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HomeMy WebLinkAbout018-1054-10-200Wisconsin Departm it of Commerce 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.16~J4 (1)(m)]. 'ermit Holder's Name: City Village X Township Triemert, Dave Hammond Townshi .ST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~Jd~-t° ~ /~ / Dosing ~ ® /~ `~` ~~ Aeration ~r„ ~ ~~~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic r' ~ ~ ~ ^ tf 7~ r ~~ i _ Dosing ~~ ! . I n iv td- ~ ~ ~ ~' Aeration Holding PUMP/SIPHON INFORM ITA ON Manufacturer y~ r ~ Demand GPM Model Number ~~ TDH Lift ~ ~45 Friction Los System Head ' TDH Ft ~ , ~... ~ , ~ 1 ~ 3~ Forcemain Leng~~! Dia .!! Dist. to well ~~ SOIL ABSORPTION SYSTEM County. St. Croix Sanitary Permit No: 453375 0 State Plan ID No: Parcel Tax No: 018-1054-10-200 Section/Town/Range/Map No: 2429.17.3760 ELEVATION DATA STATION BS HI FS ELEV. Benchmark 7 ~ ~~Z• ~~ Alt. BM ~ 1 ~i" • G a D ~li~-~ f I ~ GJ ~ ~~ ~ Bldg. Sewer ~ ~' SUHt Inlet * ~' St/Ht Outlet ~ Dt Inlet ~ ~ Dt Bottom 1 7 ~~, e U Header/Man. Z ~ Dist. Pipe ,~ ~ q, ~ C 7 / Bot. System ~. ~ ~ $ $ ~ final Grade G~osz.~ /Q~ St Cover ~ •~ Z 1 Lb . 7$' Ti' '. ~ ~.r~- 7, z~ IDS. q oz ~~~ C~ ~ 9~,~ BED/TRENCH IME Width ~ ' Length / No. Of enche ~ PIT DIMENSIONS ~~ No. Of Pits Inside Dia. Liquid Depth ~ NSIONS D g ~ 7 ee,, C- \~ ~ ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~ INFORMATION CHAMBER OR ~ Type Of System: m , ~ / ~q /I / ~/~-' /~ f- I' UNIT Model Number. ~ ~ . Z ~~ ~ DISTRIBUTION SYSTEM Header/Ma fold ~ ~~~ Length ~ Dia Distribution / t r! Pipe(s) Length ~ Dia ~ Spacing ~ x Hole Size f ~' ~,p x Hole Spacing ~ ~ , Vent to Air Intake C/0 SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Only Depth Over r Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~ ~ Bed/Trench Edges ~ Topsoil + ~ ~ L~ Yes No ~ ~1 Yes i ~°J No 1 ~0,~ ~~ ~. E C COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: //`7 /-3`'~(~ /~ F-~f Inspection #2: / / Location: 843 200th St Hammond, WI 54015 (NW 1/4 SW 1/4 24 T29N R17W) NA Lot 1 C.~" "~1 -' ~IO~''~\ Parcel No: 24.29.17.3760 S~I-- t/c Je.~ /bt$ , 78 ~ c.. r..S C- ~~ ©~ ~ J~~ 1.) Alt BM Description = 2.) Bldg sewer length = 1' ( - amount of cover = , ~~ ~~ ~ ~j ~ `lJv~ Use other s de foruadditional information. No ~ ~ ~~ b ~ '~ _ / ~ ?~ / SBD-6710 (R.3/97) Date ~ Cert. No. Buildings Division Safety and ~ Counry~~ ~ ~ '` ~ 201 W. Washin on Ave., P.O. Box 7162 . ~ ~~ ~~~/I III Madison, WI. 53702 ~ ~ 162 Sanitary Permit Number (to be filled in by Co.) I (608) 266-3151 y4~ 3 3 ~ s De artment of Commerce Sanitary Permit Application s~~ Plan~I-DQ..Number _ ° ~ ~ (P~vS. /~ ~ ~ ~ ou c ® nal infonna6on d s C Ad 21 W d i 83 h ~ ' y ~' o o e, per m. w , is. t Comm . In accor Project Address (f differertt than mailing addrtxs) maybe used for se~ndary purposes Privacy Law, s I5.04(lxm) ~ L AppL'cation Information -Please Print All Informati •, g,°, w ' • ~ ~ ~ 3 ~ ~' Property S Name ~ ~ ~ I J u ~ Ptlj'C~el #~( Lot# ~toet~ Itf(~ _ e~(e+"' t ~~ ~ t~ Property Owner's Ivtaili Address 1H,- Pro 'on City, State ~ T.rp Code 'tltle'Natffiet°'-°-' J ~] ( one / o / ~ T N; lilt E r W r III. Type of Building (check all that apply) ~ a.o (~W S . . CSM Number ~l or 2 Family Dwelling - Number of B tas /• /(o P St3~ 90 3 r 9 g ~~ , - ~ ` , • lidComtnereial - Descdbe Use Pub " ~ ~ ~ K ~' C~ City- ~~ ~~iP of . Star lhvnod -Describe Use III. T ype of Permit: (Check oily one boz online A. Complete line B itapplicable) /~ - O S - /O ^ ?~U 3~(o C A' System Replacement Syston Treahnertt/Holdittg Tack Replacement Only Other Modification m Exisdng System List Previous Pomit Number and Date (sstred B. Permit Renewal Pumit Revision Mange of Pomit Transfer to New Before E>;p'uation Plumber Owner . IV. T e of POWTS S stem: (Check all that a 1) Non -Pressurized in-Gmund d >_ 24 in. of suitable soil Moutxl < 24 in. of suitable soil At-Grade Single Pass Sand Filter Constructed Weiland Pressurized in-Ground Holding Tank Peat Filter Aerobic Tnxhaeat Unit Recirculating Sand Filter Rcdreulating Synthetic Media Filter Leaching Chamber Dri Line Gravel-less Pi Other (wtplain) V. Di ersal/PreatmentAtea Information: Design Plow (gpd) Design Soil Applieatioa Rate(gpdsf) Dispersal Area Required (sf) Disposal Area Pro sail (sf) on ~ ~ ~ V ~ ~~ enk Info Capacity in Galioru Total Gallons Number of Units Manufacturer ) • ~~ ^' tefab Concrete Site Constructed Steel Fibtsr Glass Plastic Nee,. ir:it~og r~1' C--~ ~i Tanks Tanks Septirot Hold~ag Tack Aembic Trratrt~ent Unit . Dosing Cham6a ~{ VII. Res Onsibili Statement- I, the nerd a ibilitp for lnspllatioa or the FOW15 stwwn on the attached tss. ' MPlMPRS Number Busit>ess Phone Number Plumber's Name (Prior) Plumber Plumber's Address (Sheet, City, State ) ~ r ! ~~~~C./ v ~ ~ U z /De artment Use On1 1 Sanitary Permit Fee (utcludtx Groundwater Date Issued in gent Signature o Statrtps) Approved D~PPro Surcharge Fee) 3 ~~_ OQ l en R for IX, Conditions of proval/Reasons or 'sapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (W the County only) [or the system on papa not less than illL x 11 inches is size _.. 6 ~~ '` CT Dave Triemert 1/4 SE 1/4S 24 MPRS Shaun Bird 226900 CONVENTIONAL /T 29 AT-GRADE N/R 17 W TOWN Hammond COUNTY ST. CROIX 6/24/04 BEDROOM 3 DATE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 99.1' B.M Line (not to scale PLOT PLAN ADDRESS 1239 Ctv Rd H New Richmond Wi 54017 Grading is to be done 97' to divert run-off away from system 98.1' 9 9' Scale = 1 /4" = 10' Huffcutt Combo tank Well is to meet all setbacks found in Comm. 83 Pro 3 Bedroom House 9% Slope Tank is to be properly bedded and provided with lockdown covers with approved warning labels CpPV 5' t_ 1~ 6-3\ Top of Wood AIt.B.M.C 97.8' ~~ ~~ ~4 Area 15' below system is to remain undisturbed ~~ 1 ~~~.. 200th St. B-2 commerce.wi.gov isconsin 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 Jim Doyle, Governor Cory L. Nettles, Secretary July O1, 2004 CUST ID No.226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/01/2006 Identification Numbers Transaction ID No. 1015865 SITE• Site ID No. 685798 Dave Triemert Please refer to both identification numbers, 843 200TH St above, in all corres ondence with the a enc . Town of Hammond St Croix County NW1/4, SW1/4, S24, T29N, R17W FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 966652 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.OI/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. Cpn(~1, No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, ~[,~~ stats. r DEF RTMEkT The following conditions shall be met during construction or installation and prior to occupancy or use: OF General Approval Requirements: SEE CORR~ • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.01 /01). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any PO WTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. Stat SHAUN R BIRD Page 2 7/1/04 • 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 Responsibilities. 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 plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. 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, ~~ ~ ~~~~. Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce. state.wi. us Fee Required $ .175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 .~ J~ Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Cover Page ~~c~ sq,~~ 2 8 200 ~~ e ~D~so ~~ Date: 06/24/04 Owner: Dave Triemert Location:NW1/4SW1/4 S24 T29 N,R17W 843 200th St. Hammond System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01 /31) Pressure Distribution Manual Version 2.0 (01 /31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout jal~y ., ~~ 5. Pump Chamber Cross Section 6. Pump Curve ~oMMERCs fNU NGS 7-8. Maintance and Conti ency plan n JNDENC 9-11. Soil test /1 Shaun Bird Signature License number ' PLOT PLAN PROJECT Dave Triemert ADDRESS 1239 Ctv Rd H New Richmond Wi 54017 ~W 1 / 4 S E 1 /4 S 24 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE6/24/04 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 99.1 ' B M * Top of Wood AIt.B.M.Corner Post Line (not to scale) ~ ~ @ 97.8' Grading is to be done 97' 95' to divert run-off 9% away from system 98.1 ~ ~ ^ Slope Area 15' below 99' system is to \ remain undisturbed Scale = 1 /4" = 10' Huffcutt Combo tank ~ B - 3' Well is to meet all setbacks found in Comm. 83 Pro 3 Bedroom House ^~ ~ B-2 Tank is to be properly bedded and provided with lockdown covers with approved warning labels 200th St. ~.--'• " No • Designer Date 4" Observation Pipe Perforated Below Filter Fabric ASTM C-33 S o n d --\ " Topsofi _ J ~ ~~ 1E r Non-Woven Filter Fabric Distribution Pipe G ~• _ ~ _ D ~r _.__-.. ~'. Stope ,• Force N•oin .Bed Of 4~ - 2'2 From Pump Grain Rock Cross Section Of A Mound ~S sttm Usin A ged For The Absorption Area ~ r~ I p ~ Ft. g ,~ I' Ft. ~ ~~ Ft. K• ,~ Ft. ~Ft. L _~ Rowe d l.oYe~' ~o i ~. . / F ~ ti f~ ~ L 4;~Observotion Pips-~ r_±-- -------------------------------- - ~ A __ _ ------- ~ Force Moin -° ~.-._ ------------ --------- ----- From Pump -~ -.... ` ~ ~• o Distribution Bed Of /2 - 2 2 ~ Pipe ~ Orcin RocK I ~„ 4 Obt-ervotion Pipe~~~ Permanent Morket- .t/s~~ !~~'~" ,~ ~~~ .Eivf~~-~~~Pe or Rods Pion View Ot Mound Ucin A Bed For The Absorption AreO PAGE, OF C/tea Motored Oa Bo~ro~+. EA++n~}Y SROeeo tR9T xO~L N~x7 ra Gannet}pan Ft. ~#. Signed: License Number: Date: X ~ Inches v ~ inches3 ~~ Hole Diameter ,~-~-,~ Inch Lateral •" .~.Inch~es) Mart~fold ~- Inches Force Main Z- inches # of hales/pipe ~~ Invert ~lev~tivn of Lateraisl (/ ~ fit. __.___ • Pesfora!ed PRDe OetOti r ~ SP£G~~ ICpTIpNS R~iBr.R GRQ55 SECT `~'N A~ SEPTIC TAI3K L pt~M? Gti ~FATHfRP~~ APPROVED GRADE ~ Ji3NC'C~fli~ $©X ~~QLE COVES PIPE }~" 1"'jiH' ABpvE W~TK C4~D~;T W/ PAUL~K ~ v" G} vENT i~INi~G~i 4K wARtiING ~-BE:. y ~~' ~`ROli D4pR. r ^~ ~~s HZ1~ FRESH a 1R Z KTAi4'E jE ~,~` »~ ~ ~ r,~c~ r. :1 _ e.4~....i - ~a i a ~ •i INLET ... ~GxT t •`, ~DIl1TS wI'[R SiA1'ER TIGHT 5~1"' ~- g~,L i A3d'E ItPP ~~ ~IF.E F3LT€.~ '~ "~' ~ '' N gQ(,IC SOIL ~¢~~ C ~ ' i FF PIPE 354E;~ - ~ '~ FF ~~'~ ` ~ £? D S0~ pt3~4P fl ROYEi) SEDDTNG V~~ TANK / Cpi~tC33ET~ PAS 3 ~ APP r,~ f 1~~je~.i~~ gprCZFICATICI~ l r / ,~ . BER DOSES ?£R DAY DpS£ ~ ~~ ~ ME ZP~C~DII+IG 7a J GAL- ~~K I4ANUFAC'~R£R: ~ DOSEE 31C.~ Fy~igAGK= GAL• n / ~6AL- X sZZ£S : SEPTIC r~ spy • .._ ~~-~ 33~I+CKES TAIi DOSE E.~'~; ~~~,,.~,~'" CAPAG~Ti~z A _..•---- HES = GAL ~~ ~ ~ 2 IIdC ER.. / ALARK ;'st'~FA~ ~: i.- ~ ~ 8 w ,-~ ;NGHES ,.--~j~'L. _ ~ . A~~M A5 PER I LHR L6.23 tii/-C P[1 KP HEEL C~KgER . ~`' ° ~ N I8 Z NG ~;fig 'i'SC'PE= ~ ~ CAM PU3'iP £ FEET RATE -----_' TR I Btt'~i ON flZPE {, l ~ FEET RER~IREn DZSC~iARt3CS SE~£EN PUMP Or F f-NB •'t~ZS • _ - .~~ FEET FA~TQR ~ FEET PRES~~'T/ ~pQ • gT. FR;CTIONiG ~~ .--~ vflt'FIGL fl~F~Q~ SUPPLY 'NAM ~ ~ + MIH~uH MS FflRGEl3AZN X ~GgAL DY DIwnE'f~ ------'_ FEET ~ Q~ Pu MP ~~K • LIQ~ ~ ~``"~-----~~ gN?£R~'~' ~IMENSIOI~S L I C EN' L ~~ gER : r''~-.rte--- SFGNE~~ 188 - TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE MEAD CAPACITY CURVE EFFLUENT AND DEWATERING MODEL 152/153 ' w r W w ~ ~ 50 . 153 12 40 152 - . ~ 30 z 8 0 20 0 4 -( 10 v 20 140 60 84 100 GALLONS LITERS 0 80 160.. .240 320 FLOW -PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. - '`' • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variableJevel float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available foroutdoor installations. See FM1420.- • Over 130°F. (54°C.)special quotation required. 1521153..Series 1521153 MDDELS Control Selection Model Volts'ph Mode Am SIm lex Du lex N152 115 1 Non 6.5 1 2or3 BN152 115 t' Auto 8.5 Included 2 or 3 E752 230 1 Non 4.3 1 2or3 BE152 230 1 Auto ' 4.3 included 2 or 3 N753 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2 or 3 E753 230 1 Non 5.3 1 2 or 3 BE753 230 t Auto 5.3 Included 2 or 3 MODEL 152 153 feet Meters Gol. Liters Gal. Liters 5 1.5 69 261 77 291 10 3.1 61 231 70 265 15 20 25 4.6 6.1 7.6 53 44 34 ~ 201 167 129 61 52 42 231 197 159 30 9.1 23 87 33 125 35 10.7 -- I -- 22 85 40 12.2 -- -- 11 42 Lock Volve: 38..0 Fi. (11.6m) 44.0 Ft. (13.4m) 3 27 s2 sz ,z 1/s ~ 5 1/ 1 -J- 9 s~ -~, SELECTION GUIDE 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. o cAUnoN 2. See FM0712 for correct model of Electrical Attemator E-Pak. All inatailation of controls, protection devices and wiring should be done by a qualified 3, variable level conV01 switch 10-0225 used aS a control ectiVatof, specify duplex (3) licensed elecWcian. All electrical and safety codes should be followed including dte most Or (4) float System. recent National Electric Code, {NEC) and tho occupational Safety and Health Ad (OSHA). . RESERVE POUVERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL 70: P:O. 80X 16347 _ LouisviUe,KY 40256-0347 Manufaclurersof.. ~ SH1P T0: 3649 Cane Run Road [C~~ vv„ ® LouiSViAe, KY 40211-1961 QlLQUTY PUMP9 ,,/iNCE ~3~1u ° ~~w A~ ~O (502) 77F~ r~2) 7104-03624 -PUMP http://www.zoeller.com ,Y, © Copyright 2000 Zoeller Co. All rights reserved. ENT Pt.AN O~Ni'IER~S MANUAL- 8c l'~A EM SPE IFICATI~s p01NTS SYST caetic Tattle C~'Pa`~-;-- Numi~ ~ ~~~c3al Units • Number ~ flow (average) aLed x 1 _~ OesiQn flow (P~~ (~nr goD Appi~°r' Rate Irtfiuertt/Et~~t QuarrtY Fats.- Ofl ~ Grease (i=oG) Bioche~al Oxy9~ Demand (BOOS) Total Suspend Solids {f~ Pretreated went Quality ~~`' Biochemical Oxygen Demand (BOOS) Total S~pended Solids ,(rSS) Fecal CoUbcrn (geometric rrrean) Maximum Effluent i'aRide Size SeryiGe Event rnsped oond'dion of tank(s) Pump out contents of tank(s) ~nsped QtsPersel Dell(s) Clean effluent filter inspect Pump' pump controls S alarm Flush laterals and pressure test %' _;' "' . optic Tank ~'..- -- r Ma~~rrer Effluent 1=11te --,.'-' • E}1luent Filter Model . ~ . ~ ~ ~-"""''~ Pump-Tank CaPadtY pump Tank Manufa~UCer _..6f ~ ~~ ' PilmP Mang ~~ ~- aUd Y . Pump ModBi aUda IIt l Pretnas~1ent Unit . Monthly average' ~ Sand~ro~ Filter ; Sao mgn- p Mechanical Aeration 4~fl mg11• p Disinfection Page of ' ~ al p PIA tVA ~~, ^ NA ~i a.,7 p tVA ~v at o Na ~~~ Q NA 1J'Z/ ONA O Peat Fltter O Wetland ^ Other. Sew ... -- .--- MonttdY average" OisPorounCd (1,9BYnY~ ^ in-ground (Pressurized) ~ Q In-g ~ound si0 m9 Ci gtgrade p Other_ 530 mgn- 0 pri ine . st p' cfut'l QOmI non-aon+mercta9'"~+'t°"'aw end Values type for domestic f y8 i~ct, diameter ~~ t,r,yr emuent ,~,js~wster. .. Yaluas typ~t [or Dret~~ Sgrytce Frsquency a months r(s) (Maximum 3 yrs-) At feast once every uais and-third (~~ °f ink volume When combined sludge and-scum eq Ks) (Maximum 3 yB.) nth At least once every t3 mo 0 monks r{s) At feast once every S p month r(s) p NA At (east once every _._ ~ f7 months s) O ivA At least once every t7 months fl year(s) O NA At feast once every 0 months fl year(s) ~ ~ At least ~~ every ott>er• licenses or Ma~NAPit~ INSTRti1CTiONS an tndivtduai cacMn9 one of the foElowtn~gintainer, Septa9e of tanks and disperse} °~~ shall be made by mower; POW'rs inspector. ~ any missing or broken plumber: Master Plumber Restricted on of the tank(s) LD m and to check for any bad uP limns:. Master ns must inducts s visual inspedi a and scu Senrtdn9 Op~tor. Tank inspedio asure the volume of combined atudg y ~ check the effluent teveis hardware. ~~ ~y CtaD~ or teaks, me The dispersal cslt(s) shall be visas(( lnspect+ed nding of effluent on the round surface. nding of effluent orr the ground surface. Tt~ p° utatory authority. ~ ~'~q pf etltuent on the 9 for any Po tian of the lost n9g in the obsecva-tiort Pi'Pes and to chedc~ndi0on and requires the Immediate notifies or more of the tank volume, the ground surface r~Y ind'u;ate a failing k uais on6-third (~ s~ ~ in acxordan~ ~' d'• NR mutation of sludge and scum in any tan eq a Septage Servidng Operator and dispo yy~n (fie combined eau vents, and any entire contents of the tank shad be removed ~ onents, Pre~t~ment compo Maintalnet. 113, yy~ttsln Administrative (;ode. ressurized P01A(TS comp rformed by a certified P01NTS Zile setvkan9 of effluent filters, mechanical or P ~ event is of 12 months or less shall be ~ of compieSon of any service nce or monitoring at intel'va authcrihr within 't 0 days other malntena ~ to the local regulatory A-seNlRe ~~ shaQ be prow nti eructs or other treatment tanks} ~ the pntsence of I~ n9 P . sTART tJP AND OPERATION ppW'fS check. ecsai Cep(s}. if high ~cen>Tabo~ are For new oonsVucb°n, pnor m use of the ~ s an4/or damage the disc rator prior to use. chemicals that may impede the treabkes t e~ed by a septage servicing pe detected have the contents of the tan ( ? j ..,, ~ • fcltrative sut#ace. Page _„~ ofr_ ~- ~ bored the excess ~t~conditions are h•ozen at the t y~(hen Qom • ~ up matt not coast v~'1er' ai~ove nont~ highwater levels. the ~(s} and may resuii in the g m sta flt t e dose, overloading ~k removed by a ~ es Pump ~~' rnaY cattle} in one tar9 cements, of the pur'11P r iQ outaq r or POYYTS Matntarne Qu~,Kpt tae e ~ e~ ~ 'to avoid this situation have me or c~~d a PIUR~e to the efnuent pu P um tangy pup or surface Opere~ pciot.tD ~ s~restote normal levels vrRhin the P . P ~,gs Servidn9 n ~ pump aotttr~ ~ over, or otherwise diy'tutb or ~1~. ash ~ rnartualtY QP~~ Q ~ palls. Do not dme or pa . ~ vett+d~ ~~ f~an~ etttd dispe lion area- Do ~ drnre or ~` slo of anY mound or at-grade soil absarP ve the perft~rmanot: and prolong the Qfe within 15 lost dawn PB ter stream [rtaY imPro d~reeset'S: the area wastewa dental floss: d'taPers; t~dudton or-eGminat[on of the foilow[n9 ~ butts: condoms; cotton swabs'r tine; gt+@aser herbicides; meat of the pOWTS: armbiotics: ~babYwiPes~ pump} v~rater, fivt~ and vegetable pee nsg~and softener brine. 'Ir~ot~s. n~ g P~ : P~~des: sanifsrY napidns; Campo ~ taken to Insure that the shaft fottawl steps ABAAiDO[~MEI'IT fails andlor is ~~~gntfy.taken out of service the ~soonsin Administrative Code:. When the POWZ'S ed In ~mpliance wt~h ~. Comm 83.33, Wings seated- m~ ~ properl~r attd: safety abandon ~ disooMected and the abandoned Pipe oPe a Servicing Operator. AU ptp(ng to finks 8nd pti' shall all be removed and prope1'h' disposed of by a St:P~S ,rated ana removed or their c~+rem fed'O`r~.snd the void space • ~,~ i„nter,~s of $ir tanks and P~ ~ After pumping, at[ tanks 'and pits shaft be excs filled with soft, granrel ar another inert solid material- m vide a code Pro CONTINGENCY PLAN aped ~$ foltowtng measures have been, or must be taken. It the PODS fags and cannot be rep ~rnpGant repiscerrfent system: acpa ~~ men evaluated and may be utilized for the Iocation~of a reR~ and should not ^ A suitable repi$cemen .should be protected from disturbanc8 and comps absor'Ptbn ~~..~ repy~ement area sad structure, tot lines and welts. Failure to wired sett~adss from existing and ProPo be infringed upon byarea watt result in the need for a new soil and site ~evatua tion~ ~~ tabUsh a su"rta e Proms the rep-aceme ant systems must comply with the rules in effect advances in POWYS re facement area- RePlacem P vaitabte due to setback andlor sot! ti faded POW~Sng ant area is not a rt to replace thel.and acem st reso a so re I as a la pOWTS ble . P ed the p A sulfa be install n fdiiure of _ a holding tank may ~ bte re taoement area Upo t area is available a. technology ~ a surfs P JaCemen entrfy (f no rep e site has not been evaluated ~ ~ locate a' suitable replacement area. to POVYYS- /' site evaluation must be perfa*r' $ Est resort to replace the fatted ce ~ilowing rem of the btomat at olding tank ma~e so~l~~~n systems may tae reoonstrvcted in Pty the t1JIe5 [n effect at that time. Mound and at-g coons of such systems must comply the inflftretlve surfaoe< Reoona•Cu <cVYARNtNG» ~EIQT T,4MKS MAY GO~ITAtN LETNAf. GASSES ANDlOR INSUFFICIZrNT OXYGEnt. CIRCUhiISTANCES. DEATH MAY SEPTIC, PUMP AND OTHER TRF~ DO NOT ENTER /- SEPTIC, PUMP OR OTHER TREATMENT TANK UNDF,.R CuE OF A PERSON PROM THE INTERIOR O[` A TANK MAY BE DIFFICU[.T OR IMPOSSIBLE RESULT.. RES ADOrrIOtltAL COMMENTS POWTS INSTALLER ~ Marne ~ -1Lf/ ` ~ d Phone ~'/~ --•'Z "' ~"~ POWTS MAINTAINER Name ~~~ ~/ Phone ~/.~ ~"" ~ ~ '' .,~~. ERATOR UMPER~_,,,.,. LOCAL REGULATORY ai~THORI7Y SEPTAGt: St=RViCING OP ~ `~ Agency ~~ Name ~}~? Phone ;'J.f = Phone ~~; --- ~ `r ~ "~~••~' ~ ThIa document meets n Latce, Marquette and Waushar' Cptrnty Zoning and Sanitation; - nt does not rrts aoarment w+s dtsft+ed by ~ staAe ~ the G~cse Cede. Use of this doeu~ G~ (~'t me minLr-um roau'usM•nts of rdt Comm 83.22t'1JN?(1x~~(fl'r'd 83.54(1). (2) 3 (3), W+sCOnsin admtnts~"' guarantee tf~e performance of the f'oW't"5• . (- Wisconsin D~artment of Commerce SOIL AND SITE EVALUATION Di~rjson 5f Saiery and Buildings Page of Bureau of Integrated Services In accordance with Comm 83.09, Wis. Adm. Code Attach comRlete ~tr7 plan on paper not less than 8 1/2 x 11 inchesxt~i2e~ Pfan must County ~~r include, but not limited to: vertical and horizontal reference pomp (BMjf direction and percent slope, scale or dimensions, north arrow, and location ~ttd,aistance to'iiearest road. Parcel LD. # ~ , "`~: APPLICANT INFORMATION -Please print all ~tri1`ormation. ~. R iewed by Date Personal information you provide may be used for secondary purposes (?rivacy Law, ss j5`0~, (1) (~). Property Owner ~ :~~~`: ~-dgperty Location-: p r-~ ~2~VC;tot , ~ 1/4S(,~1/4,Sn( To~ / ,N,R / ~ E Property Owner's Mailing Address '~~;; Lot # Block# Subd. Name or CSM# ,, City State Zi ode Phone Number Nearest Road ^ City ^ Village ~ Town ~IVew Construction Use: ~iesidential / Number of bedrooms ~ Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow ~) ~~~-gpd 2 ~~~ 2 Recommended design loading rate / 2 bed, gpd/fit ~ ~Ztrench, gpd/ft2 Absorption area required-~;~~~bed, ft trench ft Maximum desi n loadin rate /. Z~ bed d/fl~ ~ `^- trench d/ft2 /~ 9 9 , 9P ~ . 9P Recommended infiltration surface elevation(s) ~' %, / ft (as referred to site plan benchmark) Additional design/site considerations /yam Parent material Flood plain elevation, if applicable / ®^~~~ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ^ S ~U J®-S ^ U ^ S7~-U ^ S - ^ S ~Z ^ S SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench f ~c~ ~2 ~'~ wv S - .r; v~ 3~ ~ is/ ff ~J ~ i5~ ; -.5~ ~~ ' Remarks: a ~- ~ ~~ l -~ ~ ; , L'~i2~ a d/ % -mil - ~~ ~ ~~/ Remarks: ST Name (Please Print) Signature J Telephone No. Address ~ Date CST Numb r PROPERTY OWNER ~~~~ ~~/~'~'~"~ SOIL DESCRIPTION REPORT Page ~ of ~ '` PARCEL I.D.# ' t . Boring # Ground eyev ~2ft. Depth to limiting f tor/ G9~in. Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda R t 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry oo s Bed , Tren ch //`` (` / Remarks: Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Boring # Ground elev. ft. Horizon Depth Dominant Color Mottles T xt r Structure Consistence Bounda Ro ts GPD/tt2 in. Munsell Qu. Sz. Cont. Color e u e Gr. Sz. Sh. ry o Bed ,Trench ~_,_ ; Remarks: Depth to limiting factor 'n' Remarks: SBD-8330 (R.9/98) r Project Name Joe Dohmen a Soil Test Plot Plan Shaun Address 2022 Hwy 12 Baldwin Wi 54002 C M #226900 Lot Subdivision ------- Date 3/16/00 N W 1 /4 S W 1 /4S 24 T 29 N/R1 ~ W Township Hammond Boring 0 Well PL Property Line County ST. CRO(X BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 99.1 *HRPSame as Benchmark Alt. BM Top of Wood Corner Post with Orange Ribbon ~ ~ ~. ~ Fence Line Note: Soil test done for zoning requirement, test may not be suitable for future owner's building site Please note: no surveying was done at time of this test, lot boundries are unknown at this time. 40 B-1 9% Slope 50' B-3 B-2 Alt 0 0 N r v2~: v , TC~ ~ ~~~ ~^~a ~ OwnerBuyer Mailing Address ST CROIX COUNTY _ ENANCE A~REENffiNT o? 6 8- ~EPTIC'TANK h - ~ ~~ Oy~ER$HIP CERTIFICATION FORM ~7/ _ .~Y ~ ti t• Property Address ed tom Planning Department for new constructi (Verification requir ~s`{ _ /0 _ ?~ ~ ?~ ~ C, nig-/ parcel Identification Number City/State LEGAL DESCRIPTION / ~/ c' ' 1 T~~N-R~~W, Town of • t~V /+, d W 1/,, Sec~~ Property Loeatto ~ . LOt # ~._. Subdivision - o3J Volume ~~..._~ Page # r.~3 s Certified Survey Niap # Zo3 ~ Page # 5l ~ X96 6 5~3 ,Volume _____- --' Warranty Deed # __r___- s ^ no Spec house ^ Ye° Lot lines identifiable A~j`ENANCE remature failure to handle wastes. Proper maintenance SvCTFM NL ~~ of your septic seys~teo soonerc if needed by a licensed pumper. Wit You Put into the system improper use and mare stem. in out the septic tank every tie Y osal sy consists of PAP gon. of the septic teak as a tTeatmeIIt stage in the waste disp can affect the functi artmeat a certification form, signed by the owner and by a to submit to St. Croix Zoning Dep er verifying that (l) ~ on-site wastewater disposal system Zye property owner agrees 1/3 full of sludge. her, ourneYinanPl~b~'ros~ctedplumber or a licensedmpumP necessary), the septic tank is less than masterphua ~ ~nditioa and/or (2) af3er inspection and pump g is is proper operating rivate sewage disposal system with the standards rsi ed have read the above requ~~~ and agree to mamtam the P Resources, State of Wisconsin. Certification Uwe, the undo gn artment of Natural Zoning Office within 30 as set by the Departnnent of Commerce and the Dep set forth, herein, stem has been maintained must be completed and returned to the St. Croix County stating that your septic sy days of th~ Yom' expiration date. ~ ~ ~ ~~ DATE SiGNA"lVR~` OF APPLICANT OWNER CERTg'YCATION ' laiowled e tall statements on this form are true to the best of my (o~~ g I (we) certtfy tha vuttte of a warranh' deed recorded in Register of Deeds Office. the property described above, by ~~ ~ , I (we) am (are) the owner(s) of i DATE SIGNATURE OF ppPLICANT De artment. ' that is mis-represented may result in the sanitary permit being revoked by the Zoning p ##s+~~ Any information d warranty deed fr°m ~0 RegeferenceDs made~in the warranty decd ~• Include with this application: a stag a copy of the certified survey ~P *f4ff« Document Nnmber Grantor, Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (the ' more space is needed, please attach addendum): Lot One f Certified Survey Map in Volume l6 of CSM, Page 4351, as current Number 685903, filed in St. Cro C unty Register of Deeds ce on August , 2 2, eing located in the Northwest Quarter of the Southwest Quarter (NW r/a of SW '/.} of Section Twenty-four (24), Township Twenty-nine (29) North, Range Seventeen (17) West, Town of Hammond. Together with all appurtenant rights, title and interests. Recording Area 6 9 6 6 5 3 HATHLEEH H. MALSH REGISTER OF DEEDS sT. cROIx co. , MI RECEIVED FOR RECORD 10-31-2002 9:30 AM WNI2RANTY DEED EXERT # REC FEE: 11.00 TRANS FEE: 90.00 COPY FEE: CERT COPY FEEL PAGES: 1 Name and Return Address Robert J. Richardson 5233 McKay Ave. P.O. Box 399 Spring Valley, WI 54767 0:2 -/~7 "I~ is not homestead property / {iaj (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights of way of record. Dated this ~ n a LI day ofOctober , 2002 • AUTHENTICATION Signature(s) authenticated this day of r TITLE: MEMBER STATE HAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY _ JENNIFER A. O'NEILL, Attorney at Law SPRING VALLEY, WI 54767 (Signatures maybe authenticated or acknowledged. Both are not necessary.) !J 2031P 517 STATE i3AR OF WISCONSIN FORM 1 - 2000 I WARRANTY DEED '" seph A. Dohmen s ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. PIERCE county ) Personally carne before me this ,x~~~ day of October 2002 the above named Joseph A. Dohmen -. -. ~~,... i~ L ~~ __ to me knowu to be the person(s) who exec>xteti th0.fore~eiitg . i~tst nt,aTid ac1i11o~yledged ~ same.-.; ~~ (y _ - " Jennifer A. O'N ill "•' Notary Public, State of W I S CO h S I n `~ ~ e; t~ My Commission is permanent.-fF€~saE-e~tste•e~rpis~at~iorrdete:---- .) rr s of persona signing in any capacity muatbe typed or printed below their signature. INFO-PRO (80055-2021 www.infoprofortns.com STATE BAR OF WISCONSIN WARRANTY DEED FORM No. I - 2000 ~ wp~ovEO ~ ~ J ~ ~ _ P1Si,-. fiT. ~ cou ^' voL 76 PAGE,_ 4351 ~m . ~ ~+ XATNLE£N H. WALS}i i;.w ~ !~ Zg02 STGI ROIXOCODEENI GAR TI FI ED SURVEY MAP RECEIVED FOR i,.r.--~~ Located il~"`~aft`~bf the NW 1/4 of the SW 1/4 of Section 24, s-05-200 9:r r. „;<< Township 29 North, Range 17 West, Town of Hammond, St. Croix C RTIPIED SURVEY t1AF County, Wisconsin. R COFY FEE: 3.00 Owner Joseph Dohmen D.O.T. Certification No. ~Ei1-352-2002 ~---the W 1 /4 car. of Sec. 24, T_ 29 N., R. 17 W., found Bemtsen "Survey Mark" Nail S 89'23'08" E 5243.01' ~ 1 ~~ l ~ the east-west quarter section line. ~ 3 1 o I m -~ ~ ~ v Q~ a V o ~I N ~~ ~ N C Q ~ ~S ~ Lot 1 C_S.M. Val. 14, Pale 3887 ~3 3 ~ ~ ~ ~ ... F~- II N _~ ~ J ~ the S. line of Lot 1 C.S.M_ Vol. 14, Page 3887 a~ I ~ ~.i 33~ 33' Q- - S 89'23'08" E 523.07' Z - ~ ~ - - 490.07'- - ~ 33.00' i~ Including Right-of-way o ~.r~ 130,767 sq. ft O 0 3.002 Acres ~ N ~ N Excluding Right-of-Way ~' ~` Lot ~ 1 2 813 Ac - - - 3 i res I ~ ~ ~~ ~ ~ ~ ~ - - 100' Roadway Setback Line o ~ cp ~2 ~3 O Z . ~ ~, I 4 -~-33.00' ' ~ - - 490.07 - - l ~ ` ~ N 89'23'08" W 523.07' -I- l 1 r I c0 ~ ( ' ' 33 33 o ~ I ~ W ~~O i U ~ v Z c p ~ In N w ~ ~ CD O ( ~ ' ~ 3 J' ~ N ~ ~., t~ ~ ~ I N o o: ~ ~n `o ~) ~z ~ U NN ~ ~--- I Y w F m ' J o~ ~ 0 n~ ~o:~ ~z o W a, yN ~ ~ c°v M 0 O CV w 0 0 w ~ e ~~ S Y i ~/~vw\ +~ 1 O' (~ Q Z QI J ~I Lii I-- ~f J ~I Z UNPLATTED LANDS Nt ~ LEGEND ' ~ O Denotes 1 inch by 24 inch iron (1-1/4 inch O ment set O ) i m n r £ 4i . , . . p pe o u weighing 1.62 lbs. per lineal foot. ° °~ i • Denotes 1 inch iron pipe monument v i - m found_ ° 3 c Q Denotes Section Corner Monument .c r ~ ~ found, as noted. `o '~ f/f 1 ~ Denotes soil boring location o~ ° 0 ~ ~~ per soil evaluation report by others. -~ _ ,~ ~•• ,I ~ ; o+ '' • N A . s =~ ° ~: EV>=RSOht * = 5-i 871 ~ - O 50 100 150 200 :RIVER FALLS~~= ~~4~,y~ w~...~~.t~~~~`` Scale 1 inch = 100 feet ~. _ s~~ssv __.~ ~~ f '~ 283.80' S 89'23'08" E /3- 3- '~i~i~`~~'~" Sheet 1 of 2 sheets Instrument Drafted By. Alien L. Everson Vo1.76 Page 4357