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HomeMy WebLinkAbout018-1096-20-000Wisconsin Department of Commerce PRIyATE SEWAGE SYSTEM Safety and Building Division ` INSPECTION REPORT GENERAL INFORMATION (~TTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 ~1)(m)). 'ermit Holder's Name: City Village X Township Everts Construction LLC Hammond Townshi :ST BM Elev: Insp. BM Elev: BM Description: i~~ rd~ (~ r~ ~ G~~ i•ANK INFORMATION TYPE MANUFACTURER CAPACITY Septic J n('~ ~ ¢ ~ a~ Dosing ~~ ~ ~ c rev,. ~ ~~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ' Sir ~~ ~~, Dosing ~ ~~~ , I~ (~y ~~e ~ ~ZS Aeration Holding PUMP/SIPHON INFORMATION Manufacturer (~~ De nd Z~ F~-~,e~.--. GPM Model Number ~i ~ TDH Lift ~ Friction Loss System ad Z ~ TDH// Ft • - 'Z •6j - t0 ~ (a Forcemain Length~~ Dia. ~, Dist. towel /~ ~ SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CrOIX Sanitary Permit No: 463078 0 State Plan ID No: Parcel Tax No: 018-1096-20-000 Section/Town/Range/Map No: 09.29.17.795 STATION BS HI FS ELEV. Benchmark g O ~~,~ ~ /OCs Alt. BM~~` ~o J~ S ~ 1 ~9 ~~ Bldg. Sewer /3.ac~ 9Z SUHt Inlet SUHt Outlet ~ Dt Inlet ti Dt Bottom ~1•~ c/ 37. Header/Man. ~. ~i _I~•~ Dist. Pipe (,•3 ~g ~~ Bot. System 7-a Final Grade 5 _~ ~ --' St Cover r G Cati'~D ' ~' ~ ~~ /b BED/TRENCH DIMENSIONS Width ~ t Z Length / t'~ ~1/~ F~ No. Of Trees PIT DIMENSIONS ~ No. Of\ Inside D~ Liquid Depth ~, SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type O S tem: ~ ~ y ~ ~/ ~ n Fit ~ (~ /V UNIT \ Model Number: DISTRIBUTION SYSTEM nifold ~ ~ Header/ M a Distribution ~~ ~~ x Hole Size ~ / x Hole Spacing Vent to Air Intake ^ -~ - Z i Pipe(s) ~ ~ ~ ~ ~ ~ / ~ ~ ~-- ~~ Length D a Length Dia Spacing SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Onlv Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center t ~ Bed/Trench Edges \ Topsoil ` ~~ Yes 0 No `Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~0 /~/~ Inspection #2: / / Location: 1709 109th Ave. Hammond, WI 54015 (NW 1/4 NW 1/4 9 T29N R17W) IPheasant Ridge Lot 20 ~~0~ Parcel No: 09.29.17.795 1.) Alt BM Description = ~~~ r/ ~'1u`-- ~1,.,a~~ c~ ~oc.h-~ C~~~- ~~' 2.) Bldg sewer length = ~~t1 ~ ~ ~^ ~ ~ A1'~ , ~- -amount of cover = ~ ~~~ ~~ _- __ _ --- __ Plan revision Required? i ~ Yes '''*r_. No ~ ~ ~ '~ ~ ~ ~~ 1 Use other side for additional information. ~, y1 SBD-6710 (R.3/97) Date I !~ ~ ~7` ---- - -~ Cert. No. C Safety and Buildings Division Comty ~ ` 201 W. Washington Ave., P.O. Box 7162 1 T ~ isconsin Madi~n, Wl 5 - 1,62 fiIIed in by CoJ Sanitary Pemvt N De artment of Commerce ~ (608) 26 3151 C~ '-~ r'~ Sanitary Permit Applicatio ~~ . `D. ~be~ ~ hi accord with Comm x3.21, wis. Adm. code, pessmal ;nfrnmatim u p ,~ ;; ~- ,, 0 ~ 04(1 m) `~ d L ~ ac la x15 d f P i b d 'act (if diffeaent than mailing s) y w, . e use or secon ary Purposes r v may ~ ~ ~ ~ ~ ~~~ ~''~' ~ ~-~%~1 '~ '~ ti 1. Application Information -Please Pr[nt All Information ZCJtV! G i ~ ~ ~ FFIC;E / ' Owner's Name ...~. ~sr ~~~ ~ ~ co~s~.~~~U # Block # ~ Owner's Mailing Address ~ Propttiy l.acatim ~-rq Ci ,Slate Zip Code Phone Number * ~ ~ T' ~, t/1J~4 $+~D i S'"~ ~ ,r"' 7~p ~ ~ ~ ~Ti~p Q .~(cu~cle ) T ~7 N; R~ ` E o~ ll. Type of Building (check all tbat apply) ~ ~ rnj~ ~1 or 2 Family Dwelling - Number of Bedrooms Subdivisim Name CSM Number ~ Use ~ Q ~ I?72t e ^ Public/Commencial - Describ ~ ` ~ ^ State Owned -Describe Use v 1 s~ ~~ ~ / ~~~ ms ~ ^City_^Village (~o p of 111. Type of Permit: (Clmek only one boz on line A. Complete line B if applicable) /~/~/ `+" New System •--- ^ Replacxment System ^ Ttradnent/Holding Tank Replacement Only ^ Other Modificatim m Existing S B• ^ Permit Re~wal ^ Permit Revisim ^ Change of ^ Permit Transfer to New list Previous Permit Number and Date Issued Befom Expinttim Plumber Owner 1V. of POWTS stem: Cbeck all that a ^ Nm -Pressurized In-Grand ^ Mound > 24 is of suitable soil ^ Moues < 24 in. of suitable tl ~At-C3iade Ingle Pass Sam Filter ^ Constrocted Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment cinulatiag Sand Filter ^ Recu+cula ' S thetic Media Filter ^ Chamber Dri line ^ C3~ve1-less Pi ^ Otha ( lain) V. IKa rsaVl~eatment Ara Information: jt/ 0 Design Flow (mod) 5 Design Soil Applicatim Rate(gpdaf) Area (sfl Dispersal Area ~ s +~: 39 ~ ~ ' a i ~o s ! ~ S 0 Vi. Tsnk info Capacity m Total Number ufachaer Steel Fiber Plastic Gallons (iallaos of Units Concrete Cmstnicted New 8xisting Talcs Tadu ~M ~ ~ nn^^ C~/~ Acrob~ Tint Uait ~ % / "' "~ `J, ~ /„~ s ~i r Dosing Chamticr t Vll. RespomibW Statement- 1, the an naibiNty for imtallatlon of the POWTS shown on the attsched plain. PI Name ( ) Pl Si MP/MPRS Number Business Phone Number o Li~~-- llP /3~~6 Z ~S= 23x= 7,.~ Plumber's Address (Street, City, State, Zip ~ ~` e 9 6 8 iQil~ ~~IDl~t~l~~ lcJa' ~Sy7~''/ Vlil, onn / De nt Uae Onl proved ^ Disapproved Sanitary Permit Fee (includes Clroimdwater Surcharge Fee) y~ Qv ~3 / • Date Issued p 9 dy 7 a g t Signature ( s) Given Rearm for Denial - 5 ~ ~ ,~ ~ .~ ondifions of ApprovaUReaaona val ~ /~ LA~~yi(~Yt.S, ~"•~~> -7~L.G ~ ~~~ (~ ~L YSTEM OWNER: ~ ~G_,~ L~G~~ Septic tank d ~ ~ Q~L N'~ K.v~r effl ~ t ~il `"r a , uen t e n d v ~~~ ~ dispersal cell must all be service mainta ine er management plan reviled b lumber. ~ ~'~ OTC ~` a~ ~~~~~ II setbac re uiremen s must be maintained ~~ Q~„QL„ ~ /O ~jr //~/ ~- /~ ~ i as per applicable od / d - "__ c e or inances. d J Attaeh sompiett plw (ts 16e Cowry only) for the system a• paper sot _ntYay9112 ~] lay/)~q),'~IaGZ,,- " Or ~~/~CA J' V~~/t e SBD-6398 (R. 01/03) ~' ~~ W SCALE:1"= BM l ELEVATION_f(JU . U BM l DESCRIPT10N~p / ~~OuC O.'~_ BM 2 ELEVATION ~9 9(J BM 2 DESCR]PTION fn0 n~ l "p~-_ 0,'0~ ~ - SYS't1rM ELEVATION ~/~f, S O SYSTEM TYPE ~~ - (r fa ~ 2 CON'1'nUR EI.EVATIONf ~~,QQ Le~ z~ 12' , l 14,0 r n ~~< ce. Q..~ w, ~. \.~-~,.,(s, 1..~~..,~ ~.ollo~ 9 g , o wM ~,,,,,, ~ ,v ~, ~, / ~ ~~,~ o !~ , j I ~ .~. ~, ~~ ~.,, sue,..-~Q 2.0, Z„ hoc ~ ~ s ~, 4.0 ~~~ ~. i i ~ ~ o~ ~ (gst.o~ ` commerce.wi.gov ^ ^ ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi. gov/sb/ www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary September 15, 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: 09/15/2006 SITE: 1 Justin Everts (,~ CQ~'~C.7lA1V l.~.L• ~ ) 110th Avenue Town of Hammond St Croix County NW1/4, NW1/4, S9, T29N, R17W Lot: 20, Subdivision: Pheasant Ridge ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1058888 Site ID No. 689400 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: Proposed Three Bedroom At-grade System Object Type: POWTS Component Manual Regulated Object ID No.: 979974 Maintenance required; 450 GPD Flow rate; 37 in Soil minimum depth to limiting factor from original grade Systems: At-grade Component Manual, SBD-10570-P (R.6/99), Pressure Distribution Component Manual, SBD-10573-P (R.6/99); 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, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and with publication SBD- 10570-P (R. 6/99) "At-grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems". • This system is to be constructed and located in accordance with the enclosed approved plans and with publication SBD-10573-P(R.6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems". • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. -, ~ ~ , ; tia , ~ ~ `~ .gym. . ~, t~„ Y ti r r ~ ~. DlVl;tir~,~ ~T~dEtd / tlr i:+Jf,;;a^r 1ar'c i ,~~.. _,._ .., .. _ , J< 'j ~~i s SFp ~~p ~~c~._ R ,:. ~~ ,: Design Criteria ~~~ Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L 3 Bedrooms x 100 gal/bedroom/day x 1.5 ~b gallons/day hydraulic load In situ de~ned loading rate Depth to estimated high ground water Depth to bedrock Cross slope at system Force main length 2 ~ Manifold/header length N ~q Drain-back ~•~-~ Lateral length \~~ @ ~ 5S'O~s~•o Lateral elevation `t ~ ~~ Lateral hole size ~~`b in. @ ~`4'~ x 2 ~lz `~ holes/lateral S ~ Lateral volume ~`~~ZS b Total lateral discharge rate 3 ~'~ ~ Z Network pressure compensation losses ~ ~~S' Elevation difference ~ • 'o Friction loss ©• 1' b Total dynamic head ~ ~~ ~ Pump/sil?l~on ~ ~ gpm @ ` `~ Manufacturer ~ ° e-~l o,r Dose volume 9 b.$S' Lift/sipl~`on tank ``~ ~-~~ ~~~ ~ ~o - ~vo ~w-~ ,, Septic tank `' `' ,/Effluent filter ~ ~ ~''"`O F ` - `~ g ZZ- i4' ~ ~ Measurement pump on anal off ~ ~ S Height alarm from tank bottom 1 ~'• ~ Reserve capacity 3 ~'S~ specs.calcs.res Design Calculations ~,3g gallons/sq. ft. per day Dt,2 ~~ 3~ in. ~~5~ in. 4 Rio ft. of Z in. ft. of - in. gallons ft. @ bottom of lateral in. ( Z' '~ ft.) Spacing holes total y` ~`~Z ~ S`!2 gallons gallons/minute @ z'~ ft. head ft. ft. ft. @ ~ gallons/minute ft. ft. of head Model # ~ ~ ~- gallons ~ J'O gallons ~ `~'`~ gallons in. in. gallons Page Z of g r ~-~ -. scnLE: l ° _ , BM l ELEVATION. /~)U • U BM i DESCRIPTION,~P / ~~,Qp~, Q,'~~ BM Z ELEVATION q9 9~ $M 2 DESCR]PTION}~Q n~ l~, p~- D,~~~ ~.~\ SYSTEM ELEVATION- ff, S O SYSTEM TYPE ~-~ - (y fa c~ 2 CON'1"OUR ELEVATION ~~,QQ `S `F Z.!~ ~~.~ ~~ t2-~.~ -~\ 9 $ , O w~, ~,,,,, ~ ~'v 9g Y i 1 ~~Gk ~1 i ~ ~~~ _ lsv.~ w..~o j ~ •g~nZ , S"'i / ~~. .Z., 1~vc ~ ~ s ~.Q. 4.0 ~~P w. ~ i I ~ ~ ~~~ a-a'LCM~ -'V .~ q 3` 4~. S a.,, ~j,, ~ _ ~ e r i ~ ~ ~ o~ ~ (q~•o~ - ~- -- - - ~ - I j -- ----._ __ i _' "-_ ,_._._ __._ . _ .._ _..__,_._ ~ " ~ ~ ~ ......_._r__.,_ -....__ v _ _ _ _ _ _. ~~: -~--"---:- r---r-----Y--+--'?---- -- ---T---- ~~i^ S _ a.- ---- -- ~ ~ , ~ I ~ ~ , ... _ . ~.~ - ,. Si Iz-~t . _._ _ -- - - _ 1 ~'~~ ~ ~..- ----- ------ ... -~ ~~ ~ ~I , ~ , ~ ~ ~ i 1 ~- ~ ~ ~ M j ~ ~ 1 ~ G i .....r.. __.- . _.._- __ `__'-' I i y.___.._..___.r._. ...~....____..-._.. ~._..-..-W~. _ _ ._-.._-.. __~ '. ~ ~ .-.-. ..r ._ .- - _ _..~-_ -~-.-_ -. .. ~ -___-. _..._..._...~ f y,...-.. .. _._ ..-..._ ._........_....-r~._..._.-_..-..-...r__-. _.... _. «.. -__ ~_.. ~.-era- __-~-_-.T- -._--.~ r ~ ~0 S y,, .. ~.~: v •. --~ o ', ~~ )ate. ~. ~tb•, ~JV,t~ ,/ ,~ ~.~ 4 r C4- +.~ .~. e. G~.se.~ ~o1~a... .. `,~~_C~Fabr~ - Observation W e I I ~c S~ 12" Z •~~~-~~,-i '': .. ~ L ~ ¢.v 'l$~~ z' ~o~ 22 p ~ Distribution Lateral ~-Soil Cover ~, ~. ~ ~, ~ 2"~ W~,,,_ V S~ 4- ~ ~ g ~V ~; ~, .. .2,~ , by c sag. 4.0 ~ Z" pv c t.9. 4~ , .. 54... ~.~.. °,r.JCs ~~~v s~~z 2.9' I Z..a{. I1~o' I,o' I Z,~' I SS ~ o' S~~ o' l l z~m' 4-0 1..~,~.Q ~\ ~p ii~+v1 ~ 4 ~v vQ~ a bo t, w ~...~ s..,~ z1 w, ~ 1 c y..~ ~ • I b ~ 1..~5 0 ~. 1 .. ~- ate. c_a..,.~ r~.a. ~O I 1 o w. ~ ~. •. ~a.~ ~ ~.c~ .o'~ .,. ~- ~ • o ~~ ~v ---~ ~ o~ g -' ~. t r . ~ -~a -WCKING~GOVfiR ~--~ Lv~v~iuiNC ,c ABED . QvIcK a~.coyy-cT--~ Cr ^-Q-c L"Iw. ~aq --~--~ 4 Pv~ ,,.~ PIPE 3' {~U NOISTuR6E0 SOIL i~ r cWKOVC~. o-as~~c t- S O 11JT'S C~l~ Q \ P ~: c.o Nn1lT~ i~o1w c~~~. ~Z`~i E~F~ ~ I~S SEPTIC t ~ _SPEC{FI•GATI~tJS DOSE w ~c `K~ Tnu..S MA-JUPA~TURCR: b- LIUMBER OF Do5C5: TA-JK SIZ C ' ` ~'`'~ - ~~ g PEK Cn_ _ 11 GALl.O-JS ,DOSC VOLUME AL ~Rn f' + 1 F g~ S J ~'~ ~ b - ~, 1 J1U rv` tUCLU ACTVi1,t-R; " DIr.JC, bAGKPI.OW: L~~~ ONS i"-OOCL 1JUKOCR: . 1 e 1 1-F ~ CAPAC I7.lES; A o 24'~ 3bS.o~~ 1~JCHCS OK awITCH TyPC; ~'~`w` '"`~ C,A_.0~, HUMP /1AIJUFACTURCR; ~ gS~ MODEL -JUMDCR: I~ ~- ~ g.J 134 1 ~MQ.V~.t.v y, JWITCN TtipC; D~ . INCHES GR Cnn„~'~- IJOTE: M11,JIMUNI OISCFi/1RCs>< RATC ~~`~ GPM PUMP AUD ALARM ARC T~ bC INSTALLED 0-J SE PARATC Clata~\Tg VERTICAL DiiFERf-JCf DfTWCCU PUMP OFI /-UO OISTRIDUTlO-J PIPE ~~~ ., FEET + r1i1.11h~UM -JETWORK SUPPLY PRECL.URE . ~ FCCT ~-o~~-~' 2 ~5 .. + U` ~ FEET O F FO R C L f''U-I tJ X ~ ` ~ F T/,/ ----/oo/tFRICT101J FACTOR. .. ~^1 - ~~~~' FEET ~ 'T~-~ ~~.. TOTAL 0~-.-AMIC NEAP ~'`~1 ~ FEET •• 1 ~~\\ IuTERUA~ OIMC1J61pA}>A o~ TA-JK: LEI.IGTH .~2„ 4 .. 2 ;WIDTH ~ l_IgUID DCPT H --~ A \ BAFFLE ~ Z `~ F ° " ` M~,K WEATNERPRCJF I I .n1NOTi0H ~ 8ccc i_' ~~, Pv~ .~:, ~ a" 4 0 YchT J 3,s-, - - - --r. --- - -. '~ ~wL.D ` 4 ~, 13' o-rt c SoL~p j I C1Rputi0 4z° PurlP Go~E-,-~ bcoCK 'L 24-~5~ ~~ 1 Al4iW ~~~ ON ~,~ oc~ 9" - >. 4-~-u~sasasaa Y °a w x U Q z r 0 a 0 4 HEAD CAPACITY CURVE a MODEL 152/153 w WW ~ ~ 50 153 12 40 52 30 8 20 10 0 20 40 60 80 10 GALLONS LITERS 0 80 160 240 320 FLOW PER MINUTE TOTAL DYNAMIC HEA6/CAPACITY PER MINUTE EFFLUENT AND DEWATERING MODEL 152 153 Feet Meters Gol. Liters Gol. Liters 5 1.5 69 261 77 291 , 10 3.1 61 231 70 265 , 15 4.6 53 201 61 23t 20 6.1 44 167 52 ig7 25 7.6 34 l29 42 159 I 30 9.1 23 87 I 33 ~ ~ 125 j 35 t0.7 -- 22 ' 85 40 12.2 -- -- ! 1 t a2 Lock Volve: 38.0 Ff. (1?.6m)~44.0 Ft. (t3.4m)' 3 27/32 o»soe ~~ 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 for'outdoor installations. See FM1420. Over 130°F. (54°C.) special quotation required. 1521153 Series 1521153 MODELS Control Selection ! Model ' _Volts•Ph Mode Am a Sim lex Du lex N 152 115 1 Non 8.5 1 2 a 3 BN 152 I t 15 t Auto 8.5 Induded 2 a 3 E t 52 ~ 230 1 Non 4.3 1 2 a 3 BE 152 ~ 230 1 Auto 4.3 Included 2 a 3 N 153 ' 115 1 Non 10.5 1 2 or 3 BNr 153 115 1 A t 10 5 Intl ded 2 3 ,- ~- ~, ,._ ,--, ~:T== z ~/s ~~ * /V ~ ~ ,'~ sKZass ~i _ uo u or SELECTION GUIDE E 153 230 1 Non 5.3 1 2 a 3 BE153 ! 230 1 Auto 5.3 Induded 2 or 3 t. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. O CAUTION 2. See FM07t2 for correct model of Electrical Alternator E•Pak. Att instillation of controls, protection devices and wiring should be done by a qualMied 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) licensed electrician. All elecMcal and safety codes should be followed including the moat recent National Electric Code (NEC) and the Occupational Safety and Health Aet (OSHA). or (4) float Syslem. , d~ RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16341 ~. ~. Louisville, KY 40258-0347 Z r ~ `~ ` "? SHIP T0: 3649 Cane Run Road ® Louisville, KY 40211.1961 QVi1C/TY PUMPS SNCE ~c7clc7 PUMP f0. (502) 778.2731 ~ 1(800) 928•PUMP http://www.zoeller.com FAX (502) 774.3624 © Copyright 2000 Zoeller Co. All rights reserved. r ~ ~ ~ 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, TL 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 dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, 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. 0. If septic or dose 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 maybe required to maintain a functional system at start-up. 12. If possible, the upslope~ toe of the system should be landscaped with additional fill to blend this area into the upslope natural grade; this will minimize the possibility of the system trapping surface run-off; final settled slope should be 2-3% over the system or 2-3% diverting surface run-off around the ends of the system. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. [f 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 dose 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; initial inspections of the filter should be made every 6 months until a minimum time sequence is determined. 4. Periodic observation pipe inspections should be made by the owner 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, dose 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 Wisilunsin Department of Commerce ` .Division of Safety and Buildings ~., •~-~Nevv Construction t1se:'~-Residential / Number of bedrooms ~_ Code derived design flow rate GPD ^ Replacement ^ Public or commercial -Describe: Parent material / f i 4 Flood Plain elevnation if applicable ' l - iU`1,1,¢ W ~ . General comments ~y5~ Pm e/~t~ r / "`Sa (~ Z ~ F~ 3 lP/4,~ (/Yts/cL,~ f~(N E ~ Q ~ ~/°~ and recommendations: n p/ ~ t ~ ( ei ~ V ~ G~~' . Q ~ ` - ~_-S ~l . ~`/~-~~ r~'~.. 6'~" ~- °r/ 7/~r~° l - p 0Q/~.,(~ cL/~(~/-/ /S`~~ S-e~',~lLt/lCi ~ ~aWGti SOIL EVALUATION REPORT Page ~ of 3 County f __ l T Attach o0mpiete site plan on paper not less than 81R x 11 inches in size. Plan must _ . v i ~ ce ne o w is i s an Parcel I.D.D~ / L~ ~ arest road. and l tan percent sl ops, north arro oca on aand d cale or dime sn ions ~ ~ /~ ~ ~ ~ j V Please print al ' R e by Date Personal information you provide may be used econd6iy~lrr~9~aw. s. 5.04 (~) (m)). ~/j'h c3 1v ~ 3 Property Owner . --.. _ _ ~ Loption ~~ ~n-i~-, JUN ~ p 2002 vt. Lot Ntt,J 1/4 /~( 1/4 S ~ T Z4 N R ~ ~ E (or~ Property Owners Mailing Address ~[ (~~ ~- 170 ~ Jt ~ ST. CROIX CUUN7:l` t # Block # Subd. Name or CSM# ~~c~)„~ ,Q~d ej City State Zip Code City . ^ Village ~ Town Nearest Road ~{'or s t ~t s,7tot)-Y ~ 2Co am-~nd l ~~ ~' A ~ Boring # ^ Boring •- U '~ f}Q~~/Cf Pit Ground surface elev. fL Depth to flmiting factor ~ ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft~ in. Munse ii Qu. Sz Cont. Cobr Gr. Sz Sh. 'Eff#1 'Eff#2 2 ~ 3 2!e -~f8 - ~ Z~ vv,-~`r c s - . 9 `~ ~-d ~ ~ t ~ Sc I 2m s.bfL -fir ~ 5 -- . ~,- 5 ~4-~ .~ er 7~ 5 ~ sbk ~»~` - ~{ . ~ ~~ # `~ piarng Ground surface elev. ~_ ft Depth to limiting factor ~ ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. ConL Color Gr. Sz Sh. 'Eff#1 'Eif#2 ~ C~2 (o r C2. 5~ ( 2 mfr `S ~~ ~~ Z -2-3~ l ~ 3~~ -~ Sc( ~~- ~5 - • ~ 3~-~+S ~o ~lc~ CZP~.S r ~ 5~1 ~ - - ~ . ~ 'Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODs < 30 mg/L and TSS < 30 mglL CST Name (Please Print) Signature CST Number ~.~_~ Address Date Evaluation Conducted Telephone Number ~t ~r Property Owner 1 ~~ Parcel ID # ~d7~~~ Page . Z ~ 3 Boring # ^ Boring R?~~ ~ Depth to limiting factor 5~ in. ,® pit Gtund surface elev. Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Sinrdure Consistence Boundary Roots GPD/ft2 in. Mansell Qu. Sz Coat Cobr Gr. Sz Sh. 'Elf#1 'Eff#2 2 11- Sr' cl Z Sbk- ~ -- ~ y - 3p b - S~ Zm9b~ c s - • 5 ~ 9 ~ 50-~ 0 (o C ~P~ 5 - Sc.l k m~~ ~" _ . ~( . ~ Boring # ^ Boring [~ pit Ground surface elev. R Depth bo limiting factor in. Soil Appliaition Rate Horizon Depth Dominant Colo~• Redox Description Texture _ Structure Consistence Boundary Roots GPD/ftz in, Mansell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'i=ff#2 ^ Boring # ^ Bonng pit Ground surface elev. ft Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Des(iption Texture Stnxture Consistence Boundary Roots GPD/ftt in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 `Eff#2 - 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mglL `Effluent #2 = BODS < 30 mgR and TSS < 30 mg1L The Department of Commerce is an equal opportunity service provider and employer. If you necd assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBtY8330 (R07l00) i ~, SCALE: 1"= ~ \ 7D y BM I ELEVATION /~)U • U BM 1 DESCRIPTION ~d P O_ -^I ~pC ~, nT_ BM 2 ELEVATION q q ~ (~ BM 2 DESCRIPTION -~>_p ~ ~ /~ Q ;Q-e SYSTEM ELEVATION ~I~, 5 y SYSTEM TYPE ~+ - (y' f a ~ 2 CONTOUR ELEVATION ~ ~,Od ,~ ~' W PAGE~OF~ ® .~- I e SIGNATURE '~ -.~- ~^' ~ -_ ~- ~ DATE G ~ ~ ~ Z ~/ r ; :~ .0 •~ r ~r / r 3 " s~',S r r i ~ r r Mt0 ~ ~ ;r ~ ,~® N W f ~ ;tip: ~ ~~ r / 4~ ;~° h ~'' r ~ r~1r d' ~ 0 ti -~ w r - ..r r ~ r ODD r ~ ~ r ~ e: b .a rr ~ / 0 M o f ~', ~ / ~M ~ r ~ , NOg°08' ~1" it r ,_ '¢ N x~ r~ ~_~ / ~. . M: / ~ ~-. I ~ Q ~ ~. r ~ ~ ~ '/ ~7 r .: ~ ~".~ ~ ~ ~ o ~,- 3 r ~ , N W V -. ~ N °~ ~ N ~o N J N ~' M ii S / h. Q Q O k M m ~p N ~ x 'F£ .. ~ J O to J N N •v Cp r ~ M1 ~ ~ r ~ ZZ + ~ ~ ~'3 a60 ,O 1 o ti N+ , r . ~ ° l r -~ e st M - x ~ 1 r '6££ ap ~ ip ~ r r : ,0 ~ ON O ~ I o! cn ~ ~ , ih o v ~ ~',~ o~ ti m r ~° M do ~ ~ N , ,~ . .. ~ ................ i.,,~,~~.. 4 - ~ .................... .. ~ ..... x. o...... •... .....t . ................. ! ~ • _ ~ ~ 0 ' 1 ' _ x 0 ~ ~ ~ 4 222. 74' _ - - - - - _ o _ ------ - _. .....n ..~• .....a. ~ ~~ w~ r`e1 ~ w Tr LfNF OF THE NW I/4 r TI In n r - -c~r 1\ ~ - ,~ ~ 1 • X N 0 U/FCT r r NF nF TNF AIW ! /Q ST CROIX COUNTY ' ~ SBPTIC TANK. MAINTENANCE AGRBEMENT AND OWNERSI-IIP CERTIFICATION FORM UvvuerBuyer `~-' ~ rl ~t1.2.t~~ Mailing Address ~ ~~ 5 Property Address G 2 (Verification required from Planning Department for new constru on) Ci /State t~l0~.rv~.~ ~ ~ ~ = Parcel Identification Number ~l " /~9~ ' °~~ ty ~.,EGAL AESCRIP'I'ION Q , ~,~"S ~~am~~~ W ~ ~ ~ '/,, Sec. J . T~ N-R ~ ~ W, Town of property Location ~ /•, -.- ~Q Subdivision ~ ~ ~`~`r~ ~. Lot # , Volume ______~_- • Page # Certified Survey Map # Volume GJ Page # ~~~ Warranty Deed # ._ ~'~' ~~ S house yes ^ no Lot lines identifiable ~ es ^ ao N ~ ~ ~`~ r ~ ~ ~~ ' ure to/~~ ~. doper maintenance SYSTEM our septic system cool result in ita premature ika Improper use and maratenanceof y ~ aeed~ by a licensed pumper. What you put into the system consists of pumping out the septic tank every three years or sooner, can affect the function of the septic tank as a treatment stage in the waste dispose ~m- errt acetification form, signed by the owner and by a The property owner agrees to submit to St. Croix. Zoning verifying that (1) the on-site wastewaterdisposal system mastcrPlumb~r, jouz4eymanplumber, ~~~Pl~or a licensedpumper ~ tic tank is less than 1/3 full of sludge. condition and/or (2) aRer inspection and pumping (if naces~Y). ~ is in proper operatuig the rivate sewage disposal system with the standards is and a to maintain P State of'Wiscoasin. Certification ~, ~ undcrsigpod have read the above roquiremea i~ ~ of Natxual Resources, set forth, herein, as set by the ikpartmeat of Commerce and the Deparim Office within 30 stating that septic system has been maintained must be completed and returned to the St. Croix County Zonin Sys a lion data ~+ / v DATE / SI O APPLICAN'T' OWNER CERTIFICATION o,,1r knowledge. I (we) am (are) the o~vnct{s) of I (we) certify that all statements on this form arc true to the best of my ( ) ~d e, by virtue of a warranty decd recorded in Register of Deeds Office. (/ Q c' the pcrty ~ 7 D TE S ATURE OF APPLICANT De anmcnt. •««««~ An information that is mis-represented may result in the sanitary permit being revoked by the Zoning p •.as«« y .. lication: a clamped warranty deed from the Register of Deeds office Include vrith this app ma if reference is made in the warranty decd a copy of the certified survey P SEP, 11.2004 1. SOPM Na.019 P. 2~ ,.~ ~ 'd 610 'ON ~N-Alld3~-'dNId3 WdOS~1 ti001 'Ll 'd3S 6L0'ON ~N-A11V3~-VNId3 WdlS~L ti001'Ll 'd3S - U 2GS~ P 370 STATE BAR OF WISCONSIN FORM 7 - 1999 17ocnment Number TRUSTEE'S DEED Dine M.13onlg as Trustee of Karl M. I;Jlferts and Katherina G. Ulferts Family Trust for valuable consideration conveys without warranty to Evgrts Cbt~tgtlctions ,~I..C Grantee, the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Lot 20, Pheasant Ridge. St. Croix County, Wisconsin. Recording Area STATE OF Name and Retum Address t3REMER BANK NA 532 S Knowles Ave New Richmond, WI 54017 ois-ia96-2aoao Parcel Identifecation Number (PIN) Dated this ~ day of Setltemlaer , 20114 ~,~y , _ ..------ ------- --------.-_ _---_____.._ ----...---.~__-•-•------._..----__._..______.__---.. ...----- ~~.----- -- -'-__1~~~'~' vex!' _?~'~~Gt~S * _______ _ _ ____ * Dine M. Bonze _ __ __ Trustee Trustee AUTHENTICATION ACKNOWLEDGMENT Signature{s) Dine M. Bonte, Trustee of Kart M. Ulferts and Katherina G. Ulferts Family Trust authenticated this day of September , 2004 * Kristina Ogtand TITLE: MEMBER STATE BAR OF WISCONSIN (If not, --_.._~_- authorized by § 706.06, Wis. Stets.} 774094 KAl'HLEElE N. wALSH REGIS'CER OF DEEDS sT. ceolx co. , wl; RECEIVED FOR RECORD 09113!2884 18:28AK TRUSTEES DEED EllE1PT ik RBC FEE: 11.@0 ?RA1tS FEE: 142.50 COPY FEE: CC FEE: PAGER: 1 ss. County } Personalty came before me this _ day of _ _ the above named to me known to be the person{s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY _ _ _ _ Attorttey Kristine Ogland _ __-_-_--_--- - * - _-- _ _ -- ----- Hudson, WI X016 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are net necessary.) .) * Names of persons signing in any capacity must be typed or printed below their signature. tnfomiation Professionals Co., Fond da lac, Wl STATE BAR OF WISCONSIN 800-655-2021 TRUSTEE'S DEI?U FORM No. 7 -1994 r .I ~ 0 o N8S°3T /2' ~-I ~ ~ N83° 16' 29 0 61.34 ~ ~ v'~J~I ~~ W ~' 0 .~ I N _ii '~. N I ~ I ~ ~ i! I ~ .~ ~ ~m .~ 'y n ~-N89°4.9" 38 E... ~ 30' ~ '~~ :?n°.., M oRq~ ~~ /~/?'; ~ = 76 q F 1 _~' ~~. ~ r a. o; m ~ gm~ n -- ~ ' 20'- of cn n a. _ ~~ ~~z W r oo' y 1 z o -i m ° - ~' ' 30' ~ o~- ~ s . ~_ c } 30.00' . ' ~'' 1 60 ACRES '-- - 76.OC -- co o COURSE Z; `° w GOLF 0 1 p' ~, - 244. p w 5800 zs` o ~ 45' ' 33. 246.2 98~ T4; o -~~ ~ ~ T `'- ~' s b '-~..- ~y ` ~c: ® ~` ss s3 ~ ~. . c.or zo - i'. T9 ACRES T8, 05! S0. FT. MBE' I0T0' LFE 1072' W N 0 O Z, 252.2 !' 2"... ~3 pal 4 13.29' ~.or ~ ~ 1.83 ACRES 83.932 S0. FT. FfK~ IOTO' LFE IOTc~' -~ ~ 498..48' -------- N8$°28' 12:E - ~' __--- -.-254. 13' ___ ~, W1, --------- 244.33' EggEME i Z ~1 = S89`4 cfl ; 69, 80Q S0. FT. 51'' E /.06.00' ~ ~ ~ HWE: I0T0' su o O~ LFE ;1072' O O Q S895400~8"•W o M M tV p O N ~ 2 No ~w ~ 1si.os' cr, :200.28' tin ~ N$5° 25' 34" E N M N -p L07' 18 ti - ~,.~ 1, 6G ACRE'S cv v 72; !8T SO. FT. b MWE:I0T0' W V LFE~l0T2' ~- WEST L 1 NE OF THE NW I /4 coo ` a cn ~I- cn ~ ~ ,- W / /4 CORNER OF i'- I ~; / SECT/ON 9; T29N, Tin nn-.--____'--- R 17W. (SET P. K. NA 1 L ). a' !m ~' L i ~' 2. ~ 94, ~ H ~. 892.74 ,UN~LATTE 1~ 00 O r_.__.-= GRAPHIC SCALE - 2001150E THIS INSTRUMENT DRAFTED B~Y J!M WEBER