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Home My WebLink About008-1035-70-050;consin Department of Commerce PRIVATE SEWAGE SYSTEM Satety and Building Divisiog { 1' INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ermit Holder's Name: City Village X Township Schwartz, Kenneth Eau Galle, Town of ST BM Elev: Insp. BM Elev: BM Description: ~i Z Z ~ ~• Z C-'S 1~ TANK INFORMATION n _ TYPE MANUFACTURER ~ CAPACITY Septic ~%e~- ~,~ 3~ I ~ZSb Dosing ~~ 3. 75~ ,4ecatictz ;~ ~ ~ 7-~, Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic .,7~-~ ~ ~ ~~/ 7 s7 ~ 1 Dosing ~ 5~ / /~' ~ ~'} 5 ~ Aeration Holding PUMP/SIPHON INFORMATION L ~/ Manufacturer ~ ~ Demand PM fd ~ - G Model Number ~~ ~ 3 [ - TDH Lif Fricti L System Head /Ft TD H t ~ ~ • ~ Z ~ a . ~P Forcemain Length / ~ Dia. « Dist. to well ~ 7/~ ia 2 S[lll ~RSnRPTIt7N SYSTEM County: St. Croix Sanitary Permit No: 506160 0 State Ptan iD No: Parcel Tax No: 008-1035-70-050 Section/Town/Range/Map No: 12.28.16.180A ELEVATION DATA 9.1~i /61.35 9Z • Z. STATION BS 7•~G HI /aD.Jt~ FS ELEV. ~z • Z Benchmark Z .75 ~. TZ• Z Alt. BM ~? ~ Z~ ~~~ 7~ Bldg. Sewer 3B ~~•s7 SUHt Inlet 7•/ ~ $7 • Z J SUHt Outlet \ ~ Dt Inlet ~ ~• Dt Bottom ` Z • ~ ~ ~ ~ ~~ Header/Man. ~ •~ 9.85 Dist. Pipe ~ CG 4~ ~~/ G Bot. System S 35 ~ Final Grade 3.5 97.5 St Cover~J 3 .Z~ 9~• 7~ l..D~J tt 7 ~ Ib 95.E BEDITRENCH DIMENSIONS Width I n Length No. Of Trer~es p e~y.,, PIT DIME`ONS No. Of its Inside Dia. ~ Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: INFORMATION Type,Q[~Sy~st J : ~~ ~~ i /~~ ~ UNIT Model Number: r11STRIRIITInN SYSTEM \ Header/Manifold Length_~ Dia '/ ~ Distribution ~ Pi es ~ 7 Le igtht ~ ~ Dia ~ 5 ~ ' Spacing / x Hole Size /r ~ x Hole Spacing / ~~ V to Air I ke ~flll (`C1VFR ., oro~~..ro c..~rom~ n.,t., YV Mnnnti [1r At~rarie Systems Only •'l~/ 1wA.~/.u.i~~ Depth Over ~ Bed/Trench Center ~ ~~ Depth Over Bed/Trench Edges xx Depth of Topsoil , ~~"- xx Seeded/Sodded No Y xx Mulched es No ~ , ~ ~ es ~ 7 /• b COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / ~~/ O ~ I specti #o~t 2:~_/ / Location: 437 County R B.Woodville, WI 54028 (SE,(~/4 SW 1/4 12 T28N R16W) 40 acres Lot ~~ arcel No: 12.28.16.180A 1.) Alt BM Description = t "- ~1 ~~J~~~ 1~~U,~+{pt.. f'-~ ~./~.~SaJ~Gi~•~. (~7l ~ ~~.,7t~., 2.) Bldg sewer length = ~P~ L)~-~5 -amount of cover = ~ Plan revision Required? Yes ~ No ~ i~~~ '^~?j Use other side for additional information. ~ I ~ I -fr/-L (-J~~ Date Cert. No. SBD-6710 (R.3/97) # ~a-d ~ ~,~J~ COmmerCe.Wl,goV Safety and Buildings Division County w 201 W. Washingt Ave., P.O. Box 7162 , j y; i s eo n s ~ n Madison 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce J Sanitary Permit Applica Wis. Adm. Code, submission of this form to the a riate go nmental In accordance with s. Comm. 83.21(2) State Transaction Number ~ ~ ~~ , unit is required prior to obtaining a sanitary permit. Note: Application forms for state-o POWTS are Project Address (if different thanmailing address) submitted to the Department of Commerce. Personal information y rovide ma be used o econdary u oses in accordance with the Privac Law, s. 15.04 I m , Stats. / p « ~~ ~ G K Q 1. A lication Information -Please Print All Information ~ d. • Property Owner's Name Parcel # Sc i/,v~rZ ~ 3 APR 2 6 2007 G0~-/0",35-70-0~~ Property Owner's Mailing Address Pro erty Location ~ p~ ~ \ ~ ~ r~ ST. CROIX COUNTY ~ /h a l ~ Y O Sr G Ciry, State Zip Code 6 '/., Section /.~ L .voo yd/ d / C~/ ~ .S's,Cs (circle one ;ot~ T ~~ N; R ~ I1. Type of Building (chec all that apply) Lot # _ bdi i i N S ,~I or 2 Family Dwelling- Number of Bedrooms ~ , ~oGZ,t~ ame v on u s J --- •_--- (/ - _ ~ Q~ Block # 70 GiCJt-N~./ - ^ Public/Commercial -Describe Use-~q~q,~ ~ .8-C~ef ^ State Owned -Describe Use CSM Number ~''difiFage'of ' ~ '~ ~~ 'yu 7.i1LE ~Townot L III. Type of Permit: (Check only one box on line A. Complete line B if applicable) '4' New System ^ Re lacement S stem p y ^ TreatmenUHoldin Tank Re lacement Onl g p y ^ Other Moditication to Existing System (explain) B. ^ Permit Renewal ^ Permit Revision ^ Change of Plumbet• ^ Petmit Transfer to New List Previous Permit Number and Date Issued Before Expiration Own r IV. T e of POWTS S stem/Com onent/Device: Check all that a ~ 1 ^ Non-Pressurized In-Ground ^ Pressw~ized In-Ground ^ At-Grad Mound > 24 in. ofsuitable soil ^ Mound < 24 in. of suitable soil ~Z~~S~t ~f- /In ~ ^ Holding Tank ^ Other Dispersal Component (explain) retreatment Device (explain) L V. Dis ersal/I'reatmentRrea Information: ~ - Design Flow (gpd) De si'gn Soil Applicatio Rate(gpdst) Dispersal Area Required (st) Dispersal Area Pro sed (s F) ystem I~ evasion COC3 / BFI L ~ ~ Q ~ _ ~ S ~~'t~ G 00 ~~IO' Q 2.~ Si` Q ~ S O foar' Vl. Tank Info apacity in Total # of Manufactur r ~ ° Gallons Gallons Units ~ W V t, V N B New Tanks Existing Tanks ~ /~ ~/~ { ` c aU ~ 2 (n H ~ rn ~ ~ w~ a Septic orl~er4ixy~r-k ~.SQ .r / SO ~ / / h/ ('S/'~[. Co.~iArrt- "• Dosing Chamber T.Sd ~ 7.5-6 ~ ~~ ~~ VII. Responsibility Statement- [, ttte undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' I ure MP/teiFi+!~Number Business Phone Number E 6LKE ~,~ ,/ f' / ~ (/ .3 X1/1 ~'iS `7,T -S l Plumber's Address (Stl•eet, City, State, Zip Code) Ca? 9~ r, a r. ~ uc,o„~a ~.~' Sf' .~ VIII ount /De artment Use Onl Approved ^ Disapproved Perm//i~t//Feyye~~ ~ ~~ $ Datef ssue /I ~ ~ ~ ~ 1 ing Age Stgna~tur~ ' ~~'i~2~~'~CR~ ^ Owner Given Reason for Denial V/t/CJ v / IX. Conditions of Approval/Reasons for Disapproval /~ ~ ~A~2<Z~ 1~ S f SYSTEM OWNER: U 1 ep I , e uen filter and dispersal cell must all be serviced /maintained G~~ as per management plan provided by plumber. ~~ ~~~ ~~~ t I t ns fur the system an submit to the County onto on a er not less than R x I I inch size as per applicable t:~~~Id`F~tlS~'fi~@~. ~ / ~//~~D 6 \ .~ / ~~ _~ SBD-6398 (R. 01/07) Valid thru 01/09 ~~ N 0 6 3 H Q O O ~`\- vl S S -~ ' i T~ O I t ~ 1 #, ~~~~p J W J J Q J o ^~ `W ~ = 5 3 0 Q D o J ~ b CC~® o ~ o 2 r '~ v I ~ ~~~ ~ ~ V `~ v C` l r ~ I o ~ ~ ~~ V ' N ~ CZ ~ ~ ~ ~ ? o ~ ~ ~ ` v ~ ~ ~ ~° ~ h o V ~ !•j ~ ~'~ ~ ~ ~i v v ^1 ~ 0 y ~ Q ~~ ~p v v ,a 1. _ 3- ~ ~ b o ~i i ~ ~ O v. O Q M a b ~ ~ ~J ~~°~ ` commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi. gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary April 18, 2007 CUST ID No. 3412 HERB J PELKE PELKE PLUMBING N6298 STATE HWY 25 DURAND WI 54736 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1 i 01 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/18/2009 Identification Numbers SITE: Transaction ID No. 1385959 Ken Schwartz Site ID No. 724225 County Road B Please refer to both identification numbers, Town of Eau Galle above, in all comes ondence with the a enc . St Croix County SE1/4, SW1/4 & SW1/4, SE1/4, 512, T28N, R16W FOR; Description: Four Bedroom Mound System /New construction Object Type: POWTS Component Manual Regulated Object ID No.: 1126597 Maintenance required; 600 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, sBD-1o7o6-P (N.ol/ol) 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 enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell 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. • Comm 83.22(7) - A copv of the approved plans. specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. P.0.1,IV.T.S. COD2l~'ltlOf?,ally P~I~~ HERB J PELKE Owner Responsibilities: Page 2 4/18/2007 • .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 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, ~~~~ erard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon -Fri, 7:15 am - 4:00 pm j erry.swim@wisconsin.gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. ~3ECEI1/Ep ~, APR 1 1 2007 REC~fVEp ~Wlsc~ot~sJn APPLICATION FOR REVIE~JPR Y nap.rtm.ncof t~rrmaro. ~+~~ -Complete all pages- 1 2007 POWTS Safety $ 6ulldings DIf~RpRE~ ~ BNf~r 1 Information you provl be used (or Bureau of Integrated Services ~ec3~t~oses [Privacy Law s.1~~~t~s.},~'C For plan status, check our websito at htto://w~wv.commcrce.state.wi.us/SB/SB-DivRcviewStatusSearch.html Several counties have been delegated certain authority to review plans in Ile u of Commerce. For a current list of those counties and theft delepatlon chedr our webske at htipJ/www.commerce.state.wi.us/SB/SB-PowtsProgram.html. 1. Protect information • Fiif fn ail known information. Confirmation of assignment to a reviewer. ProJecUSite Name /~E.J /~fs/GJ.oa 3'-L Transaction ID: Location, Number & Street of proJed (lf unknown, indicated nearest road) Previous Related Trans. ID: K h `a, QD, ,cs Estimated Completion Date: S t, S Legal Descripbon:_ s ~ s, T /.T~ 0?8. T /C ~c/ Assigned Reviewer: County SI: ~.ta~X (-}~6tty (.~-~'it{age (~Townof ~/aGALLa~ Assigned Office: Mail to your offke of choice below: 2. Attar plans are reviewed, please: (check all that apply) Green Bay, Hayward, LaCrossq Madison, Shawano, Waukesha _ Call custorer 1, 2 (circle number)' _ Requesting party will pick up NOTE: We reserve the right to re-distribute plans to L Mall plans to custome~l 2 (drde number)' another office if needed to reasonably balance - 'Refers to customer number from below turnaround times. 3. Complete the following designer/owner/requestlng informatlon. Utilize the check boxes when designer, owner or requesting partyls the same to avoid repeatlng Informatlon. Deslpnef Information (Customer 1) Commerce Other Please Specify (Customer 2) ~6Ii/ 6.G Commerce First Name,/ Last Name Customer Number F'ust Nemo Lasl Name Customer Number /V`Et~ ~E1•~tE />P--IY/2 /lE•/ .-~G.N.r,/.y~erZ _ Company me Company Nemo ~E~~E Du,,,`,,.~ ~yo 9 Address Address iY ~ a7 98 .5:..6/.v r .?S' / ~ f'/ Jsa ~' .fr. I Slate Zip+4 (9digils) City // City / Stale 21pt4 (9dipfls) ' ~ /.f/ URAN~, 1.~,~ .Sy7~L L~LE.~.t/60D C/ f)' . G/~ s~G/..s Phone Number (area code) Fax or Internet cull phone Phone Number (area code) Fax or Inlemet ceA phone 7is L7.?- s~tc 7.s G7.T- s.~t7 pis' G8 !'- .>?s~s Check others (applicable Check others B opplicable ( )Owner ( )Owner 4. Information and Plan Submittal Checklists. POWi'S scheduling is not available. Plans will be assigned to a reviewer after receipt of plans. If you select a specific office your estimated completion date may be considerably greater than what would be possible in another office. Submittals received without a specific office indicated on the form may be assigned to offices other than the receiving office depending on reviewer avaiiabiiity. Submittal checklists can be found in each applicable component manual. You may email technical code questlons to powtstech(~commerce.state.wi.us. Madison S86D Hayward 5880 t~Crosse S88D. Shawano S88D Oreen Bay 58BD Waukesha S380 201 W Washington Ave 10541N Ranch Rd 4003 N Kinney 1340 E Groon Bay 2331 San Luis Place 141 NW BarstowSt PO Box 7162 Hayward WI 54843 Coulee Rd Shawano WI 54166 Green Bay, WI 54304 4M Floor Madison VVI 53707-7162 715-634-4870 LaCrosse VVI54601- 715.524-3626 920-492-5601 Waukesha WI53188- 608-266-3151 Fax:715~634-5150 1831 Fax:715-524-3633 FAX:920-492-5604 3789 Fax: 60&267.9566 Email: 608-785-9334 Email: Email: PlanSchedulo(~ 262-548-8600 700608.264-8777 PlanSchedule@ Fax: 608-785-9330 PlanSchadulet~ comrrlerce.state.wl.us Fax:282-548.8614 Email: PlanSchedul®(c~ commerce.state.wi.us Email: commorco.state.wi.us Email: Plsn3cheduNQ corm~erce.state.wi.us PlanSch ed ulo ~ comrrterce.state.wl.us commerco.state.wi.us MAKE CHECKS PAYABLE TO DEPT OF COMMERCE I TOTAL AMOUNT DUE i /1-f ~D Attach check here Review Code 7633 380.10677 (R 12r2004) THl3 FORM IS VALID ONLY FROM 01/01/2005 l0 01/01!2007 FOR THE MOST CURRENT APPLICATION, CHECK OUR WEBSITE AT www.cormrerce.stale.wi.us/SE3lS&DivFormslP04VTS 5. POWTS SUBMITTAL (check all that apply New Construdbn ()Aerobic Troatment Unit(s) ( Replacement d System () Comrsercial System SYSTEM TYPE(S) () Anclwring of System Components Required () Chbrinator () Metering andlor Monitoring Required () W Disinfedlon UnR NOTE: Submit separate sheets for each system it submkting multiple systems on the same site. () Revision to previously approved plan system. etc. () Mlsceganeous Review (S60/hr for replacement of a septic tank, add'Abn of an effluent filter or pretreatment device to an existing ) ^ Component Manual ' () Al-Grade Component Manual, SBD-10570-P (R.6/99) ()Conventional P01KiS Component Manual, SBD-10567-P (R.6199) ()Drip-floe Dispersal Component Manual, SBD-10657-P (N.6/99) () Fiflow Mound Component Manual, (N.6/03) ()Infiltrator Chamber Mound Component Manual (Versbn 5.0) (8111/04) () In-ground P011VTS Component Manual, SBD-10705-P (N.01/01) ()Mound Component Manual, SBD-10572-P (R.6/99) Mound Component Manual -Versbn 2.0, SBD-10691-P (N.01f01) ( Moving Bed Bbfikn Reador, (MBBR) Component Manual (04!02) () MuMi-Flo ATU with Drip-Line Dispersal Component Manual (10/01) ()Pressure Distnbulwn Component Manual, SBD-10573-P (R.6/99) Pressure Distribution Component Manual -Versbn 2.0,SBD-10706-P (N.01/01) (~ Recirculating Sand Filter Component Manual, SBD-10628-P (R.6/99) ()Single Pass Sand Filter Component Manual, SBD-10595-P (R.6/99) ()Spat Bed Recirculating Sand Filter Component Manual, SBD-10656-P (N.6/99) ()Other - Specify Enter Fee S75 I =GO/hr All Ueatment components are previously approved under s. Comm 84.10 (2) or (3)~ Design wastewater fbw d the proposed system: Design 1,000 gpd or less Wastewater Fkrvv 1,001 -2,000 gpd in Gallons Per Day 2001 _ 5,000 gpd Gdd greater than 5,000 gpd GPD S 175.00 5225.00 5275.00 5300.00 plus 50.05 For each galbn over 5000 gpd. One of more treatment components are not prev'austy approved under s. ^ Individual SAe Design' Comm 84.10 (2) or (3): Qndividual site design/deviafan from component () At Grade manuals and use of components without produd approvaq: ()Non-Pressurized In~round pesfgn wastewater fbw of the {imposed system: ()Pressurized to-ground Design 00 5300 ()Mound Wastewater Fknv . 1,000 gpd or less 5400 00 () Dripline () Gonstruded Wetlands in Gallons Per Day ' 1,001 - 2,000 gpd Q00 gpd 5500.00 2 001 - 5 ' Documentation must be Provided to support treatment and dispersal claims. Ina roject and attach supporting documents le for the id ti GPD , , reate~ than 5,000 5600.00 plus 50.05 9 gPd each allon over 5000 ppd p ona e ra separate statement, prov g (code sedans, test reports, technical papers, research articles, etc.) Desgn Holding tanks NOT prevbusy approved under s. Comm 84.10 (2) or (3) and ^ Holding lank Individual Site Desgn Wastewater Fbw rile construded tanks. Design wastewater Ibw of the proposed system: ()Site Constructed Holding Tank in Gagons Per Day 5120.00 5,000 gpd or less 5200.00 GPD 5,001 - 10,000 gpd greater than 10,000 gpd $300.00 SBD-10571-P (R.6/99) onent Manual k Corr ldi T Des n Holding tanks previously approved under s. Comm 84.10 (2)(3). Design t d , ~ an ()Ho ng Wastewater Fbw sys em: wastewater fbw of the propose in Galons Per Day 5000 gPd or less 560.00 GPD 5,1]01 -10„000 gpd 5150.00 greater than 10,000 gpd u observation Inle reWe Determination 5100.00 ()Soil Saturation Determinafan Report ( slog PIPS) () ~ 5300.00 ()Experimental System (One time additional fee. Submit tee for individual system as per appropriate above system type) Experiment Number ~7f ~ Prior approval from a section thief Is required for a prbrlty review. priori Review (enter same amount es normal rwiew fee listed above) tf approval !s granted, the priority wltl be reviewed within 5 days of receipt ~' . /~s ~ prlortty review fee Is double the normal review tee. Enter Total (rounded to the nearest dollar) S ~~. ~ eF ~ Private On-Site Wastewater Treatment System (POWYS) Index and Title Sheet Owner: kE,,f 5~~~~R rz• Project Name and System Type: X~,~ Styvisrz - ~ ~~ ~rad,~.o oow rs Location: ~ ~t,, `:6 ~~ Street Address sE s~ S~/ s~T /~? .18.d~ /l ~/ Legal Description ~a F E1u G7,OLL~ Sr. ~.ta/x ~. Township/County Contents: Page 1: , ~,v,o~ X ,v.ro ~i rL ~ S~~ r r Page 2: G'~ o r ~ ,o,~ Page 3: dross - S~~ ,-..,~ Ago ~,..~ ~/.~-~ eF /f,~,/v Page 4: ~,o~- L,o r~/r,.~ L.~yO„ T Page 5: • S c~"f'T/G I/ i0./,~' ~~~irP G ib~.ON,Ot'•t G AoJl • .~B a rio,/ Page 6: ~~~o ~~~ Fo/t.ti.i-/a ~ qua v~ -- Page 7: DD w rs o a./r~c s ~,n/asa ~,o.~gaE.r~.~r o~.,/ ~~ ,~ ., ~~ Page 8: Page 9; Attachments: ~1 ..,n 41111~~'NC'S 1~ ~~ i~ ~i ~~c'~ OF Sp;EZ~ ...-- 1SvQN ,nFNGE ~ii re~.~ /y,.~,/ re./.~.~a ~ /„ife, SEE ~"`~ ~ - PlumberlB~es}g~er: ,~v`~,ra 6'~-Lx~ Signed: Credential Number: /l.~-.may/L Date: ~/-7-a7 G~SED ,SaQ ^ /06 9/-~ ~~ /f u.vD C. O.yPD,vt-Nr /7./urG W !/ dil sii./ .~ O G/S~D ~ SQO - /D 70l -/~ ~` ~ilIJS~Ia t iii.r rn.,ou r.,.~ Lo ~rParlrr /'fA~/cl.~ c ~~ !j.!'.t Ji~.r .7.0 Lo„ii ~ ~„ ~% Q „ 4q y o.~D 6 PLOT. .PLAN.', .- w E- /Soo ~ N ~~ yo' o ao' Yo ~ Cs+~,oc.~r PA~cr[ ~S ~/~~ ~ [ [ Ceyir. 83 Yj .trsa.cr To rs~r Pirs ~ ~ T ,sEY,s~r;~~.5w~,~sE ~~S~L~rz~N,R«;~ ~ /.3,tv ~% C fLt.~t k ~.c~.- ~4 rAn.~o ~Rta 1 ` /'/A4,r.~/ r~rr ~Q~/R O 3 ~ u ~ pUC f Act ~.?.fG~7So ,C ~A''/ ~35~ ~o~ra• rA~k ~~ 9 J` a ~ s- l ~ Q ~ ~y~,tKL~ \ ~ G, /ao ~ R o cat ,0/s rite ~1 o ri•.,t L!t .? 9 X/,la ~ ~au.~~o /~i,1 rs ~YS. c~L. - 9` d ~a.o ~ ~ 9S. e ,t o.,i ra..,c "/L61td Sf1 L Apt s!L ~itoPosco y-,~~.. .5/sF '% ii /vL C> 4/t N,6E6o.J LR/.ol, \ 9sC i S` ~.. ~„ •a . -.,~ [,loop S v ~ dL4 W ooa s ~~ ~oN~ ~LL~ + ~ i /t~~E / PAGE .3 •OF 9 E'~~.e CROSS SECTION- =0F MOUND • F. ~.~• ~~ .:. t-1'/ABC GF1~ 6~X .. - ~ • - - . - •~ ~ - ~sYrcT~TZC coYERIl4G ~ ~ • DISTRIBIITIOn LATERAL. -/~ ry/YL . arr.Y- c-ss - • - • -. S./ MEDIUM ~SAHD g ~ G •.. • i TOP SOII< 1 ELEV. 9C .6 e./ 3 E D ~ 9's ~o ' co,v r.~,C Cccc of 2 22" aggregat FORCE MATDI PI,CktED LAYER /3-/3~'°~ Slope •. C ~xico~ ~../vG • • - ~ ~ /.?.? i { L 1 A-_~Ft.- - i B-!da Ft. ~ ~ - I--/7 Ft. G J ~ /aa FORCE MAIti -.Z "/dG /~ i J-~Ft . ~- ~ B K ~'.+. / ..~ / r r . K:~Ft. f X.. - .. -.i {!-.T 9 Ft . ` A MAxIFOLA ~ ~'~/vG ~ R X - C7~Observation .?9 ~ . _ x pipe _ r Observation Pier Dist bution Pi a&- /~/a ~~ PvG I~1~~~ ~~-- . p GEU of ~-24`~ aggregate 23 ~ ~~ = 23~~ i~ ~ z ~X.oo ~L~`= G'~ Cf~'(~ /4~ 011'd C/~Tt~ltNl4 L/1"IiCELS PLAti VIE41 OF HOUt~iU ~'N \\ ' ~ i~ 1 .~ a `o '~` ~ ~ a c k` a r . 4 O k ~0 ~' n 1~ ~ ~ h ~ ` ~L~ q -r N h ~: k ,~ ~~ ~ I^ n h ~~ 3 4 a C o \ V Z a 4 `~ V ~ ~ ~ ~.C Q ~ ~ ~ ~ .~ ~ o M o r n' b ~ . ~' M ~ .. ~ b ~ ~ ~n i 0 4 ~ . R . n -~ ~eti•ro~~~o ~~~~M• !Nw~u`~caM w.o ~ r~° R R R C • • •, . ' ~= ( ~ ~ ~I~~~ 'a .~ ~ `.~ ~ ~ ~`~ w .~ ~ •, 9 two 0 . Page S Of 9 •SEPTIC TANK E'PUMP CHAMBER CROSS SECTION'AND SPECIFICATIONS .,s ~Sc.r. f o. 4" CY VENT PYPE 12" MIN. ABOVE GRADE 8 4lEA7HERPROOF ?' /p~ FROM DOOR, WINDOW OR JUNCTION $OX APPROVED FRESH AYR YNTAKE WITH CONDUYT MANHOLE COVERS - W/ PADLOCK E ici,~~sydo - WARNING LAKEL J~. 18" MYN. INLETII.~ APPROVED ~ PIPE 3` Ot{TO SOL I0 SOIL' WATER TIGHT SEALS FIc PUMP OFF ELEV . 8~.0 ~'T . . ~~ ~ ., ~ ' ~~ i' GAS- i 1` ,~ TIGHT i ~~ vppROVEO ` A SEAL JOINTS WITN • -~-- ; ALM APPROVED PIPE -~ ~ ON 3' ONTO . SOLID SOIL C ~ t ~--. OFF ~~ -t R Y SER EX Y T D PERMITTED ONLY YF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TAN1< CONCRETE .PAD SPECIFYCATIONS SEPTIC / DOSE TANK MANUFACTURER: ~//~rs~,~ ~,~c.~~r~ NUMBER DOSES PER DAY: S:,P (/9..~'I,~ TANK SYZES: .SEPTIC _ /~so GAL. DOSE VOLUME INCLUDING DOSE 7so GAL.. ~ • FLOWBACK: /,To.B .GAL. ALARM MANUFACTURER: „f .Z~-; ,~,r„~~~j MODEL NUMBER: y;,~,r ;pc`~T .g- SWYTCH TYPE: ~9a-,c~N,~ r PUMP MANUFACTURER: ~®,~o~,,or~c MODEL NUMBER : s,v so SWITCH TYPE: iyE.~~c~.,~r REQUIRED DYSCHARGE RATE 35!.2 GPM CAPACYTIES: A = 3o YNCHES = y~3' GAL. B = 2 YNCHES = .3,1j 2 GAL . ~„~~,v~ C = ~~ YNCHES = _ /.~0.8 GAL. D = _8 S YNCHES = ~~t 9 GAL . PUMP E ALARM WIRING AS PER YLHR 16:23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DYSTRYBUTION PIPE /o.G FEET + MYNIMUM NETWORK SUPPLY PRESSURE ~,~ FEET + ..~s FEET FORCEMAIN ''X ,~.G FT/100 FT. FRICTION FACTOR _ ; 9 FEET . ~ T.OTAL DYNAMIC HEAD =~_,FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ss ~~ ; WIDTH 80 ~~ ; DYAMETER -- LIQU ID IS~F~T~ y8" ~. SD33 YJ33 Typical Application` Sump/Effluent pump Capacities SW/SD/VS33 - to 48 GPM (3.0 I/s) Heads SW/SD/VS33 - to 26 h.11.9 m) _ Electrical _ SW/SD/VS33 - 115V, le, 10.0 FLA, 60 Hz Motor SW/SD/VS33 - 1/3 HP shaded pole w/thermal overload 1550 RPM - - - Minimum Recommended - --- SD/VS33 = 12" (304.8 mm) Sump Diameter - _. SW33 =16"(451 mm) ._ __ Automatic Operation SW -Wide-angle float switch (manual available) SD =Diaphragm pressure switch VS =Vertical float switch - Materials of Construction _ _ Cast iron and engineered thermoplastic -__ _ Impeller Thermoplastic vortex Discharge Size _- 1.1/2" NPT (38.1 mm) ._ - - Solids Handling 3/8" (12.8 mm) Power ford 10' , S1TW,120' optional) Superior features • Car6an/Ceramic mechanical sea{ •Oil-filled motor w/automatic reset thermal overload • Uses single row ball bearing construction • Piggyback plug available for easy maintenance and replacement 6 ~ x ~ ~ o s i a 3 ° 0 ~~ ii j SD33, SW33, VS33 20 -- -- --- -- - - { - I--- ---- +------'------- - 10 - -- -_ ~ _ --- _-._ -- ...._ i i -__1...- D i (apaciry-U.S. G.P.M.O 10 ZO - -- ___ -_ liters/Second 0 1 Typical Application' Sump/Effluent pump _- Capacities SW/SD/VS50 - to 44 GPM (2.8 I/s) Heads SW/SDNS50 - to 24 h. p.3 m) Electrical SW/SD/VS50 - 115V, l e, 6.0 FLA, 60 Hz Motor __ . SW/SDNS50 -1/2 HP shaded pole w/thermal overload 1550 RPM Minimum Recommended SD/VS50 = 12" 1304.8 mm) Sump Diameter SW50 = 18" (457 mm) Automatic Operation SW =Wide-angle float (manual available) SD =Diaphragm pressure switches VS =Vertical float switch Materials of Construciimr Cast iron and engineered thermoplastic .. - Impeller - - - -- -__ _ Thermoplastic two vane semiopen Discharge Size 1.1/2" NPT(38.1 mm) Solids Handling 3/4" (12.8 mm) Power Cord 10' , SJTW,120' optional) Superior Features • Carbon/Ceramic mechanical seal • Oil-filled motor w/automatic reset thermal overload • Uses single row ball bearing construction • Piggyback plug available for easy maintenance and replacement 40 30 ~ 20 10 n 20 30 40 50 60 70 GPM BEST TECHNOLOGY MODEL # GFI O - 8 is° ~~ - -- 5 ~~ ~!'~ Q I7 ~-` io" _~ .,._ __, - .~ - - MAI1~T'ENANCE OF 1~`~E GF10 FILTER - ~ time frame in which septic tanks are serviced is set by state and local u~des. although they may be .different, most n~ulatory agencies suggest burr l« rive years_ - • We recotntnend the GF10 filter he cli;ancd when the septic tank is normally clc;aned anc! pumped, or as needed. _ WARNrNG;.~: ~f the liquid level in the tank is aUovt the top o~ the filter, pump the tank prior to removing the filter cartridge. Step 1: Remove the septic tank cover and pump the tan]: if necessary to _ pt.-event any solids from escaping to the field when the filter is reranved. Step 2: Pull the filter' handle and slide the filter opt of the case. Step 3: While holding the filter cartridge over the access ~~peuing of the tank, rinse the cartridge off witl, flesh Ufater. 7';tke care to make sure art solid tnaterial falls back info the tank...: Step d: Insert the cartridge back into die case rtiaking sure that it is properly Aligned and ccxnpletely inserted into the ~rse;•:; BEST sKtiN«-o~Y ~~8-333-3b ~0 POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION Owner /lE~, Se .ear z Permit # ~ DESIGN PARAMETERS Number of Bedrooms 100 droom ^ NA Number of Commercial Units -~ NA Estimated flow (average)* pp al/da Design flow (peak), estimated x 1.5* `6a al/da Soil Application Rate Q, (o ; hl~ /, o aVda ft Influent/Eflluent Quality (NA^) Monthly Average** Fats. Oil & Grease (FOG) < 30 mg/L Biochemical Oxygen Demand (BODS) ~ 220 mg/L Total Suspended Solids (TSS) 5 250 m Pretreated Effluent Quality ^ Monthly Average*** Biochemical Oxygen Demand (BODS) 5 30 mg/L Total Suspended Solids (TSS) ~ 30 mg/L Fecal Coliform (geometric mean) <10 cfu/lOUiril Maximum Effluent Particle Size 1/8 inch diameter *Wastewater Flow Verification and Calculations: (Other than bedroom based) ** Values typical for domestic (non-commercial wastewater and septic tank effluent. ***Values teal for retreated wastewater. SYSTEM SPECIFICATIONS Se tic Tank Ca cit p 1 ^ NA Se tic Tank Manufacturer ~/ Es ~,~ ^ NA Effluent Filter Manufacturer asr' ^ NA Effluent Filter Model G F/o ^ NA Pum Tank Ca cit ,S-o 1 ^ NA Pum Tank Manufacturer sec- ^ NA Pum Manufacturer pv ,orrc ^ NA Pum Model ~J So ^ NA Pretreatment Unit NA ^ Sand/Gravel Filter ^ Peat Filter D Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer: Model: Dispersal Cell(s) ^ In-ground (gravity) In-ground (pressurized) ^ At-grade Mound ^ Dri -line D Other: ^ Leaclung Chamber Manufacturer Model Laying Length/Chamber Soil Application Rate^gpd/ft2 Area Req. Infiltrative Surface/Chamber ESIA Rating ft2 Minimum Nwnber of Chambers D A = ire ate Desi n Flow/Loadin Rate= ft min Materials: all materials must comply with WI Adm. Code COMM84 and be installed per manufacturers specifications and a royal letters. DF.SirN CRITERIA ^ "Wisconsin At-grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.a1.1990) ^ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ^ "Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publications 9.6 ^ "Design of Conventional Soil Absorption Trenches and Beds". R.J. Otis - ASAE Publications 5-77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems". EPA 625/1-80-012 October 1980 D SBD - 10570-P (R.6/99) "At-Grade Component Manual Using Pressure Distribution" ^SBD - 10567-P (R.6/99) "In Ground Absorption Component Manual" ^SBD - 10705-P (N.O1/O1) "In Ground Soil Absorption Component Manual" Version 2.0 ^ SBD - 10628-P (N.6/99) "Recirculating Sand Filter System Component Manual" ^ SBD - 10656-P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" SBD - 10572-P (R.6/99) "Mound Component Manual" SBD - 10691-P (N.O1/O1) "Mound Component Manual" Version 2.0 ^ SBD - 10595-P (R.6/99) "Single Pass Sand Filter Component Mdliual" ^ SBD - 10657-P (R.6/99) "Drip-line Effluent Disposal Component Manu~il" SBD - 10573-P (R 6/99) "Pressure Distribution Cocnponenl Manual" SBD - 10706-P (N.O1/O1) "Pressure Distribution Component Manual" Version 2.0 Drip-line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEM~;N'1' MAiNTF.NANCF. MnNiTnRiNG SCHEDi1i.E Service Event Service Fre ucnc Ins ct condition of tank(s) At least once eve ^ months 3 earls (Maximum 3 rs.) Pum out contents of tank(s) When combined stud a and scum a oats one-third (1/3) of tank volume Ins ct dis rsal cell(s) At least once eve ^ months .3 ear(s) (Maximum 3 rs.) Clean effluent filter At least once eve y months ^ ear(s) Ins ct um , um controls & alarm At least once eve ^ months ear(s) ^ NA Flush laterals and ressure test At least once eve ^ months ~ ear(s) ^ NA Valves At least once eve ^ months D ear(s) NA Other: At least once eve ^ months ^ earls ^ NA -~ A rageLor~ START UP For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other Chemicals that ` may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System startup shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation ofwater-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkms condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. ^ Valves Valves shall be operated in Uie following manner: Alarms Alarms should be tested on a regular basis by the home owner. If an alann sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. INSPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Septic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater Ulan 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one-third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Pump ChamberfTreatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of any filters. Any service needs or repairs shall be promptly taken care of. ^ In-Ground Gravity Component Dispersal Cells The inspection shall include.recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component enay indicate overloading or impending hydraulic failure necessitating more frequent monitoring. page$,of 9 [~ Mound, At-Grade, In-Ground Pressure ` 'The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any dischazge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) yeazs. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of all taiilcs and pits shall be rerrloved and properly disposed of by a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement azea has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement azea should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a r~ / holding tank may be installed as a last resort to replace the failed POWTS. J~ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation <` ~1 must be performed to locate a suitable replacement area. If no replacement area is available a holding tank maybe installed as a last resort to replace the failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CII2CUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name E,td ~'te~ /yP- 3 yiL Phone 7iS C7.? - S.T LL Name Phone E,c >js- E'1 [.rt [~.,y i./ j.~ - .S.Tl SEPTAGE SERVICING OPERATOR (Pumper) _ G~.~x.,lew./ LOCAL REGULATORY AUTHORITY Name Phone Agency Phone ~ yiS ~.ca Z.~~.~s f .~~1- 6 0 K:\WPDATAIEH\POWTS OWNER'S MAIVUAL.doc Page 1~. of 9 •-lent of Comme ~' p ON REPORT Page ~ of Wlsconsln Depart, ~T 1 Division of Safefr~ and Buildings ~ !b ~ / ~ Ih'dC with Gomm tfb, vvlS. Ho ~oae A' ust Pl ~h ~+ ` County ~. C ~ ~~~ an Iry' I ir I Attach complete site plan on paper not less t an t~6 ~ ' ction nd l i h ri f l I ~ o z include, but not limited to: vertical and percentslope, scale or dimensions, north a erence po n ta re e ton crest road. w, an~l~oE;'djip~~~tjsN~ Parce .O. - (~ $ " t! b ~ ~b • Please print a y .OFFICE Reviewed Date Personal information you provide may be used for secondary purposes (Privacy 04 (1) (m)). Property Owner Property Lo S W l4 S I ~ T a~~ N R ~ ~p E (or~ Lot Govt ~ . lJ Property O~wtner's Mailing Address T ~0~ ~ ~ Lot # Block # ubd. Name or CSM# ,, ,/ , ~ ~~~,~ ~ G~4~1 ~ tai V2~ Ci State Zip Code ~`~~'~ ~~ G Phone Number S ^ City ^ Village Town Nearest Road ~- ~ ~=v ~ E ~ ~ ~ l I a~r.~ ~ o c ~S > ~ y -3 . , a -c. New Construction Use: ~ Residential / Number of bedrooms Code derived design flow rate _ ~0 GPD 't' H p ~ G S k ~~ W ~ "'r~ I'~ J e ~ ^ Replacement '~lAt~ Parent material~Qt~~:Q_Ver~~~JC~' p p $ .• W . ,rDOwr l't~reiaF-Describe: 3 ~bt ~~~qs ~}yJV<.. _ FloodPlaine:evationifapplicable _-~"f'~ry0 ~""~- ft• General comments '~;; S V des; e~ / J ~, ~ ~ ~~~ f ~t9~•9-a-•.- ~^~,t~ ~ gs' ~$ 5 ~ U - and recommendations: ~._, ~ ~ ~ ba.5 ~ D N 9 `f. S S G a rri-o ~ r> --'~ I Boring # U Boring (~ ~ (.~ (~• pit Ground surface elev. ~/1r~~ ft. Depth to limiting factor ~ I_ in. Soil lication Rate i C l ti n R d D i Texture Structure Consistence Boundary Roots GP D/ff Horizon Depth in. or nant o Dom Munsell e ox escr p o Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a -- ~oyQ3/ s: Fmk ~F~- aw aF . !o , ~ 3 -3`I Y2y! c i._ ms5k F. Q.w - vF , Y - Co y- c - Boring # ~ Boring ~/ 1 pit Ground surface elev. ~ I ~~ 5 ft. Depth to limiting factor ~ in. Soil lication Rate l i t C D ri tion R d D Texture Structure Consistence Boundary Roots GPD/ff? Horizon Depth in. or om nan o Munsell p e ox esc Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 ~ _ -,~ /D~~3 a ~, S ~ R ~~/ S r' aCSyK d K. M~~- ~ ~~- aw c ~,,~ ~F d F , , O aZ - C r:'~L~ 5 D ~ S 'Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L - tmuern rrc = ovus ~ w ~ ~ ny~ a, ~4 ~ .~•~ - ~~ ~ ~ ~~ - CST Name (Please Pri i Signature CST Number ~~e~o afl ~--~ ~ at Evaluation Conducted Telephone Number ~ -~ - ns ~ls-a yg-~~ a A ~ rvd to Property Owner ~eh ~~W ~"~~ Parcel ID # J Page ~ _ of 3 Boring # ^ Boring q [~ pit Ground surface elev. _! ~~~~ ft. Depth to limiting factor ~S in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 •Eff#2 C R h o ~ ~. - ~r ~ I ' w, 5-1- rv Boring # ~ Boring ^ pit Ground surface elev. _ ft. Depth to limiting factor in. Soil Ap 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 R lication Rate i H D th Dominant Color Redox Description Textun: Structure Consistence Boundary Roots GP D/fP zon or ep in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L `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. SBD-8330 (R.6/00) I ~"~~ _ _ _ ` ~ ~1~1 1 la~,~~ ~ v~~t. f l-o~; a , .-- _9 y..~S ---~ ~Ba ~y.$s ~ 3 9~.a3 . , ~1, r r / / l ~ ~3 ~ ~o / ~- ~_ / `~ °o ! ~,~ ` ~/~~ ~~x I I / 1 ~ f i~-t- ~ : , -3~0~ f ' ~~ 9~ , ~ -- ..- `! Z v, m E ~~`~~ o ~, ~, ~ A m ~ s _, ~ ~. ~ - ~. s ~ ~ ~ . ~ n' ~ s ~ , ,c . . o ~~ € z ;~ a o ` o~ x \L ~~ _~ m ~~ I i~' l g h ~i~ ..,d ~~~~ ~ ~' `~ ~ ~ ,, :~ ~ nv ~ ~. \ ;._ :.-' _ ~ '° a~ ~' _ ~ n ~ ~ ~f 3- ~_ d ~~' ~ s G ~U A ~ ~ Q ~i -~ ~ .F. ~~ _ . 1 ~ U ~" _ ~s z _~ N ~ _ ~+ __ ,~ _ _ _ _ _. n ~. s ~ _~ ~_ ~_ t` ~ J r _ ~ ~` R ~~ ~. PELKE PLUMBING Fax~715-672-5267 Apr 19 '07 1132 P. 02 S~'. CRpIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSIiIP CERTIFICATION FORM OwncrBuyer Mailing Address • Property Address y3`1 (Verification ~~ )~ ~~ ~~ V t ~ ~~ ~ I,lr~ ed from Planni~tg 8c Zoning Department for ne construction.) 1 City/State ~k~ _ Parcel identi~catiott Number - ~~'-~'~ -10 ~~ l(~35~'1.~ =0,~ ~ -103-7-aU -4 LEGAL-D - CRI Property Y.ocatio 4 , '/. ,Sec. i ~. , T ~ ~ N R t ~ W, Tovm of ~~ ~'~ ~ `~-- ~ c f Subdivision ~a /, ~.. SE/.s~/~- ~D~~~ Lot # Certified Sarvey Mt-p # ,Volume ,Page # Warranty Deed M ~ ~ C7 ~- ~? , Volume ~~ ~ ~, Page # ~ Spec boost yes no Lot lines idensitiabk yes mo SY TEM MAINTENANCE ANA OWNER CEIt,'I~CA~ON ImQropar nsc and maintena~t of your etptic system could result is its preatabut failure to beadle wastes. Proper maintenance consists ofpa~arpiog out the acetic teak every fbrtt years or aoo~aec, ifnetded, by a liceru-ed PtnooPec• What You ptK into the system can affect the fune6oa of the septic taale as a treater stage in tbt waste dispose! system- Owner maiattena~e responsibilities arc specitkd frt §Comm. 83.52(1) and in Chapter t2 - St. Croix Cowry 5aaitaty Ordinance. The property owner ag7[ees to submit to St. Croix County planning & Zoning Dcpartrr~crrt a certiftcatioa form, signed by the owner and by a master plumber, ja~y~ Ply, ~~ plutuber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in propel optratittg condition and/or (2) after inspectioA and purrping (if necessary), the septic tank is leas than 1/3 full of shidge. Uwe, the wdersigned have read the above requirements and agree to maintain the private sewage disposal system with tbie standards set forth, herein, as set by the Depar'trnem of Cotrpncrce sad the Department of Natural Resources, State of Wisco~asin. Certification stating that your septic system bas been maintained must be completed and tetatncd to the St. Croix Cowaty Planning & Zoning Dcpartmerrt ~rithin 30 days of the three year expiration date. Uwt cextify that atl atatemeNa oa this fomr arc true to the best of mylour knowledge. 1/we ardate the owner(s) of the Property dcsuibed above. by virtue of a wamtuy deed recorded m Register of Deeds Otf'ice. Number of bedroom SIGNATURE OF APPLIC S) PATE s•«Any information drat is misrepresented may result in the sanitary per~aat being revoked by the Planning & Zon+uag Departmert «•: Include with this application a recorded wsnamy deed from the Register of Deeds Office and a copy of the certified sttrvey map if reference is made iua the warranty decd. (REV. 08/0 !Q V0~ ~~~~PAGE~~`t STATE BAR OF WISCON3IN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between Victor O. Lee, a/k/a Victor Lee and Elizabeth A. Lee, husband and wife Grantor, and I{enneth D. Schwarhz and Lila J Schwartz, husband and wife. holding as survivorship marital property Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in SL Croix County, State of Wisconsin (if more space is needed, please attach addendum): Southeast Quarter of Southwest Quarter (SE 1/4 of SW 1/4); that part of Southwest Quarter of Southeast Quarter (SW 1/4 of SE 1/4) lying West of Town Road, All in Section Twelve (12) and that part of Northwest Quarter f~Nortlieast Quarter (NW t /4 nf_blE 1/41 f Section Thirteen (13) lying West of Town Road, all in Township Twenty-eight (28) North, Range Sixteen (16) West Exceptions to warranties: Easements and restrictions of record. Dated this p~ ~~day of ~tJ~ , 2001 AUTHENTICATION Signature(s) authenticated this day of Recording Area Es5[~iE~~? KATHLEEN H. WALSH FtEGTSTEFt OF DEEDS ST. CROTK CO. , bdT RECEIVED FOR RECORD 47-i4-2441 8:24 AN iiARRANTY DEED EXE1~I # I;ERT t~'Y FEE: COPY FEE: TRANSFER FEE: 334.44 RECORDING FEE: 14.44 ,; 1 Name and Return Address Thomas A. McCormack PO Boa 2120 Baldwin, WI 54002 008-1035-70,008-1035-95,008-1037-20 Parcel Identification Number (PIN) This is ~t homestead property. (is not) STATE OF WISCONSIlv ss. 5t. Croix County ) ~,r-~ Personally came before me th" , '~- ,s " ' ~'day'of" ~i>.,tJ~° , 2 iA;e nar~d -. Victor Lee, ictor Q Lee an i~;- ~ -~ ,. _ ~ . ¢) r TITLE: MEMBER STATE BAR OF WISCONSIN (If not. to me known to be the person(s) wh u!~ tue;roregoi instrument and acknowhedged the sam -'•.~,;,ri ~ c } } ' authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Thomas A. McCormack aldwin, WI54002 (Signatures may be authenticated or acknowledged. Both are not necessffiy) s Notary Public, State of Wisrnnsin My Commission is permanent. n be expiration e: .) ~... ._'-- -. a........ n.... no.wrifi~ mnet t1P. f~7flPlt Or Information Prcfessbnals CortpanY. FomM du Lac, vw gQp.g55•Z021 ACKNOWLEDGMENT Parcel #:, 008-1035-70-050 04/30/2007 12:11 PM PAGE 1 OF 1 Alt. Parcel #: 12.28.16.180A 008 -TOWN OF EAU GALLE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s)• O =Current Owner, C =Current Co-Owner O -SCHWARTZ, KENNETH D &LILA J KENNETH D & LILA J SCHWARTZ 1341 250TH ST GLENWOOD CITY WI 54013 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA ~ ~ ~ Off' SP 1700 WITC G,~ ~ ~.~,a,~ c~j. 2~C .~ - -~ - ~c Legal Description: Acres: 65.702 Plat: N/A-NOT AVAILABLE ~'~~- moo SEC 12 T28N R16W SE SW (SUB TO FLP ' Block/Condo Bldg: 830/205) FKA 008-1~~7II~ f$0) & INCLUDES 008-1035-95-050 (183A) P~ Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) SE,W OF TOWN RD' & INC (186A 12-28N-16W SW - - - 50 P NE,W OF TOWN RD Notes: Parcel History: Date Doc # Vol/Page Type 12/04/2003 748153 24 30 ALC 07/10/2001 650677 677/26 WD 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/04/2005 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 25.202 2,800 0 2,800 NO UNDEVELOPED G5 1.000 100 0 100 NO AGRICULTURAL FOREST G5M 39.500 23,200 0 23,200 NO Totals for 2007: General Property 65.702 26,100 0 26,100 Woodland 0.000 0 0 Totals for 2006: General Property 65.702 26,100 0 26,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ~" ) ~~ J Parcel #:.008-1035-20-000 oai3oi2oo7 12:19 PM PAGE10F1 Alt. Parcel #: 12.28.16.178D 008 -TOWN OF EAU GALLE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -SCHWARTZ, KENNETH D &LILA J KENNETH D & LILA J SCHWARTZ 1341 250TH ST GLENWOOD CITY WI 54013 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA ~ ~ ~ ~~ SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 12 T28N R16W S 245' OF E 838.54' OF Block/Condo Bldg: NW SW Tract(s): (Sec-Twn-Rng 401/4 1601/4) 12-28N-16W Notes: Parcel History: Date Doc # Vol/Page Type 03/01/2007 845621 WD 12/04/2003 748153 2467/130 ALC 06/17/2003 726175 2278/291 LC 895/69 more... 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/06/2006 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LANDS G6 5.000 5,600 0 5,600 NO Totals for 2007: General Property 5.000 5,600 0 5,600 Woodland 0.000 0 0 Totals for 2006: General Property 5.000 5,600 0 5,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 _ ., ~a~..: ~. ' ~' ~~: ~~.. ~ ~U GALLE PLAT . ~ ~; ~~ ®~ T 28-N • R 16 W ~ ~~.~ ~~ ~ See Pages 115-116 For Additional Names. i fit` t BALDWIN PAGE 40 James & ~, Shazon J s io / ii , ~ - Gossel Carey )anis& '. ~a Widiker M 17 2 i 30 Ke17 Nelson 60 54 Holmes Donald) ~8;~~ 120 by Krnt Arthur & Judi Dadel Dun Amdeson ensen Rodel Peterson Marrnnn tela H ~ rust 240 3e i t Dennis & i ; Iverson 30 ~ 77 Na tsz Kristine ~ ~ ~ i ~ . ~ s~>n f^i ao rQ Xla 9 Hillstead - _. Rnrmetst<r ze : .. CS 15 2 J Yang 137 ~ ,;' ss x Harvey ~ °~ =~ "° Halderson xnrtChriss ns~bb<Hr f 39 D 20 ~. ....:.~...., ~ 5 ~'` ttli~ BH & Johnson .. ~ ..e:c:, .;::r','; 1 'li ° °pL X RobertA Michael 2 l 94 David & asharoa "~~`zaca~ "'', "rrhur seer°~ ~;. 2 g Lee RlrhaN J y Mielke y st<wart & cr<g ti ~ ~ Trapp Hrwr ~":: ~:. ~ ` 0 sa g<rson & o Trull ~ukS? -• 2 L&N 20 trust 36 )awbson o ~ o ebl 3x ppt 43 ~ ' q7;:'=5: z Ostlie 94 RelnSCh 88 3a ~ s x s: ~_,: xs 7ffi ~<",°, errt' 50th AVE Greg & GAGS 6 ~ PffiM sWr~° ffi Glenda anet 1, ffi Lyla Maz s°bpta aye P rrusC ferry acobson B 15 '- -_ _, 21 GrinNey 34 • Wei Lund <FtrerA ~o e ~ ~k ors"" Laurence ] D 1 60 39 ~ 3"`3°"~ has rmst4e 3O & Nancy S9 ohn 1B =--- ? E ~~ loy)r Ac cgv Chris & Terry& S 9 Larson waster 8r q JEU~or&-.w As Nola cAL Ylerie 7ammi TiuSt Dorene' Nelson G s 1 ?: '~ck°° s 7 angers 78 wamstad 160 )acobson 170 ''''' 66 1 114 ~ f~ ~ ~il$ ~~5, ~! ~V' K roueF- 1 G ~ ` 45 & Wilma Donald & David & omN: s eow<n zz Mar aret Diane g David , "'~ C Harry Sw"~ar' ffi9 otso~naz \lageseth 4 Zignego Gedams t.•''. ier Schwab „ 3a 4 l09 40 42n AVE a 3 Benck, r,. lily 60 U ceP 139 ~;. F !" St Douglas A A)r s \ Dominic N o N g R"t°ph°i .. YI gnego ;~ of ffi y p ~ Z p schwar~ 40th ~1~%::. -r r_ _60 40 38 40 40 `} ~ x 20 ao _ 26 !i; _ _ `~ _ - `~ ames & _ - - - William Telford ~az ffi 4a~A~ ffi tf `'-" E! ~ j Roland wOma & Betty ,<airo ~ to Roxanne Lee Hageseffi & Jean Norvold atblson i sanara victor A - Lund 103 D R;esa<Iman Eimbem - ^. 40 Peavey 40 ° 3 Lee 14z ",'' w ,-. $1J[ `4~ AM 1MA Maori \ 288 FAR ~ " `, 10 10 ._ Stone x , D<bra Sgt] 19 ffi xA ~ -. \ 17 ~ PECAN ~ ~ z'°'°`~`° Iverson i n<<-zo L s 1 ~ -38 3 1. 2 Jo _ LN Ro1Be iAR ,~ F Craig & ames6 Lee 2 R 9 _ Pffi`, 13 Kelly Roxanne Dennis 0 1 ~1. 5E -.,, Albright ! ~` Kevin Lund 40 Duckworth 62 Sheli ffi M5 N ~~~ --. „-- 15 son 41 "dl. erry &JodY n E Gedatus 9 ._ _ ~.... ~. _ 76 Allee Wayne A Kurt & by to ~$ un Kr«ning _ ~'.: ~` e* fV AIb ~ e:: tier 8o Giezendanner Bertelson t° ,~r~ ° a~r~son ~ r~`i"rd +0 0,, s ~ ~,. ~- t 76 40 4 3 ~` ~ _ 60 152 _ _so 41 r _ tOmsp a _ ~ ~KUane s 10 P r9 Margin A GA5 2 T Lrent & & V ~VT' c~Ra. ~ ~ a m7- .wuee u ~ Stene R A own Of Barbaza 7 12 15 L ynn ~j` 'rig J 79 au Galle later 40 PaN A 1 °s ~ Ne15on SH ~ 30 ~ ~ ~. ~; - Ardason 6 Pamela 0 dS.nro 35 38 6 eailnnas x e gi; a, v Ten n ~' ~ & Laura David 7R ~ p & S aron ~~D '~ o AGlbrl & IaMy ": Kennett Hansen ~•l.c" Fre a 3ga -.x ~- Vang Lee J son 40 ~_ 46 40 40` °' >~ 33 93 81 e- tllt~-. : James & Thomas ~ ~ r3 25t 3 & )on RAj Verlyn & Do~,ia ffi .-. U b Steven trn ffi Thomas .Marilyn ~, ,, cur Ellefson oho° Patricia samara 3 ~ ~ "t10t & Amy aco'b3orl ho 54 101 is Falde 80 Anderson derson ~ Schoe- s dra j ~~': 7 Pa & Hoff 40 F so-a Casey 75 240 ri^. p '' Rickey & Linda 41 Wayne & Chi Aaou A Thomas ~ ` w son Donna ~ Josephine Yank M:tie DA 15 t! Sturtevant Albrigtson r ~~ i Koderick. AE R 10 & Janet Lee 60 ~ ~ o o~ 80 M"s"' Ellefson 80 p ~ 80 80 g ~ _ Frame 4_0 DC 10 ~ ~ ~ ~ ~ ~ ~ ~ ~ ' ~: RC 13 P b 20th AVE ac) &J Tracy) AlD Delmar .s ~~ to P to & t y 7 & jean ~`' - lmeS Robert Thnmas Phrn A K&T 20 Helge n Scott & Ka A ChauChmB ~~ 53 North 4 Zlebart Kielmeyer ~:, OIl1aS yy Joanne so emmle -. ovde eNck Kevin & Lynm° Suburan 119 Man, 80 ~, 0 4 Barbara r too Fu ate ` _ ~ ~-. Ong Rffix Larson Kenneth L Co 191 B 121 r1II1O y `~~, tt 279 ^ 2 I n Schle el 35 , ..;: L & Alison O G 15th AVE Werner N Orville & chlege] E N o'..,~ F7 A~1e Darlene 0 7 v .,. v BB so-~a ° Lien 101 12th VE S Dennis Ov'.: : ~ & Robe e peter & 3 s~ am n x°rt A & Shirley ~~ ~ . dta v~gt Sheran ~ B&K ~ ~ beth Roche t -; 78 40 31 JW tanaitis 100 x RAC s~d ~ o a oti~~o o °`""° 4U , 115 _ C e~ ~- , ~.-, 10th AVE Donald Daniel Bdwood P=NA)anis ptlson 40 ewbor6 few ' wffi1 Adolph -, ~ < Don& Pax u~~ s ne 89 BOSTON Fre~< lohnsonl l ~,t ~_ Diane 60 40 z Clark RD o 6O ~ ~3'~ ~ Gavic Brunkow °I Anderson a3 240 Harwood lffie v v = 150 Ross & , , _. r ~: w to c ~ ,d"r Elizabeth AsM t °'' , Corp 80 80 ^~ ~ Keehr 140 corns A Dort, 3- Aar°" Steven Al zo Wildwood 3 67 J e,- eO1ud Jeffrey & DenNs & Anderson orrnb<ra James - a Doreen Rebecca View & Amy ;ate 7s Diane R 20 Degnan & Jon tai zo ~ Inc 100 oxeefe Brooke 120 olfe so Allen 80 aason 4o Barry & ` Roger & chriswpn<r udrey AD s: Patrici Joseph & Michael o c o Mary F ~' ~~~ °~ terry Ryan A Nan<v ]Ue 9 H & Robe+t Teresa ffi K n eremy x A- @=-~< Lansing Peavey as am 0 F ones I Degross Humphr y ohnson ~ ~ ~ Anderson , °.. an an o 1 z sl... .. st....:, o at 139