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HomeMy WebLinkAbout018-1098-20-000Nisconsin Department of Commerce ' 1 PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Lindstrom, Bill Hammond, Town of SST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic F~v /~/~ vC.tJ Dosing /^ ~ ~~ I,~~ l Holding TANK SETBACK INFORMATION TANK TO P/L a t^ WELL BLDG. Vent to Air Intake ROAD Septic ~~ ~ ~~ 'lpZt ~ l ~~pu/ --~ Dosing 1~ i / ~ / ~L~ / i Aeration Holding PUMP/SIPHON INFORMATION ~/ Manufacturer errand C~CI ~ GPM Model Number ~ / ~~ ~~ TDH Lift,., Friction Loss System Head TDH Ft Z `~ 5 3 ~ ~ . Forcemain Lengt Dia. a t, Dist. to Well ~~ Z S(111 ~RSnRPTI(?N SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 479436 0 State Plan ID No: Parcel Tax No: 018-1098-20-000 Section/Town/Range/Map No: 30.29.17.827 STATION BS HI FS ELEV. Benchmark ~, I - ~.O 6 , ~ Alt. B 4 ~.5 Paz Bldg. Sewer ~' ~ ,Q . Z SUHt Inlet ~~: 9(p ~ 3 SUHt Outlet 1 1_ Dt Inlet "'\ ~_ Dt Bottom ' , 9Z. Z Header/Man. ~. ~ /O r Dist. Pipe ~~ Z ' ~' , Bot. System 5.9 ~o~ . Final Grade ~, z iaz.~ St Cover ~ f ~ ~ C J / ~Z . ~ p.~ ,r' y 1 ~y ~ / ' ~ BED/TRENCH Width ~ Length ~-~ / No. Of T nches PIT DIMEp~ONS No. Of Pits ` Inside Dia. Liquid Depth DIMENSIONS ~ 7 5 / ~ ~ ~~ '-'~ SETBACK N SYSTEM TO i'/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer. INFORMATIO Type O~e mJ ~~ `~ ~ / ~~ ~~ UNIT Model Number. Q I'11STRIRlIT1(~N SYSTEM AJwr~J _ Header/Manifo~d f f Distribution Cz~ ~ r~ / x Hote Size !/ x Hole Spacing C Vera] to Air take ~-77 Length~_ Dia 4- Pipe(s) ~/ Length Dia L Spacing T 3 tJ Rf111 rC)VFR „ ors«~.~e c..~•e.,,~ n.,i., ,... Mnnnrl nr At_r~rarlP Svctpms Only Depth Over / BedlTrench Center I ~ Depth Over Bed/Trench Edges xx Depth of ~ Topsoil ` xx Seeded/Sodded es I 1 No xx Mulched es No ( ,_ r' COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 / 3U/_~ Inspection#2: / / Location: 769 154th Street Halm,~mond, WI 54015 (SE 1/4 NW 1/4 30 T29N R17W) Emerald Acres Lot 20 r [Parcel No: 30.29.17.8_270 1. Alt BM Descri tion = ~'r ~ `"-_ ~' 6 U ~-- t lc.~.GkQ.~ -~~ ~"~ 51~.,,-~~ ) p 5 . GIB, ~ ~5 }-- 2.) Bldg sewer length = ~$' -amount of cover = / _ _ Plan revision Re wired? ~`] Yes ~ ` i No ~ ~ ~ ~~ ~ ~ ~ (~~ I ~~ Use other side for additional information. _ _-_y___ __~ -`-~ --~-- - --J Date Cert. No. SBD-6710 (R.3/97) ~: ~/,., Safety an ui~,dings Divl 'on County ~l 201 W. Washington Avei;.P.O. Box X162 ~~ lr ~-•- SCOO~,~ Madison, WI 53707 -'7162 Sanitary Pe ~Num 3i be filled in by CoJ (608)266-3151 ~p Department of Commerce State Plani.D.Ntunber Sanitary Permit AppT A ~~~~ ~,~~, ~ =-~,lwvs.,~~ In accord with Comm 83.21, Wis. Adm. Code, perso l inform rovide project Address (if different than~ing address) may be used for secondary purposes Privacy w, sl 04(1)(m) ~~~ I. Application Information -Please Print All Information ~ ~` ~ ~ ~6 ~ 1 ~ S-E-• N~~ E arcel # Lot # Block # Property Owner's Name ~ ~ C S ZONING pFF1C ~ ~ ~, ~' 1 ~ `', Property Location Property Owner's M/ailing Ad/dre`ss~ ~ `~ `/~l 4 l ~~~~' ~'/.f~fiL~'/,, Section lJ City, State ' Zip Code Phone Number / , /~ i one ~ lam(./ l ~ L/~ ~ T ~ N; or W ~ ~ S U^'` C M Nom II. pe of Building (check all that apply) Subdivision Name J S . ~' // Family Dwelling- Number of Bedroom n r i ^ pablicJCommercial -Describe Use ^City_^Vi1lag~eWnshi W \ ^ State Owned- Describe Use 1 ~ ~ +. '1 III. Type of Permit: (Check only one box on line A. Compl a line B if applicable) A. w System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System List Previous Permit Number and Date Issued B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New Before Expiration - Plumber Owner 5~ = . o I Z IV. T e of POWTS S stem: C ck all that a 1 ^ Non -Pressurized In-Groun nd ? 24 in. of suitable soil ^ Mound < 24 in.^o Aerobia Toeatm ~ UniGmd^ RtOrculating Sand Fltertlter a Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter p lain ^ Dri Line ^ Gravel-less Pie ^ Other (eXP ) ~ Recirculating Synthetic Media Filter ^ Leaching Chamber P c V. Dis ersaUTreatment Area Information: ~~ uired s Dis e~ Area)'~pPosed (sf) System Elevation D i Frlo~w-(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Req (~ ~ ~ , ~ ~ v i ~ -/7/ J Prefab Site Steel Fiber Plastic a aci in Total Number Manufacturer Glass VI. Tank Info C p ty ~y r Q_/~ ~~\ Concrete Constructed Gallons Gallons of Units ,~i~C J New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber y ume res onsibility for installation of the POWTS shown on the attached grans. VII. Responsibility Statement- I, the undersign p Mp~pRS Number Business Phone Number Plumber's Name (Print) Plumber' ~ afore ~~ ~~~ ~~~r~,/~~ , / ~~ `, j ` Plumber's Address (Street, City, Statej, rPG de) !,~/~ , / J l ~j`~ ~J~ ~~_l~~f /yiJ c,C~„/~ ~~i~~--~~/ l undwater DateC,Issued Issuing Agent Signature o Stamps) VIII. Coon /De 8rtment Use Onl Sanitary Permit Fee (incl es Gro Approved ^ Disa proved Surcharge Fee) ~ p / -~~ ' ^ Own van Reason Denial J' IX. Conditions pro al ~j) G~e~- ~,-t~p, ~ S~ 4~S SYSTEM OWNER, pin, -~q ~m~t~6,^- 1 Septic tank, effluent filter and I_ dispersal cell must ali be serviced !maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County only) for the system on paper not less than 81f2 x 11 inches in siu SBD-6398 (R. 01/03) Bill Lindstrom 1/4 N1N i/4S 30 /T 29 PLOT PLAN ADDRESS 1101 170th St. Hammond Wi 54015 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 100.2' 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 456 # of chambers none BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark Tank is to be properly bedded and provided with lockdown covers with approved warning labels I Pro 3 Bedroom ~ ~ House ry`' ./~ -.~ Property Line (not to scale) Scale = 1 /4" = 10 Grading is to be done to divert run-off away from system B.( #1 ~ B.M. #2 is Top of 100' 1 " pvc pipe @ 99 0' . \ B-2 Huffcutt Combo Tank r---i B-1 Area 15' below \ system is to remain undisturbed 3% Slope Slope calculates to be 3% B-3 Qeu~ ~ 99.2 99' Well is to meet all setbacks found in Comm. 83 9 8' ' 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/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary August 25, 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: 08/25/2007 Identification Numbers Transaction ID No. 1188563 SITE• Site ID No. 703505 Bill Lindstrom Please refer to both identificatiou numbers, 150TH Street above, in all corres ondence with the a enc . Town of Hammond St Croix County SE1/4, NWl/4, 530, T29N, R17W Lot: 20, Subdivision: Emerald Acres FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1035654 Maintenance required; 450 GPD Flow rate; 27 in Soil minimum depth to limiting factor from original grade; System: 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. C,o 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: D ARTI N OF ~~ • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CO "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION __ 2.0" SBD-10706-P (N.O1/O1). • 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 • This pressure distribution system is designed with a minimum distal pressure of 3.0 feet and a network pressure compensation of 3.9 feet. • 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. SI-IA[JN R BIRD Page 2 8/25/2005 • Inspection of the POWTS 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(71 A copy of the approvedplans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe 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, J Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce. state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Cover Page Shaun Bird ~~.~~~~~~~" Bird Plumbing Inc. pA ~ ~ 1 ~ c005 1008 192nd Ave SAF~:,~~~~ ~ ~~s6~`..9d~`~:~S New Richmond Wi 54017 715-246-4516 Date: 8/16/05 Owner:6ill Lindstrom Location:SE1/4 NW1/4 S30 T29 N,R17 W Lot 20 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 and Contigency plan 9-11. SC Shaun B Signatu License ~~~~~~,~~ ( y ~~ ~ P r ~n ,, .:~~ $r r or= cc ~~~~ €;c~ rEY ;y :. arcs SPQND~N ~ + ~, PLOT PLAN PRO;~ECT Bill Lindstrom ADDRESS 1101 170th St. Hammond Wi 54015 SE 1/4 NW 1/as 30 /T 29 N/R 17 w TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 100.2' 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 456 # of chambers none BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark Tank is to be properly bedded and provided with lockdown covers with approved warning labels Pro 3 Bedroom House Grading is to be done to divert run-off away from system B.M.#1 B.M. #2 is Top of 100' 1 " pvc pipe C~ 99.0' Huffcutt Combo Tan\ B-1 Area 15' below \ system is to remain undisturbed 3% Slope Slope calculates to be 3% B-2 B-3 ~ 99.2' 99' Property Line (not to scale) Scale = 1 /4" = 10 Well is to meet all setbacks found in Comm. 83 9 8' Designer _ Date No r Non-Woven Filter Fabric 4" Observation Pipe Perforated Below Filter Fabric E-S1~i G-33 S o n d '~ " Topsoil ` _____~ ~ ~j; $tOQe ~ r, a~ a 0 W ~ c 3 0 ~pistriDutio~. Pipt _= ~~J]~; K Force Moir From Pump G Plowe d Lnrer ! ~/ Q ;~ ~ . E . ~ ~,~- ~F ~- G ~--.- h ~ J E Bed 0 f ifs- 2 ~2 Qrain Rock Cress Section Ot A lrtound ' S st=m Usin A Bed For The Absor lion Area ~- p ~ Ft. i g ~ '? ft. I Ft.- - ~ ~ ~ ft. _ _ . ~.~~' Ft. _ ~ ~g _ Ft. L -- -, 4~Observation PiPt-~ ~ ~ ~ r - _ ~}•---- K ~r_^_-_- ______---------------------------- _ . A / { ---_--_ j Forct Moin ~- ~r ~~ ~~ ~~ r ~° _......._l~._._~._..,._.~___.._._._---_----- - From PvmP ~ ~^ Distribution Bed Ol /2 - ~ 2 Droin RocK Pipe i 4 ODt-ervotion Pipe ~:~c~.~=max. Permonent Morker ~.S'~s,."'- l1~ ~ ~g,~ra. 'E°>F'>f..,~1~~ Pe or Rods Plon Vitw Ot Mound Ucl~ A Bed For Tttit Absorption Areo PAGE_„_ ~F_._.- C%cz iatatsd O~ 8o~sam. ERuany Soo=:o tRST 41ots t~(ixT To Cannec~~c~ Ft. fit. Signed: License Number; Gate: ~~~ 1 i %A, YrfGheS ~~ ~ ~~' ~ InCheS.°-• Hole Diameter~~ Inch Lateral ~" ~ Inch{es? Manifold ~- Ittthes Force Main ~--- inches ~ ~f hales/piRe,~ Invert ~ievatio~ of Laterals~Ft. Pe~faaateG ~iCt Oetaii • - ---- • C-r; (,?~ p~~ ~FECF~ FCATTOKS ~ Pt3riP C~;AMB£R Cr"'.QSS SE SEPTIC TAZ`~K . ~~arH~~~~~ A~F~av~~ „ nsn. AsCvE GRAI?~ ~ ,~~~CTifl~ acx HOLE CaYER ~: ~ ~t'ENT WIPE 3:~ ~OhDtIIT ~ v G~ ~tINi30~ €1R KITH ~! Pp~33iAEK y III` IRON D40R. y,~pRK;NG ~HE~ FRESH -~ ~~ ~D~ ~,~~~.,,~; ~ r.. ~_~u HZN. E ~ ~. - ~. 3. D. ~8uM11i- + TT _ s 3S~ i~~ ~ s ~~ 3 ,~ i t -~-- TIGHT , . '>aiiitIp~FE i,iAT£R TIGHT SEAi.s ~ SEA1.- $ _ ' N ~LIQ SOIL C ~ F FF QlRD ~ pU14P 4~'F' EL `C/1= } fl SQI! 1 __~.,_! 3'~ ~pRpYED BE3~I?ING V~~_ '~A3+T1C t COi~CR£TE PAfl ~-~Jf~,.l~vwc! SPyCZFZCATZC3NS _ ~ - Nt3i'SBE~ ,DOSES ?~ 13p,Y ..r.-------' SEP'EZ NaNUFAfl'~R~R • GG ,Eli . ~~~ ~ £5 ~..rt.7I''tE ~NCc~ ~ ~~ GAL - iAl+~~ ~ G 2E5 = SEPTIC --- 6AL. - ~ _G~~~ INCHES =~~~--- - TAIiK 8,,,..- ~.~.-- pQS£ ~ GAP~CITI£S y~-~~ ' ~ s ~ 2~ Zi~iCH~S - r.~~--- SAL A___.-~ ~~EL ~tuns~ _ ~' !,cam ~ ~ = ~" ' ;NINES =~_...----~ ~z•t~C~ TYPE . ~ ~ _ ~~.~ c~EIL n = ~ IrtcK£s ...r------- ~, ~y~tFpC'~U1tER = ~ %._ ~"' ~ 11.EiR 15.23 WAC !V M - KflDEL N(,j1#SEg = ~ J fi'''r" ~ idIRZNG AS PER BITCH T'3CPE GPt'i - P' ~ £ ALAR ~, FEET `" ?IP£ FEET REttiilREn DISC~1r+Rrab RATC 'OISTRZBUTION '~ ` - ptTi4P fls £ AN13 .~ ~~----- FEET L DIFFEg'A'tC£ $£Tir1EPRE SUzzE - •'f'RZCTFE?l+~ FACTOR J~-rr~-" FEET vER'!'ICA 031K SUPPLY r~~*£/ZI3g~FT' €?Y~~~C M~ ~-=--~"~.. + M;HI~'N~ N I~ ~.----- ~flgAFs ~ ~y~yETI:R __---- + ~~ F££T .FpRC£!SA x ,-~ ~IpTFi C7 7`a -~ NSIOi~~ ~~ ~UM~ -~pyislK ~ L~Q~ID ~~ ~iAL DIME ~v~ ~'~ It~T£g L I tr Ei~ S z: i+fU M BED ~ _~---'_'""....-- S IG P[ Eta = _.._._.------'-' 13 R^= £ .l88 12 0 w x U 0 O i-- 4 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING MODEI- I 152 153 Feet Meters I Gol. Liters Gol. Liters 5 1.5 69 261 77 291 10 3.1 61 231 70 2f'i5 15 4.6 53 201 61 231 20 6.1 44 167 i 52 197 25 7.6 34 129 42 159 30 9.1 i 23 ;' 87 33 1;?5 35 10.7 -- -- 22 ~ E5 40 12.2 -- -- 11 42 - Lock Voive: 38.0 Ft. (11.5m) 44.0 Ft. (13.4m) utiaso e 100 - LITERS ~ 80 160. 240. 320 FLOW PER-MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing Panels available. ~°~" • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle'controls. • Sealed Qwik-Box available foroutdoor installations. See FM1420. • Over 130°F. (54°.C,) special, quotation required. 1521153 Series 3 27 :~ i I 72 i/e n 5 t/ f ----1- tl sKZOe< ~. SELECTION GUIDE 1. Single piggyback variable level float switch or double piggybace variable level float switch. Refer to FM0477. v enuTloN 2. See FM0712 for correct model of Electrical Attemator E-Pak Y . 3. Variable level control switch 10-0225 used aS a control activator, specify duplex (3) Ag inatagation of controls, protection devices and wiring should be done b ,a qualified Ilcensed electrician. AU electrical and safely codes should he followed including the most pr (4) float System. recent National Electric Code {NEC) and the Occupational Safety and Health Act {OSHA). RESERVE.-POWERED DESIGN For unusual conditions a reserve safety:#actor is engineered into the design of every Zoeller pump. " efAn ro: i~.o. sox 16347 Louisv;Be, KY 40256-0347 Manulach~ersof• ~ SHIP T0; 3649 Cane Run Road ., . p ® ~ous~uie, xY ao211-1ss1 Q~wrrf~a~tsa9 S,vcE 19,99 Pl//~~ !~ (~2) 77&2731.1(800) 928-PUMP FAX (502) 774-3624 hfrpJLwww.zoe/ler. com © Copyright 2000 Zoeller Co. All rights reserved. Page of ri ine an6 ism fog d anon-comn'~e"d~ "`astewa~°~ ~~ ~tfc~ ~ ~~ ~~ewster Values typ fltt~' tlOenSeS or ng one of file #ollotivin9 t"diner SeP~e GE INgTRUGTIDNS 4etss shati~ mNad~e h~ n is nod tcvld- POs tnsPe~D~ yd~ ~ ~mis~+in9 ~ men uP EeNNTENI~ acid d-isPe~ on of the fank(s~ ~~ic for anY ~ tnspe of Maw piumber: Master' Putt indude a visual inspecd ed sludge and scum and ~~ the effluent ~~ a=°~' ~ r Tank inspe~~ m ure the volume of oombin ~ visuatiY ~ ~ of ~Uent on the OP~~ or teaks, ~~ rsad oeU{s) shalt nding authn~~ S anY ~~ round surface- ~'e Gisp ~ effluent ot1 the ground surfs h~~` ~ ~ nt on the g far any pondin9 notification of the focal r~u~k lum6t the or P P~ and to d'+~ ndition and esquires the immediate ltd ~~ or more of the with ~. NR in the obaerra~ a failing co uals one-th- ~ in acco~~'ce ground sut~ ~ ind~ate a and xum in any tar-k ~ rotor and d~sPa'sed mutation of stvd9 a Ser~n9 ~~ yvhen the combined a~ shalt be r~em~ed by a Set~9 , Hants; and any entice intents of the tan ~ urized Pp1tY'CS components. ~ ~ ~ ~ p01fYTS M~nta+nef- in pdm'in+s'~~e C.ode• 113, iNlscon5 ~ anipi or press event e SotYicin9 ~ e~fueni filters. m~ Is of 12 months or less shall be Q?~ ~mpletion of any 5eN'~ ~t't cidoring ai intec~ au~ority wi~in 10 days other maintenance' or mb ~ to the Ioca1 regulatory roduds ~ other A sect shall be t~ Ce bf painting P , ~p aN0 OPERATION PODS check treatment tank{s} ~ ~ cell~ss?~if ~h aoncenfi'abons are START ~ use o~ the s anc!!or damage the lisp riot to u5e- Ft1[ R!~N ~ impede the treabn~ ~ e~ ~ py a sep~9e servicing oPeraE~ P eta >~ve the oonte~"~ of ~e • EKT P t.AIV ~EFt,S MANUAL & MAMA sPF ti=~ca~oxs Q0~'g O~ sYST~ _~ r_~c~aCitY _ i •~' ~ ~_ Page ~ -- nQitions are frozen at the infilitativ ~ ~ exams t not occur when ~'~ °° then l gysbetn smart uP std tP~ ~~ tttaY ~ above normal tiighwatet levels. sand rmaY result in the one large dose, overloading the cell( ~ Dunn9 ~rve8[°d~~ do the d ~ts~ ~~bon have the contents of the P~F ~ r'~mwed by a ~ d-e of etTluent- to the effluent pump dr contact a Plumber' or POYYTS MatAt'alner r4 tradaup or ~`~ rior.bo n~ P~ef rn the pump ~_ Sep1'aBe ~ Dpi p tttnp ~~ f° restore nonTtal levers wiff't' dtstuCTz or cornpad, the P yssist in ntantralh "g and dlspe~ t'~lls- Oo not drive or park over, ar oihen~rtse pO not drnre or park tvSb~t; ~ mound or at-grade so[1 absorPtlon area- ~e ~,~tln 15 fee scream may irnprove tfie performaliCe a~ Pig the Gfe t10li of the #+4ilowinJ fT°m the vrastewater degrease: deftt~ ~: ~~ Reduction or-elim3na rte baits: condoms; oQtton swabs; Este, ~~~ herbiudes; meal DfthepOWi~: S[ttsbio6ts:~Pe' ~~~ Krater, intRand vegetable peefuigs~ ff~o bdns. dui: ~ foutp d[8in {St ~P.. dam= sanitary napkins: tampons:'slid water ~ - scraps r-'~* ~" ~~g Pry -. shaft t~: taken tn` ~~ that the pgpA1DONMI~ ~ faits and/Ot i5 ~~~~r.taken ocit of service ~e foltawing steps Code: ~'~ the abandoned in compliance with ~- Comm 83.33,1Arist~nsln AdtrtinTsttative ~~ is properly and safety be drs~rutected and the abandoned pipe openings seated tv tanks and pits shat! - _ . ppSed of by a SePta9e Senriang Operator. • AQ Pig d its shall be rernovsd and properh' dis and tfie void space . -l-h~ contents of all tanks an 1' • After pttmpin8• alt tanks and P1ts slial[ be excavated and removed or ~elr covers re fitted >~ttrt salt, gravel or another inert solid material. or must be taken. to provide a code CpNTtNGENCY PLAN the fottowing measures have been, if the pp}~T S Earls and control be r8palied ent system- location of a repla~ent soil compGartt tiePtac~ t at~ea has {peen evaluated and may be utilized for the n~ and cornpac~ion and should not crate, tot Fins and weits_ F2u'ture to p A sabn~~m~~ mphcement area shoaid be protected from disturbs . be infringed upon try requrr~ed se~~ from ezisiing and proposed stru lacernent area'+m'lt +~urt rn the need fnr a new snit and site •evat as mat ~rn tabtish a stitable protect the rep ms must cornpty with the rules in effect advances in Pt3Y1fTS rep{acecnent area- Reptaoement syste 17 A suitable replacement area ~ betinstalled as a last resort is r Place the failed p01NTS_ 9 technology a hotdrng tank may a g~~abte replacement area Upon failure of the POWTS a sol.and to identify meet area- tf no replacement arEa is ava~iab[e a The site has not been eYatuate ~ ~ ~fe a sutable replace evaluation must be perfo~n a fast resort to replace the failed POW'FS_ removal ~ the biomat at twtdutg tank nmay be installed ~ #~ reconstructed in place {ol(owrng n systems may a rotes in effect at that tirne_ ~~~~ a e R~ moons of such systems rT'ust wmply with th <c1KARNiNt~~ EN-I' TANKS MAY CDiVTA1Pt L~[~IAt... GASSF~S AAit3lDR iNSUFFiCtENT OXYGEN- TMEAITTANK uNDERANY CiRCLfMSTAtdCES. DEATH MAY SEpnC, PUMP AND OTHER TR~TM CULT OR IMPOSSIBLE. t30 NOT ENTER A SFPTiC, PUMP QR OTHER TRFA RESULT.. RESCUE OF A PERSON FROM THE INTERIOR OF A TA~ititK MAY SEDtFFi AtiDR70NAi- COMMEI~ITS . - ~ POWTS MAlNTAlAit~t POWTS INSTALLER / game ,~ d Name ~ r.,~~.t.l'`~ ` ~:. Phone ~- .."!~J l Phone '~ ,~ ....j "'"~~ .- CtNG OPERATOR PUMP F LOCAL REGtlLATt~RY AU1N4RlTY sE~rals~ sERn Ag~~ ~~. ~' ~'` G' Name ,ry'" ~~ ~ Phons ~ '~ IS = ? ~ ~ I~~s Qca>ment Phone ~ ~~t'--' ~ ~ n~ flf the C=.t~n Lake. Martiuette and Waushara Coc;nty Zoning and Sanitation ~e~id~s t a~G 83.5a(t}. (2} &. (3}, W+sconsin Adrntn~TM° ~~- [Jss of lhls Qod~t does not rtes Coaxnant tiros t >~ the staffs ~ (11011 the minimcue rr3qu+n~nents of ch. C.omtn g3,22(2)(bX J(~d~ffl guarat>Zee the pertomraaoe of the povStrS_ ~In Department of Commerce ,Division of Safety and Buildings SOIL EVALUATION REPORT A~ ~~° 1 _ Page / of m acw~uancx w~ui wnnn w, VYIJ. ~1U111. NwC County ~. C i Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must _ ro X 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 a/I information. Revi ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.1)4 (1) (m)). ~ -~ Q r Property Owner Property Location ~~~~ ~ Govt. Lot S~ 1/4~/(,J1/4 S 3Q• T ~ N R ~ ~ E (or)~ Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# d ~ 53 ~ee T. es ~n->er-a1 City 1 State Z~i(p ~Codett 'P~}h~ocn~e Nu~mb~eQr / --7 ^ City ^ Village 0 Town Ne/ar~e^st~-Road New Construction Use: [~ Residential / Number of bedrooms . 3 _y Code derived design flow rate S~Sa ~ o O ~ GPD ^ Replacement ^ Public or c~mmerdai -Describe: Parent material ~~ ~' Flood Plain elevation if applicable ft. General comments / ~ ~_~d S*P~ ~/-e / ~ SY ~ ~ ,. '? ~t ~_ _: _._ ~p . p O and recommendations: C~h -~cu r ~r~' V ' / 7~ w ~' O ~ ~\~~ ~ ,.j' L~ ~~ +~ c.i ^ Boring ', ~~~ ~ ~dsy" ~~' Boring # Ground surface elev. C ft. ® Pit ~l ~ / d~ De th to limifln factor 2 ~ .` 'n. `' '`"~ p g 4~`'~ "'" - oil ph tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence ut '" ots `' /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ~ ~ *Eff#2 ' ~ 6-10 /p r z Si l Z m"~r ~ . ~ 3 7 3 lU r 3 Cap 7S ~ /s° sal Zr,-, L -" ~ - ~/ _ ~ Boring # ^ Boring pit Ground surface elev. ~ ft. Depth to limiting factor _ 2~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Z ~Z-Z8' lD r sip/ 2m ~ ~S - - ~( 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TS5 < 30 mg/L CST Name (Please Prim i ature CST Number m ~ umaker- ~,~~~ ~~-- Z s33o9 Address Date Evaluation Conducted Telephone Number 213 gp~~k_ ~merse~, t,~l ~ ~dZ 5 iz-.r~_o ~ C~~s)zy~-yao~ ,~ S~UV ~ Parcel ID # Page Z of Property Owner Boring # ^ Boring a~ ©.. pit Ground surface elev. ~~ ` „ ~ ~ ft. Depth to limiting factor ~~ in. Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 6-13 ---- 2 ~-s ~ v - 8 2 13-3 i c c -- ~ ~-( 3 30 3 ~ Sc.l ~k. ; ~ -ti . CA ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soit Appligtion 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 GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mglL ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Deparhnent 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.07J00j ~~--. Properly Owner ,~-~-vv~ Parce11D # Page Z of 3 3 Boring # ^ Boring [~. pit Ground surface elev. ~ , ~8 ft. Depth to limiting factor ~_ in. Soii Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 1 6-13 Z - 2 ~-S V .8 Z J3-3 --- i c ~ `~ 3 30 3 ~ Sc.l ~ i -' -~-I . Cv ^ 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. Munseli 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 GPD/ft2 in. Munseli Qu. Sz. Gont. 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 T'TY 608-264-8777. SBD-8330 (R.07/00) ~ ~` ~ ti • PAGE_~OF_~ NAME ~:~~c.f f TOT#ao T L DESCRIPTIONs~ ~Nwi4 ,S 3cr T Zg ,N,R, ! ~ E(orX~ SCALE: 1"= y0 BM 1 ELEVATION Oo • O BM 1 DESCRIPTION ~a~ a r ~ ~~$ U C BM 2 ELEVATION • ~ U BM 2 DESCRIPTION ~ P ~ t I " ~ ~ C SYSTEM ELEVATION y'9 ~'U SYSTEM TYFE I-'lacrnc~ S~/S~{ ~ CONTOUR ELEVATION `T 9 O d ~~. N l (~~~, 1 c• ' } _ + ~ ~ ~ e-c• 3 a ~~ ~~Z 4'~G1 r~ ~d .~ SIGNATURE .. Y __ DATE ~<a ~___.~~/_. ~~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~~ ~~~~ ~ ~ ~ ~''~`~ Mailing Address ~~ l 7 ~~ ~~' q ~ ~~ sy/~~ s.- ~~ property Address ~ ~ - (Verificationrequired from Planning Depar~nent for new construction)____ ~_- City/State Parcel Identification Number o l $ l /0 9~ Z~ _ ~ o ~ ~ z~~ LEGAL DESCRIPTYON ~~ 1/~~ ~ ~, Sec. ~ `r~N`R w, Town of d~~r~^ Property Locatton _,___ ~-- ~ . ~ _, Lot # =_____~ Subdivision ~ ~-f~`-'~ , , " ~-- ~-~- ,Volume ~ .Page # ap # Ce o c+°^~~-T: ~ ~! ~~~ ~~ ,Volume ~'~ °~' Page # Lot lines identifiable ^ no Spec house ^ yi SYSTEM MAINTENANCE remature failure to handle wastes. Proper maintenance Improper use and maintenance of your septic system could result in its p r What you put into the system tic tank every three years or sooner, if needed by alicensed pumpe - consists of P~P~ out the sep oral m- ean affect the function of the septic tank as a treatment stage in the waste dLSp ~~ b the owner and by a t a certification form, siip~ waterdisposal system The PrOPem' owner agrees to submit to St. Crouc Zoning ~Pa~~ ~g that (1) the on-site waste o~eymanplumber, restrictedplumber or a licensedPumPer the tic tank is less than 1/3 full of sludge. masterplumber, j Lion and pumping (if necessary), ~P is is proper operating condition and/or (2) after inspec with the standards ed have read the above requirements and agree to maintain the Private sewage Sdisposalf W~~~ Certification Ifwe, the undersign ent of Commerce and the Department of Natural gesources, Office within 30 set forth, herein, as set by the Departui leted and returned to the St. Croix County Zoning stating that your septic system has been maintained must be comp days of the three Year expiration date. ~ /~ DATE SIGMA OF APPLICANT OWNER CERTIFICATION our knowledge. I (we) am (are) the owner(s) of I (we) certify that all statements on this formdeed~recordedem Registelr of Deeds Office" the property descn`bed above, by virtue of a warranty ~ ~a~~fl~ DATE SIGNATURE OF APPLICANT ,:~***+ An information that is mis-represented may result in the sanitary permit be1IIg revoked by the Zoning ~P~ment. «~*~~* y warranty deed from the Register of Deeds office «« Include with this application: a stamped if reference is made in the warranty deed a copy of the certified survey map 'J 2262P 'i10 LAND CONTRACT Document Number ~ Fonn 11 CONTRACT, by and between Richard O. Stout ("Vendor", whether one or more) and ]SW1iam Lindstrom ("Purchaser", whether one or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and full performance of this contract by Purchaser, the following property, together with the rents, profits, fodures and other appurtenant interests (all called the "Property"), in St Crooc County, State of Wisconsin: 7243 1 0 KATHLEEN H. IiALSH REGISTER OF DEEDS ST. CROIX CO., YI RECEIVED FOR RECORD 06/03/2003 01:15PM LAHD COH?RACY EXElDT # REC FEE: 15.00 TRANS FEE: 218.70 COPY FEE: CC FEE: PAGES: 3 ~\ lot 20 erald Acres, Town of Hammond, St. Croix County, Wisconsin. This is not homestead property. Name and Retain Address bin ~A~~T r~ c ~ ~fvo S, /~.~ dry, W-~ ' ~ b ~~~4~ Sra~ f,2T • bbl tt /3~3 ~iua~/c-~-~- 7L. f~QsoN, LUl ,Sz/o/b (Parcel Identification Number) 0 !i)'- IOb ~ - SZ! -OoJ Purchaser agrees to purchase the Property and to pay to Vendor at 1353 Awatukee Trail, Hudson, WI 54016, the sum of $72,900.00 in the following manner: (a) $7,290.00 at the execution of this Contract; and (b) the balance of $65,610.00, together with interest from date hereof on the balance ou nding from time to Mme at the ~~ rate of 7.0°~ percent per annum until paid in full pets:,. PAS 6•t•ro 7~,~~j A~}r • T~,.L rwos, pA~• a.¢ ,~~QQ~ Monthly payments of $436.50, principal and interest, for one year, commencing June 2, 2003 and the second day of each month thereafter. Should Purchaser elect to extend this contract for an additional year, if he has been current in making all payments required under this contract, on time, he may do so upon thirty (30) day prior notice to May 2, 2004, to Vendor, in writing. Interest on the outstanding balance in the second year shall be at the rate of 7.5% percent per annum, and be payable monthly, commencing on June 2, 2004 and the second day of each month thereafter. During the second year, the monthly payment shall be $458.32, principal and interest. The entire outstanding balance shall be paid in full on or before May 2, 2004 (the maturity date), unless Purchaser has elected to extend this contract in which event the entire outstanding balance shall be paid in full on or before May 2, 2005 (the extended maturity date). Following any default in payment, interest shall accrue at the rate of 12.0% per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless e:acused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antic~ated annual ta~aes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required bylaw. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any time. In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall Page 1 of 3 Pages Land Contract i i i i i i i i NOO°07'07"W j W O 137 2.74' ~~ Z O~ V ~- - ~V r W Z (~ r Z W ~- LL 0 r W N W I- LL O W Z J M~1p~44C~D dLaG --~ -----