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HomeMy WebLinkAbout006-1081-60-000S't. Croix County Planning and Zoning Detail Sanitary Information Tuesday, Sehtertrber 11, 200' at 5:21:49 Ps~l Page 1 of 1 Computer #: 006-1081-60-050 Sub/P1at: NA Section: 35 Parcel #: 35.31.16.5418 Lot: 1 TN/RNG: T31 N R16W Municipality: Cylon, Town of CSM: Vol. 20 Pg. 5142 1!4 1/4: NW 1/4 NW 1/4 Owner: Hurtgen, Ellen M. 1883 240th Street Glenwood City, WI 54013 State Permit: 487989 Issued: 11/10/2005 POWTS Dispersal: At-grade Permit: New County Permit: 0 Installed: 05/04/2006 POWTS Detail: NA Bedrooms: 3 POWTS Pretreatment: NA Issuer/lnsoectar As Built Plumber Other Reauirements Ryan Yarrington NA Bird, Shaun Ryan Yarrington a>i~ rae~~.' Crt9: Yes Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 5/4/2009 WI Fund: Additional Notes Mone~Owed $0.00 Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION i (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Hurt en, Ellen C Ion, Town of CST BM Elev: Insp. BM Elev: ~~ BM Description: ~ m ~ GS ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~ rr ~J ~"'~C.v~' /~ Dosing wt roG~ ,~ l Holding TANK SETBACK INFORMATION TANK TO ~P~L \ WELL BLDG. Vent to Air Intake ROAD Septic 7~j / 7 SO ~ / 3 q 1 -~ Dosing ~~ ~ 7 $D~ ~ Aeration Holding PUMP/SIPHON INFORMATION ~ \ / Manufacturer 1 Demand ZO'2.` ~'e~-' GPM Model Number n ` I~ ~ N Z~ ~ 2 TDH Lift 7 9 Friction Loss ' System Head TDH 3 Z t ~ , 7 Forcemain Lengt / Dia. ~ j Dist. to Wetl c ~Q Z 7 O c7 SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 487989 0 State Plan ID No: Parcel Tax No: 006-1081-60-000 Section/Town/Range/Map No: 35.31.16.541 STATION BS 3 , ~ 5 HI ! c>;3~ 6 FS ELEV. ~ a~ Benchmark =, ~ lO~ ~ O am AIt.~ J ~ `r~ c , / / ~ ZS Bldg. Se er SUHt Inlet Q~Q ~,.9 S SUHt Outlet Dt Inlet Dt Bottom ~ 3~ 5 `J~. ?vs Header/Man. ~. ~~ ,z Dist. Pipe 3 ~ ~ jQ~ ~ Z. Bot. System ~ I Z! 7 Final Grade z.b ~6E~s.5 St Cover P~ a L/ z 7 ~a ~ ~ ~5 BEDlTRENCH Width ~ Length / No. Of rench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~0 ~O ~ ~ `_ `'- L SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: \ INFORMATION CHA LINER OR Type Of System: I ~ ~~ , ~O , N~ Model Number: I~ISTRIBLITION SYSTEM Nd(14.. Header/Manifold ~ 1 Distribution ,/ ~ ~/ Pipe(s) Z ` x Hole Size ~ .S x Hole Spacing T Vent to Air Intake p~ COJG~. th ` Dia 2 Len ~'b th Dia Spacing Len 37. ~ ~ g g Still COVFR ., ore~~.~re c..~•nm~ n„i.. .,,. Mn~~nrl (lr Af.r~rarla Svstamc Only Depth Over ~ Bed/Trench Center l ~ Depth Over - Bed/Trench Edges ~ xx Depth of To soil 1 p xx Seeded/Sodded No ~ e xx Mulched ~'"Qes No ~ 1 s COMMENTS: (Include code d[screpencies, persons present, etc.) Inspection #1: ~Z / S / 05 ~ Inspection #2: 5 / y / 6 ~ --' ~o w O I-`. Location: 1883 240th S eet Deer Park, WI 54007 (NW 1/4 NW 1/4 35 T31N R16W) NA Lot j~"'`-~' ~~ Parcel No: 3~~6.54'J„ d11 ~ 1.) AIt BM Description = ~`~~ ~'8J~- G~.w'..S ~ ~aG~s art 2.) Bldg sewer length = 3 l -amount of cover = ~ ~ ~' s ~ ---- - -- - - - - - -_ __ ,_ ~ __ i ,' Yes No ~, Plan revision Required? (p'~3 ~7 Use other side for additional information. ~ ___ ~ ~ ~b _ ___- _ ___ _ __.- __- _ ___ ___ ._ _ _ J Date Insepctor's nature Cert. No. SBD-6710 (R.3/97) 201 W. ~~/SC~flS~/`lr Sal De artment of Comtf•terce ' Sanitary e'er A In accord with Comm 5321, Wis. Adm. may be used for secondary putpo Y. Application Ynformataon -Please Print All lnformatfon and Buildings Division County /1 ~ ' ' n Ave., P.O. Box 7162 53707 - 7162 ~ ~(~ Sanitary Permit l~iumber (to be filled in by Co.} 08) 2b6-3151 7 C/~ :a~~~~' !r ~® State Plan LD. Nrm-ber ~ ~ f ~ ~ ~ I rovide brmation you p Project Address (if different than mailing address) s15.04 I (m) v ~ ~ ~g g3 z~a~ ~, Parcel # Lvt # Block #1 7JpNIN~FFIC ~_~ ,____ ,~ ,,` . ,~- - - t ~,~,~ ~yN` Property Owner's Mailing Address ~- / ~ ~~ Phone Number City, State ~ Zip Code w~a ~IJ; ~~~ ~ t ~ 5v ~~~ IT. Type of Building (check all that apply) '1 0,~ ~ ~/y Number of Bedroo F'I es r~'- ~or 2 Family Dwelling - ^ pubiiclCornmerciat - Describt Use ^ State Owned -Describe Y.)se ITL Type of Permit: (Check only one box on tine A. Complete line B if applicable) A. System ^ Replacement System ^ TreatrnenUHolding Tank Replacement Only -------~ ^ Change of ^ Permit Transfer to New B, ^ permit Renewal ~ Permit Revision Plumber pwrter Before Expiration IV Type of pOWTS System. (Check alt that anniy) _ Non _Pressurized ln~,round ^ Mound >_ 24 m. of sortable sorl Constructed Wetland ~ Pressurized In-Ground ~ Holding Tank S thetic Media Filler ^ Leaching Chamber ~ Dr Recirculating yn A ea Tnformation• y,, ~/., Section l c~ eon ~i 5 ~-' 1- N; R~ or W of OCa(~ - !!f'6 ! " lrX1 - c~rx ^ Other Modification to Existing System List Previous Permit Number and Date Lss ^ Mound < 24 in. of suitable soil At-Grade ^ Single Pass Sand Filter 0 ^ peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ~ ip Line ^ Gravel-less Pipe ^ Other (exptain} V_ I)ts ersal/freatment r Dis ersal Area Proposed st) l ` ~~ron l~r~ Design Soil Appiicatio dsf) Dispersal Area Required (sf) ~ lGi Y/ u~ Design Flow (gpd) ~ ~ ~~-~ Manufacturer Prefab Site Steel Fiber Plastic Capacity in Total Number Concrete Conshucted Glass VI. TankTnfo Gallons Crallons of Units /) /jy~ ~~ New F~asling iC/ ~b ltj- W Tanks Tanks SaD~ or Hotdins Tank Aerobic TreaAnent Unit Dosing Chambar j (~ VYI. Res onsibility Stateme ~ I, the undersigned, a e responsfbfGty for f~ l/MPR3 ~~~ OWTS shown on the g rho p~~lN`~~~-c/~! // Plumber's ame (Print) ~ Plumber's Si e ~ ''7,f ~j6 ,J /'P /~ .~ ~ ~..~../ Phsmher's Address (Street, Ctty, State. zip _ i /~ ~~ /, J ~,.1/f~ j ` j , VIII. Coup /lle at[ment u~c vu, _ Sanitary permit Fee (includes Groundwater PI~oved (] proved Surcharge Fes) ~ /1 ~JC~ ~ dU ^ Reason far 7!~ TX. Conditions of ApprovaUReasons for Disapproval SYSTEM OWNER: 1. Septic tank, effluent finer and dispersal cell must all be ~etvices / mairtt;~ia~ as per management plan provided by plumber. 2. Atl setback requirements must be mainlined as per applicable code /ordinances. the County only) for the system on paper not less Da~y Issued it /~o~a5 x xl c~ SBD-6398 (R. O1/03} PLOT PLAN • PROJECT Ellen Hurtaen ADDRESS 2522 110th Ave Woodville Wi 54028 NW 1 /4 N1N 1 /4S 35 r/T 31 N/R 16 W TOWN Cylon COUNTY ST. CROIX SYSTEM ELEVATION 99.4' BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none ,BENCHMARK V.R.P. Top of 1 /2" pipe ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE ~ WELL + u _ u _ r Same as Benchmark 1320' Property Line Scale = 1 /4" _ ~ O~ ~~ ~,~ ~ 3 00' Pro 3 Bedroom House ` ~r't ~ -}~ Tank is to be properly ~ bedded and provided with lockdown covers with approved warning labels Grading is to be done to divert run-off away fr s stem Huffcutt combo tank B-2 100' ,~ B.M. 99.4' Well is to meet all setbacks found in 7% Slope AIt.B.M. comm. 83 98, Area 15' below system is to remain undisturbed 1320' Property Line 240th St. `~© ~~ PROJECT Etlen Hurtaen N1N 1/4 NW 1/4S 35 ~/T 31 SYSTEM ELEVATION PLOT PLAN _ ADDRESS 2522 110th Ave Woodville Wi 54028 N/R 16 W TOWN Cylon COUNTY ST. CROIX 99.4 BEDROOM CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none ,BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100° ^ BOREHOLE O WELL *g,R,p, Same as Benchmark Filter Zabel A-100 1320' Property Line Scale = 1 /4" _ ~ O~ ~CO (~..~ ~--' 300' Pro 3 Bedroom House Tank is to be properly bedded and provided with lockdown covers with approved warning labels ~~~ ~ (,t~ ~e.~ Grading is to be done to divert run-off away B - ~ from system ~I Huffcutt combo tank B-2 100' ,~ B.M. 99.4' Well is to meet all - 3 setbacks found in 7% Slope AIt.B.M. comm. 83 98~ Area 15' below system is to remain undisturbed 1320' Property Line ,SD 240th St. Y 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. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary November 08, 2005 OUST ID No. 226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXP1ItES: 11/08/2007 Identification Numbers- Transaction ID No. 1211711 SITE: Site ID No. 707010 Ellen Hurtgen Please refer to both identification numbers, 240th Street above, in all corres ondence with the a enc Town of Cylon St Croix County NW1/4, NW1/4, S35, T31N, R16W FOR: Description: Propsed Three Bedroom At-grade System Object Type: POWTS Component Manual Regulated Object ID No.: 1049649 Maintenance required; 450 GPD Flow rate; 37 in Soil minimum depth to limiting factor from original grade System(s): At-grade Component Manual, SBD-10570-P (R.6/99), Pressure Distribution Component Manual, SBD-10573-P (R.6/99); 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: • This system. is to be constructed and located in accordance with the approved plans, and with publication SBD- 10570-P (R. 6/99) "At-grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems". • The pressure network is to be constructed in accordance with publications SBD-10573-P(R. 6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". • 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. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • ~ :nmm x_ti_c~ri ~ - inspectors. (.Oyt t~X tt0)?Q'l jy SHAUN R BIRD Owner Responsibilities: Page 2 11/8/2005 • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. , • Comm 83.52(1)(a) -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. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 730 am to 4:15 pm jswim@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 T utNARTMENT OF cnee..e~....~ r Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 10/30/05 Owner:Ellen Hurtgen Location:NW1/4 NW1/4 35 T31 N,R16W 240th St. Cylon System type: At-Grade Manuals Used: At-Grade Component Manual version 1.0 SBD 10570-P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01 /81) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Co tigency plan 9-11. Soil test Shaun Bird Signature License number ~ivl5t0 OF SAFETY ANG BUILDINGS SEE GOR SPONDENCE NCV ~ 1 2005 SAF~~ ~ BUILpINGS . . >51 ~ 8 PVC ~dAE.~.'NlAth1 •~.; ~~ r 2~ F~-TU~-3- t1QS" -- - +~ aasr~~,~.~~.a~r;ems ~s4:~ttn~ --~` SrnBt~~ QED aSa~~~R-c-iers VJ+E~t ~ ~ - ~o ---~-~ > 5' ~~ piss ' ~ ~ ~~. S = L____. , ~F~. L = ~~, vJ = ~ Z. fit. ~t~QRa,t~~ S~c~Tt~~+~ fab~Fc t~t~ ~ ~ :~~-~- ~. j ~ ~ { ~- t/6B ~if2B Fes" CELL. of %z ' Z'12 AfsGAE.~#~tE. }~is~rfbu~fon ~a~eral .~-- So'st CovQr ~--f -----'- Z'• ~„ ~ _: ~" -- ~,.`ry~ r~ ~ .... ~Lbv~l~D ~~-aYEK > ~t Plan Viev aiscl Goss Section of i73.sconsia At-grade. US1iC with a Si.s;gle ~ibscrgtirn Area an a Sloping Site {..1 G£ iJ S~. ~- ,~-- ~,tiUriaYu~~.: Page t~f tlistribvtian pipe t3et~ail for La~:eral ~etwortc ar;~~~ super ~CL~~1ti~}l1t~ ,. ~ _ ~ Last dole $houid Be l~ext To . P'~C Farce Na 1 n ~- P~tC ilistributian Pipe :'~ ~ P ,QCre sf ~~~ fiol ~ f3ia~ter ~~~ ~'Tits~h ~~_~,!- Lateral lliameter ~- Inch{es} ~ _~ 1_- Inches - - Eor~e Main Dias~eter ~' Inches ~ ~'~ Inches ~-- #~ flf Nolesf~'jPe c~'~ Invert El,e~tation IIf Laterals // ft. Signed- License ~ic~er: i3aLe: r• ~~ r Cr~t}SS SECT1CN A~``°~ SP€CI~ ICA~"IVKS S£PT~'C '~ADi3C ~ II~ri~ C~~AtrSB..R ~EhTN£"~~R~~ ~_ ~~ SENT FZ~E ~Z" 3~=N. ABt1YE GRftDE ~ Ji1NCTI~3t~ $OX AF'f}R$~ID ~ ~ ~~:~` ~Rfl~i D4~R, ~INi#fI~ 4R ~~T~ C3~iIT` MA~iHC3LE COvE~t W/ FA-LflCK ~ FR£a~z ~. R iidTAiC.. ,; I ~ ~~ f Y! f _ ~IAR~tiZ~dC~ iA$E... ~ t .~ ~ ' ~ ~~ `~~ f' ~ i _ - 18~ i~ ~ - ~ .. ! i Z a s a y~* ~ Ti,iw+ s - ~ t - . ~ ~`AS- F s a ~ inFATEg "FZG ~i"l S £ALS ~"~- TIBAT • ~~i, ~ VJk~f~r~ ; { ~3L7~Fi. ~ ~ ~ ` + ~ PIPE ._ $ -~- -- f ' ~T ~ ~• Olin SE3L.IB 9pIL APPt~~ ~ . . 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D II~ENS f.IQi~ I D ~~'^ .~j3.TL i,ICE'~~Y, 3~,$~; .. .,~_ SfGAtED= il$~ 7JTAL DY1~taiC ~EAD!~PACtTY PI:R Mttw,1TE EFFLUEAlT F.ND DEWATERlNG a° T U Q Z O Q 0 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. ~` " Elearical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable tevek long and short cycle controls. . Sealed Qwik-$ox available for outdoor installations. See FM1420. • Over 13Q°F. (54°C.} special quotation required. ~5T1153'Series MOCEL feet .Maters 1 S t.5 Goi. 59 152 Liters ~ ' , 20'1 Gal. 77 15~ ---" ~ Liters ~ 291 10 ~ i t5 3.1 j 4.6 f 51 53 231 201 70 61 i 255 231 i 2C .~ ~- 6.1 ~ 7.6 44 34 i 57 ~ 129 ~ 52 42 197 ?59 I 30 9.t 23 E7 33 j 125 I ,;J ~ 10.7 i i -- -.. 22 87 1o i ~2.z j -- i -- , ~ I 42 ' j Lock Volve: ?8.0 "-. (,t.6m) j44.0 Ft. (,3.4m)I 3 ?7 ~- 7? 7/S 1 i _1_ o» 32 32 SELECTION Gtilt)E o cAUnoN Au installation of coatrols, prateerion devices and wiring should be done by a qualified Itcansed eleetrreian. AU ~~~ and ~~' COdes sdauld be followed including the most. teten[Nitional t:lectricCode {NEC) andthe Occupational Safety and HeattltAct (OSHA)' ,. S;ngle piggyback variable Level float switch or double piggyback variable Level float switch. Refer t0 FM0477. 2 See FM0712 for correct model of EEactcical Atbemator E-Pak 3. Variable level control switch 1 Q-0225 used as a conUOl activator, speafy duplex (3} or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. --., .. .Mart ro: P.o. eox,s347 - louisvitle, KY 40256-0347 Manuracfurrrsof.. SHIt' 70: 3644 Cane Run Rcad ~' Pi~a~ ~~ ~~3~. ~ 0 ® Louisville, KY 40211-146, .a. PUMP llT. (502) 7?8-273Y • 1(800J 428-PUMP FAX {502) 774-3624 ftirp:!/wwwsoe(lercvm Q Copyright Z¢¢¢ Zoeller Co. All rights reserved. FLOW P£R MINUTE Page ~ ,, ..- lcai for domestic (non,~mentian trr and Values tYP v ~~ ~utasea t oar licenses or MAINTENANCE 1NS'1'RUCTIONS n one of tlje foiJo~~taaner. Sept I ~eris st+ait~ R din igewer, PO~"rs InsPecfi°r. P(~V-rrS ~ ~ Mas ~uPl m~bPr~Master Pturn pn of tfie tanK(s? m ides~fY anY any ~ uP aei~'. ns must indude a visual Inspect siu a and scum and ~ ~~ ~~ Ser+~9 motor' Tam Msp~ ure the volume of combined ds3 fa check the ettluera nard~ ~~y any cracks yr leaks. mays 7'he disper~ cents) straQ be visually wisp ~ ponding of efltueng t~~ ~ ~yd•~g of etttuent on the ground s~ any bonding of effluent on the ground surface- u, and to check sires tyre Irnmediabe notifica5an of the local ~ tat-k volume. ~ in the observation P "I~ndic2fle a faSing Cand'rtion and re4 or more of . NR Inct ~Oe with ch- gmtmd '~' a and scum in any tank equal one-~h~ ~ of in a~~ mulation of sludg a $eQ~9e Servicing oPe~tOr and a~si~d When the combined aaar cored by ~ ~ and any entity cot~Dents of the tank shalt be rem - t components; 113, Wiso~~ Administrative Cade- onents, P~~ ~~ ppWTS Mainb~et_ .n of effluent otters. mECharncai or ptessurized POt~'s(T'S eomP . • rin at intenrats of't2 months or less shalt t ~A~O~~ The sec~q g of ~mpteetion of any 5en+'ce ~°t" otiler malnt~~ or manrto 4 ~~ry autharitY within T A s repots shalt -~ t~~ to the local raga roduds or ath~ nce of painting P ~ START isle' APIO OPERATION PODS check treatment tank{s} for tit8 P~ tf high conoentrabons For new oonslruction. Pd°f to use of the s andlar damage tfie dcsper~ cell{ ~ that may pad ant ~~ ~, a septage servicing operator prior to use_ ~ irn a the treatm p detected i~ the contents of the tanx(s) ~ MT PLAN o~ER's MANUAL $~ MAt+lAG PF F{~,T~oxs • ~OyVTS s~rsT~ s f i~ _ Liifions are frozen at the inf~itrative sutfaCe- ~' Page ~f~_ System ~~ up shalt not occur,nmen ~'~ con n ~ tes~reci the e>oeess es pum{s ~~ maY ~ abov$ normal #tishwatec levels- ~e During P~ ~ to the dcspersat ceil(s} in one large dose. o+,rerioadng the ce.S(s} and may n>sitlt in the ~ t Tu avod this situa#ion have the contents of the PutTtP tonic temaveQ by a P~,m n~ 'power to the effCuent pump or contact a Pfula3bet o< POYYTS Maintainer m SeQiaBe $ ~~ ~ p~P C~ptitf~?i5 #O (r?stofE normal levers r~riifiirt the pump tank-. a N manuanY oPe~'~ ~ d~ ~_ Do not (ffiYl: a~ park OVQtj OC 1~t11fftSe drsarrb oi• oompact, po twt drive or park vehicles ovec ~~ mound or at-grade sol`! absorgflon area- - ~ a~a rvit~ is feet down sbpe of anY a the perfiamtattce and P~~ the fd+e Reduction or-eClrnination of the ~~ frnm the was~tewatet steam may improv t~tsers; detild1 floss; d'[aPet*;; dgarerte buns; condoms; ~tton swabs'. deg of the Pt3WTS: ~'bio6tt;s: ~~~~ umP? water, fruit and vegetable peeClitgs: gasoline: 9rt~e~ herbicides meat d.~- ~ fr~ drattt ~ P. pesticides- sarn'fary napkins: tampons; -and anratet softener btitt~ scl2ps: ins; oth nJ P - ~~~~~ taken out of service the fi~tlowirtg steps strait ~ ~'-n th insure that ~e vYften the POWtS faits andlor is Permanernty~ ~ atnrS safety abandoned in +cornPflance wlfh ch_ Gomm 83.33, Wrisaonsin Admin Code: system - pi'oP~y Intl Piping to tanks and Pits sFralt'be disconnected and the abandonned Pipe oopebnyl~~~ rvidng Opera[or_ The contents of all tanks and p~ shat! be removed and prapert3r P~~ and the wid space After pumping, aft tanks acrd P~ shad ~ excavated and removed or their covers Sited with coif, gravel of ~pthet inert solid rnateriaL CDN7'fi1fGF..NC1~ PIJ4Tt the following measures have been, or must be iaKen. to provide a code !f the POWTS fall and cannot be n'p~ compCrarrt mpent system: O A suitable ~p~laoement~ar+ea has ~~ evaluated and may be utilized for the location of a rePlaoem~ t ~ [d not aisorpbon s~m_ Tt~e ~p~oement area should be protected sect ~~re i~ ~ and ~nret~nFai"iure io be infringed upon aY required setbas~cs from existing and propo P'm~ ttre replacement anea vsrifi riesulf in the need for a new soil and site =evaluation to establish a suitable replacement area Replacement systems must campty r~itn the rules in effied at flsaf ticrse_ D A suitable replacement area is not available due to setback andlor soft CmitaSons_ Barring advances in POVVTS , technology a hold"mg tonic may be installed as a fast resort io replace the fazed ~O ~ of the PUVifTS a soa.and The sr6e has not teen evaiua~ed ~ ~~~ a suitable repiacernent area Upo _ s ~~~ rlsusti t~ ed to locate a scrifabie replacement area- if no repla~ent area is available a- t tank may be installed 2s a last r wort tQ replace the failed POYVTS_ ~~~ o€ the biomat at - Morrnd and at-grade sflrT absorP~n systems may be reconstructed in place fiattowing infitbati~ surfacer R~Dn,.-eons of such systems must campty with the nrtes in effect at that 6na~ ccYlfARt+tiN{~~ gE.p7'iC, PUMP AND OTHER TRF.AO ~~~ TRF~'ilittEt+ i TAT1K urrDER Ai~tY CC CLIMSTJ4NNCES DEA[ENT 01CYGErif. p0 NOT ENTER ~- SEPTTC, PLlIV[P RESULT- ,RESCUE OF A PERSOI~I FROM THE tN7Ft2ioR L11` /:TANK titiAY BE DtFFIGULT OR tMP.OSS[Bi.l; ABDRIONAL COMMENT'S - POY+fIrS INSTALLER fYame - ~ Phone ,~, •- " -°' povYrs i~uf~rrAif+if=x Name ~" tz iG:v<..~ , Phone - ~. ~' t-~ I^ocA~ REGULATORY tiUIHORlTY SEPTA(TE SERYECiNG OPERATOR PUMPS ~ ~ ~ ~0~~ ~tT/i- 2 nlame - Agency Y Phone ''~ f V,... f~~j°' phone ~~.rr--~c`~ "_ snd Sart~aitirxr agende~ lltis dam meet Ttus Coate arcs Qraltsd br the staffs of the Gsieee Le[ce. Marquetis and Waushard County Zarttng :. t d005 t;ot the rninimcun requmemeats of d'L Caartrn 83.27.~ZX6Xt3C~~f3 and 83.54(1}. (1] $ (3j, Wfscortsin A6mlrsisirati're Cedes [Ise of this daa~ r'~ [1J01} gvaraniee flu performance of the PC)SIY3'S_ .~~~~~~~ .,~,..i Wisconsin Department of Com erce SOI~ EVALUATION REPORT Division of Safety and Building residential /Number of bedrooms ~ Code derived design flow rate ~J Public or commerdal -Describe: ___^____ a as ui vv m oa s. ram. ~.vue ~. <. , r Attach com lete site lan on a er not less than 8 1/2 x 11 inc es in st /~ J ountyc~ 1. TC7 l l /~ ~ p p p indude, but not limited to: v cal poi (BM), direction an rcent slo a scale or dime sions ~ ~tion a d dis o nearest road. Pe p . ~TP`~~R~ Parcel LD. DO -• ~ ~ $ ~ ~ ~ ~ y ~~ ~Q Please print all information.' eview by Dat Personal information you provide may be used for aecondary purposes (Privacy Law, s. 15.04 (1) (m)). II ~~ ~~ Properly Owner / ~~ ~~ f~ ~ ~ t° ri/ Property Location Govt. Lot /t/~ 1 /4 ~~1 /4 S ~ T ~ ~ N R ~E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code hone Number ^ City village own Nearest Road New Construction ^ Replacement Parent material _~ General oonunents and recommendations: s Page of GPD Flood Plain elevation if applicable ''/~i ~ ft. ~ P, `~ Bori~ # Boring R pit Ground surface elev. ~ ` ~ ~ ft. Depth to limiting factor ~ in. Soil lication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Etf#1 •Eff#2 'J 3 0.3~~. --- s. rn ~ ~~--~ - ~ ~ ~ Z i 2 ,~ ,,- .~--- b -< uJ 3 - 6 ~--- S O~ /n ~ ~ 1 ~- . b-7 . ~ ~ -m - /rl ' ~%~ y~ ~ I ` l I Borinc # ~ Boring 44' ') ~~ ~~ Pit Ground surtace elev. j ~ tt. Depth to Ummng taaor gyn. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 •Eff#2 ~3 ~ . s , -- ~ ~~ - 6 c ; _ ~ - N~ .Nr~- J b • Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 • Effluent #2 = BOD < 30 mg/L and T55 < 30 mg/L CST Name (Please Print) na CST Number Bird Plumbing, Inc. Shaun Bird ,,. 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 /'a_~ ~ -~~~--- 715-246-4516 Property Owner _ Parcel ID # ~ Page of Boring # ^ Boring Q ~ ` / .Pit Ground surface elev. _ 9 ft. Depth to limiting factor in• mil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DJff? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 C~`I ~ ~ 3~L ---' .%1 ~- .~' M ~ . fl Z 1 Lib .~ ~rn ~ rn i Q `.~ 7 ~~ J ~ ~ 1~ ~ < ^ 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/FF in. Munsell Qu. Sz. Cont.-Color Gr. Sz. Sh. 'Eft#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/ft= in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BOD; > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #2 = BODS < 30 mgA-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. seo-esw ~e.aroo~ Property Owner Parcel ID # l Page of Boring # ^ Boring 3 pit Ground surface elev. ~ •~ ft. Depth to IimiGng factor in. Soil ~x~n 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 Z I Lib .~ - o?rn.i in i ^ 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.-Color Gr. Sz. Sh. 'Eft#1 'Eff#2 ~~ # a Bonng ^ Pit Ground surface elev. R. 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 ' Effluent #1 = BOD; > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #2 =GODS < 30 mgll. 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-eaw (tc.~oor r Soil Test Plot Plan Project Name Ellen Hurtgen Shaun Address 2522 110th Ave Woodville Wi 54028 CSTM 26900 Lot ----- Subdivision 40 acres Date 10/ /05 N W 114 N W il4S 35 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 99.4' *HRpSame as Benchmark Alternate Benchmark Top of 1/2°° pipe @ 100.0° 1320' Property Line Scale = 1 /4" _ ~ ~~ . Scale is 1" = 40' unless otherwise noted Pro 3 Bedroom House B-1~ 300' B-2 ~ 100' ,~ B.M. 99.4' ~ B-3 7% Slope AIt.B.M. 9 8' 1320' Property Line 240th St. ` ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM /"l) i , OwnerBuyer _ Mailing Address , Property Address City/State Parcel Identification Number ~~ - /D $ / - fo D - ~O LEGAL DESCRIPTION ,~ / Property Location ~ 1/ , ~~ 1/a , Sec ~ J , T ~ ~ N R~W, Town of ~y C57// Subdivision ~~ ~ ~~~ ,Lot # Certified Survey Map # Warranty Deed # Spec house yes no ---~ Volume ,Page # r-' Volume ,Page # Lot lines identifiable 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 yeazs 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of 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 pwner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ~/ /~ 9i~. SIGNA 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. ~~. d `~~- (Verification required from Planning & Zoning Department for new construction.) (REV. 08/05) ~r Z i0 t Z*tT5 a$Ed OZ T°A z ~ ~~,~ = O G7 c~ ~ "' Z w ~~_~~ m ~ a Z ~ )It10M13N SdJ .LLNf100 XIOli'J 'LS S 3H1 Ol O-~N3Fi3~3t1 3t~ SJNIW3@ ~~ W ~~ ~ _~ U ~ J ~~~ X C~~7G~1+~i1u_O Rfl Vc~ C 1 b ~7~ _ s_ '_~ ~7 ~ --~ ~QII~.J ~=/ a Qr~Jr V ti V~ d~~ O > 3Z O ~ ~~ w W ~ ~i Z ~ .90`Zb£ M .60.6Zo 40 N r W -a Z m vi x ~ ~ ~~ • [~ d ~ N $ ~ Q 0 0 M u 0 r ~ T W Z o ~ O U 0 W 2 tL 0 W to a ~ ~i ~' I "' I o ~ ~ ~ _ u~+ x ~ i ~ ~ ~ ~ N- U' ~ ~ ° ao -*` X11 ~ ~ ~~~ ~~ao~ ~ ~ O Q~ a~ m ~ ~'~~ .. z c al Di ~ .~ z N aloe ~~ t- ~ _....-... ......-... ~T tt=~ ~ ~~ ~o W o ?Z t~ ~ _ _ `~ m ,60'ZOE 3 .L6.£6e10 S d. -- ~ 3NC1d31N30 ,yS 6 tE t Z .9vzL6 ~_ ~ j,33kl1S H10f7Z _JN-1S~X3_ - ~_, ~~ p g__ 3.6QBZ•COS ~ ,_ ,~,, _,._ __ __ a z ~W~~~ O J W N W Z ~ ~ ~5~~ I ~ ~ ~~ ~ ~ ~~~ ~~~~ Q _._._ b/ tMN 3H1 j0 3NI"1 1S3M _ _ _ _ _ _ ~ ° ~ ~®[`nlCFt7 Q~~~daW ~~ pl~0~3N S,klOA~AHt18 AlNtiU:? XIOaJ '1S 00 's z33.9s11d0~ 00 'ET =~~g 03 a~ ~Axns a~r.~t~xa~ AYOZ:TT 900Z/S0/T0 Q2i00'3>~ 80J a3AI3~38 8433QO.iDX~31SZ'JBy~ NG"1VN H ~L33.7H1Y31 Zh15 ~`Jrd OZ "IOA Z'B~St~ ~!-1 ~ ~ z~ ~ ~o ~~ ~ y ~ 3~ t, ''r~......•ti' 0 y~ ~ • ~ 7 C ?' __ ~ 3 ~ V = _ v~ s H ,ci-~~t $ `s Z O ~.1~~1~~~ ~.~1 1. 2 ? 0 6 P $ 2 1 STATE BAR OF WISCONSIN FORM 3 - 1998 QUIT CLAIM DEED ~~ Document Number This Deed, made between and Grantor, teal Grantee. Grantor quit claims to Grantee the following described real estate in __ ~ .County, State of Wisconsin: 2004 00 6--/0~_~~o~-do© Parcel Identification Ntxnber (PIN) This ~ homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Dated this ~ 1st day of Decetber `~ (SEAL) (SEAL) AUTHENTICATION Signature(s) ~ ____ authenticated this day of , TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WASyDRAFTED BY ~-r (Signatures may be authenticated or acknowledged. S~t7 necessary.) 6~ ~' Names of persons signing In any capacity must be typed or printed below QUIT Cl.A1M DEED ~, Rol 7 8 1 3 6 4 KATHLEEii H. MALSH REGISTER OF DEEDS ST. CROIX CD. , MI RECEIVED FOR RECDRD 12/01/2004 04:15P1[ QUIT GLAItt DEED ~zo+pT ~ s REC FEE: 11.@0 TRAIiS FEfi: COPY FEfi CC FfiE PAGES: 1 Recording Aroa Name a~~nnnd Return Add^ress ~ / ' ` f ~XJC~.~v oV 1 ~ /~f'~v""~ 0~5 .2 .%Z //O ~ w v-o-~ltr+..~_fL,Z ~ w~ S~ U~ ACKNOWLEDGMENT (SEAL) (SEAL) State of Wisconsin, ss. S t . Croix County. Personally came before me this I s t _ day of December. 2004 _,theabovenamed Kevin Alexander to me known to be the pe~r}s'on s who executed the foregoing instrtlllttent and acknowllrpite the same. ~Ryt~`-; ~e~•k~y-3. itasmus~en ~~'I~faEY PubLc. State of Wisconsin i .l O }y~ Eo~tmission is permanent. (It nor, state expiration date: ~) ~l S~ -=:p :ros Qea. 10, 2008 _ ~~ R bF WISCONSIN W+sconscn Legal Blank Co.. inc. No. 3 - 1998 Mihveukee, wis. j FROM :OEVERING HOMES LAC FAX N0. :7155311282 Dec, 14 2@@4 1@:14PM P21 FROM :OEVERING HOMES LLC FAX N0. :7155311282 Dec. 14 2004 10:14PM P12 ,.. .n ~ umr ~ ~~ ~ ~ ' •• ~ Z _......._..._-- ---- ----------- ------ --- y ~ _ ~ ~# ! ~~ ~~ A ~R M .. ~ ~~~ ~~ ' ~ •~ _~`rrpp _~' ~~ _ N a ~a~ © /~~ M N Re ~ ~ .~. ' d ~ ~ ~~' • a ..~...~ ...... . 1 .... .... ........... f ~~ . . 1 f 1~ L `,_1