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HomeMy WebLinkAbout032-2132-60-000 n to 0 3 n d c1 0 CD cn 3 5 Z O 03 o° w• w CD 0 CD CD tj CO CL N CL n o�� N 4 0° o N' w O 40 to Z D CD CD ca D co a 0 3 a CD ° m w w O CD c� CL N N OD 0 r CO) M y O O 01 N Cn CT �1 J M Z OOO< " M • ID v �7 oc fA dJ fA �i 3 M w G O w I� ID N O X Si a 3 ;u Q m a _ m a a M m CD - N z 3 a m °. z z N Q D _+ 0 o p N ?• S � N CD C _. N 0 CD W (D a 7 Z (D 6 '� N w a A ? O0 N N (D O A 7 O 7 m m o CL Z c ;o o CO m o y Z -+ CD A N oD y N C D• O m . < D a CC O O N N Cn w ID 7 0� w G ( CD N W w a 7 N C O w Cep < f v w s S my »c'Qa C a O CD £. N N N a .C-. N d ' N o 0 N O' N CD ao ao 3 NN o m y. o 2 SU a o -off' W a Q CD a Vt 7 co CD O' � 0 W y < << N (D O a e -. (n O a 7 •p w 7 N O C _ y O N p 0 t0 'ac Cl ° cn yv °Q a 3 . o A CD C 01 N a o na N = 0 m 0 M 'm � a N x n C l y N 60 y N dl [1 M 7' G o y _N w 0, N N Q Z 0 O w� N• 3 N 7 0 C p 6 p " 0 N t0 A O (D Oro ti A o k o a � Wisconsin Department of Cgmmerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No 463340 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID N 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. Balow, Christopher & Constance I Somerset, Town of 032 - 2132 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No: 1 DO. (7 I I (��.�c �/V` — 61�_ T a� 01.30.19.1175 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic CA n w L' Bench o-�..rir., p , - y / . / e a /O � • b Dosing � K�►v� v � Alt. BM Aeration Bldg. Sewer r _ - 7 p Holding St/Ht Inlet > v / a •� Q 7— St/Ht Outlet TANK SETBACK INFORMATION 00 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet f / gild Septic , /DD 7 S - 0 Dt Bottom Dosing 2 H aderlMan. 3 ` o �( Aeration Dist.. ` ' %• 9 g57 Holding Bot. System Final Grade PUMP /SIPHON INFORMATION (Z 6 Manufacturer Demand St Co er T O q� Model Number hl• // TDH Lift Friction Loss Sys e d TDH Ft 40 Forcemain Lengt IDia. Dist. to Well _ vt,. 61- SOIL ABSORPTION SYSTEM Z BED /TRENCH Width Length No. Of Yrenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 Z i__ SETBACK SYSTEM TO P/L BLDG WE LAKE /STREAM LEACHING Manglz tmer. INFORMATION HAMBER '�Yjt�l Qi/ Tye Of System: / ! Model Number: � lJ Y✓ 7" S BUTION SYSTEM {1,o Vtt g Header/ nifol� Distribution / x Hole Sizej x Hole Spacing nt to A Pipes) v N / / ' ength 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 I n Bed/Trench Edges Topsoil Yes No COMMENTS: (Includ code discrepencies, persons present, etc.) Inspection #1;��/ Inspection #2: Locat[oni,C�"iE, Q 174th Avenue Somerset, W[ 54025 (NE 1/ 4 3 N R Rocky Ridge Estates Lot 7 Parcel No: 01 .30-19,1175 1.) Alt BM Description t�/ 2.) Bldg sewer length = SD -' ' S/- � �2 Gam - amount of cover =� I b a t 21 . -- Plan revision Required? [ ]Yes I No � Use other side for additional information. ,___ Date �7� ,, n ,�, 1_ f J -sep Si n tur4sv11 Q/ti SBD -6710 (R.3197) IXJ� -Y J L(s� ✓ 1 �L! /l/ Safety atxl Buildings Division - - - -T t aunty 201 W, Washington S7 Madison, W 537 Sa tar Departme of Commerce (608) 66-9 ���/�® Y Permit "umber (!c be filled in by Co.) Sanitary Permit ., ryry lieati n � �� �, �,� � � �� s� plan 1. D. Number In accord with Comm 83,21, Wis, Adm. Cr . f may !se used for seconder "O' t ti YOU rovide fv y purposes Pn s1 T. CROIX COUNTY _ )( Pre ZONING OFFICE ct Address (i ereru man n�uil;ng address) � 1. gppiia►tion Information - Please Print All Information , Property Owner's Na rte �_ I -7 I W l ty ll o � Lot N Pwner's M ailing Address Property Location O ` 02� _ \ City, State p! y ZIP Code - Phone Number ~ t4. sdd o — i k.Saction j (circle o c I II. Type of Building {check aIi that apply) N- R / `7 E o 11 1 or 2 Family Dwelling - Number of bedrooms Subdivision Name CSrii Number Public /Commercial - Describe Use r State Owned - Describe Use — -_ -- - ___�_- Pcity_L�Village�e fownshipof e __� III. Type oP permit: (Check only one bux on litre A. Complete line B if applicable) New System LJ Replacement System ❑ Treatment /Holdin !'aril- Replacement On Re lacemei _ T g p _ y l� Other Modification to Existing Systeiti B �] Permit Rene al I Permit Rev!sion I' �! Change of l] Permit Transfer to New , Li'' t previous Permit Number and Dare Issued 1 Before Expiration { i � Plumber � Qwner - -- 1V• Type of PU W'fS S scent (Check all that a 1 _ Von - Pressurizer! ln•(sroutkl �J Mtxtntl > 24 in. ot'suitab;e soil i Alouttd < 2ti in of suitahle soil C; n z - Grady i 1 Single Pecs Sano Filter - C Constructed Wetland C Pressurized In -G Haidtn Talk J Ptat Fitter Aerobic Treatment tittit C Rec trc mating Said Fil er I l.J Recirculating Synthetic Media Fil 'Leaching Chamber Dri Line I� Gravel ess Pipe i prier (ex la' V, Dis rsa��r�M�ent �I n �forma on: �'M - �.. - S , - - -- -' Design Flow lication Ra fj t Dis rsal Area Re u;red (st) Dispersal Area Proposed (s ci 4 <5; 'a Pe 4 pe p ystem: Eievatio �VI. Tank Info Capacity in Iota! Prefab Site � StcYt F: 'be — r T ast c Gallons Gallons of Units Concrete Constructed Glass hew Existing i Tanks Tanks �! rerptic or Boding Tank - ��-� -- - - -____ Aerobic Treatment Unit -- — — --- -- - r - aositg Chamber �-;-- �•-- - --�- vt/ �_ .�_._____.._ i - V1I. Res�onslbility Sta tement - 1 , the under signed, assutne responsibility for ' aUation of the PyWT shown on the attached plaua, Plumber's Na rr* (Print) Plumber's Si gnarure � RS Number _ Business Phone tiumt>cr � Pl'lmber's Addre ss (Street, City State, Zip )� - "- --? ty p Ctxle, VIII _ ot tnt R a rtmen t Use On l alitvrY Permit fee (includes Groundwater D to r!! Atrproved Disapproved � ss suing o't S;g ru Scamps) Surcharge Few I G Owner Given Reas for Denial . Conditions of ApprovallReaso ova ns for Disapprl 3 '��d � �/ SYSTEM OWNER: Septic tank, e luent filter and _���,/� •� Z ! s iced / maintained � 2AQ 42�Q� S � dispersal cell must all be sery as per management plan provided by plumber. 2. All setback requirements must be maintained j as per applicable code /ordinances. Attach econt it plwuc (to a County oaly, for the s 01% pep,, out t.. (bale 1171,, x I !inches in slxe 4 h A n�� r � X 29 /5= Z n Y - L.fj ,Irk g3 e ; . si s� Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in acc4nce with Comm 8[nc is. �� ntY Attach complete site plan on paper not less th x 1 inches inlan must include, but not limited to: vertical and horizontal I (BM on and Parcel percent slope, scale or dimensions, north arrow, an diso t dad. F Please prJnt all Jnformat c view y Date Personal information you provide may be used for secondary purposes (Privy a 5 as �yi(n(y�(J rev 17 // A, Property Owner ' f e, v A,j57, ,IJ, Govt. Lot 1/4 1/4 S ! T 3© N R / E (o& Property is Mailing Address Lot # Block # Subd. Name or CSM# �,�4 S 7 vsrr%r 7:7- o, City State Zip Code Phone Number ❑ City ❑ Village [Town Nealfas t d ,j j a 11 �0d'vj ('O'A) "7- ;7,?g�5' -Sev [y New Construction Use: (Y Residential /Number of bedrooms 3 — . .Code derived design flow rate 0 GPD ❑ Replacement El Public or commercial - Describe: _ Parent material .0 r ) j r W 5 Flood Plain elevation if applicable General commens and recommendations: 3 ot - /3 2 —��lLe i Boring # ❑ Boring /, Q �f pit Ground surface elev. ft. Depth to limiting factor 0 0 in. Soil Applicatim 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 I •Eff#2 1 0-Y 30 S� � / M- r- c s ( v . Gr s T — . ;; Boring # ❑ Boring Q 0 nn 7 ICJ Pit Ground surface elev. # - - -- Depth to limiting factor tn. mil Application Rate Horizon Depth Dominant Color Redox Description Texture Stru Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. - "Eff#1 'Eff#2 Q_ 3 3 ro r C S V _. , Z L � -- 3 -fD a rA 42- �- Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD _< 30 rrlglL and TSS < 30 mg/L CST Name (Please Print) _ gnature CST Number tea Zr 1 21 Adds Date Evaluation Conducted Telephone Number 7 k �Ge�.� ie°` e.t.a/ l o �1 ' S is- 7, �z-� Property Owner Parcel ID # Page ,�— of 3 N ❑ Boring Boring # o Ground surface elev. ft• Depth to limiting factor in. M*Eff#1 Rate pit Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 7 1 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. fS S Gw 3 3 -- -- . Z F-1 Boring # Boring C] Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Ef1#1 'Eff#2 I ❑ Boring # oring Ground surface elev. ft. Depth to limiting factor in. F Cl ❑ Pit _.. scA al ication Rate Horizon Depth Dominant Color $edox Description• Texture Structure Consistence Boundary y Roots GPD/fE in. Munsell " - 0a Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I • _ < TSS < 30 BOD 30 and rr►91L Effluent #1 = BOD > 30 < 220 mglL and TSS >30 <_ 150 mglL Effluent #2 s _ mgll. _ 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. PAGE 3 O F NAME LOT# LEGAL DESCRIPTION 1 /a 1 /4,S T ,N,R E(OR)W SCALE: i" _ !!ZQ BM i ELEVATION /Uy. C ) p 1 BM i DESCRIPTION -jA fS F �I'hR�l On tvani po r C'1 BM 2 ELEVATION BM 2 DESCRIPTION q t SYSTEM ELEVATION 7 T r I3e�� l C�rA SYSTEM TYPE &A li i 1�'1CJV Q 7, r �• 44o SIGNATURE DATE Safety and Buildings Division County s 201 W. Washington Ave., P.O. Box 7162 isconsin Madison, WI 53707 - 7162 ;rotary Permit Number (to be filled in by Co.) Department of Commerce (fig I5t �-- --��'� 1 334 �. .. Sanitary Permit.3 _ S Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal informaOrt you provide may be used for secondary purposes Privacy Law, s15.04(1,)(m) - Proje Address (if different than mailing address) I. Application Information - Please Print All Information t n A r���' (0 ) ��{ Property Owner's � t�� _ ('�r� �S A v6 . ( (S� ? i QW ST -N C6 Parcel # Lot # ock # Property Owner's M ailing Address Property Location 5 le /1 t City, State Zip Code Phone Nu r -�-'� t '' , :5� t 'A.Secdon �^ / -C-Ai? Az *;d "t/ 5 , D ^. 7S'f�� n (circle II. Type of Building (check all that apply) S T 2C N. R�-E orl cm PU or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ❑ Public) Commercial - Describe Use _ 6G/r �'� � ❑State Owned - Describe Use ❑City_ ❑Village, Township of III. /r e y e Type of Permit: (Check only one box on line A. omplete li Brf applicable) _ 03Z_ 2l32 - (o0 - all • / /�S A. New S stem Y ❑Replacement System ❑ Tre ent1H ding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision Transfer to New Change ❑ List r ious Permit Number an Date Issued Permit Before Expiration Plumber Owner IV. Type of POWTS sys (Check all tha a l ) X Non - Pressurized In Ground U Mound > 24 in. of suitabl soil ❑ ound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑Constructed Wetland ❑Pressurized In- Ground ❑ Ho mg Tank eat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter eachin Chain r ❑ Drip Line ❑ Gravel -les Pipe ❑ Other (explain) V. Dis rsal /Treatment Area Information: 'e jr 3 S Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Requir (sf) Dispersal Area Pro po ystem Elevation VI. Tank Info Capacity in Total Number 7 Manufactu r Prefab Site Steel Fiber Plastic Gallons Gallons of Units w/ A _ /CD Concrete Constructed Glass New l:xisting Tanks Tanks Septic or Holding Tank I 14" -- `— ����to y Aerobic Treatment Unit - - Dosing Chamber X QD e p VII. Responsibility Statement- I , the ' dersigned, assume responsibility for ' tallation of the POWTS shown on the attached plans. Plumber's Na me (Print) tuber's Si gnature MP AAPRS Number Business Phone Number Plumber's Addre ss (Street, City, State, Zip Code) I ef ,G J G' O ,Pt l� Tli / � VIII. County/Department Use Onl Approved El puave ita Sanry Permit Fee includes Groundwater 0 � � Date Issued suing ent 5ignatur (No Stamps) Surcharge Fee) Owner even Reason for Denial + ` ❑ U�— IX. Conditions of Approval /Reasons for Disapproval ' SYSTEM OWNER: 1 Septic tank, effluent filter and q 16 9 o k/ dispersal cell must all serviced / maintained t as per management plan provided by plumber. 2. All setback requirements must be maintained ¢ `� as per applicable code /ordinances L , Auach complete plans (to the County only) ror the system on paper not ss iFu 81/2 x 11 inc es in siz �I SBD -6398 (R. 01/03) C N r 3 ✓ � � i � 1 /f 7 � 3 a B w1,Z G /Y 7ir rx✓ S e B� e , F lio T-VI BS 3 : :J...:Be/1�h mu /k � �b� �' / �i�e �'�,: Souf/reccstLofco�ne✓ �L. /� O _ �L .S G'sf4�131y i fir- v T 1 O ( f -COI n c r i.L: 6 r r� C 0 • O tEorn Oct • A•f tl , `t �♦ + f'1►' ,4 !M- 6 MR M I _- • S�,e� %a,►+a �in ai' . "� J 0!e.r, �►��w %tip: a 4 'i Hai ♦� s � • •i �i •n��' "� . "/ 1s�►�'� • ♦ • ♦. mw M ♦, °� e. ♦ + •iwii`��►i,��:. ; • /i�'i�i° ti��`i� „� . � 's�' r • - : - ” •ie•%♦�s4� ►' ` ►� ♦Oi•� � ���+ • HH♦ S ° . ♦ • ♦e al�c�i y �i•i� ►ai•% 1 ♦�'. ° .�i °s♦ Os ♦.° ♦ i' i �G� ! i i �I �►l �' o! � ♦ +o�D�►.� ♦�l +�p''�'eH• /�'�u� ♦ ° � eL�• 0O ♦! 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"D SITE EVALUATION Division of Safety and,B'uildings Page of 'Bureau of Integrated Services in rda _�#'.viith s. K, 83.09, Wis. Adm. Code 1' \ County Attach complete site plan on paper not less than 1/�2 �t 11 inchkt,Sgle. Plan music, C/ include, but not limited to: vertical and horizonta reference poinit�(8 }, tion and- '_. j x percent slope, scale or dimensions, north arrow and locatis d distance to nearesf r ad. r Parcel I.D. # n APPLICANT INFORMATION - Please print all in� � / Reviewed by Date i Personal information you provide may be used for secondary pu(po'S �Rt1p�4 s. 15.O4 0 i Property Owneer / Pr erty Location I a ovt. Lot E 1/4 s� 1J4.S T 3 / 7 a ; + N D ,N,R E (or)49 Propert Ow Mailing Address Lot # Block# Subd. Name or CSM# � 3/ Ys _f1l 7 /Vf] �U CfC y Ri'd e S�af�l Cily P L State Zip Cod Phone Number Nearest 1141 614- �1 Ch Mpu nJ sTa1 7 ❑ Ci El Village ® Road Town t � (7 /S )?Y6S37s S�ame�se t- 8S ® New Construction Use: Residential/ Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 6o® gpd Recommended design loading rate ° bed, gpd /fi • sr trench, gpd /ft Absorption area required 1 bed, ft2 12 612 trrr//e nch, ft Maximum design loading rate f bed, gpd 1f ° S trench, gpd 1ft Recommended infiltration surface elevations) 10 ft (as referred to site plan benchmark) Additional design /s considerations � ,/ Parent material b / �ecc i ee /' % ,I // Bf 27 0 i aO-eells k 404 r7 Flood plain elevation, if applicable 4 ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S U 23 S ❑ U NS ❑ U ® S ❑ U ❑ S ®U ❑ S R U 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 3 2 - SL M S,6/c mvf C w 2C o .S / k m�-�, � w l/� • y ..� Ground 3 X_ 9 7, sal? R SL `/Y1 fiA- M .4, 1 / , • S" Depth to limiting fir in. Remarks: Boring # 07 mmr, c w m . y " S' * S4 /rosd k MP F, c w 1 01 3 12- 75 9 1 4 1 4 Ground Depth to limiting ro r < in. Remarks: CST P me (Please Print) ignature Telephone No. f10/7 (lrell 715- Zy> - 72123 Address Date CST Number 3qf /9Z a�e _nerfe? - u.'fs Z2-y� 2 3131y PROPERTY OWNER 94 l/ f. le4 i SOIL DESCRIPTION REPORT / 1 � Page 'A of L PARCEL I.D.# �J 0 1 l Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench / 54 11n sb/( ma f c l c w :2 Ground 3 / /, � A v r , - C nrS6k In AOzfL / SY /� 7 S D m rn rn Cf . Depth to limiting f for � in. . Remarks: Boring # -6 �ar,P S� J/nsdk In C 4. tf 2 -16 ho Y/? % C w 7s_�/� r�� /���,- . y : , s Ground ��S J (� g ' ©mm t — .-3 e y3 ft. Depth to limiting � f1;UOr S in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # SL 1h !/rr C w /YI o •S s 2 -l3 100 Mj SFr cC,'- l L� 23 7f t % e / � SZ /lns l k In C w / Ground `� ,9 75 F// -/ � ��k P } 7mfr elev. oil —9 ft. Depth to limiting MP� t r in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) _ G ti Ira //� 1'' / d� -- � /.�� ��• ; SD uf�r e4S f,G fC �e'✓ �� � D M61A O� eence �L W C ot - h e /• ,e �� ! ..,•r- --- k � � i '• J a - --- ! ... - �_ - --�- -- r �+ _. _ __�. _ _ t_ �� _ _� L� el { , 1 qr i i �6 ®�� i I t I t _ _ _ - 1- - - + - - -f -- - - - TF f r f i i , { 1 I - 1 111 , r if I _ 4__4 ! 1 I I 1 1 If 1 , ; 1 i i I l i f I I {{ r t ' � I I r ! II f , i ' , i I i f �- ` '"" ar +i► ' ...,_r � ;,,,,- = w ..wr.�' - � � � I � i � ' t J+: � . !�. R �� R � j 1 �� � '«` 1 C, �• q ..'-1 E a : •' r ` r +1 ENT Fin 1Y" MIN, ABOvE GRADE E 1 ' Fg i M I30UR , WI k;D.Q OR, 4CATPERPROOF FRESH "AIR-'Lv AXE JUNCTION DCX APPROVED `W: Tli CONDUIT � iANNFOLE C4V F.'R I`TKISHED CRAKE W/ PADLOCK 6 41 C RISER -- -...�� WARNING' i.ABEi n X` : !LET WAMER TIGiiT SEALS GAS• 1 ' TIGHT! A SEAL PRO ;PPROVE�3 JOINTS W: Tit 'IPE ' APPROVED PIPS INTO SIL 10 ON 3',bNTO SOLID. SOIL PUMP OFF ELEV . FT �* r --" ►"'OFF RISER EXIT D PERMITTED CNLY ' IF TANK MANUFACTURER APPROVED BEDD.NG U;�`DER xANK HAS APPROVAL �ON�RETE PAD SPECTF «CATSC.ti'S :EPTTC r DOSE `0X MAN'JFACTJRER: f .�.M.,.... NVMBER DOSES ?ER DAY: IAN SIZES 194 rd GAL. DOSE vG: .mr INCLUDZNG D OSE dv GAL. FLOWBACk: !S9 GA I,. �L.hRM MAN�JFACTURER: CAPA ."IES: A �/►� " MCDEL NUMBER: a:vCl?ES �....�AL. SWITCH TYPL: 9 " .,,,,� ;� "CHES � GAL. MAWFACT�,�RER : M ODE; NUMBER : �.. --� .w.,�. C INCHES s GAL, SWITCH TYPE: D ,., YNCHES i GAL DQU:R£D Di SCPARGE RAT �, ,� "- ,� P:. PUMP & A LAR M W "' R AS PER ILHA 16. SAC EM DIFFr"DZENOE $,,, MI GP F AND DISTRS NIMUM NETWOR BU ON , K SUPPLY PRESSURE ON PIPE 42 rrrT FEET FORCEMAIN X FEET FTt300 F:, FR:CTrO3 t FA�^.TOR FEET T -OTAL DYNAMIC HEAD s FEE« ` ;'"ERNAL DIME:,S:ONS OF P ' n .�. :ANY: �--- LIGU7T �, DTN ,ETER .... -., - [IGOULDS PUMPS Submersible Effluent Pump 3 871 EP05 All APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower ecal designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically IY 9 lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- resistance. Q . Canadian StandardsAssoaat+on • Heavy duty sump matic models include n Motor Housing: Cast iron (CSA listed model numbers end • Water transfer Mechanical Float Switch in "F" or °C ",) • Dewatering assembled and preset at the for efficient heat transfer, ferry strength, and durability. SP ECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Pumps 6 ISO 9001 Registered. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 'M maximum. ■ EPO4 Impeller: Thermoplas- m 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 continuous METERS FEET .......... ,.... ..._ .._ .. _, 140°F (60V intermittent. • Fasteners: 300 series 10 stainless steel. a 30 .—sGPM .._.. _ • Capable of running dry without damage to g _ _. 2sFr components. po 25 O Motor: • EPO4 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 s -- RPM, built in overload with automatic reset. a a 15 , ._.._ : _ _ EPOS • EP05 Sin le phase: 0.5 HP, 115 V. 68 Hz, 1550 RPM, 10-­-, built in overload with .. EPO4 _.. automatic reset. Power cord: 10 foot standard length, 16/3 1 SJTOW with three prong grounding plug. Optional 20 0 o n 10 zo 30 40 so GPM foot length, 16/3 SJTW with , three prong grounding plug o 2 4 6 s 10 12 mj /h (standard on EP05). cAPACITM Goulds Pumps ® 2000 Goulds Pumps <& ITT Industries Effective February, 2000 83971 rillf =9-F#vAe*4 STANDARD CHAMBER Oulck4 Standard Chamber (EFFECTIVE LENGTH) 34 SIDE VIEW ", SECTION VIEW MultiPort End Cap 16" 12" f ILI 34"— SIDE VIEW TOP VIEW FRONT VIEW Ale 0% Watt' Itspeciti t ullb V X'12' Size : X , L"x' 34"'X'52":�X WX 16" Effective Length 48' Invert He 8" or 1.25" Invert Height INFILTRATOR SYSTgMS. INC , STANDARD LIM LO 'a s i the U of chairnhat, and plate, "Ji and Other ai�W.SsOry qbriiPfrJwOd by 011111aleir j'UFIJt$'l. where installed and Operated 1 i deffiri 1 b0clifit4t; of an -sf� septic system in aLcorclai iith Ini IS Wai to en '-1 fil P'"t'le"cr ("Hoiden'' ' I I illerlaK and AO­IWI�L) S for ore year l ii the ogle that Ins SopliC vel is Issued for tto septic system cori thet Un i provided, howiff " t it a septic pisi is nt,t rocAtafm by applicable law, the warranty period will begin ui no date that Installation Or the Gallic system cormeni To —VC-i its Wal.,-ty Iiii liolber irusi notify ka,akor in wrilling at its ro'locale lrleaA� tters in Old Saybrook, Cotni within fifteen (16) teal ,,- of the Ji , ipfeo friffffainr wilt %qi;iy iepiaminent units for units cipunnned by Infitiriisir ;o no rtvered by this Urril Wwonl[y Intl? ,,W; Mi sp--i e xcludes the cost Of r emovai and/or installi of the tf,ms lUl 71,11 LIMITED WAkPAN IV r REMEDIES IN su8PARACiRAPH (a) AW LXCJJ%fVF I I 11 ARIF N( 01 HER WAPFIANTIE. WITH RESPECT 10 4 111 1;,, Ii JOING NO IMPLIED WARRANTIES OF MiCrCHANTASILITV OR R FN� S�; IWA A WARI K' xt AR P1jRPCk1!E. SYSTEMS INC fLI Ins Untied " shall be void if part of the chavilbef.srrsieni i�; i Twuta ly", The ... itw 4 j Warranty not extend -nnsoclue-Oal, special a indeed jarral ki shall not be iii for iitali Or ligiridat9et di incitijog loss Gf Environmental OnWlie WaStOWStiff SOlUtiOnSo' vr and profits, aux and Outwkalll oieit.ad costs, or of!" losses oi asiR motirecl by it* Holder IN any Ii fli Sw6cay e vuded trom Ubr,tee Warranty coverage are damage to the Units due to oi wear and tow, alieralion accident, mause. abuse Or n8i of Ine (Ii . the Units being sobjertted to %rahrots Iniffi. air Other minclitions, which are not a eittod by the installation irmtrict-ol failure to l"Ittlarwhe 6 Business Park Road • RO. Box 768 ,nii ground oOVers sal torn the Units "suillation insttxtKo% the. pia 0.mo,opa materials into the systarn cona-9 the Units; failure of Old Saybrook, CT 06475 ",a In or the septic system due to improper siting Improper szing, water usage, improper grease disposal, or impi. or operation: any other went not caused by infiltrator. This Limited Warranty r�iail be void it the Hod-e� lails to ccmply with the teirne, W f ort h in i Lintiled �'Vartabjy. 860-577-7000 - FAX 860-577-7001 F i - i rhA hifillralo, be reriporri lot any kajs or dart de 1. the Holder, re ,00r.. or any 0i party resodlrrr) Va. —l"Itnin Or ship. In-' r a f— any pitocui twArly clam. .1 Hold. or any third Pang. For this Llnijq ii o a"any to apply, the Units mast h"'hislatieurn accordai 800-221-4436 with ail cit. condlior's "Joi by state artd local codes; all other appl.c.bl. I—. and Infii V-slalkilbri 1,8bu0i .1 I.Al hi Ih. aulh,,rity I. rhani or aIeildl (his Nowarrai appl ony parry othir! than the orJf- Hoder. TteH 'vo- riapi tlw Standard i-irn,lo Waivanityofterad by infillrator, A i iniiVrd number of stales and coatties have dinerelt warrally requirl numis. Any purd tasr of onus snauki contact InAnrator'; Capaale Head);uarlps xi Old Saylxa>h, ^ .a naetiuut, prior to such puroivtre, to obtain a COPY of the apitaki wai " should carefully read that warranty prior to the purchase of Units. U.S. Patents 4.750,661; 5.017,041; 5,156,488; 6,336.017; 5,401,116; 5,401,459: 5.51 1,903; 5,716,163! 5.588. 5,839,844 Canadian Patents'. 1,329,959; 2.004,564 CAher patents pending, infili Equalizer and SlijeWiribler are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered tradarvark in France. In Systems Inc. 7 POWTS OWNER'S MANUAL & MANAGEMENT PLAN page of FILE INFORMATION SYSTEM SPECIFIICATION8 Owner CqjUsmP C.w9 6— Septic Tank Capacity ,Z al 17 NA Permit # 3 3 p Septic Tank Manufacturer O NA DESIGN PARAMETERS Effluent Filter Manufacturer 0 NA Number of Bedrooms 0 NA Effluent Fitter Model 4!l 0 NA Number of Pubic Facility Units 0 Pump Tank Capacity a l 0 NA Estimated flow (average) C 40 a_ ) _,j &I/dfy Pump Tank Manufacturer e 0 NA Design flow (peak), (Estimated x 1.5) �G� d *1 /d? Pump Manufacturer 0 NA Soil Application Rate gal/d! & Pump Model O NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit 0 NA Fate, Oil & Grease (FOG) 130 mg/L C3 Ssnd /Grevei Filter 13 Peat Fllter Biochemical Oxygen Demand IBOD.) 5220 mg /L 0 NA 0 Mechanical Aeration O Wetisnd Total Suspended Solids ITSS) 5160 mg/L O Disinfection 0 Other: Pretreated Effluent Quality Monthly average Dispersal Celt(s) O NA Biochemical Oxygen Demand (800.) 130 mg/L O In- Ground (gravity) 0 to -Ground (prossurized) Total Suspended Solids (TSSI 130 mg/L ❑ NA C) At-Grade 0 Mound Fecal Coliform (geometric mean) S10` ofu /100ml O Drip -Line 0 Other; Maximum Effluent Particle Size K in dia. 13 NA Other: 0 NA Other: 0 NA Other: 0 NA * Values typical for domestic wastewater and septic tank effluent. o hN ' 0 NA MAINTII NANCE SCHEDULE Serv Event Service Frogmay inspect condition of tank(*) At least once every: 3 mon s s (Maxlmurn 3 years) O NA Pump out contents of tank(s) When combined sludge and scum equals one -third %) of tank volume © NA Inspect dispersal cell(s) At least o nce every month(s) h (s) (Maximum 3 years) O NA 0 NA Clean effluent filter At least once every: ( is) Inspect pump, pump controls lk alarm At least once every: "Una(s) O NA 0 s) Flush laterals and ❑ NA and pressure test At )oast once every: .--- 0 s) Other` At least once every: 0 (s) 0 NA Other: O NA MAINTENANCE INSTRUCTIONS Inspectiona of tanks and dispersal cells shelf be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POINTS Maintalner; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(.) 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 falling 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 X12 months, shall be performed by a certified POWTS Maintalner. 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Property Address (Verification required from planning Department for new cstructian} CitylState � � arcel id entification Number o32 — 2) 3 Z — bo - , 6 LEGAL DESCRIPT'YON Property Location %4, S %4, Sec. -- L .,, T 3 0 N- R„1 , W, Town of 60rY`,¢x�. Subdivision oC 'L'Ls Lot # Certified Survey Map # . Volume . Page # Warranty Deed # W3 �9S , Volume , Z�S� , Page # ]lot Spec house ❑ yes Cl Lot lines identifiable 0 yes ❑ no SYSTEM MANTENANCE Improper use and mazntcuanceof 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. Ile property owner agrees to, submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, joamaymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is lea than 1/3 fu11 of sludge. Vwe, 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 Zoning Office within 30 days o three year expiration date. } SION TURE OF APPLICANT DATE OW91ER CERTIFICATION I (we) 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 p rty described above, by virtue of a warranty deed recorded in Register of Deeds Office. �dU / SIGNATURE OF APPLICANT DATE ' *.sts 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 jl U, 2 7 5 9 P KATHLEEN H. WALSH REGISTER OF DEEDS DOCUMENT NO. WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD 03/04/2005 09:38A)rl WARRANTY DEED This Deed, made between Dennis E. Geffre and Karen C. Geffre as EXERT # husband and wife as survivorship marital property , Grantors, REC FEE: 11.00 and Christopher E. Balow and Constance M Balow as husband and TRANS FEE: wife as survivorship marital property Grantees, WITNESSETH, That COPY FEE: the said Grantor, for a valuable consideration convey to Grantee the CC FEE: y PAGES: 1 following described real estate St. Croix County, State of Wisconsin:: Legal Description: RETURN TO: Loberg Law Office Lot Seven (7), Rocky Ridge Estates in the Town of Somerset, St. 359 West Main Street Croix County, Wisconsin. Ellsworth, WI 54011 PID #: 032 - 2132 -60 -000 Together with all and singular the hereditaments and d appurtenances thereunto belonging; And Grantors warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and covenants of record and will warrant and defend the same. This not homestead property. Dated this 1 st day of March ' 2005 _ . (SEAL) 4 e (SEAL) Dennis E. Geffre 7 (SEAL) (SEAL) Karen C. Geffre AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN } a authenticated this day of COUNTY OF St. Croix } ss. } Personally came before me this 1 day of March , 2005 named Dennis E. Geffre and Kar•G. •• TITLE: MEMBER STATE BAR OF WISCONSIN Geffre to me known to be the e ` Q� •k. (If not, P9,C w U %G2 z exe uted the foregoing 'nstrumC'n1 d?. / ► p authorized by §706.06, Wis. Stats.) ac owl a the sam ' , Q j Z yJ • THIS INSTRUMENT WAS DRAFTED BY *_ Lin a . Green 2 LOBERG LAW OFFICE !, ,•� Robert L Loberg Notary Public St. Croix County, Wis. My (Signatures may be authenticated or Commission is permanent. (If not, state acknowledged. Both are not necessary)c&J expiration date: 2 -15 -2009 ) STATES :t Quarter of the Southeast Quarter, the Southwest carter all in Section 1, Township 30 North, Range msin Central LTD Railroad. ' �e DS NORTH LINE OF THE NORTHEAST 114 OF THE SOUTHEAST 714 1 4' ----- --- - - - - -- 975.03 982.35 991.47 250.00' 250.00' / � 284.75' 3 � 1 W r o �' DRAINAGE N EASEMENT H.W.E. =978.2 I O all L S89'36'21 "E H.W.E. = 978.40 S89'36'21 N89'S2'09 "W 79.47' 736.64' 3 r i 589'36'21 "E I � E I / 55.94' EASEMENT � o n .w.L. it -P i M S89'36'21 "E I i ui z 5.83' 1 � :4 '- �? 1 I N56'45'57 "E / VV co 6 I °i LOT B LOT 7 3 D.8 °' j 'orb. H.W.L..p. r 187,434 S0. FT. 187,647 50. FT. ° O DRAINAGE , \\ 60 2 j 4.30 ACRES M 4.31 ACRES 3 A ° "�_' EASEMENT \$�6 /o a IL MIN. F.F.E. =996.6 m �, 1 POND � MIN,* F.F.£. =982.2 N I H.W.E. =977.9 I p 7- 38.82' all_ N89'52'09 "W 3 1 2�0 ' 157.41' ' 3 ASS ?) 6• �� E 3 -- 10 9.03 - - u.:� 1 48.38 o n 48.29 6g'S IM7 n r� IN I M h N89'36'21 "W N N N ,t DRAAGE N N ° o $ �` H.w.EASEM 9 ° / v� H.W.L. Y IO ti w N Sszs936 LOT 207,319 S0. F7, N89'52 "W -Z-• 1 x n 4.76 ACRES 25.41' n MIN. F.F.£.=9d1,f o LOT 8 0 80' RADIUS 184,262 S0. FT. z TEMPORARY CUL 4.23 ACRES EASEMENT. EASEMENT TO Ln MIN. F.F.E. - 996.6 BE REMOVED UPON EXTENSION N OF THE ROADWAY .......I. ........ N 250.43' — — — — — — — 289_64_ P 250.43' - - - -- 55.9 _ - - - - -- -- - - - - -- , •H O • — __ - - - - -- cn -N 87'01'55" E 846.45' -- - - - - -- _ i - _ _ —� ;CENTER or ` 4x *s f ---- N 87'01 E 842.98' - - - -- -- �CUL - DE -SAC . - M