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HomeMy WebLinkAbout018-1083-11-000 ~ N ~ 3 ~ 0 ~ ~ C+, 'O ik '~ ~ ~ . d ID I ~ 3 ~ ~ ... ~ ~ I ~ I ~ Q n~ m o ~ ~ I _ m °~ ~ `~ ~ I S ~ y < ~* ~ ~ N ~ F~1 rl ~ j Q ,~,~, C 7 N y ~ p~ W ~. ~ CO w ~ ~ ~ 7 V a ° ~~ °7 W ° a ~ ~ o W'' ~ 0 o ~~~ ~ v b O ^ y y A w N p „ ,,. o O I ~ w v~ v D ~ ~ ~ 4 rn ~ lr •~ ` m ~o A y d ~, C ~ I _ ~ W °~ ' I ~ o j~~ N .. ~Z o °~~ o ~ 0 0= n r to y~ 3 3 K v ~~ ~ ~ N 1 d 0 Q ~ O O O O ~ = C N o ~ ~p ~Q' ~vv y _ ~ ~ _ N 3 m ~~ 3 I ~ ~ ~ M i ~ .. =~ _ ~O O O ~ 2 N < C - O ~ ° 7 D ° co ~ m Z ~ v vfD, I ~ ~ ~ ~ n c on~~ ° ~. ,~ N I O~v ~ o c u W G v ~ ~ ~a ~ a - a ~ < 3 N N (D ' ; d ~ I ~~ N ~ o I t'1 ~mno = f S~ ~ a Z~ =+ ~m-^' y Q ~ ~ c ~ -- ~ I ~ ~r ~ y, m ~ o. A ~ v a~ m I = ,. m..a I V' N rn I ~ o ~ Z o y. ~= O 7 . ~ C r. _ ? A ~ 3 ~ m y Z ~ w ++ I I oc~ ~ n A , a v ~ ~• ~ ~ ~ i c ~z ~ °' ~m o~ o a ~~ ~ ~ p a ~ ~ y ~ I ' mv'~ I o`'~g ~' -~ a -~ ~ a. a ~ ~~ ~~ y O 01 W Q 3a v ~ m ~ ~ fi a ~ I 3m~ ~ ~ ~ v I o - ~ _ ~ N { ~ o o . ' I a ~ 0 ~ ~ ~ aC Owo I o ~ ~ ~ t:,, v n ° ti a I . o WISCM1S.n Department of Commerce PRIVATE SEWAGE SYSTEM t Safetyand Budding 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 Schmidt, Bob Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: .~~ c~.~' tstt~J s B~~` I TANK IN ORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~'D csU Dosing ~ 1 t (..~ ~, Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic A~ D f b t Dosing y ~ ~ It ~ ~ } Aeration Holding rumrr~~rnviv ~rvrvr~mr~rwrv Manufacturer ~I Demand h-c.. GPM Z Model Number ~~..}~~~ '1,'~'(~ ~~ DH Lift Friction Loss System Head TDH I Ft .~ •SZ- `-~~ ~ Forcemain Len th I Dia. Z. p Dist. to Well S(111 ~RS(~RPTIAN SYSTEM ~7\., 1 _ - _,. ~ cl,. County: St. Cr0[X Sanitary Permit No: 399403 State Plan ID No: Parcel Tax No: 018-1083-11-583 STATION BS HI FS ELEV. Benchmark ~ 2. ( ~a2.~o ~15D,D Alt. BM ~ -~0 / Oil . Bldg. Sewer t SbHt Inlet I (•~ ~ o • 3~ St/Ht Outlet Dt Inlet Dt Bottom IS:~- Sb•3S Header/Man. 6 ~ ~ 9s6o Dist. Pipe . (ol, t 9 s.1~ Bot. System _ ~j0 / 9~{'zo Final Grade wed- 5.~ ~6 •Sa I St Cover ~ zQ1 -1~1/ RENCH Width Length ( No. f Trench s PIT IMEN N No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ( OI~~-~- 3 O SETBACK SYSTEM TO P BLDG WELL LAKE/STREAM LEACHING Mappfa~ger _~' ,~ ~~ INFORMATION CHAMBER OR I r w -1-v~1'~l~F- ~ Type Of System: C~-In,U. ~ ~- I b r ~ zA I ~ So UNIT Mo Numb DISTRIBUTION SYSTEM / L~nl~ L1,~iF- f /i 1 Header/Man' Id ~ Distribution Pip x Hole Size Vent to Air Intake ~.. ` Length Dia Length Dia ing SOIL COVER r PracsurP Svsteme Only xx Meund 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 [ No ^ Yes ^ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/~ Location: 1743 96th Avenue Hammonds, WIC 54015 (SW 1/4 NW 1/4 16 T29N R17W) Pheasant Hills 1.) Alt BM Description = I ~ ~~cs.-~„su-o-~-- c9--~ 2.) Bldg sewer length = ~ (p - amount of cover = ~ ~ ``~ ; ~ ~„~( 3)~ro.Q.. p~~cro 6-{~.~L-lef. a~. d~ ~ L rece,~„a2Q Plan revision Required? Ye ps' Use other side for additiona i orma ( = $.a~ Date Insepctor's Si natug_ re ~ SBD-6710 (R.3/97~ '~~ ~w0 ~ Q•- G Ont,ot Cw,N,.s1.(1671'. 1 Inspection #2: -7---'-T~ Parcel No: 16.29.17.583 J Cert. o . ~w iC Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 C~tY ~j(. C ~~ ~ i i Madison, WI 53707 - 7152 Sanitary Permit NtmrLber (to be filled in by Co.} n scons (608) 266-3151 3 ~ ~ ~p 3 Department of Commerce Sanitary Perirut Application State Plan LD. Number ~---- ou ptnvide ersonal information de Al C 21 Wi y o , p m , s. in accord with Comm 83. tray be used for secondary purposes Privacy Law, s15.04f lxm) Project Address (if different tkt~ mailing a~ress) `( ~~ ~~ ~ 3 `6 formation P i t All I > . ~ ~ ~ r n n 1. Application Information -Please Property Owner's me/ Parcel # Lot # I I Block # Property Owner's MailIGg Address Property Location 6~ ~~~ 2~ N S~ t,~ N w ,., Secti~n . ~ ode Zip C at e City, St Phone Ntmrber ll ~ f ~f ~ 'V~ 'I.IG~ yy14r10~ (~.,)I 5~~ ~ 7 ~t~ ~N~ ~~43~ rn~y~ (circlejj~~) T o~"r N; R11 E of.11J l y) Il. Type of Building (check all that app , } ,/ ~ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision N CSM Number ~ / ,f / ~ ( ~ ~ / /~/~ I~7 ~3 ^ Pubfic/Comtnercial-Dwcribe Use ~ 3 ~~ X ~ ~ ^Village ownship of~Ort~/ ^City • ^ State Owned -Describe Use >~ -~' _ 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 B. ^ Permit Renewal ~, Pemut Revisicw ^ Change of ^ Permit Transfer to New ~ t Previous Permit Ntenber and Date~~ Before Expiration Plumber Owner `1 /` e~ / Zt>b i ~' ~' 9 ~O V. T e of POWTS S stem: Check all that a I Non -Pressurized ln-Ground ^ Mound >_ 24 err. of suitable soil ^ Mound < 24 rp. of suitable soil ^ At-Grade ^ Single Pass Sated Filter ^ Constructed Wetland ^ Pressurized ]n-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/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation ~~ ©• O ZS- 1 212.9 9 `~-2-D Vl. Tank Info Capacity in Total Nuutber Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Ncw Existiag Talcs Tanks Scptic or Holding Tank X ~- ~ / ` r ~ `/G x Aerobic Ttcattncnt Unit Dozing Chamber x/ ~ ~ Vll. Responsibility Statement- I, the ensign ass res ility for installatlon of the POWTS shown on the attached pisms. PI s Name (Pain Pl MPlMPRS Number B~~cinercc Phone Nutnbet OW ~ ~~IV .L ~ ~,~ ~ J Plumber's Address (Sheet, City, State, Zip C ,~,5~ Z~ ~/>Stl f~U ~IGiZarnalu ..Z lr ~5-/ Vlll. Count /De artment Use Onl Approved ^ Disapproved ~m~' Permit Fee (' S ha e Fee) cltrdes Gr dwatei;, Date ]slued 1 uin Agent Signattue (N ` Stamps) rg urc fur 0~~~ ^ Owner Given Reason for Deniat . IX. Conditions of Approval/Reasons for Disapproval ~~ r~.Qe~ ~K..Biu,,.v~~ - -- ~ STS 2S3 0 9. -~-~-oL ~ 9 `fit P ,.~, Attaca compktc picas l~ cue i:onaty omy) nor cnc sysrcm oa paper wa css u.a.. a„~ . „ W~~w v SBD-6398 (R. 01/03) ' _. Hinz Plumbing Inc. E5609 708th Ave. Menomonie, WI 54751 .r ~ " lr l ~~ - c ~_ / ~ C/~ 6 ~~~ ~ ~1 S ~~ Phone: (715) 235-2644 Fes; (715) 235-2592 w~uvv.tlsinipl~cmhin~.~c~m ~~ i`°° ~ r ._ .....~, ••w.c~ ..~.r. M /1 i rv W >:1-T~i b !~ PRG~J F LOCK~riG COVER 3L~+4TIor+ QL1GK G+~tOy.iiGT'~'1 > ~4w ~' :,4 ~~ ~ ~ r 1p NDISTUREyEA .., - ~+ So,~ 24" x.A. ii a 4° M4K4C1~ ~. ~~ ' ~ YE+.Ti Iq~c{ r ~"r„cc.v A ~~ kou= q" Q` ~_~, o W ctnvt.R ~ l 4 a P~ a NE>~TIOKS ~~ „"~ ~ K.~.sQ ~ . ~tT't~ T 0 Gr;au7d~ ~~~, «~ >~ b b /~ ' Go/v~.IRErt _vv ~ iI~aCK ' SCPTIC t ~ _ SPE_Gl~i'GATlb1JS _ TnN..s /r+AUUfAC~Tl,J0.>iR; IJLtM6CR 4!< DOSES: '' ~ PEK 0~.~ 7'A1JK SizE; l ~~~ ~ V~ GA~L.OUS • .DOSE VOl.41ME AL.ARr'1 ruwrJr~~cruRcar S `~ L"~ ~~-v,,,, luc~uatr~~ a~cxrLOw: ~Oa.Y GI~:.L Ors S MOOLL utlNlbtK: .1 a 1 ~F`+~ ~APACITIFS: Aa~,WCHC3 QK 3~-3 w~~0~.;5 ?UMP MJ~t`lUF'ACTURCR: [~,l_ll7~~Y1'1 ~ IG ~' C ^~IULnC6 OH ~'~ 3 _...._.~ G~~~ous MpOEL A1UMDtR: ~,.~„~ S~EF 0 p.~,,,,U IAi~:MES OR ~a~G~,~~G~. ~WITGH TtiPt; VK4.L•.~v~•ti~ PUMP A1J0 ALARl+1 ARC TO DG Mi-JIl1llM D1SC1{AyIGC RAT ~--.~.~....GIN INSTALUEO Ou SEPI~ii~TC CtKC~tr; /ERTlC^L A1IfCRCRItf OETW[tIJ PUMr dr! Ay0 DISTR1QUTi0AJ PIpC.. ~~FEi:I' t MiA11MUM u~TWoaK SUPP4~y rRfttuR~ , ~ ~ ~ _~ FCCT + „~, F~ E7 Of i"ORCC MA-tJ X ~.!_~ ~~ ~._~ FEET SOP/Ltr1clLTtou MACTOit. ~~ ~_ ~ ~~ TdTAL py1,JAM1C NEAb x ~~77 .FEET 1•~~,1 ~~.,, n 2., .treR~n~, Dlr~[IJ410WA •0I Tl~f`1K: LEA,IGTN ;W~b7H ~ 'T ;~,Iqulfl oeF,-N Zd WdZ0:S0 T00z ~Z 'FpW 560 ~~Z StiL •ON XtJd JNIlSSl BIOS QdIdIlbdJ WU2i_ Pump runs but delivers only - small amount of water. I . 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. S. 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 dean 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 b ~ 20 s 3 10 0 0 (opacityU.S. G.P.M. 0 10 20 30 10 SO liter~ond 0 t 1 3 -~. SHEF30 Performance Curve ~.~ 2" ~ S~-~ 1 fit- ~ ~`~ ~~"~ s Wisconsin`DepartmentofCommerce SOIL EVALUATION REPORT Division of Safety and Buildings Page ~ of 111 gUUVIVg11UG YYILII VVI11111 VJ, YYIJ. ,lull 1. VVUri County r Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must rC~ l include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. PI@8S@ pClllt all IIIfOl711ati0I1. Rev'ewed by Date ~ ~ ~ Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). IZ ~ Property Owner , Property Location ~O ,~ ~' ~ ~'~ ~ ~ S~ ~ r~C Govt. Lot S ~- 1/4~{.~f 1/4 S ~~j T Z~ N R ~ } E (or)~ Property Owner's Mailing Address Lot # Block # ame or Subd./N CSM/# 1 / a City State Zip Code Phone Number ~ City ~ Village [~T'own Nearest Road l-~a art of ~/ t' .~ 6J _ ( ) o (t ~ ~ '~~ [~ New Construction Use: ® Residential /Number of bedrooms ~ `~ Code derived design flow rate ~/~~~p O O GPD ^ Replacement / Public or commercial -Describe: Parent material ~` ! Flood Plain eleva ' ~licabl ,~ ~ ~ ft. ~, General comments ~/ P .Q l -e 1/ ~ © ~ , ~ / ~~ and recommendations: ~l S~ ~ ~ ~~ ~r ' ~,. ; " .-- '' REc~o~ED \' ~ ~.- ~~ ~':' ~ '~ 2!~~1 a.-- / Boring # ^ Boring ,~ G~!' ` %! pit Ground surface elev. ~ ~1U ft. Depth to limiting`f~ctor't~ii 4E _. ~ ,' ;. .-- Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure '' ,Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Z !L-L~' t6 ,- ~ - S c ~ 2vnsb~ m T ~ ~~ ~v-~ • ~ , ~ mar/ (' r / ~- q~f• ~~ 2(.~ s~- Boring # I^~ Boring L~1 Pit Ground surface elev. ~ ft. Depth to limiting factor ~~ in. ~~ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 _< 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print} Signature CST Number Y a S' ----- ,~ -----~ ZS 330 Address Date Evaluation Conducted Telephone umber ~~li-a»c tn~,~~~/ Property Owner _~-~(j~T Parcel ID # Page ~ of ® Boring # ^ Boring /_ C~ Pit Ground surface elev. ~~ ~3uft. Depth to limiting factor (1~ I in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Z / ~ -Z ~~ ~~y 6 - -sC Zm Sb~' 1T1 ~' C S - - . LI 9-~ r~~Z ~ ~~. ~ ~'~ ~--- - , ~- . ~ 9Y zap 2~ 2. (Q.(.2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. M nsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) P.A,C:F ~OF 3 zd Wd~~ :60 T00Z 80 'noN 'ON Xtid WO~Id Safety and Buildings Division County ~T ~ ~ ~ ~ ~ ~ 201 W. Washington Ave., P.O. Box 7162 l t I S~~ns,~ Madison, WI 53707 7162 Site Address Department of Commerce ,-~ =`~~~ ~ ~`~ Q~~ ` - _ ~~ ~ Sanitary Permit Number Sanitary Permit Applic ~ In accord with Comm 83.21, Wis. Adm. Cade, personal ' on ou ~ ~~ 3 ~ R`/o~ ^ Check if Revision ma be used for secon ses Privac La 1 ~V~. 1~ 4 I. Application Information -Please Print All Information ~."..~ rynP rate Plan I.D. Number +~ Property Owner's Nam '1 ,E..S ,. ~ ~pt,X e ( - azcel Number ~ ~ . ~, ~ ~ '~. -s~'3 22 \ ~~ jj QQ ner's Mailing Address ~, %`'~ Property Ow i ~ Property Location i _. "~ G C City, State ~ Zip Code Phone Lot ber Block Number Subdivision Name CSM Number ~~ ~~ckp~V~.p t~L 5~'{'0! "1 ~(~ o~4g- ~9 3 `7 ~~S T II. Type of Buil (check all that apply) ( / ~ ~ ~~ ~ ~ / OCiry 1 or 2 Family Dwelling umber of Bedrooms ' ~~ C pu /J l~S s IL ^Villa e g ^ Public/Commercial -Describe se ~I'ownship ^ State Owned Nearest d ~ ~, ST III. Type of Permit: (Check only one b on line A (numbering sch meter ~tt3' a!'~tse). Complete line B if applicable) A' 1 ~ New 2 ^ Replacement System '~} ^ Replacement of 6 ~ Ad~itiolZto For County use S stem 1`aok Onl Existin B. ^ Check if Sanitary Permit Previously Issued Permtt Number ed ?~ ]V. Type of Permit: (Check all that apply)(number' scheme is for inte~ria$US1~ 44 Non -Pressurized In-Ground 21^ Mound "?~ 47 ^ Sattd lfeltet 50 ^ C nstructed Wetland 22 ^ Pressurized In=Ground 41 ^ Holding Tank,- ~ 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic TreAtment U 49 ^ Recirculating 30 ^ Other V. Dis ersal/Treat ment Area Informati on: S`/ S; P~ ,j er Design Flow (gpd) Dispersal Area Dispersal Area , Soil A icadon Percolation to System Elevation ~~ Final Grade Requires' Propose~L~ / l0 Rate(Gal~,(Days/Sq.Ft.) _e r ~ (Min./Inch) /Q 3. ~~ 3 ..~ z Elevation ~St~ ~ ~00 ~ ~ 3 ~ ~~~ _ ... VI. Tank Info Capacity in TcNal Number Manufa er Prefab Site Steel Fiber plastic Gallons G~11ons of Tanks Concrete Constructed Glass New Existing r Tanks Tanks septic ~g ODD 6©O 1 ~=F'Ce9T ~ Dosing Chamber VII. Responsibility Statement- I, a untie ed, r ponsibDIty for installation of the POWTS shown on the attached plans. Plumber's ame (Print) PI 's Si MP/MPRS Number Business Phone Number ! ~b t_ S iN z tip t3 ~ l0 2 ~(S~Z3,f''?.bc,FS~ Plumber's Address (Street, Ciry, State Zip ode ~ ~ fl~~ >PiIO I'Yl/ L ~ 6o 9 0 8 S' . S~ ~ VIII. Coun /De artment Use Onl Approved ^ Disapproved ~~Y Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surchazge Fee) ^ Owner Given Initial Adverse . ~ Z Z ~- O U 4 Determination 1 / ` G IX. Conditions of Approval/Reasons for Disapproval Effluent filter to be installed and maintained per manufacturer's recommendations. Entire chamber must be installed in natural soil and there shall be >12 inches of cover. Attach complete plans (to the County only) for the system on paper not less thaa 8LZ a 11 inches In size ".k._ j.. ~SBD-6398: (R 0501) 7'.L. ~'inz Plumbing Inc. E5609 708th Ave. Phone: (715) 235-2644 Menomonie, WI 54751 Fax: ('715) 235-2592 www.tlsinzplumbing.com ~~ 0 ~~~'~ ~~~ ~ it °~ j ~A~II Iv /~~=~h ~ ~ I39~6 z ~o~ ~~ V~onsin Department of Commerce r AND SITE EVALUATION ,. '` •Division of Safety and Buildings ~~'`f~~~jth Comm 83.05, Wis. Adm. Code Page 1 of 3 Certified Soil Testing Attach complete site plan on paper not less than 8'/z x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and d i d di t St. CrO1X roa . on an stance to neares percent slope, scale or dimemsions, north arrow, and locat Parcell.D.# APPLICANT INFORMATION - P/eas rrlkit a7hinf~rmation . ~-p ; D ' Personal information you provide may be used for cmn~(ary purposes (Privacy`Law, s. 15.04 (1) (m)). ev we By _ ate O Property Owner ,^ ~ .., °, Bonte, Ron /,~,,~ Property Location Govt. Lot SE t/4 NW 1/4 S 16 T 29 N,R 17 W Property Owner's Mailing Address t ;~ :Lot # Block # Subd. Name or CSM# 1011 170th St ~ 11 Pheasant Hills . City St e_-izi Code Ph el~ianober ~ 5240 '~ d S~O15 7 ~6 ~ ~ City n^ Village ®Town Nearest Road nd 170Th St m Hammon - 1 :Z . Hun O ~R~sldential / Number~df b~~lfooms 3 ^Addition to existing building New Construction Use: Replacement ~ blicbr~orrlrrtprClal_cribe Code Derived daily flow 450 gpd "`~""'~, Recommended design loading rate •3 bed, gpd/ftz •4 trench, gpd/ftz Absorption area required 1500 bed, ftz 1125 trench, ftz Maximum design loading rate •5 bed, gpd/ftz •6 trench, gpd/ftz Recommended infiltration surface elevation(s) 24" below contours ft (as referred to site plan benchmar Additional design I site considerations `nstall 2 - 5' x 112.5' shallow trenches along contours for 3 br Parent material till Flood lain elevation, if a licable 3 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 w~~ u~a~-r~~r ~ rvr~ R~rvr~ r Boring# ~1 Ground elev 105.9 ft Depth to limiting factor ` > 72" 2 Ground elev 105.9 ft Depth to limiting factor • > 60" H i Depth Dominant Color Mottles T t Structure Consistent Bounda Roots GPD/ftz or zon in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. ry Bed ~ Trench 1 0-3 7.SYR 2.5/1 - sl 2 m gr ds cs If .5 .6 2 3-10 7.SYR 2.5/1 - sl 2 m sbk mvfr cs if .5 .6 3 10-33 7.SYR 4/4 - sl 2 m sbk mfr cs lm .5 .6 4 33-72 7.SYR 4/4 - is 1 m sbk mvfr - if .7 .8 Q~ /d3, 90 Z v </0 `' Remarks: 1 0-4 7.SYR 3/1 - sl 2 m gr ds cs if .5 .6 2 4-12 7.SYR 3/1 - sl 2 f sbk mvfr cs 1 f .5 .6 3 12-18 7.SYR 4/3 - sl 2 m sbk mfr gs lm .5 .6 4 ~ 18-28 7.SYR 4/4 - sl 2 m sbk mvfr cw lm .5 .6 5 - 28-60 SYR 4/4 - sl 0 m dvh - - .3 .4 a~ /p3, 1 i~ ~0 `~ Remarks: nonzon ~ nns some gr ac coo + occastonat mctustons s r x ~/4 tmcos (u, s~, all CST Name (Please Print) Signature: ` '~~ \ l ' Q~ Telephone No. Henry F. Grote `^-'"-~1 \~T 715-665-2681 Address ertt to of esttng Dato CST Number Ref # P.O Box 57, Knapp, WI 54749 3/27/2000 222774 1023 PROPERTY OWNER: Bonte, Ron PARCEL I.D.# 3 Ground elev 104.7 ft Depth to limiting factor ` > 68' 4 Ground elev 104.2 ft Depth to limiting factor • > 62" 5 Ground elev 103.9 ft Depth to limiting factor > 67" Ground elev SOIL DESCRIPTION REPORT ~ , _ ~~ Page 2 of~3 Certified Soil eTstTnR _ Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh, onsistence Boundary Roots GPD%ftZ Bed Trench 1 0-4 7.SYR 3/1 - sl 2 m gr ds cs if .5 .6 2 4-11 7.SYR 3/1 - sl 2 f sbk mvfr cs if .5 .6 3 11-19 7.SYR 4/3 - sl 2 m sbk mfr gs lm .5 .6 4 19-32 7.SYR 4/4 - sl 2 m sbk mvfr cw lm .5 .6 5 32-65 7.SYR 4/4 - sl 0 m mfr cs - .3 .4 6 b5-68 SYR 4/4 - sl 0 m dh - - .3 .4 1~3-9' 1.G~S rcemancs:.w..~....., .~ ~,...,, ,.... a~...... d 1 0-3 7.SYR 3/1 - sl 2 m gr ds cs if .5 .6 2 3-11 7.SYR 3/1 - sl 2 f sbk mvfr cs if .5 .6 3 ~ 11-24 7.SYR 4/3 - sl 2 m sbk mfr gs lm .5 .6 4 24-34 7.SYR 4/4 - sl 2 m sbk mvfr cw - .5 .6 5 34-47 7.SYR4/6 - lmcos Osg dl cs if .7 .8 6 47-62 SYR 4/4 - sl 0 m dh - - .3 .4 1 0-4 7.SYR 3/1 - sl 2 m gr ds cs if .5 .6 2 4-15 7.SYR 3/1 - s1 2 f sbk mvfr cs lm .5 .6 3 15-21 7.SYR 4/3 - sl 2 m sbk mfr cs lm .5 .6 4 21-35 7.SYR 4/4 - sl 2 m sbk mvfr cw lm .5 .6 5 35-67 SYR 4/4 , - sl 0 m dvh - - .3 .4 Depth to limiting factor rcemancs: ~ ` {~ ` 1 , .. ~- .~ r. `~ o r• -ire - 1 , o t ~ 1 ~a h S 1F- N~_~b-Z9- tc~Iw 1 o~..h; 1~ awv..o.~L~ N o ~a Vd ~ . ~' ~„-~ zz1~~ i'~ 1~ K Q.~ ov o ... ; ~ o ~„ ~. N $ u ~ ., o,,,n~~ l c~-c~ . ~ t~1 ~ c.e~ rla~ l;~t l.C~ w~/ (tfin o2 `- ~/ 7.'}0.0 I '2. \~ h ~~(1.5~ 4e~.~~' 3M (~ x.01 C n;.~~ i~.~ ~ ~-g K 46~ , I ~' ~ ~ oq ~) g=, ~,t ~ ~•a ~-'~ l • - Zb~t,g9 ~ ~ __ _ • U U .~ _ Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-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 Number of Bedrooms 3 Design Flow -Peak (gpd) t.~$b Estimated Flow -Average (gpd) Sn *tGyt ~. Septic Tank Capacity (gal) ppp Soil Absorption Component Size (ftZ) pp >~ Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soif Absorption Component Design Flow -Peak (gpd) GQS"b Maximum Influent Particle Size (in) NA 1/8 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 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 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 abandonmen4 shall be in.dcdo~dance with Comm 83.33, Ws. 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 ofdeep-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 CONTINGENCY PLAN if the POWTS falls an<i car-not be repaired the loliowing mearures have been, or mast be uken, tv provide a cods compliant rep(xement system: '~ A suitable replacement area has been evaluated and may bt utllited fot tht location of a replacement soil absorption system. The replacement :rea should be protecte4 rrom disturbance and compaction and should nat bt Infrtrlge4 upon by required setbacks from exi:tlnY and proposed swcwn, lot tints and wells. Failure to protect the replacement area will result In the need for a new soli and site evaluation to esablish a suitable replacement ana. Rsplacement systems rnust comply with the rules In effect at that t1rne. D A suitable replacement area is not avattabte due w setback andlor soli Iimltatlorls. Barifll~ advances in PObV'I S technology a holding tank may be Installed alt a ks~ resoK to reptaa the failed POWTS. D The site has not been evaluated to identity a Suitable repixement area. Upon facture of the P01MTS a soft and site evaluadon must be performed to locau a sulubfe rcp(acement area. If n0 replacsrrlent area fs available a holding tank may be Installed as a last resort W replace the failed POWTS. D Mound and at•gredr toll absorption systems may be retonsuucted in plate following removal of the biomat at the inflluadve surface. Recoruwalors of such rystems musi.comply with the coke In effect at that time. < < WARNiNG> > SEPTIC, PUMP AND OTKER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR iNSUFFIGIENT OXYGEN. DO NOT ENTER A SEPTIC, Pl1MP OR OTHf%R TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RBSIItT. RESGLIE OF A PERSON FROM TKE INTERIOR OF A TANK MAY IIiE DIFFICULT OR IMpl1tCIR1 i. ADDITIONAL COMMENTS POWTS INSTALLER Name ~, Phone ~~ _ Z .5 = 2 y~ SEPTAGE SERVICING OPERATOR (PUMPER Name -__Phnn~ POWTS MAINTAINER Name Phone LOCAL RfC4ULATORY AUTHORITY 'AaN~Y S~: Gro' ~o.~ ` n n his- - J 1 I:KV.iA l.V Ulf L Y SEPTIC TANK MAINTBNANCB AGRBBMBNT . ..AND OWNERSHIP CERTIFICATION FORM r tailing .4~ddress roperty ddress ~ 0 -~ ~ ~ ~'~ 't 3 ~ ~O~" ~ VQ (Verification required from Planning Departiiieat for new constnictioa)_1 ~~,m mn n~ Parcel Identification Number (~1~' l o$ 3 r U' d o O 'roperly 'oaf E '/,, N V~ y,, Sec. ~ ~° . T a~ N-Ri 7 W, Town of t~~ m01~~ . ~ubdi n Phe~~ar~~ N ~~ ~ ~~ . I,ot # c I Survey Map # Volume ..Page # Deed # ~2~'~ ~ ~ 3 .Volume ,~ 7 7 .Page # L{' 3 ~ Spec hoy~se ^ yes t~ no Lot lines identifiable ^ yes ^ no roper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance oonsisK o pumping out the acetic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can the function of the septic tank as a treatment stage is the waste disposal system. rroputy owner agrees to submit to St. Crone Zoning Department a certification fern, signed by the owner and by a msstc~pl ,journeymaaplumbez,restrietodplumbermaliconsedpumperverify-ingtl~at(1)theoa-sitowastcwaterdisposalsystem is is operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. tlwe, the 'geed have read the above n~ and agree to maintain the private sewage disposal system with the standards set forth, iq as set by the Department of Commeroo and the Department of Natural Resources, Stata of Wisconsin. Certification stating t your septic system has beta maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of a three dear expiration date. ~~A~~~ ~ i Z3 i o i OF ICANT DATE 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 pro rty d 'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. / ~/ ° / C3NA F APPLICANT DATB - s««««« Any infoanation that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. «««««« «• Incl~de vrlth this appltcatIoa: a clamped wamnty decd from the Register of Deeds office i a copy of the certified survey mup if reference is made is the warranty deed STATE BAR~F WISCONSIN O~M 1 - 1998 ' ~ WARRANTY DEED Document Number This Deed, made between Ronald C . Bonte and Dine M. Bonte Grantor, and o er c mi an 1r ey E. Sc mldt, husband and wife, as survivorship mari~l proper y ' Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate In St . CrOlX County, State of Wisconsin (the `Property"): Part of the SE '-~ of the NW '~ of Section 16, •rownship 29 North, Range 17 West, St. Croix County, Wisconsin, described as follows: Lot 11 of Pheasant Hills filed May 5th, 2000 in Volume 7, Page 86, Document #622544 * Dine M. Bonte 018-1083-11-000 ~v~ Parcel Identification Number (PIN) This 1S riOt homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property 1s good, indefeasible !n fee simple and free and clear of encumbrances except Easements, licenses, zoning ordinances, and restrictions of record Dated chis 1 6th day of January , _ 2 0 01 ~~Yti~ ~ ct~ (SEAL) ~ /~./~~ ~ (SEAL) Ronald C. Bonte AUTHENTICATION Signature(s) (SEAL) autheniic~t~,i~ Knutson , _ Notary Public State o ~scon TITLE: MEMBER STATE BAR OF WISCONSIN (If not. 6 3 7 1 7 3 i!A'THL..EEN H. WALSH REG:[STER OF DEEDS ST. CROIX CO., WI RECEIVED fOR RECORD 01-62-c~001 10:30 AM WARRANTY DEED EXEIiPT ~ CERT COPY FEE: CDPY FEE: TRANSFER FEE: 86.70 RECORDING FEE: 10.00 PacES: 1 Recording Area Name and Return Address Robert E. Schmidt 967 County Road H New Richmond, WI 54017 ACKNOWLEDGMENT (SEAL) State of Wisconsin, ss. St. Croix County. Personally came before me this 1 (t h day of January 2001 ,the above named Rona C. Bonte Dine M. Bonte to ,.,0 4.,,,,.,., ~„ tie .tie .,e~..,,.. ~ ...~ ... ..........._., .~- °-----~-- E ~ (_ ANDS ., . ti~E co^. Pc a r ~ ' SH££T) c.s r ~ ~ MR or r-~c rr i ~~ i } ,a 'A ~V7 ~: ^.._ s .~,, _, . ti ~~ ~~ ~,,~.; ,~ : l _~ P60S. I7' X66. ~' lSO. ~ i 66 03 ~~ ~ ; ~ . 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