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HomeMy WebLinkAbout020-1402-16-000~ '~ n ~ ~' v ~ O ~ A fD O Q~ (D p n N ~ m y ~ c ~ ~ o ~ ~ ~ ~ O 3 0 v cn v N ~ ~ j ~ C ~ a p c I ~ o , O i ~ ~ a ~ c i N ~ fl_ a i ~ ~ Z o C ~ ~' _ ~ ~ I v o' d 3 °- I ~ - m W I ~ a I ~ N O Z ~ o ~~ ~~ o ~ o I ~ ~ ~ I ~ C W (D I a ~ I ~_ m n N O. 7 ~ ~ w cod ~~ 2 D my ~m m ~m a ~ ~_ ~ m ~ ~ ~ n0= v ~ ~ Sn ~ ~ o 0 0 ~_ O fD N 0 C p n fD .!p.S N < a an a O ~ N ~ 7 N ~ d ~ x ~ OOO Q p fD ~ U1 p) N n O' i „n„ 7 C • N Q s O K ~ f~ v i o~~ O D. a ' N ~ O c m m ~ 3 < ° ... vp~ ~ a ~ O i ~ ~ ~ o o ° ~ 3 m r° ~ eo ~ ~ ~ ~ v ~ ~ ~ :: ~ !: ~ ~ ~ ~ ~ ~~ ' r: ~ C n 2 N 'C ~••~ W N ,~ p ~ ~ ,~ "^~ O m 2 co N p N J n ~ 7 V 7 N y ~ O O ~ ~ ~ ~ W 4 ~ a a, _~ fll ~ o O ~o ? ° _ o co a ~ ° N m c~rcn N 3 M a _ .. ~ w • ~ 7 ~ C ~ < c ~ S q S N N N ~ '.,.. ~ y ~oov, ~ ~ ~ ~ m m = ~o rn ° ~ f .: N zWZ c D o ~ O ' c m' ~• ~ c N ~ fD a D a A Z ~ ~ i ~ „'~ 7 a A ~ ~ ~ W ~ fn N ~ f0 Z O ~ ? ~ ° °'' m ~ y '~ Z N ~ ~ ~ T c a y A A '~ `~' A N V N °o ti b ~ w V N Safety an Div n ' County , 57` ` ox 201 W. Was n t Ave., /SCO~~,~ ~ Madison, ` Sanitary Pennit Number (to be filled in by Co.) Department of Commerce Sanitary Permit Applica 'on ., : stile Plan LD. Number In accord with Comm 83.21, Wis. Adm. Code, personal info ation you provide may be used for secondary purposes Privacy Law, sl .04(1 xm) P oject Address (if different than mailing address) I, i;KiJl ' ~~ I L Application Information -Please Print All Information ~ ~/ING t`y~ ...r- ~~.7$ - ~~ t ~ t c 1. Property Owner's Name # Block # Parcel # Lot `` /C~ Property Owner's Mailing Address Property Location 3 S S,E % ~,~ '/. Section 1 ~ City, State Zip Code Phone Number , , ~I ~<-b~ ~ ucle one) T ~ N; R~E or W Ty wilding (check all that apply) II '~~~~ !!!7 ~ . ,~or2FamilyDwelling-Number of Bedrooms Subdivision tame CSMNumber ercial -Describe Use ^ P blic/C u omm ^ State Owned -Describe Use ^City_^Villa Township of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ~ - /Q O A' New System p y ^ Re lacement S stem ^ Treatment/Holdin Tank Re lacement Onl g p Y ^ Other Modification to Existin S stem g Y B. ^ Permit Renewal ~ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a 1 ~Von -Pressurized In-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 irculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching C r ^ Drip Line ^ Grav -less Pi ^ Other (e in V. Dis ersallTreatment Area Information: 4 / Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Pr System Elevation i3 ~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ~ 0 Aerobic Treahnent Unit Dosing Chamber VII. Responsibility Statement- I, the undetsig ,assume responsibility for' Ilation of the POWTS sh wn on the attached plans. Plumber's Nat e ( rint) lumber' ignat a MP PRS Number Business Phone Number as ~ 3s ~~s'-.~~~ - ~ Plumber's Ad ress (Street, Ci State, Zi C~yie) ~~ /C~ ~1 U. ~ l~~ ~~y6a ViI ount /De artment Use Onl A roved PP ^ Disa roved pP Sanitary Permit Fee (it),cludes Groundwa er Surcharge Fee) s~(/ F d~ Date Issued ~i[j/ 1 ing Age t Sign ure tamps) ^ Owner Given Reason for Denial ff' (0 (~ ~ ~ ~ ,~ IX. (:onditions of Approval/Reason~s,fo~r~D/Jisapproval ~s ~~~~ ~ syf~ -~-~-- ~~- .~ d. Attach complete plans (to the County only) for the system on paper not ress than aru x t t tncnea m size SBD-6398 (R. 01/03) ~.1 _ ~~ . cr (,~~.~ 1a0v f aoo ~g r ~? ~~ ~UC~ -~ ~ ,r~lK - I = 1 ~0 ' T ,~ s ,~~ - a ~ / va ~c 7-,.~p r~ ~l~ 93, i3' `'9__ll ~-~, = ~ja~ 53 ~ 0 i3~~ x ~3M•l ~, fla ~v~ %'` ~~~-- ~e~~„~, ~~~ r-~ P \ ~ X ~-a 1~M-- ~ s~,,.,~~e fir- l~~ 1/ I"`a ~~oss7 N `'- ~o ~ ~- ~~ U~ /~~ COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, not top of coyer, must e~dend to a point no greater than 6" Belaw Finished Grade Cover with ~nlr;A?H flocking Device ~jX ~tppicalj NI Li~NvGT" ~~~ ~3dlfi ~~ia p IE? i~~~ Min. 23" Access Opening Ouh:t Effluent Filter ~ Inlet Baffle o,J Sn~ Access Opening, not top of coyer, must emend at least 4" A6oye Finished ade . ~PP'~`~ CAi~ /Finished Grade fitNM,Nr/~V~•yr Min. 23" Access Opening j IN/'T1! 1f ~~ovC St.~'~ ~~ .Union f~jo,2oYE.A ~/P£~ 3 Pf a,aa.~, oN~ soLia s'oi~ ~.1, ~ i TANK MFR: 3 ~~ ,Sa.n d ° r q rat v+e" T+nro unal2 ~ w ~ ~l, c+eh-{er 2., /ocuer yGhan Pd~ps :nt SepticJPumpTank /~ ~ ~,~~ on p~/fSia~e Llj~t/~f) SPECIFICATIONS DOSES PER DAY: TANK SIZE: SEPTIC ~,~f~a GAL. DOSE ~ GAL. ALARM MFR: MODEL # Switch type: ~!'l~c~ ~ PUMP MFR: MODEL #: ~ SWITCH TYPE: REQUIRED DISCHARGE RATE ~ GPM DOSE VOLUME: ~ I ~ GAL. (INCLUDES FLOWBACK & <20% OF DWF) CAPACITIES: A = ~_INCHES = ~yl GAL. B = 2_INCHES =GAL. C = INCHES = ~/BZ GAL. D = ~ INCHES = ~~.5~ GAL. PUMP & ALARM WIRING PER COMM 83.43(8)(e) VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) = 7e 3Jr FT. MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) _ + ~-"' FT. G 8 FT. OF FORCEMAIN x /.~d FT./100 FT. FRICTION FACTOR ...... _ + FT. c~ l TOTAL DYNAMIC HEAD (TDH) _ - ~ I FT. INTERNAL TANK DIMENSIONS: LENGTH ;WIDTH ;LIQUID DEPTH MP/MPRS SIGNATURE: ~ LICENSE NUMBER: aGZo.~s~ 111 F1H1nYri~~.. Hrrt.IC.AilONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: '/~"maximum: • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/~" NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA•N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 1 15 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset, • EPOS Single phase: 0.5 HP, 115 V or 230V, 60 Hz, 1550 RPM, built in overload with automatic reset. Power cord: 10 foot standard length, 16/3 SJTW with three prong grounding plug. Optional 20 foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). ~ 2003 Goulds Pumps EHectwe July, 2003 83811 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory, FEATURES ^ EP04 Impeller; Thermoplas- tic semi-open design with pump out vanes for mechanical seal protection. METERS II FEAT 10h 9 8 o ~ a W x v 6: a ~ 5 0 a a 0 3 z 0 ^ EP05 Impeller: Thermoplas tic enclosed design for improved performance. ^ Casing and Base; Rugged thermoplastic design provides superior strength and co«osion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover; Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water,resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING S~, Canadian Standards Assouation ,_ File # LR38549 Goulds Pumps is 150 9001 Registered. -- tiv 50 GPM CAPACITY 0 z 4 6 8 10 t 2 m~/h Goulds Pumps ITT Industries ~GOULDS PUMPS ~ 1175 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in arrnrrtanra with Cnmm R5 Wic Adm Cute Steel Soil Service County Attach complete srie plan on paper not less than 8'/: x 11 inches in s¢e. Plan must St. Crooc include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north anew, and location and distance to nearest road. Parcel I.D.~~ _ /~~ 2 ~ 6 / (l/'C~ Please print all information. Date Personal information you provide may ~ used for secondary puryoses (Privacy taw, s. 15.04 (1) (m)). ~ ~ i 0 Property Owner ,:.~ ~ ~~ ~,, a ~ , ~~ ~ roperty Location Stout, Richard ovt. Lot SE 1/4 SE 1/4 S 11 T 29 N R 19 W Property Owner's Mailing Address of # Block # Subd. Name or CSM# py' 1353 Awatukee Trl. ~ __ ~~ ~ ~~~~ 16 na Misty View ~ ~0 / S~ `/ ~ City State Z Code Phone Number City Village Town Nearest Road ` ~ Hudson WI 4016' ~,~;~_._~; ; , ~`, ~>31 Hudson Tanney Lane /. New Construction Use: ~; Residential /Number of bedrooms 4 Cade derived design flow rate 600 GPD Replac~nent Public or canmercial -Describe: Parent material Outwash Flood plain elevation, if applicable na General comments and recommendations: System elevation 93.75ft, trenches spaced and depth to code 5.75ft below grade l~~~i~t't- llJs~-C.L ~-~- ~u. r .¢ l~V ~ ~$. 3 ~ l ~I3, t 3 ~j 2. S 3 ~ 3 ~ Boring # _ Boring /! Pit Ground Surface elev. 99.50 ft. Depth to limiting factor 110 in. ~( Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/itZ *EtT#1 "Efft#2 1 0-28 10yt3/2 sil -fill na na na na 1 f .0 .0 2 28-51 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 51-59 5yr4/4 none Is osg mvfr cs na .7 12 4 59-110 7.Syr4l6 none ms osg ml na na .7 1.2 a Boring # Boring ' 110 r ~ ; Pit Ground Surface elev. 99.50 ft. Depth to limiting factor in. Soil Appl~atron Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDHt2 'Eff#1 "Eff#2 1 0-36 10yr3/2 -- na na 1f .0 .0 2 36-56 10yr4/4 ~'~ Cam/-C~Gc?_c~ ~ cs na .4 .6 3 56-64 5 r4/ y 4 ~ ~~ ~~ ,~ _ ~ ~ j cs na .7 1.2 4 64-110 7.5yr4/6 ~ l / i ~ na na .7 1.2 '''rn.~f ` -~ ~ 20 ~ 3 I ~~ (~~o ~ ' ~~~ ~~~ ~~~'~` Effluent #1 = BOD ~ 30 < 220 mg1L and T~ < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) CST Number David J. Steel 248956 ~ Address Steel Soil Service nducted Telephone Number 1564 CR GG, New Richmond, W 715-246-5085 /J~'_ • Properly Owner Stout, Richard Parcel ID # Borin # ~ Boring Page 2 of 3 g ~! Pit Ground Surface elev. 97.70 ff. ~ Depth to limiting factor 110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 1 0-34 10yr3/2 sil -fill na na na na 1 f .0 .0 2 34-46 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 46-57 5yr4/4 none Is osg mvfr cs na .7 1.2 4 57-110 7.5yr4/6 none ms osg ml na na ~ ( _7 ) t2 ~.~- ~ ~. 3~ ~~~ ,- sys-~. ~- ~ 3.1 2 ~~ - ~-~ ~-~~ B3~lj~f Boring # Boring 70 ft 97 th io De limiting factor 110 i / Pft Ground Surface elev. . . p n. S~ Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= *Eff#1 *Eff#2 1 0-19 10yr3/2 sil -fill na na na na 1 f .0 .0 2 19-39 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 39-48 5yr4/4 none Is osg mvfr cs na .7 1.2 4 48-11 7.5yr4/6 none ms osg ml na na ~ ~ .71 12 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Rnrina # Boring v ST'EEL'S SOLE SERVICE David J. Steel. CST-POWTSM Lic. # 248955 `~ . ~ ~ ~~o u~-" `` ~ C G7 /' 7~ ~~ ~ ~~~Pso~ , ~-~, c~~;,~ co m,.s~y ~,-~, ~ ~,, f i~ ~~~ ~9S..Sa ~`f- CHI ~tSl.Soi'~- ~L.. `79 5a~~- B~ ~~~- ~ ~ ., ~3.~, ~ /o /4r~n~ey Gil- S~u~~~~- 1564 Cty Rd GG New Richmond, WI 54017 (715) 246-5085 (715) 246-6200 ~,2 ~[nU~ 5 !``=~°~ ~,~s~,4rk ~~•/Glo.m ~ ~df-~` ~u~ ~~ pe- rd~ d~ ~/Z ` ~7 V~- ~~ ~P.e.. ~~a~ n~ le~a~~'enS _RI V ~'cl•~v~~ Wisconsin Department o. Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division , 4 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 To nshi CST BM Elev: ~ Insp. BM Elev: BM Description: ~j ~ l f9rD. 6 /DD' ~~~ TANK INFORMATION /,/„/r/p~l d~a~ TYPE MANUFACTURER CAPACITY Septic ~~~ /~ Dosing ~~D ~ y~ h O U Aeration - Holding TANK SETBACK INFORMATION TANK TO P/L ~ WELL I! BLDG. Vent to Air Intake ~ ROAD Septic 80 ~ ~ ~ /~ ~ / r>~ Dosing ~ ~ ~- Y,Ir Aeration Holding ELEVATION DATA County: $t. CI.OIX Sanitary Permit No: 420331 0 State Plan ID No: ^ /~ Parcel Tax No: 020-1402-16-000 STATION BS HI FS ELEV. Benchmark ro p OZ 3 '~ 031 I ' AI o ~.s~ 6-~ Bldg. Sewer //-0 2. o~ St/Ht Inlet // • /, 3 St/Ht Outlet l / Dt Inlet ~ l Dt Bot '3 ~• Header an. •~~ Dist. ipe ~ / - /a•~ O/3 •S eot. System I ~ 0j'~ .3 Final Grade p d ~j~ 3 St ver ,~ JT dd ~~ 5^ ~9 I~~ O~ /7 -~" r>->L v PUMP/SIPHON INFORMATION f W~= C-Gt/~.1~~-/jc~Sfl-~1,tS~. Manufacturer i-. _ Demand G'-~ GPM Model Number ~~ TDH Lif Friction Los System H~ TDH Ft ~, 3~ -? l3 Forcemain Ler~gt ~ Dia. Z ~, Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH DIMENSIONS Width ~ + a Len th i ~ ~~ , 000 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L j BLDG WELL LA EiS REA LEACHING CHAMBER OR Manufactu - f~ Tyge Of Syst~~~•~'~ 1 ~ ~ , 1 ~~ 7 v UNIT Model Number: f~ DISTRIBUTION SYSTEM /~ ~ t~,h ~, ®,~~ ~''~^ /"~"' r"~Ov`e- /-j/,~/L. Header/M ifold Distribution ~~ x Hole Size x Hole Spacing Vent to Air Intake 1 ~ Pipe(s) 5 li ~ r ~• ~-~ '~_ Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ b0'~' v BedlTrench Edges Topsoil ~ Yes ~ No J Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/~ Inspection #2: ~7 /~/ Location: 778 Starlight Ave Hudson, WI 54016 (SE , I4 SE 1/4 11-.T/2~9N R1,9,/W~)~Misty View Lot 16 ~~/~( I P r 11.29.19.25 ,7,~Q,.~ p _ 1 cY ~ ~Ukl~ l~~i(n~ ~1M'~K- ~ (it~f!'.v~ Gl'IRiY~'tloe/ -~'pCG/~t~ -'~ry7~~.J ~~~" '~ °" Paz. 1. Alt BM Descri tion - ! ~ ~J F S/.~7c-vti ~ U 2.) Bldg sewer length = ~ $1 ~~ ~ V I' G. ~ P 0 ~ I '~.S'0• ~a ~~~~e~ - amount of cover = ~ 3) ud $Oi ~ Iti, _ I0 0?/ --r---, __......_ _ - --- ---~ r--- --~--- Plan revision Required? ~`, Yes [~ No i ~, ~ ~~i ~ < i ~~, Use other side for additional information. !___~` ~~- _~ _ _.__ G~!/J~1~_ ___._l ~ ~ -_~__ __. SBD-6710 (R.3/97) Date Insepctor's Sig ature Cert. No. C~1Ro~f2 Safety and Buildings Division Washington Ave., P.O. Box 7162 201 W C°u°ryCC ~.J ~ ~.~-V"~C.~ . sin Madison, WI 53707 - 7162 " Site Address 77 ~ ~ a `. ~ ~ r ~ . ~ cou ~~ R' ent of Commerce De ' ~ Sanitary Pe Number Sanitary Permit Applica ~' ~ ~~~ ~.T Z©3 ~ ~ 3 Ia accord wilt Coatm 83.21, Wis. Adm. Code, personal info lion ~o provide Check if Revision ma be used for seco ses Privac Law, sl 1 m I. Application Information -Please Print All Information -; ~ ~,) rate Plan I.D. Number Property Owner's Name 1 Number Property Owner's Mailing Address P roperty Location l ~ S~ u~ ;S l T N,R E City, State Zip ode Phone Number Lot N r Block Number Subdivision N CSM Number 1 °~ ~~r ~~ /~~~ - ~~ 5 NM cLS (check all that apply) ildin iry ~ ~ g II. Type u ~1 or 2 Family Dwelling -Number of Bedrooms 5" ^Village blic/Commercial -Describe Use ^ P o~~P // u R d ~1 J ^ State Owned - I/ - ~~ r oa Barest / ~ `° ~ III. Type of Permit: (Check only one box on line A (numbering scheme om etc line B if a livable) P PP A For County use 1 New 2 ^ Replacemem System 3 ^ Replacement of 6 ^ Addition to S stem Tank Onl Exis ~ stem Permit Number Date Issued B. ^ Check if Sanitary Permit Previously Issued N. Type of Permii: (Check all that apply)(numbering scheme is for internal use} 44 jJQ Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filur 50 ^ Constructed Weiland 22/^`pressurized In-C,round 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Crrade 46 ^ Aerobic Treatment Unit 49 ^ ecirc a ~ g 3 ^ ~ V. D' rsal/'I`reatment Area Information: GNU Design Flow (gpd) Dispersal Area Dispersal Area oil Application Percolation Rate ystem Elevation Final Grade ) (Min./Inch) T ' 93,$~ Elevadoa Ft s/Sq /Da ls G R . . y . a ate( Required Proposed ~ D 8~ ~ ~~ ~ a = 9~, Ca i in Total Number Manufacturer YI. Tank Info P~ ty Prefab Site Steel Frber Plastic Concrete Constructed Glass Gallons Gallons of Tanks New Existing Tanks Tanks Septic or Holding Tank - ~ OV t/~ ~ Dosing Chamber VII. Responsibt7ity Statement- I, the undersigned, assume nsibility for installation of the POWTS shown on the attached plans. usiness Phone Number B plumbe 's Name (Prin//t) Plumber' gna __~~nn(( RS Number 7 G~~ L/'~ ~~~ ~ // - ~ r Plumber/s~Address (Street, Ciry_, Sta~Codc) ~ V ~ ~ ~~~~ ~ ~~~ VIII. Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) roved Approved ^ Disapp Surci Fee) ~ ^ Owner Given Initial Adverse Z2~~,~ Q (ZtBL Determination 1X. Conditions of ppro al/Reasons for Dis~prloval 1 i (' ~S ~~ ~ #3" ~Q~ SOt .~. sys~ew. ~s h~abJ_ 'to 1ry.~ l - ,T ~ ~C~ ---- ~~~ y- ~- N~ ~¢-/Ov i y ~~- Tom. a- a~.- ~ ,~ a - a /,zoo MoD 7-~ ~3~ ' ~-- ~ ._- . ~ w~-~-s~ ~-/ .83,,5'0 'N /J~, y0 i ho7~ /~ U.cn.~.~ ~ .ate /~~ ~a- y- ~- N~ ~¢ -/av a - ~y G1~- T""~. Qom.- ~ _ ~ a -a= ldoo ~''Q r SOD 7~~ ` ~ ___-, _---- * ~ u~~ 'N i~" yp tip` /~ ,~..,;~ v,~- ~ .~ ~~ ao3s7 VYscons'~hrtent of Commerce Ditasion of Safety and Builydinos SOIL EVALUATION REPORT -_ Page ~ of in accordance wrath t;omm ts5, wis. Aam. t,oae Coun ~ ~ , I Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must inducts, but not limited to: vertical and hor¢ontal reference point (BM), direction and Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. percent slope , Please print all information. R viewed by Date Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). ` tl Properly Owner Properly Location ~,~ Govt. Lot S E 1l4 ~ F 1l4 S /( T Z l N R/~ E (or) ~ Property Owner's Mailing Addfess Lot # Block # Sulxi. Name or CSMff 135 ~! e Trot J ~ Mrs U~ef,J City State Zip Code Phone Number ^ City ^ village [~'TOWn Nearest Road d l1.)1 U ('I l ) ~-i - Son n ~G ® New Corfstniction Use: [~ Residential / Number of bedrooms 3 . y Codi~*derived design flow ra ~ ~ o ^ GPD Public or commerdal -Describe: ~ ^ Replacement ^ I Parent material ~ U "1-w4-S ~ Flood Plain elevation if appli _ ° •~~ '~ ft: + General comments S Y $"~ r~ ,G(-2.~ ~ 9~/~ O U Low < ~ 4 3 . 6 ~--- ~ ~ ~, ~, ~ ~ - <, t and recommendations: ~, L ~, . ~, (.e V ~ Q'U , `FSO la w ..~ r `f ~' ~ 3 --i , . ~R~~ ~ ~ .~' ~ ST CROlX ~ ~ r;.` `, COU+yTy ..,r '" ~' ' ZONINGOFFfCE / ~, ~= ~~ Boring \ ' _.-_ _~ ,:_ . BOri # ~ f; r~ I V t SC1 ~ ~ pit Ground surface elev. Q ~• ~ U fL Depth to limiting factor ~~~ in. ~ `~.~~ Soil ication Rate n H i D th Dominant Color Redox Description TexWre Structure Consistence Boundary Roots GP D/tt' or zo ep in. MunseA Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 J -J r z it Zmc•.bk m r cs 1 v.~ . g 3 2laa i6 10 r `I~c~ frl s ~ I - - ~ -i l . 2 ~ ~I.o ~ S•6 8(.l~ ~J [.._ Boring # ~ Boring ~i ®pit Ground surface elev. 7 ~• ~ ft Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP DHf? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eft#2 I a-13 IZ 2mabk mfr cs Ivy ~ 5 Z 13-~ 4~ Sil k ~r cS - ~ 5 0 * Effluent #1 = BOD > 30 < 220 moll and TSS >30 < 1 50 ma/L 'Effluent #2 = BOD. < 30 m(t!L and TSS < 30 mgtL CST Name (Please Print) Signature l~ CAST Number cjl~tY, hu r ~ [... address Date Evaluation Conducted Telephone Number 21 t3 ~lJ'~ ~ ~nY,_~~-1, ~~ i 5y~ . G~-{~---t,-/ Cl I ~~ 2~4~ - y~ 8 Property Owner ~~'T~ 1-1- Parcel fD # .~~ ~„ri...~. ~ ^ Boring _. -, ~J Q Page Z of J i ~ ' Vv....y .. ®Pit Ground surface elev. ~f,~. ft. Depth to hm~ting tactor i ~- v in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. Soil lication Rate GPD/fP 'Eff#1 'Eff#2 I 2 O- 1 0 r.3~2 1 5~ ~~ Z 2 abk m~-' ~ 5 c Iv-~ - . 5 5 8' ~ 3 _~ ~ p m S Os - - . -~ i. z ~~ # U BOring ^ Pit Ground surface elev. ft Depth to tbniting factor in. Soil IiCation Rate b i t C D Redox Description Texture Structure Consistence Boundary Roots GP D/1f Horizon Depth in. r nan o om Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Pit Ground surface elev. ft. Depth to i®niting factor in. a~~# ° B°~ Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ig in. Mansell Qu. Sz. ConL Color Gr. Sz. Sh. 'Eff#1 "Eff#2 • Effluent #1 = BODS > 30 < 220 mglL and TSS >30 _< 150 mglL ' Effluent #2 = BODS < 30 mglL 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 608-266-3 I S 1 or TTY 608-264-8777. san-asao crt.a~roo~ tJwner ~~ ~-~ 3 eor;ng # ^ Boring ParcellD # ~2g Page Z ~ 3 ® Pit Ground surface elev. _~~L' ~,5~ ft. ~eP~ F0 9'a"`Df "~. th Dominant Cob Redox Description Texture Stnx:ture Consistence Boundary Roots Hor¢on De Soil nation Rate GPDIPF p in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#'1 "Eff#2 I r3lz 5' 2 ~-' ~5 Iv-~' ~5 8' 2 1 i t 2 abk ~ - 5 ~ 3 _~ 10 mS Os - - . ~ ~' 2 ~~ # ^ Bonng ^ pit Ground surface elev. ft. Depth b limiting factor in• Sal lication Rate Horizon Depth Dominant Cob Redox Desa~»tion Texture Sfnxiure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz Cont. Cobr Gr. Sz Sh. "Eff#'1 `Eff#2 ~~ # ^ Boring ^ pit Ground surface elev. ft. Depth b l~niting factor in. Soil lion Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz Cont Color Gr. Sz. Sh. "Eff#1 "Eff#2 'Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mg/L " Effluent #2 = BODS < 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 alten~ate format, please contact the department at 608-266-3151 or TTY 608-264-8777. 581~8330(R.O7/00) . ~'. ... PAGE~OF 3 NAME ~Tac.3 T LOT# ~~v T EGAT. DESCRIPTION 5& ~5 F i4 ,S !l TZ ~l ,N,$„ 1 q~.(or)~ SCALE: 1"= ~,/D ~ ~ BM 1 ELEVATION j/~ • O BM 1 DESCRIPTION ~p a~ ~Q-E-h z " I.~,w c,, BM 2 ELEVATION q~, 3 0 BM 2 DESCRIPTION arp o~ ~~~ Z " /,C.~ ~, SYSTEM ELEVATION ~ ~ P`7! py Goc..< r 93. Sv ALTERNATE ELEVATION •FGpYO.~ Gow s~" cjl,• 3D CONTOUR. ELEVATION 9G•so, Y~,~ ~ f5f• SO 5 ~~ LI 1 ~ I x. g,h Z B,N.I D~~ ^ a3 ~ / dz .~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner Permit # 33 DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units - ^ NA Estimated flow (average) Q al/da Design flow (peakl, (Estimated x 1.5) QQ al/day Soil Application Rate v al/day/ftZ Standard Influent/Effluent Quality Monthly average " Fats, Oil & Grease (FOG) <_30 mg/L Biochemical Oxygen Demand (BODS) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) <_30 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) <_10° cfu/100m1 Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity Q al ^ NA Septic Tank Manufacturer ~ ^ NA Effluent Filter Manufacturer r ^ NA Effluent Filter Model - (~ ~ ^ NA Pump Tank Capacity al A Pump Tank Manufacturer ~NA Pump Manufacturer ~ NA Pump Model ~ ~ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ~NA Dispersal Cell(s- In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ (~q MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ea~(sj(s) (Maximum 3 years) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cellls) At least once every: ^monthls) (Maximum 3 years) Q~ ~ year(s) ^ NA Clean effluent filter At least once every: ^monthls) year(s) ^ NA ^monthls) ^ NA p p p, pump controls & alarm !ns ect um At least once every: ^yearls) Flush laterals and pressure test At least once every: ^ monthls) ^yearls- ^ 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 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 one-third IY3) 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 51 Z 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 andlor damage the dispersal celllsl. 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 will be discharged to the dispersal cellls) in one large dose, overloading the celllsl 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: l~], 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 andlor 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 not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be 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. ^ 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 ~ ,. ,- POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ,S ~ ~Cp-~ Phone ~ ~' - 3 U ~ ~ y~ This document was drafted in compliance with chapter Comm 83.221211b11111d1&Ifl and 83.54111, l21 & 131, Wisconsin Administrative Code. • sr tLRO~ ~~ A SBPTIC TANK ~ OWNBRSHII' CBRTiFICA'I`ION FORM O~/Buytx c~E ~ ~~ rr,~ s~ 3 Mailing Address ~~ ~v.~ Andress from Planning Deparm~t Prop~Y (yerifieation required for acw constrncti~ ~oi.3 -~ - o00 p Zo -/o•/~ -/o - ooa City/State ~ ~- ~'+/-~ Parcel Identification Number T R.C~AIi D~SCR~- ~~ON ~ ~j ~ ~ ~J Location ~ %•~ G ~~•~ Sec. ~., T____LN ~sl---~-w' Town of Prop~Y Lot # ~~ Subdivision ~~~ Volume .Page # Certified Survey Map # . arras. Deed # ~~ ~ ,Volume Page # ~ 'W ~' Lot lines id~tifiable I~Yus ^ no Spec house~Y~ ^ no / ~.vc•tR,+l« MA1NTk'~1TANCE p~~ucctohandlewastos.Propernuaintenaaee a7 Z 1 isl a s. useaaa~aceaa~~ofyours~tiosyste~~o~a~ulttnnsprema ~ty~ p~;~ ~ sy~«n Qoasist~ aft ant the scpa~ tank every three or sooner, iif needed by a liceassed P~ can affect flue function of the septic tank as a treatment stage in the waste a certification forn~, s>g bY~ The pmpeity owner agrees to submit to St. Croix Zoning Department , that (1) the on-site masb~p J~y~pl resfiictalplamberor a li~dpnanpervenfy~ the tic tank is less than 1/3 full of shidge. conditionand/or (2) after inspoctioa and pmuPiag C~ n3')' ~ is is proper opesr-t~ yo maintain Private ~ ~p°~ with the standards T~ the ignod have read the abonr+e rzgnircmeats and agree ~ artrnent of Natural Resources. State of Wisconsin- Cert~~ set facto, herein, as set by the Department of Commerce and the l~cted and turned to the St. Croix County Zoning Office w~thia 30 ~~g that your septic system has been maintained must be comp days of the year iration date. . ~,~ oZ --~'~- DATB SIt#NA'I'~11t13 OF APPLICANT OAR G'`Ci RTITICAI'ION our knowledge. I (we) am (are) the owner(s) of I (we) certify that all statements on this form are true to the best of uryo( Deeds ~~. ~ p~~cy 'bed abov y virtue of a warcaaty deed recorded in Register 8' ~ / / DZ- DATE SI T(JRB OF APPLICANT ««s««« Any information that is m~is-rtod ataY t+esuit is the sanitary pmt ~n'g ~O~ by ~e 7.oning Dq~ .««««« «« cation: a atampcd warranty flood from the RfDB~ of Deeds oSice Include with this appli a ~pY of the certified survey maP ~ reft~+~ee ~ ~~ sa ~° Y decd ~~ 1 0 STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED DOCUmenl Number I This Deed, made becween - - _RICHARD 0. STOUT and JANET P STOUT. __ __. __husband and wife. _~_. _- __ _ ___-_ ____ Grantor, and __. M('('ARF.. - _____ _ Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate fn St. CroiX County, Slate of Wisconsin: Lot 1 Plat of M~,ty View, Town of Hudson, . CroixCounty, Wisconsin. FF~~- ~~ 020-1013-30-000 n~n_1014-10-000 Parcel Identification Number (PIN) This 15 riot hornestcad property. (is) (is not) Exceptions to warranties: Easements, restrcitions, rights-of-way and covenants of record. Dated this ~~~ day of , July 2002 ~ic.Jl)~-~..aLU1 \ ~ (SEAL) - ~ _ _ (SEAL) Richard O. Stout Janet P. Stout __ AUTHENTICATION Signature(s) (SEAL) authenticated this day of 6 6 4 4 8 5 HATHLEEN H. WALSH REGISTER OF DEEDS ST. CRDIX CO., 1iI RECEIVED FOR RECORD 07-18-2002 10:00 A!1 f~RAANTY GEED EXEiIti>T it kEC FEE: 11.00 TRANS FEE: 173.70 COPY FEE: CERT COPY FEE: PAGES: 1 Name and Return Atldress ACKNOWLEDGMENT (SEAL) State of Wisconsin, ss. St. Croix County. Personally came before me this _ __ day of July _?002 .the above named Ri rharA Cl _ A not and .T3Ilet_...P T[TLE: h1EMBER STATE BAR OF WISCONSIN me known to be t~~ (If no[, authorized by §706.06, Wls. 5tats.) Instrument ac nov THIS INSTRUMENT WAS DfiAFTEO BY Janet P. Stout 1353 Awatukee Tr. __ Hudson, WI 5401 6 Notary P lie. State of My co mission s F (Signatures may be authenllcated or acknowledged. Both are not _ necessary) • Names of pe.rsortc signing to any wpaclry muse be typed or prlnred below their signauve. STATE BAR OF WISCONSIN WAkRANTY DEED FORM No. 2 - 1998 ~1~s~y-,~~~1~i~~e foregoing 1ft7fYeU. BAST ~. (lf not, state expiration date: Wisconsin Legal Blank CO.. Inc Milwaukee. WIS. LJ~ ~ ~ ' Q~ ~ I j LOT 14 ~' L'I ~ 2.000 ACRES ~~ ( 87,126 SQ FT ~ ----------- ----- of --- . I I IOP w a; ~ ~ III ~ m C~'t~ ~I ~ ~ I ~ I ~`e~ a ~' ~ o I h I tfle ~! ~; ~o olll F °- I ~I v ° $ °~ I I I ~'~ III ~.., I i"• ~ III L T 1 ~ O 5 III 2.001 ACRES ~ ~- _ _ _ III 87,147 SQ FT . paG3C~C d as dodo ~ ~C~~~,_pLaC~~_f] 6~ s ( I MIN. FLOOR I I ~889°3o'oo'w~ ~ ~ ' I ELEVATION 889°62'38WV 556.96' --~~y`~ OF 913.00 ~ ~ ~. ' ' -~~ - ~. • 161.67 - i 622.82' i ` -/ ~ ~ v~\~~ -I ~ *; MIN. FLOOR ~"F ~/ ~ Q• .' ELEVATION ; ,' ~ ~ / I OF 913.00 s' e• r ~ • ~ . ~ • LOT 17 ~~,, LOT 16 ~ so m~ a ~ o~•. I 2.008 ACRES a ~``> 2.008 ACRES ~ ~ ~ ~ ~~~ ry •~ / i 87,463 SQ FT A ~``~~,~ 87,460 SQ FT ; / ~ ~ 4' a ., ~ ~N~• /~ 312.66' ~ ~ z61.e9' ~. G ~~ off` . / ~.. a S89°24'37"W 694.66' - - C8 @e~~ '`~ ~ C ELEV/ m STARLIGHT 914.6 m N89°24'37"E 696.44' ~~ ~ ~ ~ 'i 316.49'* N 279.95' ~~\ \\`~\ ~ \ \ . MIN. FLOOR ..- -..~..-..-..-..-.._..-.. ,. ~ ~ \ ( ELEVATION OF MIN. FLOOR \\~~~ - \~~ \ ' 898.00 pZ ELEVATION OF ~ •'~~~ ~~ \ ~ I S 900.00 a •. ~ ~ - ` \ i LOT 2 w 2.5000 ACRES \~ ~ g~' ~ oe6O°9oa so ~ ~ 108,892 so FT N ~-g~ . C ~ ~ I A N 1 1- ym? ~~ .~ 1276.52' '~' • % ~ ~ ~ LOT 4 ; .' , a 6 6' N01 ~ 320.12 ~ -~ i 2_001 ACRES ~` to m