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008-1068-40-000
Wisconsin Depal4ment of Commerce PRIVATE SEWAGE SYSTEM Safety~a?Id Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m) Permit Holder's Name: City Village X Township Garrison, Darlene Eau Galle, Town of CST BM Elev: Insp. BM Elev: BM Description: ! ~~ 1 G5 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ' 1 _ L l~l,J r 7r )6~ / Dosing / ~ -,~ Holding TANK SETBACK INFORMATION TANK TO P/L os~ WELL BLDG. V t to Air Inta a ROAD Septic oZ ~sA~- ~ / 30 `. Dosing bZ N~" ,30' r 3c~ Aeration Holding PUMP/SIPHON INFORMATION ,~ I/~ Manufacturer _L 1~ Q U~ ~j Demand GPM Model Number ~ ~ ~(~ . TDH Lift ,Q 1 • O Frictio~ oss ~ System He~~ad' S ~./ z TD~ g~Ft Forcemain Len t / Dia. ~ I/ Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width ~ Leng DIMENSIONS SETBACK SYSTEM LTO INFORMATION Typ~~yO"~f System: rt+aJ~ DISTRIBUTION SYSTEM th / 75 P/L ~._ ELEVATION DATA County: St. CCOIX Sanitary Permit No: 479476 0 State Plan ID No: Parcel Tax No: 008-1068-40-000 Sectionlrown/Range/Map No: 23.28.16.352D STATION ~ BS ~~3 HI lb5~3 FS ELEV. Benchmark 5 ~ 1 ~ /~ S ~ ~ ~ Alt. BM 1 _t.. ~ ~ ~~. ~~.3 , s Bldg. Sewer ~ ~9~ 97 .3~ St/Ht Inlet ~ , ~(p 9 (~ ~ 7 SUHt Outlet `~_ \ Dt Inlet \. `- Dt Bottom If- IL ~ -~' 93• /'~ HeaderlMan. 2.85 /OZ < 33 Dist. Pipe ,•~~ Z - z~ Bot. System 3 ' S ~ ~ l ~ Final Grade ' ~ 9 /~ 3 - Z St Cover ~: `` _ ds~• L /~ , `~ .~5 3 ~ s~ /' 1 l..A~itJr d" S.~ ~ ~ ~w PIT DIMENSIONS ~~ LAKE/STREAM ~ 1 ti I ~ CHAMBER OR `'~ UNIT Mndal Number Header/Manif jld 1/ Z. Length~~ Dia Distribution ~~ t~ ~ Pipe(s) ~ Spacing ~ Length 3 7` S Dia x Hole Size I' ~ ~ x Hole Spacing 1J ~ ~ Ve~+t'o' A'r Inta/ke J-iA ~ C''Q~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over 1 Bed/Trench Center / ~ Q Depth Over BedlTrench Edges ~ xx Depth of Topsoil 1 ~~ xx Seeded/Sodded xx Mul ed Y N f cc..~~ Yes No i es o COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 204 Cty. Rd. B Woodville, WI 54028 (SE 1/4 SE 1/4 23 T28N R16W) NA Lot 2 Parcel No: 2 .28.16.352D 1.) Alt BM Description = O 1..~ 2.) Bldg sewer length = ~ ~ n _ (~ 1 ~. t -amount of cover = 3 / r~ i ,~ ~ / ~''o (~~, ~ ,J rn...~1~ j "~~+~ w~ ~~•~", ~`~ Plan revision Required? [] Yes ~No p ~~ bG f _ $"~~~ Use other side for additional informati'on`. Date lnsepct s Sig re Gert. No. SBD-6710 (R.3l97) Safety Buildings t 201 W h' W truly ~~ G~ 7 - ` g . as on Ave., P.O. Box 7162 G t ~ ,sC pn~~~ Madis , , WI S$~1(I7 -x162 r ' 1~~~ anitary permit Ntunber (to be fills in by CoJ Department of Commerce 08) 266-3151 -_? 7 7 ~ 7~ 7 7 Sanitary Permit Appli '0 01X couNr ~r~lrv~ O sra~ Plan LD. Number In accord with Comm 83.21, Wis. Adm. Code, personal infotma ' ou p 'c // l ~ 7 l0 T/(~//S may be used for secondary purposes Privacy Law, s15. m) Project Address (if different an mailing address) I. Application Information -Please Print All Information ~ ~ ~ ~~ Q_ J. '~" Property Owner's Name ~ C~ Parcel # Block # -- ~ e Y'~ i ~ o o ~ -o Property Owner's Mailing Address Property cation J L'/ / S i City, Stt~at~~ p ~ ` Zip Code 2 Pho~n/e4Number 7 ~ ~~ ., ., ect on e, x l ' 3 _ V [J~ ~ ~ ~ J l ` ` ~ tJ' e e) 7~ .J~ R ,~cE T ~~ N II. Type of Building (check all that apply) ; -=~ (/ ~~ ~l or 2 F il D lli N f B b d Subdivision Name CSM Number am we ng - y er o um e rooms ~ / ~ 76 ~~~ 1 (~ ^ Public/Commercial -Describe Use 7 S ~_ 7 ^ State Owned -Describe Use ^City_ Village~Township of III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) A' New S~ ^ Replacement System ^ TreatmentlHolding 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 Owner IV. T of POWTS S stem: Check all that a ------ ^ Non -Pressurized In-Ground ^ Mound ? 24 in. of suitable so' ;~, Mound < 24 in. of suitable soil At-Grade ^ Single Pass Sand Filter ^ / Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat ter reatment Unit ^ Reciroulating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel- ess Pipe Other (explain) V. Dis ersaUTreatment Area Information-. C11t2~ .S" ~ Design Flow (gpd) Desi S '1 A li ~ n Rate(g f) ii ~ Dispe rea R st) Dis al Pr sed (stl System Elev ion ~ 1~ . /. o i a, use rsaa of VI. Tank Info Ca ry in Total Number Manufacturer fab Site Steel Fiber plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank l _ l C w~/A!9 !/W ~s~ Lp~.• 1. Aerobic Treatment Unit ~ ~D ~ ~~~ !'mil J ~l Dostng Chamber ~ `' ~ VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum is Name (Print) ~.~ n ~ Plumber's Signature a~7~6 M RS Number ~~74/~9 Business Phone Number a5'--9 5 Plumber's Address (Street, City, Stat Zip ode) VIII oun /De rttnent IJst: On Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Surcharge Fee) /~ rya ~ ~ D~ Issued ~ [ mg Agent ign re S ps) ^ Owner Given Reason for Denial 7 ~ ~- ~ IX. Conditions of ApprovaUReasons for Disapproval /'_ ~, s7~A,.'~ n ?rY, _ , _ /~ ~ ` ~~ (NYC 1 ,( ~ , , L`h 0G~~r!'i, l YSTEM OWNER: eptic tank, effluent filter and ~~ ~- ~~ Gli'4~T ~f/~~, f/h'u~` ` dispersal cell must all be serviced / maintained ~ ~~~ ~ ._s~ `~ as per management plan provided by plumber. ~ 2. All setback requirements must be maintained _ ~~Q ~~ ' ~ ~`~" `y - •t as per applicable code/ordinances. Attach complete plans (to the County only) for the8ystem on~aper of less than~81 1 nc~s io s~ ~~ ~j ~~ / SBD-6398 (R. 01/03) e (~~ -~~ I i ~ ~' 3uv~-It ha Pr.f, l.'rre 1 f i ,O - ~ ~~ ~ I QA ~ ~ ~ ~ ~ ~ BM ~ l a a f ~ ~ ~ ~ Q i ~ ~ ~ ~ ~ .S / { ~ ~ ;: ~ ~` 1 a i ~ ~ 3 e /~ ...,~~ i lq ~C 6y Gv.rcSPr ~'ol~c~-C~~ 11 ~' Q- ~ ~dppn~kfo ~ dli~ ~a y~a~.S"~.S ®'`~ s `~ ~ 4 ;,~ Pr ~p ~~ e ;/ s 4j~ c se ~ ~~. ~ J ~ L "~ toca ~;bn f ~ , < r ~ ~,lvo E.,< to ~ ~. i 3 ~ ~ ~~ ~ d I _._ _._._ _ -. G _ - - -R.o" iv . ~ - J///o-s t . '7~'7 Brt ~~, ~ 'T,/ ~~ ~j`r"T v~ ~~~p, ~~Jih ~j 64.j' O~~/'UN.I. ~ (°/~ /~~" /j,~ i p U~ Q , ` ` ' ~ ~n" Jv c ~~i /C~~rch o cal G~~ vo<.,.. o/ '£~1 ~ /Oa.~ commerce.wi.gov ^ ^ ~scons~n Department of Commerce Safety and Buildings PO BOX 7162 MADISON WI 53707-7162 TDD #: (608) 264-8777 www.commerce.wi.gov/sb! www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary August 26, 2005 GUST ID No. 220673 CHARLES L WEBSTER WEBSTER EXCAVATING, INC. N5815 770TH ST ELLSWORTH WI 54011 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/26/2007 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101. CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1189768 SITE• Site ID No. 703762 Darlene Garrison Please refer to both identification numbers, Cth B above, in all comes ondence with the a enc . Town of Eau Galle, 54028 St Croix County SEl/4, SEl/4, 523, T28N, R16W Lot: 2, FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1036864 Maintenance required; 450 GPD Flow rate; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.Ol/Ol), Pressure Distribution Component Manual -Version 2.0, SBD-10706-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. A copy 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence 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 o this letter to the owner and any others who are responsible for the installation, operation or maintenance of the TS Sincerely, Robert Kanter E `' POWTS Plan Reviewer ,Integrated Services (608)261-7735 ,Monday-friday 8:OOAM - 4:45PM rkanter@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 ~''. ~~/ r~ F ~' Y! l` ,:;?4) Llf WEBSTER EXCAVATING, INC. - N5$15 770th St. Ellsworth, WI 54011 :., (715) 273-3430 ~..---~ A Y3- JL. L1Vif~ L,L~Ul.ll. k' LL°A.°,i.4S~t' 1JL+JQi LiY1'\+11L ,,, „ ~ ~.?3.tS~C IS st 9~$~°u~?~fC'~Fci ~~c~T3 ~~^.- _~~[V~ ~~ ~~I~'y iC2i i_~TOy~3'~Y ~G~:iI~T.`'~ty'eT _ s~yy ~ Y~ 5a3 ~ ~ ~ t R t ~ y~1 C~.- ~~ ~_~v~J r~ ~ ~ ~~J ~~ ~f~~~ ljavc ~.ny- ~~acstl~zxs, ~lcase call r~~ a~ i71S~ ~~`~3-~i~;;i~. WEBSTER EXCAVATING, INC. ;-~ - N5815 770th St. Ellsworth, WI 54011 -; x (715) 273-3430 1 •~3 7'Y~ $ ~.~ TAIAI~.L'~~ ~'~c~i ~~C Arc Fi~~ ~~~~ ~ ~ ~a~e i ~~ ~ ~y~o~~d ~~~~t~~ ~o~- ~ ~ ~~droo ~~s~~i~~c~ ~'r~s~~°~ Q-~-r~~~r`~"~~je~# ~iat~e. ~~tle~ae C'~r~i~u~x ad ~~~ i ~~'sw.~r acv iii ii*' "A Ci tires- b33 AAV ¢A' ~~y? __ Pw ~~Qv iFX x ~~IIt~~it~ ~~9V yL~9; ~T63e®Lt ~*A C - M.¢3 ~~£~i iTi y F4~r ~S 4Pa~33 ~~i &-3Z~w'~.a ~~~~ ~ ~~ ~ ~1'ISEd'AKfi~LIt3I1 !'II3L' 1R...,~'+'(Di&€ ~a~~ ~ ~:i ~ ~~m ~eri~rm~r~Le ~uc~e~~ ~~€~ f ~, ~~ '#~aaa~~ra~~~ ~~~~a COh QF1ARLfS ~. v "`~ " ,~ , WEBiTfeR s 9 Et8s03 ~ E.I,L,a1NpgTy ' . ~W ~~~.: Iv~.~~~~. ~~~~~~er~~ ~~~z~.u toy ~~3~~~ ~ S 'Y~ ~ ~°~s e~~ ` GS d~V .... ?,~Re. i ti~-=- 4~ ~~ ~ ~ "'~ i {, ~ k ., i ,, E 1tiY^~~ ~V{L~.It~iVJ ~: ~` ~~ c~ ~ / f . 3 :~ ~ t~ Q y~ B~ / ~~ SIUOC`( "~.~ P~ opL,'~ J i ~p,.S~'~S'~~ ~Cf~SDtJ ~~T.a ~, d ~' V BM '~ e ~ ~ ~~ ;f ~g 1, . _ / ~ ~ ~ ;+~~ ~ ~~ ~ ~ ~ 0 s ~c ~~ ~ ~~ ~~ ,k p ~n `G J G v ~, ~ k f)( 7 i 1 l ,~ ~-.7nal. ~r7 ~~ L.J' ^..yD i' f ,t1 o h r h ~ ~ ~ ~'1 .~ .i - v ~O f ~ ~ ~2 . B ~ ~1 ~ T~~ ~-? :~:.- pv', ~,f7'° !b.n~6a.j oT ~-rU~,,r. o~ ~l ~ ~DO. ~ ~,~~ ~^ Qi7'. a%y'='~~/7s/ /U~/q~•<, Owlr1~" Y y+.i<,~h(~ ~~~ ~~~iL- ~~ [000%~"d~]~~o:.., bah ~~16h l~ti i~ 6y ~, ~~~. co,.~~~ Prci Ql~,.cfs ,~lilc: To?ert~to {id/° ~o~~alrS~,~ :, r~'~c,,cn t L'~ter ~~ Pr o~p o~"G ~/ s 4Jf ~ jio ~e C/ 20 m ~ - Pag~:~f Approved Synthetic Covering Distribuf ion Pipe F~-ST'h'1 C 3 3 Medium Sand H _"" Topsoil =-- _ G -=__ ~ r O ~- t7 Elev = t _1 ~ E ~ p - 3 ~~ . 5 °lo Slope Bed Of -2 i Force Main Plowed Aggregate From Pump Layer ~OH ~OWY P..f ~r /VOa© - D yI'~O ` l'~ / ~/ / ~ E -~, 3 i h, ~~- q ~t~ / Cross Section Of A Mound System Using ~ ~ ~ t1 r 9 /a,•h (~ v ~ J A Bed For The Absorption Area , G 0.,~ Ft. Q ~ Ft. K ~ O Ft. Li:;ear Loading Rate=~'Q GPD/LN FT B ~ ~ 7,5~ Ft. y~ t;esigr, Loading Rate-~-. .GPD/SQ FT .j ~ ~- Ft. Cam` `, ~ U"`C ~? `'~~/J~' -~ c r e s s X~ J ~ ~ d / _r__,__ F t. Gam" ~~ F ~ " .,~ ~ ~ T1trc~t~ ~ K t. :y~' /t-~e~-~ ~ b~ 1 - ~ Ft ~--- ~, Ty~.~~f E~f~~/e.~ ~ ~ w ' . Ft. ,~ . ~ . L Observation Pipe .t i {3 K /Q A I -~ ~ ! ~•_ 2 i Distribution Bed Of z Pipe Aggregate I Observation Pipe,,` (l-nchbr securely) ~, .Qf -/ ~~/.L~ C7lsC'6'Nt~ f ~~0u ~.tlPS ~~ /~1 ~~° ~ ~~•o+•{`~7~f.! ~. ~c~l-*,C?~'~'t~ O ~ ~ ~hc PJ' d e ~~-oV~ o!Y ~/ ~! / / L ~ ," °.) Cc. ~fi Cr i~`tcr f-r"~ !'.:3~,7 ~~ ~ o` ?~h C ,bo "~~'6/iri ~ftiChCS Sfa t tP~ ~ N N 3' c C ua e ~ ~y ~.~06 e~. Ptan View Of Mound Using A 13~ed For The Absorption Area 44 C~c- r~ ~ see ~ Page ~ Of ~ Parforoted Pipe Oetoil ~\ ~ S~ t d ~~'~~'~ ,~ \J .~ ~. End View ~ertoroted °VG Pipc ~ ~ ~ c Pipe -- _ !'~ ~ ~ ac° t ~'d~,:~ ~e~`~'~ F ~ Q ~S Ste ~---~ /,- Distribution Pipe_ Layout ~~i h y rs- ~-r r~ t.~. e. ~ ~ .~s' ti ~ 7'^'~:-, T ~n w ~' C'? ,r;`~4a . s~lS f ~ ~ !~ Holes Located On Bottom, Are EQuolly Spaced P 3~ Ft . 7 ~ ih olj S ~ Ft. X '~--~ Inches Y 4S Inches Hole Diameter `3~S Inch Lateral ~ Inch(es) Manifold a, Inches Force Main " ~ Inches # of holes/pipe / d ~ ~aceess b.x ~ /~s~• l i J~t~~~~~~~~~~ Invert ElPVation of Laterals Ft. p yp,,.~ ~ ~ af~c~~/dal - _~ ~_ i ;~~.~. Place 1st hole~~.a from center of manifold with succeeding holes at~in. intervals. 1 ~s~ h~fc E`s ~~ ~,~ ~a i~~~ -{'`~r=, ~dt~ ~,{ c%str..'~~-~~al~ c -e / / _ - ~~ _~ r'"' ~,, ,?r.~_ ~~+~e,,+~~a '_ 1.10,E ~~~.r~C_ a__~C r-. ~~~*~ 0 co ~ 6;e~~:,,, S~,o~,'c r~ a'~~i®`'~"sf' C~ 1 ~i6e~-- F:e,1 ~ (~raa!a 18" Minimum (No Scale) -Approved Locking ldanhole Covers i_ Wi th Warning Labels Attached Weatherproof Junction Box _. _ ~ -~~t~n?f..n; nurn ~~ ~~~,~~~ Baffle t 'h 8f.~~.. p ~ e w,'tl~.;.~ ~ &;., chi of'coye~ to P~o-•,~r~ a«~f ~o p"-"'p *APPROVED JOINTS WITH APPROVED PIPE 3' ONTO SOLID SOIL i i Alarm ~ 0 n 6 Off 6' Page ~ Of ~ ''~ <a ~--~. ear Sc.~ e d q o /P/.~sYic rent P.P~j~jo{/~7.' 7 r~~s, YP~~ vr.no~ow oI. ~/eS/7 /~ d ; r I~ ylke Approved _ Vent Cap -r 12" Minimum ~~ ~ 4" Minimum t Quick Discor~hect 1/4" Weep ' Hole A B C D / ~ q~ ,~' Conc. Block 3° of Beddins Under Tanker ~w~ ~w~p ~c1~la2wn c~1 ~.~?~ ~~tt~ ~i rc~i'7S Number of Doses:~-~Per Day Gal 1 ons Per Day/~-Doses: r~~~=Gal 1 ons Volume of Backfl ow:-/~3'~40~+ S.3~Ga11 ons lank Manufacturer: (,u%~sc,- Co..ee efi~ F'~ G'~.~c~s ,..~n~ • Total Dose Volume :........ = 3~ Gal 1 ons Tank Size-Septic/Pump : ~o urn g'~-y Ga ons nlarm Manufacturer: t~;,~f ~;fa~~~ Model Number: ~z Y Capacities: A ~ ~~' inches or ~' ~ Gallons Swi tch Type: ,;,~c~~' ~ _ + B ~ inches or--Gal l ons Pump Manufacturer: ~„d,~ f d + C' inches or ~$'-Gal l ons Model Number: ,£ ~~ ~'-! + D~i nches or ~3 6 Gal 1 ons Minimum Discharge ate: G~.6-'- M Tota1....._ ~ ~ inches or ~ Gailons Vertical Difference Between Pump Off and Distribut'on Pipe:-Feet Minimum Required Supply Pressure:... ~-S ~-.~~~ ~?~,~.......+3.~,5-~eet ~~'} Feet of Force Main x ~3-'~ Friction Factor/100 Feet: +~1=eet Inch Diameter Force Main Total Dynamic Head:...=/3 SFeet nternal Tank Dimensions : Length ~`~~ ; Width ~`' `~'; L~ qui d Depth 3 ~•~~~.~-~ _-. / / 7_ v o~ d ,f ~i-=c ~ a 2 ..__ ~~ t . P . - ~.:-~ p~~ a~ ~ - -~ - r' ~^~ %-'. ~Q~~ EP04 U EP05 APPLICATIONS Specifically designed for the following uses: Effluent systems • Homes • Farms Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS Pump: EP04 • Solids handling capability: 314" maximum. • Capacities: up to S5 GPM. • .Total heads: up to 24 feet. ``' • Discharge size:ll/z"NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, 13UNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Pump: EP05 • Solids handling capability: 3f4" maximum. • Capacities: up to 60 GPM. • Total heads,: up to 31 feet. • Discharge size:l'Fz"NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature:.. 104°F (40°C) continuous 140°F (60.°C) intermittent. • Fasteners: 300 series stainless steel • Capable of running' drywithout damage to components. Motor: • EP04 Single phase: 0.4 HP;. 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: l0 foot standard length, 1613 SJTO with three prong grounding plug. Optional 20 foot length,16/3 SJTW with three prong grounding plug (standard on EP05). ME O a W x U 5 z ~- n J 0 ~~~ ~~~~ 0~ /~-.~~~w ©1995 Goulds Pumps, inc. • FuNy submerged in high grade turbine oil far lubrication and efficient heat transfer. Available for automatic and ..manual operation. Automatic models include Mechanical float Switch assembled and preset at the factory. FEATURES ^EP04 impeller: Thermo- plastic Semi-open design with pump outvanes for mechanical seal protection. ^EP05 Impeller: Thermo- plastic enclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides eF innrinr c•4rnn~1~ and CAPACrrY ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover. Thermoplas- tic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upperand-lower heavy duty ball bearing construction. AGENCY LISTING SA• Canadian Standard Ilssociatlon (CSA listed model numbers end in "P' or "AC".) Effective May, 1995 63871 0 2 4 6 8 10 12 Rla/h .. r~..U~;pcynsinDepartmentofcommerce SOIL EVALUATION REPORT Page ~ of 3 ,J~;sion of Safety and Buildings t ./R in accordance with Comm 85, Wis. Adm. Code r~ • County ST• ~-~1~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel l.D. ~ percent slope, scale or dimensions, north an'ow, and location and distance to nearest road. _ ~- ~--~ C7 Please print all information. R ~ Date Personal information you provide may be used for secondary purposes {Privacy Law, s. 15.04 (1) (m)). i~'7 ~ "-~ ~ 3 6S~ Properly Owner w,(~ L~ ~~ ~~ S, E ~ ~ ~ ~~ ovation - SE 1/4SE1/4 S ~-3T ~ N R 1b E(or w Rcap&3y~a~e~s Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Pho a Nu er,. []City ~ Village ®Town Nearest Road Q~,1-~v~t~~Lv~ S~GU3 (~ ~Pe~~ c;-~ ~ ~v 6~-Lr~.~ C~~ ~', UX, New Construction Use: ® Residential / Number of bedrooms _~ Code derived design flow rate b 0 0 GPD Replacement ^ Public or commer ' I - D scribe: Parent material ~ ~ -~ Flood Plain elevation if applicab'^ / ~ ~ - ft, General comments Lt..~i ~ Y/r'o/ t7s~U'G~ and recommendations: 1~- OU 1JD W ! ;~ ' ~ ~ ~ ~ ~`S~~ ~3U~~ hl C-~SZ.L , ~ ~~~'^~~~ O Y - t'~l LnJ ~ /" ! U ~ ~ CI, ~ ~ n ~- S~'1'~1~ ~I L.L , 4)! .4..~ .. Ct~N~vy2.. LrL~ , tOV, p' Ce~~u,f w/GSA" Boring # ^ Boring `l ^ Pit Ground surface elev. ~~ ~ l ft. Depth to limiting factor L ~ in. Soil Applica on to Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary 'toots GPD/ftz in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 T o-~ ~D`ZY'2-3~2 - s~ ~ z~s~~ ~v~r e s ~.~ `~; ,~ ~ -l`1 102 3L 6 - S z ; 3'+? s log h~..`~/^ c,,`., 1 ~ s . ~ 3 1~ 33 >-oK2 ~L ~CF ~~S~~s~~ s, ( l,~sbn m-'f~`i~ - • 'z •3 Boring # ^ Boring ® Pit Ground surface elev. °1.1 ~ 3 ft. Depth to limiting factor _~~ in. Soil Applicati ate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz - in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I o-~ ~u~ ~-.~ tz _ s i ~ z~sb~ rn ~`~ cs Z~ , s -8 ~ ~t-1.ei l0~-Z316 - Si~( Z`~Sb Yn`Fh ~~ ~,~ ~ S -~ 3 l~ 3 ~ ! ~ ~ 2 y ~ ~ l`~ ~ -s~ 2 s /8 ~s .O 1ti, vr1 V ~I- - • ~j , b tmuent ~i = fjc~u, > 30 < 220 mg/L and TSS >30 _< 150 mglL • Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ignature CST Number Arthur. L. tdegerer ~~-X31 ' ~ 220254 Address tl e g e r e r S o i l Testing & Design S e r v i c e Date Evaluation conducted Telephone Number 421 i1. %iain St. River calls, WI 54022 1Q-3-1~Z -715-425-O1b5 it~.>l. '~-' Property Owner ~ ~ L~ ~ ~~ Parcel ID # ~ ~~~~/ ~ G Pape Z' of 3 Boring # ^ Boring pit Ground surface elev. 1 ~ 1- S ft. Depth to limiting factor 1 ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence ~ Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eft#1 •Eff#2 1 Z 0 - $ $-~$ l u'-1 R- 3 ~ z 1b'~231 -~ - sit S1 ~ Z~- f ` s b k 3 Sb12 -'~- U'Pl~ Vn h ~ s Ct,J Z~ ~ . S •S - ~ .g 3 1~ 3 SOY 2-3~ 'Q"Z~ 7_Sk2 S!S S`1.1 1L° Sbl-t lrvl`E-'1-. ~ , Z _ 3 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting.factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft~ in. Munsell t1u. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a Boring # ^ Boring . ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate .Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BObs < 30 mglL and TSS < 30 mgiL 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-6730 (R.6/00) r ,. .. ., Pi T~ ~ _ .; ~ N 0 vZ_ Z31-I Date Telephone I•To. CST Tdo Job N0. ~I - PLOT PLAPd Scale 1'=~J~' Page 3 of 3 Lo~~Z ~~~ 13-'1 ~-~ _- £~ 100, O t QN_ l p```ZYrLL.~ 31~/ ~~1~1.19- _PV C_ _1~~ f%E i^~ l L~t'1•~~ H ~ a`_/~~ e 3.3 ~0~ ~ ~ So1~ i 8 } ~ pop ~ tit. 6 ~ ~s ~ gq' ,~ g g --==_ - - - ~s , -- - -- - - '' -~`-- A $ ~ ~ N ~T ~ ~ p~-e r c~~~. ~.z O1STU2~ ~g • ~1?~Q ! O LOT tine, ~, } p_ 3_pZ 715-425-0165 220254 CST Signature , , wsco.. in Department of Commerce SOIL~EVALUATION REPORT on of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2x..11 inches in size. Plan must inGude, but not limited to: vertical and horizontal reference point (BM), direction and Pa{cel I.D. percent slope, sale or dimensions, north an'ow, and location and distance to nearest road. Please print all information. Reviewed by Personal information you provide may be used far secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner w,~~--~~~ ~~ ST~ Property Location Date 8~~ = SOS~~~`{ ~O l~y~) ~~l SE 1/4SE.1/4 S ~-3T ~ N R 16 E(ar W wRe~s Mailing Address Lot # B-ock # Subd. Name or CSM# w S S ~ ~ 6 q 0 `iL~f- Av E ~ ~--- _ t~~'•-c~PV s~ e5~1 City State Zip Code Phone Number ity ^ Village ®Town Nearest Road t3~.l.~v~t~~k,i S~GU3 (~~S )~3-t~Z~~ ~~ 6~-~~~ C'~~ `~.. `' ~. New Construction Use: ® Residential / Number of bedrooms ~_ Code derived design flow rate b 0 0 GPD ^ Replacement ^ Public or commercial -Describe: Parent material ~- O ~~ Flood Plain elevation if applipble ~ ~ ft, General comments and recommendations: M DU ~D W 1 Q r X ~ ~ ' ~lS 11Z[ l~v~.~ hl L' ~Z.(.. , ~1 tn../ ~ iv-t V h~ 1 q. t ~ 0 ~- S~j ~i (-~- . C~N~pvr,Z, L~~ , tOV, p' Boring # ^ Boring `t ®pit Ground surface elev. ~ ~ • l ft. Depth to limiting factor L ~ J in. Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft2 in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 f o -~ 1 D`Z I'Z 3~ 2 - s i 5 Z`~sb k wt V'E~Y- C S Z'~' . S .~ Z b -`~ 10~231~ - si I 3`flsb~t vyL~l^ civ 1 • s -~ 3 -~ 33 >,0~2.~1 ~-t~ ~<S~t~s~~ si ( l~sb~c m~Fh - - Z •3 Boring # ^ Boring ® Pit Ground surface elev. °l1 • 3 fL Depth to limiting factor _~_ in. Soil Application Rate Horizon Depth borninant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munselt Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 } O- ~1 l D`2 231 z ~ S L I ~S 612 -'Yl U`f1^ C S Z'F . S - S ~ a -~~I t.o ~f~ 316 - s t't Z`Fsb vn~Fr- ~ ~ ~,~ . s -~ 3 l~ 3~ L0~2 y~ ~l`F~-~`~fL s~~ ~s .Oy,., Vn V~l- - . ~ , 6 - tmuent rti = GODS > 30 < 220 mg/L and TSS >30 < 150 mglL ' Effluent #2 =GODS < 30 mg/L and TSS < 30 mglL CST Name (Please Print) ignature CST Number • Arthur L. tdegerer ~ t~.Z-Z3t ' ~ 220254 '-°'dd~ 4~ e g e r e r Soil T e s t i n Q& Design S e r v i c e Date Evaluation conducted Telephone Number 421 ~1. iiain S t . River r alts, WI 54022 1 Q- 3-l~ Z ,.715-425-0165 Page ~ of 3 ST• ~-~tX P 0..~) ~ ~ Property Owner ~ ~ ~~ w1 ~) Bori # ^ Boring Parcel ID # ~ ~D ~ -~/ G "g 101.5 per, I~1 Pit Ground surface elev. ft. DPnth to limlfinn farfnr 1 U t.. Page Z of Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounfary Roots Soil Application Rate GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Etf#2 1 0-$ l ~~. R-- 3 l z -- sit Z`f `s b k m U`P>^ c s Z . S - 8 Z $-1~ lb`2231 - si I 3`Fsb12 m ~ Ct,J l .s .g 3 1g 3 l0`~23~ '~L'F-7.S`~125l9 s~.l 1Csbl-L vv~~'h ~ - Z -3 ^ Boring # ^ Boring ^ Pit Ground Surface elev. _ ft. Depth to Ilmltinn factnr t.. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eft#2 Boring # ^ Boring ^ p;t Ground surface elev. ft. Depth to limitlna factor in Soil Application Rate .Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 • Effluent #1 = BODs > 30 < 220 mg/Land TSS >30 < 150 mg/L • Effluent #2 = BOb6 < 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 608-266-31 S 1 or TT'Y 608-264-8777. ~. SBD-dJ30 (R.N00) .,- ~~ .. PLOT PLAPd Scale 1'=y~' ~ UT L1nJ~; Page 3 of 3 ,,,p~' ~"'' ~ ~~~'O~ ~~d~" 13~-'t ~'1- -- ~?-1.0 0 Sz _~N 1 r,`h~-~ r _ 31 y--]1.. t_ ~ - . p v_C_ _1~1~ CE . _ i^11 ~~= ~ i`~~ ___.. Y~ K K._ 1 ___ __ .. .. w ~,3 eT ~ sp1o i ~ 8 ~ ( 2I 1po !/0 3}' ~L 3 ~1 !~-1 ~ _ ~-. 10 L. 6 ~ ids ~ `~"~' ~ ~~ - 1S I J gg~= - -------- ~S g.z OlSTU2c3 `TZf~3 ` Q(17~ ~' O ~~~ V f y ~ - . ~ -~ ~ N 0 .. } p_ 3_pZ 715-425-0165 220254 v Z_ Z3 ~ _ ~ "CST Signature Date Telephone I7o. CST I~1o. Job PIO. t Parcel #: 008-1068-40-000 os/o3/2005 10:27 AM PAGE10F1 Alt. Parcel #: 23.28.16.352D 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 CaOwner O -GARRISON, DARLENE DARLENE GARRISON 1309 CTY RD M RIVER FALLS WI 54022 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description * 204 CTY RD B SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 3.780 Plat: 1630-GSM 17-4452 008/03 SEC 23 T28N R16W PT SE SE CSM 17-4452 T 2 3 C Block/Condo Bldg: LOT 02 LO ( .78A ) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 23-28N-16W SE SE Notes: Parcel Histo ate ^ Doc # Vol/Page 9/24/ WD /27/2003 714790 2185/32 02/07/2003 708701 2134/253 WD 01/31/2003 707840 17/4452 C SM ~ ore.. 2005 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessme nt Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 3.780 500 0 500 NO Totals for 2005: General Property 3.780 500 0 500 Woodland 0.000 0 0 Totals for 2004: General Property 3.780 500 0 500 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 Pam Quinn Subject: A+?? on-site for Darlene Garrison ~ j S ' ~~~~ Location: lots 1 & 2, SE/SE Sec. 23, Eau Galle Start: End: Wed 8/10/2005 10:00 AM Wed 8/10/2005 11:00 AM `\ ~ « ~~ Recurrence (none) S~ Meeting Status: Accepted `„~ Required Attendees: Ryan Yarrington; Pam Quinn off Cty Rd B, south of 25th Ave. Art Wegerer did another lot just north of this that turned out to be A+0" and we need to verify soil conditions - CSM completed in 2003 St. Croix County Map Output Page Page 1 of 1 St. Croix Count Ma in ~~ ~`l -10 srA 'coo 9D1/571 ~ ` FOB ~w CSM i6-4227 ~ ' ~ ore SE 1! E 114 E SW 1l4-S ~ .. _ ..... _ ~..._ _ __ _ _.. .. _..ts1 .a..._ , _... .:.~....__ _ _ ..,,__ ..._.,__ vaB 3~z6 ~ SrA /_. ~- m...~_ .. __ ~ssa:~ii~ Ea Galte / 1 ) o v]/ 352C 352D b CSM 7 7 462 rsae.rr f '~+ wr~e ~`~< ~~ AC ~~9 i ~ N 4 Fe vvrcz ~a LO~I7. !ag r aat.ar LC7C2 3856 / ~~ T53.T3 ! ~~ ' ~' ~'~' St. Croix County Planning Department , "~ 1101 Carmichael Road .~I~ Hudson, WI 54016 Phone: (715) 386-4674 DISCLAIMER :The information contained on this map is advisory. Map accuracy is limited by the quality of the public rernrds from which it was prepared. It is not intended as a substitute for an accurate field survey. AERIAL PHOTOS :Aerial photography is date-sensitive. Features that exist presently in the County may not be present in the photos. ROE NW if4 Fe RnD2 Le~arid ~MarYClryai Bo~rrU arlet ~bdl+f lslonr ~-~~~ Cer~7C .1 Jlr vey 11.7aps u P.or Qls Ro.o4 na~no.an Drai rYage Streams Oan P'erreNal r~eArn nlennl lrrnl - Pram Vhd4r V • dl~t Q~S ~rS-a~3-3~3o ~~g al ,~ C~~4.c~~ T http://72.21.230.178/servlet/com. esri.esrimap.Esrimap?ServiceName=StCroixOV&ClientV... 8/3/2005 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page~of FILE INFORMATIVN Owner ,~~.-~en~. ~02 1-~ I^.'s4`j Permit # ~ ,(~ DESIGN PARAMETERS Number of Bedrooms ~ ^ NA Number of Commercial Units NA Estimated flow (average) ~ o O al/da Design flow (peak), (Estimated x 1.5) „~" O aUda Soil Application Rate d~ 1p aUda /ftz Influent/Effluent Quality Monthly average' Fats, Oil ti< Grease (FOG) 530 mg/L Biochemical Oxygen Demand (GODS) s220 mg/L Total Suspended Solids (TSS) 5150 m /L Pretreated Effluent Quality ^ NA Monthly average" Biochemical Oxygen Demand (BODS) 530 mg/L Total Suspended Solids (TSS) S30 mg/L Fecal Coliform (geometric mean) 510' cfu/100m1 Maximum Effluent Particle Size Y inchdiameter SYSTEM SPtctrics~~wna Septic Tank Capacity /b 0 0 al ^ NA Septic Tank Manufacturer 4,,~~.~ Cowera~'~ ^ NA Effluent Filter Manufacturer ~o,f' ~v~ ^ NA Effluent Filter Model .~',~.,5'" ^ NA Pump Tank Capacity ~,~$~D al ^ NA Pump Tank Manufacturer ~v,'e,fd- ~a-Grak-~ ^ NA .Pump Manufacturer ("o.,._~al ^ NA Pump Model E,pO ~- ~~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection Manufacturer ~ ~.NA ^ Peat Filter ^ Wetland ^ Other. Dispersal Cell(s) ^ In-ground (gravity) ^ At-grade ^ Dri -line ^ In-ground (pressurized) ~ Mound ^ Other: Values typical for domestic (non-commerc~a~ wastewater and septic tank effluent ' *+ Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ~ ^ months i,~year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y) of tank volume Inspect dispersal cell(s) At least once every ^ months ,year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ~ (months ^ year(s) Inspect pump, pump controls 8~ alarm At least once every ^ months ^ year(s) ^ NA s/~eedc~ Flush laterals and pressure test At least once every ^ months ^ year(s) ^ NA~s /vGe at' other. At Least once every ^ months ^ year(s) ~4 NA other. At least once every ^~ months ^ year(s) ~,NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage Servicng 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 visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (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 ch. 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 POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. STARTUP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process 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. +„ r System start up shall not occur when soil conditions are frozen at the infiltrative surface. Page ~_ of Fluting power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction orelimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONt~rl F 11T 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 artd 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 tanks and pits shall be removed and property 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: ~ , ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing-arid proposed structure, lot tines and welts. 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 rotes in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank -may be installed as a last resort to replace the failed POWTS. ,~ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POVYTS INSTALLER Name T«rw~+ -- . wdk .~Xcdttd~`•~ Phone 7lS~ ~ 5" _ Q' 4 ~~ $ POWTS MAINTAINER u'h k~ aN-n Name Phone SEPTAGE SERVICING OPERATOR PUMPER ~~ct~'ti~+~• LOCAL REGULATORY AUTHORITY Name Agency St C'a..' ~ok.k t' L~oh.~ Phone Phone /s- _ 3' ~' 6 _ .¢ ~ ~d This document was drafted by the staffs of the Green Lake, Marquette and Waushara County 2oning and Sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)8(f) and 83.54(1), (2) ~ (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. GMW (7J01) vi. vaw alp vv va~i i SEPTIC TANK MAINTENANCE AGREEMENT Ownex uyer Mailing Addr+ Property Address ~U Y ~ (, (Verification required from AND - -_ & Zoning Department for new construction.) City/State %~~0 ~ ~ y~G~°- u/~'~_ Parcel Identification Number ~~ 0 ' f~1~ ~~~ d~ LEGAL DESCRIPTION ~ 3~~ p) l/,o Property Location ~'/4 , ~'/4 , Sec. ~ ~ , T ~ N R~W/, Town of ~~ ~a vL` Subdivision ,Lot #~ a Certified Survey M p~7 ~~ ,Volume ,Page # ~~~' J~ Warranty Deed # ~y/ 1 ~ g ,Volume ~~{~ ,Page # / S Spec house yes Lot lines identifiable ye no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms .~ SIGNATURE OF APPLICANT(S) ~12/~~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) OWNERSHII' CERTIFICATION FORM U 2418P 152 STATE BAR OF WISCONSIN FORM 1 - 2000 Document Number WARRANTY DEED This Deed, made between Joseph A. Dohmen, individually Grantor, and Darlene Carrison~a single Derson Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): A parcel of land located in the Southeast Quarter of the Southeast Quarter (SE 1/4 of SE 114) of Section Twenty-three (23), Township Twenty-eight (28) North, Range Sixteen (16) West, Town of Eau Galle, more fully described as: Lots One (1) and Two (2) ofCertified Survey Map in Volume Seventeen (17} of Certified Survey Maps, Page 4452, as Document Number 707840, filed in St. Croix County Register of Deed Office on January 31, 2003. ~ 4 1 1 3'9 KATHLEEN H. 11-ALSH REGISTER OF DEEDS ST. CROIX CO.. KI RECEIVED FOR RECORD 09/2412003 09:30AM NARRANTY DEED EXEIIpT # REC FEE: 11.00 TRANS FEE: 162.80 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and $etum Address WESTCONSIN CREDIT UNIN~ PO BOX 308 RIVER FALLS WI 54022 ATTN: JEFF Together with all appurtenant rights, title and interests. Part of 008-1067-95-050 Parcel Identification Number (PIN) Phis is not homestead property (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: easements, restrictions and rights of way of record. TiL Dated this L~ day ofSeptember, 2003. * * J eph A. Dohmen * s AUTHENTICATION ACKNOWLEDGMENT Siattature(s) STATE OF WISCONSIN ) ) ss. ST CROIX County ) authenticated this day of * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by X706.06, Wis. Stats.) Personally came before me this 19 ~_ day of September .2003 the above named Joseph A. Dohmen to me known to be the person(s) whd y ~ oit t ment and acknowledged the ~, p ,_ ~ - - - .r ~- '~'p- THIS INSTRUMENT WAS DRAFTED BY ROBERT J. RICHARDSON. Bakke Norman. SC SPRING VALLEY. WI 547117 (Signatures may be authenticated or acknowledged. Both are not necessary.) * CCAIZllLE - '~ ~: otarv Pub ' .State of ST C T C'' :~ Q ,' My Commission is permanent. (lf no ap ate: EXPIRATION: 02-15-04 5~ .) ll of persons signing in any capacity must be typed or printed below their siga6t:. INF0.PR0 (80055-2021 www.infoproforms.com6TATE BAR OF WISCO WARRANTY DEED FORM No. 1 - 2000 ~Y M . pLE ~YPbDb~ebd IfY~eoortein • 7o'r 850 7"~784~ .EEN H. MALSN Rr..,sSTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 01/31/2003 11:SSAM EXEMPT ~ REC FEE: 13.00 TRANS FEE: c.~em uurr r-Gt: CER T ! F I ED SURVEY MAP PAGES: 2 LOCATED I N THE SE f i4 OF THE SE ! i4 OF SECTION 23, T28N, R 16W, TOWN OF EAU GAL L E, ST. CRO l X COUNTY, W I SCONS 1 N. PREPARED FOR: N WALTER FENSTRA S I/4 CORNER OF SECTION NOTE: BEARINGS ARE 23 (FOUND 1' IRON P/PE). y REFERENCED TO THE EAST LINE OF THE SE (~4. (ST.CRO/X w' m UNPL ATTED- • L ANDS CouNTY COORDINATE srsrEM). V ~_- -_- alw WEST L 1NE OF THESE-SEA - 330. 07' oy G O FF~ ~ ~ ~~~ ', J ~,. ~' }oca ti Co m ~•'~ 2 a ~~ w ~ ~ ~~a:2 w` :o ~. :cn 0 HIQHWAY 8ETBACK L SOUTHEAST CORNER OF SECT f ON 23 (FOUND ~ ST. CRO/X COUNTY ALUM/NUM CAP MCWUMENT. - a g ~gC~NB' ~ ~- '.`~' ~++ ~ ~ 1~ a, p n JAMES M. ~ ~. 0 ~„ m WEBER +a on ~ ~ '~ ~ &1804 SPRING VAL Y o c ~ , LE > m Ti~ by ~ ` Wf ~ y ~ ~~ m ~ SURV a ~ ~ w r ~~~ '' ro N w ~ a JAMfiS M. WEBER s- l eo4 ~ LANDMARK SURVEYING ' . ' " ~ ~ ; D DATED ~-oH • 'b ~ Z~.OZ. 14 NOO 38 E W~+~SC'Z7 \-3o-C~j 264. OS' -1'~ :a w $ :z :v ;cn U DE TA I L NO BCALE Os A O~ W :~ n:~ ' ~" m ~ DR ! VEWAY EASFA~ENT °. v ~ ~ m~a v ~ rn~ a "'•~ " . SOO. 1 B' 44' W o no ~ m /2P. 9/' ~ H N ~ 56.9!' B8. 00' A ~ ~ Of ~ O Oa N89.4/' ,B'M~~, $+F ..-•.. 43_ ' ~ 63 x._.... _ 124. 14' $ 66.26 f90. 14' 86.00 139.92' SHED • O - V m S04.48' 28'E # - 129 89' cr ......... 122.91 ' . EAST L ! NE OF THE SE 1 i4 I a Q - ~ -- - 2316. 89' -=4-------- - ~ -' -" -3.00. 18' 44' W _ H. o_- ~._ - ------ s00° re' a4•w E ,.4 CarrNER of 330. 08' SECT ION 23. (FOUND ST.CROlX COUNTY ALUMINUM CAP MONUMENT UNPL ATTED ,LANDS m m m m .G..T.. J_ .~ O . SETE 1'WEO/. D.I X /8' IRON ~~NEAR FOOJNG /./3LBS PER 1 " - 200' O /00 200 400 2002094 THIS INSTRUMENT DRAFTED BY JIM WEBER SHEET 1 OF 2 Vol. T 7 Page 4452 ,~ ° - ~ v rV 7-x'7 8 4 tb .EEH H. MALSH R~.;~STER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 01/31/2003 11:45AM EXEI~DT ~ REC FEE: 13.00 TRANS FEE: COPY R..~-a ~- CERT COPY FEE: CER T 1 F 1 ED SURVEY MAP PAGES: 2 LOCATED 1 N THE SE 1 i4 OF THE SE 1 i4 OF SECT 1 ON 23, T28N, R 16W, TOWN OF EAU GALLS, ST. CROI X .COUNTY, WISCONSIN. PREPARED FOR: N WALTER FENSTRA S li4 CORNER OF .SECTION NOTE: BEARINGS ARE 23 (FOUND 1 " IRON° P I PE ). y REFERENCED TO THE EAST L I NE -. m OF THE SE I i4. (ST. CRO I X w m UNPL AT TED LANDS COUNTY COORD 1 NATE SYSTEM). ~~ w ................................ ' V oil w WEST L /NE OF THE SE-SE R' NOO° 1 O' 29' E 330. OT' rn y ~ ~~~~ O ~~'~ g N"N y N ~ Qi ~ x ~ k = ~ `. ~ o~ JAMES M. `' cmo ~ U'p Q a ~ WEBER ~, m ~ ~ oa ~ •~ &1804 F ' o s o ~ " SPRING VALLEY, ~ c~Qti p ~"~~ 2 a a co `S °j , Q ,5.,~~a ~„~ cc ~„~ JAMES M. WEBER S-1804 r f ~ ;rr'~I ~~ w ~' ~"; , y LANDMARK SURVEYING ~• ~` ~' ~ N00° I4' 35` E ~ m ; v DATED ~~ • `~ "•2-~OZ .,~~ Q~: r 264. 05' . ~ 0.E^+~s~ l-3D -+~~ `° :n - :n :Z o ~ w :2 :v w m o' ~ :v . cn v m ..•~ ~ : cn w ~ DE TA 1 L 4i v - NO SCALE W ~ ~ ~ ~ :v ~ DRIVEWAY EASEMENT ~' c-'~0D0~w w w k w n~ „~ SOO° l8' 44' W m w U o n o ~ avow 122.91' ~: ~ m _A ;A ; + ~ -i y N 56.91 ' 66. DO'o ~ ~ ~~ cn N89°41' 16'~~Q~'I Q .- 124. 14' `= 66.26' ~ g 63_43_®Q,,,, , ,.,..... . "' "- 190. 14' 66. 00 ~ 138.82' '" HIQHWAY SETBACK LINE SHED S00° 18' 4 O ~ S04°48' 26'E ~ ~= 129.69' ca SOUTHEAST CORNER _ 1 2.91` EAST LJNE OF THE SE !i4 SECTION 23 fF0UN0 ST. CROIX COUNTY g I ~ Q Qj ALUMINUM CAP ___ ~ .2~•• ~ 235_ soy