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HomeMy WebLinkAbout018-2011-84-000VVisrpnsin Department of Commerce PRIVATE SEWAGE SYSTEM L Saf t~~and Btfilding Division , INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes IPrivacv Law, s.15.04 (1)(m)1. Permit Holder's Name: City Village X Township Bast, Merle Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~~`~ f- lZs6 Dosing CDr~~b .7Cb J Fr'lon ZatOtX~ 1~" r Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ sb r 1/~ 7 J~ ~ ~ ~ / 7 ,_ Dosing '7 ~Q r ~ ~ cc ~~ 7 aJ~ C ~ c~~ r Aeration Holding PUMP/SIPHON INFORMATION r1 ~ Manufacturer i ~d C.1 ~ G~ Demand GPM Model Number ~ „ I Q ~ ,~„~ Q 7 ~ TDH Lift ~/ ~ Frictiog Loss ~ (~ ~ Sy stem He d ~ ~Ft TDF) / . Forcemain Leng~t, _ Dia. Z , ~ Dist. to weu SOII ARSnRPTI~N SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No. 463459 0 State Plan ID No: Parcel Tax No: 018-2011-84-000 Section/Town/Range/Map No: 30.29.17.1099 STATION BS HI ~b ~ ', FS ELEV. Benchmark ~ _ ~ ~ ' Alt. BM ( o ~~~. ,~. ~ ~ Z .7~ /r 5 Bldg. Sewer St/Ht Inlet Id.g$ 97.72 SUHt Outlet ~ ~_ Dt inlet ~ -~' Dt Bottom I~.tyS ti3. ~5 Header/Man. .3. ~ ~ds Dist. Pipe 3. a ia$, Bot. System ~' ~ /f~ u r Final Grade Z. c~ ra . it St Cover ~. `~ ~' ~ ~ z . L' 7 ~o,r.~-ov f ~ ~.S /~~/ BED/TRENCH Width r Length No. Of Trenc es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ]~ ~ ~~ w (,Z ~~vv "'~-- -• ~! ~\ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of S stem: ; 5r / ~ UNIT Model Number: ~ ~ ~ 7 ~ ~ 1 I~ICTRIRIITICIN SYSTEM Header/Manifold Distribution ~+ %/ Pi x Hole Size 31 ~ x Hole Spacing ~ Ven o Air IntakG~ ~ i pe(s) q acin \ th !~ Di ~ S L J Z 3 L V .~ a Length D p g eng a Cnll f'C1VFR ., o~o«...e c..~re.,,~ n.,i.. ,.,. Mnnnrl nr ~f_(;rade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center / r Q r ~/ Bed/Trench Edges ~ Topsoil 1 A ` , Yes No .aC 7es No L ~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~O /~~/ OS Location: 1511 78th Street H mmond, WI 54015 (NW 1/4 NW 1/4 30 T29N R17W) Emerald Acres 1st Add Lot 8 F;~ 1 ~-- Co ~r-ems-- ~J ~ ~r ~ ~ox 1.) Alt BM Description = / 2.) Bldg sewer length = 8 S -amount of cover = - I j Plan revision Required? Yes ~No Use other side for additional information. SBD-6710 (R.3/97) ~~ ~'~ D~_ _ _. Date ' ~~ Inspection #2: / /_ Parcel No: 30.29.17.1099 _ _ t~; 345 __ Cert. No. Safety and Buildings Division County // C 201 W. Washington Ave., P.O. Box 7162 T ,S~O~S~~ Madison, WI 53707 - 7162 Sanitary Permit Number (to be Slled in by Co.) (608 Department of Commerce Sanitary Permit A a ' n s Plan l.D. Number _~s J D~ pe al i Code 21 Wis Adm In accord with Comm 83 n u e , , . . . may be used for secondary purposes Privacy La 1 O 9 2005 l~i ect Address (if different than mailing address) I. Application Information -Please Print All Information NT NIN O Y ~ ~S / ~ ~~ S~{'. FFICE G Property Owner's Name ~ Parcel # Lot # Block # .-- Property Owner's Mailing Address Property Location (~c.,~ ~~ ~1.,+, Section City, State ~1 qq ~~ ~~ ~~ ~~ Gr,C.t/ '(r/~"~/tN ~~ Zip(7C~ode ~G ~ ~ Phone Number ~1 f~ T / ~iN, ]i~ / ircli W _^ ) ppl-S k il th t l h ildi f B ec a a app y ng (c e o u 1 S CSM Number Subdivision Na m c /`- ' '` 2 Family Dwelling -Number of Bedrooms • ~ ~ ~ ~ ~ ' ~ ~~/ ibe U ial D ^ /~ ~~t!~E~-~ f,- - escr se PubliclCommerc ^ State Owned -Describe Use 1 ^City ^Villag ship of --~ ` l ~%WZ/ III. Type of Permit: (Check only one box on tine A. Complete line B if applicable) ~ 8'. ZD // - - ~O /~ A. New System ^ 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 Owner IV. T e of POWTS S stem: (Check all that a I ) ^ Non-Pressurized ln-Ground ^ Mound ? 24 in. of suitable soil ^ Mound < 24 in. of sortable soil t- ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber Drip Line Gravel-less Pipe Other {explain) V. Dis etsaUTreatment Area Information: a 8[1 Design Flow (gpd) Design Soii Application Rate(gpdsf) Dispersal Area Required (sf) Dispe Area. Proposed (sf) System Elevation ~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Concrete Site Constructed Steel Fiber Glass Plastic Gallons Gallons of Units New Existing Tanks Tanks Septic or Holding Tank Zs Aerobic Treatmem Unit Dos;ng chamber ` ~ 6~ VII. Responsibility Statement- I, the nndersigne ume responsibility for installation of the POWTS shown on the attached plans. Plumb is ame (Print) , ~ Plumber' ore MPMIPRS Nutnbrr ~~ ~~ Business Phone Number ~~ y~~~ - f~ ~~ Plumber's Address (Street, City, State, Zi/p / ' ~h ~r VIII. Coon 1De artment Use Onl Approved rsapproved Sanitary Permit Fee ( lodes Groundwater e F e) S h r Date Issued Issuing t Signature Stamps) " ~ ~ urc g e a P' ~ ven Reason for al IX. Conditions pprova SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances, Athach complete plans (to the County onty) for the system on paper nor rasa wan ai~i x a ~ mcnex ,n s~zc SBD-6398 (R. 01/03) PLOT PLAN erle Bast ADDRESS 3005 Damon St. Eau Claire Wi 54701 ~4 NW 1/4s 30 /T 29 N/R 17 w TowN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 104.0' 4 BEDROOM CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 600 # 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 Pro Town Road to 150th St. Well is to meet all setbacks found in Comm. 83 Property Line Tank is to be properly bedded and provided with lockdown covers with approved warning labels Grading is to be done to divert run-off away from system M. #1 Pro 4 Bedroom House B~3 Huffcutt Combo tank Scale = 1 /4" = 10' Property Line B'- 2 B.M. #2 4% Slope Area 15' below system is to remain undisturbed Property Line ,, CppY 104.5' 104' 102.5' 103.5' commerce.wi.go~ i ~ ^ ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. co mmerce.wi. gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary May 06, 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: 05/06/2007 SITE: Merle Bast 150TH St Town of Hammond St Croix County NWI/4, NW1/4, 530, T29N, R17W Lot: 84, Subdivision: Emerald Acres Identification Numbers Transaction ID No. 1134118 Site ID No. 698013 Please refer to both- identification numbers, above, in all cones ondence with the. a enc . FOR: Description: Four Bedroom At-Grade System Object Type: POWTS Component Manual Regulated Object ID No.: 1016891 Maintenance required; 600 GPD Flow rate; 45 in Soil minimum depth to limiting factor from original grade; System: At-grade Component Manual, SBD-10570-P (R.6/99); 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: Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "At- grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD- 10570-P (R.6/99) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST_SAS (01/81) • St. Croix County conducted an on-site on 5/06/05 to verify the configuration of the slopes. Pam Quinn indicated by phone conversation that her on-site indicates the slopes in the At-Grade site are not concave. The slopes as depicted on the soil test are not correct. • 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. (,'i Z /~AR NC ~l ~' SEE C • 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 SHAUN R BIRD Page 2 5/6/2005 • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7 A copy of the approved plans, specifications and this letter shall be on-site durine 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, .~ 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. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 RE~Et1~,R® APR 2 ,g 2005 SAFELY tk ~UrrUlrlt(.;;4 Date: 4/25/05 Owner:Merle Bast Location:NW1/4 NW1l4 S30 T29 N,R17W Lot 84 Emerald Acres Hammond System type: At-Grade Manuals Used: At-Grade Component Manual version 1.0 SBD 10570-P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01 /81) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross SectionlPipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil Shaun Biro Signature License n~ ~ifi~~rn'y ~~ ~~~ ,ar of con~~ERC~ +Frs N. ~~j~cs RESP ~ ~~- ON~7EN ' PLOT PLAN PROJEC ~' ,Merle Best ADDRESS 3005 Damon St. Eau Claire Wi 54701 NW 1/4 NW 1/4S 30 /T 29 N/R 17 w TOwN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 104.0' 4 BEDROOM CONVENTIONAL AT-GRADE ~XX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE •6 ABSORPTION AREA 600 # 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 ~- Pro Town Road to 150th St. Well is to meet all setbacks found in Comm. 83 Property Line Tank is to be properly bedded and provided with lockdown covers with approved warning labels Grading is to be done to divert run-off away from system B.M. #1 Pro 4 Bedroom House B-3 Huffcutt Combo tank B-2 B.M. #2 4% Slope Scale = 1 /4" = 10' Property Line Area 15' below system is B -1 104.5' to remain undisturbed 104' Property Line 102.5' 103.5' i 5' W ~, 5, ~ rJr ~ B ! PYC FaAGEMA~ W .,~ ,.. Z r ~. ~ ~~ - _ t- ~csrtit ~~.1Ttor~i tat~riwe. --f A ~STAgilt ~£D o$£~~`~hTtBnt WEtL ~ ~- ~0 } i/68 ~ ~ 1/66 I/28 R = ~- ~~- B - L~? .,. ~~. vJ = Z Z Ft ~tPQRa~t~a SYU~rt~.~c. Fobr~c ST~B«.i~~b ~bserva#~on-----,.~ 1t~ie i i ~ ~`\. j/ f j > ~E CELL of 1L"' Z%Z AC=G+~EGA~~E Dis~'ribuirion La#eral Sosl Cover v r~ i~ a `. ~ ~~. ~ ,~( ~y1~ T S.bV11E~ ~A~EK. A -2t ~ ?5' ~a S~o~~ Plan Viev and Cross Section of Wisconsin At-grade Unit with a Single Absarptian Area an a Sloping Site ~ibt~4TURE.: 1.1t£ri5~.#~ Page Of Distribution Pipe Detail for Lateral {~etworlc ,. * Last #iole Sf~vuld Be Next To TURN- uP ~~TuRa1-csP~~ ~CLLR~ouT~ PYC force Main ,`"~'~ ~- PYC Distribution Pipe :~ ~ p ~Cce s~ ~Q r--~ P ~~ Ft. Hole Dfa~neter ~~3o~Inch X ~-'~I Inches Lateral Diameter ~-- .Inch{eS} Y ~ `i Inches Force Main Diameter Z'"' inches ~ of Hn1 es/Pipe Invert Elevation Cif Laterals l~ ft. Signed; License Number: Date: ~- MBER CROSS SECTjCN AND SP£CZtICATIONS S£PTZC 'fAN1C ~ *~3MP Ct~~ yFEq~RPR4E~F u== G~ ~Ei3T PZPE i2" MIN - ABODE GRADE ~ Ji1HCTTflt~ .BOX APPROVED v R N ~' .`~~f ~RO~i DOflRa 4dINI70i~ t2R WITS Cf3ATBLIIT £ FADLO~K W% FttEa~x SIR Ii~tTAifE ~P~r21~ ~ ~ ~TARtiING i.ABEL Y l ~~ i8tt iN_ - - ~ ~ ~ a _ = a INLET ~ ~~ ~ 4 wAT£R TIGHT SEALS ~ GAS- + , ~ ~T sE ' ~ ~EIOiITIi ~iLTi:R, _"'~' ~ i A _ ALM D isIPE VE /IPPRO _,,, $ ~ - ; ~ N ~ D St3t.IQ SOIL ApQ~ttlStED `~ t . PIKE 3` per} SQt.IO / 9~ 5 FT , C --~--- ~ FF SEtIL ~##~fP flF'F ELF ~ // ----- B ~ u APPROV ED BEDDING UNDER TAN /~ CpNC$ETE pAfl Sp£CIf I.CATZ QN5 ~i'f9ER DpSES ?£R DAY: ,_~--- - sE~c j DasE ~Lc.~~~~L~ TANK ~~ppsCT{,{RER : ~~ ? . GAL - .~ Sr GAi . I>fl5E `~ {3 ~ ME fI'NLt~~C~ ~.r.~---, . ~ . TANK SIZES : SEPTiCt~,~ ~i,. ` _ ~` .i'~ZriCHES = GAL D~DS£ S CAPACITi I FS = A g c ~_ INCHES = ~ GAL• AyL~-~ 2~SAi~FAC1S3ItER,• ~+~ .."'~` MODEL NU~fSER = /~c(o~. ~ ~ ~.~ ~L. ~ZTCS gaypE: C ~i,>''I~CHES = ,~--- t' ~l ~ ~ ~N~cKES = ~~ 3 c~~-- piJt'SP ~N{JFACTi3RER s IT - MODEL ~~~ = ~ Z ~-c~ P'£R I LHR 16-23 SAC ~;TCH ~ - p-i?fP E AL~ftRl'"~ i~tIRING ~ /~ _~ ~',P1L i FEET RE~yg~ DISCHARGE RATE ISLITZON PIP£ `J ~FEE'F EEN PUH~' OFF ANB DI STR _ _ _ 7 U FEET VERTICAL DIFFERENCE HET - •£gICTIbN FACTOR FEET + MIp~JM N£~pRK SBppLY PRESSU F.F11i~ i3 F~fl`I'1SiL O~NiC MEAD { ~_ F~£T FOR~EHA--IN ~ ~ DIAHET£R ---- ~, „f - WiaTH~,.,~ pUr'ir~ TA1~I1C : #,,EI3G2i~ •1~,~ t~1Qi3II~ ~~+ Ii~'I£Rt~AL OIMENgYOt~~ ~~ SIGNED : _ ____---.~---- ~~•r~ 1188 T07AL DYN~nIC r.EAD/CAPACITY P: K MIfdUTE EFFLUENT t:ND DEPrATERING W U a 'a 0 p 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 for outdoor installations. See FM1420. • Over 130°F. {54°C.j special quotation required. 152!953 aeries 1 153 9CODEl.S ~ Con of Selection INodel ~ Volts-Ph EAode Am I Sim lex I Du Iex Nt52 t15 1 Non 8.5 t 2or3 BN152 115 1 Auto 8.5 Induded 2 or 3 E152 230 t Non 4.3 1 2 or 3 BE752 23(l 1 Auto ~ 4.3 Included 2 or 3 N153 1t5 1 Non 10.5 t 2 or 3 BN153 115 1 Auto 10.5 Induded 2 or 3 Et53 2~ 1 Non 5.3 t Zor3 BE153 230 1 Auto 5.3 Included 2 or 3 o caunoN All installation of controls, protection devices and wiring should be done by a qualified licensed electrician. AU electrical and safety codes should be followed including the most. recent National Electric Code (NFC) and the Occupational Safety and Health Act (OSHA). MODES I ~15_ ' ~~ 1 ~-' Feat ~ Mzters Gai. Liters Gol. Liters g 1.5 69 ~ 251 77 291 1p 3.1 Et 23t 70 i 265 t; 4.6 ~ 53 ?01 I 61 231 2~ -, 6.1 -- ' ~4 i57 52 ?97 25 7.6 34 129 42 159 I S~ g.1 :3 87 33 ~ 125 ~j ip.7 i ~ -- I --- 22 f3J 40 11 Z.? I -- -- 1 1 i 42 I Lock VOlvc: 36.0 ".. (t 1.6m) 44.0 rt. (t3.4m) 3 2'r 1 .3 t/3 I ~_ SELECTION GU1DE 32 ;2 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 2. Sae FM0712 for correct model of Electrical Aitemator E-Pak 3. Variable level control switch 10-0225 used as a control activator specify duplex (3) or (4) float system. RESERVE P0~'ERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. d>~uc ro: P.o. eox 16347 ~O SHIPT ~ 3o44CaneRU Road ~~~~~~~ ® Louisville, xy 302tt-ass, Qva~rrPrct~vs SNCf /939° * ~~/Y!~ ID. (502) 778-2731.1(800) e2e-PUMP kttp://wwwsoe/lef com FAX (502J 774-3624 © Copyright 2000 Zoeller Co. All rights resented. U uu ..... _._ -_ - . ~ t , ~ T P~.AN ..~ 01NNER'S MANUAL $~ MAKA~EMEN QOWTS sYSTEM SPECll=1CA'i'taNS of Bedn~ts Number ~ Gomm~i nits ~ liotilr (avefa9e) p~nfiawtt~~ (Esiyrnated x 1-5) son ~-PP~~" ~~ tnlfuent~tit~ QuaTrtY Fats,.0~ ~ Grease (FOG) 8iochemicai Oxygen Demand (l300~} Total SusPet1~ Sottds {TSS) P ~ttuent Quality B'loch~ical OxY9~ Demand (SOD:) Total Suspended Solids ~~} Fecal Cotifonm (geometric Maximum Effluent Particle Size Service Event inspect condition of tank(s) Pump out contents of tank(s) tnsped dlsPersai rail(s) C(ean effluent fi-ter tnsped pump, PuanP COntrois 8 alarm Plush laterals and pressure test Monthly average' s30 In9n- Q20 mgJl. Monthly avera9e« ~i0 mgn- 530 mg/L 51 D` cfut100mt y inchdiameter Septic Tank Gal~`~ Septic Tank Man~'~ Effluent 1~itter Mancr<ia~~ Effluent l=titer Model Pump-TanK CapatztY pump TanK M2tnufacturer .Pump M~~ Pump Model _ Service Frequency D months ear(s) (Maxtrnum 3 yrs.} v ~n~~~`~~ Cl Peat Fitter p Mechanical Aeration ^ Wetland ^ ether. ^ Disinfecdion At feast once every uals one-third (!i) of tank volume When combined sludge and scum e=4 .~.A year(s) (Maximum 3 yrs.) At least once every At feast once every At least once every ,0.t feast once every At least once every At least Once every Page ~ ~g~ /J O~ ~q ^ NA IVA l1 NA p NA D NA fl NA O NA' ^ NA O NA ------- t7 NA p monms ~~-~-~ ^ year(s) O IVA p months p months ^ Yom', s}_~ ~ v~ n one of ttie foitowin9 tioenses or INAIP[TENAN~ 1NS'iRUCT10N5 lls shall be made by an individual carrYl g «~r: POWrs ~n~rne~ Sep>~Je of tanks and ~persal ~ plumber Restricted Sealer POs tnspe miming or broken tnspec~ons Plumber: Master K s to tdenffy any for any backup (dons: Masher ns must include a visual inspection of g U ~a d ~m and to chi ~t ~~ SeNidn9 pp~ator. Ta"k inspecr;o ure the volume of combined dg 1n check the etfl hard~• kien~ ~Y ~~ or teaks, ~~ The dispersal cell(s) shall bs visua[lY lnspe~ ~~g ~ effluent on the or ponding Of effittent on the ground surface- nding of effluent on the ground surface- T~ po sn,,,tf„orihr- i and to check for any po uires the immediate notification of the loc~f r'egutaoory in the observation p ~ oond'rtion and req or more Of the tank volume. the ground surface may indicate a farTing uals one-thitti (~ s~ ~ in axo~ance wrth ch• NR mutation of sludge and scum in any tank eq erator and dispo When the combined aocu moYed by a Septage Servicing Op . entire contents of the tank shall be re - t nt components: and any 113, W>goonsln Administrative Code. ~ onents, prey ~ POYItTS Niaintainer- mechanicai or pressurized POWYS comp rformed by a The selvlt:ing of efllueni filters, of compieetion of arty service e'Jent. other maintenance or monitoring at intervals of ~ 2 months or Less shat[ be p? . sha(i~be provided to the local regulatory authority witfiin 1Q days q Serviinte report nti u~ or other pOVYTS check treatment tank(s~ for the Presence of poi n9 ~~~ are START UP AND OPERATION areal cell(s). if high conCen For new ppns>zuction. prior t° use of the s and/or damage the disp ~ e the treatme5 ter ~ ~ a septage servicing operator Prior to use- chemicals that may • >~ dt'.t~ed have the contents of the tan ( ? Dish cell(s) - ^ ln~round (pressurQed) ^ I~.ground (9m~) p Mound ~~ tJn~rade p p~er_ p ine - ICaI for domestic (ao~~"^e`~ tirastsr~iJer end values typ SdPf~ ~KTcaE far A~treated „ys~ter. -.• Values typ __ / . --- ,~ Page ~~~ !" ~`+ ' •~-1-conditions are frozen at the infiltrative su~face- . System start up tali not occur when is r+P5t0 bove rostra! highwater levels. tr~hen 1 ed the eX02SS resort i a d h ~~ ,,,may ~ a s D~,~ r ocrtaQes Pump cdi{s) in one large dose, overloading the cell() - ~ rrr8! tae discharged ~ tise dispersal t To avoid this situation have me ~n~~ a P(ut~ t e y m n t e k removed by a POVYTS Malt~tainer to ~ n ~garp or surface disd~9e ~ e 0 ~, prior-to-~oriRq poorer tQ the effluent pis p ~ to restore normal levers within the pump tank.. e Serviru19 Pia ~ ta p g ~ p~P ~ assist in mariuaay r'g .. ~. t3o not drive or parfc over ar oihe ~~ and dispersal ~ dsttub or canpact, Do not dritire or park vet ° ~ mound or at-grade soil absorption area thearea ~" i5 feet down slope an7l lm rove the peiforma ma ' p e ~ - oe and prolong the rfie y am er str Reduction or-efrminafion of the follo+~rir'-g fi_rom the wastes+rat arette butts; condoms; cotton swabs: de9ig"~-~: d d " ~: r~l~ bldd g rne; g of the POYYTS: antibio6c:s; vs<lpes: water, fruit and vegetable peelings; gasof n AP) a es; mead :- her i b P P lct {scu - d-~,~- ~ foutidafion dr d~' Pestiades; sanitary napkins; tarrtpons: and wafer ne. r er ~~- medk~ions; oili {sainting pco ABANDO[+I~MENT taKen out of servive the foitawing steps shaft lZ.e Virrsconsin Admin When the POYY'l'S fads andlor is peCmanentlY 33 mm t33 h C m Insure trial the Code , - _ o fiance with c system is pnperty and safety abandoned in comp . AQ piping in tanks and pits shall ~be disconnected and the aband ~ popsre~d o~la SeP~ erl ro d d Servicing Operator. y p an P The mntenfs of air tanks and pits shall be remove a[C tanks and Pits shall be excavated and removed or their covers umping ft and ffie void space , er p • A ~d wdit soft, grand or another inert solid rnateriat CONTINGENCY PLAN measures have been, or must be traken, Provide a code if the POVYfS falls and cannot be repaired the following compliant tepfaoement system: ^ A suitable r,eptacement'area has been evaluated and may be estil¢ed for the location of a eplaoernent soil absorption system_ The replacement a from existingand p oposed structure. (ot Fines ce wei~ls-nFa use to ~ not be infringed upon by repulsed Setbat~cs _ 9 protect the replacement area mil gut ms must comply with tFieirules effect at ti-iat time blisFi a suitable replacement area Replaoernent syste O A suitable replacement area is not oval ~ as a las resort o replace }the faired PO1NTSn advances in POWTS ,~~ology a hotting tank maybe install n failure of POWTS a soil.and li~i~~Si~ -site has not been evaluated to identify a suitable replacement area E1Po t area ;s araitabte a evaluation must be perform to ~~ a suitable replacement area- if no repia~'n hotting tank may be installed as a last resort to replace the failed POWfS- !~] ~~und and at~rade SoII absorPtbn sY~~s may be reoons-tructed in place fo[Jowing re of the biomat at the infiltrative surface. Reconstructions of such systems must comply Willi the rules in a at that time. <drlfARNIN©> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSF~ ANDIO INSUFfIC[EIYT O DO NOT ENTER A SEPTiC, PUMP QR QTHER TREATMENT TANK UNDER ANY G[RCUMST CES. DFATH MAY RESULT. RESCUE OF A PERSON FROiV[ THE INTERIOR OF A TANK MAYBE D[FFICULT O IMPOSSIBLE. ADOmoNAL coMl~tetvrs POWTS INSTALLER POWTS MAINTAINER Name Gc. a ,~.~ Name s ~GL u ~'/ ._. / Phone ~/~ ~ ~~~~' J~l-~ Pharze ']/~ =- ~ 6 - ~-. SEPTAGE SERVICING OPERATOR PUMPS LOCAL REGUIjATORY AUTH01217Y Name ~~,,,~ ~" ~ Agency ,~~`r C' i X- n Phone `mil ~ % ~ ~--5/~a~ Phone ~ J ~ ~ r~ 6 '- mats 7nis aoaxneirtrras dia~tsd try, the stairs of the C,~een ialce, Marquette and Waushara Cot:ntY Zoning and Sartifationagertdes^ Th1s dnatttiefd ore m6+imrurr rogaineriferitt of cr>_ Gomm s3.~2(2)(F,]{f}(dj~{ty and 83-56(1}, {2J 8 (3). Wrsconsin Adrrtirttstrafi+rp Cade- Use of this document does not guarantee the performartae of the PLrfYTS- GAAW (2/01! Wi .~arsin Department of Conunerce " SOIL EVALUATION REPORT Paya _? _ of Division of Safety and Bufld'ergs in acx:ordarrce wiUr Co-nm 85, Wis. Adrn. Ccnle County Attactr oo~rrp`fete site plan rnr paper ~rvt less bran 0 1/2 x 11 irrclres irr size. Plan must ~ ~ rn rY _., hrdude, hart not Ilmlled to: vertipl and horizontal reference point (DM), dkection and Per~el LU. percent ~ bps, scale or dimensbns, north arrow, and lopllon and distance to nearest road. Q ~ -aOf/ ' ~_ ~~~ ~ Please ~rlnt all tnfornral/on -}-•w'q t ie,^'e b Uate / Per~onel rnformnUon rou provide mad be ue - avr 5.0A (I t pn)). / f J PropertyOwrrer rty cellar I~tclr~xrc S-~ , ~ t 200 _ --~ N ~,.; va /V Dili/4 s 3v T Z9 N R17 E (or Property Ownet's Mailing Address ~~~ t # Bkx:k # Sulxl. Name or CSht# 13`3 Qtu.Y~--- ~ GOUN1~r~l• ~rY~e~c~1~1 ._I ~ a~i±IOy7 -- City State Zip Ccxle Ph r~r( OFFI City IJ Villayo .f own Nearest Ruad "' _ 7T d ~ In (s..l I Sy o i lp _ ~'7 3 }-~aYrmo r,d I Cam/ . ~ [~j-Haw Construriiwr Use: (~-Resident'ral /Number of bedrooms _~ ~ Cale derived desiyn flow rate __y ~ CO ~ _-__ GPD ^ Replacement ^ Public or cormnercial - Describo: _, __-_-___ _ ___ _ -- Parent materiel -~~_-- ____ ____ Fbod Plain elevation it ap{rlicable __!V ~ ___ R. General cwnmerds S ~ r /~ ~~ t/ r0 ~ • ~ - ---- - -- acrd recommendaliwrs: CC~ ~ ~ ~ ~ ~ Io ~~ - O U ~ ~ _ /I /~ ~ ~ /1~,~ Q„_) ~ (~I,a~/~, J LQX,C r r-c.i Bonny # ^ Bwiny `l ,~ t ~ i i i ( I t~ ~ - -- or ___ ___ n. Ut. DepUr lu hn l ny ac = ~Pil Ground surface elev. _ _ - Sol A ~ licalion Rale Horizon Ueptir Dominant Color Redox Description _ Texture _ Structure Consistence _ Foundary _ __ Rcxrl ; GPUIII' in. Munsell qu. Sz. Cont. Cokx Gr. Sz. Sh- 'Elf#1 _ 'Elf#2 J~ (( ~+ ~](.'-~y-~_ _~t C _ 3 - ~ -a - ~ ~ _ ~-r 4 51-7 0 - ~r~ , v~S _ m \ _ ~ . ~ ~C Z Boring # ~ Bonny II //--~~ Pit Ground surface elev. I ~~ ~ V it. Depth to limiting facWr _ O ~ _ in. Sol Application Rate Horizon Depth Uwninarrt Color Redox Description Texture Structure Consistence Boundary Roots GP DIfIr irr. Munsell qu. Sz. Cnrrt. Cobr Gr. Sz. Slr. 'Ef(#1 'Elf#2 ~ O~ZI 3 Z s ~ i Zmab~ ,~ _ ~ ~ 1v..~ _ . 5 • ~ 2 21-ya i~ ~ I~ _' S ~- Z~Y~Sb~ ~_ ~_ _' - --~- ~- V ~ Y ~ ~. ~ _J' ~ ~.I ' ERkrenl rM1 = BODS> 3U < 22U nrg/L arrd TSS >30 < 15U rnylL ' ERluent N2 = BUU<< 3U my/L and TSS < 3l1 my/L C57 Narne (Please Print) Address 2113 vD'~`---~ _ Same«e-~-, ~igr~ature ~ - _ CST Number __ ~ _ Z~~ ~ Date Evaluation Conducted Telephony Number ~, L= of ~_ e Pa /G ~ ~~ g - '~-O u-~- Parcel ID # -------- Properly Owner ^ Boring (~ _ f ~ Bornrg # ~.f~lt. Depllr to GnNGrrg lac r `l~_ in• L ~ ~pil GrounJ surface elev. ~ ~ Sol n r icalimr Rale Horizon Deptlr Dorninanl Color Redox Desc,~riplion Texlwe Slrudure Consistence Boundary Roots 'EffgGpD ~'Effg2 in. Mansell Qu. Sz. Cm>It. Cobr Gr. Sz. Sh. - 5 g f ~- s ~ +~ ~ = ~ ~~ ~ - ~ d-2 z ~o - - - - - LJ Boring Boring q -- ^Pit Ground surface elev. __ fl. Ueplh to limiting [actor _____ in. Sod /1 lica8on Rate ' Texture Slrudure Consistence Boundary Roots GPDIIF Hmizmr UepUr in. Uonrinant Cokx Mansell ron Redox Uescripl Qu. Sz. Cont. Cobr Gr. Sz. Sh. _ 'EItg1 'EffH7 (-~ _ _ n Boring "~,,,,y R Ground s~,rface elev. __ n. uep^r w ....o.,..y ,~..,.,, _-- ---- ,,. ^ pit -~- _ -- Sod ~ I'rcaUon Rale Horizon Depttr in. Dominant Colvr Mansell Redox Desrxiplion Qu. Sz. Cont. Cobr Texture Strudure Gr. SL Sh. Consestonr.-e Boundary Rvols GPO1fF 'Eifgt 'Effg2 r • Effluentlfl = BODS> 30 < 220 rnglL and TSS >30 < 150 myJL "Effluent If"L = BOUS < 3U my1L and TSS < 30 mylL 7~tte Ueparttttent of Cotnn~~rce is an equal opportunity service provider and en-ploycr. If you aced assistance to access services or need rt-aterial in au altcmate fomtat, please contact the dcparUncnt at G08-2GG-3151 or "1"I'Y G08-264-8777. sno-u~o rn.onorrr ~~~ I'/\CiG~01'~ NAME:~~----__._-__LC)I'!! ~~ _I.I•:Cinl.1)I:St'ItIPfI~~tJ:.Ge~11/~1~/wl~~l,`;3U_IZY,M,It, f~-):(~~r)~43 SCALL: 1' __ _ -1-~- ____ _- -- _ ____ - -I---- - ---- ~J gm( L•LL'VA'1'IOIJ:_ lc~._c~ ___. "'' Dht l DL•SCRII'flOhl: ~ a___~-~. Jc:. ~ ~ ~ ----~ ~ P- t Q?- --- [3M 2 ELL'Vr~'l 1~1N: _~fR_'~_~v.- _ _ _ ~ -- --_'_ _ ._ ~' `~- -- _ ~ L., arvl a ucsclzu'rlur,:_-~~ o~_L~v~_ p__.~p-~_------ f - , ,: . SYSTEM L•LI:Vr~'Inn'1~?i~:r _ -_ _- IG y• d •_ S~'S'1'EM'1'l'I'I;:_ft'~ "_l~~-c~.c~_ _ O1/ _VYIO~/~ .S~S~~~i SIGNA'i'UKC:_ '~ ~ ~ Ur1"I'1:_-fS~ /_' o'y ____ NOTE - 60 ft. wide area disked and seeded for drainage easement. Does not appear to have dammed POWTS sites ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT ~ AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~~ <~ I ~, _ ~ Mailing Address ~~ U property Address ~ ~~`'" S~ (Verification required from Planning Department for new l~/ 1 S ~~ Parcel Identification Number D Ig- Zol (-- g~-~~` 1 ~ City/State LEGAL DESCRIPTION , ') 2 Location ~~i/4, ~"" i/4, Sec. / (' . T~N-R~w~ Town of a Property . ~~~ Lot # Subdivision _,_ ~- ~- Pa e # ''~ Certified Survey Map # ,Volume ~ . g 2~9Z _, Pa e# 29 Warranty Deed # ~~3~~q ,Volume g Spy ho~~~es ^ no Lot lines identifiabl es ^ no SYSTEM MA-Il~ITENANCE Improper use and maintenanceof your septic system could result in its premature failure to handl~t tou ~ t~ini~the sy~em consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumpe ' Y P can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the ownerd hem masterplumber, journeymanplumber, restrictedplumber or a licensedpumper venfyrng that (1) the on site wastewaterdispo cyst yS in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. m with the standards Uwe, the undersigned have read the above requirements and agree to maintain the private sewage Sdisposal fsys~m~ Certification set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, Office ~~ 30 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning days of three year expiration date. .f;v r DATE SI TURE OF APPLICANT OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) o the pr rly desen'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. ~%01 DATE SIGNATURE F APPLICANT De artment. ***'`*~ #•#~** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning p ~« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the wazlanty deed ~~ ~~~~m~ U 2792P •y29 STATE BAR OF WISCONSIN FORM 2-2000 WARRANTY DEED TffiS REED, made between Keeton J. Bast, a married person and Richard O. Stoat, a masted person, t.,rsr-tor, and M~xk~ a married person, t.rrantec. Grantor, for a valuable coneidacation, conveys and warrada m t.rrsatee the following desccibod tool estate is St. Croix County, State of Wisconsin: ~, Plat of Emaald Acres 1" Addition in the Town Haanrand, St Croix may, Wiaconsin~-_._ E,xcoptions to wamntiea: E58emaIIta, restrictions and rights-of-way of rocotd, if any. KATHIrEEN H. ItALSH REGISTER OF DEEDS ST. CROIX CO. , MI REC&IVED FOR RECORD 84/29/2005 10:30Al1 MARRANTY DEED EXEMPT # REC FEE: 11.00 TRANS FEE: 182.70 GOPY FEE: CC FEE: PAGES: 1 Name sad 1Letmn Addraa: E~~ ~ ~ V t~.ll P lidias~Rsaly~litis~Iae: U CJg~ 1~- 4~~i0s-ils ~J ~6 1.~ ~ ~ls o n w= ~ra- ols-toll-sa-ooo Parcel Ia~niseaben xaa,~xr (Pn~ Tbis i r hor,nestosd property. • J. Bas A Fact for Richard O. Shut s ACKNOVV<~DGM)~~'f slgnaturo(s) _,_...; crown autbenticated this 26th day of April, a w,sconsin ~.~~tate o~ s TITLE: MEMBER STATB BAR OF WISCONSIN ~t~, sufitotiEed by § ?06.06, wis. Stota.) THI3 INSTRUMENT WAS DRAFI'BD BY Pete~l, Frain dt Ber>~men -Steven H. Brans 50 Esst Fifth 3trect, St. Paul, MN 55101 (Sigoamra my be wtbadiested or adcoorvledjed. BotA are m4 aeoeeaay.) ~Naa+ee otpaaom ~a ~ ~Y uMe~P n~ ~ tYPcd ~1*~ bdoA d-eirai~a STATE OF WISCONSIN ) ST. CROIX COiJNTY. ) ss. PeRaonally came before mz this April 26, Zoos the about mined Rahn J. Bast, a Marticd• Person and Krrnori J. Bast, Attonley in Fact for Richard O. Stout, A Married Pelson tame ]sawn to the s) who exoctded the foregoing the same. '~herl BCawn Notary Public. State of Wisconsin My comnisai~ is P (If lwt, state expiritian date: 3/11/200'1 ) VYA1tRANTYDC6D STATE DAROP wraentrsrN >~oywr N~.LMM ADTElENTICATION m j.. ~ 1 r~, .............: i ~ b -- -- -- -- ~ I I ~ ' ~ ~S9 I EOZ M~~OO~OOo00S I i ~ _ - _ ~- ~Ol~ NMOl '~-- - - I - - ' I c~ ~b6'£OZ 3~AO~OOo00N I ~ - ~ - -- - I - _ , ............ ; • I ~ I ,919 i I ... v ~: : I ~ fn L1.. : ~ ' c~ ~ W !~ ~ Q 130 I I F QN ~ I ~ ~ O~ ; I ~~~ I Z R1 ~ ~ I • ~ I I i I O I ~ ~,~ I ~90'Z9E3..lZ~ELo00N Z / ~ ~ 3 0 F- I W ~ Q ~ Q V y : I~ t" Q : to O ~ C ~ IN C'7 ~ N^ ~ I I m : I w AOl I Q I v I ~ • I z 3,~lZ,ELe00N : ~ ; _i w. voc. ~uFq~4 FONl11V I i I i • I ~ I ~ ~ ~ ~"` ¢ y k ~ N ~ ~I o tU^ ~ ; I I m ~ ~ ~ ~° ~ 1 t ~ 1 ~£L'Z9E3~~1Z~£1e00N ~ ~ ,90 ,~ ~N