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HomeMy WebLinkAbout018-2011-64-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)I. 'ermit Holder's Name: City Village X Township Bast, Kernon Hammond, Town of ;ST BM Elev: Insp. BM Elev: BM Des tion: ct 9. `d - CSC TANK INFORMATION n. _ , ~ TYPE MANUFACTURER CAPACITY Septic (~J, ems, ~ act Dosing `` ow.,bo v 56 G'; ~ Po I a Iz. 525 ~' Holding TANK SETBACK INFORMATION TANK TO P/~LL,, ~„ ~eb+- WELL BLDG. Vent to Air Intake ROAD Septic ~~ ~ ~ ,! ' 7 2 a r -- Dosing ~ ~ 1 ~ ^ F j-- / L t ~7 .y ~ / Aeration Holding PUMP/SIPHON INFORMATION A~/ I~tr ~i~ Manufacturer ~p V l Demand GPM Model Number ~ T TDH L~ft~' /D DU ~j Fricti~ LoLss System He~~ /%VV TDH 7~t 1 Z.. Forcemain Len~~ Dia.Z+~ Dist. to Well ~~ SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 514901 0 State Plan ID No: Parcel Tax No: 018-2011-64-000 Section/Town/Range/Map No: 30.29.17.1079 STATION BS HI FS ELEV. Benchmark `' Z `7 ~~G ~~, Alt~~` ~ ~ ~ ~ ~ r Bldg. Sewer /Z + 9 Z SUHt Inlet 12.3 7z.7z St/Ht Outlet Dt Inlet Dt Bottom il~. 3 ~ ~ Header/Man. ~ .~ ~ ~• ~ Dist. Pipe S. $ ~9~L Bot. System ~Q -y~ 0 • G.~ Final Grade ~® r/Q~ St C ver ~; l ~ ! O ` O BED/TRENCH Width ~ Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 `~ ~ , ' _ ` Z ~ ~ew~ ~~ ~_ ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:..--- ~ INFORMATION CHAMBER OR ~ ~-I~ L Type0 te~ "l ~j ~~! /~ ~ N~-- ~~ UNIT . l Modell~m~ r y1, J d , CC....~~ (...~J DISTRIBUTION SYSTEM Header/Manifold Length Dia ~I (/ T Distribution Pipe(s) Length ~ Dia ` ` Spacing x Hole Size \ x Hole Spacing \ Vent to 3r In e Ca d..+ SOIL COVER x PrP_SSUre Systems Only xx Mound Or At-Grade Systems OnIV " Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched S Bed/Trench Center ~ 7D Bed/Trench Edges \ Topsoil ` Yes ~ No ~es ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /_ Location: 795 157th Street Hammond, WI 54015 (NW 1/4 NE 1/4 30 T29N R17W) Emerald Acres 1st Add Lot 64 Parcel No: 30.29.17.1079 1.) Alt BM Description = ~' ~ ~ ~J~'~" C~4S'ti~ b ~ 2.) Bldg sewer length = /5 / - amount of cover = ~ ~ nn ~jo~ ~ ~+-~~~~ Ste, •~•.~ e ~ oJ~~ . r~' r - - Plan revision Re uired~ Yes No (~, - - - II Use other side for additional nformati~ ~_~.__~_ ~ y__, ____. _ ___ _ Date Inse tor's Si a SBD-6710 (R.3/97) `-~\ ` f T ~ 1 `.r ~ U ~~, Cert. No. eottMnsttt:ls.nW.gOV Safety and Buildings Division County r 241 W. Washington Ave., P.O. Box 7162 j ~~ r ~ ~ sGOnsi n Madismr, wl 53707-7162 Sanitary permit Number (ta be felled in by CoJ Dint a cwwnsrae 5/y `!Q / anitary Permit Applilcation State Tea>tsactiore Namber l ln accordance with s. Comm. 83.21(2), Wis. Adm. Code, stibmisaion of this form to the iete l ~ >~- unit is mgttired prior to obtaining a sanitary permit. Note: Application forms for state-o WTS submitted to the Department of Commerce, Personal information you provide ma be ~ect Addreess (if diffenart than mailing address) es in accordance with the pri Law a. 15. t m State. ./~ ~ ~~ ~ 7 ~. 1 A li i I / *~" ' cat . os nformation -Please Print Property Owner's Name ~ Y ~S~ ~ ~ `3 Parcel # ~~~-- 2a i I - icy - oas~j Property Owner's Mailing A r~s d Y Property Location ~' ID7 l ~ e~ -¢ er CROIX COUNT Govt. Lot Cit State Zi d C Ph Q bl j4 i ~ ' y, p e o orte~ jtt on ., ~~ /,,,p/~ %, Sect ,~ ~ , r r~ (Ca.drOa.) R ' N ~ f B ll T n L # 1 T~ / , ~ E W ype o a . ding (check ail that apply) ~ ~~ ~ r.."~-._._. ot or 2 Family Dwellin - Number of Bedrooms ~ (30 ` / 1 Subdivision Name g ..... 1i L/ r 5.,t,~"^,' ^ # ~ --"- ~ ~ /~ Gyps lr~ " Public/Conleteereial - Desoribe Use ~~~, `~`~ City of ~ " ^ Staff Owned -Describe Use CSM Number ~ Vill eof a8 G~ ~.) ~~~ w ~ 9 f" ~ / L--I'iG- Town of ~~1'~ ?'~ 6-Cl t~ fll. T ype of Permit; (Cieck my one bo>R on line A. ComplNe 6ne B if applicable) ~'. New System Replacement Treatment/liolding Taedc Replacerreent Only Other Modifecation to ExieRieeg 3ystart (explain) .-----°r. SYsrem R. Permit Permit Revision Change of Permit Transfer bn ~~ Previous permit Number and Dste issued Renewal Before Plumber New Otvnor Lrt ration IV. T of POWTS S tem/Co nmtlDevice: Cheek all that a on-Pressurized in-Ground Pressurized In-Grorued At-Grade Mound > ?A in, of suitable soil Mound < 24 in. of suimleie soil Holding Tank Other Dispersal Componatt (explain) Device (explain) + V. Dis rsaVFreatmeat Area Information; , ~ -~ ~' 3 Elevatirae Design Ftow (gpd) Design Soii Application gpdsf) Dis oquirad Serf) Dispersal Area Prop9aed (st) ysterre Vl. Tank info Capacity in Total # of iVlanufacturer Mtlterial q7 Gallons t3allans Units New Tanks liadating Taedcs ~ ~ /~ ~, F"~ Septic or Holding Tank ~! '" Q~j~f ' ~ g s' fi 6.~t/ G ,tom' C~ Dosing Chamber 0 i ~ ~ ~ ~ 6t Vli. Res ansiWli Statement- [, flee eodersigocd, asaame t~esposasibaity tar hselaBatioa of the POWT3 oa tae atlacMed Plumber's Name (Printl Plumber's Signature Nnntber Bosrnrss ~~ Nurnber T'• 3 ~'F 3/~ ' 9' D 7C ~ , ~ .rc~ elf ~ p Code) Plumber's Address (Street, City, State, Zi / l U ? C ~d G r~ ~~~~ LI % V11I. COpn /De artment USe On atipproved Di,_,.,_ s~norovect Permit Fee Date I / ~+ Issuing A SigerereUero ~Owne_ -~ for Denial $ 11~a . ~ ~t 6 / ~ /(Jp "-_","; CoU . ~ n~^-~ iX. Conditf~f~easons for Disapproval 3~ ~ J ~ ~ x~ ~ iXN~aY~~ ,~ ~ r ~ 1. Se tic tank, efflulnt filter and 1 ~ dispersal cell must all be servkes'/ maintained ~ a~~p4,~ ~/ ~ ~ ~"'` ~'~'`~"'~'`~' _ as per management plan provided by plumber. //~_~ ~~ 2. All setback requit+ements must be maintained , / '"'_~ /GC ~1~Z1.I 7 e es Fade 1 ..w r.~ w.~ a sn ~ r 1 lochs / ' / I~ ~i Ailaeh rD [oraprere pupal nr ^wc ~~sK«. r.w . ...............~ ....~...~ ..~- _ - ~ ~ ~/ C' ~ ~ ~' ~/_ '' r s~~-s39s (R. olio's vaua thru 41ro~ ~~ ~ `'~ ~1,. 5~ ~ '~' r ~b ~" / ~ab~~~`G f ~1 ~~ ~y ,~©~~~ /~ d 3 J I '.. ~ ~ ~' ~~ ~ ~S v ~~ h 7R ~~ M~ ~~ w O ~~ ~~ ~~ ~~ ~~~ (~~ppy /~ , G/ ~ ~ ~u ~~5~ ~ .~~ ~~~ 9~ 6 ~~~~~~~ ,~6 ~ d ~~ T ~~ ~~~ ~ ~s y v ~v ~~~~ ~~ ~U .` ~, ~ ~ ~~ ~ h~ ~ ~ ~b ~~ w r ~ ~ ~~ g~ ~ ~©~~~ ~~ 3 ~' ~ ~ ~ - ~ ~~ c~f~=sue ~ ~~.?~~9~6fo~~~/~~ ~/''7 ? / ' BUG ~6 ~ , o k,dude, hart not Ihnlted to: vertical and horimntal reference ponrt (DM nand Part~l LU. percent ~ bpe, scale or dirnonsions, r,orU, arrow, and location and dl n ly~gtest road. _ ~~g-r ~6 // ~ ~ ~~-~- Please print ~~p ~ ~^~~ Rev' od --- t ,,~... 0 ~ ~.s-o Peroonel Inromrnaon you provide mey be used I eocon , id if~rivncy Lnw, e. f5- (1 r PropertyOwner , i.,~ ProperlyL G ~ Govt Lut (~/U,J 114 1~JE 114 S 30 1- Z ~ N R / E (or _ ~~C~ r ~-~ s J , ~ _, Properly Owner's Melling dldres`s ,~ , , L t # f3kx;k # Srulxl. Name a CSM# 1~~3 ~}l,,)G`•~i~Ke~2. ~ ST.CRUi~~'~FiCE ~~ ~.-_~-~r~lYl~~~~1 `~r~ ~~CL~CZ(~j2 City r Slate Z(p Ccxle Plw F-"-"`"~" ^ Cily ^ Villaye ~-Fvwn tdearesl Ruad ["New Construriion Use: ~-F2esidenl'ral / Number of bedrooms ~~ Code derived besiyn fluw'rale _ ~~ _~.~~_-_ GPD ^ Replacement ^ Public or commercial -Describe: - _~ __ -- -__. __-_-___ ---- --- Parent material Q~-t.J ~ ~__________ Flood Plain elevation if aplrlicabl{i' _~_~ __ _____ R• General canmerrts ~~ 1 ~ v/l 2-I 'e 11 ~ ~~~ ~! l/ ~ C~~ S~~;F?~=dry arrd reconnnendatiars: T '-- Wi-=corsin Depertmer,t of Commerce SOIL CVALUATION REPORT Ulvision of Safety and Bulfdings in arx:ordar,ce will, Comm 05, Wis. Arbr-. Code County Altad, Wniplele site plan on paper riot less than 0 1/2 x 11 irrclres er s' ten must ~ `-~ ~ 1 ~ Boring # ^ Buriny /~ 111___111 ~'Plt Ground surface elev. _ t_! ~?©__ I C~ t. Ueplh to Ilndiiny factor __ O~ ____ in. -- ' -- _ rcalion Rate _ __ Sol ~ppl Horizon DepUr Uorninant Color Redox Uescriplion Texture Structure Consistence Qoundary Rarls GPU/IP in. Munselt Qu. Sz. Cont. Cobr Gr. Sz- Sh. - 'Elf#1 'Elf#2 I b_ i 2 I o 3 3 Zmst~lc - ~ 5 .~~c-~' _ 5 . B 4 a-~ la. ~ - -~s ~_ - - - y - (~ A~ ---_ _~ `.- =~ - - ~ Boring # r~~Bonny ~(pQ, - - LT Pit Ground surface elev.~I O ~ ~ ~ _ It. Uepth b liraitiny factor _ ~ ~ in. Sol Application Rate - Horizon DepU, Uorninant Color Redox Description Texture. Struduie Consistence [3oundary Roots ~ GPD!(P in. Munselt Du. 5z. Cont. Cobr Gr. Sz. Slt. 'Ef1#1 'Elf#2 _ Z 14~ ! _~L- Zmsek m~- c 5 __ ~ ~_ a __ Z EtRuent M1 = BODS> 30 <_ 220 mg/L arnt TSS X30 < 1,~iU my/L ' EOluent d2 = BOD<< 30 my/L and TSS < 30 my/L CST Narne (Pte Pra,Q ,.-~-' Siynature CST Number !1 dress Uate Evaluation Conducted Telephone Number 21/3 ~~ ~~..~ m~ ~~1~~~~- ~~ - ~-c~ _-~, Paye _ l of _ Parcel ID ft ~~ ~ ~ Paye __~_ ut ~-~ Property Owner ~ _ --- -'--------- 3 LJ Boring mm Borhtg # Ground swiace elev.`~~' ~ it. ~-^. ~° ' ~it Deptlt to Gntiting factor ~ - irt• _ __ Sol ~ r rlicatiorr Rale Horizon Depth DominanlColor RedoxDesc.-riplion 'Texture Strudure Consistence Boundary Roots GPDftE` •EtfN1 'Eft#2 in. Mtntsell (au. Sz. CvrtL Cobr Gr. Sz. Sh. _ - ~ O 2 i2_~, - s~ ?,r5~~ _,~,~_c~___ - -~ ~-o- - j - ~- -- --- LJ Boring Boring # - - ^ Pil Ground surface elev. -1t. Depth to limiliny [actor ___ irr• Sod /1 licatlon Rate liorizat Deptlt in. Dominant Cvbr Munscll Redox Description C]u. Sz. Cont. Cobr Texture SUudure Gr. Sz. Sh. Consistence Boundary Routs GPDItF - 'EIt#1 'Eff#2 U Boriny Boring # Ground surface elev. ______ ft. Depth to limiliny fa~t~r _ _ .-._'______ ut. - ^ pit _ __ Sorl A IicaGon Rale Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Cobr Texlwe Strudure Gr. Sz Sh. Consistence Boundary Rcwts GPDIfF •Eit#t 'Eft#2 • Effluent #t = RODS > 30 < 220 rng/L and TSS >3U < 150 mylL 'Effluent 112 =BUDS < 3U my1L and 1 SS < 3U ntylL "hhe Ueparttnent of Cvtnmerce is an equal opportunity service provider at-d cngrlvycr. If you nccd assistance to access services or nccd material in att alternate fomtal, please contact the depatUnent a- GU8-2G6-3151 or 'I"1'Y G08-2G4-8777. sno rutore.otrorq (~` Parcel IU Il ~~`~~~ - Paye __~_ of _~-F Properly Owner _-_~~~ ----- - ---- --- - 3 U Boring ~j ~ _ Boring # "r 1 • ~ (t. -„~, § ~ UepUt,lo'GnuGn (actor _~ ~ in. -- ~'Pit Ground surfar:e elev. g Soo n , icafiorr Rate R ' e ~ e -lurE c St Consistence Boundary Roots GPD I(t? Horizon DepUr Dominant Color RedoxDesc.~ripliun xlur T , ru 'Eflllt 'EffN2 in. Munsell Qu. Sz. Coml. Cobr •~ _ Gr. Sz. Sh. - 2 r 2-~ ~- _ ~ .y ~' __-- -- __ -__ __ - U ~Boriny Boring q - ^ Pit .Ground surface elev. __ ft. Ueplh to limitiny factor - in. Sow I'rcaUon Rale Florizpr UepUr in. Uprrinard Cokx Munsell Redox Uescriptbn Clu. Sz. Cont. Cobr Texture Slrudure Gr. Sz. Sh. Consistence Boundary Routs _ GPD!(f 'EIfH1 'ERNZ L] Boriny Boring H Ground surface elev. It. Depth to limiliny fac;l~r ___-__'_:____ in. -- ^ Pit '------ _ _ Sorl nP IicaUon Rate Horizon Deptlr in. Dominant Color Munsell Redox Despiption Qu. Sz. Cont. Cobr Texture SUudure Gr. Sz Sir. Consistence Boundary Rrwts GP 'Ef(111 DIfF 'EffH1 .,, 'Effluent #1 = BODS> 30 < 220 rnglL and TSS >30 < 150 nrylL ' Efltuent If"L = BUUS < 30 mylL and TSS <_ 30 nry1L 7~he Uepariment of Connnerce is an equal opportunity service p[vvirler and cngrloycr. ! f yvu aced assistance to access services or need material in a[t alternate fom[at, please contact U[c dcparttncnt at G08-2GG-3151 or 'l'1'Y G08-2G4-8777. sae-rtuo ra.orronr ~. I'~~c,e 3 or 3 M ' I.i~r,l N I.I:r;~ 1.I)Ial_Itll'rl~~ll:~Wli~l~,,=u~1,;.3v12q_.r,,al~et~~~~ NAMe: S1Z~ v ~'-- --- -- ' -~- - - ,, SCALE: I "= G ------- --------------- - ------ - -_--~- ~~I- ~ i B~~cLr_vA~rlol~:__~ov._~--------- -- --_-_ --- -- .: ..~- .- Dhl l DGSCRII'll<)i l: _-}~Q_o~~_,-` Pv_~_..P~P-e---- I3h1 z r_t_ev~\I li~rl. --__~~aZ 0 _ 30 _ --------- - - \ ~C=-- -- -- `, nhI 2 DI.SCitu' ric;l l - ~-~ ~__I_'~PTTvc -~~'~~ - aD V SYS'1'I:NI f~I.1:V;\ I I~ ~t ~ ~~ SYS"I'I~NI "I'ti'I'I~,:_`._0 nu~/~~~?Jr~_u r_- - ~,,~ ~~Z T 1ta _~ 6~ti t C~ r~ 5 ~~, ~ ~,1 ~~ ~-3 l ~1 6 `N_ .. ~• - .~ d' :l ,fib ~ Cil a1 1 F" ~ (~~~ ~~d I ~ W c~ ; ~ }- ~r a ,~ E ~ ~ ~30~ J ~ ~ ~ i ~ t]~ p q' ~ J `~,~ ` ~ -- O cif ~ ' - ~!. `N j ~60'~ Nlr~~~ GoOQN . ~ I ~ 1~ ~ ~ ~ ~ ~ . ~ ~~~ ~ I ~ I _ ..1 N ~~1~, z ~ ~ o ~1 ~e~ ~ ~ ~ I ~2a ~ ~ ... ~ a . ~ I ,tL'ESE11MtibA1-o00N i ..~ ~ ~'( .' • J N ~ i PS~~~ ~ '- ~ '.- N. r. -r• i i - i ~ ~ .-- *,,,, ° I ~ ~ -- , ~ ~ ~ ~" "' ~ ~ P~ ~ ~ 1~ i ~ i ~' ~ ~ •: f ~ o M ~ ~. : ~ 4 1 MW~ ~ ~ w S II 1 / ./ '^" ~ , $ 1 . I~ ~ cs c~ ° N j . . . T ~ ~ ~ ¢ I 1 i ~ ~ c1,1 11 ~ f i ~ o 4 ~I I ; ~ rj 'D~,~ ~ ' , tU ~ 1 ~~( ~-, ~ ova d' d 099898ES T G 1SFiH2133dS Wki31 Wd6 T~ T T BOOZ u~C B i COUNTY PLAT OF: PREPARED FOR: SURVEYOR N EMERALD ACRES 1 ST ADDITION Narokl&F #W~>~ ` =cxwcr~uat+ "~~~,~' "` LOCATED IN THE NW114 OF THE NEt 14, NE114 OF THE NWt 14, AND IN N~Aros~ 139AWANNEER/l ~~~~~ ~ PART OF THE NW114 OF THE NWtl4, ALL IN SECTION 30, T29N, R17W, ~~''w~°J "` co ~ a°15 NSi`t ~; . TOWN OF HAMMOND, ST. CROIX COUNTY, WISCONSIN. ~ ~y~;...........h, ' F :~ `.~ tr1 towwc I - Fuvuu ' _ sZaat ~ LL~ W• auLNr R ~ ` =~ I ~ ~Aa ~ ,I~ 2 u ~~ ,~ a~ I I pAM~~d~ ~1 VL'vfl~:l ~~NI~J A~~~~ lY,1'uJ~ NIN[CPold1YCNNCI I Vi ~C ~V.'~LO~`h, -. - - - SKETCI w.wrnmpNxroxwrw '~, it ry ';N.a ~ Ni lu I @ ~ tl`, ~I ~ sx'u I~ _ x:u mlNii91E tl Rmw.fxrorrcasr. -11 I ~'----1"------~ ~ ~ _ - SEC. 30, T29N,R17W - -- - -- ----- --- -----'_ 9 ~ ~ ---- ---- "N t311,55 - S89' --- _ ~ ~Npsrnn~ 588'4912"W 1811.53' ` ' ~ , s .. a I " ~ ~ lE 0 N: Nmt TT' ~ ` '" "° GHWAY ~ ~ ~ , `' COUNT ciau,mro,lwwm0 s%'ro,tWm, ,o T ~ " Y TRUNK HI u ~ -_ - aw i,m. - ; _ _. _ i . ~VI _ .. _„ ak"t. ] IIF2 s0 ___ _ -__ _ r4SCY.Ni-17%_ _____ ___ , -- L_. L Pz15- 3 ~ ~. .- _-___ -__.. ... fB,d _. _.. ._ ._ .... ¢ ' I '' ,Atr 2~s 8 Nw~ ms~a0 ~ I r I E R ~ I ~+` LOT 51 .. 0 I 199 ACAS . _. ~ .. I ~ ie ~ 8 .:..,. Bi 1 v _,_..........., .......... ` ~ LE4END 86,590 SO. FT. 8 ~ m ue I LBO -104580 ~ A ~ r Fr ~ 1 LOT 57 ° 6~ ~.,~ ! ~ tseccNOxsrtw.r, 8 LOTSB ~ 2,OOACRES ~m ~ `r 1 B 3 S lseocrmrgww xdr%%Ltlr% 209 ACBES 81,181 T0. Fi. n xeuNw« 1 xa 1 $ 8 _ ---- I 90534TO.FT ax.Nxd„ y s~v~,c~.c r, I; ~ i - 1 I.O0.rCNVRI0IM ~ ~ ; ~ 4B~0, = 1053,50 , ~ ^P'+s~ %@ LOT 81 - 202 ACRES $ _. 81 '' 0TH ~ LOTS LOTN L7B ADtET I S ~~~~ u m ~ _ ; n aooj w 81,918 S9 FT. ~ $ ` 1 ~'~~ 20 g 90533 SO FT 1R9 PCRES 274 SO FT 17b~ S0. FT.' ~ ~ txoofmWOUrais~. ~ieucxe,iNeamn " I ~ 200 AC ES O -BI I I p8 LBA = 105500 s, St, ',` ~' . . 82, L9II = 105730 = " 5 Sd FL ' $ $! 11 5 LQT82 a ~ . ~ ~ ae,wa%s p ~rAwRx~Mxa+~cvs . 81,12 Nvaoet,nst ~. '~~ IS9'15tlf:li7l 202 RCRES , LOT 83 1 \6 tuv.=„ss ,mrtiamw,wmsl I 9 _ 87,970 SO FT. 2,62 ACRES , 204 SO FL 1 14 ~ r+a'~cwvrWrrtw~ml , a r~ ~ 5 g E E o ~ L36 = IOSS~00 , 1 L.BA=105500`81 : m ~ __. NC4p,Ar gt3pnlt[!asa++ . Aas $ ' i Nanosf tn u i a ur% :',tn a w ~ w c , ~ i i i ~° - ~tuaras~an . R i ' _ ~ ~ \ 1~ I - ~.~omc,s I a - i 9 ~ -,s t `8. ' .I...., e<i, t''~W J ~ ~ ~ 4gt ~ ~ J G ~ L90 = 105500E ~ d , ~ %- . ( °'t¢~`~r~1`~t ''m`ytz l~ ~8 -(~. 1'. +"n/ S nxr.. ovt~w~uuro,ml ,x:,~ w~vexxu ~ Lone . A .1r 'r~~` ' ~ m ~ ~ R ,~ 8 ~~ & 1.97 RCRES FT 85 914 SQ . r J ~r0 ~ 1s 8' s0 -- ~'~~ i ~ LOT SS ~ , , , } LOT e7 ~ - LOT S4 g w RER 2,00 ACRES 25 I 8 4ASAEFI 1 b 87,(25 SO , ~ a ~ ~ LOT 80 1055ASOEFi 88 # ~ ; ..___. Z R 871 S0. Fi, 3 7, 2 . Y ~ 0 ~ , ; 200 ACRE ' S I R o ~ v 20 p T ! I, ^ `I FL ~ 91162 SO R ° . f ~ ! d9~ 90,323 S0. FT. 1 ~`''' f ~ I I b ~ `ti, ~ ~ , Os , Ndrert~sw ~ ~ ~ ' ' • P (•, ......,, .... .. ............. ................. .. .. _......,, bums b ~ I 0 ' r ` ~ w 0 ~r LOT 88 ' ~ ` R R E ' I 8 8 d ~ ! '' - ~ ~- - m N4f _. ~ ____--_7ti6. l -._ FI. , 87,2GI SO ' --imsr--- y ~ i --, __ sn ~'. S'tr ,M i Nrr°ss i ~ssa - ! Jr l~ Ic e ~ , . 9 , , i ~._..-- - _ N _ --- _. --TOWN ROAD-- I l e ' ----__ _ _ _ _ _ __ _ _ ~ ~'~ '~ Nsaze,wieart 6 I R715(Qf 8 ,7P.% 11 21ir5 .. . ;g ~W is r ~ 4 r - _. ' -. _ sn ____ m._ __ - , __- ____ B , 4 ICI P. 1' m i xNL C SSO i f '. 6d ~ ~ Q n I R ~. \ I ~ ~I I i i ~{~xn LOT BO ` 8 ~I ~ ~ ..... , 9 200 ACRES ~. , ,~ 8' ~ 5 I , ........ ................. , 1 : 81,153 SO. FT. ~ . I I I ,, ~ , , , I ~1 , ~ O 8 E v r, '~ w ~, ~. , ~f~ `8 $x e O Q AL~S i 2~ n 2dR ACRES 8 8 LOT 7S 8 - LOT 74 LOT 73 4 $ ~ ~ ---- LOT 71 ~ 1 e r «~ : ~ ~% NP9dIAf&'8 m ~y m ~» : ; ~ , 87,220 SA. FT. I ; 97,220 Sd FT, ~ L,flA, = 1067,50 2,00 ACRET 3 a e7 220 sB Fr ; 2A0 ACRES a 2.00 ACRES d LOT TZ 3 200 ACRES ~ , 200 RCRES ~ 1 ~ \~ ~ `~ i m ' B i ~ , . , 87,139 S0. FL 6 87,225 S0. Fi, 87,122 SD, Fi. 87,146 S0. FT.. ,% I I ~, ~ 0~ 1 ~ ,x g ~ ~ ~ I ~ R c ; i v 1 ,% +S, ~'' LOT 70 \ ~ ` 2 00 ACRES _ 8 ' NmLs ~s~m~>nx~r~ . - ~I I g ,: ~ ,~ , pi 87,312 S0. FT. ~ ~, ~ ~ N9['WARmwOrotO'05R'3U td .: ~ wg 1 8 , ~` I 1 . ~ ` 1 ~ ~ I ' ~i I ~~Aww ~ i 1 ~---- ---- - --'- mrs , ii m., ®% d ------ %m R Sw s~dt cNn:1w, snm rsfrCra trm r, m%~ aes zisa t`rm' ~ in ~ LISOiMENW,N(fMFNi,N' NS9°28'14'E 1912.90 mwOtsmuxuxrax~sAC , ~ r+.3acais ti-~,w~ NBB°4 8'02'E2877.35' s~° ~a -m,i~vroa`-unr+wr~ SCALE IN FEET 1'=100' l LJ~l97i`[~T1iT.u ~~'~ uwnsa:NSnrN¢matew d i s Z~i 141 ~GCV~ ~~~L~~~ w~l~ 5 ~ --- ~ 100® ~ of ~-------------- R $ ( SREET20F3SREETB ama-~rceArm~svNA~s,cewrw naA,;a ix>r ~ . POWTS OWNER'S MANUAL & M~4NAGEMENT PLAN Page of FILE INFORMATION Owner ~~ Permit # OESI(3N PARAMETERS Number of Bedrooms ~ ^ NA Number of Public Facility Units ^ NA Estimated flaw (average) 'tj~.SO at/da Desig~~ flow (peak), (Estimated x 1.5) ~-Q al/da Soil Application Rate al/da /ftZ Standard Influent/Effluent Quality Monthly average • Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand {BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS} 5150 mg/L Pretreated Effluent duality Monthly average Biochemical Oxygen Demand (BOOS) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Col{form (geometric mean) Si0° cfu/100m1 Maximum Effluent Particle Size Ya in did. ^ NA Other: ^ NA ~Vatues typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS S! optic Tank Capacity Q'~Q al ^ NA Septic Tank Manufacturer ~'es~rs ^ NA Effluent Filter Manufacturer 6 d / y ~, ce. /~ ^ NA Effluent Filter Model Pump Tank Capacity ,~'',,~~' d al ^ NA ^ NA Pump Tank Manufacturer Soy ^ NA Pump Manufacturer ~D.la ~ ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Cell(s) ^ In-Ground {gravity) ^ At-Grade ^ Drip-Line ^.NA ^ In-Ground lpressur~zed} ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: O NA MAl1V 1 G11N1111+C .11Vl7GYVLC Service Event Service Frequency Inspect condition of tankis! At least- once every: eari~s~{s) {Maximum 3 yearsi ^ NA When combined sludge and scum equals one-third tYa} of tank volume ^ NA Pump out contents of tankis) Inspect dispersal cell{s} At least once every: ^ month{s) (Maximum 3 years) ~ y~ye~{g} ^ NA monthls} ^ NA Clean effluent filter At least once every: , ~ earls} ^ month{s} ' ^ NA Inspect pump, pump controls & alarm At least once every: ~`- ^ year{s) ' ^ montfils) ^ NA Flush laterals and pressure test At least once every: ^- ^ year{s) Other: At least once every: ^ month{s} ^ ear{s) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an individual carrying one of the following 1'~censes or certifications: Master 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 back up or ponding of effluent on the ground surface. The dispersal celi(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 failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third {Y31 or more of the tank volume, the entire contents of the tank shaft be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. Ali other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the focal regulatory authority within 10 days of completion of any service event. ' Page ~_ or ......._... START UP ANb OPERATIC?N For new construction, prior to use of the POWTS ah+~bk ~fbM~rljfer{~k t~t{CIg1 flit. ;the presence of painting products or other chemicals that may impede the treatment process and/or date ~ ~ ~~ t~~~~{~i: If high concentrations ere detected have the contents of the tankis- removed by a septage servicing opetd~4i1' ~~' ~` tii'~. , :.: System start up shall not occur when soil condit'~~ 14ct~i ftetlt! a# ~'ip il~t{i'#ftlve surface. During power outages pump tanks may fill strove trfili~ {if11~1` liif+~i~f ~i~ Brien power is restored the excess wasteuvater will be discharged to the dispersal ce1Na- in one large doolitk; i$~ ~! ~11 ~~~~ i~d may result in the backup or surfaoe discharge of effluent. To avoid this situation have the contents ~~` ~ ~ ; ~1'lyfil~l ,by a septage ServleMg Operator prior to restoring power to the effluent pump or contact a Plumbtir `~{' ! , '~~~~~rf~1{iN` ilti assist in manually operating the pump controls to restore normal levels within the pomp tank. C}o not drive or park vehicles over tanks and dispettl~jl~,~+1{{, ~~ r~~k~~IK+~ ar;'.park over, or otherwise disturb or compact, the area within 16 feat down slope of any mound or at-gradg ~IpN~ ligil~1~i ~r~p, Reduction or elirhir>eition of the following from th!~.~ POWTS: antibiotics; baby wipes; cigarette butts;. foundation drain (sump pumps water; fruit and vd painting products; pesticides; sanitary napkins; tsti~ ~ ;iR RI~~r M'irlprove the performance and prolong the life ofi the ` '' ~ degreasers; dental floss; diapers; disinfectants; fat; r~~: `~'; ~~'Y grease; herbicides; meat scraps; medications: oil; ABANDOi1lMENT When the POWTS fails and/or is permanently raked tllit~ dl± ~9f~l~i~ ~h~ fplj ~riltg steps shall be taken to insure that the system is properly and safely abandoned in compliance with d~~~-t~ir ~~ ~~,~~} ~dnsin Administrative Code: e Ali piping to tanks and pits shall ba discatilttNit~ ~rRd ~ I>r~allaM~ pipe openings sealed. • The contents of all tanks and pits shall be r4!'ylli~ tili~l ~}fifp~lilll5r d4Np~±sed of by a septage Servicing Operator. • After pumping, all tanks and pits shall be fl~~~ltX~ .;il It~Jt~ldlffili~'~ their covers removed and the void space tilled with soil, gravel or another Inert solid material. coN~nNahacY ~LAIu if the POWTS fails and cannot be repaired the fc~lllplilt{~S .fd±~±di~P~~i'.hbvfl men, or must be taken, to provide a code compliant replacement system: . ~~A~ A suitable replacement area has been evtw~t~ ~tK! rri ~! .~ 4-~ili>Rik! for the bcatbn of a replacement soil absorption system. The replacement area should be ~"~# ~ #F itt~ end compaction and should not be infringed upon by required setbacks from existing end propo y~~±. l wells. Failure to protect the replacement area will result in the need tar a new soil and site ey~~i,~ieiltt ~, !i~il ~ i~~rt4ble replacement area. Replacemtent systems must comply with the rules in effect et that time ": A suitable replacement area is not availlli ~~ t~W1~ !tai sil~~~~lt ~Ni~l'pr soil limitations. Barring advances in POWTS technology a holding tank may be installed ~r~ ~{-~ 1'!'~ ~~'_~~d~M~ltir~i-~he failed PUWTS. The site as not en evaluated to iderat evaiuetian be performed to locate a may b tells s a last resort to replace. O Mound and at-grade soil absorption systel infiltrative surface. Reconstructions of suoh area. Upon failure of the POWTS a soil and site if no replacement aroa is available a holding tank in piece following removal of the biomat at the the rules in effect at that time. < <wA~nNf~> > ~~~ SEPTIC, PUMP AND OTHER TREATMENT TANKS ~~~ ~ ~ SES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTLR A SEPTlC, PUMP OR OTHER TREATMENT ~'..~ ~_ . , _,. ,~{TANCES. DEATH MAY RESULT. RESCUE OF A I~RSON FROM 7HE INTERIOR OF A TANK MAY B~ ~I ;, ADDITIOIVaI. coMMENTS ~ ' POWTS INSTAL#.ER Name ~ l A ~ L #' Phone ? / ~ ~..• 3 8 ^ ,~ / a / `' SEPTAOE SERViCINQ OPERATOR {PUMPER) l Name Phone , _ . .~ Thfa document was drafted In rompliance w{th chapter Comrn 8i~st4~4{~~~Ib-11 Gca: ~c Co~,~.,,1-~ Zo ~/S - 38 b - `~~8b 11, t2i ~ i31, Wisconsin Admirtietrativa Code. ' 5£ATIC TANK ~ :'GMP CHAN!SiR CROSS SSG+IU;~ ANA 5Pi(:1t 1~Hl~~~v' 4" CI' VENT PIPE ~ 12"~ M!N`. 'A~SOVE GRADES 1iEATNERPR00F APPROVED } 25' FROM DOOR, WINDOW OR JUNCTION BOX FRESH AIR INTAKE WITH CO~tDUIT W~/NPADLOCKV ER WARNING LABEL FINISHED GRADE ~" CT RISER ~- ~....4" MIN . 18" iMIN. ~_ B" MAX. WATER TIGHT SEALS PPRQV~D ~ B IPE 3 NTO 5pl.ID OI~• PUMP OFF ELEV . .~ T • D ., ~ ~~ ~~ I' GAS- ; '~ TIGHTS SEAL ~ i ~ t, I ~ 3" APPROV Ep. BEDDING UNDER TANK SP£GIFTCATIONS SEPTIC /DOSE TANK MANUFACTURER : ~~ `~ try ~~____ TANK SIDES : SEPTIC ~„Q~(~",_,,,_... GAI. • ppSE ~~ Q GAL. AIaARM MANUFACTURER: „~1,~.,.., __r__._.. MODEL NUMBER : ~ v SWITCH TYPE : ,,,,,,~._.._._ PUMF MANUFAGTURER : ~,~,...~- """"" MODEL NUMBER : a SWITCH TYPE: ~~~" RE UIRED DISCHARGE RATE _„~ GPM ~~ ~/f4PPR0VEQ JOINTS WITH ALM ppPR01tEQ PIPE ON 3' ONTO SO1.I~ SQI L ©FF ~`~` RISER EXIT PERMITTF.S3 ONI IF TANK MANUFACTURER I~iAS APPROVAL CONCRETE PAD NUMBER DOSES PER DAY: „~„_ p{~gE V 03~JME CAPACITIES: PUMP ~ ALAF INCLUDING ~ A :. ~ INCHES = _,;~~-GAI B s 2 INCHES = ~+~ GAI C $ INCHES = _~GAI ~~ GAi D = ~ INCHES = ,~.~. -M WIRING AS PER I LIiR ~I6.23' w' Q ,,~ FEET VERTICAL DIFFERENGE BETWEEN PUMF GFF ANA DISTRIBUTION PIPE ~ FEET + MINxMUM NETWORK gupPi~Y PRESSURE • 'FRICTION FACTOR . r•~?.. FEET + ~~ ?~_ FEET FORCEMAIN X ~~~,FT/1.00 FT.OTAL DYNAMIC HEAD =, l3• -FEET • WIDTH ; D~I~AMETER _„w,__ INTERNAL pIMENSIONS OF PUMP TANK: LIQUID ~~-- lC.,~`~'~ /,/~~x~ ~ •• SIGNED; ~ `~" ~~~ ~~ LICENSE NUMBER : „~?~?Q'p~ DATE: ~/Tr /d.~ 1/88 x ~~GOULDS PUMPS APPLICATIdNS Spefifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECtFICAT1dN5 • Solids handling capability: 3/a"maximum. • Capaaties: up to 60 GPM. • Total heads: up to 31 feet. • discharge size:l'h" NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C} continuous 140°F (60°L~ intermittent. • fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor. • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, tb/3 SJTOW with three prong grounding plug. Optional 20 foot length,16/3 S1TW with three prong grounding plug (standard on EP05). • Fully submerged in high grade turbine otl far lubrication and efFdent heat transfer. Available for automatic and manual operation. Auto- maticmodels include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermoplas- tic Semi-open design with pump out vanes for mechanical seal protection. Submersible Effluent Pump 3871 EP05 ^ EPOS Impeller: Thermoplas- tic enclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and rnrrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. METERS FEET :...........................__.......I......._.........I_._.......... 10 ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING ~• Canadian Standards Assoda>iocl (CSA listed model numbers end in "F"or "C".) f9oidds Pumps ~ ISO soot Registered. GPM s I zs,- !-~ °a 7 ~ , -_ W ~ i _ u 6 20` . ~.. °....__ w a 5 ' ° . .. F.,....,._,__....... _...._.... ~ a 4 ~ . ._ , . ......... o ~ 3 101... ' ............_i_....._...._~....._,....__.`._......__-~.._.._..._..._ ~ ~ z ._ ..... ... .....a, ._ . -... ..... F ..... ... _. _.__ 1 ;.. ..... __. ........_. .... .......:. 0 _.. 1o zo 0 2 4 6 6 10 12 m~lh u-PACmr Goulds Pumps ®2000 Goulds Pumps Effective February, 2000 83871 ITT Industries _~ U ~~97P ~0~ srA~ o~ W~ , z -1999 r~oamen N~ber WA'~iA~y Dip ~ made berareen . Cnsa~. ~'~.~.~ (~s>uor, fo7r a vslaQble - -.--..-~•~-.~- ~tao6ee. ~ i~lawing dt real ey9t~' ~ a~ataaus tia dr~ee . ~~h'. ~e of Wfacamaiu (maze Mace u pltnse att~h NW ~~V ~t,~ '~Y~, l4, l and t>bso 7 ~ V .1Y ~P X01.14, ! 3il~ ate a~ N1YV'+4 lyE ~~ PsSa 3981, N~ tifi N~1-'y4. Aa ~ $ee. 3O.1"~,9N-$17W. 9k ~ C~lr y~eaa~. Rt~l~A1111~ M~7R0 I,~.~ $30 50111112ND 1~UE, SU!>E f~ ~illilif.MOl1~, MN bS101-~31J llia~ro Lcgsl 5etvlcen ffi7IRET 433921 A ~~~~~~ sr, csnlx cO.. ~ tv$o l~ O6/t6/~4 ~~a MARR~7 ~88b COPY gg(~: ~'C F$Ey Pi161iSa ~ ~i+~~~ ~ ~'~t5~ :~'~ SS'~c~t 37074e1 WD 29it246 ~ f > av wstt~es: >menta, mobs t~ rs~sRy oi' e+eomra, ~~ ~~ based dlis 1`~ ~ dqy ~._~ _ . . 2b04 Ioc. s x _ ~= • -~-.-,~ , ~ ~..~ ~ , cam ~ m~. wdneu Nris (~ iy of 3'r,ne . Z0Y4 TrrLB; A STA~i ~ f3F wi4+v (~F nat. authormed by ¢706.06 Wis. Stun? ~ iNSr>ix>~l~r was piitA~r~ >~r At6oeae Srwbta (g>~nu'a ~ be ant~egdsateti az nslooosyed~d. gbtf-.ry not Y,) srA~ aF ~ aa. Persaori~ tie baSoea the tlda City ~ _.. the mooed ~-- .-~ a td mn ]mown t0 bC doe peraan(e) t+v6o exeante~ the faer;omg ""I tifep~msem and admnwledged Wa smne. I s s ~~, ss.n, ~ .-;. ~Y n .a penun~t. (~ mt..gitG agsi~' drte; ,~ .) ii-.~~ i bf puns dtmgB In smy pPreiq' mint be hyped or p~nped bNorr pMtr sl~meue. w A~ $i'A'18~AR 4Y Wni00! ~t1o.2-I9~! fir. ltl_4tl I1~~F I~a~o ST CRt]IX COUNTX S~:l'TIC TANK MAINTI~M1fANCE AGREEMENT ANI~ OwNFRSHII' CER'TIFtGATIDN F()Rl1+i Q.wttierBuyer Mailing Address V~ ~ ~ ~~ • ~ UCJ~ t ~~-~OC~ Itroperty Address ~~-~ /S"7 ~ ,.S'Y !~d c~TS GJr [~W~v oG }~'A7rvrienl p (~+er:reaelats requ+rcd lrasts planrrie~ Uep^mpene far new camuectian) ~~,,~~,, ~~~~ P GtylStatt t;~ F I Atlt'cel [dcntiftcation Number 418 r Zal/ ~ fog{-OQt3 LEGAL D~~P'I tdN - PropctTy E.ocauotl /~ W 'f., IV ~ '/., Sec. ~• T~~t-i-R / 7 W, Tuwtt of ~~~V9 ter! /~ .rSUh[~1VYSiOTi Z///~ ~f"C'.rr~~ ~~7~~~~~~ ~.Ox - -e Certincd Starvt~- ZN~tp ~ _ -- _ , V4lumc -- - .Page ~ WArraary Deed ~ 7 ~~~ 9e2 _ Vol"umc ~~`"9'9--//~ Pagt # ,~ ~ Spec house L7 ycs i~nv I.at tines idcntifitt<ble (~ycs Q rio 5Y .l' MA~i~'XF,rTAIY~ . intpmpv usr arcd nsYirrtensateaCyaw septic sasms KoufO tuvh in w~ psesnasurv fnriara to hstcdlc wwstes- Proper mainrepanx cttrtsisly of poste aor the septic uals eptrr three yt~ts or saaser,lt peened by s Ittcltst;~ pulrtptr rc-6ttt yVSt pos into the system • - Can atY'ep she fimerian atYtta segue taotz ss 2 brtarment srs~ in the ,ate dcaposal sysnan. ~' PsO1ie't3' a+Mner rgtt~€ to svbtctct.to Ss, ~raix Z.ottur~ L7eptltnntrrt t.tertsTi~tias farm. sorted by tlce o~rstcr and try ^ :aauc~ prarrtbar, jac„,~ymanplcmibcc. eCStisiCrcdpigent~cTar alies~putapccwtcifjrin~ tltas (1) rice on-sne~++ossewaerrdispasat svsserr. is is pt+opfc dpcatptg eoadrtia+r arnlarr f 27 sttrr rnspccrsiat tmd pumpins [iineCt~ry).'~ sCpt1C taster 1S IeaF ebaa i13 lull of slvagc. 11we, the smdtsxsgmrd ha++e read the abo+re reQwirematts arrd sglec tv raaiccrain the psi•#te sewage dispoasi syStecsr vvrsh th+~ standards set f rc9st, ac act by sLe I3rpacsrrceccs of Cwsuaerse sad clse I~anoct of Natural Aes~et%Ssate of Wisewsarn Ccrrcl;e~noa ur scprtc syslcnt t.att pKn ait7rirnr~t tnvss he Caecplcicd acrd rrLOincd io she Ss. 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