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HomeMy WebLinkAbout020-1447-17-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569546 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Bast, Kernon J. I Hudson, Town of 020-1447-17-000 CST BM Elev: Insp.BM Elev: BM Description: nn .k 1 Section/Town/Range/Map No: da Ida v 15.29.19.2848 TANK INFORMATION ELEV ION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark l Alt. Bn� P6 ' b P.a•�. ��b,` G tam o b Aeration Bldg. Sewer 0' Holding St/Ht Inlet q TANK SETBACK INFORMATION St/Ht Outlet I�. 9S. 7 TANK TO P/L WELL BLDG. an to Air Intake ROAD Dt Inlet s Septic y ZS �� / Dt Bottom Dosing Header/Man. IZ. 145 • • 3 qZ •7 Aeration Dist. Pipe /CD � 112 , (O 92 Holding Bot.System 7Z/ a• Final Grade IF PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM F' IOS-O 5 .to, I� Model Number TDH ift Friction Loss System H H Ft Forcemain Le la. Dist.to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length/ No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 7 w SETBACK SYSTEM TO I P/L BLDG WELL LAKE/STREAM LEACHING Manufacture p, INFORMATION CHAMBER OR /� •. Type Of System: / UNIT �J, C /� 1.5 7/ioo w/ Model , berT ante �V I S DISTRIBUTION SYSTEM /L 4 } /Z 5/ Header/Manifolo Distribution x Hole Size x Spacing Vent to Air Int ke Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges � Topsoil � �'1'ec, Ej No Yes No COMMENTS: (Include code discrepancies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 671 Pine Timbe��y Hudson,,WI 54016(NW 1/4 SE 1/4 15 T29N R1 9W) Coyote Ridge Lot 17 Parcel No: 15.29.19.2848 1. AI BM Description= r i Alt N / n 2.)Bldg sewer length= you ' -amount of cover= / — 00 Plan revision Required? Yes ❑ No X7,5 Use other side for addition I info ation. SBD-6710(R.3/97) Date ]rise ors S lure Cert.No. P OT PLAN PROJECT Kernon Bast ADDRESS 948 La Barae Rd Hudson Wi 54016 NWe 1/4 SE 1/4S 15 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX x- MPRS Shaun Bird 226900 DATE 5/29/14 BEDROOM 4 CONVENTIONAL XXX IN-GRO t ASSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 896 # of chambers 44 BENCHMARK V.R.P. Top of ST manhole cover ASSUME ELEVATION 100° Filter BEAR Filter ❑ BOREHOLE O WELL #H.R.P. Same as Benchmark SYSTEM ELEVATION 91.6/91.5/91.4' 5.5' below qrade All piping shall be SDR 30/34,within 10' of tank, piping shall be Schedule 40. Scale is 1" = 40' unless otherwise 2-3' X 66' cells noted Pine Timber Lane and 1 3' X 50' Cell with>3' spacing Area of very 5' B-4 poor soils B-1 150' 100' B-3 60' 40' Vents B.M.* 8% Slope 10' 60' 7' -2 CO 99' Vent Property Line >6„ Quick4 Standard Leaching Chamber Pro 4 of Cover with 20.0 ft2 of Area Bedroom 5.6ft^2/pair of end caps House 4' Long 12" Grade at System Elevation 34" PLOT PLAN PROJECT Kernon Bast ADDRESS 948 La Baroe Rd Hudson W1 54016 NW 1/4 SE 1/4S 15 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 4/20/14 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 , BENCHMARK V.R.P. Top of 1/2' pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *g,R,p, Same as Benchmark SYSTEM ELEVATION 95.8/95.2 4.4' below qrade All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. Scale is P = 40' unless otherwise Pine Timber Lane noted B.M.* 0 B-1 10' ro 4 150' droo B-3 15' e 60' 5' 40' Slope 60' 2-3' X 92' Cells with>3'spacing 99' roe Vent Property Line >6„ Quick4 Standard of Cover Leaching Chamber o with 20.0 ft2 of Area 5.6ft^2/pair of end caps Long 12" 34" Grade at System Elevation Property Owner_ Parcel ID# Page of F Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. -'So—ilApplication 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 a 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/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 Boring# E] Boring F-1 1:1 pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 Effluent#1 =BOD5>30 1220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD5 130 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-6330(8.6/00) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. l percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 7—/ Please print all information. Revie d by Date }� Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). rid l Property Owner Property Location %l'� Govt.Lot/4/LC) 1/4S!� 1/4 T 2 N R E r)W Property r s Mailing Address Lot# Block# Subd. Name CSMf w Z�4 10 State Zi ode// Phone Number ❑City C)Villa Town Nearest Road l d b ( ) i ew Construction Use;g:rResidential/Number of bedrooms Code derived design flow rate GPD ❑Replacement ❑ Public or commercial-Describe: Parent material Flood Plain elevation if applicable General mmen comments _,J. '`/} !Z_1,/d h2 2X�Oq yL^e-C� and recommendations: G�Va r+�- �fJ rn System Type G'p��.JP�� System Elevation ! `' Ong# ❑ 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/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. `Eff#1 'Eff#2 va ,t a 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/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. `Eff#1 `Eff#2 Effluent#1 =BOD >30<220 rng1L and TSS>30 1150 mg/L `Effluent#2=BOD <30 mg/L and TSS<30 mg/L CST Nam(Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted, Telephone Number 1008 192nd Ave, New Richmond, WI 54017 C__ 92� / 715-246-4516 Tumber oe, xr 'ti` Industry Services Division 1400 E Washington Ave (to be filled in by CoP.O. Box 7162 �� Madison,WI 53707-7162 � + State Transaction ber _ n a e P In accordance with PS 383.21(2),Wis.Adm.cod miss�ip or ate owned POWTS are submitted to unit Project Address(if differ mailing address) is required prior to btaining a sanitary permit. Note.Ap �It3fo the Department of afety and Professional Servies. Ration you provide may be used for secondary u oses in accorda ice with the Privac Law,s. 1 SdStats. I. A 1 -ication-1 formation-Please Pri nformation Parcel# Property Owner's 1,,ame J, 1 f Property Location Property Owner's ailing Address �C.i..���� Govt.Lot Zip ode Phone Number ,��/, '� Section F-- City, tate 1 rcle one �I ' N; k E PP 11.Type of Building(check all that apply) Lot# Subdivision Name tf2 Family D Nelling-NumberofBedrooms 21 Bloc ❑Public/Commer ial-Describe Use .--� ❑ C of A�G.+!L. El Village of r CSM Number ❑State Owned- Describe Use of lJ 1- 7- Q'6�_ ZZ -ZZ C, 141r-15 Ill.Type of Pei mit: (Check only on box online A. Complete line B if applicable) A' New System [I Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) List Previous Permit B. ❑ Permit enewal ❑Permit Revision El Change of Plumber ❑Permit Transfer to New Number and Date Issued Before Exibiration Owner IV T e of P WTS S stem/Com onent/Device: Check all that a Pressuriz d In-Ground Sys ❑ Pressurized In-Ground ❑At-Grade ❑ Mound?24 in.of suitable soil ❑ Mound<24 in.of suitable soil G 0. Ps ❑Pretreatment Device(explain) ❑ Holding Tank ❑Other Dispersal Component(explain) ` V.Dis ersal/T reat nt Area Information: pis ersal Area Proposed S Elevation Design Flow(gp ) Design Soil Application Rate( sf) Dispersal Area Required(sf) P_� _ O Manufacturer J Capacity in Total #of ;3 � a u V1.Tank Info Gallons Units b Gallons U o � 2 New Tanks Existing Tanks 2 0 � o ii 0 0 Septic or Holding Tank Dosing Chamber VII.Responsibility Statement- 1,the undersigned,assu sponsibility for installation of the POWTS shown on the attached plans. Plumber' ature MP/MPRS Number Business Phone Number P br'sNam (Print) Z /C7,.,,1 �7/J ,� �•- � Plumber's Addy ss Street,City,State,Zip Co ) C Vill,Coun De artment Use Only Issuing A Signature Permit Fee Date I sued g g Approved $ � 755 OD p iven Rea for Denial '7 IX,Condi Teasons for Disapproval 3, (Z `(�__ v�o °5(eptlqi tank,effluent filter and 4011�_ VV_q,i'Ar- dispersal cell-must all be servtCOS I maintained as per McMgement plan provided dy pluall>W, : ;?bQuWerrients�1uat-OV tteil' d 1 Ah t plans for the system and submit to the County only on paper not less than 8 U2 x 11 inches in size ttac o complete SBD-6398(F 0313) Cover Page e g ShaL n Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/20/14 Owner: Kernon Bast Location: NW 1/4 SE 1/4 S15 T29 N,R1 9W 671 Pine Timber Lane Hudson System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Pag # 1. C ver Page 2. Plot Plan 3. Chamber Cross Section 4-6.Maintanance and Contingency Plan 7. Filter Specifications Sheet 8-10. Soil Test Signature License number 26900 PLOT PLAN PROJECT Ke non Bast ADDRESS 948 La Barae Rd Hudson Wi 54016 NW' 1/i S 1/4S 15 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 4/20/14 BEDROOM 4 CONVENTION 4,1, XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TAfSK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of 1/2' pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOL O WELL *H.R.P. SameasBenchmark SYSTEM ELEVATION 95.8/95.2 4.4' below qrade All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. SC , ale is 1 = 40 unless otherwise Pine Timber Lane noted B.M.* i 100' B-1 10' Pro 4 150' Bedroom B-3 15' House 60' 5' 40' 8% Slope 97' 60' 2-3' X 92' Cells with>3'spacing ent B 99' -2 Vent Property Line >6" Quick4 Standard of Cover Leaching Chamber 20.0 ft2 of Area 4' Long ;,,,",with 5.6ft^2/pair of end caps 499 Grade at System Elevation Cro s Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 5.6ft 2 pair of end plates Finish grade elevation Typical Installation 100.2' ALLonVent Al Grade Vent g,, 4" 3' ,A/30/34 Septic Tank 5' 5' Long 1 6" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 92 ' Cells Same on other end Observation tubeNent At end of cell A B 22 chambers per cell System elevations: A_95.8' B 95.2' • !R R i Y 'aY Y-!1X i�a{ figs' d53P?Ft� �'ug>.ig3'a}�q.+ #' i alS�.�q ♦A 1 i ar ka v: x :ae !ro` '� !►� � e y s kkx. t E4> rt :'e.a (lr. -,ce: x s. •f :.skE +t R ..-rd t k. «ac[�.3. Y= it • trt C9.9t� k tM. €#r.! { =11€ +^, ! FSr. 51x ' �xe l:9a[ ♦ Y8.` �[ f:S{ .^Y :!'. E!..:C. sy 6. °YA� k?uR C'.'! Ey+f£ `' iC- A i d' Af '�k k)*..f C]»*. '�9 ii tW(3 2 6 f5 �lr.ff .� # #f ♦+ 4 ltb:a I !.4#='Y5- � .)__ end _ 4^ _ � H f u k A 1♦ ♦� ! f � .ai+f k fi''._ 'X'• 1-t 1 i«-* _ iz ta...e 4 k♦ :d It.; �k' t t tii*J l..i. t! •&tit 4 i <t R.t4 W A:..�k. ♦i _xs.i Y ao58a' - xzxr • .<.:' $' i:3::' '.tx,�-f tom" �•♦£f.` s.a :�6� tFL"i4-:rod :tk.¢ r:+s :- a sRe W r t2 Itf aTf '•s' Z t s�v: ft Y.t{i r. T�:' '+ i` Si t,ea - Q °.+ 3 RL. i }•.z t➢..-y t YL12t.:.t iww- -tY t tl. .+s Yil:w3 k .Y7 k +z k`[- ,F:i' ! k •S Id �tf++ _Y♦ t_ �[>:. c E� a�Y p)s'b¢:—x 154 a a.�i+x P,t tPSk.w♦ Yt 44i � /ry, N f t!1 A f " r M k.5 •!!W p i A i ! 16 8 1 �.. -4 k . t.; t! 4xr v. tt+�?7 h ! tE.. 6 Y $Y 5!, -+..'S ! ) R i "-ts! :.-6;' ft • t 2t4- i =H- qx3 A;.{:^k7:.`+Ki(%j tl. c 0. v:;t}ik: Y:: tb; i::kYf✓ t <.• k t,' ;at t ;° • •t fie: !i ! t p kt 4'k s t t ♦. ;+i i i !"4t. it> ;J � �.-.^aa ,.a "zz POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page—_of FILE INFORMATIO N1 SYSTEM SPECIFICATIONS 0 NA Septic Tank Capacity gal Owner Septic an k Manufacturer Permit# 0 NA Effluent Filter Manufacturer ------- DESIGN PARAMETERS NA ms El NT Effluent Filter Model Number of Bedroc s --------- Pump Tank Capacity I NA ::acility Units Number of Public -------­­T4 --------- - Estimated NA ... flow(a%erage) IMay Pump Tank Manutactur-r _Ra NA Design flow(peak),(Estimated x 1.5) Pump Mar lufacturer ------------ Pump Mociel NA Soil Application Rme ------- NA Pretreatmont Unit Standard Influent ffluent Quality Monthly average* FJ Sand/G,avel Filter Ll Peat Filter Fais,Oil&Grease (FOG) !�30 mg/L. L]Wetland Biochemical Oxygen Demand (BODs) <220 mg/L. L1 NA n Mecharical Aeration Total Suspended Solids (TSS) :�_j 50 mg/L n_ Disinfection ❑ Other: 1 NA Pretreated Efflue t Quality Monthly average Dispersal 13elil(s) 1- Biochemical xygen Demand (BODs) 530 mg/L )NcG,-Ground(gravity) LI In-Ground(pressurized) :) Total Suspended Solids (TSS) <30 M911- /44-NA ❑At-Grace El Mound 15104 CfU/100MI ❑ Drip-Line ❑ Other, Fecal Coliform(geometric mean)- —------ -------- X in dia� ❑ NA Other: 1, NA Maximum Effluent Particle Size ------ Other: I. NA Other: NA Other NA *Values typical for joirriestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Sorvice Frequency Service Event � Q month* (Maximum 3 years) 171 NA Inspect condition of tank(s) At least once every: Pump out contents of tank(s) When combined sludge and scum equals one-third(�)of tank volume Ll N A month ntN s) (Maximum 3 years) EJ NA 0' At least once every: yvear(s Inspect dispersal cell(s) ... .... month s) n NA Clean effluent filter At least once every: ......... ❑ month s) Inspect pump, pump controls&alarm At least once every: ❑year(s'j -------—--------------------- Cl monthis) I NA Flush laterals ar d pressure test At least once every: 6f�wr:---------- ❑month!s) NA At least once every: Cl year(s)........... ---------- MAINTENANCE NSTRUCTIONS individual carrying one of the following licenses or certifications: Master Inspections of lanks and dispersal cells shall be made by an ind Plumber;Master Plumber Restricted Sewer; POWTS inspector; POWTS Maintainer; Septage Servicing operator. Tank inspections must include a visua inspection of the tank(s)to identify any missing or broken hardware, identify any cr.icks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent or the ground surface. The dispersal cell(s) shall be visually inspec d to check the effluent levels in the observation pipes and to chect:for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a tailing condition and requires t1i immediate notification of the local regulatory autharit!o. When the combined acCUrnulartion of sludge and Scum in any tank equals one-third (6)or more of the tank volume,the entire contents of the tank shall be removed by a Septage Servicing operator and dispused of in accordanc, with chapter NR 113, Wisconsin Administrative 'ode. All other services, including but not limited to the servicing of effluent filters, mechar ical or pressurized components,pretreatment unit,-,, and any servicing at intervals of s12 months,shall be performed by a certified POWTS Maintainer. A service repot shall be provided to the local regulatory authority within 10 days of completion of ant,service event, Page_____of — START UP AND OPERATION eck treatment ew eonstru lion, prior to use of the POW1 S chent tank(s) for the presence of painting products or other chemicals that For n ial cell(s). If high concentrations are detected have the contents of the may mpede the treatment process and/or darrage the dispers 'tank(s)removed by a septage servicing operator prior to use. System start up hall not occur when soil conditions are frozen at the infiltrative surface. During power o tages pump tanks may fill ab3ve normal highwater levels. When power is restored the excess wastewater will be discharged to th dispersal cell(s) in one large dose, overloading the cell(s)and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of thou pump tank removed by a Septage Servicing Ooerator prior to restoring power to the effluent pump or contact a Plumber or POWT8 Maintainer to assist in manually operating the Bump controls to restore normal levels within the pump tank. Do not drive or ark vehicles over tanks and dispersal cells. Do not drive or park over, or othenhise 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; condoins; cotton swabs; degreasers; dental floss; diapr�rs; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scrap.,; medications; alt; painting products; Pesticides; sanitary napkins; tampons;and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Gomm 83,33,Wisconsin Administrative Code: All piping to tanks and pits shall be disconnected and the abandoned pipe openings seaieA. A the cc.utents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After JIUMping, 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. CONTINGENG PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement s stem: '0--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 time. CI A suitable replacement area is not av;0able due to setback and/or soil limitations, Barr ng advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 0 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must 3e performed to locate a suitable replacement area. if no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. El Mound and at-grade soil absorption systems may be reconstructed in place fallowing removal of the biomat at the infiltrative surface, Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUM AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANWOF: INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC,PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FRC M THE INTERIOR OF A TANK 1AAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL C -- POINTS INSTA ER r. POWTS MAINTAINER Name �c�r.i Name Phone ` a �( Phone 2�J�'�� :_.�L SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name _ Name �/` 2�1 . Phone d1 ' �f Phone 7/J''— 86 This document ws q drafted in compliance with chapter:;PS 383.22(2)(b)(1)(d)&(f)and 383.54(l),(2)&(3),Wisconsin Administrative Code. UTER CARTRIDGE INSTRUCTIONS � 1�Etr~tyr • S•r•ew n MV lit tare laid'cis"t.19"thm Wed W f:f1u nlutldet pits to erlavro it iu bwit4ur'ud u Idwr d»ill caors opwrtitio. If 1aot,,th$h wither trisolt tnuyw kooe ibto tit" t4ak thruu h the uutiat er muluuut Wdid(444la)aWditlulsal i+lpu torte Cho uutlnt plptt. zvvi p :t W 111to the rbtie As Still dry fitted oil thw outlet Ithu"rn4ra6unr tins 4rrvgtt, of 466-io s o his taurded to bralcl:the yfltwr to ttw tirsllt and Wall it tttNfLlrl11 the alaliotwf sul 1010"i"Ital rims svp1 mi,if side suppurt treatflud.ik I1ut utllfzktl, liromiad to dp fgtic $-YVP t Fo iowteltattwto;totillzirly ttM aptletmtl Nippltshlrilltirl side t:upi,wt_ tlWkO*r t INOWN I tine iri.•-inch pips and:o thl%t-*t6`'Cubrt. If side suppu11C hidthfld it but lttlli fot,joire toad'tu step r-ur- !io Vetlt WbW the Mel l=Obo Otto the uuhok 1AP., ttiwrt they hitel !`•r:7r�; f7j cartrtdyv ird it the Coma, 101`e61510l'l deWh MAN the filter trlltkea lMtn the iWlttaw uk r< till,cwu_ •" ti'S• If a VAS swkcll is utUAod: woo;ott irate tie,r!11tul.f,Ild kick by Wrniii(3 Clockwise 904,MWlIM +itir�(7 1. Thee efft Mt tiltut.ailuuld be c&saatud every tirrtci title ouptic will(jr, servirrilil. 2. ollekr the outlet r►rxos,r opretritr;t to Inspea-t tike tiolk acrd Nita 5„ Pump do septic tank uutratd irtoty,rnaikitlg$aura to rtstrwale the r:ludljb lwyew on q Ise,bat-td1ri of ff"s tank:tad rnrt just the srnilit utld*ffltttllit, 4. race 44111 uWluant havet ties buon lowered inflow tilt invert tof this outlet pi pia,firmly puff up un the totor htiodie to disiadya the cllrttklyr+ w tiro crsse. 5. Slide the cartorld9d iW taad or if of the 4:iw r hW cfo;ttsilig. G. tY it lrrts j witch 17at lumted Wart ulatrht Is pritbent,title swit6l .• slt'ould h rumwred by turttirati r:qutttbrcluckwifill 900 Wild t1b"oldd a t + With Write only. �. While hall 4110 flaw cortrkloo isle its vido Narita that UU04cu Nclo,v 'u dwwu)uv IaEre 4csus>5 ttpt»tblhh yiledw off the calil;rldllts tuitl6 Watfar a„ly,oro,ak ag sure ati mrrjriayle lu'l4i0i'141 is 6`111151111 back hitu tht+tank. s, if VR:i yW to Is utilimij,rwyiitti:(t by tly6gMiso into okor iold tuts!i3fo dockwice SO'. 9. ktusart tiles ifner can•trid9w biwk i4O the CAM,pre"itoo doe"nittif 41 t.. tiffs filter I cats inku ikon brlltuuti ref t'ha w7i4ua. 1a1.Roplace mid sttcure the iu;.c:r a;111MMtlg oil tho tallrolL t!,i6`..-tds.�°: '!5`74�4YIYtt»;tri{{ 'N-ti "i i;J t trrC-a.i).:•4a!!bt.Y�!" 12 .., 1 S6 rr Lar is • �` ra OF 'M M wME r✓,vf / ' 2.25 AMES so.-saw $0.Fr. Lcff 14 X , .p�A�p1El� i i i kO. MR ✓ LOST 17 2.43 ACHM LOT Is s / &46 ACM 2.39 ACMS 101223 94 FT. TOP 1'rm POE FT. ; 75m941z 17 KATHLEEN H. WALSH . _ REGISTER OF DEEDS ST. CROIX CO., MI STATE BAR OF WISCONSIN FORM 2-2000 RECEIVED FOR RECORD Documeni Number WARRANTY DEED 01/07/2004 12:35PH WARRANTY DEED THIS E EED, made between Kemon J. Bast, a married person, EXEMPT # 8M Grantor, and Kernon J.Bast and Donalda J. Speer-Bast,husband and wife, REC FEE: 13.00 as Survivorsh ip Marital Property,Grantee. TRANS FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee COPY FEE: the following described real estate in St.Croix County,State of Wisconsin: CC FEE: PAGES: 2 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Edina Realty Title,Inc. 400 S.2'd St.–Suite 115 Exceptions to warranties: Hudson,WI 54016 Easements,restrictions and rights-of-way of record,if any. 412540 20-1027-40-000&30-000&20-00 Parcel Identification Number(PIN) This is not homestead property. Dated this 6t i day of January,2004. * emon J.j wt s * AUTHENTICATI, A V0Wn ACKNOWLEDGMENT Signature(s) GbgC1 �b� STATE OF WISCONSIN ) oil?" . C,0(-1511' ST.CROIX COUNTY. )ss. authenticated his 6th day of Jap Personally came before me this January 6,2004 the above named Keeton J.Bast,a married person to me(mown to be the * person(s) who executed the foregoing instrument and TITLE:MEMBER STATE BAR OF WISCONSIN acknowled the same. (If not, authorize by§706.06,Wis.Slats.) bv-- HIS INSTRUMENT WAS DRAFTED BY *Cheri Brown Notary Public,State of Wisconsin Edina Realty Title–Doug Berg My commission is permanent. (If not,state expiration date: 400 South Second Street#115,Hudson,WI 54016 3/11/2007 ) (Signatures may lie authenticated or acknowledged. Both are not necessary.) *Names of person signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 U 2 '487P 121 EXHIBIT A The NE'/.o the SE'/.and the NW'/.of the SE'/,,all in Section 15,Township 29 North,Range 13 West,St.Croix County, Wisconsin,EXCEPT a parcel described as: Beginning at the E''/,corner of said Section 15;thence South 00 degrees 47 minutes 33 seconds Eas along the east line of the SE'/.of said Section,407.27 feet;thence South 89 degrees 08 minutes 15 seconds West 535.46 feet;thence South 14 degrees 10 minutes 34 seconds West 93.31 feet to a point on a 80.00 radius curve,concave southwesterly,whose central angle measures 25 degrees 34 minutes 33 seconds,whose chord bears North 54 degrees 32 minutes 33.5 seconds West and measures 35.41 feet;thence northwesterly along the arc of said curve,35.71 feet;thence North 14 degrees 10 minutes 34 seconds East 76.12 feet;thence North 01 degrees 07 minutes 26 seconds West 400.07 feet to the monumented south line of Certified Survey Map recorded in Volume 1,page 217 at the St.Croix County Register of Deeds Office;thence North 88 degrees 51 minutes 13 seconds East,along said south line,570.78 feet to the point of beginning. S e e eS EE ® LEFT ELEVATION !i Fim] 0 a EIGHT ELEVATION f OP6 II ---- -- ----------- - - a Q5 j I e9 Q i e p @eg 1 ----------------- IIPPEE PLOOH lul BOOF PLAN fOFf l l l II II 4IFF d / MAIN JIDOZ-FLAN I I �I III elE�� - - gill BrEJ10 011® X00 W ENP FE 000 — 9� REAR ELEVATION i A Imfl / — 0 ® _ s uu FRONT ELEVATION 0 - lOF6 I i I - /-3/-5 7 - ParrGcel ID# G Q 7 Paw Z d FI-1 �„ng# 0�r� [yBit Ground surface Nev. 8. Depth to kniting tactor in. Sod Horizon Depth Dominant Redox Description Texture SbucUae Cron Boundary Roots !!!M In. Munsed Qu.Sz. Cont Color Gr.Sz.Sh. •Eft#1 'Etf#2 AL U goring# 0 Bork9 X4.70 > A_ Pit Ground surface elev. R Depth b bftg lector in. Solt Applimlion Rate Horizon Depth Dominant Color Redwc Description Texture Sttrduxe Consistence Boundary Roots GPOW n Munsed Qu.Sz. Cont.Color Gr.Sz.Sh. 'Efi#1 'EfW2 0.1/ �o y,� �3 siG zfSh,� S w . S . S 2,1 AO si& fs i �- • 3 /O M 71Y, S D, S . -7 �• F-1 # a Boring Pit Ground surface elev. R Depth to*&v factor n. Sod Application Rate Horizon Depth Dominant Color Redox Description. Texture *tm*re Consistence Boundary Roots GPM in. M Qu.Sz cont.Color Gr Sz Sh. *M1 'Etf#2 EMuerd#1=BOD5>30 1220 rngll and TSS>30<150 mglL Effluent#2=BODs 130 mgt-and TSS 130 rnWL 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 TIN 608-264-8777. seaa=(RAoo) RECEIVED wsoonWn Depoirbywo of corrwnence DEC `� 9 WL EVALUA-nON REPORT 3 Division and eui in a�roorderroe v C nm 85 VWs. Add cafe O4y 5-r. cR OI� ST.CRO!X C Attactr site ptan an pier less tti@ tatGdfl�i di es®jp she.Plan"Um irralude• notWrited1wveftel -- i -(BM3. r and panoat I D. , penent ,scale0ramens0m�amoM4andtocadoreand mnoefon�.estroad Please print all Information. Revievred by r mrraw MW bedead%reeom"Myarpu m<t�•�t w.$ 15.04(i)(am- iirw s£ MC/ 0 Pmperty PrnperlyLaraGon J�fi k RNO A 13hS 7— Govt Lot RW 114`54)1/4 T-2f N R /I 4&(or)W Ptapedy Addmm Lot# 81odc# &bd Nerve or MW IN LA • ,849 6-&a- P� • 17 a C'o Yo ra- RCKY Zip Code UPS-CA) w. s yak '7r 5 3 8l0•�? a� 11 Vow ®ToMm Nearest Road New user[Reddentkd r Number of bedroom 3~ code deed design low isle yS0 —• O�t`1 GPD Cyr a PWftoroo -0Wcafbe: Parent nw*m t SA.V TY o�LT'��4 ffaod Pfarn ff aM§mUe tt Generw canmerrls and ` ?�•r�D %S �, oow�T�D•tJif L. h• O. l c.?•77 S T.3io®/feet t.� Ti �i h, F-/180ft# ❑ eating � Ralf Depth Dm*%WCah fledootDessaip m To*" StUO" omemenOe Boutdoy boob GPW- In. Munsel Qa.s:. caomt.WIT car.Si Sh. 1 dm *am / 0--5 IeYi2 13 GS /; s Cs 3r-1 . '7. f!• Z l -2 7,: R. LS / 4f !• Z i1 i (Al 2' (` # o 4!j Dewh to Waft bftr im ,fat Rabe Horizon t3eper Don*s"Cdm Rgdoac oesaiption fP&m ft%,M.ee come emov " Roots Gig in. MunseM Qu.Sz Conl Caton Gr SL Sh. •Eif#2 i 0.1-L Ao 3 L zfs k w y Z 1 /,0 YR 3 - Sim lfshk cs /f . z 3 /,0 YA -7 5 D,S •eked#1=BOD 2-30<m nvt and 735X30:_<10 mg& -Eftmo 02=BW <30 nV&and TSS 130+v& ca me"o �RT-- ._. WUMW Address Deb Evakxftn ConckxW ToWhone Number /I/v0 7- .2-,o 0 3 ?!-5 7.7A 3 q42- Private Sewage Consultants 10th Ave. Spring AAJ S ��2 TO],�L, of Y0 Spring Vatley, WI 54767 ZO • /017 - z.o • oav 2-0 •/0-.7 • 30 - OVO 2-0 . i017 • y© , ozrO 7 A !" /-3,-5 7--- G Q 3 Property Owner Parcel ID# / Paso of ® Ong 9 11y Boring t�Pit Ground surface elev. ft. Depth to dmiting factor in. Sod icalion Rate Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary Roots GPDffP In. Munsed Qu.Sz. Cont Color Gr.Sz.Sh. 'Eff#1 'Eff#2 eori ❑ ng / \ Boring# (� tP 3 Q Pit Ground surface elev. ` ft. Depth to dmrting factor• ` O in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsed Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Ef1#2 0-41 /,0 YX �3 SiG z-FshK S w . s . • z io ®- SQL -ic-s 3 op 0, 4vt ge A s — . 3 . s Sef - 7 Boring# ° Boring g ❑ Pit Ground surface elev. ft. Depth to.uniting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description. Texture )Strcture Consistence Boundary Roots GPDIff? In. Mu Qu.Sz. Court.Color /Gr.Sz.Sh. •Eff#1 4092 000l Effluent#1=BODs>30 220 mgft.and TSS>30:S 150 mg1L 'Effluent#2=BOD,130 mg&and TSS 130 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. $8D43MQt*W) a 1' For issuance of permits and designing Contact:Ulbricht&Associates Registered private wastewater consultant a fumbeIS 2812 10th Ave. Spring Valley,Wl 54767 715-772-3442 t 10� e� to 1N y /go r� 0 Q Ion,5� d IM AT 16' . fl vt� � r �M4 / i Z-0 7 /4�