Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
018-1028-90-000
i ~ N Q ,,. ~ ~ n y ~./ ~ I " C \ 1 ~" I ;: ': I N ~ ~ .. ~ ~ m fD ° ~ ~ cn 3 co N ~ ~ I °~ 7 ~ 0 N ~~ = V N G CI ~ ~ D. N ~ 1 I °o ~ f~D C 7 III p ~ ° m ~ A~ O ~~ I N 7 7 O Q !~ p < O r~ ~ - C1 A j fl. ~ ~ D ° 'o W ~ m I 3 ~ rn rn o i ~ ~ O ~O ~ ( N N D I . ~ y w W~ l N ~ C ~1 m , .' 3 !r ~ 0 0~ M ~ 0 ~ o : ~ ~ g g ~ N ~ ~ I D I ~ O 3 ~ ~ N O ~ Q _ p j ~ fD _ ~p ~ <D N ( ( I ~ ~ N ~ 3 °-' !V N I °~ ~ ~ •• I N ~ z z ~~ I ~~ ~ D D ~ o f a~ s ' 3 I w <?~ Q.~ _ ~ ~ o ~° ~ ~ ~ o~ C A o .~ i~ p ~ t 'J ~ ~1 ~ N ~ ~ N N A Z J 'A M I ~' ai aao v ~' m p z I ~ ~' ° o I - ~, o v v °' o. v m -, ~, cD x, ~ cD W~ N fn -~ m N w c° p+ c a I m °~ ° ~ o $ » ~ ~ ; m ~ `~ y a y~ A I I ~ ~ I acv y ~ Q ~ i n; r. M ~ i I m ~ N ~n ; I C a N o d i ° j ~. ~ A N N I ~I ~ N I ! C O. O ~ 0. I ~ m li `e I m ~ I v~ a A v m 'p O '~ . S N d ~ O ~ I , N p ~ ~ n ~ I A w I I ~ aro I o O ~ ~., N ~ commerce.wi.gov ^ ^ ~scons~n Department of Commerce INSPECTION REPORT SAFETY AND BUILDINGS DIVISION Integrated Services Bureau 13 East Spruce Street Chippewa Falls, WI 54729 www. co mmerce.state.wi. us/sb (715) 726-2544 Date of Inspection: July 26, 2004 Project Name: Maleevu Use: Residential Legal Description: SE, SE. 13, 29, 17W Site Number: 658$45 Subdivision: Municipality: Town of Hammond County: St. Croix Plan Transaction Number: 987152 Sanitary Permit Number: Wastewater Flow: 450 gpd Persons Present: K. Grabau, W. Schumaker, Mrs. Maleevu Plumber Name and Address: William Schumaker, MP 227990 1070 Scott Rd Hudson WI 54016 Certified Soil Tester Name and Add~,~: ---- - 3 y s° ~._ s Owner Name and Address: Peter Maleevu 2092 90th Ave Baldwin WI 54002 651-238-7070 ~ ?00.~ ~~ i ._~ ~. This inspection was conducted to determine compliance with the approved plans for this project. The project consisted of an extension of the toe of an existing mound to add more basal area and prevent toe seepage. The soil cap on the existing mound was peeled back using a backhoe to expose the sand in the mound. An inspection of the plowed area was completed by the county inspector prior to the placement of the sand, and this inspection. After the soil cap was removed, the plumber determined that the area of wastewater flow was primarily toward the. midpoint of the mound where toe seepage has been observed. The installer also recalled that the center area may have had a shallow swale running east and west through it, and may have directed the wastewater flow to that area -_ ~°him-'rn5p~ctioTr~e~ate~that-th~#oe -extersion. was-gerreraiiy-completed-correctly. -tiowever,-one-_ adjustment was necessary due to an apparent miscalculation by the designer. The southeastern corner of the extended toe area was only 40 feet from the well. The minimum setback is 50 feet. It was agreed that it would be acceptable to remove the sand fill and put the southern toe of the mound back as it was being 50 feet from the well. Since there was no toe seepage from this area previously, it is assumed that this corner of the extended area was not absolutely necessary to repair the midpoint seepage. Topsoil placement- and seeding were to be completed after our inspection. The owner should also be aware that the system that predated the mound is still in place west of the house. I observed what appears to be a dry well or septic tank with a pump and discharge pipe in it that was not abandoned by the previous owner when the new mound was installed. Comm .83.33, Wis. Adm. Code, requires that all below ground tanks shall be pumped out and abandoned. Removing the top of the tank and then filling it in place with soil material is an acceptable means of abandonment. The owner should determine if there is a second tank under the driveway or off the property that would also have to be abandoned. I recommend that the owner have a professional well driller or well inspector inspect the well serving the home. The well head height, seal, and electrical connections all seem to be questionable and possibly unsafe. Lastly, the electrical connections for the alarm were not connected at this time. The point for the apparent connection (a porcelain lamp holder) is a safety hazard in that unenclosed connections are exposed. In addition, the alarm may not be on a switched circuit. It may share a circuit with the basement lights, but Maleevu Residence July 26, 2004 Page 2 or 2 when the lights are turned off the alarm must still function. The owner should verify that the alarm is installed and wired correctly. The services of an electrician may be necessary for this work. If there are any other questions regarding this report, please contact me. oy G. sky, Was water S cialist Ljansky@ mmerce.s ate.wi.u E-mail 715/726-2544 Voice 715/726-2549 Fax cc: (County ®Plumber ^ CST ($f Owner ^ Other r ~ commerce.wi.gov isconsin Department of Commerce April 20, 2004 OUST ID No.267341 ARTHUR L WEGERER WEGERER SOIL TESTING & 421 N MAIN ST PO BOX 74 RIVER FALLS WI 54022 AAR 2 ~ 200 e-- 1 . v CONDITIONAL APPROVAL PLAN APPROVAL E~^:PIItES: 04/20/2006 Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary ~~ ~~~~ ~@~ r~ ATTN: Rod Eslinger E :'. ZONING OFFICE ~~ ~C,,, ~ ST CROIX COUNTY ;' ^~v~~v~~b 1101 CARMICHAEL RD ~~ HUDSON WI 54016 '`.. `. c Identification Numbers v Transaction ID No. 987152 SITE: Site ID No. 658845 Wayne Van Someren Please refer to both identification numbers, 2092 90TH Ave above, in all corres ondence with the a enc . Town of Hammond St Croix County SE1/4, SE1/4, S13, T29N, R17W FOR: Description: Extension of Basal Area to Existing Mound Object Type: POWTS Component Manual Regulated Object ID No.: 953703 Maintenance required; Existing system; 4 Bedroom Design; System(s): Mound Component Manual -Version 2.0, SBD- 10691-P (N.O1/O1) 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: At the minimum follow the construction procedures contained on the "Addendum" page of the approved plans. The proposal is to carefully open the esis±irb .^.:ound »nd exec~a*.e zn extension. of ±he 13asa1 area. This work is not to be done until proper soil moisture conditions are verified by the county inspection staff and only after the system is dried out. • This extension and repair is to be constructed and located in accordance with the approved plans; the mound itself was constructed in accordance with the Installation Manual as indicated in the previous approval letter of May 12, 2003. • .The pressure network has already been constructed back in 2003 when the mound was installed and no changes or adjustments to that work has been proposed in the current plan. 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 may include local inspectors. 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. ARTHUR L WEGERER Page 2 04/20/2004 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. Sincerely, ennis R orenson ~`~~~, Wastewater Specialist, Integrated Services (608)785-9336 , dsorenson@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 TITLE SHEET !]~~~~~ 1 of 1 i~OUND SYSTEi~1 '`~ `~',''~' (~ ., FOR ~~ ,:C" `. A ~ BEDROOM P,ESIDEiQt IQs i This plan has been prepared in accordance Faith the Mou~ ~mponent Manual SBD-10691-P and the Pressure Distribution Manual SBD-10706-P (N.O1/Ol) (N.O1/Ol) LOCATED Ii~t THE SE 1/4 OF THE SE 1/4 OF SECTION 13 ,T Z~ N,R 1-7 6d TOr~id OF }~,h'!`MU~~ S ~- °-(~-UI.X COUNTY, WISCOPdSIId. - ~_~2:~:eZ: ~~x.,~, c~c8 -102 - °t0 =~~6 INDEX ~~ PAGE 1 of 7 PAGE 2 Of 7 PAGE 3 of 7 PAGE 4 of 7 PAGE 5 of 7 PAGE 6 of 7 ~ PAGE 7 of 7 ,., ._---_--~,D D E P1 DU ~1 _ ~``' ~'..~.r....._ ~ TITLE SHEET SYSTEM i-IA~~AGEi1ENT PLAid PLOT PLAi~~ PLAN VIEi7-CROSS SECTIOPd DISTRIBUTION PIPE LAYOUT PUi~IPI:tiG CriAiiBER CROSS SECTIOiv' PUMP °ERFCRI~1Ai~1CE CURVE 2~IOUDID CONSTRUCTION TECHNIQUES PREPARED FOR c~. 1^J i'l t-C Y~l ~c V ?'~'}-3 S Ol^'1 C1Z. ~`i`.1 Z 3 S 0 I 11Z `~{ t~U~-. S~ N 1cJ3 ~~~ ~ ~A `T~03) PREPARED BY l''ZE~~RER SL7 S !_ TEST = NG A!~(D . DES = G~V S~RV 2 CE P.O. Box 74 421 i~l.iiain St. River Falls, T~)I 54022 Phone 715-425-0165 Fax 715-425-6864 ~ S1(S°` ~~~ ~~~ ~,.~~~ ~^ ~: ~ 'k~i CG~~~S~'GNDEI`s~. a j ;~ °~. ~ t, `dp' ti ~r,~t:H.~-a L"-955r ,~ ~'SF(1~6n~ON7r s „ .,'a F d.'~-~.. 'j Lam,`. ~er_ ~.. " + C l4 ~f- ~3 -~~ JOB N0. O 3 -b ~, Mound System Management Plan Page z of ~ Pursuant to Comm 83.54, Wis. Adm. Code - Septi- c Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank; If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. Alf switches, alarms, and pumps shall be tested to verify proper operation: If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution S tem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and muiched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit far this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manual ~;'s-B19=tg5, -2~p-(R~{gg~ arid local or state rules pertaining to system maintenance and maintenance reporting. ~~9 -Ib(~q•J - r No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers shor rld be inspected far water tightness and soundness. Access openings used for service and assessment shall be seated watertight upon the comp{etion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Continaencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes ~;'efective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component faits to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this s stem should be directed to: The County Zoning Office at ~1S ` 3 ~~~ ~~ Uu S`~--~. °~~~( - . The .system .installer at _ "1`S _ ~~ _ 3 ~'~ SC. i/1fl~YzLaZ The tank manufacturer at ~DL~ - 3,?S - g~sb w L~~. The effluent filter manufacturer at -8'0~ -zz.j _ S~ ti,[Z ~~~ The pump manufacturer at ~3~-~Z.Q_U~~ GUUI~i\C PLOT PLAN Scale I "= 3O ' ~3Z. , r 6 N BOi T-o~ OF _ ___. G ~t'~. ~£ ~ S 1 l~l jV ~ ~ 1ST1 aJ G ~zS To _ ~ ~_ _ lam' ~Z Cc-D ~. . x ~-~v~, ~.. 48 az' t?z. ~,~LZ qg 33 -- ~~ ~ l __~3. ~~o Na ~ ~~g ~~ 1 ~ ~ ~ Q ii o 1sTU tZS3 ~ ~ ~ ~o ,L ; ~! I ~~ J I~ 33 _ ~o s ~ n _ \ Bn1 ~~' 9v-- ~', c, .` ti (~~~ ~~. .yo J p. 1`1~ J ~~ g9 t~ ~ x ~~~ HUMS Page 3 o f ~ s 1 ~ ` i N ~G' -r--Z%,, °l ~ ~' J U /1. ~ Zbl~- bs' o~ 2t aVC r.`~'~ fy" ~~' +vor 1z~ Zoq.Z 9D ~ AVF -. -__ _. ~ 3 Z _..._.~...__.~_____._.._ Ru.w us~~ 63 - _ ~. ao -~ ~v~ NOTES : _~ - - .1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic .tank to be ~Zv~ 1800 gallon_ capacity manufactured by ~,w/~ t~aD Zr~~, Fol.-f't12 4. $ench mark • S~`w-_ I°r~dV~, 5. Divert surface water around system to prevent ponding at the uphill side. Paae ~'~ Or ~ Ppprove~ S;r~.u~:etic Co~%erw*~c . ASTi~ C33 ~ ~Districution Fipe Medium Sand Topsoii ~ " o-~-n '"` J jc -~- ~ ~ . ~ -.J ~ ~ ~ - ~ Ft ev. q ~ -- e Z ~ l ~, . °a Slope Distribution Cell of ^ ~ Force Moin z" to 2 z" Aggregate From Pump CROSS SECTION Or A MOUND SYSTEM Linear Loacing Ra ~e-10 '~C~D/I,iV FT Desicn Loadine Rz ~_= o .3(,G?D/SQ FT f1 i i.Ct I7C~Q~~'~'Qn . ~ < ~. l~ F~. i? ~,~ Ft. . I ~ ~ Ft. ~ S F~. K _~ Ft. L ~ ~ Fi. W 33 F~. ~ -Qbservation Pipe ~-fr--------- --------~-------- ------ -- -~ A a--~---- ~ 8--- --------- ------=------- =-----~ -- ~~ 6 Flowed Layer D ~' S Fi. 0 .~ ~ . F r~. F 0, ~ Ft. C 0-S Ft. H ~-0 Ft. W ~ L_ ~ _----- ------ -----------------------~--o Force Main - - ------------- ~ ~- $ erns -~- Distribution - ~ ~ , „ , „ ~~ Pipe Cell of -~ to 2 z ~ aggregate i8' Observation. Pipe ~~ U~achcr securely) PLAiv VIE?~ Or A MOUND SYSTE:1 Distribution Pipe Layout Page -s of ~ Place the holes at the bottom of the distribution pipes at equal spacing, Remove all burrs from the pipe and holes. Extend the end of each lateral up with the use of long turn or 4~ ° fitting to a point within six inches of the final ~-ade. Terminate the ends of the laterals with a valve,:threaded cap or . threaded plug. Provide access from final grade for the valve, threaded cap or threaded plug. - °r~-t P ~ c~ L CZDS S sa~-~o N pv~ Fv` Laterl- Manifold ~~ C ~ r- Lateral x I x!Z !~ L'PrN V \~ -- a. _ " P a- -- a-- -~--" _p r~c~;}.s box - -o ---0 - - ~a P Z$ •S Ft. - Hole Diameter 1 lB Inch - -- - S `1-~ F-g; ~ w - - Lateral ~ - InchEes } X- 3 ~ Inches Manifold Z- Inches - Force Main " ~ Inches - ~ of holes/pipe ~ ~ - Invert Elevation of.LateraTsq~'.q'ZFt. _ ~ ~ - Combination Sept~c~.Tank and PUMP CHAMBER CRO55 SECTi01J AA1d SPECIFICATIONS ' PAGE ,~ OF 7 ..- . ;- - •VEU7 CAP ~ WEATHER PROOF • _ JUIJCTIOU 80X . ti C.I. VElJ7 PlPC ~ ~lPPROVE.O LOCKIIJG ~ 1~' FROM DOOR, ~1K~ltJHOLE COVEK K,71"(1;'1 ~tUDOW OR FRESH ~ tNAR•>JIUG L~aEE-. u.~8P~1o>J P tpE - w!r?tRllstl•i' ~tp ~, Ft N tSt}© i ~~~ t8'nIU. wLET Approved joint w/ PVC pipe A~ruTAKE t ~ co~twtr .. r~ I 6K,nW. t~ ~~ ~ i I C ~ I • ~__ Y' Hlu. .~ 19• Mlu. a~ C i~.~~ ., ~R~ zfl8~ ~~~ ft-18op Ct_[Y.~~"~~fT ~`~~ ~ • ~• ~~ • PROV10E I AIRTIGHT SEAL I i I III _, A I I , I I III I I I aLUtx o 'i fI I I ou c •I I I P1JMP-~ --~ - ` OFF D C OIJC RETE DLDLK Approved joint w/ PVC pipe ~• RISER EXIT PERMITTED OIJLy IF TAt.JK MAi~LIFACTURCR HAS SUCH APPROVAL 3"ApP>~~D • B~DD t Nii SEPTtG E ~ SPECIFICATIOF.fS , 005E T!.uKS MAalUF1-CTURCR: L`-~1~ZCU~GZS.`~ jJ~gEA OF DOSES: 5 PER OAS TAl`IK :,IZL:W Ll~ ~~AO~$00-c~Y'r1~12,,GALt_O-JS DOSE VOLUME 2 • ALARM MAULFACTURLR: S "T'~~•~-t!~-+.- S~•-(.~ (~1`a~ -r~CLUpIt~~ bACS<fLOw: ~ ~ ~--~ GAttON: MODEL -JUMBER: l0~ ~w CxPACITIES: A= I ~ LIOU-3 ~L~Z~L.1R,C( tUCHES OR CALLOUS SWITCH TyPC: 8 = ~ IucHES'oR ~! y • S G~cLOUs HUMP MAUUFACTURCR: ~ 1ZZ~_3~ O V l.Ip, S C= ~ I ZIIJCtiES OR u0u5 MODEL t`JUMHER: -~~ ~ ~• 0 ~ ~ ~ 1 ~ -Z~~:c~ ztr\lCHES OR GAlLOUS SWiTC;H TYPE: ~~~Z-~~-c( uOTE: PUnP AfJO A~LgR~gRc To Dc~~~O MIAIIMtJM DlSCKARGE RATE Z•y~,Cp.x INSTAlLEO OA1 SEPARATE CIRCUITS VERTICAL DIFFEiCEWCE DETWCEU PUMP C)fF Auo-.DISTRt6uT1o-S PIPf:.. ~' D~FEET + KIUIMUM 1JE-TWORK SUPPLY PRESSURE , ~ ~ • SO -f- ~' S FEET OF FOR 1.3-j Fs ~ ... ' ' O-, FEET l-'-0 kl~ 3> CE MAIN X ~cF~FRtCTtou FALSOp,.,~'8 1 FEET _ TOTAL Oy1JAMIC HERO = }-b-~' -3FEET - As per manufacturer ~-~-~•'-f gal/in. Liquid depth 36'I . ..• _, Goulds ~E ~ °~ _7 Submersible Effluent Pump ~~ 3871 EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS Pump: EP04 • Solids handling capability: 3/4 maximum. ~, . • Capacities: up to 55 GPM. I • Total heads: up to 24 feet. ~` .~ • Discharge size: l'/i NPT. • Mechanical seal: carbon- ,. rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Pump: EP05 • Solids handling capability: 3/a' maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size:l'fz' NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord:l0 foot standard length,16/3 SJTO with three prong grounding plug. Optional 20 foot length,16/3 SJTW with three prong grounding plug (standard on EP05). METERS FEET 10~ 9r 31 0 a w U a z } 0 J H O e- 2; s 2c 5 4 3 2 t 0 1°. 1C 5 00 ~., ~~ ov 4u au GPM ~ ~ ~ ~ ~ ~ 0 2 4 6 8 ~ 10 12 m'/h ®1995 Goulds Pumps, Inc. CAPACITY • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Availabl? for automatic and manual operation. Automatic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermo- plastic Semi-open design with pump out vanes for mechanical seal protection. ^EP05 Impeller: Thermo- plasticenclosed design far improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover. Thermoplas- ticcover with integral handle 'and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING SP• Canadian Standards Association (CSA listed model numbers end in "F" or "AC".) i ~ ~ ::~~.. ~' g i -- i T--=-- { ~ =~- ..~'~sF-r I I i -i- -=- ' ~ I - - - - i ' - ~ i. ;i.~ ~3. - -- --- - -- -- ~ ~ _ ~ i I r., ~ i 2 - ~~ - - -- -- ~ ~ --EP05-._ _ i ~~ __ ~ 1 Effective Mav. 1995 ,. . A T1TIT+ NTITTM MOUND CONSTRTJCTION TECHNIQUES 1. All work is to be done with track type equipment entering from the North end of the mound. 2. Carefully remove the topsoil and sand fill downslope of the existing mound aggregate. Do not disturb the aggregate. 3. After removal of the topsoil and sand fill, carefully plow the site from South to North. * see note below 4. Replace the sand fill and topsoil with uncontaminated material. 5. Seed, mulch and fertilize the mound. 6. Maintain 50 feet from the well to a point dirctly downslope of the existing distribution cell. NOTE: This mound was constructed in 2003, plan approval 4865832, dated i~iay 12, 2003. A wet spot has become evident and the site has been inspected by Leroy Jansky, POWTS G7astewater Specialist. This plan extends the basal area an additional 7 feet providing a Design Loading rate of 0.36 gpd/sq ft. The original loading rate was 0.5. There are no changes to the tank. * note The plowing must be done with a chisel plow mounted on the track type excavator's bucket. ~pf g@r it" •'~ ~ J f , ,~-r F ~, ~~~ c.;CJf~~~~~'Cr~~~~~~E1 isconsin Department of Commerce March 10, 2004 William Schumaker, MP 227990 1070 Scott Road Hudson, WI 54016 ;:rear Mr. Schumaker: Re: `eter Maleevu -Residence SE, SE, 13, 29, 17W Town of Hammond, St. Croix County SAFETY AND BUILDINGS DIVISION Field Operations 13 East Spruce Street Chippewa Falls, Wisconsin 53729 t71 s~ 72s-2544 h t tp://www. co mmerce . sta te. wi. us http/rtv~wv.wlsconsin.gov .rim Doyle, Governor Cory L Nettles, Secretary RECEi~iE..' M,4R 1 2 20~i= ST CRUD>; „~.. ZONING 0=~~~I(';r Site ID Number: 658845 Please find attached a copy of an inspection I conducted on October 31, 2003, for the above referenced property. The inspection report orders you to submit plans and specifications for a replacement system by ~-;April 30, 2004 and to replace the system by June 302004. As of today's date, I do not recall receiving notice that the plans have been approved for the replacement system. Plan submittals are slow at this time and it would be wise to get them submitted now to ensure then-April 30th approval deadline is met. A state sanitary permit can then be issued by the county and we'll be set to install the system when weather conditions improve. Note that prior to the installation of the mound, the system should be dried out so that plowing can proceed without smearing or compacting the soil. If you have any questions regarding this order please feel free to contact me. Sincerely, Leroy G. Jansky, SS Wastewater Specialist (715) 726-2544 Office (715) 726-2549 Fax Ljansky@commerce.state.wi.us Enclosure cc: St. Croix County Zoning Owner ~AN ~z-'-'tE IZb~ ~t~~~^^ ."~-- P~ l lc.~Q ,;,. ~~n,~~5 Ka.w,,r_~ SBD•5524-E (R. 4198) File Ref: C:\WINNTIPROFILES\COMMUSER\DESKTOPIJANSKYIREPORTSU2EPORTS LETTERS\LEfTERHEAD.DOC isconsin Department of Commerce March 10, 2004 William Schumaker, MP 227990 1070 Scott Road Hudson, WI 54016 Dear Mr. Schumaker: Re: Peter Maieevu -Residence SE, SE, 13, 29, 17W Town of Hammond, St. Croix County SAFETY AND BUILDINGS DIVISION Field Operations 13 East Spruce Street Chippewa Falls, Wisconsin 53729 (715) 726-2544 http://www. commerce. state. wi. us http9Mnvw.wisconsin.gov Jim Doyle, Governor Cory L Nettles, Secretary RECEIVEI: MAR ~ 2 2004 ST. CI~UIX CV,. ZONING 0!FfICE Site 1D dumber: b58845 Please find attached a copy of an inspection I conducted on October 31, 2003, for the above referenced property. The inspection report orders you to submit plans and specifications for a replacement system by April 30, 2004 and to replace the system by June 30' 2004. As of today's date, I do not recall receiving notice that the plans have been approved for the replacement system. Plan submittals are slow at this time and it would be wise to get them submitted now to ensure the April 30th approval deadline is met. A state sanitary permit can then be issued by the county and we'll be set to install the system when weather conditions improve. Note that prior to the installation of the mound, the system should be dried out so that plowing can proceed without smearing or compacting the soil. If you have any questions regarding this order please feel free to contact me. Sincerely, Leroy G. Jansky, SS Wastewater Specialist (715) 726-2544 Office (715) 726-2549 Fax Ljansky@commerce.state.wi.us Enclosure cc: St. Croix County Zoning Owner ~flfN ~z ~ E 12Ea~1 ~ I ~~/ ~^" . ~- ~ ~. l lt,oQ w,, `-~~iuS Kawu~ 1 SBD-5524-E (R. 4/98) File Ref. C:\WINNT\PROFILES\COMMUSERIDESKTOPWANSKYIREPORTS\REPORTS LETTERS\LETTERHEAD.DOC RECEIVED isconsin Department of Commerce INSPECTIO DEC 1 8 2003 R~~~j;~j?C COUNTY" -IlV~I1CV~~5 OFFICE Y AND BUILDINGS DIVISION Integrated Services Bureau 13 East Spruce Street Chippewa Falls, WI 54729 www.commerce.state.wi.us/sb (715) 726-2544 Date of Inspection: October 31, 2003 Project Name: Maleevu Use: Legal Description: SE; SE, 13, 29, 17W Site Number: 658845 Lot Number: Municipality: Town of Hammond County: St. Croix Plan Transaction Number: 865832 Sanitary Permit Number: 430048 Wastewater Flow:. 600 gpd max. Persons Present: ~r~tl~tui, ~. _ Plumber Name and Address: William Schumaker, MP 227990 1070 Scott Rd Hudson WI 54016 Certified Soil Tester Name and Address: Adam Schumaker, CST 253309 2113 80th St Somerset WI 54025 Owner Name and Address: Peter and Gail Maleevu 2092 90th Ave Baldwin WI 54002 (651) 238-7070 I his investigation was requested by the county to assist in determining the cause of seepage along the toe of a newly installed mound system at this existing. home. The owners (Peter and Gail Maleevu) are the sole occupants of the residence that is sized for up to eight persons. Mr. Maleevu indicated that there is no water conditioning equipment or footing drains in the home. This level of occupancy is expected to generate a wastewater discharge of 100 to 150 gpd, far below the rated capacity of the system (i.e. 600 gpd). The mound. appears to be installed in the area evaluated by the certified soil tester. The sand fill used to construct the mound appeared to meet standards for mound sand (ASTM C-33). However, a sieve analysis would need to be completed to determine if the fill quality technically meets code standards. This type of test seems unnecessary, since the wastewater effluent is moving through the fill and leaking out at the toe and not ponding within the aggregate distribution cell of the mound. Two hand constructed soil borings did not reveal a soil limitation such as seasonal groundwater or bedrock that would adversely affect the proper operation of this mound system. One of the borings was constructed through the mound's down slope (west) toe, through -the mound fill, and then deeper through the topsoil horizon and into 'the subsoil. Upon reaching the interface between the sand fill and topsoil, it was noted that the sand had a grayish appearance. In addition, effluent began seeping out into the, boring along the sand/topsoil intertace. It has been my experience that long term, hydraulic failure along the toe of an above grade dispersal cell is either due to hydraulic overloading, poor soil conditions, inadequate surface preparation (f.e. plowing), or soil compaction during mound construction. Based on my observations, it does not seem possible that the system is receiving excessive flow from the two occupants or that soil conditions are unsuitable for the system. Therefore, I believe that the failure is due to inadequate site preparation prior to sand fill placement or compaction of the plowed topsoil during placement of the sand fill or aggregate. Soil compaction is possible since the design specified the minimum depth of sand fill over the plowed surface. Therefore, I believe that system failure is due to incorrect or faulty construction that was the responsibility of the licensed plumber in charge of the installation to control. Inadequate attention to mound construction standards is a violation of the mound system installation standards incorporated under s. Comm 83.61, Wis. Adm. Code and/or Comm 84.10(3), Wis. Adm. Code. Corrective action in this situation would consist of allowing the system/site to dry out, careful removal of the mound from the site, and reinstallation in the same or a nearby location. State level plan review and a new sanitary permit are required for this repair. Page 2 of 2 Malleevu Site October 31, 2003 The installing plumber, William Schumaker, MP 227990, is hereby ordered to submit plans and specifications for this repair to the department for review by no later than April 30, 2004, and to replace the mound portion of the system by June 30, 2004, weather permitting. All corrections, including the cost of approvals and permits, are to be at the expense of the installing plumber pursuant to s. 145.10(1)(b), Wis. Stats. This order is issued under the authority of s. 145.02(2)(f), Wis. Stats. Failure to comply with this order may lead to prosecution in circuit court pursuant to s. 145.02(2)(f), Wis. Stats. Penalties for noncompliance with an order of the department may be found in s. 145.12(4), Wis. Stats., and include forteitures of $10 to $1,000 for each violation. Each violation of a rule or standard constitutes a separate offense and each day of continued violation is a separate offense. The installing plumber shall notify me when the project is completed for purposes of reinspection. If you have any questions regarding this order, or your rights of appeal, please contact me immediately. 12/16/2003 roy G. nsky, stewater pecialist Ljansky~commerce.state.wi. E-mail 715826-2544 Voice 715/726-2549 Fax cc: ©County ~ Plumber ^ CST ©Owner ^ Other .p Wisconsin Department of Commerce ~ `~ Z ~" PRIVATE SEWAGE SYSTEM Safety~,na ~uildi4g 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: City Village X Township Van Someren, Wavne~ Hammond Township TANK INFORMATION BM Elev: BM Description: 6a~~t. ~~ ELEV ION DATA TYPE MANUFACTURER CAPACITY Septic ~..s Ir~s~ La-a 1 ~!0 Dosing 1 _ t~ • lw~, Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROA~ Septic ~ 20 t y ~~ ! H.' ~ r ~ Dosing tt 1.~ -~ " Z.9 ` Aeration Holding PUMP/SIPHON INFORMATION Manufacturer pemand ~ GPM b Model Number ^ p /~Q ~ ~l DH Lift ~e'~ Friction L so s-y c9 •`~ 1 System Head G~ `SO TDH ~Ft •~f0 orcemain Len1t~ ! Dia. Z /t Dist. to well ~ r ~ } SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 430048 0 ate Plan ID No: g3 Z =Ttra..s . I s,`~ Parcel Tax No: 018-1028-90-000 Section/Town/Range/Map No: 13.29.17.208E STATION BS HI FS ELEV. Benchmark /~Q 3.~ ~3 . • o Alt. BM ~-_i Bldg. Sewer L•~ f b-9a St/Ht Inlet q / St/Ht Outlet Dt Inlet Dt Bottom b q} 3 / Header/Man. .~ •~ ~.'pl Dist. Pipe -51'x' 3•~ 01D. OI Bot. System t Z. 4'• • J~ Final Grade w~t.~ ~~ ~ St Cove ~ t~ ~ ~ ! ~~,~ 1M~ ~ ~~ (ob to}~io !b •t~ BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Insid Dia. Liquid Depth DIMENSIONS ! b ' ~~ ~ ( _e a_ _ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHI nufacturer. INFORMATION CHAMB Type Of System: r t ,~ IT umber: DISTRIBUTION $i(STEM (L~ ,I„ ~~,,~~~P/L) Header/Manifol ~ 1 Length .~ Dia ~ Distribution pipe(s) ~ Length ~~• is ~ ' ~ Spacing '~ •a x Hole Size !/ N / $ x Hole Spacing ~ • fl Vent to Air Intake iy SOIL COVER x Pressure Systems Only 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 - Yes ~^.ai No , , , - - i' ~ Yes I P I No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1~,,~~~F~"~Y 3 Ins ection #2: Location: 2092 90th Ave Baldwin, W[ 54 02 E 1/4 SE 1/4 13 T29N R17W) NA Lot r ~J,~ ~ "~'arcel No: 13.29.17.208E 1.) Alt BM Description = t~.iR<<J ~• ~~~~~~ ~~ ~~- ~ t'S(?,~... b_`/^'"r'~bk-•,'{r'~C~~h ~ ~Wf~c bA.~f,~t•~w~.~~1~, 2.) Bldg sewer length = ~, ~ .. Y 1 a~w~ ~ ~ ~,..~ ~'~f'l ~ "'~ !~~ ~u~bwr~~~~ S,.T - amount of cover =,Z 3 C~ ,~ j 4 ~.~$"a'~ H~ ~. f03.~0 J /4•- IUD ~F• ~~~~~ ~- - -- --,- ----~ ~_ -- _ -- -- _... - _ __.. - --- - -- - --- T- - n vi~equired . Yes ~.No ~~-~ `~~ ' • _ _~ CII~ _'I Use other side for additional information. -----L_ -.- ~-= 7 ~--- _ _ _ ---J~_---- __I __ ~~J _ ~ - ~', SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. ~ Safety and Buildings Division County ~~~ ~ ~ 201 W. Washington Ave., P.O. Box 7162 ~ ~s~ons~n Madison, Wl 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce {608) 266-3151 3p~p O Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Codc, personal information you provid i5~o~ 32 '~ TraMS • I ~ ~ may be used for secondary purposes Privacy Law, s15.04(1)(m) roject Address (if different than tnai ing address) I. Application Information -Please Print All Information ~Cv»~,~ Property Owner's Na me Parcel q Lot ~ Block !s , / ' l Pro Owner's M ailin Address Property Location l Stxtion ~ 'k ~ '~ City, State Zip Cade Phone Number , ° ` ~~~'~,,~ i ) ' (circl ) r e B R~ T ~ N , - II. Type of Building (check all that apply) " ~ CSM N b ^ 1 or 2 Family Dwelling •- Number of Bedr ms ~' um er Subdivision Name ^ PublicJCommercial -Describe Use o~ 9$ •92. "~ - °'~ r 1 Q ~ ' ^ t ^ State Owned -Describe Use ID jC X00 ~lt,~md~ c,¢:Q~ Village ownship of ~,cno p tt~f/c ^City_ III. Type of Permits (Check only one box on line A. Complete line H if applicable} - OZ - O ' tT~ , o$ A' ^ New System Replacement System ^ TreatmentlHolding Tank Replacement Only Other Modificatioti to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. of POWTS S stem: (Check all that a 1) ~ ^ Non -Pressurized In-Ground jviound ? 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In•Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recircula ' Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. D` rsallTreatment Area Information: Assign Flow (gpd) Design Soll Application Rate(gpdsf) ' Dispersal Area Required (sf1 Dispersal Area Proposed (sf) System Elevation ~~ ` li ~0 ~ 5 l"~~ co cl f9; , VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ~,20D ( ~ ~ ~, Aerobic Treatment Unit Dosing Chamber ~ ~Q® P ~ :' ~~~~, !~ VIL'Responsibility Statement- I, th8 u~tdersigned, assume responsibility for allation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature M /MPRS Number Business Phone Nurr~ber Plumber's Addre ss (Street, City, State, Zip Code) VITI. Cotmt /De artment Use Oni Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Surcharge Fee) ~ ~~~ to Issued (O~9/D 3 I su' Agent Signs a (No Stampsj ` ^ Owner Given Reason for Denial ~ IX. Conditions of ApprovaUReasons for Disapproval -)E ~-~~ ~ ~ ~-}e~~ ~ ..~~ ^ Lee -d-~c.erY~rt~ -_ =~ - ~ ~ ,M ~2iW4K~4[ ~ ~pvC~1~-. U Attach complete plans (to the County oats) for the system oa paper not less roan 8112 x 11 tncees to size SBD-6398 {R. O 1 /03) C it ~ ~ N ; ~,~ c 1 f } ,; PLOT PLP1~I Scale 1 "= 3U ' ~ 3 Z. T 6 N CITE-~5`u uR ~ . ~ 8 ~ Z,' .~ B o't`ru~ O>` ~-~ ~ ~,~IZ q8 j --~5.~ I ~O NO I C.U}1p /}~- I O ~ D l9'rU tZ13 ~4-~s A tz,~ I i I ~6' G~yq~~ S t l»_ tv G _ t'~-S . P ~2 CvD x 6 ~ J - ~ ~i~ ~ B~ ~~' 9v . ~ s' ~ ~~ . j'~~ ~ • `' ,V `jai' "`, '~ we~..~ / ~ o~ \ 5 x ., o X11 Page ~ of ~ _~b' ~~ t ~ II I- (ol I ~ N ~ I I ~6 Z~Lo~o II ~ I ~-III ~ ' IIl i i ~ I ~ ~ ~J - ~ Z ~ ~, i ~ I qg°j - .b5 0 2~ - vC t=.`~'s ~y„ ~I g~ ~ ~ ~ ~ ,'bTA-rvk HvME ~ ~ f - o ~~ 'flU SZ. g _ ---- -- rJor 1z~ 2.oq.Z gD ~ AVE_• s~~ \3Z~ <17S `~~ ~ or us~~~ b3<< _ _ ~p ~_ ~~ NOTES: ~ _ ~- .1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be ~Zvo 1800 gallon` capacity manufactured by 1~J 1~~'~ CoYy G~'1E (~u ~.> >2~ /~ 00 Y1 ~ ) ,~~R l E3 4D ~ ~3 ~C. F=? L,7..`~ 4. $ench mark • 5~~-- (R$pV~ _ 5. Divert surface water around system to prevent pondin.g at the uphill side. Y isconsin Department of Commerce May 12, 2003 CUST ID No.220254 1 G~~~~O ~~G O ti~Q~ ~ ~~ ~~ . ~N~NG ti Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary ATTN.• POWTS Inspector ARTHUR L WEGERER WEGERER SOIL TESTING & DESIGN SERVICE PO BOX 74 RIVER FALLS WI 54022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/12/2005 SITE: Wayne Van Someren Residence 2092 90th Avenue Town of Hammond St Croix County SE1/4, SE1/4, S13, T29N, R17W FOR: Description: Four Bedroom Replacement Mound System Object Type: POWT System Regulated Object ID No.: 902575 Identification. Numbers Transaction ID No. 865832 Site ID No. 658845 Please refer to both identification numbers, '' above, in all correspondence. with the agency..... 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. The following conditions shall be met during construction or installation and prior to occupancy or use: Conditions of Approval: • This system is to be constructed and located in accordance with the enclosed approved plans. • 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. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the niter t'or cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • 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 may include local inspectors. Note: The proposed combination septic/pump tank is a 1200/&00-gallon tank manufactured by Wieser Concrete Products. ~.',... ~..c'.~. Ccal~e~i`~~~t~~~~ ~.~~ ~;~ ~ ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 ARTHUR L WEGERER Owner Responsibilities: Page 2 5!12!03 • Comm 83.52(1)(a) -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. In the event this soil absorption system or any of its component parts malfunctions so a~ to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 maybe made to me at the telephone number listed below, or at the address on this letterhead. The 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. Sincerely, ~~~~ Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim@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 TITLE SHEET FOUND SYSTEi~i FOR A ~ BEDROOM P.ESIDENCE Page t of ~ This plan has been prepared in accordance with the Mound Component I4anual SBD-10691-P and the Pressure Distribution Manual SBD-10706-P (N.O1/O1) (N.Ol/O1) LOCATED IN THE SE 1 /4 OF THE S E I /4 OF SECTION 13 , T Z °I N R 1~7 W TOWi1 OF }~h-1W~U~'J~ ~ S ' ' `7-- ~-.SZU1X COUNTY, WISCONSIN. r~~i~.~Z >1>Iu~, c~r8 -1O2.F3 = ~0:=_1506 INDEX PAGE 1 of 7 PAGE 2 Of 7 PAGE 3 of 7 PP.GE 4 o r 7 PAGE 5 of 7 PAGE 6 of 7 PAGE 7 of 7 ~~cEiVEo MAY - ~ 2003 SAFETY& BLDGS DIV. PREPARED BY i~IEGE~EF2 SO S L .TEST = NG AND . DES ~ Gf~1 SERiJ = CE P.0. Box 74 42i iv.~Iain St. River Falls, G7I 54022 Phone 715-425-0165 Fax 715-425-6864 plV1S!(3N OF SaF:E7Y t~ND,BUI~LC~IN~S :- SEE GORRESPO ENCE TITLE SHEET SYSTE11 I-IA~~AGEi~1ENT PLAN PLOT PLAN PLAN VIEIV-CROSS SECTION DISTRIBUTION PIPE LAYOUT PUr•IPIi1G CHAFiBER CROSS SECTION PUI~IP I'ERFORI•IANCE CURVE PREPARED FOR •z ~ s o 1 1 ~Z ~ ~U~~., s ~ ,~ ti~3 ~~7v~'-~ ~~ x'$63) ~~~~c ~~s~ ~+: F, •~~~,...,.....~. .~g w~ aN7"~~!;~ i ~ N~EGcREN 'J-47S ~ /~ f119WOA7N, a ~~ ~S1G~~ ,~s~ S -S-b3 JOB N0. f~ 3 -6 Mound System Management Plan page Z of Pursuant to Comm 83.54, Wis. Adm. Code - Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if . the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank; If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owrier of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safebf and Buildings Division. Pump Tank The pump {dosing) tank shalt be inspected at least once every 3 years. All switches, alarms, and pumps.shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution S stem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent eres~;, and to provide score protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L GODS, 150 mg/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing paint at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requirng additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manual arid local or state rules pertaining to system maintenance and maintenance reporting. ~~~ -ib~~l - ~ No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected far water tightness and soundness. Access openings used far service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Continaencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump,. pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this s stem should be directed to: The County Zoning Office at X15. 3 ~~~ ~.~,~ Uu S`r'. e-~~ The system installer at 1.~5 - ~~ - 3 t~ S `Li.t~ ~?,i~A~hr (aZ The tank manufacturer at ~'D~~-- 3.ZS - gl~s~j GV ~~~'Z. The effluent filter manufacturer at ~ ~~-~ - S-2 ~Z Z~~ The pump manufacturer at _ ~30-870 _ l( gl~~ GUUL - PLOT PLP.N ' Scale 1 "= 30 ' ~3~' J T 6 N i..~ -=ESL.. X00- 0-~-s~ N BU`CT-0 ~ OF : _ __ GHR.Wt-~~ St-pl~G / ~~ \S3l hJ G ~vrrS : ~:'T4 B o`Ct-u~..~ ~~ c-~-L @Z ~R, ~L Z q 8 j"-~Sr I ~o No i C~}'\.F ~ I O tZ. D l9'('U 2~3 -r~-~s H tZ~q I i ~ ~6~ .I ~.~ I / ~~ B~? ~ ~ ~ ~~ 9~ , ~ s' S _ ~,~~~'~ ~ W~1.L ~ ~ <'~' ~a \~ ~ ~o .LO J~. ~ `~~~~ Tit-fvk Page 3 of ~ ~b' ~~ ~ ~ II !- o ~. (II ' !N III ~~' Z%Z,°~o I -! ~ I ~ ~ ~~ I,~ ~ f I ,a~ ~~ ,, I r Z b ~ ~' \ ~ I qgA - .~S or ly" h~17D 2~~ ~ ____--- ~. r.~or ~ ZoaZ. 9D ~ __AvF_ s~~ ~~~ Lf ~ S I ~ j~ ~ Ur NOTES : `" - .1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install. 4" observation pipes with approved caps. ( Z .required). 3. Septic tank to be ~'ZVp f 80o gallon-capacity manufactured by 1ti1 lF CAyilC_ti`t~~ (1u~~ 1Ztx~ /~n0- h R~ ,y.~~f? -- (~ OD ~~ ~Z, ~t ~TL~'IZ 4. $ench mark • S~~ ~t~DV~ 5. Divert surface water around system to prevent pondin,g at the uphill side. Page ~1.ot P_ppro~ e^ Syr..thetic CoL Brine AST: C33 ' Medium Sand Topsoil -=! ~ k. ~ ` 3 +C _ istributian Fipe D G .Elev. ~I,a, 1 e Z ~ 1 ~, . °; Slope Distribution Cell of ~ Force Main Flawed 2" to 2 2" -Aggre;ate From Pump Layer . D ~~ ~ Fi. D .1 ~. E Srt. CROSS SECTIOti OF L MOUYD SYSTEM F p,~, Ft. G G-S Ft. Linear Loading Rat:.- q•0 CpD/LN FT Design Loading Rata='~.SG?D/SQ FT ~F~rc.=--~fl-~ .. L , a--~--------------- ------ A ~-~bB--- --------- o--~ _ A. ~ Ft. ~ }. ~ -0 Ft. E ~b Ft. I ~ ~ Ft. J S Ft. - ' K _~ Ft. L ~ ~ Ft. s~ ~ (~ Ft. -observation Pipe ~~ w L-! -- _ ----__ -------- _ - ----' Distribution ~ - ' Pipe Cell of z" to 2 2" ~ aggregate • Observotian. Pipe ' - PLArt VIED OF A MOUYD SYSTE.4 .. K .Force Main ~~ I ~~ ;~ Distribution Pipe Layout Page -S of ~ Place the holes at the bottom of the distribution pipes at equal spacing. Remove all burrs from the pipe and holes. Extend the end of each lateral up with the use of long turn or 4f° fitting to a point within six inches of the final grade. Terminate the ends of the IateraIs with a vaIve,~ threaded cap or threaded plug. Provide access from :final grade for the valve, threaded cap or threaded plug. NVC Laterf -1 ~. Manifold Pv C ~--- Lateral !~- L'FrN V ~ ~ _- a. _ ~ ~ P a- -- ~r~cc~c sod - -o Pvc ~oQ~, >1~ ---0 o-- ~~~~ - ~a P 3- ~•,S Ft. ~ Hole Diameter 1 ~B Inch " -- S ,3 Ft, Lateral 1 ~ Inches) X 3~, Inches Manifold Z- Inches -" Force Main " ~ Indies ~ of holes/pipe Z I - .. Invert Elevation of.Laterals R;q'ZFt. llxo.`~1 =y.S1xb - Z.~.~b 6~ e - Combination Septs.c~.Tank and Pl.1MP CHAMBER CRO55 SECTIOtd ARID SPECIFICATIONS' PAGE ,~ .- . VE1J7 CAP ~ . .WEATHER PFt00F tr-r~ : - ~-- JUIJCTI01,1 l~OX . u.~ sP ~no>J ~ !p w~Pn~.n6ar-~ Ft fv tSN~n Approved joint w/ PVC pipe ti C.Z. VEAJT PIPC ~ 10 ~ FROM ODOR, %i~Al00W OR FRESH A.rK ruT~lKE --~ ~- RISER EXIT PERMUTED OrJLy IF TA1JK MAUUFACTURER HAS SEPTIC F DOSE TA1JK ALARFI PUMP ~~ C~RRESFpNDEN~E S P E C I F I C AT1 OFJ S .lPPROVED LOCKIIJG MA)JHOLE COVER wl°M wAR.N1UG LAr6EL., OF 7 SUCH APPROVAL 3~'A?PREF.. BED7:N4 MA-1UFACTIJkCR:__ 1~-~`Z-ClJ~1C~`~' -~~gEA OF DOSES: ~'~ PER DAB TA1JK SIZE :w~`P lUOU /65~ --'12GALL0-JS DISC VOLUME r ' MAUUFACTURCR: S "$ '~~TCZA S~{_`S`{~.5` lf~iCLU0113G 6AtKfLPW: ~ 1 ~-~--3 GALtON$ MODEL 1.-UMSER: ~Ol }-}I.ti.) CAPACITIES: A. ~ ~ ~10D-3 UJCHES OR GALLOUg Y''1L~Z~Q.-Y swITCH TyPC: g. Z uc-+ES'oR ~I~.S G~LLOf`i$ GouLoS MAIJUFAGTURCR: 12 ~ C = ~^ 1L'CNES OR \Z~'~ MODEL WUMBER: _ ~~ ~ ~ LLOU3 1 0=~~ZtAIrrHES OR SWITCH TYPE: - ~L~Z~~ GALLOlJS IJOTE: PUMP AUO ALARM ARE TO 6C + MIAlIMUM DISCKAR6E RATE Z~,~6 GFM INSTALLED OAJ SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWCEU PUMP OFF AUO..DrSTR18UT10-J pIPE.. ~'-~i FEET i- MILIIMUM -~-ETWORK SUPPLY PRE55URtr ~ ~ " S~ FEET '{- ~' S FEET OF FORCE MAItJ X ~~b2Fj ~ ~ ~ ~ ~ 1. b ioo FzFRiCTlO-J FACTOR.. S FEET TOTAL Oy1JAMIG HEAD =_ 6 "s9 FEET ,-,. As per ;Zanufacturer ZZ -~-~ gal/in. Liquid depth 3b'I ., ~~~ • r. _~~ APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS Pump: EP04 • Solids handling capability: 3/4 maximum. -~:, , • Capacities: up to 55 GPM. j • Total heads: up to 24 feet. r' • Dischargesize:lt/i NPT. • Mechanical seal: carbon- - rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel • Capabie of running dry without damage to components. Pump: EP05 • Solids handling capability: 3/<' maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size:ltr~` NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. "Rater: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: l0 foot standard length,16/3 SJTO with three prong grounding plug. Optional 20 foot length,l6/3 SJTW with three prong grounding plug (standard on EP05). METERS FEET 10~ y r s~ 0 a w x U a z 0 J ta- 0 s 2! s 2I 5 4 3 2 t 0 t; 1( 00 .,, ~„ ~~ 4u 5u GPM 0 2 4 6 .8 ~ t 0 12 m~lh O 1995 Goulds Pumps, Inc. CAPACITY Goulds ~E ~_°~ ~ Submersible Effluent Pump ~~ 3871 EP05 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for 2!ftor!ta#ir, a!!d manual operation. Automatic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermo- plastic Semi-open design with pump out vanes for mechanical seal protection. ^EP05 Impeller: Thermo- plasticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplas- tic cover wfth integral handle 'and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING SP• Canadian Standards Association (CSA listed model numbers end in "P' or "AC".) ~---- --- - ----- ~ I ` = ~ ~`i~ i i - - _-_ -_- ; , --;- r --- __ 1 ~ iR~' Ff.~•i ~___ ~ '. r l ~ I I ----~-- I - -- ` ~ - _- L ~ ~ ~• ~ ~6 s9 _ . - ___ --- - -- -- . ! ~ .. , Iz~_o _ 6 ! -- ---_.-i ~ r, --EPOS;-- ' .-i~ i I ~- Effective Mav, t 995 ' Wscc~+sip Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page j of In acc~raance Nom wrrun ate, vns. rwnr. wuc t;ounty S / ~ p Q~li - Plan must si i 1/2 11 i h 7 es n ze. nc x Attach complete site plan on paper not less than 8 but not limited to: vertical and horizontal reference point (BM); direction and lnclude Parcel I.D. , scale or dimensions. north arrow, and location and dstance to nearest road. percent slope , Please pr/nt all Information. Reviewed by t/o ~ ° / Personal information you Provide may be used for secorxfary purposes (Privacy l.aw, a. 15.04 (1) (m)). ( ~ ~ 3 Property Ov+mer ~~ ~ ~~~~a Logtion Go .Lot _ 1/45E 1/4 S / T Z~ N R 1 ~ (o~ Gv a ~ a r~ r f~ Property Owner's Mailing Address r i 1, l 2 6 Lo # Biodc # Subd. Name a CSM# _ q~~ ,~v 2GG2 City State Zip Code Phon~~(x ,. , ^ _,_ C J City _ [~ Village, (~ Town Nearest Road ` ~ ~ i ~ ~ tjGtsZ C'`''r,~~ v~:FiCF ~nw O~ ® New Construction Use: ® Residential / Number of bedroon>s ~ -Y .. Code derived design itow rate Gi'•~G ~~i O GPD ^ Replacement ^ Public or commercial -Describe: /LI ~ ff • Parent material <~c +-~ t ~ aSln Flood Plain elevation if applipble General comments S ~eYV~ ~.e,,y, Gg ~ y and recommendations: •~' // I r I Rnrinn # ^ Boring .,, i_ r,n 7 tl ~~ v [J~ pit Ground surface elev. ,~ 1S ~ O(J iti uepth to Imuung rector -~~ rrr• Soil Application Rate th D ant Color i D Redox Desripton Texture Structure Consistence Boundary Roots GPDJft= Horizon ep in. om n Munsetl Qu. Si ConL Color Gr. Sz. Sti. ff # 1 'E 'Eff#2 C ' ~ `~- ys ~0 r l . s ~ m ~ GS .. ti,` 1 --- , ~ ~ Z Boring Z Boring # Ground surface elev. 9Sl 8y tt. Uepih to Limiting factor ~T' in. ^ Pit Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure '. Consi ence Boundary Roots GPD/ft2 in. Munseil Qu. Sz. Cont. Color ~ Gr. Sz. Sh. 'Eff#1 'Etf#2 • Effluent #1 = BODs > 30 < 22o mg/l. and I s5 >3u ~ eau mgrs cnwc~u rrc - v.+.+y_ ,,....,y... o..., ..... ~ _- ...~- CST Name (Please Prinq /~tgnature j ~' ~ CST Number ~, cress ~ J Oate Evaluation Conducted ~ Telephone Number ,9 r ~. ~~ -~- ~ ~~ ~- _ Syr -~~ Property Owner 1/G ~. Y~Y ~ r ParcellD # ~~, 7 ,.~ ? Boring # ^ Boring - - ^ Pit Ground sur~ace,elev. , J~ ft. , . Depth to limiting factor~~-~ in. : ~ Soil Application I Horizon Depth Dominant Color Redox Description Texture - Struchrre Consistence Boundary Roots GPD/ftz In. Mansell Ckr. SL Cont. Color ~ ~-~~; Gr. Sz. Sh. .. 'Eff/it - •Eff Boring # ^ Boring ^ Pit Ground surface elev. R Depth to limiting factor in. Sal Appligtion f Horizon Depth . Dominant Color Redox Description ,,. , . .Texture _ _ Structure Consistence Boundary Roots GPDiftz in. Mansell lZtr. SL Cont. Color Gr. Sz. Sh. 'Eff#1 'Effi ^ Boring # ^ Boring - ^ Pit ' Ground surface elev. R Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots con Hppuquon K. GPD/ft= in. Munsep 12u. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#; - 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BODS < 30 mgll.~ and TSS < 30 mg/L . _ r, 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-il)0 (R07/00) PAGE ~ OF 3 rTA~~r s fG~ v~, ~ -'-~r' ~ ~ LOT# T GAL DESCRIPTION S~ ~ ~` ~ ,~. ~ 3 T `~ ,N,R ~ ~- E(or ~ _ __ -- ~ - . _- . ~SCALE:I"= G ~ BM 1 ELEVATION Joo - O i / BM 1 DESCRIPTION CSo-{~{aw~ ~ S,oe ~' o n (9-a~p a` i BM 2 ELEVATION I ' BM 2 DESCRIPTION `-- ----~-~G -~ -~~~- -- ,---__-__ ___..._ ___ SYSTEM ELEVATION ~ R~ (U '~ ~ SYSTEM TYPE ~ ~,~ r~ c.Q ,_ -{- CONTOiIR ELEVATION ~~ -(.Q CG i ' ' 1 __ _. ~- - 1---- - - - - O ~~e b ._. ~ ~P~ . ,~' +~ SIGNATURE ~ ~ ~r ~ ~ G~ M ,Z ~I i' ~' ~LL7 _., _. V' r ,~ . ~ ~ ~~ ~~ lY DATE ~' ' Z ~- oL - ~~~ ~ FROM Schumaker Plumbinq FAX N0. 7153863121 May. 27 2803 11:01AM P2 ST CROIX COUNTY SEPTIC TANIC MAINTI;NANCL AGREEMENT AIV17 OWNERSHIP CERTIFICATION FORM Owner/Bayer ~~tyvE ___I/An/ ~So~EZ~./ Mailing Address 23So/ //Z~` ~~~ ~ ^//03 /~(CNT,~ G~/1 4803/ Property Address 2o9L 90fl, we ,c3~Dcc/i.,~- ~ w, Sjwo Z - _ (Verification required from Planning Department for new construction) City/State ~3.gGO~i~ , w~ I'az~cel Identification Number olg' ~oz~'-So _ ar3p (. 2~$'~~ ~~ )(~EGA1, D~SCI2.X~'TION Property Location S',~ '/<, ~'/a, See. ~, T~I~-R~'W, Town of ~~~ma.ciG~ Subdivisiozt Lot # Cearlr~ed Survey Map # _ ________ __ ,Volume ,Page # Waxr~nty Deed # /a 5~.~ l'~'~ _ ,__ ,Volume /~ 9.3" _, Page # ,MS'S Spec house ©yes(~ no Lot lines identifiable ~J yes ~ np SYSTEM MAINTENANCE Improper use and maiutenanee of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of ptunping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certitication form, signed by the owner and by a ntastczplumber, journeymanplumbcr, restrictedplumber or a licea~edpumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is less Chart 1/3 full of sludge. T/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the 17epartsnent of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix Couuty Zoning Office within 30 days o the three year expiration date. ~! ~ /Z /O3 SIGN E OF APPLICANT 1JATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded ut Register of Deeds Office. S/z7/a~ ~~ SIGN r OF APPLICANT DATF ****** Any information that is rt~is-represented may result in the sanitary permit being revoked by the Zoning Depar~ent. *****• *'" Tncludc wvith thi9 ApplitAtion: a atampcd warranty decd front the Re&iater of Deeds office a copy of the certified survey map if reference is made in the warranty deed . , , ," , 'von 1695PAGE 55 STATE nAR OF WISCONSIN FORM 3 - 1999 Document Number JI QUIT CLAIM DEED This Deed, made between Cynthia R Van Someren, a single Grantor, and Wayne H, Van Someren, a single person Grantee. Grantor gtrit claims to Grantee the following described real estate in St. Croiz County, State of Wisconsin (if more space is needed, please attach addendum): West Four (4) rods of East Thirty (30) rods of South Twenty (20) rods of Southeast Quarter of Southeast Quarter (SE 1/4 of SE I/4) of Section Thirteen (I3), Township Twenty-note (29) North, Range Seventeen (17) West. West Four (4) rods of East Twenty six (2E ; rods of Scuth Twenty (20) rws of Southeast Quarter of Southeast Qtuuter (SE 1/4 of SE 1/4) of Section Thirteen (13), Township Twenty-nine (29) Nortt>, Range Seventeen (17) West. This deed is given ptusua to a judgment of divorce. ~ • a a.cr~ Together with all appurtenant rights, titllIe and interests. Dated this ~~ day of _.Jv ~ y _ 2001 AUTHENTICATION authenticated this day of , TITLE: MEMBER STATE BAR OF W15CONSIN (If not, authorized by § 706.06, Wis. Stats.) a ,,.: THIS INSTRUMENT WAS DRAFTED BY ~ rf ~ Thomas A. McCormack ; d ~ ~ (Signatures may be authenticated or acknowledged. Both are not * Names of persons signing in any capacity must be typed or prinie~ t~.531 S4 ICATHLEEN H. WRLSH kEDISTEk DF DEEDS ~f. CfiDIX CO., WI RECEIVED FOR RECORD 06-07-2001 11:00 AM QUIT CLAIM DEED CER~TCOgpY FEE: 8M COPY fEE: TkAMSFER fEE: RECORDING FEE: 10.00 PAGES: 1 Rewrding Area Name and ^.etum 1Q2~ i(ii61 ~v~~tuQ Bai~~r4r1, Y~~ 54EtEi2 018-t028-90 - l7tJGrJ ~* 2 ~O E) __ __ Pan;ei Identification Ntanber (PIN) Thi; is not homestead property. liq (is not) nthia R Van Someren ___ ACKNOWLEDGMENT STATF.OF WISCONSIN _) St_Cro1x ^ _ ___ County ) Personally came before me this 2S7F+ day of J/) ti __ , 2001 the above named C~nthle R Van Someren __ satnc. ~ Ndtarj!Pyblic, State of R'lsconsln • ~ C¢rgmission is permanent.,{late expiration date: !, ~ WOWY puppe-State• uareh 17. ~ .) STATE ]1A~ 1fF W ISCONSIN QUIT CLAIM DEED FORM No. 3 - 1999 Inlormation Profexsbnak Company, Fontl tlu Lx. V'A aoassszozt