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HomeMy WebLinkAbout016-1030-60-000a Q o M w, M ~ h n ~.. C ~O O O N N ti ~i 4 '~ ti K • ~Z 0 N V I • rrJ ~^ C i-~ ® ~ • ~> w ~~ cat r`1V +a `~ 1 A a .' ~ ~ I Z '', Q' d~ Z `-' v ~ Z c C7 o z ~ ~ .- aUi Z ~' , ~ F N N U m m n a (i .~ U O O ~ ~n 3 o N ~ O ~ 0 M ~ o 0 3 O M ~ o ~ C7 xt at a a a, ~~ ~ 'c L U a ~ v c 3 LL 3 ~ Z y ' O •~ O L a m C M ~ Z Z o .. N ~ .. ` '' a 'm C..) N d i °3 ~ Fes- ~ ', ~ ~ ~ a ~ a a a a~ N ', ~ o0 00 ~ N N O ~,.~ O N ~ O O ~~''. ~_ N .~ d C 7 w ~ y V! C0 UI C w N d n a ~ I Y M O E d a d I d 4 _T c °: ~ m ~ II' O in V ~ o I 0 ~ I Q~ C O I I I I I I ~ I z I `0 I C O '~ Q I I I I I I I N I ~ I ._ ~' I m I ~ ~? o o I ~ .U N r - o ~ ~ ~ '~ .o Z Z o I I a~ ~ I ~ 'E I a. ~ I ~ I a~ ~~ I Q ~ } I Z ~ ~ O N 00 rv ~ M ~ ~ n. ~ I Q A. t0 I O ~ ~ W tll ~ N ~~„ a 0 0 LA ~ ~ N N = N ~ &Y ~ N r n v I ~ c '" ~ Y cq I I I I ,~ . Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. PO Box 7302 O ] rl~ 0n ~~h See reverse side for instructions for completing this application WI 53707-7302 Madison . i . Department of Commerce Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 , , (Submit completed form to county if not ` °~ "+ • ~ ` state owned.) Attach complete plans (to the county copy only) f this , e~' ess than 8 -1/2 x 11 inches in size. County ~ ~ S~ ~ % State Sanitary Permit Number if rev on to previbug'a ication 'S ~ '~ '~ ~ State Plan I. D. plumber 1 D / t .~ ~ ~ I. Application Information -Please Print all Information Location: Property Owner Nam ~ i ~ ~ n , ~ rty Loc at ion Pro pe a 0 ~T{,~u. ~ ~, ~~ ~ , , ~ ~ t ~ ` ' LI/ 1/4 !~/ 1/4, S '~ ,N, W Property Owner's Mai lin s ~ g/Ad s Lot Number Block Number L l f ~j ~f, /' .y( '~'~~ City, State Zip Code gtie Number ~i Subdivision Name r CSM Numb ~ eN~vBOd ~ ~ ~ ~ S o% ( i t ' ~~~ ! j~j~ rCS v~t~~ rJ<i~~ 1~5 II. Type of Building: (check one) ~ - A~ ~ ~ (!Q 1 or 2 Family Dwelling - No. of Bedrooms : v"!~- ^ City ^ Village " ^ Public/Commercial (describe use):_ Town of J$ ^ State-Owned C~-~~NCVOOo~ Nearest oad R s /~~ ~i ~ ( !, { ~ ,r ~1 v d L1r~• ~ t O V ~ ( 'K,/ Parce 0/ m~ s) -- a ~ " 001 III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) A) 1. New 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to System System Tank Only Existing System $) Permit Number Date Issued ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ^ Non-pressurized h1-ground $1~ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: ~~x ~6 V. DispersaUTreatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation R to 6. System Elevation 7. Final Grade ~ ~ Required Propo ed ~ Rate (Gals.ldaylsq. ft.) (Min./inch) --- ~ Elevation ~ god o ~ ~~. o y~, ~ ~ . VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks s~ ~/ G X 2~~ f ~ ~ SCR ^ ^ ^ ^ uMp ~ ©~ o X l.~r~ / ~ / ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) ,~c.- Plumber's Signature (nos ps): ~ MP No. Business Phone Number ~~ ' Ca~4- S Ni / / ~ ~ ~- .2 2 ~. ~,~ -. Plumber's Address (S V e et, City, State, Zip Co e ) / , l ` ,p i ~ ,,/f y / / Kl / ~ ~f- G~ ~ (iL~ ~QV r~ l~G~ ~ Q /~ IX. County/Department Use my pproved ^ Disapproved ^ Owner Given Initial Adverse Sanitary Permit Fee (Includes Groundwater Surcharge Fee) _.~ Date Issued L Issu' Agent Signature (No stamps) ~~ - ( t:(~ ~ ~ Determination , ~ X. Conditions of Approval /Reasons for Disapproval: 1~ ~G~~~' ~, l~~ 541-w~~ ~e ~~. ~ ~Vtea! ~,c~o~~( ~ ' '~u ~~i ~~ i '~;~ u ,/6 ri ~ k•~. bc.U- ~5 ~ S v b c ~ `~' ~ ~' ~'Et.4 -'~ ~av S~t~L~k2~~. Sa. a 7t, ak` SBD-6398 (R. 07!00) /* 1 w,scons;n Department of Commerce PRIVATE SEWAGE SYSTEM safety and euiidings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes (Privacy Lbw, s.15.f}4 (1)(m)]. ownship TANK INFORMATION TYPE MANUFACTURER CAPACITY Setatic (~ ~ z So 50 Da=Ing ~~ Atr ation Ha din T `~~K SETBACK INFORMATION ~~ ~. ",NKTO P/L WELL BLDG. vent to Airlntake ROAD -tic ~~~ ~~~ ( - - NA wing ~ (gyp( ~` .,, Z ~ NA ration NA siding FI t`veTIAN DATA co`~~':Croix Sane Pg7 it No.: State P an 10 No.: rcel Tax No.: 016-1030-60-000 /4.3.0. tS- aa4 STATION BS HI FS ELEV. Benchmark Cj , 9 ~ R S -I•g r It. BM . `fS` 9S. 33 Bldg. Sewer °(. Go $!~ . 18'I St / Ht Inlet `r'. 8 $ ~S : 0 ~ St/ Ht Outlet ~' ~----- Dt Inlet Header /Man. ~. ~ °('-{~• c Z Dist. Pipe I • 9`f. 02 Bot. System Z' ~ g3.2rd Final Grade ~j ;~l ~ I ~t ~ -- no ~- JMP !SIPHON INFORMATION anufadurer (,~,~.,,Q~. ~ Demand --r(~i~I odel Number .~io ~ a~ GPM ~2`~v t~H Lift ~2.0~ Fridionp.q~ S tem 5 TOH 1~•~t orcemain length ~' Dia. 2 " Dist. To Well nu eQCAQDT1AlU ~VCTf~M k D Width ~ gtty Le No.Of PIT No.Of Inside Oia. liquid Depth ~ j~o IM N I SYSTEM TO P/L BLDG WELL LAKE/STREA LEAC nu acturer: SETBACK AMB Num r M INFORMATION TYPe O ~~~ , I ~ ~ 1 ~~ J OR UNIT . e System: . _ ~ ~- DISTRIBUTION SYSTEM z~~ 2 `t length ~ Dia. 1? ibution Pipes , I N q x nose ~~Ze ~r Length ~' 33 Dia. ~ 1 Spacing ~Z ~r!3 2 x Hole Spacing I Vent To A O" SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded 1 Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No Ion n nspec Ion ---~ / COMMENTS: (Include code discrepancies, persons present, e CI~I(ow ~ C~ Location: 1591 310th Street, GI nwood pity, WI 54013 ( W 1/4 NW 1/4 14 T30N R15W) -143 5 1.) Alt BM Description = ~~-~ ~~~~ CC sfis;~.~'~ 6~ ~Q~•e~ A--IVV ~ ~ ~ ~' 2.) Bldg sewer length = Ib.d' -amount of cover = 36`~-f- 3.) contour= q2•}a~Csls~t`«~ 3.Or °~ ~~ = 95•~~ 1 ,, n e/~ Plan revision required? ^ Yes ~No o Z o I -~. ~~sc-JO lUse ther side for additionnal i~nfor a on ~T >p ,~,'S•, W ~J'i'r} t,.~w5 ov{~..5•'~,~~` ~ Date Inspedo~ s Sign pert No. 0~.~ -671aQL~eUTC6v~ ~ ~ ~ 1 , . ~. r ` s ~ ~scons~n Department of Commerce Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264-8777 www. corn me rce. state.wi. us/sb www.wisconsin.gov Scott McCa(fum, Governor Brenda J. Blanchard, Secretary May 17, 2001 CUST ID No.222234 GALE W SMITH 3228 HWY 170 GLENWOOD CITY WI 54013 A7TN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/17/2003 Identification Numbers Transaction ID No. 641470 SITE: Site ID No. SITE ID: 629544, KIM KNOPS Please refer to both identification numbers, ST CROIX COUNTY, TOWN OF GLENWOOD; 310TH ST above, in all cones ondence with the a enc . NW1/4, NW1/4, 514, T30N, R15W FOR: OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 791875 P•~ 1 C~ndp The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. (:PARS MSt The following conditions shall be met during construction or installation and prior to occupancy or use: 0 _ ~N General Approval Conditions: G~,~-~_,''` • This system is to be constructed and located in accordance with the enclosed approved plans and witt~ef ~ COF "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 ofthe project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The maintenance plan for this system must be given to the owner of the POWTS. Site Specific Conditions: • 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 azea. l , ti GALE W SMITH Page 2 5/17/01 • The designer proposes to install an outlet filter to achieve the requirement of wastewater particle size. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic tank outlet filter will be required. The outlet filter shall be installed per product approval stipulations. • Maintain well and waterline set backs per COMM 83.43(8)(1). A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely,. d'`~ ~' ,. ~-~ G n . ~e-,..~ ~i PATRICIA L S NDORF POWTS PLAN REVIEWER ,INTEGRATED SERVICES (715) 634-7810, FAX: (715) 634-5150 , M-F 7:45 AM - 4:30 PM PSHANDORF@COMMERCE. STATE. W LUS DATE RECEIVED 05/02/2001 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 WiSMART code: 7633 cc: KIM KNOPS I~ ~_. MOUND SYSTEM DESIGN Residential Application INDEX AND TITLE SHEET Project ~ ,~,~~ /~DN/~ Owner ~/~(~J /1 /~/4,OS ___ Address ~ ~~ ~` ~d o f ~ ~ ~~ ~L~ ~ w o o ~ Grp 7`v `u ~, SyD/.~ Legal Description /~/~t~, /i/~rJ, ~/t~ 7`,~O /, /Q /_~lrJ Township ~L~NuJDOa~ County ~f (~~, ~l / <. Subdivision Name -'-'~ Lot No. -f ~'~~ _.n~~y Parcel ID Number D f ~ --~~,~0 ~- ~O ~ D D4 '~ Plan Transaction Number A ' " r (uEFtSION 2.0) January 30, 2001 ~-' GE + PONp Index and title sheet r Page 1 Mound calculations Mound drawings Page 2 Page 3 ~j l.-` ~ y Pres. dist. calcs. and laterals Page 4 TDH and pump tank drawing Page 5 Pump curve , Page 6 Site plan Page 7 Soil test (a,b,& c of page 8) Page 8 Managemant plan Page g Designer ~~~ ~ ~ S'/yJ / ~~j License Number ~- ~ ~ ~~~ Signature ~~~~~ Phone No. ~~~->~~~~~~~~ Date L,/~~ ~- O'~ Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result In disciplinary action under s. 145.10, Wis. Stats. Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). ,c • I ~; Straw, Morsh Noy, Or Synthetic Coverinq~ Madlum Sand Topsol l _"...{s~e 3 Slope E3ed Of 2~- 2~ Aggregate Srgncd: L i cc+nse liumber : [~~ate: Force Moir Frorn Pump Cross Section Gf ;~ triour~d S~~stem Usirul A Qed l~or f he !'+l~sorptian. <.rE c A ~.~l~ Ft. g~Ft. 1 1~,o rt. J ~ rt~ ,~6 ~~. f'luv.ed Layer D , .~ ~ E~ ~ ~~ G ~~` / H ,U~ L . _. _. I - -- At~S~'rvat'ion Pike ~ F - ~__.__ __------ .-_ K r- ~ _ °~ i ~ A ~. ~I f Ot(:(: MOlri ~ ~ ~ J From Pum;~ w ~ . ~ _ -- ____ ._._ _. - ._ - _ - --- - -- - - -- -- . ~• i` pisiribution (3ed Of ~ - 2'2 Pipe llggregote I Observation Pipe f'c:rrnanenl Markers Page ~Of ~ Distribution Pipe .~ ~ G ~~~~=- F o ~~ Plan View Of Mound Using A lied For Tl~e ~t,sorl.~tion l'+reu Page Of~ Perforated Pipe Detail End Yiew peR poR Atzd p~4 p/'Ne ~,~ ~t~R~A~ ~~~. S{ A 0~ Side of ce 11 ~ .~X\ Force P~iain PYC Inspection box Holes located on bottom of force main are equally spaced ast hole should tie next to •t~pice,l long sweep e:ll with, ~a.lve ~ or crap Distrihutation pipe layout Invert Elevation of Laterals ,.~Ft Signed ~ Liae nse ~ Date a ~0 GPM Discharge rate per. lateral PO~t i~~I nche s S~I nche s X~I nche s Y - Inches Hole Diameter ~/.~.2Inches Lateral " Inches Planifold " ~ Inches Force I~lain " ~ Inches ~ of holes~ipe ~ 6 # of laterals Page~~' ~/ COMBINATION SEPTIC TANK/PUMP CHAMBER (No Scale) 4" CI Vent Pipe with Approved Cap, +25' Approved Locking Manhole Cover From Buildings W'th Warning Label Attached n Weatherproof Approved _ " - ~ Junction Box Vent Cap --{~ ,,1: 12" Minimum i Final Grade-~ 6" in+mum ~ 4" Minimum " ~ ~ ~ Quick 18" Minimum ~ -~ Y ~ _ ~ ;.___ ~ Disconnect t 1/4" Weep ' Hole Baffle:;; ~ xA~ e~ ~ * R -/©d i A - ~~1f~R ' Alarm ~ B * On ~ C i *APPROVED Off 6' ~~~v, ~/~~ JOINTS WITH APPROVED PIPE D 3' ONTO Conc. Block SOLID SOIL 3" of Bedding Under Tank Note: Pump and Alarm Are On Separate Circuits Number of Doses: ~ Per Day ' Gal 1 ons Per Day/r~o -Doses : //,2~ Gal 1 ons ' tYolume of Backflow:.......+1 6;3 Gallons Tank Manufacturer: (,~J / ~°S"~ R Total Dose Yol ume :........= ~ 4,v Gal 1 ons Tank Size-Septic/Pump : / ~~'o % 7 !~'"D a ons Alarm Manufacturer: r,~- ~LTeGfRo _ Model Number:_ %~ / /y w Capacities: A~_inches orb/ Gallons Switch Type : M ~'F? ~ U R y + B ~ nches or . 3~ _Gal 1 ons Pump Manufacturer: ~ 0 4 ~ d S _ + C`~inches or /~.9 _6a11ons Model Number: ~ o + D__E~__i nches or 6 Gallons Minimum Discharge ate: ~ ~ Total....._ inches or_1~Gallons Vertical Difference Between Pump Off and Distribution Pipe: •0 Feet Minimum Required Supply Pressure: ....... .......... ......+ 1~..3_5'Feet fG0 Feet of Force Main x /, . ~~Fri ction Factor/100 Feet: +'~~~'eet ~_Inch Diameter Force Main .- Total Dynamic Head:...= D~ Feet Internal Tank Dimensions: Length -- ;Width; Liquid Depth ~6,/~~,~L ~~'`~ /N~ Signature License Number Date - _.. US`fR1AL RD. Goulds ~~~'~ ~ c N, wl 5401G Submersible . - Effluent Pump ' ~ C~7 r EP04 ' EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS Pump:EP04 • Solids handling coFability '/~" maximum. • Capacities: up to ~S GPM. • Total heads: up t~ 2a feet. • Discharge size: 1 ,;' NPT. • Mechanical seal. carbon- rotary/ceramic-slal~oniry, BONA-N elastomers. • Temperature: 104 'F (40'C) corl:nuous 140"F (60 'C) intermiUent • Fasteners: 300 se-yes stainless steel. • Capable of rurn~irg dry without damag? to cerrponer,ts. Pump: EP05 • Solids handling capability: 'h' maximum. • Capacities: up to 60 GPM. • Total heads: up to 31(eet. • Discharge size: 1'~j' NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BONA-N elastomers. • Temperature: 104^F (40^C) continuous 140^F (60"C) intermittent. ®1995 Govlds Pumps, Int. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. f~lotor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz,1550 RPM, built in overload with automatic reset.. • EP05 Single phase: 0.5 HP. 115 V, 60 flz, 1550 RPM, Guilt in overload with automatic reset. • Power cord; 10 foot standard length, 16/3 SJTO ~:ilh three l~iotlg grounding plug. Optional 20 foot I?ngth,lG/3 SJTW with three prong grounding plug (standard on Ef'OS) AIETERS FEET 10, ~ 0 a w U i 0 J Fa- 0 8 30 i -~--'-- e I 7 2,, i i ti 20 - 5 ! 4 3 2 1 0 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Automatic models include Mechanical Float Switch assembled and preset al the factory. FEATURES ^ EP04 Impeller: Thermo- plastic Semi-open design . with pump out vanes for r~echanical seal protection. ^ EP05 Impeller: Thermo- plasticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior sUength and corrosion resistance. _.. i .. .. ~._ .. 15 ........ .. .. i ...._ _... _! _. 10 -- -- :.... ..r __._..._...._ ._ 5 __.__i_......... L___ ___ . ^ Motor Housins: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Caver: Thermoplas- ticcover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING SP Canadian Standards Association (CSA listed model numbers end in ' F" or "AC".) ~-~ -~! I-t-SGPM--..~.__ _.. ~-'~--~2.s Fr ~ I ...._.a---1-- i -- ---I ---~.. I I t i --•~---- EP00 ~_ _ ._. . i 10 20 -- 90 -._•-•40 2 4 ~ 6 8 CAPACRY EPOS = G 12 m~/h Errecliv~ Mar, 1995 89671 _ ~-- ~~, ~- P.~~_~_e --- ---; . . _ ... j___s _ ' ~ ~~'6 /~ o ~ - - -- - - - - - --~-- - I - - - _ - ^ ' _ - - / h s - __ --~----{ --- !- --~-- _ r -- - . - -- - - -- - _ - --- _ -- -~ -~- i - ~ --- - ` _ : --- -- ~ --- - --- - ---- - - 7~ ---- ~ -- .-- --. - - -, o -- _ - - ~ - ~ -1 - --- ~ o ~ - -- - ~ - ~ - - ~ --- a- ~- ------ ~ ~ - ~_ - a- i ---- --- -- --- - --- ~ --- - --- - -- - - - __ --- - -- -- -- --- - _ - _ - -- --- - ~ ; fi~ -.---_ __ - ~ ~ -- -- __ - _ __ -- - r - i - --- - ~. - - __ ~, ~ Y i --- - - - - - - --- -- --~----- _ _ F~_ ; --- ~ - -~- -- - - - ~ i '- ~ ~ ~o i ___ i-_ ~--- _- ___ ~_-- ---- -- -- - _--- -- -- -- -- - --- - Q- --- ---.- - - - ~ ~ _... _.1 _ -_._1--~ . - _ . - -_ ..--. -_ _ _~ ~ I I ~, ~ ~ ~ I ~ I- _ ~ ~.~_I--~ .__..- __.._f ____ 1.._- _-_.. _____- __~ _-. ._- - ..- - ~ ~__-_ ~ _- _- i I ` - i -_ - __ _ -__ O . _ ._..__ _ - _ ._ .I ,_ -.. i - __.I--. L__~. ~~ _... _.~f__-, I ~ ___ _ ___ _ -. -- w `` ___ i ` ~ I ~ _.-..-~_ V\ --_ , i I _ .._. .. _-- __._ _._ - -.I_._~. -+ ~ I _.~._- it _~ ~ ~ __.._ __ __~ --_ - -_ _. I ~ _-__ -__ - - - _ I ~ -- ~ - _-- _~- _~ _-_ -_-. __.-~ _- - ~----~.._ ~~ ~ ~ i __'-f--- ~ ~~- ~ -_-_. ~ ~ 7~- l` vV - - 1-~. .-__ .__ .~.__ _ - - - ~ - -~ --,---- -- - - - -- - -- - - __- - - -- ~ --- ~ --_ - __ - _ - - ~ ~-- -- -- -- - ~ ~ --- ' __ _ _ ~ I .-...I . `w` X- ~_ - y _~ _ ~---. If _~, _ -~_ _ __ ~ _. i_-.t- - __~. (~ _ _ - .._ _-_ 1 ~ i - `.-__ .~_ -_1_ -~__ __~ _ ~ -~. ` -.~.-. ` ~_ ~ ~ ` ~, Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter. shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall approved for septic tank use by the Department of Commerce, Safety and Buildings Division.. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. 1f an effluent filter is installed. within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound Is not recommended since soil conpaction may hinder aeration of he infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/LTSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure testis peformed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General , This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD-10572-P (R. 6/99)) and local or state rules pertaining to system maintence and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. Contingency Plan If the septic tank or any of its components become defective the tdnk or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be repaired or replaced immediately with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. . Questions on the operation or maintence of this system should be directed to your county zoning or health inspector. z olY/~y~ /-~1~ 3~~-y~~c ~r~~ e .SM i 7`h ~~ 7~.5 =~2~.~ = y~.~~ ~_~~ --R ^~ t I ' t ~ ~~ 1 .,.~ .... ~ ~~. '~ ti ~'nsinD entofC ~erce `t SOIL EVALUATION REPORT i '~ n of Safety a d $uil~f ' ( ~~` ~ ' - ~ in accordance with Comm 85, Wis. Adm. Code ~';~- ~ C~,X ~ County ~~- com let~i gQ~ r noj less than 8 1/2 x 11 inches in size. Plan must G but not li (>;iFG€"rticaa rt~`horizontal reference point (BM), direction and Parcel I.D. ertihslope, r dimensions, north arrow, and location and distance to nearest road. 0~6 ~. . \j` ' Re awed by ~ Please print all information. Personal i ~ n~iay.p~a6(de may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). //~~ ,~~ id1.~._~,®t Property Owner Property Location " ® Govt. Lot ~/G(l 1/4 f{fll4 S Property Owner's Mailing Address Lot # Block # Subd. Name or ,¢ r ~ - - -- ~ s io' -~/ Page ~ of o ix ' - d Q-o4 Date I s/3~/r T~O N R I.s' ~i W City State Zip Code Phone Number ^ City ^ ~Ilage ~ Town Nearest Road New Construction User Residential / Number of bedrooms Code derived design flow rate ~ ~ GPD ^ Replacement ^ Public or commercial ~ Describe: -__-_ __ __ Parent material ~L ~ C / ~ L ~/ ~ L Flood Plain elevation if applicable ~ ~'1 ~ ft. General comments A A ~ ~ 1 i~ s'~/ .~ ~e /~f and recommendations: ~ •~ ~V Borin p g Boring # Pit Ground surface elev. ft. Depth to limiting factor ~'~o in. Soil ication 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 G rJ ~t?i /~M / 7 ~ S 1' /~ i .~ a ~- L s~ k ~ ~ -- - ~~ ^ Boring # ~ Boring ~ ~ ~ pit Ground surface elev. ~ r %o~ ft. Depth to limiting factor ~~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D1fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 l ©- 9 0 32 ~ ~. ~ s4S - e S -' . 8' o -- e ~- ~s~61; c - - .. • Effluent #1 = BOD > 30 < 2f20 mg//L and TSS >30 < 150 mg/t. " Emuent ~~ = rtuu < ;su mgit_ ana i 55 < su ntgru CS~ `(~ L~ ~M / ~! Sign cure ~~ a o~ 2 ~ .~ L . Address Date Evaluation Conducted Telephone N ber ~ r 5~/0/ 3 Property Owner ~~ ~~ ! 1 /~D /~ S Parcel ID # ~/ O ~ ~dJO ~ ~ a ~d0 Page ~ of Boring # ^ Boring (j ` ' ' •. pit Ground surtace elev. / /~ ~J ft. Depth to limiting factor ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft= in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 'Eff#2 o - io 3 - s~~ as ~ ~~ ~ ~ , S s ~e~ ~ s a Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f(' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil iption Rate Horizon Depth Dominant Col Redox Description. Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mglL '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 608-266-3151 or TTY 608-264-8777. SBD-8330(8.6/00) ~ ! , . . , r ~ _ _ _ __ _ __ _ _, __ __ __ ~ ___ ~ o _ ~__ __ _ ___ _ _ __ , ~ r f ~_ ___ __ _ ___ ____ _ __ r_ __ __ _ ~ ; r i _ _ ~ _ ~ __ _ _ -~--~ _ ~ __~ __ __ ___ _ __. ~ _ _. ~ ~. ~ C _ __ _ _ _ _ _ . ~ ~ ~ l _ _ _ _ _ ___ ~ ____ ._ ~ __ __ ~ ~ _ _ _ _ ___ _ _ _ _ ___ ~ ~ _ __ __ __ __ h t ~!~ ~ ~ ~ ~ - ~--- -- -- _ ~ ._a _-_- ~ ~ ~ - - -- -- - -- ---- ~ .- ~ --- ..-- i --- -- -- - ~ -- _ - - - ---1-~ --- - -. -- `1 - ~ - -- -- ---- ~ -- ~-- ~ - -~-. - --- -- - t~{ I ~ -- - ` - y - f- -- - ~. I~ AA`` __- - - - ~ - - --- -- -- -- --~ - ~ '-' - I ~ ~ - ~- ` O __- __ ~- -- - ~ i - - - - ~ --. _...- -- -- _ ~- ' -- - ~ -- _- .__ ° - _ _. ~ _ . __ ~- - . --- - - 1--- _ _. ! ~ I I 1 - -- - - - _ __ -- - --- --- - - - - _ _ ---- - - -- --- - ___ -- -- r ___ --- -- ~ --- - ~ , - -- - _ _-- _-- _ _ - _ _ - - _ __ - ~-- _ _ _-_ --- I- - --- -- -- - -- --- - I- _ __ .__ , ~_~ _ _ I __ ____ _ __ __ __ _ _ _ __ _ _ _ __ __ _ i ~ __ T __ ___ __ _ _ , a__ __ ~ __ _ ~ ; , -- -_- - _ I-_- - _ _ _ _ -- - __ --- ~ -- , ~ ~ - -- r . ,- --- - ~ ~ ~ 9 l~G -- -- ~ -- 1--- -- -- - - - ---i ~. O ! i I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/ ~/ /~ ~iVD~ S Mailing Address ~~ ~ /~D 7`"/~ ~ y'~ Property Address _ (VZsification required from Planning Department for new construction) City/State GLe~v~a ~ d ~/f.~ !~ ~~ Parcel Identification Number 4 ~~'' ~~-34 ' d©'4 oa ~""ya /,~ LEGAL DESCRIPTION property Location ~ `/., ~ `/~, Sec. ~ T~O N-RAW, Town of Subdivision _ .Lot # ~ Certified Survey Map # ,Volume ,Page # Warranty Deed # .~.~~ ~-~ ~ ,Volume ~ ~ Page # D ~ Spec house ^ yes, no Lot lines identifiable ^ 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 Query 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 mastCr plumber, journeyman plumber, restrictedplumber 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 ffie 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 of a three y expiration date. -- ~/ a/ ~ SI T[JRE O PLI 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 p perry des n above, by virtue of a warranty deed recorded in Register of Deeds Office. SI ATURE O APPL CANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the rectified survey map if reference is made in the warranty deed • ....DOCUMENT No. WARRANTY D~-~+ THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2 -1982 533539 .~ : , REGISTER'S GFFICE II ~ i ~~ i ~ v~~~~.. ~~ { ~c~ ~~ ST. CROIX CO., WI - Recd for Record Robert J. Palewicz, a married man - - -- _ .. -- -. - - -- - - .. - - S EP 7 ~99~ _. - _ - - - - ---- ---- - -- --- ---- -- ..._ -- - - 8t 12:15 P. (N conveys and warrants to _Peter__Kim.Knops--and_Brenda_Knops-,_-____ ~~~/~_ ~1+ lr~~ husband..and--wif.e.,_.a_s._ suxviv-o_rship._mar.it.al-.p-r.o_p-erty_-.___ Re~gi~tMaroTTf Deeds ctc , ; k- -- _~o ~ ' I; ~ET RN TO ~v ~ ~~~ J the following described real estate in -___. ~.-..St,---CrO1X,-- -.-__.-- -_--.County, I~'_ ~ S~~- _-~)-=5~~~ ''~ State of Wisconsin: Tax Parcel No: -.016-10.30-6G-- -_ The Northwest Quarter of the Northwest Quarter (NWT of NWT), of Section Number Fourteen (14), in Township Number Thirty (30) North, of Range Number Fifteen (15) West. ii .f FANS' ~3 •~- F This 1S_11ot-__-.____.- homestead property. (is) (is not) Exception to warranties: Subject to all easements, restrictions and covenants of record. }~-~ •~ Se tember Dated this __.__ day of ._ ._ P _ .- .. __ -...- _ ..-., 19..85 - _...- - - _-.. -- - - _ _ _ _ _. _ (SEAL) _ _ - -- -- - - --- - - - L) Robert J. Palewicz _. - _. _ _ - - _ -- - - .(SEAL) _ _ _._.-.._ -.. _ _(SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) ___.. Robert- J.-_ Palewicz-_- _ __ STATE OF WISCONSIN ss. ~ ------•------------------------•--•--County. ... n ~. _ c ,.,.. ,,,..~. ,. ,. _ o a II Dated this -_..._ ~' _--__-- day of ._-_--_ ..September - - -- ------ is--~5 ~~~ ~ _... ~. ~~ _ _ - - - - - - ---- ~- (sEaL; I ;; --- - ----- --- - - L) - - - _ _ - - Robert J. Palewicz _ - -- - - - ---- - . (SEAL} _ _... . (SEAL] -- - -_ - « - --- - - - - - - -_ -__ AUTHENTICATION ACKNOWLEDGMENT Signature(s) _____ Robert_ J.__ Palewicz _ ___ STATE OF WISCONSIN ---- //__T'^ - - --•----•-••----County. authentic ted this . W--;day of-_-_. Sep_ ember __ 19 95__ Personally came before me this - ---- ---- -----day of i -- -•---- -- - "'-F--~QM..- - -----------•------------~ 19------.- the above named "----Hendrik_W_.-_Van Dyk-------- --- -- --------------- ---------------------- - _ ,; TITLE: MEMBER STATE BAR OF WISCONSIN - - --`--- -`" ----"------' - _ -------- ------ 'I not- ----------------- •---------------•.._- authorized b -____"'--""-"'-"----- Y § 706.06, Wis. Stats.) ----------------------•----------------------------------------- - -- - -. to me known to be the person ...-.-_-___ who executed the foregoing instrument and acknowledge the same. I' THIS INSTRUMENT WAS DRAFTED BY I. REINSTRA & VAN DYK, S . C . ------ ---- - ----------------------------------- ---- - - - ~~ -201 S-.--Knowles Avenue------------------------------------ -Ne;a--I2i~k~~na~Id-~--~i-s~:o-~.sil~--~4QL7_--•-------------- -- - Notary Public ---------------------------_---- -_------County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: - -- - -_-_---------------------------------- 19---- -•) __.._ "Names of signing in any capacity should be typed or ~-- - ~ - - - --- - persons printed helow their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. FORM No. 2 ~ 1982 Ivtilo~sukee,'N:sconsin V „- _~ .~ N Visit our modrl/olTire at 147511HV. 6S • I\r~c Richmond, FYI 541117 (715 246-9ooa (888) 345-9004 toll free • (715) 246-3513 fax S6~ • ~n~Morit~d Bui~d~r / ~ ~~n ,~• -- --- - ~_ "Modular and Custom Homes" mw+o . . "Your Best Investment" ., i~ "~ ~ ~ ~ (715) 246-9004 (888) 345-9004 toll free • (715) 246-3513 fax ~ ~~thorizrd 8~;~ / ~~-~ ~. "Modular and Custom Homes" mw~o . . "Your Best Investment" ~ ~ t -- . ~~~ gig{ O O m O ~I Z m j ~~ i ~ O 0 'O ~ ~~ i i '~ r ~~77 i C5 i ~ ,, o~~ j 00 ~ I ^ ~ ~~ ~ CVG ' ~ ~ ~ ~ 1~ ~~ i ' i ' i ' i ' ~a;~ ~, ~~ ' ~~ ' ~o ~~ , 'O ~~ ~~ ~~ o ~~ MAY3 0~ e ,,~-- , ,.., ,i'-' •, ,R.w~ ~.t BEARINGS ARE REFERENCED TO THE ~' .' NORTH LINE OF THE NW1/4 OF SECTION N ~ 14, ASSUMED TO BEAR S89°5T41'E. d ~, ~° v 0 ? m ^~ ~ ? ~ N ~ ~ `/ ~ ~: -~ ', n `0 Z z N ''~~ ca ~0 N G °o ~^ z ?~ ~ ~ ~o ~ ~ 3 ~. ~ rn N t0 Iv y rri Z ~ m N~_nM__pdLa4~'C~D ~Q _nM_ D~ ~ 6 O(~Ii ~JC~D ~ ~l G°P~~L~_G°~ I m I ~ Z ------------------------ -- o ~' ~ ~i NOO°17'53"W 248.23' I Z i 220.58' 27.65'_ ~ ~ i ~~~~ ~ ~ ~ ' ~i ~~ Q c I i~ 'I N ~y I so ~ /a~ ~O ° /~ , r ' W N N Z W i~ ~g ~A ~I I~ I C_ ~ V 'Z 1 cc~~ v~ ~ cn m ~ m I I ~+ ' p~r ~Z w ' - ,I ;~ W ~ ~ y !~ ~~ m I I ~m ~ ~ ~~ C ; Z ,. 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