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018-1013-30-000
~ ~ ~ ~ I ~ ~ ~ ~ e ~ ~ ~ ~ I ~ W I ~ :' ~ I O D d O v O~ c 0 ~ fD D 7 ~, d C pM ~ p O> ~ m u i '~ ~ o I W rn a~ N C z n, ~ y w o O 3 fD 7 ~• N ~ N O. ~ O ~ N O ~ o ~ < ~ o c ~ 7~ ~ 5. a g o a I °' 3 o a ~ ~ ~ I ° ~ to z ~ ,~ o. ~ I m v> -< D ~' ,~ a z W co ~ a co y d ~ a ~ ~ o I ~oI ro ~ 3 a W O ~ J o 0 0 ~'~'o O N T r ~ ~ S ~ ~ y N N ~ I ~ " O O O 0 0 0 d ~ ` s ~ Gov; I = Q Gov; ~ m m .. d ~ d I N ~ 3 d .. ~ ~ .. ° I _ o. H ~ D D D o I =~ O ~ ~ a ~ ~ O ~ ~ Si' N N a I o > t~D ~ N ~ w ~1 ~ (~pp ~ fD ~. 3 I v N $' ~ ~ o m I W a ~ 3 c ~ C ~ p ~ (b a Q I ~ a ~ ~ 4. I ~°, g I ~ g ~ e o o, ~ I e o a N I ~ ~ ~, z 'O ~ A m W I y D ~ I ~ ~ D ao o ~~~. I y~ o ~ ~~ 7 N ~ ~ C (~q fC N _ C cn~ o a I ~ N c a O ~ y 7 ~ N A F " ( ~ CT1 o ~' x I cn ~ ~ V O ~ I c ~ d O ~ N I ~ ~ 7 I 7 ~' I m 'p N ~ 07 fA ~ O O (D N 0 a 0 I 0 t ~ . O O - ~ ~ o n ~ '30 o~i ~ W = O O N ~ 3 •`° ~ ~ o ac~o W o m ~° °o N w ~ 3 M c w D 0 w cc 0 J A O A 2 O .. O z N v m z z ~ A d m m ~s O ~• O ~• Q ~• 1 Q A wY' Q ti „~O ti V w ;+W dp N ~ C 'r b ti ~,,,~ _ - ~ _-.. ~ ~ - -- ~~~, ~- AS BUILT SANITARY SYSTEM REPORT OWNER p A/~~ ~t MtSak TOWNSHIP ~1 .~i?L1n,N,-ok.~ SEC.~T L ~-I~~'~ ADDRESS /~~q`., ,, ~,,. a....+~ !,r/• "~ '"` ST . CROIX COUNTY, WISCONSIN . . SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 Q1e~...EyE$y_THING• WITHIN 100 FEET OF SYSTEM __ _ _ -- - -- _.- _ I _ _ _ - .._ ~ -- _ _ /~ ~ ~ _ _ _. _ _ --- -~ _ _ ~ I , -- - - ~ I _ --t ~-- 4 C. '. I di a e o th Arrow ~ I L ~~ _ ._ ~ - , . SC L i ~ I +BENCHMARK: (Permanent reference Point) Describe: Elevation of vertical reference point: /D'O ~ Slope at site: ~_~o_. SEPTIC TANK: Manufacturer: ~;k s,~,2 S Liquid Capacity: ~/o~_ Number of rings on cover.: $ Tank manhole cover elevation:l,~ ~;,~~ Tank Inlet Elevation• qQ'- /' Tank Outlet Elevation:~y_/" PUMP CHAMBER Manufacturer: Number of gallons _____ Number of gal. pump set or a cyc e gallons; tota capacity ~~ distribution lines gallon: size o pump _hea~l:. gallon per minute horsepower _ _; ~ranc~ name ~~( ,~~~~ and model number Tv~e of warning evice DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS P.O. BOX 7969 MADISON; WI 53707 INSPECTION REPORT FOR PRIVATE SEWAGE SYSTEMS CONVENTIONAL ^ ALTERNATIVE ^ Ho ing Tank ^ In-Ground Pressure ^ Mound AAI tHIAL: NV. UIJII-(. UIJii PIPES: DIA.: COVER MATERIAL: NAME OF E MIT H~ A DRE S F PERMIT HOLDER: INSPECTION DATE: BENCH MARK (Permanent reference polnt~E IF DIFFERENT ROM LAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Na a of plumber. MP PR No.. County: Sanitary Permit Number: ~~ SEPTIC TANK/HOLDING TAB (C: • d MANUFACTURER: ~Q~~ LIQU10 CAPACITY: ~ E LE V.: TANK IN T (~ (~ -I 7, /Q TANK O LET ELEV. ~7, ~~ WARNING LABEL PROVIDED: YES ^NO LOCKING COVER PROVIDED: ^YES ^NO BEDDING: ^YES ^NO VENT DIA.. VENT MATL: / C( HIGHW ER -- ALAR Y O NUMBER OF ROAD FEET FROM NEAREST : ~ ,~y'~ CJV PROP LI TV !1 V WELL BUILDING: I ~ VENT TO FRESH AI~NS~ET V VJrrYll Vr7 MIYIOCr MANUFACTURER. I. BEDDING: LIQUID CAPACITY. PUMP MODEL: PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ^YES ^NO ^YES ^NO ^YES ^NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF 'RGPERTV WELL- BUILDING. VENT TO FRESH AIR wLET (DIFFERENCE BETWEEN FEET FROM LINE: I . PUMP ON AND OFF) ^YES ^N~l NEAREST-~ SOIL ABSORPTION SYSTEM. Check the soil moistu re at the depth of plowing =L, ~iTH oInMETER MATERIAL ANO MAR KwG FORCE or excavation. (lf soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) MAIN BED/TRENCH DIMENSIONS NIDTH C V LENGTH- `G"b NO. OF TRENC ES: DISTR. PIPE SPACING. ~--~- COVER M IAL: ..c-t.~~ PIT NSIU IA. #PITS: LIQUID DEPTH: -_L.cF I:i. BELOW IPES FILL DEPTH ABOVE OVER. UISTH. PIPF ELE .INLET DISTR. PIPE ELEV. ENDp: -l~o.rJZ- DISTR. PIPE MATERIAL: (! N PIP R. NUMBER OFPROPERTY IN NEARESTOM _-1~~ ~ WELL: ~YK BUILDING: VENT TO FRESH AI~R/I NC,L~ET: -4 1 Mound site plowed perp ndicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown up ope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ^YES ^NO SOIL .`OVER. TEXTURE. PERMANENT MARKERS: OBSER NATION WE LLS. ^YES ^NO ^YES ^NO DEPTH OVER TRENCH BED EPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED- MULCHED. CENTER DGES. ^YES ^NO ^YES ^NO ^YES ^NO PRESSURIZED DISTRIB ION SYSTEM: NIDTH. LENGTH. BED/TRENCH DIMENSIONS VIANIF LD PUMP ELEV.: ELEV. ELEVATION AND DISTRIBUTION INFORMATION HOLES E HOLE SPACI i COMMENTS: ~ PERMANEN NO. OF LATERAL SPACI TRENCHES. MANIFOLD DISTR PIPE DIA. ELEV. OBS ^YES ^NO ~ U o,3Z ~~.~~. ~r ~~,3L N T ~ or32. ~.~z 'em on de. 'BD 6710 (R. 01/82) SAFETY & BUILDINGS DIVISION BUREAU OF PLUMBING State Plan I.D. Number: (1f assigned) L& PLANS: _ ^YES ^NO NUMBER OF PROPERTY WELL: BUILDIN FEET FROM LINE: NO NEAREST 1 ~'4 . `~'~ ~-~' ~ - ~~ q S , 0 s..~ I C~,,, my file for audit. DfPARTI'OIENT OF APPLICATION. SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DlVisloN LABOR AND PERMIT P.O. BOX 7969 HUM~QN RELAT)ONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'Is x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailing Address: David Jlrneson Hamrnon 5,l~O1 Property Location: -or ownship: County: NS '/a NE '/aS '~ iT 29 NiR 1 W Hs~mmoad St. Croix Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan LD. Number: 7th St ~ (lf assigned) TYPE OF BUILDING Number of ^ Public* ^ Variance* ^ Other (specify)* Bedrooms: ~ 1 or 2 Family *State Approval Required. 3 TOTAL GALLONS NUMBER OF TANKS PREFAB CONCRETE POURED-IN PLACE STEEL FIBERGLASS NEW INSTALLATION REPLACE- MENT OTHER (Specify) SEPTIC TANK CAPACITY lOQO 1 x x HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: Weiser Conorote Products, Inc .EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ®NeW ^ Replacement ^ Experimental ^ Seepage Bed ^ Seepage Pit ^ Alternative (specify) ®Seepage Trench ~4:. 15, 12 750 Water Supply: Owner's Name as Listed on Soil Test Report (If other than present ownerl: ® Private ^ Joint ^ Public Dewid J-rneson I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Signature: MP/MPRSW No.: Phone Numbar: Stephen L. Asby ME' 1$ (6 8 - 2 0 Plumber's Address: Name of Designer: Box 25~,* Woodtrilla, tiJi COUNTY/DEPARTMENT USE ONLY ignat/rya of Issuing Age Fee: rr'~ Date: J Sanitary/P~er/mit~iumber: <!~ ~ .~ / ~/~(J ~ ~__ ~ ~~'" ~ DISAPPROVED ~ ~[/ K~O ~ a~~ eason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHRSBD-6388 (N.03/81) USE DATES OBSERVATIONS MADE NS: A TS: RATING: S= Site suitable for system ~. U=Site unsuitable for system , ~)j ..r- ~~ ,~ ~P~ ~G ! ~ ~ C~~TI~~ IVY _~. Q~ IN-G~ND-~ URE: SYSTEM-IN-FILL HO~LDING~NK: REC MENDED SYSTEM:loptional) If Percolation Tests are NOT re wired q DESIGN RATE: S ST If any portion of the lot is in the under s.H63.09(511b), indicate: .Floodplain, indicate Floodplain elevation: /V O ~,~ PROFI LE DESCRIPTIONS NO. BEDRMS.: COMMER~lAL DESCRIPTION: ~esidence ~ /~~~ ~t 6fi+tNew ^Replace BORING NUMBER TOTAL DEPTH IN, ELEVATION. PTH TOGROUN OBSERVED DWATER-INCHES E T. GHEST CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- -V ~ ~'.S /~url/J~i ~ ~o ~ "$~. / 4'/~~~ ~~ G `r'~" Li'o/k rZadr B" / f% ~, ~ l1/ rL. / ~~ ~ JI /y f„• % ~ " ~ / C. ./ ~ N jtl ~ / /~ f~I.f / ' B- mac' ~~ y ..5' t 1~~- ~ ~ ~ . a ~a .- IZ• s ~ ~ ~/ ~ `~•~ ; T~ ~ ~ ~'' ~ B- PERCOLATION TESTS TEST DEPTH- WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. P RiOD 1 PERIOD P R PER INCH P_ 36 ~/Q ~Q ' ~ l ' y P- ~ .Z. ~e ? ~ ~ ~ s P- 6 ~ ~a ~ ' P-_ P- P- D~PARTrnENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707 >1~~~. ~1?.1_v_~_ _ U~. p~___ S c ~L ~ ~ ''=. ~, o 8ks~~w rrps7~ /'Lfr«~s Foe J)Av~a ,jR,~cwn ~y ST~~-~~.~ L l~~ls~ r v o o alp ~ L t~ Gv; Sal a ~, ®~ P~oN~ J a~x ,~ ptPx4r,~~Ty C"c~~K o~ ST. CROIX COUNTY ZONING OFFICE ~ RECEIVED JUL 1 2 2007 CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC AIY~ROix COUNTY This is to certify that I have inspected the septic tank presently serving the D~ ~~-~-~ residence located at: NE `/4, ~1E 1/4, Section '? ;Town ,z q N, Range~_W, Town of ~ , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service ? ~ ~ - ° ~ Did flow back occur from absorption system? (if no, skip next line.) Approximate volume or length of time: _ Capacity: / 0 6 0 Construction: Prefa Concrete ~ Steel _ Manufacturer (if known): t~ ~,~~... Yes No _ gallons minutes Other Age of Tank (if known): A~„~ r ~ 3 ,,,,~,,,, it (Licensed Plumber Signature) (Print Name) f (Title) ~- /~. -07 ~ "? -Z l ~ (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM ,Safety an~f~Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ermit Holder's Name: City Village X Township Arneson, David & Shirle Hammond, Town of ST BM Elev: Insp. BM Elev: BM Description: /~ ~ ti GST f ANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ Ex, b~'~ ~, ~ i ems. ~~O Aeration l _ _ F; '~`~ •lt~, ~ ~ ~a IQ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ,7 Sc~ ~ 7 Say /~l > ~ ~ Dosing 7 5a / 7 'sc~ / ~ y ~ zo' -. Aeration Holding PUMP/SIPHON INFORMATION 1 Manufacturer ~~ ~0~,~ Demand GPM Model Number } r~` / / ~S TDH Lift ~•9s s Friction Los 4. II System Head ~,z TDH Ft 1,43I Forcemain Length ~ /??k~ Dia. ~/ Z Dist. to ell y 5~ ~ Cr111 ARCt•1DDTIrIIU CVRTFM ELEVATION DATA County: St. Croix Sanitary Permit No: 499273 0 State Plan I No: Parcel Tax No: 018-1013-30-000 Section/Town/Range/Map No: 07.29.17.97E STATION BS S 78 HI / '] FS ELEV. /dam Benchmark 3~ b 1 ~~~ ` ~ ~~ Alt. BM z~ ~.~3 9'~ , a, Bidg. Sewer SUHt Inlet ` ~~~ ~ h ~ St/Ht Outlet ~ ~~~ ~ 93 • q ~ 1,~ ~,,~ l~. es3 ?! ~ ~5 Dt Bottom 5 17~ $$'.z3 Header/Man. +O ~ ~5 ~ ~g Dist. Pipe ~O b ~ ~ /C J Bot. System ,!I L, qY. ~' Final Grade Q ~ / , ~~ ~ /~ St C ver Cb~~-n ~.. ~ ' a •' ~ ~3. 5 BEDITRENCH DIMENSIONS Width J /~, Length ~ /~cT ~(~ No. OfSrenc s KG JC PIT DIMENSIONS No. Of Pits 1. Inside D~ Liquid Depth SETBACK SYSTEM TO P/L BL G WELL LAKE/STREAM LEACHING ER OR Manufacturer: \ INFORMATION T e YP~ stem: YQU ~. / ~ ~~ ? ~ /~ ~ A__ CHAMB UNIT Model Number. r11CTDIL21 ITIl1NI CVCTFM 1 . ]O~.i-~ Header/Manif ~ // Distribution ~~ / x Hole Size / / x Hole Spacing // Vent it Into ~ ~ Z ~ Pipe(s) Q i ~ / ` ~ S ~ a ~ ~ ~ ~~ ~J.~-- pia Length pac ng Dia Length Cull !`n\/CD . n____.._., c.._a...«.. n.,i.. ..., nn.,~~~a nr et_(2rarlo Cve4ama only 1 1 _ w, Depth Over / Bed/Trench Center J / ~ Depth Over ~ Bed/Trench Edges ~ xx Depth of Topsoil ~ ~-• xx Seeded/Sodded dyes ;' No xx Mulche Yes r No _ 1 w ~ ~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~P / Z / V ~ 1lnspection #2: / / Location: 1090 160th Street Hammond, ~ 54,01 (NE 1/4 NE 1/4 7 T29N R17W) NA Lot 3 ~~\'j4Q, ~Ot.~ Parcel No: 07.29.17.9\7_E~ ''~" ` ~Dlq,. (~ t~J~5.7 1.) Alt BM Description = ~+'~`" '~' ~~v~ Cw~`'~5 ~ ~ u /~^~ $I•+~•Q,, ~a 2.) Bldg sewer length = EXr ~:...~ ~/ara ~ ~~~ Safety and Buildings D' 'ion • Sf ~ ~ 201 W. Washington Ave., P. o . ( p iscons~n Madison, WI 53707 Sanitary Pertr-it Number (to be filled in by Co.) Department of Commerce (608) 266-3151 ~/ 9 ` Z 73 Sanitary Permit Applicati Plan I.D. Nnmber p yG~VE D 3 y ~ ~ ~ ~/ In accord with Comm 83.21, Wis. Adm. Code, personal informatio you p~a,Rtte may be used for secondary purposes Privacy Law, s15.04( )(m) Proj ct Address (if different than mailin g a ddress) C t ~ ti I A li I f Pl i P ll ~ ~~ 9D ~60 ~ . pp ca on n ormat on - ease rint A Information ii 1 Property Owner's Na me ~ Parc >Y Lot 2 Block !/ DA'll~~ ~5~~-R. Z-F A~{,/~/' or~loi330~~~ 07 ~\ Property Owner's M ailing Address Property Location 1 04® 1~a ~ ~~, ~~ t~ ~'~ S ti ~ City, State Zip Code Phone Number , ec on _ r'~ ~+ /1~ /V1 ~ /~ D ~ e S `/ ~ t S ~ / 5 7 4 j, ~' y S ~ ~ ~ (circle g ~ 7 ~ II. Type of Building (check all that apply) E of W T N; R • 1 or 2 Family Dwelling -Number of Bedrooms l7u Subdivision Name CSM Number ^ Public/Commercial -Describe Use 3 ~~ ~~ U ~ ~ P ~ b ^ State Owned -Describe Use ~ ~~ v - ^City_^Village Township of~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ^ New S stem y Re lacement S stem ~ p y ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner ~ r ~~ Du u D IV. Type of POWTS System: (Check all that apply) ^ Non -Pressurized In-Ground ~ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recir ulating Sand Filter i ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain)~q ~ ~ ~ $~ V. Dis ersal/Treatment Area Information: ~p Design Flow (gpd) Design Soil Application gpdsf) Dispersal Area Require (sf) ~ Dispersal Area Propo (sf) 0 ~ System Elevation ~ ' ~- ®~ I , ~ oa ~ o ~~ 6 o c~ ~ 9 4 ~ 3b VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Alew Existing ~ ~4} ~n /fj `xT IQtDG "~" ( ~ Tanks Tanks ~ / , Septic or Holding Tank ~ ~ a a ~~ ~ W. C:.ssr-e. ~ Aerobic Treatment Unit Dosing Chamber ~ ~.~ ~ ~~ ~ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature MP/MPRS Number Business Phone Number Plumber's Addre ss (Street, City, State, Zip Code) ~~'~ L~ ~~ Q W: s-~r~ ~~ VIII. Count /De artment Use Onl Approved isapprov Sanitary Permit Fee (includes Groundwater Date Issued Issuin gent Si re o S ^ caner iven Reason Denial Surcharge Fee) 55 T ~ (~ J V N- ~L Zg '~'fo IX. Conditions of Approval/Reasons for Disapproval ~ ~~ t~ t 3) C _ _ f ~ l (7~tJc C o ( , n SYST~liA G1NN~tt: ~ c, ~ ,, a.~.. c..~c4_ • 1. Sepik tank, eMuent finer and • ~ (_ ~ / , l J dispersal cell must all be services 1 mauttained ~ n C'. e. ~• 5 ~ Cr~ . as per management plan provided by plumber. A 2. Aa setback requirements must be rttaiMairtsd X11 ~ C 1- 5 6~ ~ ~~y Ip cr~ «XX y 7 JJ as per ~ aade / order nn G Oct, , attacn complete plans (to the County only) fo- the system on paper not less titan Sl/2 x 11 inches in size ' f SBD-6398 (R. 01/03) S' -i ~ a~°a ~ 15 ~~ US d-tn~e-~ ~ef~i(r-c~~'' rro t^~.. -~vt,~sf- b.~.. Gowyot~-~ . commerce.wi.gov isconsin Department of Commerce Safety and Buildings PO BOX 7162 MADISON WI 53707-7162 TDD #: (608) 264-8777 www. co m m e rce . wi . g ov/s b/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary December 07, 2006 CUST ID No. 226375 ROBERT W ULBRICHT ULBRICHT & ASSOCIATES CO 2812 10TH AVE SPRING VALLEY WI 54767 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/07/2008 SITE: David & Shirley Arneson -Dwelling 1090 160TH St Town of Hammond, 54015 Identification Numbers Transaction ID No. 1347714 Site ID No. 721030 Please refer to both identification numbers, above, in all corres ondence with the a enc . St Croix County NE1/4, NE1/4, S7, T29N, R17W FOR: Description: Mound Object Type: POWTS Component Manual Regulated Object ID No.: 1110067 Maintenance required; Replacement system; 600 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and ocated in accordance with the enclosed approved plans and with the component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. As specified in s. Comm 85.40(3)(a)S.d., Wis. Adm. Code.,. the soil test plot plan must show ground Co J2 surface contour lines at an interval appropriate for the conditions present. A single contour line does not satisfy this requirement. 2. On page 1, the system plot plan must show two-foot contours or other appropriate contour interval DfP within the system area as specified in the approved mound system component manual. A single D1VlSI contour line does not satisfy this requirement. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to SEE CORF 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. ROBERT W ULBRICHT Page 2 12/7/2006 Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincer , n c1 ~ eter E Pagel ' Private Sewage Plan Rev~e er ,Integrated Services (608)266-2889 , M - F, 0630 - 1500 Hrs pete.pagel@wisconsin. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ' ULBRICHT & ASSOCIATES CO. 281210th Ave. • Spring Valley, WI 54767 Reg. Designers of Erpj~ing Systems 715-772-34.42 Private Sewage Consultants Plan I,D. # PROJECT INDEX Owner ~~1(~i!' ? .S'Lii/~/~cl! ~, ~jV~SDN___ Address /d / ~ ~~j 0 ~ s' ~. ~^ ~~,y~io~vv h Legal Description ~ ~p r- ~} 3 Stir 35~aCo 0 , Town of ~~~~aJv~ C . S . T. ~'EJ~J~ Y ~ L.$ (~ t c ~ ~ ~ b s~1~J' 7 ..----.. Local Authority/ Supervision sr-. c~2ot~C ~rY_ Zalv~~~ ~.EP1-.. PROJECT DESCRIPTION tic ~'STt ~J (r- ~2~4P~'F~'E~~ ~ ~/~, ~~4i/inJjr, %~v S~Sov.~/~Y S~rv~p~~v Soj/s -? ~3. ~ . Sti q a ~.e. ~ t3r~Nt~aN ~c~ . • ,~~%9-oE~l~,v 7- ~ ys~-~-,y Fo/' rtv ~X ~~s r~,u G..- rv o wJ ~ y /~ ~~~M . h~ ~~ . ~s r~,~-~.~- rev ~.~ ~ Gy ~ ~s ~°~,~ ^-' CU1!"S ~-~~o u~ =- ~ oo ~'~S . CDti UEti rtou~-~ J~ o uN v ~~ l O s~ ND "I'~2 ~X i S Ti N ~ ~S'~i i `C ~T~t ~~ ~ ~ ~° ~ c ~4- S T- ~i4 SSC~.y ~v ~ iV S p e-~' ~U ~o ~ Goth ~ CD /•c ~0 ~ i ,q. ~ ~ ~ -? R~ • •u s E~ _- ©~. w i S E .4 1u ~- w -7 s D ~ , C.t~ i ES ~ C4 ~ ~ .L ~ . S~~p 1"r' c Tit ~ ~ S~ ~4 // ~e i ~ S~f ,4 ((~2~ ~-~e~~ o~ ~M~ ~ r~'~K . ALL NON-CONFORMING ~~o~~iS TREATMENT TANKS SHALL ~l~ BE ABANDONEQ PROPERLY,~~~ ~~ PER COMM. 83.33. qy ~~~~~~~ pEC ®~ 2pG~' rl„p, ~~~ i ti jR~,p , ~ ~ utmncer ~~~ orttq ' : HUD30N.1M1~~ a'`4 °ii.~sT ~jI i~ "_,~ ~yO ~ _~~ ~ .~. Pg.l LOT PLAN VIEWS 4 Z SYSTEM CROSS S & SYSTEM PLAN VIEWS {REVERSE SIDE ~.., DETAILS INSPECTION. PIPES & FABRIC/TOP FILL DETAILS) Pg.3 PIPE LATERAL LAYOUT (REVERSE SIDE SHOWS DETAILS OF LATERAL CLEAN O~7TS ) Pg.4 DOSING CHAMBER CROSS SECTION & SPECS. cx Pg.5 PUMP PERFORMANCE SPECS (REVERSE SIDE SHOWS PUMP DETAILS) ~ Pg.6.0i~ERATION, MAINTENANCE REQUIREMENTS (REVERSE SIDE .SHOWS SYZ'}~!: & SPF.CTFTC PRf1.TFt`T T1FT~ TT.T,`T1 TNF(11?M~TTf1HT _ TTATTlITT'G` T!1 ~r' Date NAG' .Z~ • !~w -Phone 7~.5. 7~~ • ~~,.,s~ ~~•S. 5~ot S vo/ 3, P~. c~~~ County ST• Cho i ~ Installer 0 ~ V` o fi N Z G ~~£z v ~~~~ Q l PA GE ~ of ~ ~ KEY; ~~ ac"~~~~: aQS It1DiCATED go(L! N~tr; • ~o~ttdUR: ,. 5c-A~ E : ~ ., t 3 0, ~ s s"9 L /~ ~, ~ ~ '~ j ~ r~ ~ ~ ~ ~~. d0+ tf1 a ~~ ~~ ~ • n b ~ ~. /~ ~c `ion ~,}~ I ~ mQ 3 o ~ t ! ~ ~ ~ ~ ~ Y ~ ~ °. a t` ~ ~ ~ r~ i ~,, l w ~^ w t o ~, ~ ~~ ~, ~ ~ iwt~~ / '', o~ 1 ~~ ~ / "" ~,,, ~ j `~ ~ ~ - -~ ~ ~ °~ ~ A r ~ ~ Xi ~ ~ 'off Z ~ ! ~~ i ~t t i g ~£~~n S ~ m r D z ~° ~~-~ ~ m ~ ~ vs ~ °- co ~" -° -~ ~~ ~C e~ ~ .-.. ~ `~ ~. m ~ y ~~ Q Pa.oQ, ~N6 ~~~ ~~~~ ~ ~ O~ ~ ~ yo ~ m ~b ~~ 3 3 ~~~~ p v ~ _ -- ~ ~ ,~ ..G -p ,oa p G a'- ~ C! ~ ~ '~ C 25 Z m c~+ C g ~~ AD3 D c ti Z~ ~. p° p° m ~° ~ O ~ ~ ~ ~m ~ ~ o `~ V y' ~ \ ~ z ~n o `~" ~ O O .O ~~ Z N ~~ .~ 3 ~ ~ A d ~ °~ . ~ F ~ °° W w ~p ~ C ~~ ^~a mo ~ ~rq ~~ ~~ i ~ U Zz o^~,mpn z '~~ !:~ ~ ~!> ~~~ f~~ .~ ~, Cf2y55 SECT ~O1J O~ Iy1DU~ D ." ~ w i T t•} ~3ED D~ z°~3 Cs, Tkick,~sE'Ss °F '-'° P SOP L U73i Ft~RM L-~'~ E T©~' DiST~2if3UT4o,V P l p t,~ C,- r~v~ T~iQi4l.U~ cjo's. L -.----.._._..... 3 ~ j~~ j RRT-O • •,. MED. .•. I ~ • . /f/~Piow6D TopSoi L 1~/ ~11/ ~t ~1 ~o stopE ['LAN tlttw r~~ Mou~D - w~rt~ t3~D C L'',c9 Tf~PA-~ FdRc,E M>~IN L i t=oR~~ M/W~ OEV of % " ro ~ ~.~ A~g~~SATE s ysr~M E IEVh T'io~1 ~~ 111 ~// f ~h V ~3 ~ Fb (21'1 E ~ ~vnroa u,~ oER t3ev 13• s o ' E ~•a2 Fr.~/3") ~ r• ~~o - iluv~RT of ~ y ~, 1AT~Rh~S F • g~ FT~ . • T o p o f R o c~ 1~'.~. /~ 5' ~ 9 1 ` ' ~ ~ D FT. . ~ I ~r~ R ~ ~ s °P ° F ' r ~~ a i T ° ~ ,~ ~~ ________~_,__ ___.~ ± i k ~~ ~° ~ r _a u ,h ~ F r• ~3 io0 Fr K /~ F r 1~ ~~ ~ r ~ FT T /~"" Fr Ut! Z-1 ~~ ~ `RED aF /~.t \ Pvc cApp~p Tb i y" Aq~ R~1r~;T~ d(3SERVhT~a,~ P f pe s /oc~s-T~avs : /~ ~'r- ,~ F~o~ ~"~v p ~ OF cE,/. PER1~iha EnsT t~ hR KERS (Ta~S D ~ Gl~-,4,v O c9 j ~S' w ~~S~ ~ ~ ~ Observation pipe f Distribution ceff ~t , ~.. Fi11 materitE! f' Cotter ma#eriai (ASTIR C33, fine ~' ~ ~.` a99rer3ate) _ - ~ - y- ,___ '~-Ti!!ed area {~---Slope Force main . Figure 6. Cr©ss-section of a Moe3nd System Vlrater Ught cap ~` min. dia. Top cauptings 6"min. infiltrative surface Water Ciosei Collar Bar(3/8 j(nin. dia j figure S -Observation Pipes ~ ~~ - _ ~~~~~ ~ . v~~~ ~~~~'ot~~~~ ~ - _ spiv- r~r~~ qtr ~~ itr ~~~ i . ~ ~~~~~~ 4 v~~~ << ~ `' ~ o . ~~~- -~ L r{ rt ,. __._~- - ;D ts~Ti~ QU1~D~ ~ ~i~E' L~4~ DU7+ ~EtJTk~4t.. Fn RcE- MRt'>v a 5 Fr. _ __-- ~ ,~ ~~\~ -+ ~ :Puc _' r~ . 5 ~ ~ (o ``~ ~~ p y8 Fr ---_____ R z- i" r x .3 (o y i8 --------__ di`tc ~~Rt~h(3lE ~ •Di ST~a C~ ~ _ToTA~ va~o Va1U~rE ~~ GtilS. ~ ©IE ~~i4}1ET~R j-•"hT ~ R~ L +t .'EJt3T~~ ~~tJ ~ F L7L p ++ ~- ~t~RcE MAiN ++~~' , ~ , NGN~S ~ _ d~ t t{ ES Z i uG!{~S /7 SEA ~~VE~'SE StaE' ~.0~ ~E I~4i (_ ~ PER FoR ATE D Pi QE i.Z i `~~ • R~MovE- ~'!li Rill 13uRR5 ~ ~ y ,S~ •~ HorE s l ocA ~ '~i/ T a b o,~ t3 o tTo M B E t~ v~ t t Y ~ ~'sTRE 13vr~a,~ T~tsch ~Q ~ ~- „. ~__ ToT~s~ f/o%y~ °P ,~7tva,E'K /7 .LuvERT ~l~Vi1TtC o F L ATi~ ~~15 , ~y ~~ ~1Pi ~i c~- D~v S%r~ g. S~ s~. ~-r~ ~~~. ~ ~~' s pAc~ v , .• ~DE r~11 L o ~= LA-TAR/! L ~~O /~~PES• o~~ ~ i L /t ~ ~,v~ o _ ~ ~~~~ ~'~T~~~4-L . ~~ 1 Vi -- J il/ ~_ I// /it ------ _ ___-__ L,~~vv S~iPiv,~~ "y~!/U~ ~~ /3D~ ~rE-v TLS . ~~1 y5~, 13E,~~ ry~~~~~v ~~i,gi~ ~9~~/~rE~ ---_. /BUG' 1.3~// v~I /U,~= G-~9 r-~ ~. ,~ . ~~ ~G_r ~S ~~~ P SEPTIC TANK ~••PUMP CHAMBER .::.CROSS SECTION AND SPECIFICATIONS 4` ~, 4" CI VENT PIPE 12" MIN. ABOVE GRADE ~ ~I ? LO' FROM DOOR, WINDOW OR FRESH AIR INTAKE Z ~~ ~r, _ ~~ 5.a INLET ~/, a .~--- ~~ StD. 4Ci PtK Pi Pte; ;'gyp SOLID SOIL il~ ~.. '~~ F ~ __ _ Mo~~~ #' /4"/bd ' zS _ PUMP OFF ELEV.~~' FT. ~ NS ~~~ t___r .-. (~ ~ G ~t 1 ~-'~' SEPTIC 1 DOSE TANK MANUFACTURER: !WEATHER PROOF JUNCTION BOX -WITH CONDUIT --a. ~ ., , f' GAS- ~' ~'t TIGHT i ~~ A !SEAL ~_ ~ ~ B ~ -- 3 ~ '' ~-- ~ i r~,~ 1 ~' ~ D 3" APPROVED BEDDING UNDER TANK v SPECIFICATIONS sN~~' APPROVED MANHOLE Ct Wl PADLOCf WARM NG Lt 4" MIN. ~* APPROV ID ~,~[ JOIN$S W/ N PIPE 3' OA SOLID SOII FF *~ RTSER F PERMITTID .IF TANK MANUFACTUR HAS APPROV CONCRETE PAD ~D~UCrs NUMBER DOSES PER DAY TANK SIZES: SEPTIC /00 D GAL. L•~P /''100~'L DOSE C9S0 GAL. 5.3 -~_ DOSE VOLUME INCLUDING C~ T/o D ~ . F LOWHAC K : ~~ / GAL . ~Y ~ ALARM MANUFACTURER: MOD L,~U~/ ~~'~'I ~2 • CAPACITIES s A = Z7 INCHES = D?~ G EL NUMBER : tJ L SWITCH TYPE: ~/p,4-r- ~ B = 2 INCHES = 3J G. PUMP 'MANUFACTURER: ~ 2~~~1~/ / C = 7 INCHES = ~~~ MODEL NUMBER : J~ 1 N'P L[~ tJ J 6, SWITCH TYPE: _ . ~ ~~Y13A.~~ F~o~9-7""' D = ~ INCHES = ~~3 G, ~ t~ REQUIRED DISCHARGE RATE /.S GPM ~ PUMP ~ ALARM WIRING . AS PE R ILHR lti.23 ~ VERTICAL DIFFERENCE + MI I~IllM NETWORK BETWEEN PUMP OFF AND DISTRIBUTION PIPE - ~'~ FEET ~ SUPPLY PRESSURE + ~ ~jj FEET FORCEMAIN X ~•EI FT/100.FT.•FRICTION FACTOR . ZS FEET .. FEET /~, TOTAL DYNAMIC HEAD =. ~~~ FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH aaZ. v ; WIDTH gy ~ r ; DIAMETER~.~ LIQUID DEPTH ~ ~ ~~ SIGNED: LICENSE NUMBER: DATE: THIS POVVT INCORPORATE SYSTEM SHALL PER COMM. p C~C -- SPECS •- 83.44(2)c A D PROPER ZABEL ~~~~ ~ 4 ~~ =-~E~ FILTER MO EL # ~, _ fd ~ "" ~~n G Fl ~T~C s HEAD/ W CAPACITY ' CURVE SEWAGE and DEWATER/NG i 2i 2i x ~ 18 Q W s 16 V ~ 14 Z 1r ~. 12 J O --~ 16 6 . 6 4 2 0 GALLC LITERa u EFFLUENT 2 and ~ DEWATER/NG ~ a ~ to 0 ~ 16 F ~ 14 12 ~ 10 a 6 4 2 115 110 ~? f~ 5 105 ~, o 100 - ~ ~ . 7g ' MO DEL MODEL 189 18 5 70 65' Bo 55 ~ MO DEL 1 63 MODEL 188 ~~- 35 MO DEL 2s 137 38 1&S 1g MODEL MODEL 181 10 7 MODEL 5 53, 55, 57, 59 10 2i 30 40 SO BD) 70 80 1 60 100 ~ ~ ~ ~ 4 110 "13T' Cast Iron Series "139" Bronze Series • Automatic or Nor:-Automatic. • 'h H.P., 1 Ph., 115V, 200-208V or 230V • 'k H.P., 3 Ph., 200-208V or 230V. 80 180 240 320 400 FLOW PER WIINUTE OELLER O_ 3280 Ok/ MJNsrs Lane P.O. Box 16347 LoulsHNq, Kentucky 40216 HEAD CAPACITY UNITSJMIN Peet Meters Gal. Ltrs- 5 t.52 104 394 1 C 3.04 79 3C0 is a.s~ sa za2 ze s.ta 3s t3s au 760 240 320 400 180 580 610 720 FLOW PER MINUTE Mound System Management Pfan ~ f D ~•~ Pursuant to Comm 83.54, Wis. Adm. Codes ~~. septic rank - The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48. State. The contents of the septic tank shat) be disposed of in accordance with NR 113. Wis. Adm. Code. The operatirat pxtdiliort of the septic tank and outfit RRer shad be assessed at least oirtce every 3 years by inspectbn. The outlet fitter shalt be leaned as necessary to ° ensure proper operatbn. The Rifer cartridge should not be removed unless provisions are made to retaiit'solids in the tank that may skx~h off the litter when removed from its encbsure. If the Biter is equipped wRh an alarm. the finer shaft be serviced the alarm is activated continuously. Intermittent Biter alarms may indicate surge Rows or an impending wntinuous alarm_ The septic tank shah have its contents removed when the volume of sludge and scum in the tank expseds 1/3 the Rquid volume of the tank. if the contents of the tank are trot removed at the lime of a triennial assessment. maim®reance personnel shy adv~e the owner of when the next service needs to be performed to maintaM less than maximum spun and slue acctamdatkm in the tank. The addition of biok~gical•or chemical addilhies to enhance'sepBc tank perfomtartpa is gerreragy trot required. However. if such products are used they shag be approved for septic tank tree by the Department of Commerce, and Buildings t7Wiskm. ~ _. Pump tank ' The pump (dosing) tank shalt lie inspected at least once every 3 years. A11 switches, alarms, and pumps shah be tested to verify proper operation. tf an effluent filter is installed within the tank iE shall be inspected and serviced as necessary. Mound and Pressure Distribution stem No trees or shrubs should be planted on the mound. PlantMgs maybe made around the mound's perimeter. and the mound shag be seeded and muk:hed as necessary to prevent erosion and to provide some protection from frost penetration. Tragic (other than for vegetative maintenance) on the mound is trot recommended since snit corr>Fraction may hinder aeratbn of fhe infiltrative surface within the mound and snow compaction in the winter wiR promote frost penetrrtkm. Cold weather installations {October-February) dictate that the mound be heavRy mulched for frost protection. influent quality into the mound system may not exceed 220 mg/l BOD5, 150 mg/t. TSS, and 30 mg/L FOG. Influent fkwv may not exceed maximam design fksw speciRed in the permit for this installation. - - The•pressure distribution system is provided with a flushing poinE at the ertd of each latest, and it is reco-nmenbed that each lateral be flushed of accumulated solids at least once everyl8 months. When a pressure test Is performed it should be compared to the iriflfal test when the•system was ~staNed tti determine if orifice dogging ha"s occurred artd N orifice leaning is . required to maintain equal distrR~utkxt withM the dispersal p~ii. - Observation pipes within the dispersal cefl shag be-checked for siflue~nt ponding, Ponding levels -shall be reported to the ownor, and any levels above 4 inches considered as an impending hydsulic failure requiring additional, more frequent monitoring. General ' . - This system shag be operated in accordanp3 with Comm 82-84 Wis. Adm. Code. and shag maintained in accordance,wtth its' component manual [SB©-10572=P (R. lilgg)] and total or state rules pertaining to system maintenarx~ and mafntenanp3 reporting. . No one should ever enter a septic or pump tank since dangerous gases maybe present that coutdycause death. Septic and pump tank abandonment shag be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no kxiger used as POWTS components. Septic br pump tank mantrole risers, access users and covers should be inspected for water tightness and soundness, Access openings used for service and assessment shall be sealed waterlght 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 shag be secured by an effective locking device to•prevent`accidental or unauthorized entry into s tank or component. . Contingency plan ~ ' if the septic tank or any of its components become defective the tank or component shalt be repaired or rapt: c:ed to keep the "~ system in proper operating condition. ~,~ tf the dosing tank. pump, pump controls. alarm orretated.wiring, becomes defective the defective component shall tie immediately repaired or replaced with a cromponent of the same or equal performance. if the mound component fails to accept wastewater or begins to discharge wastewater to the ground surfapa, it wN He repaked or replaced in its' present Ioption by increasing basal area if toe ~akage occurs or bS+ rerrtoving biologiglty c;bgged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring tfre system inho proper operating ~ndition. - Questions on the operation or maintenance of this system should b® directed to your oaunty zoning or health inspector. SEF REVERSE SIDE Pg.6 FOR MAINTENANCE-REQUIREMENTS SPECIFIC TO 't'If tS SITE, DESIGN, AND COMPONENTS OWNER's MAINTAANCE ~OF~ SEPTI-C SYSTEM ~ ~ , POWTS (landowner} is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary far the safe healthy operation of, this system. The owner is required-by code to submit all necessary maintenance/inspection-reports to the controlling ,authorities. SPECIFI C CONTACT AGENTS $T . c2 o i x- . c~-y. * Governmental authority/ inspectors: 20'v ~ ~(~.- ~~7` ~ l .s -. ~ ~Co ~ ~l X80 ' . * Licensed installer, responsible for maintenance."Users' manual: Providing an operation/ `t t s ~ -~-~~ • 3 ~~ Z R. ~ ~~ ~t'c f~~- M pis ~ - ZZ.l~ 3 ~ S * Licensed serv~rce I inspection ;agent other than installer: ~1PI -" GT'~ -5.4~1.'T>9-TiQV ~ll~-l jar ~ ~- ~ ' ~ . '~ Electrician,-for pump, electric controls, wiring units: 1. 2. 3. IMPORTANT OWNER MAINTENANCE RE UIREMEMTS Winter traffic (sledding, shove~ting, etc.} across the area sha11 not be permitted, or frost can/will penetrate into- the cell, freezing up-the system. Discontinuos use in the . winter.{a yacact3on.trip, resulting in no water use} can-also lead to freeze ups. _ Water conservat-ion needs-to be exercised! Or system can be hydrolically overloaded and destroyed. This svs¢em was designed for a maximum wastewater flow of . ~O~Q gals. daily- POWTS are not designed to accomodate wastes from a garbage;.. disposal unit, or any other unnatural sources of waste. Any introduction of such waste 'materials will overload:and destroy this system. 4- If a power outage occurs, or a pump fails, it mayfiresult in a temporary overload of effluent being pumped into the cell. which may adversely impact the cell (leaka'9e}. It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. ~. Neglect of the ve . erosion getative~~~cover (the. cells insulation ~ preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE- VEGETATION OVER A SYSTEM!! Effluent in the.~Ystem beneath IS NOT sufficient alone t0 maintain a ~1 .cover. .e ~• Periodic inspections b necessar Y the owner, or his agents, is Y- Inspection pipes and ports have been incorporated fnto the system: on the mound ha~a> >....- .__-- inlano.,a s __ _ a vin oep~nettE or C~ SUf L E~l/4LtJl~Tf Qf~f ~if~ PC}R3' p~ ~ ~ ~. Div3s£arsc~€Sais~yand8t~ in a~ .Wis. Adm. Code ,s~ttacts carnptete site plan ors paper not less #~ ~ Ii2 z 11 i inclurl~ lx~ not wed to: ver#ic~t and ! [ ~ Pla ~ J ~ . ` 1~0 / X a r er~ce i percent slope, state or c~rrsensions, nortts a ~ sst {Slat , d s _ Parnei l:Q. o/ { X0/3-30 000 Pease ~~ ~.~ . ~ ,ate PeMSOnsE i~tomu6«e 7P'~ ~y 6e esseA tii'wacy triv,:w 5_ irt)). /Z /L d Owner p ~ . AA ~Vl d and Sh i r tt e,~ ' tot ~ ~ 11a ~ 1kT 57 r z 9 N lz ~^] E {~ PtnperiyOwtte~sitdait Atldcess ---._ ~~Q~ ~/_O't'N S~' __ # titockll &~ar~ • UDC 3- P . ~i(o State ~ Gode i~xuse l F1~M ono W' S`~515 X715 ~ -54.59 f~ Cry f~ ViNa_ ge ~ Ttswn N ~wDND l~asesf Road t l6b'" 5t • _ _ --- ~ t+Te,~Gons~ Lls~. Rasider,~ral 1 Nrarst>er or bedrooms t;ode derived aes~rs ttanr ra6e GPO Q or oonxner+~ P:na:st rtk'~tefTal '7~i /~s ~, 1f' ~i~ Ls O U4ra ll7fS~GY E7aod t'&~t ewe ifapp~abie _ ~. Generalcar>ma:sis CC~'M~.~!"~O .S/~,~QSfpvE ar~d /~FS%DU.4l $' Area K Spot Tested suitab~le~for~~a mOtutd {P.O.W T S.} system using .z..... ~- - _ 2 ~ '~ .~ ~ P~ t; stxtace elev; q a ~ 59 e Z C4 . ~ ~ iac~r ~.`.. ~ Rage l ~ Redoos f ors 'imchse Stsue Oorssistes~ Basrsdasy Roots GPO/!l< in k[ ~ . s~tss E,~ Sz. C.orst. Coker Gr. Sz. Sh. 'Et~'l '~2 - ~ D^ll 4123/1 -- ~ am bK Ct~/ ,3V-~ ~ (o • ~ a 1- f? 0 2 3/ - i c I a m b hn-F'i C w v-f ~}- 3 -a~ ~o~R ~/ - S ~ CI •!~ rae bK v-f-; w I v-~ . -- E #t =1308 > 3p < ZZa ~, and TSS >3Q < 950 mgAL ' ~ #2 = 8t?i'? <30 mg~!_ and "rSS < 3Er ~ C5I` itfe~me i Punt} e ~ - n Gfr./b _~ ~. ~5 ~`~~ ~lr>ra>~ a~~a t b*'r ~,~. spri h~ l/a i/e y, Wi No /. a t, 2oa~ ~ ~ 5 • ~rra • 3 ~~a ,~ 2 ^ ^ - . :^Qr^t~c -_~~ CiG~ i.7u~at,iY ~.~. s ~ L ~ otry o', 9~. _ ~ G p S ys~,y ,;v ,vov . co~E- co.~,0 /i~•v% foils ~'s~-~u~~,C'e~ Before local zoning permits can be ggranted -THIS PROJECT WILL RE4UIRE STATE LEVEL PLAN APPROVAL. Plans will need to be submitted by a qualified designer per Comm. 83.22(2)(C)1. ~ u R lllF_Sb~l (~ ~ a ~# 6i~t,~~ -ooo ~ a d 3 ~ - ^ ~• }qj aawwl a~wwun aCY. ~ i • ~ ~ n. ~~ q wllww~ Iif~A v ~ • w^. .~ Hotlmn OeDft- Oomirrrnt Redooc Desafpf+a~ TexLre SUuc6ure Cecwe Sotrrtary ttootg C~P DAE a~. trtu~sef Qu. S'z Cant Color [~: Sz. Sh. 'lR~i '!~2 I - ~p't 3/, ---- i m bK m -~ 3r~F • ~ ~ - [bYR -- ~ o2~bK I»~; w a~ ~~ 3 -3~ ~0~2~/ ---- C/ ~ m bx ~v~i CS - .~ .~, '~' 3?-5`7 '7•S'r~Z4/ S I ~ m /Y- V~ U.W -- O. o O• o ~ ~ tiadmon ~ Oonitanf Redoot Destxipion Terd~re Stnrr~uue Cor~enoe Boundary Roofs CP DYIE ; ir. flu. &z. Cant. Color t1r. Sz. S'fi. "'~1 'E~2 ^ ~~ ~ ~ ~9 . e1 Pff Groturdsurfaaeetear. A QepO~fain>~rg~or Saii Role tiortaon C~ Dotr~irrt Redmc De~salpfion. Taxers Car~ice Roofs GPOA!° i~. flu. Sz. coot Color ttr Si 5ll. 'fit 1 'E~ a ~ ~ ~ ~ C,rarrd str'faoe alev R l3epfft irt- Brti6n8 fersor in. Horiaon DePftf Darninant Redorc Oesaip6an. T S6rr~re Oansistenoe Bourdery Rails in. ~. St. Cant Bator Gr. Sz. Sh `#t=60Qs>~<220~fgA_gdTSS>~_<150ngIL 'Hf~t#2=BODa<_~n~gll.andTSS_<~t~gll. ~. ~ ~ ~~ ,Zn `~ Z ~~£z v ~~~ II L u ~~ ~~ ~m o , £ ~~ a p w 00 w w ~ ..~ ~o ~. ~~~~ v ~ o & m ~ b L ~° Z ~ '~ ~ ~ ~ ~ ~ PAGE 3 of 3 KEY: 8a-~-~tnA~K= rQ5 rNntcnTEO Cn~ttouR: 5cAt~: ' ~ n ~ 3Q, P0.oP, ~n-6 ~ m ~ ce` 3 ~ ~~ ~ ~ r m i ..lJ w ~ ., ~ '~ .-- ( ~ ~ a~ q~ L W ~ ~ x ~ V "`~ .~ o -~ (/~ ~ s N ~ O ~ ~ oW w A ~~ c Z 3 £ ,~ o n ~ '~ E v o ~ ~ ~ ~ - - ~ C~ ~ Zm o0 D 3 ~ ~~ L ~ a ~ `,~? / - 1 ~ v ~ ~ N w z ` ~ ~t ~n ~ Z ~ Z m -~ t ° j ~ -~ ~ ~ O ~ 1 ~N "' O ~ °El .°° ~ m x ~° ~ ~ ~ ~ , ~ ~ ~ ~ ~ ~ N ~ l ~ Z Q" ~ A ~ t~ ~ X p ~ c~ _ r `~ ~ "~ o .._ ~. _;_ ~~~~L. ~~ ~ ~ -' . ~~~ ~!> j = ~ °> ~,;. 9 ~` P ... ~ ~ c ~~~~ ... ~ ~'1 ~s.~2ss i~ CERT! FIED SURVEY MAP I, Arthur L. Wegerer, registered land surveyor, hereby certify: That in full compliance witk the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St. Croix County Subdivision Ordinance and under the direction of Thomas Powers, owner of said land, I have surveyed, divided, and mapped said parcel of land, that such plat correctly represents all exterior boundaries and tlLe subdivision of the_ land surveyed; and that this land is located--in the N 1/2 of the NE 1/1~. of Section 7, T29N, R17W, Town of Hammond, 3t. Croix County, Wisconsin, to-wit: Beginning at the NE corner of said Section 7; thence South along the East line of Section 7 294.73•; thence S89°40'44"W 665.96*; thence NO°43'36yW 294.73'; thence NBg°40*44"E 669.70' to the point of beginning. Said parcel is sub3ect to a roadway easement over the Northerly 33' and Easterly 33* thereof; also A parcel, described as commencing at tke NE corner of said Section 7; tkance Sg9°40*44"W along tlee North linty of said Section 7, 100yy...']O* to the point of be~inning, thence SO°43'36"E 294.73'; thence S$9°40'44"W 321.61•; thence NO 18*36"W 294.73•; thence N$9°40*!r4'-E 319.47' to the point of beginning. Said p~~osslr„~,,~~ subject to a roadway easement over the Northerly 33 * thereQ,~`SC Q f~fS~'••,,.,~ ~• ,E. ••. ~i r A/PROVAL OF THIS MINOR SUSDiVIS10N~ ~ A~ ~F ~R •• ~ ~ r,L ~ DOES NOT M:AN APPROVAL FpR^ „~ ` AUg ,28 197$ ti BUILDING S+7c OR SEPTIC SYoTEM, ELLSWORTH ~ ~ ~ ~ O• REFER TO H62.2Q Z ~, ' WIS. ~ ~~or p~~ ~ c''°n,y Dated this 4th day of 1~~~. ~ •`~~ pl_ ~0 ~~. APPRQVED •,~`"'~'~~,, Arthur L. Wager r Al! G 2 3 1978 S+. _ . ~:.. _ _ . . COMPaEtL-eNSIV~ Yn+cKS PLANNING ANp ZOWNG COMMlttrai O I"X 24" IRON PIPE WEIGHING 1.13 LBS./LINEAL FOOT • IRON PIPE FOUND W CDR. OF SE7C. 7-29-17 00 319.71 ` ti0 v ~~pp O fv0'. ~c9'~` N IA ~ LOT I N M a ~`LO es~, o ~' 321.61' ~ ~~ N S 89°40' 44" W Wis. R.L.S. No. 3-963 Dittl off Engineering Coo River ~1~0 02 Falls 1 ~ S ACREAGE vo TH rs LOT 1 1.93 AC. EX. ROAD THE EAST LINE OF L07 I 2.17 AC. INC. ROAD SEC.7-29-IT 4S LOT 2 2AI AC• EX. ROAD BEARING NORTH LOT 2 2.27 AC. INC. ROAD {gSSUMED) LOT 3 1.80 AC. EX. ROAD LOT 3 2.25 4C • INC . ROAD SCALE 1"=200 100 O 100 200 300 400 NE CDR.. OF SEC. 7-29-I s 89°4x'44"w - - R4AQ s 89°4o'44W -~ 669.70' ~ 335.00 )ji _ 334•~`~ _ 334.85 890~ 334.85' ~ 3p 1 .43 ` ~; ~ p ~ ~ ~ vJJ ~.f' N LOT 2 ~ N LOT 3~ ~ •l o `~ M N $i F o Z ~,ya o ' y ~ s•, a I v~ 335.00' 334.85 Z 298.11' S 89°40'44"W 665.96' ~ VOlume 3 Page 668 E I/4 CDR. SECT-29-1 7 78- 101 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM caner Buyer ,(~ ~..~ ~ ~;~, Mailing Address f o g o f 6 0 ~. $f, Property Address ~ saw-. (Verification required from Planning & Zoning Department for new construction.) City/State ~ ~,vrvwurr.-~, ~ ~ Parcel Identification Number of ~ tdf 3 3 a p °o LEGAL DESCRIPTION Property Location /~! E y , ~ y, , Sec. 7 , T~ f N R / 7 W, Town of !-1 Subdivision ,Lot # ~ Certified Survey Map # ~ a~ ~ ~~~ ,Volume „3 ,Page # io68 Warranty Deed # 3 7 7~ Z 7 ,Volume ~p ,Page # ~ 7 ~ Spec house ^ yes ono Lot lines identifiable yes ^ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 Planning & Zoning Department within 30 days of the three year expiration date. 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of ooms ~1~i~a6 SIGNATURE O APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05)