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018-1096-32-000
Wisconsin Department of Com- m~e ~-PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Nickleb ,John Hammond, Town of ;ST BM Elev: Insp. BM Elev: BM Descriptio TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 8 / Dosing O ,`~; u l Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ .7x ~ ~1~r ZS I Z 5 J Dosing ~ ~ 1 ~/ ~~/ ~ ~ i Aeration Holding ~~- PUMP/SIPHON INFORMATION ~ ~/ Manufacturer and ~ GPM Model Number ~ /~ ~J 1 ~ 3 "'[ TDH Lift 1 Friction Loss System•Head 5S TDH 1 ~ o_ co ~ Forcemain Lengt ~ Dia. , Dist. to well / ~ Z D SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 463302 0 State Plan ID No: Parcel Tax No: 018-1096-32-000 Section/Town/Range/Map No: 09.29.17.807 ELEVATION DATA STATION BS HI FS ELEV. Benchmark (~ -3 z.z5 ~aa . ~ Alt. ~, Bldg. Sewer ~' ~ ~~ SUHt Inlet la, Z ~v ~ SUHt Outlet ~ ~ Dt Inlet -. .~ Dt Bottom Header/Man. Z• Dist. Pipe ~ t! T C p~ l C Bot. System 3, J q ~, Final Grade ~' z St Cover ' Cb w~-'o ~ r' `~ 7. Z BED/TRENCH Width ~ Length ~ No. Of Trenche PIT DIMENSIONS No. Of Pits Inside Dia. Liqui Depth DIMENSIONS fj( / V Q~ ,U ~ \ y ~ SETBACK SYSTE M TO P/L LDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of ys em: ~ _ I Z~ ~ ~ ~/ UNIT Model Number. I~ISTRIRUTInN SYSTEM ~ !SIC .{~--,. (tJo.l„_ _ d-:., .A t. lz,L,v~_. Header/Manifold Length \ Dia Distribution / Pipe(s) ~~/ ~) Length ~b O Dia ~ Spacing x Hole Size ~/ ~ ~J / x Hole Spacing Z ~ Ve to Air Intake ~J ~i~ S(lll rf~VFR ., ore~~~~.e c..~fe..,~ nrn, vv Mnnn~t nr Af.Ararla Systems ~nlv Depth Over ~ Bed/Trench Center Depth Over ` Bed/Trench Edges xx Depth of Topsoil ~ xx Seeded/Sodded i ! No ` xx Mulched No ~ ~ 1 s ~ ~ _ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Za/ ~~ Inspection #2: / / ~'o.~J O k Location: 1749 110th Av ue Hammond, 154015 NE 1/4 NW 1/4 9 T29N R17W) Pheasant Ridge Lot 32 ,~( Parcel No: 09.29.17.807 ~-~, I ~,dc. waD 1.)Alt BM Description = ~~ '~"~ ~ r ~ ~~~ ^~ ~' -^~ ate' /~~ ~~~ti-. ~Q 2.) Bldg sewer length = Z~ ~~ ~ ! ~S ~JC~~O ~ ~ 3 ~ ~ -amount of cover = / a i K,JCt7r t f n'5~-"'~~,,~-' °, „ ~"' I ~ ,,. ~a ~..~ . Plan revision Required? 'Yes No /~ --- _ -, - Use other side for additional information. ~ ~ ~ ~ - '- r~- - b' 0-_ _ _ -- _ __ --.----- Date Insepctor•s Si ature Cert. o. SBD-6710 (R.3/97) `` Safety and Buildings Division County ~ ~ ashington Ave., P.O. Box 7162 , r' ~ ` 1 _ = I~~O~~,~ ~di , W t Permit Number (to be fill in by Co.) vl 66-3I~E~EIVE ` ! Department of Commerce 3 b . Sanitary Permit Appli ~ personal informatio 21 Code Wis Adm In accord with Comm 83 you prtlliftld ~ ~ 200 State ~ Plan I.D. Number z ~ ~~ J , . , . . may be used for secondary purposes Privacy Law, s] 5.04( (m) Proje Address (if different than trailing address) UNT I. Application Information-PleasePrintAlllnformation ZONING OFFICE ~ /7~~ //~ ~ ~~ / Property Owner's Name ~ ~ 1 ~ Lot # Block # Parcel # ~ ~ ~ ~ ~ ~ o ress dd Property Owner's Mailing A Property Location ~[ Jf / ~ E~ ~ .~ / ~/ ~ C f ~/ ` z ~ ~ ~~, ~~, Seciion City, State Zip Code Phone Number , , D Q ~ J v ~/ trc one) ~ t N; R~E W (chec all that ap ly) e of $uildin II p g . p ~~ 3~~o m~. ( 2 Family Dwelling-Number of Bedrooms iv Sion Name CSM Number ~ .~-S - ' /b ribe U bli i l -Des ^ P /C ~~ a c se u c ommerc ^StateOwnod-Describe Use ~p r'pp,Mg I v` IOaAQ.N~ ^City ^Village ship of III. Typ f Permit: (Check only one box on line A. Complete line B if applicable} ~ ~_ ~ _ - A_ New System ~~ ^ Replacement System ^ TreatmendHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal iration Before Ex Permt Revision ---- ^ Change of Plumber ^ Permit Transfer to New Owner Lis/t ~evious Permit Number and bate issued ( ~ rn~j ~/~~ p ~ ~ . ~ I IIYY ,,JJ IV. T e of YOWTS S stem: (Check all that a 1) ^ Non -Pressurized In-Ground ^ Mound >_ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil - ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Tr ent Unit ^ Recirculating Sand Filter ^ ~. Recirculating Synthetic Media Filter ^ Leaching Chamber rip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: Desi Fl d) Design Soil Application Rate(gpdsf) Dis ersal Area Required (sf) a Proposed (sf) Dispersal Ar e System Elevation ~ ~ j' ~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units ' r ` ~ `~ ~.1 Concrete Constructed Glass N i E ti Gn.1pC-~ ew ng x s Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber ~ [~ VII. Responsibility Statement- T, the undersign assume responsibiliiy for installation of the POWTS shown on the attached plans. Plum ~ Name (Print) Plumber' gnature MP/MPRS Number ~ Business Phone N(um~r _/ ~f~ ~~ ~ ~~/~ `~ r i Plumber's Address Street, tiy, S to Zip C VIII. Coon /De artment Use Onl Q(1i!pproved ^ Disa ov Sanitary Permit Fee (includes Groundwater Date Issued Iss ~ gent Si e o S ~/ ~~ ^ Owner en on r.I]enial Surcharge Fee) .~{ VC ~~ •~ c J ~~ IX. Conditions of ApprovaUReasons for Disapproval ~` 5 6v~t ~ ~ \ v"~ /V1~bt" ~j~ Y . STEM OWNER: ,J S n / 1. Septic tank, effluent filter and .~-- ~{~<,C,(',r ~o~l / , ~~ dispersal cell must all be services /maintained fa.~ ~^~~"' ~ /// as per mana ement lan rovid d b l b U ~( ~ ~~ g p p e y p um ~ /!~ 1 ~ er. ~ ~ o I/~ 111 Z db . a adc rogtmements mint be maingiirted aM pM ~PPlfgbM ood~ / oroirnlto~s. Attach complete plans (ta the County only) for the system on paper not teas roan arr~ x t t tncnes m stye SBD-6398 (R. 01/03} PLOT PLAN PROJECT, John Nicklebv ADDRESS 6351 St. Croix Trail N #128 Oak Park Heiahts Mn 55082 NE ,1 /4 NW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 100.5' 3 BEDROOM CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none ,BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' FiilteI' Zabel A-100 ^ BOREHOLE O WELL * H. R. P. Property 110th Ave Scale = 1 /4" _ ~ Or _ t Line B-1 Well is to meet all setbacks found in Comm. 83 0 B-3 1 % Slope B-2 i Pro 3 Bedroom House B.M. #2 100.5' Area 15' below system is to remain undisturbed B.M. #1 System is being installed as a at-grade to due to marginal soils for being a conventional. Huffcutt Combo Tank Tank is to be properly bedded and provided with lockdown covers with approved warning labels COPY Property Line PLOT PLAN PROJECT- John Nicklebv ADDRESS 6351 St. Croix Trail N #128 Oak Park Heights Mn 55082 NE i/4 NW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 100.5' BEDROOM 3 CONVENTIONAL AT-GRADE )OCX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none ,BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION Ioo~ Filter ZabelA-100 ^ BOREHOLE O WELL "H.R.P. Lineerty 110th Ave Scale = 1 /4" _ ~ O~ ~ t B-1 B-3 1 % Slope B-2 i Well is to meet all setbacks found in Comm. 83 Pro 3 Bedroom House B.M. #2 100.5' Area 15' below system is to remain undisturbed B.M. #1 System is being installed as a at-grade to due to marginal soils for being a conventional. Huffcutt Combo Tank Tank is to be properly bedded and provided with lockdown covers with approved warning labels Property Line commerce.wi.gov isconsin 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 Mary P. Burke, Secretary May 17, 2005 CUST ID No.226900 ATTN.• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/17/2007 Identification Numbers Transaction ID No. 1135563 SITE: Site ID No. 698363 John Nickleby Please refer to both identification numbers, Lot 32 Pleasant Ridge above, in all corres ondence with the a enc . Town of Hammond, St Croix County NE1/4, NW1/4, S9, T29N, R17W FOR: ~ Description: Three Bedroom At-Grade System Object Type: POWTS Component Manual Regulated Object ID No.: 1017917 Maintenance required; 450 GPD Flow rate; 50 in Soil minimum depth to limiting factor from original grade; System: At-grade Component Manual, SBD-10570-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: Approval Requirements: • This system is to be constructed and located in accordance with the approved plans, publication SBD-10570-P (R. 6/99) "At-grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems", and the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". • 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. CO~r • 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 r D1;PARTMI • A Sanitary Permit must be obtained from the county where this project is located in accordance with the ON 0 S requirements of Sec. 145.135 and 145.19, Wis. Stats. ~'' ~ SEE COR • 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. Stat SHAUN R BIRD Page 2 5/17/2005 • 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 Department, which mawinclude local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincere ,l1 ' ~ ~/,~.~ ~~` ~ '~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce. state. wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 \1 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 5/6/05 Owner:John Nickleby Location:NE1/4 NW1/4 S9 T29 N,R17W Lot 32 Pheasant Ridge Hammond System type: At-Grade Manuals Used: At-Grade Component Manual version 1.0 SBD 10570-P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01 /81) Page# 1. Cover Page 2. At-Grade Plot Pian 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contig ncy plan 9-11. Soil test Shaun Bird Signature License numb 226900 RECEI~~E1D MAY 1 0 2005 SAFETY ~ ~uILDINGS ~'®yllljry ~~ OF COlbP!yFRC~ ~N LQINGS ---_._ < SPpNpEN ~ ~r PYC ~t~AC,EMAI ht r..~, ~_ ~~._.~ .~ ~ rJ: r-- ~ ~; y Y~TUR~3- tJtgS _.,r..._.. •,. __ _ i t-- piSTlSt`~~~TtDUL Lptg.R,AL ""~ + VI( ~ ~ srn$tz;a~.e oa~z'.<,~eltctaes ~,tet,i,`~ ~ ~ 1 _ .~_ .~_ a__ ~ ~.+ ~i lip ~~ ~ 166 p=~Tt S = ~ fit. ~ - ~ ~-~. ~ _ ~. ~t. ~I/G=_ CELL flf %z ' Z fZ pC~GttCf~ArTE ftPf'Rb1tED SYtJTt~E,'T~c. Fabric 5Tt~81~.~1~~b ~bservat~an----_,,_ We I t ~ } ~E Distribu~ior+ La~eral n ~... ~ iii. .r-„~ ---~ 2'~ :•• •+- ~~ A 1 r ~-2 i Sail Cover .. ~t.~VdED (.p`{ZK ... > 5' Plan Vier•* and Cross SBCtion of Wisnonsirt At-grades Unit with a Si'Ctgle pbsorptxan Area an a Slopizzg Site l.i CE ~t 5f. ~= ~,,G~a-ru K~ Page Qf Distribution PiR+e Detail Ior lateral Metaorlc * Last Hole Should Be Next To tuR~i-~P _~. t' TuR~ • uP~~ ~~,rtouT} PYC Force !lain "~""~ ~- PYC nistributian Pipe ;~ ,~ ~ _ ACcest' ~Q~ Diameter ~/~ ~ Inch P ~ ~ Ft. Hole - X ~ .---- Inches Lateral Diameter .~ Inches} force Mai» Diameter ~~- Inches Y 2-`~ Inches ~ flf Holes/Pipe Invert ETevatian Of Laterals ~ .~~ Ft- Signed; License number: Dale: 'TANK ~ PUMr~ C CROSS SECTIaN AND SP€CI3'ICA?IONS ~„ LI ~E1~'I ,PIPE ~Z" i'~Y1~. ABOVE GRADE ~ > ~~` FROH D04R, WINQa~ gR FRES~i: ~ [A ;riT,psiCE ~~~:t E ~p ~ ~-'~ PIRx '~ ~"~ GRAD ~ L. ~1 ~ / i ~' _s~ i_...~; ;~~ Iii'- -~ ~ - INL~t ~A~'£lt TIGHT S ~~ to PIPE 3` c St3IL }~#I+FP QFF ELEV !'~ /~ FT • D ~rEA'tNERPft~f JUI~CTIfli~ 8DX WITH CONi3DiT 2.D ~'; { 1 `~ { ~ GAS- t •FIGF~T , SEAL ; ' . r , i i APPROVED 1yANHdLE C0~1 ~ W/ g~Lt3CK ~ NpR~tilliG iABE:. - ----~" HZl~ . t8~ Ms~- Jtf1~I~ PE SIC SOIL a A,ppROV ED gEDDI~+~G UlFD~ ~ ~ ~ j ~~ J~y~C~ONCRETE PAfl SI'ECY~'ICATI0135 f (°'"V DpSES ?ER DAY =_, ~ ---- SEPT~C ~ DdSE /' LI:r~ r~~a1~ ; . ~ ~.~ ~ FACTUREx: nflsE v~~ME IKCu3D~~ ~~--~-'~GA~.- jA3+SK 1"lANt1 GAL- F~~ SEpTiC 6AL. _ ~~~;bCHES = ~ •'~~ L. TAtiK SIZES = }1pSE CAPACITIES: A ?,'1 GAL. MARK Mp~gf~C1~3RER;= 8 - ,~.;,~ _ ~xCHES = r1..__--~- _,_.__ M~EL ~$~ _ ~u~ C ~'..~';xcHES = ~ rAL. ~I'pC8 s 1 'F GpL. pE7t~iF` HAR~pCTL~RI~ s I L~ ~• Z3 WAS -- MODEL ~!#BF.R : ~ J ~' /~~'~~ AS PER 3'YPE= tit i~JI'RZNG SiIITCB __ ,,,/ ~ G°;'~ P[i3'iP ~ ASR FEET D;SCEiARG£ RATE ~ PIPE - R£t~3IR£U $EN PUMP OFF i~Nn DI ~Tgi~~~~cf,,~-~ ~ • _ _ '~- FE~E`T vER''PICAL IfIFFERENCE $ETN Fg;CTIOK FACTS _ FEET Ppi.Y PR SSU E '~' ~ FT - :iC fiE~'+D + MINiK'~ HORK '~ X ~_,d=,t,-FT! ltd Q F4RC~AItI 'FflTAL DYi~"` ~" i S"~~ S f F££T l ~ 1 S,~I;DTI~~; I3iAd'4£TER ...------ UM? 'IAiSiK: ;,,EZ,iGTf~ AL 131MENg;Ot~~ {3'F F LIQi3ID ~~. IN'i~~ 4As~= SIGNED= _ if88 L 3 ft.ONt PER MINUTE CONSULT FACTORY FOR SPECIAL APPLtCATtONS . Turted dosing P~~s available. ~" =lied with . ~ a~a~s, for duplex systems. are available and suPP an alarm. are available for controlling single phase • Variable level control switches ~ back varia~e level float switches are available for variable • Qouble piggy decontrols. -evel long and short cY availa~e for °~~ installations. See FM142 . • Sealerf Qwik-Bolt wired. • Ova 1~°F. (54°C.) speaa- quotation req .......~ evaos ~ CAUTION ebpuid be done by a 9~~ n devices sod wiring includinD the'n°st Ai< won of contrds. pr° ~°d sefetY codes sdould be f°~ Hwade~-llet 105NA). ~ abonel ~Q~t~~~theOccuPa~n~Sate<Y EFFLUEtvT ~MD 4EwATE RING MOCEL ~ X57 t.... Feet Meters Goi. {3ters Gal. Liters 5 t ,5 59 251 77 291 10 3.1 5t 23t 70 i 265 t5 4-S 53 20t St 23t 20 6.1 ~ 44 ?57 52 ?97 25 7.b 34 ?2g 42 ?59 30 9.1 i? B7 33 ~ t25 3j 7 t1 __ r-. Z2 ~ $5 . 10 12.2 __ .'"_ 1 T 42 l (,t.Sm) 0 ~t 38 144.0 Ft. (13.4m) ±ock v2: Vo . . oTSSOe 3 ?) ~? T/9 I _~_.-- s2 a SELECTION GUIDE 1. Single Pf99Y~ck variaf><e level fbat switdT ~ double p99Y~ vanab~ Ieve- Qoat swi~tT. Refer to FMp477. A~ E-Pak 2 See FRh0712 for correct model of Electrical a control acrva~. sPe~Y d~ (3} 3. Variable Ievel cor-Vol switch 10-0225 ~ o< (4) float system' RESERVE POWERED DES~tGN 9n of every Zoeller pump. factor is engineered For unusual ~ndi6ons a reserve safety ~aL,ro: Po. aox ts~al Man>~~.. r louisvi0e. KY ~oz~s-o~+ SHIP To: X49 liyne Rua Road Lol~svil~. KY 402t1-1961 - Q ~O~ FAX (~ T74~~4 p~//V1P ~ J~K,,~oellercom ~ copyr,~ht 2004 Zoeller Co. All rights reserved• "[~urrP:~~ ~~E /939° GE~E~T P~A~ wTS pw~EFt'S MpI+2UAl. ~ MANA SY'STE~ SPE~PiGpTiONS Pa m+~~- - _ _ -c •. r-t rv s ~r~...__.--Pam ~~ b Gt+ease ~~~ : Bbd~em~at Oxy9e" ~ Tptai SusP~'-ded Fecal Comm' Machan~ ~~O" ~mfection ~. o w+ -y tan a Na o Na in~round ~+essurrz~d? ri ne waste ane vah~s typtd ~ doh tno~ eu. ,,,raste~,,,ieer. r~ tirv~ o v on+~ fotto~'-9 ticerrsea ••~ an ind•,~(dusl cattYjn9 Maunta'~r• Sep~+Be iCE li~($TRUGT~G ~ ~~ ~ti be made by ~ pp~g insP~~~ ~d any m a~'~'dc uP MN of farfks ate d1sPs Piumb~ Restincted ~ ~ the thttk(~ for anY t~ piumlaer:llAas~ ude a yisuai inspecd a and scum and m ~~ levels T~k inspe~O~ m~~~ ~,e vofU~ ~t~~ ~~~ uy,s~tty ~nd~9 °f effluent on ~ °r teaks. Tt~ disPe mend Surface- i ulatprY authoritY- Natd~• ~ ~~ the grpund s ~ ~Y P°nding of effluent CUi ttte-9 n~{~a5on of the ~ m9 a' p PKPeS and th a'~~ydlyon and mgtyires she immed~e or more of the lank V°1um$'~th, NR ttie ~ ind~ate a Easing tai-k equals one-thy ~ of in aoa~~a°~ ~ 9~ ~ emulation of sip e ~ a S~eP~ a erv~ing Operat°r and drsP~ vents: a~ anY ~~ ~ ~ tank shalt be mn' relent compo five Code. comPoner'ts, pretreat ppyytS Main~r. 113. VVis~n Adm , ~anica! ur pressurized P~~stiaii be Aerfotm~ ~ a ~fied semi event nths ar fess on of arty ~ °~~ ~ ~ritoring at irtteNa~s ~ ~ ""a~o~ min '(0 cfaYs of ca~np~~ otft~ °~ snag ~ ~+~ to me rota ulatory or n sew c , if ~ ~~ttrabons S check ~reatmeM tanks} ~ ~ii(sPr'~~ - ~ STARTUP ANO OPERATIC use of ~ POD s ~d/or damage ~+e dispel F°r' tfeW ~ tmp the mn~$~tmp~soved by a septage serncang aPecalor prior t° ~- ~ the oon~~ °f the d ham sepdC?~ ~, ~-- ~~r F~bec M Pump Tank t3apadtY II at,rric Tank M~_ ~ - conditions are frozen at the infiltrative surface. Sysberit startup stmt not occur when sod ti hwater levels. when ~~ ~ r the is ~~ ~y ~ above norntat K3 sand may c~esutt in the ~ tie d~mat ~it(s} in one tatge dose, overtoadn9 the ~ j tan[c nernoared ~ $ D~"°'9 tw~O1d~ ~~ ~ have the contents of the p~P ~~ ~ ~ Wit, Tv avoid ~ the effluent pump or cor+tad a Plttrt~bec or POWTS MalMainer to ~ ~ fftB t~F ~ ~~ ~~ fevers within the pump tank.. ~ dispersal tits- Oa rat drive ar patio over. or ~etwise disb~ub or compact, f3o ttt-i drirre a' park v over' ~ mound ~ atgrade sal absorption ar>ra- the ~ wlt~ 15 feet down slope ~ rntn the vr~ sfieam may lmP~e ffie petfo affil pnD(Ottg the fife Redus~ ~•~ of the ~ - d tt; dent! MOSS: matte baits: candottts; cotton swabs; eg 9 t~ tt>eat ~ the pOtfif TS_ ~ antibi~Cs: tab'Y ~ vtiater; fruit at~d vegetable peelings; ga~lne; dam; {~ fa~tida~on dt'aht {swnp f?~P} , ~rY nap{ans: tampons: ~~ water sorter brine. scraps; rt~ O~ ~ _- AgANOOtlt~tiEt±lT taken out of senrfce the fo[tawfng steps shat[ he taken do Insure that the when the POW'[ S faits sradlot es ~~ y ~ property 2ond Safiety ~ in cornplrance with ch_ Comm 83.33, IATisconsin Add ~~ ~ pig ~ tonics and P~ shall .tie disonnneded and the abandoned pipe openings she ~~~9 Operator. .. The oonfents of aft tanks Sttd >~ 5haU be cerraOVed and properly drsposed of 6yr a Septa9e . AtiJec p~P~Q. alt harttcs and pits shaft be excavated and removed or tfaeir covers t,emov+ed•and fhe void space 1~ y~ Sep. gravel t7r attolf~er inert solid material CONTINGENCY PLAN ftte fof[tnvfng measures have been, tx must tie taken. ~ provide a Dods if the POINTS fafis and cannot be tepa~ oorrrp~6attt ra~lataerneni ^ A suftable ngpiaoernent area has been evaluated and may be uf27ized f~~t rban cX>ntpaction and ~~ not The mphcement area should be protected absrxpMn Setbadrs from existing and proposed sutrdur>r, lot Mes and welts. Failure bo tae irsfringed upon try regwred riesuK in the need far a new soil and site =evaluation m establish a suitable Pr'o~ ~e ~,pl~ement aces wN must comply with the rules in effect at that time. nepiaoement area. ReptaoeR-ent systems advances in POWTS O A suitable cePlacem~t area is not avaitab~ due to setback and/or soil [imitations. Barring a hording taNc maY eB ~~ as a last r>?sort to replace the failed POVYTS_ The site tt2ts tarot teen ~ to identify a suitable replacement area Upon faalure of the POwTS a so~.artd . area is avatlaWe a. s cation must be performed tq Itxate a suitable replacement area- it no refit oldarag tank -a'+aY be it~t(ed $' a fast resort to nepJace tfae failed POwTS_ s be reo0nstnaded in pfaoe following r>rrraovai of Ste biomat of and at-grade soII absaP~n ~ ~h the rotes in etiect at that tmie,. 5utfaoB. Fhs~~Ons of such systems must comply <cVtlpRNIN©' TANKS MAY CONTAM LETHAL C,ASSt=S ANDIOR tNSt1FFtCIEM OXYt,~I. SEPTIC. PUMP AND OTHER TREATMENT t30 NDT ENTER A SEPTIC, Pi)ltAP OR v'tNF-lZ TREATMENT TANK UNDF~ ANY CtRf:,uMSTANCES. OEATH MAY KFSUt_l- RESCUE OF A pERSOIII PROM THE INTERIOR OF A TANK MAY BE DIFFICULT DR lMPOSSiBLE. AonmoNAL cOMil~Nrs POWTS INSTALLER Name .- r ~~ ~ . Phone 7~~' ~~ Powys 1KAtfaratNER Name ~" ~.~/,~~ /r'J r Phone ~,;~ ..~ ~ /~-~ ~% SEP'TAGE SERVICING QpERATOR PUMP LOCAL REGULATORY AUI~IORiTY Name v',-~-- -.YI'1 ~ A9e"~' ~.,~ ~'T ~i-- ~ x r ` '9 ~~~ rs Phone `~11 = Z ~, --'~< d Pfzons / ~ c:~ . `~.%~ grad Sart~tiota - This "~ rRis trowrnenut was clia!!ed by are ~ of ore t~teen ~. AdargtreCe and wauslaara County ~nN9 ue inirmrrcrtn rbga~ ~ e!L Comm 83-22~2J(f+?C+3(~($ ~ 83-~(T). Cl} & {3). wrsconsin Alfmii~b~r~tim Cady tJse of this docrxaa~t does trot guat,ratee tl>e psrfonraance rd the POwTS. p~tw foot} `- Division CA1"'~ ~~- ~ C ~ ~, • g Buildings 201 W. '~'y n ve., P.O. Box 7162 ~~, pc ~ ~ ~~w be filled in by Co.l ~r~conn~n ~ ~`~ ~31s~EG ~ g plan LU. Number De artment of Commerce ~ ___ Sanitary Pernut Ap yon p~6~ 0 ~ 2005 ect addtrsa Gf d ~11°s'~105'~0i') In acwrd with Comm 83.21. Wis. Adm• Coda l~ tKm) \ Pnvscy S T. C C~ may be usod for ~t t tiQa ONING OFFICE S' ~ ~ ~ '~ 1 /0~ ~V~• L Applicstiam ~formatioa - Plestx ~ Lot ~ Block _~____ ply pyvna's Natnc . Prop~7' pwro~ Ma~1mg Addscas , r(-/ - Q - "f ~ ~ ~- ~ ! /~ 3t. "`~Si~. saaion ~. '7j S ` r c) ~- 1 pC.~.J" phone Nnmbu ?rp (bde City. State ~ Q ~ . f~N: r W check au t aPPb) 3 ~ ~ Subdirisio N~ , ~~ otsdlding t . -- ~ -~` ~ 2 qty Dtf •• Nw~ or Scooo.~ Gty Village of Pubi~~' p°sr~be Use . star ~e _ Describe Use 0 6 3 2 -oa0 . QL Type Pere t~1ed` O°ly o~ hoz on lice A. complets line B if kpliablc) Only © ode Mods«woa w s~ianng sy:o~n laoement System g•~eut/fiold~og T ~t Ar ew System ~ i,ist pjyvioss Permit Numbs sod Dace hsued Change of ' ~ Peanit Traasfer to New B. Permit Renewsi Petmit Revision Pltupber ~~ Before F.aP~OQ ,S ~ _ 3y, of pOWTS t~-eek all that • 1) wt-Grade singk~ satd~6r-_~ Monad _> 24 in. of suitable soil Mound < 24 in. of suiisblo soil ~ Filter -P+~~~ h`~u~ Peat Fiber Aerobic Trr~t Unit /~ Consuuaed Wedaiid Pressuri~d 1a'~'d Holding'i's~ Omer f L3 ~i _ - Lice Qavei-less Pi g 'c Medu Fititer ~~ Asea (st1 gym adoa Q Arei Information: Aces ttegaiced i~ Disp~ . S 7 ~ ego pair (gpd) Desipi APP Rates ~ ~; ~~ ~ Pmtab ~ " ~ ~'~ ~ ~ Ntim~r Manu6~ Cotes Coostmetod (lisp ad la Total VL Tank Info ~~ t3aliotis of units oO~ ~ ~ { ill for ~atioa or the POWi'S abo+sn on sns asa~c.wr ~- Statement I, the MPlMiYRS Narnber Business Pboric Number[ VII. pliupba's ~~~,~ z ~ / J ~~ Name (~) l/~ •~ Z ~j r~ Q pluaibets Address (Sttee4 City, State. `?3p ) l/L/ ' ,s sorchatge Fee) .: - a~eat~ ct~~~"1 Con8ltioffi of Ap~°a i[a~ Dfstlppro~'al SYSTEM OWNER: . 1 Septic tank, effluent filter and dispersal ceA must all be serviced I main#e~,ined as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable codetordinances. a (1t1g00es vswu~••«•- 3~r ,d3,'~E).~ ~~ cis ~~ b.~ ce~~ .,.;.~, 3~ s-y. rr ~o~ w , t!. ~2 ~ / ~. ~- ) I for the systan~IeP ~~ _~~~~~ r~~9`~ 0.dpw~pnl7~ ~f) S~ ,~, (off ~'° tom- ~S~ i•. ~ w~~ PAL .' ~- ~ ~~ C~-• ~ p}sos (to the Cotuii! PLOT PLAN PROJECT John Nicklebv DRESS 6351 St. Croix Trail N #128 Oak Park Heiahts Mn 55082 NE 1/4 NW 1/4S 9 !T 29 N 17 TOWN Hammond COUNTY ST.CROIX 1 !31 /05 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL IN-GROUND PR SURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1212 # of chambers 39 ,BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100° Filter ZabelA-100 ^ BOREHOLE ~.J WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 99.6/99.5/99.4 1' below grade 110th Ave I r 0 15' / m operty Well is to meet all Li 10~ ~s 200' 10 30' setbacks required by Vents WDNR 1 40, % Slope 3-3' X $3' Cells with 0 >3' spacing ... B-3 25' 35' Combo Tank -2 Plans Designed Using Conventional Powts Manual Version 2.0 Pro 3 Bedroom House COPY ,~.M. #2 top of 1" pvc pipe @ 100' Please note: system is to have fill brought in i #1 and have >1 of cover over chambers as per code, also soils will be field verified before installation to ensure a >3' seperation from mottles =~~,Vent ~ a ~~ ~ ,._. Cover 11" 6' n~ ~~Standard B~diffuser L Ching Cha~er ~ wit 1.1 ft2 of A a Q~ V Grade at tem El vats ~ ~ .~ PLdT PLAN PROJECT John Nicklebv DRESS 6351 St. Croix Trail N #128 Oak Park Heights Mn 55082 NE 1/a NW 1/as 9 !T 29 N 17 TOWN Hammond COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 1 /31 /05 BEDROOM 3 CONVENTIONAL IN-GROUND PR SURE CONVENTIONAL LIFT )OOC HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE •4 ABSORPTION AREA 1212 # of chambers 39 ,BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter ZabelA-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 99.6/99.5/99.4 1' below clrade 110th Ave o be 15' ~ m p~operty Well is to meet all \Li setbacks required by Vents WDNR ~u -1 40~ % Slope aLL7 3-3' X 83' Cells with 0' >3' spacing 100 I ~ B-3 25' Plans Designed Using Conventional Powts Manual Version 2.0 Pro 3 Bedroom House ~, 35' Combo Tank -2 200' • .M. #2 top of 1" pvc pipe @ 100' Please note: system is to have fill brought in 10 ~ and have > 1' of cover over chambers as per code, 30' also soils will be field verified before installation • to ensure a >3' seperation from mottles _ Vent ~ a ~ ~ ---~ ._ #1 / `. >(„ ~ ~ % of Cover I 11" 6' bong 34" '~ ~ -. !fir V i ~~ ., ._ , .~ tMsoonsen Department oP Corrfinerce SOIL EVALUATION REPORT ~ Page ~ of J~ ©ivis:on of Safety and Buildings .. . a...~..,.o...,~ ..................... ...... ................ minty ~ C r0 Attach corr~lete site plan on paper not less than 8112 x 11 ind-es in~size. Plan must ! X indude, but not limited to: vertical and horizontal reference point (BM); direction and Parcel I.D. ~ ~Q ~~ 3 2- D~ Z~ ~/ percent slope, scale or dimensions, north ion and distance to nearest road. O _ • Please prin all iri~~l E p Re awed by Date Personal inforrrration you Provide may be us for secondary Purposes (Privacy . s. 15.04 (1) (m)). ~ 'T Q~ Property owner. .. 4 2002 ~ lion ST. G t Jv~ 1/4 /VkJ 1/4 S~ T 2 `~ N R! Z E (or) Property Ovmers M~ fling Address ~ 1' ZONING OFFICE Lot # ~ Z Block CSM# ____ - -- ~~ City State Zip Code Phone Number ~ City _ ~ village own Nea Road 1 1 c I )~ -//2(~ ~ l~D~~, ®-AJew Construction Use: ~--Residential / Number of bedrooms p Replacement ^ Public or cmnmercial - Descxibe: Parent material ' / ~ General comments c' ~~ ~%v r ~y %9'~ Code derived design flow rate GPD Flood Plain elevation if applicable and recommendations: ~ ~ r ,,-,,, O.T_ ~~lYerze~y ~s~,llex~ ~d'' Canes-~~-~ -- C~ ~ " . "- 4 - o 2 ~ ~ Nti~ ~tYX~~6 ~ }-eath~ -ale to f~~a'u-c~.d ~' so ,8! Boring ~ ` v~~ / v, .. i--•~.~ v v w .r ~ - - Boring # n Pit Gnwnd surface elev. l~ .~U ~~ In. ~t ft. Depth to limiting factor Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsefl Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 •Eff#2 2 ~2-4 iv ry I ---- s~ cl 2 ~ ,~r,~- ~ 5 - r ~ . ~ ~ s -p C 7. I ~~ m i ~ - - ~ 1, Z q,2 ~ ~s z'' ~ ~- I~'l '' -~-:, 3~ ~, a Boring # ~ Boring /\ ® pit Ground surface elev. {~ • ZU ft. Depth to limiting factor ~V in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Ou. Sz. ConL Color ~ Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ 6 -~ Z I© ~ ~' S~ I ~ ~ C . `~ . ~ 2 +Z-3$ l I~ ~ %c r ~ 3 - I ~tl~ - ~S l ~ ~ ~ 1. 2 0- t~ 4 ~ ']. ~ c~ ~s mil - - .-I l . Z Z (~P ~( ~hL~,. ' Effluent #1 = dODS > 30 < 22('f tng/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mglL CST Name {P ease Print) 'gnature CST Number - ~~ Address Oate Evaluation Conducted Telephone Number 2i~~_~- . ~~~, l,~l_5`~02~ - -~ -;S'- o z ~~~5)Zy1-~{cx~ Property Owner ~ r~~ ~ i ~ Parce11D # < d ~ ~~ Page ~ ~ of a Boring # ^ Boring . °~Pit Ground surface elev. ~~ -~~ ft. Depth to Itmiting factor 5y in. Soli Application Rate horizon Depth Dominant Color Redox Description Texture Strucdrre Consistence Boundary Roots GPD/f-z in. Mansell Qu. Sz Cont. Cobr ~ Gr. Sz Sh. 'Eff#1 - 'Eff#2 ~ U -12 i 1 r-- ~ k m~~- c 3 I .~ , ~ , 8" 2 1 Z-~(U ~o y Si cJ Zr~bk -~' c S - ~ `-{ . ~ _ q~Ll ~- lS'" 5~'' ~,, ^ Boring # ^ Boring ^ pit Ground surface elev. ff. Depth to limiting faGor in. Soli Application Rate Horizon Depth Dominant Color Redox Descriptron Texture , Struchrre Consistence Boundary Roots GPD/ft~ in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#'! 'Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. R Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Sfru(~(ue Consistence Boundary Roots GPDtftz in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 - • Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mglL ' 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 department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (807100) PAGE~OF~ SCALE: 1"= Zd ~ BM 1 ELEVATION /OCR - d BM 1 DESCRIPTION •~npT-~ / yC_ ~ 'O-P BM 2 ELEVATION /QQ. O BM 2 DESCRIPTION -~~ ~-~ ,~ ~ ~t!~ ~,~~ SYSTEM ELEVATION ~~rl 9', (0 0 Low e ~ °l9 SU SYSTEM TYPE ~'n n u n ~, `a ~ a CONTOUR ELEVATION JGo • ov 3 f o l~ a ~ N -~ - 30~0~ ea~~x.f. ~~ S ~e~ ~~~ ~~ ,~, RKS: ' 'ER OF SECT ION 9 - 1082. 2 I' "'`` 'ORNER OF SECT ! 1 ON 9 - !069. 63' ~ • ---------------xt~,•-=--=--=-r r • (NO SCALE) NW I i4 N I i4 CORD SECTION 9, (FOUND 1 " SO I ° 47' 24" W I NO I ° 47' 24" E S89° 4 t' 59" E 454. 59' 36.63' 38.7!' 413. 17'- ~ ~ 240. 19' ~ ~ 214.40' I UI ~ • i ~ra ra s+ !~ ~ ~+ ~ 4p~ ~ 4O;• ~ $ i _ ORA 1 NAGS EASE ~ LOT 1 ~~ ~~ - 1.50 ACRES ~ `~'~. •' ~ •~ i ~ _ .os .................................... ~ ........... ........ ....... ... 65, 394 S(?. FT. t~;:~ •% , :. .. ....... . { ... ...... S o..y L 0T • 31 ,~ ,. .L .......32. F 'r ©,: / 1.51 ACRES ~o ~ 1. O ACRES l~ • ~ 65, 981 SO. FT. ; ; 65, I 1 S0. FT. `~iS~, ~7 / . ~~~ HWE 1062' ' ~ ~ H 1062' • i ~ • LFE 1064" ; ; LF ' `s ~ i ~. ' ~ ~ '~ .•• :• .~• h • 1'~~'' q1 •% ..' s'u~•• ~ ~ 9°51' 03" E 266.6c ,~ ~ 2 ,~p~ °F ''6 EASEMENT Q ''~,,/ ,~• yJ- •~ `C• ~/~~3• LOT 30 86 ~ 21.9 . 54' f ~ ~' , Fj~ ®' • 1.63 ACRES %~ ' p~ p ~ a -° 0 2/ -' 71, 184 so. Fr. -' S89 5 I 03 W 235. /~~/ 3 5~ X00 2` /~ ti~ HwE 1062' ~'~ ~9 • " , ~(~ ,~ ~~ ~~ LFE 1064' ~ 'p~ ~ 1• 2 6 ~ ~'~ ° ZOT 29 3° • ,90 ~" moo. ~6 ~ 1.57 ACRES 'a'S' 68, 524 S0. FT. ~ '• HWE 1062' ~ ,'~'S/o LFE 1064' ~ ?o, . ice, ; ' . ~•.,~ 9~ i ti~ i LOT 28 , :2~5 1.54 ACRES i 8o sS~ ~7, 027 SO. FT. ~ ~ ~~ ~ 02• ~ ~i i 6 y~ ~ ~ ~P a i ~titi ~O i i ~h' i ti ~i moo. .a . ~. ,~ ~ ~'~~ ~ : ~ °~ ~2 ~ ~~~ ~~~P~~ ~ ~~ ~a~~~ 1 ~' ,LO ~~~ ~P ~~0 Q~~~. ~~ .~ << PAGE 3 OF~ rT e * ~cS (~ t P T OT# ~~T EGAT DESCRIPTION A/~ %~lJw 14 .s q T Z4 .N.R. / ~ Efori~W SCALE: I"= Zd r ~ BM 1 ELEVATION /OCR - d _ BM 1 DESCRIPTION ~r~0 D-~ ~ I~ UG O 'O~ - ~ ~~ BM 2 ELEVATION /QQ. O BM 2 DESCRIPTION ~ ~' f ~ ~' SYSTEM ELEVATION {t~ ~ cl Q, (0 0 Lout e,r ~9 SU SYSTEM TYPE ('~ n u e n ~-, 'v n G CONTOUR ELEVATION JCro • yo 3 !0 (~ a ~ . ~ o O ~ M ~; 3 .8T' ~ 4.! ~ ~ 33.00' ~ ~ ~ O ; ~ M ~i ~ ~ Mtn h \ c0 ~ d: v _ `" ~. ~ to Ki 3 x ~ ~ ~N ~ N M I~ i ~ ,~ ~ {~~ ~~~ O ' Q ~ ~ ~~ ~ 100 ''Q _~ `~ ~~ ~ \ ~, ~~~~ ~ ~ a r 0.... -- ~ (~ ~ ~~ ' I~ y ¢ ~+N '~owc-.. a ~ N/ O:X ~~a ~ '~ ~' ~ \ • o:. ... zp~ Z ~ ~ ~ ~ y ~ ` ,~~ r~ i t st, ~`1`~~~ .~ 4 M N. ~ ` ~ v~~s 9~ ~ n9 '~ ~ ' s a1~? 0 ~ ~ ~ ~ 29~ "tea o ~~, '~ ..i ~ -~sc, I ~ ,og .~i~. `~ '' ,11 ~ ti is0 ~ '~•• `+ ~ a,. tiO J . ~ • "ao . i :v~ `9i~ ?1 .~0~ j ~ ` S C'c~ `:t'~ ~~ \ ` ~ \ i ~ O ~ o ~ s ` ~ ' 3• ` r,~`b `s' ~ ' i ~ 3 ~ ~~.~+ ~"zs o . tl' e 0~ ` , `~, ~ 0 ~ ` ~~ ~ ~~ • ~ ~ ~ 9 . `, ~o • is ~ a ~ ~ ''~ a- '~ - y .~6 ~`Q.9 ;~ ~ 9 ~ ;~ ~ 100` ~ '_'_"~- ~ '•,. ~. o ~ I I ~ ~ _~ ti J ~ to '~ _ `` ~ ''~ S£P'TIC TANK ~ FUMP C~~p,MB£R CR ~„ G. ~ ~~ PIPE y_ ~~}` £ROM DOOR . FR£S~ ~ [R ii~TAKE FZI~i~._ ,YO GRADE i K-•~;. 38" II~^- INLET ___.- ~ AND SP£~ i A"t I~ S S S£GT.t~. IZ•. HIN. ABO~/E GRADE ~ ~~~Qaw ag ~~ t ,r~~~g~ - ~ ~b ~tEATHE~PROQf JUHCTIfli~ gQ% WITH C4I~flti Z' ' _,~. R f s ~ •. i ~ •r2GHT t SEAL ; 3 i F WATER TIGHT S~-~ APPI~YED ~- Fi~~ 3' C 0!1?t} SQLIO $ElIL PU2hP flFF ELEtit -~~~-' FT• D BEDDII+t6 UNDER TANK 3 ~' APPRt)v ~ SPECIE ZCATIQi'IS SEPTIC f DOSE sAiZK MANL)FACTEiRER: TAtiK g;Z~S : S£PTZ D~S£ ~ ~"v ~---' GAL - ALARM MAI4UFAC1~3RE'R,~ -~-""' f70DEL ~g`YPE gWITCH pUKp ~li~tETFACTt~RER = xoDE~ ~~~ ~ITCx S£S ?£R DP-Y " "~--- PNMBER Da DOSE y{y~ME I1~C3.7~DING -~ ~ .~ GAL- F L~,igACK : ~- - 3 Z'~ ~ - 7, .~A~. ~N~;EiES --PACITiZ~S= A -.-„' 3 ~ GAL- S = ,•.,_~_ [Nt: HES _.---~--- ~ fiAL C rv • ~ IN:;~€ES ~ GAL n = 9 I~1c:KES 1~=r~ -4--- ~ I LRR 16. Z3 WAC ITSP £ ALARM FARING ~5 ~ F ECT RE4~31RCD aISCHARG~ gAT'E Zv `'r`te - FIP£ - ~~rr DISTRIBUT£~ FEET PUMP pFF AND ----~"' FE£T VERTYCAi. 33IFFEREIdCE $E~EPRESSURE - •pRIC'TIDt3 FACTQR - _..--~-~' FFET MIHIl~413~i N£Ty~tOBK SUPPLY X ~~ 3 £T! ltd 0 • FT - T FORCEMAII~ ___.~ Tfl`fAL DYN~IC MF.AE y r~i-~"""' _----- + ~_ F££ ~~ /i 6 ~}F pij!'i? 'SANK= L Q~ ~ ~__a~" IN'I£RNAL DIMEI~S D /~ 2~~D~/ LICEi~Sz`. ~ SIGPi£D~ AgPRQV ~D MANHOLE COv Eii wf ~AaLOCx ~ -~' ~a°,~~a. -t -~~rE~ ~Lp~~1~pLPiPE • ~gQ SOII e C0~ ~R E:TE PAD ~= ls~al(vr4 =I88 . ~i ~ I~ HEAD CAPP,CITY CURVE , ~ ; w!~i~ MCI7~LS 53~55/57~~9 ~, j L 5 i II ~,I ,I 2u ~ I I I! o -; i ~ Q ~ ~ i ~_ ~-l. ' ,1 .` , ~, I I I z `~ -i i ~ I o i ~~ _ \ iU ~` ~ I ~. i 2- , I ~ 5 I Q i i 10 2G 30 40 50 U.S. GALLONS ~ _j j FA5 ~ ~~ ' SO G LCVu PER P~I!NUTE oosas7 Variable level float switches available. Variable level long cycle systems available. • Available with special cord lengths of 15', 25', 35' and 50'. Alarm systems available. Duplex systems available. Model ~ VOlts Phase ~I Mode Amps Simplex Duplex ,.,.,.._ ~ _ 0 7 BN53 115 ' 1 Auto I ~ 1 -- BN57 115 1 Auto 9.7 ! ~ """" ' BE53157 ~~ 230 t i Auto ~ 4.8 I '_ D53155 8 D57/59 230 t Auto ' 4.8 t 5 TCTAL DYNAMIC HE.4C CP'~,CIY FtR ^~1i NU-` EFFUJEN' ANO DEV ~TE~; NG -- -----t P~1ode; 5~, ~5 ,%~ ~ 5~ '~ ~ - ! ;Meters ! Ft _ Gol ~ Ltrs. i . - 5 1.5 ~' '! ~~ ~L ' ~'63 ~~ -- ,, 2g ' I 3 1 i i S'r.ut-off Heed 1 19.E ft (5.9m) /2 -i1 i/2 N?i ~ ~t6 ~. i 1,`'~ 6 ~j- ,o 3/3_ 1 i SK858 1. Integral float operated mechanical switch, o ex. ~rnal control required. 2. Single piggyback variable level float swift or cc uble piggyback variable level float switch. Refer to FM0477. 3. Mechanical alternator "M-Pak" 10-0072 of 10-0(~ '5. 4. See FM0712 for correct model of Electric. Alte.i ator. 5. Variable level control switch 10-0225 usec ~s a : mtrol activator, with Electrical ~ 1 Non 4.8 ! 2 3 or 4 8 ~ ~ , Alternator (3) or (4) float system. _E53/55 & E57/59 I 230 I Single piggyback switch inc'.uded. _- c~unar ] ~nnationonadditionalZoellerproductsrefertocatalogonPiggybackVariableLevelFloatSwitches,FM047T j_e -- - ' s ; s L ` , Aftemator, FM048(3; Mechanical Attemator, FM0495; Sump/Sewage Basins, FM0467; and Single Phase _ Y,c_. V , np ControllAlarm Systems, FM0732. ~, For unusual conditions a reserve safety factor Is engineered/into theJdesign of every Zoeller wmF. _._____-- iWA11 T0: P.O. BOX 16347 Manuf :curer ~f. . _ Louisville, KY 40256-0347 a r SHIP T0: 3649 Cane Run Road G~ qv-- ' ® Louisville, ICY 40211-1961 ~, y ~ i tlP6 /rNCE ~~/i7 - - ` ~ PUMP !O. (502) 7 FAX (502) 77403624 PUMP - -. ____- J_ ---~--'"-- ©Copyright 2002 Zoeller Co. All rights reserved. Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 cy Plan Option #1. system fails, determine cause of failure, use alternate area and install new system in tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shaun Bird #226900 .. ~ST CROIX COUNTY SEPTIC TANK. MAINTENANCE ~-GREEMENT AND OWNERSI-1TP CERTIFICATION FORM OwnerlBuyer ~ , ." , - - dress ~ ~ b I ~T G Y~ fl ~ ~ ~ `7- v4 ~ (._ IN t7 ti L- ~" ~ ~2 ~ Mailing Ad Property Address ~ ~ ,D ~ .,~ (Verification required from Planaing Department for new construction) ~ ~y9 ! ~c~ ~ ~Fv ~ - ~ ~ ~J' ~ Parcel Identification Number 4 /~'' ~° 96 - 3 2 -~ ~ ~ ~' City/State LEGAL DESCRIPTION ~ c~ -~ Location ~. `/~,L~^'~'/,, Sec. ~, T_LN-R_- ~ -W, Town of a rw Property .Lot # 3 ~. Subdivision Certified Survey Map # Warranty Deed # ~ ~ 2 S~ ~- Spec house ^ yes~no ~,Page# ~ Volume Zlo'~ 3 ,Page # ~~ Volume Lot lines identifiable ~ yes ^ no SYSTEM M AiN'TENAN--~E remature failure to handle wastes. Proper maintenance Improper use cad mamteaanceof your septic system could result in its p What you put into the system tic tank Query throo years or sooa«, if needed by a lioeascd pump~r• consists of pumping out the sep can affect the function of the septic tank as a treatment stage in fire waste disposal system. ~ a c~rti5cation form, signed by the owner crib b em 'lfie property owner agrxs to submit to St. aroix Zoning DePartmVe~y~B that (1) the on-site wastewaterdisposa yst masttr plumber, Joun~eYman plumber' trstrictod plumbex or a licensed pumper ~ tic tank is less than 1 /3 full of sludge . condition and/or (2) aRcr inspoction and pumping (if necessary), ~P is in proper operating 1 em with the standards is and a to maintain the private sewage dispose syst ~~ the undxxsigaed have read the above r+equircmea ~ ~ of Natural Resources, State of Wisconsin.. Certificatio^ set forth, herein, as set by the Department of Commerce and the Deparim Office within 30 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning da of the three year expiration loco. Zoo !~ /__ Zvi - DATE SIGN OF APPLI ~~,NT p~ER CER'TI~CATION our knowledge I (we) am (are) the owners) of I (we) certify that all statements on this form Le~~~ ~ Register of Deeds Office. the property described above, by virtue of a warranty ~-- D f iZ~i 200s DATE SI ATURE OF APP «.. «. Any informs[ion that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ssssss waminty decd from the Register of Deeds office •• Include vrith this appllcatlon: a etampod if reference is made in the warranty deed a copy of the certifiod survey map • r~ 't~ 11 I U 26N3P 150 I STATE BAR OF WISCONSIN FORM 7 - 2000 Document Number TRUSTEE'S DEED Dine M. Bonte, as Trustee of the Karl M. Ulferts and Katherina G. Ulferts Family Trust dated September 1, 1995, for valuable consideration conveys without warranty to John D, Niclcleby and Kathe J. Nickleby, husband and wife, as survivorship marital property, Grantees, the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Lot 32, Pheasant Ridge, St. Croix County, Wisconsin. Recording Area Name and Return Address Edina Realty Title, Inc. 400 South Second Street Suite 115 Hudson, WI 54016 ~~~-qa9 018-1096-32-000 Parcel Identification Number (PIN) Dated this L 3~ day of n ~^~1 u S r 2004 • Dine M. Bonte Trustee AUTHENTICATION Signature(s) 7725 1 2 KATHI,EEH N. MALSH REGISTER OF DEEDS ST. CROIX CO. , NI RECEIVED FOR RECORD 08/24/2084 82:48Pl1 TRUSTEES DEED EXEMPT # REC FEE: 11.00 TRAIiS FEE: 171.00 COPY FEE: CC FEE: PAGES: i Trustee ACKNOWLEDGMENT STATE OF WISCONSIN ) ------ ----------------) ss. ---- - 00 ,^, - -S.. ' CF!/ ~~ .. .County ) authenticated day of _ __ -- - ~---- che~~ ~ blic # to ~~ ~Jis~oi~~ -- - ---- -- -- eta _-- --------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY _____Brent R. Johnson ___!___~.. Lommen Nelson Law Firm, Hudson, Wisconsin (Signatures may be authenticated or acknowledged. Both are not necessary.) Personally came before me 2 ~ -'~_ day of -- --~~ i,(5-1- ____-- , 2004 _ the above flamed Dine M. Bonte, as Trustee of the Karl M. Ulferts and Katherina G. Ulferts Family Trust dated September 1, 1995 to me known to be the person(s) who executed the foregoing instru~m~entQa~nd acknowledged the same. - I~A--~`--~`=--- ------------ Notary Public, State of -~~LOIn I"1.____._______. My Commission is permanent. (If not, state expiration date: << • Names of persons signing in any capacity must be typed or printed beiow theft signature. INFO-PRO (BOOMSS-2021 www.ioroproforms.com STATE BAR OF WISCONSIN TRUSTEE'S DEED FORM No. 7 - 2000 • Tr ~______ ___ _____ _J L _ ~ L ___ __ ~ 1 1 j ~; Ch ~~~ ~ ~~~~ ;I;Q ~ :,c -. W ~ ' J i i Q i'i ~ ~~ ;~;.. ~. ~ ~~ ~,~ ,_ y ~~g ~~ ~~ ., ------___-+ I ~-- .__ ___________i r_. STREET ro ~ H ~ 22 N 0 O~ o' ~ ~rn W i ~ ~ ~ ~_ a o~ ~ ~, y U ~ tW O V 02 m ~ ~ . ~: _~~ ~Q m °~ ~ ~~a UO t o ~'' ~~2 i~o z~~ 2 SOO° 21 ' 22" E 33 T. 87' 33. 00' ~ 304. 87' 1 1 1 ,~ z ~~ ~ I y ~' Q 1 ~` W IN W ~ ~ ~ ~ 1 t 2 ~' Q ~ ~ ~ W a 0 ao i--=-- i; 1 2~' i i i~ ~_ ~. 'o ,~ :N '~ O av ~ y 88 W ~`O ~ ~ J tp ~~i~ :90,~-------• : `~ ,~ :~W~' .~QV, ~~ W ~ .N ~~~'~ ~~ d- 1 ~ J~~; N 1 i ~ 00' co f~ ~ I ~ ~t M ~ ; 0 1' i i i i 8~~ M ~ F- N Q 2 . 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