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Wisconsin Department of Commerce Safety and Building Divisio;t PRIVATE SEWAGE SYSTEM 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 S itzmueller, John & Ka Hammond, Town of ~ST BM Elev: Insp. BM Elev: BM Description: ~tro ~~ 1 G5 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic W I e.~J~. Dosing G~ ~ ~~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 5 ~ Z9~' Z~3~ Z3~3 --- Dosing ~S ~ 2~7 ~ 2"7~' Z73 ~ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number ~ ~ 3~4'`~ TDH Li Frictions o ~ System He~d ~t TD~ `~ ~ ~ Z Forcemain Lengs ~ Dia. ~/ Dist. to well ~z II Z Z °~ Snll_ ARS~RPTI~N SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No 463386 0 State Plan ID No: Parcel Tax No: ~ ~S-I~ Section/Town/Range/Map No: 30.29.'!,7.833 STATION BS HI FS ELEV. Benchmark Z • ~`h l02 .~~I ~ °~ Alt. BM ~,{ ~ ~ r4~ ~ .~ Bldg. Sewer y 4` ~ • ~.~ + SUHt Inlet 3.0 G p~ . SUHt Outlet ~ Dt Inlet ~ ~~ DtBottom 1(p~~ ~ ,S~ Header/Man. p Z.7 0 /~,~ ~W Dist. Pipe ~g +dU , ~~ Bot. System 3.5 I ~~ Final Grade i ' 7 $ ~ ~ 1 StCoverrt~ ~- d, /~ 1 /a7r~ QQ ~'~V p ~ 1 D'~ ~f- Lo .Z qF~~~Z BEDITRENCH Width ~ Length J ` No. Of nche PIT DIMENSIONS ' No. Of Pits Inside D,La. '~ liquid De- pth \ DIMENSIONS ~ ~ ~. ~_ \ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type te~ ~~~ ' 3Z~~ ~~• J / UNIT Model Number: ~~ T ` O IIISTRIR11Ti(~N SYSTEM G~,r~' Header/Manifold / ~ ~ ~ / Distribution Pipe(s) ~ /'Z' 1. ~ ~~ ~ l ~ ~ Z x Hole Size ~ '~2 J , x Hole Spacing. 7 Ve~nt/1o Air I take V ~,~ ~l Length Dia Z Length Dia ' Spacing / Cell C(~VFR .. Drmm~rn Cvc4nmc (lnla vv Mn~~nrl (lr At~rirAflP SVS}2R1$ Or1IV Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center I ~~ Bed/Trench Edges \ Topsoil ` ~ ~ es ' No s No 1 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / Z t / d-~ Inspection #2: / / 0, O Location: 739 154th Stre~t„H~~rrtmond~54015 (NE 1/4 SW 1/4 0 T29N R17W) Emerald Acres Lot 6 J~ Parcel No: 30.29.17.833 1.) Alt BM Description = ~ ,~i '~1 f ~ ~ 2.) Bldg sewer length = ~~ g I~a bQ-- ~~e ~e ~ , ~~~ -amount of cover = ~ Plan revision Required? ;! Yes I No U~ ~ ~~~ Use other side for additional information. _ Date Insepctor's Si ature Cert. No. SBD-6710 (R.3/97) . ~ Safety and Buildings Division 201 W Washi t A P 7162 O B County S ~ r . ng on ve., . . ox ~ ~~~®~~,~ Department of Commerce Madison, WI 53707 - (6 ~~EIVED anitary Permit Number (to be filled in by Co.) ~ 3 ~~`~ Sanitary Per plea on c ~~ ~ to Plan I.D. Number J In accord with Comm 83.21, Wis. A . C e, n i 'on yo ~0}~de~l ~ ~ ~ ~~~ 9 ~ ~ieA/~ maybe used for secondary purposes c 1 (1)(m IXCO~NTY P jest Address (if different than mailing address/) ~ I. Application Information -Please Print All Information ZONING O ~~~ ~ S ST , I1 ~~ Property Owner's Name / ~ ~ ~ 1 Parse t Block # ( Property Owner's Mailing Address P r o pe rty Location r~ v ~ O~~ ~ ~ ~ ~ IJ 1 ,~ ~, ~L g 5~' O j ity , State C Zip Code Phone Number ~ %., /<, Section , i ~~ ~ ~ ~ 1 -i ' v (circ~e.er3e#, T N ~Z ~~/ II. Type of Building (check all that apply) l/~ ; R E 'T~ or 2 Family Dwelling -Number of Bedrooms t~J Subdivision Name CSM Number ^ PublictCommercial-- Describe U ee a ^ State Owned -Describe Use ' ' ` 0 ~ ~ ^City_^Village ~clwnship of ~, ~- III. Type of Permit: (Check only one box on line A. Complete line B if applicable) `~' ~ew S stem y ^ Replacement System ^ TreatmenUHolding 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 Owner N. a of POWTS 5 s tem: Check all that a 1 Sj~ ~ S /~/5 (AS.~D ~~ ^ Non -Pressurized In-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 reatment Unit ^ Recirculating. Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (ex lain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Applica 'on Rate(~;dsf) ( ` Dispersal Area e uired (sf) Dispersal Area roposed ( System Elevatio ~ (,~ Co lJ0 b ~ 3 l ~ o -~ ~ 7 w . 7 (~U~ ~ '1 l0 4 ~l 1 $ 1 VI. Tank Info Capacity in Total Number Manufacturer Prefab Si a fiber Plastic Gal]ons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tanis O Aerobic Treatment Unit ~ ~~ J~ Dosing Chamber ~ 1 (~ ~~ f VII. Responsibility Statement- I, the undersigned, assume responsibi 'ty for installation of the POWTS shown on the attached plans. Plumber's Name (Print} ~~ Plumbe ' igna re _,_ / MP/MPRS Number Business Phone Number e ~ ~ ~,~bq 1~S a35-1~3~ Plumber's Address (Stre ,City, State, Zip Code) ~- ~ _. l ~ ~ (Sl/~.i {~ G~..-~ J VIII. oun /De artment Use nl Approved ^ Disapproved Sanitary Permit Fee tncludes Groundwater ` Date Issued Is tng Ag Si tur tamps) ^ Owner Given Reason for Denial Surcharge Fee) ~ ~ '1 ~ ~~ ~C /~/ ~~ a ~ ~ IX. Conditions of Approval/Reasons for Disapproval -~ ` ' /~ TEM OWNER° (( 3 a~~~0~/"n.e ~ S' f~~~~~` ~ 'P3•S`~ ~) ~ / ~ ~ - ~~. ///~ ~i~{,~ ~-P-~d~`-~~-e¢.- ~?~"~ " r~~' 1 eptic tank, effluent filter and ~ dispersal cell must all be serviced /maintained r3'~ vc~= as er mana ement plan provided by lumber. 2. II setback requirements must be maintained ~~ ~ ~ ~ 3 Z~ d , , as per applicable code/ordinances. v~tS~zP~ ~- ~~~ ~ ~ . a/tfi ~h ~oS~-51~~1,~-~'~'k .yr~acn compiere puns tto tAe trounty only) for the ystem on p per not less than 81/2 x 11 inches in size ~ C~ ~n~.~ + v- sue- ~ I-ed w~~!-1~~v~ -~'liQ Gtj~a 612 ~c~G ~~r~~" ~,nv'n~ ~`~ SOr~t II vim- ~s ~~ and l bz an ~~ 54~~ ~~c~ti ce,~~,,. h.a~ .S ~ ~ ~ n~ ~~~ ~ ~ ~ ~ ~~ d ,s pry ~`n,Q.o i'~ l ~ (/~i~c~~-1S -~ l?a nV` Sy~ ~ (.il aS i h~~S~~CC 5 ~ r 1 ~~} 1 t L sCALE: ~"= y0 BM I ELEVATION /Ch , O BM 1 DESCRIPTION -{~ ~q o .~ 1 ,~J rG BM 2 ELEVATION ~{ `j • y0 I3M z DESCRIPTION ~Q o~ ~ ~~~ . SYSTEM ELEVATION ~Q ~ ~ SYSTEM TYPE /1'io~ ncQ sy_S~ev~ CO TOUR ELEVATION q'Q, o tl IG~lv~t. (/~ ~ ~~~~ t i i I •r I i I L-- I Pc , 3 0 lnrQ,~ OG-0.~bN /. G~`, b C\ O~". ~ JZ.~ ~ - lN, ¢.t p,Y 1 L» • ~~ S~w~w..~ d[.Jha.;~ (~ ~~ ~~, 0..y }o-:~. O-Ce..W3 J( ~_ Q,0`S (1~~ Igo ~.•' ~'~c s~ ~~ ~,~-s b 1`~'°v 19' `~ li I r ( ~``~ 'tom , °~'+r'tv. qli - dC o ~..~ S~ o ~- ~ ill o w 9 g.s ~-o,,.~ ~`P ~~c , ~~~ ~4~/s5 ~ a~•z .. ?.11cx~' ~, }p~.. M b QO X60' ~ , ~~ ~ o ~ ~ ~ ~ I / ~ \ ~ i ~ it ~, / j 1 X 1047.4 ..-1{- ~~ ~ - / ~ J ~'.<s~ i ~ p ; y I - _ C-;; I ,. ~ ~' I / - t~ I / /~00 ACRE ::~< .~ `°> ~ ,. / ~ ~ S ~= ~ ~ i % X 104 .3 ~ ~~ ~r `~ I~,. - C~ "~ L.! ~~ ~, i \ °~ _ -__._ --- ~/ / ~~ ice. ,~ ~ ~ . ~ ~ \~ . t~ ~ ~-- ~;,., oo i -, ~ 3~ ~ _- ~ -;o~ it== .; rod ~,_.__--- ------~ i `'~ i ~~~~ ~`_ 4 / ~ ~- ',,T ~ ~ `c 1 +~ ~~;I C N ~..: ~ r O ~ ~ ~ 5:00-ACRES l ~ ~~ ~~ ~~~ r ~ t~~ ~[ H~V1/.L. 1022.00. "~ ~ ''~ '~ / k ~'~ S~:r ~C ~y~~y~ ` / ~d } I!~ ,, i x / , 1 / / / ~ i.' I I~', /~ ~T I. J. .~ ,,44 /~ / ® 1 j/ i I C ~ ` ~ ~ ~ } n31~ .,^. . 1 ~ 1 i.,, / / ~ } ~I f ` ~ FIT RE~ R STl'~ ~' ~~~~,~~;~ '~ ~. -TO E~CON RUCT~ED.,-=' ~ j p `~~~~ ~ ~ '~ BY ERS /~ ~~ ~ ~ ~' ;_,~,~ o ~~ ~~51 T -- ~ , _ '~~. ,_ ~~~ ~.59~" /~ ~ 1 ~. ~' .,.•THE NEy /4 OF H SW1 /4 ~ %~ ~---.Y ' 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 March 17, 2005 CUST ID No.225094 MICHAEL P ROGERS ROGERS PLUMBING E4457 HWY 12 MENOMONIE WI 54751 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/17/2007 Identification Numbers Transaction ID No. 1119921 SITE: Site ID No. 695913 John & Kay Spitzmueller Please refer to both identification numbers, 150th Street above, in all corres ondence with the a enc . Town of Hammond St Croix County NE1/4, SW1/4, 530, T29N, R17W Lot: 26, Subdivision: Emerald Acres FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1008721 Maintenance required; 600 GPD Flow rate; 28 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. ~'(~' T.S. ~c~~~drtt'otza, • MICHAEL P ROGERS Page 2 3/17!2005 • 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 ins ecn tors. 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)-7$9-7892, 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 T coder cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Henry F Grote ,Certified Soil Testing e ~FC~~~~~ John & Kay Spitzmueller- Mound Construction Materials and Techniques BAR 1 6 ?0~~ 5~~~ ~ ~'~;~~af ~~ i.:. All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: __ Mound, SBD-10691-P (01 /01) Pressure Distribution, SBD-10706-P (O1/O1) Location: Lot 26, Emerald Acres NE'/4, SW'/4, Sec. 30, T 29 N, R 17 W Town: Hammond County: St. Croix Date: March 16, 2005 Owner: John & Kay Spitzmueller Address: 1041 Adam Drive Hudson, WI 54016-7169 Plumber: Mike Rogers Signature: License: MP 225094 Attachments: SBD-10577 -Plan Approval Application SBD-8330 Page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management ~ ~~E~~ EpgItTMENT OF cND BUILDINGS DI IS-ON of AFE7Y C ~~~ CORRE NDENCE page 1 of 8 1 Design Criteria Y~~ Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL _ Fats, oils, grease < 30 mg/L Bedrooms x 100 gal/bedroom/day x 1.5 ~ "~° gallons/day hydraulic load -- Design Calculations In situ designed loading rate n X34- gallons/sq. ft. per day •~ Depth to estimated high ground water ~~ ~ ~ in. Depth to bedrock ~ ~o in. ~ ~Q ` ` ~ Cross slope at system •~ % ~-°- ~ •~ `°~ Force main len tli ~ ~' ° ft. of ~- in. 2 ~° " ~ ~ Man d/header length 4" ft. of ~~~ z- in. ~ ' ~ ~' Drain-back ~ ~ • ~~ gallons Lateral length ~" @ ~ ~ S~ ft. of ~~~ z in. Lateral elevation ~ 4 •`t Z ft. @ bottom of lateral ~ Lateral hole size ~~ b in. @ 3 ~ • ~ in. ( 3 • d ft.) Spacing ~ ~ holes/lateral S ~ holes total Lateral volume ~~• ~ gallons Total lateral discharge rate 3 ~.3 2 gallons/minute @ ~ ~ ~ ft. head Network pressure compensation losses ~ ~ ~S~ ft. Elevation difference ~ ~~` z -z ft. 1 Friction loss ~ ft. @ 3 S gallons/minute Total dynamic head ~~-~ ft. Pump/si~aon ~' gpm @ 2 ° ft. of head Manufacturer ~o e`~°^r Model # ~ ~ Z Dose volume Q b ~~ Z gallons Lift/sip'bfon tank ~-~' ~ea o~. ~'-=~~- ~r~~ c..a-,~`Qo ~-S~ gallons Septic tank '' ~ Z'~ gallons Effluent filter ~~~~ ~`- ~~zi-«-~s+~ ~„ ~w~~, (~-"-~ Measurement pump on and off ~ • u in. Height alarm from tank bottom ~~- ~ in. Reserve capacity ~~ 3 ~ b gallons specs.calcs.res Page Z of j~]AMF ~ _' V t, T I C1T#7 (~ ,• i I?FSCRIPTION ~1 ~ ~ ,S ~ T L`3' ,N. R. / ~-E(or7~ BM t ELEVATION /G~ , 0 BM 1 DESCRII'"I'ION -la A 0 BM 2 ELEVATION 4 q • `/4 fiM z DESCRIPTION ~Q o~ ~ ~ Dec SYSTEM ELEVA'Z'ION qQ ~ ~ SYSTEM TYPE ov rLcQ ~e M CO TOUR ELEVATION ~'9, o d ~(I yte~- ' See no~2- ~C~F:~rv "" t i i I L_. Pc , 3 0 -- --; C~~ ! / w -}pv~ N h' ~9 0.~ S: ~c ~G:L~ ~~ w~ `~ ~ e~ ~. "`' ~ ~ a~ ~ OL0.i+bN 5~~ ~'~~ nn ~~~~ d•Cx~ ~1 (~ ~~ lV `~ ~ e- '~ O y~l~- t\ 4 o c~ V, ~ ar I LYL7(\ • }S Q ~O K~yp ~\` SUS _ ~ ~~o ~•~ ~~~~ s~ k~~~ , `' ~OrcQ wa : v, ~~ I ~~~ I k ' 1 ~~ //,, (( ~~ Hot.(L~ C.a. Quw / `tom 1 a. •1- ty ~l.L S - CX o ~ y. S1 0 ~p ~. l J' C9 ~I S~ ~ 'Z ~~ Qo 16~ o I ~~ ~ o ~ g 8M~ ~S ~z~~~, c~osS 5~~.~;o~ ~ -~- , ~, „ .. ,~ 1rOC.k 9~ 0.~~Vt~Sa.tt ~V~~ 9~1ow(~, Zw,~~ ' ~ ~ ~ ~ 4~ O V ~ l ~..~ frv ~ c. ~ v a+,r ~~i q~C,9 Z O~ 1 1 ,~ ~~ ~ ': Sa,.~ 9 g•~ 2,~- 2.~d ,1~__ 4,2' X3,0' --~ 1~.~, 3,3' 'iT- _ ._ _._ .___ _ ~~.5-', Q , u i 1 ' ~ f .~ .``~ --~ o ---, ~« .. ~\0.~, y;c.~..~ i a __ ~_ ~~ O I -~- ~4, s' 4 , ~, Rb-gl O~, 4` ~VC. ~~ ~ obtQ.rv~.'i~oy ~.~.t~~1 'T~ boo.,.. a~ tie^_1~ `~~ t~ ~ 1\ t\ 1 ~ ~r ut K ~ ~f~, 't, 0 1Q ! \ a -F 2nr ~ ate.....: r..r ~ , `~ ~-O ..-. Pk~~ ~3 ~~~z P``v~ cam`, 4~ `..'tar• ~`S - ~s , ~ l 11 ((~~ (~ ,, (~~~Z ~uc 1~`, 4~ 1~ l b • o \ ~ S y. 1 ~-~- m o w t ~..~ ca--.~ ~0~'r b 0 ~ -+ ~ ~ ~ ~~ 1 b ~ , O ~~ e„_ ~ ~ , O l ~ ~ J\ ~ l\ 1\ ` ~(J QX ~ Ol. Y ~X p,,.~ S Z V~ O \ L~ ( \ ) ( T O ~ 1,` v ~~ ~, 2 ' nv ~ ,~~, 40 ~...~.. w1_~, ~I 1`I I' U Z Pvc t~ 40 ...... ~~/ ~,,~ ~ o~ ~ /~._ GI ~[. ~_I 1 I~ ~ ,.. 1-` x ~ T ~~ k T~ 1 ~.. -. -11JCK11JG~GOVfiR LvAn'N ~c ~ ABED . NICK DNC.OMY/LT-~ ,, /^ ~Q _ ~eC~G+~a~o ~r "-c ~-~. , 9.~ C1a..,. -~ °~ Plv~ 3' oK1b tiplgTURBED \ 501 I_ 24" _,.~. ~ M,gAluO.Ltc /A<f T ~\ Roa~~ ~~~~ WEAT~IERPROOF ~,J1INCTION Br.~c 12~ ,.. ~,i ~ T ~~i 1c.~ C Y KT~ ~~.~ 1 . ~~~~ - - - ~..wLCG pp8fi.ovLD A 3 0~ o `~ f+a~ ~., n V~ ~fiSKET J21lrT'S ~ S`~` ~ BAFFLE Ru. Plrfi d ,AU C~s~ \ 3' ono (iQKN ELTI O>'+b ~ w/ ~ w( ~ (~ - ` V,~ Z' QN ^' ~ ) 1Y~CASTVC>Z o~ ~r0~.e..p ~ToS~Z2- D C 12 `1 q .4 ~ ~ PuwtP ~~~ _ ~ ~ e~o~~ SEPTIC t SpECIFI~CATI ~ ~ , QIJ$ oosC ~ ; ~~ .~~i T~uKS M^1JUFACTURC:R: (JUMDER OF DOSES: PER p~.~ T^-JK SIZC : ~~~~ ~' ~S~ GI~I_COUS ,DOSE VOLUME ~ I ' ~ Z AL1,R1~ NI/WUiACTUif,GQ; S~ ~,~`~~'~~ O IIJCLU011JG 6ACKiCOW: G~..O>r5 MODCL -,lUMDfR: ~O1 ~``' ' ~O'° CAPACITIES A= WCNCS Oft -\~3~(0 CaA~~OliS SWITCH Ty/L: ~,~°~'a~~ = "~I° ~ ~Z ~ P MP / ~~ ~~"~ B= ` I-JCMES OR G.e~~C~.S U ~AIJUFACTURCII: p ~ 9.~ 14~', g ~ INCHES OR ;,^..0~.5 JWITCN TYPE: ~""`O''""" '"~`~ iJOTE: PUMP A-JO Al_A0.M ARC TO pC MI-JIMUM DISCMARGt RATC ~4'¢ G/M INSTALLED 0-J SEP~RAT f CIRC.. 'S VfRTIC~.I. DIPFERfWCf ~CTW[[U PUMP OFf AUO OIOTRI~1JTt0-J PIPE.. ~.~Z FECT + hiI.1IMUM -~ETWORK SUPPI.y PRfLSURE z'S~ FCCTy"O'~~ T,/ / + 1~~ FEET OF FORCC P'1AIfJ X Z_~g F/00 /ZFRICT101J F/~C.TOII. 4'13 FEET ~ ~S ~ ~~-, TOTAL. Dy-JAMIC NEAP ~~'3 FEET IIJTEK1JAt„ DIME1J510/JG Of' TA1JK~ LEIJ6TH `Z12~~ ~ ' ~-'~ ;WIDTH ~ ~ ;LIQUID DEPT H 1~a~.~ 6 ~~ R ~ ~- . .• TOTAL DYNAMIC HEAtS/CAPACITY PER MINUTE EFFLUENT AND DEWATERINO 0 a W x V Q Z r O Q O 0 ousoe FLOW PER MINUTE MODEL 152 i I t53 ~ Feel Meters Gol. ~ Ulers Gol. ,Liters , 5 1.5 69 ~ 26t 77 , 29t ' 10 3.1 6t 231 70 265 ' 15 4.6 53 I 20t 61 I 231 ~ 20 6.1 44 i 167 52 ' 97 ~' 25 7.6 34 r i 29 ~ 42 ' S9 30 9.1 23 87 ~3 35 10.7 '----~ ~ 22 --.,-.,--_ 40 12.2 -- -- ,t -~ Lock Volve: 38.0 FI. (t!.6m`,~ec0 =, ~•ic~; 3 27/32 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 C!wik•Box available for'outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 1521153 Series „____ __ 1521153 MODELS Control Selection Model _ Volts•Ph Mode Am s Sim lex Du lex N t 52 _ t t 5 t ', Non 8.5 t 2 or 3 BN t 52 t 15 t _- Auto - 8.5 Included 2 a 3 Et52 _230 t - Non 4.3 1 2or3 _ B_E t 52 230 1 Auto 4.3 Inducted 2 or 3 Nt53 tt5 1 ' Non 10.5 1 2or3 _ B_N t 53 _ t 15 t i Auto 10.5 Inducted 2 or 3 E t 53 _230 t Nan 5.3 1 2 or 3 BE 153 ~ 230 1 Aulo 5.3 Inducted 2 or 3 O CAUTION A11 installation of controls, protection devices and wiring should be done by a qualMied licensed electrician. All electrical and safety codes should bt followed includlny the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). ~'~,! -->S-_~ z.. ,~2 ~/p ~ -~' - --T gI ~ ---- II ~ ~ L scow SELECTION GUIDE 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Alternator E•Pak. 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) or (4) float system. ~~ ~ ~ ~+ U ~ RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 Z - ~° J ~ Louisville, KY 40258.0347 ~ O • ~~~J` ~ SHIP T0: 3849 Cane Run Road Manufacturers ol. S~~ {' Louisville, KY 40211.1981 p pqp ® QU4L/TY PUMPS SNCE ~~/~/,/ • PUMP !O. (501) 778.2731.1(8001928-PUMP http://www.zoeller. corn FAX (5021714.3824 © Copyright 2000 Zoeller Co. All rights reserved. -" ~~ 0 80 160 240 320 System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, Rogers Plumbing, 715-23~- 1 132, or the St. Croix County Zoning Offce, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1. If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or dose tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. 12. If possible, the upslope toe of the mound system should be landscaped with additional fill to blend this area into the upslope natural grade; this will minimize the possibility of the system trapping surface run-off; final settled slope should be 2-3% over the system or 2-3% diverting surface run-off around the ends of the system. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the dose tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the filter should be made every 6 months until a minimum time sequence is determined. 4. Periodic observation pipe inspections should be made by the owner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. ~. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. 1 1. Warning: Do not enter septic, dose or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.4 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 POWTS OWNER'S MANUAL MANAGEMENT PLAN 7~".YI.~E INFORMATION Owner -, ~ Permit DESIGN PARAMETERS Number of Bedrooms 100gpd/bedroom p NA Number of Commercial Units NA Estimated flow (average)* gal/day Design flow (peak), estimated x 1.5* gal/day Soli Application Rate al/day InfluentJEffluent Quality (NAp) Monthly Average** Fats. Oil & Grease (FOG) < 30 mg/L Biochemical Oxygen Demand (BODs) ~ 220 mg/L Total Suspended Solids (TSS) < 250 mg/L Pretreated Effluent Quality ^ Monthly Average*** Biochemical Oxygen Demand (BODs) 30 m Total Suspended Solids (TSS) Fecal Coliform (geometric mean) <10+cfu/1 Oml Maximum Effluent Particle Size 1/8 inch diameter * Wastewater Flow Verification on and calculations: (Other than bedroom based) ** Values typical for domestic (non-commercial wastewater and septic tank effluent. ***Values typical for pretreated wastewater. SYSTEM SPECIFICATIONS Septic Tank Capacity gaI ^ NA Septic Tank Manufacturer `~~ ^ NA Effluent Filter Manufacturer ~~ .e, ^ NA Effluent Filter Model ^ NA Pump Tank Capacity gal ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ^ NA Pretreatment Unit A p Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer: Model: Dispersal Cell(s) ^ In-ground (gravity) ~ ressurized) ^ At-grade (Mound ^ Drip-line p Leaching Chamber Manufacturer Model Approval Stipulatio n Soil Application Rate"gpd/fit Area Req. Absorption Area Credit per unit ft Minimum Number of Chambers p Aggregate Design Flow/Loading Rate= min Materials: all materials must comply with WI Adm. Code COMM84 and be installed per manufacturers specifications and approval letters. DESIGN CRITERIA ^ "Wisconsin At-grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.a1.1990) ~."Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 p ."Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publications 9.6 ^ "Design of Conventional Soil Absorption Trenches and Beds". RJ. Otis - ASAE Publications 5-77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems". EPA 625/1-80-012 October 1980 ^ SBD -10570-P (R.6/99) "At-Grade Component Manual Using Pressure Distribution" p SBD -10567 P (8.6/99) "In Ground Absorption Component Manual" ^SBD -10705-P (N.OI/Ol) "In Ground Soil Absorption Component Manual" Version 2.0 ^ SBD -10628-P (N.6/99) "Recirculating Sand Filter System Component Mauual" p SBD -10656-P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ^ SBD • 10572 P (8.6/99). "Mound Component Manual" 'SBD -10691 P {N.O1/O1) "Mound Component Manual" Version 2.0 SBD -:1OS95-P (R6/99) "Single Pass Sand Filter Component Manual" ^ SBD. -10657 P (8.6/99) "Drip-line Effluent Disposal Component Manual" ^ SBD - 10573 P (R 6/99) "Pressure Distribution Component Manual" ~C~SBD • 10706-P (N.O1/Ol) "Pressure Distribution Component Manual" Version 2.0 ^ Drip-line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ^ months yeaz(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (1/3) of tank volume Inspect dispersal cell(s) At least once every ^ months year(s) (Maximum 3 yrs.) Clean effluent filter Atleast once every p months year(s) .inspect pump, pump controls & alarm At least once every ^ months year(s) p NA Flush laterals and pressure test At least once every p months year(s) p NA Valves At least once every O months p year(s) NA Other: At least once every p months •:p year(s) - NA Page~ot .~ S']l ART Ulf For nc:vv 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. System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property. owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation ofwater-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other cleaz water treatment devices and foundation drains should be dischazged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fiuit peels and seeds, bones, and food solids such as those produced by a gazbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette busts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. Valves ~' Valves shall be operated in the following manner: (Alarms ~/ Alarms should be tested on a regulaz basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. INFECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). [~(~eptic Tanks Component // __ Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one-third (I/3) or more ofthe tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. `~ pump Chamber/'Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hazdware and the condition of the filter. .Any service needs or repairs shall be promptly taken care of. ^ In Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. ~ / 2 Page y of .J ^ Ivi2und, At-Grade, h1-Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or dischazge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. Y2EPORT5 Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Coda ABANDONMENT When the POWT$ fails and/or is permanently taken out of service the following steps shall be taken to ensure 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 properly 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 other 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 maybe 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 azea will result in the need for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the replacement azea 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 azea 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. L7 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 azea is available a holding tank maybe installed as aeast resort to replace the failed POWTS. L~, 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 CONTIAN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEAT$ MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR 11lZPOSS]d3LE. ADDITIONAL COMMENTS I'O'VVTS STALLE POWTS MAINTAINER Name 0 Name Phone -] l,S'- Z 3 ~ !/ 3 ~- Phone SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name Agency Phone Phone ~( ~J K:\WPDATA\EH\POWTS OWNER'S MANUAL.doc Page~of~ T t`R++i~ ~'~~:: ~t~ JN'T'i' S11?Trt~ TF~NK Iv1AII~dTEN;~N~E ?LGREE~I~lT :;.i~L~ OWNElh:ai-?IP CEl:T1~ICATION FORI~1 U ~ I ._lt~41 .~~1_~ r i ~~ _ ~~I ~~~ wl 540 l ~o - ~ ~ (~Icrificatiou required iiom Planning Deparancnt wr new construction) °i u:`~tar~ _rlQ~~/1/~ll~ . ~~.~" Parcel ldentizicacion Number O/ ~' ~D~ ~~ ~9 eg~ _~ . ~33~ _ ran __ +'ul~+uLt~ .~-il7C::llli~ii ~~ Slty ~_ !li? ~Gl:. ~~ , 1 ~~___~~i-K ~~Y', L'Owll JI r y l ,__~~~' ~ _ro _ 1.OL m`~ ,,, ..ti ' 1«.lul~. ~ lit/ ~~~ ~ui4d ~~ruey ~;t.~~ # Vuhune ,Page # ~:~~.~:.~~.~ ~~~~. # ~ ~0 ~ 7 ~ Volume ~ Page # ~~' ~-.- ~,s~t~ ~1;3~ir ^ ~f~S ,~27fl Lot lines identifiable J~'yes ^ no 3zxnpxoper use and waiutenance of your Septic syst~ m could result in its premature failure to handle wastes. Proper maili rc~~:~ ~_ .~u',:>,tSta i>f'pitnapiug t~tlt the septic tank every three years or soomer, ii' needed by a licensed pumper. What you put into tug s V~:ci._ .::.i: ufrcs:t the futzaticu of the septic tank as a treatm~ut srago in the waste disposal system. Tits praprxt~f owner Agnes to submit to St. C.`,roix Zoning Department a certification form, signed by the owner :.:.~. b~, .utistitrpluznber,}QUrneymanplumber, restrictedplurnbcr or a licetuedpumper verifying that (1) the on site wastewaterdisposa! ,y ~;;~_:. as iu proper opctatiug condition aadlor (2} after inspection and pumping (if accessary), the septic tank is less than 1/3 full oz ~! ~:~+.> ~`t~, ~e ttridetsi~uedhaye read the above requiremeuu and agree to maizttain the private sewage disposal system with the 5~~_ nci; ii~r~t, herein, xts sei:by the Department of Commerce and the Department of Natural Resources, Siaie of Wisconsin. Cert_ii~ stio;__ to ~ that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office uric. ~_ i; •3:a~y~a'f three year axpiratiou date. f r `~ ~1~l~AT t~F APPLICANT DATE ~`~~~c ~~t~.`~~`~~~~CA'TI~N I (ve} cer#ify [hat all statements on this form are true to the best of my (our) lo~owledga. T (we) am (are) the U~Yncri~s) ~i u~~ ap y ~ ~b above, by virtue of a warranty deed recurdcd in Re inter of Deeds Qffice. . ~' `S ~31..3D1.~-Sr- Cil~tA ' LIC1sNT DATE ~"'"~"~"'' Azty iaatormation that is min-represented may result in the sanitary permit being ravokad by the Zoning Depar[tncni. "t4'"' " ~'°` siclur2e ih this upplicatiou: a stamped warranty deed 1TOnz the Register of Deeds o$ice a cagy of the certined stttvey map if reference is made in the warranty deed r t ~~zo~~ Wisrxxgs~rf Department of Commerce SOIL EVALUATION REPORT - Page / of 3 division of Safety and i3uildings county ~. C a Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must . r include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. v ~~/ Q~ ~~ l4 9 t7 ~ l~~~ Please print all information. Re ewes y Date ~ Personal information you provide may Ge used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 2~ Property Owner Property Location R~ '~ Govt. Lot 1/4 ~ 1/4 S 3Q T Z ~ N R (~ E (or) Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1 53 ~ee ~- f0 ~n-~e~-c~ r~s City State Zip Code Phone Number ~-4 R Old (~~) 549-(0731 ^ Ciry ^ Village ['Town Nearest Road /{a -~ ~.~ I s~ ~- s~ New Construction Use: ® Residential / Number of bedrooms ~~ Code derived design flow rate G ~s D °~ GPD ^ Replacement ^ Public or commercial -Describe: /~' Parent material ____~~ ,~~ _ Flood Plain elevation if applicable - /I ft. General comments !~ -e%( 0 ~,y,%, and recommendations: sY ~1~~ p~~ O~ ~ ~rl~ih~ ~~~h-,' ,"- `~'~.,~~Q `~.~!,z~ Coo ~ ~ ~ ~'' ` / ~ ,~~1NT~ C~n.f ~ 1 , ~?~~~~ ~ `~ l °~ ~ © ~~ 1 ~~ Boring # ^ Boring ~ ~ ~~,~yG ~~~G~ `" ~,: ®Pit Ground surface elev. ~ Q ft. Depth to limiting factor Z ~~°~ Z~.~~F So'f tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bou ry ~ Roots , .:, PD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. '--`~- Eff#1 *Eff#2 1 v-8" l0 3/2 - Sal 2n-, cs Iv-~ ~5 .~ 2 ~Z~ 16 yl 3 -" Si ~1 2mS~ r c - C,o d. Boring # I^I~AA Boring -7 6L1 pit Ground surface elev.~Ti ~ t. Depth to IimiGng factor ~~O 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 b- I/ / ~3 2 --- s i t ~ rY~i-r C ,~ f v . rJ 2 Il-Z~ l y l --~ 5 i ~-! Z r ~ - • y -~ 3 /o r-4/~ - SL m }~~ i ~ - 5 . 9 ~ ~ o ~l F 7. ~ l3 s~ msbk ~ - _ . 9 cnwern tr ~ = rsw5 ~ 3u ~ tzu mgi~ ana i s~ >su _< i 5U mgii_ "Effluent #2 =GODS < 30 mglL and TSS < 30 mg/L CST Name (Please Print) Si ature CST Number . - __ - da humaker --= _-_ - 2s33a9 Address Date Evaluation Conducted Telephone Number 2113 ~(j~ ~. ~mer5i°->~', Cyl ~~to Z 5 ~ Z-~~_a ~ <~is)zy~- yoo~ • ! 3 Property Owner S•UU~ Parcet ID # Page 2- of 3 a Boring # r^~ Boring ~~ii o L'/ 1%r Pit Ground surface elev. 7~ ~~! Q_ ft. Depth to limiting factor ~TID 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 Z ~p ~ 10 r `-~-~3 S r'cl k m r ~ ~ 4 -~ 3 i~.~ ~ / ~ ~ - • 5 .9 ^ 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. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#i "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/ftz in. Munseii Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 " Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 my/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. SBD-8330 (R.Ot/00) PAGE~OF~ LiTA_ME ~ TC3t..1 ~ LOT#Z(o LEGAL DESCRIPTION i(1 ~ e4.SaJ i4 ,S ~ T Z`C ,N,R, ! ~E(or~ SCALE: I"= BM I ELEVATION ~Gb . d BM 1 DESCRIPTION ~-~o ~ Q_~ G BM 2 ELEVATION Q `~ . y0 BM 2 DESCRIPTION '~~ p~. I ~~ ~yr 5 P~• 3 ~ SYSTEM ELEVATION q~ g c' I SYSTEM TYPE i'Yl a~ ncQ S U. S~~ `-'~ + ~ CONTOUR EI.EVATIC+N ~q~ o d I ~ r~ q~ ° q9. 0 '~~.6 ... i i _ ~ ~ - ~ -~- I I ~ a~1- i i I ~ I ~ ~ 1 ~ ! 1 ~ ~ ~ I i \/ i Y ~ ~ ~~ / ~ i ~ ~ i ~ , ~ ~ ~~ r03: ~~ X 1047.4 i.00 (4.7 ire' \ ~r .r ~- O? i ro~4 ~ ~ 1 ~ °N 1 2 ~Y ~ ° 1 5.00 ACRES ~ ~ ~' ~° 1 ~ (3.4 ACRES) ~ ~, ~ ~. G 1 H~uv.~. _ ~ o2z.oo . ~1 1 C.. ~ , ~ Q1 m ~ , MIN F = 1024.00 p ~ ~ 1 = O 1 1 ~~~ ~G G ~ ~ , ~ 1 ~ 1 ~ ~ 1 1 1 1 51 T ~ _INE,.~Ot~ THE NE1 /4 OF~'HE~ SW1 /4 ~ ' 0 i / i ~~ ~ i ~ i~ ~ ~ ~+ . ~_i V 5. O ACRES . (.9 ACRES) M FFE = 1024 159' +, N' .. Private On-Site Wastewater Treatment System (POWYS) Index & Title Sheet Owner: Project Name and System Type: ~ ~O t l,~ir b.~.~ IP"®[~ 1'Y^1 t~Nl ~ LUiI~ Location: ~ ~ ~~ ~~~ ~~~ Street Address ~ '/ ~ , ~~f~~ c~3~~ ~ t~ ~, ~ 'l ln) L gal Description j _n Yl(1 I(YYl tYl ~ ® ~~ ~ ~ ~~ f Contents: Page 1: Sanitary Permit Application Page 2: Plot Plan Page 3: Soil Test Page 4: State Approved Plans Page 5: Septic Tank Maintenance Agreement Page 6: Warran Deed Page 7: POWYS Owner's Manual Management Plan Page 8: POWYS Owner's Manual Management Plan Page 9: POWYS Owner's Manual Management Plan Page 10: Certified Survey Map Page 11: Copy of House Plans Attachments: Plumber/Designer: Mike Rogers Signed: , ~-~ ~ y Credential Number: 225094 Date:J ~ a. ~~ ~S t U _ 2626 P 25y ~• STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED Document Number RICHA DeeO.nSTOUTe an JANET P. STOUT, _ _ __ husband and wife, -- --- - - - ._._ Grantor, and __ JOHN J. SPITZMUELLER and KAY D~_ _ _ ____ SPITZMUELLER~ husband and wife, _ -_-- _ --------- _ _ Grantee. Grantor, for a valuable consideration. conveys and warrants to Grantee the following described real estate in St, Croix ___ County, State of Wisconsin: Parcel 1: Lot 26, Plat of Emerald Acres in the. Town of Hammond, St. Croix County, WI_ and Parcel. 2: Together with an easement for joint driveway purposes for the benefit of Lots 26 and 27, Plat of Emerald Acres in the Town o£ Hammond, St.Croix County, WISCOnsin This corrective warranty deed is being recorded to correct the legal description as shown in warranty deed recorded 04-14-2004 in Vbl_ 2548, page 432 as Doc_ No. 759624. ~7~Im~~ KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROZK CO., MI RECEZVED FOR RECORD 07/28/2004 03:15P![ MARRANTY DEED EXEIPT i 3 RfiC FEE: 11.00 TRAIiS Ffifi: COPY FEE: CC Ffifi: PAGES: 1 Namge~and Return Adtlress ~ 3s3 /~w aI~ ~ ~ - 018-1098-26-000 Parcel Identification Number (PIN) This iS nOthontestead property (is) (is not) Exceptlonslowarranties: easements, restrictions, rights-of-way and covenants of record. 23rd day of July Da ted th ts 200 4 ( ~ _ n ,~ ' ~y. ~-~t ~ ~U ~ ~~A~ ~~~~ /J~ / .ff'C ~ (" JI(/i/t l ~~ ~'Z~ . .. - ~ . , u .t (SEAL) --- (SEAL) Richard 0. Stout Janet P. Stout (SEAL) _____ (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Slate of Wisconsin, St. Croix ss. county. .authenticated this day of Personally came before me this 23rd day of J u 1 y i h d ,the above named d __ R c ar O_ Stout Stout an Janet P_ __ TITLE: MEMBER STATE BAR OF WISCONSIN _- _ to (If not, me known to be the person S who executed the foregoing authorized by §706.06. Wis. Stets.) Pamela A. Wiilman jn5tn,tn~nt and acknowledge the same . Notar•l, c-•„(~iic n_ ~ ` / // / l TliiS INSTRUMENT WAS DRAFTED BY _!~.. r't a~ __~ - R_ mX r State ofvv~consin ~,rA,- -~------- Janet P. Stout 1353 AWatukee Tr. /~ - ~t'or...,• l.. ,L~ ~.J~tl. ,_,~,,. _____~_ HudSOn, WI 5401 6 Notary Public. State of Wisconsin ' _ My commission is permanent. (If not. state expiration dale: (Signatures may be authentcated or acknowledged. Both are not e2 r[-.L''Q ~^______ ___ ___,) necessary.} • Names of persons stgning in any capacriy muu be typed or p rinted below [heft sfgna[ure. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1998 wrscons;n Logal glans Co., Inc. Milwaukee, was. N ~o~ \ ~ Do N I W w `~ ~~ \ ~ A ~ i pw ~ ~~ \ \ ~N \ N ~ I-- -- -~ ~ ° \' \ I y 9£~OZoLOS ' I 0- ~6q'L817 3~~ I w ~~.~--~ W ~ ~ _ ~ ( ,s a \ \ eN I \ \mc N __ _J ti3~o ' n o v D .-"' r. N ~ ~,.. A ~ ~~. ~~~ W ~ ~ `~. O' r Z 9L-, .. i ` .. yoZ4N 7 ~' A w ~ NM~l .,~ w yW Qd~a . _ ~, ,o~ ~, .. 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