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HomeMy WebLinkAbout014-1006-60-000partment of commercQ ,~ PRIVATE SEWAGE SYSTEM .suilding Division TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ Dosing -7 / ~ r Aeration -~r'l Holding TANK SETBACK INFORMATION TANK TO ~bP(,L ~ ~ BLDG. Vent t Air Intake ROAD Sep \~b / ~/ r [~ 7 / n~ ~,,,,, 0 - Dosing l ~ ~ Aeration Holding PUMP/SIPHON INFORMATION~iGi~ ol. ~a /C'~ Manufacturer ~ Demand GPM Model Number ~~ TDH Li~ Frictio Lo~s_/ System end Tt~ Ft SS ,(~j ~ Forcemain Length Dia. ~~~ Dist. to Well' ~ vvi~ r-owr~r r wIY JTJ 1 tM ELEVATION DATA County: $t. CrOIX Sanitary Permit No: 420782 0 State Plan ID No: ~' Parcel Tax No: 014-1006-60-000 Section/Town/Range/Map No: 03.31.15.47 STATION BS HI FS ELEV. Benchmark 0. Z boa. Z /0 D . ~ Alt. BM ~T` rf Y 3. 2 Bldg. Sewer SUHt Inlet scF/ 0 i:~v $s- Z SUHt Outlet Dt Inlet ` Dt Bottom ll•~~- Header/Man. ~ Dist. Pipe ~~. Z Bot. System ~ RZ 5~ Final Gr e ~~(P St Cover / Yt ~ w/~ 2` '• y ~ ~~- 2 2 ~(~ BED/TRENCH DIMENSIONS Width / Length / ~ No. Of Trenches / / _ ~ PIT DIMENSI S No. Of Pits Inside Dia. Liquid Depth ~ • SETBACK INFORMATION SYSTEM TO P/ BLDG WELL LAKE/STREAM EACHING Manufacturer: Type f ystem: ~ CH E R ~~/ y I ~ Crl ~ / ( ~ D Model Number: DISTRIgIJT I[)N SYSTEM a .4clLi,., ~ , -. x hole 5rze x Hole Spacing Vent to Air Intake I ~// Pipe(s) 1 ` c, r / / ~~~~ ~~ ~ ~ y ~ ~ / ~n Length Dia Length_~ Dia__ Spacing ~f' SOIL COVER x Procc„rn C..cln...~ n..~.. _--- ••---_ sr_ -' '~ -- . .. - '^-- .a Depth Over ~ Bed/Trench Center Depth Over xx Depth of xx Seeded/Sodded xx Mulched ~ ,~~ Bed/Trench Edges To soil p lyQ ~ ~] Yes ~1Vo ] Yes ivy GIY I a7: (Inc ude c. ode discrepencies, pessor~s prese~ etc.) Inspection #1:~_/~/ U ~ Inspection #2:_~/s /~3 Lo ation: r Lake, 1.54005 (SW 1/4 SE 1 4 3 T31N R15W) 40 acres Lot ~- ~Q _ ~AM_ ~[p r~cel No: 43. 1 1 .47 1.) Alt BM Description = ,~ I , t~Dt~~ -~ ~ I r __. '~ - p ~'~~ ~- -~ 2.) Bldg sewer length = ~~ / - ' v ~ ~'`'~~~ /~~~~ - amount of cover = GG~~fi ~ ~ /It.o~~/~~'T~YcJc~ ~~ ~ ,~1. - -- _ Plan revision Required? ~ ] Yes ~ ' No i ~ r ~ ~ /~ ~ ~ - J Use other side for additional information. ;/ (~, ~ ~%iYu2~ ~ ~G~/ti11, SBD-6710 (R.3/97) Date Insepctor's ignature Cert. No. INSPECTION REPORT niERAL INFORMATION (ATTACH TO PERMIT) srsonal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ~ N O ~ N C, O 7 7 ~ Z y mom."" D o. ~ Q r. Z O W '0 a ~ ~ IQ ~~ C1 C 7 O 3 N tD C CD 3 tD ,3-« N D a a 0 d Z 0 m N O N 69 ~ O o° a ~ ~ o o d 3 3 ~ ~ ,~ ~ 3 ~i ~ N C N ~Q' N L N y ~ °' m a so d ~p o n A ~ ~ ~ N ~ o ~ O W C O ~ ~ ~ ~ N N ~ 0 o v o ~ fD ~ ~ N 3 °1 ~ D o ~ c ~ a 7 fD N N 47 7 N A y C N Q fD y W ~ °' 3 o' 0 ~ ~ N Z T C 7 a 3 d o ~ n 3 e~ ~ o~i O W ~ N ~ o ~, °o ~ ~ V ? G ~ O N O C M 0 n y -~ -~ fA A Z O A Z O .. ~ O (Cn ~ W < ~ ~ ~ m ~ J d ... h~l R 0 ~• O ~• 0 .Z A a 0 N 0 w A w 0p ?p ;!i R N N ~ g, a ~~ Safety and Buildings Division 20l W W hi County ~ C ` m . as ngton Ave., P.O. Box 7082 f ~ ~ ~scons~n Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 261-6546 ~O ~Z Sanitary Permit Application State Plan I.D. Number In accord with Comm g3.21, Wis. Adm. Code, personal ' form C~g p~o~p ' e C D rev ma be d f d ~S~ ~~v = TrT~S. ~~ . 1 C y use or secon ary purposes Privacy La , s 15. ~i C ject Add if diff h ress ( eren t t an mailing address) LL " I. Application Information -Please Print All Information CAS--S S'ft ~'T °~ ~S~' APR ~ 8 2003 ~ „to Property 's Name I O ~ r ~U `/~ /~ ST. CRUIX COUNTY 1~-- arce g}~(~ sad `{- b 6 ~ Property Owner's Mailing Address an - 0- . ~ Property l~ ' ~- a ~ 5 3a7~ ~ ~ s ~ ~ City, State/ // o~ p ~ ~ p~ A /~ `P Zip Code ~O 6 ~ Phone Number ~~5 ~~j ,3 0~ ~ofP~ ~', Section ~_ "' ~~` circle oy~ ~ II. T e of Buildin yp g (check all that apply) T _~ N; R ~ E or~dt~ ©"1 or 2 Family Dwelling - Number of rooms Subdivision Name CSM Number ^ Public/Commercial -Describe Us ~ ~ ~ S• ~ ~ _ Gf~C .~ u ^ State Owned -Describe Use X `j- ' Q (. ~0 ^City ^Village 0 Township of O •P h III. Type of Permit: (Check only one box on line A. Complete line B if applica ) A. New S stem y ^ Replacement System ^ Treatment/Holding 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 e of POWTS S stem: Check all that a 1 -(pa ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculatin S thetic Media Filter ~ ~ ~ g Yn Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) ~ 4 ~., ' V. Dis ersal/T reatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Proposed (sf) System Elevation . v o-~ ~6~ 9~, VI. Tank Info Capacity in Total Number Manufacturer Prefab Site S 1 Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ~ 2 S x Aerobic Treatment Unit Dosing Cbamber ~ I VII. Responsibility Statement- I, the undersigne some responsibility for installation of the POWTS shown oo the attached plans. Plumber's Name (Print) Pl b ' um er r azure MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zi p e) ' p ~~ ~ ~ <~~r~~ ~ , s ~- ~ VIII. Coon /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issui g Agent Signature (No Stamps) Surcharge Fee ^ Owner Given Reason for Denial Z ~~ - 0 IX. Conditi~o)ns of Approval/Reasons for Disappr val ~1. /nI ~~ ~QCJ~ ~~ -~jiL tM41-n~1~Rb' od Mr ~~ Gb~?c ~d~~e~tir) dyt~~ 3 „ - ` T7 ~ l~"~'"`''~~ ~ V1tU.td~ ~ r WIO.t~r~~f~'~tY U0 ~ /1AQtgt.C-'~tC -_ ~ L- {-~,~ ~~ ~~ ~~ , r S~•e.ci,t-tc.t~~S f dt_dC SYSIR.w.. ~.ud~' ~ w-a~-~It.¢~ ~~- ~,.ti5~-t.d~cv ~ ~~ ~1e1: Attach com lete la t th C p p as (o a ounty onty) ror the system on paper aot less than gl/2 x 11 inches in size SBD-6398 (R. 08/02) C~{t,~ ~ = ~~ C) 'Z~S~~ ~~;N1~tve, t PLOT PLAN obert Fuller ADDRESS 2937 230th Ave Clear Lake Wi 54005 -'' X1/4 SE 1/4S 3 /T 31 N/R 15 W TOWN Forest COUNTY ST.CROIX ~_ ~_ MFRS Shaun Bird 226900 3/23/03 4 DATE BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK ._._ MOUND ~~ SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING NTA K SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. TO ipe ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL +H.R.P. Same as Benchmark SYSTEM ELEVATION 97.4' Scale = 1 /4" = 10' w N O Grading is to be done I ° to divert run-off away from system m B.M. Tank is to be Alt. B.M. ~ properly bedded 9 6 ~ and provided with B - 2 B -1 , ckdown covers ~ 5 nd approved warning labels 350' B- 4 B- 3 Huffc t ~~ ~~~~a~~~t/ 1 % Com ~ }.( pl~ 9 5 . Slope Tan Pro 4 Bedroom House Area 15' Below System to remain undisturbed Well is to meet all setback found in Comm. 83 ,N" 3 0 230th Ave >h ~ ~ iscons~n Department of Commerce Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264-8777 www.commerce.state.wi.us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary Apri103, 2003 CUST ID No.226900 SHAUN R BIItD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI 54017 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIItES: 04/03/2005 SITE: Robert Fuller 230TH Ave Town of Forest, 54005 Identification Numbers Transaction ID No. 851856 Site ID No. 657008 Please refer to both identification numbers, above, in all correspondence with the agency. St Croix County SW1/4, SE1/4, S3, T31N, R15W ~,F~ ~ FOR: New mound, 600 GPD ~~iltti Object Type: POWT System Regulated Object ID No.: 896462 ~~~ . The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes Z ., w~ and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in 0~ K7MEt chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. t7i ~ OF SP ,,, ~, The following conditions shall be met during construction or installation and prior to occupancy or use: ~~."~ G,..,...-= General Approval Conditions: ,~° ~~ r ~E GOR • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD-10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10706-P (N.O1/O1). • 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. Note • A soil absorption system should be designed as long and narrow as possible. This system has a linear loading rate of 8.0 gallons per foot, which maybe high for the existing soil conditions. 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. a. Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 3/23/03 Owner: Robert Fuller Location: 230th Ave System type: Mound System Manuals Used: Mound Component Manual version 2.0 (01 /31) Pressure Distribution Manual version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-9. Maintance and Contigency plan 10-12 Soil Signature License ni 3/23/03 1.T.~• ~DYP U of .. c iYt~ND ESPONDENLt PROJECT Robert Fuller SW 1/4 5E 1/4s 3 /T 31 PLOT PLAN _ ADDRESS 2937 230th Ave Clear Lake Wi 54005 N/R 15 W TOWN Forest COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE3/23/03 BEDROOM 4 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND ~~ SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark .L W N O -v 0 -a m r m SYSTEM ELEVATION 97.4' Scale = 1 /4" = 10' Grading is to be done to divert run-off away from system g,M, Tank is to be Alt. B.M. properly bedded ~ ~ 9 6 and provided with B 2 B - 1 lockdown covers and approved warning labels B-4 B-3 350' Huffcutt 1 % Combo 95' Slope Tank Pro 4 Bedroom House Area 15' Below System to remain undisturbed 1 1 Well is to meet all setback found in Comm. 83 ~~ ~ r}1 V~ 230th Ave t Non-i~loven Filter Fabric 4" Observation Pipe Perforated Below Filter Fabric ~ C-33 S ond--~ ~" Topsolt "`~ib'acL lr0 Date t E 7. StoFt Bed Ot fg 2 2 Orain Rock ~ ~ fr ~k~nw/°s 0 a W ~ z - 3 0 O _Plan Yiew Ot Mound Uclnp A Bed For The Absorption Areo PAGE_~OF tribution Pipe ~_ Forct Mein From Pump 1 ~Flowe d l.oyer .. ~~ ~ _, ~ .-~_ =•~- ~ 40bservofion Pipe ~`~"' P -`- - K A , - ~------- --~ ---------- --------------------- i Farce Main ~ From Pump .: Distribution Bed Ot ~~- 2 %2 Pipe • Drain RocK h 4 4bcervation Pipe Permanent Marker Pipe or Rods Cross Section Ot A 1r4ound System Usino ~ ~ ~~~ A Bed For ~TAe Absorption Areo ~ F ~ ~ ~ A Ft. h < J 6 ~S ft. ~ t 3 Ft. • ._ J ~, Ft. LFt. ' is ~~7Ft. ~L aka Signed: License Numt~er ~$ t@.' :otse On $o~tan. uonY Spoe~a tiC0..L Nti7i'f TO Caf1f~K}~ X ~ Inches Y Inches -Hole Diameter _~1,~Inch Lateral ~" 2 Inch{es) Manifaid Z Inches r Force Main " L Inches # of holes/pipe;? Invert Elevation of Laterals[ 7~/ Ft. Pertoraled pipe Detoti ANK ~ PUMP C~{AMBER CROSS SECTION AND SpCCIpICATIONS SEPTIC T 4" CI " MIN. AHOYE GRADE ~ PENT PIPE 12 NEATHERPROOf JUNCTION BOX ED MpNH ~ 25' FROM DOt3Ft, WINDOW OR WITH CONDUIT COyER OL W/ PADLOCK 5 FRESH AIR INTAKE ~ _. -I~ipttNlNG {,,ABEL FINISHED GRADE ~„~s<" MIN. n, 4 ~.w. ~~ 26" ~• INLET ~ ~• ~ . ~ WATER TIGHT SEALS "';" . TIGHT ~ EO A SEAL ~ • dOtNtS 1iITH f1LTER ~ ~ LM APPROYEO PIPE APPiQOYED ,. --8~-- ' ~ ~ ON Spt.IO SOtI PIPE 3' OpTO SOt.IQ FT (~ ' ~ ~ OFF . SOIL . < PUMP OFF ELEV - D 8u APPROVED BEDDING UNDER 'TANK ~~ CO RETE PAD SPECIFICATIONS < ~~~ OSES PER DAY: ~ ' SEPTIC / DOSE NUMBER D TANK MpNUFACTaJRER: ~ „$~ GAL. DOSE VpI~ME INCLUDII+K; ,~:~--,--/GAL. TANK SIZES: SEPTIC /G~~~ GAL. FLOi,igACK: DOSE ~~! ~HCHES = ~l'~ GAL. .S CAPACITIES= A -- pLA~ MANUFACTURERa G' 8 ~ ~Z _ INGHES = GAL, MODEL HUMBER : ~ l SWITCH TYPE: ~ ~ J C ~.,~IMCHES ~ ~,,,,,, `~ ~''L. ~~ e pUKp ~~IFACTtJREtI: J' D ,~ ~ INCHES = ~~L. My-W3TCH TYPE: M WIRING AS PER I LHR 16.23 UiAC ~/~ GPM PUMP ~ ALAR // REQUIRED DISCHARGE Rr-TE ~:--~- Zt~t PIPE / d FEET y , FEET dF.RTICAL DIFFERENCE BETWEEN PUMP OFF ANA DISTRI~1 _ FEET MI IMUM N~TOF4RCEMAIN X~ S RFT/100'FT. FRICTION FACTOR .~~E~ FEET ~~~~ FEE TOTAL DYNAMIC HEAD ~, ~--- DIAl7£TER 5iONS OP PUMP TANK: L£NGTHD t~: J DTH INTERNAL DIMEN LIQUI DATE: LICENSE NUMBER= SIGNED: . }/88 x v_ 0 r 0 r- FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL-APPLICATIONS • Timed dosing panels ava~le. '°' • Electrir;~ aiterrl~ors, for fi,gPac systems. are avafl~le and suppi~ with an alarm. • Vartai~ level conkd switches are avae for cbnNdlirtg s phase • Double pi9,gybadc variab~ lave! flr>at switdles are ava~ble for variable level long and shat ~ coritrds. • Beefed (,l+~dlc~-Bac ava~able #orartdoa i~taltations. Sce FM1420. • Over 1~°F. (54°C.) spedal quotatiat regtiued. 152tt53 series' i5tl'i titodd vote-P6 lbde N152 115 t Moo 8.5 t 2or3 8N152 115 # Aub $.5 hiciuded 2or3 E152 230 t Non 4.3 i 2or3 Et_15'1 230 1 Atdo _ 4.3 hiduded 2or3 N153 115 1 Non 10.5 1 2a3 BN753 115 1 Aub fOS teshded 2ar3 E153 230 i Non 5.3 1 2or3 BEt53 230 1 A~ 5.3 lndu~d 2or3 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING MODEL 152 153 Feet Meters Gal. Liters Gol. liters 5 1.5 69 261 77 291 10 3.1 61 231 70 265 15 4.6 53 201 61 231 20 6.1 44 167 52 197 25 7.6 34 129 42 159 30 9.1 23 87 33 125 35 10.7 -- -- 22 85 40 12.2 -- -- 11 42 Lock Volve: 38.0 Ft. (11.6m) 44.0 FL (13.4m) o~uas ti r/s sa s2 t s r/a SELECTION (altlDf 1. Single piggyback variable Level float swN~h or double piggyback raria6le Level Boat ssdN9s. ReterbFM0477. a CAUTION 2 See FM0712 br correct model of ElecaicM Apemetor E-Pals. AM ha~ioe of coatrob, proMelfon device and wktag ahouW be done hY a geared 3. Variable level contrd swflCh 1025 used as a rnnbot ac6vabr, speaTy duplex (3) tkxnsed alechician. AO electrical and safely codes shoats be fo0ovred hrcludtng the most ~ (4) float sysb~t. rac~t Nadontl Hectric Code (tiEC) and the Oaa- sahtY and Heath Act (OSW y RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every ZoeNer pump. IIAft Tn: P.Q &tiC 16317 r~ ~ Afaeurac<frarsaf.. ~ t!(Y102tt-1961 ~j~yPy~,~,AZ~ ~~i7 , P~rr~i~ ca. '~''~A~~'n ~~ ~ Copyright 2000 Zoelter Co. Atl rights reserved. """" 0 80 1S0 240 320 Maintenance and Contingency Plan for a Mound System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7. Owner agrees to leave the area 15' below mound undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump with out float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715-246-4516 Pumper: Tom Mondor 715-246-5148 St. Croix County Zoning 715-386-4680 Service Event inspect condition of tank(s) Pump out contents of tanic(s} inspect cart(s) Clean Ott l~p~ ~ parnp contras & alarm t~h rates ~ ~ Ssrvtce Frequency e ever ~ t7 months ~yCeaKs) (Maximum 3 yrs•) y At least onc When corrrbined sludge and scum equals one-third (~ of tank volume ~ D months~l-~'(s) (Maximum 3 yrs.) At least once every , At feast once every O months s) ve ~ ©mordhs (s) O NA ry At least once e eve 3 O si~earis) O NA ry At least orwe At feast once every O morphs O year(s) O tdAA At least once every D months D Year(s) ^ NA MAINTENANCE ~TRUCTIONS l ~ be made by an ~ t~'ryk+g one of the iotlow~g Boe<tses or inspections of tanks and Rid Sewer- POVIfTS Inspector: POWi'S Ma~-tainer: S Plumber s ~ or braaen certiticdions: Mas~ ~ a visual lnspec~ian of ffie t ~) ~ ~ ~ ~y bads uP ~y cceclcs or leaks. mearsuce the vol<u~ne of oorrrbined sledge ~ ~ ~~t levels ~ p of ~ ~ 9~ . The dispen~ ~i&) ~ ~tace• The por~m9 of es'flct~ °n tl,e in the observafbn P~ ~d >b dredc far arty pord~9 of eft °" trie not~Cat-,ar, ~ ~ load a"tl1Ority' 9~ may inaCa-6e a faNn9 condfion and requires the When the act and saun ~ arry t~k equds one-third ( of the tank vaurne. the ~umda6on of sludge ~ ~ accordance with ch• NR entk+e contents of the tardc shaft be removed by a Septage Servidng Opp 113. W~onsin p~dministrateve Code. - - pn~~t mtg. and arty tamer. The S ~ e ' POYVi'S ao~• at intervals of 1 r~r~.. -~ a lei be P ~ a oertfied PAS ~nt+ s~4e ~~ ~ pronnded do the bcat re9+Y ~ within 10 days of a~ sent~e START UP AND OPERATION s for the ~ P~~ ~~ °r other For ne~v oonstirudion, prior ~ t atr ~ pO a doge ~ d~persad ae~(s). If tugh c~~s are ~ that may impede a senrldn9 opt P~ to use. detected have the cmitents of the tank(s) removed by ~~ .,.,.A,-rc nwNGR~s MANUAL 8~ MANAGEMENT PLAN P'~ ~t . Page ~ or staff up snail not oocx+r when sod'cortditans ate frozen at the ktfdtratiue surface. ~g p f taritm ~y ~ above norrr~ ~ Ievr;LS. When paver is resbor~ed the exoe~ trrasteyvzder w~ be discharged to the ced(s} fi vne large dose. a~ ~ its}and may n &~ t~ bada~ or ~aoe drsd~tge of ~ To avoid this shtratron have the con6eMs of the pimp tank remoMed by a - SeptageServicing Operaboc prior.lo t t b the efiioent punk rx contact a or POWi'S M m assist ~ me<xtady opera~g ~e i cot~nots tq restore normal teve~ wit ills ptunp tacdc-. tb rat drive ar park vehk~as over tanks and di'spetsal cefis. tb not drive ~ park aver. or otherwise distiub or compact, the arm wdhin t5 lest down slope cf any mamd a at-9~ t~ area. - Reductbn oredrNnatlon of the ~ ftnrn the Mrasbewafier' stream may itnpnove the R and pnolortg the Cde of the POVVTS ~ ~y - : condort~ cohort tnvabs; dep+aa$e~ dental floss: diapers: disintecbusts: tat; foruid~on drab ( P~P~ : >ruk and vegetable peed gasol~re: Ides; meat rn~catiats; o~ pig P Pte: y : iampons~~mtd Water saftetrer brine. ABANOOtT takt~n out of setvtce the fottotirhg steps stre6 i~ taken to t~tue that the When the Pd11V7 S f~ andtat is pemmrmndy~ ~ arm in corr>pGanoe wit ch. Comm 133.33.1Arisoortsin Adre~str~ve Code: Ad pig b tarnks and pds shad be dtsoorutected and the atamdoned pie openings sea~d- ~ The contients of ~ tanks and pis shaA be rentared and property disposed of by a Septage Servk~g Oper~oc • Attec ptsrtpMg, ad tanks and pks shad be e~ocanraTed and retraved or they covets removed ~ the veld space tilled wdh sag. gtavet ar another sett solid rria6e[ial. CONT'INGEMCY PLAN if the POWTS and cannot be tepair~ed the following meastmes have teen. or must be taken to provide a code nom' O A suitable ropi~errtent~area has been evaluated and main be utdiaed for the location of a repNaoement sod abscxption syseem. The nit area should be protected from disturbance and compaction and shouts not be ~ ~ bIl secs fr+orrt e~astx~ aed ProP~ ~ bt lines and weds. Facture m proy~ the r+epiacerrtent anal w® resuk in the need for a new sad and site evaluation fD estabGstt a suitable reptaoentmtt area. R~ ~ must comply wdh the nrtes at effect at that t"erte. ~ A ~ ~ att~;s rat available due to setback and/or soil limitations. Barring advances ~ POWTS tedtnotogy a hok~j tar~c msy be Mstaded as a last resort to tie the faded POVITfS. The sde has rat been ev~ated tio~ keels sca~aWe replacement area. If ~ r+ep~oementable a stye tnralttatkm must be performed {~~ tank ~ be insta9ed as a last tesoR b replace the faded POVY~S. retrtonral ~ ~ biomes at ~MMound and ed~ade sod absorpdon systems ~Y be teoonstruded 'n place toao~wmg ttte trddtrati,ne - R~otrstrudions of such systems must oomP1Y wdh the rules in etiiact at tlrat time. «1NARNINts7> SEPTIC. PUMIP At+ID OTHER TREA7~T TANKS tIItAY CONTAMI t_ETHAL GASSES ANdOR INSUFFIgEHt1' OXYGEN. i2ESU T. RESCUE OS F~At PERSON FRO~'TF~tE MTERIOR OF A TANKNDMA~Y pNPF(CUl.7' ~p~g~, NUIY ADDt110NAL COIIAiIIlt~+1TS _ POWTS INSTALLER POYYTS ~~!~~ Name /Sf.LlL M 13J ~ Name tLl~// ~/ Pte J J~- `"`7.3~ .G ~ -Phone ~ -~ 7~" i•r SF..PTAGE Sl?tVtCING OpEitA,TOR UMPER LOCAL REGULATORY AUTHORITY r Name ~ . r Ptarte ~~ ~~ and wawa county z~+s a~+a san!ason a• ~ '"°~ n~ ;~ ~-~ orthe o~+r~. tl~e atiNnwm rem d ch. Carom 83.22(?~NX~Xd)~ and 83-Si(t). Cll 8 (31. V ~° Code. ties or Wis daaxne~ ~ na guarantee Utie performance of ~e PaWi'S. C,MW (ypt} °Msoonsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page ~ of m acx:oroance vin~n wrnm aa, vvis. rwm. was Plan must er not less than 81/2 x 11 inches in size Attach ~m lete site lan on a n County s L ~ ~ . p p p p include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel. I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. ~Y~oa- 3lfo/V7 Re 'wed by Date ~ Personal int lion you provide may be used for secondary Purposes {Privacy Law. s. 15.04 (1) (m)l~ yA~ V Property Own Property location 2 / N R E (or Govt. Lot (i,~ 114 ~ 1/4 S~ T/ Property Owner's Mailing Address lot # Block # Subd. Name or CSM# ~ a ~ - -- ~a ' State Zip Code Phone Number ^ City ^ village Town Nearest Road i New Construction Use~Residential I Number of bedrooms ~f ~ Code derived design flow rate .S~ GPD ^ Replacement _ ^ blic or co 'al -Describe: rr ~~-- _____,___. Parent material Q Flood lain el~~i-it~li a '+ ~ ff. General conrnents S~~f'g~"' ~ I~ ~ ~~ , / /~ and recommendations: / 7 2002 aG~. 1 4 ` ~ ~5~~~~ ~~ ST.CROIX000~~Y ~~ # Boring ~--~'.~--~-~-- ( pi{ Ground surface elev~ ff. Depth to limiting factor ~~ in. Sa'I ication Rate Flaizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fi? in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Z- 6 6I ----~ s, ~~ 1 ~ ~ -~' - ~ • 3 S ~ . s ~ ~ ~// ~ -m - ,-- .ter I~ - 4 ._--~ ® ~~ # IOC ~n~ ~~ 1~. Pit Ground surface ele . `~ • ~ ft. Depth to limiting factor Sal ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/tt= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 0- ~ ~ G~ ,-3I ~,r ~ S ~---- • Effluent #1 = BOD_ > 30 < 220 moll and TSS >30 < f • Effluent #2 = BOD_ <_ 30 mdL and TSS < 30 mglL (Plea Prirj) ~ ~f gnature ~t,/ ~f/ Address Date Evaluation Conducted Teleptrone Number BSS ~ ,°.~- 6l 7 r ,- ~ ~_ ~ -~ ~e .~ ~3 • P. Property Owner Parcel ID # Page ~ of ® ~;~ # ^ Boring ~ i- ,~ pit Ground surface eiev S ~ ft. Depth to limiting factor in. ~;I ~~ Rate Horizon Oepth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. `EtT#1 `Eff#2 o-~Z 3 z ~` ~,-n ~r ~ -s -~ Z - 6 6 c~J -~ ,_3 ~ - , s CZ G - - „~ ~+~ r'' ~ ~ , O ~~ # ~.p~~ Ground surface elevl `~ ~ft. Depth to limiting factor ! ~G in. Soil iption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsefl Qu. Sz. Cortt. Cdor Gr. Sz. Sh. `Eff#1 'E1f#2 12 ~lZ ~ ~ C~.l'' "^' Z Z-~ ' 3 S~~ . a ^ Pit Ground surface elev. ft. Depth to limiting factor in. # a ~~ Soil ication Rate Horizon Depth Dominant Cdor Redox Description. Texture Stnx:ture Consistence Boundary Roots GP D/ff in. Munsefl Qu. Sz. Coot Color Gr. Sz. Sh. 'Etf#1 'Eff#2 `Effluent #1 =BODE > 30 < 220 mgJL and TSS >30 < 150 mgJL `Effluent #2 =GODS < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-31 S 1 or TTY 608-264-8777. ~u-e3w(tewnor Soil Test Plot Plan Project Name Robert Fuller Shaun Bi Address 2837 230th Ave Clear Lake Wi 54005 Lot ----- Subdivision ------- Date 10/11 /02 3~ ~ S W y/4 SE 1/4S 3 T 31 N/R15 W Township Forest Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation y 00 ft. ~ Top of 2" Pipe Z g µ~k.~ ) System Elevation 97.4' *HRPSame as Benchmark sT cROlx covNTY ~~ 3. a b 4 3 SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSIiIP CERTIFICATION FORM OwnerBuyer ~~ ~ ~ h" ~ ~~/ ~~ Mailing Address Property Address yea Jf' ~~ ~ ~A ~~ (Verification required from Planning Department for new v ~ City/State Parcel Identification Number b i ~ - 1 ~ ~ - 60 - o~ ~ `f~-) 1( EGAL DESCRIPTION Properly Location ~ %4, ~ ~ '/., Sec. ~,, T 3 I N-R I W, Town of ~~ t ~O5 ~ Subdivision ~ ,Lot # -' Certified Survey Map # `_ f~ "'~~ _, volume "~ ,Page # `J ~-11.5~' Warranty Deed # - ," ~_ " ~ - 6 ~~-~~ . Volume 2I S~ .Page # ~~ Spec house ^ yes C~'no //~ ~ U Lot lines identifia~~`T~ yes ^ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastCrplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is is proper operating condition and/or (2) a8er 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 Zoning Office within 30 days o e three ear expiration date. ~,,;E',~ ~ ~~ SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prope descn'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. 3~~1~3 SI TURE OF APPLICANT DATE «««««« ent. «««««« Any information that is mis-represented may result in the sanitary pennut being revoked by the Zoning Departm «« Include with this applicaflon: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the waaanty deed `' ~~ 1 2157P `f00 STATE BAR OF WISCONSIN FORM 1 - 2000 Document Number I WARRANTY DEED This Deed, made between Robert J. Fuller and Rita L. Fuller, husband and wife, as survivorship marital property, Grantor, and Robert J. Fuller, Jr. and Rachel D. Fuller, husband and wife, as survivorship marital property, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property"): The SW 1/4 of SE1/4, Section 3-31-15, St. Croix County, Wisconsin. ~iis78 KATHLEEN H. NALSH REGISTER t3F DEEDS ST. CROIX CO. , WI RECEIVED FOR RECORO 02/28/2003 @9:30AN EXEMGT ~ 8 REC FEE: 11.00 TRANS FEE: COPY FEE: CERT COPY FEE: PAGES: 1 Name and Return Address Bert D. Petersen Attorney at Law 2624 County Road Q Clear Lake, WI 54005 Together with all appurtenant rights, title and interests. 014-]006-60-000 Parcel Identification Number (PIN) This is not homestead property Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except municipal and zoning ordinances and recordded easements, restrictions and reservations. Dated this .S day of F.~-6 , 2003 . <:~~E:./ " -* -- --- Signature(s) AUTHENTICATION authenticated'this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ---~ ~~~tttt'L-~~~~~ii authorized by § 706.06, Wis. Stats.) `~~ ~ Q.\ ...«.~~IC,Q'•~,'! THIS INSTRUMENT WAS DRAF3'ED$~Q,O ~ QR}'.'~ Bert D. Petersen Attorney at L_aw ~ <+.~ ++~ Clear Lake, WI 54005 ~ ~ ~!/ t1 t l~+ : ~' _~__ _._ .s ~ .~:~^-~ fie' (Signatures maybe authenticated or acknowledged. Botf-,~rd~nojr~c'P~Sa%.1,~~ _~' "Names of persons signing in any capacity must be typed or WARRANTY DEED T * Robe .Fuller " Rita L. Fuller ACKNOWLEDGMENT STATE OF Wisconsin _ ) ~ ) ss. ~'a /jt~ County ) Personally came before me this S day of ~_ ~2 ,fI 2 u-a.~,y 2003 the above named Robert J. Fuller and Rita L. Fuller, husband and wife, to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. -----_ ~u-e - tary Public, State of Wisconsin - i Commission is permanent. (If not, state expiration date: H6tblWlheir signature. INFO-PRO (800)655-2021 www.infopro(omu.com STATE BAR OF WISCONSIN FORM No. 1 - 2000