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002-1027-90-000
Wisconsin Department of Commerce Safety and Building Division GENERAL INFORMATION Personal information you provide may be us d for Permit Holder's Name: Sn der, Gerald Jer CST BM Elev: Insp. BM Elev: tr0 TANK INFORMATION n PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) 'IZ[ivacy Law, s.15.04 (1)(m)]. ,City Village X Township J Baldwin, Town of Description: (~ I(V~, I G~T~ FI FVATION DATA TYPE MANUFACTURER ;y~.S CAPACITY Septic ~ ~ ~ 5 ~ ~O~ Dosing Co,~,b J~ L 7 Aeration FCi Dew s ~-~. ~` ~ ~-~.+._ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 7 50 / 75 ~ 3 ~ Dosing / 7 So 75 ~ s S --- Aeration Holding PUMP/SIPHON INFORMATION %~ ~/ Manufacturer ~ ~ Demand }~ r w lc.. /`- ~ GPM 'I Model Number TDH Lift ~ • Friction L o ~ System N ~ TDH ~ t Forcemain Length'a / ~! Dia. Dist. to Well L inn nocf-DDTI/lAl CVCTGM county: St. Croix Sanitary Permit No: 514961 0 State Plan ID No: Parcel Tax No: 002-1027-90-000 Section/Town/Range/Map No: 13.29.16.198B STATION BS HI FS ELEV. Benchmark ' ~ / ~a,~ Alt. BM~; ` Go t.~ ~ I /~ Z • ? Bldg. Sewer ela~•J L~eaKo g , 9~, v I St/Ht Inlet /o. Z Ito , 3 SUHt Outlet Dt Inlet `~ Dt Bottom ~/' ~ ', ~Z~ 5 Header/Man. 7~ C ~py / Dist. Pipe 9~ 1~ 1 7 ~ Bot. System /O' O Q ' C / J Final Grade (,. a /00.5 st cov~~ .~ ~ , ~ ,az • BED/TRENCH SIONS Width ~ ~I Length / No. Of Trench~,S..~ PIT DIMENSIONS ~ No. Of Pits Inside Dia. ` Liquid Depth _~ DIMEN L~ Z trel/IL~K! ,., - SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: T~ ,~ / `0. -F ~ ~'" INFORMATION Type Of System: , ~ ply. Gnn Je >~ / ~~ , z ~ / ~ . / ,v UNIT Model Number: , n~c•TOrD~ ~TInAI CVCTGM G _ . ~-- ................._.. _.-- Header/Manifold / ---• v Distribution x Hole Size x Hole Spacing V to Air Intake u~ !,,( ` Pipe(s) ` ` acin th \ Dia ` S ` Length Dia g p Leng [+•111 /+A\/CD __ ..____--__ e._._a _.Y_ ~.-~.. .,.. 11n......~ Ar er_r•_.~.~o Sucfumc f]nly I Depth Over jj Depth Over xx Depth of xx Seeded/Sodded xx Mulched '' Bed/Trench Center ~.( Bed/Trench Edges ` Topsoil ~ Yes ~ No Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 2674 90th Ave. Woodville, WI 54028 (SW 1/4 SE 1/4 T29N 16W) metes & bound`s~Lot Parcel No: 13.29l1~~0~~ /1 1.) Alt BM Description = ~'' ~ ~~'• ~5 d ~ 7•',S / ~ ~ (p Ss ~og,r,,,~, ~~~~ , 2.) Bldg sewer length = 7~ ! / ~ I ~ a.be~e. ~~~~ ~~~ ~^ -amount of cover = 7 u i'~ c....~~"~ ~ A _ ~~,,~ ~ 1~ Plan revision Required? 0 Yes No ~ ~ ~~~ I ~ Use other side for additional informati _ ~ L-~ _~ _____ __ __ - - . -- - - -J ~ --~ Date Insep is Si tur Cert. No. ~ SBD-6710 (R.3/97) ~ ~ ` ~ ``~ ~ ~ ~ ~ ~ A ~~~ I ~, (~+-/ ~ 3L ~v~_ ~~m~ eommerce.wt.gov Safety and Buildings Division County ~ ~ e e~ l 201 W. Washington Ave., P.O. Box 7162 x ( ' ~+ ~ Madison, WI 53707-7162 be~ toe filled in by Co.) m t Sanitary P ~ man ~ ~ ~ 5 / ~!% Sanitary Permit Application ... ~ State Transaction Number tal submission of this form to t1tE't na a gov~ Code Wis Adm 21(2) Comm 83 cordance with s In , . , . . . . ac unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned PO WTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide ma ondary sea in accordance with the Fm c Law, s. 15.04 1 m , Stets. ~ Z ~~~ ~~ ~ ~~e I. A lication Information - I ase Pri AI fo tion Property Owner's Nam G, G, (' x r Parcel # n ~~v U 2 0 2008 c ~2 _ /oZ~~ 9a - c~~ Property Owner's Mailing A dress OIX COUNTY Property Location p (, ~ `I $ 47 ~-~'°~ ~~ ~'~ ST. CR OFFICE Govt. Lot t ate Ci ty , S Zip Code um er S L,J '/a, ,5 I< y,, Section ) n ~ / 7- , ~ l / G~/LfJX ~l ~~~L W °~" J ~"~ Z ~ ~j ~ ~,~ ~~15 ' ~o~~ T L~ N, R 1 b( lE orr~ pe of Building (check all that apply) T II Lot # y . ~1 or 2 Family Dwelling -Number of Bedr 3 Subdivision Name ~~~ Block # ~ ^ Public/Cotnmercial -Describe Use ^ City of ^ State Owned -Describe Use CSM Number ^ Village of , Town of ~%4-L-D C.J 1 tt~ III. Type of Permit: (Check ly one box on Gne A. Complete line B if applicable) A' ^ New System Replacement System ^ Treatrnent/Holdin Tank Re lacement Onl g p y Other Modification to Existin S stem a lain g y (~ ) B. ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ~ ~,' ~tT7'~'2~ IV. T e of POWTS S stem/Com oneot/Device: Check all that a 1 /~ ~ Non-Pressurised In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersai Component (explain) ^ Pretreatment Device (explain) V. DispersaUTreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gp Dispersal Area Requved ( Dispersal Area Proposed (~ System Elevation VI. Tank Info Capacity in Total # of Manufacturer ~ Gallons New Tanks Existing Tanks Gallons Units ~ d ~ c ~ ~ ~ .°'o ~ ~ J ~i/ ~ ~Ea.cB f ,~~Ftit.. rl~ U v~ % ~n w C7 P~, p' Septicor4ieldia~k pegs V W (j» ~-~- t~f ~ ! l Dosing Chamber O ..~-- ~, ~.~ J~U- ~ i5 ~. VIL Responsibility Statement- I, the undersigned, assume sponsi 'lity for' stallation ofthe POWTS shown on the attached plans. Plumber's Name (Print) Plumber's i MP/MPRS Number Business Phone Number TODD L . SINZ 1 . 139462 715-235-2644 ~= - Plumber's Address (Street, City, State, Zip Code) ,' E5609 708TH AVE MENOMONIE, WI 54751 II. Coun /De artment Use Onl V I ~, / t~ Approved Dina a -it Fe e P~ Dat Issu Issuing nt Signatu JJ ~~ u ' na 5 $ v ~ z 1 ~ ~ O ^ Given n for Denial V ` j- I ~I_~~ o IX, Condit~~~~/Reasonsfor sapproval 3~ ~~ ~ 5~~ ~ a I/~2 `u . ~ 1. Septic tank, effluent fiNer and r1 dispersal cell must all be servlt:ss /maintained ~ L o1.Q , as per management plan provided by plumber. 2. AN ee'mack rbr,)ukiarner~s mttstbe maintained Attach to complete plans for the system sad submit to the County only on paper not Less man a uz x u mcnes m sou ~~ ~,-~ i ~~~ ~~ ~ o- ~ M . ; ~~ ~ ~J r `~~ M ~~ ~ ~ s ~Z ~ 7 v ~ a ~ o y ~ ~ "~ M ~~_ S 1 ~ ~- ~ ~ :~~ ~ 3 ~ ~~ ' ~ ~I ~-- .,~ ~ W ~ ~ ~ ~ ~ ~~ ~~ ~ ~ ~. ~ F~ ~ 3 ~ r° - 1 . ~~ ~ Q 4~ ~~ U ~ ~- ~ s J ~ y ~ ~ ~ ,,, .~ ~„ ~= ~ .~ a f_ ~ ~ ~ ~ ~~ M ~ ~ ~ J O (/1 `4 1 l~ ~_ ~ 3 S - ~_~~_ ~ Q ~ 1- N ~~ ~ ~i ~ ., ~ ~. ~ J ,; ,~ \ 1 ~ -°- ~i , ~ ~- b ~' ~ ~~ v ~~1 n_ . 0 ~ c=' J ~ ~ a M ~!' 3 ~. ~- C~ 1 ~~~ ~... ~`~~ ~. ~~ n ~ ~~ e ~YJ ~1 ~~ i `~ ~ ~~ I V ~~ o s '< M 1 3 ~ 7 ~ ~ ~ ~~ ~ : ~ `~ S ~~ ~ ~ T v Zi o 1~ C J 7 M `~._ s I ~ ~ N ~- ~ `_ ~ ~., ~ ~ 3 ~ ~ ~~ ~ ~ - ~ ` ~ ~) Q ~ n v ~ ` f ~ ~~ ~ M ~ K 1 ^ ~° -.J ~ -~ ~ 1i1 W ~ ~- n , V ~ ° 3 ~ ~_.~ ~ 3 ~ r° ~~- ~~~ ~ ~ 1 ~~ ~ _~"' b J 7 N 1 ~ 4~ Sl v ~1 ~ ~- s J PO y 2 f_ P ~ ~ ~ ~ M 7 ~ ~,. ~ `-~ ~ ~ 1 O.i. t~1 I. r ~ o _ ~~ \3~~ ~~ ~i ~ ~ ~~ ~ ~, _,.. O ~``41 .7 n.. (~4 ~ T ~ 9 ,\ M c,~. C~ .~ _~.. ?n~~~ (~]CO PY C •, oRf~~Na~ Wisconsin Department of Commerce SOIL. E ALUATION REPORT page 1 of 3 Division of Safety and Buildings ~j _ ui acxx~ruancx wicn ~.vmrr ; vv~s. urn. ~,ou~ County ST. CROIX er not less than 8 1/2 x 11 inch 'n size Attach com lete site lan on a n t p p p p . include, but not limited to: vertical and horizontal reference point ( dire parcel LD. 0/` ~~ ~ 9 (J lJ ~ ~7'- percent slope, scale ordimensions, north arrow, and location and dista tone st ((,, 7 7 WV r / WV U Please print a!1 information. Reviewed j' Dat P l i f m ti id b d L 04 (m)) 15 ersona n or a on you prov e may e use r se aw . , . . ~,,. Property Owner ~{'~~ roperty Location ~ ~ ~ SNYDER, JE ovt. Lot SW 1 /4 SE 1 /4 S 13 T 29 N R 16 r) W Property Owners Mailing Address of # Blodc # Subd. Name or CSM# 2674 90TH AVE ST. CRUIX COUNTY .,. /~ D ~ GG'v l~"u City State Zip Code Phor~jltilh1l8e0FFICE ity ~~Ilage Town Nearest Road WOODVILLE WI 54028 ( 71~ 698-2655 90TH AVENUE ,~ New Construction Use Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ~ Public or comrrteraal -Describe: Parent material LOESS OVER TILL Flood Plain elevation if applicable ~ n fl. General commer>ts INSTALL INGROUND, NON PRESSURE'CONVENTIONAL' TYPE SYSTEM WITH LIFT STATION TO and recommendations: DELIVER EFFLUENT TO SYSTEM ELEVATION OF 94.5' ZELOW CONTOUR LINE OF 98.5'. ~o `~-~'.~~ 3~ ~~ ~~~J sy~~ 1~ Boring # ~ Boring a pit Ground surface elev. 98.5 ft. Depth to limiting factor >96 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 7.5 YR 3/3 - S1L 2MGR MVLR CS 1F/M .6 .8 2 4-36 7.5 YR 4/6 - SIL 2MSBK MVLR CS 1F/M .6 .8 3 36-96 7.5 YR 5/8 - MlCOS OSG ML _ _ •7 1.6 ~ t~ 2 Boring # Boring 98 5 >96 Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 7.5 YR 313 - SIL 2MGR MVLR CS IF/M .6 .8 2 6- 7.5 YR4/4 SIL 2MSBK MVLR CS 1F/M •6 •8 3 36-96 7.5 YR 5/8 - M/COS OSG ML - _ .7 1.6 tt * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effl t #2 = BO < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature ~„ CST Number LEWIS C BJORK t' 253976 Address Date Evaluation Condu Telephone Number E7818 COUNTY ROAD E MENOMONIE, WI 54751 6-21-08 715-308-7375 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mglL and TSS < 30 rrglL 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-8330Test (R.07/00) Property Owner SNYDER Parcel ID # 2 3 Page of Borin # ~ Boring g ~ Pit Ground surface elev. 98.5 ff. Depth to limiting factor >96 in. Soil liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/tf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0-5 7.5 YR 3/2 - SIL 2MGR MVLR CS 1F/M .6 .8 2 5-36 7.5 YR 4/4 - SIL 2MSBK MVLR CS 1F/M .6 .8 3 36-96 7.5 YR 5/6 - M/COS OSG ML CS _ .7 1.6 t ~~ ^ Boring # ~ Boring pit Ground surface elev. ff. Depth to limiting factor in. Soil liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring Boring # Ground surface elev. ff. Depth to limiting factor in. Pit Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 ~~,~ ~ ~ U~ z ~3 fi 0 ~i .o ~v ,~' y i M N 91--J a~ N~I~ ~~ ~ N C~ O A -~ , --~ ",'" ~ --~ d _O a1 W 0 ~ !j 4~ M ~1 ~' ' ~II~~~ -~- ~ ~ ~ ~ ~ ~ r~ --= v q -~- ~ N -4- N z c--- 3 ~ ~ W a~ ~ s^ -~- ,, ~~ _ ~ ~ ~ 2 ¢ ~" 2 ~ ~ -d ~ ~ ~ a ~ g _, ~ ~ ~ a m a ~ ~' ~~44 t~ ~ i . O ~- ?~S .~~_ 2 M Q' ~ + N J 4 ~ f; /; <~ 4 ~s ~L ~~~ oaQ ~..JJ J ~ w ~ J ~ Q ~~ ~ ~ ~ N .1. w r ~ - ~r-- M ~Il ~ N l s W ~ ATff >c fi PRL~J F 1.OCKrNC3 CpyER 3LNC,T~or. Lr/R.t'N~ t ~48k"~ . ~ QLi~K w~ro~.~tGT'--1 ~~ ~ ~ Gi P~ 3' ;; 1U ND~STURBEA .,. - ~ ; So~i. 24 `' x..U. it Gx 4° 1 ~ va+~T t~-aKUo~ _. -. . I /~.S T V ~r~ _- _ _ ~"r„u.v ~ .. HQr~ ~~.SQ~ O W KCYi.Q (.E~T ,~atr'J ~T ,j 4 a Pc1t~ ~FFL.~S ~QL 3' ono a ~„ N E L,T I O?+S ~^ ~"`/ ~ ~i, ~ i.-'G, ~ ~ ~ `~"~?`` r ON •• (~j i~K O ~~~ • ~ 4~" acs b b„ ' toMr.~gT't Qv ~ 4~aCK scPrlc E s~ r1o t4'`~ ~/,,~', oost ~,~i-~~w~ s T/~-J.,S h~A-JUi1-CT1.iR~fC: ~Lt/"16CR 4f DDSES: P>rK O.e~ 7'NAJK SIZC_; t ~~~ ~ ~~ t~ALLOAJS ~ .DOSE VOLUMC AL.ARM1 KA~11Jr'ACTl1RG4: s `i 1~~~"~-~yb, t~JC~-uDjl.~4 b.LtxrLOw: IDU,C~ G~t~O>`:S npoCL -.lyy~=x; . 1 e ~ 1* ti, CJ-PAGITIJ:S: A: owrTCty Tyv=; "'-a~'~~ wpb ~ wcr~cs ok `~-, ~~w~~o~s g ~ Z i1JCxES DR 'Z.a g W~ip~,;J SUMP /'11,-1UFAGTURCR: ~/'~-i-tlCll JwiTGN TtiPrC; VwQav.~.~v •~ u~T~ PUMP Au0 ALARM ARC T~ 6E 1NSTA~,LEO p-.I SEPtitQATC F,vfcCU~r; ~ERrrc~L atrpcR[IJCf OETWC[~1 Pt31~1P pry h1,i0 DISTRtb~JTiC11J PlDE., ~, ~ , FEC7 ~ /`//~ t n~ulMUM -~~TWo~K SUPPC.y tREtruR~ .... .. - ~'J ''J FEGT + ~O~ ~F; E7 or roacL I''1AItJ X Py SOP IL ~RILT to-J MA4TOR...~` ~QE T `-' TOTAL >Oy-JAMtC NEAO x g'~ f!<Er -^ .1rcR~n~, OIMLIJ4tO1Si Oir TAIJK: LEh.IC~TH - ~~-`~W~p7H LIQUID OCFY H Franklin Electric Submersible Effluent Pumps are desighed for use in normal sump and general dewatering applications where higher pressure is required. The-pump is designed for pumping non-explosive, non-corrosive liquids with up to 3/4'' spherical solids. Do not use for raw sewage. Automatic operation can be achieved with the use of the RFS. Remote Float Switch. Other accessories such as basins, check valves and covers are also available. All models have a 1-1/2" NPTdischarge. Do not over-tighten discharge pipe into pump volute discharge. UNPACKING: Franklin Electric pumps are carefully packaged, inspected and tested to ensure safe operation and delivery. When you receive your pump, examine it carefully to determine that there are no broken or damaged parts that may have occurred during shipment. If damage has occurred, make notation and notify the firm from which you purchased the pump and they will assist you in replacement or repair, if required. SPECIFICATI©NS: Discharge: 1-1/2" NPT vertical Handling Capabilities: 3/4" screened opening Housing: Cast iron Volute: ABS plastic Impeller: Closed design with stainless steel wear ring Motor: Single phase induction 1750 RPM, with automatic reset thermal overload protection Hardware: 300 Series stainless steel Bearing: Ball Radial Bearing: Sleeve -Permanent lubrication Shaft Seal: Mechanical, spring loaded, stationary carboh with rotating ceramic seat Impeller Seal: U-cup, Nitrite Volute Seal: O-ring, formed Nitrite Motor Housing/ FIGURE 1. ~~ ., ~~ ~z i~ ~3 ,.w. .ourzzsv .n ~ •''';' Upper Volute Seal: Vellumoid gasket Power Cord: 16 AWG 3-cohductdr copper stranded Cooling; The motor housing contains a cooling oil to.provide cooling fqr the motor and to lubricate bearings and. seals. These pumps are capable or operating with the motor housing partially exposed for extended periods of time, providing sufficient motor cooling and bearing lubrication., however, for the best cooling and longest motor life, the liquid level being pumped should`normally be .above the top of the cast iron motor housing. SAFETY GUIDELINES: ~ ., r .~ Risk of electrical shock. This pump is supplied with a grounding conductor and/or grounding-type attachment plug. To reduce the risk of electric shock, be certain that it is connected<to a properly. grounded grounding-type receptacle. Read all instructions,and safety guidelines thoroughly. Failure to follow the guidelines and theinstructions could result in serious bodily injury and/or property darnage.t Your effluent pump is equipped with a 3-prong electrical plug. The third prong is to ground the pump toprevent possible electrical shock hazard. Do not .remove the thirdprong from the plug. A separate: branch circuit is recommended.,D.o not use an extension cord. When a pump is.in a basin, etc., do nat touch motor, Pipes or water until unit is unplugged or shut off. If your installation has water or moisture preseht, do not touch wet area until all FIGURE 2. FLOW -LITERS/MINUTE 0 100 200 300 30 w w ~" 20 0 Q w io 0 io e v7 w s w a ~ w 2 0 0 20 40 60 BO FLOW -GALLONS/MINUTE ~ " W~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~~~~ i~ Shc (,/ ~~ A Mailing Address ~(v°7 ~( ~~ ~ ~~ ~pt~ ~J~ l (~ ~ ~ 5Lf U Z g Property Address ~~" (Verification required from Planning .Department for new construction) City/State LEGAL DESCRIPTION Property Location ~ '/,, ~~ Subdivision Lot # Certified Survey Map # Volume ,Page # Warranty Deed # ~ , 1 ~~j~ ,Volume 5 G ~ ,Page # Spec house ^ yes ^ no Lot lines identifiable gC 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 master plumber, journeymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposal system is in proper operating condition andlor (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 fr?rth, herein, as set by the Department of Com.*nerce sad the Departzent of Nati:ral Reccarccs, State of ., isconsin. Cer-:ficatior: stating that y ur septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days ee year expira on date. //S/d'~ IGNATURE OF APPLICA 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 th rope described a ve, by virtue of a warranty deed recorded in Register of Deeds Office. c~ //~/ a~ ~ A OF APPL DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** Parcel Identification Number (did ~ - ~D ~ 7- 9~ - ~~ '/4, Sec. /3 , Z' ~~/ N-R /~ ,Town of ~i4L1~l~iA ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner J l% ~ ~''~ Permit ~ DESIGN PARAMETERS Number of Bedrooms '~ ^ NA Number of Public Facility Units .~-tdA Estimated flow (average) p al/da Design flow (peak), (Estimated x 1.5) ~-}-~~, al/da Soil Application Rate 1 ~ al/da /ftZ Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOD5) <_220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODS) <_30 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Ya in die. ^ NA Other: ^ NA `Values typical for domestic wastewater and septic tank effluent. ^AAIwITC111AwInC QPLJCt1111 C SYSTEM SPECIFICATIONS Septic Tank Capacity ~ (~(~Q al ^ NA Septic Tank Manufacturer ~-~}~~~ ^ NA Effluent Filter Manufacturer (~~~Cp ^ NA i Effluent Filter Model ~rG g~~-11~~~ ^ NA Pump Tank Capacity ~(~(`j gal ^ NA Pump Tank Manufacturer ~ , =f- ~,~ I"~ ^ NA Pump Manufacturer f ~G~`f ~ ^ NA Pump Model S~ "C~ ~-~- ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: ~-NA Dispersal Cell(s) ^ NA ~cfn-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade ^ fVlound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Ir1/"~~I~~r~r/'vw~. VV~~i.V V~.~ Service Event Service Frequency Inspect condition of tankls- At least once every: ^ month(s) (Maximum 3 years) ~ ~ ,~ ear(s) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY,I of tank volume ^ NA Inspect dis ersal celllsl P At least once every: ~ ^ month(s) (Maximum 3 years) l--o ~ ~yearlsl ^ NA ^monthls- ~~, ~ ~-C-r 2 ^ NA Clean effluent filter At least once every: ~ ~ F~year(s) , Ins ect um pump controls & alarm P P P, At least once ever y' ~ ^ month(s) ~-~ ~ ear(s) ^ NA ~ ^ monihlsl NA Flush laterals and pressure test At least once every: ^ yearlsl Other. At least once every: ^monthls) ^ year(s) NA Other: ^ 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 Servicing 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 celllsl shall be visually inspected to check the effluent levels in the observation pipes and to check for any pondinc, 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 IY3) 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 NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatmen~ units, and any servicing at intervals of 512 months, 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. ,.~.. ,'r •' . • ~ ~ Page of ' .. START UR ANQ !pP1~RATIQN ..~ FOf rtOW QOR>(t(U¢tiQ(1; prior to use of the iPOWTS pheck treatment tank(s) for the presence of painting products or other chemicals ' that may ~mpecls ;the treatm9~i prOQ~als; :arid/or dargage the dispersal; cell(s), If high concentrations are detected have the contents of the tank(s- removed by a septage serviginb operator prior to use. ;System start up shall not occur. when soil conditipns are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be '' disoha~ged to the dispersal ce(lls) 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 feat down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the 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;prpducts; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT .When the i'C?,WTS fails and/or is: permanently taken out of service the following steps shall be taken to insure that the system is _properly and safely abandoned'i~'campliar-ce with chapter 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 properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material CQNTINGENCY 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 bean 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 and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding talk may be installed as a last resort to replace the failed POWTS. O The site,has not been ~eyaluil'ted to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed tQ locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a la$t resort to replace the failed POWTS. O 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 INTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT.. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name. G ~NZ mil- lid' ~/ L- Phone S ~/~~~' ~ - SEPTAGE SERVICING OPERATOR (PUMPER) POWTS MAINTAINER Name ~ Phone LOCAL REGULATORY AUTHORITY Name C ~~/~ c~-~i~//~ Phone ~ '~~ -~ - / ~d This document was draftod In comp0ance with chapter Comm 83.22(211b)1111d1&If) and 83.54(11, 121 & 13-, Wisconsin Administrative Code. Name... ,~. ~ ~~ Phone f, . .. , . ~: t ~" `~~: F'~~. ~ s 1Vird~' ~ ~ dad ~ • October , A. D., 1973 -~~betwe ~~" Johnscan and li'ola Jahn~s©n hu . -<~ , sbt~d ar~"~ wifb, as joint tenants and t yeah' in his or her own right ~~ '~' ~ ie s of the Brat part,: and "'~ `fi "Gerald~D. Snyder and Marlys Snyder, husband and wife, as Joint tenants • r`~ ~' t ~ ~^" pard e s of the second part 4 ~itttl~~ltt4: "hat the said part ies oif the Srsi part, fat arld in consideration df the sum of **Si~l'Thoueand Five Hundred and no/100 ($6,500.00) Dolhars** ' to them in hand paid by the aald part ies of the second' part, the receipt whereof is hereby r confessed and acknowledged, ha glren, jranted, bargained, sold, remised, released, aliened, canveged and confirmed, end by theae prtaents do give, grant, bargain, sell, .remise, release, alien, comrey'and confirm unto the safd part ies of the second part, their heirs and assigns forever, the following described real estate, situated in the county of St. Croix and Stae of Wisconsin, to-wit: (! S~ ~ v S 30 acres of SW~ of~Section 13-2916 ,,, This instrument is executed by the grantors herein. as full sa iafaction ofrthe terms of a certain contract rea©rded on November 26, 1g68, with the Office of Register of Deeds, St. Croix County, Wieaconsin, in t/blume ~+47e Page 399-, said contract executed by and between the same Parties as herein. - r; i ~+r i r L.G~ ~.,.~ ~ __ EXEMP' ~ " ~ ~ ; y, ~~ s ~,yy ~~.. ~~ ~$~~ with all a'trd ti~~+tt,tlta ,hat~td~ft8ments sn8 appurtenances thereunto belonging or in anywise appti'taftting vtd ell fbe eetite, ri~Lttt t}tie, interest, claim, or demand whatsoever, of the said part ies b,of & ~^+tpltrt- +~;~r~ ~y1 ~#',Rai{ilier,ln~padsession or expcctanay of; in and to the above bar~'ataed s arsd.tihetrl~edit~ts snd .appurtenanced. '+.~t'tt~r #q ~d~~r. tha rt3,~`ypremises as atbove described with the heredit~ihsents seed appurtenances, rrri'ta ,~hir~aiti'd patiti,ea of "_the scooted part, and"to ~ theirheirs end<aesigns FOR"1£~~-R~ `~r~Eb7:e,V~~;:;,~itt ~p~:, Jcihnesox~ , ~'or the~il~~rse ~ th~i~i~ ~~ exerutara end .~drr~fnstr:tars, da ~, cva»a ,g bttgain seed ~. + ~,fialfY`, ~~, ., ~ >' 152'' 4 ffta!•att=t6fitet;@~li4d1l~bf t~$~~~' ~~tf~t' '~'a~;are ..~tl se , , ~d ` e ,pre~ri~rs above described, j~y~y~~~j jy~~~; Yp~ ,' ~~ "`~~~ c" ~~~yy~' j ~ ata~~f 1n13t+11'it~ ~~p~~ sl~+rn~t t7ItQ. L~,;/RTlTf 11r ~.TVY ~A~T ~Z1lc~[i fr~l{i Yf~ I~~~a~~~~~~~~~L~~~~'~ h .~.` ~r~~~K y ~. y, r ~~ S ,~ ~~1. '~~3i ~ 7#i ~yt+;'K-rk?`~'f '~ '11~'~~;~! ; }AS. r ~ ~~ ~~"'" „'~ " "1` r3 ~i~! ~ ` ' ~ -%cR~! ~ - .C +.q,. ~~ ~ ~ .- ~ , , ~,,. 4~ ,. ~ahy"t9~ ~ ~. ~ ~ ~ ; .. ~ ... ~S <, .; cwr ~: ire? r~~ ~' ,.,. + ` . ., , ~-` .: "z ., ~~f 1~~r5~' , k~wl ~i J 1 ~fiX *Jl~i:~•r :yos~ ".W];'!~ Y ~ ; l "~~ ~R~ ~! I" ~ ~ . A~. ~ ,la.~t [~ '~ - -~ .it`ri ~.. 5~' ~ ( am 3 4ii 1 ~, y:~y~l.~'~~r':"jyy SI'Y' k~."2A'Mi 4._.~.~c.r2..~.~'9~i~ ~ -._.. ~ ~. _ .ii .~, .. ._ ... -:. ~: .... r., . 1 s{ '~ ,.: r; `~ '`~ ,_ .; bi. t" ~a ~9 f,~r~e Si, ~.i fib' ~rjt+ ~ f'i `): t*t~. ~ _ ' A„~'y ~P,j~.~ '" ': :, 1 , , , ~ .. *~ .. .'~ ;:t4f9~`.i"'~'` :R,w+ ;{,' `~'SJ:4 3',~.R.~ .~i~t4' l;t[;S;y.">~ C'1Afi4YS~d°`t'r~i •'°3F61I'S~MC'; ~ i' fs._ ,. ,.~ ~~FY. .~"„t,i ~iq .}~1 n~i.~:S + 3?X~ 4~'"~3~'1~ ~'Mh~ ~~~ y •4 fiii _~ v l .7, ... .._.........4~t.~i.R...~.aR+ka.....».:......~...,...~.DLZAt~ ~ ~• ~ t s;; Personally came be#ore me, this d;y o~ October , ~~~,~~ a ;1 the above named Lavern Johnson and Nola Johnso ~' to ma known ro 'be the - •' ~ '.`: '~ i~erson awho e~recaNd the fgrega~ng in ~ ~ eut's~f tar~# ~`. r ~ I~l ' \~ t( ~. ~ Notary 1?ubJic, ____,F,~er s ~ r ,, p 1;= vr,,"n r..t,~ .aa. ~ >r~y corrtml$'aloA i. ' -~ John G. Neatin en Baldwin Wisconsin ~- ' Dra#Eed by .. , ....._..,_._, S , .~.. (; :.. t ~. (N.~.--0i if wM. fMf~. a~idw that X11 1a~earw» b L~ ~wad~0 absll hen vkf~ D~td o~ bAwNMw ~1~os tYr_~~~d tY~ ~.. ~+. tts~aM~, w11rM~ as1 weears.) i ` - , _. z ;, ';, i a ~ ~~~~~ ~:~ E i { ~' ,;_ F ~ ~3 ~> ~~ d'~''"s ~ ~6 ` ~ ~a~, ~,. i1.lt ( ~r ~i '~"i ~' 1. t t v ~ ~ ,y ~~ ~-,, ~~ f~~ 4 .~ ~`'°' ~~~ ~`~ r ' ~ti,~ ~ ,' ~.nyq r ~, If`[ ~ , F4 ..1 ~ , ~ ~ 1 k :: F .. !' '~ • ~ ~; ~ r i, '~ S r PPP"" P c, .~ _~. r ~ ~..' •• ;{ ` Parrnl ft• M7_1 n77_Qn_Mn 07/09/2008 08:25 AM PAGE 1 OF 1 Alt. Parcel #: 13.29.16.1986 002 -TOWN OF BALDWIN 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 -SNYDER, GERALD D &MARLYS GERALD D &MARLYS SNYDER 2674 90TH AVE WOODVILLE WI 54028 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description ` 2674 90TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 30.000 Plat: N/A-NOT AVAILABLE SEC 13 T29N R16W S 30 ACRES OF SW SE Block/Condo Bldg: TOWN BALDWIN Tract(s): (Sec-Twn-Rng 401/4 1601/4) 13-29N-16W Notes: Parcel History: Date Doc # Vol/Page Type 504/627 7nnR CI IMMARV Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Description Class AGRICULTURAL G4 UNDEVELOPED G5 AGRICULTURAL FOREST G5M OTHER G7 Totals for 2008: General Property Woodland Totals for 2007: General Property Woodland Last Changed: 04/11/2008 Acres Land Improv~ Total State Reason 25.000 4,300 ~0 ~ 4,300 NO 05 0.500 100 0 100 NO 1.500 2,600 0 I 2,600 NO 3.000 12,000 150,700 / 162,700 NO 08 30.000 19,000 'I•S.Q,_7s10 0.000 0 30.000 18,600 142,700 0.000 0 169,700 0 161, 300 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 510 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Tota I 0.00 0.00 0.00 ~. .~.~ ~. COUNTY OF ST. CROIX STATE OF WISCONSIN I~MIn~~~• i ~ ~~ ,I Wells Fargo Bank N.A. 600 2nd St. Hudson, WI. 54016 j ~n _ VOID AFTER SIX MONTHS Check Date. check No. Aiaiount - -~--- _ 11/12/091 01042480 $432.00 z' - _ J o PAY X FOUR HUNDRED THIRTY TWO DOLLARS AND 00 CENT'- o a i U i F- ORDER '; SNYDER, GERALD & MARLYS ~~,, nn ,.. ;''-"'~~ OF 2674 90TH AVENUE WOODVILLE WI 54028 _~a~~ i~14 ~~ ~ ~ Authorized Signatures ~ ~,,~-. II'O L04 248011' x:0759 L L988~: 38779 x,98 L511' COUNTY OF ST. CROIX STATE OF WISCONSIN vENOOR: SNYDER, GERALD & MARLYS _ INVOICE DESCRIPTION ---__ ___ 11-09-2009_ WI FUND GRANT REFUND DATE CHECK NO. VENDOR N0. 1.1_/12/09 01042480 777777 VOUCHER N0. RMOUNT PAID 00161585 432.00 ~~~iY ~~ iz~ RECEIVED OCT ~ ~. 2008 commerce.wi.gov T, CROIX COUNT isconsin ZQNINGOFFIC~w er$ Department of Commerce Application Safet and Buildings Division Instructions For Property Owners: You may apply for a grant award for up to three years after you have received a determination of failure and after you have obtained a sanitary permit. Complete Part A of this form, attach evidence of your annual income explained in Section #7, and return those items to the sanitation or health department office in the county where the property is located. PART A. TO BE COMPLETED BY THE PROPERTY OWNER Please p Wisconsin Fund - Private Onsite Wastewater Treatment System Replacement or Rehabilitation Financial Assistance Program TO BE COMPLETED BY CO "'""C Owner ~ ~~~~ ~ ~- rl s S~ ~~ Owner Owner Owner Address City, State, Zip Code Telephone Number "Grant awards will be issued in the name and address of this If ere are additional owners, attach documentation listing all owner. owners. 1. Is this application for a principal residence or a small commercial establishment? (Complete both if applicable.) Principal Residence Small Commercial Establishment If applying as a principal residence, do you occupy this residence 51 % of the year? If applying as a small commercial establishment, do you own and occupy the small es No NA commercial establishment? If es, lease ex lain: 4. As the owner, are you a licensed plumber or contractor engaged in the business of installing private onsite wastewater treatment systems? Yes No 5. Will a portion of the replacement system be funded by another program? Yes If es, ex lain: 6. How did you hear about the Wisconsin Fund-Private Onsite Wastewater Treatment System Replacement or Rehabilitation 4 2. If a I in as a small commercial establishment, Yes No NA pp Y 9 what is the name of the small commercial establishment? Description of Small Commercial Establishment (farm, restaurant, etc.): 3. Has there been a change in ownership of the principal residence or small commercial establishment served by the failing system within the last three years? Yes No !~ LL f+~-~-~ i. Evidence'of income. If you are applying as a principal residence, attach a copy of your federal income tax return for the year of or prior to the determination of failure. If you were married and filed separate forms, you must also include your spouse's return for the same year. You must include evidence of income for each owner and for each owner's spouse. If you are applying as a small commercial establishment, submit a copy of your federal profit and loss form for the year of or prior to the order or determination of failure. If you or any owner listed above did not file an income tax return, contact your governmental unit for further instructions. Evidence of income will be kept on file at the governmental unit and is subject to verification by the Department of Commerce Property Owner's Certification. I certify that, to the best of my knowledge and belief, the information I have provided on this form and all attachments are true and correct. Owner',~Signature Date Signed Co-Owner's Signature Date Signed ~~~ you provide SBD-9163 (R. 02/2005) ,,~. t ~-- ~~ n s be used for secondary purposes [I Law, s. ~~~ d~ PART B. TO BE COMPLETED BY THE GOVERNMENTAL UNIT 1. VERIFICATION OF OWNERSHIP On the document used to verify ownership, do the names match those on Part A of this application? If no, please attach additional documentation explaining. Yes No If the applicant answered yes to question 3 on Part A of this application, did the applicant(s) own the property when the order or verification of failure was issued or the system installed Yes No and incur the cost of replacement? Document used to verify ownership: Q rrcx Document or Pa Number: ZS 2. Is a public sewer available to this property? Yes No 3. Has a previous grant been awarded for this property under this program? Yes No 4. Principal Residence evidence of income. Please indicate applicable annual family income: $ ~ ~ ~~ ~ 3 Federal income tax form ~~ b Line 3~ ,Year ZOD7 OR Affidavit of ,Year Small Commercial Establishment evidence of income. Please indicate applicable annual gross revenue: $ Profit & loss form used: ,Line ,Year 5. Date of the Order or Determination of Failure: ~~ . Z~ When was the existing failing system installed? P ~ - - 12-1-1969 to 7-1-1978 Vertical distance from the bottom of the existing infiltrative surface to a limiting condition: 0 to Less than 24" 24 to Less than 36" Equal to or greater than 36" 6. Private onsite wastewater treatment system failure caused by discharge of sewage to (check all that apply): Surface water or groundwater ............................................................................................................... Category 1 A zone of saturation ............................................................................................................................ A drain the or zone of bedrock .............................................................................................................. Category 2 The surface of the ground ... .............................................................................................................. Category 3 Back-up of sewage into the structure served ....................................................................................... 7. This request is for what type of replacement system: At rade Conventional If this request is for a system not listed at the right, please explain: Expenmental Holding Tank In-ground Pressure Mound 8. Uniform Sanitary Permit Number S/ ~ 9 ~ l Date Issued $ ° Z / ° C~ $ Plan Approval Number Date Approved Ex eriment royal Number Date A roved 9. After reviewing this application, I have determined the applicant to be: Eligible ne igi e If ineli ible, reason ineli ible: 10. Governmental Unit Representative's Certification. I certify that I have reviewed and verged all information provided on this form and attachments and that the are true and correct to the best of m knowled a and belief. Signature ut ed Govemme I Unit Representative Title Date Signed commerce.wi.gov Wisconsin Fund - isconsi n Grant Private Onsite Wastewater Treatment System Department of Commerce Worksheet Replacement or Rehabilitation Safe and Buildin Division Financial Assistance Program Owner's Name: Governmental Unit: er ~ l ~ ~~ fie(' ~~ ~'o,~~ ~o ,~. PART 1. GRANT FUNDING TABLES In Sections B-F, the number of bedrooms determines the grant award. To use the grant funding tables for small commercial establi ments, divide the estimated dail wastewater flow rate in allons d b 150 er a , round off to the next hi hest whole number, and use the result for the number of bedrooms. A. Site evaluation and soil testin Grant amount $250. $ ~ ~O B. Installation of a replacement anaerobic treatment component. Number of Bedrooms Grant Amount .............................................................................................................................$500 3 ..............................................................................................................................550 4 ............................................................................................................................... 650 5 ............................................................................................................................... 725 6 ............... .......... 750 ...... 7 ............................................................................................................... ............. ....875 8 or more ............................................................................................................................950 /'~ $ 5 ~ Q C. Installation of a dosing component, lift pump or siphon: Number of Bedrooms Grant Amount 9 ° "" ........................................................................................................................$1,100 ~ or4 .............................................................................................................................1,200 or more ...................................................................................................................1 250 $ / Z CSG , D. Installation of anon-pressurized and in-ground pressure POWTS treatment or dispersal component. Percolation Rate Design Loading When Properly Filed Rate in Gallons with the Governmental Per Square Each Additional Unit Before 7-2-94 Foot Per Day 1 2 3 4 5 Bedroom: Minutes Per Inch 0 to less than 10 0.7 or more $ 1,400 $1,450 1,925 $2,100 $2,100 $250 10 to less than 30 o 9 1,475 1,475 2, 00 2,200 2,250 250 30 to less than 45 0.50 to 0.59 1,475 1,475 2,100 2,400 2,450 300 45 to less than 60 0.49 or less 1,475 1,550 2,325 2,725 2,750 300 $ ~ 9 Z S E. Installation of an at-grade or mound POWTS treatment or dispersal component. Type of Design 1 2 3 4 5 EaBedrooltrronal At-Grade $2,050 $2,350 $2,600 $3,200 $3,800 $275 High Groundwater Mound 2,550 3,500 4,100 4,750 4,775 300 High Bedrock Mound 4,000 4,600 4,675 4,775 4,775 350 *Slowly Permeable Mound 3,250 3,600 4,400 4,750 4,750 375 Mound with less than 24" of suitable Soil or reater than 12% slo e. 3,050 4,175 4,400 4,775 4,775 375 ~~ $ "`A slowly permeable mound may be designed using percolation test results property filed with the county before 7/2/94. A slowly permeable mound is defined in s. Comm 83.23(1)(b) as having a percolation rate of greater than 60 minutes per inch and less than or equal to 120 minutes per inch or having a , soil loadin rate of 0.3 or less. F. Installation of a POWTS Holding Component. Each Additional 1, 2 or 3 4 5 6 7 8 Bedroom: Grant Amount: $2,800 3,200 3,850 4,400 4,775 4,775 $400 ,,//~~ $ ~/'fi Personal information vn~ ~ nrnvirlo .,,~., tie ~ ~~sa s ....._,.....__. _..______ ..,__ __ _ ~ . _ _ ..... .. SBD-9167 (R. 10/08) __..__. ~ r••• r..~..~ p ~ ~.a..r ~avr, a. w.vti~ i~~i np. PART 1. GRANT FUNDING TABLES continued G. Installation of a Replacement Exterior Grease Interceptor by Gallon Capacity. Gallons: Up to 1,249 1,250-1,499 1,500-1,749 1,750-1,999 2,000 or more ,~ 1/~ / Grant Amount: $550 $650 $750 $800 $900 $ /~ n Amount Requested H. Installation of an Experimental System. For Installation: If you are requesting funding for an experimental system, please submit a copy of the Wisconsin Fund $ ~ /~ pre-approval letter along with a copy of the plan approval letter and experimental approval letter "/'~ containing corresponding identification numbers. Amount Requested For Monitoring: List the total cost of the experimental system and monitoring that is being requested separately at the $ ri ht. Co ies of aid invoices must be submitted with this re uest. I. Installations not Covered by the Grant Funding Tables. The Department on a case-by-case basis reviews installations not covered by the Grant Funding Tables. If you are requesting funding for an installation not covered by the grant funding tables or listed in Sections A-H, please explain your request here, attach a copy of the paid invoice showing the cost of the item, and request 60% of the cost of the installation at the right. N ~- $ TOTAL PART 1. $ PART 2. GRANT AMOUNT CALCULATIONS ~ S A. Enter the total from Part 1. $ I B. Is the applicant a licensed plumber or contractor that installs private onsite wastewater treatment systems? If yes, enter 2/3 of the amount from section A in this section or $4,667, whichever amount •Z ~ is less. If the a licant is not an installer, car the amount forward from Section A to Section B. Z $ cJ C. If this application is for a small commercial establishment and the annual gross income of the business that owns the small commercial establishment is less than $362,500, the amount listed in Section B is the total grant award. Car the amount in Section B forward to Section F. is application is for a principal residence and the annual family income of the owner(s) is less than $32,001, the amount listed in Section B is the total grant award. Carry the amount in Section B forward to Section F. If this application is for a principal residence and the annual family income of the owner(s) is between $32,001 and $44,999, list the amount in Section B here and o on to Section D. $ D. Calculate 30% of the amount by which the applicant's annual family income exceeds $32,000 here and then continue to Section E. Annual Family Income Subtract - 32 000 Subtotal X .30 = $ /lJy.1. E. Subtract section D from section C. This is the maximum grant amount for this applicant. Car this amount forward to section F. $ F. Total grant award requested for this applicant up to the maximum of $7,000. (The amount in this section must be at least $100 for the applicant to be eligible for a grant award. 4 _ ~ If the amount calculated is less than $100, the a licant is not eli ible. $ / ~ ~~° ~ ~~~ V'V.Ai tQVG & Z~MII~I~ NOTICE OF VIOLATION July 9, 2008 GERALD SNYDER 2674 90T" AVE WOODVILLE, WI 54028 Code Administration RE: Failing POWYS at 2674 90th Ave. 715-386-4680 Land Information ~ Town of Baldwin- St. Croix County, WI Planning Computer # 002-1027-90-000 Parcel # 13.29.16.1986 715-386-4674 Dear Mr. Snyder: Real Property As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in 715-386-4677 violation of § 254.59(2) Wisconsin Statutes, COMM 83.32(1) Wisconsin Administrative Code, and Article 12.1.F.4.d of the St. Croix County Zoning Ordinance. This Private Onsite Wastewater Recycling Treatment System (POWYS) has failed under the definition in § 145.245(4)(b) Wisconsin Statutes 715-386-4675 (Category I). This violation was first noted on July 9, 2008. The violation has been documented as septic effluent discharging to the surface. An on-site inspection conducted July 9, 2008 verified that septic effluent was discharging to the ground surface. If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed from July 9, 2008 in accordance with Chapter 145.12(4) Wisconsin Statutes. THE FAILING POWYS ON THIS PROPERTY POSES IMMEDIATE HEALTH CONCERNS AND NEEDS PROMPT ATTENTION! REQUIRED ACTION: A sanitary permit must be issued through this office. You have already contracted with a certified soil tester (Lewis Bjork) to have a soil evaluation conducted. The soil evaluation determines the type of on-site wastewater treatment system necessary, the required sizing, and its location. You must then contract with a licensed plumber who will design the replacement POWYS and apply for the sanitary permit. The POWYS must be replaced by December 15, 2008. If you have any questions or concerns that I can address for you in this matter, please feel free to contact me. Your cooperation in abating this violation is appreciated. Sinc rely, Ryan Yarr' gto Zoning Technician cc: file „ter,,-„ ,-~,~„-~~.,,,, ~,,, „~ ST CRO/X COUNTY GOVERNMENT CENTER 1 101 CARM/CHAFE ROAD, HUDSON, W/ 54016 715-386-4686 FAx