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HomeMy WebLinkAbout018-1096-01-000isconsin Department of Commerce Safety and Building Division GENERAL INFORMATION Personal information you provide may be Permit Holder's Name: Ulferts Family Trust PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) for secondary purposes [Privacy Law, s.15.04 (1)(m)]. City Village X Township Hammond Townst sv: BM Description: ~~~ ~ , cv~ ~~`f /3Jt~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ' v..~~ ~- ``~- r+ ' o ~' w / c> r~©e Dosing Aeration Holding -.___ TANK SETBACK INFORMATION TANK TO P/L WELL BL DG. Vent to Air Intake ROAD Septic ~~, ~G~ a 4 ^7 CL -_. -_ •~..._~ Dosing ~ _ ... Aeration Holding ;~ '° _...... ~ PUMP/SIPHON INFORMATION Manut~turer Demand Model Num~r TDH Lift 'ction Loss System Head TDH Ft Forcem Length Dist. to Wen .--" ELEVATION DATA County: $t. CrDIX Sanitary Permit No: 430259 0 State Plan ID No: Parcel Tax No: 018-1096-01-000 Section/Town/Range/Map No: 09.29.17.776 STATION BS HI FS ELEV. Benchmark ~ , I ion ,~ I per. Alt. BM ~ ~ ~~, Bldg. Sewer / ~.) ~7.~ St/Ht Inlet 5L ~ ~ ~- ~} 74!5 SUHt Outlet SZ ~~.5'0 Dt Inlet Dt Bottom Header/Man. • 6.'S ~Jr-~o0 Dist. Pipe Bot. System ~~ ,w 7; 9 ~N• Final Grade ,/ St Cover ~ ~ /DO, Sf)IL ABSORPTION SYSTEM f~C:~1LG~Nt,~w?/1e~/ ~O~.t.1/~ BED/'rRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS w~ ~ ~---- --- ~~, SETBACK SYSTEM TO P/L BLDG WELL _ LAKE/STREAM LEACHING Manufa~ar :,, INFORMATION ''"~"~ CHAMBER OR r ~'-1'v ~h- M Type Of System: G~ ~ ~ z,~ ~1 ~ .- ~-~U , ~ ~~ , ^! 3 T- UNIT ~ Model Number: Ste- ~-~ ~ ..~ ~ ~ cL1w>v . DISTRIBUTION SYSTEM '~_ __..... - ~~-~~~ ~ ~ ni,r.. ~Y , ~ ri. .~. vrc.. -L.-~ Header/Manifold Distribution ~ x Hole Size x Hole Spacing Vent to Air I nt ake r _„ th ~ ~ L `'~ pipe(s) _..._.. _ _..,,.. _..,.~7~ _ _._. _ j ~ eng Dia Length Dia Spacng ~C/ SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over Bed/Trench Center ~' i 3 3 - Depth Over Bed/Trench Edges ~". xx Depth of Topsoil xx Seeded/Sodded ' xx Mulched .. _._ ~___ _ _ 1 No Yes i , ~, J ~; Yes i ~ No COMMENTS: (Incl a code Iscrepencies, persons present, etc.) Inspection #1: /d' l Z`j / G~~" Inspection #2: / / b~ L ,~ ~V~ Location: 1094 174th Street Hammond, W~ 54015 (NW 1/4 NW 1/4/9~T29N R17W) )Pheasant Ridge Lot 1 Parcel No~J•J\09.2 .776 ~j"~ Lpn L/a-.~Q. [.C. r~CY I~ A~../ F-/i ~~[/L~C T~GV 1.) Alt BM Description = >6a~c ~ U ~9q, a/ ~ ~ 97 ~p 2.) Bldg sewer length = G 3n' / ,_ -amount of cover = Cry v rte,-..-.~ -~-~,~ ~~T i n S~(~ ~ `1/ ~~ ~ + ~j`~ / ~ ~">~ ~. ~'I'~-' C~...~ ~ ~~~ . ~~ W'Z,/ ~ r~ l ~ o/y/1 --. -- - _ -- -- _ y~-_ .. revision Required? Yes I No ~~ ~ ~ Zg ~ G3 J _~~ I L~~' _` ~"c_ _-_ ' ether side for additional informati n. ~ ~ Date Insepctor s Signature Cert. No. 10 (R.3/97) Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 C~h' ~ Madison, Wl 53707 - 71.62 ~ Sanitary Permit Number (to be filled in by Co.) ,~~~~ ~ (608) 266-3151 {~Z~2 ` J , Department of Commerce Sanitary Pernut Application ~~.. State Plan LD. Number _._ ersonal inform "on yo ~ ~ , -- - Code Wi Ad 83 21 ith C . .. , p s. m. . , !n accord w omm may be used for secondary purposes Privacy law, s15 lxt f> . '~ ~ ("- k ° ~ a ~ ~ . gject Address (if di$'erent than mailing address) ... ., x. / ~~ /~~~ 1. Application Information -Please Print Ail Information n, t~ f ~ ,, b -,o -Quo Property O er's Name ' ~ '" P el # Lot # Block # Property Owner's Mailing Address ,-. ` __ ~- ,_,R.. o n y Locati ~,~ ~ ~ ) /+t/f~/ '/., ~"~ %., Section City, to Zip Code + ~~~i l circle o ) T ~ N; R~E or~ l ~* s y) Qj ~ t , 1 . Type of Building (check all that app Subdivision Name CSM Number ~s, ~1 or 2 Family Dwelling - Number of Bedrooms ~ ~/ C ~ ~ ~. /) ^ PubGc/Cotrrmereial-Desrribe Use p2 S t ' ~ ^Village~Township of f~~ ^City , 7 ^ State Owned- Describe Use O _ 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) Q Q~(D " ~ (" ~~ • A' New System ^ Replacement System ^ TreatmenUHolding Tank Replacement Only ^ Other ModiScation to Existing System B. ^ Permit R®ewal ^ Permit Revisi~ ^ Change of ^ permit Traasfer to New list Previous Permit Number and Dace Issued Before Expiration Plumber Owner 1V. T e of POWTS S stem: Check all that a 1 ~ ~ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 nr. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized ln-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculatin Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less P~ ^ Other ( lain) V. Dis ersaUTreatment Area Information: ~ t Design Flow (gpd) Design Soil Application Rate(gpdsl) Dispersal Area Required (sf) Dispersal Area Proposed (sf) Sys ~ vatio ~ ~ fj~ ~ , S 9c~ 33 • Vl. ank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Ncw Existing Tardcs Taldcs s~pa~v~+iri+r~nttk b00 ~~ / ~ ~ Aerobic Ttcatmcnt Unit Dosing Chamber Vll. Responsibility Statement- i, the mtdersig d, assume nsibility for installatlon of the POWTS shown on the attached plans. PI s Natne (Print) PI Signet MP/MPRS Number Business Phone Number Plumber's Address (street, city, state, zi C Vlll. Count /De artment Use Onl ,Approved ^ Disapproved Sanitary Permit Fee (i Surcharge Fee) dudes Groundwater ~ n f- Date Issued ~/ ~/ 1 g Agent Signature (N tamps) ~ L• ~, ~ ^ Owner Given Reason for Denial 1K Conditions of ApprovaUReasons for Disapproval ., ]~ ., - ~ ~~ ~ 1 ' n Se a c bx dpi '~i e~1 S S~-~,- ~- ~~~e`~'~`'~^ ~1'`.t'ct ~ ~ vent _ (to t6c County oply m on pa r not Ices th~}n 91/2 i 1;inches in size - ~'~'! SBD-6398 (R. 01/03) 1 ~/~T~+'~~~ Y ~~~'~Y T.L. Sinz Plumbing Inc. E5609 708th Ave. ~ JL~~~S i~~~L ~~5~ Phone: (715) 235-2644 Menomonie, WI 54751 ~~ [/ ~y Fax: (715) 235-2592 Gp ~ ~ ~1~E,4-s~-~ivT' /~(G~~E www.tlsinzplumbing.com ~D ~l~f / 7~'`~ S~ ~c/G~ %' /V w /y~ S 9 Ta 9 ~°/ 7 w Tt,~~.l D r ~ M,~ I ~ ~~,~ ~ ~ 7 ~~u~ ~r ~ l A'~I ~~~o>~ Z- 2~ ~ ~ ~13~3 ~N~l ~o ,v ~~~~ ~3L~ ~`l°v~~ ~~ ~ I / ~°'~ ~ (J/-~°~js tr~i'fiK~L ~,~5~ Phone: (715) 235-2644 p`~ Fax: (715) 235-2592 ~l~E.,¢Sf~ivT' /~-IG~c~E www.tlsinzplumbing.com 7~ t~ Sl ~vw y~ s 9 Tag ~i ~ ~ D r iN M~ ~~u~ ~~= ~ t=i l~-~~t-~0-~- C ~s ~, r=F~eu ~~ (o 0 0 ~ ~-cf ri-1 ~3L ~ V~ `(u v~~~ v T.L. Sinz Plum ,ping Inc. E5609 708th Ave. ~~ Menomonie, WI 54751 ~ " 1- ~v % ~ ~D ~~ ~/~ Y~ ~~~ ~ r a-~I ~~~ ~~ ~S ~ Wisconsin Department of Commerce rlivicinn of Aafw}u and Bul7dinn3 SOIL EVALUATION REPORT Page ~ of _ - - in accordance with t;omm e5, wrs. AORI. ~oae County (~ v ~ Attach complete site plan on paper rat less than A 1/2 x 11 inches in size. Plan must include, but not Ilmited to: vertipl and horizontal reference point (BM), direction and north arrow, and location and distance to nearest road. scale or dimensions ercent slo e parcel i , p , p Please print all fnfolmatlon. R ed by Da}e~~ ~~ ~ / , Personal information you provide mey ba used for secondary purposes (Privacy Law, s. 15.D4 (1) (m)). ' ` Property Owner ~~ ~. ~ ~~/ Property Location Govt lot ,// ~ 114,,(~(,~J 1!4 S ~ T Z N R , E (or)® Prop/e/rty Owner's Melling Addreyss` ~~ ~~~ Lot # Block # Subd. Name or CSM# a..sa ~,°o~ ~ Pl~ V / . Crty State Zip Code Phone Number ^ City ^ ~Ilage [Town Nearest R d ~6] New Construction Use: [~ Residential I Number of bedrooms ~_ Code derived design flaw rate Q ~ GPD ^ Replacement ^ Public or commercial -Describe: _ ---- -- - fl• Fbod Plain elevation if appticab _. P t t i l a J~ ~~ ------_- aren ma er a _- -_ _ General comments SY S~ ,~ t~ ~ .t t) ~ ~ P 9y ,~ ~" ` /• / ~i O d : d ti d ons recommen a an , ~,~~f ~~w Bormg ~''~ ____ ~ '" ~ / Boring # t~, p pit Ground surface elev. _ ft. De fh to limiting factor _ in. Sod A licadon Rate tion i D R d Texture Structure Consistence Boundary Roots GPD/ftr Horizon Depth in_ Dominant Cobr Mansell p escr ox e Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ - 3 a "Z -- S i 12 -F-r^ CS 1 J ~ 1 ~ ~_ io ,~ - ~s ~ ~ e s ~- r [ Z ~' 10 -` -~ ~ . .~ -~ ` Boring # ~ Boring ` pit Ground surface elev ~V~ ~ _ ft. Depth to limiting factor ~_ in. Sort A icatiorl Rate H i th D minant Color D Redox Description Texture Structure Consistence Boundary Roots GPDlft= or zon ep in. o Mansell Du. Sz. Cont Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 3/ -- s,~l h1 ~-- - ~ 5l -~ ~ ms I -- -- , z ' Eflluent iMl = BODS> 30 < 220 mglL and TSS >30 < 750 mg/L - tmuem ru = tsvu3 ~ ou mcyt. arw r ao - w ..~.. CST Name (Please P ' 1) i lure CST Number A clrvw ..~ s 3 Address Date Evaluation Conducted Telephone Num er 2~1 I ?~~ `6U~ S~ So~-.Q rSQ~- wl s'yoz.~ `~ " .~' c~3 y~s-7~ ° ~°~ ~~~ ~. r. Parcel ID # ____ Page of Property Owner ____ U Boring /~/ ~ Boring # Pit Ground surface elev. " t~_ ft. Depth to Gmibng fac6Dr in. Soa Uon Rate t Structure Consistence Boundary Roots GPDItP Horizon 2 Depth in. p.. Dominant Color Mansell la ~ ~a~ ~ / Redox Description Qu. Sz. Cont Cobr -~ -- ure Tex s' ~ S~~I Gr. Sz. Sh. m:Sh~ z ~ ~ w~,~~ ~ S c J~ -- •E~ rS- ' Eff#2 t zb ~~, raj ._ Zn~ s m ~~ ~ ~ ~ , . SO U Boring ^ Boring # ^ Pit ,Ground.surface elev. ft. Depth to limiting factor ~n• Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Mansell Qu. Sz. Cont Color Gr. Sz Sh. Sofl A liCation Rate GPDIfP 'Etf#1 'Eff#2 (J Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Sod A I'rcation Rate Horizon Depth Dominant Color Redox Desuiptbn Texture Stratton: Consistence Boundary Roots GPDfftt in. Mansell Qu. Sz. Cont Cobr Gr. Sz Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mgll and TSS >30 < 150 mglL ` Efiuent fE2 =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-N1)0IR.07lOlp '. ~~-3~'-3 ~O~" ~ ~f1Dl~S4./I ~ ~~~9,P ~~ o Rrn7_ -4-a~ o ~- 3iU ~~~ ~-P~ q ~v~`' g~~ ~U,v~ e ~~' ~J ~ ~ ~~, 1 ~. y~ I 4 ~ ~~ ~~~ ~~ ~~ i t~ ' -~( ~- ~ ~~-"' D~ q~, o~ Q~~oo C~~~ J ~ . ~'-S d~ i ^• ~.. , Vlii'sconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page .,_~___ of 3 m aawruance vnur wrrun ~, •ns. rwm. vwc County ~ Plan must er not less than 81R x 11 inches in size a Atta h c iete site lan ~ ~ . p xxr>p p p c include, but not limited to: vertipt and horizontal reference point (BM), direction and parcel I.D. O~ p .- v percent slope, scale or dimensbns, north arr~v, and location and distance to nearest road. . 0 lOg ~/ ~ ©/ ~ (~Q Please print all fnformatian. evie by Date Personal information You Pro'ride maybe used for secondary purposes riva s. 95.04 (1) (m)). ~, ~',{~y`~ Z 2 ~ D3 Property Owner RE party Locatio 6 ovL Lot N C 1/4nJ ~( 1/4 S ~/ T 2 9 N R ~ ~] E (~ W~ Property Owner's Mailing Address JUN ~ 0 2002 t # Block # Subd. Name or CSM# Rid io` ~~~ ~ ~ ~ City State Zip Code Phr~e ~rC O U N TY City ~ Vllage ~ Town Nearest Road - ~y I OFFICE / (D~ ^~ ~, New Construction Use: [~. Residential I Number of bedrooms ~ - `"~ _ Code derived design flow rate ~~C~~ (~ O[ l GPD Replacement Public or commercial -Describe: Parent material ~,/ ~ Flood Plain elevation if applicable ~~~ ft. General comments S~S~ewl ~ P U ~ / Cj ~ O C ~ ~, Q ~~. ~_ fo ~ 3G ti ~ c~,S~ SAP and recommendations: ~ ~ I . v r ~ ~ ~, V , ~ ~j; S`O -.. (~, ~"i~ G~ yn-tlw+s-ol ~ C~e.~i - nod ,.:-io~-~ ®, pit Ground surface elev. q$ . oC~ fL Depth to limiting factor ~ Z~ in. ~~' # ^ ~~ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsefl Qu. Sz. ConL Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ (~-~$ lO 3(2 ~ S~~ I 2 bk rrr~r ~ 5 )v~ ~ S ` S tJ pit Ground surface elev. ~~ fL Depth to limiting factor y g in. Soli Application Rate Horizon Depth Dominant Color Redox Oescripton Texture Structure Consistence Boundary Roots GPD/ft2 in. Munseil Qu. Sz. ConL Color Gr. Sz. Sh. 'Eff#1 *Eif#2 ~ D - D (©. 2 - Sit 2m cS j v~ . 5 • g ' Effluent #1 = BODS > 30 < 220 mgfL and TSS >30 _< 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si ature CST Number -~--~ ~ o Address Date Evaluation Conducted Teleph~e Number ~, • ... Property Owner ~n Parcel ID # ~v ` / Page ~ of Borng # U Bonng ~ L~~ in. Pit Ground surface elev. ` ' 9c~ ft. Depth iD limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Descriptwn Texture Stnrdure Consistence Boundary Roots GPDIRz in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. `EN#4 'Eif#2 l 0-15 t o I z. S.1 Zl~sbk c S 1 .5 - 8 ~fO 5y ~~.. `t ~o~ " m~ Os m1 _ ~ . ~ I . Z Ong # ^ Boring ^ Pit Ground surface elev. ft Depth to limiting factor in. Soli Application Rate rizon H th De Dominant Color Redox Descripti~r Texture Structure Consistence Boundary Roots GPDfft2 o p in. MunseB 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 Application Rate Fbrizon Depth Dominant Color Redox Descxiptia- Texture Stnx~ure Consistence Boundary Roots GPD/ftz in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 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 departrnent at 608-266-3151 or TTY 608-264-8777. SBD"8330 (R07/00) -~ PAGE 3 OF~ NAMF. ~6~ t e LOT# ~ T EGAL DESCRIPTION~IJE ~~ 14 ,S ~I T Z Q ,N,R, l ~i E(or~ SCALE:1"= 'i'U g 1 BM 1 ELEVATION /(~. d BM 1 DESCRIPTION ~,,p a -~ / ~~,pv c- ~ pe _ + -- BM 2 ELEVATION 9~ (D d BM 2 DESCRIPTION ~v~ ~~v~ Q.~2 ~ SPC SYSTEM ELEVATION /00, o U SYSTEM TYPE Y-~--f -(? - c1 ~ -e CONTOUR ELEVATION 9 9 S o ~ ~ o~ ~,f3 ~fi 8-l a 1 ~, C ~°7 ~ ~ ~ ~ i, b r..i _ ~O \~~ ~_L gqcP SIGNA'T'URE ~~~- --~C~__ __~ ~ ~E ~ -~ Q2. as 1 r ~ 1 `~O• ~ ~ A • m n -~{'' off, 1 ~ ~~ s ~ r0 ~ y ~ 1 . f OQ ~ ~ ~ ~ 25 1 ~ ~ 1 \~~ '• ti so ~; ~c ~ 1 .g, .~w ~ ' .. W . o ~ ~ o~ . o r. °- ~ ~. o ~~. n '0 ° 1 o , • ~ i~ 1 ,, ' Ste, 94~ O i ~ \ ~ ~a ~ ~ ~~ ' A ~ _ I ~ A ~ ~ \ A 1 \o v ~`` Ot~\ ~ ~Q` r0 ~ A, 1 ` • ~ ` •V ~ ~ 6 , ,Q\ ~. \ ~ ~ 0 0 1 ~ $ c ~ .\ 1 ` ~ ~ \~ ' 1 ~A 0 ~ +d ~:J . ~ ° ~ O ~ ~ \ S ~w y N \~ ~`~ ski cS \`~c9 G! ~ ~ ~ ~' C ~~ , ~~ O- 1 ~. ~ • ~~ ~ is ~ ~ 1 \2S ~' 0~ ~ / tn; ~ ~, ~ 04 ~L ~6~ 1 ~O \ ce, _ _ ~ ~ ~'~~ ~~ o L~ w o, 0 ` 4e • ~ ,A gyp. ~\fp ~ "~' V ~ cpey'~ ~ •` •/a.9 - " t~- 6'~ S 0 w ._ _ st ~ n ~~•~•..... a - ~ w oI1 ~ uo .~, .• __ ~ \ ~~vA"'~: min ~:ro~~ ~ ~• O ~ ~~ ~ 1 ~ to ~ ~ o ~ ~ i>, .001 Cn tp a ~~ ~ N ~ V ~ ~ O n,i IY SAFETY AND BUILDINGS ONISION Field Operations Bureau chi INSPECTION REPORT es wi sa~i9 isconsin ~w.commerce.state.wi.us Department of Commerce scatMoCadurr4Govemor Philip Edw. Albert Secretary Date of Inspection: July 18, 2002 Project Name: Pheasant Ridge Use: New -Residential Legal Description: NE, NW, 9,29,17W Lot Number: Lots 25-26 Subdivision: Pheasant Ridge Municipality: Town of Hammond County: St. Croix Plan Transaction Number: Sanitary Permit Number: Wastewater Flow: 450-600 gpd Persons Present: Jon Sonnetag Rod Eslinger ST. CROIX COUNTY 20~FFICE This onsite investigation was conducted because of conflicting soil and site evaluation reports by Henry Grote and Adam Schumaker. CST Schumaker felt that the contrasting soil colors of the substratum might be indicative of seasonal soil saturation. Two soil pits were reviewed (one on lot 25 and one on lot caiors w~ iHtryly ift`~p~ifEeti byw~ltet* ~ t+eElexkr~^~~,. . .. . f~ddl~ v event ~ofbrs o" ~ ~-~ ~~ streaks noted in the horizontal bedded sands are like due to uneven weathering of~minerals In the sand rather than contemporary redox feature formation. Recommendations for these lots include keeping the dispersal areas as shallow as possible and not to load the fine sand over 0.4 gpd/ft^2. Sizing example: 3 bedroom home 1125 ft^2 or about 37 chambers 4 bedroom home 1500 ft"2 or about 49 chambers if there are any questions regarding this report, please feel free to contact me L y G. J sky, ast ater Speci ' Ljansky~ mmerce.state.wi.us E- it 715/726-2549 Fax 715/726-2544 Voice Plumber Name and Address: Certified Soil Tester Name and Address: Henry Grote CST 222774 E 4366 353` Ave Menomonie WI 54751 -___._~__ Owner Name and Address: RECEIVED Ron Bonte 1011 170' St ~Ll~ ~ 4 2002 Hammond, WI 54015 ~: County ^ Plumber ^ CST ^ Owner ^ Other /~ ~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN. Page of FILE INFORMATION ~ ' Owner ~ ~.* ~~~~ Permit # 2 ~ DESIGN PARAMETERS Number of Bedrooms ~NA Number of Public Facility Units J~NA Estimated flow (average) ~ d0 al/day Design flow Ipeak), (Estimated x 1.5) '~.~d al/day Soil Application Rate . ~ al/da /ftZ Standard Influent/Effluent Quality Monthly ave rage* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (6005) <_220 mg/L ^ NA Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent Quality Monthly ave rage Biochemical Oxygen Demand IBODS) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Ys in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. SYSTEM SPEG1F~cF-1 wns Septic Tank Capacity ADD al ^ NA Septic Tank Manufacturer ~~ ^ NA Effluent Filter Manufacturer ~~,~' ^ NA Effluent Filter Model ~'"'~V D ^ NA Pump Tank Capacity al ~A Pump Tank Manufacturer /" "A Pump Manufacturer NA Pump Model ~ ~NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: A Dispersal Cell(s) ,,~'~n-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE 5CF1tUULt Service Event Service Frequency ^ month(s) (Maximum 3 years) ^ NA Inspect condition of tank(s) At least once every: ~ earls) Pump out contents of tank(s) When combined sludg e and scum equals one-third (Y,1 of tank volume ^ NA ^ month(s) (Maximum 3 years) ~ ^ NA Inspect dispersal ce(lls) At least once every: year(s) ^ month(s) D~ ~ ^ NA Clean effluent filter At least once every: ~ year(s) ^ monthlsl ~A Inspect pump, pump controls & alarm At least once every: ^ year(s) ' ^ month(s) ~NA Flush laterals and pressure test At least once every: ^ year(s) Other: At least once every: ^ month(s) ^ year(s) fd'NA L /LJ NA Other: MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certification: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tan inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leak: measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface The dispersal cetllsl shall be visually inspected to check the effluent levels in the observation pipes and to check for any pondir of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires tF immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the enti~ contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 11: Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatmei units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. *~ Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at'~he infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) in one large dose, overloading the cellls) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or,must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T e site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site ~aluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT 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 IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name /j,, N Z, G- NG. Phone ., ,. POWTS MAINTAINER Name TL. ~rN2 ~' N4 Phone 7lr Z~~~ 7i~ ~~ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ~~' ~ /ti! Phone Phone ~l a ` '~~~~ ~~0 This document was drafted in compliance with chapter Comm 83.22-21(bl(111d1&(f) and 83.5411), 121 & 131, Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGRBEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer K t ul ~t Mailing Address I yzo 0 avis 5~1. S ~ °~ . a'~ proporty Address I.o ~ I P I, eaSC-n~ Q 'f lion iced from Planning Department for new (Ven ica requ /` w ~ Parcel Identification Number o I ~ I ° 9 ~ - ° I - o e a , • ~ ~ City/State N-a, ~ o LEGAL DESCgIp'I'1<ON Location ru -'~4, Nw '/., Sec. _9 • T ?`t N- 1~ ~, Town of N QM,.~.~n d ~p~y - Lot # t Subdivision Volume °i .Page # 2 ~ Certified Survey Map # ,_ G B~ z 3 9 Deed # 5~~~`~ .Volume t3~F9 ,Page # ~~ Warranty Spec house ~ yes ^ no Lot lines identifiable ~ yes ^ no SYSTEM ~TNTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper mamt~ out the septic tank every three years or sooner. if n~oeded by a Lcens~ ~`t you put . consists of pumping can affect the function of the septic tank as a treatment stage in the waste disposal system. eirt a certification form, signed by the owner and by a The property owner agrees to submit to St, Croix Zoning DepartmVe~y~g that (t) the on-site wastewaterdisposal system mast,~rplumber, journeymanptumber, restrictectplumberor alicensed ~)~ ~ septic tank is less than 1/3 full of sludge. is in proper operating condition andlor (2) after iaspoetion sad pumping (' to maintain the private sewage disposal system with the standards ~, the unde<siga~ have read the above roquircments and agzne ~ of Natural Resources, State of Wisconsin- Ceriification set forth, heroin, as set by the Department of Commerce and the Departm Office within 30 ~~g that your septic system has been maintained must be completed and returned to the St. CSroix County Zoning days of the throe Year expiration date. 7 /Z, /03 inn po~ ~. ~ G)1!tJr DATE SIGNAT[JRE OF APPLICANT OIL, R CER'rIF~CAT~ON our knowledge. I (we) am (arc) the o~"meds) of I (we) certify that all statements on this form are true to the best of my ( ) descn'bed above, by virtue of a wam+nty deed recorded in Register of Dads Office. the property ? / z~ / 03 ~yi, ~ ~ DATE SIGNATURE OF APPLICANT «««1f1 «.«««« Any information that is nus-represented may result in the sanitary pmt ~~g evoked by the Zoning Department. warranty deed from the Register of Dodds office «« Include with this application: ~ stamPod~e certified survey map if reference is made is the warranty deed i DOCUMENT N0. QUIT CLAIN DYiD n ~1 ' ~i~1. Karl N. Ulferta and Ratherlna G. PlLerta, a/k/a Katharine 0. Ulferta, a/k/a Katherina UlLerts, a/k/a Kat• Ulterta, a/k/a Katharlna Ulterta, hus..~nd and wife :folding as sur~~ivorship marital property, quit claims to Karl N. Ultert• and Katharine 0. Ulferta Pamily Trust, Dine M. eonte, Trustee, Ronald C. eonte, lit Alternative Trustee, having full power to sell and encumber, the following described real estate in St. Ccoix and Pepin County, State of Wisconsin: See attached Exhibit "A- for real estate description. The purpose of this Quit Claim Deed is 'o terminate that occupancy right as originally reserved by the Grantors by deed ae originally dated Sep ember 1, 1995, recorded in St. Croix County Register of Deeds on November 1, 1995, at 10:00 a.m. 1n Volume 1147 of Records, Pages 22- a~, as Cocument Number 535679 and recgrded in Pepin County Register of Deeds on N~~~ember 13, 1995, at 9:OG a.m. in Volume 106 of Records, Frges 29i-295, as Document Number 093165. EXD;lPT PER WISCONSIN STATUTE 77.21(1) Thie is homestead~roperty. Dated this r day of August, 1998. ST. CRG„C CO., WI ( Rst'd 'uf Raac~d AUG ~. ~ 1998 ~ 3:30 F~ R.wh irr er e..d, NAME A.'JD RETURN ADDRESS Leo A. Beskar, Attorney F.ODLI, BESKAR, BOLES & KRUEGER, S.C. 219 North Main Street, P. 0. Bux 138 River Falls, iVI 54022 Pepin County 010-484-0000; 010-510-0000; 010-507-0000 St. Croix County 002-1026-80; 002-125-40; 018-1018-20; 018-1018-30; 018-1018-40; 018-1018-50; O1E-1018-60; 018-1018-70; 018-1018-8U; Parce I ent~fi^ation Nu, er (PIN 018-1018-90; 018-1015-G~; 018-1015-70; 018-1015-80; 013-1015-90; 018-1019-00 __ _ ___fSEALI AUTHYNTICATION Signatures of Karl N. IIlferte and at arina G. Oltsrt• authentic a 's da of August, 1998. Leo A. Beskar TITLE: MEMBER STATE BAR OP WISCONSIN lIf not, authorize by §~ 706.06, Wls. Stets. THIS INSTRUNHNT WA9 DRAPTYD BYt Leo A. Beskar, Attorney RODLI, BESKAR, BOLES 4 KRUEGER, 3.C. 219 North M.tin Street, p. 0. Box )38 River Palls, WI 56022 (SEAL) Ka~M. UU •zti ~^ Katherina G. Ultezta ACKNOWLEDGl~NT STATE OP WISCONSIN ) su. COUNTY ) Personally came before me this day of 19 t~ above Hamel. to me known t~ be the person(s) who executed the foregoing instrument and acknowledge the same. Notary Public County, Wii. My commission ~e permanent. II no~ration date: `. tq,, ;. •.;. +`K,~ Y ~1 ~~• t ~~~., ',.`yM `~;`~, a:. tab„L~ 9 ~:1~.: ~~; ,;fit {fin 1'Y ;'Vw'~ :~•`f J~~l~(+. t.fN"!'Y'K,~a rf {iT: '•'Sy ;-T?"~.~•" Y~`*,:,il~°'`~: t _.. _......__._....__.-__...._,w...~._.,...._..~_.._.__..._..._......,._ ....... ......... .._....__. .. _ ..___ __ ....._ _. .... - - _... __ EXHIBIT "A"~ Real Estate (St. Croix County, Wisconsin) Northeast Quarter (i1E 1/4) of Sectia~ Eight ($), Township Twenty :line (29) 27orth, Range Seventeen (17) West. AND; West Half (W 1/2) of Section Nine (9), Townsh~p Twenty Nine (29) North, Range Seventeen (17) West, EXCEPT Commencing at the Southeast corner of said West Half of Sect.ion'9; thence North on quaoter section line 341.8 feet; thence N82°W 340.0 feet; thence 552 W 170.0 feet; thence S39 W 170.0 feet; thence S56°W 263.7 feet to section line; thence East on section line 798.78 feet to Place of Beginning. i AND; South Half of Southwest Quarter of Southwest Q1~arter (S 1/2 of SW 1/4 of SW 1/4) of Section Twelve (12); And Northwest Quarter of yorthwest Quarter (NW~1/4 of NW 1/4) of Section Thirteen (13); j All in Township Twenty Vine (29) North, Range !Sixteen (16) West. Real Estate (Pepin County, Wisconsin) ~ I Lot Five (5), Block Two (2), Klampe Subdivision to Town of Pepin, Pepin County, Wisconsin. AND; Lot 4, B:Lock 4 of the Klampe Subdivision in ~~the Town of Pepin, Pepin County, Wisconsin; AND Part!of Lot 1, Block 5, First Ad3ition to~Klampe Subdivision, described as follows: Commencing at the Southwest corner of said Loth which is the Point of Beginning; thence North 46°8' East, 135 feet j thence South 43 52' East, 91.40 feet; thence South 80°1~4' West, 163.03 feet to the Point of Beginning. Located in Government Iot 2 of Section Twent}~II-One (21), Township Twenty-three (23) North, Range Fifteen (15) Wlest, all in TOWN OF PEPIN, Pepin County, Wisconsin. I 1 I 3 F. ., I i 1 - t S a [ L a I I ~ I L' E 1 •p t ! t ! I ~ I ~ ; --- -- - I r r ~,~ ,~. , =# ~ ~ I :' I ~~ v ~; ~ I ~ C ~•e~ a.- ;!fie iTie~ I I b -~ ~ t ;I u ' ~~ S i ~1 ~ w_: ~I gl V°~ I ~ ~~ ^ ~_ 1 ~, ~~ ~ I ~ ~ x 4~~~ yw ~i 1~ ~~ M ~ y ~ I O ~ 1 ~ ~r^ U vjZ _ I$ L W~ ~ I I ~ I n n ~ ~'~•1 ~ ~ I ~` ~ I $ I } I - 1 ~ iAi ! ' ~ I 1 : d Yi = - ~ ~ I I ~ ~ eR a~a y~ i~~ : i~ I ~ ~ y sY~~ 3 ;~~~ !: 0 ~ ~ yG6C ~~ ~k e ~ 1r A I I ~e I s ! I' 1 !~$~ $~:i I ~ I ~il e ~~ I ~6k~ I aa _.__ - J - 1 KM1~1 ltC~lOl lIK 1 ~F~ ^i=< 3~a a`~ ~~ r~d~>s ~ '~g~i + ~ ; a ~~ ~ t E~gc r r5 _~ ~ ~E~ pp a~yygg~~ 1'!E ~~e t6~~~ 8~~ p~ k. La E u~ iE ~ ~ i ! 4 ~ ~ ~ 2 ° ~~ ~'~i; i ;lai a xR ~ e- a~~~ ~~ • „ c a a ~ E ! a ~q~~a e : 1 ~kjr g ~a~p~~. \'s ~$A~ W • 4 iC E a i 9l t i 8 MY ~r ~` Y ° ~1 5 l y ' Y •p, is c ~ 8 #~ ~. ~ ~ vH L ,e pi sw • k . • ~ _ ~ ~! E k a a e~ 1...._. a p,y ! i a 9 9 TCL~ € ioris` i