Loading...
HomeMy WebLinkAbout030-2143-19-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 499235 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: k St. Joseph, Town of 030 - 2143 -19 -000 CST BM Elev: Insp. BM Elev: B : Section/Town /Range /Map No: /b V1/L 1 05.29.19.2088 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER •' , CAPACITY STATION BS HI FS ELEV. Septic 3 Z �� Benchmark SZ 10 . $ /an G•'t - 1 d v .�z,� GoBMd�'G�;o ti 1 5 wc-L 'f' • 5 3 , SS Aeration Bldg. Sewer 5 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht outlet 16 Z7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ GJetd Septic 5 //) g , 7 3 g / _ Dt Bottom \ \ Dosing /V/d Header /Man. > 5 7, Aeration Dist. Pipe SIT 160. Holding Bot. System Final Grade 5 PUMP /SIPHON INFORMATION 3(A I Manufacturer De nand St Cove G '7-( 11+05 le / b � I y Model Number r, T Lift Friction Loss ISvste ad TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Tren PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 I / ad I �o H —_ SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: _ INFORMATION CHAMBER Type Of System: G / / l AA— OR G / Model Number: AA— DISTRIBUTION SYSTEM Header/Manifold it IlDistribution x Hole S' e x Hole Spacing Vent to Air take 1- Pipe(s) \1 \ Z. - i Length __ f' * aw Dia Length Dia \ Spacing fo SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over / Depth Over xx Depth f xx Seeded /Sodded xx Mulched Bed/Trench Center 2 L Bed /Trench Edges Topsoil Yes No Yes ;I No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 441 Bluebird Drive Unknown (NE 1/4 NW 1/4 5 T29N R1 9W) Bluebird Bluffs Lot 19 Parcel No: 05.29.19.2088 CO Ja S G'bc. 5 1.) Alt BM Description v- = � �— 2.) Bldg sewer length= 3� - amount of cover = Plan revision Required? Yes No 1 1 1 0 Use other side for additional information. _ - - -- - - "' -- Date Insepc is Sign re Cert. No. SBD -6710 (R.3/97) Safety and Buildings Divislo unty �—}� ` 201 W. Washington A x 7162 J( t 1 Madison, WI 53707 — 71 Number be filled in (to by Co-) 4 itary Permit Department of Commerce (608) 266 -3151 2 3 s' O Sanitary Permit App ca CEIVED /State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal nformation you provide different may be used for secondary purposes Privacy La , sl5.04(IX m ) J ect Address ( if than ma ili n g ad s) 1 2nnG I. Application Information - Please Print All Info ati a� 7 Property O s Name Parcel # Lot # Block #N A— K iel, o 3o � a1 - 0 -C)0 Property wnees Mailing Address Property Location 3 �' /. XV- /., Section 5;_ , City, State I Zip Code Phone Number J�� � 7 A• R 4.q5 IL Type of Building (check all that apply) S tM t - (/lrl or 2 Family Dwelling - Number of Bedrooms e. ❑ Subdivision Name CSM Number �} Public/Commercial - Describe Use 11 State ed-Describe ❑Cit _ ❑Villa g e )Q Townshi p of � _ e III. Type of Permit: (Check only one box on ' e A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System 1 B. [I permit Renewal C1 Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that a Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in, of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ravel-less Pipe ❑ Other (explain) V. Dis ersaUTreatmcut Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (st) Dispersal Area Prop (st) Systems Elevation ©V t 0 -0 QQ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing n � Tanks Tanks ` D Septic or Holding Tank 1 \. Aerobic Treatment Unit { 4 Dosing Chamber c VII. Responsibility Statement - I, the undersigned, assume responsibility for i of the POWTS shown on the attached plans. PI tier's Name Prm Plu s Sign umber Business Phone Number d Plumber's Ad ress (Street, City, State, Zip Code) I "\ & 9 I V `e-W t t S 0 r' Coun /De artment Use On � Sanitary Permit Fee Welud Groundwater Date issued 1 ui Agent Sign o Stamps) A roved ❑ D' ro Surcharge Fee) ved PP ❑ O en Reason for vial IX. Conditions o p val 3 j C. SYSTEM OWNER: , � w IZ 1 Septic tank, effluent filter and � dispersal cell must all be serviced /maintained 1 ° ' FA ' as per management plan provided by plumber QA" O.V\ 2. All setback requirements must be maintained tt��2,� as per applicable code /ordinances. V Attach complete plow (to the County only) for the system on paper not than 81/2 x 11 inches is size CLV 4 � SBD -6398 (R. 01/03) l 5� • s r Safety and Buildings: Division County n t Nvisconsin 201 W. Washington Ave., P.O. Box 7162 i Madison, WI 53707 — 7162 Sanitary Permit Number (to be fill6d in by Co.) Department of Commerce (608).266 -3151 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used.for secondary purposes Privacy Law, sl5.04(1)(m) Project Address (if different than mailing address) L Application Information — Please Print All Information (f,C / n t, SQ Parcel I # Lot # Block # Property Owner's Name ( nn 19 �S no fJ i b-3 o I 3 C. Property Owner's Mailing Address Property Location Q ty 1�9 , RECEIVED �,,, Nw .,, section _ City, State Zip Code Phone Number I (circle,ante� N; 1t,�E or W KP lublictCommercial II L Type of Building (check all that apply) ubdivision Name CSM Number or 2 Family Dwelling - Number of Bedrooms - Describe Use t t Q .� (�,,.� � ❑ State Owned - Destribe ❑City_ ❑Village Township of�� f III. Type of Permft: (Check only one box on lind A. Complete line B if applicable) A. XNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 3 6 y q q a as IV. Type of POWTS System: Check all that a pply) 9 ' Non — Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ ❑ Constructed Wetland Pressurized In -Ground ❑ Holdin g Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line TG- vei -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation p , oZ 1 300 0 1 3 ©c c 1 4k/, - 8' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New T Existing Tanks I Tanks HoWing Tank 1( [X5 O ' , ,P$ f S Aerobic Treatment Unit f l Dosing Chamber VII. Responsibility Statement- I, the undersigned, qw&W responsibility for inst f the POWTS shown on the attached plans. PI mber's Name (Priptl Plumber's Sign re RS N tuber Business Phone Number Plumber's Address (Street, City, State, Zip ) VIII. CountyMepartment Use Onl ❑ Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) El Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval Attach complete plum (to the County only) for the system on paper not ha than 81/2 :11 inches in size SBD -6398 (R. 01/03) a P/ c27 �- S Lvac n 0 F l /� N w yq S S Tdl 4 u R19 LO �t 3� 9 •e-[ h. o Qu ti . nrn ti ssr ag sr . ti s ► c too 0 pal (o k S7 �Y t �[� Qn toy - Q�V,ocns Q Bn\ TO n. -\ U-�r Q14 F_ 1 loo` Q At `fo (�i) it i to�, it I � �! � �� flaws Fed /wO✓�... ' •dG, a y 99.2 � Ti r '?(l Z COPY ;P /o1� h 1. �. / /-a7 -6 �- �/�m �s 1� e ✓� �Aa vr, m e r °�- S �l�e vie ,� d p Al E l Iq /u w yq S s ? �l u P/9 ct,-; I 9,34 9 �el h. o Qu e N . `�° 'Ou eA s[tx�s � �9dd Col -/, ) c�a`a.� M N sst ag sr - k ,< - "I - C 0o I Y iaso �Qs� k of foks-� y rk f v b o � ' /P EpC� SeeV OIAS �6 S "-c4o' DorA It -01*7 _p 1� R r'\ `top o-T,- en ® E t loo` A A-Vt 10 , 9 �f S 16 6' C Y r O p t �r+1uS kcj �A) F /� N ( -'..; _. /t! r, 19 UJ IV 9 I �C7 S aws s s py 46 .7- / 1 o C� w 1 err s [ti e n�, vh nr +2 r cr Q- f' , V A ( c` � r ;�q )u R 19 AT o� � �i /vim T 064 / 1-4.JLA ss- f: 46 Job d" a � � 1 i 5 /0 �o Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 81 /2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. pending percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information, 1 ! > 46w ed b Date N1 ? Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). �, V 3� Property Owner Ri F- C F- I V F. F, Property Location ❑ El s :� Brushy Mound Partners Govt. Lot NE 1/4 NW 1/4 S 5 T 29 N R 19 E (or) W Property Owner's Mailing Address ; � 2 Lot # Block # Subd. Name or CSM# 1505 Hwy 5 19 - Bluebird Bluffs 1st Addition Cit Smote Zip ?ho( ►??lost tiY Village _own Nearest Road New Richmond WI 5401 U P� i � • 42nd Street I St- Joseph I ( ZON)NG OFFICE Q New Construction Used Residential / Number of bedrooms 3 to 4 code derived design flow rate 450 to 600 GPD Reptacement [] Public or commercial - Describe: Parent material Loess over outwash and glacial tiff levation ti appligbte ft. n�tcomments This site is sulfa r a conventional below grade system, recommen that a pressurized system with equal and recommendations- ' distribution used so as to distribute the effluent over the entire avai a e e to the massive(Om) sl. This is of a, code requirem=but a suggestion I FT] Boring # 0 Bo �— �.� p and surface elev. •� to limiting facdor �� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP /f in. Munsell flu. Sz. Cont. Color Or. Sz. Sh. 'Eft#1 'Eff#3 1 0-8 10yr3 /3 - sil 2igbk mfr as 2f .6 .8 2 8 -28 l 4/4 = sil 2msblc I Infir cw if .6 .8 3 28 -90 7,5yr4/4 fsl 0M mfi - _ .2 15 E 2 Boring # Boring >96 Q pit Ground surface elev. I O (v . b5 ft. Depth to limiting factor In. — - --- - -- ___.__ Boil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -7 10yr3 /3 is Osg mfr as 2f .7 1.6 2 7-42 7.5 4/4 fls Osg ml ew _ 7 1.6 3 42 -96 7.5yr4/4 fsl Om mi - _ .2 .5 ' Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = B D < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature ��_ CST Number Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, Wl 6/5/04 715- 246 -2454 Property Owner Brushy Mound Partners Parcel ID # Pending Page 2 of 3 Boring F Boring # pit Ground - surface elev. I OS• yO ft. Depth to limiting factor '90 in. — Soil Appilcation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/11? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 1 0 -13 10yr4/3 - 1s Osg ml as 2f .7 1.6 2 13 -90 7,5W4/4 - is Osg ml - - .7 1.6 F-1 Boring # Boring Pit Ground surface elev. ft. Depth to hmiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure' Consistence Boundary Roots GPOW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EM2 Boring # Boring u Pit Ground surface elev. ft. Depth to limiting fiac�or in. Sal ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 ' Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = B013 : 5 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. M- 8330'red (R.07M) Bluebird Bluffs 1st Addition lot 19 L 0 t 98' Q1 100' 102' 104' BM I Op ' 140' 8% 106' 50' slope 2 O . t 1,-,- ' -► A Z BM2 2 Oe Scale 1" = 30' BM 1 Top of conduit 100.00' BM 2 Top of conduit 106.90' B1 99.70' 132106.65' B3 105.40' SW lot corner Thomas Nelson 227387 AC f - rill, K� „gym Let '4" Cl VENT PIPE 12" MIN. ABOVE GRADE E WEATHER O 25' FROM.DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR I-NTAKE, WITH CONDUIT HANHOLLOCK ER WARNING LABEL 4 MIN. 14LET �• � `� WATER TIGHT SEALS GAS- -`�' TIGHTi 4 11 A SEAL APPROVED JOINTS W/ CI �I PIPE B ONM PIPE 3' ONTO 3' ONTO SOLID SOIL SOLID C SOIL PUMP OFF ELEV. 18 FT. +- --- r' OfF ft's RISER EXIT PERMITTED ONL� D IF.TANK . MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE L TANK MANUFACTURER: (,V` s (dj NUMBER 'DOSES PER DAY: TANK SIZES SEPTIC oc� GAL. DOSE VOLUME INCLUDING y � . DOSE — sec) O_ GAL. FLOWBACK: y GAL. ALARM MANUFACTURER: CAPACITIES: A = /`�� INCHES = ��• 7 GAL. MODEL NUMBER: t)t c ' B = 2 INCHES = _ AL. SWITCH TYPE: 1.,�1 PUMP MANUFACTURER : C = _Z INCHES =y GAL MODEL NUMBER: SWITCH TYPE: D = CIJr INCHES = 5, SAL REQUIRED DISCHARGE RATE - -=-f�- GPM PUMP B ALARM WIRING AS PER ILHR 16. 23 WA( VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 0�6 FEET + MINIMUM NETWORK SUPPLY PRESSURE . C0-J"wN `� FEET + Op FEET FORCEMAIN X .3..3 FT/ 10 0 FT . FRICTION FACTOR . w • FEET TATAL DYNAMIC HEAD FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER LIQUID DEPTH -3 •A' ke A lLyh &\�Af' Ql- [Q GOULDS PUMPS Submers /So r Effluent Pump M OD EL .. WE Seri PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS ■ Shaft: Corrosion - resistant, Single phase (60 Hz): can be operated continuously Specifically designed for the stainless steel. Threaded • Capacitor start motors for without damage when fully following uses: design. lodmut on all models maximum starting torque. submerged. • Homes to guard against component • Built-in overload with O Bearings: Upper and • Farms damage on accidental reverse automatic reset. lower heavy duty ball bearing • Trailer courts rotation. • STTOW or STOW severe duty construction. • Motels ■ Fasteners: 300 series oil and water resistant � �, Severe • Schools stainless steel. power cords. duty • Hospitals •'/� —1 HP models have rated, oil and water resistant • Ind P ■ Capable of running dry NEMA three prong Epoxy seal on motor end • I s ems mahout damage to grounding plugs. Provides secondary moisture components. • 1'A HP and larger units have barrier in case of outer jacket ■ Designed for continuous bare lead cord ends. damage and to prevent oil SPECIFICATIONS operation when fully wicking. Standard cord is 20% Three phase (60 Hz): Pump submerged. *Class 10 overload protection Optional lengths are available. • Solids handling capabilities: MOTORS must be provided in ■ O-ring: Assures positive 3 /0 maximum. sealing against contaminants ■ Wl subm separately ordered starter -` �, • Discharge size: 2" NPT. ly erged in unit and oil leakage. • Capacities: up to 140 GPM. high -grade turbine oil for . STOW power cords all have AGENCY LISTINGS • Total heads: up to 128 feet lubrication and efficient heat bare lead cord ends. TDH, transfer. rested m uc 7 and •Temperature: ■ Class B insulation on ■ for C C�� csa zz.s 108 stagy Operation: Pump ratings are By Canaaw standards 1041(4VO continuous A -1 h HP models. Association 140°F (60 intermittent. ■ Class F insulation on 2 HP min the motor manufacture rs s Re #may • See order numbers on models. recommended .working limits, is W 9001 reverse side for specific HP, voltage, phase and RPM's M AS FEET available. 130 L— SERIES: WE 120 — _ I SIZE: 3 /0 SOLIDS FEATURES 35 110— _ . ' _ RPM: 3500 & ■ impeller. Cast Iron, semi- 3 0- 100 scM : r open, non -dog with pump - 90 i stT I ► I out vanes for mechanical 25 _ seal protection. Balanced for smooth operation. Silicon 20 70 i bronze impeller available as 60 an option. 1s so ■ Casing: Cast iron volute 40 type for maximum efficiency. 10 30 r NPT discharge. zo ■ Mechanical Seal: SILICON 5 10 CARBIDE VS. SILICON s CARBIDE sealing faces. ° 0 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM Stainless Steel metal parts t � t t i t t � t t t � t � i �--` BUNA N elastomers. 0 s 10 1s zo 25 30 35 nroft CAPAW Goulds Pum ®2°°a I TT Deem WaW b w. 2 200o v bgy, lux Effective <& ITT Industries Decemer, 00 vww garids.com 83885 0►Y�QS . -e A Aft m wi lefIN 203H fit, �; �� ��LLs , s - faud4 vvvsvov �.�, :�. � •: L. ' Y • �� •:.•': '•.• voveovv ovvvvvs ' " ": h�• • eevevovv ego ; � �..''s. lee vsa 1^�� WTV VVq ove �,! oeV T 24 ►' vve oov ove vvv 4.625" vvv voe 1/2 Circ. = 18.84" vvo vvA oev vve vvv vvv vov vv VVV1WW v •v ovvoiv ♦avveve a vvvvvvvveovv evoevvv veovavv vvvvwvvvvvvvvv vvesovo OOOV OVO ev0 vevvvevevvv evaveae A Bottom 3611 - 12 -1/2" DIA. (typ.) Vold Volume S Interface Area (n. 12 �Lt Void Coefficient in Aggregate given at 57.4%. Sidewall (2 Sidewalk) 2 e 18.84in = 3.14 O.D. of 4" pipe - 4.625 inches 12m lR Void volume per linear ft. = 3.14. 2.3125in l . tft - 0.117 ft' Bohm 2.00 " 12in / ft j O.D. of centercylinder = T2.5 inches Total Soil Interface Area 5.14 SQ.FT _ 2 Void volume in aggregate of center cylinder - 3.14 • rr 6.25in 3.14 ` � • .574 -.422 ft' `l2in/ft) C 2.3125in 12in /ft ) O.D. of outside cylinders- 12 inches Projected Trench Area Void volume in outside cylinders - 2.3•laf bin 574 ft' Sidewall Height = 12 in. •2 = 2.00 Sq.Ft. ` it2inI fl Bottom - 36 in. a 3.00 Sq.Ft. • . � Void volume at bottom between cylinders - f r 24in 6in l - (3.14 bin ) l 0.215 fP Projected Trench Area = I2in / ft 12in / ft l l t tin I ft J, - 1 5.00 Sq.Ft. Void volume at outside bottom corners (1/2 of void volume between cylinders) 0.215 / 2 -0.108 ft' Total void volume - 0.117 + 0.422 + 0.901 + 0.215 + 0.108 = 1.763 cubic ft/ ft Gallons per ft = 1.763 X 7.48 = 13 gallons Per linear ft tI � EPS Aggregate Trench System ED 203H EZflow Ring , -Industrial Group 65 Industrial Park Rd. Oakland, W 38060 SCALE FILE MMF g120M -vs1 SHEET: 1 of 1 11 -27 -01 { � POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pace 4- of FILE AVSTNA owner. -r-` Pennit # S Septic Tank Capacity al 13 NA Septic Tank Mautufactura�' � C, DiF.Si�ll PAAgMET Effluent Filter Manufactuuw D NA of Bedrooms ° 0 NA. EfHueitt, titer Modei O NA N of Public Facility Units Pump Tank Copacf V � O NA Estimated flow (average) a Pump Tank Manufacturer LA-) " -eS f0 � NA Design flow (peak). (Estimated x 1.5) p Pump Ma<nufactaW O NA s Sod Application Rata a � Pump Modal - NA Standard anfluentmffluent Ouaiity Monthly av�ge• went Unit NA Fats, Oil & Grease tFOGJ :930 mg/L 0 Sand/Gravel Fitter O Peat Filter Biochemical oxygen Demand i[30t} 5220 mg/l. O NA O Mechanical Aeration O Wetatd Told Suspended some (TSS) :Sl40 mg/L O Disinfection O Other: Pretreated Effluent Quality Monthly average Dispersal.094W 0 NA &ochemicai Oxygen wand (8006) f.W nWL k (gravity) p In- Canard (Pressurized) Total Suspended Solkla OWI 530 mg/L 0 NA At -Grade O Mound Fecal Colform (geometric mean) - 510' efuJ100rmt O Drip -tine D Other: Maximum Effluent Particle Size Y in dia. O NA odor: U NA Other. O NA Other. O NA "Values typical for domestic wastewater and septic Murk effk*nt_ Other O NA MAMt�MANDE MMM SeMr:e: Eraent , Send -inspect condition of tanks) At least once every: ts1 n 3 Yoags) 0 NA .PWV out contents of tank(s) When combined sludge and scum equals one4hird IV of tank volume ❑ NA Inspect dispersal cell(s) At least ;once every. 13 momthts} saute) (Nmdrnrmn 3 VON 1 O NA Clean effluent fil ter 13 At least once every I rrwrrd R yeads ) O NA Irnspeat Pump, pump controls & almm At < t st once every: ! month (si ❑ NA Flush laterals and pressure test At least once every: O mmnthis) Other Ci year(s) ' O .At feast once o mt� ► r Odor CI NA MARSTE 1lANCE iNSTRUCTONS inspections of tanks and dispersal cans shall be made by an #nd)vWUW carrying one of the following koenses or moons: Mash Plumber._ Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank must include a visual inspection of the tank is) to,idenWy any missing or broken hardware, identify any cracks or leaks, measure the volume of combined siurdge and scum and to check for any back up or ponding of effluent an the The dispersal cellist shall be visually m dte�k the effluent levels in the-observation pipes and to check for any pianding of effluent on the ground surface. The ponding of effkrant*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 scun..in any tank equals one-third (Y) or more" of the tank volume, the entire contents of the tank shall be removed by Wisconsin Administrative Code. a e Servicing Operator and disposed of . accordance w#tfn . NR 113, AN other services. including but not limited to the swvichV of effluent filers, mechanical or prized components, pretreatment units. and any servicing at intervals of 512 months, shag be perfoffned by a certified POWTS Maintainer. A service raepm t Neat) be provided to the kmW regulamry authority within 10 days of completion of any service event. START UP AND CATION For new + rCth prior a to that the use of the POWTS deck meatment tank(s) for the Preaenc� of treatment pr xmn NWVor damage the d• Paemtittg Products o►:other Via(& Of the tank(s) removed by a oAeramr Aries ro eras, ceN(s). !t high u rattans arc detected have the contents System start up shah not occur when sop conditions are. frozen at the nfUtrad" surface. During power autages Pump tanks may fill above normal deecharged to the dispersal COMB) -in are targe•dose, ��' 1Mt>!sm power is restored the exr.ess.wastewatsr win be sfftt�nt. To avoid this situation have the conwft of tank removed may result S the s ing or.surfece discharge of power to the effluent pup or contact a Pkxnber pOw/� pAaintainer to asst m manually O Prior to restoring restore normal levels within the p� tank, g the Pump controls - to Do not drive or park vehicles over tanks and dispersal cells. Do not drive or within 15 feet down slope of any -grade . � am. mound or at park over, °f ° disturb or compact. the area Reduction or elimination of the fbHowbmg from the wastewater stream may improve the Performarce and Prolong the life of the POWTS: anobiatics; baby wipes: cigarette baps; condom; cotton swabs; degm8ms: dental floss: diapers; disinfectants; fart. IbUndatwn drain {SUMP Pump) water fruit and vegetable 'P t,' lie;, Whose; hwbWW. meal scraps, tsmedicatiorw oil: P : Pesticides: sanitary napkIns,-:tompons. and water so .brine. ABANDONMENT Whorl the POWTS faits and/or is Porn onently tarn out of service the foNowhW steps shah be taken to irreure that the system is umd safely abandomW in compliance with dWOW Comm 83.33, W Administrative Code: • AN Piling to tanks and Pits Shall be disconnected and the abandoned pipe °pings sealed. • The contents of all tanks and pits shall be reMOVSd and Properly disposed of by a SWtoge Servicamg Off • After Pumping, all tanks and Pits shall .be excavated and removed or their covers removed and the void MR. space filled with li, gravel or another inert solid materiel. CONTMNGENCY PLAN N the POWTS falls and cannot be repaired the following measures have bean, or must be taken..to provide a code compliant replacement systern: /10 A sultois ropkeeement area has been evaluated and may be utilized for the location of a rePlas�rterat Boil absorption syateM. The r*lamament eras slwndd be Protected from disbubarmos and of ahMN M Wr uporn• by requked from ad 'W P�Sed stn cdme, lot lines and wells. t=apurs to protect Ilm Aphooment area will result in the need for anew wW and alto -ev orn •to eatebNsim sisultoble-replocanum area. 01M. Re mart systems must comply with the roles a emlfae t at that me. ❑ A suitable replacement area is not evailabis due to setback and/or soli mutations. Baring advances in POWTS technology a holding tank may be InStaRed as a last resort to replace the failed POWTS. ❑ The site has not been evd uoftd. to ideAMy a sudabb r+a}ulaCam ant area. Upon failure of the POWTS a soil and site evaluation must be PwfGnNW to locate a suitable roplooemnent Wee. if no replacement area is available a holding tank rill be iced as a last mmHaOrt -to rye the failed POWTS ❑ Mound and at -grade sN abWptien systems May be "Marauuatad in P reermov� of the bio<nat at the nfiltrative surface. Reconatre�orms of such systems must comply with the rules in effect at that time. < <WA;[Mllllp> > S64= PUMP•AND OTHER TREATMENT TAWS MAY CONTAIN LETHAL 8'ANOJOR i1118UFFl�11T OX1f66N. DO NOT A 80 PWNP OR OTHER TIEAUgW TANK UUM ANY �lMST g. DEATH MAY RESULT. JE OF A P8WN FROM THE .INTVRIOR OF A TANK MAY BE D T OR &WWSMLE. ADDIIIICINAL COMMEM WIN LLER PEfW= E _ C9 W t r S Name: Phone �S S Phone BABE t1PMATOR VUMPM LgC1LL TORY AUTHOiBi'1F Namrne E ( ne his doctQrment was drafted in coaWftr oe v.*b dupW Comm 8&22i2}�lit }tdl&(ti arxt83.54it1,' (21 a (3n. 1Mecotm1rm Administ VIM Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT . AND OWNERSHIP CERTIFICATION FORM OwnerBuyer -- 7"QMAS 1�1.4MM Si- I~+41�Ot�1 t�r�l1� Mailing Address [ L 9 - 4 4 W a A Q 1 Lav Property Address �W tc F vb, rLts oti& �= (Verification required from Planning & Zoning Department for new construction.) City /State - %b W i Parcel Identification Number 03y --11 `e q — a a a LEGAL DESCRIPTION Property Location i /4 % a , Sec. , T Z 'l N R tl W, Town of �os Subdivision L_rS-F . N60 tV <.10 , Lot # . Certified Survey Map # , Volume , Page # Warranty Deed # �3 b�j -L , Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 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 stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of b drooms /� SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) rya J00 Q067 ST CROIX ^ CO REG OF DEEDS Q002/002 ` ]K ATHLEEN A. WALSH REGISTER OF DEEDS ST, CROIX CO., bI THfS DEED made between Brushy Mound Partners, LLP, a RECEIVED FOR RECORD Wi scOflSin Limited Liability Partnership ('Grantor) and T homas P. let/11/2m 08e50A)i Kendhammer and Sharon L Bolger as tonants in -common. WARRANTY DEED WITNESSETH, that the sold Grantor, for valuable consideration MPT # conveys to Grantee the follovAng described reel estate in St Crvix County, State of Wisconsin: REC FEE: 11.00 TRANS FEE: 327.00 COPY FEE: Lo Plat of #W111)[dp1u ifs Firs Addition in the Township of 5t. Re*wding CC FEE: Name and ph, ft Croix County, Wisconsin The First National. Bank of Hudson 307 2nd Street PO Box 187 Hudson, WI 54016 030-2143.19 -000 (Pete" rdenllfkauon Number) This ILM homestead property. Grantor. Brushy Mound partners, LLP. a Wlsconsin Limited Liability Partnership, is an affiliate of Derrick homes, LLC. a Wisconsin Limited Liability Corporation. Grantor develops iarid and Derrick Homes, LLC is a home construcdOn contractor. Grantor agrees to sea this lot to Grantee an the corutit)on that Derrick Homes, LLC wilt be the builder of the home for Grantee. if Grantee does not commerica construction with Derrick I bores. LLC 8s the opntractorlbuilder w+hlt two (2) years of Bte date of sale of trite lot 10 Grantee, Grantee gives Grantor the Irrevocable right to re- purchase the Iot for the Same price as Grantee paid Grantor for it when Grantee bought it from Grantor. ff Grantee desires to sea the lot to another purchaser before constructing a fame upon this lot, Grantee gives Grantor the right of first refusal to wpurCh ftte lot for the same price it from Grantor. as Grantee paid Grantor for it when Grantee bought Dated this Qifi day of jjqp�Z 2GQ0. ttel AUTHENTICATION ACKNOWLEDGMENT Slgnelure(s) STATE OF WISCONSIN ST, CROIX COUNTY PersormIlycam m e before e rife P& day of Qp , 20Z me atalt+entigted this day 0f , 20 above named Michael R. Stevens and Ronald L Oarrfdk. YFIOmk- of Brushy enders, LLP, a Wisconsin Mrsons slstewro who eYecrx lPe Ins a and acts+ w the bw or t netne same TME: MF"8ER STATE BAR OF WISCONSIN signature 19 MA AM (if n04 J. AUf1.EDQE authorized by' 706,06, M. Stals.) type or print name pig; soft Wboolum IV Notary Public St Croix County, Wisconaln. TH IS INSTRUMENT WAS GRAFTED ey My COmmission E*hCS: AO 27.2tT08 Brushy Mound P artners? 'mares or person signing A any eapeaty ahoutd be typed or PO Box 445 Prf w ocrow their slFwPoes, New Richmond, WI 54017 Michael R. Stevens _ _ _ . .� /. - ., •, V `l l 14Y.ly JUJ YU JU c 334.14' I to 12' V AUTY SL�A / - y I r� -� o EAIENT _ C 6B' 9 - :f� (TYPICAL) V)I _ e �s• c� 57.52- C4 ' U- 390.65' - - . :� - _ C S, , _ N _ `�` CO -- � sp y' '� �- . � 00 1 `1� N N. 00 s- LOT L7 391.93' �- � I • Clp ? ` � s• z _ 1,330 sq. ft. r-: C i 122.so 13 - -- �., �•� - 3.01 acres m N J I �I m �T - m / Qy' �0 _ • �j SS 3s. - L.B.Q. =924.6 W _ J S m ..... .... f ,k �f.. _ 2• �,ss 3 F� �' - w 3¢ •8j• M i w S �1n a 9• 6 i� Q9 N89 7 E p 3 M.rIfL93Q1' 'L '` - 59.75' p M 04 o SOB /E o CO �\ 0 Z r `' 6 1 .08, 61 O co L�1L. N8977'07 1 F 96.12' rn C�''�S89'S6 "17 "W co LOT 20 0 59.75' ca 133,191 sq ft. 3 LOT 1E9 J. - I - 06 acres 1 L. B. 0.=932.1' 130,692 sq. ft. 3.00 acres L. B.0.= 9.32.1' o� 282.92' z 7 "E 563.70' �� h LOT 18 a 01 130, 707 sq. ft. M J I 3.00 acres LOT 22 Q 132, 539 sq. ft. N 3.04 acres 966.4 569.19 - 1103.29'- 110.43' 423.67' S89'1 7'07"W 1118.24' South Ane of the NE -114 of the NW -114 LOT 4 LOT 5' C.S.M. IN VOL, 11 - ---- onr`r-7 zlnQ