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018-2005-08-000
Wisconsin Department of Commerce Safety and Building Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) r 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 Miller, Sam Hammond Townshi CST BM Elev: I Insp. BM Elev: BM Description: c1~ 3a ~JS- 3c~' St w•~ 2 ..c~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~ ~ C ~ J I ~Q ~~SD Dosing C~-N~- << Aeration \ - - - --__ \.~` Holding ~, -'~ '~~- TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~l ~ ~ I ~~ Dosing , ~I I t ~. ^ ~ r ~• Aeration __ __ Holding _ PUMP/SIPHON INFORMATION Manufacturer Demand O~LL,E'Q„ GPM ~(Q Model Number ~ t~ ^~~ TDH Lift ~ .~+' FrictionOLo~ss~ 1 System Hesad~, TD;~r • `~ Forcem in Length ~ Dia. ~ tt Dist. to Wel 501E ABSORPTION SYSTEM DISTRIBUTION SYSTEM ELEVATION DATA STATION Alt. BM Bldg. Sewer SbHt Inlet SUHt Outlet Dt Inlet county: St. Croix Sanitary Permit No: 453449 0 State Plan ID No: oi68~~ =TR~tt. I p ~ Parcel Tax No: 018-2005-08-000 Section/Town/Range/Map No: 31.29.17.934 BS HI FS ELEV. /7 Off. ~S/ Jr. l7 t7~ • ~ i x.90 9ft.18' Dt Batl6rr, /) ' /I~ I q • 5„ r I Header/Ma .Header SS 4 r 3 oo. Dist. Pipe ~~",,~, r S.G} 1 Bot. System `.~ 49.43' F' al Grade ~ q St Cover ~ ~'~- .az. ~p , D ~~l.~~Cs: ~:\ x.20 9~.~~ D . r.33' s.,,.0 -~t~, Header/Manifold ~ t/ n Length `'~ Dia' Z Distribution ~ t 11 r Pipe(s) .Z• ! 2 •,v Length b ~ a ~ L Spacing x Hole Size t t ~ U x Hole Spacing ( ~ ~3 Vent to Air Intake ~---s SOIL COVER x Pressure Svstems Onlv zx Mound Or At-Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/7rench Edges Topsoil L~ Yes No [J Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:.X~` ~h~~~ Inspection #2: Location: 652 153rd St Unknown (SW 1/4 NW 1/4 31 T29N R17W) Highland Ranch Lot 8 Parcel No: 1.2 .17.9 4 1.) Alt BM Description 1 ~ ;.•. 2.) Bldg sewer length = ~~~ a r `-~~ °i~~ - amount of cover = ~ ~ Z 3.) Co~nto` ~r =~ ~9~.3a' ~~ "~,~ PI revision Required? ~ ;' Yes No 2 ?.~ - ~ _- - - _--- ' r Use other side for additional informs ion. ~ __ SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Btrildings Division , County i ` a, ~ 201 W. Washington Ave., P.O. Box 7162 ~ ~~~ __ c/'~O~~,n Madison, Wl 53707 - 7162 Sanitary Permit Num ~ o be filled m by Co l vv ~` De artment of Commerce (608) 266-3151 ~ ~ _ - Sanitary Permit Application State Plan LD. Number ' ~ i In accord with Comm 83.21, Wis. Adm. COde,•personal information you provide ' ~Z ~ ~ " - ~ u~vs • I ~ tray be used for secondary purposes Privacy law, s15,04(l~m) Project Address (if difl'erent than mailing add:.;sl fo S 2 / S' 3•Y0 S 7-- L Application!nformation-PleasePrlntAlllnformatlbn i~ i/_~~m~~ ~~ /-T"' 1 Propety Owner's Name Parce! N t p Blau a ', ~ S~ m i'1/1 ~ ~.G.~'yt, ~S Property Owner's Mailing Address i Property Location Section % t~ Ciry, State Zip Code Phone Number , ''+t-~= ~- 7~s`~~.'Z7 ~0 7 (cimlz one) T ~ N; R~E~ 11. Type of Btillding (check all that apply) ~p / (~ n i i i S bdi N 1 or 2 Family Dwelling -Number of Bedrooms ~ pmdt~ ~Cw~! r ~t..r~ ez v s +~+ u on ~ ~ ~ ~ 4• ~ ^ Public/Commercial - DescribelJse ^ stagy owned - Descrilx use ~ g. SD ~) ^Ci ^Villa e Townshi of ~11K0 ry_ g ~( p ~ H a i ill. Type of Permit: (Check only one boi on line A. Comple a line B u appl[cable) p ~$- 2(7ps-0 _p-8~ • 93 A. New System ^ Rtplaceivent System ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Existrng System B • ^ Permit Renewal ^ Permit Revision ^ Ghange of ^ Permit Tlansfer to New List Previous Permit Number and Date Is;uzd ~ Before Expiration Plumber Owner ` 1 V. Type o(PO WTS System: (Check all that apply) ____ ^ Non -Pressurized ln-Caound ~ Mound ? 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ i Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Reciroulating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leachin C7tatnber ^ Dti line ^ Gravel-less Pi Other (ex sin) C V. Dis ersal~I'reatment Area Information: ~ b.0 3 ~.~; Uesigsr Flow (gpd) Design Soil Application Rate(gpdsQ Dispersal Area aired (sf) Dispersal Ar P posed (s!) • t Elev ' l f V1. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber j ?Ia;t:~ Gallons Gallorss of Units ,/1 ! ~ CO ~ Z b Concrete Construaed 1 Glass !, Ncw Eziatin . K *r<. ar g Tanks Tankr S:pric or Hoping Tank QD~ C ~~ ~ ' aerobic Tsatmcnr Unit Daing Chamber ' I V 11. Responslb(llty Statement- >~ the undenlgned, asstrnre responslbWty for lnstsllatlon of the POWTS shown on the attyched plans. _ _ ' ~ Pluutber's Naa Y (Print) Plumber' ignature MP/MPRS Number Business }'hone Number ! // ~~(( / Ik.fi~ ,•1~ ~K~/ I 2 G ~~SrOv!"' WZ-his =1y~z7 ^ _ Plumbe'r's Address (Street, Ciry, State, Zip Code) n /~ ~ ~[ " `11L Count /Dc artment Use Onl __, Approved ^ Disapproved ~~' Permit Fee (includes Groundwater Date lssue~ !s uin gent Signature (~ o S.any~s) ^ Owner Given Reason for Denial Surcharge Fee) ~ ~~ 1\. Conditions of ApprovaUReasons for Disapproval •~ l Qverca. nrni~tr=o. 7 / N~ 1 r ' ~`VVUI"~" `~.,"h ~~1~1J t k~ 1 . Septic tank, effluent filter and ~~~tt-~„` 1 G~~~,t,~~,,( ,,Q.~~- dispersal cell must ail be serviced /maintained -l ) ,~.~, Q _ as per management plan provided by plumber. 2. All setback requirements must be maintained ~~ as per applicable code/ordinances. Attach eompktc plans (to the County ooly) for ibc ~ystcm oo paper not kaa than 8112 z 1 I lachc~ is stzc SBD-6398 (R. 01/03) A E,~`s~ ~ ~rade elev: • /oc~~ed/orop. SCQ/Q • / ~= f/Q• Cu(- a~ -Sac, /53 =-°` 5 E.~~ ~ ~ a a 0 r~ 2 Q 1 c W J V ~~ Propose o/n~ou~da-E ~z. 8/X/e9. Ba •~/ d i S'~i 5 u,L~~'~n /¢ ~,i-st /Sw t /~X i~f~28 0 \ q~~ 'b 99.0, 4$0• ~ 9~.a' ~ , ~~ < < < r ~ ~ t 1 ~ ~~ ~ ~ ~ ~ ~~ '. ~~ s ~ ~ ~~ ~ ,t ~ ~ ~~ ~ ~ ~ ~ ~~ ~ 1 ' `~ b ~~ 1 t N ~~ 1 l -~ ~,~ e- ~ 0 ~ ~ `i ~ ~ ~, ~ ~ 1 ~ ` \~ t ~ ~ ^ ~~ ~ 3 `~ ~ ~ 1 ,~~ `~~ Oar4pL °~~ Prcposrd 1/ loco tt I~ropos<,d S bcdnoo ~ ~0' res,~/a c ~~ \ r z'sck. P.r.c. .3b If"Sr~. YoNV.c- 64i/J;~ 5rwer ~2 Yr'O~OOS~-'I Ct~CGSCf COn~.. wC.F~ ~ ~~~-~'m~ ,~ ~ . ~~1.,? Tod of i ., P ~ c'. F;~o.E E/~v~ ~ 9~ 30.' 22U~i~ , commerce.wi.gov i ^ ~sconsin 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 July 30, 2004 CUST ID No.225036 MICHAEL P MC DONELL MILLER CONSTRUCTION 1070 HUNTER RIDGE RD HUDSON WI 54016 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/30/2006 Identification Numbers Transaction ID No. 1026807 SITE: Site ID No. 687195 Sam Miller Please refer to both identification numbers, 1410 136TH Ave above, in all corres ondence with the a enc . Town of Hammond St Croix County SW1/4, NW1/4, S31, T29N, R17W Lot: 8, Subdivision: Highland Ranch FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 97]989 Maintenance required; 450 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.01/Ol), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: ('LJI`t Di".F'ARTME' ~~N OF • 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. • 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 SEE CGIlI • 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. MICHAEL P MC DONELL Page 2 7/30/04 • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(71 A copy of the approved p(ansLspecifications 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/instal lation/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 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, ~,~ d ~s~vJ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 prn 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 ~~ MOUND AND PRESSURE DISTRIBUTION COMPONENT LiESI~;,W" ~~ ~~ Residential Application ~ ~GG~ O INDEX AND TITLE PAGE ~~O//~~ y~~ Project Name: Sam Miller 3 bedroom residential mound system ~`/ Owner's Name: Sam Miller Owner's Address: P.O. Box 151 Trout Brook Road Hudson, WI 54016 Pcl. Add.: 652 153rd Street Legal Description: SW1/4NW1/4, Sec. 31, T.29N., R.17W. Township: Hammond County: St. Croix Subdivision Name: Highland Ranch _ Lot Number: 8 Block Number: na Parcel I.D. Number: 018-2005-09-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications >7r~~jy Page 6 Management and contingency plan Page 7 Pump curve and specifications ~D Page 8 Site Plan ~co~rM~RCE Page 9 Soil Evaluation Report ~+4NU ptNGS ~f'OiVliLN Designer: Mike Mc Donell License Number: 225036 Date: 07/21/04 /~ /~® Phone Number: 715-386-8692 Signature:~~~~li ~~t~t Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 3.0 (03/01/01) Page 1 of 9 Mound and Pressure Cistrbution Component Design Design Worksheet Site Inform ation (r or c) R Residential or Commercial Design 300.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 450.00 Design Flow (gpd) 7.00 Site Slope (%) 98.50 Contour Line Elevation (ft) 20.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 90.00 Dispersal Cell Length Along Contour (ft) _ 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Pressure Disribution Information (c or e) c Center or End Manifold 2.50 Lateral Spacing (ft) 4 Number of Laterals 0.125 Orifice Diameter (in) (e.g. 0.25) 2.50 Estimated Orifice Spacing (ft) _ 2.00 Forcemain Diameter (in) 50.00 Forcemain Length (ft) 93.00 Pump Tank Elevation (ft) 6.50 System Head (ft) x 1.3 6.33 Vertical Lift (ft) 0.95 Friction Loss (ft) 13.78 Total Dynamic Head (ft) Lateral Diameter Selection in. dia. o tions choice 0.75 1.00 x 1.25 x 1.50 x x 2.00 x 3.00 x Note: Sand fill (D) calculations assume a Table 83-44-3 in-situ soil treatment for fecal coliform of <= 36 inches. 5.00 Cell Width (ft) Are the laterals the highest point in the distribution ~ _____ Y _ _ _ network? Enter Y or N If N above, enter the elevation (ft) of the highest point. [ _ ___ __ _ _ _' 6.25 ft2/orifice Does the forcemain drain back? Y Enter Y or N 8.16 Forcemain Drainback (gal) 81.25 5x Void Volume (gal) 89.40 Minimum Dose Volume (galj 29.66 System Demand (gpm) Manifold Diameter Selection in. dia. o tions choice 1.25 x --_____.__ 1.50 x I -_ _ _ X_ _ _ _ 2.00 ----_.___ 3.00 Gallons/Inch Calculator (optimal) Treatment Tank Information 646.00 Total Tank Capacity (gal) 1000.00 Se tic Tank Capacity (gal) _ 38.00 Total Working Liquid Depth (in) Wieser Concrete Manufacturer 17.00 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 646.00 Dose Tank Capacity {gal) Zabel 'Filter Manufacturer 17.00 Dose Tank Volume (gal/in) A100 _ Filter Model Number Wieser Concrete Manufacturer Project: Sam Miller 3 bedroom residential mound system Page 2 of 9 Mound Plan View 1_ ~- ~- - .. - y_1-/_1.0 B_• Observation Plpe '0' .~. :rl .r: .j~ .r. I~r. '.' I L Mound Component Dimensions A ~ 5.00 ft E 20.20 in B 90.00 ft F 9.50 in D 16.00 in G 0.50 ft 450.00 (ft2) Dispersal Cell Area 5.00 (gpd/ft) Linear Loading Rate -, -i H 1.00 ft K 9.90 ft z 11.30 ft L 109.80 ft J 6.51ft W 22.81ft 1466.77 (ft2) Basal Area Available 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.63 (ft) . ff,,, F 99.83 (ft) --- Dispersal Cell :.3~ Elevation f I~ ~ Dispersal Cell 100,33 (ft) Lateral ~--~ Invert •.•.•.• D :~ t ~~ 98.50 (ft) Coniour Elevation 7.0 % Site Slope Shading Key :' Topsoil Cap Q ""' Subsoil Cap ASTM C33 Sand "~:`~``.; Tilled Layer 5^ ~: Aggregate ~i a- o ~ C 1.5 ft ~ H ~~ 0 0 -~--- Dispersal Cell ,~ y vPical Lateral ;:;}}; A T 1 Geotextile Fabric Cover See lateral details on Page 4 for number; size, and spacing of laterals. Laterals are equally s;~aced from the distribution cell's centerline in the distribution cell (AxB). Project: Sam Miller 3 bedroom residential mound system Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. I P •=Turn-upwl ball valve or IEX~IEx12 I x121 cleanoutplug Holes drilled on the bottom of the lateral. "I' S Number of Laterals 4 Orifice Diameter 0.1'?5 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 44.28 ft Orifices per Lateral ~18 Lateral Spacing (S) 2.50 ft Orifice Density 6.25 ftZ/orifice Lateral Flow Rate 7.41 gpm Manifold Length 2.50 ft System Flow Rate 29.66 gpm Manifold Diameter 1.50 in Total Dynamic Head 13.78 ft Forcemain Velocity 3.03 ft/sec Dose Tank Information Lockin cover ~,v!th warninc Electrical as per NEC 300 and ---- Comm 16.28 WAC _ Laterals are identical Laterals & Force main of PVC Sch 40 per COMM Table 84.30.5 9 J label and locking device ar:d se-al}ed-vratertight 4 in rain. Disconnect ~_ Tank component is properly vented Wieser Concrete Ca acit 646.00 Volume 17.00 Manufacturer Gallons gal/inch A B C D Dimension Inches Gallons A 18.61 316.37 B 2.00 34.00 C 5.39 91.63 D 12.00 204.00 Total 38.00 646.00 under tank. Alarm Manuafacturer LevelArm _ ~_ _ T__~ Alarm Model Number DLV _`~- ~ __._ - _. _ Pump Manufacturer Zoeller ~ _ Pump Model Number 98 _~~ Pump Must Deliver 29.66 gpm at 13.78 ft TDH E-- Alternate outlet location Forcemain tliameter ~! 2 in. Weep hole cr anti- siphon device Pump off elevation (ft) 94.00 •Dose tank elevation ('t) 93.00 Project: Sam Miller 3 bedroom residential mound system Page 4 of 9 Mound Svstem Maintenance and Operation Specificatiorys Service Provider's Name Jim Thompson #30021 _ Phone 715-2.48-7.767 POWTS Regulator's Name St. Croix County Zoning Dept. Phone 715-386-4680 Svstem Flow and Load Parameters Design Flow -Peak Estimated Flow -Average Septic Tank Capacity Soil Absorption Component Size Type of Wastewater 450 gpd Maximum Influent Particle Size 300 gpd Maximum BOD5 1000 gal Maximum TSS 450 ft2 Maximum FOG Domestic Maximum Fecal Coliform '~i8 min 220 i mg/L 150 mg/i_ 30 mg/L >10E4 ;cfu/100 rn'_ Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Ins ect and/or service once eve 3 ears Should ins ect and clean at least once eve 3 years Test once eve 3 ears --- Should test month) i Laterals should be flushed and ressure tested ever 1.5 ears ~ Inspect forpondin~and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a n~atertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wa. Adrn. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished .~~~~~........ ............... Grade ~ • 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box •' •' • . . Plug or Ball Valve Distribution Lateral Long Sweep 90 or Ywo 45 Degree Bends Same Diameter as Laterai Project: Sam Miller 3 bedroom residential mound system Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no Ivnger used as POWTS components. Septic or pump tank manhole 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, defecti ~e, or subject io failure must be replaced. F~cposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at ,east once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be remo/ed 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 equippeu with an aiar m the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank pertormance is generally not required. Hvvvever, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pumo Tank The pump (dosing) tank shall be inspected at least once every 3 years. All swftches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound sr gall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than to vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow ;ompaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 10°cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flvv; specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flusned of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test .vhen the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution witnln the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported tv the owner. and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continaency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the sys em n proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal pertormance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in ts' present location by increasing basal area if tce leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Sam Miller 3 bedroom residential mound system Page 6 of 9 HE AD CA PACITY CU RV E w EFF LUE NT MODE LS ~ ~ 140 I 42 1}5 ~ - 40 uo ' I 125 38 20 t 36 191 ~, ~,~ I I S 3a 11 ~ I -T-. ' 0 I -+_.. i }2 105 100 I ~-_ 30 95 28 90 186, 26 gg 4186 80 24 165. 75 416 22 70 i 20 65 60 163 IB . 4163 1 89, _ _ _ j 55 4189 ~ t6 50 16 45 1 12 40 _- 35 1 a0. 9110 188, 4188 1p 30 8 15 137 •185. a185 20 6 /3.78' - 2 5 161. 4161 53. 57 9 - 0 U.S. GAL LONS IO 20 40 50 60 70 80 90 100 11 0 12 0 13 0 14 0 15 0 160 LITERS 80 160 240 }20 400 a80 560 6a0 D CAUTION._~ tv'~oit°I 13; 14IE5~rl.J~ not be s~uj~aau to Ic-s~!nan JO la al TCr, iLOW PER MIN UrE .Z9eGG~.io•r~r. at;n;•r,w„ 3~,0%, ~t~c re~`~`"" TOTAL DYNAIAIC HEAD~CAPACITY PER MINUTE EFFLUENT AND OEWATE RING Moae1 5J/5) 9B 137 140/a UO 161 /a161 163/a 16} 165/a165 185/a185 Id6/418o r8r>/+188 ~ lb;/189 3. ~ i ueters Goi Llrs. Gol. Llrs. C91. Llrs. CoL Urs. Col. Urs. Col. Ltrs. Gal. Llrs. Gal. Ltrs. Gol 1 s. Gd. Llrs of ~ t s r~ ~s 5 1.5 4} 165 72 17J 93 351 91 }44 100 379 61 231 61 23J 58 _ 270 Ia ~ ~ Say Ia _ a _ _ a~: 12 S.t _~ }a 119 61 231 79 299 84 318 93 352 61 231 61 131 58 <0 1.1 ~ ~ 53L I 14i. _ 5 <, 'S 4.6 19 ~ ~0 • 6 72 45 170 64 242 76 268 B5 322 60 227 6l 231 58 2<0 ISc _ 507 IS` _ ~1 < 1 C . J 25 95 36 I}6 68 257 79 299 59 223 60 227 58 220 128 ~ 48a I} yc a: 1 ;; --i 7.6 8 30 59 123 70 265 57 Ii6 59 223 58 1e0 11: a6. 12: a7., a 1 ^. :0 9.1 I 49 185 62 235 55 206 58 220 85 522 58 120 IIL I }- a}9 12r; <5a ~ a: ~ '~^ 11.2 i, 21 79 45 170 a6 V2 55 206 70 265 58 220 )s 9a 109 t1 a; 1 c 15.2 ~ 20 76 33 125 50 189 51 19} 58 120 9C~ }4 9% 367 a:~_ - EO ~ 19.3 _.: IS 57 39 148 31 121 58 270 111 76S ~ 3`- -Sp ~ a,~~-- ~ 21 i I i 23 87 9 34 52 _.. _. 197 .-_~ I ____ i 19 S ___ 26 ____- `. <, _ A 24.4 ',, 10 38 45 n0 E 10 ~'.. _ y3 r- - , _ I -~ --_ _ ,0 30.5 16 .,~ oa -a,~_ __ 7 I 32.0 i i 4 15_ ~ _ S~-~ -~ -] ',. 36.6 ~ i0 'i }96 ~ -k vale ~19J 11. (5.9m) 311. (Im) 61E (7.9m) 61E (Ibm) 6 It. (17.I m) 6 II. (20.im) 6.511. (26,4m) } II- (213m)I - I --* II4 II. (}a.'rr ll r - 9 I (277m' _ - - -- 110 I _3}5 ) -__ __. 1~ c IL-c ~ ~~ a1'- PMA ~ <oM; _ r ~ .L MEMBER ~ 7,os~~ ti, t SUMO f S A ~~ ~ oUMO MfRSf 35x. \~=~ © Copyright 1998 Zoeller Co. All rights reserved. (p5.7~t9 I N ® ~,~5~ ~ ~rade e/ev: • coca-~ed~0i^o~o. 5C4/e: /~=,IO~ _ G ~' - StQG ISS f ~ S C~ ~F. G-'~ b 1 O Q 1 C n A Propo~ o/titounda-~.~z. B/;t'/~ 8a'~/ ~/ %g "or; F•'ces ,~cec/ a d .z •S.~ ~eraare. \~ \~ ~ ~9qo, 4$0" 97.0' < < eon6eu.~ ~ ~ z"Sc~i.~lOP,r.G ~ ~ t ~ . 1 ~orU nai.. ~ ~ 1~ ~ \ ~ \ ~\ 1~ ~ ~ ~ ~~ ` ,~ `~' 1 ~~~ ~ ~! ~ ~ ~ >> ~ b ~ ~~ ~ ~ ,, 1 ~ 1 -~ o 1` n ~ 1 ~ ~, 1 -, ~ ~ \~ ~ ~ ~ ^ ` ~3 0 ~.._.._ P~opostd w~cll laCa Pion ~"sue. YOr:v.c~ 64;/d;,,~ Scwer W _~_ i ~ t ~~ r OZ Pr'O~ODS~'l CC~iG4.[./ CO/IL'. WGF~ ~ (,1~7~~aSC.)-Olk ~~ 1 ~ ~ E/tc~ ~ = 9d. 30; ~ n n r,~7o",o a~" / ~Pd, C .~Ji/+2 . \ ~ ~~ _ - - I~rc p a s~.cf 3 bldro~.., re5r~~e~cct P~.B~y SOIL EVALUATION REPORT Page ~ ~ _~ vVr.,cons;n Departrnent ct Commerce JNuion of Sa!ety and Bur~itngs In accordance wish Comm 85, Wis. Adm. Code ~~ ACaCh compwate site p4~n on paper cwt leas than 8 1/2 x 11 !ndyes M e¢e. Plan must include, but not ltmlted to: vertical and hortmntal rnferonce point (8M), direction and Parcel ID. percent sbpe, scale or dlmenskxu, north arrow, and locetbn and distance to nearest road. Reviewed by Date Please print a!/ lnrormadon. Fn~wner lrito'm.tbn ycu vrvvlde m.y bn use r«..cortdh't~9~ (Privtcy Ln~. s. t5.01 (1) (m)). Pm pe cry Owner Property Lot~tfort ~ ~ ~ Govt Lot ~ 1/4,(~OV 1/4 S T Z ~ N R / ~ E (or~~ (=~:r~__c_~ ?roperty Owner's Mailing Address l.ot # Block # Sutxi. Name or CSM# ' f--h ~~'a , ~' ~a c~ ct ~ ~~~' ` ~~ ~~' - ~ ~ Cry ^ Nearest Road ~~~m~ State Zip Code Phone Number VlUage own ~a,tirnn~o~~J- _~w( I.`~fv~S (~~S ~q~~-5`91 0 c{ 5~~~' New Construction Use: Q R~ci~dential /Number of bedrooms ~.._~ Code ~~ ~~^ 8Q1M rate `/ ~ ~~ / [(L.~, " vrv ,i Reokxement ^ Public or cammersial -Describe: ~~ / ,n ft p8re~a malenai __.~,~_~~ ~~V~, W___p 1~ ~! ~~ ~]~Q ~- Fbod Plain elevatlon r7 applicable ~"~f- ve ry°ra I Comments $ \/ S~ F C~ C I ~ V ~ I 1 ' ~ U and mcommendalions: ! ~ ~ (`ul\~-~~u~ ~~~'~' ~~'Sd Baring ~`I t3orng ~ ~~ ~ ft. De ih to IUnltirt factor ~~_ in. Pit Ground si,rtaace elev. ~~ P g SoB Application Rate i t T SttuCture Cons'stence Boundary Roots GPO rtf Hov.rn ~~ ~ ~ Depth '.n. o_~ i , _ Zv ~ Dominmt t;obr Mansell ~, z ~,. ~ ' Redox Description Qu. Sz Cont. Color - - ex ure s ~ ~ Gr. 3z. Sh. , b ~- ~ ~~ cS ~ w I~l - 'Eff#1 ,s ' `~ 'Eff#2 i - B ? ' ~ ~ i I ~~~I poring N ~ Boring nr, I c~- i ~ Pit Ground surface elev. ~~_ ft• Depth to limiting factor ~ x. _ in. Sbd AApticabon Rare tbn Descri d R Texture Structure Consistence Boundary Rools GPD;1tr _ Hoc¢rn I Depth Dominant Cobr p e ox ' ~ in. Mansell Qu. Sz. Coat Cobr Gr. Sz. Sh. 'Efi#1 Efi#2 ___ _ I--_--~-_ , ~ - ~ %~ - Sim ~ ~ S ~ ` ~ ~ ~- .z ~ i- -~ ` -- ' - ~ _ - i--1-- ~ - _ ~ _a ' Eftluertt it1 = BODS > 30 < 229 mg/L and TSS >30 <_ 150 mg/L - trnuent ~[ = rsuu ~_ su mgrs arw ~ o~ - av ..,y,,. _ C,,, i Name (Pleasn`Pm) ~ ~ lure ~ / ~ ~~Q ,.~y~i~; Date Evaluation Conducted Telephone Number ~'~ ~ ~ 0 ~-"s-~, .~;,,~~ ~--I~c~ - ~ ya~.S C~-~3 -6~ pis- -~~ oz ~'!_ m ~ 'rop©rty Ownor _ I' C~~-~_- --~ ~] Boring Parcel ID # ! ~ ( ~ i Page ~ of ~_ L , ~ J ~•••~y ~ ~ Pit Ground surface elev. `1 (P•(Oy ft. Depm oo arr>~~g racaw y~•• ~ ~. Soi ication Rate i _ Horizon ' ~ _ l Depth in. ~-z~ Dominartt t;olor MixueM .~z Redox Description Du. Sz. Cont. Cobr - Texture Structure Gr. Sz Sh. Consfstence Boundary ~ Roots - GPD 'Ef##1 ,y /fP 'Etfi#2 ~ ' ~ 5 ~-~-~ U y/ 7S c~ O ~nd-~~ ~ - , z , ~---- i ~' ~ t3onng Bonng # I-I o,~ Ground surface elev. ft. Depth to iirruting far~or ~n• ~ Soil Aoolication Race i Nonzai Deptf, in. Dominant Color MunseU Redox Description Qu. Sz Cont. Cobr Texture Structure Gr. Sz Sh. Consstence Boundary Roots GPOIfP 'Eft#1 'Etf#2 ~___ Boring Boring # Ground surface elev. R Depth to limiting tatxor in. ~____J ^ Pit Soi Application Rate ri tion D R d Texture Strucwre Consistence Boundary Roots GPD/ft' Horizcx~ Depth ;n. Dominant Color Munseil p esc ox e Du. Sz Conl Cobr Gr. Sz Sh. 'Eff#1 'Eff#2 i .-~_ ~i 1 i i 1 i ' EfBueni a' =GODS > 30 < 220 mg1L and TSS >30 < 150 mglL ' Etiluent #2 =GODS < 30 mglL and TSS < 30 mglL "The Department of Commerce is an equal oppommiry serrice provider and employer. if you need assistance to access scrvtccs or need material in an alternate iorrnat, please contact the department at 608-266-3151 or TTY 608-264-8777. snox>>o ia.ai~ooi • PAGE~OF~ ~;9M~ ~~<~ l I LC~T# g I FC', L DFSCRI~'1C~N1~~t,~ ~~(/w~ S 3~ T Z~[ N R, ~~ E(or7~/~ SCALE: 1"= "/ ~ ~ - -- --- ~ I T3M I F1.EVATION ~Oy ~ ~ I ~ I E3M 1 DESCRIPTION ~o~a_~~ uc ~,'D~ - i '1' I)M ~ ELEVATION c(~ ~ D ' ~ ~ S cc, 3 ~ I3M 2 DESCRIP'T'ION ~~ o~ ~ fJy~ p~'Pz ~ --' - - SYSTEM ELEVATION ~9, 9 0 SYS"I'EM 'T'YPE; ~'l Uy,~ CONTOUR ELEVATION 9S- ~ ~ ~~ _y~~_~- l~- ._...__.1~ ----- s~c1Nn~~uRE ~/~ ---~~'----j ~ DATE co- /S"- ~~ SOIL EVALUATION REPORT ~ Page ~ ~~ wisconsm Deparbr-ent of commerce Division of Safety and Buildings ~ aocordar~e wdtr Co ~,~..,pdnt. ,Coda -•~ °- °~~, ', ~=r~ { i a F,„ . Attach cortrplete st6e plan on paper rat less thane 1/2 x f 1 in sietr~+++u~ `.._ ~. inducts, twt riot Ikni6sd to: vertir~t and hafaotNal reference po (BM), direction and ID. percent sbpe, scats or dimensions. nortt- arrow. and locatbn a d d[stance to nearest road . f Date Jl~i.~ ~ ~ LC`~.a R' by Please prlnlt aU lnfiormadon. / . , 4. 09 Persond infom~atlon Ya+ ~e may be used to secondary pwD~ rivae}!,4ar,,_3, 7S.~,d11 im~1• ,,, .~•el Property Owner Z' '.FArQQ~'~d(~tbn_._,.. p f U C Govt. Lot ~ 114~jw 114 S T Z l N R/~ E (or~1- prop Owner's Mailing Address Lot # Biadc # Subd. Name ar CSM# ,~,~ ~ ~,. a ~ U /1 gay ~D state Code Phone Nurtdrer ^ City ^ Vitiage own Nearest Road l.f'.r. ~,,,,,,,,,,,~~~ , ~,~, ~ 5~/al.S' ~ ni.sl ~Qro-S~9'I ~l/'h YY~OlL~ ~ 1Sa~' [~ New Corrstrucsion tJse: ~ Residentlal 1 Number of bedrooms ~ Code derived design fbw ram ~ ~~ ~..G Dom--- GPD ^ Replacement ,~~,, ,` ((~~ ^ Public or commercial - Descn'be: f L Parent material ~ rah ~ ~ 5~-- ~ - W J/ "~ i II _pQd~.t=_ Food Plain elevation i appiicaWe ~/ / alrecammendations: ~'y~~ ~ ~ ~ l ~ v ~ I I ~ ~~ ~~+~~~ ~I~~~ q~~s'd Bonng # ~ Pit Ground suAace elev. ~~ ~ ~ ft- Depth to lirnitlr-g factor ~G~- m. ~~ tim- Raf Constance Boundary Roots GPDItf? Horizon Dept Dominant Cobr Redox Descript~ Texture Structure 'Eff#1 'Elf#2 in. Mansell Qu. Sz ConL Color Gr. Sz Sh. ' ~ 1 n~-~~ ~w -~ - z r- o ~ Boring 3x Boring # ® ~ Pit Grou ~ ~) nd surface elev. ~~_- ft • Depth to Hmit'arg factor -t ~` in. Sol txm Rate Horizon Depth Dominant Color in. Mansell Redox D~criptlon Qu. Sz Cont Color Texture StrucWre Consistence h . Gr. Sz. S Boundary Roots r GPD/f~ 'Eft#1 'Eff#2 ) ' 3 zz ~ v /(~ _ ~ ~ mob ~ ~ ~ ~,~ - _ 7 s' l • Ellkrerrt #1= BOD; > 3D ~ 220 mg/L and TSS >30 < 150 ` ERtuent #2. _ TSS <_ 30 mglL . c~ ..-{~ r .b . "1 ,~ . "' ~- l~ ~ ~~~~~ ~r~.G~-~ c.~ I . ~y~~s ~-,3 -~3 pis ~~ ^oz~'~. r ~~_ Parcel ID # "1.~--~ Property Ovmer ^ Boring ® eormg # ~ Pit Grotatd surface elev. ~ ft• Depth to fn~ng tacbDr Florizrnr Depth Dom~raM Color Redox Description Textue Slrudun3 Cons in. MunseN flu. Sz Cant Color Gr. Sz Sh. ~ ©-z ~z ~ s, ~~ m Page ~ ~~ ice Boundary Roots ~rurtr •Et7#t 'Eff#2 cs 1 U-C, ~ S `~ •tc~~ . ~ ._. 1 ~ i ~ j D Boring # ^ BOnng iGround surface elev. ft. Depth tD rmri~g factor in• Sod q tion Ral ^ Pit Hor¢on Depth Dominant Cobr Redox Des<xtptlon Texture Sbur3trre Consistence Boundary Roots GPDffP Qu. Sz Cont Cobr Gr. Sz Sh. 'Etf#1 'Etfi#2 in. MunseU Boring # ^ Boring Ground surface elev. ft. Depth to laniting tacsDr in. ^ Pit Sol ~ tion Rate Redox Description Texture Structure Corrsisberrce BourMary Raots GPD!([~ Horizce Depth Dominant Color 'Eff#1 'Eif#2 in. Mansell Du. Sz Cant Cobr Gr. Sz Sh. • E7 #1 = BODS> 30 <_ 220 mg1L and TSS >30 <_ 150 mglL ' Effluerrt #2 = BQDS < 30 mglL and TSS <_ 30 mgtL 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 depaRment at 60&266-3151 or TTY fi08-264-8777. SBD-$lltl IR.OTMRI I ~ ~ w PAGE~OF~ NA_I~sE ~~ l ( LOT# g LEGAL DESCR iPTION~W ~ ~IJ~.~r `a S 3 ~ T Z q N R ~ ~ E(orY~ SCALE:1"= i ~~ BM 1 ELEVATION /O y . O BM 1 DESCRIPTION ~o Q d ~ (~ ~ u c ~' D,T? _ BM 2 ELEVATION ~g~ 3 O BM 2 DESCRIPTION ~~ 6~ ~ ~ ~ ~~ ~ P i'~ ~ SYSTEM ELEVATION `~6~~ q SYSTEM TYPE I~Y~Ocy/1 CONTOUR ELEVATION ~g~ ~ S cc4 3 ~ s- ~~ .~ t SIGNATURE _~ai~_-~ ~' ~~ DATE Co- /S--~'~ P01NTS OWNER'S MANUAL & MANAGEMENT PLAN Page I o; Z ~MATION c~ ~ , t~ I L~.C`~_ ;IAN PAROMFTFRS .,;r"~ber of Bedrooms ~ ^ NA 1 ': n-be~ cf Public Facility Units l A __- ~st~m~ated flow l~verage) ~50© al/da Ces~gn flow tpeakl, )Estimated x 1.51 '~S~ elide Soil Application Rate ~ a[/da /ft' Standard Influent/Effluent Quality Monthly average ` Fats, Oil & Grease (FOG) 530 mg/L I J~ochem~~cal Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSSI 5150 mg/L et~eated Effluent Quality Monthly average Biochemical Oxygen Demand Total Suspended Solids I (BODE) (TSS) 530 mg/L 530 mg/L ~NA I Fecal Coliform (geometric mean) ~ 510' cfu/100m1 - "."~ax~mum Effluent Particle Size l Ya in die, ^ NA 'va'~ues rvo~cal for domestic wastewater and septic tank effluent. CvCTFM SPFCIFICATIONS Septic Tank Capacity /Doo 7so al ^ NA ~ Septic Tank Manufacturer (,J~ S ~~. ^ NA Effluent Filter Manufacturer Za-b~, ~ ^ NA Effluent Filter Model ~ - ~p ^ NA Pump Tank Capacity '~ ~D al ^ NA Pump Tank Manufacturer ,f I,,~o,; S ~ ^ NA Pump Manufacturer Za. ~ Z~. ^ NA Pump Model ~'1' ,(~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: ^ NA Dispersal Cell(s) ^ NA ^ In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade ~ Mound ^ Drip-Line ^ Oth~ Other: ^ NA Other: ^ NA Other: ^ NA r,' 41N I tNAfVC:t Jl:l-ttUU~~ Service Event Service Frequency i^spect condition of tank(s) At least once every: ^ month(s) (Maximum 3 years) ~~ ~ eari,s) ^ NA mp out contents of tank(s) vV When combined sludge and scum equals one-third (Y,1 of tank volume C NA '_-s^ect dispersal cell(s) At least once every: ^ month(s) (Maximum 3 years) ~ year(s) ^ NA -- ^ month(s) ^ NA Wean effluent fitter At least once every: ~, ~ ear(s) ^ month(s) ^ NA -soect pump, pump controls & alarm At least once every: ^ year(s) - ' ^ month(s) ^ NA F „~sh laterals and pressure test At least once every: ^ year(s) -~„ P, At least once every: ^ month(s) ^ year(s) ^ NA !- ^NA'~ MAINTENANCE INSTRUCTIONS 'nsaections of tanks and. dispersal cells shall be made by an individual carrying one of the following licenses or certlflcat~ons r,!aster Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tan'K ~nsoect~ons must include a visual inspection of the tank(s- to identify any missing or broken hardware, identify any cracks or leaks. ^~easure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. 'he dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding ~' effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the mmediate notification of the local regulatory authority. ,'.`hen the combined accumulation of sludge and scum in any tank equals one-third (Y,I or more of the tank volume, the enure ~~~~tents of the tank shall be removed by a Septage Servicing Operator and dispo$ed of in accordance with chapter NR 113, .^:'isconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatmem 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, ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSIiIP CERTIFICATION FORM OwnerBuyer ~~ f 1'j~ ~ ~.L ~i/L , Mailing Address ~~ X ~ ~5,~/ ~/ ~,},o K (~¢~ ~ S~0 ~ G Property Address ~ s Z / S3 v ~ S ~ ~ n (Verification required from Planning Department for new City/State ~~ /k ~(A o w [~ / Pazcel Identification Number o drys- 2~s- o$-- ow(. ~3`~ LEGAL DESCRIPTION Property Location~~ '/., ~ '/4, Sec.3 1 , T 2 ~ N-R ~ 7 ,Town of ~~ h1 r+? o K~ . Subdivision ~ ~ c ~ ~ ~.b- 12a,rr ~ h .Lot # Certified Survey Map # ~ 3 7 O ~ 3 ,Volume Page # $ Z Warranty Deed # 7 ~ ~ ~ 9 9 .Volume 2 s8 7 .Page # ~ Z Spec house ~- yes ^ no Lot lines identifiable (,yes ^ no SYSTEM 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 tank 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 mastorplumber, joumeymanplumber, restrictedplumber or a licensedpumperverifyingthat (1) the on-site wastewaterdisposal system is is proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 f the three year exp' tion date. ~7 3 ! /~ ATURE PLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of rty described abo/v~e,~by~virtue of a warranty deed recorded in Register of Deeds Office. C~ Lk:XJ~ v " l l ~ ATURE P CANT DATE s*«**« 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 ~1_ Z587P STATE BAR OF WIS<:ONSIN FORM 2 - 2000 Document Number WARRANTY DEED This Deed, made between Bruce J. Mol! and Thomas S. Aa Grantor, a am E. Miller, a s gle person 6 Z t{ ?64699 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 06/03/2004 10:30AK MARRANTY DEEb EXEMRT ~ REC FEES 11.00 TRA}18 FEE : 792.08 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum:) Lots 4, 5, 6, '7,~9, and 10, Plat of Highland Ranch in the Town of Hammond, St. Croix County, Wisconsin. Recording Area Name and Return Address Fi=c t3 018-1069-00-000 Parcel Identification Number (PIN) This is not homestead property. 6i~ (is not) Exceptions to warranties: Easements and restrictions of record. Dated this c. ~ day of , 2004 r * AUTHENTICATION Signature(s) authenticated this _ day of T1TLE: MEMBER STATE BAR OF WISCb+1' ([f not, =_-L authorized by § 706.06, Wis. Stats.~Q ,: THIS INSTRUMENT WAS D ~c'FE Thomas A, McCormack 3,yZ ;~ Baldwin, WI 54002 ~~i (Signatures may be authenticated or acknowledged. eot k * Names of persons signing in any capacity must be t WARRANTY DEED Bt/~; * Bruce J. * Thomas S. Aaby ~ r 'ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix County) i~ rsonally came before me this ~ day of 2004 _ the above named Br J. Moll and Thomas S. Aaby to m~'icnoyVft j.6 be the person(s) w)~g/e~cute~T~e foregoing ~~. N ~ in~t iu~uwicu c i ~ Y g'~ z y _~f u _ Notary Public, State of CONSIN ~° ~__- My Commission is penman t. (If not, state expiration date: ~ J , CiZ.O .) rtt~~~,X,~- •------. or printed below their signature. - STATE BAR OF WISCONSIN FORM No. 2 • 2000 INFO-PRO (800)655-2021 www.infoproforms.com ~t ~~~~ I ar.~4uu~v.Y NN°J Wai/ifN%IUf/ BIWW'V a lJ3x.+(YW uwwvu MV.W iLLdO MUII 3111 JO i(119Y7 ss•eae ~ a .9e. < <.oo N ~~~, ~ ~ \rk ~ mYr1 I Iltx ~ aaon~ ,.~. # ~' ~ I ~ ~ . . • y •1 ~ FS lPl%P uM+µ ~ YI Wl a `u O~ 1~ ~~ (~ r+ ~ ,'' .4{ ~ A M;U 4004 ~ ~ •ro••H -T~ ~ ,~ v/ / ~ V^. ~ ' ~ .~~ ~~ ~ i~ I ¢~ ; ; ~ rM 1400; - - - ~ " ~ , ~ _ _ ~i aa1 aa I ~ ~ s „ice ! ~ ~ ~ ~ ~ J ~ --------- ~--~---- ~ ~ 1 ~ _ ~ a i p1eo~ ~ y 1 I ~ ~ ' ~ ~ ~ 8 ~ ~ ~ \ err i I ~+ % \ ~ ~ ~ i ~j\ I o I ~h s ~ a ~ ~ ~ ~ ~r~ ~J ~ 1 ~ ~1 ,~ ~ I, / 1.' ~ ~ tl Rt'79i:100M ~ ~ Q ~ 1 ~K ~~~°MA.pp ~1~ 2~~' 1 1~ I ' -'tri17 •ariu-'---- ~-~ '~~sr< ----- - w ,, r ~ ~ ~\ \ '• A •/ -'W1F~YRWi0o1: QItJ •' ®I 1 I® G(y1 `} ~ _ jC[Y- ~I g "r r., a l C~/ ~Y N r ~ i : j~ 1 ~ ~ ~, 1 ~ 7 ' ~N N~ ::: ;,. ~ ~ I ~ ~ ~ ~ I i X ~ • k it J ~ ~ ~ 7 ` ~ ~ ~~ ~ ~ ~ j~ ~ ~ a~u a1w uciu -J - j ( 555 . ~~ 4 rY ,1 ~ ~ I ~ v-- I i .: _.... .pia irivM.wwmt 1 oi.~~... .{~ ~ ~ ~ I yaroivi wawa wor m y '- ' Y ~ K~ , MJQ l000i r ....p'"1 i ~. -~ ; °' v a1t;1 ,w ~ °~" ,to•ora M .aa,~o.oo S ~-~ ~ a ~~ ~ ~ ~ ~ 4 ' ~8~ ~ n ~~ J' ~~ ~ m ~-~ I~ I ~ of ~v~ I~ ~ I °~ i~, ~y ~ I I I I I ~ 1 i ..~~. , ~. 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FT. ~_ . ~ ~~ \~ ~ , HWE = 1000.00' ;~ i 383 ~Q \ ~ 'S1~' E~ 34 C4~ • w _ B~ ~ / ~ • ~ ~- ~.l ~ ~ 1 / ~ S 89°48'25 E ' 45.81 Ci i y 2 • ~ ~ ., . i ACRES i ` , `~ ~ O ~ ~ ~ ~ , SQ. FT. ~ ~ ,r . , 1002.00` ~•. _ --~ L. 1~T 7 ~ I a •. ? .55 ACRES ~, j ~ ~, 67.455 SQ. FT. ~~ ~ ~ v ' ~ ~ 1.6~ ACRES . ~, ~ 70.436 S~~ FT. ~ ~ ~VVE = 1004.OQ ~ x;89'39 38 E hP ~ i 41 ' 1 ~i __ -- `-- t8J3 339 51 -- I; 395? 83 E 1113.14' ,_ ~: ;~ ~, ~ -_ T y!S iNSTRI;~,~tE.NT DRAFTED BY MICHAEL ERICKSOPJ ~±QE3 NO.01-89 DATE 6-5-0? i~ .~ ~N. tffu,'$ ~~ ~ ~~~ ~~~"f ~~°8 i~~ ~~'~ ~~~~ ~~P l~~~ ~~s~y ~~~ ~~t ~• ~ ~~i9 p 9 p p p a s o p a 0 ~ ~ . . a _ ~5 r ~ r ~ ~ G ~ i E B 6 6 ~ ~ ~ ~ ~ ~ a R ~ 4 qg p ~ e ~ ~ Y ! ~ ~ ? i ~ ~ e ~ t ~+ ~ i ~ q S +5 ~F i . r ~ ~ '~ y ~ ~ 4~ ~ Y ~ 2 ~ ~Z x ~ ~ ~ ~ s ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~1 ~~ eC ce y T pp ~ S K F R 7 rJ, 1 C i z ~i % ~ ~ p ~ R~ Z j ~ ~ 1 ~ ~ ~ A 1 2 „ < ^~ A ~ ~{ y ~ ~ ~ ~ d `~ ~ ~ ~ '~ i ~ = ~ ~ n ~ ~ _ < 2 ~ ~ ~ 1 .a .. p ~ A o ;~ J O W ~~ OOB~6l9'0~ 6itY0mi X100® ~d OP~A®1• '~ ____________ ~i •0••t•!W -' f~ ~~~ ••°•••• 160TH 8TRE~' ~ - K0° - ~°*~'- i opro+yr w.> ~s• r , -~- ~ SSii ---------- r ~ ~ i i 1~ ~~i . is ~~i 1. ^ ~ f~. ~~s ~ ~~ ~ I •ooa.rrw ~ i~igi+ ~ i iRM ~ Yg ~ i8 ° p 6 a * ~ f i ,) i ~ M ~~ e ~~4. i ~~ ~~ ~, ~~~ ~~ •oom w..ooo s .. ..oo,• __ __ ," ..~.. ~ ~ ..;,.~ r .~ : , a ~~ ~ ~~wa~. » ~.vM~ ~s ~ gs ~~ [ :~ €~~ ~C yy i~ ~ ~ ~ ~ R ~ ~ 14 ~~ ~ ~ ~~ r------- ~ ,, ji ~~~ ~~ ~8~..