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HomeMy WebLinkAbout018-2003-18-000 (2)Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)] Joshua and Stephanie Wick TANK INFORMATION TOWN OF HAMMOND SVk.\M rr t U t &U9' ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing4,( sT z �� W�Se� - 3za Aeratio nn 'g• cbf Holdi d�.ke TANK SETBACK INFORMATION TANK TO P!L WELL BLDG. Vent to Air Intake ROAD Septic Dosii arZ >' r f f / aera, Hol ' g PUMPISIPHON INFORMATION Demand to SOIL ABSORPTION SYSTEM C2-1~T..4rJ r. St. Croix omit No, 648409 ID No: No: 018-2003-18-000 wn/Range/Map No: 18.29.17.912 STATION BS HI FS ELEV. chmark I r 30 All. BM Bldg. Sewer SUHt Inlet SUHt Outlet Dtlnlet Dt Bottom I erlMa r3� r� 'o�, ' DZrS2 Dist. Pipe Bat. S' stutt�nLs $ -Lf3 B Lf 3 al Grade SIC Qry r (o 12 ^ 2� � p rll.�'a ,2� toz•5z # 2 (Al (A) cic +t& Width t Length f No. f Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid eplh DIMENSIONS 3 /l Qn pawl (il/ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Ver;McVQr� INFORMATION Type Of System' w _ .ir_ /) a� I - I)�"LI '> CHAMBER OR UNIT Model Num DISTRIBUTION SYSTEM Header/Manifold 11-engthiDia r I ( Distribution P pe Spac Length Die ing x Hole Size x Hole Spacing Vent to Air Intake > ' O0� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over zx Depth of xx S eededlSodded xx Mulched BeNTrench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons 5present, etc.) Inspection N1:3 'f2.VZ3 llE(yr{o.Lercat`io- Location: 1569 97TH AVE 1.) Alt BM Description = p�I♦�S o� V�1e n 2.) Bldg sewer length = _ `a °tlQ tti� � r. �&14rr5 Lt W C,�AQIiv�B.dC amount of ter = `f C&-4A&&k1 k" �;Or deue Qo 3) 3 `��'l r. •e p cr fir! &IT— flelf-pTt'rT I / , 6 DLk .cafr 1'►^� u,*, it e r Ev n 1p'tt,�4�o�- Plan revision Required? Yes ANo 3/cf/�Z3 �(�,� 5�/�—��I& o Use other side for additional .infoor�mrepation. / p., �p,.� �1�'t"'� iei-'�°'v�- � � ' T/I1/�IQ-t//� (� 1't��g ) Ov�--J `<G4"H i�t/tA.""��Q�'f3'Llil QIGf pctor's�u'e n �`��^— �✓ r Cer , ` I pDate L Vl >� Kevin Grabau From: Kevin Grabau Sent: Tuesday, February 14, 2023 11:49 AM To: Paul Koehler Subject: SP-648409 - WICK Attachments: 20230214120810380.pdf Hello Paul, Attached is the Sanitary Permit for system replacement, for Joshua & Stephanie Wick. SP-648409 1569 97'h AVE Town of Hammond PLEASE SEE ALL CONDITIONS ON PERMIT. SOILS MUST BE VERIFIED, AND AN ADDITIONAL PIT(S) ADDED TO DEFINE SYSTEM AREA. IF MASSIVE SOILS OR BEDROCK ARE FOUND, THEN SYSTEM TYPE MUST BE MODIFIED AS PER CODE REQUIREMENTS. Thanks. Have a great day. Kevin Grabau I Community Development - Land Use Planner ST. CR VNTY - "rSlY,r1Ju From: Kevin Grabau <Kevin.Grabau@sccwi.gov> Sent: Tuesday, February 14, 2023 12:08 PM To: Kevin Grabau <Kevin.Grabau@sccwi.gov> Subject: CDDIa1 This E-mail was sent from "CDDLA3" (IM C4S00). Scan Date: 02.14.2023 12:08:10 (-0600) Queries to: helodeskgDsccwi.aov Kevin Grabau I Community Development - Land Use Planner 1101 Carmichael Rd Hudson WI 54016 T: 715-381-4382 ( C: 715-716-0698 Kevin.G rabau@sccwi.gov ST. C R NTY r� �(r�rif HV19—n—I ZAN -2673 — o/ 3 6 Gn AB Department of Safety lily ScT ROIX FEB 08 2023 & Professional Services, Sam sari ) Permit Number (too be filled in by Cocj � Industry Services Division Industry St. Croix County , / I / eeymitl IF See ' Application akdWfIbifiIn State Transaction Number accordance with SPS 393.21(21 Wis. Adm. Code, submitsiort of this form to the appropriate governmental unit Project Address (if different than mailing address) is required prior to obtsirting a amitary pumit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy law, s. 15.04(1 m), Suits. Property Owner's Name (—(a Parcel a Joshua and Stephanie Wick 9--200—/$—oo a Property Owner's Mailing Address Property Location 1569 97th ave Govt. Lot City, State Zip Code Phone Number Hammond 1 54016 nw v. ne %, section 18 T 29 N R 17 E orW x P. Type of Building (check ag Ant s Lot g Subdivision Name 0 1 or 2 Family Dwelling - Number of Bedrooms 4 18 R W.l 6 err'V to &W-AL00 Block p ❑ PubadCommercial - Describe Use ❑ Crty of ❑ State Owned - Describe Use ❑ Village of CSM Number 0 Town of Hammond 111. Type of PORTS Permit: (Cheek either "New" or "Replacement" and other applicable on lime A. Cheek one box oar line B. Complete line Cif idblc A. ❑ New System y ® Replacement System p y ❑ Other Modification to Existing System ( rig y explain) ❑Additional Pretreatment Unit (explain) B' ❑ Holding Tank krGround ❑ At -Grade ❑ Mound ❑ lndividtW Site Design ❑ Other Type (explain) (conventional) C. ❑ Rcncwal Before ❑ Revision ❑ Change of Plumber ❑ Transfer to New (honer List Previous Permit Number and Dare Issued Expiration W. rsal/Preatmeat Area rid Tank Information Design Flow(gpd) Design Soil .Application Rate(gpd/sf) Dispersal Arta Required (sf) Dispersal Area Proposed (sn System Elev �fit 600 .5 1200 1200 101 J Capacity in Total N of Manufacboer Tank Information Gallons Gallons Units tJ $ = New Tanks Priming Tanks ru C 4 U cn v a V Septic or Holding Talc x 320 x 1000 1320 2 weeks / Wieser x Dining Chamber V. Rapoosibility Statement- 1, the aaderdgaed, asss aae respainalli ty for lostallation of the POWTS shwa a the attached plant lumber's Name (Print) Plumber's Signature / _ MP/MPRS Number Business Phone Number 715-246 2660 AUL R KOEHLER /� `/.� 225410 lumber's Address (Street, City, State, Zip Code) 21 WISCONSIN DRIVE NEW RICHMOND WI Comety/De astmeart Use Only ppV1. io1 Approved ❑ Disapproved Permit Fee s � �r Date Iss Issui Agent Si tie ❑ 've n for Denial Comdi S Approv I2 ; rEVlotis ai 7l / SYSTEM OWNER: - loe- 5 ptie tank, effluent filter and diSr,-,:.• . , u l'J ust be serviced /maintained tab r �- �Ma.SS - �e- anagement plan provided by:C -L .. S 1 tback requirements must to �,,, �a a t`A SC4 l S � - Sp. S w. 5 oMa-, ! . . ; I al! 1 e IH }Jn far 6e room NW waorit to aft Cawa1y aaly as !a+ aw ter a in a 1 �.��rk rwlf vWt1 i�1 it V7sot C wit - S SB 399 s03/22) p�Q,Dt��V� f "K�� 0 OPY 4,A Tos�.wq dJ S;cpha��c, WjGK Ow P►tc,�� Ol -70D3— l8- ODo �1 4V Suite 4c slows. \ Rcplae�rnh.'� 4�Sftr, r- IY�O r�►i D of �' SIle o'` ynv 00 (,,v lo-I fv \ 2on -,CpPY RECEIVE[ ❑PageBoring M Boring # ® Pit Ground surface elev.AR O t ` Depth to limiting factor in. / elev, ft. 81,+ GROlxcoutl Horizon Depth Dominant Color Red— D t' In. Munsell escnp on Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots A 0-16 10 YR 2/2 ------- --- ----- — SL 2 M GR MFR CW 1 F B 16-36 10 YR 4/4 __________ SCL 2 M BK MFR CW 1VF C 36-72 7.5 YR 4/6 -___----- _----- SL 2 M GR MFR C1 ---- C1 72-108 10 YR 6/6 ------- --------- O M SG ML C1 ----- C2 108 --- BEDROCK OM MER ------ 7i .29,/- 2 r�U; ❑ Boring # ❑ Boring ❑ Pit of Soil Application Rate GPD/Ft2 *Eff#1 *Eff#2 6 .8 .4 .6 .6 .8 .7 1.6 0 0 Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 *Etf#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots Soil Application Rate GPD/Ft2 'Eff#1 *Eff#2 * Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS s 30 mg/L / 11©s lets 1k r PROJEdr P.C. CoiloVa Mrs, Inc. Soft A 1/4 NE 1145 18 2$ ind System PLOT PLAN ss P.O. Box 489 Somerset wl 54025 /T N/R TOWN Hammond COUNTY ST. CROIX MPRS Shaun Bird 226%0 5/9/03 BEDROOM 3 DATE CONVENTIONAL XW IN -GROUND PRESS E_ CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANKS E HOLDING TANK SIZE LOAD RATE -5 ABSORPTION AREA 933 # of Chambers 30 BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A-100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 101.0/100.8/100.6 5' below grade Alt. BM Top of 2" Pipe @ 100.0' f/ Pro 3 „ �J+ TLAj Bedroom, House 80' lo' 83 0, o z / N ® IG W � 70' 30' B-3 3 ► U 544, Vents Property Vents 10, lAne 80, B-2 B- 4% SIope 220' 3-3' X 63' Cells with >3' Spacing Flans Designed Using Conventional Powts Manual Version 2.0 vent >611 Standard Biodiffuser Of Cover Leaching Chamber with 31.1 ft2 of Area Alt 6' Long 11 11 M. Grade at System Elevation r •� Id 61. -- —� � LOT 78,397 S. F. C b L90 8 p 'q C. � ro 1Q14 N' . \off LOT �8 �0>1Qo LOT 17f N 14 0 F al z 102763 S.F. a9, 3.23 s Lao In �o W 5 79'59'13* W 374,10' _ 266.36' - 107.74 HWE : h '+ 10041 4 10040 F� 3¢5.12, S 89'3324" W N 692, 76, 0 W w N v NPIQTLED ANDS 102328 S.F. a+, 2.35 Ac, a• S La0 ., f0 '!'I V E ,IVED 0. O• c IX COUNTY CDD . �tS• 0Y NO oLOT 2 m 0 A \ w 89098 S, cn 2.05 Ac. z` LBO 1007' m v O p 0 .. c twn '9iy9 n HWE a 1004, g A 166, 70' � ANDS SCC ArcGIS Web Map 3/8/2023, 4:25:44 PM 1:1,560 Site Address Points Lot and Units Park General Common Element I 0.01 0.01 0.I mi DrainageEasement Outlot Lot Tax Parcels Public ROW Unit Limited Common Element 0 Subdivision/CSM Boundaries SCC CDD 0 0.01 0.03 0.05 km Web AppBuilder for ArcGIS SCC COD 1 WDNR. SCC COD I SCC CDD and SCC Highway Dept I FEMA. 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Page 1 (Cr Nay o�— Tot w0. aM s{G�I,aTIL W;GIC 16 69 q?tl, pVk N.xnn n^ I Po,4F,-f1 0, -7pD3- i8- oDo -, PI f y1 c«IS Z1 1�w i is -'iD Scs� �' Slo�ocr '\ aeplac�rn�h� 4r�stcrr, Q`SvOA) 20' r a R Zory °►'~ Sal. Go1C'P. SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Ppis_d_ Project Name: 3 3 80 3 meyer - wick No. of Cells 8 Per Cell n Cell Width 24 Total No of 10 n Coll Length 50 aq n EISA Per Cell n Cell Spacing 1200 aq n Total EISA Y.n�d.rfinv YnAd 1 .VIM 1 rVAh FMA R.H.. InMraw Q120*i-M 5 V 25.0 ez12031+10rt 10.01 50.0 Gravelless Leaching Unit Manufacturer: ez 1203h-10ft Gravelless Leaching Unit Model: infiltrator Finished Grade It Yinin 12 in in ................::.:: Typical Cross Section Observation Pipe with approved cap or vent Soll Backfill Geotextile Fabric S—n Infiltrative Surface O I �n Limiting Factor Stoned and Anchored Vent/ Observation Pipe with Cap ............................................... Plumber/DesignerSignature: �/` ��� Ucense t: 225410 Date: feb 7th 2023 POLYAOUIP -� Mm7COM in Precast Drainage Zabel PL-525 Effluent Filter 6 Wastewater Produets A DMebn of Po" hc. PL-525 Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. I - Features: • Rated for 10,000 GPD (gallons per day). • 525 linear feet of 1/16" filtration. • Accepts 4" and 6" SCHD 40 pipe. • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4" or 6" outlet pipe. If the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace and secure the septic tank cover. PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PIr525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. 7. Replace and secure septic tank cover. 1/16" Filtration Slots Accepts 4" & 6" SCHD 40 pipe ENS Outdoor SmartFiltere Alarm Polylok, Zabel & Best filters accept the SmartFilterO switch and alarm. Alarm Switch (Optional) Accepts 1' PVC Extension Handle Rated for 10,000 GPD 525 Linear Ft. of 1/16' Filtration Slots CortM*d to NSF/ANSI standard 4t: Gas Deflector Automatic Shut -Off Ball Extend & LokTM Easily installs into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Tbll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com 4" CAST -A -SEAL � rr-= ---- N 1 1 FILTER OR BAFFLE ' CAST -A -SEAL rn a 4 � a IT -_-- OUTLET pp � N D a t a C I►� I I n ASTM C-1227 W320-MR TANK SPECIFICATIONS DIMENSIONS: WALL.• 3' BOTTOM: 3' COVER: 4' MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 58' LENGTH: V-2' WIDTH: 4•-2" BELOW INLET: 46 1/2' LIQUID LEVEL: 43' WEIGHT: 3,880 LBS, INLET AND OUTLET: 4' CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 8.00 GAL/IN LOADING DESIGN: 8'-0' UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN r8 (NO FIBER) TANK: MIX DESIGN /10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: k' 0 0 W 53 LAA YLo Lo 00 I Z04 � N M � I 0 Hx� W_ OF POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION Owner Joshua Stephanie Wick Permit I DESIGN PARAMETERS Number of Bedrooms 4 ❑ NA Number of Public Facility Units kl NA Estimated flow (average) 400 gaVday Design flow (peak), (Estimated x 1.5) 600 gaUday Soil Application Rate •5 gaUdvylW Standard Influent/Effluent Quality Monthly average• Fats, Og & Graeae (FOG) 530 mg/L Biochemical Oxygen Demand (BODe) 5220 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBODe) 530 mg/L Total Suspended Solids (TSS) 00 mall. ❑ NA Face[ Coliform (geometric mean) 510' cfu/100m1 Maximum Effluent Particle Size Ye in dia. ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank afflusm. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity 320 al ❑ NA Septic Tank Manufacturer WiESER ❑ NA Effluent Filter Manufacturer POLY LOCK ❑ NA Effluent Rlter Model 525 ❑ NA Pump Tank Capacity al *3 NA Pump Tank Manufacturer NA Pump Manufacturer M NA Pump Model Q NA Pretreatment Unit ❑ Sand/Gravel Filter ❑ Mechanical Aeration ❑ Disinfection ❑ Peat Filter ❑ Watland ❑ Other: ❑ NA X Dispersal Cell(s) * In -Ground (gravity) ❑ At -Grade ❑ Drip -Line ❑ NA ❑ In -Ground (pressurized) ❑ Mound ❑ Other: Other. ❑ NA Orhw.. ❑ NA Orhsr: ❑ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 60 Isl ❑ month(sl (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third %) of tank volume ❑ NA Inspect dispersal call(s) At least once every: 3 ❑ mlxrlsl a) (Maxilman 3 years) ❑ NA Clean effluent filter At least once every: ❑ monthls) (� year(s) ❑ NA Inspect pump, pump controls & alarm At least once ev°n'' ❑ month(s) ❑ earls) IR NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ earls) Q NA Other' At least once every: ❑ month(sl ❑ earls) N NA Other: M 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(&) 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 calls) 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 (Ye) 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 fitters, mechanical or pressurized components, pretreatment units, and any servicing at Intervals of S12 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 avant. Page Z of 7-1- START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) for the presenoe of painting products or other chemicals that may impede the treatment process and/or damage the dispersal colds). 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 Boil 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 calls. Do not drive or park over, or otherwise disturb or compact, the area within 16 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; tat; foundation drain (sump pumpi water fruit and vegetable peelings; gasoline; grease; herbicides; most scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POINTS tails and/or is permanently taken out of service the following steps shall be taken to insure that the system is property and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Sep tage Servicing Operator. • After pumping, all tanks and pits shag be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rubs in effect at that time. ❑ A suitable replacement area is not available due to setback and/or sod limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. alua - o g tank e si �W-i191'I�a ¢bQ-l�/ LONS7Rtl�?lpN ❑ 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 rubs in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS INSTALLER Name COUNTRYSIDE PLUMBING Phone 1 715-246-2660 POWTS MAINTAg11ER Name PAUL R KOEHLER Phone 715-246-2660 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name MARCO SEPTIC Phone 5 84-5100 Name s^r. ( 2&J114 Phone —7l S— 3 Sfo— 40 a code This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d)&(f) and 83.64111, (2) & (3), Wisconsin Admmistratrva File M: ST. Clto' NTY SANITARY SYSTEM Of�ceUseOnly OWNERSHIP/ADDRESS FORM cmaw-'12021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Joshua and Stephanie Wick Mailing Address 1569 97th ave City/State/Zip Hammond Wi 54016 Phone Number (required) n/a Email Address (required) n/a Parcel Identification Number 018-2003-18-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location nw 1/4 , ne 1/4 , Sec.18 T 29 N R 117 W, Town of hammond Subdivision Plat: crick bottom overlook 1/32 018-03 Certified Survey Map # Volum Page # Lot # 18 . Warranty Deed # 109 1 302 (before 2006)Volume Page # Number of bedrooms 4 Spec house 0 yes ■ no Lot lines identifiable ■ yes O no er�„.aaiv•. +.p OFFICE USE ONLY ;„ iti+eY• Y:,f:, New Property Address (Verification of new address required from Community Development Department for new construction.) (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwi,aov 1101 Carmichael Road, Hudson, WI 54016 wwwsccwi.00v Parcel JF: Ultl-lUUd-.LtI-UUU vane as or uz u / blLUL3 v1.vu 1'M Alt. Parcel #: 18.29.17.912 TOWN OF HAMMOND ST. CROIX COUNTY, WISCONSIN Owner and Mailing Address: JOSHUA J WICK STEPHANIE R WICK 1569 97TH AVE HAMMOND WI 54016 Districts: Dist# Description 2422 SCH D ST CROIX CENTRAL 1700I N9RTHWOOD TECH Abbreviated Acres: 3.230 Description: SEC 18 T29N R17W PT NW NE & PT SW NE CRICK BOTTOM OVERLOOK LT 18 (3.230AC Plat e nc 2022 Valuations: Class and Destrinn. 2022 Taxes Bill # 22627 7 Co-Owner(s): WICK, STEPHANIE R Physical Property Address(es): * 1569 97TH AVE Parcel History: Date Doc # Vol/Page T pe 101 8/2019 1302 / WD 11/22/2013 487 / WD 10/06/2003 74_2695 2429/264 WD 04/09/2003 716 ll 9/57 PLAT more... Tract (S-T-R 401A 160% GL) Block/Condo Bldg 1 R-701J_1 7�u •n�i ur ...� - _ Values Last Changed on 06/26/2014 Land Im 0 Fair Market Value: 379,100.00 Not Tax Amt Due Amt Paid Balance Special Assessments 4,409.71 4,409.71 0.00 Special Charges 0.00 60.00 0.00 60.00 0.00 0.00 Delinquent Charges 0.00 0.00 0.00 Private Forest Crop 0.00 0.00 0.00 Woodland Tax 0.00 0.00 0.00 Managed Forest Land 0.00 0.00 0.00 Prop Tax Interest 0.00 0.00 Spec Tax Interest 0.00 0.00 Prop Tax Penalty 0.00 0.00 Spec Tax Penalty 0.00 0.00 Other Charges 0.00 0.00 0.00 TOTAL 4,469.71 4,469.71 0.00 Interest Calculated For 0210612023 Payment (Posted Payments) Date N Total If 248,900.00 0.00 Assessment Ratio: 0.6566 Installments End Date Total 1 01/31/2023 2�32 2 07/31/2023 2 Net Mill Rate 0.019062273 Gross Tax 5,265.93 School Credit 521.33 Total 4,744.60 First Dollar Credit 78.20 Lottery Credit 1 Claims 256.69 Net Tax 4,409.71 t # TvDe A.-u Note 126 1 T 1 4,469.71 Info Pro Key Payment Type: A - Adjustment, R - Redemption, T - Tax * - Primary STATE BAR OF WISCONSIN FORM 2 - 2003 WARRANTY DEED Document Number This Deed, made between Steven Belling Jr. and Candace K. Berling, FKA Candace Kiefer, married to each other (Grantor), and Joshua J. Wick and Stephanie R. Wick, married to each other (Grantee). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate together with the rents, profits, fixtures and other appurtenant interests in ST. CROIX County, State of Wisconsin. SEE ATTACHED EXHIBIT A Return to: Burnet Title 5151 Edina Industrial BI Edinn, MN 55439 Atln: POST CID%In0 1091302 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 10/28/2019 02:09 PM EXEMPT#: REC FEE 30.00 TRANS FEE 959.70 PAGES: 2 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Name 8 Return Address Burnet Title #500 1301 Coulee Rd. Hudson, WI 54016 �/ Q 4 018-2003-18-000 Parcel entification Number (PIN) This homestead property Exceptions to warranties: municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services, recorded building and use restrictions and covenants, present uses of the Property that violate the foregoing where such violations were disclosed by Grantor in its Real Estate Condition Report and in Grantee's purchase contract, aan` general tax lev' d i the year of cl sing and thereafter. Dated this_—G�day of. ,: —ft AUTHENTICATION Signature(s) Authenticated this day of TITLE: MEMBER STATE BAR OF (If not, Authorized by §706.06, Wis. THIS INSTRUMENT WAS DRAFTED BY: Burnet Tille-Andrea Noble, 5151 Edina In( 5543912134019-12794 C. Hoy:., J:............. �pTARY1 Oil Nd. #5*, Edina, k P U1 Co 0 ACKNOWLEDGEMENT State of Wisco sin } La SS. County of nJ MElyP came befo e this 25A day of , 20�, the above named Steven Berling, Jr. and Candace K. Berling, FKA Candace Kiefer, married to each other to me known to be the person(s) who executed the fore in i r m nt a7 w d t ame. i I V Notary Public, State of Wisconsin My Commission (ispermaFaent) (expires: (Signatures maybe authenticated or acknowledged. Both are not necessary) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 'Type name below signatures. St. Croix County 1091302 Page 1 of 2 EXHIBIT A Lot 18, Crick Bottom Overlook, Town of Hammond, St. Croix County, Wisconsin. (Signatures maybe authenticated or acknowledged. Both are not necessary) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 'Type name below signatures. St. Croix County 1091302 Page 2 of 2 LBO IOW P. 06.00, LOT 19 �•F \ LA 78397 S.F. 1 32w laC 1014' I \ \ � \ I.00' 7.703 ��— � '! \� uf.z'��io rph�1'1 r � � � 18 LOT ?°�• y �Q �� F \\ 1 IN LOT 16 W LOT 17 3.23 Ac. �. '4- N 8 LOT 20 A g$ 102763 S.F.067999 S.F. \\ ,y, Lw _ lam �N U "' cA 2.36 Ac. s/i, w 89098 S.F. r 5 �N o T 1 �, 1.56 Ac. �^ � \ 2.05 Ac. z w 180 • ,arr a '�'.� Ord �+ r, 05 S.F. �o . iooas' \ \'Q f� \ I Leo • taar i 15 Ac. + I ''' 'cr, x � O �,. w -4 1 rn a0 �3 fie' w--�p.]e 111i ' 5004' 17'O. Sg1 �t7.7s Ln -�04 e -1/+ r4, 'Icell 1003' � 11111E - IW4' } IZ of 4.00'y sa.os 154.00' 345.12' 250.65' 166.70' rT1 4' E 562.34' z' » nA S $9633'24' W i ! 692.76' eVp 1/4, w 67'is'w [ �7 4&70 G V W 0 �' 1a03' e. VNtwndn owww wd co Camisrot SOIL EVALUATION REPORT Paps / a arwon d 6aittp and Budrgs h aomdtnot wlltt Comm ab. Wh. Adn. Cods � . 1 Alaoh oon�ltb tb � an pww not ba ow a 112 x 11 riai.. tlna U I V E kckx . a t na !hind b: varid and txxbonbl ntwanoa Pobt twat w. prow-dWo.tcwbardr IDnt,noAhavow.andbcWonand ID mod PNasa pine aN bdwmaftm MAY 0 1 20 rw�arlMbiwtto�rwp��►s.w0terwowMryvuvo.n �...s.�t.WIgF�M• � I pmp"owm e, ep/O c, 1MS 4 T gj N R E W Lat I Bb& I Nt a C9W vr. Taws Nuffid Rmd N wr Ca�Yucion I Nuri�tr a badoanr Coat cM dtt� tiow nett S 0 OPD D Rtpbotmtrt O , ,ram N Pamnt mrubl 9� •C.l � Fbod Pltb WWA4m M gOkn +b o71— do, --J { o3.3D F„ /Ir'l� CST *Avtw (Pltala F" DM Evdrim (.brdi cbd Tthpha�r Nunbar Addicts ; , a - - � -1 labs 3 property Owner — © Bo�tp 8 %� � %Parcel ID 0 Ground atsbce dev. i _11L f A. El Bwft C►. Pit & plt t]enn, ti i..rr.v, Pape o1 Pr.7 6WM ��M�®� U BO&Q 0 U � ❑ Pit Ground s rlace aim_ Bodng A U B0"ro ❑ Pit Ground staLce elev. R. Depth loft db [actor In Horizon Sol Rale Depot DomYtark Redwt Deeortptbn. Terms SMuclae CorrFalsrtca liotatdary Rook In. mwmw Ou U Coat Color Gr. SE sh. 'EIMH I 'E8l2 Effluent 01 - BODE � 30 1220 mWL end TSS �30 < 150 mWL ' E1lkierK Art • SOD, 130 mplL and TSS 130 myL 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. ewur•(aseo) Soil Test Plot Plan Project Name P.C. Collova Bldrs. Inc. Sha d Address P.O. Box 487 Somerset Wi 54025 TkA#226900 Lot 18 Subdivision Crick Bolton Date 12/4/02 1/4 NE 1/4S 18 T 29 N/R17 W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. =Top of Survey Iron, g„ 41 System Elevation 102.9' *HRPSame as Benchmark Alt. BM Top of 2" Pipe @ 100.0' P 3 8 M Woo ij rcJ 40, 913M�711 010-2003-19-000 IL pNsconsitDepartm ritofoonanerce SOIL EVALUATION REPORT Division or safety and (i "nps in accordance wNh Caron 85. Wis. Adm. Code Attach complete WW plan on paper not less than 8 1/2 x 11 itches in size. Plan must Include, but not WNted to: vertical and horizontal reference point (BM), direction and Parcel I.D. percartl slope, scale or dimensions, north arrow, and location and distartoe to nearest road. P/aase print all lnth n atlon. Pow Inlorrrlason you previee may be used for uoar0ery PUPeeea (Privecir Law, e. 15.04 (1) (m)). �rop.rty �, Property Location CD/ c✓ZkJ-.4-Govt. Lot 111N s h°D"Owrnses Maiirnp Lot a Block 01 or A �d lac /0 � r NearetP4W New Construction llse tecidantlal I Wimber of bedrooms Coda derived design flow raft Y 1� GPD ❑Replawnnent Pubic or Dawlbe:---_—.---- — Parwtt mmww &0*e Flood Plain elevation H appi able � ALOWN" Cal, Intel R. and risocirrimentislions Plat Ground auhoe alev. OSol Appicsion S'R Depth b YmIti factor In. Role Norlmn Dsplh DornY+rM Color Redox Desor"on LT Structure Coraistance Boundary Roots GPM it. Murwo Qu. sz. cat color Gr. Sz Sh. 'Eff#1 'Efi12 ZE w C �. o Borkv pit Ground stafaca ale✓A" -S R. Depth to IimtitW factor in. as • --'- --- core i»I��r.��G���6��� ©WAAK?M IVA, //17 �1.�11C�7�� ©r5jI»1,0 A0/F/ . Wes,. A F11JMM. 1UA,T fir I/W% �vJ,!!�0 "I.yr, ; MJI.;JMi6M Et1aNrR a1 a BqA > Ju I !N ITWL 411110 1 -%3 >JV c l "VL CST Norm (Please PIM CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date valuation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401 ��� 03 715-246-4516 Qo;%123 Par ■!ice �����■�� QB.. .. :. . mQQ�Q . EMMA f7 - am, > 30; = moil aM Tw �301 ISO moll • Mwt 82 - DWI 130 moL and M _ 30 rwbl The Departmem or Commerce u an oquW oppmum" .m"= povida and employ«. 1 r rm need asai$"= to acmes services or oeed matmW in an ahernato rorma4 piau coMad dye departmem at 608-266.3151 or M WS-264-E . y559� �s\s°\I EAST LINE OF30.31' c HESW/41 _ I NE 1/4 / O 100.44• nl cd0co Q co fin °p S!5'13~ M �37g.64• ti O x ,LO p � 215.29' 126.22• 5 � 164.35' -� rs•1e Inv } O r .9sro s H o , b •-4 vi u - •OD / �66 E+ ►� S `LG1 +v ro. ��� N N n C Q n aDr. �jo� � � ►� i cV ►-7 5// 9r s r �P a� OD co LA: I s N p0A5 ~I 7 rill, L Q 1` O �' N M r S 3331'25" Q 0.23• E �• `� I F-1 p N � I r a2.e4� 1i7 in• r- Witiomsin Dep81ti"Bnt of r'� 1 PRIVATE SEWAGE SYSTEM Ssfaq and Building DhWon ' INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) PerborW Information you provide may be used for aacalldary purPoaea PhK*W Law, w15.04 (1 XMH. ----�tlD•c1 TANK INFORMATION TYPE MANUFACTURER �CAPACITY Seoc ufJ Dosing Aeration Hddhq 1 j TANK ACK INFORMATION "�Mm� -. . ��Im� PUMAIPHON INFORMATION Manufacturer Darrlarid M Model TDH Lift Friction Loss System Head Ft F Length Die. aabwel F_a] I aTC"s]NJ 118:: "4:1114! • DATA -wmM ui��•c. �;I�i ENC DIk1EN Width 1 3 Lergel t N0.pp Tmxtm (rbA C 3 Mt DMMB*NONS No. Of Pits 4016e Die. Liquid Daplh SETBACK SYSTEM TO jvA. IMAM IWELL LAKE/STREAM LEACHINGe/FORMAT10N Type«„-__-__ iPl ' � 16('1 `i CHAMBER OR Model Nm*w. •,/1 001 KIDUI *TOTEM DIOMMon x Bola Sfae S b Air Irdaks LRieeiK�da M i•rgN Die Spedrl�_ OVIL V VYCK It Pr asua System Or11y xx Mound Or At-0rade Systems Only Deph Over Dep1A ow xA DepM of:R Seeded/5odded kelldted aedrirMlrll Colter BeGrTrrrll Edges Tapeaa Yea No Q Yee It ND CO ( - c90e persons Present etc) Inspewon A 3 IrcPactian Location: 1569 97th A� , WI 54015 (NE 714 NE In 18 T29N'Rt ) Crick Bottom 8.29.17. III 1.) All BM Description = "' �T •� —f Vo 2.) Bldg sewer length = + 5' r -amount of cover=�Z• a'JJr Plan revision Required? N - Isl Use other side for additiona ah SBD-6710 (R.7197) ��ja D knepdofe sowwm n Cart pb. Soil T s and System PLOT PLAN PROJECY P.C. CoNova Bkks. Inc. A Ss P.O. Box 489 Somerset w 54025 ` 114 NE 1/4S 18 /T 29 N/R 7 TOwN Hammond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/9/03 BEDROOM 3 CONVENTIONAL %00( IN -GROUND PRESSWE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 * of chambers 30 BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100- Filter Zabel A-100 ❑ BOREHOLE O WELL •H.R.P. Sams 35 Benchmark SYSTEM ELEVATION 101.0/100.8/100.6 5' below grade Alt. BM Top of 2" Pipe @ 100.0' Pro 3 I L � aer Bedroom House 80' 10' 70' B-3 30' 3 Vents 540' 10' PropertyVents Line od 80' B-2 B- 4% Slope 220' Plans Designed Using Conventional Powts Manual Version 2.0 3-3' X 63' Cells with >3' Spacing elm >6" Standard Biodiffuser Of Cover Leaching Chamber with 31.1 ft2 of Area Alt L/06' Long ll I , C',raAr at System Elevation B.M. 1 2 A V�T_ - 5y4 Ir. LKU 19 cou NO. 648409 STATLANI�,RY)PERMIT �.�L PREVIOUSNO. q2?977% OWNER PLUMBER WIYA 1 SEC,T�� AND/OR LOT I EXPIRES SUBDIVISION (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit Is to allow installation of the private sewage system described in the permit (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for ■ specified period. (d) Changed regulations will not impair the validity of a sanitary perm►[. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (1) The sanitary permit is transferable. History: 1977 c.168; 1979 a 34,221; 1981 c. 314 y Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. RIZED ISSUING OFFICER - DATE f" 3 i/24t" UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11/20)