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HomeMy WebLinkAbout018-1083-33-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building-Division ,1 s 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 Bonte, Ron Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: f / O l TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic /~ Dosing ~6 ~ r'P Aeration ~' ~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Ven Air Intake ROAD Septic / ~~ 1 Dosing 3 ~ ~q~- Aeration Holding PUMP/SIPHON INFORMATION PM TDH Lift Friction Loss ~ System Head TDH 811 r- 2.~ i - Forcemain Len ~ Dia. w r Dist. to Well SOIL ABSO TION SYSTEM ,~ BED/TRENCH Width ~ / ,~,. Length / No. Of Trenches ~ DIMENSIONS ~1"' 41~ SETBACK SYSTEM TO P/L BLDG WEL INFORMATION Type f System: / ~ ~fi~ S` s~ DISTRIBUTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 420339 0 State Plan ID No: Parcel Tax No: 018-1083-33-000 STATION BS HI FS ELEV. Benchmark 3, 5 ~ , ~~ a Alt. BM ~~~ Cd ~ /a l ~ 'S Bldg. Sewer . ~ 3. St/Ht Inlet SUHt Outle ~ _~ Dt Inlet ~/ ~/ Dt Bottom • d ~/ d d ' He a Man. q t ~. 7 Di .Pipe TO ~, g s Bot. System ~. Final Grade ~ yam. ~ St Cover Z ~/. DIME-~ISFONS INo. Of Pits Ilnside ~ ~~ CHAMBER OR v~(Jr'• ~-//f'7/ 7 «QO't UNIT odel Number: /2 f~ HeaderlManif~ld f1 Distribution ~ ~ x Hole Size x Hole Spacing Vent to Air ake h pipe(s) / ~ ~ Lengt Dia Length Dia Spacing ' SOIL COVER ix Pressure Systems Only xx Mound Or At-Grade Systems Only (/ ~ ~ ~ q( Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulche~~ Bed/Trench Center I BedlTrench Edges Topsoil ~ ~~ Yes ~ No [~ Yes [, No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ ~/ 2-/ O Z Inspection #2: / / -~"'~d Location: 1712096th Aven~ue /H~a~m~mond, WI 54015 (SW 1/4 NW 1/4 16 T29N R17W) Pheasant Hills LGotp3~~ Parcel No: 16.29.17.605 1.) Alt BM Description = ~ / `~ (~v ~~2 DYf`B S~/~~'~i~ Q~d~'l~ -/O~d ~~'dLt/1J~ ~2G~''`~~~~~ 2.) Bldg sewer length = ~(~ ~yJ ~Qh/ ~- ~2 . - amount of cover = \ ~ / Plan revision Required? Yes !+'NO --~r~-~O r -- - _..___ __. _ i ~~ 1 Use other side for additional information. ~ ~~___1 - -- ---_ -- ---~:1~ - ---. ~~ ~ -~ SBD-6710 (R.3/97) Date Insepctor's S nature Cert. No. 01~~8~- Sanitary Permit Application safety ~ Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. PO Box 7302 `~SCO/1Sin See reverse side for instructions for completing this application Madison, WI 53707-7302 department of Commerce Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County State Sani Permit N ber ^ Check if revision to previous application State Plan ~. ~ ber ro~>< a 3 I. Application Information -P lease Print all Information, Location: Property Owner N e c a tion o Property L -~ ~ ~ ® l~t~ ~6AJ I ~L `5`COiri~ ~V Ir~l-U1L ~ ~ ~ ) c~ ~1/4 ti/"`il/4, S I ~ T a /,N,1~~ (or Pro Owner's Mailing Address Lot Number Block Number Ci ,State Zip Code ~ Phone Number Subdivision Name or CSM Numbe II. Type of Building: (check one) ~ s : 3 of Bedro 2 F il D lli N 1 ^ City ^ Village ~ g~ or am y we ng - o. d02 ): bli /C i l d ib Yl/} ^ P ~'7'own of ommerc e use _ c a ( escr u ~ { r ~ ~ ^ State-Owned ~ O~~^II~ ' 1.~~4.St' ~~ i ~ ~ :,G ~F, / ~T 3xa~~ iS z~~~ - Ne estRo T~ - ~ ~ ~ ~~ ~ l~di1'H'~cY/Yy P ~ III. Type of ermit: (Check only one box on line A. Check box on line B ifapplicable) A) l . New 2. Replacement 3. Replacement of 4. 5. 6. ^ Addition to System System Tank Only Existing System B) Permtt Number Date Issued ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ~~~$ ~ ~/ ~ Non-pressurized In-ground ^ Mound Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V. DispersaUTreatment Area Information: 2. Dispersal Area 3. Dispersal Area 4. Soil Appli\ation 5. Percolation Rate 6. System Elevation 7. Final Gra 1, 1. Design Flow (gpd ~ Required Proposed Rate Jda /sq. ft.) (Min./inch) Elevation ~~ ~~o ~ X33 ~ ~ .~ ____ 9~~ 9~ -~ VII. Tank Capacity in Total # of u~acturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing /~ W Q~P~ ~- ~ Crete structed Tanks Tanks ~~ r c, pc~b QDq 1~- ^ ^ ^ ^ -vl. ~D ~ ~s~~~ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for ' s ]lation of e POWTS shown on the attached plans. Plumber's Name (print) Plumber's ig atu o ps): MP/MPRS No. Business Phone Number LS,~L ~ l 9 bZ ~-2 -2~ Plumber's Address (Street, City, State, Zip Code) IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater e Fee) Surchaz Date Issued ~ suing ent Signa a (No stamps) Approved ^ Owner Given Initial Adverse g ^ ~ ~ ' ~ ~ Z ~~ ~~Yfi+~- Determination S , ' o C Q . Conditions of Approval /Reasons for Disapproval: 5~~,~,6~ ;; .s{~i~. Gc•K 2Q 1a.~.~~~/ B 3 ~Q a 5 • y ~6 ~~ ~~~,~r Sy~l-~r-• Mus7' 6A. 6~4~:~¢d Con-fau`•/~7 d p _ q~~~~ ~ -tl1~r lrno~.~ ~ ~~d.~- d~~ S't~ ~ ~~~w~6a- s ~ L~~FKeu.~ 3'~ U=~c,~ _ ff~rum.- a ~ - -~~ -~: Pc~-~ ~ ~ s °''''.. • 0 C,~iar~c_~.cvn~.u-~.c~ - u,U-a~r~G%~4X~ ~'159h ~ C'a~~~y-~ 22 ~ ~ ~°'~ k7~ ~ 353 T.L:.Sinz~Plumbing In qq' ~~ s I ~~ ~~ E5609 708th Ave. tiJ k~.oNT~ Menomonie, WI 54751 o-r 3 3 ? rt~S rtxl i ~ l I S .S u B c~ ~ J. 5~ '/~ N ~ '/~ s I to T Z9 (Z l 1 r.J \~ 1-~w-vn-~ T~~~n~c~~P ~ ST L~('b~x ~o. M .. j~p ~% L'or~~ec ~~~~ (3wt ~ ~ _ goo v ~$ 4 X7.8 liwl a- a, 7 X 93,7x' s~~ ~ l q`.s ~~, o l~v~ rr ~oa~/'°°'~ G'o,~r cam, 7'-~Mi< ~ `~ ZrczscG 14--1~0 ~ ~~~ - W Phone: (715) 235-2644 Fax: (715) 235-2592 www.tlsinzplumbing.com ~,,, ~a~ tJ M~ T--~~ o,v~x.rrrn~ bZ ~~~g~ T.L.' Sinz Plumbing I, E5609 708th Ave. Menomonie, WI 54751 ~° M~ ~' ~,o ~ 2jV't ~ ~ ~,~I3S~3~q.1 qq ~, / ~~ N ~Nt~ oT 33 >~~Yt'SN-r~Ji '~IIS SuB t)iJ, 1y~tvx ~ T~~~ sbFi ~ sT ~/'brx ~ o, ~~P ~~- ~~~,~~ec ~~~~ Qwt ~ ~ = ~ o0 v ~$ v ~ , Q ~~.8 ° .Tn.s Tel ~ . ~- a, 7 X 93,75' 30 ,5 ~~ ~~~~ ,n~~eo~ C~o.~r ~ 7`~ric Zrt'isCG ~lUO ~-t lft2 y ~rc,y,,c ~~~ ~~:~~ 3 v pv~~ 3 ~E~ w ~~q . Phone: (715) 235-2644 Fax: (715) 235-2592 www.tlsinzplumbing.com ~ ,~, Go "` ~ T~~ pN(eh.r~7J?.QZ Sys ~~ ~s-o `~..~ • J ~ ~g~bv r~ FRS iM CERTIFIED StJ I L TESTING ;~ Cr r`~-e- b~ =1~„ ~..--.~i ¢~- Pyc ~..M 'rlll 10 t~s~sDsSTuR6E0 Sail. ~~ r ia~rtwto c~T 3DrNr-a F~l-~ _ H,rLTt arcs ,_~~ L~~ ,24" I-T~. MA~uO~ ~ a ~ ZS b FRX NO. 715 233 03'3 L--'x;~- 1~~.~~;1 WCKtrt.~14 GONER `~ t~.i~v~~.~ a .c ~I~'E~4 . ~wcK P~acaw~tAC'~--~ ~ '4 M ._. ;: J!_in. 14 2t~2 05:52Rf'I P3 ~ ~ T~ o R ~ ~{ .----_-. M n+ K W~.AYµEt;PRa3K (~1 3L wCY tea t+ ~ ~y &~ t-^` ?~ c i \ 4" 4 o v~~f ~~ NtaG ~" P Sa..~: ~~~rs ~ Q,L ~ 3' a+ra ~z~.~~ ~,. lo~~'~ _~PECft:I~GATtCSA,-5 sE~r~c F ~ 005E r ~ ' y,~+~rt.4~ ~ TA 1J r.5 MA-~UFAGTURCR: ~l13M6ER Of POSES: PEK DAB TA--sK $ix~: `~~ r `~~ ~sALl.G1JS ~ .OdSC VOLUMC 9q ALARM M/WlJ1~~1C,TLifi~,R: s'1 ~~'~ai..~-rte IIJCLUCIAiG QAtKPGDW: ` / (.AL~ONS r,ooc~ uuttiscR: . 1 a ~ 1-~ ~•,~ CxPAU7it:s: ~ ~ 0?7, 33 wcNCS aK ~.. c,A~~o>vs Swr~CH 'T'tIPC: ~~4" ~`~(~' 8= Z' ~tic-+£S OR 'Z'~~'a G~icouS YZ,1N1P MAFJUFAG7UR>ie; ~ r0 ~L ~„~~ t:~!~o ~uGn~S OK~ L~~~C~S MOPES -JUMDER: Stf~~3o ~ ~R~r ' D~ ~tv,.;,; 4+~s.:KEScR G1~ SWITCH TLi?C: ~t~v~v .L_ ATE: P~1M~ RivA Al+~~iht AR- t-o bC MiR.4 t MUl"'y QISC-i#.1lC.E R~TR ~0 GSM -NSTALUED Ot•! 5£ Pr.0.ATE G~~KC _!'' ~ VLRTIt+IL c~Fts~,r~rcc DErwcru Pcsr~ot~-,tuc D~~7R~t3t3Ytow PtPE..~ FEET ~~, + M3u~nuM ~,t=rwortK su~~c.y ~R~tsuR~ ...... , S ~~cT .. _ a ~ ,,[ + s~ FEfT of PORttr M/-IN X ?~ ~~4~x,FlticTiau s~-cTaA..~,;,~„~ FEET ~ ~ ,,,~., j a ----~ ~ J fiOTr-t. D~UAI'tIG. H[AO = ~O'~ FE.Er J~ , ~ y :AfTERaJAS_ p1MEfJbspl~s~C of TAt.tr~: [,~tiiGTN ,,,~ ;W,pTN ._. ~ ; 1_tgUsti DEPTH Perfarn~an~e ' Wholesale Products Page: 6350-1 Dgtp Section: Performance Data Dated: January 2001 RPM: 15 SO Discharge: 1-1 /S" Solids: 3/4" 12r 4( 9 ~ 30 W Z ~ 6 ~ 20 a = z 0 3 '-10 OL 0 Capacity-U.S. G.P.M. liters/Second 0 10 20 30 40 50 1 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~ FIYDROMATIC' Wis`c'onsin De artmentof,Commerce LAND SITE EVALUATION Pa e 1 of 3 "'Division of Safety and Buildings ORIGIrd with Comm 83.05, Wis. Adm. Code g 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 t road t l l di i th li d di t t St. Croix . percen s ope, sca e or mems ons, nor .arrow, an on an s ance o neares Parcel LD.# ,, APPLICANT INFORMATIO Please printall i rmation ®/ -/03~- (oo- ® - . Personal information rovide ma e used for secop~pr ur Law t s oa (t) (m)) ou oses (Pri c s R d By Date y y p p , . . p y , . Y ~ ~ ~ er .~ Property Owner _ ~ ~ ~" " " l . -- ; Property Location Bonte, Ron. ! Govt. Lot SW 1/4 NW 1/4 S 16 T 29 N R 17 W Property Owner's Mailing Addr ss,:. ~' ` ~' ' '`' - , Lot # Block # Subd. Name or CSM# 1011 170th St. ',~.. , ST CB~,.X 33 / Pheasant Hills City 4 :State p u fief:, ~ ~ ' ^ City n Village ®Town Nearest Road 170Th S T Hammond - WT':~, 5 15-7,9 ,-~ 0 t. Tammond v- 1 ber of bedrooms 3 ^Addition to existing building New Construction ^ la ~`~=~d~~t _ . Use: - _' Replacement [] Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate •3 bed, gpd/ftz •4 trench, gpolftz Absorption area required 1500 bed, ftz 1125 trench, ftz Maximum design loading rate •5 bed, gpd/ftz •6 trench, gpolftz Recommended infiltration surface elevation(s) 24" below contours ft (as referred to site plan benchmar install 2 - 5' x 112.5' shallow trenches along contours for 3 br Additional design /site considerations 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 UC~7~rRlr 1 IVIY RGrVR 1 Boring# 15~ Ground elev 96.3 ft Depth to limiting factor > 88" 2 Ground elev 98.2 ft Depth to limiting factor > 70" Horizon Depth Dominant Color Mottles T t Structure Consisten Bounda Roots GPDIftz 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 4-29 7.SYR 2.5/1 - sl 2 m sbk mvfr cw if .5 .6 3 29-50 l OYR 4/4 - sl 2 m sbk dsh cs 1 f .5 .6 4 50-56 l OYR 4/6 - s 0 sg dl cs - .7 .8 5 56-68 SYR 4/4 - sl 0 m mfr cs - .3 .4 6 68-88 l OYR 8/2 - fs 0 sg ml - - .5 .6 Remarks: 7.SYR 4/4 sl band @ 73-76" 1 0-7 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 7-22 7.SYR 2.5/1 - sl 2 f sbk mvfr gs if .5 .6 3 22-40 7.SYR 4/4 - sl 2 m sbk mvfr gs if .5 .6 4 40-51 7.SYR 4/6 - is 1 m sbk dsh cs - .7 .8 5 51-70 7.SYR 5/4 - s 0 sg dl - - .7 .8 Remarks: CST Name (Please Print) Signature: _ Telephone No. Henry F. Grote 715-665-2681 Address ertt to of esttng Dato CST Number Ref # P.O Box 57, Knapp, WI 54749 4/16/2000 222774 1074 PROPERTY OWNER: Bonte, Ron SOIL DESCRIPTION REPORT ~ page 2 ofr. 3 PARCEL LD.# ~ ' " ~ Certified Soil ~ri~. 3 Ground e 97.0 ft Depth to limiting fac > 60" 4 Ground elev 97.8 ft Depth to limiting factor > 60" 5 Ground elev 97.0 Depth to limiting fa > 67 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 GPDlftz Beds Tench 1 0-5 7.SYR 2.5/1. - sl 2 m gr mvfr cs 1 f .5 .6 2 5-22 7.SYR 2.5/1 - sl 2 f sbk mvfr cs lm .5 .6 3 22-3 7.SYR 4/4 - sl 2 m sbk mvfr cs if .5 .6 4 36-45 7.SYR 4/6 - is 1 m sbk dsh cs - .7 .8 5 45-60 7.SYR 5/4 - s 0 sg dl - - .7 .8 A~' S a ~ _ ii ~" ~a a ©y a G~/ Remarks: Gtit.~I/ ~f~i c:C~ta ~~2. iftc~t~l~ a~ic~~ ~„ ._ ~ ~ _i 1 0-4 7.SYR 2.5/1 - sil 2 m gr mvfr cs if .5 .6 2 4-22 7.SYR 2.5/1 - sil 2 f sbk mvfr gs lm .5 .6 3 22-44 7.SYR 4/4 - sil 2 m sbk mvfr cs if .5 .6 4 44-57 7.SYR 4/4 - sl 0 m mfr cs - .3 .4 5 57-60 SYR 4/4 - sl 0 m mfi - - .3 .4 Remarks: 1 0-5 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 5-21 7.SYR 2.5/1 - sl 2 f sbk mvfr gs lm .5 .6 3 21-3 7.SYR 4/4 - sl 2 m sbk mvfr gs if .5 .6 4 38-48 7.SYR 4/6 - Is 0 sg dl cs - .7 .8 5 48-67 7.SYR 5/4 - s 0 sg dl - - .7 .8 }~" ~S'~•o ~ = z~u 6~ - -~ ~ N v 9~ ~ .' 1 bg.Sl. ~ I~ 2"~ ~ ISM LQQ.i~ \\Oh 1~OMTP-\ \p~ ~14•, ~l~ L~rv.o ~ • Z ~~ (~ ~4 1C1 cq~-g~ r 4 ~i' C 4'~ •o ~ ~~~ X41..3) i3-3 .Z c~ Qc . °( ~' \ Vo.t4' 430.- 4, 1. o ~ 3 5 ~ 1~ ~. ~..,.,.,,~ ~~ ~ ~~s N Jca.1~ ~„ z (,~~ 0 1o t,o /~„~`.~ 1 ~(. 41.< ~ ( (~ ~ ba.a~cln.oe ~:~ ~ .~ ~co~.~•ve«~e`.1 saC~.v 30~~. A W - -._ . 1. . ,~ `. - ~. - -_ - ~ . EJ11 T; I AL USE ~ - IDENTIAL US~_ " <- _- ~, _ _ _ tal; ~; .£F I,££ _ _, o ~ I ~7.lf~.... M ~~~'O .,~-€-of3~ltt--~-_ _~ _ .ia ~ :.. .....- ...~.6•~~':80 ..... ...........................,~ - - '~ - --- Vr-, Do-- ~'' - ~ ~ o ,, ,..~ ~:` - _ `" C~- Cal ~° _ ~,~ N ; r _ ~ j N ~ ~ ~ - ` ` _ ' / J ~ ~ fir, ~ /. %. -~- n ~ ~~ ~ ' a ~ i` ~.. ~ ~ ~ ~ T I jI ~ ~ 5 . / ~ /1-•.., Pty v. cn' ~ . ~ ''. 3"!f~ t sb ti - •4. l r d a 6' -. ~Z s 1 ~ ~ ~ _ " 4/ ':~ N ~ - - w ti s.~- ~ . . ~` .' ~ •' ,' , r r. . ~ ~ ~ ~~ t: ~ ~ ~ -~fl1~t0 ~ tq ! O ~ -- v ~ ~ ~ CD ~ ) .. ;~ I - - ` ~~ i ~ O ~ ~ ` ~ 1 ~~~ ~i N ~ ~~ 0 ~ ', ~ .~ ~..'~'f ~ NN ~ -.a ~ `~, l~ .~ ~ ~ it ` .~•• ~ r •~~' ~ U ~- ~ ~ ~ ~ _,~ (A , / ST • ' `I ~- ~ . a, .. ~ r, ~ ~N Ql (n 1'1 C!7 •~ l ' _ ~ l`~ ~ N ~ ,. ~ •.~ .~ ~ _ _~ rrr a r~rrncMeT1ATJ POWTS OWNER'S MANl1AL ~ MHivtivt;[ncty~ r~rliv -~a,~..,.. ~. Owner ~ ~~yi, ~~ Permit # ~a ~ 339 DESIGN YAKA1"1C~cec~ B d ~ ^ NA rooms e Number of , Number of Commercial knits ^ NA Estimated flow (average) ~ ~frr~s gal/day Design flow (peak), (Estimated X 1.5) ~ gal/day Soil Application Rate c S' gal/day/ft2 influent/Effluent Quality Monthly average* Fats, Oil ~ Grease (FOG) s30 mg/L Biochemical Oxygen Demand (BODs) <_220 mg/L Total Suspended Solids (TSS) s 150 mg/L Pretreated Effluent Quality ' ^ NA Monthly average* Biochemical Oxygen Demand (BODs) <_30 mg/L Total Suspended Solids (TSS) _<30 mg/L Fecal Coliform (geometfic mean) <_ 10' cfu/ l OOmI Maximum Effluent Particle Size % inch diameter MAINTENANCE SCHEDULE Service Event Inspect condition of tank(s) Pump out contents of tank(s) Inspect dispersal cell(s) Clean effluent filter Inspect pump, pump controls BL.alarm Flush laterals and pressure test Other: cvrT>:M SPF['IF1C_ATIONS Septic Tank Capacity al ^ N/ Septic Tank Manufacturer ±-}~,~e.~ T ^ i~ Effluent Filter Manufacturer ~ ^ N~ Effluent Filter Model f u0 ^ N' Pump Tank Capacity gal ^ N. Pump Tank Manufacturer ~ ^ N~ Pump Manufacturer Z ^ N, Pump Model ~Jf7~ ^ N' Pretreatment Unit ^ N. ^ Sand/Gravel Filter ^ Peat i ter ^ Mechanical Aeration ^ Wetland ~~ ^ Disinfection ^ Other: I,;,,~ ~a Manufacturer Dispersal Cell(s) ~Cln-;round (gravity) ^ In-ground (pressurized) ^ At-grade ^ Mound ^ Drip-line O Other: * Values typical for domestic (non-commercial) wastewater and sep tank effluent. * * Values typical for preveated wastewater. Service Frequency At least once every ~ ^ months 'year(s)(Maximum 3 When combined sludge and scum equals one-third (Ys) of tam e At least once every fit least once every At least once every At least once every ~At least once every At least once every ^ months J~ year( ^ months ~ year(s) 3 ^ months ~ year(s) (Maximam 3 yrs. ) ^ NA ^ months ^ year(s) ~JA ^ months ^ year(s) gyNA ^ months ^ year(s) C~-NA MAINTENANCE INSTRUCTIONS Inspectioru of tanks and dispersal cells shall be made by an individual tarrying one of the following licenses or certifications: a Plumber; Master Plumber Restricted Sewer; POWTS InspectormPsO or brokenihardwape, identify any cOrackstor leaks,kmeasure muss include a visual inspection of the tank(s) to identify any g volume of combined sludge and scum and to checkn~leveisbncthe observation p pesfand to~ heck fo~any ponding ofheffluent~o cell(s) shall be visually Inspected to check the efflue 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. the entire When the combined acail be removedsb ya SeptageuServicing Operagtorland di porsed o)f in ac~ordan eewith ch INR 1 13, Wisco contents of the tank sh Adminisvative Code. The servicing of effluent filters, mechanical ormonths ordlessOsh i be performed by a certified POWTS Main[ainerany ocher maintenance or monitoring at intervals of 12 A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START U P AND O P ERATI O N For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other c err that may impede the veatment process and/or damage the dispersal cell(s). If high concentrations are detected have the cone ~~ rl+n ran4rfs~D ramovPd `=Y ~ ~Pnt~e servicing operator prior to use, .* ~a~e _of._ System start up shall not occur when soil condltJons are (roan at the Infiltrative surface. During power ouu>res pump tanks may flit above nomul hl~hwater keels. When power is restored the excess wutewater will tie discharged to chc dispersal cell(s) In one large dose, overloading the cell(s) arsd may result in the backup or wrface discharge of e(Tluent. To avoid this situaUOn have the contents of the pump tank removed by a Septa¢e Servking Operator.prior to restorlnti power to the effluent pump or convect a Plumber or POWTS Maintainer to assist in manually operatlnai the Dump controls to restore ncrmal levels within the pump unk. Do not drive or park vehicles over unks and dispersal cells. Do not drive or park over, or otherwise 4lswrb or compact, the area within 15 feet down slope of any mound or at•grade soil absorpton area. Reduction or elimination of the following from the wastewator itrearn may Improve the performance and prolont the life of the POWTS: antlblotla; baoy wipes; cigarette butts; condoms; cotton swags; degreasers; dental Ross; diapers; dlsinfectanu; tat; foundation drain (sump pump) water; (rust and vegttlblt peclings; gisoAne; grease] h~erblddss; meat scraps; medications; oil; palntlnR croducts; oesticides; sanitan naakins: tampons; and wacer sofuner brine. ASANDONEMENT shall be taken to Insure that the system is When the POWTS fails and/or Is pem~anently taken out of service the foiiowln>j steps propCrly and safely abandoned In compliance with ch. Comm 83.33, Wlscoruin Adminlsuatlve Coda • All piping to tanks and plu shall ba disconnQCted and the abardoned Piet openings sealed' • The contents of all tanks and pits shall be removed and property. disposed of by a Septage Servicing Operator. Aher purnpin~, alt tanks and pits shall be excavated and removed or their covers removed Ind the void space filled with soil, ~~~avel or another Inert solid material. CONTINGENCY PLAN If the POWTS fails anti cannot be reraired the followlnt measures have been, or must be uken, W provl4e a code compliant replacement system; O A soluble replacement area has been evaluated and may be utlllred (or the location of ~ replacement soil absorption system. The replacement area should be protecte4 horn disturbance and compaction and should nat be Infrlniie4 upon by required setbacks from ext:ring and proposed strucWre, lot Ilnts and wells. Failure to protect the repla<ernent area will result In the need for a new Boll and site evaluation w tsubllsh a suitable replacement area. Replacement systems rnust comply with the rubs In effect at that time. O A sult~ble replacement area is not available due W setback and/or soli limlptions. Barring advances in POWTS technology a holGing unk may be InsaAed as a last resort to replay the faileQ POWTS. O The site has not been evaluated to identify a suitable replxement area. Upon failure o(the POWTS a loll and site evaluation must be performed w locate i sulUbie rcplace>asentarea. if n0 replacement area is available a holding unk may be insulted as a last resort to replace the failed POWTS. O Mound and at•grade soil absorption sysums may be reconstnacted In place following removal of the biomat at chc Inftluaclve surface. Re<onswalons of such rystems must.compfy with the ruks In effiect at that time. < <WARNING> > SEPTIC, PUMP AND OTKER TREATMENT 7ANK5 MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT D ATH MAY RESOULTENRESGUE OF A~P6RSON FFROM TKE IN?ER t~R OFAA TANK MaY sE DIFF(CUIT OR E5. IMPCICCIRI i AD01710NAL COMMENTS ontarrs IAISTALLER Name ~, Sl b ~ Phone ,~ ~ - SEPTAGE SERVICING OPERATOR (PUMPER Name Phnnt POWTS MAlNTA1NER Name ~ it/L Phone ,S ~vS- ZIo~S~ tACAL, R>rGLILATORY AUTHORITY ~ncr ST G~i'®/~ L''a r1~~ h n - 8 - a ST CROIX COUN'T'Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Ro..old G ~on~c Mailing Address ~ e -- - 7 0~~- s-- H e....w. o~r-d ~. w t S `l 01 S Property Address ~} 3 3 Pheas wn~ N ~ 11 s 1? l 2 4 btti a+ A v~ !~ a,Mn-on d (Vcrification required from Planning Department for new construction)-~ City/State FFan„MOnd + wI Pazcel Identification Number LEGAL DESCRIPTION otg- log 3- 33-aoa N E Fl~aw.nwa•. d property Location S w `/., ~ `/,, Sec. l b . T 29 N-R t'1 W, Town of Subdivision iP1~ . - -' Ni tl s ,Lot # 3 3 Certified Survey Map # ,Volume ,Page # ~,S nty~"Ijeed # ~p 2 ~~ . Volume ~~ ~ ,Page # ~~ ~~ Spec hour ^ es ^ no Lot lines identifiable .P~ yes ^ no SYSTEM MA]~IT'ENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping 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 Deparhnent a certification form, signed by the owner and by a master plumber, j ourneyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tan]c is less than I/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to jmaintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office anthrn 30 days of the three year expiration date. ~I'10.1C~tJL ~. v SIGNATURE OF APPLICANT Z ~ ZZ.~ O Z DATE OWNER CERTIFICATION I (wc) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the ownez{s) of the property described above, by virtue of a warranty decd recorded in Register of Deeds Office. 471 .!X ~ . _ - SIGNATURE OF APPLICANT 7 /t2/aL DATE sssss« s s s s s s Any information that is nus-represented may result in the sanitary permit being revoked by the Zoning Department. s« Include with this appllcatlon: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed • Vrll..~~~~1PAGE37z 620963 KATHLEEN H. WALSH REGISTEk OF DEED5 ST. CkOIX CO., WI RECEIVED FDR RECORD Dine M. Bonte, as Trustee and Ronald C. Bonte, first alternative 04-10-2000 10:30 Rh Trustee of the Karl M. Ulferts and Katharina G. Ulferts Family Trust, for a valuable consideration conveys without warranty to TRUSTEES DEED EXEAPT M Ronald C. Bonte and Dine M. Bonte, husband and wife, Grantee, CERT COPY FEE: the following described real estate in St. Croix County, State of TRANSFE~R'FEE• 240.00 Wisconsin: RECORDING FEE: 10.00 PAGE5: 1 Thomas A. McCormack 1020 10"' Ave. Baldwin, WI 54002 018-1034-60, -70 The North Half of the Northwest Quarter (N '/: of NW Y,) of Section Sixteen (16), Township Twenty-nine (29) North, Range Seventeen (17) West. Dated this 24thday of March , 2000. AUTHENTICATION Signature(s) authenticated this ~ day of _ signature type or print name TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.Ot3. Wis. Siats.) ~~~ ,~...J.. THIS INSTRUMENT WAS DR~ ;~ ~ Thomas A. McCor a ~ ~''= Baldwin, WI 540t~.: G ~ ~ ' : ;: q i - r .` _. . ~ 4 .~~ "Dine M. Bonte Trustee `Ronald C. Bonte Trustee ACKNOWLEDGMENT STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this 24t1bay of Bch 2000 the above named Dine M. Bonte, Trustee and Ronald C. Bonte, as first alternative Trustee of Karl M. Ulferts and Katharina G. Ulferts Family Trust, to me known to be the person(s) who executed the foregoing instrument end acknowl~ge thpr same._ signature type or print name Dale I}~~ JenseR Notary Public St. Croix County, Wisconsin. My c m Is I n is permanent. (If not, state expiration date of f~ ~~ .) 'Names of persons signing in any capacity should be typed or printed below their signatures. IMOrmation Profaui0nale Company Fontl tlu lac. Wiscon,in a00.655- - W ~ `•'' ' '~ x 5 at. o.~ w ..~ •~ G ~ , .. ~, LOT 3'6 ~ w •- : ~ 2. 29 ACRES •~ ~ ~ti~, ~~ ` - ,,,~; ~ ~. 99, 603 S . ' Pv A ~ l 2. 29 ACRES) ~~ n , N ? v m w m _ ,, ~ • ~, -1GE 3~83~ ~ ~'~ .. ~~ ~'~ a p ~o. 22'! ,, 0 9-170 2: 50 ACRES ' ~ ~' '' 030 S0. ~ M: ! (2. 50 ACRES) ~; ~•~ ~.~ r~' ice; ~ ` d' ~~ ~ ~ ,, 021.. ~ ~ 359. 99' • F S ~ .............. 9 .....~......... ............. .... .. ~` J X60 ~ N ~._~.. - $ ~. ~ w . ~ ~ .4 • • ~ ~- ~'~ 2,'25 ACRES : 9T, 9T9 S0. F~. `; `~ ~ 15 0 33 •~~~ 01 ~ 2. 25 ACRES) ,.0 I CRE - ,' B-J3~ - .29 F T. : ~ LOT 32 ~ _ , it 1. ACR S) o •:. 2. 49 ACRES ' ' 108, 6~9 S0. F T. ••1 •. w 3\, - ~ . ` or, (2. 4 9 ACRES) ~. ~ , 39~>'_ ` ~~ .~TeQC ~ ®,'' ~ j ~ ZBp. ,>~ . p ~s ~~ ~ ~ ~ ~ 'i /, X62 ~ ~ h ` .T 1060 -._---- 0~, ~~ \\~/ ..~ • ~, 2T ~ F s ' ~~ i~ n 2 0 ~~ ~ h~ ~ i,~ , ti ~ ,~• o ~ ~, . _,.._ 1-'Ht~'.JAIV 1 1 I1LLJ L OCA~TED ! N THE NE I i4 OF THE N!N ! i4, SE 1 i4 OF THF_ NW ! i4 AND PART OF THE SW 1 i4 OF THE NW I ~4, AND PART OF THE NU'~ 1 i4 OF THE NW 1 ~4. ALL IN SECTlO~J 29N. , T R. ! 7W. , TOWN OF HAMNiOND, . 5T. CROIX COUNTY, WlSCONSlN J l IoorN AvEnuE _E T LOT 23 ~. Y 4 ~'~ O P ~%® ~~ a/,., ~ i • ~'' ~ ~^ LOT 17 i~ ~' ~~. SEA ^~ V N b~ i , ~~ LOT 15 v SHEET ..2 `````~+`~`.li.>~........ ~.. i .~~..~... ~I ( . ~ I I ~ • M Mr It ~ Kit .~- s• ' -,-. fi V ~ ~ W.n I sf>a t x'~ rrt+ L . _L~ _ _ _ ..~ ~ocArla s~crc~ u cr+a +a r. tw.. ~. ~ n.. raw yr ~•~+ I.or rv >'c.a~ 7 THE 10, UT1lITY EASEMENTS MO PCIE 'R @UR~fP CABLES ARE i0 8E PttiCEO SuCti TNAr ..,f aONGt~r1lOT~ME aY17REETNIINERVEr STAKE. G1~ ~S1a~Cr vls+C+r rME DlsrvRBA«CE os A supvEr srAKE Br Alvr;.vE Is A rrOtArl~ ~ SET}fORr1+,ARfFf'~ ~MEC~EfOisPUBIrCSBOOTE31,u,7pfv4~liN~SJTi`~~FS+Y NAYtNG 1„f RIGNr TO SERVE TO AREA. '-'_ -~_ 4_ ~. ~•'S 11'~ _~'!. r _._ ~~. • -.~ ,__ LEGEkO f FOUND f' IRAN PIPE O ~r rrlr0 O • Z i IINE.u PER lB5~ JE6S Nor E: SEi I'>t2~' IRON PiPE IY(rSnrMG PER l INfAR FOOT AT Al; 7. I! 195. OTHER l0i Cd+NEas (TYP 1 ---i-- . • Uill f TY EASEAfhT SE TBa~Ks ,fl ~alvcrAr LpCATIGri4 Q ~ ~ `~~gC C~ ~1~~~ SEE r~~ ~ 2 ~ _ ~ ~. ~ ,~ ;~ s ~ .~ „Q ~$'t'FaIS OF~FiL(: ~: Rlow'~d 1oc R~oocd Itas .~ --~ At D ~.tz~ r~~ !l Rws~ r~ 7 ___~- ~~~~-