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004-1031-70-150
Wisconsin Depart ,'.:ommerce PRIVATE SEWAGE SYSTEM Safety and Buildin n INSPECTION REPORT GENERAL I .~ ATION ~ ~ (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Barnes, Kim & Shane Cad ,Town of CST BM Elev: Insp. BM Elev: BM Description: S. TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 7 ~-. / Dosing >~eratien Holding TANK SETBACK INFORMATION TANK TO ~ ` P~~ W l'+ WELL BLDG. Vent to Air Intake ROAD Septic ~J 1 h U1 1 t ~cJ ~~ , Dosing ~~t ~~ /c ` 7 ! `J ` '- ti A era on Holding ~~~_.,, _._...__. _~ PUMP/SIPHON INFORMATION /'11~ Manufacturer n dtf a~n«~-c~ Demand GPM Model Number. 5~ ~~ Z~ ~ TDH Lifti~'Q~ D Friction ~os~ System Hea 3.3 / TDi~•~~Ft f~ Forcemain Length / Dia. i~ Dist. to Well ~ /GCS Z CAII ARCl1RPT1(1N SVCTFM BED/TRENCH DIMENSIONS Width i ~ Length ~ `~( / V No. Of Trenche PIT DIMENSIONS No. Of Pits Inside Dia. ~" Liquid Depth ~ SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer. ~`- Type Of Sy t : ~ ~~n ~~f ~~f ~ ~ ~ ~ UNIT Model Number. r11CTRIR11Tlf•1N CYSTFM ~ l.,c~L Header/Manifold ~ ;1 ~ / Distribution ~~ ~/ r~ ~ Pi e(s) x Hole Size i/ x Hole Spacin~ Ve~ Ai~take V ~-i ` Z D p g t ~, acin 3 th ~ Dia S L ~ ~~ ~ /`r'te' Length y ia p g eng Cnll rf1VFR ., o.~~~...e c.,~Fe.,,~ n.,~.. .... Mnnnrl nr Af_(;rarlp Svsteme ~nlv Depth Over i Depth Over ~ xx Depth of xx Seeded/Sod ed xx Mulch d Bed/Trench Center ~ ~~ 1 Bed/Trench Edges ` Topsoil ~ ~ • t~'V es jl No _ s L] No ELEVATION DATA STATION BS '. b HI q9.5 FS ELEV. 9s. S Benchmark ~ v o ~R, ~ ~• Alt. BM ,~ Bldg. Sewer lD•3 ~$, 9 SUHt Inlet ~~. b2 ~ ~ . (~ St/Ht Outlet ~ ~_ Dt Inlet Dt Bottom f ~.z ( 85 : O Header/Man. 2.59 9~ . ~r I Dist. Pipe Bot., system 3, 3L} ~f~ ~ ~ w Final Grade I , 5~ ~ 7 q 1I st co~P J Co ~ ~03 T 7 9 f~ . Ca,~- ~r . g q.~s F,~c1.~.. ~~~. Z.`r~ 9~.SS county. St. Croix Sanitary Permit No: 479347 0 State Plan ID No: Parcel Tax No: - 31-~~~ -~5~ Section/Town/Range/Map No: 14.28.15. COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ G~_~ In pection #2: / / Location: 372 320th Street Wil WI 54027 (SE 1/4 NE 1/4 14 T28N R15W) NA Lot 1 50' ' S G~ Parcel No: 14.28.15. 1.) Alt BM Description = ~ ~ GI,•.~, `v,n~ ~ ~s N^,~e~. n n 2.) Bldg sewer length = ~ P~~,,,,) ; E^ ~o..:.n.. S~or~S -amount of cover = / ~ (- ~U~,~ Oft. 9 ~ L~ ( S ~ ~ ~ Plan revision Required? ~ j Yes ` No ~!~ ~ , Use other side for additional information. !_. _Z~ ~'! ~ O - _~ ~__- Date Insepctor•s _~ 3`f ~~ Cert. No. SBD-6710 (R.3/97) Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 SF- ~.(a/ X ,~~~~~~~ Madison, WI 53707 - 7162 Permit Number (to be filled in by CoJ De attmFtilt of Commerce (608) 266-3151 ~ ~ "'7 ~ ~~ ~ LD. NumbCer Sanitary Permit ~1 ~ t ~ ~ /~~ / U 83 d d l ' id ' d i h C Wi C e Tn aooor w t omm m. o e, persona .21, s. A 20 jcet dress (if different than mailing address) may be used for secondary purposes Privacy Lew, s 1 S.0 JU~ ~ ~ ~i '' i I. Application Information -Please Print All Wormation CR ST. O~FI ~ 37 ~~ Z. .~,~o Sr. NING Property Owner's Name Parcel # Lot # 1 Block # r ~- .S ,dE`~'~I,~r~t''r) n3.t!.t./Et _'~e~.dl,:v:. Property Owner's Mailing Address Property Location r( sI ,~/7 Ce. ~I,o. N sE ~/., it/E vS Section _~ d N b Ci S Zi C Ph e one um er ty, tate p o ~S/ o./ b/ 1. SyO.T 7 7/.f 11.1 ' f ~7 T ~ N. R~ . II. Type of Building (check all that apply) D!t w3 ~it.. 'r j ~M,v Subdivision Name CSM Number ~1 or 2 Fatuity Dwelling - Number of Bedrooms .3 / I , ^ Publio/Commeruial -Describe Use ~'~ ~"'~' U / BEity ~ge ownehip of CA,OY ^ State Owned -Describe Use (o X 7 [~ ~t)J (~~, ~ .~.. , ~"' n IIL Type of Permit: (Check only one bo: on line A. Complete line B if applicable) A' New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to F.triating System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T of POWTS stem: Check aU that a 1 ^ Non -Pressurized 1n-Ground Mound >_ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Send Filter ^ Conatntded Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobia Treatment Unit ^ Recirculating Sand Filter ^ Rceir+oulatin Synthetic Media Filter ^ Leaohin Chamber ^ Dri Line ^ Gravel-less Pi ^ Other (explain) ~ V. Dis rsal/Treatment Area Wormation: a ~ ~ ' Design Flow (gpd) Design Soil Application Ra f) Dispersal Area Required (s Dispersal Area Proposed stem Elevation Sy yso /. o yso 75v 5'G8 oq o /l. / a,J 9sSCo./Tiua VI. Tank Wo Capacity in Total Number Manufacture Prefab Site Stcel Fiber Plastic Gallons Gallons of Units Concrete Consttuoted Glass New Existing Tanta Tanks k"~ l Septic or Igo~-.k Od0 O ~ ~/!'S ~t ~onJGA YE ~ Aerobic Treatment Unit Dosirg Chamber 600 ~' Q n ~• / VII. Responsibility Statement- I, the Imderoigned, assume responsibility for imdtllatlon of the t'OWTS shown on the attached plans. Plumber's Name (Print) Plumber' ignature I~/IvIPRS Number Business Phone Numbs Plumber's Address (Street, City, State, Zip ) N .198 Sr. ~r .9,~ urrA~o 6JI .~~ VIII. cure /De arhnent Use Onl Approved ^ Sanitary Permit Fce (includes Groundwater Date Issued Iasuin t Sign ' Surcharge Fce) `/ ~ ~ Op ~ $ ~ D~ ^ ~w< assn al 1 IX. Conditions of Approvsl/Ressons for Disapproval // n . ~ ~~ ~) ~S i tom ~Q i d', a 3 ~ . ~ + C_.o ~K. SYSTEM d1AlNER: 1 Septic dedt eltluent filter and ~ ~~-- . , ~ C tlbpersal Cell must all be ,~rv_~ces Mpef rnenegement plan prowci:-d by pNatltllr. 2 AN ssbsck requirements must ue msNMsk)ed is'psr app1~CM>fe code !ordinances. Attach rnmpkte plans (to the County only) for the system oo paper sot less than 81lS z ii rashes re arse -~ SBD-6398 IR. 01/03) ~~ Q~ ;~ i °~ ~~ ~: =~ __ __ ~- ~ -~ v V ~ ~ !h v ~ ~ ~ i ~ ,r ~ -a ~ •~ , ~ ~ ~ ~ y s ~ • ~, ~ < t O ~, . ~ , t M ~~ ~ M ~ ~ n ~~~ ~ ~ v ~ ~ ~ g i ~ ~ za ~ ~ v ~ ~~ . ~ ~'` v ~ x `ob~ I Q v a q v v w `a 4a ~ v o ~ ~+ ~ 4~ 8~ ~ o ~~ V v ~ V N~ t' T ., L /`~ ~'~ ; 1~ ti ., .: '. t- ~ .,~ ~ i K V e V z S ~~ _ o? ~: o 0 I ~` + ~ ~~ v E~ ~ .~ 0 ~ ~ ~ z ,r ~ ~ ~° ~ ~ ~ ~ O Z ~ V ~ t Q ~~ v a ~ `~ ~° v ~ ~ I iq ~ ~ ~ 3 ~ W v Z V d ~ a v ~ ~ ~ ~ ~ €+ ,. v ~~ ~a~~ ~ ~x x ' ~+ ^oy'` ~1 ~ ~ 1 ti V v v o V ~. i ~~ d ti o ~ ~ ~ ~ ~~ b ~ o ~~ V v a. ~ ~ b N ~ t' 3. s O ,T r ~ h V Q ~:~ v a ~J ~~ ~ _, .. ~ t- ~ .~ ~ i ~ V • V commerce.wi.gov i~ ^ isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. co m m e rce . w i. g o v/s b/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary June 22, 2005 CUST ID No.231346 JOHN PELKE PELKE PLUMBING N6298 ST HWY 25 DURAND WI 54736-8114 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/22/2007 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1149098 SITE: Site [D No. 700407 Shane Barnes Please refer to both identification numbers, 320TH Street above, in all corres ondence with the a enc . Town of Cady, St Croix County SE1/4, NE1/4, S14, T28N, R15W FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1024588 Maintenance required; 450 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. Co3i-d~tio;r No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. ,~ The following conditions shall be met during construction or installation and prior to occupancy or use: DEF TMENT OF C OF EY91 Approval Requirements: l2 ~~ • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORRESPC "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction,' excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat JOHN PELKE Page 2 6/22/2005 • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local ins ectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, /~~ ~ GL ~ ~ ~~~~J ,) Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce. state. wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ ' 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 ~~. ~ eF p Private On-Site Wastewater Treatment System (POWYS) Index and Title Sheet Owner: ~,~//,a.~e- c~.~~.~~'S Project Name and System Type: .~,siv.~E QA,~dES- .,s? ,fir ~l.~,~o !'o~ rs Location: .,~,Td ~°` .Sr Street Address Legal Description ~aw./ of ~AOY .~r, ~,voix 1. Township/County Contents: Page 1: /,,i,o~x ,o.ro ~ ~rLE S~~rr Page 2: G't o r G~'i.~~ Page 3: ~itoss - .~~~ ri...i ,o,~o ~..,~ ~/.~.~ ,f /~,,,,~o Page 4: ~,o~ 1,o re~t,~d L~r„ r Page 5: ~t^PTic ~ „~.~ /~~.,,P ~idoyo~.c C~olf • .~~ ~ r.. ~, Pa a 6: ~/ ~ F,ir.~,.i.rc~ ~urvf 'nl1y g uyr ~~r ,~~ Page 7: ~ps/I"S O,v./rs s ~y,/,/a,~a iyo.~,vtl~rE.~~- ALi~ `~fMERr~ ~~ ~u cs ~, Page 8: ~~ ~~- ~cvc~ Page 9: ~~ ,~ ~~ Attachments: ,.So ~ a ~d.C~a9 rivr ~ES.,, r fig rE.~ /yi~,/ rc.~.~,~<< /.~fe. Plumber/]~esigt~e~~: ~% aiy./ ~''Etc~~ Signed:_ Credential Number: /7i4/1S- .?.T/3yl Date: G-y as G1sEO SlfD - `~ ' J /O L 9/•P /yiu.vD ~o rlPo.vr.~ r / ~ ./a~vG ~` v £~t Jie./ .~ C G1 s~ro = SGO ~ /0 701 -i° ~` ~illls a.r ~ ~is r~ ~aN r..r ~o ~Pa/!.r r /~•~.ra,o c ~~ l~dt ti..r ,7• e PAGE -3 OF 9 D„i,~Ft. E-...~.$_~.e CROSS SECTION- ~OF MOUND F•- .9 Ft. . ~~~ •.. • > • .~ ~ _ • • ~ •SYNTID;TIC COVERING ~ DISTRIBIITION LATERAL -/% %~c. • ..rrrr- c-ss • .. MEDIZTM •SAPID H• G TOP SOIL ~ Y. ~ ~I,F'V. ~L,/'o./ S~ / 3 E D . 9,f S ~ oar ra•~• CELL of z 22" BggCeg2.t RORCE MAIN PL04ffIED LAYER d-3 ~ Slope ~. 6 !~ ~~~.~. ;7~" f-oc . ~ 9~ ~ 1.. L A-_(~Ft.' ..1~ Y-~_Ft. C , J 7B ~ FORCE HAIti -.? ~/°/~- • K J-_f _Ft • ~ r .•~. .r r .. .~ .r .r ~~.~ ~i K=_~Ft . x .. t-t-_,~o Ft. ~ ` A ~ I'p'~~f' r~~~ C~~Observation a0 t7 ~. _. _. ._, x YiPe Observatioa Pipe .._. Distribution Pipes = /~ "' ~~c.'~ DELL of ~-2•f" aggregate ~ l X78' 8 z p~'r UAI~NANlO L/T!/C~LS PLAN VIEFI OF 1-fOUNU HOLE DIAMETER-~Yn. LATERAL. " - ,~In. t4ANIFOLD -~~In. FORCE 2~SAItT " =~,In. P-~8 Ft. S- 3 Ft. X _~F t . Y ~_Ft. PIPE I:ATERAL LAYOUT ~~ ~P J"u.t a/r0 ~ ~f Te'.C .I c. G1f C/.~•ca-.~icra .QLaG . ~c/~ / ~~~dL SLlrve' PAG& y OF. 9 ;~ ~ ~~ P-38 /ya~rs : Loc.~ra~o E'vrNcr CN Qa1'foM J ~% /~ Ne«s~,~r~itAt K yL,trt, s y4 ~ot~s ,c . dG~/~~,sU~r~ _ .?<, i~ sr~.s/i,-w. Csrsrrry flow .~C.rr~~ DPI ' JD L,RS s . ~ /!.a!/~yu.~r ~Oes! dst . ~P~' /,~v~.~ r ~s rr. = 96.7 ~ Pale S Of 9 SEPTIC TANK E'PUt•SP CHAMBER CROSS SECTION AND SPECIFICATIONS ..t Scx. t'v. 4" CI VENT PIPE 12" MIN. A$OVE GRADE ~ WEATHERPROOF ?' /p~ FROM DOOR, WINDOW OR JU~JCTION 80X APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVERS W / PADLOCK E fivisvco ~~ WARNING LABEL b ~A,oe~' ~ ~ y ,cE~.,~ ~,~.~~ • +~_ 4 " MIN . 18" IN. ~"~ ~~l ,~ ~ INLET i- ~ ~~~ WATER TIGHT SEALS GAS- ~ ~ Zg6EC. .~ TIGHT i ~` /APPROVED Fic rE~ p SEAL ___~___ ~ JOINTS WITH APPROVED A-/oo ~ ~ ALM APPROVED PIPE PIPE 3' --~- i ON 3' ONTO Ott70 SOLID ~ C ~ . SOLID SOIL SOIL' PUMP OFF ELEV . 83.E FT . -~- I OFF •'~'Y RISER EXIT • D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TAN1< CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TP.NK MANUFACTURER: ~/~E',~t-,c Lo,,JC.~rrl N'JM$ER DOSES PER DAY : „S ~/8, !~?o~ TANK SIZES: SEPTIC /ooo GAL. DOSE VOLUME INCLUDING 8,?'9 f.?l.3 DOSE Loo GAL.. • FLOW$ACK: /d9..Z .GAL. ALARM MANUFACTURER: „T pp~y,~as CAPACITIES: A a ~ INCHES = 3.~'`• GAL. ` MODEL NUMBER: `",,,,C r S' SWITCH TYPE: _ /'yd~t~asr_ /~. 8 sacs. $ = 2 INCHES = r33. ~ GAL . PUMP MANUFACTURER: ./f/1'pAon~ric. ~~~ f C = ~ C. ~ I?JCHES = /G9Z GAL. MODEL NUMBER: .S~/So SWITCH TYPE: _ ~y~-,~ou,,y D = 7.S' INCHES = ,~! o GAL. REQUIRED DISCHARGE RATE ,~l s/ GPM PUMP E ALARM WIRING AS PER ILHR 16:23 WAC ~VERTYCAL DIFFERENCE $ETWEEN PUMP OFF AND DISTRI$UTION PIPE /~~ .FEET + MINIMUM NETWORK SUPPLY PRESSURE ,~ 3 FEET + /~o ~ FEET FORCEMAIN 'X /.S FT/100 FT. FRICTION FACTOR 1• y , FEET TOTAL DYNAMIC HEAD = /8.8 FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH S.T" ; WIDTH_ 78 •, ; D+I~AME-T-E•R --- LIQUID ETA- 3! ~~ ~. G a~ 9 ~_ r „`Mr r' -.-rr ~ir...- 1••..._ SD33 Typical Application' 1 Sump/Effluent pump _ (opacities SWJSDNS33 - to 48 GPM -3.0 I/s) Heads SW/SDNS33 - to 26 h. (7.9 m) Electrical SW/SDNS33 - 115V,1e,10.0 FLA, 60 Hz Motor SW/SD/VS33 - 1/3 HP shaded pole w/thermal overload 1550 RPM Minimum Recommended SDNS33 =12" {304.8 mml Sump Diameter SW33 =16"(457 mm) Automatic Operation SW =Wide-angle Float switch (manual available) SD =Diaphragm pressure switch VS =Vertical Float switch _ __ Maieriols of Construction _ (ast iron and engineered thermoplastic _ __ _ Impeller Thermoplastic vortex _ _ _ Discharge Size ___ _ _ __ 1-1/2" NPT (38.1 mm) ____ Solids Handling 3/8" (12.8 mml Power Lord - __-- _____ 10' , S1TW,(20' optional) -p Su erior Features - --- • Carbon/Ceramic mechanical seal • Oi{-filled motor w/automatic reset thermal overload • Uses single row ball bearing construciian • Piggyback plug available for easy maintenance and replacement 9 -- 30 6--~20 w a ~ x 3--t'-10 0'- 0 (apaciry-U.S. G.P.M.O liter/Second 0 ~~ YJ33 1 1 _Typical Application" Sump/EfNueni pump _ (opacities SW/SD/VSSO - to 44 GPM (2.8 I/s) _ Heads SW/SD/VS50 - to 24 fi. (7.3 m) Electrical SW/SONS50 - 115Y, le, 8.0 FIA, 60 Hz Motor SW/SDNS50 -1/2 HP shaded pole w/thermal overload 1550 RPM Minimum Recommended Sump Diameter SDNS50 =12" (304.8 mm} SW50 =16" (457 mm) Automatic Operation (manual available) SW =Wide-angle float SD =Diaphragm pressure switches VS =Vertical float switch _ Materials of (onstruction __ Cost iron and engineered thermoplastic __ Impeller Thermoplastic Iwo vane semiopen ___ __ Discharge Size _ 1-1/2" NPT(38.1 mm) __ Solids Candling 3/4" {12.8 mm} _ _ J Power Cord 10', S1TW,(20' optional) _ Superior Features ______ • Carbon/(eramic mechanical seal • Oil-filled motor w/automatic reset thermal overload • Uses single row ball bearing construction • Piggyback plug available for easy maintenance qnd replacement 40 30 ~ 20 10 10 20 30 40 50 0 10 20 30 40 50 60 70 ---~ --- _ __ ---2 - ---- - _ _ _ _ a GPM Q`~~~back Switch'0i G9 J~ ' POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION Owner ,~ ,~ ,t,/~s Permit # DESIGN PARAMETERS Number of Bedrooms 100 droom 3 ^ NA Number of Commercial Units -" NA Estimated flow (aerage)* Oo al/da Design flow (peak), estimated x 1.5* ,so al/da Soil Application Rate /, O al/da ft Influent/Elfluent Quality (NA^) Monthly Average** Fats. Oil & Grease (FOG) < 30 mg/L Biochemical Oxygen Demand (HODS) < 220 mg/L Total Suspended Solids (TSS) 5 250 m Pretreated Effluent Quality ^ Monthly Average*** Biochemical Oxygen Demand (HODS) < 30 mg/L Total Suspended Solids (TSS) ~ 30 mg/L Fecal Coliform (geometric mean) <10 cfu/100m1 Maximum Effluent Particle Size 1/8 inch diameter * Wastewater Flow Verification and Calculations: (Other than bedroom based) ** Values typical for domestic (non-commercial wastewater and septic tank effluent. ***Values icalfor retreated wastewater. SYSTEM SPECIFICATIONS Se tic Tank Ca ci /000 ] ^ NA Se tic Tank Manufacturer L/ ,~ ^ NA Effluent Filter Manufactwer ZA6EL ^ NA Effluent Filter Model /oo ^ NA Pum Tank Ca ci !O d 1 ^ NA Pum Tank Manufactwer L,/i~- ~,c. ^ NA Pum Manufactwer rim ^ NA Pum Model s/ So ^ NA Pretreatment Unit ANA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufactwer: Model: Dispersal Cell(s) ^ In-ground (gravity) ^ In-ground (pressurized) ^ At-grade ~ Mound t~ Dri line ^ Omer: ^ Leaching Chamber Manufactwer Model Laying Length/Chamber Soil Application Rate_gpd/ft2 Area Req. Infiltrative Surface/Chamber-ESIA Rating ftZ Minimum Number of Chambers n Flow/Loading Rate= ate Desi re A ft min g g ^ gg Materials: all materials must comply with WI Adm. Code COMM84 and be installed per manufactwers specifications and a royal letters. DESIGN CRITERIA ^ "Wisconsin At-grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.a1.1990) ^ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ^ "Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publications 9.6 ^ "Design of Conventional Soil Absorption Trenches and Beds". R.J. Otis - ASAE Publications 5-77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems". EPA 625/1-80-012 October 1980 ^ SBD - 10570-P (8.6/99) "At-Grade Component Manual Using Pressure Distribution" ^SBD -10567-P (8.6/99) "In Ground Absorption Component Manual" ^SBD - 10705 P (N.O1/O1) "In Ground Soil Absorption Component Manual" Version 2.0 ^ SBD - 10628-P (N.6/99) "Recirculating Sand Filter System Component Manual" ^ SBD - 10656-P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ^ SB?.? - 10572-P (R.6/99) "Mound Component Manual" 'SBD -10691-P (N.O1/01) "Mound Component Manual" Version'l.0 ^ SBD - 10595-P (8.6/99) "Single Pass Sand Filter Component Manual" ^ SBD - 10657-P (8.6/99) "Drip-line Effluent Disposal Component Manual" ^SBD - 10573-P (R 6/99) "Presswe Distribution Component Manual" SBD - 10706-P (N.O1/O1) "Pressure Distribution Component Manual" Version 2.0 ^ Drip-line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT t~ltiiTTiii ~ MAIN"I'1~:NAN(;E MV1V11VK11`Ilr a~,n~L~ Lr. Service Fre uenc Service Event Ins ct condition of tank(s) At least once eve ^ months 3 ear(s) (Maximum 3 rs.) Pum out contents of tank(s) When combined slud a and scum oafs one-third (1/3) of tank volume Ins ct dis rsal cell(s) At least once eve ^ months ,3 ear(s) (Maximum 3 rs.) Clean effluent filter At least once eve months ^ ear(s) um controls & alarm Ins ct um At least once eve ^ months 3 ear(s) ^ NA , Flush laterals and ressure test At least once eve ^ months 3 ear(s) ^ NA NA Valves At least once eve ^ months ^ ear(s) ^ Other: At least once eve ^ months ^ ear(s) ^ NA Pace 7 of 9 START UP For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation ofwater-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. ^ Valves Valves shall be operated in the following manner: Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. INSPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Septic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one-third (1/3) 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 NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of any filters. Any service needs or repairs shall be promptly taken care of. ^ In-Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage 'or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page$of 9 START UP ' For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemipals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by.a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation ofwater-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. ^ Valves Valves shall be operated in the following manner: Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service 1?OWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). (~ Septic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one-third (1/3) 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 NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. (Pump Chamber/Treatment Tanks Component The inspection must include. a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of any filters. Any service needs or repairs shall be promptly taken care of. ^ In-Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any ' evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page~of 9 Mound, At-Gracie, In-Ground•Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of all tardcs arTd pits shat. be rei;.oved <~d pro?r:y disposed of by u Sept«gc Servicing Gp.•rator. - After pumping,. all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and 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 from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATIi MAY RESULT. RESCUE OF A PERjOiY FROi+ii TIIE I:'v'TERZO OF A TANK 1Vs AY BF DIFFICTJLT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ,]-oN~/ Ec~rE /'1i°RS-.?3i3yL Phone ,/..,5' 7.? -,S",lQL SEPTAGE SERVICING OPERATOR (Pum er)-C/„~,e•„iea.~ Name Phone POWTS MAINTAINER Name -J aN./ Kd' f'~•~•rE d'La Phone 7/s"" 7.?- .~6G LOCAL REGULATORY AUTHORITY A enc T' oix i•/~ fFie Phone 7/S' 386 - 80 K:\WPDATA\EII\POWTS OWNER'S MANUAL.dce Page 9 Of The interval for servicing septic tanks is set by state and local code. Throughout the United States there is a wide difference of opinion on what this interval should be, but most regulatory agencies suggest two to five years. The Zabel"' filter, which does not increase the frequency of servicing for the tank, should be cleaned when the septic tank is normally inspected and pumped. However, our filter is virtually self-cleaning. The continued action of the anaerobic organisms on the Zabel filter causes lodged particles to disintegrate and fall to the bottom of the tank. !f your filter contains a SmartFilter"' alarm, you will be notified by an alarm when the filter needs servicing. Remove the tank and pump the ~ necessary to pr any Solid: escaping to the when the f~ Firmly pull the and slide the c 'Note: A tee handle ma to be used it the /filter Is below ground level to Contact Zabel /or inlo handles ,~~ ~- While holding the c~rtridg~ ov~Y ~,. i, ~,, t ;. the access opertitl~ I'~~Q"b x .`~' ~`~ Insert the filter ~>~ff~(d~Q~ cartridge with fr~3tl~r , ~i~ r back in the.. ~ ;i~x' ~lkl" careful to nnse all ~`8 ~ ~ ~ s sure the fill b proper) •Nore: n is nor neces completely i 'spotless'. The bioma , aides in the prefreatme be left on the h7fer. (ll n maybe disass 6 ,'' Replace t .,, . _ , ~. ~~~~ /.Vi MADE IN USA The product(s) shown are covered by one or more al the lollowing patents: U.S. 5,762,793, 5,580,453, 5,591,331, 5,759,393, 5,683;577, 5,562,716, 5,779,896, 5,593,584,5,795,472,5,736,035, 4,710,295, 5,382,357, 5.482,621 U.S. Des. 386,241, 349067, 4605501,5098568, Des. 309007, Australia: 134440; C2nada: 2,135,937; Israel: 111574; New Zealand: 264824, Other Patents Pending Call for a free ZABEL ZONE An Onsite Wastewater Magazine 1-800-22y -5742 • Website http://www.zabel.com To service the filter: 'Servicing any zabel filter should only be done by a certified septic tank pumper or installer. Locate the outlet of the septic tank. ~~~ ~~ ~. Wisconsin Department of CommeTL11 V~ SOIL EVALUATIO ORT Page / of .~ Divisbn df Safety and Buildings L ~ in accor~, it Com .. Attach complete site plan on paper not less than 81/2 x 11 nches in size. Plan must `~ y' CnO/X include, but not limited to: vertical and horizontal reference oint (BMj,~c} xer~oq a paw( l,p, percent slope, scale or dimensions, north arrow, and locati and dj~}~r1ce a road. ~ Please print all informatio S~ CRQ-X~,OLIN~,y. eviewed Date Personal information you provide maybe used for secondary purpo s (PrivaCP~(1~.115.e~a ~ ~ f7 Property Owner / Property location ~,~;+, ~3 moo' R./ES . ~ .sue or,~ ~uTt Govt. Lot S 1/4~r' 1/4 S /yl a $ N R /S ~(orJ1v~v Property Owners Mailing Address Lot # Block # 9tlbd:-Pler~e or CSM# Cily State Zip Code Phone Number [~-Gity ~ViNege ®Town Nearest Road L/lLso./ 6,JI o 7 ( S) 7.?- y87 ~ 3,7o-~.Sr. New Construction User Residential / Number of bedrooms -3 Code derived design flow rate S/Sd GPD ^ Replacement ^ Public or commercial -Describe: Parent material LaESS a uea 4oArtY Tiac a ~lnc .fS ~Q Fklod Plain elevation if applicable dt/R ft• General commer>ts ~ ~ ~~~ and recommendations: ouu0 fw,aJ f'S , ,j S,o.~o ciGY~G , aP6./ /f/,~Y f/`/Qi ~E-LO.y,~,F./D .Srs. E'i. - 96. / o./ 9sS ~ co.~ rouQ / ~ Boring , ~~ Boring # ® pit Ground surface elev. 9s..s- ft. Depth to limiting factor .3a? in. Soil lication Rate H i th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft~ or zon p in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. •Eff#1 'Efi#2 / a R 2 -' 6 s. s o7 r r/v ~'^ 3 6- l 7.SY~t - /Yd,1 r7 .~ /l ~~~ u - >f o so Fr alE•vKL Y ,~rco S l~v~o i~ 02 Boring # ~ Bonng ® Pit Ground surface elev. ~3!S ft. Depth to limiting factor 3d in. ' „ Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eft#1 'EfHl2 L i. Z -zo y .sal ~ ~ cu v~=~ .8 a 20-a° src ~ - / s6 ~ c.J - io 3O ~ D Q 7 A.CLY Ll f./TIO SS ! ocK ' tTrlUerH $l = tSVU ~ JU ~ LN Rlg/L ana A c lau rr191L uiiuc~ n n~ - wv - .. y.~ o~... _ ...y.~ CST~Nyame (Please Print) ig r CST Number // E /~ Cy`T Address //jj Date Evaluation Conducted Telephone Number /~0 3 ~u~.~r .fir.. .~,vu ~i.oirr !/..r S'1~'JJ~/ s -,70 -aS S 83 - 8~io Property Owner S/i/A~/E' ~.>'.o./~S Parcel ID # / Page o? of 3 ^ .3 Boring # ^ Boring u / ®' pit Ground surface elev. 9S. D ft, Depth to limiting factor ' ~ _ in. Soil A lication Rate H i th D Dominant Color Redox Descrpton Texture Structure Consistence Boundary Roots GP D/fP zon or ep in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. •Eff#1 •Eff#2 L!. Z d -,t O Y 3 -- / Z /Y s /~ L 3 .t3 - yo . S a / .~ s r, ~ - 1. D 5/ o -s6 , s S'YR S 6 irE.rr a ~ c tJ - . -7 s f a 7 y o<r .~ SS o,oocic Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. •Ef~1 'Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit SoU lication Rate Horizon Depth Dominant Color Redox Descrptbn Texture Structure Consistence Boundary Roots GPD/ft' in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =BODE < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. . SBD-8730 (R07/00) .. ~~: Property Owner -~ A~/d /~.~Aw/!S Ban;ei ID # / Page ~ of 3 -3 ^ Boring U Boring # ~ Pit Ground surface elev. 9S: ~ ft. Depth to limiting factor~_ in. Soil Ikation Rate Horizon Depth Dominant Color Redox Description Texture 'Structure Consistence Boundary Roots GPD/fF in. ` Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. •EffAk1 •EfNF2 ~ ~ o o Yit 3/L di / .a ~ ~v ~' AS v~= ~. G . 8 2 0 -.t 0 3 - / 2 s ~ t ~3 .f3-too .S a ? s ri ~ - 1.0 o -sG S'YR ~r~~~r s ~ c _ . 7 t O 'y i~' .~T SS AocK Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Sod licatlon Rate Horizon Depth Dominant Color Redox Descriptbn Texture Structure Consistence Boundary Roots GPD/fP in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. $h. •Ef1#1 •Eff#2 a Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Descripton Texture Structure Consistence Boundary Roots GP D/ft' in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 •Efi#2 • Efduerd #1 = BOD` > 30 < 220 mgll and TSS >30 < 150 mg/L • Eftiuent #2 =BODE < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. . SBD-83)0 (R07100) ~- t 3 • e I~ ~ ~ a ~ I a a h ~ 1 ~, o ~ ~ ~ y~ ~• A a a M N . . o a I _ ~ ~ ~ _•-I __ o ~ a --~~ o ~= ~~ a e eQ ~ ~ ~o` . ~ a ~ A lT ` ~ ~ ~ ~ ~ ,N ~ ~ Z ~ e ~ ® e t,, F R1 ~ \ ~ 2' O l - V ~_,\ ~ -, ~v~ a L J ~~ ~C O A W ;' ~ a ~ ~ ~ ~ w '~- ~ O ~ ~ a .o a h ~ M ~ a '~ _~ i A ~~ ~ Or ~ ~ ~ O ~ °a a o e w Sa A ~` o~ r~ ,~ ~ 1 " ~ - - - -~ l ~ A ~ O ~ a t ~ 1 t ~ t q ~ * A'1 ~ _~ _ .+1 -- ~ ~ ~ r ~ ~y ~ t ~ N C1 ~ .x ~ •• C C7 ;U C+9 ~ N I -c w O O ~ H O y .. H I °z I` IN \ ~ r ry a o a ~~ o ~ 2 ~ ~ o ~ a ~ ? !~ ~ 9 ~~ ~ ; o ` 2, A 5 ~ q v ~ o n , a ~ ~ ~ ] i 1 ~ ~ ~ , 0 v I ~ p I~ LV 0 (~ ro 0 r z sr c~zo~ cocmrrY SEPTIC TANK MAIIr''TBNANCE AGREEMENT AND ~~'VNERSHIP CERTIFICATION FORM Ownser/Buyer h` ~-~ ~ Y ~ ~ ~C~Y Y~ Q Mailing Address E S ~ ~ ~ ~~ P e. ~' ~`~ ~ ~.no rno n - t W Proptxiy Address u~5 l (Verification required from planning Departeat for new G~tyOState; ~ ~ ~ ~ ~ ~ Parcel Identtfiieation Number ~`~l~ ~ 03 ~ -1 ~ ` GS O LEGAL~FSCRIPTION Pmpaty Location S~ %., N~ '!., Sec. ~ T~N R,~W, Town of L~„_' ,,r~ Sub3ivisioa Lot # ,~ Gerdiled Survey Map # ~ ~~~ J .Volume o O Page # 500 "~ . w,trrstnty Deed # ~ ~ a a volume . .Page # Spoe house O yes (~ no I,,ot lines identifiable ~ yes ~ na SYSTEM MAINTENANCE Improper »se sad maiateoanceof your septic systetttcould result in its pt~emature failure to handle wastes. Proper maintenance consists of pumping .out the septic tank every tlu+ee years or sooner, if needed by a licoased pumper. Whst you put i4to the system can afr'oCt the Rtnctioa of the septic tssik as a tr+eatmcut stake is the anste disposal system, The property owner agrees to submit to St. Croix 7,octiag Dtpartmeat a certification form, sigaod by tine owner sad by a ~pl~,l~P~~.nsaictvdplsYmboc sae a lieeasedpa~mperveritSring that(1) the on-site wastewaterdispasal system is in proper operating condition sad/or {~) aRet inspection sad pumping (if necessary), the septic tank is lees than 113 full of stodge. i/wt, the nadeasigaed have read the above requirements and a~+ce to Main the private sewage disposal system with the standards sett forth, honi~ os set by the Department of Commerce sad the Departtasxit of Natura3 ResoutGOS; State of WrSCOttsin. Cectcfication sdttiag drat your septic system has bees tnaintaiued must be completed and returned to the St. Croix Coaaty Zoning Otfrce a-ithin 30 days of dre tbr+oe year expiration date. SI(II+TATIJR$ OF APPLICANT DA'I~3 OWNEIZ _CERTIFICATION I (we) certify that all statemients on this fozm ors; true to the best of my (our) knowledge. I (we) am (are) the oamer(s) of the property desctt'bed above, by virtue of a warttmty deed recorded in Resistor of boeds Offrce. f r -~ SIGNATIJRS OP APPLICANT DATE seers: pay information dssi is role-reprs:seated may result is the sanitary permit being mvokcd by the Zoning DeparW~nt. "`"`*~ ss Lrctude whir this appilat;on; a stamped warranty deed frees the Register of Deeds office a copy of the wed etstwey snap if resferdn~oe is made >n flee warranty des;d 799~rr3 von 20 Paae soo? KATHGECR K. RE'1iISTER OF OE6dS aocai~xa~' fisrarioaa ~i~izaes i::sraa CERTIFIED SURYBY NAP - COPT FEE ~ ~. N c~RTrFr~~ suRv~y M1~~= z LQCA rED jN T ~ S~.1 CRO COUNr1's V1SC~NSII~ T28N, ~ ST R15V, p . CAl? Y PR~'PARED FQR~ R[]8£RT BtJTI_£R NvRr,#asT ceRNE~a - sic rtnN 1 ~. oF CFOUWD A1.UYMINUM Cam) VQL-41.M~..~ 7 .G~ S.,l'1~.. ~ I~p rr TE~ BEARINGS w-?f REFERENCED L u T 4 TNC EAST LINE DF' THE NE lea ~' . 4 ~ I a TO OF SEC r1pN P4. ~asswKED). pq~~,,,4,5.6.1.. ; ^' __ ~~$ NORTFI. LINE OF THE SE- Nf ~n I N 89'S2'02'E 583.00' 33' 33' - ~ ~ 530. DO' 33.00 REC. AS N89'2Tt9'E ~; ~ ~, ~ G ' w' ~ ' ~ ti = 1 DO ~ E S~P~ l s~ 5t OT 1 ~ ~ ti ~ ~ ~~ ~ I ~ , 3 DO ACRES } FT ~ 672 SO 130 , ~ h :. ' b b . . , 2.93 AC. EXC. R/W ~: a°~` w ~ : d r- ~ hd 123,275 50. FT. ~; a' 100' ;: of ~ : Q~ q H ~ _ r y y a 33.00' y ssa.oo' ~ : s 8q•52~o2~w 583.oa~ 33. 3s'~ '" ~~ ? ,ANDS , UNPLA T TED ~ ~ ~ , ....... ......... Y7 4 ~p~ ~ ~ o:$ ~ ~~ f z o $1 EAST 1/~ CORNER OF SEC TI+QN I ~. ~, Y AIL) N CFOUND SURVE # LEGEND o - SET t' O.D. X 18' IRON PIPE WEIGHING 1.l3 CBS PER L.rNr=AR FOOT. B = GOVERNMENT CQRNCR AS NpTE11. O : j - IRON PD°E FOUND. 1' = I00' o so '°" zoo SHE£ T 1 OF 2 200503:! /HIS INSTRUMENT pRAFTED BY J!M VEBER Vol 20 Page 5007 Z d ~~bl.~GB£~9 "~tv/4E~~~1 '1S/lb~9l 900c it l(1~(NO~~} ~l-LAEB M. IIVR~JR JAME3+'M, 1~7~A7rr=180 " LANAMARK SURVEYING. INC• DATED woa~ CER TIFIE~ SUR VE' Y MAP I.~DCA TED IN TFiE SE d/4 Oi- 7'NE ~ I/4 OF SECTlplV 14, r26lY, R15V, rpVN DF' CAD1', ST.CROix CpuNrr, VISCpNSlI~R DESCRIPTION A pared of Isnd located in the SE'/a of the NE'h of Section l4, T28N, R} SW, Town of Cady, St.Croix Courny, Wisconsin, more fully described as Anllows: Commencing at the NE cot'rxs' of Section l 4, T25N, Ai 5 W: Thence $00°29'09"W along the East line ofthe NP '/., 1317.80' to tha nottheau corner ofthe SE'/a of the NE '/+ of said 6ection 14, said point also being the POINT OF B1~GII~iIYING: Thence continuing SOO°29' 12"W along said line 224,1 S'; Thence 589"52'02"W 5$3.00'; Thence NQO°29'09"E 224, l5' to a point on the north line of the SE '/~ of the NE'/. of said 5eCtiort l4; Thcnts N89°32'02"E 553.00' to the point of beginning. Contains 3.00 acres subject to 320's Street eight-of--way and any and all lldditional eastmenis, tipltt- of ways or conveyances of record. ;SURVEY RQ 'S CERT ICA'I'E 1, lames M. Weber, registered land surveyor, hereby certil~+: That is full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the SI.Croix Couerty SubdiYision Ordinat-cs and under the direction of RobeK Butler, L tu-ve surveyed and mapped the hereon described patter of land and that this map is a correct representation of the boundary thereof. s. ~..~ Dated this o~G ~' day of /7'1 2005. ~_ V\~ - b3 James M. weber S-1 B04 Landmark Surveying, Inc. NOTE: The parcel shown on this map es subject to State, County and Town laws. rules and regulations. (i.e. wetlands, minimum lot si:.e, access to parcel, rte.). Before purchasing or developing any parcel, wntact tl-e St.Croix County Zoning Office sad the Town. of Cady for aavice. APPR~IIED JUN 3 0 2005 N nsc raoora.u wi+w au em a ~e,~w a...ow~~ °rrs e. Sheet 2 of 2 pus and van 2005033 Tbie instrument dtaRed by Jim Weber Vol 20 Page SOU7 E d 8~b~z~;8E£9 'C~f~i~8 ~ 5 l '1S/?tr ~ ~ ~ GO~~~ ~ G 1(l~ (NOUJ) 6~4a~ 07118x'2005 10:45 FAb 715 292 6920 WESTCONSIN CU U 2835P 017 .~ STATE BAR OF WISCONSIN FORM I - 1998 !~ WARRANTY DEED . i. 17octanenl Number This Deed, made between e t+-~'~ ! _ ", Grantor. ! and ':`,j,P.rl.t n~S __.._.,r !_ , ___ Grantees Grantor, for a valuable consldara[lon, conveys to Grantee l}se following ! described teal estate M S~• Coo ~ ~' Coun[y, Stace of Wlsconsln r (the "Property ); Ii..IU:orOing urea GS-t~ ,E.;Q, ~. f - - ~1 Nrna aM FNlun Addrm ~o~t)f-~e. 070~~ Pc~g~~oo?..t .~~' ..~ ~es- i ,~ ~ ~a c3 "Deg ~ - - ~--- f-.ocm~'~d. ~n r1r-~ S~. !Iy err the. N ~ ~ /„~;)s~n~ r~ `Sy°~~ ,. '/~ of 5~ck;on {~F~ ! feu, R~S~' '~ --- _ .. _....-- ~~qwn of C0.dy ~ ST, CroiX CA~~fi~f, l~ e $C~r1Sth. Together wkh all appudenent duets. title and !n[eresn. ~l 002 799222 tATRLfiEA H. YALSH REGISTER OF DEEDS ST. CRGIX CD.. MI Rscslvm FOR RECDkA O'7/O5/2N3 •19:00,11 V1 EI PYT t ~ RFC FEE: 11.00 TRAITS FEE: 9.00 CDPY FEE: CC FEE: PAGES: 1 Do y-L,z~lf - 7D - nso Parcel IdonlNeatbn N~rtber (PtM This e ~ homesctad property. (is) (ls not} Grantor warrants lhaC the title to the Property It good. Indefeasible in fee simple and free and clear of encumbrances except Dated this ~~ day of ~t^~~/ ~ UOS , LL~~ (SEAL) AUTHENTICATION Signuute(s) (SEAL) wtleentinted tAb day of ~ - TITLE: MEMBER STATE BAR OF WLSCONSIN Ql not, suthonzed by §706.06. Wis. Sptx.) TlilS INSTAUMEN7 WAS ONA~TFO BY _,,, f t. 0 6 er'g' .S ~ $ ~-~ ~ ea' (SEAL) ACXNOWLEDGMENT (SEAL) Scats oC Wisconsin, ~~ t:. ~ ~/ ~; `-~ t:ountlt ~ t1 Personally ame helots me thts _ day of ~ des above named -- i i A _ J ~ ~/ _ _ i'` eo i~ nsc known to be the person who aXfCuted the [t,regoing i 1tr+trumerl[ and acknowledge the same, i I, Notary Public, Sate of Wisconsin i My commission b permanent. (If not, slate txp_r~o~: I (Signatures may be authenticated or acknowledged. i}orh are noc .' necusary.) Nartr oI pecnty flyNng In any WpJCIq muv !K ~ypld > Aimed below eAev sianauue. STATB BAR OP WISCONSIN ~. WARRAN?Y DEED PORaI No. 1 - 1996 wsaonsln lwpal 9Wac CO., a1E. MMiauYN. WK. O C ~ tD ~ r..-+ O Q _ ~ ~ 'G ~-- ~ ~ ~ N ~' . '~ O cv ~.- Z 0 0 ~ ~ ~ ~ Z N a ~ ~ ~ ~ ~ ~ ~ ~ ~ c~ i .- ~. 0 z~._a. ~ ~ 8~bL~8SS9 'CPd/~S ~ 9 l '1S/£b ~ 5 l 90Cc l l lfl ~ {N 04^!) 1~0a8 FRGhi ~~ ~~ ~~ii ~s9 ('+1GU) J l)L 1 1 ?005 13: 14%ST. 13 :12/N0. 633E~27742E P 3 - n ~~ ~ 00 Ee Q ~ a N M444111 ~~~ w O ~~` ~~i N ~ 0 N ~ Q ~ ~ ~ i~ ~ 0 ~ ~ ~ _ ~°° o o o ~ W o Q o 0 ~ ~ ~ ~ Y~ .~,~ ~_ ~~>~ ,o-.a W h~ t Q M ~F V ~~ ~~ ~~ V~ ~.. ~~ 00.. ~~ ~,,, f~ ~~ ~ ~d i ~~ ~~ ~~ u~ .~. ~y ~ ~~ r-~ L+, ~~ M e ~ ~~ ~~ r f~ Q A d Wisconsin Department of Commerce f)ivi~inn nt Rafofv and Buildings SOIL EVALUATION REPORT Page _~ of .3 In accordance With Gomm Sb, WIS. AOm. l.OOe t i Pl County /~ `S _ r%noi an mus ze. Attach complete site plan on paper not less than 81/2 x 11 inches in s but not limited to: vertical and horizordal reference point (BM), direction and include parcel I.D. , scale or dimensions, north arrow, and location and distance to nearest road. percent slope , Please print all information. Reviewed by Date Personal information you provide may ~ used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location „iE it./E1. ~ ils.d Q [ Govt. Lot s 1/48' 1/4 S /y/ T a S N R /S~(°f~ Property Owner's Mailing Address Lot # Block # Stlbd:-Nerve or CSNq~ .3/ 7a? Co. l10. sir/ ~ City State Zip Code Phone Number [~-pity ~•Y+Nege ®Town Nearest Road ~/~,ta./ 6J1 0 7 ( S) .?- y87 ~ 3,70 Sr. New Construction Use Residential / Number of bedrooms -3 Code derived design flow rate S /So GPD ^ Replacement ^ Public or commeroial -Describe: Parent material LOFSS eosc LoA~+rY !'icc a ~~+~. st ~.Q Fbod Plain elevation if applicable A r/A n• General commends ~ /~ouw0 ~JSJ i'S . S S.a./D ciFr'~G ~~ aP~./ iY.~Y f/ELD~ d ti and recommen a ons: / , ~ ~Ecoro,~l.~o .Sys. Ei. - 96. / o.~ 9S. S ce.d ToN~ Boring # ^ Boring , ii ® pit Ground surface elev. 9S. S ft. Depth to limiting factor 30? in. SoA lication Rate tion i d D R Texture Structure Consistence Boundary Roots GP DHP Horizon Depth in. Dominant Color Mansell escr p e ox Qu. Sz. ConL Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 a 1 _. J ~. e? v ~'.~ - _ 3 6- 7.SY~f ~u~r ~ ~~ ~ ~ - ' t o sa~r alrAx~ r .~roo S ~ Ao ~c ~' oZ Boring # ^ Boring , „ ~ Pit Ground surface elev. Sys n. Depth to limiting factor .30 In. Soil lication Rate i H th D Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl= or zon ep In. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Efdt2 2 -ZO Y ~ .Si~ .2 i~ cr/ v~= ~ .8 3 20-30: Sit - l .t6 r col -' /0 30 ~ o ~ 7 ~~'tt' tE ~.rr~a SS d oa ' Effluerd #1 = BOD > 30 < 220 mg/L and TSB mglL ' tmuerrr ez =ova ~ av rnyr~ ar~u i ~o - .+~. ,,,yv~ CST Name (Please Prod) aS~~tlrel ~ ~ CST Number Date Number r .~`,vu <<.oirr ~/I . e s Property Owner ~~/.I.Jd ~A.I~/d-S Parcel !D # Page a of 3 .3 Boring # ~ Boring it ®' Pit Ground surface elev. 9S. 0 ft. Depth to limiting factor--~~ m• Soil A licatlon Rate i da B Roots GPD/ft' Horizon Depth in. Dominant Color Mansell Redox Description Qu. Sz. Cont. Cobr Texture Structure Gr. Sz. Sh. stence Cons ry oun `Ef~1 •Eff#2 L /. z a- oY Y3 - / Z s ~ ~ 3 ;. y ~ .t3-yo o -s6 .S ~ sY•t .vE~rr a s ~ ~ c - _ 1.0 , 7 r a y it' .~ SS ,vocK Boring # ~ Boring ^ Pit Ground surface elev. ft. Depth to luru6ng factor ~n• Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft~ in. Mansell Qu. Sz. Conk Cobr Gr. Sz. Sh. •Eff#1 'Eff#2 Boring # U ~~ ^ Pit Ground surface elev. ft. Depth to limiting factor In' Soil lication Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GPD/fl= in. Mansell Qu. Sz. Conk Cobr Gr. Sz. Sh. •Eff#1 'Eff#2 • Effluent #1 $ 80D~ > 30 < 220 rr~/L and TSS >30 < 150 mg/L • Effluent fl2 = BOD< <_ 30 mg/L arxi TSS < 30 nmg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (807/00) A ~ a n~o ~ o ~ a ~ A" ~ ~ ~ , 1 ~ ~C tr` ~a ~. `y V~ ~, ` a y ~ w4 h i ~ *~ ° - ~ w i ;~ ~ h ~ ~ M 1 w 4 O ~ a .o h • w h ~ r a ~ a a ~, M 1 I ~ ~ ~ ~~ ~ a ~ ~.4 ~ ~ a ~ O ~ ~o ~. ~• ~, ~ '~ ~ t" es ~®o ~, ~ '~. e c.~, r\p i ~ `~ ~ ~ x t ,. i .. ~ . ~ r _ _ ~ ~ `i . • i ~ ~ M' ~ w a ~ ~ ~ A~i i 1 . '~ a~ ., w ~. ~o . -- ~ ? ~, -_ _~ F C°oy L rr H ~ H C=7 ~ H ~ I~ ~ I ~ 1 ti h q~ n ' z ~ A ?! ito w ~ • r ~ ~ L wa>°. q s h ~ o ~ ~ ` .. h j i 111 t e C _. `Gt ,~~ ti ~Z O o t+7 [i7 H H o Y y .. H °x '~i ~w 0 w ~~ -c c K r 9 2 a~c c:~cuuic cuurt•rY SEPTIC TANK MlAIIVTSNANC~B wGRES~NT AND • QWNP.R6F~' CBRT>P>(CATION 170RM OwaerlBuyer ~yhc~rnQ, ~' ~Q.`j °I- ~:i ~M~r~ ~ ~X~PS g ~~~'~ ~ ~ - '1 Cfi" {~u ~„ ~ ~r'~br+~-ovc.~ e W ; 5~1 ?5 f Proporly Addr~6 -~LJ~n .J`j 1 , , (Vaziiiaatioa Inquired from Flaoofot Dspar~eat i~or taw coo:trudiaa) C54rJ~gte w y ~ SU ~ ~' + Perccl Identffioatioa Numbor C~~ ~ ©3 ~r ~~"~S~ Pt+opaty Lccattoa ~ Y., N ~~ '/., Sat. ~ ~ . T~N R ~ W. Town of CIGt L Svbaivisiom ,~. _ ~ . C,ot ~ .._.~ c«tit~a surrey ktatp ~ 7 `~ `~ o ~ 3 vole ,~,a -.~ ~ o0 Wu~'xiq Dead ~ Voltm4e ~ _ -. Page M Spec i~awe D yes ~ no Lot lines identifiable O yae O ao Ia~s~ertne soduoiiote~aoeo[Yotttsepltcry~emooddrewltla Iq PramamietliWee~o i~ad[~Nas~ez PropetaACe oooaieM otpuepio~ aut t5e tarlc twerp twee Ceara m aeeaae~ ii eooded M' a lioeuMd p~par. Whit you put pato t6s ~m ow sAbot tfie ilwotiab, df fhe eepea twk ae a treatasetat stags is the wa:0e dlipoW ayaoem. 'i~-e property away ap+ea m au>mdt eo St. C~+oiz 7,oeti~ Departaamt a oertitfatioa farm, sipaod by the owner sad by a Pa~la'P~.reearicaaplambet vas Mcsoaeapampervarflyli+e d~.t(1) fife on..ite erasfavsoerdilpoaal ayrEeiu is is pr+pper epaeatir~ ovdities ao~ac (~) aRx ia+pe~tiao aed paarpiad (it aeeeeeacy), ~ Mpda tank b t~ ~ L31M1 of amdpm. t~ the mdasiped ~ tesd fir aLove its eel agree oo maiaais the prirata aswrage diapoa~t ~~ with tbs stasdar~d+ set ~ as sK by me Departase~t of comman..oa me Depattmeat o[ Namrat ltpottto~oa, Stine a[ ~tsoopeia~. CaRmcatioa tee tLt~t Yuen eeptlo Naeam use baa-iasialaiaedmwt ba aoatplgod and ~et»oed ro tae st. ~ oount~- T.oa4g offioa within 30 l i6e $ree exwrad~ort dale. ~ 7 I S I a,r '[ZJRt3 O /1Pp11f,.AI~T't DATB 1(wa) eeetlty- drat all aeaoeeranb ort tbia facts are taus m the beat of my (cur) Imewrladpe. I (ire) stn (an) tho oevtraa~c} of Ih~a pr+aperiy deseabed t~bove, by vicars of a wanwaty deed rooerded is 1R,e~tet of Doedr O~cs. SIGNA'!'URB OP ApPLtCAIdi' DATE be' i~olcCdb~-tbvZroai~DCpart~~~es"`s• •••••• Ant isfommdoa mat is min-~Ceseatoa my ~eRtc is m4 s~wl~r p~ me •s 6tdnds wim t)1M wppUntlee: a damped wtgraey dead tom tiffs R~b1vc of Deeds omaa a espy of t!» ~fisl enrws~- emp ;F atie~aa~a is mad is Aa waewsq- dsd b d ~ZbZ~.G~ ~~9 'OPT/Z~~ ~y l '1S/ZG ~ ~ L y00~ l l ~~r (vOUJ) 'n10b~