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HomeMy WebLinkAbout018-1098-06-000v Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division t ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Koo man, David Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: 98. z~ (s3 ~- ~ 5 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic / JtJ ~C ~ y /~ Dosing t -~b C~ Z ~ ~(~ ~~~ Holding TANK SETBACK INFORMATION TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Septic + ' f /v g e ~ / _ Dosing ~ (~ ~ ~/~ - ~/ Ss ...--. Aeration Holding / 1 PUMP/SIPHON INFORMATION ~ V Manufacturer ~ {~~ errand GPM Model Number ^ ~ /~ -~L /J/1 _ /v TDH Lift ~,~ Friction Loss ~ ~q~ System Head 3.~ TD Ca+3 Forcemain Leng h ~ Dia. +I 2 Dist. to well ~~ SOIL ABSORPTION SYSTEM _ ELEVATION DATA county: St. Croix Sanitary Permit No: 463394 0 State Plan ID No: Parcel Tax No: 018-1098-06-000 Section/Town/RangelMap No: 30.29.17.813 STATION BS HI FS ELEV. Benchmark Z ` 1 ~'~ ~ ~ • Alt. BM ~~~ GaJs-~`- 7 G .~ ~7• Bldg. Sewer 7. Z 93• SUHt Inlet g 1~ q~ ` C I J SUHt Outlet ` ~ Dt Inlet ~ ~ Dt Bottom '~ •~ ~' Header/Man. Z-Z `~ ' ~ Dist. Pipe ~.Z qG / o Bot. System ~ ` ~ 1 ~ , ' Final Grade ~ ,.~ cq~ r // p St Cover ~,~ ~ 2 q l G~~ • ~ 1 Ga.,~~-oJ f- , Z ~~ Q -5 5 -~- 9~.g BED/TRENCH Width / Length ) No. Ofxenche PIT DIMENSIONS No. Of Pits Inside Di~ Liquid Depth DIMENSIONS ~ J'~ /.1~ ~~ ~~ ~~ SETBACK I MATION O SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: NF R Type Of stem: ~~) l~/ Q A ' / V ~ UNIT Model Number: ~~ ~ u 111STRIRIITIAN SYSTEM C_cl~ Header/Manitj Id Length~_Dia Z ~ I ( Distribution J Pipe(s) Length ~~ v f Dia ~ f Spacing x Hole Si~ ~ ~ / Jf!~ x Hole Spacirjg Z Ve t to Air Intake ~/l v "'^~~ S(~II CnVFR v Drom~~~n Cvc4nmc Anly vv Mn~~nrl (lr ~t-(.'.rarte $VStemS Or11V Depth Over Bed/Trench Center ~ Depth Over BedlTrench Ed es g xx Depth of Ta soil ` P ~ ~ xx Seeded/Sodded ' ~' ! xx Mulched '~~e N ~ ~ \ t i~V~ es No o ,~,,~"'~ , es i ! COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / 9 / ~ 5 Inspection #2: / / /. C C.L~;~.~o.,..~ Location: 1518 73rd Avenue Hammond, WI 54015 (NW 1/4 SW 1/4 3 T29N R17W) Emerald Acres Lot 6 ,1 _ _ n Parcel No: 30.29.17.813 ) F~l.~.. Go.~a~...pl~,n+~iAcl. `.'Se-dt+ c..~....,, +.. s ~- L-erg.: 1.) Alt BM Description = ~,,(~j~ ~'(~ ~ o `'~' 2. Bld sewerlen th= ~ ~"~~,'"~O~c.~+ ~' O~~'""' ~~ ~~ ) -amount of cover = ~ ~ ~ ~ ~~ ~~~ ~' ~ Plan revision Required? I Yes ~No ~ q ^5 Use other side for additional information. I _____~ ___ ~ U ~ L_ ____ ______ _ ____ _. - - - Date Insepctor's i nature SBD-6710 (R.3/97) ~Qutt.~. R-~Gr+hQ~/ ~~3~175 Cert. No. Safety and Buildings Division County I /` ~ i 1 •'~- ( `L t 201 W. Washington Ave., P.O. Box 7162 , ` j `+a•/~0~~~~ Madison, WI 53707 - 1162 Sanitary Pe it Number (to be filled in by Co.) ^~7~I (608) 266-3151 Department of Commerce . Sanitary Perm' plicatio Sta% P~ I~ umbe / In accord with Comm 83.21, Wis. Adm. nal information ou pro~~ c C l b may be used for secondary purpo b w, s15.04(1 m) FI VE ddress (~ ifferent than mgiling address) /~~ ~ r ~~ I. Application Information-PleasePrint In r atl PR ' Property Owner' ame ST. CRO/ ~ ZDIV~N ~ vuNT>' ' ~~ ~ Par ] # # Block # ~ ~ 3 G ~ G Q / a„ i , Properly Owner's Mailing Address /~ ~ /e ~i J / ~ ~ ~ ~ '~ ~~ erty Location ~GL~/. /., Section CitCy, S _• , _ ~ Zip Code P ne Number , g~ _ f Buildin (check all that a l ) T II ~ ~ pp y , g e o . 4 ~ ~ ~ east_ ~ CSM Number vision Name Subd r 2 Family Dwelling -Number of Bedroo i ~i ~ U i l D ib ~ li /C ^ s " _ ~"`~`' ommerc - escr e se Pub c a ^ State Owned -Describe Use ~ ^City ^Village ip of III. Type of ermit: (Check only one box on line A. Complete line B if applicable) A" stem ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Own r ~ [r,`,~~ IV. T e of POWYS S stem: Check all that a I ) ^ Non -Pressurized Tn-Ground ^ Mound > 24 in. of suitable soil ound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatm ent Unit ^ Recirculating Sand Filter ^ 7 ~ ~~ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ G 1-less Pi ^ er (explain) ~ p e2 t V. Dis ersal/I'reatment Area Information: G- Design Flow (gpd) Design Soil A~p lication gpds Dispersal~o sed (sf) Dispersal Area Required~ G S m Elev7ation ~ / .Tank Info Capacity in Total Number anufacture Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New E~asting Tanks Tanks Septic or Holding Tank ~/ /~ Aerobic Treatment Unit Dosing Chamber T VII. Responsibility Statement- I, the undersigne ssume responsibility for installation of the POWYS shown on the attached plans. P] Name (Print) Plrrmber' gnature MP/MPRS N ber~T Business PhoneN/run/ber~f Plumber's Address (Street, City, State, Zi ~ r Y~i Y/ ~ ~ ~~ ~ ~,~ ~ ~ s VI . Coun /De artment Use Onl Approved ^ Di ed Sanitary Permit Fee (includes Groundwater Date Iss Issuin A t Sign S ~~ Surcharge Fce) , / ~ ~ '" ' / /,C 6i ^ O v son for nral ~ V` J LX. Conditions of ApprovaUReasons for Disapproval 5~-a.1.~ ~( JPrd 2 ; . ~ ~ Gam ~~-~o~n . , o .{r ~,~~' ~~ R' G~r2. 1 ~- E~~ ~ ( ~ ~ ~ I 195 ~eCw~-t ~c-- ~ u nt filter and ersal Ceti rr+,a~t ++~'_~ ~ti,raiced / maintaMed Go ~~ - dis ~3 -S Z. 5 e.G ~ c~~ p as per rr,ar'~u~;n~nt clan urtrv~~r^! 1:~+_ 1 plurtibeP. (~a,~r~ a ~. All sett>a~:l ~~.f~r~',,,~'-rzts rr,ust t , ;naintained ~ ' ,,~.~2. v ~- ~cs~ ~n.. ~c.. r ~ppGcaoie cuarautaulances. o b t~ a~ et e Attach complete plans (to the (:ounty only) ior•'t6e system on paper not teas man atr~ x r r mc~es m pze ~ \ ~ V l0 G4~'7 0 J~ S SBD-6398 (R. 01/03) ., ~ , ~ PLOT PLAN PROJECT David Koovman ADDRESS 167 N McNiaht RD Ant. 215 St. Paul Mn 55119 NW 1/4 SW 1/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 98.7' 1.2' Sand lift! 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 1" pipe ASSUME ELEVATION 100° Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark 385' ~~ ~ Property Scale = 1 /4 = 10 ~ -4 Line J Area 15' below 3% Slope system is to remain / undisturbed g Well is to meet all setbacks found in Comm. / 83 97' B-2 97.5' 9 8' Pro 3 Bedroom House `~ PY B.M. #2 is top of 1 " pipe @ 99.2' Grading is to be done to divert r -off away from system B-1 .1' 1 B.M. #1 ~ JHuffcutt Co ank Tank is to be properly bedded and provided with lockdown covers with approved warning labels 250' '' Pro Town Road to 150th St. ~' PLOT PLAN PROJECT David Koovman ADDRESS 167 N McNiaht RD Ant. 215 St. Paul Mn 55119 N1N i/4 SW i/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 98.7' 1.2' Sand lift! 3 BEDROOM 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 1" pipe ASSUME ELEVATION 100' Filter Zabel A-100 ^BOREHOLE O WELL sg,R,p, Same as Benchmark Scale = 1 /4" = 10' Area 15' below system is to remain undisturbed g _ 3 Well is to meet all ~ setbacks found in Comm. / 83 97' 6-2 97.5' 9 8' Pro 3 Bedroom House Pro Town Road to 150th St. 3% Slope B-4 O / Grading is to be done to divert run-off away from system a B-1 ~Huffcutt Combo Tank Tank is to be properly bedded and provided with lockdown covers with approved warning labels 385 Property ~ Line B.M. #2 is top of 1 " pipe C~ 99.2' B.M. #1 250' °' ~ 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.wi.gov/sb! wwrw.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary Apri108, 2005 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: 04/08/2007 Identification Numbers Transaction ID No. 1125165 SITE: Site ID No. 696753 David Kooyman Please refer to both identification numbers, 150th Street above, in all corres ondence with the a enc . Town of Hammond St Croix County NW1/4, SW1/4, 530, T29N, R17W Lot: 6, Subdivision: Emerald Acres FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1012616 Maintenance required; 450 GPD Flow rate; 22 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/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. 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. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P(N.O1/O1). • The pressure network is to be constructed in accordance with publications SBD-10706-P(NO1/O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems -Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. P.~~~ S. T, C°ilcdi~ioytally -- SHAiJN R BIRD Page 2 4/8/2005 • Comm 83.22(7) - A copy of the approved Qlans, specifications and this letter shall be on-site dur~ construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • 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. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim@commerce.state. 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 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 4/6/05 RF~~~~ S qpR ' ~ ~~ gFEjy~ zoos ~ljj~~N ~s Owner: David Kooyman Location:NW1/4 SW1/4 S30 T29 N,R17W Lot 6 Emerald Acres 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 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance ; 9-11. Soil test Shaun Bird Signature Contigency plan License y~imber 226900 dEPARTMENT Of COMMEi~CE V1510N SAFETY ANO dUik~lM~3 ~~ •_,----~ ,~... ' DeSigaer _ No Date 4" Observation Pipe Perforated Below Filter Fabric s s~r~t C-33 Sand --~ ~ TopsoN ` r Non-Woven Filter Fabric ~DiitriDuliOn Pipe i r E ~_. ~%-ti ~ ~- ': Slope fled Ot;j~- 2 %2 Force No'rn Drain Rock Ftom Pump i Cress Srctian Of A Mound Systtm Usin A Bed For The Absorption Area q ~_ Ft. g ~ ~ Ft. r ~ ~ Ft.- ~ Ft. L'~~~ZEt. id ~,°~a ~Ft. F iowe 6 l.nYtr ~ p ~, 'E ~°~~ F ~p~~ _.1__-- ~ ~~ ti ~_ __ L -~ 4-Observation Pipe-~ .1 ~ _._______ - .~. - .~.------~--- K r ------------------ ----------------------- _ . ~ A ' ~' ~ ~ Force Moin ---------------- 1 ~, ~--__ ___---------- ----- From Pump ~ i . ~. ° ~istributian Bed Of /Z - 2'Z ~ ~ Drcin RocK Pape I `„ 4 0hcarvation Pipt=._ry~~~~~ Permanent Mork>*r iS~"'~ ~~.~jy'~ ~ ~~~„~ bv~ ~ Pipe or Rods .s,~,~~- Plan Vit>w Ot Mound UcInQ A Bed For The Absorption Area PAGE OF C/~G tototed On 8otso~. c E4~a~Y SGOCed cRST tR01.L r[r,.1GT ro CannsCt Ft. ] i _ F~ 'r ~, Signed ~LicensE Number: ~-a to X / i r+c~+ES ~`" ~ ~ fnche5~ J/// Hole Diameter // b Inch i.atev~al ~" ~ ~ Inch{es~ !~a n 2 foi d ~ Inthes Force Main "~- inches ~ of hgles/pipe ~ Invert I:ievdtior~ of i.ateraTs ~~~ ~Ft,.. Pei#ora!z~ ~~Ce petail ~TipN ~,,~~ SPECIE jCATZpNS ZC TANK ~ P'~!"!P C~:tiMB£R CRASS 5£ S£PT ,. ~IN_ ?ABOVE GRADE ~ ~~~ ~,~, ~tENT PIPE I~dINDOi~ 4R y ~~` FRtlM DOfJR, ~, '- ;CIA INTAiC.r r:- is ~ ~ ~ i.~ + .. .... - -•~-- i,iATCR 'FSGHT' SST"' i a --~_' APP£~ C ¢(~ Ci~it Sfl~LY~! ~ pD2+TP QF~` £L£V < r~ FT • D SQI ~ z ~~aTH£RPR~F J~NCTIflK 80?t ~,tITH COHD~-IT 3.fl :! :i i s + ~. i i ~S. 1 TIGNTj sE~i- t t ~ APPROVED gEDD~3~tG V i+TL3f:K TANS 3 S PEC Z f ZCATI C31f S SEPTZC ~ DCiSE ~'~`'t' l'/ : Ai~i K MAI+t~1 FAC3uREft t,,Ai.. TA)ilC BI ZES : SEPTIC~~,~ GRL • . DOSE ALARn~yA~~3F2~'CTi31t~E+F~t;: i~~EL ~~~E~ - ~` ~ ~ .t ApFROV ~D MANHi}LE COV Eit t~I FP,i)Lt30x ~ idARHING iA$EL _.4" HZN fig" ~-~+~- .1DI~I~~ ~,g~SOIL e ONCgETE p'AU I~LJHBE#Z POSES ?ER 3?AY = ___.----- .~IIiCHES = ~ ~ ` ~ GAL CAPACITI~' ~ "~+- ~ GAL. ~ ~ ~ 2 _ 23dCHES = w--- ~` ~ _,~''~ INCHES C - 5_ ~'-"'_.~ n = ___. II3CiiES = ~-~ GAL. I LHR Nsy;q'C~T"t~~ ~'°'~ Gn~~~- p,LI3~i~' £. w~~rF iJIRZiJG A,' PER FEET REt~ ZRF.D DI SCHt,RGE Ti,pT'E _...--~=-- IIZ STR I BUT I ~ °IP£ - ~ - ~~,~ ' " _ FED EN PUi'4P fli F ,A~Tg - - - ~ ~~=~--_"FE£T vER'!'ICAL DIFFERENCE ~ETWE SSUsZ£ ~ ~-~;CTTQN FACTOR FEET + M;~II~~ H~?~70RK S~PP~~ ~R~FT~ ~.~ ~ FTflTAL £?YN~'IC MEAD j ~% + ~~~ FEET .FORC£tiA. ~- ~ ~Y~-r~+~TER --..--- £N~IOI~~' 0~ PIJt4? TAI4K : LE13C:1H INT£gl~L DIM 4R.'£ L2L~jv5 t. ~~Q~~- IGNED: _ it&8 a° _U ~" a r 0 0 F LITERS 0 80 160.. 240 320 FLOW PER -MWUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. ~`~ " _ • El~trical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available fordutdoor installations. See FM1420. • Over 134°F. (54°C.) special quotation required. 152!153 Series 1521153 MODELS Control Selection Model Vohs-Ph Mode s Sim lex Du lex N752 775 1 Non 8.5 1 2or3 BN152 175 1 Auto 8.5 Included 2or3 E152 230 1 Non 4.3 1 2 or 3 BE152 230 7 Auto 4.3 Included 2 or 3 N153 175 7 Non 10 5 1 2 or 3 TOTAL DYNAMIC HEAD/CAPACITY PER M;NUTE EFFLUENT AND DEWATERING MGDEL t52 t53 _~ Feet Meters Gal. Lifers Gol. Liters 5 1.5 69 I 261 77 291 10 3.1 67 231 70 ~ 2ii5 15 4.6 53 I 201 61 237 2D 6.1 44 167 52 1 ~i7 25 7.6 34 1i9 42 1~9 30 I 9.1 ~ 23 87 33 t :%5 35 I 70.7 -- -- Z'_ i:5 40 12,2 -- ~ -- l i 42 Lcck Veiv2: 138.0 ~ i (t l .6m) 44.0 Ft. (13 4m)- 3 27~ ~~ ;2 ~r• I I } I I ,~ i~: r __1_ SK206s BN153 115 7 auto to.5 Inemded 2 or 3 SELECTION GUIDE E753 230 7 Non 5.3 7 2 or 3 1. Single piggyback variable level float switch or double pggybade variable level float BE753 230 7 Auto 5.3 included 2 or 3 switch. Refer to FM0477. o CaurroN 2. See FM0712 for correct mode! of Electrigi Alternator E-Pak All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control Switch 10-0225 used as a control activator, speafy duplex (3) licensed electrician. Ail electrical and safety codes should be followed including the most or (4) float system. {NEC) and the occupational Safety and Health Ad (OSHA). d C t E i o r c lec e recent National RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump - esAr~ ro: P.o. eox ts347 Louisvile, KY 40256-0347 Manufacfurersof.. Z SNIP To: 3649 Cane Run Road p ~ ® Louisville, KY 4021 f-1961 Q(/p(/TY~OUdlps ~/'NCE ~9~ip tl m - (502) 778-2731.1(800) 928-PUMP httpJ/www.zoeller.com PU/Ii1P !O. Fax(soz) n4-3s2a HEAD .CAPACITY CURVE MODEL 152/153 r W W ~ 50 153 2 40 157 30 I za 10 0 20 0 60 80 10 GALLONS W CJ c 4 ,--. ©Copyright 2000 Moeller Co. All rights reserved . pOWTS OVKi+IER'S MANUAL 8~ MANAGEMENT PtAN - SYSTEM SPECiFtCATIONS F[[.E INFORMATION = .~`~ ~ ~ Septic Tank Capa~y Oar ~€. ' ~` `` Septic Tanis Manufai~urer Petrrtit ~- _ Effluent Ffter (Manufacturer ~•. Number of Bedro~S Number of Commel~i Units ESti-tnat~ ~ (av~ge~ pegign flow (peaKl, (Esdmaoed x 1: 5) Soi11-PPn Rabe trdiuentlEftluecrtQuslity Fats,. Oil $~ Grease (FOG) Biochemical OxY9eri Demand (BODE Total SusPe~nd~d Solids {TSS) Pretreated Effluent Cluafity - NA tiochemical Oxygen Demand (t30Ds) Total Suspended Solids (TSS) Fecal Cot+form (geometric mean) lM~mum Effluent Particle Size MAINTF~MANrCE SCHEDULE Ser+rice Event Inspect condition of tank(s) Pump out contents of tank(s) tnsped dispersal cell(s) C(eatt effluent filter Inspect pump. Pump ~ntTOls ~` alarm Flush laterals and pressure test NA Effluent Fitter M_r o:de~ ._._. ~ Pump~Tank Capacity pump Tank Mantafac~urer .Pump Manuf2~r = Pump (Model pret<+eatment Unit _ D gandlGr~vel Filter ^ Mechanical Aeration ^ Disinfection t~'`~ gal(C ~_ aatl~ ~ oallday Monthly average' S30 mg/L 42U m9n- Monthly average" S30 mg~L. 530 mg/L s'f 0` d~4 00m[ Y inchdiameter Page of al O NA [CIA ~~,.~ ^ NA 4 ~ ~.. , p NA D 9ai 0 NA NA ~~ •{~- t ~.~~-~ D ILIA ^ Peat FUter ^ Wetland ^ Other. Dsspersa[ Cell{s) In-ground (pressurized} ^ in.ground (gravity) ~ Mound ^ At-grade ,p~ther_ O Ori ine Values typiGar for domestic (non-a~7e~A yrdstewatar and + septic tank etftuent. „~.~tewater. .~ Yalues typical ror Pretreated Service Frequency D months r(s) (Maximum 3 yrs.} At least once every of tank volume vVhen combined sludge and scum equals an ~'~ ~~)(tVlaximum 3 yrs.) '~ ^ months At least once every _ - At least once every At least once every At least once every At least once every At feast Once every p months -~eany1 ^ months ear(s) ^ NA ^ months ear(s) O NA ^ months D Year(s) ^ NA ^ months ^ year(s) O NA MAI~ANCF INSTRUCTIONS one of ttie following licenses or of tanks and disper~l Ce1~ shall be made by an individ~~nY-nnspe~r POWTS Maintainer, Septage Inspections Master Plumber Restricted Sewe ~ ids fl~ any rrtrssmg or br+uken oer5facations=. Master Plumber, back up Servlcln9 Operator. Tank inspections must include a visual inspection of the tae and scum and to sheds for any hatd~. ~~ any cracks or leaks, measure the volume of combined sludg ~ c~~t,edc the effluent levels round surface- The dispersal self{s) shall be visually rnsPec~ nding of effluent on the ~ p~d'tng of effluent on the g nding of effluent on the ground surface. The p° uta authoritY_ in the observation pipes and to check for any po uir~es tlae Immediate notification of the focal reg tor)' ground surface may indcate a failing condition and reQ uals one-third (X) or more of the tank velum ~ NR a SePtage Se~dng Operator and disposed of in accordance'"`ith YVhen the cem of the tank shallbe mrnoved byd scxrm in any tan eq entire contents ~ ~ vents, and any 1 t 3, Wisconsin Administrative Code- ~ events, 'pretreat ent compo The servicing of effluent filters, mechanical or pressurized POWTS comp ~~~ by a certified POWTS Maintainer_ other maintenance or monitoring at intenrais of 1 u story uthority wifttin Q ~ of pompletion of any services event A ~ repot g~ be provided to the loss Eg fl1e r,esence of painting products or other START UP ANO OPERATION For new eonsTritction, prior to use of the POwTS sheds treatment tank(s) ~ ell(s). if high cor,certtrations are chemicals that may impede the treatment process andlor damage the disp nor to use. dg~~( have the contents of the tank(s) removed by a septage servicing operator p ' . , _..._ Page of„_ /~z conditions are frozen at the infiltrative sur#ace. - `~ ~ ~ t not occur when s~I ~ tmnrater ~~~. Y~(hen power is restored the excess System,start up shat ~ above normal 19 result in the Oaring t~ef outlges Pump tan ~e d"ryspersal ~ti(s) ~ one large dose. overloading the ceti(sj and may ~~,~n1t be d'~~9~ ~ t To aYOrd this situation have the contents of the PAP tank rr'tttoved t]y a bac~wp or surrac~e d'~scE-arge of etRuex! ~ ~ the efnuent pump ar contact a Plumber or POYVTS Maintainer to e Secvidn9 OPT pnor t0 tn9 PcW nq the pump ~ to restore normal levels within the purnP ~-. assist in manually and dispersal Dells. Do not drnre or park over, or othetwlse dsturb or compact, Do not drive or parts vehi~es oveF tattles the area ' 15 feet dawn stops of arN mound or at~yrade soil absorption area. im rove the performance and prolong the life of the #ollowlnq from the wastewater stream ~Yswa s degneasets; dental floss; drapers; Reduction or-el'tmtna-lion d~~ hum: ~ndoms; sotto of the POYtifTS: antibloticx; ~y wipes: water, fruit and vegetable peefingsi Sas°tine; grease; Itetb'rcides; meat disinfectants: {~ fOUtida~on dialti (sump p~Pj . ~-~, medicatior~ ~; painting pcnducts: pesficxdes; sanitary napkins; tampons: and water satterter brine. ggptdaOt~l~SAt :NIT taken out of service the following steps shall Ibe taken t° Insane that the VYhen the pOWTS tails and(or i5 t,~tttlanentlY. in Administrative Code: -and safely abandoned in compliance witfi ch_ Comm 83.33, 1Ariscons ~~ zs prot~y ~ shaft be disconnected and the abandoned pipe openings sealed. Alt plptng to tanks and p' ~ dis ed of by a Sepfiage Senridng Operator. The contents of alt tanks and pits shalt be removed and property Fos In ail tar'ttcs and pits shall ~ excavated and removed or their covers removed and the void space After pump g. filled with soil. graver or another inert solid material. CONTINGENCY PLAN the following measures have been, or must be taken, ip provide a code if the POWTS farts and cannot be rePa~ compliant replacement system: p A suitable replsoemenYar~ea has been evaluated and may be utilized for the ioca6on of a replacement soil at~sorption system_ The rep~cement area should be protected from disturbance and compaction and should not be infringed upon b}r regained setbacks from existing and proposed structure, lot rives and weUs_ Far7ure to ported the repiacernent area ~~ resuitms must comply with the'ru es Sn effectrat that b ethb~ a suitable replacement area_ Replacement syste O A suitable replacement area is not available due to setback and! ar s~o~ ~ ~ ~O~S 9 advances in POWTS technology a holding tank may be installed as a last resort to rep The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must tae performed to locate a suitable replacement area_ if no replacement area is available a. holdng tank may be insfia!!ed as a last resort to replace the failed POVYTS_ removal of the biomat at ound and at-grade so7 absorption systems may be reconstructed in place following the infiltrative surface. R~ty~uc#ions of such systems must comply with the rotes in effect at that time. acylrARNIN©~ SEPTIC, PUMP AND OTHER TRt`,Ai74~ENT TANKS MAY CONTAIN LETHAL. GASSt:S ANDIOR INSUFFICIENT OXY EN. OOSU~T_ R~ESCRLIE OF A PERSON FROM THE t~i'rERIOR OFTA TANK MAY DIFFICt1LT OR INFO S LE. ~Y RE ADtJITIONAL COMMENT`' . POWTS INSTALLER Name ,~ ~~ r,~ Phone `~ ~ 3" ~-- ~'~~ _°' t ~~°- POVYTS MAINTAINt.R Name ,~~ ~.GL, r`,~' I Phone ~1 J ~ ~`~ ~..~~ SEPTAGE SERVICING OPERATOR PUMP>=R LOCAL REGULATORY AUTHORITY A9~cY ~: ~ rai5. ~~~. Name ~ ,,~ ~J Phone -~? / ,j ~/ '~~'' ~"/ ~~ Phone ?~~J~-.' ~ ~~ ~ `~ ! C~ This dowmeni eras drafted ay tha staffs of the' Csreen Lake. Marquette and Waushara County Zonln9 and Sanr?ation agendes. This document meets the minimum re4uirements of cat Comm 83.2?(2)(bXiHd)~(fl anA 83_.54(13. (2} 8. (3y. Wesopnsin Admtnisftatnre Cade. Use of this Qourment does not guarantee the perfoanaaoe of the PO1rV'CS. GAIN (mil . CpUN't'X . ST CRO ENpNCE A~~E~~. ~EEp'~IC'T ~'Si4INT~ . FORM . .. ". D~EgSHIP CER'T'IFICATION ~ // ~Q l own~Buy ~ _ ~ ~ ~ ~ ~ •linS Adams ~ _ _ ~, ~' ~ i Vial ~znt for now constsucnoa) Address Plug DeP ~, ~~ , f~ ~ -~ PropcrtY ~erif"icatioa nq~tired ~ (~ ~ g ' ~ , ~ Parcel Identification Number . City/State A~P~oly_ r vv, Town of u '~,`, r^^ S LEGAL D j L ,, T~N-R 6 1/,~L'`~ i~`' S ---- Lot # .,.~_ . Y~p~3, ~oatioa ~~ ~~ ~~ ~" page # Subdivision ,-~ Volume ~1r e 1Viap # Page # Certified Suns' Y ~ ~ / ~j 1 Volume . d # ~ ~L/ 1 C~ no Dee idsntifiab :~'~~s Warranty Lot lines P ho p yeS p no :. Propermaint~ace S ~ its prssuature failure to ut into the system of your ~ptse ~,~ could result is a liunsed Pte. What you p ,~ ~d ihreC years or sooner, if needed by tie taa]~ ~~ went stage is the waste disposal sy~• ~ by a consists of pip cut ~1C sep by the owner l ~n esa affect function of the septic tats ~ a tree cation foray. ~ _ Croix ZoniaS D~0°c~ s that {1) tho as-site wa~~"s ~ full of sludge. to St. venfYinB the yep ~ less than ow'~r agt~ to ~ ~ plumber or a licensadp~~cessarY): tic tatak T~ erP~ouraeY'a~ plumber, t~ coon and F~"r~ ( ~ system with the standard inspc ~Pop~pesati~ coadztsoa sad/or (2) ~ ~ agree to maintain th ap~t~°~ucges. S~ °f Wuco> ~.~. 3~ ~ d hsve read the above of~e an got ~l~ ~~teturasd io the St.' Croce ~~ Zoning set forth, ~'~ ~ set by ~ fl mined must b ' system has Veen matn ~ ~ ~' stxtiag that y~e~~~piratioa date. DAT_..~ of the ~ C3NA'TtJRE OF APPLICANT owpet(s) ymowledge. I (we) am (arc) ~ ^'"'°''''~~~ATI~ form are trot to the bcst °~ter of Deeds O~c• 0.~--- „ -~••~oents on ~ ~cd recos~ ~ Reg I (,+re) eettifY • - - ~`I "~ i~viitue of a warranh' y ~ r' ~ the gmp~Y ascribe above, by DATE yoked by tlu ZonsnB Dep~ment. s"' SIGNAT'tJRE ~~'°'PPLICANT eralit bed n ' on that is mis-repn~~ maY result is the sanitary P esssss pay 3aformaa the Register of Deeds office deed d warranty deed from to the warranty this aPptitatioa: a e certified survey map'f refcrcnce is reads ss Inciude with a Dopy of ~ ~~ Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT ~ ~~a~ Page / of .................. .................... ..... ...~. r.... ~....,,.~.. County ~ ~ . Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must 6 K include, but not limited to: vertigl and horizontal reference point (BM), direction and l t l di th i d l i Parcel I.D. Q I ~ ~ percen s ope, sca e or mens ons, nor arrow, an ocation and d stance to nearest road. - Q ~ - ~ - Please prinf all Information. Revie by .. , Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot,, f~/,t f 1 /4~ 1 /4 3G T Z~ N R / ~ E (or~AU Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1 53 ee Tr. ~ e ld cr~e.S City State Zip Code Phone Number ^ City 9 Village [Town Nearest Road ( ) -131 h'~ m wLo -2 cP /sa ~ s.,l New Construction Use: [~ Residential / Number of bedrooms 3 -~' Code derived design flow rate ^ Replacement Y- ^ Public or commercial -.:Describe: Parent material __ [ ~' (~ Flood Plain elevation if applicable _ General comments ~`~ S~Cl~rl t° (-e t/ ~ ~~; ZO and recommendations: t ('Gt1~~r e(~J~ ~,OQ ,`, ~/,~ / lop 6 GPD ft. `~/~'~ ~~ ~ ~~~ . , Boring # I^~t Boring ,l ~ -_ ; ~ 4 L ~ ~ t ~ ar ~ L~ pit Ground surface elev. d ~ ~ ft. Depth to limiting factor Tn , ~ "r`f '' ri • ~ , Soit.A'pp cation Rate Horizon Depth Dominant Color RedoxDescription Texture Structure Consists i~iunda ~~; ~`'•-, D/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ~„~ ~ ~~,. '~ •;~ 1 *Eff#2 I n--i Z l u r l2 ~'i ~ 2mabk ~r ' ~ 5 . ~ Z I Z -28 t y 3 S i c l ,~, k ~r c..S - . y .~ 3 2~ 3~ ~ ~ r 3l ~ ~F -t. 5 13 5 L s k mfr - - ~ 5 . q a Boring # ^ Boring ~~~c ® Pit Ground surface elev. (~ ft. Depth to limiting factor Z 2 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 1 o-t~ I~ r3~2 Sil a,b ~r^ ~S ~ vl' . 5 . ~ Z IO' Z2. (~ ~ ~ -- S i ~/ Z -fir c.5 - . ~ C, 3 22-3b ( SAS ~~ ~1 - - -- NP ~tP ' Ernuent #1 =GODS > 30 < 220 mg/L and TSS >30 _< 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Plea Print) Signature ~ CST Number C1~ e ~ ~.---~ Z Address Date Evaluation Conducted Telephone Number 2l~ 3 ~U~ ~}, Sbmer~.-}, I.~I 5~ 2s I Z - 17 - 6 ~ ~7i~) 2 y 7- S~OF" er• w Property Owner ~~~~ Parcel ID # Page 2' of 3 ^ Boring # ^ Boring / ''\\ pit Ground surface elev. 6 U ft. Depth to limiting factor 3o 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 ~ o-- I ~ 312 - s; I k -~- ~ s / ~~ - 5 . S Z II-30 ~ yl --' s l c.l 2 m b~~ ~'r ~ S ~ `f - ~ 3 -y ID r 51g - Fra I-m eS~ne ~ ~ `- N ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appliption 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 ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 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. SB0.8330 (R.07/00) .~~ PAGE~OF~ ~TA_R~E 5-~a v ~ LOT# ~ LEGAL DESCRIPTiON~tlc~J ~ScJ~ ,S 3a T Z R ,N,R. t ~ E(o~ SCALE: 1"= y~ ~ BM 1 ELEVATION SOU • G BM 1 DESCRIPTION •~ P a ~- ~ ~~~OVC ~P e BM 2 ELEVATION ~I~, Z y BM 2 DESCRIPTION ~ -~ ~ ~~ PJc P; pT SYSTEM ELEVATION ~~, ~ ~ ALTERNATE ELEVATION ,y~14- CONTOUR ELEVATION Q~ OO ~,,3 • ~ ~J. Z C~n~Jr sc~~ 3v `~." - x da ~.. ' ~; 0 ~~ 6 Z ~,, . ,as 6" ~Sa i ,~ SIGNA ~ ~ _~~ DATEV U 2659 P 552 • STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED Document Number This Deed, made between RICHARIrI O- _STpL1T and TAIVFT P _ STOih_ _ husband and wi few __ _ _ _ __ _ _, Grantor. ': and DAVTD P-_KOQVMAfJy a_ ci ngjp F2e.T8on, - --- _ ___, ___ _ Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee [he following described real estate in $t - Cr'OiX County, State of Wisconsin: Lot 6, Plat of Emerald Acres, Town of Warren, St_ Croix County, Wisconsin. '774861 KATHLEEA H. MAL5H REGISTER OF DEEDS ST. CROIX CO., VI RECEIVED FOR RECORD 09/21/2004 10:00Al1 MARRAHTY DEED EXEMPT i REC FEE: 11.00 TRANS FEE: 218.70 COPY FEE: CC FEE: PAGES: i ~... - n:i;r .:<i -'. Name and Return Address ~f1n Gt- ~ eQ T l~l'1 Y/ x(00 ~v • Z 5t- ~t r~s ~fsovi , wr ~-ro~lo 018-1098-06-000 Parcel Identification Number (PIN) This i3 not homestead property. (is) (is not) Exceptions to warranties: easements, restrictions, rights-of-way and covenants of record. Dated this 20t-h day,o~{f~ ~SP~~tpml-~Pr ~Ola4 .Q 1 ,_ - ~~ ~ \ D ~ (SEAL) / - . ,~ (SEAL) Richard O. Stout Janet P Stout (SEAL) Signature(s) AUTHENTICATION authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not. authorized by §706.06, Wls. S[ats.) (SEAL) ACKNOWLEDGMENT State of Wlsconsin, ss. St. CRoix County. Personally came before me this 20th _^.w day of Septembgr _ , 2004 ,the above named Richard O Stout and .Ianet P S t nut -.--~----- --- - [o me known to be the persons who executed the foregoing lns[r~nt a/nJd acknowledge the same Pameia A. Willman 1~~~_~.__fe) t~1~,... THIS INSTRUMENT WAS DRAFTED BV l~iotafy PUhIIC -- ~+ - Janet P. Stout 1 353 Awatukee Tr. Stat@ Of V1fi3COTlSIn Hudson, WI 5401 6 Notary Public, State of Wisconsin r My commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not __ ..~~~.5~ D ~ _, ) necessary.) • Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wlsconsin Legal Blank Co., Inc. WARRANTY DEED FORM No. 2 - 1998 Milwaukee. Wis. w _ 1 T w _ _ J - ~.. ~ - ! 389°44'16"W 1450.22' _ - _ _ f H.W.L. = 1015,00 _ ~_ _ _ - - - - - - a 319.62' a, 3s.a~- ~ 314.69' L-10 - L.g a \ c~ ~Qi~ / ~ ~ . \ ~ \ \ ~~~ i w m ~ ~a~ e, ./ ~ ~ ~ ; ~ ~ ~ N lM~ • 1005.00 ~ / ~ / ~ o ,~Q- ~, ~ v ~+ _ - ' QZ IP.4~ L-i3p w O `~ ~ 8.96' - ~ V 8 L.~- ~ ~- ~ V 7 W ~~ ~ ~' 6 ~ 5.00 ACRES rn ~ ~ `~°- V 5.00 ACRES ~ 217,800 80 FT p v 217,800 SO FT +~ ~ ~ m MIN FFE = 1005.00 f',, 5 a 2.50 ACRES m 108,900 SO FT .. - 2365' tye'E 478.04' W - A '8i'W 479.39' ~~ $ I / W 319.62' -~ ~3o1aZ9~~ c3 wW ROAD N89°44'S6"E 891.18'-- 47.72' 1 ~ ~ 1 W 889°44'S6"W 891.18' C2 ~ _.ng"v') 184.34' 223.'.54' - .. - r~l ~ ~i 250.46' L 30.72' / 1 ~..-.. - ~Q R ~ ~ ~~ ~ l .....1 ~----------- -- ~ ---r-~~~/' ~~ S 0 33 ~~ 34 ~ RES 2. f~.d0 ACRES ~ 108,904 SO FT ~~ :., ~ 8 W A p 2. ACRES i 108,900 SO FT AmA 0~ V gl t~ 31 A a 2.50 ACRES m 108,900 SO FT W a N Parcel #: 018-1098-~6-00~ 04/14/2005 08:24 AM PAGE 1 OF 1 Alt. Parcel #: 30.29.17.813 018 -TOWN OF HAMMOND Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): " =Current Owner * KOOYMAN, DAVID P DAVID P KOOYMAN 7684 JASMINE AVE S COTTAGE GROVE MN 55016 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description * 1518 73RD AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 5.000 Plat: 1933-EMERALD ACRES 1/35 018/02 SEC 30 T29N R17W PT NW SW EMERALD ACRES Block/Condo Bldg: LOT 06 LOT 6 (5.000AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 30-29N-17W NW SW Notes: Parcel History: Date Doc # Vol/Page Type 09/21/2004 774861 2659/552 WD 09/10/2002 689889 9/33 PLAT 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 56924 62,700 Valuations: Last Changed: 06/30/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 52,500 0 52,500 NO Totals for 2004: General Property 5.000 52,500 0 52,500 Woodland 0.000 0 0 Totals for 2003: General Property 5.000 52,500 0 52,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings m accoraanc:e wnn wrnm oo, vns. rani. ~.cwe County ~.~ , ~ {- } Plan must Attach com lete site lan on er not less than 8 1/2 x 11 inches in size a p p . p p indude, but not limited to: vertical and horizontal reference point (BMj, direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. d ~ ~ - ~ ~ 9 $ ~ ~o - ~~ Please print all information. Review by Date Personal iMorrnaGon you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). ~ ~~ 65 Property Owner ~ ~ Property Location S ~ 3O n Lr N R E W I [~ \ ~ (,~ 1/4 Govt. lot T /4 S ( r) Property Owners Mailing Address Lot # Block # Subd. Name or CSM# City ~ ~ State. 1 Zip Code Phon Number 1 ^ City ^ Village wn NearestR,oa~d/ 1 ~ T Gt. lam, /V ~ ~ ( ~ /~ ~/l~Lr ..5 / New Construction Use:~Residential I Number of bedrooms J Code derived design flow rate y..1~ GPD ^ Replacement ^ Public or commerdal -Describe: ________ __-_-___________ ___ Parent material Flood Plain elevation~ifcapplicable /~ ft. General continents `~~ f, f `n ~ ~ / i r~/ ~yS1`Y-~~ and recommendations: ~ I ~v `J /1 Boring # BOring ~. Ground surface elev. V ~ ft. Depth to limiflng factor ~_ in. Soil lication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. •Eff#1 'Eff#2 Z ~ ~" /vim ~ y 3 ~l 3 ~ 7, s ~ ~ ~ l~- ~v -'~ 1 Borin4 # 0 Boring ~~ ~-.'' +~ pit Ground surrace elev. n. uepm to ummng racxor - ~ ui. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'E 2 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 'Effluent #2 = BOD < 30 mg/L and TS.ti < 3U mg/L CST Name {Please Print) a CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~- ~ ~ ~-~ 715-246-4516