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Home My WebLink About030-2101-30-000 0 0 tv , � E ; ■ � � � 0 cn \ \/ �\� / \§� O e - e k q m a P, ■ 2\2 ( 3 2$e R , g � 8 c : 4 § k § °® co ha k § o = E c 2: ° m z # / % A % E e � CO i v \ \ $ B \ � CD @ / % . / f § \ J § E r \ 0.ac _ / 0 } 7{ 3)§ k N J 0 R / ° c� £g� C \ 0. 2 co � { � § \ o / n % / / o§ �- . � , CD / \ Cl) CL } } \ _§ ; CO) � - - c ■ _ . \ C L g 0 C § 2 § J z § e ; Cl) 2 U) 2 � -P, +r2k /i�E/ ESE_ § §m2@G c }a =§ a 2&2\ CL J 2fCA ? dam% @g0 ¥ to) !CL G $E% X27 f \3c �vf cz ) CD 0 » G t $ / § a � % N VIsconsin Safety and Buildings Division County 201 W. Washin r26 6i:1 PO. Box 716 5 Madison 5 i►' E S itary Per mit Number (to be filled in by Co.) Department of Commerce (6 4 Sanitary P: pp s to Plan I.D. Number In accord with Comm 83.2 1, Widmode, pe I info tion you provide may be used for secondpurposes Privacy La , sl (1 xml P ject Address (if different than mailing address) 1. Application Information — Please Print All Information = �� Prope Owmer's Nam e Parcel # Ldt # Block # a� Property Owner's Mailil Address Property Location City, State Zip Code Phone Number N 59 /, Section )1 4A) s $ 1 ircle e) II. Type of Building (check all that apply) T N; RjjE ot� Subdivision Name CSM Number or 2 Family Dwelling — Number of Bedrooms c N ❑ Public/Commercial — Describe Use ❑ State Owned — Describe Use ❑City_ ❑Village grownship of sr �- III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A —/0 b A. New System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only 11 Other Modification to Existing System B, List Previous Permit Number and Date Issued ❑ Permit Renewal 'Permit Revision 11 Change of 11 Permit Transfer to New Before Expiratfon � Plumber Owner IV. Type of POWTS System: Check all that appl IN41on — 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 Jal eaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (st) System Elevation � c_J�) o-_) / a / ti 9. /e ! 30 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks I Tanks Septic or Holding Tank �a 60 / Aerobic Treatment Unit ! OC Dosing Chamber �y 96c) I VII. Responsibility Statement- I, the undersigned, assume responsibility for stallation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum Signat a gt�17 /MPRS Number Business Phone Number 0 3s Plumber's Address (Street, City, � Stat Zip Co ) Cllr s Yc, VIII ,our /De artment Use Onl Approved I ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Is ng Agen ign M(mps) Surcharge Fee) /� p r ❑ Owner Given Reason for Denial � (Q ✓ ` 2 d r7J IX. Conditions of Approval /Reasons for Disapproval 694 1 4yf�eM b4-1 Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) I -- 1 N it l aoole oo 3 9 /�- 3 - 13 7 X 730� X 13-1 /1�/,O 3 � 03,557-7 COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, not top of cover, Access Opening, not top of cover, must erdend to a point no greater must eidend at least than 6" Below Finished Grade 4" Above Finished Grade . , Coverwith Wr:A1)4 V0"rr q�i� . �5' 1 v Lockingg Device � b„J 89X PPee`'FP CAP (typical) Finished Grade a ui c- vItjIl� h .... � Min. 23" > 30 Ifi > Access Opening 0 IM!5ULA-116 Min. 23" Access Opening Pi i 2 „ �q i liG ,�b,�c�/ri,4 /�/ Ouh:t Effluent Filter j JA//77V S� -,Union 4 wp P /PE 3 Pr. Inlet Baffle ON`1a SOL ID S'O/L i Pu p 3 ,n o 99 u .er wi;kA eeh-lEt-2 /ewer ed g e." Two ComparFment Septic/Pump Tank o n Ovfside SPECIFICATIONS TANK MFR: DOSES PER DAY: 3 TANK SIZE: SEPTIC 1626C GAL. DOSE VOLUME: RR3 GAL. DOSE 7 0 GAL. (INCLUDES FLOWBACK & <20% OF DWF) ALARM MFR: _ /, _ec�( _ CAPACITIES: A= d , 3 NCHES = ' 09 AL. MODEL # lam Switch type: B = — 2 - INCHES = Vc� GAL. PUMP MFR: C = /U, 6I INCHES = GAL. MODEL #: SWITCH TYPE: yk-� D = CINCHES = GAL. REQUIRED DISCHARGE RATE o7 GPM PUMP & ALARM WIRING PER COMM 83.43(8)(e) o VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) _ 10, MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) _ + FT. FT. OF FORCEMAIN x A/0 FT. /100 FT. FRICTION FACTOR ...... _ /,5 FT. TOTAL DYNAMIC HEAD (TDH) 82, FT. INTERNAL TANK DIMENSIONS: LENGTH ; WIDTH ; LIQUID DEPTH 339 MP/MPRS SIGNATURE: LICENSE NUMBER: 0207 0 3 5 7 LF GOULDS PUMPS Submersible Effluent Pump EPO4 & EP05 Seri es APPLICATIONS • Fully submerged Bearings: U g ed in high ■ EP05 Impeller: Thermoplas Upper Specifically designed for the grade turbine oil for tic enclosed design for pp and lower following uses: lubrication and efficient improved performance. heavy duty ball bearing • Effluent systems heat transfer. construction. • Homes ■ Casing and Base: Rugged • Farms Available for automatic and thermoplastic design provides AGENCY LISTING • Heavy duty sump manual operation. Auto. superior strength and corrosion • Water transfer matic models include resistance. FF , Canadian Standards Association Dewatering Mechanical Float Switch ■ Motor Housing: Cast iron _ File # LR38549 • assembled and preset at the for efficient heat transfer Goulds Pumps is ISO 9001 Registered. SPECIFICATIONS factory, strength, and durability. ■ Motor Cover; Thermoplastic • Solids handling capability: FEATURES cover with integral handle and 3 /4 " maximum. ■ EPO4 Impeller; Thermoplas float switch attachment points. •Capacities: up to 60 GPM. tic semi -open design with ■ Power Cable: Severe duty • Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water.resistant. • Discharge size: 1 NPT. • Mechanical seal: carbon- seal protection, rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 104°F (40°C) continuous 140°F (6000) Intermittent. METERS FEET • Fasteners: 300 series 10 stainless steel. - -- • Capable of running 9 30 dry without damage to 5GPM - -.— components. a ' o 25 2.5 Fr Motor: a -�--- • EPO4 Single phase: 0.4 HP, 6 20 115 or 230 V, 60 Hz, 1550 -- -- RPM, built in overload with > 5 automatic reset. - � 15 • EP05 Single phase: 0.5 HP, �<_ 4 . 115 V or 230V, 60 Hz, 1550 ° ........ . RPM, built in overload with 3 10 EP05 automatic reset. • Power cord: 10 foot EPO4 standard length, 16/3 5 I SJTW with three prong 1 ........... -- grounding plug. Optional 20 0 ° o { foot length, 16/3 SJTW with 10 20 30 three prong grounding plug 40 S GPM (standard on EP05). 0 2 4 6 8 10 12 mI /h CAPACITY 4 Goulds Pumps C 2003 Goulds Pumps Effect ve July, 2003 83871 ITT Industries Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 405056 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: Myers, Phillip St. Joseph Township 030- 2101 -30 -000 CST BM Elev: / Insp. BM r Elev: BM Description: V) tup _ tc V, L .tip, c1 1 N1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic BenchmarlS_ Dosing Alt. Aeration / - Bldg. Sewer Holding - / St/Ht Inlet ;nki- aj4 � � 5 St/Ht Outlet] TANK SETBACK INFORMATION TANK TO P/� WELL BLDG. Vent to Air Intake ROAD Dt Inlet L.(1 Septic t ! + 7 Dt Bottum ? Dosing an. Aeration - - -- -�� Dist. Pie Holding Bot. System ( _ PUMP /SIPHON INFORMATION \ —/1 L (r j� 'L 1{� I Final Grade Manufacturer N Demand t'Cover v/ ; 23 3 GPM Model Number C44 ��• TDH Lift /� Fri ti n L 1 System Head TDH Ft Forcemain Length Dia. t/ Dist. to Well SOIL ABSORPTION SYSTEM n , BED/TRENCH Width Length No. Of Trenches PIT DIMENNSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS `A /_ -7 a� -- I -Z SETBACK SYSTEM TO P/L xl4 4 DG WELL LAKE /STREAM LEACHING [ M an r:', INFORMATION CHAMBER O �UNIT er: Typ Of System: / DISTRIBUTION SYSTEM (,L Header/Manifold / Distribution ` x Hole Size x Hole Spacing Vent to Air Intake -, .. Pipe(s) � , 1 t = } " t I� _-tC � �- 0 ) / 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 Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / ' Inspection #2: Location: 452 Highland View Hudson, WI 54016 (NW 1/4 SE 1/4 29 T30N R1 9W) Highland Hilk iN 22 Parcel No: 29.30.19.822 1.) Alt BM Description 2.) Bldg sewer length - amount of cover = _j ��r C d c� ✓ J c� ,/�vu �i ,� d(�ss �`�J '7 �'� L Plan revision Required? o res [] No �� Use other side for additional information. SBO -6710 (R.3/97) Date Insepctor's Signature Cert. No. I .' 1 � , T, v i � � � � �� / _. — -. �' Fes. n �� r. ,� iI �� ^J' I: ?, `r , ,, �, ri , -� ---- � �� , � �. �i ,��. . '� �- �� Lam. � N �\.. °�� . �. '. J Safety and Buildings Division County ,SC6S4n 201 W. Washington Ave., P.O. Box 7162 r. CAel�• Madison, WI 53707 - 7162 SiwAodress Department of Commerce 9 0 Z — ' 75 - 2- Sanitary Permit Number Sanitary Permit Application � In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision May be used for secondary purposes Privacy Law, s15. 1 m Information State Plan I.D. Number I. Application Information - Please Print All Inform ri�IV�y.J Prope r' N Parcel Number & <30 6 30 APR 2 L L LLla -- Property O�Zr,s Address Property Location V/ ST. CROIX !;C�,;N i Y N�, AA 5 S T 3ON, R E rr Ci ,State Zip Code Lot Number Block Number ' �Z Subdivision Name CSM N ber Type of Building (check all that apply) / P �P� �Q� _ Doty or 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public/commercial - Describe Use 3 �' '� d��n6c Afownship t5 ❑ State Owned y Nearest Road III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable A For County use 1 New 2 11 Replacement System 3 ❑ Replacement of 6 ❑Addition to System Tank Only Existing stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(nulubering scheme is for internal use) ' 3iv d 44KNon - Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 Constructed Wetland � ��f =.•L(�.t 22 C3 Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 El Drip Line �X 31. 45 ❑ At Grade 46 [] Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. D' tment Area Information: 1 3 6 P�l D es i gn Flow (gpd) Dispersal Area Dispersal Area Soil Application I P ercolation Rate System Elevatio Final Grade Required Proposed Rate(Gals./Days /Sq.Ft.) (Min./Inch) 7-) - 9 5./ 0 / Elevation �Qa /aoo lal • VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank o Dosing Chamber �. VII. ResWnsibllity Statement I, the undersigned, assume res 'bility for ' flan of the POWTS shown on the attached plans. Plumber' Name (Print) lumber's RS Number Business Phone Number C11�14 _ c,3 s7 - V: %X Plumber's Address (Street, ity, State e) ✓� Yap VIII Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issu' e gS i g na , , , ,, No Stamps) Approved ❑ Disapproved Surchar a Fee) L� ❑ Owner Given Initial Adverse Determination ppr � v �� IX. Conditions of Approval/Reasons for D' ov � �� - S "� t /- p Attach cwfiplde plans (to the only) for the system on papa not less than 8112 x 11 Inches In dze SBD -6398 (R. 05101) 3 v r3 T o wr2 44 , 1/ 51dc cw d t4�a �M QZ 9y' f A ,nor 3 13' 8' 11-P 770 zo soy 1 CL t �epL 13 2 3 013, s6 s `�vwsoonsin Department of Commerce SOIL EVALUATION REPORT page of 3 Division of Safety tend BWtdings In accordance with Comm 85, Weis. Adm. Code Camhr Affadt 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. Percent Slope. scale or dimensions, north arrow. and location and distance to nearest road. 6 36 - Z - / O /,30 - 0 0 0 Please print all Information. RevI1506d by Date Poisoner iMonnabon you provide mar be uW nor uoondery auvom (Privacy law. s. 15.04 (1) (m)). PropeityOwner property Location 2 U1 , 4 __ ' � M �{ � 5 Govt. Lot 410 va 5; 1/a S 21 T36 N R / E (orQ PmpeityOwner's Malling Address V Lot # 18bck# 1Subd.NameorCSW t Cb n� Tree ai l- �uh� f /�s City State zip Code Phone Number ❑ City ❑ Village Town Nearest Rom , r, (6,67 ) Cp kd I. New Construction Use: (,R ResidentW / Number of bedrooms -3Z-;L— Code derived design flow ram GPD ❑ Replacement ❑ public or cormnerdal - Desafbe• i? Au _ Parent �nateriai l CLG ``G l a�i % �� Flood Plain elevation If applicable a- R and recommendation: S y s �e rY► f /e v, o f 9F, v APR - 7 - re M4 e5 S Gee 'fo C vc�Q 1 7' OU ' �e � � 20 02 z oN c �kc F/_1 Boring ® Boring Groinud surface elev - arc to - factor g M. F �F Pit �J� Depth �trrg Soil Rate Horizon Depth Dominant Color Redox Desaiption Texture Structure Consistence Boundary Roots G in. Munsell Qu. Sz. Cont. Color Gr. Sz- Sh. •Etf#1 •Effil2 —8 / C- , �F Z Boring # O Boring C / M pit Ground surface elev. I r • R Depth to limiting fac*or ° Sob Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fft In. Munsd Qu. Sz. Cont. Color Car. Sz. Sh. TOM 'E1f#2 Z, I .Z Icy -5 r on A-- r i r c I , % vt o r►k; M vTr- n k 6 Em 4" -1 ql7v a e 564, to "50 d,. JH lev. • Effluent #1= BOD > 30 220 mg& and TSS >30 1150 mg/L • Efllueit #2 = B OD < 30 rrrglL and TSS _< 30 mg& CST Name ((fi�ee rd) Ow" CST Number Address Date Evaluation Conducted Telephone Number e v fi w47 d L) t -5 f61 /7-0Z s Propert Parc ID # D3 Page -or F Baring # Cl e«f ti Q / - (3 Pit Ground surtace elev. `• it. Depth to knift tador / b WL Sol Application Rate HNtMDn Depth Don*iwnt Color Redox Description Texture Strum Carwistence Boundary RootT GPDW in. Munsd Qu. Sz Cont. Color Gr. Sz Sh. Etf#1 'Eif#2 t O-g, /o Z— n•0 - 2 rh 5 /k M Fr g= 2� oy,P n 0 5;c� 2.rri btt rV1 jrr cS 3Y one ri vsb i rv% Xr- g � 3 g 3 i/ g Pit Ground surface elev. 3, t3o ft- Depth to &Wft factor �_ In. t-wrimn Sol � Rage Depth Dornk ant Redox Description Texture Skuctrre Consistence Boundary Roots GPDRf IrL Munsell Qu. Sz Cork Color Gr. Sr- Sh. 'Eff#1 'Eff#2 t /0 ib `� o -c. sic 2 rh S6k Y��r � �� f •� 2 1 0-37-1 /D hor�� S�'�� ?.w►SGf rK fir- 5 ✓F ff 3 3 z - /-7 on - x ti :S fC tK 4 S � Bodn g # 0 Boring ❑ Pit Ground surface eiev. R Depth to ikdit factor in. Horizon Depth Dar*wnt Redox Description. Texture Structure Consistence Soil Rate Boundary boots GPDfif in. Murnsell Qu. SL Court Color Gr. SL Sh. TdM *lEf #2 • Effluent #1= BOD > 30: 220 nv& and TSS >30 < 150 nngll. ' Ol vent 02 = BOD 130 uQ& and TSS <_ 30 nol. The Department of Commerce is an equal opportunity service provider OW employer. If you need assistance to access services or need mttaial in as attanate format, please contact the department at 608- 266 -3151 or TTY 608- 264.8777. c1 ad 67 l vt- s J l � Y f 00 � ra 9y i� 7 y 3 , / Apr 25 02 11:12a 11.1 APR - 24 -2002 10:09 COLLINS ELECTRICAL 04/24/2002',10;23 7153816541 E5129209 P.01i01 LACASSE CUSTOM HOMES PAGE 01 /O1 ' 8'1' CROIX COUNTY } S1311'11C;''I'ANK IWA1N'FENANC11 ACItI3LMUNT AND OWNPIRSUIP CURTIF CA'1'10Iq FOIUA Owllel'/I3ltyct' 1 Mailing Addreu • . fi Prol3arty Address (VotlCcsdou rcyuilceJ fium l'Ian11jilU Ucp8lUUcu( for new Coll -11( city /state 1'ArCC� 1 t 1 C11111iC1111U11 NilllTs)L•r - L R G,1iL n A01t1 N Proparty Location dikl %, '1A, Svc. 1 t Subt(ivislOtl , Lot it Certiflt!d Survey Muir fE , Vulitino , WArratAty Decd 11 .. '''• /�'� �. v —Z$e 1�L1t;C Spec ltause 0 yes qua 1 ,ut !Ines idC11tjlil►bl0 as L.1 no fi�`li_ �„MA1N'1'I!1tdANCL la :pr4par use anvil tttaiuteltanccof yuur septic syssettt Cutlld result fu its plelnattuc fuilute to J,audle wastes. prapernlalnteum" oomista of pumping out 1110 septic tank every lhrco yews or suouer, if nettled by a liceltsed pun,i Whet you put luto tho systeul can affect tlae futtcffila of Lilo septic tank as a (realntcnt stage In the waste disposal syatctu. 'Me pioperty awutr agrtes to aubnlit to St' Croix Zu"19 I)ePilltnteat a M total, signall by 1110 owner and by a mat;terplumber, Jountay,tum pltuitber, resttictod illutliber ur a iicenstd pumper verifying Itrat (i) the ell -silo wastewatardtsposa! syslenl is in proper operating can (1lttou and/at (2j aRt r'jrtspcedon and Irun,pi11g (if necessary), (Ito sepllu (ank is less than 1/3 full of sludge. Ilwe. the undersigued 11av6 road the sbovo tequit cult uls and agree to 111811,!211,1110 I)rlvale sewage disposal sy$I*W with the standards set ford!, !Lenin, as set by the Doparinlent of Conutlerce gild (110 I)ep:lrtaleul of Natural Resources, stage of Wiscottsla, Cartltication elating that your septic system has been timintained Must be cotuplelcki slid returned to the Sl. Croix �owtty Zauing ptiieawtlh 3Q Y cx'piraUon data, SI[3NATt! to t7)� o AI'I't.1CAN'r -�7 A' OwrrE n f -A' any E (waj certlly ILat ■II sia de lelttattts Olt Ulis fuult atc (tilt to the best of my (oor) knowledge. I (we) ant (are) the owutr(s) of ZNA ty ed above, by vjltu0 of a wallunly dead 1ecmded in 1tegistar of Doeds Office, � S l R OF Al'pL1 CANT bA D •+ +► +t ,pity ittfonpation that is utis•rellresett(Cd may result i1► the sanitary 110111111 being rovukcd by die Zordag Depat MV0. • + * +" luclude wilt, oils apitllcaUon: a slalupcd watrauty dead ftont the ttegiater of Deeds uftloo a copy t,f the certified survey n,ap if rtfetcuce Is 11111 in the watmuty deed TO: DEPT: Cp�sJG F h,, f CO: _� r�YLKJ FROM: J TOTAL P.01 • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORM TI N SYSTEM SPECIFICATIONS Owner Septic Tank Capacity 0 al ❑ NA Permit # S Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer �, ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model — QQ ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer ❑ NA Soil Application Rate F al /day /ftz Pump Model ❑ 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 (BODO 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 :530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Colifor (g eometric mean) :510 cfu /loom[ ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: p NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTE NANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: a ❑ y ear(s) (s) (Maximum 3 years) El 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: ❑ eo Isl (Maximum 3 years) ❑ NA mon Clean effluent filter At least once every: ❑ year (s) ❑ NA year controls & alarm At least once every: m ) ❑ year(srls ) ❑ NA Flush laterals and p ressure test At least once ever ❑ month(s) ye ar(s) 11 NA P y� ❑yearls) Other: At least once ever ❑ month(s) ❑ NA y: ❑ year(s) 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 round surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the 9 P 9 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 9 servicin at intervals of 512 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. I Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the 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 cell(s) 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 POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: • A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. • A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY 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 INSTALLER POWTS MAINTAINER Name Name Phone _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY It Name Name Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. . Vol. 1479PAG:636 i° STATE BAR OF WISCONSIN FORM 2 - IM 615955 Document Number WARRANTY DEED KATHLEEN O DEED REGISTER Of DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, [Wade between Hiehland Hills a Partnership. 12-27 -1999 9:00 AM WARRANTY DEED EXEMPT 1 CERT COPY FEE: Grantor, conveys and warrants to Phillip T. Mvers and Jamie L. Stets —. COPY FEE: Vie RECORDING FEES 10.00 rs husband and wife TT ER FEE: E90.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the Recordimt Area following described real estate in St. Croix County, State of Wisconsin (The Name and Return Address "Property"): 030 - 2011 -30 Parcel Identification Number (PIN) This is not homestead property. Lot 22, Plat o Highland Hills Second Addition in the Town of St. Joseph, St. Croix County, Wisconsin. Exceptions to warranties: Easements, restrictions, covenants and rights -of -way of record, if any Dated this 2 day of December, 1999. Highland Hills, a Partnership B * ' ] nn Persico, individually and as attorney -in -fact for Bruce Peterson and Roger Ruelin a r AUTHENTICATION ACKNOWLEDGMENT Signature(s) Highland Hills a Partnership by JoAnn Persico individual) attorney-in-fact for Bru STATE OF WISCONSIN ) Peterson and R er R D authenticated thisZZ& this - day of December, 1999. County ) Personally came before me this day • Kristin Ogla4d of December, 1999, the above named to me known to be the TITLE: MEMBER STATE BAR OF WISCONSIN person(s) who executed the foregoing instrument and (If tat, acknowledge the same. authorized by § 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristitta Ogland Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If tot, state expiration date: (Signatures may be authemicated or acknowledged. Both are not necessary.) 'Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE DAR OF WISCONSIN FIRM No. 2.199E INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI a06655 -YDT1 1 � m O O � N � f1 tp A' N • �/ m 1 33. / Q 1 �� / S />o 1 U1 9, .. S43 Ss. 1 ' 3' 0;0 1.N. zo r � � Z o, w r sA /o m CO O A N OD .n *awe w M 9 O N ' ? St • N (FOUND N N N P O O' o u 01 (FOUND P 0.48' SOUTH) a N CL ? 0 r N � � N t � 4N � w 0 (FOUND 0.68' SOUTH N O w �G n 514.79' EAST LINE OF THE NWI /4 OF THE SEI /4' 1313.46' LANDS S:y Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or # dimensioned, north arrow, and location and distance to nearest road. PAM APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION VIE D B n _.� N PROPERTY OWNER: GR LOCATION4 r 4 Sl l�s� (or) W Joanne Persico E AN PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. 0 ' v 400 S_ I;er!ond St. 22 na Hi Hi I' S Addn. CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE E]fOWN >"} Hudson WI. 54016 (715) 386 -9060 St. Joseph #E' [X] New Construction Use [ Residential / Number of bedrooms 3 ( ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd /ft .6 trench, gpd /ft Absorption area required 900 bed, ft 750 trench, ft Maximum design loading rate ._ bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) 101.3- 100.0 - 99.8 -97.6 ft (as referred to site plan benchmark) Additional design / site considerations trench design system Parent material pitted Glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem :E S ❑ U ERS El CES El RkS E] U ❑ S 61 U [IS @ 11 SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -11 10 r3/3 none sici lcsbk mfr cs 2f .2 .3 2 11 -28 10yr4 /4 none sici lcsbk mfr gw if .2 .3 Ground 3 28 -84 7.5 r4 4 none sl 2msbk mvfr na na .5 .6 elev. 10 ft. Depth to limiting factor +R4 Remarks: Boring # 1 0 -8 10 r3 3 none sici 2msbk mfr cs 2f .4 . 2 8 -36 10yr4 /4 none sici lcsbk mfr gw if .2 .3 Ground 3 36 -84 7.5 r4 4 none sl 2msbk mfr na na .5 .6 elev. 1 04.6 ft. Depth to limiting factor +84" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715 -246 -6200 Address: 1554 209&. Ave. New Fi hQ(z(h4 WI W17 Signature: Date: 11 -14 -96 CST Number: m02298 PROPERTYOWNER Joanne Persico SOIL DESCRIPTION REPORT Page 2_ of PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 3 1 0 -10 10 r4 3 none sici 2msbk mfr cs 2f .5 .6 2 10 -29 10 r4 4 none sici 2msbk mfr Cfw if .4 Ground 3 29 -80 7.5 r4 4 none sl 2msbk mvfr na na .5 1.6 elev. 10 ft. Depth to limiting factor +80 Remarks: Boring # 1 0 -18 10 r4/3 none sici 2msbk mfr cs 2f .5 1.6 >.4.... <:: 2 18 -36 10 r4 4 none sici 2msbk mfr qw if .4 � .5 Ground 3 36 -80 7.5 r4/4 none sl 2msbk mvfr na na .5 .6 elev. 10 ft. Depth to limiting factor +80 Remarks: Boring # 1 0 -12 10 r3 3 none sit 2msbk mfr cs 2f .5 6 2 12 -36 10 r4/4 none sici 2msbk mfr 9w if .4 !.5 3 36 -80 7.5yr4/6 none sl 2msbk mfr na na .5 .6 Ground elev. 100. Depth to limiting factor +80 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Joanne Persico New Richmond, WI 54017 MPRSW 3254 NW4SEg S29- T30N -R19W 715 246 -6200 town of St. Joseph T lot #22- Highland HIlls Second Addn. N 1 =40' BM.= top of SW lot stake C el. 100' 4,_2 5 2 I Gary L. Steel 11 -14 -96