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008-1043-40-000
sJVisconsin~Department of Commerce PRIVATE SEWAGE SYSTEM Satety and 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)]. ermit Holder's Name: City Village X Township ~anOverbeke, .Adam Eau Galle, Town of ST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CrOIX Sanitary Permit No: 515131 0 State Plan ID No: Parcel Tax No: 008-1043-40-000 Sectionffown/Range/Map No: 15.28.16.2196 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: nISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing Still COVER v Prncm~ro Cvc4cmc Only YY Mnnnrl C)r Ot-C,rAdP_ SVStEmS OnIV Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil Yes ,i~« No ILi Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 2465 Cty. Rd. N Woodville, WI 54028 (SW 1/4 NE 1/4 15 T28N R16W) metes & bounds Lot Parcel No: 15.28.16.2196 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? tau Yes ~ No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) .~/I %/~Y ~/~,li~~~P COIYIIOtA1+C9.,iNi.~V Safety and Buildings Division County ' ~ " 201 W. Washington Ave., P.O. Box 7162 ,sjr Cjr o/ ~ Madison, Wi 53707-7162 m y prrmitNamber (~ }~ Slkd in by Co.) Ai 5~si~~ Sanitary Permit Application I d itf C s~ ~~ ~ ~ n aooor ~oe w a a omm. 8321(2), wis. Adm. code, submissive of this foam to the appropriate governrodttai nail i$ requited Prior to o6laieieg a saetlmy permit Note: Application tams for state-owned POwTS are suMvilted ~ the Departatea# of Cotnmeroe. Persoml ia8ortos<ion you provide may be used for secondary Project Address (if dilfasat than madam addt+eas) 1, m aceordaatx with the Lave, s. 15.04(1 m Stets. tt ~t I. licatiea Iefor~atierz -Please Prlat All Ia anon „?S/eS ~e. ~O. /V Property owner's Name r I AUG. 2 7 2009 ,,,p~~.,~ DOS - /0~ 3 - ~D - Q~ Y~''s Addmss 5l CkUiX COUNTY NNING 8 ZONING OFFICE ' ~~ ~ ~ ` PropenyL« l set: 7 DiC.y n! .QLE ~/~~- PLA ~vk Lot C+ / City, State Zip Code Phone Number `/ / '!y ,r/ ` ,~ ~ ~ 4 G ~~r /l1Gr L/ ~ .SyJ~~ /.S Y~S- !3/~J~ T ~ ~ ~ II. Type of Baikling ( a8 that apply) tsEc. a.ls Lot # r o N R u ~l or 2 Famdy DweltBCg- Number of B .,3 Srrbs>ivisio®Name ~ mt17q... ~ $bc~c# D V -Desixdte use 1 o bed ~ ; r. b4~.,M.~...~ t ^ State Owned - Destxle Use CSM Number f X 5 g /' L ~ -G ~ Town of SRN GAL~E~ lIL Type of Ptxati~ (Check only o®e boa oe Ike A. Coca pkts lige B if appticabk) . A. ~, Sys ~ SYstem ^ T/HoWing TaHk Replacxm~ Qn1Y ^ Other Mod>n to B. ^ PemrR Reaewrd ~~ ~ ~ Permh Revision ^ t of Ply ^ Permit Transfix to New Owner Lim Previous Petm~ Number sad Date Issued IV. of POWTS S /Coca t/Device: C@eck aN ffiat a ^ Non-P Lt-Ground ~ Pressuriaod la-Ground ^ At Grade ^ I~uad> 24 in. of suitable sod ~ Momd <24 in. of ~bk sorl ^ Hems Taalc ~ a~ DisPmsai Component (explain) ~ Pretteatme~ Device (ems) V. 1/ra~etrtmeat Arat Iaforntatiea: F~ es~ soil n;sp«sal Alta t~ ana afl sysaem ySo /, a ysoi2'~ ~c y '>{ZI 97. s /ow 9t. o Boa row VL Tank Info Capacity in Total # of Gam Gallons Units ~ , ~ New Taaka F.xalmg Taoics A W Z~¢Q /~t'~t~ '$ ~ `'g" Q~ RC ~ in yg~ V~ ~ o~ W C~ ~ Ga o -- Goo ~ E. ., / VII. ~ 5tateea~t I, tlae mace reaposmib~ty fa~ iasfaNatiaa of tie P`OWT3 shown oa tie attaeial pleas. Phueber's Name (Print] Plumber's S" lure MPRr@14S Number 13nsi~.s Phone Number " " ~ ,e~ o .v ~ zu .? 3 ~3 t~G rrs' G7.? -S.?cG Plrmnbet's Add {sheet, CAy, state, Zip Code) ' l ~ 8 ~y ; t/ .~.~ 4RA.~ D G/~ .5~7.~ G VIII. Coen rt~~t Use Ora Approved cal rove Permit Fee Issuod S' 4 er Givee oe.for Denial S ZS. m ~ O Z7 Og AA /~ IX. Coact' ' eves for Disapproval a) ot~! Syb~e+v`. ~ ~ ttidlort E~ vwNE- R'_~"^ 1 Se tic tank efflue t f Ct a JJ . p ; n r er nd ~. " dispersal cell must all be servtbes maintained C51„~, ~,OJSQ-- ~~ ~~ ~ c.~ywCJ~ v~ as per management plan provided b plurrai r y . e 2. All sgtbackrequirements mr,~t be ~ ~~,~ f ~~~ as 6tx .o .+.~p..... ~~ .v....c ~aaa. eau sags err ~HC iaaa[y smj W P1tICf Yai 7!S lain a rIl z 11 ateilS ~ dal SBD-6398 (R. o?J09) valid tbtll ovl l RJo s'~' al'~!'~e /Y,v..r l/EL L ~ , 8 x S8 Rocie ,vis rat /emu rio./ 3/„S st 8.? / G~'cL /"lau,~p ~owTS `s E, ' 91. S ~,,, pl. a' `iAi ~O~ 1'au.c /.~aa.~r EEC _ 98. ~ ~~ Q. M. /aa.o ~ - 1-oP of ~~S' rr ~J L ~/~' y/ r of l/6~L6G T'ie.~! ~,/ Sd, ZS of L6L4 t ~.~t rN ~ ' Co,/cAv~", oA' Jr'LO 60,~1-ovc ~, i ASS ~ S6. 2s' ~ 7/ ~ jj /~LyAitL GEL4 oEnJLT,t~ ~~~~ x ~ ~ ~~~o ~ ~~ ~6..y ~ ~a~y, rAB`C' w o.t.~.rce- ~~/aQe,~ E~x/s ri,~c .ysE C"° 4~' RE'rsooElJ r v~~ j ~/Zt3 d®~/dL Y' .~j,QAn1D®.al~eG7 ~f~/~ ~!a 9ao~ °-~--~ /~ ~ o~ ® ~C,©. .~ j ~ / ~P~e9s41 ~.~$seldtlda'~ ~f~'t~" ;.:~5`~' ~~" '~:.~ ~'f~y ~~ ~'..,~..~.. . ~._..,.. ~._ L°~, ;~s~ a"° y m+~ .~ ~~~L~ , ~ . ^ 1 .. __„~r ,~..y ~ ,o~ y , iVA/L /./ ~a ~/~qsy -~ rAB6 ~ o,~q./tf ~~/aQo.~ ~x/s ri,~c .ysE C"a ad !L~'~yeoEO Y ~rJo rd p ~ ~d~ /YA/.J ~/EY L ~ , 8aS8 lloc.,e D~sr~/gur~o,/ .3/,S/KSd ~ GEtt. .S /'7a u„rp ~a wTS 9l, o ~o a ra..,t li.+~ J~u~r~ r E~~ - 9a. ~ ` Q.M. /aa.o ~ - T"oP of i ii /~ y ~J G ~%>d i , ~ of ~!d/dL~c r'ien! ~.~ Sd, ZS' of L6LL L6.~ltr~/ ~ ~ y ~ sc. zs , 7./ ~Grusc c~~a ~ i LE./c r,~ = ~7./~o x . ov,16S) ~~ x Sl..?S = S7, y `rw~.~raq cE'./~ sN~ 99 3 L= tt !S S"i.,J6 SEe®i'i~ d Y`~ Y"e'rf ,y a r,Y~° .~/Xa/°.E"it6Y .,6J.f~AeJDoAJ.4',c7 f !~t/~/ -~, rd C~]COPY ~® ~~. ~ /i commerce.wi.gov ^ ^ ~scons~n Department of Commerce Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 Contact Through Relay www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Richard J. Leinenkugel, Secretary August 14, 2009 CUST ID No. 231346 JOHN HERBERT PELKE PELKE PLUMBING N 6298 ST HWY 25 DURAND WI 54736 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/14/2011 sec ype. omponen anu egu a e sec Maintenance required; Replacement system; 450 GPD Flow rate; 18 in Soil minimum depth to 1' g factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distributior Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Effluent Filter SITE: Adam Vanoverbeke 2465 Co Rd N Town of Eau Galle St Croix County Description: Mound, 3 bedroom residence gEE GORRESI Ob' t T • POWTS C t M al R l t d Ob' t ID No • 1236291 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. 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: Key Item(s) • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • This mound is designed to be installed on a concave site. • The mound must conform to the shape of the contour. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. SW1/4, NE1/4, S15; T28N, R16W FOR: ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 I Identification Numbers - Transaction ID No. 1693897 ~ Site ID No. 750374 Please refer to both identification. n ~, above, in all corres ondence with the a pEF EA E(~(/P ~i/ w ,`. ~ ~ j,pi1~ 0~ ~t JOHN HERBERT PELKE Page 2 8/14/2009 Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • The existing POWTS must be properly abandoned per s. Comm 83.33 Wis. Adm. Code. 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. Beginning October ls`, 2008, small wastewater holding tanks with estimated flows less than 3,000 gpd that are based completely on approved POWTS component manuals must be submitted to the appropriate governmental unit and will no longer be accepted by the Safety and Buildings Division for review. Please refer to s. Comm 83.22, Wis. Adm. Code for further information. 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 rovide a copy of this letter to the owner and any others who are responsible for the installation, operation amtenarice of the POWTS. Sincerely, POW3~-Flan Reviewer , Integr ed Services (715) 634-7810, Fax:`'( 4-5150 , M-f 7:45 am - 4:30 pm pat. shandorf@wiscons in. gov Fee Required $ 250.00 Fee Received $ 250.00 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. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs arty building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www.commerce.wi.aov/SB/SB-Buildin~ContractorProaram html JOHN HERBERT PELKE Page 2 8/14/2009 Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • The existing POWTS must be properly abandoned per s. Comm 83.33 Wis. Adm. Code. 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. Beginning October ls`, 2008, small wastewater holding tanks with estimated flows less than 3,000 gpd that are based completely on approved POWTS component manuals must be submitted to the appropriate governmental unit and will no longer be accepted by the Safety and Buildings Division for review. Please refer to s. Comm 83.22, Wis. Adm. Code for further information. 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 royide a copy of this letter to the owner and any others who are responsible for the installation, operation amtena~ce of the POWTS. Sincerely, YUW"F-~~~~~n Review,er , Integr ed Services (715) 634-7810, Fax:\(~1Sa- 34-5150 , M-f 7:45 am - 4:30 pm pat. shandorf@wsconsin. gov Fee Required $ 250.00 Fee Received $ 250.00 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. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www.commerce.wi.~ov/SB/SB-BuildingContractorProgram.html i ~ fig, 5 ~ ~ ,_ , Private On-Site Wastewater Treatment System (POWTS~ Index and Title Sheet Owner: /~oa~r //A./O dER .QE .e~" ' Project Name and System Type: ~,OA, •r l~.4.0•' ~,~,, R rr.C - ~- ~~ . ~o uav maw TS Location: ~d ie A75'~ S Co. moo. /V Street Address ~~t~ .S!/ ~ .III' /` ~/ Legal Description /oa,/ off' Aa~£ Sr. C~o~ Co Township/County og - GE Page 1: ,o~x Contents: ~- ~ .~ Page 2: o r ~ sa . Y Page 3 : ~ito ss - .S~a ryi.,~ ,v,/o ~ .id !/~./ a `' /7v:.,,ly ` Page 4: ~i.od L.o re-~r.~~ L,~yo.- r Page 5: ~t-~r~t t~~r„ix~~u~rP C.dvyo~,~ Gross-..~£arso./ Page 6: ~~,,~ ~~"ai'o.P.y...r~r C~Ar.r Page 7: 4asrrs o.~.r.-a 's ~r.~~~,.~ /9.ON~+iE/y/~'.dl ez..~ Page 8: Page 9: Attachments: ~o i a G~dA~NA rio..~ ~~~~A r ; Plumber/r. ~,y„i ~~"iK~ g Credential Number: /°1~- aI~/3yG Date: 7- .?s- 0 9 ~.ls£o set - `, /GL ?/~~ ,/yeuv0 CorlPo.vtvr ~./aiG y !~£aSia./ .7. o Gl servo ~ s60 - /0 7'ot -P '~~ir~ss~v~ ~ his r.~~~?a r..r Co.~-BarE~r ~~N~ ~ " d~,~ sir a.o V ~ ., . e .~ z ~~ . , (~ .-_ N -- .. ~ o ~~ - H' A W . ~ - ~- ' - ~. •~: - ~ -=~_ A.' - ~~ - - - - - ~a -=. ~ - ~ Ri - - 3~t .~ - - '~. H ~ ~~. - ~. ~ -~ - . ~ - N `k ~, _ - ,~; .ao_ Ca3 - V ~ rt. O - K K v ,~~ - ~ _``~ - - - tR y ~ ~ - ~ (/.~ m • - - i~. l-E . ~ ! V3 _ -~ .Zi _ t'! e p - ._ ~ ~ ` ~•• - . H - ® r • s ~"= - o ~ ~ ~ ?d y'~. . !+ v a w __ _ - o - ~ t kv ~- , - i - ~u - v ~ ~» ~ - ~ N + ~. ~ ~~ - ~ PtN~k ~• l ~, ~0 ~ ~ - - . ~ o ~ v~ " o w ~' ~ ~ _ 0 . ~~ ~a ~ " _ t;~ 14 t n ~ . - ~ ~ ~ k _ a v - ! a.. ti • ~ ~~ - _ ~ ~b - . ~ y . ~ ~ ~ : k~ ° - ~ir h ~ ~ \ o - . n ~. - ~k a a- h W ~ - V ' - ."~ . ... - - w- ~, -w ~.- % w 'w m'~~ ..a.~ .~ 0` k+' Q a` .~ a N w .~~~ a O ~ ~ ~ ~ ~ ~'~ ~ 'o ~~ ~~~~~~ ~~ vQ.. ~ ~ . . t~ F-~t t~ to ~~ ~~\I~~ ! 1 9= p4 W ~ r ~ ~ e ~,.; x~ x~s a,~ v aHZ~p~~ .~ fse p~+ .~y a~i ~ ~ ~ 3 W ~ ~. . a ~~ h Q v ~~ ~ °'~ v Z " t V V ~ v ~ ~ o u a ~ ~, v h ~. e a ~ ~ '~ ~l X X ` ~~ ~ " ~. W ~ ~ ~ W Z V ~ 0 .~ ~\ y . ~~3 " .: ~~~v ;'''..:. ~. SEPTIC TANK 'PUMP CHAMBER CROSS SECTiON'AND SPECIFICATIONS s.t Sc.w y0. 4" Ci VENT PIPE 12" MIN. ABOVE GRADE ~ ?" /p' FROM DOOR, WINDOW OR FRESH AIR INTAKE /CJw//-*'Nd4 . G rlwA~ ; 18" lMIN. I NLET f .. APPROVED PIPE 3` ~OttTO SOl I D SOIL •~ B C -- .-~- D WEATHERPROOF JU~tCTION BOX APPROVED --WITH CONDUIT MANHOLE COVERS W/ PADLOCK E , WARNING LABEL ~.,.._.-- 4 " MIN . ~~ ;~ ~ ~~ ` , GAS- ~ ` ~ TIGHT: ~ ~APPROYED SEAL ~ JOINTS WI7ti ~ ALM APPROUEO PIPE ~ ON 3' ONTO ~ f. SOLID SOIL l ~ OFF '~~ RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS AFPROVAI, 3" APPROVED BEDDING UNDER TANK CONCRETE-PAD SPECIFICATIONS SEPTIC.! DOSE TANK MANUFACTURER: ~ ~//EsE~<ro.dG.t. NUMBER DOSES PER DAY: l S.3 ~/~'. 9 °!o TANK SIZES: .SEPTIC /~ GAL. ~ ~ DOSE VOLUME INCLUDING 8S -~ 7. y- DOSE Goa GAL.. - ~ - FLOW$ACK: ~,~.y .GAL. ALARM MANUFACTURER: ~" '~ ,~T E ~ifo,,,,,~twr• CAPACITIES: A = .?o `~" INCHES = _ 33~. GAL. ~ MODEL NUMBER: 7-~qy,~ ~~.~r = SWITCH TYPE: , ~~ittaai' ~ ~ /C g 6,,~s.. B .. 2 INCHES . 3,~ G GAL. PtlliP MANUFACTURER: ZoE~cE~. / /~~y C = ,5:,~ INCHES = - 9,~• ~ -GAL. MODEL NUMBER : fir- ~/ SWITCH TYPE : ac~aa:Y D . = 8'..S INCHES = _ /Y.?.8 GAL . REQUIRED DISCHARGE RATE `~ y GPM ~ PUMP E ALARM WIRING A S PER ILHR 16:23 WAC ~VERTICAL~DIFFERENCE BETWEEN PUMP OFF AND DISTRI$UTION PIPE so FEET + MINIMUM NETWORK SUPPLY PRESSURE 3.3 FEET + - .80 FEET FORCEMAIN `X /.S FT/100 FT. FRICTION FACTOR j ~ FEET . ~ TATAL DYNAMIC HEAD = FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH S3 ; WIDTH 78 ; DIAMETER -- LIQUID IS~~T i- 34" . a y dE~o•- s.~~i~ WATER TIGHT SEALS - , PUMP OFF ELEV . 93. / FT . w LL PUMP PERFORMANCE CURVE MODEL 1511152/153 sa ~ I f 4 45 153 _.._ -.. ' ---- `-'----f -- 1 ' M1 2 40 - -i- °¢ 35 ~ - -~ - -- i 10 152 30 ' a ~j~ 0 8 25 751 ~ g 20 -~' --} -- ,5 4 10 2 5 0 10 20 30 40 50 60 70 BO 90. 10 GALLONS FLOW PER MINUTE 014508A • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F (54°C) special quotation required. `] 5111521153 Serio t51/1521153 MODELS Control Selection Model Volts-Ph Mode Amps Simplex Duplex N151 115 1 Non 6.0 1 2 or 3 BN151 115 1 Auto 6.0 Included 2 or 3 E151 230 1 Non 3.2 1 2 or 3 BE151 230 1 Auto 3.2 Included 2 or 3 N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 E152 230 1 Non 4.3 1 2 or3 BE152 230 1 Auto 4.3 Included 2 or3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 Non 5.3 1 2 or 3 BE153 230 7 Auto 5.3 Included 2 or 3 SELEC71flN GUIDE i hTA~ DYNAMIC HEAD/EL.Q51`v` _._ PER MINUTE (=1=FI_lEs'Jj A~Il7 DE~%`1~.; E::~~,11`l('. (-- MODEi_ 151 I 132 Feet Metes Gal. ~ Liters ~ Ga ~~ - gal ~ 1 ters -- 5 -- 1.5 50 189 ~ 69 261 77 ~----- ~ 291 10 15 3.0 4.6 45 38 170 144 61 53 231 i 201 70 61 ~ 265 r 231 s ZO 6.1 29 110 44 167 52 197 25 7.6 16 61 34 129 42 159 30 9.1 - -- 23 87 33 125 35 10.7 -- -- - -- 22 85 40 12.2 - -- - -- 11 42 Shut-off Head: 30 ft. (9.1m) 38 ft. (1 t.6m) 44 ft. (13.4m) i-f- 6 7132 ~1 3 7!8 ~ 4 518 -~ i I ---~ I © ~ l i 3 718 - ~ -~ t ~ 3 7B e _ ~ j 11 nns 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 2. See FM0712 for correct model of Elecrical Alternator E-Pak. 3. Variable level control switch 10-0743 used as a control activator, specify duplex (3) or (4) float system. A CAUTION I 415/1fi _~ ' SK2444 U14JUtltl Models 1521153 3 7l8 18 IB "Easy assembly" (pump ~ disdtarge pipe not included.) ~I~7"II~N~~ I~~~F ~'i~~.iwf; e.' = Reduces potential clogging by debris. = Replaces rocks or bricks under the pump. = Made of durable, noncorrosive ABS. ' Raises pump 2" off bottom of basin. = Provides the ability to raise intake by adding sections of 1'/z" or 2" PVC piping. Attaches securely to pump. Accommodates sump, dewatering and effluent applications. NOTE:. Make sure float is free from obstruction. SK2064 For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. ____ _ ___ -- --- _ _ __ - ©Copyright 2008 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION Owner ,q „JD Permit # - r1rrCT(~IV PARAMETERS Number of Bedrooms 100 room 3 f)3[ NA Number of Commercial Units -- NA Estimated flow (average)* ao Uda Design flow (peak), estimated x 1.5* ySo aVda Soli Application Rate /. D aVda Influent/Eflluent Quality (NA^) Monthly Average** Fats. Oil & Grease (FOG) < 30 mgJL Biochemical Oxygen Demand (HODS) < 220 mg/L Total Suspended Solids (TSS) <_ 250 In Pretreated Effluent Quality ^ Monthly Average** * Biochemical Oxygen Demand (HODS) < 30 mg/L Total Suspended Solids (TSS) ~ 30 ing/L Fecal Coliform (geometric mean) _<IO cfu/100m1 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 ipt for. retreated wastewater. cvcT~nr cpt~rr~rrATrntvS Se tic Tank Ca ci ~~,~ ~ ~ 1 ^ NA -___, Se tic Tank Manuf . cturer 1/i,ESE',e o„x. ^ NA Effluent Filter Manufacturer ZR6 G O NA Effluent Filter Model -/vo ^ NA Pum Tank Ca ci o0 I ^ NA Pum Tank Manufacturer 6/iES~'R ~ NA Pu .Manufacturer ZDEL~E2 ^ NA Pum Model S/ ^ NA Pretreatment Unit ~A ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ OQter. Manufacturer. Model: Dispersal Cell(s) , ^ In ground (gravity) ^ In-ground (pressurized) ^ At-grade. f~Mound ^ Dri line ^ Other: ^ Leaching Chamber Manufacturer Model Laying Length/Chamber Soil Application Rate_gpd/fl Area Req. fl Infiltrative SurfaceiChamber-ESIA Rating ftZ Minunum Nwnber of Chambers ^ A re a Desi FIowlLoading Rate= ft" min Materials: all materials must comply with WI Adm Code COMM84 and be installed per manufacturers specifications and a royal letters. ^ "Wisconsin At-grade Soil Absorption System, Siting, Design 8c Conswction Manual" (Converse et.a1.1990) ^ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, 3.C. and E.J. Tyler. Publication 15.22 ^ "Resign: of Pressure Distribution. Networks for Septic Tank-Soil Absorption Systems' Publications 9.6 ^ "Design of Conventional Soil Absorption Trenches and Bps». RJ. Otis - ASAE Publications 5-77 and "Design Manual - Onsite Wastewater TreaUnent and Disposal Systems". EPA 625/1-80-012 Oclol~r 1980 ^ SBD -10570-P (8.6199) "At-Grade Component Manual Using Pressure Distribution" ^SBD -10567-~ (8.6199} "In Ground Absorption Component Manual" ^SBD -10705-P (N.OIIOl) "ln Ground Soil At~sorption Component Manual" Version Z.0 p SBD -10628 (N.6i99} "Recirculating Sand Fitter System Component Manual" ^ SBD -10656-P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ^ SBD -10572 P (8.6/99) "Mound Component Manual" ~( SBD -10691-P (N.O l!O l) "Mound Component Manual" Version Z.0 ^ SBD -10595-~' (R.6l99) "Single, Pass Saexl Filter Component Manual" p SBD -10657-~'' (8.6/99) "Drip-Inc EBluenf Disp~at Component Manual" p SBD - 10573-P (R 6/99) "Pressure Distrsbution Component Manual" SBD - 10706-P (N,O Ut? 1) "Pressure Dlstribaton Component Manual" Version 2.0 ^ Drip-line. Effluent Dispersal Component Manual far Multi fla Onsite Wastewater Treatment Units n __ vfimf~lT ~1Tlr}? 1L/l1TiTA7f 21Tl~ C~/'~IIT. TiST T. j1iI11j\ i rIj\[11•t.i't yiiVi~l L V+«+~ V yvaaa-iY a Service Event ,a+~ Service Fre uenc In t condition of tank(s). At.least once eve .. ^ months. ear(s) ([vta~mutn 3 rsJ Pum outcontents of.tank(s) When combined stud a and scum uals one-third 113} of_ tank volume. Ins t di rsal cetl(s} At least once eve ^ months ,3 ($[ ear(s) . _ (Ma~mum 3 rs.) - Clean effluent filter At least once eve months ^ ear(s) Ins t n , um controls 8c alann At least oncx eve ^ months 31~ ear(s). ^ NA Flush.laterats and ure test _ _ . At least once.eve ^ months 3 earls} p NA_ . Valves At least once.eve ^ months ^ ear(s) NA Other: At lease once eve ^ months ^ ear(s) p . NA D.y.u. 7 of START UP For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products ter other chenucals tli~t may impede the treatment process and/or damage the dispersal c~eil(s}. If high concentrations are detected have tl:e cantents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infilUative 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 tl-e performance and longevity of your 1'OWTS. 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 true is the only paper that should be discharged into the system. Other non biodegradable items such as baby wipes, tampons, sanitary napkins 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. O Naives Valves shall be operated in the following rtiaruter: Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to setvice POWTS, 'Mere is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems rvith the system are corrected to prevent badc~ip of sewage into the dwelling or surfacing. INSPECTIONS Inspection shall be made by an individual carrying acne of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer> POW TS Maintainer or Sepiage 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 teaks, measure the volume of combined sludge and scum and to check for any baedtup,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 shad be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective Ioeking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum is any tank exceeds one-third (1/3) or more of the tank volume, the entire cAntents 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 arty accumulated solids according to manufacturer's specifications. Provisions are to be made m retain solids in the tank. Filter cleaning maybe necessary at more frequent intervals than stated in the maintenance sidtednle to keep the system operating. Pump Chamber/rreatment 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 outer hardware and-the condition of any filters. Any service needs or repairs shall be pmmptty taken care of. p In-Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if an3- 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 wmponent may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Pagc 8 of 9 START tIP For new construction, prior to use of the 1'OW'I'S check treatment tanks} for the presence of painting products or other chemicals tl~a may impede the treatment process and/or damage the dispersal c~eit(s}. if high concerd`~rations are detected have the contents of the tank(s) removed by a seetage servicing operator prior to use. System startup shall not occur when soil conditians are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the PQWTS 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 daes 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 ttiadegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products,. paint, disinfectants, pesticides, antibiotics, sotvenis, etc., should not be flushed into the system as they can seriously damage your POWT'S 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. t :ompaction of snow over the dispersal unit may cause it to freeze up. O Valves Valves shall be operated in the following manner. Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, wntact 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. INSPEC'T'IONS Inspection shall. be made by an individual cariying one of the following licenses or certif cations: Master Plumber, Master Plumber Restricted Sewer, POWTS Ivtaintainer or Septage Servicing Operator (per the attached IVlaintenanee Schedule}. Septic Tanks Component Tank inspections must include a visual inspection of the tank to fdeatify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup,ar ponding of etJluent to the ground surface. Access openings used for service or assessment shall be seated and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an efi'ec6ve locking device to prevent accidental or unauthorized entry into the Tank. When the combination of sludge and scum is arty 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 aa~rding to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning maybe necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Pump Chamber/TreatmentT~nks Component The inspection must include a test of all etectrical equipment such as pumps, alarms and floats. A visual check must be made for leaks,~backups, surfacing, missing or broken security devit•.es and other hardware and the condition of any filters. Any service needs or repairs shall be promptty taken care of. ^ In-Ground Gravity Component Dispersal Cells . ~ The inspection_shalt include recording the levels of ponding, if any in the observation tubes and a visual inspection far any evidence of surface seepage- or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority: Ponding at depths greaterthart 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Pagc ~ oC 9 Monad, At-Cnadeti jn-G4roimd P`ressm+e The iaspoc~ion shall iachide roconding the levels ofpondmg, if any in the observation tubes and a visual inspection for any evidence of s secYage ar dischazge. Any discharge to the t;~ surface must be ps~ptly reported to the regulatory ~~Y Paading 8 than ~S% of the hedght of the ccma~poaent may indicate overloading or impestding hydraulic failure The P distr~On system is provided with an opexeing at the end of ead- in be used for finshing. The lat~xals should be Susl~d at least a~ evexy three C3) pears. Pressure checks ofsysbems with mnhiple haerals should be done to ensure that equal ~ of is oex~ring in promote the Ioegevltlr of fhe system. REPORTS Repocls far maiateaaucq mspediom, and momtariflg shall be snbmi~ted in accordan<x with COMM 8355 Wisoomsin Administrative Code. When the POW fs fads aa~d/or is piy talcea out-af service the foIloRrmg steps s1~aIl be takes to ensure that the system is paropexisr and safely abandaued i complmnce w~ Ch. COMM 8333, Wisconsin A~oive Code. - AII p ~ ahd ~ stall be ~ and ~ ab pope openings sesded. - The cow of sIl taal:a and pits shall be rennervod and properly dosed of by a Segrtage Servicing Operator, - After p~ng~ all taaics oral pats shalt be excavated and removed ex their covers removed and the void space filled with soil, gravest ar other inert sour! nuadrLial. cc'~VARNII~> SBPTtC; Pte' AND OT)EI~RTI~AT)i~ITTAI!I$S MAY tOOAt'1'IAi~I LBTHA>GGASSBS ANDAOR I~~FTCIENT 4XYGffi~ DO NOTASSPTxC,PDffi'tliR OTSSSTBEATlM)~1TTA1~IItUNDERAt+Tl[ CIIttR3MST`ANCES. DB~iTH Md1YRJlSUI.T. R OFAP)~R9QNFROMTt~ 1NiTItIOROF ATA1+lKIKAY BE DIFFICULT OR l~iV)pOSSIBI~E. ADD11TOlYAL COIaIIMi~I'I'S Noma .J"ohfN PcCLrE'~' lfl~- ~3/3YG SEPTAG>% VICII~IG O TRATOR (PamP~'1- L/,/,C,row,/ Name Phone x.~wrnwTS~rowrs owrtEe~s ~xaAi..a~ POW'1'S MAIl~ITAINER Name .TD~iV ~Y.rc4" EL/lE f L~iy~i./t P /S 67.2-„S'•?6L LOt~AL TORY A ORiTY Agency t ~Za~X •, ovi..~G DFjitEt" ~ 38e: - Y~GB o Page Q ~ of~ aintenence The ~erv~ for s~anr~g sic tics ~sir~~~~e a<rt# local c Ttxot~gt~out ~e ut~ed des it~e ~s a ~~ «, a~~tt~ fi~o~oi~yt~rs. ~ -~ ~a ~, ~~ - ~ , -. -nom aor~r a~ ro a the ~uti~t: 5anyza6e,F~erstx~r~aFun~be dbr~ebya aert~lsdse~c~kput~erarer. t~r~s~e otiYet of $~ ~~~ ~ 1A11i~! ~lB j,. .: ~ ,= ' tsi{ w i, i y, i ill ~ I ~ ~V~ ~pslsrrrssdbYt~aearmams dOrs~P= ~U S. 5r75~790. 3rSS61.~ :~.3i.3'99.a~. 3. ~~• ~•77"9.e~6,. Stt.S.~,.472~.73s.4~. ~.7ia.2~ 5,~¢.~7. s2~ tJ.S. tbs. 1. ~90B7.t1t. Des.9990~7.'f3~l~Ot Caa~ fit: !steak t1tSl~k t~brr Z 261824, t`,a~ sera ~ee~ABELZONEAn olrtsAe IN~r y-800-22i-5742 • web~e ~py~ww.zc~m •- c .~~AI Wisconsin Department of Commerce ildi S f t d B ~ v` I Nage ~_ or ~ C u ngs a e y an Division of in axordance wi Comm 85, Wis. Adm. Code County ~ Attach complete site plan on paper not less than 812 x 1 inche ~zee((~~PP~~r~j~~ '°' {?lf1d~ ti di~ i t include, but not limited to: vertical and horizontal referenc c or po n (, Parcel I.D. [~ ~/ .~n~v, ~ ~v 7 3-' d 0 v percent slope, scale or dimensions, north arrow, and loca . T C~ on and distance to nearest roa Please print all informat n. ST. CROIX COUNTY Revie Date ZONING OFFICE ti /~ 1S (/ Personal information you provide may be used for secondary purp oses nvacy aw, s. m Property Owner C ~L L a za -y.:, S7 ~i Ck ~2~. Property Location I' Govt. Lot SW 1/4/v~1/4 S ~s T ~ ~ N R ~ ~, E (or W Property Owner's Mailing Address ~~~ Lot # ~- Block # Subd. Name or CSM# X37 ~ ~~~ ' ~ Cily State Zip Code Phone Number ^ City ^ Village own Nearest Road '1v ` ~1~~,~ ~~ S~o~~ (7/S)68 -~9~0 .~a~-c. le.._ e. T.l-F. New Construction Use: ^ Residential /Number of bedrooms ~_ Code derived design flow rate S-O GPD ^ ReplacementE- f ^ Public orcommercial -Describe: Parent material L c~ eSs n t.ley `f ~ ~ Flood Plain elevation if applicable A) tt• ~ C am I ~ General comments p ~ ~ i / ~ ~' S~,ti of u„~ ~l,er~ w~ ~ b- ~cQS e ~ " " "r vu~ ~ S ~' ' and recommendations/: / J, % 7 S Gov~`~6ulr 9G• u ~ as f~e ~,•• CIe ot~ - ~ ' ' roinn -e CC~xt ~C. 5t o F- t°~op~ct J ~~ ~ ( n ,~t~TF_ ~ o~ De~~ec~~n~ art S6. s- ~~/Co ~ ~fwy ~ ~41d(u5c~n Cell I~eK~~~ ~CoV~Co-V~. S~oipe Bori g J Boring # Pit Ground surface elev. ~ • J ft. Depth to limiting factor ~ in. Soil A lication Rate i ti D R d Texture Structure Consistence Boundary Roots GPD/fiz Horizon Depth in. Dominant Color Munsell escr p on ox e Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~ ~.~/v r 10y~ 'pip l~ ~ ._ ~ ~~ ~ /h S~tG f y ~ w ~ ~ ~ r'~ 6 .~ ~ ~ -rt - fby ~~f .s ~t„ I ~ .. ~ ~3 9~ ~j C' Boring # 0 jng L`'J" Pit Ground surface elev. 93 = ~ ft. Depth to limiting factor ~ in. Soil A plication Rate H i th D minant Color D Redox Description Texture Structure Consistence Boundary Roots GPD/flz zon or ep in. o Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff #2 ~~~ ~ °---' ~ ~~ ~^ ~V LW r ~ ~ UU ~ O -I to Y~ -- 2 ~ b ~ ' ~ . ~ ~ $ - e ~ 2 ~S © 5 - ,.S ,~ * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent ~z = rjvu < su mgi~ ana I as ~ .x, myi~ CST Name (Ple Print) ~ Signature CST Number e vt U1 I 2 r2 ' o ~---- ~ ~ ~ ~~~ Date Evalu ion Conducted Telephone Number Address , ~q ~>~a9 77C~ f~Z ~'~'.. S~r~~ . i/a~~ ~L SP ,L -2S: ag 77~._3~`78 s~~,~> i' . Page ~ of 3 3 Boring # ^ Borin~ N~ ~ ~9 Ground surface elev. 9y / ft. Depth to limiting factor ~~ ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/flz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 l o ib ~ ll ~ ~ w ~.~ .~ •~ ~ ~- t 1 ~~ '~O ~ 1 I ~ 11 . 4 a ~ `- ~t l~ ~ ~ ~ Property Owner I'~ ~ ~ ~ ~"~~- Parcel ID # Boring # ^ Boring . ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP D/itz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structun: Consistence Boundary Roots GP D/fly 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.07/00) propr:rty ~~^ner i ~ '~"'~_ t~rCel ID •. ~ 4~ug«s • °~_oi ~ I ~~'"•a ° ~s'~"'' c3rpuna svrreea olov, Ik Odplh to IkniUng ldorizon 1?epUa DamlruJed Colat Redox DeeQ'Iptlot, Ttacwra Straeluro in, AAUh~atl t2u, Sx. Cent. Corr or, St, Sti. fadQ.r,,~ •^"G- on. C9alsirotterace• toundary Roola SaII tk OP '[st1tY'1 mtlon Raee D1fY 'Elite r>T ~ '~:hLC ll ii ~<~ i ~"1 . 11 tlorinn ~W„„~, ,~ gyn. © Flt Graund surface eteV._,,.,._,_...ft Depth ~ lime ~ actor tlon Texture 5tfudur~a t:ottzls~tenoe Boundary Reote tl D Soli A p1lCttio4 Rata G , riorizon bspfh in. Dgmlgdnt Cobr Munsolt p esc Hedox Qu, f3z. Coat, Color Gr. sz. Sh. •Eft~ft •EfUY'2 I ~ i i ~ l __ _ ~ E batln~ 8ar:'na # l3rplild surfaoc elev. ____~_, It. Depth IA IImIUng ftietor ~~ Itti• Fit SoN bntfOn Re Nadton Depth fbtnlta'tnt Golot RedaX Doccrlptlon Tuxturtr 9ttuatXe Consloianco boundary Roots •~~ PD ~~ in, t4lunsoll Qu. 52. Cont. Color Gr. St. Sh. ' ~~ ~~ i , - Eyluont fit = BOD •~ ~ ~ and TSs _` Jo rnpfl. • Effluent ~1 m Eit?D~ } 90 ~ 22Q rnSiL and TSS 30 < 1t50 rngll. ~ Th,s l~i~pFU'tment o•f° Gcmiruuca is an zcleisi oppoc{wuty sx~rvioe'providex and erltploy~. If you aced aaaieitsttce to access sctvices ®r turd mmte~al iu ~~ alt~astr, fa~~at, pI+'~'~ aQatacC tau dep~nont st 608-266-3151 or TIY 608 2154-8'777, ~G96aS~8~ti~ti S7~ti~ dl~I~ddIHJ~IJIJ~~ 9~aB8 FJE~EtZ-~~-1.d~d 5 ~ ~ ,:e ¢ ova ~~~a~~ ~~ ~ ay~S ~ o ~-cR~-S `"'~5~..~~ropeo-- ~~~~ `Q.l~l. l b7. ~ p~~ a~' ~Jo rc~ ; {~~~or~ .tN aO~~~a, ~4s1~ Tr~..e_ `ro ~~ Rewto~e~Q m l dt }}o4:~e a E~~Sf~^5 ~..' J To ~ 1'~ ~`~' g3,3 3 5r, ~Ro~~k Coc,~.~Ty s~ y ~~ -~ s~~, is r~ g ~ R ~ b ~ pN" ------.. Qj`D ~y,~ -q~~ .~ I ~' I ~ ~ ~ ~3 / o~' / ~ ` I ~ gib l ~ 816 slob y d Slo ..i, s i ~ QiD (~~~~ t- ~ ~ I ~ ~ p a~ ~ ~ ~ ~.. 3.M. ~c~o. oc~ -r op ~ 1 ~ ~~ ~ U~- P~ p e G-~~d~ ~°`~~~ Q3ro p os e~L -~t~EGI~ ~ ~~ ~o~ ~ /~Ct~, y~ o-F J]~fle~ft~~„ rr 5~.a~~o~ Cell I~e~~ cs~ cam-I-o~,~ ~b.d ~ov.cc~u-~ Sloe ----_. -~---- ~.7"N . ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIl' CERTIFICATION FORM ~ ~ OwnerBuyer ~/D<{M ~~l~~~~l~£ ~ ~JR- J.~vD / ~~'~ Mailing Address Property Address ~~ 7 /1/o/~-r~vD.~G~ ~,ef ~~/ (Verification required from Planr GJbovli/GG ~ & Zoning Department for new construction.) City/State li/ooDY/LG-~'~ G•!~ Parcel Identification Number 00~'-/o~/y-~S~ooo, Ooh'-/Dy3- ~1o-oOo LEGAL DESCRIPTION Property Location `~~ '/a , ~~ '/a ,Sec. ~S , T ~ N R ~ ~ W, Town of ~M~l b~ ~ ~~-- Subdivision Certified Survey Map # Volume ,Page # Warranty Deed # ~~ ~?®2- ,Volume ,Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three 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. Uwe, 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 tike Department of l~Tatural 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 arn/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms v'2 1 ~'c~.x1~ ~ ~ SIGNATURE OF APPLICANT(S) ~ / zy/ 09 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) Lot # Document Number State Bar of Wisconsin Form 3-2003 QUIT CLAIM DEED Document Name THIS DEED, made between Rickey R. Lee and Donna M. Lee, husband and wife ("Grantor," whether one or more), and Adam D. VanOverbeke and Brandi M. Lee, as tenants-in-common and not as joint tenants C"C`.rantee "whether one nr morel- Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Atl that part of Southwest Quarter of Northeast Quarter (SW I/4 of NE 1I4) of Section Fifteen (157, Township 1~venty-eight (28) North, Range Sixteen (1~ West, lying Southerly of the State Road. North Half of Northwest Quarter of Southeast Quarter (N I/2 of NW I/4 of SE I/4) of Section Fifteen (IS), Township Twenty-eight (28) North, Range Sixteen (16) West. Parcel Identification Number (PIN) This is not homestead property. (is not) Dated ~U °~.. ~ ~ Q AUTHENTICATION (SEAL) Signature(s) (SEAL) lillll fllll l~fll VIII VIII VIII If~l Ifllll Illf lill * 9 0 0 6 0 2 1 ~~~ BETH PABST REGISTER OF DEEDS ST. CROIX GO., WI RECEIVED FOR RECORD 07/22/2009 10:50AM QUIT CLAIM DEED EXEt4PT t $ REC FEE: 11.00 TRANS FEE: 75.00 PAGES: 1 Recording Area Name and Return Address Thomas A. McCormack 1'O Box 2120 Baldwin WI 54002 008-104M95-000,008-1043-40-000 ACKNOWLEDGMENT STATE OF WISCONSIN authenticated on . ST. CROIX Personally came before me on the above-named Rickey R. Lee TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06 ) THIS INSTRUMENT DRAFTED BY: Thomas A. McCormack Baldwin WI 54002 Li~ (SEAL) f ~ Yl i 1' 1. ~C. Q D (SEAL) * Donna M. Lee ss. COUNTY) ~ o Q~ ~ ' Ind na M. ' , ~ ~.~':~J` to me known to be the person(s) instrument an~ knowledged the s~ Notary Public, State of WISCONSIN My commission (is permanent) (sx~as: (Signatures may be authenticated or acknowledged. Both are not aecxssary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. 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' Parcel #: 008-1043-40-000 10/07/2oos 10:30 AM PAGE 1 OF 1 Alt. Parcel #: 15.28.16.2196 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 -LEE, RICKEY R & DONNA M RICKEY R & DONNA M LEE 2378 20TH AVE BALDWIN WI 54002 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description " 2465 CTY RD N SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 10.000 Plat: N/A-NOT AVAILABLE SEC 15 T28N R16W 10A SW NE S OF HWY Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 15-28N-16W SW NE Notes: Parcel History: Date Doc # Vol/Page Type 02/08/2005 787016 2746/070 OC 01/19/2005 785244 2733/053 QC 08/10/2000 627924 1533/325 WD 09/21/1999 610717 1457/629 TI more... ~nno ~~ ~ne~n n ov Bill #: Fair Market Value: Assessed with: ~.., ., . ~............ r... . Use Value Assessment Valuations: Description Class Acres Land Improve RESIDENTIAL G1 2.000 22,500 24,800 AGRICULTURAL G4 7.000 700 0 UNDEVELOPED G5 1.000 100 0 Totals for 2008: General Property 10.000 23,300 24,800 Woodland 0.000 0 Totals for 2007: General Property 10.000 23,300 24,800 Woodland 0.000 0 Last Changed: 05/12/2003 Total State Reason 47,300 NO 700 NO 100 NO 48,100 0 48,100 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Q O tr .~, O d '', N a 1 C 0 N 0 y) O V C H • IOC N .~ }~ y • `hi C 7 LL I ' ~ 3 v ~ Z ~_ W z " ~ ° ,y l1 ~ •~ o L Z ~ a m ~ ~ c C7 o Z d' U ~ ~ d Z ~ ~ ~ r 0 a a~'i N m a ~! J U O O L". F.1 i.~ tQ C', c~ O o c °o m 3 O ~_ ~ M N N ~ ~ f0 o C7 N ~ O ~ W it w i6 a a m ,_~ L v a ~ A v c O O7 iC N N .? N a` o Q Q Z Z z ~.~ _d a 'R y d ~ coa ~ H H H O "_ a a a rn rn °0 0 0 ~ 0 0 Z .a ~ m >' j ..~. 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