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HomeMy WebLinkAbout038-1070-40-001 PRIVATE SEWAGE SYSTEM County St. CfOIX sanitary Permit No: 77 7 0 IPA Wisconsin Department of Commerce INSPECTION REPORT 5 Safety and Building Division (ATTACH TO PERMIT) State Plan ID No! GENERAL- INFORMATION [Privacy Law, 5.15.04 (1)(m)}. Parce~ 7'1 Personal information you provide may be used for secondary purposes Ci village X Township permit Holde 6 Nan!e:e, BM Description: Sectionl7own/RangedMap No: CST BM /~I► insp. BM Elev: r--n^^^( r-. -I Efev:~ VVVV ELEVATION DATA „ s to HI Fs ELEV. TANK INFORMATION CAPACITY STATION + L V. TYPE MANUFACTURER ZJ Benchmark Z ~ 5d..i w Dos 17-1 b Alt. BM g.7 6 ~d Aeration Bldg, Sewer N a; S V.5 ~ ~So ~ St/Ht inlet St/Ht Outlet 2~ g . 5 • X77 TANK ' J /.J1~ g3 • s(° TANK SETBACK INFORMATION ent Air intake ROAD Dt inlet TO P/L WELL BLDG. rg Septic ~ "5 o - Dt Bottom /.1.6 • Header/Man. 2.47 Dosing 4 g 2-1 Dist. Pipe -17 11)2.-7 Aeration Bot. system 3 J Z ~AL Holding Final Grade 0 ~d 3 PUMPISIPHON INFORMATION Demand St Cover '`KP gq' Manufacturer Z10 GPM4 3(o -J~AIG LQ p r ~p I C ^ Model Number " 12 Friction Loss J System H a~~ TD 3 1 ~t Y TDH `i2•SS •or Well Dia. i i Dist to ell ~p3 Forcemain Lerrg~O~ Z Inside Die. Liquid Depth SOIL ABSORPTION YSTEM PIT DIMENSIONS No. Of Pits Length No. Of Trenches BEDITRENCH Width LEACHING Manufacturer. DIMENSION S BLDG WELL LAKElSTREAM CHAMBER OR P/L SETBACK SYSTEM TO -7 / 66 / UNIT Model Number' 71 INFORMATION Type ystem: S`4 ' L> , v d Ve to Air Intake x Hoie Spacing) Size r l DISTRIBUTION SYSTEM x Hole 3Z Z HeaderMtanifold Distribution / 1. 5 Pipe(s) 3~•4~ Die Spacing / 3, Die- Length ,a Mound Or At-Grade Systems Only Length Oniy xx Mulched x Pressure Systems xx Depth of ro: Seeded/Sodded Depth Over 5 O No Bed/Trench SOIL Center ~s BedRrench Edges COVER Depth Over Topsoil e E) No ~ Inspection #1: Inspection #2: Z- COMMENTS: (Include code discrepencies, persons present, etc.) c _ n P) 0 Parcel No: Location: L}~'~ plow ~ 1.) Alt BM Description = 2.) Bldg sewer length amount of cover = CerL No. ' D ~T_ Plan revision Required? YesInsepct s Signa re Use other side for additional information. Date SBD-6710 (8.3/97) County RECEIVED Industry Services Divisi St. Croix 1400 E Washington Ave San' Permit Nunih;er (to be filled in by Co.) k p~~1J P.O.Box7162 Madison, WI 53707-716 l X70 ST. CROIX COUNTY ~OMMU UJ-1- Et" State Transaction Number ni ary ermit Application 2579877 In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary /gyp N 17 Q . purposes in accordance with the Privacy Law, s. 15.04(1)(n), Slats. same Z17& L Application Information - Please Print All Information 1:11 . Property Owner's Name parcel # E' 3 f'Cl~o - you -Dov 038•-1070 -yo'~° Male, Clyde & Judy AJ Property Owner's Mailing Address Property Location 2176 Island Drive Govt. Lot City, State Zip Code Phone Number NE 1/4, NE 1/4, Section 17 54025 le one) Somerset, WI T 31 N R 18 E oro H. Type of Building (check all that apply) Lot # ® 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name Block # ❑ Public/Commercial -Describe Use ❑ City of ❑ State Owned - Describe Use CSM Numb er❑j Village of 101 1770 -Z MA Town of Star Prairie III. Type of Permit: Check onl one box on line A. Complete line B if applicable) A. ❑ New System ® Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ❑ Permit Renewal F1 Permit Revision ❑ Change of F-1 Permit Transfer to New List Previous Permit Number and Date Issued B. Before Expiration Plumber Owner Z FIND ((-Z&-1-1?7 IV. Type of POWTS System/Component/Device: (Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ® Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dissp8ersal Area Proposed (sI) 1System 02.08 Elevation 450 Rate(gpdsf) 750 0.6 VI. Tank Info Capacity in o 41 Gallons Total # of Manufacturer 1 .0 2 I L> Gallons Units New Tanks Existing Tanks a U N n u" p Septic or Holding Tank 1200 2400 2 Week's Concrete products ® ❑ ❑ ❑ ❑ Dosing Chamber 750 750 1 Wieser Concrete ® ❑ ❑ ❑ ❑ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber.' at MP/MPRS Number Business Phone Number John Schmitt I LA,,# 223760 715-760-0486 Plumber's Address (Street, City, State, Zip Code) 616 150`h Avenue, Somerset, WI 54025 VIII. Coun /De artment Use Only LY3Approved El Disapproved Permit -Fee/ Date Issued Issuing Agent Signature $~ll ~~~4 ❑ Owner Given Reason for Denial $ IpZi7 . 00 IX. Conditions of Approval/Reasons s for Da~~ ovV 8~ q3 / / / ( Gy AA,u~ Ik5uL ~ ~I l t 1, -0U~90~ gaote~o 6Lj5-V00fr1aA1 CCU • corYt~ilJ~l1 a.~ • "R) ~ ~ (217• -~-n~c~st f~E ,y-t a2 l~f3a✓~ P Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 X1 I inches in size SBD-6398 (R03/14) • NiT ~ DIVISION OF INDUSTRY SERVICES T 3824 N CREEKSIDE LA ~i HOLMEN WI 54636 Q~ Contact Through Relay 9~0 P ~G http://dsps.wi.gov/programs/industry-services www.wisconsin.gov S A~0 sSt4~~1~ Scott Walker, Governor Dave Ross, Secretary August 04, 2015 CUST ID No. 223760 ATTN: PO WTS -Inspector JOHN F SCHMITT ZONING OFFICE SCHMITT & SONS EXCAVATING ST CROIX COUNTY SPIA 616 150TH AVE i 101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/04/2017 SITE: Identification Numbers Clyde & Judy Male Transaction ID No. 2579877 2176 Island Dr Site ID No. 815259 Town of Star Prairie Please refer to both identification numbers. St Croix County above. in all correspondence with the agency. NEIA, NEIA, S17, T3 IN, R18W FOR: Description: Three Bedroom Mound System / 17% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1548083 Maintenance required; Replacement system; 450 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code CO requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, DEp7• 0 stats. PROFES ) The following conditions shall be met during construction or installation and prior to occupancy or use: D'V►SION OF ~ Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. SEE C • 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. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. NOTE: Designer states road between parcels is private and that both parcels are owned by the same person(s). JOHN F SCHMITT Page 2 8/4/2015 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • 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. In granting this approval the Division of Industry Services 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. erard M Swim When You Receive That Invoice, POWTS Plan Reviewer, Division of Industry Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jerry.swim@wisconsin.gov WiSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm j l MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Male 3 Bedroom Mound Owners Name: Clyde & Judy Male ~E Owner's Address 2176 Island Drive Somerset, WI 54025 Legal Description: NE1/4, NE1/4, S17, T31N, R18W Township Star Prairie County: St. Croix Subdivision Name: NA Lot Number: NA Block Number Parcel I.D. Number Plan Transaction No. 'ARQV a~CY Page 1 Index and title Page 2 Data entry JNgL ST YARD Page 3 Mound drawings DUSV/CES Page 4 Lateral and dose tank V/C Page 5 System maintenance specifications ES Page 6 Management and contingency plan Page 7 Dose tank specifications Page 8 Effluent filter information ONpENC,, Page 9 & 10 Pump specifications and curve Page 11 Plot plan Page 12 Septic tank maintenance agreement Page 13 Existing Septic Tank Certification Page 14 Warranty deed Page 15 CSM Attachment Soil evaluation report Designer: John Schmitt License Number: 223760 Date: 7/14/2015 Phone Number: 715-760-0486 Signature: 1I Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01/01) and both SSWMP Publication 9.6 Design of pressure Distribution Networks for ST-SAS (10/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01) Version 7.0 (R. 03/2012) Page 1 Mound and Pressure Distribution Component Design Ue's!gri `',Norr,sneet Site Information 'F or C) RI Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ soil treatment for 51 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of 36 inches. 450.00 Design Flow (gpd) 1700' Site Slope _101.16 Contour Line Elevation (ft) 25.00; Depth to Limiting Factor (in) In-situ Soil Application Rate (gpd/ftz) Distribution Cell Information 64.* Dispersal Cell Length Along Contour (ft) = 7700 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N C or E, C Center or End Manifold 3.50 Lateral Spacing (ft) If N above, enter the elevation (ft) _ 4 Number of Laterals of the highest point. 1___0.156; Orifice Diameter (in) - 2.00; Estimated Orifice Spacing (ft) = 7.03 ftz/orifice Forcemain Diameter (in) 180.00; Forcemain Length (ft) Does the forcemain drain back? Y / R 08 00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 29.36 Forcemain Drainback (gal) Vertical Lift (ft) 57.74 5x Vol " 1 d Volume (gal) 4.51 Friction Loss (ft) 87.10 Minimum Dose Volume (gal) 0.50 In-line Filter Loss (ft) 34.46 System Demand (gpm) 31.22 Total Dynamic Head (ft) RLaterall Diameter Selection Manifold Diameter Selection o tions choice options choice - 1.25 x x 1.50 x x 2.00 1,50 x x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information ~1-- Total Tank Capacity (gal) 2400.00; Septic Tank Capacity (gal) _ Total Working Liquid Depth (in) Week's Con P IManufacturer --~--__v_ gal/in (enter result in cell 649) Dose Tank Information Effluent Filter Information 7500; Dose Tank Capacity (gal) `SIM/TECH~ Filter Manufacturer 20.28 Dose Tank Volume (gal/in) ~STF-100 lFilter Model Number Wieser Concrete Manufacturer -m` Project: Male 3 Bedroom Mound Page 2 OEM Mound Plan and Cross Section Views T 1/10 B : J Observation Pip e • ; T 5 ` A W :L::::::::::: - y ' - -:-T B l:. ; ' L Mound Component Dimensions ft A 7.00 ft E 25.28 in H [Aft ft K [Aft B 64.30 ft F 9.50 in z ft L ft D 11.00 in G 0.50 ft J W 450.10 (ft2) Dispersal Cell Area 1787.93 (ft2) Basal Area Available 7.00 (gpd/ft) Linear Loading Rate 6.43 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.87 (ft) H F 102.08 (ft) - Dispersal Cell 102.58 (ft) Lateral Dispersal Cell Invert D Elevation ' . 101.16 (ft) Contour Elevation 17.0 % Site Slope Geotextile Fabric Cover Shading Key a- Dispersal Cell See lateral details on 1 Topsoil Cap a 1.5 ft Page 4 for number, size, ® Subsoil Cap w o and spacing of laterals. © ASTM C33 Sand Z F Laterals are equally ® Tilled Layer 0.5 ft lvp~cal Lateral spaced from the © Aggregate ~t distribution cell's o ,`•::•;'•:'.:::':a:`:°:`:;:_°::.:.: centerline in the A distribution cell (AuB). Project: Male 3 Bedroom Mound Page 3 Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at any point. Laterals are identical ~E P S Turn-up v,fball valve or `E-x-~,E xf2 W-)l 7Laterzadlss &forcematt Sch 40 PVC clesnoutplug Table 384.30-6 Holes drilled on the bottom of the lateral Number of Laterals 4 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.03 ft Lateral Length (P) 31.47 ft Orifices per Lateral 16 Lateral Spacing (S) 3.50 ft Orifice Density 7.03 ft2/orifice Lateral Flow Rate 8.62 gpm Manifold Length 3.50 ft System Flow Rate 34.46 gpm Manifold Diameter 1.50 in Total Dynamic Head 31.22 ft Forcemain Velocity 3.52 ft/sec Dose Tank Information Locking cover with warning label and locking device and Electrical as per NEC 300 and sealed watertight SPS 316.300 WAC 4 in. min. Disconnect Tank component is properly vented Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in Ca aci 750.00 Gallons T Volume 20.28 gal/inch A Weep hole or anti- DInches Gallons B siphon device 19.69 399.26 2.00 40.56 C ~ Pump off elevation (ft) 4.29 87.10 ~ 80.92 11.00223.08 36.98 750.00 D _ose tank elevation (ft) 3" Bedding under tank. 80.00 Alarm Manuafacturer SJE RHOMBUS Note Switches Alarm Model Number Tank Alert AB T containing mercury may not be used in Pump Manufacturer Zoeller this svstem. Pump Model Number 140 Pump Must Deliver 34.46 gpm at 31.22 ft TDH Project: Male 3 Bedroom Mound Page 4 Mound System Maintenance and Operation Specifications Service Provider's Name John Schmitt Phone 715-760-0486 POWTS Regulator's Name St Croix County Zonin _ n_._.. .Y.aPhone: 715-760-0486 System Flow and Load Parameters gpd Maximum Influent Particle Size 1/8 in Design Flow - Peak du Estimated Flow - Average gpd Maximum BOD5 220 mg/L Septic Tank Capacity gal Maximum TSS 150 mg/L Soil Absorption Component Size ft2 Maximum FOG 30 mg/L Type of Wastewater Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequencv Septic and Pump Tank Ins ect and/or service once eve 3 ears Effluent Filter RLaterals ould ins ect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System should be flushed and ressure tested eve 3 ears Mound sect for pondin and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished • Grade • 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution` ~ Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Male 3 Bedroom Mound Page 5 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01, R. 10/12), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01, R. 10/12)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L SODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continnencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 M-NLdW :31IJ 99- ~2-9Z~-008 d 0 094,09 IM 'N00a N3OIVW OL IMH Sn 91LEM Z \ c 770d-iSOd :31v(, 00/00/0 :31vo ivnNdW OIld3S :2lf10d-38d :31v0S dOM Sl8 NMV o 31380900 8V4-O9LdW ~ 0 W N w w J ri: J U H Q x JW O O U co O U a W I- _ OJ F- J 3c Q 0 a N\O X O W O E Q O Co Ll W ¢ O m O~¢ Z_ 0 d W? Q Z 0 0 o z U_ UtMa f- J ZJ= \ mF h H O W L L ow 0 o w ¢ a U J¢ rn `p u¢i a ( oz ?..a LL, 00 00 O aWWx o min JWw 0 I-- Z o~ U fl. > G U > X a a vi J 0 (W ao O = Z (n a w r- LLJ CL UJ V) a °OUF-~MJ Wa mWN O UC O Q Z O_ z ¢ a Li 4k < -1 VI N cv¢¢_~WWJ~ ~-Q¢ WN¢ N O_~ 00 w 0 Z fn~ I U IJ-ZN UO Z V) S UO ZO \M~WW.tJiOLLJ co x: Y I..WZJ,. MNi- OZx U YJ O = "N w~ ¢O z ..0..~°~°30~ o¢Y OOw ¢ Z¢¢w w m °o Q Z3mU0M=Om , 5 2 ~l Za< ZNO U pUO O Z W ~x NU Z¢O Z U mO ~ ~ F- 0 0 0 Y X.. O LL. D z z -JU' _ Q OQ D H U F- U J W I Q ~ ~ ¢ w Z w U F- Ab o w o a¢. w ~ Of W- x w~\ I I f v II O -1 of V) m `IE o s i ~F I W F-- - w W I JJ O w w N w O J Z W U W ~a a3MO32A Sv z w Y Z H Page 7 PRESSURE FILTER INSTALLATION & SERVICE INSTRUCTIONS F/LTER 1455 Lexamar Drive Toll Free 888-999-3290 Office 231-582-1020 BoyneCity, M149712 Fax 231-582-7324 Emailtiaies-a&au-stmtech.com Webs%%1 mLe,hrjmn INSTALLATION: When installing an STF-100, screw filter into discharge port of any pump that has a 2" National Pipe Thread. Pumps with a smaller discharge port may be adapted to fit. When installing an STF-100A2 a tailpiece and male adapter will need to be added to the inlet end of the filter (end opposite of the cap) to the desired height and a 2" union will need to be added to the outlet end (the end closest to the cap & on the side of the filter). Always install the filters in a position where they can be . easily serviced. **Always use caution when starting threads to avoid cross threading". Plumb force main into the 2" sch 80 PVC union. "We recommend that the union remain together during gluing to insure that glue or cleaner does not ruin O-ring or sealing surface**. c:'r 13 =✓t: C ins, lied Suf. t:l ixil Cs IC; "°'e outlet Gs iii' SERVICE: Service of filter screen is dependent on usage as every system is unique. For most residential systems we recommend inspecting the filter within the first year to determine the necessary service intervals for the filter. In high volume systems we recommend inspection within the first 6 months to determine necessary service intervals for the filter. Once the service interval is determined it should be consistent unless something changes in the system. Always inspect the filter screen for any damage or corrosion and replace if necessary. If our STF-101 service alarm switch has been installed and adjusted properly it will alarm when the filter requires service. It should be serviced no less than when periodic pumping of the septic tank and pump chamber is performed. Servicing will be more frequent if using any one of our optional filter socks (600 micron, 150-190 micron, and 100 micron). Check your local health department for septic system servicing recommendations. If the screen becomes clogged before the periodic pumping requirements, a high level alarm or light will indicate the need for service. If system is equipped with a "pump on light" that stays on longer than normal, this also may indicate a need to service filter. To service filter screen, unscrew the 4" cap. Pull filter screen from canister and wash out thoroughly in appropriate location with proper protection. In some cases an additional filter screen allows quicker service allowing the dirty filter to be washed later at the shop. Note that in cold conditions the filter cap maybe difficult to remove. Keep the filter in a warm area or pour warm water over the• cap before removing. Once the filter is installed in the tank it maintains a stable temperature and removing the cap will not be a problem. If the system is equipped with our Service Alarm Switch, the filter screen does not need service until the Service Alarm Switch activates a light or audio alarm. We still recommend that the filter be inspected once a year for damage or corrosion. NOTE: The total dynamic head loss of the system must be increased by 0.5 feet of head to overcome friction loss through the filter. SERVICE ALARM SWITCH The alarm switch is available in three pressure ranges, low head, medium head, and high head. Installation is simple, on SIM/TECH FILTER systems, remove plug from base of filter chamber and connect tube fitting. Next, run the tube up into the tank riser and connect to service alarm switch. The alarm switch is fastened to the side of the riser via the nylon strap provided. Run alarm wire to alarm box. The service alarm switch can be wired with its own alarm or with the high water alarm. Pressure adjustment is made by removing the end plug, and inserting the 7/32 alien. Clockwise increases pressure. One turn equals approximately 3 PSI. The low head alarm switch comes factory preset at 8 PSI and is completely field adjustable within it's range (3 to 24 PSI). We recommend the use of a ball valve when using an alarm switch. Once you have installed the filter and alarm switch, the ball valve can be closed off to simulate a plugged filter so that you can make sure the alarm switch is working correctly. ****TRY OUR LID/SCREEN REMOVAL WRENCH. Our wrench holds filter lid firmly and hooks screen for easy removal and installation. Made of PVC plastic. WARRANTY All products are warranted against defects in material and workmanship for a period of two years from the date of purchase. In no event shall GAG SIM/TECH FILTER, INC. be liable for any consequential damages or any labor, material, freight or expenses required to replace, correct or reinstall the product. GAG SIM/TECH FILTER, INC.'s liability is limited to repair or replacement of the part. All warranties are void if the product has been improperly modified, applied or installed, subjected to misuse or abuse. Except as stated herein, there are no warranties expressed or implied, including the warranty of merchantability or warranty of fitness for a specific purpose. EFFECTIVE September 13 2005 Page 8 SECTION: 2.20.045 QVrlt/TY Pl/MP4 FM1502 1211 Product information presented e- ® Supersedes here reflects conditions at time ~ "-7 0710 of publication. Consult factory Z 19. regarding discrepancies or inconsistencies. MAIL TO: P.0. BOX 16347 • Louisville, KY 40256-0347 visit our web site: SHIP TO: 3649 Cane Run Road • Louisville, KY 40211-1961 www.zoeller com (502) 778-2731. 1(800) 928-PUMP • FAX (502) 774-3624 Durable Cast Iron , construction ~ 14014140 & 14514145 Cast Iron Series µ Model 140 features a Non-Clogging engineered (For Pump Prefix Identification see News & Views 0052) thermoplastic vortex impeller design and passes 1/2" spherical solids "FLOW..mMATE" Model 145 features an engineered thermoplastic single vane impeller design and passes'/."spherical solids Motor - 60 Hz, 3450 RPM, oil-filled, hermetically FOR SEPTIC TANK -LOW PRESSURE PIPE (LPP) sealed, automatic reset, thermal overload protected AND ENHANCED FLOW STEP SYSTEMS Available in both single or double shaft seal designs EFFLUENT Carbon/Ceramic mechanical shaft seals OR DEWATERING PUMPS Assembled with Stainless Steel bolts SUBMERSIBLE Stainless Steel lifting handle 1'/z" NPT DISCHARGE Upper sleeve and lower ball bearing funning in bath of oil 20 ft. UL Listed Neoprene cord with molded plug cap ; and ground wire d 1 5 11/3" NPT vertical discharge annti del BN145 45 ~n and odel 140 a 1a5 BN and BE models include a variable level float Single Seal Single Seai switch and 1'/2" X 2" PVC adapter fitting Pinnios Purm)s Operates at temperatures to 130eF (54°C) in effluent or dewatering applications Corrosion resistant powder coated epoxy finish Note: The sizing of effluent systems normally requires variable level float(s) controls and properly sized basins to achieve required pumping cycles or dosing timers with nonautomatic pumps. ICA C US Modet 4141 Tested to UL Standard UL776 r and ceMad to cSA a txcF t t Y .s smWard 022.2 No, 108 Double Seal ® Pumps ~~..rt •'r POWDER ~7 Z_ le 77 MAIL TO: P.0. BOX 16347 COATED Louisville, KY 40256-0347 TOUGH' SHIP TO: 3649 Cane Run Road Louisville, KY 40211-1961 (502) 778-2731. 1(800) 928-PUMP MODDEL5 AVAILABLE FAX (502) 774-3624 • Automatic (Models BN & BE) • Nonautomatic Manufacturers of... • 1 HP, 1Ph 115V or 230V (140/4140) % HP, 1 Ph 115V (145/4145) ff~~~~ QVQL/TV /7ZIW © Copyright 2011 Zoeller Co. All rights reserved. Page 9 W PUMP PERFORMANCE CURVE TOTAL DYNAMIC HEAD/FLOW MODEL 140/4140/14514145 PER MINUTE 5 EFFLUENT AND DEWATERING WQQIII~ zz 3718 65116 70 MODEL 140/4140 145/4145 "5'6 55 Feet Meters Gal. Liters Gal. Liters } m so 5 1.5 86 326 61 232 ° ° 3 2932 ss 10 3.0 80 303 60 228 + ,615 4.6 73 276 56 213 ° o so 20 6.1 66 250 53 201 ° 14- 25 7.6 59 223 49 186 111211112 0 30 9.1 49 185 45 171 U ,z 40 40 12.2 28 106 35 133 _ 50 15.2 - - 26 99 's 1660 18.3 - 16 61 o Shut-off Head: 50 ft.(15.2m) 74 ft.(22.6m) s m 12 13132 ,s 4 150080 d 10 4532 2 s SK7524A s ads ~ f0 20 30 I'D SP 80 71 so eo GALa LRERS 6 4; 180 240 31 FLOW PER MINUTE lied with 371P 65718 • Electrical alternators, for duplex systems, are available and supplied with an alarm. 4 • Mechanical alternators, for duplex systems, are available with or without alarms. • Control alarm systems are available for 1 phase pumps used in simplex system. See FM0732. • Variable level control switches are available for controlling single phase systems. 3x`32 • Double piggyback variable level float switches are available for variable level long cycle controls. + • Sealed Qwik-Box available for outdoor installations. See FM1420. • Refer to FM0806 for applications above 130°F (54°C). 14014140 & 145/4145 MODELS - SINGLE PHASE Control Selection Model Model Volts Mode Amps Simplex Duplex N140 N4140 115 Non 12 1 or2 3 E140 E4140 230 Non 6 1 or 2 3 BN140 BN4140 115 Auto 12 - 16118 BE140 BE4140 230 Auto 6 N145 N4145 115 Non 13 1 or2 3 } 452 E145 E4145 230 Non 6 1 or 2 3 1. SK15248 BN145 BN4145 115 Auto 13 BE145 BE4145 230 Auto 6 SELECTION GUIDE *Single piggyback switch included. 1. For automatic use single piggyback variable level float switch or double t 4 piggyback variable level float switch. Refer Reduces potential clogging by debris. to FM0477. Replaces rocks or bricks under the pump. 2. See FM 1228 for correct model of simplex Made of durable, noncorrosive ABS. "Easy assembly" control panel. Raises pump 2" off bottom of basin. ~umnott included.) pipe 3. See FM0712 for correct model of duplex Provides the ability to raise intake by adding sections of 1 W or 2" PVC piping. control panel. Attaches securely to pump. a cauTloN Accommodates sump, dewatering and effluent applications. none ~ =a.ic see a NOTE: Make sure float is free from obstruction. rr, 'anon a I I ..o S 3'^ > .-SER 37').... For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 0 Copyright 2011 Zoeller Co. All rights reserved. Page 10 PLOT PLAN N Project Name: Male 3 Bedroom Mound Legal Description: NE1/4, NE1/4, , 7, T31N, R18W p,l,p: STI ubdivision Name: NA Lot R7'X64.3' Township: Star Prairie Parcel Size: res SCALE: 1" = ao' County: St. Croix Contour Line Elevation: 101.16' Cell Dimensions: 4 inch Sch 40 -ASTM D2665 System Elevation 102.08 Mound Dimensions: 84.12' x 32.19' 2 inch Sch 40 -ASTM D1785 Slope: 17% 11/2 Sch 40 -ASTM D1785 BM1 Elevation: 100.00' To of 2' PVC pi 2e BM2 Elevation: 100.35' To of 2' PVC pipe Backhoe Pits: Existing Tank: 2-1200 allon Se tic Tanks New Tank: 750 allon Dose Tank with SIMITECH STF-100 Effluent Filter For a complete view of parcel see page 4 of Soil & Site Evaluation L A, o0- 7i f ,sJ i $ .Z Z i ' 17 rho 2 1.! SLI Ev5rruLr WGLL % i 11~'GI K l f i~ Z- E_Xi57-1NGs 75_0 6r}l 12n.; GAL rAti'r~ P/C -I 0 i ~j ttir- 14 iaf L y / "5 y Page 11 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Clyde & Judy Male Mailing Address 2 176 Island Drive Property Address S a m e (Verification required from Planning & Zoning Department for new construction.) City/State Somerset, WI 54025 Parcel Identification Number LEGAL DESCRIPTION Property Location NE t/4 , NE %4 , Sec. 17 , T 31 N R 18 W, Town of Star Prairie Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house Oyes[1no Lot lines identifiable ElyesFIno SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 A URE OF APPLICANT(S) D i TT ATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) Page 12 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 2176 Island Drive at: NE 1/4, NE '/4, Section 17 , Town 31 N, Range 18 located Town of Star Prairie ' St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service 7/13/15 Did flow back occur from absorption system? Yes No X (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1200 + 1200 Construction: Prefab Concrete X Steel Other Manufacturer (if known): week's Concrete Products Age of Tank (if known): 18 Permit number (if known) 299067 7 John Schmitt ( censed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS 7/14/2015 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 Page 13 RECEIVED Department of ~ ~ 6 ?_~i p SOIL EVALUATION REEQRT q 76 YSL #1792 Safety a in accordance with Comm 85, Wis. Adm. Code Page 1 of 4 Profession C OUN7-y Schmitt Soil Testing, Inc. -'OMMUNITY f1~/ County Attach complete site plan on paper notTess 9hl9 tt*nj1nches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information. 038-1069-40-000, 038-1070-40-000 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). p!b ~.7Dt~ I-~ Property Owner Property Location Male, Clyde & Judy Govt. Lot NE1/4, NE1/4, S17, T31N, R18W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2176 Island Drive D 7--7770 City State Zip Code Phone Number [ City Village 0 Town Nearest Road Somerset WI 54025 608-732-1718 Star Prairie Z f 7(o Island Drive New Construction Use: Z Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD U Replacement ❑ Public or commercial - Describe: Parent material Glacial Till (Amery Series) Flood plain elevation, if applicable 75.31 ft. General comments Area is suitable for a mound system. System elevation is 102.07 based off a conour line established at 101.16'. Slope of area is and recommendations: 17%. Depth to limiting factor is 25". tZcE1.5 com 1N ~4,)4-65M DO/-. -PL 017770 04) F-1~ Boring # Boring Pit Ground surface elev. 96.57 ft. Depth to limiting factor 25 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/3 none sit 2fsbk mvfr as 2m,2f 0.6 0.8 2 8-18 10yr5/3 none sl 2fsbk mvfr gw 2m,2f 0.6 1.0 3 18-25 10yr5/3 none A lmsbk mfr gw 1vf 0.4 0.7 4 25-41 7.5yr4/6 c2d 7.5yr6/6 sl lmsbk mfr 7.5yr6/2 gw 0.4 0.7 5 41-64 7.5yr4/4 m2d 7.5yr6/8 sl Om mfi 7.5yr6/1 0.2 0.6 2] Boring # ❑ Boring Pit Ground surface elev. 97.31 ft. Depth to limiting factor 32 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2 1 0-7 10yr3/3 none sl 2mgr mvfr as 2m,2f 0.6 1.0 2 7-21 10yr5/3 none sl 2msbk mvfr gw lm,2vf 0.6 1.0 3 21-32 10yr4/4 none sl 2msbk mfr gw 1vf 0.6 1.0 m2d 7.5yr6/6 4 32-45 10yr4/4 7 5yr6/2 sl lmsbk mfr gw 0.4 0.7 5 45-72 5yr4/4 m2d 7.5yr6/8 7 sl Om mf.5yr6/1 0.2 0.6 " Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS S30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt e4~~7- 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd St. New Richmond, WI 54017 6/26/2015 715-760-1978 SBD-8330 (R.07/00) Property Owner Male, Gyde & Judy Parcel ID # 038-1069-40-000, 038-1070-40-000 Page 2 of 4 F3],Boring # ❑ Boring Pit Ground surface elev. 101.46 ft. Depth to limiting factor 26 in. Soil Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Application G DRate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-7 10yr3/3 none sl 2mgr mvfr as 2m,2f 0.6 1.0 2 7-26 10yr5/3 none sl 2msbk mvfr gw 1m,2vf 0.6 1.0 3 26-34 10yr4/4 m2d 10yr6/8 10yr6/2 sl imsbk mfr gw lvf 0.4 0.7 4 f34-66 10yr4/4 m2d 7.5yr6/6 sl 0m f 7.5yr6/2 m 0.2 0.6 EJ Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 ❑ 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 GPDfft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = B0135 , 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-8330 (R.07/00) Schmitt Soil Testing, Inc. Conducted by: Page 3 of 4 Conducted For: Schmitt & Sons Excavating, Inc.. Name: Clyde & Judy Male Thomas J. Schmitt, CST 227429 Address: 2176 Island Drive 586 Valley View Trail City, State, Zip: Somerset, WI 54025 Somerset,Wl 54025 Phone: 715 0-1978 , PID: 038-1070.0-000 Sfgnatu Lot No. NA Date Legal Description: NE1/4 NE1/4 S17 T31N R18W Backhoe Pit Township, County: Star Prairie Township, St. Croix County A Bench Mark 1 El. 100.00' Top of 2" PVC pipe A Bench Mark 2 El. 100.35 Top of 2" PVC pipe Slope= 17% Contour Line Elevation 101.16" Scale 1"= 40' Contour Line Length 64' NOTE: SEE AERIAL PHOTO FOR FULL VIEW OF LOT (Page 4 of 4) IN, I~A ( I / l7 Fous& WELL fS l , / > t f/vcD j~~ ~ivk S' G \ / 15' 11' N3' ~a' ~3, !o- . F a Ki'f r.. v: 8..: ! !rrt:.. r 9C Y P < < k •e :r 7.1 fig` ~l} V -~'X~ ~~"V~ ~x•,:~ k;~x',"<. :y~`, t Sw _ y. Y C ' ?4 -AN .d - I II w_ 4 i , <A .a<s a sx a ,.3 ~y s STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS SUBDIVISION / CSMJ / LOT SECTION- T3N-R 1 W, Town of 57 ,~(^~,~,(h ,tSL ST. CROIX COUNTY, WISCONSIN P VIEW SHOW EVERYTHING WIT 100 FEET OF SYSTEM l~ rr a~ rlie - X ~ M 1~-1 W1 INDICATE NORTH ARR W Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. s BENCHMARK ALTERNATE BM: SEPTIC TANK PUMP CHAMBER / CO=LDINGTANK INFORMATION Manufacturer: 'I - Liquid Capacity: Setback from: Well 8 House / Other Pump: Manufacturer Model# Size Float seperation r Gallons/cycle: - Alarm Location SOIL ABSORPTION SYSTEM Width: Length of trenches Distance & Directio neares ine: Setb rom: well: House Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: -.5/1 CL4-4-]lp,~) LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations ST . CROIX Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH T PE MIT) SanitarL9 y2e~rr1i N_: ~ ( Ufa i'Indkoldt"me: alitlan~,qdown of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: r BM Description: tctr Parcel &I 9,i-1069-40-000 40 TANK INFORMATION ELEVATION DATA A9700384 30 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septi Benchmark 0 S Dosing Aeration Bldg. Sewer Holding C zd1~ ep Ht Inlet s TANK SETBACK INFORMATION eQ' 2 / Ht Outlet z2' Ventto TANK TO P / L WELL BLDG. Ai Intake ROAD Inlet r 7 S. J6, s-, S9! Septic A Dosing.. " e Hol _ ys I / - ID' PUMP/ SIPHON INFORMATION F* Manufacturer Demand Mo umber GPM TDH Lift m Ft Forcem ' Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT Inside Dia. Liquid Depth DIM I N SYSTEM TO LL LAKE/STREAM LEACHING Manufactu SETBACK CHAMBER INFORMATION TypeO Mo a Num er System: k Ut DISTRIBUTION SYSTEM Header nifold tribution Pipe x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Dia. Spacing SOIL COVER x Pressure Systems n y r At-Grade Systems Only Depth r Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil El Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRARIE 17.31.18.293D,NE,NE Plan revision required? ❑ Yes 0114/0 Use other side for additional information. 9 s~ SBD-6710(R 05/91) Date Inspector's ig ature Cert No. Safety and Buildings Division N)Lconsin SANITARY PERMIT APPLICATION 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. _ ,moo • See reverse side for instructions for completing this application State Sanitary Permit Number 1Q41gd&1? The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plar11.D Number 1. APPLICATION INFORMATION- PLEASE PRINT ALL INF RMATION Property Ow~r Name t0 Cl> _ Property Location /4 /4, S T , N, R/, T62 Property O n r' ailin dr I Lot Number Block Number City, State 7 Zip Code Pho a Number Subdivision Name or CSM Number II. TYPE F . BUILDING: (check one) ❑ State Owned o ;ila a Ne t R ad Public 1 or 2 Family Dwelling - No. of bedrooms pF-Iown F_-5/7 ,e 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo g• 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New lacement 3. E] Replacement of 4 E] Reconnection of 5. ❑ Repair of an ______System ________System Tank Only Existing System _________ExistingSystem B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11E] Seepage Bed 21 ❑ Mound 30E] Specify Type 4 lding Tank 12E] Seepage Trench 22 ❑ In-Ground Pressure 4 ❑ Pit Privy 13E] Seepage Pit 43E] Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (s,cl. ft.) Proposed (sq. ft.) (Gals/day/sq. ft_) (Min./inch) El 7~nA1 2 Yq- l 1. P,,/ P Feet eet VII. TANK Capacity in g gallons Total # Of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank ~C ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for instal tion of the to sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Si e: (No Stam MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, a , Zip de): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved S tary Permit Fee (Includes Groundwater ate Issue Issuing Agent Signature (No Stamps) ~~Approved Surcharge fee) TT Owner Given Initial Q ?4(, 1 Adverse Determination 0 X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R.11196) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, plumber INSTRUCTIONS ' 1 _ A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line !B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. SANITARY PERMIT APPLICATION 201eE. W shington Ave sion Vsconsin Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code P.O. Madison Box 7969 , WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. _ log • See reverse side for instructions for completing this application State Sanitary Permit Num er a9Ia6I The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State PI Num r/ 1. APPLICATION INFOR ATI ON- PLEASE PRINT ALL INF RMATION S/"rf U~ Property 0vy11e f Name e O Property Location 1 74-1 yc1/a p/4, S1 T , N, R ,'~E (or Property n r' ailin dr Lot Number Block Number Cit , State Zip Code Ph ,e Number Subdivision Name or CSM Number e, Ile II. TYPE F BUILDING: (check one) ❑ State Owned o . it~r ~ Ne st R ad _y cr_ llwn of r oaf S A ~i Public 1 or 2 Family Dwelling - No. of bedrooms III. BUILDI G USE: (if building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo e1r ~v 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: spe+ ify IV. TYPE OF PERMIT: (Check only one box online A. Check box on line B, if applicable) .,A) 1 _ ❑ New ~c8eplacement 3. E] Replacement of 4. E] Reconnection of 5. ❑ Repair of an ------System --------System Tank_Only______________ Existing System Existing ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41+lolding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallon Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (s,y~ ft.) Proposed,( q. ft.) (Gals/da /sq. ft-) (Min-/inch) A,1 I n/ i ) /l./ 1Tttr" 1 Feet . C/~eet VII. TANK CacitTotal #~of Prefab. Site INFORMATION in gallons Tanks Manufacturers Name Concrete Con- Steel Fiberglass- Plastic AppExper. New Existing Gallons strutted Tanks Tank Septic Tank or Holding Tank C; G~ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for insta tion of the to sewage system shown on the attached plans. Plumber' Name: (Print) Plumber's S re: No Stam MP/MPRSW No.: Business Phone Nu ber: 151 fel Plumber's Address Street, City,, t Zip de): / f Gl~' ) IX. COUNTY / DEPARTMENT USE ONLY Coll / ❑ Disapproved S~tlitary Permit Fee (Includes Groundwater ate Issued Signature (No Stamps) Approved ❑ Owner Given Initial ~ Surcharge Fee) JJ Adverse Determination 7m: X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: Z/ 7 9, GU /Y SBD-6398 (8.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber - INSTRUCTIONS , 1. A sanitary permit is valid for two (2) years. 2. YauJ- sanitary permit maybe renewed before the expiration date, and at a time of renewal any near c iteria in the Wisconsin Admi'ni:stratve Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a license l pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning- your onsite sewage system, contact your local code administrator w 'he State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: 1. Property ow d~`z name and mailing address. Provide the legal description anci par--,21 tax number(:,) of w'riere the system isto be ,nstailed. H. Type of building being served. Check only one and complete # of bedrooms .f 1 o, FZm ly D n ^ Ill. Building use. 1;- building Type is public, check ael appropriate boxes that appi, d. _IY ` of per. ~P wci o .:y ane on line A. Complete line B if perr,?'t is for tan', rcti.i cement, recap section, or repair. V', Tvoe of syster Cli)eck appropriate box depending on system type V1. GC:O"pt.ly^^.l sysi-e ~inrlT Stl0r i)rnvide all info-matlon r?quester' fr), num,i 1 [ rc,,UQi? i+!!. art. riiV !r', the capcclty of ?uer; =tewlor existing ta+i;sf the ;IUmC u: ,c";1; a nr.y nCi IdMe, !i.G''cate prefab car :.~e ._-.tructE'd .3nC Dteria ..or r ete 'or all p`,amp/sinhon anc _rl:sS ,t m. Lnt' K exPe.':-- =Lal approval o,-..:y i ,a 5 rec.: ?o r.e:)-, 1 f t;approval from Di' H'i. 'E 1~;~- e^ ''1 -.r ..r :-.;e _.t t, t' n iU°Y'f.~::.: ..0 fill In name :s:~.-.":sP. !IUmDe `!S -.p ropria -x ( .E,. MI, i..) a, `dr`' ,_:nih pi-,one number. Plumber mu,,* sign application forty`. X County/ Department Use Only. X. County/ Department Use Oniy. L L s°"..C pia a s SF?et. fI"_?ti0 S tr.ar 8 1/2 ^CheS must, b "t ?j =C ±f ?qr X1815 must OW:-Ir- t Pi0 p;3.} . 1 _....:ale or wits; -omnlete d;mer '3 :i ; 5; well tN_.._ mainsi'Na: 9 ? r :J o s pn^ Eme- cvsT..n- ar~,.., a'.- :'1U ._'nC. a ago. r. a e4Jr f' c r1t-, J ete 5-i-i fJCs 1. C-_ vJlUn,c r. 1, kz, GROUNDWATEP SURCHARGE 1983 ~l?` ~ . ` 4? J +n~tilclE creation of sur--narges i i°051 FOr a n'vrnl wer of tE d of is;:' l- icn can effect groundwater- The moniet<ilectedthtougi,these surcharges ar,- :l for moni'_orirggr ;ndr.,(7 C,-! lcl.3'nati, estig«tion-. a nd establishment c) f standard'` . SAFETY AND BUILDINGS DIVISION 15837 USH 63 Hayward, Wisconsin 54843 isconsin Tommy G. Thompson, Governor Department of Commerce William J. McCoshen, Secretary September 10, „r19~7 BIRD, BYRON JR 896 68 AVE AMERY WI 54001 RE: PLAN S97-21205 FEE RECEIVED: 60.00 HOUCK, ROBERT & MARTHA NE,NE,17,31,18W TOWN OF STAR PRAIRIE COUNTY OF ST CROIX HOLDING TANK The Department has reviewed the above-referenced submittal. Conditional a %rgval is hereby granted for the system plan submittal. All noted items m tibe..corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries shotld"be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, Patricia Shandorf fff~ POWTS Plan Reviewer (715) 634-4870 6213R/ 1 t SEP-10-1997 07:40 FROM CONNECTING POINT AMERY TO 17006345150 P.04 PLOT PLAN PROJECT Roberfand Martha Houck ADDRESS 115 oselawn 146seville Mn 5511 NE 1/4 NE 1/4S 17 /T 31 R I S T N Star Prairie 'COUNTY ST. CROIX 3 MPRS Shaun Bird: 3532 D E8/6/97 'BEDROOM CONVENTIONAL, IN-G OUND PRESSURE v'CONVE TI IVAL LIFTOLDYG YANK ~OOC MOUND :SIPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE2.1000 gallons LOAD RATE N/A ABSORPTION AREA N/A BED SIZE none BENCHMARK• k.R.P. Bottom of Window Sill ' i ASSUME ELEVATION 100- BOREHOLE: DWELL '"H.R.P. Same as Benchmark SYSTEM ELEVATION N/A Site Does Not Meet Slopes and to irregular for Mound Setback Requirements Property Line for a Mound System. 8°1o Slo~ee owl Sloe 8% Slope 6' B.-1 P 20' B-2 45, 15' Tanks to be 0' 1' Seperation Properly Bedded Between ar d.Pravided with a 30 _3 6''anks Lock&wn Covers with Ala roved Proposed ervice War' m' Labels E: 32' A 7 ' i 0' 3 Le Bedroom 10 ST DW Squaw Parking Area/Driveway 6' House Failed Systerr! ~li a l~ C U ✓:z// ,fie U1,f c - 5~ 12 c 6~ ~e oK it d I~ % U r l' oa d y~.v_ r .Well P.0. W! T.S Coftditionally 6' AP PR ONED DEPARTMENT OF COMMERCE wl,KCk a) Ci r , t / Q o 1 r jiff *6 ke (j DIVISION OF SAFE Property Line EE CORRES ONDEN RECEIVED SEP ~ 0 19a7 S97-21205' SAFETY SLOGS. DIV. TOTAL P.04 E L Page Of :3 a) E E 4-) •C ~ L _ v co w r 4- O r to L C' r a) C C O- > N ov o >v - r U L. ( N -0 CL 41 O a) u w a x o " 0 `4 > Q W u C 0 4-J OL 4-1 OL to Q 3 n c n !O r. 0 o ` 1 Q) -0 v m c rts •v ~o •r J C CJ u U rn O C J •r C C C7 L b ~ 3 ro -0 a, a E 4- c 0 4-) 3 E C M X L L \ _ W L v a) v N E z :3 o 0 V) ~Jf~N UZ Q r Z U b L O O U C) l(a N 4- r U W LLJ r-~ 4- = a i-) CO In r -Nc r- •0 •r W V d 3 c C (0 o 3 ~ a c/) U a1 b (Es 2: 2: N O V) v Z i r cn C) -0 1i a: z ru .-r LLI I V L b U ~ C~ OJ I Y C!7 W Z O P+ N, d d Z QU' (o p H r a as N LL- z ~N~ I CD 19 - L U 1 (3) 4-) x - ro 3 c~ Om 3N C \ .c _ o d u w rp c a) H Ull a v a > 41 U C OL U C RS ` r r- W U Z L E V) to v~ w P7 z n L z i T7 0- - - N L W 4-~ N ;U / L a)r N4 m ro C S- m o C O~0s 0 O "a N S- 4-J CY) U Q) O O J r •U b aC L O dJrU a. NJO d v Q) r `L ro -Wisconsin Department of Industry, SOIL AND SITE EVALUATION 'Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site pla er not less than 1 inches in size. Plan must County C include, but not limited i and hoibontal re n point (BM), direction and ~ ~rb I percent slope, scale o nsi ~r~*E'row, and f cgti n and distance to nearest road. g b ztr Parcel I.D. If APPLICANT INF _ A(~ -Mea UAff nformafion. Reviewed by Date Personal information you r i e may be us6 or s dary pdr~s s (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 114 ~~,41 S T N,R E (o Property Owner's Mailing AddTftq ` i v Lot # Block# Subd. Name or CS M# ~ J~ O w Ci State Zip Code Phone Number [_j City Village 52 Town Nearest Road ~ ❑ New Construction Use: Residential/ Number of bedrooms Addition to existing building Replacement [Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate " bed, gpd/ft2 trench, gpd/ft2 Absorption area required ajl bed, ft2IVI,4 trench, ft2 Maximum design loading rate///# bed, gpd/1`12,✓ ,trench, gpd/ft2 . Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark). Additional design/site considerations (,t✓ -Q e Parent material Flood plain elevation, if applica le A11 ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system El S WU ❑ S U El S Ku ❑ S U ❑ S KU 54S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Ground _y 3 y~ / 1 -m- J X 9 ft. Depth to limiting factor in. Remarks: Boring # Qell, 1 Along, - - CIS- Ground q Depth to limiting factor in. Remarks: CST Name Please Print) ture Telephone No. II r Address Date CST Number 71 iSOIL DESCRIPTION REPORT PROPERTY OWNER e0 i page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed. Trench Ground 3 _ fO y~ 6 >G/ - "e, n %7~~ elev 1tt Depth to limiting n. ILI ; Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) Soil Test Plot Plan Project Name Robert and Martha Houck Byron Bird Jr. Address 1155 Rosel-awn ~9~ 4441/- Roseville Mn 55113 TM #3479 Lot Subdivision Date $/6/97 ~1 /4~-1 /4SZ~ T N/R W Township Star Prairie Boring ()Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Base of Window Sill System Elevation N/A * H R P Same as Benchmark Site Does Not Meet Setbacks for Mound Property Line 8% Slope 36' B-1 50' 20' B-2 45 15' 0' / 30' f~w~ 4 G~oS B-3 36' to (4-6 -01 c c~ 32' B. M. 75' 3 Bedroom Squaw Parking Area/Driveway 6' House Lake J1 2' . Well 1 66' r d Property Line HOLDING TANK SERVICING CONTRACT Contract Date X-) / This contract is made between the Holding Tank Owner(s) Name(s) and Pumper's Name 40 t c t, We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:) 1. The owner agrees to file a copy of this contract with the local governmental unit hereinafter called the "municipality", which has signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - with the County of ~T C~ 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all-weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the municipality and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) I Owner's Signature(s) Zee' Ae I } Subscribed end sword tti befoime on this date: ~Ac Pumper's Name (Print) I Pumper's Signature Notary ublic My commSs(an _ire Pumper's Registration Number SBD-7574 (R. 09188) This instrument was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations - , .565929 HD 1y oa L 1266 Murr _ 6'7 A Document Number Docm eat7SUe ci&cwY JaKK ~p,cowcGw MISTER'S OFFICE ST. CROIX cot, WI Read for Reaord SEP 2 6 1997 os-15 M . Rift- R e~t'r~of Dep aJ,~ Name and Rd= Address rev Pared Ideatificifioa N=ber (PM "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" TThis information mambo eomptUod by aibmituc doeeaau Ede, name & return addmss, and PIN (iregrdred). Odrer informadon such as dhc jrandnr clauses, lcral d-eripoon. ctc- may be piaccd on this firsr pale of dic docu mau or may be placed on ad& oaal parrs of the doeum a%4 Nou. Use of dais oorcr part add` one part so your documt a and $2.00 to ncctreor&nr fee. wLreorvin Ssanaes, S9_S17. WWA 2196 VOL 1266PACE268 Wisconsin Department of Industry, HOLDING TANK AGREEMENT Safety and Buildings Division Labor and Human Relations Bureau of Buildings and Water Systems Document No. / Plan Identification No. This agreement is made between the This space reserved for recording data governmental unit and holding tank Agreement Date owner(s) County or Local Governmental Unit Holding Tank Owner(s) -S 7` c ro / X\ Z e49 called Municipality below We acknowledge that application is being made for the installation of (a) holding tank(s) on the following property: (Provide legal land description) 1,7 Return To or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83, Wis. Adm. Code, or Ch. 145, Stats. As an inducement to the County of >I/- to issue a sanitary permit for the above described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the municipality to prevent or abate a human health hazard as described in s. 254.59, Stats., the municipality may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66:60. Stats. 2. The owner agrees, pursuant to s. ILHR 83.18 (10), Wis. Adm. Code, to have installed in a new building or new structure a water meter approved by the County and State. The water meter shall be installed by a plumber authorized by the State to conduct such installations, with said installation complying with State regulations and manufacturers specifications. The owner agrees to be financially responsible for the purchase, installation, maintenance, and repair of the water meter, and agrees to allow the municipality to enter the above described property on a regular basis to read and/or inspect the water meter. 3. Owner agrees to pay all charges and cost incurred by the municipality for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. The municipality shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 4. The owner, except as provided by s. 146.20 (3) (d), Stats., agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have the holding tank serviced and to file a copy of the contractor the owner's registration with the municipality. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the municipality within ten (10) business days from the date of change to the service contract. 5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the municipality on a semiannual basis a report in accordance with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code, for the servicing of the holding tank. In the case of registration under s. 146.20 (3) (d), Stats., the owner shall submit the report to the municipality. The municipality may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 6. This agreement will remain in effect only until the local governmental unit responsible for the regulation of private sewage systems certifies that the property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit the agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. wner(s ame(s) P " t No rized ner Sig refs).~$a~~,, nr, a on this date: PC) DvC~ Subscribed Skpt r 4j • Na ary Public jMyUn'c,*p,I Official Name -Pit Munic al Offical Signat / C4 2-- My com%sse?r'~Kgires: J> Municipal Of i ial Title - P.rint~ ~r ids 3 y~r OLIN The information you provide may be used by other government agency programs IPrivacy Law, s. 15.04 (1)(m)) SBD-6123 (R. 04/94) 1"" PWt E oiiI Jj,~6 "APACEM Part of NE1/4 of NE1/4 of Section 17-31-18, described as follows: All that part of S 200 feet of N 725 feet bounded on the W by shoreline of Squaw Lake and on the E by the following described right-of-way: Commencing on N line of said NE1/4 of NE 1/4 540.25 feet W of NE corner thereof; thence SEly by a deflection angle of 96'421, 75.5 feet to place of beginning; the,ice continuing on a deflection line just described 151 feet; thence by a deflection angle of 7'26' to the left 232.2 feet; in thence by a deflection angle 8'16' to the right 502.66 feet; .4i thence by a deflection angle of 73'49' to the left 335.0 feet, :A- more or less, to centerline of traveled road. AND A parcel of land located in the NE1/4 of NE1/4 of Section 17-31-18, described as follows: Commencing at a point which is 61.44 feet West and 525.12 feet South of the NE corner of said NE1/4 of NE1/4 of Section 17, which point is on the West line of the town road as now laid and traveled, and the point of beginning; thence west and parallel with the North line of said 'Y NE1/4. of NE1/4 of Section 17 a distance of 371.5 feet to the East line of a 33 foot road as now laid; thence South along the f. East line of the said 33 foot road on an angle to the left of 84'081 a distance of 201.06 feet; thence East and parallel to the North line of said NE1/4 of NE 1/4 of Section 17 a distance ^ of 331.48 feet to the West line of. said town road; thence NEly along the West line of said town road on an angle to the left 95'33' a distance of 200.9 feet to the point of beginning. All in St. Croix County, Wisconsin. t, x k,. i 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 Location of property4Z-- l/4_, 1/4, Section T,7/ N-R1 W Township Mailing address / 5 JAuh✓ Address of site,fp S~ Subdivision name Lot no. other homes on property? Yes__~,<~No Previous owner of property Z~4,,f, Total size of property All,* Total size of parcel Date parcel was created Are all corners and lot lines identifiable?,<,<_Yes No Is this property being developed for (spec house)? Yes No Volume ~S and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE 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 references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No.and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. ig to e of Applicant Co-Applicant X_ 7 Date of Signature Date of Signature OA DOCUMENT No I STATE BAR OF WISCONSIN FORM 3-1988 OUIT CLAIM DEED VOL' 259PW45(1 564322 = REGISTER'S OFFICE ST. CROIX CO., Wi Robe.rt L....Houck. and Martha E. Houck, husband.and_ wi.fe-... R&O'd !a Record AUG 2 5 1991 quit-claims to ...Theresa. Houck,__Mary_HgbsQrLr..>]9~7X1-Itouck............ 9:30 \ A James_ HOUCk,.-.Leo-.Houck,..and.-Joseph..Hauck«-.as..Joiit..--.---.. fi C~•1a~. Tenonts--and.. nQt..Tenants...in-Cjorurnn - . County, - ~ r T the following described real estate in St.. .............Croix State of Wisconsin : IRTURN To RCK A -0 vC Ic Q D__ i sm. IIP M ssii3 4 See Attached Exhibit "A". Tax Parcel No:.............................. z a r F t, This l S homestead property. -(is) (xi{AOI.~ this 2nd June 1~7...... Dated - - day of ...............(SEAL) (SEAL) ' Robert L. Houck . Martha..E.....Houck .......................(SEAL) ...................................--•---.....(SEAL) • AUTHENTICATION A IBNOWALSDGMSNT Signature (s) STATE OF MU000MM ta. t DAKOTA County. S authenticated this ..day of 19...... Personally came before me this ..2Ad....... day of June , 19.97--- the above named Robert..L:.. Houck and Martha E: - Nouck,........ " - - TITLE: TITLE: MEMBER STATE BAR OF WISCONSIN (If not, . authorized by § 706.06, Wis. Stats.) to me known to be the person 5.......... wbo executed the foregoing instrument and acknowledge the same. ' - VOL V59 PAA 51. EXHIBIT "A" ` Part of NE1/4 of NE1/4 of Section 17-31-18, described as follows: All that part of S 200 feet of N 725 feet bounded on the W by shoreline of Squaw Lake and on the E by the following described right-of-way: Commencing on N line of said NE1/4 of NE 1/4 540.25 feet W of NE corner thereof; thence SEly by a ' deflection angle of 96'42 , 75.5 feet to place of beginning; the,►ce continuing on a deflection line just described 151 feet; + thence by a deflection angle of 7'26' to the left 232.2 feet; thence by a deflection angle 8'16' to the right 502.66 feet; thence by a deflection angle of 73'49' to the left 335.0 feet, .1. more or less, to centerline of traveled road. AND A parcel of land located in the NE1/4 of NE1/4 of Section 17-31-18, described as follows: Commencing at a point which is 'y 61.44 feet West and 525.12 feet South of the NE corner of said t NE1/4 of NE1/4 of Section 17, which point is on the West line of the town road as now laid and traveled, and the point of beginning; thence West and parallel with the North line of said NE1/4 of NE1/4 of Section 17 a distance of 371.5 feet to the 4} East line of a 33 foot road as now laid; thence South along the East line of the said 33 foot road on an angle to the left of 84'08' a distance of 201.06 feet; thence East and parallel to ' the North line of said NE1/4 of NE 1/4 of Section 17 a distance of 331.48 feet to the West line of said town road; thence NEly along the West line of said town road on an angle to the left 95'33' a distance of 200.9 feet to the point of beginning. i All in St. Croix County, Wisconsin. a. r~- r ' ' ~