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HomeMy WebLinkAbout036-1078-50-110 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safetl and Bultding Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 488012 0 GENERAL INFORMATION 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: Halle Builders Inc. Stanton, Town of 036- 1078 -50 -110 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: (JV • 6 Q� ALA4 _ t6a_ 31.31.17.487A10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark to 3. !D � v, o Dosing Alt. Ar Z 3 O Y1- 3. Aeration Bldg. Sewer Z 30 3 .* 36q D 3 • IS Holding SVHt Inlet �� v 76S' 197.6 St/Ht Outlet - 1- 3 TANK SETBACK INFORMATION TANK TO P , /L_ WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 1 s , Dt Bottom 1v / Dosing / Header /Man. Aeration - Dist. Pipe / �, 7 7 S� 3 S Holding Bot. System r/ PUMP /SIPHON INFORMATION Final Grade o aef Aid- . O 9 - 7 q Manufacturer Demand St Cover . Z / ©0 GPM Model Number TDH Lift Friction Los Head - 7 DH Ft Forcemain gth Dia. Dist. to Well SOIL ABSORPTION SYSTEM / 7 &"YQ,� �G<-�� qff J .tit BED /TRENCH Width f Length No. Of Tres PIT DIMENS NS No. CfrPits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WE LAKE /STREAM LEACHIN Man a r: INFORMATION CHAMBER O r Type f System: �/ / UNIT Model Number: L_ I l DISTRIBUTION SYSTEM Dya Header anifold Distribution x Hole Size x Hole Spacing Vent to Air Intake( p I Pi pes) ' Length Dia Length 0 Dia Spacing �— ` SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only 7 7 Depth Over , Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center 57� Bed/Trench Edges Topsoil Yes [', l No ai Yes No COMME S: (Incl ctec ode discrepencies, persons present, etc.) Inspection #1: � / 3 / 07 Inspection #2: Location: 1433 18�st Avenue Star Prairie, WI 54026 (SE 1/4 SW 1/4 31 T31 IN R1 7W) NA Lot 3 �� Parcel No: 31.31.17.487A10 1.) Alt BM Description = -- r6, 6f CtXCAA- 4 WA# 2.) Bldg sewer length = �S / p I C� ( L. f o - amount of cover Plan revision Required? Yes /No - 31�� Use other side for additional information. Date Insepctor's Sign ture Cert. No. SBD -6710 (R.3/97) commerce.wi — Safety and Buildings Division County . / Y ( ° - - -- — 201 W. Washington Ave., P.O. Box Aft s V o n s i n Madison, WI 53707 - Sanitary Permit Number (to be tilled in by Co.) Department of Commeroe _ _ _._ _01 1 5 ----- - - - -.. Sanitary Permit Applicatll state Transaction her In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the ap late governmental unit is required prior to obtaining a sanitary permit. Note: Application forms f owned PUWTS are Project Address (' different than mailing address) submitted to the Department of Commerce. Personal information on or econdary Pu orp ses in a with the Privacy Law, s. 15.04(1)(m ), Sta 1. Application Information - Please Print All Infurma n — - � -F ' Ale- Property Ow er's Name Parcel # APR Z 4 2007 03(_10 :�_o -!!d Property Owner's Mailing Address Property Location !/ , f –7 I CROIX COUNTY 1 /e ST / � �1� Govt. Lot - - - -�_ City, State 7 In , ea' %, p - (c �i _ ) �/ s ' %, Section / C� / / 0 7b " " ' 0 / T_31. R /X--oAW - - - -- - - - - -- II. Typ Building (check all that apply) Lot# 3 Subdivision Name or 2 Family Dwelling -- Nunnber of Bedrooms Block -_ - - -- - -- -- ❑ Public /Commercial - llescribe Use ❑ City of _ � - - - - -- --------- - - - - - -- CSMNumber Village of _- __ —_ -- ❑ State Owned -- llescribe Use —_ �- /��/ �� 9 Town of _�- 4--..__.___---------- I1I. Type of Pe (Check only one box on line A. Complete line B if appl icable) A ' New System El Replacement System [I Trea — in Tank Replacement Only El Other Modification to Existing System (explain) — -- - - - - -- List Previous Permit N and Date ssued El B. ❑ Permit Renewal Permit Revision Change of Plumber El P mit Transfer to New l/ d- Before Expitation ner IV T e of POWT'S 5 steut/Coto o neut/De vice Non- Pressurized In- Ground El Pressurized In- Ground El At -Grade Mound> 24 in. of suitable soil 24 in, of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain _. _ Pretre ment Device (explain)— V. Dis ersal/Treatment Ar Information: _ -- --- Design Flow (gpd) Design Soil Application Rate(gpdaf) Dispersa Area Required (st) Dispersal Area Proposed (sf) System Elevation VC. 'Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks a U in m vi L4 Cl+ Se ti r ldoldmn '&I k lO O D- ingChamber - - - - -. -- V11. Re sponsibility Statement 1, the undersign some respo -ibiiity for installati of the POWT s hown t the a plans. ---------- Plumber's Name (Print) umbe ' Sign _� - --- . umber Businr s Phone Number Plumber's Address (Strut,), ;ity, State, Zip Code) 3.x"2_ l �® S7" t4bl -•e.. 9/ Gu.r �' S/ f _ -- - - - - -- - VII1 un /Dea Disapproved rtmen Use Only - -'- Permit Fee (]� Date I ued Issuin gent S ture proved ❑ -7 El Owner Given Reason fel Denia ° _�_ O / - - for Disa ' ov V IM PP Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. Cv w All setback requiremen must be maintained - - - as per applicable codd4rxatndeJS plans for the system and submit to the Co y only not less than i rrz 11 inches i on paper u s / SBD -6398 (R. 01 /07) Valid thru 01/09 / e Vo /e racle 1 �7 796 _ 2 do � �. � 06 I _,ac 3s c-mca wlcvt = i r0. 417 b ;•,.,rar S�an•n Ar'te ci 14 �J,P /r�rema.,c -Sy S�d Ai . S { i i i Ill � AMC/ P r� 80 0 53WOH WO.SRO 3TIVH LZZL90ZSIL 9Z :9Z LOOZ /0LfbB wxyx. ",r,,.�wmu„wW._ . .. -..,. , µ`.....y.�w.......... —.., ....... ......w.".�...uww,... ....«.. »w. w n f Its • w' ' • w ". • � � �ni - 0 it 11 . fND cr l , �'• ~ o � � ' " f h �M 'IW fy� i ,..� ....w mw. ,..,„' M1� T^�+' �, ' �^ +... � •� � 1 Ik141w 1wn. .� -..-j JI �x/a, ] p�}�, , N h.. " : ,. M '• q, a.r.,,x• nJ a � 1' • � wp.li Ro a 4 ' rw+.✓ ^�''�•, ww k u hw � N6 I, �Mkq� ,k t J 1 04704/200/ 10.07 PAX 7166376847 BARROW CO ZONING 001 SYSTEM SPECIFICATIONS In- ground Soil A.bsogydon Component SBD - ,ePIL Project Name. _ Distribution Cell Type Septic Tatak ,Aggregate ❑ a- aching cbatmbe *ffl Mitt. Septic Tank Volui ae ga. Wastewater {duality Septic Tank Vo me Tremd p Unrreared ❑ mmmfactuzier Number of Bedrooms 3 Effluent Filter Design Loading Rate (OLR) � lkG=es (Maximum Soil ApprimfioQ Rate) � Cr�t�b�.ed waseervater; Number of bedrooms Pump Tank: geld /day/bedroom — Daily wastereter Flow (DWI-) Volume g'3- Cleat and gmywater orlly: Number of bedmorns Divettet valve ❑yes ❑no gal. /day /bedroom Manufutum 17ar'Ly Wasr�v�watc Fl {DWF� __ Model Note : The vac of a dive Tex valve; shall be ind%cared an t31ac kwatex rile management tAfirs W olth;g bow aad when the 'valve Number of bedrnoms __ sha be use& pl/day lhedtoam a Daily Westewater Flow (DWI - ) Distxibution Cell Sizing (Aggregate) Oistribution Cell Sizing (leaching chambers) Leaclung Chamber Mgmufactox Model . _ -- --- Adjusted Design Loaning Ram /'7 glad /fe Chamber size„ bottom area System -- DVS+' / ADLR. / C 1=3ht= S zee (D" (AD111t) (s-00 # of ehsaibecs Number of chambers to be used � � Page of Mineral mule 16:Ju YAI 715 386 4666 ST CRX CO ZONING U002 ST CROIX COUNTY SE PTIC TANK MAINTENANCE ACxREEMEW AND OWNERSHIP CE RTIFICATION FORM Owner/Bayer /A �d-oa Mailing Address ��� 3 Gil sye, Property Address (Verification required from Planning Department for new couurtruction) rI a G City /State A- Parcel Identification Number QS G LF D CRV ON Property Location %s, %, Sec. 3 . T / N R? 'W, Town of h /o rt Subdivision Lot # Certified Survey Map # - ! O 5 -5 T volume S . ,Page# ZZOG , Warranty Deed. 6 ho 3 � -- Volume o2(0 /S age # Spec house yes 0 no Lot lines identifiable yes Q no t 5���yI MAINTENANCE Improper use and maintenanceof your septic system could remit in its prematuft failure to bandle wastes. Proper maintenance consists of pumping out the septic tank revery three years or sooner, if needed by a licensed pamper. What you pat into the system can affect the function of the septic teak as a treatment stage in the waste disposal system. The propotty owner agrees to submit to St. Croix ZOUM Department a caztifi[Mbon form, signed by the owner and by a mastprplumber, journeyman, plumber, msim tad plumber or a hcensedpumper verifying that (1) the ou -site wastewaterdisposal system is is proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. Itwc, the undersigned have read the above requitummeats and agree to maintain the private sewage disposal synem wfth the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Cer cation stating that your septic system :2w maintained a must be, completed and returned to the St. Croix County Zoning Office within 3o days o "T" te. ATME OF APPLICANT DATE OWNER CERTTFICATION I (we) certify that all statements on this form are tree to the best of my (oar) knowledge. I (we) am (arc) the owner(s) of the ptopetty described above, by virtue of a warranty deed recorded in Register of Deeds Office. I I SIGNATURE OV APPLICANT DATE ** * * ** Amy information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department,****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a COPY of the certified survey map if reference is made fa due warranty deed P4WTS 0WN9R'S MANUAL & MANAGEMENT PLAN FILE 111WYP 7 A 'ION 5Y87� S�'IrCUalcAl Owner Perny)1 s ?sue r`w+ S+W10 T ank Ctiyaulty O 0 6 el NA _ M _1i Sept Tank Mantst NA rEs tihmated, N6al3p,�I !rllluent i^llter Manuirsoturer U NA r drt' lrSa -� .�...,.- _._�,._. NA Effluent 1'iltar Model 7, V_ N r of Publlc. Ptaalllty Units 4 NA Pump Tank Capaci U NA flow (siverage) _ ---- _ _ ®O V e!Ldy L Purnp Ta nk Manufacturer 0 WA: t)"10ra flow (peak), (Estinuited x 1.6) 1'urnri MarAftbturW U NA Sall Application auto r aUda lire ptunp ritladsl � �0 NA Standard Influent /Efflusnt Quality Monthly saverAtjo* Pretreatment Unit �0 NA- I =Sts, Oil & Crease (FOG) a0 mg /L © SandlGraavel Ater LJ 1 Blochernlc al Oxygran Derr nd lBOD „) 5220 mg/l, Ll NA Ll Mechanical Asaratlori rJ 'Wetland Total Suspended Solids 1T881 51 Sd moll. _ 0 Di ainf ootlr n Cl Ot Pratreated E•Ffluarct Quality Monthly average Dispersal Crall($) U N.A. 810chsjtn(081 Oxygen Demand (MOD „) S30 mg/L 13 In- Qroutzd (gravity) 0 In - Ground (prsessarired) "I"OW Suapanded Solids (T88) 530 mg /L 0 NA Cl At Ilrade 0 Mound _ Pam C oll fo rro IfJoa inattla mean) el 0 cfu /100nil 0 Drip -Lin d Other: _ Maximum 1Wt'fluent P 51ze Y In die, IJ NA Ot�er�� - ` NA ” f3 NA DtFtell � NA w Valuas typical for damustlo wastawater and saptlo tank effluent, othan 0 NA MAIN`i'MIIIANCC 8CHMDULM Sonfl se Went Survics Frequency inspect condition of tank(s) At least once every: moat a (ri(lasutltxWns S yew) U NA ..,,�.,..•.y.,_.._.. _ ._...�.._._...M....._......._.� � �' Years) ....M..�....... - ._._..__.. PLUM Out contents of Tankle) When combined sludge and scum equals one -third (Y of tank volurno 17J ItJA laspect dispersal collie) - - � At least once every: � srs °n (s) (lV(tWniurn 3 yours) �tJ NA Clears affluent flltsr �����r, onthlta At least anus every., ' r�alls) 0 NA _ _ w ..._..._ inspeat purrsp. Pump controls & aiann At least once everyd srtan 'l rs) U NA Plueh laterals and pressure test At least once avwy: Cl months 0 NA ' . __ Q y earls) Oman At least once every: rnar,t s !.:! NA I LJ ysuarlts? Aer. 0 NA MAINT111NANCM INSTRUCTIONS Inspections of tar►ke and dispersal cells shall be made by an Individual caryy)ng an& of the fallowing licenses nr cOrtiflOaatione: Master Plumber; Master Plumber Regulated Sewer, POW TS Inspector, 00WyT8 Maintainer: Septage Servicing 013amtnr. Tarok L,saeuflor s enust Include aY visual Inspection of the twk(s) to identify any inissing or broken hardwraM, identify any orsaks or leant:;, rncaaeure the volurne of combatted sludge and s sum said to check for any back up or por+ding of effluent on the ground aurfr ec `alias dispersal oall(ss) shall be visually Inspected to check tltse effluent levels In tills observation 134308 and to ohook for any pundirsg Of effluent all the ground surfrave" The Nbnding of effluent an the ground surface may Indicate a failing oonditloo and requires th a Immediate notifloation of the local regulatory authority. Whw-i the combined accumulation of sludge and sours In arty tank equal$ oncathird 1%) or more of the tank valura7e, the Outlaw contents of the tank ishall be removed by a Saptaage Servicing Operator and diepoeed of in accordance with ofsap'tctr NR '1 13, Wisconsin Administrative Code. All cheer services, Inaludind but not llnllted to the servicing of sftsmt filters, mechanical or pressurized components, pr8tre3tn•►snt units, and any servicing at Intervaisr of 5 man" - , shell be performed by a aartif)ed POWTS Maintainer. A service resort shall be provided to the local raaguWtory authority within •10 days of ea lmPl ftn of any ssarvioe event. GmW (4 /ut) Pago _2�r START UP AND upowrioN Vor new carishuotiort, prior to use of the POWTS chooktreatment tartk(s) 'for the prose rloo of palsitIng products or other chunliouls that rnay Impede tile treatment process and/or dainage the dispsreal It high conowntratlans are detected have the contentu Of the tank(s) removed by a eaptage servicing apahsteir prior to 088. Systoill start up sligil not occur whiml sail conditions are f rozen at the InAltrative surface. During power outages PUIT11) UVIICS may 1111 above nornial hIghwater Iaval& When power Is restored tile (.)XQasq wastewater will be discharged to the dispersal callis) in one large dose, overloading the cellW and snay result 1r; the backup or autteoe dtschofaLk of affluent. To avoid this altuattan have the ocriteM of tits pump - tank removed by a Septage 'Servicing Operator PylOr tO restoring power to the effluent pump, at contact a PILimber or POW rS Maintathel' to 8981st In 111anILIBILY OPUrStInt.1 thG i)w-np conteols to restore hornIal levels within the pump taiik. Do not drive or park vehicles over tanks and dispersal calls. Do not drive or park over, or otherwise disturb or co►lipaot, tile of IOU w1thIn 16 feat down slope of any niound or ga-grade &oil absorption area. 1`449duatlon fir anallantlorl of the following I th w aste wa ter streal-11 rr►ay Improve the performance and prolong the life of the r-6wris. aadbiotics; baby vviriss; clgarette butts, ocridains' , caftan swabs,- degreasers; dental floss: diapers, dlelotectants, &Z loundetlan dr&i (sump pump) water; fruit and vegetable pealinge, gasoline, grease; herbicides. most scraps.- rijadlCatlokle; oil, Painting produots, veadeldes, sanitary napkins, tampons; and water softener brina. ABANDONMENT When the POWTS falls ghd/or Is permwiently taken out of service the following gtops shall be taken to insure that the wyotern I& proparly arid safely abandoned In cort,13112nos witi• chapter Comm 83.33, Wisoonaln Administrau'V6 Code'. • All pljYjng to tanks and pits shall be disconnected and the abandoned 1211w opar►ngs sodded. • Tile contents of dill 'tanks and pits shall be removed and propw0y diapnead of by a Saptage Servicing operator. • After pumping, all taiiks and pits shall be extavrated and removed or their covers removed and thu Vold 0 13acs fill w'ltl• tall, Gravel or anoth r inert solid 1118t6tial. CO or 0"'o"I go", grave CONTINGENCY P have been, ear riluist he taken, to provide a code cornoll wrt N`G If the POWTS f s and cannot be repaired the folWwlng measures replacement karri in 610 . pj� and nlay be utilized for the ovat 0 1 a y soil absorption er Jr suitable replacement area has beell evaluated . , � 1." systeirn. "rho raplacament aroa ,should be protected *am disc•turbance and compaction and should not be infringed 11 by required setbacks frorn existing and proposed structure, a. , jkles and we F t p -the repleoem ant eras vVill rasult In tile need f a now soil and s he evaluation to establish as suitable rapigaamoilt area. F10010neffid"t sYstO "tubt comply with the rubes In effect at that time, Barring advances in P OWTS L A sultable replacement area is not available due -tri ogtbank. and/or gall UrnItatio teohnolugy a holding tank maY be Installed as a last resort to repidee the failed POWTS. V a suitable replacernent area. Upo failure Of the POWTS a gall al'Id site I'] Yhs alts has not been evaluated to IdOrktif 11 no r9p l a osillarit area is available a holdIng tailk avaluatiori. must be performed to locate a suitable, roplaoemaht area. rrwy be Triatelled as a last resort to replace the 121118 r'OWTS- Mound and at-grade soil absorption sys reounstructed in Plat tems may be .0 following removal of the blornat at • ho I sur%ag. RuconSVu&flvns of wah systems must cornoly whfi the rules In eff%ut at t hat till �t -4 WAkNING � �t* SEPTIC. PUMP AND OTHER. TmATivir-sr TAmKs WAY CONTAIN LitrNAL GASSES AMID /OR iNSUPO'C"T OXVIJEN' 00 N(3'r 191 A 89PUC, pUMp OR OTHER TRFATMENT TANK UNDER ANY CIRCUMSTANOgS. I)gA MA Y RgSULT. RESCUE OF A p9RSON PAOM THE INTERIOR OF A TANK MAY 919 DIPPIC OR IMPOSSIBLE AqDI AL q0MM�nktS._ POWTS INDA99 OWTS M NTANEFt Narns Phone P Phone _2LL- X0 F Zh R9 _H LXrORY AU;HORIT "T'O SEFfA09 SEPIVICING OPONTOR (PU rGAIL MPER) ZZ. "y Narne hane L P a E E-: = 11ila drie-Litileat VVIta drafted In 001TIP11finoe with chnoter Comm 83.22(21(bj(1)(dWf) and 83.640), (2) 13) VV l8 *0 nfjIn AdniltilstmWO Coda. f f U: 2615F 250 —& 3 31 Ia9' STATE BAR OF WISCONSIN FORM I - 1998 WARRANTY DEED NATHLEEN H. WALSH i REarSTER OF DEEDS Document NUMOer ET. OR= Co. WE fECEZVED FOR RECORD This Deed, made betw een T FRN I1 _ SWF NRY 4.7 �13�2004 11:30AK kARRANTY DEED -- - Grantor, E%DNT M ( and _ ....... �L.l.i L 1� PS .,- 2 JJe EEC FEE: 11.00 TRANS FEE: 90.00 — COPY FEE: CC FEE: --- -.__.._ .... ._.. Grantee. PA -SES: 1 Grantor, fur a valuable consideration, conveys to Crantee tt,e following described real estate in—,_ ST_ C ()TX County, State of Wisconsin ,� ilL[ dingko {the " Property " ): _ LOT THREC (3) OF THE CERTIFIED SURVEY MAP N n; aid Rev Adze " RECORDED TN VOLUME 8 OF CERTIFIED SURVEY MAPS j ON PAGE 2206 AS DOCUMENT N0 45575 BEING Aft }.- `` I' PART OF THE SOUTHWEST 1/4 OF THE SOUTHWEST' 1/4 i.. ON 101:.. 40 000 AND THE SOUTHEAST 1/4 OF THE SOUTHWEST 1/4, OF PAI 4,30 .18 40A SECTION' 31, TOWNSHIP 31 NORTH, RANGE 17, WE ST t' arc[ taenttl�catLOT homestead _ mA This .�JIl1T homestead property. ii f i �I Together wiui all appurtenant rights, title and interests. i i Grantor warrants that the title to the Property is good, indefeasible in fee simp)e and free and , ,lear of r n:umbrances except NO EXCEPTIONS Dated this _L72. day of MAY, 2004 (SEAL) .�rs'+sj11 �C � (SEAL) �L1LLF.,EN- 1'1,— �►''E II — (SEAL) _ __......._.._.. (SEAL) I i AUTHENTICATION ACKNOW11DGMENT ;i Signature(s) State of Wisr ansin, ST. CROIX__ _County. authenticated this _ —_„-_ day of Pe{�cyl�Uy More me tt IS �-`; day of I� t the above named I ` TITLE- MEMBER STATE BAR OF WISCONSIN (If not, me knuwn to be the T rrson _ _� who exec ;otng ; authorized by E,706.06, Wis. Slats,) instrument id aclutow tcige thu hre. A jNO � THIS INSTRUMENT WAS DRAFTED YE _�' COLLEEN D. SWENBY NOTAR 1164 HIGHWA 11644111 KIRK A. LINDEl.]. NEW RICHMOND, WI. 54 017 Notary Public, State of 1,•iscon5in Ped : c[ rnmi: ion is pe manent. If n (Signatures may be authenticated or acknowledged. Both arc not — necessary,) Nmm� ur per..uru signing in uny eapaclry must Le [yped nr printad below then signau.re. STATE BAR OF WISCONSIN . W�s:an;;ir, l.epa stank oo , I— WARRANTY DEED FORM N.. 1 - I998 1 Mlwaukes Wis. Z0 39Vd S3WOH WO1Sf10 3_1 LZZL9bZSTL 9Z 9T L00Z /0Z /00 I 1796 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 4 Division of Safety and Buildings ' in accordance with Comm 8 is. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8'% x 11 inches in size. P n D County St. Croix include, but not limited to: vertical and horizontal reference pant (BM), direc an percent slope, scale or dim (� tance to d. Parcel I.D. 036 -1 78 -5 -110 l�l a prnit h ' Revie By Date Personal information you may be used for seowday purposes ( Law, s. 15.04 (1) (m)). �/ Z9 Property Owner Property Location Colleen Swenby Govt. Lot SE 114 SW 1/4 1 T 31 N R 17 W Property Owner's Mailing Addre ss 7 0NING v� F - E Lot # Block # Subd. Name o CSM# IG" P.O. Box 21 3 1 CSM Vol. 8, Pg. 2206 City State Zip Code Phone Number _j City _j Village W1 Town Nearest Road New Richmond WI 54017 1 715 - 246 -2223 Stanton 1 181St. Ave. 0 New Construction Use: gel Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD _f Replacement J Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install two trenches at elevation = 94.30 using 28 leaching chambers Lift station will be needed to reach system elevation. Boring # Boring ✓/_ 1/ Pit Ground Surface elev. 99.33 ft. Depth to limiting factor >1 U2" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -16 10yr3/2 none sil 2fsbk mvfr gs 2f,lm 0.6 0.8 2 16 -24 10yr4 /3 none sil 2fsbk mvfr cw 20m 0.6 0.8 3 24 -36 10yr5/4 none sil 2fsbk mvfr cw lvf,f 0.6 0.8 4 36 -51 10yr5/4 m2d 7.5 r5/8 sil 1fsbk mvfr aw 1vf 0.4 0.6 5 51 -58 7.5yr416 none s 0 sg ml gw - 0.7 1.6 6 58 -102 10yr5/6 none s 0 sg ml - - 0.7 1.6 Comm. 85.30(3)3 applied to discount rdox. concentrations identified in H#4. V a Boring # J Boring 1/ Pit Ground Surface elev. 98.75 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr3 /3 none sl 2fsbk mvfr as 2f,lm 0.6 0.8 2 10 -26 7.5yr4/6 none sl 2fsbk mvfr cw 2f,1 m 0.6 0.8 3 26 -38 10yr5/4 none sil 2fsbk mvfr cw lvf,f 0.6 0.8 4 38-42 7.5yr4/6 none Is 0 sg ml cw 1vf 0.7 1.6 5 42 -95 10yr5/6 none IS 0 sg ml - - 0.7 1.6 ►I * Effluent #1 = BOD ? 30 < 220 mg/L and SS >30 < 1 mg /L ent #2 = BOD . 30 mg/L and TSS <-0 mg/L CST Name (Please Print) Signatur . CST Number James K. Thompson S -- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 5/172004 715- 248 -7767 Property Owner Colleen Swenby Parcel ID # 036- 1078 -50 -110 Page 2 of 4 r F31 13oring # J Boring 1e Pit Ground Surface elev. 99.58 ft. Depth to limiting factor > 106" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence 7 gss ry Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -11 10yr313 none sl 2fsbk mvfr Alm 0.6 0.8 2 11 -19 7.5yr4/6 none sl 2fsbk mvfr 2f,1m 0.6 0.8 3 19 -29 10yr5/4 none sl 2fsbk mvfr gw 1vf,f 0.6 0.8 4 29-45 7.5yr4/6 none Ifs 0 sg ml cw 1vf 0.5 1.0 5 45 -106 10yr5/6 none s I 0 sg ml - - 0.7 1.6 Vertically oriented Inclusion of 1 msbk sil w/ m3p 7.5yr5/8 redox ooficent ions observed at NE corner of pit from 47' - 66'x 40" wide. Inclusion is an isolated deposit & is not indicative of groundwater. F 4] Boring # I Boring 60' Pit Ground Surface elev. 97.13 ft. Depth to limiting factor >95" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#1 *Eff#2 1 0 -15 10yr3/2 none sl 2fsbk mvfr as 2f,1mc 0.6 0.8 2 15 -24 10yr3/4 none sl 2fsbk mvfr Cs 2f,1m 0.6 0.8 3 24 -32 7.5yr4/4 none Icos 0 sg ml cs 1vf,f 0.7 1.6 4 32-40 7.5yr4/6 none s 0 sg ml gs 1vf,f 0.7 1.6 5 40 -70 10yr5/6 none s 0 sg ml gs - 0.7 1.6 6 70 -95 10yr6/6 none s 0 sg ml - - 0.7 1.6 F Boring # I Boring 10 pit Ground Surface elev. 97.71 ft. Depth to limiting factor >115" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -15 10yr3/2 none sl 2fsbk mvfr as 2f,1mc 0.6 0.8 2 15 -22 10yr3/4 none sl 2fsbk mvfr c8 2f,1m 0.6 0.8 3 22 -36 10yr5/6 none Its 0s9 ml cs 1vf,f 0.5 1.0 4 36-49 10yr5/4 none sil 2fsbk mfr cw 1vf,f 0.6 0.8 5 49 -70 10yr5/4 m2d 7.5yr5/8 sil 1fsbk mfr ai - 0.4 0.6 6 70 -115 10yr5/6 none s 0 sg ml - - 0.7 1.6 Comm. 85.30(3)3 applied to discount redox. concentrations identified in H#5. * Effluent #1 = BOD ? 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD <30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. • Property Owner Colleen Swenby Parcel ID # 036 - 1078 -50 -110 Page 3 of 4 6 ] F Boring # J Boring Pit Ground Surface elev. 96.35 ft. Depth to limiting factor 58" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rood *Eff#1 *Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -14 1 OY r3/3 none sl 2fsbk mvfr as 2f,1mc 0.6 0.8 2 14 -26 10yr5/4 none Is 0 sg ml cs 2f,1m 0.7 1.6 3 26 -58 10yr5/6 none s 0 sg ml aw 1vf,f 0.7 1.6 4 58-60 10yr5/4 m2d 7.5yr5/8 sil 0 m mfr aw 1vf,f 0.0 0.2 5 60 -82 10yr5/6 none s 0 sg ml ai - 0.7 1.6 6 82 -106 10yr5/6 f2d 7.5yr5/8 s 0 sg ml - - 0.7 1.6 7 106 -110 10yr8/3 m3p 7.5yr5/8 sil 0 m mfr - - 0 0.2 .0 F—I Boring # Boring J pit 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. F—I Boring # --� Boring ft De h to limitin factor in. I pit Ground Surface elev. g Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rood *Eff#1 *Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD S mg/L and TSS <_30 mg/L The Department of Commerce is an equal opportunity service provider and employer. ff 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. SOIL AND SITE EVALUATION 1796 Page of 4 PROPERTY OWNER: Colleen Swenby PARCEL I.D.# 036 - 1078 - 50110 A.C.E. Soil & Site Evaluations REPORT MEMO Area of B-4, B -5, & B -6 is not suitable for conventional POWTS due to stratification and inconsistencies in depths of suitable soil. • / e/ L Ale. ■ So,/edalua� - i al6 �os!So' ♦ EXisf�'n q �ade e�cvat' • 4 o � Sca /e•' / ='�b� Q '� /7% 98. 6 Co lleen 5wen6`. P�oPe/�,, ASP oXimQ ■ /0 L' 3, C5•►1 41oe �. -206 b�.c;lding S %tc S�S�J 5: 31� Tn, of 5���; U Xi S�• e roi/r C� ; cJ 1, 98.78 �o ail a W. 76( T,o o f 31,* bay as ■ A5Sumtd clev-- = i00,cD 82 CO n1 1�eSetde 4 83 ■ �c lct C£rYlen� SySEz�, Qt2: Bi 0 Ali. 6. 7 o — lo 8 'j�faar X33 YrG - 73.39 So f P S/o�� o FILED �. MAY 151990ft- tt JAMES 0 LL ��f J Re9lsier of naeC� ` SL Croix Co., WI . m N O m o o m o :- ro o ri N Cn r Cn cr s C r--• L C O E C 7 �y� ` i• -� m r� rt �-• rt a m ---I =' -3 =o m m x CD x CD (D • O n 1� n N� O .-•• n cn ro- O `G O Y O '] O 7 X M -n CD n X v N o o �c r f �Cn > > (-n r ro O In F rt r r o CD - v . z Ln Ln o Ln o Cn rr 'i • . t " :C: 7D o F 't F F v F rt - r7 b v o 0 0 o v °•� m m (D ' r- o c V v V v m N3 unplatted lands owned by others D -- lan rt o0 (D C) s IN Sol 01 340.99' x o ° – rt = z l0 I± N 7' r• ro l O ro In m y rn o _ / F X o x o m �c' s o+ m O rr ~ O O -0 7 F O1 � � W N T ti o 0 rr o v o o n o Q N N ro � Cr =r 1° rs 1 N N g aj m .p n d, '7 rt (D _� W l0 1 8 x rl Cn w ~ CD C It '• — N W I d m 'c 50 N m '< t0 �•., - £ 1 �-•• .. ...:.,, m O 50 1 / N N r r rt o 0 1 y o o c I I rt N _ n V 17 �✓ v I d o N01 001115 "W I T ro 'rt ' rur N 366.95 V - O� C. o west 1 ne the SEA - N -of the SW} 66.00' Z r 1 1 v NO1°01 f � N N _ 1 1 rt I O Cl) v N --- i 1 ti o w r 1 , z o N01o01 "W r _ L 328.46' o coa a O o rn rn r I Cn N U1 W O L O cl W 7' � CO ro cn r. O N o Ln _z n v Cn o M ' a w I I � CD C) m \ N NO1 15 366.29' tO i i ° 0 0 ml ' m o 1 m —T– 1T1 353.471 o rn -i �• CO v _n c 1 0 < S n _ W F • I N I H N W N F r S X 0 1 H 1 1 V N N d 0 O ro Cn n I F o 0 O `� m .o m r• V o I ti z rt, . ' rn N O to 1 ' I N n-t ° o I o\ v r"r I / C2 661 z u m 331 ME m 4. — 33 .061 355.86' (rec• 364.89 r ' 331 NO3°1515911E ao ° (rec. NO38131E) 388.92' Cr Ln o, RUSTIC LANE DRIVE an o C7, _ v 1 • � N - I� N 1 tD _ O ;; 661 u nplatted lands z m - -------- -- --- � F bearings are referenced to the F south line of the SW} of section 31 assumed to bear N89 CO LO 0 Ln .� I i!a vou.tE 8 PAGE 2206 1 0 to O 0 to O'' 3 0 a (D o< 0 a co w o m v cZ o o m 9 w w° C �• co p co o 2 N C (D C C 3 J v �• N j N , (Q CD N CD (D 0 n N CD fn D rr !►i CO H n y N O C C "3 Z D m a w v: Z D CD F. ( � `:5 D N CL D `n M ri co IW OD _ O _ �rt D D z N N z N CD O cn CD O V CD N C !ri v cn �, * * * � * * "ft, N W z 3 N f�A f�A CD Cp f�/1 N FD D ( _ ] �1 G G �tr o C G O d'� N O CD (D Vj 00 07 N 'C 7 fu 'O cn N N M = t A 7 ID - M A (Q CL "" d N N 3 y N N N N O fA a) z z z E z N O D O D M zr S N o N �• (DD TJ (D p n (D n CD (D ? a CD A - 3 O v 3 c n 3 CL N p, A Z 0 w in Cl) w W m pp m m CL a z o° 3 0° 3 N z N CD < It, W W N O 7 2 D cn. 3 D oco a) A O T O O N C co C D N c CD O 00 CD O_ O� a N C O G -0 F N N n U) C F O '- CD CO p 7 c 3 3 ° 6 fD CD (� N N N Z 7 fA CD CD 3 ti O 3 Q A 0 O O O CD CD Op N 0 0 O a ° o C o i .' RECEIVED NOV tS Z U 1) ST, CROIX COUNTY ` c an County 01 W � 2. Washington Ave., P.O. Box 7082 S �t iseonsin Madison, WI 53707 — 7082 Sanitary Permit Number 00A filled in by Co.) Department Of Commerce (608) 261 -6546 , / $ F0 Sanitary Permit Application State Plan I.D. Num r In accord with Comm 83,2 1, Wis. Adm. Code, personal information you provide /V may be used for secondary purposes Privacy Law, s 15.04(1 xm) Project Ad dr (if different than mailing address) I. Application Information — Please Print Information Pro Owner's s Name Derh Par Y Lot p Block M p ,C� L _, /0 3 Property Owner's Mailing Address rop Location City, S Zip C Section Code Phone Number I I! , ►'� p f �� �� circle O M Type of Building (check aU that apply) Eo W T N; R e4o7� 3 O 4a ��b,�•: 01I or 2 Family Dwelling —Number of Bedrooms Subdivision Name M um Ij ❑ Public/Cornmercial — Descnbe U/sse �a u�U� 2. r V � S 9 _ as ❑ State owned — Describe u.2 Ui Lj ❑Cl•ry_❑V111a o ship of IM Type of Permit: (Check only one box ou Une A. Complete line If appl' ble) A New System =em ' ❑Replacement System ❑ Treatment/Holdin `Tan eplacement my ❑Other Modification to Existing System IJ B. ❑Permit Renewal C3 Permit Revision ❑ Change of `,Permit Transfer to New T P it d ucd Before Expiration Plumber er IV. Type of POWTS S stem: Check all that a 1 K Non — Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ ound < 24 i , of suitable soil C1 • A nde C] Single Pass S ilter ❑ Coasauctod Wetland ❑ Pressurized "round ❑ Holding Tank Peat Filter Aerobic Treatment Unit C3 Recirculating Sand Filter ❑ 11 Recirculatin Synthetic Media Filter Chamber ❑ Dri Line ❑ Gravel•] s Pipe ❑ Other (explain) V. Dis ersal/Treatment Area Information: , C , Design Flow (gpd) Design Soft Application c(gpdso Di ersal Area Required (sO Dispersal Area Proposed (so System Elevation Sec 7 &��.1I� 6y9 4 ,�5 VI. Tank Info Capacity in Total Num Manufacturer Prefab Site Steel Fibcr Plastic Gallons Gallons of its Concrete Conswcted Glass New ic a Exist ne Tanks Tanks sept Holdin; Tank /600 / Aerobic Trrauneut Unit V Donna Ch mbcr 660 6o VII. Responsibility Statement- 1, the undersig ed, assume reaponsibillty for I tallation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum igna e M PRS Number Business Phone Number �i�°,�l f3 dV 4 �aa.3l 7 Plumber's Address (Street, City, State, Zip Cod VIII. County /De artment Use Onl pproved Sanitary Permit Fee (includes Groundwater Dat Issue lssui gent Signaler (N LIMPS) ❑ Surcharge Fa) en Rees n for I L - �� {L Zq a5 IX.. Conditions of Approval/Reasons for Disapproval 3� P)j it M,).6 � o w SYSTEM OWNER: ,nA i }-� �C� 1�� 1. Sepbe tank, eMwrtt tNtet' and i '" U dispersal CO MW al be nrA= / stitiYttsknd at pe► mWiAgwroM plim proidded M pfir d*. ' I Ovv_"LA J O-4- . Z. AN NOXICk raqu WrW is nwd be mai bWad as pw appkew code / a C1 artoes. A $-5 /oob/600 T ol �S 3 3 13 -1 -a 3yx ly t _45- , I ........- .... -. . )[PARTMENT OF S'AFETY BUILDINGS f,F)USTRY, REPORT ON SOIL BORINGS AND i U M - AN A RELA,TIONS PERCOLATION TESTS (115) (1-163.090) & Chapter 145.045) Pa"�'XI-OCKEL*TY: L C� F N� 571 IL 5 i - 2t 4 F�7j 7C fj 10 N: if ') I ii/a n n a '/GNT '/4 , 31 N/Rl7xE Stanton SE /T -'C N T Y: OtNNER;S RYS ANIIE: MAILING ADDRESS: - St. Croix Colleen Swenby P,.R.#!, New R Wi. 54 DATES 0,.iSERVATICNS Fr1 5 E 4 a -XNevv j Re lATING: S= Site s; ., for system U= Site unsuitable for system TAN T� END F�D E ] <x E] U F S E I U F- S - I convenLIcnal Ej S Z� Q I - I S 9�j� U f Peicoliticn Tests are NOI'required DESIGN RATE: f the tested area is in the jf:d- s,H33,09(5)M, indicate: class 2 Floodplain indicate Floodplain elevation: n/a deciflizal, PROFILE DESCRIPTIONS page 20 SIB C R! N G 'O-A I-OiT, FELEVATION -)EPTHTO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, CO )MOER DE OBSERVED I EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON LACK) [3- 1 7.26 98.79 none >7.26 .75b1.1. .92bn.sil. .67bri.s.l. 4.92m.c.s. B 2 �7.00 98..61 none ' i 2y *en s .83bl.1. .75bn.sil.. 5.42br..c.s.w W.T motts. 2.33x1.50 to depth of 3.25 8.00 98 none 3.83 less 75bl. 1 . I .17bn. sil. I . 33bri. c. s 581m . r, I: t sil. than 1.00 4. 1 7bn. c. s. 4 7.25 97.71 none 3.50 less .92bl.1. 1.75bn.sil. .83bn.mott,s1 than 1.00 3.75bn.c.s. g. - r,. '2b 5 7.33 971.40 none >7.33 1.33bl.1. 1,50bn.sil. .58bn.l.s. 3.9 - .s. B - PERCOLATION TESTS TEST DEPTH I VVATERINHOLE ' T EST I I V1 E DROP IN WATER LEVEL-INCHES M E r, I NCHES I AFTERSWELLING iNTERVAL-MIN. PC -p7 se T desi LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of s:jit3hle soil a.uas. Indicate sca:a or distances. ghat are ',l,e )ntal and vertical elevation reference points a sh(DVJ their location on the plot plan. Show the surface elevation at all borings and the dl,rLCt:c)(, Z;ro f la ,d slope. U 2615P 250 � �1 768631 STATE BAR OF WISCONSIN FORM 1 1998 9� WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number ST CROIX CO., WI RECEIVED FOR RECORD This Deed, made between 07/13/2004 11:30AK f 0T T FFN n S_WENRY - ' WARRANTY DEED EXERT # _______ ____ Grantor, ' " L /J REC FEE: 11.00 and L( ���1 / �- TRANS FEE: 90.00 — COPY FEE: CC FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in ST GROIX County, State of Wisconsin (the "Property „): siinq tue� LOT THREE (3) OF THE CERTIFIED SURVEY MAP Nape and Retu n'Addfess RECORDED IN VOLUME 8 OF CERTIFIED SURVEY MAPS � Y ON PAGE 2206 AS DOCUMENT NO. 458575 BEING A X5/0 i PART OF THE SOUTHWEST 1/4 OF THE SOUTHWEST 1/4 026 1011 40 000 AND THE SOUTHEAST 1/4 OF THE SOUTHWEST 1/4 OF PAR 40 40 SECTION 31, TOWNSHIP 31 NORTH, RANGE 17 WEST Parcel Identification Number (PIN) This IS NOT homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except NO EXCEPTIONS Dated this 17TH day of MAY, 2004 (SEAT.) , ]GOULDS PUMPS Submersible Effluent Pump EPO4 & EP05 Series APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: U er and low Specifically designed for the grade turbine oil for tic enclosed design for pp er following uses: lubrication and efficient improved heavy duty ball bearing proved performance. construction. • Effluent systems heat transfer. • Homes ■Casing and Base: Rugged • Farms Available for automatic and thermoplastic design provides AGENCY LISTING • Heavy duty sump manual operation. Auto- superior strength and corrosion matic models include resistance. S P Canadian Standards Association • Water transfer Mechanical Float Switch _ File # LR38549 • Dewatering ■Motor Housing: Cast ir on assembled and preset at the for efficient heat transfer Goulds PUMPS is ISO 9001 Registered. SPECIFICATIONS factory. strength, and durability. • Solids handling capabilit FEATURES ■ Motor Cover: Thermoplastic y; cover with integral handle and ' /�" maximum. ■ EPO4 Impeller: Thermoplas- float switch attachment points. • Capacities: up to 60 GPM, tic semi -open design with 9 Power Cable: Severe duty • Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water.resistant. • Discharge size: 1' 12" NPT. • Mechanical seal: carbon- seal protection. rotary/ceramic- stationary, BUNA -N elastomers, • Temperature: 104°F (40°C) continuous 140°F (60°C) Intermittent, METERS FEET • Fasteners: 300 series 10 — — -- - - - stainless steel. - - ........:.. • Capable of running 9 30 dry without damage to ► -5GPM - -- components. a 0 25 � 2.S FT 2 Motor: a W _ ... ........... • EPO4 Single phase: 0.4 HP, y 6 20 1 15 or 230 V, 60 Hz, 1550 - RPM, built in overload with } 5 automatic reset. 15 - • EP05 Single phase: 0.5 HP, o q �p 9.. 115 V or 230V, 60 Hz, 1550 RPM, built in overload with 3 10 EP05 automatic reset. 2 .................... • Power cord: 10 foot EPO4 standard length, 16/3 5 SJTW with three prong I — -- ,......I......... grounding plug. Optional 20 0 0 foot length, 16/3 SJTW with 1 20 20 30 40 three prong grounding plug S GPM (standard on EP05). 0 2 4 6 8 t0 CAPACITY 12 ml /h J;t_ Goulds Pump r 2003 Goulds Pumps Effectwe July, 2003 /7 83871 �! 3� � ITT Industries COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, not top of cover, Access Opening, not top of coyer, must adend to a point no greater must eldend at least than 6" Below Finished Grade . C Above Finished Glade j L J " �"I C3 � r Coyer vuith w� � B � - Y � 401 � Zn�'aIGx- Lockin� De vice �JN b� �' Finished Grade A' (typical] jZ Wit: V�/ ETL Min. 23" ) '30 Pf >47 1' Access Opening 0 e- Lm;e I-Wu Min. 23" Access Opening N PI P'r' i Z ^6 neec^4/N I Oulet Effluent Filter j r v�TH if �'�vG Ste' union App PI AC 3 PT, Inlet Baffle � i 1 OA sa z- /D S'O /C_ C Pu p 3 ",Sar►d or raw- On under uvj;4h eenjler2 ershah Qd�ex Two Compartment Septic/PumpTank (4► * "� o o &- s X d SPECIFICATIONS TANK MFR: CA� DOSES PER DAY: 3 TANK SIZE: SEPTIC 1060 GAL. DOSE VOLUME: 1- GAL. DOSE 600 GAL. (INCLUDES FLOWBACK & <20% OF DWF) ALARM MFR: A'c CAPACITIES: A= I ,9 INCHES= 3) 5 W GAL. MODEL # G, U Switch type: B = — 2 — INCHES = 31 ,5 _ 6 GAL. PUMP MFR: C = b, nI INCHES = X5 GAL. MODEL M SWITCH TYPE: -� _ D= 4� INCHES= 9 y 6$ GAL. REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING PER COMM 83.43(8)(e) VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) = /D FT. MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) _ + FT. b0 FT. OF FORCEMAIN x 1,.5 FT./100 FT. FRICTION FACTOR ...... _ + 'vZ FT. TOTAL DYNAMIC HEAD (TDH) FT. INTERNAL TANK DIMENSIONS: LENGTH ; WIDTH ; LIQUID DEPTH 3 1_ _......... MP/MPRS SIGNATURE: LICENSE NUMBER: O?o?O 3S POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ! of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner` Septic Tank Capacity d Q a l ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model S ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) 30 gal /day Pump Tank Manufacturer J , ❑ NA Design flow (peak), (Estimated x 1.5) Vj5'0 gal /day Pump Manufacturer ° ❑ NA Soil Application Rate gal /day /ft' Pump Model E O ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) :_30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD : 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :_150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODO 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :_30 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size % in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: months) (Maximum 3 years) ❑ NA year(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: R month(s) (Maximum 3 years) ❑ NA year(g) Clean effluent filter At least once every: months) ❑ NA 4 1 0 1 years) Inspect pump, pump controls & alarm At least once every: I month(s) ❑ NA year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the 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 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. 2 ' START UP AND OPERATION Page ' ' of 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 cell(s). If high concentrations are detected have the contents of the tanks) removed by a septage servicing operator prior to use. - 7 System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(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 not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 1`r T alua ' a o mg tank b e a� e, �fZ01 -/18 TTa✓T� �D� J�/�✓ la'DNS7RCJ�TL0 ❑ 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. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name s—�—, G 0QL , �t Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 0 �`D B Mailing Address Property Address ` (Verification required from Planning Department for new construction) City /State Parcel Identification Number 0 3 6 f U 7 - SO - 4/0 LEGAL DESCRIPTION Property Location sec. , T 3 N -R W, Town of S Subdivision • Lot # 3 Certified Survey Map # y-�g ? , Volume _, . Page # aO�d Warranty Deed # 76 9 G , Volume a C� S Page # Spec house 0 yes ❑ no Lot lines identifiable kyes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mae=plumber, journeymanplumber, restricted plumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the car exp date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all state is Fra" form ar e true to the best of my (our) knowledge. I (wc) am (arc) the owncr(s) of the pro descri above, by v ty deed recorded in Register of Deeds Office. 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