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HomeMy WebLinkAbout032-2153-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety aW BAIding Division 4 INSPECTION REPORT Sanitary Permit No: f t 463028 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 - 2153 -90 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: / aP►k, r 15.31.19.1332 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Benchmark �,s� l . 5 103,54 reCS Dosing Alt. BM n ' b ' W rLJ ` �' Bldg. Sewer �Z •G C 1 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet �— TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 5 / /5 i 1 Dt Bottom ' Dosing r' �. i i Header /Man. 475' Z Aeration Dist. Pipe Holding Bot. System 4 74 Z_ PUMP /SIPHON INFORMATION Final Grade Manufacturer emand St Cover �S 5 Ov GPM ,� ` Model Number / 45 TDH Li Fricti j s System Head TDF- , �� 'J Forcemain Length Dia. f Dist. to well V � SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONSQ •I �� v� 1 _ ► `-� �. \ �� SETBACK SYSTEM TO � P/L BLDG i WEL LAKE /STREAM LEACHING Manufacturer: Type Of System: INFORMATION CHAMBER OR . d i G � wee i .' f �J 1 r � / w /./� — UNIT Model Number: n o i DISTRIBUTION SYSTEM ! Gr Jv �p 7-3,r ZZ :-- 4 15 �D�..�, Header /Manifold �� Distribution x Hole ze x Hole S acing Vent to Air 1 take Pipe(s) Z N k- c Length Dia Length \ Dia \ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth o T eeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges \ Topsoil 3. Yes No Yes - No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2193 59th Str t Somerset, WI 54025 (NE 1/4 NE 1/4 15 T31 N R1 9W) Shadow Pines Lot 34 Parcel No: 15.31.19.1332 1.) Alt BM Description = ��'� —� ca, �° $ 2.) Bldg sewer length - amount of cover = / Plan revision Required? Yes No /t I Use other side for additional informa ' n. _" � IL SBD -6710 (R.3/97) Date Insepctors nature Cent. No. Safety anti Buildings Division County --- - I 7N*11 4swcons1 20I W, Washin$!on Ave,;., P. 0, Box 7i62 �7" �Ya Madison, WI 53707 - 7162 i Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 Salutary Per ml,k ica iQ �� Pma LD. Number In accord with Comm 83.21, Wig. Adm. Gods tx ( Pe tnfar [itrn y May be used for secondary v y purposes Privacy Lay�si tl�(i j,Jl� oject Address (if different than mtlihrtg address] I. Application Information - Please Print Alt Information � Vr-perty � C01 Owner's Na me ZONING OFFICE 2/?3 Parcel # Lot # B� lick p Praperry Owner's M ailing Address _ Property LuCatinn j . city, State Zip Code t Phone Number '��r -- r�i•.�t6.5ec :io,: �� j 46�, circle n 1 1 II. `--- / /0 E Oro �� ) 33Z Type of Building (check ail that T N; R t apply) 1C�L or 2 Fattul Dwelli__ i CSlvi umber 1 y rig - Number of Bedrooms L1� Subdivision Name N ° J i'ublic/Corntrcial Describe Use ._ __ _�t a✓__� -5 _ �� { L State Owned - Describe Use .. �% i s�I Cie, g (I ownship .� � �y r'T - - _ — - --� iIi. Type of Permit: {Check only one btix on line A. Complet line $ if applica , New System ❑Replacement System Treatinens/Holding Tank Repiacenterit ©n:y Other Modification to Existing System T R O'f 'Permit Renewal ermir Revisian m ange of Permit'1 ransFer to New ' Li "`v Permit yumber atxl ISate (s,ued ore Expiration.--- --- Owt>rr �/ / "7' { - Type of I'O WTb' System (Check all that a p ly) ---- Non - Pressurized tn - tari>urui Mound ? 24 in of suitable soil is Mound < 24 in. of suitable soil Ll At -Grade 1_ Singlo Pass Sand Friar C onst ruct ed la nd nd Pressurized In- Grouad ❑ Bolding Tani: iJ Peat Filter ❑Aerobic Treatment Unit Recirculating Sand Filter t� Recirculating Synthetic M edia Filter e aching Chamber C Drip Li Gravel -l ess P ipe i.� Other (e xplain) r V• Dis /Treatm Area Information: ^` r i Resign Flow (gpd) Design Soil Application Rate(gpdsf} Dispersal Area Required {se,; l Dispersal Area Proposed � System Elevation 1I Tank Info Capacity in Total Number - Manufaututer T Prefab site Sleet Fiber 1 � -- —' NlaSiic Gallons Gallons of Units ) Concrete Constructed 1 Glass 1 New Existing -•��//�� ',^^ r; Tanks a a„to r51, ►t /t� e,", G �.{ C, Septic or Holding Tasrk 1 Atlrobic TreatnYnt Unit Dosing C hamber VII. Res nsibilit Statement 1, the undersigned, assume respon sibility for ' 1 114a ll a tion of the POWTS shown ors the attached pl ans. _ Plumber's Na trio (Print) Plumber's Si gnatire MP ItS Number — � Business MM: \umtxr 1P t Plumber's Addre ss (Street, City, State, Zip Code) VIII. Cotmt !Y/Dep ar tment Use Oul roved Disapproved Sanitary Pctmit Pe (includes Groundwater Date ssu Issuing re, Signature N ..I?, ps Surcharge Fee i 65 ,ji _.. 1 i�'en Re ason fur _...J..,._.. t.X. Conditions of Approvalfkeasans for Disapproval '! SYSTEM OWNER: 3� /va /o>< r Cc ow ,'ti- t. Sepik tbr*, effluent finer and j / ct.j'ec>A 5�►o,.�w v � - (,fl 'w disposal cell must all be services L Taint i:r z d f as per management plan provio e , i 7- AN setback requirements must ne marr to , e i , (_) g � 0LJ�� as per applicable code i ordrnanr.es. ^ f t "� Attach complete plsua (to the County onto; for ' the systetu on, paper not less than 81 2 x i 1 iBeim to size � - V r M �fl A i vd ? : epo.R pd g, or d Wisconsin Department of Commerce SOIL EV V'Reviwed T Page of Division of Safety and Buildings in accordance with Co 85, Attach complete site plan on paper not less than 8 112 x 11 inc'a in size. Pla 7 include, but not limited to: vertical and horizontal reference point ( M), di I.D. 1 i n a location n i neare Z G pe rcent slope, scale or d me s i ons, north crow, and ocatio a d stance tone 6 Z 5 6 -" Please print all Information. ST. CR Dace Personal information you prov ide may be used for secondary pu es (Pr' cY Law, Property Owner Property Location U '�7<J� /\ -,p Govt. Lot � 1/4 *,X S T l N R 1 E (orX Property Owner's Malting Address `, Lot # Block # Subd. Name Or CSM# City State Zip Code Phone Number t:1 City ❑ Village aTown Nearest Road r\ � J c (7 /S),5 I 6 - 50 New Construction Use: q Residential / Number of bedrooms 3 - Code derived design flow rate 1 69 U 0 GPD ❑ Replacement ❑ Public or commercial - Describe: _ Parent material 1) a 4 Sk Flood Plain elevation if applicable ..[i General comments / /+� and recommendations: 5 V _ 4&W"' &W "' �t C U - �y �/ `i a Boring # Boring s U� pit Ground surface elev. ' ft. Depth to limiting factor �_ in. Sol 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 3 S l- J r C_ O D " W ir C 5 luf / 20 s o W\ Boring # ❑ Boring Pit Ground surface eiev. - t - , qO ft. Depth to limiting factor _W " 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. 'Eff#1 •Eff#2 1 - e (0i's -' L � L �, k' O ra r _ &5 - r Effluent #1 = BOD > 30 < 220 nVL and TSS >30 150 mg/L ' Effluent 42 = BOD 5 30 mg& and TSS _< 30 mglL CST Name (Please ) - - tore CST Number �- 3a Address Date Evaluation Conducted Telephone Number t_�1 Gnu l ? - D S `715_- 76 0 I - • y, Property Owner S fC (} Parcel ID # f�(IT I Page � of ❑ Boring Q 00 ✓ a � # S Pit Ground surface elev. o ft. Depth to limiting factor Z in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 6-11 G .0 L c o -1 I- Y/( v ` Z .311 ❑ 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-1 Boring # ❑ Bo Pit Boring ng ❑ Ground surface elev. ft. Depth to limiting factor in. • S(if 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 •Etf#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 material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. w seoa3 cR.broo) i I _ Y PAGE —3—OF NAME LOT# LEGAL DESCRIPTION 'A '/a,S T ,N,R E(OR)W SCALE: I" BM I ELEVATION BM I DESCRIPTION OX ��� � fT BM 2 ELEVATION r BM 2 DESCRIPTION SYSTEM ELEVATION `7, SYSTEM TYPE O!> »l1 j e-14 b �0 Jz lb s, fi J SIGNATURE 7 DATE r - e � Buildings llivi,i Washington Ave., P, �. =! artment pf CO Madison. WI 53707 164 , ? Sant --- =�� ,}�- -.r�__. _ _ i f (60A) ..tr!i•3151 Y t'errnit hurrobr7r (1 to be flOaf in b C 1 Sanitary Perrnit I r A �__lic c - � 3 02 �� =,,, d wire Comte 63.21. Wis, Adm. Code, pp GGEI state Plan 1.b'. Number 1___. rel be usm for seconiiary purP�s Privvac.y Law fs1 - ion YOU pruvicir _ *1)(M) i• APPI�tiort Intor `._``---- -'--�— �, j _ _ tttution - Ple�te Print Ail —.,P.. , 111). ) Address (it'dif'fcrent Man ma (I address) Intar L- a.._... PrnpErry Owner's -- _* 21 S $T. - -5 ` R I x C U U: • j q ZONING OFFICE eel Liu r // P r"P*rty Owner . ailing Addreat Ci -`" �"'.~ `��L t,� -tee �� ! ✓ c � , f Yropeny Locaann ----- _- t d,: *,.,t1 Phone A'umbes 77 • 'I `ype of $uildin ---- _ �'�_ /�.• ai (cha7t that aP'PIY) l i ur 2 Family Dwatiing - Nwn rat M T � N; R or Al r f a4drooms t, Subdivision Pubtic,'Comntercial - Describe Use rate own _ _. - -- ba - rscri __......_.._ - - ' Ty of PO rrnit. (Check only Dort - _ eCity_Qviltaya Gwn3hip of j A - 1 � ' "�" box line A. ompteta II B If applicable)— I rR New sys tem ��' ......._ . t. 1te i acetnera System } -- - — 03z Z- !S 3 — i r p Y 'fresirrkaV . CJing Tank ) [till f �� _ - other Moditicsrson w Exisunt, Systairr Permit Renewal iJ Permit Revision 13eture Expiration g 1 rrnzit "1'rarr fdr to dew�� �� -1 "� _._ _ _ _j l.rsr Previous permit Nurnt>er anet 1�atc 1 „ued ( Plu t Ow of'OWTS S stern: (Check al l that _._n�r 'Non - Prrssuri2nd !n -ap r- ound r_, Mound > 2a sui in. of C W r !r sty ;; °'"ou"d c 24 u;. of suitable soil At -Uraae f Jttt{(ir Pass Sand filter 1 Pressuriltd Ire CirouRd L' iaCclirt T ank f _R S1etii htadia Filcer 8 Near ! iltrr r' ,erolsic Treatment Unit 1 Tier ircutautttl Setter Filter ``. Litt rS h* ' -odia -•••IC _..� Laaa.in C 7f111x:.r :._1 F >'l? jr k.�� C.i7'71VCt fC95 .t C � aUTrw'+ttn Arr� Infat'risaitlotl: _ U '� Other to a!n I Design F low (&W) Assign So Application 12at - s�'-' b4per'sal A rea jee rd is 61, - 2 C+ersal Area Propos /t System vatirur _­ _c. Tank ""—` -- 0 � C V ( !nf Capacity in T ” p Number 7 ' /a ?2- • 50 i Gatlo I ue anu`ac r Prrfi _ p its of Units Site Stye! !"fiber �Tew z I + t✓ ��� , rQ1� - t`;l�) Cana to CcrRStruct i ! til:ss PlastC Setx;c ur Hukriny Talil - —— � _.__w. �eroAtc reunrent L nit T .. ..`_- ! r 1 j Rc9po�� tjh ;ltd Statem t, Plu nber s arsurty respusthllit �' for " !s taliatiw of the PUt� x ttawr► on shown ._ ! 't r1 is Na me (Prirul a _ plates, _ r 6natur �'13PkS Nt:mbrr r °d7 13usincss Photrr Nurubi r __ FCumher'e Addre $s ((Suter, - city, �°���/�` �7��r- Y te, zi _ .._� Count /De tment • Unl --�- Lt's._. __ _ 7..� Li pisapprr d -` { Sariit«ry Prr,mr Fog (includes Groundwarer Surcharge 1zee: Date Issued sui: Agent Signa.ute (eta Sumps) ryo, }" — _ Owner riven itead;or, liar Denial I_ 1X. Conditions of ApprovellReasona fur Alsapprrve� - SYSTEM OWNER: - .3j �j j -- 1 Septic tank, effluent filter and dispersal cell must all be serviced I maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. rip �ty9 t � ~troth co� ow. Manx lro the SB iCauniy orgy! ?ar ttu sysicxn s» e a -6398 (A. 0 P wr iesx rasa j2.�21 !1 1 pCl1t319 gist — '_`-""' - _._ a .: 1 i'GO� F XY�s�G�fC�� •� c" % „ /��s�it c�t�/�� �i n���� � s i � �w r e- i j^ D I r er Al i O G J -c' ti $j a W �p z z 0 1, X e wis :ment of Commerce SOIL AND SITE EVALUATION DivF - ry and 6�ra ry and Buildings Page 1 of 3 B6reau ted Services in accordance with S. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in siz,e�' Plan must County include, but not limited to: vertical and horizontal reference point (BMy`dKeeton St . Croix pe rcent �. Parc4t I.D. # scale or dimensions, north arrow, and location and dlstallee to ne elst road' . APPLICANT INFORMATION - Please print all inforrallon ' a 'ewpd by Date Personal information y ou p rovide may be used for second purposes Privad Law, s. 15.04. ` QQ Y P Y ry P rP � Y f`��TCnD��31k r� Property Owner Richard Stout 4' Govt. Lot NE -; st NE 1/4,S1 5 T31 N,R 19 E (orW Property Owner's Mailing Address I i $1' ck#', ubd. Name CSM# 1353 Awatukee Trail 1 Pines�� AD 1 City State Zip Code Phone Number City Village ® Town Nearest Road Y1 Q Q Hudson j Wi 1 54016, (715)549 -6731 Somerset 60th Street ER New Construction Residential / Number of bedrooms Addition to exist building Use: � 4 9 9 ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 6 0 0 gpd Recommended design loading rate • 7 bed, gpd /ft • 8 trench, gpd /ft Absorption area required 8 5 8 bed, ft2 750 trench, ft Maximum design loading rate .7 bed, gpd /ft � trench, gpd /ft Recommended infiltration surface elevation(s) See plot plan ft (as referred to site plan benchmark) ALT .5 .6 Additional design /site considerations Parent material CoC2 Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S❑ U OS El U [j S❑ U l ils E U EIS Z U EIS Q U SOIL DESCRIPTION REPORT Boren # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring Texture Consistence Boundary Roots < in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 2 110- 10 r4 Ground elev. 95 ft. Depth to p limiting 1(• �z , factor 7 6 in. `4 L Remarks: Boring # 1 0 -1 10 r2 -- 2 2 18-86 10yr4/6 -- ms osg ml cs -- .7 .8 Ground elev. 94 ft. Depth to limiting factor 8 6 in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number Z,- PROPERTYOWNER Richard Stout _ SOIL DESCRIPTION REPORT Page PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 1 0 -1 1 r k m 2 1 18-116 10 r4/6 -- ms Oscf ml cs -- .7;.8 Ground elev. 94 Depth to / limiting 92, SO factor S-6 —in. 2"f O Remarks: Boring # 1 0-1C 10yr2/2 - is lmabk mvfr cs 1f .7 ;.8 4 2 10- 10yr4/6 -- ms osg ml cs -- .7 ..8 Z elev. 96. ft. Depth to 92,T limiting 7 factor 76 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 # 1 0-3E 1 0yr2 /2 - is 1 mabk mvfr cs 1 f .5 ' . 6 5- 2 1 36-SO 10 r4/6 -- sil 1abk mvfr cs -- .7;.8 Ground elev. 9 4 -D— ft. Depth to limiting factor - 9-0 -- ' n. Remarks: Alternate System Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) l aF3 r ' � �� � ��y� " L W �3 a , 7"A 97, / ,4 -T pp V� i a x 1f, ti � B `� ` rr...... -- ... � i• `` �. P w� Y..L�.r� j C 1 _ A : C "µ ~ T C • v A : t n N .`,1rw.w �..w.w .+.ww- r.w... 4 PIPE 12r' MIN ABOVE G.JADE $ 4CATHERPROOF 't 5' FROM Donn o WINDOW OR FRES4 AIR INTAKE JUNCTION SCX APPRO`!ED :KITH CONDUIT V.,VHOLE %CovEP FyNISHE GRADE W/ PADLOCK 6 :� CS RTSE�i 4 --�-�- WARKI iG !ABrL i f WA�.R ' 1 ! i t ""� r2�ttT SEALS 7 OV�o a SEAL 4o;� wiry ia�RGVEO r 'IPE 3 $ +. {ALM App" VED PIPE )RTO sa i o '"�""` ON 3 ONTO TOIL j C ' SOLM SOIL PUMP OFF ELEV. _ ,....,.� a� R1S£R EX:T ��''"OFr PERMITTED ONLY IF TANK MANUFACT'J. Sit APPR OfEZs $EDD; NG u tiDER TA�pK HAS APPROVAL r. T C QbNwRETE PAD ,�„ pFrLJ.� «4�i t�it� iPTIG DOSE `A:vx MhN �` �► r"�M ER Z OSES PER JAX: 'AAy' SIZES : SEt 'i G �, .... DOSE dv ""' GPI,. Xt+C JDrNt� .�.. FLp�v$ACK. !9 � GA... MpNVFACTURER : ,� CA,P.�C i'IX E S s p . � j��?► ,� �. MODEL Mil4a As _ 114CHIS " ...4 �..... S AL . SWITCH TYPE: r -- ....1�2.E....�,.�....�. 8 ,..., INCHES N«ANUrACrJRER ZA MODEL NUMBER : � C '� INCHES SWITCH TYPE: ZQU'6RED DISCN .. ,i ..,.....__GAL. .ARCS£ RAT — �P ALARM WiRiNG AS PER ILM, 16.23 wAel ER 1` +C'AL JIFFERE��CE BE. ��LJ� Oi � ,� <ND DISTPSBL'TIQN POPE � ; MINIMUM NETWOU SUPPLY PRESSURE FEE2' FORCEMAIN X . r . FELT , FT�2�3 �'j.�FR.GTION FACTOR FEET O.AL DYNAMIC �iEAI? _ " .n TERNAL DZMENSj , r E; .C;�$ �F PUMP T6I;y: :µAG w-- ---- - WIZTN k4 .At ---Qu c SrANDARD CHAMBER Quick4 Standard Chamber 48• (EFFECTIVE LENGTH) n in 1 1 2 "` SIDE VIEW SECTION VIEW MultMort End Cap 12" 1 I ra �� i 1 1 1 i - 1 k—)l SIDE VIEW TOP VIEW FRONT VIEW Effective Lan�th 48" invert Height 8� or 1.25" Invert Height g" t -STAN-DA-8 I 11-k-UMA116-ANT—Y )'R-a stlixtunil ritegmy of a";;! 'rahiLiii end plate, wedge aina aO by liffitlalu ("Uh-ts"). At- installed rand or calif j a 1-i or all net s(o,c sys;a,m,i a mor d al , with ,fill a. •s ostridais, ift A-.Ked IL) ti i- against ni to lets -0 for -. year .ran the data th the 't (ii ' E syste'r ; W i , Qm"r, hat if a sei pi I`0" nit i' "sup". if" al" i4 n), reqi hy applKabio law, [he warranty perod will hi i 4 T M.i. Holder ft—t notitv rifii XK`f it- idalo 'he: 1 zali lA the septic K� caninonCe!3 '1 01 in "King al C-1XV0O 11 l, li'lur al,,r Wit upPly 14)e-I'Mont Unite "(fr Uni dele vrl.� r � Y ni be Co"a" by "S "M'10" W—W-yr 11 Z. the w6tift vrno,,ai ari nslali=, or m. Units. Til f 1NSUP JVJ1AGRAPH ;llARF LXGi 11i ARE NCUlh,=AWt,,RHAN7jE6VvqH FZSPECT ((It IHE LIINUT, WAFIRAN AND RFVElYH TFIF UNUS. ;MULOING No iW-Llr-D WAli OF W HAVIAZILTYCq Fl MR. A ! Ali JKA1,A i PURPOK. onit.J�e to o'di SYSTEMS INC le I., i"Inaft"i, �11 rquiLlai ��fi 6.Ka ,.Ss or Envirmutilli Onsli Waslfewatw Soludions L:�JlclpW and ini ]am and majaiali Methi WatI, a the, i i�e, Holder or any �.,. " i K..13kXX1d ?"O'n I Kil l 0 'Allai ' i are dan i to the. n.y a flar awhi M t aftlae1io�, a�rci r. r" `­ he Unjis, life jr su ni o ,"o M a SUSA. &Z, Se or rei or ir d In yel trai or ether Mitch are not PPar by tra 'retaliation iltislactions; th -ii ground Co,mls set birt the Mlel6fron the Oa,�wn i i . n p ropel f - 6 Business Park Road • P.O. Box 768 � 1 the Units or the %pli system d ue exCe s" Werai if the system Containing the Jz (alum, of -,tA Oaused i lo "" 'Z Or , wai U53i , Mt,rope, yrease dw4x*.%.. O""woppiv nMatii o' Old Saybrook, CT 06475 ,n v wher event nut h5qrstor.p r rai Warranty, ` 61J ii void 0 1, a Pli i4i;�s to Corhi W0 aii Or the form Eel orlh it !t.K Lkinitod 860-577-7 F,,. the ,, inirx,, e,.lt..,,hajj jajg, a� , damage lass or daage to the li I or any third pad/ Mathi IrfiV,n1aI1alCn or 000 - FAX 860-577-7001 iii , ), from any Pax1tj,,t l'ail V third pony, For lh s L 1 4apnj to fiPpyr the jr�a ­S.! be atili ac�,waki $00-221-4436 w ' 111 ste - Ckrvne 11 1 ), lete and local codes: al 01 applicable tali and ,010,ali r, lSIadL1hoh:nst—tr,.,,,K (' N- 1 arx5s-11ldf(1. of ih.hillaiior tias [no wthorly to clun . e-rand this 1-ut wwow, No womanly W 1. -Y party nine. x1rian the p hut. "al lrna aL-- lepra.ai, the Sunda it n SIC CON Cline applicable warranty, WOhou,j carefully read tout warranty orlor to the purchase of t)NZ Canadian Patents' 1,329,959: 2,004,564 Other patents pending In',iltrator, Equalizer and SideWinder are r egistered trademarks of infiltrator Sysie"Is ln: Infiltrator s a registered radarri Fran. Infiltrator SyS%WIS Inn is a registered trademark lrillflex:w. Contour. Contour Swivel Connection, wirciLeaching, PoyTutf, Snapi ChamberWacer, PosilLock, DulcItCull, play RECYCIEOPAPER and Qd&4 are trademarks Of Infiltrator Systems Inc. 0 2L,13 Infiltrator Systems Inc Printed iri LJ,S.A. Quick [b]GOULDS PUMPS Submersible Effluent Pump rr 3871 EPO4 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 ' • • Farms manual operation. Auto. superior strength and corrosion land& SUMatds Assoaaaon • Heavy duty sump matic models include resistance. • 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 "F" or "C ") factory, strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds pumps 4 t509001 P4stered. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 1 10 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 (40°C) continuous METERS FEET , 140 0 intermittent. • Fasteners: 300 series 10 stainless steel. •Capable of running 30 �� m - s o� dry without damage to a 2.s Fr components. 25 , Motor: x • EPO4 Single phase: 0.4 HP, ° 20 115 or 230 V, 60 Hz, 1550 s RPM, built in overload with automatic reset. a 4 , • EP05 Single phase: 0.5 HP, c Fp05 115 V. 60 Hz, 1550 RPM, 3 lo built in Overload with automatic reset. 2 • Power cord: 10 foot s standard length, 1613 _ STOW with three prong grounding plug. Optional 20 0L Od 10 20 30 40 so GPM foot length, 16/3 S1TW with three prong grounding plug --- (standard on EP05). 0 2 4 fi s 1 12 m CAPACITY Goulds Pumps 0 2000 Goulds Pumps ITT Industries Effective February, 2000 83871 �- POWTS OWNER'S MANUAL & MANAGEMENT PLAN P#ge __ of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity L 61 al D NA Permit 63 O O- Septic Tank Manufacturer ❑ NA Q , DEMN PARAMETERS Effluent Filter Manufacturer U NA Number of Bedrooms ❑ NA Effluent Filter Model elf d NA Number of Public Facility Unite NA Pump Tank Capacity G NA Estimated flow (average) L g� lday Pump Tank Manufacturer r�, �, ❑ NA Design flow (peak), (Estimated x 1.5) 4'e g al/day Pump Manufacturer . 13 NA Soil Application Rate () • - 4 tilde /fts Pump Model O O NA Standard Influent/Effluent Duality Monthly average" Pretreatment Unit A Fats, Oil A Grease IFOG) 530 mg /L C3 Sand /Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (SOD.) 5220 mg /L ❑ NA ❑ Mechanical Aeration O Wetland Total Suapanded Solids ITSS) 5160 mg1L ❑ i Wrnfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cools) © NA Biochemical Oxygen Demand (BOD 530 mg /L Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA rAt-Grodo ❑ Mound Fecal Coliform (geometric mean) S10 cfu /100ml ❑ Drip - Line ❑ Other: Maximum Effluent Particle Wks Y in dia. ❑ NA 09M ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Servilce Ev Service Frequency Inspect condition of tank(s) At least once every: ear a) s (MaAmm 3 years) O NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cells) At least once every: m onth ( Maximum 3 years) C3 NA wls Clean effluent filter At least once every: ys (el E3 NA earls) Inspect pump, pump controls & alarm At least once every: ttr thfs) 0 NA 13 ear(a) Flush lateral months) ❑ NA a and pressure test At least once every: r p rta) Other: E3 month(s) ❑ NA At feast once suety: p yearis) Other: O 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(a) 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 pending of effluent on the ground surface. The dispersal cents) 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 intwv of s12 months, shalt 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. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the p resence of painting products'or other chemicals that may impede the treatment process and /or damage the dispersal csll(s). If high concentrations are detected have the contents of the tank(*) 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 cellis) in one large dose, overloading the callis) 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 buns; 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 takers 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. a 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 falls 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 requited 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. site ❑ T tank 'A e ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SE PU AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. 00 N EAF SEPTIC, PUMP OR OTHER M THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. TANCE$. DEATH MAY RESULT. RESCUE OF A PERSON ADDITIONAL COMMENTS POWTS INSTALLER pOWITS MAINTAINER Name Name � �/. ec ��. a�C�Y Phone Phone LOCAL REGl<ULATORY AUT HOI;iTY &EPTAGiE SERVICING OPERATOR (PUMPER) Name f K Cwt � Ph Na 5` . CV Phan* s. �O o . F This docu"M was drafted in cornpNance with chapter Comm 83.22(21(b)(i)(d) &M and 83.54t1), (2) & (31, Wisconsin Ad"Onistrative Code. FW;t P10. ,GG7' lan. zfu FT iq cROIX cou'N'TV , Fm ENT I�r,PTIC TA.Nle:�' '.IYIAINTFNANCE AG RL. ANO OwN,ERSHIP CBRTIPICATION EOM teq unrcd f rom Pjuiaitg Dootma-nt for Ilew N mbar U cit" 'State UAQAY�== Locztior - Town Of tat volumc $,go c, Sur Map 0 ael __, page # Doed 4 Spec 'L lines idtnOable C Kye$ L7 to M. IU PTcMtujc f haridle PrQPcI ce of Y 010 Wdc system could Te-sult by a tsui.� every titer years Or if of P=P�tg O tIlt 1'- \Mte &SPO"I symem- can kff�t *A t�=�= of 0�0 U#0 i cap W wtification ��gned by oww"r agrTes 10 wbrait Z=bjf, Deputzo flm =4,te wftstewa,IQ� 6sposal A full of S1116&c� usne pj=bet, re &±&Oy (2) twpect�on wA p=PiD9 (if the is lass t h t pr i y �tp, T state of Wir, with ,ead the above ;NvAr u "' agec to ma t inaiu 0=f's;, Konsi:ft. Un dttsigtod have NaMI'at 30 Depu=Mt Of COm an thr Dzyutment of Croix cc=ty Zouing M ier u wt by t j muss bt, compittad tad to the St wtem hat been =Wa ,mting **t yow "Ptit the thlte YtIs We. DA � ..._ its OF CANT of 41jr (we) oardry tut All tt,,-.cat3 on fb�z farm Mro Mq W , 6, by Y�t�d of S''W=Inty dmvd rtcc�zded in Rd iLb*v (-PA OY nir-ANT LI the Sa peryut being revoked by khe, Zctmnz De7xytmt Ication: a stamped de*d fvc�m the Register of D"dl , ff Ire Include With this IPPI a cop. of the wlified SLIryty p it = d s i the `deed VOL n. UfWN8 A17. 5 7 4 085 STATE DAR OF WISCONSIN FORM 2 —1982 VV WARRANTY DEED DOCUMEN NO. William F . r•--.,..;e anti rat A_ _ - gEGISTF.,T1S OFFICE som_merfeldt_, hLSband_ and wt fp ST. CROIX Co., WI RNy � R"ee� -- MAR 0 2 1999 I ower and warrant., to R { h a rA 0 - St nn t and o iV.la�. *9 SPACE RESERVED FOR RECORONG DATA NAME ANn RETURN ADDRESS ' .he following described seat estate in St rrni ,r -- Count); 'E State of Wisconsin: NEU Section 15- T31N -R19W except South 200 feet of North 1380 feet of East 400' _ feet thereof. Also except Lot 1 of 032- 1042 -30; 032 - 1042 -40; j Certified Survey Map recorded in Vole. 5 of Certified Survey Maps, page 1372 as 02`2-1042-10 1 Doc. No. 389372, and.except the following -. described parcel adjoining.said Lot 1: ' Commencing at the East Quarter corner of said Section 15 ; South 89 West (assumed bearing referenced to the East -West Quarter Section line of said Section 15, 391.12 feet along said line to the point of beginning; thence continuing South 89 i West, 158.88 feet along said line; thence North 1 West, 336.35 feet; thence North 89 East,.158.88 feet; thence South.1 East, 336.35 feet along. the West line of said Lot 1 to the Point of Beginning. Further excepting the N%NE=U ani. the N%NWUNE 'A, except the West 330 feet thereof. The above described parcel includes Lo*_ 2 of Certified Survey. Map in Vol. 6, Page 1537. Q i This i s _._ homestead property. (ts) (Is not) Emptiontowamndes: Easements, restrictions and rights -of -Way of record, if any. s C6 3 5 25 YR H.W.I.. If ` ! / o�I 949.20 Q II •�;! .. 130,941 SO. FT", N � T . 5 4 52 i O !/ 3.01 ACRES 1 N ! / 3 1 S80'13'30 "E N43'2015 "E �` - �35.32' 43.23 N18!58'31"E N89 24 2> "W y `� `O , 59.29' 528.23 — 211_65 316.58' S29'51 '17 "Wl . . - N89 2421 "W 50. 49.63' +N00'07'11 "W 33.13' .1 �� a , `= +11.81 DRAINAGE ! N S00'07'11 "Ek. 9`� 35.74' �t �� b EASEMENT S89'24'21 "E- . 107.42' / I / 26.74' _ • . 131,1 3U / 3.0 25 YR H.W.L. / I 951.60 3 : U') : / 1 O1 �' 1p ply Ala / 134, Q. FT. h . i 3.09 ACRES �u - - - 118.54' S Z I I N LU ed b S89'23 E ��V " V1 • ,,\ �� ��! �8 107.42' 0 0,9. ai 131, 3.( �O 2 F BENCH MARK: 0. A O� >> TOP IRON PIPE �Q��It+ ELEVATION = 999.35 \ 0 S8923'33"E �� 3 140.18' *� •�� M 0 G n - 2 S892333 0 ' �� 37.35,� N 1\ V 1 ; W TOTAL AREA N34'50'43 "E s 1 SOUTH UNE OF THE '' 137,211 SQ. FT- 7o.mr , - .- / NE 1/4 OF 1NE NE 114 3.15 ACRES i •' j� �S71 *09'07 "E Z DRAINAGE V) 1 3.91' 587'30'45 'E EASEMENT 17 78 Z43 4s 84.38' d S85*13'21 „E i I1 561 "E S35 ,1 j 105.4 ��� �\ 55 3� 25 YR H.W.L. t4136-38 25'E ; ; S 42'58" -'.. _ ..`` - \50 23.75 7 "E ' 944.69 08.89 133.6 E - 25 YR H.W.L. ' - , 44.60 ` 4� `� !/ \ vi 9 j z: - 173.03' -- 4.48 - -10 s i 96 -70 , " `• N3 'W y \ _ S85 7321E 208.7D 1 25 YR H.W.L. __ 23.3 37' ' X 270.04' 937.56 N86'19'51 "W 321.95' - NO2'43'a2 "E 20' DRIVEWA Y_EASEA,IENT C 10' ON EACf 48.65 i 126.71' OF' CENTR OF OR /12" -- -` pp S82-42-41-E ----- -OL. N Sss S -►N42'1032 "E - -` DRAINAGE �8b3 F �� -' 54'29' 31 W EASEMENT S87'47'57 "E 22.05' J I 4X ' 9i �h N a N N �!•IOR u m loll o �� >3 AM Z. AN WSW AT= Q I " s 1 91191 91 I n. ------ - - - - -- :., fi. b + 1 41 I : if ' -- t •� �� I f 1 � f Z j I f a #/I. Ason" ' L----------------------- - - - - -a ! 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