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HomeMy WebLinkAbout020-1400-11-000Wisconsin Department of Commerce ~QJ~~ PRIVATE SEWAGE SYSTEM Safety and Building Division , • / - ~ ~ ~~~ e-~.~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 0 Personal information you provide may be used for n ary purpo~es rivacy 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 Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 1~ 2.15 ~ 2 5b Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ t ,~(~ Z ( / ~~~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacture Demand GPM Model Number TDH Lift Fri n Loss System Head DH Ft Force in Length Dia. FOIL ABSORPTION SYSTEM~I~)~~j~¢r5 ~-~~~,t~ ELEVATION DATA County: St. CrOiX Sanitary Permit No: 430095 0 State Plan ID No: .~~ --+ Parcel Tax No: 020-1400-11-000 Section/Town/Range/Map No: 11.29.19.2501 STATION BS HI FS ELEV. Be hYmark ~ 2.J1 ~, S ' ~ • 0 r Alt. M Bldg. Sewer C,~~ .~ i 99.2.2 SUHt Inlet p, ' ~ . ~~ SUHt Outlet (~ , [ 1 ~ T 1 ~ g ~p ~ Dt Inlet Dt Bottom Header/Man. ~ • q 0 I ~ Dist. Pip ` //~II,,----_ , Bot. System .I~ 'p •~ • 3S" ~ Final Grade S•~.p (~ l s I ~1 St Cover /Q~ t ~ ~'tJ 1 ~ ~ i o 'aV 13~'~' r~ a 3.3 ~~ • ~ t BED/TRENCH Width t Length No. Of Trenche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Z t q~•~,S ~~ Z~ SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manu ct -i:' _ C( A~ b ICI" .JT'~"~4~ Type Of System: r / m > ~~ l UNIT Model Number. I/ Zo t s / ~ . DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing to Air I k~ Pipes , Length Dia Length Dia Spacing ,`(~ J' r SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only `~ ~S'~ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil n Yes ~l No ~ irk Yes r j No COMMf STS: (Include code discrepencies, persons present, etc.) Inspection #1 ~~.~/f_!~-' Inspection #2: --'7-T""~ Locatf6n~!' 772 Packer Drive Hudson, WI 54016` (SE 1/4 SE 1/4 11 T29N R19W) Hopkins Estates Lot 11 Parcel No: 11.29.19.2501 1.) Alt BM Description = ~ 4' ~ • """a''~~O`4 ~p"~~, 2.) Bldg sewer length = --Z,.~ r -amount of cover = ~ $ it4„ . ~,; l ~~~.~ ----- -- - - --- --- - - J -- - -- PI revision R uired? f~ Yes ^ No ~ ~ 3 I ' ~ Use o ide for additio I ~or of r~ !.-__ I' -- --- -- ----- --------- --- - -- ---~ SBD 710 97) ~ S~~ ~~/~` ~~/. Date Insepctor's Signature Cert. No. f'rtwPS~~ii r}~ r~4~J'~( JMAM Z8~ Z~o3. Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 County /~ ~ ~~S~o (/~ ~ ~ ~~~On~~~ Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (608)266-3151 oOq k Sanitary Permit ApplYCatYOn State Plan I.D. Number .. _____ personal information you provid Adm. Code 21 Wis 1n accord with Comm 83 , . , . may be used for secondary purposes Privacy Law, s15.04{t}(m) ~ Project Address {if different than mailing address) a I. Application Information -Please Print Al] Informati ~ 7~ Q-C /~.~ y DY Property Owner's Na me ~ ~ ~ ~ ~ P eel >y l ~~ Block k M ailing Address 's Property Owner ion roperty Loca p / ~~! O ,~ d 6~¢.Y •~ ~ t 2~~k,Section ~~~ ~~', City, State Zip Code Phone Number ,. „ ~CL~Sd-~/ ~ ,~`t~4/ 6 {circle ) T ~9 N; R ~~ E o~ { k all that a l ) ildi f B h II T pp y ng c ec . ype o u Subdivision Name CSM Number ~ 1 or 2 Family Dwelling -Number of Bedrooms ~y ~ ~ bliclCotrunercial -Describe Use ^ P ~ ~ -S u ^ State Owned -- Describe Use C2~ 3 [ K ~ 3 ' S - l / ^CiryJ^Village~Township of a- oeS'G~ ~ III. 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 Renewa] Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Dace Issued Before Expiration Plumber Owner ~ 30095 J~.Z3t ?.ll~ 3 IV. a of POWTS S stem: (Check al! that a 1 } -(~ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soli ^ Mound < 24 in. of suitable soil ^ At-Grade ^! Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized Tn-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Fitter ^ Rectrculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Grave]-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (s System Elevation ~s~ ~ ~~ Sd VI. Tank Info Capacity in Total Number Manufacturer Prefab Concrete Site Constructed Steel Fiber Glass Plastic Gallons Gallons of Units New Exis[ing Tanks Tanks Septic or Holding Tank r~/ /~ ~~C~ P~s~ ~ ' ~ ~p y Aerobic Treatmen[ Unit Dosing Chamber VII.' Responsibility Statement- I, tht! tindersigrted, assume responsibility for it allatian of the POWTS shown on the attached plans. Plumber's Na me (Print) ~ Plumber's Si gnatur P PRS Number Business Phone Number 4 ~~`` (~ s ~ ,S`c /~ a rn .c 6ley ~ ` ~~ a? ~ 7 ~'~ J' ?1.~~'.~~G'~ ,~ 102 l Plumber's Addre ss (Street, City, State, Zip Code) / ~' c ~ ~d.s`o~l GtJ < ` ~ y ~ VIII. Count /De artment Use Onl +~Approved "'~ ^ Disapproved Sanitary Permit Fee 'eludes Grourxlwater Date Issued su' g Agent Signature No Stamps) / - Surcharge Fes) ~ ~,_ ~/~%~ Gb ^ Owner Given Reason for Denial J J h easons for Disapproval va l / IX. Conditions of App ro R ~ Q Q ~ S t, ~'~ ~_"""~' 'J`am SL~~ ~ ~ . ,. l [ SyS~ q,~; - ~ . ~D tQ ,n,t~- ~ err. ~ C.~ ~--,~) ~ f Attach wmplete plans (to the County only) for the systom on papor noc less titan atrc x u u,cnes ,,. „~.: SBD-6398 (R. Ol/03) ~~PYiV.Oa/ ~GL ~ ~ L ~ ~~1~D.f7fS ~g ~~ ~BGo.y 4 ~ l°~G~/~4e'..t/ i i ~ ~~ ~~ ~~ v ~~ ~~ ~ ~ g ~' ~~ / ~~ x~ m ~° j~eks~ r $~ ~ ~.` s ~~~~ ~~' _~ Co- d Sc ~.C ~ ~ ~~ Y~ w~ De~~ent ~ SOIL EVALUATION REPORT Division of Safety and Buidings in aooordan~ wipt Comm 85, Wis. Adm. Code { ~7 County _S~/ (. ly~ ~ q~qr ~ gibe pien on paper not less than 81/2 x 11 ~ duectbn amn t Parcel ID. inchrde, but not Ihnf6ed ro: vertical and ftortzorrlai reAerence pokrt ( ). pertasnt sbpe, scale or ctmensions, rrortl- anow, and locatbn and distance to nearest road. ~ please print ap inibrmaHon. .` Peraoael inrolma0on you provide may 1» used fw secondary WMP~ (Pm~1' Law. s. 15.04 (1) {m)). propertyOvmer ~~ yrro,v ,~Gc.s~ prop~tyLocatbn qa rV1 , ~~. ~~5~,.~ G Govt Lot S~ 114SG1(4 S Il Ta Lot # Block # Subd. Name tx CSM~ Page ~ ~ Date ,, / ~Zt~ D N R /y E (or~ property Owners MaiBng Address / / ~ ~ ~ . ~ ~1~5 ~6QY ~- ~~ City S Zip C/ode/ Phone Number [~ City ^ ~pa9e ®Tovvn Nearest/Road f New Construction t>se: ~) Reside,rdal t Number of bedrooms 3 ` `!' Code derived design flow rate y.$-U/G d d' GPD Replacement ^ Public or commenciet -Describe: /f ~ >~-t ~ a S G~ Fbod Plain elevatbn d applicable ~/ / ~- ft• Parent material ^. ` ` ---,-} a~rid~recommendations: S`/S ~~,,•~ e~r(/e 9~. s V ~ a o 'q Boring # Ground surface elev.d ft. Depth b tfrnitlrig facLOr ~~ in. Soi lion Ra ® Pit ~t Bounda Roots GPD!(t= Horimn Depttl in. Dominant Cobr MunseU Redox Description Qu. Sz Cont Cobr Texture Structure Gr. Sz. 5h. ence Cons ry •ElfilJ?1 'Eff#2 o ~ / 3/Z - ~i~ ~ mfr CS /v-F ,s •fS 3 G ~ -~ ~>.~r ~/Co - S ~s i~ r - > ~ / Z 3•`fs-' ,, q 2 ® Boring # U Boring (~ ptt Ground surfaceelev. / ~ OQ _ ll. Depth ib Hmitmg tacbr ~ Z ~ in. Soi Uon Rate Horimn Depth Dominant Cobr Redox Description Texturo Structure Consistence Boundary Roots GPDlltz in. Mansell t1u. Sz. Cont Cobr Gr. Sz. Sh. 'Eif#1 'Etf#2 Z 6-l~ it 3 `~ 3/z ~ v y~ `- _ S,/ s, Z n'tS r ~r ~, CS ~. ~ -~ ~~l ,- - ~ r5 ~ y ,~ • ~ l 2. ~ .~ _ ..... _ _. nn , ~n ...n e...1 TRQ c 3I1 rnaA_ • Effluent tt9 a 130U > 3D < rxr my/l arlo l a> >n+ ~ ~ ar +.y.. _ _ _ _. _ _ _ _ _ _ CST Name (Please 1~) j,JSignature !••--~ CST Number S i/ -__' Address Date Evaluation Conducted TeN~te Number Part:el ID # Page ~ Property Ovmer ^ Boring a # tt. Depth ~ facEw ~. Soil Ra ^ Pit Ground surface elev. _---- ~~ Oep~ ~~ Cobr Redox Texture Stnrcture Consistence Boundary Roots GPD1fPE~ in. MunseN Qu. Sz Cant Color Gr. Sz Sh. ^ Boring # ^ Bonng Grorsrd.surface elev. R. Deptfi to firtriting factor in• ~~ lion Ra ^ Pit Hor¢on Depth Dominant Cobr Redox Descripl~ Texture Structrrre Consistence Boundary Roots GPDIIt? Gr. Sz Sh. 'EtT#1 `Et#k2 in. MunseB Du. Sz Cont Cobr Boring ^ Bonng # Ground surface elev. ft_ Depth to luniting factor in. ^ Pit Soi tion Rate Hor¢wr Depth Domtrrant Color Redox Description Texture Structure Consistmrce Boundary Roots GPOIft? Gr_ Sz Sh. •Eff#1 'Etl#2 in. Hansel{ Qu. Sz Cott Color • E #1 =GODS > 30 < 220 mgiL and TSS >30 <_ 150 mglL ` t~fluent #2 =GODS < 30 mgll and TSS <_ 30 mglL The Department of Cornmerce is an equal opportunity servue Provider and employer. If you need assistance to access services or nod material in an alternate format, please contact the departrnent at b08-266-3151 or TTY 608-264-8777. SBD-X1301R.W/OIp PAGF,~OF 3 lvt~mn J-aSG i~ n y LOTS l ~ I EGAL DES vC,'~ rnt~T ~ f S T .N.R. E,(or)W L scALE, i" = y~ BM i F~,EVA'TION 100 ~ ~ _ HM i DESCRIPTION ~ ~ r~dv ~ ~;, f~~ BM 2 ELEVATION -` BM 2 DESCRIPTION SYSTEM ELEVATION Q~, -~~ SYSTEM TYPE (~ o n v-~ n-~~ ~ ~ °`~ CONTOUR ELEVATION 9 ~ .v G ~- ~~ ~ ~' ~~`o~~`fi,°~ ~~ ~~ ~~ ~~~~~ I ~' ~~ . ad ~'1 ~z~ ~~S ~t:~ ~ cs' ~~ 0~~ B~n M~ SIGNATURE .~ ~~ DATE ~ Z~ a ~ ~ Safety and Buildings Division County r S~~ L I 201 W. Washington Ave;, P.O. Box 7162 - YC~ C J ~ ~ ~~, Madison, WI 53707 - 2 Sanitary Permit Number (to be filled in by Co.) ,~~ ~ (608} 266-3151 ~~ 9~ De artment of Commerce Sanitary Permit Application Stag Plan I.D. Number . personal informat' ~ ~'~~~ Wis Adm. Cade In accord with Comm 83 21 , , . . may be used for secondary purposes Privacy Law, s15. 1)(m) '"-- Pr 'ect Addtess (if different than mailing address) I. Application Information -Please Print All Information ~ ~ ~ ~?, ";~,a~i~ ~ 6 ,.. ~ ~~z P~~~~ DR . Property wner's Na me ;~~~ Pare ! ~ Lot ~ Block N x ~ ~1 . Property Owner's'M ailing Address ~~ ~~ ,~~ / ~~g~!'c I G` Property Location . 0 .s ~ !4 ,~~ eation ' Cit ,State J,`` / Zi C e Phone Number (circle T ~ ~ N; l9 E o~ (check all that a ly) . ~ e of Bulldin II „"~ s pp . yp o•e ~ ~ Subdivisio me CSM Number ~1 or 2 Family Dwelling -Number of Bedrooms Public/Commercial -Describe Use ^ ~ ~'''v~ T . ^ State Ownal -Describe Use - ^ _^Village ~!'owtuhip of~~~ III. Type of Permit: (Check ogly one n line A. Complete line B if applicable) ~ - I tf t~ - / - Ot3D • ZSb ~ A' ~ New System ^ Replacement Syste ^ TreatmendHelding Tan Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ange of ^ mit Transfer t ew List Previous Permit Number and Date Issued Before Expiration Plum Ow r IV. T e of POWT5 S stem: {Check all that a l ) ,Non -Pressurized in-Ground ^ d > 24 in. of suitable soil Moun 2 , of suitable soil ^ At-Grade ^ Single Pass Sand Filter ` ^ Constructed ^ Pres In-Ground ^ Holdin~nk eat ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recircuia ' Synthetic M r ^ Leaching C mbar ^ Drip L' Gravel-less Pipe ^ Other (explain) V. Dis a /Treatment e f tian; Q a- rn -- 2 ,neat 3 x 3• Design Fl (gpd) Dest te(gpds al a re Dis al Area Proposed (sf} System Elevation ~. . '7 ~, ~ ~q. Sa VI. Tank Info apa cit Total bar a rer Prefab Site Steel Fiber Plastic G nits Concrete Constructed Glass ew ' iln asks Septic or Ho1QinII ~l f ~ ~ ~ Y Aerobic Treatment Dail ~ /!i-~(OD Dosing Chamlxr ~G rf, VII: Responsibility Statement- 1, the tinder , e o for t llatlon of the POWTS shown on the a ed lans. Plumber's Na me (Print) Flun Sl a PRS Number Busines one Number Plumber's A~ddre ss (Street, City, S ip C 7~ c tT ~ o ~ r " ~~i~Gl~ VIII. Count /De artment se Onl Approved ^ Disapproved ~ rmit Fee (includes Groundwater Date Issued lss in gent Signature o Stamps) Surcharge Fee} ~ ZZS ~_ Z 7~~ ^ Owner Given Reason for Denial (.W IX. Conditions of ApprovaUReasons for Disapproval ~ ~ ! ~~ ~. ~ _ ~J .~ ~ J t G2rX '~ ~' '""""'`~ ~ 1 (lam ~L P ` ~ - wttaca complete pleas (to tno t;auoty only) rot' tao systotn oa paper nor teas rnaa aa~c x sa wc~ca ,., oua ~~ SBD-6398 (R. 01103) x • ~~ , ,, :a- ,~ ~. ~' ~ ~~ ~~ ~ >d '~;: , ~ . r ~4 ° `~1 ~,~I~.y ~~- ~-. ! !' ~ '~ ~k,s ~ $ ~ ~, ~~ `'~~, ~, .. r_ ~ ~.o, / 5~D ~~l,v~,`~ .;~ ~~~~~~a,1GO.d ebb ~~ ~ ~o ~b~ .U ~~ ~} ~~"` .~~ l~~ , ~a ~~ ~~ i / M' ~~ U s e s~ ~\ ~aa~'e ~~~~ ,~ ~~, C^ C Q ,~' ~: y ~... -,., ~~.,' .. rT .~ • l~. N;v~ "~ r~ ~~ ~~ ,~;, f~k~~ ^~,~ ,~3~-~ `~ - -s~%f ~'~ /~ sc ~ /1 ~ o~~il~p~f .;~' ~.s-~' ~~.s..~/ 5~~~.~. i "- yo ,fly!/.i,o.`l ~;cl ~~,,~,e/,~~~160.d ~~.`1.:u3`;Ds~.,C ~.C Qy l0e d ~b~ ~~ ~ ,~m~.U~ G~/~.~~'- ~~,0 -~~"~ `yam ~,2 ~ X90 6~1~~0..3 ~~:~ ~ ~~ } o. a. R ~ F. r ~ ~ :~ Y ` ~.,-~ MK1,. i 5 P Y 7. J~ t 1 4. ... ` ~ r ., ti •' w M'•? ~~ b. .. ~• -,~ M s SEPTIC TANK ~ `r'LMP C;HAM?EFt ~ CKCSS SECTION Ar~D S?LCZFIcaTZCNs 4" CI VENT PIPE 12" MIN. tiBOVE GRADE ~ JUNCTION OHOX APPROVED >_ 25' FROM DOOR, WINDOW OR WITH CONDUIT R W ~pA p V FRESH ASR INTAKE ~ / , LOCK - -WARNING LABEL FINISHED GRADE ~ 4 " C I RISER ----- _„_} ~_, ~ 14 MIN . ~' f NLET .~_ ' `~ i WATER TIGHT SEALS ~ , i S GAS ' TIGHT ~ `~ PPROVEd p SEAL ~ JOINTS WITH ...3. ; APPROVEd PIPE -PPROVED B ~ ~ 3' ONTO 'IPE 3` '"~"" ~ SOLID SOIL DNTO SC}L I d TOIL PU OFF ELEV . ~ ~'T. i OFF ~"~ RISER EXIT PERMITTED ONLY D I F TANK MANUFACTURER HAS APPROVAL 3" APPROV BEDDING UNDER T CONCRETE PAD SP FICATIO SEPTIC / DOSE TANK MANUFACTURER: ~/o~~s~~ BER DOSES PER DAX: Z'ANK SIZES: SEPTIC ~as"d GAL. DOSE ~_„_ 6AL. ALARM MANUFACTURER: MODEL NUMBER: SWITCH TYPE: PUMP MANUFACTURER: ____._ MODEL NUMBER swlTCx TYPE: REQU"RED DISCHARGE RATE VOLUME INCLUD~NG FLOwaACK: _1~ 9~ GAL. CAPAC~ES: A = ~~ INCHES = _,,, ~I,~1 .GAL. B ~ 2 INCHES ______ ~' INCHES GAL. (G~$ GAL. D INCHES = _l?,(' GAL. i GPM PUMP ~ ALARM WIRI AS PER ILHR 26.23' wAC VERTICA L DIFFERENCE BETW 2 + MINIMUM NETWQRK SUPPL + ~ d ~ FEET FORCEMA INTERNAL DIMENSION OF PUM? TANK: LENGTH --- 3 WID1H LIQUID ~r3~"~„~1~/~O.~v l SIGNED: ~/,,, %~ ~, ~~ LICENSE NUMBER: ;T~7l~D'---- DATE; "~ ~ Q3 N PUMP OFF AND DISTRIBUTION PIPE 1 FEET PRESSURE FEET X ~.GO FT/ 10 0 FT . FRICTION FACTOR 7 FEET TOTAL DYNAMIC HEAD = FEET 1/8b PUW7S OWNER'S MANUAL & MANAGEMENT PLAN >7a~®~ of ~ ir11.E INRORMAI"1>2N Owner Permit #~ 3~S / ~ pESKiN PARAMETI~i$ Number of t3edrooms ~/ d NA Number of Pubuo Facility units O NA Estimated flow taverage} ~ ~'Q at/da Design flow Ipeakl, (Estimated x 1.5} ~~ p ai/da So& Application Rste slid Iftt 6t~dard inftuent/Effluent tluatity Monthly average' Fats, Oil 8e Qrease lFt3G} S30 mg/L Biochemical Oxygen t3emand IBOt)a} 5220 mpli» O NA Total Suspended Solids tTSS} 6160 mglL Pretreated Efftusnt i&itllity Monthty average Bioohemicai Oxygen Demand IBODs} s30 mmy/!!. Total Suspended Solids iTSSi s30 mg/L ^ NA Fsoal Coliform igeomstric mean} st0° cfuJ100m1 Mexir+num Effluent Particle Sits ys In dia. ^ NA ~~'~ ^ NA °°Values typical for dornsstic wastewater and septic tank effluent. SY$TEM $Pl:CIFiCATIONB Septic Tank Capaohy ,2 ~ al O NA Septic Tank Manufacturer ~ 0 NA Effluent Fllter Manufacturer ~ ,~ O NA I:ffkiant Filter Model Q'J' 0 NA Pump Tank Capac}tY ai DNA Pump Tank Nlanufaoturer reS ~ 0 NA Pump Manufacturer ,~.~.u/ a NA Pump Modal ~ ©NA Pretreatment Unit Q SandiC3ravel Filter D Mechanical Aeration D Risinfection n Peat Fllter ^ Wetland D Other: 0 NA Dttpersal Cents) O In-Grournf (Aravltyi D At-f3rsds D Drip•Llne O NA ~ !n-Oraund ipressurited} Q Mound ^ Other: Othu: ^ NA w ^ NA ~~ 0 NA MA{NTIEIiAMCE •Clil'+.i~18 t ~Wnt $erlliCe FiegYMC'y lr:apect condition of rankle} At least once ovary: 3 ~ s tMaxlmun+ 3 years! ^ NA Pump out contents of tankta} When combined stodge and scum equals one-third l~} of tank volume DNA Inspsat dlapereal cell(s) At least once every: ~~~~ tMaximur-t 3 yeah} ,~ lrf ^ NA Clean sfftusrn fEtar At least once every, mon a1 ;~' rte} O NA inspect pump, pump cantrota ~ alarm At least once every: ..---- m~thte} C{ saris} DNA push laterals and pressure teat At least once every: .--- t3 m u4s1 s} DNA Osf+er: At least once every: „~,. ~ montthls} ^ NA Other: Q NA Ma~+IT~tANC~ IwsTRUCTianis inspeatia~-a a! tanks end dispersal Della shell be made by ansndividual carrying one of the following iiaenses or certifications Mewter Pkrr~ber; Meater Piurnber Restricted Sewer; t'OWTS inspector; POWT'S M+a'snta~er; Septage Servicing Operator. Tanl ir:spectlona moat include a visual inspection of the rankle} to identify any miasins or broken hardware, identify any creaks or leaks rneasurs the volume of ocmbMed sludge and scum and to check for any back up ar ponding of effluent on ~e ground surface The dispersal cstilei shall be visually inspected to check the effluent levels &~ the observatbn pipes and to check foe any pending of effluent on the Around surface. The ponding of atfiuent on the ground surface may indicate a faiiMg conditbn and requires the immediate notification of the boat regulatory authority. When the combined eccumuiation of sludge and scum in any tank equals one-third tYy} or mare of the tank volume, the entin canter:ts cf the tank'sheli be removed by a Septags Servicing Opsrstcr and disposed of in accordance with chapter NR 113 Wiaoonsin Admir-Utrative Code. AI! other services, including but not limited to the servicing of effluent filters, mechanical or preseurlxed components, pretreatrnen units, end any servicing at intervals of S12 months, shalt be performed by a certified POW`l`5 Malntalner. A service report shalt be provided to the local reEulatory authority within 10 days ot` aompletkm of any service event. Page _____ o~ START UP AND OPERATION For new construction, prior to use cf the POWTS check treatment rankle) for the presence of painting products or ether chemicals that may impede the treatment process and/or damage the dispersal celltsl. if high concentrations are detecteel have the contents of the tank(s) removed by a saptage servicing operator prior to use. Mound and at-grads soil absorption systems may be reconstructed in place following removal of the biomat at the infittrative surface. Recartatructions of such systoma must comply with the raise in effect at that time. System start up shall eat occur when soil conditions are frozen at the infiltrative surface. paring power outages pump tanks may fill above normal highwater ravels. When power is restored the excess wastewater will be discharged to the dispersal celltsi in ono large dose, overloading the cellist and may result in the backup or surface discharge of effluent, To avoid this situation have the oontents of the pump lank removed by a Septage Servicing Operator prior to restoring power to the a#fluent pump or contact a Plumber or POWTS Maintainer to assist in manually apereting the pump controls to restore natural levels within the pump tank. i~o not drive or park vehicles aver tanks and dispersal cei{s. Qo not drive or park over, or otherwise disturb or car pact, the area within 16 feet down slaps of any mound or at-grade sail abaorpticn area. Reduotion or elimination of the fallowing from the wastewater stream may improve the performance and pro{ong the life at the F01NTS: antibiotics; baby wipes; cigarette butts; condoms; caftan swabs; degreasers; dental frees; diapers; disinfectants; far foundation drain tsump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ail; painting produots; pesticides; sanitary napkins; tampons; and water softener brine. ASANDONMt:NT When the POWTS fails andlor is permanently Laken out of sen+ice the following steps shall be taken to insure that the svstern is properly and safely abandoned !n compliance with chaAter Comm 83,33, Wisconsin Administrative Cade: • Ail 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 Servicing lJparatnr. • After pumping, all tanks and pits ahaii be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CCNTINpENCY Pt.AN Ii the POWTS fails and cannot be repaired the fallowing measures have bean, or.must ba taken, to provide a cods compliant rsplaoement system: O 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, Eot lines and wells. Failure to p-otect the replacement area wail result in the need for a new soil and alto avaluetion to establish a suitable replacement area. Replacement systems must oompty with the rules in effect at that time. Q A suitable replacement area Is not available due to setback andlor soil limitations., $arring advances in POWTS technotogy a holding tank may be installed as a last resort to replace the faired POWTS. ~~ 0 T $~ alts tank d < <WARNINQ> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL t3ASSES ANDlOR INSUFFICIENT OXYGEN. DO N0~ ENTPA A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMBTANCE8. DEATtf MAY RESULT. R@SCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY Bi~ pIF>:iCtJL.T OR IMPOS816LE. ADDITIONAi. COMMENT8 ' POWTS LN8TAt4ER Name e ~51r~C1 /~•'+ ~w1~G~ Y~ Phone 7 l ^ ~ ~ _ ~ ,,;~ POtNTB MAINTAINER Name Phone SEPTAt3E LERYICINO OPERATOR IPUMPERI LOCAL REGULATORY AUTHORITY Name Name ~.._r___--- Phone Phone This document was drahad In compliance with chapter Comm 83.2212itbf{litdl&{ft end 83.54111, {2i & tat, Wisconsin Adrnlnlstratlve Code. nstnDepartmentotGommerce SOIL EVALUATION REPORT Page~of,~ t7ivision of Safety and Buildings '` in accordance with Comm 85, Wis. Adm. Code County Attach cxxnplete site plan on paper not less than 8 112 x 11 ind~es in size. Plan must indude, but not limited to: vertipi and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and d'isiance to nearest road.. Q ?®'~' /~90 . I - ~~ P/ease print ail information. viewed y /Date Pefsaial information you provide may be used Law. s. 15.04 (1) (m)). ~- G'(,(jl~~ , / ~ 5/ (~ ?j Property Owner Property. Location P ~- r1o a 5 Govt Loi ~ 1146 = 1/4 S~ T 2 N R) 9 E (or)© Property~}Owner's M/Jailing Address `` ~ ~ 2 Q 02 lot # Block # Subd. N~/ame or CSM# (,, f `1 y (,C,c ~G e d , ,~' , , I h ~ /I S f'c.~f ~° S City State ip Code P n UNTY ^City ^ Ullage I~ Town Nearest Road ZONI G 0 FI ~~s~~ (~JI y4 0 ~ ~ ~~rdr^, g New Constnxxion Use: ~ Residential / Number of bedrooms ._ST/y Code derived design ifow rate ~SCJ - (. QU GPD ^ Replacement L ^ ~ubiic or commercial -Describe: Parent material ~'~ V r W C.~S Flood Plain elevation if applicable ft General comments O , 7 ~ ~ / -- ~f I. ~b~ py~ ~,-~~c/ti ~ ~/~S- ~ and recommendations: -S.~.,~s ~~r , ~-~- -rt,e-~ Boring # ^ Boring -_ ~3~- Uil 7 ~ , i ~ _J tQl Plt vwuuu auuacc c~cr. r ~ -~-- - u. vcNu~ av nnnuny ~aa..v~ J • .i u.. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 ~ -I io Z `~ ~ 1 Z~t~bK ~~ ~ I v - ~ , Z _uo ~ - ~ ~ ~ ~- ~s ~ : s , I is - ~ ~ I _ 1-Z ,- o ~ ~ gq ~ ~(~ . `~ 9~ 4~ ^ Boring ~ Boring # •--~ ~ ~J r ~ _ , 7 ~ =~ ~^J Pit v~w,nu ~w~~c cicv.. - ~~. ucNu~ ~~ u~~ea~~y ~a~..w - - "~. Sa'I Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/FtT in. Munse ll Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 j/~~ Z 1V~ 3~Z ~ /~ /\' C S 1/ V a~ V -Z~ - ~ C 5 - ~~ r $~ /- ~ d i G ~ -- ~ -- _ 1 ~a z ~a.g~, ~1 ' Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = 80D5 < 30 mg/l_ and TSS < 30 mglL CST Name{Please Print) Signature ~ ZCST NumO 1~ r ~ ---- Address Date Evaluation Conducted Telephone Numtapr Z t~ 3 ~o t`' ~f 5©wi e ~s-e~- ~ I ,~ y a Z s- ~ i ~- z u) y o e 8- ~~ ~~ i3~ ~ 1` Parcel ID # r~ _ n Boring ~ ., . , - ,~ - A ~ ~_ ~ 3 1 ~ /~ v~,. w.y ., Y ~ - ! v Pi{ Ground surface elev. ~ P ~mi Sorb Application Rate St ct Consistence Boundary Roots GPD/ft~ Horizon Depth in. Dominant Color Munsefl Redox Description Qu. Sz. Cont. Color Texture ure ru h. Gr. Sz( S "Efi#1 'Eff#2 / ~. r ( ~ -1 Ic ~ I - I , Z ^ ^ Pit Ground surface elev. it. Depth to limiting factor in. Soil ~-~~ Rate # ~ i tion D Texture Structure Consistence Boundary Roots GPD/ftz Horizon Depth in. Oaninant Color Mansell p escr Redox Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#'I 'Eff#2 ~~ # ~ Bonng Ground surface elev. ft. Depth to dmiting factor in. ^ Pit Soil Application Rate tice scri D d Texture Structure Consistence Boundary Roots GPD/R~ }~¢on Depth in. Dominant Cola Mansell p ox e Re C2u. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mglL ' Effluent #2 =GODS < 30 mg/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. ~~ ~ % ~ sso-ssw ~-o~rool :. ' • • ,~ ' PAGE 3 OF 3 NA_IyIE ~ G S ~ LOT# ~~ LFGAL DESCRIPTION S~= ~~E~ ,S 1 ~ T ZY ,N,R, Jc( E(or)~ SCALE: 1"= L~~ ~ BM 1 ELEVATION ,/[` C~ ; 6 BM 1 DESCRIPTION ~; ~- ( i` L~ ~~ ~ ~` ~ ~~ ~ BM 2 ELEVATION pd , o ~ a- BM 2 DESCRIPTION t~1tz i ~ i t~ ~ja 1C 2~C~ i°~ ~" c~ j r SYSTEM ELEVATION ALTERNATE ELEVATION ~K ~ S a _ CONTOUR ELEVATION ~3, SCS •~ q~ 5 g ~~ ~~ ~~ 5b .~ ~~ ~ ~ t~`' ~m~ ,I.. r I~~r 1 ~~+ i~~~ ~~ SIGNATURE /y"~~ _ _:/~ DATE ~''~'~ "p ~ .. ~ ~. ' _ i '1 ! / - C ~ ~ _. ,, _ _. _ ~ i r~, "~ _ ~ I _ _ .. -., __ - - age ~ , ~ / ~ z -- <2N _ ~ I ..~- _ 11.E ., ~' y~ ~ I ~ ~ . ~ _ ~ , ..~ , _ / / / / I ~. ~' -~- i~ I ~ ~ ~-~ -- ~ _... r i F`, -- -- - - ~' ~ •- • o ~~ ~ "~ ~« _ _. t~~ ..~ _. ~ ,~ .~ ~ 1 ~ ~ ~ r ~ \ \ \ `\ ~ `) ~ ~ YI " .~ ., • ~ I t ~ ~ ~ ~. ~ ~. - ... ~ , ~; ~ ~ . _ 1 ~ x I" `~ i /- / ,~~ \~ j~ ~~ - ~ / ~~~,~~ ~ " / ~ ~ r~ / ~ ~l ,°~1 ~ r~- -889 _ .. cs~ ~ 4 ~„~ ~ . - A--l_ _ _ PT S ? 5+ T, `~'-~ 4 ... Ste", - "~~-, ~ ~ `~-- -- - i, ~. _~ ~ -II"~i ~ ,NCI ~~- -~ i ~ "+ I t ~ f ~ ' ~ c s (A _ ~ ~ li . Q.~ ~' ' _ ~i , ~ ,. ,, ~' u~iJ~~S P'~CG~" ~ o~ ~ ~~I~n~~~`S1~~8 Ef~1~u~~# Pump 3871 EQa APPL4o~i1i& Sparcal4y dared fie' the foi#awsrg u: +>Cffluernsystem~ . • Homes • Farms +! H@8Vy duty sump • ~Natar transfer • D~rlnp 5~~~lFlClitlOMS ~: EPtl4 • Soads handling ca~a~iliiy: ef4= r4~X~R'41~R). cidos: up tie 55 FPM. Tt~tai heads: up t0 24 feet., • pisc~arga s#ze: t'!z" NPT, • Mat~aRfcal sea~i: carban- rotarylcerar~ic-stationary, BUNG-N alastamars. • 1~4~ ~~°{~ C411~1J1i14#i6 140°f: ~6ti°C; intermittent. • ,F,a~~__++Re~'S~:. y3,~,d~S0~ Series aA(fdf+ti• o Capable of running drywithout damage to eornponerns. Pump: EPp6 • Solids handling capability: ~~i` maximum. • CaRacZ!tias: up to 60 GPM. ~Qtal heads: ~aR t0 31 feet. • Gisc;hiaCge 8#X~ 1',~t` NPT. • Ma~hanicai seal: carboR- rotarSrfoeram~-stationary, BU~IAA-I~i shastvmtrs. • Tem~era#un` tii~'f (4t~~ cQrttirtuotsS 1~0~ ~40°G} int$rmlttant. ~j ~ 19!6~U Putt {nc. • Fastenar3: 300 Series staunless steal, Capable ol• running dry without damage to companernts, lVlator: • Ei~i Single ease: 0.4 HP, 115 or 2303 V, 6~ Ha, 1550 RPM, built iR overload with automatic reset. • EP05 Single phase: D.5 HP, 115 V, $4 Hz, 1550 RPM, built in overload wfth automatic reset. • Power aard:l0 ftx~t standard tenpth,l&I3 S,lTO with thr~ prang grounding Rlug. Optlonai 20 Poot ler~,ith,1613 S~1'T1V with three prong gra~nding plug !standard on EP05). aft: reR~ `)` t=ai ~Qi' S ct ~ a s • Fully submerged iR high grade turbine oil for lubr'~catir~n and effic~nt heat transfer. Available for autAntatk u!d mama! opat~atson. Atd~metlo mtulels lncluda Nleabanlca! Pleat $witcla asi6rnbled and preset a# ~ factory. FF.osTIiRE~ at 5!~ Impeller: Thermo- Mastic Serni~apen design with Rump out vanes €or machanicai seal protection. o EPllS lmAeilet: Therma- piastic ancl+~ed design for improved perforrRasECe. o Caslog and Baas: Rugged thermoRiastlc design provides superior strength and t~rr05ioti- r~SG~'1Ce. o iwtotnr ~oualnp: Cast iron for effidant hit transfer, siren, a't'<~I durr*btlftj+. ^ ~lator der. Thermapias- t:~ aver with [ntegral Dandle and fioa# switch atl~,fitrlerlt pants. o ~owsr Ca6lo: Severe dt~ity rated off and water rosi~aRt. ^ ilsr~. tipper and lawar hebvy duty bal! bearing cor~truction. ~d~CY UBTIfNti ~• 8lad~wda Ammon jGSA i~tad mode! numbers end In "F"ar "AG".~ Gi i ~ ~ r ~ ~Y~ r I r,' ~~ ~a _. ~i ._.___ i r...._ ~ _ _ f `~ f .....,..~......r.w 11 II r ' ~ 2D I k t ~ ~ t5 ~ ~~ tp 5 i I ~ n ~ n ~ n s ti 4 n S O tiPAA i e .L 1 ' l a z ~ s e ~v xz m=m ~fi•tl~ve ~Y, 4~U8 FRCIM Schumaker Plumbing Owner/Buyer Mailing Address r~m~cr naar~. FAX N0. :7153863121 Sep. 26 2062 11:36AM P1 ST CROIX COUr'TX SEPTIC TA.Iti'K MAINTENANCE AGREE.NIBNT AND (3WNERSHIP GERTIFICATIQN FARM BasT ~ cq 6~~. RD ~~a l~tcK~ nK. NUO~, wr 5401 {Verifficaticen roquitad from Planning Department for new City/State TT ( ~,~0 Y~ r 1A,L' _ Parcel Identification Number Property i,ooatiori ~ '/., ~ Y/., Sx. ~ (, . T~N-R.,~ Ta~am of Subdivitdon ~ op .~ --~.,,,~,1 _ -- --- , J.~t # ~. Certified garvc~y Map # ,Volume .Page # Warranty aced # ~.~4 7,47 .Volume 'S'~6 ,Page # /~~ ,_. Spee tense C7 ye$ ~ na Lot lines identif able ~ yes I~ Aa ~'Y'$~-+IAII~iTENANCE YmpOCOper use and msiffi+sasacao~'yaur septic system could:esetlt im its pt~ematme failtun W handle wastes. Proper maiatenanee consists Qf ~~ o~ad tfie septic tank every three years ar saanar, if peeded by a lic~ased pumprr. What you put into the system caa affect tlta iimctioa of flue septic 'tonic as a trot ataga is the waste disposal system. Tho property owner agrees to submit to St. Cmfx Zaatiug Aapattmeat a certification farm, signed by the aeraer and by a masterplutaber, jatarpeyman piutnber, t+estrietedphtmber or a liceasod putt~c vetifyiag that (1) the oa-site wasGetMUUt+arrdispOaal systosu is iu pmper op~atin$ cottditiou atdfar {2} slier iasgectiott and pumping (ff necessary), the aepdc tank is loss than 1/3 fbll of sludge. Uwe, the untiers' Lave read the above t~agteireuteuts aad agree to maitttaitt tho private sewage disposal system with the standards set farts, by the Dopardment of Camntera and the papatttneat of Natural Resources, State of Wtsconsit>_ Certificatiam statm$ a been tnafatainedmusi be eoa~leted a~ repented to the St. Croix County Zomung Office withi» 30 ~rdays tho a te. /~ a6 ~ /3io3 SIt~ 'tY]ItE APP4TCANY' DATfi I thax li statements oa this form are tale to the best of tuy (our) lmowledge. I {we) am (art) the owtua(s) of the virtue of a warranty dead r~orded iit Register of Deeds Office. /~ ~ ©6! /~i a3 3IQN DATl3 '"" +* Any iaformatian that is mis-represeiltcd may result in the sanitary pe:utit being revoked by the honing Deparpgnent. "'*"' ** Ynelnde with thw applicatton: a ssamped warr&tty deed &ae» the Register of Deeds oi~aa a copy of the certified survey map if refereaea is made i>! the warranty deed ' ' ' yri. 1546PAG~ 169 '' I •STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between Wallace L. Billy, a/k/a Wallace Lee Billy, a/k/a Wallace Billy, and Katharine M. Billy, a/k/a Katharine Billy, a/k/a Katherine Billy husband 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 descrtibed real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): SW I/A of SE1/4 of 1 I-29-19, EXCEPT South 198 feet thereof, St. Croix Counry, Wisconsin. Recording Area 630707 KATHLEEN H. WALSH kEGISTEk OF DEEDS ST, CkOIX CO., WI RECEIVED FOR RECORD 09-~8-2000 9:15 Ail WARRANTY DEED EBEtlPT N CERT COPY FEE: COPY FEE: v,oa TRANSFER FEE: 135 RECORDING FEE: 10.00 RAGE5: 1 Name and Return Address I /~ l..- ~n ~ m a stn non Parcel Identification Number (PIN) This is homestead property. (is) iFb7td0 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/k!a Wallace Lee Billy, s/k!a Wallace Billy, and Katharine M. Billy, a/kla Katharine Billy, a 1 a Katherine Billy, husband and wife, authenticated this ~da/y of tip{' 7Q,'d"Z> V - t • Kristine Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland Nudsan, W[ 540th (Signatures may be authenticated or acknowledged. Both are not necessary.) • Names of persons signing in any capacity must be typed or p WARRANTY DEED + Wallace L. Billy, a/k/a Wallace Lee Bill , a/k/a Wallsce Billy • Katharine M. Bill`, a/k/a Katharine Bilt , a/k/a Katherine Billy ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. County ) Personally came before me this _ day of the above named to me known [o be the person(s) who executed the foregoing instrument and acknowledged the same. a . Notary Public, State of Wisconsin My Commission is permanent. (lf not, state expiration date: I,•amalion ProlMaiwub Campenv. io~+E du Lx, wl eooass-sosi ~o rioted below their signature. STATE BAR OF WISCONSiN FORM No. 2 - 1999 1~ '. C.Tb~1~ CaQt~ {~~'~5~~ ~~ 'AYES ' SECTION 11, T29N, R19W, TOWN ( ~ ~ ;ING LOT 2 OF A CERTIFIED SURVEY ~ I IE ST. CROIX COUNTY REGISTER OF __ ~ -~ ---------------- ---~ ~ I--- .._- BENCHMARK yApy~~ 9 ~n 0 a 0 ~~p~~~~ __~~~~ TOP OF 1• IRON PIPE WIpTM FENCE 4.5+/- SOUTH U.S.Ci.S. DATUM OF 1928 ~ ~ - _ ~ OF LOT CORNER ELEVATION = 915.59 I - 354 ~ FENCE 3'+/- SOUTH OF LOT CORNER ~ ~ ~ I ~ T • I ~+ ~~ ~ ~ ~ ~~: ~-- ,Oa ~ 11 : ~~ , , N 0 W ~ 2.03 ACRES ~ ~" ~ ~ ~~ 88,433 S(~. FT. ! Cs~l , I ~ . i i ~ ~ I i 9~ ~ a' . ~ ~ O ~ ~ ~ `~ - ~IT89°41'15'~IV340.i5'~ ~ ( i L ~~'~~ D TO THE PUBLIC O i I ~ "' ~. ~ DEDICATE .,~- ,,=--- DRIVE -~-----------~ o' ~~ -----------~, u ,- ®~. ~ ~' ._. S89'41'15'E340_15' ._. _. _, _. _. _. ~ ! ~- ;---------~-- -~ ICI W~ ~~ -- , i d I ~ , ~. ~ , % ~, i ~ I I o i~ ~ ~ / ~ ' ~ i .. ~ a 100' ~.i ~ ~ .~ 2 H.W.L. _ i , .• z a93.oo i_ ~ i ~',~ 3.1fi ACRES i , ~ I ` I i ~.~ 137,561 SD. FT. !'" m i . ~ ~- 1 Z MIN. BUILDING i i ELEV. =895.0 ~ i ~ ' II 3 ~' ~ i W ' ! ' 2.84 ACRES ~ 123,516 SQ. FT. MIN. BUILDING