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018-1089-01-000
Wisconsi °±artm~nt of Commerce PRIVATE SEWAGE SYSTEM Safrty~~l i~? ~ 4ivision ~' INSPECTION REPORT Gl:~IIER/tC. INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Skutt, Jason & Lori Hammond Townshi CST BM Elev:/~ V - Insp. B~tM~lElev: t OD ' ~ BM Description: S~ o~ ~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~) roo6 Dosing ~ Lv ~~~L~.f~ ~ ~ ~ ~-r7 Aeration Holding TANK SETBACK INFORMATION TANK TO ~/" ^L_ f, I W ~ WELL .BLDG. Vent to Air Intake ROAD Septic o / ~'W) '~r~/ C1 e ' Dosing ~ ~ ~ I Aeration Holding 1 1111\I!1/•~1l111A\1 1\II~AA\~ ATIA\1 rutvirrarrnvrv uvrvr<mr+i wrv u - - Manufacturer Demand GPM Model Number ~ / /~~ ~~ TDH Li~ 2 ~ / Friction L~oss~ Systemlieat~ TDS ~Ft 5 `~ h 5 , Forcemain LerJgt~ / Dia. a Dist. to ;II ~ ~ SOIL ABSORPTION SYSTEM county. St. Croix Sanitary Permit No: 420571 0 State Plan ID No: Parcel Tax No: 018-1089-01-000 Section/Town/Range/Map No: 31.29.17.706 ELEVATION DATA STATION BS Hf FS ELEV. ~ ~~// 1I Alt. B M s-r C~ is Bldg. Sewer ~ ~ ~ f d '~ ~ OVe I SUHt Inlet St: H '~ i1 r7 ~ o ~ /r f9• D SbHt Outlet ~~ r Dt Inlet ~~ Dt Bottom v q ~ 1 Header/Ma~~ ~ // P 31 g ~d Dist. Pip ~~ /~ s~~ ~ ,r 3.~5 t!o3.2~ Bot. Sys~m 11 ~++ 0• S 1'-'t r !~ V l 2 ,7 Final Grade ,}. ~ ~~ S st Cover 2, 3 ~ ~ ~-~ ~ .q $ ~ o Z. / ~ ~~-I'X fIZ •S• ,,, BEDITRENCH DIMENSIONS Width ~ Length ~ No. Of Tr~nc es ( PIT DIMENSIO o. Of Pits Inside Dia. Liquid Depth '~ G SETBACK SYSTEM TO P/L5 BLDG WELL LAKElSTREAM LE G Manufacturer: INFORMATION `CHA OR Typ O System: (~/ `` ~ j l ITV ~ ` ~ ~~~ ~ NI Model Number: DISTRIBUTION SYSTEM ~~ ~~ Header/M d Distribution ~ i ~ / x Hole ize x Hole Spacing V~ Air Intake -~ P pe(s) ~~ /i /~ ~ ( 2 •~ ~ j 1 / / b ~ Length Dia - Length ~ Dia Spacing! ~ /(o • a SOIL CbVER x Pressure Systems Only xx Mound Or At-Grade Systems Onlv Depth Over ~,,, Bed/Trench Center Depth Over Bed/Trench Edges xx Depth of Topsoil xx Seeded/Sodded (J Yes ~ ] No xx Mulched f ,] Yes [~; No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / 5 ~ Inspection #2: S /l~-.~ Location: 647 150th Street Hammond, WI 54015 {NW 1!4 SW 1!4 31 T29N R17W) Sunny Hill Lot 1 ~~ Parcel No: 31.29.17.70 L~"~~~' ~ 1.) Alt BM Description ~ ~~~ ,/ (l'1tiC,5-~y~ (~~, ~ i i 1 ~_~~ ~~~ 2.) Bldg sewer length = ~ Z~r *" ~~ ~'GC~~ ~~,~ ,~ ~ ~ i /)W ,~. ~ 4 Gr// -amount of cover - ~~.~ ~1 - I - d~~-t~C` ~u~Kl - U 66 7 / `~~~ 3.) Contour = ~ ~ Z (S t~ L•.rGQ1L hP Plan revision Required? j ""?. Yes (-~ ~~- 'lj ~ -- - - -~- ~-_-- - - ~ -l~, ~ -- r- - - , Use other side for additional information. i_~ ~ v ~ __-,. - --- - -~_---~ 1~ `C' ~---I SBD-6710 (R.3/97) Date Insepctor' Signat re Cert. No. CP~~- ~- ~ ~ ~ ~~ 1~ 3 } ~~=' . Safety and Buildings Division County ~ k~ *-~ ~.r „ ` 201 W. Washington Ave., P.O. Box 7162 ,~'"~+ ~ lvladison, WI 53707 - 7162 Si[e Address ~_ D~ artment-cif Ccammsrce ~y7 /,S"b~ S T `Saarlitary Pern~t A l ti SanitaryP e rmit Number ~ag7 Ca on In accord witli Comm $3,21, Wis. Adm, Code, personal information you providz G ~ I '2"v ~~' ~ heck if Revision ma ba used. for second ores Privao 3. Appiieation Iuforruafion -Please Print All Informatio State Pl e ~ ~3~~" Pr ~ ner's e. MAR 2 0 ZOOS _ Pte/ g ~/a ~'" o/ -poc [. 706 Property Owner's ilittf;l4tldress ST. CROIX COUNTY Property Location ZONING OFFICE ~ ,{~ ,/,, S ~ T N, R City, State Zap Code Phone Number Lot utnb r Block Number ~ ~ ~- ~Q f~ ~~ ~~ Subdi ision Name ~ CSM Number r ' IY. Type of Ruildiing {check all that applyl ^Ci ~ ry I i or 2 Family .Dwelling -Number of Bedrooms ~ ~_ ^Village ^ PubliclComtnerc Des a Use • '~ , ^ ~ ~ Township State Owned / Nearest Road ~• '~Pe of i' . (Check ~Y otte b~ on line A (ntunbering scheme for internal use). Complete line B if applicable) '~. 1 New 2 ~ Re lacement strut R '~Y 3 ^ Re placement of 6 ^ AEldition to For Cotu-ty use S stem Tank Onl Exisdn S stem B • if Sauitarir Pextnit Previously Issued P°~ Ntunber y~o Aate Issu d IV. T`y'pe a€Permit:: jCheck all that appl ~(nttmbering scheme is for internal use) ~ ~+ ~ Non-Pressurtzettln Ground 21Mound . ' 41 ^ Sand Filter 50 ^ Constructed Wetland 2 % D Press~t'i~d iu•Gr4und 41 ^ Holding Tank 48 ^ Single Fass 51 ^ Drip Line 4S Q At Grade 46 ^ Aerobic Treatment Uni[ 49 ~ Recirculating 30 ^ Other V. Dis ersallTreat ment-Area Information: Destgtt Flog (gpsl} • Aispersal ~~ Dispers a Roquired ~ Propos ~~~~' Soil Application ~ Percolation Rate System Elevation Final Grade Rate(Gals./Days/Sq Ft ) (Min /Inch) El i Asa -~ias ~ ~6 0 7 • . . . on evat a8 /~~. l~5 iDy 6~~ , Vl:. Tank. Info Capacity in llon G .Total ll Number Manufacturer Prefab Site Steel Fiber Plastic ~, a s Ga ons of Tanks Concrete Constructed Gl New F.,xistiug ass T Tanks Septic of Iioldittg Tank .' ~~ DosinE CI~Ct c It ViI. R.es onsibilit S#atement- the und~erai ; as re for installation of the POWYS showm on the attached plans. 1 -- a MP/MFRS Number Business Phone Nutnher ~ ~~~~~aq~- ~~~ ~- Plurnbmr's A,ddross (Str t; ' iiy, ode •~ t VIII.- Count JDe ~ tnent Use Onl Approved D Disapproved sanirary Permit Fee (includes Groundwater Date Issued Issuin Agent Signa o Stamps) ^ Owner Given Initial Adverse ~ Surchar a Fee) ' Determination z I _ iX. Coaadit~us +~ A,;pprovaUReasons for Disapprov ~ n _ (J n ~ s Y s A-(( C~rQ ~-•~ of ~~ I ~ c~-- com plans { C plate ~ e~unty only) for [he syscem on paper no[ less Wan 8112 x 1 inches in size C~ ) r } ,` `" /SOS s-£rec.~ Scalc: / ~~= ~O' ---~m~ ^ ~a'/fYsc~c~6'o.. wS o v. a-- ~..c ~ ~ ~ Elc~o~ • prop. Sic //c;~lacd i4^:/y Tn /of ~ 0{x/0/°f ~OStc p/a~o,<Sk.,ny~~ Scc.3/, Tn. of j~m,n v» d~ ~. Cro~cCo .,~~. w w v ~_ ~e.`1 ~ ~ ~' ~..-w: >, 42_. ~~~ .~ s w:~ i~~ ~ /03.0' ,~ (~~+ ~ ~ , L" 1 c. s ~ 40 1 i-orc 2 w a: ~ 11 o y.ai~ ~ p .ate ..~1~ O1~-o.~L /02.0 ~ ., ~ , pf~_-ii t , - .~~~~ io/.o t.E.. 6, : 7 ~.E CO/qt/O~ , lot1. E/.~~'z,~S _ i ~ 4 x --L.s• 1~ ( ~, a krc~°~ ~ 1-otto..~ ~ot.tl ~,y..~o~... bJ O 6 i1LS~~L~~!d Qa Tp ovo /o~ S~e • ~, l~" S.~ c~.'< tJ ~C a*. '`~-'~O ~~ ~ ~ iscons~n Department of Commerce March 04, 200.1 CUST ID No.225094 MICHAEL P ROGERS ROGERS PLUMBING N4563 320Th ST MENOMONIE WI 5475 t Safety and Buildings 4003 N KINNEY COULEE RD lA CROSSE WI 5A601-1831 TDD #: (608) 264-8777 www. coin merce. state. wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles,. Secretary ATTN: PO,WTS Inspector ZONING OFFICE ST CROIX COUNTY SP[A 1101 CARMICHAEL RD HUDSON WI 54416 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/04/2005 SITE: Jason & Lori Skutt 150TH St Town of Hammond St Croix County NW1/4, SW1/4, S31, T29N, R17W Lot: 1, Subdivision: Sunny Hill FOR: Description: Three Bedroom Mound System (Revised) Object Type: POWT System Regulated Object ID No.: 880469 Revision Identification Numbers Transaction ID No. 843368 Site ID No. 653163 Please refer to both identification numbers, above, in all comes ondence with the aQenc . 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. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • 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.01/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). L'1 • Per manual cited above, limited activities are allowed in the area l5 feet down slope of the component area. ~~~, Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal ~EPAR are prohibited. Q rovided er Comm 84 product approval conditions. Maintenanc~e.1/~~ • Access to the filter for cleaning must be p p SEE Ci information must be given to the owner of the tank explaining that periodic cleaning of the fitter is required • The "off setting" (D) is proposed to be at six inches from the bottom of the tank. The pump pad, along with the legs of the pump, may leave the impellers out of the liquid effluent before the pump off setting is reached. This should be checked at time of construction to insure this condition is not encountered. This setting maybe adjusted, with the inches coming from the reserve capacity area. • 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 . I ~- +~ L W /SO~j-~rec~ `~ ` 5~~~ - ~~~o~ seta... C.~ l9-~ ~o ~. Cl.- L O r I Sca(~: J ' = ~O' ^ ,~a,'/Odsu'c~6~~ P,~~ Pap. She //Mac.( ~-~iy % /of ~ oFp,~°~' P/at` olSulln}.~ Sec.31, Tn. of f la.r, m vr~ d, $E. Gnixco ,~cJ W v v ~_ ~..~`~ ~~:~ ~, 4i ~ ~~~ '_ _,.~ ~ ~~ of ~ w ; ~ Q... l pro • (fl cro ~a3.o' , ~~, Z„ 1 ~L S~. ~O (('~ '~-OtcC ~... a:M Slo y~ y.x lp 00 1 ~ih .-c~ .1-a...~ /OZ.o ~ ~ '~ _ - rt i i ~ l ---'-_._ ~ r -- rI- o{ 1o~.5f~~a~ Top o•f' /o~ s~~ • ?, ~" s~lt,,.'~ < ~ ~.~.30 ~Q Y' • . , „ .. ~, 3 is e~ 0. ~~re ., t Cv" ~s~ o..,,, ~ Z. y oc~ ' C.> ` 11 ~~ ~o3,i~ ~ o \ ~ 1 z r, s ~ ~ j ,~ n.S ~ ©~ ,~. ` 1~~~ Z o.v a.a.~ , ~ o z .1'~ ~,'~ °t a 1Qt.9', 1'1 O~f-'. ~ OC~ ~``C~ 0.Vy kvM,,~ `~~~ ~ 0. 7C J, C u ~ ~ ~.i '• Pume~ Charactaristica / /Meth UrJt Srsbrnerslile Arrfcnatk Models SN11]OAI µon+gr<wK .30 F.ll hood Aqs i.0 1Mter Bladed dole 14 ) R.~JrI. i SSO -iase 0 1 YeN 11S N err: 60 lerrrperet~re 1~0'F Astt`{ent NEMA pesife ~ hselatia G.u A Dixlar She 1-I/2' M-1 ~Sl~ Solids Hesi~isq 3/4' 119rwJ UeJr 1Metgitt JO 6s. /ewer Cord 1 b/>, tJTW, ZO' std. Pae~rttrteblCA Dot4~ tr 6 -~ p s r~ to 1 a ' o ~ ~, ~,...,.,.._.._.».._ t umlSwd a ~ t Total Nwr f~~t 4 i 12 1t ZO 4~1 d~M N.s.l 44 3~ 24f 3= 12 0 Dim~nsidnal Data f . Y Arwno«e ~ iidet l~ kr'r+«aianrJ r~r. x co~~ ~, Ry : iA ~~ 3. ed briK.auawnpupur ups i.tt+d ~ eM.»m+od..a0lurr~ ros rpFn:6nee S. ONOfI ~ a~unoYr 6. 'Ik rwrr~ M ri,l+t A ~ nr~iar< a u pnluct sd tAw ~prdimtuu nNlo~t nerict ~,,.. ••~f. i ll. `. / ~ r ~ rid (JO it ~4~t1 (2.60 =_{--~ ~Ma~ ~ rte. '; ~° i I~ HYDR4MATIC" ~ 810 Raney Rspd AsNenl, Oho 4415 iel: 419•I69.9041 hx, 419•Ial a0i1 Weh Site: wrr,prnldrpunp.rom SAl4S OfIK[S IN Atl MJ,14A CITIES ANO COUlYfRIES qem r: W•U2.8330 1204 !SM ~^ 1999 HYdrevnoric' Purnp~, A~Igroi, Rio, N' Rg - Yaw Aurhor,zrd lord (Xsrnbu+or - x~ ;I ~ 1 _ ~ .... r..... i I __T... , I _ I I Materials of Construction ~ • ' - ~• ~ System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, Rogers Plumbing, 715-235- l 132, or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. I . If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2 Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. ~. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. I f . I f construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. Maintenance I . The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. a. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. ~. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompan} their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. I I . Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoriil~ may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.4 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designinU. andior installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 ~. \'\ ~ t ~. ~ Private Un-Site Wastewater Treatment System (POWYS) Indez and Title Sheet Owner: ~- r P'rQ,~ect Name and System Type: _ ~ ~Q/.(I't ~~~~ J ~,ueatlon: ~~( )~ ~ Legal. Descrip '" - ~`avvraship/Ccaaunxy o ~ r , contents: Pagel Page 2: Page 3: 11 ~ l/ Page 4: /~ 1 / Page 5: / / I ~ . !r I( Page 6: Page 7: Page 8: t ~ /( // ~l 1( 1l Page 9: Atta~r~,tments: Piuxuber/Deaignex: .aredial. Number: Siie~r{~ ~a~r~.5 !11 UI/ // . O ~ ~/ /7 . , f ~. / l . T FY l1/ , /~ l!7 U1 POW'T,$ O~y 'S AL EMENT LAN Irv ~~°e~ -~?MI-'~~ m~"~i~e,^- o~,.~~,, -~ c~ ,~- ~'e.~~~/~1 .a3.t.Elty`~~;-221Y1A.TJ.+QN~ v SYSTEM SPECIFICATIONS Number of Bedrooms flflgpolbedraom DNA l~Ttunber of Couunercial ni#~ ~---- NA Estiruatcd flaw {average)* ,3 gallday 1]esi,gn flow {peak}, estno.ated x 1.5* _ gaUday Soil Application ~a#e Y B, aUday IufluentfEflduentQuolty (NAp) Monthly Average** Fats.. Oil & Grease (FOG) ~ 3fl mg/L 13ioc~hernical t~~cygen Demand {BODs) Total Suspended Solids {TSS) s 220 mg/L S 250 mg/i, Pretreated Effluent Quality p Monthly Average*** biochemical Qxyg~n Demand (BODs) ~ 30 mgJi.. TatarSttspez-dedSolids-(TSS) Fecal Colifarm. tgeoane#na mean) ~ 30zng/L ~ cfu/lflOml S10 Artaximum Effluent Particle Size 118 inch diameter * Wastewater Fls~w ~7'erifica#ion og and calculations: (atYzer tliau bedrown based} * * Values #ypical for ~rnestie (non-con3mereial wastewater and septic tarp fluent. I *** Values typical for etreated wastewater. Septic Tank Capacity gal L~ NA Septic Tank Manufactuuer ^ NA Effluent Filter Manufacturer DNA Effluent Filter Model ^ NA Pump Tank Capacity gal O NA Pump Tank Manufacturer 1 [~ NA Pump Manufacturer f ~/~~' , ^ NA Pump Model ~/~ ^ NA Pretreatment Unit Q NA ^ Sand/Gravel Filter p Feat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer: Model: Dispersal Cell(s) ^ In-ground (gravity) p -ground (pressurized) ^ At-grade Mound ^ Drip-line Q Other: ^ Leaching ChamberNlanufacturer Model Approval Stipulation Soil Application Rate gPd/ft2 Area Req. eft Absorption Area Cxedit per unit ft'- Minimum Number of Chambers D Aggregate Design Flow/Loading Rate= ~ min Materials: all materials must comply with WY Adm. Code COMM84 and be installed per manufacturers specifications and approval letters. DESIGN CRITERIA !~ "Wisceha„siu,A~ gcad~-Soil Absorption System, Siting, Design & Construction Manual" (Converse et.a1.1994) Q "Wiscoiisi~u N~ouud Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publicaticui 15.22 q "Design,of Pressure Distribution Networks for Septic Tank Soil Absorption Systems" Fublicataons 9.6 D `~esigo of,Couventional Sail Absorption Trenches and Beds". R..J. Otis - ASAE Publications 5-77 and "Design Manual - Onsite Wastewater ZYe-atmeut and Disposal Systems". EPA 625/I-80-012 October 19$0 [~ SBI? .- IOSTO--P (85199) "At Crrade Component Manual Using Fressure Distribution" Q SBD -r10567:1' (8.6/91) "In Ground Absorption Component ManuaP' D SBU -1t?7Q5-P {N.OU01) "Jn Ground. Soil Absorption Component Manual" Version 2.0 Q SSD -•.1062$ P (N.G199) "Recirculating Sand Filter System Component Manual" Q 513D --10555--F (N.b199) "Split Sed Recirculating Sand Filter System Component Manual" Q S13D ~• 10572 P {I~.6111) "Monad Component Manual" p 513D * 1Q5~1-~' {N.Oll01) "Mound Component Manual" Version 2.0 Q Sly} -1Q~95-1' (R.61~3) "Siagie Pass Saud Fitter Component Manual" q SBD -10532-~* (R.6/9s} "Drip-line Effluent Disposal Component Manual" C'1 S13D -10573 F (R 6119) "Pressure Distribution Component Manual" p S13I3 ~ 10705-~' {N.O1101) "Pressure Distribution Component Manual" Version 2.0 Q Drip-line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treafinent Units Mt~!+ITRIYANCE lY[U1~lITURIlYG SC~EIlULE Servicx Event Service Fre uency Ins condition. t~f tank(s) At least once every ^ months ear(s) (Maximum 3 yrs.) Pump out contents of tanks When combined sludge and scum equals one-third (1/3) of tank volume Inspect dis .cell s : At least once every p months year(s) (Maximum 3 yrs.} Clean. effluent filter ans. ect urn pump controls & alarm At least once every At least once every O months p months 'year(s) year(s) DNA Flush torals and ensure test At least once every p months D year(s) p NA Valves ' At least once every ^ months ^ year{s) DNA Qther: At least once every ^ months • D years} ^ NA Page of ' ST CR(7T,+: COUNTY SEPTIC TANK MATTITI=NANCE AGREEASCNT AND /~ JO,,W~NERSH~I/P CTyRTIrICATION FORM QE~nerBuyer .~~t~ ®~ ~ ~ ~ K 1 ~ i~lailinl; Address Pr~party Address (Verification required from Planning Department for new construction) City/State Parcel Identification Number ~/S" 1~(~9-~,~:1.~ LEGAL DESCRIPTION Property I.ocatian ~~'/.~,~~ `/~, Sec. ,~~, T~N-R~W, Town. of Subdivisian Lot # __,~___. Certified SurYey Map ~~~ S ~ -~ ~joltlme ~ ~ ,Page # ~~__j~_~ , '~'~'arrauiy Deed # _ ~ -! ~~~~ Volume ~ / ~ ~D, Page # ~ ~~ Spey; hawse Q yes ~1 no Lot lines identifiable ($'j yes O no S'S.'STE11~i )+~IAlNTENANCE Improper use and mainteuanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consistsof pumping out the septic tank every three years ar sooner, if needed by a licensed pumper. What you put into the system 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 owner and by a mast~rplumber, journeymanplumber, restrictedpluaiber or alicensed putnpervcrifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary}, the septic tanl: is less than lJ3 full of sludge. Uwe, the undersigned have read tlne above requizements and agree to maintain the private sewage disposal system with the standards set forth, herzin, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certificatior_, stating that your seprie system has been maintained must be completed and returned to the St. Croix County Zoning Office witri , 30 days of the three year expiration date. ' ~V ~ ~ U l ~l G~-- S N~'i'L.TF~E OF APPLICANT DATE O~'~rNER CER'FTFICATION 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) of the properly described ab/o~ve~,b-y-virtue of a warranty deed recorded in Register of Deeds Office. ~~.~C~J ~ 0 / f y/G ~ SIGPtATCII;.E OR APPLICANT DATE `*`*** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. **'~*** " Include with this agglication: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed iv~~ 1J.1J rn;l rta .~olL:'td t;vtr LUrliti UFS X1003 -- - ~'I~' ~1¢II L ~.~.~ i4'2 ~~ _ ~. s'e ° ~',~" 4161. ~,4„ 5'D" ,i,~" i "'- ----- - ~'A" o srha g I ~-2x12 ~2 s ' ~` ,,.~. M ~ _ ~ a ~- ~ - - -- ' - -~ ~- - - - - - - ~- - ~ doug fir ~I I ~ i ! ~„ en InBersd Irdsr -I • $ ~ I _~~_ ~ ~r~^:n~ - - j- "~ _ ~ _ _ " i ~` ~ `-n G.I. 2'6 ~ ,,,~ . ,~ , ~OBOV - - - - - - - - °- I '~ I _ _ - - i (; ~ 8 „~ door Bt ~ ongineer d beam~~ 4 _~ i MASTER ~ ~ ~~ ~` ~'~" ~~* , I I BEDR ~ ~I ~, 31611 ,~~„ `\ sip ~ ~ E3 a i QOM ~ ~ J' "a' .~ '~-~i' 2 4 1 note= ~, ~ I 13`b" x 11'0" v; I ~ y. eh~lves ~ i > y ' a~ DINING { i ~ ' dw ' I '~----i-- Imo, ~' '~ ~ ~ ROOM I eoe ® K~TGHEN Q.ol~ x ~,a,l ;~ i ~ ~ -note Z,E„ •, ° a lo'~" >< io'6° ~~ ~ e ,n I Sy m ~3 w I `~ \> ~ v ~I Pfr ry i ----„--- •~ ~~ gos flrepk+Ga 6 0 2,e , do -~ Instdll as per I ~ / II ~~ nxXanufactur•erE3 _ ~ I V 'i'2 i2 • ~'i" 9'3" 2'4' m ~! speselFleatlon~ I uQ7E ~ ~ I ` +'erify tub R.Q, (7rior ~ N "_ ~ 4 ko conytruotion -; 4.1. 2'8" ~ I ~ ~-2x10 e2 and ad usk rvaNE3 pockok ~ ~ ~ ~ ~~ fir ~ i ~. accord~(y door ~ o I B~DDRQOM/ ~~ ' o LNING I , ~ ~ i; ~ ~ BROOM ~ IQ'O° x q'b" ~, I ~~~~~ 176° x 14'Q` I - I z~~y• 2xb well I ~ 28" yeli clo;:er I ~~~/// /fir Ia YW9ather 5trlpping I i ~VVLJLLF. rE%QUIrOG I '~X ~~ I dou fr ( GAR,4GE ~ Ib`6" x I~{'p" 3'O" c/w ~ cnglneered I 9~B 5Q. FG, side~ighte beam I _ 7 enc inesrsd irdar kruae -' on ' Brad irdecr tru~~ I Y ~ . s I + ~ i ~ BnAinoared n rof brussESS I I i ~ Z4" o!c rarnng I j ~ + - - • - - - ` - ~ - - _ ' - - - - -~ - l 4" concrst~ ~I ~b I ~ cpnNle ver truss®a ~ i i IOmm rebGr ~ 2~ " o/. I 5 eompactvd sand ! i ~; ~ 24" ~ o/c i i i E,, i and gravol I ~ I ,~. I i I I ~I N , ~ i I I 16' x 7' o/h goraq ~ daor 1 . i ~ I , I i ~ ~ I ! ~ ~ I douG fl ~ j, - ~ .-- ----- ~ r-- -_.'---- ---~- - ~ I~" roof o~ar'nong i '`~" I I II' insions For ekana I'G ~~ Ib'c~ pq" 32" ~~'©" g'3" 8'q" ;a Included .'~ ...-. fcE'F1' - J _ .I N 0 ~~ • i~ , r^ I~ I I, +4 I~ I i i I f I J l i I~ I~ l •.-1 I 1 I _i I I 1 I. A' I i i I I I I I -~ I GJ. I _I I I I I' I I , I' i i I I I (' I I I '~ I '~ 1 I .. crag ,002 1:1:14 t'AX 715 J~51 '6:14 I~'a" r• ---•---n--------• -. I II 5srcp i i •~ l ~ ~ Uh'F1~115HED z'6" ''~ ~ e ~S~M~NT up ~,~~r ~ I N y cut for -.,~ f i ~ •~ ,y,p3 hGOdrOom i , I Q '-~ (Y} ~ N 2xS bearing wail ~ Ib" o/c I c!w gglri hs ai midspan I on 511f gq75ket or egvival®nt --b- I Ib" x E' cancrokC strip Footing I ~®InFOrGi ~g aa, aqulred - _ r:vn Lua_v pro a~'a'~ Irj---~-~ ~I -. , I I ~dGUg Fir ~ i--==-- ,I ~~. ~~ ~~",~`'~~ I I '~ afn ~. I I ,. 5 I 3 6" ~ '-- ~ a'6, I r _ ~ I I I I, f l i I '-v~pproved Steel tolei on 32" x ~~„ x 8 r~ i II 11 ti l II ~r =^ ~_I ---, concrete food ~ ~~~I II II ~~ I r`. I ~' GJ ~ ~ Q ~I- " Iv % I ~ o ~ ~ PgF ~ 4 concrete alcb 5 co ~ r , ~ u L._ ~ __ ryJ~ .n- ~_---`- " ~dG tad sad --- and grovel I i vn Ib" x ~' concrete I atnp Fookrn~~ --~~ relnPorcing o . rE~~,uired I I cJepress ~:rmere:ko wall I t0 QGGpR rTlodOtG i 2'8" entr i door I I I I GARAGE SLAB f I 8" concr&;e wolf I ~ On 10" x b" aoncrate I' strip ~aotng rdlnforclnC~ as required I I depr¢;e concr®to to acccxnmc~c late ~ I6 x 7' o/h garagm door I -------- --- _T---..S~~.r~ _, ,; ' .3 4'Q" ~'~ Iq~~~~ ,.... --~ hrr 3 Q 7~ `"~ .,., w.~ B. ...L:. ,,,.,. :~;.. ,..;...~ P + ~9GOmin Benkero Asaocitlion 2002 ,.^, DOCUMENT NO. REAL ESTATE MORTGAGE (For Consumer or Business Mortgage Transactions) ("Mortgagor,' whether one or more) mortgages, conveys, assigns, grants a security interest in and warrants W THS FIRST NATIONAL BANK OF HUDSON, 307 2ND STRSST, PO Box 187, HUDSON, WI 54016 ("Lender' in consideration of the sum of TLIELVE THOUSAND AND N01100 Dollars ($ 12.000.00 ), loaned or to be loaned to JASON A SKUTT and LORI A 287 Recording Prea ('Borrower; whether one or more), I Name and Return Address evidenced by Borrower's note(s) or agreement dated OCTOHSR 12 , 2 002 the real estate described below, together with all prfvllsges, hereditaments, easements and appurtenances, all rents, leases, issues and profits, all claims, awards and payments made as a resud of the exercise of the right of eminem domain, and all existing and future improvements and fiMUres (all callod the 'Property"1 to secure the Obligations described in paragraph 5 on the reverse side, inoluding but not llimited to repayment of the sum stated above plus certain future advances made by Lender. 1. Description of Property. (This Property i s not the homestead of Mortgagor.) flel fl~ noq ATTN: Loan Processing Tst Natrl Bank of Hudson PO BOX 187 694'702 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO., YI RECEIVED FOR RECORD 10-18-2002 2:00 PH MDRT6N6E EflEMVT # REC FEE: 13.00 ?RAMS FEE= COPY FEE: CERT COPY FEE: PAGES: 2 ~~ OI (~~3)olo(v 018-1069-10-050 arcs on ItTer~o. LOT 1 PLAT OF STJNNYHILL IN THS TOWN OF HAMMOND, ST CROIX COUNTY, WI SCOUTS IN . M checked here, description continues or appears on attached sheet. K checked hare, this Mortgage is a construction mortgage. ©N checked hors, Condominium Rider is attached. 2. Tide. Mortgagor warrants title to the Property, excepting only restrictions and easements of record, municipal and zoning ordinances, current taxes end assessments not yet due and n /a 3. Esaow. Interest will not bs paid on escrowed funds d an escrow is required under paragraph 8(a) on the reverse side. pwn txiu nd) 4. Addittonal Provisions. Mortgagor agrees to the Additional Provisions on the reverse side, which are Incorporated herein. the undersigned acknowledges receipt o} an exaM copy of this Mortgage. NOTICE TO CUSTOMER IN A TRANSACTION GOVERNED BY THE WISCONSIN CONSUMER ACT a DO NOT SIGN THIS BEFORE YOU READ THE WRRING ON THE REVERSE SIDE, EVEN IF OTHERWISE ADVISED. DO NOT SIGN THIS IF R CONTAINS ANY BLANK $PACEB. c YOU ARE ENTITLED TO AN EXACT COPY OF ANY AGREEMENT YOU SIGN. d YOU HAVE THE RIGHT AT ANY TIME TO PAY IN ADVANCE THE UNPAID BALANCE DUE UNDER THIS AGREEMENT AND VOU MAY BE ENTRLED TO A PARTIAL REFUND OF THE FINANCE CHARGE. Signed and Sealed OCTOBSR 12 , 2002 (SEAL) R~ Or QYQinliirlOnl By: (SEAL) ~dQGa~7 (SEAL) JASO! A SKUTT /~~ By: (SEAL) r~ ,L~ ~ ~ fr'~ (S~) L A SKUTT By: (SEAL) (SEAL) By: (sErW (sEAL- AUTHENTICATION OR Signatures of authenticated this day of `,tpttquruyrrrr Tide: Member State Bar of tMaconsin or authorized under 4706.06, Wis. Stets. This instrument was dratted by A~D G ANDSRSON DON : X' ---ac-~ = ~' : ~'; ~ , :% IIG _ , •,i i7~ .••~~ ` '?ype or print name signed shove. rr4rrunun~"`~`~` ACKNOWLEDGEMENT STATE OF WISCONSIN t ss. County of cr Croix j This instrument was adcnowlsdgsd before me on OCTOBER 12 2002 , by JASON A SKUTT and LORI A SKOTT (Name s) p~rwnap)1 as n/a (ryp~ or wrhortty: ~,g„ Lr, truaee, ale., an Ut ems pent' p---~ n 1 manl wac rrK~cWrrtl. it ~nY) DONI3TTS fiLLfiFSON Notary Public, Wisconsin My Commission(5lpires)(IS) MAY 15 2005 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety, and Buildi, g Division INSPECTION REPORT GENERAL INFOf21~1AT90N (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village x Township Skutt, Jason Sr Lori Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: 4NK INFORMATION TYPE BM TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding Inlet Bottom Pipe 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 DISTRIBUTION SYSTEM ELEVATION DATA C°unty: St. Croix Sanitary Permit No: 420571 0 State Plan ID No: Parcel Tax No: 018-1089-01-000 ELEV. HeaderlManifold Distribution x Hole Size x Hote Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Only Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ~ No ~ Yes [~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 647 150th Street Hammond, WI 54015 (NW 1/4 SW 1/4 31 T29N R17W) Sunny Hill Lot 1 Parcel No: 31.29.17.706 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = 3.) Contour Plan revision Required? ^ Yes ®No ~ Use other side for additional information. -J -- -- - ~ - -~ SBD-6710 (R.3l97) Date Insepctor's Signature Cert. No. Safety and Buildings Division County ~~'! ~ _ ~, 201 W. Washington Ave., P.O. Box 7162 ~s~~~sj~ Madison, WI 53707 - 7162 Site Address ~ Department of Commerce /~- ~ -t)Z 3t~69~S ~ ~y~- Sb S-l- . Sanrtar Permit A lication Y PP Sanitary Permit Number . ~-2o s~~ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ^ Check if Revision ma be used for second oses Privac Law, s15.04 1 (m I. Application Information -Please Print All Information --~---°-„~ ~`° ° ~ ~~: t .. ~ ~e~~ State Pl . Nu er . , ~ Pr°~' Owner's Na~e ~ ~~ Pazcel Number s,F,;-~; ~ :- 2002 •~..~( ©/$- o - o - Wo (. ~-0b~ Property Owner's ' ing Address Property Lo on ~,- f,.C~i~ ,IY~ ~ ' ,~ iC°: k: S ' T N, R ~jJ City, State Zip Code Lot u r Block Number ~~Q I`n d~ ~ ~D I~ ~ - ~ Sub ision Name SM Number ' , n Type of Building (check all that apply) , City 1 or 2 Family Dwelling -Number of Bedrooms , ^Village ^ Public/Commercial -Describe Use c• ~'~ ~"` Township ^ State Owned '~''e-'i '~ ~~ f°'r `'~~ ` ` Nearest Road ' n Cty+.~, a7f- I o Z• I S~ «~ "~t~~S e-Q.Qowe.t~ ~. s III. Ty a of Permit: (Check only one box on line A (numbering scheme for intern se). omplete line B if ap 'able) A' 1 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For County use S stcm Tank Oni Existin S ste B. ^ Check. if Sattita 't Previously Issued Permit Number Date Iss IV. Type of Permit: (Check a tap 1)(numbering scheme is for inte use) /~. -(pp ~"' 44 ^ Non -Pressurized In-Ground Mound 47 ^ Sa Filter SO ^ Constructed 22 ^ Pressurized In-Ground 41 g Tank 48 ^ g as rip ' 45 ^ At-Grade 46 ^ Aerob atment Unit 49 eci acing 30 0 V. Dis ersal/Treat ment Area Informati on: Design Flow (gpd) Dispers tea ,~yy,, Require~l~ tt') Dispcrsal ea Proposed~~t~96 it Ap ation oladon Ra 5 to levatio /D s/ Ft ) ( /I ch) d ~ . I . , ~q. n on ADD 1 ~~~ l~~~ VI. Tank Info Capacity in .Total Number Manufa Prefab Site S 1 Fib Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing T Tanks Sagdc or Holding Tank _ n (/~ Dosiag Chamber ~ t VII. Responsibility Statement- I, the undersign ,ass a res 'ty for installation of the POWTS shown on shed plans. lu bet's Name (P ' Plumb ig MP/MPRS Number Bus' one Number m ~~~509 ~ -/ l Plumber's Address (Stye t, ity, State, p ode 5 ~h VIII. Cotmt IDe artment Use Onl ,Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Stucharge Fee) ^ O wner Given Initial Adv e . 325- ~~// ! Zo% Determination Z IX. Conditions of ApprovaUReaso r Disapprove .•ww wwyic~c pwua tw wo ~,ounty omy~ Ior me system on paper not Less tnan tSl2 x 11 inches In size SBD-6398 (R. OSI01) t _~ ~ Sit d ^ .5a% U6scrc~ba P.•~ poop. sic ~iiJ~aG( ~~~y Tr !of ~ o~ JO~~aes~ p/a~o{Sknny~~ " Stc.3l, Tit. of SE.. ~ro7cCo.,c~i. • So ~~ of ~.j,, ~a3,o' 1.~ , F /ot c~ aTp , rt,7. E/. ~pz~s ~ ~.,, t, 4 ~s..~ ~u:c_9 w.~Q.,~t~b_ /s~~ s-~r^ec.~ 2." \~uC. SdG 14G M. atM 1,0 ~ YO I ~~.~~o . r ~(~~ ~, Y ~ 'U ~, ~ UL~~ C4f~~ w/ ~. 1 A ~~{ b1 U off` S~e• '. V" S~lw.~~ o ~C e~ ~~.~230 ~~ rsconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (60B) 264-8777 www.commerce.state.wi. us/sb wwrw.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary November 1 1, 2002 CUST ID No.225094 MICHAEL P ROGERS ROGERS PLUMBING N4~63 320TH ST MENOMONIE WI 54751 }~ ST.C.'~~;-, - ~~'- __ ~.~ ~ -, CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/11/2004 SITE: Jason & Lori Skutt 1 BOTH St Town of Hammond St Croix County NWI/4, SWI/4, S31, T29N, R17W Lot: I, Subdivision: Sunny Hill FOR: Description: Four Bedroom Mound System Object Type: POWT System Regulated Object 1D No.: 880469 saction ID N ,D No. 6531b1 umbers identification numbers, ~ndence with the a enc The submittal described above has been reviewed for conformance with applicable Wise Adminis~~ and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. Th ner, as defined chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with ali code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: ~. u ~w~ ?'~ • 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.O1/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" S$ D- l 0706-P (N.01 /01). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The welt tnust be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption COQ area. chs. NR 81l & 812c ~~~ • A Sanitary Permit must be obtained from the county where this project is located in accordance with the ARTME requirements of Sec. 145.135 and 145.19, Wis. Stats. M~S' iih .d9 • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the SEE CORI designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 • 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. MICHAEL P ROGERS Page 2 11/11/02 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 constructionlinstallationfoperation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~ _~- Charles L Bratz POWTS Reviewer I[ ,Integrated Services (608)789-7893 , 7:45 am - 4:30 prri Monday -Friday cbratz@commerce, state.wi.us Fee Required $ 175.00 Fee Received $ 175.0.0 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky , Wastewater Specialist, (715) 726-2544 Henry F Grote ,Certified Soil Testing 4 t • . . ~ ~. ~C' ~~ ~v F~~ Jason & Lori Skutt -Mound ~~ `1 FO ~~ Transaction # ~~` Op Oy~ Construction Materials and Techniques Q~'- All materials must comply with Comm 84 and be installed in accordance with manufacturer's v specifications. Construction methods must comply with the following Component Manuals: Mound, SBD-10691-P (O1/O1) Pressure Distribution, SBD-10706-P (01 /01) Location: Lot 1, Sunny Hill NW 1/4, SW 1/4, Sec. 31, T 29 N, R 17 W Town: Hammond County: St. Croix Date: Owner: Address: Plumber: Signature: License # Attachments: November 11, 2002 3ason & Lori Skutt 6748-Plan Approval Application SBD-8330 page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section ,~ 5: plan view, lateral detail lV1l~ 6: pump tank exit detail ~~~~ 7: pump curve ?F 8: system management~~- ~ ~p~ page 1 of 8 ~ 1415 Broadway, # 2 Hammond, WI 54015 r ~ ' Design. Criteria ~ ~ Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mglL Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L 4' Bedrooms x 100 gal/bedroom/day x 1.5 ~ ""~ gallons/day hydraulic load In situ designed loading rate Depth to estimated high ground water Depth to b ock Cross slope at .stem Force main length Manifoldiheader leng Drain-back Lateral length @ Lateral elevation Lateral hole size 3~Ib in. 1 ~ holes/lateral Lateral volume Total lateral discharge rate Network pressure compensation losses Elevation difference Friction loss Total dynamic head Pump/si3jhon ~" gpm @ Manufacturer ~o Dose volume q b-~ Lift/sip}~on tank ~ ~ w~o-+• ~ ~- ~av Lo ..~„o Septic tank •~ '' Effluent filter w~ ~ - t ~ ft. 3 S~ gallons/minute ft. ft. of head Model # ~ ~ Z gallons ~S-~ gallons t zsb gallons Measurement pump and off ~ • o in. Height alarm from tank bottom i 4 • o in. Reserve capacity ~3 ~ {" gallons specs.calcs.res Design Calculations 0~1 ~ gallons/sq. ft. per day T- 3 ~ in. ~Z- in. ~'~ % ~ ~ k 1 `'' ft. of Z in. 3 ft. of Z in. Z .t t gallons 5~•~ ft. of ~ ~ a in. 1o3.~s ft. @ bo of lateral 4'$ • ~ in. ~' • o ft.) Spacing S ~' h s total ~ g ~ 4' allons ' Z Z gallons/minute @ Z • ~ ft. head ~' • ft. • t l~ lo.gt 'Zo Page 2" of $ /SOS j-~rec~- ^ ~a-'/46scrc~s6 P.•~ E~ct~+or, • prop. Sic ~i~1ac.( `~w:~Y /ot ~ oFPre~ai.' PlQ~ ~s~~~y, SCC.3/, Tic. of f+~•n in a» d, Sb- G~iXC'o .~c.~ w J v /01.0 /off L! o{ /~ ~. E. /off. 1 o t . t~ ~.~y.. ~,,.,~ K 2~ '~/.moo S z ~~~, c~ ~o s S S ~ ~. ~., o~ . =~- 3 1 (- p (~ lo'S ~~oW~ o.v tam, a.~ov c/ ~ (~ a vt ~~t (a" ~s~ow Z" ~~~3' 40~) ~.b OVA I..L .~. C•v\.\a, ..a "~ ~~ ~ ,. (o toipt~~, ~\ 1 .l. ~ ~ b" s~~co:1 ~ L O ww.V C ~ ~t~3.q ~,'L.~ ~ , Y c\ r ~~~ Q "7" •~ ' ~ , , ~~.~.~ ,„ Ill p„ ~ z ~~. ~ a.?ar ~`S 2„ n~ s~o~ x~~ :.~ ~ ~~~~ ~S ~~~ ~~. ~. ti IZ n~~ ~~~, ~ • lie ~. o~ ~ ~ '~ ~ ~ an `, ~ ~ : ~ ~ 4'x•0 ,~~ d.~- Cg''~ t S o .. .. ~1r ... cat. o l\o ~ 1\ ,^ 1 3 ~ o\ a..~ ~ ~. 1 a. ~4 .9x ~` S Z ~ o \ c ~ 'Y o -t- a..~ ~ ~~ ~ ~~~~ ~;Q~ t c~,.Z~ 1 ,~ s, ~, ,.5. -~ z•~' ~'O~ 2z.s , ~.Y L~~ d..~, ~ o l g r- , ~ ` _. 1 xl1 ~tiT~ll.... Cr ~--~ `^<oz.S r- ~a..,. ~ P~o~ 3, V'f0 No-g~uR6ED SOl L r-- i~s.s r ~av~apvr~ ~SK1=T ~NT'J .l. DtIL ~rt)r E LT I O NS F>re~, Rs. ~s C mow. 6'~ 24`' I.D. r~uwuo>.~ I.OCK1uG~GOV~R "-'~ CvA,~~v,wc ,t,4QE~ . GiLICK DNCGVViLT-~ . t{ ~~ g~~ A IA F o2~~i . ~a W E ATI~ E R PROD F ~,,TUNCTION tsac A 33• a" uo:r ,~- 6a1FFLE ~ a~ ~-s~. a z C ~~ ~K ~ o~ PurtP CoNtaeEr~ . BioCK Q~.o l~,~z ~,.Q Q ~;~, SEPTIC E S G I~GATIOfJ 12' -,~,,,~~ (~ uc.. Sc~ Q" ~ 0 YENT w;s' L4.. nv~ s~~ 9~ 3' owTo 1ycDaSTliCb. G RouKn oosf ~; T~,-JKS MAWUFACYURCR: ~ (JUM6ER OF DOSfS: ~'3 PER DAB TAfJK SIZC : \~~~ ~' G~Ll.O OOSC VOLUME ALARh1 /"1MlUFACTURGR' F\~.a.~~p IAJCl.U011JG 6ACKiLOW: ~~°.~ (,A~~ONS MOD>`L -JUMDCR: ~ ~ ~ ~``' CAPACITIES. A = 33~o IUCNfS Ott S;~Rb GAELO US ( ~ `~~ $= i1JCNE5 OR GA~LOUS PUMP MA1.IUFAGTUR ~~ C~ ,O"~ iUCHE50R ~L'~ G~~~OUS MODEL lJ DER: ~, Z p. ~ ~U~~ ~ INGHES OR GA~~ONS S~"~ITCN yPC: - ~,.~n.4a......,~ `~'~O lJOTE: PU A-JD ALA RM ARC TO ~C MIA11M M1 OISCKAKGC RATC _ 3 Z!' ~k GFM INSTA EO p-J SEPARATE CIRCUfTS VERTICAL DiFFERtIJCf DCTW[[U PUMP Oi- /11J0 DISTRIDIITIOAI PIPE.. ~~~ FEE 1 IIJTERAJAL. DIMEN510A1G Or TA1JK: LE-JC~TH `Z~~'1j ;WIDTH ~ 9 ~ LIQUID pE PT H --. + M~-.11h1uM -~ETWORK SUPPLY PRCLtUR7E~. ~ ~ 2'~~ FLCT'~' •~~ + ,~ FEET pF FOiIC[ MA41J X Z_ S F/ ~ ~ -oo-tFR1CTIOIJ FACTOR. ~'Z~' FEET ~ 3~ -, ~~-ti TOTAL Oy1JAMIC HEAD = ~~'~~ FEET • ~ •t • ~ • , • ` HEAD CAPACITY CURVE MODEL 152/153 w~ w w ~ ~ 50 153 12-~ 40-r-'~ 152 ° ¢ w 30 ~, z 8 r o 20 0 4 10 TOTAL DYNAMIC HEAd/CAPACITY PER MINUTE EFFLUENT AND DEWATERING MODEL 152 153 Feet Meters Gol. Liters Gol. Liters 5 1.5 69 261 77 291 10 3.1 61 231 70 265 15 4.6 53 201 61 231 20 6.1 44 167 52 197 25 7.6 34 129 42 159 { 30 9.1 23 87 I 33 i 125 II 35 10.7 -- I -- 22 '~ 85 1, 40 12.2 -- -- i 11 ~ 42 Lock Vclve. 38.0 Ft. (??.6m) 44.0 Ft. ('•3.~) ou5oe 0 20 40 ~0 80 100 LITERS ~ 80 160 240 320 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL A PLI( • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied '1 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.) special quotation required. 1521153 Series _ ___ 1511153 MODELS Control Selects Model ' Volts•Ph Mode Am a Sim lex ex N752 ~ 775 1 Non 8.5 1 or3 _BN 152 ! 115 1 - Auto 8.5 Included 2 or 3 E 152 ~ 230 1 Non 4.3 1 2 or 3 I BE152 j 230 1 Auto 4.3 Ind 2or 3 ~N 153 ' 115 1 Non 10.5 1 2 or 3 ' BN153 115 1 Aut 10 5 duded 2 3 3 27/32 -~-- ,_ ~,rs i \' 3z z2 5 sKZOSa _ o n or SELECTION GUIDE Ei53' 23o t Non 5.3 7 2 or 3 1. Single piggyback variable I float switch or double piggyback variable level fk>at BE7531, 230 1 Aulo Included 2or3 switch. Refer to FM0477. a CAU710N 2. See FM0712 for correct model of ctrical Alternator E-Pak. All installation of controls, prof ion devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NECI and the Occupational Safety and Health Act (OSHA). or (4) float system. ~ d~ ~ RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 18347 Z ` '~71 '~` '~~ ~ Louisville, KY 40256-0347 ~ ~ • ' ~~ ~ -~ SHIP T0: 3849 Cane Run Road Manufacturers ol. . ' ~v Louisville, KY 40211.1961 p httpalwww.zoe-ler.com ~~' PUMP t0. (502) 778.2731.1(800) 928-PUMP QV4L/I-Y PUMPS .5/NCE ~~~~/ FAX (502) 774.3624 TIONS © Copyright 2000 Zoeller Co. All rights reserved. r ., System Management Management bf this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, Rogers Plumbing, 715-235-1132, or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1 . If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2 Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. ] 0. If septic or pump tanks are no longer used, they must be properly abandoned. 1 1. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. S. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. 1 1. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.51 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 1330 ' SOIL EVALUATION REPORT p~ 1 of 3 Wisconsin Department of Commerce A.C.E. Saf & Site Evaluations Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8'IZ x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizonta{ reference point (BM)tan~ce to nearest road. Parcel I.D. percent slope, scale or dimemsions, north arrow, arldlgcagrrt2~4is. 018-1069-40-050 Please print al-,ifi~'ormation . ~ R ~ By Date Personal informatan you prove maybe used foi secondary purges (Pnvacy ~ •s. 15;04 (1) (m)). (~' 20 DZ property Owner ~ F ; ~. , - ;' Prdperty Location Steven & Rene Heinbuch Family Tr'usf ~~.~~ NW 1M SW 1/4 S 31 T 29 N R 17 W Property Owner's Mailing Address "' ' . "%•' Lot ~t Block # Subd. Name or CSM# Sunny Hill 1624 Co. Hwy. C ~ ~ ~ t City State Zip Code Phone`~::~~: ~ City ~ Village Town Nearest Road Hammond ~ WI 54015 ~-Y71'~7J~-5521' ~ Hammond 150Th Street 4 Code derived design flaw rate 600 GPD /~ New Construction Use: ~ Residential /_Number of bedl::~s f Replacement _.,.~ Public or canmerc"ial - CSescribe: na parent material Glacial drift over weathered sandstone bedrock __ Flood plain elevation, if applic~le - General comments and recommendations: Recommended system elev. = 102.65' at 6" above 102.15' contour. I ~ I Boring # --~ Ong 40" in. Soil Application Rate ~_u._~ ~ pit Ground Surface elev. 100.68 ft• Depth to limiting factor -~ Stnirfure Consistence Boundary Roots y^M,•GPDIftY~~ Horizon Depth Dominant Color Redox Description Texture 1 0-11 10yr2/1 none sil 2 11-28 10ry3/4 none sic! 3 28-40 10yr4/4 none ~~ sl 4 40-55 10yr5/4 I f2d 7.5yr5/8 s 5 55-64 10yr4l6 f2f 10yr5/8 Ifs 6 64-78 10yr7/2 m2d 7.Syr5/8 & f2f 10yr6/2 SSBR _ Boring # ~ Boring pit Ground Surface elev. 101.34 fl. Horizon Depth Daninant Color Redox Description 1 0-12 10yr3/2 none 2 12-28 10ry3/4 none 3 28-44 10yr6/4 none 4 4~2 7.5yr4/4 i2d 7.5 /8 5 62-80 • 10yr7/2 m2d 7.Syr5l8 & f2P 10yr6/2 * Effluent #1 = BOD ~ 30 < 220 mglL and TS5 >30 150 CST Name (Please Print} Sig ure: James K. Thompson Address A.C.E. Sal & S'ne Evaluations 340 Paulson Lace Lane, Osceaa, W154020 2fsbk mvfr as ~ 2fm 0.5 0.8 2msbk mfr cs 1fm 0.4 0.6 2msbk ' mfr cw 1 f 0.5 0.9 Osg ~~ ml as - 0.7 1`2 1 msbk mvfr ci - 0.4 0.6 Om mfi - - 0.0 0.0 Depth to limiting factor ~~n• Sal Application Texture Structure t;ons~sr~ce ovun~rn~ ^ww *Eff#1 *Eff#2 sil 2fsbk mvfr. as 2fm 0.5 0.8 si 2msbk mfr cs 1 fm 0.5 0.9 Is 1 msbk mfr cw 1 f 0.7 1.2 sl till 1 csbk mfi aw - 0.4 0.6 SSBR Om mfi - ~ - 0.0 0.0• * E =GODS < 30 mg/L and TSS <~0 mg/L CST Number ~~ 3602 Hate Evaluation Conducted Telephone Number' 11!16/00 715-248-7767 /S~~ s~re.c.~ ~. 3 o~F'3 I ~a,"/f,~i6saf't~~6a P,•~ E~c~£a~ pap, sic ~in~ac~ ~.~:/y 7 /o'f ~ oFJ~~%°~ p/a.~ o{Sc~nnyfi~ Sec. 3/, Tn. of ~mmord~ S£. GnikC'o,,cJJ /oz.o i0%. s. E. /o~., ~e~ '~~-x.30 t: y-~ a t 4 y Owner: Project Name and Systemm Type: Location: /~~~ Street Address NUI /7~ . ~ ~ ~~6 %~. ~) .'J ~ . ~ ~ % /V . K ~~ ~~ Legal Descripti~ Township/County a Contents: Page 1: Pa e 2: ~~ g __ [/ y t~ Page 3 : f ~ l~ Page 4: l~ Page 5: /i Page 6: Pa 7 ~~ ge : -_ ' ~ Page 8: i I Page 9: i~ Attachments Plumber/Designer: . .Credential Number: // // !( // 1/ (/ ~ /I Private On-Site Wastewater Treatment System (POWYS) Indez and Title Sheet Date: ~~~~,~~~~ L POWTS OWNER'S MANUAL MANAGEMENT PLAN TII,L RMATI N. o weer , Permit # ~{205~ ~ DESIGN PARAMETERS Number of Bedrooms 100gpd/bedroom ^ NA Number of Commercial Units - NA Estimated flow (average}* gaUday Design flow (peak), estimated x 1.5* gaUday Soil Application Rate , gaUday InfluentlEilluent Quality (NA^) Monthly Average** Fats. Oil & Grease (FOG) < 30 mg/L Biochemical Oxygen Demand (BODs) 5 220 mg/L Total Suspended Solids (TSS) <_ 2S0 mglL Pretreated Effluent Quality ^ Monthly Average*** Biochemical Oxygen Demand (BODs) ~ 30 mg/L Total Suspended Solids (TSS) S 30 mg/L Fecal Coliform (geometric meanl <10+cfu/100m1 Maximum Effluent Particle Size 1/8 inch diameter *Wastewater Flow Verification on and calculations: (Other than bedroom based) * * Values typical for domestic (non-commercial wastewater and septic tank effluent. * * * Values typical for pretreated wastewater. SYSTEM SPECIFICATIONS Septic Tank Capacity gal ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ^ NA Pump Tank Capacity gal ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ^ NA Pretreatment Unit ^ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer: Model: Dispersal Cell(s) ^ In-ground (gravity) ^ -ground (pressurized) ^ At-grade Mound ^ Drip-line ^ Other: ^ Leaching Chamber Manufacturer Model Approval Stipulation ~_ Soil Application Rate_gpd/i~ Area Req. Absorption Area Credit per unit ft Minimum Number of Chambers ^ Aggregate Design Flow/Loading Rate= min Materials: all materials must comply with WI Adm. Code COMM84 and be installed per manufacturers specifications and approval letters. DESIGN CRITERIA ^ "Wisconsin At-grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.a1.1990) ^ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ^ "Design of Pressure Distribution Networks for Septic Tank Soil Absorption Systems" Publications 9.6 ^ "Design of Conventional Soil Absorption Trenches and Beds". RJ. Otis - ASAE Publications 5-77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems". EPA 625/1-SO-012 October 1980 ^ SBD -10570-P (8.6/99) "At-Grade Component Manual Using Pressure Distribution" ^SBD -10567 P (8.6/99) "In Ground Absorption Component Manual" ^SBD -10705-P (N.01I01) "In Ground Soil Absorption Component Manual" Version 2.0 ^ SBD -10628-P (N.6/99) "Recirculating Sand Filter System Component Manual" ^ SBD -10656-P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ^ SBD -10572-P (8.6/99) "Mound Component Manual" ^ SBD -10691 P (N.O1/Ol} "Mound Component Manual" Version 2.0 ^ SBD -10595-P (8.6/99) "single Pass Saud Filter Component Manual" ^ SBD -10657 P (8.6199) "Drip-line Effluent Disposal Component Manual" ^ SBD -10573 P (R 6/99) "Pressure Distribution Component Manual" ^ SBD - 10706-P (N.O1/Ol) "Pressure Distribution Component Manual" Version 2.0 ^ Drip-line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAINTENANCE MONITORING SCHEDULE Service Event Service Fre uency Inspect condition of tank(s) At least once every ^ months year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (1/3) of tank vohune Inspect dispersal cell(s) At least once every ^ months year(s) (Maximum 3 yrs.) Clean effluent filter At-least once every ^ months l;~year(s) Inspect pump, pump controls & alarm At least once every ^ months year(s) ^ NA Flush laterals and pressure test At least once every ^ months ^ year(s) ^ NA Valves At least once every ^ months ^ year(s) ^ NA Other: At least once every ^ months - ^ year(s) ^ NA rage- j_oi START UP For pet~toconstruction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the t~nlc(k) removed by a seetage servicing operator prior to use. System start up shall not occur when soil conditions aze frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation ofwater-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other cleaz water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fiuit peels and seeds, bones, and food solids such as those produced by a gazbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. ^ Valves Valves shall be operated in the following manner: ^ Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regulaz operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). ^ Septic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one-third (1/3) 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 NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications: Provisions aze to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. ^ Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. ^ In-Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or dischazge. Any discharge to the ground surface must he promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page Z of~ ~-'~., ^ jvleWndr At-Grade, In-Ground Pressure ~ The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authori Pondin ty. g greater than 75% of the height of the component may indicate overloading or impending hydraulic failwe necessitating more frequent monitoring. The presswe distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) yeazs. presswe checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to enswe that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of. all tanks and,pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measwes have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement azea has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement azea should be protected from distwbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failwe to protect the replacement area will result in the need for a new soil from existing and proposed structwe, 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 azea. 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 maybe installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failwe of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement azea is available a holding tank maybe installed as 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 CONTIAN LETHAL GASSES ANDiOR 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 Phone Phone K:IWPDATAIE~POWTS OWNER'S MANUAL.doc POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Agency Ti . C.2O ~1C C.:~tiNTY ~ Phone ~ tS . 3 ~ - ~o Page 3 of 3 • ~ ° ~ sT cR~r~; coulvTY ~4~. ' SEPTIC TANIt MAITITI±T1t~.NCE AGREEIt~NT '~ AT1D /~y~ }O~W~NERSHIP CIP~TITiCATION FORM OwnerBuyer ~,~~V 1(_ ~ i~J6Yl,~ Mailing Address Prupcrty Address ~0 y"~ ~ ~ (~ (Verification required from Planning Depatement for new CitylState Parcel Identification Number (/'C~~ ~~lC~ [~-'T~ ~~ LEGAL. DESCRIPTION ~t /y Property Location ~'/,,~J~ `l., Sec. ~, To '7 N-R~W, To~;m of Subdivision Lot # ~_. Certified Survey Map ,~ l ~ S l~ -~ Volume ~ ~ ,Page # 3~~ 02 . Warranty Deed # ~ ! ~..SJ~ ~ Volume ~ ~ g ~D, Page # J ~ Spec house ^ yes ~ no Lot lines identifiable ($'( yes ^ no S'i'STEAi MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tanl: every three years or sooner, if needed by a licensed pumper. What you put into the system 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 owner and by a master plumber, journeyman plumber, restricted plumber or a licensedpumperverifying that (1) the nn-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards sct forth, herein, as set by the Deparnnent of Commerce and the Department of Natural Resources, State of Wisconsin. Certificatzo~ stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office with? 30 days of the three year expiration date. ~ ~ Ul °l/GZ~ S NATURE OF APPLICANT DATE O~'4'NFR CERTIFICATION I (we) certify that all statements on this form are tn~e to the best of my (our) knowledge. 1 (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ~ ~a,Iy,U SIGNATURE OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** 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 warranty deed , ~+ ~ , .• ~ •' ~ STATE BAR OF WISCONSIN FORM 7 - 2000 Document Number TRUSTEE'S DEED Herman R Heinbuch and Delores C. Heinbuch as Trustee of Heinbuch Trust dated July 10,1996 for a valuable consideration conveys, without warranty to Jason Skutt and Lori A. Skutt, husband and wife Grantee, the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Part of the Northwest Quarter of the Southwest Quarter (NW 1/4 of SW 1/4) of Section Thirty-one (31), Township Twenty-nine North, (T29N) Range Seventeen West (R17W), more particularly described as: Recording Area Name and Return Address Lot 1, Plat of Sunny Hill in the Town of Hammond, St. Croix County, Thomas A. McCormack Wisconsin. 1020 10th Avenue PO Box 2120 Baldwin, WI 54002 Ol&1069-10-050 Parcel Identification Number (PIN) This IS not homestead property. ~ (is not) Dated this 1st day of October , 2002 ~ ~,~ ~ ~, * Herman R Heinbuch Trustee AUTHENTICATION Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Thomas A. McCormack Baldwin, WI 54002 (Signatures may be authenticated or acknowledged. Both are not necessary.) ~ ~~,~~ ~ ~ * Delores C. Heinbuch Trustee ACKNOWLEDGMENT STATE OF WISCONSIN St. Croix County ) ss. Personally came before me this 1st day of October 2002 the above named Herman R Heinbuch and Delores C. Heinbuch to me known to be the persons hoe cuted the foregoing instrument and acknowledge e s Notary Public, State of WISCONSIN My Commission is permanent. (If not, state expiration date: ~ Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN TRUSTEE'S DEED FORM No. 7 - 2000 INFO-PRO (800)655-2021 www.infoproforms.com ~; ~ •: ~~ W 00 A z m ~Z d w ~ ~ Q 0= ~ Z ~ O~ ~Z a ULL ai 0 t~ ~N Z,A ~~ . • ~' ~, Nag°6~ y ~~ :~ • II ~` ` ~l I ~I I ~~I 300°15'41'E 462.10' 231.00' ~ 231.10' ~ ~ I r~i a ® ~l ~ ~ ~~ m ~ W • IPn O' •. 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