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HomeMy WebLinkAbout018-1083-06-000 > ~ ro > ~ ~ ~' . ~ # I ro ~ ~ ~ ~ o . , I ~ g ,~ -; gi n I ~ ~ ~ d I ~ ~ o n~ w ~ N O o w ~~ -+ OO • ~ ~ y ~cg 3 N 7" J (~I b Ioo, w e ro o 2 cn ~ 3 o ~ -+, a s ro ~ a ~ b O C A A 01 y' O O~ ~ O I ~ tC ~. O ~ (~1 l~ y w N ~ m ~ C p I ° I m cn z D ~ D c eo .roa. rn ~ a ~ ~ ID 3 ~ o o~~ N ~ ;_ C i D N ~ ( O I ~ O O fl1 ~ ~ c 3 • ~ v'v~~ O O O a :: o N 3 N N ~ ~ ~ ~ m ti c ~ ~ a ' O o ~ ~ ~ ' s: ~ 2 N 3 m :. w a. .%- I Z .. .~i I ~' _ C = Z '° 7 O ~ ~ ~ I ~ ~. G n ~ o ~ ~ v w I ~ ~ ~ ~ c ~ ro C , N a I <„~ ~ ~ ~ ~ I Z - m c`i ~ -+ -~ m I ~ ~; y o a _ A?~ ;~= d a j•' ~ ~ I ~ ~~ ~ z ~ o z ~ ~ I o z v H ~ ~ Z ~ w A I ~'9.gtn D ~ ~ ~ Q f A -- -- ~ v of ro m s3 ~ I ~ Z~~Q m ~ c ro"z'd~ z a I Qro a-. o ~ ~ y ~ ~ ` I o <_. !d ~ I 0 ~~ ~ n ~ y~~ A re v x ~; b ° ~o I c ~ ~ x 3 ~ (!1 O 'p ~ ? ~ ti ~, I >>~' o - Qm ca a w I ~ ~ ~ I ~ ~ 'b ~ t ro ~ ~ ~ ~ A ° ~ V' o /'' _~ Wiscc~r•:~n Department of Commerce PRIVATE SEWAGE SYSTEM ,Saifeiy and Buildings Division INSPECTION REPORT CENE1?~'.I~ INFORMATION (ATTACH TO PERMIT) Pers::,~ral inA~rmation you provice may be used for secondary purposes [Privacy law, 7(.15.04 (1)(m)l. ~~d~tiYl~e: ^ city ^ v1~1A'tF~l ~ownsh l~'~ r CST BMElev.:- Insp. BM Elev.: BM Description: /a 4 ,- ~ ,° S,~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ OHO Dosing ~ ~I Q Aeration Holdi TANK SETBACK INFORMATION TANK TO • P/L WELL BLDG. vent to Air Intake ROAD Septic '~' ~ 5 L° ' ~ r NA Dosing ~ ~ ~ .~ ~-~ ' S L~7 ~ NA Aer -- - ----- - - - - NA Holding ,, PUMP /SIPHON INFORMATION Manufacturer ~(,r ~ Demand Model Number ~~ GPM TDH Lift ~ ~ ` Lnctlon System TDH Ft Forcemain Length ~[ ~' Dia. 2,' Dist. To wen SOIL ABSORPTION SYSTEM IS ~~_ / _ _ n p ID No.: ELEVATION DATA STATION BS HI FS ELEV. Benchmark ~ , y. lv so Bldg. Sewer 9, qd , SO / Ht Inlet ~ , ~~ 3S 5 Dt Bottom /,~- O 9 . ~ Header /Man. ~J Dist. Pipe '~, 9 ~J'~ Z Bot. S stem y L 9.3v F~~~ '° ~-3 9 . BED /TRENCH width ~ Len th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth Dt EN I N ~ '~3, S~ Z- DIMEN 1 N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHIN Manu act ~er: SETBACK r A N M INFORMATION Type O t2 r r > S ~- IT um er: e ~ • System: ..S ~2 . , DISTRIBUTION SYSTEM Header / i old ~ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake a Length Dia. _~ ~ Length ~%~~ Dia. ~ Spacing I's / ~ 7 f 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 InS ect10 #'Q Yes / ^/No Ill e~dtYofl #~ No / / ~nMMENTS: (Include code discrepancies, personspresent, etc.) ~S /° ~/ O/ Location: 1721 96th Avenue, Hammond, WI 54015 (SW 1/4 NW 1/416 T 9 R17W) -162917578 Pheasant Hills -Lot 6 ~.,~, ~ ~~~~~ a,,,,o/ t ~,.,~,,,cj, ~;,~,,~ ~ ~.~,/{ 1.) Alt BM Description = ~/ep o~ knr~ wa// ~. ~~ 2.) Bldg sewer length =~ ( -amount of cover_ />/ z/y " ~~ ~ w~ ~~ of ~r~.R,/ ~ j 1 I 3 ~ OtlSC r UQ~~~-- ~ ~5 //lrS f~l~ / - / ~~/ ~-"'"Y '~"~`i" (1VR,5 GtD[li~~°(l' ~''4.~~. ~~ h ~ "~ Gt/ f-~-o-~ ~ar~•~ ~(- ~ ~P ~J ~o ww~ Ca / Jt I^J k-Sc ~ Plan revision required? ®Yes ^ No Use other side for additio a information. SBO-6710 (R.3/97) Date Inspector's Signature Cert No. ~` • Z..a~ ~':L. Sinz Plumbing Inc. ~ D~ E5609 '708th Ave. Menomonie, WI 54751 ~a~,T~. ~l..u T ~C.u4~s~ ~ ~~.~.~r~- ~ ~ is Phone: (715) 235-2644 Fax: ('715) 235-2592 'r~ .i~ ~r= Ga ~ ~ ~ p~ ~ ~ ~o~ (! p~ /~ ~~ Z ~o''i SE ~8 ~~ orJ 4000 ~ .~aJ~C- ~Yr~ ~ A~O~ ,, ~,~ ~ "~°y ~~~ N ''~~ ~ a,~,~q3 mss. ~~, ~ W ~~~ ~~ fry ~~~ / sr~'N ~ n B~~z v~uxh ~q.4 ~MT~ ~ a l •6 ~~ i ,o~ Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 City Madison, Wl 53707 - 7162 Sanitary Permit Nuutbeer (to be filled in by Co.) j~~O~~~~ (608)266-3151 3 ~~ Department of Commerce State Plan LD. Number Sanitary Permit Application rovide ou ti f l i ~ p orma on y n In accord with Comm 83.21, Wis. Adm. Code, persona be used for secondary purposes Privacy Law, s15.04(L xm) ma Project Addtess (if different than mailing address ) y ~ 1. Application Information -Please Print All Information I ~~~ l ~ Property Owner's Name ~ Parcel H Lat k Black # I, o~~- ib Pfd ri ~ ~~ Property Owner's Mailing Address Property Location ~ ~ ~ ~ ~~, ~t/s, Secuan ~_ City, State Zip Code Phone Ntrmber /~J~urcle ) ~ 'I'~ N; K/ / E o~/ 11. Type of Building (check all that apply) f B d Subdivis~ Name C M Ntrmber ' ~ rooms e or 2 Fancily Dwelling - Ntrmber o ~ ~~ ~ PulilidCotnmereial -Describe Use ^Vdlage ship of ^City ^ State Owned- Describe Use _ m 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System list Previous Permit Number and Date Issued B. ^ Permit Renewal Permit Revision ^ Change of ^ Permit Transfer to New Before Expiration Pltnnber Owner ~ ~J ~ ~~ Zcj Q a IV. T e of POWTS S stem: Check all that a 1 ^ ~ Non -Pressurized ln-Ground ^ Mound ? 24 in. of suitable soil ^ Mound < 24 ut. of suitable soil ^ At-Grade ^ Single Pass Sand Filter i Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leac ~ Chamber ^ Drip Line ^ Gravel-less Pi ^ Other ( lain) V. Dis ersal/'I'reatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsn Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation / ~ ~~ ~ ~~ -- VI. Tank Info Capacity iv Total Number Manufacturer Prefab Site Steel Fiber Plastic Concrete Constructed Glass Gallons Gallons of Units Ncw Exisning Tanka Tatdcs Septic or Holding Tank y, !~ //~/» ~/v~+~ ~ ~ Aerobic Ttcatmcnt Unit / N Dosing Chamber ~~ / ~ Vll. Responsiblli Statement- 1, the ersigne , respons[bility for installation of the POWTS shown on the attached plans. siness Phone Number B u Plumber's Name (Print) PI 's Si t MP/MPRS Number ~s-may ~ 13¢~~z ~~ a . T;csjnZ Plutber's Address (Street, City, State, Zip C ) ~ sGog ~~h f~i~ /r~e~~~ wr .~~'s` Vlll. Count /De artment Use Oni Sanitary Permit Fee (includes Groundwater Date Issued lssuutg Agent Signature (No Staztrps) ^ Approved ^ Disapproved Surcharge Fee) ^ Owner Given Reason far Denial 1X. Conditions of ApprovaUReasons for Disapproval I Attach compktc plans (to the County only) for the system on paper not Irss Chao gl/2 : 11 inches in size SBD-6398 (R. 01/03) T.,~,. Sinz Plumbin Inc. ~"°T ~ ~~~~T ~~ts ~ a~vn n ~ 1~-rNsLc.r~c~ E5609 708th Ave. Phone: (715) 235-2644 Menomonie, WI 54751 Fax: (715) 235-2592 ~T` N /~ ~~_ ~d ~ ~T~ / ~ ~~~~~~~° ~8 k~~"''~ ~~ dEf f~' r~ ~`~ Z ~~ ~, 1 BJ~.2 ~~ul~= ~~~~ ~~~~ 1~ d~ p~~ 1 ~ a~~ eft. 3~ ~, e~ ~ ~q.~ ~MT~ /~ASTi~-ll ~iK 1-/R- // OIL .SyST~~r ~ ~ 6 To rv~ rf-~'~ / ' G D ~~~ 1~9~4~/ ~'`~ I ~Ov • 1 M~~ ~~H W E ATt:F ~ K PRL~J F LOCKINC3 Cpn/BR JL~+c,T~oK cAy~cK P+~C.Oy~>rGT+~1 Cr r--~-c 6„ ..~._ ,.,~ r '4a ~' y ~ ------'s a I . 1U NDISTURB€D ... Sc>Il~ 24 `' x.~i. it d~ 4° t~cwuo~ _. ' ~ v~ti~ ~~ ~~ /~K~ r ~r~ ~- _ _ ~"wr.~n A .. How q" P~ ~_'~, o W Kcvtt~ ~ 4 p C~.T abarr-J ~AFFL.ES ~A~ 3' ago Ptr'~ a , ~e~. C~Gt Purtr' b ~„ ~ GONC+tETt _ gv . 4~a CSC SCPTIC E ~ SPEGIIrl~GATI~tJS T/~-J..S MAIJUiACTlJ0.C:R~ llllM6CR pf DOSES: ~ / F£K OJ~~ 7'I1-JK SizC : t tT~ - V~ GI~L.l.bA7S • .DoSC VO~tJME / AI.NIlP1 /'VUJLI~ACTLSlRLLL: S •~ la'~~t~y„f IIJCLtlAlA74 batK/LOW:..,L, ~ G~~~ONS Mao r. uuHtitl~: . ~ d ~ ~ ~ tAp~clrlFS: ~ _ ~ WCHCS 4K X93 Go,~~o~,s OWITCM 7yOi: ~~`~ "'~~ SUMP /1J1UU>rAC7llRCR: ~dY~ ~~~ iuCn[6 pH ~~ W1.~0~.i5 MPDEI. 1UUMDLR: F ~ 0~_,t? IAU;tiES OR ~R~-GAI~G+.~; ~WITCN TtiPS: V~4~..{v ... ~~. IJOT QUMP A1JD A~l-RM ARL TJ DL f"111JIMLlM DISCHAKGC RAT GIN INSTA~t_EO pw SEP^RATC CtKC~Ir; /ERTICAL At-FCRCAItf OCTWCtIJ PL1MIt Oft Ay0 D15T'R3~1JTiQlJ PIVE.~ ~~, FEW t ~M,~~u~iKU/~ ~1CTWoaK SUPP4~'~ !'R~EQLtuRI~ .... .. I .....~~ FECT "~ '.-~'K_.F~EY OF iORCC M/11~ X ~L..L~~,Q pPILiR1CT{o1JlrAf,TOil. ~'O~ rRQET ~' ~ ~ ~~~ "' TCTAL DyAJAMIC. NEAO +x f><ET J7Ertr.tl~~ oiM[1.14101JA •pi TNIJK: LEAtGTN-,--,,,,,._-`~W~DTH ~~ ~I..IQU~D O~PTrt Zd Wdti0:E0 100 ~Z 'FpW 860 S~Z STL 'ON Xd.~ JNIlSSl BIOS QdI ~Il2~d:7 wGb. Pump ,runs but delivers only small' amount of water. 1. Pump may be air locked. Start and stop several times by plugging and unplugging cord. Check vent hole in pump case for plugging. 2. Pump head may be too high. Pump cannot deliver water over 24' vertical lift. Horizontal distance does not affect pumping, except loss due to friction through discharge pipe. 3. Inlet in pump base may be clogged. Remove pump and clean out openings. 4. Impeller or volute openings may be plugged or partially plugged. Remove pump and clean out. 5. Pump impeller may be partially clogged causing motor to run slow, resulting in motor overload. Clear impeller. Fuse blows or circuit breaker trips when pump starts. 1. Inlet in pump base may be clogged. Remove pump and clean out openings. 2. Impeller or volute openings may be plugged or partially plugged. Remove pump and clean out. 3. Pump impeller may be partially clogged causing motor to run slow, resulting in motor overload. Clear impeller. 4. Fuse size or circuit breaker is too small. 5. Defective motor stator: return to Authorized HYDROMATIC Service Center for verification. 4 Motor runs for short time then stops. Then after short period starts again. Indicates tripping overload caused by symptom shown. 1. Inlet in pump base may be clogged. Remove pump and clean out openings. 2. Impeller or volute openings may be plugged or partially plugged. Remove pump and clean out. ,s~ 3. Pump impeller may be partially clogged causing motor to run slow, resulting in motor overload. Clear impeller. 4. Defective motor stator: return to Authorized HYDROMATIC Service Center. 9 30 a ~ za s 3 10 0 0 (apociry-U.S. G.P.M. 0 10 ZO 30 40 SO UUrs/Sttond 0 I ~ ~ ~. SHEF30 Performance Curve /* Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, x.15.04 (i)(m)j. F~rd~~~e: ^ city ^ vl~Fni~li#~ ~Ownsh CST BM Elev.: Insp. BM E ev.: l/ ~ BM Description: U / / V G ~ I° S,~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic K ~ /OC~~ Dosing ~ ~~ Aeration Holdi TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic '~' ~ S Lo ~ ~ r NA Dosing ~ ~ ` ~~ r > Z~' NA Aer _ __ ._ NA Holding ,- = PUMP /SIPHON INFORMATION Manufacturer ~ Demand Model Number ~~ GPM TDH Lift ~ ~. ~ Lrictio System TDH Ft Forcemain Length ~I Z ` Dia_ Z ~~ Dist. To Well SOIL ABSORPTION SYSTEM /,S ,,~,,_ /__~ ip n ID ELEVATION DATA STATION BS HI FS ELEV_ Benchmark G , ' y. Id ~o Bldg. Sewer ~J, gd , sp /Ht Inlet ~ .~ qS- 3S s Dt Bottom ~,~ O 9 . 0 Header /Man. [~ Dist. Pipe ~ 9 ~/'~ "/Z Bot. System L 9, 3v 9 F~~~dS~ ~ ~- 3 `~ . BED /TRENCH Width ~ Len th ' No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N ~ ~3, S' L DIMEN I N SYST MTO P/L BLDG WELL LAKE/STREAM LEACHIN Manufacty~rer: / SETBACK ~ ~' INFORMATION Type O t Z > r S t_ A IT Mo el Num er: ~ • System: ,S ~2 . ; DISTRIBUTION SYSTEM Header / ifold Distribution Pipe(s) r x Hole Size x Hole Spacing Vent To Air Intake a Length Dia. ~_ ~ y,s length~~ Dia. Sparing 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 InS ectl0 #13 Yes / ^/No InS e~dti!on #~t No / '' COMMENTS: (Include code discrepancies, personspresent, etc.) ~S /° ~~ O~ Location: 1721 96th Avenue, Hammond, WI 54015 (SW 1/4 NW 1/416 T 9 R17W) - 162917578 Pheasant Hills -Lot 6 y.~.~j,,ctw.+t,~., ~~~~~ a,,,,fl/ L ~,,~,,,~. k,~,.~ ~ ~.~,/~ 1.) Alt BM Description = ~op e~ kid wa// ~ ~~ 2.) Bldg sewer length =~ ~ s` ` G ~ ~~ -amount of cover = >z/y J ~ w~ ~ I 3 ~ o6ie r v~~ ~.- ~+. jc5 ~u {~r.A ~-~ ~`~"/' liv4,5 GtG~G~eO~ -" n P e~.- ; Plan revision required? ®Yes ^ No Use other side for additio a information. SBD-6710 (R.3/97) Date Inspector's Signature x ~Si~ Cert. No. '~'1 Sanitary ~'ermit Application In accord with, Consm 83.21, Wis. Adm. Code Scc reverse side faf irssavctions fdr completing this application Perspral inforrAation you pro~~dc may be usad for secondary pltrposeF (Privacy Z.aw, s, 15.04(1)(m)J ~ tons (to the coos co von for the sum, on er not loss than 5t~te ~u~t~P~m^c 1`lumber ^ C6eck if rcy~on to Devious auolianden on information -Please D!I l'7D ~' s7- Ciry, swte 7a Code elaen..azu~ p II, Type of Building: (check one) L~ l or 2 Family I3welling - No. ofHadroams : ~ <`i ' Q PublidCorrunorcinl (describe uso)L '" ~" '~r .~ O State-Owned `~''~''"'+ LTT. '>^ a of crurit: Check onIV one box on line A,' Cixeck b'ox o A) 1. ow 2, ^ Raplacement 3. ^ lle3~i8cement of _ o.e~„ ~ smm Wank PnI , I~' $) rriirAlvtn r.-.. d A Sanit$ Permit was rcviousl iastccd -, ` ~, ri, Type of 1?OwT Systepn: (check all twat apply) ~ = (Q~j ~Iorrpmssurizcd Tn-ground ©Mottnd C~ Pressurized In-gourd p Holding Tatlk Q ``fit" ° ^ Aerobic 'Treatment Unit V. riis ersaUl7catment Area TnformatioA: ~ ~ ... 1. Des~~n tew (gPdJ Z~ ispersnl A,ea 3. Dispersal A}ca 4. 5vil Appbcaoon (_(~j ReQlrizrd Proposed Race Gal J 'VII. Tsnk Capacity in Total # of Information Gallons Gallons Tanks New Existing Tanks 2'eaks ~T L [DOb -- /C~~o ~ Responsib111ry Statement ~~ it, ~!~ T Safety & Buildings Division 201 W, Washington Avo, PO Box 7302 Madison, WI 53707-7302 (SulYaut cornpktcd form to county if not 1 ~uoalwsyon NatUO Ou' GSM ber -S a (~-~~'s~,v7- ~s ^ City `-' /~ ^ Vi]lage IK~/l~~ J~'!'o wn of ?0 ~ O l R='~DS3 -DV' DOO ~^. ' ParpplTnxNuRl s ,a ~l~ lbl ''~ 5, 6. ^ Addit -T. v~~ O Sand Filter C1 Constructed Wetland ^ Single Fags ^ ]}rip YJiu~ s ciayJsq. it.} (Minfnoh} ~ 97. / Manufactt~er Prefab Sitc Stec1 Fiher• Can- Con- glass crere strutted ~CJTT Oll i -~ w ~ ~N z ~ ~6 z <S-z - Z~ Plambcta Address (8troot, City, Stare, Zip 17i. County/Departrnent Use Only O Disapproved Sanitary permit Fx (Sncludea Grocmdtivator Da<clsived " g Agent S (No stamps) ~Appevvcd G OwnerGivcn Initial AdvCrsc 8o Fee) ~ ~ ~ ~ Determination Z~. X. Condit[on5 of Approval ~Fteasons for 171ssppraval: ~ 12 u Sa-;. ~ C e~,e.~. 6e..~ w~.t~~ a~e.~ st~S~- ~ c~ Se+ ~ / w~~ lo-t_ tnJl.~~vt~el S S~ , ~ Pt^- I5 St ~ ~ ~C aD- GS CKl/y-nA-i~ ~o ~- +~ t J'e-e.8~+n.~NP,tnoQa.~t~9vt$, T.L. Sinz Plumbin Inc. ~T b ~~~~T ~~ls g lawn n ~- l~~-r~r wc.,rYC.v E5609 708th Ave. Phone: (715) 235-2644 Menomonie, WI 54751 _,~r-'"'~~ Fax: (715) 235-2592 ~m / ~ ~ ~~ I ~ ~D° ~!d`/- v~ z rd~ 5~ ~ ~~ ~g~ ~~ orJ ppo ~ ~~ f l~~r~~~ k~pD N~ ~~~ ~~~~L~. ~ ~i 1,1'tR- ~~ ~w ~~~ I W -Y'~ ~~ fry ~~ll pJ~k vfuN~~ / ~~`'~ ~~ p~~ yes' q3~~ ~ ~ a~~P cis . 3~ /,ns t~N ~ G~,t. ~~' /lrrsT~~ ~Kr~~- ii v~~ ~sys%~.~ To rvr r~-K~ ~ ~ GG ~-~._ /~ ~i. ~d ~ V ~~ Y ` 3,~~Y /~~ ~~ 1 ~ o''- .. Wisconsin Department of CommeGRIGINAL~SOIL AND SITE EVALUATION ' Division of Safety and Buildings i accord with Comm 83.05, Wis. Adm. Code Page 1 of 3 Certified Soil Testing Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must Count y include, but not limited to: vertical and horizontal reference point (BM), direction and ercent slo scale or dimemsions e north arr w and locati and dist to nearest road St. CTO1X p p , , . , o on ance f,....._ _.~.~ Parcel LD.# APPLICANT INFORMATION - Pl~se~prmf"a'll rnfrfo~•mation . Personal information you provide may be used'for secondary purposes (Privac'y;l-aw, s. 15.04 (1) (m)). ieWQd By Date ~ 2,QF) ` Property Owner ' " ; Property Location Bonte, Ron f ~ `~. Govt. Lot SW 1/4 NW 1/4 S 16 T 29 N R 17 W Property Owner's Mailing Address ~ " ~ Lot # Block # Subd. Name or CSM# 1011 170th St. ~ ~ ' 6 Pheasant Hills City State Zip Code, ~honeNumber ~ 5 0 52 0 ' d ~ City n Village ®Town Nearest Road d 170Th St I~ Hammon 4 4 , WI ~ S :. Z~S~:~Q6- . arnmon ~~Residential I Number o~tiedrooms 3 ^Addition to existing building New Construction Use: ~; Replacement ~ PuBllcor-coinraercfal describe Code Derived daily flow 450 gpd Recommended design loading rate •3 bed, gpd/ft2 •4 trench, gpolft2 Absorption area required 1500 bed, ft2 1125 trench, ft2 Maximum design loading rate •5 bed, gpolft2 •6 trench, gpolft2 Recommended infiltration surface elevation(s) 24" below contours ft (as referred to site plan benchmar Additional design /site considerations'nstali 2 - 5' x 1 ]2.5' shallow trenches on contours for 3 br Parent material till Flood lain elevation, if a livable NA ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system ® ^ U ®S ^ U ®S ^ U ®S ^ U ^ S ®U ^ S ~ U ~7VIL LJCa~V I[IP 1 IV IY RCrVR 1 Boring# Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. 1 1 0-5 7.SYR 2.5/1 - sl 2 m gr 2 5-26 7.SYR 2.5/1 - sl 2 f-m sbk Ground elev 3 26-55 7.SYR 4/4 - sl 2 m sbk 99.1 ft 4 55-63 7.SYR 4/6 - is 1 m sbk Depth to limiting factor , Or > 63' ~ ~b Remarks: Ground elev 98.1 ft Depth to limiting factor > 66" J ~?,tr0o -si ~ . #.k ~ GPD/ft2 ~ nsistenc Boundary Roots Bed ~ Trench mvfr cs 1 f .5 .6 mvfr gw 1 f .5 .6 mfr cs if .5 .6 mvfr - - .7 .8 1 0-4 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 4-14 7.SYR 2.5/1 - sl 2 f-m sbk mvfr gw if .5 .6 3 14-32 7.SYR 4/4 - sl 2 m sbk mfr cw if .5 .6 4 32-44 7.SYR 4/6 - is 0 sg ml cw - .7 .8 5 44-54 l OYR 4/4 - mcos 0 sg dl cs - .7 " .8 6 54-66 lOYR 4/6 - s 0 sg ml - - .7 .8 1 ZI ~ ~ - T ~. tv` ~ L WIC Remarks: ;,ST Name (Please Print) Signature: Telephone No. Henry F. Grote _ 715-665-2681 4ddress ertl ie or esttng D to CST Number Ref # P.O Box 57, Knapp, WI 54749 417/2000 222774 1077 PROPERTY OWNER: some, Ron SOIL DESCRIPTION REPORT ~ Page' 2 'ofd 3 PARCEL LD.# Certified Soil eT s[mg ~ ~~ 3 Ground elev 99.5 ft Depth to limiting factor an• 4 Ground elev 1 /~!1 C G Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPDIftz Bed Trench 1 0-4 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 4-14 7.SYR 2.5/1 - sl 2 f-m sbk mvfr gw if .5 .6 3 14-33 7.SYR 4/4 - sl 2 m sbk mfr gs 1 f .5 .6 4 33-60 7.SYR 4/4 - sl 1 m sbk mvfr - - .4 .5 ,2$ • 0 fob{. ~ ,~' ~. ~ . ~ Remarks: ~~„~~ ~~ ,~~ ,~~~ ~~~« ~ ~ 1 0-3 7.SYR 2.5/1 - sl 2 m gr mvfr cs If .5 .6 2 3-17 7.SYR 2.5/1 - sl 2 f-m sbk mvfr gw If .5 .6 3 17-32 7.SYR 4/4 - sl 2 m sbk mfr cs if .5 .6 4 32-48 7.SYR 4/6 - is 0 sg dl cs - .7 .8 5 48-60 SYR 4/4 - sl 0 m mfr cs - .3 .4 6 60-b5 SYR 414 7.SYR 6/3 sl 0 m mfr - - .3 .4 Depth to limiting factor 60" 5' Ground elev 100.5 ft Depth to limiting factor > 105" Ground elev KemarKS: ,.., ... ~,., ., """.,.,.,.~.., .,....,."~.,"" ., 1 0-25 7.SYR 2.5/1 - sl 2 m sbk mvfr cw if .5 .6 2 25-46 7.SYR 4/4 - sl 2 m sbk mfr cs if .5 .6 3 46-63 7.SYR 4/4 - is 0 sg dl cs 1 f .7 .8 4 63-85 7.SYR 4/4 - sl 1 m sbk mvfr cs - .4 .5 5 85-105 7.SYR 4/4 - sl 0 m mfr - - .3 .4 KemarKS: ,.,...., s. ~...., W ~., , .,..,,~.,,".a..,, ....,,~ , ....,.,.,..,.., .." ...,.,~.,.. Depth to limiting factor ~20~ ~3 e.~~-~- ~~~.~ ~~1~~ 13_t ~,~ ('18.1 'V ~ i ~ ~ O ~ C7 I / ~~ V ~T71 22Z'~ ~ Sb'S ~ ~ v o .,. ~ ~ eto , p~ i~ 2.Llr 1~~ 11o~a, ar. Sw '-~oy ~RS.VS C3 ~O (arc`/~ ~ o ~ p~~ ~ ~ • d~/ ~ tea. J Q~v ~}Inr.o ~ ~R o ~ ~~ ~~~.b5 (~LoT b } { ~2.a~~ q.tiT I~~b1.i S~ . NW •1l.-z.q-I~w I X13 +3 4 k~ ~~ 3 a~ 4 Q ~1 ~ q q,t~ 1~ l X80. o' Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity tn-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number 3 Number of Bedrooms Design Flow -Peak (gpd) ~ p Estimated Flow -Average (gpd) $b tv,US P,C,e ~t Septic Tank Capacity (gal) p Soil Absorption Component Size (ft2) ~ol0 5 T 5~ Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soif Absorpti n Compo ent Design Flow -Peak (gpd) trap +'~ 5't Maximum Influent Particle Size (in) NA Maximum BODS (mg/L) NA 220 Maximum TSS (mg/L) NA 150 Maximum FOG NA 30 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Should inspect once a year and clean once every 3 years Soil Absorption Component Inspect once every 3 years 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 (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se tic tank and outlet filter shall be assessed at least once every 3 years by inspection. The u let felt shall be cleaned as necessary to ensure proper _operation. The filter cartridge shou 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 fitter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic ~P~) Management Plan for a Septic Tank and Soil Absorption Component tank shall have its contents removed when the volume of scum and sludge 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 an 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. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for 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 the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible, Tank abandonment shall be in °accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 2 ST CROIX COLfN1`Y SEPTIC TANK MAINTBNANCB AC~REEL~~ AND OW1~tBRSHII' t~R'TIFICATTON FORM Buyet< ~O~ro~-I~- ~. ~ ~D-'~ ~~ S~a~S C,II 17~~h Addross ~ 7 a ~~~~ A ~~. . (VesriBcati~- required from Pianaiag Department f~ ter c~nutio~ a y~nd~ ~ ~ Parcel. Identification Numlaa' ~ ~ ~ - I~$3~rO -~ ~~ ~ aq, i 7. S7b r,~rAi. ~,~,,>~oN ,~t n~ ~ y., 1 " ~ y~, Sec. ~ T~~ N-R ~ .~ W, Town of ~O.YY~ Yv~p phty Loaatro / ~,~, t~ p..~Y~~ ~'"~ ~ ~ l S Lot # c_____-~ $nbdivision Certified Sarvey Map # _,, Volume Page # ~- `~ ~ S ~ 7 ~, Volume _ ~ __._, PaSe # Warranty Deed # -- ~~ ^ yes'F~ no Lat lines ide~tifiabio ~ Yes ~ no ~Wi~1RR ~'~',,~ZCAZZON e. I wa am are fibs owacc(s) of I (~~ tbst a~ its cui ties form are uttie ~ tha best of ~ (our) ~ ( ~ ~ y by of a warzx~nty dcod regarded in Rte' ~' Deeds {?ffiice. ~_ ~ °~ SIt#i•IATfJitI3 taF AP'PLICkNT DA'[E t rcvokod by the Zoning Dot- `««•«« ssssss ,~„y information that is mis-roptrseutod msy rmvtt is die saaitsrY P~ ~~ s. ipdade atW Was ~riiwegon: a stamped warranbr deed from tha of Do4ds office a copy of We cmrtifiod survey map if ~ ~ made: ip, ~ warranty deed oral. ~.~()1~372 Dine AA. Bore, as Tnrstee and #2otnald ~. Some. Ttrst attemative Tntsi~ of the }Cart M. Utferti; and KSttlarirta G. Ut(erts Family Trust. fot a valuable consideration catrveys ovitttot,R taarrartty to Ronald C. Bong and ~ M. Bete, hustaarxf and wile, Grantee, ttre fc~awirig descxibed rea! estate in 5t, Croix Ccxttrty, State of t~JiSr.~tsin: Es 209tta.3 KATNLffti H. YALSN REGISTER 1iF DEEDS ST. Ckt7IX Cfl., WI Rt:CfitlEl FOR AECSIRE 01-19-2004 14c30 qM / BfED CERT COPT Ftf: COPT FEE: iRNt~FTR Fffs 210.90 >il~ ~: }9.49 t'hgnas A. tMr~artnedc ., 102010'" Ave. tit, W! 51002 Ott3-1034-6(3, -7Q {Farce} klerttif:cation Number} 'The North Nat# of tt~ Norttrrmtsst Quarter {N ~4 of NW y) of Section Sixte~t {i6), Toatatship Ttaettty-nine {29y t~4orth, Range Seventeen {37} West. l a4ttt~, of Mareh _ AUTHEitTICATtON s) a~ ! day or T Eypa a ptiM rsanle TlTt.E: MEN93E12 STATE BAR f}F WtSCONSiN (W atot. a dY $ 708.tI8. VY+s. Stems.) THRS &vSTRi.-NtEkT WAS Thomas A. 8ak}uritt, Wi 5~ 'Mete nit. Trustee 'Ro+tatd G. t3o~ste Tn>st~e ACN~N)W~.EOGl9ENi STATE C?f 1MSCOPtStN ST. CR(?i?C Ct)t1NTY Personalty carne tlebore ma #as 2~t3'day ai t~sarc~t 2000 ttte above named t~irter Rd. Borde, Trustce and Roc-aid C. t3onte, as :feat attmntative Tnn~e or tC~! M. tJRerts and ttat}evvirts, G. tftierts F~rlily Trust, tvr me krtowxi kt t~ cite PeESOrt(a) vrtro executed ttte foregoneg hts6lxnent and the same, sigr>aturo type nr print Warne CJelB ~~ Jensen tdotary PubsOc~St. Croix Coextty, Wfisr+. ~y0~-t13n r' permanent. (if riot, state expiratidt date: ~U~ .) "~ ~ '- .iD ~ 'tyantes ~ p~rrs~+s sgrtm9 n arty capacity Sitouid toe typed a 1 ~ .r ` tt+in~ below sign®kues. Q + •~~c r+«m,~ «~a.. cry ww aw t~ vn eoosss- . -~~~~~ ~ ~ P f~ E~!.S A NT HILLS LOCATED t N THE NE t /4 OF THE NW t /4, THE SE 1 i4 OF THE NW I /4 AND PART OF THE SW t i4 OF THE NW t /4, AND PART OF THE NI~J 1 i4 OF THE NW 1 /4, ALL ! N SEC T t 01'J t o, 29N. , T R. t ?W. , TOWN OF HAMNi0N0, . S T. CRO t X COUNTY, W! 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