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032-2075-10-000
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Bubble m C x x `D w Pattern Z —I D m fn p !11 C ' -2 S Diffuser m m m m - co Membrane s o, °-' Cleaned o • d -< -< -< - o Air Filter c CL o) umi 0) Cleaned o s O o^ -< z -< lnoculant ,X m 0 m � � �p. N Replenished CO r co 3 .A n .o o c CU M N • -� w - 0 -s Cr) CD• co �. •p = —. WI X d 0 0 Dmm o I) o 0 � N y A 3 W CD v f , � a W 0 O O O 3 y E v ^, git 0 ' ,o � fCc y 0 > . 3- :J 3 O O a a 0 ° m m m = A - 1 A m °, 1) 0 0 .iti i- to co u) a : o g. _. 4 cn g n o 0. .T, �Z7 _. 2 A 3 w /w OS z -1. 'o --• QD q' Oc 5. A CO -o r g CD D.a N , ND ' ■ ° -r v v N , x 0 N) 0) z 7 0 !D w i n N 0 a co "J D c. o Cl) m 0 0 E z 0 Breakout Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552306 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Kei ert, Steven J. & Julie M. Somerset, Town of 032-2075-10-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 14.30.20.786F TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic " ' ` Benchmark L Dosing Alt. BM -r-, Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic I Dt Bottom 73 e ('M t - Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number Xt~ TDH Lift Friction Loss Syste Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO Xf BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution Ix Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER I~ N Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes [E No E Yes [2 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1527 Twin Springs Road Houlton, WI 54082 (Gov't Lot 3 14 T30N R20W) Twin Springs Lqt 2 Parcel No: 14.30.20.786F 1.) Alt BM Description = C it,% 5 d cl/G. 2.) Bldg sewer length = t -amount of cover = J Plan revision Required? 7 Yes XNo ` ( d I Z Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor ignature Cert. No. County ft! Safety and Buildings Div' ' n i r`. 01 W. Washington Ave., P.x~ Sanitary Permit Number (to be filled in by Co.) t1 cps 1 FEB 17 201? Madison, WI 53707-7 U 55 Z3z~lo ST. CRnIX COUNTY Transaction Number Application A- is 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 Servies. Personal information you provide may be used for secondary W ~j~(~~ purpo ses in accordance with the Privacy Law, s. 15.04 lxm , Stats. J5Z / L Application Information - Please Print All Information PS, Property Owner's Name Parcel # 5-T - O JC4L/e kEla6leT 03Z-Z075-10-000 Property Owner's Mailing Address r D Property Location C / 796 /5Z-7 W I rJ ~5>~ Fr N&S 1~ O Govt. Lot Z t" City, State r Zip Code Q Phone Number y4 s ~1 y4, Section O U L/ v ri 1' ~qoV T 31D N; R Z Vrc1E oio H. Type of Building (check all that apply) Lot # Subdivision Name I or 2 Family Dwelling - Number of Bedr ms t L~ Block ff- ~Lo I N S pe/ /V & S ❑ Public/Commercial - Describe Use kel L) V%. ' GA- ❑ City of CSM Number ❑ Village of ❑ State caned -Describe Use _ 00 Town of S®i !r e5 67 ^ 375 e 0f) III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only A®Other Modification to Existing System (explain) /oo I -T1 L~' ❑ Permit Transfer to New 1st Previous ermi umber and Iss B. ❑ ❑ Permit Renewal ❑ Permit Revision Change of Plumber Before Expiration Owner 5l 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 1sooiil ❑ Holding Tank ❑ Other Dispersal Component (explain) [9 Pretreatment Device (explain) WN I Tr I x IV / o V. Dis rsaVI'reatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 415-0 ! w - -3-7(a /OI. O,4 VI. Tank Info Capacity in Total # of Manufacturef Gallons Gallons Units A 00 511"/ jt~ 11 ~ ~ U 2 _ y 2 New Tanks Existing Tanks 5TH :n 2 O. a~/U v~ ti v~ w 5 Septic or Holding Task 0 0V 10gi F - 'S C. Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum Si a MP/MPRS Number Business Phone Number J ~J 5CHM(T ZZ37loD I7is -760-0'196 Plumber's Address (Street, City, State, Zip Code) 61©TN hoe 5c) W -5"110 zJ V oun /De artment Use Only Permit F 14 1 Date sued Issuin gent Si pproved ❑ sapprov P J/~ 111111: . .00 17- /.Z1 Own en Reason for 1 IX. Condi*11914 "a"easous for Disapproval ~.la lo~ 1. Septic tank, effluent filter and 3) 1~ . ~i~0~ /I dispersal cell must all be services / maintained. 0 as per management plan provided by plumber, 2. AN Setback requirements must.be.malritained r r t W 31*10948 ~ / ordinallics. 7L6 ✓Yla.. n Attach to complete plan for the system and submit to the County only on paper less than s 1/I 111 inches in size 0 SBD-6398 (R. 11/11) ATU COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Keipert ATU Owners Name: Steven & Julie Keipert Owner's Address 1527 Twin Springs Road Houlton, WI 54082 Legal Description: SW1/4, SW1/4, S14, T30N, R20W Township Somerset County: St. Croix Subdivision Name: Lot Number: 2&part of 3 Block Number Parcel I.D. Number 032-2059-80-100 Plan Transaction No. Page 1 Index and title Page 2 Existing Plot Plan Page 3&4 Asbuilt Page 5 ATU Tank Cross Section Page 6 Dose Tank Cross Section Page 7 Effluent Filter Information Page8&9 Management & Maintenance Plan Page 10 ATU Servicing Agreement Page 12&13 Maintenance Contract Page 14 Septic Tank Maintenance Agreement Page 15 Deed Page 16 Knight Treatment System Approval Letter Attachment # 1 Existing Septic System Documents Attachment # 2 White Knight Manual Designer: John Schmitt Licnese Number: MPRS 223760 Date: 6/2/2011 Phone Number: 715-760-0486 Signature: PROJECT o9s.^ ao/hOerf S. I 5F / ti-IX L, /Y&J/~c1i j~W 1/ SJ)//T p WRR~2DW TOWN C(atJNTY 1 MPRS t3yron Bird J(. 3318 DATE BEDROOM CLASS PERC_,J CONVENTIONAL IN-GROU RESSURE COtWEfrl?~ LIFT MOUND, & HOLDIKIG TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE .rn LDING TANK SIZE ABSORPTION AREA ! T _ PERC RATE C2_BED SIZE d: L. Benchmark V.R.P. Assume Elevation 100/' Location of Benchmark Ag.s - c -r/ cJ//, * H.R.P.__ ~oeperrQj-AL -t (rrbw< ~a/ o r~ Tcc~.., S~D~y. E] Borehole Q Well Scale Feet 0 Pere Hole System Elevation /o h~• ~ef•~~.//i/~~s~~~ ,n 5 r,n ONSITE SEWAGE SYSTEM q3 41 A P P R 0 t"'WH E EPARTY.ENT OF INDUSTRY. LABOR AND WMAN RELATIONS DIVISION OF SAFETY AND BUILDINGS SEE CORRESPONDENCE 1A 0 3 08>✓ I ~,,,~y c gp, h ~J 1 -4 ao S91-20561 J STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER >lCJ[~-=yP~~^~y-- ADDRESS SUBDIVISION / CSM# LOT °'2 _ SECTIONT_N-R W, Town of Sw►.r.-S ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM xeel n r~ u sF-/' ,r t ~r INDICATE NORTH ARROW Provide setback and elevation information on reverse Of this form. Provide 2 dimensions to renter of septic tank manhole cover. BENCHMARK: ALTERNATE BM' SEPTIC TANK / PUMP CHAMBER / HOLDING-TANK INFORMATION Manufacturer: ~G+GA Liquid Capaci:ty: Setback from: Well _,&O el ouse Other Iry" Pump: Manufacturer Model Site Float separation _.4; _ Gallons/cycle: Alarm Location 'A_/ -:SOI ABSORPTION SYSTEM /Width:_-_ s ! Length ~ Number of trenches_ n / Distance & Direction to nearest prop. line: /OHO Setback from: well:_Ai~ause Other ELEVATIONS fl7a~ /~c/ ~I4 ~3- Building Sewer 14P7 V/ ST Inlet:_ ~ ST outlet PC inlet PC bottom--,2 ` Pump Off v Header/Manifold~~ Bottom of system_tj Existing Grade Final grade DATE OF INSTALLATION : PLUMBER ON JOB: LICENSE NUMBER: ~31g' INSPECTOR: 3/93:jt Tank 1 SEPTIC TANK DETAIL / SINGLE COMPARTMENT Project Name: Steven Keipert Tank Manufacturer: Week's Concrete Products Tank Model: 1000 Construction Type: concrete steel Fiberglass Polyethylene Tank Volume: 1000 gal ATU Manufacturer: White Knight - ATU Model WK-40 99.57 ft Inlet Elevation Outlet Elevation 99.29 ft 23" Minimum Manhole w/locking device n < and warning label S Airline M Baffle - ► White Knight MIG WK-40 ding nder ank Plumber/Designer Signature: Lic 223760 Date: 15-Feb-12 DOSE TANK DETAIL Owner's Name: Steven & Julie Keipert 99.24 ft Inlet Elevation Weatherproof Manhole with Locking Device Junction and Warning Label Quick disconnect fitting Alternate forcemain outlet Sim/Tech Filter ' reS (a) Dimensions Inches Gallons a 19 413.44 separa n (b) alarm on b 2 43.52 ---------------far;------- pump on dose Vol 'e (c) c 4 87.04 t d 12 261.12 off €~r "Total 37 805.12 pump d (d) 95.5 Intake Elevation Tank Manufacturer Week's C. P. Pump Manufacturer Zoeller Tank Model 800 Pump Model 98 Tank Capacity 800 gal Alarm Manufacturer Existing Tank Volume 21.76 gal / in Alarm Model Existing Filter Manufacturer Sim/tech Filter Model STF-100 DOSE VOLUME CALCULATIONS TOTAL DYNAMIC HEAD CALCULATIONS Design Flow (DWF) 450 gal / day Min Network Supply 2.5 ft Number of Doses 5 / day Passive Vertical Lift 5.57 ft - (Header/D. Box elev. - Pump intake elev.) or Max. Dose Volume 90 al Friction Loss 3.02+0.5 ft F00 Length x Friction Loss g Factctor))/1/100 + Filter Filter Friction Loss Drain Back 7 gal Total Dynamic Head 11.59 ft Design Dose Volume 97 gal Min Discharge Rate 46.8 gpm NOTE: Pump and alarm are to be installed on separate circuits. INTERNAL DIMENSIONS OF TANK Diameter 80 in Liquid Depth 37 in Plumber/Designer Signature: License 223760 Date: 15-Feb i s.: The Sim/Tech fifer, with it's unique design and mounting location, atows the filtering screen to be scrubbed while in operation. providing maximum maintenance intervals with unmatched performance capabAities. The fiilter screen is a type 347 stainless steel with .062 diameter holes It is 3 Inches in diameter and 18 inches long with a 69.52 square inch open area This large 41% open area Mows the filter to pass 83.8 gallons per minute at i psi. With features Ike these even a partially clogged screen w11! keep the system well protected and working properly. This preformance product assures quality effluent with lowar T5S l6wis. keeping your pressurized system functioning at X30i°a6 EfficiEncy. Engbreers and designers now have the ability to offer a simple safeguard. to assure systems w1U function as designed now and in the futuriL The SimlTech Otter can fm used in both residential and cornmerclal appli"Gons. STF-100 Y Flow rate w clean screen: 120.672 *G-RD, ~ I PSI STF-IDOA2 Flow rate w 95°o pied screen. 04.912 GPO. 18 PSI Comnwrchd rnanlfoAd Total head ross:.5002 tr or.21 PSI as5onft www.ga9w-5imron.com 888-919-329D1mtcch*frffnway.nCt A SO ~ 11 WK FLI ®r~Jf Toll Free 888-999-3290 Mailing Address Office 231-582-1020 1455 Lexamar Drive, Boyne City, MI 49712 Fax 231-582-7324 Email sirntech@freeway.NET Webwww aaQ-simtech.com INSTALLATION i& SERVICE INSTRUCTIONS 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 to the desired height and a 2" union will need to be added to the outlet end 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**. 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 Eftrcap maybe dWc & to remove. Keep the titer in a warm area or pour warm water over the cap before removkrg Orxe U►e ftr'is installed in the tank it maintains a stable temperature and removing the cap will not be a prablem. 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 W 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. Installation Service Instructions.doc POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page-of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Steven & Julie Keipert Tank Manufacturer: Week's C. P. F NA Permit # r Septic E Dose Holding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: Week's C. P. F NA Number of Bedrooms: 3 r N E Septic El: Dose Holding Volume. 750 al Number of Public Facility Units: F70 NA Vertical Distance Tank Bottom (s) to Service Pad: ft Estimated (average) Flow: 300 al/ Horizontal Distance Tank(s) to Serivice Pad: ft Design (peak) Flow = estimated x 1.5: 450 al/Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 1.0 al/da horizontal is > 150 feet. Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: SIM/TECH r NA Fats, Oils & Grease (FOG) 530 mg/L Effluent Filter Model: STF-100 Biochemical Oxygen Demand (BOD5) :5220mg/L t✓ NA Pump Manufacturer: Zoeller r NA Total Suspended Solids (TSS) 5150mg/L Pump Model: 98 High Strength Influent/Effluent Monthly average Petreatment Unit Fats, Oils & Grease (FOG) 530 mg/L Manufacturer: Biochemical Oxygen Demand (BOD5) 5220mg/L r NA rv- Mechanical Aeration r Peat Filter r NA Total Suspended Solids (TSS) 5150mg/L r Disinfection r- Wetland Petreated Effluent Monthly average r Sand/Gravel Filter r Other: Biochemical Oxygen Demand (BOD5) 530mg/L Soil Absorption System Total Suspended Solids (TSS) 530mg/L r NA r In-Ground (gravity) r In-Ground (pressure) r NA Fecal Coliform (geometric mean) 5104cfu/100m1 r- At-Grade I✓ Mound Maximum Effluent Particle Size: % in dia. r N r- Drip-Line r Other. Other. F Other: WO NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third of tank volume Pump out contents of tank(s) When the high water alarm is activated onth(s) Inspect condition of tank(s) At least once eve : 6 Em 5) Maximum 3 earsr NA pr, month(s) Inspect dispersal cell(s) At least once eve : 6 r- year(s) (Maximum 3 ears r NA r month(s) Clean effluent filter At least once eve : 1 year(s) r NA month( s) Inspect pump, pump controls & alarm At least once eve : 6 year(s) r NA T7 8 Flush laterals and pressure test At least once eve : 1 year(s) r NA morrth(s) Other: Maintain White Knight At least once eve : 6 year(s) r NA s Other: Add Bacteria lAt least once every: 1 year(s) r NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspeciton of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Admininistrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, petreatment units, and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. (Rev.2/05) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide the opportunity to obtain a sanitary permit for a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ® Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name: John Schmitt Name: John Schmitt Phone: 715-760-0486 Phone: 715-760-0486 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY i Name: Owners Choice Name: St Croix County Zoning Phone: Phone: 715-386-4680 This document is intended to meet minimum requirements of Ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. (Rev. 2/05) Illilllillilliilllllllllll8111 8 0x44036663 9 Document Number Document Tice 950997 St. Croix County BETH PABST REGISTER OF DEEDS AEROBIC TREATMENT UNIT (ATU) ST. CROIX CO., WI SERVICING AGREEMENT RECEIVED FOR RECORD i 02/17/2012 4:33 PM Late Plan Transaction Number - EXEMPT II 1 REC FEE: 30.00 PAGES: 1 Name - (Owner) Typed or printed Being duly sworn, states, under oath, that: 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume / Z/ / Page (036 Document Number S; 5-29o St. Croix County Register of Deeds Office: Record; Area Addre a A parcel of land located in the of the _ of Section Name and Return T N-R Z0 W, Town of SEU15100 K~z~CQT /5'Z7 i WitJ s POeI `jGS ,eoNa Se>Ale12SET , St. Croix County, Wisconsin, being i-~Dct r:T~rU, VJE .5-1610 eZ duly described as follows (include lot no. and subdivision/CSM or detailed legal description): PAR-r o i=- G ov' f Lo r3 „v 5 et >1,:1v N 0 3 Z - Z 07S - 0 - p 00 -0 W rJSr/r P 3 0 M., kA NC. Z o W 0.5scAeIS 45n Parcel Identification Number (PIN) Agreement Date: Z-/? - I Z A5 Lo T Z o Ct.Qri 0116 J S 4-1 ti VeV vyt a 0 F/ L e D rW Ts+E o r ~i c C C9< THE Re&,57-trg 00 per-as 5~• G,~eOrx COcI,VTy~ ~iStc~VSi.tJ SN V04_ Y AAG_ 11146 14s 0ociurrtE.VT st 37S'goo As an Inducement to the county to issue a sanitary permit fog a POWTS equipped with an Aerobic Treatment unit on the above-described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Comm 83, Wis. Adm. Code relating to Aerobic Treatment Units (ATU) and the maintenance requirements for the proposed POWTS (Private Onsite Wastewater Treatment System) technology. if the owner fails to have the POWTS and ATU property serviced In response to orders issued by the governmental unit or the Department of Commerce to prevent or abate a human health hazard as described In s. 254.59, Stets., the governmental unit (Town) 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. 66.0703. Slats. 2. The owner agrees to maintain a contract with a licensed POWTS maintalner for the life of the system. The POWTS maintainer will perform periodic inspections and maintenance as required by the manufacturer and the Department, including, but not limited to: the blower, electrical I controls, and treatment unit operation and sludge depth. These Inspections are to be scheduled every 6 months for the first two years of operation and yearly thereafter. 3. The owner agrees to contact the POWTS maintainer Immediately upon any malfunction of the treatment unit and to maintain the unit so as to not create a human health hazard as described in s. 254.59. Slats. 4. The owner recognizes that the county, Department of Commerce, or POWTS maintainer may make periodic inspections of the components to complete performance monitoring of the unit. I 5. The owner or the owner's agent agrees to report to the department or designated agent at the completion of each inspection, maintenance or servicing event in a manner specified by the department or designated agent within 10 business days from the date of Inspection, maintenance or servicing. . 6. This agreement will remain in effect only until the county office responsible for the regulation of POWTS certifies that the aerobic treatment unit no longer serves the property. 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 this agreement to the Register of Deeds, and the agreement shall be recorded in a manner that will permit the existence of the agreement to be determined by reference to the property where the Aerobic Treatment Unit is installed. Owner(s) Name(s) - Please Print Subscribed and swom to before me on this date: Notarized er's Signature(s) N Public l Governmental Unit I Name, Title- Please Pr • yro is o xpires Gove ental Unit 1 S' nature -tc [j d by. a P nal In orrlation you provi -used 6Gbidary pure ses [Privacy Law s. 15.04(1)(m)) F "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" This Information must be completed by submitter, document title. name & return address. and PIN(if requirvd). Other information such as the Wapting douses, legal dowilption, etc. maybe placed on this first page of the document -maybe placed on add/tional pages of the document. Note: Use of this cover page adds one page to your document and $2.00 to the recording fee. Wisconsin Statutes, 59.517. Document Number Document Title Maintenance Contract for Septic System This Maintenance Contract for a Private On-Site Wastewater Treatment System (POWTS) is Between Steven & Julie Keipert and John Schmitt. Recording Area Date of Contract: February 15, 2012 Location of POWTS:1527 Twin Springs Rd. Houlton, WI 54082 Name and Return Address: Legal Description of Property: Part of Gov't Lot 3 in Section 14, Township Steven Keipert 30 North, Range 20 West. Described as Lot 2 of Certified Survey Map 1527 Twin Springs Rd. filed in the office of the Register of Deeds for St. Croix County, Wisconsin Houlton, WI, 54082 in Vol. 4, Page 1146 as Document # 375800 032-2075-10-000 Parcel Identification Number As Inducement to the County of St. Croix to Issue a State Sanitary Permit (PIN) for the Above Described Property, We, the Owners Agree to the Following: I . The Owner agrees to have the POWTS inspected and maintained by a qualified maintenance provider. 2. The owner agrees to provide access to the POWTS for the qualified maintenance provider in order to service and/or maintain any and all components of the POWTS. Accruing to the maintenance and monitoring schedule provided by the POWTS manufacturer (including White Knight, St. Croix County Zoning Department, and Wisconsin Department of Commerce. 3. Minimum performance monitoring will include: a. Type of use b. Age of System c. Type of Fill Material Used (If Applicable) d. Nuisance Factors, Such as Odors or Complaints e. Mechanical Malfunction Within the System. Including Problems with Valves, Mechanical or Plumbing Components £ Material Fatigue, Including Durability, Corrosion, or Integrity of Construction and Design. g. Neglect or Improper use of POWTS. Examples Include Exceeding the design rate, Poor Maintenance of vegetative cover, unapproved covers over the POWTS or inappropriate activity over the POWTS. h. Pump Malfunction. Examples Include Dosing Volume Problems, Pressurization Problems, Breakdown, Burnout, or Pump Cycling Problems. i. Ponding in Distribution Cell. Ponding Prior to Dosing is Evidence of a Developing Clogging Mat, or Reduced Infiltration Rates. j. Overflow or Seepage Problems. Often Apparent When Sewage Effluent has "Ponded" at Surface of Ground. 4. The Owner further agrees to pay the qualified maintenance provider for all charges incurred while inspecting, pumping, or otherwise servicing and/or maintaining the POWTS in such a manner as to prevent or abate any human health hazard caused by the POWTS. Contract Drafted by: John Schroeder " 5. The Owner agrees that if required by the qualified maintenance provider, to have any components of the POWTS corrected by a Wisconsin Licensed Master Plumber that has knowledge regarding the installation and/or repair of the POWTS. 6. The Owner contract is binding for two years from the date in which the final inspection is made for the fully installed POWTS. This date will be ocate on the inspection report filed with the St. Croix County Zoning Department. 7. The Owner agrees to contact the qualified maintenance provider to have the POWTS inspected and maintained annually (or at intervals required by the county or state governmental unit) after the initial two years. (Additional evaluations may be required if warranted by operational condition of POWTS.) 8. A qualified maintenance provider shall possess a POWTS maintainer credential from the WI Department of Commerce. 9. The qualified maintenance provider shall agree to submit an inspection report to the St. Croix County Zoning Department on an annual basis. (Or intervals required by the manufacturer, county or state government unit.) 10. Recordation/Acceptance Conditions. This agreement shall, upon execution, be recorded with the Register of Deeds for St. Croix County, WI. By the recording of the easement, Grantee, or itself and its successors and assigns accepts and agrees to abide by all of the terms and conditions hereof. Qualified Maintenance Providers Name: John Schmitt Lic. #223760 John Schmitt Septic System Services Qualified Maintenance Providers Signature: ---The Following Requires Notarization--- The Owner(s) Name: Steven KeiWrt Owner(s) Signature: Julie Keipert - 01 ~ Personally came before me this day of 20 /d-, 1 dsIg`~G aye The above nanie:/ e O-e-i ~i p c f- r r9~F O~ ~C( To me known to be the person(s) who executed the forgoing instrument and has/have acknowledge the same. re of Notary Public Notary Public, State o£ Contract Drafted by: John Schroeder ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~TC►~ 5. t•c Mailing Address w%7 r l h Ab p o 400 Y 0'$Z Property Address I 7-1 TwIl S Cv 1 !!W Ora a9. , o KT Tt' x v^7'1A1p (Verification required from Planning & Zoning Department for new construction.) City/State ~w - 7le Parcel Identification Number o3 7- , Z O 7Y-10 _ 000 LEGAL DESCRIPTION Property Location '/4 , '/4 , Sec. T O N R ),Town of S©t fl c X25 c- 7 Subdivision Plat: , Lot # . Certified Survey Map # J75-690 , Volume , Page # Warranty Deed # 5 z 9'0 q (before 2007)Volume / 7- 1 I , Page # 63 ~ Spec house C yes)( no Lot lines identifiable CI yes ❑ no 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 §Comm. 83.52(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. Uwe, 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 Commerce 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 r orded in Register of Deeds Office. Num er of bedrooms 3 'J/ t/4/ l t._ SIG ATURE OF APPLICANT(S) DATE ***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. 09/07) a, ' y.~. ri.,., ~ . ti~ ~ •T. toO°~~ 9p9 STATE BAR OF W-ISCONSIN FOPR 4 3981 QUIT CLAIM DEF-D DOCUMENT NO VOL 12211"PAcf 6`~6 Gc - r - ST. CM, U Rcc'dicrRaccrd 0 EC 4 1996 quit-claims co ~---f a) it 0A. _ liS rsS2~d at jQ tM~ a ,AYon(~t di L2:15 P. `~~-=.L•.~ 'i~C L.~a3ats it it It i of ottedi the following described real estate in _ o! County, State of Wisconsin: t D p T SPACE RESERVED FOR RECORDING DATA / of Rov'k G 3" in SYC3'%'Cwj lowns44 Zo „ 1 NAMES AND RETURNADOREES I' z~'i~++"r~ 5~'cutr~ V . t~ ~7yCC~ Ei GN~1f~~) s~n~ 7iC tt~~C•~J~,~ ~l'St1'trotLt Gi~,yGs9' Z sT' C s b/I /r } `N J~+l~A3'C Vl~w ~C+~~ ~ 7 f^i ~ ~ 7l't'i ~'C(It ~~C!` O r ~ t'iC dr3 1.' C i y ~t„ O tcC p V 0',L'23, m#J SV17,6 ' 4~.t /VG "SO[' ~•[Ot}I c. Als•1`7 VJ. -U- cs Docc~i+r[n~ JA; 37T6410 /o jl t) PARCEL IDENTIFICATION NUMBER I; it ;I FEE i+# - YY~ jt n l; j! %i This ~S HpT homestead property. ii (is) - (is not) q Dated this Y day oC L)IL[mh*0 v^ I, i- (SEAL) (SEAL) (SEAL) (SEAL) st AUTHENTICATION ACKNOWLEDGMENT Signatutt(s) State of WJiscortsin, ss. authenticated this day oC19 Personallv came before me this day of Q eC-~ht the above named T rITLE: ivlb.MBL'R STATE BAR OF WISCONSIN (if not, _ authorized by &706.06, Wis. Stats.) to ine known to be the person who executed the foregoing I i -ihstYament and acknowiedge the same. 1 TM 1`u TRUMEt/~SED t3Y. `4~ C (~cV°o JL Z e ~ j'~-(f---_--, s t.... r- t~V~:P ri•. 1.1- I. ~ !a G, 3 J : Cti _ 16otgt-y Public, _ S7 e r d I County Wis. (Sign-lobes may bt' authcneicated or -icknowlcdgcd. Both are,16ott- 11 . II commission is permanent. (1( not, state expiration date: ncct•ssary.l y''• . 4 N~m.S .al p.r,..... axnmp, m a -.,poi :rv 1h.-Id by tepcd , : pnmcd QUIT (.1 AIM DI-VID ST:\'(DR iL?F,3},1$,4 (,~i51CF.°• w.scon;m taga' {m ~A~a I e. v1-s SAFETY AND BUILDINGS DIVISION Plumbing Product Review coI1 met' emi.gov P.O. Box 2658 Madison, Wisconsin 53701-2658 tcepwUn i sco ns i n TTY= Contact Through Relay M Jim Doyle, Governor Richard J. Leinenkugei, Secretary October 2, 2008 KNIGHT TREATMENT SYSTEMS MARK C NOGA, VP 281 COUNTY ROUTE 51A OSW EGO NY 13126 Re: Description: CHEMICAL OR PHYSICAL RESTORATION FOR POWTS Manufacturer: KNIGHT TREATMENT SYSTEMS Product Name: WHITE KNIGHT MICROBIAL INOCULATOR/GENERATOR Model Number(s): WK-40 AND WK-78 Product File No: 20080513 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters Comm 82 through 84, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of DECEMBER 2013. This approval is contingent upon compliance with the following stipulation(s): • This product must be utilized in accordance with the manufacturer's printed installation instructions and this product approval. If there is a conflict between the manufacturer's installation instructions and the product approval, the product approval requirements will take precedence. • The elevation of the system's infiltrative surface must be above the estimated highest groundwater elevation or bedrock by the distance prescribed in column entitled "Fecal Coliform >10000 cfu/100 ml" in Table Comm 83.44- 3, Wis. Adm. Code. • A copy of this approval letter and the manufacturer's printed installation instructions must be supplied to the buyer of this product. • The outlet baffle of the septic tank, which has this product installed, must have installed an effluent filter capable of filtering particles of 1/8 inch in size or larger. • This product must be installed by a properly licensed plumber. • A state Sanitary Permit must be obtained when this product is installed. • The IOS-500 inoculant must be exchanged at least on an annual basis. SBD-10564-E (N.10/97) File Ref: 08051301.DOC KNIGHT TREATMENT SYSTEMS Page 2 October 2, 2008 PRODUCT FILE NO. 20080513 • This product is approved to be installed in existing and new treatment tanks to rejuvenate failing soil dispersal areas. The product may be installed in single or two compartment tanks. . The product may be installed in the second compartment of a septic tank; preference is to have the product placed in the main compartment or inlet side of a two compartment tank. . To promote having an area of quiescence and that of settling in a single compartment tank, locating the product off center--towards the inlet side of the tank-- is the preferred procedure. • For installations where the access opening is not directly above the desired product location within the tank, a standard installation practice involves the use of a flexible air line between the air supply's riser entry point and product; in some installations to existing tanks, access modification may be needed. This approval supersedes the approval issued on 12/23/2003 under product file number 20030401. This approval letter shall be incorporated with your previously approved plans and/or specifications approved under product file number 20030401. The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may result from its use. During the period that this product approval is in effect, it is the responsibly of the submitting party to inform Commerce of any changes to the contact information or an address change. Renewals will be sent to the address of record. Sincerely, Jean M. MacCubbin, CST Engineering Consultant—Plumbing Product Reviewer Commerce; Safety & Buildings Div. PO Box 2658 201 W Washington Ave. Madison WI 53703-2658 Phone: 608-266-0955; Fax: 608-283-7456 E-mail: Jean.MacCubbin@wisconsin.gov Enc. li S STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS SUBDIVISION / CSM#w-L~ L > LOT # °Z SECTION. Z~-/TZ'0- N-R,,~ W, Town of Jd~ crS~` ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r ~ YY ~ r~i r/! ` Jy r- \ ~ ' nr ! ~~°ef s INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r BENCHMARK' le- C' ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING-.TANK INFORMATION Manufacturer: Liquid Capacity:, Ora Setback from: Well ,410 (,r/,ouse Other Pump: Manufacturer 2~ ,c el-- Model#--~~`-~- Size Float seperation _ Gallons/cycle:~o?O. Alarm Location ~7~ /~cel~ SO ABSORPTION SYSTEM i A/Width:_A/?~ Length Number of trenches Act, ~ Distance & Direction to nearest prop. line: f~0 Setback from: well: 6rJ~ House Other ELEVATIONS Building Sewer O~7 ST Inlet. ST outlet 9 . PC inlet PC bottom Pump Off Header/Manifold Bottom of system _ Existing Grade - 0:~ Final grade D~ ~ DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt -7 BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION Manufacturer: ze'le e Liquid Capacity:, j a i Setback from: Well 4 ~x/{ ouse Other Pump: Manufacturer 2z lclll- Model#~ Size ,z Float seperation t' 147 Gallons/cycle: ~O. r Alarm Location '614 <1 f SOI ABSORPTION SYSTEM f Width : _ Length //,-7 Number of trenches ~dk~N Distance & Direction to nearest prop. line: Setback from: well: Jf House ,--0 Other ELEVATIONS '01>2 .7 411 Building Sewer ~7 510/ ST Inlet: ST outlet . i' PC inlet PC bottom_,~!~ Pump Off Header/Manifolds-t- Bottom of system . Existing Grade Final grade 0,49 A ~t~~✓°~ DATE OF INSTALLATION: PLUMBER ON JOB:- i LICENSE NUMBER: INSPECTOR: 3/93:jt LQQAT,UNt a,tSQXM38Ty,1.4. 30.20.MOAW SWA&MVEffRINGS RE-County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitar rmi GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI t ~Rff v.. nsp. BM Elev.: BM Descriptio g Parcel Tax No.: -72 S t 60 as ;tZ,I_Z~ " :::I TANK INFORMATION ELEVATION DATA A9300172 / TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic' Benchmark Dosing AeratiorT- Bldg. Sewer Holding St/ Inlet yl s a TANK SETBACK INFORMATION St/ Outlet S, /-7 910, TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic r 4 NA Dt Bottom e4~ Dosing >14d NA -+/Man. d/, o? Aeratio NA Dist. Pipe /Q~ 7 Holding Bot. System 3'~13~ 3, PUMP/ SIPHON INF ATION Final Grade anufacturer Demand ! ` c~~ ✓a 3,'5'5 pD OgGlodel Number < ~~~GPM• Itf TDH Lifts,/, Friction,,O';, System ,3) ' TDH ,DQFt I Loss mead Forcemain Length 6 Dia. Dist.Towell SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length - ' No. Of Trenches PIT f Pits Inside Dia. Liquid Depth DIMENSIONS f DIMEN I N LEACHING acturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM f r, CHAMBER Mod um er: INFORMATION Type O System: yykt.< N OR UNIT DISTRIBUTION SYSTEM -Hosier / Manifold Distribution Pipe(s) „ r f x Hole Size x Hole Spacing Vent To Air Intake Length Dia. c~ Length o?~ Dia. _Z Spacing 30 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of i, xx Seeded _ xx Mulched Bed /Ttg%k1-Center Bed /47,wKh Edges /Z ' ld Topsoil ~O plf es ❑ No 1:1 No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET14.30.20.7$6,SW,LOT 2,TWIN~S R~ING5 RD. 160,Q~. P . 4 rr f , ) t { E a , A Plan revision required? ❑ Yes rlJ No Use other side for additional information. A41 Inspector'sSignature Cert. No-- SBD-6710(R 05/91) Date M ADDITIONAL COMMENTS AND SKETCH r SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION r.OILHR COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than / 93 S,)& 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S91- %j6 S (0'/ PROPERTY OWNER PROPERTY L ATION ai ecA-e_ A' f e r %a51W'/a, S T. 30, N, R z d E (or PROPERTY OWNER'S MAILING DRESS LOT # BLOCK # O CITY, ST ZIP COD PHONE NUMBER y7y6 SUBDIVISION NAME OR CSNUMBER 21 11. TYPE OF BUILDING: (Check one) CITY L NEAREST ROAD ❑ State Owned ~ VILLAGE S" SOn~e 2 Tr.~ " - tin ,S ❑ Public L',, TAX 4 or 2 Fam. Dwelling4 of bedrooms PARCEL NUMBER(S) + 111. BUILDING USE: (If building type is public, check all that apply) ? 0 E, 1 ❑ Apt/Condo J 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 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 in line A. Check line B if applicable) A) 1. Z New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 X Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ 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 (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 13761 V X13 73 Feet Feet VII. TANK CAPACITY Site INFORMATION in gallons Total # of Manufacturer's Prefab. Fiber- Exper. New istin Gallons Tanks Name oncret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank ll o Ltd Lift Pump Tank/Si hon Chamber Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumb nature: (No Stamp MP/MPRSW No.: Business Phone Number: it Z ~~<l --3 l~ PI elr's Address (Street, Pity, State, Zip Code IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater a e ssue Is 'ng Agent Signat (No Stamps) E] Approved E] Owner Given Initial p ~ Surcharge Fee) / Adverse Determination, X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) 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 the time of ren(-~,val any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to thl:> permn ' must be approved by the permit issuing author 0y. 4. Ch<srrges in ownership : r plumber requires a Sanitary Permit Transfer,+c?r ~wal Fear; H 6K9) to be submitted to the county prior to installation. 5. O! ire sewage sy4.term wust be-properly nna.intained. The s-_.pts, tank(;) rr!iir3t be pu!rp.'. by a ic.r,nsecl pumper wheriever necessary, usually every 2 to 3 years. 6. It you have questions concerning your onsite sewage system, contact your local code adwinisttator or the State cf Wisconsin, Safety & Buildings Division, 608-266-3815. 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 end complete of bedrooms if 1 or 2 Fami'y Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that applq. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, ecornection, or repair. V. Type of system. Check appropriate box depending on system type. Vt. Absorption system information. Provide all information requested in #1-'. Vt1. Tar:k rmation. Fill in the capa6 y of every new and/or existirid Iao list tI,o toy tl _io!:- nUrn lit r of tanks in d ! ~ r~u¢acturer's name indicate prefab or site constructed and ta.rif. arc ri ~i. t ~'~~~te `o all septi. and holding tusks for this system. Check rl~nf.rrt ~ ~~rpr~~.+ai a 'is H,_,- , ~ceived expo iir ;a, c;uct appnwal from DIi HIR Vlhi Pe-sponsibikty r:-'e Went. installing plumb-i i=; rn fill in na^;e, license nuivii, woh a.)pr=)p, re prefix (e.g. NJP, tc.j.. asp-,.! phone nurnber. P!a:rnt)er must sign aptiic:at!on torrn. iX. CountyiDepartment Use Only. County/Departmerl~ Oise 0.riy. Complete plans arid spec +i^ations not smaller than 8'h 11 inches mcis,t br :ubrr!itt, d to t"e cot sty. The plans rntlSt inci'--le !`2 fot;r?--h,ng: A) plot plan, +,i"awr! to scale or .:iilh co l "...:'r)r rat'o!1 Of h^•!•.~~~. tank(;), scpii:, to-lk;~,) or other treatment tar:ks; building se ti e._ %vw; > w rr ii:: crater ~ arvice; • < r ,.,;T,. ;anti lak-s urrip or siphons tanks, distribution boxes; soil absc- .i -;VStPM- - ; °,.,rr!er syste(:! as it f. lj:..1 Gf 4ra 7Uiid ng 5 1, 9) horizontal and ;Jo i . .,i,: rc~' I i.. i.) complete specifications #o; pumps anu ca!>trols; dose volume, eiev.ati,) `r !o is, pump performance curve; pump model and puaip manufacturer; D) crass PC,_,M -:he so!: ah-.-nlson s; stem it required by the county; E) roil test data on a 115 form, and F) all sizing nfon ration. - - - - - - - - - - - - - - - - - - - - - - GROUNDWATER SURCHARGE 1983 'Aiisc:onsin Act 410 included the creation of surcha3rge~, (t'ee:s) for a nurn, i!-~r o requl,,Ied practices which car effect gro-indwater. The FYiQn?k (rstieCtH(j through these SW`CharnH?5 are use r'! n1oii.., ".titer, . C. water cortarnination investigations and establishment of siaridarcis. - SBD-6398 (R.11/88) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, GG DIVISION LABOR AN HUMAN REDLATIONS PERCOLATION TESTS (11J) MADIS ONBOX W 53707 R 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: COUNTY:: MAILING ADDRESS: ~J Cam/ o P r f C dc~C~Jina,oj USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER TION EST Kesidence l~ XNew ❑ Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IIN-FIILLHOLDING TANK: RECOM ENDED SYSTEM: (optional) E]S ~a EAS ❑U ❑S MU ❑SN❑S ®U { o o'<.~/ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate:. Floodplain, indicate Floodplain elevation: laol~ PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- C ~dOf L B- 160- /v°-..c .2.c C B- S ao o^~~ a2 _ PERCOLA 10 TES S -0 A;7 T tie TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IVOW AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P_ o S3 P- o O P- =r-1 D P_ 1 P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION To 4«lelee"'"' ,5tu~~. 0 44 64 150, dl fro _er D5r 1, 1 4'0 V ~ i - VE8 44 INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well Is - Fine Sand Bldg - Building Is- Loamy Sand - Greater Than 'sl - Loamy Sand - Less Than 'I - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point FILED a C J FES p- 3982 r-w C7 JAMES 0' CONNELi "fwr of Dods y~ cm. Cosh, CERTIFIED SURVEY MAP a~ LOCATED IN GOV. LOT 3, SEC. 14,T30N,R2OW, TOWN OF SOMERSET, ST. CROIX CO.,WISCONSIN. SEE REVERSE SIDE FOR DESCRIPTION. / N62°0300"E 1.?T;F;_D S~ikV`Y / 55.22 A.1 G . 78 . 2 . L. 3,, . . / ~tK F , ti h6 ~~S i Oh~ - aLOT ~ Rl / .1 .94 A C. 10 844 15 SO. FT. ti J SR3o QO ~ O Q0 0) 57 00, 00, C\ A, Al. L 0 T 2 4.01 AC. hh 174600 SO. FT. J (10 a i / ~ Y •ti P. R.3o ° APPROVED ,C p FE B 16 1982 STC-100 This application form is to be completed in full and signed by Ithe owner(n) of Hla nrn►~n,.~ t. _ S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ADDRESS_ ~O~J~b N Sf~• X71"• FIRE NUMBER CITY/STATE ZIP_ SS) 7 PROPERTY L<OCATION : ,5w 1/4, SW 1/4, SECTION N , T N-R as W TOWN of JO ~'~Q`~`~C~ St. Croix County, SUBDIVISION I w~r1 S~h~~ , LOT NUMBER z 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 septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix county accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1). the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/11e, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that vour sent-in hac h=mn "n; r,4-,; ....a DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED ` 48957 VOL MPkGE210 REGISTER'S OFFICE „L Sl: CROIX CA„ W1 t Recd for Record O C T 0 G 1992 conveys and warrants to at 11:30 A., M : } RETURN TO the following described real estate in `hd'-'e County, State of Wisconsin: AAA I/" /&--o /7 _"C'"-7L Tax Parcel No: ca- le ~ ,.v Gtr t'' k '/L~ /l -c~ f C Ly- Ito 4P / fRAN4SF This _ , C2 tom homestead property. (is) (is not) Exception to Warranties: It/ 6 n day of Dated LIS 9 . (SEAL) (SEAL) < < (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT m ~e.nE~S~J'EY'~ Signature(s) STATE OFiAI'I'8GONem se. RACCvSF::~► County. authenticated this day of 19 /7,,^ t Pe`sonally came before me this day of X5 OPTIONAL WORKSHEET 1. MOUND SYSTEM II. IN-GROUND PRESSURE SYSTEM-Continued- I 1. Wastewater Load, Total Daily Flow= gal. 10. Force Main: yG - J6 Use section H 63.15 (3) (c), Wis. Minimum Dosing Rate = gp Adm. Code and PROVIDE A DETAILED Diameter = in. LIST OF SIZING ON PLANS. 02 11. Total Dynamic Head: 2. Depth to Limiting Factor = System Head = 2.5 ft. 3. Landslope = _ j % Vertical Lift ft, 4. Distance from Dose Chamber to Friction Loss 4 fI. Distribution System = t. ft. TDH = 44 fl. 5. Elevation Difference Between 12. Pump Selection: Pump and Distribution System = 6 ft. Pump will discharge at least y` gpm 6. Absorption Area Sizing: at . ft. total dynamic head. ~0 -e- Area Required = j 4 71, sq. ft. Pump model and manufacturer: Bed or Trench Length (B) _ 4J '7 ft. Bed or Trench Width (A) = ft. 13. Dose Volume: Trench Spacing (C) ft. 10 Times Void Volume of 77 7. Mound Height: Distribution Lines= .~L- gal. Fill Depth (D) _ ft. Daily Wastewater Volume r Fill Depth Downslope (E) _ ~,Cs!2 ft. 4 Doses in 24 hrs. _ gal. Bed or Trench Depth (F) Backflow = gal. ' Cap and Topsoil Depth (G) = ft. Minimum Dose = 00,0r-+2 gal.. Cap and Topsoil Depth (H) = ft. 14. Dose Chamber: 8. Mound Length'. Volume gal. End Slope (K) = ft. Total Mound Length (L) = ft. 111. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: 1. Wastewater Load, Total Daily Flow = gal. Upslope Correction Factor = Use section H 63.15 (3) (c), Wis. Upslope Width = ft. Adm. Code and PROVIDE DETAILED Downslope Correction Factor LIST OF SIZING ON PLANS. Downslope Width (1) = ft. 2. Required Septic Tank Capacity = gal. Total Mound Width (W) = ft. 3. Percolation Rate = min./in. 10. Basal Area: 4. Absorption Area Sizing: Infiltrative Capacity of Refer to Table 2 in chapter H 63 Natural Soil = + gal./sq.ft./day and PROVIDE A DETAILED LIST OF Basal Area Required = sq. ft. SIZING ON PLANS. Basal Area Available = 01A sq. ft. Required Area = sq. ft. 11. If Standard Tables from Chapter Length = ft. H 63 are Used, Indicate Table No. '92 Width = ft. 12. For the Distribution Network, Use Numbers 5.14 in Section 11. Number of Trenches= Trench Spacing = ft. if. IN-GROUND PRESSURE SYSTEM z~ 5. Distribution System: 1. Depth to Limiting Factor = $ Lateral Length = . ft. 2. Landslope = % Number of Laterals = 3. Percolation Rate = min./in. Lateral Spacing = in. 4. Proposed System Elevation = ft. Distance from Sidewall to Pipe = in. 5. Wastewater Load, Total Daily Flow: gal. System Elevation = ft. Use section H 63.15 (3) (c), Wis. Adm. Code and PROVIDE A DETAILED IV. SYSTEM-IN-FILL LIST OF SIZING ON PLANS. Fill in All Items from Section III Required Septic Tank Capacity gal. ' 6. Absorption Area Sizlhg: V. SEPTIC TANK Percolation Rate = min./in. 1. Capacity = gal. Area Required = sq. ft. 2. Manufacturer. System Length= , ft. 3. Show Site Constructed Tank Details on Plan System Width = ft. 7. Distribution Pipe Sizing: V1. DOSING TANK Hole Sire = in. 1. Capacity = gal. Hole Spacing _ -yr'~yLh 2. Manufacturer: Lateral Length - a It. 3. Pump Manulaclumr: Lateral Size - in. 4. Puntp Model: Lateral Spacing it. 5. Operating Head= ft. Dislaoce. Irnn► tiituwall -to Pipe in. 0. Flow Rate= gpm• N. Distribution Pipe Discharge Rate: 7. Show Site Constructed Tank Details on Plans Number W Boles Per Pipe O low Per Pipe 4 1 gpnt. VII. HOI.UING'l ANK 9. Manilold Sizing: I. Capacity = gal. Type (center or unit) • ,e 'FC 2. Manulacturer: Length = It. 3. Show Site C structed Tank Details on Plans Diameter 2056 -SHOW ALL INFORMATION ON PLANS DILHR SBD-6761 (R.03/82) r`//v 1 r'LK PROJECT 0 1)4SGcl 1/4 S%y /T~p N/RW TOWN COUNTY ~ _ ~rc,1 MPRS Byron Bird J(. 3318 DATE BEDROOMq CLASS PERC__,~-_ CONVENTIONAL- IN-GROUN PRESSURE CONVENTIONAL LIFT- MOUNDn. HOLDI G TANK SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE OLDING TANK SIZE ABSORPTION AREA PERC RATE _.,_3 __BED SIZE 4 L Benchmark V.R.P. Assume Elevation 100' Location of Benchmark cJ//, fc 5/ * H.R.P. _14=K>, Lr•^rLr^G- (rra~t ` 0 Borehole Q Well Scale = Feet 0 Perc Hole System Elevation ONSITE SEWAGE SYSTEM q3 P P R,.0, V, ED, DEPARTME NT OF INDUSTRY, Lr;BOR AND HUNMN RELATIONS DIVISION OF SAFETY AND BUILDINGS SEE CORRESPONDENCE I tf~5 < < ,,,emu 6 r•, n, Y,..,-. W ~~~.c.kS Pte''" 1 ~L <b3• ~ 0 P,3. 691-20561. i ~ : boo ZY W i ~c!~y Page --.Of Straw,' Marsh Hay, Or Synthetic` Covering Distribution Pipe Medium Sand Topsoil H G ;RX Slope . ;ptSBed Of i - 2 2 Force Main Plowed Aggregate ,,,.From Pump Layer Cross Section Of A Mound System Using E L Ft. A Bed For The Absorption Area F 7 -Pt. G j- Ft. Signed: A Ft. H -S~Ft. B 7- Ft. icense Number. /Q K fo Ft. Date: ,7.-,1.~-- E _IEZ Ft. `7. Alternate Position J Ft. of i - Ft. Force Ma i.n W v?`6 Ft. L i J' t- Observation Pipe--,,," KA A ----T-- - - W ~o - Farce Main Dlstrlbutign Bed 03 2 Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area g~ - 2,0561 grit -h « Page _ Of 1 Perforated Pipe Detail •-iMi DEWTP Li"J t,. i-AA G AND lit1 AN RELATIONS E3-Y AND BUILDINGS Perfora4ed CORRESPONDENCE End Cap] Pvc Pipe f. b Ct+e Holes Located On Bottom, S w Are Equally Spaced S P + PVC Force Main w PVC Manifold Pipe Distribution Alternate Position of Pipe Force Main Last Hole Should Be Next To End Cop End Cop .0 Distribution Pipe Layout P -5 Ft R S X 6) Inches y 960 Inches Hole Diameter Inch Signed• Lateral _ Inch(es) License Number: e/ Manifold Inches Date: '7 Force Main Inches # of holes/pipe /o Invert Elevation of Laterals Ft. S91-20561 Qtr36T2 SEWAGE SSYSSTCM Approved Vent Pipe OiV,v.~°~, i' ~.~+tLt~sUuJ Minimum /Fi nal Grades-. N., & pf f Approved Joint ~ ~18" Minimum f SPECIFICATIONS f 1 1~ TANK New Existing - - - - Manu acturer• Approved Joint Tank Size: allons w/ C.I. Pipe Extending 3" Onto Solid Soil NUMBER OF BEDROOMS: GALLONS PER DAY:__ 3" of Bedding Under Tank Owner's Name: Address: I~~ er` Discription: v2p~~''`°•~~~`.jJo/~ t unicipal n fyv5- n - G,^~ x - q0-u w PLUMBER/DESIGNER Signature: License Number:,' Date: S91-20561 PAGE BUMP `CHAMBER CROSS SECTION AIUD SPECIFICATIOUS VEiJT CAP w"C.I. VEAIT PIPE WEATHER. PROOF APPROVED LOCKING JUAJCTIOKI BOX M HOLE COVER 25' FROM DOOR ~Wcttr►~ . k bc~ WINDOW OR FRESH t2 MIIJ. AIR nJTAKE G R A C1'E CONDUIT - Ia~rtw.. - SG~hJ16,1~C ~ i- IIJLET ONS 9TEy1q'i I n ✓t~J,pLTI&HT SEAL i I ( { i~ t-7 , - --717-) APPROVED JOINT A^~ ( I APPROVED JOINT. W/C;x. PIPE -p r, e a'I I I WjC.I. PIPE EXTENDING. 3' R~LP,~IONS I £XTEMIDJWG 3' 0)1T0 SOLID SOIL ALARNt I ONTO SOLID SOIL [}11~"t~[OdV C11~ Aie1J U`UiLDIhGS I I ON C ELEV. FT. _ ,Eil<3 PUMPS -1 ,w. OFF D CONCRETE BLOCK RISER EXIT PERMIMIRD~ G) L4 IF TAUK MANUFACTURER HAS S CH APPROVAL jq, f d SE iC E SPE IFIG~6TIOU AKlK MANUFACTURER: WMBER OF DOSES: ---PER DA-4 TANK SIZE : A 426, GALLOWS DOSE VOLUME jL ar - IKICLUDIMG BACKFLCW:,,! ~a y f,ALLOMS ALARM MANUFACTURER: MODEL IQUM$ER: CAPACITIES: A=MATCHES OR "Q GALLOWS` SWITCH TAPE". B=.9, iIJCHEs oR _ 10 CALLOUS PUMP MAMUFAC.TURER: C. IAIGHES OR ....L t2 GALLOWS MODEL 1JUM6EK. ~f7 D• INCHES OR Z-60 GALLOUS SWITCH TYPE:' I~} /^G u •'f/ NOTE: PUMP AND ALARM ARE TO DL MINIMUM DISCHARGE` RATr 6PM/ INSTALLED CaKJ SEPARATE CIRCUITS VERTICAL DIFFEREMCIE DETWEEM PUMP OFFJAKIO DISTRIBUTION PIPE.. FEET MIUIMUM METWORK SUPPLY PRESSURE ,r.... 2.5 FEET -1- FEET OF FORCE MAIN X s2F/apFRlCf1o1~1 FACTOR.. 991 T F- EE5 91 0 C ~qJ TOTAL Ot WAMIC. HEAD = /2 FEET IMTEKUAI, DIMEWSIONS OF TAWK: LEK,IGTH T ;WIDTH .11LIQUID DEPTH LICENSE 1JUMBER:✓~ SIGNED: DATE: . HEAD CAPACITY CURVE TDH W 20561 W 90+ TOTAL ovNA WC "E AWCAPACtTT ►tn tetttutt oftuttrt will 06111mmilli p 26 # sIE ss.sT.s• n M.+Ie +a us EFFLUENT AND DEWATERING f t Qk GfL oft GAL GAL -43 a tOS bt •t 24 SEWAGE AND DEWATERING +0 N sT to e+ et tS a a to so T` !o 27 !e e0 4- is- 29 sy 59 % 30 SI A \ 40 46 16 so a St t S:t I ~ _e0 _ 1S a 20 N 4- 20 30 163 % eo Em RA - WER - t._ ae sT -1 ` % MODEL Lack V10", - ~t► 1+5 16~J~---4- ~ , i •lvIMOE At00lwNttINNO % •E1Mq Iet •1• >N IN !p 16 GAL Gfa tsfL Gft Gift 1 ! s ,c. ,oe 130 Teo _ T s to eo s: •s Tii is 20 a S7 to 14 E ,-T--~- 20 • a in `k 1 i n t• so ss 12 t 35 MODEL b ti w 10 L.... Lock Va" .e !t 26 s sa 8 MODEL$ , t t i I i •t k• M DEL 6 ~r ODE 2194 2921 % M DELs i 2 % 57 M DE MQ EL 59 i 07 2~7 1.,-WN mm LITERS 80 160 240 320 400 480 5 C 0 FLOW PER MINUTE N OV - - PARING BU~EAIJ i use Ow N►thws Lem iWnlAat:Msrs of . ` cky 40210 L Q. LoulsWft Kentu (S02) 778-2791 ~Q~.~~rr ,ou,.os 'FlArr /93Q a 40 i i 8C 801 J"4o. 8 8 CROIX ~,,RIVER' - 5 804 _ -r-P y 07 G S . `OO 808 86$ - 09 867 78 ss ' \6 810 r~ mod' 8.11 865 780 {y' . z $ I 6~ 884 JOv 863 QPU { ~y -812 g x : 814 8s2 ` LOT 2 S 815 _ _ '8 F : N- .r 6 8b~ 860_ . - a 73]730 _ r ` brj. 859 . a\~ ~ 8 741 856: 785 6 z ` e,g a ♦ .254 78 5 C boo _ oe 2 A' Q 797 - 799 798 , a 877a ~0 , 875 876 B 2617i 876 A - LOT 1b 873 874 B 786 D ~ _ 9 BM, m 793 CERTIFIED SURVEY MAP 87% \ VOLUME 2, PAGE 399 231.71 _ o 3~. 78 793 \ 9 _9 786 A ' 3 L 'o-f, ' 786 C ' MfVr C.SM_ VOL. 2, PAGE 334 _ _ 5W Q ~z`C, l T3o,U ,e2O ' h k ST. CROIX COUNTY !y k4~ ~Sr S hJ ♦ WISCONSIN r ZONING OFFICE i ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 July 18, 1991 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation of the Roger Winberg property, located in Gov't lot 2, of the SW 1/4 of Section 14, T30N-R20W, Town of Somerset, St. Croix County, revealed 24" of suitable soil requiring 1 foot of fill for an onsite sewage disposal making this site suitable for a mound septic system. Should you have any questions, please feel free to contact this office. Si cerely, Jame Thompson Ass stant Zoning Administrator cj 30 r~~; o- / 7- - Croix., uJ/, ie - '1~EM f Ih N- United States Department of the Interior Y1 NATIONAL PARK SERVICE ■ ST. CROIX NATIONAL SCENIC RIVERWAY IN REPLY REFER TO: P.O. BOX 708 ST. CROIX FALLS, WISCONSIN 54024 July 13, 1993 L1425(SACN) Mr. Steven Keipert 6370 North 45th Street Oakdale, Minnesota 55128 Dear Mr. Keipert: We have received your request to construct a single family residence according to the plans you submitted on your property, Tract 12-188 of the Lower St. Croix National Scenic Riverway. On July 11, 1993, Park Ranger Joseph P. Hudick of our staff inspected your property and reviewed your plans and the proposed building site. Based on this inspection and his recommendations, this request is permissible under the terms of the easement presently in effect on your property. However, you should note that our permission is only provisional and is contingent upon your compliance with all other applicable land use controls. In effect, our contingent approval indicates only that the riverway scenic easement conditions are fulfilled. It in no way evaluates the merits of the proposal in relation to local zoning or the Wisconsin Department of Natural Resources, and thus does not preclude or supersede any actions by those units of government. Therefore, you should be aware of the need to comply h the regulations, ordinances, and land use controls of Somerset Township, .six ;,`and the Wisconsin Department of Natural Resources, to whom copies of this letter are being sent. Your cooperation in the compliance with the terms of your scenic easement is appreciated. If you have any questions, please do not hesitate to contact this office at (715) 483-3284. Sincerely, r n 1 Anthony L. Andersen 'ZI Superintendent 15