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018-1094-25-000
ientofcommerce PRIVATE SEWAGE SYSTEM ~7ivision • 4 INSPECTION REPORT (FORMATION (ATTACH TO PERMIT) n you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit older's Name: City Village X Township Waters, Ton Hammond, Town of CST BM Elev: f Insp. BM Elev: ~ BM Description: ~ coo . o tzo . a P.~.v s~•,, g• I = b,~•, s TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic L L 1Z (®o Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic t ~. ` ~ ( ~_ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift F ' ti Loss System Head TDH Ft Forcemain ength D Dist. to well ELEWATION DATA county: St. Croix Sanitary Permit No: ~ ~ 479383 ~/ I State Plan ID No: ~ ~ Parcel Tax No: 018-1094-25-000 SectionlTown/RangelMap No: 17.29.17.765 STATION BS HI FS ELEV. Benchmark ~ i Alt. BM /~J Bldg. Sewer ~, °/ rj". 3 , SbHt Inlet SUHt Outlet . ~ 93 3(~ ~ Dt Inlet Dt Bottom Header/Man. Dist. Pipe •3 2 ~~3 ' 92-9~ Bot. System °I • u ~~. ~0 r Final Grade St Cover n t s~4 /~~ CAI( ~RCARPTION SYSTEM `--~/C~tL~. A _ ... hDrt~~ R NC DIME S Width 3t Length ~g't ~ No. Of renches (Z PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO /L BLDG WELL LAKE/STREAM LEACHING Manufa r. INFORMATION OR CHA E T e Of System: ~.--tea f ~ ` .~, ~S ~~ _ uN T Model Nu ber. ;c.k n M ~•-- 7 Header/Manifold '~" istribution x Hole Size x Hole Spacing Vent to Air Intake o.~ Length ~ Dia_ o pe(s) Dia Spacing ., o.e~~..~e c.,~•e..,~ n.,i.. ,r.r Mnnnrl Ar 04.r;rada Svetems t]nly Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil (] ~~ No Yes ~ Yes ~ No L1 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ L`~F_ 4~/ ~ Inspection #2: Location: 983 168th Street Hammond, WI 54015 (NE 1/4 NE 1!4 17 T29N R17W) Prairie Run Lot 25 Parcel No: 17.29.17.765 1.) Alt BM Description = Nl~' t 2.) Bldg sewer length = !t-~ 3 ~ -amount of cover = c~(~ ~ t ~ ~, ~n ...- Cre ~'~ ~ -- --- Plan revision Required? [] Yes No Use other side for additional informatiopn~. ~~"' O~ ~~ ~~__ ~-sQl'ci .~ ~ 1 Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ~~ ~~ Sufoty and L3uildings Division 201 W. Washington A ., County I /~ G/ ` C fill b ) b d i b ,~~~~~~~ Madison, (608) 66-31~~~ ~~~~D y o. s (to e n Permit Num o ` ~ ~ De artment of Commerce Sanitary Permit Applicati n ~, ~ z0~ 3ta Plan I.D. Number ~1 _ ` N personal informati Code Adm Wis 21 ith Comm 83 I d ~ you provide T ~ . , . . , n accor w may be used for secondary purposes Privacy Law, x15.04 1 xm) Proj •t Address (if different than mailing addn~s) ~~~ . vi~~~~,x coul~~r ~~~ I. Application Information -Please Print All Information l ~ ~$ 3 ~ ' Property Owner's Name ~ Parcel # Lot /!a?_ Block 11 1 Property er's ailing Address Property Location r,Y ~'b, ~'/i, Suction ~ City, Sta ' ' ~~ 7.ip C<xic - ~~~ 1'honc Number ,- ,- ~ ci •IoyRg, C. ~~ 5 T N, R o~ l ) ll th t k h y ~ v r;3; ec a app a I. Type of Building (c ~''~~ SNbdivision Name ~1 or 2 Family Dwelling - Number of Bedrooms S uLr,r,l.; ~D_°. ~ I ^ Public/Commercial - Describo Uso ^ State Ownod -Describe Use 2 ,~,~ ~~ ~ W Z. '~ Z 7 C~ ~~~ ^City illage~I'ownship of III, Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ^ New Systom ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal Permit Revision ^ Change of ^ Permit'fransfer to New Iast Previous Permit Number and Ante luuod . b O (] ` Bofore Expiration - Plum er wnor . ~ l ~ l 1 IV. T e of POWTS S stem: Check all that a I 1a Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ .Constructed Wet an rressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculatin S nthetic Media Filter hin Chamber me ~- ve - i ^ Other a lain V. Dis enaVTreatment Area Information: Ratc(gpdaf) repo oa Wutr st) Disperral Aroa Proposal (sQ Systom Elevation Dosign Flow (gpd) Design Soil Applioatio / Vl. 'l'ank Info Capacity in Gallons Total Gallons Numbor of Units Manufacturer Prefab Concrete Site Constructed Stoel Fiber Glass Plastic New Existing ~ i0 ~ ~ +~ Tanks Tanks Sepdo or Holding Taak a Aarotrio TreatrnoM Urdt Datag Chamber VII. Resp sibility Statement- I, the uaderoigned, a me responsibility for installation of the POWTS s4owa on the attached plans. Plum r' ame Prin ( Plumber' • Si at ivil'/MPRS Number Business•Phone Number. ~ / ~ S 3~~ tate, Zip ode) P umb8r's Address Street, City ~ ,vl~// l/J1 VIII. Coua /De artment Use n roved tsapprove Sanitary Permit Feo (includes Groundwater Date u Issui t $i o pp Suroharge Fee) // TT pD ~ ' ~z 5 d en Roason for ial (0 (X. Cond~~ta~ rov easoua for Disapproval ~ /~ t ~~ r ~ ` ~`~ 1, Septic tetdt, effhaint Piker and dispersal C~II must aH be services / rriaintaine~ ,~ • as Qer management plan provided by plumbK. • 2 AM s requirements must be mairttairtsd - ss per code /ordinances. Ar{ACY Wmpwre pww lrv cue a.vuuy vary/ wr we a7awa. w. p.yw ..v . ...............- - ........o ... _. . ~.. SBD-6398 (R. OX/03) [ \ ~ ~ ~ ~~; ~~ ~ ~ S n ~o ~ ~ ~ ~ ~ ,~ ~~ ~ - ~ ~ ~ (~ ~ ~_ ~~ _. ~' ~ g ~~ ~e ~, Cam,, ~\ R~ ~. v\ T a, ~~ ® ~- ~\ ~ ~ ~ ~ \ ~ \ ~ Q. ~\ a~ ~M ~vc~~d y .~ ,- Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ~~ of .~ Division of Safety and Buildings m accoroance vhur ~.omm aa, vws. f+am. ~,oae C Attach complete site plan on paper not less than 81/2 x 11 inches in size. ~ ' ' include, but not limited to: vertical and horizontal reference point (BM), di ion ~, . rest -' l,p, 0~$ - 1 d~~ - ZS ' t~ peroent slope, scale ordimensions, north arrow, and location and distan road. to nea Please print all i~ormation. ~ b Date Personal informatlon you provide may be used for secondary purposes (Privacy Law , . f 5.04 (t) (m)). e ~ / b Property Owner rope~gt LQ ,~tha~: '~~; ,~ ovt, T N R ~o Prope er's Mailing Address Lot # Blo # Subd. Name or CSM~ City State Zip Code Phone Number ^ City ^ Vllage Town Nearest Road ~ \ ( ) ~• ~J New Construction Use: ~ Residential / Number of bedrooms Code derived design flow rate ~~'/_9 GPD ^ Replacement ~ ^ Public or commergal -Describe: ~ Parent material ; / . %l Flood Plain elevation if applicable ft. ~ General comments ~ ,-, ~~/1 and recommendations: ~~-~~> .~-~ - ~ 3~ ' //~O ~~~ ~~'l t Boring # II~~ff Boring lal pit Ground surface elev. ~~ ft. Depth to limiting factor in. Soil lieation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fh in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 e / ~ ,8 ~ ~ ~ Q 9 f ~ ~ ~ ~'~ r - ~d / - - ~ ~Tl•4o * Effl #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mglL * E nt #2 = BOD < 30 mg/L and T55 < 3o mglL CST Na ase ~ Signature CST Nurrtber ~. Address Date aluation Conducted Telephone Number f - - - ~'~ .,.,,. ~,..,,.n~.,~,.~ ^ Boring S3•~/ dz--r+* Boring # Pit Ground surface elev. , l .S~ ft. Depth to limiting factor ~ ~ in. Soil (ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. *Eff#1 *Eff#2 _3 ~ , d s _~ _ a ~s~~ Property Owner ~ Parcel ID # FS/~~,~~~~ /~~/J Page ~ of .~ Boring # ^`Boring - ~ Pit Ground 8urfaCe elev. ~=~L~-~-ft. Depth to limiting factor ~~- in. Soil licaflon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DffF in. MunseN Qu. Sz. M. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ,j e ~s'G 6 ~, `~ Q s ~ _ _ Q 4 ~ d - ^ Boring # ^ Boring ^ pit Ground surface elev. ff. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP " " 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 lication Rate Horizon Depth Dominant Color Redox Descripflon Texture Structure Consistence Boundary Roots GP DlfP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 =BODE > 30 < 220 mglL and TSS >30 < 150 mgll * Effluent #2 = BODa ~ 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 (A.07/00) • , Property Owner _~ ~~ ~~2 Panoel ID # _ rjf ~~ fry 9~~5 ~ l~/~ Page i--~ of 3 - u rn ........ ............ ....... ~~~ wp... w nnuu~~y ~ ~~~ i m. - SoN {ication Rate Florizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/flz in. Munseq Qu. Sz ~ Color Gr. Sz. Sh. "Etf#1 "Eff#2 ,~ e ~s'G 6 _ -, q P _ ~ _ _ q 4 ~ b _. „ .~ 9/ ?o~ ^ Boring 4 l.o~ `l ~• iC Boring # ^ pit Ground surface elev. ft. Depth to limiting factor m. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP " in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'EtfR2 ^ Boring # ~ ~~ ^ pit Ground surface elev. ft. Depth to limiting factor in. Sol ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/(f in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Etf#2 'Effluent #1 =BODE > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #2 =BODE < 30 mg/L 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 60$-264-8777. SBD-8330 (R.07/00) ~- ~° --~ ,D.~i,iJ/1~K / i .~ r M ,a ~ ~ M~ `3 M O V l~ n ~~ 9 ~~ ~- .~ -?Z~ Q ~ o ~ ~ ~. ~~, ~ ~ ~ ~~ ~ ~ o ~~ ~ ~ ~~ ~~ ~ 1 0 ~V `~ ~ ~ ~ ~ ~ n ~ Leo ~ w ~~~~ ~ ~~ ~~~ ~ ~ ~ _o , /. ^ // ___ ' Safety and Buildings Division County ' ~ 201 W. Washington Ave., P.O. Box 7162 ` j ~~~~~,'~ Madison, WI 53707 - 716 i (608 Sanitary Permit Nugmber filled in by Co.) ~ Cie artment of Commerce , R .~~ t, ~~ 13 ~ ' -~AD1tAl'y P ~p hC aOri' ,tate.Plalt;LD. Numb~~; -w ,,a~ ' ~ ~ ~• In accord with Comm 83.21, Wis. Adm. e; ion yo d~ $ ' ~~~ ~ ~ ~~ ' may be used for secondary purposes Privac~; w 5 (1 xm~~ "' '' Prpjoct Address (if different than mailing address) , , ~. NTY ~ I. Application Information -Please Print All Information ~ ~ON1NG OF~IC~ Property O er's Name Marcel. # Lot # aj 131ock # Property O or's ibng Addroas Prupotty Location ~ % '/ ~ S i / Cil Stat 'Li C d P N ., ., > , _ ect on 7 y, p o e hone umber (c7cle ) R [ ~E N T~2 , „ o ; . IL Type of Building (check all t t apply) ~ ~ S ~ " ° f ~ 1 or 2 Family Dwelling:- Number of B rooms eW4S . Subdivision Name ; k SM-Number ^ Public/Commercial - Describo Uso ' ; ,~'' . ^ State Owned -Describe Use ^ ^ age,~9'owasltip of '"`'~~~ III. ' Type of Permit: (Check only one box on Ir a A. Complete line B if applicable) - „ ' A. New System ^ Replacement System TroatmenbHolding Tank Replacement ly ^ Other Modification to Existing System B, ^ Permit Renewal ^ Permit Revision ^ C of (] Pettrtit et to New List Previous Permit Number Date Issued Beforo Expiration Plumber Owner ' IV. T e of POWTS S stem: Check all that a 1 Z ' ~i Non -Pressurized ln•Ground ^ Mound >_ 24 in. of suiwble soil ^ M n 24 in. of suitable soil ^ At-Grado `' ^ Single Pass Sand Filter ^ I Constructed Wotland ~ Pressurized ln-Ground ^ Bolding'funk ~ Neat Filter Aerobic'('reatmont Unit ^ Rocirculating Sand Filter ^ Recirculatin S nthotic Media Filter ^ Lcuc:hin > Chamber ^ U' line Gravol-I i ^ Outer (cx lain) V. Dis eroal/Treatment Area Information: Design Flow lgpd) Design Soil Applioaation Rate(gpdsf) ispersal Area Reguir~(sf) .pis Area Proposed (sf) ystem Bletrstiat , °. l _ VI. Tank Info Capacity in Total Number Manufacturor fab Sito ,Steel Fibs .Plastic Gallons Gallo of Units W I~ ~ S l~ ~ Cone Constructed ~ Cihlas New Tacilca Existing Tanks - ~~ Soptic or Holding Tack _ ~ ~ . Aerobic Trowneot Utut Dosing Chamber ~~ ~, VII. Rasp nsibility State nt- I, the undersigned, assn responsibility. for installation of the PQVI+ TS shown on the attached phins. Plumber's ame 'nt Plumber` 5ignat ~ MP/MPRS Number Business Phone Number -`. Plumber's Ad rrss Street, City, S ,Zip C ' ~ ~ ~ VIII. Coon !De a meat Use Onl ' Approved ^ Di roved Sanitary Permit Foe ~'pcl~d~ Groundwater h S F Date lastlod Agent $ o ttmpij urc arge oo) 4~~~---, ^ n for Denial `tC" ~ ,j0 ~~ a~a. ~.VUUK~V~~i ^ lltl{1 1 VGA ~~pi{3Vni IV>f~DrJ~7ti{~FYi{I SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must. all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. as than 810.E :11 fae6ea is sift Attach complete plans (ta the County a SBA-6398 (R. Ol/03) ,~ ~~ ~ ~ ~~ :,~ '~ ,~ ~~ d ~~ - --~ ,~ :~ .. _~ ~,'~ \\~ I~~l ~ ~ ,, ~~ ~~ k ~~ ~~ ~~a ~ ~/~ J ,o ~ - ~. S ~ ~, ~~ '~ ~; ~~ q: -~ ~ ~ 4 ~ ~~ ~~ ~ ~ ~ ~~[ ~ ~ ~ ~ ~~~\ .u ~ ~' ~~ ~ , ~~ ~.~ COPY 0 / ~ ~\ M `~~ ~ `~ I ~ ¢~\ i / ~~ I v ~ ~ ~/ ~~ - _~ ,~ ~~ :~ _o 0 _~ 00 \~ ~~ a ~ ~ ~ _~ \ ~ ~ p/ ~ ,~\ ~~4 ~ 80 8 ~ ~~ ,~ ,~ k ~ ~~ `~ 4 ~°~ ~~ ~ a ~~ k ~ ~ \ ,:i ~~ ~ ~ ~ ~\0 ` U ~ ~ ~ \ vJ ~~ r '.~.: ~' Wisconsin Department o) Commerce SOfL EVALUATION REPORT Division of Safety and Buildings ~~~ Page ~ of ' County /#ttach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ~ include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. R iewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner 1 ~~ ~ Property Location , S ~ L Govt. Lot ~{/~ 1i4,U~ 114 S~ ~ T Z Q N R /~ E (or) ti~ Property Owner's Mailing Address Lot # Block # Subd. Name or M# ~~ t ~~ ~ s ~ Z~ a ~ rut, City State Zip Code Phone Number ^ City [] Village ®Town Nearest Road a /t.v~ w ( W ~ (7/S") 7 G - z ~ 4'3 rK ~,1,2Q /4`0~ [~ New Construction Use: [$ Residential /Number of bedrooms ____~ Code derived design, flow rate ~°• Goo GPD ^ Replacement ^ Public or commercial -Describe: ~ 1 Parent material T ~ t ~ Flood Plain elevationrf a plica a •~- ~~ ~~ ft. General comments „$' ~/ $ -e rI~ ~~° //r Q ~ ~ ~w t r / Q' ~•S !w~-?.~ ~, and recommendations: ,AG / t~ ~ ~~ ~. ~ G O ; ry ,, , ^ Boring 4~...mcavrrR~ , .,: Boring # ~ ® Pit Ground surface elev~~• ~ ft. Depth to limiting fact { In ~. '• ~~ ` ` Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence ary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I !(~ ~ ~ 5i ~ 2r rrk~r c s I v-~ 5 • 8 Z ~ ~-~ LS m cS - ~ /-Z 3 ~ /~ ms ~ - - ~ 2 9 S fl~ 3i.z ~~_Z ^^ G Boring # I,^1 Boring ~ // ~ Pit Ground surface elev. ~9 ~ ft. Depth to limiting factor C.~.~~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDJft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 z ~~-yZ i ~~ ~ - r- z 3 42-~ I ~Co `- rr1S a .~ /. Z ~~ • o/ .~ _~ * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 _< 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L C T Name lease Print) Signature CST Number n er ~ ~ ~-----~ 2530 9 Address Date Evaluation Conducted Telephone Number S ,r .~ _~ SBD-8330 (R07/00) w Property Owner ~G~ 1~~_ Parcel ID # Page ~ of v Boring # ^ Boring ~ Pit Ground surface elev.~ G, O ft. Depth to limiting factor ~ 2' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz 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/ftz 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 l-exture Structure Consistence Boundary Roots GPD/ftz 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 = BODS < 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-8}30 (R.07/00) ~- r' ~ ~ .• ' PAGE.30F~ TT•A ASE ~ ~ ~, ; ,~ S LOT# J SLEGAL DESCRIPTION SUE ~N~ l4_,S 1 ~- T Z R ,N,R, ~ ~- E(or)~ SCALE: 1"= ~4 ~ l BM 1 ELEVATION 00. O ~. K BM 1 DESCRIPTION~Q ~ -~- ~ 2 PJc- ~.'(~e -- '~"' BM 2 ELEVATION q ~ ~ ~ ~ BM 2 DESCRIPTION~e a -~- ~ z ~~ ~Jc. Pr' P-e- S `~' ~ SYSTEM ELEVATION ~P q'? ~ Lower- q~• ~ ALTERNATE ELEVATION Y$• oy CONTOUR ELEVATION 1 Q a° + /Oo . ~ boa ~ ~ ~""~< ~ G { • 3 t '''M1 /ou. o /~J g, Z , Q, ~ 9y SIGNATURE / ~~ ,~~ ~ ~.--- DATE /Z-/- a ~ / dr~~ I,ViJ-~.feS PUMP C hM~E•~ CRO55 SE Y!4N, AN4. SPcChICATI0r1S ' V'E IJT CAP • ,~PPJl4VL0' ~OGKING y' VENT PIPE WEATNCRPROOF'__,,,,__• 'MA-JHOLL COVGR iNITh ,: JUUCTlO-J DOX T~ WnM+tNG LABkf~ •~ Z¢' /ROM DOOR, IJ,'MIU• I WINOOW Oti f R C y N , .."'- AIR INTAK t G~APJC ... I _.~_..,..-..-•--. ~.r W" MiIJ. ~/ I 4~ / l - w ~.. w..w~...w COtiJDUiT'"~ .....rw-'- w~' -' ~~ Ic•KIN, ~ 1 ~____.- Al d.tla11T (~(.~.~. I I \ / • I vvv {tirl.C T I III 1~PP0.0YC0 JG~~• ` W~ ~ -IPC ARPROVEC> JOIIJT A I III CXTCUOIUG ~,,/~ PIPS I II AI.ARN p-JTO SOLID `~: CXTCNOIW6 3' I II 4 I 0-JTO SOLIO SOt~. o I I/ Oti . C I I, C G C V .._..,-.- f T, r U h P --•., `~ r J ~,l 4 r I r. 0 RISCfI EXIT PCRMITfCD 0-J~.~ IF TAIJK MAUUFAGTIJRCR Hn5 SUGH APPitOVAL ~'~ prPPRoVE~ aCDPING u„d~~ 't'r~Nl< S n,~ C 1 K I~C AT I OIJ~ p05C l.luMct:R OF DOSCS; ~ , YAKS Mn-UUrACTUKCR ~ ppSC vO~.uMC ~'p~ ~~~,,, G A 1„ 1, O /J S (~ A ~ l J 1 TA-JK 51ZC : w-.--~ ~~(, 11JCLU01lJG QA4KiLOW~ , ,,_ ALARYI MA-JUFACruR.ca. ..ItJCNCS oR ,~ GAllo- CAPAGI11C5J ~ ~ ~> r`10DC1. IJUMDCR: 8 s~„I-JGNCS OR .~ GA~~~' qa y W I TC: N T ti P C ;/ C ~„~,,,,, IuC HC S QR' ~-- G~ ~` J r a ,~~~ M ~ N U F g C T U R C K~~ ~ ._.-.---"---'-~' _._. ~ G'. l t. r, p~ M p ~ p r .,~"~.._ I N C I I C S O R daG71lGw~- .~'~t~11a.C~~`1~~Qr+JP~r)t'f' I'Uh~P AUO ALAK'M AitC YO 0L yWITCN T;JPC; ..... INST~UUCQ Qu.-S~pAaATC~CIKCUITS MIIJIMUM DIS~NARGC RArC~----_GrM q~ ....Lf.G-- `C C 7 • VCRTICAh p-rFGtiCNC4 o~TWCCU ruMr oFr Au0 DI.',TRIbtJTIOU PING°. . ~'~_....~ F' G C T + MI-JIMU/'I NCTWOKK SUPPI.y PKCS;,/If~. ~ 1:~FCCY 1 ,~``~r {'RiC 1 iv~l r1~GTgN......t.. ,{• f'L ET OF ~'ORCC f'~AIN X ~+--~ i0a lr. ~'~ FLC,T ~.-. TOTAL. py-JAh11G HEAP ,, ° .w I p' f 11 .,,,,,-..---^~' j L I A V 1 ~ 0 E P K H ~- I u T C R U A ~. l11 M G 1J S I O N G O F 1• A 1J K~ r,~ L N G '~ r+ .~.----~-~- I U M 11 L IZ t ..._-.......-....-.,.~-"._.._ O A T E:--^-"-- ~_ ~tjJ~ :~li'virii.w ~N~ ~~~~s APPLICATIONS Specifically designed for the following. uses: • Homes ; • Farms • Trailer courts • Motets • Schools _ • Hospitals • Industry • Effluent systems SPECIFICATIONS Pump • Solids handling capabilities: /a" maximum. • Discharge size; 2"NPT. • Capacities: up to 140 GPM. • Total heads: up to 128 feet TDH. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • See order numbers on reverse side for specific HP, voltage, phase and RPM's available. FEATURES ^ Impeller: Cast iron, semi- ~pen, non-clog with pump-out tines for mechanical seal protection. Balanced for smooth operation. Silicon lJi Vi+ze impeiier avalable ~s an option. at Casing; Cast iron volute type nor maximum efficiency. 1"NPT discharge. ~ Mechanical Seal: SILICON CARBIDE VS. SILICON CARBIDE sealing faces. ,, Stainless steel metal parts, BUNA-N elastomers. w003 Goulds Pumps Effective lu!y, 2003 83885 ^ Shaft: Corrosion-resistant, stainless steel, Threaded design, Locknut on all models to guard against component damage on accidental reverse rotation, ^ Fasteners; 300 series stainless steel, - _. ^ Capable of running dry without damage to components. ^ Designed for continuous operation when fully submerged. MOTORS ^ Fully submerged in high- gradeturbine oil for lubrication and efficient heat transfer. ^ Class B insulation on '/3-1'/z HP models. ' ^ Class F insulation on 2 HP models. METERS FEET 40 13C 12C 35 11C 3U~- IOC 90 25~- 80 20L 70 r so c 151- 50 r ~ 40 tai- 30 5~ 20 10 o~ o ~upr~ne~sit~ie :~ ~ .Effluent P~~p ~ ~ , , .. ,~ ,.. ~WE Series ~~~~~ PROSURANCE AVAILABLE FOR RES,~DENTIAL APPLICATIONS. f..°," ~ r, . Single phase (60 Hz): can be operated continuously • Capacitor start motors for without damage when fully; maximum starting torque. -submerged. -• : , , • Built-in overload with ^ Bearings: Upper and automatic reset. lower heavy duty.ball bearing • STTOW or STOW severe duty 'construction.'' l oil and water resistant power cords. ~ Poyver Cable: Severe du ry •'/3 and'/: HP models have rated, oil and water resistant. NEMA three prong Epoxy seal on motor end n. grounding plugs. provides seco~rdary moisture.: b rri r i • 3/, HP and larger units have bare lead cord ends a e n case of outer jadceT damage and to prevent oil "< . Three hase (60 Hz): ., p wicking. Standard cordk'20'. Optional lengths are afailable. • Class 10 overload protection . ~ must be provided in ~ 0-ring: Assures positive rately ordered starter- sealing against contaminants unR and oil leakage. ' • STOW power cords all have AGENCY LISTINGS bare lead cord ends.: ' r~d~otnnaa~a ^ Designed for Continuous ®. csnu-t lossw~ ; Operation: Pump ratings are' ~ ~' syc••a~,standa~ds within the motor manufacturer's ~ us ~ ~9 ~ ~ ` , recommended working limits, Go~dsrumps~lso9o01 ~, - .-` - .~ ' M ._; . ~ .-- ._ __. __ ._ __ _ _. _- _ _- SERIES: WE SIZE:'." SOLIpS '. - '.. __ --_ .- _- _-. ..f. __ _ ... --- .-- - _ _ RPM: 500 & i. _.. .. _ S F , Z . _ ... _. ... . 0 H.. _ w ~ . __ .- -- -- -- -_ . ... ... .... .... . ..:. _ _ ~0 i__.I.. w~ ...i - -°- - .. ---t•-- -~~ _1._ _. ... ._ . .... .... . ... .. --- --- -_._ .-- __. __. T __.. . - .-. .. _ _..- - _. .__ .--I---- ---- -- --_ .-_ , r;' ,: ;' v iu cu .tu au ~u 60 7u 80 90 100 110 120 :.130 140 150 160 GPM 5 10 15 20 25 _ 30 `'' 35- m3lhr CAPACITY . ,GQulds Pymps, wwW.9o~id:.nom W ,ITT Industries POWT$ OWNER'S MANUAL & MANAGEMENT PLAN,,..,. , Page ~.. of ~ FILE INFORMATION ~ ~` Owner Permit +Y ~ ~ 3 03 ..e-n,nr, nwnwreeTeDC vNumber of Bedrooms DNA Number of Public Facility Units j8' NA Estimated flow (average) aI/da Design flow (peakl, (Estimated x 1,5) al/da Soil Application Rate ~ al/da /tt~ Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand {BOD6- 5220 mgll. ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ~ NA Fecal Coliform (geometric mean) 510' ctu/t00m1 TMxximum Effluent Particle Size Ye in die. ^ NA Other: DNA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPEC~r~4A r was ~ Septic Tank Capacity • ~ al 0 Nl~ . , Septic Tank Manufacturer ~ 0 N'~ Effluent Flltar Manufacturer i D NE~• { Effluent Filter Model Q N<; Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ ~JA Pump Manufacturer .5 O NA Pump Model _ O ~ DNA ` Pretreatment Unit .~~ D SandlGravel Filter O Peat Filter ^ Mechanical Aeration O Wetland D Disinfection O Other: 1 Dispersal CeI11s) ^ NA ': ~ In-Ground (gravity) ^ In-Ground (pressurizedl O At-Grade ©Mound ^ prip•Lina ^ Other; Other: D Nf, Other: DNA I Other. O NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect conditian of tankis) At least once every: D monthls- ` (Maximum 3 years) ~ j ~ ear(sl .~ ^ NA Pump out contents of tankis) When combined sludge and scum equals one-third .(Yi) of tank volume- ©NA Inspect dispersal celllsi At least once every: D monthls) ''" (Maximum 3 years) ~ ~ year(si DNA- monthls! D N;:, Clean effluent filter At least once every: year(s) ^i O rnonthlsl p NF. ~ Inspect pump, pump controls & alarm At least once every; .® ear(s) _ D month(s) r~ ~ •• ~'Z1 Nk Flush laterals and pressure test At least once every: D aerial Other: At Ivast once every: ^monthls) Q ear(s) ,~J NA Other ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septag® Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. ~'he dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pondin~ of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires thc; immediate notification of the loos) regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third 1Y31 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. ' ~'''~ ~~~ ~ •~ 'f - } All other services, including but not Vimitad to the servicing of effluent filters, mechanical or pressurized cOmponenta, pretreatment units, and any servicing at intervals of 512 months, shall be perfarmed by a certified POWTS Maintainer, A service report shall be provided tp the local regulatory authority within 14 days of completion of anY service avant. GMW )alp: i . t.;,.+.. PdQe ~ pt START UP AND OPERATION ' For new construction, .prior to use of the POWTS check treatment tank(s) for the presence of painting products or otk-er chemicals' that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are defeated have the contents of the tankis) 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 hiphwater levels. When power is restored the excess wastewater will bc+ discharged to the dispersal cell(s) in one large dose, overlaadinq the cell(s) and may result In•tM~ backup or surfw~ discharge of effluent. 7o avoid this situation have the contents of the .pump tank removed by a Septaga Servlolnp Operator prfot:to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to asalat in manuapy'operating the pump' Controls to resrore normal levels within the pump tank, Uo not drive or park vehicles over tanks and dispersal cells Do not drive or park over, or otherwise. disturb or compact, the ar~~ within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wasteHrater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floes; 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 fails and/or is permanently taken out of service the following steps shall be taken to insure that the systdrn i; properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings ~ealed.r. s, • 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 ba excavaterd and removed or their covers removed and the void space fHied with soil, gravel or another inert solid rnatorial. CONTINC3ENCY 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: ,~,,, ~.., :~,,. ,,,., , , A suitable replacement area has been evaluated rand may be utilized for the location of a replacement soli 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 evaluatior to establish a suitable replacement area. Replacement systems rnusi comply with the rules in affect at that time. D A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS.-~A~-'-~~- • ~- --~ ~-~ D The site has not bean evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area.. If no replacement area is available. a holding tank may be installed as a last resort to replace the failed POWTS. .. .... ., _ D 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 CCiNTAIN LETHAL. GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUM8TANCEB, DEATH MAY RE$ULT, RE8CUE pF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS -art? <,r• r'-^ , twos eP st~r~.;;4 •.' ~y~'r1'l xrr ~' POWTS INSTA POWTS MAINTAINER . . Name Name 'r Phone ~, .~-~-- Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REQULATORY AUTHORITY Name Phone N ame ~ ~. .4, r t~ Phone .r 3! r.'~ .. r• i'his document was drafted in eomptianee with chapter Comm 63.2212)Ib)tt}Id)&tf) and 133.b41t), l2) & (3), 1Msconsln Administrative Code. ST CRO1X COUNTY SEPTIC TANK I~~-II ~NANCE AGREL'I~NT OWNERSHIP CERTIFICATION I+O1tM owner/Buyer Vtaiting Address f,~! Praperty Address - ~ ~ v' . (Verification required from Planning Department for new construction) Parcel Identification Number ~ I~ ~ l~1`f - 25 " O°° ~~ }6S~ City/State i EGAT DESCRIPTION T N-R~._w. Town of Property Location ~ ~'/,, ~- '/,, Sec. / 7 ~- Lot #~. ~ ~ ~~ 1 1 Subdivision _ __----- _ __ `--" ,Volume ~ Page # Certified Survey Map ~ g S.~S.- , Volume Z~~1 ~ ~ Pa e ~# Warranty Deed # ~~~ Z ~ ~ , Lot lines identifiable yes ^ no Spec house ^ yes (~ no STEM MAINTENANCE ~iproper use and maintenanceof your septic system could resulninat aprymahtnremfa~ p~p~~~at~ou put~int~~ ~ system consists of pumping out the septic tank Query flute years or sooner, if sal system. can affect the function of the septic tank as a treatment stage in the waste dispo ~ b the owner and by a owner agrees to subuut to St. Croix Zouiiig Dep~tment a certification form, sign Y gal s em The property um verifying that (1) the on site wastewaterdispo. Yrt mast~rplumber, journeymanplumber, restrictedplumber or a lice»sed p P~ the septic tank is less thaw 1/3 full c f sludge. if necessary), is ~ proper operatingconditionand/or (2) a ftcr inspection and pumping C undersi ed have read flu above requirements and agree to maintain the Private sewage disposal system with ~~ standards ctification I/we. the » Ollice within 30 set forth, herein, as set by the Department of Commerce and t°kn'Dep~ and returned to tlleeSt. Crone County ring ~ stating that your septic system has been maintained must be c p days of the three Year expiration date. ? , 2~~ P~ DATE SICiNA OF APPLICANT Q~x~*;ER CERTIFTCATI.ON our latowledge. I (we) am (are) the ~ .wnec(s) of I (we) certify 11-at all statements on this fo ~ are true to the best of ter of Deeds Office. the property described above, by virtue of a warrant deed recorded iu Reg ~ ' ~ / ~~ DATB SIGMA OF APPLICANT *«**** ***+** Any information that is mis-rcpreseuted may result in the sanitary permit being revoked by the Zoning Departm ".nt. ** Include wttu lots apptieatioa: a stamped warranty deed from ae RcgcfercnceDis madef in the warranty deed a copy of the catificd sucvcy I J 2197 505 DGCUNFEN'~ NUMBER' WARRANTY DEED Midwest Equities, LLC, Grantor, conveys and warrants to Tony Waters, Grantee, the following described real estate in St. Croix County, State of Wisconsin: Lot 25 Prairie Run, being the NW 1/4 of the NE 1/4 and part of the NE the NE 1/4, and part Of the SE 1/4 of the NE 1/4, and part of the SW 1/4 of the NE 1/4, all in Section 17, T ?.9 N, R 17 W, Town of Hammond. 7 1 6 2 9 7 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , liI RECEIVED FOR REGARD 04/08/2003 08:25AM MARRAHTY DEED Ez~T ~ REC FEE: 11.00 TRANS FEE: 108.00 COPY FEE: CC FEE: PAGES: 1 NAME AND RETURN ADDRESS First National Bank of Hudson 915 Davis Street PO Boa 28 Hammond WI 54015 018-1094-25-000 Parcel Identification Number This is not homestead property. Exception to warranties: All easements, restrictions and rights-of-way of record, if any. Dated this day of April, 2003. '~ (SEAL) a ry J. W 1 ns, Managing Member of M' w t Equities, LLC (SEAL) AVTHENTICATZON Signature(s) authenticated this day of 20~ (Signature) fName Printed oz 'Npedi TITLE: MEMBER STATE BAR OF WISCONSIN IIf not, n„rhnr; voA ha, 6'!nc nc w; a Gtdt ~) // THIS INSTRUMENT WAS DRAFTED Leo A. Beskar Rodli, Beskar, Boles & Krue P.O. Box 138 River Falls, WI 54022 ~~.~~ pAN (; ~;/~~. r, .S.C. ~:,~ .~~ '~ y . kr Y /~` ~~_~ i ., ~'~ ~ iOi~ ~ ~.+ . • ~`~ ~~ ~r~~~~N,.,~~ .~~. ACKNOWLED(1NENT STATE OF WISCONSIN ) COUNTY ) (SEAL) (SEAL) Personally came before me this 7 ~ day of April, 2003 the above named Larry J. Wellens to me known to be the persons(s) who executed the regoing inst~Trpument anted ~ackn/o~wlJedQge the same. ~~"z-^~ /~ • ~~""~''J Signature: °* ~ /V ~ ~ /C~ /?~sE'iL ~i- rNa~ Printed or Tvped, /~^~ Notary Public SY~ C...e.0 / 1C County, Wis. My commission is permanent. ~If not, expiration date:) 9- 2 p- '~. 0~, ~ - g ,~~o ~~ N .p , ~~~ a ,~0' W % __~ ~ Nay Q . ~ O ~ ~, 2 : ~ ~ ti ip i°° • ~ 2 a . 2 y . ,,~ _ , ® ~ ,SSA /~. ~a _ 'hRi ,. ~ ~ '~ ~ ~ W , -,3 ~. :, ~ ~ N a a ~~ ; ~~ ~,,,,, y Q i ~ '~ ~~ ® , ~ ,a~ s,F `~ ~~,, ,~ ,~ .. _3~BF ~~ W ~ 2~ W y '~\ 1y I N ,g ;~ y ig Vf W C~ Jtip .. QtrfV~ ~~Q~;, UFW-~Qh 0~~2W ~ +.j~ yQ~.".16 ~ W 1i ~ ~~cr"a a_~U°$ y K ~ ~ ~~~2~ ..~WHa; Z~~~~ ~~~ s