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HomeMy WebLinkAbout032-2157-00-000 0 Vr 0 j 3 v 0 C7 c o 3 A. M 7! ° c �• 0 $< Z m Z o rn N 0 N W `C l�l • a� 0I o c o w � A W N '.y k N N d. , .' N N y N" N C3 W d U! 0 CA 0 N N d N O 3 O CL G f N O 91 C " a i co CD = _. O 4 Q _ W � I.•. N � V N 0 ::z O CL O W f0 CD 0 0 Err ! 0 go N -G 000o it �• = _ CO) ° ro Or o = v M a D m w C D v a, �+ ` = ID D O v� N N m 0 1 _ _. N O PC O. A 3 CD 7 a to -1 N • z -i M w N CD CL Z a m I D 0 T I m c 0 4 CD I I 0 I � a I I I I � I e N O O I 0 ti I m i oo w I rn O p i ti Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 463025 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: Stout, Richard I Somerset Township 032 - 2157 -00 -000 CST BM Elev: Insp. SM EIQv: BM Description: Section/Town /Range /Map No: 94 `I � 3 C.'S� 12.30.19.1352 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Z Benchmark G bi I Z) 1 I 9 Y Dosing Alt. BM ,1 5 Aeratiert - / Bldg. Sewer C S Holding St/Ht Inlet 11 - Z5 1 1� b Gu , `� ;, I TANK SETBACK INFORMATION St/Ht Outlet O 7 "1' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 1 1 Dt Bottom - L - 7 7 Z J Z Z ZO ,`1l0 Dosing Z . ��/ ��� Header /Man. /i - Z5 - Gi 7' Z_ Aeration Dist. Pipe Holding Bot. System f o , PUMP /SIPHON INFORMATION Final Grade z •Z 9") -7 Manufacturer i Demand St Cover I 13 7 5 GPM Model Number TDH Lift Friction Loss System Head TDH t 11 1 Forcemain Length / I Dia. / I Dist. to Well r SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length t No. Of Trenc PIT DIMENSIONS No. Of Pits Inside lea. Liqui Depth DIMENSIONS L� I `\ " SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufactur — INFORMATION Type Of Syst , ^ CHAMBER OR - C_' c `� em: (/�J G Ov\je� G+ , �i UNIT Model Number. DISTRIBUTION SYSTEM Header /Manifold Distribution Hole ize x Hole Spacing Vent to a it In �e Q y / Pi pe(s) ng 3 f �✓`��` Lengt Dia Length Dia Spacing i x SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over / Depth Over xx Depth f xx Seeded /S dded xx Mulched Bed/Trench Center Bedrrrench Edges Topsoil \— y 3 Yes No X Yes [] No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: //� / Location: 876 167th Street Somerset, WI 54025 (NE 1/4 NE 1/4 12 T30N RI 9W) The Highlands Lot 10 Parcel No: 12.30.19.1352 1.) Alt BM Description 4, , 2.) Bldg sewer length = ZZ I - amount of cover = i Plan revision Required? j_ l Yes _ No — Use other side for additional information. SBD - 6710 (R.3/97) Date Insep or's Si t we Cert. No. _ 4 V f Safety and Buildings Division i Coann ����� � . 201 Al Washington Ave., P.O. Box 716 Ytj 1C Madison, Wl 53707 - 7162 SanftBry Prrmi[ Number tw be ►flied in by Co De artment of Commerce (608) 266 - 325 463 02s— - --_ __ _� Sanitary Permit Application ~-� State Plan I.A. Number i In accord with Comm 83.21. Wis. Adm• Code. persoA�' ,. ° l may be used for secondary y purposes Privacy aw, s m) t Project Address (if different than mailing addres� �sj I. Application Information Please Print All InformatiolY r Property Owner's Na COU, Pareet N Ci Block M 5l u Lot N� ZONING OFFICE✓ �� Property Owner's M ailing Address A l� J. 7" 21 /��� � �� Prol�ny I.ocanon City, Stan Phone Number `e ottildin L1 _ k _ ;,;1i1i _ , � a t __ `_. rcle Typ f B$ (ch apply) T �� N, R E { X or 2 family Dwelling - Number of Bedrooms Subdivisiar. Name CS .N4 Number u Pub]iciComtnereial - Describe Use - — f St State Owned -• Describe Use i - ._.._....__._......�_ _ � ! L iCity_ ❑Village l�Ownship i?f`__ Type of Permit: (Check only one box on line A. Complete line B If applicable) -----�— d 2 --_215 f - o -000 �I New Sy st em —` ` - -- �'�''' `'� — 3 S " i Y• i_.. Replacement System 1 �J Tres Tank Rcplacc,__ Unly !� Other -Modification to Existi Svatem B. Tmit Renewal ._i Prrmi( Revision ! 7 Chof 1 I L 1st Previous Prrmi( Number and Dave issued eore Expiration 8 Permit Transfer ro New j Plumber bN'rier Y yj v of POW TS S em (Che al l that _ app1Y } I Non — Pressurized In- Grouted (�' ;Mpund > 24 in. of suitable saki `^. Mound < 24 iu. o suitable soil f ❑ Ai-Grade I� Single Pass Sand Filter Constructed Wetland rJ Pressurized In-Ground El Holdin Tank !: L Peat Filter , A.crobw Treatment unit C7 Rrc;rculatit:g Sand Filter R S nth Media Filte --j. &. _ cachi Ch ain , r Drip Line rl Gavel -lees P� ❑ Other (explain V. I)is rsal/Treatment Area In f_orma tiotu Design Flow (gpd) Design Soil Appl,'catiun Itate(gpdsf) vesper al Area kegtiirw� 's� llis Area Proposed (sO st� vation ' Y `t SU v 2de) Vl. Tank Info Capacity in Total _______1 - - -- / 2l T T _ . l —� �- V mber Man , fac[urer —� ���� ` /� E ( Prefab Shtr I Sheri Fiber + Plastic Gallorts Gallons of Units to 1 Concrete Constructed ' I Glass I New kxis[inP e J i Tanks Tanks I 1 Septic or Holding Tank Aar ubic Treatment Unit - -L I Dosing Chamber .— -- -;- -.- , —__ �.....__� � _ I , i _Z, r.._. VII, Re sponsi b ility Stateme C , the undersigned, at;sutne responsibility for lr altatinrh of the P01�1'TS shown on the afta _.. _ -- _ Pi, r,lcr's Na me (print} — '� Plumber's Si gnatur PRS Numt>zr � 11 , 3 /v $usiness Phent Number Pl[t mher's Addrr u (5rrtret, C s Code) "���_��'—" �'� `__._ �?j>� VIII. Count /De artment Use Only ! Approved r i D pproved Sanitary Prrm t i ee ,' ctucrs Groundwata r �D'etr Issaed�T i X Surcharge Fee; Issulr Agent Signature (Ne Stamp o App✓ nen Reaso for C ondltiolls of Approval /Reasons fur Di;app j SYSTEM OWNER: 3)0 �s t _ -- XW44 p 1 Septic tank, effluent filter and -rf dispersal cell must all be serviced / maintained aS I 'tits rJ��Q as per management plan provided by plumber. mss. . �„p. - � - •� 2. All setback requirements must be maintained as per applicable code /ordinances. Attach epetplet' plyns ho the County ouly) for the system on paper not'us than bla tt 11 itches in sine —I SBD -6398 (R. 01/03) c i le'd i pi d O I c o ir S " Gax JL 1 I czT apip� AT I e e' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 Divisio6 of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code ( County S4 Cra 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. 032-? 0(1q-g0 —Oed o W6 Please print all information. R ewe y 6 ate Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 6 3 Property Owner Property Location Govt. Lot N(_, 1 /4 /QE 1/4 S( Z T 30 N R 9 E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1'653 wq fee - Tr . City State Zip Code Phone Number E] City ❑ Village [.Town Nearest Road c�Sh 540 ( 1 15 699 31 c New Construction Use: Residential / Number of bedrooms Code derived design flow rate 5U 4 C� _ GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material t / Flood Plain a vation ij applicable General comments ft and recommendations: 5q km ele 4-p lIp1U `{ 00 beJtn�Js � � Q14. - k .75 / n pil I v S ' tt -7— r 0H 3u r sa, s 0 s slo s - uY 2n.� t Boring # E] Boring 5 y5 / S n�Q`5- � d t peA4 o S 4- Z6 c )a ® Pit Ground surface elev. `f o• 76 ft. Depth to limiting factor 1 9 in. Soil.A N 'o ate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Ro I G in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 i d-!Z tp 3/ -- 5i I 1rmab MA- c5 l V 5 S Z Jl- t 1 t' — S i cl Ztr m -.s 3 yi -tl _ G is r — 5. �+t 5 // Ian d, -7 n 2 r. K W h Z �T. - w serf a Boring # Boring E4 Pit Ground surface elev. rn q • 16 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 I b ti �f 4 I Z `- 5' 1 2 mfr cs i v.� • 5 .$ 2. )4 -yZ sib 2msbk nPK 3 yZ 1� I SL A m I * 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 Print) i ature Sch 'r�3Q? Numb Z Address Date Evaluation Conducted Telephone Number ZII CJ 5yoz� �o C�� Z 7-q SBD -8330 (R07 /00) a . Property Owner _S464 Parcel ID # Page L of F Boring # ❑ Boring 3 ® Pit Ground surface elev. qy'<b ft. Depth to limiting factor j in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 _ A — I 1 1? S i I 2 s JVf .5 • 13- 1 Si r — . y co 3 3� SL 54 m I _ - .9 c `n. 51 Aj ,19 ✓ 03 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 /ft 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 /ft 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 materi4l in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) r PAGE 3 OF 3 NAME S 4Cr �+ LOT# 1 LEGAL DESCRIPTIONAj E Xtir- i4 S 1 T W,N,R, q E(or SCALE: 1 "= J BM 1 ELEVATION / O _ BM 1 DESCRIPTION 4o 9 BM 2 ELEVATION '7-7,6 0 BM 2 DESCRIPTION ( I SYSTEM ELEVATION Tog gSdG Low -t f,oy ALTERNATE ELEVATIO 9 . jo j, Gl �. p0 CONTOUR ELEVATION RS. , tl 2 13 -3 a -Z � S yr% 99 0 G \J� G d SIGNATURE DATE w � • .�.1 'A r OWN Ak 1 v 9 �x � r►�. v \. ►, t i t :8 Ik® 1 V AV J i Orr AW In A� TO jb �� ��L rSl . Ah• _ k Y f t f + + p�6rAIa ,T srN � A ., .. � � r 1 .. F �.. �1 r, V L t,' � .J ` .'1!% � �. 1. .� `. R • � �, ;. ,, f'. � ♦ C , c ` .„ p ,� T r• �„'� `* it Cl VENT PIPE 12" MIN, ASJV i G:iADE $ 25 ' FROM DOOR, w- N:;Ow OR 4£ArN.ER aQOf FRESH AIR INTAKE JVNCIION BCx APPROVED WITH CONDUIT V NHOLr 'COVER FINIS 3E GRADE W1 PADLOCK 8 "' Cl RISER - �--»�' i i WARNING LABEL ......,,,,t .. j 4 " r. N . 3 x :!SLIT a �1 1 L Y WAMr R TIGHT SEALS i "� Gas - ' PpROYED A SEAT, JOIN'S WITH �PPROYEJ 1�'pRgVE PIPE ,1PS 3' s... j B ' `ON I } 3' O! o y�'0 Sit ID ,+ 1 c � ; 1 SOLID. SAIL PIMP 0:'i ELEV. 1'T, k '' _1 i a* 7 �.......- RISER Ex.T T;4 ! PEAMI TTED CNL IF TANK MANNFAC7 iER APPR GV D BEAD +NG U NDU TANK HAS APPROVAL CONCRETE PAD 5F E`�FI�AT:C'�5_ SiPTIC % DOSE TANX MANUFACTURER: ;;�, c"�e r h'��iP: ER D OSES PER DAY: .._ — Y. . s Z US °C GAL. LOSD VOLUME IhGJDrNG DOSE do """` GAL . F LpW9AC K: i6"? GAL . % Lr4Ri MAN W' : �' ...�"_ CAPAC I TIES: A - I �"'"` MODEL NVM$ERa 'vCmfS a SAL. SWITCH TYPE: 9 2 , INCHES x `, fNom'P MANUrACTURER MODEL NUMBER: ,_- G INCHES : 1 sk'o . SwIA CH TYPE: D i S C FARGE RA T r w -�"- -- GPM PUMP E ALARM WIR NG AS PER I LHR 16. WRY ERT +CAL DigFERE, CE BE. Gi AtiD 1 rBUijDN PaPE f,2 1" T :IN'MUM � SUPPLY PRESS nn�AI * / I� y r E£. •U CEM ♦ L�.L� + :'• �SRe.r Y , ry 1 ' ' � FE 'I.ON FArTGR rrrT � ..O.AL DYNAMIC K£AD = FE;,'^ '�'."ERNAi. DYME:�'S:ONS OFrL'Iyp T kl .. r � LI Qr ;JD t�—' �TFi `- T Dr ,ETER '..`�. iC£NSE ?�J`fBiR _ CA"' k _. [qGOULDS PUMPS Submersible Effluent Pump 3 EPO4 871 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. heat transfer. ■ Casing and Base: Rugged • Effluent systems • Homes Available for automatic and thermoplastic design provides AGENCY LISTING superior strength and corrosion • Farms manual operation. Auto- resistance. �' Stand Association • Heavy duty sump matic models include • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "I" or "C ".) factory. strength, and durability. SP ECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Pumps is ISO W01 Registered. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 3 /4" maximum. ■ EPO4 Impeller: Thermoplas- ■ 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 (40GC) continuous METERS FEET 140°F 6 intermittent. • Fasteners: 300 series ° stainless steel. •Capable of running g 30 ' --`" dry without damage to $ 2.5 Fr components. 25: _ Motor. a • EPO4 Single phase: 0.4 HP, 20 115 or 230 V, 60 Hz, 1550 RPM, built in overload with 5 15 automatic reset. a 4 • EP05 Single phase: 0.5 HP, ►- - EP05 115 V, 60 Hz, 1550 RPM, v built in overload with EPO4 .... . automatic reset. 2 ; • Power cord: 10 foot standard length, 16/3 -_ SJTOW with three prong grounding plug. Optional 20 0 % 10 2 3 0 ao 5 0 _ GPM foot length, 16/3 SJTW with three prong grounding plug — 1 (standard on EP05). ° 2 4 6 s 10 12 ml /h CAPACITY Goulds Pumps m 2000 Goulds Pumps ITT Industries Effective February, 2000 83871 i i Quicrk4 STANDARD CHAMBER Qluick4 Standard Chamber -- - -- 48" (EFFECTIVE LENGTH) l iL 34 " —__ 1 - SIDE VIEW SECTION VIEW I MultiPort End Cap — 0 16" 34" - -- __ . SIDE VIEW TOP VIEW FRONT VIEW ,����� � Quick4 Standard Cham�er��ominal S scifica #ians��'��I r � ' , "� � tk �`� ��f, � � � .� � MultlPort end GaQ Nominal S,�eciflcailons >" ' r; . Effective Length ' 48" Invert Height 8' or 1.25" Inve Height g" I —ILTRR T R Y TIEILB STAN 1 IMITEd AW RRAN (;,) The oclura ntag rly of 9 ch rharnber, end plate, wedge sad 01111" ac ks- n A —(, low f,1,. ('Ltr•.its ). Mnan als;aiicld and ore affil '•n a —hfiedd of do osit'l aewrdanoe With 'It ator's rc tr Pais, is w 1a' ni ' to 'f u dyirral pu¢Y,azcr t "Holder "1 a3alnsi cIelOCtrNn anal an± vvurk um. ;.ia ro. me year Iran the date that the -Plu; Pend is IJS 1 I 1 the „ optic Swlletn ooteIaining Ine Units; pnwrtled, howavec War f a ceplc Pennt Is not 1101011ed by aPplkablo taw, the Wn"Y period ,rU helkn .inn the dalo that r,aallauon ul the seplk system ,;ornnronces. T:, r.n se its wa 3niy riPhf S. Holder In „si notify Infitralor in wrdlny at It a;'Wa,e Headgl adars n 01(l Saybrook, Gonrlec:fcut weilm Nfh :erl t15) day o1 ttie aaegod deieot stfiu slur will supfdl of IaFenuml Unas fix ttn d to nlned t y + tferatnr Io be ;ousted by Ulm U'rniled Warranty. UA • r in Iltafurk Ikabdrty, sPe 1caIN er u :I&S in. nost of removal nmd• or ihslat is o ft. Unit's IUl 7H L MI .'[' JyARRANT” AN aFMEDiES N SI'W Ar,AGRAPH it) AR l- ( L L� VE It I rft ARE NO l OI HER WAFIRAN11u„ WITH H�~>PECT 0 IU HF UNI rS Nf L. DING N IMP[ 10 WARRANTtC - Or MERC r1ANTAnIL r '?; FITNI ION A AFRI IG LI.N PURF08F. S YSTEM S r IN I I c l 1A d Wa ly Sh Ml l e v- f 1. Da ­)j M the :h me sl a LjI.x'.I I t } - 10. tnal t terl'olor The Lir tai Wananty (Joey {,.{� ,a. I ,. d 1, InC 1k, r I utj ant 3 .1:— 1: , al O ('iCt.l r.ld }.-5. I trtt 1 start tot q I. W 1- taa"Is) li •udated damages, iroudng ioss o! Envilmmental On$fte W8$teWatw SotuftnC p r a and prof is 'bcn and state kMs, overhead costs cx other rnsS- or er<peng e ts inawrr+.d W the Hliltktr a any third tarty SLxcrlicssy xc , did igVrl Llrri tail Warranty (:pverdge are da> aye to the Unite doe w ordinary wet" and :ear, ahem ;lprl, apdideni, m :SUSe, abuso Or ne5710C`. of the L is !no Units cas ny subjocted l t ;icle trelfic w other ondilions - MIkh are not Pe o lted by he :nstal'atia'+ Irslnxaions, le kue to maintain the 6 Business Park PO n+m crouM covers sPt IrNyh in the installation ntstrucacn$ the Placennent -, f imioMPE1 materials Vile the system containing the tinily; failure of ad P.O. i? Q. E1�X 768 Ir,e unit's E the no t c system ilia lO irteproper siting a irnrlroper sizing, ext,asskre water usage, anprope oryase d4iosal, v improper Operation; 0, Cid Saybrook, CT 06475 r event not caused try In4llratOr. Ths Jinvted W'arrmly shall be vo 1 t the Floidcr :ais 10 comply with ail of OP IUM set fortrl In this Umiled 'fJa 1,y 860- 577 -7000 •FAX 860 - 577 -7001 F.Ithu rn ro evarrt 4 1 1 01 "sill atcr be espin We tw any loss o vanngr, to It a HiU,rer, the ! I or a :y Ihrru pady a oltrny k<yn nstallalbn pr snlp- n� /�I� L or 6 arty n Wuct Iiapiiiy (.4itme of r Older w sl y thirct p£N1y For this Limited Wa anly to - pp;y, the Units n ,t be insfalled ir, accorwme SOU - GG� - 4436 W"h of site av�dillons reooired ny state ano kXal codes; all Wrier app'icat'e laws; and n611ratort utslarLntbr. :nstructiuns. (tl No atha5entalno of Infllhak tas IF>6 aulhCr ly b change a exlervJ to s 1- A War. l y Nn w:u .. NY PPlies to any pang other Than the orvgi- rlI of Tr, auuva r;presanlc the Standard 4mtrkl Wa '%'1 uternrl by m!',eaWr A kr ntocl numbe of stores m v �:nlntias 1 uva d :4errnr ova an.y regonc n •6n13 Any Pon"flaw, JI 1/n116 st o, r(),'1taLt Inlnl''s Cq'Wnfe H%Ci(Narter5 N: Old SnYbl -k, 4 ;glna :fusel, prier lu suCn Purchlase, 1!r Cblallt a =opy cl Iite appllcabre warranty, and should calefloy read that wanar.ty,rtor to the p,frchase of Units. ).S. Patents: 4,759661 5,01 x,041; 5,156,486, 5,336017, 5,401,1 If3 5,40 r,4 1 ,i9: 517.903; 5,716,163; 5.588,778, 5,839,844 Canadian Patents 1 2,004 564 Othor patents pending. Infiltrate Eqi.,aluef and SldsiWinder a.e registered trademarks of intilirato Sys ens ir.c. Infiltrator is a registered !radslnark .n France- Infiltrator Systems Inc. s a registered trladema k ft MekiC;o, Contour, Contour Swivel Connection, Microl eaching, PolyTo SrTapl -ock, CharnowSpacer, Posit_oy , Ot, , 1, QuickPfay NEQt GLEO PAPER and Oulek4 are trademarks of Irllttrator Systems Inc. 0 2003 Infiltrator Systems Inc. Printed In LI.S.A. - POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of Sy$TSM SPECIFICATIONS FILE INFORMATION s, D NA Owner Tank Capacit d Se ptic an Cap tY Own p � ku- �r�.r� S T o NA i Tank Manufacturer e, Permit a� Sept b2 . 3 Effluent Filter Manufacturer Z'e O NA pfesc{QN PARAMETERS 0 NA r peak), Bedrooms 4 / d NA Effluent F'dter Model cI`� pump Tank Capacity al Q NA Public Facility ))Hite p NA low (average) alias Pump Tank Manufacturer B '& Pump Manufacturer E3 NA (peak), (Estimated x 1.5) G4 d Slide A a pump Model tion Rate . SD al Ides !ftp fluendEfffuent ou asty Monthly average" Pretreatment Unit Fats, Oil & f3rease (FOG) 530 mglL C1 Sand /f3ravel Filter D Peat Filter Biochemical Oxygen Demand IBOt} 5220 mg/l. DNA ©Maohanical Aeration d Wetland O Disinnfectian 0 Other: Total Suspended Solids (TSS) 5150 mg /l. 0 NA Effluent 4uallt Monthly average Dbpersal Cants) Pr treated Effiu Y and e In -Ground (pressurized) p - Ground (gravity) [� {n G hemical oxygen Demand (BOD 930 mg /L n Beoc Yge p Mound Total Suspended Solids (TSS) 930 mg /L O NA 0 At -Grade . c,fu /100m1 o Drip-Lino C] Other: 10 Fecal Coliform (geometric an) etric m S otrwr: 0 NA M: E7.E uent Particle Size Y in dia. ❑ NA 0 NA - - Ci NA ot her' othu: E3 NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE She Frequency Service Event a (M&* wm 3 years) C] NA Ej inspect condition of tank(s) At least once every: ,3 ear a Pump out contents of tank(@) When combined sludge and scum equals one-third (Y of tank volume C3 NA month(e} (Maxim m 3 Vests) 0 NA Inspect disparsal cells) At least once every: swig) mon el DNA Clean effluent filter At least once every: •�mottth(s) p NA Inspect pump, pump controls ik alarm At least once every, 13 (a) monthtsl 0 NA Flush laterals and pressure test At toast once every: P p earls) O Mortthta) ❑ NA Other: At least once every: -- O arts} ❑ NA Other: 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, Septsge Serv n c rack or. Tank s or inspections must include a visual inspection of the tankta foamy back or pondin9d t of effluent the ground surface. me the volume of combined sludge and scum an d onding The dispersal cell(s) shad be vi ins onding to of c he ck the e ffl uen t l in the ant an t he ground surface may dicate a fatting condition and eo P os the of effluent on the group s P immediate notification of the local regulatory authority. the entire When the combined accumulation of sludge and scum in any tank equals one -third (Ys) or more of the tank volume, contents of the tank shall be removed by a Septage Servicing Operator and disposed of A accordance with chapter NR 113, Wisconsin Administrative Code. All ndw services, including but not limited to the servicing of effluent flitera, mechanical or pressurized components, pretreatment units. and any servicing at 1.1tervals of 512 months, shalt be performed by a certified POWTS Maintainer. of com Iatian of any service event. A set vice report shell be pr)vtded to the local regulatory authority within 10 days p Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(sl 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 tanks) 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 does, overloading the call(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 riot 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; meet 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: e All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. e The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. e 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 sail 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. p e suitable re placement hold' Stank may avai due to last resort e to aeplacs failed li POWTS. Barring advances in POWTS °�' site �A O T sit tank e 13 Mound and at -grade nail absorption systems may be reconstructed in place following removal of the biomat at the Infiltrative surface. Reconstructions of such systems must comply with the rubs in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS TANK UNDER ANY CIRCUMSTANCES- INS OXyGEN. 00 RESULT. RESCUE O F ENTER A &EPTiC, PU MP OR OTHER A T REATMEN PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADWTIONAi. COMMENTS _ POWTS INSTALLER POWTS MAINTAINER Name Name 1')31,'e -( �•, c/fGY Phone Phone LOCAL REOUTATORY AUTHORITY SEPTAGE SERVICING OPERATO UMPER) Name I , !K lAJ Name � -- Phonel� - tS r✓ • �� .... Phon Wisconsin AdrMnlst Ative Code. This dpCUmsnt s drafted in compliance with chapter Comm 83.22(21(b)(1)(di &M and 83.5411), (2) & 131. COL TENAN - p C TA ), AIN T11 C. t 3E'2-) Town '��ltjilj.tk'7,NACLI£i „� >. __ ,,....--= e^,,,-. �-". � '..,'.��-- --`....w..,� "'"'"'."' L;Cii: +` ,,.. .....,..__.. "c;vIiilul. surveY , slap Spec 110't-l�lox ye's �:' tic to cc , o f yo vr aqtac fYqtp.m nuld Te at you 1)�� it 1 ,11 nf ;hl6gv La PH� S��V)L�p W16 -, PM6 the above vtlj,�M(:q, if end tilt vba- str tir, ;) hm knolvl�6,gc . ( wCJ p" min �o t all this Ir h" o " , 711�(�6us Oa"xm, be of 6 by Y� 1.0 I OY T rewnozd Mg 66,* 0"'m the rn C, 'e'T of the n,,,adr STATE BAR OF WISCONSIN FORM 2 - 1999 � S9$tO4 Document Number WARRANTY DEED K A i HLEEN H. WALSH REGISTER OF DEEDS ST. C:RO.TX CO., !JI This Deed, made between Thomas M. Boumeester and RE t;F1'V£D FDR RECDRD Elizabeth C. Boumeester husbanA and wife, 10 -23-2001 8:00 AM Grantor, and Richard O. Stout and Janet P. Stout WARRANTY DEED , husband and wife, EXEMPT M 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 (if more space is needed, please attach addendum): Recording Area NE 1/4 ofNE114 and N1 /2 ofSEI /4 of NE 1/4 of Section 12- 30 -19, St. Croix County, Wisconsin. Name and Return Address KRISTINA OGLtIAND ESTREEN & OGLAND 304 Locust HAirknn W1 032 - 2044 -10 & 032- 2044 -40 Parcel ldentification Number (PIN) This is home7property. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. (Is) MXOO Dated this 1 day of October 2001 homas M. Boumeester Pliza th C. B oumeester - AUTHENTICATION ACKNOWLEDGMENT Signature(s) Thomas M Boumeester and Eliz C . STATE OF WISCONSIN ) Bo umeester, husban and wi _ ) ss. ,,`` County ) authenticated this V � of October 2001 L Personally came before me this _ _ day of _ the above named + Kr istina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN _ (If not, to me known to be the persons) who executed the foregoing authorized b y § 706 06 Wis. Stets) instrument and acknowledged the same. , . HIS INSTRUMENT WAS DRAFTED BY - - A ttorne y Kristine Oglsnd H udson, WI 5401- Notary Public, State of Wisconsin '- -- -- — - My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) _ ,) ' Names of persons signing in any capacity must be typed or printed below their signature. Information Proraaslonata company. Fond du Lac, m WARRANTY DEED STATE BAR OF WISCONSIN 8W FORM No. 2 - 1999 1 -- N a N _ LLI M 53 i - .. cv tz T21E 398.4T M 812°0 I I r (Vi 53 LO I ; Lo w� i u i v Cl) 1 3Z ' 1 I 3 \ • 1 Roc 493.81' -- ,pb \ L O 63.19' X23'53 'E 557.E \ \ r- La. N , \ J LL � i ce, W e j sit ° 99V E 19E'9L6 L fteg.vzo 008 :: I VANN 3H1 d0 aA 1SM3 3H1 dO 3N11 JS3M A&&] 9 b05] -- -------------- � ' om o a d MEL@ E 110 A@ bTTd � -