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Please advise if more information is needed or contact Pinky's Sewer Service if needed. Thank you. Stephanie Taylor Project Coordinator Glen Johnson Construction Inc. P.O. Box 809 Hudson, WI 54016 ST. CROIX COUNTY WISCONSIN PLANNING & ZONING OFFICE ��'• ff M / /II�M■ rrrr� COUNTY GOVERNMENT CENTER w 1101 Carmichael Road f A " Hudson, WI 54016 -7710 (715) 386 -4680 FAX (715) 386 -4686 April 13, 2005 Steve Nelson 774 Mound View Road Hudson, WI 54016 RE: Non - compliant POWTS installation, Town of Hudson, St. Croix County Parcel # 020 - 1433 -01 -000 (11.29.19.2689) Dear Homeowner: This is to notify you that the septic tank component on your Private On -site Wastewater Treatment System ( POWTS) was installed in violation of Comm 83.26 (2), which states that "no part of a POWTS component may be covered nor any POWTS component put into service until the governmental unit (St. Croix County) has had an opportunity to inspect the system ". The septic tank has been used as a temporary holding tank without prior county notification or approval. The building inspector was told that a servicing agreement with a licensed pumper had been obtained to facilitate the final construction inspection and allow approval for occupancy. A copy of this pumping agreement and receipts for tank pumping must be submitted to the county to document that this violation has been abated. The remainder of the POWTS was installed and inspected on 4/13/05. The leaching chambers were installed on the westerly portion of the soil - tested area, with additional replacement area preserved between the tank and new dispersal cells. The building sewer and septic tank inlet had been covered during installation, so elevations recorded on the county inspection report are based on the plumber's estimations. The septic tank size and manufacturer should be a Wieser 1,250- gallon model, as proposed on the approved permit. Should you have any questions, please contact me at this office. Sinc amela Quinn Zoning Specialist Cc: B ' Wert, Town of Hudson Building Inspector j,an en Johnson, Glen Johnson Construction, Inc. Leroy Jansky, Dept. of Commerce Regional Wastewater Specialist Bill Schumaker, POWTS Installer file P.O. Box 43 • Stillwater, MN 55082 651- 439.4847 • 651 -436 -5788 • Fax: 651-769-0584 Attn: Amanda 3 -30 -05 On Monday April 4, 2005 Pinky's Environmental and Sewer Service will go to address 774 Moundview Road, Hudson, WI to check on septic tank and evaluate whether it needs to be Pumped. If it needs it, we will pump the septic at that time. Pinky's Sewer Service PO Box 43 Stillwater, MN 55082 651- 439 -4847 "Trusted & Recowwwnded for Ovcr 40 Ycars" z.d e26 :11 SO b0 Rew g i ft PINKrS SEWER SERVICE, INC. P.O. BOX 43 STILLWATER, MN 55082 439 -4847 777 -4005 - 429 -4266 FAX... FAX... FAX... FAX... FAX Date: _ 3- / To: .1A) r Company: f vtU1 FAX Number: 1 7 1 5 - c - f PINKY'S ENVIRONMENTAL & U1-)' PINKY'S ENVIRONMENTAL & SEWER SERVICE, INC. 3 t 3 SEWER SERVICE, INC. P.O. Box 43 STILLWATER, MN 55082 3-f �.0. Box 43 STILLWATER, MN 55082 Phone (651) 439 -4847 (651) 777 -4005 Phone (651) 439 -4847 (651) 777 -4005 (651) 429 -4266 (651) 429.4266 0 Y ❑ATE y 6 - S SOLD BY (� DATE `l ` 1 ] - O l P ' O QX V \ AA 6 CASH I C.O.D. I CHARGE ON 7 CASH I C.O,D I CHARG ON A a� ............... RECEIVED BY RECEIV ED By All claims and returned goods MUST be accompanied G by yt this bUL All claims and returned goods MUST be accompanied by this bill. 3985§ ® To Reorder. < �ank 7hank 800-225 -6380 or neba.00m `You 39878 To Reorder, 800.225 -6380 or nebs.00m G YM * If this transmission is not received in good condition, please advise our office at ( 439 -4847 immediately. &S "Trusted and recommended for over 30 years" i 4594986 p.2 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cro w-----, S and Building Div j iSn �Sani Permit 463198 INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) tate Plan ID o: 0 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Beer, Richard I Hudson Township 020 -14 3 -01 -000 CST BM Eiev: Insp. BM Elev: BM DesEpilign Section/Town /Range/Map No: L(>0_0 (6 ' - rw, 11.29.19.2689 RMATION ELEVATION DATA TYPE MA UFACTURER CAPACITY STATION BS HI FS ELEV. e tic / `r M Gl.GI _ VU ! 2 Benchmarks 0 3 7 lo/, Dosing / C0 t n z Alt. BM g � Aeration Holding SUHt Inlet �, �/ � G �-.• � TANK SETBACK INFORMATION 1/I f S u e� TANK TO P/L BLS Vent to Air In take ROAD Dt Inlet Septic D / > p Dt Bottom Dosing / 3 a - e r • R 5 Aeration Si Dist. Pip o� �a� 6 Holding Bot. System Z I J � -" 23 r 11 b �•� • Final Grade PUMP /SIPHON INFORMATION ,P� 8 S /�• Manufac lul er Demand St Cover q GPM !- -�--'� DD . l Model Number pyL o24, 6 TDH Lift >101i Loss System I DH Ft Forcemai ength Dia. Di st. to well J SOIL ABSORPTION SYSTEM - 2 Z+ - _ Z 3 GL BED/TRENCH Width ) Length No. Of Trenches PIT DIMENSIONS N& Of Pits Inside Dia. Liquid Depth DIMENSIONS S c! 1 1 SETBACK SYSTEM TO ( 1 1 1?1L _ W 113LD JWE LAKE /ST M ACHING M�tarsr an n f INFORMATION CHAMBER O Type f System: . V U Model Number. 1 PSTT� BUTION SYSTEM rt (•!/tJ Header/ nifold Distribution .L x Hole Size x Hole Spacing Vent to Air Int ke h Pipe(s) S + I ' + _/ g h Di a Length Dia 4 { Spacing �' SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over r Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 7 Bed/Trench Edges Topsoil Yes No Yes [ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: -/ 3 / Inspection #2: Location: 774 Mound View Road Hudson WI 54016 ( SW 1/4 NE 1/4 11 T29N R19W ound View Estates Lo Parcel 1 l No: 11.29.19.2689 1.) Alt BM Description // _,, ,1� � 2.) Bldg sewer length dY��lL� amount of cover =� + GCI y s IVW -- , 1 7� 469 M4LIE 1- Plan revision Required? Yes o / 3 OS Use other side for additional information.__ SBD -6710 (R.3/97) Date Insepctor's Signat re Cert. No. rte. ST. CROIX COUNTY `�. . � WISCONSIN PLANNING & ZONING OFFICE �•�• � / /N / /NAM■ M���r_ COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson WI 54016 -7710 (715) 386 -4680 FAX (715) 386 -4686 April 13, 2005 Steve Nelson 774 Mound View Road Hudson, WI 54016 RE: Non - compliant POWTS installation, Town of Hudson, St. Croix County Parcel # 020 - 1433 -01 -000 (11.29.19.2689) Dear Homeowner: This is to notify you that the septic tank component on your Private On -site Wastewater Treatment System ( POWTS) was installed in violation of Comm 83.26 (2), which states that "no part of a POWTS component may be covered nor any POWTS component put into service until the governmental unit St. Croix County) P P g ( has had an opportunity to inspect the system ". The septic tank has been used as a temporary holding tank without prior county notification or approval. The building inspector was told that a servicing agreement with a licensed pumper had been obtained to facilitate the final construction inspection and allow approval for occupancy. A copy of this pumping agreement and receipts for tank pumping must be submitted to the county to document that this violation has been abated. The remainder of the POWTS was installed and inspected on 4/13/05. The leaching chambers were installed on the westerly portion of the soil - tested area, with additional replacement area preserved between the tank and new dispersal cells. The building sewer and septic tank inlet had been covered during installation, so elevations recorded on the county inspection report are based on the plumber's estimations. The septic tank size and manufacturer should be a Wieser 1250- gallon model, as proposed on the approved permit. Should you have any questions, please contact me at this office. Sine amela Quinn Zoning Specialist Cc: Brian Wert, Town of Hudson Building Inspector Glen Johnson, Glen Johnson Construction, Inc. Leroy Jansky, Dept. of Commerce Regional Wastewater Specialist Bill Schumaker, POWTS Installer file n O 3 v n tv O �1 w f a) ° �1 (D ' D) (D r O r• A'+ O C:) 0) W C C/) - N O N • 3 C2 m CL iv ° A O .3-. O m O y O ° O 0 ° A ►+ W (D 3 c c o OD =r O N O" O O N ° O D co C: CD a O J K 7 fll V O O CD cQ D cQ A w a s j . t� Co CL 3 °- a a m O O CD w o � l� i (\ Z Z O N N O (� O O c Cl O CL j ca C Q V7 O. d h z m 000 ° �• o Cl) c n c c r CO) N CO) o �f 3 3 cr ? v v m N I CD ro 3 m m 0 (D Q 3 3 C N 0 3 3 co o D 5 Z y O _, O o o co • m ° (D p c c C n m W N A n. 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CC t PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space is needed, please attach addendum): game and Return address Lot 1, Plat of Mound View Estates in the Town of Hudson, st. Croix County,, Wisconsin. Subject to the temporary sign agreement set forth in that certain Warranty Deed between Richard L. Beer 020 1433 -01 -000 and Phillippine U. Beer Parcel tdentitication Number (PEN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated l �"� r Glen Johnson Construction, I (SEAL) (SEAL) « *BY: Ghod �VA-5& a (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OIL ) - j '' ' • :, r ,�'— =''*�% V`'. �( � ss. COUNTY � TITLE: MEMBER STATE BAR OF vYdSCO IN Personally came before me on (If not, the above -named Glen Johnson Construction Inc. authorized by Wis. Stat. § 706.06) By: Glen E. J hnson, President to me known to be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: rument and know g the same. Attorney Kristina Op-land Hudson WI 54016 Natary Pu 14T State of My Commis n (is permanent) (expires: (Signatures may be authenticated or acknowtedged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO -PRO^" Legal Forms 800.855 -2021 www.intoprolorms.eom U; 2732P 145 j State Bar of Wisconsin Form 2 -2003 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number Document Name ST. CROIX CO.. VI RECEIVED FOR RECORD 01/18/2005 04:15Ax THIS DEED, made between Richard L. weer and Philipeine U. Beer, husband and WARRANTY DEED wife ( "Grantor," whether one or more), EXE z and Glen Johnson Construction. Inc.. a Minnesota Corporation REC FEE: 11.00 ( "Grantee," whether one or more), TRANS FEE: 240.00 COPY FEE: CC FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee the following PAGES: 1 described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Name and Return Address Lot 1, Plat of Mound View Estates in the Town of Hudson, st. Croix County, Wisconsin. Seller reserves the right to maintain the sign L advertising "Mound View Estates" until such time as the second phase of "Mound View Estates" is sold out. oza1a33- Parcel Parcel Identification Number (PK The sign shall remain in its present location. Once all of the lots in said second phase are sold, the Seller This is not homestead property. shall remove said sign. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any, Dated (SEAL) ' (SEAL) * *Richard L. Beer (SEAL) Q L V� 4�� (SEAL) * *Philippine U. er AUTHENTICATION ACKNOWLEDGMENT Signature(s) ,-'� ;El "� ) authenticated on r STATE „ ) ss. ' ". 'jin COUNTY ) S TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on (If not, the above -named Richard L. Beer and I'ftiiigpiae CJ. Beer, authorized by Wis. Stat. § 706.06) husband and Lvlfe tol me known to bet erson(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: Wn,a the same. Attorney Kristina Ogland Hudson. WI 5401 * L Nota;y c, State o My Comm Sion (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 " Type name below signatures. INFO -PROW Lao Forms 800 - 855 -2021 www.Intproforma.com La 3 Zo tw o �� 2) o � i 2 • § \ ; 3 i J %I� 2 ■ 2 @ § i § 2 [ ° A E C 7§ . - ID r - S. �� =�� k / o \ \ a ! 2 $ O E E 4 a S E JA § 0 ° @ v > f R @ 0 V A CD 0 § � ® ƒ C) \ z % § B n r ■ a ■ o c CL c §' [ 0 0 0 0 , = 2 3 3 k ƒ \ i -0 a 2 I § �(D E {kk \ M to / co . § E o w R o \ n (n {N 3 7 } � CD § k/0 CO f 2 E CL p 2 . � C/) § Ix z M \ � /f k � 0 =r U) F$gEgEt± i @ ° °F 2C -0m —:3 CD § a /! { =� =0) 0EeE7& E= §?E \ /E[\ / /a; C ®# 5� % CL =bCD ( D Z % / \ \� \ } = C§ U) i fk § § ® % \ /E . @fm ��a o a a ■ CD =r 0 ; ƒiE[]�0W P= E\RzE § § /m& o a ; ±0 Z °E § rP22+ §Ekmgf q _� =EEgEj,< 7 \0 0(c= aE 3 §ƒ 3L : 3 /iD \ 2ki�[CD mg P� ® . m 0) C ■ o « < § \ p ? § 8� �7 Safety and Buildings Division County ' ���� � 201 W. Washington Ave„ F.Q. Box 7162 i ,5consn Madison, WI 53707 - 7162 Sanitar ermit Number (to be filled in by Co.) De artment of Commerce (608) 266 -3151 Sanitary, Permit Ap lic�l State PlanIrD<Number In accord with Comm 83.2 Adm. Code, perm al inf "* rmation you prov;P Is may be used for s ndary purposes Privacy aw, �5A 4(1)(m) Project Address (if different than mailing address) I. Application Information - Please Print All Informati n ' ST. CROIX COUNT 0- O — Property Owner's Na me FIC Parcel 11 Block A' K I __ t _ Property Owner's M ailing Address s -_ [�� Property Location 2& �V _ SC� '/k,Section 1� City, State = 4 � +Phone Number k (circle ) T N; E II. Type of Building (check all that apply) R�� � . , 1 0( 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number Public /Commercial - Describe Use _ ]State Owned - Describe Use PI S T . C,✓Z - � w 2 Z 3 Gcity Evinage Xt ownship of — - III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' CirNew System ❑ Replacement System ❑ TreatmentiHoiding Tank Replacement Onlv ❑ Other Modification to Existing System B. ❑ Permit Renewal Permit Revision ❑Change of i_.i Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner / f0 V / b O I V. Type of POWT S ystem: (Check al th at ap ply) 7 N - Pressuriz i ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in, of suitable soil ❑ At- Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground E Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter X Jeaching Cham r ❑ Drip Line ❑ Gravel -less Pipe ❑ Othe p V. Di s rsal /Treatme Area Infor ration: _ Y - Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (st) Dispersal Area Pr System Elevation VI. Tank Info Capacity in Total Number Manufacturer T Prefab Site Steel Fiber plastic Gallons Gallons of Units Concrete Constructed Glass New Existing I Tanks , Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statem 1, th undersigned, assume respo nsibility for ' • aUation of the POWTS shown on the a ttached plans. Plumber's Na me (Print) Plumber's Si gnature i M ✓MPRS Number Business Phone Number Plumber's Addre ss (Street, City, State, Zip Code) 1 VIII. ount IDe artment Use Only ' ❑ pproved ❑Disapproved _ Sanitary Permit Fee (includes Groundwater - -Date Issued I mg Age n Signature (. mps) Surcharge Fee) ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reason$ for Disapproval A '(1 s s C L� t (Ail t complete plans o the Count aly for th s stem, on paper not less than 81/2 x 11 inches in si SRn -f�39R (R. 01 /f13, 3►0 4 f v J-D 0 (7 - so re.� C3 j0l/ �4t�ACRES R. (1"7 SO. FT.) L.B.O. 9i7.o z. 4 • 1 _ j/I S .. � �, ,�,. _ ... �4• � i ��tin w �. / Y yy 243 .�. ' S 1. . (14786 SMM) LBA T• � ' I s i J t w. ►' `� tot SF 1/4 LJNE wo-o � � •� Y LA fJ V @ UMLb v./ V V V Y V" S O - t�rJ� t i"�? �' • Seva2 w Mai" t t 4 I ), w LL i .. ° t i ! . L �'. •+ R yS T) ♦ �. 5 : ;} i d $ H y. l L A .�i p 2 d Hi J< A 7 �5r• aJ'F' J� A 1 .Y i t�j �v 8� t � Y 'ks✓'�f + � � S y ,. , c � � �u� 7 �ws � 4:ls .+Y • . �• � ..,, �,r � t. Z�� 4 �`scv. ;Ar" �, 0 i ) � .�. {' a , . .... ,� .. �.p . r, �s,,,�±1!'! =`� ay'�3';a +� «'� '���i�' .�•°� 4 .,a.`.�`3 `�. �'..= w ... ''•t'�. r - I,ta" "i PAO R _ NAME c.`' LCTO I LZOAL Ds SCRIPTION TZ'f N R E oR 'SCALr. SM 1 E LEVATION 1 !I t DESC RIPTION ,&0 O BM 2 E LEVATION BM 2 DE S CRIPTI —` SYSTEM ELEVATI q y SJ SYiTam TYPE C`C� ali . : ! a/01 / ' i o04 vvv r / vd — - ' ► kJ 1 YT 1 4 �r A .� SIONA RiL ti -_. __:: -. ` DATIt x• x �, X x 927.5 ea 423 6 928.2 / 919.3 �c \� x 63 8 i CA Gf AC. — L )3.00 AC) 920 ; ? 4 ' ".O AC) .0 / \ \ 6.0. _017.0 922 / x a► j C z� 1 2 7 1 915.2 911.8 1 � 1 ' H.W.E. s / 015.0 01 919.0 . X r r � 9 .7 6 T I x 3.1 A TM f 918.1 4.4 (j. A ) Le. 7.0 N co ' ♦` Q I "I 'AC. — X h Ic AC) 917.3�6 c C I g 9186 x i 913.4 8 25.0 2 C i E. _ X H.w. C 016.0 �� �3 C 906.9 X I � r � "^ `� � _ I a�Q CO • • ...: I � `� d J 920.9 i x >f AC. x 1.96 A 22.2 904.9 L .0. • 1. � � '•914.3 ; • 9 2.3 , :r 2 Wisconsin Department of ,I Division of Safety and B D SOIL. EVALUA4N REPORT Page Of _ in a ance wi �9145�Vi4, Aden 'Code Arch oo*mWgte site plan on paper not less th 8 1/5 .1( C0 �'h' r include, but not limited to: vertical and horizon ferea s ip,size. Plan st percent slope, scale or dimensions, north arrow, a dirls&ion d Parcel I.D. _ tone est road. 3 3 � 1j � — OCJU Please print all information. nonei information ou y, b Dat Y provide m be used for secondary Pumftes (Privacy Law, a. 15.04 (1) (m)), / Property owner - 3 0 Property Location a'r't •' E Property Owner's A c o^ Govt tt - 1 /4Ao i/4 S 1 f T N R E (or Block sum. Name or csM# State p Phone G v e\: ' U ; -e `A �. S & � YID r� Nearest Road G� Se ,'� iN � S yc: Now Use: ?V Residential / Number of bedrooms 2 . Code derived design flow rate _ ❑ Public or commercial - Describe: GPD v c ` s Flood Plain elevation if applicablets ft• and recommendations: S y s I? "- if /t ✓ L7r RhuS � UU -I ON L oT2 �3/ 9 E] Boring El Boring © Pit Ground surface elev. ft. Depth to limiting factor 2 U in. Sod 8WrAdon Rate i brizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/i in. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eft#2 7 a 1 Z IG� S a h� I _ ,7- 1. _S ( 04 I # ❑ Boring z ® Pit Ground surface elev. & 20 ft. Depth to limiting factor - in. Sad 8ppEcation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/IIf in. Mu nseli Qu. Sz, Cont. Color Gr. Sz. Sh. , •Eff#1 'Eff#2 I o-( 31Z S,'/ Z)41 n� � 3 �l1 c, L — vV\ c — r7 -I � EfAnent #1 - SOD > 30 1 220 mglt. and TSS >30 1150 mg/L • Efiuent #2 - SOD 130 mg& and TSS _< 30 mg/_ CST Naxrne (Please Prim �, signature CST Mxnber u � A5 Address We Evaluatim Conducted Telephone Number i 'LLLS ALL Io 19 1 £ ie iva tumdap atp imnuoa oseald 'ieuuo3 2. , its. AM - ti' paau s o saa1n.ias ssaaae of minsisse paou neAjj - iadotd= pus ,Jap!nold aoinaas Ai!unuoddo tenba u 0o jo i vauiiieda(j at LL _ _ llu 06 > SSt PLm llu OE > aos = Z# www3 . 'tAu 05 t > og< ss.L Pue j6w o2Z > of < ° 406 • l# Juer o i Z#J13. 1 00. '4S 'zs 'JJ joloJ woo 'zS 'no sunW W MGdf) 2 NepunoS eoueislsuo0 WnianiiS a ceI uogd!x>sa4 xopea Joloo lueuluao yide4 uozuoi l el" uogeol lbS 'u! J au.q!wn of video 'Jl nep eosyrns punoa0 lid o # 6 u" 2#113, x#113. '4S zs E) jolo'Jwoo 'zS'nb pesunyy u MCdJ siooLl Ampunoe GOUGAlsuwJ GinimiS emixel X uo!idpne0 21 30103 lueulw 4Jdep uozu� eaea uog ul JopeJ 6u4luall of video .0 •nele eoelans WMJO lid ❑ A. —."-pV67 Bup% ❑ # 6UOS t / 1 3 7 �� o'K 1"", o Z VW3. 4#113. 4S IS 'j0 ,opo woo •zS -no ul dJ/od0 siooa AGepunoe eoueislsuo4 emiar 4s emytel uaiduoseo xopea �olo•J lueuluroo yide4 uozuo}l elet! uogeal IIoS • A JoioeJ 6uliKull of 44dea it p .� 'nele eoepne punoj0 lid Z 6uuog # 6t4108 T 1 Z shed / n # of Iced O� ✓1 u ; j AUedad PAds ..o� ......_ NAME c. L.OTs 0 L (i1At D E SCRIPTION 3ivll� — 'h S TLz( N R SCALZ: >» BM 1 ELEVATION SM 1 DEscal"ION BM 2 ELEVATION -- BM 2 DESC RIPTION SYsTEM ELEVATIO q y SJ SYsTEM TYPE L �4 I i } R s j � J E I . l ~ 8l�iNAT RE DATE /_7 Je O Safety arxi ulldings Dive' S 4 201 W, Washmgto Ave, P. ��' ��� �� - — D� nsin Madison, W 53707 - 7 62 r niber (to be filled in by Cc).) C ommerce (608) 266-3151 Sanitary Permit Stat� I.D. Num er um t Application In accord with Comm $3.21, Wis. Adm. Code, personal intornut 81. may be used for secondary purposes Pr ion you Pr ide ivacy Law, sI5.04(I )(m) G t (it'ditfeent w1mai"Ifigaddressi, !• Application Information - Please Pt lot Ail 77 7 _ W ,3_ 1en_y Owner's e Owner's TnI r Na N —a in Parcel # Lot # O � nor's )4 Property Owner's M ailing Address I tion ity� state Zip C _7'i Phone Number 1.4,Secuon — �.._ ^, 11. Type of Building (check all that a pply) 7 N; R E or �- t or 2 Family Dwelling - Number of Bedrooms vision Name CSM Number DPubilc/Commercial -Describe /,Z/, 'e- r -] State Owned - Describe U Ocily 0"Volage ownship of 111. Type of Permit. (Check only one box on line A. Complete line If _applicabFo_ New System Replacement System ❑ - Treatment/Holding k Replacemen !ti 0 edification to Exisfiq System List r U rm l i1mihe Issued B. ❑ Permit Renewal D Permit Revision Change of Per it Tra er to New Before Expiration Plumber Owner foll" ZOO IV Type of POWTS System: (Check all that - Qpk1XL_.___ Non -Pressurized In-Ground [J Mound > 24 im of suitable snit 1- Mound < .4 in.. f suimble soil [j At-Grade 0 Single Pass Sand Filter ❑ Constructed Wetland L1 Pressurized In-Ground ❑ Holding Tank pea( titer Aerobic Treatment Unit Recirculating Sand Filter ❑ Rmirculating Synthetic Media filter �'.kleachinl Chamber S Drip Mine r ] ' vl-le Pipe ❑ Other V. Dispersal/Treatment 2N - Design Flow Design Soil Application R e( Dispersal Ar-3a quired (0) DispNve ; Area P ropo evaticii Y 0:2-5 VI. Tank Info Capacity in Total =NanFx, Manuf Prefab I t Sire Gallons clailons of Unit,; concrete ConsLrucwd Glass New Existing Tan Tanis SqxK or Holding Tank y Aerobic Treaunem U nit / � Dosing Chamber X the attached plans- porAilbility Statement- 1, the undersigned, ass responsibility lor t flati of the POWTS shown F7, Ual V11. Res, B Phone Numl)ei PRS Ntmit:ier Plumber's Na me (Print) pl Si gna 7lumber's Xddrc as (Street, City, State, Zip Code) 'go N rtnient Use Only Iss uing t gent r Sa n ita ry !inc r%.,. ISE ing VIII. unt /Depa Da IS- I Permit 14t Groundw Disapproved VIII. Surcharge Ferl 7 I J V � ,�.� 1 D ._�. . owner Given Reason f Denial IX. C of Approval/Reason or Disapproval O SYSTEM OWNER: G'IYIk /���I`��' E � = / '� / /6 , �/ d y �, L t. r'7 tan , effluent filter an V1 6-.), dispersal Cell must all be serviced / mainWiDed cis per management plan provided by Plumber. 12. All setback requirements must be maintained 11��J7�� AS Per applicable code/ordinances. 2 - 11 'W� c. � SIT oalgl for per n o6C1 lhal� county Ames CM9 A z:P / Awl .fir Ito 4v _ o y 4f, Z7- i �d S� em �ryi z ly�� 98� ,Sd � I Cpl � es s j �U 6 i p l y a i �d Gi/•�1 --�� ` ,•�-7 S%pTIC.'TANK HUMP ChAEBZR CROSS S % C =IC AND sPLCIFI�:fiTzv � ..SEPT -_ 4" Cl VENT PIPE 12" MfN. `ABOVE GRADE WEATHERPROOF > 25' FROM DOOR, WINDOW pR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK 6 WARNING LABEL FINISHED GRADE 41, c I R I SER ._1..,, �► „ M IN. 1$" IN. 61, MAX • NLET WATER TIGHT SEALS GAS- `" TIGHT + �� PPROVED A SEAL JO INT$ WITH ,_.}.._. ALM APPROVED PIPE 3' ONTO 0E , ON SOLID SOIL NTO SOLID ,�„ ! , OFF �`�' RISER ]EXIT OIL PUMP OFF ELEV . FT s t PERMITTED ONLY ._•___ D IF TANK MANUFACTURER HAS APPROVAL 3" APPROV ED - BEDDING UNDER TANK CONCRETE PAD SPECIFICAT SEPTIC / DOSE NUMBER DOSES PER DAY: TANK MANUFACTURER: 1,, e r TANK SIZES SEPTIC JD� GAL DOSE VOWME INCLUDING �- GAL. DOSE 19 4 — GAL. FLOWBACK: l -- — ALARM MANUFACTURER: 1 - .gt6m CAPACITIES: A = 'ot INCHES = _ jEf - GAL , MODEL NUMBER: n A v _ ,_._ B : 2 INCHES = 32 GAL, �, SWITCH TYPE= ,trr _ .._.,. C = INCHES =GAL. PUMP MANUFAC JRER : a " ��.�.____ MODEL NUMBER: ,� D = INCHES = _ GAL, SWITCH TYPE *$ r REQU IRED DISCHARGE RATE GPM PUMP & ALARM WIRING AS PER I LHR 16.23 WA( VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE • • - a FEET FEET + MINIMUM NETWORK SUPPLY PRESSURE • FEET + FEET FORCEMAIN X , FT'J1Ofl FR r FEET • WIDTH DIAMETER �,.. INTERNAL D ;�iENSIONS OF PUMP TANK: LIQUID T�'EP'I'A"� �•�� C.,&��,��x• • LICENSE NUMBER: ?.27047 DATE: 3 SIGNED:� - [qGOULDS PUMPS Submersible Effluent PUMP p EPO4 "y 3871 EP05 'i PPLICATIONS • Full submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower A grade turbine oil for tic enclosed design for heavy duty ball peg Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. • Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion Cmadim standards Assodadon • Farms manual operation. Auto- resistance. • Heavy duty sump matic models include ■ Motor Housing: Cast iron (CSA listed model numbers end • Water transfer Mechanical Floats Switch for efficient heat transfer, in "F" or "C ".) • Dewatering assembled and preset at the strength, and durability. factory. Goulds romps K 'so 9001 Registered. SPECIFICATIONS ■Motor Cover. Thermoplastic FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 3 /4" maximum. ■ EPO4 Impeller: Thermoplas- a Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1'12* NPT, seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 104 (40°C) continuous - - 140°F (60°C) intermittent. METERS FEET _ • Fasteners: 300 series ` stainless steel. 30; .. ..... .. _ _ _ -► .— • Capable of running tz S FT dry without damage to 8 components. 2s i 3 motor z -- - • EF04 Single phase: 0.4 HP, v 6 20" ° - 115 or 230 V, 60 Hz, 15500 s RPM, built in overload with c 1 s automatic reset. 4 EPOS • EP05 Single phase: 0.5 HP, o 115 V. 66 Hz, 1550 RPM, '" 3 10: built in overload with epoa automatic reset. 2 • Power cord: 10 foot s standard length, 16/3 STOW with three prong grounding plug. Optional 20 o 00 . 19 20 30 40 so GPM foot length, 16/3 SJTW with ' three prong grounding plug 0 2 4 6 s 10 12 m (standard on EP05). CAPACITY Goulds P ITT Industries <& ®2000 Goulds Pumps Effective February, 2000 83871 M «ter/ y��k � ww�rr r� r �� STANDARD CHAMBER 52 "— Quick4 Standard Chamber - -- era" - - ---I (EFFECTIVE LENGTH) 34" �{ SIDE VIEW -- SECTION VIEW i MuitiPort End Cap -- - 3a" SIDE VIEW TOP VIEW FRONT VIEW 4 � : Qu>}ck4 >Stantlard Chamber fifominai Sp cifrcetio+�s�a ,z Multit i dud Gap Nom nal S ec�fications �.... __ , �.... , r • �,, --s F of f ,, 3 4" x i6 " "x 12" Size W x L x H `34 "x 52" x 12'' Wx�L x H) Effective Length 48" Invert Height 8" or 1.25" Invert Height al, INFILTRATOR MTEMS. iNc sjaNpARD LLNff -ED WARRANTY {h1 The stiucit l intalFrY of each Cheri end Plate, wedge and Cher accessory nlerldariured oy t.-Ill 'Units"), wi1fX1 ilr51ali0d and Operated A a iaachrteld of an onsite seplic ayslem in accordance with In'il[ralo 61 ncfiorts. �S warranted to the original purchaser � HOklari agavist dclMa efe rr'aterals and wattmanship for one year Iran Iry a that the - pfil t"'nnil 1 vied fur the s"Ptic system con Ine Units. I r. Noel. howew;r. Ihat it a sepic pennd +s nor raq::irad by a{ p caf, law, tha wd'a. tti per+ xl w 1 Lk*',) ulwn the dale lhal inslailai a •� the SeP lc System iAmmencfla. • w to exercise as warranty rights, Holder must naity lntil 1 wntux: + ns �N r ,rat F1aarNT .a! r�. t n Go Saybrmk• Calmcl with. fiiteet (1 fit l days of Lae allnyad defect. inftltrala wd s ,play mplacen en wits for Lin is into rnlncwl L Y M felr:ll?r b be covcrM try Illis LimltM VVaranty. 1 Infihra1 l5 hifry spaciticalN axcWdes the cost of rertq•/a1 antvcv In$raea+or ul the Units. Q I", THE LUn`l - .O Wri.`lJl AND REWIEDlES IN SURFWRAGHAPF: (411 ARC tVGU15lVt, l FIFFIE AnE NE) OTHER WARRANTIES Wfffi RESPECT �Y�TE M S INC TO THE NITS, U INCLUDING N IM D PUED WARRANTIES OF MCrtCF1ANTADIl OR FITNESS FOR A PARTICULAR PURPL+SL. (q lnis Smiled Warr a q shat) be vole it any parl of the Clanlher systa n is mandrel by inyorle other than InbYlator. The Llmired 1NW 8hrly dots �f � e.�l v not Bxtend to Inc a 1. ' — sequeri 1, sPnciai or ihdir%,t damages, initlirata ;hall not hn ;iabla for penalties or liquidated d..mages, including toga of Emk onmentat OrWte t!WaStewl 8otutions� produdion and profits, labs and mater als, overroad ors s a Ott— insses a expansos incurred by the Holder a any third pally Specifically a,cltuled from Li r,0,10 Warranty coverage are damage to the Units clue to ordinary wear and tan+; alteration, accidenl misuse, ak•uae or nf3gbEC1 d 6 Busi Park Road • P.O. Sox 768 nix• Units: the U'ltils Wig suiyecterl to whicle t: aaic a other mrldltiuns which are on pe ion @ nnilled by the installation larlura 10 maintan the — imum ground covers set forth in the instatiat'�on inatruolians; the pa -ia nant of improper nialerials IMO the system containing the Units: failure W Ol Saybrook Cl' 06475 'a Urli,a a the saptic syslarh due to improper still or imrroper Will e xc assive water usage, improper gral disposal. or improper operation: a r any ol+ler event not Caused by Infilhata. This Lorl Warranty Shah be void if the Holder fmlS to oomph/ with ail ni the terms set forth in this. Limilac Warranty. 860- 577 -7W0 • FAX 860- 577 -7W1 Further; Ir. no event sl vil8rator I. lesil lble la any it, danwge to the Holder, the Units, a any third party resulfing I— installation or Cho 8DQ_221 -4436 rner;t, m or fro any proof liehilky <;—li. of Haider or any rh 'I hx ;rc pally Fir If.,, L"l Wu:-e Iy to apply. fhe l in.at be in:aaaod in 1=ord - wifn all she tinnoil�On6 required by Stare and tunEf lulu it other applll law,; r,rid I.Alb. tor'a 'il.l. atwn ;- 114110ne. {d1 NO reprasentelhn) el 411iaralOr has hw autncrity to cnarlge or exta rli lilis 4unlrxl Waranly, No waaaoly Sq)jl to any party other than the a'k,)i- nal Holder. . , .... . Thu above represents the Standard Limited Warranty olll by Inf arala. f. anilni rimier oI states and — ,,,ties haws dirfelent warranty req. menis. Any purchaser of Units should contact Infiltralor's Corporate He 4quaners in Gld Saybrook. C_ronllel:tian, pnor to such purchase, to obtain a copy of the applicaole wan aft and should careluty read that warranty prior to the purchase of Urn's. U.S. Patents. 4,759.661; 5,. 5,158.488; 5,336A17; 5,401,116; 5.4.01,459; 5,51 2103: 5,716,163; 5,588.778; 5.839,844 Canadian Patents: 1,329,959; 2,004,564 Otrler palentl3 pending. ;nlilirator, Equalizer and SideWinder are registered tradamarks of Infiltrator Systems Inc. Infitlrator is a ragtslerod t /tidemark in France. Infiltrator Systems Inc. _ .._L, gECVCrsO tAia7R _._,__�... ;r eaoyi� R.,ntnia, Contour Slwyel Connection, MicroLeaching PolyTuff, SnapLock, am pacer. ChberS PowLock, Ourictiol QuickPlaY .. n o�rn_n AW w�sconsm Department •otcommerce SOIL EVALUATION REPORT Page of 3 Division of Satlpty and Buildings in accordance with Comm 85, Wes. Adm. Code fumy Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must -4 include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel ID, percent slope, scale or dimensions, north arrow, and l ocation and distance to nearest road. 02- 0 - 1 3 3 -Ol -" &V b FTi Hy Date Please print am ln!owist/an..- -- �§ � 3 / 31 / 0 -3 Personal information you provide may be used for econd* ..(t'Rr/ 11- s. 15104 (1) (m)). Property Own S 1 l T 29 (o W 1/4 N 1 roperty Location Lot S\I L 1l4 N R (q E v Property Owner's Malting Address ot Block # Subd. Name or CSM# I��o Uiew tsfa s City State Zip Code Ntlfdber _ _ M dity ❑ Village (9 Town Nearest Road New Construction Use: t�R Residential / Number of bedrooms Code derived design flow rate " GPD ❑ Replacement ❑ Public or commercial - Describe: _ Parent material __ - 4 _w a S L. �_��___ Flood Plain elevation if applir at�le General comments 73 5-/ ry S l e f-e V • 9' y Q 0 S r� � � $ V 82 and endations_ o>�d21�rrP�Y�- ` El Borin Boring # n q r'j ft. Depth to i factor _ in. Uu pit Ground surface elev. _� ��9 Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff= in. Munsell Qu. Sz. _Cont. Color Gr. Sz. Sh. •Eff#1 - Eff#2 I O- 10 l r3J3 Zn- abK ►�,� CS I .5 - c5 L4 a Boring # ❑ Boring m B Pit Ground surface elev. !_' _ tt. Depth to limiting factor ) 2 O in. Sol lion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/If in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2 1 6 1 r 315 — S 2' rr�r cS `J $ 5r c l 2� r- cs < Effluent #1 = BOD > 30 220 mg/- and TSS >30 < 150 nng/L ' Effluent #2 BO D _ 30 mg/L and TSS < _ 30 mg/. CST Name (Please Print) ( � CST Number - Address Date Evakuation Conducted Telephone Number all 9 61—' -4 -� w/ ��o S - 71 2q; Q m 1 d r" e cv,4-Lt la v. Property Owner i� er — Parcel ID # - - - -- Page 2— _ of_ 3 a Boring # ❑ Boring g'Pit Ground surface elev. ft- Depth 60 9 factor in. Soi Ap Rate Horizon Depth Dom Ina M Odor Redox Description Texture Structure Consistence Boundary Roots GPDHF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'ES#1 'Eff#2 CS 2 b y r C F—I Boring # E] Boring El Pit :G�d.surface elev. ft. Depth to kmibng factor in — . Soi (cation Rate Horizon Depth Dominant Color Redox Description Texture structure Consistence Boundary Roots GPDlflz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'ETf#1 'Eff#2 F] Boring # F1 Boring El Pit Ground surface elev. ft. Depth to Willing factor in g . Sod tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff lo, Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I I I ' r=%jent #1 = BOD > 30:S 220 mg/L and TSS >30:S 150 mg/L " Effluent #2 = BOD <_ 30 mg/L and TSS <_ 30 m91L The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608- 264 -8777. SBD- 3330(R.07100) PAGE OF NAME: Q o c� LOT# I LEGAL DESCRIPTION: Sw 1/4 E I /4,SLTZ-q--,N,F AE(or)io SCALE: I "= LI y 1 ELEVATION: .100. f BM I DESCRIPTION: d-�� s4ce eod BM 2 ELEVATION: ' Tg• �O BM 2 DESCRIPTION: : 69 L>( �y sle I�ad SYSTEM ELEVATION: %yl0 0 SYSTEM TYPE: A a •u a , ' W l r' D b B -3 SD vvuj� ly � SIGN / DATE: / s � s I PAGE 3 OF NAME: o c� LOT# LEGAL DESCRIPTION: _ I /4UF I /4,SLTyq,N,R,AE(orW a SCALE: I"= ELEVATION: K)0.6 � BM I DESCRIPTION: S4e e ( (od BM 2 ELEVATION: �g C BM 2 DESCRIPTION: 4,,p lee- SYSTEM ELEVATION: 7 SYSTEM TYPE: NAV eyx, +,lcjAa,( , I �\ r \A SIGN / / DATE: PAGES OFD NAME: Q LOT# ( LEGAL DESCRIPTION: SW 1 /44( r - 1 /4,SLTLq,N,R, -tE(or) SCALE: 1 "= w 1 ELEVATION: 100 y BM 1 DESCRIPTION: fin�4 e el F-o� BM 2 ELEVATION: �g �k BM 2 DESCRIPTION: 44 cif S l ee j �d ; SYSTEM ELEVATION: 9y O d SYSTEM TYPE: y► J c ✓� v na l �� � r 13 c .. II B-3 q s'� 1 -- -__ - -- SD �D SIGN DATE: POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pop � of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity Ig ga l 0 NA Permit * Septic Tank Manufacturer O NA DEMN PARAMETERS Effluent Filter Manufacturer g 4' ,, 0 NA Number of Bedrooms e{ 0 NA Effluent Filter Model d0 d NA Number of Public Facility Units 0 NA Pump Tank Capacity gal 0 NA Estimated flow (average) al/da Pump Tank Manufacturer r�S �, O NA Design flow (peak), (Estimated x 1.5) 4,414 gal/day Pump Manufacturer 0 NA Soil Application Rate '� S allda /ft: Pump Model 0 NA E3 NA Standard Influmrot/tffluent Quality Monthly averaga+ Pretreatment Unit Fats, Oil & Grease (FOG) 00 mg /L ❑ Sand /Caravel Filter 0 Peat Filter Biochemical Oxygen Demand (BOO,) x220 m91L 0 NA 0 Mechanical Aeration 0 Watland Total Suspended Solids (TSS) 5160 mg /L 0 Disinfection 0 Other: 0 NA Pretreated Effluent Quality Monthly average Dispersal Collis) Biochemical Oxygen Demand (BBD,) 930 mg /L 0 in-Ground tgrWty) Cl in- Ground (pressurized) Total Suspended Solids (TSS) $30 mg /L D NA O At- tirade 0 Mound Fecal Coliform (geometric mean) S10 cfU /100mi O Drip - Line 0 Other; Ot C3 NA Maximum Effluent Particle Size Y in dia. 0 NA Ot her: I,7 NA Other: 0 NA Other: C) NA `Values typical for domestic wastewater and septic tank effluent. SCHEDULE Servfoe Event Sennoe Frequency WON Inspect condition of tank(s) At least once every: ,3 a s tMaudmum 3 ysam) DNA pump out contents of tank( When combined sludge and scum equals one -third ilk) of tank volume ❑ NA monthis) t a m 3 yam O NA Inspect d(speraat cell($) At least once every: 3 (a1 — Clean effluent filter At least once every: ye () C] NA monthts) U NA inspect pump, pump controls & alarm At least once every: ---- 0 arcs) month(s) 0 NA Flush laterals and pressure test At (seat once wary: -- O earis) monthts) ❑ NA At lest once every: o s) Other: O NA MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an individual carrying one of the followin S ervic ing glicenses r c a ofcaton Tat Master Plumber, Master Plumber Restricted Seaver: POWTS Inspector; POWTS M b�dware. i . leak rn inspections must Include a v inspection of the tank($) to identify any missing o i'oken of effluent tf the crock any creaks rs surfa easure the volume of combined sludge and scum and to check for any back up or pon sky har g n The di�aparsal cell(*) shall be visually inspected to check the effluent levels in the observation pipes and to check and any ii of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY or more of the tank volume, the an mu t contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 11 Wisconsin Administrative Code. ems pretreatmi All other services, including but not limited to the servicing of effluent fliters, mechanica or pressurized pompon units, and any servicing at intervals of 512 months, shall be performed by s certif'yed POWT8 Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page _ o f 7, r START UP AND OPERATION l p roducts or other chemicals ' For new construction, prior to use of ss he POWTS damage check treatment diape tacellislorlthe presence Of P a detected have the contents that may impede the treatment prose lain o perator prior to use. + of the tanktsi removed by a septa4e serv p System start up shall not occur when soil conditions are frozen at the infiltr When power is restored the excess wastewater will be callisl and may result During power outages pump tanks may tali above normal highwater l of discharged to the dispersal cellos) in one large dose overloading the a See+�backup perator restoring effluent. To avoid this situation have the contents of the pump tank removed by a Septag power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually op the pump controls to restore normal levels within the pump tank. ict and isper sail lls, absorption saes drive or park over, or otherwise disturb or compact, the area Do not drive or park vehicles over tank DO f within 15 feet down slope of any mound at-g ormance and prolong the life o the ion or elimination of the following from the wastewater stream may i the part Reduct POWTS: antibiotics; baby wipes: cigarette butts% condoms% cotton swabs, degre herb ciid �ome diape disinfectants; fat; at scraps; medications; oil; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; g r ea se; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT out of sorvice the When the POWTS falls and/or ` n per ( nc tak chapter Comm 83 33 f W sconsin Administr be taken to ative ative Code: insure that the system s en properly and safety abandoned i p e 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 Septsge Servicing Quid space fined with • After pumping, an tanks and pits shall be excavated and removed or their covers removed an d soil, gravel or another inert solid material. CONTINGENCY PL If the POWT Is and cannot be repaired the following measures have been, or must be taken, to provide a coda compliant replac system: t& fnr the Location of a_ replacement soil absorption, A suitable replacement area has been evaluated and area s ou a protected from disturbance and compaction and should not be infringed upon y eye to protect the replacement area will required setbacks from existing and proposed structure, lot 1 ish a su elsreplaclement Was - Replacement systems must nos an. result M the need for a new soil and site evaluation comply with the rules in effect at that time. Q A suitable rep area is not available last resort to setback epia r eplace fail rPOWTS a Barring advances in POWTS technology a holding tank may be installed as ed site ngiding tank A1 - 6- 0�. all e and at-grade ell absorption systems may be reconstructed in place following removal of the biomat at the C3 Mound a 9 with the rules in effect at that time. infiltrative surface. Reconstructions of such systems must comply < <WARNING> > PTIC, PUMP AND O'T'HER TREATMENT TANKS MAY CONTARI LE AND INSUFFICIENT O DEATH MAY RESULT. RESCUE OF A SE ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UN PERSON FROM THE INTERIOR OF A TANK MAY BE TNFFtCULT OR IMPOSSIBLE• NornONAL COMMENTS POWYS INSTALLER POWYS MAINTAINER / Name k lne r�l /off w�dZ }�^ Phone LOCAL REGULATORY AUTHORI ` SEP rAt;lE SiAVICINt9 OPERATOR (PUMPER) Name �T C, ie - ---- -- Name Phone � — b Phone This documsrd was drafted in compliance with chapter Comm 03.22(21tbiil l(dI01 and 83.W1 1, Ill r!< (31. Wisconsin Administrative Code s ST CROIX COUNTY SEPTIC TANK MAnfmNANCB AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer G �'� ,�2 e e -- Mailing Address �l 6 G o 61A Property Address WA Lj V (Verification required from Planning Department for new construction) City/State IXILC Parcel Identification Number MAL DESCRIPTION . 2la89 Property Location - '/4, '/4, Sec. l T E N.R., - W, Town of ,4 Subdivision j LA -mod lei '� 7� . Lot # Certified Survey Map # , �X , volume Page # Wunnty Deed # 2 . Volume y� Page it .^_ Spec house dyes 0 no Lot tines identifiable IX yes 0 no Improper use and smaintes lance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three yearn or sooner, tf needed by a licensed pumper. What you put into the system can ~ the lienction of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certifiM600 form, signed by the owner and by a wasterphtsmber, Journeyman plumber, resttietedplumber or a licensed pum p" verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is teas than 1/3 hell of sludge. Vwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set fords`, bierein, as set by the Department of Commerce and the Department of Natural Resource:, State of Wisconsin. Certification elating that your up sys tem tem bas been maintained must be completed and returned to the St. Crone County Zoning office within. 30 days of the three year expiration We- SIK3KZUR B O APPLICANT DATE ,On =R CE�RIZFICATION I (we) certify that all statements on this form are true to the best of ray (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIONATLME OF APPLICANT DATE saaar* A information that is min - represented tray result in the sanitary permit being revoked by the Zoning Department- as Include with this application: a stamped warranty deed from the f sgfere Of O ffice the wamaty deed a Copy of the certified survey sup DOCUMENT NO. �� l j WARRANTY BEEN Ego( U P / STATE OF WISCONSIN —FORM 9 V C" U O T= RACE U=V *a nctieDwa DATA TWS DMINTURE, Made by Leonard J. Beer, also rct_ GISTERS OFFICE known as Leonard Beer. a si nfrl a man ST. cfzoix co., wis. Recd for Record grantor of St- r r o i x County, Wisconsin, hereby conveys and warrants day of _ APT_U _ _ _ _ A.D. 19_Z D to Ri char 1. Rear gnri Phil 11 Reizr blighan at__ _$;30 ____ A ? M. and wife as joint tenants R�iffer f s grantee S NETIRN TO Of St. Croix County, Wisconsin, for the sum of One Dollar and other val ilable consi deration the following tract of land In - ;t ( r n i x County, State of Wisconsin; The Northwest Quarter of Section Two (2), excepting therefrom: Commencing at the Northwest corner thereof: thence South 159.6 feet: thence Easterlv 40 chains to a point on the East line of said Northwest Quarter (NW 0 which is 121.3 feet South of the Northeast corner thereof: thence North to said Northeast corner; thence West on the North line of said Northwest Quarter (NW4) to the point of beginning: also The Southwest Quarter of the Northeast Quarter (SW4 of NE the Southeast Quarter of the Northwest Quarter (SE-', of NWT), except a parcel of land describedias follows: Commencing at the Northwest corner of said Southeast Quarter of the Northwest Quarter (SE4 of NW4): thence East on the North line thereof 815 feet to the place of beginning; thence South 33 feet: thence East 100 feet: thence North 33 feet: thence West on the North line thereof for 100 feet to the place of beginning; also an easemen for roadway purposes 20 feet wide on the `�iest side of said excepted parcel: also a right of way easement over the roadway as now traveled in a Northerly- Southerly direction over the Northeast Quarter of the Northwest Quarter -(NET of NW all in Section Eleven (11); all of the above located in Township Twenty -nine (29) North, of Range Nineteen (19) West, also The Southeast Quarter of the SouthwestQuarter (SE,' of SW's) of Section Thirty - five (35) Township Thirty (30) North, of Range Nineteen (19) West. Subject to easements and highways of record, and containing 275 acres, more or less. Grantor reserves the right to live in dwelling house on premises for his natural life. Subject t to Federal � Land Bank in the sum of $11,450.00, which raa ff&ESS�� E(lP' Ae saFd � ha X hereunto set _ hi S hand and seal_ this 2nd day of A nri 1 , A. D., 19 _ -70 . \ SIGNED AND SEALED IN PRESENCE of C� ' + , �L (SEAL) Leo nard 4- l J (SEAL) / H u gb (SEAL) Ruth A. Johnson — (SEAL) STATE OF WISCONSIN, v_ — St Crni x County. } . _... " TD T Personally came b 2'ri cT ... _. A r i l efore me, this day of P A. D., 19—LO. the above named Leonard J Beer, also known as L eonard Beer, a single man to me known to be the person _who executed th oufg vru,and ackn edged the same.