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HomeMy WebLinkAbout020-1400-08-000Wisconsin Department of Commerce Yafety and Building Division }~~p~? PRIVATE SEWAGE SYSTEM ~/ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) .. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Bast, Kernon Hudson Townshi CST BM Elev: Insp. BM Elev: BM Des dption: A Ida,. Q ~~ j TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ,/ /, , L T / ~U n (J Dosing w Aeratl n Holding TANK SETBACK INFORMATION TANK TO P L WELL BLDG. Ven to Air Intake ROAD Septic 7 /L ~~{ ~ t ~~'1 Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer mand GP Model Number TDH Lift lion Loss System Head TDH Ft Forcemain Length Dia. ist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 420722 0 State Plan ID No: Parcel Tax No: 020-1400-08-000 Section/Town/Range/Map No: 11.29.19.2498 ST! TIO~ BS HI FS ELEV. B nchmark ~~ ~ , 3 0/ 3 ~ /~ts- Alt. BM S/ lc~tr s: // 2 • ~ , 2 Bldg. Sewer Cy ~~- .~ 9`• ~ St/ t Inlet ' ~s~ S Ht Outlet ~~~ ~~.. ?/ /1 Dt Inlet ~ .~..^ Dt Bottom ~d~ .~ .~~ Header/Man. 9. ~ 9~. ~ Dist, Pipe ( Z I /• °~0•~ Bo .System ,c I Z ~ (~ I. S Final Grade 7•a St Cover ~ ~ ! y~ 7 ~ v BED/TRENCH Width ~ ~ Length r No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ SETBACK SYSTEM TO P/L BLDG W LAKE/STREAM ACHING Manufacturer: INFORMATION AMBER OR Tyg@ Of Syst~e~~~ (rw,~r~` " T~/ ~/ ~~ M / ~ ~ UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution + x Hole Size x Hole Spacing Ve o a e ~ ~ Pipe(s) 4/ ~ ~ ~- ~~ Length Dia Length Dia cing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Svstems Onlv l~- t^.l'tQ~s ~~~~ ntt Airlnt k g- Ana Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ K . ~ Bed/Trench Edges Topsoil ~~ Yes ~ No r] Yes (; ] No V(~-~ V - COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/ 03 Inspection #2: / / Location: 756 Packer sD;r Hudson, WI 54016 (SE 1/4 SE 1/4 11/T~29N R19W) Hopkins Estat~es~Lo~t 8 ~ / ~ P~arc'e~l/No: 11,.2~9.1~9.24~98_ 1.) Alt BM Description =5~{~ `Nr~ ~1 I ~ C't„~~/I/.Y~~..' /v(.cu. ~ v++^y"'E'6~.u'~ /6~'C~- "'o """ 2.) Bldg sewer length = Z+5'.r.~ S~Fk~ ~(h.~ 6Q -amount of cover = / ..~ Za`~,~ ~2 r----j---~---- Plan revision Required? r -_ Yes I~ No ~ w O iD~ i ry COQ- /,/,.,.• I ~ S Use other side for additional information. i,_~_j--____~-_-_-~ i __ G~2~k~ _ ~~ I L_ r __! Date Insepctor's Sign lure Cert. No. SBD-6710 (R.3/97) ~~ k X' y~ ~~ ~"~ b~ d~ ~~w~ ay ~~ y/3~~ ~- ~, ~`;' 1 \• ~'~ ' ` ~ '' , ~ \~ ~ A ~93~ 1 1 ~+ 1 N 1~~' ~il~ ~~ ~ ~ ~ 2 . A-CR i 'i ~ <<., _' 9 , ~ k .•.,,_ / w ~o ~^ ~, C~ ~ ~~ ~ ~ ~~ ~---- 3os' ~~No ~ 8~ ~ ~L~ ~ ~ 5~ ~l Z-9 / 4w ~,.~.~ a~J o ~ ~1 OS a-yl ~ r g ~~ K<~s Lsrrr3~ s `~~~ ~ ~Y°'~ ~ o~^~ `1 ;.,vim 2~ Dy, COPY a ~0 Safety aad Buildings Division 201 W. Washington Ave., P.O. Box 7162 C~tY ~ ~~ C~~ ~( ` 1SC0~~,~ Madison, Wi 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608)266-3151 d Department of Commerce State Plan LD. Number Sanitary Permit Application _ /,l J/ ersonal information you provide Adm Code Wis 83 21 h C d i , p . . , omm in accor w t maybe used for secondary purposes Privacy Law, s 15.04(1 xm) ss) ing addre ail f dit3' t than m ss ( i Project Addre ~ - - / ~ y Q 1. Application Information -Please Print All Information I/ y,~ ~Zv -/'~~d ""~ --~OIAO Property O er's Name ?~„S ~- tv1l~ ~' ~ .~ 2003 Parcel # Lot # ~ Block # Property Owner's Mailing Address ~~ ~ ~ i G f~ 01 X C V U N~~ Y Pr°~,ty Lncatron ~ S ~,. ZONING OFFICE ~ ~~ (~ ~~J g8 '/., '/., Section City State Zip Code Phone Number . ` ,, •• ,, lv W~ ~~O~b ~f ~ ~.3 {o"Z I s ~ e T ~9 N; R ~~1(cEoe~) l ll th t k y) a app a Il. Type of Building (chec 3 ~~P IoDW~ f 13 b d li Subdivision Name CSM Ntunber rooms er o a ng - Num 1 or 2 Family Dwel J f ,/ Pf ~ h ~ ~S ~ f-~'~. S ^ Public/Corumereial -Describe Use , ,,,, - / / 3~X f~ ~ I ~ ~~ '~L~J~1 ~ ~' ~ ^Village~`fownship of {7iS~Y~ ^City ~fi n . 7 ^ State Owned- Describe Use _ 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B, ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Ttaffiter to New list Previous Permit Number and Date Issued Before Expiration Flambe[' Owner 1V. T e of POWTS S stem: Check all that a 1 Non -Pressurized ln-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 al. of suitable soil ^ At-Crrade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized ln-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Fiher ^ Recirctilating Synthetic Media Fitter ^ Leaching Chamber ~p line ^ vet-less P~ ^ Other ( lain) V. Dis rsal/1'reatmentAre~ Info K r 3 ~' Design Flow (gpd) Design Soil Application Rate(g f) Dispersal Area Required (sf) Dispersal Area Proposed (sfj Sys Elevation ~{So . ~ ~ 3 ~8~ ~ 5~.3 . ~ QManufacturer Prefab Site Steel Fiber Plastic Vl. Tank Info Capacity in Total Number ~ ~~ Concrete Constructed Glass n~ Gallons Gallons of Units ~ ~i'-~"'~ < ~ Ncw Existing /~ t Tanks TarJcs Septic ~ . u,a~,-~.,I~ ~ ~~ 0 ~ ~ ~ t,~y-' ~riV fi' Aerobic Ttcatment Unit Dosing Chamber Vll. Responsibility Statement- 4 the under d, a ponsibiUty for installation of the POWTS shown on the attached plans. Plumber's Natne (Print) Pl s i MP/MPRS Number Bttsiness Phone Ntrrrrber /'~ ~lp/3~y~b 2 a~S= z3S= 2L~{~ Plumber's Address (Street, City, State, Zip e) bog 7D~ `~' ~' Fi~//o~t.,(Or!/~ lv-r S~?~i Vlll. oun /De artment Use Onl d ^ Di ~~rY Petmtt Fee (includes Groundwater Date Issued suing A t Signature tamp) Approved sapprove Q` D Surcharge Fee) ~ ~ ~ ~ r0 ^ Owner Given Reason fot Denial , 1X. Conditions of ApprovaUReasons for Disapproval ~~~ ~ r ~~°~~' `~~" ~ ~ c ~ ' ~ s ~ s ~~ d - ~ ~ -~ ~ YI. e ce u ~~`ccu~,,a- - ~ . sa.~~d~ . a~¢ .,Co~- ~ s)rl,/Pin, ~P~rn~,~a vN p .7~pd~~f ~~ ~' ~ ~~ ~ 8z ( ~ "~ Q ~ ,~~~ nd 1 ~S~^G~ Attar comp~tc plans (to the County only) for the r~ m oo paper oot Y~se than St /Z :11 inches iu su•.c 3 ~Cy4~ru~cd e ,/,Z/ u~ ~~,~.f~' f~l~7s ~~. P.~u~t ~~~w-h ~ir-yl ~s ~Piy,, -~Zacc.e- yc~.r~I-l- G~:~:~'-w"..Q~ SB~~R.~ CI~~ ~ `~ ~ G~ ~' `~ ~ ,a-e ~~-~~~ ~-c_ ~ ~,~ ~ ~-mot.,-ri~3•~~-~' 0 ~ ~ ~~ ~\ ~ / \ ~ 879.2 ~ X 8 .5 ~o ~ n ~ / 1 ~ (~I- ~ ~ ~ plv ~ •9 881.5 . X81. , - ~._ _ -- -- ---- © ° e ~d 0 9 C \ --- o ~ _ _ r ~ '' 372' H. __ X 902.9 ~ ~ I~.L ~ =884.50 895.00 80.1 96.5 X Q,~g A - 891 X (1 .9 C) N X 905. MIN. BOIL NG / ~/, = 89~, % 905.6 X 7.7 ~'S _ 3 © ~ (' X ©~ ~ 895.2 Q X .9 z © 2. C ~' / " (.3A • ~ 8• ~ . ~ © •,, 1 . B DI G 907.4 ~ a E =8 8 3.• • © 6 - $ • ~ ( d 896.3 ~.-- , ~ ~ ~~~/ , ~ .\ • ~ V1 9 .1. ~~ 3 3 ~ 8 ~ \ /~ . ` 882. • H.W 880. ~ ~ < ~ ' ~X \ X •880.3\ ~ \ 873.0 ~ / 893. •- \ • ~ H.W.L. = 882.80 \ ~ i Ir , 878.4 ~ j ~ / . ~ .. • ' / 91 6 \ ~' _ _ / / • • • ~ ~ ~ / X 903.2 /~ G s8 .2 fi _ - 887.50 x. _ ~/~/ .5 A • • (1 6 ) x 95. 0 ( 0 8 .2 883.9 ~ H. _ 1 IL G 8 7. UI ~ ~~2n1o ~ 8~ % ~Lo T PL~J ~~ ~ o i ~! OS 6~ ~ T ~ ~P K<,~s ~srn-i~ s ORIGINAL D ~~~~ ~ r a - Wiscaisin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in arxordance with Comm t35, Wis. Adm. Code County > ~, C (' C Attach complete site plan on paper not less than 8 1i2 x 11 inches in size. Plan must f . t BM d'rection nd Page ~ of mdude, but not l~rruted to. vertrpl and horizontal re erence pan { ), i a Parcel l.D. p percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~ ~' ) ~~ 0 ~ ~~ Please print all information. Re "wed y Date Personal infonriation you provide may tie used f 15.04 (1) (m)). G~'(//jjy~-, ~ ~ ~3 Property Owner Location E' ~ i~10 ~C~. T vG Lot S~ 1/4Cu j: 1!4 S ~~ T ~ / N R ! ~ E (or) ~ New Construction Use: (Zf Residential !Number of bedrooms 3~y Code derived design flow rate t-l ~d ~ ~ ~~ GPD ^ Replacement L ^ Public or commercial -Describe: ' Parent material C1 V 1- Wdti,$ ~ ~ Flood Plain elevation if applicable ft. General comments S`L.S t.~~''l ~ ~ ~- U f ~ p ~~ ~~ Lvt..~., e r- ~'S FS, 3G / .~-G~o , ~ • -S Spa and recommendations: ~, ~ Si ~ a2~~~ 'rr~ ~ l •S-~~i' ~. n ~`~ 3 ~ d- ~~,liJ ~~~ we l f ~ G~Q~~.t~~' ~") Sat~S Boring # ^ Bonng ~-, a~~ ~n 17 ~ _J F'II Vwuuu aunaa.c crcr. ~ i~ ~ u. arcNu~ av nnuuny ,aa.w~ - n~. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Strudure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'EtT#1 'Etf#2 1 for ~ r ( w~c~bl< r C S - f . ~ ~ g' ~ ~ ~- i ( 2~G r c - ;S: ~ 8~ io `~ - ~ ~, _ ,~,, ~~ # ^ Boring „J ,mil F'Ii V~wnu aw ~aa.c c~cr. - ~a. vcNu~ au ~u~wm'y wa.aan ~.~ ~- u~. Sal Application Rate horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPblftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#I 'Etf#2 o--Z ~o r 3 2 - r ~ h w- ~ C ~ ~ ~ S- ,~ Z 2- ~ ~ ~ ~ - ~ k IM~r c S - ~ , ~ i~ ~cx~ , o y ~ - S a i/~i l -- - , 7 ~ ~ , Z ' Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mglL ZIl3--fro ~'~' ,s'f- Sowterse~' (~.~ I $~to2~ Property Owner's Mailing Address ot~ Block # Subd. Name or CSM# ~ L~ a e ~ . . ~; S -~ I< ~ ~n s ~s ~~ ~~S City State Zip Code P p6N, NG OFFICE ^L~ ^ Vllage [Town Nea~e~t~Road o ya( c ) v ~o l~.cK~f oar. ' Effluent #2 = BODS < 30 mg/L and TSS _< 30 mglL ~ CST Number ~------~ ~S'.3 30 9 Date Evaluation Conducted Telephone Number I- I ~- 0 2 1,1 S' Z4~ yv© ~ •, a , ,, ,. Property Owner 1 C' S~ Paroat ID # (~ ~ o Page ~ Of U Boring _ ~g # [~ Pit Ground surface elev. ~~ ~~' ft. Depth ro limiting factor i ~. ~ in. ~ gpP~tion Rate l t C SCxiption Redox De Texture Structure Consistence Boundary Roots GPD/flz Horizon I Depth in. o- z or o Dominan Mansell ~~ z , Qu. Sz. Cunt Color ~ Gr. Sz Sh. ,~ K fr C S ~ ~ fi 'EtT#1 , s 'Eff#2 ,~ - __ r wta K __~ ___ _ ; ~ _ Z i ~ - ~ ~, ~,~ S .f~~ S ~ ~'~ ~ ~" ~(• - .Sates 2 ~~ ~ ~f 2'~• ~~ # ^ Bonng ^ Pit Ground surface elev. ' ft Depth to limiting factor in. Soil Application Rate t C l Redox Description Texture Structure Consistence Boundary Roots GPD/ft~ Horizon Depth in. or o Dominan Munsefl Qu. Sz. Copt Color Gr. sz. Sh. 'Eft#1 'Eft#2 ^ Bonng # ^ Bonng ^ Pit Ground surface elev. ft. Depth to bmiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Mansell Qu. Sz Cont Color Gr. Sz Sh. 'Eff#'I 'EfffE2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 =GODS < 30 mglL and TSS < 30 mg/t The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in as alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. sso.ssw ~e.o~roo> ,~ PAGE~OF 3 NAME 1.0.5 ~ LOT# g LEGAL DESCRIPTION SE. ~ ~ i4 ,~ ~ I T ZC1 ,N,R, (Cl E(or~ SCALE: 1'"= ~~~ BM I ELEVATION lG(~ ~ ~ BM 1 DESCRIPTION,, i' ~ ~ /t I a " ~ ~` riQ BM 2 ELEVATION /Q C7 ~ ~) BM 2 DESCRIPTION I~cr ~` C c •'~ ~ ' [~j~eb(v I i SYSTEM ELEVATION ~~ ~ `~~~~ ~c~„s~r ~ ~' ALTERNATE EI-EVATION ~D Sl ~, 3U ~w z r Flo . ~ a CONTOUR ELEVATION ~~j', Sc° ~ `~Z• 5 L e 1 ,~ i - ~ ^- XU ~ SIGNATURE ~~ _ ~.~''~~~. _ DATE ~ Z (~ - C3 ~ y • ~ _ ~~, ice" ~.. ..._ x x ~~~ X -..• K ~ ~,~~ ~ r. ~ ~ ~~ ~ ~~ ~ ~ ~ Z r~ ~ ~ tso x _ _ O ~'~ '. -r, I ~\ ~ ~ J / / •~ -- W _. ~ . ~ - _ n _ __ -, ., ~,.,; ~ A .... I ~~ , ~_ X_. MoD ~~~~%`~,~', ~ / , // i ~~ ~ ,/// -- ,, _. .. ~ ~ ' - - / - .~ ,~ `, /~ ~,' ~. ~ - ~~ n -- - - / ~ ~ . ~ - _ _ . - - ~ '. u~ ' '" ~~~, %` i OAS ~. ~', ~ ~ ~ ' ~~ ~~~ ~~~~~~_ ~ rr ~ ~ D :- w ~ , / _ ~` I~ / ~ ~,~ . ~;:~ ~ ~,!.1 ` }} 1 .I 1~ ,, i~, ~.~i ~`~. ~ . ~ ~~ ~'\1( ~, ~, \ ~ 1 ~/ ~/ ~l i I i~ ~ ~, I ~ ~~ ~ ~ / 1 ~\ ,. i. ~ ~ '~: I ~~ I , ~. ~ ~ 't ~' ~ eel C~ I ', 1 ~~ a ~~) i ,~ I ~ . i ~~~ ~ '~i ~` ~ ~ 'i~ ~.; I I 1 I~I~ ~~ ~J /~, 1'\ ~Q `\, r 03/04/200 22:48 FAX 17152x52592 TLSINZPLUMBING __ f~J02 U1~1G~GL~,U'J 1J. JJ cu~iYrn~Lri~ ~ ~~'~'+'-'~~'-' . l ~~ ~''~ ~ SOIL EVALUATION REPORT °'~J--°-i ~ ~.r1a ~~ ~ ~m~• ,~ emirs 4 ~i a~ ~~ ~, ~~ ~ ~,QSe es. ~, /~. Gads Camel ~~ _ _ '~~ ~ f Q /~ ~~ i O~- ~ ~ not ie~ ~+ snde~~ ooira (~). Por- ~ aesrs v ~' ~- end ~omr~ s+a ~ d n~ tone. ~O ~/ ~~se~c P~ pliritalllyd°r'nab°A' ~ .~' i!~~~Zl~i,,2d i ,s,ar~a"v 3 0 ~~ ~ a~ ~,~ ouf~, comas m+r~ 5 ~~, ~ .~ ~~ FieQa ~ OC~etir K tip ` r IZD l02. N oertera t ~ ~ ~d~~ X20 Sty c e~t,aan ~ cvolR Cir. St 5R '9Ri 'F o~ r CS ivf • ~_ 2 v~~, ~ ~7 I, -- -- -~~~e ~e.. ~ .m.,.r,/i 2~~3 64 N` 5'~: Somerset LJI S'Vo~~ ~ ~~ 1N~ 1i4 S ~{ T Z~1 M R ~~ Ef 91odt ~ Suhd Nstre s GSMi E G j~-b,c K e y of r. f~ Gu.e- 0 I c ~ ~ ~ ', case m+~ e~ ie. ~ NCO - O ~ ~D - B p~dOratdal t Iriwha d Modtm+~ / . , _ ~ , ,fi }~~ ~ P ~~ Lalyetr ~F,~ NQ~-~~~~~,~3 S. ,~' 5 e ~ ~ . 1~ lL4~ D~~ ~~~ x~ ~~~.. ~~.~,.9y;~ . Flae~ D~ Ton ~ Qu. S. Caul fdrll ~....e s,sraea dr+v. 4 ~ Sa r< ~"~~- d2 ,., _..~ ~.n.~s < ~o ntaA. Z~S LV ~ yoc~6 ~O~y~4/~2003 22~48~ FAX ~~7 ~5~2~'5,~2592 ~~~~~~ TLSINZPLtTMBING ~-- Parm! w ~ /o f O v,ooers acre ~-z, ~v;n~ ~ ~ ~ d~.~e s~+~+~ d,.,~ ~ ~ e'n+~'Irq Facer ~.~-- "'. ~?~ 7etttQe Sluesue Ca+siste+Q Bard r+~n O~ panisd Gra itaara ocafpt~ ~_ SY. SA. _____ r s a- Z -~ Z K c r~ ~ c:z~ ,~`- ~ 1,K CS 'G ,- o S '. U n_~2 ia.,r ~!G D 9ai~o ~ ~ ~ 9 G~o/b s~ataQ eM~. ~ D~eP~` tq fn~np fmdof .._.~~~ _~]03 • ~I .~ ~~ •plsl 'E4R ~ 5 •~ ~~ ,~ 7 -, Z • EMreM !R ' B OO, c 301ngA. and' T5 S < 30 m9lE EPy~t it = B4ds ~ ~ ~ ap ,~ aid T5S >30 ~ 150 myl. rnma senitx ~idR.od couployer. If you nerd e.~statKt to a~ aes~ rr the D~°L of Cotn~c is as equal °PP° y ~ d eQnmt al (p&2663151 or TTY 608-26~-8777_ ~ ~raiel in as a]1c7s~are form[, plcasc coota+-'t ~ smR~ ^ BoITiO * ~ ~~ Cad s+siaaz elQr. tL OsDtl1 to IineQtq fac.~an _--- R` Saul - Rtile ^ Rr GppAP 7estvie 5-uca+'s t;,~saa~+~ Baund~lr Rmt9 FloiQe Ot~~ R>ro~+t G~ Redo= Do~o~t Gr. St. SA- •Et~t •~l b. 1~0 (b. Si CoAI Gdor 09/~J4/200a 22:48 FAX 1715252592 TLSINZPLLTMBING tlll1D/x^1703 17.» GV1~`u+rtC~.~ ~ ~ ~.~uauc~u ,~ - Pa~r~oF 3 I ~ ar.r ~ 1~6 ~!O " ~a t r~vAnorr /oe . o BiL 1 DFSQJPIION ~ 1 ~ A ~ a'' ,~ B~ 2 ~.EYATION 10 0. O BL[ 2 D~Ipf70N flu • ~ ~ ~ ~ ~' ~la~ P~ nt. SYSIF~t FZENgTION ~i~l30 L*u~• ®g' ~ ACTf~YJA't'E ELEVAT]OTl~g 7 3~ ~u~ r X~ 3a CONI'OLTg F1E1~ATiON_ q~! Sy 1 9 Z. S~ ~./~/~~v _~J04 s~ N1/4 CORNER ~ p R E L I M i NARY PLAT SECTION 1 t ~ LOCATED IN PART OF THE SW1/4 OF THE SE1/4 ST.CROIX COON ~~/ p ~ /~l ~7 Z j X 884.4 '~. ` ' ~ 879.2 X ~~ i (E4EV. = 1 902.9 ONED AG- .5 ~X 886 X .7 Feb 28 03 11:07a Chad Bleeker 715 381 8296 p.l 0?/^c8F2~3 11:14 EDiNRREALTI' ~ 93818296 NO.B33 D02 Feb ,28 03 10:1za C-+ap Bleeker 715 361 8296 P•2 .~ut+ xca~.cinr 1718)?96-25I9 p• t ~'eb 26 09 Os: l 1 p ~ ~O~ CO1A't'1'Y~~ ~PTiC TA~1K &fA]Nti owN ~~rJG-T[~1 Foy pwner18a71Q ~` ~ ~~ ~ ~~ eo -~ a~~ ~' w, sue. ~.. '~~ *xai.!Q w. T°"'° ~ o~d~`~ lpealioo ~ yy ~- I,ot # ~~. Voltt>~ . ---^^' PMT ~ ~~, C $tu+~- iN~P ~ psae M ~-------' w.e.~.uq- ue~ >f ~a~m(~ t,oi ~ `~ ~ ~' ~ spy _ ,~.~,N °aeats ~~of f1e ~ ~`e~ S telol~ sM/~ i ~ ~ ~ taat~ .~ 4Y m0 °'r°ee o°d by • ov dfiia ...~t• mti~° .ts~~l ~ eo 9t ~ ~'°` ~"~~ . ~ ~] of siud[ .~ °'rae`t~r~ ~~~C`~~islmsth.s .. ~dimnatt~A4 b is paooaro~ ~ ~~ me ~b ~'°_` `~ Ccrtifiatioe `~~~.~e.oe~i~~'~MIb~Sr.Otela tal _ ~,+~ ~ ~r/data DA~~j~~~~"J Vow ..._~ J i'~oN ~ ~,s best a~ w (~1 eu au.~eots oe tt~ [ottu tat ten. of p..~ otfiee. -- - a- - --• reed uccot0e0 m 1(ye) a (ata) the ma(t) of HATE ~ Cam, ...... 'fi3ltt t y~ ~evolm0 by tae Z~a.~ot DaA"msa°t" ... " o t1~t k ~s-RPns~d°sY te'°°1t is 1i~s aaw-ew Pea9tt tawt•de wt~ eta n~ ~ oo~ade e~na'Ge~w.~ ~ tt.e~w' ~~ ...n+.tr /e.o /~ rn e wcndlue~nu ..~.. . Owner ~rl~~- 7S(v 'Permit #t ~ D ~ '1 DESIGN PARAMETERS Number of Bedrooms ~ ^ NA Number of Public Facility Units $NA Estimated flow (average) O al/da Design flow (peak), (Estimated x 1.5) S~ al/da Soii Application Rate ~ al/da /ftZ Standard Influent/Effluent Quality Monthly average` Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (RODS) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBOD51 530 mg/L Total Suspended Solids (TSS) 530 mg/L ~1 NA ~ Fecal Coliform (geometric meant 510° cfu/100m1 . Maximum Effluent Particle Size Ye in dia. ^ NA Other: ^ NA `Values typical for domestic wastewater and septic tank effluent. ^~AI\ITC\IA\If~G C/~L1G~111t C ~POWTS OWNER'S MANUAL & MANAGEMENT PLAN SYSTEM SPECIFICATIONS Page of Septic Tank Capacity ~ al ^ NA Septic Tank Manufacturer iT ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model lQ,Q ^ NA Pump Tank Capacity al '6rfdA Pump Tank Manufacturer ~8'MA Pump Manufacturer 'f~NA Pump Model ~ $'NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ~ ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Cellls) ,~'In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ in-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA IYIMII\ 1 L~\fV ~ V L. vvl ~~./v Vim. Service Event Service Frequency Inspect condition of tankls) At least once every: 3 ~ ear( -1s) (Maximum 3 years) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY,1 of tank volume ^ NA Inspect dispersal cellls) At least once every: 3 ,~ year( )Is) (Maximum 3 years) ^ NA Clean effluent filter /~~-~.A At least once every: ~yea~is)(s) ~~ ~ ^ NA ^ month(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^ yearlsl Flush laterals and pressure test At least once every: p year) 1(s) ^ NA Other: At least once every: ^ month(s) ^ year(s) ^ 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 tankls) 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 cellls) 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 ode-third IY,1 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 authority within 10 days of completion of any service event. ~' ~ f ~ ~ Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that tray impede the treatment process and/or damage the dispersal cell(sl. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. r. 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 dispersal cellls) in one large dose, overloading the cellls) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist~in manually operating the pump controls to restore normal 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; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the 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 all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ~A suitable replacement area has been evaluated 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. ^ 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. T e s' has not evaluatef~-t identify astable replace t area. on failur of he PO a soil n site ev I atio must a pe orm~~o to teas 'tab' le ~eplaceme ti are If replace nt area ' vailabl Iding ank C may be in tal as a las -resort to rep failed i~J~ ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. wnnlTl/1111A1 f~A11AAACIUTC POWTS INSTALLER Name ~,,. $~,v ~-Sb• NL Phone ~~'„ ~s"~ ~(~ nAU/TQ ^AAt1UTAt1000 rv~^ ^v . Name (~ ~N Z ~!~ y'l/L Phone S= Z,3 $ ~ Z(p t~ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name S /~' ~~ Phone ~(~•-- ~8'(p-- This document was drafted in compliance with chapter Comm 83.22(21(b)(tlldl&lf) and 83.54111, 12) & (31, Wisconsin Administrative Code. Y ' I STATE BAR OF WISCONSIN FORM 2 - 1999 - Document Number WARRANTY DEED TIIis Deed, made between Wallace L. Billy, a/k/a Wallace Lee Billy, a/Wa Wallace Billy, and Katharine M. Billy, a/Wa Katharine Billy, a1k/a Katherine^Billy; ht2sband and wife, __ Grantor, and Kernon J, Bast and Donalda J. Speer-Bast, husband and Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): SWI/4 ofSEli4 of l 1-29-19, EXCEPT South 198 feet thereof, St. Croix County, Wisconsin Recording Area 630707 YA'THLEEH H. WALSH kEGISTEk OF DEED5 ST. CkOIX CO., WI RfCEI4ED FOR RECORD 09-28-2004 9:15 Ail WARRANTY DEED EXEMRT 11 CERT COPY fEE: COPY fEE: I3So•oa TRANSFER FEE: RECORDING FEE: 10.00 RAGES: 1 Name and Return Address ~~ C_ ~n t nt ~ an ruin Parcel Identification Number (PIN) This is homestead property. (is) iF8~00 Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this ~ [ `~~ day of _ August 2000 AUTHENTICATION Signature(s) Wallace L. Billy, a/Wa Wallace Lee Billy, a/Wa Wallace Billy, snd Katharine M. Billy, a/Wa Katharine Billy, a k a KatherineyBilly, husband and wife, authenticated this day of -~jlU ~- r Kristine Ogland + Wallace L. Billy, a/Wa Wallace Lee Bill , a/Wa Wallace Billy • Katharine M. Billy, a/Wa Katharine Bi111 , a/k/a Katherine Billy ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. County ) Personally came before me this _ day of the above named TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If nnt, instrument and acknowledged the same. authonzed by § 706 Q6, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland Hudson, WI 5401 _ (Signatures may be authenticated or acknowledged. Both are not necessary.) + ----- Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: _ ) i~ • Names of persons signing in any capacity must be typed or printed below their signature. traom,ation arofessionai. compMy, tone au tx, vn STATE BAR OF WISCONSiN 900~ass-soar WARRANTY' DEED FORMNo.2-1999