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HomeMy WebLinkAbout018-1082-10-090 sconsin Deportment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix afety and building Division INSPECTION REPORT Sanitary Permit No: 429997 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Zschernitz, Travis Hammond Township 018 - 1082 -10 -090 CST B I v: Insp. 6 Elev: BM Description: Section/Town /Range /Map No: 1 g� 30.29.17.572 TANK INFORMATION V I ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic i , / /v -,1 Benchma y'rh -42 0 n up n Dosing Alt. BM 5T-� � g 3 &� Aeration !� Bldg. Sewer Holding SUHt Inlet 5C14g6 St/Ht Outlet TANKS TBACK INFORMATION _-- TANK TO __P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic /no X701 01 22' n ' . 'a Dt Bottom / Z, Dosing 11 A � Header /Man. Aeration Dist. Pipe ' Holding Bot. S��� Final Grade S� PUMP /SIPHON INFORMATION p �' �S� 1 0- Manufacturer Demand St Cover S y 2. =� S Model Number c "31,11, TDH Friction Loss System Hea TD Ft a. 6 1 [ f" - S I 1 10.0 F main Len th r Dia r Dins. to Well �� ) SOIL AaSORP SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �� *d SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM EACHI G Manufacturer: INFORMATION CHAM@FA OR Type Of System: / ,�/� `) Model Number: DISTRIBUTION SYSTEM i h Header /Manifold Distribution x Hole Si x Hole Spacing Vent to Air I Vev Pipe(s) ff Len th Dia Length Dia S acin SOIL COVER I x Pressure Systems Only xx Mound r At - Grade Systems Only GwP/La Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Qed/Trench Center Bed/Trench Edges Topsoil � D `] Yes L. � No � Yes No - NITS: (Include code discrepencies, persons present, etc.) Inspection #1: /1/ / d3 Inspection #2: & 1 49 1 0 -3 "th St Hammond, WI 54015 (SE 114 SE 114 30 T29N R17W) Meadow Ridge Lot 9 X l / Parcel No: 30-9. 7. CIO )y des No - - - - -- ,formation. Date Insepctors ignature Cert. No. Al Safety and Buildings Division County W 201 W. Washington Ave., P.O. Box 7162 ST CROIX F1 Nvi sconsin. Madison, WI 53707 - 7162 Sanitary permit Number (to be filled in by Co.) Department of Commerce 1 (608) 266-3151 4 f29 � 1 7- Sanitary Permit Application State Plan I.D. Number SITE 656044 In accord with Comm 83.21, Wis. Adm. Code, personal information you provide TRANS ID # 865870 may be used for secondary purposes P tv .04(1)(m) Project Address (if different than mailing address) I. Application Information - Please Print All Info-1-nation V CU Property Owner's Na me 9 2 003 Parcel N Lot k Block # TRAVIS & WENDY ZSChERINITZ Sr 9 Property Owner's M ailing Address zpNING OFFIC T Y Property Location 1278 220TH AVENUE City, State Zip Code Phone Number — !4, c)E 'A,Section 30 NEW RICHMOND WI 54017 715/248 -7166 (circle one) II. Type of Building (check all that apply) T 29 N; R 17 E or& Ej 1 or 2 Family Dwelling - Number of Bedrooms 3 Subdivision Name CSM Number ❑ Public /Commercial - Describe Use o* TT - J0 MEADOW RIDGE " ❑ State Owned - Describe Use t k1 M&UJ * 1l -0.n a if ❑City_ ❑Village WTownship of HAMMOND M. Type of Permit: (Check only one box on line A. Complete line B if applicable) 018' X08 Z —/p - v 90 5--2- A. [I New System ❑ R System y p y ❑ Treatment/Ho Replacement Only ❑Other Modification to Existing System B. El Permit Renewal El Permit Revision Change of Permit Transfer to New ist Previous Permit Number and Date Issued Before Expiration Plumber caner 420734 3/14/2003 IV. Type of POWTS System: (Check all that a 1 ) ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil [X Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) I Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (so System Elevation 450 1 450 4 ' 450 89.2 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 1000 1000 WIESER CONCRETE X Aerobic Treatment Unit Dosing Chamber 600 1 600 WIESER CONCRETE X VII. Responsibility Statement- 1 , the undersigned, asstune respo ibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plum 's Si gnature MP /MPRS Number Business Phone Number BENNIE HELGESON 220292 715/772 -3278 Plumber's Addre ss (Street, City, State, ode) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VIII. County/Department Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I suin Agent Signatur (No Stamps) Surcharge Fee) 1 ❑ Owner Given Reason for Denial IX. Conditions of Approv � S � S�e✓,,,,., -1ti � �vJ� ,� tr �d.� -�� oQ tea, --a �4 �.e�- Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) f e r; i� 3 too.1 _ 7py e• F Ekci �� 4F "PuL ZZ' �. Pwpd��. lc�oo /600 �- r \ � P ,it \ MeadZ m w rR kAla r « Safety and Buildings 4003 N KINNEY COULEE RD • , LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commerce.state.wi.us /sb Department of Commerce www.wisconsin.gov Jim Doyle, Governor C ory L. Nettles, Secretary May 13, 2003 R CUST ID No.220292 TTN: POWTS Inspector BENNIE W HELGESON ONING OFFICE HELGESON EXCAVATING T CROIX COUNTY SPIA W 1229 770TH AVE CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 05/13/2005 Transaction ID No. 865870 SITE• Site ID No. 656044 Travis & Wendy Zschernitz Please refer to both identification numbers, 70TH Ave above, in all correspondence with the agency. Town of Hammond, 54002 St Croix County SE1 /4, SE1 /4, S30, T29N, R17W Lot: 9, Subdivision: Meadow Ridge FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 902593 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. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • 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.6/99). • 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 POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c coy • A Sanitary Permit must be obtained from the county where this project is located in accordance with the APP requirements of See. 145.135 and 145.19, Wis. Stats. DE M SI OF • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat SEE COF • 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. BENNIE W HELGESON Page 2 5/13/03 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, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@conimerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 w' INDEX SHEET PROPERTY OWNER: TRAVIS & WENDY ZSCHERNITZ 1278 220TH AVENUE NEW RICHMOND, WI 54017 PROJECT NAME: TRAVIS & WENDY ZSCHERNITZ PROJECT LOCATION: SE 1/4, SE 1/4, S 30, T 29 N, R 17 W MUNICIPALITY: TOWN OF HAMMOND COUNTY: ST CROIX 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 r t/E Page 3: Distribution Pipe Layout RECEI Page 4: Septic Tank & Pump Chamber Cross Section & Specifications MAY - ? 2003 Page 5 WLP1000 /600 -MR ZABLE Tank Specifications SJ-FET'Y & B LD G S D 1V. 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 Sign Address: W1229 770th Avenue • Spring Valley, WI 54767 Credential Number: 220292 Date: May 5, 2002 iIOV E® EY� M uERCc Gs SPOIVDE14CE Pin piar� (�cJn�er rt - a-Qis �- �ekc��. z 7, 5 cA11 Ifz I J� r T or 0� FDR fu,c�ha�n5�orrv�s.� Ek-c � "pucr proper - C k IOMA00 5.ep +�c/ flu -►1iO Chgw%_6e s- M cx , CL � � c I Q I Z z Page 01 Synthetic Covering Distribution Pipe ASTM C-33 . o Medium Sand _ G Topsoil _- H"'""" f � a 3 I E / %, Slope Plowed CCL�.Of 2�— 2 1 2 Force Main From Pump Layer Aggregate D ° S" _ Ft. E .� Ft. Cross Section Of A Mound F ; V Ft. G . S" Ft. A Ft. H _ /,O Ft. Signed: g 7, � — Ft. License Number; K 7.35 _ Ft. L 11,2 Ft. Date: j y L Ft. T 7.5 Ft. W .3 Ft. Observation Pipe A I W Distribution t ' t ' Of 2 — 2 ' 2 Pipe Aggregate Observation Pipe 101-2. S vas °-� rea Plan View Of Mound Oc�n -I Tra fz - Z s c�, �►; i 3aF 0 - C )eo•�r� Perforolad PIPE 061011 �G� rsC-, End Vlew Perfwaled rr PVC Pipe .1 -Ai Holes Located on Bottom are Equally Spaced �� i'c�r 1"l• I �. �u ..../� 641r10ullon..- Plpe Distribution Pipe Layout P .. - sa r �• R i S 3 1" X 2 —S .zr Y 3 ; ;r "I- Inch Hole Diameter fT Signed: '• Lateral i J 5 Inch (es) License Number: Manifold " ? Inches Dace: Force Main " ;2 Inches y,UVE�t1•e�. g� 7 Y T l-Eo l�s { d eb - �.gTPV•ct l - 3 � SEPTIC TANK E; PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" .PVC.. PIPE 1WINMIN ABOVE GRADE £ WEATHERPROOF JUNCTION BOX APPROVED >_ 25 FROM DOOR, O WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK E WARNING LABEL FINISHED GRADE 4" MIN. u b nin. K y "PUS ObSERW►T,'otj 18" IN . PI Pe INLET WATER TIGHT SEALS TIGHT i � �IAPPROVED A SEAL JOINTS WITH FILTER _ ALM APPROVED PIPE APPROVED 2A 2r= L- B + ON 3' ONTO PIPE 3' i SOLID SOIL ONTO SOLID C OFF SOIL PUMP OFF ELEV . S FT . D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS • r 1 c T L_cLi"•e r at�S SEPTIC / DOSE r I3 , 3 / X TANK MANUFACTURER: I,(; «�- O GAL- DOSE VOLUME�INC G �� G AL. TANK SIZES: SE PTIC _Q— GAL. /s &1 FLO BACK DOSE �.QS� MANUFACTURER: s s 4 ,- ,„,,CAPACITIES: A = �$ INCHES = D� l,�g GAL. ALAR 3• �� AL MODEL NUMBER: L B = 2 INCHES = 3 GAL.. . SWITCH TYPE: GAL. C INCHES = / PUMP MANUFACTURER: t'/' MODEL NUMBER: D INCHES = /GAL. SWITCH TYPE: 16.23 WAC REQUIRED DISCHARGE RATE 3 /�o GPM PUMP E ALARM WIRING AS PER ILHR FEET DISTRIBUTION PIPE VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DIS FEET + MINIMUM NETWORK SUPPLY PRESSURE . • • • ' ' ' FEET + FEET FORCEMAIN X �.� FT /100 FT. FRICTION FACTOR • - - ��FEET �_ TOTAL DYNAMIC HEAD - LENGTH WIDTH DIAMETER INTERNAL DIMENSIONS OF PUMP TANK: LIQUID Sc, SNYC�, 74 Per IviC C SIGNED: LICENSE NUMBER: DATE: 1/88 r o O o w� z LwJ ¢ U 8 Q' r l ° c C� N a - J - ��o. Z �.r t o � o I o a� o L� °oa\ 0 �m Q zz ° 0 pUW o0 V pQ �� _ -J ¢ p aaN N �L o ,,, (A ¢ Q a En EE x 00 v > 0 w W w c� O z ( '� ,J'' ��� l J w w Ef J Ix O W c c i q CD (n Q o w cNil 0 r, o m rz co W O _o Opol'�,n mww O O Z V! C ` 0 rn to O < N I� Q O t= _i r, 1- Q F- � e N>to L Li ui C.) w Z } 0 0 Y �LOL;jlo co jw� �in� U U M7 J .. Z LY En O Z o� = =� ..30= °mY oo= a w o C-9 q52 0 Q O �OOQM+ L ��t 0 c 0 U O r On9O82M *m-I z ►LI w Ld Cy 0 I W > LJ a Z� d Z 1 I' 1 I I W t f �I j 11 W Cl- < IV 1 1 Q N o (.) ' N . 1 I 1 • 1 1 V) 1 1 1 t Z I I U,I Ii 1 1 > t 1 �i fttt i i ` 1 J „95 Q D � n t; Tr, v1 �e VlfxG Z s� e_r t z P� 6 a �S H 3 7/8 6 1/4 HEAD CAPACITY CURVE • W MODEL 98 a 5/8 'I 25 I i e 3 5/8 6 20 m O = 4 3/16 S2 15 4 9 10 1 1/2 -11 1/2 NPT 0 2 5 0 U.S. GALLONS 10 20 30 40 50 60 70 80 LRERS 0 80 160 240 009971 12 FLOW PER MINUTE 4 3/16 SKI 102 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. • Mechanical alternators, for duplex systems, are available • Double piggyback variable level float switches are available with or without alarm switches. for variable level long cycle controls. Standard all models - Weight 39 lbs. - % H.P SELECTION GUIDE 98 Series Control Selection 1. Integral float operated 2-pole mechanical switch, no external control required. Model Volts -Ph Mode Amps I simplex Duplex 2. Single piggyback variable level float switch or double piggyback variable level, M98 115 1 Auto 9.4 1 — float switch. Refer to FMO477. N98 115 1 Non 9.4 2 3 or 4 & 5 3. Mechanical altemator 10 -0072 or 10-0075. D98 230 1 Auto 4.7 1 — 4. See FM0712, for correct model of Electrical Altemator. E98 230 1 Non 4.7 2 3 or 4 & 5 5. Control switch 10 -0225 used as a control activator, specify duplex (3) or (4) float system. CAUTION For information on additional Zoeller products refer to catalog on Piggyback variable Level Switches, All installation of controls, protection devices and wiring should be done by a qualified FM0477; Electrical Alternator, FM0486; MechanicalNtemator, FMO495; Sump/Sewage Basins, FMO487; licensed electrician. All electrical and safety codes should be followed including the most Single Phase Simplex Pump Control, FM1596; Alarm Systems, FM0732. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 18347 Louts^ KY 40258-0347 Manufacturers of. . SHIP 70. 3649 Carte Run Road x e Loulnft, KY 40211 -1961 ZuIUTYPUMPB S NCE /9s�✓ r PUMP !O. (502) 778.2731.1(800) 928-PUMP htgo://www.zoeller com FAX (502) 7744624 0 Copyright 2001 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL & MANAGEMENT PLAN page 6 of FILE INFORMATION SYSTEM SPECIFICATIONS Owner TRAVIS &WEND Septic Tank Capacity al O � Permit # I Septic Tank Manufacturer WIESER CONCRETE O DESIGN PARAMETERS Effluent Filter Manufacturer Z ABEL O N Number of Bedrooms 3 O NA Effluent Filter Model A -100 12" x 20P ON Number of Commercial Units 9§ NA Pump Tank Capacity 600 ga l O N Estimated flow (average) 300 QaVda Pump Tank Manufacturer WIESER CONCRETE N Design flow (peak), (Estimated x 1.5) 450 gal/day . Pump Manufacturer ZOELLER PUMP C0O Soil Application Rate altda /fe Pump Model 98 O N, Influent/Effluent Monthly average* Pretreatment Unit C1 N, ❑ Sand/C�ravel Filter ❑Peat Filter Fats, Oil &Grease (FOG) 530 mg /L ❑ Mechanical Aeration O Wetland Biochemical Oxygen Demand (BOD 5220 mg/L ❑ Disinfection O Other. Total Suspended Solids (TSS) 5150 m /L Manufacturer Pretreated Effluent Quality O NA Monthly average** Dispersal Cells) Biochemical Oxygen Demand (BODO 530 mg /L ❑ In- ground (gravity) O In -ground (pressurized) Total Suspended Solids (TSS) 530 mg /L O At -grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu /100m1 ❑ Drip-line 0 Other Maximum Effluent Particle Size Y. inch diameter Values typical for domestic (non - commercial wastewater and •• septic tank effluent. Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every 2 ❑months year(s) (Maximum 3 yrs.) Pump out contents of tank(s) F When combined sludge and scum equals one -third (4) of tank volume Inspect dispersal cell(s) At least once every 2 O months ER year(s) (Maximum 3 yrs.) Clean effluent filter At least once every 1.1 O months . Clyeags) Inspect pump controls & alarm At least once every 1 O months Ckyear(s) O NA Flush laterals and pressure test At least once every 3 O months gyear(s) O NA !! other. At least once every O months Cl year(s) O NA other. At least once every O months O year(s) O 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 Maintalner, Septage Servicing 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 visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum In any tank equals one -third (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreattment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintalner. A service 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 chemicals that may Impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. OWNERS: TRAVIS & WENDY ZSCHERNITZ Page 7 of System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal ceil(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintalner to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, own slope of an mound or at -grade soil absorption he area within 15 feet d p y - area. 9 P Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life I • de of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs, degreasers; , dents floss,* 'dia rs• Pe disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; most scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of'service the following steps shall be taken to Insure that the system is properly and safely abandoned in compliance with 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: • A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction. and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. • A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. • 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 locate a suitable replacement area. If no replacement area is available a holding k t n may be installed as a last resort to replace the failed POWTS. Y P • Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name HE GESON EXCAVATION INC Name JOHNSO Phone 715/772 -3278 -Phone 715/273 -5811 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Agency 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 Sanitation agencles. This document meet the minimum requirements of ch. Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. GAAV 2101) • PL` S 28.84 ACRES f5 . hJ1.i 1f �� o � ti h�mo 6 " "� o o h ooh o a` "J PL TT- L A a NORTH INE OFT E SE i/ OF TH SE I N89 3 "E I 5. 9' ` 50 LOT 8 0 2.2 ac.. al I 5� j / LOT 2.0 ac 8 ��- i ns CGed q N tD F s 2S R. T +1062.7 MPORA L- OE SAC 10621 9 M ° 1032 y 3 O 13 /w 190' S89 0 58'06" 325.0 ..,:. 02/24/2003 11:20 6087859330 SAFE I aS PAGE 01 Of Wisconsin Department of commerce SOIL EVALUATION FF= / , DMslon of Safety and Buildings (p accordBttGg With Comm S5, Wis. Adm. Coc. ;. X Aftch complete site plan on paper not Was then S 1/2 x 11 Inches In alas. Man must "/� /D P � ✓ /�� T include, but not limited to: vertical and horizontal reference Dint (BM), direction and percent slope, Scale orxfir long, north ar�V. and location and distance to nearest read. i t"'. Please print all hiformatlon. asas (pdveay L-aw. s. 95,94 _ Personal Inrormotion you pnwlde may be used W saoanday DrnP. Z/ Property L Aion 3f7. 2�. )�'. 5 Prope Y nor 1 y [;ovt. Lot _ . Lot# Slack Prapley Owner's Meiling �tl�o� ' r [2 city, � �{ 'r� ` 1r��u.. toad C y late p Cody Phony NI GPD New Co an Use: [] ResldenI I Number of bedrooms nstr [] Repla tent p he ar ardal _ Describe: (L fk. Flood Plain ,!i,val, ab1` L6,I /U Parent materlsl ;r – General comments � d Wl , si" d 4q (( wo _V and recornMendatiort3: J D Boring App Gcatlon Rate Boring # g Pit Ground surface elev. ' ft Depth to l'+: _T unce C GPD /tt� Redox Oescriplion Texture titre. -v i I f "Eff'12 Horizon Depth Domina+rt[:ator Cont. Color In. Munseli . Qu• L 241 C1 Boring p+q Boring # Ground surface el ®v. 0 1I ^ Sr,11 Ap I{catlon Ram p'd GPWfta Horizon Depth Dominant color Rodox Deserlpt(on jexlurF �, ,. . °�ff#1 `Hff/12 Munsoli 4u. Sz. Gant. Color Gr Ph " 5ffluent #1 BOD, > 30 < 220 molt- and 'rS5 %30 < 151) mg /L mDes U ; _+ t;S"f Norma ( / lY f `� _ one Number Plegse Print) ,t'�Ff9ht 5 � e �. ��,. Address �.�✓ '- _ ' SBD -9334 (807/00) 02124/2003 11:20 6087859330 PAGE 02 rr =iF- M. Pa.� Property Owner AU4 ParcB1 I D # Bodng 0 ❑Boring c� p Ground surface slay. ft. Depa r , Spli Appllcativ„ Rate Hortian Depth Domlmnt Color Radox Descllplion Texture un:: into , GPD/11 in. Mansell cu. sz. Cont. Color c- .:. _ 5 *Eff#1 EM L� fi jS� s CZ e s 3 T/ th-LvAj _ .... i t-�1 r Boring # ❑ Boring ❑ pit Ground surface elev, tt ref irr' soil Application Rate Horizon Depth Dominant Cola' Redox Description Textura -wire ;:.t.: GPD /fig In. Munse9 Qu. Sr- Conk. Color 'Eff 41 'Ef##2 Boring # ❑ Boring ❑ Pit Ground surface eiev- tt. : � _ Soil Application Rate Horizon Depth Dominant Color Radom Description Teatw?s t:• GPD/tl' In. Munsall Qu. 5z Conk Color "Eff #1 "Eff#2 t ' Effluent #i BdD > 30 < 220 mprt. and T55 >30 < i 5U rnpl L 30 mUfL 'Ihre ilepmt vmA of Commerce is an egetal opporliuuty service prey .,: _ ss ser ices or 7, neod matarial is an alteznato fornzalt, please contact '.tic r r 7 • seus»o tumhwl .: 02/24/2003 11:20 6087859330 - PAGE 03 aM - , f .............. ......... ... • 1 . i 1_... _._ ...^ r Ic I j - -- 7 i r Wiso6noin Department of Commerce SOIL AND SITE EVALUATION Div*n of Sa* and Buildings Page of 2 -- Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Ad'r. Code Attach complete alto plan on paper not less than 8 1/2 x 11 inches in site. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and s'7 - ..__ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel t l•.. a 0.! 9 - -. /o U -10- 10b APPLICANT INFORMATION - Please print all information. RevieV ea r,y Date Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 { 1) (m)) Property er Property Location ., & Govt, Lot Ira 1 ?4,S .� T � 9 AR � � E (of Property owner's Iling Address �- -- Lot fr Biocka ; Sut.ri "1aq)e or CSM# — S7 �Q_ �_.• i - r state Zip Code Phone Number ❑ City 1-j viliag�' Town Nearest Rom :- , S'y 4�IS' )�4G 3 70 7� New Construction use: ❑ Residential / Number of bedrooms _3_ Addition to em ;i ; ig ou.iding ❑ Replacement [] Public or commerciat - Describe Code derived dally flow X 5,2 gpd Recommended design loading ,,,le Lt bed, gpd/ff 2 _ tremh, gpd/ft Absorption area r iced ,T-)� __bed, ft trench, ft? � - � - -• / Maximum design loading �atc /._L___oed, gpd /ft gpolfti Recommended infiltration surface elevation(s) .. -_.. _� ©�.'_ ._._ .. .. _ It fits relf•rr +;:a to site plan benchmark) Additional design/sit Parent materlai �____- ' _.._ _.._..... .- Flood Nam elevation• it applicable _ft S suitable for system Conventional Mound In-Ground Preksure AT Grade System in Fill Holding Tank U C Unsuitable for s Q S Cif ❑ u ❑ S �N a f_ ; 0S 0w M Rl u SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure i pMry2 g in. Munsell Qu. Sz Corit, Color 1 exGrre Gr Sz St, I t_ ,•r,s�stflnce boundary Boole Bed Trent ...... fly r fi►c jg::� "'S* r Ground 3 7 � /I �,_ s .�s ._ �''�,_._.._... i .irfi. —• -` -�- ----- eiav, a -- i Depth to kniting in. Remarks: Boring # J 11E� w I Ground - Depth to __._.._..Y _.... __ _..._. . limiting ' -, ter 3 - 7 in. Remarks: CST Name (Please Print) Signature Telephone No. Address A)2- t te CST Number rr►-t� �' 3 t tl*t C PROPERTY OWNER _ La /p SOIL. DESCRIPTION REPORT Page Z, of PARCEL 1.0.0 Boring # Horizon Depth Dominant Color Mottles Structure z In. Munsell Clu. Sz. Cont. Color Texture Qonsistence Boundary Roots Gr Sz. Sit Bed , Trench � ^- - - _ I __ Ground - - -� �lG Iv �r I� : Depth to - -- --- limiting tac10r - -- — - -- - -- -- Remarks: Boring # Ground elev. Depthto __. - _- -.._.______.----____ _ ._..- _- ---- •- -____,. limiting factor In. Remarks: Horizon Depth Dominant Color Mottles exture Structure Consistence Boundary Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Sod . Trench Boring # Ground elev. ft. ' Depth to limiting factor — - Remarks: Boring # Ground ft Depth to limiting factor - -In Remarks. SSO -8330 (R. 07/98) ufl 31 T U1 fl '� 2196P 320 71tS100 '( KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., MI RECEIVED FOR RECORD This Deed, made between Halle Builders, Inc., a Wisconsin 04/07/2003 09:50AN Corporation, WARRANTY DEED EXEWT # Grantor, and Travis L. Zschernitz and Wendy S. Zschernitz, husband REC FEE: 11.00 and wife as sure vors p ma a ope TRANS FEE: 103.50 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Lot , Plat Town of Hammond. Recording Area Name and Return Address Haile Builders, Inc. 1113 Highway 64 New Richmond, WI 54017 1 018 - 1082 - 10-090 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: municipal and zoning ordinances, easements and restrictions of record. Dated this 27th day of March 2003 HALLE BUILDERS, INC. C /► „ ­ �` � Y � ` J J (�/ p ' • By: Marc G. Halle, Vice President AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. ST. CROIX County ) authenticated this day of -k-V— Personally came before me this �-, day of 2003 the above named are alle, as Vice President of Halle Builders, Inc. i TITLE: MEMBER STATE BAR OF WISCONS (If not, i to be the person(s) who executed the foregoing M the v�4i►s authorized by § 706.06, Wis. Stats.) acknow ame. * Q THIS INSTRUMENT WAS DRAFTED BY r,4 TE G Judith A. Remington-Remington Law Offices Public, State of Wisconsin P.O. Box 177, New Richmond, W154017 (715) -342 y Commission is permanent. not, state expiration ate: (Signatures may be authenticated or acknowledged. Both are not necessary.) R a , _ 2 ) * Names of persons signing in any capacity must be typed or printed below their signature. IMormadon Professionals c ompany. Fond du Lac, wi WARRANTY DEED STATE BAR OF WISCONSIN 800- OW2021 FORM No. 2 -1999 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division. c INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 420734 0 GENERAL INFORMATION State Plan ID No: 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 Parcel Tax No: Halle Builders Inc. I Hammond Township 018 - 1082 -10 -090 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 30.29.17.572 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent t Air Inta a ROAD Dt Inlet Septic Dt otto Dosing Aeration Dist. Pipe Holding Bot. stem PUMP /SIPHON INFORMATION Final Grade Manufacturer Deman St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO I P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number. DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No I M Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 724 159th St Hammond, WI 54015 (SE 1/4 SE 1/4 30 T29N R1 7W) Meadow Ridge Lot 9 Parcel No: 30.29.17.572 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = 3.) Contour = Plan revision Required? r J1 Yes ON No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7082 ST C4,.,.4 NNrl isconsin Madison, WI 53707 - 7082 Site Address Department of. Commerce 7Z 15 Sri Sanitary Permit Application Sanitar P e rmit Number In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide ❑ Check if Revision may be used for secondary purposes Privacy Law, sl5.04(1)(m) I. Application Information - Please Print All Information State Plan I.D. Number VZO `f.5 = i r. Property Owner's Name P cel� Number 019-0 �o • � s� a Property Owner's Mailing Address / MA 1 3 ZUU3 Pr perty Location ��a✓ ST /� r� l0 J ' S4s ; S3(V T .2 N, R/ City, State Zip Code one u l N G O F F ICE Lo N Block Number Su on Name CSM Number by Sy0 - 7 II. Type of Building (Check all that apply.) V 4 Pe Sw auS. City ❑ 1 or 2 F Dwelling - Number of Bedrooms ❑ Villa ❑ Public/ - D scribe U e g e ❑ Townshi ❑ State Owned O Nearest Road y� Q S lMcswns� cJi�Q t = o so' (o ") 7� dire III. Type of Permit: ( only one box on line A. Numbering is for internal (Complete line B, if applicable.) A. 1 — Ne - w — T 3 ❑ Replacement of 6 ❑ Addition System 2 ❑ Repl a nt System Tank Only Existing S For C y use • B • ❑ Check if Sanitary Permit Previ Issued Permit Number D;t tA IV. Type of POWT System: (Check \Oing Numbering is fo ternal se. 44 ❑ Non - Pressurized In- Ground 47 Sand Filter Cons e 22 ❑ Pressurized In- Ground ank ❑ Single Pass 51 45 1 1 At -Grade eatment Unit 49 ❑ Recirculating V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area oil Application Percolation Ra ys Elev 'on Final G Re Pr Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) El lion (�bo Cooa ,Z9 400 5� VI. Tank Info Capacity in Total ffumber Manufacturer Prefab Site r Vlasti Gallons Gallons of Tanks Concrete truc[ed New Existing Tanks Tanks 6 X Holding Tank 12 S-0 1 Dosing Chamber 7SV td,.iged, VII. Responsibility Statement- 1, th assume responsibility for installatio the POWTS shown on ached p Plumber's Name (Print) tI Signatu MP /MPRS N r Business 11 n n, "s C; Ire z2 ikn / >is - G3 Plumber's Address (Street, City, e, Zip Code) 3� z Iqo `� �� ( ws s - vo6 VIII. Count /De artm Use Onl Disa oved Date Issu su' Agent Signature (No Stamps) Approved ❑ O r Given Initial Adverse Sanitary Permit F (includes Ground De rmination Surcharge Fee) (: ee) ' IX. Conditions of Approval/Reasons for Disapproval I Q I , L- p� v ►nn� 4A `cam c c complete plans (to the County only) or they sy�m3n paper hot less thALd 8112 x 11 inches in size SBD -6398 (R. 05101) .� _, �, ., .,. r { �- �; �. � ,,� f � � � � ��� r' a �' . � �. �� ,bi � �► ` �� .....w:1; � � 1.� 1 I e ! ��'� � � I /��► �1 � _ - -- �' ,, - - � , .� �. �� � i �►. � � �� �� SCI `� �� -� �� ��a i � � `, �► `� ► �,, � �\ �� ��- �� ., ��.��. � ����. � � ��� fi ., �. Y R Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 TOO #: (608) 264 -8777 isconsin www.w www commerce s iscon s i n.gov isconin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary February 25, 2003 CUST ID No.221471 ATTN: POWTS Inspector DENNIS J GILLE ZONING OFFICE GILLE TRUCKING & EXCAVATING, INC. ST CROIX COUNTY SPIA 372 140TH ST 1101 CARMICHAEL RD AMERY WI 54001 HUDSON WI 54016 CONDITIONAL APPROVAL ratification Numbers PLAN APPROVAL EXPIRES: 02/25/2005 Transa n ID No. 842045 SITE: Site I o.656044 Halle Builders Lot #9 Pl e refer to both identification numbers, 70TH Ave a e, in all correspondence with the a nc . Town of Hammond, 54002 I IIIIIIL St Croix County El /4, SE1 /4, S30, T29N, R17W L 9, Subdivision: Meadow Ridge FOR: Descrip : Four Bedroom Mound System Object Typ OWT System Regulated Object ID No.: 2817 The submittal describe bove has been reviewed for con ance wi applica isconsin Administrati es and Wisconsin Statutes. submittal has been COND ONALLY V . The owner, as fin chapter 101.01(10), Wiscon Statutes, is responsible r compliance with a de requirements. The following conditions shall b et during constr ion or installation and r to cu nc u� General Approval Requirements: CO • This system is to be constructed and to in accordance with the enclosed appr d th "Mound Component Manual for Privat to Wastewater Systems VERSION 2.0 -10 -P .01 /01) A"P I and the SS WMP Publication 9.6 Des' of ure Distribution Networks for ST_SA (01/ DEPART OF • Per manual cited above, limited a it es are allo in the area 15 feet down slope of t co onent area. Soil compaction, excavation, ve ular traffic and oth imilar activities that impact th tre ent and dispersal- SEE CO are prohibited. • Access to the filter for cle ing must be provided per Corn 4 product approval conditions. Maintenance information must be give o the owner of the tank explaining that iodic cleaning of the filter is required • The well must be a m' mum of 25 feet from any POWTS tank, and a in um of 50 feet from the absorption area. chs. NR 811 12c • A Sanitary Pe t must be obtained from the county where this project is located i cordance with the requirements of See. 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 • 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. DENNIS J GILLE Pa 2 2/25/03 • The changes made to this plan on 2/24/03 by this reviewer were acknowledged and approved by the system designer. 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/ instal lation /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, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz @commerce. state. wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Commercial Application INDEX AND TITLE PAGE Project Name: HALL€ BUILDERS INC. Owner's Name: HALLE BUILDERS INC. Owner's Address: 1113 ST. RD.64 NEW RICHMOND WI. 54017 Legal Description: SE SE S 30 " T 29 NR 17 W Township: HAMMOND County: ST. CROIX Subdivision Name: MEADOW RIDGE Lot Number: 9 Block Number: Parcel I.D. Number: Plan Transaction No.: Page 1 Index and title Page 2 Data entry RECEIVED Page 3 Mound drawings f . Page 4 Lateral and dose tank' FEB 2 1 2003 Page 5 System maintenance specifications pF Page 6 Management and contingency plan _ ' OF CO�C�RCF SAFETY & BLDGS DIV. Page 7 Pump curve and specifications rE N 4/0 teiw s ESPOND Designer: DENNIS GILLE License Number: 221471 Date: 02/ 0/03 Phone Number: 715 - 268 -6637 Signatur Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.11 (R. 06/01) Page 1 of 7 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) r. Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150%) coliform of - 36 inches. 600.00 Design Flow (gpd) 7.00 Site Slope ( %) 89.00 Contour Line Elevation (ft) 33.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 75.001 Dispersal Cell Length Along Contour (ft) = 8.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest oint in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) C Center or End Manifold 4.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) (e.g. 0.25) 2.00 Estimated Orifice Spacing (ft) = 8.33 ft /orifice 2.00 Forcemain Diameter (in) 125.00 Forcemain Length (ft) Does the forcemain drain back? Y 79.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 20.39 Forcemain Drainback (gal) 10.50 Vertical Lift (ft) _l t 67.44 5x Void Volume (gal) 3.89 Friction Loss (ft) � _z 87.83 Minimum Dose Volume (gal) 18.94 Total Dynamic Head (ft) 38.77 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x X 1.25 x 2.00 1.50 x X 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 750.00 Total Tank Capacity (gal) 1250.001 Septic Tank Capacity (gal) 45.00 Total Working Liquid Depth (in) HUFFCU17 IManufacturer / 1667 gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 750.001 Dose Tank Capacity (gal) JZabel Filter Manufacturer i 7 16-671 Dose Tank Volume (gal /in) JA100 Filter Model Number HUFFCUTT Manufacturer Project: HALLE BUILDERS INC. Page 2 of 7 Mound Plan View T 1/10B . Observation Pipe Q ' J K ' .' •�•'.•'.•'..'.•'.•'•••• - r :••r•r•r•r »t : °ray:. -L :" ..r•. •.:r•, •. •r:. ................................... W ... . .................................... ............. 'LJ I L Mound Component Dimensions A 8.00 ft E 12.72 in H Aft ft K flft ft B 75.00 ft F 9.50 in r ft L ft D 6.00 in G 0.50 ft J W 600.00 (ft Dispersal Cell Area 1 1269.78 (ft) Basal Area Available 8.00 (gpd/ft) Linear Loading Rate 1 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 91.29 (ft) —► H .�rrrrrr�r 2rfrrr.. G . frrrrrrrr rrrrr.. F 90.00 (ft) Lateral ♦ Dispersal Cell 89.50 (ft)- — Invert Dispersal Cell ' . t Elevation E : D; . •. . A C ' - ' 89.00 (ft) Contour Elevation 7.0 % Site Slope Geotextile Fabric Cover Shading Key �, Dispersal Cell See lateral details on Q ® Topsoil Cap .a 1.5 ft .• .• Page 4 for number, size, r'' } 'f Subsoil Ca 5 ° and spacing of laterals. w o r; P 9 © ASTM C33 Sand i° ° ''''' • r •• Laterals are equally FAI Tilled Layer C 0.5 ft eaypical Lateral °�, spaced from the ❑ 1 :�tir r�•��•��•'; �� ��•= 5 distribution cell's 5 r:r•r• Aggr o _ j___ . •r•r centerline in the 0 A distribution cell (AxB). Project: HALLE BUILDERS INC. Page 3 of 7 Center Connection Lateral Layout Dai ram Force main connection via tee or cross to manifold at ang point. Laterals are identic at P S •= Turn -up wfball valve or IE X IF x12 ( x12 Laterals & force main of PVC Sch 40 cleanoutplug per COMM Table 84.30.5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) - z5 2-M *- —e Lateral Length (P) 21— -75 ft Orifices per Lateral 18 Lateral Spacing (S) 4.00 ft Orifice Density 8.33 ft /orifice Lateral Flow Rate 9.69 gpm Manifold Length 4.00 ft System Flow Rate 38.77 gpm Manifold Diameter 1.50 in Total Dynamic Head 18.94 ft Forcemain Velocity 3.96 ft/see Dose Tank Information Locking cover with warning label and locking device and sealed watertight 1 Electrical as per NEC 300 and —► Comm 6.28 WAC 4 in. min. Disconnect Tank component is property vented �— Alternate outlet location Forcemain diameter HUFFCUTT Manufacturer 2 in. Capacityl 750.00 Gallons Volume /'7 16:67 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 5 31.72 YG ..5528:8'1 B 2.00 33.34 C Pum off elevation (ft) C 5.27 5 - 87.83 ♦ 79.50 D le 6-00 1 EG-62 D Total 1 44.99 750.00 Do se tank elevation (ft) 3" Bedding uncTer tank. 1 79.00 Alarm Manuafacturer LEVEL ALARM Alarm Model Number DVL Pump Manufacturer IZOELLER Pump Model Number 1140 Pump Must Deliver 38.77 gpm at F 18.94 ft TDH Project: HALLE BUILDERS INC. Page 4 of 7 Mound System Maintenance and Operation Specifications Service Provider's Name I DENNIS GILLE I Phone 268 -6637 POWTS Regulator's Name ST. CROIX CTY. ZONING Phone 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1250 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600 ft Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliforml >10E4 1 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Ins ect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. observation pipes are slotted and materials conform to Table Comm 84.36 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished ••..........••. ............... Grade 6 -8" Diameter Lawn _� Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve p Distribution Lateral '`► Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: HALLE BUILDERS INC. Page 5 of 7 . Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBDA0691 -P (N.01/01) and SSWMP Publication 9.6 (01 /81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Seotic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet finer shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced If the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 30 mg/L TSS, 10 mg/L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. g2grigencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. 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N '.t � I � � t•rNitidC�ttl � .� �" txu�s �In7i.� IfJd 6aU ed ]ham 1f yf �6 J imi l JV�A'um l'r # #m) alas tha aL11r7�tlhkll rYkW( llk iltllWlk3�1 111ttilMt�' •w�yeruuuunsuu �kr,�uu. suurY+uuokd><alurruUhtYSV,dLddd S�nrENUt•tnrru[•eeaa7r r'W4 Oft Old ft1th Aett l9" ft kvntrol Wkutab. ����yy��MM pp�?��yMpg !!pp ��{{qppp!!??{��pp ��pp,,pp rk'�1�+yDRwIRVS R•"O WER •V itl�>t"wSrk N Ni llndo',lti " , ulPn dldonJ3 p rssertrre 89My S'aclCtJr Is eng ineered in to to "gn o wS>y Z06 pttrPta. JxarLrac A.01 tax INV Lo*QVAMY fu+A'Qfka RPdth 4�ltdfr,+zn dP . !!' s«Tm MDCnrja RUN Auft My 4 . a. I ko Rw,Itu+tJl� OA 4t?f31 Aw rl &2741?1 7(duo)Uatt.FrJ P f . . ........ .... . Ze.T . ... . ... ......... Xx" Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85, Ms. Adm. Code County A0 / /e Attach complete site plan on paper not less than 8 1/2 x 11 inches In size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Propayne, Property Location '✓. e i Govt. Lot 1 /4SZ 1/4 S 36 T•21) N R, 7 )N .: E (or Property Owner's Mailing p A d dress Lot _# Block # Subd. Na a or CSM a City State Zip Code Phone Number 0 City, ❑ Vil ge P Town earest Road New Construction Lisa: ❑ Residential 1 Number of bedrooms Code derived design flow rate Go 0 GPD 0 Replacement P lic or erc;al - Describe:, Parent material Flood Plain elevation if applicable ft. General comments and recommendations: Boring # n Boring ® pit Ground surface elev. u (' ( ft. Depth to limiting facto in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *E in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. /Yj L caw hIr Boring # ? /. ft. Depth to limiting factor -' In. Application Rate pit Ground surface elev. I Soil App' Redox Description Texture Structure Consistence Boundary Roots GPD /fl Horizon Depth Dominant Color Gr. Sz. Sh. *Eff#1 'Eft#2 in. Munsell Qu. Sz. Cont. Color IV/ r�� fir A " Effluent #2 = BOD c 30 mg/L and 7SS <.30 mglL " Effluent #1 = BAD � 30 < 220 mg /L and TS.S >30 < 150 mg/L CST Number % 11 CST Name (Please Print) 01 )lr-- Date Evaluation Conducted Telephone Number Address '� '� j qo S i � ✓ SBD -8330 (807/00) Property Owner r–I Parcel ID # Page of J Boring # ❑Baring j J ® pit Ground surface elev. � %- ft. Depth to limiting factorr In. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application — Rate GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring ❑ Boring g ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Soil APp lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff41 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOO, < 30 m g/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity q pp tunny service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608-264 -8777. SBD -8330 (R.07 /00) I , .. I f ...... 111 I _. ... ....... . . .. ..._...._.. �_.._ _._. - t. __.. ... ...... _ ...... __.. I__.... 1. .. ........ T 1 p i t 1 � I { LL I i - , ..._ ..i.. .._ . .... i _ _ _ .. ►__.. _ I ...... .... ..... ... .... . . ... ......` I I ; f 1 _ I �- L . O T I I I i I f �.. -_ .. _ _. t ..._ _. ..... -. i..._. - Vii._. .. t - # _..... ..... f _ t __ ' f _........1..... �_.......... _ ._._ . {. -. ._ { i 1 ' � I C4 .... ._ `. _ .._ ._ ... _ ... � I , _ .._ .... . .._ ...... i _..._ ....... �.._ - -- i ...........l.... �... _...._.1 i......... 1.. 1..... .. ..- _L..._:_ J ..... �...._ ..... .._ � _.._.._. . •- - ._. _..._.. I ! - t- Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of? < Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code [/ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 5 - include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print al fril Re iewed by Date Personal information you provide may be used for secondary pu o I (Pri�aw, s. 5.04 (1) (m)). aici3 Pro ner P perty Location perty &U&4 MAR . 3 2003 G vt. Lot &: - 1/4 1/4 S 3Q T21 N R � 7 E (or)(9 Property Owner's Mailing PAodres�sr ST. CROiX COUNT'r L t # Block # Subd. Na a or CSI AL 1 ST f� q OFFICE City State Zip Code Phone um er City ❑ Vill ge fix] Town fAlearest Road 4,44J I W -T- I YY (71,�" dY - 688/3 1 '70 7k emu, ® New Construction Use: ❑ Residential / Number of bedrooms = Code derived design flow rate Goo GPD ❑ Replacement ALI lic or cpr�ynercial - Describe: Parent material �� Flood Plain elevation if applicable o General comments and recommendations: M Boring # ❑ Boring ® Pit Ground surface elev. 0 / • / ft. Depth to limiting factor 13 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 11 s yr d orb 0tv 1AP ,, , 9' V / 1 ..� S ® yr, L au 11 " ,s Boring # 1❑ Boring y t� Pit Ground surface elev. t1 Q / q � / ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 v 'e au) 0- 9A n►� aw J119 , 9 qtr , A 19 i" z O RSA Ks * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) re CST Number a nhrS (3 84 '22 //- 7 / Address Date Evaluation Conducted Telephone Number )2 1 S; /'yN1�tr �/� / -03 7 >�= .Z 6�'GC SBD -8330 (R07 /00) Property Owner Parcel ID # Page Z of F3_1 ❑ Boring Boring # Q' ® Pit Ground surface elev. v (P , ft. Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 3 M) th T0Z- Rs/8' FS fd �-�► �- F-1 Boring # E] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. El Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) 114 ; , WT ; 2 1Ng /7 Kd f � 1� OL -sue I - I i 1 i �y i I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBu Y er 41 Mailing Address t� 4VOU Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number rs, LEGAL DESCRIPTION Property Location ' /,, t/ 12—W, 30 . N -R�W, Town of Subdivision Lot # 1 Certified Survey Map # , Volume , Page # Warranty Deed # ? /!7 N Volume �7 Page # Spec house ❑ yes W no Lot lines identifiable X yes ❑ no SYSTEM MAINTENANCE 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 Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying 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 completed and returned to the St. Croix County Zoning Office within 30 da the three year xpirati ,13,0 on date. 3 A F 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 owners) of tho-D roperty described ve by virtue of a warranty deed recorded in Register of Deeds Office. 3 d GNA F APPLICANT DATE « « « « «« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. •« Include with this application: 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 nnctimcNr WARRANTY DEED STATE'; E1. gR OF WISCONSIN FORM 2-1992 493432 vo FrDEC CERALD J. SMITH and JEANNINE B. SMITH, Grantors T CROIX CO., 0 Recd for Record 3 01992 1 :30 A. M ronveys and warr:inta to f1A1 j k BJIGDEKS, -INC. ,. a Wisconsin corporatiou, Grantee _► d Deed ,7 I it ... ... .... .......... .. . - - .. _ -.. .. .... .. �1 the following described real estate in ......... St. Croix ...County, - - - -- 1 Sta,a of Wisconsin: Tax Parcel No: .............................. V i (i Southeast Quarter of the Southeast Quarter of Section 30 -29 -17 EXCEPT South 12 rods of the East 20 rods thereof. jl it rRANSFE11 .SQ i FEE TOGETHER WITH and SUBJECT TO reservations, restrictions, easements and I rights -of -way of iecord, if any. �I I I ' This is not (i s not) hom property. e�tcad II Gt30 I i �) Exception to warranties: 7 I ' Dated this 1lJ day of - December.. - _ __ 19 92. ._ - - -- _ (SEAL) -- - - (SEAL) I I G D MITH .......... .... ........... . _ _. - - .0 . . .. _.. - ............. .(SEAL) (SEAL) 1� JEANNINE B. SIUTI�' j D � y . m �o m M A m z U PLAT I cC 0 o N8 9 °48'30 E- 599.54' r Q z m v i IC Z w _........... ®.!_ . . o _�,� LOT 8 r^ 0 I 2.68 ACRES m 116,924 SO.FT. � 1 is N S89 -- �30 w o p � 3 N 134.2 — W v ` N8e47'30 °E ,� h _ 1 34.2 I 0 = � e0' ?O Q• 9/ I� CENTER OF CUL-DE-SAC IS` x \ 305 y J:' LOCATED 41 13 E, \ /pp � Z A FROM THE E N o N OF CORNER OF C7 LOT 10. w ° f - - ssosa p VCJ - �' O ep. '9 3O4' 9/ ° ro S �\ FD LOT i &0 k TN RM 2.72 ACRES q F D S /O F N Op V Off ' S, 118,315 SO. FT. '''• p N - 0T' .10' t47