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Wisconsin Dep-_rtment of Cot merce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 506128 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Schorn, Joseph I Kinnickinnic, Tow of 022- 1097 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: i '0 or 33.28.18.526A TANK INFORMATION ELEVATION DATA 5.79 J0 /00 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Z - 75 /oz 75 /ct::, Septic to Benchmark Gkc� F 1.,` /060 5. y a /e� `f /nom Dosing P � Alt. BM ADO ��, 5• ( / • /Z AAen t'O O Bldg. Se r 92 y Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht outlet TANK TO WELL BLDG. Vent to Air Intake ROAD Dt Inlet f 0 . Septic 1 ZG , �) Dt Bottom / 29 '91 -'K 7 Dosing , / Header /Man. 9.5 31 Zl• 2/ -:.5 f' 3 )02 -Ilo Aeration Dist. Pipe V 3, 3 3 laZ •4(0 Holding Bot. System PUMP /SIPHON INFORMATION Final Grade Z.33 Y03.46 ak Manufacturer j� S Demand St Cover N # ` Model Number c 8 Z6, S Z 5. JS �. Z5 1" TDH Lift s Friction Los System Head TDH Ft 3,6 Forcemain Length + Dia. I/ Dist. to well ad Z SOIL ABSORPTION SYSTEM lj ,1 y . 1 '7 BED /TRENCH Width Length It No Of Tren es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS L p 1 Z Q �� SETBACK SYSTEM TO / P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION + CHAMBER OR Type / C�f,`�ystem: 2,` - / / pv Z 7 I j � v Model Number: DISTRIBUTION SYSTEM Header /Manifold 0 Distribution x Hole Size ++ x Hole Spacing Ver�hto IIntaly J Length 1 ' S / Dia � t5 Length Z Dia Z Spacing Z S �/ 3Z S Y `� ! SOIL CO x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sod ed xx Mulched Bed/Trench Center / 1 13ed/Trench Edges \ Topsoil Yes ❑ No _)S;:�es 0 No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / 07 p Inspection #2: / / Location: 1173 County Road M River Fa1I WI 54022 (NW 1/4 SE 1/4 33 T288N R18W) metes & bounds Lot G A Parcel No: 33.28.18.526A 1.) Alt BM Description= �GOfb �^'" ���- ✓ t , (�ptJ�L 2.) Bldg sewer length= 19,1+-Z_ 6 Ce J ?- P � 0 "� - amount of cover = / 2 , w iCC�k Use other side for additional informatio _ -__�� Plan revision Required? SBD -6710 (R.3/97) Date Insepctor's ignatu Cart. No. Safety and Buildings Division County p / N201 W. Washington Ave., P.O. Box 7162 pisconsin Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -315I 0 /, Sanitary Permit Application to Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal information you r do may be used for secondary purposes Privacy Law, sl5.04(I)(m) il ojcct Address (if different than mailing address) I. Application Information - Please Print All Information �QiYytk Property Owner's Name c y _ �) Parccl # Lot # Block J e-S k Sclo v - /0s7 - (oo —off Property Owner's Mailing Address APR Z ?007 Property Location / 1 ) - 75 4 J '/., L ' /., Section 33 City, State Zip Code P A (t!£ �S �g c irc e �yo cl) II. Type of Building (check all that apply) T N; R �� E oN ' �<l or 2 Family Dwelling - Number of Bedrooms ? Subdivision Name CSM Number Cl Public/Commercial - Describe Use ❑ State Owned - Describe Use ❑City_ ❑Village gTownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System ,X Replacement System ❑ Trcatmcnt/Holding Tank Replacement Only E) Other Modification to Existing System B• ❑ Permit Renewal 1K Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 3 7vz41 IV. Type of POWTS System: Check all that appl ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil Y Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wctland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Linc ❑ Gravcl -less Pipe ❑ O er (explain) V. Dispersal/Treatment Area Information: eT , Design Flow (gpd) Design Soil Application Ratc(gpdso Dispersal Area Required (sf) Dispersal Area Proposed (so System Elevation S L( / -/ 5�. --L I Pyl�ql - Z � /,0/, 7</ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New I Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit !/r�� IV I KS Dosing Chamber V11. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum 's Name (Print) Plumb 's Signature MP/ N umber Business Phone Number Plum 's Address (Street, City, State, Zip Code) / r VIII. unty /De artment Use Onl Sanitary Permit Fec includes Groundwater Dat Issued I mg Ag ) ent ignatur o tamps) pproved ❑Disapproved Surcharge Fee y� El Owner Given Reason for Denial (p D(/ C IX. Conditions of Approval/Reasons for DisapproyAt L Q SYSTEM OWNER: 3 (�_ 1 Septic tank, effluent filter and V 6�� CS��� dispersal cell must all be serviced / maintained cs, as per management plan provided by plumber. ��/7 e6 - 2. All setback requirements must be maintains as per applicable code /ordinances. Attach complete plans (to the on for the s stem o paper not less than gig x I IjAches in s'u SBD -6398 (R. 01/03) A,/ Loll JAI `. � 14pP 5 o c o 20 135 rlAl C C 13 13o Th7M 2 —� 53 A pe S�Di.v( � /oo. Ldp F ell /00 S Z w � c � � o zs ��� �•� I I I 5 a-os Q..._at�. � ,,,,, ,,,,,L a rx,, WC NS s. —s -- Az P PP• x�� S , }i� a4,�y v f, •� f4'� 11 { ��y �4. Y � 7 j�. tw ��T y�' h`1Chry�. {t , " t J , Q Safety and Buildings 4003 N KINNEY COULEE RD ,t commerce .Wi.gov LA CROSSE WI 54601 -1831 ic TDD #: (608) 264 -8777 ��O �' www.commerce.wi.gov /sb/ www.wisconsin.gov epartment of Commerce Jim Doyle, Governor Mary P. Burke, Secretary September 12, 2006 CUST ID No. 226524 ATTN. POWTS Inspector ROGER L TIMM ZONING OFFICE . TIMM EXCAVATING ST CROIX COUNTY SPIA 3128 20TH AVE 1101 CARMICHAEL RD WILSON WI 54027 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 09/12/2008 Transaction ID No. 1318135 SITE: Site ID No. 158038 Joseph Schorr Please refer to both identification numbers, 1173 County Hwy M above, in all comes ondence with the agency, , Town of Kinnickinnic, St Croix County NEIA, SETA, S33, T28N, R18W FOR: Description: Mound / Three Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1095968 Maintenance required; Replacement system; 450 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 101); 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 component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Gondi Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. APF • The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. DEPARTMEN N L • A Sanitary Permit must be obtained from the county where this project is located in accordance with the l requirements of See. 145.135 and 145.19, Wis. Stats. SEE CORR • 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 • Comm 83.22(7) 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. i ROGER L TIMM Page 2 9/12/2006 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 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 J Charles L Bratz POWTS Reviewer II , Integrated Services WSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday charlie.bratz@wisconsin.gov cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Henry F Grote, Certified Soil Testing Joseph Schorn - Mound Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's t specifications. Construction methods must comply with the following Component Manuals: r Mound, SBD - 10691 -P (01/01) Pressure Distribution, SBD- 10706 -P (01 /O1) '/4 E' /4 Sec. 33 T 28 N R 18W Location: NE , S , Town: Kinnickinnic County: St. Croix Date: July 27, 2006 Owner: Joseph Schorn Address: 1173 CTHW M River Falls, WI 54022 Plumber: Roger Timm Signature: — &dw Au,� License: MP )S 226524 Attachments: SBD -10577 - Plan Approval Application SBD -8330 Page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail da � 7: um $ 2 p p curve 8: of COMM � system management ; - M� EPCE QiNGS page 1 of 8 NDEN 't- W r c= y cn 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 3 x 1.5 Bedrooms x 100 al/bedroom/da gallons/day h k g Y g Y draulic load Y Design Calculations In situ designed loading rate 3 gallons /sq. ft. per day Depth to estimated high ground water in. Depth to bedrock `' in. Cross slope at system % Force main length ' ft. of in. \ b '� Manifold/header length 2 ft. of in. Drain -back \ 1z, 4- 1 ° gallons Lateral length @ CA 0' 0 ft. of 1 l4 in. Lateral elevation s 1 o Z,Z - ft. @ bottom of lateral Lateral hole size ���- in. @ ° ° in. ( S ' ft.) Spacing l 1� holes/lateral 3 holes total Lateral volume gallons Total lateral discharge rate 2 °'' - Z- gallons /minute @ ft. head Network pressure compensation losses ° ft. X \ z 4, Elevation difference ft. Friction loss ft. @ gallons /minute �— �V Total dynamic head `a ft. Pump /sioWn gpm 1 .S ft. of head 0 A ��� 4 Manufacturer Model # P Dose volume b. `t gallons Lift/sigon tank o- � gallons Septic tank `` `� T `'`° gallons Effluent filter O Y o_,� F: i O 1 Z - n - 14 (� Measurement pump on and off 4' in. Height alarm from tank bottom in. Reserve capacity 4 , , 4 gallons specs.calcs.res Page Z of g I CL o6p �QP Ito 5 hG+.t f t 1. zo 13 5 q� a SST , 1 -- / �o a � v pe l w 3 d — "o i 5 W P 1- r t I � r Rlds - 0 I3 moM r �P �. 6tt o S! p r4 O F '(T TOP OF Gr4-SIN . /002$ i.K - x.. , IOU goo 0 P V L y j, lT7` Y S . 4t> W k ow. 1 0-o r z.4 c-e•M .ro wv 5p t J', 4t V�_,f ��• � tY WSI /•. 4L (L w s � 0. 3 1, b•. Z 1 o2. 2-4- 4r. \ $`M 1 a,►�., ,. � �, i 4 z 2 5 ,0 1 f i i { v .v.Yai�wNY� W. i Imo" �I 14,4' V i s � ; V 06\40- � � tC O M "0�.�.: Govt o II • i w.ti ;h VEQT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING 25' FROM DOOR, JUIUCTIOQ BOX MA►JHOLE COVER, - � W WINDOW OR FRESH �Z, LAQ�L AIR INTAKE I GRADE COQDUIT -- ��` PROVIDE - _ - AIRTIGHT SEAL I I I 22, C)" I I c ` _ I I I APPROVED JOINTS W/ PIPE ` I II ALARM EXTEUDIUG 3' OWTO SOLID SOIL Ou . �S o" I PUMP -� - -� OFF r _ _. .. BLOCK fo �3 0" i • [qGOULDS PUMPS Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing lubrication and efficient improved performance. construction. following uses: • Effluent systems heat transfer. ■ Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto- superior strength and corrosion Canadian standards Association • Heavy duty sump matic models include resistance. • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "F" or "C ".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Pumps is ISO 9001 Registered. •Solids handling capabili FEATURES cover with integral handle and 9 P ty: float switch attachment points. 3 14" maximum. ■ EPO4 Impeller: Thermoplas- S Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1 1 /2" NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic - stationary, BUNA -N elastomers. • Temperature: 104 °F (40°C) continuous METERS FEET 140OF (60°C) intermittent. • Fasteners: 300 series 10 ...... .......... ...... j.. ... + - stainless steel, g 9 30 ►sGPM — — • dry w thout to 8- + - -- zs j components. - 25 7 Motor: _ • EPO4 Single phase: 0.4 HP, 6 20 115 or 230 V, 60 Hz, 1550 5 _ RPM, built in overload with D 15 — _.._ ----- automatic reset. 4 • EP05 Single phase: 0.5 HP, c _ EPo 115 V, 60 Hz, 1550 RPM, 3 10 built in overload with . EPO4 automatic reset. z • Power cord: 10 foot 5 standard length, 16/3 1 ......... .. .... SJTOW with three prong I grounding plug. Optional g g P g, ona P • 0 00 10 20 i3o 40 50 GPM foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). 0 z 4 6 8 10 12 m3 /h CAPACITY Goulds Pumps ® 2000 Goulds Pumps s3 g ITT Industries Effective February, 2000 B3871 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, Roger Timm, 715- 772 -3214, 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 mound 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 would 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 compaction such as vehicle traffic within 15' down -slope of the adsorption system. 8. Avoid disturbing the 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. 11. 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. An necessary monitoring shall be done in accord with the requirements of Comm 83.54 P Y rY g 9 (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 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Tam ��c,Ccarre Mailing Address It 7 3 /fil Psis KJr Property Address ------ lcy,�e (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location 1 /4, 'Sd� '/4, Sec. 33 , T v& N -R 6F W. Town of Subdivision . Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (r f ,3 (� �- , Volume /q 7/ . Page # 3 �� Spec house ❑ yes jo no Lot lines identifiable )20 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of theee 7year p ira ' e. S,;G'&XTffRE OF APPLICANT DATE / i OWNER CERTIFICATION I (w certify that all st9flem nts on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prope escrib d a ve, v' a of a warranty deed recorded in Register of Deeds Office. NA E OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner moo S6kO Septic Tank Capacity l6 (/ d ga l ❑ NA Permit # Z Septic Tank Manufacturer (��- ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Tg,4 -- /j/3 ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 1 9,e- Q,l 'fi/(� ❑ NA Number of Public Facility Units A Pump Tank Capacity 00 al ❑ NA Estimated flow (average) 3 C) gal /day Pump Tank Manufacturer � J ❑ NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer .—�� L S ❑ NA Soil Application Rate , 3 al /day /W Pump Model (!�7p Q ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit �NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD _ <30 mg /L / ❑ In- Ground (gravity) ❑ In- and (pressurized) Total Suspended Solids (TSS) _ :30 mg /L QYNA ❑ At -Grade ound Z2 W j Fecal Coliform (geometric mean) 51 fu /100ml ❑ Drip -Line ❑ Other: .Sii ' d/e Maximum Effluent Particle Size Y in dia. !ON A Other: ❑ NA Other: NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: —j ❑ ear(s) s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: h(s) (Maximum 3 years) ❑ NA ear s► Clean effluent filter At least once every: ❑ year(s) ❑ NA Inspect pump, pump controls &alarm At least once every: 3 ❑ month(s) ❑ year(s) ❑ NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other. ❑ month(s) At least once every: ❑ year(s) El NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y 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 NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of :_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page 2 oi( y START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of 9intin products or other chemicals P that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(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. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cells) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWT fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacem 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 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. W T aluat t be ' ai . 1 lTi� Vb A16W CafVSTX(1�'1. prrJ Mound and may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALkgR POWTS MAINTAINER Name Q �Z J'y/ Name Phone — — 7 31 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ST. C ( (7U ZOft�ltil Phone Phone —71S— This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.540►, (2) & (3), Wisconsin Administrative Code. Wisconsin Department of Industry, SOIL AND SiTE EVALUATION / 3 tabor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 112 x 11 Inches in size., Plan must County ST Clf'0/ X Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to r-arest road. Parcel I.D. # 07- 0 APPLICANT INFORMATION - Please print all Information Reviewed by Date Personal inlonnation you provide may be used for secondary purposes (Privacy taw, s. 15.04 (1) (m)). Property Owner f'l� G 0 n � Property Location C /� IF056 p �/ `t /� Govt. Lot �� 114 sC 1/4,S ,3.3 T 2.0 ,N,R 19 E (orjo Property Owner's Mailing Address Lot f1 Block# Subd. Name or CSM1f //73 e 7 l�o.� -� /�'I � . city State Zip Code Phone Number Nearest Road �C %il,Gt� �i4��s �!! /� Sy DLZ (� /S )42S �y�`f ❑ cit �. ❑ V1112 e, -T wn Iif6U /�� ❑ New Construction Use: esidential / Number of bedrooms Addition to existing building r — [gKeplacement ❑ Public or commercial - Describe: Code derived dally flow 7 gpd Recommended design loading rate _'f bed, gpde trench, gpd/11 Absorption area required ' S — bed, ft 3 7 � trench, ft Maximum design loading rate _ .-5 ' -5 bed, gpd/fl trench, gpd1ft Recommended infiltration surface elevation(s) - 5-94e- ��"" it (as referred to site plan benchmark) Additional design /site colnlsiderations,C S� nyrGB V!^C�_ ��� �,sE 40 ~ .S Parent material �/►�'4 -K.` -s e Ueh Z 4 � Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pr sure AT -Grade System In Fill Holding Tank U = Unsuitable for system ❑ S U S❑ U ❑ S I 1. ❑ S ❑ S ❑ S SOiL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 0.13 /OY,e 3/i S/G fs 1 W fe ,�•, /eye y/3 4"7',e ew ,7 .•s' . Ground 3 lot' yl�e �'' SSG /�'sti,� . f. ' ej • 2 : • 3 elev. . 1 — ft. �. /p ,S /� CG /7_5.0 AU SSr� Y� Depth to limiting factor Remarks: Boring # Z . $ •� 1 0- 13 ioyR 3/Z SIG �fsdr•�,� as !v Yid Yf3 iL 2, s� �+ iE' C-41 !f . s ' 3 Ground �byW 2_ elev �Qf7 •�ft. , Depth to limiting .s factor ! In. Remarks: CST Name (Please Print) � � �� Signature ��/f Telephone j. /T' ;/�/( �r— =GC's, 7� • 3 N CO CJ U Address Date �+ p CST Number Ulbrlcht & Associates • •�- Z 0 ; Zl 2--. private ewage Consultants 865 O'Neil Rd. Hudson, Wis. 54018 f� i�e3 X57" _ ---_.. 'PF�oPERTY OWNER � , p / ✓ SOIL DESCRIPTION REPORT Page 2 or 3 PARCEL I.0.0 Boring Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 Y /oye 3/� s�� 2fsAf- � w 2 • S • Co / io S/C h �2 S / Ground �• / elev. �t 4 O J / �f17/� Depth to Z / ;N limiting A!V? 6/Z factor /97 In, y / Remarks: Boring # .L .S /L. .2f2 s ,/ nH fA its :x o L .f �f d GZ HO ff� elk c •Z ' • 3 Ground elev. / Depth to limiting S factor in. Remarks: Horizon Depth Dominant Color Monies Texture Structure Consistence Boundary Roots PD/IF In. Murisell ou. Sz. Cont. Color Gr Sz. Sh. Bed , Trench Boring # / 119YA Y3 r YA fa /0 t c Ik xOJ5 G Ground D XiW2- elev. �( .gn. Depth to limiting factor y � In. Re ar �X - STI�� -- Rj1jrJ ,4 s /�P 60 - 9rU4_t _ s v Bbring # Aj Ground elev. ft. Depth to limiting factor i "' Remarks: SBDW -8330 (R. 08/95) I CL (� 6p6p APP 5 � v O C O 1 s Ti vr� 20 135 ple 1 5c,4tE - 3 D _ 6 kn P r as 6q B o TmM F � o- - �e f" SIPA.0� rtap OF G3� �v, / 00, .5,2 W t [ L O Lo i (( I' rkru 5 d3 SS I l ' 30' u S�ST� vl2 - r 1' 9,45 r �� 3 of Wisconsin Department of Industry, AND SITE EVALUATION Page / of 3 Labor and Human Relations Division of Safe and Buildings �• - �i �c ordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less han 1/2 x 11 inthbshrrsize County Plan must Include, but not limited to: vertical and hors c4ntgll refgcgor�e pint (BM), direction and percent slope, scale or dimensions, north a row. and16c"orlbnd d e to Nearest road. Parcel I.D. # �T CRO X COUNTY - r APPLICANT INFORMATION - P1ea *e"0rintt0H*9Al i0ff." Re ' wed by Date Personal information you provide may be used for secoiN ry pyrposes (Privacy 's. (1) (m)). IL Property Owner" L Property Location C /� �SC ph, ! rC i OA Govt. Lot N� 1/4 SC 1 /4,S ,3 3 T �CJ ,N,R l� E (or� Property Owner's V Mailing Address Lot # Block# Subd. Name or CSM# //73 'Cry city Staate Zip Code Phone Number �/ Nearest Road El rC VAI- �i tl��s W/ SyoZZ (�/7 ) •07 ©9 ❑City / ❑ Villa � ff�U /''/ ❑ New Construction Use: esidential / Number of bedrooms Addition to existing building EWeplacement ❑ Public or commercial - Describe: !� Code derived daily flow 7 gpd Recommended design loading rate ( bed, gpde trench, gpd/tt Absorption area required 32 5 * bed, ft 3 7 ,,y trench, ft 2 Maximum design loading rate bed, gpd /ft gpd/11 Recommended infiltration surface elevations) s-A ft (as referred to site plan benchmark) D id Additional design/site considerations .5*- rz 4tze,B V4 - fY • /'0 `' �A Parent material 6' © U ood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pr sure AT -Grade System in Fill Holding Tank U = unsuitable for system El s U as El U ❑ S [�U ❑ S [� E] S U ❑ S `� S OIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench o /3 ioV 31)- SiL fs fe � 2 . :• G Ground 3 IvYe og 17C rAe f/' ew • z ; • 3 e /D S /CQ C2 CG �5. 144 k 1- 0 — �U s Y,e 7Z r Depth to limiting factor l/ Remarks: Boring # � �, �3 t y,� 3�z SQL �fsdr nr �,� ctS � � • 5' ' •G 1,3 a /0 Vie X/3 " S /o Y ? !Y16 e. 2- l A /Ir 7e/ ' cw - • Z ' •3 Ground ele Depth to limiting •s Ze factor l 9—In. Remarks: CST Name (Please Print) nO / n ^� Signature rk � '! Tel • 185, /C •Jc�/� lij �- „� • 3 O Address Date CST Number Uibrlcht & Associates 0 0 s va a Sewage C onSUIt Ant S 665 O'Neil Rd. Hudson, Wis. 54018 r A;1 ����D OR IGNAL PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of 3• ~ PARCEL I.D.M Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Mft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench x 3 0 10YW 31-�— afsfll- w 2f . S . - l io S/ S / •S. •� Ground C S/ L �S�/e /!� �/ C' • 2 : • 3 elev. ,d 77 SY/� `` depth to Z ^ N limiting ioy� �lZ factor //41 Remarks: Boring # NT p L I �S Ground 7. S W�Me elev. �ft. Z !© � Depth to limiting St factor if - i n. l � Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # D .3 1 z— lA 16 d i �� C 01 e, HOJ5 %J Ground c e ' L 2 ' elev. 7• o Depth to limiting factor / 6F—j Remarks: � i�?� Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) i J A ft f ill 1 /A) y M CL 696 /4PP94K. 5 h6t-es v o C o 1, qtr � �5 `Y �x�STI j 9_ g� 9� E,��sTi�v f ) - N S� T • _ �s,4c,� P�, rs r j w i 13 US . 5 E� OF �' i,v To O f= v, 100,52- wE�ct- o U3 G�SiN�r Lt) i t 4 I 'AAA Pf p J - j OE- I NF oRMNP� SS oN ,co N *s p , d3 N o It R PNOON o31%)' e oa F 3o' sT v� goys l ( 85 I aJb ' Z �a ypp' G/ r �- _ 4 o a 4f L Gdwn Tom+ u a " taN Owe In It *ck Cauft r FM "449d "449d � � fi�.� or oo.o yet of Nav 1f4 of SE of 8s on 33.20. �g 1�1t ►sect toL C.T.H. "M" right of ray. Of Deaft an < MM Mh 11, l ow as D -. �j /� 11a[f� /� ► �y � may.. Asa�{jntlle Land Canbsd �W �. jqM. .YrMrw on avid on AMI SS DeGodw 13,1906. by the St. Croix Cw* RepMw of Dee& as Doc. 3 M wA that A*Wanmwt of lard Cant ud dsot Ded'er (tll 1 2, ,. raCOtdAd on DecwrAw 13, 1 M. by the 8L tTt CRS VALLEY 1 I tiE. A SE uC Crak CoufN Repigsr of "Oeeds as Doc. No. 563'2e2. Vd.1213, pegs 734 roO dt l 6i.1�L �arreo � SC � 0 r (� la.rrltle.tl�arl Numbs* ©s G h Thb r not nwmsl..e PIP«to - S . -7(,,Pq f A4 Z, � - 1 Otl►d 1t. t of .c> (SEAL) M. Rods. T � � of otia ` k law am & r Schorr irrevocable dated 12 -98, Tnww (SEAL) ( SEAL) . { . Trud" N WN AtITHETMAT ACKNOWLEDGMENT enticdl of Wendy k Rods outhsd ihis4 dwy ot N�` STATE OF WISCONS r COUNTY P aonry crne bsk m me NO day of C: - -- _. t o above named bmskWA"d Tnik MEMBER STATE BAR OF WISCONSIN be petion(e) who wee. red the inevuff" t and (it not wt advnosdpe the tame. SAXWked by 3 706.00. WI& Stets.) THIS INSTRt1MENT WAS DRAFTED BY TWe or prirt nsrns nty ney Notary Pubk _ Cou. P.O. Box 48 My Commission is permanent (M not state debt , RWw Falls, W 54022 N anwe nr a Of Pff rrNr ` should be typed a 06 0WATM PRCFESSONALS 00~ r oro ou LAC wt .os.e"ms t ,; N T.28N. R.18W. KINNICKINNIC W • E S See Page 30 Me pean &Glenda 69.64 Simonson � W997 Ck-d canmtmr4;rr, mr. s. cl.-d. MN 56301 >, 40 Dan & Jacqu Hansen Farm Inc C xlu 4 38.97 lohnaon = 72.52 _ N 42.5 Lawrence Ir Gloria c x 65 Nelson zB z 3 ° c v `,Z re & Fderick Frederick Arnold & • r ❑ r 193.34 E u v, M Va IF 5 Lenertz & Lawrence Vorwald to m ry Abdul71.8 Marcella ¢ B F Harold Luark � z Hunter Lenertz ro m 40 116.71 152.48 S s ham 196.6 z � _ ; Muz r Frederick gq ta 197.5 Sg 156.35 x Lenertz DNR c Gerald & 1 KI Galen "I Robert & < ° s_, 33 ttoa9 X 659 Robert ,pl q Kathleen Benson Thom�n 20 1 1 &Doris etal Joseph & 120 40 a vale 34 Barbara Mark & Mers Net.. 169.77 1 . Robert Garbe eo 0 73.22 Jt3sephine ° 232.5 eveenke,k b Ickler Laurie 19.88 r� Gx ^ Garbe w U 160 80 Bazdell v Alvin & Holly Lisa Delander 1 &A DI Fam 53 N Ha $ Paul, Van Beek Sollom 118 sd�miu 19.9 Johnson 4Q 117.5 O Sandra, & James 60 50 )df° N Arnold & 115 40.27 y Lubich cA Gordon & Fisk � Kh� m..ak• Alvin Susan M snedtOdler Joanna &Mary 35 "" � Marcella Lueck � 160 �M V1. g cvata. Pi ki ham - a van Beek 8B x Sumner James Jr & uo A Mod x 160 p var E &6 B 9 Mary Pau Kka Av' Elaine Ray z E&GDaniel d DkNM a Marvin 180 45 zoa viola rhonws &L;sa o K rrD Gx 127.36 loves tl^ OIrkM n� Hill J� 13.6 R6G Vnrv+ald C Johnson 'I RMaaun Liddle 01. 8 a C N .4 Fm�Tr 84 & 157 73 lull a zz. 20 TFa I' 3 v aWve1T DP Charles& C Y: >" x sb. 158 JRO e sbbs RkI 15.9 :y 5 Anne Kao 4 Z • 2 ' 160 27 i� m z e � x Stee W &P 20 rrT,W - rsr 63.36 John & Lenertz F derick z 305.7 Wl Liddle Edwin & Carol & LUOOe Marvl & +t„ : s&r 5.5 CkR Phoebe r� Eileen Madsen Farm S. C = Frederick Feyereisen = 3e.n « �" a D 10 Kathryn H 6 &shine Paulson LaMothe ryn •w, .rj D NE Philip & 'a v a 6laR Y Call Nelson Oethan - P &R ; E' CN Kurtz 3g 40 P. 20 100 R rt &Dorothy 113.4 etal L;nehan 1a9�r s i u m F 2 40 1z r' 'w x 2 Harold & ��'�• Phillipps 142.6 40 PB Zm� 3 - P &3.59 John •r Agronomics Geeraltz W1 J oan n e ere ory Morrow 6 unehan Inc DNR Morrow 113.2E & Cr A 117.37 a0 etal Schmidt Dk1 ,- MlckelsOn x z z •N 138 3 37 40 cna Png 173.5 167.82 4 _ Gel 3 122.23 1+ 4 ao 221.06 T4 z.3 J � Iv `� 6738 Coudreault t 1 t aeh z „ Ix 192. s.s V 2 & K C er z av a • Km un $ , � - 40.6t J �°' Ro�arcre`,�n "` 73.BS � 197.68 75.33 u 139 David 4 - a= 3 154 Jeffrey &Nancy F= rr 52.5 Walter ffi David Murlkittrick& Christensen o " Dorothy „ eerata Ts20 � o2 Orlande v ° E Schroeder &Ross CR Quiggle F William & Gerald How s .„ nay o&c ip Ps Screaton w4x e i sa Esther Fuller 190.19 ��"� 39 &Robin KaK Kenaedr 40 oars Peeereun 1T P d -x <[ RkL rn Fam rust y a Norman e 7 r Dr4R 4 Rick zo H 4 naith 40 Donald & Gloria Gerald go a B s r lr & I a LL Gera & & aY Maiden Glenn & V Kin 1 a , d der Mueller o < call as z me ' 20 20 too op w 40 oe.n& y sRl Thom JJ Robin Rick lames , gonna Badje cC b Phyih: rE .z 103.4 Lowe John 6 80 'w �+ John ? v,� Alien 43 N x n Dale& 4.9 Kurt& Tertance " R a ymond 158.7 SO d 1 31.3 Thomas & Fuller 8 250 wn n m9 EKE Gallen" Ra y Bettendorf Olive J a ¢ c Leif & Beverly L E= c °trey „ 4o t m David & Rebecca neR x 140 ° Z 40 140 Juliann Luse Erickson az9s 2 9 Deiahnnena Robert Jr w & Wynona o 1 9p.47 31 0 74.33 M � Howard ell 91.37 40 � a. o Timothy Gordon 80 Keatle o o m x r Cenval 3 Family Hans Trollan Le y Madsen 78 y y ]H Ir & N Daniel & Ann Pc Feeds T,,,,t & Jan a MA o.0 S 20 z sm rrs x g� rB.6 a Ms z «a, u Griffey p � nmpson Krumwiede 160 Tru B,g a3.a9 John & gwr 31.87 a 35 M s M John &y I JH Jr & N Martin 30 Candace N la & Mctaughlin Kimbell a, s v Daniel & &Ibris R. Gary mes 63313 tM Sofum W Perkins v Dominic 168.8 13ettendorf °u° Lee &Sharon Do-. Anderson N 431.5 '" z Thompson Trust Kreac `� & Jeanne 9 Cu s Hill Allen & Linda o o le &S r Had i y Sally lilek Clark 39 Kei th & '� k Ke11Y Florer 40 df <` 40 3 31 1 sm IkD wn I.1 6. Leota Andrea � River Falls .; Nyhagen RR n D&lw' = Aieen � 40 LirWa 1S F Trs x".14 H10 Debora 40 77.87 10 ut �qp c1 26.8 Andrea 70 1 Land Trust 2073 . �E K 5.1 49 & • Sm w a SH5 „ 40 a StCroix 'o 48.9'! r „0�.• 3 cerala s&ccvaa _ ^ County z 4.3 >" ce 15 V ~65 66.36 a e & Punw a �a 314.58 80 •LS1 H Paul& - z E TkK �1 315.5 �J Z chd nP K Suzanne +(t Trust i 910 59z RL 2 (o ?3 Way,re nx. &�"" co c 2QQ Kcamec 60.96 42.79 3 8 .a v Soderbeck G Krueger 40 {V z Da e Vernon rs 3 4 41 x 'tare 37.x' Q c t / tiY1 Rollan 112.8 138.86 Peskar ' 4 s v f` 1 Harry [ 3 Eugene & r ttr'''''111 Vernon & 91.16 & Deborah Kw 7 3 t Judith C Peskar L r11 Fuller Daniel & as vemon & Stanley Arnold Adeline Peskar Hansen k Fm Tr °a ° Betty Swenson 94 Robed &Karen 1 Stanley 114.32 M r 23.2 40 40 M;IIer 0 David Janet Bauer 103 Pes 8 Peskar &Rose r R aM8 Darl 4B o 9.9 Glenn Yr rcm Larson Yunker Judith V. &recd saner Gary & 0 DaL mwt Da N 39 FL & Pe ae♦ C s W �- Hansen � Wacbtler eul Judith Grimm 140 219 R9r t "' N N ao Paul & Sara Larson 37.3 Lottrnan u ; 101.63 59 10 c Janet Cu Gerald 40 u 7 s - P vemon & JJ __ .y avid &Debra 1.87 80 8 F ] &E M o & Carol Paul & e •M " swdey Pes ar ❑ v" 177.85 65 3 E 40 't 3 C OvSak Z 35 Doh y John & o ., Williams Margaret Walker = eE s3 wY „ Re n C3 T Alice Hanson .. 7.9 Vernon & 30.93 x w 5 Stewart Grace j a to 213.82 n Lucille Kelly o TAT 13. ; = Nelson y 132.56 steinmeu 130 m a P too 40 Lentz G 39m Todd & B 256.3 Tucci 39 Patric a o Y RIVER x z.3 KM t0 ^ Robert v Theodore P&L Norman& Dean Bergseng 199.99 Room o G �" )Kenneth & Darlene v Grace Nelson 120 40 FALLS Karen Miller h 40 1400 1500 & ca of G &Rut Lee Nichol on will;ams 102.4 RF GoI(Club xl2 1300 M 000 57.3 3 g 1100 Pierce County 9()D 1 as • • Furniture •Appliances, •Accessories •Sleep Shop RNISHINGS RNISHINGS Carpet • Linoleum • Ceramic • Hardwood Floors • Custom Design Work • Professional Installation Where You Will Find Name Brand Merchandise At Mill- Direct Prices! r`The Friendly Place" F 155 State Rd 35N •River FaIIs,WI (715) MSat 9 - 530 URNISHINGS 425 -2782 Your One Stop Home Host Cleaner... Yes, we have Host Dry Carpet Cleaner in stock. &AIINX nPcoratine Specialist , a k , _ HOLDING TANK SERVICING CONTRACT Contract Date Ix ' 0 2 This contract is made between the Holding Tank Owner(s) Name(s) and Pumper's Name C ✓� x ) ( 0 id n We acknovAedge the installation of (a) holding tank(s) on the following property: (Provide legal descriptions:) s _je . - - o -------------------------------------------- 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Comm 83.52(1)(c)1. Wis. Adm. Code and the approved Holding Tank Component Manual. This agreement will also be filed with the St. Croix County Zoning Department. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit that has signed the pumping agreement and to the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volume in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with local governmental unit and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed and swom to me on this date: 5 a5 Ch ol �Q Today's Date � Pumper's Name (Print) Pumper's Signature Pu t5tgnnat (jON Oct r/ 04 n1 Psro <7o 2odq Pumper's Registration Number UF Vii; I `j mission Expiration 7 7F r - O O n p 6 y3 O O. b4 O N 00 Qr O O v '0 N N y i N O Q O N CM N N 3 C C C C N i� M T > N p d d a L N d m aa))Ua gy m( 3 y 2.2 M 0) a p O y (? ° �o c° 0 —2 'O N m c m w i _ � m � U m ! a) C_ C N .2 _ E » - @ o - 2 ?, c2umN �� a3 0 C C C 7 0 C >` ° C m CD m O N C 0 c E — ti N C N 7 L U m N m N L L O (a 0= U mE Y cnN r O C E� L N O N O C O O O a) U c C +' U _ C T W ' w U m O N 5 m - p O c N () V O y ° N O O O C V C N a) - C C z a) Lo C > m -0 C 0 N m L o z yow:°. v z 1 o o o �U 3 N 7 L O O m C �a O) m U O m y LL C O O U O LL O w C L C C N ?� c n� E E-2LO y cL.5 0 3 �°, ° a a y= a vi co N o E Q 0 E Q CL v U U m M m M CL CL 7 N u; y O C C 2 v £ o E o � m U z d d d m C cn M H z a m ° U -° 0) N m C N N N O z Zt E d Z N c C V1 F r a) a) C O_ m N C m N m w = _ �O Q L N CL ca d a 0 •� ° (D o >a L L_ m C C O O O In 0 «. © 2 z z 2 z z N N _ � _ E 7 N m £ N m E L 7 L a7 O1 't 0 N 01 0 ; `O C m ` O Ln C • = m - O o G a E E G G a E E H H E LL O O O ~ w O O O a l- • m m a m .. g o u� 2 o V) J U o ° o ° ° o ° m Z N z m N .- N C O C O O !]] O m U N Q C7) U N O 2$ _� Q z i'� 'p O Q z ., O Cl) m M O C C n H O W C H ^ N H y O L N C p L o F I a _ O CO N U m _ N U O U U O O C C O m L Yr C N C N m y�i O Y co O In C O U U C ° N ° c 8 c 2 `� � E t M � I C c L N CO C U m O U (D 0 N N O O to N o m Y Cl) Ln o z Ln d z (1) M o z N Y z v � E m E a� `i..i E d c c a c c d c r� L `�.t A 0 a O 0 0 2 % k k k � U ' z x E z c §ƒ 3 / 8 ; W ¥' CD @ ° ; Q - CD i } j i\ c 9 ; 0 \ al / / ;: oe 0 E E \ CD . @ z > j f o § 0 E _ $$; \ z § CL n r ■ o § rr 1 < M o o '- § % § k § IT S CO) CO) ■ @ : 2 E do §. f� \ 0 �..�§. } z z = > > o � FL a(D CD CL X72° =r Cn 0 \ \ « -4 c CD § / /� \ § — ■ T co /§ E§ z =� ; ®� ] f o , q CD CD f k >eFra \ k % 0) cr § � m�k\ /()( c BEos§] ƒ A 0 EL CL ( A o CD co o C E / ƒo§$ RaE — Er a 0CD @ eo §&' ® m� Q, =r CD ! � /(ƒ /E n CL = 0 § /kR k � k% E ■ 0 m I \ e o § § i � � � ST CROIX UNTY PLANNING & ZONING October 4, 2006 Mr. Joseph Schorn 1173 County Rd. M River Falls, WI 54022 Code Administra 715 - 386 -4680 RE: Notice of St. Croix County Ordinance Violation — Sanitary Ordinance Location: NW '/ SE % Section 33 T28N R18W Land Information & ' Computer #: 022 - 1097 -60 -000 Parcel #: 33.28.18.526A Planning p 715 - 386 -4674 Dear Mr. Schorn: Real Prope 715 -3 677 Enclosed please find one (1) $250.00 citation for violating Section 12.1 F.1.a and 12.1 FAA & e of the St. Croix County Code of Ordinances. You are hereby notified R J-386-467 5 *g to appear in the St. Croix County Courthouse, Hudson, Wisconsin on October 11, 2006 at 10:15 a.m ., or make a cash deposit with the County Clerk of Court by the same date. Please read the citation form carefully on how to proceed. Citations may continue to be issued for every day this violation continues to exist. If you have any questions, please contact me at 715 - 386 -4680. Sincerel , Pamela W. Quinn Zoning Specialist t Cc: Don Gillen, Assistant Corporation Counsel (St. Croix County) w /Enclosure Town of Kinnickinnic w /Enclosure Enclosure (1) .s , ST. CRO /X COUNTY GOVERNMENT CENTER 110 1 CARM/CHAEL ROAD, HUDSON, W/ 54016 715386 FAX PJOCO. SAINT- CROIX. WI. US W W W. C O. SA I NT-C ROIX. W I. U S Citation Form St. Croix County Planning & Zoning Department STATE OF WISCONSIN CIRCUIT COURT ST. CROIX COUNTY. The undersigned, a duly authorized official for and on behalf of St. Croix County, states upon information and belief that the alleged violator did, on May 10, 2006 violate the St. Croix County Zoning Ordinance, Chapter 12 Sanitary, Section 12.1 F. 1.a, FAA & FA.e. The issuance of citations is authorized under St. Croix County Code of Ordinances, Chapter 1 and 12.8.6.1. Description of violation: The property owner is allowing a failed Private On -site Wastewater Treatment System ( POWTS) to discharge domestic wastewater to the surface of the ground. The POWTS has not been brought into compliance with Comm 83.51(2). This violation was first documented on August 20, 1998. First Name: Joseph Last Name: Schorn Mailing Address: 1173 County Rd. M, River Falls, WI 54022 Property Address: 1173 County Rd. M, River Falls, WI 54022 Town: Kinnickinnic Computer #: 022 - 1097 -60 -000 Parcel #: 33.28.18.526A Cash deposit require $ .00 Officer's signature Title Zoning_ Specialist Date: October 4. 2006 You are hereby notified to appear in the St. Croix County Courthouse, 1101 Carmichael Rd. Hudson, Wisconsin on October 10, 2006 at 10:15 a.m., or make a cash deposit with the County Clerk of Court by a same a e. /0 ,/ / 6 If you do not make a cash deposit or do not appear in court at the time above specified, an action may be commenced against you to collect the forfeiture and costs. If you choose to make a cash deposit, you must sign below and return this citation with payment of the cash deposit. If, after making a cash deposit, you fail to appear at the time above specified, you may be deemed to have entered a plea of no contest and forfeit the cash deposit. I, the undersigned and above named alleged violator, have read the above citation and agree to make the cash deposit for the alleged violation as set by St. Croix County Citation Ordinance Chapter 1(V). Alleged violator Date Original copy is sent to the St. Croix County Clerk of Courts cc: Alleged Violator Corporation Counsel "s N OT (' b E VIOL ?1 1 �. s M TO: JOSEPH SCHORN DATE: June 8, 2006 LOCATION: NW' /4 SE' /4 Sec. 33, Town of Kinnickinnic PARCEL #: 33.28.18.526A SECTION(S) VIOLATED: 12.1F.1.a. — Sanitary Ordinance } -DE (�I;tI* (dN#dF VIOILA�TIOt�: d� ^fir The septic system on your property is failing. Section 12.1F.1.a. states: 12.1 INTRODUCTION F. GENERAL PROVISIONS 1. COMPLIANCE a. All domestic wastewater shall enter a POWTS unless otherwise exempted by the State or this Ordinance. /�, �p �i� (20 �II'20 t S I l I/1 I� Yyj/y( (a �.Z � "�� `" l }4/YC U ✓u�t�'/ ' ✓� Y� 3. 51 OwWvt re, sP6nSbl.� . k(( � ��� ViS�ca < <y t�s zuery 3yc�rs J °tQ R OLV8TH ISMATT1E YOU - MUST DO THEE FOL�LO�1 " Have the septic system replaced no later than August 31, 2006 FINEST &FORFEITURE$ ' y Noncompliance with this order will result in the assessment of fines not less than $100.00 and not more than $500.00 per day everyday the violation exists. If you have questions, please contact Jennifer Emmerich at the St. Croix County fanning & Zoning Department at 715 - 386 -4680. t June 8, 2006 Mr. Joe Schorn 1173 County Road M River Falls, WI 54022 RE: Alleged Zoning Violation Parcel # 33.28.18.526A Computer # 022 - 1097 -60 -000 Dear Mr. Schorn: Enclosed, please find a Notice of Violation regarding your property on County Road M in the Town of Kinnickinnic. If you have any questions, please contact me at 715- 386 -4680. Sincerely, - "A6 Jennifer Emmerich Zoning Specialist cc: Deputy Zoning Administrator, Town of Kinnickinnic Enclosure r - Code Enforcement Trackiniz Sheet Origination Date: 05/10/2006 Violation #: Owner Name: Joseph Schorn Project Name: Septic Failure Property Address: 1173 County Road M Mailing River Falls, WI 54022 Address: Municipality: Kinnickinnic, Town of Computer #: 022 - 1097 -60 -000 Parcel #: 33.28.18.526A Zoned: Ag- residential Overlay: Unknown Codes section in 12.1 F.1.a. 12.1 F4.e. question: Ordinance Subject: Sanitary Code (Waste Disposal) - Ch. 15 HISTORY OF CORRESPONDENCE: Letter of Inquiry Notifica ' n Final Notification Citation Letter /Corporation Counsel Citation Issued: Forwarded to Corporation Counsel: Compliance Date: Staff Signature: Findings of Resolution: b O2 Cd 0�'� � .4 1 G� (�-, 2Lo 2- - v� I W -V —,ZV – 'Owner: Schorn, Joseph Computer #: 022 - 1097 -60 -000 Address: Parcel #: 33.28.18.526A Unknown Municipality: Kinnickinnic, Town of Address: 1173 County Road M River Falls, WI 54022 0511012006 1 Jenn Emmerich I received a complaint that the property owner has a failed septic system. 05130/2006 Schorn, Joseph Jenn Emmerich I called and left a message for Joe to contact me re: his septic failure. 0610112006 Schorn, Joseph Jenn Emmerich I called Joe back and told him that the program I was thinking of has to come from the plumber. I told him to tell his plumber about it and he can call me back if he has questions. He is still coming tomorrow to discuss WI fund. 0610112006 Schorn, Joseph Jenn Emmerich Joe called me back. I asked him about the failed system and he said that he knew about it. He said that he has been trying to find the money for the system. I told him he has to replace the system by the end of August. He is going to contact Roger Timm (who normally does his septic work) and ask him about installing the new system. He also asked about funding and I told him about the Infiltrator Systems, Inc financing. He will be stopping in tomorrow morning to get the information. I will also give him info about WI fund. 0610212006 Schorn, Joseph Not determined Joe stopped in and Jessie gave him W I Fund info. i I Parcel #: 022 - 1097 -60 -000 09/29/2006 11:21 AM PAGE 1 OF 1 Alt. Parcel #: 33.28.18.526A 022 - TOWN OF KINNICKINNIC 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 JOSEPH A SCHORN O - SCHORN, JOSEPH A 1173 E CTY RD M RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1173 E CTY RD M SC 4893 RIVER FALLS � SP 0100 CHIP VALLEY VOTECH`" Legal Description: Acres: 5.000 Plat: N/A -NOT AVAILABLE SEC 33 T28N R18W 5A N435.5' OF E 500' OF Block/Condo Bldg: NW SE EZ -UT- 1503/378 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 33- 28N -18W Notes: Parcel History: Date Doc # Vol /Page Type 11/17/1999 613962 1471/363 TD 07/23/1997 1166/251 LC 07/23/1997 764/42 'f' (/'YN* L U 2006 SUMMARY Bill M Fair Market Value: Assessed with: U " ` 0 Y?/V Valuations Last Changed: 08/11/200 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 60,000 146,100 206,100 NO Totals for 2006: General Property 5.000 60,000 146,100 206,100 Woodland 0.000 0 0 Totals for 2005: General Property 5.000 60,000 146,100 206,100 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch #: 132 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 6.00 o p 3 -0 n tv �1 O c v a y m �1 `(D 3 � Z CD N Z O a) n W to O < N O w S N fD 7 W N t0 O O m ' o M .. g o v N O � V R N N a � CD p 3 N J O D O !� cn Z D O N CD a O f I O N �V I N 3 O O C) �1 y O CO) ( w o m C m T � CA w Ch v , , m � D _C o N 0 q M N N (O ' ID N O" a I M D D o O O CL N m C I m 3 CD -1 V1 � A z o I Z N W a A w z O ( cn ao m � I v a w v I m au; m - 0 D 3 y a m w 1 o � ~ S' a v c (D G I 'D o cn N N N 0 O fD cl a =r = N < m y m � QC A 17 O �D C D ° :gym r'z m — a 0 m m a t NaDm N N N a I myo.p O fD CD V bi O 0 'O O V O i cD O p 0 CD dp Cfl O ti O C) C ° o a �, i Parcel #: 022 - 1097 -60 -000 02/07/2006 11:21 AM PAGE 1 OF 1 Alt. Parcel M 33.28.18.526A 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Ma # Sales Area Application # Permit # Permit P App Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner JOSEPH A SCHORN O - SCHORN, JOSEPH A 1173ECTYRDM RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 1173 E CTY RD M SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 5.000 Plat: N/A -NOT AVAILABLE SEC 33 T28N R18W 5A N435.5' OF E 500' OF Block/Condo Bldg: NW SE EZ -UT- 1503/378 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 33- 28N -18W Notes: Parcel History: Date Doc # Vol /Page Type 11/17/1999 613962 1471/363 TD 07/23/1997 1166/251 LC 07/23/1997 764/42 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 144018 203,800 Valuations: Last Changed: 08/11/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 60,000 146,100 206,100 NO Totals for 2005: General Property 5.000 60,000 146,100 206,100 Woodland 0.000 0 0 Totals for 2004: General Property 5.000 30,000 103,600 133,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 132 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I i i � r 0 � "•.,,,'"""..° Xupmy pun Xumuv)d .GuuvJYgveJn'IS Wiscons�m Depattment of Commerce Cyf. Croix Safety and Buildings Division PRIVATE SEWAGE SYSTEM Coun INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanit�%3"tNo.: Personal information you provice may be used for secondary purposes [Privacy Law 2.15.04 (1)(m)). Permit Holder's Name: ❑ City ❑ Village Q own f: State Plan ID No.: chorn, Joseph Kmmc Townshi CST BM Elev.: Insp. BM Elev.: BM Description: ParcebT "7 -60 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air i to ntake ROAD Dt Inlet Air Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand St cover Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia_ H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufa SETBACK INFORMATION Type O CHAMBER mod Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 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 1___ No COMMENTS: (Include code discrepancies, r o r s Location: 1173 Highway M, River Falls S SE 1/4 33 T28N R18W) - 332818526 1.) Alt BM Description= / � �' Ll 2.) Bldg sewer length= - amount of cover 3.) contour= _ Plan revision required? ❑ Yes ❑ No Use other side for additional information. F1 I IJ SBD -6710 (R.3/97) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH ` SANITARY PERMIT NUMBER: 3 3 . . g i € C e 1 � . ftt w a 3 g t ? [ 1 I � wm � s t M m ,e.e. s ....« t k 2 ,. 1.e..— .e..... ..J,., - �...d..,....,._ w� .. �.m.....c. .-.... .F »r...,. ... ..�..a.� ... ..... .......a._ .Q _�.,.«�.e......,,- .,...,.. ..._..,. ......m.ds- �.....m.L... .....,w...„, -.--,5 Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue isconsin P o Box 7302 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, Wt 53707 -7302 • Attach complete plans (to the county copy only) for the sy 114ot(1 County than 8 tie x 11 inches in size. • See reverse side for instructions for completing this ap On R tats Sanitary Permit Numbe _r 3(0 3 915 Personal information you provide may be used for seconda purposes , -� Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. /�1 v �� t State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT .- NFO N = _200'9$ Propert wner Name i cation SC 4 ,," ? 33 T 2,B r N, R/J? Xjor)Q Property Owne s Mailing Address Block N er // - 7 1$f G --- City, SPtEL Zip Code Phone Number u Islon Names CSM Nu qq II. PE F B IL ING: (check one) ❑ State Owned ❑ it� Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms _ ° jir Town of .Ctz 1�c[ Ill BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) /1,9 /n, 5 ^�A 1 ❑ Apartment/ Condo Q'ZZ -- 19 7— GO O a �( 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. N Replacement 3. ❑ Replacement of 4 ❑ Reconnection of 5 ❑_ Repair of an ______System ________System Tank Only______________ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 []Seepage Bed 21 Mound ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Groun7Pr / �-� 42 ❑ Pit Privy 13 ❑ Seepage Pit � / r-- 43 ❑ Vault Privy 14 ❑ System -In -Fill 2 ` VI. ABSORPTIONS EM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 1 7. Final Grade j Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation '7' 1 ? 38 % Zv Z- 141, Feet .1 Z • 60 eet Capacit VII TANK in Ca g llo 5 Total # of Prefab. Site Fiber- plastic Exper. INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete st acted Steel glass App. Tanks Tanks Septic Tank or Holding Tank zwo I /m / &--i lak e ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 1jcon 1 1 6 1 / w y Cr ❑ ❑ 1 ❑ ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb 'U : (Print) Plum is Signature: ( b Stamps) MP /MPR Business Phone Number: 3 7/ - -7 7 Z - 5 Plum ber'sf d�r_ess (fit 0 t, City, StatQ, 7,ip Code); � / �/� 7 �� G � D X � �'7 f5 t ( 7 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved W itary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signa re (No Stamps) [ Approved ❑ Owner Given Initial Surcharge Fee) L Adverse Determination �a 5 � � X. �CO APPRO j 5+�4L6rt�ta_/ S P A n N � SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative.Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 -266 -3151. To be complete and accurate this sanitary permit application must include:. I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII_ Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mainstwater service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. I Safety and Buildings - 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 �Fsconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary June 14, 2000 CUST ID No.226375 ATTN: POWTS INSPECTOR ZONING OFFICE ROBERT W ULBRICHT ST CROIX COUNTY SPIA 655 ONEIL RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 0611412002 Identification Numbers Transaction ID No. 320088 Site ID No. 158038 SITE• Please refer to both identification numbers, Site ID: 158038, JOSEPH SCHORN ST CROIX County, Town L "above, in all correspondence with the agen of KINNICKINNIC; 1173 HWY M, RIVER FALLS 54022 NE1/4, SE1/4, S33, T28N, R18W Facility: JOSEPH SCHORN RES MOUND 1173 HWY M, RIVER FALLS 54022 FOR: REPLACEMENT MOUND, 450 GPD - REVISION Object Type: POWT System Regulated Object ID No.: 418384 ➢ This approval is for a revision to previously approved Transaction :136861. The changes approved are: the septic tank and pump tank shall be relocated on the eastern side of the dwelling instead of the northern side (see plan); the tanks shall be shallower than originally proposed; the vertical difference between `pump off' and the distribution pipe shall be 9' not 13.5' resulting in a total dynamic head of 13.7' rather than 19.1'. F The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes CnplditlOY and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in 0 chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. A IP I KIT�oof C The following conditions shall be met during construction or installation and prior to occupancy or use: D1 1. This plan action is subject to designer comments on the plan. SEE CORRESF ➢ The approved changes will become an addendum to the plans previously approved. All other portions of the installation shall conform to the original approval. CAUTION: Wis.stats 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary permit approval if submitted to the issuing agency on or after July 1, 2000. Note: There is a otn ential for a law suit that may delay the effective date of the code so this status may or may not change. 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. ORIGINAL • ROBERT W ULBRICHT Page 2 6/14/00 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 05/31/2000 FEE REQUIRED $ 60.00 C FEE RECEIVED $ 60.00 TRICIA L SHANDORF , PO TS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE. WI.US WiSMART code: 7633 cc: JOSEPH SCHORN uLBRIC ,& ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineerhig Systems 715- 386 -8185 ReceiV FD Private Sewage Consultants f f 0A-) TO MAY 3 - 0 1000 PROJECT INDEX SgFf7Y 484DG DILHR Plan I.D. Date Owner J OS"1? -5 wN Phone 7/J!. 4�u - D yo Address x/ 73 Cry/. �� • �� '( /Pi� �l`s / S: .S yKp 2_ Legal Description P11U 022-- / - 6 , O -- �O /f S' -- - - - -- —_ N — S,-�, • §-�. 3 3 72-8A- Town of f� %NNf• • C County 5 7 e:� C.S.T. RoQ7— ZoG�d�� 2�fg Installer Local Authority/ Supervision PROJECT DESCRIPTION 2 s/%sr j l�;� l of �� � ley G %y ��7iGt� pNDE NCE 1�; 2- 130 T Se�ffov /f/A ,SST - e � `� A av�p sYs�: ,o,�s'�� Covs��ev�nv �� t� PROPOSED REVISION (5 -24 -2000) Pg.l PLOT PLAN VIEWS - - New Wieser Precast Septic tank Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS (1000gals. ) and new pump chamber shall exit Pg.3 PIPE LATERAL LAYOUT shallow, through wall of basement on east side Pg.4 DOSING CHAMBER CROSS SECTION of house. Deep floor drain bldg sewer shall be Pg•5 PUMP PERFORMANCE SPECS abandoned, and rerouted inside house. This,design for installation is based entirely on measu landscape conditions cements, elevations The accuracy di his s ( slopes etc.) and soil suitability ' " " " VI Pecs, as reported, shall remain the . - 4 7 F, r....... j of the CSTM. _ OBERT UL ICHT Any use of this POWTS design ty any licensed plumber, or any 01160 related unlicensed parties or persons (excavaters, laborers) HUDSON,WI shall not be construed as an assumption of responsibility by �• the designer for the workmanship, construction, placement, ,� � » ,,, » � t �• 4, substitution or selection of any components not specified, or any assumptions by the plumber that any unspecified components '','���q�i /ipr���mn�M ►� are state approved or proper, or the effects of poor judgement if working unaer adverse damaging weather conditions (wet /frozen - soils) by any such parties or persons. CL '4PP �o x 5 /tG,.2 f' o c o 1 13 s�sT, l ' v o 5c ,4tE b / "= 3O d = ST /NS fipl.? S . y ?q P u°' ' . �o o -' 13o ir Top OF (55hv. /00.52 w t c t- o l I 1 pup o p1P� Qi P L i �� O NE TANK OPERLY BE ABAND FOR ILHR 83.03(2)• �o Sct" CK Sg v �` cd ° /- - - - - -- - - - -- - --i 3o' i zs th1 B�Ba Z� il, below the 101111011118101 b SOiI lkli llo ON mud Imil W , - -- -- ----- - - - - -— - -- - - -_ -- - - - - -- - - - -- - ___ _ .. - - -- SO(7� pp p, G j,U� P5 z of 5 C S of JAI OVk)D W i T H B eD Qeo -0 F % ro Al3ec 'DISTRi(3uT�o� Gr 1"Nt ck c 9 pi I/J G- of T�pSOiL sysrEM e IEvh r ioo U " i F R IA T OE N /G /. 7✓r W'Aj E . - PIowto To p 501 _f r (" us.) M - Z- To stoPE FoRcE Et� vAT�o�.t �u�R MAW ,r r E (.(0 Fr. IN VERT O F 2 I ATE R/4 / 6Z - F • FT• . To P of Rock / -.6 G /• a F- • It I H • TOP O F 2— FT. IATERAIS /�� I — PLA W VIEW OF Mou-oD - Wi rte 13E D t= N� F opu z MA A " Fr• Fr K iz Fr I• a _.� i L. /D� F T' o ' , ! // F T k 6�• w r_ � � D a. N o Fr _j BE of To I y" PER PLUMBING PRODUCT APPROVAL TPvc �Apped A 9 FI Are_ ,CODES, ALL ABOVE - GROUND PVC o (3Se rt Vhr� o,� PIPING (FROM TANKS & SYSTEM AREAS) P r p e s MUST BE SCH.40 PVC MEETING ASTM D1785 OR D2665 STANDARDS. PERMhNP-uT MhRKERS R EC2 uiReD BASAL, RReA 'D Ait. whSrE'Fl �f 3g sc i L ra� IrtRnT r - C APhctry G� sa. Fr, PRoposEd BASA4 AReA = B s a� - T, ME40 Series �® 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 U) 30 !L 8 "Z 25 Z 20 6 J Q 15 _ d -- 0 4 0 F- 10 5 2 0 0 0 10 20 30 40 50 60 70 60 90 100 CAPACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. ME40 SERIES 4/10 HP Effluent and Drain Water Pumps POWER & FLOAT CORDS PLUG DIMENSIONS Quick - connect, watertight Replaces switch assembly fittings are interchange- for manual operation. 1 able, replaceable from IW NPr pump exterior. *� ' Discharge Discharge M CHMNICAL FLOAT r �� Mercury -tree. 90 angle operation. I �' ° • 5.66 (144.) - - - -� 11.68 - - --- - - (296.5mm) - - '1 r i ..ON.. MOTOR HOUSING Cast iron for efficient; heat transfer. : �• OVERLOAD SWITCH Built -in to protect against overload conditions. 4/10 HP MOTOR _ ` '* S 1600 rpm, 60 Hz, 115 or N v r 230V, single phase. Oil - cooled and lubricated. ROTARY SHAFT SEAL Carbon, ceramic faces. - -. -- - - -- .-- t' .. ___ A _ . __ -- l\ I T - - PERFORMANCE CURVE --- - - - -�— -- CAPACITY LITERS PER MINUTE 1 O 50 100 ISO 200 250 300 350 r. 40 ._ 12 VOLUTE/l11dPELLER SEAL 3s RING 10 Maintains high efficiency 30 and reduces recirculation, e replaceable. 25 M ENCLOSED TWO VANE 20 6 Q IMPSL Y High efficiency, passes HIGH EFFICIENCY ADS 's 4 '/" spherical solids, with VOLUTE I0 stainless steel wear ring. Corrosion resistant. Passes THRUST spherical solids. I W 5 ' 2 THRUST WASHER, SLEEVE W NPT discharge. Enhance smooth operation � 0 10 20 30 40 50 60 70 80 90 100 � and extend pump li CAPACITY GALLONS PER MINUTE K3319 5i92 ® 1101 Mye s Parkway Company Printed in U.S.A. Ashland, Ohio 44805 -1923 419/289 -1144 FAX: 419/289- 6658,TLX: 98 -7443 I ' P5 z Of S C ROSS SE T IOAJ o ICI '" w rti f3eD Oto -bF ro ViSTRiBuTio 1 1- " A 13e C G TIC; ck►s F s Pi P I G- � � O T °P sort SysT e I EvA r io o U FORM To E uf 11 N 1 /G1 - 75 u i 3 F I — ---- L ' SAup Plowmc> Top So i -Z °10 SIoPE FORCE' u►J� FaRM j M h C S I WAT+oa U oER F F_LEvArlo►J S -- E INVERT OF 2 1A F •85 F T• Top o F Rock 102,60 G. /-0 FT. H ��� F T TOP O F 2- IATERA IS /0 ,2 PLA VI EW of MOUK)D ~ wi rtH BE D LNJ7 rvRcE MAW 1 f3 0 Fr j< /z Fr I• a .� L ,_------- _______ -__ -- o w ' ---- - - - - -- --- -- - - -j 1 // FT W r_ � � F r I Bev OF AD.. To I a " PER PLUMBING PRODUCT APPROVAL PVC L 0t3SeftVAr1oa A 99RE5ATe- XODES, ALL ABOVE- GROUND PVC PIPING (FROM TANKS & SYSTEM AREAS) MUST BE SCHAO PVC MEETING ASTM 01785 OR 02665 STANDARDS. PERMAA1E,3T MARKERS REG2UiReD BASAL. AReA tvhSrFFloto C f 39 y _ Solt- t o I nQAT10 E C APAC t 5 4. Fr, PRop©SEd BA SA4 AQeN = B s a�, r-T �E►u� RAt_ MNOI F t_p D oN P I P E N erwoR k TO V oLU v F L ATE R A C.- ��� /2 s �157R1r3uTI��J LA - TERAI. ENv SAP l T I sr A X h� �-' M LAST Hn s HA II BE " E1-T - To t- CAP Vo i D Vv 1 uM t F'o R / 1 /0 F 9AIs. �uvERr >✓IEV�1r�o� dr- 2- FoRcE MAW 2.3 /02.2-5 PERFoRArED PIPE DETAi L U _ -- `` (3 OT roM 5H A11 Be I Y VARiA(SLE y E (RONI y 5PAC�D. bi s r�NcE P 76 H OE Di AMt= Te R 1 4 10. L A T - E R A I- 2, MAw FvLo -- �N . X IJUCH� S n 'Z FoRct=_ MAIk) _ tN. Y 11UG(.E s or 14VIES , 2.0 P � P�� DISTRi t3uy1'IVk) D�gc�1AS�vE RATE PER L A T ER AL_. � G'AI _rOI - A t. `D15CkAR6E nATE / t�EtwoRk Z3• J GA P �-� s PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS P IE `f OF 5 -VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING MANHOLE COVER ?-5' FROM DOOR, JUNCTION BOX tu /4VyfIA) /A)`' IA13EI WIUDOW OR FRESH 12 °MILI. AIR INTAKE / RADE ' �E ��) � O Al n/ � I I aiLll IIJ. „J� `1 S- °O ' CO I ` -- IWMIN. q WDU T �- 3,0 ��,, ---- - - - - -- fIEU.�r� nti � INLET PROVIDE I - - - -- 1�_. —�- - -- AIRTIGHT SEAL I III f APPROVED JOINT A I N5 I �.1 I III APPROVED P JOINTS w/C.T. PIPE 1 I" M I I I EXTENDING 3' '00, I II ALARM EXTENDING 3' OIJTO SOLID SOIL ^' , \ I I I ONTO SOLID SOIL l y 3�'' 3 I I ON o� 3,z5 c ' I I- LI- V. FT. PUMP -�. OFF 'L/SE ,j OrQ p �, y / CF �(AN k lgtnv/� I Srhvp BLOCK RISER EXIT PERMITTED OIJL9 IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIOUS DOSE � TANKS MA NUFACTURER: "'� j� /' elM � � IJUMBER OF DOSES: -- PER DAH - /sa TANK SIZE : �C/�� ` GALLONS DOSE VOLUME ee �'w INCLUDING BAGKFLOW: igs GALLONS ALARM MANUFACTURER: /ey� /l140 MODEL HUMBER: 1)' V' L CAPACITIES: A= INCFIES OR 3V GALLO SWITCH TYPE: - ��d4/ B = Z INCHES OR 5- GALLONS PUMP MANUFACTURER: / " / /�' ` S �D C= 7 / INCHES OR / � V � � � GALLONS E MODEL NUMBER: /7 D =INCHES OR iG3 �//�,� ,{/ L GALLONS SWITCH TYPE: L ? /.�/�CJI'7 /r 7- NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE _�% GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 9 .0 FEET - rAok S'P U C S -I-- M NETWORK SUPPLY PRESSURE . . . , , . . 2 . 5 FEET EAGIn. I FEET OF FORCE MAIN X �F FACTOR.. � AA � 2 FEET TOTAL DyIJAMIC. HEAD = ✓J FEET Q IMTERNAL DIMEIJSIONS OF TANK: LENGTH / ;WIDTH - "� ;LIQUID DEPTH 3 Al (J... PER PLUMBING PRODUCT APPROVAL ;CODES, ALL ABOVE - GROUND PVC PIPING (FROM TANKS & SYSTEM AREAS) ALL NON - CONFORMING I ' MUST BE SCH.40 PVC MEETING ASTM TREATMENT TANKS SHALL D1785 OR D2665 STANDARDS, BE ABANDONED PROPERLY FOR ILHR 83.03(2).