0 0 6 (O z O '' z y z CD o; zm n D �CD m CD CL CL W 0 O 0 O > > m 0 0 N y Er C4 5: z a rr y O N m 7 O 0 7� N N N N ( d j O f?o 0 S y :3. m > A y 7 Er W A 3 N 0 fD N C_ ti <C °a a v o CL i 0 y y tv 3 o p w =r w m m O mm ao o N Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' 1 INSPECTION REPORT Sanitary Permit No: 463117 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 I Warren Townshi CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: Gcj l 29.29.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM q AerdM Bldg. Sewer 12 • 6 Yb , ? Holding St/Ht Inlet 12 (� *? b S TANK SETBACK INFORMATION St/Ht Outlet \ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 5S 7 ! . I ' I / Dt Bottom I -,T Dosing J / i Header /Man. Aeration Dist. Pipe 4 a Holdin Bot. System 8� 1­ 3 Final Grade � v PUMP /SIPHON INFORMATION (a "ZI Manufacturer I Demand St Cover N GPM Model Number TDH Lift Friction Loss System Head TDH Ft ISIS 3 . Cv 2_3 -of:) C d r /01), Z_ Forcemain Leng Dia. i 1 I Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length , No. Of renche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 8 -- 7 ( A SETBACK SYSTEM TO / `p P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION T eQ J $y stem: CHAMBER OR yp n/ � �qft( Sv � Y 10 1 33 1 /(/,/� . UNIT Model Number: .� DISTRIBUTION SYSTEM / W (-- I � 7 x Hole Spacing Header /Manifold Distribution i x Hole Size Vent to Air Intake i I/ Pipe(s) �� 1 i i / 2_' Length Length -7z Dia Z Spacing ,3z SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded /Sodded j xx Mulched Bed /Trench Center 2,3 Bed/Trench Edges i Topsoil t c - r es [] No s T No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /C / Z-�. / �y Inspection #2: Location: 782 103rd Street Roberts, WI 54023 (NW 1/4 NW 1/4 29 T29N R1 8W) NA Lot 4 ` :1 Parcel No: 29.29.18. / ^ A, t 7L. /PGA C/ 1.) Alt BM Description C5 � 2.) Bldg sewer length = - amount of cover = 2_ 10 � �Ct C L c� fid" 1 ��u ✓r`. � � v�n�h.. W i 't'1 -. Me-.i Plan revision Required? ]Yes No /b 1-79 Use other side for additional information. ut SBD -6710 (R.3/97) Date Inse ctor's _7 nature Cert. No. M AI Safety and Buildings Division 201 W. Was • t7162 L isconsin MM ° W Sanitary Permit Number (to be filled in by Co.) De artment of Commerce P 4 3 /1 - 7 Sanitary Perm eatio state Plan I.D. Number In accord with Comm 83.21, Wis. Adm personal informatio may be used for secondary purposes Privacy law, s 15.04( Proj Address (if different than mailing address) L Application Information — Please Print All Information NG OFFICE Property Owner's N (I A Parcel* Block # Property Owner's Mailing Pro perty Location f aty,StJate l tip Code Phone Number Section c7 / �a no) II. T e of Building (check all that apply) N: r W aS C owe I or Family Family Dwelling - Number of Bedrooms N Pub rclCotntnetraal - Descdbe Use `7.31 State Owned - Describe Use City_ Vdlage wns6ip of l/ III, Type ermit: (Check only one box on line A. Complete line B U applicable) `, System Replacement Sy" Treahnent/Holdi Tank Replacement eplaoement OnlY CNfier Modification to Existing System B • Permit Renewal Permit Revision Change of Permit Transfer to New List Previous Permit Number and Date Issued Befon Expiration plumber Owner IV. Type of POW1S S stem: (Ched all that a 1 Non - Pressurized In- Ground 24 in of suitable soil Mound 124 in. of suitable soil At -Grade Single Pass Sand Filter Constructed Weiland zed In Ground Holding Tank Peat Filter Aerobic Treatment Unit Recir cu"ng Sand Filter Recirculating Synthetic Media Filter Leaching Dri Line Graveldess Pipe Clduer (ea lain) V. DispersalflYmbnnt Area Information: 0 l2 �� 20> Design Plow (gpd) Soil n spasal Area Requited (sf) Dispersal , Proposed (so System 'on YI. Tank liafo Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New i«iisting Tanks Tanks Septic or NoWing Tank Not sz) Aerobic Treatment Unit IV Dosing Chamber ,1-0 VII. 'bility Statement- I, the s ility for inshullatiou of the POW1S shown on the att"ed Plu / N�dne (Print) � Plumber's MP/MPRS Number Business Phone Number �7 Plumber's Address (Stn et, City, state. 7p ) VIII. CountyMepartment Use Only Approv She Flee) Fee (includes Groundwater Date ued Agent Signatute (No Stamps) Reason 3�- O /8 1 :71 IAA,, X. Conditions of ApprovaUReasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and 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. Atiaeh complete plants (to the CAUntY only) for the system on paper not less than ow x it inches in size PLOT PLAN T GarvMaier ADDRESS 794 103rd St. Roberts Wi 54023 NW i 4 NW 1/4S 29 /T 29 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 101.2' BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of Lot stak� ; Pa vk ( l ASSUME ELEVATION l oo , Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark 0 Property Line 100.2' � _ .:�� B. B -2 ��` 99 100 f�fading is to be done to divert run Area 15' below off away from system is to system remain undisturbed 5% Slope Well is to meet all setbacks found in Property Comm. 83 - 1 Line 3 50' Tank is to be Property properly bedded Line and provided with Huffcutt Combo Tank lockdown covers with approved warning labels Pro 4 Bedroom r� r House M. gAlt. op of Scale = 1 /4 = 1 O Lo@ 103rd St. Safety and Buildings ` k 4003 N KINNEY COULEE RD commerce.wi.gov LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 i i n www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary October 11, 2004 CUST ID No.226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/11/2006 Identification Numbers Transaction ID No. 1066875 SITE: Site ID No. 690447 Gary Maier Please refer to both identification numbers, 103RD Street above, in all correspondence with the agency. Town of Warren St Croix County NW1 /4, NW1 /4, S29, T29N, R1SW Lot: 4, FOR: Description: Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 984679 Maintenance required; 600 GPD Flow rate; 27 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P IN. 01 /O1), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 101); 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. Com'.,gt No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. I The following conditions shall be met during construction or installation and prior to occupancy or use: DEI: ARTMt ".:•i1' t General Approval Requirements: OF S �&jE • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORr E "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01 101). • 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. Stalls. SHAUN R BIRD Page 2 10/11/2004 • 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 cony 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 f� 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 vy �l ' Cover Page �N� �F o "o O �O o� O Shaun Bird s O Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 09/27/04 Owner: Gary Maier Location: NW1 /4NW1/4 S29 T29 N,R18W Lot 4 103rd St.Warren System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve' 7 -8. Maintance pandontige, cy plan rhP�;. cc 9 -11. Soil testL . Shaun Bird Signature License numb PLOT PLAN PRDJECT GarvMaier ADDRESS 794 103rd St. Roberts Wi 54023 NW 1M NW 1/4S 29 /T 29 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 101.2' BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1 ABSORPTION AREA 600 # of chambers none kL BENCHMARK V.R.P. Top of Lot stak f ^ S. ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark r Property Line 1t.o 100.2 1-01, k SB. 100' B -2 99 , Grading is to be (� done to divert run - Area 15' below off away from system is to system remain undisturbed 5% Slope B -3 Well is to meet all setbacks found in Property Comm. 83 B-1 Line 350' Tank is to be Property properly bedded Line and provided with Huffcutt Combo Tank lockdown covers with approved warning labels Pro 4 Bedroom I House .M. Alt. Top of Scale = 1 /4 " = 1 O Lot Stake @ 103rd St. 'Aesignet Date - Non -Woven Filter Fabric 4" Observation Pipe Perforated Aisfribulion, Pipe Below Filter Fabric ASTK C -33 s a n d —� G }H T �� - - = - =- -` o --- E i % Slope 2 �. Force W-Gin - ,,- - Plowed Bed Of t f�- '1 Layer Drain Rock From Fump D . E �'--�— Cress Section Of A Mound S stem Usin F A B For The Absorption Area G A Ft. g �? IF t. Ft. SFt. K i!1 Ft.. L %-IFt. Ft. L 4' Pipe K --------------- r= - -- -- ----------- - - - - -- - - -- - -- _ A Force Moin -_ }}Jj' -------------------------- -- - - - - -- --- - - - - -- - - - - - -- From Pump 'r - - �.f r - - L o Distribution Bed 0f i 2 "t Pipe Drain RocK I 4'Observation Pipe pCcLkz� Permanent Morker ,J pipe or Rods V 074 16 1iv.1'.w ,bv�- ,' Pion View Of Mound USIng A Bed For The Absorption Area pAG E; OFr r - - Perforated oipe Detail 0 End ',► iarr • �PertOraftd � + PVC P +Dt o bales LcrOlO On Bottom• 0 61 "t /� v E Art Equatty Spoced tE'IY t e ,Z r' PVC F ace Main n y . F [ Ot*T -A*LL µ�xT r e C onnte � ie 1 , PVC Manifold Pipe Ole , Ois�ri0ua�an Pipe 1 1 - Distribution Pipe Layout P Ft. 44; -e_4 R R. X —� V Inches Y o,_. Inches Signed: Hole Diameter L Lateral Inch(es) License Number: Manifold = Inches Oate, Force Main Inches # of holes /pipe Invert €levdtion of Laterals Ft. CTIGN �,ND SFECItICAT ' p�3MP C�RMB£R CROSS S£ SEPTZC TANK £ w£ATHERPRMF APPROVED ABOVE GRADE jU NCTION BOX MANHOLE COVEN C; vENT PIPE I WT 00w OR WITH CONDUIT W1 PADLOCK 5 y .. MOM DOOR, CIA ;�tTAK�E WARMJMG LABEL FRC�I= Fiii = RADE • �M�11i• 4 MIN- 6 . = a I8" . i INLET WATER FIGHT SEALS SEALT _ ', jol NTS WITH APPROM PIPE fI LT Ek ""..�.a• _ ; ALA'! B ' N s IpSOIL APPROVED PI?E 3' C OFF OM SOLID. q/' -+- SOIL PUMP flFF F , D BEDDING USPAS E �NCRETE pA 3- APPROV f SPECIFZCA 9AY PER : 5 1+FLIi'fS£B 'DOSES Z /r' SEP'Mc D OSE AI+RIAC3�IREIt: � sr VOLUME INCL I �J �9 GAL- TANK SEPTIC � GAL . DO F LLOWBA -----r 1�T,AL TANK S I ZES : -J:- ^'� L.. 2 � ZILCHES DOSE CAPACI TZ'F.`� = A ALARM MANSJFACTi31tER = 8 r 2_ INCHES = GAL. MU3lSp�. ' � = O INCHES = � SWITCH TYPE: C ® �s �-- _ INCHES = f .� GAL - pEltlP MA�FAC12iREt; = � s^ D KpDEL I+1UKDE'R: PER IL HR 16.23 WAC SWITCH TYPE= GPii PUMP £ ALARM Wlft'NG AS PIP£ FEET FEET RgQUIRM DISCHARGE DAT E IFFERENCE RETWE£N p+ top oFF .ANB.flIS. ZgUTION - FEET VERTICAL D gR ;CTIoN FACTOR FEET + M ;KrWJM NETWGRK SUPPLY PRESSURE FT /100.FT- NAMIC MrAD 0 FEET FORCEMAIIi X .�-- TOTAL 0 DNS or PUMP T L I ID�H DIAm£TL ..... ---- INTERNAL D 1l4ENSF LIQUID ����-- 5- ----'. DA 7E = LICENSE i�iJMOF.R S FGNED: _ f TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE k52 EAD CAPACITY CURVE EFFLUENT AND DEWAT RING MODEL 152 MODEL 152 153 Feet Meters Gal. Liters Go1._ Liters 5 1.5 69 261 77 291 10 3.1 61 231 70 265 12 40 15 4.6 53 201 61 231 °¢ 20 6.1 44 167 52 197 W - 2 � 30 25 7.6 34 129 42 159 d 8 30 9-1 23 87 33 1.7_5 0 35 10.7 -- -- 22 11 20 40 12.2 -- -- 42 0 4 Lock Volve� 38.0 Ft. (11.6m) Ft. (13-) .4 014509 10 0 E20 60 80 100 GALLONS s 1/4 LITERS 0 So 16D 240 320 _ 3 27/32-------- 5/8 FLOW PER MINUTE 3 27/;:2 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. ® 3 21/" l • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik -Box available foroutdoor installations. See FM1420. • Over 130 °F. (54"C.) special quotation required. 12 1/8 1521153 Series' 15211 MODE 8 Con of S on - 5 t/8 u Ox Model YoIts -Ph Mode Amps Simplex 2 or 3 N152 115 1 `Non 8.5 1 SN152 115 1 Auto 8.5 Included 2 or 3 J _L sK2oe4 E152 230 1 Non 4.3 1 2 or 3 aE 552 230 1 Auto 4.3 included 2 or 3 N153 tts 1 Non 10.5 1 2or3 SELECTION GUIDE SN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 Non 5.3 1 2 or 3 1 1. Single piggyback. variable level float switch or double piggyback variable level float BE163 230 1 Auto 5.3 Included 2 or 3 switch. Refer to FM0477. o c au rloN 2. See FM0712 for correct model of Electrical Alternator E -Pak All installation of controls, protection devices and wiring should be done by A qualified 3. Variable level control switch 10 -0225 used as a control activator specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most or (4) float system. recent National Electric Code ( NEC) and the occupational.Safety and Health Act ;OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL To: A.O.80X 16347 Louisvioe,'KY 40256 -0347 Manutiiawersof.. SHIP T0: 3649 Cane Run Road n ��? „ Louisville, KY 40211 -1961 Q�[q(/TY/ SSE INN O (502) 778 - 2731.1(800) 928 -PUMP http:lAvww.zooller.com PU/1�1P !0 FAX(502)774 -3624 m Copyright 2000 Zoeller Co. All rights reserved. T PLAN Page of owfiER'S M�A14UAL &MAMA SPEC FJCAT10NS PovVTS SYSTEM �,�s at 0 NA Septic Tank CaPa NA FILL iNFORiWAT1ON $eptic Tank Nan rer 0 NA oar Filter Maw` "�' ' permits. Effluent � f � p NA . D hL4 Effluent Ftfier-Model 13 NA P� Tank CapadtY `' al Number of Bedf+00mS pump N A Numbet of Cornrrterdat . Units a}tda Pump Tank Manufacturer o NA msbad flow (gam) G aVd . PUMP Mar►uta J"�Z- 0 NA x 7_5) poWn flow . (Estimated 1;> al /d P ent Unite _ ❑ NA Sots APPM Monthly averag ' O San&GraYel 0 W Fibe influentSMuent Quality S30 mg/L ❑ Mechanical Aeon 17 Other. Fats,, QS 3 Grease BOD) Q20 mg/L ❑ Disinfection iodtiemic el Oxygen Demand {BOSS, Si 5o m /L Manufacturer B Toter Suspended Solids R ma r Cett(s) Efflu Quay Mon" average" � ln�round (gravity) ❑ round (pressurized) 0 mg/L ound preb' BODE � C3 At -grade C3 other t Oxygen Dema d SoIids crSS) /L p Dri ine Biochemica 530 mg • Total Susp -<1 0 cfu/10om noacomma�? Vfastewaftr ow FOCBi ��� ( g eometric mean) . Y =toes typicar for d t Y inch diameter sepw tank effluent wastewater - Maximum Effluent Particle Size .. Values typical CE SCHEDULE Service Frocit J r( AiNTEt'�►N s) (Maximum 3 yrs.) M service Event 13 months At least once every equals one -third (K) of tank volume ,were condition of tank(s) yvhan combined sludge and scum 4 ears) (Maximum 3 ym.) [3 Months pump out contents of to,' At least once every r(s) ceil(s) p months Inspect disperse' At least once every s) 0 NA Glean effluent filter p months 8 alarm At Least once every � [3 months s) ❑ NA Inspect pump. Pump O°ntro At least once every a s p NA Flush Iabe+ sls and Press' test At least once every D months [3 ye ye ar ( s ) «' p months ❑ ye ar ( s ) DNA 0V W least Once every ° li censes or MAINl'EN/Wf IN an individual carrying one of the is maintainer, Septage of tanks and dispersal cells shall be made Sewer: PODS inspec den* ing or broken a ny miss Plumber: Master u any for any back Inspecons Plumber on of the tank(a) e m and to check up a�.. Master ns must rude a visual Inspecd a and scu Servicing o Tank i luj or l o u fe the volume of combined sludg � check the effluent levels hardwac kfentifY a QeLacs or Teaks. meal The dispersal Celt {a) shall be vtsuatty inspe� ndng of effluent on the or hardware Of effluent on the ground surface. ding of effluent on the ground surface. Tt>e po i ulatory authority pipes and to check for any pon wires the immediate notification of the loca l n'rg in the observalion indica a failing C-0 s cum and req or more of the tank votumech NR ground surfac a rnaY a and scum in any tank equals one { dispo in accordance with accumu lation of sludg a Septage Servicing opera and When the combined and any entire Contents of the tank shall e e mov ed by refreshment Compo nents; 113, Wisconsin Administratne POWTS �mponents, P a 0ettified POyVTS MauntaiAer. anicai or pressurized rfo�ed aY The servicing of effluent filters, meal o f corn of any service event or monitorng at intervals of 12 months or less shall be pe other maintenance i l uiatory autho�tY within 10 daYs A 981140,9 1`61301-t shat( *be provided to the loca products or other � the pence of painting ens are START UP AND OPERATION PODS check treatment tank($) ceil(s). if high concen For new aonSftUC n, PROr t0 use °f s and/or damage the dispersal lm a the treatment process �; a sepm9e servicing operator prior to use. chemkals that may P the ed detected have the contents of -..- Page of -' Products: e Now at the infi ltrative surface. sad co onditions are men i5 rezored the Y.0 = shat not occur when above nottnal highwater levels. a 0 efi(s) and may result in the Syst7em s up urn tanks My in one large dose, overloading the tank removed by a Ducin9 te °u j arged Lo the di8P� �i t th� motion have the contents a P jnnr or POw7 S Maintainer to wastOWMAr " t. W the effluent pump or corttad rfgco °f �' ppeca�or normal ievets min the pump backVP S age Se Q ng the pump °°n rK over, or otherwise disturb or compact compact assist In manUW and disper� cefis• Do not drive or pa vehicles Over tam mound or at -grade soil absorption area - Do not dl ° P a the performance and prolong the fife the area vr(th(n '15 feet down slope ern the vraste++� sa trem may imp �� dew floss; diapers; Reduction or- erimktatOn of the following dg�ette butts; condoms; cotton swabs; e9 fi e: g � herbiddes; meat Of the POWTS: s�ntiblot ' • $ Rump) v�rater, fruit and vegetable peelings; g softener brine. disinfectan ndation drain { p�sYCidas; sanitary napkins; tampons: - and water sett s: dons: Ot 0tntint7 5 W t to Insure that the bp ASANDON$MF -NT sndlor is perni �n�yr.taicen out of service the fottowing��nsin gdmtnistrativrs Code: When the POWTS fails ed in compliance with ch. Comm 83.33, sings seined. system is properly and qty abandon disoonneded and the abandoned pipe o� a Servicing Operator. Art piping to tanks and pits shall and properly disposed of by a Septa9 The contents: of a[! tanks sits shall be removed nd removed or their covers removed and alt tanks and pits shalt be excavated a the vot space nd p • Aft pu mping . nave! or an o ther - inert solid materta filled tenth !soil. gravel rovrde a Cade CONTiNG�S P d cannot be n3pa �$ following measures have been, or must be fatten, P if the PO system compl replacement t•area figs �� evaluated and may be u tilized for the location of a reps a�d should not p A suitable repiacemen ent area should be protected from structure, tonnes and we Facture to absorption System- The reptat cks from existing and propo be infringed upon by requraed setba ent area vrilt result in the need for a new sonl and site °oval a that time tabiistl a suitable i protect the repia�m Sys tems must comply with the rules in effect ent sus ceme area is not ayaitableo e ° i2rcx'�e moiled POWTS- adv replacement area. Replacem �due to setback �s in POWf O A suitable replace be Fled as a last resort P Upon of the POWTS a soli and logy a holding tank may to identify a suitable replacement area Upo to locate a suitable replacement a rea. if no replacement area is available a e site has not been evaluated site evaluation must be p resort to cep re moval of the Nomat at otdutg tank may be installed as a last tace the failed PO place following Mound and at-gralde sob absofPWn systems may be reconstructed p the rules in e ffe c t at that time- e tnfiltrathre surface Re��ction of such Systems must comply with ccVYARN(N4� TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. RCUMSTANCES. DEATH MAY SEPTIC, PUMP AND OTHER TREATMENT 00 NOT ENTER A 8EpTiC, PUMP OR oTHER TREATMENT TANK UNDER ANY Cl RESULT_ ,RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADOMONAL COMMENTS POWTS T,OJNER� POWTS INSTALLER Name 4211— // Name �w ,� 13i Phone I J = ZZ`� —yJ f Phone LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR PUMPER R �!? Agency Name / Phone }— 3 9 1-1 o I ooanPhone ) J ©� This do�N n take. Ma quede and Waushara County Zoning and San llation sD- ment does Oct Th is +wt was draped by Dw staffs of the GMn Code. Use of this d= the nlwmurn mgweeme As of dt_ Comm a3.22")(jXd)&(0 and 83.54(1}. (2I t31. Wiscons f,MW ry01f gvsrantee &,e performance of the POWrS- 1789 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site Ian on r not less than 8'% x 11 inches in size. Plan must County P P P� St. Croix 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 P /ea qe - :-A -f t e ' By Da Personal information you provide may be.u�fisbontl (Priv Lew, S. 15.04 (1) (m)). o ( :7 - . I I 1;1L1 Property Owner Property Location Gary & Gail Maier APR 4 2004 Govt. Lot na NW 1/4 NW 1/4 S 29 T 29 N R 18 W Property Owner's Mailing Addres 3 Lot # Block # Subd. Name or CSM# 794 103rd Street Prop. 4 na Proposed CSM City _J City _J Village ✓f Town Nearest Road Roberts WI 54023 715 - 749 - 3442 Warren 103 Rd Street 0 New Construction Use: a Residential 1 Number of bedrooms 4 Code derived design flow rate 600 GPD _ I Replacement J Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Install mound system at elev. 101.68' at 9" above 100.93' contour. Boring # - I Boring Sol Pit Ground Surface elev. 100.97 ft. Depth to limiting factor - 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 1Oyr3/3 none sil 2fsbk mvfr cs 2fm 0.6 0.8 2 12 -23 1Oyr5/4 none sl 2fsbk mfr cs 1fm 0.6 1.0 3 23 -31 7.5yr4/4 none stiffs 1msbk mvfr cw 1vf,f 0.4 0.7 4 31-63 7.5yr4/4 f2f 7.5yr5/8 sl/Ifs 1 msbk mvfr - - 0.4 0.7 H #3 & 4 consist of an unsorted mature of Icsbk 7.5yr4/4 sl, 7.5yr4/6 Its & 10yr416 fs. Boring # I Boring 0 Pit Ground Surface elev. 100.89 ft. Depth to limiting factor 27" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 1Oyr3/3 none sit 2fsbk mvfr as 2f,1m 0.6 0.8 2 12 -27 7.5yr4/6 none gr Ifs 1 msbk mvfr cs 1 vf,f 0.5 1.0 3 27-60 7.5yr4/6 f2f 7.5yr5 sws/s 1 msbk ml cw 1vf 0.4 0.7 4 60 -72 7.5yr4/6 Q 1 36yr6 & gr sl 2msbk mfr cvlf - 0.6 1.0 5 72 -85 7.5yr4/6 m1p7.5yr5 /8 sc Om mfi - - 0.0 0.0 H#3 consists o unsorted xture of 1 csbk 7.5yr4/4 at, 7.5yr4/6 Ifs, 5yr5/8 fs & 10yr4/6 fs. * Effluent #1 = BOD ? 30 < 220 mg/L and iSS >30 < 1 mg/L * ffluent #2 = BOD < 30 mg /L and TSS <,0 mg/L CST Name (Please Print) ignature/ CST Number ,fames K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, 1 54020 426/2004 715- 248 -7767 Pro Owner Gary & Gail Maier 042- 1079 - 20-000 Pa 2 of 3 party Parcel ID # 9e 3] Boring # Boring 1/ Pit Ground Surface elev. 99. ft. Depth to limiting factor 32" 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 10yr3/3 none sil 2fsbk mvfr cs 2fm 0.6 0.8 2 12 -20 10yr5/4 none sit 2fsbk mfr cs 1fm 0.6 1.0 3 20 -32 7.5yr4/4 none sl 1msbk mvfr cw 1vf,f 0.4 0.7 4 32 -56 7.5yr4/4 t2f 7.5yr5/8 & slAfs 1 msbk mvfr - - 0.4 0.7 f2d 1 /3 H# 4 consists of an unsorted mature of 1 csbk 7.5yr4/4 si, 7.5yr4/6 Ifs & 10yr4/6 is. F—I 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 QPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F—I 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Effluent #1 = BOD 5> 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. Vol' nch To /off Sta. N Soy %eda/uA oil A FXist %� grade �3 e lev. �o AID.• exrt.: Ta oC /of 54aA. Elect = /0 3. ld3 �d 5tstt� �� 3oF 3 COUN'T'Y ST C ROLK 'NOCE AGREEMENT SEpTIC'TA AND TFIC AT ION FORM . CER py�1NER pwnerBuYer ��/ S . Mailing Address r 03 ent for new construction) Property Address ired fr Planner Deparma (Verification required Identification Number City /State DESCR P. — /� own of propc�Y Z ovation /= 1 /'s " 1 /`' Sec j.Oi # Subdivision g page # �� S� _703 Volume Certified Survey Map # S1 Y_ . Page # ��'3 Volume Warranty Deed # ` �� ( p no Lot lines identifiable no house es [� Spec �� p lure failure to handle wastes. Prope main tena nce CE d re sult in its prema What you put into the system SY NAN cool STEM of your septic systcu d b a li !fir ixaprcper use and main � eYery three yew or sooner, if nee ded o system p out the sep as a treatme stage in the waste disp owner and by a consists of P s igne d by can affoct the function. of the septic tank artzoeat a cc ztificatioa form. disp system owner agrees to submit to St. Croix Zoning DeP rve ifyingthat (1)theon- sitewastewater or a licensed the septic tank is less than 1/3 full of sludge. The p roper t y lumber, restnetedplum i f necessary), masterplumber, journeymmP 2 after inspec and pumping ( system with the standards i is proper operating condition and/or () tain the private sewage disposal cation cats and agree to main Resources, State of Wisconsin Certifi eat of Natural Zo set fo ning O flice within 30 I/we, the u n d ers ign have zead the above crce and the Departm e d to the St. Croix County t of Comm forth. herein, as set by the Dep> n we d must be completed and return =SI Our system has been main three' iration date - DATE ICAI+]T I 'knowledge. I (w am (arc) the o wner(s) of OWNER CATION r'ER form are true to the best of er cf Deeds Office. I (�) certify that all stake of a warranty decd recorded in Reg the grope described above, by A = , __0Z � DATE SI ATURE F APPLICAN rtrut being ievokedby the Zoning Department- on that is m is. represented may result in the sanitary pe An informatt d wa�nty deed from the Reg ister of mad in the watran� deed atio n: a stamps i f is ma «* Include with this aPPI a copy of the certified survey P • DOCUMENT N.O. 1 /.. � TM04 SPACC RESERVED FOR RECOROIMO DATA WARRANTY DEED 46376 STATE BAR OF WISCONSIN FORM 2 -1989 V � W-: SK- PA21,S3 REGISTER'S OFFICE ST. CROIX CO., WI Anthony L. Koshenina and Alice A. Ret for Record Koshenina, husband and wife NOV 0 11990 ....... ..._..... .... .... ....... 11:05 A. µ ......... Ga W. 'pia r a Ga couvec+ and warrants to y. � and ..' .... �.�.. F Maier, .husband -ai,Zw fie, hGlding..as .................. survivorship marital .propel`ty...... .. .. ..... ... ...... ..... ....... _.. ..... -... . -,... .................. .... RETUPN TO ... .. .. . ... .. ........ . . . . .. ... ........ ... ...... .. ..... ------- . the following described real estate in ........St.._ CroiX - ,_County, state of Wisconsin: Tax Parcel No ............................... North Half of Northwest Quarto- (N2 of NW4), except that part thereof lying north of the Highway, AND FURTHER EXCEPTING that part of the North 1lalf of the Northwest Quarter (NI of NW4) of Section Twenty -Nine (29), 'Township Twenty -Nine North (T29N), Range Eighte - 2n West (R18W), lying Southerly of 80th Avenue (Badlands Road) and Easterly of 103rd Street (Ross Drive). This parcel contains Thirty -five (35) acres, more or less. , AND FURTHER EXCEPTING a parcel of land located in the Northwest Quarter of the Northwest Quarter (NW% of NW- and the Northeast Quarter of the Northwest Quarter (NEn of NW';) of Section Twenty -Nine (29), Township Twenty -vine North (T29N), Range Eighteen West (R18W), Town cf Warren, St. Croix County, Wisconsin, described as follows: Lo} One (1) of Certified Survey Map filed the 19th day of October, 1990, in Volume 8 of Certified Survey Maps, Page 2284 as Document No. 463381 office of the Register of Deeds for St. Croix County, Wisconsin. Js not 'ti "• •;:�'f..g This 'not) _. homestead property. XXX(is not) S 30*60- Exception t.; warranties: Easements and restrictions of record. jm II I Dated this - - _. _ day of ( 1990 (SEALS . Anthony L. Koshenina (SEAL) C� l � G e. G ✓- e t > L i -- k Alice A. Koshenina . -- AUTHENTICATION ACKNOWLEDGMENT Signature(s) .. ............................. .. STATE OF WISCONSIN ss. St. Croix - •-- -- - -- --- - - ...... •--... ------ County. authenticated this .__. .... day of ....................... 19 ------ Person-ally came before me this ------- - -------- day of ...- ..-.---, 1'9 9.0 - -. the above named ................................ ....... -- •--- - -• -•- -------- - - - - -- - - - - -- Anthony L. Koshenina and Alice A. - K - o__ sh -- -- --- enina ------------------------------- TITLE: NIEMBER STATE BAR OF WISCONSIN (If riot, ----------------------------------------------- _.._.. ...... authorized by 3 706.06, Wis. Scats.) S to me known to he the person _ - who executed the foregoing '' , n�trumgn q tt and acknowled;e the same. T'-IIS IN3TRUMENT WAS DRAFTED BY Thomas A. McCormack 1 - Baldwin, WI 54002 -' -- ---• ------- •...................... ............................... tiota -p Public .._ St.- Croix -Conn (Signatures may he authenticated or acknowledged. Both �Iv conlm}ssioa is permanent (If not. stat• �1 are not necessary.) date 4 1 1 � / -.Name* et Demons sixnins in any capacity should be typwi or prinuA bl lnw their i¢naa.rel. WARRANTY DEED STATE BAR OT W 'FORM N ?'63949 VOL 18 PAGE 4759 KATHLEEN H. WWLSR - -- REGISTER OF DEEDS ST. CROIX CO., NI 4 00. r,F,FED O UIRVMV MAF* RECEIVED FOR RECORD 05/26/2004 03:30PM LOCATED IN PART OF THE NW1 /4 OF THE NWi /4 AND IN CERTIFIED SURVEY MAP PART OF THE NE1 /4 OF THE NW1 /4 OF SECTION 29, T29N, REC FEE. 13.00 R1 SW, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN COPY FEE: 3.00 INCLUDING PART OF LOT 1 OF CERTIFIED SURVEY MAP RECORDED IN VOLUMES, PAGE 2284. cn BEARINGS ARE REFERENCED TO THE ST. CURVE pgTA n CROIX COUNTY GPS NETWORK. LO CATED ON .- Soo °00'41 "E 1322.87' M(t�PL i44C D Ln HD SHEET2 S00 °00'41 "E 33 P, . Z CR Z 600°00'41 "E 1269-81' _ WEST LINE OF 1255.41' 34.41 n A THE NW1 /4 D APPROVED f ; ST. CROUC COUM Y an r r z 1 Plaraft Zardm d Parks Cc>mmMm r :—I MAY 2 6 2004 �ZI;`� �IQ I OJI� If not n1O0rdW ua@rin 30 days of P� m approval data approval *OR be — - m 1 " 17-61 O Q null Ond VOW � I� A X ° m 33' 331 y 1 m a O o .. I z> y- N � OQ c : z vi : m A — —� R1 I z C) m v I N00°42'36 'E 1243.48' 352.84' 33.04- O �� 289.55 ► ► ► 284.74 ► ► 283 .ao' NOO °42'36 "E I 9 r ► ro ► �, ► 385.84' � I m ° ► �n gb Z I m o',Lp 4 Z a , r�+O CA _ 0 $ ni— w� 00 1 = ; N m 8 -1 cn �i c�7n� N) 0 ni �n C_n l N I N O ( y ? � I�� 1 -41 0. pI r.., -�. ` ilow 11 I im fl m i o p N01 ° 03'x7 "E ,852.96' o o wusr + _iZ + _ +284T81' _. +284.73' y °i 284.73' �' _ NO1°03'47 "E 852_50' Q`I I LEGEND OwbM� N �I Cph 49 ALUMINUM COUNTY SECTION CORNER i m C)= z ° w 11� MONUMENT FOUND �.r i X -11 m CA D y�. i % J': ( O 3/4'X 18" IRON REBAR SET, WEIGHING 1.50 cn Z m m ` I LBS PER LINEAR FOOT. p —��' 0 C f f 1 5/8"0.0 IRON PIPE FOUND cD �' m t 1 I jN < 0� 1i I -0- EXISTING POWER POLE W Z m 1 1 I -- PROPOSED DRIVEWAY L7 A SOIL BORING Z n THIS INSTRUMENT DRAFTED BY EDWIN FLANUM SHEET I OF 2 SHEETS JOB 04 -36 DATE 4 -7 -04 Vol 18 Page 4759