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HomeMy WebLinkAbout020-1402-14-000__ _ _ _ Wisconsin department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division - • _ ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township McCabe Homes Inc. Hudson Townshi CST BM Elev: r Insp. BM Elev: / BM Description: ~ / (9p . O Qt7 . J I(2uc5tmn IR~rnA ~ -- TANK INFORMATION - ELEVATION DAT TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SE~BACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ' ~ r ~` > ~ / r co ~- Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufac rer Demand GPM Model Num er TDH Lift ric ' Loss System Head T H Ft Forcemain gth ia. Dist. to Well SOIL~tBSORPTION SYSTEM county: St. Croix Sanitary Permit No: 420703 0 State Plan ID No: ....- --. Parcel Tax No: 020-1402-14-000 Sectionlrown/Range/Map No: 11.29.19.2525 STATION BS HI FS ELEV. Benchmark `~3v o . oo~a' Alt. BM Bldg. Sewer S•85 r0 •`fs~ SUHt Inlet -'1 ~ i t 96 • s,D St/Ht Outlet $ , o0 9fQ .30- Dt Inlet Dt Bottom Header/Man. ~ ` „~{. Dist. Pipe 9; ~~ o. ~s r 3•s Bot. System . a O . `~ 3 • ~ • (00' Final Grade ` ~, St Cover e„ BENCH Width Length ~ o. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM S ~ ~ ~ CZ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufac rer: ^ INFORMATION ~ CHAMBER OR S Grcr Type Of System: ~~ . ~ 'Z~ } , /. UNIT _ Model Number: rt DISTRIBUTION SYSTEM Header/Manifold t ( Distribution x Hole Size x Hole Spacing Vent to Air Intake X02 ~ `~ Pipe " ~ r 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 Bedlrrench Center Bed/Trench Edges Topsoil [] Yes [ No ~] Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/~/?.W~ Inspection #2: ~T"~ Location: 1028 Cresent Cir Hudson, WI 54016 (SE 1/4 SE 1/4 11 T29N R19W) Mi~t View Lot 14 Parcel No: 11.29.19.2525 1.) Alt BM Description = ~~~ 1 T ,~ ~ 1, ~ - 2.) Bldg sewer length = ~Ip r . `..~ j` ° t1~Q.C~1 ~.. - amount of cover = (.,;~~ ~ `~2 " ~~+'.Q ,.,,,_ l1 -' ... prr ~ ~..~+-/. "Citn"x' Plan revision Required? Y s No ~ 'i ` ' i I i~4 other side for additional orma ~~~ ~'l ~ ~,l_.h~~ / ~~- ~ ~ ~ Dase glnsepctor's Signat~uf'e.o Q /~ ~ ~ Cert. No. '-6710 tR.3/97) ~ ~ (~/(?~,(~ rL /~ [}•. ,~/~n(3~OS D/~~~Mf+ ~,,Y ~F/y~ dTrr ~l" 0~-s. +~1~~/ ~ f C,b~-?~- ~'~'~'` C~ v'~-4'lj~t,~u ~ C..~U~tV1QQV Safety and Buildings Division County : ` ~ , J 201 W. Washington Ave., P.O. Box 7162 t ~--a.. iseonsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266-3151 ~-7~ Sanitary Permit Applieati State Plan [.D. Number _~ In accord with Comm 83.21, Wis. Adm. Code, personal informati u p de may be used for secondary purposes Privacy Law, s Project Address (if different than mailing address) ,:.. i. Application Information -Please Print All Information ~ b ~ (~ ~ U Property Owner's Name r~ r,p 4_,, Lot # Block # Parcel # Prope r ty Owner's Matting Address ;_;-i CKQii; ~:UIiNTY' Property Location C ~ ( 3,~' ~s ZONING 7FFiCE j ~ y, s~ ~/. Section ~l ta[e ,S City Zi Code eNumber hon P , , p J J ~ // ~1. '" ~ d~,3 / ~ t0~7 l - a7S~ - ~'~` /Q'~ T ~N; R l l Ecoe~ wilding (check all that apply) Type I; , . or 2 Family Dwelling -Number of Bedrooms Subdivisign N me ,/' C~SM~.Number ~ ^ Public/Commercial -Describe Use ~ `~`""" ^ State Owned -Describe Use ^City_^Villa a ownship of / la III. Type of Permit: (Check only one box on line A. Complete line B if applicabl ~- ~ d pzp+- ~ Z ~ j - A' y ew S stern ^ Replacement System ^ TreatmentlHolding Tank Replacer ent Only ^ Other Modification to Existing System B• ^ Permit Renewal Permit Revision -- ^ Change of ^ Permit Transfer to New List Previous Permit Num rand Date Issued ~ Before Expiration ~--- ~ Plumber Owner ~~~ .~ _ ~ ~ _ a~ IV. T e of POWTS S stem: Check all that a 1 -Pressurized [n-Ground ^ Mound > 24 in. of suitable soil ^ Mound <24 in, of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Ching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersaVTreatment Area Information: Design~~pd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sE) Dispers I Area Proposed (sf) ' Systym ~levat~i~n `,zO / `{7 ~ / ~ 7 ~ ~7 moo a ~Q r o ~ . c VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Pias[ic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Taiilcs Septic or Holding Tank Q ,,,~ 7~v 'JC .~ Aerobic Treahneot Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for i Ilation of the POWTS shown on the attached plans. PI be 's a e ( nnt) ~ ~'~ ~ ~ Plum s S' nat ~ P PRS Number - Business Phone Number - ~ ~ aa,~ ~~s a~ ~ ~ ~~s Plurnber's Address (Street, City, State Zip Code) l ~ N k ~(~. Lc..~' .S-5~'oa VIII. Count /De artment Use Onl Approved ^ Disap ved Sanitary Permit Fee eludes Groundwater Date Issued Issuing Age t Signature (N Stamps) ` _ ^ O r en eason for Denial Surcharge Fee) "~ Z~ ,~ ~ ..,~t . an n~• i c T ) itions A gal/Q~nnc fnr IX. Co n d .., I{Q (,. --t l/ /! ` ' C~'~tM ,//~~ /- ~ ~ s ~ -~ Y tr ~~ ~.S} fUD ~~ ` Attach complete plans (to the County only) for the system on paper not less than atrz x 11 inches in size SBD-6398 (R. 01/03) ~V ~~ ~ f s~. ~_ioo Faso ~ ~,~-. ~~ Ii r ~ l_ ~(~ ,~- ~y ~~ ~ ~ 3 ~ ~-r. ~ c9~. 9~i 3~o s~. r c< <~ S - _ - ~-a~.~' ~ ~, ~, f.~ ,, (fie. X `OfvisiondiSef~yaredt3uiidin9a ~~ ~,,~. ,~. ~ , ~_ ~., ,~ Attach t0lrlplete Site plan on paper IIDt leBS than 81/2 x 11 irclles iR sire. Pion moat include, tut rwt ~rlHed b: verdCai and tloliaotaal ref`eeremoe pout (e~1, direa~bn and goat tD. percent slope, scale or ditnensials, rsortit arrow. and bcadon and distance b nearest road. Reviewed by Dade Ple8S@ ~Ift ~ 1/!>lr0/f'1l8~OR. F~psone11u1oimstisn yov provide may Ifs used tar secondary pNpoees (Privacy isw, a.15.eA (7) (mp. Govt La ~~' 1Ja s~ 1J4 ~ ~ ~ T 2 °~ N R /~ E (a) W Lot 8 Block # Subd. Nertie ar GSMB ^ ~(y ^y{{Wage ~ Town Nearest Road i-f.a:Y Cu dt 4 ® New Constnx:tioa use: ~tl RaMier~at ! N~srebes of tedrooms 3 " `~ code derived deaiipl flow rate T.~`' C' ~ 0 GPD ^ Replaoenlerit ~ Pudic or commercial - t)escxiba: ,__, -- Parent materiel ~--()? ~ ~.-- ----- Food Plekl elevation 5 applicable - ~G'~lr - ft• {. Gl) ~(: General OOlrirrlent5 } ~ ~.~z v/t l ~~ ~- ~ ~: ~-+' ~ . and ~ ~ ~ ~,~~ 3 ~ ~{ ~ 2. ~' ~~ ~, ~ ~ ~~~~ n n t , i ~~ ~ © Pit Grotmd surface ekv. ~ ~S , .f ~' ft_ OepUl b MmIW19 (ardor / l / - M' ~ lion Rate Horizon Depth in Ocminant Color MllnseN Redox Oeacriptlort Coot Cobr flu. Sz Textue Stnrdura C,r. Sz. Sh. Consistence Boundary Roots GP[ •E~1: Ml? •Etff~2 . -, ~;,~ r ~rn~~ ~ ~ ~ ~ t I~1~~ ~ r 5`~ z~ t - ' ~ -- ~ cis m I - - /. Z r-n n U o,,..,y ~ Horizon OeMh in. ©Pit Dorr161etlt Munse Ground suAaoe elev. ~;~~ __ ft. Galor RedwrDesw(ptbn Terdw'e M Du. Sz. Cmt Color Depth b Yrrli0n9 tacbr r ~ t~ in, ShuCitne Consis6anoe BaundarY Gr. Sz. Sh. Rawl: s~ GP •EtSf'I Rate Dftt? 'EtHi2 ' Z ;c - ~) 9~ , y -- S ' G ~;n,_s.~ y r `- -{ ~" ~ 5 - : ~s , y ~ y ~ C ,/ y ~ 1 J • Eillll erd 81= tjOD .> 30 < 228 mp1L• and TS.~i >30 ~ 1 50 mgfl. ` F.fiuent X12.= ®OD < 30 mglt, aid TSS ~ 3o nrgJL CST Name {Please Print) . Addr~es Fignature ----- Date Evaluation Canducsed" - CST Nwltber Tele(>flone Ntarrber _ ,~ ~ . n _ - ,. .._/~...,._...... D r ~ ~-~-~C ~JIT~ r`e C~2.t~ t ~ ~- y~l~' J'2 C e.t. V~-~l ~- ~~ ~ ~.~- , ~~-s-„-~. csi ,d~,,~,t S • ~°' ~°''``~ Zvi ~'6 F'ACIF~OF;,,~, NAMl;: LOT# / ~ LEGAL DESCRIPTION:_l/4____f/4,S T_,N,R, E(or}V1/ SCALE: f"= l~(~ ~y~IELEVATION:~CCJ. C> BM f DESCRIPTION: ~-~eQ c>~ ~c~ tcFn ~e-c.~ U t /a..K 5.~ ;.,~ ~,-.~ ~ B.M 2 ELEVATfON: `~- R*1 ` ~F~~RIPTi(~lAl: SYSTEM ELEVAT.fON: ~ ,~ : ~ ~ SYSTEM TYPE:~'~;~/l ~~' /b~~'~.1~c F ` ~ Sanitary Permit Application saint, ~ , ` In accord with Comm 83.21, Wis. Adm. Code 201 ~~ ~i a;t~,, iseonsin See reverse side for instructions for completing this application Cepartment or Commerce Personal information you provide may be used I'or secondary purposes ~ ^1 adu~r. \1 [Privacy Law, s. 15.04(I)(m)J (Sub ompletea funs i~ ; , Attach tom lete tans (to the count co onl )for the s stem, on a er not less than 8-1/2 inches in size `~~5~/ ~ .Blatt Sant `J ~ry Perm~Number D Check if revision to revtous a licatwn S e PI n I D Number I..A lication Information -Please tint all Information N rr, openy Ownrr Name LOCation: Qa L'~ Z c ~- -I "~ ~- ~ Progeny Location ~~+ I^Pen> Ow-cr's Mailing Address FEB 2 0 200. ~ ` Sj'I/~ I/a. S ~ ~~~ ! \ //~ ST. CROiX CO TY Lot Number ~;, ` ' ~~ StatC ! VL--11 r ZONING 0 ICE Zip otle Phone ~~ ~ /~ ~ ~ ~~~ ~oSjZ Subdiwi~sjion Name or C`S,ti't lumbt 11 Type o oil (check one (V ~ 1 ( l ~ - l ~~~ V ~ ~~ .~ I or 2 Family D ing - No. of Bedrooms:~_ l/~ 1 ~ T D City ~ Publ~ciCommercial escribe e): f~i~/Fiil/ E~ LOLvFsT villag ~ Stair-owned ~ g1.Town III Type of Permit. (Chet only one bo.~n line A. Check box on li B if ap liable Near P ) est Roae-~, n / A) i C~ New System 2. D Replacement 3. ~ ~(-•t (~'~ O Replace l of 4. Addition to Par Number s; stem Tank Onl +/, }~ B) xisti stem j' ,_/ y_~~ D A Sanita Permit was reviou issued Permit N ben D Issued (V. Type of PO WT System: (Check all at a I ~ ,~NOn-pressurize d PP Y) l~lZy ~ ~' rc~s~ln-ground D Mou ,2S2S~ D Hol g Tank Iter O C~struct ,d 11'eiland .~i-grace S e Pass D,~rip Li ,_ ! Ae bit Trea ent Unit c' u ~~Other: / V Dis ersaVTreatment Area Information: ~ ~`)~ :.e>~gr, Flu w(BP~i 2 Dis ersalArea ~ u' ~ d ~ ~' P 3 Dispersal Ar A. Soil Application 5 Percolation e ~~~~~ ~~ Requued Proposed '~{' y Elevauon ~~ } Rate (Gals /day/s ft (Min./inch) ~ ~ ~"~~=, ~'I Tank Capacity in T ' I ~ ~ ~ ~~~ ~~ b of Manu tuner ~ ~~ D Information Gallons G ons Tanks Prefab Site tee ~ Fib, _ New Existing Con- Con- i ~,~;, .. Tanks Tanks Crete strutted I `'II Responsibility Statement u I L !, the undersi ned, assume res onsib' t for installation of th POWTS shown on the an lied tans. ~' ~mocr s .N' e (print) lu en's gnatur ~ ~ MP/MPRS No Business Phont~Numotr ~moer s Adare s (Stre , Cit ,State, p Code) ~~~~~~ ~ ~ ~LC~ r~ CU l-~ \'I1J ounty/Department se Only ~~ O Disapp ed Sanitary Permit Fee (Includes Groundwater APPro'~ea ^ Owne ivG,n Initial Adverse Surcharge Fee) Date Issued Is rig ent Sign ,,;,~,,,~~ Deter anon o~•s~ ~-~ a Conditions of proval /Reasons for Disapproval; /a/ ~3 ~~- Aq-13 Z , sit d h e~.c,~. v, ~- !~ ~f " - sys~n, ~f ~ ~.~~t ~a "6~~t,~/,duh 0~ ~'~ld vin' ~tat~.S'Rirtds ~,~aa~_ CGtl.~i~t_ ~75f~ '~e~eal -~'d ~~`.~!>;~U` ~~L~-`~t_ a.~-_..2er~a~- ~Gvxe sf~~ ~ru.e,~ °~~,~~4.. h~._~Ci~Crucd~ ~ . ~ ~ w/s~~l_es~ ,a,~~r2~-c~c- . w . ~ ~ ~'~ ~ ~ y R' l~~ z b-G-Q . 1 aSv ~.~,.,. Sb.~ 9 3. S° ,.~ V i~'1 ~F` ~; .3 - 3 ar,~. ,~~~ ~~ ~ ~ ~sB~I C '~! laso ~-~~ ~'~~ 9~ sG ~ ~'~ ~ 07~ ~ -S ..~ wiss~ar~i irrterrt of commerce t)ivisiAm of Safiaty and Buildings f ~ ~ 3 SOIL EVALUATfON REPORT ~ I~IZ~ ~~IPaye U'i ~9 il in accordance wnh Comm t3h, wls. aom. i.oae ~ . County ~ Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must indude, but not {ginned to: vertical and horizontal reference point (BM), direction and scale or dimensions, north arrow, and location and distance to nearest road. percent slope parcel I.D. (L Q Z (~ ~ 17 d ~ '" / , ~ , Please print all informatfvn. vied Y Date Personal irrfor(nation you provide may be used for secondary Purposs~s (Privacy Law. s. 15.04 (~) (m)). t' ~ ~ 6 Property Owner Property Location ~~.~ Govt Lot S ~ 1/4S ~ 1/4 S /~ T Z 9 N R ~9 E (or~! Property Owner's Mailing Address Lot # Block # Subd. Name or CSMrI: ~ ~ ~~ I `-I Mi ~ ~ 6e Zlp Code Phone Nurrrber Sta City ^ City ^ Village Town Nearest Road (~ New consfiudion tlse: [lGResidential t Number of bedrooms 3 - y Code derived design flow rate 0 GPD ~ ' ~ ~ _ , ^ Replacement ^ Public or commercial - Descr~e: '' ,/ Parent material b u -Ew•G.. S h Flood Plain elevation if applica ~. ~" ~~ ' General comments S y 5 ~ ~^'~ 2 l e v • Q 3• ~ `~.'`~~ ' ~ ..~'°:~,~€. ~ ~~ ~'~\ and n~commendations: ~,. L f , e I { V ~~(3 . ~~ ~% ~ d . a 1-e -.~-~. r ~'' Stc 6 ~-,'n~1- 0~'t jai 1 des ~-i-,, a I ~- ~ ~ ~ + '-"~~~ ~ . // ~ n _ s~ // ,' `~,/, I ,, /,,._ ,, t, .~ ~ f~~..~ . n / ~~ a. ~ in. ~Lln gam. !L. /Jf/.~ nOOil. s /~.[~~C;~ tlX~d6 !X~" .. Q~~ ~A~.. . ~.~~ __ F ^ "V"'^J tV1Y9iYLl L.A~"1'1VC f:\ 3.~ ~~ # ~A- Pit Ground surface elev. ~Y• yy fk Depth to Smiting factor ~~ ~•i .t-, .~ -'~ "~ ` ,. lion Rate H i De th D minant Cobr Redox Description Texture Structure Consistence Bou GP D/fF or zon p in. o Mansell Qu. Sz. Cunt Cobr Gr. Sz. Sh. "Eff#1 'Eff#2 D-~ IO -'".3~2 Sil Y77~ c5 v~ . 5 . g Z _ ( -- S i ~ Z. ~- 3 -~/~ l0 ~~ ~ --- m5 ds m ~ - - • ~ 1.2 ~~ CST Name (Please Prantl lgnatu~~ ~ ~~ ~ ~ i Adam ~c humak~r 1 Address Date EvaSiation Conducted Telephone Number 21 l3 $b'' ~ ~rtr,~'tie-~ ,~ i 540 :5 ~~ ~ ~-~/ ~l 15~ 24~ - yon 8 o ~~# o ~~ ®Pit Ground surfaceelev. q9 3d ft Depth to Smiting factor ~ Z in. SoS ~~ ~~ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/(1? in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I o- 2 /6 ~ lZ Sil 2r)-x~k rY1-~r c5 I v~ . 5 Z 12 - I r" ~~y - r / 2 n~r c s - . 5 • g 5 2-<, ~ i "Effluent #7 = BOD_ > 30 < ~0 mall arxi TSS >30 < 1 50 nio/L ' Effluent #2 = . < 30 mglL and TSS < 30 mglL property Owner ~~T[lt 1-~- Parcel tD # .. 1 p~ Z of J ~~~ # ^ Boring ® pit Ground surface elev. ~ 3 4 ft Depth to limiting factor 118 in. Sal '~ Rate Horizon Depth Dominant Cob Redox Desaiption Texture Stnrcture Consistence Boundary Roots GP DlfF in. Munsell Qu. Sz Cont Cobr Gr. Sz Sh. 'Eff#1 'Etfff2 i o-l~ ID 3 2 Sil -fir ~5 ~ v~ • g' Z -2 1(~ `-i Si I 2m ~ r c 5 -' 3 2 l~ ~l s m/ - - . ~ 1. Z ^ ^ pit Ground surface elev. ft. Depth to limiting factor in. # ~ ~~ Soil ication Rate Horizon Oepth Dominant Cob Redox Descxipdon Texture Structure Consistence Boundary Roots GP D/fl: in. Munsell Qu. Sz Cont Cobr Gr. Sz. Sh. "Eff#1 'Eff#2 Boring # ^ 8orir-9 ^ Pit Ground surface elev. ft Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/it= in. Munsell Qu. Sz Cont Color Gr. Sz. Sh. 'Eff#1 "Eff#2 • Etfluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mglL ` Effluent #2 = BODS < 30 mglL and TSS < 30 mglL T'he 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 cmr-tact the department at 608-266-3151 or 7"CY 608-2G4-8777. SBU-8330 (R07/00) .' _,-. -~ Property Owner ~ Tf(~ 1 t Panel ID # ~ Z ~ 3 o eori~# ^ ®Pit Ground surface elev. . 3 o ft. Depth to factor / 18 in. ~ ~ Rate Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary Roots GPI Mf in. Mansell Qu. Sz Cont Cobr Gr. Sz Sh. 'Ett#1 'Eff#2 J o-l o ID 3 2 --- Si 1 -fir ~ 5 ~ v~ ~ g' Z -2 l~ y Si l 2m < r c5 - . 3 2_ L~ y l s m ~ - - . '-1 /. Z a Ong # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Sod ' n Rate Horizon Depth Dominant Cob Redox Description Texture Struc~rme Consistence Boundary Roots GP D/fft in. Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh. 'EB#1 'Eff#2 ^ ~9 # ^ Bonng Ground surface elev. R Depth to 1~9 factor in. ^ Pit Sod nation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/tf in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 =GODS < 30 rnglL 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. 581}8330 (R.O7/00) ,~ f PAGE~OF ~ NAME .5~~~ LOT#~y LEGAL DESCRIPTION ~ es.SF i4 ,S /~ T Z9 ,L~I,R, /9 E(or1j~ SCALE: 1"= `7i~ f BM 1 ELEVATION ((~G• d BM 1 DESCRIPTION ~ ~ o~ ~..~~ Z '• ~~~- L. BM 2 ELEVATION `J ~. q U ~ mac. -. ) I BM 2 DESCRIPTION ~p(1 a-~ 'G~ _ Z "~.~~ SYSTEM ELEVATION ~J' 3. $'v _ d ~ ALTERNATE ELEVATION I~• S ° ~,. .+. CONTOUR ELEVATION YY.Gy, 99. ~a ~ I llA"1~~ iv `c o - o/ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of ?i FILE INFORMATION Owner ~ C Permit # ~ L 2/ 03 DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ NA Estimated flow (average- ~D al/da Design flow Ipeakl, (Estimated x 1.51 ~ QC's al/day Soil Application Rate ~ allda /ftZ Standard Influent/Effluent Quality Monthly average• Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand IBOD5) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Qual"rty Monthly average Biochemical Oxygen Demand (BOD5) 530 mg/L Total Suspended Solids (TSS) <_30 mg/L ~.iVA Fecal Coliform igeometric mean) 510' cfu/100m1 Maximum Effluent Particle Size Ys in dia. ^ NA Other: ^ NA "Values typical for domestic wasy~water annd septic tank e~fff luent. ^wwulnwlwune ~nucnlu c T 0/4~ / .A']An d ~_ ~~ -' svsTEM SPECIFICATIONS Septic Tank Capacity a ~ al ^ NA Septic Tank Manufacturer ~ ^ NA Effluent Filter Manufacturer . . ^ NA Effluent Filter Model - ~(j © ^ NA Pump Tank Capacity al ~NA Pump Tank Manufacturer `~'NA Pump Manufacturer ,f[~NA Pump Model ~ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland O Other: ~NA Disp al Ce(lls) In-Ground (gravity) ^ At-Grade ^ Drip-Line p` ^ In-Ground Ipressurized- ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA 1\IMII•IG\!'ll^VG VVIILVVLL /~ - VV ~ v/~ ~" vJ"- Service Event Service Frequency Inspect condition of tankls) At least .once every: ~ ^ earl IIs) 1Maximum 3 years) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY,1 of tank volume ^ NA Inspect dispersal ce(lls) At least once every: a ^ monthls) (Maximum 3 years) yearlsl ^ NA ^ monthls) ^ NA Clean effluent filter S ~~~~ t least once every: yearlsl ^ monthls) ^ NA Inspect pump, pump controls & alarm At least once every: ^yearlsl Flush laterals and pressure test At least once every: ' O monthls- ^ year(s) ^ NA Other; At least once every: ^monthls) ^ 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 cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a. failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third 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. 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 may impede the treatment process and/or damage the dispersal cell(s). If high concentrations 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 wil{ be discharged to the 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 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. ~~ ^ The site has _ *^ _a _ ` '' " ' '-'- -- `~"• ^f +hP POWTS a coil and site e ~ ~ ~. .i ~ ,_ ..~.~., hnnmant araa If nn ronhr I !•! !` Id mil tank ^ 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. ADDITIONAL COMMENTS POWTS INSTALLER Name Phone O ~ ~~~- POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name S~ ~l,p-~b.. Phone ~l, j~~ ~ ~j ~ ~/~ g ~ This document was drafted in compliance with chapter Comm 83.2212)Ib11111d1&Ifl and 83.54111, 121 & 131, Wisconsin Administrative Code. ST CROIX COUN'T`Y SEPTIC TANK MATNTBNANCE AGRBBMBNT AND. OWNERSHIP CERTIFICATION FORM OwnerBuyer ~ ~ C' Mailing Address .3s ~° ~. /,O • ~v~T ~~ ~ssraa3 property Address (Verification required from Planning Department for new wnstrudioa) Gr/2'~ Parcel Tdentification Number ~~D - /O/3'"3v -G~ tatyJState ~~/~"~~ LEGAL DESCRII'TION ` _ ~ Locafion<~~ t/4, ~~ 1/,, Sec. ~ I . ~~.N R. ~ ~ w~ Town of ~`-± •1 Properly /~ Lot # ~y . Subdivision ~__ -- Certified Survey Map # ,Volume o7 .Page # a Warranty Deed # 7O oZ ~ .Volume Page # Spec house yes ^ no Lot lines identifiable yes ^ no SYSTEM l1ZAINT]ENANCE Imptopor use and maintenantxof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every flute 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. nt a certification form, signed by the owner and by a The property owner agrees to submit to St. Croix Zoning Deparlme pl journeymaaplumbe~ restrietadplumber or a licensedpumpcr verifyinS fat (1) the o~sibe wastewaterdisposal system is is proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. have read the above is and agree to maintain the private savage disposal system with the standards Uwe, the undersigned ~ set forth, herein, as sat by the Department of Commerce and the Department of Natural Resources, State of RTisconsin. Certification tic tem has bean maintained must be completed and returned to the St. Croix County Zoning Office within 30 stating that your sap ' sys days of threw year expire • date. ~ / /,~ ~~ SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements oa this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property descn'bed above, virtue of a warranty deed recorded is Register of Deeds Office. ~'' ~ ~i3~ ~L3 TURB OF APPLICANT DATE **«««« ««««*« Any Formation that is mis-represented may result is the sanitary permit being revoked by the Zoning Department. «« Indude with this application: a stamped wa:tanty deed from the R ~ o~ ~ ~° ~ ~ qty dud a copy of the ixrtifir~d survey map 1 208~~' 572 S`fATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between Richard W. LaCasse, Grantor, and McCabe Homes, inc., 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): J,~t l4, Plat of Misty View in the Town of Hudson, St. Croix County, Wisconsin. 7P,~-c 649 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , M1I RECEIVED FOR RECORD 12/19/2002 08:30AM EXEagpT ~ REC FEE: 11.00 TRANS FEE: 202.50 COPY FEE: CERT COPY FEE: PAGES: 1 Ret:ording Area Name and Return Address ~~ ~~~ 020-1013-30-000 Parcel Identification Number (PIN) This is not homestead property. - (~) (is not)- Exceptions to w-arran(ties: Easements, restrictions and rights-of--way of record, if any. Ifl / 'da of December 2002 Dated this __~_ .~ Y ~ _-.. _-_-, __. s AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ - STATE OF WISCONSIN ) ------ --- County ) authenticated this day of _ ,h ---- Personally came before me this ~ day of December 2002 the above named -- pP afA- Richard W. LaCass ~ a~'-.t1~_ ~ ''i'ns -- TITLE: MEMBER STATE 'iR' F ~1SC ~, to me kn wn to b erson(s) who exe rt the foregoing (If not, _ _ ~ ~ ~ instnt nt an c vledged the sam authorized by ~ 7011.06, St '~ ,~ a _ TH15lNSTRUiVtENl~jj, 1~R~~«FNr~'i~",~ * - - ~! Attorney Kristina Ogland ~`'~i O `~~ Notary Public, State of Wisconsi - -- _ _-_ ---_-_ ----4iq~Tnr~_-_ ~a'~_ ___. - lludson, W_1 5401G __ _^ _ptu1M ___~.,._ My Commission is pennanen . ([ not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) _ yL_-~ +-~~-') * Names of persons signing in any capacity must he typed or printed below their signature. ~nrormaaon Protessanais comvarry, ForW du Lac, tM 800-655.2021 WARRANTY DCED STATEBAI20FWISCONSIN FOR114 No. 2 - 1999 ~\ ~~~~~ ~.. - - _~ ST. CROIX COUNTY WISCONSIN ZONING DEPARTMENT ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 Phone: (715)386680 Fax (715)386686 To: ~e ~~ ~~Z ~1/~C , From: Fax: (Q ~~-- oZ 7 s " ~ ~3 ~ Pages: v / ~ ~~~./) /~- Phone: /r0 ~~ ~ {~Li~AD~.D~/~i~ic i Date: vY ~l ~/1 ~ Re: ~~^j' ~ CC: ' U ^ Urgent ^ For Review ^ Please Comment f~Please Reply ^ Please Recycle • Comments: ~- Q ~ q~ 3( ` anal d ~~- ~ ~~~ ~~ ~~`~' ~ ~,.Q~J~ ~--G~~Gt„~,,_. ~-' ~ cum ~/ ~ a ~13/Z ~~~ct.c.2- ~~~~ ~ ~1~..~ ~ Qe~~{eQecm~ °~ eu~ i~~ ~ ~ti". ,Aso Pc+ d~-~~ ~~ ~ ~~ 3~ QC~~~ r~"/~.eccsde (~ ~~ ~ ~~12. 'DVS +~a l~w~~~„l2rr~~ uv a ~ B,e. ~ ~+ T ea>>'~• ~_,. s Q ~Y~~ ~~~~~~ ~~$~~~ r ~~. ~~g S ~~~ W ~a~~~ ~~ on _~ ~~ o~ ~_ 8 -~ ~® zA (~ N v ~ b ~ O z ~ ~~~ s b -~tt t~- r ~ 70 o ab ~ °o c,~ ~ cv fJ O A ~~~~ 0 x ~ ~~ RESIDENCE FOR: v \ II t~r~c~~~ ~oMES. 11~tG. I_s ~~~ ~~ ~ ~ CpmpW RrWM~ri [kOXNS $wAtN zns wunmpwe omr • exxa+. 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