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HomeMy WebLinkAbout042-1086-40-080 r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567256 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Jesse, James& Sandra Warren, Town of 042-1086 40-080 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: /06 6 ✓A I CST 31.29.18.483A80 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER,Art, CAPACITY STATION BS HI FS ELEV. Septic X D � / Benchmark Q /5 ��g.�!) /bb t,1;e's. -_- 6lt, 3 , 0 Dosing Alt. BM 7. 1 /pd. 35 Aeration 6�4-' V` Bldg.Sewer . /1. I /67.65 Holding St/Ht Inlet 11 . 7 9`• z5 St/Ht Outlet TANK SETBACK INFORMATION \ TANK TO P/L WELL BLDG. Vent t Air Intake ROAD Dt Inlet 4 t Septic 7 5Q1 /1 /S Dt Bottom /5, if 7 2 � ,75 Dosing I �'t' i / Header/Man. 7 5o Nth- /5 2-4 t lr'yk rr- 71 /40. 75 Aeration Dist.Pipe /dd. SL, Holding -Sot. System Q z Final Grade y A/ PUMP/SIPHON INFORMATION / /7 l%1'��� Manufacturer f Demand St Covert I 20 P�1 GPM�4.. r M�(it GOB►4 7.6' /�• 35 Model Number / l TDH Lift / Friction Loss System He TDH Ft 6• Le 1. Le C-- Forcemain Leng4 I Dia. i t Dist.to Well Z ilt) SOIL ABSORPTION SYSTEM BED/TRENCH Width / Lengt 6 No.Of Trenches �� ]^� PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 Z (fewL /J — ......___ \ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacture / INFORMATION � / CHAMBER OR X774-. /If-Io.4 -Nye(.�b tiJ.Cte . 0,".."..(2_, 7 46/ 'Oa-- ,t)A UNIT Model/mot ber: ! r81r'• DISTRIBUTION SYSTEM 4.44-- no 4-/4 = 3Z • , Header/Manifold q Distribution x Hole Size x Hole Spacing Vent Air Intake p� I Pipe(s) �,_ �'-- �_ ✓ Length 77 Dia IA 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 3•D t Bed/Trench Edges �' Topsoil Yes No h Yes Li No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 944 65th Ave. Rob erts,WI 54023(SE 1/4 NW 1/4 31 T29N R18W) NA Lot 2 I / Parcel No: 31.29.18.483A80 1.)Alt BM Description= 7 Ga Jam-- // 1 GIA.a.•:.�•� i-- L oc./G'b o,. 2.)Bldg sewer length= I✓ ‘,,AA-:re- -amount of cover= li// n n 5t�b 11�j , �Je4 5 a r�. act[-x. J i .1 Plan revision Required? Yes No j ?� j 1 3 f . . ! 3 ' Use other side for additional information. v J t SBD-6710(R.3/97) Date Insep'or's Si••. ure Cert.No. kg\ 6:f k 0, il.41\ o (A IX ("k In_ N U\ N f. N I 2 Lk, k ■ n C '1 1! It '�' Z \ k ska ,0 xj 1 L n o 2. 1---i-- C�—i—� ~ N N Iv n n k `� w ■ W t� 0, N r■ u 4' I j164‘ I I I f.-- o t. .n EN .a 0 wk O •N I y ' �o c..1\- p — c. a d w ki c iJ �p a • Ck;o i \ — z J Z o n •k a `C 0 e c P t ._„ r\Z., 1 cc\C L N44 \ s,,.......:i...... i I . . .1- 4/Nye- /4/c1 �,, County ft' Industry Services Division 57' e/Lo/X s. (� '; 1400 E Washington Ave Sanitary Permit Number(to be filled in by Co.) c:'4` $p '''.,,it ,s. P.O.Box 7162 '',` "V �8.V Madison,WI 53707-7162 _. ' ` =.-;1� ,` State Transaction Number;" nary Permit Application }/4 In accordance 4‘ S 83.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit Nofe:Application forms for state-own I;S are submitted to Project Address(if different than mailing address) obtaining a sanitary permit. e is required prior to obis g ry pe ma r Gonda + the Department of Safety and Professional Servies. Personal information you provide � ry ; �.' purposes in accordance with the Privacy Law,s.15.04(I)(m),Slats" ' 4 C� t.. `_ TM A I. Application information—Please Print All Information C5 Aire./ r 1j Property fQwne 20 i, Parcel# 0,„ r'k4`.itj - T3'A `- Prope Owner's Mailing Address / > COV Property Location • �� �,. MTy /� ✓IO _ 9.�1. �/� !i J'r � Ad,. Govt.Lot / �~ -City,State r Zip Code Phone Number SE y., /1/4/ 1., Section 3! /�O,$E�c rS/ �S. 5YO,?3 C.r/ �/e?8- S ' (circle one T a�9 N; R/8 j W H.Type of Building(check all that apply) - Lot# Xi or 2 Family Dwelling-Number of Bedrooms , .3) r a Subdivision Name `,..4:',.-. 2.,:;kt,,i vt4/ ir,.1"sky Block# 0 Public/Commercial-Describe Use 4 B-C-Kr"af CSM Number 0 State Owned-Describe Use -° _ t )., : * (g Town of CZ9'4E4l I ,. Y,r v III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. "New System 0 Replacement System 0 Treatment/Holding Tank Replacement Only 0 Other Modification to Existing System(explain) List Previous Permit Number and Date Issued B. 0 Permit Renewal 0 Permit Revision . '0 Change of Plumber 0 Permit Transfer to New Before Expiration Owner IV.Type of POWTS System/Component/Device: (Check all that apply) %Non-Pressurized In-Ground 0 Pressurized In-Ground 0 At-Grade 0 Mound>24 in of suitable soil�r...O Mound<24 ii)„of sujtablp soil 0 Holding Tank 0 Other Dispersal Component(explainy''?r 1^d`?.-* `' 4"-.-r `��' UTPretreatmenf Device(exptain)' `3" I r a /^ P'ftF -s1<'S.r✓t°ci'K'? .e144-1 V.Dispersal/Treatment Area Information: 's ,, ,.- ,' % v%' Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required(sf)' Dispersal Area Proposed(sf) System Elevation yso . 7 j G 93 G Ai,. 2 J VI.Tank Info . Capa6ity-in Total #of Manufacturer Gallons Gallons Units ° u_ U U H New Tanks Existing Tanks °' ° 2 , rs iN A:L) in y c",1 w tD 0.. Septic or 14ehiingienk /Odd /COO / Ili Co.✓G.te'rf `" Dosing Chamber 4 L) ■ -- GOO • / to tt t/ VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's a p MhfMPll;6 Number Business Phone Number .16,04) A-z/ei ,,,73/,3e 7/c era-S.?LL Plumber's Address(Street,City,State,Zip Code) A/ G 07M fir. /V�ry ?s �Z esat�o� 4JS Sy7.4 VIII,j-6unty/Department Use Only 5 [ pproved ❑ Disapproved Permit Fee Date Issued /issuing Agent Signature / $ t r 0 Owner Given Reason for Denial �' .., IX.CondSlOSTEMewelfeasons for Disapproval ti I r p % ; f ., .$ �r, / -C. -°- - 1.Septic tank,effluent filter and ' , dispersal cell must be cyi :d/maintained �� ." % f },' • t ,a i f�?»~ el as per management plan provided by plumber. { w _ - 2.All setback requirements must be maintained as per applitdilmcpitaiiior al for the system and submit to the County only on paper not less than 8 in x 1l inches in size SBD-6398(R0313) / a, / Private Onsite Wastewater Treatment System Index and Title Page . Project Name: Ti,, f JA,04 Y TESsc-' 3-I • ki,fou....L' A' Ti Owner's Name: fire, ‘, ./Y _ iss Owner's Address: 934 4,6Ea rs 41I 5-9aa7 9028- 5986 Legal Description: SE, /V4. 34 0?9/1/1 /841 Mnniclpallty: Town, Village, Gi4y of dr14,eEN County: Y77 6t'/)C Subdivision Name: • Lot Number: o? Block Number: Parcel I.D.Number: 0 Yd -/08G - yo- aeo Page 1 /if/,OEx t $/ea-r Page 2 'tor At./ Ai/ Ross- .44 rid.✓ + AAJ lliEr i Page 3 SEAM /R44'K /Auao 4M/swot 6toss-.SEC rio..! Page 4 4,,r, . "EX,co,t..aA✓c evit dE Page•5 Aidrs 0aAlev s /'lfdui6 I" /J9,1/,1e,VENr /4(4.41 • Page 6 Page 7 />1 rE2 /24M) tMdGE /a.AD. Page 8 Page 9 l YTAo cira-Air r e-r/Ai cm,r, .,i deE/lo t 7' Name of Designer: 72>,s9AJ ,styes- License Number: /Y/ 02.E/3'/4 Signature: Pa Date: /D-a?3-.?oi3 Designed P suant to the Following POWTS Component Manual and Comm 81-85: • In-Ground Soil Absorption Component Manual for POWTS (Ver. 2.0) SBD-10705-P (N. 01/01) • r �. O. "„•L 1 • z n fi 0 .�1 n H _ f-I --�Ii� o .. X. IF .2 fi O` cr 0 I .e._., t,ht 1E-44 (1\ t k .0.yti O 9" L n N `l ■ %-•r- _i-'—_; v ~ N N k f\ n '0 h W . 14 Q ` 0 r\ 't\ r r u rZ . O ka + t. , I - a 1 ---'"' -----__ -- I N. n \ {n^\0 D -. r+ r w g• (Ii.k ti -1 a D.- n w k,kA N o X. "1:5... 1,.....,,,,......K4a- s, cIilt‘N , , \ I w n o V C o z , r\t 7 t.. N. .N,...„,:"........ s. 1 Page 3 Of 7 • SEPTIC TANK g' PUMP CHAMBER CROSS SECTION' AND SPECIFICATIONS • • . • ..rs'ucfo. • 4" CI VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF ?' /4� FROM DOOR, WINDOW OR JUNCTION BOX APPROVE) FRESH AIR INTAKE WITH CONDUIT MANHOLE COVE fi.��svra y"orzow — W/ PADLOCK i oktoe WARNING LAB G./tole- 11 `-- !!YC �--=-4" MIN. 18" IN. ::‘ I. ■ ..r, ** INLET - 1•',r WATER TIGHT SEALS ifs T __ GAS- ; i�...�I.■l , • i _ Gf-/o --� r' A SEALT, �t vAPPROVEO Fit rem —J , ' JOINTS WITH PIPE 3' g ' :,ALM APPROVED PIPE •Ot�70 SOLID -1'- ON 3' ONTO SOLID SOIL SOIL' PUMP OFF ELEV . 82o FT. a. -- - j OFF `eft RISER EXI' D 4 I PERMITTED ON IF TANK MANUFACTURER 3" APPROVED BEDDING UNDER TANK HAS APPROVAL CONCRETE PAD SPECIFICATIONS SEPTIC I DOSE TANK MANUFACTURER: 4'ESER Z6.4/otEre NUMBER DOSES PER DAY: .S3 08.7 f,) TANK SIZES: SEPTIC /000 GAL. DOSE VOLUME INCLUDING Bye '` 8'a = DOSE 4 o GAL.. FLOWBACK: 92.y .GAL. ALARM MANUFACTURER: 5,.7"E. X1/40fd�is - CAPACITIES; A = do.S INCHES = ,3yy, y GAL. MODEL NUMBER: ,f x Aze4r. / SWITCH TYPE: 6f/4,✓/GA1.- , - B = 2 INCHES = 33 4 GAL. /G. GALS. POMP MANUFACTURER: _ ZOEILE/1 w r MODEL NUMBER: itic� C S.,.S INCHES - 92.V GAL. MBER: S SWITCH TYPE: I1/6GN,q.,0GAL. D = 8,4 , INCHES a /3y,y GAL. REQUIRED DISCHARGE RATE ap , GPM PUMP & ALARM WIRING AS PER ILHR 16:23 WAC 'VERTICAL'DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION N PIPE F + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . • • /.- FEET + . , D FEET FORCEMAIN `X - FEET /.D FT/100 FT. FRICTION FACTOR „S FEET T.OTAL DYNAMIC HEAD = X2,5* FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH .5311 ; WIDTH 78�� •; DIAMETER -- LIQUID DEPTH ,3� --- k II," 7 • W PUMP PERFORMANCE CURVE TOTAL DYNAMIC HEAD/FLOW LL MODEL 151/152/153 PER MINUTE 50 EFFLUENT AND DEWATERING 1 14- 45 153 ,z- MODEL 151 152 153 35 I� , Feet Meters Gal. Liters Gal. Liters Gal. titers 1 10- 5 1.5 50 189 69 261 77 291 `? 30 � .■ I 10 3.0 45 170 61 231 70 265 0 25g , 15 4.6 38 144 53 201 61 231 8- '+ 20 6.1 29 110 44 167 52 197 0 6- 20 �. � , 25 7.6 16 61 34 129 42 159 4- ■■■iw�1 30 9.1 - - -23 -87 22 85 75 i 35 10.7 to ■188111 40 12.2 - - - '- 11 42 Shut-off Head: 30 ft.(9.1m) 3811411.6m) 44 ft.(13.4m) 2- 8 0145088 0 Model 151 Models 1521153 10 20 30 40 50 60 70 it eo 100 GALLONS TERS 67132 --- LI 67/32 0 lo 8U 12o 180 200 2411 280 320 300 PLOW PER MINUTE 3 78 -- 8518 3 718 4 @8 014508.A i z --- CONSULT FACTORY FOR 1 -lt '` . 37/6 3718 SPECIAL APPLICATIONS ,e zF f E®� - ___1 37 • �� 3718 � ��� 3116 Timed dosing panels available. + •Electrical alternators,for duplex systems,are available and supplied with an alarm. i I •Variable level control switches are available for controlling I i single phase systems. ! "°•" •Double piggyback variable level float switches are available 1 1 t I =l nt+ for variable level long and short cycle controls. I I = •Sealed Qwik-Box available for outdoor installations.See „1,,,5 I I1 12 t"FM1420. I �— " IInII I _L, = I i 11{11111111•Over 130°F(54°C)special quotation required. ` {I _ ,` 4 75/16 lddtaaliWt iii t i.I, (a 538 UMW. 1 I j ► 1^111* -`151/152/153 Series SK2444 SK2064 15111521153 MODELS Control Selection Model Volts-Ph Mode I Amps Simplex Duplex N151 115 1 Non 6.0 _ 1 2or3 O BN151 115 1 Auto 6.0 included 2 or 3 ':e E151 230 1 Non 3.2 1 2 or 3 ' 114 81E151 230 1 Auto 3.2 Included 2or3 N152 115 1 Non 8.5 1 2 or 3 "Easy assembly" BN152 115 1 Auto 8.5 included _ 2 or 3 \��• from t&chol.e Pipe �` r not included. E152 230 1 Non 4.3 1 2 or 3 A, ��;F�:'�k 8E152 230 1 Auto 4.3 Included 2 or 3 �I' , N153 115 1 Non 10.5 1 2or3 0�r� BN153 115 1 Auto 10.5 Included I 2 or 3 E153 230 1 Non 5.3 1 2 or 3 ��\�`J el� 13E153 230 1 Auto 5.3 Included 2 or 3 �1 � J SELECTION\.itiiDE TO 1. Si let back variable level float switch or double piggyback variable level %' � L ' 1'A VIv �}r�3 "It t�?'1 P 99Y P 99Y float switch. Refer to FM0477. Reduces potential clogging by debris. 2. See FM0712 for correct model of Electrical Alternator E-Pak. Replaces rocks or bricks under the pump. 3. Variable level control switch 10-0743 used as a control activator,specify duplex Made of durable,n bottom noncorrosive ABS. (3)or(4)float system. , Raises pump 2"off botto of basin. Provides the ability to raise intake by adding sections of 1%2" IA CAUTION l or 2"PVC piping. tl„ n t,ae;n=Uvnt, • Attaches securely to pump. • , 3t cunt e`iCti5 ar l 1 I,I t ,,,zt,,cti t;ctrt.iz ,.1 u,:.,rri ,Inc.>-:f , ,,,_; .,,u. :■,, , .. Accommodates sump,dewatering and effluent applications. t.,rt..c„�� ,, ;rt.r,,,,I 1 ,,;.rc�.;Curia ittitrc,. t ; .. NOTE Make sure float is free from obstruction. Ar t t^stta,. p.RESERVE 1. to %siL3 For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. ©Copyright 2008 Zoeller Co.All rights reserved. I Ir Wisconsin Department of CommokelM SOIL EVALUA f 1 RT Page 1 of 5 Division of Safety and Bui D A ccordance with Comm 85,Wis. A Code Attach complete sit •11• per not less than 8 1/2 x 11 inches in size.Plan must 6 20 j 7` include,but not limited to:vertical and horizontal reference point(BM),directi and •no percent slope,scale or dimensions,north arrow,and locatiopn and distance to ne�rt�,r,P d. Iasi D' r- Z--i 14(p—y0-4:1,-.-1-1 Please print all information. �N 'e •� D�ate ;1 Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). • �C,( I / (V' 3 Property Owner Property Location 2/( ✓J „SA,cc Govt of,s-T 1144 /4 S 3 T 7 N R/ E(or Property Owner's Mailing Address of Block# Subd. me • ,9 I D /3s 3 w�.�,40 , 7'>-a..c � �Z, — Al.. . Ph 5�0v City State Zip Code Phone Number W-GRy ❑vill ge ro 4 Nearest Road "�`_p 1 Gt/1I 6 ®l4l ( ) S Lt/ 7/44.--- ' I 6..5--4/1/s-", iVew Construction Us 1 Residential/Number of bedrooms 2/r Code derived design flow rate • .)-0/160./) GPD ❑Replacement ❑ Public or mm�erdal-Describe: Parent material Z7L/c t Flood Plain elevation if applicable A/1/4— ft. General comments and recommendations: System Type / l, System Elevation I F.3 0 D❑' Boring / ,7 # �, pit Ground surface elev.i V!' ./ ft. Depth to limiting factor /�1/ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. `Eff#1 *Eff#2 I 0/ lU . 3I.2. _s--/ d J721: - 1 J o S AL - C /0 Z -3 , r/y - c/ 6X ?,ri- 1-4 , , ,C 3 24//0 /V y r y/4 ------- _..< OS; /2/ N♦ ii Aii.t ; , O V/ a Boring# ° Boring Pit Ground surface elev./0/ ft. Depth to limiting factor_//ti in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 *Eff#2 I O—' tyr 3/2 - '' ,li.✓r in Fr . GS 0201, -6, 1.0 % 8-3 v yrsly ✓ c.,1 �,.,sl,K „ SFr "' /f` f .b 3 -/ o I r ./ S ds rr / yo, /'' ,7, j6 Effluent#1 =BOD,>30<220 mg/L and TSS>30<150 /If •Effluent#2=BODS<30 mg/L and TSS<30 mg/L CST Name(Please Print) .i �,/ CST Number Bird Plumbing, Inc. Shaun Bird /� 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 / 3 715-246-4516 4 I Property Owner_ Parcel ID# Page of Boring# ❑ Boring ® pit Ground surface elev. /Q 3' eft. Depth to limiting factor ///_.7 in. I Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 1 O— — 0 1 -. e. C.i. aan L i✓ 1.('L+ Z- 6-30 lc y-52y c-t 2 t Atty. . iv, t-P _ •4 , (.° _ 3 ,50—i/6 io y 'tic, - s os� �,t 1r,�� nJ. , 7 /, Boring# ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. ) Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 •Eff#2 ) ❑ Boring Boring# ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon 'Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BCD,<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330(16100) J • Soil Test Plot Plan • Project Name Richard Stout Shaun d Address 1353 Awatukee Trail //! Hudson Wi 54016 #226900 Air Lot 2 Subdivision Date 6/24/13 SE 1/4 NW 1/4S 31 T 29 N/R18 W Warren Township Boring Q Well PL Property Line County ST. CROIX k BM or VRP Assume Elevation 100 ft. Top survey iron System Elevation TBD *HRpSame as Benchmark 65th Ave Scale is 1" = 40' unless otherwise noted B-3 40' 103.5' •� ►D 72' 301 B.M.* 102.5' -\ ` ` , ►/ IOC 101.5' 20 80' B-2 4% Slope • 387' Property Line V POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 5" of 7 _.FILE INFORMATION SYSTEM SPECIFICATIONS Owner 7.-/M )+. „SAn1DY SSE Tank Manufacturer: 411ZdF. t Co.ta.tEri ❑ NA Permit# t°° IN Septic ❑Dose 0 Holding Volume: /000 (gal) DESIGN PARAMETERS Tank Manufacturer. l„jaa,t, 6,.Jt,t -Yd( ❑ NA ' Number of Bedrooms: 3 ❑ NA ❑Septic AI Dose ❑ Holding Volume: GOO (gal) Number of Public Facility Units: ti?NA Vertical Distance Tank Bottom(s)to Service Pad: /5' (ft) Estimated(average)Flow: 300 (gauday) Horizontal Distance Tank(s)to Service Pad: 7O (ft) Specific servicing mechanics must be provided if vertical is>15 feet or Design(peak)Flow=(estimated x 1.5): !/SD (gal/day) if horizontal is>150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: 7 (gal/day/ftz) Effluent Filter Manufacturer. 4-6)"."' ❑ NA Standard(Domestic)Influent/Effluent " Monthly average Effluent Filter Model: 5f-/D Fats,Oil&Grease (FOG) 530 mg/L Pump Manufacturer: 2 otILEst ❑ NA Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA pump Model: fSI Total Suspended Solids(TSS) "5150 mg/L High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer. (BODs) >220 mg/L ❑ NA ❑Mechanical Aeration ❑Peat Filter (TSS) >150 mg/L ❑Disinfection 0 Wetland Pretreated Effluent Monthly average ❑Sand/Gravel Fitter ❑Other: (BOD5) 530 mg/L Soil Absorption System (TSS) . 55.30 mg/L ❑NA Fecal Coliform(geometric mean) 5104- N'In-Ground(gravity) ❑In-Ground(pressure) ❑ NA ❑At-Grade ❑Mound Maximum Effluent Particle Size 3' in dia. ❑ NA ❑Drip-Line ❑Other. Other: ❑NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) When combined sludge and scum equals one-third(3)of tank volume ❑When the high water alarm is activated Inspect condition of tank(s) At least once every: ❑month(s) 3 0 year(s) (Maximum 3 years) ❑ NA At least once every: ❑month(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) ry: 3 j 0 month(s) Clean effluent filter At least once every: /3 o month(s) ❑ NA ❑year(s) ❑month(s) ❑ NA Inspect pump,pump controls&alarm At least once every: 1�year(s) TFlush laterals and pressure test 'At least once every:. - • ❑month(s) ,�j(NA ❑year(s) Other: At least once every: ❑month(s) ❑NA ❑year(s) Other: ❑ NA • MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). 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 a check for any back up or ponding of effluent on the ground surface. The soil absorption system 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 treatment tank equals one-third(X)or more of the tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator(pumper)and disposed of in accordance with chapter NR 113. Wisconsin Administrative Code: All other services,including but not limited to the servicing of effluent filters,mechanical or pressurized components, pretreatment units, and any servicing at intervals of 5512 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. • • Page O. of 7 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s)removed by a Septage Servicing Operator(pumper)prior to use. , Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended,as the excess wastewater will be discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator(pumper)prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. 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 treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants,fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps,medications,oils,painting products,pesticides,sanitary napkins,solvents,tampons,.and water softener brine discharge. ABANDONMENT . When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with s. 5/5383.33,Wisconsin Administrative Code: • All piping to tanks,pits and other soil absorption systems 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(pumper). • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: XA suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort. ❑ 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 1 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK .` SUFFICIENT OXYGEN TO SUSTAIN UFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: • . POWTS INSTALLER POWTS MAINTAINER Name ,7 ,j , 2‘Lx-e- /1A—0?.?/,3f G Name -rewA/ageLKE (A-6KE /u/YcS/im Phone 7/,; G7.? -�sd4t Phone /.S -G7.?-3-..?G4 • SEPTAGE SERVICING OPERATOR(PUMPER)— il4A,t/o4J,J LOCAL REGULATORY AUTHORITY Name Name cr. C/zovx Za ti..0 Dff/G E Phone Phone 744-- 384- yGBo 1 • _ _ 0331 LHII1 rt•� 1 m o m h•� a m'6 - - J 11 O 3 0 6-v, m n o • o — ___. a 3 in 1! v o fD A f0 d,...• r l"'r rip. 0 r n N m. m L m �+nm O 'O 1. 3 .Da y �ipm � _^' L. G _ 0 0 m a 7 3 y ifs N o m =m :. Cn 3 m a. m Er, - -•li ?� s d Q.� . y r - 0 lH, o n g a m co o l !lh•! �m^0 o O 1 = 4...ii cc N m 3 0 tu a r; 3 °m9-u I e�f.. N » o v 00 . . . N �.rt O 5s tf . r O c a m ort m p m N =Y _ O 3 _ » -m 3 „ ,S,J , 0- :L.. 'a Sm 7.= 7 o � • m CD c m D w` m m n= . `� , _ °; tea'" ! oaws� Q.NN » fsm a i" ... ff�.� N . }�� m `• 7 11 "5-0 o a m s m La —m t. t" CD h Oa a 7 » n K [Hi _ A� n ro � ?j IiJ . -, n 0 N G C S m -� 3 vm V GI C_.p m • O n — ^ --- - — fa -5-.z ^ c 3 o a3 = N • O» N m (D � Q» a p3 h n`1 iti al -n 0 ism m CO al� _ O Dew t70 �_ atia Ur �� m 57 tL!ilIi ! ! Q = < CM Ea O O� HE.. 11111 .- Q n 4'3 g� f= ! t/1 O rt x = c s F n A� oy — _ N 4� Z � � =Nam+ _ - fD ZT 1...' CA o „ » o �_ Q cl, r4. x j, O a.N m m - !� T - ill I� . 1 - >v saN o ^•ate _._ . 1 Q `a . 1V Ct cQ t.,.. , , -,, '' I tO Mt VI _] ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer . ,a • a _ I_ ,a r Aid S " Mailing Address 936, (0 /4-ie , Property Address ! N 5 n VW (Verification required from Planning&Zoning Department fc nevi;construct'on.) \ y City/State �� y Ro e5 W,,I Parcel Identification Number — Og -440 - DSD LEGAL DESCRIPTION Property Location S 1/4, did 1/4, Sec. 3 I , T a9 NR 1? W, Town of J,JQ r r e n Subdivision — —--- — , Lot# a . Certified Survey Map # q,q 3 alp lP , Volume 2(o ,Page# 4 • Warranty Deed# GI q 3 2 Lf 0 , Volume , Page# Spec house yes („1_72 Lot lines identifiable el no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§Comm. 83.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning& Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s)of the ro described above,by virtue of a warranty deed recorded in Register of Deeds Office. property Y tY g N mber of bedrooms '` 3 / ice, / laSr1,� ;:IGNATURE OF APPLICANT() DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.08/05) tt 983266 BETH PABST REGISTER OF DEEDS CERTIFIED SURVEY MAP RECEIVED FOR RECORD LOCATED IN PART OF THE SE1/4 OF THE NW1/4 07/30/2013 11:50 AM OF SECTION 31 , T29N, R1 8W, TOWN OF WARREN, EXEMPT #: ST. CROIX COUNTY, WISCONSIN. REC FEE: 30.00 COPY FEE: 3.00 PAGES: 2 NLEGEND THIS INSTRUMENT DRAFTED BY EDWIN FLANUM ■ ALUMINUM COUNTY SECTION JOB NO.13-50 CSM-2 DATE 6-14-13 ciCORNER MONUMENT FOUND O'' OWNER N .° ® 3/4"IRON REBAR FOUND RICHARD AND JANET STOUT w rn "<„ 1353 AWATUKEE TRAIL - z 0 3/4"X 18"IRON REBAR SET,WEIGHING HUDSON,WI 54016 .-- s 1.50 LBS.PER LINEAR FOOT z ' A SOIL BORINGS SURVEYOR EDWIN C FLANUM cc,A-■ z E NORTHLAND SURVEYING,INC. z o o P.O.BOX 152 t z AMERY,WI 54001 Q = Z 2 ° aeeeeeeeeegg1 LW ®me�! /A,000 Zit TZ f EDWIN C °; *'S. e FIANUM UNPLATTED LANDS S_2487 _ no t S AMERY s ® WI NB9°52'42"W 225.12' io o II _-- f 00IB aS U[�v w o 08 v eeee��e LOT 2 2.29 ACRES INC. R/W 99,842 SQ. FT. cu I - o rr � CC.2.00 ACRES D R/W I .7 f 87,121 SQ. FT.E. 0 •I �I co c M v I UI Q vDl �I O I -,-4.`-f `Eo I UI �I Z. i ,_ gl F- o I (w, y ,I NOI c .o �II ��//// I I---I I—I cn Z "ii (/ t I Lc •I F` ` I —JI �I I • N' Z, A ■--o VJ O C, X CO I S89°52'42"E 225.12' M 65TH AVENUE - W1/4 CORNER _ - �_—. — _ —� 61/4 CORNER SECTION 31 i., SECTION 31 ® S89°25'09"E 2178.42' / EAST-WEST 1/4 LINE —^ _,1 S89°25'09"E 2905.43' S89°25'09"E 225.13' / i UNPLATTED LANDS I UNPLATTED LANDS J C S.M' 31 9g2_• SCALE IN FEET 1" = 80' I / .— ' �91 80 0 80 I / SHEET 1 OF 2 SHEETS 1 of 2 I Vol 26 Page 5944 CERTIFIED SURVEY MAP LOCATED IN PART OF THE SE1/4 OF THE NW1/4 OF SECTION 31 , T29N, R18W, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN. OWNER SURVEYOR RICHARD AND JANET STOUT EDWIN C FLANUM 1353 AWATUKEE TRAIL NORTHLAND SURVEYING,INC. HUDSON,WI 54016 P.O.BOX 152 AMERY,WI 54001 SURVEYOR'S CERTIFICATE I, Edwin C. Flanum, Registered Wisconsin Land Surveyor, hereby certify that by the direction of Richard Stout, I have surveyed,mapped and described the parcel of land which is represented by this Certified Survey Map;that the exterior boundary of the parcel of land surveyed and mapped is described as follows. A parcel of land located in part of the SE1/4 of the NW1/4 of Section 31,T29N, R18W,Town of Warren,St.Croix County,Wisconsin; described as follows: Commencing at the W1/4 Corner of said Section 31;thence S89°25'09"E,along the east-west 1/4 line of said section, 2178.42 feet to the east line of Lot 1 of a Certified Survey Map recorded in Volume 24, Page 5702, in Document Number 915512 being the point of beginning; thence continuing S89°25'09"E,along said east-west 1/4 line,225.13 feet;thence NO0°07'18"E 444.41 feet;thence N89°52'42"W 225.12 feet to said east line;thence S00°07'18"W 442.61 feet to the point of beginning. Described parcel contains 2.29 acres (99,842 Sq.Ft.). Parcel is subject to town road (65th Avenue) right-of-way and all other easements,restrictions, and covenants of record. I, also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described;that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes,the Land Subdivision Ordinance of the County of St. Croix and the Subdivision Ordinance of the Town of Warren,in surveying and mapping same. ;V:3 0�3 Edwin C. Flanum, R.L.S.2487 Date 4` •4040.UUg,, ®` \S0 0' V esi APPROVED . EDWIN C 'g `r? e FLANUM JUL 3 0 2013 , s-2487 o AMERY WI S I,C:KUIX CAJUN I Y COUNTY TREASURER'S CERTIFICATE ° IPA ° °.•°0 e PLANNING 8 ZONING OFFICE Oe�-6/O °..y.°.°° e®� STATE OF WISCONSIN)SS i4�1,,S+UR�j ,,`o‘ COUNTY OF ST.CROIX) I, Laurie Noble, being the duly elected, qualified and acting Treasurer of St. Croix County,do hereby certify that the records in my office show no unredeemed tax sales and no unpaid taxes or special assessments as of '1-3n— I 3 affecting the land included in this Certified Survey Map. • • '1130 1(3 Laurie Noble, Date County Treasurer Each parcel shown on this map (plat) is subject to State, County and Township laws, rules and regulations (i.e.,wetlands,minimum lot size, access to parcel, etc.).Before purchasing or developing any parcel contact the St.Croix County Zoning Office and the Town of Warren. SHEET 2 OF 2 SHEETS 2 of 2 Vol 26 Page 5944 1 STATE BAR OF WISCONSIN FORM 2- 1998 WARRANTY DEED i; 3174545 Tx:4143849 Document Number. -- — 983840 This Deed,made between BETH PABST RICHARD 0. STOUT and JANET P. STOUT , REGISTER OF DEEDS husband and wife, ST. CROIX CO., WI , Grantor, - 08/07/2013 2:06 PM and .TAMES JOSEPH JESSE and SANDRA MARTF ,TFSSF,• it EXEMPT#: NA husband and wife. REC FEE: 30.00 TRANS FEE: 105.00 , Grantee. PAGES: 1 Grantor,for a valuable consideration,conveys and warrants to Grantee the following described real estate in S t. _C'.ro i x County,State of Wisconsin: . .;Recording Area Located in part of the SE 1 /4 of the NW 1 /4 ii __— -— - of Section 31 , T29N, R18W, Town of Warren, INameandRemrnAddress St. Croix County, Wisconsin; J/a (Tessa- , More fully described as: Lot 2 of Certified � � �� Survey Map recorded in Vol. 26, Page 5944 i� A.064N/75, GO/ S a 23 on 07/30/2013, as Document No. 983266. . �`tz -708-6. --471c9-o Ca . Parcel Identification Number(PIN) This iS nothomestead property. (is) (is not) Exceptionstowarranties: easements, restrictions and rights-of-way of record. I Z. &el Dated this day of, August , 2013 . R)‘CHQIA11). (3).S .A--- (SEAL) (SEAT) * Richard 0. Stout Janet P. Stout (SEAL) (SEAL) * • AUTHENTICATION ACKNOWLEDGMENT . !. Signature(s) AIL . State of Wisconsin, ss. •1 St. Croix Coun 6 authenticated this day of 9 _0 `.,, Personally.came before me this 9 2.II 1 day of O�,( �,Q August . 2 01 3 , the above named Richard 0. Stout and Janet P. Stout TITLE:MEMBER STATE BAR OF WISCONSIN lto (If not, me known to be the person S who executed the foregoing authorized by§706.06,Wis.Stats.) instrumen .nr acknowled:e the same. THIS INSTRUMENT WAS DRAFTED BY r Janet P. Stout 1353 Awatukee Trail * CiirH ig a' - Hudson, WI 5401 6 . Notary Public,State of Wisconsin My commission is-permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not '3 1 15 -) 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. WARRANTY DEED - FORM No.2—1998 Milwaukee.Wis. • • Parcel #: 042-108640-050 eamig) C 07/10/2013 08:04 AM °� /� i PAGE 1 OF 1 �/ Alt. Parcel#: 31.29.18.4 3A- r f� , 042-TOWN OF WARREN Current X (,)) ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 05/04/2010 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner 0-STOUT, RICHARD 0&JANET P RICHARD 0&JANET P STOUT 1353 AWATUKEE TRL HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description SC 2422 SCH D ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 10.010 Plat: N/A-NOT AVAILABLE SEC 31 T29N R18W SE NW; EXC W 298 FT OF Block/Condo Bldg: S 330FT&EXC THAT PT TO ST OF WI AS DESC IN 913/201 &EXC AS DESC WD 828166 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) ASSMENT INC 042-1085-50-025(478A)& 31-29N-18W SE SW 042-1086-20-015(482A1) EXC PT TO CSM 24-5702 Notes: Parcel History: NEW FOR 2011;TAKES PT 042-1086-40-000 Date Doc# Vol/Page Type (483A) REMAINDER 042-1086-40-050 05/04/2010 915512 24/5702 CSM (483A-15)&CSM 24-5702 042-1086-40-100 06/23/2006 828166 WD (483A-30) 02/21/2006 818902 EZ-U 10/30/1998 590366 1371/568 WD more... 2013 SUMMARY Bill#: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/15/2011 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 10.010 1,900 0 1,900 NO Totals for 2013: General Property 10.010 1,900 0 1,900 Woodland 0.000 0 0 Totals for 2012: General Property 10.010 1,900 0 1,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 t l' �°:z.a k SIB I;I; R q 15E5 II § 4 § Y f. a J -_, — , III 4l'nlll-L'14111'IIh'il'11I�• I' 1 l I•I,;I•I l l jlllll-IIIIIIIIIIIIjIIIII! / jlll9lil�i dill IIII IuI ill.9 111 0,0!101 EN I dllill �a ;II1iI;I•: =.. II-R�Iili�i IIiR•9lil .. rior6,ill III�ilI'Idlli-; ■ii �Ild :11 .: I'IIII r�1 i�l ' I.I. �I.•.I 0i I. IAI habk 0 _ -� I�1�I�II'�II�I'IUP�IIII! 1.enver. m e 1 III 1� 6 c �� 'tea.mA o ® T. z I < < € t. IIIIIII ,, 1_ ®®®®UPI ®®®®IIII ;r -i®®®®® 014 ' c..... : Homo 414 (IIII, ! ®®®®® 001:1101 OF I f; ',I H I A < D. O 8 z 411- .1:_ „i, _. 3? ., e ia z a s s 5, a PRO]EEL - E` $°O :4 = o o JESSE RESIDENCE Midlsrrsi Did iir.l N D611,1•1 %, s` - tv m0 BUILDER: PAGE INFO: RESIDENTIAL•MULTIFAMILY•LIGHT COMMERCIAL WATERS EDGE CONSTRUCTION EXTERIOR ELEVATIONS 2920Enl,eSo-reL,SusIU 1°I-H•a.�,WI 54016 r rt PH.]I5-181-9J58 0