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HomeMy WebLinkAbout032-2145-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 404962 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: Johnson, Cory & Kari I Somerset Township 032 - 2145 -30 -000 CST BM Elev: I Qb.v Insp. BM Elev: BM Description: � TANK INFOkMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic L ,e, . _� Benchmark c.f) B'0.c) Dosing Lc Alt. C4 Y.'_ V A_ �S• IQ . W w� Aeration Bldg. Sewer Holding St/Ht Inlet hips- . 3• O TANK SETBACK INFORMATION SUHt Outlet T g - TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet i Dt Bottom i �t Septic • + `,._� g !l• l�• 9 ? Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Q�l- �b� �.pz Final Grade PUMP /SIPHON INFORMATION C, 3. Z Manufacturer Demand St Cover GPM Model Number C�a 5 TDH Lift Friction Loss System Head TDH Ft Forcemain Lengt- I I Dia. t� Dist. to Well SOIL ABSORPTION SYSTE MVMF- Width Lengt � No. Of Trenche Z s IPIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DI S SETBACK SYSTEM TO P/L LDG WELL LAKE /STREAM LEACHING Maaa ir h INFORMATION CHAMBER OR ;,:6C Type Of System: UNIT Model Number: T r♦ �C DISTRIBUTION SYSTEM Header /Manifold Distrib tion x Hole Size x Hole Spacing Vent to Air Intake Q Pipes Length l� Dia Length Dia paciag SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of T7�e�od xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes i • ° ,, I No =ji COMMENTS (Include co a di pe cren 'es, persons present, etc.) Inspection #1: Inspection #2: D . /� /�� Ins �- -�— ✓ 77 �� Location: 803 15 th Ave Som4set, WJ 54 25 (SVy�1 /4 E�30N_R19W) Nathan Hills Lot 3 n S Parcel No: 13.30.19.1265 a ,�,.,�,,.,,,� 1.) Alt BM Description^ 2.) Bldg sewer length - amount of cover 4 Plan revision Required. j Y l No Use other side for additio ormati Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) g Safety and Buildings Division CO1mty 5 CRo I K 201 W. Washington Ave., P.O. Box 7162 N visconsin Ma dison, Wl 53707 - 7162 Site Address +u De artment of Commerce I/ S"o - O / /?- 7z e)(03 15(0 A V Sanitary Permit Application Sanitary Permit Number �0 cm 2- in accord with Comm $3.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision Maybe used for secondatyptuposes Privacy Law 815. 1 1(m ) I. Application Information - Please Print All Information RECEIVED State Plan I.D. Number Property Owner's Name Parcel Number C.drr1 � KAR.z T0A4S0rJ MAR 2 2 7002 I o32 21 - 3o Pro Owner s Mail' Address P Location 3 - �� � ,-� " ST. CROIX COUNTY to -7 5 55 Toca (,, rJ I't .Ac.� ZONING OFFICE 5U) 'A Ke, iA. S T N R City, State Zip Code Phone Number Lot Number 13 Block Number Subdivision Name CSM Number CU`TAG„i� �,2ovo N11J 5 651)°1 -C�38Z 0 A .-tiq P"o H1 H. Type of Building (check all that apply) ❑City V I or 2 Family Dwelling - Number of Bedrooms e �° `s ❑Village ❑ Public /Commercial - Describe Use ®Township ❑ State Owned st Road 3 3 X 62.5 � S Neare 1 bo 11 AV III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B If applicable) A. 1 K New 2 ❑ Replacement System 3 ❑ Replacement of TExisdnit 6 ❑ Addition to For County use System Tank Only System B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Perrot: (Check all that apply)(numbering scheme is for internal use) _4C A--(03 6r, 44 K Non - Pressurized In -Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treat ent Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate Sys�efn Elevation Final Grade Required Proposed Rate(Gals./ Days /Sq.Ft.) (Min./Inch) ,/ Mevation !o CA,O 851/ 51 1.2 — q5,8 VI. Tank Info Capacity In TOW Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Cons<n;cted Glass New Existiq Tanks Tanks n _ Septic or Holding Tank 1250 12 Dosing Chamber -7 ,54- --- Z 54 VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) P is Si ro M RS Number Business Phone Number R oo FTeu PaveLL, �'Z(o5 (a4 - 115 (031 Plumber's Address (Street, CIty, State, Zip Code) 1444 13 Ad 15ATMOO LT 54ar�, VIII. Cotmt /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) g p ❑ Owner Given Initial Adverse Determination .21.5 M ZZ 2� IX. Conditions of Apprgy"e ons for isa� pproval Ad ( od p, «•f0'Lt Attach complete plans (to the County only) for the system on pepw not leas than 81/2 x 11 inches In size SBD -6398 (R. 05101) SltE PLA PROPER'T'Y OWNER! CORLt t ('BAR= - OKOSor'j Sw� NEB 4 5ac. %3 1 300 T- cl W Tt LOT 3 PROPERTY LOC11'I'TON! N A-1A-rj I4 1tAt T w iJ O� S arvt�►LS S S"i C.2�- x C-� . 15 io `� A U RECEIVED o OCT 0 4 2002 ST. cROlx. couk-!; 'y � ZONING OFFICE O PVC. W 0 LLI i/ �VG � S AL? 0 M G• r b 9 az` q3 ' ID BM BENCHMARK! IEL 100 Q N A, %, � f t.A.6� 10. J V O A K ALi F.Sm vl. 0 15.8` C. C-"T2 ter I�ov��' �ouNpraT�o�J �t.Tp Pu,nxp CNAm8WR— Eton ����d�11 X226564 iV�W t'2�c� / 'l5 � g p► CO rti ran "['p rJ Ic. P.--, , _ � (� Cows ;0 1011161 9 3.15 ( 15 cl+amg aVus Pay.. Q e U e;t 90 1- t pax), Os�o wLOUl LC) ►O , pq- oQ �°�5` t3R -T Lim AtJVA L- Sn�u p►t3Svt� ►o^ M St3i7 [qGOULDS PUMPS Submersible Effluent Pump II 388 PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS ■ Shaft: Corrosion - resistant, Single phase: ■ Bearings: Upper and s tainless steel. Threaded + Built -in overload with lower heavy duty ball bearing Specifically designed for the design. Locknut on three automatic reset. construction. following uses: phase models to guard • All single phase models ■ Power Cable: Severe duty • Homes against component damage feature capacitor start rated, oil and water resistant. • Farms on accidental reverse rotation. motors for maximum Epoxy seal on motor end • Trailer courts starting torque. provides secondary moisture • Motels ■Fasteners: 300 series . y and Yz HP —16/3 SJTOW stainless steel. barrier in case of outer jacket • Schools with 115, 208 and 230 Volt damage and to prevent oil • Hospitals ■ Capable of running dry three prong plug. wicking. 20 foot standard • Industry without damage to • 3 /, -2 HP —14/3 STOW with with optional lengths • Effluent systems components. bare leads. available. ■ Designed for continuous Three phase: ■ 0 -ring: Assures positive SPECIFICATIONS operation when fully • Overload protection must sealing against contaminants Pump submerged. be provided in starter unit. and oil leakage. • Solids handling capabilities: • 1 /2 -2 HP —14/4 STOW with bare leads. 3 /4 " maximum. MOTORS w Designed for Continuous AGENCY LISTINGS • Discharge size: 2" NPT. ■ Fully submerged in high- Operation: Pump ratings are Capacities: u to 140 GPM. CSA2 .210 • Ca Stands p I} grade turbine oil for lubrica- within the motor manufacturer's C5A22.2108standards • Total heads: up to 128 feet tion and efficient heat ® By Canadian standards TDH. transfer. recommended working limits, can be operated continuously CM us Association • Temperature: PttefILR3854s ■ Class B insulation. without damage when fully 104 °F (40 °C) continuous submerged. Goulds Pumps Is ISO 9001 Registered. 140 °F (60 °C) intermittent. • See order numbers on reverse side for specific HP, M ET 40- 130 - I _. voltage, phase and RPM'S E,BH 1 II i i SERIES: 3885 _. _ I. 1__ .__ SIZE 3 /4' SOLIDS available. 35 120 i i RPM. 3500 & 1750 i 110 WiS21 H I ► 5GPM t FEATURES 30- 100 5 FT 0 90 V' 1 H ■ Impeller: Cast iron, semi- I 1 open, non -clog with pump- 25 80 out vanes for mechanical seal a 70 20 protection. Balanced for 60 - smooth operation. Silicon bronze impeller available as 15 50 o H an option. ° 40 ■ Casing: Cast iron volute 10 30 WEo M type for maximum efficiency. 20 5 2" NPT discharge. 10 ■ Mechanical Seal: SILICON CARBIDE VS. SILICON 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160GPM CARBIDE sealing faces. I ' I ' ' ' � � � 0 5 10 15 20 25 30 35 m Stainless steel metal parts CAPACITY BUNA -N elastomers• Goulds Pumps © 2000 Goulds Pumps ITT Industries Effective February, 2000 VVV B3885 culIU SChfi1C M111/PUMP CIIAI40ER Approved LntOid Manll"ie Cover wi Warni LA66 At.ta trued Wpgtht~r"t toof -_r__ _ Approved IJlrning I -1br.1 -+ �"tic tltstl tlttk , Vpnt Cap v/ 1 1. Ilnllm 4 -- lit n i mum - -- -- — bisconnect 1 - 1 /4 11 Wrrt/ nlrrte5 011 1 C ArrltrtM) Ot t dr 1- JttIN1S W1111 AhrltoMU htht , Conc. dick 3 oNto A , - Sol .1N SOIL _..�� - - -- ---�� of tleddlnd Under` flank -� n,tr� homy -m(l Matto Are Uri $et1:lrAtO C{rt:ults Humb @r of bows! her NY callnrl� 1;a11 hay hayff — bows , i ate Vdlutnp tit h"t;kt1ow!......1a 1_.r� 5 KA:� 1 26GAI7_ � _ ttitAl 0696 p Vnt utnt' ! .... , .. ,- �Z r r,�11 u►IS 11nk Fi�tnutar.tu►er: ' lrlk Slza- 5ell:lr. /1'iiml: �altuns A i11tn It;llluf , _cr - — Ct~pat;ltlps! ^ �.� Ilrhes n1 t;� ll nnt finlirl _ ------ ------ - - - - -- _ I a 2„ inches at• 32 G�11nns Swi lch .1 ypp ! MCA - - - - - - -- - - -- _�_. C v �nCItUS bt• 6111 1'111n F11r111tr1Ci.Urer: - -- — - -- n11� _ Inches oll a_ - Co l lv►►s 11 i rl inulln it I scii�►•y tl�� :� __. �c� - vrri.lr.�i 111 ttot•tinrp between rump Ott and b4ti-lbUthblt plea! JA rL3 pt 111 11{tlllllt) nt?flillt't'd 5 11 �111y pressur e!..... #s.. r i 1 l isss1sss 5� rpPt: tit rorce M AN x 1 - rrictitln PAttOe /100 Z inch 01"Pleter• rut-ce Main lobo bynamtr: lluadh I' rapt lnl.rrnll 11nt 111nIpNSitlns: 1_hngth 54 1 Wldth ( 4 Llquld bept 4'7 r L Nlnnber2Zlo5� ¢ bate 3L Wisconsin Department of Commerce SOIL EVALUATION REPORT Page - t — Of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County C C90 ( x 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. 037-- 2-14-5 3 Please print all information. Rev ed y D Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 2 Q 3 Property Owner ` Property Location CoR,y V KQ iz.� ZTb N � � tJ Govt. Lot ISU_) 1/4 M16 1/4 S 3 T 3 0 N R I Cj Xdor) W Property Owner's Mailing Address Lot # Block # Subd. ame or CSM# - 7 3 55 3o ca L.-r � �Pi�c e NATHAIQ H tc f._S City State Zip Code Phone Number E] City n Village [, Town Nearest Road "Ac- la G�4 - M 4 55 o i to c t )1 - r� z 5 v 1 btu AV New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement _ t E] Public or commercial.- Describe: Parent material I) IJ Kpta,J Flood Pldin elevation if applicable ft General comments � and recommendations: RacAr m e'^IDa D �ysTe7n� �L'dGVA i t oNJ d AT 0 4 2002 ST. Ci�01X COUN - rY ZONING OFFICE Boring # ❑ Boring eb o 14 pit Ground surface elev. 1 3 G? 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 2- f d 2 S i t Zen vY► r (m- ,'� • g 4. - _g lov 6 mS 05 Im 1 cl o,o , 31, Boring # ❑ Boring p 2 ® pit Ground surface elev. 3. ft. Depth to limiting factor / Q in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. $z. Sh. 'Eff#1 I 'Eff #2 e5 S i Z.mi� yn q 5 I n1 a-5 rnI CLO 1 .� iAL 4 - Ir7Yrz 41- Effluent #1 = BOD a 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Number CST Name (Please Pr i S S 5� F 'o 60- Address ed Telepho ne Number 14 l -y` & -j j3. oLjj 64.6 l o I (52 15 - 020 SBD -8330 (1107/00) Property Owner AS0[A Parcel ID # Page 1 of _3_ [] Boring p 3 Boring # 'Z .1� Z. � l� in. � Pit Ground surface elev. ft. Depth to limiting factor 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 r trim v- a zm=f 5 2mob m r w 1rn 5 �i aL Li 1 i Rp f — 33, g u ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor _ In. Soft Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft Eff #2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 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 /ftz 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 vice p rovider and employer. ' an e qual op ser er. If you need assistance to access services or p p Y The Department of Commerce is q need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 - 264 -8777. siro - 81-10 (R 07/M) SITE PLAN PROPERTY OWNER: �Q{�-'1 KA-e a lwl z►�} LvT 5w� ¢ S�cr t3 T3Ur.1 1 (Z Iccta.) NpTNA►.1 N ��,S PROPERTY LOCATION: (LSD -- 5T C?R.U K Ga A-v U d' d (� L R / �' I u E) BM BENCHMARK: 15L 10 0 -0 IJ AI (' � f -C, l iJ W O'& t< &V 'C. f5m M l � 5.f'i� co"(FR" 6f:� WOWS& F0 ,BORE HOLES:, Ron Friedell 4226564 3 N CAax,r i V 2opap:�y U"055 SITE PIAN PROPERTY OWNE COQ' KARL �0A05On) Sw � iJ�Yh SF3c. i3 T"300 R19 Q 1.07 3 0 A Wuts VLaT PROPERTY LOCATION: _ 5j C,�i X Co�►J"TY I ow�J of 50miza::50T AN , l� +I -yE 4 Bra � 51� P, 8� . B BENCHMARK: eL i00•O Top of NAIL 1N �oPIAK.TR$E . 1��NL�I AtZK I �o3.3 -f OF K)A« iN 2ndt icon rrl�!dell #226564 5( .�P.G `' tC�TA►�k� Pump CHAmt3�2. iw 9 3 Cgu. @ l02.5 Wi3G 30 CN�rv7i 3aa.s TcrT►0.l, 'N- o posao Wew 'ic,�J "('jASr✓o 0►) CorJv3�YfioNPi. 5ai�. AF3SbRPf�arJ Cov►p . IYIAPUA� 58D _ ID5fo2 P(•R SITE PLAN PROPERTY OWNER: Cog-► KArz..L Z SLo 1J� 4 l 3 T500 F- i,J Loz 3 0 Mli P4J Wit l.5 R.AT PROPERTY LOCATION: jowl o � _ Chi )c C000 S DP-1 v t, to }1 4-t5o con House � r PC, B3 B f3ry) �. B BENCIiM11RK! eL ipo.© Top OF MAIA, IIJ PopI.AR -TZoa t, 36frx ti ACK I o3.3 T of M AIL rN Eton 1; ri�!doll 4226564 Puw+p CHAIn � . T►JFct..?R.�s ?IV�J FI c. ��G CAFac.it`i CAAm6e4Z- 3 Cgs, Gd (02.5 l or3u - - 3o CNFm - r. Tom, WBu. �c,IJ t� 00 CorJu�yrJ'fioNPL soia.. AF35oRPfIOjJ Cov►p . IYliaNura�, 513c) Wisconsin �Department ofCommerce SOIL EVALUATION REPORT Page 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 ✓ r / 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. Please print all information. R sewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). + ZZ Property Owner Property Location S ,,D� h Z( j rn Govt. Lot i( Z : 1/4 S+ T �j N R 1 E (or W Property Owner's ffail' Address Lot # Block # Subd. Name or CSM# City Statg Zip Code Phone Number ❑ City ❑ Village 4 2rTown Nearest Road ��► R; M New Construction Llsel"2�, / Number of bedrooms Code derived design flow rate S"d GPD ❑ Replacement ❑ Publi or commercial - Describe: Parent material &7 Flood Plain elevation if applicable /1 � ` ft. General comments _ and recommendations: Sy S fe e � Boring # � Boring 9 " F - 1 pit Ground surface elev. ft. Depth to limiting factor / 6� tn !_ "a Soil 'on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary. Roots GPD /ftz in. Munselll Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 - a Gt� 12— � - a ® Boring # Boring O-Pit Ground surface elev /4 a ft. Depth to limiting facto 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. /r *Eff#1 *Eff#2 S=f� /0 , s1 62 G� 0 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 1 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Nam ease Print) iyn J C T Numb 6 v Address Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00)' Property Owner Parcel ID # Page of ❑ lil Boring # Boring `-�j Pit Ground surface elev/ /� y ft. Depth to limiting factor m. 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 ❑ 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 1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = SOD > 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 material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07/00) Soil Test Plot Plan Project Name Brian Boardman Sha it Address 824 East 11th St. New Richmond Wi 54017 M #226900 Lot 3 Subdivision Nathan Hills Date 5/13/01 W 1/2 NE 1/4S 13 T 30 N /1319 W Township Somerset Boring Q Well PL Property Line County ST. CROIX (kB+rVRp Assume Elevation 100 ft. Top of Nail in Poplar Tree System Elevation 95.8 *HRPSame as Benchmark AltJBM Top of Nail in Poplar Tree @ 1 03.3 ' Soil Test was done to fullfill zoning 98' requirement, test may not 100 99' be suitable for desired builind location Alt 35' BM 200' 35' 35' 3 %Slope 300' 35' C B- Pro Town Road T. N F+ L,T R.A.T i O O CO u.S FNiSN GfLAOG l FO of 0-14'Am3 eL c n 2 rru 3 MOBS C N AMi3��SP 1. pFi �.TA►TdK.. �'� 1 G,N C,A(�G i T` V e►JT �t PAS �.. � (o FR.� rn GD•CN CAN f � l�Es1C�rJ bASGsD 00 CptlVeOT+CX1Al. !SOIL, 1A�35o2'f Comp. mA�vwal. �b-g�t,Z(�R. I CuMBINAI sLr _ttc tnFh; /ru��r COMER _- (Ntl sCa le� , Approved LoWlt Mar,hnte Craver Wf tit Wahntttq LA lei Attarhed IJt'atherpruur -- Approved 41,rt►in I_�br.l - Juuctlutl [lox Vent Cap �.-/ d r 11 frf fill nn r 47, IJ { tt i mltm - - ' — Disconnect .I 1 2 � /4" - t � Itoie _. ►tip Al arm b oil 6, -- 1 C t AP PROM Urt d �- JttiNiS W1111 U Ahr►t rlrt , Conc. ttinrk 3' UNtU 5rtf_ 1 D SO - - - -� — ' ---- i' - - �" of tiedcli ud UndeN fiattk -� tnr At-r. Ulf 5�1i:rrr�tr! cir�ults Number tlt Doses! 4 her bay c, in f, r r uin .•rr,d A I r ' es" . t 1 u r r Lal lans hpr bayllf o"U Imo - -.. Vulump tit hatkrinw!...... ►� __ 5. r� tinns t Ink M1trlt rhr. till _t SKp�,., _ I _ +✓GJ -� — � _ tutal buss �altous Almon 11ft fill rlr. t:t11 er ��_ �I�c,T1z.��___ __ — Capac I t� es � A � 5 1 11c{tes nr•40 [;�1 t nns ttnrlri fl umber:_ _ 1�s�.----- .____.._.__ -- ltic let nh. GA iypp: 1 l lr Stritch Y1 - - -- - - - - - - -- C S jttcNt ?S tt r _Ga �tic hes Off- Ga11r,n� F1r,dr' 1111mbpr -- ? r __--- ---- - _ �M fetal ►,, ► ► �_ �nches br CaI "m ti f 11 f nnnn it { 01,14—ge g Vrr I fral lil r tt� hpnc; e 11P[weert pump Urf` stud blsthlbuti�att pipe+ rpet tllnirnrnn tterlUit rd c, Mply hr e � s s t ! r �victitill act 00 reetl � ► 4 - -1 "eet 4.5 reef: nr rot F11♦in x q4 2 inch Diameter r-m-ce Main Yutal Dyn amic Nead4,, reet lntrr Yank i)lmpttsinns: 1_e_ngth�4�__; W1dth(�.5i Llqu {d Depth ¢�_ • Llcettse Nlnnbet•�21o�.�4 -[late `��b2 [q GOULDS PUMPS Submersible Will Effluent Pump FMIME 3885 PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS ■ Shaft: Corrosion - resistant, Single phase: ■ Bearings: Upper and Specifically designed for the stainless steel. Threaded • Built -in overload with lower heavy duty ball bearing following uses: design. Locknut on three automatic reset. construction. • Homes phase models to guard All single phase models ■power Cable: Severe duty • Farms against component damage feature capacitor start rated, oil and water resistant. on accidental reverse rotation. motors for maximum Epoxy seal on motor end • Trailer courts • ■ Fasteners: 300 series starting torque. provides secondary moisture • Schools stainless steel. • '/3 and '/2 HP —16/3 SJTOW barrier in case of outer jacket with 115, 208 and 230 Volt damage and to prevent oil • Hospitals ■Capable of running dry • Industry without damage to three prong plug. wicking. 20 foot standard • Effluent systems components. • 3 /4-2 HP —14/3 STOW with with optional lengths bare leads. available. ■ Designed for continuous Three phase: SPECIFICATIONS operation when fully • Overload protection must • 0 -ring: Assures positive submerged. be provided in starter unit. sealing against contaminants Pump and oil leakage. • Solids handling capabilities: • '/2 -2 HP —14/4 STOW with 3 /" maximum. MOTORS bare leads. • Discharge size: 2 "NPT. ■Full submer ed in hi h- • Designed for Continuous AGENCY LISTINGS • Capacities: u to 140 GPM. y g g Operation: Pump ratings are Tested to UL 778 and P P grade turbine oil for lubrica- within the motor manufacturer's • Total heads: up to 128 feet tion and efficient heat ByCan Can Standa recommended working limits By Canadian3tandards TDH. transfer. Association • Temperature: can be operated continuously �c us File teLR38549 04 °F (40 °C) continuous ■ Class B insulation. without damage when fully 10 1 (60 °C) intermittent. submerged. Goulds Pumps is ISO 9001 Registered. • See order numbers on reverse side fors ecific HP, p METER F130 sFl � I� SERtES:3885 voltage, phase and RPM's 120 E1 , E: 1/4" SOLIDS 35 available. - vuE2 R ► 5GPM RPM: 3500& 1750 110 I FEATURES 30 100 FT j 90 we, ■ Impeller: Cast iron, semi- ° a 25 " ` !_ open, non -clog with pump- = 80 WE11 H - out vanes for mechanical seal a 20- so protection. Balanced for Z smooth operation. Silicon o wj�a bronze impeller available as 'S 50 eo hi I an option. 40 ■ Casing: Cast iron volute 10 30 who M, - I- type for maximum efficiency. 20 wIEo L -- 2" NPT discharge. 5 io L_ 1 j. �. 0 0 I 90 + 100 + 110 120 130 140 ■Mechanical Seal: SILICON � � � CARBIDE VS. SILICON 0 10 20 30 40 50 60 70 80 150 160GPM CARBIDE sealing faces. ' ' ' ' ' ' ' ' ' ' ' ' ' Stainless steel metal parts, 0 5 1 0 15 20 2 30 35 m CAPACITY BUNA -N elastomers. Goulds Pump © 2000 Goulds Pumps <& ITT Industries Effective February, 2000 VVV ���jjj 83885 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa j o 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Permit # C0R- kj Qgz o O al Septic Tank Capacity ❑ NA � 2 r j0 fpZ Septic Tank Manufacturer Is ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer L%A' ❑ NA Number of Bedrooms G�- ❑ NA Effluent Filter Model A _ 10U ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity 54 gal ❑ NA Estimated flow (average) q.po al /da Pump Tank Manufacturer 5KAw) ❑ NA Design flow (peak), (Estimated x 1.5) 600 gal/day Pump Manufacturer ❑ NA Soil Application Rate ► 7 al /da /ft2 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 (BOD 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 JR In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510" cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: O NA Other: Other: ❑ NA ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA Ili year(s) 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- 0 month(s) (Maximum 3 years) ❑ NA lW Y ears) Clean effluent filter At lea ❑ month(s) st once every: I Q year(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ® year(s) Flush laterals and pressure test At least once every: ❑ month(s) gL NA 13 yearls) Other: i At least once every: ❑ month(s) ❑yearls) ❑ NA 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 tanks to identify an tank s) missing or broken Y Y g e hardware, identify Y an 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 (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 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. G 1 MW 14/0 ) Page 2 of 1TART UP AND OPERATION ' For new construction, prior to use of the POWTS check treatment tankis) for the presence of painting products or other chemicals that may P 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 cellls) 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. 00 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. < <WARNIN(3> > 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 0 15) 651- 25024) Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name �5T C,e0jX DfJ Phone Phone C� D 5) Wtp — + g o This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) 0) and 83.5411), (2) & (3), Wisconsin Administrative Code. r ST CROIX COUNTY • SEPTIC TANK MAINTENANCE AGRBEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer l , or 4 �n � -11, 4A) Mailing Address 7 3 SS J 0 0 0L p �� c.e Property Address g 3 � � u /�P� � �� ��o ��� 1 6 7 0 ) ? (Verification required from Planning Department for new construction) City /State Alew ecA e nd wJ Parcel Identification Number LEGAL DESCRIPTION Properly Location Al ry /4, %4, Sw. / 3 1 .30 1 / l ', 1 -*m of -5O ML ✓` S C4 Ne 'l Subdivision 1✓ck +A-\ a 6`1 61 s • Lot # 3 Certified Survey Map # � S / (o y G , Volume g , Page # .5 ? Warranty Deed # ( q 3 W -'f , Volume . Page # Spec house ❑ yes 9 no Lot lines identifiable J23 yes ❑ no SYSTEM MAIlVTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, joumeymanplumber, restricted plumber or a li cense d pumper 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 less than 1/3 full of sludge. Uwe, 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 flWk your s< ptic system has been maintai:. d must be completed and rebarned to the St. Croix County Zoning Office within 30 da of the year expiration date. 3 / Le-il SI A OF APPLICANT DATE OWNER CERTIFICATION I (we),. rtify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of th roperty, , above, by virtue of a warranty deed recorded in Register of Deeds Office. 3i 7 7 G OF APPLICANt DATE « « « « «« 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 U 1855P 496 STATE BAR OF WISCONSIN FORM 2. 1998 7 3 8 m Q WARRANTY DEED KATHLEEN H. VALSH Document Number REGISTER OF DEEDS ST. CROIR Co., NI This Deed, made between Nathaniel Stephen Enterprises, LLC, a RECEIVED FOR RECORD Wisconsin Limited Liability Company 03 - 18 -2002 10:30 AN WARRANTY DEED Grantor, and Cory Jay Johnson and Kari Ann Johnson, husband and wife, EXEMPT t REC FEE: 11.00 TRANS FEE: 210.00 COPY FEE: Grantee. CERT COPY FEE: Grantor, for a valuable consideration, conveys and warrants to PAGES: 1 Grantee the following described real estate in St. Croix County, State of Wisconsin: Rec rdin Ana Name and Return Address t 3, lat of Nathan Hills in the Town of Somerset. 032 - 2145 -30 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: municipal and zoning ordinances and easements ofrecord, Dated this / j day of March 2002 NA)FIANIE� EP)�EN E ERPRISES, LLC + r By: Brian K. Boardman, Member r + AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ) ss. ST. CROIX County. ) / � Personally came before me this y /x day of authenticated this day of March ' 2002 the above named Brian K. Boardman, as Member of Nathaniel Stephen Enterprises, LLC r TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledge the same. authorized by § 706.06, Wis. Stets.) j THIS INSTRUMENT WAS DRAFTED BY Judith A. Remington, Remington Law Offices ' srE>~%fANyE /Y ��S / A 1 d P.O Box 177, Ne w R ichmond. WI 54017 Notary Public, Statc of Wisconsin (Signatures may be authenticated or acknowledged. Both are not M ommission is perms ent. no , stay expiration ate. necessary.) (} a Q ) *Names of persons Signing in any capacity should be typed or printed below their signatures STEFMK A DE.SlNO WARRANTY DEED STATE BAR OF WISCONSIN FORM N., 2 - 1998 Notan�Public -State of Wisconsin 1NFORMATION PROFESSIONA COMPANY FOND DU LAC, WI 800- 655.2021 m 624.80 • 4 .. - 5 g x _. J N / � X40 930 9865 Ch 9 PITT _ 59.5 x \ '9 • 3 S FT �� ��` O N \ 987. ' 13 A 960.1 ° x °`4 (( 957.6 C �. ol `�� 930.3!- / 954.3 ! , / 950 oo 33.1 ��� 0� / x --:�so � % `- -- m p \\ O V N �5L 375.04 :.� \\�\ _WES U AR\TE 6 x 95 .6,�� a% S89'2O15 W 2 6 E 1 I ��x 961.9 -- � .� � � o \�, x � o� 952. \�, . 983.9 \ ,ru�, er , ,, \`\ �o \ .'1 961-4 , . �) .S ! � • 1 . \' .. � \ � . 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