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HomeMy WebLinkAbout016-1068-90-000 p o I O � p °�- I C o I O N I I I 'B I I I c 3 (0 U. C a I Cl) z E is z = o v £ z a ) 0 I O z I v in F N � I c 0 0 o p m 4 O O N © Z z 0 o v Z o M y LO N > CL > N d ti N L a m F- 0 0 0 0 • mil ;� 3 M a M a o a� O N Vi v ° C> (D y N N N .�— t 0 to •� � I. ° o •�+ N tA Q .CSl O CO C N C L O O 3 O H O O C c Cd O O Tr O� 't U E y C N N p co L2 O N C C N O p c 3 pi ID -° a U) c � c _ • �a O N O N O O u O p CO _ Z w � M U' M O � O q � I r CS £ y y a E i C C ' d p `�1 A U i m O N u Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 399557 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)I. Permit Holder's Name: city Village X Township Parcel Tax No: Benware, Gunner I Glenwood Township 016- 1068 -90 -000 CST BM Elev: Insp. BM Elev: BM Description: 2 `' au TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 4, Benchmark � OCR /0 (D Dosing Alt. BM Aeration Bldg. Sewerp Holdin t Inlet TANK SETBACK INFORMATION ! TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic y _ Dt Bottom 0 7 l 0 ` d' f Dosing O � Header /Man. / r Aeration Dist. Pipe / 1 /G l � V Holdin Bot. System I o 99- yd Final Grade PUMP /SIPHON INFORMATION ��O 5 Manufacturer j� Demand Cover 6 ` GPM Model Number V f tv TDH Lift Fricti n Losses 1 System Head TDH Ft 1. 1'V 3 T / E3 d r l Forcemain Le � th Dia. Dist. to Well S L �� SOIL ABSORPTION SYSTEM BED/TRENCH Width Leng No. Of Trenches PIT D ENSIGNS No. Of Pits Inside Dia. Li Depth DIMENSIONS el SETBACK SYSTEM TO P/L BLDG IWELL LAKE/STREAM L Manufacturer. INFORMATION Type Of System: CH A UNIT Mo mbar. }` DISTRIBUTION SYSTEM Header /Manifold Distribution 7 / x Hole Size x Hole Spacing Vent to Air Intake �/ Pipe(s) <-a / Z p / / 3 f �� z !I Length Dia - Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of ded Mulched xx Seeded /Sod Bed/Trench Center Bed/Trench Edges Topsoil Yes [W No No ® Yes ® No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: P Inspection #2: // /�/� Location: 1265 280th Street Glenwood City, WI 54013 (SW 114 NW 114 32 T30N R15W) N%t Parcel No: 32.30.15.480 1.) Alt BM Description = 1>4 c,e v � tte_�/ 5 2.) Bldg sewer length= I -� -�- r e)V'6 ; Cjs - amount of cover = 1l � / 3.) Contour= z L ��, S >Ivu -y,� (e- (� ( ✓! / �i p /14� G(�vjp � 711, Y Plan revision Required? ❑ Yes No r Use other side for additional informati n. I Date Insepctor gnature Cert. No. SBD -6710 (R.3197) >c ve ->. � r S K n EO IS 4- rao 4 ;� - 29c� PO ' Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 ®Visc®nssn Personal information you provide may be used for secondary p urposes Madison, WI 53707 -7302 Department of Commerce (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number • Pro 1 � 1 3 °1 S75 '+ ( (0W I. Application Info rmation - Please Print all Information Location: Property Owner Name Property Location ] s' P► (\L- J n A (.C) /4N�1Y14, S R" T '�!N E (or)O Property Owner's Mailing Address Lot Number Block Number City, State Zip Code y n a l�iu� Subdivision Name or CSM Number II. Type of Building: (check one) t a �ECEI� City 1 or 2 Family Dwelling - No. of Bedrooms: f\ ❑ Village ❑ Public /Commercial (describe use): _ o ff' o ' 0 State-Owzpad T CP0 .gyp r GQ � Neazest p ,. ,' ZONiNGOFF I X 1 M � f '� a Parcel Tax Nr>y er,(s .A C k.. III. Type o rmit: (Check only one box on line A. Che b x otiline pplicable) A) 1. ew 2. ❑ Replacement 3. El Replacemen 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ❑ Non - pressurized In- ground �4ound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade ��o - 4��o C) 'r, 0 - Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) � Elevatio VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete strutted Tanks Tanks 7 F1 ❑ ❑ ❑ ❑ VIII. Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWTS show on the attached plans. Plumber's Name (print) Plumber's S' re o stamps): MP/MPRS No. Business Phone Number Y_1� Plumber's Address (Street, City, State, Zip Co i / ` 7 IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) X Approved ❑ Owner Given Initial Adverse Surch az a Fee) 60 Determination 3ZS • ' _ , /b S - 4 X. Conditions of A�Iprov /Reasons for Disapproval.- -� -----^ C_ '���`i°iS' 3 �8��� �t�Gz.. 1 5e� r - SBD -6398 (R. 07/00) Safety and Buildings 10541N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8 A www.commerce.state.wi.us/sb www.wiscon.sin.gov Department of Commerce Scott Mccallum, Governor Philip Edw. Albert, Acting Secretary October 22, 2001 CUST ID No.226900 ATT'N: Powts Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1.008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/22/2003 Identification Numbers Transaction ID No. 678641 SITE• Site ID No. 637002 Gunnar Benware Residence Please refer to both identification numbers, 280TH St above, in all correspondence with the agency. Town of Glenwood St Croix County SW1 /4, NW1 /4, S32, T30N, R15W FOR: New mound, 450 GPD Object Type: Powt System Regulated Object ID No.: 814946 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. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: co • 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.01 101) and SSWMP Publication 9.6, "Design Of Pressurized Distribution Networks For Septic Tank- Soil Absorption Systems." • 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 ad 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. • 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 area. • SHAUN R BIRD Page 2 10/22/01 • Materials shall conform to the requirements of COMM 84. • The bottom of the distribution cell shall be level per the Mound Component Manual. • The maximum finished slope of the mound surface shall be equal to or less than 3:1 per the Mound Component Manual. • Maintain well and waterline set backs per COMM 83.43(8)(1). • The designer proposes to install a state approve 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. • Insulate building sewer per COMM 82.30(11)(c). • Provide frost protection per COMM 83.43(8)(c). 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 correspondenc5j=y be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, Fee Required $ 175.00 �'- Fee Received $ 175.00 Balance Due $ 0.00 Patricia L Shandor Powts Plan Reviewer, Integrated Services WSMART code: 7633 (715) 634 -7810, Fax: (715) 634-5150, M -F 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: Gunnar Benware Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 9/24/01 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 •`'' onally 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve E 7 -9. Maintance and Contigency plan 10 -12 Soil test Signature License number 226900 9/24/01 I • P O PLAN PROJECT Gunnar Benware DRESS 3666 60th Ave Clear Lake Wi 54005 SW • 1/4 NW 1/4s 32 /T 30 5 w OWN Glenwood COUNTY ST. CROIX MPRS Shaun Bird 226900 DATES / 24/01 BEDROOM 0M CONVENTIONAL IN -GROUN PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XX)a SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # 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 SYSTEM ELEVATION 99.3' N O O 'a CD r m Pro 3 Bedroom House Tank is to be properly To have >42" of cover � bedded and provided with lockdown covers with Huffcutt Com approved warning labels Tank Well is to meet all setbacks found in Comm. 83 99 98 B -2 7 300' 96' Grading is to be done B.M. to divert runoff away t Alt B.M. from system 8% Slope 400' Area 15' below system is to remain undisturbed 280th St. Designer r Date 0 41' Observation pipe perforated Non. - WOvOn Filter Fabric BeloW Filter Fabric ' pislripvlien Pipe A3714 C -33 Sand " Topsoil �" ►+ G .exaar.sii.rs. r E "ea x',r ID 'fifi Z. Slope Bed Of r 2 %: Force Main �'N.,,F'iowed Drain Rock From Pump Layer ID Cress Section Of A Irfound "5YSteen U sina � o wn A bed for The Absorption Arco F @, G A Ft. Ft. I / Ft. J 7 Ft. K i Ft. L Z2ft. W-2 Ft L � �'Observotian Pipe �—•-- -- E --- ---- -- �...,�. -- K A W N �O -°... w---- -- ---- -- Force Main c ..._ .� .,._ .,...._ ..w.......,. ._......._ ....,. From P u m p a © Distribution Bed Of 't Pipe Orain Rock Oboervation Pipe Permanent Marker Pipe or Rods i Plan View of Mound Using A Btd For The Absorption Area Perforated Pim! r.r Oe1011 r� / PRrtO►RtlQ �, moue 1.046tta on 8911OT, C'�R/►Ut.�' Jj) Are Cquanr OOaaRa AJA C * P PVC FewcR hm4" -' f tR{IT ttla�t.t: titt %Y rs Car+ruC �� PVC menfok! Piet Old Oiil�iout�an d l jj Pipe I Distribution Pipe Loy"I P Ft. R �•f. Inches Signed: Y ° 2 Inches Hole Diameter Inch t�ic ense. A ? `�` ` lateral 2 ' IRONS) N Date ; Manifold " 2. `"` - Inches Force Main " Z . Inches # of holes /pipe Le Invert Elevdti ®n of Laterals91e n : SEPTIC TA fitUMP CHAMSER CROSS SECTION AND SPECIFICATIONS I 4" Cl VENT O%PE 12" MTN. ABOVE GRADE E WEATHEROROF R 25' FROM DO ®R, WINDOW OR JUNCTION BOX APPROVED rAtSH AIR INTAKE 4A"S- CONDUIT MANHOLE COVER FINISNCD GRADE w/ PAD LACK c WARMING LABEL Pon "M�a, w q" MIN. tN. rift ! x. aiitR�M s. o. INLET WATER TIGHT SEALS TIGHT• F11.tER ---- -� ..1� SEAL ALM JOTi WI PlPPf 310 a ! ON A EQ PIPE ONTO $;%to T € � SOLTQ SOIL SOIL PUMP OFF ELEV . FT. - + - 4 FF D 3" APPROVED BEDDING UNDER T ANX / ,CONCRETE PAD SPECrF ICATI ONS Dl^o SEPTIC / DOSE TANK MANUFACTURER: NUMBER DOSES PER DAY: TANK SI S: SEPTIC f� GAL. pqS£ VOLUME INCLUDING A7iJ DOSE GAL. F LOWBAC K t �._..�, GAL. .•► ALARM MANUFACZVRER: .111e .- S�reoCAPACITIES: A 3 27 , .5 ' INCHES s 7. J GAL. MODEL NUMBER s ......,. SWITCH TYPE: �l�C✓"GG�r� 8 ` 2_ IUCHZS ; ,3Q.._..c'AL. PUMP, MANUFACTURER: ion C 'a •� INCHES r GAL. MODEL MlMSER: - �„ D : INCHES • GAL. SWITCH TYPE: REQUIRED DISCHARGE RATE GPM PU14P S ALARM WIRING AS PER I LHR 16.2'3 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE /) FEET * MI IMUM NETWORK SUPPLY PRESSURE . . . • • • • . �i . FECT FEET FORCEMA2N X . I_FT /100�FT. FRICTION FACTOR FEET TOTA DYNAMIC HEAD ., Z q- rEET INTERNAL DIMENSxONS OF PVMP TANK: LENGTH °-t TNt DIAMETER LIQUID nTTII : -- � SIGNED: LICENSE NUMBER �/ 1 /8S En gineering Deta Porkmanca Ckft 40 30 Pump Chanuft SOCS dill 20 '"'"w 1 l�IR400t J110 '� to IM it ' 0 ° d° 20 30 40 50 60 70 � to It � Nrft N Told Ifew tow) 10 14 17 121 t 28 kO 120' F � Fiett n� A oft {tK OPM) !0 40 00 40 00 Mss A Me -•� I'M NM' ' r Dimo1 skmal Data !ee►a<Crt ti/7. li'ri t ree,2, -., 1, IfH� � chm, Imft for cw ' 2. COMWO & mw x�a�s of +Cons"vction ,►, 1/a twill. Ai I Z& ;r 3. 4.Otmmko and "*tj in Sw oppactm�riA Y re a t FIF j , t i• HYDROMATIC ' Y ra t840 104 WOW, OW 441H bt W-289-9W wry: Z1 Wob SALES OMO $ IN ALL MAW CITIES AND COIJII #15 J xd , Refer to "Pumps" is A t y eBmr Pages of your p6m direfty for }rout local %tri6to +reap w 02 6680 1798 SM nlr. 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 fitter. 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: Jerry Kolve 7 - 425 -9188 St. Croix County Zo in 715 - 386 -4680 Shaun Bird #22690 9/24/01 % c POWTS OWNER'S MANUAL MANAGEMENT PLAN Ps. of F" SYSTEM SPECIFICATIONS Ow tW cv Septks Tank Capadty ll al E03 NA P�etfttit S. Septle To* Manutmettrer p NA O ON p�AM E.fl usit Faller Manufacturer 13 NA t2!� Numbcrr of Sedragme ' o NA Ef&w t Filter Model p a NA Number*(C wrwtoitll Units NA Pur»p -Tw* Capadty e� d NA bernated now ( avKage) 3 Cl o wn Pump Tank Manubc urer NA tin l w (peat, (Estmated x 1.5) J- pump Manufddu NA Soil Appkatlorh Rate r g1 ftof PUMP Nadel s o NA UAusntlE3kw t C1u aft Mora* avomge• Pratreetmunt unit Fab, Oil 3 Grease (FOG) s30 mg/L a SandlGrlsvel Fier o Peat Plater Sicohemkad Oxygen Dernand (BW MO mgA. (3 Mechanical Ae+ation 0 Wetland Total Suspended Solids (TSS) sS60 nxYL O Dbkftcdaon O Other.' gaoled Effluent Qu:3d W O NA Monthly average— 01spsrsal CeA(s) BWwnW Oxygen Demand (800 s30 mglL Q In1pound (gravity) O In (pressurized) Total Suspended Solids (TSS) s3o mg1L 0 At - grade Mound Fecal Co#kXm metric mean s1W ctuflooml ❑ Other Mwdmum Effluent particle Size K Inch dia meter • v ws p+ ww tar damewc (nova m me+ loo wssw gter and sep0a WsitetAuent. VaMes typical for pretreated rve WMUr. MAINTENANCE SCHEDULE Service Event Service Fr+equsncy Inspect condition of tank(s) At least once every L7 months J34year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combine sludge and scum equals one -third (K) of tank volume inspect dispersal cell(s) At least once every � E3 months ar(s) (Maximum 3 yrs.) Bean affluent filter At least once every O monthe 2 ar(s) > . f , g i Inspect: pump, pump controls d alarm At least once every 0 months ;jrear(s) O NA lush iaiterats and pressure test At bast once every 3 D months 8((s) ❑ NA 06W. I At least once every d rnonths © year(s) odw. At least once every ©mortiths t1 year(s) MAINTENANCE INSTRUCTIONS one of Me faltowirvg iiaeftses or Inspeotlans of tanks and dispersal cells shall be made by an khdivldusl carrying aatlors: Master Plumber; Master Plumber Resiricted Sewer. POWTS InVsctor. POWTS Malnteirw- Septa" $ervldr+� OpereOot, lank inspections must include a visual Insiaec� ion of the tank(s) to Identify any rni:isirtg or broken har * any cracks or leaks. measure the volume of combined sludge and scum and 110 check for any R on the ground Surface. The dispersal oS( �I�we s or pottdlnp of ef�tien shall be visually Ind to dw* the of luent and to check for any ponding of effluent on the ground • The P�hV of Sluent on the In the cbservgSo Wound sur1009 ate a fading condition and mgtsres the Immediate notification of the 1=1 regulatory aritl�orlty ViRhert cont ents o f r t h aoce tank sh abbe of r bY a s Servidn equ peraw an disposed isposed m f In�aa�rrdancs t with ch NR entlre cont 113. Wisconsin Administrative Code. t comporhsnts, snd any The swvk" of efficient otters, mechanical or pressurized POWTS � . Pre pig Maintainer. 04W m� or mo *Odn9 � intervals of 12 months or less shall be pe�� rn etlon of any service event. A s report shah tae provided to the local regulatory rity+ autho WNW 10 days of conhple START UP AND OPERATION t�tment tank(s) for the AMS&= of brig ptodtaGts cr other For now cOnshu 6m. prior to use of the POW �S dispersa W NW - if high c onWritratlons are chemicals that M&Y Impede the treatment process an a s ervicing operator Prior to use. detected have the contents of the tank(s) removed by Systeern start LIP shall n rxrr ot oo when Wil'oonditlOns are frozen at the lnM ativs surface. Pete or__^ _ Ou"ing PcWQr outages PUMP tanks may tR sbove rio mel highwartar levels. When power Is restored the excess waecswOW wet be dtaoharged to ate dtapenwat o®a(e) .In on es tmrge dow, ovar$000M WM mss) SW r„ay result In the bWkUp or SU*ft dtsr tw" of avant. To avoid this 8 & 0 &m have the contents of the pump tank removed by a Iii P b`A 004W to the effluent pump or cranes a Plun>lbsr Or POWYS MNnta+ner to f BO W I" Mwm**PGnt*VVW PUMp*DoMnlstonwkw norms! tevsbt vA do ft pUMj p tNk. Oo not *We or park vtttdoles ow brdw and dispersal oohs. 00 #W drive or park ovbr, or otherwise disturb or compact, the arcs within 15 Meet down slope of any mound or at-grads sol absorption area. Reduction or.ohmiradir n of the koov*V *0m the waisWwatsr eps rf#ay kMavm m• perm mans WW of the POW S. suttlbWM. %*es; butts; cmftnW canon swabs; d%PVNsersr; derMM floes; � 1t � (am* pUmP) wager; tnrit artd vegetable peeEga; Eucpne� itabiddes; meat saaPs; moons; oiY; P N Pte; pesttddes; serdtay napkkW � and water softener brims. At3AND01' When the POWTS falls and/or is Qerr&nengy taken out of servic the kftwtng steps shah Its taken to kssurm that the oYSISM Is Property attd safst► atrentdcnsd In compliance with ch. Comm 83.33, Wisconsin Adatlnh6ratttve Code: • All Aft to tanks and pits sheds be disoonneoled and the abandoned Pipe openings seeded. • The cOnients of all tanks and pb shallim removed and property disposed of by a Septage Swvking Opwator. • After Puanpirrg, ail tanks and pits SW be excavated and removed or their covers removed and the vokl space 110W wigs soft, gravel or another inert solid malarial. CONTINGENCY PLAN If the POWTS fags and cannot be repaired the foikowing measM$ have been, Or must be taken, to provide a code axo oant mppwsrrtent system: Q A suitable replacement area has besot evaluated and may be utilized far the location of a repiaosmAnt soh sYsbem- The replacement area shoW be protected bran disturbance and cot be u pon by raqutr'ed sefbacks f m existing and Faction find should net proposed SbtirdtJr�O, lot lines grid Wehe. F*iltmp t0 Pmt the VOI31aCement area will result In the need for a new soil and site evaluation to establish a suitable I "MOW area. Replacem" systems must comply with the rules In effect at that time. (3 A sub* teptamnent area is not available due to setback jrWor soil rrmltabans. Barring advances in POWTS h =,*a a tank may be Installed es a lest resort to replace the failed POWTS. The s not been evaluated to icteu�fy a'suitable � area. Upon failure of the POWNIf 5 a soli and sx &M mead be performed to locate a suttabie rspiaOement area. If no replacement am Is available a h tank may be VWbdW as a last meort >O nspiace the faked POWTS. WW SIVrade soli absorption systems may be MMWMxftd In place f $M*V removed of the btanat at the � surface. Reeonstruc;t;orm of such systems must comply with the rules in effect at that "me, <<WARN1WG;,o SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDfOR INSUMCU NT OXYGEN. 00 NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMP08Nt8L.ig, ADDITIONAL COMMENTS POWTS INSTALLER POWTS MA TAINER Name c 0 ,- V-4. -` Name Phase _,5. / SEPTAGE SWtVIC W OPERATOR UMP LOCAL REGULATORY AUTHORITY Name `? Agency t''e f?hane Phone TW* dmwerrt was &WWd by the wxffs or for Gnon Lek., MaMuelfe end waushrg County Z0" lard g " fnk"wn � olah. Cmm 83.n(40)(rXd}d(� OW 83.540), (2 3 (3), Vftfmnsk►Ad� Code This s I* Ocamteat dos not q ua IM" the performance of the POWS. GMW (2101) 2 c , Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Ilan must County include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. _ percent slope, scale or dimensions, nortlt arrow, and location and distance to nearest road. Please print all information. Fie iewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 1 �Q0 Property Owner Property Location l J C 641AA a i:. /L �?� � Govt. Lot ,SC.c� 1 / 4 �I/Ld 14- S� c. - N R/ J E (o W Property Owner's Mailing Addmss Lot # Block # Subd. Name or City State Zip Code' Phone Number ❑ City ❑ village own f� Neargst R o 8zX 4vt sf+' New Construction Us Residential / Number of bedrooms Code derived design flow rate SO GPD ❑ Replacement / ❑ Public or com rcial - Describe: �1 Parent material �l ��`�� Flood Plain elevation if applicable ft. General comments � and recommendations: �f g 5 ,e� �� 7,1, 3 Boring # ❑ Boring Pit Ground surface elev. 7ft. Depth to limiting factor cl� � in. E Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 i - ,jig s . 7 -IT 4-' ®Boring # ❑ Boring � . Pit Ground surface el _ ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 2 3 / 1001 111 l Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /l- * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (PI ase Print) Kg n T Number Address Dat Evaluation Conducted 'Telephone Number SBD -8330 (R07 /00) r t a Property Owner Parcel ID # Page of F31 Boring # Boring ❑ �it Ground surface elevYsll ft. Depth to limiting factor —3" in. Soil Application 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 I 'Eff#2 , 2 i� f e • ❑ Boring 1 ••�.> F-1 Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in arr•alternate format, please contact the department at 608 - 266- 3151.,or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) "• l t Soil Test Plot Plan Project Name Gunnar Benware Shau ' Ld Address 3666 60th Ave Clear Lake Wi 54005 M #226900 Lot ------ Subdivision ------- Date 9/24/01 S W 1/4 N W 1/4S 32 T 30 N /13 W Township Glenwood Boring Q Well PL Property Line County S T. CROIX BM or VRP Assume Elevation 100 ft. Top of 2" Pipe ,- System Elevation 99.3' *HRPSame as Benchmark Alt. BM Top of 1.5" Pipe / W N / O `! O (D Pro 3 Bedroom m House 99 98 B - 9 7' B r a_ 300' 6 13 ' B.M. kfo \ 8% Alt B.M. Slope 400' 280th St. 6K '7 -7 -0 1 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page /of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must 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. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). �tfrO�I� Property Owner Property Location Govt. Lot _, 114 114 S T 7 N R or�l V�j Property Owner's Mailing Address Lot # Block Subd. Name or CSM# City State Zip Code Phone Number City Village EZ Town Nearest Road New Construction User Residential / Number of bedrooms Code derived design flow rate GPD [] Replacement Public or commercial - Describe: `•. �- ` - / Parent material Plain elevation if applicable ' ft. General comments and recommendations: C F/-1 Boring # 8 7 7 /�\ Zv"" 9 Boring Pit Ground surface elev. ft. Depth to limiting factor �_ in. 1` p • tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary GPD /ftz in. Munsell Qu. Sz. Copt. Color Gr. Sz. Sh. *Eff#1 I *Ef / f#2 Z / (o Boring # ❑ Boring ® Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. So�h. *Eff#1 *Eff#2 0-S el s� * Effl ent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L * fFluent #2 : D < 30 mg /L and TSS < 30 mg /L CST Na e '1 se P Signature CST Number — G G 9 Address ate Evaluation Conducted Telephone Number SBD -8330 (R07/00) Property Owner C "&tea ° u) �' Parcel ID # Page of ❑ Boring # E] Boring 3 JZ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 3 r s 7 f — ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # ❑ Boring El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 /00) -I y IS Ivs CO V-z S /-i�s IOFJ qa ue ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT Arm � � OWNERSHII' CERTIFICATION FORM Owner/Buyer . a n Y�� � A Mailing Address - . � -6 4�h e A,� �� �� /. L',[ J �00 � Property Address a (o (Verification required from Planning Department for new construction) City/State Parcel Identification Number LEGAL DESCRIPTION 22 Pm Location- �J ` /a, E�J %, Sec. J . T � N -� W, Town of 6 /�'t L- a�2Z Property Subdivision Lot # Certified Survey Map # , Volume , , Page # . , Warranty Deed # `7� Volume Page # Spec house ❑ yesR no Lot lines identifiable y es ❑ 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, joumeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days 7 three year expiration date. R DATE SIGNATURE OF APPLICANT 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 owners) of the property des above, by virtue of a warranty deed recorded in Register of Deeds Office. DATE SIGNATURE OF APPLICANT * * * * ** 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 certified survey map if reference is made in the warranty deed von 166 4 fi 538 64$912 STATE BAR OF WISCONSIN FORM 2. 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Donald R Thompson and Dorothy M. RECEIVED FOR RECORD Thompson, husband and wife 06 -21 -2001 8:30 AM -- WARRANTY DEED EXEMPT Y Grantor, and Gunnar J. lBeoware, a single person CERT COPY FEE: COPY FEE: - TRANSFER FEE: 168.00 RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and wan-ants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Southwest Quarter of Northwest Quarter (SW 1/4 of NW 1/4) of Section Thirty -two (32), Township Thirty (30) North, Range Fifteen (15) West. Recording Area Name and Return Address FIRST NATIONAL BANK OF BALDWIN 990 Main St 6aldwin WI 54002 016-1068-90 Parcel Identification Number (PIN) -- -- - — This Is not - - - -- homestead property Exceptions to warranties: Easements and restrictions of record. UV (is not) Dated this t h day of :FLA. y e. 2001 ' • Donald R. Thompson hi 1104Q50 -- AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. St Croix County ) authenticated this _day of — �- Personally came before me this J'qjj _day of 2001 the above named Donald R Thompson and Dorothy M. Thompson TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the pgrs6n(s) who executed the foregoing ( not, instrument d ackhoyl<Fedge Pd saw authorized by § 706.06, Wis. Stars.) THIS INSTRUMENT WAS DRAFTED BY • _ — Thomas A. McCormack Notary Public, State of Wisconsin twin, W I M n is My commission perm nt. not, _ to exprratron to (Signatures may be authenticated or acknowledged. Both are not necessary.) _. LIMl 5 . ) • Names or persons signing in any capacity must be typed or printed below their signature. Inf —uon Pmtea.d,als corrpany. Ford do Lie, W WARRANTY DEED STATE BAR OF WISCONSIN 800-655.2021 FORM No. 2 - 1999