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HomeMy WebLinkAbout022-1011-30-100 0 g . ° 2 . § ; n T j 7 7 }� ƒ oj 7 (/ 0 A o ( B G �, =r — ! « c < , Q ¥ - > E a £ 5 m ( � @ ■ . � c ; o o i � e � 7 / N) k , ;a G;� , c- _ c a) a) ®j0w ■ . §) m c c\ E E 00 / & . . � g ■ n, % ■ � a � ƒ F R� CD e A ai a ; \ 7 7 0 2 {j ( f & ; e CD / I § / f n r CO) / w ¥ $ & g z 0 0 0 \ 2 z / A ] ■ ■ ■ % > E $ 7 OD � . § § e 2 CP w £ # r O OD Z f .. . / \ §§m . E C :3 D � I CD ' � � � � / k iz z m ■ ? ; . ■ � ƒ � G) 9 w T 2 % Z o % f 2 / \ 2 a § a # W rr % [ I . � E \ . � § � cz § � � I � ■ � CD § Lh ) o § , � Wisconsin Departrqent of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buildinll Division le INSPECTION REPORT Sanitary Permit No: 420641 0 GENERAL INFORMATION (ATTACH TO PERMIT) late Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). T = TES • / 4 Permit Holder's Name: City Village X Township rarcel Tax No: .Hove, Scott I Kinnickinnic Township 022 - 1011 -30 -100 BM Elev: / Insp. BM Elev: BM Description t CID . l7 •t7 Y1ou' H . �w0.L. = Q L 1 - TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. SepticI / 30 Benchmark C) � L FGw � 6 �•�5 D(W (M. Dosing Alt. BM 4, �`•�` - O r Aeration Bldg. Sewer / ) Holding St/Ht Inlet ! qq� 7• `to qZ. o TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL eLDG Vent to Air Intake ROAD Dt Inlet Septic M ! > Dt Dt Bottom ZZ Dosing t , l 10D i Header /Man. Aeration Dist. Pipe to O Holding Bot. System 2.30 Final PUMP /SIPHON INFORMATION 7 vj will (z l t- Manufacturer Demand St Cover � J5F_ GPM - � �O! Model Number 6U ( 2 - 0 .30 q9 •� t�•�` • H Lift Friction Los System Head TDH Ft O / 1 3.3 ,1 6 C.e�.t/ �' . �o Q3 1 Forcemain Length 1 Dia. Z l l Dist. to well > I w ! -- o SOIL ABSORPTION SYSTEM BED/TRENCH Width i Length ! No. Of PIT DIMENSIONS No. Of Pits Inside Dia. Li uid Depth DIMENSIONS � 5 '� 4i� S SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEA Manufacturer: INFORMATION BE Type Of System: f 1 UNIT del Number: DISTRIBUTION SYSTEM Header /Manifold Distribution l` x Hole Size x Hole Spacing Vent to Air Intake - ll Pipe(s) J 1 ,, if 3 /� �l ll Length "c.� O Dia Length •p ia Spacing T^ � SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil g p � Yes No Yes (] N�o�e, COMMENTS: (Include code discrepencies persons present, etc.) Inspection #?V-4a Z .3 Inspec�ttii�o,1n�# �3 Location: 1082 Cty Rd V 2ober , �5402 114 NE 1/4 5 T28N RI 8W) NA Lot 1 Pa cr< el No: 5.28.18.67A 1.) Alt BM Description 2. 9 sewer length = -► 9 th Gi �", - amount of cover = 4(2' 3. ) Contour = V4t r Plan revision Required? [] Yes No Use other side for additional information. _ SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. a Safety and Buildings Division County 201 W. Wa"gton Ave., P.O. Box 7162 r N VIsconsin Madison, Wl 53707 - 7162 Site s De artment of Commerce �'3' Application 5awe(e, --� f D$ 2 " Sari Permit A Pew N , In accord with Comm 83.21. Wis. Adm. Code, Personal irdbrmation you provide qx o &`H may be used for Law, 815. 1 m 0 c Revrsron I. Application Information - Please Print An Information R ECEIV E state Plan I.D. �q Property owner's Name ZN # J AN 0 6 7.003 02 2 • )D11 M6 0 ta+4 Properly owner's blailiag Address n �\/ Property Locxdon -- 16 g� - ( ! , ` O ' �II ST. CROIX.,OUNTY P ,�/ ZONING OFFICE !4 /v !f S T (Sty, State Zip Code r Bioct Number 2 D � visi� Name r UJ1 0 -Z v� IL Type of Building (dieck an that apply) 5 „, h7y Bedrooms y ' or 2 Fam Dwelling - Number of _ y� ---- r-- ��U �VrUage ❑ Pabiic/Co y 0 State Owr Ca- '1b"50 Ux 4 IN nsitip a Road //// IIL. Type Perm: only one boa on lime A (numbering scheme for internal use)• COUVIeWfine B if applicable) A. 1 0 New System 3 0 Replacement of 6 Additimn to For County use Tank Oull B. ❑ Chx1c if Sanitary Permit Previonsly Issued Permu Number Date Issued IV. Type of Permit: (Check all that app )(anmbering scheme is for internal use) t Cro 44 0 Non - Pressurized In -Groin VU44ound 47 0 Sand Filter 50 0 Contacted Wedand 22 0 Pressurized b4totnd ' / 410 Holding Tank 48 0 Single Fast 5111 Drip Line 45 0 Att 46 0 Aerobic Treahnent Unit 49 0 Recirculating 30 0 other V. Area Information: Design flow (Bpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Fim1 Grade Reqoired Proposed Rate(Gals./Days/Sq•FL) OhnAnch) El �-r s0 ZYO ))6 3 , VL Tads Info Capacity in Total Number Marrer Prefab Site Steel Fiber Plastic l �W Gallons of Tanks Concrete Cormhthrted Glass New Tadrs Tanta kpde or Hokft Tads _ Dasiog Chamber 1) d VIL Itt;sponsibility - the assumte responsibility for installation of the POWTS shown on the attacbed plans. s are (Print) N PAAM / Number Business Phone Number 'hammer's Address (Street, City, State ) L "P. mil. /De use Sanitary Permit Fee (includes Groundwater Date Issued Approved ❑ Dhsappro vod Samcharge Fee) lg Sr�nalure (N° Staffs) 0 Owner Given mitiat Adverse Determination 1 �' .14 - X Conditions of Apps for Disapproval — �OO� �r ' 2 , , , `� 1hs some COUnq ady) far syates ea paper las tan g1/2: l� in size B -6398 n (R.. 05101) PLOT PL N Scott Hove AD S 1082 Ctv Rd N Roberts Wi 54023 114 NE 1/4s /T 28 N/R w 5 T N Kinnickinnic COUNTY ST. CROIX 12/10/02 BEDROOM 3 APRS Shaun Bird 226900 DATE ' ONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND )00( SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none IL BENCHMARK V.R.P. Top of nail in tree ASSUME ELEVATION loo' Filter Zabel A -100 BOREHOLE O WELL •H.R.P. Same as benchmark SYSTEM ELEVATION 97.3' Scale = 1/4 = 1 Old System is to Area 15' Below be pumped and System is to buried remain 200' undisturbed Vent Pipe 4% B. M. " Slope 95' B- w II � Dry e B-2 Force Main 9 6' 1 sr 1 9 7' ❑ B -3 4 Grading is to be Old House to divert run -off away be torn dow Alt. BM from system 100'To Sh W Shed Huffcutt combo tank Tank is to be properly bedded a and provided with lockdown w 0 covers with approved warning 0 labels Pro 3 D Bedroom House Q ,r• Safety and Buildings . 10541N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 Visconsin www.commerce.s i n.gov www.wisconsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary December 30, 2002 CUST ID No.226900 ATIN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL Ident 'Numbers PLAN APPROVAL EXPIRES: 12/30/2004 Transaction ID No. 822647 Site ID No. 654298 SITE: Please refer to both identification numbers, Scott Hove above, in all correspondence with the a enc . 1082 Cth N Town of Kinnickinnic, 54023 St Croix County SE1 /4, NEIA, S5, T28N, R18W FOR: Replacement mound, 450 GPD Object Type: POWT System Regulated Object ID No.: 885665 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes �;i and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in Cn ' chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. p The following conditions shall be met during construction or installation and prior to occupancy or use: , t 00� General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10691 -P i ( N.01 101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10706 -P (N.01 101). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Note • The proposed pump is near its limit with the proposed total dynamic head. If upon installation, the total dynamic head increases, the proposed pump must be reevaluated and may be inadequate. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. SHAUN R BIRD Page 2 12/30/02 • Materials shall conform to the requirements of COMM 84. • Abandon failing system per COMM 83.33. • Maintain well and waterline set backs per COMM 83.43(8)(i). Consult the Department of Natural Resources for well setbacks and exceptions to the setbacks. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. 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 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, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Patricia L Shandorf V POWTS Plan Reviewer, Integrated Services WiSMART code: 7633 (715) 634 -7810, Fax: (715) 634-5150, M -F 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 Cover Page g Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 12/10/02 Owner: Scott Hove Location: Lot 1 Cty Rd N System type: Mound System Manuals Used: Mound Component Manual version 2.0 (01/31) Pressure Distribution Manual version 2.0 (01/31) t orially �t Page# 1. Cover Page ° MER °s � a 2. Mound Plot Plan SAF 3. Mound Cross Section fOR RE oN ° 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section `� 2 6. Pump Curve 7 -9. Maintance and Contig ncy plan 10 -12 Soil test Signature License number 900 12/10/02 PLOT PL N PROJECT Scott Hove AD S 1082 Ctv Rd N Roberts Wi 54023 SE 1/4 NE 1 /4S 5 /T 28 N/R W T N Kinnickinnic COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/10/02 3 BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none BENCHMARK V.R.P. Top of nail in tree ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as benchmark SYSTEM ELEVATION 97.3' Scale = 1/4 11 = 10' Old System is to Area 15' Below be pumped and System is to buried remain 200' IF undisturbed Vent Pipe 4% � B. M. Slope 95' O �B- 1 Drywell B-2 Force Main 9 6' ST 97 B -3 Grading is to be Old House to divert run -off away be torn down Alt. BM from system 100' T hr W Shed Huffcutt combo tank Tank is to be properly bedded and provided with lockdown O -D covers with approved warning c labels CD Pro 3 Bedroom r House m uZ,titSuGL bate Non -Woven Filter Fabric 4" Observation Pipe Perforated Below Filter Fabric ! Distribution Pipe - Am G - 33 S vn4 f } " Topsoil ` -= = = - =`_ ` _ o E ` w 1 �. Slope ~�`Piowed fled Ot r - 2 Force Moen f�� �2 Layer Drain Rock From Pump ,D E • fie i � C ress Section of A Mound - S stem Usin F A Bed For The Absorption Area G — i A '? I �l►_Z- Ft.- �. Ft. ft. ' KZ _ : - - - L 1i Ft. k rn u'�s,r W a("7 Ft. .__. L - CObservotion Pipe --� d B — K 0 40 A 1 - ------- - - -_ -- --------------- - - - - -- Farce Main � �o �--.. - - From Pump W C1 Distribution Bed Of Pi Drain Rock L U � 40bservotion Pipe Permanent Marker pipe or Rods Perforated pipe Aetoil �0 Ertel View )Perforated i+ PVC Pp* . ae Holes Latotsd oa 6otta�. Are Equally Spoe *a eka an vr.Ot T - Fur 1D Ir ♦ Q PVC Force Moil. n FIOMT "t.L NgttT 1'e C�7Rf1ttG; k E6 PVC Morifotd Pipe Pipe �, If Distribution Pipe Layovt Q Ft. R R. X Inches Y 421 Inches Signed: Hole Diameter /�� Inch Lateral Inch License Number: Manifold " Inches Date Force Main Inches # of holes /pipe Invert Elevation of Latera s ` ti I� • raVC V SEPTIC TANK L PUMP CliAMBER CROSS SECTION AND SPECIFICATIONS EATttE y" Cl VENT PIPE 12" MIN. ABOVE GRADE 6 W R PR PR00F BOX APPROVED �► 2 5. FROM HOOK, WINDOW OR WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK b �. - - --- WARNING LABEL FINISHED GRADE 4" MIN. i N� = � . - ••- �5,......� y C.-L. �tBiERN r.b. C. 2e" I N. pfE I #AS*• INLET 1 ', GAS— ` WATER TIGHT SEALS TIGHT ED A SEAL f • JOINTS PITH f11.TER _ A __3._ ALM APPROVED PIPE APPROVED B ' ON ' PIPE 3' F' I SID SOIL ONTO SOLID C � SOIL PUMP OFF ELE1i !J • -+— OFF D • 3" APPROVED BEDDING UNDER TANK ' CONCRET PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: NUMBER DOSES PER DAY TANK SIZES SEPTIC GAL. DOSE VOLUME INCLUDING ..._L —.— GAL. GAL. F I,OS„tBACK DOSE .26 _ GAL. CAPACITIES: A INCHES p ALARM MANUFACTURER: l/ J D GAL. MODEL NUMBER: L- B = _ "? INCHES s __._.. SWITCH TYPE: C - . ef INCHES v / GAL. ppMp MANUFACTURER : � � GAL . MODEL NUMBER: • ^ .. Ae - L-- .�-- D - � INCHES = SWITCH TYPE: ,�- GPM PUMP & ALARM WIRING AS PER lc I LHR 16.23 1dAC REQUIRED DISCHARGE RATE c 7 DISTRIBUTION PIPE % FEET �? FEET VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DI FEET +MINIMUM NETWORK SUPPLY PRESSURE FT. FRICTION FACTOR FEET + � —FEET FORCEMAIN X �3 TOTAL DYNAMIC HEA ! r f ; IDTH e!!� � : DIAMETER INTERNAL DIMENSIONS OF PUMP TANK: LEN LICENSE NUMBER: & DATE: SIGNED: 1/88 TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND DEWATERING En MODEL 152/153 MODEL 152 153 g 50 Feet Meters Gal. Liters Gal. Liters 5 1.5 69 261 77 291 153 10 3.1 61 231 70 265 12 40 15 15 4.6 53 201 61 231 20 6.1 44 167 52 197 X 30 25 7.6 34 129 42 159 $ 30 9.1 23 87 1 33 125 Yo 35 70.7 -- -- 22 85 a 20 40 12.2 -- -- 11 42 0 L Lock Valve: 38.0 R. (11.6m) 44.0 Ft. (13.4rn) 4 'y. T.6. o 014SO 10 0 60 80 100 20 � GALLONS 6 1/4 LITERS 0 80 160 240 320 - 3 27/32 FLOW PER MINUTE 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS _- 3 27/32 • Timed dosing panels available. am available and supplied vAt1 • metrical alternators, for duplex sy . an alarm. • Vile level c0ntrd sWkhes are avail�le for conlr0Nln9 single phase 1 I systems. • Double Pk 9Yback van We level Mal S"t&M are available for variable 1 level ktng and short qde c>onbots. • Sealed (wdk43ax avaRable foroutdoor in latials. See FM1420. • Over 13VF. (54°C.) special quotation required- 1 12 1/S 152H53 Soda' 451!1 5 1/8 !lode! 1rol� Pb —° ga r 1 2or3 � mw ON1 115 1 tbo g.5 4lduded 2or3 BN151 115 1 Auto &5 i 2or3 E152 23D 1 R kM 2or3 BE152 23D 1 1 4 3 1 2or3 SELECTION GUIDE M53 115 10.5 Needed 2or3 EN153 115 1 A�dD 5.3 1 2or3 1. S 11199y levelfloats ad0uf11BP99y�ck level bat E153 230 1 Non 5 3 d 2or3 swildl. Refer 1b FM0477. 8E153 230 1 A 2 See FM0712 for correct model o1 Eteftei A9erslator E*ak V be dons by a gw 3. ariable level a xord solich 1UM used as a aX*d ad4nrdW- duplex ( ��widol s SW or (4) flit system Ap deck of ooaMa P> codes aboldd be Mewed bdnI11109 Met joadmo,a EleetrICC048 @Wand lb o=gpd xWSd*andNedfhActPW I RESERVE POWERED DESIGN For unusual condoms a > salty is engineered ,fD the design of every Zoew PumP- IINL 70: P.O. BOX 16347 {,outnft KY 40256.Q317 9 Case Ron � ,�., AN' L KY 0 p011778-2731.1 (60016 J nr aoeffencom PUMP l0- FAX (W 7X21 ® COpyrtght 20oo Zoeller Co. AN rights reserved- I Maintenance and Contingency Plan for a Mound System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7. Owner agrees to leave the area 15' below mound undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump without float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715 - 246 -4516 Pumper: Tom Mondor 715 - 246 -5148 St. Croix County Zoning 715 - 386 -4680 Shaun Bird #226900 12/10/02 I - Page ar POWTS OWNER'S MANUAL & MANAGEMF SYSTEM SP ECOGATIONS Ffl-E of B"Oom NA pu ndFORMATtON Septic Tank Capacity g 17 NA Owner L' tic Tank Manufa �' i # Fig ,c+er ' ❑ Na DESIGN PARAM S FftC ❑ NA - ©� Model Number mp -Tank �3 O 13 NA Number of Corm wclat Units ply Tank Maaufawt m DNA . wedflaw Pi> . Mand ❑ NA D flaw ( � (mated x 1 .5) D Pump Model Z ❑ NA ' t unit soil D Peat FO' InfluehVEffluentQ f � 13 Welland & Grease (FOG) F Oxygen Demand (��-- D Medh�lpl D Other. 420 n%VL D D� �� St i per gIed Solids (rSS) 5150 0 Prefteated Effluent Qualky Mon1W fie.. p (gravity) D I round (pressurized) Biochemical Oxvuen Demand (BODe) S.iO mg/l- D At -grade Total Suspended Solids (TSS) 5 mg 30 n - D ❑Other. Feat Cow � Weom mean) s10` cfulltmml � wa stewate r ow �kwhd�meber � �a� fordot ttm Effluent Particle Size v ted wastewater. AGE SCHEDULE Service Frequency Service Event 17 tThor� s) (Maximum 3 yrs.) of tan k s) At least once every of t volume inspect condition When combined sludge and s cum equals one -third (Y) Pump out contents of tank(s) � ❑ months s) (Maximum 3 y rs .) At least once every Inspect dispersal cell(s) At least once every D months ]Spar(s) effluent titter s) ❑ NA clean e ��Is & alarm At least once every 3 D months s) ❑ NA Inspect pump. i P At least once every D mono's I Flush (aberats and p uro test At least awe every ❑ months D year(s) 0 NA othee D monk p year (s) 0 NA At least once every other. MA1N7'ENpNCE INSTRUCTIONS be made by an k carry" one Mai ntaiw. Septa9e In tanks . Ma plumber ResWW SeM a or broken ohs' Master must iackide a visual kispe n of the slud an �� and check tn � any back UP Servickg Open W- Tank inspec lea measure volume of combined skidge to check the effluent levels hardd. ldentfy any f The dispersal cefl(s) shall be Vi of effluent on the The poreM a P o f on tike ground sur P of effluent on the g round o the locct autthodtY Kr the obsen►a and to ch conddm and r e quires the � rw h voiume. the gel m ay Indicate a faflug One (K) or more of the tank Whet the combined accumulation of sludge a e O rotor and disposed of in accordance with ch. NR entire contents of the tank shag �• and any 113. Wisconsin AdrninrsbratiYe l or pressurized POWrs components. pro w POWTS Maintainer- Th e � effluent n is of 12 months shall 1 � � o ary service event A sew report shag be provided M the local regulatory � pctnting products or other STARTUP AND OPERATION o use of the POWTS check treatment tank(S) for the ate For new construction- prior c Ws). If high concentrations chemicals that may imPede the s removed n septage servtdag operator Prwr to rise. detected have the contents of th I Page of - System start up shalt not occur when sod conditions are frozen at the infiltrative Surface- IN above normal hVwrater levels- When power is restored the excess �9 powe outages Pump lands may cell(s) in One large dose. OvefLOadutg os s) and Y result in the wast81Al� Wdl be disc ar+ged to the dispersa tits sl7StiOn love the contents Of the pump tank i�Med by a avold backup or disd=P of � to the efts pump Or contact a Pl unbet' Or POWYS Maintainer to septa" S Operator prior power assist in the PUMP controls m restore normal le+rets wdhin the Pump -. Do not drive or pork vehicles Over tanks and dispersal ceps. Do not drive or parts Over. Or otherwise drsWrb or comPaM the area WNW 15 feet down dope of any Mind or ad-yade soli absorption area. from the wastewater s"am may drove the c e rde Reduction M Of the bum condoms: cotton swabs: d A the POVIITS: �b7/ 9 tom becomes. meat ,�� � k� dcairi ( p�P) water. MR and astd wader softener brie. rte ions: Oil p p ABANDONMMENT fak�t out of servos the fo(fOwirM steps shy bs ' to intone that the When the POWTS fnNs deV is p�ni compliance . va ch. Comm 83.33, Wisconsin Administ<ative Code: system is properh► and l � In sued. • Al piping to tattles and p(ts shat be disoonn and the abandoned pipe � Operator • The contents of al tanks and pits shall be removed and propene d II d by $ePI • After pu mpbg. an tanks and plts shag be excavated and removed or hea a and the void space Ned with Sol. gravel or another Inert solid matedal. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the Mowing measures have been, or must be taken. to provide a Code comp p, a replacement has been evaluated and may be utW=d for the location of a �t son absorption system The replacement area should be protected from disturbance and compaction and should not be iniffinged upon by rettdred setbacks from exisfty and Proposed structure. lm Gans and wept. Failure to proted the replacement area wll result in the need for a new soli and site evaluation to establish a sortable replacement area. Rat system must comply with the rules in effect at that tune. In Pi 0 A sudablO replacement area is not evadable due to setback andJor th faded POWTS. t Y a W tank may be Installed as a Last resort m replace taikue of the pi a sod and The sle has not been evaluated to tdeatify a surl�te replacement area- Upon sRe eva luation must be Performed to locate a suitable replacement area. If no went area is available a twKM tank M ay be as a last resort to replace the faded POWTS* removal of the biomat at Mound and at - s� ab�P�! t may be r�eoo cted in P� fa 9 surfaoe. Reconstructions Of such systems must comply with the rules in at that time. «WARNING» AM" INSUFFICIENT OXYGEN. SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES UNDER ANY CIRCUMSTANCES. DEATH MAY NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT RESULT.. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR VAPOSSIBLE. AQOLTIO NAL COMMENTS WTS INSTALLER Plows WAiNER UIIAI PO Name � • i . Name � a Phone / % Z �l Phone Z ✓ SEPTAGE SERVICING OPERATOR LOCAL REGULATORY AUTHORI I� [It mf t doomwt a"Wits e yiL*j^ -! A9Y S7 �r f e ? = 02 tai Ptrone 7 ?3 �i Ord Saiatarion a This aocu n mIt W= jafd b gm sbdfs of the Green LAID. Old w a COUW zo'+g Cade Use of eft doaara� d t* �► � of sir. Canna 83.22MXIXtd)&l and 83.54(,). m � (3). cLq (vot) guarantee nie vecionnanoe of the POWTS. � � ��� IBS Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. // percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 Z Z — I o f l 0 — (► b J Please print all information. Ift evilmd by Date Personal iotamation you provide maybe used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). . 0 0 3 Property Owner Property Location Govt. Lot , 1/41 1/4 S J T N E ( W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# W L/ , CRY S Zip Code Phone Number ❑ City ❑ Village wn N6 rest Road l ❑ pew construction Us Residential / Number of bedrooms Code derived design flow rate y� � GPD Replacement / ❑Public commer Describe: Parent material Flood Plain elevation if applicable G� ft. General commend 2002 and recommendations: DEC 1 6 ST. CROIX COUNTY [] Boring a A � # pit Ground surface elev. J / ft. Depth to limiting factor 5i7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 12 -51 , c2 0 Boring # ❑ Boring Im a pit Ground surface elev ft. Depth to limiting factor in. App lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDHf In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 2 Effluent #1 = BOD > 30 < 220 mg/L and TSS < 150 mg/L ' Effluent #2 = BOD 1 30 mg/L and TSS 1 30 mg/L CST (Please _ Signature Tymber Address Date Evaluation Conducted Telephone Number 1 ,2 o; i r Property Owner Parcel ID # Page of F BodN 31, # Q Boring Pit Ground surface elev. 6 r �-� ft. Depth to limiting factor .-�an. -I Sail Application {ate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 1 2- O J / �. Z —�' V . s ❑ Boring # ❑ Born ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # E] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPQ fi? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 Effluent #1 = BOD, > 30 1220 nx L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD4330 (IL 6=) Soil Test Plot Plan Project Name Scott Hove Shaun B' Address 1082 Cty Rd N Roberts Wi 54023 CSTfa #226900 Lot 1 Subdivision ------- Date 12/10/02 SE 1/4 NE 1/4S 5 T 28 N /R W Township Kinnidannic M Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Nail in Tree System Elevation 97.3' *HRPSame as Benchmark Alt. BM Top of Shed Foundation @ 100.0' Scale = 1/4 = 10' 200' Vent Pipe 4% � B. M. " Slope IF 95' B- 13 Drywell B -2 96 5T 97 B -3 Old House to Alt. BM be torn dow 100'To Shared Well Shed rn q Pro 3 Bedroom House CD r CD J L T. v a C Z y 2 �J a 3 Q CL. IF y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 9 5 3 Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number 0 22 - 1 01 f - 30 - 1 0 . 0 • 4A DECAL DESCRIPTION 'on s % �C� '/s Sec. Td N -RJ-W, Town of 1,1 Property Location , Subdivision -- . Lot # / Certified Survey Map # .,� , Volume Page # <:�/ Warranty Deed # � � 1�l -3 -�, --------- Page # 3c� Spec house ❑ yelp -no Lot lines identifiabW ❑ no Sy - - AL NTENANCE 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. Wbat 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 Departinent a certification form, signed by the owner and by a masterplumber, jomneymanplumber, restricted 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 stag t your 'c system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 d a y s rT expiration date. OF APPLICANT DATE i OWNER CERTIFICATION A dy ) certify that all statements on this form are true to the best of my (our) k1lowledge. I (we) am (are) the owner(s) of above, by vir tue of a warranty deed recorded in Register of Deeds Office. OF APPLICANT DATE * * * * ** t be' revoked b the * * * * ** Any information that is mis- represented may result in the sanitary Perini b Y 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 VOL 1744PAc4326 STATE BAR OF WISCONSIN FORM 5 - 1998 59932 PERSONAL REPRESENTATIVE'S ;'(WHLEEN H. WALSH Document Number DEED REGISTER OF DEEDS ST. CROIIX CO., WI Doris A. Kretiziger, as Personal Representative of the estate of Rudolph 0. kE EiUED FOR RECORD Krellzilzirer. a / K_rryzigcr ( "Decedent "), for a valuable consideration '.0-24 -8001 8:15 AM conveys, without warranty, to Scott J. Hoye and Julie C. Hove- hushand and PERSONAL REPRESENTATIV l yife, as survivorsh ]marital rop!crty Grantees, the following described real EXEMPT A estate in St. Croix County, State of Wisconsin (hereinafter called the CERT COPY FEE: "Property"): COPY FEE: e TRANSFER FEE: 255.00 RE:ORDING FEE: 11.00 Lots One (1) and Two (2) of Certified Survey Map in Volume Eight (8) of PAGES: 1 Certified Survey Maps, Page 2186, as Document Number 455242, filed in St. Croix County Register of Deeds Office on January 22, 1990, being located in the Southeast Quarter of the Northeast Quarter (SE 1/4 of NE 1/4) and the Southwest Quarter of the Northeast Quarter (SW 1/4 of NE 1/4) of Section Five (5), Recording Area Township Twenty Eight (28) North, Range Eighteen (18) West, Town of Name and Return Address Kinnickinnic. Scott 1. and Julie C. Hove 1082 Co. Road N Subject to C.T.H. "N" right of way. Roberts, WI 54027 St. Croix County, Wisconsin. 0 /- 1 ) 022 -1011 -40 -160- 022. 1 o11 -30 -100 Parcel Identification Number (PIN) Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which the Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the Personal Representative has since acquired. I hidF day of Ortol>_er 2441. `Doris A. Kreuziger, Perso p. of Estate of Rudolph O. "Doris A. Kreuziger, Personal Rep. of Estate of Rudolph O. Kreuziger, a /k/a Rudolph K uzi er. Kreuziger, a /k/a Rudolph Kreuziger. Personal Representative Personal Representative ACKNOWLEDGMENT AUTHENTICATION STATE OF WISCONSIN ) Signature(s) K C FV - 2 1 ) Ss. County ) _ Perso:ully came before me this _ day of authenticated this Leday of ) L' GU l the above named , to me known to be the person(s) who executed the foregoing instrument and acknowledge thr same. TI I'LE: MEMBER STATE BAR OF WISCONSIN r (If not, Notary Public , State of Wisconsin authorized by § 706,06. Wis. Slats.) My Commission is permanent. (If not, state expiration date: THIS INSTRUMENT WAS DRAFTED BY Stephanie J. Zeman 200 E. Elm Street, River Falls, WI 54022 (Signatures may be authenticated or acknowledged. Both are not necessary •Nanio of persons signing in any capacity should be typal or printed below their signatures PFIISONAL KEPRESENTATM'S DEED STATE BAR OF WISCONSIN FORM No.S - I"S INFORMATION PRONS,ONALS COMPANY FOND DO LAC, WI 800.655.2021 C C N 455242 o Eu CERTIFIED.'SURVEY MAP RUDOLPH KREUZIGER Part of the Southeast 1/4 of the Northeast 114 and the Southwest 114 of the Northeast 1/4 of Section 5, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin. 0 Indicates 1" x 24" iron pipe weighing 1.13 lbs. /lin. ft. set. m N 1/N LA m a � S 03' 20' 00"E 444. 23' N' Q N �' h 4/6•/ I N o1 % k k. W �' 2 � ^• IN. h � � �• V 4j ❑ m N = yc (Q�M DO k 19� nl H / h y h V v,00 .1 m W - O V1 1` 1 �o Q p $' A6 � L E � / Iq �I ?.N O` N m W 2 / Ep /1 °N 'Ih V 2 I Q N W ?� ., 3 �� � p� .J I .. Oft CA ey / / /�0 �t 9 2 ®0 ICI p eel m o 0 o 1I 2 N (1 40 3 %J n ` O �1 2 ' �'v Q v► � / / © � ly i W s GZ ��`�'•�`. W Hoy / � o J \ O O j) LAU /// % Owner's Address FENCE / a 3 = m PHY Z � 1713 ,%. Route 1 A A +`�,' N •'. R ER FALLS d� • Roberts, WI 54023 \ © �� F ' , WiSC. , •` �, �•� Dated: December 12, 1989 3 / ♦'•. F� LAND i .Laurence W. Murphy a h Registered Land Surveyor � Q - h o ALL BEAR /NOS REF. TOTNE E/W //4 L /Nf OF SEC. 3, v � r;�,� J �•:'__• T28N,R16W, ASSUMED N90 "E y j Vol. 8 Pane 2186 0 ''" Certified Survey Maps St. Croix County, Wisconsin ,��, „� ^n ,•. 3 SHEET / OF Z VOLUME 8 PAGE 2186 wisirmsin Department of Commerce SOIL AND SITE EVALUATION . Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach comp lete site an on County pl plan paper not less than 8 1/2 x 11 inches in size. Plan must � include, but not limited to: vertical and horizontal reference point (BM), direction and 1 ,percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please inf rma ii►P9 Reviewed by Date Personal information you provide may be used for pu w, SN . 1) (r)). Property Owner Pyokerty Location i _ , - 1 a, A , Go . Lot 1/4 1/4,S , T ,N,R(or Property Owner's Mailing Address M . i r ,� 1a Block I Subd. Name or C Z9 UC City Stat Zip Code P City ❑ Village Town Nearest R T I ^ dsting building 5&A) ►'` C S KdZ G E2 `� g rate �S = bed, gpdfft , L trench, gpd/f? �,M- ig rate ..5 bed, gpd* —' trench, gpd4t p s / UU✓✓"" s referred to site plan benchmark) / Ain elevation, if applicable ft AT -Grade System in Fill Holding Tank El ®U ❑S EZU ❑S Ou E I h Consistence Boundary Roots � P� � L Ground j �J elev. , ft s X' Depth to S limiting factor Remarks: Boring # / Ground W AA elev. s y � Depth to limiting factor ;2 ,1n. Remarks: CST Name "(Plea Pri ) / Signature Telephone No. Address Date CST Number z SOIL DESCRIPTION REPORT PROPERTY OWNER � Page PARCEL I.D.# �� AW/ - 7e 10 Boring Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell flu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench - 3 Ground _ � Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # r K Ground elev. ft. Depth to limiting factor ' Remarks: Boring # Ground elev. ft. , Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) ,� jr s�yoo -7 1 s� K , 1 `� /'- �_ i � < '► G I f ,� i LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF KINNICKINNIC COMPUTER NUMBER 022 - 1011 -30 -100 Parcel Number 05.28.18.67A OWNER NAME: First SCOTT J & JULIE C Last HOVE PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 1082 CTY RD N SECTION 5 TOWN 28N RANGE 18W '/4160 '/440 Line Description Line Description TOTAL ACREAGE 2.503 PLAT LOT BLK 01 SEC 5 T28N R1 8W PT S1/2 15 02 NE1 /4 LOT 1 CSM 8/2186 16 03 2.503 AC 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF KINNICKINNIC COMPUTER NUMBER 022 - 1011 -40 -100 Parcel Number 05.28.18.68A OWNER NAME: First SCOTT J & JULIE C Last HOVE PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 1084 CTY RD N SECTION 5 TOWN 28N RANGE 18W 1 /160 '/440 Line Description Line Description TOTAL ACREAGE 2.500 PLAT LOT BLK 01 SEC 5 T28N R18W PT S1/2 15 02 NE1 /4 LOT 2 CSM 8/2186 16 03 2.5 ACRES 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit