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018-1099-41-000
~ N o y o °o m o °o I ~o 'r p °~ °~ p °~- °~ I o ~, 4 o o 0 ~ ~ I v N fC w 0 p N w O p ~ H ~ ~~ C ~ M ~ m O N D y~ C ~ N M ~~ O N S ~ 3rn m ~ T N 30~ m N T i ~a t a~~i a~ ov, ~~ ~~ va t ~ a~ y O y w~ ~ y I ~ p C~ O d N j C d O O Ma` > C V O C~ p d N j C d O ~ M > C O ~/ L o 'y ~ T o v a m •o « ~' '~ ~ >, o -p .o 01 rn~ o c I ?, ! ~ C y 0~ O Z~ O C ~ C y 0 O~ rn O C '~ y I v o o E~ Em ~ a10i~•-° m m o v oo o E~ Em a ~~ m m o o i ~ I ~ ~~ ~ a ~o ~ o . ~i 3mQ?a c ~~ ~ ~ y~ o . 3mQ~~ I , ~ y~ v i crn~ ~ a~ °c~ai~;n a`~i ~~ . cuTi~ cov~in I G O U Z ~ N C O ~_ O~ N C~ E~ C N O O ~ O U ~ Z O C' O O ~ C ~_ ~p N ~ E~ C I O LL ~- C _ N O~ O w N O) ~ . -~ C- C _ y fC .~ O w N •C O 3 O y O. - ~~ y~ C O N C !''' O y O. C ~.'U-' ~~ N~ C O N I 'O N O pp y o v N V) 3 O> I` v y 0 y O~ y N~ O j ~6 d Z a N E m ~Sv rno m d z a ~ E m ~ S~o rno rn I ~ ~ I I v Z y I ~ a' V ~ C ~ I Z ~ z a m I rn H 0 o I O Z ~ ~ ~ C v ~ ~- ~ 7 ° ..~'.. c a ~' O I z N H ~ a i z y I o E ~ E ~ ~ ~ N M ~ M N w 3 7 .? 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N a O O ~'~ ~ i d O ~ a O O `p ~~ a°ia~a°i' ~ ~ ~? aUia~~ M U 41 O y a d C -O C r' N a~ C~ C Z w U C U T I O~ CJ C O T ~ O y 0~ ~ Z~ N ~ O~ C- C N~ Gl ,1 c- C N~ y O N~ O E (p V O~~ O~ (6 :o ~a ca>> - ~- o. c~~ a ago minor ~ `0 3•- a~in~ Q Z O. m vi N ~ Q Z O to T N \~ w ~ ~ ._ c N N .~ `m t O C O U 0 Z '~ M c 0 .~ U w 0 Z a C N c a> N .~ N a~ t ~', ~\ j,. a a a a a C a a ~ ~ f" . ~ ~ ~ ~ ~ c c ~ ~ c c w a ~ ~ 'o a in z ° ° ° ° z z z z N m ~ ~ 3 a m fp Q ~ Q ~ w (n Q ~ Q ~ d Z in Z <n Q Z <ri Z in 0 ~ ~ o ~ d ° ~ o N ~ (p a N o N N N > ~ 3 ~ U d O C ` C N D d U C ` N ~ ~ Y ~ ~ fn Z ~ Y ~ N N 7 ~ 01 D1 ~ to N C C m m O O .~ .~ a a O U O U O O vOi' Y w `1 .50 c0 f I I i I 1 0 `t U s k. o ~~ M ~ I i• C o .~ U Z ~ C N O ~ z ~ N I II ~~ a ~ •~. ~ ~ ~ ~ U fl ~ = O t4 ~ N C ~ 3 a C N ~ g I I II Wisconsin Department of Commer-c~ PRIVATE SEWAGE SYSTEM Safety and Building Divisii,n ' f ., , ; INSPECTION REPORT GENERAL INFORMATION ~~~~~ (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes IPrivacv Law, s.15.04 (1)(m)l. Permit Holder's Name: City Village X Township Ulferts Famil Trust Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: ~,// TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic , ~ ~.~ ~.~ ~c ~ {~ 1 mss.: ~ Dosing ~~ -- '-( C> ..~ , W ~ 1 ~ ` t r; 7 / t~. .. -- Aeration ... Holding _, ...----' TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic .,.,_..?L., ~ N . ~T ,' ~-.. ; ~ ( . . ~. ~-.. Dosing _ Aeration .. ) Holding _ ... _. PUMP/SIPHON INFORMATION •odel GPM Head Forcemain SOIL ABSORPTION SYSTEM , z r L, _ ELEVATION DATA county St. Croix Sanitary Permit No: 430411 0 State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: ``~, 09.29.17. STATION BS HI FS ELEV. Benchmark ^, ~, /oZ , 2 /oo_ oa ~~ . A . M F~ N Bidg. Sewer 7 ~ 48.ZZ- SUHt Inlet ~ ~ q~ ~ . . SUHt Outlet ~. •~'K 3 Z 9.t . 1 Dt Inlet Dt Bottom Header/Man. ~. QS- Dist. Pipe Bot. System.. t <~n 4 r ~ %~-4 nt„ 4 •9~1 ` 9~I.y5 Final Grade '' ~: ~ ~ '~•Z St Cover ..l , ! oo.'S~ ~-r v + :.. cl ~ 5 3.2. ~ic,f 5 ~.ts Nu/ cd-f~ r.rnl-~.r ~n1 c• 93• ~ BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS _~ ~ -- . __ -- .. SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manuf ctur r: t( ~ rti ~ ` Type Of System: ~ f~ _, ~~ ~ ; ^_ UNIT . ~ • 41 Model Number5;,~ n 1 ~ -~ DISTRIBUTION SYSTEM ""'^ " " ' " y I' j - ` ~' 1 ` `" ~ ~ 1 ~ °~ Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Length Length Dia Spacing "~ ~ SOIL COVER ~--Q'j ~ " ~" z'~'ressure ~bstems~nl~ xx Mound Or At-Grade Systems Only Depth Over ~ '° ~ ~ ~.-~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~ Bed/Trench Edges Topsoil L- Yes [i No Yes ~ ° No C ~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:! -' / ~~~ /~J Inspection #2: ! / Location: 1047 174th Street Hammond, WI 54015 (NE 1/4 SW 1/4 9 T29N R17W) Pheasant Ridge 1st LPt 41 Parcel No: 09.29.17. ! ~) S.t•,.~ = ;.,, vri~~,~IS •- ~..`1 s"`'~ x=/73 1~~. 1.) Alt BM Description =S. ~ • cc,~ ~: Y w ~~ ^ . S 5-, ~,,,-. ,~ ;.. h .. ~ tti f' Iv, yh, ~ '~ Ci `j , ~ -- rl~ 2.) Bldg sewer length = ''~.3`-~ ~ ) .,cam, r.( (gyp , ... ~ wr,v~ Pa e~..~•-~.Z,,.~ lJ.r:,..y w.`w ~Ce,,.~,Io "J -amount of cover = ~ ~ .,/~ rr ,.~ '3 . ii = D..,r,~., l~ ;tea ~ ~ ~ s'cls f .> y~ Scr S ~ ~ ,~ ,~.~ !3 ~ ti .~i-h ~~ Oita c: f ~ 5 h.i ~ t t.;/~ r ., ~! 1~ 1.40 +~o}~ ~ ~0..5~- _ loo :- . 5..--~ tN_wo .. ~ - I - ----- ------- ~ I plan revision Re wired? f ,1 Yes ~~ q [~ No ether side for additional information. i I ~ __ __._ _ ~_ __._ _ _ -.. _ ~ ___ _ ~...___ ..____._._1. ..__-- L._____ _..._______-__ _ -..___.____ _-.______ __.. Date ~nsepctor's Si nature Cert. No. ~~ 10(R.3/97) i~. aCC+~.Q"~Gv/i.l¢ ~j~c ~Qw~ 1.ue.+~lGQ n0~ ~+od~ '~~a-~ - ~4n'~.6t a.Q '~..4 A~.K~'@M , }~d1 ~~6r~ (~®r: ~ Wao ~ow't 3 .AOt .~ o/n. `~'hv .c a-5 1' ,aw~roC 9a `~Ttie n a r'I~s+ '~'r.r..- d~- Safe and Btuldings Division Co'IDh' 201 W. W shington Ave., P.O. Box 7162 ~~ vl ~ ~~ be filled in by Co.) ` ~ ~ . _ uatbet 7162 Sanitary Penni Mai tl , ~ ~ r O 2003 (~j 26~31 51 ~~O~ II~ I E l Department of Co mer ' State PIanLD.Number ~tr~.,nkpp ' ation x ~-, San tat~t . In accord with Co 83.21~4i1~iQl~6t~r ~ ~ ormation you provide 'diff'erent than mailing address) Address (il t s15.lYt(lxm) Projec oses vary w ur , p may be s p / L [ 1. Appllcatlon lnformatlon -Please Pr1nt All Information Parr I N Lzrt k '81'&`k'f~ Propert Owner's Name ,f/ ~~ ~~~ '. ~/ ~..r'eIQ~S 1~7^~ ~ r ti~S ~ y !.aced Properly Owner's MailingttAddress /~ %.,~ %., Section ~~~ D~O Cit ,State Zip Code Phone Number , (circle //~~QQ ~` ) ~~ ~ G ~ i S ~' T ~ N; E oi:J~ ll. Type of Building (check all that apply) Subdivision Name CSM Number ~ - I or ? Fanuly Dwelling -Number of ootru ~ ~ r~fl ~ ~ ^ PublidCotnmcrcial -Describe Use .'~ s 3 ~ K ~ W ^City_^Village ownship of U se ^ State Owned -Describe 111. Type of Permit: (Check only one boi on Ilne A. Complete line B (f applicable) ' A' New System ^ Replacetrrent System ^ 77eatment/Holding Tank Replacement Only ^ Other Modification to Existing System ` list Previous Permit Number and Date Issued ^ Permit Transfer to New ^ Chaage of B. ^ PetmitReoew Permit Revision - ~rD~// Plurrtber Ot4D°• 5 Before Expiration 1V. T e of POWTS S stem: Check all that a 1 ^ -Pressurized ln-Ground ^ Mound ? 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter N on Constructed Wetland ^ Pressurized In-Grouad ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ ^ Ocher lain) Aecirculatin S thetic Media Filter Chnmba ^ Dd Line ^ Gravel-less Pi V. Dis ersallTreatment Area information: - Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sn Dispersal Area Proposed (sf) System Elevation ~~ i fiber Pl tic 1 S ~~ ~~ as tce Manufacturv Prefab Site Ca i in Total Number V1. Tank info P~ b Concrete Constructed Glass t f (J 5 n1 Gallons Ga110nS O Ncw Exixin~{ Tacky Tardcy Scp~ic a.iLrlJiry.Ji~ O O Aerobic Tsaimcru Unit i ~ DwinK Chumbcr D V11. Res nsib(11 Statement- 1, the under d, ass a nsibW for Installatlon of the POVrTS shown on the attached fans. MP/MPRS Number Business Phone Number Plu s Name (Print) PI Si Plumber's Address (Street, City, State, Zip C ~ V 1. Count /De artment Use Onl Sanitary Perurit Fee (includes Groundwater Date Issuod issuing A nt Signattue (No S s) proved ^ Disapproved Surcharge Fee) `~ ~ '_ ?'~'~ ^ Owner Given Reason for Denial , a~ _ _ u „~Q ~.. ~R~t~~B'v~ 1X- Conditions of ApprovaUReasons for Disapproval ;1~{ • ^~"""'" ~ ~ ~ SYSTEM OWNER: / `l ~ 1 Septic tank, effluent filter and oti- ~'t'`'~ `~ ` t!~ ~- ~~ ~~ dispersal cell must ail be serviced i maintained W, ~ ( ` ~ ~oQ. ~t'~ Q , er,~. A as per management plan provided by piumbe~. 2. All setback requirements must be maintained ~ '"~,,. S ~ 1 as per applicable code/ordinances. .., ...........,....~ ..., ~.M~ der tcu than sin s tl mend ~ yl'L! nnaco comFucac t...,., r......~ ...,.._., -- ~, -. - -,------ r ~~ SBD-6398 (R. 01/03) ` 1 T.L. Sinz Plumbing Inc. E5609 '708th Ave. Phone: (715) 235-2644 Menomonie, WI 54'751 Fax: (715) 235-2592 www.tlsinzplumbing.com ,L.a T ~f l ~t~~ts~ i ~~9E 70 ~/ o ~ ~r~r~ ~.~~0 ~- L T~ / ~~~Qo ~Z f ~/}' 1C"`~_ x,11 .... :.. s r -~ 1 ~~ ~~ ~s yr ~J~,p,~u~'~ N„ 33" TAP 4 ~~~ r~ ~ /C Ce "Y J ,y y/J I ~ , ~JNy f -v ~'~ ~~ j~ C_ v, ~ ! ~'Y _ C• v-~ ~ v c ~ r ~ ~ 5 6,~ ~~ - i v ~ ~5 u ~ s -~ k--.. ~ v < <~ 3 ~~ . ~3 ~• ~ ; ~~ ,, ,~ girth ~ ~ ~ 51 ~~~ -~,J / n ~o `p ~.~` ~ T.L. Sinz Plumbing Inc. E5609 '708th Ave. Phone: ('715) 235-2644 Menomonie, WI 54751 Fax: ('715) 235-2592 www.tlsinzplumbing.com (~ La-~-C~S ~~~ /r T~s i ~ ~" ~/ ~f~~tsfrJT ,e~9E ~tl~ Su1 4 2 9 1 7 u~ "/ aw^~ o G ~~rr~ ~~~ / y` `lam / 7"~' / ~ ~ 2 ws ~'~ ~~si~ 3q S~ q~. ~~ ~~ ~ Q o 1 Z S ---__ ~ , ~vo,o ~,a ~ o r ~j ,p,r~u~''~ 6~~Q"x'~" ~~ ~ --~ !~ ~~--~ V~' 1~4~ ~. .~;A ~,. /` ` ,RECEIVED = Wisconsin Department of mmerce IL EVALUATION REPORT Page / of n:..:..:.. ..r e.~Fd.. end RuBri nn n n n ~1 --------~ - -- - , pE(~ fd a~CObdiThle~ with mm e5, inrs. nom. ~oae County S t ' l- , v 1 tires in size. Plan must Attach complete site plan n paper nni~tt 7t.x 11 idbn~ rents p int (BM), direction and ti parcel ID. cr include, but not limited to: er nsion'~td61~ and distance to nearest road. di l e or e percent slope, sca ' t D Please print all fnformatlon. ed by e t a e D6~" "~ Personal informelion you provYde maybe used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). Proper Owner Property Location t Lot A ~ 114 ~w 1l4 S ` G T Z`~ N R E (or~~ r ~ ~ ~ ' ov Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# ~ 'c~L C 1 ~ ~- ~ ~ G~ hzG~5~, - ~ i City State Zip Code Phone Number ^ City ^ village [ti.}Town Nearest R d ti ~ Ati ` W ! ( ) vh Q New Construction Use: ~ Residential I Number of bedrooms ~_L Coda derived design flow rate ~%,~~' ~.i_) GPD ^ Replacement ^ Public or commercial -Describe: -- ~ 1~ fl ain elevation if applicable _ _~! ~ ---_---- Fbod Pl Parent materiel i' • _- / General comments ~ ~ [,I ~ r Cj ~~ ~.u ,,r Z. ~~ ~ j , ~ t,l i ons: and recommendat Boring # U Boring C' C Ground surface elev. _ '~ ft. Pit Depth to limiting factor _ Vic. ~ in. Sol lica6on Rate Horizon Depth Dominant Cobr in. Mansell Redox OescripGon Qu. Sz. Cont. Cobr _- Texture ~S Structure Consistence Boundary Gr. Sz- Sh. ~n-~~ - Roots GPDffI= 'Eff#1 'Eff#2 _.. /. Z d 0 '~ 3 Boring # ~ Boring '~( y~ ~ - t-- pit Ground surface elev. ~%r ~ % ~ ft. Depth to limiting factor .5 in• Sorl rcafion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDItt= 'Eff#1 'Eff#2 in. Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh. ~.. GN.. 2 « I Z ' 19 /~ f 3 Elflrrent M1= BOD > 30 < 220 mg/L and TSS >30 <_ 75U rngn. rwron..rc - o.,~ _ .,., ,.,y.~.o......,... _ -- .--a_ Signa CST Number CST Name (Please Print) ~ Z S, 3 ~~~- f~' valuatwn Conducted Telephone Number Addr1ess /d~ ///~~~ ,- ..~ {/ 7 I 7 /'~ ~J Z'I ~ VO~ ~Y ~~~ ~, ~~-~1~ •' L..r~ _O~ ~/~I I~`~ JO(i ~9 Property Owner i' G 11~ Pan:el ID # Page __.,~ of _~ Boring # U Boring U~ Pit Ground surface elev. ~ ' ~ J ~ ft. Depth b limiting factor ~ in. SoB ica6on Rate tion ri dox Des R Texture Structure Consistence Boundary Roots GPDIfP Horizon Depth in. Dominant Color MunseB p c e Du. Sz. Cont Cobr Gr. 5z. Sh. 'Eft#1 •Eft#2 ~, ~ LS Z ~ ' ~ --- _-- ~ ~ °~~•c~a 22 - ~ s~• g a Boring # ~ Boring pit 'Ground surface elev. ft. Depth to limiting factor in. Soil A ication Rate Horizon Depth Dominant Cobr Redox Desrxiption Texture Structure Consistence Boundary Roots GPD/ff' in. Mansell Du. Sz. Cont Cobr Gr. Sz Sh. 'Eff#1 'Eft#2 Boring # ~ Boring pit Ground surface elev. tt Depth to limiting factor in. Soll ication Rate i H th D inant Color D Redox Destxiption Texture Structure Consistence Boundary Roots GP Dlff zon or ep in. om Mansell Qu. Sz. Cont Cobr Gr. Sz Sh. 'Eff#f 'Eff#2 'Effluent #t =GODS > 30 < 220 mglL 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-B3301R.07ro(q ,, . R PAGE~OF~„ NA.ME;~:1~_LOT# ~ 1-- LEGAL DESCRIPTION:_I/4_,I/4,S T___,N,R, E(or)W SCALE: 1"g ~~ L~ ~rti. ELEVATION: ~(t r ~ I BM 1 DESCRIPTION:.~~ ~ ~ ~ ~C i' Y~v~C."I (~L h ^- BM 2 ELEVATION: ~~ ~ C ~ c~ BM 2 DESCRIPTION: SYSTEM ELEVATION: .-~,P ~~• ~JG? l.G~~_2 i ~l~ ~(G , --_. ~ . - SYSTEM TYPE: ~' (~ n u ~ /~ T ,~r'l ~' ~ ~`' '~ l4 _- \ ~~~ ~ 51~~z.,z-~y~~, Y \~ ~,G e' ~~ - ~~ ~v Y3,~- c~~,~ L_ .. rrll ~„ l V -, ~`~ ~ ~, ` , V J ~~ SIGNATURE: // - DATE: J Z ~ Z , POWTS OWNER'S MANUAL 8~ MANAGEMENT PLAN Page of _ FILE INFORMATION Owner UL ~r~S ~~•(,~/ %~t1ST Permit # y.3p ~,., ~' DESIGN PARAMETERS Number of Bedrooms ^ NA, Number of Commercial Units ,~0'NA Estimated flow (average) ~ gal/day Design Bow (peak), (Estimated x 1.5) gal/day Soli Application Rate ~""' gal/day/ftZ Influent/Effluent Quality Monthly average* Fats, Oil at Grease (FOG) <_30 mg/L Biochemical Oxygen Demand (BODs) <_220 mg/L Total Suspended Solids (TSS) x150 mg/L Pretreated Effluent Quality ^ NA Monthly average** Biochemical Oxygen Demand (BODs) <_30 mg/L Total Suspended Solids (TSS) <_30 mg/L Fecal Coliform (geometric mean) <_104 cfu/100m( Maximum Effluent Particle Size r~ inch diameter SYSTEM SPECIFICATIONS Septic Tank Capacity Z~Q gal ^ NA Septic Tank Manufacturer ~ j'T' ^ NA Effluent Filter Manufacturer ~~{/„~' ^ NA Effluent Filter Model .Ypp ^ NA Pump Tank Capacity ~ gal ^ NA Pump Tank Manufacturer uW ~~ ^ NA Pump Manufacturer Sj~ ~p ^ NA Pump Model fd~y~.~ ~L„^ NA Pretreatment Unit ~A ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer Dispersal Cell(s) n-ground (gravity) ^ ln-ground (pressuriz ed) ^ At-grade ^ Mound ^ Drip-line ^ Other: * Values typical for domestic (non-commercial) wastewater and septic tank effluent. * * Yalues typical for pretreated wastewater. MAINTENANCE SGNEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ^ months year(s) (Maximum 3 yrs. ) Pump out contents of tank(s) When combined sludge and scum equals one-third (Ifs) of tank volume Inspect dispersal cell(s) At least once every ~ ^ months year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ^ months ~'year(s)Q,G ~lS /VSG Inspect pump, pump controls 8z:alarm At least once every ~fj 'sj ^ months year(s) ^ NA Flush laterals and pressure test At least once every ^ months ^ year(s) NA other: At feast once every ^ months ^ year(s) NA other: At least once every ^ months ^ year(s) NA MAINTENANCE INSTRl1CTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Maste Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Ys) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less shah be performed by' a certified POWTS Maintainer, A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START VP AND OPERATION For new construction, prior to use. of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contenu Page of _ System start up shall not occur when soil conditions are frozen at the infiltrative surface.:... ~ - ~ . . , During power outages pump tanks may fill above normal highwater tevels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. ~ ,. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; batty wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectanu; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; paintine products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONEMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. After pumping, ail tanks and pits shall be excavated and removed or their covers removed and .the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement rystem: j fY A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resorc,to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the nines in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFiC1ENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPAC.~IRI.F. ADDITIONAL COMMENTS POWTS INSTALLER Name Jj AJ J/li Phone SEPTAGE SERVICING OPERATOR (PUMPER) Name POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Agency ~' L~ e7!l~lA1/f '' 3~Sb~ ~f+bHo • L:. 'Ic i ~ 1J ~.•~r «,.: ~ .~ ~` to var~~ 11t~1'~1{ERPRpaF ' {.QeKtNL3 COVER 3~tahitTWM LdiPn`N~ 1,~d'~.f , iil~ ' ~uCtit C~~auwKact'--~ '" .-...~. Q, +4~ C.T. t*+tr~+t+S1~M OVirN+Qr ~ i T ~•- 4 ~~ 6u :T ~•~' 1~` ~ ~~ i twt~l6TiaA~ svwi. 24" ~.~. •~~ auc.r. ~r ~~i ~ ; v~ur rN,~. «+csr uo~ ~~~ A c.x. ~• PtP'~ _ 4 Z" ~ r W~~Zti~W- EG'7'2C~ ~ ~ +Cl~y1~C ~ ~ ty @~U ~ i'"YSY ~ 6 ~' v~.+. -I;nP'~~rtG E S{P•~, ~ ATi~t-.f U ~:Q ~Q g 4. , ~ ~ K ~ .T G .4~ • w..SiM-,fy"R• 1. ~ r "Al.lr: MtialtlFAC"s"UR~R: i+11llrlb~R OF GOStS: `~ PER OJ~.~ TANK SIZE: 1Z•~^O ~ ~S~ 6At,.l.OAtS ~ ,A49E VOL4r~4i< ALARM /~t,J,F'AG'Y'tliir~lt: $ S 1C ~ a..a IR3CttJDllLiCs {~AtKFLOW~ `~~•~ Cd1-.L41.I5 J"tf3CiiC(. ~tttKltCK: ~ ~ 1 1-; `y ~` Q.?i c~~AC~ris:s: ,~ ~ ~utuES oK ~..L,.. ~~tA©W s sw~TG+~ Type; '^"°a'.a'"'.`' "' uMP KAIJUFAGTUtecR: ~- c ~ 8~~~~+cKSS aK l~y ' r,~~~cus r~bnE~ uu~+eck; a~ ~ ,-a:,-~~s oa tot.4t ~AS.LO~s SWITCH T!3#~iC; `r`~~''•" ~ TE' p~1MP ASiD ALARM ARC, TO s£ f"tll~llM3.iNi D3SC~llkliGi RJ1Tl-~---~..,.G~I~IL/0' 1~51'Rt.~~O 01ti1 S~PwRATC CcKtu-rS EitT'lCdtL i~tiF8RtlttGf iSETMrftt~ DLt1~ 01~F A1,10 pISTR1b1iTtPu P1pE.. ~,. PEE7 MtAlllrlUM ~fEYWORK StlPPi.`J PKCfiSU1tL~ ~ . ~ . .~~~ ~ FEET ~f~ET OF tORCC MAfN X .L:=L,i.,...P~a~xgKttTIGi1 ~A[•rOR_.._.;{~;.,gF~'ET ~" ~"~ ._. ....,.,.,,_~ a[~ T'or~~ a~~-An~c Kc~p . = ..,1~.. ~i:er Tea~.tAt. r~iMCUS~au,i o~ r~lx~x. L~k-arr~ ~~5 ~ •` l i~ ~~- l• v R •Gd Wd00:60 Z00Z €~ 'hpW 860 €~~ SQL 'ON Xdd ~JNIlSSl BIOS QSIdIl21~~ WOZld Wholesale Products Page: 6350-1 Section: PerFormance Data Dated: January 2001 12r 40 SHEF30 9 ~ 30 W Z ~ 6 ~ 20 v = J ' = IQ-' ~3 ~ 10 0 ~- 0 ~ Capacity-U.S. G.P.M. ~- ~iters/Second 0 10 20 1 30 40 50 2 3 The curves reflect maximum performance characteristics without exceeding full load (Nameplate) horsepower. All pumps have a service factor of 1.2.Operation is recommended in the bounded area with operational point within the curve limit. Pertormance curves are based on actual tests with clear water at 70° F. and 1280 feet site elevation. Conditions of Service: GPM: TDH: I~ HYDROMATIC Wisconsin:DepartmentofCommerce 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)]. Permit Holder's Name: Ulferts Famil Trust City Village X Township Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA county St. Croix Sanitary Permit No: 430411 0 State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: 09.29.17. STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer St/Ht Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Svstems Onlv zx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes [~ No Yes ~~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1047 174th Street Hammond, WI 54015 (NE 1/4 SW 1/4 9 T29N R17W) Pheasant Ridge Lot 41 Parcel No: 09.29.17. 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = q ~ Yes Plan revision Re uired~ 0 No - ~ - _ _ _ _._ _ _ Use other side for additional information. ~_ ' , ~, SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. S Se die as All as . Safety and Buildings Division Washington Ave., P.O. Box 7162 201 W County ST r!iY'~I11 . ~ Madison, Wl 53707 - 7162 Sanitary Ptav~it Number (to be filled in by Co.) ~~~O~~t~ (608) 26¢3151 ~ 3(~ Department of Commerce State Plan LD. Number Sanitary Permit Application:: ' ' ~ N p on yo~ ~ ~ In accord with Comm 83.21, Wis. Adm. Code, personal tnfo ~ '°'r ~:"""' be trend for stocondary Pmi>~s ~"~7' Law, s 15 1 X~n ~ (f ~ ma ~~ Address (tf different than .ling address) y l [ on !. Application information -Please Print All In[ormat ~" '-, ~ y ~ ' elk Block N Property Owner's Name ) F i Property Owtn:r's Mailing Address ~a:...,,-o` ~,F y l.ocatio City rate Zip Code Phone Number p ~[ 5 O, ~~~ ZQ~~ ~ZyFO ~~ /~ T/~ N; R~E ort;~ ) ing (check all that apply) ~ ll. o 'vision Name CSM Number 1 or 2 ' ly Dwelling - Number of Bodroottu r Ord E ' ^ PubtidCo ial -Describe Use x /Sr Lv~~ ~ ~ L~ ibe U ^City_^Village~Townshl~p of se o ^ State Owned - tr ill. Type of Permit: beck only one boz on line A. Complete I e B If applIcab e) r A' New System Replacement System ^ Ttratrrteni/Holding Tank Replace Only ^ Other Modification to E ' y . I viotu Permit Date B. ^ Permit Renewal ^ P 'Revision - ^ Change of ^ Permit See Before Expiration Plutrber Owner 1V. T e of POWTS S stem: Check a at a 1 Non -Pressurized ln-Ground ^ Mound >_ 24 of suitable soil ^ Motmd 4 at. of suitable soil ^ At-Grade ^ S' P Constructed Wetland ^ Presstuizod In-Ground (ding Tank ^ Peat ter ^ Aerobic'freatment Unit ^ R trlating and Filter Recirculatut S thatic Media Fih~ ^ Dd Line Grave6less Pt ^ Othc lam ~ ~ C ~~ • V. Dis ersal/I'reatment Area information: - ~ Desi Flow (gpd) Des' Soil Application Rate(gpdsf) rs ea Required (s Dispersal Area Ptopos sf) System »~Vauc~,. ~ ( ~ 6 9 ~ 5'7 ~ ~ana ~ `, S a ' ' ~ i V1. Tank Info ity iv Total Number az~fac~~ O~ " Prefab Site Steal Fibe lastic Concrete Constructed Glass Gallasts Gallons of Units H Ncw Exiating O ~/ d7v~ Tadts Tucks s~Pd~ ~.~+.+~'.nt. ~D Aerobic Treatment Unit Dwin~ Chamber ~ ~/'f Vll. Responslbili Statement- 1, the under ass re slbW for lnstaUatlon a PON~1'S shown on the attached fans. RS N B~~cin~ce Phone Number Plurnber'3~Irtr~e (Print) PI s MP // ..~n/z t~/39 Z ,l= 23.1'- ?-+~ Plumber's Address (Street, City, State, ' ~ ~/~[ ~l4 ~~ ~~~~ v tJQ Vlll oust /De artment Use Onl lss ~ Agent S' true s)t Sanitary Permit Fee (includes Groundwater Date ~ Approved ^ Disapproved Stucharge Fee) ~ ~ !/'C~ ' /v~ - A ~ ^ Owrrer Given for Denial IX. Conditions of ApprovaU nos for Disapproval /L -~'D L` ~1 ---SG'vr~,~ j''~ ,~ filt i t , er an tic tank, effluent ersat cell must all be iced /maintained ~ i ~~ , / ~ l~ b 'I er. er management pl rovided by plum etback require s must be maintained ' er applicable code/ordinances. , p •i ''`~/ ~ ~ SBC D-8398 (R. 0.1/03) v .-.~ complete plans (to the County only) for the rystem oo paper ool feu than S1R s It inehn lu alxe ~DUJT~ M.~ ~~~ ~iJSf,4ti1 2- 2.7~;8'l~0~ ~, ~p / Nor /-FrrE~ FiL ~L~S L28 S~L~ S~ ,:, ~L~t~ ~~S . 95,a,, L i ~u,~'~-~.~- -e / `~ ~~ ~ _' o ~9n.~~ ~~ ~ ~ z ~ 0~ 7dP ~~ `~~ ~~~ ~~ o ~ ~~ s~ FROM : CERTIFIED SQ I L TEST I IVIa {F±RX IVU.t (7'15 2533 17398 ' ~ 4, k i i' 1~ 2'7 ~. , 1 ~iDCK~~+tG~GOY~R --s c~.rv.~~ rNa a rr~".C . Gti,iCK t~cat,oyvt~sr-^~ t~ -----3 k ~YL E• ~~~ ~ fl~~` ~' q ~ND-SSURBED r~t + rw+c.s r ~~~ CrT ~7~17':J P~'G H Ec.Y, arcs LEv ~~ ZD" 2.17. MA-tuW.E ~ ~ C ~_' ~ G s r b" st' •. L~FF1.E C~rrC.4Frc 6coC+C i -- StPr,c E __~PEC1~1~tAT1 ~4~ _ ~ DoS~ ~Gti~ t~ 5 Tn,,i•.. 1'1,~,-]L.IFACYU4~R: t.Jl.1!'•1B~F1 OF AOSCS: ..,,_+'Lh ~~.~ TA1JK 513x ; 1 Zb`Y3 ' ~s'U t3.tLLp1.f5 • .0o5C VOLUMC / A~-A9~1°t !'~layillFACTL11RGit; S d 1~~, v,r tiA1CLUfl1iJG> ~ACXP~.C~rd: • ~~ tiA~.~~]S P'lOOCL -•{UYbCIt: . 1 e ~ 1-4 "~ GhPAGITIfS: ~_..,.~,=_.{1JtiifS dK ~"~{v~'~o~= S~.i1TCH T~PC: w~'`•*"`` bWl~'' z-- n ~~•14 :':JMP MAk!UFAGTURC1t: Ca ~ ~utKfS pK Z~ :,.~~~.:ti5 r MODEL IJUM~iC: ~ «~ Dw ~ iu~>i£5 GR l°1.~2.G~~tG.~~ SW,TtN T}3PE; "~~`"`~ ° T`£: PUHP AUD ALARM .aRC TO 8G Mi)~.lIM1tSI"1 D1SCF{A1tGE RATC G1'h1 f1J51'AIC.EO p-J SEP~RAT£ Cti:C::•"s Vt0.T,CAL D,iFt1~CiJGE bEYWGCA! PUMP f AUp Q13TRlQUT1 0-14iPC.. Z" FCC1' } r-~~-..ti-t M -~-~TvJOA1{ SUPAi.`! P FL LUR~ . !'GCT + ~~tET pF PORGC j'~.{h} }( ~ QQ '~r F/1Qp~~FKlGTl9k1 fAGT01t.~ E6T ~ ~ , ,~ ^ ~ ~ v -- gTAL 0`jlJlkl"llt HfA(~ ,.~ ' --. ~ FE 1TCR ] 1~ 4 . /ti;, DIMCIJS1oiJfi Of TAUK: L~AiC+TN _.,....._ ~,k1i01'H -- ;~-{Gt1t DE.P7't-~ -- ~ b ~ a .Jun. 14 2x02 b5:5~FlM P? ~ n2~x ..~..~.. 'r1 t, ~ n ~j Wf~,'~NERPRcki1= ,! ~ ~ .hJ rt C7 t c t+ I H~ ,• r P.sc \ ~~ \ ,,, 4 0 V Y c ~y ~ y ~~, ~ w i.,. a ~ f f t: rti _ ~ ii6:.r ~ ! ~ 1~ 4` Q~ ~ ,, ~ ~ ~ 3' ow- o ON ' ` ~ ; ~ u-uca ,~ T , ~ ~~ f i ~~ ~ 1 P pw~ perfOrfllglfCB wholesale Products Page: 6350-1 . ' Section: Performance Data ~qtp Dated: January 2001 RPM: 1550 Discharge: 1-1 /Z" Solids: 3/4" t 12 r 40 9 ~ 30~ W t/'1 LJ.. W Z ~ 6 ~ 20 Co = {„LJ J _ ~ 3 X10 Ol 0 Capacity-U.S. G.P.M. SHEF30 liters/Second 0 10 20 1 30 40 SO 2 3 The curves reflect maximum performance characterlstlcs ~tittiout exceeding full load (Nameplate) horsepower. All pumps have a service factor of 1.2.Operatfon is recommended In the bounded at'ea with operational point within the curve limit. Performance curves are based on actual tests with clear water at 70° F. and 1280 feet site elevation. Conditions of Service: GPM: TDH: ~~ HYDROMATIC s !Niscca~rin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page _ i of rn accoraance wan Comm aa, YYIS. NUrrl. VWe Plan must 8 1/2 x 11 inches in size t l it th l t l A h County ~ . an on paper no ess an comp e e s e p ttac include, 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. Please print all information. viewed Date Personal information you provide may be use ~(~1`tJSA~ (Pf'lYaGyaw; ~ 15.04 (1) (m)). ~jy~~ ~ ~ ~ 3 PropertyOwn r ` ` F4ropertyLocation ~TC ~ I I + _ Govt. Lot ~/~ C~ 11451.v 1l4 S 1 T Z~j N R ~ 7 E (or W dre s < ~'~ ~ _, ~ ', Property Owner's Mailing ATd1 ~ l;ot # Block # Subd. Name or CSM# d 1 ` . - - ~I ~~+ ~( ~ , City State Zip Code Phbhe u ber ~ City ^ Village _ ~ Town Nearest Road [~ New ConsVuction Use:I~Residential /Number of bedrooms ~_~_ Code derived design flow rate _ ~so1_~_~~___-__ GPD ^ Replacement ^ Public or commercial -Describe: _________________-__._-__---_,_--__--__ Parent material ___ T ~~_____________f~' ~ ___ Jp~r~ )a elevation iF applicable ____~1 ~_.,_________ ft. General comments S S-{-P~--~ ~ ~'t v' "' ~ ~~~y/ and rewmmendations: ~ ~^U~ 9~, O d / tJ~ 6 a ,~t.c. Co-- ~ ¢~ - - Guy ~lz l~.~C >L/a•z.~~ ~~¢-Qo'~ s)'S~''~'" fir.,.~Sa-r.Q 9~[.u~-C.t. Boring # ~ Boring Q Q Pit Ground surface elev.--~ ft. Depth to limiting factor _ / V _ in. Sorl A icalion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff? in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 ' ~~ ~ ~ O ~~ -~_ c Z ~ ~'- L ~ n I -1^ 2 IZ~3~ i`G~ -' SZ 2 IC ~ ~5 -- . 5 . ~ .3 ~s-9 U r ~- - ~ s I ~~ vn ~r _ - /. Z 5 'i ,, Boring # I~~ Boring (~~ /'~~~ / /~ L"h Pit Ground surface elev. `i I , ~J~.1 ft. Depth to limiting factor ~ f~_ in. - Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft= in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'EH#1 'Eif#2 i D-IZ ~~~ _ Sri Zip ~r ~ .,,r . s -~ Z IZ-`I6 1 ~~ - S L w-rF r c - 9 Effluent #1 = BODS> 30 < 220 mglL and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TS5 < 30 mglL ST Name (P ase Print) ature CST Number c. h ker~ ~ 2 5 3 09 Address ~ Date Evaluation Conducted Telephone Number LI 3 ~U~~ S-I . Somer~e-~ r ~~ l I ~y2S- ~ z - s- a z C7i5) z~ 7~ yc~~ Property Owner ~~2~~~~'1~i I~(YU~r Parcel ID # Page __ L of _ ~__ Boring # ^ Boring (~ Q~~ /~ 1~ Pit Ground surface elev. _! ~_QLJ ft. Depth to limiting factor _ ~l.J _ in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DlfF in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 1 ~--iZ - ~ -' ~ C ~v - rJ z - - -- s~ k ~ - ~ . 9 3 ~~-~~ IU w/ ---- ~ I ---- -- ~ ~- Z. ~ ~ ' sa 60 ' 0.7 ^ Boring # ^ Boring ^ pit Ground surface elev. _________ ft. Depth to limiting factor ______ in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fit in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring Boring # Ground surface elev. _________ ft. Depth to limiting factor _____ in. ^ Pit Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIfF in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 • Effluent #1 = BODS > 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 (R.07l00) r ' - PAGE~OF~ NAME U 1 ~z~ ~ LOT# y ~ LEGAL DESCRIPTION ~fiE ~ Sw ~ ,S Y T ~Q ,N,R, / ~ E(or~~ r SCALE:1"= Gl~ BM 1 ELEVATION /OU' U BM 1 DESCRIPTION -~ p o -~ % s ~-.? ~ / ,~o ~ BM 2 ELEVATION ~f , 3 C~ BM 2 DESCRIPTION -~o ~ ~~ ~ iy ,~~'ee / ~o ~ SYSTEM ELEVATION~P gS.6y Cc:,~-~,~ 9i/,ov SYSTEM TYPE ~Gn u y r~~.~~, r.a CONTOUR. ELEVATION ~/S , cc~ - r ~~ ~~c> SIGNATURE ~ J ~- DATE /-/p ° Z PAGE~OF~ vIF. )1 ~-~~~ LOT# y~ T EGA_L DESCRIPTION ~fiE `a Sw 14 ,S Q T ~Q ,N,R. / ~ E(~ SCALE: 1"= ~~ I BM 1 ELEVATION X60 • U BM I DESCRIPTION -~-~ p o •~ %y e5~~ ~ / ~o ~ BM 2 ELEVATION ~~, 3 c~ BM 2 DESCRIPTION -~o p n .~ ~ ~ S~-~e / ~o ~ SYSTEMELEVATION•-lnp q$,Ou /,~;,,.~,r 9y,oo SYSTEM TYPE (~cn u ~ n ~-: ~ ~. a CONTOUR ELEVATIONS, oa - Y 9• oU SIGNATURE N S«• i f~ ~J ~_ DATE /-/p ~ Z ST CROIX COU1~tTY SBPTIC TANK MAIN7CBNANCB AGRBBMBNT •-AND OWNERSHIP CBRTIFICATION FORM 111teP s ~ra+~:l Irub~ Lul'~ Ilbjl' S~• roporty 'roperty i.b ~ 'ji P h ensue} Q-i d (Verification requirod from Planning Department for naw µo,,~,~.a,a w i Parcel Identification Number~~-~~+`'~ ,ovation ~ '/., S~,' L.. `/a, Sec. ~~ T= -R~.~ ~1- Town of _~• ,n Pl~easan ~ ~id~e 41 F irs~ A-d.~`~ ~ ion .Lot # `1 ~ Survey Map # _ .Volume ~ • Page # r Deed # 7 z o 31'3 .Volume ai -Page # Spas hose ^ yes ~ no Lot lines identifiable yes ^ no ~~ .. ~. roper t>se and au~ntenanoeof your septic system could result in its premature failure to handle ovastes. Proper ma~atenance ooead* 1?~P~ °~ ~ tank every rhea years or sooner. if zreeded by a licensed pumper. What You Put into the system cxn the function of the septic task as a treatment stage in the waste. ~P~1 '' property owner sgcas to submit to St. Croix Zoning Dq~artment s fO~ ~ ~° owner and by a joiuneymanplumber, r~rictedplumb~xor a lioensedYe~Y~B that(1) tha otk-sits wasbean-tardiapossl system ~ is operating condition and/or (2) after inspection and pumping (if n,ooessary), the sepElc tank. is loss Haan lr3 ~ of sludge. anti sgroe to maintain the Private sewage disposal system with the standards ~. ~ have nand the above o~ of Natural Resources, SEste of Wisconsin. (xctif~ication ~ fly, • as set by the Department of Commence sad ~ ~ to the S't. Croix Connty Zoning Offia within 30 ~g t your septic system has boon maintained must be completod and rcbrmed ~ of three year expiration dato. cj ~~o~u3 • DATB ~(}NA OF APPLICANT p g ~>a:u_'~`ICAZ'I;ON the owner(s) of that all statements on this form are true to the best of my (our) lmowlodge. I (we) am (are) I (we) certify of Deeds Officx. ~ described above, by virtue of a warranty doed recorded is Register' gria~o3 DATB ~(}Np OF APPLICANT Any information that is mis-c~epresented may result in the sanitary pccmit bcurg evoked by tlu Zoning Departmen~'ss««s s•s«ss ss jnd de with this appllcattion: a stamped warranty deed from the Register of Deeds office a copy of the certifiod suz,-oY map if seferrm~e ~ nnsdo is the warranty dad '~7` POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pege ~ of Z FILE INFORMATION Owner ~ S ~ f 1 "~~ Permit # 2,,, // DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ~NA Estimated w (average) al/da Design flow Ip ), (Estimated x 1.51 (gyp al/da Soil Application Rat * al/da /ftZ Standard Influent/Effluen uality Fats, Oil & G se (FOG) Biochemical Oxygen Deman GODS) Total Suspended Solids SSl Monthly average* s30 mg/L 5220 mg/L ^ NA <_150 mg/L Pretreated Effluent Quality Biochemical Oxygen Demand (RODS Total Suspended Solids (TSS) Fecal Coliform (geometric mean) Monthly average <_30 mg/L 0 mg/L NA 100m Maximum Effluent Particle Size Y8 in ^ NA Other: ^ NA s. ..1 ..~... ~., ..L effl.~ values ~yNwal wl uu,,,caaw vv coat r.aaa, c.... v SYSTEM SPECIFICATIONS Septic Tank Capacity Z.~ ' al ^ NA Septic Tank Manufacturer (~~~ ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model /~'-~U ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ! y1'w p~ ^ NA Pump Manufacturer ~y,K,~?t.. ^ NA Pump Model 3 0 ^ NA Pretreatment Unit ^ Sand/Gravel F' r ^ Mechanical ration ^ Disinfect ^ Peat Filter ^ Wetland ^ Other. NA Dispersal ellls) !~ In- nd (gravity) ^ rade rip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: her: ^ NA Other: ^ NA Other: ^ NA MNIIY 1 CIYNIYVC JVIICUIJLC Service Event Service Frequency Inspect condition of tankls) At least ce ever ~ ~ month(s) earls) (Maximum 3 years) ^ NA Pump out contents of tankls) Whe ombined sludg d scum equals one-third IY,1 of tank volume ^ NA Inspect dispersal cell(s) A ast once every: ^ monthls) 1. ~''yearls) (Maximum 3 years) ^ NA ^ monthls) p,L, /("j /tJ~C ^ NA Clean effluent filter t least once every: yearls) Inspect pump, pump controls & alarm At least once every: ^ monthls) .~~, earls) ^ NA onthlsl ~NA Flush laterals and pressure test At least once every: ^ rls) _ Other: At least once every: ^ m h(s) ^ ye ^ NA Other: ^ NA Wisconsin Administrative Code. MAINTENANCE INSTRUCTIONS Inspections of tanks and disp al cells shall be made by an individual carrying ane of Master Plumber; Master Plu er Restricted Sewer; P WTS In ector; POWTS Maintai inspections must include a ual inspection of the t Isl t ide y any missing or broke measure the volume of c biped sludge and scum nd t he for y b~ck u or The dispersal cell(s) sha a visually inspected to c e levels in th e of effluent on the gro surface. The ponding of efflue on the grounds in immediate notificatio of the local regulatory authority When the combi accumulation of sludge and scum in an one-th" IY31 contents of th ank shall be removed by a Septage Servicing a rand osec~ All other services, including but not limited to the servicing of effluent filte echo units, and any servicing at intervals of 512 months, shall be performed b certifiec A service report shall be provided to the local regulatory authority within 10 days of the folTowi licenses or certifications: i tage icing Operator. Tank wad, identify any cracks or leaks, g of effluent on the ground surface. io ipes and to check for any ponding is failing condition and requires the me, the entire otter NR 113, or any Page ~f ?~ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at~the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) in one large dose, overloading the celllsl and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a hooding tank may be installed as a last resort to replace the failed POWTS. s' a as not a evaluate to 'dentify a ble replacement area. Upon failure of a POWTS a oil and site I lion ust a pe rmed o local a s 'able re~i{ cem area. ~o-re}~la em area is available a holding tank ma be insta ed as a last ort to replace the failed PO S. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name S ~!Z Qbr /N'C. Phone '? S-• Z3s POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name s~ G'r'Qtri t~o Z/x Phone Phone (sue '&Qj, This document was drafted in compliance with chapter Comm 83.221211b111)(dl&(f) and 83.54111, 12- & 13-, Vtllsconsin Administrative Code. DOCUMENT NO. QUIT CLAIM DisD 58;~.`.:0.~ .9l ~:~~1~o~rF~~n1. I Karl N. Ulferts and Katherina G. Ulferts, a/k/a Katbazina 0. Ulferts, a/k/a Katherina U1lerta, a/k/a Kat• Ulferts, a/k/a Katherina Ulferts, hus~~nd and wife :~olding as aur~ivorship marital property, quit-claims to Karl N. Ulferts sad Katherina 0. Ulferts lamily Trust, Dine M. eonte, Trustee, Ronald C. eonte, 1st Alternative Trustee, having Cull power to sell and encumber, the following described real estate in St. Croix and Pepin County, State of Wisconsin: See attached .Exhibit "A^ for real estate description. The purpose of Chis putt Claim Deed ie ~o terminate that occupancy right as originall/ reserved by the Grantors by deed as originally dated September i, 1995, ree~rded in St. Croix County Register. of Deeds on November 1, 1995, at 10:00 a.m. in Volume 1147 of Records, Pages 22- t~, ae Document Number 535679 and recorded in Pepin County Register of Deeds!on ti~~•ember 13, 1995, at 9:00 a.m. in Volume 106 of Records, Frges 294-295, as Document Number 094145. EXDMPT PER WISCONSIN STATUTE 77.21(1) This is homestea~roperty. Dated this ~! day of August, 1998. AUTHKNTICATION Signatures of Karl N. Olterts and at arina G. Ulferts authentic s da of August, 1998. Leo A. Beekat TITLE: MEMBER STATE BAR OP WISCONSIN (If not, authorized by 5706.06, wis. State. THIS INSTRUMENT WA8 DRAPTLD HY~ Leo A. Heakar, Attorney RODLI, BESKAR, 80LES 4 KRUEGER, 3.C. 219 North Main Street, P. 0. Box !38 River Palls, WI 54022 RCZi" I LR J V f r ICE- -~ ST. CRG~:( CO., WI Rat'A 'ur Raao~d t AUG 1 ~ 1998 ~ 3:30 f~ R.A),ia, er e..~~ NAME AND RETURN ADDRESS Leo A. Beskar, Attorney F.ODLI, BESKAR, BOLES & KRUEGER, S.C. 219 North Main Street, P. O. Bux 138 River Falls, ielI 54022 Pepin County 010-484-0000; 010-510-0000; 010-507-0000 St. Croix County 002-1026-80; 002-125-40; 018-1018-20; 018-1018-30; 018-1018-40; 018-1018-50; 018-1018-60; 018-1018-70; 018-1018-8U; Pazce I ent fi^ation Nu er PIN) 018-1018-90; 018-1015-~~; 018-1015-70; 018-1015-80; 013-1015-90: 018-1019-00 (SEAL) / W : G)~L 1 ~;f_,.C-~, i'%+, f.CE4L? Kaz~i~ts y/ (G~'' ['~~ I' /' 7 p (SEAL) `~-~t Ul.c~`l -`- `•S/~-. ' (, ~ (dyLPALI Kathar na 0. Ulferts ACKNOWLSDCNYNT STATB OP WISCONSIN ) sr. COUNTY ) Personally came before me ehia day of 19 C »~above namef. to me known tw be the person(s) who executed the foregoing instrument and acknowledge the same. Notary Public County, Wia. My commission ie permanent. I not, expiration date: i. _~' .' ~'{~ `'~",..::y r~ f..t.'i, ~.~~~~1•j~ ~e~ ~~'~~~ L'; f~~~ .~ $~:tt^~ r,~p; r~'F"~'-y.~C*s*~}`""ia,`Tr'l[~ ~'~°'t.'.'Y~'1ii:jl+1?.i'~ '~ EXHIBIT "A" Real Estate (St. Croix County, Wisconsin) Northeast Quarter (JE 1/4) of Sectiaa Eight (8), Township Twenty Nine (29) t7orth, Range Seventeen (17) West. ~ AND; j I West Half (W 1/2) of Section Nine (9), Townsh~p Twenty Nine (29) North, Range Seventeen (17) West, EXCEPT Commencing at the Southeast corner of said West Half of Section 9; thence North on quaoter section line 341.8 feet; thence N82°W 340.0 °feet; thence 552 W 170.0 feet; thence S39°W 170.0 feet; thence S56 W 263.7 feet to section line; thence East on section line 798.78 feet to Place of Beginning. ~ AND; South Half of South rest Quarter of Southwest Qlaarter (S 1/2 of SW 1/4 of SW 1/4) of Section Twelve (12); And Northwest Quarter of Northwest Quarter (NWl/4 of NW 1/4) of Section Thirteen (13); ~ All in Township Twenty Nine (29) North, Range (Sixteen (16) West. Real Estate (Pepin County, Wisconsin) Lot Five (5), Block 'Iwo (2), Klampe Subdivision to Town of Pepin, Pepin County, Wisconsin. AND; Lot 4, B:Lock 4 of the Klampe Subdivision in 'the Town of Pepin, Pepin County, Wisconsin; Part of Lot 1, Block 5, First Addition to~Klampe Subdivision, described as follows: Commencing at the Southwest corner of said Loth which is the Point of Beginning; thence North 46°8' East, 135 feet thence South 43 52' East, 91.40 feet; thence South 80°14' West, 163.03 feet to the Point of Beginning. Located in Government Iot 2 of Section Twent~I-One (21), Township Twenty-three (23) North, Range Fifteen (15) Wiest, all in TCWN OF PEPZN, Pepin County, Wisconsin. k }r t r .. ~ ~, - N N OC ~ • 1 I ` ~ y 1 • y 7 39 ~•' i 0 ~ ~ o 3 ~ ~ ,- ~ I ~ 2• ~ V /, i / trf ' '' ~ ~ ~ . / i i / ~ J ~ ' ~ v ~ x , r o~ ~ ~ ' M ~ • ~ ~ W ~ ,~, _ ~ k o e sF~ _ _ ~ ~ x ~ 0 ~ ~ _ ~'N . I ~ ' Q ~ i - i ~ ~ ~ M ~ ~ ~ ~ ' ~'~ , ~`_ p `; ; M ' `` . `` ~~ ., \ ~~. 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