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HomeMy WebLinkAbout032-2156-10-000 . g ■ 2 0 7 � 0 J 0 ° S m Cl) S . o c co 2 j§ t i ) $ \ ; % ƒ ( 0. { / \ �\ 0 \i/ CD / v ƒ CL a CO .. _ 3 \ f 7 9 CD J m § CL 0 k § § /� CL ® F � k \ - / CD 0 0 0 0 _ Oro k % I § § § \ / 3 \ i \ B m 2 9 5 = k 0 / ? <§ 0 t 7 $ CL m @ §O m •_ oRg $CD to z 0m 0) 6 ¥cn o , , 3 ■ z m - E � § k CL � § ) E =a . f 0 w T �$ /# E ] / CD 0 � \ k °_ z �f � I co ± CL 0&2@ \ =ma o @@ =2 G c =I2a E E] j k a,ot % /emt ;�$ K =n } 70 C 0. \ ; ƒ/ / \gym CD qb o » ; _; q Q \ 0 \ \ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430280 0 (ATTACH TO PERMIT) GENERAL INFORMATION ` 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: Stout, Richard Somerset Township 032 - 2156 -10 -000 CST BM Elev: Insp. BM Elev: IBM Description: ^q Section/Town /Range /Map No: O �/ t,j j 4__ �`5 12.30.19.1343 TANK INFORMATION r ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. ,6 ,k Septic Benchmark / � 45 /6 i5 94 - `?Ca Dosing; /7 / Alt. BM � J ' /off -5l� Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht outlet G 1 % 7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / 15 , 15 1 Dt Bottom Dosing Header /Man. // 7 -`Y Aeration Dist. Pipe `/ 4 S 4r n 93. ZS Holding Bot. System it • O f _3 , 4Z, dk fez 5Ck I 141 `1Z ZS final Grade PUMP /SIPHON INFORMATION f33 a,+ cl , to Man Demand St Cover 3 C M �6 3 J odel Number rb s TD Lift Friction Loss System TDH Ft Forcemain Leng ia. I Dist. to Well SOIL ABSORPTION SYSTEM 2 Z d A4: A[a BED /TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. f Pits L DIMENSIONS O tau SETBACK SYSTEM TO V P/L [v BLDG WELL LAKE /STREAM LEACHING Manufacturer:. — INFORMATION CHAMBER OR LjAg I lia 771_ Type f Sy tte` : t � `� NN UNIT Model Number: Cu C DISTRIBUTION SYSTEM 1 io �� z .� Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) `\ Length 7 10 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 Top3oil Yes Yes No No COMMENTS: (Include code dis repencies, persons present, etc.) Inspection #1:�/ It /0� Inspection #2: N(1 Cht- Location: 1695 89th Street .� t, WI 54025 (NE 1/4 NE 1/4 2 T30N R19W) The Hi hl rids Lot 1 Parcel No: 12 0.1 1343 God Sa I. "1 _ 1 e� l vlGq cum 1.) Alt BM Description = rJ'� �U °'"� 2.) Bldg sewer length = '7 GL � I '�'e k^t90 iv1 l'ir!tCvY�2 - 6P/lir/ - ti, . �C ✓`�- amount of cover y S 0 P-�' t` ►�5� C f S�Smo S 4�t 7 s / -- Plan revision Required? Yes Use other side for additional ' to ation. -- - -- SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. } ~ y cv Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 -5 YD z X N VI-sconsi n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 /,30 �-�� 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, si5.04(1)(m) Project Address (if different than mailing address) I. Application Information - Please Print All Information Property Owner's Na the t b, r A -, Parcel a / Lot 11 Block A 03 2' Property Owners M ailing Address ,;,. tl !,,_ Property Location • 3 (� �e '4 'A,Secdon l� City, State Zip Code Z PitRractF (circle o I" d�6 T s.Z_ N; R i E o� II. Type of Building (check all that apply) Subdivision Name CSM Number 9 -1 or 2 Family Dwelling - Number of Bedrooms r� � � � a \ �,� ❑ PublicfComercial - DescPublic/Commercial i ❑ State Owned - Describe Use �¢ 1 ❑City ❑Village ownship ol �7O1rr r`S'e7 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal El Permit Revision El Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) ' Ton - Pressurized Lt- Ground 1 ,u 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 Xcaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersal/Treatment Area Infor ation: a S rw* I 7v Design Flow (gpd) Design Soil Application Rpte(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) S em Elevation 1 01 V_ _=;� ! VI. Tank Info Capacity in Total Number Manufacturer Concrete Cons 1 Glass lactic Gallons Gallons of Units New Existing , Tanks I Tanks 1-Sep-tic or Holding Tank Aerobic Treatrnent Unit J � Dosing Chamber G.�O xi, VII. Responsibility Statement 1, the undersigned, assume responsibility for allation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature MFRS Number T usiness Phone Number /v.' /lion, S ��ir 1 wa?%'y' e� 1 .s- �8G -3 %a Plumber's Addre ss (Street, City, State, Zip Code) 1 ; S Z 6'�- 4� VIII ount /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Gr Da Issued ssum gent Si natu o Stamps` Surcharge Fee) � V�6 ❑ Owner Given Reason for Denial �� IX. Conditions of Approval /Reasons for Disapproval t, IMF , N*, eoy` eta is Id 3 / Attach eomplote plans (ty the County only) for the system on paper not less than 8112 x 11 Inches in size S 398 (R. 01/03) 0 gjed \ S `b Y� N� a • � Y '1 � a l °a � � N C ^ \ f � O I� A/I g1 e l , �i Q G 1 0 -� a e �a V ,Msco'sjp Department ofCommerce SOIL EVALUATION REPORT Page _L of Division of Safety and Buildings in accordance with Comm 85, 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 Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. lain Please print all information. R by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 2 S Q 3 Property Owner Property Location P a �+ Govt. Lot 1/4,(/ —114 S 12 T N R E (or) Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# 1553 (r• I la City State Zip Code Phone Number ❑ City ❑ Village CS Town Nearest Road H ucl i Lo 1 5(4 0/4# 015)5 Son-er + t'lUT'` A ve. New Construction Use: 0 Residential / Number of bedrooms 3 /4 Code derived design flow rate GPD ❑ Replacement ❑ Publi or commercial - Describe: Parent material oU-}t, nx ' n , , n._F Pla' el if a licab A + `'• �i' ft. General comments ��� and recommendations: m etev• i �OW@f: q Z.a� avfisv s 011. elegy, t. GC I�ff i � Z -�o � S' SS���. • i� �: Boring g r�ii Boring # fG� I pit Ground surface elev. ` ft Depth to limiting factor / J in. Soil li ion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary ,hoots PD /f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 `Eff#2 l Q9 312 S rJ Zra mfl,' CS I p .5 .8 2 �'3(q — .Sic/ M_ 1< c Is . 3 !Z to V r m — mS d t - .1 1. ❑ Boring # El Boring ® n _ Z pit Ground surface elev. 9 q' ft. Depth to limiting factor in. Soil Applicati on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 LO !z — s; J Z Mir �s I S -3 Alin rn 0 = 5Y '196 Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please rint) Signatur CST Number Z5 30 Address Date Evaluation Conducted Telephone Number ZtJ 54 . �- 5� 16 -30 - o C7J Z4� boo Property Owner )1w Parcel ID # Page �- of 3 3 Boring # El Boring © pit Ground surface elev. Q7 • (d) ft. Depth to limiting factor �� in. Soil 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 I *Eff#2 - Sc l +" c r `fl m S b 1 - 1 1.2 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑Boring Boring # Ground surface elev. ft. Depth to limiting factor in. El Pit Soil 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 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 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 matkual in an alternate format, please contact the department at 608 - 266 -3151 or TTY SBD -8330 (R.07 /00) e r Property Owner J•i J r Parcel ID # Page �- of 3 Boring # ❑ Boring © pit Ground surface elev. Q (d) ft. Depth to limiting factor _ in. Soil 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 Z S -1 - s c.1 -P C 5 .3 4 11 Lf-/ m S d 5Y'11 a F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff #2 F] Boring # F1 Boring El pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 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 matgraal in an alternate format, please contact the department at 608 - 266 -3151 or'ITY 264 - 87+ S13D -8330 (R.07/00) PAGE 2 OF__:3 NAME S4n UT LOT# � LEGAL DESCRIPTION N E Y,u i4 ,S T 36 ,N,R I E(or SCALE: 1"= y0 -- BM 1 ELEVATION !CG • 0 J BM 1 DESCRIPTION la e 6 -� 3 jy ' evc P Pe — } — BM 2 ELEVATION 9 1, 90 I BM 2 DESCRIPTION n d ,� SYSTEM ELEVATION w L r L O v ALTERNATE ELEVATION " O V CONTOUR ELEVATION av _ q , o w., y, c c) VO -A-� cou Qf 9G,ao Fr 3 9y r'ivw,.y C( 6 P,A ri g -z SIGNATURE -� DATE /Z - Z9 0/ PAGE,5_OF-3 NAME S40 04 LOT# LEGAL DESCRIPTION N F- X y E L4 S #,P, T 36 ,N,R, 1 E(or) SCALE: I"= / 6 BM 1 ELEVATION /co • ' BM I DESCRIPTION Sly' evc PrPc• E + BM 2 ELEVATION 0 I BM 2 DESCRIPTION 10 p D SYSTEM ELEVATION l w r 9 L ,O c) ALTERNATE ELEVATION G3 YD. U V CONTOUR ELEVATION ,csc q6, ov, p y,cc) 9f 00 �-3 9y r'Movy' 6 � 4 1•a . r r►Z $ -Z SIGNATUR DATE /Z - 29 4/ — I � = fiINED BY OTHERS LOT 1 � � VOLUM • ` i • • 1 1 •� 1 1 I !d 1 1' ! 1 r � • � W N,= r I o o Y Y , WCAWFAW SEPTIC TANK PUMP CHAMBER CROSS S"t.: CTION AND SPECIFICATIONS 4" CI VENT PIPE ' 12" MfN `ABOVE GRADE >; WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE TAK WITH CONDUIT MANHOLE COVER W/ PADLOCK 8 1. FINISHED GRADE WARNING LABEL 7 4" Cl RISER 4" MIN. IS" IN. 6 MAX. ke1t f 'NLET I` WATER TIGHT SEALS GAS- TIGHTS AL APPROVED ' SEA L JOINTS WIT H PPROVED - + ; ALM APPROVED PIPE IPE 3' -v- ON 3 ONTO N ?Q SOLID SOLID SOIL OIL I RISER EXIT PUMP OFF ELEV . FT. OFF PERMITTED ONLY D IF TANK MANUFACTURER HAS APPROVAL 3 APPROVED. BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: Z eS� NUMBER DOSES PER DAY: TANK_ SIZES_ SEPTIC 1f�d' ._ GAL. DOSE VOLUME INCLUDING GAL. DOSE ,l 5`4 GAL. FLOWBACK: ____ ALARM MANUFACTURER. eli -4 ,,-- CAPACITIES: A = ' 41 INCHES = GAL. MODEL NUMBER: _ 2 INCHES =� GAL. SWITCH TYPE: rte, B ' --- -r-� -- PUMP MANUFACTURER: C = S INCHES =GAL. a cs/ MODEL NUMBER: D = v INCHES = _ GAL. SWITCH TYPE: m��c .--.- REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . . FEET + FEET FORCEMAIN X g, FT /100 FT. FRICTION FACTOR . L 1 7 _ FEET TOTAL DYNAMIC HEAD 1 FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER LIQUID UEPTH , + � /,, �, / 11 LJ LICENSE NUMBER.' ga7�g0 DATE: 1/88 Submersible Effluent Pump 3871 EP44 EP05 won It Ni�tJ1 'IOMN • Futlnero : 300 sere • Fwlyy sub In hio a vow Hots: Cut Iron pp raW t o dl for fw #" fit r" trier, SW** dWWW tr ft + � Nrlrfi iutxi�on Vt e1l�Ont I�' �hd ouro liy. dN wit demsp to hut *, vaiw oow►t t Yh � ermopies• eu + SI_t�� phase: D141�R, (r dt IIt 011 p L traa'wdK i 1S or ?� Y, 6Q Hz, 13 0 Fled o teh omws ! end ■ . Swere duty • RPM, Wt in cverftd wtlh Al et be kdwy- rdid d Intl water Tow ant eutonu * neat N r Wd lower • M%04hue: 0.3 HP, d b =no 1560 RPM, FE�Irlill� ��. Ptaov: b� Wb 1 Im�+rEaer; Thoff a" • Soft h� bili p�ft 6emi -cw dulon AG W YMNO w nwmumw + Power ow: 10 foot wig Rump aut WK for o e - • up to V GPM. eW4W WO. 16/3 SJTC mechanic ti scan pro"ovi, It UAWS way AM** • wb tm pmnq grounding � Them T , twwds: up to 24 W. / • DfeehC► qxe; t "fib, p1up. Optiorw 20 foot (CS11 iMW model numbers + �I se:I: arrbon- lenpth,194 SJTW with plant ea�d *r end "P" or AC" ryry �, thr" p rong grounding plug imowk paw. BwNl�eir�irel ;fiend on EM), t�hercr�o eed � pro�deti • i�' oor�nuo Superb etren� end 1401 (SK i<rtemant, ten; 8QQ e N mtrw Pe: • � t�t d i dry dw*1 to 4� s Pu go _ I I ii . solids *Ong repeb � N "Itkn. 1 ...., • t0� '' ups 31 fut • e I° I ► r i Won- Ioff wonuous j,� t� ry�w 1� I 14� rte mkwtl 2 w ` s C L 1 I I w � � ILu di Ilurr. l/La � � •� b - r - FM . nAG� O F_- 02 CD CD tj -0 3 IT11 11 MI F fn D . a- e � LO a� m m .- a: L.0 q a `� C p CL S` �c a x (D 1 ; ;T a �tl C.3 C3 m Ci 4� _ ITIf r g •� _IL IA Y y s '''' I III. _ k 3 0 _ c o •0 c c J CL J °• x -co � �• � � rte•. _ 9) Q. -< a' O C (/) 0 Q - D CJ CL (D CD c O ` stn C 0 I �� CL O 0 O `C i 3 N m M CL * °o EF CO `C 0 0 I CD Q cn n W �, CD . wcn x =Q33 N A� v O Cr 1 C" G 0 O x c _ 3'`� C -1 (J) C c 3 _3 a i :3 < Z coo = ?� o IT Invert 1 V (D 0 t. N �;, ocnumafccr rtum��nq Fi X NO. . 7153OG3121 Jun. 10 2003 02: 2'_''P'1 ST CROIA couNn' ' . SAEPTIC TANK -MAINTENANCE .AGREEMENT A'ND OWNE.RSHI? CERTIFICATION FORM Ownerfftyer ' ` t 3A C) f % Cd Mailing Address \� 3 Auj2,, 46,r --t-(Z d c Propariy Address (VarEAwicu required from planning Department for new consuxtcti=u City /State Parcel Idetatification LEGAL UFAMEMON • i 3 �f3 Property Location 'r�, ' /,, Sec, Ea , T N -R-1ji, Town of o e Y-<&f Subdivisiol7—ke— , Lot # CerdfIed Survey Map 4 ,/ , Volu - Me , page # ._,..�..._ Warranty 3Deed # 4 0d 7 , Vcluazee . f . .._, Page # l� � � .._• o Spec hom is yes 0 to Lot lines iden,iflabre yes 7 no Impropat ume and. meiateaatzraaf your septic system could result in its prom.mure failure to baudle waste. Propar Mai. euusigra Ofpusrap* nut *0 aseptic tank ovm three yem or wooer, if ncydedby a licensed punper. What you pat Ln o tht oast &Set the flgttotian of the septic task as a anal =s ata4o in the waste disposal eystgm, Tile pmerty owner agrees to submit to St Croix Zoning Dq aamew a rartifteadusa form, signed by tho c•x per s'�t mastcr plumber, joursYaymsaphsmber, restrietedpiwn_`w o a licensed pumper verify* tart (1) the on•site wumvater 31r%; , ❖ is irx psaper operrtiM coudilion atadlor (2) after ins tit;a acid puasping (if nocesaary), the septic tank is leas than 113 - ijl OF t:.: ilws, the uudarsiped have road the abova nequitemolits and 451" to Maintain t3se privats sewage disposal system wit!. ':hay set fbrtb, herein, as eat by t1wDeprtatentof Cos =arce and the Dspartmant of Nattual Resoarcos, State of Wisconsin wes* `s vi-"" stating +At your septic system bm been main t edmtsst be compl%ad and _reftzsd to the fit. Crain Cc =ty Zoz4 0k"F ce w s.of taus *M year oxPul4wdue. fii4�NA'TU b �; F . PLIC WT DATE o WAR CAItTIF &ITIG1N I (wo) Ddrtify that 4if sw eMuts vst °leis foss, are true to the best of my (Oz) I mowl I (we) air, (are) the ow �, paopenyy enib c y Vilt= of a Wt — ran ry deed recorded -:rj pegistar of De*dsc Office. SIGNA.'riM OF OPLICANT VATS +snorer pnv iaxfbrnt *%t is rXtis- tbpY46eatttod may resul in sl,e &%itary v mit being rcvok.ed by the Zoning Depa"r a > ;: w* lnelude with this appliertian! a stamped warranry dead 1.6om the �agistar o£Deeds office a copy of the certified swvsy map if rc fermae i.9 made im the w8?mnty dzex? POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I or y FILE INFORMATION SYSTEM SPECIFICATIONS Owner ' � Septic Tank Capacity lile g al ❑ NA Permit # t7 Septic Tank Manufacturer r`C ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 6 e ❑ NA Number of Bedrooms Q NA Effluent Filter Model QQ ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity gal ❑ NA Estimated flow (average) g al /day Pump Tank Manufacturer ' -e v . ❑ NA Design flow (peakl, (Estimated x 1.5) gal/day Pump Manufacturer !��sa 0 NA Soil Application Rate gal/day/ft' Pump Model (7 NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit O NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (800 5220 mg /L 0 NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L GI Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Collis) DNA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ in- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L NA 0 At -Grade ❑ Mound Fecal Collform (geometric mean) 510' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other; ❑ NA Other: ❑ NA Other: D NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency month(s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: ear {s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA monthfs) (Maximum 3 years) 0 NA Inspect dispersal cell(s) At least once every: 3 earls) month(s) C3 NA Clean effluent filter At least once every: earls) Inspect pump, pump controls & alarm At least once every: O month(s) ❑ NA "" D earls) ' Flush laterals and pressure test At least once every: ^- ❑month(s) p NA ❑ ear(s) 0 monthfs) 0 NA Other: At least once every: ❑ 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 ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third W 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. 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JBMOd u94M '919nel J9 i8 M 4514 I9wJOU enoge H1; Am sluei dwnd saboino Ja Bulind n000 au e s do ;leis wsisA e e uszoJ eJ8 suo.1!puo0 os usyM J 3 li 4 S •e0e ;Jns en138J31! ;ul 43 1 ; Il no uv e •esn o1 lo!Jd Joleledo BuloinJes eB84des a Aq p veal (s)X i 43 } o slu03uOO 044 ane4 po40elsp sit suo!ieJlueaUOO 4514 ;1 ' {g }lla0 lesladsip 0 43 eBewep JO/pue ssaooJd 1uew ey4 epedwl Am 1844 sl901we40 J9 Jo s;onpoJd Bulwied ;o souaseld 9 44 Jo; (s)juei wewleOJi 40640 SIMOd 941 ;o eon o Uollon aNV dfl u JOA N0il so T 989d 17 Z13 pAcE 1 9b .$ TATE BAi OF WISCONSIN FORM 2. 1999 C. 5'.3$04 WARRANTYDEED vA,"HLEEN H. WALSH Document Number kE61STER OF DEEDS 3i. CROIX CO., WI This Deed, made between Thom M. Boumeester and RECEIVED FOR RECORD Elizabet C. B oumeester husband and wife, . - -- — 10 - 23 -200i 8:00 AM IIARRANTY DEED Grantor, and Richard 0. Stout and Janet P. Stout, husband and wife, EXEMPT N CERT COPY FEE: COPY FEE: TRANSFER FEE: 1530.00 _ RECORDING FEE: 11.00 Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix _ County, State of Wisconsin (ifmore space is needed, please attach addendum): Recording Area NE 1/4 of NE1 /4 and N1 /2 of SE 1/4 of NEI /4 of Section 12- 30 -19, St. Croix Name and Return Address County, Wisconsin. ��q KRISTINA OG ND ESTREEN & OG 304 LOCUSt — j:Uirjqnn- W1 54016 032- 2044 -10 & 032 - 2044 -40 _ Parcel identification Number (PIN) This is homestead property. 00 pix00 Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of October 2001 homas M. Boumeester ' + lizab C. Boumeester AUTHENTICATION ACKNOWLEDGMENT Signature(s) Thomas M Boumeeste Eliz C . STATE OF WISCONSIN ) Bo umeester, husban and wi fe, ) ss. _ County ) authenticated this U of October 2001 t� Personally came before me this _ day of _ _ the above named • Kristine Ogland - TITLE: MEMBER STATE BAR OF WISCONSIN — (if not, to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, State of Wisconsin H udson, W 1 1 54016 - - — _ -. _ My Commission is permanent. (if not, state expiration date: (Signatures maybe authenticated or acknowledged. Both are not necessary.) . — , — _ •) + Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Company. Fond du Lac, wt STATE BAR OF WISCONSIN 800.6552021 WARRANTY DEED FORM No. 2 -1999 i Vol 1 � a 6 '�. —4t " Am MOMMA IL d4 . 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