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HomeMy WebLinkAbout042-1090-20-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division , INSPECTION REPORT Sanitary Permit No: 479448 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: Lancaster, Robert I Warren, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: " 6 32.29.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Alt. BM Aeration Bldg. Sewer 5.4� y z Holding St/Ht Inlet t;,. 35 c i'7 3 TANK SETBACK INFORMATION SVHt Outlet (0 k 9 TANK TO i P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet X C+ r�♦ Septic , / /v A— r Z , 1 2 1 Dt Bottom c Dosing Header /Man. 7.35 /�-• S Aeration Dist. Pipe 7, 3 Holding Bot. System TC ' Z 'S' Final Grade y� �S PUMP /SIPHON INF ON +Z- 1 Manufacturer Demand St Cover GPM Model Numbe ' TDH Lift Friction Loss System Head TDH Ti Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS __5l _ 1- \, SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer. _ �J\ < r , INFORMATION CHAMBER OR J- Type Of System: i / �/ n UNIT Model Number. h �� DISTRIBUTION SYSTEM ��' c� .c_G� - 3 Header /Manifold � Distribution x Hole Size x Hole Spacing Vent to Ai ntr Pipe(s) \ \ \ Z ( �•'� Length g Dia Length \ Dia Spacing 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 ti ' Bed/Trench Edges \ Topsoil \ Yes [] No Yes E 1 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 693 104th Street Roberts, WI 54023 (NE 1/4 NW 1/4 32 T29N 8W) NA Lot 1 Parcel No: 32.29.18. 1.) Alt BM Description = F� t C '`� '� G�•c;� < -� �x >� 2.) Bldg sewer length = 7 / - amount of cover = Plan revision Required. X0 Use other side for additional information. Date jr ature Cart. No. SBD -6710 (R.3/97) r - Safety and Buildings Division County 201 W. W hmgton Ave., P.O. Box 7162 Q k iscons' jn Ma n, 537 - 7 Sanitary permit Number (to be filled in by Co.) De artment of Commerce i Sanitary Permit App State Plan 1.13. Number I to accord with Comm 83 21, Wis, Adm. Code, petsonal in Lion you provide may be used for secondary purposes Privacy Law, 5.040 ) t i; n ; l �l). roject Address (if different than mailing address) I. Application Information - Please Print All Information fd ST, CtJ1X GOUNTv M-1171 5?v— Property Owner's Ntutie Parcel t Block # Property Owner's Mailing Address -�'— V^r C el -petty Lo ati City, State Zip Code Phone Number 40 ! 14 , u V4, Section i i t ,'D .� rcle II. Type of Building (check all that apply) T � N; R E or� �l or 2 Family Dwelling- Number of Bedrooms ez���,- n � � FSubdivision CSM Number ❑ Public /Commercial - Describe ❑State Owned- Describe Use � 1 �- / ,�� village , [owMship of W. Type of Permit: (Check only one box on line A. Complete line 13 if applicable) A. kNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only G Other Modification to Existing System B. ❑ Permit Renewal Permit Revision C Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expirati n Phtmbet Owner L/ IV. Type of POWTS System: Check all that apply) 7 / 1 X on - Pressurized In-Ground G Mound > 24 in. of suitable soil G Mound <24 in. of suitable soil G At -Grade ❑ Single Pass Sand Filter ❑ -� Constricted Wetland ❑ Pressurized In- Ground G Holding 'rank ❑ Peat Filter ❑ Aerobic Treatment Unit G Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Xcaching Chamber ❑ Dri e t ravel -less Pipe ❑ Other (explain) V. Dis rsat/Creatment Area Information: LC r'G 5 Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersa rea Requited (sf) Dispersal Area Proposed (sf) System Elevation � G � '7 ✓ G'Y. ✓ � � ego u , VI. Tank Info Car pacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber I VI Responsibility State ment- [,the undersigned, as sume r for i tion of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature _ MP PRS Number Business Phone Number .`l�:`u »K r 4 c�u Irla ei' 7/S -3 S '�: 3 /mi Plumber's Address (Street, City, State, Zip Code) VIIL C n /De artment Use Onl v pproved 1� _ a Sanitary Fermit Fee (includes Ground water Dat Issu Issuing t Signature o S ps) Surcharge Fee) 3 _ Ro nson for Deni , eX7 II (]S IX. Conditions of Approval/Reasons for Disapprrova! �— 3 \ ^ , \ SYST 1 ovule: ) A- -, J 1. 46ptic tbnk, etttt ent ttitar and 4 1 N � / �l cc�t cJY1 t 'ti Fir � dispersal cell must all be services / malrttalrtad J as per management plan provided by plumber. 2. AN setback requirements must be maintained U per applicable code / ortNr>e rAm, J Attach complete plans (to the County only) for the system on paper not leas than W2 x I I inches in size SBD -6398 (R. 01/03) 7`4 1 /,r/ 'Y ........... w X `Y Xo7 . 0 S r ao�/t/ D/C G Ja 'Y t us o ,6r �kIc- r wisoonsin Department of Commerce SOIL EVALUAT IQ,Ql.S6P6Rfi Page of Dlvition of Safety and Buildings In accordance with VrD Attach complete site plan an paper not less than 8112 x 11 i s in A. an must inducts, but not limited to: vertical and horizontal reference pdn (BM), direction and n� P I.D. percent slope, scale or dimensions, north arrow, and location a distj#ne r4',t raD5 P,� CSrvl $p 16 Please print all information. Re Date NT Personal Informedon you provide may be used for secondwy purposes ( vacy g�, � t E Property Owner L On V% e Ct Govt. Lot 1 1/4 1/4 S ,� T.Og N Rl C E (or)65 Property Owner's Meiling Address Lot # Block # Subd. Name or CSM# - 10 < 1 ILI y - 11-1 -1 m City State Zip Code Phone Num1w ❑ City O Village ® Town Nearest Road R 5 wt 41u New Construction Use: (Residential / Number of bedrooms 3 Code derived design flow rate — �,� /l GPD ❑ Replacement ❑ Public or commercial - Describe: —_ -- Parent material J 5 Flood Plain elevation if applicable /r /1 � —� — ft. r one: sys�ly-� and F # ❑ Boring ❑ Pit Ground surface elev. W, 6d ft. Depth to Iim&g factor 12 3 In. Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 �3l2 S 2 o t S Gs 'Yn1 AZ Boring # ❑ Boring ® Pit Ground surface elev. y R Depth to limiting facts / 2 ir in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Elf#2 6 -11 iCyt L- Zvn'A r r✓ S V r , U L io Mot t #1 BOD > 30 1220 nVL and TSS >30 < 150 mg& ' Effluent #2 = B00 < 30 nVIL end TSS 130 mg/l. / CST Number Kv/+'r k zS' 3 �J Address Data Evaluation Conducted Telephone Numbeir property Owner Parcel ID # Page . L of © Boring # ❑ BcnM ❑ pit Ground surface elev. ft. Depth to g factor in. son A0011cation Rage Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOW In. Munseil Ou, Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 1 •011#2 r k G Z I - OS yY\ - -2 Z C o - VY\ F ❑ �, # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor h• Sod Applicalion Rate Horizon Depth Dominant Color Redox Description Texture Strixdure Consistence Boundary Roots GPOIff in. Munsell Ou. SL Cont. Color Gr. SL Sh. '81#1 '01102 Q B«� # ❑Boring Ground surface elev. ft. Depth to YrNting factor h. ❑ Pit Sol Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPM in. Munsel (lu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'EtF#2 • Effluent #1 = BM,: 30 < 220 mgk and TSS >301 150 mg& • Effluent #2 = BOO, 5 30 mg1L and TSS < 30 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. �a w Property Owne T"� ✓ Paroel ID # Peke L of Boring # ❑ BorkV ® ❑ Pit Ground surface elev. ft. Depth to Iimft facto in. [ Sol Application Rate Horizorr Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell OU. Sz. Cont. Color Gr Sz. Sh. '81181 1 'Eff#2 1 0-11 lC' r Z - �L r CS' I v 1• o Z Z F - 1 ❑ Pit Ground surface elev. R Depth to limiting factor in. Rate Horlmrr Depth Dominant Color Redox Description Texture Struck" Consistence Boundary Roots GPOW In. Muned Ou. Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 F ❑ # ❑ Ground surface elev. IL Depth to factor in. Pit Soil Rate Horizon Depth Dominant Color Redox Description. Texture Structure C mistenos Boundary Roots In. Munsell Ou. Sz. Cont. Color Gr, Sz Sh. '0111 'EtF#2 Ettkrent #1 = SW,: 30 1220 mglL and TSS >30 1150 mg& ' Effluent 02 = SOD, _< 30 mglt. and TSS 1 30 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. usarssswrue.wo� A PAGE —3-- NAME ( QrCO LOT# LEGAL DESCRIPTION 1 /a 1 /a,S T ,N,R E(OR)W � l SCALE: 1 " = V BM I ELEVATION G BM I DESCRIPTION p a fat' y a,r SM 2 ELEVATION BM 2 DESCRIPTION �/ SYSTEM ELEVATION SYSTEM TYPE CCJ �'L✓e✓1�h R.f cc o k7 iy` I Q i — i i SIGNATURE DATE 20 . I W. Washington Ave., P,O. Box '7162 45cons Madis W 7-716 in Snitary Permit Number (t e it e i n Department of Comm a ' Comm ( b d Ul — — _j_ Co . t Sanitary perMit ti Sta Plan I.D. Num r In accord with COMM 83.21. Wis. Adm. Code n Personal informs ou 4UCiie may be used for secondary purpose's Privacy Law, slS. (1)(m) Pr I A//A different dtan moiling 1. Application Inlormation dress) lease Print Z_L_nF(;r_-atiz_ ZONING OFPICE Pr-p.erly w nor s Na me 03 -A A ! Parcel P 1 '1/ 1 luck # Property Owner's M cz. e ailing Address ----------- P rty Location City, State 'A Zip Code__Tft;�iu_N_utnbjr V4,Sd"iOrj {circl IL Type Of Building (check A that apply) T_,� N; RZLE of at ........................ V-1 or 2 Family Dwelling - Number Of Bedroon Subdivision Name - 7, ��)-VoS— CSM Number PublIc/Corninercial - Describe Use ;State Owned - Describe Use [ !City _L1VillaS* ❑Townsitip of Type of (Check only one box on Cora to line B if a cable) A T PLNe. System Replacemetu System C71 Treatment 'olding Ta Replacemert o F Modification to Existing Systell, Permit Renewal i ❑ Permit Revision Chang PermitTransfer to New e of It List Previous Permit Number and D Before Expiration ;t. Issued Plumber rwr IV. J e 'OYKT—S XP 2! 1 ?iXjS1Wn_1 (Check lo ll th ' at apply) Y . Non - Pressurized ln-(jrounii Mound > 24 in. of suitabic ;oil Abound 4 in. 0� unable soil At-Grade Single Pais Sand Filter Lj Constructed Weiland Pressurized Fn- Ground D Holding nk Lj peat - - - - I Fi Aerobic Treatment Unit L Rocirculatin Sind Filter recirculating Synthetic Me" Filte L Leuhing Chamber Dri Line � , U Gra- -less Pe Odier (explain V. Dispersal/Treatment Area Information; Design Flow (gpd) esign Soil Application Ra �j i8peTsal Area Required (st) —7 PTOPC&ed (0) System Elevation �',-'Tank Info p 'I cky in To mber Matwfacturcr Prefab Si Steel --- FIFiber plastic G Galion f Units Concrete Constructed Glass NZw__7 SvVic Or Holdinj Tank Aerobic "ment Unit --------- tAl Dosing Chamber L 1, the rsigned, assunie ibillity for j!!s aUation of the POWTS shown the attached plalls. P mber's Na rov (Print) I bet's Si griarule Business Phone Number 0 T Pe Plumber's Addre ss (Street, City, State, Code) - - ---- I VI I1 AIC I 'o ment U -- sek ---- I I anittry Permit fec,�includes Groundwater Da w lsvwd Zing AA ent Apppro D Disapproves S urcharge fee) Owner Owen Reason for Denial -3 OD t Conditions of Approval/Reasons for Disapproval y I EM OWNER: A (t/- e2- 1 Te p tic tank, effluent filter and dispersal cell must all be serviced / maintained 4&�eUd a&,- as per management plan provided by p lumber. 6 a /- 113 2, All setback requirements must be maintained d-a9l as per applicable code/ordinances. % ✓ aAa 4- g — & 4& Aftchempleteplans (to the County only; for the s3ment on pikper not rats than 81,'2.% it inches N fk N In r A fi ,e � t I N 4 - - r Th welt A4 • • y edZeiizosi VOL 20 PAGE 5024 KATffLLT < H. WXLSH C ERTI FI EC S V RVEY MAP ST. REGI W r LOCATED IN PART OF THE NE :'1 /4 OF THE NW 1/4 07/21%2005 e3: OF SECTION 32, T29N, RI 8W, TOWN OF WARREN CERTIFIED SURVEY NAP ST. CROIX COUNTY, WISCONSIN REC FEES 15.00 COPY FEE: 4.00 OWNER SURVEYOR PAGES: 3 DICK STOUP EDWIN C FLANUM 1353 AWAWKEE TRAIL NORTHLAND SURVEYING, INC. HUDSON, WI 54016 P.O. BOX 14 ROBERTS, WI 54023 CORNER SE CTION 32 S89 °52'46 "E N 1/4 CORNE SE io 889 °5246 " E 477.95' SECTION 32 — \ 93 2151.01' 70TH AVENUE NOR LINE TH - W 1/4 $ - N89°5246"W 412.00' 33'I 33' -- -- -- -- — H.W.L. = 77. � 9 50 cy o 0 !V m LOT 1 N N 0 a l - 2.00 ACRES o 87,317 SO. FT. N I o0 1\ N. B.A. - 1.4 AC. ° Celt 1 o a L.B.O. = 979.50 q I d I 8)i Z N89 °22'05 'E 365.34' 24.98' BENCHMARK ELEV. - 988.30 X7 DEDICATED TO \ al THE PUBLIC / �i iii w w �I 0 c3 LOT 2 0 �I B �' ` ✓ 2.00 ACRES r O �� 87,213 SO. FT. N al LEGEND N.B.A. = 1.7 AC. O Q° I z �2 ALUMINUM COUNTY L.B.O. = sae.00 < I SECTION CORNER 1 MONUMENT FOUND Z -= t y e s ` W `� N uj • FOUND O. D. IRON PIPE w s0 0 I 1 5/1 B" O.D. IRON PIPE Q3 0 FOUND 3/4" IRON REBAR FOUND W LOT 3 `� al 0 3/4"X 18" IRON REBAR 2.00 ACRES SET WEIGHING 1.50 L.BS. 87.235 SO. FT. PER LINEAR FOOT O N.B.A. = 1.5 AC. _ -- _ -- _ 20% SLOPE L.B.O. = 988.00 100' BUILDING SETBACK LINE BENCHMARK A SOIL TEST ELEV. = 1004.58 N.B.A. 1.9 AC. NET BUILDABLE AREA C 1 = INTE HIGHWAY 0 94_" r JOINT DRIVE EASEMENT 12 WIDE UTILITY EASEMENT S 1/4 CORNER r H.W.L\ PONDING AREA TO H.W.L. SECTION 32 986A0� H.W.L. = HIGH WATER LINE ELEVATION (= L.B.O. LOW BUILDING OPENING SCALE IN FEET i" - 100' THIS INSTRUMENT DRAFTED BY SAM ADAMS JOB NO. 04 -113 DATE 2 -2 -05 SHEET 1 OF 3 SHEETS 100 0 100 Vol 20 Page 5024 . c I ) �A\ � 1 LA r lap_ SEPTIC TANK PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" Cr VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR-INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK E FINISHED GRADE WARNING LABEL 4" CI RISER ;4" MIN. ........ .. ....... ,rr ,ti 18" IN. 6" MAX. ......".t 2JLET ! + 1 GAS- ; ' WATER TIGHT SEALS --�'- TIGHT , �, APPROVED A SEAL ' ` JOINTS WITH 1 v-4JALM APPROVED PIPE PPROVED B r t ON 3' ONTO IPE 3' f + SOLID SOIL NTO SOLID + OIL PUMP OFF ELEV . FT. OFF RISER EXIT PERMITTED ONLY D IF TANK MANUFACTURER HAS APPROVAL 3" APPROV ED.BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS i SEPTIC / DOSE TANK MANUFACTURER: NUMBER DOSES PER DAY: TANK SIZES: SEPTIC O GAL. DOSE VOLUME T�vCL'JDING DOSE GAL• FLOWBACK: GAL. ALARM MANUFACTURER: u�P �-n, C APACITIE S : A = INCHES = �3�y GAL, MODEL NUMBER: t•v B = 2 INCHES = 3 Q _ _ GAL. SWITCH TYPE: r C = INCHES =GAL. PUMP MANUFACTURER *. e� $ MODEL NUMBER: a 5/ D = G INCHES = l GAL. SWITCH TYPE: rn�e -c REQUIRED DISCHARGE RATE _yf GPM PUMP 6 ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . FEET + FEET FORCEMAIN X �.G FT /1J0 FT. FRICTION FACTOR FEET TOTAL DYNAMIC HEAD r INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH DIAMETER LIQUID +�• " - // ¢&,l / /,,o�, 1 rr SIGNED: LICENSE NUMBER: - ZZ 7""V DATE: 1/88 nGOULD S PUMPS Submersible Effluent Pump �. 3871 EP05 APPLICATIONS • Ful♦y submerged In high ■ EPOS Impeller Thermoplas- • Bearings: Upper and lower Specifically designed for the gra turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and Aicient improved performance. construction. • Effluent systems heat transfer. * and Base: Ru • Homes Available for automatic and thermoplastic design provide AGENCY LISTING • Farms superior strength and corrosion manual operation. Auto• rseistence, �' can,dra„ sr ndrd. Assodadoe • Heavy sum " n0Nde • Water transfer p Mechanicalfloat g�ch 0 Motor housing: Gast iron (CSA listed model numbers end • Dewatering assembled and preset at the for A heat transfer, In " F" or "C ".) factory. str ingtlt, and durability. SPECIFICATIONS M �i OW Cover: Thermoplastic G&M Pulps is ISO San negist W. • Solids handlin capability: FEATURES cover with Integral handle and '/, "maximum. ■ EPO4 Impeller: Therm flail switch attachment points. opias- • Capacities: up to 60 GPM. do Semi -open design with M Rower Cable: Severe duty • Total heads up to 31 feet, pump out vanes for mechanical rated oil and water resistant. • Discharge size: 1 1 /2" NPT, seal protection. • Mechanical seal: carbon - rotary/ceramic•stationmy, BUNA -N elastomers. • Temperature: 104OF (40 continuous 1401(60`"C) intermittent. METEns FEE • Fasteners: 300 series 10 stainless steel, �-.. __..,, • Capable of running a 30 "`'„ -. ♦ J.r -sG�l dry without damage to a , 2s Fr components. z5 ' Motor: i .. _... ;.. .. _.. _ • EPO4 Single phase: 0.4 HP, " 20,- 1 t 5 or 230 V, 60 Hz, 1 S50 RPM, built in overload with s� automatic reset. • EP05 Single phase: 0.5 NP, r ' epos 115 V, 60 Hz. 1550 RPM, built in overload with Epos automatic reset. 2 • Power cord: 10 foot standard length. 16(3 SJTOW with three prong grounding plug. Optional 20 0 ° o �o zp 30 40 so GPM foot length, 16/3 SJTW with three prong grounding plug -'- (standard on EP05). 4 6 8 10 12 MIA CAMCITv Goulds Pumps 0 2000 Goulds Pumps >� ITT Industries Effective February, 2000 83871 �#IMC*4 STANDARD CHAM8,9? 52'--- Qii Standard Chamber 48" (EFFECTIVE LENGTH) r 4 12' l i � oil main Vi SIDE VIEW SECTION VIEW MultiPort End Cap 12" I j FF 16• SIDE VIEW TOP VIEW FRONT VIEW w � _QuIck4St an a d Zhambo Norninal so Cific a tia WgL Muli I" ! ' Ca` I&C fllcatloflst� T d ' Size (W x L x H) .77 Size 'x "x Effective Length 48" Invert Height 8' or 1.25' Invert Height 8 11 F 1 N Ffi-T-�A"—R-$YSTE-M-SlRQ,-aTA-NPAELO 11MIMA—WA lt-j'ty 0­0",­w eild Plate, !Iy 411111 ('Uinti nnveri;als antl wprkmanship Ior one goy Iran the date that tl>a st'i.dk: ruarmd i9 Issued lu the sePlk: syslam uMdair.ng Ilxi Ururs; Provided, howover, teat it a septic permit is not rei by alaprCbla law, the warranty i wtN boyi upon!i date that jrjsjnllalki Of 11i Soi SYSIM 0011tiolOnCOS in e case its wa rarity i i "oust notify Infiltrator in viriti at its Corporate Heedtlooli in CIA Saybrook, Conriwjii cvjpjin fifteen (16, days of he alley eo dsfi Infiltatin, will supply iter wantent ands for Units oietoonvi by lni 10 be covered by Iho Limited tVai s wi Wei k!Kli the coltl of ieqi - .tndjor Insidliati j tilp, i "k (Lt THE LfVllrL WARi AND r�EW iE WZ; �UOPARAGR VI-4 (.�APF FX('j_i _�l Ii 0 ARE I,0(14ER WA.qRANTIFt; WITH RESPECT T O ' D 0 7 1 ONI T'i. INCLUDINC, NO IMPLIED WAR4ANTiES OF MERCHAN OP. H i 1',"i A F91FK;Ui PURPOSE SYSTE NC t) 11v'I"I'. led * ty snal be I any an o trio 'I'aa oar Lly )11y1no ni i Ink ralor, n* Ijn vitjorml does MS I rwr cIlin' J t­itli �.� lorlIi ; p a of trdirect damages. 1• 1h 4l i be, 01:w 1'. Pei oriiq rvAL�d q l of Environmental Omite Wastewater Solutions'" AUr" .11 at of .1111i 11 ­11 overhead coa!v, of other rossi �,, e D�-S 411,,,­ by in. Hddi n ' my In In 6 oody I— i 'War­i? cover uqe w."fai to live Uri doo tox. ahi anc; nw*ct of th,, U':I� ."q "'A miod to vehco;,ali or other 'Godii which are pernt,wd by tne,nulotIal 6 Business Park Road - RO, Box 7W 1111 LIM, �,' the ­i evst— due �o Inp,�opeir sdog of troprow size exci wale usage, inµaoPar irP gmase disposal, or ii ` rj ' h e ` ,r o paralk". or Old Saybrook, CT 06475 an ofter event not cii by infill i The Limited Warranty shi be v0d 0 it,@ Hoti rats 10 ci�irrroy Min ale of Ill$ lemns, set k LitrIled Warranty, 860-577-7000 • FAX 860-577-7001 Fi rt e In'In. evens st" Ii ayy oss or damage to 1; iii Hooter, the Unii or any t6rd pirrily resulting from irr c4 shp roar l or Ii at iy Product liatolriq oia,,n of Hades of any thud par For y. ll,,s Linideo Wai 4)1 to Ito Units most be metalled in tf000Ljori 00- -In 3T i ronditti 'i by late and (Xii rodi all outer a li ;Ind j 13 �, a lal oo ir%jfwIrjj, 8221 -4436 (d) 14 of i.4ji CaLl line Ji to chior, o o-Iond this hi Wai No warranty tiopos to my W rit o f j nat Holds I the nog, tl,o Sl Airy pure 13 t �f U ,,a,,n , ,`�, o., CNAULl Infifirati Gorporaj H in Oki Sayl"*, Coon i;, i 6 c �h pujolo n, In c i a espy G' 11 «s Api wof­ty and stow carefully read that *&ranly prior To the pacha. of u L, G. Patent,; 4,759.661: 5,01 7.04 1; 5,158,488 5,336,017; 5,40 1,116; 5 401,4,'9; 5,5 ;,903; 5.716,163; 5,563,778; 5.839,844 carfai Patents: 1,329,959' 2,004,564 Other pa pending, infiltrator ; , EqURfizi and SideWoncler are registered trademarks of :nlillralor Systems Err Infiltrator is a registered travlarnark n France. ioliltralor System Inc is a iegstered trademark in Klexico. QjIntoi Contour Saav t:onnbctlori MCI o"Gack ling, PolYluff, SnapLock, CharnberSpaoti Pos Quicki Qu4i RECYCLEOPAPER I Wisconsin Department of Commerce Division of Safety and Buildiny SOIL EVALUATION REPORT in accordance with co Page 1 / of3 Attach complete site plan on paper not less than 81/2 x 11 i as it include, but not limited to: vertical and horizontal reference an must Percent slope, scale or dimensions, north arrow, and location t d dlst) n �aies�tb anr and Please p all information. ^ r I.D. Personal inforrnation You provide may be used for seconds Date P secondary Purposes rivacwL�w�(� +� ., Owner `Ck co( on Property r Owner's Ma 'ngAddress Govt. Lot .6/t. 1/4 S Z N R I E (or) lW J I 1 e Lot # Block # Subd. or CSM# CRY p State Zip Cio:11e Phone Number w yd ❑ city ❑ village gown . Nearest oad New Co nstructiO Use: 43 Residential /Number of bedrooms C3 Replacement - Code derived design flow rate .r Public or commercial - Describe: t3Pt?` Parent material ❑ ) L k - .> -t S y` General comments Flood Plain elevation if applicable and recommendations: - 6 i'�" l' ( v' . 9 5-6 4k 7� - 33 o . '7 %O-A__) � - Boring # II Boring ED 1. � Pit Gro und surface elev. d& Depth to limiting factor a in. Horizon Depth Dominant Color / Redox De scription Texture S Std iwtion Rate In. Munsefl Qu. Sz. Cont. Color Structure Consistence Boundary Roots , GPD/fF Gr. Sz.:Sh. 'Eff#1 '011#2 Y,\s r- , c:S - 1, D WN ED Boring # a Bones 5 1 Pit Ground surface elev. 9 7 S i ft. Depth to limiting factor in. Horizon Depth Dominant Col Redox Description Texture in. Munsell Sop Rate Stnxxure Consistence Boundary Roots GPDy Qu. Sz. Cont. Color Gr. Sz. Sh. C> — f 0 3/ Z 'Eff#1 'Efl#2 YV\ 0 Effluent #1 = SOD > 30 < 220 Mg& and TSS >30 < 150 Name (Please Pr4rt)� - ^ '.E}tluent•#2 = SOD < 30 and T,SS 30 mgll, CST Number f 3 Z-11 Data Evaluation Conducted Telephone N 3 U_ �, So. 10 -2 (3 . 716 -c) z } c T� r Pa e Z of 3 Property Owner S Pa cel ID # � � 9 ❑ Boring # ° Boring (3 Pit Ground surface elev. , c ft. Depth to limiting factor __/ Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/fF in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •01#2 f�oI ZL 16 r DSc ► — ❑ Bo ring # Bonn ❑ pit Ground surface elev. ft. Depth to limiting factor 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 •Efr#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface slay. R Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF In. Munson Qu. Sz. Cont Color Gr. Sz. Sh. •EfI#1 •E Effluent #1 = BOD > 30 1 220 mg& and TSS >30 < 150 mg& • Effluent #2 = BOD < 30 mg/l. and TSS 130 mg& The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. seo43w QtAWi I r PAGEZOF� WA t>� LOW l LEGAL DESCRIPTION t ,/ '/ :/•,S T ,N,RI� E (or) W SCALE: I' BM 1 ELEVATION /DU BM I DESCRIPTION A4 o �` / � Q'%Q BM 2 ELEVATION I BM 2 DESCRIPTION 4v SYSTEM ELEVATION ALTERNATE ELEVATION CONTOUR ELEVATION i i .i �7 Z a �..- SIGNATURE 9 DATE ST CROIX COUNTY SEPTIC TANK MAMENANCE AGREEMENT AND OWNERSHIP CERTIFICATION NORM Owner/Buyer Mailing Address �e lit Property Address (Verification required from Planning Departnteat for new construction) City /State Parcel Identification Number L W P37ON Property Location %4, '/4, SOC. , T 2 f N -g, -W, Town of Subdivision . Lot # Certifled Survey Map # i . Volume Page # .tea Warranty Deed # A? . Volume . Page # e 7� Spec house O yes 19 no Lot lines identifiableA yes 11 no S YSTEM MA=NA.NCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance oowsists of pumping out the septic tank every three years or sooner, if needed by a Ucenaed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system no properly owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a aw torplumber, journeyman plumber, restricted plumber or a licensedpumper verifying that (1) the on -site wastewatetdisposai system Is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is lea than 113 Mil 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 DepsAnicnt of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained roust be completed and returned to the St. Croix County Zoning Office within 30 days of the �yejtgpiration date. SIGNATURE OF APPLICANT DAT 3 QMM C1:13TIFIGATIOhi . I (we) certify that all statements on this form arc true to the best of ray (our) latowltdge. I (we) am (are} the owners) of the property described abo , by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICAp'1' - - _. , DATE * * * * ** Any information that is mis- rcpresaaW may result in the sanitary permit being revoked by the Zoning Department. *w• *`* *• Include with this application: a stamped warranty deed from the Register of Deals office A copy of the certified survey map if reference is made in the warranty deed • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page Y ot FILE INFORMATION SYSTEM SPECIFICATIONS L wner 7 a � �. e.A-67' Y Septic Tank Capacity 40 © al ❑ NA rmit Septic Tank Manufacturer t ezre ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer A & ❑ NA Number of Bedrooms �? ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity Q al ❑ NA Estimated flow (average) _3cj gal /day Pump Tank Manufacturer s h y ❑ NA Design flow (peak), (Estimated x 1.5) �� � gal/day Pump Manufacturer ao4 Agw ❑ NA Soil Application Rate , ' gal/day /ft2 Pump Model O NA Standard Influent /Effluent Quality Monthly average' Pretreatment Unit A Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD :5220 mg /L ❑ NA O Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L 13 Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mglLNA ❑ At -Grade ou d Fecal Coliform (geometric mean) 510` cfu /i00m1 �� ❑ Drip -Line E03 Other: Maximum Effluent Particle Size Y. in dia. ❑ JNA Other: ❑ NA Other: ❑ 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) [3 NA sar(s) Pump out contents of tanks) When combined sludge and scum equals one -third iY of tank volume ❑ NA Inspect dispersal call(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 3 Wyear(sl) Clean effluent filter N6n e-6 At least once every: ead 1(s) E3 NA i Inspect pump, pump controls & alarm At least once every: ..._ 13 mom E3 yeart s) ) O NA ' ❑ months) ❑ NA Flush laterals and pressure test At least once every: -- ❑ ear(s) Other: At least once every: ❑ m ont h( s) 13 NA 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 iY 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 Fomponents, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. 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(s ?lead lesjad eD eyi of od Su oslp u jo set s! jennod uayM •sIaA01 jaleN+46!y lewjou enoge 11!; Aew siluei dwnd seBeino jennod 6uunQ eq 1tiM jeiEMe1SBM SSeaXe @ P 1 •aoe;jns OA1494111u) 94118 uezoj; sje suoll!puo 1los u94m inwo IOU Ile4s do vets w@l8AS •asn of joud jolejedo Bu!g!Aues eBeides a Aq p9AOwej (s))Iuel 9 41 1 0 819 suo lejiueouoo 4814 ;1 'ls3eieo lesj9ds!p a41 95ewep joipue sseaoid l 941 epedw! Aew ie4l siu0luoo 041 9Ae4 peld@I I e o esn o1 joud 'uolionjlsuod nneu J0:1 sleo!we4o j0410 jo sionpoid Bugu!ed 10 9du959 eu jO; {s!�ue3 iuewie0n �1d04d SiMOd 41 N011VH3d0 GNV do 1HV15 10 a8e� �� Z , P, X0432 1 STA E BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX CO., MI Document Number RECEIVED FOR RECORD This Deed between 08/24/2005 10:05A1i RICHARD 0. STOUT and JANET P. STOUT, WARRANTY DEED NARR husband and wife, EXEMPT # Grantor, !' and RQRF.RT M T.A NCASTER and NICCILE T-. GA BRIEL REC FEE: 11.00 TRANSFFEE: 169.20 COPY CC FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St'-- Croix County, State of Wisconsin: t Recording Area . _... .. Located inpart of the NE 1/4 of the NW 1/4 H Name and Return Address of Section 32, T29N, R18W, Town of Warren, St. Croix County, Wisconsin; more fully "Ja nC-* � described as: /�JjG� Attee 7/q Lot 1 of CSM recorded July 21, 2005, in ✓ ✓�I'Tu7II7 50� �l J /Sv Vol. 20, page 5024 of Certified Survey Maps as Document # 801051. � 042- 1089 -95 -000 { 042- 1090 -20 -000 ( Parcel Identification Number (PIN) I This homestead property. s (is not) �I j ii I �1 E i I � I Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record, including a joint driveway easement. i 1 Dated this 1 day of 1AA L&ST Z ©o 5 (SEAL) — � (SEAL) I, * Richard O. Stout * Janet P. Stout { (SEAL) (SEAL). << * * I AUTHENTICATION ACKNOWLEDGMENT Signature (s) State of Wisconsin, SS. Gl e1 k County. authenticated this day of Personally came before me this day of 066 the above named f Ri hard n_ Stn> it and TanptP S o i TITLE: MEMBER STATE BAR OF WISCONSIN to (If not, me known to be the person S - who executed the foregoing authorized by §706.06, Wis. Stats.) inst m t and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout p N1lgrnan 1 353 Awatukee Trail N otaryPub l ic avi,ut• Hudson, WI 54016 pf 19�n Notary Public, State of Wisconsin Sta t 8 My commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not P n -.f' -o 7 ) necessary.) * Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. (1 WARRANTY DEED FORM No. 2 - 1998 Milwaukee, Wis. 08/29/2005 M 9118 PAX 115 386 4687 ST CROIX Q0 REG OF DEEDS 200 21002 r T 4 1 6010Z3 I YQ 2O AGE 5024 KARfEEA H. AP REGISTER c 01BED5 CIERT' FI E SURVEY M RECEIVED FOR kCMlW LOCATED IN PART OF THE NE 1/4 OF THE NW 1/4 07/2L/2005 63: 43PK OF SECTION 32, T29N, Ri 9W, TOWN OF WARREN, CERTIFIED SURVEY MAP ST. CROIX COUNTY, WISCONSIN_ RUC FEEn 1 5.00 COPY FEE. 4.00 PAGES: 3 OWNER S'.URViYOR DICK STOUT EDWIN C FLANUM 1553 AWAIAJKF TRAIL NORTHLAND SURVEYING, INC. HUDSON, WI 54016 P.O. BOX 14 ROGERT'$.wl 54023 iLI1�[P�LQ41!'C�© �G'�JCi� NW- 3 i ss H 3Z 2;31.01' SEW52.46 -E N 1/4 CORNEA m 889 0 52'46 "E 477.95' sEC 'nON 32 E 7 0TH AVNUE RTH LINE OF "HE NW 1/4 � NBE 412.00' 3a av KW.L. - 977.50 X11 l �.•�" r �, N CY W W ... LOT 1 N Lei Q 2.00 ACRE$ 0 t Qi 87.31 f Sa FT. I ne a N.B.A. 1.4 AC, 979.50 NW22 365.34' 24.08' 1 3 e Z BENCHMARK 966.30 cv) DEDICATED TO J _ ( 'A ^ � YHE PUSLIC C3 1 r LOT 2 2!70 ACRES c w ti J 137,213 SO. FT, w L EGEND �' � `'-- ( N.H.A. - 1.T AC. O °❑) 1!r ALUMINUM COUNTY rY - i � Q ` W S SECTION CORNER • - 4 W Lu MONUMENT FOUND - •: _ _ _ -- � x & (21 z 2 3fW O.O. IRON PIPE • __ - 00 3 co FOUND , r 15116'O.D. IRON PIPE FOJND - _ --_ 341 IRON REBAR FOUND = _ - �� J i w r.oY s � 0 3W X 18' IRON RESAA 2.00 ACRES SET WrIrHING 1.50 LBS. 87235 30. Fr. PER LINEAR FOOT N.E.A. _ 1.5 AC- -: -' -_ 20% SLOPE L.Et,O. = 9B13.C4 - I QC1 GU.IILOING WTBAt;K IJW BENCHMARK A SOIL TEST -- - PLEV. - 1004ZB ' N y AC. NET BUILDABLE AREA C 1 INTERSTATE HIGHWAY — - 94" $ JOINT DRIVE EASEMENT i ^ 12' WIDE UTILITY F-ASCMBNT 1 S 114 CORNER PONCIING AREA TO N W.L � SECTION 32 ty 888. - j H.W.L. - HIGH WATER LINE 6LEVATIOIV L.B.O. LOW BUILDING OPENING SCALE IN FEET 1" — 100 TY14 W$TRI thirlhIT hQAGTwn oY 9Ahi AT9.w-i JOBNO,04 -113 CAT - OS SHEET 1 OF 3 SHEETS 100 o Vol 20 Page 5024