Loading...
HomeMy WebLinkAbout018-1094-35-000 C1v~0 3~n d I ~ w ~ .~. ~ .r ~ 3 h _ ~ ~ Z o w ~ _ ~ m `~ }~1 • c i I m ~' ~ ~ ~ ~ ~ ~ ~ x ` ~ ~ ° po y ~ ~ = v ~ ¢ C o a ° ~ m a ~ ~ "'! ~ ~ o ~ o ~ 4" ~ rn I 3 y ~ ~ ° C ~ a o C7 I ~ cn z D c o a cn ,o t ~. I m cn D y e a m `C I v ~ W ~ I C N D 0 I Z ° ° ~ ° N~a w w N• rt ~ ~ ~ a 7 °» 0 0 0 ~ vy o p '~ i ~ o 3 ~ ~ y ~ w ~ °' ~ i 0 ~ 5: o ~ m ~ ~ ~ ~ ~ ~ ° c ' .. mo ° ~ ~ d. I N ~ . 3 ,°-' I a I z .. ° C f/~ Z I =; ° ~, o 7 y - fy/1 N . . 01 ' N ~ ~ N. ~ C_ ~ C ' fD I ~,~ • m ~ d a I n ~ a ~ ° Z ~~'- ~ vcb _ ~ Z ~ A 0 << 5. 7 y C ~ ~ L*. ~ ~~ -~ n A ~ ~ I o _. ~ ~ .. 7 y V dy" W ~ ail N ~ z I ~ 3 N a ~ A F ~ o° :~ ~ z I ° 3 ~ m ~ y ~ ~ A ~ I I a~ a I ~ ° ~ N o. o I o~ m' ~ ~ ~ o a ~ I CD ~ y ~a I > > I I ~ a ~ I ~. O ewe (d I ~ v I I o - ~ ~' ~ N W O b A I ° I ~ ~ ~ ~ o ° ~ v' o - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division . i 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 Midwest E uities Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic --er.~ i ~- ~ a Dosing ~~ ~ ~ Aeration Holding TANK SETBACK INFORMATION TANK TO ~ WELL ~- BLDG. Vent t it Intake ROAD Septic >~~ f '~V ~ _~ ~ ~ Dosing Aeration Holding PUMP/SIPHON INFORMATION (~'}CA~'V~ ~~ Manufacturer Demand GPM Model Number TDH Lift Friction L System Head TDH Ft Forcemain L gth Dia. Dist.to well county: St. Croix Sanitary Permit No: 430125 0 State Plan ID No: Parcel Tax No: 018-1094-35-000 Section/Town/Range/Map No: 17.29.17.775 ELEVATION DATA STATION BS HI FS ELEV. Benchrr~ark V Y. ~ ~D lO~ ~ D Alt. BM sT~GO ~- ~e Bldg•J Gf-1 Zf (~ ~o • (Ot] St/Ht Inlet 7 •~~ SUHt Outlet ,,r ~ q l Dt Inlet ~ Dt Bottom ~_ Heade an. -^~- J S ~ /, ( Dist. Pipe ;j~ / ~ p3 s' Bot. System ~ , q , z ~, ~ Final Grade lrw s~' S'•3 9~.9~ St Cover 2 ~ r~ ~• SOIL ABSORPTION SYSTEM X71 ~/ -- .,Ln /~lrt.,.,/_ BEDITRENCH Width / r Length No. Of Trenches PIT D~I ENSIGNS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ ,1~" lJ SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREA LEACHI G CHAMBE OR Manufacturer: /-, ~ 'T"' T~ r TypgO~y~em: ~~ ~' ~,~~ ~ r~0 t ~- Model Number: ~I&~`RIBUTION SYSTEM t/O.r,~~.ru..~dl/ C Header/ nifold Distribution ! x Hole Size x Hole Spacing Vent to Air Intake I c. Pipe(s) ~ ~ • C -_ ~_ ~Jl ~ Length Dia Length Dia Spacing J ' I V SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ,L , • fit/ Depth Over xx Depth of xx Seeded/Sodded ux Mulched Bed/Trench Center '~f (j V-, r _ _ Bed/Trench Edges Topsoil ~~ Yes ~ _J No I~_-,JI Yes '~~: I No ~d COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /I / ~ 0 /~ Inspection #2: / / Location: 1695 99th Ave Hammond, WI 54015 (NE 1/4 NE 1/4 17 T29N R17W) Prairie Run Lot 35 ~~ Parcel No: 17.29.17.775 1.) Alt BM Description --~~° ~~~ D~ ~/ DINCT ~' 2.) Bldg sewer length ~~~/~/ t~ -Fbp~y~ /H,~Lt~l(,~(f~----rU~ ~-Y`1i/~ ,,,~,'] ,~,~Q -amount of cover = ~ SA){ ~S-ti~" C[~~C{/jitd /~:~CG,C-~'vuj~ r`~"' .S`"~ ~~ C -•_"v_ "__J _ I_ l e t -F_ __~a_ s -_ __ __ Plan revision Required? [':; Yes ~_; No ~ I ~ ~ ~ - ~~ Use other side for additional information. I;___~__. ~ ! _..____ ___ _______ ______ _- __ -_-___. _ ___-! L _ _. - __ ____ _- _~ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) Safety and Buildings Division County /~ ` m 201 W. Washington Ave., P.O. Box 7082 S" , ~,/ ~ ~ scons~n Madison, W[ 53707 - 7082 Sanitary Permit Number (to be 6,led in by Co.) De artment of Commerce _ ~. 6 -• '~ pl<- S • ~ u°- t.- ~ Sanitary Permit pplicatton State Plan LD. Number In accord with Comm 83.21, Wis. Adm. Code, nal ~'~f ion you provide ~ ~ maybe used for secondary purposes 'vacy Le4ki~p~(I~m~ O ~~ ~ ~ Project Addr (if different than mailing address) I. ApplicaHoa Information -Please Print All Infor atiol6 ~ , ~ , , ~ ~ J f ~( ti ~ ~ ~ Property Owner's Name """"---•°•----....,,..~.._„ Parcel # Lot # 35` Block # . ,._ Property Owner's Mailing A Property Location City State Zi C d , J p o e Phone Number ~ ' Z ~ (circle ) T~ N R1~E ~ I I T e f B ildi h k ll h ; o . yp o u ng (c ec a t at apply) ~~ ~, ( Xy t or 2 Family Dwelling - Number of Bedrooms =~ Subdivision Name C$M-Alanfbet- ^ Public/Commercial - Descnbe Use ^ State Owned -Describe Use W 1 C ^City ^Vil ge ~ownship of III. T ype of Permit: (Check only one box ou line A. Complete line B if applicable) _ ((~j(~ 170 S A' New S em yst ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a I Non -Pressurized fn-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Fiher Ching Chamber ^ Dri Line vel-les Pipe Other (explain) V. Dis ersaUTreatment Area Inf rmation: ~'~ l~ ), Design Flow igpd) Design Soil Application Rate(gpdsf), Dispersal Area Required (sf) Dis 1 Area Proposed sf) System Elevation ~ ~ . Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber ~ as c Gallons Gallons of Units . , / ~ nil Concrete Constructed Glass New Existin / / ~ (~(J liC Tacks g Tanks / Septic or Hokfing Tank ~ ;~ Aerobic Treatment Unit Dosing Chamber l,,, ~ z 7 VII. Respo sibility Statement- I, the undersigned, a me responsibility for installation of the POWTS shown oo the attached plans. Plum 's ame tint) ~ Plumber' Si `~ MP/MPRS Number Business Phone Number - ~ / , s u bet's (Street, City, State, Zip Code) ~~ VIII. nun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Surchar F '1 (/ ~ l~at Issued ( Issuing Age Sign lure tamps) ~ ^ Owner Given Reason for Denial ge ce) ~~ ~ O( _~ ~ ~~ G2 ~ I onditions of ApprovaVReasons for Disapproval ~ ~~ ~ ~ Pte. ~ ~l ~~~ r ~ r~~ ~ -~,, s~.~, ~ ~... ~3 _sz i ,~ wnaca complete pleas (to the County only) rot the system oa paper act kss thaw al/Z x 11 (aches is sirs ~~. SBD-6398 (R. 08/02) i I i i ~ ~ ~ , ` I ~ ~ _ i i ~ ` ~ I ~ ~ ~ i i i _ 1 1 ~' ~ , ~ ~ ~ ~ ~ ~ ~ ~ i .~ i ~ I , '~ I j i I ~ ~ ~ !! ~ V ! ~ , V ' I ~ i ~'~ j ~ ~ I M i i _ Y ~ - - ~T' i h ya ~/ ~ ,.., ' a!• I 1 ~ y ~ i ~ i ~ ~ ~ I I t ~ i ~ ~ i ~ ~ ~ t i ~ ~ i I ~ I ~ ~ ~ / ~©~ ~ ~ ~ ac ~~ \ _~ ~ ,~ ~ ~ ~ ~ _ ~ ~ _ M `f. J _ _ _- ~~~-~ ~ ~ ,~ .. __ ~ _ ~fi ~ ~~~ - ~~~ M ~ ~ ~~~ ~ ~ - _ ~ h tti; .Z ~ . , _~:~~~° ,,, - _ _ ~ _ _ _ . ~.~ ` 3 -W °~ _ _. _ __ _ .~ _ ~ ~ _ _ ~~ _ ~ ~ ~ ~ ~ _ ~„ ~ ~ _ _ _ .~ ~ _ ~,; V~ ~ ~ _~~~~~ _ --~ ~ _ , _ _ ~ \3 G _ i ,_ ~~ m \ o ,J ~; ~, ~. - I _ J L l>I,IJGLIt=S7 ~1j~'C4, LL ~iC~ '~" C °~ D ~ _~s YA6 E ~/ PuMP CN~Mt~EK CKoSS SECTION AlJO SPECIFtCAT10NS V E A!T CAP 4~ VENT PIPE ? 2S' PROM DooR, WINpOW OK F R E S H AIR IAITAKE WEATHE RPROOF_ JI.IucTIO~J gox 12'MIU. I ~RAOc le'nlr~, IAILET APPROVED J01-JT A W/ PtPC CXTCNDIfJb 3' p-!TO SOLiD Sptl. D C i_~_cv FT. 0 II I I / ~--- couDUIT-~ .^"_ OF /-PPAOVC p LOCKING MAWNOLE COVC.R WITH WnA>JING Ln6El y~ MIU. f. ~~--= = Ie-Mlu. _ ~\~; 1 ~kov;D[ I' A~,<.ri~~iT sc~l_ I I I I I I I Pu;1P -` -~ ~r~ GO-JCRCTC DLOGK 11~ ~ I j l II ~ I I J~PPROYCD Jou:' ',j I W/ ' PIPE I III ALARM EXTUJ0I~:C. 3' I I I 0-JTO SOLID Sole. OU . I bo~F -~• RISCR CY.IT PCRMI'TTCb GI.IL`i IF l'AI,Jt( MAIJUFI~GTURCR IIAS SUCH APPROVAL. 3" nrraovE>, dcPta~~,~ u,.~~« rr~~K SEPTIC E SF~~CIFICATIOIJS oosE ~ TAUKS MA-JUFACTURC:R: 61d,~,c',~C ~lur~.OLR of DOSS: =~ ,PER DAB TAIJK SIZE : ~~~ ~ GAt_LO-JS DOSC VOIUMC IAJCLUDIUG 6ACKFLOW: ~~~~•~7 GALl01J_ ALARM MAUUFACTUR,CR: _S__l. ,F'lcc-~~, MODC:L -JUM6fR:r//~/~~~~ .ll.Q~-~--- CAPACITIES: A=~c~.IAICNCSOR ~,/~~GALLOu„ SWITCH TyPC: _L..(~ e ' " 9 a,g,/2~•,_IIJCHES OR „~/3, r.~ GALLO-JS PUMP MAIJUFAGTUR[R; C=J 1_._IUGHESOR/,~~~~7GALLO-J~ MODEL 1JUM~ER:~~~L / - D ~ ~_ INCHES OR s~ GAll01JE SW17CH 'f'yPC:: ~ ~• ~~,~cC~/ss..aM~-•--- t%'~1~~~ f'UNV AUD ALARM ARC TO DC INSTALLED OU SE PARATC CIRCUITS 1'111JIMUM DISCHARGE RA1"C~GPM VCRTICAL DIFFERENCE DETWCCIJ PUMP OFF AUO OISTRIQ~UTIO-J PIPC,. $•~. FECT + M11.11MUM IJCTWORK SUPPLE P-R7C,,S~SUR,E/, • '~' FfrCT -F- ..~ 5 FC E7 OF i'ORCC MAIIJ K~[z~~/ioa rr.F•atC flail FAi.ToK...~.~.1 FELT TOTAL Oy-JAM~c. NEAP~~_.____.-~~F•EET~/ ,~ r 8/ / %- ....E 'Sf'~[ ~~ IIJTCRAJAI. DIMC.-JSIO-JL Of 1'A-.1K: 1.E~1C~T-t jWID'('I~ -jI.IQUID DEP'!H ~Z- ` LICEIJSE 1.JUMGER: ~.-,~~~'? DATE: ';IG-JEO: . Performance ~,,- _~s Curves METERS FEET 2b 20 F tS 10 S 0 Submersible Effluent Pumps 90 ~ ~MODEL 3885 ~ SIZE 3/ " Solids a ~ 70 WE15H - -' ; ' ._ ._.. _ - ~ ' Y _ ._ I. • W E07H b0 I 40 WEOSH ~ WE09M _ -} ~- ~ , -i.. , ~ WE091 IO 0 L_~_.._._. ~ u to lU so n0 50 60 70 8G 90 100 t 10 .120 QPM ~ .... _..._....~_.. ..L _... ..._.. .. _ I I 0 10 20 30 m~M ~ CAPACITY ' ~GOULDS PUMPS, INC, SA~FCA ~,KLS PEW ~QAC i3N8 METER8 FEET 12 1) ~~ i 2b• '. 20 p tb ~ X10 t0 ~ 20 5 10 0 0 ~~- ..... . ; - MODEL 3885 " 3 WE15 0 HH _ .. __ _ .SIZE /4 Solids , .. ~ : f : ._ . _ .. ._ .+ _ .. l ....._ .. _. _ _.- -•-I-••- ~ ~ .- --~-- ......,_. _ .. ~..I. _ ~. _I-_ -~-_ _,_ ~._ . ~.. ` ' :~ i' ~ 90 80 0 60 0 t 0 20 30 40 ~) 80 70 80 60 100 110 120 QPM L~....... _ .. _.... _.. . ~_ .__..~----- _----- ~ 0 ~0 20 30 m~~ GAPACITY ~ 1666 0ouldtt Pump, Ina EfNotiW Juty, t 985 ~" 0885 :~' r r ~fi- ~ , i Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page I of County ~~( Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ~ i r include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or~dimeosions„north arrow, and location and distance to nearest road. Parcel I.D. - ~Q~~-3S ~~ Please print all information. eviewed b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). -2 ~ Q/ Property Owner Property Location Govt. Lot ti~ 1/4~/~1/4 S / ~-- T Z ~( N R / 7Z E (orb Propert Owner's Mailing Address / '~ S `~ ~~ Lot # ~ Block # S d. Name or CSM ~ > ~ / ~o rL1ir~~ un City State Zip Code Phone Number ^ City ^ Village ~ Town Nearest Road ~~ vh mm ~ U, ~ SYU~ s' (7~s~) 79~ - Z ~i3 m n~taa ~ `GG ~~ . ~, ~ci New Construction Use: ® Residential /Number of bedrooms 3 - , ^ Replacement ~ ~ ^ Public or commercial -Describe: Parent material rr General comments S ~/ ,S ~f ~ eft U' ~~ 9 ~' q ~' and recommendations: I ~.`f. el{(/• Ian q ~.oo ~,d w~~o Code derived design flow rate S a~ G o ~ ' `'`• GPD ~4air~elevat+er~~€ appli ,/~/~° ~ -lV~ ~`•~ ft. rrtr Q ~ 7Z~ -~ .a~ ~~ v i ".v7C.9~M '. r.~, J~ +~~~ °,.{ Boring # I^~ Boring ~ ~ \ iV ~ , ;y ®, pit Ground surface elev. ~ ft. Depth to limiting factor ~ in. ~- • oil 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 ~ 6-12 10 ~ z~ ~ 5~ ~ Zrr~bk mf'r' ~~ ~v~ 3 35- p ~~ - s m ~ m'r~r c5 - - i. 2 tea- IU ry/b 3 ~. r4 ~ LS i ~ i . ~ 1. Z I~ ~.~ Boring # t^n~I Boring ~- (,~~ LJ- 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 ~ 0 5 10 3~1 5 ' ( Z ~.bk m~ ~ cis I v-~' ~ 2 - - I 3 - Srcl 2~r-5b k r ~ - ~-1 . Co ~ 31-12 ~`~ ~'~ S~ rn i< ,,I~ ~ ~ - 9 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 _< 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number A ~ ch a..ke r ~~-----~=~~-- 25 330 °I Address Date Evaluation Conducted Telephone Number Z t t ~ ~SV~ -eel ~ (~..) ~IOZS l /- 2 $ -b l C7i ~~ 2 ~'7-'~Ga Stall-25330 (KU7/00) ~~ r• ~ "~ Property Owner ~~~k~n~ ParcellD # Page ~ of Boring # ~^1 Boring ~I Pit Ground surface ele i. qg 3 ~ ft. Depth to limiting factor ~~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 ~-~ j ~- - Sj I .2 m-~r ~S I v-~ . 5 . 8' z ~~- ~ ( 3 -- 5; I rn~r ~ ~ - y ^ Boring Boring # ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/Land 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 fonrnat, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) • •+. (._ w PAGE 3 OF~ NAME t~~ c,cJ ~ ~ ~ ~ LOT# 3~ LEGAL DESCRIPTION /1/ F ~~1/F 14 ,S 1 ~ T Z a ,N,R. ~ ~- E(or)~1 SCALE: I"= ~~ ~ BM 1 ELEVATION / Go • t~ BM 1 DESCRIPTION-~•~ ~ a-F ' z ~ Pv~- P~~Pe BM 2 ELEVATION 9~• G y BM 2 DESCRIPTION ~ ~ o •~ ~ 1 r Pv~ p,' fie. SYSTEM ELEVATION ~aP cf ~.., y 0 Lc+w ~ r 9 ~ ~a ALTERNATE ELEVATION ~o (~ `I~~ 00 Lt~w-e~'`~•' 90 CONTOUR ELEVATION Tp ~~ ~-/GCJ • d ~~,v (3vv1 ~-2 • c ^ ~' 3 ~ ~,,Ir. ^ ~- l SIGNATURE ~ Qvh Z oC ~~'~ N X ._.. -~-. 5ec,, DATE / Z ~ ~ Z `G ~c~~- 2 ~ 3 Z~9 S7[' CY~tJ1fX: CO'rCTNl'Y SEPTIC TANK MAINTBNANCI? AtJRL~13MENT .AND OWNrRSIiIP CL~RTIFICATION FORM owner/Buyer Mailing Address Prop©rty Addl-ess ~ ~ ~~ Sf (Verification required from Planning Department for new City/State ilvr~~ ~'L~ lam! -Parcel Identification NulnUer ~~~ /b~y' ~~~~ LTGAL DI;SCRTI''I'XON ~7~5 Property Location ~..'/;, . 'E _ '/~, Sec. ,,,(7 , T f-~ q N-R..L_~~N, Tovsm of S~IUdIV1SI0I1 ____~ ~~i~ ~ ~;; _- LOt ~ ,.,:,~_ Certified Survey heap # Volume Page ## Warranty Deed # ~ /~~/ ~ ,Volume L-~~-~ ~"~ ,Page ## Spec house ^ yes I30 I.,ot lines idelltifiable yes ^ IIo SYS'TI';M[ MA.>CNTENANC~ Improper use and tnaintcnance of your septic systcnt could result itt its premature failure to handle wastes. Proper matintet>,ancc consists of puutping out the septic tattle every three years or sooner, if needed by a licensed pumper. What you put into the system can a$eat the function of the septic tank as u treatment stage in the waste disposal systcttt. The property owner agrees to subttut to St. Croix Zoni,~g Department a certification form, sighed by the owner and by a ma.StOrplumber, joun~eymau plumber, restricted plumber or a licensed putttperverifyivg that (I) the on-site wastewaterdisposal system is in proper opcratiag condition and/or (2) alter inspection and pumping (if ttcccssary), i[te septic tank is Less than I/3 full of sludge. Uwe. the undersigned ltavc read the above rGquirctncltts attd agree to maintain the private sewage disposal system with the standards set foritr, lxerein, as set by the Dcparlntertt of t^,otnmcrcc and ilte Dcpart~nettt of'Natural Resources, State of Wisconsin- Certification stating that your septic systetu ttas been maintained utust be contpicted and returned to tlic St. Croix County Zoning Off ce withim 30 days of c thrcc year cxpi.ration date. I A F APPLICANT /%~~ ~ DATE ®WNrR CrRTTIf+'ICATION I (we) certify that all statctttettts on this form arc taste to the best of my (our) kttowlcdge. I (we) aui (arc) the owner(s) of the property described above, by virtue of a warranty decd recorded itt Register of Deeds Office. `~~~~ .~ ~ Z Zl 6~ NATU O ~ APPLICANT e DATE Any information that is mis-represented tnay result in tlic sanitary permit being revoked by the Zoning Deparirucnt. **~*~~ f4ti-~F• •t Include with this appticAliott: a stamped wan~anty decd front tltc Itcgistcr of Deeds office a copy of Ilte certified survey map tf rcfcrouce is made in tttc warranty dead POWTS OWN +'R'S MANUAL & MANAGEMENT PLAN Page Lof ~ PILE INFOR ATION Owner , s ~ ' ''ermit # DESIGN PARAMETERS Number of bedrooms ~^' o NA Vumber of Commercial Unit ~ NA '~sti-nated flow avera a al/da )esi flow eak , Estimated x 1.5 al/da tioil A lication Rate al/da /ft influent/Effluent Quality Monthly Average* Fats, Oils & Grease (FOG) <aU mg/L Biochemical Oxygen Demand (BODs) <220 mg/L Total Suspended Solids (TSS) <150 m /L Pretreated Effluent Quality ^ NA Monthly Average** Biochemical Oxygen Demand (BODs) <30 mg/L Total Suspended Solids (TSS) <30 mg/L Fecal Coliform ( eometric mean) 4 <] 0 cfu/100mL Maximum Effluent Particle Size '/a inr.h diameter SYSTEM SPECIFICATION Se tic Tank Ca acit al o NA , Se tic Tank Manufacturer ^ NA Effluent Filter Manufacturer o NA Effluent Filter Model o NA ' Pum Tank Ca acit al o NA Pum Tank Manufacturer o NA Pum Manufacturer ^ NA Pum Model ^ NA Pretreated Unit ^ Sand/Gravel filter ^ Peat Filter n Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer Dispersal Cell(s) ~In-ground (gravity) ^ In-ground (pressurized) ^ At-grade ^ Mound ^ Dri -line ^ Other: * Values typical for domestic (non•commercial) wastewater and septic tank eftluent. ** Values typical for pretreated wastewater. ~9.-~INTENANCE SCHEDULE Service Event Service Fre acne ns ect condition of tanks 'um out contents of tanks At least once ever When combined slud ^ months e and scum a ~ ear s uals one third (Maximum 3 rs) 'h of tank volume nsj~ect dis ersal cells At least once ever ^ months ears Maximum 3 rs) .'lean effluent filter At least once ever ^ months cur(s) ns sect um um controls & alarm At Icast once ever u months - ~ cur(s o NA -1utih laterals and ressure test At least once ever o months o ear(s) ~'NA )thee: At least once ever ^ months o ear(s) -ANA )thee: At least once ever ^ months o ears A MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: :'vlaster Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage 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 backup or ponding of effluent on the ground surface. The dispersal cell(s) 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 f'~tiling condition and requires the immediate notification of the local regulatory authority. Vdhcn the combined accumulation of sludge and scum in any tank equals one-third ('/~) 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 ch. NR 1 13, ~`'isronsin Administrative Code. The servicing of effluent filters, mechanical or• pressurized POWTS components, pretreatment components, and any other ,maintenance or monitoring at intervals of 12 months or less shall be perl•or-nctl by a certified POWTS Maintainer, A service report shall be provided to the local regulatory authority within 10 d~-ys of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that my impede the treatment process and/or damage the dispersal cell(s), If high concentrations are detected have the contents of the tanks(s) removed by a Septage servicing operator prior to use, ()WnCr: ~ ; ~' ~~r~i.• Puge~of.~ '~~~~~?a.~[.S._"~.~J' System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages purnp tanks may fill above normal high water levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent Dump or contact a Plumber or POWTS Maintainer to assist in manually oper~iting the pump controls to restore normal levels within the pump tank. I)o not drivt or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact. The area within 15 feet down slope of any mound or at-grade soft absorption are. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONEMENT 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 ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage servicing Operator. • After pumping, 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 (f the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replac ment system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and 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 that tune. ^ A suitable replacement area is not available due to setback and/or soil limitations. $arring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement arr.u. C11~on failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. 11' no Ceplacement area is available a holding tank may be installed as a last resort to replace the failed POWT5. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at the time. «WARNING» ~+EPTIC, PUMP AND OTHER TREATMENT TANKS MAY CON'T'AIN LE'CliAl. CASh:S AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR O'1'H1~.R TREATMENT TANK UNDER ANY f'IRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK ~1AY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTAL E ` Name Phone ~ - SEPTAGE SERVICING OPERATOR PUMPER) Name Phone POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHOR TY Name ,' ` Phone 'J 2252P 3y0 DOCUMENT NUMBER xAxaArrrY aasD William E. Hawkins, Grantor, conveys and warrants to Midwest Equities, LLC, Grantee, the following described real estate in St. Croix County, State of Wisconsin: Lots L, 3," 6, 10, 11, 12, 13, 17, 18, 19, 22, 27, 30, 35 lA and 3A, Prairie Run, Town of Hammond. This is not homestead property. Exception to warranties: All easements, restrictions and rights-of-way of record, if any. Dated this S 3 day of May, 2003. (/J/~~ G N ~~~ (SEAL) William E. Hawkins (SEAL) AUTH&NTZCATION Signature(s) authenticated this ~ day of , 2003 (Sianatuoel (Name Pointed of Twed1 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) THIS INSTRZA4$NT WA3 DRAFTaD BY: Leo A. Beskar Rodli, Beskar, Soles b Krueger, S.C. P.O. Box 138 River Ealls, wI 54022 ~~~~~i KATHLEEN H. IiALSH REGISTER OF DEEDS ST. CROIX CO.. MI RECEIVED FOR RECORD 05/23/2003 @2:20PM MARRANTY DEED EXEPtPT # REC FEE: 11. @0 TRANS FEE: 594.00 COPY FEE: CC FEE: PAGES: 1 NAME ND RET,UtRN ADDRESS 9f0 f~~ /(~,~~fsf s~ //a 18-1037-10-000; 18-1036-90-000 18-1036-80-000; 18-1036-70-050 Parcel Identification Number (SEAL) (SEAL) ACIQ7OiPLaDGI•~NT STATE OF WISCONSIN ) / ) ss. COUNTY ) ~J ~ J' '~1 J ~~}}~~ V . Personally came before me thispCJ `.~~ay13~~M~p, ap03 the above named William E. Hawkins' •' '~ e to me known to be the persons(s) whO•.ex~~u the r foregPinryry~~instrum t and acknowledde••th~s~0~ ~~ /~ VVVVVV ~ ~.a,~~C/ A ~-1,, _f J~ Si na CUCe * (r 1 `~R,.' ~' ~ ) ~~ ~•. Name ~~,,r' `Ed or T ed Notary Public ~y . ~o~iri~y, •wis. My commission is permanent. (If not, exgiratiori date:) SOO° 39' 03' E 600. 00' ~ __ _. --- __. . ._-. _ .._. 0 I ~~ ~' I M I I OJ ~ N >; I M ~- z ~ w 1 I 0 O Q, I ( W' p ~~ ~; ( I~ ~ ~ o ~ 1 ( W; ~ I ~' Z I3 ~ ° ~ e S00 39 03 E ~ 300. 00 I ...... ...~ :.... .................... ........1 ~ 0 ~~ ~ ~ ~ (°' >-: N I ji i M ~ I ~ . , 8I-{ ^ ~ ' 0 M i0 M ~o ti' ~r a~ 13 ~Q { 1 ' { ~ aD y e!6' SOO° 38' 03' M -- - -_ ~ ~ M 7 O s ~ ~. N I+f • 0 S00° 39' 03 I~ g a® i 1 ~ 50' 1 _ N ~ • .~ ~' ~ V ~ ~ ~~ :~ 4 - ~ ~ ,I ~ d .O ~ N ~ ~ - I ~ : ~ : N ~) ~ ~l: W~ ~ I ~ ~ ~ : : z i ~ 50' SOO° 39' 03" E 33.00' 267.00' 6' 1 1 ~ ti ~ ~ ' N Q~ N OOh I ~ ~ ~ ~~' ,: ~ 1 1 3 00. 00' Noo° 39' 03" W 300. oo' fit' ~ ~ Q y~~ ~'- ~ 8~ o~ J ~` w ~ NOO°38' 03"W 567.00' ~ ... 1 : i 267.00' 300.00' 1 $ g ~w~ M ~' ~ ~ . ti M ~ V y ~ Q y M ® ~`' Q o h a ~`~' p~ ,~ ~. _ NOO° 39' 03' { a ~ ~ M i O 1 1 cp ~ 1 ao ~ , i - 1 ( 1~ 1 N ~ 1 i I ~ ~ ;~, ® N g' 1 I W , { M E- ~ ~ 1- ;W 1 ~ ' J 1 ~_ ? ~~ o~ { ao ~ ~ .................. - ~ 3 ~i C ai , Z 1 S00°55' 46`E ~- al 3a' { 3J' ~-- 162.38 --- 1 ~d .J. •• { ~ PUBL 1 C g ~ ®~ { ROAD • m ' ° ~ r a :~ r NOO 55 46 W I ; 162.38' 1 1 .................... ~ ( 1 1 1 ~ . 1 1 M Il") N Of h N O t n ~