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HomeMy WebLinkAbout012-1044-20-000Wisconsin 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)]. Permit Holder's Name: City Village X Township Bertelsen, Chris Erin Prairie, Town of CST BM Elev: Insp. BM Elev: BM Description: 00 , o' 6v.o ' CST ~~~ i ^ y~ ~ s~ . TANK I FORMATION EL NATION D A TYPE ~ JVIANUFAC ~vRUE~ c~~ ACITY Septic W t E7~~Q._ ~ffo b 5~ Dosing CBwI,~ u Aeration o Ing I~ TANK SETBACK INFORMATION en o it na e epic ~ ~ 1 ~~~' I ~~•~ osm9 u k u 2. 1 era Ion o Ing PUMP/SIPHON INFORMATION anu ac urer eman Ba,~L,~s GPM `t. o e um er Pot [ '7 GOS~ i I ric Ion oss ys em ea N S.o ~ .3`f -- ~• 3 em i f ia. « qo Z County: St. CrOiX Sanitary Permit No: 488177 0 State Plan ID No: Parcel Tax No: 012-1044-20-000 SectioNTown/Range/Map No: 19.30.17.290A STATION BS HI FS ELEV. Benchmark ~Ja I~• ~ ~ ~. ~J Alt. BM Bldg. Se"we~r •~ ~ .-ki edr l N• IS'sp ~ 9~ A6.33~ 1 t net t t ut e t net 0 om C~ ea er an. ~ • q•~ ~~• ~ , Is . Ipe o. ysem ina ra a 'DSO ~8•.2-S ~ over ~. ~ ~~I.O"' JVIL ALS~VKr' I IVIV J T J 1 GIYI S~( .L...~F•n 5/ DIM NS ~ 1 ?®~ r ~ ~ ~ ~ `~~ INFORMATION ~" LII CHAMBER OR ~ ~• l'~ro~l ~."' I aQQ, Z~ `i"~/ ~ (~ i ~ UNIT ?,Zv..2t,~. u Pipes Length~~= Dia ~~, Length Dia Spacing ... S~ x Pressure Svstems Only xx Mound Or At-Grade Systems Only Bed/Trench Center Bed/Trench Edges Topsoil Yes No .~ i Yes No - GoMMEN 15: (Include code discrepencies, persons present, etc.) Inspection ~ I:~~l. f~~ vv,~ ~~~~N~~•~~~~ ~~• Location: 1521 County Road G Ne~w_R~i~ch~mQo~nd, WI 54017 (NW 1/4 NW 1/4 19 T30N R17W) NA Lot 1 Parcel No: 19.30.17.290A 1.) Alt BM Description = $.T• ~~'^""' "~ ~~'~ Cb'^ ~e_.u'Se~ ' ~• ' ~~ ~ 6 `` .~ ~~. 2.) Bldg sewer length = t•q ~S' ~ 5 ~• , -amount of cover = n S ` I Cdr. • ' 9S - ~b '3s 3~ ~.VII~+•~.- ~~~ s sL~;,-. ~ ~.pac _ ~ r t S• = `t ~ . is , _ _____ ~ 9S~`i3 __ _ -- -- Plan Ision R uire .Yes No • ~ ? I Use other side for additionalCCCCCCiJJJJJJnformation. ~~,., ~ ~~~b Uj~~xC~•4S ~_ _ i tae - C-e . No. SBD-6710 (R.3/97) l ~ 5ast:[ ana is tdiri • gs Coun ~~~~~~ W, Washingto Ave., P:O. Box 7162 .SAC yv ~~~ MadiSan., 53?07 - 7I ki? Sanita Permft Nur ber (to be filled it by Co.) peQartment of Comme (6ff8} 6-31MAY 1 ~ 7.00 ~ ~ ~ ~ Sanit ~ r 't pplicati scale ar, l.la. Number --------- ST. CROIX COON In aecord with Comm 83.21, Wis. Adm. Cude, persona! informati you provide may be used for secondary purposes Privacy Law, s 15,44( m Froject Address (if different than mailing address) I. Application Information - Pltsase Print All Information Sa~'~- ~. ~-~ ~I Se n ' ~-~ r A ~ -~~y ~~~~ Property Owner s Mailing Address . _. Property Locaticn rs~~ ~~ City' State Zip Code ~( Phone Ntvnber ~'"~ -• ii+, ~~%, Section ~l y ~~Q, // ~~1,~...~i~'~r+-0,d11` ~/~' -~yd/~_ f~7~.5~YG°~D~~ 11. 'Type of Building (check aH drat apply) -- tcircleo T - 3~ ~; R,~_~6 0 ~1 or 2 Fantiiy 17w•eliine - 1'vumber ofHedrooms ~ 5ubdivisio 'erne - ^ Public/Cornmercial -Describe I;Jse "'"'-`"'~~'_~____ •/3 ~7 ~ ~ ~ 6~ Z ~"~ State Owned - Describe Use ~~ _~.r ity_I'Village~Tow>asitip of~•,v~~~~ til, Type of Permit: (Check only one box on Eitte A. Complete line B if appNcable} p i ~;vew• System ~Re iacem t S t Q ' • , p un ys em TreatmerttlHolBing rsnk Replacement Unly !~ Other Moditication to Existing Systerr. B• i~ Perncit kencwal Before Expiration ^ Permit Revision ' d Chan a of $ Plumber 'i L ?ermit Transfer to New Ow List Pt'evious Permix 1Jurnlx~r ar.1 Data tssued~~• iV 'r '.~..-..rn~urrn ~_ .~.. -- - ner Non -Pressurized In•Ground ^ Mouno ~ 24 in- of suitable soil a Mound < 24 in, of suitable soil Q At-Dade ^ Sinele Pass Sand Pilter l ; !' Consttucrod Wetland Q Pressurized In-Ground r1 fiotding ; ank ^ Peat fritter ^ Aerobic Treatment Linn C Recirculating Sand Fi?ter [; Recirculating Synthehc Media Filter Leachin Chamber I] Dn Lin ^ eve! •iess Pi ^ Uther ex lain) V.1)is eraaUTreatment Area Information; C yy~ ~~ D~Sign Flow (gpd) Iksign Soil Application Rate(gpds~ 'Disperse Arse Req rred (sF) Qispersel Area Pro !~ Elevatio~R i f) d ~ t5~(> !~ ~ S _ lr `f`~ 3 ~ ;dam ~ aJ c~.d~ VI. Tank Info Capacity in Total Num~r Manufacturer refab Srte Stex( Fiber Galians Gallons t of iJni / ~ Piasttc b' 1 ~p-~ ~ `f ~ ncrete Constntcted Glass New g ' ~ ~~ Tatdcs Ta Septic or Holding Tank Gd~ Aarobr ~c ~i i~~nit '~ ~S~ ~ ~1 1 i VII.12esponsibilityStetement- 4 the ut+dersigned, assume responsibRity for Plumber's Namc (Print) Plum/ber's Signature het 5~lz:.~wy Gs~ " , ~ _. Plumber s Address (StrNet, City, Stele, Zip Code) of the PdWTS shown on the attached J~ Approved [~ Disa Sanitary Permit Fee Wrrciudes L'7roundwater Date issued Issuing Agent Sigratur t`Na Stamps) Surcharge Fee) `,lH(T(.," la Own ven Reason for ia! w( ' ~ ~j6 I.X. Conditions Apr val vat SYSTEM 3)C-k:S ~M~~~,~ 1 Septic tank, i~ffluent filter and ~~ ~ °~K- -""- "'°` °i~J ~ ; dispersal cell must all be servict~~ ~ ~ ~ as per management plan provided by piur~~er. '-- ~,~, ~ ~ •~ i 2. All setback requirements must be maintt€~in9ct 'C) ~ ~~-. ~ ' Q ~-- ,,~„~ ~ ~y_ _'1`"`~V ` , as per applicable code/ordinanc$s / `P, ==--= -1--- - ~f AMaelt tnapkte plane (to the County oily) for the system on papa nornirsa than{~atlL x t i Inches in lira SLiTa-b3~8 (R, 01/0:3) a.~ w~.l~SSw~e ~a.wt S®i_QS I-{~ ~ o, p.c.~~~d1/`t'I z ~ea~1-•~t9, .~.o~.~ ~ s~s~,, oQes~~y . ~~ R C~ ~~ 6j w ,~ ~~~ ~~~ ~~ v~ ~~ d ~ ~ ~. 11 ~• I' ~~Q J Z ~~~ U~~S~ ~,p,,,- ~~~L` ` ,' Y~ , - -----~- ~~ ~~ ~v~~ ~` ~~ ~ ~~ \ N d eo .~~" ~, Cd~Y ~'S ,f~ e v 9"e ls''~ Go ~?~ ~ ._ 0 ~~a[~ ` ,; ys , -T T~ 9j ti ~° ,~ ~~~ ~~ v~ d ~~, M '~ CI~ ~~~~ ~' ~~ ~ ~~ ~ N eo . ~' 6j e~ ~ ~ `~ ~~ ~~~~ C~/~~ f~~~2 ~~lr~ Wisconsin Department of Commerce EN~I~t~A~l~l'~O~PU T P~ 1 of 3 Division of Safety and Buildings m ra vnm ua, vvrs. Hom. ~ ST. CROIX C NT Cat St. Croix er not` ess an 8 1 x 11 inch in size Plan must lete site lan on a Attach com . p p p p include, but not limited to: vertical and horizontal reference point ~ ~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Pacel I.D. 'I 2 - 0 44 - ~ O - UUa , zg0 P/ease pr/rit a// /r-format/on. a wed by Date P 15 04 1 id d f d i L M / 1 ~/ ) (m)). aw, s. . ( Personal information you prov e maybe use or secon ary purposes ( r vacy Property Owner Property Location Chris Ber[elson Govt. Lot ,{/!~ 1/4 ,~(JL(,1Y4 S ~g' T ~d N R 17 Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# V ~ ~ 3 f Z 8'~- ~ R ~ ! C ~ 5~ 1521 cty. G . s~ o . City State Zp Code Phone Number ity ^ Vllage • own Nearest Road New Richmond WI 54017 1 7~5-2A6-9038 Cty. G New Construction Use Residential !Number of bedrooms 3 Code derived design fbw rate 450 GPD Replacement ~ Public or commeraa -Describe: Parent material till Flood Plan elevation 'rf applicable ~Jlf4 ft. General comments ~ ~s~,ev/l e /ftl . 2 y " r~~G~ It rz~ ~-C and recommendations: ~ ~ ~ (~ ~ l Z „ (~ ~ ~ 1 r`2w~o~--. p,,.~p~ c~..~C~ \2csA.s~ ~n `~ ~'`~ ASS ~ 1re ~13.,^~ ~oa.wt SAS ~ ~'~ +~ ~) I~ 1~ Boring # ^ Boring ~ ~'~....,.~„ a pit Ground surface elev. 99.20 ft. Depth to limiting factor ~ in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Cortsistence Boundary Pioots GP DJff° in. Munsell Giu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 1 0-8 10yr3/3 - sil Zmsbk mfr cs lvf .5 •8 2 8-21 1 r4/4 - cl 2msbk mfr cs lvf .4 .6 3 21-39 10yr3/6 - sl 3m r ~ cs _ ,6 1.0 4 39.80 10yr3/6 - sl ~ Om - - ~ ~' 1 ,,,. 2 ~ Boring.. 74 Boring # 95.90 Q pit Ground surface elev. ft. Depth to limiting factor in. Soil A ication Rate Horizon Depth DgM~nt Color Redox Description Texture Structure Consistence Boundary Roots GP Dlftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 1 0-18 10yr3/3' - sil 2msbk mfr cs lvf .5 .8 2 18-32 1 4 - cl 2msbk mfr cs _ .4 .6 3 21-40 10yr3/6 - scl ~r~tsbk mCi cs _ .4 .6 4. 40-74 10yr3/6 - sl Orn mvfi ' Emuent #t = BUOs > so < zzo mgn. ana Tss >ao < 150 mg>l. ' tmuent az = c~us <;eu mgn. ana I s5 ~ su mg2 CST Nave (Please Print) Si re ~' CST Number Adam Sch 253309 Address Date Evaluation Conducted Telephone Number 1679 89th Streetti, WI 54017 04-11-06 715-760-0279 ~. ~~~ Owner Bertelson Parcel ID # Page 2 of 3 Boring 3 ^ Borin # g ~ Pit Ground surtace elev. 95.50 ft. Depth to limiting factor 74 in. Soil A ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP O/t~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 1 0-20 10yr3(3 - sil 2msbk mfr cs lvf .5 .8 2 20-29 1 r4(4 - sicl 2msbk mfr cs - .4 .6 3 2A63 10yr3(6 - scl sbk mfi cw _ .4 .6 4 63-75 10yr3/6 - sl m mvfi cs - • Z • ~ 5 75-84 10yr414 - s lmsg mvfr - - .7 1.2 ^ Boring # L _.I Boring pit Ground surface elev. ft. Depth to limiting factor ~n• Soil A ication Rate Horizon Dep t Color Redox Description Texture Structure Consistence Boundary Roots GPD/iP in. nsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 :, ;~ ., .~ Boring Boring # Ground surtace elev. ft. Depth to limiting factor in. Pit Soil A ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 * Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mglL 'Effluent #2 = BODS < 30 nxllL arxi TSS < 30 mgA. 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 Y608-264-8777. SBIlffi307'est (R07/00) w-'~IIM r PAC3E ~ OF NAME ~~r~so n LOT# LEt3AL DESCRIPTION '/a ~/a,S T ,N,R E(OR)W SCALE: i" = ~(,~ r BM i ELEVATION ~~©~' ~ ~ca -f'1-c~ ~,.~ csr ~- SJ-ee/ ~~ ~. ~rta ©/~ .~ c~ BM i DESCRIPTION BM 2 ELEVATION - BM 2 DESCRIPTION SYSTEM ELEVATION ~~ ~`''~pw ~:--~rG~c~ SYSTEM TYPE )'1't~a.c-~~ ~~ ~= KCk-ed. S ~-~c [m.`v-~'n,,,,,.. 5 ~ nd Q. rd S .Eo r A C~GYI.u? n,f-t.~on u l ,f'Y 5-f t /YI ~y ~"~~ C d-'~ w ~~ ~~ ~~~~~ ~k.G~ ~~ ~~ ~~ J ~4 ~ C _ _ _ ._ 4-~ ~ ~ .~ _ i .. ~~ ~A ~~ ~~ SIC3NATURE ~~~~_- '"`'~~~~~ ~ I J DATE ~~" SEPTIC TANK 8 PUMP CHAMBER CRASS SECTION AND 5PECIFICATSGNS u" CX VENT PIPE 12" MIN. ABOVE GRADE ~ ? 25' FROM DOOR, WINDOW OR FRESH AIR INTAKE FINISHED GRADE 4 " C I RISER -~--,+ 16" IN. 6" MAX. NLET WATER TIGHT SEALS PPROVEd IPE 3' pro Say z a Q~L PUMP OFF ELEV . FT . A __i;__ B ~F"' c D 41EATHERPROOf JUNCTION BOX WITH CONDUIT ;e, ,~ .. ~, I' GAS- ; ` TT_GHT i ~, SEAL ~' 3 " APPROV EI3. BEDDING UNDER TANK APPROVED _MANHJLE COVER W ! PADLOCK E -WARNING LABEL - v" MIN. ~ ~ti VAPPROVED JOINTS WITH ALM APPROVED PIPE ON 3' ONTO SOLID SOIL OFF '~~` RISER EXST PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: f ,~~Sey TANK SIZES: SEPTIC /p~fGi' GAL. "~ _ DOSE ,~,~`6 GAL. ALARM MANUFACTURER: MODEL I+3UMBER: SWITCH TYPE: PUMP MANUFACTURER: MODEL NUMBER: SWITCH TYPE: REQUIRED DISCHARGE s~ s. v l~~ ~~ - Govsr ~~o-~/ ~~~c RATE ~ GFM NUMBER DOSES PER DAY : ___~__~ DOSE VOLUME INCLUDING- F LOWBAC K : ~~ G~ApLt,. CAPACITIES: A = ~ INCHES = _,~,~:~.._ GAL. B = 2 INCHES = .~~ GAL. C = ~ INCHES =GAL. D = G INCHES = _~GAL. PUMF ~ ALARM WIRING AS PER ILHR 16.23 WAfi VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE ; ~ FEET + MINIMUM NETWORK S~IPPLY,PRESSURE 3 FEET + l d FEET FORCEMA2N X ~,Gd_FTIlOD FT. FRICTION FACTOR ~ FEET TOTAL DYNAMTG HEAD = ~ ~' .FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WSDTH ; D~AMETER LIQUID ~" -- S I" ~' £D ' ~-~'~ . ~~~~~~_ LICENSE NUMBER „~~?9Qd DAVE: ,~ ~,~ 1/88 Ce~, GOULDS PUMPS Submersible Effluent Pump ~~ 3871 EP°° EP05 APPLICATIONS Specifically designed for the folbwing uses: • Effluent systems • Homes • Farms • Heary duty sump • Water transfer • Dewatering SPECIFICATION5 • Solids handling capability: 3Je"maximum. • Capacities: up to 60 GPM. • Total heads: up to 3I feet. • Discharge size: 1'/z" NPT. • Mechanical seal: carbon- ratary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, fi0 Hz, 1550 RPM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatit reset. • Power cord:l0 foot standard length,l6/3 S1TOW with three prong grounding plug. Optional 20 foot length, t 6J3 SJTW with three prong grounding plug (standard on EP05). ®2000 Goulds Pumps Effective iebruary, 2000 83871 • Fully submerged in high grade turbine oil for lubrication and efificient heat transfer, Available for automatic and manual operation. Auto- maticmodels include Mechanical Fbat Switch assembled and preset at the factory. FEATUftES ^ EP041mpeller: Thermoplas- tic Semi-open design with pump out vanes for mechanica# seal protection. ^ EP05 Impeller: Thermoplas- ticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for effident heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power table: Severe duty rated oil and water resistant, ^ Bearings: Upper and lower heavy duty Bali bearing construction, AGENCY LIST{NG ~' Canad'+an Standards Association (CSA listed model numbers end in "F" or "C".) Gard: pumps as rso Soot Registered. 0 2 4 6 8 10 I 12 m~lh cnpaarv Goulds P mps ITT industries `~x' ~ a~~ J " .~_ u~~ 4 STANDARD CHAMBER Quick4 Standard Chamber -~ - I ~~,. _L t3 MultiPort End Cap ' l' ~ r~ '~ ~ ~~~~_ ! i'~ FRpNT VIEW . ,~ 1 r.. ~' n1~ fi>r i~ ~" ~ , .3~ , ,,~ ti ~ _ ~ ~ ~~r , ~ rah Quick Standard C_ hamber>Nomiinaf'S_pecfftcatfans Size (W x L x H! _ __ 34" x5~" x 12" Ettectivs ~ength ______ _ 48° ,overt Eieight -8a f ~' r A S _I d! ~ ~~ f ` ~ f ~d~~ i-- ---~--..J~ SiDE ViEW _---__. --- 52"---_ (EFFECTIVE LEnNGTH) li 1 _ ~J_Jf ~____._~ li r sln~ vsl:w -i--- 16" i -- TOP VIEW ~ ;,~ ,~. lR4~5, ~.r Size W x ~'x~~__•_' T. 34' x 16' x i2'• Invert Height __, ~ 8" or 1.25" INFILTRAIQN ~~ST~.1~.~S.TANS?AR~.I-~T~W-•~fl•R~NT~f ,.p P b.1r:l! t o r~ n-. a n a,a~ w C W- ~9 awl itf,ar a rn v '.an x ~.v[, t by N I IU u I 'Ww I wen .star a -1 .,,wi n J I ACt I ata 01 ~+ ~ I . ~..nr sv'te , n, sec da:*..« with Inklt ator'a nel rka1 s w, a k/,1 tl; lru I t(f ,I tnnU aver I Ipl fer'1 a ~ 1 r rHVe ~.;ii ,r.1 , dl,p Wf~41 of '.nµ1 kN Mf, .l1k Inx~ 1no data 1h811h~ 9a{lil; orxtn I N .r6111Y1 ':7 12, rry)Iln 3Y if I IAV11011In J Foe l11 y, Vf - ieU 1 <w~.ver Is ~,al a BFtI~-Per . „ut reaWrtlf7 try aOPiirat114 law. the wazrantY period wU uei7ln vS,rn, tar dal@ Ihal n)shUialigl c the SnPlr. r1Ys nn oommenr'rr•. 'n nx r .rG! ds wararlA nP rs. ~?'~Ue+ rcyesl rtollfY MfNlrafor In wrN!rg a; NE l',OrP.xate liuar r•} F1Im9 M U+d SdYbrc10N.. Con",e[.1wuN wM,'itfeen It51 '!'!YS a! th= abOSpd r>43-act ,t9ltralfJ wit st1aYY il>olacammlt thFNS to Jre1N datan!ir4n1 tw N,rtlratro iq ba CbvAR,d by Ihl» S:+,NiarS Wwrarl4v. -?alrat[><s Nahilny { ac:d~ ^tA gkbalaR title COST M rnrlune>< anlYa N,staNatron d e,e iln+ts. r v vl°EO wn`wav Y atio aEt~cYr=~ ~ ~uHVaaar>Anr>fi ta) nreE rx ustvt i tl rr ~a viz n11tGn w,tpHnn:r,l=_' wits to .a_cr ~':) I! 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Pox 7B8 Oid Saybrook, CT OEia 1 r~ 860 `TT-7000 • FAX $FiJ-577-7001 Spp-221-4436 r `>..`t7L3,776i 5,&?`1.t3~,4 17; 5,AOl,i 16; 5,4G1 45:1. 5 vt 1,[303; t 16 6~: I :. a ~S9 Cf...:. 0,104 t; S,15E.4NHi 5.33f}.Q k ji 4t~rB~ ll lAt{tale' 6yrw".a 1n.:- Other Ylalanis pending. .~C CU( Q41~~t~~~ man„..o-1r I P.>tnrls- 7 321,9:,9; : ,0[;4,.)C+4 51Ef1`t In.. itil~tt6lW r9 it IP,(31f'.tf' c~ itJ!k1Kr~ P~tsIL']GK, ~u~^ t ~ a rnrrur8l„t sY , vi>t sun Sf1~f%.k. rt~~rnkstStl~' „-.r,r:a•or, st~,,,,,(,:r•' un,+ ^,Irtew~nder are replsterad radrvna is ~i regislafe,G' tradelnarii irr MexIW. C.ontOUr, Gontotir yyrval (}OrY~eetion, AR,uat_e,a:.hin i~ Ili U~S.a. _ - . ,,. __........,..,,,.arl.< .,1 intitlrata Svsienxs Inc ~ 20~k9 6't(iinalOr SV~Rrt!5 ktG. Fttfi eaC~teeoa~vFp WVi I?'11~+11 ` SECTION VIEW POWTS OWNER`S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner ~ r~ Permit ~ ~/ 1 ~„ pESION PARAMETERS Number of Bedrooms ~ ^ NA Number of Public Facility Units A Estimated flow (average} 3Cr0 al/da Desig~i flow (peak}, (Estimated x 1.5} ~Q al/da Soil Application Rate ai/da /ft~ Standard influent/Effluent O.uality Monthly average " Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand iBODB! 5220 mg/L ^ NA Tote{ Suspended Solids (TSS} 5150 mg/L Pretreated Effluent O.uality Monthly average Biochemical Oxygen Demand 18006! S30 mg/L Total Suspended Sal'~ds (TSS} 530 mg/L ^ NA Fecal Coliform (geometric mean} <_10° cfu/100m1 Maximum Effluent Particle Size Ys in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. iueiurFNeNrF cr•_wFnu~ c SYSTEM SIPECIFICA'TIONS Septic Tank Capacity Q'DQ al ^ NA Septic Tank Manufacturer ~'~.5~.° ^ NA Effluent Filter Manufacturer 6L ~ ^ NA Effluent Fitter Model ~' ~'0 ^ NA Pump Tank Capacity © al ^ NA Pump Tank Manufacturer 1~y ^ NA Pump Manufacturer ,,~~~~, ^ NA Pump Mode! ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Cellls} ^ In-Ground (gravity} ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized} ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Freq~erlcY Inspect'condition of tank(s) At least once every: ~ e°&n.~s~{sl (Maximum 3 Years} ^ NA Pump out contents of tank{s) When combined sludge and scum equals one-third (Y3i of tank volume ^ NA Inspect dispersal califs} At least once every: ~ p-monthls! ( aximum 3 years? pJ yearlffi? M ^ NA '~ Clean effluent filter At least once every: monthlis! yearls? ^ NA Ins act urn um controls & alarm P P P. P P At least once every: ,...-- ~ monthisl ^yearlsl ^ NA Flush laterals and pressure test At least once every: ' ^ month(sl ^- ^ yearlsl ^ NA Other: At least once every: ~ yearlajlsl _._..- ^ NA Other: O 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; 5eptage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or teaks, measure the volume of combined sludge and scum and to check far any back up or ponding of effluent on the ground surface. The dispersal cell{si shall be visually inspected to check the effluent levels in the observation pipes and to check far any ponding of effluent on the ground surface. The pond'ong of effluent on the ground surface may indicate a failing oonditwn and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y~1 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 pressur(zed components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page ~~ of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment ranks! for the presence of painting products or other chemicals that may impede the treatment process andlor damage the dispersal cefl(sl. If high concentrations are detected have the contents of the tank(si removed by a septage servicing operator prior to 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 highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellts) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the. contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal calls. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS faits and/or is permanently taken aut of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • A1! piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator, • After pumping, ail tanks and pits shall be excavated and removed or their covers removed and the void space filled with soli, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the foiiowing measures have been, or,must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing, and proposed structure, lot lines and weNs. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback andlor soi6 limitations. Barring advances in pOWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ~~ ^ T site h nd site e tank O Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDlOR INSUFFICIENT OXYGEN. u~i ri07 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 gIFF1CUtT OR IMPOSSIBLE. ADbIT10NAL COMMENTS POWTS INSTALLER Name ~ j `/f,' ~ ~.s~ ~ r K mod? Y. Phone ? l - _ ~. ~ ~ " POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER} LOCAL REGULATORY AUTHORITY Name Name Phone _ _ " Phone This document was.drahed in compliance with chapter Comm 83.221211b111ildl&tfi and 83.54(11, (21 S (31, Wisconsin Administrative Code. ST. CRO1X COl[JNTY x < ~ SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Qwner/F3uyer G'- ~ ~. • 5 ~ ~ r7`~ls°•~ ~ Mailing Address ~_ i $" ~Z ~ ..~..-------~~r - ~ a~ ~ --~.__ ~,.,........___...~ .~ Yr~~perty Address --S« rvL ~ (Verification required from F}Iaru~ting & Zc-tung I}eoartment for new construction. j City;State _~~~ ,~~~/, ~.,,,r, ~ I'ul•cel Identification Nurrlber ~~ ~ - ld ~ aafDp c~ _ LEUAL .DESCRIPTION ~ 2900 _._ Property Locatian,~/~J '/a , ~'/a ,Sec. ~~, T ~N I7_~W, Town of ~~~•~ ~a: `~.' ~= .. Subdivision Certified Survey Map # __ ___ ~ (Z Lot # ~ volume .__,~ _.~ ___, Pale # 3 ?`~.._ Warranty Deed # __~_ ~ ~ ~ 3 1, ~ __..._.._..__,- _._, ~"ol~ume ~ ~ ~.~~_.._, Page # Spec house yes Lot lines identifiable yes t~ SYSTEM MAINTENANCE AND OWNER CERTIFIC.ATI 7~N Improper use and maintenance of your septic system could result in i[R 1-remature failure tt~ handle wastes. Proper maintenance consists of'purnping out the septic tank every three years or sooner, if needed, by a licensed pumper. What yuu put into the system cart affect the function of the septic yank as a treatment stage in the ws5te disposal system, Owner maintenance responsibilities are specified in §Cotzun. 83,52(11 and ir: C.hapter 12 - St. C,'roix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County I'ianning & 7.3ning Department a certification form, sikned by the owner and by a master plumber, journeyman Ulumbcr, rests icted Irlumber or a licensed pumper verifying that (1) the ou-site wastewater disposal system is in proper operating condition and/or (2) after inspE~.tion and pumping (if ztecessary), the septic tank is less than i/3 full of sludge. if`we, the undersigned have read the above requirements and agree to maintain the pri~Fase sewage disposal system with tine standards ses forth, herein, as set by the Department of Commerce and the Department of lV'atural Resources, State of ~,~'iscotlsin. Certification stating that your sep~c system. has been maintained must be completed and returned to the St. Croi~c County Planning & Zoning Department ~vithin 30 days of the three year expiration date. Uwe certify that all statements on this forrri are true to the best of mylour knowledge. Irwe am/are the owner(;) of rl~e property des4ribed above, by virtue of a warranty deed recorded in Rogister of Deeds Office. Number of bedrooms _-~~ SIGNATURE OF APPI.IC.'ANT'(S ) 5 i..~r_o ~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning ~ 7.otung I)epanmen±. *** luclude with this application a recorded warranty deed from the itegister of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. t>~v. osros) V~~i.1473P~~: 419 STA'L'E BAR OF WISCONSIN FORM 2 - 1998 614397 DocDment Number WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS 5T. CROIX CO., WI This Deed, trade between Joanne P. Gotdstnith ~i nom' lP~ RECEIVED FOR RECORD ~ I1-23-1999 3:45 PM IiARRAIITY DEED or, conveys and warrants to Chris J. Bertelsen a single person EXEMPT N CERT COPY FEE; COPY FEE: TRANSFER FEE: SI6.00 IN6 FEE: 0.00 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the 1 following described real estate in St. Croix County, State of Wisconsin (The " Property "): Record' Area Name and Return Address ~~/ i~< ,(''~~,~~ T f/~ ~ yvr~J. ~i~ i~~ r~-~.(~3`~, u1I,5~~ d/~ ~~ t~%~ a8~ yis 012-1044-20 Parcel Identification Number (PIN) This is homestead property. Part of the Fractional NW 1/4 of the NW 1/4 of Section 19-30-17 described as folio s: Lot 1 of ertified Survey Map filed October 28, 1999, in Vol. l3, Page 3759, Doc. No. 612871, St. Croix County, Wiscon ~--~ =`y Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any Dated this 1/~' day of November, 1999. AUTIiENTICATION Signature(s) authenticated this `day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 70t5.Qti, Wis. Stars.) THIS INSTRUMENT WAS DRAFTED BY Attorney Krishna Oghtnd I3udsoa, WI 54016 (Sigttaturcs tray be authenticated or acknowledged. Both are not necessary.) DIAfVE M. 8ARR01V Notary Public State of Vitjisconsin /7 A ''Joanne P. Goldsmith ACKNOWLEDGMENT STATE Ofi WISCONSIN ) ,S-~ Cro r ~ ) ss. County ) Personally came before me this -1~ daY of November, 1999, the above named_ Jotmne P. Goldsmith to me known to be the person(s) who exec{u/red the foregoing instrument and acknowledge the same. I i . •w _ L .,n Notary Public, Slate of Wisconsin My Commissio is pe anent. (If trot, state expiration date: 'Names of persons signing in any capacity should be typed or printed below their signatures WARItAMY DEED STA7E BAR OF WISCONSIN FORM No. 2 - 1995 INFORMATION PROFESSIONALS COMPANY FOND DU LAC. WI >100655-2n21 yM~s.'• ~~,~, .. ftj~' pis :f R+~Nl~ll: I: '~ - APPROVED f 7' 1NM`.:r?!~ 'w BT.CROIXGOUNTY ;: ~ _ , . _ PIwINiC YonMp and Parks Commritee :: "iw~4 4, ~'. f OCT 2 8 1999 F_1.%~L~`~`3. ~ ~ ~ 'yM ~.~ ~ rl~ ~~~~~ 9 9+''•Ia ~'/' S._' ~: ' c •l~pow K nOt raoordad W1MIM 90 days Of S `"`"`' ~~" ~, ~ C E R T I F I ~' ~n ''1~~11/ E Y M A SLED do OCT281999- The Fractional Northwest Quarter of the Northwest Quarter of Section 19, Township 30 Nort ~ i~11THlIDdH W11LSH Range 17 West, Town of Erin Prairie, St. Croix County, Wisconsin. islerdDeeda ~ ~ S~LGWItCo..W! ~ Prepared for and at the request of: ~ OWNER: ti ~ Joanna Goldemtth 1521 C.T.H. "G" New Richmond, WI 54017 UNPLATTEDLANDS NORTH pUARTEN CORNER SECAON 19-30-17 Drafted by. Ty R. Dodge (FOUND SURREY NA/L) ~ ~ ~ --- CST. H.-'G' -- - ~` ~ I / ~- J - 588'48'00" W 2243.34'- - - - - - _-~ 1L NOR7N L/NE OF 7HE FRAC770NAL NW 1/4 OF THE NW / 4 ~ / ~ o \ y ~ G 455.67' 1 , 596.00' S0 2' 1 ~ ~ ~ ~ ~ a 50.03' 50.00' ~ --^ 568 48'00"W -~~ 594.51' _ r .~ ~' - ' ~ ` `-~457.63'~_ 1052.14' - DRIVEWAY /I 1191.67' ~ ~ ~ ^ ~ r! ................. I i - • - - • - sEPnc ~VEN~ •I I~ ~o~ o ®I I ~7~ ~ LOT 1 I ~ ~~ H ) m TOTAL AREA: O I N ~ ~ ~ I LOT 2 g 389,763 FT. gA~y I ~ 2 8.9 S TOTS AREA: 'a AREA E_X, R-O-W: I ~ N I 1,009,114 SQ. FT. 'o ~ 360,000 SQ. FT. I I iri I 23.17 ACRES ,~ 8.26 ACRES I ~ AREA EX. R-O-W: b, ~ '~` NI 986,282 SO. FT. r I ZI I 22.64 ACRES ~ ~ ` g o+ I I t r`r`' \ n ° of ~I m ~ ~~~ i ~~ SI zI ~' I ~ ~ '~ zI JI ~ _ ; + N ss6.4e'oo"w s7s.22' ~ # ~ ~~ ~I ?'~ ~ ~ N o r ~ ~ ~ ~ CV [V JI ~ N sn o ~ ZI ~ 1 ~ o =I I j 2 I NOTE: The parcels shown on this m ore subject to State, County and ~~ v 3 Township iaws, rules and regulntiona i.e. wetlands, minimum lot size, acceaal ~ ~ to parcel, etc.). Before purchasing or developing any parcel, contact the St. I '~ ~ 2 to ~ Croix Counly Zoning OfTice and the appropriate Town Board for advice. I ~ k ~ ~ 30 ~ ; ~ ~ ~~ '~` I ~ ~ ~ i-AREA SOUTH OF SHOWN FENCE ~ ~c ,Sp~G 7E3T AREA I ~ I I MAY BE AN AREA POSSESSED HY I ~ /i ~~ (NOIAW) ~ ~ 3 I IOWNER OR OANAATTORNfYIBEFOREDI ~~ ~ W 2 } LEMOVING SHOWN FENCE. - T, J ~ 2D.4' ~ SOUTH L/NE OF THE F74ACTIONAL ~ ,~ } ~ Nils 1/4 OF THE NW 1/4 ~ ~X~ ~ ~~ X-a1f-X . 1 sa9.lrto'w 1063.92' 2.1' I ~ UNPLATT,~D L.At!iDS W 1 FPFND' 1 ~ io ~ County Section Comer Monument ~ m pf Record 1 ~ ~ If/FST QUARTER CORRNER • Set 1" x 24" Iron Pipe weighing Qv ~ 5EC170N 19-30-17 a minimum of 1.13 pounds per ~ ~ (ALUM/NUM MOA!) linear foot. • 9uilding Setback Line (100' From R-O-W) JOB /99113 (Sta. 1) 200 0 200 NO 11-I Prepared by. A & E GRAPHIC SCALE LAND SURVEYING do CIVIL ENGINEERING SCALE IN FEET: 1 Inch ~ 200 feet Phone No. (715) 246-4319 BEARINGS ARE REFERENCED TO THE NORTH LINE OF THE 109 East Third Street. P.O. Box 325 NW 1/4 OF SECTIOhi 19, TOWNSHIP 30 N., RANGE 17 W. New Richmond, VN 54017 WHICH IS ASSUMED TO BEAR N88'48'Oq"E. Sheet 1 of 2 Vo1.13 Page 3759