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HomeMy WebLinkAbout018-1090-61-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and t~.uilding 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 Smith, Dustin Hammond Townshi CST BM Elev: Insp. BM Elev: BM Descri tion: Csrl~~~ ~bp~b /v0. v _ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ w ~ ~• v Dosing Aeration Holding `~ TANK SETBAC INFORMATION TANK TO ~~ WELL BLDG. Vent t 'r Intake ROAD Septic 1 i ~Z~ 7 7i~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand PM Model Nu TDH Lift Frictio s System Head T Ft F ain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DATA County: $t. CrOiX Sanitary Permit No: 420766 0 State Plan ID No: Parcel Tax No: 018-1090-61-000 Sectionlfown/Range/Map No: 16.29.17.726 STATION BS HI FS ELEV. Benchma~ / 3- io /i73, L ~ DC7- d Alt. BM .ST , C6 Qb• Bldg. Sewer ~d;/G SUHt Inlet (~-Z X17.3 SUHt Outlet r ~r'J q / 7~ / Dt Inlet ~ Dt Bottom / Head Man. ~ P' / ~ 1 ~ 3 , Dist. ipeE °l i 1 D• ! ,Zy (f 3 - .3~ Bot. ystem ~ ] - I Final Grade ~^ .~ . b S St Cover 3. ~ Q. BED/TRENCH DIMENSIONS Width ^ ~ + ( Length ~ f / No. Of TgnChes 1 PIT DIMES No. Of Pits Inside Dia. Liquid Depth v n ~f 0 ~ SETBACK INFORMATION SYSTEM TO P/L BLDG WE L LAKE/STREAM EACH( G HAMBER OR Manufactur~c=f ~ ~ /y / /_ __~ c~T 'h ~i'L~ T f S stem: yp~,,^^ ~ /` 30 t wI ~ " ~ UNIT Model Number: t __ OYl DST ftIBUTION SYSTEM ~ ,2 ~ ~~#- ~..cS eader/ anifold ~ h ~~ Distribution ~ Pipe(s) y, ~ p ~ g ~ ~~~ x Hole x Hole Spacin Vent to Air Intake Lengt Dia Length Dia "S in ~~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ~ L ~ 'i Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedJTrench Center 2 Bed/Trench Edges Topsoil ~ Yes No ~1 Yes f-; No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 5/ /~ Inspection #2: / / Location: 1775 96th Ave Hamm/~o~nd, WI 1.) Alt BM Description = ~~. "~~~ 2.) Bldg sewer length = f ~''"3 ~ ~> ~ -amount of cover - Plan revision Required? ~ ~ Yes N Use other side for additional information. SBD-6710 (R.3/97) 54015 (SE 1/4 NE 1/4 16 T29N R17W) Pheasant Hills .Lot 61 Parcel No: 16.29.17.726 rr ~p i-,----~ ~ - -- i ~--- 0 Date Insepctor's Sign ture Cert. No. 1s S ~' tiE s~~ ,~ ~ ~ i~ w ~~~~ ~~ic•9s~~ f /-~ r/s ~b t r~dd~~ ~2~ z•~'x GB.~z` cetc~ 54~ and r,~~,,,,1~~k~ 4.C~4. U'v,F1 ~, b ~.rt.,s s Y s~-~.. ~I ~~ . 9a.c , s ~~61e ~~~o~o ~~ ~"!~~ ~^~~ i ,~ ,~ a N ~,,y~2 t (~ t~,o ~~ . ~ ~,o 4 ~_~ 7~„%s' ~~ G~DivG .iv ~iC ~li~ ---~ ~y ~~s ~3~~ ~N ~ ~ ~-.~-,4.~t. Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 County ~T' G r`o ~ X ` isconsin Madison, WI 53707 - 7162 (608)266-3151 Sanitary Permit Number be~ in by Co.) Department of Commerce Sanitary Permit Application State Plan LD. Number ~//~ ersonal information you provide Adm Code Wis 21 83 iU C , p . , omm . r !n accord w may be used for secondary proposes Privacy Law, s15.04(lxm) htl~ Address (if different than mailing address) ~ ?~r v,~ tti 9~~ 1. Application lnformatIon -Please Print All lnformation Property Oyr~ger's Name ~ , ~~ ~ Parcel # Lot # Block # Nf/ +( N s f'iN Property owner's Mailing Address 7 7~ ~~/ "' ~r/ I%i Property Locat~io~n / ~ ~y `!'~'~., section ~ t0 City, State Zi p Code Phone Number ~ f~ / fy ~~ ` J ~~ 7~5"' 9 ~' n T Z'i N; R / cE oe ~~ ~ .~a6 l h t ll y) t a app 11. Type of Building (check a ~~ 1 or 2 Family Dwelling -Number of Bedrooms __ Sulrli ision Name CSM Number ~~ G~~y~ U[/~ ~ t ~ ~~ 7~// 7 / ^ Public/Coarmercial -Describe Use /~ ~}~ ~.~+ f it/LG"/yG~LS ~ ~~ ~ ^City_^Village~Townslripof ^StateOwned-Describe Use o N 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' New System ^ Replacement System ^ Treatmeut/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit TransSer to New list Previous Permit Number and Date Issued Before Expiration Plumber Owner V. T e of POVVTS S stem: Check all that a l Non -Pressurized ln-Ground ^ Mound ? 24 in. of suitable soil ^ Mound < 24 m. of suitable soil ^ At-Crrade ^ Single Pass Sand Filter ^ Conshucted Wetland ^ Pressurized In-Ctround ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recir+culating Sand Fiher ^ Recirculating Synthetic Media Filter Leaching Chamber ^ Drip line ^ Gravel-less Pi ^ Other ( lain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf j System Elevation ~ 9~ . ~s~ . ~ Y3 ~ y Vl. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Ncw Existing Tanks Tanks Septic or Holding Tank u/ Aerobic Ttcx[mcnt Unit Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the atfac6ed plans. P (LS.r, Z Plumber's Signature /~l~ /.39 G Z B~=.?3,S'"~f~ Pltumber's Address (Street, City, State, Zip Code) ~" ~ l~UC /~'lCrw/r1on-v wr SY~S"~ Vlll. Count /De artment Use Onl ^ Approved ^ Disapproved ~m~'Y Pernut Fee (inclttdes Grotmdwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ^ Owner Given Reason for Denial 1X. Conditions of ApprovaUReasons for Disapproval m" /' (/ l~ J~ v AltYtll GOn1QICrl' PIYYf t[o [0C ~,oun[y uwy~ .ur .rc sysu:w uu NaW. uva aa....... o,... ~ .....~........ -...- ~•l SBD-6398 (R. 01/03) Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7082 C~h' .S~ ~- ~ Madrson, WI 53707 - 7082 i Sanitary Permit Nnnrber (to be filled in by Co.) (608) 261-6546 scons~n Department of Commerce State Plan LD. Number Sanitary Permit Application rovide tion ou l i f ~/ ~ y p orma n In accord with Comm 83.21, Wis. Adm Code, persona may be used for secondary purposes Privacy Law, s 15.04(1 xm) Project Address (if~ ffye~rgnt tl>an mailing addr/) f All I i ion orms n nt 1. Application Information -Please Pr ~`~ ~, ~- Property Owner's Name ~ n ~ ~ o o ~ APR V Parcel # Lot # Block # ~/ w~' I ~''~I Property Owner's Mailing Address u ST.CRCIX000NTY PropertyLocanon ~~ s+ ZON4NG OFFIGE l ~ y,, ~r %., Section _~ City, fate Zip Code Phone N ~ S ~•!! l ~+ ~r S- Z O circle o e) / - ~ 7Z~ RI7( E ~ , ~I (N(. Y o i N; T 11. Type of Building (check all that apply) ~,/ ~~~~ .L~J 1 or 2 Family Dwel-ing -Number of Bedrooms _---_~~ - ,i• y`~ Subdivision Name CSM Number i. • ^ Public/Cotnmereial -Describe Use ~ r~ C~ ^City_^Villagell~Township of . ^ State Owned -Describe Use ~ 111. Type of Permit: (Check only one box on line A. Complete line B if a licable) `~' ~ New System ^ Replacement System ^ TreatmenUHolding Tank Replacetent Only ^ Other Modification to Existarg System list Previous Permit Number and Date Issued B. ^ Permit R®ewai ^ Permit Revision ^ Change of ^ Permit Transfer to New Before Expiration ~~ O"'~ IV. T of POWTS S stem: Check all that a L Non -Pressurized In-Ground ^ Mound > 24 in. of suiffible soil ^ Mound < 24 ut. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized !n- ding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recireulating Sand Filter ^ Recirculating Synthetic Media Fil (~.eaChin Chamber Drip line ^ Grave s Pi ^ Other (ex lain) ~ V. D[s rsaUTreatment Area Info Z ?~ ?'1~YL 3 1• I ~~ Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required Dispersal ea Proposed (sf) System Elevation 5a - `7 '~ ~ ~3 `~ .- ~o ' Vl. Tank Info CaPaclty m Total Number ~ ~ ~Ma/nufacturer Prefab Site Steel Fiber Plastic G~"'v""' ~/ ~ Concrete Constricted Glass Gallons Gallons of Units ~t/ i Ncw Exiv~ing ~ Tanks Tanks Scp[ic ut`id~ldily~S3plr ~` ~O ! ~.~ Acmhir T.+,~,,.,cnt Unit '~~,.,~ Dcning Chamber +-~ I ~~ VII. Responsibility Statement- 1, the unde ned, ass r nsibiiity for installation of the POWTS shown on the attached plans. Business Phone Number Pl~umb~er's Name (Print) P 's Signs MP/MPRS Number / o~0 1. ~u ~.. la 2. ~- 2aS'" 2~ Plumber's Address (Sheet, City, State, Zip ~ ~ fir [~/+~,}.~~ g ~ 'Zi~ ~ ~/f/Qr U T' L v f Vlll. oun /De artment Use Onl Sanitary Permit Fee (includes Groundwater Da Issued umg ent Signatur o Stamps) Approved ^ Disapproved Surcharge Fee) ~•}a~ ~ ~D y~a v [-~/ ' ' ^ Owner Given Reason for Denial is fo r ApprovaUReasons ~/ ~0~~ ~ J o f ditions n LX. Co approval ~ / C D~ ~ ~ ' ~r ~,~o. ~ /g ~ ~ ~ ~ / iQ. jG -E 7 / - " Q ( l~ (.,X.I~~rxN~~L41^'r~£^~' ~ Gt/~-~" ° U ~ ...r ~... then alrz x 11 iacMe~ ie size ~~ U ~ ` Attit6 conlpM p.~wc~u.7~i/~~~r. --..--- --__ ,,yl~,.,. ,-~ ah.c ~fP't•-ti LY ~ ~Q2d'ri- lU/ SBD-6398 (R. 08/02) I~ ~e-,~s r~-'~.~ - l~ ~ is ~ s T y~ ~ ~ -fir ~rn ~T ~r~ ST ~ (\D ~,~ ~o. ~ ~e,,~s rt-~T ~~ ~ls 1sT ~ ~, z-r ~ ~r ~c S~ ~ ro r,Y ~o. ~`~- (o`r ~/~ ~~ - ~-- ~~ ~ ~ ~ ,- ~ ` x . .- -~~'~. 1 ,\ ?, I~-15 ~~~ , ~' r ~ 2.97' ~I~RE~) _ _ - _~~ _` \, ... S€T6AC~ x ~ Q _ - ~ f i_ ....... ---.... ~~~`.... t .~, 1 B_ 19 r.~, ~ ELEV. •~ ! l2T. 73 ~ '- - ~ 3 ~ ~~2; ~-._.__ ; ' s=ue X ° ~. r s9 - R O p - -~-~ _._. _ ._..--~- , 9 3 .. .....~ .... . ... ..1`. ....... r ~ 226. 43 ~ _~, /-~. 95 t,l ',.~ SF Tg 1AIC~IC .. .. i .... , `, x `~ ~,NE c3- \ • ~ ~ ~ ~'~,~ a ,' ', ~'~ J B-23 x ,! ~, /~ ~,~, ~.-~ - r ~~- _ N -~_~ . ; - - ~, _ n x ~~~ t " ~. ~ ~ , O ~. ~ -- -, ~C 2A~E'S'fr'1VE7 BUILOABFif S~ \ y _"-~~--.,~-'~-,-~~ - ~` ~~ ~~ ~ `-•` ~' %~ --- n EX I5T f NG FENC ~ ~.-.~,~1 --__ /_ _ _~_~.~ x_a+.oxl ti~.......ti.,.,,,,` . ,~ ... -~.i/ % ~ ' x. SPOT ELEVATI ~_~~,-`' ij~\__.. ` ~'' ~7 ,_-___:' - EXI5TING BUILDING '~ ~ ~ =r: THAT (/' -~ ~ EXISt1NG TREE ~,~,S,O~S Nelsen-Weber. L. ISIONS ~ 8-1 ~ = SOIL BORING AN0 NUMBER r / 1 S; = I ND 1 CATES SLOPES OF 12x- ! 9x 9Q8~ RED CSD11A 9T'R$ET 9U1T8 5 ~( 1 Np 1 CA tES SLOPES POx OR GREATER If~EOIiI~' ~' S47b1 (y16~..296-6841 .. ' ~ BENCHMARK ' ... ..... .•.•... .... •.... ..... ..~. .... ~... ..~~~•~.•~•~.•r~.•... r.•..~.. ` ~.. 1 ..... .....~ .. ... ... .. ... .... .. /', "'iii,"' M R i r WEATHERPROOF LOCKING C:OVfiR ~ 'TUNCT'o" 4v~cK Oi°c.o.~~tcT--~ ~~~ ~ ~ -a.,, b„ ~, .4~ ~ 1.' --~ ~ }° PIPE 3" p NDISYuR6ED Pic ' ,\ kl, I SOIL ~y;1~~Z4" I.D, ~I 4" 4 0 '' YENTI ., h 7,:~ ins r ~rc~ _ _ _ G'wU.o QW is ov to. , -- ~ :T ~irrr•J _~ ~FLES ~ 4 0 PIIG 4 ~ A~ 3' ono 1 n ~ ~N .. u+i~,n.>'c4 ,EC.'/~o>•+S `~yc ~1.~ ~o.~X, . ~ -`1`1'0 ,( G~auuo CacF Pw~P ~ P l Corvr.~e~r~ Fem. -.___ i bcoCK I ~EPT1C F OSE 'A-.~~:5 IARI"1 JM~ SPECIFI~CATIOIJS i-S- ~ MA-JUFACTURCR' " ~~` u S .gj TAi.1K SIZC ; ~ tT ~?O ~ ~~ GALl.O-JS Sw1TCH TyPC; ~~`"~` '"`~ SWITCH TtiPC; ~¢.~..iv w M1IJIMUM DISCHARGE RATC_ 3~ GIh1 UM@ER OF DOSES• PEk 0~~ DOSC VOLUME IIJCLUOIIJ6 6AGK/LOW: 9~ GA~~ONS CAPACITIES: ~- ~~~ WCNCS OK ~~ W~~o~s o, S;3 ,UcHES oK ~~ c~~~o~; D"~ IN~HES OR S~, GAl~~1J: IJOTE: PUMP A1J0 ALA RM ARC T O @C INSTAll.EO OIJ SCPARAT C CIKC~ ~~~ _RTICA~ DiiFCRC1JCf OCTWCCU PUMP OFF AA10 OIJTRI~UTIOIJ PIPE.. _.~~ FCCT • rt~uihuM -JETWORK SUPPIy PRCLZURE ~ ~ _~ .FCCT • ~ f C ET OF FORCC MAIN X~--'-/~O ILFKICTIOU FACTOR, _ ~~s . FEET (~ 3S 1 r„` - TOTAL D~-JAM-C HEAD ~~ FEET ~~ TERtJA~. p~ME-.1610/JG •0/ TA1JK: LE-JC,7H ~~ ;W;DTH 2'11 ~LIQU10 OCPTH 2 ~ `~ 4 Wholesale Products Page: 6350-1 Section: Performance Data Dated: January 2001 _~ 9 ~3 W V1 LL W Z 6 ~2 v = ~ ~ z 0 3 '-1 OL 0 0 0 SHEF30 n Capacity-U.S. G.P.M 10 20 30 40 50 ~ ~ Liters/Second 0 1 2 3 The curves reflect maximum pertormance characteristics without exceeding full load (Nameplate) horsepower. All pumps have a service factor of 1.2.Operation is recommended in the bounded area with operational point within the curve limit. Performance curves are based on actual tests with clear water at 70° F. and 1280 feet site elevation. Conditions of Service: GPM: TDH: ~~ HYDROMATIC 12r 4 wtttconsin Department of Commerne SOIL. EVALUATION REPORT Page ~ ar ~. Division of Safety end Buildings in accordance with Comm 85, V16s. Adm. Code ~~ Attach oompletie site plan on paper not lei than 8112 x 11 incites in sue. Plan must • inducts, but not IitniGed to: vertical and horizontal referem~e point (&IA), direction and Parcel I.D. // ~ 'r7~ ~ peroeM slope. scale or dimensions, north arrow, and bcatiort and distance to nearest road. p - 0 + (o /- OU ~ Please print aN lnfor~aibp~-.~, 1 ~ -, . Date P~~ >~ yw, r ~y bs used nor ~gr~lv~v-tar~.s. ls.oa (tl tm»• GGf/1/ir~, '~ Z 6 3 riy location Property Owner Ry~.,l f i~~.~l~l~U Gorr, lot 1/4 1/4 S T N R~ E (or~ PropeAy Owner's Maipng Address Lot Block # Name or CSMIf . ~~ ~ ~ - -~ 0 C T s ~ 2Q00 _ •~ Cdy gtate Zip Code ~ ~~one 1rC,ity Q Village (,1~1 Tawn Nearest Road ~ ~..-- -~~ w.~, . 1 . ~I . CI I n.GY~i~C ~YSL~~~' ~v ./LUtv~.~M/lMV', 1 1~^~ ~_ New Ca~uc~ort tJse: (~ Residential / Nurr~tl~r oE~p ~ Code deriuoed design flow retie a UCJ GPD ^ t~acernent a P~Nc or oommeraai -~De~ba:---' Parent ma6erial ~ i l / Food Plain elevation if applicable ft $ ,Sf etv-~ of ~ ~ • ~oP 9Z.sd 6 a w t /" q2 . o a ~cru. L.w~ ~ Z. S' i5. ~ o Pit Ground surface ebv. ~. (o(J R Dept to limiting factor ~_ in. ~ RaOe H i D th i t C b D iptbn Redox Des Texture Structure Cortsistertoe Boundary Roots GP D/dP or zon ep in. om nan o MunseN d t1u. Sz. Coat Cobr Gr. Sz. Sh. •EffB'I 'Eff#2 o v --- S •l 2 ~~ • Z ~f ~ ~ - , g lyd M 1-- rn,S 1 -- ~ /• 2 D-o = 5~. L., ~~,2~ tiring # 0 ~"~' ®Pit Ground surf~e elev. 5 d ft to limiting factor _- 3o in. ~ Rate Horizon Dominant Redox Descxiption Texture Struchtre Cortsistertoe Boundary Roots GP D?dP in. Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Eff~1 "Eti#2 I 2 ---- 5i/ ~ v~ Z c -- $ 3 .~ ~ .._.- 5 -- -' • ~ 1.2 o ` ~ `~ * cm. ~..a ~ .- ann ~ nn ~ mn ....,n ~nr) TCC ~Rrl ~ ~ 5r1 mutt • Etih~ant !R2.80 Q < 30 moll acid TSS < ~ mpll - -- -- _ - - CST Name (Please Prvtt) _ Signatu CST t~xriber A,~~ Da6e Evaluation Cortdclcted Telepftor>e Number 2\~ $p~' do lo-lu-cx~ t--2y~-yc`~O~ Property Owner ~ /1 T'~ Parcel ID # Page ~~~ ~~ # ~ Borg Pit Ground surfar;eelev. • 2~ft. Depth m Ircniting facbDr! s~-1-in. ~ I~~ ~th ~tiOn D Texture Structure Consis>sence Boundary Roots GP D/fP Hor~on Depth in. Dominant Color Mur>sell esa Redox Qu. Sz. Cont Cobr Gr. Sz. Sh. *Eff#1 *Eff#2 2 p~ 2 ---- ,~ Sf' I . ~ Zmab c ~ v~ .-. •~ ~~ # U Bonng ^ Pit Ground surface elev. ft. Depth to limiting factor in.~ ~ Sad Rate tian i D d Texture Struc~ue Conctsbence Boundary Roots GP D/fP Horizon Depth in. Dominant Cob Munsell p esp Re ox Qu. Sz. C,ont Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # U Boring ^ Pit Ground surface elev. ~ft Depth to IimiUn9 factor in. Soil Rate tion Desai d R Texture Sb'ucture Consistence Boundary Roots GP D/fr? Horizon Depth in. Dominant Cob Munsell p e ox Qu. Sz. Coat Cobr Gr. ~. Sh• •Efflf1 * * Effluent #1 = BODS > 30 <_ 220 mglL and TSS >30 _< t50 mglL * Effluent #2 = BODS < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. san-s3so (ttmroo~ PAGE~OF .~ NAME 1~01'1-Ff LOT# (~ ~ LEGAL DESCRIPTIONSL '/oNt'/4,S!(~ T Z4,N,R / ~E (orJ~ SCALE: I"= ~~ ~ BM I ELEVATION j~ - BM I DESCRIPTION Yla r~I ~• ti (o ~~G~ ~ BM 2 ELEVATION /OU . U BM 2 DESCRIPTION y(~e ~• ~ +~ ~ (9 •~ -G~~ SYSTEM ELEVATION ~p HZ•S~ Guwer 9~'pO ALTERNATE ELEVATION fo ~ °t'/.Ct. ° /mow-~-,- 9l-ba CONTOUR ELEVATION 0 ~ - x /~ I 03/10/03 MON 18:05 FAX 651 578 5332 Woodbury CRC - 2nd Floor Mar 14 03 o3:3Qp 6ants! Exeavatinl; [7151796-P519 OwnerBuyer Mailing Address Property Address ST CR017L COUN'T'Y S~P'TIC TANK MAINTBNANCB AGRBENI~NT AND Oq/Ng~HIP CgRTIFICATiON PORM A ~ sM --~h .~ A ~~.. i ~( 6~ ~~ (vecifieadon tequitod ftat>a Ptattutn6 ~P~ for oe~r l~ t~oo1 P-2 61X- logy - 61- (x~o ~'•. - M~ ~l [~ ~ ~~. Parcel Idzntifieation Number --- ~ly/Start r unr r - ~v.,r_ ~i . DF.SCR'I'~T'IDN Location %•,.~.~'/.. Sec. ~ 6 . T~N-Rr.~--W~ 'Towu of ~u - ~~ ~-- ~-~`":_ -N' l Is s~ ~-~ C-~ ova I.ot ~ .J....Y. Snbdlvision ---~--- - Vvltnae Page # (~rptied Survey M,ap # ~ ~ ~ ~ ~ ~ Volume ~ ~ Page # I 'QVarrxntY Decd # _ '-r' -- Spot boost ^ Yes ~ eta Lot Iin~e idaatifxable Ql l+~ O no ~~ tt:ta Wald s'e=ult in its p 4ilune tv handle wrutes.l'toper maiotet»ncc ~rot~ ~ t!u sepdie tattkofevery Ibrsre yet+ra a svaaer. if aaoded by a liosdtad pamp~i• What you put ittto die ry:tem eoositt~ of putnpiaS tank ss a tt+eamxnt serSe in the wsate dsspo~ ~~' ap, 'oat the fztpetlott of the ieP1k a atr fotm. sig~od by the otHSer and by a The prape[tY owner ag<~oes to submit to St t~oiat Zoning aDt±;~°' ~y~ ~t(1) ~ on-cite ~vastewauxdisPos+l ~~ masrtrptvmber, joaraeY~ Pl~• ~iOdP~ m s lic~sed ~ ~ ~e tank i! less dtan 1/3 fu11 of sludge. is is psnpci opefi~8 eoodidoa wd/ar (~) alkr iaspootto° as~d P~P~ (. vabe sewsQe disposal aY~m' with the srandsrds h,~ ~ ~ Itava teed the above •vquitsme'ass and a~ W maia0i;i ~ Pre State of Wi~~ Cestifiptioo of Commia+ea and tba Deparaneat of Nataaal RRSOUCOes. t7f~ ~vlthia 30 rat forth, hci~eio. ~ sct by the Dapt~t eo the St. t~vix C.ouatY Z~ sp4p~ that yom septic system bas been maintaiatd mwt ba eotapleted turd rettnaed da of the 1"CU expiration date. DATE GNA OF APPI,ICANC OWI~iER CERTiY'~CATIOlY ald e t we am <~) the owaeKS) aC t (wt:) unity that alt rlsteaaents on this foran arc fiat to ~e best of er of Doads Office. • ( ttee pro sty deseri above, by vis{ua of s wattattty deed tuoeded in Rasict 3~ co, 0 ~~ DATE O 1-PPLICANT cnt ...... AnY tpfostoatiott that is aftis-szprescntcd may result is the canitacy pesmst boiag ravoked by the Zoning Depattm .••.•. •• lndade wftb this applteattea: s ctaatpod rvatnsngr deed from dse Iteg~ of Deeds office a spy of the certified esuvay soap if tt:feteoee i; made in the watssntl- deed ~,~3 : 28 ~ O1 TUE 15 :11 FAX 715 388 4686 ST CRX CO ZONING ~dx~ ~ 0~1 POWTS G1WNEl~'S MANUA4 aL MAii`4p1UC!'''fl~i~l !"LAJtV .-.r r^ r z w to vw.f ATt['11~1 -~..a ,.~.....-- - Owner Permit # ~!~ p "~ Q „ -~ DESIGI~I PARA!"1C1r.~ '? Q NA Number of Bedrooms , Number of Commerdai Units --~-~A Estimated flow (average) ~~ gaiJday Design flow tpeak), (Estimated x t.5) d gat/day Soil Application Rate ~-~ gaVdaylft~ inffuentl£Ffluent Quality Mond,iy average` Fats, Oil bL Grease (FOG) X30 mg/L Biochemical Oxygen Demand {BpDs) X220 mg/L ToWt Suspended Solids (T55) s i 50 mglt Pretreated Effluent Quality ' ^ NA Monthly average*' Biochemtcai Oxygen Demand (BODs) X30 mg/L Total Suspended Sopds (TSS) X30 mglL fecal Conform (eometric mean s 10' cfu/ ] OOmI Maximum Effluent Particle Sine ~ inch diameter MA1NT>ETIANCii; SCHEDi1LE Service tcvent Irupect condition of tank(s) Pump out Contents of link(s) Inspect dispersal cell(s) Clean effluent filter inspect pump, pump controls BL:atarm FiusEr taterats and pressure test Othere SYSTEM SiaECiirlcwnvn~ Septic Tank Capadty ! ^ NA Septic Tank Manufacturer ^ NA affluent Filter Manufacturer ^ NA Eniuent Fitter Model ^ NA Pump Tank Capacity gat ^ NA Pump Tank Manufacturer Q NA Pvmp Manufacwrer it. ^ NA Pump Model '~ ^ ~' Pretreatment Unit ^ NA ^ Sand/Gravel Filter ^ Peat Fitter p Mechanical Aeration ^ Werland ^ l~isinfeCtlon ^ Qther: Manufacturer Dispersal Celi(s} ,igL.tn-grQUnd {gravity) e•~ee~r~d-{~ 15*vi~`-re'd} ^ At-grade ^ Mound ^ br! -itne ^ Qther: * Values tyRka! for domestic (non.commerclal) w#SLew~ter end sept(t tank effluent. • * ValaQS typical for pretreated wastewater. -- Service Fregaenty At least once every 3 ^ months year(s) (Maximum 3 yrs. ) When combined sludge and scum equals one-third (Ys) of tank volume Ac least once every '3 ©months ear(s) (Maximum 3 Yrs.) At least once every At least once every At least once every At least once every At least once every ^ months D months 1r'~S-ear(s} Cl NA D months ^ year(s) ^ NA © months D year(s) ^ NA ^ months Q year(s) ^ NA MA1NT>+NAI~ICE IAIS'iR~CTPONS (nspettlons of anks and dispersal cel~ewelr• POWT5 ~nsaector POaWTS Maintainer;f SepUge Servicing Operator~Tan lnspetn'on Plumber; Master Plumber Restricted S , must include a visttai inspection of~m and to checkfor an b k uP or Pending of effluention the ground surfateeaThe dispersal volume of combined studg~e ands and to check for any pending of effluent on cell(s) sha[I be visually Inspected to theck the effluent levels to the a(~servation pipes the ground surface. The pending of effluent on the ground surface may Indicate a failing Condition and requires the immediate nadfleation of the Sava[ r~tlatory autharity- When the combined ac (l be IrUmovedsluda $eptage Servtdng Operatorland d pissed o)f in atcordan etwith th.iNR 1 ~3, Wiscansi contents of the tank sha by Admintstrattve Code. The servicing of effluent Biters, ~ als o~i 2 morn orl Qhail be performed by a certified POWTS Ma ntaine~ ny other maintenance or monitoring at In A service report shall be provided to the focal regulatory autharlty within l0 days of completion of a>Sy service event. START UP AMID OPf~tATI~N for new construction, prior to use of the POWTS check treatment tank(s) fo~f' hi¢it oncentrations are detected have~the con eln~ that may impede ~ treatment prates and/or damage the dispersal cell(s). ~r ~ti. rantrfSb ramovad 5Y ~ tent~-e srrvicing onerztor pcio~ to use. ;:3!28'41' TGE 15:11 F:l.Y 715 X86 466 ST CRg CO ZONING ~ 002 Pica __of.,,- System start up :half not occur when sal Con41t1ons are frorm at rift InfUtraclys turlace• During power autaBes pump sinks may n!l above nomtaf hfattwacer levels. Whin powsr es s+tstor+ed the exceu wastewater wits be d'ucharged us the dlsaersaJ cell(s) lrt one verge dose, ovsrfoading tise celt(sj and may rcsltti fn the backup or sutfica dJschar~ v+ oftlucnt. To ivold this situat-on havr the Contents of tlfs pump tank rlrtl4vtd by ~ Se~uttt Servking Opentor•prior t4 resccrtnx power co tfx affluent pump tx contact a Plumber ar PpWTS Malntakter to assist in manually operatlrtg the pump Cgntrols w rrstare normal levels within Lhe pump tank. . Do not drive or park ventcles over tanks ind dispersal cells. Do Hat drive or puk ovrr, or athetwlss dbturb or compact, the area wicttlrs 15 feet down scone of any mound or ac•Erade soft absorptloh xe'ea. Reductlott or rUmtnacfon of the loltowirlg tr4nt tht wastewater atr~arn ~y fntprovs ~ Ptrforn'+ir+Gt astd prvJotsg tt-s tits of t`k POWTS: antlbiotla; baay wipes; clgarstte buttst condoms; tottoA swabs; dsgreasera; dental Rost; diaptr3j dWnfettanu; tat; founQatian drain lsump Hump) water; frtttt and wtgttab(t petUrt~ easnNnsf 6r'easel herb~icf4~t; msx scups; medications; oi-; nalntfnR eroduct3: pestfddes: sanitary n~okins: tampons: and water Softener t7-1rsl. AgAN DOtd EM IEN7 When the PQWTS faits and/or is permanently taken out of service the tolfowlrsg Seeps shat) by taken tv incurs that the system is property and sifetY abandoned to compilance with th. Comm 83.3, Wiscortslrr Adrntnbtratiw Code: • r4tl plptrtg to tanks and pits Shall bt dlscPntrKtsQ snd Ilse abattidoned pips qH~t~ jsakd• The contents of aA tanks and pits :full lye removed artd prc+per'y_ disposed of by a Sept,~e Servkln~ Operator. • Aker hvrnping, ati tarsks and plu shall ba excavated xnd removed or thtlr rovers removed. sn0 the void space tilled with soil, ~ravti of invther Inert svQd matrrial. CONTiNGENG'1' P6AIN tf the i~OWY'S faits atilt cannot be repaired the tatiowing measures have. l~stn, or must bs taken, to provl4e a cods compliant reptxe nt system; suitable replacement area has been evaluated and may bt uUtiud for the iocatlors of a nplaetmsrst soft absorption system. The rsp[atemsnt area should be prbtkcte6 from diswrbaate and cornpatr{on and should not be infrts~sd upon e>• regttiretf Setbacks from sXistltlg and ptoposrd itr4iCtW'e, lot titses• and wills. Pailvre to prote~Ct the replacement area will result in the need for a new sell arsd site evaluatfari to tstat+{Ish a suttasale replacemett aria. Repfxtmsnt rystsrns rnwt tQR'1Qly Witr- CFte rUJei In sffiect ;t thaC C1trIR• p A sultablE repfacsnxnt area is not avatlabte due w srtl?ack•and/or soil Ifmltatbns. 13arttt~ advutc~ts In PC?WTS technv(egr~ a hvldfng tank maY be it~ita>aed lei a fast re•svrt W reptact the' ti(Isd PGW1"S. /~ a si a n tit cWl led tp l lily m ~+Itabh seat U faiitue the PC'- a sot] a d site /~ (v Y ~ e tlo st parr nn , to I a ae nt a. I t#p to L oval olds g-t.s+~1C rn ~ ba instilte as a lac rt W acs t acted O S. p Ntound and at•grdde sac( absorption systsrtu rniY be retotsstrutied fn plies fottowinr rsrnovaJ of tl~t bipmac at the InAitragve surface. Reconstructions v! such systems titust.cvmpkj with the lutes its si'fect u that dme. < < WAitNI1JG ~ ~ SES+'TlC, fPtf1MP AND O~TKER TREATMENT TANKS MAY.CONTA(tri r<.E'rFl14L GASSES ANO/OR 1TdSt1F1+1Gtgl1T OXYGEN. OC NOY EHYER ~ SEr'fIC, PuM- OR OTN~ Tf-tEATMEN? TAwK UNDER ANY CiRCuMSTaKCES. DEATH M~tY RESU(-T~ JRESGUS 4F A pERSOAt fRgM T>IEE INTERIOR OF w TANK MAY iE D{PFfIGUtT OR tliDl1CC1R1 i. At'~?Dt7{~GNA6 COMMRNTS f OWTS INSTAl.1.fcR 1~t~me Z Phofie ..~ SkPTAGE SERVrC{NG OPERATQR PUMi'tER Noma n ~4WTS MAiNi'TAINER Name L. S:,,t1'Z, F- JZO +~ TORY AU7H - 6 r- _ _a ~~ ~ Q ~/,\,~ . / `~v ' ~~ ,. '' ~~~~~ LOT 29 I.3T ACRES 68, b24 S0. FT. ' MYE 106P' Sao LFE 1064' ,~ ~~ ,, s. % P~ ,~0 2 ~ r i ' ' pQ` 1~` 5~ ~ a~. 28 , ~2~s ~~` ti :RES , 6s, ;0. FT. ~ ~~ ~~. i i ~, i i ~ ~~' OO • i / 1^'-~~ Y~ ~0. ~O • l~ UT I L ItTY~~ EASEMENTS NO POLE 'OR BUR 1 ED CABLES ' ARE:.TO . BE PLACED .SUCH THAT THE INSTALLATION, W0UL0 DISTURB ANY SURVEY STAKE, : OR OBSTRUCT VISION ALONG ANY L OT L I NE OR STREET L 1 NE. THE DISTURBANCE `OF `. A:SURVEY STAKE''. BY ANYONE'. IS~~ A VIOLATION OF SECTION., 236.32' OF: W I SCONS 1 N. STATUTES. UT 1 L I TY EASE14ENTS AS' HERE 1 N;; SET .FORTH ARE FOR .THE USE OF PUBLIC BODIES AND PRIVATE'UTILITIES'HAVING THE R 1 GHT TO SERVE 'THE AREA. o SET 2. 3 TS' 0. D. X 30' 1 RON P 1 PE` WE 1 GH 1 NG 3. 65 L BS. PER L 1 NEAR FOOT. NOTE : SET 1 • O. D. X 24' .; , I RON ~ P7 PE `WEIGHING :.1. 13 L BS. PER L 1 NEAR FOOT A T ALL OTHER LOT CORNERS. • UT I L 1 TY EASEA•~NT f TYP:) , • • • • ROADWAY SETBACK ~:, f ~/ PROPOSED DRIVEWAY LOCATIONS ~ JAME3 M. ~ ® ~ WEBER ,., ~; , . S • 1804. --------°----- •DRA -NAGE AREA "3PRIN0 VALLEY B GOVERNhENT CORNER ~AS 'NOTED <9 ~~~_' O. f ~, HWE H 1 GH WATER 'ELEVATION "'~~~~ LFE LOWEST• FLOOR ELEVATION ~~~If11~ON0~~,~ ' THE PARCELS SHOWN ON TH 1 S MAP. ARE," SUBJECT , TO ', COUNTY AND TOWN LAWS, ;RULES- AND' REGULATIONS WETLANDS, MIN 1 MUM LOT S 1 ZE, ACCESS :.T0 ..PARCEL,. ~. BEFORE PURCHASING OR DEVELOPING ANY,PARCEL, ACT THE ST. CRO I X COUNTY ZON 1 NG OFF f CE' AND` THE f C~~ ~P art iVb4 ~~~ ... Y. ~~,~V ^-r ,. ~~ ` . ~°~ ~ 62 ..ma, \6 h •~ ' ~2 TOP OF. 1':. IR PIPE 1061. DSO'-' hoc ~ 6 ~ X23 q _.~~~ Via. 1,srcROrx~co.wrs, ~~ 0~, ~ 'ADs~p~ ~t v'c1oc~ M:R.coo~tt'd~od is ~`9i S 1 i4 CORNER OF - SECTION 9, T29N, R 1 TW. (FOUND ALUM 1 Nl MONUI4ENT ). U 1879P `t03 STATE BAR OF WISCONSIN FORM I - 1998 WARRANTY DEED I)oclattere Number This Deed, made between Ronald C. Bonte Glenn A Knudtson Grantor, and Gary S, Smith, Suzanne A. Smith, and Dustin A. Smith . Grantee. Grantor, for a valuable consldentlon, conveys to Grantee the following dcscrlbed real estate In St _ f'.rn i,~ County, Slate of Wlsconstn (the 'Property'): Part of the SE ~ of the NE ~ of Section, 16 Township 29 North, Range 17 West, St, Croix County, Wisconsin, described as follows: ~- Lot 61 of Pheasant Hills First Ad 'on filed May 8th, 2001 in Volume 8, Page 8, Document #644952 6 7 7 4 4 3 KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 04-29-2002 9:30 AM WARRANTY DEED E)<ENPT 1 REC FEE: 11.00 TRANS FEE: 105.00 COPY FEE: CERT COPY FEE: PAGES: 1 Recadinp Area Name and RNum Addraa KRI^T'~t.1 OGLAND AT:~ ~,. q-~ LAW "': 3,ri9 HU_,,:.. ,J154016 018-1090-61-000 Pttrcer loenuaca0on Number p+IM This iS not homestead property. (Is) (Is riot) Together with all appurtenant rights, tlt:~and interests. Grantor warrants that the title to the Property fs good, Indefaaslble In fee simple and free and clear of encumbrances except Easements, licenses, zoning ordinances, and restrictions of record. Datedthls 25th day of April 2002 1'~" `_""" ~ . 1S'_'' " `~ (SEAL) ~~~~ ^ (SEAL) . Ronald C. Borate •_ Glenn A_ Knudtson (SEAL) (SEAL] AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wiaconatn, ,,. St, CTOlx County. authenticated this day of Personally came beforc me this a~L,}~., day of Apri 1 , ~_, the above named Ronald C. Borate Glenn A. Knudtson fITI,E, MEMBER STATE BAR OF WISCONSIN _;~~'' to (If not. ma known to be the person s WhQ,! Ce~the.foStgaing authorized by §706.06, Wls. Stars.) Irutrument and acknowledge ma ~ ~ ~'~' • THIS INSTRUMENT WAS DRAFTED BV ! ~ ~;+ ~/ Ronald C_ Borate 1011 170th St ~L'21~i7f N ~:.~~~~• Hammond, WI 5401 5 (71 5 )-796-5240 Notary Public, state of Wlscoruln >< My cornmisslon b permanent. (1f not, atttptritlon date: (Signatures may be authentlcaled or acknowledged. Both•aq not• •) necessary) ~ - ~ ~ ~ ~ ' ~ ~ ~ ~ ' • Nunu ar penoM slanlna In my NplClly InuN bt IypW Or pda1W EeloW qNY tl/Mllln. STATE /A0. OP WISCONSIN vyy~„•n t WARRANTY DEED pr Btstnk Co.. M,c. PORM No. I - 1991 rAMrl,r wq