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032-2059-80-100
0 ' ft -A /1 O � � (h►•� O O O O O O (gip n 0 3 _ ti��o Vn '® ♦� � i�- Q, O O O O 9 C V/ N O C o r c g G FL�OG� 'n � o AQ; y QA� S y ;r V1 Z Z Z Z Z 3i 3 O O O O O x o O O o o o o A Bubble C 0 T. v) Pattern y �, � m 3 i ser x cmn m m m m Membrane R Cleaned o m y m < =' Air Filter c �, umi cmn ai ai fl Cleaned so m nocu ant _o. CD m O O m Replenishe c d A Cll ? n G y d C C C C C A a y '+ a1 O O m m m m y .a ' > m S y x v i O T O y O m m m m ; gch cn cn cn cn a 0 N CO) 5 0 co o, Q x _ f;0 H o < rc D m ass CO N .�. O O O O x d rt 0 C4 Z W � v ° X N N i 7 O vj N N N co 4 O A3 Q>' A � _. s m 0 7 w "l s A �1 -' 0 W 0 ao m A a 0 01 3 rn rn m o o cu o 8 Pi N N N • < 4 V O O O O Cs is O D a_ W N N N 0 -= 0 CD 0 0 0 0 2. 3 gl CC r- og G - 3 d y OC N C7f D <D N M A G V -0 3 y 0- 01 rt Z Z z z f c ( O O O O 0 3 p1/4- v O .i 4 . Bubble III C 0 0 0 0 x _ a Pattern N Z- C m 41) 3 m m m -< 3 Membrane of ? V/ m co Cl) Cl) Cl) 3 Cleaned o o w (0 rX -< -< -< -< �. v Air Filter o 2. CD co co cmn cmn umi n Cleaned 2 s s^ Inoculant 2 * 0 zo Replenishe o el d <o 0 cn s X03' 13 f X MU] � � m 5 Z * a a v 5 • O -< -< -< a k a. a O '1 X _ W m mmm a s `0 m 0 N ! c c c ` ' N a m- _ • _ N N 3 , to U1 01 co o� rn sta if = (y co to is —u2 g < > . ci in i W ii 0 O .� OV a O° O O O O = P ca 0 W C C 3 0 O lR`� N m tD to 7 so 3 a m . 0 0 rill N :m c, N r z ,' X �//� O © mC .� Z Cs� 1 0 FCo ty: St. CrOIX Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM tary Permit No: Safety and Building Division INSPECTION REPORT 538790 0 GENERAL INFORMATION (ATTACH TO PERMIT) e Plan ID No: ---- -I Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Parcel Tax No: Permit Holder's Name: City village X Township 032 - 2059 -80 -100 Somerset, Town of —i Riedel, Michelle TrieboId Section /Town /Range /Map No CST BM Elev: Insp. BM Elev: BM Description: 17.30.19. t 3613 ELEVATION DATA TANK INFORMATION STATION BS HI FS ELEV. TYPE MANUFACTURER CAPACITY r. � Benchmark Septic / 1 d� l�eP.lo`� GK�af:' s� / Alt. BM Dosing tt 11 2 �dd� W 2 � Bldg. Sewer Aeration SZ - St /Ht Inlet 0 Holding St/Ht outlet $ &.7t /bZ•b TANK SETBACK INFORMATION TANK TO P/ WELL BLDG. vent to Air Intake ROAD t Septic 5� > sa IZ' Z,r%' / I Header /Man. Dosing S� 7 SCE Z.4 � ; Dist. Pipe ; Aeration -- Bot. System Holding — Final Grade PUMPISIPHON INFORMATION Demand St Cover Manufacturer GPM Model Number TDH Lift Friction Loss Syste ad T Ft Forcemain Le ia. Dist. to Well — Tp BSORPTION SYSTEM Len th No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid i)epth DIMENSIONS 9 LAKE /STREAM LEACHING Manufacturer M TO r /L� BLDG WELL CHAMBER OR System: ]/� UNIT Model Number /v Imo- DISTRIBUTION SYSTEM x Hole Size x Hole Spacing vent to Air Intake ESOILCOV Distribution i \ Pipe(s) Dia Length �., Dia Spacing \ x Press a Systems Only xx Mound Or At - Grade Systems Only Depth Ove xx Depth of xx Seeded /Sodded xx Mulched Topsoil Yes 7 No Yes er Bed/Tren Edges Inspection #1: / / Inspection #2: COMMENTS (Include code discrepencies, persons present, etc.) G�u y Location: 1547 47th Street Somerset, WI 54025 (NE 1/4 S1/4 17 T30N R19W) NA Lot 1 Parcel No: 17.30.19.736t3 �/ o `I� S O ✓� 1.) Alt BM Description = ` � -1 ����j tve 1 \YVu 1 2.) Bldg sewer length - amount of cover -� Plan revision Required? 0 Yes XNo I Use other side for additional information. - -- Date V Insepctor's Sign wre I� SBD -6710 (R.3/97) Safety and Buildings Division County /+ 201 W. Washington Ave., P.O. Box 7162 S%, C...lL X Madison, WI 53707 - 7162 Sanitary Permit lumber (to be filled in by Co.) (608) 26 1 S 7 Department of Commerce State Plan I.D. Number Sanitary Permit Application k In accord with Comm 83.21, Wis. Adm. Code, personal information you provi project Address (if different than mailing address) may be used for secondary purposes Privacy Law, s15.04(l)(m) f� J I , L Application Information -please Print All In io rl Parcel # Lot Block # Property er's Name CL R/ e,0 JUN U L O 1 D Z 1 I E-f - �- - ZOS T. IX Property Location !� property owner's Mailing SCRO Address /, pL AN I . C & ZONING OFFICE •/ S / / 7 T� S %,C �: % `,.,�, Section Zip Code Phone Number City, State ircle one T30N; R II. Type of Building (check all that apply) Subdivision Name CSM Number l (Q ❑ 1 or 2 Family Dwelling - Number of Bedrooms r J l 7 ❑ Public /Commercial - Describe Use ❑City_ ❑Village ®Township of I K. ❑ State Owned - Describe Use III. Type of Permit: (Check only one box on in A. Complete line B if appy ble) A. [I New System ❑ Replacement System ,S Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New // Before Expiration Plumber Owner l z - � U -7 /Q Jf Ip IV. T of POWTS S stem: Check all that a pply) [I Non - Pressurized in-Ground El Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil El At Grade El Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter )C Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ r Recirculating Synthetic Media Filter ❑ ❑ ❑ Gavel -less Pipe ❑ Other (explain) Leaching Chamber Drip Line V. Dis rsaUTreatment Area Information: Dispersal Area Proposed (sf) System Elevation Design Flow (gpd) Design Soil Applica Rate(gpds rspersal Area R cared (sf) P S 3 .7 0 5 v ty o / 5 Ttal Number Manufacturer Prefab Site Steel Fiber Plastic Capaci in o VI. Tank Info Concrete Constructed Glass Gallons Gallons of Units �L j,) k. ��� •1 New Existing Tanks Tanks Septic or Holding Tank / ev0 000 1 S Aerobic Treatment Unit / /ESC k° f'/'(/�7 4 Dosing Chamber VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached 1plan Number Plum S afore Mp/MPRS Number S _ f l w Plumber's Name (Print) � �� �� � FB;usine / (J .J 14K) �C # #/( �� Plumber's Address (Street, City, State, Zip e) 1 A - � T / I-I V� �j` p/ it VIII. Coun /Depar tment Use Onl tamps Sanitary Permit Fee (includes oundwater Dat Issu Issuin ent Si (N Pproved ved Surcharge Fee) a O ( I 1'7 Y Own i en Reaso r Denial CJ VL Conditions of Approval/Reasons for Disapproval 3> ,n� �� h �� o -k /a gy p SYSTEM OWNERU 1. �J�icZst'p�.- rw� Septic tank. effluenFfilter and dispersal cell must 9 be servIc" "maintained as per management plan provided by plumber. 2- :A setback requirements must be maintained d l t PQrNA . W&H as per qV kl" -Wft for the sys on paper not less than 81R 11 inches in size Attach complete plans (to die County only) Y SBD -6398 (R. 01/03) PLOT PLAN (Riedel Property) ♦ BM1 Elevation = 100.00' Top of Northern most concrete porch footing. 0 BM2 Elevation = 89.33' Top of existing Drainfield vent pipe. N ■ Backhoe pits Slope =2% System Elevation = 83.62' System Elevation = 93.78' on original Septic System Documents Lot No: 1 CSM, 611670 S17 T30N, R19W Legal Description: NE114, SE114, Township: Somerset County: St. Croix Q� F KV e4TY L! J 1 � / /g�C 53 8 New 11)006 5 ° �FFLUEIUi r�LTc "� i EO Housc /Oro i / 1bc�i� ®yVc'LL E ll v t ! 0 I � pRIVEWAY �t5e3 0�2 I�r4�UD0E� 17rP�;`��il�b u W N TANK rfV . 10 CE: c®1j 6ucrC- ArT i 05T/ 5 -D ATU COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Riedel ATU Owners Name: Michele Riedel Owner's Address 1547 47th Street Somerset, WI 54025 Legal Description: NE1l4, SE 4, S17, T30 1, R19 Township Somerset County: St. Croix Subdivision Name: Lot Number: 1 Block Number Parcel I.D. Number 032 - 2059 -80 - 100 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 ATU Tank Cross Section Page 4 Effluent Filter Tank Cross Section Page 5 Effluent Filter Information Page 6 &7 Management & Maintenance Plan Page 8 Deed Page 9 ATU Servicing Agreement Attachment # 1 Existing Septic System Documents Attachment # 2 White Knight Manual Attachment # 3 New Soil Test Designer: John Schmitt Licnese Number: MPRS 223760 Date: 612/2011 Phone Number: 715 - 760 -0486 Signature: Page 1 of 9 PLOT PLAN (Riedel Property) ♦ BM1 Elevation = 100.00' Top of Northern most concrete porch footing. 0 BM2 Elevation = 89.33' Top of existing Drainfield vent pipe. N ■ Backhoe pits Slope =2% System Elevation = 83.62' System Elevation = 93.78' on original Septic System Documents Lot No: 1 CSM 611670 S17 T30N, R19W Legal Description: NE1 14, SE1 14, , Township: Somerset County: St. Croix Scale: 1"= 40' W O R T14 p Ra tK i y a hJ E i +A C lB')C 5 3 . 13aD New l0006ki- 5.7. �F� Lt,fENT r /LrrP 13 `� I--, 7- � lap °�''- �.;• ED Mousr / / Or o i / A ® VVc'LL c v I ' I � ® j1 ry E X /5 i rV & 5 r rc i ,4ti l� T ��r�b 14,5E6 0,4 A&,4Vjj0)UEA p61 K TANK rNsP6 TO L�i� � ©LE Com buCri.O AT I05rj4LLA 54-o Tank 1 SEPTIC TANK DETAIL / SINGLE COMPARTMENT Project Name: Michele Riedel Tank Manufacturer: Week's Concrete Products Tank Model: 1000 Construction Type Concrete Steel FitorglOw PoiY Tank Volume: 1000 gal ATU Manufacturer: White Knight ATU Model #: WK-40 98.15 ft Inlet Elevation Outlet Elevation 97.9 <- 23" Minimum -> Manhole w /locking device n < and waming label c "` ' -sr a s r a ffi a• s .� r s i a sn e r. s r r a r a ,�, •# r i a a a r w a w a s 9ib Airline � F Baffle -- White Knight MIG WK-40 3 Bedding Under ank Plumber /Designer Signature: ' Lic #: 223760 Date: 2- Jun -11 t SEPTIC TANK DETAIL / SINGLE COMPARTMENT Project Name: Michele Riedel Tank Manufacturer: Wieser Concrete Tank Model: WLP1000 -MR Construction Type: co- a" FftMM` Po1jrot"Ww Tank Volume: 1000 _ sal Effluent Filter Manufacturer: Pol lok Effluent Filter Model: 525 97.7 ft Inlet Elevation Outlet Elevation 97.45 ft <- 23" Minimum -> Manholes wllodcing devices and warning labels > ■■ r ■ . r ■■ r r r ■■ r . r r . r r r a r■■ r ■■ i •■ ■ rrr j n t Go C S 1 aw . 4 + +^` V Baffle _, Effluent Filter Clear Space ing nder Tank Plumber /Designer Signature: Lic #: 223760 Date: 2- Jun -11 Page 5 L Pau INSTALLATION INSTRUCTIONS f 1 ip� . PL- 525/PL -625 FILTER X25; PL -625 FEATURES & BENEFITS Features & Benefits= I Rated for 10,000 GPD PL -525 = 525 Linear Feet of 1/18" Filtration L PL -625 = 625 Linear Feet of 1/32" Filtration lei PL -525 PL-625 * Accepts 4" and 6" SCHD. 40 pipe e Built in Gas Deflector The PL- 525/625 Effluent Filter should operate efficiently j for several years under normal conditions before *Automatic Shut -Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped or at least every • Alarm Accessibility three years. If the installed filter contains an optional I alarm, the owner will be notified by an alarm when the *Accepts PVC Extension Handle filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. MMENDED PRODUCTS �— Polylok PVC Filter Extension Handle ' A 13 c i4 r a i i Risers & Riser Covers Extend & Lok- Riser Safety Screens Filta ma rAlarm Panel and SmsrtFitterTM Control Polylok risers bring your Polylok Extend & LokTM Polylok safety screens Switch septic tank cover to grade. is a simple, easy to use prevent tragic accidents This allows locating and solution that can extend from happening by children Polylok filter alarm panels servicing your fitter easier the inlet or outlet pipe and and pets falling into open and switchs provid a visual and time saving by eliimi- make filter and /or baffle septic tank entrances. and audible notification of impending filter and tank nating digging to find tank installation a snap. servicing entrance. Fits 3" and 4" pipe. For a full list of Polylok products please visit our web site at: www.polylok.com 8 � x ?4020912 7 Document Number Document Title 937341 BETH PABST St. Croix County REGISTER OF DEEDS AEROBIC TREATMENT UNIT (ATU) ST. CROIX CO., W I SERVICING AGREEMENT RECEIVED FOR RECORD 06/09/201 1:08 PM EXEMPT #: tatfa Plan Transaction Number - REC FEE: 30.00 PAGES: 1 R Name — (Owner) Typed or printed Being duly sworn, states, under oath, that: 1. He/she is the owner /part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume 1 Document Number ZS 422 St. Croix County Register Page Z Recordin Area of Deeds Office: Nam_--A[ and Return Addr A parcel of land located in the N 1 t /4 of the 5i t /4 of Section f" jC)4t5LE T"^' 1 5TH T 30 N — R / 1 W, Town of / S'f 7 - St. Croix County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or O Z _ ZO J - $ 0 / oC detailed legal description) Parcel identificauon Number (PIN) Agreement Date, e - g —ZC d As an inducement to the county to issue a sanitary permit for a POWTS equipped with an Aerobic Treatment Unit on the above - described property, we agree to do the following: sed POWTS (Private Onsite wastewater Treatment System) technology. It the owner fails to have the 1. Owner agrees to conform to all applicable requirements of Comm 83, Wis. Adm. Code relating to Aerobic Treatment Units (ATU) and the maintenance requirements for the propo th° governmental i ) a enter upon and service unit or the Department of commerce se tth or POWTS and ATU properly serviced in response to orders issued by abate a human health hazard as described in s. 254.59, the owner bg the charges onthtax bill as special assessment for current tank or cause to have the tank to be serviced and charge services rendered. The charges will be assessed as prescribed by s. 88.0703, Slats. intalner 2. The ow ner er aj Inspections and maintenance as required licensed rnanu eaturea a d re for the Depart Infe of the system. The ng but no l mited h ower. ectrical to maintain a contract with a controls, and treatment unit operation and sludge depth. These inspections are to be scheduled every 6 months for the first two Years c,r operation and yearly thereafter. 3. The owner agrees to contact the POWTS maintainer immediately upon any malfunction of the treatment unit and to maintain the unit so as to not create a human health hazard as described in a. 254.59, Slats. 4. The owner recognizes that the county. Department of Commerce. or POWTS maintainer may make periodic inspections of the components to complete performance monitoring of the unit. 5. T own nee or the o a �e n agr t report the d he department o e t or d s d ated a within t 10 business n days from s the� i dat m of n inspection, agent maintenance or servicing. _ risible for the 8. This agreement will remain in effect t only until the county office may bepoancelled by executing and eccordi g said certification with reference to his no longer serves the Property agreement in such manner which will permit the existence of the certification to be determined by reference to the pro party ng upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement he aeement 7. This agreement shall be bindi to the Register of Deeds. and ere the Aerobic Treatment b U in manner that will permit the existence of the agreement to be determined by reference to the property pwner(s) Names) - Please Print Su 'bed and swom to fora me on this dal: � t Q- U �i R No ry Public ��� Q . ' Notarized Ow Sign _ _ A R * ? lku ii, 6V M Commission Expires ; �r _ � ' vemmemal unit Official Na Title - Please Print y tat Unit Official SI attire Drafted by: O tfnJ min /? pers m onal Inforation you provide may be used for secondary purposes [Privacy Law S. 15.04(1)(m)) "THIS PAGE 18 PART OF THIS lEf3At_ DOCUMENT - DO NOT REMOVE" � yM be completed by submrtfe 92gUmenr U& name i M1Ua address. and PIN (if required). Other information such as the 1 �jrl�itsnttl(rp ed on placed lac eta rosy lac this first papa or 6, d or may be placed on additional pages of the document . flN i pre. pa a document and S2.00 to t� ra220Vno fee. Wisconsin Statutes. 59.517. Ooctrnent Number Doc~ Tae St. Croix County AEROBIC TREATMENT UNIT (ATU) SERVICING AGREEMENT f a t e Plan T r a n s a c t i o n Number - M i c u FI E 1r R l u gL Name - (Owaer) Typed or priated Being duly swam ages, m►dw oath, that- 1. He/she is the owner /part owner of the following parcel of land located m St. Croix County, Wisconsin, recorded in Volume ZS V7 page L7 z Document Number 7S '? St. Croix County Register of Deeds Office: A parcel of land located in the N r '/4 of the 5 i '/4 of Section Noss aid ft @Wn Addnw / 7 , T 30 N - R / g W, Town of '501 lrt25t= T . St. Croix County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or 0 8 0 - / 00 detailed legal description): Number (PIN) ft Agreer+«a 040110: As an kWuoernent to t1e county to' a sanilgry permit for a POWTS SW4) d with an Aerobic Trwtrnent Unit on the above- defaibW Party we agree to do the tollowkg: 1. owner apnea 10 ocnbrm b al spplic" wgWrornanb of Comm 83, Wis. Adm. Code re"V to Aerobic TmWnsM Units (ATU) and the mskhtwwha requkennwhle fer tttr pnopeaed POWTS onom Waabweeer Tnts*wrt Sysbm) Wdnsbgy. M tits owner hits to have the Powys and ATU p apady anvloed h Faepenea i erdan retied by the govern Oft UN Or ft 01110111011119"t Of txnrrharde 10 prevent or sbes a tamsm ha dih hmwd as dassrtba I in a. 21114A. SIM. is 9ewmtarISM unit (Town) rosy erttrr t4M tthe properly and service the tarsi or cause b have to W** b be WAc*d WW dhsge Its OMW by pk►Ckhp the dhsrgaa on 1M tax bit a a gww nsewnwit for current wAm roMered. The al aa will be essessed as prescribecl by s. 418.0M. Sh". 2. The owner agre 10 rr10Yttairh a oonkact with a licensed POWTS rns"eirw for the We of ll syssm es . The POWTS nM kNak ws Perform perbdic khepaaYOhI - and mskhMrwhoe as fsptrkad by on ^ and the Oeps merht. khek►dkhg, but not MrthN l lo: ft mower. escafeai asnsor, and *"&A** late sow n sad skWpe` dope► W_ Mrfhectla» ire b britasdeMO every A rrrontate for tlht Area two yeah of cpersta► ww yowy 3. The owner sgraas 10 o - -, the POWTs maintsiner irnmedalMy upon -Y nhetunetlon Of 1118 treatment unit WW to nwint l the unit so as to rat eraas a humen lsseh l woom d w described in s. 284.86. Sts%. 4. The o psAbrrnaas moNbrkg OegA d ansM CorrlrrterCB, or POWTS makNWsr MY mNre psradb kspeotlons Of the oomponsnts to d 5. The ownst or 11s awmh agent agrees to report to the deperbnant or (1eeigrhasd sgerlt at tin compbtlon of each inspection. meknenance a serv%bV event in a rwnnr specked by the deportment or deoWmftd ellent wWAn 10 IxaYSss days from is daft of Inspectbn, mNnsnance or servicing. 8. This sgreerrhent wle rertsin in etaat only urN is county omit MPasims fbr t regulation of POWTS deroea tat the eaobIC beemsM unit no longer serves tun property. In addition, " egnwnent may be earaseed by exearting and nr m is rp No a on 9 rh with reference to this m agreaerd in such mw-- whloh will permit tthe et-" , of is antlaoaton to be determined by reference b ttn property. bkWkV The owner T r a peed�i a senB eM b r loo 1 e dw in rtW owner, OW assigness of #0 — W wii pen* V* sswsncs of gee�rrsM a Nennkl� �r reeerence b as property when is Aerobic Thos nnM Unit Is i ateW. W10 - 1(11) Names) - Pras Print and swam b me an this dw: L . . 1 hq►um..,,�� ,,' NoaKizsd OwnWs �_ N*T* Public 11 '� AqY = G ' tMh •Peas Print My n # . PU 5\. . Governments! Unk OMW Sipnskre Orelsd by ����n►rnuhol PersonM kAmration You Provide may be used for secondary purposes t.aw s. 15-0 "I PAM M PART OF TNta t aOAL DOCUMff – 00 NOT RWOHE" TMs kl bm.Nftr must be aomF! I O at►brttktar " arwi�l lan9tAb1. Otlur kerb rwfbn each se tyhs 0w*VabwabDddwaMomi,WL wb*jAosd@n##k d ebarmamfa+ aey6epteosdarad�baet0ageso /tlradbarrsnr. tlx: Ube of ob owwpop adds one paps b yewdswm M sa NMcaskr Staerlra sa 317. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: FTank Manufacturer: Week ' s C . P . O NA Permit # Septic 0 Dose [] Holding Volume: 10 0 0 gal k Manufacturer. Concrete ❑ NA DESIGN PARAMETERS Wieser Number of Bedrooms: 3 ❑ NA ■ Septic ❑ Dose ❑ Holding Volume: 1 O gal Number of Public Facility Units: ® NA Vertical Distance Tank Bottom(s) to Service Pad: ft Estimated (average) Flow: 3 0 0 gal/day Horizontal Distance Tank(s) to Service Pad: ft specific servicing mechanics must be provide if vertical is >15 feet or d Design (peak) Flow = estimated x 1.5: 450 gal/day horizontal is >150 feet. Specific insbuctions t0 be provided on back. In Situ Soil Application Rate: 0 _ .5 gaudayKe Effluent Filter Manufacturer: polygok ❑ NA Standard Domestic Influent/Effluent Monthly average Effluent Filter Model: 525 Fats, oil & Grease (FOG) s30 mg/L Pump Manufacturer. ® NA Biochemical Oxygen Demand (BOD5) 420 mg/L ® NA Pump Model: Total Suspended Solids (TSS) s150 High Strength Influent/Effluent Monthly average Pretreatrrtent Unit WK -40 Fats, oil & Grease (FOG) >30 mg /L Manufacturer: White Knight ❑ NA Biochemical Oxygen Demand (BODs) >220 mg/L NA S Mechanical Aeration ❑ Peat Filter Total Suspended Solids (TSS) >150 ❑ Disinfection ❑ Wetland Pretreated Effluent Monthly average ❑ Sand/Gravel Fitter ❑ Other Biochemical Oxygen Demand (BODs) s30 mg/L Soil Absorption System Total Suspended Solids (TSS) S30 mg/L ❑ NA 0 In- Ground (gravity) ❑ In -Ground (pressure) ❑ NA Fecal Coliform (geo metric mean) s10'cfu/10pml ❑ At -Grade 0 Mound Maximum Effluent Particle Size: 36 in dia. ❑ NA ❑ Drip4 ine ❑ Other Other: ❑ NA Other ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) 0 When combined sludge and scum equals one -third (36) of tank volume ❑ When the high water alarm is activated Inspect condition of tank(s) At least once every: 0 month(s) (Ma)imum 3 years) ❑ NA 1 ® (s) Inspect dispersal oell(s) At least once every: ®❑ m�(s) (Maximum 3 years) ❑ NA ❑ month(s) ❑ NA Clean effluent filter At least once every: 0 year(s) Inspect pump, pump controls & alarm At least once every: 0 y�o'�s) ® NA Flush laterals and pressure test At least once every: 0 month( ❑ yea )) NA Other: At least once every: M month(s) ❑ NA Ser ice WK -40 ❑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 (pumper). 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 a 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 treatment tank equals one -third (%) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the 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 30 days of completion of any service event. (Rev.2/05) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(S) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil 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 extended 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 and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons, and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • Alt piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide the opportunity to obtain a sanitary permit for a code compliant replacement system: It A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name: John Schmitt Name: John Schmitt L7 Phone: 715- 760 -0486 Phone: 715 - 760 -0486 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY LName:Apostle Name: St. Croix Count Zonin Se tic Service hone: 715 _ 4 97_5929 Phone. — — This document is intended to meet minimum requirements of Ch. Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POVVTS. (Rev. 2/05) - 7nc3 �2 U 2 5 4 7 P 17 2 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number QUIT CLAIM DEED ST CROIX CO ., vI RECEIVED FOR RECORD 04/1312004 09:30AM q uit claims to MICHELE K . QUIT CLAIM DEED MARK E. TRIEBOLD, Grantor, q EXW # 89 TRIEBOLD, Grantee, REC FEE 11.00 TRANS FEE: the following described real estate in St. Croix County, State of COPY FEE: CC FEE: Wisconsin: PAGES: 1 Part of NE 1/4 of SE 1/4 of Section 17 -30 -19 described as follows: Lot 1 of Certified Survey Map filed June 24, 1986 in Volume "6 ", Page 1670. This Deed is given pursuant to the terms of a Judgment of Divorce granted in the Circuit Court for St. Croix County, Wisconsin on May Tax Parcel ID # 032 - 2059 -80 -100 6, 2003. RETURN TO: Barry C. Lundeen 110 Second Street Hudson, WI 54016 This is homestead property. Dated this Zk day of March 2004. (SEAL) 14 ark E. Triebold AUTHENTICATION ACKNOWLEDGMENT Si ture(s) of *and * authenti ated this a day of STATE OF WISCONSIN )ss 2003. COUNTY OF ST. CROIX TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me this 9 day of March, 2004, the If not, authorized by t 706.06, .Wis. Stats. above named Mark E. Triebold, to me know to be the person who executed the foregoing instrument and acknowledged the THIS INSTRUMENT DRAFTED BY: same• t o cM� Barry C. Lundeen, Attorney Mudge, Porter, Lundeen &Seguin, S.C. N Public, State of Wiscons' 110 Second Street, PO Box 469 6 GNEl.LF C�\ Hudson, WI 54016 My Commission (expires): (Signatures may be authenticated or acknowledged. Both are not necessary.) * Nor y cn . 9y �, P 9� •Karnes orpersons signing in any capacity should be typed or printed below their sigmturcs. Q UIT CLAIM DEED SKr /ScoN�'\,G' Apr- 26.2011 01:45 PM St. Croix County Plan /Zoning 715.386.4686 7/15 SANITARY PERMIT APPLICATION ra Cou L - HR In a0cord with ILHR 88.06, Wl Ad m. Code ATE SANITARY PVUff f - Attach complete plans (to the county copy only) for the system, on paper not less than TE PLAN IA. NUMUNK 8% x 11 Inches to size. -See reverse side for Instructions for completing this application. L APPLICANT INFORMATION - PLUM PRINT ALL IWORMATION. paA v RIANC! Cc] � ❑ NO OWNER PROPINny LOCAT1oN NA,wr Air- BAL J2 g T NR E ( or rO PROPE M OWNlEh'A MAe.NO ADDn LOT NUMNO BLOCK NUM BBR sUBDNWW NAME CI ATE ZIP CODE PliOlrE NUMB NEAfiEeT A0�10, LAKE OR LANDMARK N. TYPE OF BUILDING OR USE BOOED- �• a:�o '~ � Number of Bedrooms it 1 or 2 Family -r--- OR 13PUMIC (815401110 NI. PURPOSE OF APPLICATION: (Check only one In #1. Check B 2, 3 or 4, K applloabla) 1. a. WN b. ❑ Replacement C. [I Replacement of d. 11 Reconncti Reconnection of e. ❑ Repair of an system System . Septic Tank Only an Existing System Existing System 2 A Sanitary Permit wee previously Issued. Permit * Date Issued 3. An Existing System has been Inspected and soil conditions most minimum requirements. County 4. The System Is shored by more than one owner /bulWing. Attach Common Ownership Agreemen t ty IV. TYPE OF SYSTEM: (Check only one In 01 and only arts In AM 1. a. t Conventional b, ❑ Alternative C. ❑ Experimental 2. a. © System- b. 13 Holding a. 13 Pit Privy d. ❑ Vault Privy e. ❑ Mound t. 11 IOP In•FIII T ank V. ABSORPTION SYSTEM WORMATION: (Check one) b. ❑ Sonoma Trench C. ❑ Oman Pit 2. PliR00LATION RATE: 9. Atl80RP riON AftEl1 4. AStiOAPTK)N AREA 5. i3Y9TEm 1if.EVATiON 8. WATER BUPPL (Minutes pew inch): REQUIRED (8 are Fast): PROP080 (Square Feet) Private ❑.hint ❑ Puwlc VI. TAMK i na llane Tofsi # Manufacturers Nants Pwb Steal aims Plastic fi INFORMATION Salton Tanks 26 or Nddm Tank Lin PumpTsWft VII. RESPONSWLITY STATEMENT I, the undersigned. sesunte responsibility for Ineullstion of the Private eswaps yrMsm Shawn on tM attaohad plans. Plumbers Nsms (Prime Plu s 310natunr. (Ns aw" M Businsss Phens Number: DurAw e gn�r VW. SOIL TEST INFORMAT WIT 95WIM Name r IX. COUNTY MMARTUIDIT USE OlN.Y Aypd n DWWWwad alurahlsrae es IdApprowO 18 Owner0lvenMitlel X. COMMENTS/REA80NS FOR DISAPPROVAL: Owner. Plumber S504Mt (formerly PIb4n (R. 03MR DISTR10UTION: OAVAW b nty Cou. Ors Copy To' 9u0e0 of PlWnbmip, .Apr -2b -2011 01:45 PM St. Croix County Plan /Zoning 715. 386.4686 8115 APPLICATION FOR SANITARY PERMIT 8TC -100 This application form is to be completad in full and signed by the owner(s) of the property haft$ developed. Any inadequaCiaa gill only result in delays of the permlt Issuance. Should this development be intended for resale by owner /contractor, C'spec house "), then a second fors should be retained and C=pleted when the property 18 sold and subsitted to this office with the appropflote dead reoordlag. Owner of Property i4.P r 4C/3ma Location cf Property ,-&'= - �i, section /7 W Township -- Mailing Address RT. - � 8S'P..L /Ll/ sya45� Address of Site REX - ,�.�rre�i�sr�r 111t• subdivision Name - Lot Numbs AM previous owner of vroperty GG /NTd1tf �)G& Ae.Z&d' Total sise of Parcel + Z Data Parcel was Created Bat= /9,P' Are all corners and Lot lines idantifiabla2 Yes No is this property being developed for resale (Spec house) 7 — 'Fag L� No Volume , and Page Number /93 as recorded with the Register of Deeds. INCLON WITH THIS APPLICATION TE POLLOWM A Warrants Deed which includes a DoRumsnt number, volume and passe number and the Seal of the Resister of Dead& In addition, a certified survey, if available, would ba helpful so as to avoid delays of the reviewing process. If the dead description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY 04MCR CER FICAI'10M I (G1e) dekd4y that att 4*t mextA on .this 5m axe tAue to At but aj my (oux) knarale4w #tat I (WO am (ade) At oW WA J a1 fh2� dtAeUbed U AU .t jVANa�tton JOAM, b Vtttut of a WWOWAty daoli xoeo .Ln tke 04 at Ob the Couw�y a Reg tex o6 vee ab ' Document Ma. and fiat I i(We) O WY O M flee pnopoeed 4tte ox file 4emaoe dta oA eye lox 1 (we) have obtatned an eaAeme►bt. to �IUUt uaLth ge about detcAibed piwpeA#, ox& At don6tkadtton og Aatd 4tfAxlm, and the eamt has been dldy xedoxded .Gn.the 09 446 od the County RegU ttk 0 Geode, ae Document No. YZ YZ49 . Ask SIGRATM OF OWNER SZONATW o8 CO-OWM (IS' APPLICABLE) OATS BIGM DATE SIGNED Apr-26-2011 01:45 PM St. Croix County Plan /Zoning 715386.4686 12/15 I<APAO Ir 11 Ak r TyP �R 30 Ric r, ,S ysrRO'f &A. oil I r �4+ ALr Bs aM 4 tP�Pos� . w DRAWN6- AVR, �� 9 -�d �R, �,�� Oyu `Apr -26 -2011 01:45 PM St, Croix County Plan /Zoning 715. 386.4686 t1l15 REPORT ON SOIL BORINC+S AND SAFETY °i BUILDINGS DlPAA r OF P.O. EO% 7890 LABOR PERCOLATION TESTS (x,15) ' 111ltDIB0A1, wl Es7m LABOR ren.. HUMAN RELATIONS (H9s oat11 L mww IL 9:rl/ N N 1 nA oaEfiiv R t le. w No WMA.b1e for fts t Sc If a" Wow of to taNwd arro is to do If f+treeUtlon Tsa w NOT reooked FIND Indbw Pogdwwm dowdea: „ v� PROPILi D69CRIMTIONE ELEVATION , 55 1 r w 'r 6, I r s 1 � 1,01 qj. N I �� I•17 a► I LIy , T s — . .33t irs ) S,7Y' �ls 9,�l5 f 98,x3 r / ' 8 /sfo gyp B. e. q,l►' loo,3y N f� � PERCOLATION TO I i, n 01 um, =11 WAOt1 NO dM dwArAl m d N4nid1 sot woos. Indiwetw 11wM� botletr NO dkn toed O� SOT PI AIIt tlbw I 1100011 ,* W dwW tb* WINN On OW OW 0"' ah" *a Won oiMden at mntd NO vwww ovedw ffibmw of WA 1190. �y► SYSTEM N ATION tN • o' q.7 t� �_�__�__ D b pi = Phont Fj Im-10 I, tM undltdtmd. hwrMtY 01iffY dW tM 1aU 00 160"d en 110 form WNW mw M by on M sum-d wM IM 0MOMWO and nwOied/ apedrod Adrtinm►wdYw fbde, and sm IM daft -wad and #, oedon o of dtw "M we omrwat P eA1 boat of atY bmw sdo NO 11" f e � G t 1 ✓ pyo 33 n w OIfTRItUTIfNIs OrW" and om My w Woo Au,IwI1Y, PreasrtY Oww and toy Tutor. ,w.F. Apr-26-2011 0145 PM St. Croix County Plan /Zoning 715.3864686 10/15 ` H H H a r STC - 105 H SEPTIC TANK MAINTENANCE AGREEMENT q St. Croix county 19 d H OWNER /BUYER t &h r �1 ,�,J. Q n W ROUTS /BOX NUMBER L! , A � __ Dire Number CITY /STATE �OMdr.� S ST' _� J /'� ._ ZIP Yo.2S" PROPERTY LOCATIONS si, ' j t, section L7 , T _ 30 N # R�W, Town of , St. Croix County, Subdivision Lot numbe Improper use and maintananee of your septic system could result in its premature failure to handle wastes. Proper maintenance Con- sists of pumping out the septic tank every three years or sooner, if nsaded. by a lieenee_d_ septic tank up roper What you pUt into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents mix, be eligible to receive a grant for a maximum of 602 of the cost of replacement of A failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1960, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on - lasts Wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary). the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to H three year expiration. Ac I /WE, the undersigned, have read the above requirements and agree y to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart - 'd ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Offl,pa within 30 days of the three year expiration date. SIGNED DATE 7 • $G St. Croix County Zoning Office P.O. Box 96 Hammond, WI 54015 713- 796 -2239 or 713 - 423 Sign, date and return to above address. ,Apr -26 -2011 01:45 PM St. Croix County Plan /Zoning 715.386.4686 5/15 Form - 8 T C - 104 YSTSM RMRx ,ry AS StiILT S/iliTPAkY B OWNER �atn TOWNSHIa .Sr�rrR<:= T SEC, T DT a W ADDRESS ST. CROIX COUNTY, WISCONSIN 6vsn IV lsloN LOT LOT 6229 PLAN VIEW Distances and dimeasions to Meat requirements of IS.HR 83 slow RVSRYTHINd WITHIN 100 PEET OF SYSTEM �. *F4 if /0 0, o �< <) 0 �Or Sy g .+sir AVACe4 yy,43 xN»xcsT$ NORTH ARROW 31MCBMAR[: Describe the vertical rafarance point used 7TU R J?.& V - 8lavation of vertical reference point: /D& Q Proposed slope at sites SEPTIC TANK, Manufacturar: 1),rtsrA'S Liquid Capacity: 1!_r LIS Number of rings used: A.-- Tank manboia cover elevations Tank W et Elevation 9P. jS Tank Outlet Elevations Number of fast from nearest Road: rront, 1 0 Rear, � /a _Z fast 1 .From nsarast-prsparty lines Front ,QSide,fymRear, O fast Number of feat from: well BQ btsildW: (Include this informatiou of the above plot plan)( 2 reference dimensicis to septic tank) `Apr•26.2011 01:45 PM St Croix County Plan /Zoning 715- 386.4686 6/15 DEPARTMENS OF iNOUSTRY, INSPECTION REPORT FOR SAFETV III BUILDINGS LABOR al HUMAN RELATIONS PRIVATE SEW SYSTEMS DIVISION BUREAU OF PLUMBING P.O. Box 7111010 MADISON, WI 63707 p !p�/ W, .� ❑ (�7 NVENTIONAL ALTERNATIVE Yt wrr ai " ❑ Ho Tank [I In-Ground Pressure G Mound I W it O � N71W of Mark Triabold Rt. 2 Somelrselt WI S402S , a+la .... Nrll N8 89, Section 17, T30N -R19W, Town oP $ games _ w r W. Donavin Schmitt 3203 St. Croix 1 83790 IC TAMK D NO T ANK, MaI OUT IL IV V p Nflp l.J Z7� 1" .� O?. OS/ YES LINO )YE n v t �+ am wormr— To 11 VIN fful .�.».. /. t B EET FROM / s O � EIYU ONO E ALLON v I_ ❑Y LIVES E PERENCE BETWEEN ON AND PIT SOIL ABED te moletun at the d1lothillf PIDWAII PO or a><owation, (if /all can be rolled Into a Wln, 00 01011 ONO until "Sell it dry #nouah to ooetleua.) j'ii�fifli •i�Tw i »ri+. BED/TRENCH 1 tnrNllNS I MaL: PIT DIMENSIONS ` v nn w I.N" "w�, }11�1`nn Ilfv cull u� I;; I Fear FRQM T V / 3 Mound site plowed perpendicular to Slope G W* the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown UPOOpe: mound systems to make certaln that it ON REVERSE SIDE. SHOW ELIEVA- meets the criteria for medium and. TIONS MEASURED. El ves CINO _ 1 Itl1 m. i 1'1 F r JY rlY�s I I i :11 1 r/1W 7N U Iuf 11 .w + ;1+ i1N:tF la r:I Y y 'Ir PRESSURIZED 01 STRIBUTION SY EMt 1 t or "D/TRENOH H + Iwnu DIMENSIONS IICfR�rflfr110 lag 1T71tr+ n. + IR !IA WV llfY atA f1.tV , RtAVATION AN DISTRIBUTION , v 1 N INFORMATION + + t " 1 + +� ' �r 04 AN 71vrs �Q�� 11y es OOINMEN aB>iAtt I R[B�RTI NL g MBFIRI�U! uNt — g^TT / u Pr D YES Y NEARlST _ Sketch "@in on Ratai ty file for audit. Rowse Side. IF E rr DILHR $SD 6710 (R. 011821 Apr -26 -2011 01:45 PM St. Croix County Plan /Zoning 715- 386.4686 r gl15 ' T1H+ *PAM IWaaYap Iaa aa0��af DATA oocuM * NO. STATE AAR WARRANTY S DI RD i _ !salt ,aa 9x my 746 PAcs} : M@iT3IERS office — a. com co, WI& Ciiaton J. Bch1111a� ». bed. iof Rooard ft 7th ... . .... ...... ................... ............................... da)►af C, ,,,,. A.D. 10j6 ... _ ..........Urantor, $ and....Jllark, Trishal. st.., asLd. �tiah�t].+ t.��..Trd.abaldv..i+uat+and•. ». � . and..vife . . � oiLit .t8* 4101 • .......... ............... I.......... ........ ....... . ..................... ... � ............................ _. avant", witr, ,th That the said Orantar, in a valuabu eomddurstim..... th! idh+wiss dyOr�+d real oelats in .. .. : Cso ...... -.. aetvau Te ............. conveys to Grantee .. . Counts, state of wise in: Part of Mk of Sick of Section 17 -30 -19 described as follows: Lot 1 of Certified Survey Map filed June T FnwNa . -- --» -• ». 24, 1966 in V OlUMa 1161 rags 1670. FEB 1 This ............ itE. it9.t... homesuad property jam( (h eat) tens Tosow►ar With all end Mnaelar the hered►Lema y + Jo + S 'chillin8 hi !! of •t.••.•� ....................... Aad............ I.. 1s ....».....� a�fait S too i(de and fra! j" +liir of mam:bmmm =Mt warrants that the tille seedy easements and protective covenants or restrictibas of record, if any. and Will Warrant and defend the came. �. day of July ................. 16..8b... Dated this ................ ..... . .... - -.. . 'J" .............................. ............................... Cl Schillin ` ............. »........» ........ .........................(SEAL) ...:. ,. - ...........(SEAL) B. oy Chilling .. ............................ ....... .............I....... I..................... .............. • ..... .... .. AQTBHNTIOATION ACKNOWI.'nOMBNT ............................... _ ..._.... STATE OS WISOONEN eSSaatuss(s? � n. _ 7 C►.. ....dmy of a s we M she above non" TITLE: KEM'B1& STAT3 BA8 OF WISOONSIN ...... ! i���►Y 708.09, "W�i� �Le.S . known to 1a` `.ear firbp a7twutd tU! I tMia {M"UMSMr WAS DSAr"M By »- Lns ••, d same_•.......... it Haywood, Carl, Murray & Sherburne �» James 'Coyne!! - - .�. Eoicl° 1 .. ............................... wauiY "�: "Caii;'T : gas. Cioix' Conn pltstMn ........ Qpy is vommn (if 'no%'rtite aY (slsnetvrs! =y be aatbantiaetad or admo'a'lldied. Both . ,.�3tri1 p it:» » » ».....� !re not aeemesans.) date, ......... _ i ' f •tfoe,e o< ia>see etnau I. ey eaeet►r eleaM e, t1lea or Pb" btle,r tMk yglede,r. e Knight Microbial Inoculator Generator m W h �t 9 U Patent # 7658851 Design, Installation, Operation eration & Service Manual Updated October 2010 © 2010 Knight Treatment Systems, Inc. All Rights Reserved i WT i6N Guardians of Water QuafityC; 281 County Route 51 a, Oswego, NY. 13126 1- 800 - 560 -245 www. knig httreatmentsysterns. vom R! •• AIWW TREATNlENT It make the • tre atments b etter" We make them (I) INTRODUC'M Biolog Augmentation of Onsite Wastewater Treatmen noculums in tandem with a The Enhanced Biolog spe selected microorganisms tho ugh of introducing a group of task spec microbial inoculation generation device that is placed into an on s stem performanc trea rehabilitate l typically the septic tank, to significantly improve overall treatment Y dysfunctional systems and assure system longevity. inoculates a septic tank or The White Knight Microbial Inoculator Generator' (MIG) continuously inoc bacteria selected other treatment vessel with naturally occurring selected strains of non-pathogenic metabolize organic material. continuous Inoculatio on is mediated and 1ebubb� 9 def �O for their ability to re c i rculation, _ cultivation of IOS - . Through airlift m 500TM inoculumssixing, 1 The introduced principles the device brings the selected bacteria into contact with fixed en t vessel. T and the suspended organic compounds in a septic tank, or other process treatmost of the organic cultures of bacteria grow at logarithmic rates as they voraciously digest constituents that are found in the wastewater in addition to the organic waste matter that has been transferred to the soil. riven airlift features of the White Knight Microbial Inoculator h gherate circulation of The fine bubbled en and low maint ppl n suy designed to allow for more efficient transfer of oxygen rap digestion. The tubular wastewater through the device, a Md across the fix ro idinngi for4more ra p abund 9 9e supports the introduced IOS -500 bacterial cultures p internal media is clog resistant and provides for uninterrupted flow across abundant configuration surface area for the establishment of the selected fixed -film culture. a g g ressive at Many not of the natural bacteria found in wastewater such a the and form cannot compete with he IOS- its the of the organic constituents found m was tewater ea cultures. The tank serves as the breeding reactor that cultivates an d rel ses th e 500 TM introduced cu . the effluent stream out to the so introduced bacteri functionality. � capabilities an =el $u�ificetions'. Size of Minimum Minimum Approx Diffuser Model BOD # of tank size Air Flow (CFM) i# loading Columns Column Air lDpe @ 2 PSI mg /l/ @ per Model (dia" x height'l 500 gpd r unit 1.5 1 16" x 1 /z" 1000 Gal WK -40 UP to 27.5" 750 3.4 2 16" x 3 /a" 1500 Gal WK -78 UP to 27.5 1500 K id enti I ^., �� t 'nn Guid elines: 1. Model WK 1 to 4 bedrooms based on minimum 1.5 day residency time of average daily flow within tank. rooms based on minimum 1.5 day residency time of average daily 2. Model WK -78: 5 to 8 bed flow within tank. n io I & omme ial Aoulica G uidelines: The use of multiple units may be required based on wastewater compos for each specific , existing tank ize a n d i"a/ average daily flow. Consult with Knight Treatment System s repr application. In general: 1. Institutional Waste Streams: Tank size must allow for minimum �1.5 G 2000 gallons average daily flow with 2 or mo 1500 m/t /day BOD load @ 500 gpd. s less of tank volume and up to 9 2. Commercial Grease Interceptors: Tank size must allow 8r mi gallons orslresid ncy time of average daily flow with 1500 r mg /I% l ay BOD toad @ 0 gpd. interceptor volume and p to Air cMW c cificatio Model # Minimum Maximum Amps Volts Output @ Air Pump 2 psi Sound (CFM) Level @ 3 ' WK -40 1.5 32 dBA 1.2 120 WK -78 3.4 36 dBA 2.1 120 Kitchen Wastewater to Grease Ills interceptor: taknowp— rs • Minimum 1 Day Retention Time of Total Daily Peak Flow from Kitchen. White Knight Microbial Inloculator Genera►torTM Recommended Omnwdal & Institutional System figuration Trash Tank with Effluent Feller • Receives Settled Grease General Notes: interceptor Effluent, All 1, All wastewater treatment processes generate other Wastewater odor and its prope management is an important Generated & so16 of EQ element of achieving client satisfaction with Tank Dose Cycle. system performance. As such it is highly Minimum 1 Day Retention of the recommended that all c omponents Time of Total Daily Peak treatment train be vented through an Flow from Facility. appropriately sized Wood Chip J Mulch Air giofiiter. Technical assistance is available upon request. White Knight MIG Tank with Effluent 2. In lieu of using two individual tanks for the Filter: -T & "White Knight MIG Tank" a single 2" • compartment Precast Concrete Septic Tank may Receives Trash Tank Effluent, be substituted if mo dified in the follofollowing n Minimum 2.5 Day Retention Time of Total Daily Peak Flow manner: in f low • Reverse tank end for end so that t � side from Facility. White Knight utilizes the smaller of the 2 compartm Minimum (2) "'Trash Tank" and the larger compar then MiG Columns for 1 1000 becomes the "White Knight MIG" Tank. Gallon of Physic al Volume. Adjust inlet and outlet Pipe elevations accordingly (1) Additional White Knight at the a ppropriate !options to allow for gravity MiG Column for each flow through the tank. additional 1000 gallon (or . Some Precast concrete tank manufacturers only fraction) of physical volume. provide a pump out access ewer that stra the impartment wall in their septic tanks that Timed Equa posing Chamber does no t facilitate White Knight MIG Column t MiG Tank installation &maintenance• The tank may need to Receives White Knigh be special ordered with additional access Effluent & Doses Absorption System: openings i in the appropriate locations to address • Minimum Volume Twice Tots! AN this other recommendations contained in this Daily Peak Flow. Equip with Auxiliary Air document apply. Diffuser, (1) for each 1000 For tether suPPod or questicins please contact Gallon of physical Volume • Recirculate So% of dose back Mark C. Noga, VP at 315 - 575.4 to Trash Tank. T In Tank Installati n W K - 7 Cross Section View R --------------------- 2 3 4 4 ........_ _._ _.. _ ..._........ OUTLET INLET 8 6 5 1. 120 volt electrical supply through Alarm /Control Panel to Air Pump 2. Air pump installed in weather tight basin, outdoor location 3. 3 /4 " ID plastic main air supply line from pump location to tee in riser. '/2" ID flexible air line from each side of tee to each column 4. Service risers for monitoring and maintenance 5. (2) White Knight Microbial Inocul GeneratorTm Columns in 1St compartment of 2 compartment ta 6. Outlet equipped with Effluent Filter 7. System Alarm Panel 8. IOS -500TM Inoculant Packets T ical In Tank Installation WK-78 Plan View 3 �. 6 a 4 a. 0.. 5 4 _ .., 4 (III) Site Oualific�#i9[�. Mi crobial Inoculator Generator's success is directly linked to the proper White Knight M The m's dysfunction. In order to determine whether or determination of the root cause of an onsite syste System is a candidate for enhanced biological re�bbilita must a not the dysfunctional SYst tent authorized p evaluation must be performed• To this end a competent and record search in determining e comprehensive site evaluation and owner /ope rator a and to su the appropriate hermit actual nature of the problem(s) being xpe application(s). Septic Tanks, Distribution Boxes and The system's infrastructure must be sound and free of defect- Sep damaged or deficient. vents must be evaluated and repaired or replaced under a a approved repair permit other compo local authority, must be performed All such repairs, if required by in the repair application in which the installation of the White Knight is and may be incorporated specified. • . Corr oded ! 8 . �. R I major impact on the hydraulic performance Surface water runoff infiltrating the system will have a ng to its dysfunction. and treatment efficiency of the absorption system contributi 1.. Roof ! • • ess ! ' ! Tank acc Roof f! e• Run .- • slope of ' t _ must be from impermeable areas such as rooftops and driveways during or Sources of co ncentrated flow ents. VKding a dysfunctional system of the identified and directed away from system compon patterns shortly after a significant rain event can be invaluable tool in assessing the drainage property. (IV) Tn; rallat��On The following compo vents are provided with each White Knight MIG supplied by Knight Treatment Systems" H40 Air Pump, Air Pump Housing, (2) IOS- 500 Inoculant Model WK 40 - (1) Generator column, n hour meter, 25' Alarm Tubing with '12" PVC Packets, Pressure Sensing Alarm Panel with pump rucoverage, 1 year of 6 -month & 12 -month ing tee, 1!9t year of component warranty s 1 IOS - 500 TM Inoculant Packet shipped at time of 12 - month service notification. �H40 sens service notification , ( ) H80 Air Pump, Air Pump Housing, (4) IOS -500 Inoculant Model WK 78 - (2) Generator columns, n hour meter, 25' Alarm Tubing with '/2" C PV Packets, Pressure Sensing Alarm Panel with pump ru Overage, 1 year of 6 -month & 12 -month SCH40 sensing tee, i year of component warranty at time of 12 - month service notification. service notifications, (2) IOS -500 Inoculant Packet shipped All other compone for a complete and proper installation shall be supplied by the installer, which include but are not limited to: Air supply line between air pump and MIG column locations. Air supply line transition fittings, glue, sealants, etc. Electrical supply to Alarm Panel and Air Pump Effluent filter. Replacement tank if necessary. Riser system if necessary• installation. All tools and services required for a complete and proper provided with the assumption that those involved with Important Note: The following directions are pro � the installation of the White Knight Microbial Inoculator Generator hold know/ of, adhere to, practice and promote Ifie Protection of the health a n safe of their colleagues, the public and the ls and OSHA Safety Requirements environment. Becoming educated in and complying w nibiity the installer. Knight Tr t and goveming Regulatory Requirements installer or by othefs System is the sole respo s Inc. assumes no risk or liability for any omissions or actions of the associated with the installation. 1) Expose the top of septic ns tank. cted and ALL solids be pumped, visually Pe removed prior to installation of the White Knight' Tanks and risers must be y4 watertight. Openings, risers, and tank interior must be structurally sound and c tanks found to be corrupt must intact. Septa x be replaced with a tank that meets local Y requirements. '' 5) The location for the White Knight MIG Column TM is the inlet side of b Column should compartmen and t tanks, wal�Is.by the diag rams be placed equidistant from the near end and side Single Compartment Tank Dual Compartment Tank 6) Installation and placement of the White Knight MIG Column must not interfere o i code function of the inlet tee. If the tee is modified to facilitate installation it must be res tored t compliant condition. 7) Septic tank openings may need to be modified. i the Whi integrity of the existing opening any opening modification must not compromise se the overall tank. 8) The optimum depth for the bottom of the White Knigh is o 4 rating depths greater than liquid in the tank. When tanks are encountered with liquid winless steel 1.5" long screws elevate the White Knighfm to the optimum depth. 9 securely fasten an inverted 5- gallon plastic bucket to the bott the everted beer with t o ac i c e ate in the base of the bucket to prevent floatation. Trim sides of optimum depth. For tanks with depths greater than 6 feet suspending the White Knight from the riser with non - corrosive attachments is also an acceptable practice. 12) The locations for the Alarm Panel and Air Pump Basin should facilitate running of airline to the White Knight riser and the related electrical connections for the panel and air pump. The location should shield the basin from direct sunlight and weather events in so much as possible. Air Pump Basins should be slightly elevated when flooding is a possibility and always placed on a 2" bed of washed gravel to facilitate drainage. Drill airline entry hole in bottom of basin over sizing the penetration to allow for the drainage of any water that may find its way into the basin. .W v '� rt > t 13)A trench must be provided for the air supply line between the Air Pump location and the White Knight service riser. Excavation may be accomplished by either hand or with the use of power equipment. Trench should uniformly slope from the air pump location to the service riser to prevent any airline condensate from pooling. When performing an excavation make sure you are in compliance with local procedure and safety practices with regard to the protection of underground utilities. NOTE: Where an airline must cross vehicle traffic or parking areas such as a driveway the air supply line should be protected by placing it in a sleeve such as a 1" ID Schedule 80 PVC pipe Installed a minimum of 12" below the surface of the traffic area. 17. After positioning air pump, have an electrical contractor or electrician the National Eb taine l all necessary permits; connect the alarm panel and a pump according Code, any applicable local codes, and in compliance with wiring diagram provided by Control / Alarm panel manufacturer. Do not turn on electricity at this point. I M _ r r IMPORTANT NOTE: ALL EXTERIOR ELECTRICAL CONNECTIO CONDUIT AND ED AND PROTECTED BY NEMA LISTED EXTERIOR WEATHE R 18. Run the airline into the riser. On installations where two White Knight towers are used, a tee and valves are required to divide and balance the airfl t b between the �to ID tower When th using 3/a" the piping for the main air supply line make the transition adjustment valves to feed each tower. ti Piping and any manifolds should be configured so, that if neces ers th e to r is ca a bl erl f b eing must removed without causing damage to the air supply I l line should be protected by cross vehicle traffic or parking areas such as a driveway the rs minimum of 12" below the placing it in a sleeve such as a 1" ID Schedule 80 PVC pipe install surface of the traffic area. 21. Activate the air pump and with the White Knight tower in place and refill the tank to normal operating level with clean water. Caution must be exercised for properties served by a well with regard to depleting the water supply. Always attain property owner permission to make use of their water supply. In situations where there is questionable well capacity water should be brought in to refill the tank. DO NOT gEFILL REFILL TANK uurna SEPTME FROM PUMPER TRUCK. w 4 x. . �f 22.The IOS- 500 is placed into the system via a 1" PVC wand shipped with the unit that must be assembled. Wand Assembly The wand is then inserted into the center of the tower's tubular media with the IOS- 500 inoculant packet affixed to the "Tee" side of the coupling with the supplied plastic cable ties. The coupling serves a dual purpose, as a stop to prevent the tapered end of the wand from coming into contact with the fine bubble diffuser located beneath and the method to attach the upper portion of the wand, The upper portion serves as the point of attachment for the IOS- 500 inoculating packet and is provided with a "Tee" fitting which facilitates wand placement, removal and allows for maximum circulation of the air lifted effluent throughout the tank. The IOS- 500''T" inoculant must not be put into place until the system is active and the liquid level in the tank provides at least 2 1 /2" of cover over the top of the tower. 26. Secure all access covers and restore excavated areas. Complete the White Knight MIG' Installation Registration Form provided with the unit returning it to Knight Treatment Systems in a prompt fashion. 27. Areas of the absorption system that had broken out and have untreated sewage exposed must be addressed. Apply lime to the affected area followed by a thin layer of topsoil, seed and mulch. (V) Operation: 1) Following installation, operational guidelines and the requirement of routine periodic maintenance must be reviewed with the Owner / Operator of the system. A "White Knight Microbial Inoculator Generator'" Owners- Operators Manual" is supplied by the manufacturer to assist with this task. 2) Each OWTS will develop its own unique operational personality over time based on operator input and change of usage patterns. Periodic adjustments may be required of the Owner - Operator as the operational personality evolves. 5) As part of each service visit a 1 /2 " diameter pole or ridged plastic tube with sharp edges removed should be inserted down through the media column of the tower and the diffuser membrane gently bumped several times while in operation. Biofilm sometimes form on the membrane, which could{ reduce fine bubble production if allowed to build up. "Bumping" the diffuser breaks free any biofilm. 6) The effluent filter must also be checked. It should appear relatively free of undigested organic materials and will typically have light brownish biofilm on it. Inorganic materials should be removed and disposed of properly. Do not remove the beneficial biofilm. 7) Should extraordinary amounts of foaming be encountered it is typically caused by the over use of detergents or the use of high sudsing formulations. , Spraying the foam with water from a garden hose will knock down the suds so that the system can be maintained. 8) Infrequent foaming events will not have a major impact on the overall performance of the White Knight but can cause nuisance concems and trouble calls should the foaming become visible. The user must be made aware of the situation and corrective actions implemented. i 9) The air pump's air filter must be removed and cleaned annually unless unusual dust conditions exist. The foam filter is easily cleaned by washing in a mild soap and water solution, rinsed and allowed to dry. Cleaning and rinse water should be disposed of at the inlet side of the tank. (VII) Forms White Knight MIGT" Site Evaluation Form Owner / Operator Interview: Property usage Single Family Residential Multi Family Residential Commercial /Institutional Type of enterprise If Commercial /Institutional has a lab analysis of septic effluent been conducted? Y N Lab Results: BOD5 FOG TSS pH Alkalinity How long has property been occupied? years # Bedrooms # Tubs /Showers Hot tub, spa, whirlpool bath? Y N Garbage Disposal Unit? Y N Food Service? Y N Number of Meals Per Day Commercial Dish Washer? Y N Grease Trap / Interceptor? Y N Size Water Supply? Well Municipal Water Meter? Y N If yes average daily flow If well, does a water purification /softener backwash discharge into septic system? Y N Does the property have a sump pump? Y N Discharge into septic system? Y N Laundry discharge into septic system? Y N Laundry detergent? Liquid Powder Describe Laundry & Cleaning Habits (products used and how often): Has property usage expanded since installation of original septic system Y N Inlet Access Y N Center Access Y N Discharge Access Y N Date of Pump Out & Name of Pumper Depth of tank from inside bottom to outlet invert Depth of soil cover over tank Baffle condition Discharge effluent level " above outlet invert Septic Tank Discharge pipe description Grease Interceptor Size Tank Material Tank Condition (observed following pumping) Inlet Access Y N Center Access Y N Discharge Access Y N Date of Pump Out & Name of Pumper Depth of tank from inside bottom to outlet invert Depth of soil cover over tank Baffle condition Discharge effluent level " above outlet invert Grease Interceptor Discharge pipe description Ponded Effluent level in leach field /trenches Biological clogging confirmed Y N (If yes, attach photo) Soil Type & Description (Attach photo) Observed Depth to Ground Water Storm Water / Snow Melt Infiltration? Y N Apparent structural damage or other unusual findings (Attach photo) Provide sketch of system layout and cross section of absorption system. Please indicate all breakout points, boundaries and depth of ponded effluent within system. Soil Absorption System Weather: Precipitation previous 48 hrs Time of inspection Surface Condition: Dry & Firm Soft & Spongy Saturated Breakout / Location(s) Distribution Box accessibility via Riser to grade: Yes No If yes inches static water above outlet inverts. Notes: Repairs or Modifications Performed: Additional Comments: Service Visit Report Left With Property Owner Technician s Signature #1642 %SCO/�S%tf SOIL EVALUATION REPORT 1 4 Dt nent of Coertlerr�e in accordance with Comm 85, Wls. Adm. code Page Division of Safely and Schmitt Soy Test, Inc. Attach complete site picrr on paper not less than WA x 11 Inches in size. Plan must COY St. Cr obt inchrde, bbd not limned to veil and hortw tol reference point 00, direction and percent slope scale or dimensions, north arrow, and location and d da rm to nearest road. Parcel I.D. 032-205940-100 Please pmt Alf Wbotnadon. Revimaod By Date Persorw Mnnoft you provide may be used for seown!" purposes (Pdwwj LSK s. 15.04 (1) (m)1 Property Owner Property Lorafion Riedel, Paul S Miele Govt. Lot NE1/4, SE114, S17, T30N. R19W Property Owne{s g Address Lot # Block # Subd Name or CSIYt# 1547 47th St. 1 I I Vd.6 Page 1670 City State Zip Code Phone Number City ❑ 1ffage N Town Nearest Road Somerset 540251 Somerset I 47Th St. ❑ New Construction lbs. ® Residential / Number of bedrooms 3 Code derived design lbw rate 450 GPD ®Roplaciernord ❑ Public or commercial - Describe Parent material Glacial Series) Flood plain elevation, if a na ft. General commsft andreconmemmidathum An aerobic fi 98tFTM t unit is mended for this she either as remecjadon of the ebdating drairdWd or to pretreat the ellium t to a new drairbfieid. see ails plan. O Baring F1- ® pit Gourd surface sfev. 92.10 ft Depth to Ding tarter 98+ in. Son Application Rate Horizon Depth Dorrdrwrft Color Texture Structure CGrablew Boundary Rods GPD/fl= b- Mrrnem Ou. Sz. Cont. Color Gr. Si Sh. 'E11d1 'Mfl#Y 1 0-5 10yr3/3 none I 2mgr mvfr as 2vf .6 .8 2 5-29 5yr4/4 none grsl 2msbk nrvfr cs 1vf .6 1.0 3 29-36 10yr5 /4 biome gruos OS9 mi a .7 1.6 4 3690 7.5yr5/6 none gr5l 1msbk mvfr _ .4 .7 ❑ Boritrg # El Buf ® Pa Ground surface elev. 96.05 tt Depth to bnft g fegpr Horizon in ms Depth Domtrrart Color Redox D on T Struck" SOi n In. Rode Qu. Sz Cant Cobb y Rods GPOW 1 Q-63 Gr. 3z Ste. 'Ef®►f 'Etilf2 FILL 2 63-69 10y13/3 Cif 1 0Y W6 CS 0.0 0.0 so 1 3 10yr5/3 c2d 7.Syr6/6 mfr as .4c .6 7 so imstbk mfr -- Ac .6 #1 - B013 30 < 220 mglL wrxi TSS >30 < 150 mWL • CST Name (Please Pr;nt) S +r+s. Eftert 92 _ B00 !S30 mgt!_ and TSS s mgrL ThRm J - i — :/ CST Nu<rteer Property Owner Riedel, Michelle Parcel ID # 032 - 2059 -80 -100 Page 2 of 4 IE Boring # ❑ Boring Ej Pit Ground surface elev. 90.30 ft. Depth to limiting factor 0 in. Soil Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots App Ra in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eif#I 'Efl#2 1 0-25 FILL as W 0.0 2 25-40 10yr3/3 ci l�i 6 SO lmsbk mfr a 3 40-54 10yr5/3 c1d 10yr6/6 .6 ipyr6 /1 sit 2msbk mfr gw 8 4 54-72 5yr4/6 m2p7.5yrs/6 10yr6/2 grsi Om mfr — .6 Boring # �-I Boring © Pit Ground surface elev. 88.70 ft. Depth to runiting factor 96+ in. Soil Application Rate 7oin Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz Cont Color Gr. Sz. Sh. 'Efr#1 'EM 0-18 FIL L as ivf 0.0 0.0 2 18-24 10yr3/3 none sit 2mgr mfr as .6 .8 3 24-36 5yr4/4 none grsl 2msbk mfr a .6 1.0 4 36-96 7.5yr4/6 none grsl lmsbk mfr — 4 7 F -sl Boring # ❑ Boring Pit Ground surface elev. 91.90 ft. Depth to limiting factor 98+ in. Soll Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Efr#1 I 'Ef#2 1 0-5 10yr3/3 none sil 2fsbk mfr as 2m, 1f 6 8 2 5 -13 7.5yi4/6 none sl lmsbk mfi a 1vf .4 .7 3 13 -98 7.5yr4/4 none grsl Om mfi — .2 .6 ' Effluent #1 = BOD 30 < 220 mg/L and TSS >30 <_150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS -i_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 60 8-266-3151 or TTY 60 8-264-8777. SBD -8330 (807/00) SdM t SON Tesfixj Inc. t Conducted by: Conducted For. ge 3 of 4 r . Schmitt Soil Testing, Inc. Name: Michele Riedel Thomas J. Schmitt, CST 227429 Address: 1547 47th St. 1595 72nd St. City, State, Tip: Somerset, WI 54025 New Richmond, WI 54017 Phone: 71 760 -1978 Address: 1547 47th St. Sig � Lot No.: 1 CSM 6/1670 Dante —d 9' o?o // Legal Description: NE1 /4 SE1 /4 S17 T30N R19W ■ Backhoe Pit Township, County: Some p ty: rest, St. Croiz County ® Bench Mark 1 El. 100.00' Top of Northern most concrete porch footing A Bench Mark 2 El. 89.33' Top of existing drainfield vent pipe Slope= 7% ** NOTE** The soils in the replacement drainfield area (131, B5, & 136) are 0.2 gpd/sgft soils. With this rate there is about 1/2 of the required area for complete drainfield . replacement * *OPTIONS** 1. remediate the old system with areobic treatment 2. add as much drainfield as possible, let the existing drainfield dry out then switch back to the old drainfield after a given amount of time. 3. Add an areobic treatment unit so the new- drainfield would receive preteated effluent and install a new drainfield at a 0.6 gpd/sgft rate. By t 1.23 We a� -■DS' \ J f Age/' _ I l Phi /r Sh Property Owner Riedel, Mididle Parcel ID # 032 - 2059 - 80-100 Page 3 of 4 a pit Ground surface elev. Boring # � Boring 93.50 ft. Depth to limiting factor 110+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtft' in. Munseil Qu. Sz. Cont Color Gr_ Sz. Sh. 'EfM 'Effn 1 0-6 10yr3/3 none 1 2mgr mvfr as 2m, if .6 .8 2 6-18 7.5yr4/6 none sl imsbk mfr gw 1Vf .4 .7 3 18-45 7.5yr4/4 none grsl Om mfi Cs .2 .6 4 45 -110 7.5yr4/6 none grsl Om mfi — .2 .6 ❑ Boring # ❑ 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 GPD/ftz in. Munsell Qu. Sz. Cont Color Gr. Sz Sh. 'EMM 'EfW Boring # ❑ Boring ❑ Pit Ground surface elev. R. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munseii Qu. Sz. Cont Color Gr. Sz. Sh. . . Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 m - 9/L 'Effluent #2 = BO0 < 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 SOD-9330 (R07/00) IIeed material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. Sdm n Soft Tes", Inc ,. � CO) 9� _ 0 o a $ HJtb x FL �.m � R � 302 cr aim 'p e. rn ti o r. 3 jPe t C:w I .ta;�Jf C�" Document Number Document Title Maintenance Contract for Septic System This Maintenance Contract for a Private On -Site Wastewater Treatment System(POWTS) is Between Michele Riedel and John Schmitt. Recording Area Date of Contract: June 15, 2011 Location of POWTS: 1547 47 St. Somerset, WI 54025 Name and Return Address: Legal Description of Property: NEIA, SETA, S17, T30N, R19W Michele Riedel 1547 47' Street Somerset, WI, 54025 As Inducement to the County of St. Croix to Issue a State Sanitary Permit for the Above Described Property, We, the Owners Agree to the 032- 2059 -80 -100 Following: Parcel Identification Number (PIN) 1. The Owner agrees to have the POWTS inspected and maintained by a qualified maintenance provider. 2. The owner agrees to provide access to the POWTS for the qualified maintenance provider in order to service and/or maintain any and all components of the POWTS. Accruing to the maintenance and monitoring schedule provided by the POWTS manufacturer (including White Knight, St. Croix County Zoning Department, and Wisconsin Department of Commerce. 3. Minimum performance monitoring will include: a. Type of use b. Age of System c. Type of Fill Material Used (If Applicable) d. Nuisance Factors, Such as Odors or Complaints e. Mechanical Malfunction Within the System. Including Problems with Valves, Mechanical or Plumbing Components f. Material Fatigue, Including Durability, Corrosion, or Integrity of Construction and Design. g. Neglect or Improper use of POWTS. Examples Include Exceeding the design rate, Poor Maintenance of vegetative cover, unapproved covers over the POWTS or inappropriate activity over the POWTS. h. Pump Malfunction. Examples Include Dosing Volume Problems, Pressurization Problems, Breakdown, Burnout, or Pump Cycling Problems. i. Ponding in Distribution Cell. Ponding Prior to Dosing is Evidence of a Developing Clogging Mat, or Reduced Infiltration Rates. j. Overflow or Seepage Problems. Often Apparent When Sewage Effluent has "Ponded" at Surface of Ground. 4. The Owner further agrees to pay the qualified maintenance provider for all charges incurred while inspecting, pumping, or otherwise servicing and /or maintaining the POWTS in such a manner as to prevent or abate any human health hazard caused by the POWTS. Contract Drafted by: John Schroeder 5. The Owner agrees that if required by the qualified maintenance provider, to have any components of the POWTS corrected by a Wisconsin Licensed Master Plumber that has knowledge regarding the installation and/or repair of the POWTS. 6. The Owner contract is binding for two years from the date in which the final inspection is made for the fully installed POWTS. This date will be located on the inspection report filed with the St. Croix County Zoning Department. 7. The Owner agrees to contact the qualified maintenance provider to have the POWTS inspected and maintained semi annually (or at intervals required by White Knight, the county or state governmental unit) after the initial two years. (Additional evaluations may be required if warranted by operational condition of POWTS.) 8. A qualified maintenance provider shall possess a POWTS maintainer credential from the WI Department of Commerce. 9. The qualified maintenance provider shall agree to submit an inspection report to the St. Croix County Zoning Department on a semi annual basis. (Or intervals required by the manufacturer, county or state government unit.) 10. Recordation/Acceptance Conditions. This agreement shall, upon execution, be recorded with the Register of Deeds for St. Croix County, WI. By the recording of the easement, Grantee, or itself and its successors and assigns accepts and agrees to abide by all of the terms and conditions hereof. Qualified Maintenance Providers Name: John Schmitt Lic. #223760 John Schmitt Septic System Services Qualified Maintenance Providers Signature: - - -The Following Requires Notarization-- - The Owner(s) Name: Michele Riedel Owner(s) 'Signature: J/kA I Personally came before me this 15 day of 2011, The above -name W I C, tE u�: IL P j , To me known to be the person(s) who executed the forgoing instrument and has/have acknowledge the same. .` * U, TA 's u',, ' . '�(ie G . 52 aigna of Notary Public '4��` ��''�i �OP �W;S`� Notary Public, State of: (fit S Contract Drafted by: John Schroeder N Visconsin ATION REPORT #1642 Depa rtment of Commerce w ith Comm 85, Wis. Adm. Code Page 1 of 4 Division of Safety and Buildings Schmitt Soil Testing, Inc. Attach complete site plan on paper not less than 8%s x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal refe rence oint BM), direction and percent slope, scale or dimensio �� oG' �st�q[� an I stance to nearest road. Parcel I.D. 0 y C (J 32 059 100 Please rint a fn orma ►on. Revi d By Date Personal information you provide may used for secondary purposes (Pri cy Law, s. 15.04 (1) (m)). Property Owner jUN 1 3 I I Property Location Riedel, Paul & Michele Govt. Lot NE1 /4 E1 /4, S17, T30N, R19W Property Owner's Mailing Address PLANNING & ZONING OFFICE Lot # Block # Subd. Nam or CSM# 1547 47th St. 1 Vol.6 Page 1670 City State Zip Code Phone Number ❑ City ❑ Village H Town Nearest Road Somerset 1 1 540251 Somerset I 47Th St. ❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial - Describe Parent material Glacial till (Amery Series) Flood plain elevation, if applicable na ft. General comments and recommendations: An aerobic treatment unit is recommended for this site either as remediation of the existing drainfield or to pretreat the effluent to a new drainfield. See site plan. F-1 I Boring # El Boring Pit Ground surface elev. 92.10 ft. Depth to limiting factor 98+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fts in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -5 10yr3 /3 none I 2mgr mvfr as 2vf .6 .8 2 5 -29 5yr4/4 none grsl 2msbk mvfr cs 1vf .6 1.0 3 29 -36 10yr5/4 none grcos Osg ml cs - - - - -- .7 1.6 4 36 -90 7.5yr5/6 none grsl lmsbk mvfr - -- - - - - -- .4 .7 2] Boring # Boring ❑ Pit Ground surface elev. 96.05 ft. Depth to limiting factor 0 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 -63 FILL a 0.0 0.0 2 63 - 10yr3 /3 clf 10yr6 /6 sil 1mp1 mfr as - - - -- .4c .6 10 r6 2 3 1 69-76 10yr5 /3 c2 7.56/6/6 7 .56/6/2 sil lmsbk mfr ---- - - - - -- .4c .6 7 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 CST Name (Please Print) Signature: / �22742u Nmber Thomas J. Schmitt --uu 9 Ad dress Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 4/29/2011 715 247 -2941 SBD -8330 (807/00) Property Owner Riedel, Paul & Michele Parcel ID # 032 - 2059 -80 -100 Page 2 of 4 .Fi] Borin # Boring g Pit Ground surface elev. 90.30 ft. Depth to limiting factor 0 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. *01#1 *Eff#2 1 0 -25 FILL as 0.0 0.0 2 25-40 10yr3 /3 c1f 10 A lmsbk mfr cs - - - - -- [ 7 .4c .6 40 -54 10yr5 /3 c1d 10yr6/6 sil 2msbk mfr gw - - - - -- .6 .8 3 10yr6/1 4 54 -72 5yr4/6 m2p7.5yr5/6 grsl Om mfr - - -- - - - - -- .2 .6 10yr6/2 Boring El Boring g # X Pit Ground surface elev. 88.70 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -18 FILL as 1vf 0.0 0.0 2 18 -24 10yr3 /3 none sil 2mgr mfr as - - -- -- .6 .8 3 24 -36 5yr4/4 none grsl 2msbk mfr cs - - - - -- . 6 1.0 4 36 -96 7.5yr4/6 none grsl lmsbk mfr - - -- - - - -- .4 .7 Fs-1 Boring # U Boring g E Pit Ground surface elev. 91.90 ft. Depth to limiting factor 98+ 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 -5 10yr3 /3 none sil 2fsbk mfr as 2m, 1f .6 .8 2 5 -13 7.5yr4/6 none sl lmsbk mfi cs 1vf .4 .7 3 13 -98 7.5yr4/4 none grsl Om mfi - - -- - - - --- .2 •6 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS <30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 2648777. SBD -8330 (R07M) Schmitt Sdi Testing, Inc. Property Owner Riedel, Paul & Michele Parcel ID # 032 - 2059 -80 -100 Page 3 of 4 Fil B Z Poring Boring # Pit Ground surface elev. 93.50 ft. Depth to limiting factor 110+ 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 -6 10yr3/3 none I 2mgr mvfr as 2m, if .6 .8 2 6 -18 7.5yr4/6 none sl lmsbk mfr gw lvf .4 .7 3 18-45 7.5yr4/4 none grsl Om mfi cs - - - - -- •2 • 4 45 -110 7.5yr4/6 none grsl Om mfi - - -- - - - --- •2 • ❑ Borin g # F1 Boring E] pit Ground surface elev. ft. Depth to limiting factor 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 F-1 Boring # El Boring El pit Ground surface elev. ft. Depth to limiting factor 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 I *Eff#2 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS <30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. S$D -8330 (R.07 /00) Schmitt Sod Testing, Inc. Page 40f S Conducted by: Conducted For: Schmitt Soil Testing, Inc. Name: Michele Riedel Thomas J. Schmitt, CST 227429 Address: 1547 47th St. 1595 72nd St. City, State, Zip: Somerset, W154025 New Richmond, WI 54017 Phone: 71 - 760 -1978 Address: 1547 47th St. signatum Lot No.: 1 CSM 611670 Date y a ,7 q — �?v�/ Legal Description: NE1 /4 SE1 /4 S17 T30N R19W ■I Backhoe Pit Township, County: Somerset, St. Croix County ♦ Bench Mark 1 El. 100.00' Top of Northern most concrete porch footing A Bench Mark 2 El. 89.3T Top of existing drainfield vent pipe Slope= 7% ** NOTE** The soils in the replacement drainfield area (131, B5, & 136) are 0.2 gpd/sgft soils. With this rate there is about 1/2 of the required area for complete drainfield . replacement. * *OPTIONS" 1. remediate the old system with areobic treatment. 2. add as much drainfield as possible, let the existing drainfield dry out then switch back to the old drainfield after a given amount of time. 3. Add an areobic treatment unit so the new drainfield would receive preteated effluent and install a new drainfield at a 0.6 gpd/sgft rate. bmc tt gyp, 13Y � �►'( ` l6° ` 1.23 (32 f Out B� y` Stiff 0 { O � � �� h� d� , 1 (��� `yattN 4 �' �� i ^4 d�' � :_ 5k�p"N �J -� •� l /•� .. �� :! '�....,.. �`'i'. 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N .E E w ° �j O O N C IV c 04 O E p (m0 F- U d c c Q a- O O O C N N v 4. 3 M • A N O N N O L Z N 4 m E v° Z s a� O CO t y O CO c0 O z N F - v RS . m d a 7 w • s a m .� L: (L a "�1 A 0 a Oin0 1 i 'S' ,` HM/77' X ,.S'II NX N,'X('A V A 7I NG aav T' t - Y die w irrtii Somerset, WI € ylvzd L'e[: TI &64it1-T76t 1'1na: ?16-6%661 September 27, 1999 Mark Triebold 1547 47th St. Somerset, W154025 715- 549 -6308 On September 24, 19991 inspected the septic system at the Mark Triebold residence. 1547 47th St., Somerset, Wisconsin and found it to appear to be functioning properly, 2n no water, no overflow. 1 Donavin L Schmitt 586 Valley View'frail Somerset, WI 54025 MPKS W 221741 I i (D b " N td 3 A r� p rt G I ! t7 I �, n 3 rl rt W � E V W Lo 9 ar p z " u , x �. (D CD 4.1 _ a� Z £ N) I _ 0 3 w c 0 o v 00 M. a l CD + p V W• C fD Z O- to O fD C N cQ ` _ + O I N N a N an d y 0 j N -4 ^ 7 O n V Cr1 I C ( C O 7 O O D) O tj O CD i O <D V ° I I + CD co m y a° CD 00 ON 00 H H I z�u I oN� O ° C D om V C. o co w' Artn o m 0) CD j to o cr rn r-� i V] I n 'a 1 0 T m �• N 0 n Fl* I N : to to to g D rrt r7 v I 0 = to a z W z N i CD O a to CD m c I C CD �p W s O I ° m 7 Z + o A z CA A z c W� mop CL 4 Z I c a) E2 M co a z + I CD a I w � i a D d a a g E3 I c I o z o, 0 I CD CD I n I fi I a I I a I fi A I � I ON I ti O I cz I I A 0 W I O OQ ,cam„ I O 0 ti C�i1 ti PHONE 80 0 - 222 -3400 FAX 800 - 222 -8595 c oo-ei� w oJo K4 4�.,`� WA -lD VOL 1 460PAGE 21 8 EXISTING SEPTIC 6 1L 1L Z3:23 M SYSTEM AFFIDAVIT KATHLEEN H. WALSH Document Number RE CO DEEDS Name & Return Address RECEIVED FOR RECORD Mark Trie St. bold 1547 47 09 -30 -1999 4:00 PM Somerset WI 54025 - AFFIDAVIT �. EXEMPT # CERTT COPY FEE: COPY FEE: 2.00 17.3 0 .19 , 7 3 6 B TRANSFER FEE: Parcel I.D. Number RECORDING FEE: 10.00 032 - 2059 -80 -100 PAGES: 1 Computer Number The existing septic system which serves the dwelling being added on to must be verified by an acceptable soil report or be inspected by a licensed soil tester for compliance with high groundwater and /or bedrock separation requirements as set forth in s. COMM Chapter 83.10 (2) WI. Adm. Code. The results of that inspection must be made available to this office. If the existing septic system meets these minimum requirements, and is properly functioning, an addition may be added to the dwelling without• updating that system. This addition must not, however, encroach upon the required septic system setbacks as setforth in s. COMM 83.10 (1). Property Owner(s) Mark E and Michelle K Triebold Property Mailing Address: 1547 47 S t. Somerset WI 54025 Property Legal Description: Lot # 1 Subdivision VOL- (3 � 16 �T %a _4F_ %4, Sec. 17 , T 3 Q_N -R_1,9_W, Town of Somerset Comments: The existing septic system was sized and installed for a three - bedroom dwelling serving a two- bedroom structure. The structure will be remodeled to have a total of four bedrooms. Donavin Schmitt stated in an inspection report on September 27, 1999, that the septic system was functioning properly. I, as the owner of the above - described property, hereby affirm that the septic system serving this dwelling meets the above referenced state private sewage system codes. I realize that this addition may cause the existing septic system to become undersized for a dwelling of the resulting size, and I will make this information available to any future parties interested in purchasing this property. Signed: Notary Public Subscribed and 36— Q P �51�{ , l r . before ule on this date: Date: 1 y> t,4.)A Zoning Dept/ tment ission expires: Approval: Date: 9 �0'�� / ✓ �,� Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 1 (� /�(' %1C� TOWNSHIP SEC. T N -R W ADDRESS ITT ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /* L - lJ _ f 3 Vic' /� INDICATE NORTH ARROW DEPARTMEN?�OF INDUSTRY SAFETY &BUILDINGS INSPECTION REPORT FOR DIVISION LABOR,& HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS BUREAU OF PLUMBING P.O. BOX 7919 MAOISON 53707 ❑ALTERNATIVE State Plan LD Number CONVENTIONAL ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound INSPECTION DA7E. 1 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER, GJ(/�� Q/yy [�Jyy Mark Triebold Rt. 2, Somerset W1 54025 REF PT. _ELEV CSTHEE PT ELEV BENCH MARK (Permanent reference paint) DESCRIBE IF DIFFERENT FROM PLAN. NE SE, Section 17, T30N —R19W, Town of Somerset 3205 St. r unt/ Croix Sanitary Pe,mn Number MP /MPRSW No.. N,-1 ntPI -111t ' 83790 Donavin Schmitt SEPTIC TANK / HOLDING TANK: OVIDED PROVIDED LIQUID CAPAC ITV. TANK INLET ELEV. TANK OUTLET ELEV. WARNING LABEL LOCKING COV MANUFACTURER / 0 47 10 /�� / Or/ ^ �, �Q 0 YES ONO DYES _ NO ROAD. PROPERTY WELL BUILUING TO FRESH HIGH WATER NUMBER OF J AB INLET BEDDING. VENT DIA. VENT MAT L.. ALARM / / I LINF.� /�' G FEET FROM � f ` S /V / DYES O ` ❑YES ❑NO NEAREST DOSING CHAMBER: PUMP SIPHON MANUE ACTUHE H WARN ING LABEL LOCKI NG COVER LIOUIU CAPACITY PUMP MODEL PROVIDED. PROVIDED MANUFACTURER BEDDING ' ONO ❑YES FIND OYES NO FHTY WELL BUILDIN(; �AINTTo FHFSH E GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. LINE F (DIFFERENCE BETWEEN DYES ONO NE ST PUMPON AND OFF) L ,TH I)IAMETEH MATI HIAL AND MARKING SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth ce plowing FOR or excavation. (If soil can be rolled into a wire, construction sha until ll cease M the soil is dry enough to continue.) uouu) CONVENTIONAL SYSTEM: wst slri aPirs DEPnI WIDTH' LE NO. OF UISTR. PIPE SPACING MATERIAL! PIT BED /TRENCH ND THENCHES DIMENSIONS Q PROPERTY WELL BUILDING VENT TO FHF SII GRAVEL DEPTH FILL UEPTH I)ISTIi PIPE DISTH. PIPE DISTR. PIPE MATERIAL NO. DISTH NUMBER OF LINE../ AIH PIPES SS �L 7 sg BELOW PIPES � aY4 �<�vEH E I Ev I71 I ELEV EN � � V 7 NEAREST O �% MOUND SYST 9 `71 Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. El YES NO PELIMANI NT MAHKI HS nits( HVA IION WI I IS SOIL COVER TEXTURE ❑YES ONO _ F-1 YES LINO — SOODE 1) sEF DE 17 MULCHf O — DEPTH OVER TH[NCH BED DEPTH DVEH TRENCH BEU DEPTH OF TOPSOIL — CENTER EDGES ❑YE ❑ ❑YE ONO ❑YES NO PRESSURIZED DISTRIBUTION SYSTEM: - FILL DEPTH ABOVE COVE H WIDTH LENGTH NOEOCHES. LATERAL SPACING (;RAVEL IJ P H HE LOW PI BED /TRENCH DIMENSIONS TH P UISi RIHUI ION PIPE MnTI IIIAI & NIAHKINI MANIFOLD PUMP MANIFOLD DISTR. PIPE MA IF L MATE HIAL O IPES OIS p�""' DIA ELEV. ELEV. DIA. ELEV ELEVATION AND . DISTRIBUTION PLANS coven MATEHIAL VERTTCAI 1 IFT CORHESPUNUS TO nPPHGVI D HOLE SIZP HOLE SPACING DRILLED CORRECT I.Y INFORMATION - ]Y ES ❑NO DYES ❑NO PR OPERTV WELL BUILDING PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF LINE. COMMENTS: FEET FROM OYES ONO OYES ONO N C11 - "\ Retail ty file for audit. Sketch System on Reverse Side. TITL SIGNATURE DILHR SBD 6710 (R. 01/82) A L11 -HR S ANITARY PERMIT APPLICATION COU TY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # '79z> —Attach —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER PROPERTY LOCATION NA&K OL '/a _ ' /a, S T,�Q , N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER I BLOCK NUMBER SUBDIVISION NAME CITY, STATE ZIP CODE PHONE NUMBER Q CITY �'Q��'�S� NEAREST ROAD, LAKE OR LANDMARK 11. TYPE OF BUILDING OR USE SERVED: ®e441e-- x0j . S05-1?— — 0 Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. XNew b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System • Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. WConventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. X Seepage Bed b. ❑ See a e Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): i Feet j XPrivate ❑ Joint ❑ Public VI. TANK CAPACITY Site in gallons Total # of Mft' Prefab. Con- Steel Fiber- plastic Exper. Manufacturer's Name INFORMATION New xisting Gallons Tanks Concrete stCon- glass App. Tanks Tanks El Septic Tank or Holding Tank �E ❑ ❑ 1:1 Lift Pump Tank/Si h I F-1 ❑ ❑ VII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumb 's Signature: (No Stamps MRnTtLW Business Phone Number: DOAM� e rr - - is y -6Gs/ Plumber's Address (Street, City, State, Zip Code): Name of Designer: Y a Vlll. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST # L= (5O CST's ADDRESS (Street, City, Sfate, Zip Code) Phone Number: T , 3 __ 1�ugs I . — 4 IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee Adverse Determination �Y � � X. COMMENTS /REASONS FOR DISAPPROVAL: I jr SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber 3 APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, ( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property a�C_:B Location of Property � G 1 4 , Section 12 , T N -R W Township Mailing Address R Z2 19 Address of Site R7 I Subdivision Name &A Lot Number Previous Owner of Property CL/ & M/l/ 1 —w Total Size of Parcel y Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume _ and Page Number __.Z,9-3 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING A Warranty Deed which includes a Document number volume and pa&e number and the Seal of the Register of Deeds In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTy OWNER CERTIFICATIO I (We) ce&ti.by that att 4tatement6 on thi,6 6otm ate tAue to the best ob my (out) knowledge; that I (we) am (cute) the owneA (S) o6 the pto pent y da n ib ed in this i pdcu M Erar No. STATE sAE WARRANTY SDEED FOR 1 --1982 THIS SPACE RESERVED FOR RECORDING DATA U bo ` 4 6 PAGE`1.93 RE10 15TERS OFFICE -- — Clinton J. Schilling and ST' CROIX 00 WIS. This De e d , made between -- .-- •-- - - - --- --- --- ---- -- -- -- ----- - -- - --- rkoc fo Record N 3 7t h F. Joy Schilling, his wife - ------------------------------ --- ------ -------------------------- - - - - -- day of JU�A.D. 19 -- ------------------------------------------------------------ - - Grantor, 4 25 - - - -- and - -_. Mark- _E..- _T_r_i-eb—ald__and__Mi chp-le._K,._ Triel old,.- _husband - - - -- and_ wife__ as -- Joinz-_ tenan- ts--------------------------- - - - - -- --------- - - - - -- -- - - - - -- RoC tmr o1 q�od� -------------- ---- - - - - -- -- --- ------ - - - - - -- ------ -- -- -- ..__.�..,�. Grantee, Witnesseth That the said Grantor, for a valuable consideration__ -___ --------------- RETURN TO conveys to Grantee the following described real estate in ---------------------------------- County, State of Wisconsin: Part of NE of SE of Section 17 -30 -19 described as follows: Lot 1 of Certified Survey Map filed June Tag Parcel No: ----------------------------------- 24, 1986 in Volume "6 ", Page 1670. FEE This is not homestead property. 14XX (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; Clinton J. Schilling and F. Joy Schilling, his wife, And -- - - - - -- ----- - - - - -- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and protective covenants or restrictions of record, if any, and will warrant and defend the same. el July - - -- 19 -. - Dated this 86 - ---- --- -• -- -- ------ ---- --- -- - -- day of -- - - - - -- �I - --- -- -- - ----- - 1 ' (SEAL) - U ' --------- •- - -• - -- (SEAL) Clinton J. Schillin * -------------------------------------- -- — . - - - -- (SEAL --- ' ......__(SEAL) F coy chilling * -- --- - -- I AUTHENTICATION ACKNOWLEDGMENT Signatures) __ -_____ STATE OF WISCONSIN ------------------------------------------ - - - - -- - ss. H z ST C- 105 r 9 H SEPTIC TANK MAINTENANCE AGREEMENT z St. Croix County c7 a OWNER /BUYER Fire Number _ ROUTE /BOX NUMBER ZIP .CITY /STATE r)D PROPERTY LOCATION:k� Section, T R - W. Town of O E.PSF , St. Croix County, Subdivision , Lot numbe Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sooner, sists of pumping out the septic tank every three y ou put into if needed, by a licensed septic tank pumper What y the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant, a maximum of 60% of the cost of replacement of a failing sy which was in operation prior to of 1980 + July 1, wit the St. Croix County accepted this program in August their systems u properly that owners of all new systems agree to keep maintained. County Zoning a The property owner agrees to submit to St. Cboia master plumber, certification form, signed by the owner and by P journeyman plumber, restricted plumber or disposal proper fying that (1) the on -site wastewater y if nec operating condition and (2) after inspection and pumping essary), the septic 'tank is less tha oxi /3 full of slud rio tscum. Certification form will be sent app d p H three year expiration. ° z I /WE, the undersigned, have read the above requirements and agree x to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of N atual theoStCeCroixeCountyaZoning o 0ffi ,ce within co 30 days and retur of the three year expiration date. / D SIGNED DATE St. Croix County Zoning Office P.O. Box 98° Hammond, WI 54015 715 - 796 -2239 or 715 - 425 -8363 Sign, date and return to above address. SAFETY &B IL BORINGS AND B UILDINGS DIVISI DEPAR - OF . REPORT ON SO B OX 7 ON • . T INDUST • o". P.O. BOX 7969 LA&0R -r— PERCOLATION TESTS (115 MADISON, WI 53707 HUMAN RELATIONS (H63.090) & Chapter 145.045) �t0 O �/ r ^I-O�Nj: p r y� NSHIP MUNICIP OATS NO.: BLK• NO.: SUB�DI /VISION NAME: f� / V4 / 1 / T -30N/R IqE for R MA� DR S: C NTY: 1" /V /t/ t� UL OWNER S NAME: UY Q C .�f I X �r DATES OBSERV I MADE USE 1 1 A I N ESTS: =R1CJ:, C OMM'1 =R ALD S RIPTION: M ew 1]RePlace Residence / /(f �V RATING: Sa Site suitable for system Um Site unsuitable for system ONVENTI NAL: MOUND: IN -Gf aPRESSU=11§�M FILLhFoLOI NG, ANK: RECOMMEND ED SYSTEM:(opti all s �u $ ❑u ❑u , 10S If Percolation Tests are NOT required DESIGN Ll..dplain, indicate 11..RATE: If any portion of the tested area is in the dplain elevation: under s.1-163.09(51(b), indicate: r PROFILE DESCRIPTIONS BORING TOTAL PTH T R UNDWATER INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, T (SEE ABBRV. ON BACK.) EXTURE, AND DEPTH NUMBER DEPTHi� ELEVATION pgSERVED H TO BED ROCK IF OBSERVED 5�` 8r /� , lo(o/ 5,�.9`�B� S` B- x.18 q,5(o A 7 78 1 r 1.�.� s = /�►'��' 1 1.11 BJ s 1, � • � �'I s l�' •� I N � , . 7 �1 j.S�r'8l 1 / ,'7S' Brl J, 33' Br�l• •7',�rIS�W��r B. g��� q9.11 N I y;� 5.�' •8►' 3.17' 3.b' �r s u'� B- IC01:34 10 Pr B- PERCOLATION TESTS DROP IN WATER LEVEL - INCHES RATE MINUTES TEST DEPTH WATER IN HOLE TEST TIME R PER INCH NUMBER INCHES AFTER SWELLING INTERVAL -MIN. RI 9 1. ? 1 I r •� 1' 3 note D9 I P - y.5� ► n� P- P- P PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location ---111 on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION • 6A ^ t 0 � (� � r � Lam; 1'w AL 15-5 1 YI 61 bt J. t� O lt 4 4� 17 o a d Phones f�l� Lt /oo.� �; a x ` y" G ,4 � e Tf�'� APW or - ��� 9�'• s° , TyP� R 30 _ 3 ( 6 (f 3' 6 IV /� v OG l` �v ° Vtl • �, .,r o� B � ®� i F Vol /000 C-AL -' � SRrPTfc Ti'ti�K /}[,T 8 s �Ar 8 �0 gel �ju5 BS eY U� ffv- pRAw>X6- FdR, 7 7 - ofi,4wfxc- 13y �op?ERsz --r yal5' � - J