Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
006-1093-20-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safetyand Building Division INSPECTION REPORT GENBK'cAL Ih''FORMATION (ATTACH TO PERMIT) Personal information you provide Maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Burton, Ann C Ion, Town of CST BM Elev: Insp. BM Elev: BM Description: °~ 5 . ~ 63 - I cs TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic (~- l ~ S ~., z~ b S~ Dosing ~ ~ p !Qcy~,~,,,~j t t Aeration Holding TANK SETBACK INFORMATION TANK TO P!L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ f+ '~ ~ J,~~ Dosing tt Y ~ / 0 Aeration Holding PUMP/SIPHON INFORMATION 11~ Manufacturer Demand ~,L~s' GPM c Model Number ~P,~ ~` D TDH Li ®~ Ftictign ~~ System, ~I~ Ft T ~ Z . . ~~ O • ~ Forcemain K ia. Lengths Dist. to Well Z C/lll ARCCIRPTIC)N RYSTFM County: St. CrOIX Sanitary Permit No: i ~~~b 47 9337 C to Plan ID No: z~35S= T1~paS- ~ D.~ rcel Tax No: 006-1093-20-000 Section/Town/Range/Map No: 33.31.16.616 STATION BS HI FS ELEV. Benchmark 3 .Sv 163 ~ ~ 4 9. cP Alt. BM /ve C W Z,~j /ad . 35 81dg. Sewer .y / ~ ~/ to J ~ .O6 St/Ht Inlet ~~~ may, 3/ / ! ~ St/Ht Outlet '~ Ut Inlet Dt Bottom I (, 0 ~ ~, gl 1 reader/Man. z S3 ~ t . Dist. Pipe _ • ~~~• 3s„t Bot. System S' Z ~ / t30. Fi al Grade y w . l~ Ise ~ ~+ 2 + -- St Cover ' o ~ ~ ~tiitrY ; ~ h ,SU ~ 0/. 3 ~ / C~~t 3.1`7 99 • ~ 3 .vl ~l .S ~ ~ y 170. B /7'R'L'1lCH Width ~ Lend 1 PIT DIMENSIONS No. Of Pit Inside Dia. liquid Depth IMENSIONS ` J 5 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHIN nufacturer. INFORMATION CHAMBER O Type`O~f Syste ~~ ~ ( ~ UNIT umber. r•0 1'-ICTOIQt ITIf1A1 CVCTGM ! 1 _ ._t/ .L~ i A_ W - 1'/L 1 Header/Manifol ~ I /r f.~ (~ ~ IZ ' Di Distribution 1 ~ tr v .. ~- / Pipe(s)n ~24, ~ T ~ c Dia S acin th L x Hole Sizg ~~ S/32 i x Hole Spacing / / ~c"~~- l Vent to Air Intake Length 1 a . . p g eng Cnll /'n\/GD ., ~..,........., c..~s.....~ n..~.. .... 11A...~.~r1 nr et-(:rarto Cvstams Anly Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center BedlTrench Edges Topsoil ~ Yes ~ 1, No ! : i Yes L~ No C ~nM~~~ITSlude cede r enci s, persons pr ent, etr,) Inspection #1: ~~ go / OAb Inspection #2:~/~/ Ud~ +Cyx. ` G6'1hS~f'ul~ ~i ~Qlb.Q C~j vt p~ ' is u l -~t'M~ ocatlon: 1818 Coun~Road O Deer Park, WI 540 7 (SE ]j4 SW 1/4 T31 N R16W) A\Lot 2 'fir P cel No: 33.31.16./616 t ~~~~ / `1AA~ J Skb~"' ~ou~J-ovU(~ ~~ ~ ~Od' 'Sa.¢_ ~ ~/ . 1.) Alt BM Description = l? %~ ~~ Yt6~A- ~~' 2.) Bldg sewer length = ~ q t u -amount of cover = 7 Z'{ __ -- -- ~ --7 ,I~ ~y~ Plan revision Required? , ]Yes ~ ~ No ~ ZT P / ~~ _ - -- Use other side for additional informa5on. ~_~ " I~_~_ __ --- -- - - -- Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ` ~ Safety and Buildings Division 201 W. Washington A P.O. Box 7162 County ~-, ~{L ~ / , ~ ~~~OJ~~,~ Madison, WI 5 - 7 2 Sanitary Permit Number (to be filled in by CoJ Department of Commerce (608) 26 y 7~ 33 Sanitary Permit Application State P lan I.D Number G ~ 7 S~ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide < ~ (~ may be used for secondary purposes Privacy Law, s15. '~ ~~ Project Address (if different than mailing address) I. Application Information -Please Print All Informati n .~ f ~ / ~ ~~~ Property Owner's Name O C Parcel # Block # A J ~•-. ~ V NTY L o Property Owner's Mailing Address ~-yC ST. ~ ` 0 7 ~/ `^ ~ ~ Property Loca tion t r C ~~ '/. J ~/. Section ~~ City, State Zi p C o de Phone Number , , ' / / / L \ ~ Jr 7 ~~ 7 7~s- -~Y3 -S / / / circle ) 50 ` (O T ~ N R~E ~ <• II. Type of Building ( eck all that apply) ~ ~ „ ~e~r ° ; ~ " ~ 3 °i Subdivis n ame CSM Numbe .~I or 2 Family Dwelling - Number of Bedrooms o J °N^- 1 NO d'SQ- o /L~ t~/~, ^ Public/Commercial -Describe Use ,, A ^ State Owned -Describe Use ~ k' S 7 /Y1 anti. ~. (, ~ ^City ^V i g ownsfiip of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) D 0~! ~ ~ ~ ~0~ ~ A. ^ New System ~ Replacetnert System ^ TreannenUHolding Tank Replacement Only ^ Other Modification to Existing System g, ^ Permit Renewal ~ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and ~ to Issued Before Expiration .---~~ Plumber Owner o or, ~ G~ IV. T e of POWTS S stem: Check all that a 1 ^ Non -Pressurized In-Ground ~ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recircul ling Sand Filter ^ Recirculating Synthetic Media Fitter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) q , 5 ~" V. Dis ersal/TreatmentRrea Information: Design Flow (gpd) Design Soil Application R dsf) Dispersal Area Required Dispersal Area Proposed System Elevation ~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Siie Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Tanks Existing Talcs ~/ ~ $cptic or Holdin_ Tank //lwO IIJJCC~~~~ ~ ),/ ~ V / V , _ _ ~. (~t.t.JLSv"'~. Aerobic Treatment Unit Dosing Cfiamber 0 ~ oO VII. Responsibility Statement- f, the undersig ,assume responsibility for installation of the POWTS shown on the attached plans. Plu Nam (Print) Plumb ignat a /MFRS Number Business Phone Number aab~s~ ~~s ~~~~ Pl nbe 's dress (Street, Ci ,State, p C e) //' ~ ~C/ ~ ~ ~~ ~/~ ~ ~fJt~ VI . Coun ~/De artment Use Onl Approved ^ D' pproved Sanitary Permit Fee (includes Groundwater Date ssu d Issuii gent Sig fur N p ^ iven Reason o enial Surcharge Fee) (/ • ~ '~ 6 iX. Conditions of Approval/Reasons for Disapproval / SYSTEM OWNER: 3 Latn.d~t' ~-t atn.S effluent filter and Septic tar* t ~ ~ 5~-4~e.- p~ f-- , . dispersal cell must all be sgrvlces /maintained / ~, e ~ ~- / ~ / ttJ~ t~~ 5 ~~ ~ ~''• as per management plan provided by pkltnber. 2. Alt setback requirements must be maintained ~ ~ 9 /~ li tsN d dina s ! ~ ~~ I ~ ~j~ ~ ~`d v~- y - U e ~ e co e nce aa par app ca or . w l r ec~ ..o.np.cac pmm tcu cM ~ounry Dory[ ror me system on paper nor toss loan nv[ x u mcltes to size 33 7 ,sibs SBD-6398 (R. 01/03) e PLOT PLAN PROJECT Ann Burton ADDRESS E 1340 1205th Ave Downing Wi 54734 'S~ i/4 ,SW 1/4S 33 /T 31 N/R 16 W TOWN Cylon COUNTY ST.CROIX SYSTEM ELEVATION BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 653 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' ^ BOREHOLE O WELL *H.R.P. Same as Benchmark Filter BEST GF10-8 ~ Neighbors Well B M * A deep tilling depth will be required to till to a depth of 12" to 16" B-5 B-1 Alley ^ B-2 B-4 Tank is to be properly bedded and provided with lockdown covers ell with approved warning labels Scale = 1 " = 30' 0% Slope Please note: Old Well may not need to be abandoned if mound is shift north and east ^ B-3 Weiser Combo Tank Cty Rd 0 Pro 3 Bedroom House All lot lines must be verified prior to installation! 182nd Ave To abandoned to DNR Code r , PLOT PLAN PROJECT Ann Burton ADDRESS E 1340 1205th Ave Downing Wi 54734 ~SE 1/4 SW 1/4S 33 /T 31 N/R 16 W TOWN Cylon COUNTY ST.CROIX SYSTEM ELEVATION 3 BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK )p()( 1000 gallons LIFT TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 BENCHMARK V R P T f 1 /2" # of chambers none . Op O pipe ASSUME ELEVATION 100' Filter BEST GF10-8 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark ~ Neighbors Well B M * A deep tilling depth will be required to ~ till to a depth of 12" to 16" B- Alley ^ B-2 B-4 Tank is to be properly bedded and provided with J lockdown covers W e I I with approved warning labels B-1 DOSE TANK SIZE 653 Scale = 1 " = 30' 0% Slope Please note: Old Well may not need to be abandoned if mound is shift north and east ^ B-3 Weiser Combo Tank Cty Rd 0 Pro 3 Bedroom House All lot lines must be verified prior to installation! 182nd Ave To abandoned to DNR Code commerce.wi.gov i ^ iscons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. co m m e rce.wi. g ov/sbi www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary October O5, 2006 CUST ID No. 226900 SHAUN R BIRD 1008 192 ND AVE NEW RICHMOND WI 54017 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/05/2008 Identification Numbers Transaction ID No. 1327355 SITE: Site ID No. 719052 Ann Burton Please refer to both identification numbers, County Road O & 182ND Avenue 'above,' ui all corres ondence with the aaenc . Town of Cylon St Croix County Lot: 1 & 2, Block: 6 FOR: Description: Mound /Three Bedroom /Level Site Object Type: POWTS Component Manual Regulated Object ID No.: 1100945 Maintenance required; 450 GPD Flow rate; 38 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. ~~i ~/~i!~IC Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. ~~~~ Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and '~ ~ D' ARTMENT OF dispersal are prohibited. ON~ SAFT~yY • The well shown on the lot lan is to be abandoned in accordance with the provisions of NR 812.26. ~_ - _ ~ p p SEE CORRESf • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat SHAiJN R BIRD Page 2 10/5/2006 • Comm 83 22(71 A copy of the approved plans ~ecifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making.them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure,. or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~1~.~~ ~~_.J~~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charlie.bratz@wisconsin. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 • t~ f r Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 8/ 30/06 Owner:Ann Burton g~~~i sqF °°r . ~'FO ~y~ 2~oos ~~~~i ~~s Location:SE1/4 SW1/4 S33 T31 N,R16 W Lot 1&2 village of Cylon, Cylon System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01 /31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curare 7-8. Maintance and Contigency plan 9-13. Soil test Shaun Bird Signature License number 1 ,.~~` GO NS j '~,,,. ,~ : • -, SHpV B-ao 1864 ~ pND~ z NEW RICNM „~~ r, .. 4 y" ^irby ~C . V I y' Si ~-C•i•L `~dt1 CtrYGS 'ON~ENC ~, •Designer • Date No 4" Observation Pipe Perforated Below Filter Fabric AS1T~i C-33 5 o n d " Topsoil ~ .\ _-1 ~ i E 'Y. Stiope Bed Of f~- 2 %2 Drain Rock Non-Woven Filter Fabric Distribution p;p~ ~_~_ _~D G Force MQin from Pump ., ~/ ,a~~fo1 ~~Ffowed~~~ Lover O ~ ~ ~ E ~ Cress Section Of A Mound System Using -- -~ F ~ A Btd For The Absorption Arta ~ s' c , A $ Ft. k j D 6 ~~ Ft. I `o Ft. . Ft. J .~ _ • I q - _ __ ___K~~ •_r Ft•_. ~... _-- -- _ _- __- -~---_.. _ Alternate Position L?Q.~4 Ft. of Force Ma i rt h~ ~Q Ft. L r4~06servation Pipe ~ ~_ g - K - -- - - - -- --- - - - -- ~~ --- - - - j _ - - - - - - - - b A ~ - ~ - W `~ ~~-_~_------------ (~ - ---------------------~~ __ Force Moin From Pump 3 p Di ti t ib ~- 2 %2 d Of % B s r on u 2 e Pipe 'Drain Rock I ~ ~~ 4 Obcervotion Pipe Permonent Morker Plon View Of Mound Usinq A Bed For The Absorption Areo - /, PAGE OF I , 1~ Signed: License Number: Date: page . 0`. Perforated Pipe Detoil ~~~~ voted On Bottom, uolly Spaced Position Of i t. nchPs nches _ Hol e Diameter ~ /-~ <'-Inch Lateral l~ Inch(es) Manifold ~ t Inches Force. Main v~- Inches # of holes/pipe Invert Elevation of Laterals~DJ ~ Ft. ~:. . S£PTI~ TA1~~ ~ P~3Mr CLAM ___._- ~r~flSS ~~~TiC;~ ~'~~ SPE~Zi Fc~~~ar~s ~ZN . ~ ~GiiRt?E ~ . ',fin ~~ ti£t~T PIPE ~~'f ~ 4g~0 £ ,9 ~•. I~ i~A~ TI6H~ SEA ~~ ~T APPS C. ~i~ ~` SE1IL ~ D y~~t~R40f Jib ~£~C~~ii3i~~ ~~T~ _- r. ~ = a T ~. s Gf45- ; TZ~~ , SEA~- ; ~. r ~~ a gppR~ ~ ~~£}LE C~D~ Eit ~d! F~L#~K ~{{ ~~~~~~ ~~L~Y . un ~i~_ t8°~~~. •- - --- ~~~P ~~;, IC 3`t pspPFt~~ BE~IIT~~ ~~~ '~~~ ~~ . CDNCI~ETE Pl~7 sPYcz~xc~.-~xor~s ::l %I ~, ~ ~~j~. l ~wbo ~uz~s~ ~os£s sE~r~cc ~ ~osE ~ ~~ xxcs~~T~ r~3.._ ~~, S' s~ ~Ai.- gAL- S S~ ~,gl~C~~Z~s= v ~ ~~ Z3~HES .__.------ ~~~,,E ~}~FAC3f3~tF.A;: y j ~ 9 7 fiA3-- ~ ~- ,~csvR~ _ `tip ~ " ~ ~,.~ sic s~xrc~ ~~: ~ar~ _ ~~ £ R ~EE~ ~- TI 0~ FZP£ - - ~ FEET RE~iIRE3~ ~y;SCt'#~R~iE g~1TE Os ~ Al'iT ~~gTgIB~ - _ FE£Z ~~~ FACTO - ~ FEET VER"f`xCAL D~FFERENC£ gg~EFg£gSU~E - - £~ €~Y~~~C ~~'~ ,~ -/ ~ IrIIN~~ ~~~K S~ X o~ , ~ ~'~f Ig ¢ f,FT' ,~ p£~T F43RC~gp1~# ~ ETA ~ DI~~~ _..,---- ~p Pure `~~~: ~£~~~ ~~~~ ~~n~r~sxor~~ ~~ SI~MED= z1~8 ~GOULDS PUMPS • Fully submerged in high grade turbine oil for lubrication and efficent heat transfer. Series APPLICATIONS Specifically designed for the following uses: • EfBuent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: 3/0° maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: t Yz° NPT. • Mechanical seal: wrbon- rotary/cera mic-stationary, BUNA-N elastomers. • Temperature: 104° F (40° C) continuous 140° F (60° C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: •EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, buih in overload with automatic reset. •EP05 Single phase: 0.5 HP 115 V or 230V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 SJTW with three prong grounding plug. Optional 20 foot length,16/3 SJTW with three prong grounding plug (standard on EP05). Available for automatic and manual operation. Automatic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^EP04 Impeller: Thermo- plastic semi-open design with pump out vanes for mechanical seal protection. Submersible Effluent Pump EP04 & EP05 ^ EP05 Impeller: Themto- plasticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing con- struction. AGENCY LISTING Canadian Standards • Association c us Fle # 1.838549 Goulds Pumps is 150 001 / ,.p~S ~` w ,~~ ~~~~ \~1 METERS FEET _.. 10 9 30'; _ _ __' - s °a i v_ a r 0 7 _ __ _ _. :_.___.__- SGPM zs rr 6 20. _ _ _ _ _ _ I ___. __; ___ 5 15'- _ -- ._... .._.._ _ _ _ - _ __ _ _i-. _._ .- - --- -----__ _ _- - -- __. v ~- 3 1 ~2•~ z -~--, o~~ `~ o~~ ~,\~ o z 4 6 I 8 cAPAaTv 3~~ ~ ®2005 ITT Water Technology, Inc. Effective January, 2005 63877 EP04 40 50 GPM 10 12 m'/h Goulds Pumps ITT Industries p~ _.. __ - __--- _ - -- - 5r _ -_._ o_ _ ~ ---_ 10 20 T 715 bbd ~SCLf ; may-o-uv L.JVt wy . ^s- -. Sent By: HP LaserJet 3100; ~~ . H v~"'iERIES "' Ui~IP/EFF~-DENT PU!'~P 9E .n. ~,., .,~_.._ _..-- www Lftt{eGiaatPu~np.cam ,,PER'S MANUAL 8~ MAI~AGEMEI''E~ P~.AN pOWTS ~ fiber of Beds . Number of ~'amm Units _ ~ ~~ alld EsSm~d flow {a>~e~age} _ aced X s~ t7~ t1Pw ~' fpm d f , c7 ai/d ~ ffc~ Rabe Sod ~`'P MoMhiY average` tnfiuQuatity ~ ~ Grease ('F'OG} Fats ~ m9n- lL ~ 9iod !D~~ pemand {8t?Ds7 l SusPen'd~ed Sorlds {'t'SS) t S22fl rrtg ~ 5'150 m /L « a To i+lp Pry went Quality Monthly a,rer-age S30 mglL B"~tierniral OxyrJ~ Demand {8OOsl Tote{ Suspended Solids {~) ~i0 mgt 51 ~ ~~ OOmi Fecal CoTiforYn (9®°i'netric mean) 'Y inchdiameter ~a~oimurn Effluent Partide 5¢e Ser+rice Event [ns~ an of tank(s) pump out contents of tank(s) Inspect dispersal caeli{5) C(eart efRueni filter Inspect P~mp• pump C°nLrats ~ atarrn Flush laterals and pressure test Page` ~_ Service FrsQaencY ^ months ~jrearfs) (Maxrmu:rt 3 A2 least once every `.r ua~ ~~~~ (~) of yank voturne 3tviren combined sludge and scum e4 «,~ ~ r(s) (Ma~ctmura 3 yrs.) At least once every At least once every At Seast once every At least once every At least once every At feast once every p m..- a - J - ,,.,._ ~ . p months KS,~ HA p onm the Ysar(s) 0 [~iAA Q months a Yearfs) p ~ Q months II yeaKs) D t1A - or 66A11!I'fENAN~ 1NSTRUCTtONS 1 ~~ st>a1i be~ made byr an ind'Niduat carrying aria °~ POWTS Mainf ~ Sepfa+8~ Insp Of tanks and dl.SpBf~a Restricted Sewer: POs tnsper~ • a 9 ~ ~~rkn uP Master PIuRlber pn of the tanks} tD iden8fy ny ~' ~ ~a~ ~K~-„upedions rr-ust inducts a ~r'ssuai inspe+~ a and scarm and so d~~ ~ a~ Servidn9 4pttg or teaks. measure the voivmE of oornbined studg fao check ~~~ ~tevets t,atd~a. klertt?[y any crad~ Tt~e d~petsal oeU45) shall be viscratlY ~ ~ the or pond'mg of etltuent on the graund sur'faOe_ nding of effluent on the 9ra(lnd suir'face. The po~tl~ulabory auti'~Y' In the observaiioii DrP~ and tIo d7edc for any Pa ulres il'ae ~Immed"raffi natificatron of the focal n9g industte a farT+n$ ~ndrtlon and req pr more of the tank volume, the gmund suil`ace may min any tank eQuais one-~irzf (K1 ~ in arooordance'"'ff' ~'. NN When the ovmhined axumulatian of stodge and scu for and disposed elttin; contents of tits tank shall be ~Irloved by a SBPtage Senrlcing Opera ~tr>~nt components; and any 113, Wi9oonsln Adminis>ratr+re t;ode. on@ttt5, P a ~~ ~y~g Maintainer. The ~ of eiilueni fltel's, rnechanicai or pressurized POWT'S comp at ~,~,rals of 'f 2 months or {ess steal[ be p?~ o f ~ pf~on of any s~'~ int. outer malntenanoe or mortiboring into authority within 'f Q d~ A seri~oe r+epa>:t shall ~~ Pf°`n~ #o ills local regu rY ce of Paine Qroduds ar ether S?AR~' UP ANO OPERA71ON ppWTS cflec~c treattttent tantc(s} for tfte Pin ff-atiorts ane For new eocisttt>rc6on. Pdoc to use of the era[ cell(s). if high conoP.n ctlernirdls that may ~i~e the treatment Pis aridlar damage the dis ~ rater prior io use_ detected hate the contents of the tank(s) removed try' a septage servicing pe Yarurs typloi ~ domestic (~c*'°°R."°"^'"' -------- t3tsic eRiueni .+ Yet utYP~~ f~ ` Page_ ~ S Sfad up shah not occctr y~ed ~n"i•condfions are frozen aL the intrltrative sut'face_ t)uring pow ~~ P~'+P ~~ ~ ~ above nomlai heghwaier levels. Vtthen fir' is FeS~ted ttte v~rast~aterwiTt tie discharged to the dlspe~ t3elt{s3 in one large dose, o~rt=_rloadtng the taus} and may nasult is the badotP or ~~ d-e ~ t To avoid this situation have the contents of the primp farlk terrinved by a Septage Serrri~cin9 Operator ~m ttes~R4 to the efnuent pump or contacx a Plttmber• or Pt7YYt"" Mairisaicier ~ a ~ ~~, operai5ng tt~e pump conCois to rr~tore normal revers within the pump tank Dv rlok drire or,padc ~ otiter ian#cs and dtsp~i mss. i3o not drive or patio overt or of~erwise drs~irb or compact, the areea witTiln t5 Beet down slime of any motmd or at-grade srn'1 absdrptiort area. - Redaction or-ei"untnation of the g from the wastewater sir~atn may improve ffIe perforllranCe and pe'olong fhe ftf~ of iht: POVYTS= arttt'bio6es; ~ ~ buns; condoms, cotkon swabs; degreasers; denfat floss; dtapei5,' drsint~arsts; t~ focfridafion dtafi tstsrrp pcrmg) vsratet; fink and vegetable peertrzgs; fie; gr+ease;- tterbit~s; rt>eak saaPs; medicaGatstts; oil; ioait~5tx_f pcodirc~s; pesi:ades: sanr"fary rrap[aris: tampons:'arzd ~vatetsofterter bc7ne_ ASANDi1i~{t=NT Vllhen tfie POWTS falls and/or is pevtttanecnlY-taken ouk t7f service ftte foIIokvitx~ steps strati i'te taken m insu,~ that the system is proptsiy and safely abandoned in oorrspiiance wifh ch_ Comm 83.33, ltiriscons-in Administrative Cade: • ~ P1P~g ~ ~k•' and P~ sFiatf -be disconnected and tfre abandoned pipe openings sealed_ + . The con~rsLs of all larks and pits stzall be removed and property disposed of by a Septage Servut~rtg Qpexatar_ • After piimptng, atl tanks and pits shalt be excavated and rr'mov:;a or their cogs removed•and the viaid space fi((ed rvtth soil, grayer ar another inert sorrd rriaLeriaL COPfT'iNGENCY PLAi11 if the POWYS fads and Gannot be repaired fhe fo{towing measures have been, ar must be taken, m pravide a code mmprrant replacement system: D A su["tabie ~eplacerrient'area has been evaluated and may be utE~{szed for the location of a replacement soil absorption system_ The replacement area shoo{d be protected from d~sturbanoe acid conepae~on and should not be infringed upon by riequir+ed setbacks from existing and proposed structure, tot Frees and v~refis_ FarTure to profec;t the teplaoernent a['e2t'i+trlti tesutt in the need for a new sot{ and site °evaluatioon to establish a suitable replacement area_ Replacement systems must comply tvitn the rues in effect at f3sat tirne_ D A suitable feplaoement area is not araTab{e due io setback and/or sot( {imita5ons_ Barring advances in POWYS technology a hoid'tng tank may be lnssatted as a fast resort to rQp{ace the fazed POl+V"FS_ the site has not been evaluated Uo identify a suitable rep(acerreent an=a_ Upon failure of tfie PoWT'S a sod.and srte evaluation must be performed ~ kxate a' suitak~le replacement area_ if no repfacesnent area is available a holdng tank rriaY be installed as a last resort to replace the failed POVYTS_ Mound and at-grade soul absorption systems may tie reoons-tructed icr place frsflo~ring remowai of the biomat at • the ir~rrtiratiye surfaces Reoonstrucixons of such systems trust corrrply vvifft the rules in effect at ti~at 5rne. «VlfAftiYli4G» SEPTIC, PUMP AND OTHER T'RF1tTMENT TANKS MAY COItitTAli~r LETi-lAL C~,ASSES ANdI©R iNSUFPiCt3='M' oXYG~N. no HoT ENTER A SEPT4C, PUMP OR +QTI~ tl~R TREaTMEbrr T,arrEC uxQF_fz AI1iY cii~ClJl4isTAt+icES. DEATx IfRAY itESlnT_ t;ESCVE ol= A l?Et~son i+ROl~i ~r~-fir ~rrl~woR a~ a. -rAluK {~sa~ ee Qi~rcuLT oR ii~ossisLE. ADDtTIOtWAL COMMENTS . POW~'S INSTALLER Kame Phone ~ ,- _ a 6 `~ - 6 ,~ PQVYTS MAtl1Ti'AENER Name ~ j ~ Phone ~.r Z~6 -~(.~~ SEPTAGE SERYlC1fYG QPERATOR PUMP L©GAL FZI=GULATQRY 1iUiHORlTY ntame l~ Jt^- r/~~/ - Agenc3' ~ . /` r Phone ,~ 27 C7~ l ?hors ~,~.~ ~b - Q Q n:;s a.as draf6ad by tfse staffs of tfie Green L.atre, rViart7uetts and Waushara County ,Zorting and Sanr7atiat a9etldi'S This daam>ertt rricels the minimum req~+rr~ents of ch. t.',omrn ffi_22(2~(6}{ij(6}d.(f} acid 83_Sa(1}, {2} 8 (3}, W+scvrrsin A6rnfnrsYra£ire C;cdG Use of (1>IS r tft7Q5 trot guara~rtee tht: perfomnaaoe of the PQUIi'rS_ C~(INi} Soil Test Plot Plan . Project Name Shaun Bird Shaun Birc Address 1008 192nd Ave New Richmond Wi 54017 CSTM # Lot 1+2 Subdivision Village of Cylon SE 1/4 S W 1/4S 33 T 31 N/R16 W Date 4/13/05 Township Cylon Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1 /2" pipe System Elevation 96.2/96.1/96.0 *HRpSameasBenchmark 16_ B_M. 142' Property Line 10' B-1 35' 0% Slope 75 ~n+ B-2 -3 Alley Old Pump Handle Well 40' 100' ve To be abandoned per DNR Code at the time of well being drilled, as per conversation with land owner. This is not being used! Well Old System location unknown Old House Foundation Scale is 1" = 40' unless otherwise noted Rd O ., 'WisconsinDepan7rtentoft,,ommerce SOIL EVALUATION REPORT Page of Oivtsion of Safety and Buildings to accorgance wrtn Comm oa, vvis. Ham. t,cx~e ~ County S n must Pl i i 8 1/2 11 i h T ~l. lU n s ze. a x nc es Attach rmmplete site plan on paper not less than inducts, but not limited to: vertical and horizontal reference point (BM}, direction and parce- I.p. pert:ertt slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal iMormation you provide may be used for saco~dary purposes {Privaq Law, s. 15.04 (t) (m)). p~Ry Oamer ~ ~~,~ I Property location Govt. l.ot ~ L 1/4 4 S N R 5~ ~ ~ ~ ~ E or 1 ~ Property Owners Mailing Address Lot # Block # Subd. Name or CSM# City fate Zip Code Phone Number ^ City ^ Ullage Town Nea R New Construction Usey~Residential / Number of bedrooms ~_ Code derived design flow rate ~/~'z~ GPD Replacement i ^ Public or commerdal -Describe: ----- -------------- -- Parent material Fl~in,elevation if applicable /'L//~~ ft. General corrtrnertts /~ ~~ njf~~~(,,o ~'~S~v~. ~~ ~Dtt ,~i. ~'- _~f and recorttrrtertdatiorts: P/ ~' opt rKY ~ 1 . ~ ~ .~ System Type T "~ /c ~ ~~stem Elevation ~` ~~ # Boring ~f ~ L,~ ` pit Ground surface elev.-~--~-- ft. Depth to limiting factor / ~ in. Soli iption Rate Florizon Depth Dominant Cdor Redox Descript'son Texture Structure Consistence Boundary Roots GPD/fg unseA Qu. Sz. Cont. Cdor Gr. Sz. Sh. `E8#1 `Eff#2 M in. Q" C~ / ~ V r J~Z C r ~s~" ~ ,~ r /< p ~y y SID- 7. ~ r ~ ~ _ ~ ~, ~ ~i~ yid , ~~ ~~, d~ s~'rv t? ~ t~ ~ ~•- a ~~ # ~- Bonng --~-j~~---A- pit Ground surface elev. 1 ft. Depth to limiting factor ~ ~ in. Sql iigtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 `Eff#2 v , ~~~- ~- ~.~~ ~ n i v 2 ~ ~~~ s~ EtflueM #1 = BOD > 30 < ZZO mglL ano t SS >3u < 1S(i ' tmuern st = rsvv ~ ou fiKJ/L ana 1 a~ ~ sv mcyL r..ST t~tlQ (PtBaSe Prtrit) SI CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~---~s= /~ ~ 715-246-4516 ` t ~ ~~ '• ~ . Soil Test Plot Plan Project Name Shaun Bird Shau t ' d Address 1008 192nd Ave New Richmond Wi 54017 C~ #226900 Lot 1+2 Subdivision Village of Cylon Date /25/06 SE 1/4 S W 1/4S 33 T 31 N/R16 W Township Cylon Boring ~ Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1 /2" pipe System Elevation *HRPSameasBenchmark 16= ~,B,M. 142' Property Lin~JI~ Well 10' B-5 0' B-1 35' 0°Io Slope 30' B-2 5' Alley B-4 Old Pump Handle Well 40' 100' No Groundwater observed @ 99" ve To be abandoned per DNR Code at the time of well being drilled, as per conversation with land owner. This is not being used! /75' Cannot make setbacks from neighbor's well to instal a standard at grade system Old System location unknown Old House Foundation Scale is 1" = 40' unless otherwise noted Rd O / ` . RECEIVED ~~ • AUG 3 1 2006 Wisconsin Department of C merce SO L EVALUATION REPORT Page of Division of Safety and Buildin ST. CROIX COUNTY in accordance with C m 85, Wis. Adm. Code ~ County ~~ ~(~ ~ Attach cemplete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must l• indude, but not limited to: vertical and horizontal reference point (BM), direction and parcel i.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~ ~O ~ 09 ZO - 00 O Please print all information. Revi ed by Date Personal iMorrnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~f ~ ~t~ Property Owner Property Location ~~.h/ I ~ Govt. Lot ~ ~ 1/4~(~,~4 ~ ~ I N R 1 ~ E (or 1l Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City fate \ Zip Code Phone Number ^ City ^ Village Town Near Ro S a ( ) O l~~ New Construction Use~Residential I Number of bedrooms ~_ Code derived design flow rate ~.)'~ GPD ~Reptaoement ^ Pubtic or commerdal -Describe: ________ ____,_____,___.__ ___ Parent material / Flood PI in elevation if applicable /2//i¢ ft. General cornrt,ents ~ ~D 1j/-J ~~,^S~ec~ ~ ~y. CALL /1. ~ /I A and recorrunendatians: a ~° Q /~pGl ~,~.(/ ,~r~ ~~ ~~ System Type ~' /cam' ~ c9/l~stem Elevation - ~ !lv • !> ~~ # ~ ~nng ~~~ / pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 1 0`~ U ~rJZ 5~ ~,r IJi CJ ~ l~ -~~ ~ ~ ~ / ,3 y- ~ -- - ~ r~ wi _ /Vt~ v OaSC/U~cx ~~' •~ Borirg # BOnng Pit Ground surface elev. ~~~~ ft. Depth to limiting factor ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 U ~ 3J~- - ~ ~~~' rv ~ . (~ ,,` i v r~u ,se • Effluent #1 = BOD > 30 < ~0 mg/L and TSS >30 < 150 • Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~~ s=ue 715-246-4516 Property Owner, Parcel ID # Page ^ Boring Boring # ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil iption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dlit? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure ' Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon 'depth Dominant Color Redox Destiption- Texture Structure Consistence Boundary Roots GP DIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mgll. 'Effluent #2 = BODS < 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. ssaaaw trt.srao~ Project Name Shaun Bird Address 1008 192nd Ave `~ ~..v New Richmond Wi 54017 CST 6900 Lot 1+2 Subdivision Village of Cylon Date 8/25/ SE 1/4 S W 1/4S 33 T 31 N/R16 W Township Cylon Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1 /2" pipe System Elevation 96.2/96.1 /96.0 16' ~*u ra 10' B-5 'n' 35' B-2 40' Alley Old Pump Handle Well 40' Soil Test Plot Plan Shaun Bi 00' * H R PSame as Benchmark 142' Property Line,JlO Well I B-1 0% Slope 0' -3 No Groundwater observed @ 99" ve To be abandoned per DNR Code at the time of well being drilled, as per conversation with land owner. This is not being used! /75' Cannot make setbacks from neighbor's well to instal a standard at grade system Old System location unknown Old House Foundation Scale is 1" = 40' unless otherwise noted Rd O _ _ _ --~ ArcIMS Viewer Page 1 of 1 ~, . ~ Vl '~. _`" ~ ., • ~~. Q '' ~~ },.~~; ~r ~ ~_~:. TN CYLON ~~ ~~~ ~~ ', ~ A'~1 - r ~'.. 'f ~ A ...-. ~f~' •ta.~ fin y,~N: ~ ~ ,~ X ~. - ~ x :~ yb~ f L, ~p~ ,~ ,~:.. t~~ ~'~* .ti Sy. 3 ~,,,`~ t 4 ~' ~.i f~tx ,7-. ~ v~~ '' '~ http://72.21.230.178/website/LRPortal/ARCIMS/MapFrame.asp?PIN= 8/22/2006 ~-., ~sconsinbepartmentofCommerc O EVALUATION REPORT Division of Safety and Buildi , ~G~~~ /1~\ Page of ~v macwrum~ wu~rc.unr 1 a, vis. r~urn. t,vue D County ` ~ ~ Attach com letes ~ 8 1/2 11 inches in lan on er not Ies a n must ~ 'ro ~ p i d d t li b p p p ~ B i ~ 't t l f i t d n u not ma e, u percent slope, scale to: verb , aiaYl n a re ere po n ( on r dime o , north arro~ahd I tion and distan on an to nearest road. parcel LD. P/eaS~tG~UU f/0/1. Review by Date Personal information y ovid~rr~~~ G r secondary purposes (Privacy Law , s. 15.04 (1) (m)). `f~ ZZliS S Pn)pe~y er Jc ~ ~~/ r Property Location ` ) Govt. Lot ,$ ~ 1 /4 JW 1 /4 3 3 T 3 ~ N R / p E( r) Property Owner's Maili Address Lot # BI # Subd. Name or C,~M#/~ ~ /, ^ ( ~j J+ 2- Sri ~ v/`~ ten , to Zip Code Phone Number ~ s~ b ? z~b'`~~~/ ^ City ^ Village wn N st Ro L' / D (" - c , ~~ . (i~ ~ ~ ,~ New Canstrudion Us Residential / Number of bedrooms c3 Code derived design flow rate -~ GPD Replacement ^ Public or mm dal -Describe: ________ __~ __ Parent material D , Flood Ptain elevation if applicable /1~~. ~ ft. General comrrtertts ,/~ [ l / / ?7 y and recommendations: % °' ~/ ~~ " l ~ t7 ~ U ~7\ I ` rh Bortng # BO"~ ~9 ,~ /l~ ~. Pit Ground surface elev. ~ ft. pepth to limiting factor ~ in. Soil ication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 'Eff#2 ~- ~ Id 3~~ _------ S .j-- ~ , O ~ s' '-~-' S m~s la . D gyp- s <-------- s , ~ ~ . ~ s. 5, ~ ~~ I .--)` I Boring # ~ Bonng /~f?1 /I ~ ~ .._ JL_'l~Pit ~rouna surtace elev. ~i u r~ err. uepm ro nmmng raaor ~9~ u,. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a-1 ~ , 3~ z ~______ s ~~- , ~ ~-- L~ 3z S ,---- ~ w~~ ~/~C ~y- ~ ~ 3 ~~ y .____~- S ~ s ~,-- 6a'I ,~ s -- ~ S ,~ ~/ J ~~ • Effluent #1 = BOD > 30 < 220 mg/L anti TSS >30 < 150 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Nante (Please Print) - - re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401 .~ ~ ,._ ~ ~ 715-246-4516 f~ Property Owner _ A~ Parcel ID # Page of Boring # ^ Boring ~~/`~ 3 ~ Pit Ground surface elev. ~~ ft. Depth to limiting factor ~ in. Soil liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ~'1 ~ ~ ~ 3 l y _--~--- S' ~ - (~ ~ /~ ~. z 33 , ~ ---" ~~ , ~ 3-~a ~~ Q,~'~ ,~ ~ Day s .~ ~.-- ~ a~ ~ ~,~- , ~ ~ ~~' ~3~ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Boring # ^ Boring G d rfa lev ft De th to limitrn factor in ^ Pit roun su ce e p g Soil ication Rate Horizon Depth Dominant Cdor Redox Description- Texture Structure Consistence. Boundary Roots GP D/if in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 •Eff#2 'Effluent #1 = BODE > 30 < Y20 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 rng/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. seae3ao (R.~oo~ Property Owner _ n~ Parcel ID # Page of Boring # ^ Boring ^~,~ Pit Ground surface elev. ~~ ft. Depth to limiting factor ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dlfl? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z. z ;33 , s ---" ~' - ~ p 3-~~ ~~ ~ Q~ ~ ~ D0~ ~s ~ ~-- J% ~..s- l~ i~ ~ ~ ~ ~~~ ~3~ ~~ # ^ Bonng ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Cd Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ^ Boring Boring # ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODE > 30 < 720 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mg/L and TSS < 30 mglL 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. seo-s33o (R.6roo~ _I `~ Safety and Buildings Division County - '~~~ 201 W. Washington Ave., P.O. Box 7162 .~r resin Madison, WI 53707 - 7162 ~ •' DE,' artment of Commerce (608) 266-3151 i~Y Permit Number (to be filled in by Co.) . Sanitary Permit Applicatio , ~ ~ 7q 3 ~ to Plan .D. Nu~ In accord with Comm 83.21, Wis. Adm. Code, personal inform may be used for seco ids ndary P~~ Privacy Law s15.04j1: ~ O Projxt Address (ifditTerent than mailing addiess) L Application Information -Please Print All InformaY ~, Property Owner's Name • ~ ''' Parcel # n, c:~~. ~` ' c ~ LOt Block # ;~°~ . ,~ Property Owner's Mailing Address ~ ~ - ,z 1 a 1 0.~~ ~ cJ, ~ .. city, state C / ' ^ Zip Code one Number L .~~A, Section I II. Type of Buildin the all that a ~ ~ 3 7/s" ~ y'3 sa3 ~((circle e) ~ ` ` PP Y) '1' ~ N; R ~C~ g o~ • ~I or2 Family Dwelling umber ofBodrooms ~ '~~~' ~'c+ ~1-ow.¢_ ^ PublidCommorcisl - Desc USe ^ State Owned -Describe Use W ~ (o d- III. Type of Permit: (Check only o box on line A. Complete line B A. ^ New System ~RePlacemen tem ^ Treahrrent/Holdin B• ^ Permit Renewal ^ Permit Revision Before Expiration ^ Change of lumber IV. T e of POWTS S stem: Check all that a 1 ~on -Pressurized In-Ground ^ Mound > 24 in of s •tabl _ - - (~ (~ - ~OC1 Zo -- B T Replacement IY ^ Other Modification to Exist;n S • g ystem 00(a -109 - /d - eDD Permit Transfer to New List Previous Permit Number and Date Issued OWnW - ~ m e SO1 Moue 4 in. of sui Constructed Wetland ^ Pressurized In-Ground ^ Holding T Peat Filter ° Single Pass Sand Filter ^ Recirculating Synthetic Media Filter ^ Aerobic Treatrnent Unit ^ Rxiroulating Sand Filter ^ V. Dis ersal/Treatme t Aaching Chamber ^ rip ~ ^ Gravel-lrsa Pin,. __ .___ , .. ~~ n rea Information: ~~ ~ f Design Soil Application J/ /~~1~~ ispersal Area Re VI. Tank Info Capacity i~ / ~ Gallons bef i, Gallons Units New E~datiag Tanks Tanks lcptic or Holding Tank lerobic Treaunent Unit O D~ (`..~.U.-t VII. Responsibility Statement- I, the unders aed, assume reapoasibi6ty for Pl~ujmb r' N L~e (Print~ /~'~/ ,~D ~° !~ ~~~( (// L ()-/fIS ~ Plum S/ 1 ._ 1 / ~, ~ ,~ Prefab Site Steel Fiber Plastic Concrete Constructed Glass of the POWTS aho__~on the attached r~wnocrs•nutlress (Street, City, State, Zip l~' . ~ ~ J~. VIII. Conn /De artment Use Onl (,~ PProvcd ^ proved Sanitary Perrrrit Fee (includes undwater Date Issued ^ Surcharge Fee) C issuing Signature o Reason for 3D~ , o0 7 z J D Dt. Conditions of ApprovaUReasons for 'approval n SYSTEM OWNER: ~ dCl'o i J + 1. Septic 15rdt, etl'ltlertt Piker aril (- 6~_"er^"'~ ec.~~ dispersal cell must all be 'ces / mait-tain~/ mair-tain~ ~D 9 ~' 6t~~ ~~ ir+~"; ~~-~~--~ ~ ,1 as per mmapement plan provided by plumber. 2 All aei'back requirements must be maintained ~ ' ~ ~ d ~ ~. c5 . >Ma per applicable Code /ordinances. t~/ , / ~° ~,Pt Ptaoa (to the County Daly) for the rystem on paper sot less rhea 81/2 z 11 inches is site lWl1f(u'M-®J'llI 1 v I, ~,, f n II t vim- B -63 98 ( 1 A03) ~"~`' ~ o r~. (,~}~,~ d1~ 4 ~ c5Q ~ , P ~ 25 ~. S P l^^~ -S0 ~~~ mvb~-~ /l1aw~~~ y • ~ Soil Test Plot Plan Project Name Shaun Bird Shaun B~ Address 1008 192nd Ave New Richmond Wi 54017 CST #226900 Lot 1+2 Subdivision SE 1/4 S W 1/4S 33 T 31 Village of Cyfon Date 4/13/05 N/R16 W Township Cylon [~ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1 /2" pipe System Elevation 96.2/96.1/96.0 *HRpSameasBenchmark 16' 10' B-2 B-1 5' 0% Slope "., 3 Alley Old Pump Handle Well 40' 100' ve T,ejbe abandoned per DNR Code at the ime of well being drilled, as per conversation with land owner. This is not being used! 5' Well Old System location unknown Old House Foundation Scale is 1" = 40' unless otherwise noted 142' Property Rd O 3 - ,~ . ~.~ ,~ -~~ z 3 - /~ c.~-'~'` ® ,~jn ~~ ~-,~ o~~- sy 9~~~ 1 _~~ Ct)PY ~q~ d~ots7 Y 11 ~ ~~lJl~%`~ ` ~ -~a~ ~3 - l~ c y~X ly~ ® ~~ ~~ ~~~ a~ sy 9~~~ ' ~k~; .;(A'o 35~ ~" U /~ St. Croix County Map Output Page Page 1 of 1 6 s2o o 6'I 9B ~ I 519A ~ i 4 s1s 3 s17 ° 2 fits 1 s~5 4 _~ ~ , <~ ~F ? ;~; _S _~ f~ ~/ n :-~ ~a_r+n AvE aka, ' 588 ~ =16 587 ° ~ i4 6 , 59s ,_ $ 589 ' 5 58fi ° ~ '~'" 5 595 9 590 ~ `' 4 585 ~ I ~. ~.Y 4 594 L ~ b~:: 3 584 ° ~ . ~ '~ ,> 3 593 o ~ -` 2 583 2 592 %h .,,~i St. Croix County Planning Department ', 1101 Carmichael Road Hudson, WI 54016 Phone: (715)386-4674 DISCLAIMER :The information wntained on this map is advisory. Map accuracy is limited by the quality of the public rernrds from which it was prepared. It is not intended as a substitute for an accurate field survey. AERIAL PHOTOS :Aerial photography is date-sensitive. Features that exist presently in the County may not be present in the photos. 7 $ 61 9 s~ 0612 i • 11613 s1~ 7 597 8 598 9 599 10 600 11 sot Leigend b7aNCll•a1 ®o~r~darbs ~l/.dl V If I arts ~~~ cer/7e d Aruey Maps Raralt Ro.sf Ra/road Orai Wage Streams Darn PerrcrYai team ~~bmnl Irenl .^..Kam lllbrrr http://72.21.230.178/servlet/com.esri. esrimap.Esrimap?ServiceName=StCroixOV&Client... 7/26/2005 18 SOIL SURVEY lower part. The substratum, to a depth of about 60 inches, is yellowish brown sand and gravel. Available water capacity is moderate, and permeabil- ity ranges from moderate in the silty subsoil to rapid in the underlying sand and gravel. Natural fertility is medium. The .organic matter content of the surface layer is moderate. Most areas of these soils are used for corn, alfalfa, and grasses. Representative profile of Brill silt loam, 0 to 3 percent slopes, in a cultivated field, 450 yards west and 95 yards north of center of sec. 12, T. 31 N., R. 15 W.: Ap-0 to 9 inches; very dark grayish brown (10YR 3/2) silt loam, light brownish gray (10YIt, 6/2) dry ; weak fine and medium subangular blocky structure; fri- able ; common roots ; neutral ; abrupt smooth boundary. A&B-9 to 16 inches ; brown (10YR 5/3) tongues of silt loam (A2) ; moderate thin platy structure; yellowish brown (10YR 5/4) slightly heavier silt loam (B) ;weak fine subangular blocky structure ;very friable ; common roots ; slightly acid ; clear wavy boundary. B&A-16 to 20 inches ; yellowish brown (10YR 5/4) silt loam (B21t) ;moderate fine sub- angular blocky structure ; penetrated by brown (10YR 5/3) tongues of silt loam (A2) ;weak thin platy structure; friable; common roots; very strongly acid; clear wavy boundary. B21t-20. to 26 inches; dark brown (7.5YR 4/4) silt loam, high sand content; few fine dis- tinct strong brown (7.5YR 5/6) mottles; moderate medium subangular blocky structure; friable; thin patchy clay films; common roots; very strongly acid; clear wavy boundary. IIB3t-26 to 30 inches; dark brown (7.5YR 4/4) loam, high sand content ;common medium and coarse distinct strong brown (7.5YR 5/6) and few medium distinct dark gray- ish brown (10YR 4/2) mottles ;moderate medium and coarse subangular blocky structure; friable; thin patchy clay films; common roots; strongly acid; clear smooth boundary. IIC-30 to 60 inches ;yellowish brown (10YR 5/6) sand and gravel ; single grained ; loose ; medium acid. The solum thickness and depth to sand and gravel range from 25 to 35 inches. The silty mantle ranges from 20 to 30 inches in thickness. The Ap horizon is very dark grayish brown, very dark brown, or dark grayish brown. The C horizon is 10 to 25 percent coarse fragments. These soils are strongly acid or very strongly acid in the B horizon and medium acid in the C horizon. Brill soils are near Antigo and Haider soils. They are more poorly drained than Antigo soils, but they are less poorly drained than Haider soils. BpA-Brill silt loam, 0 to 3 percent slopes. This soil is in narrow to moderately broad areas on stream ter- races and outwash plains. Most areas are elongate- and range from 8 to 20 acres in size. Included with this soil in mapping are some are where the subsoil is heavy loam or clay loam. Also i eluded are some areas of Antigo and Haider soils. Som. of the included Haider soils are less poorly drained tha is typical for that soil. Runoff is slow, and the hazard of erosion is slight. Tillage is delayed for relatively long periods becaus this soil remains saturated early in spring and after heavy rain. This soil is moderately well suited to most of the commonly grown crops, such as corn, oats, and alfalfa- brome hay. The main concerns of management are maintaining tilth and soil structure and removing sur- face water. Capability unit Its-1; woodland group 201. Burkhardt Series The Burkhardt series consists of nearly level to steep, somewhat excessively drained soils on stream terraces outwash plains, and areas of pitted outwash plains. these soils formed in sandy loam sediment un- derlain by sand and gravel. Native vegetation was mainly oak savanna or native prairie grasses. In a representative profile the surface layer is about 12 inches thick. It is very dark brown, very dark gray- ish brown, and dark yellowish brown sandy loam. The subsoil is about 8 inches thick. It is brown, friable sandy loam in the upper part and brown, very friable loamy sand in the lower part. The substratum, to a depth of about 60 inches, is brownish yellow sand and gravel. Available water capacity is low, and permeability ranges from moderately rapid in the loamy upper part to rapid in the underlying sand and gravel. Natural fertility is low. The organic matter content of the sur- face layer is low or moderate. Most areas of these soils are in hay, pasture, or wood- land. Afew nearly level and gently sloping soils are used for corn, soybeans, and garden vegetables. Where these soils are irrigated and fertilized, they are well suited to potatoes and other special crops. Areas of Burkhardt soils are a good source of sand and gravel. Representative profile of Burkhardt sandy loam, 6 to 12 percent slopes, eroded, in a cultivated field, 320 yards south of northwest corner of sec. 32, T. 31 N., R. 18 W. ,2~p-0 to 8 inches; very dark brown (10YR 2/2) sandy loam ; weak medium subangular blocky structure parting to weak fine granular ; very friable ; many roots ; medium acid ; abrupt smooth boundary. A12-8 to 10 inches; very dark grayish brown (10YR 3/2) sandy loam ; weak medium subangular blocky structure; very fri- able ; many roots ; medium acid ; clear smooth boundary. A3-10 to 12 inches; dark yellowish brown (10YR 3/4) sandy loam; weak medium sub- angular blocky structure ; very friable ; many roots ; strongly acid ; clear smooth boundary. B2-12 to 16 inches; brown (7.5YR 4/4) sandy ST. CROIX COUNTY, WISCONSIN ~• • ° ,, structure ; friable ; thin continuous clay ,~+~ '~! films; slightly acid; clear wavy boundary. B22t-25 to 34 inches ; dark yellowish brown (10YR 4/4) heavy silt loam; weak coarse and medium subangular blocky structure; friable; thin patchy clay films; medium acid ; gradual wavy boundary. IIB3-34 to 37 inches; brown (7.5YR 4/4) loam; weak medium subangular blocky struc- ture ; friable ; strongly acid ; clear smooth boundary. IIG-37 to 60 inches; yellowish brown (10YR 5/8) sand and gravel; single grained; loose; about 10 percent coarse fragments by volume; contains many dark colored minerals ; slightly acid. The solum ranges from 26 to 45 inches in thickness. Theailty mantle is 24 to 40 inches thick. The A horizon is very dark brown or black and 10 to 18 inches thick. The C horizon is 0 to 10 percent coarse fragments. The, B horizon is slightly acid to strongly acid, and the C horizon is slightly acid to medium acid. P~(lot soils in St. Croix County contain less clay than is defined in the range of the series, but this dif- fe ' 'ce does not alter their usefulness or behavior. (ot soils are neer Dakota and Sattre soils and Je'` ' t, sandy substratum. They have a silty mantle an' ontain more silt and less sand than Dakota soils. T `° .'have a thicker and darker colored A horizon and a t 'ker silty mantle than Sattre soils. The B horizon fo' `d mainly in silty sediment, whereas Jewett, sandy su "atum soils have B horizons typically formed in sa;~ loam till. Pillot soils also have a thicker, darker A° ,izon than Jewett, sandy substratum, soils. `~~~ -Pillot silt loam, 0 to 3 percent slopes. This s`, on outwash plains and stream terraces. Most a are oblong and range from 10 to 160 acres in size. `` ded with this soil in mapping are small areas of 'a and Sattre soils. Also included are a few areas '"the depth to sand and gravel is 40 to 50 inches. ~ off is slow, and the hazard of erosion is slight. t areas of this soil are used for crops. The soil is ately well suited to corn or other row crops. Main- '' tilth and organic matter content are important of good management. Capability unit IIs-1; not "d to a woodland group. fd Series lainfield series consists of gently sloping to ply steep, excessively drained soils on stream and outwash plains. These are sandy soils un- yloose sand. Native vegetation was mainly oak 'presentative profile the surface layer is about of dark brown loamy sand. The subsoil is about s thick. It is brown, very friable sand. The um, to a depth of about 60 inches, is strong '.e water capacity is low, and permeability is ural fertility and the organic matter content Eace layer are low. eas of these soils are in pasture, woods, or plantations. A few gently sloping soils are ern, soybeans, and garden vegetables. Where 45 these soils are irrigated and fertilized, they are well suited to potatoes and other special crops. Representative profile of Plainfield loamy sand, 6 to 12 percent slopes, in a cultivated area, 200 feet south and 50 feet west of center of NE1/4 of sec. 21, T. 31 N., R. 19 W. Ap-O to 8 inches ; dark brown (10YR 3/3) loamy sand, pale brown (10YR 6J3) dry; weak fine and medium subangular blocky struc- ture ;very friable ;common roots ; slightly acid; abrupt smooth boundary. B-8 to 24 inches; brown (7.5YR 4/4) sand; weak coarse subangular blocky structure part- ing to single grained; very friable; few roots; slightly acid; clear wavy boundary. C-24 to 60 inches; strong brown (7.5YR 5/6) sand ; single grained ; loose ; slightly acid. The solum ranges from 18 to 34 inches in thickness. The Ap horizon is very dark grayish brown, dark brown, or dark grayish brown loamy sand or sand 6 to 10 inches thick. In some wooded areas the Al horizon is a very dark brown or black loamy sand that is 2 to 4 inches thick. The C horizon is 0 to 10 percent coarse fragments. Plainfield soils are near Boone, Gotham, and Hubbard soils. They have a thinner, lighter colored A horizon than Hubbard soils. Their B horizon contains slightly less silt and clay than is typical of Gotham soils. Plain- field soils are underlain by loose outwash sand, whereas Boone soils are typically underlain by weakly cemented sandstone bedrock. PmB-Plainfield loamy sand, 2 to 6 percent slopes. This soil is on outwash plains and stream terraces. Most areas are oblong or irregular in shape and range from 10 to 40 acres in size. This soil has a profile similar to the one described as representative of the series, but the surface layer is slightly darker and contains slightly more silt. Included with this soil in mapping are a few small areas of Hubbard soils, a few areas where the surface layer is sandy loam, and a few areas where slopes are less than 2 percent. Runoff is very slow, and the hazard of erosion is slight. Soil blowing is a hazard. This soil is used for farm crops, but crop yields are generally limited by low available water capacity. Some areas are in woodland or planted to pine tree planta- tions. This soil is poorly suited to most farm crops. Where irrigated, it is used for such row crops as beans and potatoes. Controlling soil blowing is an important factor of good management. Capability unit IVs-3; woodland group 3s1. PmC-Plainfield loamy sand, 6 to 12 percent slopes. This soil is on outwash plains and stream terraces. Most areas are elongated or irregular in shape and range from 10 to 120 acres in size. This soil has the profile described as representative of the series. Included with this soil in mapping are a few areas of Emmert soils and a few small areas where slopes are less than 6 percent or more than 12 percent. Runoff is slow, and the hazard of erosion is slight. Soil blowing is a hazard. This soil is used mostly for pasture and woodland or pine tree plantations. It is poorly suited to most farm crops. Slopes 'facing south and southwest are more POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ' of Z'' FILE INFORMATION Owner '~ Permit # DESIGN PARAMETERS Number of Bedrooms ~ ^ NA Number of Public Facility Units ^ NA Estimated flow (average) ~Q Q gal/day Design flow (peak-, (Estimated x 1.5) ~.~~ gal/day Soil Application Rate s S gallday/ftZ Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand IBODS) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) <_30 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 510' cfu/100m1 Maximum Effluent Particle Size Y$ in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity ,dam O al ^ NA Septic Tank Manufacturer ~~ ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model b ~ ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Cellls) ^ In-Ground (gravityi ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tankls) At least once every: ~ ^ month(s) (Maximum 3 years) earls) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third (~) of tank volume ^ NA Inspect dispersal cellls) At least once every: ^ monthls) (Maximum 3 years) year(s) ^ NA Clean effluent filter At least once every: monthls) year(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^ month(s) ^ yearls) ^ NA Flush laterals and pressure test At least once every: ~ ^ month(s) ^ yearlsl ^ NA Other: At least once every: ^monthls- ^ year(s) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cellls) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page ~ of Z START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process andlor damage the dispersal cell(s1. 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 power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal 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) water; 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 and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, alf 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 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 that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. alua ' a o ing tank 1`~ ~ T be ' e ai a ~fZD+~lI'~ lT>/n ~D12 N~1~/ Ca~v577eclc~D ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name Phone ~ _ b ,_ s~~ POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ST. t/' ( !9U ZOII~fN Phone "'11 S- 3 gCv- f0 C7 This document was drafted in compliance with chapter Comm 83.22(21(bl(1-(d)&Ifl and 83.54(11, (21 & 131, Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer /~ Itit~1-- /, Mailing Address /c Property Address C ~ ~ (Verification re u L t~ ~ City/State LEGAL DESCRIPTION fec..~ -„~ ~ y 7 3 from Planning Department for new construction.) Parcel Identiftcation Number Property Location ~~ '/4 , J~ ~'/4 , Sec. ~~, T ~ ~ N R~W, Town of r, n ~ n Subdivision Certified Survey Map # ,Volume ,Page # Lot # Warranty Deed # ~ ~,~.3y / ,Volume ~"Z ~j__C?~~, Page # y~ Spec house a yes~io Lot Lines identifiabl ryes i~ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix County 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. t/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 Commerce and the Department of Natural Resources, State of W isconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Departm within 30 days of the three year expiration date. "~~ 7 //.5~/ 0~' SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION 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 prope described abov , by virtue of a warranty deed recorded in Register of Deeds Office. ~--~. ~. 7 /~s io s SIGNATURE OF APPLICANT DATE ****** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. ****** Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. ~~ U 2805P yy5 State Bar of Wisconsin Form 2-2003 WARRANTY DEED Document Number ~~ Document Name THIS DEED, made between Shaun Bird ("Grantor," whether one or more), and Ann T. Burton ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lots 1 and 2, Block 6, Village of Cylon. St. Croix County, Wisconsin. Exceptions to warranties: Easements, restrictions and rights-of--way of Dated --S'/O ~ C~ J 795391 KATHLEEII H. MALSH REGISTER OF DEEDS S7'. CROIX CO. , MI RECEIVED FOR RECORD 65/19/2005 10:i5AM MARRAHTY DEID EIfEMPT i REC FEE: 11.00 TRAILS FEE: 54.80 COPY FEE: CC FEE: PAGE5: 1 Recording Area ~- Esb'een & Ogland W ~ 304 LOCUSt Street ~ Hudson,1N154016 l~ ~ 1~ 006-1093-10-000:006-1093-20-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) if any. ~~~' Bird (SEAL) (SEAL) * * AUTHENTICATION Signature(s) Shaun Bird authenticated on *Kristina O land TITLE: MEMBER TATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) ACKNOWLEDGMENT STATE OF ) ss. COUNTY ) Personally came before me on , the above-named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Attorney Kristine Oland Notary Public, State of Hudson, WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM N0.2-2003 • Type name below signatures. INFO-PROTM Legal Forms 800-655-2021 www.infoproforms.com ., k .~'~ .. • i~-. i ] k , ~ , • YtC Y 1 ~y ,. ~ I M l ` ~ ~ r A i 1 3;}k i b ~b~. k ~ ~ _~- .. rl { iJ~~ \~~~~T ~W - ~ ~I 'fin I '~r~ e ~` 4 9~ 7YI z„z ~ -- ,t -- - .r. 7V 2' -> y ~ 5 d ~ °~ X' N ~° ~ ~ ~ ~ ~ ~- y 1 -y w ~~ rr~~ W q ~O d i M1 f ~, ~ 3 r ~~ 76 71i2> V v ~ V ~ (~ tl `` tl y ~ ~ ~ ~ y e ~ 7.4 2 ~-> ' V i6~ ~~ tP V V A . `I ~~ "{. a r `c ' I _ ~~ ` ~~ it ~ ' J - ~ T ~_. E f =T - - - ~- Zfe ~z [ ~-~ 11" ai ~ { st \ / v ,~ a