Loading...
HomeMy WebLinkAbout032-2099-60-000 n y O 0 to O K v 0 L o .. K o a CD m Q Z X m Z p W= 4 O W O O CD to 0 O Q m O N '«? (O CD p N N m W ee • �• U1 S < c G O 7 3 j N to N N` N Q eD 7 O 0 7 m > > > > O ca cD O S. N m 1 N N Q� pt N N S m 2 ro o o c v n o o Q 0 c - O CD to tJ1 t0 r .7 �• V ID CD o V ID o A Icn CL cD A G �07 N N p I O Q. O (IIn�_ M O ON 0 f�rl`f �.. _ ° CD O N OC� 01 y N O O ! cn 0 c l��1 o C 3 C N N 3 cn CD a O O O m O O O Vl N fA fA lR In N CL Lri C L d Z co Z A p Q D o° N - D °�—� o O C CD N O N P•t • O O y CD N O> c o to (rl (D s O F4 N V 3 m j(D � ° m ° � Z co D c O �vi C .r `� . 3 z 2 0 Cn W tT G a , tD - Z 3 c 3 3: x N .. 3 •. C z < CD <. A A A y O ' _ 7 C t9 p N N � C 3 3 a o CT =to 'o o m . N �� c - 3 I Q' c N NEn C. i<D 1z a 0 O .: N ip �w 0 0 En f C a v 0 @ 3 a cr o 3 w7 cr 0 co CD N O O CD N N N ° o m N O R CD 3 ZZ S N W nG 7r a k CD ° c a O N tv N � s 0 0 o iv _ i � a CID m 69 0 o 0 G.�. v 'co -ti��e� , � Wisco�` in Departtn Ice County ent of Commerce PRIVATE SEWAGE SYSTEM St. Croix Safet✓ and Buildkg Division INSPECTION REPORT Sanitary Permit No: 399696 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)]. r- ----r' Permit Holder's Name: City Village X Township Parcel Tax No: Dendin er, Justin I Somerset Township 032- 2099 - 60-000 CST BM Elev: Insp. BM Elev: BM Description: ' n LM •a 1� c7 0 = CST Rw TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic O e- Benchmar � I y ,i D D . (7 ti Z6 Dosing Alt. BM �. I M•8S Aeration Bldg. Sewer , I �-• zs 91D • 85 Holding St/Ht Inlet I St/Ht Outlet , TANK SETBACK INFORMATION TANK TO PJL WELL BLDG. Vent to Air Intake ROAD Dt Inlet .29 Septic � � � /, \ , J � _ Dt Bottom Dosing �t �� 50 , Header /Man. Aeration ( Dist. Pipe 1 0.31 f Holding Bot. System [ I s� 96. SS' Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number ,/ L,.) C - 0 l M c �S 4 Z I a•D.8Z T Lift Friction Loss System Head TDH Ft I 05 1. S --d a L . sr d l� S 99 4o Forcemain Length 30-0 Dia. Dist. to Well SOIL SORPTION SYSTEM 5 ` Q 0ftftENq0 Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMEN NS f cl3 e ^ � CZ SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR S��Pec✓1 Type Of Syste / m: r , UNIT Model umber: DISTRIBUTION SYSTEM o'?4 ft-4 &O- Header /Manifold n Distribution I x Hole Size x Hole Spacing Vent to Air Intake Pipe( Length��! Dia Length Dia Spacing f aO 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 ', No Yes J No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:1 P jj 0 Z — Inspection Location: 1968 62nd St Somerset, WI 54025 (SW 1/4 NW 114 26 T31N R19W) Pinecliff Lot 6 Parcel No: 1.) Alt BM Description= Z z • i S" 2.) Bldg sewer length amount of cover = > N "D 3) q L4 B Z , S S z(� Plan revision Required? I -.:'', Yes No � � 4k_—(,�� Use other side for additional information. D ate Insepctor's Signature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County -- 201 W. Washington Ave., P.O. Box 7162 N* fisconsin Madison, WI 53707 - 7162 Site d dres s Department of Commerce Sanitary Permit Number Sanitary Permit Application , / 9 �e In accord with Comm 83.21, Wis. Adm. Code, personal information you p e ~r F ! �. h if Revision ma be used for seco purposes Privacy Law, 05.04(1)(m I. Application Information - Please Print All Information x State 1 D. Number Property ownefs Name Parcel Nurnm Property Owner's Mailing Address , Propety! lion 1 �b n wk j !4 S T&I N, R > City, State Zip Code Phone Number Lot Number Block Number ubdivision Name r II. Type of Building (check all that apply) ❑City J°•' I or 2 Family Dwelling - Number of Bedrooms ❑Villa e 8 ❑ Public /Commercial - Describe Use NTownship ❑ State Owned /� Nearest Road C III. Type of Permit: (Check only one box on line A bering scheme for inte use). Complete line B if applicable) A. 1� New 2 ❑ Replacement System 3 ❑ Replacement of 6 Addition to For County use S stem Tank On Exis • S stem B. 0 Check if Sanitary Permit Previously Issued Permit Number Date Is ed z / IV. Type of Permit: - (Check all that apply)(numbering scheme is for internal use) 44 Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Regirculating 30 ❑ Other V. Dis ersal/'Iteatment Area Information: , - - .". Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade - Required Proposed Rate(Gals./Days /Sq.Ft.) (Min.flmh) Elevation VI. Tank Info Capacity in Total Number _ Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks ���` /C Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank S+ Dosing Chamber — ) VII. Responsibility Statement- I, the undersigned, assujAe responsibility for installation of the POWTS shown on the attached plans. Plum r' Name (Print) Plumber' Si MP/IviPRS Number Business Phone Number /.. — J Plumber's Address (Street City, State, Zip Code) VIII. County /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ❑ Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse Determination IX. Conditions of Approval/Reasons for Disapproval 1. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. This revision/transfer was submitted to reflect a change in plumber and owner. 3. The sanitary fee ($225) for the original permit was submitted by Kim O'Connell on 1/24/02 (receipt #020890). If the original plumber (Brady Ut and ) can provide proof that thi chinded Attach complete plans (to the County only) for the system on papa not less than 81/2 x 11 Inches In size SBD -6398 (R. 05/01) i i ftDWM e • CwboMm - s,bs, -mac MOW" • S1657N41 rWpia j a O m O ZZ mZ D D p n n of n i ` x O n , v i -c I I rm CD Q � Q £n 01� ~ co V'} I � CD i i i �{,s r,,1 � ��'�cJo �aJ�� �° .�s�,.� �- i✓w��5/ s.�� �� T -- �c � .4 /��r -� �t �✓� - tea c� 2 / .Ce�r l^jjG�l 3 ° h'e use ,441 s� � �� - T3��✓ x PLJ /n J 7 A .!�,JeN /XOr r �� ��r � - ��d e 3 2 �iCe�pr�s�Lw Wj7.�l ve Sze n a i 90 ' 0 PUMP C AMBER CA055 SECT AND :'PECIFICATtON�_ VF WT C ^P VENT PIPE WEATHERPROOF pPPAOVED LOCKING _ JUWCTIOM eOX MANHOLE COVLlt WITF1 z 3' FROM DOOR, T AMIING LA6LL WINDOW 011 FRESH ILMIU. AIR IWTAKE GRA0C i 4' MI►J. _T COIJDUIT l - - __- ______- ItlMIAJ, \ ; \ 11 , PROVIDE I IWLET AIK1'IG11T SC.AL APPROVED JOIN A I I A PPROYCO JOIU' W/ PIPE ( III W/ PIPE EXTENDIU6 3' i j i ALARM EXTEWDIWC, 3' OWTO SOLID SOIL, ONTO SOLID $01 D I I I ow LLEV, FT. PUMP - - -j f 1 b OFF 0 COUCKETE DLOCK I RISfR EXIT PERMITTED OWL'.l IF TA UX MAIJUFACTURCK HAS SUCH APPROVAL B" APPRcVE4 6CI>bI u.�dc� r SEPTIC E SPECIFICATIOKJS DOSE TAWK5 MAULIFACTURER: .1 11 Wv/ BER OF DOSES: PER DAB TA►J 51ZE : G ^LLOIJS OOSC VOLUMC / / ALAKM MAIJUFACTUR.L R: 5.J, S C INGLUUIMG DACKf -0 W: MODCL WUM5ER: LI CAPACITIES: A = C06 — I►ICHES OR ,�R­2� GALLOuS SWITCH TVFE: 8 = .�- _ INCHES OR GA, LL0W5 PUMP MAWUFACTURER: ?Gd C a G S IQCHE5 OR GALL0US I MODEL MUMDCR' jj j 1 D INCHES OR ,LIZ GALLOWS SWITCH TVPE:' �► �s �� ' �� c -- s �(aiir +✓ M OTE' PUMP AWD ALARM ARE TO DC MINIMUM DISCHAIRGE KAT - GPM INSTALLEU OW SEPARATE CIRCUITS VE DIFFEKEWCE D ETWEEIJ PUMP OFF AUO DISTRIbUTIOW PIPC.. � FEET C A + MIUIMLIM NETWORK SUPPLY PRESSURE , . . . . . . . P -Y FCCT 7 -F- f E ET OF FORCC MAIM X. /on FI.FRICTIOLI FACTOR FECT _ TOTAL OtJQAMIC. HEAD FLET WTER OIMEIJSIO OF T'A LE: GTH ;WIDTH - - - -- ;LIQUID DEPTH t cI ► �� LICEIJSE OAT E: I Performance zo ubmersible Effluent Curves P U I P METERS FEET 25 80 SIZE � /a' lids WE15H _ -- i 70 20 WE10H i 60 -WE07H 15 50 I WE05H I i 10 30 WE03M 20 5 10 0 p F 0 10 20 30 0 50 60 70 80 90 100 110 120 GPM 0 10 — 20 30 W/h CAPACITY �GOULDS PUMPS, INC. METERS FEET S8 ECA FAILS PEW YM 13148 35 � 120 MODEL 3885 110 WE15HH SIZE 1 /4 " Solids 30 100 90 25 80 Q 70 I 20 J 60 OR _ _! 15 50 WE05HH 40 10 30 20 _ 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 0 10 20 30 W/h 0 1985 Goulds Pumps, Inc. CAPACITY _ Effective July, 1985 ` C3885 1 w*onsin Department of Industry SOIL AND SITE EVALUATION La. .r and Human Relations Page of ,� Di ion M Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complirm siteun on paper not less than 8 1/2 x 11 inches in size. Plan must County r. > include, but not limited :o: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # 'f:? APPLICANT INFORMATION - Please print all information. R iewed by +`J 3 Mte Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). r Rchx 2 Property. ner Property Location ^'� r ,TNING Govt. Lot 1/4 1/4, ' (o & Pro erty Owner's Mailing Ad ress Lot # Block# Su . N e or i Ci State Zip Code Phone Number Nearest Road ( ) ❑ C }V*We O.Town New Construction Use: ® Residential / Number of bedrooms Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow L ®o gpd Recommended design loading rate 7 bed, gpd/ft gpd/ft Absorption area required gybed, ft ?.575 trench, ft Maximum design loading rate bed, gpd/fl trench, gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations Parent material ���f�,, f �7 ���ifs �/ ��e ''r 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 [I s❑ u s ❑ u D s ❑ u ®s ❑ u ❑ s B u El s u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Con . Color Gr. Sz. Sh. Bed , Trench 13 Ground 3 3 S elev. 29-1 ft. — Depth to limiting / 7 A — jam, ILP factor 7, Remarks: Boring # 13 , l r Al 4 s Ground e- i S s a elev. Al Depth to limiting factor m in. Remarks: CST Name (Please Print Signature Telephone No. Address t (� Date CST Number bra q - 7 PROPERTY OWNER SOIL DESCRIPTION REPORT Page of �0 PARCEL I.D.# " Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GMO in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench y S •3� Ground _ �? elev. _ S -z , } Depth to limiting 9 Q factor 4 o J gin. 2, $ • (o Remarks: Boring # Al HE 1 w •S �MA ..... .....4' Ground L _ elev. Depth to 3• $ limiting factor _(min. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # z2 _-2 ® .S 3 - $' Ground - elev. .1 / / t - 7 Depth to limiting 44 1 6 , 6 s / factor - in. Remarks: Boring # MIS; :1 Ground elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) I 0 / 0 qz / � P �x za J lie LJ J62 i JAN.CJ'lUUL 1U :1�0 tbI /A 'L1L1 WOODBORY PIVANGIAL fZUJ9Y e.4 EMMA 0 ' AND OWHtRSKt! Cgl1'tMGt►� laAM '. • ONPWWMP ..� ,r+.rf«+y nMreu 1efN tM «� fVn►Mc�M ► e 1 w:►td hi,MI plrnMIlt Oe,t+M�► � 00 WNW 1'val tf "iff,""A "wo C!t!/iMw L aht s�� pt titftyl �N 4� — Lot 6. row<iv4liM �if�iM�i =tirv.� Mai M wtttri►hn ANt r �, tl;,p �MCtRJl1� KYN O �' • S MtiN C+ yRr� ar!�F,: iy�r+r :awl / �taw,'t ift i►tfatri.we !r,IVM t► Ift+MR% wort tt*ef A, vo+rft�MM � . ` f 1* FA i r•,wu d w*► +�A cM Nutt ISO bore yelps of Mo+'I� ` +wok i�+ih►9 rte. atn tRoa tie At"f•• st qM tr! is n•k tM tai ,et►r+te► she w .Rr r�1 ar• f Crtle � � t �ttkitA�l /iflf►. ry�M � 1Nt i' R"""' ryr•a eo p t,ytt ;• i stet t t) sM N•rur r ya�+►e►. fe�u,lx A1+ aetl 1 % 00 "" "R�f(tiiifeta»�1. I%* toots 1*0 isIm ,'�` „� nAttN►a� aM andw () "k ItrorrA► r „► Aea1, ►i ►h ate �t,vitf N rrw 4110"' ►rN21 ' of i • ,,R lrNl� °!� hlYt '2i+! Ilse Above �#V ° "�r'a �oV i► ee +n1 uM ft . rt ti, 1" d W cat ?t..... �i�•r " oi l ' ✓ aAt Q Port" IN ff C��i , «er t111►tM C M �l' 1K M fro GVltt �► gem”, • IN ��Alt RtritN. N M 1,11► Mi tNN 08 Owed ,ItAR 911r *1at.eA N+� attf�►R+� :II4 IRS: y" N t IM ,ef► date bp ata •MM tK lGah fll' A1�1•t Ah'� n,s,rw ,h,t t•r!a M O w 16 tte wa KRllr (�rl W,�rlogr• ► 4 11111 64 N + ilwo of i . 7 ' 4 0 W wood -4 Al_,... •� * ,w m MD ,Mq► /rAfft IiNM `col of as Soft MM trrtt• AA1r� mod u tt 1 +Iq * 1t�lU � � NAyMIR rrslNAey �� ��� � a "A � • �/�il'bif� *'1wl�R;t rs �tf�9 w��/9•If1 .at�t4�tafi POWTS OWNER'S MANUAL at MANAGEMENT PLAN Page Z of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity a( [3 NA , I Permit # Septic Tank Manufacturer s ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer - / ❑ NA Number of Bedrooms ❑ NA. Effluent Filter Model A. ❑ NA Number of Commercial Units NA Pump Tank Capacity gal ❑ NA Estimated flow (average) gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer s ❑ NA Soil Application Rate gal /day /ft' Pump Model ❑ NA Influent/Effluent Quality Monthly average* Pretreatment Unit 9NA Fats, Oil 8t Grease (FOG) s30 mg/L ❑ Sand /Gravel Filter ❑ Peat Filter E3 Mechanical Aeration ❑ Wetland !220 mg/L Biochemical Oxygen Demand (BODs) ❑ Disinfection ❑ Other: Total Susp Solids ( TSS) 15150 mg/L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average ** Dispersal Cell(s) Biochemical Oxygen Demand (BODs) s30 mg/L KIn- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) s 10' cfu/ l OOMI ❑Drip -line [3 Other: Maximum Effluent Particle Size % inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months ,)tS•,year(s) (Maximum 3 yrs. ) Pump out contents of tank(s) When combined sludge and scum equals one -third (14) of tank volume Inspect dispersal cell(s) At least once every ❑ months Z year(s) (Maximum 3 yrs.) Clean effluent fliter At least once every ❑ months year(s) Inspect pump, pump controls 8z.alarm At least once every ❑ months year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) ®' NA Other: At least once every ❑ months ❑ year(s) IS NA Other: At least once every ❑ months ❑ year(s) .121 NA MAINTENANCE INSTRUCTIONS carrying Inspections of tanks and dispersal cells shall be made by an individ ual rryi g one of the following licenses or certifications: Maste Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank 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(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate nodflcadon of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (A) 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 ch. NR 113, Wlsconsir Administrative Code. The servicing of effluent niters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a cerdfled POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION es For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting p rodu cts or other chemical. that may Impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a sentage servicing operator prior to use, r System sun up shal not occur when soil conulUuns are (roten at the InMlvidve surfacer, During power outages pump tanks may fill above normal hlgftwater levels. When power Is restored the excess wast,ewj(tr will t dischargtd to the dispersal cell(s) in one large dose, overloading the cell(s) and may result In the backup or surface discharge v� effluent. To avoid this situatlon have the contents of the pump tank removed by a $eptage SerAdng Operator prior to restoew power to the effluent pump or contact a Plumber or POW75 Malnulner to assist In manually operating the pump controls w 'restore normal levels wlthin the pump wnk, Do not drive or park vehicles over Links and dispersal cells, Do not drive or park ow, or otherwise diswrti or contpact, the are within 15 feet duwn slope of any mound or at•gnde soil absorpWn area. Reductlon or elimination of the following from the wastewater stream may improve the performance and prolong the life of c,"K POWTS: antibiotics; baby wipes; clgarette butts; condoms; cot ors swabs; degreasers; dental Ross; diapers; disinfectants; lit, foundation draln tsump pump) water; fruit and vegetable peelings; gasoAne, Breast; herbleades; moat scraps; mtdreaciuns; oil, paintlnst crodtrct ogso Lies; sanitary nooklns: tam pon); and wette whener brine, ARANDONEMENT When chi POWTS fails and /or Is ptmtanencly taken out of service the following steps shall be taken to Insure that the system ic properly and safely abandoned In cornolince with ch, Comm $3,33, Wisconsin AdminlsuaUve Codes • All piping to Links and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all wnks and plu shall be removed and properly disposed of by a Septage Servicing Operator. AMer humpin all t.mks and plu shall be excavated and removed or (heir covers removed and the void space flncd w soil, gavel or another Inert solid matrrlal. CONTINGENCY PLAN if the POWTS fails ante cannot tx repaired the loilowing measures havt been, or must be taken, W provide a code Cornpllani rtpiactment system; A suitable replacement area has been evaluated and may be udIded for the location of a replacement soil absorption system. The replacement area should be prQwcw4 from disturbance and compaction and should not be Infringed upo required setbacks from exlsdng and proposed >trvcwre, lot lines and wells. Failure to protect tM replacement area wii result In the need for a new soli and site evaluigon to establish a Irritable replacement ana, Replacement systr rnu�; comply with chi rules In effect it that time. 0 A sulUble replacement area Is not avatlaDle due W Ietback and /or soil Ilmltations. Barring advances In POWTS technoi. a holding Link may be Instaped as a laut resort to replace the failed POWTS, 0 The slit has not been evaluated to identify a sultabte replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a sultable mpiacement area. If no replacement area is available a holding Ling; r be installed o a list resort to replace the failed POWTS. Q Mound and at soil absorption syswmu may be reconstructed In place following removal of the biomat it the inflluacJve surface. Re <onswctlonu of such syswrru 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. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES DEATH MAY RESULT, RESCUE OF A PERSON FROM TKE INTERIOR OF A TANK MAY 69 DIFFICULT OR IMMMAI IF ADDITiONAL COMMENTS POWTS INSTALL POWTS MAINTAINER Name - Name Phone _ phone SEPTAGE 5ERViCING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name App, Phont Phnn� PAGE 1 5 78 VOL 1 2 2 STATE BAR OF WISCONSIN FORM 2.1999 Q 4 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Pine Cliff Partnership, RECEIVED FOR RECORD 10-01-2001 9:45 AM Grantor, and s n inger an inger, EXEMPT DEED EXEMPT li u )and and wif CERT COPY FEE: COPY FEE: TRANSFER FEE: 143.70 RECORDING FEE: 11.00 Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot Six (6), Pine Cliff in the Town of Somerset, St. Croix County, Name and Return Address Wisconsin Edina RealtyT10o 400 S. 2nd St., #115 Hudson, WI 54016 333&98 032 - 2099 -60 -000 Parcel Identification Number (PIN) This i not homestead property. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. 06) (is not) Dated this day of September 2001 Pine Cliff Partners Z - Z • Michael J. Hartimn AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. '54r Y �1 17� Y County ) � authenticated this day of pi,� Personally came before me this e28 — day of September 2001 the above named Pine Cliff Partnershi by it's r 11, Presiden TITLE: MEMBER STATE BAR OF WISCON (if no(, a kn to be the persons) wh ecute a regoing authorized by J 706.06, Wis. Stats.) u and acknowledg e, THIS INSTRUMENT WAS DRAFT K er S Atto Kristina Ogland H Ntntry Public, State of isconsin t• 01X Huds WI 54 016 Commission is permanent. (If not, state expiration date: 1Signatures may be authenticated or acknowledged. Both a -7 2W1 ) " Names ofpersons signing in any capacity must be typed or printed 0W eir signature. irc «mason ProtauanWi C —Pang, Fmpa,LW. WAS STATE BAR OF WISCONSIN 800-656 -2021 WARRANTY DEED FORM No. 2 - 1999 I • SIO °01'3 7" J 251.65' W ' N � I � •w — df W a y N 0 O y M M N 0 N 7 4i 3 cy N O 3 ° 55'35 "E � 587.31' 2 36:65' ` 3 25.31' - o • W ~ W O = U. V 1- bD N O X yy W • ��, n Q y M CD W ' p N p W 8 O t0 g Z y .\ .�• M M N� W M y V a � L ` N / 'to, / z o N M a°o X 0 � ,9696 V cr- � 529 ap � PO NS 1-- BEARINGS ARE REFERENCED TO THE WEST LINE OF THE NWI /4 OF SECTION 26, ASSUMED TO BEAR SOO 12'42 "E . I THIS INSTRUMENT DRAFTED BY ED ..m..-- J Safety and Buildings Division County �- ANA 201 W. Washington Ave., P.O. Box 7162 isconSin Madison, WI 53707,:;,U62­77 S' Address ,� Department of Commerce �' -w l �r San Sanitary Permit Applicatl `` ,`,, Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal info o u provi Lam.` , ❑ Chdek if Revision may be used for secondary purposes Privac Law, s15. I. Application Information - Please Print Ali Information far ,, State I.D. Number ri Property Owner's Name parcel umber _ Z t, _ 3 ( - S C G 0Fr- zCxwNG�Pct` • ,� b3Z Zo ? p Pro rty Owner's Mailing Address �� �, ` Property Location Gj -A N v Sri; S T N, R / E City, State Zip Code Phone Number Lot N ber Block Number Subdivision Name CSM Number II. Type of Building (check all that apply) - / ❑City Xor 2 Family Dwelling - Number of Bedrooms G � - []village ❑ Public /Commer - Describe Use ownship ❑ State Owned // 14, 7 © 7 ,L /'� Ne �t�Road III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A For County use 1�New 2 ❑Replacement System 3 ❑ Replacement of 6 ❑Addition to system Tank Onl Existing System B. El Check if Sanitary Permit Previously Issued D Permit Number ate Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44�ion - Pressurized In- Ground 2111 Mound 47 ❑Sand Filter 50 ❑Constructed Wri 22 11 pressurized In- Ground 41 El Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line p��� 45 11 At-Grade 4 6 ❑ Aerobic Treatment Unit 49 11 Recirculating 30 11 Other lJQ / V. D' ersal/Treat - ent Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System lion F e Required Proposed Rate(Gals./Days /Sq.Ft.) (Min./Inch) 11-11 El g` s Elevation /j + VI. Tank Info Capacity in Total ber Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility on of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe ' Si tore /MFRS Number Business Phone Number 4g�f /?A 0 1 �7 - o74 Plumbe X ss (Street City State, p Code) — VIII. Count /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Surcharge Fee) El Owner Given Initial Adverse o ` Determination w`� • _ Z VOI IX. Conditions of Ap roval/Reas for 1 1 f .1 _ u� S9• 01*_�j 6-dh. r?"L U C f •r°° - n Attach complete p (to the County o*) for the system o not less than x A size t w.u.,�n,�•:iv'�.tlt o� per tMO�e -ff. SBD -6398 . OS /Ot) A ., 1 o � laSv t!l 40 YT r D� � - -- - - - •cgs. ,. �,,.,., - ,. .,�,gj-R,y..-aer:' -.. .,. .. .., gpy: S CIl01x COQ �'`° SEPTIC TANK MA AND :t 0.MNCRSHSP CERTIFICATION FORM own /Buyer P� v,o S � ,�✓ i. r _ Mailing Addroa t it 6- P� N � Ci -1 � rar lt"J rt Address v ? .Pfo(1C y IjmrnW C OnatfUCtiOa)„� (Vcr+fieauon rcqu:re,t from 1 lanntny Dct+js , r-s Aarccl ldantiftcation Numbor City/State I& SeC � �/ W, Town of ° Location ..'`'_'r'• �tj E , T N -R l /. Qrcpercy Lot N SAdiviftion Page N Cer'tifled Survey Map N t� 2� , paao tY � 3 9 , VoF,mc Warranty Doed a 1�- es 0 no lines identifiable C] yes C3 no Spec house g. y N �" � . �c,t,: system U in its premtturc fallwc to hanCle s A -euld •e•u waster Proper inp P W'tat ou -Jt into tite systel" rope" use and rnaiatcnnnceof ye,. T �n out :ht septic tank c�cry• �:rcc years cr soorcr, .r needed by n li:ensed pumper. Y consists of �u...p i C6 aftec+ ttic funcaon of the sap r tank as a Icatment s ;arc in the waste 4,00"' system. O wne r a fees to wbmit 'o Ss Croix Zoning Department a ceftiCicatio. form, signed by the owner and by The p'oPe�Y o ' e t: r, . ;im n Gf necessary), the septic tank is )us that 1�� !bll of sled r lurnoer, jot.rneyrran p:umber. res+rictcA p' umber or ^� P Censed pumper venfy�ng that; ort•site wastewatefdiaposa syus• •< maste p , n propel oparotin4 cond�� on ancL•or (�) a ^c u• +pccuen a P +rn h 'he stardards ' 1 1 ;�k '1!: abuvC !Cy'-! < •alts at,�f lt,�eC Ip !t1179t31n the Private scwaf;c d�sFosol•sy�I 7n1 M. CpRIf.Cat' ` set (0,1h. Rerun, as set h) the cpa ;:rc+' u loncrce an te p d h i)C�rtment of Ci ; St C? i Co u• uery to sy stem has bear ma rta� ^cd must Se co- ++l•Ictcd any returned to the St. Croix Co n�ni Office W'�+'n '0 ' siting the: your Rap + .. y i+ days of (he three yeor eap,rattcn :fart. i• DATE !CANT QWNF° C RI Fi &UQ (wa) am (are) the owner( i (wt) csr,�fy the t a ll sta;cments w a,a loan ate %nte to the best or my ( out) f Deed Oredlic t s) .,.r t h e property dsseribed above. by vutua <st a ,v.rranty decd regarded n ROOM o l l ' DOTS Yt;ae or nrP►.Ic ^�T fMtant•'•••r• •••a•• Any infonnatton that is m ;s•rtproaented fray rewlt .n tM sanitary peetntt bang revoked by eIN 7.pnitte Oipt Iteatton • awn+,xd .. amnty d"d from the UStstef of C"41 ofllt;s •• Inetude with ibis app a copy of ills « niAsd sufvey rftap if rcrotgnes is mad# in this wafnttgi 4"d ta•s • 1Mt&WAV1 216glig Wa vs:41 * Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number 1 Number of Bedrooms 1 Design Flow - Peak (gpd) 4 Estimated Flow - Average (gpd) Septic Tank Capacity (gal) bu a l Soil Absorption Component Size (ft 4 , Type of Wastewater Domestic Table 2: Soil Absorption Comp onent - Limits of Reliable Operation Septic Tank Component Soil Absor tion Component I nn �ee,�,� -- Design Flow - Peak (gpd) z —rs a� -`� Maximum Influent Particle Size (in) U 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se k and outlet filter shall be assessed at least once every 3 years by inspection. T e outl t fitter hall be cleaned as necessary to ensure prQpgq_peraWn. The filter cartridge s e removed unless provisions are ma e o retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 C Sale Sar of Wisconsin Form 2 .— 1982 .� .s2i7•� WARRAN rY D ST CROIX �„ DOCUMENT NO. � -- MAY 9 1995 � - George_T._P0nnock aka George Pennock,,_ r _ - 11:00 A.r.i conveys and warrants to — ._Finer-lif -_Part- ne):,ship___ —k THIS , FACE 111111 £D 111 n(CORDING DATA t - — ~— — _ - ^- --- NAME ANC nE URN ADORES i the following described real estate in County, State of Wisconsin: I (Parcel Identification Number) W1 /2 of NWl /4; SE1 /4 of NW1 /4; NE1 /4 of SW1 /4; all that part of NWl /4 of SW1 /4 lying Ely of Apple River and that part of SE1 /4 of SW1 /4 lying Ely of Apple River; all in Section 26• and all that part of NE1 /4 o. SE1 /4 lying Ely of the Apple 'I River of Section 27; All in Township 31 North, Range 19 West, St. Croix County, Wisconsin. i (I -7 ij II �I I� I I' �I I� This --is not homestead property. !i XW (is not) Exception to warranties: Easeme restrictions and rights -of -way of record, � I) if any. Dated this —_ 6 —_ day of — - -. (SEAL) _�K —_ (SEAL) • _ Geo Penn a/k /a George P ennock (SEAL) _ (SEAL) ITHENTICATION ACKNOWLEDGMENT 11_ I SrrN+1• ^*� T . Pennock 8/k/a STATE OF WISCONSIN ��`� � — —. —_ County. t, w 1� -; day of — M ;Y 19 95 Personally came before me this — day of r 19_ the above named Jj land — - - -- TI JOB STATE BAR OF WISCONSIN (If no authorized by §706.06, Wis. Stats.) to me known to be the person — — who executed the , foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ; Kristin_ ORla — Attorney at Z.3w - -_ - -_ _ - -- _ Notary Public County, Wis. (Signatures may be authenticated or acknowledged. Beth are not My commission is per- manent. (If not, state expiration ,:ate: 1 necessary.) I • Namo of :rvrns .1,111116 in any cap+.il) slkwW be :yprJ or printed heluw their ai,nalurr.. �I ` I WARRANTY DEED ii STAT£ BAR OF WISCONSt Wisconsin Legal Blank Co.. Inc FORM No. 1 - 1982 Milwaukee. Wis. I