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~~ 0 ~/ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division + INSPECTION REPORT GENERAL 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 M land C. Llo d Famil Trust Hammond, Town of CST BM Elev: ~ Insp. BM Elev: BM Description: t~.o ~o.~~ 3~y'1 pJL = 6~'~I Tw~11/ ~~Ir/~1•fwwAT1A~1 rl r\/wT1A\1 r1ATA AI\f\ 11\~ VI\It1A11V1\ TYPE MANUFACTURER CAPACITY Septic I ~ ~, / n ~~ / Dosing ~ ~ tt Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ I ~ ~ 5~ 2 S t ---~ Dosing t ~ + t ~ _~ Aeration Holding PUMB18iPHON INFORMATION Manufacturer Demand ~6(.L-~L_ GPM Model Number ~ ' SZ. Lift Friction Loss System Head TDH t .(~S Z•Sg 3.zs' 3• orcemain Length t Dia. N Dist. to Well ^` ~t~U 2. SOIL ABSORPTION SYSTEM / ~~ l /C ~ Z. , ~l~_r--- LLV\Al IVl\ VI".1 /". County: St. Groix Sanitary Permit No: 487965 0 St to Plan ID No: 12o b 5$= Te~us . /e .~ Parcel Tax No: 018-1073-00-~~0 SectionlTown/Range/Map No: 33.29.17.509A STATION BS HI FS ELEV. Benchmark • 3 os. ~ rTe . o Alt. BM Bldg. Sewer ~ ~ .Z$ 1 ~.~~ St/Ht Inlet ~ / ~ -~Z r SUHt Outlet Dt Inlet Dt Bottom + l~ -29 r Header/Man. 2-~' 02.6 Dist. Pipe Bot. System 3. ~ ! © , Final Grade St Cover BED/TRENCH DIMENSIONS Width I Length ! ~ ~ No. Of Trenches , 1 PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufact er. ~ ~ INFORMATION CHAMBER OR Type Of Syst_e~ /H~ ~ ~ ~ ~ ~ / r D UNIT Model NumObe: ~ ~ I~ISTRIRIITION SYSTEM ~ i Header/Manifold Distributio pJ,. 2.0 ~ x Hole Siz 3 6 x Hole Spac' Vent to Air Intake 1+ / 2 Length Dia Pipe Length Dia Spacing ~ I 2 ' SOIL COVER v Prncenrc RveToms Anly xx Mnund Or A}-Grade SVStemS Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~~ Yes ~] No I- j Yes ~ '' No r COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~~5~ Inspection #2: Location: 633 170th Street Hammond, WI 54015 (SW 1/4 NW 1/4 33 T29N R17W) NA Lot 1 Parcel No: 33.29.17.509 1.) Alt BM Description = _ r _ , r I ~y~y r 2.) Bldg sewer length = "`" 3 S . 0 / ZS •O -~' '~'~"`~~ '`'~ -.. (p ~y,,.,~IL~. -~le~-) ®(~°' C - amount of cover = ` ~ `` ~,rp<~ ~~~w\y Plan revision Required? ~.~I Yes No Use other side for additional information. SBD-6710 (R.3/97) o ~' ,- Date Insepctor's Signature Cert. No. Safety and Buildi D' County ~ ' ~ ~ ~ 201 W. Washington Ave., P.O. Box 7162 ~ ~ / ~( I~~O~~~~ Madison, ~~ 5~ anitary Permit Number (to be filled in by Co.) Department of Commerce (608) `'(cd' -7 ~~p II / Sanitary Permit Applicati Scat Plan I D. Num bet In accord with Comm 83.21, Wis. Adm. Code, personal informatio you p>I~ ~ Y ZOOS / ~ ~ 9 b ~~ maybe used for secondary purposes Privacy Law, s15.04 )(m) Pro ct Address (if different than mailing address) i I. Application Information -Please Print All Information ZONING OFFICE ~ '~' ~ ~ ~~ ~ `~~'r Property Owner's Name Parcel # Lot # Block # ) ~ ~ ~ L i a >~ ~o t_J ~- Property net's Mailing Address Property Location P. o, Bo ~ ~ -~ ~ r h 3 3 r Cit St t ~4 1= ~`° Sectio y, a e Zip Code Phone Number Gt,tT_ J.~ Q ~ S ,• ~ C~.. g®~ a (circle one) ~ ~' .l /..~i T ~ N R~ 7 E ~ + ! ~ IL T ; ot ype of Building (check all that apply) ©~ ~ ~ 3~~ ~ ~ ; S bdi i i N SM ~r 2 Family Dwelling-Number of Bedrooms ~l ~~~ ` u v s on ame C Number Ga ~ o a3 ~ ^ Public/Commercial -Describe Use VtY 3 0 ^ State Owned -Describe Use ! k 9 ~ Q.. ^City_^Village ~owrship o l ~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ~ $ - I b ~ - ~ S i `~ w S stem y ^ Replacement System ^ Treatment/Holding Tank Replacement Only _ _ ^ Other Modification to Existing System ~ I I i ' List Previous Permit Number and Date Issued ~ j I3 • ;~ Permit Renewal ^ Pemtit Revision ^ Change of ^ Permit Transfer to New ~ ~ Before Expiration Plumber Owner I _ _ I IV. Tv' e of POWTS S stem: Check all that a 1 ~ ~ ^ Non -Pressurized In-Ground ^ Mound >_ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ~1-Cnade ^ Single Pass Sand Filter ^ ~ ~ l:onshl~cted Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ~ eR circu]ating Sand Filter ^ i Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) ~ V. Dis ersal/Treatment Area Information: ~_ ~ ~ ~ Desi~m Flow (gpd) Design Soil App lication Rate(gpdsfj Dispersal Area Reyuired (~f) Dispersal Area Pro sed System Elevation ~ / ~~~C~ ~ b ~ ~~" C~ / '7 G] ~ ~ ~ f ~~ VI. Tank Info Capacity in Total Number Manufacturer Pre ab Site Steel Fiber Plastic ~ Gallons Gallons of Units Concrete Constructed Glass ~ New Existing 'T'anks Tanks i Septic or Holding Tanl: ~r~~ ^ --'~ Aerobic Treatment Unit ~ 1' Dosing Chamber - 1~- DO ~~,L, _ _`__-_j I ~.__ ~ VII. Responsibility Statement- I, the undersigned, assume responsibi ' fc~r installation of [he POWTS shown on the attacLed plans. I i Fhnnber's Name (Print) Plumber' gnatu MP/MPRS Number Business Phone Number ~1, k~ ~a s ~ -- .s ~ ~ 7~5 a3s ~ i3 ~__ ~ um er s Address (St et, Ctt y, State, Z o e) ~ / ~/ Z J fl~ri ~ Z d !~ l~ ~7 ~~~ _ ~~ VI . Coun /De artment Us I Approved ^ _ Sanitary Pern~it Fee 'ncludes Crcowtdwater Date sue Issuin gent Sign ure n Stamps ^ Surcharge Fce) ~ / ~ , ~C5 - ~ 0 ~ ~ Z er Gi eason for ial 7 I?.. Conditions of Approval/Reasons for Disapproval ~~ U `"J~ .,.en.. ,,..,..~s. ~i~Gf~ ~~~` ~ -. 1, t J-___._i NW v ~ v ~ cm v~mct[. " - ~ , 1, 'Septic tank, effluent filter and ./1 ~ I ~a ~ L s ~ j J~ ~ ~~, dispersal cell must atl be services /maintained ~j-" t as per management plan provided by plumber. J l < 2 AN setback requirements must be maintained N D UG,~I yLr~z~ ~~G~P/Q.~/~•.~ SlLfYYn~ ~Y`~ /'+'ltv as psr appligWe code /ordinances. U Attach complete plans {to the County only) for the system nn paper not less than Rl/2 x 11 inches in size SLED-6398 (R. 01/03) -- + ~.s.-~ Sw-sue -~S_za-~~~-..~ ~~~~ w~~ ~o~ 'v 0 ~nct ~, ~- Legend 1" = 40' • = Benchmark Ele. Top of 3/4" pvc pipe ~ =Alt Benchmark Ele. Top of 3/4" pvc pipe Q =Borings w~ w ~~' .,~" ,~ ~,. S ,- ~~ lb ~~:~~ _ ~3 ~~ ~" ~ s~.~:~ -~ ~ ..-~ ~ aro, b o0 - - --- 3of-g N 100.00 ft 100.00 ft ~_ r7~ ~~ ~-, ~~- . ~_; ~~ -_ ~- ~6Do -l- w e S ~'" ~~ ~~~ ^,~ ~\~~~~z ~~~ ~. ~„` ~~ ~~1~ w~` `~ ~ a ~f X ~c Legend 1"=40' • =Benchmark Ele. Top of 3/4" pvc pipe ~ =Alt Benchmark Ele. Top of 3/4" pvc pipe ~ =Borings ". ~~I 1 o c, a li u ,.~ ~ -~-: ~~ s; ~~ ~~:~~ M3 ~, ~« s ~. ~:.~ - ~,;.,; e.,,,,, ~ ~- ~~ _ --~ - ~ __ -_,~~~ __ \_ 3of-g N 100.00 ft 100.00 ft a~ ~ - -~ro~~ 1 ~ ~- - ~,;~. ~~~~ ~`. , ~°~ Sow' ~~~ ~K~ ~. .,-~ x,,,-~,~ t=om-Ft~ IBS' ~," ~~~~ yy,~ s ~ 4.0 ~~~ ` a "S \ O w ~ O l, q C-,Y~••, ~~ ~0~~ commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. com merce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary October 27, 2005 CUST ID No. 225094 MICHAEL P ROGERS ROGERS PLUMBING E4457 HWY 12 MENOMONIE WI 54751 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/27/2007 Identification Numbers Transaction ID No. 1209658 SITE: Site ID No. 706625 Lloyd Myland ~ Please referto both ideritficationmsmbers, 170TH Street above, in all comes ondence with the a enc . Town of Hammond St Croix County NW1/4, SW1/4, S33, T29N, R17W Lot: 1, FOR: Description: Three Bedroom At-Grade System Object Type: POWTS Component Manual Regulated Object ID No.: 1048000 Maintenance required; 450 GPD Flow rate; 53 in Soil minimum depth to limiting factor from original grade; System: At-grade Component Manual, SBD-10570-P (R.6/99), Pressure Distribution Component Manual, SBD-10573-P (R.6/99); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the "At- grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD- 10570-P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10573-P (R.6/99). • 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 • 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. ~` z:~- ~N ~~l G SEE( • Inspection of the POWTS 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 MICHAEL P ROGERS Page 2 10/27/2005 • Comm 83 22(7) A cobs of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~'~' ~ ~~i Charles L Bratz ~ POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce. state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Henry F Grote ,Certified Soil Testing Lloyd Myland - At-grade System Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: At-grade, SBD-10570-P (6/99) Pressure Distribution, SBD-10573-P (6/99) Location: Lot 1, Lloyd Myland Family Trust CSM NW'/4, SW'/4, Sec. 33, T 29 N, R 17 W Town: Hammond County: St. Croix Date: October 20, 2005 Owner: Lloyd Myland Address: POB 387 Hammond, WI 54015 Plumber: Mike Ro .-_____~ Signature: License: MP 225094 Attachments: SBD-10577 -Plan Approval Application SBD-8330 Page 1: cover 2: design criteria & calculations 3: plot plan 4: plan view, system cross section 5: lateral detail 6: pump tank exit detail 7: pump curve 8: system management page 1 of 8 RECEIVED O C T 2 4 2005 ,., _ .~' YY ,. _.~, ;~i l QF /`/y~~,!,'r, »''"'''11111LLLLLiiiii ~~~~~~~ -kFTEY 41.1 , , r~~,~ ~~~lWGS ~~~ESP ~//.- '~' ~~~ENC SAFETY & BUILDINGS -- ., .. Design Criteria ~ ~'~ Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L ~ Bedrooms x 100 gal/bedroom/day x 1.5 ~ L' gallons/day hydraulic load r Design Calculations In situ designed loading rate ° • ~ gallons/sq. ft. per day Depth to estimated high ground water ?~ S3 in. Depth to bedrock ~ ~ ~ in. Cross slope at system S ~ S~ Force main length ~ ~ s~ ft. of Z in. Manifold header length h1~ ft. of ~ in. Drain-back 1 `~ ~~~~ gallons Lateral length ~ @ 4"`~ ~ ° ft. of O- in. Lateral elevation ~ ° Z • Q- ft. @ bottom of lateral Lateral hole size 3~~ ~ iri. @ ~-~ • o in. ( z • ° ft.) Spacing 2 ~ holes/lateral 5~ holes total Lateral volume ~S~a~~ gallons Total lateral discharge rate 3 3 • ° gallons/minute @ 2 • ~ ft. head Network pressure compensation losses o ~~'sl ft. Elevation difference ~ ~ ~ q ft, Friction loss 2 ~ q ~ ft. @ ~ S gallons/minute ' Total dynamic head i ~ $ , ~ z ft, Pump/siphon g' ~ gpm @ Z ° ft. of head Manufacturer ~O ~`~ ~ Model # ~ S ~ Dose volume ~ °~ ~s~ gallons Lift/sip'l~on tank ~ ~ ~ ~ ~ ~ - l~ ~ ~ ~-~i-o ~ ~''° gallons Septic tank `' '' `' ~ ~~ gallons Effluent filter ~ ~ ~ (a -~ ~-o ~i ~v 2N~o ~ ~ 0 4? z-z• ~ 4- ~ ~ Measurement pump on and off 6 ~ 0 in. Height alarm from tank bottom ~ ~~ ~ in. Reserve capacity ~ t ~ ~" gallons specs.calcs.res Page ~- of _g w, f } 5~ s' S~ 11 ~,~~ 5~ l~ ~, ~~S S I ~ O ~O ~~ L~ 12o3N I ~ ~ -- ~ J ~ U,, c l l ~ n, ~-•.~ ,. ti b,~ ~4 ~4- ~ w. '~~' "Fabric 1 ~b~`~d- ~..~.~.~ Observation-~ W e I I rr S"~ ~. ~~-~ tt (( l I ~~ 0~j1Q~.vat~or. w,Q.~l Cl.s~-~ ~~~« Distribution Latera '~L 12" .~ ~~ - /~ Soil Cover ,. /~ ~`~ s.,,l o Z . L ~ a.v l~l,~. ~ ~` ~ ~.~' ~_~4-~L g 1 b` -~~ @': y. 1 ` ,+ s 2\\ ~ ~v c s~9, 4-0~ ~,, e - 1 R~ n •,..Y, ~ V L i~ ~7T~ ~/~/ 2, ~~ 2., ? V c. s,~, ~ ~ -~~-Q `~ a ~ ~ ~t g,d, L ! I - (~ I ~~ v Vt ~ S~ ~ ~. a ~~ zl ~, ~1 ` > ~~ ~~ ~,~~ ~ `~~~~ s ~ ~~~ ~~~ v. Si.K ~ ~ '`'O ` ~ w C~-~ S`JV QX ~'f i'~'~l rW` ~ ~ `M ~ w. ~ O a ---~ ~. 1 ~; . ~ ~+ ` h,~ n ~ rv ';~~ WEATNERPROJF ' WCKING C;OVfiR s~'"~T'o'' ,I. Lc/A~N /NG d /~BE~ . ~ ~ QUICK Di~COVVIGT--~ .~ l ~ l ~~ •' \ •'~• Grade, elev. (, ~ ~ ~~ . 4 ~ ~, 4" PVC sCh ~ ~ 40, 3' onto solid ground '\4" PVC Sch 40 \ 20~ I.~~ I III ~ vent $, MAH u O1E .... .,. ~~ i~u r / --~+. ~ ~ . i ~~wEG•p ~ ~ ~ GA'~Z0vt.0. A i `q p., NWLE / 4" PVC ~ASI(.ET 3bM'J ~- ~F~E ~ sch 40, ~~U P114 p ~ Al 3' onto c ~ rv,, E c.T . o -+S ~- `^^/ ~ b .cQ. ~ - \ X1'0 ^j _' O N - so 1 i d (' 1 `~ \ 1 t ~ 1•: \ -'r e.~, : h o ~....~• \...'t' ground Cie,., b o" 3~„ ~`~'~ ~ ~dZZ-C 4 ~3A PuxP ~ 9 ~, C o nrc,~e F-r~ FU~~, btOCK ~Q.Si SEPr~c ~ _SPECIFI•CATI~O~S 1~~~`~O ~~~`` oosE ~ T~uKS MAUUFACTURCR: ~ ~~'~ uIiMBER OF DoSCS: S•~ _ per day T^uK SIZC ; ~ ~" -~~ GI~LUO-JS • .DOSC VOWME A~ARY~ I'~1WUFACTUii,CR; S J `}l'-~-~'r~ IIJCUUDIAJV 6AGKfl.0W: \ ~'S ~O gallons MOOCL uUV4pCR: 1 e 1 1-} ~ CAPACITIES; ~ . \ 9' ° ~\ ~ ~" 1~1L>aES CR gallons SWITCH TyPC; ~'y`~` "`b ( B = Z ~uC-+ES oa 33•S Z gallons PUMP r~~uUFACTURCR: ~O~- `'~` ~O' O 14ti S ~ allons C a _ 11JCHE 5 OR ~~ _ 9 MODES -JUMDCR', lS Z" ISo.4f~ D' ~ INCMES ok gallons JWITCN TbPC; ~MQ.V•~v „~, IJOTE: PUMP AWO A~ARI~ ARE TO 66 Mi-JIMUr~ DISCMARC~ R~Te ~;'`o INSTALLED 0-J SEPnRnFE circuits G-M vtRT~c^u oliiEllClJCf DCTWCC-1 PUMP OF- hUO DIJTRIDUTIOU PIPE„ 11'~ FECT + '"~"uIMUM -JETWORK SUPPI.y PRCiLUItE ~ I . ?`'S FCCT~-o~~S~ + ~ IS EC E T OF FORCC MAiN X 2.5~ f~ ~ ~ q ~ ~ ----- Ioo -tFKICTiou FACTOR. ' FEET ~ ~ S - TOTAL Oyl,),t,MIC NEAR X4.12. '-` ~ t FEET ~{- ~ i ~ IUTER~.1^t^ 01ME-Jb10AJG •Of TA-JK; LE-.IC.TH I~ ~~ ~~ ;W~oTH ,Llqulo osrPTH - ~• NI. '~ ~ ~I~ .PUMP PERFORMANCE CURVE MODEL 151/152!153 so 14 45 t2 40 .,.8, ~v ~~ ~ 35 = 10 ~ ~ 6 2b r ~ 8 20 t5 a 10 TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENT AND DEWATERING MODEL 151 152 153 Feet Meters Gal. Liters Gal. Ulers Gal. Liters 5 1.5 50 189 89 261 77 291 10 3.0 45 170 61 231 70 265 15 4.6 38 144 53 201 61 23t 20 8.1 29 110 44 187 52 197 25 7.8 18 81 34 129 42 159 30 - 9.1 - - 23 87 33 125 35 10.7 - - - 22 85 40 12.2 - - - - 11 42 Shut-off Head: 30 ri. 9.tm) 38 fl. (1 t.8m) 44 ft. (13.am) oiasoas 160 200 24 FLOW PER MINUTE ~~i~St~LT ~,4C~`t~I~Y ~'OR SPECIAL ~-PPLIG~TIcJNS 014506A • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 15ih5?J153 Series 151!15211 53 MODELS Control Selection Model ' Volts-Ph Mode Am a Slm lex Du lex N151 115 1 Non 8.0 1 2 or 3 BN 151 115 1 Auto 8.0 Included 2 or 3 E151 230 1 Non 32 1 2 or3 BE151 230 1 Auto 3.2 Irtduded 2 or 3 N152 115 1 I4on 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 E152 230 1 Non 4.3 1 2 or 3 BE 152 230 1 Auto 4.3 Inducted 2 or 3 N753 115 1 Non 10.5 1 2 or 3 BN 153 115 1 Auto 10.5 Included 2 or 3 E753 230 1 Nan 5.3 1 2 or 3 BE 153 230 1 Auto 5.3 Included 2 or 3 Model 151 3 27 Models 152 1153 i n I t/16 ~ i 1 O CAUTION ai. in~iallakion of controls, protection devices and wiring should be dons by a qualified licensed eleciriclan. All electrical and safety codes should be tollowed including the most scent National electric Code (NEC) and the Occupational Safety and Health Act (OSHA). ,, I t2 1/e I ' ---t- /! ~ i ~~. 1 i _~ SELECTION GUIDE 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Alternator E•Pak. 3. Variable level control switch 10-0225 used as a control activator, specify duplex (31 or (4) float system. RESERVE POYVERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TD: P.O. BOX 16347 ~' `` .; Louisville, KY 40256.0347 ~ ~ SHIP T0: 3649 Cane Run Road ® k „ e ,,o Louisville, KY 40211.1961 http//wwwzoelle~.com '~~ PUMP !O. (502) 778.2731.1(800) 928-PUMP FAX (502) 774-3624 ® Copyright 2003 Zoeller Co. All rights reserved. -T a 3/8 t rst Manufacturers of . . Q!/r1L/TY PUd/P9 S,vcE f~~J Y ~ e ~' ~; d J i ' ' ~ 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- . 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 dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, 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. 10. If septic or dose tanks are no longer used, they must be properly abandoned. 11. 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. 12. The upslope toe of the system must be landscaped with additional fill to blend this area into the upslope natural grade; this will minimize the possibility of the system trapping surface run-off; final settled slope should be 2-3% over the system or 2-3% diverting surface run-off around the ends of the system. 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 dose tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the filter should be made every 6 months until a minimum time sequence is determined. 4. Periodic observation pipe inspections should be made by the owner 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. 5. 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 comp ton such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbi e 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, dose 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 83.54 (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 POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMA ION ~t3vvn~r € Permit # c V DESIGN PARAMETERS Number of Bedrooms 100gpd/bedroom ^ NA Number of Commercial Units NA Estimated-flow (average)* C, gaUday Design flow. (peak), estimated x 1.5* ~ gaUday Sail Application Rate ~ gaUday InfluentlEffluent Quality (NA^) Monthly Average*'- Fats. Oil & Grease (FOG) 5 30 mg/L Biochemical Oxygen Demand (BODs) ~ Total Suspended Solids (TSS) ~ 220 mg/L <_ 250 mg/L Pretreated Effluent Quality ^ Monthly Average** ~ Biochemical Oxygen Demand (BODs) < 30 mg/L i Total Suspended Solids (TSS) j Fecal Colifonn (geometric meant 5 30 m 510+cfu/100m1 Maximum Effluent Particle Size 1/8 inch diameter * Wastewater Flow Verification on and calculations: i (Other than bedroom based) I R * * Values typical for domestic (non-commercial wastewater and septic tank effluent. * * V slues typical for pretreated wastewater. SYSTEM SPECIFICATIONS Septic Tank Capacity ~p0 gal ^ NA Septic Tank Manufacturer ~.~,~„^ ^ N~, Effluent Filter Manufacturer ~ ^ NA Effluent Filter Model _, pv ^ NA Pump Tank Capacity ~v v gal ^ NA Pump Tank Manufacturer , ~ 5 ~/ ^ NA Pump Manufacturer ~y_ ^ NA Pump Model ^ NA Pretreatment Unit ^ N,~ ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer: Model: Dispersal Cell(s) ^ In-ground (gravity) D In-ground (pressurized) ~¢At-grade ^ Mound ^ Drip-line ^ Other: ^ Leaching Chamber Manufacturer Model Approval Stipulation Soil Application Rate_gpd/f1.z Area Req. Absorption Area Credit per unit ft2 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) L7 "Wisconsin Mound Soil. Absorption. System: Siting, Design ~i 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 625/1-80-012 October 1980 ^ SBD -10570-P (8.6/99) "Ai Grade Component Manual Using Pressure Distribution" ^SBD -10567 P (8.6/99) "In Ground Absorption Component Manual" ^SBD -10705-F (N.O1/O1) "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" L SBD - 10691 P (N.O1/41) "Mound Component Manual" Version 2.0 ^ SBD - 10595-P (8.6/99) "Single Pass Saud Filter Component Manual" ® SBD - 10657 P (8.6/99) "Drip-line Effluent Disposal Component Manual" ^ SBD - 10573 P (R 6/99) "Pressure Distribution Component Manual" ® SBD - 14706-P (N.OU01) "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 Frequency Inspect condition of tank(s) At least once every ^ months (s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and equals one- ud (1/3) of tank volume Inspect dispersal cell(s) At least once every ^ months ear(s) (Maximum 3 yrs.) Clean effluent filter At least once every ^ months ear(s) Inspect pump, pump controls & alarm At least once every ^ months ear(s) ^ NA Flush laterals and pressure test At least once every ^ months ear(s) ^ NA Valves At least once every ^ months ^ year(s) NA Other: At least once every ^ months ^ year(s) A Page oI S`fAI2T UP Igor new construction, 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 tame(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. C+PEI2ATION 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 clear 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. '1~is system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be dischazged 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. l~~,aintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system componens. Compaction of snow over the dispersal unit may cause it to freeze up. Q 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 regular 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. INFECTIONS 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}. ~~E'~.~Se~ltic 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-0penings 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 specii~cations. Provisions are 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. t3 ChamberJTreatment 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 hazdwaze and the condition of the filter. Any service needs or repairs shall be promptly taken care of. d 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 be 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 of ~ound, 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 dischazge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure 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) years. Pressure 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 ensure 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 measures have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank 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 ANDlOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIItCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone ~ Phone SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name Agency Phone Phone K:\WPDATA\EH\POWTS OWNER'S MAMJAL.doc Page of 1/~ I (/ ~Is~onshr Department of Commerce SOIL ~A, T n~°1y~~~~i1, in acco nce ria.>~$YV4G#..Adm. ode #1793 Page 1 of 3 Steel's Soil Service, Inc. Attach complete site plan on not less#h n 8' 11 in es in 9~: Plan rrtus4 ~I~!" ounty St. Croix inGude, but not limited to: vertical ortzonta nce int (BM), direction and arcel LD percent slope, scale or dimensions, no w, an ocatio and ~l~-~KU~~~CJN I Y d. . 18-1073- 05 Please print all info lion. ZONING OFFICE eviewed By ate Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (mp. Property Owner Property Location Lloyd, Myland Govt. Lot na NW1/4, W1/ , S 3, T29N, R17W Property Owner's Mailing Address Lot # Blodc # Subd. Name or CS P.O. Box 387 na na City State Zip Code Phone Number ~ City ^ Village ~ Town Nearest Road Hammond WI 54015 715-684-9010 Hammond 170Th St ®New Construction Use: ~ Residential ! Number of bedrooms 3 Code derived design flow rate 450 GPD ^ Replacement ^ Public orcommercial -Describe: na Parent material Silty sediment,loamy glacial till, and clayey dolomitic limestone Flood plain elevation, if applicable na ft. General comments At Grade or Mound design, system elevation 102.90ft based on contour line elevation 10~.90ft. and recommendations: Boring # ~ Ground surface elev. 101.90 ft. De th to limitin factor 58 in. ® P 9 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D/ftz in. MunseN Qu. Sz. Cont. Color Gr. Sz. Sh. *Eft#1 •Effrx2 1 0-24 10yr3/1 none sil 2msbk mfr a ivf .6 .8 2 24-40 10yr4/4 none sicl 2msbk mfr gw ivf .4 .6 3 40-58 7.5yr4/4 none sl 2msbk mfr gw na .6 1.0 4 58-86 7.5yr4/4 c2d 7.5yr5/6 sicl om mfr na na .0 .0 Boring # ~ ® Ground surface elev. 103.50 ft. Depth to limiting factor 53 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP DIft= in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 "Eff#2 1 0-26 10yr3/1 none sil 2msbk mfr cs ivf .6 .8 2 26-40 10yr4/4 none sicl 2msbk mfr gw lvf .4 .6 3 40-53 7.5yr4/4 none sl 2msbk mfr gw na .6 1.0 4 53-86 7.5yr4/4 c2d 7.5 5 sicl om mfr na na .0 .0 • esa...,..•.xe . cnn . ~n . ~s~n .,,.,.n .,..a Tcc ~~n ~ ~ cn ..,..n * esa..e..4 *~ - Gnr'1 ~ 'tf1 mnll ~nlr TCC a 4n mnn ~..rwo~n..~-.,~....5 .. -«.,rr.y,..a.,,,...W-.... _ .......y.~ ~...........,r~-.......-5= .....7,~.......... _ ...~._ CST Name (Please Print) Signature: - CST Number David J. Steel 248956 Address Steel's Soit Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, W154002 9/14/2005 715-760-0347 i sn~-asw rn.ouw~ Property Qimer Lloyd, Myland Parcel ID # 018-1073-00-050 Page 2 of 3 Boring # ^ Ground surface elev. 101.50 ft. Depth to limiting factor 54 in, ® Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#t *Etf#2 1 0-35 10yr3/1 none sil 2msbk dfr a 1c .6 1.0 2 35-54 10yr4/4 none sicl 2msbk dfr cs 1f .4 .6 3 54-68 7.5yr4/4 flf 7.5yr5/6 sicl 2msbk mfr na na .4 .6 ^ Boring # ^ Ground surtace elev. ft. Depth to limiting factor in. ^ Soii Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#t *Etf#2 ^ Bonng # ^ Ground surtace elev. ft. Depth to limiting factor in. ^ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#t •Etf/12 'Effluent #1 = BODS> 30 < 220 mglL and TSS >30 <150 mglL ~ Effluent #2 =GODS < 30 mg/L and TSS <30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/001 StcePS ~ ~'~• ~• ~, x David J. Steel CST-POWTSM Lic. #248956 STEEL'S SOIL SERVICE INC. 3 of 3 _ Myland ,~ ~ o y C` 994 200' St. SWl/4,NW1/4,S33,T29N,R17W Baldwin, WI 54002 Town of Hammond, St Croix Co. Direct 715-760-0347 Fax 715-684-3449 Legend N 1" = 40' I • =Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • =Alt Benchmark Ele. 100.00 ft Top of 3!4" pvc pipe C1 =Borings Boring Elevations B1 = 101.90 ft B2 = 103.50 ft B3 = 101.50 ft B4 = 0.00 ft 1 ~~~ lam! ~(J/'r~1/~L wGL~ /O/, !'pnCe ~, ~. ~~ 0 .~ S"3 ~ ~`f' / 7' a7 ~ r `~ I ~i o w.-~ S o~/. c_ . t_~3 '~~ f C~r~~~ ~ ~- ~, ~d~~~ ~/O ~~ ~~_ ~...- ~, e S` ~- ~ ~' ~,~^a- f~.~ r„~_.',,,~-~--tip- ~~ ~~ a~ ~ - /7 o r ~'`~ .,C-o ~ ~~ ~~ /~~~ ~~ ~ ~ ~°~ 50~,~ I ~~~ ~~r- Vi'''i-~, /03 ~ "~ ~.~ i ~ jy-~s • ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address T (Veri/f~ication required from Planning & Zoning Department for new coc~truction.) d"'~t City/State ~/r9-n1 rylmv~d~ Parcel Identification Number D ~~ - / 073 ' ~ - ~ 5 ~ LEGAL DESCRIPTION Property Location ~ W '/a , ,rGJ 1/a ,Sec. 3.3 , Subdivision T o't 9 N R W, Town of f~/~I ~'I yy~~,~G ~ 3~~1~-~ Lot # ~i~GP~~" Certified Survey Map # a 7 4 olume ~ y ,Page # 3 9© S Warranty Deed # ~ ~ ~ y ~` ~ ,Volume ~ ~~yy ,Page # 3l ~ Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 I/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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of be ooms _,~ SIGNATURE APPLICANT(S) ~)~/ v~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) Viii..1,~~~PAG` J1U Iryie Peterson and Ruth Peterson, formerly Ruth Heksem, husband and wife, conveys and warrants to Nyland C. Lloyd Family Trust, Tamarah S. Wink, Trustee, Melissa A. Wittstock, 1u Alternate Trustee, the following described real estate in St. Croix County, State of Wisconsin: See Exhibit A attached hereto and made a part hereof. This deed is given in fulfillment of that certain Land Contract between the parties dated January 2, 1981, and recorded January 5, 1981, in the office of the Register of Deeds for St. Croix County, Wisconsin, in Volume 623 of Records, at Page 476, as Document No, 368690. ~~ ~ 'Lyle eterson 'Ruth~Peterson Exception to warranties: al( easements and restrictions of record, and except any liens or encumbrances created or suffered to be created by the acts and defaults of the grantee, their heirs, successors or assigns. This isnot homestead property. Dated this 13~_ day of ~L , 1999. AUTHENTICATION Signadre(s) authenticated this _ day of , s~, type or print rLarra TITLE MEMBER STATE BAR OF WISCONSIN (If not. atNwtized b11 §706.08, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Thomas A. McCormack Baldwin, WI 5401;2 60744 1 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO.~ WI RECEIVED TOR REIIIRD 07-26-1999 9:30 AM wAR>tatir DEED EXElIPT D it CERT CtD~ FEE: COPY TEE: TRANSFER TEE: RECORDING FEE: 12.00 DARES: 2 AKiT M~1fONAL BAPI(AF tN~9p1~ PO 19oz t7 ddwln VN 5+100¢-0007 01&1072-90; 01&1073-00; 018-1073-10; 01&1073-40 (Parcel Identification Number) ACKNOWLEDGMENT STATE OF WISCONSIN ST. CROIX COUNTY t Personally came befors me this r, dlt 1999, the above named Ruth'~Qryon; foifiRu;lt Heksem and Lyle Peterson 'td~mer=ltttgi4tj'Yo'bl~- the person(s) who executed the foFegoing iristyment~and acknowledge the same. ~- : -;' - ~ ; r,~ ~~~(-~~_ s~ature 1.J.7-,,.I,,,~ ,,,, ki[lJ[8I' Q ~, or print name ~ a car w R~_ ~~ Notary Public St. Croix County, Wisconsin. My comrpis~ion is permanent. (Ii not, state expiration date: 1 , ,~2L~) 'Names of persons sgning in any capacity shouk! be typed or printed Oebw their signatures. / L.r.. ,;., :;I ;f ;i InMtmelwn Pr0(aiaierNLS CanWr'~Y FmA Au Lae. NM1tearom 9COc5S2rY11 ,~ - - _ <_ . .. _ ' V9i_ ,~~~~PAGE 3i~ _ _ ~. .. -- -- , - - i t - _ t °_ EXHIBIT ~ Southwest Quarter (SW's} of Section Thirty-three (33), Town- ahi~ 'I~renty-nine (29) North, of Range Seventeen (17) hest, kept the following: Commencing at the Southwest carnet of said Section Thirty- Three {33); thence East, assumed bearing 973.81 feet along the Sauth Line of slid Section Thirty-three (33) to the poin~• - ---~ ~ of beginning; thence North 0° 30' East 420.00 feet; thence East 430.00 feet, thence South 0° 30' West 420.00 feet; thence West 430.00 feet; to the point of beginning; ~ except the South 33 feet for town road easement. j i Commencing at the Southwest corner of said Section Thirty-three(33); thence East, as- - sumed bearing 773.81 feet along the South line of said Section Thirty-three (33)to the point of beginning; thence East, assumed bearing 200 feet along the South line of said Section Thirty-three (33); thence North 0° 30' East 200 feat; thence West 200 feet; thence Sauth 200 feet, more or less, to the point .of beginning, except the South 33 feet for town road easement. -- ~~ ~ - _ __ _ - _T __,- ... , _ ~. ~; -- „-~ . e ~ _ - ~ ~ ~~ x ~.;_. ~~~ ~i~ d 6v Q 3 °v~ 0 ~- F vr~ 1~ ~r Private On-Site Wastewater Treatment System (POWYS) Index and Title Sheet owner: Project Name and System Type: ~T - ~s-vr~!P Location: /70 ~ ST- Street Address 4cv,- ~ C,J ~ s 3.3 ~ ~ 9.~ ~ / 7w Legal Description ~ f _ Township/County :.`ontents: Page 1: Page 2: Page 3: Page 4: Page 5: Page 6: Page 7: Page 8; Page 9: Attachments: Plumber/Designer: _~/1~ Signe .Credential Number: ,~..~ ~- o ~~/ Date: Pi3lrcel #: 018-1073-00-050 11/01/2oos 11:06 AM PAGE 1 OF 1 Alt. Parcel #: 33.29.17.509A 018 -TOWN OF HAMMOND Current X~ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -LLOYD, MYLAND C FAMILY TRUST MYLAND C FAMILY TRUST LLOYD C - C/O TAMARAH WINK TTEE C/O TAMARAH WINK TTEE 612 230TH AVE SOMERSET WI 54025 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 38.885 Plat: N/A-NOT AVAILABLE SEC 33 T29N R17W NW SW FKA Block/Condo Bldg: 018-1073-00-000 (509) EXC CSM 14/3905 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-29N-17W NW SW Notes: Parcel History: Date Doc # Vol/Page Type 07/26/1999 607441 1444/310 WD 12/31 /1997 570612 1285/439 OC 12/31 /1997 570611 1285/438 OC 07/23/1997 1034/348 C~C mo ... 9(1f1~ CI IMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Description Class RESIDENTIAL G1 AGRICULTURAL G4 UNDEVELOPED G5 AGRICULTURAL FOREST G5M Totals for 2005: General Property Woodland Totals for 2004: General Property Woodland Last Changed: 07/14/2004 Acres Land Improve Total State Reason 1.000 3,000 400 3,400 NO 29.885 3,700 0 3,700 NO 1.000 100 0 100 NO 7.000 7,000 0 7,000 NO 38.885 13,800 400 14,200 0.000 0 0 38.885 13,800 400 14,200 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 n ~ .g o ~ N Q- O ~ O ~ O v m .9 c 3 CD Ifs Z O M (i 7 N d i oZ ~ ; w_ O 7 i w n Z ~ ~ I ~ v I o I I I I I I I I Z ~ ~ .~ flf fi '~ O N < N ~ ~ ~ p ~ { ~ ~ ~ m ~ v ~ o m ~ 3 s ~ ~' N a 7 C fp n p ~ ~ ~. ~ O W ~ ~ s Z :i? 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