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HomeMy WebLinkAbout008-1035-95-100 (2)Wisconsin Department of Commerce PRIVATE SEt~AGE SYSTEM safety and Building Division INSPECTIgN REPORT GENERAL INFORMATION Y<°•T H'~R'7'O 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 Bond, Scott Eau Galle Townshi CST BM Elev: Insp. BM Elev: BM Description: ,/yam TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ Dosing / Cad •. ~f~ ~i3n ~ ~ u. Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic / ~~ 1 ~/ ! / Dosing J ~ /~/ /~/ Aeration _..._..~ Holding _s' °~~•- -. - PUMP/SIPHON INFORMATION ,~V~ Manufacturer Demand GP Model Number ~1 TDH Lif~~ , / ~ cj Frictioq Los$ `Q . `1 System He d TDH t Forcemain LengJ~ Dia. Z / 1 Dist. to well _ 1 SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 453121 0 State Plan ID No: Parcel Tax No: 008-2003-20-050 Section/Town/Range/Map No: 12.28.16.554B ELEVATION DATA STATION BS HI FS ELEV. Benchmark ~~ J~ I ~ ~~ Ait. BM~~ `tt~ l~a~ /v ` ~ / 3 - J~ Bldg. Sewer f 5' ~ v 9 d St/Ht Inlet /~ ` 8~. c SUHt Outlet Dtlnlet ~ \ Dt Bottom Zd ~~ ~'S Header/Man. ~ .~ /bb .7 Dist. Pipe 3. S io(, Bot. System 1 /~ i/ob Final Grade Z • /al . ~ St Cover ~o : c~ ti 33 ~s5 BED/TRENCH Width ~ Length / No. Of Tr ches PIT DIMENSIONS No. Of Pits Inside Di Liquid Depth DIMENSIONS ~ \ \ ~ ~` SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR T e O tem: yp / ~~ C i J A) ,/~ ,v fT UNIT Model Number:` o u DISTRIBUTION SYSTEM Header/Manifold ~ ~ // Distribution~~~ \ // / ~ 14t, Pipe(s) r x Hole Size /~ x Hole Spacing J~ V t to Air Intake ~ Length~_ Dia Z v Length Dia \ ` Spacing_y~ ~.- °` SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over 1 Bed/Trench Center Depth Over Bed/Trench Edges xx Depth of Topsoil xx SeededlSodded xx Mulch d \ 1 es ~, No es No ,97 ~,,.~ oK COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~! ~ / d~ Inspection #2: ! / Location: 2614 Sandpiper Ln Unknown (SW 1/4 NW 1/4 12 T28N R16W) NA Lot ~~~~ ~~ Parcel No: 12.28.16.5546 1.) Alt BM Description = ~ ~~ ~y ~~ ~ ~ O G ~'s.5 b`~ 2.) Bldg sewer length = 3 J -amount of cover = ~ , / / `'- ---- -----r ~ --- Plan revision Required? Yes y'~No ~~ ~ _. Use other side for additional information. _ 1 _`_ ~~' i __ ___ _ _ _ ~"`~i__I '~ - SBD-6710 (R.3/97) Date Insepctor's Si ature Cert. No. Safety and Buildings Division P B C County ~~ C~G • ox . . 201 W. Wasltrngton /.^•c., r iseonsin Madison ~ VED Sa titary Permit Number (to be filled in by Co ) Department of Commerce (6 ) 266 ,I Jr3 2~ Sanitary Permit Applicat on ~P~ 1 6 2004 State Plan LD. Number d S G ~ ~ = 12AIJS ~ D personal informa on you p ovt e Code Wis Adm 21 lit accord with Comm 83 . , . . . , may be used for secondary purposes Privacy Law, s15. (1 xm) ~ ~ ~ CROi%~CO~,~~ Pro ct Address (if different than mailing address) ~T. `/ L Application Information -Please Print All Information ,.~„~,~•.•-~---'~' ` (7 ~~~ t • e ~ L Prop('e~rty Owners Name ~~ ~v ~ Parcel # of B~ieek-#~ ~~ ~ r ~ V~iO wner's Mailing Address f' ~- pertyO Pro y Loca ti o Prop e rt / g ( ~ ~ L / ~f ~ / City, State ~~ r„/~ ~_ / - l Ci ~ /1 K.~ t Zip Code f~~lt~(jZ Phone Number / (/ ~~ y " `~ 1 ' ~2 ,~ y circle one) T -L(J N; R~Jtor W l ll th t h k Oto e~ 'S ~~ P. y) a a app ec II. Type of Building (c fitt~elrvisivrt-Name CSM Number or 2 Family Dwelling - Number of Bedrooms tn~. ~ j `L~ ~I ~~ ~ ~ ~f 9~ ~3 ~~~ . ~q, 3 . ^ Public/Commercial -Describe Use s ! s ^ State Owned -Describe Use `t • J~ r x ~j ~ ^City_ Village o_wn2ship of ~//~~ ~ s ~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) .-ZO~3 - ZO -8$'U '~ New System ^ Replacement System ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Existing System B ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date issued Before expiration Plumber O~utier IV. T e of PO\VTS S stem: Ch all that a 1 ' ^ Non -Pressurized In-Ground Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ AI-Grade ^ Single Pass Sand Filter ^ Constntcted Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis etsal/TreatmentAree Information: Design Flow (gpd) Design Soil Applica ' te(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) 'System Elevation 3 w~ p3 . ~~,~ .~~, ~,~ ~ 6~ X0 VI. Tani: Info Capacity in otal Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units 2 t ~{ ~-~ ~, oncrete Constructed Glass ~ I L /~ New Existing T` Tanks Tanks Septic or Holdinc Tank 1,Z(~(J ~ q ~/{~ r Cis' ,~ '` Aerobic Treatment knit Dosing chamber ~'GU .1 ~ i ~ / // VII. Responsibility Statement- I, the and igned, assum onsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu er's Signature ~PetP7MPRS Number Business Phone Number ~'~ e s'~fcy~ X23 y?5~ 1- ~/S'-G~Y-s'/G6 Plumber's Address (Scree[, Ci tale, Z' `~ ode) / J ' / '/ ~/ VI11. Count ~/Dc artment Use Onl roved Sanitary Permit Fee (includes Groundwater Date Issu d Issu ng Agent Signature (No Stamps) roved ^ Disa A pp pp Surcharge Fee) ^ Ow n Reason for Denial ~ 3 ~ IX. Conditions t Approve SY3T~M 0 N~F~ 1 ~5eptic tb , effluent flteF'~fld dispers8l cell must all be serviced / rnetniained ~& per mana~ment plan provided b~ plumber 2, All setb~k requtrelnents~lust be maintained as peI appM"cable code/ordinances SBD-6398 (R. 01/03) omen eomptere ptaas fro me a.ounry onryr ror me sys,cm o.. papc...v, .wa .... ....................., ... ,,.... . Gro~~.~ >=1eu, ~1/. G --~>~~ {~ro~~s ~ 1~80~8~ G~.~ 1 .SAP-~~^(G/DBSC ~YtSG,~0.1 1Qn~ Wt~' G. ~~~c~ f~-100 ;_ ~~~ 0 b 0 to '~ z n C ~~b \ 0.,. P P n 0 !"= yo' ~~ ~~at^ • ;~ d COPY Con`~'our ~Ie~ 99.03 /01.03 ~o 1 ,e-~ . [3,M, 100 - t~ ~ o~ ~` p ~'rPt ~o-~. !~ bbo~. ~(~ t 13,M. X03. og Natl ~ol-g ~,bbnh commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary April 15, 2004 CUST ID No.223475 JOE STANG STANG PLUMBING & ELECTRIC PO BOX 263 WOODVILLE WI 54028 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/15/2006 SITE: Scott Bond Sandpiper Lane Town of Eau Galle St Croix County SW1/4, NW1/4, S12, T28N, R16W Identification Numbers Transaction ID No. 985018 Site ID No. 672635 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 950290 Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual, SBD-10572-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 enclosed approved plans and with publication SBD-10572-P(R.6/99) "Mound Component Manual for POWTS". The pressure network is to be constructed in accordance with publications SBD-10573-P(R.6/99) "Pressure Distribution Component Manual for POWTS". • 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 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. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized reRresentatives of the Department which may include local inspectors. ~.® ~~~/,'~°.~. Cc~n~z~~~~c~~~,~ ~~ D[PARTMENT OF C6fJIMERCE JOE STANG Owner Responsibilities: Page 2 4/15/04 • 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. 7:30 am to 4:15 pm j swim@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 INDEX .SHEET SCOTT BOND 640 BIRCH STREET BALDWIN WI 54002 PROJECT NAME: SCOTT BOND 9F sq,~~gp,~~F/vF~ ~~~0~so r~ PROJECT LOCATION: SW 1/4, NW 1/4 , S 12, T 28 N, R 16 W MUNICIPALITY: TOWN OF EAU GALLE COUNTY: ST CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD-10573-P(R/99) MOUND COMPONENT MANUAL SBD-10572-P (R 6/99) Name: Joe Stang Address: PO Box 263 Woodville, WI 54028 Credential Number: 223475 Plot Plan Cross Section and Plan View of Mound Distribution Pipe Layout Septic Tank & Pump Chamber Cross Section & Specifications W 1250/800-MR Tank Specifications Pump Specifications POWTS Owner's Manual & Management Plan - Pg. 1 POWTS Owner's Manual & Management Plan - Pg. 2 Signed Date: April 5, 2004 Vik~~~ut. vt Jr;rtl J HtdU b~1iLUiNG$ ,I ~~ `~G~~' ;;LL GURR PUNDENCE PROPERTY OWNER: CONTENTS: Page 1: Page 2: Page 3: Page 4: Page 5: Page 6: Page 7: Page 8: ~. r C7ro~~~ bleu, %/. ~ro~~s ~ r~ So~ B vo C~.-~ _scp~~~~Dase ~~s ~a Lv~f 1, ~~.[,~I ~1-~00 b 0 N '~ ~~i~ S ~ a l~ f ,, . ~o' a (~~a~ ~~a~.. P~,oF~ Contour F~e~ q9, 03 101.03 ~ / ~ owl o 5 (od-~ .~ r C3,M. IOD.Oo ~~ ~ o~ ~j ~~ /RUC. ~,P~ ~o~. !~, bboh /~Lt 13,M. lD3. og /Uau~ Sorg R~bb~h Page %~ Cf ~ ASTNt C 33 Sand Topsoil g % Slope Synthetic Covering _~ ~ ~_ 3 CE~~ Of z~- 2 '2 Aggregate - Distribution Pipe _ e~ , /~/. t ~ry• -- Cross Section Of A Mound Signed: License Number: Date: Position o f ---~ Force Main L W ., , Force Main y9.o3 Plowed Layer D ~ Ft. E ~.~~ `Ft . F . 8,~ Ft. G o r Ft. q ~•5 Ft. H ~_ Ft. g /3~1 Ft. K~_Ft. L /S~ Ft. ~ S. (o Ft. I /O ~7 F t . W ~, Q Ft. Observation Pipe ,} 13 K ~ ------ -- ,_----------~ y e ~ v L A -- O- -- -(~ O ~D.istribution CELL Of 2~- 2 2~ Pipe Aggregaf e I ~~ ~~ Observation Pipe TURN-UP ~ J~45~,1 ~r-t~ .- ~p 36; ~ L7 - Plan View Of Mound ~~ 3oF8 C )ea~.o~~i" A-~~Cs` ~~~~~~ • C ~ IEctv~Cx-'-~ PerforoleA i'Ipe Deloll ~ ,~ End Vlew P~rlorair0 P V G P I D f ~.~-- l.. ~e0.n Owls Holes Located on Bottom are Equally Spaced err PvC Force •I.loln From Pump ~~/ Distribution Pipe Layout Signed: License Number: Dare: OItIrlCullon..• ' Plp~ R - . 30~~ s x 3~ r 3____ ~s `~ ~ Hole Diameter _~ Inch Lateral " ~ Ynch (es) Manifold ,~_ Inches force Main " ,~,_ Inches y,UVE~t ~I~~e~.1 //~'D, s3 /VC.~mdcr I-/Des /"~rGaT'e~-4~ ' ~ ~ f u vv1 ~ ~ o f ~ a ~~ ra /s ' X 'y T~/~ / /vlr. wt.J er D ~ r! 0%PS = ~~~ Page~Of_8 ' SEPTIC TANK 6 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS "MIN. ABOVE GRADE E 41EATHERPROOF APPROVED 4 ~~ .RUC.. V ENT PIPE 12 JUNCTION BOX >_ 25' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK ~ WARNING LABEL _. n ~_ -4" MIN. t. 0. ~ ~~ 18 ~~ I N , ~ ~ ~ ~~ 18 MtN. ~~ INLET ~ ~ ~, GAS- ~ ~ ` , WATER TIGHT SEALS ~ TIGHT ~ ~- ~/APPROYEO A SEAL JOINTS WITH FILTER __f___ ~ ALM APPROYEO PIPE APPROVED ZA $~~ B 3' ONTO PIPE 3 (a"xr(,'' -4- ~ ~ ON SOLID SOIL ONTO SOLID C ~ SOIL PUMP OFF ELEV . .OFT • -~ OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD. SPECIFICATIONS SEPTIC / DOSE /, X '~ %" ~'="- ~`;,' TANK MANUFACTURER : ( t ~sc'r TANK SIZES : SEPTIC (~_ GAL. DOSE6V OLUME FLOWBACKG ~ ~7 ~s GAL. DOSE S~°- GAL. 3~. ~QI.~ = S/O/, 7 GAL. LARM MANUFACTURER: S ~T Ele~~'r~ -SyS~~~S CAPACITIES: A = f ~I INCHES A ~_GAL. - MODEL NUMBER: ~a~ rl~.J g = 2 INCHES = . SWITCH TYPE: M.~vc ury~~°Ci~ ~~3, ~ GAL. /~ / C = ~ INCHES = PUMP MANUFACTURER : CTOc.c / , '/ -~ MODEL NUMBER: W ~OSN D /b~' INCHES = Q~~L' SWITCH TYPE: y-r ~lv--~ F~O«~' 16,23 WAC REQUIRED DISCHARGE RATE ~~ GPM PUMP E AI-P'RM WIRING AS PER ILHR . VERTICAL DIFFERENCE BETWEEN PUMP OFF•AND•DISTRIBUTION PIPE • ~(O~ FEET + MINIMUM NETWORK SUPPLY PRESSURE ~ FEET FEET FORCEMAIN X ~.y7 FT/100 FT. FRICTION FACTOR .- FEET + ~ ~ TOTAL DYNAMIC HEAD - '-9 WIDTH DIAMETER INTERNAL DIMENSIONS OF pPUMP-}-TANK: LIQUID 6'~P'I`A-~_y- J~ ` ~~o.~ ~ci~. I~t- .l.Nc~~ ~SeL /aHK S~D~Ic. 5,12~e ~ IGNED: LICENSE NUMBER: DATE' 1/BB 14 ~ "~~y' ,75" W1280/800- M R TANK SPECIFICATIONS T(1P \/ICU/ SCALE: 1 /4" = 1' •~RT}Alikt MANHOLE ACCESS DIMENSIONS: WALL• 3" BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. HEIGHT: 54-1/2" O.D. LENGTH: 175" O.D. WIDTH: 84" O.D. BELOW INLET: 43" O.D. LIQUID LEVEL• 38" WEIGHT: 18,000 LBS. INLET AND OUTLET: 4" BORE WITH STOP FOR QUIK-TITE, FERNCO GASKET, CAST-A-SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FlLTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 33.44 GAL/IN (SEPTIC) 20.60 GAL/IN (PUMP) LOADING DESIGN: 8' 0" UNSATURATED SOIL MN TANKS: HALL HAVE ONE VENT OVER OUTLET AND WILL HAVE TWO VENTS IN COVER OVER INLET CUSTOMIZED TANKS: TANKS CAN BE CUSTOMIZED CONTACT WIESER CONCRETE ~InF vl~w SCALE: 1/4" = 1' ~~~~C~Q ~o~r~ar~~~ W3716 US HWY 10, MAIDEN ROq(, NA 5750 800-325-8456 MODEL W1280/800-MR y SEPTIC/SEPTIC, SEPTIC/PUMP OR SEPTIC/SIPHON JANUARY, 2001 Fly: w~zao eoo-uR ., Performance Curves METERS FI 25 F 20 O 1- 15 tOh St 04 GPM ~ R1~~11 ~, GOULDS~. PU~M~pS~IN~C. METERS FEET 120 35 110 100 30 90 25 ~ ~ 70 = 20 60 O H 15 ~ 40 10 ~ 20 5 10 0 0 0 L 0 ¢~ Submersible Effluent Pumps 10 20 30 4U au w ,.. .._ -- 10 ~ CAPACITY 3o mom Elbctlw July, tO06 10 ~ 0 CAPACITY POWYS OWNER'S MANUAL & MANAGEMENT PLAN 'FILE INFORMATION . Owner Permit # DE51GN t'Atwm~+~n~ Number of Bedrooms 4 ~ ^ NA Number of Commercial Units O NA Estimated flow (average) 40U aUda Design flow (peak), (Estimated x 1.5) 60U aVda Soil Application Rate 0.5 aUda /ftz influent/Effluent Quality Monthly average' ~ Fats, Oii & Grease (FOG) ' 530 mg/L Biochemical Oxygen Demand (BODs) 5220 mg/L Total Suspended Solids (f,SS) 5150 m /L Pretreated Effluent Quality .~ ~ NA Monthly average" Biochemical Oxygen Demand (BODb) 530 mg/L Total Suspended Solids (TSS) 530 mg/L. Fecal Coliform (geometric mean) 510' cfu/100m1 Maximum Effluent Particle Size Y, lnchdiameter w~rcu cDFr`IFICATIONS Paye ~ oi,~ Septic Tank Capacity 1280 al . O NA Septic Tank Manufacturer 'IESER CONCRETE ~ O NA Effluent Filter Manufacturer ABEL O NA Effluent Filter Model 100 1 l" x 16"' O NA Pump Tank Capacity 600 al " O NA Pump Tank Manufacturer IESER CONCRETE O NA .pump Manufacturer GOULDS PUMPS hN~7 NA Pump Model 3885 ,,6; WE05Ii '~'`` ~~:0 NA Pretreatment Unit ^ Sand/C~ravel Filter O Peat Filter O Mechanical Aeration O Wetland O Disinfection O Other. ~~ y Dispersal Cell(s) O In-ground (gravity) O in-flround (pressurLted) O At-grade I~ Mound' O Drip-line O Other: • Values typical for domesOc (non-oarmerdaQ wasl~w-atQ end septk tank effluent. . •• Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency ct condition of tank(s) I At least once every 2 ^ months W year(s) (Maximum 3 yl,$.~ nspe l k Pump out contents of tank(s) Inspect dispersal cell(s) Clean effluent filter ~ When combined sludg At feast once every At least once every vo ume e and scum equals one-third (Y~ Of tan 2 ^ months O year(s) (Maximum 3 yt's.~ 13 ~ months . O year(s) Inspect~pump, pump controls ~ alarm Flush laterals and pressure test other. At least once every At least once every At least once every 13 ~ months 3 ^ months ^ months O year(s) year(s) ^ year(s) O NA O NA O NA other. At least once every ^ months O year(s) O 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, POWYS Inspector POWYS Maintainer; Septage Servidng Operator. Tank inspections must include a visual Inspection of the tank(s) to Identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be v(sualiy 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 (Y) 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 cit. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWYS components, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWYS Maintainer. A servir~e report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION. For new construction, prior to use of the POWYS check treatment tank(s) for the presence of painting products of othef 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. Pafle _~L of ,,,~ ~ystei~i 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 ceU(s) and may result >n the backup or surtace 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 othefwise 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 Ufe of the POWTS: antibiotics; baby wipes; c(garette butts; condoms; cotton swabs; degreasers; dental floss;'diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbkides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMfVIENT 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 ch. Comm 83:33, Wisconsin Administratlve 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, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: O 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 compactlon,and should not be infringed upon by required setbacks from existing ar)d 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. O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank maybe installed as a last resort to replace the failed POWTS. O The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a SoU and site evaluation must be performed to locate a suitable replacement area. If no replacement area Is available a holding tank may be installed as a last resort to replace the failed POWTS. t~ 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 CIRC,UMS7'ANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS PnwTS INSTALLER Name STANG PLUMBING & ELECTRIC • Phone 715/684-5166 POVYTS MAINTAINER Name ABC SEPTIC SERVIC ~- •Phone 715/235-1666 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY ' ' `~ ~ ~~ ~ ' Name ABC SEPTIC SERVICE - MENOM Phone 715/235-1666 Agency ST. CROIX COUNTY ZONING • Phone 715/386-4580 ~~ This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agendas. This docxlrftent ntleeti the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)8(f) and 83.54(1), (2) 8 (3), Wisconsin Administrative Code. Use of this documentdoas not guarantee the performance of the POWTS. oMyytyp~l ~r~~_.=J ~,....,. _ 3 { 8orina # "s="~ goring Pur;;ei iD 1i _ 005_~r~rr3_~0=qnn -- ~~~ ~ -~r--= L t VI Pit Ground 5urtace elev. _ ^ _ 7 i • to _ _ n• ueprn ro uminng racror L4: in. i Soil A~lication Rate ; Horizon j Depth ' Dominant Color ~ I Redox Description ~ i Texture I Structure ~ Consistence ~ EBoundary Roots ~___. OPOLft?_~~ ~ in. Mansell Qu. Sz. Cont. Coles i ~ Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-10 ; 10yr3/2 ~ none sit ~ 2f..bk mvfr ; as '' 2f,1 m ~ 0.5 !t.8 L__ __ 2 _ --- r 1015 ---} -- i I 10yr4/4 --------- j-------- - I none - - { _-_-- ~ sit ;- ---- -- ---- ' 2fsbk ~ -- rt-- - ds ~ - - -- t _ r _- _ _- cs i 1f }-___-- I 0.5 ~ .8 f -- - _ - }- -- -- r-- -- --- -__ _ } - _;- } I_ . ~ ~ ~.,. ; J'L`Y ~fi1 i•3iG ~ ~ nVne 71 , '. -. LrT1Jr)rC ~II ' .YV IVlrf V.:J ~ i U.J 4 ~ 24-30 10yr4/6 f2f 7.5yr5B _ 1. LL _sl_ _ ~ __ l msbk _ _ _ 1__ _ mfi ~ cw - 0.2 0..~ _ 5 1 30-35 I 7.5yr3/4 ~ f2f ?.5yr5/9 ! scl ~ Om I mfi ci ~ - ~ 0.0 0.0 6 35-47 ~ 10yr5/6 ! none i scl ~ Om ~ mfi - 0.0 0.0 ~ H#6 con tains approx. 5()96 lim estone fragements of 1 /4' - 4" with spaces between f ragements co mpnsed of limestone r esiddum. rid eonng # --~ """' ". { it Ground ourface ~de~ ~~3:~ ft. Depth to limiting facto; ~~~ in c _ _ _ _ . ^ - .._il Appl!ca l~u; Rate Horizon Depth Dominant Color ~ Redox Description Texture Structure Consistence Boundary Roots _ GPQfj~____ in tit f~calV fi;i G~ ^nr.i_ ~'nfnr r C7, ~1} i •Fffti1 'Frf#7 _ ___/_ JI~/~' o R ~~ ! - -r---- -__- -- - ---- a v~ , -__ _ _ ~ ~, ~ ~ yie .___._ k ~ ' ® ~,d ~ ~ ~ ~ g~~ _ _ W~-~~ ~ 1 u'~ i ~ --- -- _ ~~ - --- _ _ ~ - ~. __ . 1 u ._- -- 1 -r-- A /~ - CLC~GY~c/" cZ ~~~0 /-i n off. ~c Jilt • - ---~ 5•l~-C ~• '~- ------ ---- --- ~ -j ~ B v~o~ ~ r- ------- ~ , ; i T6 ! _ _ ~ !h c,~cas-~ `--~a~.h~( s; z~: ¢a ~ - P ~ oa G, j _ _ __ ___ A i i ___ *------ --- --- ---------~----- ~ ----- I ~~, ~ ~ ~ ~ t~ r+-It-l- ~----~_ - -- -~/J-- - -- - - i Boring # -=~ Boring -- ---- `' ~~~ _,! Pit Ground Surtace elav. ft. Depth to limiting factor ;n, r __.___-__ Sci~ ! r";nr rr r~inr 4;a;a H rizon ; Depth in. Dominant Co•.er Mansell Redox Descripton Qu. Sz Cont. Color Texture Structure Consiste ~~e ; >?~cundary Rccts ! r: Gr. Sz. 5h. 'Eff#1 'Eff#2 ~- -+---- ;_ __ ~ ~----------- . ~L___----------- . ~ i , ~- --- -- ---------_ Y I I ---- i --- -- r---- - j~ _-_~ , ' ' ~ i _~ -----__~_ ----- - i - --~ ~ -- -- ~-- 1-- ~--- I ~ ~ ~ ---- -~ ----------- --- -- t----------r-__-----~--- --;_._.---r ~ ~ ~ ---___---- ~~ . ~o . to cf"u~rri it i 4 cvD 5' ,,.. _"~U 1;1 "L ~r1u T:S3 ~~u 4 7 ~G r;; -ice - - '~ ' y' _ 5 r=rtiU6rit *« = GUtiS _~v ir~y;L aria i ~~ ~ Jii rnyi_ The llepartment of C;ommeree is an equal opportunity service provider and w.lplo~ et 12}~ou need assistance to recess sen"ices or _.~ _._ ..__~_r •_ __ _i... _.. r_ _... _r. .. ..r_ _ r. in.~ ~,. ~ ~. - ~ .~..rv inn ni • .. ~. ^.., 1 a{ I SCi~ QJa- ~t.tCt. ~iWj pe ~ ~ l~dcrtr'o Sc~.1~../~. ~' 7` /a !98'=`. ct~c/r~I ``~ ~/~~ ~QOt-l~4 ~ ~ll~s 5iTt .~K o r~-ec~l ti C v- ~e a s -~ ln.. o ~~ of S ~ 2.~ ~~~ ,, ? d~( ~3 e~ 1 . ~ - r~ .~ 199, t~O" l ~~ ~ ~ C if ~~ . TC ~~ g . _____ __. _ _ -- ! .~ ,' h'`/ ~. #/ ~, "-8z ~~ P-.~s Y0' /OD.A ~n'f~b r° ~ ~~ <~ ~+~.\\\ Y ~.. ~ F,~e. ,QsSunrcd e tee _ ;C~.:2?., i ~p~ yard s ~~~' `~ f 1 ~.. _ r- I _ 11 ~t`\\ ~. ~~ \ ~ ? 1 I ' ~'~/ `~! l \ 1 ~~ 37S `~' 1~ f a; 1~~ ~ sa.,,~ ~~ n ~! ~ -- - __ ~` ~ ~~ , 32 ., iGID.O G~n"bb r' y'1.'o' l ~, ~t'. ~ 5S cu:Ka` c i`t 4: = UGC, •=~'.' opt yard ~,- -~ f~ ~L- C3. ir, : Via, l i -~ o'ou 6 /e 5t~.n ,.: c ~"' /.~ tic e. Ele ~ = X03. a8 t /98 ~=` 13i .~ . < < _ 1725 VJiscorsin uepartment vi Cornriie+ce S~iL EVALUATION ~tE~'OF~ 1 Division of Safety and Buildings Page - I of - i in accordance with Comm 85, Wis. Adm. Code R,.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8% x 11 inches in size. Plan roust ~~~r-~nt=~ include, lwt not limited to vertical and horizontal reference point (BM), direr-ion and St Croix ~j~ -- ---- ---. __. _.-_._____-__..______I percent s ope, scale or di~nemsions, rrrth arrow, and bc•~tian and distance to nearest roaJ. Per ~I i.D ,p/~3e 008 2003-20-000 jNrr)t :d1111riviirauvi:. _ _ __-_ .. -- _-- Persor,sl inkrmatiat you provide Reviewed iiy lJate j may be used for sscdide~y pa~eves (Privacy Law. s. ' 5.04 ~ t) !m?~ !1 Property Ovvner Property Location .__ ___ Cleo ititchner Govi. i_o: 511V 1/4 R;W 1/A S 1~ T zs Property Owner's Mailin Address ------ , --- - - --. - -----------. _-.-,-- g Lot # ~ - -- __. - -- I Block # ~ Subd. Nan.e or CSM# .. _ 2616 Sandpiper Lane ~ Plat Of Country Estates II _- _ I ------- rty State Zip Code Phone Number -_-- - - --` `---__-.., _ - -__ _, City Y{ village J Town Nearest Road Woodville ~ WI ; 54028 i 715-698-2657 Eau Gaile ( Sandpiper Lane New Construction Ose: ---.----.--.- yi Residential / Number of bedrooms $' Code derived design flow rate QO T Replacement - .-- --__ _ ~_ ,jL3ii~ GPu Public or commercial -Describe: t'srern r„„aterial _loess over glacial ti9 `----- ±=1c!xi ;;lain ekvaticn, if appli=abtc n.a . ~ienerai wr+xnenis -----..__ --- and recwnmendations: lnsiail mound system at elev. }88~{=at i2"above-68:41` contour. ( ~'~ /vv.~3 99.03 I I -1 I Soring # -' Boring L-_.-~ 6!° Pit rn. 0-10 2 ` 10-15 15-24 4 ~ 24-28 5 r 28-39 Mansell 10yr32 10yr4/4 7.5yr4/6 10yr4/4 10yr4l4 approx. Boring # _.! Boring ILL„___,,,,,,~~~j ~, Pit Ground Surtace elev. _ 98.86 __ ft Redox Des~ipticn Texture _ rJu Sz. Cont. Caor none sil none sil ---- ---F---~ none ---- _ _ _ _ l _ . S!___- I none ,__ ! scl --~- i none ~ sc! tints of'1l4" - Ground Surraca ~~ rca ao ~; Depth to limiting factor -___ 24~_ __.-in. Sa' A~.pli~alron Stn~cture Cons stence I Boundary Roots ii GPDIf~ Gr. Sz Sh i ~ I-'Eff#1 ~ 'E i fsbk ______ ntvfr as 2f,1 m . s 0.5 ~ 0.8 _- -r-----_. ----}-- --- ---~_- 2msbk ds ~ cs 1f ~ 0-5 0.8 - _ ~__ .- _,_ - _ ~ 2msbk V ns h w 1~,fi,f~ 0.5 ~ 0 9 ------- -- --- - -- -- _- ~ _-- - l . lmsbk ~ rnfi 1 9i - - - ~ -- 0.2 _ 0.3--. Om _- loll ~ _.- f _--____--rt- - 00 __. 0~~ --___ ___ -- _---- spaces between fr•gcrients comprsed of irt,iestone residdum. -tnn~nn ~iih kurtinant Color R d " "-'-" _ ~____ _-_ n. Soil Appli - cation Rate ' e ou Description Tex(uie " Structure C i t rn. AAunsell ~ Qu. Sz. Gont- Ccior , Gr Sz. Sh ons s ence Boundary Roos ,- ---G? •Eff#1 C/ff=_-- .-- •E # ~ 1 ~ , , ff 2 0-11 10yr32 none I il _ _ i__--- _ _-- s ~ 2fsbk rnvfr as 2f,1 m 0.5 U.8 2 11-14 10yr4/4 ~ none r- sil ; ------ - - lthinpl --- ---__ ds ~_ :- cs ; ---- 1f 1 0.2 ! 0.3 -_ 3 114-18 10yr5/4 ~ none ---- ~ sd ~ 2fsbk dsh cw 1vf,f I 0.5 0.8 4 ~ 18-36 10yr4/6 -- ~ none _~ ~ ._ -r- sl ; --- ---- 2csbk ----- mfi ----= -----~- ---, -- ---- _ . _ _ __. _ . _ _ _ ----- -_--- - ~ ~._----- ------ -' - - - - - ~ 0.4 0.6 5 36-51 7.5yr4/6 I f2f 7.5yr5/8 ----____~.____ ~ __-. __ si I -- 1 rnsbk mfi ! _ i- - ~ i 0 4 ~ 0,6 _ __ - 7--____ ..~_~. __ - i , - trrruent rrt = BGD ~> 3d < 220 mgiL atti CST Name (Please Print) ` James K. Thompson Address A,C.E. moil 3, Site Evaluations 340 Paulson Lake Lane. Oscee TSS >30 < 1 St+ nxJIL ,/~~_-- Efri,,r~t #2 = BODE r 30 mg/L and TSS <_,'s0 mglL Signatur : CST Number .. ~'-` ".`_ 3602 Uata Evaluation Con"uct~r, T'elept;anrn Ptum~:- W ~~ 9232003 715-248-776' Wisconsin Deparxrnent of Commerce SOIL EVALUATION REPORT Dmslonpf Safety etrd BUIIdIngS in srrnrii~nrm with r`.nmm RS Wic Aram (:n[t[± 1725 Page 1 of 3 A.C.E. Soil & Site Evaluations ~ Attach complete sde plan on paper not less than 8'r~ x 11 inches in size. C ~+E'v ~ St. Crobc a L V include, but not limited to: vertical and horizontal reference point (BM), dir parcel I percent slope, scale or dimemsiorrs, north arrow, and bcation and dicta to nearest road. . . 008-2003-20-000 Please print all information. " (~ ~ 1 ~ 2 04 () mp s 15 rovide ma be used far seoauler ti P l i f (~+~ gy, Date ~`F~23' . . . y y ornra an you P ersona n Y 0 Pr°perty OHmer pro~~ FFICE ONING 16 28 Cleo Kitchner ~. L~j NW 1/4 S 12 T N R Property Owners Mailing Address Lot # Bkx:lc # ubd. Na or CSM# 2616 Sandpiper Lane 2 ~ Plat Of Country Estates II ~ Z City State Zip Code Phone Number J City J Vllage Town Nearest RR d 2) Woodville ~ WI 54028 715-698-2657 Eau Galle Sandpiper Lane ~n !~ New Construction Use: 1/ Residential ! Number of bedrooms 3 Code derived design flaw rate 450 GPD ~ J Replacement ~ Public or commercial -Describe: ~ ~ Parent mater~l loess over glacial till Flood plain elevation, if applicable na General comments and recommendations: Install mound system at elev. 100.41' at 12" above 99.41' contour. 00 ~t {~ Boring # ~ Boring 0 " . 2~+3 in. Soil 14ppiication Rate 1~ Pit Ground Surtace elev. 98.86 ft. pepit~ to limiting factor 24 ~1 Horizon Depth Dominant Color Redox Descrg~tion Texture Structure Consistence Boundary Roots GP D/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr32 none sil 2fsbk mvfr as 2f,1m 0.5 0.8 ~ (Q 2 10-15 10yr4/4 none sil 2msbk ds a 1f 0.5 0.8 . ~, 3 15-24 7.5yr4/6 none sl 2msbk dsh cvv 1vf,f 0.5 0.9 , 4 24-28 10yr4/4 none scl 1 msbk mfi gi - 0.2 0.3 , Z 5 28-39 10yr4/4 none sG Om mfi - - 0.0 0.0 H#5 contains approx. 50% limestone fragements of 1!4" - 4" with spaces between fragements comprised of limestone residdum. o~~# ~~~ Pit Ground Surface elev. 99.49 ft. Depth to limiting factor 36° in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dlft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 1 0-11 10yr32 none sil 2fsbk mvfr as 2f,1m 0.5 0.8 2 11-14 10yr4/4 none sil lthir~ ds cs 1f 0.2 0.3 3 14-18 10yr5/4 none sil 2fsbk dsh Lw 1vf,f 0.5 0.8 4 18-36 10yr4/6 none sl 2csbk mfi - - 0.4 0.6 5 36-51 7.5yr4/6 f2f 7.5yr5/8 sl 1 msbk mfi - - 0.4 0.6 " Effluent #1 = BOD y.> 30 <_ 220 mg/L a TSS >30 < 1 L jEffluent #2 = BOD < 30 mglL aril TSS <~0 mg/L CST Name (Please Print) Signatur . CST Number James K. Thompson °~'-'- 3602 Addre~ A.C.E. Soil & Site Evaluatiors Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, , WI 54020 9232003 715-248-7767 ~ 1 ~// . ~ ~,y~.~ ' ~,~P"' . ip .~ 1 Properly Owner ~~ IGtchner Parcel tD # 008-2003-20-000 Page 2 of 3 3 ' ,.,~ Boring ~~ # 97.16 ft. Depth to limiting factor 24: Sal xxtion Rate II' Pit Ground Surface elev. ~ Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 'Eff#1 'Eff#2 1 0-10 10yr32 none sil 2fsbk mvfr as 2f,1 m 0.5 0.8 2 10-15 10yr4l4 none sil 2fsbk ds cs 1f 0.5 0.8 3 15-24 10yr4l6 none sl 2msbk dsh cw 1vf,f 0.5 0.9 4 2 10yr416 f2f 7.5yr5/8 sl 1 msbk mfi cw - 0.2 0.3 5 30-35 7.5yr3l4 f2f 7.5yr5/8 scl Om mfi ci - 0.0 0.0 6 35-47 10yr5/6 none scl Om mfi - - 0.0 0.0 H#6 contains approx. 5096 limestone fragernents of 1!4" - 4 with spaces between fragements comprised of limestone residdum. ~~ # ~ Bonng Pit Ground Surface elev. ft. Depth to IimRing factor in. $al Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots *Eff#1 !'Eff#2 . lp . ~, ,~ ^ Boring # ~ Boring J pit Ground Surface elev. ft. Depth to limiting iac~or in. Sal Appligtion Rate Horizon Depth in. Dominant Cobr Munsell Redox Description (~. Sz. Cont. Cobr Texture Structure Gr. Sz. Sh. Consistence Boundary Rood 'Eff#1 'Eff#2 ' Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mglL and TSS a 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access servrces or need material in an aUemate format, please contact the department at 608-266-3151 or TTY 608-264-8777. • ^ ~o~% ¢/a lua.~ P%~ ~ I Scale: / -' s~0' I !1 ~e~ ~ X7.25 ~98't ~~~-"~~%o~ of ~y "p.~.c. ~,pe, ,4ssu.rcd e l~v~ _ /Gb.GU., opt yard /~~ I i:?zfL" 9p:~aggt.7.~p~s."'zyz.~'t~svzg..~x~^:[use.a+sg~.}a~-....g.~.°.+.~q_ry..~_y~-yq~'{ ~+(~ }.J'YY L~L:rS'l.RA.tJ.J. 'l.: Li.k'~+..&.i'AV.rt"L.L ffiLJ1.'C S'~/ i~2aiilt~~ .~,t~clr~ss _ __-__.------._.._ 1'ro~erty 4ddress {~,'erificatiuts regtaired fresm Pialuiing cpa nt for xiew con5taucLelii_e,,,_______._ ___._ ~.ifi}~,'S~~te. w~vc~ c/ r ~~.e ~ ` Parcel 3.derttaficatac~n ~Iun~l~er __-_.----__ ....... ~_~GAIi.. ~IESCRIPI`IC31~ / G L yaperry Lacatxc~n ~ •J~v. 1~ ~i./ I$9 x.7 tnr. 4 _---~ 77 ,~.,,{ J1j~ ~ti~tVTStt)t] ~ l V ~/ Q ~ s- `~ ~?%flii.tltle , pAge t# rl p ~;~~~ s~~~~ ~a~ ~ - ~~rf-a~~r Reed #1 ~~ ~~a~use C~ ~{es ~~ Ica Loi lines i~.er~.ti~Z~tb!e ~ yes "--` nay SYSTEM MAIPt`TEN ~~~~ Improper use and m2lnten~an~~~ cve ~ st3iree ycarseor saoiaer, if'ne ,, dcd. v~ li ~r~sed p~+~s~ ec~ ~[ 3.~ t yflu ou~int ~the~s~s e~:r~ ~:cvsists ~L iaun~pil!~ out IiI~ septa ~` quo aff'e~~t t$3c: f'uaiatioat cif the segtic twta~ as ~ trcattnclzt stage iu dac ;paste dzsaosat s;~~l~tr. "The propcz#y o4rn~r agrees to summit to St. Croix Zoning Dc~a~nt s ccriificatio~ farm, signed by t_hr owner and ley a asi iumbcr, ZestriCicdplum€~ar OF g tacensed oumgervcrafnng til2t z j ih. ou-site: wastewatcrdisposal systcri rnasterutura~er, jacrncyn P ? ectioa and uanging cif ~°c~ssa`y?, ~° set ~:;~, tank. i; iess thzn 1f3 full of siud~e. in prca~:r operating c-audition andlor (..) af~er insg F •v,1ih the sla3adar~L ~~~re, tiae aaaLdcrsiglzeci have. read stae abo~,~ rmcn#s uud agar, to maintain tl~e pz-iu~.te se~,~age disposal .s~tezn ;;ct fcartt~., hercixt, as set by ttae 1:3~partu~eni of C;ozramerce b d ~ ~ Lepaa~aent n[ >~aturai Resosrces, St~`ate cf ~~~ is~flnsin. Certiftcu~ozz uzL?ieted anct rcturra°d tQ the st. +.:'roix t/CSlazaty ~oa~iug O~ ~ within si~rzint; tit your sepc~~ s~~ tem ~s ~e~A uaained must d&ys of tine three year c~piration data. ~ r`' ~ / 6 (/t ;~ T~ATEj'-. t~~AiLLtktE C)Y~ ~'I'L.1~CA14~ I (we; Certi~ ti3at all StateIRZIIt.`. OI: this ~Qn_t_ 3IC ~C rd d to Reg c =r c€ i3ee3~~C3+.ito3L. t r tE.°'; xr:~ (atel LiI~ rs~vner~s) ^~ !3z~ t~IOPer,y dcscrilx=d aiaeve,'az• virtt;c a£ ~ :{•aran#y dc.,d r I3P.T~~E K _ SI.G:~IATiS.i 4JF AP1'I.I~AI`Ti' r¢,~,~,~. ~a~*4«~ ,r1ny infoFlnLation th$t is ruts-rtpreseAdlr~g result is ti`ac satsitar; nct-~;it i~cisag revo~cd by the 2alain~ L)enarhncnt. ~~ Ittciude ski#ii tills applicatintt: ~ ~ Hof the certified savoy s*3uP 'z£ercac~cr: efe ma?€e 3.n the svsaarty dcrd r~ ~~ ~~ ;~ m a a ~, r O M tD .~ m R U) E 3 ~ - LL r N .-1 7.. tD 9 ~- ~~ ~~ rc-~ OP T t Qi1AL ~ SfAf RyliEtl ~~n~cts fror~- • ~, - ~ , lwn51EA OPt~ONn~- a~~©a~ e~~~ao~ + t+rcr. oEN~ -tl' ~~ 12'-tl' 995f18-A 3272(69} ApproK_ 2063 5~. Ft. ~~ Tic Co~e~orc ~erPQtYtion nrtF ~T~~~ tr 14' ~' 99508-A t 'm .~. `~ ~ ~ .. ..~ N 'O O 'n "~0 'Pi 0 a :` t HF'R @2 2004 16s iS FR COhIMODORE h101'1ES 2~~1R M 0~I'1H LL ~~ y V ~C o ~ ~ f71 o~~o n ~~ ~ ~~~ ~ ~~ ~~~ ~ ~ ~ ~~ ~~~_ ~ ~ ' s~~r5 ' ., ~ Y L ~~ ~g~~ ~ ~~ 4~, a Rv Qr- p ~~w~~ Q ~~ ~r ~~ pp p Ri .~ ~ ~F iA~~ 1D ~ n N.Z. ~~~ ~ Q r ~ ~ ~~ V 1~ ~ E ~w S N 0 ~~ N~ v v ~~ n ~~ ~~ ~~ ~~; ~' Q s m g ~y N r _~~~ ~~ o i• ~' 1 --o r 4-v d I. ~~ ~~ .~~~ ;~ ~a a 4 ~; ,- ~. - .., ~• ~~ .. .., A O ~~~~~ ~ ~'~ ~ ~~ ~~~~~ ~ ~ ~ G~ ~^ ~ y N 574 534 0163 TO 17156326609 P.02~02 E ~ O {it•Ut .~ Nt•.iR .~ .at A •1 ~~ ~~ ~~ m ~~~~ ~~~ €~~ ~~~~ ~ ~~~ ~~ ~~~~ x ~ N ~ ~~q r~ ~ ~" ., ,d... . --, ~. ~ Q ** TOTAL PAGE.02 ** U. 2Sl~i P Oaf 8 STATE 13AR OF WISCONSIN FORM 3 - 2000 Document Number QUIT CLAIM DEED This Deed, made behveen Cleo M IGtchner, a single person _ Grantor, and Scott J. Bond and Kimberl}' R. Bond, husband and wife Grantee. Grantor quit claims to Grantee fire following described real estate in St. Croix ___ _ _ _ ___ Count<~. State of Wisconsin (if more space is needed, please attach addendum): Part of the Southwest Quarter of the Northwest Quarter (SW 1!4 of NW 1/4) of Section 12, T28N, R16W, Town of Eau Galle, St. Croix County, Wisconsin; Being Lot 2 of the Plat of Country Estates II, more particularly described as follows: bf ('ert_ feet c.K.°;, xn,,p fled necember 23, 2003, in Volume 18, at Page as Document No. 749953 ~-~ .-~ /~~ ~~ f /~ c~ U l sp ~~~- ~~ C2~ l~s ~ C s ~ . 75488 KATHLEEN H. MALSH REGISTER OF DEEDS 5T. CROIX CO. , MI RECEIVEEi FOR RECORD 02/23/20@4 09:30A11 SUIT CLAIIt DEED EXEM~? t# 9 REC FEE: 11.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Retttm Address Thomas A. McCormack 102010th Avenue Baldwin, WI54002 n I~ Z J ~ `" 008-2003-20 - O~ C_J ~ erg) Parcel Identification Ntunber (PIN) This is not_ homestead propc~r-ly. (~sc) (is not) To her with all appurtenant rights. title and interests: - _-.._ Dated this ~~ _ day of ~o~~i _ ----------- ~'~~' 2004 ----- ~ 0 -- ~ U -_ _ ___ - -- --- --- ---~ ~?-----~1~ ~'~- * * Cleo M. Kitchner AUTHENTICATION Signattue(s) authenticated this _ day of - _ _ ACKNOWLEDGMENT STATE OF WISCONSIN ) St. Croix Coturh~ ) Personally came before me this ~''- _ day of ~, _ , 2004 -the above named Cleo M. ' chner, a single person ~j~-qr~ ,: 1~ ----------- _._ -- --_ --r--, ., TITLE: MEMBER STATE BAR OF WISCONSIN ____. _ (If not, to me known to be the persons o ecuted the Lo, ti ~' _ _ ___ instnunent air acknowledge a e. authorized by § 706.06, Wis. Stets.) --- . _ i ~ v ---_ _ - ---- --- --- v THIS INS1'RUME~T WAS DRAFTED Bl' * ~ ` Thomas A. McCormack ~~IS ~• ~~ ~ -- -----------__-- ----.-_-- -- Notary Riblic, State of WISCONSIN __ . g _~. ,; _ _ --- - ;. Baldwin, WI54002 My Commission is permanent. (If not, state e!:pira :~° (Signatures may be authenticated or acknowledged. Both are not necessary.) ~ '' * Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCOtiSIV QUIT CLAIM DF.F.D FORA \'n. 3 - 20W INFO-PRO (800)655-2021 www.infoproforms.com 7 4 9 9 5 3 VOL PAGE 4678 KAT H. ~-- REGISTER OF DEEDS CERTIFIED S V RVEY MAP RECEIVEDxFOR•~tECORD LOCATED IN PART OF THE SW1/4 OF THE NW1/4 OF 12/23/2003 03:30PM SECTION 12, T28N, R16W, TOWN OF EAU GALLE, ST. CERTIFIED SURVEY IlAP CROIX COUNTY, WISCONSIN; BEING LOT 2 OF THE COPYFFEE: 3300 P LAT OF COUNTRY ESTATES II. 1"IRON PIPE FOUND S31°56'03"E, 1.24 FEET FROM COMPUTED CORNER. © 1"IRON PIPE FOUND N04°09'50"W, 0.65 FEET FROM COMPUTED CORNER. ©1"IRON PIPE FOUND S64°32'56"E, 0.46 FEET FROM COMPUTED CORNER. O 1"IRON PIPE FOUND S44°36'50"E, 0.54 FEET FROM COMPUTED CORNER. O 1"IRON PIPE FOUND S79°30'41"E, 0.47 FEET FROM COMPUTED CORNER. n n n W 0 /~//~ Y/ o I ~I ~I ~I Q I a ~I ~I ~I 021 ~I I a~ O' ~~ P I I ~I DI di NN wW ~r w 0 O M UVi~ zw ¢O ~ N ~Om wLL0 o~ ~z~ MG~G~LC1`t~t~C~D dLel[r`.llD o ? h Cn N87°17'13"W 662 12' r-•-- -- -- 334.70'-•-- --•--•- I ~ 12' UTILITY EASEMENT I I I I I i I dOo ~! ~ C50Mfn~_ I ----------- I I LOT 2 3.65 ACRES i 158,841 SQ. Ff. ( ~ i Z ~ ~, I ~ a I w SOIL TESTS v I I ~ 2 J I I I ~ j -. I I I I I I I ~. • •~~~~ i ~ _._ I ~'~ ~~ ~`Z ~ C1 C3 ~' I ~ i , ~, O i ~-' I.' - / I ,) ~ ~ ~~!, 80"Ryo I 3 ~ ~~V, .. PREPARED FOR SCOTT AND KIM BOND 640 BIRCH STREET BALDWIN, WI 54002 OWNER WILLIAM AND CLEO KITCHNER 2616 SANDPIPER LANE WOODVILLE, WI 54028 SURVEYOR EDWIN C FLANUM NORTHLAND SURVEY-NG, INC. P.0 BOX 14 ROBERTS, WI 54023 ST: CI#OIX COUNTY ~annlnp Zontnt~ and p I I arks Commi~tw, ? i ~E~ ~ 3 2003 If "0t reco-'ded within 3U days of [~~'4~a `~~~~1 date approval I I shall be -----_-- null endvald ~. I w ~ w LOT 1 4.32 ACRES ~ 188,031 SQ. FT. r I I I I OUSE I I I I I O GARAGE GARAGE ~P~ 1• o~``J ~ 3•~ ~~~sj , ~ ~gZ~~ ~~ - 66°25 N d04 ~3 ^ ^ ~ ~~h/QQ ~ o ~~/ _..._ ~~ ~~?' SCALE IN FEET 1" = 100' ~, /`~ \ 100 O 100 200 / ` THIS INSTRUMENT DRAFTED BY MICHAEL ERICKSON JOB N0.03-101 DATE: 10-30-03 C~OMG~4G°~~ C~~4La4C~~_0~ LEGEND 1 1/4" STEEL REBAR FOUND 3/4" STEEL REBAR FOUND 1"X 18" IRON PIPE SET, WEIGHING 1.13 LBS PER LINEAR FOOT 50' ROADWAY SETBACK SHEET 1 OF 2 SHEETS coo M W O O O Z ~I ~I ~I ~I I ~I ~j ~I 00 ~ D', ~I ~I ~I I Opl I ~I ~' ~~ I ~I I QI ~I ~I I ~I a I I al I a Vol 18 Page 4678