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018-1096-11-000
Wisconsin Department of Comrperce PRIVATE SEWAGE SYSTEM Safety and Building revision ~ a 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 Couillard, Jan Hammond Townshi ;ST BM Elev: Insp. BM Elev: BM Description: Ov. t~ 3~ t~ ~G ~i l~ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic DD Dosing ~~ Aeration Holding TANK SETBACK INFORMATION ~~'!~ ~6d /u.~-~-l.~y TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic l ,~ ~ 33 / 33 / ~~ Dosing S' - Aeration Holding PUMP/SIPHON INFORMATION ~~ Manufacturer Demand GPM Model Number S Z- i 25 . TDH Lift / Friction Loss / • System Head ~ 3.25 TDH Ft 21 • ob Forcemain Lengt ~ 0 ~ Dia. v Dist. to well ~ ~ SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 430686 0 State Plan ID No: Parcel Tax No: 018-1096-11-000 Section/Town/Range/Map No' 09.29.17.786 STATION BS HI FS ELEV. Benchmar m / 3 .l0 ~~3• ~~ d • Alt. BM Bldg. Sewer r ~ v ~ ~J St/Ht Inlet .~ SUHt Outlet -- --- Dtlnlet __ Dt Bottom 2!. • Header/Man. 5,20 (~D~ Dist. Pipe 5,~0 odr Bot. System 5. a Final Grade ,~i J. . G ~. o Io/, b St Cover ~ µ~ ~' i !s~• D y.l `~troa ' 1111 ~ iYll.1,~) - S S /aSr L~ ~ ~ ~.~~i BED/TRENCH Width Length No. Of Trenches DIMEN Pits I Dia. ept DIMENSIONS ~ ~ ~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING cturer: INFORMATION C B R Ty~0 f System: e(.l) ~ ~ I' ~ r ~ , Model Numb 6 u DISTRIBUTION SYSTEM Sb~(^- JUG-7r- Header/Manifold / y ~ ~ Distribution 1 a / Pies ~ I 2 x Hole Size ~ /j x Hole Spacing ~/ ' Vent to Air Intake Len th Dia Len th ~~ Di ! Z S / i !~O 7 N7~ g g ng a pac r SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over Bed/Trench Center ^' ~ - ~/ • Depth Over Bed/Trench Edges ~ ). ~ ~V xx Depth of ~ Topsoil I ~ xx Seeded/Sodded Yes No xx Mulched ' Yes No I~ s~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/~~.L• Inspection #2: d~/ ~/OyF•L Location: 1714 109th Avenue Hammond, WI 54015 (NW 1/4 NW 1/4 9 T29N R17W) Pheasant Ridge Lot 11 Parcel No: 09.29.17.786 1.) Alt BM Description =,.)~~ (3)ll ~u~ I~ ~i ~f 2.) Bldg sewer length =~ C DVQiY brl~'vl ~~~-• ~~~~ ~~l ~~~ = OK_.. - amount of cover = S~ c~R,~,o~r ~w--5~ d~ b~ d ~ C5) on ~,~~ = talc. Plan revision Required? i Yes ` ~ Use other side for additional informati No I,, 1..~ i ~~~ ~/1 SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. rcc d B dings Division Ctamty ' E~b} asbington ve., P,O. Bax 7162 ~~' '~ ,~~O~~i~J~ Madison, Wl 3707 - 7162 Sanitary Pervut Numbs' (to be filled in by Co.) ` ~8) 26 3151 [ICS? p(o~ 3 2~~ s. De artment of Commerce Sate Plaa LD. Num C/(a3~ Z = ''~ Sanitary ermit A ~ iCion ~ Abp ~ atloa provide P ----` !n accord with Cotrtm 83.21, W . AdaSiCo~e, Xm) Address (if difftaeat than mailing address) + may be tutod fix PmP~ ' 1. Application information -Please Prfnt All lnformatfon Parcel M wLLa # ~ PropcrtyUwner'sName L~~ ~~.~s~J 7 hpropeat~y"l,ocation property Owou's Mailing Address •,~. `, (~ S O ~ L ~~, ~r~ '/~, section -/ Zip Code Phoac Numbs C~State (circle one) ~~ ~ WS' S 1-33 TAN; K~1 -Eor~ 11. Type of Building (check all that apply) ~ 5 Subdivision Name ~SM Number ~I or 2 Family Dwelling - Number of ooau , s. ~/~,r ^ PublidComaxtt;ial - Describe U ~"°"`" " - ~^City_^Villagry 1 ownsl>ip of / KI~ ^ State Owned -Describe Use (o K ~ _ ~ wn itiutM^ - 11 L Type of Permit: (Check only one boi on line A. Complete line B If applicable) U - Oq ~ ~ ^ t7~ ' A' ~`Ncw System ^ Replacement System ^ 'I1ratrnmUHolding Tank Replacement Oaly ^ Other Modification to Existing System e list Previous Permit Nunnbt:r and Dau issued B. ^ Permit Renewal ^ Permit Revisim ^ Change of ^ PermitTtaasfer W New Plumber ~~ Before Expiration IY. T e of POV1rCS S stem: Check all that a t ^ Sin ~ pass Sand Filter ^ ^ Nov -Pressurized hr• Around Mound > 24 In. of suitable soil ^ Motmd < 24 in. of suiuble soil ^ At-Grade gl ^ Coaswcted Wetland ^ Pressurized la-Ground ^ Holding Tank ^ Peat Filter ^ Aeroble TO>~ Unlel~^ Recirculating Sand Filter ~~ ~ l.+ne ^ Gsave6less Yi Rexirrulatur S thdicMtediaFUta ^ QC~L ( ~! V. Dls ersal/I'reatment Area lnformatlon: ~ Dis 1 Area Pro e~ (s!) stem Elevation Design Flow (gpd) Design Soil Application Ratc(gpdsq Dispersal Area R ~~ ~st) ~~ ~~~ •~~ Ci•D Prefab Sitc Steel Fiber Plastic Manufacttuu Glass V1. Tank info ~Il~sm dons of Units Concrete Constructed New Hxiatina Tanlcr TarJty scpiic ~- ~..,,=~ JDO~ Do L~- Acrobic Ticaemcru Unii C,6vwDO DuwinK Ctwmbcr d V 11. Res nslbUl Statement- 1, the under aed, asstune as1bW for ~ tlatlRosnuf tumh~e POVNI'S s6otvn °° the Business Phone Number Plu s Name (Print P1 ~s S /J/~ ~ r '~ 1~ /Otter L ~( 3 9 b Z (/l Plumber's Address (Strtet, City, State. ~C tQ~o//„'n~/ ~ ~~ ~ , ~rj .ate V111. Couat /De at went Use Onl a gnature o Stamps) Sanitary Permit Fee (includes Groundwater Date lssuod !s in g nt Si APProved ^ Disapproved Surcharge Fee) 3~ "'._ .1'3 ,~ ^ Owner Givm Reason for Denial lX. Conditions of ApprovaUReasoas for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and , dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Atueh tomptete plaai (to the County only) ror.tM rystem oo paper not tcu than a1R x Il laeha In rize SBD-6398 (R. 01/03) ' J ~. r isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce. state. wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary January 29, 2004 CUST ID No.139462 TODD L SINZ T L SINZ PLUMBING INC E5609 708TH AVE MENOMONIE WI 54751-5520 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01/29/2006 S[TE: Jan Couillard 110TH Ave Town of Hammond St Croix County NW1/4, NW1/4, S9, T29N, R17W Lot: 11, Subdivision: Pheasant Ridge ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 965092 Site ID No. 670352 Please refer to both identification numbers, above, in all corres ondence with the aQenc . FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 940531 Maintenance required; 450 GPD Flow rate; 28 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.OI/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/Ol); Biofilter 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, Condih stats. ~~~~~ The following conditions shall be met during construction or installation and prior to occupancy or use: DEF TMENTC OF E General Approval Requirements: ~ SEE CORRES • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. - ~„~Ncc„~„ ~, ,ur pnvate sewage sysrem msrananon 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. Stat • Comm 83 22(7) 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 Denartment_ which may include Incal insnectnrs i ` ~ ' `F ~' ~~q CF/ Jan Couillard -Mound ~~~~ ~,2 ~~ ~' I 8~p ~9 Construction Materials and Techniques ~IO All materials must comply with Comm 84 and be installed in accordance with manufac`ture~~~', specifications. Construction methods must comply with the following Component Manuals: ,~: Mound, SBD-10691-P (01 /01) Pressure Distribution, SBD-10706-P (O1/O1) Location: Lot 1 1, Pheasant Ridge NW '/o, NW '/4, Sec. 9, T 29 N, R 17 W Town: Hammond County: St. Croix Date: Owner: Address: Plumber: Signature: License Attachments January 28, 2004 Jan Couillard SBD-10577 -Plan Approval Application SBD-8330 -Soil Evaluation Report Page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management ~Alynn ~tJ 'MMERC$ 'n ~ NGS NDENCE page 1 of 8 1011 170`h St. Design Criteria ~~ Residential Wastewater Contaminant Load: 30 mglL < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 1 SOmg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L 3 Bedrooms x 100 gal/bedroom/day x 1.5 ~~ gallons/day hydraulic load In situ designed loading rate Depth to estimated high ground water Depth to bedrock Cross slope at system Force main length Manifold/header length Drain-back Lateral length ~ @ Lateral elevation Lateral hole size ~~~ b in. @ ~ holes/lateral Lateral volume Total lateral discharge rate Network pressure compensation losses Elevation difference Friction loss Total dynamic head Pump/sijs~on ~ 4'' gpm Manufacturer ~ oe~~~ Design Calculations ~,'~3 gallons/sq. ft. per day ~~ Z.8 in. ~ `~O in. ~.,5~ ~ 3 ° ft. of 2 in. 3 ft. of ~ in. Z~'~' gallons ~-2, ~ ft. of ~`~F'1 Z in. ~ ~ -Z ft. @ bottom of lateral 4"~ ' ~ in. ( 4'' ~ ft.) Spacing ~ g holes total ~ ~ '~-~ gallons 2~' ~ g i gallons/minute @ ~' ~ ft. head n ~~S' ft 1b.Z, l , 43 l ~.~ .-Z b ~-' Dose volume ~R , ~- Lift/si~on tank ~~~~-~~' t,'~ - ~~ ~~ Septic tank `` ~' Effluent filter ~ ~~..`o ~'~' o~ LZ - ~ 4 ~3iG1 Measurement pump on and off ~ - o Height alarm from tank bottom ~ ~ ~ a Reserve capacity 3~"z+- specs.calcs.res ft. i ft. @ ~ S gallons/minute ft. ft. of head Model # ~S Z gallons b `~ gallons ~ o'~O gallons m. in. gallons Page Z of g PAGE~OF~ 1,,nl,,lr B~ ~ LOT# ~ ~ T EC=AL DESCRIPTION A/~• 1 ~ ~~ S 9 T ZQ N R ~ ~ E(or)~(~ SCALE: 1"= ~D BM 1 ELEVATION //JQ, CJ BM 1 DESCRIPTION ~ e BM 2 ELEVATION 9 ~ y0 BM 2 DESCRIPTION 0.~ ~ ~ PyT_~~ ~D SYSTEM ELEVATION ~ g0 SYSTEM TYPE /11 au n GQ s~ S ~ rn CONTOUR ELEVATION ~,~, Od ~~,v N Cgq,o~ '~ ~ ~, '~ 1 Zoe ~., Pic s~ ~ w, ~ ---,--',~ I N..~c~ ~-~. ~ ~ sv~, - l~ ot, c.,, w.(,~, I ~~k K ~ ~ 1 `-~ 1 r o ~.s:o, C~ ~ ~"•S ~ S ~ ~ ~9,~~~ w~ .~ -S~~ I ~~ ~ \99s ~O G 'S~ 3 ~ 5:~ ~~ ~ qs SIGNATURE ~ti ~----_,._..1~.. ~,...._-.~ DATE ~ -~ ~~ _ ,___ . .. ~ }, ~ ~ , ~~ ~ ~~' - f; ~ _; r ~~ ~, ~~ 1 3 e. M! a.~t ~y'~ gilow Zu / _~ _ \ 4.~o O V ~ ~. vv ~ ~a.~,, ~ ~ ,z 3 ~ ~ ,~ ~ ~~~ ~(~1',~ ~ t>tirh ~v ~o~pt~;~ N s~~~ io1 ° "'~ Q`w 3 0 ~s'~i' j - __ // j F{. _~.--~ O 'T _~ F1ah V :4r„ _ ~ ~ I . O ,s ZS, I ' , i 14-1'2. -!I 12. o' ~,3~ ~.o~ 9,3. ~~.6~ O'. 4 t?V~ c. a.cX o` Li.M`v ~.'Fi~• ~...al\~ ~T ~~ ~ o~.. ~ r ~~~ ~~[ p ((`' l 2`~ ` 1 I%l ~ I /\ / ~ ~ d 1~IZ, Pvc ~.~~ ,0 1 I 4VhN~~ ~/ .4.~•4~ p~Q~ G'q.yy .4.0 SKY ~bOLiif(4 ~~~-C.~,r~ w./ V ~~vt ~~ XtC or w:vR,~O+wT J ~~ ~ ~ \ c 1 ~~ ~ -~ a~ ~ .~ s ~~ -~ ~ .: ' , I G-.---~ ~ ~ > •~{ ~, -`-~ ~ ~. 4m GIP6 3' no NDIgTuaBFo Sol ~' 24" I.D. MMiu01E ...,. ~ %wu r ~ D P-' K Ovi.R SKET J~iN1"J ~ PtPG ~-w E C.T t O -~ Cl.ev. ~4-.~ iC t.F~. ' ~~. o A \ ~•_ ~FLE a M ow•t 1.01 ~ ~\i -LUCKING GOVfiR ---~ lvv,~N ivc ,c ABED . avlcK Ot'~COVVtGT--1 .~ 2 S• ~ i a~c,w~l Z„ F'T' m tit-14tg Fl ~ ON - ` 1 1 ~~ .'iv h Ow}1. a. 1 ~;p a.~ 9„ ~~ FoR~~ h'~n~H WEATNERPROJF ~JLNCTION Bwc ~•wt,.P H (a.G Pw~P CoA~Fr~ bcoCK 4. ~j L~ i_, TT~ • P~ a" 4 0 Y 6 hT J ~ e' __ _~~ ~ ,~~ 4c 3' ono G:.;u-.o 14 ~ ~ SEPr~c f SPECIFI~CATI~tJ ~ ' "'~ 00 5 E . T~u..S ~ k. ~-~ ~ti~' MA-JUFACTURCR: (DUMB ~Cj, ER OF D TA-JK SIZC : ~ ~~~ - V~ GAL.LOIJS • DOSE OSCS: PEK C~~ V AuARr~ . 11 OLUME /'tiAaIUFACTUR[R; S J ~x~ •c.i~~~ IIJCLUDIAJG 6ACKFLOW: ~ ~ `~ (,ALL0~.:5 MODCI, AIUµ~ER; . \ e 1 1,4 ~ CAPAC ITIES A - ~~` O ~~Z,S~ SwITCM TyV(; ~o Z 2Q~~' HUMP MAIJUFACTURCK: ~02~ ~ 8 = i1JCHE5 OF ;....,J... ~9t~ ~ ~ ;7u ~1 Z MOOEL -JUMOfR: iULNES pH C' ~~..:..,: Fl ~ SWITCH TdPC: LK2t-`"~v .~. • ~3 4 I D' INCHES GR ~,,._:,' uOTE: MIIJIMUNI pISCMARCsF RATC S.1 PUMP AWp ALARM ARC TJ bC -NSTALLEO GPM OA1 SEP~R~rC C~~._ -;, VORTICAL DiFFERCAJCf DCTW[CU PUMP OF/ AUO OISTRI~UTIOAI PIP ~~'~ E„ + MiuIMUM -JETWORK SUPPLY PRELiURE ~ ~ ~ 1 FEET 2,S F ~o ~~ 3p + ~ ' i'E ET OF rORCC M/-IIJ }( 1 .39 F.T,/ ~ FR ~- , CCT ~ ~ 1 z5• ~' ' 1 ICTIOIJ FACTOR -~-- goo -t `• FEET _ ~_~ y~ r. TOTAL. DyIUAMIC HEAP ~`I'~-~' ~ o F ;i • EET ~~, IIJ7ER-.1AL, DIMEIJbt0A1>: •0/ TA-JK: LEAJbTH \ ~~tt W ' ~Z.11 ~- ~• 2 , ~ iD~ -~ --~-_~i ~LIQU1O OEPTH (( -,t 1'au~ 6 ~ 0. ~ ---, 1' • HEAD CAPACITY CURVE MODEL 152/153 wW ~ ~ 50 12 40 152 o a w x 0 ~, z 8 r 0 20 a 0 4 10 ousoe 0 20 40 60 80 100 GALLONS LITERS 0 80 160 240 320 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Owik•Box available fol`outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 1521153 Serles 1521153 MODELS Control Selection r Model ' Volts•Ph Mode Am a Sim lex Du lex N 152 ~ 15 1 Non 8.5 1 2 or 3 BN 152. 115 1 Auto 8.5 Incuded 2 or 3 E 152 ~ _ 230 1 Non 4.3 1 2 or 3 ^8E 152 ~ 230 1 Auto 4.3 Included 2 or 3 N 153 115 i Non 10.5 1 2 or 3 BN 153 ' 115 1 Auto 10 5 Induded 2 3 TOTAL DYNAMIC HEALS/CAPACITY PER MINUTE EFFLUENT AND DEWATERING MODEL 152 153 Feet Meters Gal. Liters Gal. Liters 5 1.5 69 261 77 291 10 3.1 61 ~ 231 70 265 15 4.6 53 20t 61 231 20 6.1 44 167 52 197 25 7.6 34 129 ~ 42 ~ 159 ~', 30 9.1 23 j 87 ~ 33 ~~ 125 i~ 35 10.7 ~ -- ' -- ~ 22 fi:, - ; 40 12.2 -- ter -- ' ? ~2 Lock Vclve: 138.0 FI. ,1 1.6m) I aa.0 Ft. ('~ 3.4m!, J 27/32 ~- T II __~~ ~i2 ~/F i ,~ ~2 sKZaea _ or SELECTION GUIDE E 153 230 1 Non 5.3 1 2 or 3 1. Sin le I back variable level float switch or double back variable level float BE 153 ! 230 1 Auto 5.3 Induded 2 or 3 g p 99Y p~99Y switch. Refer to FM0477. o CAUTION 2. See FM0712 for correct model of Electrical Alternator E•Pak. All installation of controls, protection devices and whiny should be done by a qualified 3. Variable level control switch 10.0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed Including the most recent National Electric Code (NEC) and the Occupational Safety and Nealth Act (OSHA). or (4) float System. ~~~a RESERVE POWERED DESIGN ~~ For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. ~ MAIL T0: P.O. BOX 16347 Z • ,~.. , Louisville, KY 40256-0347 Manuladurers of ~ t I '~ SHIP T0: 3649 Cane Run Road ~• ® Louisville, KY 40211.1961 Q~aurr f~~,uas S,vcE /9~9 http://www.zoeller.com PUMP !O. (21778.2731.1(800) 928-PUMP FdY /Fn~l 77d•9R'Jd © Copyright 2000 Zoeller Co. All rights reserved rl .• System Management ` Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, T.L. Sinz Plumbing, 715-235- 2644, or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1. If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. 1 1. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 WiscxJn~;~ Department of Commerce SOIL EVALUATION REPORT page ~of~ •Division of Safety and Buildings ~~--; in accordance with Comm 85, Wis. Adm. Code County . Croy Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must indude, 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. ~ ~~ ' / O q (o ' ~ / - ~O O _ Please print a anon. evie by ~^a~te p ^? Personal irrfarmation you Provide may be used r secor~ Law. .15.04 (1) (m)). ~- `,(~jyyy-~ !~ ZO t7 J Property Owner operty Location n JUN ovc. Lot ~ (,~ 1/4 N 1 /4 S 9 T~ N R ~ 7 E (or Property Owners Mailing Address Lot # Block # Subd. Name or CSM#n r ~b~l ~?O'j~ ~, ST. CROIX COUNTY ~1 ~~~ ' City ~ ~ I State Zip Code ^ City ^ Vllage ®-Town N rest Road ®. New Construction Use: ®.. Residential / Number of bedrooms ~ Code derived design flow rate ~-f.~J ~ l~ m GPD ^ Replacement // ^ Public or commeraal -Describe: Parent material 7~ ~ ~/ cfO ~a Flood Plain elevation if appli le ~ ft. General comments S,/Sfe~ Qt'QV . 7 7~ v d '~ ~ jr /Yw~+.- . S~GC ~! ~ ,''l r D, I ~S~-~' /2 ~' and recommendations: CO /l ~ U r ~' eU ` ! ~' ~ ~ w~ ~ ~ ~h , SQ~ ~, U''~- (,tI~Q,S~" ~'~ ~~ ~- I Boring # ~ Boring Q(~ Pit Ground surface elev. ``[~ ft Depth to limiting factor ~_ in. Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roofs GPD/ft2 in. Munseil Qu. Sz. Cont Color Gr. Sz Sh. 'Eff#1 'Eff#2 ~ 0-13 16 ~2 Si ( r c I v~~' . ~ ,~' 2 13:30 / / - S` c Zrn m-Fr ~ S - ~ ~f ~ -3 40 / /3 C~3~ ~.5 ~~~ S~~l Zmsbk ~~~ - - . ~l . ~ Boring # l^~ Boring n LJ Pit Ground surface elev. `lQ • ~C~ ft Depth to limiting factor ~~ in• Soil Appliption 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 'EffiY2 ~ ~ (~ z zg Sc k ~ ~ - . ~ . B- ~a C ~-5 r~ Si r1 Z mfr - ~ ~1 • ~ 'Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mglL CST Name ( lease Print) 'gnature CST Number -. ~ -_--- Address Date Evaluation Conducted Tel phone umber 211~_~U~_~. ~~rr~-I~-~15`4c~2~ _ __~ -s- oz (~~.5~~7-~av~' i ~ Properly Owner `-~' Parcel ID # - ~ _~ ~• page ~ of Boring # 1~~~~I (~ ( f 3 ~ t ~ Pit Gnxmd surface elev. -1 O . `t b ft- Depth to limiting factor ~ in. Soil Appliption Rate Horizon Depth Dominant Cola Redox Descrtption Texture Structure Consistence Boundary Roots GPD/ft2 in. Mansell t]u. Sz Cont. Color ~ Gr. Sz Sh. •Eif#1 - 'Eff#2 ~ -IZ I~ 3I2 5i ~ C ~ ~ S 2 12- 5 1 y ~ Si 2mSlC~ c - ~ ~( ~ ~ - g ~ y l3 c~--I.S ~ icy sc~:.I z bk ~ - - `i . ~ Boring # ^ Boring - ^ pit Ground surface elev. ft. Depth to limiting factor in• Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture _Structure Consistence Boundary Roots GPD/lt2 in. Mansell Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 ^ Boring # ^ Bonng ^ Pit Ground surface elev. ft Depth to limiting factor in. Sal Appliption Rate Horizon Depth Dominant Color Redox Description Texture ..Structure Consistence Boundary Roots GPD/ft2 in. MunseG Qu. Sz. Copt Caor Gr. Sz. Sh. 'Eff#1 'Eff#2 - ' Eflluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mglL ' Effluent #2 =GODS < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (807/00) -; ~ , PAGE~OF~ ~~ ~ T OT# ~ ( T EGAL DESCRIPTION I(f ta1 ~ llkt114 ,~~ T Z4 ,N,R, ~~ E(or SCALE: T"= ~~ ~ BM 1 ELEVATION //JQ, v _ __ _ ___ BM I DESCRIPTION ~D ) .~C' ~ ~~ p~ ~,'D e BM 2 ELEVATION 99 y0 BM 2 DESCRIPTION 7o,p ~~ ~ ~ ,Pv~ O~ ~D-2 -v---- SYSTEM ELEVATION y~• gD / SYSTEM TYPE /Il Gc~ n GQ s ~.StP~n CONTOUR ELEVATION ~94C~ ti ~~" N -~ + i_ II ~~ ~ g.-~ ~~b ,,. \ (~ \ \\\ ~3 ~ ~ $-z ~99~-, a G G `~S d SIGNATURE ~~ -:--- ~ ~-~«----~ DATE ~ -"~ ~~ 133?~1 S lOL 1 t-i t MN 3H1 ~O 3N 7 1 S3M r, - - _ ~tL.~ . a..... ~ ~ ----.~----- ----.~---- -- -------~ --- o -- -~-~-_ -X -_ -_ -_ - -_ -~ ~ ~~~ i ~ ,58 '9L ,~ 0 ~' ,..} ..................~i z , ~ ~' ...... .o ~ .U. ................ .~........ ..... p, o o ~ ~ x boo , n!~ w x . ; ~ ' o ro o ~ s oo N 6 NOS ~ n1~, c ~W ...h O \o; ~ ~ Pry ~ W ~ A f= ® y r.. ~ ~P Oo y cN0 ~ N ®i t ;D x _N O~0 ~~ m. ~ ~ x ~ 339. ' _ :. ,% _ s ~ ~ ~~ 1 ~ o o ~ , $ .. ti®: ,~ _ ~ • ~ ~ ~ N ~ 33, 33 ~ ~ o~ s '~ ~ w W . ~o ~ ro ~ A ro m o c s "`~ / H 1 a a N w ro roo~-~ s ~i p• N a 1 w °: ti~q ' ~ ',~ N1p°25 9«E, ~ •2 ~A ~ ~ to • Vii, I ~r~ti o ~ . ~• ~ SO1 ° 16' ~ ~ ~~ - r- ,, ~ v ~ ~ ~ (p ~ ~ Q , vI ~ d "' ~g ~ ~ V ~ ~ H ~ C ~ c ~ (~ ~ / 7 E cr r• ~ N ; l ° i 48. 6T ~ 8' , ..$• s ~•.~ a O~ ~ ~ /30. l3• i ~ ~N ``~ ~ ~ ,gyp ~ ~ ,• ~ iIv 00D O ~Y ~ V V n \ o 444 ~ ro o ~ \ 3y F 5 f ;~ 0 ~ o, Ow ' \ ~ •w O• ~'•~ : ' ^~ n ~ + , ~ ~ ~ ~ ~; n ~ ~~ / ~~ Sd7 44•32.w mac., .._ ~ ~ ~ .w ST CROIX CUUN'1"Y ' SEPTIC TANK MAINTBNANCB AGRBEMSN'T •-AND /` ~OWNERiSHIP CERTIFICATION FORM -wnerB er -SO.Y~ ~t~. ~ ~ 1 C~Y~~ • ddress ~ ~ S y o ~. l-livy ~ y ~ ; I r~-~ ~ ~ ~ Sy y 3 ~ roperty ddress ~ ~ 1 ~ ~ ©9 ~ ~ ~ ~~ - - (Verification required from Planning Department for new constructton) ~ty/Stat ~'~` m ~~~ ~ ~ ~ Parcel Identification Number ~ I ~' ~ 0 `~ ~° ` ~ (~ ~ ~ ,~Aj, ~I.~S'C.kCIY~1.i1V1`I {~. lion I " ~'`) %4, ~ ~ `/., S ec. ~ . T ~ N-R.-W. Town o f ~ w~ Irmo Y`\a1 ~~ ~ Lot # ~~ iubdi ' on ~ ~ ~~ `r`~- ~ ' Certifi Survey Map # ~ Volume -,,Page # ~7'j0~ U `1 Volume °~yg y--~ Page # S~~ Warren Deed # Spot hose ~ yes ^ no Lot lines identifiable (~ yes ^ ao ~` -~~~ fora failure to handlo wastes. Proper maintenance roper use and maiatenaacxof your septic system could result in its prema ~~ P~• Wl>at yon put into the system ooosists o lumping out the septic tank every three years or sooner, if needed y can aff the function of the septic tank as a treatment rtagc in the waste. disposal system. a certification form, signed by the owner and by a property owner agroes to submit to St. Croix Zoning Departmwt~,y~ that (1) the oa-~cita wastewaterd~posal sY~cm master , journeymanplutnber, restrictedplumberor a licxnsodPus~r the septic tank is less than 1/3 full of sludge. is in operating condition andlor (2) after inspection and pumping (if nom'). to maintain ilia Private sewage disposal system with the ctaadards Ilwe. ~ have read the above requirerncnts and agree of Natural Resoura;s, State of Rlisconsin. Certification ~ fem. in, as sat by the Departauat of Comnurce and the ~paitmentm~~ to the ~ Croix County Zoning Office within 30 ~• t ti6,sysiem l~s been maintained must be comp days df ear a lion date. _.__.._._ . ._ ~ pl XJ DATE %~trnJw OF APPLICANT son this form aro true to the best of my (our) laiowledge. of a warranty deed recorded in Register of Deeds Office. I (we) am (are) the owner(s) of DATE / '~C3I~IA OF APPLICANT ~ t being revoked by the Zoning Deparimcnt- `f «• «~ ~/ •••.•• pay information that is mis-rcpresentcdmay result in the sanitary pew •• Incl~Cde vrith this application: a stamped warranty deed from the ~ ~em~ ~ ado in the warranty deed a copy of the certified survey reap U. 2~18yP SS STATE BAR OF WISCONSIN FORM 7 - 2000 TRUSTEE' S DEED Document Number Dine M Bonte as Trustee of Karl ~. Ulfer~s and Katherina G. Ulferts Family TzSzst as Trustee of for a valuable consideration conveys without warranty to ~T~ R. Couillard and Geraldine L. Couillard. Husband an¢ wife as su,PyiygrshiD Marital Prog~rt~ Grantee, the following described real estate in 3t. Croix County, lsconsin (if more space is needed, please attach addendum): Lot 11, Pheasant Ridge, Town of Hammond, St. Croix State of Wisconsin. Y, 7 52rE~44 KATHLEEN H. k'ALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 01/05/2004 09:45A?1 TRUSTEES DEED EXEMPT II REC FEE: 11.00 TRANS FEE: 105.00 COPY FEE: CC FEE: PAGES: 1 Recording Area Name sad Return Address 7a~ ~ C~ era.Qc~ n,e C ~ ul, < <a r~ w, ~5~ ~ a ~y ~`~ ~ C-t I l Joc~n.~n ~ ~ ~ 1 ~`~`t 33 018-1096-11-000 (• 7. ~t,>art of 018-1018- 0 Parcel Identil5eation Number (PIN) Dated this 30th day of December , 2003 Trustee Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF WIS( (If not, authorized by § 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFT l ~L ,~,.~ARy '.~ • _.Z .,~ 3Y~ `G • •, ~~ ._ '~ s Trustee ACKNOWLEDGMENT STATE OF WISCONSIN ) ^• . ss. ,~j~. C~ J ~ County. ) Personally'came before me this 30 *-'' day of .70o the above named to the known to be the person who executed the foregoing instrument and acknowledged the same. , ~c„R4.~'~~ ' Heather A. Serier Notary Public, State of Wisconsin r- My Commission is permanent. (If not, state expiration date,) (Signatures may be authenticated or acknowledged. gbDtt~ March 11 , 7007 not necessary.) 'Names of persons signing in any capacity must be typed or printed below their signature. TRUSTEE'S DEED STATE BAR OF WISCONSIN FORM No. 7-2000 AUTHENTICATION n WhiteRidge Real Estate LLC 1420 Davis St, Hammond WT 54015-9624 I~ Phone:(7ls)760-1189 Fax: J W Fletch WhileRidgeReal Bs 1'5412170.ZFX Produced with ~pFOrtn^' b'/ RE FormsN•t, LLC 18025 Fin•en Mil• Road, Clinton Township, MicNpan 48035, (800) 3839805 t i .,.... ~ ~_ _.--- '~" _._. _.._. - '" t ~ oTH ~~,D !CATS __- - :23; y___,__....------ _ -'" " 236 T • 2 ', t _~____ 99 5~ ~ 4t•5,0, _ _ 6~ o 47`~" " 2 ~ ..• a ~ ~ ; ~ ~ - .... K t ~ i 44s ~ b:...... ... t - O ... { O ~ i ....... ...... O ~ M ... ;........ ,Y, f ~ ~ t ... ..,...~ ; ~ ~ LOT t ............ . •N ~ ; _ . T L 0 3 ACRES N - • , .... ' oo A ~' ACRES - t . 60 co i ~, T ' `~ .~, ~=t' "~ r 6b, 508 gQ. FT. ~ sg. 492 SQ. F'' O ~ i ono •~. ~, 72 ACRES co Rl' w m t~ ..75.059 SQ. FT• ~ ~ ~-° a. o rn `~ % ~ 't O co t Q ~ ~ ; tra try + ~ 00' ~ Q' ~ ' t O , Z t - ~ ~ O t ' M ~~ ;' nas4°22' 34" w O i Naga 32' S9" ~ ~ 23C7. 4 (' c2p~ 49"W tv t ~ 264' 8p - N t ~ ~' t 4 ~ + ~ M t ~ ; ~ ~ tip t ~ ~ ~ t ~ , ;. 3 `°, ~ ~ ; pT t ~, O~ 'rv ~-~~ ~ ..,; t, 61 ACREF7. ~` n.. i._ • ~! ~-~ t.5t•_ ACRES ~ a ~~ 70. 292 g0. ~ t. 92 S0• FT. ~' ~ ~ ~~ sg, g6~ SQ. FT' ~ ~+; `~ -= 56, 232 - , ' O ~ 0 i, 1 UO` ;20 204 ~ ~' cp + , rn ' ~ Q t .. .... ...., .......~... ._`.....,... , tt t ..... -~...,. ~ ..... _ '' ~ ~ t~ D .., S89°49,38 ~ - ---`- -~- __ ® -•~--• ,...... ............. ~ y__ _ -- __ ~O3w ?3 -o .0 . ...... ...... ~ 61.34 ,a t, '--- _ _ 2/O, 94` '- ... C7 ~ tU83°37' 12" :r, - '--- ~ -- - N7 _ ~,' ~5u .~ ~ t-4Q~J- ~ :..:---r-- --~------- =?~_ , _ _ _ _ BRA ~~AO'E FttS,EA~r T --"_`- - --._. rn Qr-~~gQ49' 38pEI ~... .... '~ 338.85'-" ---= _,- N _sT3~~7~ ~5~~~, z~ .. ._ h-TN/Sop - --_ -~ z 4 ........ ~ ~ 82. 5 ~ - t ~ n `'-• ........ ....... 33 °Er 68;1 ~~_ C , ~ to D ~ - .. ~ ('~ D' ~ ~ i ~T 2a t1 i N ~, ; L 1 , ~v rn ~ t 30.00' f -~ o ~ ; _?~~ ~--- '' i . 80 ACRE F ~ _ rn ',~20 201 - ~' ~ z ~ ~" ~~ ACRES sss°4 51'~ tc~. ~' 88: 024 Sa' ~' o ~'p'~ E , 6d• F Qo , T. ~ cs, ~ ~ p = ~` OO cn ; t 00' '. ~ t vy; ~ 9 5. 00 0 32p' OS 230. 86 '; ZOr', z w~ N 2 ~ - gg, 20~ 526, 23' N; ~ ~ -~ Q, ;