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022-1014-90-100
, • ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner /P /�'�✓ s/> �i!/� /U.e�SO�✓ 5% x- Address b�J.tJd �D� y r. - ,�•� /City /State .J 4l -r O /6- Legal Description: Sr Lot /I- Block Subdivision/CSM - Y, N W '/e W , Sec. &, T 2LN -RZk W Town of 1Ci,y�/ / " V O N r D • db SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFO hteili y� Tank manufacturer 4,0 G ,G Size ST/PC / Setback4elfw.,House Well PAL Pump manufacturer 7--& Model U . Alarm location .VSO (HOLDING TANKS ONLY) C� Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: M 0 U A) p Width Length 1 go Number of Trenches Setback from: House & D _ Well P/L 7y ' Vent to fresh air intake > ELEVATIONS �"� /vd t oeu Description of benchmark TO p of h- �� 57-Q Q ZW 0A1 ' 4or L ' Elevation / 0-0 Description of alternate benchmark _pit%ID DDaie �Sr! /— �dl�/,�,ST Alf7PT' Elevation /07. 3 S r I 8✓� DS r D 9 dX 0 Building Sewer ST/HT Inlet � • �� ST Outlet � 7 ' G PC Inlet / ' al. p � PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines () l0SV O Bottom of System O �� 7 • L 15 Final Grade Date of installation / / Permit number 3 0 ZjL State plan number zzle3 S /7� Plumber's signature License number Date Inspector .Gl1l�) Complete plot plan •� ORIGINAL r � O o kA �IZI - b b CL fT < n -M az O )� o �, � I I I I I bt0 � ` I � I i I i 1, 4 7 - 0 10 I I � Zk I N n � r N w � o o 1 h 3 ■ ■►�Emig ■ i■ ■r�l \ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■■■■�■■■0 WIN ■►�11■■■■■■■ ■ ■■ C = ■■C■ii�i■ =i ■� i ■■■■■■■ ■■■ ■ ■ ■ �\�r•.IM,M■■■■■■■■ ■■■r11!r■■■■■■■ ■■ �I■� ■111 ■ \ ■ ■ ■ ■ ■ ■■ ffi X11 \1 ■ \�� ■ ■■ ■■ �\�►HNI■OM®■■ ■■■ it \I 211 1■■ ►\■■■■■ \;0 M■ ►1r■■■ ■■ �.1111 ME ■■ m ■■■ ■■ 11�! \�\■ ■ \MEN N■ ■11 all ► ■ ®■■\ \■■ GRIN . q q \r\�1►.� \\O■■ ■\■ ■►firi 1■ 1.1.rIr► ■ ■■ ■■ ���■■■■■■ MEMO l ■■ ■r■■■■■ ■■� \■■■■■ i • - • _.1JLi r ua6, *) vlrisoons oePe olCorrxrieroe PRIVATE SEWAGE SYSTEM a+ntr satehi Brings onnsan t. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal IMonnadon you provide may be used for secondary purposes (privacy Law, s.1s.04 (1)(m)l. 84292 Permit H er s Name: City ❑ Vi rage ❑ Town o : State Plan ID No.: Nelson, Brian Kinnickinnic Township bZ1,3� CST SM Elev.: Insp. BM Elev.: BM Description: !I Tax No.: 22- 1014 -90 -100 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ) 4_41 - sool - t Z-OD Benchmark a j 6p Dosing L.-P I tXIV Iti BM 6A) 3' 0 Aeration U Bldg. Sewer . ) c,57. 8M' Holding St / Ht Inlet T(2' /os - - W TANK SETBACK INFORMATION St/ Ht OutletLQ 7. 33 TANKTO P/L WELL BLDG_ Ai Intake ROAD Dt Inlet Septic > �s' r NA Dt Bottom I �• �- o/, oo Ong 3J d ` NA Header /Man. Aeration NA Dist. Pipe ` 2 p8 p13 Holding Bot. System '93 PUMPI SIPHON INFORMATION Final Grade Manufa rer Demand t Q over L Model Number l ;iC'GPM I/k 2.29 Il2.2g r TDH I Lift S.'bS Frictio ,S em , T r DH IS �t Forcemain Length - 4 ' ,Dia. 2 r / Dist.ToWell SOIL ABSORPTION SYSTEM �(,,,,; ,b� + • �$ = t /.� BE ENCH width r Length 1 0. PIT No. Of Pits I ide Dia. Liquid Deptt EN I N 0'D l OIMEN I N M SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM Q - Manufactu r er: INFORMATION Type O CHAMBER r: System: A16.4 Q �j j / OR UNIT DISTRIBUTION SYSTEM G+-" �• 7� Header / Mani old Distribution Pi ( ;) i� 1 x Hole Size x Hole Spacing Vent To Air Intak Length Dia. , Length Oia. [ Z Spacing 3•S I 3/ V I z I 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 ❑ Yes ❑ No ❑ Yes ❑ No C MMENTS: (Include code discrepancies, persons present ction #1: 9R / ��� section # : D9/ J jo I w•• pq/ob/D1 (f) tow Z.r) Location: , (NW 1/4 NW 1/4 6 T28N R18W ) - 06281866D Lot 12 1.) Alt BM Description 2.) Bldg sewer length= Ig-o' - amount of cover 3.) contour = jo535, 6.35 02-30�� Plan revision required? ❑Yes 10rNo ,� OSI S Use pt r e ltional information. -� SBO -6 10 q-W97 j �e r' Date Inspectors Signature Cert N( Safety and Buildings Division County ., 201 W. Washington Ave., P.O. Box 7162 iseonsin Madison, WI 53707 - 7162 Site dress De artmont of Commerce Sanitary Permit Application Sanitary Per umber In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 38 12 4 `-1 may be used for secondary ses Privacy Law, s15. 1 m ❑ Check if Revision I. Application Information — Please Print All Information - State Plan I.D. NumberGZ! S3 s Property Owner's Name r� �F Parcel Number 04A.) 3 Sl�fAVV Da /t� -G�So N � f ✓ j ok/ v , 022 - I o/ `l I �'' /0V Property Owner's Mailing Address PropPrope Locat 8 ZZ �• AM A -on % 11 W , S G '8 N, R E City, State Zip Code Phone Number Lot Number' Z Block Number ,� �! 0 �A1 ss OS S �, Subdivision Name fV(/ /.r CSM Number 44 IOU eq 75D0 voi . is •y/ H. Type of Building (check all that apply) ❑City 1 or 2 Family Dwelling - Number of Bedrooms 3 - , j, 0 r sir ❑Village ❑ Public /Comore ial - Describe Use P ownshi / �V /G/('/ N PI G ❑ State Owned •9 `� Ilk) 1 W Nearest Road yo dL sT• III. Type of Permit: (Check only one box on line A (n g scherncfoi nal us¢ - omplete line B if applicable) w 2 11 A. A stm Ne Replacement System 3 11 Replaceme dl' . 1.0 ..6 ❑ dill�tl�o � ounty use m T ank Only S stem B. 11 Check if Sanitary Permit Previously Issued Permit Number �.� Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use). 44 ❑ Non - Pressurized In- Ground 2%LMound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dis ersal/T tment Area Information: Desi� F�11) ispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade ►S equired 0 Rate(Gals. /Days /Sq.Ft.) (Min./Inch) Elevation s VI. Tank Capacity in To r Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing "' Q /► , Tanks Tanks t'� •' Septic or Holding Tank y Q Dosing Chamber , WM ' X VII. Responsibility Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature NP/MPRS Number Business Phone Number ?o�3E�pr z2 37S' 71S 3P Plumber's Address (Street, City, State, Zip Code) 6 55 G ,v e iG �!� • �J S ����Sa S ��l VIII. Count /De artment Use Onl 14 Approved ❑ Disapproved Sanitary Pernit Fee (includes Groundwater Date Issued Issu' g ! �g gfrp'( tamps) Surcharge Fee) \ ❑ Owner Given Initial Adverse t dD 2c>A► `�` � Determination 3Pt 5_. • EK. Conditions of Approval/Reasons r Disap (� � t wua.p� �yQ dA0.6 — X t � f'il'e C�'1�e �- C9�w� . Q,� .� i 2t�s?1' . -- , r `• �! '� Attach complete plans (to the Coun ty o ]) the em on paper n uKdti�lOrLt�l�� In C1> SBDy6398 . OS Ol 9 f /off i� V �( 0 � � � A po ' �-�. " 7 ti5 OJ ck 7 ' NO D r � Lot go �ac„t afgG W its 5� p11e 1 r —off '� M , 4iN / 1 / 9 i 55 ( c� 11, below the Whops 141 of to _ 1he area Anil abso� lion System moil rema►n uadisl11we TU B, or j " ��� ��� ��� , w/ P D .S r x Safety and Buildings ,r PO BOX 7162 MADISON WI 53707 -7162 TDD #: (608) 264 -8777 visc ?0 1 0m si www.commerce.state.wi.us /SB Department m " Scott McCallum, Governor Brenda J. Blanchard, Secretary 4 f O March 09, 2001 CUST ID No.2263 ' �' , S �Oil ~ F 1 G� ATTN: POWTS Inspector ZONING OFFICE ROBERT W ULBRICHT �' �` ' ST CROIX COUNTY SPIA 655 O'NEIL RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/09/2003 Identificaf hers Transaction ID No SITE: Site ID No. 627006 STEVE GERMAIN - RESIDENCE Please refer to both identification numbers, ST CROIX COUNTY, TOWN OF KINNICKINNIC; 90TH ST above, in all correspondence with the agency. NW1 /4, NWl /4, S6, T28N, R18W, LOT: 12 FOR: DESCRIPTION: NEW MOUND SYSTE 600 GPD OBJECT TYPE: POWT SYSTEM REGULA CT ID NO.: 783194 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. On page 2, there shall be six inches of aggregate under the distribution pipes and two inches of aggregate over the distribution pipes. The aggregate shall be covered with approved geotextile fabric that conforms to s. Comm 84.30(6)(g)., Wis. Adm. Code. Refer to the approved "Mound Component Manual for Septic tank Effluent for Private Onsite Wastewater Systems ", [SBD- 10572 -P (R.6/99)]. 2. On page 3, Y = 24 inches. 3. On page 4, pump switch setting "D" is equivalent to 560 gallons. 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. ROBERT W ULBRICHT Page 2 3/9/01 Sincerely, DATE RECEIVED 03/02/2001 `!� n FEE REQUIRED $ 175.00 vG FEE RECEIVED $ 175.00 PETER E PAGE91EWER BALANCE DUE $ 0.00 POWTS PLAN R, TE GRAT>D SERVICES (608)266-2889, M - F, 0700 - 1530 HRS PEPAGEL @COMMERCE.STATE.WI.US W S iA "`c d T633 cc: STEVE GERMAIN I Safety and Buildings PO BOX 7162 MADISON WI 53707 -7162 TDD #: (608) 264 -8777 ,ScOnsI n www.commerce.statemims /SB Department of Commerce Scott McCallum, Governor Brenda J. Blanchard, Secretary March 09, 2001 CUST ID No.226375 ATTN.• POWTS Inspector ZONING OFFICE ROBERT W ULBRICHT ST CROIX COUNTY SPIA 655 O'NEIL RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/09/2003 Identification Numbers Transaction ID No. 621535 SITE• Site ID No. 627006 STEVE GERMAIN - RESIDENCE Please refer to both identification numbers, ST CROIX COUNTY, TOWN OF KINNICKINNIC; 90TH ST above, in all correspondence with the agency.:.. NW1 /4, NW1 /4, S6, T28N, R18W, LOT: 12 FOR: DESCRIPTION: NEW MOUND SYSTEM / 600 GPD OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 783194 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. On page 2, there shall be six inches of aggregate under the distribution pipes and two inches of aggregate over the distribution pipes. The aggregate shall be covered with approved geotextile fabric that conforms to s. Comm 84.30(6)(g)., Wis. Adm. Code. Refer to the approved "Mound Component Manual for Septic tank Effluent for Private Onsite Wastewater Systems ", ISBD- 10572 -P (R.6/99)]. 2. On page 3, Y = 24 inches. 3. On page 4, pump switch setting "D" is equivalent to 560 gallons. A copy pp 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. I MIGINAL r • r ROBERT W ULBRICHT Page 2 3/9/01 Sincerely DATE RECEIVED 03/02/2001 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 P TER E AGEL BALANCE DUE $ 0.00 POWTS PLAN REV WER II , INTEGRATED SERVICES (608)266-2889, M - F, 0700 - 1530 HRS PEPAGEL @COMMERCE.STATE.WI.US Wi MART'rode.7633' cc: STEVE GERMAIN i !JLBRICHT ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 =�i " t rs ageC �a ferns 715- 386 -8185 , MAR 0 2 2001 'AF TY R 8LOGS. PROJECT INDEX Plan I.D. # Date Owner 54euE' 6 fA-j/i/ Phone - 745 -, 7f T f/ L Address &0/ 11VPs'O.J Legal Description /of -j? 12, PeAsjg1*W 6 - C_5N . ? , Z /9 C4-Q, S . 41k) / V U) . Go T ex) R t8 Lo Town of • County S - 17. G o ! yl_ C.S.T. W441el �, �43 Installer Local Authority/ Supervision PROJECT DESCRIPTION BeV,4I . ' Soy /5 �� ��'�ii r�'� /�. . S � �` • 2 13v t Se ,+S641tIll S r .a�>< Z a. l� s - ,•f� - ,'s ' S'v 1 F4-IS /-t-- dg'�- 4- i . to Or Pq . 1phall� \` ``�~ oars l RT Tp� � f306ERTW. /' �_ S�rF Y O b 01160 _ C 0 HUDSON, WI \_ C l k l Rfflrl r:iJ;r• P;. 1 PLOT PLAN VIEWS Pg. 2 YSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS Pg. PIPE LATERAL LAYOUT Pg. 4 DOSING CHAMBER CROSS SECTION & SPECS- Pg. 5 PUMP PERFORMANCE SPECS Pg. 6 OPERATION, MAINTENANCE, AND PERFORMANCE REQUIREMENTS CORRECTION NEEDED SEE CORRESPONDENCE �. This design for installation is based entirely on measurements, elevations, S landscape conditions (slopes etc.) and soil suitability provided by CSTM 7 1 3 L The accuracy of his specs, as reported, shall remain the sole responsibility } of the CSTM. Any use of this POWTS design ty any licensed plumber, or any related unlicensed parties or persons (excavaters, laborers) shall not be construed as an assumption of responsibility by the designer for the workmanship, construction,- lacement, substitution or selection of any components not s ified, or v. any assumptions by the plumber that any unspecified mponenta if ar e working under e adverse o damaging t weather c conditions (wet /frozen I soils) by any such parties or persons. l lo i 4� V� ill ") Sc�GE • / 30 J 0 o �� - _ �O 1 yO , {� �; r 7 1 5 No o o l.,,l �� � a g 40 GDa uJ i ts D l /we ,, 1 ci ir yA c � , Ito area ib 1. below lht dowdsiopt till it lire ss O OV is an�islurbe�, � °u� �� r ma �o�l absorpl�on System must a � � , 2 / v o 7R p /I-If lka 9'bao, 9s OA, � 6 I� w d • L a T` � C R =SS S L CTIOX J 6 M00AjD w r Q11 (;ORR cl NDENCE o o OF % r g�� C 4 R RESPO � �,' A 59e c E 'Di STRi(Wrtco Cs° TNi GktiS ES 9 pi it.) G-• of To p S o i l w� 7;Feh 1.UAL s ys r e M EIE'v/1TioO k 7. 'Y5 SAup / /// p l o wfrc) T o p `_+ ` V u 1 Fb �'1 R ol SIopE F ORGE EtEV/1Tr0� 0"M-R MAW S3� �0 5• � � FT. — Et_EvArl s --' E, /• p8 Fr. IN veRT - O F IATERM S . S?3 FT - Top o f R o c /0 V. Z (� b G /O FT. (� 11 H /. FT o • T °p OF y IATER IS /L � PLA VIEW OF Mou,)JD wi rti 13E D Z „ roPm MAW R (e FT, Fr 0 0 FT Fr � w x w 33 UD FT B E i7 To I y" df35 ERVh T�o� 53 PEI ATE P t p E s /ocA T %dNs = 167 fl* E. vA S PEaMA,jEA3T MARKERS REG?UiRED (3A5AI- hReA = 'p wh SrE-F / ow y ce O SCI L- 1010rRATiuE S 5 4. pT, c APAcity PRopoSEd BASAL AReA = B ( A + : � l J s at. FT. Qu 0 P y oU 7-- — f 4 CEOTR AL P � S RS T ya /E X F �/ Fr Fr TR L- R n c CEng A � E M A I ►� N 5 - a Fr 2 •� CORRECTION NEEDED o f P v c SEE CORRESPONDENCE Y V ARI'A(3LE TOTAL V(gID UbjuME GA1.5 Vl5 TApjc& N oi t� ��AM 311& - rOML, vo/UAy R Inc N � L hT E R/! L '� 1 s OF Ntwoo pk' f 2- 'PC 14155 C EAJT R AL MAWFvLE Z ��• �-PS, jj �� I 1 -C7�CE ll'1/11ti1 II��F{ES iu V f; RT E LE � V i1T O k O L ATEIQ AI5 SEE PtolLpSE SIDE .Fpp, /07 �S Tl- i"A L CAD b 8q L { - D E F ' 4 i L_ PER r-o R At R�►tvvE ^11 I)Rill (3uRR5 \ Y NelE �oc o,v t3 oT1'oIH G'QvAli S PAc v . 17j STRi BL)r,o" DISchAR &E R NT� Po R �RCh L A - r ERoi � PsR �ti s �� S"C� • l TO T AL 0(,STRt[3OTloo 3)►5cVi^RGE RATE r-o R MI'NI'MUM r � `D ETA i 6 F L ATL7R A L C p o vE A i E� E til� > OF EAce4� �iN�Sff�� �1pU,uD �iPi¢DE GU / �A A CCE S s �J �F�� /IF ISO SLUE � d 2 /RUC /.3/4 // �9 7- � � PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS P/} JE g OF sa , fo 6v,,voocv D49OR VEIST CAP I PI r � VEfJT PIPE WEATHER PROOF APPROVED LOCKIRIG JUIJCTION BOX MANHOLE COVER / 09.0 12 "M10. I �,fifNGU(r %A/SE1 1 GRADE 1/'�l,f�t �/t V /o Al I 'i" MIIJ. Z'' — I IB" MIIJ. COIJDUIT -- f l�U� rl �'v /03' I IMLET PROVIDE I I - i -.. AIRTIGHT SEAL APPROVED JOINT A INS�K rn i I I W�PROVP PEOINTS PIPE EXTENDIHG 3' C).0 ALARM ^ !, I I I EXTENDING 3' ON IJ u / V JIJTO SOLID SOIL B I I TO SOLID SOIL q , 3.3� I 564 . go Puc y b ou I I ELEV. FT. ' r PUMP - -� 'LrSC 3 D -� D , q0 OFF �IOiPE' eF Sitv1P it VII � %O d BLOCK - RISER EXIT PERMITTED OIJL4 IF TAUK MANUFACTURER HAS SUCH 'APPROVAL SEPTIC E 5PEC.IFICATIOUS DOSE Gy /��s CD , uG�,Cr� - e- �.IUMBER OF DOSES: PER DA-4 TANKS MA NUFACTURER: TANK SIZE: /0 OV GALLOMS DOSE VOLUME /00 n G V ��i47PiK INICLUDIAIG BACKFLOW: GALLONS ALARM MAMUFACTURER: n MODEL IJUMBER' y L " F)M INCHES OR � GALLONS SWITCH TYPE: , - r � RREC� �pEN / L INCHES OR '�� GALLONS PUMP MAMUFACTURER: : MCHES NCHES OR CALLOUS MODEL UUMBER'. / D= Z2 O R GALLONS SWITCH TYPE: Loll 5 y U//�� �� GK + j" - NOTE: PUMP AMD ALARM ARE TO BE MINIMUM DISCHARGE RATE 7 0 GPM INSTALLED OM SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTIOM PIPE.. 6 , 3 5 FEET - rAok 5 Pcc -4- MIMIMUM NETWORK SUPPLB PRESSURE , ' � 5 C FEET EAC(A, O ~ J P th i -I- � FEET OF FORCE MAIN X �- 2 -- F XoFT FRICTION FACTOR.. FEET tAo 2 TOTAL D HEAD = ' F E ET `i IMTERNAL DIMF_WSIONS OF TAUK: LENGTH �D/ ;WIDTH �"' ;LIQUID DEPTH 7� i I SEPTIC TANK, per Comm.83.44 (2) (c) shall be eq uipped q Aped with an outlet attached approved filter device (Zabel fliter). Tank shall have an approved above ground locking manhole cover for regular (every 12 months or less) inspection & servicing by a licensdd service pumper. , ME Series M 1/3 through 1 -1/2 HP Effluent Pumps Performance Curve CAPACITY LITERS PER MINUTE O 50 100 150 200 250 300 350 400 450 � I 100 90 28 80 24 70 Cr W M��O� 20 W U- 60 Z Z 0 50 M��$ 1.6 w W = = J Q 40 MF$ �- F- 12 O O H 30 8 2 10 4 0 0 0 10 ?0 30 40 50 60 v 100 110 130 CAPACITY LLONS P MINUTE F. . Myers, A Pent it Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3327 7/91 Printed in U.S.A. 1 y . U UL O • Mound System Management Plan • Pursuant to Comm 83.54, Wis. Adm. Code Sep tic Tank tic tank shat / P I be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the The se septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge ge flows or an impending continuous septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 the liquid volume of e the tank. If the contents of the tank ire not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pum Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg /L BOD5, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual ISBD- 10572 -P (R. 6/99)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption ?nd dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector. a SEE REVERSE SIDE Pg.6 FOR MAINTENANCE REQUIREMENTS SPECIFIC TO THIS SITE, DESIGN, AND COMPONENTS Pg. 6 Continued. POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of this system. The owner is required by code to submit all necessary maintenance /inspection reports to the controlling authorities. SPECIFIC CONTACT AGENTS s4,elwa ; aqw— * Governmental authority/ inspectors: ��/ W -` '? • y4 ; 0 o • Licensed installer, responsible for providing an operation/ maintenance "Users" manual: • Licensed service / inspection agent other than installer: T,el ,- e , s4wl lio-v (:fo- . • Electrician, for pump, electric controls, wiring units: 7 i s - 17-1 • 33 <�- IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic (sledding, shoveting, etc.) across the mound area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. Discontinuos use in the winter (a vacaction trip, resulting in no water use) can also lead to freeze ups. 2. Water conservation needs to be exercised! Or system can be hydrolically overloaded and destroyed. This system was designed for a.maximum wastewater flow of6r6V gals. daily. 3. POWTS are not designed to accomodate wastes from a garbage disposal unit or an other unna tural P y Ural sources of waste. Any introduction of such waste materials will overload and dest oy this system. 4. If a po er outage occurs, or a pump fails, it may result in a tem orary overload of effluent being pumped into the cell, wh om ch may adversely impact the cell (leakkge). It is recmen d that a licensed pumper empty the dosing tank, allowing he pump to return to dosing the correct amounts. Consult yo r installer immediately for advice. 5. Neglect of t e vegetative cover (the cells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in t?:^ system be.i e th IS X-0 sufficient alone tO maintain a grass cover. 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressurized laterals, at each tip - for flushing and cleaning the laterals out. The filter system in the tanks (via a.locked above ground cover /manhole). Only a licensed properly quali6ied Person should be performing this work which involves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. i • r Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code c/Poi Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County 57; 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. / 2 - ' 0 • /0V Please print all information. iewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner / �M/�� /� Property Location )�, SfEvE V E e Govt. Lot /VW 1/4 AdI14 S T 2 ' 9 N R d E (or W Pr wner's aili Address Lot Block # Subd. Name or CSM# City State Zip Code Phone Number LJ City ❑ Village ®,Town Nearest Road flops 540 lly (? is ) ?yq• Ya 3 Z Ki,,y liG , New Construction Use: VQ Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if a plicable f(. General comments �z and recommendations: S! • T� / �1�I S `z/yi� • �� J C �''y/�v� /�/9,/(JGC�Q� R�� � uT ��r• e . r���,e 3) MoU-vo I`Yp45 sy sT2,s Boring # ❑ Boring 5 • l 5 Pit Ground surface elev. 1 J ft, Depth to limiting factor _ �T in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I I •Eff#1 'Eff#2 toyk /3 511- zfs 4 s •8 2 G •IZ /o t/R 31 S/L 2 , m s At z . !' CS — . s c .Z. .3 . & /oyRG MaT5 c� 17Sk io e7ci N s YA P -1 Boring # [] Boring l � 7 • (� 5 Pit Ground surface eh,-v. 7 fl. Depth to limiting factor in. --- Rj Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Si. Sh. 'Eff#1 'Eff#2 z • 13 /o YR 31 5'1 Z- 2.,14, s fe 3 13 - 19 i R Si L //-/'s h k .►M f i' cs . Z .3 �-3 /a yk 4 2 MOTS 6 /fs e Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L ' Effluent #2 = BOD, < 0 mg /L d TSS -1 30 mg/L CST Name (Please Print) Signature 1 Z2. T Number 80156 & r W 37 5 Address Date Evaluation Conduc d Telephone Number Ulbricht & ASS OCIaleo Private sewage Consultants 2 — QrjfV 1355 O'Neil Rd. Hudson, Wis. 54016 RE N ST CRUX COUN' ( ZONMGOFFIG` �h t y Property Owner � ' /V Parcel ID # / d � Z ' , ! o Page 21 of 3 Boring # g 9 �n Pit Ground surface elev. / ft. Depth to limiting factor C/ in. Soil Application Rate 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 0•/2 10YR Y? - 51L Zf-f 4. f �� �� •, s S Yle / F1 Boring # ❑ Boring ❑ 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/ft' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. h. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. •Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < ISO mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of CommOce' 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. SAD -�J)0 (R.6/00) PA /o - 7. G/S M h f B ,4 IE� �.�` 30 • �� of �5 w /�/D � G o T G i •vQ. � t,' l� 99 o c 00D � / G•�1�1,� �' /�l�, = 9.S 2 S � ST CROIX COUNTY SEPTIC 'TANK MAINTENANCE AGREEMENT AND /! OWNERSHIP CERTIFICATION FORM C Owner /Buyer /e /l4nl S�T/ji✓NDN /W IT e ..) � � J � ' 71.0 � + ra 7 Mailing Address ltg� iV AOe r 11Vfl • 5 Property Address 9 90 ' (Verification required from Planning Department for new construction) 5-fil 1 City /State Parcel Identification Number oo,� - /a jy �O • / dZ7 LEGAL DESCRIPTION a 07 OF Property Location NA) NAI '/,, Sec. 4 , T 2� N -R W, Town of Subdivision , Lot # 12 -- Certified Survey Map # So 0 , Volume t S , Page # y/ A L. Warranty Deed # 6 `T V6 � , Volume 4 // , Page # Spec house O yes )(no Lot lines identifiable )(Yes O no SYS'T'EM MAINTENANCE Improper use and mainlenanceof 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 (l) 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. I /we, 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 stafing that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days the three y r e ti date. St TURE . APPLICANT DATE 0 OWNER CERTIFI N I (we) certify ll at all ate ents on this form are true to the best of my (our) knowledge. I (we) Am (are) the owner(s) of the prope described ove y v toe of a warranty deed recorded in Register of Deeds Office. SIGNAT RE Or ICA DATE * * * * ** Any inf ation that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** u ** Include with (his 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 .1 U 71 PAGE 3 71 STATE BAR OF WISCONSIN FORM 2 - 1998 64'9565 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number ST. CROIX CO., WI RECEIVED FOR RECORD This Deed made between Steven B. Germain, a single person, 06 -29 -2001 1:30 PM i WARRANTY DEED _ Grantor, EXEMPT # and B rian J. Nelson and Shannon L. Nelson, CERT COPY FEE: us and and wife, as survivorship marital COPY FEE: + P TRANSFER FEE: 135.00 property, RECORDING FEE: 10.00 Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recording Area Name and Return Address Eagle Valley Bank 1301 Coulee Road Hudson, Wisconsin 54016 i art of: 022- 1014- 90 - 1_00+ Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Part of NW 1/4 of NW 1/4 of Section 6, j Township 28 North, Range 18 West, St. i Croix County •sconsin described as follows: (-Lot 1 of Certified Survey Map filed June 001 in Volume 16 , P ge I 4108, as D ocument Number 647500. i Exceptions to warranties: Subject to easements, reservations and restrictions of record. i i! I' Dated this ��/ day of June 2001 ; i I (SEAL) (SEAL) STEVEN B. GERMAIN !+ , I (SEAL) (SEAL) i j AUTHENTICATION ACKNOWLEDGMENT � I• Signature(s) State of Wisconsin, SS. ` ' St. Croix County. it authenticated this day of Personally came before me this ,day of June et�AG gamed G Steven B. er mai I ; Gov TITLE: MEMBER STATE BAR OF WISCONSIN � I. (If not, me known to be the person authorized by 5706.06, Wis. Stats.) g • ST �'`�',• instrument and acknowledge the same. 7 L j THIS INSTRUMENT WAS DRAFTED BY if Stephen J. Dunlap Onu /d f A l. Irk a �2S'a A l l / Notary Public, State of Wisconsin j Hudson, Wisconsin My commission is permanent. (If not, state expiration date: II d � �,P 1 do I (Signatures may be authenticated or acknowledged. Both are not •) I , necessary.) Names of persons signing In any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. WARRANTY DEED FORM No. 2 - 1998 Milwaukee, Wis, _ ) 3 =ClIH c CAA3 0 0 O JW QW z o cc m Q • W In W N . 11. V d^ Cm � LLJ ox p � c �u- LA- LLJ ZL�:H A O WeA�W S = w Lj- i,- L ' 0 cii LLJ L;j M ZHV o CD iLi�3 i �i - CERTIFIED SUR YEY MAP Located in the NW 1 /4 of the NW 1 / 4 of Section 6, T28N, RI 8W, Town of Kinnickinnic and the SW 1 /4 of the SW 1 /4 of Section 31, T29N, R1 8W, Town of Warren, all in St. Croix County, Wisconsin NOTE: NO NEW PARCELS HAVE W1 /4 CORNER, SECTION 31, BEEN CREATED IN TIM N T29N,R18W, TOWN OF WARREN. TIM c`! ( ALUMINUM CAP FOUND) TWO NEW PA RGE11S .ARE N ENTIRELY wmHN TI1E 3 TOWN OF K NMCKINNIC. v U to v, N CERTIFIED SURVEY MAP A ° Scale 1" = 200' z I VOLUME 13, PAGE 3755._ � 1.22' - - - - - NOTE. I " IRON PIPE FOUND a ci �� 0 , X ,"'�+� I 89° 17' 14" E 708.48' N44°16'04'E 0.71 FROM v� n - 31.79' I 676.69' COMPUTED POSITION. o0 °� I I ^ DINT ACCESS EASEMEN y c oc� ,,, fT - °z OWNER /SUBDIVIDER =T o. n � I I) z I STEVEN GERMAIN DETAIL W > �,0 601 90TH STREET NOT TO SCALE LI H HUDSON, W1. 54016 I rn I W /hIQ Z � BEARINGS REFERENCED TO THE WEST LINE LOT 10 o. 33.00 F p,> OF THE SW1 /4 OF SECTION 31, T29N,R18W, W : ui z W, PREVIOUSLY RECORDED AS AND ASSUMED I TO BEAR NO52"W. `r Oy20' fro v)I N I W w 27.76'1"3 7.76 .0 W z' w DWELLING 33.00 zl z o N a ��` M M; Z p o133.00' _C SECTION 3 1 1 s S LINE +- N 1 � �" "' LOT i2 co � SHED SECTION 6 a. W ° z ` t 1 0 ° 0 27.6 0 1017 BUILDING SETBACK LINE w z CL I - z z FROM RIGHT -OF -WAY. -t m (n LOT I I ( W Z l 1^ I O m n N Z) 3 LOT 10 W IC M W z I 33 ' I v z` z 633,373 SQUARE FEET (14.540 ACRES) N m y O G ' w INCLUDING RIGHT -OF -WAY SO W z I v w W' cr 607,253 SQUARE FEET (13.941 ACRES) iv �I� LEGEND yy -- SECTION CORNER Q I `� y EXCLUDING RIGHT -OF -WAY b y MONUMENT (AS io W 1 w c l m NOTED o I ri I Z , m • I" IRON PIPE FOUND. J Z U co N IZ l" X 24" IRON PIPE r- WEIGHING 1.68 LBS. / W fj2T.7V N 89° 17'37" E 709.10' LINEAR FOOT SET. ° I - I 681.34' — - FENCE W LOT 12 m N I N 89' 40" E 317.6 ' 142,553 SQUARE FEET +' • 290.00 ( 3.273 ACRES) N IT27.62 LOT 11 INCLUDING R.-O.-W. N 140,725 SQUARE FEET cn , e 1 121,252 SQUARE FEET (o 5 (3.231 ACRES) L (2* ACRES) o EXCLUDING R. -O.W. INCLUDING R: O. -W. 252.00' _ 'Q I w 0" W 'ti Go � ' ° 3 110,862 SQUARE FEET b w W I ( 2.545 ACRES) cn ?- EXCLUDING R. -O. -W. O IV o - �) I i I26.83' '317.87 431.13' m 3��. •• .... �s /,� col I 291.04' 140.09' * °:" E yy •; S 89° 17'40"W 4 7.96' 2 B 5 G W �� uil. UNPLATTED LANDS N V RICHMOND ` +• •►• � I O ~ � • SCALE IN FEET 1" : 200 , ., "••• 3 ti0 .....••• LU UI , 0 100' 200' 400' SU W1/4 CORNER, SECTION 6 PREPARED BY: 222 T28N,R18W (1" STEEL SURVEY NAIL FOUND) GRANBERG SURVEYING 1239 C.T.H. "E" NEW RICHMOND, WI. 54017 THIS INSTRUMENT DR D BY: : JOSEPH W. GRANBERG SHEET 1 OF 2 PHONE ( 715 ) 246 -7529 JOB NO. 00-063 Vol. 15 Page 4108 III � HEAD/CAPACITY CURVE HEAD CAPACITY CURVE EFFLUENT M ,NONE so 10MIOE38MM , ENO ■1 ®® ®mmmm ®m ®mmmmm ®m®mmmmmmmm ®� �mmmmmmm ®mmmmm ®mmm ®mmommmmm ®m ■ \ ■ ■ ■I�m �i� ■ ®m0�m ®mom ®m ®■ ■mom ®® ■\ ■ ■ ■I�mmmmmmmmomm ®mm ®mm ®mmmmm ®mmmmm �mmmmmmmmmmmmm ®mmmmo ®ommmm ®mm ■� \■ ■I�mmmmmmmmmmmmmmm ® ®�mmmmmmm ® ®m \■\ ■ ■I�mmmmmmmmmm�mmmm ®mmmmmmmmmm ®m �mmmmmmmmmm�mmmmmm�® ®mmmmm ®mm ' 'M mmmmm mmmmm mmmmm ®mom ®mmmmm ®m .. ■ �■\■ I�mmmmm ■�immmm�mmmmmm�mmmmmmmmmm �mmmmmmmmmm�mmmmmmmmm ®® ©ommmm ■W\■ Rmmmmmmmmmm�mmmmmmmmmmmmmmmm® mmmmm mmmmm�mmmmmmmmmommmmmom I■\ \ 1 \ ImmmmQimmmmm�mmmmmmmmmmmmmmmmm [A CAUTION Model 185/4185 should not be subjected to WIMIRIMEM! 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