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HomeMy WebLinkAbout018-1083-29-000C1 V) O 3 'o n d I ~ ~ ~ ~ A ~ ~ ~1. ~ ~ .'. ~ ~ D ~ I ~~ n p3j f~D N O O N O N ~ O ~1 • N 3 j' ~ V ~ ~ ~ ~ ~ ryl ~ ~ ~ ~ O w o S ' J W O N n O ~ a ~ IV ~! I ~~ ~ ~ ~ a ~ o ~ O I 3 3 a can ~ oc a w v ~ ~ ~ ~ w cn z D a ^~ I c ~ D W a 7vai 3 0 oWV N ~ f3 N 3 O c o0o nrtn ~+ I °w w a 3» Q ~~ ~ ~ ~~~ °: o O O O o v~ v_ ~v 3 fA fA ~ cND ~ ~ ~ v v_ y I ~ S.~ ~ ~~ I a ; - ~ -- m ~ x I 3 °1 v, N I a ~, I z .. 0 I ?i ~ ~ o ~~y~ Q o ~ ~ o°'~N" ~ ay w~~~~ -~y ~ ~ ~, ~. c w ~ y~ ~ d a I Z 3~~ m ~~ ~~ y I ~ v301y a AZT I d v,~m a A~~ o -m ~ ao'v m~O1 n~~ a ~ ~ ~ m ~ o C :. z aim ~ Z ~ A W _g D Q y a a ~ ~ m y ~ . o _ c o ~, ~ o a -~--. m p N ~ ~ ti ~ ~ a I rn ~, b I ~~ ~ I °w°w A I ~ ~ ~ ~ I m N I ~ ~ o I ~ c.°, I 1~ ' ti _ ~ ~ I ~" ~ oro o Q ~ I ~ ~ ~ ~ o ti a I o~ ~ ~ W~~ Departine<lt ~ ~~~ SOIL EVALUATION REPORT Division of safety and Buidings ~ ~~~ wiftr ~~ 85, wrs. Adm• code Attach rammplete site plan on Paper rat less thane 1!z x „inches in sae. Plan must ~ ~--~j~---\ include. but not ~rrti6ed to: vertical and ftorborNal nsferance ; dire~Oaand,...... ~._. r Parcel lA percent sbpe, scale or ~mensions, north arrow, and and !~d• Reviewed by Please print a!l inibnnatN . Persoosr information you provide maybe wed roc oeoortdxy pure (Prive4y R . f. 1 I.DL;(~) ~rt())• PrOpBrlyLocation Page ~ ~ Date Property Owner ~1i ; ~ ~ Cavt.,Uft ~ 1/4~~ 1!4 S ~ T N R j ~- E (ar . ( ~ ~ , ; / G C - ~ property Owner's Mailing Address _.,..: .1.~._ ' `_.. Biodc # .._..._,_.. Strbd. Name ar CSMI~ ~ Oti ~,// -e 6 ,~ v~ ~ k aSq~ Nearest Road City ~ p~ ryo~ ^ Cfty ^ Village (~ Tovm f ~/ ~/l ~ ~ GPD New Construt~iori lJse: ~ Residendai 1 Number of bedrooms - Code derived drstgrl flaw rate - ^ Replacement ~ ('~GN // ^ Pubtic or commeraaf - Descr~e: 5 l1 fc ' Fbod Plain elevation t7appiicabie ~~lG~- ft• Parent material ,~ General comments (i e / 5 Ys~c ~/l .~/~ {/ , ~ % T7-~c /~ ys . Sd G c ~ e~ 9S. a rJ and recommendations: U ~n9 Boring # © Pit Ground surface elev. ~ d ft. Oepth to lfmitirig far~or _ I~U Horizon Depth Dominant Cobr Redox Description Texture Structure Cons~tence in. Mtrnsetf Qu. Sz Cont Cobr Gr. Sz. Sh. 2~ SG- ~S ~ r Q /~ O ~" 7 y-ll~ /~ ~~ ~- d in• Boundary Roots f /~ C~ l vt` ~~ ~~ tion Rate GPD/ft? 'Eff#1 'Etf#2 '~ r ~ r ~ ~ /. Z U Boring Boring # Ground surface elev. ~~~_ ft. Dept b HmiOmg factor ~~U in. Q Pit Sol lion Rate T Structure Consistence Boundary Roots GP Dlftr Horizon Z Depth m. ~ ~ - 30 ~- o Dominant Cobr Mansell G 3 ~ ~ ~~ , Redox D~tion Qu. Sz. Cont Cobr ~ - i exture ~~ y 5~~~ i s Gr. Sz. Sh. ;~ ~~ ~~ ~ rn T m l c c S - l ~ - -- •Eff#1 ~ ss ~ 'Efi#2 , 8 ~ ~ , z ~n ...n ...,A TCC ~ all mn/t • EfAt>ent iP1= CST Name (Please Print) 3U < 22o Iilg/l and T5.`3 ~JU ~ 79U rrrgr~ a...,..a.,...~. - ..-.. _ -..._.~-.- _ - - Signature CST Number ~- ~- ~ _ Property Owner ~L~-"-'~~ Parcel ID # / d ~ ~ 7 Page ~ °f B~9 ~ ^ 8oring ~ Pit Ground surface elev. ~ ft• ~P~ ~ 9 factor f •~----- ~• Soi lion Rai Horizon Depth Oom~t~ttCobr RedoxDe~P~ Texttme Structure Consistence Boundary Roots GPDi'ff Gr. Sz. Sh. •Eff#1 'EtT#2 in. MtrrtseN ~• ~• Cant. Color ^ Boring # ^ Bormg Ground surface elev. ft. Depffi tD limiting factor in. Sod tier Rate ^ Pit Roots GPD)'fP Horzon Depth Dominant Color Redwc Desrxiption Texture Strur3ure Consistence Boundary Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'FJf#2 in. MunseU Boring Borrng # Ground surface elev. R Depth to Iurtiting factor in. ^ Pit Soi tion Rate Horizon Depth Dominant Cobr Redox Descripflorr Texhae Structure Consistence Baur)dary Roots GPDAF in. MunseU Qu. Sz. Copt Cobr Gr_ Sz Sh. 'Efiti:i `Eff#2 * Effluent #1 =GODS > 30 < 220 mglL and TSS >30 <_ 150 mgll ' Effluent #2 = BO05 < 30 mglL and TSS <_ 30 mglL The Department of Commerce is an equal opportunity service Provider and employer. [f 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-r3)0(R.07lOtt) PAGE~OF_~ ~T ~~ Qre~j i~L ~° I''`' `~~ ~ TOT# ~ ~ LEGAL DESCRIPTION !y ~ ~ ~ ~ S ~ <o T L `~ N R. ~ ~ E(or)~ Ilia _ ` J, "c Sf +~ r~' i \~~ TUBE 6=1 49,~a ~t.~,6y DATE l - i/' 03 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building C+kiision 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 Horvath, Pat Hammond Townshi CST BM Elev: ~ CA •a Insp. BM Elev: ,a ~ BM Description: 01~!„-ems L~- cs~vrRr =~~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~Dt~ ~~~ ~ t ~- Dosing Aeration Holding PU IPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL RPTION SYSTEM ~ ~ ~a,~,1p~ ENCH idth ( Length ~ o. f Tr`enc s DIM 3 `~• ~ 1., SETBACK SYSTEM TO P/L BLDG INFORMATION Type Of System: ~ ~ V , 1 e./)9 DISTRIBUTION S~(~$T~ll ! `fr County. St. CroiX Sanitary Permit No: 420740 0 State Plan ID No: Parcel Tax No: 018-1083-29-000 Section/Town/Range/Map No: 16.29.17.601 ELEVATION DATA STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer 10 ~ Q ~~`t ~T f~` ++ St/Htlnlet ,QD ~ ~ , ~• SUHt Outiet ~ZO ~'CO ~ I Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System I$.10 l l . vc 9 S • Sb' Final Grade St Cover ©•,~ b ~.' Q PIT DIMENSIONS [No. Of Pits (Inside Dia. (Liquid Depth ~t LAKE/STREAM LEACHING CHAMBER OR .~,,,~- UNIT Header/ anif d ~ Di tribution x Hole Size x Hole Spacing Vent to Air Intake ~ . P e(s) ? 1 ~~ Lengt Dia Length Dia Spacing SOIL~CiOVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedfrrench Center Bed/Trench Edges Topsoil Yes ,~„~ No ~ Yes ~~~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1~_ Z /~,3 Inspection #2: Location: 975 172nd St HamTmond, WI 54015 (NE 1/4 NW 1/4 16 T29N R17W) Pheasant Hills LotV29 Parcel No: 16.29.17.601 1.) AIt.BM Description = ~. i • -~~w.~ ~r~ 2.) Bldg sewer length = , ~ t tt -amount of cover = > ~j~j • ~ v ~~ i Plan revision qu ? Ye ~ No ~ I Use other side for additional ' mation. ~ ~ rt __~ l~ ~ ~ --- - sepctor's nat `e,5 ~ ~ ? ~,.~+~Il 1;~a+( t1 SBD-6710 (R.3/97) / V h9~ V (1 `/ ~' Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 C~tY ~ ~ (1~ ~ ~ rseonsrn Madison, Wl 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 26(x3151 a ® ~- Department of Commerce State Plan LD. Ntunber Sanitary Permit Application N ersonal information you provide Adm Code Wi 21 h C 83 d i , p s. , w t omm . In accor may be used for secondary purposes Privacy taw, s15.04(lxm) ~kojed Address (if ~ Brent than mailing address) 1. Application Information -Please Print All lnfor p / _ ~p ~~O - Il)S~ - Z Owner's Name Parcel # t # Block # y Owner's Mailing Addr~s n ~l ion Property locat ~ ~ q? S ~ ~ Z - 1 ~1~ y., N~ y., Section ~ City, State Ztp e ZONI I _ _ ~ Q 1/>j, Z S>-~ ~ ~~~ ? ~ ~ ' T ~ 1 (circle one) ~O N; R I~ E o~ a l h k h t i ll y) ec a t a app ng (c 11. Type of Build Q tT/Y~ ~.1 or 2 Fanuly Dwelling - Number of Bedrooms _ ~ '~ t0 ~ Subdivision Name CSM Number ~f _ `~ I~~e~'SBk'~ r ~~ S ^ Public/Commercial -Describe Use _ Z _ )( ~ u/ JS(~G`ri.~-Q/!q/ ^Village ~I'ownship of lUl~vl ^City ^ State Owned -Describe Use _ Ill. Type of Permit: (Check only one boz on line A. Complete line B if applicable) A' ~ New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other ModiEcation to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Chan a of g ^ Permit Transfer to New list Previous Permit Number and Date Issued Before Expnation Pltmtber Owner IV. T e of POWTS S stem: Check all that a t Non -Pressurized ln-Ground ^ Mound >_ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Cnade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In- ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Fiher ^ Recirculating Synthetic Media Filter ^ L.exhing Cha ^ Drip line ^ Gravel-less P' ^ Other (explain) V. Dis rsal/'1'reatmentAxea lnfor r-S ,f Desi Flow (gpd) / Design Soil Application Rate(gpdsY3 Dispersal Area Requites (stJ Dispersal Area Proposed (sf) System Elevation / goa t/ q33 ~ qs.~ .~ V . S ~Sa _ Vl. Tank info Capacity in Gallons Total Gallons Number of Units Manufacturer i~_ , „ n~ b~ ~y ' Prefab Concrete Site Constructed Steel Fiber Gtass Plastic Ncw Existing ~/ / f'r t ~Zl~-(GC Tanks Tanks Scptic~l'foldtttg'~artk ~OO DOO Y~~ D Aerobic Ttcatmcnt Unit Dosing Chamber /~...0 ~u ~~ ~/ Lfs t717 ~ -p ment- I, the undersig d, assu espo ibility for installatlon of the POWTS shown on the attached plans. a t e Vll. Responsibility St Plum 's Natne (Print} Pl s igtrature MP/MPRS Number Business Phone Number l a~r~ ~ SAN t_ P 39 ~Z acs-z3r z~~~ Plumber's Address (Street, City, State, Zr'p Cod ~~to 0 9 708 7"ui ~~ ~ ~Ea161~''l~/~ ~ J 4~? S" Vli Count /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Surcharge Fee) p-p ~ Date issued ~ ssuing A t Signa o Stamps) ~ ~ Z 5 ~ ~ ~ GL' ^ Owner Given Reason for Denial ~ t IX. CQn itions of Approval(Reasons~ rr DisQ~ -~t'~-~ ~~~~ ~~~„Q~ y,~ ~~,~„ ~rr[/JJQ~~ r1 ~ ~[~~ ~ '~+' ~-~`id!en~ .A.(~ '°~ - , S~IS~/h. Q~eQ~E. GhCvrt- fxll.C.i- 0 Q,r~.~~~~~Cuh,C~ ._ CU ~~ ~ ~ mpleQtc Plans (tn th2 upty only !or the eyatem O~papcr~i r~ss m ~ri~ t ~ rocoa~~7.Q'W t"~ 0K ~/ ~~ ~~~~~ ~~ T.L. Sinz Plumbing Inc. E5609 708th Ave. ~"T ~'~~'r~ ~~ r ~~"~ Phone: (715) 235-2644 Menomonie, WI 54751 ~T Z9 Pt~~~ ~T 1`~'` ~~ S .Fax: (715) 235-2592 TOtN~ yr ~.d-r~wtnlu..t p www.tlsinzplumbing.com NE -.1~ I~ Zg t1 gw ~` +: _ (o0 T~u-t ~ Z- l Jp2.~ / ~i ~ i ~~"` ~ =-l~t~ NE r a 1~ r- C+o~~ ~ju,(µ 2 I Del . ~ I (3 Z D s-r-~ O ku~ 1 N~ t •I frrt~ S ~ stews o R} ~~ oG.~' has `~ ~u ~,~i `'-, Too ~V~~~ l~ Lt 1'~'~oJ ~~rR-~I ~ `H,1 2~ ~~ L1-t/L -~. Stk£F 3u ~~w`,P N~ ~ ~ pl~~~b~ ~- ~ ~ ~d sT ~~ i~ 2 c~-~- T.L. Sinz Plumbing Inc. E5609 708th Ave. l~'"T ~4i"~''~ ~~7- ~~"~ Phone: (715) 235-2644 Menomonie, WI 54'751 J..oT Z9 P~~~ ~T I~ ~~ S .Fax: (715) 235-2592 ~w+J v ~= ~~ n~ n.1 p www.tlsinzplumbing.com ICE N~ I~ 2g ~~ Sup ~ I . =1~ g~u'~ I = ioo N~ r~ 1~ r 1o~,f.~. 3t,,~ ++ 2 i off. ZnST~ 2- ,~~~.~' R3,3 ST~''`~ ~ -K-~ I N~ ~ ~I f-rvF4~ 5 ~ S+~`~s ~ ,~. 6 33 ~~ '~`o .~.. Nom ~- l ~ p 2. l N~ ~' ~~ ~ ~ -T ~~~ ~~ ~~ ~~. ~ ~, ~~ 1 ~~ T.L.. Sinz Plumbing Inc. E5609 708th Ave. ~"T ~QW ~ ~~T ~~ Phone: (715) 235-2644 Menomonie, WI 54751 ~'`DT Z9 F'~e`~''t'1'T l~ ~(s Fax: (715) 235-2592 ~tN~ v~ ~.~-~twtr-1u.~ tD www.tlsinzplumbing.com /JE -J~ I~ 2g t1 Bw ~ ~. (oc~ ~l +~ Z ~ ~~ ~0 ~ ~~'` ~ ~ log NE LP 1-.0 ~ ~~~~ ~,,~ *~ 2 , i off. ~ ~nST~ 2- ,2,7. srti,,,o~ tr~~~~ 3o S+~L`'s B-' ~~~ . ' 11 .~..... M I- i H w~~-ruraavao~l= i.OC1C1-iCS CGV6R 3LNC+r-o-+ k/r/.ti~vwt~ld L//8.~~. BGIIt t~y~J:K a.coa.~>rc~~ la.., '. '4" ~ 3' ..~i ~ ~ ~ PIPS. 3' ~ ~„~ iO NDISTUR$~EA ... ~. Solu. 24'' x.~. ~ d~` 40 ,r M~4-luCtff ~. ' ~ Y~-•tT I~K~ r o~ Kcvt~ ~ 4 a c~T 3ba,rra ~_ ~FFI.E.S PJJ'f~ a J. a~. 3' a+To ~" uK~:.rxe.. N E G.TI O J+S ~'~`~ '""l ~ ~,i, ~ iQ ~ ~ ~ tT'c~ ~ 4N " (~ ~uKG ~~., , ~ c~ d ~ ., + to~Et-~ , _QV, i~e.a CSC SEPTIC E ~ _ SPEGI~J~GA'Y^1b1J5 00 S L I ~ ~,~ ~ ~.~, • T/~-,J., MAJJUiACTU0.1LR. 1JLtM6CR OP DOSES: 'S P£.K 01.E 7'I1JJK 'SIZC,: t s'~ - l,o,p TiAI..C.JSUS • .Doss VOS.uME Al.A1lI.1 MA-.JiJ~ACT~JR~R: SJ 1'~•~YVwr JIJCLiJDJAJCr a~G1GFLOW:~,.I y~ GA~~O~.Is. n4oEL -SUJ~4i'ltRi • ~ ° I ~ `~' C1-PAGITlFS; As ~~ WCHCS 4R l~ ~b w~~ ou s sWrTCM TyPL; mo`w` "' $: L iJJtxES DJl ~'a g (.glL01vS PUMA /11,J,1UF'ACTIJRCR: pry ~~~ C ^ ~ ~~`` Irvt:nE6 pJt 9D . ' MOOEL IJUMptR: ,~,~ Q ~ IAk;NES OR ~R~GAlLO~: J W I T C 1{ T b p 4: b`ti 4w ~+~, Y ~ ~ 111WIMUl~'1 DlSCKAIIGC RAT 30 GIN^~ NSTA~ EOApuRSEPtia TC CtKCu+r; JsrRF1G^U Crrp[RCAlCF OETWLtV PLSMM pfd 0 OISYRib1JTlOA7 PtpE.. _.,I~ FESY t M~uIMUM uCTWoaK SUPP~.y tR~tSUR~ ....... ~ .. ~ FECT ' "+' ~ IO ~~ E7 OF i'ORCC MAIN X l~ ~ , ~/'p0/L~RICT{O-,J MACTOR. ~.• I FCET ~ o~~ ~ "' TCTAL Oyf`IAM1C NEAP nc flLCT J7[Rr.JA~. DIMEAJ4101.1iL 0I T11JJK: l.£AltiTN i~.,.~ 11 ~" 2 Zd Wdti0:60 ti00Z ~Z 'hpW 860 £~Z STZ 'ON Xd~ ~JNIlSSl BIOS Q8I~I1b80 W02id Wholesale Products Page: 6350-1 Section: Performance Data Dated: January 2001 12 r 40 9 ~ 30 W Z ~ 6 ~ 20 a = J _ ~ °--- 3 '-10 OL 0 Capacity-U.S. G.P.M. ~ o zo ~o ao so Liters/Second 0 2 3 The curves reflect maximum performance characteristics without exceeding full load (Nameplate) horsepower. All pumps have a service factor of 1.2.Operation is recommended In the bounded area with operational point within the curve limit. Performance curves are based on actual tests with clear water at 70° F. and 1280 feet site elevation. Conditions of Service: GPM: TDH: I~ HYDROMATIC° ` ~ 1Ni cs or'+sin Department of Commerce~RIGINALOIL AND SITE EVALUATION Page I of 3 i Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8'/z x 11 inches in size. Plan must .County nt (BM), direction and include, but not limited to: vertical and horizontal re~ecenee-p.Qj St. CrO1X Y t d a roa . nd lacati0n/an istance to neares percent slope, scale or dimemsions, north arr¢w l Parcel LD # ;, APPLICANT INFORMATION - rint ,(1 inforriat n ase . ~ ~ ~ ~Z9 . , .e p ~ Personal information you provide may be use~fdr secondan~'ptupo,~eis{~rivacy ld~, 15.04 (1) (m)). eyIBW ~Date~ d, 0 ~ Property Owner , roperty Location Bonte, Ron i r ' ~ i ovt. Lot NE 1/4 NW 1/4 S 16 T 29 N,R 17 W Property Owner's Mailing Address of # Block # Subd. Name or CSM# 1011 170th St. ~ ,,. 29 Pheasant Hills City State Zipp Code""l~Hb I~ur4tliL ` , ` 715 796 52 0 ~ City n Village ®Town Nearest Road d 170Th St ~ - - 4 ; ,/ Hammond WI SE1015 . ammon New Construction Use: ~ Residential~fVttetber~of bedro~rns 3 ^Addition to existing building _ Replacement ~ Public or commercial deser~ie Code Derived daily flow 450 gpd Recommended design loading rate '3 bed, gpd/ftZ •4 trench, gpolft2 Absorption area required 1500 bed, ft2 1125 trench, ftz Maximum design loading rate •5 bed, gpd/ft2 •6 trench, gpolftZ site plan benchmar d to Recommended infiltration surface elevation(s) 24" below contours ft (as referre "" ~~ "" install 2 - 5' x 112.5' shallow trenches on contours for 3 br 7v0 C:numL~/~J ~ D~ SSO)' ~S Additional design /site considerations ---_ - Parent materiai rift 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 X U a7VIL UC~7VRIr 1 IVIY RGrVR 1 Boring# 33 Ground elev 97.4 ft Depth to limiting factor > 82• Z Ground elev 97.4 ft Depth to limiting factor > 60" H i Depth Dominant Color Mottles T t Structure Consistent Bounda Roots GPDIft2 or zon in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. ry Bed ~ Trench 1 0-4 7.SYR 2.5/1 - sl 2 m gr ds cs if .5 .6 2 4-16 7.SYR 2.5/1 - sl 2 m sbk dsh cs if .5 .6 3 16-39 l OYR 4/4 - sl 2 m sbk mfr cs 1 f .5 ~ .6 4 39-53 l OYR 4/6 - s/mcos 0 sg dl cw - .7 .8 5 53-75 I OYR 4/4 - fs 0 sg dl cs - .5 .6 6 75-82 l OYR 8/2 - fs 0 sg dl - - .5 .6 Remarks: some gr to hortzon ~ U 1 0-3 7.SYR 3/2 - sl 2 m gr mvfr cs tf .5 .6 2 3-9 7.SYR 3/2 - sl 2 f sbk mvfr cs 1 f .5 .6 3 9-20 7.SYR 4/4 - sl 2 m sbk mvfr cs if .5 .6 4 20-32 7.SYR 4/6 - Is 1 f sbk mvfr cs If .7 .8 5 32-51 7.SYR 5/4 - s/mcos 0 sg dl cw - .7 .8 6 51-60 SYR 4/4 - sl 2 f sbk mvfr - - .5 .6 c1S. ~{ = Z~{~' ~G~r Remarks: CST Name (Please Print) Signature: Telephone No. Henry F. Grote 715-665-2681 Address ern to of esang Dato CST Number Ref # P.O Box 57, Knapp, WI 54749 4/16/2000 222774 1061 PROPERTY OWNER: Bonte, Ron SOIL DESCRIPTION REPORT ~ page 2 of 3 PARCEL I.D.# Certified Soil e7"sting •+ 3„ Ground elev 95.8 ft Depth to limiting factor > 65" 4 Ground elev 95.3 ft Depth to limiting factor > 62" 5 Ground elev 97.5 ft Depth to limiting factor > 60" 5 Ground elev Depth to limiting factor Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots - GPDIft2 Bed Trench 1 0-3 7.SYR 3/2 - sl 2 m gr mvfr cs if .5 .6 2 3-8 7.SYR 3/2 - sl 2 f sbk mvfr cs if .5 .6 3 8-23 7.SYR 4/4 - sl 2 m sbk mvfr cs if .S .6 4 23-55 7.SYR 4/6 - is I f sbk mvfr cs 1 f .7 ~ .8 5 55-65 SYR 4/4 - sl 0 m mvfr - - .3 .4 Remarks: 1 0-6 7.SYR 3/2 - sl 2 m gr mvfr cs if .5 .6 2 6-15 7.SYR 3/2 - sl 2 f sbk mvfr cs 1 f .5 I .6 3 15-33 7.SYR 4/4 - sl 2 m sbk mvfr cs if .5 .6 4 33-62 7.SYR 4/4 - sl 0 m dh - if .3 .4 I i Kemancs: 1 0-5 7.SYR 3/2 - sl 2 m gr mvfr cs if .5 .6 2 5-9 7.SYR 3/2 - sl 2 f sbk mvfr cs I f .S .6 3 9-27 7.SYR 4/4 - sl 2 m sbk mvfr cs 1 f .5 .6 4 27-33 7.SYR 4/6 - is 1 f sbk mvfr cw if .7 .8 5 33-45 7.SYR 4/6 - is 1 m sbk dsh cs - .7 .8 6 45-51 7.SYR 4/6 - s 0 sg dl as - .7 .8 7 51 0 SYR 4/4 - sl 0 m mfr - - .3 .4 rcemancs: ux.~,o w i - ~+ Remarks: ,~ i . ~ p f 8 ~ + t- ~ N 3 f '~s -~ 1 ~ f - o , d ~ { ~~ "~ d '' s ' d C. 9 -~ ~ ;~ //YV' 1 ~ ~ J / a' ~ ~ s 3 D Z ~ c? '~ 6 2 ~ ~ \r /~ ~ Z ~ ~ ~ ~ u ~ Y ~ ~ ~, tf n c q o-' ;Q v n c ~ ~/ S d .-~- 0 d ~- f 0 s 9 0 ~~ J R~ ~ ~, ~~s~v ~~ 0 v er' ~` r~ 1 p o h ~ ~ ~/ J v s ° ~l "+ '' ~ ~y ~~ ! ~. f ~ Q ~ ~ ~. CY d t 4 '~ ~V 0 M t U 0 _~ a 0 8 ~% N 3 -~ -~' rt' ~ Z i ~ d o ~ ; ~~ ~ ~ ~ ~ ~. J ~ ~ ~ 3 Z 's 3 ~ 2 ~ ;~ _~ .,{- D ~ D ~ .-~ U' ~ ~ r ~ 2 s`i . ~ ~i 1 s ~-1~ 0 0 t 0 (`n ~ N `~ ~ J ~ ~_ n i ~ 6 v_ ~~,! ~v 6 y~ ~ .~ ~ ~ ~ ~ -^ dry. v b ~'' ;~ v ~; ~,: R J- ~ a~ ~ ~ ~ ~ ~n 0 `~ N ~ ,~ v o s s o c r , '~ ~ ..~ ~ ~ ~. r1 f 0 ~-t' ~ O ~ d 'r 4 a-~• 0 `yam r ` t~ ~ a ~ x- 0 '' ~ ~~ ~ ~- ~ o M ~ S ~ o ~~ ~1 0 ~i `~ ST CRO1X COUNTY SEPTIC TANK MAl[NTENANCB AGREEMENT AND OWr1BRSHIP CERTIFICATION FORM OwnerBuyer Mailing Address '~' 9~~ any amr~wv~ W~ S`/~~S Property Address _ . (Verification required from Planning Department for new consbcuctioa ,.---- m~ ~ ~~ C~~~--o`er ~ Parcel Identification Number ~ ~~ City/State ~,~ sr - DESCRipT~ON ~~ ~ / `~ ~ '/., Sec. ` ~ . T~,N-R,,,_ ~ w. Town of ~ property Location /4, ____.- ~ ~ ,~ Lot # ~. Subdivision ~`~ Certified Survey Map # Warranty Deed # _ ~ ~ ' ~~ Spec house ^ yes ~ no Volume C _, .Page # -~7 ~ Page # ~~' Volume -~ Lot lines identifiable ~ yes ^ ao ~~rT.rnr n2e nv'i'FNANCE Y remature failure to haadlc wastes. Proper maintenaacc a}..a.,~ Improper use and tnaiatenanceof our septic system could result by a ~~ p~p~• ~t you put into the system consists of pumping out the septic tank every throe years at sooner. can affect the function of the septic tank as a treatment stage in the waste disposal system- e~ a certi5cation form. signed by the owner and by a The property owner agrees to submit to St. Caoix Zoning Departm vetifyinE that (l) the on-site wastewater disposal system ~pl~~,I~ymanplumber, restrictodplumberor a licensed ~)~ ~ septic tank is less than 1/3 full of sludge. is is proper opcratrrrg condition and/or (2) after inspection and pumping (• is and agree to maintain the private sewage disposal system with the standards ~, the undersigned have read the above roquisnmen ~ of Natural Resources, State of Wisconsin- Certif'cation as set b the ent of Commerce and the Depa~ Office within 30 set forth, herein, Y stating t Your septic system has been maintained must be completed and returned to the St. Croix County Zo~B Sys ~ three expiration date. ~ ~ ,~z, ~___-~~~ DATE GNAT[JRE OF APPLICANT OWNER CER'I'IF~CAT~ON our knowledge. I (we) am (are) the owncr{s) of I (wc) certify that all statements on this form~~trrecord~ ~ R~~er of Deeds Office. the pr desen above irtue of a warranty J ~~ DATE S ATURE OF APPLICANT «««.. Any information that is mis-represented may result in the sanitary pelt being evoked by the Zoning Department. «««««« warranty deed from the Register of Deeds office «« Include wfth this appUcation: a stamped if reference is made in the warranty deed a copy of the certified survey reap / POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of ?/ FILE INFORMATION Owner '~~~-- ~, Permit ~ D ~ DESIGN PARAMETERS Number of Bedrooms "3 ^ NA Number of Public Facility Units -E3-NA Estimated flow (average) (00 al/da Design flow (peak), (Estimated x 1.5) /~Sa al/da Soil Application Rate ~ ~ al/da /ft2 Standard Influent/Effluent Qualit Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand IBOD51 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly ave rage Biochemical Oxygen Demand (BOD5) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ~NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Ye in dia. ^ NA Other: ^ NA `Values typical for domestic wastewater and septic tank effluent. ^~A1wITC~IA\If~G C/+Ll Clll 11 G SYSTEM SPECIFICATIONS Septic Tank Capacity pp c7 al ^ NA Septic Tank Manufacturer ~w iT ^ NA Effluent Filter Manufacturer Zp,~y, j,~ ^ NA Effluent Filter Model ~. - p ~ ^ NA Pump Tank Capacity (~g~ al ^ NA Pump Tank Manufacturer J l~_ ^ NA Pump Manufacturer ~~ ~ c___ ^ NA Pump Model S~{- ~' "~ p ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection - ^ Peat Filter ^ Wetland ^ Other: NA Dispersal Cellls) 3 D ,SQ / ~ A ~-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade O Mound l~~u~~" ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA 1\IMII\IL.1•MI\VI. VVI11-VVLL. Service Event Service Frequency Inspect condition of tank(s) At least once every: ~ ^monthls- earls) (Maximum 3 years) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third 1Y31 of tank volume ^ NA Inspect dispersal cellls) At least once every: 3 ^monthls) ear(s) (Maximum 3 years) ^ NA monthls) jj,e ~3 /~ ^ NA Clean effluent filter At least once every: ~ .e1 yearls) Inspect pump, pump controls & alarm At least once every: ~ ^ monthls) year(s) ^ NA ~ ^monthls) ^ NA Flush laterals and pressure test At least once every: ^yearls) Other: At least once every: ^monthls) ^yearls) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cellls- shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals o~,e-third IY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and' disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page ~ of l/ START UP' AND OPERATION For new c~instruction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cellls). If high concentrations are detected have the contents of the tankls) removed by a Septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) in one large dose, overloading the cellls) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the foilowing measures have been, or,must be taken, to provide a code compliant replacement system: ~A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. e sit ha of been e a ated to id ' y a suit replace n area. po failur of a PO S soil site ,~` ~aluat n us be pe orm to loc e a s itab repla amen area: If n repla nt area i ailable ding tank 1 _ may be in tailed s ast reso to place the lied PO ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~(~ Slr~ Z >zL~Er ~~ L Phone ?(~ '~~ ~ ~~ POWTS MAINTAINER Name TL ~~NZ /~Ly/i!/3/N / fir" Phone ~/,~ 231- Zl. ~ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ~~ ~D ~ ~ ~ N Phone '1rS~ 3~b- ~b~o This document was drafted in compliance with chapter Comm 83.2242)lb)41)(dl&(f) and 83.54(!1, (2) & (31, Wisconsin Administrative Code. J 2153? 506 ~11~~3 '~~ STATE BAR OF W ISCONSIN FORM 1 -1998 WARRANTY DEED This Deed, made between Will M. Evans and Jennifer L. Evans husband and w'Ife ,Grantor, and Patrick J. Horwath and Jennifer A. Horwath Husband and Wife ,Grantee. Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of Wisconsin (the "Property"): XATHLEEH H. YALSH REGISTER OF DEEDS ST. CROIX CO., NI RECEIVED FOR RECORD 02/25/2003 10:15AM EXEMPT t REC FEE: 11.00 TRANS FEE: 111.00 COPY FEE: CERT COPY FEE: PAGES: 1 Patrick J. Horvath Jennifer A. Horvath 975 172nd Street Hammond, WI 54015 018 1083 29 000 Parcel Identlflcatlon Number (PIN) This is not ' homestead property. QS) (is not) _- Lot 29, Plat of Pheasant Hills in the Town of Hammond, St. Croix County, Wisconsin Together with all appurtenant rights, title and interests. none Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 20th day of February, 2003. (SEAL) ill M. Evans AUTHENTICATION Signature(s) (SEAL) authenucated~iFsN ~ Y d~fATZ I NA NGSTAFtyY'Pl76LTC~ - ~T9TF ~1= WISCONSIN TITLE: MEMBER STATE BAR OF W ISCONSIN (If not, authorized by §706.06, Wis. Stats) THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet 1301 Coulee Road Hudson, WI 54016 3-24180 (Signatures may be authenticated or acknowledged. Both are not necessary.) (SEAL) ~~~ enni r L. Evans ____ (SEAL) ACKNOWLEDGMENT SL Croix County State of Wisconsin, } ss. Personally came before me this 20th day of February, 20~~ the above named Will M. Evans and Jennifer L. Fv~ns, Husband and Wif to me known to be the person who executed the foregoi instru ant and acknowl ge the same. • -e y SQL Notary Public, State gfWisconsin My commission permanent. (If not, state expiration date: ~~~/~~ .> Names of persona signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 1 -1998 Milwaukee, Wis. 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