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HomeMy WebLinkAbout018-2005-09-000~~~ti ~~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION ,REPORT GENEFfAL INFORMATION (ATTACH T~ P~i2MIT) Personal information you provide maybe 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: ,~ r Insp. BM Elev: / BM Description: TANK INFORMATION EL ATION DATA TYPE MANUFACTURER CAPACITY Septic ~~ ~~ ZS~ ~~ Dosing `~'l~-h,~,,~,p `-') rt Aeration Holding TANK SETBACK INFORMATION STATION Benchmark Alt. BM Bldg. Sewer St/Ht Inlet SdHt Outlet Dt Inlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ? ~ t ~ r Dosing ~ ~ ~ ~'~ Aeration Holding PUMB~5IPHON INFORMATION Manufacturer ~ Demand L.L~-- GPM Model Number ~ ~ O D H es Lift Lift ~ Friction Loss Friction Loss System Head TDH ,Ft ~b ~ 2.0 -- o h Forcemain Length r s Dia. tt Dist. to Well Cover SOIL ABSORPTION SYSTEM ~ (~12'x 81. ZS + (11 ~' x Lf~. ~~' ~_ ~f) ENCH idth Length No. Of en hes IPIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DI 3 ~ v,~, eg SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHA OR Type Of System: ~ t ~ ~ _ ~ I ~ ~ UN T Model Number: v ~ ~ . - I t ~ D ~ - DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) ~ -~ 5 r Length Dia Len is Spacing SOIL COVER Y Praccura Svsfamc only YY Mrunri Ar 4t.Grade Svstpms Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Ed es 9 To soil p ~ Yes ~ No ~ Yes ~ No OMI~AEIYTS: (Include c di~pengjes, persons present, etc.) Inspection #1:~ ~ ~?~~ Inspection #2: T'T o tron. 656 153rd St Unkn n (SW 1/4 NW 1/4 31 T29N R17W) Highland Ran Lot 9 ? ~ Parcel No: 31.29.1nn7.935 1.) Alt BM Description = ~~-S ~JQ `/~ Ci~ G~/.1/ ~~ /L ~/~ ~ I wer l n th = ~ /~ 2.) B dgmsge~ t ~fe g .~-" ~- I~/~ ~ -~/ (/lit ~~ ~ ~ 3~ Z ~y /Scov~ e~~ v'~~( ~~ ~a.G~r~ ~ .S ~`~do Q/~-C''~n~~~ ~1/ /~)~^ ~ A Plan revision Required? LJ Yes No III 2l f ?,dO Use other side for additional information. ~__ . 1___ SBD-6710 (R.3/97) 1 o ate _ A _ r S Lnsepcror`s ~lgnature County: St. CrDIX Sanitary Permit No: 453327 0 State Plan ID No: r-- --~' Parcel Tax No: 018-2005-09-000 Section/Town/Range/Map No: 31.29.17.935 BS ,~ HI ~~ ELEV. Iz.2(~ .0 9g ~' ~-~. r~. ~ q/. 3 poor Ip I.oz Cert. No. S y; ~~.98.~ (~~ 12.~gg.~ LG c. `~~ t z . ,~ ' = ~~.~ z' lZ. tb 2 ~~.9'2~ ~2.oZ _ `~9.~0~ 0,~3 z ~~.Zq' ., _~~ _ ~ - i yl 33 IZ I~~ ~~ s= ~S ,~ ` ~ ~ Safely and Buildings Division , 201 W. Washington Ave., P.O. Box 7162 County ~ 5"t-~ ~. rp r ,r f c~O~~,~ Madison, W! 53707 - 7162 Sanitary Permit Number (to tx fiUt' d in by C;;. De artment of Commerce (608)266-3151 / 3 3Z '~• __ Sanitary Permit Application Stag Plan `°. Number !n accord with Comm 83.21, Wis. Adm. COde,•personal inforvtation you provide ntay be used Cor secondary purposes Privacy Law, s15 Project Address (if difl'erant/than mailing ad~dr~c/s~s- sG / s~ ~` sf"~~ ~ 1 ( 1. Application lnformadoo - Please Print All Lrformat ~ f '/ ~ Progen w yO ner's Name Panel b Lot p Bla'~ a ~ - A ~ ('~~ S ~s~ 9 ~~ / I'Y 1 a ~ Property Owner's Mailing Address Property location ~ a ~/ ~ ~ s u/ ,, tN "~ ~ Section 3 ~ Ci:y, Stat G OFFIC Phone umber ~ ,, e i r CY .S Ot.. ~ ~O ' Z.7 y ey T Z C N: R' 7 (cE oo~ 11. 1 ype of ti Wlding (CheCK AU that apply) j ^ I or 2 Family Dwelling -Number of Bedrooms ^ Public/Commercial - Describel)se ~~ ~~/GLr, ^ stag owned -Describe use 3 3 . t s'• i 111. Type of Permit: (Check my obe boz on Ilse A. ~s o 1 tJ~ t O < lete Une B l[ applicable) Subdivision Name v CSM Numtkr ^City ~VUlag~ownship of~.k n' Ncw System ^ Rcplacetnmt System ^ TreabnenVHolding Tank Replacement Only ^ Other Modification to Existing Systec~ - b ^ Permit Renewal Permit Revision ^ Change of ^ Permit Transfer to New list Previous Perutit Number and Datc lssucu Before Expiration Plumber Owns ~-- 5332~- ~~.t~- t v. type of Y V W 1 S System: (C;hecK all tbat apply) l - !, ^ Noo -Pressurized ln-Ground ^ Moues > 24 is of suitable soil ^ Mound < 24 ia. of suitable soil ^ At-Grade ^ Single Pass Sand Filter u j Constructed Wetland ^ Pressurized In-Ground ^ Fioldin Tank ^ Peat F' ter ^ Aerobic Treatrrrent Unit ^ Recirculating Sand Filter ^ Rximulatin S thetic Media Filter Leacambc' ~~G~ i g yn ~ g ^ Drip line ^ Gravel-less Pipe ^ Other (explain) V. Disnersal/T'rcatment Area lninrmatlnn~ [ksign Flow (gpd) ~ Design Soil Applicadoa Rate(gpdsf) Dispersal Area uued (sf) ~ Dispersal Area Propos d (sf) ~ S stmt Eleva u ~j$. 3~ sag, o0 ' lob Dr yd /Sow /S23.g ~TS~.os 9g.e~ _-- I Vl. Tank info Capxiry in Total Number Manufacturer Prefab Site eel Fiber I alas;.: t:lallons Gallaos of Urrits Concrete Constructed Glass ', Ncw l;xir<ing ~ Tanks Tanks __, S.~piic or Hol~lin8 Tank 2 S~ $a • '. A:ruble Tn:umcot Unil 4 II c,~~ns cnamx~ -- I V11. ResponslbWty Statement- I, the under red, assunse responslbWt for lnstallattoo of the POyYI'S shown ou the attAChed plans. __ Pluusba's Name (Print) ' Plum 's Signature MP/MPRS Number Business !'bone Numb Plumber's Address (Street, City, State, Zip Code) ~ 111 Coun /Dt: artment Use Onl IApproved ^ Disapproved ~~Y Permit Foe (includes Groundwater Date Issut)¢. ; lssuin gent Signature (; Szny~s; Surcharge Fee) < Owner 'al Z!!]D 1X. Conditions u pprovaUReasons for Disapproval ~ f SYSTEM OWNER: 3~ (t1+.111 ~ Ot_~ a C~-~~ 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. ~ ~. 2. All setback requirements must be maintained r°1~~ °~'~~ ~~ ~/ as per applicable code/ordinances. ~~ ~~,~,n'~- ~-QoA Attach compktc pleas (lo the Couuty only) for the syrtcm oa pa cr not kss tbaa 81/2 x 11 lucbcs is st<c SBD-6398 (R. 01103) -- a ~ _ ~ ~~~ - ~- ~ £ , ~\ J , ., ~iJ 1,, V ~-o` \ , v -r~,,,, \ ~., ,•G ~ J ~_'o 1 ~• V M J t ~ N ~ a ~ ~ ~4 J Y4 _1 h" r , ~~~~ Sa ~ ~~ ~ J a ~~, // \ ~ ~"~ 0 ~ ~ T ~ ~ 4` iJ ~ O ~ ~ ~ ~ E~ l~ ~ ~ ~ i ~~~ -~ ~ ~ - ~ s ~ ti , i l • p[ ~' M ~ v_o ~ ~ ~- ~ s - -. ~ e d .} ~ ~ d , to :~-Z ~, ~ s ~ i v~ . - , ~_ , , ~ (~ k~ ~~~ f ~ ~~ , V aG d ,, N ~~ ' i ` .1 a I 4 •~ t { v V . ~ ~ l1~ ~ ~ ~ ~ I~ !' ~ p u 3 ~~ ~ ';Q; V ~ V ~ , ~ ~ ~..~ ~ 3 r ~, ;~-- ~ e ~ []i ~. \ vl ~rn~? ~ ' ` A ~' 1 ~~ ( ~ ~ \~ ~~ ~ ~ ~ h . _ i -_.._. _ ~ ~ ~o h r o a 7. w~~- ,. ~, 0 a ~ k ~ f (' ~V f'F' r ~ ~. i ~~" r ~, ~ ~ ~ ~ ~ ~ ~ f - / .., ~- ~ d o -~ ~ o ~- ~ ~ ~ J ~ ~ ` `~ l ~ J S ~ ` 1~ M I . 1 V4 r _. 0 ~ e d .} t/1 ,~ - , ~ ~.Z U .9 A- z ~ w w ti J .~ N ~a ~, ~Q J Y~ 1 A SEP-08-2004 08:20 AM A.C.E. Soil & Site E~al 71S 248 7764 Dose Tsnk Irrfonratlon ENobioei ~ per NEC X00 snd ~~^- Comm 1es.28 WAC 'r'ank ~npa~! M prope~q vented Wleasr WLF8000 Ca 775,70 Volume 1x.12 Dlmenslon inches asllons A 28.50 4$7,10 B 82.24 C 7.50 120,90 C 193.44 Total 48.00 773.76 Manufaduror GaHone ~" gaUlnch A C D 3 Bedding un er tank. ~J Alarm Menuafaadurer LevaIM11 Alarm Mode! Number DLV Pump Manufacturer oe er Pump Model Number ~ Pump Must Deliver 2.9 gpm . at 14.24 ft 7DH Project: Miller Homes -lot 9, Park Hollow laaanp cover wrth wsrnirm rbN srld bOrdrtip device end ee~Nd vrebertiph! ~ In. min. l--- Alhniets outlet kioellon ForoertiNn dlemeter 21n. Weep how or end siphon dwio. 5 ~ta~lc elevatlon R 91.45 Pape 4 of 9 P. 02 ,~ ~'SS ., ~~ ~~ a ~ ~ i ~ o 0 p C~ ~ ~ ~°o Z ~~ U o //~/~ wJ ~~CD ~ VI ~~ ~ ~' Y ~ ~~ZO 3° ~~ ~o ~~ o ~W' ~~~ ' .r.. Y W~ W ~ ~ ~~\ Q ~ O O F v ~. Q ~~ I'7 \~ U OV o o ~ ~m ~kQ ZZ ~ ~ O ~_ Uw O ,O oQ ~~ ~~ N ~~o a~~ N W ~ ~ ~fn WHW (.7 C9 Z ~nnnx 00 J W ~ } ~V o m O I tJWW O 1"~~~~ 3cno ~ O ~a/~ ~ o d ~ rc°i J N al Q W U~ a0 ~ ° ° `° W ~ O N NsOOUF-Jn 1-~Q mNQ N~ ^ ~3 ~ ~ r~ a M~ ~~ ~~ Z~ ~ J~ U ~~ N M .. J.. "~-J .. F~-~f' ~'Z~ U Z ZJ~~ZC7U~0~C9 OmvYi DOH Q ~ QW OJO_ ~p U ~3omo~=wpm=,~3 ¢~t~ a3~ z _~ J J Q Q D Z Z J O ~a~ z M I I I I ' I I I I I I i (3j,j II ns I ~~~ W II S ~ .s~ S ~ a ~ W J I _~ J O U N U to N i H i a ~ 1 I I I I I i y~e ~ rs~ ~9CJ -------- -------- 1 ~ ~ 1 I ~ ~` 1 j ~ I ~ 1 \ ~ I I ~ I ~ i I I ~- 1 I I I I I j ~ : ; ; I . ' . I I ~ ~ 1 I I j ~ -` ~ I ~ ' . ~ ` I I I i ~ I I Q j I ~ ~i I O SEP-08-2004 08:20 AM A.C.E. Soil & Site Eval 715 248 7764 P. 01 !'I Ile +~ I ]~ '~ +x ]e 145 7a 16 "I •nl 7/ rlO ]1 103 ~ I00 93 2B 9O 76 e5 21 ~ )6 ft I] m 7C se 16 60• ~ !S' • le :ro• u 45• 17 /0• 7! 10 ]0• e-~ 76 6~ !0- •. ~ m ] 9 0 ~~ GAL ON I G 7u e0 O 9 /lOW P A MIN1/11 rOtAL pvNA/1IC NEAP/CAPACIh pER NINVI( E/rW[N7 AND bEWA1ERIN0 lap 1~0___~SO leaf ea Ie0 91a OAO ~0 cA~TioN Model 185!4185 shoulLiu Lnot be gubjetted to lesg than 30 feet TON. ~ AbGN SJ /57 9 B 1 ]7 110/ 1110 lel/ /161 IaJ/ 1161 Ie5/ AIa3 165/ 119! Iefi/ I le6 Iaa/ l lee IE9/ +Ie9 t p~~~, f •' .. .. ' _ , ~ ~ ra_. Mlteri Ppl 1v1. Onl Lln. Ca. I b~ C9I Llrc. Gd Un 60l urs Col llr1. Cut. llrs. CoL Ur7 Car. w1 Col Lvs C I LIr I S S 1; 16J 7) 773 9J )37 91 JAI IOU S79 GI 731 fil 231 - •~58 770 115 719 I13 . •.~N! AS I>V IO ~ .11 I 31 129 91 731 ~ 799 61 Jla 9J ... SS7 61 2J1 et 7JI 5e 770 110 9J0 110 IS 17 I) 1.6 Ip I 17 q I70 64 /l'L /G 29B 95 377 60 777 61 jtl DB 131 7 ~~~1 5 SSp 0 ~r_2V 6.1 I hh' 23 93 3fi t3a be 751 79 _ 799 D9 72.J GO 171 ... _. S6 770 '/'!0 176 SQ Ig1 3 l!1 SIt W6 41 ~.. !i0 1 I) e5 r.G ~~ a ]0 59 77.f 70 7G5 57 716 79 ~~ 77s 7e 22u l77 . 1a7 1Ye 1 n ~ IS 0 , YYY 1rG ~ 3.7 /9 195 62 7J5 55 706 ~.. 770 65 327 7G 22D Ilfi /Jp rt 7D q< li 17 ~ ~0 ~r U 7 ... 2t ~ 79 15 va - IG n2 SS 206 70 767 ;.N ._ 770 l0. J9A 109 tl7 .. _ 0 ~ 7 'S.7 _ _ 20 7a )) 173 50 !e9 - 51 19) 5a 120 90 4A1 97 a 1 0 ' 60 IeJ _ _ 15 S7 39 116 J7 111 56 220 /1 . 7G9 a5 Sal ~3Y! e5 /! 1C ~ 1 23 e7 9 JA B2 197 ~ 51 19J a9~ 761 l5 I n 110 Do n.l - _„ ~ ~ • IG Ja /5 -170 29 106 ... 71 19J ~iy a0 9e 771 ~~ _ __ __ _ J' _ ! 1/ 2 ... 9 N 100 N15 ... .. ID 60 ~ f] 129 i /5 n0 i no nu ... • a s0 lyl / le >D 11. IIO 166 i 13o sa 6 .. - _.. 0 • 76 , Loci veal • 10) n (l.9MJ ].t fl (7m) ZG II. (79m) Ia q. (llm) 36 f~•( 171mj 6D II ( 701mJ 965 Il. (76./m 7J 4. ( 2'/Jm) I1/ 0 (3AJm) 91 II. ( 777m)_~ I IV tt (].15m 1D U7 h. ( ya , /1 Brrr)I ~ ~ ,~ S~ ~ ~: MA• W17 AIM HEAD CAPnCIir CURvF EFF(,UENT MODEI S HI 166 Ils , e I GS. Ilfi I« .. 163 I I I , ++6] l ea, I la g 4G. I/ O AI 1 Il7 lel, +Iea r 1 u 9+. /l fi~~e r 96 ® Copyright 1996 Zoeller Co. All rlgnts reserved Safety and Btuldings Division ~ ~ 201 W. Washington Ave., P.O. Box 7162 cCO~~~~ Madison, Wl 5~7Q7 - 7162 `~ (608) 266-3151 De artment of Commerce Sanitary Permit Application !n accord with Comm 83.21, Wis. Adm. Code,•personal information you provide ~' maybe used for secondary purposes Privacy Lawn s15.04~~m~ L Application laformadon -Please Pr(nt Alt Inform P.-openy Owner's Name s~ M M I «1=~ Property Owner's Mailing Address !3 D,,1( # / S / Ion JUN ~ 4 2004 ~ I~ vi ~(JI~ i,, iJ'..fIJ i ~~ ZUNING OFFiCk. Ciry, S Zip Code Phone Number (~ u G ~ ~ ~ ~ S ~/ o / c. 3 fj~-2 7 (P 11. Type of B g (check aU that apply) I or 2 Family Dwel -Number of Bedr ^ Pub tirJCorrwiercial-De se ~~ ~)1`wtba!' $ T~~d. ^ Srate Owned -Describe Use ~. ZS • eMt ~O'~/S ~ ~3 as O~ O Ill. Type of Permit: (Check on a boz an line A. Complete Une B tf applic ) A. New System ^ Replace System ^ Treatmmt/Holding Tank aament 6 ^ Permit Renewal ^ Permit Rtvision ^ Change of ^ ~t' nsf Befar>: Expiration Plumber er County ' ~T'. CeDI Sanitary Permit Number (to be Gilled iv by Co. i . 32 __ ' State Plan LD. Number ~' Pr//oject Address (if different than mailing add: _ssj W S ` /S3rd S*r a a~r ~sa•N N~ Ov ~t ~ ~ Parcel ll L,ot p Bla> ~ ~ ~ Pro L,ocatioa 1 %, ~ ~ %, Section 3 ~ ~~ (circle o T 2q N; R ~ 7 E o~ Subdivision Name ~ ~ 1~ t~ca..~ n~ i ^Ciry_^Villege os ship of i ~ - 190 t7'~ S ^ Other M Lxrstin st • IJst P=vious t r t ued lV. T e of PONrI'S S stem: Check all that a 1 Non -Pressurized In-Ground ^ Mound ? 24 in. of suitable ^ < 24 in. of suitable soil -Grade ^ Single Pass Sand F' ^ Constructed Wetland ^ Pressurized In-Ground ^ Bolding T eat Filter ^ Aerobic Treatment t ^ Recirculating Sand Fi Recirculatin Synthetic Media Filter ^ Machin Chamber ^ Iki ^ Caavel-less Pi ^ Other (ex lain) ~ V. Disoersal/I'reatment Area lnformatlon: ~F- Z ~ 1 - 1 n e iC.~'~ i l'~-a.r/' 1~1 ~' Dcxign Flow (gpd) Design Soil Application Rate(gpdsi) Di nal Area ed (s~ Dispersal Area Proposed (st) System 1; vauon ty a '{ 6 . ~~ ~~ oo c~.~ /5tso /523.9_ .~-: '>7.00 ' __ ~'1. Tank Info Capacity is Total N Ivlanufn er Prefab tee i a;i.,; ', Gallons Gallons of is Concrete Constructed Glass Ncw Bxiiaing ~' Tanker Tanks ~' ' S:piic or liol~ling Tank (2 ! o • ~ / ~ ~SE 2. Aerobic Tn:atment Unit 7 Vy '' ~ Dying Chamber i r - ~'1l. ResponslbWty Statement- 1, the under ed, asstuare responslbWty for tnstnlladon of the POWI'S sho on the attached plans. P!umbv's Name (Print) Plum s Signat MP/MPRS Number Business Phone Number ~'~l ~ lid. Wl ~D o~ ~ ~ l ~A,`- Z z. Sn 3 ~ /2 _YGs ~ ~ 9 Z Plumber's Address (Street, City, State, Zip e) ~'11L Coun /De artment Use On ! Approved ^ Disapproved ~ e a t Fee includes Groundwater Date Issue~L suin gent Signature No S.an~psi g ) ^ Owner Given oa for Denial ZSt~ ' ~ ~'~ lX. Conditions of ApprovaU asons for Disapproval 3 ~ f t S ,.q.- ~? ~/~p.,Y.a a ywtlA..1( v'en t-7F~ ! SYSTEM OWNS Ar 1 Septic tank, luent fitter and ~- ~ S~ t1n~~~~~~ t /~ `~- ~! dispersal cell must all be serviced /maintained Q~~,,,~~ c as per management plan provided by plumber. °"'R" I a - "~ '~ ,~,•'~, o~ p !, 2. All setback requirements must be maintained t~194S , as per applicable code/ordinances. ~ -- Attach complete plans (to the County only) for the ryitcm on paper not less thxa SU2 : 11 loche~ is il<e SBD-6398 (IZ. 01/03) ~ _ $ ~ ~ ,J r ~ ~ ~o P l ,~ ~ ~ 6... 3 `~ r w ~? ~ ~ ~~'~ ~~ ~ G ~ ~~ _ ~ I £ ~ w C ti~ ~ ~ 3 '~ •„ z r c~ a -~ r °o ~Q `N b 0 ~'_ .~' ~ ~ p ~ ~ , ~4 'I °Q t o: t ~ ~ ~~ ~ ,~.,~ ~ .~. .. :r,.~ ~ S - ~ tin 0 Ooo ~ i ~ ~p tb r 3 ~ "~ ~.~ ( ~ ~y V it ' ~ ~A ,. Z ~ y °~ W w ~ ~ ~ ~ d ~ 3 ' `k~~~~J ^^ V ~ ~9. r nn ,r ~" M d _. M ~ 0 r ~ I T v'' iJ d o ~ ti ~ i ~ ~ .~- ~ / ~~ ~ 9 w -~ ~1 0 l ~ J ` s ~ s ~ M ~ 1 ~ ~ ~'0 I 1 _ O ~~ 7 i ~ ~ d ~ ~ ~~, 7 3' ~ V1 ..~ d, VI Z ~ v ~ ~ = 1/~1 `` ~ w~onsin Deparbr-ent of commerce SOIL EVALUATION REPORT Page .L_ ~ -~- Div~ion of Safely and Buifdhrgs in aa:ordarrce wish ~,`:a-• ~•. -fie . ~~ Attach complete sibs plain on paper rat less than 81/2 x 11 ~l~I~PXaA itt~tG.-~ ` inchide, twt not gmibed bo: vertical and hotizorNat nsfsronce (BAA), direcNan and Paroal ID. (/ ~S percent stops, scale or ~mensions, north arrow, and and distance to nearest road. ~~ d ~U~ 5 ~ ~ ~ ~ ..~1~("~ ~ t'~ ~~0'~~i R by Please print ap iniiormad Peraowl information you proMde may bs used for secondary VurP lPtnacy Law, s. r5.Q4 (~) (~!))• 0 PropertyOwnm, ' ,` Prkocatttxt Govt. Lot ~ 1 J4 /UW1 J4 S 3 T Z N R / ~ E (or) Yd3f Lot # Bbdc # Subd. Name tx CSM~ proper/try Owner's MaiBng Ad f~ j _ ~ ~ R d Phone Number [] City ^ Village ~ Town / S~ City oa Nearest ~ S7~'~ . I-Iq m t~Vt,a w l 5Fl ~~ (?iS 7 !o S 9 [)C] New Construction lJse: LZ3 t2esiderrHst J Number of bedrooms ~~ Cade derived design ttaw ram ~ ~ ~~ O O GPD ^ Reptaoement ^ Put>fic or cartmercast -Describe: ~ ~ ft (lr 3-~twJC% S(^ Fbod Plain elevation fiapplicable Parent material _ ~- - Genetal comments Sy 5-(e rh 2~ e ~ ~ ~ P ~~ e nct~ ~(~ ~ 3 C~ l.~ w -e l' ti • ~ ~ • ~ and reoommenaatiorts: ~ v..,n ~ C.c~ ~r ~ ~ .,~ u.~ ~ Fem. o ~g eormg # [~ Pit Ground surface elev. ~~' ~o ft. Depth to ifmittrtg factor _ i!D C' in. Sol fiat Rai Hor¢ar Depttr Dominant Cobr Redox Descxiptiar Texdtre Structure Cons~tence Boundary Roots GPOlitr •Eft'!X1 'Etiff2 in. MunseU Qu. Sz. Cant. Cobr Gr. Sz. Sh. /~~ ~/ l ~/ ~~ ~ ~'1 ~ /~ ~~Il~ ~ ~~ J~ ~ cJ r ~.~ ~~p •~ .s Boring ~ Boring # ~ in. Ground surface elev. ~~_- ft. Depth to HrrtiUrtg factor Sol bon Rate t T SWtXufe Consistence Boundary Roots GP DIftt Horizon Depth in. DaninantColor MtmseN RedoxDdon flu. Sz. Corrt. Cobr ure ex Gr. Sz. Sh. •Efl#1 •Eff#2 ~-!~I ~- L~ rJ'lS ~ .,- ---- ,~ , an ..n .....1 TCC c 'Nl .nnN • tEflkrerrt ~J't.3 BD~s> ~ t f1Q rrlg/L and TSS >3U < laU IrK3iL fS~ipnarin CST Name (Please Prim- l ~ Date Evaluation c;wtouctea ~ °1°v'^"'° ~•`"••~°. ~~~ .s '-k a U properly Owner Parcel ID # /O~ -1 Page -~ of~ (] Boring /J (f? ~ in. a Boretg # ~ Pit Grotstd surface 7 • ~ ft. Depth to ~nib~g Soi Rate : Horizat Depth Oom~tt Cobr Redox Texture Structure Consister-ce Boundary Sz Sh Gr Roots GPD1ft '~1 ~~ in. Mutseil Qu. Sz. Cont. Cobr . . ' r C ~ U ~ _~ / 3iZ ~ Z i! -z ~l-bl ICY/ - ~ g ~ . S U Borg ^ Boring # ^ ph rGround surface elev. ft. Depth m 9 factor in- Redox Description Texture Structure Consistence Boundary Roots Hormort Depth Dominant Color in. Mussed Qu. Sz Cont Color Gr. Sz Sh. ~~ tion Rate GPDIfP 'Eft#1 `Et~2 ^ Boring U Boring # Ground surface elev. ft Depth to rertibrtg factor in. ^ Pit Sot tart Rate Hori~t Depot Dam&t~tt Cobr Redox Descxiption Texture Structure Consisbettce Boundary Roots GPD/fP in. Mussed Qu. Sz Cunt Color Gr. Sz Sh. 'Eff#1 'Eff#2 ' Et>tueltt #1 =GODS > 30 < 220 mgll_ arm TSS >30 <_ 150 rtxyL ` Eftkient #2 =GODS < 30 mgf L and TSS <_ 30 mglL The Department of Commerce is an equal opportunity sernce Provider and employer. If you need assistance to access services or need ~~~ in an alteroabe format, Please contact the department at 608-266-3151 or TTY 608-264-8777. sBD-703018.07/0111 w 4~ PAGE~OF~ q 1~ E(or~1 ~T~.tLME ~C~ u LOT# t I EGAL DESCR~'ION St~J la ~U~~ ,S 3/ T Z q ,I~I,$, r SCALE: 1 ° = yo ~~ , _-_-~ BM 1 ELEVATION f~ • y I BM 1 DESCRIPTION ~ ~ ~ u_ ~ ~ ~' ~ ~ _ ~ 'I~ BM 2 ELEVATION q~ , StU I ~ SSG ~ 3 BM 2 DESCRIPTION ~~ ~ b'c- ~' ~ SYSTEM ELEVATION j~ ~ ~' ~ 30 Low ~ ~ ~ ~-. ~ SYSTEM TYPE ~'o ~ v-~ ,~-~ ~ `d r~~.~. ~ CONTOUR ELEVATION c zl~ j j t 1, a~r~ ``bU: >k~ [~'~'~' ~ /~2 r- ~ ~~ e= ~ ~-~ ~ `~ ~ v -~ ~~ ~, ~~ _~ b" ~ ~~ 1 '~~. ~q~~° SIGNATURE ~~~i/ ~~~ - ~ DATE ~ - /~ o~ ~ ~ / L L ,E 12- ~~S /i. /ae k .~ /e Q n e. /i. •Cm 7' # y Te 'f~ E / r. q s~. 3 0 Lo,.vE/, q~,~o. BioDif f user Spec~f ica~ti~-n~~ . ~~, ,~ ~~~,~ ~ Z ~ ~-0 3 0 o. ~6~ __-_-.l ~ 0 00 =o nc o o0 c~r~ 0 00 0o ~r~ ~c~ o corn 00 oco 0 cn~ ~0 ~0 00 00 00 00 00 0 0o coo =o c~r~ Oo 0 ° ~o ° 0o coo 0 ~ T ___t~ ~, I`~ 4' Knockout Universal End Cap `~-==-t<~. , POWTS ~WNER'S MANUAL & MANAGEMENT PLAN Page ( of 2 FILE INFORMATION Owner .-~".~ ~/~ ~/ f ~ L ~~ ~. Permit k ~ ~ -7( DESIGN PARAMFTFRC G. Number of Bedrooms ^ NA Number of Public Facility Units A Estimated flow (average) ~~~~ al/da Design flow (peak), (Estimated x 1.5) (~, ~~ al/da Soil Application Rate ~ al/da /ft~ Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) S30 mg/L Total Suspended Solids (TSS) S30 mg/L ^ Nq Fecal Coliform (geometric mean) 510' cfu/100m1 Maximum Effluent Particle Size Y8 in dia. ^ NA Other. ^ NA 'Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity ~ Z 5 b al ^ NA Septic Tank Manufacturer ~ ~ ^ NA Effluent Filter Manufacturer ~~~L ^ NA Effluent Filter Model ~.. (~ p ^ NA Pump Tank Capacity al A Pump Tank Manufacturer ; ~ NA Pump Manufacture~~ A Pump Model ~ A Pretreatment Unit '6~1A ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Cell(s1 ^ NA ~In-Ground (gravity) ^ In-Ground Ipressurizedl ^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other. ^ NA Other: ^ N,A Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s1 At least once eve n'~ D month(s) (Maximum 3 ears) ear(sl y ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third (Y,1 of tank volume ^ NA Inspect dispersal cell(s) At least once eve n'~ ~ ^ month(s) (Maximum 3 ears) -.f ^ year(s) y ^ NA Clean effluent fiher At least once every: i -- ~ ^ month(s) year(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^ monthlsl ^ ear(s1 ^ NA Flush laterals and pressure test At least once every: ~ ^ month(s- ^ year(s) ^ NA other: At least once every: ^ month(s) ^ year(s) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls- 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 back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority, When the combined accumulation of sludge and scum in any tank equals one-third (Y,1 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and dispo$ed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of S12 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. f ', UP AND OPERATION Page ?' of 7i new construction, prior to use of the POWTS check treatment tanklsl for the presence of painting products or other chemicals nat may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of tx~e tanklsl removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface, During power outages pump tanks may fill above normal highwater levels, When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge o! effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells, Do not drive or park over, or otherwise disturb or compact, the area within 1 5 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain. (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. •" After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled v~ith soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or, must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system, The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area wi~i result in the need for a new soil and site evaluation to establish a suitable replacement area, Replacement systems must comply with the rules in effect at that time. ~~ b e ale , r3v3tr3IITe a h o l d ~ n g `a n k ~N 57X (JC-~Tl O N Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name M ~~~ h'1 ~ (~ d~~F~~ Phone ~~ t- 1_ S`~ ,C~ Z~ POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone This document was drafted ' I' Name S C ( b 20ti1/~C.l Phone "'~/~~'_ 3~~0- ~O C.~ in comp lance with Chapter Comm 83.22(21(b)Itl(dl&(fl and 83,54(11, 12- & (3), Wisconsin Administrative Code. A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSIiIP CERTIFICATION FORM t?wnerBuyer S fE M rY1 / L L E.2 Mailing Address ~ e x #' / -~"/ ~~+ ~S o •1 w I S-5/o /,F, Property Address ~S ' S3 rc~i STr c. o.~ f-~ ~'•~• u~ o~. s y~i s (Verification required from Planning Department for new construction)- ~ ~ ~ City/State N6 r'^ ~"°~ ~'~ ~ '~-~' I Parcel Identification Number ° ~ 8 - 10 ~ `{ r o ° " y o0 LEGAL DESCRIPTION Property Location 5 ''`~ '/4, N ~''~ '/,, Sec. 3 1 , T 2 9' N-R ~ ~ ~ Town of l-Ia ~ w~ o a ~ . Subdivision (-~ ~ c ~ i ~x & IZa.~. L.~ _ .Lot # 9 Certified Survey Map # 7.3 ~ 0 7 3 ,Volume `i ,Page # 'g ~- Warranty Deed # ~7 4 `~ ~ ~'9 ,Volume Z. S S 7 ,Page # ~ Z y Spec house ~ yes ^ no Lot lines identifiable ~ yes ^ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in 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 days of the three year expiration date. NATURE F APPLICANT 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 the property described~/a'bo~ve, by virtue of a warranty deed recorded in Register of Deeds Office. C~ °~i //~ l ~~ S NA F LICANT 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 decd from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ~1._ 2587P Document Number STATE BAR OF WIS(:ONSIN`FORM 2 - 2000 WARRANTY DEED This Deed, made between Bruce J. Moll and Thomas S. Aaby Grantor, and Sam E. Miller, a single person 6 2 t} 7E-~CF699 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 06/03/2004 10:30AK NARRANTY DEED EXE'PT # REC. FEE t 11.00 TRANS FEE: 792.00 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, 8~and 10, Plat of Highland Ranch in the Town of Hammond, St. Croix County, Wisconsin. - Area Name and Return Address Fr- c. a 018-1069-00-400 Parcel Identification Number (PIN) This is not homestead property. 6i~ (is not) Exceptions to warranties: Easements and restrictions of record. Dated this ~ _ day of , 2004 * AUTHENTICATION Signature(s) authenticated this _ day of , * TITLE: MEMBER STATE BAR OF WISCb'~' (If not, =_-~ authorized by § 706.06, Wis. Stats.~ ~` i Q: THIS INSTRUMENT WAS D[ ~c~E Thomas A. McCormack 3~Z ~ Baldwin, WI 54002 ~~i~, (Signatures may be authenticated or acknowledged. BotAk B1/~; ti~~ 4N :3O ,~ * Bruce J. *Thomas S. Aaby `ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix County) n ~'j !Y rsonally came before me this day of > 2004 _ the above named Br J. Moll and Thomas S. Aaby to m~'icnoy/n j6 be the person(s) wt}g~e~cute~ti~e mooing Notary Public, State of My Commission is pen N att. (If not, state expiration date: ~- ~,~•) ~~ * Names of persons signing in any capacity must be typed tir printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN INFO-PRO (800)655-2021 www.infoproforms.com FORM No. 2 - 2000 r W W Z_ d a 6 r gl I I uxela/vucvrL au:~ w+r,uwWUV Nuuv:/v/ u w~e,esesW uu/lutnu III I / 1\ .. MWNiLLJO NUM ~It>tD iflltNi - - - - - - - 166'Bae ~ i .~ L C:.00 N ~~'e 31t1- ' ~ ' ~ ' JOM ~zi$~„ ~. 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