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HomeMy WebLinkAbout042-1057-20-426 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal Information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m]] TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SFTRAGK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Head to SOIL ABSORPTION SYSTEM BM Bottom BS BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer: Type Of System: Model Number: "Z T3 �.l1A�Y�r�\\IV•L�i�ti 11 Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe($) Length Dia Langth Dia Spacing Depth Over Depth Over ha Depth of roc Seeded/Sodded xx Mulched Bed/Trench Center BedRrench Edges Topsoil Yes D No �; Yes C No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Location: 620 106TH ST 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑w Yes ❑a No Use other side for additional information. Date InsepUor's Signature SBD-6710 (R.3/97) Inspection #2: Con. No. r RECBVED-_',CI � -3 ent of Safety V-LOLS-bU �a�y df Pro nap Services, r, fcoi c senit.ry Pa nit iNtwber (to be lulu in by co ) 8T. ��, Services Division _ . 'oases •�~ Communi Development 1 ,C (ij491101 Sanitary Permit Application sane Tt.aaaion Nv In aooadmoe wi16 SPS 38321(2), Wis. Aden Code. sebmialifn dtLia form so 6e apptoprirc povawmenW isroodradUnk Pam b a monY I Nola: AppMeadm 6m for etneowmd POWTS we aA=itted w 60 150PRtmunt of Swfwy and Ptotbrbwd 8avicec Peoronal mioronUM Project Adbae (if dlffesenr thaw mining addtcsa) you provide may be and for se000duy in aoeoalsom with the Law, s. 13 1)( Sfrs 82,0 /de Ell $r, Property Owe sNsme 0 + Lis.v /'Y Para s Property owwer's Mailer Address OY�-'/os7-.la-yr6 Property Loco;= r Govt. La City. sate LP Codeoe Phsws Nmmber LJX Syo/.! 1 Su ./" SE tv, SGCOM WO T P19 N A 8 'L TYPO of 30111109 (dA&k si 00 apply)V, Lots R( I or 2 Fsn* Dwelling - Nnmbs US.&. 6 h�tbai„ontt N.nte ❑ AtbbeCanameW - DearieUse Bloac s 0 City of O safe Owned - D"aft Use 0 Vinge of CSM Number W y_ e /SO �rj�x jQCC, Q g Zp $(Town of Xe,-Y lIL Yjpe of POM 8 (Ctafit Aber of to, 0er rneplweemmur frd odmr spp6ew mee M Ims A. Cbeek sns box an tine IL Campleh live C If A. New OR -II umSystem ❑ 06W Modifintim 1. F5[idiat 3�w (esPlse) ❑ Additiowsl Pteneatmenc Unit (apeiw) p ❑ Hol&g Tank br(haad ❑ AE4ede ❑ Mormd ❑ mairi8rl sre Dewpt ❑ 06er Type (eapktin) i Previous Perms Number and Daft bored C• ❑ Renewal Be<se Expiration ❑ Revision ❑ Cbente of Murnber ❑ Tmder In New IV. Dim alfrrambamt Ana Mad_ Duarte Pbvw (mod) Deatw Soil Appriession RWXWd" Ms Regabvd (sf) Dispenod (en Syx ra Elevabon 0 7 071 0 FAB 1?.7.1 Twit Info nsdon Totes for Mem&Ctmer Calkno In Now Tries 6cietaK To," dt�o>r Uwib v-S+ If;A-1vac �a QC Idk � s.gle ar ti.Ifiy.T,ak S8 s -SdS r l✓/ESEc �a.�c.c, r oe:.eca�ew 9So — so r La.r,6a �- 1. fYa eeNrflPelr wserc nrpanai■fy V. 6►howbeft scat Pow rs aMww N do a M&M plus, Plumber'sName ( ) Mumer's SMOLans MP/lYilt Number Baooes _ Pbom Number / �LCe ?3/3y6 /9 4C"7- s?4' P1ateer. Amer (sees, city, sme, zV Code) G ? 98 Sr. .? 3 RAAAW GIZ- Y73G a �•Bud M only Approved p - Permit Fae Dace hated Ateot Sitamae � for Dsisl Z Cooditiass 3) EM OWNER: S` r4A-t1. Septic tank, effluent filter and dlsperael cell ��,�' JDi"fit"" t(I must be serviced / maintained as `''� ; � be ri ryd/ rt , per management plan provided by plumber. ,y ` 2 `J P AN setback requirements must be maintained )( a wso r rr Sei>-639e (t. 03122) — /dG rL4 $ r. �a,yf LISR 111ANN-$aD ' , S,7/8 C 3Y.4 S� E, apt 4 jr of L.)RAAFN, 5 c.-q'7•�r yo � O p c Js� r5, ,.OL Ac.cE to f Ac c 5 /s 383. y3 slraA�Ks "' lytT ` � a lye 5` o ASS 5�950 Go.vho rAALX /u c 3 m. yo (y3 FeAeE �� fOd4 y sir. yo 6b PA09'« PA 61'"" 5,Ax. 14sE 0 134 Sul -- - 144.40 uE.rr LArs<l� Ao - SEcri" ) V " Sy L/,IArrdlAi x .?4.o fr1- /GSD,d>/d 8 f(i`rerA�� ryl�. AEQu/pro = 750 v .7= /a71 fry �f97.T� p 3 9717 y t , 3' F/tt� - The TO/ .r IAON ///f �E6Peedd 7Y� / J4l' 3 �/��/� ddSEcuA• /I/fs(3 36,�v 3� ScA. 9e 14,4,0 illlu (Jo SCALE/ A..2 7 S1p /o4 to 3r. -o n, 0 a 4< Page 1 of 2 Private Onsite Wastewater Treatment System Index and Title Page Project Name: Tan f 1 /SR exaw - S- b r I -a x&- a flaw 1-dais 6 Ew) Owner's Name: it it of Owner's Address: /9.J0 110,42-oA/t Sr /1AIV00, w. LJ I 5Y615* Legal Description: 5 !o S E+9.V' /8 Municipality. Town, Village, Civy of 4%,4AAC* County: 7 r. e t a"X Lot Number: /O Block Number: CSM Number: ? 7- (/SG Subdivision Name: 8,J ew & 5r Parcel I.D. Number: aY?-/a.s7-.to-y,T[ Page 1 Index and Title Page Page 2 Plot Plan with Cross -Section & Plan View Page 3 Septic Tank / Pump Chamber Cross -Section & Specifications Page 4 Pump Performance Curve Page 5 POWTS Owner's Manual & Management Plan Page 6 POWTS Owner's Manual & Management Plan Page 7 Filter Information Name of Designer _ TO E E License # �1P- .? 3 I3 yL Signature: 7 7-1 le Date: Desigo2d RWE.M no the ggNja POWTS CMggn= MamW and DSPS 381-385: "in-Siouad Soil Absorption Co=ponent Manual for POWTS" Version 2.1 (May 2022-2027) Attachment; Soil Evaluation Report n r7 s or t'il 7 erg ob •07s E � /, �F)s9/// •rnrssvo x/may rF 7/+/ r oV/ y. /�d o/ 199 Arv,la�a�97/ r° -A; p W/ ot6 - a7ld rNY ,c *'4 Lzb r � L rC ra 'h �t16 f L *1 r 1 1 T�r Y 776 ' 6 -N1s3a •r,rssr/ •rrw , rco/ =L' a `/ F'f sirs sue) 8dd41 eo'sR0/ - � o'vC x 9+'19A-'Yj17 �S / BS rr,tFMr/� srsyNYp7 4 v�rnb soJrrffyr'/ )tn 1 �b i �1% f,r7 fNn i , 1 1 Y �r� o96/s 8S/ oti'v�s y•!h� '1Pj/Mh t l ah ah fomy.1 9 tti'f8F f/S J °1 3r7V 9o'C 1 i ror� ,�� �r0/, !'rb -.73 S 'NfYr i1('i x,vr.7 1 f r �N6t ror'3r MS 6•Fc B/, y�/ d s r r 1 Mod Page 3 of 7 COMBINATION SEPTICIDOSE TANK CROSS-SECTION (DRAWING NOT TO SCALE) MANHOLE RISER & COVER FINAL GRADE (var sPS 38425M a (a). approved IS" n 11 •uMa •arf fmm macktoa derira. & awnkw later: roww ma twwa) fm PMPw &*k"w) mrada char a neca•aary.} 4' lab. Srh. 40 PVC Trek Vanl ELECTRICAL 6000W 1r abovo graftor 24' f JUNCTION BOXeb° Regmr.W Fko d EWabon BUILDING SEINERakdtTaborepradear2a'(per SPS 382.30(1 1)) ar Rapgnal Flood f7ava4on icomplr � SPS 316 MW NEC 3001 / I } FORCE MAIN OPTIONS >+e •ura+o.e .... rl Farr It . sorrow OF 0A.0 amarioa 3' Her Tr" HOW i I R&ET— H �'•'♦ � warm Fe: Y3 6 F-ro / c On F«~ t'RilTr!! APP rW EMa" FRNr a i a.• anar> " P�1ida Sa off Flnr R.w..e on Ouse A Br. ............ ............... -.. ..'. ` MINIMUM OF 3- OF SUITABLE BEDDING BENEATH TANK & MAXIMUM BURY DEPTH OF 96' Anchor" of tank may be requked per SPS 383.43(a)(g) Tank Manufacturer W1,rSE,4t_ �edtaErT Septic/Pump Size: ISO J'/9So (]allons Alarm Manufacturer. S T 4F IdAb.VAW5 Model Number: )r,#,jK AL Ea r / Switch Type: IfIEZNA.Iic, L Effluent Pump Manufacturer. ZQELLC.t Model Number. /sl Minimum Discharge Rate: d-T GPM vertical lift (pump off to lateral invert) ............ (� It System head (distal pressure x 1.3 ft): — ft YS ft Force main x _Z_L_ll00 friction factor .7 ft Filter frlctlonloss...................................... — tt Daily Wastewater Flow (DWF): 7S0 GPD Number of daily doses: 53 i / 9 7.\ Force main volume: -yS ft x . /,e3 gen = 7.3 gal Actual dose volume: /SO gal - " gal = /YZ 7 gal (total dose volume - volume of force main) DOSE TANK CAPACITIES: Reserve above alarm A2 in = S.fd gal (D) Alarm float above on float _ ; in = SO gal (C) On/Off float measurement. wl_ in = /Sd gal (B) Off above tank bottom S in =. *?00 gal (A) Total Dynamic Hamad (TDH): 61.3 ft Outlet height 38 in M VVKRh /O/ in Gallon/inch 473.O PUMP PERFORMANCE MODEL MEMO MEN ��800 ON ©�RE■■■■■� s�\` NONE MMEM ■\ NOON NNE NKAMW ■MMEME�0 e ie a m tie m 20 mo yn reo RM111 r1a1rtE 0145.M CONSULT FACTORY FOP SPECIAL APPLICATIONS Timed dome wnels avaiehle. • F_IeCtriCal alkenl*m, for duplex systems, are available and suppled with an alarm. • Variable level control switches are available for writrolkng single phase systems. • Double piggybadt variable level that switches are available for variable level king and short cycle controls. • Sealed Qwik-Box available for outdoor instalatiom See FM1420. • Over 130'F (540C) special quotation required. 1S1fIS>r19 I No" V►bA6 I �+ e Co as 2dwo tt I N/61 BN151 115 t IIS 1 _Non Atb by _ 1 as I hdatd 2a3 E151 2]e t Now 3] 32 - 1 203 BE151 no t Alb 1 bwbW 203 Nte2 115 t Nm e5 t 2a3 tt5 I Atb a5 ktvtaei El E1 _ t Akin N 1 a BE152 230 t —A M 43 bdrii 2/r3 1 Ilan 1 f a GN153 115 1 Ab taS fMritdm 2ar3 E153 230 1 Nm 1 0 1 2a3 OUR 230 --Lj—A9t-j &3 1 bdded 1 2or3 1. SkO Oggybadc vandb bMpJ loaf srerh or dmt k pipgybadc variable level float elrlldl. Rdw b FW4T7. 2. See FWA712 for coned modal of Ebilrical ANerreor E-Pak. 3. Venable lever coned switch 10-0743 used as a control acwaor, specary duplex (3) or (4) Ilml system. I to^,r ' .,. n: ':.1 •, ,; al .mil sal I c�ko she^,NI br fnN.� w.+' uich.dnry +r �. ...�' �AI'� .411 a�u �.0 .Ir.. �•1.,..i .•4rf.,Y Vlu �I�.4,i TOTAL DYNAMIC HEADIFLOW PER MINUTE EFFLUENT AND DEWATERING �0000©0' 00o0©D0 'omssoo■oo omiss■�ii�i© ® ss � OILI Model 151 !- ►m 1 I - Sae t 57M I j I i .,4ie1. Models 1521153 i .Easy may. (w�a a ii . 6,10 nlr Yldsirdl r� Reduces potential clogging by debris. Replaces rocks or bride under the purnp. Made of durable, noncorrosive ABS. Raises poop 2' off bottom of basin. Provides the ability to raise intake by adding sections of 1'/,- or 2' PVC piping Altedkas securely to pump. Ws yryAc�carmrodatessump. d wateriingg�an�dJe Effluent applications. NO.G. UM M "V a" as fr w has trWMVn. F�F�Ff?'.rr »•,�,f.-.,ram >•,.-..,. For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 0 CoPyTight 2006 Zoollor Co All nghto r000rvod. Page S of 7 POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION dM Permit # rNMU_N aAnlraa•rsna Number of Bedrooms Number of Commercial Units Estimated flow (Ave) (100 ) - O gpd Design flow (DWF) — estimated x 1.5 7Sa sod Soil Application Rates .7 htfluent/Effiuem Quality (0 NA) Movably Averap Foos. Oil & Omar (F)G) < 30 mg/L Biochemical Oxygen Demand (BOC s) < 220 mWL Total Suspended Sob& (fSS) < ISO mg/L Preu'ated Effluent Quality (M NA) Monft Average Biochesniai Oxygen Demand (BODs) <_ 30 mg/L Total Suspended So" (M) < 30 Feat Colifo m (geometric main) < 10 cfW100ML Meuimnm Effluent Particle Sim I lg inch diameter SYSTEM SPECINCATIONS Septic Tank Capacity 159-IrNAJ Septic TankMmufexnrer /£34L O JeA- 13NAJ Effiueat Filter Mamt6cburer E S 1' 0 NAJ Effluent Filter Model D N Pump Tank CApecitySol O N Pump Tank Marmthctnrer W /ESEs. CA. O N PUMP MmEficom 2ositiCA ON Fump MOB S/ 0 N Pretreatment Unit (3 NA) O Swd/Qravel Filter 0 Mechanical Aatadoc ❑ Disinfection Maanfacpuer: O Peatmer 0 Wetland ❑ Other. Mom: Soil Absorption Component (❑ NA) 0 h"round (gravity) O In pvtod(prossuui=d) 0 At -grade ❑ Mound 0 O Other. Vertical Distance TaokBotlomteServicePad: Horizeotal Distance T&W As)joserviaopa& R g &O=Pwaat Uan MrgJMadtl NUttaba . ZAVIL re.f r6A 42ulex -Y 0 NA Soil Dispersal End Cap (Disperpl Unit EISA) p�ARWJG9=J&= — Area RwuhW- Ej$e + or Mmeb Width) # Units or Total lAngtb of Tronch(s) 7$0 7 — /d71 - CJ.3 .�O.O Sy GNAnldss DRSiGN CRrMRIA / 9.B Frr ❑ "At -Grade Component Mewl forPOIWIS' (Pressure or Gravity. Version 3.0 (May 2022-2027) "Dnigv O of Preseae Distribution Networks for Septic Tank-W Absorption Systems." Publics iart 0 "FZ Flow Mound Cotinponent Matwl" Version W13/2017 (April 2019-2023) 9.6 (WWMP Mwtal) 0 "W*Grouud Soil Absorption Compcneet Manual for POWTS" Votsion 2.1 (May 2022-2027) O Mound Component Manual for POWTS" Version 2.1 (May 2022-2M7) ❑ "Pressure Distributmo Compooeut Manual for POWTS.- Version 2.1 (okay 2022-2027) O Other. MAINTENANCE MONITORING SCHEDUEZ - MAINTENANCE AND MANAGEMENT Service Event Service f drw fiber 1 es At least on13 months ®3 (3Other: nett Flushedpressure vest hxeais At leaf coos . ❑ months 9 3 ❑ NA At bast onus Way❑ momhs 0 3 Years CFNA vaoaa err ..M WIL" ll ■w; Pot new OeOrh'tlCbOp, poor to wing the POWTS aback treatment prodtwM or other chemicals tl o may sfor the presence Of painting y impede the treatmetn process .nd/ar dawge the dnpetsd cell(s). if high gh concentrations We detected have the contents of the tank(:) removed by a septagv servicorg operator prior to use. Systtastart" dMH noteeear wbea No "Mdkb= are ftWaa at the Infiltrative surfim The ProPCFtY owner is r=Wntstble for the operation and mainf opt of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the pmfc matoe and Ieagevity of your POWTS. The installation of water -saving applienoes and fixtures along with Prompt re:Pmr of lake reduces the wastewater vohane. Also the brine or waste from water wftenoM iron removal units, otbinclaudcleear launwalesdwaaVextment devices and foundation drams should be dbchw ed b the ground surface whenever Poeible. Nola: this does not ry ste, sbowen, dishwatcr, etc. This system is designed to handle domestic strength wastewater; however, the dispoeal of food based coeds, bones, and food Solids, such as those Produced by a garbage disposal should minimized Toilet tissue use onlgpaper that Peels, be discharged into the Sysbm. Other ten Y PaPa the abound biodegradable item such a baby gripes, tarr>Pons, aninsy napkins ooadorns, rigareme outer, dental floes and cotton swabs, aboetld not enter the tyatem. Chemicals, such as peholoum product&. Pact, disinfectants, pest►cider. antibiotics.solvents. arc.,shwild not befiushedmtothesystem beraretheywnseriouslydamageyourPOWTSwdcoutsmiriaesu I Ong wr=m enPP1Y• Maintain a regnLr steady flow by spreading kundry washing ilm 4hout the week. Avoid vehicle traffic over all system cotitpoaenta. Compsotioa ofsnow over the dispenud unit may cause it to Rion up. disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and eontamroate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. INSPECTIONS & MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and check for any backup or ponding of effluent to the ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings greater than R inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks. When the combination of sludge and scum in any tank exceeds one-third (1/3) 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 NRI 13, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Solids washed from the filter shall be retained in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. ABANDONMENT: When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. SPS 383.33, Wisconsin Administrative Code. - All Piping to tanks and pits shall be disconnected and the abandoned pipe openings scaled- - 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 other 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: IQ 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 render it unusable. Replacement systems must comply with the Hiles in effect at the time of replacement. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Baring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 CONTIAN 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 MAINTAllVER Name J'd#A' ELKS r!P-1311 ve Name Wilef llwoYA144 Phone /.S 6 70 - SV4 Phone i/S C7?- S.i L L SEPTAGE SERVICING OPERATOR m LOCAL REGULATORY AUTHORITY Name I Agency Sr. L.10/r LONAiYdjrr OFrFt✓xadY Phone Phone %/S 31 d - PV 06 Pavc d of % cInstallation Instructions for the GF10 Filter Stop 1: locate and remove the septic tank cover. on the outlet side of tank M"4: Glue the fitter case onto the outlet pipe. Insert the fiber cartridge Into the case. (Make sure the fitter Is completely Inserted Into the case.) ate-__" Sap 1: Before installation. place the fitter case on to the outlet pipe. Make sure the case is positioned so the filter an be removed from the tank for mainte- nance and service 91 Stop 3: For Installations that require or desire additional support (if additional support Is not needed, go to Stop 4) Glue a section of 1' Sch. 40 pipe to the two hubs looted on the bottom of the case and the hub looted on the side of the use. 0 t I Step S: For installation where It will be difficult to reach the handle, place 1' Schedule 40 pipe Into the tee on the handle and extend It to Might that will make It easy to remove the filter. Installation of an Sense aaanew system onlytMsopNctank i existing system. must be pumped pdortoInstallation. 011111 1111111 — — — — — — 11111 1111111 1111111 — — — — — six — — — ei Maintenance of the GF10 Filter A time frame In which K"k tanks are serviced is set by state and local codes. Although they may be ddlerent. most regulatory agenckn suggest two to five yeas. We recommend the GF10 filter be cleaned when the septic tank Is normally cleaned and pumped, or as needed. WARNING: If the liquid level in the tank is above the top of the filter, pump the tank prior to removing the filter cartridge. Mai SGaIMNNW aaaaaaaa-t OCAUTION: USE RUBBER GLOVES WHEN HANDLING FILTERS! Step 1: Remove i necessary tank cover and pump the tanknk Nnecessary to prevent any solids from escaping to the 6.1,1 ..a.... 4.. Run. 1. ..,.A e Step 2 Pull the filter Stop 3: While holding the Step 4: Insert the cartridge handle and slide the filter filter cartridge over the back into the case makasg Out of the case. access opening of the tank sure that it is property rinsethe cartridge off with aligned and console" freshwater. Take care to Insertedlntothecase. make sure all solid material falls back into the tank BEST TIKNNOWGY 3 Falrfie d Blvd. WslknpMrd, Cr 06492 t-M-7M4a6B6 Fax:203-n44S14 �,w,•a 2°`X .-Wpm" mal ON mmmmml� MME�D MAIN LEVEL FLOOR PLAN 11 UU 11 3opxll ST. CKo UNTY SANITARY SYSTEM File*: Office Use Only OWNERSHIP/ADDRESS FORM cremed2/202r Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Thomas Or Lisa Mann Mailing Address 1320 Marjorie ST City/State/Zip Hammond, WI 54015 Phone Number (required)920-629-0592 Email Address (required)Immann Q@hotmaii.Com Parcel Identification Number 042-1057-20-426 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location SW '/4 , SE 1/4 , Sec. 20 , T 29 N R 18 W, Town of Warred Subdivision Plat: , Lot At 1 0. 6150-CSM 27-6150 042-2015 101 t2 Certified Survey Map # Volume Page Warranty Deed # 1157812- (before 2006)Volume Number of bedrooms 5 Spec house 0 yes ■ no Lot lines identifiable 0 yes 0 no New Property Address &t'aff Initials) OFFICE USE ONLY (Verification of new address required from Community �3 (Date) �� Department for new construction.) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and o copy of the certified survey map if reference is mode in the worronry deed. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center cddPsccwi.gov 1101 Carmichael Road, Hudson, WI 54016 71S-245-4250 Fax V.,i', .,2;; uNOFFICiAL COPY Document Number State Bar of Wisconsin Form 2-2003 WARRANTY DEED Document Name THIS DEED, made between Stave Dalton ("Grantor," whether one. or more), and Thomas Mann and Liss Mann husband and wife ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): That part of the SW114 SEI/4 of See. 20-T29N-RI8W, Town of Warren, St. Croix County, Wisconsin, described as follows: Lot 10 of Certified Survey Map recorded In Vol. 27 of CertMed Survey Maps, Page 6150 as Doc. No 1018128. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated 1157892 OETH PAB.ST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 08/25/2022 09.02 AM EXEMPT#}: REC FEE 30.00 TRANS FEE 360.00 PAGES: 1 **The above recording Information verifies that this document has been electronically recorded & returned to the submitter Recording Area Name and Return Address Attorney Kristine Ogland 304 Locust Street Hudson, WI 54016 042-1"7-2w24 Parcel Identification Number(PIN) This Is not homestead property. (is) (is not) (SEAL) ,% P OJT (SEAL) * 'Steve Dalton (SEAL) (SEAL) r r AUTHENTICATION Signatures) teve to authenticated on *KrI tins Oviand TITLE: MEMBER ST E BAR OF WISCONSIN (If not. authorized by Wis. Stet. § 706.06) THIS INSTRUMENT DRAFTED BY: Attorney Kriissthta Oaland Hudso0 WI54016 ACKNOWLEDGMENT STATE OF _ ) ss. COUNTY ) Personally came before me on the above -named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. Notary Public, State of My Commission (is permanent) (expires: 1 (Signatores may be antaenticated or acknowledged. Both are not necessary.) NOTE: THIS 18 A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY HIENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO.2-2003 • Type name below signature. INFOPRO- LWW Forms 100.655-2021 www.lydaproresrns.com St. Groin County 1157892 Pape 1 of 1 \- \p ar v 1Lo IWI14 31.I/4 Swiee 11p OMIRER ,It VI IIAIMN WliI IN+AVF IMNVF SURVEYOR FI ?MN 1' I AM IPA M41114ANO 7J4M YING. INI I, (I INA M• AAN IIY M `NIMII c s su .� LOT 10r- M Zo" lot ww 1T �i' w ul s SZt �\ r�Q WLLNV! bpi 9 Z'Z f143.L)()'-- LEGEND RI I'rV MA fI M MJ I Y '4 1I M IN fl MC4 1 1`f I'a1M M4 VF I11KIIN4I11111 !;IM �i 14 """"I NK IN11N1- Nil I I A'. M It' (I 1 f [! [IIf 11NM1171RAJ I:J IINN:IAM ' ifT�/_1M I"IIiG. 11 NI MN N+I(M 11 � 1 1 � r111)tip M11117 fIMM111 ` S'4' 1 N In"riW111 M R 111 nI� �1) SIM IN MNM wti ';} 1.1 ^.I f' iYl GI/411(Ml SFI'. TI N I IM AN IN 11) io J AMM IN I Is�' .IMIIIIIIM 1N IIM `q-Ip.faC :ll 49 NiN1'IIMOM 44111)P I MW-Ilrfl'1 'lfMi47 l IMAI M ►EEY r iir 114!,IN':IMMIFNI I MW IFI1 InY I lMIN41 IAM 1J 1 ww m '- I M 44MI I -,IV IWMI r.:a IIAIF I, IN IN tip 0 iH '4411119' AIIT 1.1: 4 CERTIFIED SURVEY MAP i ifJl 'I di �I 1 � I •V•i11;� NpZJ77rt M2 M : • "'� n LOT 13 IIWNFIi � T y^ - •�•! 1 = SI1M1011 �J LOT 12 600 LOT 11 �` / F•11 ' 14A. su �� ,••!••!l1111111.1• If UI,T 1 I f (_A Nit \ ,or • ti "L wNFwFffI 129 1� CERTIFIED SURVEY MAP LOCATED IN PART OF THE SW1/4 OF THE SE1/4 AND PART OF THE NW1/4 OF THE SE1/4 OF SECTION 20, T29N, R18W, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN. UNPLATTED LANDS N89'2M"E 452.9C — LOT 13- 2.00 Acres 87.213 Sq. Ft. Cz Z s Iy LOT 12 Acres 2.00 ly 87.326 Sq. FI. I Q N hR 4154.90 LOT 11 2.01 Acres O 87,393 Sq. Ft � O 1018128 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 09/04/2015 4:10 PM EXEMPT *: REC FEE: 30.00 COPY FEE: 3.00 PAGES: 2 Ir �� ly_ i� ao W14 4•SE1 S WI1V.—SE„4 I� OWNER STEVE DALTON — 930 BRAVE DRIVE SOMERSET, VA 54025 jr- SURVEYOR I� IC) EOWN C FLANUM 1p IN NORTHLAND SURVEYING, INC. IS3 P 0. BOX 152 1% AMERY.M 54001 IGO _ L� I4. 1 1 Ir 1 J 1� Im 1 Im Irn L = VA is su _ t or to o � 2. es 4 �.°,t ` 89.613 Sq. F1. \ \ _ ,,e.W 5213T ,33.3z swv LOT 9 - : j1011582 Z` v'jjpj6143,_ N 2i O LEGEND \ \ \ 8MU w Z ST. CROIX COUNTY SECTION CORNER \ \ POSITION VERIFIED WfTH TIES OF RECORD OR MONUMENTED AS NOTED `1 X4' X 18' IRON RERAN SET WEIGHING 1.50 LBS. PER LINEAR FOOT t' O.D. IRON PIPE FOUND 314' IRON REBAR FOUND SV4 CDR. SEC 20 (g) SOIL BORINGS SE COR. SEC 20 ALUM, MON. FO ALUM. MON. FD. L JA SOUTH UNE OF THE SE114, SEC. 20 NW— Ioih'E 48.07' / / N89.10 m 2106.42' — THIS INSTRUMENT DRAFTED BY EDWIN FLANLMI JOB NO 15-02 DWG - CSM DATE 5-19.15 SCALE IN FEET 1' = 120' 120 0 120 SHEET 1 OF 2 SHEETS St Croix County 1018128 Page 1 of 2 Vol. 27 Page 6150 REG_:'.'::D Y SEH 03 't015 Wis. Dept of Saferyand Profe sore l e,,,, eW SOIL EVALUATION REPORT Page of j Division of Safey.anmiX .Uf TY L4WMUNI DLb_L.WhfiffMncewith SPS385 Wis. Adm. Code County I Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must S / X include, but not limited to: vertical and horzontal reference point (BM). direction and Parcel .D percent slope, scale or dimensions, north arrow, and location and distance to nearest road — Please print all information. Re wed by Date Personal informabon you provide may be used for secondary purposes (Privacy law. s. 15.W (1) (m)). �� 1✓ Property Owner Property Location fw J o 5-"r v •[/ r PO AJ Govt. Lot AJ --- 1i3 of lit G p T N R E,or) W Property Owner's Mailin Address Lqt,#� Block # Sutd. or CSM# 930 A-..vG 'DR-- `7�, I I z7- W56 3C State Zp Code Phone Numoer ❑ City ❑ Village Town Nearest Road a`i►+n,c.St wl 5Yu.1. ? r 1 1 10kJ.1 A. A-t i.l 0/elb r. 3`f I& New Construction Use: ® Residential ! Nurnw of tearooms 3 - s{ Code derived desgn flow rate s/J D - (0 0 0 GPD ❑ Replacement ❑ Puu,ic or convnerctal . De ,te. Parent material F:Ocd Plain elevation if applicable ft General comments and recommendations: S. S fF„�, tj /c r. • g L . ❑ Boring; / Bcr rig # Ground 7 • -7 3. Depth to hmdmg !otter 7 // � :n. p,; surface elev. Sod.l:clicancn Rate Horizon Depth Dominant Odor Redox Descnption Texture Structure onsisterce Bcundary Rocts GPD it in. Munsell Cu. Sz Cont. Color Gr. Sz. Sh. ❑ Boring " i"s f ❑ Baring # V (3� ® p,; Ground suAace elev. / 7• R. Depth ;o limiting !actor Horizon Depth in. Donunan; Color Munsell Redox Descrption Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsisterce eundary Rocs GPD R 1 T oft j'3 - �. c I r6 r yG r� s 1 ✓ . Z- I 3 f SJ - o`fZY/b - S os: -.„ ! c,.. - •? 1 • Z- tnRrenl X1 - BVU • ) 30 1 ZZU mgrl and WY6 -> J < ' oU r-4 L - tmuenc a[ = ovu ] au Hx end i oa _ V - CST Na Print) 1Z S gnature CST NLmcer QC. 01 i c'.. wfJ 7Z— Addres Oslo Evaluation Gcnductad Telephore NLntoer Fv k.e/e 1.,.• H" �3 Z9-/s r/. -; Property Owner 2) v I i d Parcel ID # Page ., of 3 3 # u�ng �— Bourg � pit Ground surface elev. it. Depth to limiting factor `fin Shc Apaiication Rate Horizon Depth n. Dominant Color Munsell olti f1 Redox Description Qu. Sz. Cont. Color _ Texture S /C Structure Gr. Sz Sh. PC onsistence eundary Roots GPO,B P'1 #2 1 z� 3 6orng �!+ ❑ Boring # p t Ground surface elev ft. Depth to limiting `actor n Sed A^Ulcaticn Rage ! Hcnzor. Death in. Dominant Color Munsell Recox Desorption Qu, Sz. Cont. Color Texture S'aucture Gr. Sz. Sh. onsJsterce cundar, Rce:s GrC `I If 2 U Bonng Boring # Ground surface elev. ft Depth to limiting factor n. pit Sod AppIICaLcn Rate i Horizon Depth in. Dominant Color Munsell Reoox Descrpnon Cu. Sz. Cont. Color Texture Structure Gr, Sz. Sn. enslsterce unary Roots GFC ft R#2 ' Effluent #1 -SOD , > 30 < 220 me L and TSS >30 < ' 50 rig L - Effluent .c = BCD , < 30 mgL and -SS <_ 3C mS L The Dept. of Satan and Professional Sercires is an equal opporuntty sari ice prodder and emplo er. If you need assistance to access sort ices or need material in an alternate formal. contact the department at 603- 00-i I' l or TTY through Relay. SYMJJUAII 1U N •v vJ 00 / ' ^',,.? 3 svl �woS s IM . r✓ v,�, � N Q � � 3 f-S R (YWP&k"M) 5CCV61-XCOUNTY STA OWNEF j E ni0. 648404 SANIT�ARY PERMIT Rro yob sY) PREVIOY� NO, PLUMBERSW-?.ft".LIC,#,-2%1 NO TOWN OF SEC _'�,T��NR IS AND/OR LOT BLOCK 2*00 • 1 SUBDIVISION CHAPTER 145.13f(2) WISCONSIN STATUTES (a) The purpose of the sanitary permit Is to allow Installation of the private sewage system described in the permit (b) The approval of the sanitary permit is based on regulations In force on the date of approval (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal Is sought, and that changed regulations may impede renewal (f) The sanitary permit Is transferable. History: 1977 c. 168; 1979 G 34,221; 1981 c. 314 Note: if you wish to renew th!permit, or transfer ownership of the permit, please contact the county authority. PVM&%. AjTt1O ZED ISSUING OFFICER - DATE' ! 3 EXPIRES J.UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11/20)