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032-2154-00-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buil, !ng Division r INSPECTION REPORT sanitary Permit N 463008 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)]. y Permit Holders Name: City Village X Township Parcel Tax No: Stout, Richard Unknown 032 - 2154 -00 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: "' C s 'T P V �,? 15.31.19.1333 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration " "— Bldg. Sewer S,7 Holding SUHt Inlet 1� c I X7.7 TANK SETBACK INFORMATION St/Ht Outlet 7, 7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System ct .J7 r, Is / 5 9 .-1 - PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover Z ---- GPM Model Numbeh-•.- TDH Lift Icti Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS _ `i2 SETBACK SYSTEM TO P/L JBILD6 WELL LAKE /STREAM LEACHING Manufacture: i +r J � u f INFORMATION CHAMBER OR �r Type Of System, Ce, Model Number: / `� J N B N UNIT DISTRIBUTION SYSTEM S �— Header /Manifold Distribution x Hole Size x Hole Spacing ant to Air Intake Length Dia y Length Dia Spacing / SOIL COVER _ x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over j xx Depth of j xx Seeded /Sodded xx Mulched Bed/Trench Center L� Bedrrrench Ed es Topsoil g p Yes] No I r Yes No COMMENT�- (lraslade code discrepencies, persons present, etc.) Inspection #1: /Z 1--S 1 Inspection #2: Location: 2195 59th Street Somerset, WI 54025 (SE 1/4 NE 1/4 15 T31N R19W) NA Lot 35 % "" Parcel No: 15.31.19.1333 1. Alt BM Description = f3c, r - 5 c C Cs 2.) Bldg sewer length - amount of cover = _3 . 3 Plan revision Required? [ Yes kn Use other side for additional informat SBD - 6710 (R.3/97) Date J Insepctor's Signature Cert. No. 2 � lac. P 1 �BrI 3 �� •ry i ..t- I �y oil y kQo 0/00 �b ,( I ti /4 y-. - f 5 ,x 17r� 'v c uJ a� I f- I I s: Sp FA'P 1 7 LC --,G G,- J J F caoix couNIT SrTTIC MAINTENANCE ACIR-BF-lv ANO 6v p arce l Id .n N=bal 0 3Z — -2 W Town Of Stc, I oration 1r��' �, ti �Sh�� Q c - D )Y 6 ' 'Lot ap /it/ 11��� 2 celftfled, surve,!-P Page 4 4 I' De*d :!�— to Spec, yes to h ,, IZA=AiatdtIuCe of Y010 0,pdc System COU16Tesult i n IU PTeM 21-11C VFtlat you t�t into tbP liY0,171 ;a=PMg out tlx, Septir, t 6vk�r� thret, years 0E bo o t, tht &SPO&SI atetst -�T P=Por =-P,� Itz j_ wy), the is lt�u them t/3 full of 31116&c� Is ix, pm pst openting .)j ntccs =t&tiOTI &t&O tnspecdon P= I �Ystern w t � t � turd.-&rds zWer � pr s ewage dispcw jgted have mad the ab OV "qvAr Md tifxaticn e, ;}le unskts )x=trt o f C OMMarc . t an d tho Dqutment Of Natm RtW4MfI;, state of Wi georLsin, Cert se r nth, eP by the I o r itt�ej mw be, =PlMd 1-nd Office witin 3C, tatjn tl *t yCk � , w �• -4--Qf tbA three Yw e 0j DATE ) 23'.A' 6 oertify tut x31 statements t1ir best of r (rrz) V'nowlldg� ( am (arc) tha t 4NnibtA by �Y�t�o of AwwMinty ru,01 in Register afrw4", jr—ANT rasuth t h e ja ritary pem Aty =Y off de ed I the Register c)f D"d$ - I *Ith thil OPHUtLOn; a de jr ref is tra i th wm auTy deed a copy of the cer tified survey Map i R S T VT 'I per t the Northeast t, Quarter Town ofdSomersettSt. Southwest Quarter of Including st North, Range 19 West, I PLO -21- SHADOW PINES / - - - - -- S89'2333 "E 442.96' " ° 3`3 r33' 2 '18 * W j � er N74 24'27 " `�� � N36 '35'57 "E N L� LOT 2 84 4 '� -- -- 18. 2 CERTIFIED_ SURVE O - - - - -- - -- - r w w 21E N0. 5 N192T14" t c} DO -- 6.17' C o. 6 O o ro .- AGE VOLUME 10 P AGE 3 5 N 6 : � ,a A w. � � O von ----- - - - - -- o 949.20 N 130,941 SQ. FTAn � � —� � g � "ET i � O 3.01 ACRES N� r 3 S80'1 3'30"E r � • / N43'2015 "E ' � - 43.23 / �� _ 35.32 R =N89'58 57 E / o ^ � • s.8s' N1 59.29 8.' 528.23' "E S89'24�21 "E 328 N89 74 21 "W - r Z . 316.58' 60.4 - -- 211.65' 1 295.56' _ _ 4 - / - -- - N89 24'21 "_W 507.21 ' S29'51'17 "W! .' \� - - N00'07'11 "W 33.13' 9.63' S00'07'11 "Ec y 95 DRAINAGE 35.74' a� � EASEMENT 1 S89'24'21 "E d 589 23'33 "E 3 6 26.74' N to7.42' 131,115 SO. FT. / 2YRHW.L* 3.01 ACRES j I 34 : I° 134,694 SQ. FT. 3.09 ACRES W • � S8973 33 E .507.21 8.5 4' I a _ . - 11 - N 3 o Q . n h: P �n $ 589'23'33 "E 00 6 1 . 107.42' 3 S 8; / 4, 0 , o �o o , 131,119 SO. FT. I 8s ? � N 3.01 ACRES BENCH MARK: ' Zo o , TOP IRON PIPE ELEVATION - 999.35 58923'33 "E 507.21'- - -- -- N Safety and Building — County j 2GI W, WashingtoAve., ! ■s�O nsl Madison, WI 5370 Sanitary Permit Number (to be filled In by Cu.} _ Department of Commerce (608) 265- 1 j Sanitary Permit A I p��ICat1Un s rate Pl I.D. Number In accord with COMM 83.21, Wis, Adm. Code, personal it: m toration yotj prnvi (`. m _ _ ay be used for secondary purposes Privacy Craw, s15.04(1)(m' 1 ' % r Proirct Address ,i' f irferorc all r,aiic r radraso f I, Application Information - Please Print All lnformation �` l ► Sl °t,)NINI� CUFF 1 - I Property Owner's Na me t P arcel ( Praperty Owner's M ailing Address Pruperty Location 032-- _- S —CIS L' Suitt ip Code Pt one Number _.___.._ _ S- q UL ` �GL�Sa�tJ y,� - -• -- icirar or H . Type of Building (check all that apply) ✓/� 1— - ---___ R L - X1 or 2 Family Dwelling - Number of Bedrooms 1 Subdivision Name CSM Number ❑ Public - Describe Use LI State Owned - Describe Use a P1 s 7 - . C'EZ -I fife �a - 0 []City (,JVil1age,1 of� , �� y----- [11 Type of Permit: (Ch eck only one box an line A Comp line B if applicable) _ i XNew�Systemm Replacement System 'Treatment/Holding Tank Replacement Oii.y� O r Modification to Existing System i I ` t B. Permit Renewal kx �' �+ 1 T f List Previous Permit Number and Date slued f X- Permit Revision Change of L1 Permit . rans er to New � Before Expiration Plumber Owner 3 IV. Type of P OW TS Sys tem: (Check all that Non - Pressurized In - Ground ❑ Mound > 24 in. of suitable sail ❑ Mound < 24 in, of suitable soil ❑ At -Grade LJ sutgle Pass Sand Filter ❑ Consmttted Wetland U Pressurized In- Ground ❑ Holding Tank _j Peat Filter Aerobic Treatment Unit Recirculating Sand Filter j ❑ Rmirculating Synthetic M edia Filter M eaching Chamber Ej Drip Line n} Gravo -less Pipe ❑ ain) I ' V. Dispe rnUTreat tnent Area Information: — - Design Flow (gpd) Design Soil Application Ra gpdst) nispetsal Area Re' quired (sf) i?ispersai A P 80 System Elevation VI. Tank Info Capacity in Total Numb Manufacturer - Prefab SFte I Stall Fiber i Plastic Gallons Gailons ! of Unite Concrete Constructed j Glass i New Existing � I i Tanks Tanks - � 1 Septic or Holding Tank Aen>bic Treatment Unit posing Chamber VII. R2 ��OZlSibility Statement I, the ttrtderslyz assum responsibility rot ' J1 ti of the POiYTS shown on tits at plaits. P/ PRS NO nber flusi:,ess Pharr lumhe Plumber's Si gnature I Plumber's Na me (Print) Cx� _ Plumber's Addre ss (Street, City, State, Zip Code) VII ount /ik suin rtment Use Oat __ —_ ..�- -- — -- _i Sanitary Permit Fee (includes Gruurxlwater Date lssued nt S' na ( o I Stamr•s L: Approved 12 Disapproved I Surcharge Peel 1 r 2 Q — ❑ o wner Given Rea for __ --- - �. I IX, Conditions of Approval /Reasons for Disapproval S STEM OWNER: cm �C� 1 I Septic tank, effluent filter and �� L I dispersal cell must all be serviced / maintains _ ' /J ,� , �p /L� /Oy �f as per management plan provided by plumber. 5�'�` ' `�1 t 2. All setback requirements must be maintained i as per applicable code /ordinances. _,_ - - - ---- E Ali11Ch (t0 the county only) for the system o01 paper not wmDkto plaits toss tliao Elri x tt incises s» size J L)0 t �7 vj 1 n 0 D . P � I I I 1 ' 1308 Wisconsin Depa rce SOIL EVAL ` \, ' E PORT Page 1 of 3 Division of Safettanings in accordan �i';. Adm. Code Tom Schmitt County Attach copaper not less than 8'% x 11 i has in siz e. Plan must St. Croix include, brtical and horizontal reference int (B Z� M), doqq a4 percent slsions, north arrow, and locati� and di to r'�arest road. Parcel I.D. e printaHinform . ation COUNT` 032 - 2154 -00 -000 G FIDE Re 'wed Date Personal information you de may be used for secondary (Pmra�L / Lo Property Owner Property Location Stout, Richard Govt. Lot SE 1/4 NE 1/4 S 15 T 31 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1353 Awatukee Trail 35 Shadow Pines 1 St Add. City State Zip Code Phone Number J City Village 16 Town Nearest Road Hudson WI 1 54016 1 Somerset I 59Th St !M New Construction Use: l61 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: i Parent material Outwash Plain Flood plain elevation, if applicable NA General comments and recommendations: Area is suitable for a conventional system with a 0.7 gpd/sqft rating. Possible system elevation for Area 1 is 94.0'. Slope is - D Boring # Boring Pit Ground Surface elev. 100.02 ft. Depth to limiting factor 112+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft *Eff#1 *Eff#2 1 0 -5 1Oyr4/3 none Is 1csbk mvfr gw 1vf .7 1.6 2 5 -11 1Oyr4/4 none Is 1msbk mvfr gw 1vf .7 1.6 3 11 -32 10yr5/6 none Cos a� Q Osg ml Cs -- .7 1.6 4 32 -112 1Oyr6/4 none ms Osg ml - - -- .7 1.6 Boring # Boring 01 Pit Ground Surface elev. 97.97 ft. Depth to limiting factor 110+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF *Eff#1 *Eff#2 1 0 -13 1Oyr3/2 none sl 2fsbk mfr as 2vf .6 1.0 2 13 -22 1Oyr4/3 none sl 2msbk mfr gw 1vf .6 1.0 3 22 -32 7.5yr4/6 none sl 2msbk mfr gw 1vf .6 1.0 4 32 -39 7.5yr5/4 none Is 1csbk mvfr gw - ---- .7 1.6 5 39 -56 1Oyr5 /6 none cos b Osg ml Cs ---- .7 1.6 6 56 -110 1Oyr6/4 none ms C Osg ml - -- - -- .7 1.6 ' Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD S mg/L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 10/29/04 715- 247 -2941 Property Owner Stout, Richard Parcel ID # 032 - 2154 -00 -000 Page 2 of 3 73Boring # I Boring 01 Pit Ground Surface elev. 98.02 ft. Depth to limiting factor 108+ in. Soil Application Rate i Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD : *Eff#1 *Eff#2 1 0 - 12 1Oyr3/1 none sl 2fsbk mvfr as 2vf .6 1.0 2 12 -22 1Oyr4/3 none sl 2msbk mfr gw 1vf .6 1.0 3 22 -36 .5yr4/4 none 2msbk mfr gw 1vf .6 1.0 36 -57 1Oyr5/4 none cos Osg ml - -- --- .7 1.6 5 57 -108 1Oyr5/6 none ms Osg ml -- ---- .7 1.6 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 QP *Eff#1 *Eff#2 F-1 Boring # I Boring Pit _J Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 " Effluent #1 = BOD 5> 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. I ._., y Page 3 of 3 Conducted by: Conducted For: Schmitt Soil and Site Evaluations Name: Richard Stout Thomas I Schmitt, CST 227429 Address: 1353 Awatukee Trail 1595 72nd St. City, State, Zip: Hudson, Wl. 54016 New Richmond, WI. 54017 Phone: 715- 247 -2941 Subd.Name: Shadow Pines 1st Add. �Q '2 9- b cy Lot No.: 35 Legal Description: SE 1 /4 NE 1 /4 S15 T31 N R19W Township of: Somerset Bench Mark El. 100.00' Top of 2" pvc pipe Alternate Bench Mark El. 100.66' Top of concrete on walkout wall Slope= 4 Contour Line El. NA i N e Scale I"= 40'' \ i l � i `tPO Safety and Buildings Division County -- ,��� • , 201 W. Washington Ave., P.O. Box 7162 nsrn Madison. WI 5.5707 -'162 Sanita Permit Number (to be filled in by Co.) FI-Application � artn'rent of Commerce (608) �M -3151 Sanitary Permit Application State Plan i. Number _ , In accord with Comm 83.21, Wis. Adm, Code, Personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) �I_ — Project Addres (if different than mailing address) Information - Please Print All Information Property Owner's Na me 1 � Parcel ff Lo Block k zd Property Owners M ailing Address /S-1 3? � /J � ��� Pro pe Location 1333 City, State Zip ode � 'a,Section /S P I Phone Number 'A, � (circle o II. I�pe of Building (check all that apply) / � L -'� T f/ N; R1�E o 111 or 2 Family Dwelling - Number of Bedrooms Name CSM Number ❑ Public /Commercial - Describe Ilse c ,� ❑ State Owned - Describe Use �. -- ❑C't t y_ ❑Village Township of III. Type of Permit: (Check only one on line A. Co mplete line B if app able) - ' A. Neww System - ❑ R Syst ❑ Treatment/Holding Tank eplacement Only h Other Modification to Existi B • ❑ Permit Renewal s permit Revision range of - ermit Transfer to New List ev us P it t a ssued i Before Expiration Plum net IV. T of POWTS Sys tem; (Check all th apply} A -Non - Pressuri In- Ground ❑ Mound > 24 in. of suitable soil M < 24 in. of suitable soil a -� - .� At - Grade IJ Single Pass Sand Filter J Constructed Wetland ❑ Pressurized In•Ground ❑ Holding Tan L Peat N ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter W-L c , Chamber ❑ rip Line ❑ Grav ss Pi ❑ Other (explain) V. Dispersal/Treatment Area Informat - Design Flow (gpd) Design Soil Application Rate(gpds flj is sal Area Rey ired (sf� ispers , roposed (s em Elevatio — ' 4'I. Tank Info Capacity in T -oral Numb 9'70 9y r Manufacturer Pr fab Site Steel Fiber Plastic Gallorts Gallons of U Concrete Constructed Glass I New Existing _ Tanks_ Tanks Septic or Holding Tank - -- -- v At robic Treatment Unit -� - Dosing Chamber Odd VI Responsibility Stateme 1, the i ndersigt d, a ssume responsibili for Wation o f the POWTS sho on the atta ched plans Plumber's Na me (Print) Plumber's i gnature P/ PRS Number - Business Phone Number _7 � Plumber's Addre ss (Street, City, State, Zip C , VIll ount /De artment Use Onl �� I Approved ❑ Disapproved Sanitary Permit Fe (includes Groundwater Date ssued ing Agent ignature ( tamps) Surcharge Fee) q3 ❑Owner Given Reason for Denial YYY ��� "` (J . / 3 ! L'tC• Conditions of Approval /Reasons for Disapproval —� -- -- -- ---- i ' SYSTEM L1(NFR L,6tAk4Q��/ •Yl."2GJ iu lf�� � 1 Septic tank, effluent filter and ��✓-r l� r�t� I"v�?� dispersal cell must all be serviced / maintained C ��� O � as per management plan provided by plumber. 2. se ac requirements mus a malntalne y L as per applicable code/ ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size -J SBD -6398 (R, 01/03) - ' " d b Gr if e may r P /99P Vin e - mac7 Ter4' - yvzay trot be "k -fa end t3H1 6 �G fi3.� ���Dly des Sam e Y S c " d t� 6 e- cal Qx pl - r a /99P V;O .e. re - yvzay not 6e b le 4 4d t3H1 • .' F . 1 �.. '. l, 1 [, G �' `: °� y r. i S. IS t h ... �, - r+ nr ♦ /' Y . i -t +, i. _ l 'n C A w � N v VZNT PIPE iv MTN,. ABJVF. Gun b FRO - D0Olt* W1N�QW o'R 4CATHERPROOF FRESH AYR INTAKE JUNCTIO r B X APPROVED GRADE CONDUIT MANHOLE CO'JE?� FINSSHEw W! PADLOCK � t+ "' Cl RISER w-- WARNYI+G LABEL WA`ER TIGiim SE 7 _ 1 GAS- "T TIGHT , ' VSD ,PPROVE ; A SEAS, ;` ' JOI W ITH 'IPE 3' 9 �ALM A19 PIP E 'N'!'0 SIL 10 ij -�-- j ON 3' ONTO SOLD, SOIL, OFT. . RISER EXIT �� --�- -- � ►"�"' � P E RMI T TED CNLY IF TANK `..'...•"`� MANUFACTURER 3 " APPROV BEDD NG U tiDER TANK HAS APPROVAL CONCRETE PAD 3PECIF :CAT`Cti`S EP2SC i DOSE �"A�IK MAN�JfACTJIpEIt: � e h ".it�BER i;OSES PER DAY: � ".=,NK SIZES: 5Ei�"'IC GAL. Los VCLt3::E SNC:JD:NG DOS E dv GAS.. F LOWSAW r 59 GAL . kLARM MANUFACTURER: � MODEL MiMBER: � �.r CAi'AC A a 4NCHES a ..ryl:iM..... SWITCH TYPE: "" "'� ' MAi►tL rACTURER, MODEL NUMBER: INCHES * GAL. SWITCH TYPE: D a INCHES a: r.�irairwr�wGA EQ'� :RED DISCHARGE R A ypm PUMP �, ALARM WIRING AS rFJt :L�Fc 26. Z3' WAC ERT;CAL DTFP£R.LNCE BE.. M'NIMUM NETWORK SUPPLY PREW� OFT AND �ZSTp. ?BUTTON FSPE , d FEET F RC FEET �_ 4 EMAIN X Z jC 0 FT /1So r FR :C"i :CN FACTOR FEET 'IO":gL L �'NAMIC HEAD s *HT "'TF.,RNAL DIML':t'S�.t7iS CF r"t,'j? � i D.. + ..TER CNLD : ..� r [IGOULDS PUMPS Submersible Effluent Pump 3871 EP05 APPLICATIONS • Fully submerged in high s EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing p y g following uses: lubrication and efficient improved performance. construction. • Effluent systems heat transfer. ■ Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto- superior strength and corrosion Auto �• canadimtstandardsassodaeon • 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 is ISO 9001 Registered. �. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. '/•' maximum. ■ EPO4 Impeller: Thermoplas- 0 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: V/2" NPT, seal protection, • Mechanical seal: carbon - rotary/ceramic - stationary, BUNA -N elastomers. • Temperature: 104OF (40°C) continuous o METERS FEET 140 (60°C) intermittent. • Fasteners: 300 series 10 `- ---- . stainless Steel. 9 30 _ f -5 GPM • Capable of running dry without damage to I 8 i 2s FT components. 25 Motor: _ • EPO4 Single phase: 0.4 HP, u 115 or 230 V, 60 Hz, 1550 - RPM, built in overload with S automatic reset. D 1 . •EPOS Single phase: 0.5 HP, c 4- Epos 115 V, 60 Hz, 1550 RPM, 3 10 __. . ____ ___._ __._._ _._,. built in overload with _ _.. !.. EPO4 automatic reset. 2 • Power cord: 10 foot s° standard length, 16/3 1 _ S1TOW with three prong grounding plug. Optional g 9 P 9• p • o 00 14 20 30 :. 4 so _ _ GPM foot length, 16/3 SJTW with three prong grounding plug - (standard on EP05). 0 2 4 6 s 10 12 w/h CAPACITY Goulds Pumps m 2000 Goulds Pumps ITT Industries Effective February, 2000 83871 uick4m" STANDARD CHAMBER Quick4 Standard Chamber !- - - - --- - - -- -48" - -- (EFFECTIVE LENGTH) ! -_tom - - -- - 34 "--- - - - - -- -•� SIDE VIEW SECTION VIEW MultiPort End Cap - — 1 6 ' I j _ — _ - - - - - -- - - - -- 34 " - - - -- -- ._` - -_,�+ SIDE VIEW TOP VIEW FRONT VIEW $' Quicik4 5tandard�Chainbe��Nominal S�sc flea #tons �� � MuttlFfrori=Fnd Cap Spettications ` ��� "� �t f.��y " Size W x L'x H 1 `° Efitective Length 48" Invert Height 8" or 1.25" Invert Height g^ INF11�T TQR _6 .YSTEMS 1NC. STANDAaQ Lunt p vLAR89N.L 1�) I he slrr•ri�rgl rl ] Iy U cr h ha' tLar, eod plate, Wadfil Sul 'that ac :e 5o n I. Nei EW "u larod :std cf.I ar, on51e system i, . a(Co,dtNlCa with I1'.!ratOr's it {ru lio' 3 m Warranted 1., the 1 7 , I Fu .:h:.sp j "Holder f alainsl u;tivE, h :ila a ia14 a t i w Iau -t for •'Y1n yoga +rpm Illy d itto — that 1 1a w'c — permit h iR o. t _P!" rw r the _P.Uerl. i r11 dlling the U' „ rs, provide(' pwmvrlr h filet 1 � j pur w r t s rot ra(fuirud by apGtie W law, the wa.ranly Per�.,xl W411 bI uI— the :late that rlstailation of the septic sys e» rommenees In axe < se Ls w�rrflrlIV rights. Holder must notify 1 ftrat(r in wntlnq at iln (]drpgaie Headduadurs In I SaybrOnk, C 'Wt I .;j fifteen (151 • da 5 i the aaage(i ie icy. InfdU aloe m wwy reptauomtna Unts for un -ts dewminecl by InfNtra 5 Ip be covered by !his IJnriwel War any. , Inf 1lrahxk Yabflit} sfHdcihnellq eY C:Udes the Coo) of re!I1dval andl , Il Gtallalipn 01 file Units "1 7 1 1 9 ; M O iU7 7Hi N LWrs, WAHRAN7Y >N(, RE MM WA IN SUBPARA MERCh AHF Tx LU31VE. if IL ARE R U1HFft URK) NT'PS Wff�H HESPEGT Tt �YSTE M S IN � 1 HE NffS Ih1GL JUIN , C, aLIEE) WA4RANTI °„ Of MER(" hgIJ1AGr IN OR ITNPy� r('Av A f'gRiiClJl 9R FUHr'OSk'. c; 1 h L plod W m uy h,dl c void «airy liar( if 0 a ,fiat Yh sY tc n mart ht; t 1101 ) o/ anyvns 01r it en ;nBliratw. The bmao,j Warranty ss i cl AW.S "It rn er 1 to nr, dental a quaMrei ypc ca n - rvlirsct der r q irliII I sl a!1 1101 b I abl for penalf o.s o liquidaled damagef, di;orng ;o Environmental O�tS�te Wastewater Solutions” prrxYr u1. on and Loflls hahor And mat -, als, mail vad Costs u otho Iogea d, x{:en9ue tcuned by the Holder or any Third party. l7rXilicaliy P" Ipde t I — l,ln'ted Warranty C.— ge j d m Ge to II a UN S C w rx lrwry :year 1, r, -,.1 a@or Hal -Jar or an hir p , riV 6 IX lica OI Ina SJ t. the Unls " subia.l i to article Ir t(:c or oche 0end o wl c` +. are trot p r IItxS by lne nrtalalrno r�i X'IiOnsl Iaitu2 to malhlain 6'0 6 Business Park Road • P.O. Box 763 ! Ill In rt nr grouts overs set bath n the . fallarpn nsl'UC(Iw s Iht, p ::Morn of AT r t)F %r mdterlal5 map Irti Y'sSP.rrt containing the JNIS, IaQ11nl 01 nn Units is Cr Ih3 sups system due 1 p Cper sHing Cr imprc Gar sIZ '., n ]SS VP Afar usage, it 1WIVi I � reacs cLapusd(l 19 In+p(p, tlPrraii0fl', a Old Saybrook, CT 06475 Joy n he. emnt ,w1 riu5nd by infill.tur. nls umiteu warranty saw rf. you I .:to Holder iaL t0 comply with al; :A the tern �t IWIIt in this Umiled warranty. 860- 577 -7000 • FAX 860-577-7001 Fu 1Ee ht rip event .,hat O r a o lr c bn respen; b1a hx any lo:,. x anyaa !n :na Holder; the nas- 'Yr any Ora, early resunirg It" rnstwlalioh a ship 800 -2/„ - `�w� n -en1 pa or rpm arty ,rrM.uCt Ilabilily laims pf HuMer w any ;hard party, For t s UrI War amy o apply the Units mist he ns+ahed in acccrdanco LGL L� s with l S eonul,rcn, required by s!afa and beat codas; all other app icai)� laws; and Inh!ralnrs mslelkl!lon Instru,ilons. ,of No iep'e IhtatiVa of (nfiltralot has the attti In rhanoo or eaten(i Ihrs Limilea vyana . No warranty apples to any early ull, than the mg{- nal Holder. (110 above repraser)fs 1I Star died Llmilr>:i Warran',y o«ered by Iriatra+or, A I ied rurlber of stales and p m«e5 h ;Iflererrl waranty regrtire� - tarns. 4ny Purchaeer or Un Is should atnI. Inlft:ata a ( - ale Headquarters vc Old Saybrook, Ga hOCtIUI, prxY to sus purchase, to cblI a copy of the applicabe warranty, end should carefully read that warranty prior In the lnirc!Yase ei unta U.S. Patent& 4, 75j,661: 5,017,041; 5.156488; 5,3367,017; 5,401,116; 5.401,458:5,511,QU3; 5,716,163; 5,588,778; 5,839,644 Canadian Patents: 1,329,959; 2,004,564 Utner patents pending. nfiltrator, Equalizer and SldeWinder are registered trademarks of Infiltrator Systems Inc. lnti tra'cr is a registered lrade'nark in France. Infiltrator Systems Inc. is a registered trademark in Mexico. CiOM00L Contour SWivei Ccrnection, Microl-eac'iing, Pclyluf1, 5napt-ock, CharrlberSpacer, Posil_Lc(, QutckCut, otuckPlay RECYCLED PAPER and Ouirk4 are tradannorks of Inliltratnr Svxtnmtc Ina• 5 nnrtZ lrtfltralnr q-1 Ina• 0,im i 6, I 1 c e i f W,iscc inin .Department of Commerce S QND SITE EVALUATION visiorvo� Safety and Buildings Page _� of Bt4reau� of Integrated Services. I d r tide With`s, IILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less th lk jt2 x 11 � ice. I'9an mVst County include, but not limited to: vertical and horizo iai- fkference `I n �i�Jirection any St. Croix percent slope, scale or dimensions, north arr " "and to tion and distance to neare$t road. k� ��; Parcel I.D. # E'{ 0 APPLICANT INFORMATION - PleaSe 0irint all' trei�, l Re iew by c� Date q TY dn Personal information you provide may be used for secd6ry pu+loPr Law, s. 16.04 (1) (m)).�� i Property Owner \ G f Location Richard Stout •��' �,- '� ` ' Govt. Lot S'� 1/4,4/E1/4,S �� T 3l ,N,R �� E (or) W Property Owner's Mailing Address " Block# Subd. Name or CSM# 1 353 Awatukee Trail 36 3 S 0rrJ City State Zip Code Phone Number City_— i age Neares d Hudson WI 54016 ( 715) 549- 673yue��� �-- ® New Construction Use: ® Residential / Number of bedrooms 4 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 6 0 0 g pd Recommended design loading rate • 7 bed, gpd /ft • 8 trench, gpd /ft Absorption area required S bed, ft 0 Maximum design loading rate • 7 bed, gpd /ft • 8 trench, gpd /ft Recommended infiltration surface elevation(s) See - plot Flan ft (as referred to site plan benchmark) Additional design /site considerations Parent material C'n(' 2 Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system ® S ❑ U I U S ❑ U Ri S ❑ U 0 S ❑ U ❑ S I U ❑ S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -8 10 r3 3 Sil 2mabk mvfr cs 2 8-36 10 r4/4 Sil 2mabk mfr Ground 3 36-90 10 r4/6 ms osq ml elev. y , Depth to limiting factor 90 in. Remarks: Boring # 2 2 12- 10 r4 4 Sil 2mabk mfr C S 1F i 3 30- 0 r4/6 ms o L Depth to limiting 3, 2Z factor g in. Remarks: CST Name (Please Print) Signature Telephone No. William Schumaker�/j _ (715)386 -3121 Address Date CST Number 1070 Scott Rd Hudson WI 54016 ; I SOIL DESCRIPTION REPORT "fs-�► PROPERTY OWNER Bt9�1� Page_of` PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots ._ Bed ,Trench 3 1 0 -1 10 r3/3 S1 2mabk mvfr cs 2 12-l'.0 10yr4/4 Sil 2mabk mfr cs Ground 3 30-98 10yr4/6 ms os mi elev. �fG It. Depth to limiting factor 98 in. Remarks: Boring # 1 0 -12 10 r3 3 Sl 2mabk mvfr cs , 4 2 12 -30 10 r4/4 Sil mabk mfr 3 0 98 0 r 4 6 ms 0scr mi roun ' elev. Depth to ! n limiting factor 9 8 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 -8 10yr3/3 Sil 2mabk mfr cs @ F 5 2 8 -3 10yr4 /4 Sil 2mabk mfr cs 1 F 3 36-90 10yr4 /6 / ms Osq ml Ground elev. , Depth to limiting factor -9-(,.-in. Remarks: Boring # , Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of 2 FILE INFORMATION SysYliM SPECIFICATIONS Owner _ �-+ Septic Tank C (�.� $-� at DNA Permit it Septic Tank Manufacturer 0 NA Zc2i r. DESIGN PARAMETERS Effluent Filter Manufacturer t- e 13 NA Number of Bedr e 7 l ' 0 NA Effluent Filter Model elf 0 NA Number of Public Facility Units O NA Pump Tank Capacity al 0 NA Estimated flow lev erage) g ot /day Pump T ank Manufa l r '.Sv'y ❑ NA Design flow (peak), (Estimated x 1.5) �C� g al/day pump Manufactur �,, � / 0 NA SON Application Rate ai /da /ft: Pump Model 0 NA Standard InfluenVEffluent Quality Monthly average" Pretreatment Unit NC14A Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (SOD.) 9220 mg /L 0 NA Cl Mechanical Aeration 0 Wetland Total Suspended Solids (TSSI 51 SO mg /L ❑ Disinfection 0 Other: Pretreated Effluent Quality Monthly average Disperse! Coll(*) O NA Biochemical Oxygen Demand (SOD.) S30 mg /L X L-Ground (g ravity) O in-Ground (pressurized) Total Suspended Solids (TSS) S \ 30 mg /L 1$nA 0 At- t e © Mound Fecal Coliform (geometric mean) S ` cfu /100ml O Drip -Una 0 Other: Maximum Effluent Particle Size Yi in die. O dNA Other: 0 NA Other: a Other ❑ NA "Values types for domestic wastewater and septic tank offluemt. Other: 0 NA MAINTENANCE GCHEDUU Service Event Service Frequency Inspect condition of tank(a) At least once every: 3 metal s lMsudmum 3 years) O NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Ys) of tank volume Q NA inspect dispersal cell(s) At least once every: Y fion O) s) (Maximum 3 yawn) 0 NA Clean effluent filter At least once every: Onth s) 0 NA ,'�'yearle) Inspect pump, pump controls & alarm At least once every: -� 3 this) O NA Q y jartel Flush laterals and pressure test At least once every: man s) G NA O arts) Other: p months) 0 NA At (east once every: --- O earls) Other: D NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells *hail 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 ponding of effluent on the ground surface. The dispersal celf(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding Of effluent on the around 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 NA 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 -L12 months, shall be performed by a certified POWTS Maintalner, A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. 'apo0 eA110 ulsuo3slM '(£) R (Z) '(t)fS'£$ Pus (l) W14 ?WS8 UJWO:) J91043 43JM sau211dwoo ul pe?4ejp seem VJOUMOop SNI OU y ,. 9u04d 9wtN 9weN A.I. 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ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan. must `County include, but not limited to: vertical and horizontal reference point (BM),.,direction and € ' -' t Croix percent slope, scale or dimensions, north arrow, and location and distance `to neat Vst rda� parese I.D. # APPLICANT INFORMATION - Please print all infornrlaiion } �qr� Review ;d by Date Personal information you provide may be used for secondary purposes (PrivacX Law s f. Property Owner Propolf*V(Yation i Richard Stout ` d ! t� F NW ., 1 /4NE 1 / 4 ,S15 T31 N,R 19 (of Property Owner's Mailing Address ; ipt + a e or C L_ OT n _ 1353 Awatukee Trail ` Shadow Pines 1ST f�D7>- City State Zip Code Phone Number Clty ❑ Village ❑ Town Nearest Road (p Hudson jWi P4016 1015 $49 -6731 Somerset Pounty Road I ® New Construction Use: ® Residential / Number of bedrooms 4 Addition to existing building ❑ 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, ft 750 trench, ft Maximum design loading rate • 7 bed, gpd /ft • 8 trench, gpd/ft Recommended infiltration surface elevation(s) See plot plan ft (as referred to site plan benchmark) Additional design /site considerations Parent material CoC 2 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 ERs ❑ U FRI S ❑ U ® S ❑ U EIS ®U ❑ S O U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g in. Munsell Ou. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench 1 1 0 -1 E 10 r2/1 -- sil 2 18 -110 10yr4/6 ms os Ground elev. 94 -1n ft. Depth to limiting factor 1 1 n in. Remarks: Boring # 1 - 2 2 1 1 r -- Ground elev. 96 ft. Depth to limiting factor 8 0 in. Remarks: CST Name (Please Print) Signature Telephone No. / Address Date CST Number i PROPERTYOWNER Richard Stout SOIL DESCRIPTION REPORT Page 1 .cf = " 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 1 1 0-1E 10 r2 1 -- M 2 118-48 10 r3 2 sjl 2 m Ground 3 48 -110 10yr4/6 ms OSCF ml c elev. 95 ft. Depth to limiting factor 1 1 in. Remarks: Boring # 1 )-24 1 0 r 2 -- 1 f 4 2 4 -7 10yr4/6 -- ms Oscf M1 r S __ Ground elev. 96 ft. Depth to limiting factor 7 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 -28 10 r2/1 -- vti 5 2 8 -5 10 r3 2 3il M Al t -- 3 50-93 10 r4 6 Ins Ground elev. 94. ft. Depth to limiting factor 9 in. Remarks: Boring # o Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) �,,cc c 7''A c 7"" 3G' r ao9' 3 o F 3 o �e r3 � B Ad r 3 G � c 4 t7 STATE DAR OF WISCONSIN FORM 2 — 1982 57�U8 J d I 8 WARRANTY DEED DOCUMENT NO. William F. , ommmerfel dt and L.oia_ _ 8, _ -- REGIST OFFICE Sommerfeldt _ huc_hand and wi f ST. C ` I CO., w( V ' MAR 4 x 1999 ratveys and warrant, to Ri chard Q Ri•nrst ; %,a a:oo a M R+ iar d Qwdn INIS SPACE RESERVED FOR RECORDING DATA NAME ANO RETURN ADDRESS slue following described Teal estate in St rrni x Count); State of Wisconsin: NZIA Sectizin 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; Certified Survey Ma rec 1 5 %M fthwz of Certified Survey Maps, page 1372 as 02- 1042 -10 1 Doc. No. 389372, and except the followin g described parcel a Lot ommenca.ng at the East Quarter corner of said Section 15; thence 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 N3M5=34 and he NNW?(NEI,i, exce .the West 330 feet t ereo . describe describea parcel nc u es Lot 2 of Certified Survey Map in Vol. 6, Page 1537. This i s homestead property. (W (is nod Exception towarranaes: Easements, restrictions and rights -of -way of record, if any. Dated this o�1 day of Fe ra y A.M.19 -9a - \ . (SEAL) _ (SEAL) William F. Somme eldt S L ( S EW (SEAL) .ois A. Sommerfeld AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of VAN O1 KNX FLORIDA ss. County wdlenticated this _ . _ day of . 19 Personally canoe before me this day of FPh_»ary 19-911- - the above named Wi 1Ii am a` Rn/nmorfel and — Loj,g G'� m rfpol hLahand and TIRE: MEMBER STATE BAR OF WISCONSIN Wi fA r Of not. %. thorized by 3706.06, WhL Slats.) to me known to be the person who executed the foregoing instrument and a knowledge the same. THIS INSTRUMENT WAS DRAFTED BY / Attorney Kristina Cgland Hudson, WI 54016 Notary Public. Countx WM (Signatures may be authenticated or acknowledged. Both assar re not M commission is pennatent. (if not, state expiration date: necessary.) �anuc.✓t.., • Names of pc-sons signing in any capacity should be typed or printed below their signatures ;,"p. 3HE Cm Inc. bTATE BAR OF WISCONSIN .i MY C=Lv a" Alrrra ao wr WARRANTY DEED Form No. 3 – 1951 t0 X , �! FBI ROT A00ITIClN � i� l�Nr i�wMi ��MwA MN tf 116 � � r R OrY�prdx �r�ii�i � CAOlX CORKY F7-Rr / ! 21 SHADOW PINES wim 449w nor � an wo LOT � � suavEY MAP DOG NO. 5m an CE SURVEY M y t]ttr�c 10 PAGE 2823 D OM DOG NQ. 521878 Y9lUME 10 PACE - -- - - - - -- __ _ mss'' saw" b � t ST CAM aw a+r awsr aruw O"TY <' p . j w.on E 5 i� s ''` S MM Aw ' 34 31} 30 MM sw3uwv SV.W 37 +� sv ►c {29 ) 3 3 Mw mn 40aw s's "a"m VQI ME 807 PAGE ago tEK 4t � pot NO. A3822a i of r m � .� AVMIW &M Lai WAP aw OIL. s so i.�, 3 12 ttyw. � sn ir. sias+eiR grit tO1 1 t 301 M �f � 1D�1L NKA UM MFJY TOM ARM 2 23 " 0'AOM s www A. i M ir �,--� wr�r«rr u�ln► T It T i 7 i AL 5 i 4 's S H A 01 O w P 1 N E S t �c A° to , - r • Dom. b�' V ' .• � Z lott " 0 l''"