HomeMy WebLinkAbout042-1004-70-100 ,onsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
,ety and Building Division
INSPECTION REPORT Sanitary Permit No:
* 488053 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)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Stout, Richard Warren, Town of 9/ o
CST SM Elev: Insp. BM Elev:. BM I Description: _ Section/Town /Range /Map No:
/on & yv\ ( 03.29.18.
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ( ' ZOt� Benchmark ' /t3 1
t e-�, s , /cz)
Dosing t Alt. BM
GD w�•Yo b SUa rr l Goy 5l. Z7 cm . 1
Aefettion— ( n Bldg. Sewer
F►�, zw�. -ems /
Holding St/Ht Inlet /D' V( y�
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. xent to Air I take ROAD Dt Inlet
of v
Septic ) 1 z 1 Zy Dt Bottom Z 71r
Dosing Header /Man.
JZ r Z�f Z y b. 3
Aeration Dist. Pipe b 3
,
Holding Bot. System W, $
7•
PUMP /SIPHON INFORMATION Final Grade oIg' y
Manufacturer Demand St Cover
G ova GPM c d { 9.
Model Number 4S
TDH Lift , • Friction L oss System H�a„d TDH Ft
Forcemain Lengt Dia. X 1 1 Dist. to Well _ I /t
SOIL ABSORPTION SYSTEM ��JR1
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS i t .5 d- 3 _
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: �, \�O�FZ! L
INFORMATION CHAMBER OR �
Type Of System: UNIT Model Number:
/ 5
0 D ✓� / `f /IJTT' v i
DISTRIBUTION SYSTEM coak Z7 Z I LQ
Header /Manifold j Distribution x Hole Size x Hole Spacing Vent to r Intake
c ' Pipe(s) \ ` ` y4 Gtn D
L T Length Dia Spacing C_ .
SOIL COVER x Pressure Systems Only xx Mound Or At -Grad Syst ems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges \ Topsoil \ I Yes jX_] No Yes I` j No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2:
Location: 1195 120th Street Roberts, WI 54023 (NW 1/4 NW 1/4 3 T29N R18W) NA Lot 1 Parcel No: 03.29.18.
1.) Alt BM Description = ` ' �J414— t
2.) Bldg sewer length= 3n
- amount of cover = 5
Plan revision Required? j Yes o
Use other side for additional information. "� I
Date Insepctor's gnature Cert. No.
SBD -6710 (R.3/97)
Safety uildltlgs Division r
01 Wash' to
rgn
N* 6 c onsl n 73 147 e� unitary Permit Number (w be filled in bt
D of Commerce 1-,.. _ 8} 266 3151
Sanitary Permit Ap tion ' thte Planl.D Number
In accord with Comm 8321, Wis ..den Code, personal in titration yoy yrQy';(ie r
may be used for secondary purposes Privacy Law, 15.t}4(l)(nil l i Project Address (t( different that, madine a itiressl
[[ Application Information - Please Print All Information
( Property Owner's Name - — �_.��.� X arcel 4 Lot >+ _ _- - -_ BkKk N
S' 7
w �.
Property Owner's Mailing Add /J ?` Property Lo tion
3 J 3
City, State Zip Code Code - f atone Number
�7/4�' t �y circle o )
i p a d �� l �Y Q a� � �J r o 6 N: V E ow
IT. Type of building (check all that apply}
Ck ab pa„� s 0434-%W Sabdivision Name � err
I or 2 Family Dwel ling - Number of Bedrooms
D Public/Commercial - Describe Use , _ -. - - -- --
❑ State (;wnzd. Dcsuibc Usc �, - t Z _'�' Z t ' .. C.�kkv � �Ctty_7Viliaga iewn � p rJ
sh:p o:ic -�,
1I1. Type of Permit; (Check only one box on line A. Complet line B if applicable) _ _ -��
A . S stem � � J
!1 �. y' Replacement System �_ ; Treaunr., r/Hoidtng Tank Replacement Only �� othar Modification to Emsrine System
List Previous Permit Number and Irate Issued --�
B. 7 Pernut Ronew:tl 7 Permit Revision Q C hange of � -� Permit Transfer w New
Befor; Expiratino Plumber Owner
Iy. Type of PUWTS System; (Check all that apply)
oil Ntin - Pressurized lri- (;found 7 Mound > 24 in of suitable soil Wtund 24 it, of suitable soil ❑ At- Grade ❑ Single Pass Sand Filter
Cbmtrueted Wetland ❑ Pressurized 1n- Ground ! � Holding Tank Pest Filter A Aerobic; Treatment Unit :1 Reci.oulating Sand Piltci
Recirculatin4 5y nth euo M F+Iter Leaching Clamber i j Drip Line _ {:ravel -l ess prpe Other (ex piain)
V. Dis ersaVrreatment Area Information
Design Flow (gpdi Design Soil Application Rate(glx +.sf} i Dispersal Atea Required (st) Dispersal Area Proposed (s System Elevation , �I
VI. Tank Iafo � Ca ~ i in focal Number I Manufacturer Prefab Site Steel Fiber plastic l
Gallons C:attttns i of units I Concrete Constructed ; i;lasti
i Nov Existing ' LI-)
r=ks r.,,ks
Aerobic TreatatGet Unit
i Dosing Chamber �� :,� t? r I
+ Vl1. Responsib Statement 1, tare underslgned, assume responsibility for inst llation of the PUWTS shown on the stfacbed lass.
Plumber's Name (Print) Plumber's Signature PPS Number Business Phone Number
Plumber's Address (Strcer, City, State, zip Code)
VIII oun /De artment Use Only
�_ Sanitary Perinit Fee (inclW s Groundwater aD,1 Issuin9 gent Signat iN tamps) pproved Ltis Surcharge Fee)
D _ i � 1 J
IX. Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER: ) k1e ti YNyv`a p
t . $tlplic tank, efruent tNfar and i �
dlspsrsal call must all be services i rminWmd 1 V1G�• n v �Uvua r..c c>` o vti ,
I U i
as per management plan provided by plumber. i
2 AN setbsck roquirements must be rmh tsirted
as per lappiloft Codt / ordinances.
Atrtech eosepleb plans (ta the County 001'0 lcr the syseam on !raper not' ran fibrin tills x 11 11K in slu
5)3D - 6398 (R. 0"1 /03)
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wiaoonsin Department of Domme jp SOIL EVALUATION REPORT
Divltion of Safety and Buildings Page — L — of
Co 7tan '+ ��` Attach comply site plan on paper no 8 1/2 x 11 inchilat 1 Lr Include. but not limited to: vertical and horizontal poinnd percent slope, stele
o dimensions, north arrow, and location anr est P 1.0. ' Please print all Information. - ; j l �' Re D Personsi information you provide may be used for secondary purposm
( t►, J i. / s / D it
Property Owner YZOM LLocaflon
1 vv r __��t'V i� Govt. Lot A/ L 1 /4f; tt r 114 S T L N R E
Property owner's Mailing Address Lot # lock # 54W Name or CSM#
B
CCity State Code Phone Number ❑ City ❑ village ® Town Nearest Road
-s wt 115 (T /s F
(� New Construction Use: Q Residential / Number of bedrooms Code derived design flow rate YS — 0 4 T Cj (J GPD
❑ Replacement `/ C3 Public or commercial - Describe: M _
Parent material 1 Flood Plain elevation if applic _ Z2 ;?T R.
General comments
and recommendations:
R Ong # ❑ Boring
Pit Ground surface elev. ft. Depth to limiting factor Z in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
In. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 1 0#2
S,` Zms �� G S v� •5
5 - 2 %y _ S. ( ?rn Ir"f ir S i
Boring # ❑ Boring
® pit 77 Ground surface elev. , •T'c ft. Depth to limiting facto in.
Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff
in. Mtmsell Qu. Sz. Cont. Colo Gr. Sz. Sh. •Eff#1 'ER#2
t o -r i�. 3t �- I rrm c c t v ,
, 4 r
3
Efldrertt #1 = BOD > 30 1 220 mg/L and TSS >30 1 150 mg& ' Effluent #2 = SOD < 30 mg/L and TSS 1 30 mg/L
CST Name (Please Print) CST Number
Address Dat�E�, on ducted Telephone
. �i{.w C , c w S'y r � 1 �
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,
f
Property 40 - t Paroei IQ # �� T r Page z of ___ -
Bortg # ❑ Boring
P Pit Ground surface elev. 4 , ft. Depth W limiting factor in. Soli Application Rate
Horizon Depth Dominant Color Redox Description Texture Stnxgura Consistence Boundary Roots GPD/N
In. Munsell Qu. Sz. Cord. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
. ( 1 U
Boring a# °
C] pi Ground surface elev. ft. Depth to limiting factor �• Shc Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •E GPD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
Boring Q Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate
H n Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots rr •E GPD �tf#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
r
• Effluent #1 SOD, > 30 _< 220 ffV1L and TSS >30 5150 ri1gk • Effluent #2 s BOD, 130 rng& and TSS = 30 rngIL
The Department of Commerce is an equal opportunity seance provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608466 -3151 or TTY 608- 2648777.
atwax(R•W)
pl owner ZI z 3 Parcel ID # / C3 7 Page of
❑ Boring
Boring # JR Pit Ground surface elev. 0 + 0 ft. Depth to limiting factor _ in. � Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDMf
in. Munseii Qu. Sz. Cont. Color Gr. Sz. fS-h. 'Etf#1 'E1
MX r , S f
Boring a # ° Boring
❑ Pit Ground surface elev. R Depth to limiting factor in. Soil Applicatiori Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munselt Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Ef#2
Q Bmft # C] Boring
❑ Pit Ground surface elev. ft. Depth to tirrriting factor in.
• Sol Application Rate
Horizon Depth Dominant Color Redox Description. Texture structure Consistence Boundary Roots GPDIff
in. Munselt Qu. Sz. Cont. Odor Gr. Sz. Sh. 0 0#1 •Eff#2
• F_flluent #1 = SOD, > 30 < 220 nWL and TSS >30 1150 m91L ' Etlluerd #2 = BOD, 130 mpk and TSS 130 mglL
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.
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ST. CROIX COUNTY, WISCONSIN 31
., for relatively long periods in spring and after heavy plains. These are sandy soils underlain by loose, fine
rains sand. Native vegetation was oak savanna.
This soil is well suited to corn, oats, and alfalfa. It is In a representative profile the surface layer is very
frequently used for corn. Controlling erosion is an im- dark grayish brown loamy fine sand about 6 inches
portant factor of good management. Capability unit thick. The subsoil is about 24 inches thick. It is dark
IIe -1; woodland group 1o1. brown, dark yellowish brown, and brown, very friable
FoB— Freeon silt loam, heavy substratum, 2 to 6 loamy fine sand. The substratum, to a depth of about
percent slopes. This soil is on low ridges of ground 60 inches, is brown fine sand that has bands of dark
moraines. Most areas are oblong and range from 5 to reddish brown fine sandy loam.
40 acres in size. Available water capacity is low, and permeability is
This soil has a profile similar to the one described as rapid. Natural fertility and the organic matter content
representative of the series, but the substratum con- of the surface layer are low.
tains more silt and clay and the subsoil and substratum Most areas of these soils are in pasture. Some of the
are saturated with water for longer periods. gently sloping soils are used for corn, soybeans; and
Included with this soil in mapping are a few areas garden vegetables. Where irrigated and fertilized, these
where the soil is underlain by shale residuum. Also soils are well suited to potatoes and other special
included are small areas of Arland, Renova, Santiago, vegetable crops.
Skyberg, and Vlasaty soils. Representative profile of Gotham loamy fine sand, 2
Runoff is slow, and the hazard of erosion is slight. to 6 percent slopes, in a cultivated area, 370 yards north
Available water capacity is very high. Permeability and 200 yards west of southeast corner of sec. 13, T.
ranges from moderate in the subsoil to moderately slow 28 N., R. 20 W.:
,, in -the substratum. The lower part of the subsoil is Ap-0 to 6 inches; very dark grayish brown (10YR
saturated with water for long periods throughout the 3/2) loamy fine sand; brown (10YR 5/3)
year. Seasonal wetness delays tillage and plant growth. dry; weak fine subangular blocky struc-
F Most areas of this soil are cultivated. A few areas are ture; very friable; common roots;
in woods. The soil is well suited to corn, oats, clover, and strongly acid; abrupt smooth boundary.
grasses. Controlling erosion is an important factor of
131-6 to 13 inches; dark brown (10YR 3/3) loamy
good management. Capability unit IIe-1; woodland fine sand; pale brown (10YR 6/3) dry;
`��',oup 101. weak medium subangular blocky struc-
FoC2 -- Freeon silt loam, heavy substratum, 6 to 12 ture; very friable; common roots;
, scent slopes, eroded. This soil is on low ridges of strongly acid; abrupt smooth boundary.
and moraines. Most areas are elongated or oblong B12 -13 to 24 inches; dark yellowish brown (10YR
range from 5 to 20 acres in size. 4/4) loamy fine sand; weak medium
is soil has a profile similar to the one described as subangular blocky structure; very friable;
resentative of the series, but the surface layer is common roots; medium acid; abrupt
ter colored and the substratum contains more silt smooth boundary.
clay; also, the subsoil and substratum are saturated B2t -24 to 30 inches; brown (7.5YR 4/4) loamy
"water for longer periods. fine sand; moderate medium subangular
luded with this soil in mapping are a few areas blocky structure; very friable; clay
." the soil is underlain by shale residuum. Also bridging between sand grains and in
Ided are a few areas of Arland, Renova, Santiago, pores; common roots; strongly acid;
rg, and Vlasaty soils and a few areas where slopes abrupt smooth boundary.
`ss than 6 percent or more than 12 percent. C-30 to 60 inches; brown (7.5YR 4/4) fine sand
-off is medium, and the hazard of erosion is mod- containing bands of dark reddish brown
.Available water capacity is very high. Perme- (5YR 3/4) fine sandy loam; single
ranges from moderate in the subsoil to grained; loose; medium acid.
tely slow in the substratum. The lower part of The solum ranges from 24 to 40 inches in thickness.
soil is saturated with water for long periods The A horizon is very dark brown or very dark grayish
bout the year. Seasonal wet conditions delay brown loamy fine sand or loamy sand 6 to 15 inches
mend plant growth. In many areas, erosion has thick.
the tilth to deteriorate and has reduced the The Bt horizon is loamy fine sand or light sandy
of organic matter in the surface layer. loam. The C horizon consists of fine sand that has bands
areas of this soil are cultivated. A few areas are of sandy loam or heavy loamy fine sand. The B horizon
The soil is suited to oats, alfalfa, and a limited is strongly acid or medium acid, and the C horizon is
gf corn and other row crops. Controlling erosion medium acid to slightly acid.
" ) A aining tilth and organic matter content are Gotham soils are associated with Dickman and Plain-
t factors of good management. Capability unit field soils. Gotham soils have slightly more clay and silt
oodland group 1o1. in the B horizon and they have a darker colored A hori-
zon than Plainfield soils. They contain slightly less silt
Series and clay in the upper part of the solum than Dickman
N soils. ham series consists of gently sloping and GoB--Gotham loamy fine sand, 2 to 6 percent slopes.
mewhat excessively drained soils on stream This soil is on stream terraces and outwash plains. Most
.utwash plains, and areas of pitted outwash areas are irregular in shape and range from 10 to 40
KATHLEEN H. WALSH
Document Number WARRANTY DEED Sl ,TER OF DEEDS
RECEIVED FOR RECORD
Richard W. Hopkins, Shirley L. Wickline, John M. Hopkins, Susan J. 09- 03-1949 2 :00 Phi
Anderson, Jane M. Held and Gerald M. Hopkins, conveys ,and warrants
to Richard O. Stout and Janet P. Stout, husband and wife, as WARRANTY DEED
survivorship marital property, the following described real estate in St. EXEMPT #
Croix County, State of Wisconsin.- CERT COPY FEE:
COPY FEE:
TRANSFER FEE: 816.00
RECORDING FEE: 10.00
PAGES: 1
Recording A rea
Name and Return Address
Richard O. Stout
1353 Awatukee Trail
Hudson, WI 54016
042- 1004 -70 -000
(Parcel Identification Number)
The North Half of the Northwest Quarter (N' /z of NNW' /4) of Section Three (3), Township
Twenty -nine (29) North, Range Eighteen (18) West, St. Croix County, Wisconsin,
EXCEPT the following parcel of land: Certified survey Map filed April 30, 1975 in Vol. 1
of Certified Survey Maps, page 121, as Document No. 326689,
AND ALSO EXCEPTING Certified Survey Map filed August 3, 1983 in Vol. 5 of
Certified Survey Maps, page 1330, as Document No. 386986.
AND ALSO EXC'EPTTNG Certified Survey ?-Tap filed May 16, 1990 in Vol. 8 of Certified
Survey Maps, page 2208, as Document No. 458642.
Exception to warranties. all easements and restrictions of record. Covenants, restrictions and easements of
record.
7
This is not homestead property. Dated this day of 1999.
�l
"Richard W. Hopkins ichard W. Hopkins, a. A r ey -In -Fact, for Shirley L.
W ckline, John M. Hopkins, Susan J. Anderson, Jane M.
* Held and Gerald M Hopkins
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
ST. CROIX COUNTY
Personally came before me this 2— day of June, 1999, the
above named Richard W. Hopkins to me known to be the
authenticated this day of pe w o
w
0/
ackn I executed the foregoing instrument and
acknowl ge the same'
signature
e or not name signal e
type p type or int name i' . y� �,���.r r� �•
TITLE: MEMBER STATE BAR OF WISCONSIN Notary Public St. Croix County, .
(If not, My commission is ern pent (If not, state expiration date:
authorized by §706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY *Names of persons signing in any capacity should be typed or
ROBERT F. WALL printed below their signatures.
,Hcp1<ihstoStoutW D)
Information Professionals company Fond du Lac, Wisconsin 800.655 -2021
Ia
VOL 20 PAGE 5026
HATULM H. wwLsw—
RMISTE)R OF DrEDS ST 0mix m vi
I
E"' y 07 r 22 / 2 005 MAP
LOCATED IN PART OF THE NW1 /4 OF THE NW1 /4 OF 'SECTION 3. T29N, � C ERTIFIED SU ,
Rl8w, TOWN Or WARREN, ST, CROIX COUNTY, WSCONSIN, REC FEE - 15 Qm
DRAINAGE EASEMENT PAC 7'E&a
1'�CyE.S ;
LINE '"ABLE 1
,4 011PE'C770V DIST 04 - CMN -
E; sov '; °w sn, sic' Es yes aw 101 "5,,9' S L'►FWE*"1 oR.- PREPARED F F
14 d.1•�' DOUGLAS J, Z!-L'? R ? @?dAiD ST OUT
E.7 5'89- 55159 "W 2.250 ' E'B S do N LAND SURVEYING. INC, 1252 AWATJIIEE TRAil- {
I 44 300171'39'W _7297 E'9 76Rr0'r0 "W 1076.9' 2020 ENLOE STREET HUDSON, Wt 540ld 1
F5 5'63'414f'W 9,108' FIO M89',539'59 "E 374..'19' HUDSON, 14+1 W16 III
DUCK PC NDI ! I L OT Z C'.�.M, N i 1(JTN�PLATTED LANDS �
,
E' scX PE ` VO 5 PG. _______ ________
1 j f? 51P�5 "W 26 28,85'
NORTH UNE OF 'ME NWt/4 NW COR, ,489 50'59 W 444.85 .1x. - �6 R --
_ 3100'• <' 2184.Ck?' ' N1 ; d nom,.
15 a' —. �50 WIDE Row" I J!NE SEC. 3
, EAMM _ w
..
! Qt i ACRES c
, E (87.6"Gi FT.) *= rya ..7
TPLATTED IA i
ANDS
- - -
S�D• " .39
LOT 2
I
A
(57,734 SO. FT.)
I a► j
LOT 4"
i I $89'39'40 "IE 406.36' 2 418 ASS ; 1 1 :
I f ! LOT (87,827 SQ. FT.) .
i C•+ I 2-014 ACRES ?
1 ?
(87,734 1�4. Fr.) �
? # i e -
��,� n r
33 3y
291,62 74 z
PUBLIC sTplurT ___j
CURVE DATA TABLE LF_NrTHS Apt IN I �
Curve Radlus Central Chord afford Arc Tan i 84arin p
11
Number/ Lot Length Angle p1wring Length Length Tangent In Tangent Out
C1 80,00 48°074'10' K23122'23 "E 61.32 92.93 NOO'K'18 "E. N4,5'34'28
C2 MOD 270'4J8'lV' M139'29'41.5'W 113,00 377.38 N45'34'28'E S4433'51 'E I
c'! BOUNDARY 80.00 162"17'21" N451912.5 0 W 161 .96 254.76 N45°34'2!3'E x.,"43'0707 - W
4 80.00 87 S00'43'2.2'E 110,93 122.43 S4 trro7 W S44 - F:
CZ3 80,00 45'04'08' S,22'01 '48.5 61,37 02.03 S44 "33'51 "E SOO O'18'W
b F. 41AKU1A LUUMI T
SEPTIC TANK MAINTENANCE, AGREEMENT
AND
OWNERSHIP CERTIVICATION FORM
Owner/Buyer V-A Q S_6cz _
Mailing Address
Property Address A
(_ -4 rcq g7 ui S redfrom Plot Zoning Department for new cow� �tioWj
City/State Pat Identificafion Number
IJQAL DE,5CHj=Pj,
Property Location/ J 14,,&C 4 , Sec. , T 2 NR./f4fflvv
Ton of J .� Inr
_
Subdivision Lot #
0 a
Certified Survey Map V o l umc. , PaS
Warranty Deed # Volume .--, page
:spec hom
SYSTEM MAI.M 414
Q OWNES CAEWVgAjjQZj
Impropw %3BO and rraiw=44ce Of your septic system could result is irs Premature failuro to larAc wastes. Prnper
maintenance consists of pumping out the swric tank every throe ye4rs or sootier. if needed, by a licerzed pumper, What you put 4 M.
the system can affect the function of the septic t As a treatment stage in the waste disposal system, owner maintenance
responsibilities are specified in Konim, 83,52(1) and it. Chapter 12 - St. Croix County lsaTiitary Ordinance.
The prDpertv, t)w;= agroes to submit to S1, Croix County Planning & Zoning Departmtmt a certification form,, signed by the
owner and by a master Plumber, jout-neymittl plumber, restricted plumber or a iieunsed pumper verifying that (1) the nn-sit.:
wastewater disposal System is in proper operating condition Agd/o• (2) After inv
r0c a nd pumping (if necessary), the septic ta.nk is
less than 1/1111 of sludge.
1 /we, the undersigned have read the above requirements and agree to mintair the private sewage di V0341 system with the
standards set forth, hereirn as set by the Dopartmont of Commerce and the Deparmtent of Nawml Reaources, State of W isconsin
Ccmfioation stating that your septic system has been maintained must be cormllctcd and returned to the st. Croix County Planning
Zoning Department within 30 days of the three year expiration date,
Uwe certify that all summents mi this form arc true to the best of nly/4-gir knowledge. i/we auditre div owner(-0 of the
property described above, by virtue of a warranty deed recorded in Register of Deeds 01rice.
Number of bedrooms
SIG OF APPLWAKT(S) DATE
***Any information that is misrepreSOMd may result in the sanitary peim* being revoked by the Planninz & 1ofling DtPgmhe"t.
Include with this application 9 recorded warranty deed from the Register of Deeds Office and 3 copy of the certifled survey map if
reference is made in the warranty deed.
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' '� nooa 12 Mr
FRESH . W+ h:) OW Olt 4EATHERPROOF
ASR �N,AKE JUNCTION BOX ArPRO'dEA
WITH CON'DuST `SANNOLE a G'JER
„ W!
PADLOCK
4 Cl i 5'R --- �. WARNING C i
.�.....�,�., i ....,....r. !ABEL
F
LF
WAT
WA:`ER Tz G HT SEALS GAS• '
T TIGHT'
;f I AN In A SEAL . pROVEa
'IPE 3' i.,.._ JOINT'S WITH
ALM APPFOVEO P IPE
}RTO $10 a '"F" to ON j 3' .OMTO
;OIL SOLM SOIL
M4 OFF ELEV , F T , ...... „I C }}
.. `.` .1-1 j RIM EXIT
D i PEAKITTM CN I V
' 1 IF TANX
MANUFACTURER
3 " APPM ED $EDD.NG UNDER TANX HAS APPROVAL
SPECIF.',CAT " CNS CONCRVTE PAD
DOSE
'Al'
X HAN'.3FACTJRETt: 4 �o��
= .r.�.,�. ... ,..,,_.. "UM'ER % OSES PER DAY:
:.,NK SI2ES: GAL.
DOS GAL. FLOWSACK: j. 4011 . GA
►i ; .
.AR,u MAM1�'AC�,!RER: �
CA _j. A � � : ..
MODEL MJMBEiR ,_ ?tiCKlrS „�� aA L .
SWITCH TYPE: JYZ
v: P INCHES MANUFACTURER: ' -am No* GAL.
MODEL NUMBER, � INCrIES x ,.,...GA: ,
SWITCH 'TYPE: -
Di9CKARGE RAT ,� D - .• iYCNES .. „�G,.....GAL
„ �P:. PUMP E ALARM fvIRiNG AS PEA ZLHR 16.
FAT_CA NETWOR OFF
L DIFFL'RENCE 8E, d1
MINIM SUplLY PRE55URg FIFE .
�pR; M 7: c7N FACTOR FCET
+ O..4L D NAMIC MEAD : FLEET
FEZ:
�mCRNAL D�ZME:�:'O�5 LF gu4a : — .......�...
G i
L «Q;,YD y f WI7TK �i V.
i. ' ENE' �' .
L PUMPS •
Submersible
Effluent Pump
EPO4
a.
3871 EP05
APPLICATIONS • Fupy submerged in high 8 EK> in peller T hermoplas- ■ Hearings: Upper and lower
Specifically designed for the 9 � turbine all for Oc endoW design for heavy duty ball bearing
fallowing uses: lubrication and'q Qc eutt improved prfatmance. construction.
• Effluent systems heat transfer. g1 Casi ,znd Base: Rugged
• Homes Available for auto q and thermoo Oic design provides AGENCY LISTING
• Farms superior ngth and corrosion
manual oparatlpn;ApUt- rra,dw, stepd•rd: ekfodnion
• Heavy duty sump nMtic models INt4b. fRince
• Water transfer 1Nkdtattkal FIonI S tep * IYll , oi, Housing: Cast iron (CSA listed model numbers end
• Dewatering assembled and fgr e., ' li It heat transfer, in "F" or "C ".)
psl�t Et the
factory. iovrio !, a1d durability.
SP ECIFICATIONS i Oiioir Coyer: Thermoplastic GwJ& Pimps is 50 9001
•Solids handling capabili
FEATURES integral handle and
9 fit sot attachment points.
'/4" maximum. ■ EK4 Impeller Thotmoplas- IN Pgwir C4Me: Severe duty
• Capacities: up to 60 GPM. tic Semi -open design with ►eted ol) aiid water resistant.
• Total heads: up to 31 feet. pump out vanes fa Merflanical
• Discharge size: 1 NFT, seal protection.
• Mechanical seal: carbon.
totary /ceramic•stationary,
BUNA -N elastomers.
• Temperature:
104OF(4K continuous METERS FEET
140 t60 intermittent.
10
• F asteners: 00 series - -
stainless steel. a
• Capable of running
dry without damage to
components.
fUlOtOr: x
• EPO4 Single phase: 0.4 HP, g zow
115 or 230 V, 60 Hz, 1550
RPM, built in overload with
automatic reset. EPOS
• EP05 Single phase: 0.5 HP, c ;
115 V, 60 Hz, 1550 RPM, 3
bulk in overload with
automatic reset. z _ EP
• Power cord; 10 foot �--
standard length, 16/3 1 :_
SJTOW with three prong
grounding plug. Optional 20 0 ° e3 1
o zo 30 40 so GPM
foot length, 16/3 SJTW with
three prong grounding plug ` ��—
(standard on EP05) 0 2 4 6 a 10 12 milh
caPaciTv
Goulds Pu
0 2000 Goulds Pumps ITT Industries
Effective February, 2000 W
$9671
urck4
STANDARD CHAMBER
52"
Quick4 Standard Chamber 48"
(EFFECTIVE LENGTH)
r
12
34"---- SIDE VIEW
SECTION VIEW
MultiPort End Cap
?INN
f 16"
12
L- rn I � �z°
SIDE VIEW TOP VIEW
FRONT VIEW
i; Ali
dd
illiffildaiNkIfi tion
l S
"34 X 16 X 12"
Effective Length 48 Invert Height 8* or 1.26"
Inver'l Height F .
INF�TRAIQB-aK$TEM$—INC-SIL%-NDAR"&-LTEkWARRA-HLY
A TI a ,,, .h of o to. �,, ., _ , ir m i,;tf by I I ( aholi livered arid cflxsrateci
1. Go' .,, I l . ,
-pt" system ., a Ordal -Irl I'ttill'alor'.."(werons, i ins—And 1. 1: "1 onpoill puta oijdw) aow Jbiww
fo, "'. lr(u. from the dill, fil pell,bt Is 1—lad for Poo
h. t pe 11! 11 llyse a :h. II provided, . hro�er
i ""ll KK,6td hv V$�—f law, if* warranfl, l ltirti boon upol " clst, roil N I
T nos *Sept. 5116lemool"InellL.,
, � 91 w,,f rights. 1 1 hcttfl, Infili in miling a, Its C(irporal in C ',�aytfl Cvrnw�fjcrt vr,flitto Iffirfern 09
1,, 01 It" 6efent illil 101 Suj)llly wpiwit-orl Jrvis for Ul fy:1Ntt. 1�r Io Do ccivoreld by th,3 LmLirld 1 4a , ,anly
11101al.1 I Ew..I o'cluf Ina w,I of rel of me—Ina I Mk 4 1 ; At
;
(L'i TI 0 I-WiTF.13 t%ARRA-,11Y AND REMECES IN SUBPARAGRAPH a) ARF (.XGLU. 14 1 AFIE lq 011 if WARRANTIFS RF..SPECT
To !JI l It 11S INCL�;DING NO IMPLIED NALfRIII OF MERCHANTABILITY OR LnI �1 )C 4, HII, 101- F'jRI
(0 I 'S t —1 bc ar I Inc chamber jja ,
J , j U.,rQIho SYSTEMS INC
'r jna.:rf,jI the Gthitall Warrant) does
: iot P.4bod 10 110,1014.i. C7` l'Packil 01 todirw darfai l I SNIII n- t. II f"r p6liall'o, IN klu'dall d—ages, 60011 toss of Enwwnmental Orisde W"tewatw Solution
,tldLo5W and ploll M.Allao lNemead c6sts. 01 other 1 so. 1 -
. incur-I cle life liticklis a airy third ;;arty. rboul;Cally
ex k de :i Iron: UIT11180 Wal""Otly COvOraI it@ damage to the Units O - twr iftldl mCi(II llrriWsc, attriall, or riall of
0� urlAs the lJills I:Mnl9,,j1ojrI to vehicits rafk 0, othar Cond wh;- a not Left Nod by the instaliabon fa it, mental ) ths, 6 Business Park Road - P.O. Box 768
(rW�j -t (Mr. in the i-T.11I f the Pla� t Df;mPI motorists into the. System opigaining thre Units; fainara
Zr Units or the septic Syst-im aille to iinw per still or improper 81209, brlQl,551v8 WAW usage In'PrOill qr�, drsprosat, or improper operation, or Old Saybrook, CT 06475
7 1h. L1n*o0WamaoIy�hl Do Yo it the Holtler I0nh)ndibL.nflw
W arranty 860-577-7000 - FAX 860-577-7001
n , .II Ill I'll vwrl� Sinai .1I he responsitAw for arrilloss o, Aral I. ti. Holder, the Un-w, c,, any thil part rIfaijftavlroirin:ltalf c i l ains o f Hot o for any Ifilid party,
Partvsf_ImitqdVV f p V. rho Ul Ill[
l 800-221-4436
wain W site C-dIIINIS WjInted I Wall arid War coded; afl orlher applicarle laws; and Infiltrators wislaillition ivrstruoOWSL installed of ac(rYderrGV
11)f N nFrV`esLyl1,1r-) of k4llator has the at,thl to change or elnafie this -iAled Wzirrao!y. 1 `41 6 , ,, Ilyaniry atripwAto III pang Off- than -
the on
dal 1 Jo 9
Thil) aI twriff",ts the Sla,tdarcl Lirnitod Warranty 0"I by fill A : rm-) rL o' trt.tev I cophf.s have dat _3,!y aiji ir a.
n-016, Any pin.1 o! Urjrjs.qflLx4d contact Inallator's Corporate H (,ad' juarlers in Ord Saybrock, Carnookut, I to suon purciviso, !0 obtain a
coot' of the app.caole a,,wjv and $1I caretufflead joal warranty prior t th e purchal :, 47r
Pal 4,769,661; 5,01 5.156,488; 5,336,017; 5.40 - , 16; 5.401,450, 5,5; 1 4163' 6,7116,M; o,586,778; 5,839,844
Canadian Patents: i.320,959: 2,004.564 Other patents pending
LI'lirDlor, Eqt4ize and sidewnow are regstread trademarks 01 Infiltrator Systems Ir-I Infiltrator is a fegisterLd tradooril in France, Infiltrator Systeints Iric.
it, i rwgisanat:i Ifalitent in Me"'co. Contour. Contour Swivel Connection, M;ciol-oadwrig, PotI Sna CharnberSpacei, PostLock, QuirkCut, QuickPlary RECYCLED PAPER
at , J Oul are trademarks O Irldrinatar Systems Inc. 0 2003 Inf0tia(or SvStei inc. Printed in U.S.A. 011 11)(VU-10-A
- POWTS OWN481 MA14UA . & MANAGEMENT PLAN Page of
FILE INFORMATION y TEM SPECIFICATIONS
Ownbr
$eltlo Tank Capacity ,? d al D NA
Permit a
$e c Tank Manufacturer � O NA
DESIGN PARAMETERS lffluent Filter Manufacturer A 4 G O NA
Number of Bedrooms 9 7 1 0 NA . en Filter Model O
t F del NA
i
It
Number of Public Facility Units, 13 NA Puling Tank Capacity a l D NA
Estimated flow (everago) , re' &I Pump Tank Manufacturer Z — I S ❑ NA
Design flow 1pesk), (Estimated x 1.51 d al/ d Pump Manufacturer 0 NA
Soil Application Rate itu P Model 0 NA
Standard Influent/Effluent Quality Monthly overap, Prfttroatment Unit D NA
Fats, Oil & Grease (FOG) 530 mg /L q SandlGravel Filter d Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L O NA Q Mechanical Aeration O Wetland
Total Suspended Solids (TSS) 5150 mg /L i3 Disinfection 0 Other:
Pretreated Effluent Quality Monthly eyerage O NA
Biochemical Oxygen Demand (600 530 mq(L q (n- Ground (gravity) O in- Ground (pressurized)
Total Suspended Solids (TSS1 %30 mg /L q NA la At-Grade O Mound
Fecal Colifonn (geometric mean) 510° cfu /1Q0ml q 06p -Line A Other;
Maximum Effluent Particle Size Y, In din. C3 NA O NA
Othsr:
13 NA 0 NA
"Values typical for domestic wastawater and septic tank effluent. fi O NA
MAINTENANCE SCHEDULE
Serwlae Evart Service Frequency El Inspect condition of tank(s) At lent once every; 3 s s (Maximum 3 years) O NA
Pump out contents of tank(s) When combined Sludge Sid scum equals one -third (Y of tank volume Q NA
Inspect dispersal cell(s) At Ieflst once wOry; earth s) (Makhmm 3 years) O NA
rnonth(e)
Clean effluent filter At least once every-, t' ,'IE' sar(r) O NA
tr►ontt►(al
inspect pump, pump controls & alarm A; D NA
West once every: p {s)
Flush laterals and pressure test At leest once every; -- month O NA
O earls)
Other: O months) O NA
At !hill); once ewuyl O (s)
Otter: Q NA
MAINTENANCE NSTRUCTIOfl16
Inspections of tanks end 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;, Saptage Servicing Operator. Tank
Inspections must Include a visual Inspection of the tltnk(s) to ldernt any missing or broken hardware, identify any cracks or looks,
measure the volume of combated sludge and scum tb check for any back up or ponding of effluent on the ground surface. I.
, pd 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 falling condition and requires the
Immediate notification of the local regulatory authority.
When the combined accumulation of sludgs and sown in any t 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 effl4ent filters, mechanical or pressurized components, pretreatment
units, and any servicing at Intervals of s12 months, ahail 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.
I
Page of
START UP AND OPERATION
For now construction, prior to use of the POWTS check treaatment tanklal for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dlf►porrial call(al. if high concentrations are detected Have the contents
of the tankla) removed by a septage servicing operator prier jo 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 highwtaiter levels. When power is restored the excess wastewater will be
discharged to the dispersal cells) in one large doses, Qverlaa�iind the 061.1116) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pulnp tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintain 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 coils. Do Rot drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -gra0a soil absorption *rob.
Reduction or elimination of the following from th e wastswater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butrs; cohdoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; tat;
foundation drain Isump pump) water; fruit and vigetbpf a pei1(naa aaisoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and 'watar softeher brine
ABANDONMENT
When the POWTS falls andfor is permanently taken, out of sorvice the following steps shall be taken to insure that the system is
properly and safely abandoned In compliance with ghaptor Golan 8 :.33, Wltisconsin Administrative Code:
• All piping to tanks and pits shall be disconneptod and the abandoned pipe openings sealed.
• The contents of ail 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 thq following measures have been, or must be taken, to provide a code compliant
replacement syetorn:
O 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 Nnee and wells. Failure to protect the replacement area wilt
remit in the need for a new soil and site evaluatlen to eptatbllsh s suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
17 A suitable replacement area is not av+tlie due to ae tbagk, and /or soil limitations. Barring advances in POWTS
technology a holding tank may be instailad as a last rosort to replace the failed POWTS.
13 Th 4ja nnit hasn,M IA.
a mail d site
Al e a tank
El Mound and at -grade soil absorption systems may be taoonstrvoted 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 TANK$ MAX CONTAIN [;THAI GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC. PUMP OR OTHER TREATMENT" TANK uNDPIR ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE 0101040 - on WPOSOWLE•
AppITIONAL COMMENTS
POWTS INSTALL1l81 if0 I!< MAINTAINER
Name .' Name
rIL ll ' u �•-� � Q 1"
Phone / _ J — S Phone
NOW SEPTAOE SERVICING OPERATOR (PUMPER) m(liso ULATORY AUTH4RiTY
Name
Phone
715
This document was drafted in compliance with chapter Comm $3.22(2114911, . 54111, (2) S (3), Wis consin Administrative Code.
Page of .
START UP AND OPERATION
For now construction, prior to use of the POWTS aheok trpatment tanlcla) fcr the presence of painting products or other chemicals
that meter ° impede the treatment process and /or damage tho dlllporolil cellle). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing opera ;or prior tla ugei.
System start up shall not occur when soil conditloho 4m frozen at the infiltrative surface.
During power outages pump tanks may fill above neitrtlel hibhwatsr levels. When power is restored the excess wastewater will be
discharged to the dispersal cellls) in one large clasp, ovarkt�inp the oitilllsl and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of tho pump tank removed by a Septege Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber cr POWTS M.01rit4,1nor to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles aver tanks and dispersal cells. D o not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grasf o soil absorption Gros.
Reduction or elimination of the following from tho wastelwatgt stream may improve the performance and prolong the life of the
l�et8
POWTS: antibiotics; baby wipes; cigarette butte, oan+dorns; Qotton elvirab #; degreasers; dental floss; diapers; disinfectants; tar,
ao(ine; grease; herbicides; meat scraps; medications; oil;
foundation drain !sump pumps water; fruit and vsb�e pa � rl .
painting products; pesticides; sanitary napkins; tarn' 00, and ;ejr eoheher brine.
ASANDONMI"eNT
When the POWTS fails and /or is permanently taken out 4f service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with Ootilr Corn 133.33, Wisconsin Administrative Code:
• Ail piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents at all tanks and pies shall be tpmovef and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and torrioved or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
It the POWTS falls and cannot be repaired thg following measures have been, or must be taken, to provide a code compliant
replacement system:
O A suitable replacement area has been eva Arid may be utilized for the location of a replacement soil absorption,
system. The replacement area should be Oret�i0d from 01OW( orloe and compaction and should not be infringed upon by
required setbacks from existing and proposed ptruature, lot priae and wells. Failure to protect the replacement area will
resuh In the need for a new soil and site evaluation to 00 #blt9h *suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
E3 A suitable replacement area is not svilleble clue to setback, and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed awe a last resort to replace
the failed POWTS.
Al � D sit d site
e tank
❑ Mound and at -grade soil absorption systems may be reconnruoted in pieta fallowing removal of the biomat at the
infiltrative surface. Reconstructions of such seylstems M, . aafr ply With the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANK$ MAX CONTAI" THAI, GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT` TAINT UND13.1I AIEY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY of Fli0�1L� flit �111p�lii�BiBLE.
AL/DITIONAL COMMENTS
POWTS INSTALLER PO .. $ aAAAiNTA1NER
Name 4) , A , ' ex �*+ w Q y+ Nelms
Phone 7 _ r,�► -- Phone
SEPTAGE SERVIC OPER ATOR (PUMPER) L LATORY AUT
EOU HORITY
Name N am e 5+!- C x e
Phone Rhone '7 15 - WS 6
Wisconsin Administrative Cede.
This document was drafted in compliance with Comm 43.22I2ltblltild 01 mW 83.54!11,(2) a tai.
cume
i