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HomeMy WebLinkAbout018-1087-74-000Wisconsin Department of Co^imerce PRIVATE SEWAGE SYSTEM Safety and Building 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 Parendo, Lance ~ Hammond Townshi CST BM Elev: ~ Insp. BM Elev; BM Description: TANK INF RMATION ~ ELEVATION DATA TYPE MANUFACTURER CAPA\ITY Septic ~ ~~' (~ / Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic -~ ~"~ t > D t 2 ~ ~ ~---r Dosing ~ ~ t "- 3 3 Aeration Holding ;= PUMP/SIPHON INFORMATION ~' INFORMATION DISTRIBUTION SYSTEM 3gr 25 ~ ) (oOf mar ~ ~C county: St. Croix Sanitary Permit No: 405093 0 Stat Plan ID No: /~-j• o Z l- / IPb~nC' . /~ .ll Parcel Tax No: 018-1087-74-000 STATION BS HI FS ELEV. Benchmark Alt. BM ~~ 3-cf3 -9,01 Bldg. Sewer O ,~ l ~ Q~.a U St/Ht Inlet I t. z~ gg.36 , SUHt Outlet Dt Inlet Dt Bottom /`f,fi .8S Header/Man. Q /~/~~ Dist. Pipe C~ ~ .tr ~ J 3, 1~{ r R~ Ig Bot. System (r,0 J 3• 9 ~ Final Grade C~SGe l~ St Cover e~,~J_ ( ~d (.33 `ot.~3, (~ O~ .~ ~ -~ S LEACHIN CHAMBER UNIT Dia. Header/Manifold Distribution f/ x Hole Size x Hole Spacing r~ Vent to Air Intake O t Z /r ~ ~ t ~' O f ~Z S /Z L t l ,/ 3 r/2 ~ ~~ Length • Dia ength Dia _L_'_t~_ Spacing J p . SOIL COVER ~ Pressure Systems Only xx Mound Or At-Grade Systems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~~ Yes n No ^ Yes ~ No COMM NTS: Incl c iscrepencies, persons present, etc.) Inspection #1: D / 1 DZ- Inspection #2: Location: 1650 87th Ave Hammond, W'I~5y4,0~1~,5 (SE 1/4 NW~p1,/4~2~0 T29N R17W) Hammond Oaks Loo 7 Parcel No: 20.29.17.694 1.) Alt BM Description = ~ ~ 5^'- -1 % ~~ "'r` ~ ~~' 2.) Bldg sewer length = 1 ~ rr -amount of cover = ~ 3. Contou ll -- /~ r n n ) ~ ~ ~' • O w ~ ~ 'ate ar~`__ [ __.~ c.lks~_~~ ~`~-~--_b~- ._ +~±±~d~-_-°- 4 _ - - - ~~s~~ Use otherlside for additional informatio>No ~ ~ j ' ~ ~ ~-, II _ _ 1 _ ~ ~ Lam' SBD-6710 (R.3/97) Da Insepctor's Signature Cert. No. SOIL ABSORPTION SYSTEM ' ' Safety and Buildings Division 201 W. Washington Ave., P.O. Boz 7162 __ County ST . CROIX iseonsin Madison, wl 53707 - 7162 Site Address De artment of Commerce 5 zd 4 ~ '~ Sanitary Permit App 'cation ~'~"" P"'°'"r~" ~ ` 3 In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ^ Check if Revt4loa rna be used for second ses Privac I. Application Information -Please Print All Information State Plan I.D. Number 64401 Z TRANS ID # 730802 Property Owner's Name SAY ~ 5 2002 arcel Ntunber 20.2. • (oQ LANCE PARENDO t7iS - ID$ 7 -Tyr_poo Property Owner's Mailing Address ST. CROIX COUNTY Property Location ' ~ 641 RON DRIVE ZONING OFFICE SE NW . 20 29 17W u !i•S T N R B City, State Zip Code Pbone Number Lot74 ber BktckNUmbet Sub~~`'~°OAKS 1ST A~'.•. NEW RICHMOND WI 54017 715/246-6192 II. Type of Bttilding (check all that apply) c.s Py S~"^^~ ~ ^Ciry 1 or 2 Family Dwelling -Number of Bedrooms 3 5 ~^ ^Village ^ Public/Commcr -Describe Use ®'!'ownshi Hammond ^ State Owned ~~"~~Oir~ ~~ r ° Nearest Road ' 6' ' M~ caQQ ~~~.. - 0 S t Gtr 160th st III. Type of mit: (Check only one boz on line A (ntunbering scheme for in nal use). Complete Une B it appIIeable) A For County use 1 ~ New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to S stem Tank Onl Exisdn S stem Date ~~ B. Permit Number ^ Cbcek iP Sanitary Permit Previously Issued IV. T we of Permit: (Check all that apply)(numberIng scheme is for internal use)~,E- ~'-f°9 44 ^ Non -Pressurized In-Ground 21(~Mound 47 ^ Sand Filter 50 ^ Conswcted Wetland 22 ^ Pressurized !n-Ground 41 ^ Holding Tank 48 ^ Single Pass Sl ^ Drip Line 45 ^ Ao-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other D'u ersalJ'IYeatment Area Informat V ion: ' . Design Flow (gpd) Dispersal Arc Dispersal Area Soil Application Percolation Rate System 8levatioII Piaal Otade El ti Required ~ Proposed Rate(Gals./Days/Sq.Ft.) (Min./Incb) evs oa 450 450 450 1 NSA 97.5 99.33 Tank Info VI Capacity in .Total Number Manufacturer Prefab Site Steel Fiber pl~tta, . Gal lotu Gallons of Tanks Cotrcrete Cortsttucted talats8 New Ezistiny Tanks ranks Septic or HoldinP Tank 1000 - 1000 1 WIESER CONCRETE X °osinY Chuntxr 600 600 1 WIESER CONCRETE X VII. Responsibllit Statement- I, the undersigned, assume responsibIllty fot installation of the POWYS shown oa the attached Plumber's Name (Print) Plumber's SIgnature MP/MPRS Number Bttsiaess Pltoro Number BENNIE HELGESON 20292 715/772-3278 Plumber's Address (Street, Ciry, State, Zip Code) W 1229 77UTH AVENUE, SPRING VALLEY I 54767 VIlI. Coua !De artment Use On! ~, Approved ^ Disapproved Satutary Permit Fee (includes Groundwater Date Issued A,Qent $igaatut~e (NO $ {.. ,, - Sunbarge Fee) ~_ ^ Owner Given Initial Adverse . 3Z~ (/ t¢ 'e~~^'` Determination . IX. Conditions,,nnof ApprovaUReasons for Disapproval ~..p_ ' `~- QS c s.~ ~ ~~~ tm.rre c~~ .) / ~ nn _------ comp cte Plana (to e 8 x11 tnehn !a aisa . cp1n..~~9R ~1R. OS/Ol) P(of ~1 a~ ~. ai~t c ~. I-0.1-cnl3Cc~ /I , ~ + w Ifs Q (- . 1. )r Y~ /~ i .r ~~ "~S O c~ ~• `.~ ~ 07 9.~ 3 c. e +- ~.--~ .~ dot 7y q~, o ~ko. ~31~. loci. o~ ~ Eke. 9s o ,~ ~, r of ~~ea. 0 ~- d i ' ~ ~.. ~~ .c _ ~ i~ ~ ~ o i~ ~ B~ v° ~ 59 ~ ,coo/`oo ~sep f:~l,~P ~ TQ.~ y'' ~ ~ 1 s~ P~ ' ~'~5` ~~oPo:c~d 3 8Q~ t ~ ~~ ~ No,,,,,,e. m~N ~ ~ i' 83 - i ~ ~ L/~cl(ow S ~~.~ ~ 1' 1Jo WELL y.~t- ~G l a F $ ~~ ~c4.~-e r''_ yam' 87~'h. f~~c~ - r ~ ~ ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.state.wi. us/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary May O 1, 2002 CUST [D No.220292 BENNIE W HELGESON HELGESON EXCAVATING W 1229 770TH AVE SPRING VALLEY WI 54767 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/01/2004 A7TN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1 lOl CARMICHAEL RD HUDSON WI 54016 S[TE: Lance Parendo 160TH St Town of Hammond St Croix County SEI/4, NW1/4, S20, T29N, R17W FOR: Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object [D No.: 849619 Identification Numbers Transaction ID No. 730802 Site ID No. 644017 Please refer to both identification numbers, above, in all cones ondence with the a enc . The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDIT[ONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD-10572-P (R 6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10573-P (R 6199). • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management lan or as required under s. Comm 83.54(4) shall be considered a human health hazard. P ~.~.1.s. Conditionally BENNIE W HELGESON Page 2 5/1/02 Owner Responsibilities Continued: • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shal I be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~~ Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim@commerce. state. w i. us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G lansky ,Wastewater Specialist, (7l5) 726-2544 INDEX SHEET PROPERTY OWNER: LANCE PARENDO 641 RON DRIVE NEW RICHMOND, WI 54017 PROJECT NAME: LANCE PARENDO PROJECT LOCATION: SE 1/4,NW 1/4 , S 20, T 29 N, R 17 W MUNICIPALITY: TOWN OF HAMMOND COUNTY: ST. CROIX ~~ s~~t ~~ :~ ~ ~~~ ~~~~ t~ ~`f~~ °1~ ~~r', ~~ ~,, ~ ~~ DESIGN: PRESSURE DISTRIBUTION MANUAL SBD-10573-P(R /99) MOUND COMPONENT MANUAL SBD-10572-P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank & Fump Chamber Cross Section & Specifications. Page 5: WIESER WLP1000/600-MR ZABLE Tank Specificaiton Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Address: W1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 G Sig d Date: Apri125, 2002 DEPARTMENT Of COMMERCE DIVISION OF EtY BIfILDINGS ~ SEE CORR>rSPO. ENCE AA P(o~ ~t a~ .f~ll~he r ' L aKc~. ~0.r-CnOlc~ ,~1 ~ef ~--^r ~.of 7y ~3.1~, loci. oo `rop o~ Gr~~e~ s~~ k~ a E ~t,. q~. °k ~~ , o ~ ~. ~ L (Eke. 95 v a , ~r a~ ~- ~ ' ~ ~~ U 1 L 1 (~ I s ~ j , 0 ~ ~ ~ S9 ~'" 8 ~ r ~~ rn~a ~ ' ~ ~ ~ ~: 83~ 1 ICOo~6o0 ~ ~~P tic/~sP aV Ta-~ ~{'' ~~ L SI p~ ~'S~ ~~oQo~~d i ~' 3 g, ~ ~ (~o v+^~ rove ~ ~I~,v . y ;~' ~? O ~ E L L ~~ ~tl(ow S ~.kt _ ° I o Q y~~- ~~ ~ a F g i--- .-- Page a Synthetic Covering Distribution Pipe AsTM C 3 3 ~ -, w 9. Medium Sand ~ H" Topsoil, - :"`' ~~= F ~ " ~ Slope C E Lii.O f ?M- 2 %2 Aggregate '" Cross Section Of A Mound Signed: License Number:. Date: ~ ~k 97 ~ Force Moin From Pump A = Ft. B 7,j Ft. - K . 7,$~ Ft. ~ .~- Ft. ~ ~~ Ft. I ~_ Ft. W ~~~ Ft. Plowed Layer o °s Ft. E s V Ft. F ~3 Ft . G , S Ft. H ~_ Ft. r--`- ~ 1 Observation Pipe ~ K f ---------------------------------------a -- , A ' ~ J $ ~~~f --------------~-------_ w L _ _--i _ l_____-- - N ~~ C~Lt_ Of i - 2'2 - Distribution Pipe Aggregate n'' I ~~ ~,.~„ .. /~sv Observation Pipe Plan View Of Mound ~~], ~ n ~ v-' Lain r P. ~G...r'C~,Ya-r,10 C )ea~o~" A-~crs~ ~E'ctN~'-`-~ • ~ Porlorolnd Plpa Oo~ull / End Vlow Perlorolod / ~5 3 ~ ~ s~. Holes Located on Bottom are ,E^qually Spaced ''ff LL ~c~~e N~xT -~o ~ah~+o( -- C ~~~ ~~,. Distribution Pipe Layout Signed: License Number: Date: ~ r, p ~' Sa R i S 3 x a3~ ~r 1" r ~ 3 .~ ~- Inch Hole Diameter Lateral _~~ Inca (es) Manifold " °~_ Inches Force Main " __ y Inches No Ins 'P~~ l..a~eral = k ~wo [,a~-~~Q is - 7~ ~/a,~ ~J~~~ ~!. v, r e ~C~.Y`P.~IC~ r~ Page~Of$ • SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS u" CI VENT PIPE 12" MIN. ABOVE GRADE E > 2$' FROM DOOR, WINDOW OR FRESH AIR INTAKE ~ FINISHED -GRADE 18" MIN. y,~C.Z. 0-~SERW-t~oal PIPE INLET ~- WATER TIGHT SEALS F~~TER _ APPROVED ~~ $~~ PIPE 3' (a "x~(,'' ONTO SOLIO SOIL PUMP OFF ELEV . X3.5 FT . A ~._ B ~- C D NEATHERPROOF JUNCTION BOX. APPROVED WITH CONDUIT MANHOLE COVER W/ PADLOCK E ~----WARNING LABEL ~ l~._4" MIN. ty~r S,D. ~~ 1 ~~ ~' GAS- ~ ,~~ TIGHTS ~~, SEAL r, i r* ~ , 1 ' 3 " RPPA OV ED BEDDING UNDER TANK SPECIFICATIONS ~$~+MIN• JOINTS WITH ALM APPROVED PIPE ON 3' ONTO SOLID SOIL FF CONCRETE PAD SEPTIC / DOSE /3'3t/ X s = ~''-'- ~`~~' TANK MANUFACTURER: (~/~str TANK SIZES: SEPTIC /(~O GAL. DOSE VOLUME INCLUDING GAL. -GAL . lam. ~ ~~l ~ F LOWBAC K : ~_ DOSE S CAPACITIES: A = ~ INCHES = ~6 GAL. ALARM MANUFACTURER: ~ ~~ ~(r~~~3--`yd~e'''"S ~ GAL. MODEL NUMBER: /o/ ~-lt_1J- g 2 INCHES = ~.~_ SWITCH TYPE: r ~0~~ GAL. C ~o I NCHES = L~-~-s~- PUMP MANUFACTURER : ~^- • ~ MODEL NUMBER: ~ ~~~ D ~ INCHES = GAL. SWITCH TYPE: ~ ~(°O`~ 16.23 WAC REQUIRED DISCHARGE RATE~~ GPM PUMP E ALARM WIRING AS PER ILHR /~/.S FEET VERTICA L DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE•• ~ S -FEET + MINIMUM NETWORK SUPPLY PRESSURE ~~ FEET + FEET FORCEMAIN X 3.3 FT/100 FT. FRICTION FACTOR •_ ~_FEET /~D TOTAL DYNAMIC HEAD • WIDTH DIAMETER __ INTERNAL DIMENSIONS OFyPUM/P' TANK: fLIQUID 6I~'I`F~~ -3~~`r+ -~ / Ci~r /~ ~' P~ ~r~C~~ ~~~QSe. S'ec /cCn~ S/)P~. S~'l~t~ SIGNED: LICENSE NUMBER:-' DATE: 1/86 n ~ D ~ ~ .. m C n ~ L Z ~ ~ ~~ c r° °' ~ D r ~ N ~~ p~UGJ p N ~ n ~ ~ o 0 n m Q, c~ n ~ o N b ~' Z Cs7 .~ _ o =n I ~~~ OtA~ ~ ~~ ~ ° zm '~ N ~ ~ ~ ~ o o n m ~r m ~' ~~ ~ ~, o ~ ~ ~ ~ ~ ~ 56" 39" o c r m -~ O D 0 z O m c~ Z J O a C Z D D 0 O r A r O c 0 n D D n -mac .... N my m ono \~ ZZ ~m c .~ v (~ .~ z m --i ~ D z v ~~c -N+? m Nfm*I~ D ~mm~ _ ~ V1 O N n ~ D 0 m "D ~ ~ 'm u ~ z m -.~ D ~ Z ~ W O m~~ =gym ~~r~n D ~ .~ I DN m~ ~' O m ~ OTC ~~ ~~ m ~- ~rn :U Z n 0 84" i i i i g ~ s 5 rm~rx~c)mguzi r~1+ ;omommy° D- ° '~'' !'~ •+~ J ~{ C G7Cp~~==f*1-IrZ ~~~ ~ cn ~rjz~ v' ~ ~ O P~ fT7 M • U1 OsN a :r ,r~0~ ~ ~° N°~~~ m ~ ~ •J ~ T T N ~ N 0 Z m t/1 N 0 T °C' ~. r s 42" ~ z ~/1~Y' U.~n~~ `Y ~` c~ o Performance Curves METERS FEET ' M 0 I 20 15 0 L 0 METERS FEET 120 35 110 100 30 90 25• ~ ~ 70 I 20 H ~ O H 15 ~ 40 10 ~ 20 5 10 0 0 0 L 0 ~ubme~ibl~ Dumps ,0 zo 30 l ao so so 3s~~~- 10 20 ~ ~ ~ °" 10 fflu~nt ~5~~~~8 70 80 90 100 110 120 GPM ~ 30 m'/h CAPACITY ,... -- _-1_ 20 CAPACITY ~GOULDS. U~MIPS~IN~ 30 m'/h Ellectlw July, 1985 POWTS OWNER'S MANUAL 8~ MANAGEMENT PLAN Page 7 of $ .... r_ ~-~enDiulA'TIl1N Owner LANCE PARENDO Permit # ... u~TC~c DESIGN F'AttAmc 1 ~n~ Number of Bedrooms 3 ~ ^ NA Number of Commercial Units ®NA Estmated flow (average) 300 aVda Design flow (peak), (Estimated x 1.5) 450 aVda Soil Applicatjon Rate 0.5 aUda /ftz Influent/EffluentQuaiity Monthly average' Fats, Oil 8 Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5120 mg/L Total Suspended Solids (TSS) 5150 m /L Pretreated Effluent Quality ,• [R NA Monthly average" Biochemical Oxygen Demand (GODS) s30 mg/L Total Suspended Solids (TSS) s30 mg/L Fecal Coliform (geometric mean) s10' cfu/100m1 Maximum Effluent Particle Size YS 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 & alarm Flush laterals and pressure test TIONS SYSTEM sPECIFiCA Septic Tank Capacity al ^ NA Septic Tank Manufacturer IESER CONCRETE ~ NA Effluent Filter Manufacturer ZABLE O NA Effluent Filter Model A 100 12" x 16"^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer IESER CONCRETE O NA .Pump Manufacturer OULDS PUMPS INS NA Pump Model 3885 ^ NA Pretreatment Unit NA O Sand/Czravel Filter O Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection O Other. Manufacturer Dispersal Celt(s) ^ In-ground (gravity) ^ In-ground (pressurized) ^ At-grade ®Mound ^ Dri line ^ Other: • Values typical for domestic (non-commercla~ wastewater and septic tank effluent. H Values typical for pretreated wastewater. Service Frequency At least once every O months O year(s) (Maximum 3 yrs.) When combined sludge and scum equals one-third (Y,) of tank volume At least once every 2 O months [~ year(s) (Maximum 3 yrs.) At least once every At least once every At least once every At least once every At least once every 1 O months . Q year(s) 1 ^ months ~ year(s) ^ NA 3 ^ months ~ year(s) ^ NA O months ^ year(s) O NA O months ^ year(s) ^ 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 Servidng Operator. Tank inspections must include a visual inspection of the tank(s) 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 cell(s) shall be v(sually 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 accumhall be removed by a Septage Servicing Operators atnd disposed of in accordance wi tech. NR entire contents of the tanks . 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreat+finent components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A servicRe report shall be provided to the local regulatory authority within 10 days of completion of any service event. STARTUP AND OPERATION. For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other cete edihave the contents oft a tank(s)tremoved by aoseptage servic ng operatoripnorlt h se~ncentrations are d ct -OWNER: LANCE PARENDO System'starf up shall not occur when soil conditions are frozen at the infiltrative surface. Page 8 of ~ During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one Large dose, overloading the cell(s) and may result in the backup or surtace 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 riormal 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. ABANDONMMENT 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 ch. 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 property 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 following measures have been, or must be taken, to provide a code compliant replacement system: . O 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 aid 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 §ultable 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. ^ The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to loca4e a suitable replacement area. 1f no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ® 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 ANDi'OR INSUFFlClENT 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 MAYBE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name HELGESON EXCAVATION INC Phone 715/772-3278 POWTS MAINTAINER Name JOHNSON SANITATION •~ • -Phone 715/273-5811 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY ' ' Name JOHNSON SANITATION Agency •ST. CROIX COUNTY ZONING OFFICE Phone 715/273-5811 Phone 715/386-4680 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanftatlon agendea. Thla document meats the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)8(f) and 83.54(1), (2) & (3), Wiscons(n Admtnlstrative Code. Use of this document does not guarantee the performance of the POWTS. GMW (2/01) ~Vtlisconsin"Department ofComm~rce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Gustum Septic Service Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference ,direction and St. CroiX M percent slope, scale or dimemsions, north arrow, an iQn s to nearest road. ,. ; . ~ , ~ ~ >. _ Parcel LD.# APPLICANT INFORMATION - pl ~ ,~ t ll i. m t~ • n i l1 ea e, a or a -oi . . Personal information you provide may be used for dory p ri y Law s. 15;04 (1) (m)). ~ I ~~ mewed B Date ( ~~~ r Property Owner l ~ Property Location Humbird Land Corporation ~ e ... r .: ; ~,~ Govt. )_ot n/a SE 1/4 NW 1/4 S 20 T 29 N,R 17 W Property Owner's Mailing Address '" " Lot #i Block # Subd. Name or CSM# s-/- G~,~; 332 Minnesota Street, E as t 1404 `, ~~ n/a Hammond Oaks ~ Addition _ __ _ _ City State Zip Code Pfn~I~FtCS City ^ Village ^Town Nearest Road Saint Paul MN SS I'41. 651-222-SSSS . ~ Hammond ~ 160Th Street ^ New Construction ~ Residen tier • ° ooms 3 ^Addition to existing building Use: ^ Replacement ^ Public or comfneraal describe Code Derived daily flow 450 gpd Recommended design loading rate •5 b~, gpd/f~ .6 trench, gpolft~ Absorption area required 900 bed, ftz 750 trench, ftz Maximum design loading rate •5 bed, gpd/ftz .6 trench, gpolftZ Recommended infiltration surface elevation(s) along 97.0' contour ft (as referred to site plan benchmark) Additional design I site considerations 13M 2 = 97.4' Parent material sand stone Flood ain elevation, if a liable n~a ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system ^ S ®u ®S ^ U ^ S ~ u ^ S ~ U ^ S ®u ^ S ® u SOIL DESCRIPTION REPORT Boring# 1 Ground elev Depth to limiting factor ~- 2 Ground elev Depth to limiting factor l Remarks: :.ST Name (Please Print) Signature: Telephone No. Tom Gustum ~~ 715-658-1344 4ddress Gustum Septic Service Date CST Number Ref# N13450 937th St., New Auburn, WI 54757 3/1/00 227618 1179 H ri Depth Dominant Cokx Mottles T t Structure Consisten Bounda Roots GPDIft2 zon o in Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. ry ~ Trench 1 0-9 10yr3/2 none sit 2msbk mvfr as lf,lm 0.5 0.6 2 9-16 7.Syr4/4 none sit 2msbk mvfr cw if 0.5 0.6 3 16-25 7.Syr4/6 none gr. sl 2msbk mvfr cw - 0.5 0.6 4 25-32 10yr5/6 none gr. sl 2msbk mfr cw - 0.5 0.6 5 32-40 7.5 4/6 Yr c2-3d 10 7/2 7.Syr~ gr. scl 2msbk mfi - - 0.4 0.5 ~~ Remarks: 1 0-11 10yr3l2 none sit 2msbk mvfr as lf,lm 0.5 0.6 2 11-19 10yr4/4 none sit 2msbk mvfr cw if 0.5 0.6 3 19-24 7.Syr4/4 none gr. sit 2msbk mvfr cw - 0.5 ~ 0.6 4 24-31 7.Syr4/6 none gr. sl 2msbk mvfr cw - 0.5 0.6 5 31-42 7.5 r5/6 y t2-3d 10yr7/2 7.Syr5/g sl 2msbk mfr cw - 0.5 ~ 0.6 6 42-48 7.Syr5/6 none WB m mvfi - - n.p. ~ n.p. ¢uJ~e •S .~ .~ . t' PROPERTY OWNER: Humbird sand corporation ___ SOIL DESCRIPTION REPORT PARCEL LD.# 3 Ground elev limiting factor 33' .. ~ ns page 2 of 3 r:..~,.,., eP,.,;.. c,.n,:.v. Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Copt Color Texture Structure ~ ~ ~ sistence Boundary GPDIftz Roots - Bed ~ Trench 1 0-10 10yr3/2 none sil 2msbk mvfr as lf,lm 0.5 ~ 0.6 2 10-18 10yr4/4 none sil 2msbk mvfr cw if 0.5 ~ 0.6 3 18-27 7.Syr4/4 none gr. sil 2msbk mvfr cw - 0.5 0.6 4 27-33 7.Syr4/6 nond gr. sl 2msbk mvfr cw - 0.5 ~ 0.6 5 33-41 7.Syr5/6 Q-3d 10 7/2 7.S~g sl 2msbk mfr cw - 0.5 ~ 0.6 6 41-48 7.Syr5/6 none WB m mvfr - - n.p. n.p. Remarks: Ground elev Depth to limiting factor .~ ), • S~ •S -r ~ ~ - 1 ~- _ I_ ~, -- i ~ ~ ~~ ~ ` Property Line ~~ ~ m ~, ~ ~ N J ~ O J ~ O l j co o~" .~ 1 ~ ~ ~ '4 N ~ i ~ c~ d co o O J cr ~ ~ ~ o~' ~ o Q C a ~ ~ C ~ ~ ~ O ~ `-G ~ ~ ~ m CD U~ Property Line m W~ ~ ~ ~ -A cn N n II I II II m m ~ p m m O f O < < m rTl ' ~ G7 a z cD ~ W m ~ ~ v o O Z O ~ o ~ ~ ~ ~ ~ o z 0 0 - cr~ z ~ C C,~ m o I o I o c~ ~_ o - ~ o -' ~~ o ~ z C/7 C ~ ~ ~ z O CO O TI D ~ ~ ,J ~ n m ~, ~ n ~ 1. n m ~ _ ~ o ~ rmr, o o z m ~ ~ o -' cn r IV n N z ~ -~ m~ ~wc 'T' ~ _ ~ ~.oN3 ~- ~ ~ Q m a, O~ c ~ 'O. O Z = ~ ~ _ ~~ZOn cn ~~~~o n m°~om~ ~ ~ ~ ~ m N o T 1 ~ .~. ~ o m _ ~ A $ ~ ~ n 0 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMBNT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer OV ~ 10 ~ ~ Q~ fe~.~ Mailing Address ~~ - ~ , ~ ~ ~ ~~ ~ ~ ~~-, t~~ -~ `~lJ/ 6 Property Address City/State Parcel Identification Number ©~ ~- X06 7 ' 7 y -mod ~ LEGAL DESCRIPTION Properly Location -S~ i., ;U UJ '/., Sec. c~ T~N-R~._W, Town of ~r ~ ~y~n~t ~. Subdivision t~ a~ w~-o~ ~ ~~L ~ s .~~ ~~~; ~ ~ ~ .Lot # ~~. Certified Survey Map # _, Volt.une ~~ ,Page # -' Volume ~ g~ ,Page # Warranty Deed # ~~~~-62Z Spec house ^ yes B'no Lot lines identifiable Dyes ^ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 Department a certification form, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be cornpieted and returned to tvc St. Croix Ceunty Zoning Office ~"ith~n 30 days of the three year expiration date. SIGNA OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property scribed above, by virtue of a warranty deed recorded in Register of Deeds Office. ~G~2y~ ~ l 7 / Zt;~~ ~~' DATE SIGNATURE OF APPLICANT kkkkkk s««s«k pny information that is IIlls-represented may result lII the sanitary permit being revoked by the Zoning Department. i l.Q S O ~~ `~`" (Verification required from Planning Department for new «s Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey reap if reference is made in the warranty decd ' U 1880P 'i85 STATE HAR OF WISCONSIN FORM 2 - 199a ~ ~ 7 6 ~ ~ WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO, ~ yI Tbis Deed, made between Merlin Land, LLC, a Minnesota Limited RECEIVED FOR RECORD Liability Company 09-30-2002 8;20 All NNRIipHTY -EED Grantor, and Michael L. Pareado l:MF~IPi g -- REC FEE: 1].00 TRAMS FEE: 71.70 - COPY FEE: _ CERT COPY FEE: Grantee. PAGES; ] Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in SI. Croirt County, State of Wisconsin: Re^ordin Area Name and Rcturn Address ~ C ~ of 74 I-[amrnn~g 1st Addition SubdivisiogTown of Hammond, St ix County, Wisconsin nw,t~ Q~t~~wt~dl. ~ wr S+l~l 018-1os7-7a-ooo Parcel Identification Number (P]N) This is not homestead property. (is) (is not) Exceptions to warranties: Subject to notes, easements,rostrictions,covettatus and rights of way of record, if arty, including but not limited to those for drainage,water retetltion,ponding,and or utilities as tray be shown on the plat of Hammond Oaks 1st Addition Subdivision recorded in Vol. 8 of Plats, page 25, St. Croix Couttty, Wisconsin. The warratdies of this deed, either expressed or implied aze limited by the grantor to the grantee, or arryone in the chain of title, to the consideration expressed hereiq that being the sum of 523,900.t>D. Dated this 22nd day of April 2002 Merlin Land,LLC AUTHENTICATION Signature(s) authenticated this day of , TITLE: MEMBER STATE BAR OF WISCONSIN (If no[, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Paul A. Baillon, Attorney at Law `~ (Signatures may be authenticated or acknowledged. Both are no[ necessary.) + by G~~, ~",/~(/~j~ President + Austin J. Hailbn ACKNOW LEDCMENT STATE OF WISCONSIN ) } ~- Ramsey County. ) Personally came before me this 22nd day of April , 2002 the above named Austin J. Baillon to me known to be the persons}who executed the foregoing instrument end acknowllt ,,,~„„~,~,...,,,,,,,,,,~,",,K~ ~~:~~::- ~ ~ ~'~ei.NFSUTh "Paul A.Bailbn ~~,:;y: ~'"roln~r.•- .~:r._srat300~ Notary Public, State of Vli32i~i sl4i`""'""'d`~"""'"'~^'~''^^^^''" My Commission is permanent. (If not, stale expiration date: January 31 2005 •) 'Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OP W IaCON91N YORAr No. I - 199a INFORMATION PROFESSSONALS COMPANY FOND DU LAC, WI 80D-555-2031 ~~: ___._. _ _ .. _. ._1 r fK7RTtt 1 sECTK7N STEEL M UNPIATTED LAND ---------- - - - - - - NORTH LINE SE1/4-NW-1/4 LINE OF SEC. 20 S 89'43'29" W 1312.89' 2e8.5!' 169.!6' 1!0.00' 15200' 15200' 16106' LOT 14 m ' '' -- 622.58 OT 6 -- , T , I -- 4.31' -- rn 1 s. L 9 1 00 ~ ~ ~" LOT 70 LO I ~ OT 72 4 r . ~ 'h 43769 sq. ft `~ 1.06 Acres 46157 f 1 ~ Acr ~' 45918 sq.' ft-~ ~' '•~ ~~ i ( .LOT 73 ~ ~T 7~ - - - - -m i, ~ "i sq. l ~ ri, I 4 38 sq. (t ^ 1.00 Aeres rC 1.00 Aces ~ ~, ~ ~ m ~ 43650 sq. 1t a 43661 aq. ft I Fl m 7 9 e i ° I I 4 LOT 15 43 sq t L . I ~ m -- ® Sa1s tiaa6o~ J I ~/5zoo~ 1520d _ 1bEO6! ~, ~ _ _ _ _ _ _ _ _ - - - - - A i fa6va16e"'LT :,a.1r TOWN ROAD ~ 9wwe0r'ts f7xn Q a- _ - _ - _ ` r I ~ SM'lSb611 t16.7P ~ 4 8ti 4.f!' ~' - -t3~60' _ ® _ _ - _ 37TG Y ~ 7 LOT 16 N I I Z l0T 67 ~~ ~ ~ .5t M. ~ 2t _ /urn $.S OR ~ 5 f ~ I 1.170 Aaes 43594 ft _ _ - - - ~ I ~ - - ,l AINA OE'EAS!'AIE 1T 8 NT o 1 sq. , = ~i'L {_ 1.. i;, F6DIf WATER ~ - - jj - - ~ q. e - ~ a ) ~ ~ ~/ 3r' ~ 68 b ELEVATION 1079.00 § ~ '4'~ ~ ° V71 0 ~ u g LOT 65 LOT 6~ I ~S* i to l Y 't $ u OT 66 >•.. 1.01 Ares V ~ 1.03 Acr '{0T' \b e11s' ~ _ ?~ '3. ~ QI m I 1.00 Acres ~ 43918 aq. fl ti 45017 sq. Ift $I I ~ _ _ _ I I wse~5'tst siT-j~ ~ ~)z21 ° ~ I 43672 sq. ft ~ .,,, y~ ~ t u' , ;~ .~ 'T1~ LOT 17 I ~ oN T~ $ I ~ ~ ~ ~s ~r ~ 6~~ I ~ ~ I ° LOT 77 .,y I ~ ` ~I M s oY I 1 1 0 ~~~~. ~>w ~ 2.33 A«es W / - - - ~I _ - . rum's ' ' t6s.io' t6t.fi6' JOINT ~ ~ ~ 01317 aq. ft g JO' 6R~IruCE ~ ~A~trCNT ~ W 1!6.58' 1!7.01 rMe'15'OSE 5]!7.19' ~ ~ Z ~ $- / I LOT B3 o LOT 78 I LOT 18 N N a 7.03 Acres ~ 44923 sq. ft I ~I I ~~ I I 1.92 Aces c, / x 83873 sq. (t $~ o § ~ ~ ~F I rn LOT 60 ~ LOT 61 '! ' « - - - - - - 4 ~ 4 8227A ~ft ~ 474 4 aq k ~ >" I ~ ® ® L / ' \ ~s / sq LOT 62 ' ts.6t ~ _ a~ ~ 4 1.19 Acres /last 519754 ft Q 9 - - ~ ~ ~/ / / '~~ / / LOT 19 sq. / O , ' 1!7 01' 1M l3' f~- "+~ r ~'- \ 150.70 . . ' ti ~ o fMVS'ari asts' ~ TOWN ROAD ~ d;a' ~ _~ ` ~`. r ® ~ m , -- - ~ / --- -. --- --- LOT BI \ LOT 20 LOT 84 ~ ~ 82 'q ~ \ LOT BS S LOT 83 LOT 82 LOT 8( !~ 1.01 Aeres 44091 sq. ft ,,, 1,01 Aaes 44090 sq. it m 1.07 Aces 1.60 Acres 46793 sq. ft 69827 aq. ft 2.95 Aa LOT 21 ~ 15 1S 128412 s< \ ~ °a 1312.26' N 89445'08' E t16.OD' 1!6.00' 168,10 1!7.80' N9.97 55l.JY SOUTH LINE SE1/4-NW-1/4 LINE OF SEC. 20 WEST 1/4 COR. SEC. 20. T29N, R17W FOUND RAILROAD SPIKE N 89'45'08" E 1312.25' UNPLATTED LAND SOUTN S£CTIOh FOUND COUNTI