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018-1069-00-300
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division `' ~* INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Schreiber, Tim Hammond Townshi :ST BM Elev: Insp. BM Elev: BM Description: ~ 0~ ~ ~ o d ~ ~ Lam. ~ u~~l/~r~" s%~l ,h ~ ~ SANK INFORMATION ELEVATIO ATA TYPE MANUFACTURER CAPACITY Septic ~ ~~ ~ l ~ v b Dosing ~ S ,E U Aeration Holding TANK SETBACK INFORMATION County: St. CrDiX Sanitary Permit No: 420631 0 State Pian 1D No: Parcel Tax No: 018-1069-00-300 Section/TowNRange/Map No: 3129.17.474A30 STATION BS HI FS ELEV. Benchma i~ .off /a .o vn Alt. BM Bldg. Sewer ~-- Gc.~e,sf 9 9..s~ SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom Gys~ y ~ Header/Man. ~ / ( a - /~ Dist. Pie ,Z 3 Z-- 3 D - 7P~ Bot. System Final Grade `~ St Cover .----- `~ 2 .Z Ul • ~ .o TANK TO 1P/L b WELL BLDG. Vent ntake ROAD Septic ~ 30 ~ r~ / I rs~ Dosing / ~~ ~ Z , YY! Aeration 1 Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number ~'?~ 3~ TDH Lift • ~~ Friction Loss ~ System H d ~ . TD t Forrcemain Len~S1 , ia~ 6~ Dist. to W`~ell~~ , SOIL ABSORPTION SYSTEM t BEDITRENCH Width Length / No. OFTr s PIT DI NSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 ~ u,~(, ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM L ACHIN Manufacturer. INFORMATION CH BE R T e S tom: YP ~ ~ ~ ~ r ~ ~ I ~ Model Number: DIST ON SYSTEM " ~~) Heade Manifc)I ~~ Distribution t c~ x Hole Size x ole pacing V nt to Air Intake 2 Pipe(s) ~ ~ ~ I r ,L..Q~ a ti Length Dia Length ~ ~ Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ~~ Depth Over '- Depth Over xx Depth of xx Seeded/Sodded xx Mu h d Bed/Trench Center I Bed/Trench Edges Topsoil /' ~ Yes ~ No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / I~~ /6 Inspection #2:~/ (f`!~~ / a3 Location: 667 150th Street Hammo~nhd,~Wl 54015 (SW 1/4 NW 1/4 31 T29N R17W) NA Lot 3 -~"' -/~~~ Parc 1 No: 31.2 .1T.~74A~3/0~~~ 1.) Alt BM Description = /' `41~~ f` ~~ ~Z~'1Z~6Gf~0'1/J -~~~ ~'h~~~"~W': ~i C~ 2.) Bldg sewer length =/ rj -amount of cover = ~ Z a,,.._~~ n ~G~G~- Plan revision Required? ~~' Yes No ~~ `-~ Use other side for additional information. ~_~i l I U~ __ __ __ SBD-6710 (R.3/97) Date Insepctors Si nature Cert. No. -- ;~, Saftty and Buildings Division 20 County y~ ~~ ~ ~ ~^ ~ m l W. Washington Ave., P.O. Box 7082 n t l / __ ~~ COrys f~ Madison, WI 53707 - 7082 Sattitary Permit Number (to be filled in by Co.) De artment of Commerce (608) 261~i546 ~4~.~.~ QK- _ rw Sanitary Permit Application State Plan LD. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 0.3 ~r' ~ - ~/~s • (~ maybe used for secondary purposes Privacy Law, s 15.04(1 xm) ject Address (if different {han mailing address) I. Application Information -Please Print All Information ~ ~~ ~- r ~t+ ~ . Property Owner's N.-~-r ~~ ~ Parcel # Lot # Block # ` / f ~1 v~ ~'~ of - lc~ - oo- c~ , y~ f ~- Propdty Owner's Mailing Address Property Loca tio n / ~ ~' Gtr y ~ S ti City S to Z ec on •, , ~ ip Code ' Phone Number? ,~:~ ~ " `'~ ~ ~~ < cl j ~~ ~ ~ rcle one) R~E W ~ II. Type of Building (check all that s I PP Y) or : ~l or 2 Family Dwelling - Number of B ~ ~ Ntttrt ^ PublicJCoromercial -Describe Us ^ State Owned -Describe Use 5 ~ ~ c • ~ 'ty ^Village~['ownship of ~ 11 IIL Type o it: (Check only one box on line A. Complete line B if applicable) A' New S rem Ys ~R la rem eP Ys ^ Treatment/FIoMing Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal Before Expiration Permit Revision ^ Change of Plumber ^ Permit Transfer to New Owner List Previous Permit Number an to Issued ` ~ ~ \) ~ ~ ZC~ ~ Q ~/ 7 IV. T e of POWT'S S stem: Check aU that a 1 4 ^ ^ Non -Pressurized In-Groundfound > 24 in. of suitable ii ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersaUTreatment Area Information: Design Flow (gpd) Design Soil Application te(gpdsf) Dispersal Area (sf) Dispersal Area Proposed (sf) System Elevation ~ - ~ S~F VI. Tank Info Capacity in oral Number anufacturer Prefab Site Stoel rber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ~~ ~~« ~ x Aerobic Treatment Uait Dosing Chamber ,TLj~ C~ ~'' I VII. Responsibility Statement- I, the untiersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum 'Name (Print) //f Plum s 'gnature //'J ^ ~ ~ MP/MPRS Number + ~ Busine ss Phone Number ~~j/ _ z ( // 1 / / + ~ ~ f / l 6~ Plum s Address (Street, City, State, Zip od ,/ r e -~. ~ -~ ~,~' ' ~ C~ `7 ~ ,-~ VIII. Coun a artment Use Onl Approved ^ Disapproved Sanitary Permit ce (includes Groundwater Date Issued Issuing t Signature tamps) (' ^ Owner Given Reason for Denial Surcharge Fee) (~ ~ ~ . v IX. Conditions of ApprovaUReasons for Disapproval ~ n /~ _ SYSTEM OWNER: 3) 0~~ .,D~-~~ 5~~ ~r~ 7 Septic tank, effluent filter and i_ ((JJ~._ ~~ ~ ~~QM' `_ _ n 1 d Oa- ~~~C l ne .. 1~8 dispersal cell must all be serviced / mai as per management plan provided by plumber. , ~nn ~ ~_~ 6e~,~ d ~Q~ . 2. All setback requirements must be maintaine ~l '~~ ~-- ~ ( .~ oe Q licable code/ordinances ~o r< ~ s' t r . , . ,~, ti . . c. app , as pe c ~) 4ttack compk¢P Dina; (toll~e County only) to~`systFln oa~pQape~?a~,li~!lQ~a I1 iae~ ~ v~ ("' n - h SBD-6398 (R. UB~ul) ~~ ~ ,tom ,~~ ~ ~~'~ ~ ` PLOT PLAN Schreiber ADDRESS 1052 65th Ave Roberts Wi 54023 ''~f ,tJVV i/4s 31 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX 8/11/03 BEDROOM 3 S Byron Bird 3r. 220527 DATE ONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 805 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none ,BENCHMARK V.R.P. House siding bottom ASSUME ELEVATION 100' Filter 1 A-1 Zabe 00 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 101.1' 150th Scale = 1/4" _ ~ 0 Area 15' below system is to remain undisturbed 100.1' B-2 Please note: tanks were eady installed under a previo s sanit ry permit. The previous soil test Grading is to be done to divert run-off away from system Well Garage ° 10% -1 found the tested area suitable for a conventional system but a onsite indicated that it was only suitable x~' fing3 Bedroom House B.M ~ ~ I ~ v 1 01' -°a 1 00' 99~g r- Q B-3 for a mound. a a ~ ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi.us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary September 02, 2003 CUST ID No.220527 BYRON BIRD JR BYRON BIRD JR. PLUMBING, TNC 896 68TH AVE AMERY WI 54001 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/02/2005 ATTN. POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Tim Schreiber 150TH St Town of Hammond St Croix County SW1/4, NW1/4, 531, T29N, R17W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 918042 Identification Numbers Transaction ID No. 903717 Site ID No. 664130 Please refer to both identification numbers, above,_in all correspondence with the agency. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes C~hl and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 'The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. ~~~ The following conditions shall be met during construction or installation and prior to occupancy or use: DE ARTMEf N OF General Approval Requirements: SEE CORA • This system is to be constructed and located in accordance with the enclosed approved plans and with the "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. • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required • 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 • 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 BYRON BIRD JR Page 2 9/2/03 • Comm 83 22(7) A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. 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 i f Byron Bird Jr. Byron Bird Jr. Plumbing Inc. 896 68th Ave Amery Wi 54001 715-246-4516 Date: 8/11 /03 Owner:Tim Scheiber Cover Page Location:SW1/4 NW1/4 S 31 T29 N,R 17W Hammond 150th St. 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 7-9. Maintance and Contigency plan 10-12 Soil test Signature License number 220527 '~~~ ~9~ q~ ~/~ ~~ ~1 s FO `~~~ ~°o~ °~s o,~ .~ .~~~~~ ~~D ~N MMERCE _ !CD/p S ~pNpEN t , PLOT PLAN `PROJEi..'t' Tim Schreiber ADDRESS 1052 65th Ave Roberts Wi 54023 SW 1/4 NV1/ i/4S 31 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 DATEB/11/03 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND )00C SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 805 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none BENCHMARK V.R.P. House siding bottom ASSUME ELEVATION 100° Filter Zabel A-100 ^ BOREHOLE O WELL ~H,R,p, Same as Benchmark SYSTEM ELEVATION 101.1' 150th St. Scale = 1 /4" = 10' Area 15' below system is to remain undisturbed 100.1' B-2 Grading is to be done to divert run-off away from system 10% II II Welt Garage ° -1 Existing 3 Bedroom House ~ DT Please note: tanks were already installed under a previous sanitary g.M, • permit. The previous soil test B - 3 -. o found the tested area suitable fora 1 01 , 9 9~ $ ~ conventional system but a onsite 1 00 indicated that it was only suitable r for a mound. Designs= Date `,~ ~ ! ~ u,P s ` f 4" Observation Pipe Perforated Below Filter Fabric ASTM C-33 S o n d -~ ~ soli ~~," Top ...~.-~- -''_.. No !J~ Non-Woven Filter Fabric 1 ~ ~. S-ope Force Moin From Pump Cress Section Of A Mound S stem Usin ___- Aged For The Absorption Areo .---- q ~ Ft. g ~ Ft. I~ Ft.~ . ~ 5t~, ~ Ft. ~ ~ Ft. w~A;Ft- ~DistriDulion Pipe !~ ~'~o 4H -r,-== F _ ,. _ ; _ D E _ « bed Ot;J~- 2 ~z Drain Rock v Ffowed Layer ;P i '' ~ -~" F G __ 1 __ }; L ,. 40bservotion Pipe- r_~ -- -------------------------------- _ . ~ A / ~ ( Force Moin ° --------- -------- ----------_ ~ From Pump ~ ,' o Distribution Bed Of /Z~- Z IZ ~ Pipe -Drain RocK I 4"Observation Pipe=-ryc~~.~.~ Permonent Mocker ~' -,~-- t f~~ ~ rf~a.r~ f~~?f'', ~ ,Pipe or Rods Plon Yiew Ot Mound Ueln A Bed For Tie Absorption Aree PAGE„_, ~F ~ ~ (- `~4 _otatea On 8oitom. EtZuOf!y Sao=ea C5T KoI.L Ki.XT ro Canntt}~cf Ft. ~~. Signed: License Number: Gate: ~_ iti~heS ~' c~ Inches Hale Diameter Inch Lateral ~" ~ ~ Inch{es) "fan i fol d ~' Inches Farce Main ~ Inches ~f holesfpipe~ Invert ~7evation of i.ater~als/G'/.j-~Ft.. Perfiora!e4 ~+R! Qetaii ' ~vrn~- t~M.s,~R e~oss scc--n-4 k.*~c~ ~rcca~aca~u~~t •~r.s .~,..,,,~, ii• ,..~.~. r-•y.r.~-vcwt c~-~ i.:. rRL! "AMC ~"'t' . i Mtt~TMtR!'0.0oR 4 •t~RpYta 40CMiO16 ~ i~ s~liaa ipiR. ~ ~ ~~sut'rsO~t 1oY :N~1rlMitt ~nVDIC iwOwdl- risl~ ~s`~'~• ~~~. 1~T ~ rROv,Ci . A-RT'+6Kt !!A~„ f ~ i • { ~~ _ 1 • ; ~ 4 ~ Ai.ARM } CL ~~4tld3EMtTr- ~ } O~ ~~,~~GL.. t1' ~P ~ ~ PIPE su~+s-.~ _~ ~ 581~.~0l~Clt '~'' ~ CowcRSrs stiscK a01! ~ R-tiR t~uT ~RAl7lt~ Owi.Y tr Ty-Wt ~wwlMlyeTLRl.R isAf iYCM Ai~!-R fi. _ a~tD<1RtGRTl~1~ -A~t;tfi~CT3iRl~~~ ~~ rA~t~,ht 01~ pNip: #~t ~1-ti ~t iisi` `~ b11 O~fi DOiC VOLYAC J~lMtlil~irli~SA? ~ ~ ~ ~VCiYDiMtr !~liKPii~It M-~.fpM -'b0<i w11M~iR~ tAlAClTI~= A ~` .~ • iMH!'~,li ~'~! ~~ ~' ~ s iK~~~~i Mkt . MY~ti ~• _ ~-~ C • +~1tNti M MNM ~"~OOii. iR. w~,,,.r..~..... O~rL;,.,.~iNi~fM M~LOVt ~~'~CM ~~~ ~ Ri4'rjr. lYMr A1i0 AiiRr- RRi 'FO DR ~f1AYA ~ Qr/~t _ !O Obi ~tlMf1A!'t ~~'ti ~nt~ ~n;~ 1Rt+wss~ *~4tr w~ oaT+efwT~~.t .....1 -'~ttT ~ ~ ~~ * Mriu.~„~ +ucT1~tK au+~~t Mttf~c ~.~> .~ stcT ........... ~ + ~ ricss er ~aeee ~u x s.~:...~~. ~ ~.+as..c~:~,~.'eet _ _`3~ ~~ 4'nytw~. e~~tw#~ieats Q~ ~.~u~: L~.~J6Tti «~.....;w1aTK ..~~ ~ `EQfStD QC~ti~....w..,,., .n o: w 12 0 w x v z $ 0 0 r- TOTAL pYNAMIC nEAU/C,4PAClTY PER MINUTE EFFLUENT AND pEWATERINu I MODEL 152 153 I fQ~ ~Mzters I GcL I Liters Got. liters 5 ~ 1.5 '~, 26i 77 09 ~ 291 10 ` 3.1 I 7q 1 6t i 231 265 ,5 4.6 201 61 I 53 i 231 20 .I 6.1 44 ~ 167 52 197 i 25 7.6 129 42 34 ~ 159 3r 9.1 23 !, 87 33 1 ~~--~ 35 10.7 ~ 22 ,i -- I -- S~ '~ 4r i i 2.2 ! 11 -- -- 42 I t---------- Lock 'Jolve: i 1.6r-,~144.0 Ft. X38.0 =t (1 ~.-_- ('3.4mj~ -----soa ip ,, ? ~ 2 FLOW PER MINUTE ONSULT FACTORY FOR SPECIAL APPLICATIONS C • Timed dosing panels available. • are available and suppiled with • Electrical alternators, for duplex systems, an alarm. • Variable level control switches are available for controlling single p ase systems. • Double piggyback variable level float switches are available for variab e level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420• • Over 130°F. (54°C.) special quotation required. „mi>ti3 Series p CAUTION a ualified pJl installrtion of conVols, protection devices and wrong should be done by 9 Inc ent Nations EIecVActCode (NEO) a d the Occupat oval Safety and Heatih Act QSHA). ~ rec _j_____ ,z ~,~a I I 1 ~------ S2 __,: e s~ SELECTION GUIDE back variablelevelfloat 1. Single piggyback variable level float switch or double piggy switch. Refer toFM0477. 2. See FM0712 for correct model of Electrical Alternator E-Pak. 3. Variable level control switch 10-0225 used as a contol activator, specify duplex (3) or (4) float system. RESERVE POWEREDdDES eGN Ign of every Zoeller pump. For unusual conditions a reserve safety factor is engln MAI4 T0: P.O. 80X 16347 Manufacturersof.. • ~~`,~ Louisville, KY 40256-0347 S,vcE f~~.g~ ~~ ~ ~ ~ ~" ~~ SHlP 70: 3649 Cane Run Road Y402f1-?961 Q/JQL/Ti'P//MPS ~ Lomsvtlle, K ~ ~J ,,< "~ .p t' ~~ <, ® {502)178-2731.1(800) 928-PUMP Z ,S ,,' FAX (502) 774-3624 _ ~UNrr cr: hnp;//www.zoe/ler.com ~ ~ _ ,-,,,,~• .,nnn 7noller Co. All rights reserved. Lt 1 Cn.~ O t5V ' "" FILE INFO p,Nner Pemnit # PpwTg pWNER'S MANUAL. & MANAGEMENT PLAN SYSTEM SPECIFICATIONS ,RhAATION Septic Tank CaPa~tY ~~~-~i~ ~ Septic Tank Manufacturer Effluent FOter Manufacturer DESIGN PgRAmt ~ Gn•' ~ ~ ~ N Number of gedroprns :El.i~t Number of Commercial Units 3 , aVda Estimated flow (average) . l x 1.5) Design flow (peak). (Estimated . aVds aVda h ~ Soil Apptlgtion Rate Monthly average' tnfluent/Effluent Quality FOG) Oi18~ Grease ( Fats 530 mg/L , l Oxygen Demand (BODS) i ~0 mg/L ca Biochem Total Suspended Solids (tSS) 5150 m /L " ~j,IA d Effluent Quality t Monthly average e Pretrea GODS) B'locttemigl Oxygen Oemand ( (TSS) lid 530 mg/L 530 mg/L s Total Suspended So Fecal Coliform (geometric mean) S,iO. ctu/10pm1 Y inchdiameter Maximum Effluent Particle Size [MAINTENANCE SCHEDULE Service Event Inspect condition of tank(s) Pump out contents of tank(s) Inspect dispersal cell(s) Clean effluent filter Inspect Pump, Pump controls 8. alarm Flush laterals and pressure test Effluent Filter Model Pump Tank Capacity Pump Tank Manufacturer .Pump Manufacturer Pump Model Pretreatment Unit ^ Sand(Grevel Filter O Mechanical Aeration ^ Disinfection Disp rsrs i Celt(s) ^ in~round (grav"Ity) ^ At-grade ^ Dri ine M Page of gal ^ NA y ~~ ^ NA z...~-bt%1 ^ NA ~7, ~ gai ^ NA '.r / ~~ ..Z. ^.~ ^ Peat Fitter ^ Wetland ^ Other. ^ In-ground (pressurized) ound ^ O er Ical for domestic (Wort-catnmerclaQ vrdstevsrater end Values typ septic tank effluent Values typical for pretreated wastevwdter- Service Frequency ^ month ` ar(s) (Maximum 3 yrs.) At feast once every `5 uals one-third (Y,) of tank volume When combined sludge and scum eq ar(s) (Maximum 3 yrs.) At least once every At least once every At feast once every At least once every At least once every At least once every ^ months ^ months ~ea~s) '^ months ear(s) ^ NA ^ months~ ~'Year(s) ^ NA ^ months ^ year(s) ^ NA ^ months ^ yea_ r(s_) ~ NA other. licenses or MAINTENANCE INSTRUCTIONS n one of the following pections of tanks and dispersal cells shall be made by an ind'lvidpO~s i~pe~or. PpVY1-g Maintainer, Septage Ins s to identify any missing or broken cer{'~fCa6ions: Master Plumber, Master Plumber Restricted Sewer, for any back up ons must include a visual inspection of the ~e and scum and to check Seridng Operator. Tank inspecti shall be visually inspected to check the effluent levels hardware, identify any txacl~ or leaks, measure the volurmsael celi~(s) btned sludg riding of effluent on the of effluent on the ground surface- The dispe round surface. The Po authority. or ponding riding of effluent on the 9 ulatory in the observation pipes and to check for any Po wires the immediate notification of the local reg ground surface may indicate a failing condition and req uals one-third (y,) or more of the tank vow chlNR When the combined acctk ulation of sludge and scum in any tan eq shall be removed by a Septage Servicing Operator and disposed of in accordance entire contents of the to ~ fetreat~ment components; and any 113,11YISCOfISin Administrative Code. orients, P Maintainer. donned by a certified POyVTS The servicing of effluent filters, mechae~is oQ12 mo the oo~ S~mb ~ (,t ietion of any service event. at In within 10 days of co P other maintenance or monitoring ulatory authority shall be provided to the local re9 ~ rodud~ or other A service report resence of painting P TION POWTS check treatment tank(s) for the P STARTUP AND OPERA ersa- cell(s). if high concentrations are For new constnic~lon. Prior to use of the o rator prior to use. e ttte treatment process anNor da~mae s thrvi d 9 ~ d1emrcals that may imped of the tank(s) removed by a sep 9 detected ha'!e the contents ~" ~ ~ ~ re frozen at the infiltrative surface. Page of System start uP shall not occur when sod conditions a r is restored the excess r outages pump tanks maY fin above normal highwater levels. When powe Durie~g p~ . tsa[ cell(s) in one large dose, overloading the cellms) a~nndk ~a~ s~ult~ a e wastewater vinll be discharged to the dispe backup or surface discharge of effi}~ent To avoid this sduation have the contents of the p P Operator P~ tp restonn9 power to the effluent pump or rooted a Plumber or POWTS Maintainer to Septage Servicing um controls to restore normal levels within the pump tank assist in manually operating the p P Do not drive or park vehicles over tanks and tdrnd~~~ cerallde soil absorption area over, or otherwise disturb or compact, the area within 15 feet down slope of any mo -9 Redudion or~elimination of the following from rte buttstecondoms~; cottonyswabs degereasers dental floss; diapers;e Irfe of the POIi'YTS: antibiotics baby wipes; d um grater, fruit and vegetable peelings; gasoline, grease; herbiddes; meat disinfedants; fat foundation dram {sump P P) soaps; medicatrons; 014 painting P~u~; pesficides; sanitary napkins; tampons: and water softener brine. ABANDOPIMMENT taken out of service the following steps shall I'~ taken to insure that the yyhen the pOWTS fails andlor is perrnanerttty system is properly and safey abandoned in compliance with ch. Comm 83.33, ~~nin s~sealed. We Code. • A[I piping to tanks and pits shatl be disC°nneded and the abandodnied psi oP by Septage Servicing Operator. • The contents of all tanks and pits shall-be removed and properly Po • After pumping, al! tanks and P~inert solid m~ateriaL .and removed or their vets removed -and the void space filled with soil, gravel or another CONTINGENCY PLAN tred tfie followin measures have been, or must be taken, to provide a code If the POWTS fails and pnnot be reps' g compliant replacement system: A suitable replacemenYarea has been evaluated and may b ~utif end df std I band compa~n aid should not absorption system. The replacement area should be protect sed strvctu ,lot lines and wells. Failure to be infringed upon by required setbacks from existing and propo prated the replacement area will result i stmust comply with theirules intellect at thatttimetablish asuitable replacement area. Replacement system O A suitable replacement area is not avaiii~bl as a last esort to rep~ace ithe failed POyy1'Sng advances in PO technology a holding tank. may be tnsta e site has not been evaluated to iden~t<'f~ as suitable eplacement area. if no replacement area rs avai able a site evaluation must be performed to holding tank may be installed as a last resort to replace the failed POVYfS. removal of the biomat at curd and at-grade soil absorption systems may be reconstructed in pwitlcei tf~e(i~ s9 n effect at that time. e infiltrative surface. Reconstructions of such systems must comply «WARNING» SEPTIC, PUMP AND OTHER TRF-ATMENT TANKS MAY CONTAIN LETHAi- GASC R MSTANCESF DEATH MAY GE . DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY RESULT.. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name = ~ a/ ~'~' Phone `'/ .S ~ ~~'- r' POWTS MAINTAINER r Name c~r.~ Phone '~/~y-~ ~°" LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR PUMPER Agency ~~~ ~'~ ' ~ ~~ Name ~~ Phone ~1,~-- / J '~~ Phone ~~J "'.~ ~~ odes. This dowment meets the staffs of the Green Lake. Marquette and Waushara County Zoning and Sanitation age mart does not This document was drafted by a Use of this docu GIViW (~i~ the minimum mquimments of ch. Comm 83.22(2)(b)(1)(d)~(f1 and 83.54(1). (2) 8 (3), Wisconsin Adminlstrative guarantee the performance of the POwrS• ~~` ,~ ~~- ~~ o as ~ s PAID Wisconsin Department of commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code county ~ G 7^O ~ Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must indude, but not limited to: vertical and horizontal reference point (BM), direction and paroel I.D. t ~~ percen sbpe, scale or dimensions, north arrow, and location and distance to nearest road. ~ 6 Please print all inlbt'Imnt/on. R iewed by Date Personal information you provide maybe used for secQr,dary purpose6 (Privacy Law, 5.45.94(1) (m)). 7 ~ 3 Property Owner Property Location . ~~/~ Govt. Lot /4 1/4 S T N R ~ E Property Owne s Mailing Address Lot # # Subd. Name rX CSM# ~-~..~ C' Si..~e Zip Code tlrfe°Numbe~ ^ ~ ^ Village 'Town Nearest Road _ [ ,, New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD ^ Replacement ^ Public or commerdal -Describe: Parent material Flood Plain elevation if appligble ft. General comments and recommendations: Boring # IQ' Boring ~y ^ Pit Ground surface elev. %~ ft. Depfh to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Stnxxure Consistence Boundary Roots GP Dff~ in. MunseU flu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o - le ~ ~ /~i ` .S oc,s( `j Boring # ~ Bonng ^ pit Ground surface elev., /B~ ~~ ft. Depth to limiting favor .~ in. Sal ication Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GP D/f~ in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EN#1 'Eff#2 / ©~ O~ 1^ ~ ©- e ~ ~ 'Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =BOO < 30 rrtg/L and TSS < 30 mg/L CST Name Print) ~rL /~r Signatu CST Number ~~. ~ sa Address Date Evaluation Conducted Telephone Number Properly Owner ~/ ~ ~~f / ~"' ' N Parcel ID # Page of Boring # ~ Boring ,, ~ ~ ~/ ^ pit Ground surface elev,/~O~ ft. Depth to limiting factor in. Soil 'cation Rate Horizon Depth Dominant Color Redox Descriptan Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 'Eff#2 ~---~ ,,.. G~ ~- Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft° in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Et7#1 'Eff#2 Boring # ~ ~~ ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 =GODS > 30 < 220 mglL and TSS >30 <_ 150 mgll • Effluent iK2 = 80D5 < 30 mglL 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. SBP8330 (R07/00) ' Soil Test Plot Plan Project Name Tim Schreiber Syron Bird 3r. Address 1052 65th ave Roberts Wi. 54023 CST ~ 220527 Lot3 Subdivision Date~~15/2003 CountyST. CROIX SW 1/4 NW 1/4S31 T 29 N/R17 W Township Hammond Baring Q Well PL Property Line# Alt. BM ,BM or VRP Assume Etievation i 00 ft.aase of siding System Elv. H.R.P. same as BM Wisconsin Departs+entnf Commerce ~ PRIVATE SEWAGE SYSTEM Safety and Be:;~ii~tl~ Divi~io,;, >~; <~ , ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) corcnnal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Schreiber, Tim Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic r ~~~~ V~~~- Dosing Aeration Holding TANK SETBACK INFORMATION County: $t. (,r01X Sanitary Permit No: 420631 0 Stat Plan ID No: a1~ o ~(~ ~cus . Jd#" Parcel Tax No: 018-1069-00-300 3,.2~. ~?. ti~H s~ ELEVATION UA I A STATION BS HI FS ELEV. Benchmark ~Z Alt. BM Bldg. Sewer /,~ l ~ ~j/ 9 0 /,e St/Ht Inlet /_ . /~ t ~ I~ • St/Ht Outlet /~ ` ( ~ ~ 01 f 6 ~f Dt Inlet A T ' 70 Dt Bottom O.IZ gr. / eader/ an. Dist. Pipe Bot. System Final Grade St Cover TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~_ Dosing i Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM rtr I ..Q..19,. _ 1f'f'~- 'r'~ to • -t a- l BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: NF ATION CHAMBER OR I ORM Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Praccurta Svs#ams Only YY Mnunrl Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil ~ Yes ~ No ~ Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection # • ( ~.S Inspection #2: / /_ ~~ Parcel No: 31.29.17.474A30 Location: 667 150th Street Hammond, WI 54015 (SW 1l4 NW 1l4 31 T29N R17W) NA Lot 3 ~~ ~ 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = Plan revision Required? ~~ Yes n No ~ Use other side for additional information. --~ ~_ _ -~ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ~ rrua~~ ~. Pr -- ~:u i Si 6-.^ Sanitary Per it Application Safety & Buildings Division a ~ ' ~~ ~ `~ In accord with Comm 83.21, Wis. Adm. Code See reverse side for instructions for completing this a lication 201 W. Washington Ave. PO Box 7302 sconsin pp Madison WI 53707-7302 Department of Commerce Personal information you provide may be used for second u oses ~ p ~ [Privacy Law, s. 15.04(1)(m)] , Submtt com leted form to coon tf not ( p state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County ~ e /'m State Sanitary Permit Number ^ Check if vision to previous application ~. ... ,. State Plan I. D. Number I. App ication Information -Please Print all Information ~• ~~ ?"` ocation: Properly Owner Name opetty Location ` ~ ~ ~ ~ ~ e Y- ~ /~ .. 1/4/4, ~ T , R ~E (o Property Owner's Mailing Address? Lot Number? Block Numbe City fate Zip Code Phone Number "" ~----..,~ Subdivision N ~SM Number II. Type of Building: (check one) 1 or 2 Fam' D lli N f B d ~ ^ City Vi11 we ng - o. o e rooms : T of Public/Comet (describe use):_ ~ 3 ~ ^ State-Owned ~ ~ ~ ® h ~ / /~ ~~ ~ ~ ~ Y7 ( ! O © Neazest Road y~ ~ ~_ / J~ ~~`S, - ' _n~ "/ Pazcel Tax Number(s) O - v6 III. Type of Permit: (Check only o ox on line A. Ch ck box on line B if applicable) . ~- A) 1. New 2. ^ Replacem 3. ^ Replacement of 4. ^ A System System Tank Only ~ ~, s em B) ^ A Sanitary Permit was previously issued Permit Number ~ J -[ Date Issued ~ Z- Z IV. Type of POWT System: (Check all that apply) on-pressurized In-ground ound Sand F er nstructed Wetl ^ Pressurized In-ground ^ ing Tank Pass ip Line ^ At-grade ^ Ae 'c Treatment U ' ^ Recir lating V. DispersaUTreatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. So cation 5. Percolation Rate 6. Sy feet Ele lion final Grade _ ~s ~ Required Proposed ~ Rate ( ay/sq. ft.) (Min./inch) Elevation ' ~~5~ f S 23 . ~ a V ~ ~ VII. Tank Capacity in Total # of Manufac r Prefab t 1 antic Information Gallons Gallons Tanks Con- - New Existing Crete s ed Tanks Tanks ~~-- ~ ~~ ~-e ~C' TI~ h x ~~ ~ ~:h ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for install n of the POWTS shown on the attached plans. Plumbe Name (print), ~ ps~ Plumbe ' ign a (no s;~''' ~ MP/MPRS No. Bus s Phon um r 7 ~ ~tJII^C _ ~~ "°~ - ~ L~ !~~ Pl be ' A/ddress (Street, City, State, Zip Code) IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui g Agent Si re (No stamps) Approved ^ Owner Given Initi dverse D i Surchazge Fee) ~ S~ ~ // ~(Z ~~0 3 ~ eterm nation ~ X. Conditions of Approval /R ons for Disapproval: ~- S ca,~,.~ ~ 1 ~k~.a.r. 9 S , so' - - scc s.+~-Q -ta~rtn~f' -- ~..~" ~ ~ ~ t ~ Sy 5~.. w~.~.o.~-I~e.~,~ ..*-- ie~..~- ~ Z u ~. c.e~,.e. aver c~Q.~.~rs . 6-,~.~. s.+~Q w..~c`~ t~.~~ (. [ ~..,~ ~~au~e.fie. h ,c,c~soi.Qa ~ ~ ~e_._~sfiw~6~. ~-e~ ~u~ `' fn ,,,.~ . ~ ~ a.. , Q. ~c- ~,~. ~ ~~~ ~- ~-- ~~ ~- ~ ven~e.~ ~.`-~ s~{S~w. ~w~ ~ ot.Pk s~-beat:~C. s wtruLn,~+1e~4.. SBD-6398 (R. 07/00) yE-pus-wer- tlo$Q ~e,~-- ~~,., C~,,~(.,~~ ~ce S , PLOT PLAN PROJECT Tim Schieber ADDRESS 1052 65th Ave Roberts W. 54023 SW 1/4 NW 1/4S 31 /T 29 N/R 17 W TOWN Hamm011d COUNTY ST. CROIX r 6-23-03 BEDROOM 3 MPRS Byron Bird Jr. 2205 `' _ DATE CONVENTIONAL XXX At- rade C NVENTIONAL LIFT HOLDING TANK 1000 gal LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE ~ LOAD RATE •3 ABSORPTION AREA 1500 # of chambers 49 ,BENCHMARK V.R.P. top of iron pipe ^ BOREHOLE ~ WELL *g,g,p, same a sBm >12" of Cove Long 1 ASSUME ELEVATION 100' ~~~e~~ ~~ PUMr i;.1~P.P^„4R CRASS Se:CTIQ-J A-~ SP CIFI ATI I+JS .. (NO SCALE) 'i~~C.I. V~'J. PIPC ~ 25' FROM DOOR, WINDOW OR FRESH AIFt INTAKE GRADE 18"MIN. 11.1LET •• A * a c ELEV. a5' O FT, 0 yam--- V E t\1 T C A P WEATHERPROOF JUAICTIOAJ BOX 12"M I U. *APPROVE JOINTS WITH APPROVED PIPE 3' ONTO SOLID SOIL APPaOV~D' LOGKiNG ~MAA)HOLE COVER PUMP --~.G-, COAlCRET1< ~LOGK SPEGIFIGATIOt~JS / SEPTIC f LOSE ' TA1JK5 MAIJUFACTURER: !_~ '• • ~_~.:....-~ ~ IJUM OF ~pOSES: ~.. PER DAB TAA1K SIZE : =' _~'_ ' Ar'I'~ =''' _ GALLOFJS/ D VOLUME ~~6- ALAR!'1 MAfJUFACTURi<R' ALHI~P'S, '•~~ ~/ ~~ I LUOIIJG 6ACKF4.OW:.._'._ ~,/ //G~~ALIONS C _[ ~~[,AlLOUS MODEL IJUMBEit: ^~" ~~'~ CAPACITIES: A=~~,~1LHES OR SWITCH TYPE: MERCURY c 8 =L~ ;`;CNES'OR ~d ~ALLOAIS PUMP MAAJUFACTURCR: ___.. ~.`: ... p ~ '~~ C= ,L~~ IA1LH£S OR ~ ...~~LOUS MODEL AJUMDER: R •/ ~~~~ D a ~.'~. `:,-CHES OR ~ vAlLOl.1<• r ' SWITCH TYPE: MERCURY - IJO PUMP AUD ALARM ARt TO D[ MIIJIMUM DISCHARGE RATE GPM AlSTALLED OfJ SEpkRATE CIRCUITS VERTICAL DIFFEREAICE DETW><EIJ PUMP OFF DISTKIBUTIOAI PIPE.. / EET -}- MIUIMUM AJETWORK SUPPLY PRES RE .. ...' .. ...._- - 'f -f- G.Pa :'CET OF f'ORCE MAIM X . ~ ~. ~ pp ~FR1C710-J FAC70R_ .+ FEE = T AL Dy1JAMIC HE~eA''~D = rr.ET I?,ITERLIAL DI,MEklSIOIJG OF TAA]K: LEAIGTN yG~;WIOTN ~•,LIQUID OEP'TH __.~~ i/ SIGtJE d:__ "r.:~~_ LICEIJSE IJUMBcK:..vv ~ ~"~• _ DATE: (G '~s~Y- ~~ SSC - 7, ANSWER SHEET (PAGE 2) I ~ , ( • ( 'i"MIA]. I • I I B" M11J. COAIDUIT ~"-' `\` ~~ ~~~., 1 PROVIDE I ~~ _ _ _ AIRTIGHT SEAL I i I I ~ f I I (Ii * I I i II ALARM II I i oil` D ~ i I _ /SD S ~cet . P;t • • /oca~cdp~op. S~a~e ~ ~X% /ar~io•~t.de {~ ~ Sca/e: / < <10' Bench /rlar,(~~ T~o{~;~'on /ot / SEai(~e. Ass~.,ne.d ~ ler!' = icb.cn' ~' GG' EaScrosnt sf . B.irj.: TP of/oZ`S~a'~. E/e~: ~ io1.6a' ...--~- i s~~a°~ "~. 97.36 ~ d,,,~t/l;nq, 8• ~pPoscd cJc!/ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner ~~ ` Permit # ~ 0 b 3 DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ NA Estimated flow (average) a~ "- al/da Design flow (peak), (Estimated x 1.5) `~~ al/day Soil Application Rate al/day/ft2 Standard Influent/Effluent Quality Monthl average" s, Oil & Grease (FOG) 530 mg/L Biochemical Oxy Demand (BOD5) _<220 mg/L ^ NA Total Suspend olids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand bl 530 mg/L Total Suspended Solids (TS S30 mg/L ^ NA Fecal Coliform (geometric mean) 04 cfu/100m1 Maximum Effluent Particle Size Ya in ^ NA Other. ^ NA "Values typical for domestic wastewater and septic tank efflue MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity ~~ al ^ NA Septic Tank Manufacturer ~,~Q>`T ^ NA Effluent Filter Manufacturer u, .~ ~ ^ NA Effluent Filter Model ~~.~ ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ~~ ^ NA Pump Manufacturer Z8 ,C ~ ^ NA Pump Model ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Cell(s) In-Ground (gra 1 ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other ^ NA Service Event Service Frequency Inspect condition of tankls) At least once every ^monthlsl (Maximum 3 years) ear(s) ^ NA Pump out contents of tank(s) When combined dge an m equals one-third IY,1 of tank volume ^ NA Inspect dispersal cell(s) At least once ry: ^monthlsl (Maximum 3 years) yearls) ^ NA Clean effluent fiber At least one very: onthls) I..Z ~ ISI ^ NA Inspect pump, pump controls & alarm At least o every: ^ mo 1 ^yearls ^ NA Flush laterals and pressure test At least ce every: ^ monthlsl ^ year(s) ^ NA Other: At lea once every: ^monthls) ^yearls) ^ NA Other. ^ NA 3 MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall b ade by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Se er; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of a tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and um and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page of START UP AND OPERATION ' For new construction, prior to use of the POWTS check treatment tanklsl for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(sl. 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. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cellis) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall tie taken to insure that the system is properly and safely abandoned in compliance with chapter 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, grave{ or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~-yt j Phone -- ~' ~ ._ SEPTAGE SERVICING OPERATOR (PUMP R) Name Phone ~ / Lf~ PAWTS MAINTAINER -- - Name ~ ~ C ~" Phone ~L f 3 Sl LOCAL REC3ULATORY AUTHORITY Name ~ fl/ Phone This document was drafted in compliance with chapter Comm 83.22(2)Ib)11-Id)&If) and 83.54111, 121 & 131, Wisconsin Administrative Code. r .a EROSION CONTROL PLAN COMMENTS: For Lot 3 667 150`h Street Hammond Sanitary Permit - owner(sTim Schreiber 1. The main source for construction site runoff will be the house foundation excavation, driveway runoff, and any soil stockpiled until final grading and stabilization is complete. Septic system excavation/installation causes temporary disturbance, but plan to apply seed and mulch as recommended in #5. 2. Divert contaminated runoff into vegetated areas by creating temporary earthen berms ALONG CONTOUR between construction activity and any drainage ditches or waterways. Maintain existing vegetation between potential receiving waters (including ditches) and the house foundation & septic system excavation sites. The in-ground system will be approx. 20 feet from the west lot line and 150' St. road ditch, which will require excavator to keep equipment and soil from trenches within established berms or silt fence barriers. If builder/excavator grades the site to create temporary berms (see #2) to contain sediment and leaves adequate vegetative cover to protect areas of concern, installation of silt fence MAY not be necessary. Use mulch or other appropriate cover materials to prevent erosion. Silt fence or other approved sediment control products will be required if sediment cannot be contained on owner's property with the berms and vegetative buffers. The POWTS inspector will evaluate ESC plan effectiveness and make recommendations to owner and building inspector for any action required to comply with applicable regulations. 4. Construction equipment and vehicles must use only one driveway access off town road that is properly stabilized for heavy equipment; this helps avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and/or drainage ditches. This includes cement trucks, well drillers, and other contractor's vehicles that access the property during construction. 5. Stabilize new topsoil cover over septic system with seed and mulch immediately after installation - do not wait for final stabilization and/or landscaping of entire site to cover exposed soils on the system. If weather will not permit seed germination, a heavy straw mulch cover will prevent erosion until grass/vegetation can get established. Erosion control matting can be applied any time of year and if installed properly, will provide protection even if seed germination is delayed. Attached is a copy of "Erosion Control for Home Builders". Please feel free to contact me with questions or ask for assistance with erosion & sediment control installation. Pamela Quinn, So Erosion Inspector #665054 .1 ~~ ~- jrp- Safety & Buildings Division A t Sanita Permit A lication 1'Y PP 201 W. Washington Ave PO Box 730_ ISCOnsIn 'In accord with Comm 83.21, Wis. Adm. Code Madison, WI 53707-7302 Department of Commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not w L [Privacy Law, s. 15.04(1)(m)] jtL~ ~ state owned.) Attach com let la s to the count co onl for the s stem, on a er not less than 8 -1/2 x 11 inches in size. ~uunty S-~ cr~i State S nitary Permit Number ^ Check if revision to previous application State Plan L D. Number --------_---- . an ~ I. A lication Information -Please Print all Information Location: i'roperty O«~rer Name ~!1 ( / l Property Location ~~ ~//L~~j~ ~I- ~ ~ - :Q//'^ 5~1/4n~ ,53~ T ,N,R ~ W Pr;~pert}' Owner's Mailing Address 20p~ Lot Number Block Number -E7Q ~J ST CR ~ . OIX fT Ciry, State Zip Code ~f®FF/CE Subdiv' n Name or CSM Number C~s (~ o ~ ~S ~ ~ OdZ3 ( ) 7 3 ~ a•~ ~s . S/o88 II T} pe of Buil tng: (check one) ,/ 3 ~- iry Village J I or 2 Family Dwelling - No. of Bedrooms: [9~(own of ~ Public,~Co ercial (describe use): State-osvne QiYf/n ~d LII Type of Fermi heck only one box on line A. Check box on line B if applicable) Nearest Road ISO ~eG A) 1. New Syste 2. ^ Replacement 3. ^ Replacement of 4. ^ Add n to Parcel Tax Number(s) app S stem Tank Onl Exist' S stem ~/~-I~/c 9-GYJ-,~ Ij) Permit Number Date Issued ^ A Sanitar -Permit was iousl issued f V. vpe of POWT System: (Ch all that apply) ~ ~,pnt~c~~o', 3 ~' /~/ 3 ,Y/p ~(o f/(o, f" ~~ yg 'on-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland Pressurized 1n-ground ^ Holding Tank ^ Single Pass ^ Drip Line ~ A[-evade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V Dispersal/Treatment Area Inform atio S d. =o•3~PP•~~ = L .f~• =3~•~ .fe 6.rs,,~ sl~.,ofo.dr~,c~~.~- ` 9 .Design Flow (gpd) 2. DispersalArea . Dis a Area 4. Soil App ' ion 5. Perco anon Rate 6. System Elevation 7. Final Grade Required Propose Rate (Gal ay/sq. ft.) (Min./inch) ~" Elevation DSO ~ , sod. ed ..Fg /, Sa3. .~{. 0.3 .P/~, / /1 ~- • 9S. SS ~ 97 TS ~ 98 s/O VI 'Tank Capacity in Total of Manufacturer Prefab Sit e ter- Plastic information Gallons Gallons s Con- Con- glass /J LL " ~ ~ New Existing Crete str ~ C~ 1lJ% !/1'! Tanks Tanks ftY ^ ^ w C~ ~ ~7 ~" ~ c , f~ ^ VII Responsibility Statement I, the undersi ned, assume res onsibilit f r installa ' o e POWTS sho the attached lans. _ i'lumber's Name (punt) Plum is Signa ( s ps): M RS No. u e Number - ~ ,~ a~-c ,3 y7S 108~/- i'lumber's Address (Stye t City, State, Zip C e) ~ SG ~ai~ ~ . W ~~ SS~d C~~ VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater D ssued Is ng Age ature amps) AI>proved ^ Owner Given Initia dverse Surcharge Fee) ~r ~~ s _~ ' J Q °Z" ;Determination i IX. Conditions of Approval /R ons for Disap royal: 1 I ~ ~e.[e-c ~ • °` Sot 'n" ~ ~n~'- e.~- ~-~C~ IZ~t ~.., ~ enter tn'er CJ ~~ ~ ~" ' ~ ~~L : fit C~.~- ~-+ ~ ~ ~ s;-4-~. ~ t-- rs, QS I )~. c, w~.,~~~ _w~ a.~ ~:~`'~~ -- l~ t~ vn 6 e r -I a p~v~ ~- God °~ f~z,'"`.~ `~ CSC ~.~~ ~ o-u, _----- ~ ~.~ ,co .~ ~ / M~/2 min ~~t~ ~ ~,SC ~~n. ~d ~ ~za~~' ?5 -s1.~? ~~4.~-~-y a~t.,~csa-~ -s ~rr. Cow -f err a ^ ~ o/l ¢dQ /tca~'on /SD ~ S ~'cet ' Pit ~c ~ ~Xl~/a.~~~d¢ 3 30. of ' 5cro~ic~ii~'~ 6c..n~OC.JY<.r,6~~ wiC~ S. T ou.t /ct • Pro~scd e lei: ~ bot-,Eo~oFs•T=87.sa.' \ QI 8~ eA i ~~ ~ 97.09' "~ c 6 ~ bu:1d;.1q Se.u.wr. ~o~sc d .z b~.draDr~ ~O 97.36 ~ d~c/l;nq, ^ 8sF as, 98. /8' ~ g7 yB.89 ~ • '~ ^ 9979' ~o poscd t.,7c!/ ~- ~, /y W i ~ co.~/a0n ~ sbD-io~os-A(~. o) ~ y9 tycn~rd ~n~'f~'a~'- cla.,, oPosed gz.zs' /e~ = 95.sS; Two {parr c.~s.t ~.t ~ /~• 8d' ^ ~ 98•Vo' a ~t/'~nc! of 3'x io7. /O; ,~ f r 3 30.0/ " BanGh h1ar,(~~ Tpp o~'i/'on /ot S~a~Ne. Assu..-~u~ ~ lei` = /c~.co.• c~ GG' ~aScrncnf .¢lt . 8.,.j. ~ Tp of/otSfa-~. E/ear. ~ ion. ~o' .r~-- :<-, ~3 l ~~ ~ i n~ ~ 3 s v L ~ _3 s ~~ 3 ~ ~ ~' S d -(-- 9 L~ i _~ .! 9 d 3 it S x `~ • / `: ~ ~. ~ o C~v ~'^ ~ n ~ M // ~ /~~ ~~ N ~ ~~ .- ~ .. .~} J ~ ~, ~ ~ ~ ~ Z ~ t ~ ~ `'+ w.% .~ D l d ~ _ scr •--1' ~ ~ 0 0 ~ a ~ ,~ d f ~ ~ ~ ~ M o ~ 9° S ~ ~ '^~ p ~ !~ n u ~ ~ -~- ~ D :~i /' ~ J ~.i d/ f~ °' d s bo ~ ~ ~ ~ ~ i N d J 0 Q~~ V~" r J ~,.N ~ ~_ J 0 N Io J J d a ~ \ v f .J f vim- \ ~ ' rr u L~ ~~ ~ \/, `~ / ~. ~o \ ~-s d V~ pp~ ~d" ~ - a ~ P ~~ , ~~ ~~ ~ ~ ~ ~,~ ~ ~~ d .^ Q ~ ~~ .~6 ~) _~ 0 r~' P^ Y a .,! ~9 u 4 n( ~` M rn "~ /so ~ S ~rce.t $o~" ¢vit/ua~'an Pit • /oca~ea(~p~oP. ~c ~ Ex :Stirs L~E/~ on 3 30, of ' ~a-bel ~-/CYO PfF/uent ~F'; lc.ei'Q~ S. T ou-t /mot • ,o~e~s~d Q lei of 6otxYlrr~ oFs•T = 87.sa.' \ BI 8~ 1"sul. too R/,c. ~~ o~P~ ~oree-Ka%n `9~0.'~~ ~e~ 97.09' ~~~' P- o g6 ~ bK: ld,~ Sew<.,-, ~opos~ d z b~dr~ ~v F'''~ 97.36' dwc/%n~, ^ 89 a3, 98. /8' ~ g7 y8.89 ~ • "~ ^ 9979' ~ppascd c.)c!/ ~F ~!l Eo 6.ePro/i a/e d- mininti~.:~ ~Z.`ovc.-• ~'sp~rsn.(ctl/ a s nteole~,/ s!o ~^''+P/y wig C'on/AVn</J~ Manus.Q 58D-~o7oS-Y(lI.O1/0~ ~ y9 Stand .~n/'ftra ~- c/o..,, 6~.rs~O~oPosed 4z~s' Q~ 2 /e~- . 95.65; Two •~e., ~.r et 3 'x i~• 8a' 330.0/ ' BanGh /'rlar~~ T p o{ ~~or~ /of SEaiC'e. f15Su.,na.e~ c fev` = ~G`~•Gt~' ~~ GG' ~aScminf ,¢/~. 8.,r/, : TP off'/oZ`5~,~. E/e~ ~ ion. 60' Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -- Comm 16.28 WAC Disconnect ~ 4 in. min. ~~ Tank component is properly vented Wieser Concrete Ca aci 603.36 Volume 16.76 Manufacturer Gallons gal/inch Dimension Inches Gallons A 18.00 301.75 B 2.00 33.52 C b.oo /cam Sb D 10.co J ,76 Total 36.00 603.36 3" E- Akemate outlet location Forcemain diameter 2 in. A Weep Hole or anti- B siphon device C P• ump off elevation (ft) 88.33 D Dose tank elevation (ft) un er tank. ~ 87.50 Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Goulds Pump Model Number WEO3H ~ ~ T Pump Chamber Calculations Force Main: Diameter 2" Length 90' Flow rate 65.00 alg /min. Friction loss 7.35' (90')(8.16ft./100ft.) = 7.344 ft. 2. Total dynamic head: Min. supply pressure 0.00' Vertical lift 6.00' friction loss 7.35' Total dynamic head = 13.3 5' 3. Pump selection: Manufacturer: Goulds Model number: 3885 WE03H Pump will discharge approx. 65.0 gpm @ 13.35' TDH 4. Dose chamber: Manufacturer & capacity: Wieser WLP 1000/600 combination ST / PC liquid depth: 36.00 (a~ 16.76 gal./inch (603.36 dal. actual) Sizing: A) One day holding capacity: 18.00" = 301.68+ ag_l. B) Alarm setting: 2.00" = 33.52 gal. C) Dose volume + flow back: 6.00" = 100.56 aal. (450ga1.)(20% Design flow) +(.164)(90') = 104.76 gal. Max. dose D) Reserve storage: 10.00" = 160.76 gal. TOTAL 36.0" = 603.36 gal. MkiENS EEEI ~~t ~ tJ0 O )u Q = 2!. V a z ~~~ 0 4 H O r. Pump Specifications '/:~ through 1'h HP Up to 130 GPM Maximum head to 123' Discharge size 2" NPT Solids:'/a" maximum Motor All motors feature ball bearing construction. Available in Single and Three Phase 115, 200, 230, 460, and 575V. All single phase models have capacitor start motors. Materials of Construction (;lst IfOll St~~inless steel 120 i10 90 \ HU i\ 0 \ eo „G hHP ~+NP to %t /fV, pE ; 20 '61U+~1 ~ ~ ..~ ,G 1 0 t0 20 JO CO 50 60 ~0 90 90 100 110 120 1J0 100 ~.S.GPM r 5 fam,: arsuta, cruse Fea ur s and Beneft s 'All models feature silicon carbide mechanical seal faces for superior abrasive resistance and extra long life. • Cast iron semi-open non-clog impeller with pump-out vanes for mechanical seal protection. • Rugged cast iron volute type casing adaptable for slide rail systems. • Corrosion resistant threaded stainless steel shaft. • Motor is fully submerged in high quality oil for lubrication and efficient heat transfer. • Optional silicon bronze impeller available. •CSA listed models available. U~ Underwriters Laboratories Pump Specifications Features and Benefits '/2 HP 'Glass filled, thermoplastic vortex Up to 75 GPM impeller with stainless steel Maximum head to 18' insert and pump out vanes for Discharge size 2" NPT mechanical seal protection. Solids: 2" maximum 'Rugged glass-filled thermoplastic casing and base design provides Motor superior strength and corrosion All motors feature ball resistance. bearing construction. Single phase: 115V 'Cast iron motor housing for efficient heat transfer, strength Materials of Construction and durability. Cast iron Thermoplastic 'Corrosion resistant threaded Stainless steel stainless steel shaft. • Available in automatic and manual models. •CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware o ~ ~. ~~ Q Q Q Q W O V ~ W X Q ~ ~ O N 1 W IJ Ui V X 3 Q ~' O - 3 rn tJ CT I~_ N -_I I~ N S m D Z v ~v v 0 Q z "17 O n 2 ~INVERT~ 7" . ~ Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites According to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, a soil erosion control plan needs to be submitted and approved prior to the issuance of building permits for 1 & 2 f ~ ' in those jurisdictions where the soil erosion control provisions of the Urnform Dwel ing C~~' ter ed. his Stan- dard Erosion Control Plan is provided to assist in meeting this requiremen . i.,_,.. `, 7 2002 Instructions: 1. Complete this plan by filling in requested information, completing the site diagra an~~rh~ \~ I' ~~~~~ropr to boxes on the inside of this form. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time of building permit application. Site Diagram Scale: finch = feet EROSION CONTROL PLAN LEGEND _ _ _ PROPERTY LINE _ _ EXISTING DRAINAGE -~ TD TEMPORARY DIVERSION FINISHED -' DRAINAGE _ _ _ LIMITS OF GRADING SILT ~ ~-' FENCE STRAW ~~ BALES 'Ia GRAVEL O VEGETATION SPECIFICATIOr ® TREE PRESERVATIOr STOCKPILED SOIL Please indicate north by completing the arrow below. I -N- I PROJECT LOCATION ~Yy nwyy, ~~ 3/~T ~9 A, ~P /7w , ~ cf /~.»mond /off' 3 CSnt doh /S J~1 S/A~9 BUILDER H~ ~~l ~~~~~s - -- '~ OWNER Tin Sc/~ /'e/6cr WORKSHEET COMPLETED BY-~+~rn / ~0~~°'~ DATE ~ a3 °~~~ ~ , ' ' ~ ` ~ ~ EROSION CONTROL PLAN CHECKLIST .~ .~ \~ Q~ Check (/) appropriate boxes below, and complete the site diagram with necessary information. F~ ~~ ~o/?o Site Characteristics ~C North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways. _/ ~`_, /Location of existing drainageways, streams, rivers, lakes, wetlands or wells. ,,e' Location of storm sewer inlets. _/ Location of existing and proposed buildings and paved areas. The disturbed area on the lot. ?~ Approximate gradient and direction of slopes before grading operations. ~/ Approximate gradient and direction of slopes after final grading operations. ~' ~' Overland runoff (sheet flow) coming onto the site from adjacent areas. Erosion Control Practices /~ Location of temporary soil storage piles. Note: Soil storage piles should be placed behind a sediment fence, a 10 foot wide vegetative strip, or should be covered with a tarp or more than 25 feet from any downslope road or drainageway. ?~ Location of gravel access drive(s). Note: Gravel drive should have 2 to 3 inch aggregate stone laid at least 7 feet wide and 6 inches thick. Drives should extend from the roadway 50 feet or to the house foundation (whichever is less). L~ Location of sediment controls (filter fabric fence, straw bale fence or 10-foot wide vegetative strips) that will pre- vent eroded soil from leaving the site. CY Location of sediment barriers around on-site storm sewer inlets. ~'~ ~ Location of diversions. Note: Although not specifically required by code, it is recommended that concentrated flow (drainageways) be diverted (re-directed) around disturbed areas. Overland runoff (sheet flow) from adjacent areas greater than 10, 000 sq. ft. should also be diverted around disturbed areas. '~~ JS LOCatIOn of practices that will be applied to control erosion on steep slopes (greater than 12% grade). Note: Such practices include maintaining existing vegetation, placement of additional sediment fences, diversions, and re-vegetation by sodding or by seeding with use of erosion control mats. /Location of practices that will control erosion in areas of concentrated runoff flow. Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through use of such practices as in-channel fabric or straw bale barriers, erosion conbol mats, staked sod, and rock rip-rap. When used, a given in-channel barrier should not receive drainage from more than two acres of unpaved area, or one acre of paved area. In-channel practices should not be installed in perennial streams (streams with year-round flow.) ~LOCatIOn of other planned practices not already noted. 1 1 r ~' ~ a c~a Q~c~ Indicate management strategy by checking (/) the appropriate box: ~a Q.`'c ~o Management Strategies ,,~~ Temporary stabilization of disturbed areas. Note: It is recommended that disturbed areas and soil piles left inactive for extended periods of time be stabilized by seeding (between April ist and September 15th), or by other cover, such as tarping or mulching. i~;/ Permanent stabilization of site by re-vegetation or other means as soon as possible (lawn establishment). Indicate re-vegetation method: Seed Ef" Sod ^ Other ^ Expected date of permanent re-vegetation:~wne J.~~3 Re-vegetation responsibility of: Builder ^ Owner/Buyer Is temporary seeding or mulching planned if site is not seeded by Sept. 15 or sodded by Nov. 15? Yes C~No C ~(Jse of downspout and/or sump pump outlet extensions. Note: It is recommended that flow from downspouts and sump pump outlets be routed through plastic drainage pipe to stable areas such as established sod or pavement. ~ Trapping sediment during dewatering operations. Note: Sediment-laden discharge water from pumping operations should be ponded behind a sediment barrier until most of the sediment settles out. ~l Proper'disposal of building material waste so that pollutants and debris are not carried off-site by wind or water. _/ Maintenance of erosion control practices. • Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to half the barrier's height. • Breaks and gaps in sediment fences and barriers will be repaired immediately. Decomposing straw bales will be replaced (typical bale life is three months). • All sediment that moves off-site due to construction activity will be cleaned up before the end of the same workday. • All sediment that moves off-site due to storm events will be cleaned up before the end of the next workday. • Gravel access drives will be maintained throughout construction. • All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized. For more assistance on plan preparation, refer to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site Best Management Handbook, and UW-Extension publication Erosion Control for Home Builders. The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available through State of Wisconsin Document Sales, 608/266-3558. Erosion Control for Home Builders (GWO001) can be ordered through Cooperative Extension Publications, 608/262-3346 or the Department of Industry, Labor and Human Relations, 608/267-9360. ~; SOIL EVALUATION REPORT Wisconsin Department of Commerce Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code 1179 Page 1 of 4 Certified Soil Testing Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must oun y St. Croix include but not limited to: vertical and horizontal reference oint BM dire ti d , p ( ), c on an percent slope, scale or dimemsions, north arrow, and location and distance nearest road . Parcel I.D. CSM Pending Please rint all inf p o ED R ev' ed By Date c Personal information ou rovide ma be ed for 5~ ~f~t ses P i La t 04 1 ~ IZ y p y ( l ( r vacy w, s. . ( ) (m)). ~~ /OZ ropey caner ll M B `~ ~ 2002 ope y oca ton , o ruce C G .Lot SW 1/4 NW 1/4 S 31 29 N R 17 W Property wner's ai mg ress ~NTY Lo # Block # Subd. Name or CSM OiX CC 1840 80th Ave. ST. CR FFICE 3 CSM Pending City State Zip ode P Cit Village Town Nearest Road Hammond ~ WI 54015 715-796-5491 Hammond 150Th St. }~ New Construction use: Residential /Number of bedrooms 3 Code derived design flow rate GPD _j Replacement Public or commercial -Describe: Parent material till Flood plain elevation, if applicable NA General comments and recommendations: no residence staked; 3 br assumed; shallow conventional system OK B-5-6-7 area; mound OK B-1-2-3-4 area Boring # ~ Boring /~ Pit Ground Surface elev. 91.9 ft. Depth to limiting factor ~_in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 ~ 0-5 10YR 3/2 - sit 2 m gr ds cs 1f/m .5 i .8 2 5-20 7.5YR 4/4 - sl 1 m sbk ds cw 1 m .4 .6 3 20-26 5YR 4/4 - fs 0 sg dl cs 1 m .5 .9 4 26-48 10YR 4/6 - fs 0 sg dl cs 1 m .5 .9 5 48-60 gR -> some gr co in orizon y rests ante o pene ra ion, very ig - weakly cemented ^ Boring # Boring Pit Ground Surface elev. 92.3 ft. Depth to limiting factor 46 in• Soil Application Rate T -, Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-9 10YR 3/1 - sit 2 f sbk mvfr cs 2f1 m .5 .8 2 9-17 7.5YR 4/4 - sl 1 m sbk ds cw 1 m .4 .6 3 ~ 17-29 7.5YR 4/4 - sl 0 m r-- mfr cw 1 m .3 .5 4 29-46 10YR 5/6 - fs 0 sg dl cs 1 m .5 ~ .9 5 46- 5 R -- ~ ~ y rests ante o pene ra ton, very ig -wea y cemen a ;some stratified 10YR 7!6 fs in horizon 4 Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BOD < 30 ma/L and TSS < 30 ma/L ,_ - - ~, ame ease nn Igna um er Henry F. Grote 222774 Address Certified Soil Testing ate Evaluation nducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 51 8/28/2000 715-233-0398 Property Owner M011, Bruce Parcel ID # CSM Pending P89e 2, of• 4 ^ Boring # Boring Pit Ground Surface elev. 89.9 ft• Depth to limiting factor 21 in. _~~ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. 1 0-3 10YR 3/1 - sil 2 f sbk mvfr cs 2f1 m .5 .8 2 3-21 7.5YR 4/4 - sl 1 m sbk ds cw 1 m .4 .6 3 21-36 ~., 2.5Y 5/3 c2p 7.SYR 4/6 l OYR 6/2 scl 0 m mfi cs 1 m NP NP 4 36-53 7.5YR 3/4 - sl 0 m mvfr cw 1f .3 .5 5 53-80 10YR 5/6 - fs 0 sg dl - - .5 .9 6 ~ 80+ 50% g poc ets s m onzon ; gr co in onzon ^ Boring # Boring Pit Ground Surface elev. 94.5 ft• Depth to limiting factor 21C in. Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-7 10YR 3/1 - sil 2 f sbk mvfr cs 2f1 m .5 ~ .8 2 7-21 7.5YR 4/4 - sl 1 m sbk ds cs 1f .4 .6 3 X21,-27 7.5YR 4/4 - scl 0 m mfi cs 1m NP NP 4 27-64 2.5Y 5/3 - scl 0 m mfi - 1f NP NP onzon 4 as irregu ar an s strati ie 7. 4 s rom - 5 g 'Boring Borin # -~ Pit Ground Surface elev. 98.9 ft. Depth to limiting factor ~ 76 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-8 10YR 3/1 - sil 2 f sbk mvfr cs 1f/m .5 .8 2 I 8-23 10YR 4/4 - sil 2 m sbk mfr cs 1f .5 8 3 23-33 7.5YR 4/4 _ sl 1 m sbk mfr cs 1 m .4 ~ 6 4 33-45 7.5YR 4/4 _ Is 1 m sbk mvfr cw - .7 2 5 45-46 5YR 4/4 - sl 0 m mfr cw - .3 .5 6 46-76 4/4 - sl 0 m mfr - - .3 i .5 onzon is an irregu ar an iscontinuous m p aces ~ `tS.~s __ `~° 'z~ ~-6 • z `Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8130 (RA7/00) Certified Soil Testlng if i . ~ ' Property Owner ' M011, Bruce Parcel ID # CSM Pending Page 3 of 4 ,~- gS.iS ~~ ^ Boring # Boring ~ Pit Ground Surface elev. 97.5 ft• Depth to limiting factor ~ 70 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-4 10YR 3/1 _ sil 2 f sbk mvfr cs 1f/m .5 .8 2 4-12 10YR 3/2 _ sil 2 f sbk mvfr cs 1f .5 .8 3 12-25 10YR 4/4 _ sil 2 m sbk mfr cs 1f .5 .8 4 25-30 7.5YR 4/4 _ sl 1 m sbk mfr cs 1f .4 .6 5 30-70 7.5YR 4/4 _ Is 1 m sbk mvfr - - .7 i 1.2 ___.____-_, onzon as occasions s me usions strati ie gr co - 4 Z3 ~~ ~ . Boring # Boring Pit Ground Surface elev. 96.7 ft. Depth to limiting factor 50 in. -~~ Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 1 0-4 10YR 311 _ sil 2 f sbk mvfr cs 1f/m .5 ~~ 8 2 4-12 10YR 3/2 _ sil 2 f sbk mvfr cs 1f .5 ~ 8 3 1 12-25 10YR 4/4 _ sil 2 m sbk mfr cs 1f .5 ! .8 4 25-43 7.5YR 4/4 _ sl 1 m sbk mfr cs 1f .4 6 5 43-50 10YR 5/6 - Is 1 m sbk mvfr cs - .7 1.2 6 50+ BR onzon as some gr co y resistance to penetra ion, wea y cemente Boring # ~ Boring f Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots -- I ~ I ` Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Certlfied Soil Testing 3 ~ ~~ ~ S a 0 n, ~ ~ ~ 3 s s ~~ ~ 3 s ~~s D 0 s d --(- 9 I ~~ 1 d ~. ii, sl `~ / _~ ~ ,- ~ ~ o ~~ ~• ~~ c~ fi ~. .. ~ M ~ N ~~~ ~ ti ~ ~ ~- ~ o .~ f d ~~ ~ ~~ di f/ o ~ d s i ~, '~ ~ ~ d N cT J 0 r} '''''i' a r o N J \~~N 0 2 ~- ~J N ~-Y 1 ~ ~~ ~ : 3 ~. J ~ ~ ~. ~. ~ `. ~~~ f ~ t r 7~ o! ~ ~ ~,J `mod .~ d J d " ~ ~ r~ ~ a .~ -~ ~ ~ 0 :. ~ ~-; ,~s ~ -~ o ,~ a ~ ~] d I / o' ~ \ u .n 9 ~ ~ u ~~ 'C+J J \ c~ / ~ t f'' ~. ~ ~ .~ -r P `~ ~3 ~ r d `r~ ~~ .~-r ~1 .~ 0 r^ ~3 a T a .! _9 N 4 g~ ~ M r..J 1 9 • , Property Owner Moll , BrDCe Parcel ID # CSM Pending Boring # /Boring Pit Ground Surface elev. $9,9 ft. Depth to limiting factor in Horizon Depth i Dominant Color Redox Description Texture Structure Consistence ` Boundary n. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 1 0-3 10YR 3/1 Page 2 of 4 `~ Soil ADplication Rate - sll 2 f sbk mvfr cs 2f1 m .5 .8 2 3-21 7.5YR 4/4 - sl 1 m sbk ds cw 1 m .4 .g 3 21-36 ~ 2.5Y 5/3 o2P 7.SYR 4/6 10YR6/2 scl Om mfi cs 1m NP NP 4 36-53 7.5YR 3/4 _ sl 0 m mvfr cw 1f .3 ,5 5 53-80 10YR 5/6 - fs 0 sg dl _ _ .5 9 6 ~ 80+ 50% g po ets s m onzon ; gr co (n onzon ^ Boring # ~ Boring Pit Ground Surface elev. 94.5 ft. Depth to limiting factor 21 (n• Horizon Depth i Dominant Cobr Redox Description Texture Structure Consistence ~ Boundary Roots Soil Application Rate n. Munsell CRr. Sz. Cont. Cobr Gr. Sz. Sh. 1 0-7 10YR 3/1 _ sil 2 f sbk mvfr cs 2f1m .5 .8 2 7-21 7.5YR 4/4 _ sl 1 m sbk ds cs 1f .4 6 3 ~1,-27 7.5YR 4/4 - scl 0 m mfi cs 1m NP NP 4 27-64 2.5Y 5/3 - sG 0 m mfi - 1f NP NP ^ Horizon 1 Boring # Boring Pit Depth Dominant Cobr in• Munsell 0-8 10YR 3/1 Ground Surface elev. 9$,9 ft. Redox Description Texture Qu. Sz. Cont. Color - sil Depth to limiting factor Structure Consistence Gr. Sz. Sh. 2 f sbk mvfr ~ 76 Boundary cs in. Roots 1f/m Soil Applicaton Rate .5 I 8 2 i 8-23 10YR 4/4 - sil 2 m sbk mfr cs 1f .5 ' .8 3 23-33 7.5YR 4/4 - sl 1 m sbk mfr cs 1 m .4 g i 4 33-45 7.5YR 4/4 _ Is 1 m sbk mvfr ctnr - -7 ~2 5 45-46 5YR 4/4 - sl 0 m mfr cw - .3 ~ .5 6 46-76 4/4 - sl 0 m mfr - - .3 ~ .5 ~- ~s.~s onzon is an (rregu ar an isco ous (n p aces --- 'Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BOD < 30 mg/Land 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. Certified Soil Testlng S d 9 ~-, i ,i• 1 9 d j s r _ ~ f ` `! ~ ~ o "' ~ s ~~ ~ M / ~ ~ ~~¢ ~ ~. f ~ . ~ Q' Q ~J d d / ~ -~ ~- o ~: / ; d c 0 0 ~...~, J `~fJ 2 ~--~ it ~ ~ 0 N 0 J J N 1 ~` 3 ~ ~~ F j d ~• v J ~, ~ J ~~~ ~ s+ G 3 ~ w.% a,~ ~- d j ~ ~ a 0 J ~ ~ f .! ~ ~ ~o f 0 ~ ~ ~ ~ . c~~ ~ ~ d I / I ~ \ v .n ~„ ~ \ ~ rt ~- - ~. .~ ~ `~ ~ ~1./ r d ~~ ~~ ~ ~~ \ ~ ~3 ~ P 1 ~~ ..a ~) .~ 0 r~' ~3 3 T a ..! ~+ 0 0 ~L M s 9 ~ ~' , ~ Gt~f /D ~ ~ - a y7y~ ,~~ti . ~ C~~B- Ob4 Old -/o ~/ ~~ 8 ~ ~ ~S~I ! ' 1 c - G o(~ 9 -- ov - 3cr~ ~ 7 y~9 -3 ~ , ti ~~7 j~' o ~8 "/a8~e' 645866 O S y~ ~ . ~ ~-3, C.sm rr~ D/8- 1D~4-o ~~ 0-aoo ~(7Y~ ~(1 Ma Orb- /064- oo- SGod ~7 y~-ya ~ ~~" a 1 Cs~rt rS/~/~S ~. ~ s ~.~~' ERTI FI ED S V RVEY MAP ~ATED IN PART OF THE SW7/4 OF THE NW7/4 OF SECTION WIS NSIN CROIX COUNTY MMOND ST F ~,,, . , , . ..~ 9N, R17W, TOWN O HA NW CORNER BENCHMARK© LEGEND SECTION 31 SE CORNER BRIDGE CONCRETE CURB ~ ALUMINUM COUNTY SECTION CORNER "' OWNER ELEVATION = 989.32 MONUMENT FOUND U.S.G.S. DATUM " " ~ 1 BRUCE MOLL IRON PIPE SET WEIGHING X 24 O u~ 1840 60TH AVENUE 1.13 LBS. PER LINEAR FOOT HAMMOND, WI 54015 100' ROADWAY SETBACK LINE (OR AS SHOWN) ~ ~ DOUBLEMSPKKE m MASONRY NAIL FOUND ~ ~ o IN POWERPOLE OO 1"STEEL SURVEY MARKER FOUND ~ ~ w I ELEVATION = 989.33 U.S.G.S. DATUM (N7 Z ~ MG~JP~44C~D ~~1D~3 OMn1~lGD ~ ~ OO 4GJC~G°3~ ~ ~ ~ g B ---_-___---~----~-_-_---_~___-__-_---~----__- NORTH LINE OFTHE SWt/4 OF THE NW1/4 ~ S89°24'2~.1673,16' 1`` r m M ~ i wl w z ,n i i~ ~~ ~ 33.00' ~ ~ ~~~ ~ ~ ~~ P POSED ; ~~ , DRIVE ` ' `~ ~~ S89°°~ 38"W 363.01' •` sa ., 33.00' • 330.01' P POSED ~ ~17~(~4^'3~ ,., DRIVE LOTS ~ gg ~' ~ • IN,~T~ ~ `~ HIGH WATER LINE ELEVATION (DETERMINED FORA 10X0 YEAR X `~ FLOOD PER NOTES ON THE HYDRAULIC REPORT) WAS DERIVED `~ FROM A HYDRAULIC REPORT DONE FOR THE 150TH STREET /yjGH~q `~\ BR`DGE. STATE PROJECT ISD.ou 7H BRANCH ~VHF~ ~~'~~, KINNICKINNIC RIVER ~~2' ~~~ ------------------- `~ CENTERLINE OF • ~~~ LOCATED SWALE -~ "---v---- -"'- .~ ~~ 1"` r ~~ ~ ~~ z 'oo ~ ~ '~3.w 330.01' \ Q~ .-200.00' ~$ JOINT DR E EASEMENT ~~ ~ ~ ~.200,p0~ ~ FOR L TS 2 AND 4 ~ .+ ~ 330.01' &+ BORING ~'j 33~ S8~°,3`~',3~'V~13, ,01; LOCATION ,,, ,~ (TYPICAL) ~~ N N ~ ; LOT 2 "• ~; ~ y7yg -~.d $ ~~ 33.00' : ~ S89°39'38'W 363.01' w~i ~~ 330.01' • 61 ~ P POSED ; y7y,¢-/~ ~ „ ~~ DRIVE 'SEE NOTE B • • Z (~~ $ $ I LOT 1 $ ~~ g g ;SHED ~SI-L IO ~ ~ 33.00' ~ 0 I i BARN ai ~ N8~9'38'E 363.01'. ~ RUINS ~i 3.25' ~ ~ N89°39'38'E ~ S00°01 FR"14~ '- o ~ EXISTING - 170.00' DRIVE I > O~ FOUNDATIONS N89°39'38'E ~ 256.25' SEE DETAIL w, i. ~no~iro .\ ,` _~~-__~ LOT AREAS LOT 1 2.00 ACRES INC. RNV 87,122 SO. FT. 1.82 ACRES EXC. R/W 79,202 SO. FT. LOT 2 2.00 ACRES INC. RNV 87,122 SO. FT. 1.82 ACRES EXC. RNV 79,202 SO. FT. LOT 3 2.00 ACRES INC. RNN 67,122 SO. FT. 1.82 ACRES EXC. RNV 79,202 SO. FT. LOT 4 34.58 ACRES INC. RNV 1,505,530 SO. FT. 34.24 ACRES EXC. RNV 1,491,428 SO. FT. EAST -WEST 1/4 LINE 1111.14' N89°39'38'E 1113.14' w U w w LOT 4 `~•~ ~ ,g ., ~d OO~~ ~~ UW ~~ ~ . ~~a0 c7 0~~9~ ~.~~o~ Q~ ~ ~m Q~ Z~~~~ ul Z ~~ OO J O ~~ Z ~~ in ~? vi ~ ~~ Ww 1 O r O w m ~.' ~~~ ~~a.o~31 Conventional System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10567-P (R.6/99). Al] local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 1 13, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alartn, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is not recommended. Soil compaction may hinder aaration of the infiltrative surface within the system and will promote frost penetration during cold weather months. Cold weather installations (October- February) dictate that the system be heavily mulched for frost protection. [nfluent quality into the system may not exceed 220mg/L BODS, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Contin~ency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by removing biologically clogged adsorption and dispersal media and replacing said components as deemed necessary or by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to your county zoning or health inspector. Pg. 4 Of ~ Z0~ ~ , ~ ~ ~9ti 8LL S TL : WOtId :oi sv:6® a0-60-ZT ST G'ROIX COUNTY SEPTIC TAI~IIC ~NANCE AGRBBMENT AND OWNERSHIP GBRTIP`ICA'ITON FARM ..~-° _ o Owuer/Buyer f I~ ~ ~~ Mailing Address Frvger'ty Address City/State LEGAL DESCRIPTION I'roperfy Location ~,~ '/<, ~L~ , %, Sec, ~~,,,~, T L N-k~,~W, xawn of ~ ~ X1`7 (~l ~ f ~ J - Subdivisiozl _ ~5 ~/a~/S f/~8 Lot # # Co S~~~Co ~ Voltunc /s ,Page ## ~0~~ Map Certified Survey , . ~ 9~~ 3 ~ Volume oZ ®y9 .Page # ~ ~~ Warranty Deed # 0 . _ . Spec batlse ^ yes ~no Lot lines identifiable ;yes ^ no SYSTEM MAINTENANCE Iuapraper use and maintenance of Your septic system could restilt in its premature failure to handle wastes. Proper mainteman+:c consists of pumping out the septic tank every three years or sooner, if needed by a licensed p=~ r- what you put into rho system can affect the function of the septic tank as a ueatmeut stage in the waste disposal system- The property owner agzus to submit to St_ Croix Zoning Deparunent a certif cation fotYn, signed by ~ owner and by a master plt~bcr, jottrncytxsan plumber, restricted plumber or a licensed ptunp~ verifying that (1} the on-site a~asstewatcr disposal system is izt proper operating condition and/or (2) after inspection and ptunpirtg (if necessary), else septic tank is less than 113 full of sludge. Ilwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system ~~ the standards set forth, herein, as set by the bcpartmezit of Commerce and the Department of Natural Resources, State of Wisconsin. (^crt~Cation staring that your septic sysicm has beers rnaintaincd must be cotnplctcd and reformed to the St_ CYoix County Zoning Ofrcc witbin 30 days of~the three ycsr etcpiration date. ~_ 7 " ~ ~~~ DA'I~ f O~ GNATLFRE QF APPLICANT dW1~IER CTRTTFICA'I'IO1~I Y ( ) am are the avmcr(s) of 1 [wc) certify that all statements an this farm are true. to the best of m our knowledge. I (we) ( } the pra~aerty described above, by virtue of a warranty deed recorded ira Register of Deeds (}{lice. S GNATCFRE 4F APPLICANT DATL ****•+ 1\ny inforntatia~t that is mis-tcpresertted tstay rC~ult in the sanitary permit being revol:cd by the 7-onin$ 1JeP ** Include with this application: a stamped warranty deed from the Register of Deeds office deed a copy of the ccrtificcl sttrvcy snap if reference is made in fire warranty ~ U-r~~~.~t~ n (Verification required from Planning 17epartmcnt far new Farael Identification Number =d WHYS:'?(=1 ~C6~? E~1 'c'~Q ~ti9b `c~LL ~Zc'_ 'ON Xt~~ ,~NI JNIlh(ld~n~ NI]SIl1HW WO~~~ t , ^c.Od~ ~ c Ei4b 8LL SiL:WO233 Aec C32 Q2• C7~: ~9p ~l 20~i9F Q;~ STATE i3AR Q£- WISCUNS[N l=ORtvL L 1999 ~au~enc ~U@~r ~ Vti'ARRAI\iT~' DFFX? ~ttis ~?eed, made betµ~en Tiara E usek. a sinsrle oerson, Grantor. znd 'I'imothY d. Schreiber.-a sin~Ie~ersnn, Grantee. Crrantor. fvr 2 v3iuable coasideratian, oanveys arstt wa: raTtts z~ t,rtutice tlzc i,Y[law-ti-,g dc~rbed real, es:~ta ~:¢ 5t. ~r C.aumy, Slate cE ~viscansut {the "P:ogerty"} {ii more spati:t is needed, plaasc attach addendum}. I,vt ~ f Certified S'[:rvey Map, Frled M8y la, 2iK1I :n Volu[]~e 15 of Certified urvey YLaps, F,~e atJ88, as DacLmcnt No_ 6,5866, rotated in par[ of SW of LYWtFi of Seccioli 3f. Tawstsi~ip 29 North. Rutge t7 ~v'rst. Sc_ Croix Ccn:nty, vuisr:Unsia- RnrorrCirg Area 01 t~b:60 Z0-60-ZT p, 2 ~~~a~s lfA~Fli..$E$ i[. iFALS{f R~IS'f~ 4~F B'E£4S S1', CR~JI~ CO. , Mi 3Z/I5t2O@2 63:3~Alf E'>'~+i # )?EC FEE : 11 _ >~ Y ~~E: L~2T GQPY F~£ PAGF-S; 1 ;game and Rea.rr .43Ccr-zs 1:'irS% til2t~p"_`c3~, ~2iik C-' \E-,d R'_chu:~nc! a~ ~~ gg New F,ictltrG>af 4s~ ~flG~i? Together w~cl, att appurtensut rights, iicte a»d inLCreats. _- .li.Ia69-11Q-1Xlp Parul IdG.nScarian I`amLcr Lplh'ti r!)IS _ ~s iloc ~bomestcad P=oPCS~Y (is rxx} Grantor tvarrant~ that the tide ttr :ttc Property is ~ocxi, inciefexsib(c m fee simple and free a_ntI clear a:- ca:.utnbr::nCes except Lisps, BJtCtlrnbrstJZees, resiriCtioxts Of reCard,)) if any. 4aied this '~ day ^.f i' i~ f,~ d :1uL.k3.Y.~--- . 2M5]~ -- A.'L"~HE1r'FSCAT~O`Y SigtS;~t urc(s j au[ttzncitaccd Chia duy of ACIC~S:l~1'I~F1?G1~i1~~'T ST'~iTE QF WISCQYSF71 j TfTI-E~ ;vt£MBER STATE BAR OF WfSCQNS(DT {If nut. _ authorized by §~706.tXi. Wis. Sc:s-j~~ !~{~ ~t$T~'~11GCEtYJ ~A~ i1>~f1~1~ ~Y &tir„~el ~. dac~hsan, iiaxc:mear4tck 4(ureaY lie Jacuhacut, S.C:- 714 N. ,~1ain St., F.O_ Sos 467, I2ivrr Falls, WI 5x022 i$ignarurca may he sutP~pticuc,l or zel~wwLa,tgcd. 8rti arc np[ ge:cessary.j 14aI~1C5 Pf ~'rso,i5 aiXrllns' is 7f1Y W.~I2Yta:\Tl' VEF.'I? ~~(.yt:l. J~ ~{hett>,btsjtau'zcd ~~t n ~•. _ . ~f _ ~- rd one Irnnwcc rQ bn chi persorts~ wh ~ rAd,th~.forCgucug`:~y 11Y~' ~_. iftstrumcpt :u>~ cknawt • ged d, ;ty = . - ~ ` - ~ '~ ~ °_±= - hL,x$r}' Public. Szat_ of hi~9L-`Sin__ -:::.::.~•.• . -_ . My Contnzissiorx is ptr:r.3trer:t- tIf nai. 3[h[r cxpirati4r3 date; I~ ASS".~~~.~..---'- ---° .. -_. -_LOF]]-- -_ ~J i msc tx tyyed or pc ~nma ticlP~v {tVClr s[6Pa01ra_ l:1Lr.:;l~:;o~ .r^ro7Cl:~py!`~ Co . F.tn(I dv Lac. W i STn'1'E QNi OP WLSCO[rSLV ryyl~a5~ :alt FORH No. [ - ~ 999 Pezsgttslly rime be:'dre me rztis f~ ~-aay OC t1 ,`,~ W(~«:SGJ ~C~G~~ E7 '~'3Q Lti9b E~~Z ~TZ 'QN ,{tip 1NI ~1NIlHi^t~1n~ NOSIl1HW WO~~~ . , , ~, Olii.3-'U3 ':410' 15:27 Fat 715 3811 ~EiBG ,, ~~ ~17~d~30 ST CRT CC] Zt:1tiI'\G 1~jntii ~~ ~ j'~•."_ Safety ~~. Buildings D:~isio,n Sanitary hermit Application ~,_ ~o:; ?~u~ _ ~~~~~~~~~ `In aocord with Comm 83,21, Wis. Adm. Code Madison. `v'.~ 53?n?_-~,u^ =_~~rcr,-cat o• comrnaro~ :Personal information you provide may be used for secondary purposes 'I (cubnv; c~mpletec '_~. -. to L gut`:} i` rc w (Privacy Law, S. 15 U4(1)(m)] ~ / ~" - ~._st~[ o'•~-t ~ '~ %t,tt:`. Con1 Ict la s ("to the count ~ co ~ only) fur the svstcm, on a er not loss than 6-1!2 x 1 1 inches in s;ze State. S•nltary Pcrrii[ `rurrhe~ ^ Che~~ it rcvison to prr~-ious app'r;cz:icr. _ _ ,~~ ~ S~.rc P;an !. D. tiur,_c- ~8~ ~o t L .a licatinn Information -Please Print a3I Tnformatiotl location: _ _ x C,i, _. `a.^c c,r._r. F'rOpe'~ty Location ~.~c~1J:~71G/ ~ - z~177 , ^ c ~ur 'i$ 'r: nr;'T', :J'.t ;'... _ ~;='.. . ~, Ga Lot `UTI':b Cr t3.__.. ):.: T~~^,. d - ' ~} / y ~ • 5 ~ G ,~ " ~p ~" ~ ~' - ' ,. ;:~,_ 'ip t_Ol~^_ i ~~~9Ft=~C~+ t Subdivision Nxr"~c o• CSa~'~,.•.i':,~,'~~~ 0 (:~ n ~ ~ t,c~ ' ~ D~3 c 3 7 3 ~~ ~P is ~08~ 11 T~ pe of Fitlil~ 111Q: tt:heck one) / / ~ ~ City Q L1;lage Ur 2 =aril:i~ U•,,c~::,-tg-lra. ofDedrooms,_ LzYloi,r of / ''~L':~~ C~.r~ricrcr,a (cscribc use): r1 d 'I~ ~ ° L J '>[stc-l%11'riel~ 7 / j ( Il7l ?'mit: ;;+~izcck ani,~ one box on line A. Check box on linr. S if applicable] Pe III '1 ~'i~z of Nearest Road ~~Q,~Q ~G~ ~ ~ ;~) . f~f tie•,~ wys:cm ~ ^ Rep':ace.ment 3. ^ Replacement of 4. ^ Addition to ' Parer, pax ~um;~rr:;s; ~~ ,~7p 9- C~-~ ~!~-/D( :em System Tank Onl " Existing S 's o _. Permil'.v`umbc; 33} '' Ualr sS.:Cd _ - a. San:t~", Fr:rlit ~.{ras rcvrou5?v ts'SUed l~'. ~ pe of PO«' I" StiStectt: c'hc~k all that apply] ~ ~'n.e-~°'~ ~ ~' 1 D/ 3 X /4~ ' /6 r/~. ~'.l~ ; ~'~ ' rr-~re5~.,. ~ ~ lr. ~~~~lr.a ^ titound ^ Sane Filter etia:Td ^ Cons[r[:eted t~ ,urn. ^ Holding Tank ^ Single Pass 'r-"ss.xi~,rr~ ., - ^ Drip Ltnc _ _ " . ; ,r;;; ^ Aerobr Trea[rtien: L'r.rt ©Rec(rculating C Qther: `' L7t5Lurs31 Treatn;ent area Infottatation: ~s0 d. =o.3~pP.re+fe - 152iy ~.}'~. r 31.1~,,~~ ~x:~,,~,o~~o(~d~n~+'H1+4•~q' ~ ~9Ch~•.r ' ~~ ~ , (',;, ~ :;; :. P ~cr;a:~arca ~=±-•Uispersa Area ! 4, Soil App'.car on ~. Pcrco.atian l±y:c I G. Sys:err. l=le~at+o: i ('I 4J'.+L,: " ~ ~ ~ ~' ~ i La hecu.rrn ~ Proposed 'RatefCjals.,tlw~sq t;.~ rnlm.:ir.ch) ' ' u . . . . ~S~ 9~sf0 55' 5 ~5~3,90 "~. 0.3 .~/~ /~~. ~ , ,s~•o~ .~ ~15 . ,9y 9 1%I 'T`ank Cspaciky in To[al ~ of vlanufacturer Prcfzb Sit c; ~ txr• F~:,;.:.~' f t:firrmatfon __ l3allons i Gallons Tanks' Con- ~ cute ' ' ~ E Gon• glass structcd a ti arstinn i //]] ____,,__,, L ~ ~ ~~ C ~ ~ j .O~'7~ ~ ~ ~ ~ . ~ u, L;P r VII Respon5t6ilit. State-nent ~njersiTnF:~ ,as,imc resnon~ibilit ~ i r installation o e PUWTS shover. on the attached Qlans. _" _ __ .'!.rune f'~+< c .,l rc:: ' Plum is Sig-alure f" s ipsi: 4(P~MPRS tio, ~ y7~ ~? -~"~ $usiness P'r~o.,a ~u~racr (9/SJ ~~~~ ~/~~ . arc. ~ _~G C -_ . :r,.~ ._. ~ .a~.irrss :".. _ ~ ~ i:~r 5i^,lt' Zin (' e) . ~%IiI Coutitl'T.lepartment Lae 0111}' __ ~iya~, r~~;e~] ~anitaryPermitFccilnc':uciaiGrourlr.'.~va:er Date ssucd ! Is}c[tingA$c Sia ui;c• terms; ~~ ~„ ^ , ~~r v,vcn Ini;iai Adverse .Surcharge Fcc'; ~+ ~~ j~'a~~! ~ ~ ~~~~ ~ ~ ~- ~ ~ '~ c I~. (`nnditions of Approt~~.t3 iRessons for Dis:tp rQVal: /} gr, r ~, ~ r~ ~ L~ h ~ - ~ ms s~ t t << ~, s . C---r , 1 ~ +~ _{ 1.. - -' .~ .1 r.... fL ~ , ~ -i.- L, s `tr r. ~ n ~ ~~ ,.+. ~.n ~.w.C; ~ Aaw.n 2~ ~~ C S 0.1 ~i ~/ SRS. ~~~.~ s. ~3f ~i ~ ~ W9(J~~ ~- c~-~ ~ N~~£-+ '~ e.ti.~ - `C''' ~ aw ~cr'uv~*~Y~-ter . J ~P ~ c~t S ~'~ vw.aus.x;-. 3s~- `~i h£.c~ J . '~°D ~.~~~..-v~,.._ ~kS~~~ l ~ ~aG~ ~'~~i44 ~ ~` ~_ t,,,, o~+i~ .. 6 Q r -fir ~w~ ; : ~..a~'t~ a,~ ~~~ ~~C ~. ~ c9 u. ~.~f Y i0d , ~`, 'v Ei9~ 8LL STL:WOtI.3 ~C.~1'1~115~~'` 1' City !State: ~`CC~ 1rYl ~Y1_ t41~ ; , 1 Site Address: ) ~P~ `t`h ~-~ Lot #: i Directional Notes: {vrint) ~ ~'Nt l-EA'M M~ N ~ . ~d 1_ ~ . t"1 tt~ 6 >~ Cry -a '{ C'> '] Q`t'`n ~~-- - - -- O ~J 1r.~_ ~ i Oif-site Truck Par4cing ~.acation (also show on map) :OZ ZE:Oi Z0-60-Zi Qrde~ ~~d~ O Date Map `d Builder ~~ Qu~t~~~tS Contact: Q ~r~C-~, Bus. 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