Loading...
HomeMy WebLinkAbout032-2154-10-000 r - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and'Building Division INSPECTION REPORT Sanitary Permit No: r • 463027 �,{�, o 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 - 2154 -10 -000 CST Elev: linsp. Elev BM Description: Section/Town /Range /Map No: 7 Sa s µca �� r nor B Z 15.31.19.1334 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER \ CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing 0 Alt. BM Aeration Bldg. Sewer r .`z `�9• to Holding St/Ht Inlet 97- TANK SETBACK INFORMATION St/Ht outlet r .csp 9q•Qo TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ' r 2( / Dt Bottom �- Dosing Header /Man. w. Aeration Dist. Pipe r Holding Bot. System gyp, I -- 1 0 ,S-1i q3.2-0 / PUMP /SIPHON INFORMATION Final Grade q� Clr" Manufacturer \ Demand St Cover Model Number ) TDH Lift Fri n Loss System Head j TDH Ft For main Length Dia. o Well SOIL AB ORPTION SYSTEM BGD NCH Width t� 3 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM NS t I 2, Z / SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufact a .` INFORMATION CHAMBER OR Type Of System: D ! / UNIT Model Nu er: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Length V­�_ Dia Length Dia Spacing 'T S SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes [,-]q No Yes � No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Qqj Inspection Location: 2184 60th Street Somerset, WI 54025 (NE 1/4 NE 1/4 15 T31 N R1 9W) Shadow Pin Lot 36 Parcel No: 15.31.19.1334 Cart '/ 5 1.) Alt BM Description = Ukia- S •�• v"`D" "'""' ` 1.�„-/ � � � �� Z) 2.) Bldg sewer length = 2 1 r �-�- 1 S r - amount of cover = Use revis de for additional in formation . Yes o No i "T – } Re _ SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division County iseon , 201 W . W qson, n Ave.. P.O. box 716 4 sfn M 26�11�� anitary Permit Number (to be Riled in by Co.) Department of Commerce LL// 1\1 ' Sanitary Permit , p on , d ;� � s Plan LL7. Number In accord with Comm 83.21, Wis. Adm. Code, per ntion you provide may be used for secondary purposes Privac 4 (ISM)CROIX COUNTY Preject Address (if different ttan mailing address) N_j1� ZOQ FF1CF L Application InformationPiease Print All Information — i Property Owner's Na me Parcel X Lot Block # .operty Owner's M ailing Address Property Locatica City State - t/a ic�� 1G,Section i ty. 'Lip Code Phone Number (circ��l �e / ?� (� T �< N; R / E t L . ��.V IL Type of Building (check all that apply) q ; — _ lei or 2 Family Dwelling - Number of Bedrooms a - I „ Subdivision Narte CSM Number 1 Public /Commercial - Describe Use ❑ State Owned - Describe Use Z3+22 Ciry� ]Village A!Township of III. Type of Permit: (Check only on box on l ine A. Comple line B it a �ja a, �7 C � I D - 'Q no j �ewSystem C Re lacement S stem f--. p y ❑ Treatment/Holding Tank Reptatemcnt Only L.] ether Modi.��at.on to Existing System _ l ❑ ri _ - iQ B. Permit Renewal Permit Revision � Change of I _� Permit Transfer to New List Previous Permit uniber and Date issued Before Expiration Plumber ! Owner IV. of POSNTS System: (Check all „ � - V-Non - Pr In- Ground ❑ Mound > 24 in, of suitable soil (_I Mound C 24 in- of suitable soil j At- Grade ❑Single Vass Sand Filter ❑ Constructed Wetland ❑ Pressurized I - Groune _f Holding Tank El Peat Filter ❑ Aerobic Trtar -neat Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter }Leaching Chamber ❑ Drip Lin IL Gravel -less Pip J Oth (ex.p _ I � V. Dispers /Treatm Area Information: � � — Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal Area a ropos System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic: Gallons Gallons of Units Concrete Constructed Glass { 'New Existing T T Tanks Tanks I Septic or Holding Tank 1 -- Aerobic Treatment Unit Dosing Chamber - VII. Responsibility S tatement - I , th und ersign ed, assun r or' a tion of the P TS shown on the attached plans. r Plumber's Na me (Print) Plumber's Si gnature P'. PRS Number i Business Phone number - I_� Plumber's Addre ss (Street, City, State, Zip Code) VIII. County/Departm U se Onl pproved [� Satnitary Permit Fee (inc ) odes Groundwater Da is765 lssui , gent Signa (No S mps) I Surcharge Fea) 1 � // /�� /� L3 0 riven Re n for Denial �N l 6 ' on I ii. Conditions of Approval/Reasons for Disapproval 1 A / r SYSTEM OWNER: 3 J v d ! d l �d �2V ,4eQ�3j cam{ Vw e ( 11. , Septic lank, effluent filter and dispersal cell must all be sarylen I as per management plan provided by plumber. 2. AN setback requirements mast be maintained a$ per applicable code / ordinances. L Attath complete plans (to the County only) for the system on paper not less than 91/2 x 11 inches in size SBD -6398 (R. 01103) l� w ko 1- 3 JK���cw/ G lit� S p 6 l S! id �3 R l f, ,:� 4 a vd la GA - ez � 133 R ,v Wisconsin Department of Commerce SOIL EVALUATION REPORT pap of Division of Safety and Buildings in Wis. Adm. Code Attach complete she plan on paper not less n 8 x 1 i County Include, but not Ilrrdted to: vertical and horizon ref poi M), di on Parcel I.D. dime < percent slope, scale or dim north arrow, nd I . a�,di�)anc�e to nearest road 3z Z� cJ Please print all In U �' '� 2QQ5, Revi by Date Personsl information you provide may be used for " s. 75.0, (1) (m)) 11 0!5 Property O_ ING on S /V;CN 4->rj- $ r rx 114 1/4 S T, f/ N R / f E Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1353 klrw�i� G-e 1;/ ' /:A c'L�j � S City State Zip Code Phone Number ❑ City ❑ Village EaTown Nearest Road R New Construction Use: &M Residential / Number of bedrooms Code derived design flaw rate 5fS�4% l C) c� GPD ❑ Replacement ❑ PubN or commercial - Descrlibe: Parent material Gu+ c:c S Flood Plain elevation If applicable ft. General mmmerds s �/� t YY� and recommendations EO Boring # Boring �j (� Pit Ground surface elev. / f . S ft. Depth to limiting factor U in. SoN Application Rate Horizon Depth Dominant Color Redox Description Texttme Structure Consistence Boundary Roots GPDM In. Mu nsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 12 -GJ /c S , I I e7 rr �I i� Bodrq # 0 Boring �� , � • � y ® Pit Ground surface elev. � ft. Depth to ihniting factor / Z in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Shicture Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'E11#2 1 0 ._ G ( _ 5 L. 2 V0.5 VY` r C v 4, '( i ► 0 d Vii' Win, o 35- / o, ( YY)( I e7 n IL Effkrertt #1 BOD > 30 1 220 — — and TSS 30 150 Effluent #2 BOD 30 < and TSS 30 CST Name (Please Print) CST Number &CLIAAra 5c: 3 3� Address Date Evaluation Conducted Telephone Wwdw � s Z � � 9 / c ply Owner ' J Parcel ID # Page ? — of 3 _ Ocring F�l # soft ❑ 9G • ®' Pit Ground surface elev. ft. to limitin factor l Z / in. son Rs;e Horizon Depth Dominant Redox Description Texture Structure Consistence Bmmdary Roots GPDIfF In. MunseN Ou. Sz. Cora. Color Gr. Sz. Sh. - Ef1#1 •Eff#2 I( Ir E Boft # ❑ Suing ❑ Pit Ground surface elev. R. Depth to WAN factor In. Soti Rate Horlmn Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIN in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. - EfW1 •Eff#2 F B'drg It 0 Borin9 Grotuud surface elev. ft. .Depth tD IfrMting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description. Twaure Structure Consistence Boundary Roots GPQff In. Munsell (XL Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eft#2 • Eflkw t #1= BOD, > 30 <_ 220 mall. and TSS >301 150 ng& ' EfOuerd #2 = SOD, < 30 fall and TSS 130 mg& 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- 2648777. I mn.uwta.wo� Property Owner S �Z' J Parcel ID # Page of Boedv © # ❑" Pit Ground surface elev. ft. Depth to limiting factor 2-1 in. SON gate Horizon Depth Dortdnant Color Redox Description TexUae Structure Conelstenoe Boundary Roots GPDRF In. Munsefl Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •0#2 i o - I In 3 SL Zvn ��— C S /,IV 1,'G 13-3q 10 / = S6 L- 2-"k M r C S M -1 71 w ! , f S asC vr1 — — b Z.. if dn I( ❑ swing F Borin # Ground surface elev. it. Depth to limiting factor h. ❑Pit Soll Rate Horizon Depth Dorninant Color Redox Description Texture Structure Consistence Boundary Roots GPOW in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Efl#1 •Eff#2 E Bod ng # ❑ B ring Ground surface elev. ft. Depth to knifing factor In. Soil Role Horizon Depth Dominant Color Redoc Description. Texture Structure Consistence Boundary Roots Consistence ( i3 Munsefl ChL Sz. Cont Color Gr. Sz. Sh. •Efr#1 •mf#2 • Effluent #1: BOD > 30 1220 rnWL and TSS >30 1150 nV& • Effluent #2 = SOD, 1 30 wak and TSS 130 nWL 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 - 2648777. PAGE ---a - _ NAME S' > U" LOT# LEGAL DESCRIPTION*e /a[/� /a,S /1� ,N /� E(ORkW SCALE: I" BM 1 ELEVATION l G ©. U BM I DESCRIPTION r�c>hCl'cc CJ ✓1 BM 2 ELEVATION BM 2 DESCRIPTION SYSTEM ELEVATION OJ Du/ ✓�r�K SYSTEM TYPE / D C!� , 5 -s� 4 C 1 } �t SIGNATURE DATE /1-" _Q J 0A Safety and Buildings llivision Couny �— -- �������� 101 W Washington Ave., P.O. 7 e Madison, W1 53707 - 71b i d� artment of Commerce (5508) 26fi- 3152 ","^ L ___ Permit Number (to be filled in by Co.i Sanitary Permit Applieati� n 1.D. Number !n accord with Comm 83.21, Wis. Adm. Code, personal i ortna �_ may be used for Secondary EGBI Y purposes Privacy l aw, s15. I (m) _�_ _ _ roject Address (il' Application I different than mailing acldres,) ! 1. pforrnation - P lease Print All information - 5 7_ Property Ow� me _— G Parcel M Lot k Dicx k M � ; 70NING OFFICi_ r Property Owner's ng Address - """"- `- ~ ---- -• °'°"° '��- 6 ,. ��•�� � �i. ! • Pt Location -� City, State Zip Code _ �-T Section Type of Building (cheek all t appiy) T �f N; R (circle one) E or W l or 2 Family Dwelling - Number of pp ff s -- �- Subdivision Name S CM Nu b I Public -Describe Use ❑ State Owned - Describe use Doty DVillage Townshi of III. � _ . -.._. _ p - Type of permit; (Check one box on e A. Complet line B if pliable) 0 2 - z _ y ~ A. New S stem - IS� —lt dQ71. l3 3 y i L kePlaeernent System Tr1WrneatdHolding rtiirk Re lacertx nt onl --- -� p y Other Modification to Existing SystetTi - B • C I Permit Ren (� Permit Revision —4 ! - ` —� i tinge c: t Transfer to f Permi .dew List Previous Permit Number and Date tssued Before Expiration � I Plum r � •` Owner IV. Type of] S ste �_ (Che alE that apA1Y) { Non - Pressurized in-Ground Mound > 24 in. of suitable s Y ,,� Mound c 24 tr.. of suitable soil ❑ At Grade l I Single Pass Sand Filter i Constructed Wetland Pressurized In- Ground [` tloldtyt Tarp Neat Filter `, Aerobic Treatment Unit Ll Rcc irculatiutt Sang Fitter L_RCC1fCUTA Sytsthetic Me Filte ` $ - _ �i Leaching Ch r ' u F1 Cir�tvel -te Pipe _Other (ex la n� � V. Pispe rsatf treatme Are Informat _ � 2 D sign Flow (gpd) lksign Soil Application Rate( sf) —� CllrX - $pd Dtsp al uired (s� I)ispersat Area Proposed W) I System Elevation " i _5"7 i 93. 3-o VI. Tank Info Capacity in Total `:Number - - --- Mane urt r Prefab w - '- -""" Gallons Gallons , of Uni t., (,-_Z..,b, A _ / Site Steel Fiber Plastt� ie'w T`Fxisiine Concrete Constructed Glass i Tan ( kaTanks Septic or Ho)diny Tank Aerobic Treatment Uri . L_S__ �G3 f� !� � ft e- Dosing Chamber R esponsibilit Statem 1, tilt dersigned, asswne responsl for 4 tatiatiou of the PO S show -- - `�'" * tut the atta plans. _ 1'tumber's Na me (Print) Umber Si na � - � _ 8 M /MFRS Number Business Phone Number P!umAr's Addre ss (Biter, City, Stat zip Code) �— VIII. Count /D r _ a true Us Approved ( Disapprove ~~ ) Sanitary Permit Fee (includes Groundwater ? -_ate Issued Isstti g Agent Signature (Ne Stamp,) ± Surcharge Pee; i ❑ Owner G' en Reason for Denial L 2so . R Condititms of Ap a1/Reasons fur Disa , --"-- SYSTEM OWNER: pproval 1 Septic tank, effluent filter and 3 Ala ' ` � ^ dispersal cell must all be serviced / maintained n as per management plan provided by plumber. 0.S � �t � 6, 2. All setback requirements must be maintained j as per applicable code /ordinances a J K CYO �Q/ Atlaeh complete plans (to the County only) tar the s tern ttn r of less P Q _ _ than $l�S 3otl c(tes Ut else SBD -6398 (R. 01!03) Ct°"�iP/ l�� `� tn� pax Axon S I�r at� S t�rY� •( i _ w n rx � m- d _ p t� i � ..,." t \ V d oll ; Ne l N A 4b r A v l S �( o w �l / - tO N19'27'14 'E,/� W D OC._ NO. _ 5 / Iti Fes: 25 YR H.W.L. 66.17 // r $ VOLUME 10 PA _ r , / 3 5 $ 949.20 V1- -�- '�'•� . ,. 130.941 SQ. FTA ' 52 3.01 ACRES 77 3 eN43'20'25 "E S8 43.23' "E I ,I a� I ^� �• R =N89'58 5i .0 h 9.Sfi. N18'58'31 "E 589�'4�2�~E N89:24:21 'W �N' ` �� 59.29' 528.2,3' - 316.58' 60,54 ;, _ 211.65 295.56' _ / S29'5117 "W< `. - -N8924 W 507.21. / 49.63' - +N00'07'11 "W 33.13' ,' .,, S00'07 11 Ec h'` 05 DRAINAGE 35.74' \ a c3° ��' EASEMENT ` r I • y% � ° I , / S89'24'21 "E � S8923'33 "E I 26.74' N 107_42' 3 ) 15 SQ. FT. 25 YR H.W.L. 1 ACRES _ 34 i 951.60 i 134,694 - SO. FT. •� 3.09 ACRES ku 1 80 S8923 E 33' 507.21 , a�ss 1 Nj O� S89'23'33 "E 107.42' 37 ss s °o h �/,'vS 131,119 SQ. FT. B S S , N 3.01 ACRES / F BENCH MARK: A M U '�� p 7 8�, TOP IRON PIPE <p�Pj ELEVATION = 999.35 -- 58923'33'E 507?,'--- - s SOUTH LINE OF THE -A/E 114 OF THE NE 380 ._.._.._ bSb ti b3'Jb � Wisc Department of Commerce SOIL AND SITE EVALUATION 1 3 Divisi Safety and Buildings Page of Ewreau of integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach comp lete P lete site Ian on paper a er not less than 8 112 x 11 inches in a'larf must siz County ',/� include, but not limited to: vertical and horizontal reference point (BM�a�dire0bri and St . Croix percent slope, scale or dimensions, north arrow, and location and lstilnoe to neariftt road. rcel I.D. # APPLICANT INFORMATION - Please print all inf rmation. r Revy w y d by Date Personal information you provide may be used for secondary purposes (P vaGyt Law, , ;, '1404 P) (m)).���f� Z en J Um Property Owner to ocation r' ' " . t l;: Richard Stout AIR t b*� ,�hY; /4NE 1/4,S 1 5 T 3 1 ,N,R 19 E (or Property Owner's Mailing Address 1 � W a r CSM# 6-5- 1 353 Awatukee Trail ~` r3tJ w -Pines I -Sfi �`1� City State Zip Code Phone Number City ❑ Village ❑ Town Nearest Road Hudson yi 4016 (715)549 -6731 Somerset 160th Street [R New Construction Use: E51FIesidential / Number of bedrooms 4 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 600 gpd Recommended design loading rate • - 7 bed, gpd /ft • 8 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate • 7 bed, gpd /ft • 8 trench, gpd /ft Recommended infiltration surface elevation(s) S e e l i = p c)t p l a n ft (as referred to site plan benchmark) Additional design /site considerations CO Parent material 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 12S ❑ U R] S❑ U L�j S❑ U 1 51 S El U ❑ s I U ❑ S q 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 0-12 1 0 r2 1 1 rn4BK 2 1 2- 7 10yr2/2 -- is 1 rn49 K mvfr cs -- .7 .8 Ground 3 27-89 10 r4 6 -- ms os ml c -- y / g s 7 .8 elev. 97 .4() ft. Depth to limiting ; factor $q- in. Remarks: Boring # 1 0 -17 10yr2/1 -- is 1 tO 140r mvfr cs 1f .7 8 i; 2 2 17 -40 10yr2/2 -- sil 2mAo mfr cs -- .5 .6 4k 3 40 -90 10yr4/6 IMS osg ml cs -- .7 ..8 Ground elev. 97 ft, a+ q3. io Depth to limiting factor -9-0-- Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number Richard Stout SOIL DESCRIPTION REPORT PROPERTY OWNER — Page 2 PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 – -- Y4A- mvfr cs 1 f .7 '. 8 2 2 - 8 10yr4/6 -- s l osg ml cs -- .7 .8 Ground elev. 98. ft. 93• Depth to limiting �,(p factor Remarks: Boring # 1 0 -10 10yr2/1 -- is 1 M 48 mvfr cs I 4 2 10-80 10yr4/6 Ms osg ml cs -- .7 :.8 Ground elev. 9 7 4-0-ft. 3- Depth to limiting factor 8 0 in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure GPD /ft Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 1 0-18 1 r m 5 2 18 -48 10yr3/6 -- sil 1 ~r, mvfr cs -- .5 ,.6 3 48 -96 10yr4/6 IDS osg ml cs -- .7 ;.8 Ground elev. 9 8.2�ft. Depth to limiting factor _ Remarks: Boring # Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) c 141 a7 g Y. 2 d 5 Ale �Y L.07`3� •8� 6L °d n� V 85 /.dreg 'T •,°v^ -...� 4 ' 0 CI VENT PIPE 12" MIN. ABOVE GRADE 5 5 " ritom DOUR W itiDaW OR 4£A1'�!ERPROt�F FRESH AIR INTAKE JL T NCTI OO I N � BAPPROVED t x A ��/�+ r FyNZSHED GRADE W1 PADLOCK � �' CZ RISER WARNING' 1AB£I ....."'T I 4 ." M ` N , All TIGHT SEALS GAS- TIGHT r A SEAT, PPROYED PPROVE�J `'� ' ,,, JOINTS WITH 'IPE 3' 8 A�.M + App"VED PIPE Wo S IX 10 � j ~-�° ON � � 3' wo iC1:L O SOLID SQII PL Mp OFF £LEV .` r RiS£R EXIT PERMITTED ONLY ,. IF TANK .4ANUFACT'JRER APPRu�'ED B=0T*XG UNDER TANK �S APPROVAL ..O NC" RETE ?AD �ECIFZCAT;0,45 SEPTIC % DOSE TANX MAYJFACTJRER: e h". MBER D4S «S PER DAY: a N SS T2E5: SE'P''IC .lam GAL, DOSE VOLU?o IA�C :JDrNG DOSE G.L. FL�iSv8ACK; 1....._.9........ GAL. M ki.ARM MANUFACTURER s - � I , CAPACITIES : A ��MODEL NUM$ERs . a.'vC3?YS ' �rC ._._ GAL. SWITCH 'TYPE. - .�.��.......... J,rp MANUFACTURER ; MODEL NUMBER : ,�- C a ,.. INCHES : SwxTCH TYPE: G AS,. 'EQvjRED DISC 1i� ... . NARG£ R.AT GPI,. PUMP t ALARM WIRING AS FER ILli?, — 26.23' WAS £JiTICAL DIFFERENCE S«. t".T Of AND wISTATS�TTION PIPE , N:MUM NETWORX SUPPLY PRESSURE � �.a�t4...., FE" FORCEMAIN X jL FT/?n r - , + FR:G x. o T ' C FEET ,� h �A..ro rrrT .0t %L DYNAMIC M£AD = " DIMx „ , T FEZ WID TF. RGOULDS PUMPS Submersible it- Effluent Pump EPO4 3871 EP05 APPLICATIONS • Eully 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. • 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 Q Cansdian5ta�xlarosAssociettion • Heavy duty sump matic models include resistance. • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatedng 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 5001 Registered. • Solids handling capabili FEATURES cover with integral handle and g P ny: float switch attachment points. 1 /0 maximum. 0 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: 1 NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 1041 (40'C) continuous 140OF (60°C) intermittent. METERS FEET 10 -� • Fasteners: 300 series _ stainless steel. 9- 30 "�^� - *+.� " —► S GPM • Capable of running dry without damage to $ 2s FT components. 25 ... Motor. s • EPO4 Single phase: 0.4 HP, a 20' 115 or 230 V, 60 Hz, 1550 RPM, built in overload with s automatic reset. a 4 1 s • EP05 Single phase: 0.5 HP, EP05 115 V, 60 Hz, 1550 RPM, 0 . b 3 10 uilt in overload with automatic reset. 2 EPO4 _ .. . • Power cord: 10 foot 5,.. standard length, 16/3 __ .:.... SJTOW with three prang grounding plug. Optional 20 0 00 10 20 30 40 so GPM foot length, 1613 S11W with three prong grounding plug L (standard on EP05). 0 2 4 6 s 10 12 m) /h CAPACITY Goulds Pumps ® 2000 Goulds Pumps ITT Industries Effective February. 2000 B3B71 to STANDARD CHAWER 52 " - - -- - - - - -� Quick4 Standard Chamber ---48" - (EFFECTIVE LENGTH) � ra fa E r r f � 1 - - - -- - - - -- - 34" - % SIDE VIEW SECTION VIEW MuitiPort End Cap - T— - -- - __- - - - - -- s -- �- -- 34 -- - - -� SIDE VIEW TOP VIEW FRONT VIEW WAW ,Quick4 Standard Ghamber�lominal Specficatrons J:nd Ca t Nominal`S eciticatrods Size (W x �� - --�-i? --� L x S H) 34" x 52 "x 12 ' Size (W x Cx H) y "`34`06 x 12" Effec Length 48" Invert Height 8" or 115" Invert Height 8" -- - - INFHLTRA70RYS7�M INC. STANDARD It MITED WAR RA6�7_y (U1 7 e t vqur8 ins, ay of e on _iamb &, and plal6, wedge u o o nor iKwrsFAxy rra+ r r a,7 by !nllllra�cr I'Un:ts "t Mien ns,a iecl and operalefl n a u hl ld of urn t s,G+t c system in ifc ordanrG with rFlt - e.er's it �l a1s, r u;d to the oriz}�rwl purchases t "HO'(to, ..ga+'at N lectrva arts — a anchlp for ,me year frun :he date tile: file wplld Penr t is ;_s k,l 1 e 5Upti6 sysfetn ca^tdining sei 'Hor p,�wide I;uweear lh jr 1 a seryi(x: pared +s nr_rl 197.rirect bV appGCabk; law. the earranly pwlod wal tuw,,n U,yx 1ne oal9 that ir,htadehon of the septic sy ;leo'i conu h P Cr se Its W d ly nNhf :; Holder Im'! not ty'r. it rate/ n -turd 31 du CtRportie Head N. nla 11 010 Saybrook Co. x.' 'i(;rl( wr1h111 hffeen It51 lily' of 1. aliegod ialect, Infilf aico wiN supply aliacar,ent ruts for Units delerrmned by ualUatn, b ve cowered by Inrs umAtyd vvananiy. ' In llat,:f 5 nabil,i, swii.calty ii-i oas to roO of rempvaf and/or rkstaflatrd, of Ine Units 1 HE LIM'Tr!1 ViARHANTY ,AN) RFMEDES IN Sja[MAGRAPH ja{ ARE Lt01 j_ 1 _ r ABE NO GI HER N1ARHAN71ES WITH HFa ?ECT O IU if I NJ- 'CLUDINIC No Irdl WARRANTIES OF MFRC'.HA.N fA SN.' " - _ )q FIN FCil A rmp At ' f" 141.M 7 Ful'il $E h S YSTEMS INC It ! ''tn t H d I any parr of 1 a .hdrll(,(+ Y tern - - 1 4a 1 r 11 y llv Jlha rW In1iNr:1lor Tletl IJrt t 1 Warranly dlJBs r 1 i l i n d to I - 3,c rata rats, a ..poi r er , _­t : .,mss. Inl�u at , s xf) not nsu i Naore I7r IM,ranmS ur Iyuidated damages nc n:dln;� doss of Environmental Onsite WaStMater Solugans`" lc Ir rr r en ( of atvx are. cvflatrd Coss other as5 or ur ex(a unad by the HMCbr or any Ihird party p S "ra: f,iany ex I daI from r n test Wu arty cow .,je are damage to tie Units due to orUrnry wee d leer ahe ation, 30CUfere, msuse, abase ^ ri of f the rJnd tx,ng s nor a 1 to va!ticle manic a o;f19r corldi in rs we1K;h are not pr, nniorJ by !h0 mslalhtion iIL"inlCtidiS, 181 re to hlak,iax, ;ha 6 BUSIneS$ Park Road • P.O. Box 768 the J mn rnum grouYA cow c >Pt rSJth in the inst9tkifron Insiructi r. the pi2eeinenl dl irr nalahalS InIU the system containing the Unds' /adore of Via t or ilia mat -ystam ilea Io;mprope, ailing « imp dl�r arzirtg, 9x e eyaler U ago, improper grease disposal, v toper pperalion; d, Old Saybrook, CT 0r^ "_475 any n n9. sw;n( rxd cau�d bit Inf;lhaioC (his limited Warranly ;hall fie void tl V Hlo!dur f. is to comply with all of tae fauns set Iorh in this Limit9d Warranly. F360 -577 -7000 • FAX 860- 577 -7001 Fu the in m 9veld s\ II r edtralr:r t tel responsible 1. any Y)ss of Jarrage to the Holder, 1he ' L', or any third party'eslgtiny barn instil abort or ship- O y /� !ns n. pr I,— any Product riaoully cla w ims of Holder a•y third peril. °or this LVmiied Warmly .c eop-V, the Onµs -;at be inslapetf m accordance 900 -22 1 - �F43S '"in all ste ::aril tp s re.�,urrat! .ry slate arM Iota -riles; all JI Ifir appNCeoe law;, and Irrhtlra0.:t irlstal4Nidn instrx:!4rrrs, ill N•� n'IX65eneatNO 01 4d;rVal;.r r'•as IhC aulrp,ty to C.l o; -1—:1 this lirn'tn+i We nnt,. N'o w ardy appli_ to any party alHer nwn the nryi- A� folOnr'. 7ti aWIVe rapr9::enl IlH Sf.andaa ..ill = Warranly nllera[1 by I ilhelUf. A I nilIXJ number of —1- at ,ry+es h-ry H glrleron' w ;y rerq:,,e r•ranla. Any µ,Hr, ase f Unite - old WntaGi Inli�IrainfS (:or rani HeaUgUartars to Old $3vMcck, (:orinecN:;Ut. prior to win =opy of the apd:cable warranty, WO shuuO carefully read that wananly prior to the pi Itches, o! Units P::rr,iiase, 'o oblaln a J Patents: 4,753.661; 5,01 )r,041; 5,156,488; 5,336,017; 5,401,116; 5.401.459:5,511.9W; 5,716,163; 5.588,778. 5,839,844 Candler Patents 1 .329,959:2,004.564 Other patents pending Infiltrator Equalizer and SOMfinder are registered trademarks of infiltrator Systems ;n;. Infiltrator a a registered trademark in France. Infiltrator Systems Inc. s a registered tradernarr Mexoo CcuttoUr, Contour SNaYaI Conner for McroLeaching Poly7ufl, SnapLock. Cl,arnbvSpacw. PosiLock. QuickCUt, CluickPlay RECYCLEDPAPFR and Qiliak4 are tradervancs u, Infiltrator Systems Inc. 0 2003 Infltrator Systems Inc. ?rifled In U.S.A. 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of Rd INFORMATION SYSTEM SPECIFICATIONS Owner R IGS S Septic Tank Capacity ,7 d a l O NA Permit # Septic Tank Manufacturer �, O NA DEAN PARAMETERS Effluent Filter Manufacturer O NA Number of Bedrooms 4 7l' O NA Effluent Filter Model e0 O NA Number of Public Facility Units 0 NA Pump Tank Capacity Are al 0 NA Estimated flow leverage) 01 �'�j g al iday Pump Tank Manufacturer Zd c le=, � eL 0 NA Design flow (peak), (Estimated x 1.5) a al/dav Pump Manufacturer z!V' ,* U / 0 NA Soil Application Rate at /d Eft Pump Model (GPO O NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit A Fats, Oil A areas (FOG) 530 mg /L 0 Sand /Gravel Filter O Peat Filter Biochemical Oxygen Demand 1800 5220 mg /L 0 NA 0 Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg /L 0Disinfection O Other: Pretreated Effluent Quality Monthly average Dispersal Colds) 0 NA Biochemical Oxygen Demand (BOD,) 530 mg /L lAln- Ground (gravity) O In- Ground (pressurized) Total Suspended Solids (TSS) S30 mg /L O NA 0 At -Grade O Mound Fecal Coliform (geometric mean) 510 ctu /130ml O Drip -Line 0 Other: Maximum Effluent Particle Size Y in die. © NA Other: A Other: O NA A *Values typical for domestic wastewater and septic tank effluent. Other' A MAINTII NANCE SCHEDULE service Event Service Frequency E3 month( Inspect condition of tank(s) At least once every: 3 s s (Maximum 3 years) O NA Pump out oontents of tanks) When combined sludge and scum equals one-third (Y of tank volume 17 NA Inspect dispersal calif &) At least once every: imenthis) onth dr s) (Maxmm 3 years) 0 NA ,� erfs) Clean effluent fiker At least once every: O NA . � earls) Inspect pump, pump controls & alarm At least once every: --- Cl nm j(s) la NA Flush Ia wals and pressure test At least once every: months) O NA O ear(s) Other: At least once every: 0 mon ti y (g) O NA Other: 0 NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: M PI Mager Plumber Restricted r POWTS Insp ector; POWTS Maintainer: Septage Servicing Operator. Tank Mager umber; Masi umbe Rest clad Sews , p , inspections must Include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(sl shall be visually inspected to check the effluent levels in the observation pipes and to check for any pondiing 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. page O,f� _ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal call(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 call(s) In one large dose, overloading the call(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do riot drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the fife 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; peinting 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: is 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 fitted with soil, gravel or another inert sol 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, F j system.. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. p 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 A Ao T tank ❑ 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> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. 00 NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDIER ANY CIRCUMSTANCES. DEATH MAY RESULT RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS pOWTS INSTALLER POWT8 MAINTAINER `l Name �✓r�� u �wr o� t^ Name Phone Phone 2 r w ,� „Z SEpTAGE SERVICING OPERATOR IpUMPERI LOCAL REGULATORY AUTHORITY Name Name Phone ; . $lo• (SO Phone 83.54(1 /, l2) A (3i, Wisconsin Administrative Code This dooum rn drafted in compliance with chapter Comm $3.22(2I(b)(tlidI&M and f ' FH,'t' I e 71c._ ... _I an. Z l_'7 FF'j�l °1 . �C f�Lll ,� I;Gt r l Ll i11� 1 t iQ CROIX cuL" TN' FTIC TANK �1AI1�TENANCE AGP B �? T �}V�;z1 RSHIP CERTf FICATION FORM dr? 721 �uT1Cx�ti��f �i vi�iiir�8 Address i S �' t�I'bpCi�:j' �a mri8 ftlY new (�'oxll�csti�zl zaquired from Plaz>nin� �" pccl Ident?cati� Number Erika I /. y /a, W, Town of Locatib�l � page c,tittled survey Map Volume Page Sz<ec ho X ' es L tat Trot 1in�s idcnasi0�le � �� � no etaatuzo failure tb harrdle wast;eA. proper m1 rizcttau-e ce of y�, septic system could result .n. id by a licezz3cd pumper.�tt ynu pit into the ayatcm It " wilt a =* a te every three years or tooter, if osl systems c:n xts ! 0 a a=mt age ?� tae waste can aff�►ct the &Utiw d th>e+ ✓moo t a oestificatioza term, s4u'-d by r.t� owner and @� a ht Crohc Zotu ptrtmag PSae c�•rite wartewetGi dtspasttl system Tb4 pay O agrees w wbmit to er ver.1,�riY *mt ben, reatri3O,*dpinsnbea Ur e Laett P p ncG s ), tae •optic ta, is less t e�n 1.13 full of situlge e an Ium if n �aster p�bti, jcusss �' P it p Aer o mtdition is i �d'nr (Z) al�wr sgtCtiou and pummp+ 9 dia asl+i system with tlxe ctar�l rrds iiw?, }he untinzaigaed have read the abova to a ea and thee) to mainttiu "tae p rivals sewr¢�g p set forth. haiuL u sit � the Daps ez� of Cammaec.a and the peg�tsrsent Of Na� t the �'� �i� �aG:nty Zat Clf�^•e w�tbL-�t30 a tin tl'sst YonC �� Wtom hae been m4inteined must be c�mplet4d 0 �'� • f the tbrac yw expinrivp Mete. 21 , S1Cvlti��`A� G7�' �PL.IC�`� of TTun to Paz 1c a�uledge. I (we) am (are) *'a I (woo) fy t ut A U atstcaae;nts ou this fgcm de�d =ozd deinpRd� er Q ')cod'* tht prvp�Y ecribd above, by virtue Of a vaatranry d n - AP ar{ Tyr � �}�+ SLY1..Jllll{1 1YPOWWM SIt,N�. f"4 erxu *. bawn revoked by the Zoning ntp tnt «��w+ i� the sa�itery p A�3' inf'a�rmt<tiots that is mia�xeprosentad zua� zasult Cittf�n; a $tarttp�d warranty dee in th d f!'am the Register of peeda affiae * Include wtth titia 0 a spa e t certt de A urva y mop tt refcrcac is Ada e warranty doed J f , we Uf S `408 STATE DAR WARRANTYIDEEDM 2 —1982 DOCUMENT NO. { William F. rt5�mmerfeldtt n � and Loin REGIST 'Vol OFFICE Snmmerfeldt, d _huahan and wife. CROIX CO., WI - ST. R"% tow ROD" --- MAR 0 x 1999 eonveys and warrant., to Rieltard Qtrnst ��� ,� 8:00 A M 1Nis SPACE RESERVED FOR RECORDING DATA NAME AIM.) RETURN ADDRESS ;tote followingdestxibed tealestate in Af County, i � .State of Wisconsin: � l NZIA Sectioin 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; f Certified Survey Map recorded in Vol. 5 of Certified Survey Maps,. page 1372 as 1 032- 1042 -10 Doc. No. 389372, and.except the following. - ? described parcel adjoining.said Lot 1: ' Commencing at the East Quarter corner of said Section 15; thence South 89 0 38 1 55" West (assumed bearing referenced to the East -West 1 Quarter Section line of said Section 15, 391.12 feet along said line to the point of beginning; thence continuing South 89 West, 158.88 feet along said line; thence North 1 0 01 1 32" 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 NWENNEW any the N%NWUUE'4, except the West 330 feet thereof. The above described parcel includes Lot 2 of Certified Survey Map in Vol. 6, Page 1537. i s ead This homest propetry. (is) (is not) Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this f day of _ re to ,y A.D., 19-9 (SEW `. S ( EAU William F. Somme eldt I (SEAL) (SEW .ois A. Sommerfeld AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of SliMSKM FLORIDA sr. CDim uuhentiated this _ _ _ day of . 19 riersonafly came before me ddi day of Fo}srssary -- 19 a R - the above named the 7 1 1 am F gninin; l Ai- and . _LQt& g--mie zeAl i- r htahan.i and TnU: MEMBER STATE BAR OF WISCONSIN wifp- (if not. w..thorized by 9706.06, Wis. Stets.) . .. to tie known be the person - who executed the foregoing im mmmnt knowledge the same. THIS INStRUMENT WAS DRAFTED BY / Attorney Kristina Cgland n Hudson, WI 54016 Notary Public, C°t' ry Wis. (Signatures may be authenticated or acknowledged. Both are not M commis b permanent. (if not, state expiration date necessary.) Q t.t • Name of pt -sons signing In any capacity should be typed or printed below their signmure + « STATE BAR OF WISCONW1 . MY COIW=" / CC WM °A l �� re. WARRANTY DEED Forte Na 1— 1961 �MfDy a bYv+�lrea '�''�� . Bache Tlwt Nohry Rib titduwtRata F � et,: o•; I f .71 49 1 � / .y / �h trim 2- 4w �. 5 a d 4- - 3.� Z A�i ar art a sn ww wr �M r k1Y rw wr Ar r r ' 0 sl lot i JM= 36 W po i z NI ao. Ass _- `� I r Q a A !� r ft ^ o # C N In �— �� lip � • -• k � �y �� � 0 • � I � � iwaiw 1 L is 3 t L ---- - --------------- --- - ----- a i i ! tom► � �'� � -... O M O 4 H S N I NI 041 i It d f Maw �A AM 25