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020-1002-50-030
sin Department of Commerce PRIVATE SEWAGE SYSTEM ety 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}(mp. Permit Holder's Name: City Village X Township Johnson Land Develo ment LLC, c/o Tami Sh Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: ....- ~ IN ~~ t i GS TANK INFORMATION (J.+,~,~'~ TYPE MANUFACTURER ~ ~~ ~'} CAPACITY Septic F;~~," ~ /~ Aeration Hoiding TANK SETBACK INFORMATION TANK TO ``'' P/L Naf~ WELL BLDG. Fes}.} Vent to Air Intake ROAD Septic ~~, ~ A 33 Dosing eCG1•.. Aeration Holding PUMPlSIPNt7N INFORMATION Manufacturer Demand GPM Model Nu TDH L Friction Loss System H Ft Forcemain Length Dia. Dist. to Well Snll_ AE3S(]RPTION SYSTEM ELEVATION DATA County: St. Cf01X Sanitary Permit No: 515115 0 State Ptan ID No: Parcel Tax No: 020-1002-50-030 Section/TownlRangelMap No: 07.29.19.5A30 STATION BS HI FS ELEV. Benchmark ~• ~ /~'~ /~ Alt. BM F; ~ , ~ ~ + Bldg. Sewer 5.5 9 (o . 5 SUHt Inlet 'R ~ •~ 9 2~ Z J SUHt Outlet 9 . ,a r ~,I. ~ . Dt Inlet ~ ~ Dt Bottom ~ Header/Man. ~ ` ~ ,~., ~ 7 5 Dist. Pipe / a. ~,/• Bot. System tl. ~~ .4 Final Grade ~`' /~ 3 St Cover~,l ~~~ ,~/~ 3 g$.• 9EDlTRENCH Width / Length / ~ No. Of Trenches PIT DIMENSIONS ` No. Of Pits Inside Dia ~` Liquid Depth ~ DIMENSIONS "L ~ Z e _ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactured--- ~ ~ INFORMATION CHAMBER OR e~ ^ ~ ~/ae T e Of S stem: ((~~ yp ~ / / 5 ~ ~ UNIT Model Number: ~ ~ bv hJ +a~ 6 t ~ 7 u . c,i . + IIICTRIRIITICIN CYSTFM d ..4-+ /!..+ r ~ . Header/Manifold ~~ Distribution \ Pi x Hole Size x Hole Spacing Vent to Ai41ntak ~ ~7 pes} ~ ~ ~1 i Di S .~.~, ~ „~G' d' a i Dia Length pac ng Length a EMI rnvFR v Drocmvn 4vc~nm~ Anly YY Mnunrf Clr At_GrarJt± Systems Only `" "'~'~"'-~ Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched BedlTrench Center ~ ~ BedlTrench Edges ~ Topsoil ~ °.~~ Yes 0 No ~Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: I 1_ Location: 336 Krattley Lane Hu, dson, WI 54016 (SE 114 SW 1!4 7 T29N R19W) NA Lot 3 t(• 1.) Alt BM Description = `_ '/, \~_"'- ~ `~"~`-'` ~~`^"'° 'ms's Z.} Bldg sewer length = ~L., -amount of cover = /tom t ` ~ ~ ~~ t 1 Plan revision Required? Yes ~No ~ ZL.}~q~ Use other side for additional information. v tt Date SBD-6710 {R.3197} Inspection #2: / /_ Parcel No; 07.29.19.5A30 o~ o~ ~ Io~r-i ~ = a~ t->:d~ 1 Cert. No. ~. ^ ao~tlms~R.W1.gDA- __ - _-- Safety arrci Rufldtnga Division 2 7 W CowRy A [ 1 . Washington Ave., P.U. Sax 7x62 ~ ~ j Madison, 'WT 537(17 71b2 9snipry Perrrrit t!lrrorber (lo be filled in by Co.) Sanitary Permit AAplic^aiaioa ~"° """°" `° " ~ ""'~r to acc+mMn~oe with s. Comm, 83,2!(2), Wis, Adm. Cede, submission of this foxrrr to the sppapristo ®aYCmtwnnlal ~~ /~ /,,// ) /~rJ" emit is rrsgerirrc! prior to nbisining a sanitary permit, Nate: Application tiorrrrs for state-owned PbWT3 are suim-itted ra tlu Depertnrcnt ad' Cao-nmercr:. Perasrrsl inPornmthnt yon prwida may be u the aeoorrdary Plrojeet Address (ifdillbnart tlrsn K atddres) inlrOWrt~aCOWitt)fhC)?ri i.aVl~ 8. t$, t nl ~a, f'r /~ f ~ I A I ° /t Y~ l~~ ~ ~Q,v'G ~~ . nfor~oadio~a ~ Pisae Print All lr~ttornretiorr Property Owner's tVama ,J .La.w a~ e vela .e Panoei N o - - D - a Pnrperly Ownrn's Mailing Addreas Prolrerty L.aaYion ~~' ~ C° d ~pL aavt >..nt Cityy, gteto ,lap coda Pharra Niyrnbar ~ ~ ~~ y,, sk /+, 3ectian . 1 ll. 'l'ye n1f RarildhtR (cheek aN thpt apply) Lot # ~K ~ iruor+Name 4 bdi , _ ~i or 2 Ranrily Dwelling ~ Number of ~ ^ v a fJ }~ ~~~ ~ ' ~ ' Hloclctf T P. +, Public/Commerniat -~ Describe lice opt b~';' ~ of Cit y 91Me t)wrred-txscr8x ltse ~ ~~ C3Nt Number Q Town of 6~~.s"U Iii, '('ypc rrf Pcnttlt; (Cheek a ly mae brut an line A. Camplde line B S rrppliarble) A• Nm„ ~,~,, ~lecerrxart TaagrnardHolding Tank ~ ~Y Ottrd' ModKicatiOn l01 (~~) 3yiaem ~_,_ li. Petrrrit Permit lbwiston ~ Pemrit Tnratt'er m Liat Pravrons)Permil Nmnbdr and Data Isiuxi ttena~eMl 8etbre Plumber New Qglner )ex ration iV. ofPOWTS S otlDevfae: Cheek aU that Ph-n-Pressuriv~ed in-(imund t'r~uriaed In-i3round Atdhada Moerui > 24 ~, ot'suimble eott MaaW S 7A fa. of suitable soil Holding Tank Other l)lspersal Component (explain) ~ D41`~ (amain) ~ Fi 1 ~• ~_ Y. D etlwVt'r~errgtAettt At'ra Infat'taattlan; ~` O a ihxign Flow (Bpi Design 3oi1 Application Rr~o[gpdsf) At~dl itecWined (:>~.' Dilapexesl Alm ~ ~ ByMem ~® i°n' ~ ~ n Matuisi capeaity in Tatal 8 of k int'a Vl. T rr Oaik-ns ctsllans Unim ~ ~~ ~r ^ Ncrr Taake ~ciging 7Ymice ~ N ~ )' ~ G `~ '` Septic nr NnidinR Tank ~ f ~ ~ ~ •l~C 'fi`r Uosing ('itsmbtr VII. ReapatdelMBiy Bmtement^ I, the ed aestteae tbirt.~alNrtton •trhePl7Rt7'S _ w tlierpfaeiaa Plrarrn NAnnbrr 1i1 41urr~r'a SIB~e ~ Allrtnller 91Vartte (Prinfl ~ ~~ ~ ! Phtmher's Addre~ (Sites[; City, 9tatq lap Cn~) VIII. Cwt t Usc 4 Paretic Fee I7uMa jmuim3 proved Ass SipMMtrro net Oiv a~ n[a1 g .~.~+ ~' 2 ~ ~~ i - ~n l~. ~~,dlti~r~,r~~erreana rRr' l~~sapprn~a•~ 1, Septic tank, effluent filter and dispersal cell must alt be services /maintained as per management plan provided by plumber. 2. AU se'0rack requirements must be maintained SAn-f3~8 (R. [11/(17) Valid thnx 01/09 3) ~r1 ~ v a ov • ~~„ - -- -- ~,,.~.tia r.cQ„ i ~ j .~...q c~~~r,.~Dt:1'~staatttww.o'6~ ~ a~ ~~~ D ti. ~ ^. Q ~ 7 5Q wo~5 ~/ .~1h.U.~~il/ Z~s-~cz ,~~fl e.~B~Of~l~',d ~cr~J~ ~' JAI ry;~,,~5'c~.~/ „~ ~ ~ ` d ~~ '~ aY ®,,'~`~/v~d'2 ~D ~` ~~1`'/yi~ ~ vu~ ~ O.uG/~,~,~ ..1 /'cam - ~ ,~ .~~ rrz•L~ '~.lL_ ~~ ~~ ti ~" V , ~~~ Q~~ X ~ a1 ~1 ~ ~ n ~ da°© ~~ ~ f ~ ~~ ~,- ,` ~U7'j`''' G . S'~ rye ~~ s v ~~ ~.~]C O PY ~' ~ r b ~i$ '~° aG~ ot~i~/v~~2 TD ~ ~e ~'`~~N~SL ~ cr u ~ r^ D,~/Gfia~ ~ _./ /v ~u a•L~ / ' ~ y~ , a~ ~~ ," U ~~~ ~a~ ~~ ~~ n~ ~1 ~ ~ J~ S 2 l d ~ s la' ,~ ~G~~Y G~ ~ ! d ~ (~ ~'~N~/ ~~ gl~~.v ~~ *~~ ~~ V ~~ ,~ RECEIVED ~ p,~ i D WisconsinDeparbnentofCommerceAuG '~ 2009 SOIL EVALUATION REPORT Page of Division of Safety and Buildings ST CROIX COUNTY _ PLANNINI~~Q~tt'aCS~it^'~""'~"~rnm oa, vvw. r~arn. ~.vue County ~ t Plan must Attach complete site plan on paper not less than 8 1/2 x 11 inches in size - I . indude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. d20 /Gb Z- ~O 6 ~ ~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~ - Please print all information. Revi ed by Date Personal information you provide may be used for secondary purpoaes (Privacy Law, s. 15.04 (1) (m)). S Zd a Propert~Owner Property Location ~~ Govt. Lot .J~ 1/4~4,JI/4 ~ T~ ~ N R E ( W Property Owners Mailing Address lot # Block # Subd. Name or CSM# ~. ~ .r p Code Pone Number City State Zi ^ City ^ tllageTown Ne est Road t " rn/ / J ~ ) ~ I ~.P New Construction Us Residential / Number of bedrooms ~_ Code derived design flow rate ~J~J GPD ^ Replacement ^ Pubnlic or commerdal -Describe: _^____. __~_~________.__ ___ Parent material ~~.1~~ /X/~-~ Flood Plain elevation if applicable ~i /~ ft. and reporecartxndations: ~= ~` p ~ ~ ~ t'`r-i f°~`,"~-J 5c,~,i.,(,~ ~ l~ ~nl J~ ~~~5 ~ ~' O• `j~ System Typew .w ~JC~rt7~ ~` !!'~'<"~ - System Elevation / ~~ t GS~(' ~~ # O Bonng Pit Ground surface elev. ~ ft. Depth to limiting factor s dZ in. Soil ication Rate Horizon Depth 'Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/ff' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 'Eff# 'Eff#2 ~r / ' r-~ ~ ~t 1r ~• Baring # ^ Boring ~I >~ pit Ground surface elev. ~ ft. Depth to limiting factor /s/ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 'Eff#2 Z l - a - - ~~.,' ~,~- L l ~' - ~ C7 i 7 It << Effluent #1 = BOD > 30 < 220 ntglL and TSS >30 < 150 mglL Effluent #2 = BOD < 30 mg/L and T55 < 30 mg/L CST Atame {Please Print) Signature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~._. ~ j_ ~~ 715-246-4516 ~~. ~.ve.~.~.., ~a:.a. row .. P Property Owner Parcel ID # Page of ^ Boring Boring # [C1•. pit Ground surface elev. ~~. Depth to limiting fades ~ in. Soil ligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~1 ,~ ~ ~ . ^' Otd..t~ i s ~J Boring # ~ Bonng l-J U Pit c~rouna surrace elev. ~~. uapu~ w onnm~y ieuvi ~~ ~. Soil lication Rate Horizon Depth Dominant Coles Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon 'lepth Dominant Cdw Rector Description. Texture Structure Consistence. Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 • Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mglL '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. SB0.8330 (8.6/00) Property Owner Parcel ID # Page of r7 Boring # ^ Boring Z ~~~ J ~. pit Ground surlaoe elev. ~~. Depth to limitlng factor -~- in. Soil cation Ram Horiton Depth Dominant Color Redox Description Texture Structure Conslslerue 8ourtdery Roots GP DIM in. Munsep Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 •Ett#2 ~ ~ ^ Boring ^ Pil Ground surface elev. H. Depth to limiting factor in. Soil icatfan Rate Horizon Depth Dominant Color Redox Desorption Texture Structure Consistence Boundary Roots GP Offf' in. Munsell tau. Sz. Coot Cobr Gr. Sz. Sh. 'Eff~1 'E1l#2 ^ Pit Ground surface elev. it. Deplh to Ilmitktg factor in. Sot n Rate Horizon 'depth Dominant Redox Dereaiption. Texture Struchre Consistence Boundary Roots GP DItp in. Munsell Qu. Sz. Cont. Cdar Gr. Sz. Sh. 'Eff#1 'Eff#2 Efluent #1 =BODE > 30 < 220 mgll and TSS >30 _< 150 mgA. 'Effluent t;<2 = BOD, < 30 mg4. aril TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. Ff you need assistance to access services or need material in an alternate format, please contact the department al 608-266-3151 or TTY 608-264-8777. seo-e~o ni.sroo- Z'd ~61~90 £0 OL ^oN - Soil Test Plot Plan Project Name Todd Shurman Shaun Address 484 E C R d ove oa Hudson Wi 54016 Lot 3 Subdivision SE 1/4 S W 1/4S ~ T 29 N/R 19 W CS#226900 Date $/ 5/09 Township Hudson Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of foundation System Elevation TB~ *HRpSameasBenchmark f -°% ~s ~~ S~ u r.~~.~ d~ Jd~ti s~ ,v ~.~~ ,O~ ue~.~~~ e o' ~07~~ ~ .gn, lea ~sa~ ~~ a ~~ ~,~,3 ~~ _v a ~ ~ ~ ~~ ,- ~ ~, ~v~~~~ ~~b ~~~' ~~ ~eas~ ~.` 3'-~ a w~ ,~hJ~lGP~a,.-1~7;a.,~ i~o~ a~ ~, ~.jr______. ~~ ~~7 9~ ~ ~li~~©~ ~.rAin - ___. v..a Revi 5i e n ~.nnM,Qlatr Safety and »ttildinga Djvt~ E ~ zai w. weahinglon ave.,>P ~ca s~ n Madison, ~ ~~~R~ ~a~2 ,,,,~1 N ~;~ ~ ~.) ,~ Sanitary Permit Application T ~""~"~"~'°""""~" I ST CROIX COUN in ea:etardataoe with s. L'ontm, ii3,2I(2), Wis. Adm, Code, autunisaion of this form 4a the ap r11~9ptagt0a i ~„ FICE /V unit lg reaµtitaxt prior to obtaining a aatdtary permit, Nato Appilduion tbrtn8 for atal~wn~ ~W7'3 aye ailing nldra f tn) nm pmt Addaeaa (ifdi>tfiu w e ntd submitted n, the Deparunefrt of Commerce. Personal iaafattrtatitm year prawida may w>c aped far aet~ery es in aoeottMtxx with the Pri Law a. 15, 1 m 9tats, 1 , { ~~ ~ (/ / + / ' ~ ( ~ ~ / ~ G ' / r (\ i a- t ! ~ e ~'^ I. A fiicadon Infal>7oatltfion .- Pk~ass Print A11 Toforaaaatioal Pao~erty r'a mt: ~vh .J ~a•v~ ue1 fi ~ 0Z0 -• /Ci~ - • d C7. Property Owtaax's Mailing Address Pity Lotion ~ GO !/8- Oorot Lot 7 coy, State lap Code Plamae Narmtter ~~ '/+, S~ '~a ~~ u $ yd`,~ jQ ~~t ~ E ~W A g N a I ts of BaiWhw )I (eb eek ll tkat T b) Lot # ! 7 1-1 ' ~ 6 ~ a. ~ y( R a aPP .-y C 1_]141 or2 Ramily Dwelling--NumltaxofB A , _ ~~~ ~ s~ t PatbliGCommerciai -~ De9axibe Uae d ('+ ~ - ~C~ ~ M. Q Slate Owned -- lkscribe Use Cstaf Nam ^ VUhge of Town of ~r-. '['ype of Pet'mlr• (C~ttn!k on one btnR on lipo A. crnnplete B ilkabllo) A`• New System ----~~ ]t~l.cseraetat gy~ppt. T Tank ~ ~Y Olhd'taRediOadbn m 131chthtli SyAaan (eetpMm) Ttaarfq' to Liiat Pnsvimaar Perstil Nartaber std Dsto iiswted )f>ti ~tmit Itetat3wa113ethte Pa;trrtit Aevlsion ~----s C Plumber New Owne Ex lion 1V. of PowTS at/Co oneltt/Dr~*kr. CAade tdtrt > 2A in. oi'suileble soil Matnd < 2Q ht. of saai~fie eoii Non-Pta+auritxd tn-Cimueul Ft~esaw'i~ed fnd3mund At~lrade Moutd- [] Holding 7'naak Outer Dispersal Gontpaaasaaemeleatplain) ~~, ~v~i) ~ ~~~j ~ ~- ~ _ v_. D twtl/Rrewtt~lt ~ itttllbtrrttntiloat.: .]~ iNa I Ares Pmpaad ( S ~`~~ t)esign Fiow (gpd) 1)rsigrt Soil Application Rste(gpds~ Dis t+ca Required (sly i ~~ ~ ~ ~' C ~ ~ La al Go.r! ~ ZS ~!~a D. ~ .~c5 d ' i i Z M _ >r a Vf. Towk iinfa salty in Tai ~ of flathttls Clsllans [Infra o atet r / /' 1VoN Tanks Existing Tm+kn ~ / ~ ~dh, F't ~ ~ Squie ne Hnidinq Tank `~~ ~r'~.~ G J/ -'T-- G O,.UG' r e 4a- Oming Ch~mbet Vrr. an>tibilli Btatelnennt- I,llte , aawnte far hNttAatian of the P()gip11"S rtt dos titt'alltad 3Ntutaber B>~ttemPla°s°Tlautaber hhrmttrr'a Name tPrintl Piatmbet's i 2 ~ 7 ~ q'~ '7 3 = 38' ~3r%Ij Plumber°s Addr~ (Slta~i, City, Slate, 7.ip Cade) ld'7~ Sees -vrrr• cotl^ aiim~nt u~ on perrtlit)'~ Halo tatted t»a~tag sigadu pt~~ ea(i q Owner Oive niel $ Z! CC $l Zp !~ J I ~~ / a~tta fnlr nisa~rpxavual ~.i~na~t~,~~ii«t ~~ ~g~;~...~ 1 ~p~. '1~ re ; fie.. ~t ~ I~a~.~eo~.~.NU-- pr / ~ •~ ~y~t,,,~-~~,q,.~,.Q„ i/la~`.+~e..~'t~al`- 1. Septic tank, effluent filter and w~ dispersal cell must all be services /maintained as per management plan provided by plumtier. cd 2. Ali setbacK rsgWremenis must os rraarn~a~rou 7,J J ~, ~• ~ •.-~-•-^-~---- --~-.___~ AtUehbeampk~ illhaaryalrsaaamE+atwalttalltaeCP+~+I"~f'"'M~''"`t atAaxtlMelr~ ~~~~GS~ SAD-6596 (tt. 01/07) Valid thnt O1R19 ~- ~ P ~, ~- s~ ~~t~~.MW.Qtl11 Safety and Buildings DiviBion 20l W W hi O County ' ~ ~~ ~ . as ttgtolt Ave., P. . Bavt 7i62 M ~ G9.~' ~ ~ ~ ~ ~ N t ~~ attiatm, WI 53707-7162 t3ertibry Poennit Number (to be filled in by Co.) pM tn~ant o/ 5 /5/~S Sanitary Permit AAplication ~' iinb" 1n accordance uritlt s. Comm. 83.21(2), Wis. Adm, Code, submission of this form to the approprute govetnmapal ~~ unit i.9 rr;tptited prior m obtaining a sanita ermit N A li i ry p . ote: pp cat on forms for state-owned POWTS are Submitted to the y~ ptmride ~~ lxpartmeltt of Commerce. Peraortal iafmrrmtiat s i M Pltajert Address (ifditionwrt than rratiling addroae) e n acearr rrce with the Pd t.aw s. l s. t m 3tata, // i. A licrition information -Please Print All iath-ranati 3 3 ~P 7~ r" L Properly Owner's Nattte h .e v ~/e .,<e~ ~~~ ~ ~ ~~1~~ Paced °~ 6Zp • /Gl3Z- ~'~ - d 3b Property Owta:r's Malting Address 5i CRUIX COUNTY P~h, iocsifan /t^ ~\ ,.~yy ~Y ~ ~;w~ ~ ~ „~ a PIANNING & ZONING OFFICE ~ aa~ >~ (~ //! J City, 4tate Zip Code Phone Ngtaber '/ ~' 7 S ~ '' -S /~, scalar ~ ~`~~ // ,% II. Typc of Buikling (elteck all that apply) ~~ Lot # T R / E W o? 9 ^ ~l or 2 Family Dwell ittg - Number of Beds s 3 ~ Name i? r Sv ." ~- ~ PubliclCotm e i l D i P stock # r rc a - estx be Uee ,~~ ~~- ~ ^State Owned - Describe Use CSM Number ^ Vilhrge of 2 ~- l 8'~'~ 3~ ~~5658 ~Townof ~~~s'a.-rl ~- Cet 5 ~-.~ 2 + ~ ~ lil. 't'ype of Psrmlt: (Cheek only ne Amt en litre A. Compl~e line B Neat A• New System Replecrntetil Treatment/l~oiding T ncerrrent Only Othtx Modification too Exiatin6 S!'~ (~Phm) system B. Permit tienewar titefbre Permit Revi9ton Change of Petmr ratitkr m Plumber ewOwner Lin ~'~ Perstit Number and Date Istitted ~~' ,~ L _ ~ _ Bx ration r ~ ~_ ~ir~lC~" ~T 1fV. ofPOWTS 3 nt/Co nent/Devfee: Chrxk atl that a < <- ^^~ ~ Non-Pressurised In-CiAUUnd Pressurised In-Cironad Atd3rsd Mouad> ?A in. of a mii Monad <7A ia. ormtW>te soil lla ng ank her Dlapereal Component (explaist) ^ PoVtce (explain) y. n nsal/i'reatrt isntArtu iaformtition; <~ < • l Design Flaw (Bpd) Design Sell Application f) Ai heel (a~ Aiapexsel Area (af) syetan Blevation Vl_ Tanh info (rapacity in oral # of Manaractu rer Material flaUtKts Ilona [3nifa NewTaakr ExistingTwtks / / /~ /_ f"i~~~ Septic ar Harding Tank ~B pp ~ ~ r` ~. ~ ~ ~Q,~J~ y~ ~ ~~ Dosing Chamber /sue ` 1 I ~ ~ YI i, ices sIbIN $t9teAtletit- ][, the nodereignedr atnamt: ttibllky far biala11s1irta o1 tYe POW'1'8 as Ore attached piaaa. Plutrtber'e Name (Printl Plutttber' Signature ~ Number B1Mnt6fa Phone Ntaaber 1`am S~ u>h~ G Q~~ Plumber's Addn~s (Stnei; City, State, 7.ip Cnde) 7D ~ ~ C!~ ~ ~ O'/ ~ VIIi. Coup /De rtmeat Usc 4 pproved u! ~ PermitP~ Ike Iasui 3i ~ ~~ Q~a` ial t~wner x ~t 7S. as ~,~ 09 11X. Conditi~tt~>I~araotaa for Disapproval 3, i'p Ji I ~ 1 >~C ~ ~ P rot1: ~~Q„ /Le.r.J . ~ 1, Septic tank; effluent (ter and / r ~' ~ ~ ~ ~~ Cam` ° rL : ~'^a-"~ r ~ ~ YV~.a. dispersal cell must all be services / maitttairusd f,~,~ - as per management plan provided by plumtier. 2. Ail setback: requirements mast be maintained ... ~ .~ .......... r... a... l;.e * r t f.eln+ hr sloe AaAen ~ ewwpe.c pwn ^or .nc.~..o........................< <..-"., ___, SBD-6398 (it. 01/07) Valid thnt 01109 ~l~~i,,~JSd-,.cl ~~~/~%/.~p~r~.~,107`3 C~'/7J ~~~~.~~ L~`~C~~Sm..t1 M ~~ - 4 .S`~ Qc ru ; ~ ~ 4'.~ ~ ~ l 06, ~s6 i r ~ /D 9f1 ~2 ~ ~ ~~ r~~~ ~~~~~ s~°~-~ ~~~ 6 ~g y !NCO PY - ~4 ~ ~s~'.~1 ~~ y~ /.~ s~,~-,~~- ~;~,Zo 7`3 CSi71 a' ~li~--~°~ ~ z~~.~sd ..J - • ,~ ' ~~~~-e ` =YD ~ ~3 ~_,~,~ Utz T~e...i<h ~S' a T ~s~ ~ ~ ~ Apo 5r1~ ,~~, ~; r~ •~d?l ~~~~.~ s-~~~ ~~~ ~` der i ~- ~J ~ .. Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPQT g 1 _, Page ( of m ac~oraanc;e wun wmm aa, vv~s. ram. ~,ove n~ ~f . ~ ` f ~ ~ ~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Plan ust . indude, but not limited to: vertical and horizontal reference point (BM), diredi d ~ Lp, ~~ ~ ~ , /~ ~ _ ~`~ percent slope, scale or dimensions, north arrow, and location and distance ton st road Please print all information. R 'awed b Date f/ f Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). - ~,uy,/y„ / D ~ ~d Property Owner p (~ Property Location q N~\ n~ ~ ~./ ~ 1 /45th 1l4 S T~ 1 N R E (or W P rty is ailing Address lode # Subd. Name M# ~UJ~- City State Zip Code Phon Numl~~~ ~ q ~ J ( ~ Q o~SA City ^ Villa a Town lYt7 Barest Road , ~ ~01 ( s o (,V u,c r Ql. ~lew Construction Use~Residential I Number f bedr IC 'ved design flow rate GPD ^ Replacement , .~yg- ^ Public or merdal e: ________ __ _________.__ ___ Parent material ~ ~'~X., l~J cQ~,~l~ Flood Plain elevation if applicable jU ~ ~ ft. General conxnents ~/~ N o S v~ V ?~~ c,c~ ~ ,y ,, and recommendatinons: /~ ~/ ~} ~/ System Type ( c7 A~ tJ~ ti-~t ~ ILCUc--- System Elevation ~/~~f~G~ 9''/~'! ~i. ~/ /•~ ~~ # Boring 1 pit Ground surface elev.~~ ~ ft. Depth to limiting factor ~ (~ in. Soil lication Rate Horizon Depth Dominant Color Rector Descriptor Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 •Eff#2 Z Z~ Z r ~/ ,U-S ~ ~~~ Lc~ L 3 6- ~ ---~ ~- O sic ~-~ ~~,¢ ~ir9 . ,~ . c7 .z ,~ t 3~ Baring # ~ Boring l ~7) Pit Ground surface elev~~ ~ ft. Depth to limiting factor / ~ `~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 2 1~av _- ~~ ~t.s ~ ~ 1 / .~ a-/ ~ ,~ s" ~J~ ivy . s , ,~ 3b 'Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mglL • Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL CST Rtamg (Please Print) Signature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~~,~/ ~~ 715-246-4516 P~rope~rty Owner _ I ~ I eorina # ^ Boring Parcel ID # ~7. Page of ` i r,-y. r (U 1 ~ Pit ~rouna surrace elev. ~ i ~ n. vepui cv nrnmr~y ~auvr ~ ~ ~ ~~ ~• Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/it' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 "~- Z -ZZ U ~ ~----~_ ~ ~ ~ ~ . ~ ~ Z2-i ,. - D s .v/ ~- ~ , ~ a 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 GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 t3nrina # ^ Boring U U Pit ~,~~,,,, ~~„aw o,~ _ .................., ...... .. Soil ication Rate Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GP DHf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 720 mglL and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 rrtg/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 608-264-8777. seae~3o nt.~ao~ t, Parcel ID t! Pie ~ property Owner . Boring ~~ ~ ~ pit t,rotmd surfaoo elev. ~ n- Depth to iirn~ing lador ~1JL1 M. SoA lion Rate TeXlun4 Structure Consistence Boundary Route OPDA°1! Horizon Cepth pominanl Cdor Redox Descstption •Et'~k1 "Effp2 ~. MurLSett flu. 3z. Cunt Cotta Gr. Si. Sh. /~ ~-+ ~} ") Z ~ ti Z Z_ 2 ,~ -----'~ ~ ~ ~~ ~ ^ Bt~ir,9 ^ Pit Ground sutfaoe elev. R. Depth to l~mi4ng faaa __~,__~.__ in• Soil. 4catJon Ra n Texttie 3trudtxe Consistence Boundary Roots ~~°• Horizon Depth L-crrrinartt :.Wor Redtbc Deems "Ettft1 '£itlt2 .. _ ,... ~~ n...,~ rr.M. [3r. Sz. Sh. ~_ ~~ ~ O 6odr>g --- In. Q Ptt t3rovnd surface elev. h.. DePifi ~ ~i1M9 !actor c,,,oq ';cotton Ra Te~cho'e Strtx*ure Corusistertca rY 42t~ QPD"R` Hortzun 'lepth Ocxninant Cdor Redox Dastxi~lon- dr. Sz Sh. 'E.If#1 "E1l~2 in. 1NunsfA _ Qu. 52. font. Cdor Emtrent A~ = 84L~, > 30 <_ 220 ~ and 7SS >3p :150 mgt. ' Edluent if2 ~ 84O, ,<. 30 ngA. end T5S _< 30 rr+glL The Aepartmtxd rnatCen 1Rin~sn alternate forma ; ple a eontact~t2-e de ctmt-ntnat 60&2663 51 or a':'~`Y 60$- !264-87'17. cervices or ,ses»w ne.wn ~~~1 Soil Test Plot Plan Project Name NWP Holdings LLC Sha Address 484 E. Cove Rd ~ Hudson Wi 54016 C #226900 Lot 3 Subdivision -------- Date 10/21 /08 SE 1/4 S W 1/4S ~ T 29 N/R19 W Township Hudson Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 94.8/94.6/94.4 *HRpSame as Benchmark 245' Pmnertv Tine N~S -~~~ u,r~ Jx"J~r'J . X!P ~C3Fl~G.~ ~~ r'rJ c. *1RrR+~REb fTb1lt NWP NOLD~NC39, CI+C. 43<fABTCOVE RD. HunsoN. wt 34o~a =I~RVEY~R: TY R. nW3E S 8 N LANG StJftVEYlNO.1NC, 2Y'10 iNLOH 3fT1@ET SUt71E tC1i NuaSON, W13~Oi8 cou~rr Ta~ara~cu>nlgR: c~anri~rCarrE sty. ~ w-~oa~~i cam„ ~ sr, cuss !, Ch•y18bn4, b3inp 4,o tluiy 9~4 quaNttaG atd NCUna tr~usiu•+ d St CroCc County: da hanrby eR•fNy th9t the rovoro~ ~ my alAc9 snow ra unrod~orrwE tau nsiu aid no unpe~iC tox9s or sp~i uNwfrwnq s~ UriS GS~i,ivey~li~~ ~ uuta fnClud3d on roilrfi Treajt~x,fr '~' ~/"/Y'G7$ L~®lE~1j~ FC~NO f' STt;EL 3URVCY MaftK NgIL PCUNt? ALUMNUM CO{p,JtY SECTION CORNiR MONIfMtJt( ~ FCUNO 3" OUTSIDE OLAMETLP !RON PPC SEr 1.OU7y1pB DI0.M8TER 6Y t8' Q IONt; !RCN MPE, h4LypMlNO 7.,3 '~~ uis, fv~ie utit:Are FOOT /1 FUUNb7.1J4`OUTSW£ ~:/ DIAMt3rtiR IRON PiF~ ~ REC~RDtD efiAWNQ ANDfOrt gISTANGE -"" - FENCE ~~ ~ PROFC3i:D ORME ......•..••.......•• SO'RCApWAY3EI~ACK I~ 864828 NkTNIE:N 1i. W~,~$y REOISTEft OF OEEDS ST, CROIX CD., MI RECEIVED FflR RECORD 11/t7/2008 b9;55At1 c~rrlfz~n suRV~ w1P VOI: 'L3 Pt~GE; REC Fff; 13.00 COPY FEE; 3.00 f pAt~S: 2 s;Aauay~a~~~ i ~d r I I -~ (~ f~~ n ~ • u~"c~ison OT~i c•rro.l' of.aglen ~ E7 ( W "~' ~- ~ P•rP•i4M4tlha•oJ:4py»•r.ml1l,Y.b••n -a ~IV ~~ r- ~ ~of' w • Sa4Vrw ~ NON 1+34 a Ntano•0 ~ ~ r ~ ! ~ -+ C Y Y F+•DM•d try,lph•• lltl~tgr~K ~ ~ I ~ ~ ~ i • Dartlen of th• P•P4Ib lneWerQ kt W L N I I ~ `~Y 9usd rn rM~MSen4eX NAtlU•• e ~ ` • •~• ~ ± ~.~~~- ,h• tIm•, v~tl t110 MM the •Y ~ _~ wrv4y wwrn ttw s•cNon wo haver r.• f q ~ sn,ena !ooaro•. I b41r~ the M+4 aw4•r a 14°'t a ~ = ELI@T 9 C.~.~i. 3~ I ~ .aAiar, na b•~+++roa~n•a.ne w4rAa•4 ~...._.,.~-. ~ • • m.a,.!rwtlce Pegtlun ta•••a oi+ •tr•tpht ~ IN ~6 3 ~ I s Y. con. ~ $ o p,~ w'.r"ar snan.ao„ e•mrun ~ ~ g1Yi100~~ ~ P~. 201aB acc. r, v~•ner oom«,. , '93N,Rtaw SCALE iN F~ EACIt PARCEL 3MOYIPt CNTH19 Nµy l i 81:eJECT TO 6TAT7E. CCUNfYANO 300 0 300 ~orNiiiE ~c~se ~ iL~¢T~cJ i~o~nNO o uw OtYYtoL01°!MQ ANY WAIgCEL CONTAG7',. -~ eT. CItOU(::6UNYY Z~uINb 7H!S WSTRLIMENT OR4FTp0 eV: Yr7RLtAaA KAIe; OFFKK~; ANO THi T4YYN OF MW80N f C+AADVkIE. JOB N0.34gT~ DAris:,N23xippg SHEET 1 OF 2 vnt z5 Pege 5558 CE~T'fFll~~ ~~~t'VEY MAP LOGA?EC 1N PART QF'ME N8,l4 O!<THE fiW 9/4ANDlN PART OPTf~ 3E f/4OF" t~ 9W 1;4 OF SECTit?M 7, 729N, Af9W, Tt7WN 0lrNUD50N, 57, CRWX CtiUNTY, P4GE 80G AT TKE 87~. CAO rCOL~IN7Y RRiC~~1i97~frR ~~J$ QFFlE~RDED IN VOLI'ME 3, POWTS OWNER'S NfANUAL & MANAGEMENT PLAN Page of r" r FILE INFORMATION ~ n1 ~--~ ~ Owner ~~ ~ ~O Permit # DESIGN PARAMETERS Number of Bedrooms 3 ^ NA Number of Public Facility Units ^ NA Estimated flow (average) ~f.SD al/da Design flow (peak}, (Estimated x 1.5) ~'0 gal/da Soil Application Rate al/da /ft~ Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease fFOGI 530 mg/L Biochemical Oxygen Demand (BOD6- 5220 mg/L ^ NA Total Suspended Solids (TSS} 5150 mglL Pretreated Effluent Quality Monthly averagr~ Biochemical Oxygen Demand (BODs} 530 mg/L Total Suspended Solids iTSS} 530 mg/L ^ NA Fecal Coliform (geometric mean) 510" cfu/100m1 Maximum Effluent Particle Size YB in die. ^ NA Other: ^ NA 'Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCWEDUtE SYSTEM SPECIFICATIONS g Septic Tank Capacity ~f®~,1 al ^ NA Septic Tank Manufacturer rreS~, ^ NA Effluent Filter Manufacturer ~d/y ~. cam. /~'` ^ NA Effluent Filter Model Pump Tank Capacity .~'',,,~,~' ~ al ^ NA ^ NA Pump Tank Manufacturer ~ ~gy. ^ NA Pump Manufacturer ~dL+ ~ ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Ce0(s) ^ In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized! ^ Mound ^ Other: Other. ^ NA Other: ^ NA other: O NA Service Event Service Frequency Inspect condition of tank(s) At least once every: ~ r afthls) (Maximum 3 years) ^ NA Pump out contents of tankfsl When combined sludge and scum equals one-third (Y3} of tank volume ^ NA Inspect dispersal cell(s) At least once every: ^ month(sl (Maximum 3 years- ~'yearls) ^ NA Clean effluent filter At least once every: tnonthlsl /; yearlsl ^ NA Ins ect pum ,pump controls & alarm P P At feast once every: ~-- ^ month{sl ^ year(s) ^ NA Flush laterals and pressure test At least once every: ' ^ month(sl ^ year(s) ^ NA other: At least once every: ^ month(s) ^ yearls} ^ 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; Septage Servicing Operator. Tank inspections must include a visual inspection of the tanks} 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 cells} 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 sffluent 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 (Y3} 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. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory aurthority within 10 days of completion of any service event. Pape of START UP AND OPERATION ' For flew construction. prior to use of the POWTS check treatment tanklsl for the presence of painting products or other chemicals that may impede the treatment process and/or damijge the dispersal cel(lsl. If high c~c~trations are detected have the contents of the tankls) 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 highwater levels. When power is restored the excess wastewater- will be discharged to the d}sp~ersat cents} in one large dose, overloading the celltsl 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 reator~g power to the effluent pump or contact a Plumper or POWTS Mainta~er to assist in manually operating the Pump controls to restore Harms! levels within the pump tank. Do not drive 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 soil absorption area. 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; ail; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the I'f)WTS fails andJar 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 chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of ail tanks and pits shall be removed and properly disposed of by a septage Servic'mg Operator. • After pumping, ail 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. CONTLNOF.NCY PLAN taken, to provide a code compliant If the POWTS fails and cannot be repaired the following measures have been, or.must bq replacement system: ^ A suitable replacement area has been evaluated and may ba 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,. an d site evalusation to establish 8 suttahte replacement area. Replacerr-lent ystems musf result in the need for a new sa}I an comply wkh the rules in effect at that time. ^ 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. sh' ,~ f ^ T .t tan! ~~ e ,' ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the }tiomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect'at that time. < <WARNINf3> > SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CO DF.ARI p1VYrCIRCUMSTANCESD DEAT MAYI RESULTYORESCE OF F.NTIeR A SEPTIC. PUMP OR OTHER TREATMENT TANK UN PERSON FROM THE INTERIOR OF A TANK MAY SE DIFF(CUL7 OR IMPOSSIBLE. ADDITIONAL. COMMI+NTS POWTS MAINTALNER POWTS INSTALLER Name Nana ~ t `~j~' u ~~ ~ ~ ~ ~" Phone Phone 7 l _ ~ _ ,,4 +Z LOCAL REt3ULATORY AUTHOLiffY SEPTAOE 8ERVICIN(; OPERATOR (PUMPER) ~ ~ ~ ~ ~ Marne 5 G!'o: k ~ •~. ~ Name Phone 7/S - 3$~0 - ~rfl $.b~ Phone T'hia document was drafted in compliance with chapter Comm 83.22t21Ibl{t}td}~tf) and 83.bM11, {2} & {3}. Yisconsin Adiniriistrativ Coda' .~ ~ SEFTIC TANK ~ pL'MP CFAt".3iR CROSS s~c:zo:~ ~N~ SPE~Ir 1~ti1~~~~~ 4" CI' VENT 'PIPE ` 12 "~ ~i~fN'. 'A80VE GRADES 4iEATNERPR00F >_ 25' FRAM DOQR, WINDOW OR JUNCTION HOX APPROVED FRESH AIR INTAKE --- wiTH CONDUIT WANP~LOCKV&R FINISHED GRADE ~ ~'{ ~ WARNING LABEL 4 ~~ C T RISER --'-•«i ~ l r--- ~ - 4 n MIN . 18" iMIN . ~ 6" MAX . ' NLET r ~ ~ ~,.,,,._ WATER TIGHT SEALS ...t~-. PPROYED a , IPE 3' T' NTO SQL I4 C OII. PUMP OFF ELEV . ~ FT. --~-'-' D ~, ~ -.. ~' << ~ ~~ GAS- ; '~ TIGNT~ ~ SEAL ~ ~ A7aM aN ~ + OFF ~~ aotuTS wlrN APPROVED PIPE 3' ONTO SQ4I0 SAIL ~~ RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED. BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE NUMBER DQSE5 PER DAY : ~._.. TANK MANUFACTURER: J ,'~ s~Y .,~. TANK SIDES; SEPTIC 1„ GAL. D QS E .^r.~~'~ GAL . A1..ARM MANUFACTURER: f~•~ ~~~lav~~ ""`~"" MClDEL NUMBER: ",,,~ s~ v,,.,~., SWITCH TYPE : ,,,,,_,,, ~e ~ ,_... PUMP MANUFACTURER : ,,,,~ u; ~ .,._.. "~" MODEL NUMBER: e SWITCH TYPE: ,~ /N~r^G REQUIRED DISCHARGE RATE ~,_ GPM DOSE V OI~3ME F LOW$AC KG /s~_~= GAL CAPACITIES: A = ,~, INCHES =~Y GAL• g ~ +~ INCHES = 3~_ GAL. c = ___8 _ zNCxES =~~~aL FUMP ~ ALARM WIRING AS PER ILHR 16.23' WAC VERTICAL DIFFERENCE BETWEEN PUMP GFF AND DxSTRI~BUTION PIPE • MINIMUM NETW©RK SUPFI~Y FRESSURE ' + ~~,~_ FEET FORCEMAIN X ` .G~,~'T11~{~0 FT.OTALIDYNAMICAHEAD ~ FEBT ""'1",•~' F EET ~ FEET _1~~ Z-FEET • LJIDT#i D'I'AMETER ____,_... INTERNAL DIMENSIONS OF PUMP TANK LIQUID ~•- 1~,~~- ~~~~" ~ ~~ SIGNED; -'~ :x~~,~,,,~..,,._._. LIeENSE NtfMBEg: ,z?~?Q~'~ DATE: ;3~~ /o.~ 1/88 ~GOULDS PUMPS • fully submerged in high grade turbine oil for lubrication and efficient heat transfer. 3871 E~ APPLICATIONS Spedflcal{y designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: ;/," maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size:l'1i" NP°T. • Mechanical seal: carbon- rotarylceramic-stationary, BUNA-N eiastomers. • Temperature: 104°F (40gC) continuous 14Q°F (t0°C) intern-ittent. • 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, buiR in overload with automatic reset. • Power cord:l0 foot standard length, 1613 S1TOW with three prong grounding plug. Optional 20 foal length, 1613 SJTW with three prong grounding ph~g (standard on EP45}. ®2000 Goulds Pumps Effective February, 2000 83671 Available for automatic and manual operation. Auto- matic models ind~e Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller. Themnaplas- tic Semi-open design with pump out vanes for mechanical seal protection. ^ EP051mpeller. Thermoplas- tic enclosed design for improved performance. ^ Casing and Base: Rugged iherrnoplastic desgn provides superior strength and con~sion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ MaRor Cover. Themtoplastic cover with integral handle and float switch atrachmetd points. ^ Power Cable; Severe duty rated oil and water resistant. METERS PEE7.__.~.__..,.~..._.....__......;_...__....._...,.......... 10 ~ ....................~.._.........~....~...................,... -- Submersible Effluent Pump ^ Bearings: Upper and lower heavy duty ball beanng construction. AGENCY LISTING ~• caae~an Somdards Ascodotlon (CSA fisted model number end in "F" m "~"•) c~ulds P~ Sao 9oor ~. sGPM zsFt EP04 i ~ ,, ....i.... _.__.._ ...................._...__._._..___ __..... 40 5D GPM s 8 10 t 2 m'!h D z a `~"'~`~ Goulds Pumps ITT Industries . - ST. CROIX COUNTY ' SEPTIC TANK MAINTENANCE AGREEMENT _ AND OWNERSHIP CERTIFICATION FORM OwnerBuyer o ~ t~s v r. ~~. tn~ i`p • • Mailing Address Property Address (Verification required from Planning ~~8 ~~ vc~son. ~; ~~©l t for new construction.) City/State f-f~dsor~. fiui Parcel Identification Number a aO - ~ o"a' LEGAL DESCRIPTION Property Location ~L %a , ~ LL1 %4 ,Sec. `~ , T v~~ N R~W, Town of _~-r v v Subdivision /'V/4 Certified-Survey Map # ~S ~ 3 a~ ,Volume , Lot # ~. Warranty Deed # l~ ~ ~ -~~ ~ ,Volume ~ ,Page # ~ .S ~~ Spec house ye no' Lot lines identifiable yes no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle waste .Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner ma' tenance responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Zoning Department a certification form, signe by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site astewater disposal system is in proper operating conditionand/or (2) after inspection and pumping (if necessary), the septic tank is 1 ss than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage dispos standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, Stat Certification stating that your septic system has been maintained must be completed and returned to the St. Croix Department within 30 days of the three year expiration date. ~+~~ SIGNATURE OF APPLICANT OWNER CERTIFICATION Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the property described above, by virtue of a warranty deed recorded in Register of Deeds Office SIGNATURE OF APPLICANT ****** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the reference is made in the warranty deed. -O 1 system with the of Wisconsin. ~ounty Zoning DATE ner(s) of the _/_/_ DATE ;parhnent. ****** d survey map if State Bar of Wisconsin Form 3-2003 QUIT CLAIM DEED Document Number ~~ Document Name THIS DEED, made between NWP Holdings, LLC, a Wisconsin limited liabilit comoanv ("Grantor," whether one or more), and .Johnson Land Development L.L.C~ A W7_SGON,~„jN LIMITED LIABILITX rnMaa>sv - ("Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): That part of the NE '/< of the S W '/, and part of the SE '/, of the S W '/< of Section 7, 'T'ownship 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin described as Lots 1, 2 and 3 of Certified Survey Map recorded in Volume 23 of Certi fled Survey Maps, Page 55 8 , as Document No. 881+32$ in the Office of the Register of Deeds of St. Croix County, Wisconsin. iif~i~ i~i~~ ~~i~i ~i~~i i~ti~ iii~~ {iii i~i~~~ i~R~ iii * 8 8 4 5 5 8 1 88455 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 11/20/2008 11:50AM QUIT CLAIM DEED E%EMPT IR REC FEE: 11.00 TRANS FEE: 113.70 PAGES: 1 Recording Area Name and Return Address River Valley Abstract & Title E2o0 Hosford Street Hudson, WI 54016 File No. 2699'755 Part of 020-1002-50-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not} Dated September ~~ , 2008 NWP * Edward F. Member Signatures AUTHENTICATION MCMAHON authenti ated on NOTARY PUBLIC STATE Zit TITLE: MEMBER STATE BAR OF WISCONSIN (]f not, authorized by Wis. Slat. § 706.06) THIS INSTRUMENT DRAFTED 8Y; Doug Berg_ 1200 Hosford Street, Suite 201, Hudson, Wl 54016 (SEAL) ACKNOWLEDGMENT STATE OF WISCONSIN ) ) SS. St. Croix COUNTY ) Personally came~~bef~~ore~~me on September l~ , 2008 , the above-narrtet~ro~rfd F. Nuebel, Manakin:? Member to known t e the pars who executed the foregoing inst ment d acknowle d th~same. No Public, State of Wisconsin ~ ~ _ ~ ~/ My Commission (is permanent) (expires: ~ J1 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CL.41M DEED ®2003 STATE BAR OF WISCONSIN FORM N0.3-2003 ' Typc name below signatures. 1 of 1