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HomeMy WebLinkAbout020-1433-02-000 n y O 3 n C c l 3 A A n A C A n 3 . 3 y O _W N d N IV _Q F* oo O zt O. ^. n N ? C O ?;o 7 W 1 00 W O O O n O N O o 0 o 0 Cl C. o • CD c co d cn z D 0 a o m m D �^ a C W co a o =° e CL 00 00 co N O C V � o o c n r 0) 000 Or o � l�l Z � ? N � � (j) CA CA a -- 3 v o v ° x (D d < CD FD * CL N .�► N Z 3 co pp p C 7 Z 41 7 O 0 p d \ N O fD � I v m p c cn C C7 N 3 A a n Z m m (6 N c ,'a CD y ( / G A z j O 3 fl <� z co c M z m y z m W C A I N co,- Q G I N d � c O7 7 N - 7 V 9 o P- - - q O N 3 p a y O < ~ W `< O �C 03 j 3 O M Ul o 0 CA ° N fa fD N N Q O_ bj �O A ti j y X N C7 CD 7 CD O A o A �0 • 0�p O (D ~ ti R C RO I C O AA UNTY NN ING March 16, 2009 Dante McLachlan 1059 Daniel Drive CodeAdn nistrat Hudson, WI 54016 715 - 386 -4680' Land Information & RE: POWTS Installation Inspection, Sanitary Permit #453144 Planning 715 - 386 -4674 Location of Property: St. Croix County, Wisconsin Real _ Municipality: Hudson Township 715 -3 677 Subdivision or Plat: Mound View Estates SW 1/4 of NE %of Section 11, T29N, R1 9W Re cling Lot Number: 2 - 386 -4675 Address: 1059 Daniel Drive Dear Mr. McLachlan: tgk.. An inspection by county staff of the POWTS servicing the above referenced property was 3 � conducted on August 18, 2004. At the time of the installation inspection, this Private On -site Wastewater Treatment System ( POWTS) was found to be code compliant for a three (3) bedroom home. The septic tank installed has a capacity of 1250 gallons, which is larger than the minimum required for a 450 gallon /day design wastewater flow. The maintenance record indicated that the system has been inspected /serviced within the Wisconsin Dept. of Commerce Safety & Buildings' y recommended 3 -year interval from date of installation or most recent inspection. te a: If you have any question regarding this wastewater treatment system, please contact our office at 715.386.4680. a e a Quinn, PO S Inspector #665054 �u r: ST. CRO1X COUNTY GOVERNMENT CENTER 110 1 CARMICHAEL ROAD, HUDSON, W1 54016 7153864686 FAx PZ @CO.SA /NT- CRO /X. W1, US WWW.CO.SAINT-CROIX.WI.US Wisconsin Departm4nt of Commerce s PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453144 0 GENERAL INFORMATION (4CTACH TO PERMIT) State Plan ID No: 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- 1433 -02 -000 CST BM Elev: Insp. BM Elev: BM Desc ' on: / Section/Town /Range /Map No: - D 11.29.19.2690 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ( /� Benchmark / 04 l (�(J i 'yam Dosing Alt. BM :S; t, Aeration Bldg. Sewer Holding t/ tt Inlet TANK SETBACK INFORMATION 01 t Outlet �- 7 _7 c 17 -f TANK TO _P /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet e__ t bu o �svt� c— Septic 6 r Dt Bottom Dosing He /Man. Aeration Dist. Pj_o r 9,7 X 6W(�i 6� rrO- , n. 0 , 1 1 1 -1 -- 0 � Holding PUMP /SIPHON INFORMATION FualGrae Manufact r Demand St Cover / GPM (- Model Number TDH Lift Friction Loss em Hea TDH Ft Forcemain Lent Dia. Dist. to well I SOIL ABSORPTION SYSTEM / a BED /TRENCH Width 3 / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ")-- SETBACK SYSTEM TO P/L BLDG WELL LAKE /BYRE LEACHING anufacturer: INFORMATION CHAMBER OR Type System: dC� 2"� f C�Q / Z UNfT Model Number: DIS UTION SYSTEM 0 W,1VW ITT2 7wlm4 P eaderjbhdnifold Distribution x Hole Size x Hole Spacing Vent to Air Intake> f k Pipe(s) / f �� Length Dia Length_ Dia Spacing �— t SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over IDepth Over xx Depth of 1 xx Seeded /Sodded xx rf6jIch4d Bed /Trench Center Q Bed/Trench Edges Topsoil U //�� Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / � U Inspection #2: / / f Location: 1150 CTY Rd A d' W 1/4 NE 1/4 11 T29N R19W Mound View Estates Lot 2 Parcel No: 11.29.19.2690 1.) Alt BM Description = .ST GO V - e - 0 �Q� 1 J "" " 1 2.) Bldg sewer length ' �ST T - amount of cover =' N 7 3 74Y�- lJt- vl AmmW 1Z �oQ l�t.�l v[ o 5,p Plan revision Required? Yes "o— Q / / r Use other side for additional information. _ _ ^ � � ( a ` -- 1 O SBD -6710 (R.3/97) Date l� III nsepctors Signatu V� � tiv`� Cert. No. Safety and Buildings Divisiun County 201 W. Washington Ave., P.O. Box 7!62 N VIsconsin Madison, W1 53707 - 7162 r Sanitary Permit Number (to be led' by Co.) De artm )nt of Commerce (608) 266 -3151 Jr P Sanitary Permit Application State Plan I. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide A may be used for secondary purposes Privacy Law, s15.04(1)ttn) Pmjoet Address (if dif &rent than ntaBing address) - 1. Application Information - Pletase Print All Information Property Owner's Na me Z H � #--� Property Owner's M Address ` City, state �'?� I zip Code emu' oN s y0 / 0 o II. Type of Building (check all that apply) /_ f ' Xl or 2 Family Dwelling - Number of Bedrooms d � (F � CSM Number ❑ PublictComalar vial - Describe Use -� - j ❑ State Owned - Describe Use ;2 17 I Sr. c�E � wl f J _ � ,t of III. Type of Permit: (Check only one box on line A. Complete A. New System ❑ Replacament System ❑ Treatm�e-nUH'oll ing System B• ❑ Permit Renewal Permit Revision Chang ae' f g erm it Transfer to New List Prev x ious Permit Number and Date Issued Before Expiration (Check all the l Plumber n_ a p s3 � qV Q o N. of POWTS stem; 1 ) *Non - Pressurized in- Ground J Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil 13 At- Grade ❑ Single Pass Sand Miter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tanis ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leachin Chamber C' Dri Line ❑Gravel-loss Pipe ❑ Odter (ex lain V. Dfs tgaU1'reatment Area Information: 3 Eck s I o Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Arcs P ( sf) I? System E �+ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Fiber Pl iC Gallons Gallons of Units Concrete Constructed Glass New Fatisring Tanks Tanks , r Septic or Holding Tank D � Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement I, the al2&rsijE assume tea nsibWty for hAtallation of the POWYS shown on the attached plarns. Plumber's Na me (Print) Plumber's Si gnature eNP 1PRS Number Business Phone Number ~� Plumber's Addre es (Street, City, State, Zip Code) -� 1 VII ounty/1101D Use Q, i Approved ❑ Disapproved Sanitary Permit Fee (inciudes Groundwater Dai / Issued +wing Ag�'ur o tamps) Surcharge fee) �j � ✓ �� 7 6 O } �. ❑ Owner Given Reason for Denial �p IX. Conditions of Approval /Reasons for Disapproval 41 s , — z �a S s Mt � 3-c� O-xJ kl: 0 ,T pal z 6& 0,4..eJ, wa�_Owd UA l� a -7 S � ' ) Ab n S �z . tab compl to tq e Count o for tb� 9a p}ptr x It tacdas in stag SBD- 3� 98 . 01/ 3 (/vr t I c �^ 0� " a2 67 > I 8 J- I 1 I i i t i i 1 j 1 �i Yd CJ � ' e'/r IZ 0 r � �?e�ef/� !�(�e lam' t� /1 a`.4�Lf� � °� �` I 8'� 3 � / �\� YF• 1/ r c�� O �'��r 1 I -/� ��� t I 3 o s`�� /tea /�s-� I �_ .� �J �� zed �-�- � 1 I i i I Wi cozrsinDepartmerdofComnrerce SOIL EVALUATION REPORT Pay o _� Division of Safety and Buildings in arxrordarn.e wiun Conan 85, Wis. Adrn. Code County Allach complete site plan Urn paper trot less than 0 112 x 11 brclies in size. Plan must � ` - - -- i nclude, hrrt not Dtnited to: vertical and horizontal reference point (BM), direction and Paull I.D. percent r rope, scale or dimensions, north allow, and location and distance to nearest road. _ Please print all flirotroaflofl. evrawed Date Personal kiformation you prvvida may be used for secondary prnposes (Privacy Lno, a. 15.04 (1) (m)). PrvpertyOwner PlopertyLocallor 's � ut Sp n t 1 G�� y� c)/ GovL Lot —S� S 1J1, b-d /v N �114 S (l t' 0 2 k? G�' N R E (o� Property Owner's Melling Address � Lol If Black # uamr CStl // !S e ov o "�e � 5� e S "D GD ' � � -sz�- sue_ - - - -- �_ C' Y- Ccxle PiiuneNumber it - Village rt State P ❑ City q� (J g i2� (own Nearest Road a i s'ydi I ( ) lY v 4 sc New Construction Use: F9 Residential 1 Number of bedivonts Code derived design llow rate _ l� 00 -_ —__ GPD Replacement ❑ Public or commercial - Describe: _ --------------- - - - - -- - -- Parent Fk)od Plain elovauon if applicable General comments S YS I m � . r +4 13 � S�S��, pw( and recommendations: 7 C / I J &"J �g ' et&)- ( W 1 G Boring Boling !/ , Pit Ground surface elev. iJ S �It. Depth to llndting factor -/3�___ in. - -- — - -- _ Sol Applical Rate Hurizon Depun Dominant Color Redox Description Texture Sbucture Consistence Boundary Rlxlts GPD /f [' ­ ill. Munsell Qu. Sz. Cont. Color Gr. Sz. Sir. _ 'Effrkl 'Efpt2 4�r Z 3Z "y /011, r / — S.ti r r, s6 , c — . 16 3 �v — 4- C r � z] Boring N El Boring ]�� r Q Pit Ground surface elev. L L b- q- fl. Depth to limiting factor in. Sol Application Rate Hofzon Depun Doninant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfe Ill. Munsell Qu. Sz. Cont. Color / Gr. S''zII..- Sh. _ 'EMI 'EOM2 59- 5 - c —� l� C P -s r/ 5 �� s6 �, S r - -- 12 0 / —__— -- - Effluent #1 = BOD > 30 <_ 220 nx3/L and TSS >30 < 150 rng /L ' Effluent H2 = BOD < 30 nrg/L and ISS < 30 mg/L CST Naine (Please P ' Si eat re CST Number &JQ f� Address Date Evaluation Conducted Telephone Number It 3 w11 ^ Parcel ID if —/0 ------- - - - - -- Page -- Z _ of L:31 Properly Owner _ -- ° --- -_ - - -- ❑ Boring # Boring ��` ,� ft. Depth w GneGn factor f�_ in. ❑ Pit Ground surface elev. P g Sol n icatirnn Rate Horizon Depth Dorninanlcolor RedoxDesc. Texture Structure Consistence Boundary Roots GPDffP Gr. Sz. Sh. 'EffN1 TIM in. Munsell Qu. Sz. Cont. Color _ — o _3 _ -1 o�r GS IPf'lC - 7 - 7 r ' � ✓ � r - -— ❑ (� Boring # Boring -- u E] pit Ground surface elev. it. Depth to limiting [actor ___— in. Sotl A lication Rate Ilorizorr Depth Dominant Cukx Redox Description Texture Strudure Consistence Boundary Routs GPDI(F in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. TIM 'EffN2 (�� ❑ Boriny U Boring # Ground surface elev. ________ ft. Depth to limiting factor ❑ Pit _ Sol Application Rate Horizon Depth Dominant Color Redox Description lexture Structure Consistence Boundary Roots GPDItF in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff #1 'Eff #2 EEtluent #1 = BOD > 30 < 220 rnglL and TSS >30 < 150 mglL ' Effluent #2 = BOD, < 30 mglL and TSS < 30 mgfi- 7 he Uepartment of Commerce is an equal opportunity service p►vvider and employer. If you need assistance to access services or need material in all alternate format, please contact the department at 608 -266 -3151 or "1 "I'Y 608 -2(rA -8777. SRD -8330I R.ONOO) PA(; N 1()H: 1/4 SCALE: I --------- ELEVATION: 0 BM I DESCRIPTIOH: , BM 2 ELEVNI MN: BrvI 2 DESCRIPTION: SYSTEM I- 1: 4? SYSTENITYPI: DATF:_ SIGNATURE-_ Safety and Buildings Division j County — i 2u1 W. Washington O, Box 7162 �"T"GY � X Y v a rtment Madison, wI s 31G ?? I rmit Number -- nitary Pe (ta be Piled in by Co SC�If,1 `It (608) 6- 3151'' VF of Commerce i _ Sanitary Permit Appl12ti ' n $tA PIaA I.D. Nut��er A In accord with Comm 83.21, Wis, Adm. Codo, personal isd rtttat n you pro vidt ' r /✓ I ttnay be used for secondary purposes Privacy Law. 0,0 (1)(mo , 'i , P }oct Address (lf differen than. mail1aga adires L Application Information - Pleats Print All Information Property Owner's Na me ( Parcel N N Block M } Property Oww's M thins Address ' ty Location e 2 61?0 / /� 4d .3k✓ k ..v,� u ,section / l City. State Zip Code Phane Number r I � I ,�,•� /� � (circle ) £I. Type of BteildW T g (cheek all that apply) �/ G� Subdivision Name CSM t�utnbtsr } 1 ot 2 Family Dwelling - Nusuber of Bedroom& _ � - _ Pubiw /Commercial - Describe Use i � .. State uwmd - Describeuse_� �l G� -C.�S_ ~ 2?� w i' ; Gcity ❑VillaBercutownshipof` III. Type of Permiti (Check only one box on line A. Comp a tune E it appl ble) A X New_ Rwu< (� Replacernert System 1 'Treacnentr ins Tank. R lacement Only j O r ModiC ation to Existi *, Sytt, I List Per it ' et ate cu rl mom RX i g• L Permit Renewal ❑ Permit Revision C Change of P mit Transfer to New do l I pits n P l umber i a, i - IV. YPe of POWTS 5ystttm: (Check all diet gp ly) OeNon - Pressurized to- Ground ❑ Mound a 14 in. of suitable soil Q nd 4 in. of tuiuble soil ❑ At -Grade J Single Pats Send Filter f ❑ C� vuowd Wetland a Pressurized In- Ground ED Holding Tank Aerobic Treatment Unit _ Recirculating Sand Filter P Jcircul&N Sy nthetic Media Filter ,.Leachin Chamber Dri Gra I -less Pi 00"r(explain) V. Disi reJitlRelat Area iniormationt vu�c�{ _ Design Flow (WO Design Soil Application Rato(gpdsp ptrsal rqulred (sf) I i1per5al Area P System Eleva.ion _3 { ---, VI. Tank Into Capacity in Total Number I r Site Steel Ftber FIaSnC i Gallon& ( Gallons of Units i . / / i Concrw Constructed Glass i < Tankt, T t Septic or Holding Tacit /��� C AVOW Treaunant I Elit j Dwins Cit&mber _A VII. Responsibility Statement t, tiao unds rte, ass res onsibility farjWpila o f the POWT sirwsi on the att ached plains. Piueuber•s Na ras (Print] Plumber's Si anasu MP IPRS Number ; ausine" Phone Numbef �!/, l ,` �t -s'�'li • �_, �� �Y94 � � /. �3d�G -3l� l Plurntwr's Addre a (Streit. City, State. Zip VIII.)Cotmt /De artmasst Use Oat _ ---; oVW ❑ Di tppreved Sanitary Permit F (( lncner udec Groundwater Date Issued suing Ag t Sigma (N iSg) i Q Owner Given Reason for Ueniad Surchargs Fes} � �D � i L2 IX. Cotadlt G of ADpruvailfj for Dlsr3pprarai p j SYSTEM OVrNER � � C '' 0 3.SZ f 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained - � 6 5 t /� as per management plan provided by plumber. (,vtc� 5� �' l `�� i Ila- 1 2. All setback requirements must be maintained i (b tAe Cmtttty ow—Y) rbt• tbe.ysq — cR n_t�q> rR ni may 3 Y3—( - iii . 7 47,-7 ,our �� T ��,�� /� 0 � a 't O � 4 0� c � a 6y °n� p r O U o . O b a �6y V y C TANK & HUMP CHAYBER CROSS S�C:iO`� AND SPiCTFICATiO'� SiPT a VENT PIPE'12'! Mf N. 'ABO GRADE b WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX MANHOLEDCGV£R FRESH AIR INTAKE WITH CONDUIT W/ PADLOCK FINISHED GRADE -- WARNING LABEL 7 K CI RISER NLET + WATER TIGHT SEALS GAS. , '+ TIGHT + PROVED A SEAL t JOINTS WITH PPROVED _i_ 4 ALM APPROVED PIPE IPE B 3' ONTO NTO SOLID i"` � , ON SOLID SOIL OIL PUMP OFF ELEV . FT. -. -- OFF * RISER EXIT � D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED. BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: ...4• NUMBER LOSES PER DAY: TANK SIZES SEPTIC _ GAL. DOSE VOLUME INCLUDING DOSE 5 - 4 GAL. FLOWBACK: GAL. ALARM MANUFACTURER: ����elaa -�., CAPACITIES: A = - 2 e l INCHES : � GAL. MODEL NUMBER: �, v SWITCH TYPE: `! H = �r. z.. INCHES - GAL, PUMP MANUFACTURER: . C; ,�;% _ C = �_ INCHES = _ GAL. MODEL NUMBER: o y SWITCH TYPE: D = INCHES = _ GAL. REQUIRED DISCHARGE RATE _ GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . FEET ♦ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . -Off FEET + FEET FORCEMAIN X �,� FT /100 FT. FRICTION FACTOR . L r7 FEET T.CTAL DYNAMIC HEAD - 4 Z,XZ FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH DIAMETER LIQUID DEPT "A" lC, /,��x• ol SIGNED: .fYs�"' LICENSE NUMBER: r ?97� 7 f DATE: 3 Dx 1/88 W LQRER $OIL TEy RAiE A Goulds pv a� f . Subm®rdb le -- Effluent Pump r N 3 EPO4 EP05 101111GATlOfli • ors. �Op seas . t: � N eleslp�ee to► riw steel. s tptl ► • Mott Raw* w � • *ywNhec to ehC4rd i d r O[Im{1afflnb. tilellr 1111 III . T11ormplu. Me* Mem" iK m + �e eud calr 14 If*IQnMIMndJe • s ° , • EN44 O.d H ?, +arN wee. N11s1g1tlq .wO 1W"ft dWment � Y, Ipkt.15�O fj MNw1 tMNq� Oot�. �'10Gf EePO rem rbnd hwM Coe: kin 4* rlith 1 tgllll�IN IM ■ . halery. Need ciwg vW , 110 V, A 0.0 l ■ 11NaN', iJppsr W4 bmr PO W X04 boils d 1' 60 RPM, HA *IV duty beN 11mr( . ti tlt owead r t ' tO� Thermo- aot oumbm n0 Us mod". • Mrd: low pieWC S"W'spp amp . : lop to 50 GPM. 1Mglh, tt� SJ7p '"w f ►e1J*0 Tow br Ati�Y I,JfTtltG ,1. • Mods: up b 2s leN, w1p1 ? me a t 'M Nor Plug. I ■ � f r - . tea &TTW with tcsal ttaed Rml +umbers 6f lA�! mete pp Oroundfrlp pfuq fmOroMd end in Or • i n , {Mn mom uan EP1) ■ aew daces Rlrooed ��� rontleuoue he"�O drMfgrt pr�oNer t FWW 3M nt Mssr oOrroaiOA .bfe of N Aritnp ) Pmw. g% wbBdGPM, i • T O *k sip to 31 fleet � ft 1%8 MPT, el!'Onrt• e i CaA1Nyo� s t o' � � t meat ' e a Wiscons in Department of Commerce SOIL EVALUATION REPORT Page I of 3_ Division of Safety and Buildings in accordance with Comm 85,'Wis. Actin. Code county Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel d Z O� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 3 3 Please print al/ In for Date maNfa, - - Personal information you provide may be u fa sq�l�idafyst!Y Lard S. 75.04 (7) (m)). 0 3 (i(�/y'` d M Property Owner Property Location Govt Lot `j Yy 114 NL -I14 S I T 2-q N R 19 E (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1I5ri C+ i 2 H& Viev) Eslsde City State Zip C Phope, Nynil ❑ City ❑ Village ® Town Nearest Road i 1"4r1r1 —( Gn. fig New Construction Use: ® Residential l Number of bedrooms _3 �_ Code derived design flow rate cV, `/2 O� GPD ❑ Replacement ❑ Public or commercial - Describe: _ Parent material _ — 0 u cr-5- k _ Flood Plain elevation if applicable General comments �Wti��ha� S� cflq�t�"G�{Jr� t�y� and recommendations: _ Y y F-19 Boring # Boring ® Pit Ground surface elev. 97 6 ft. Depth to limiting factor c? in. Soil tlon Pate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfM1 '01#2 1 $ i0 r 3, — s0 2 CS I .-C cJ 2 3 2en 02 K) -III r rn — — (. Z boring # Boring 9 ® Pit Ground surface elev. �P 7 � _ ft. Depth to limiting factor 125 in. Rate Sol Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munseil Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-1Z to ( s' I Q5 I .5 2 - 12-2_1 16 L r C .41 (v 21 -43 1 5/4 02 It 5i ► 3-12� 0� /.2 Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS :5 30 mg/L Signature CST Number CST Name (Please Print) O q Adder Date Evaloation Conducted Telephone Number /S Property Owner _ @ lr — Parcel D# O2 O — 1 33 _6 Page -- of - 3 Bonn # ❑Boring 2 Boring � Pit Ground surface elev. 10 1 ft. Depth limiting factor ' in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#1 1 I - Ett#2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 1 6- IZ� X313 Si Z � tc *, 2- 12 -2q L1 ic ms r 5 `f l O 3 A-44(1 �0 514 C2Q�.5 y sic 2m — q . 4 F] Boring # ❑ Boring ❑ Pit Ground, surface elev. ft. Depth iD laming factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfP in. Munsell Qu. Sz. Cant Color Gr. Sz- Sh. 'Eff#1 *Eff#2 B . . ❑ Boring # Boring ❑ Ground surface elev. ft. Depth tD iRnihng factor in. El Pit Sol Apoication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Efr#2 * Effluent #1 = BOD > 30 220 mglL and TSS >30:S 150 mgiL ' Effluent #2 = B00 :S 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 -3151 or TTY 608- 264-8777. SBD -8330 (R.07M) n N , PAGE -OF 3 NAME: t e1 LOT #_LEGAL DESCRIPTION..w 1/4 1/4,S I T71N,R,LE(or) SCALE: 1"= go ELEVATION: 0. t BM 1 DESCRIMON:Logo � 4 <l c co.-I klo" o"! . N k BM 2 ELEVATION: qq . (p 0 S ec. I l BM 2 DESCRIPTION: c,- , 61 cel IO" SYSTEM ELEVATION: q7 OO SYSTEM TYPE: �onuc✓���ona( r vl, SIGNATURE: _�� " ' t DA PAGE3OF 3 NAME: Bt e ( LOT #_LEGAL DESCRIPTION-Cv 1/4Pr I T-Zq,N,R,LE(or)lg SCALE: I "= r: ELEVATION: -1 BM 1 DESCRIPTION: 10 BM 2 ELEVATION: (y s eC ; �I BM 2 DESCRIPTION: SYSTEM ELEVATION: qZ , o y r ` SYSTEM TYPE: ��nUcn�. oval U r � „ � 1 rw SIGNATURE: _ t DA I rM STANDARD CHAMBER Quick4 Standard Chamber - -- — - - -48" - - -- - - -- — I (EFFECTIVE LENGTH) L I — -- .— - _ SiOUVIEW SECTION VIEW MultiPort End Cap -- — r __ — — -- - - -� - ----- ..__al `— SIDE VIEW TOP VIEW FRONT VIEW 't d-C F•13�'trf?5 r„ .k� r r' Quick4 Standard Chamtier Nominal S ecificatiens }t *° x "' _ a 4 P M ultaPort Entt Cap Nami�al S�eciticatlA Size Mx Lx H) 34 " x52rx12" Size (WxCxH) _ 34 "x16 "x 1 2" Effective Length 48" Invert Heig 8" or 1.25" Inve Height 8" INFlLTRAT4 SY$TF� INC. STg(i L IMITE=D WAR -HANT ia7 1h "IrA`..Urtel t+y, Iy d e r h chamttar enq okto. w•odgc rd gtt'o' acrrs ;tc *y mnnufactt+red by !rNNrdlor ( Wi fs ; when nslnlled arC n!N?•alrr. In a leachfield of oostt -Ptc sysle m apcortiance 1.1h t'i nsirjut ons, s warranted to the orgt a. Purchaser (^Holder , 'rgarns'!icfsctiv!� , -paler als and w ktmt s..p to one yea: rrurn rlrs date 1hal ft neirt < permit u issuea Ior the sep(c sysl nh cnMaavng MP tJrtns, previaeri, "Cwe.Ver, that f a 'eptic P. i_ ml required by aPPk -"e law, the warant! pWiad 111 YVI two the date t1 W inslallalvxt d 11tH sepiic sv5 ,m contntmtr es, 'o erwc w its war any nghts. Holder must notity "'14ratM' m wntara at i;s twolpol are Headquaders in ( Saybrook Conner It wt wNMn fifleen (i 5) days ur the a +la deloo, InANratcr will sup* rwacarnen )nits a ;Jnt deter - rhm by lneflraf!t, to be Covered try the L mated Wn tar.. y . I! , • Infillratork trahirry sper�rU71h. °rciuues Ihr; cost of removal a a�Or nslatatrl r, the Unlrc. nit I - LIMITF;C WARRANTY AND REMEDIES IN SLUPARAGRAPFI to) APT LrCLUSV : IFRE. ALL N6 OTP EP WFRR rNT•'S O E WITH RESPECT TO THE UNI r& ;N +DING N0 UPLIED'WARPANTE3:}f M£RCI IANTA0�1 .n rtittE 5 FOR A pAHtICt ;AJ> p Inpp•'F. SYSTEMS INC (d 11 Linnled 1ka lnty haft a vpl I I? any Pan of 1a chamtw sYSfern n r u a. D. r• h yY t nit r r h n, krfltl alot Th. Lunne+l ft—! co- I%l extend Ig — denl JI .'ISE,g(xanikal soda! or lndteo; da ,. age Ir!Irir for 4h. I :,. W NYj f x Pmaelr., or iqudat:. I d:anage nrl(.di. 1 .ass or Environmental Omit& Wastewater Solutions" tx(xl chop antl P ofirs laocr and raterials, over'tead costs a other losses or or..,enses e- ,,,art c'y rim Hdtler or 8- rr,Iny 11anv, „mr. akca3y r It dad hrxn L� r at W a.,anly ccr,orays are tl3maeta to the J tl due to or fh iry w«�a d to aaareficn, -01091)61 Buse, aL*.rse read;pc; M n o the U. ho Jo is t ng - bim,red is .hick 1 .N era Hit lc or other an lms wh' .h t ,xr o- by it. n.tallalpr, ihoj IMax+9, lu meir the 6 Susineas Park Road " P. O . BOX 768 mrn mum g t+JM ^wars set forth in the lhslaNnion ns:tmlrurrs ,he pi; — of irlpn/pt er::tts n)o the ey.slem orotmn;t'q rttn LM „ - 7t the UnIS or itw W , (, systero due to improM simng )r Improm5 sirrrg, wcttr4ive water u age �'nprom 9m"e' disposal. or Lpmne operalknn rR Old Saybro T roc any otJ even: not caused by M1rator This limNed Warranty a:•all bit •mid N Ihs Hgk1eY fml to :ompM weh all e1 the lean vIV Iorth t. Nns umNe(f Y r L 1 w4 75 War arty. 8601- 577 -7000 • FAX 860- 577 -7001 Fr,rihe. it nn event sneH t ni lntlo be .sno "sibfe tgr env IW or damage to 1hA Fk;dsr, the t Mils, ,x am ;hard 1lariv recuN6YJ Irmt insta7atkxt nr stNp- p A �f �] �}C maM r ,m any pro fuc. �iatAlNV crn; n; pl Roder a a; y Ihrtl parry For th s Limned Warranty IC apply, Ine'JnNs nrus'. bit installed 4t acalrrAarrF, 800 - 221.4436 urfh a I rile on ^C•,Im repaired by stale antl local CedeS: eh other aprJ "ble oven er (l In .a :or'r v�statlabon B1,gfrorttgrlS. ' g al He da �resentat aI (^,' I!ratgr has the arAMrfiv in c -hanga or ex +er)1 !h1s Li;"t- Wananry Nu warranty at)DGeS to any parry Nncl tha,7 the wkj - - :1'.e above rertresP 8;. the Sta dx--; Lin lod Warranty oMere(.- by irat ator. A limited n(,mbe of steles and col,n%s have diNerent wananly jaguke- nents. Any p•; rc -....a err or Units G k} .^.mraCl Inf''hal!x's ;,grporata HeadrahItars M OLr Sayl;rook, C Ine,11 -1, prier to such pu to obtain a copy cf !9,e ar!plir„abie warranty, and sh+uld carefully road !hat warranty .)nor to the ptacM;e of Ores. iS. Patents: 4.759,661; 5,017,041; 6.156,48 &, 5,336,017; 5,401,116; 5,401,459; 5,511,903: 5,716,163; 5.588,178; 5,839,844 Canadian Raionts: 1,329,959; 2.004.564 Other patents perding. Infiltr9 , Equalizer and SldeMrl am registered tr9demartw Of -1t Ira or SySieT; Inc Infiltrator s a registered trademark tr France. Infiltrator Systerrm In 3 a reg twed trademark in Me60 Contour. Contour Swivel Connection . hAicml- eaching, PolyTi,tr. Snap[ —k-, Chamher paw•', Poeil.0ok, Guic1(CUt, QUickl' IdY nacrccen a.,+e� ar•d Ouick4 are trademarks of I ,fit!ratc;r Systems Ina 0 2003 Infiltlator Sy5lems Inc. Printed in USA 0011203H `b -0 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page .L of Z FILE INFORMATION SYSTEM SPECIFICAnONS Owner Septic Tank Capacity Cj © al 13 NA Permit # Septic Tank Manufacturer r ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 6L ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model ,�f �� ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) X1_5 a36p g al/day Pump Tank Manufacturer & ?=Lei, ❑ NA Design flow (peak), (Estimated x 1.51 �e g al/day Pump Manufacturer s!id� ❑ NA Soil Application Rate 6 , gal/day/ft' Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (SODj 5220 mg /L ❑ NA ❑ Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Call(s) ❑ NA Biochemical Oxygen Demand (SODJ 530 mg /L �n- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L (ANA ❑ t- ra e ❑ Mound Fecal Coliform {geometric mean) '. 5w u /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: 13 NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: month(s) (Maximum 3 years) 13 NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: p (Maximum 3 years) ❑ NA pJ y ear(s) Clean effluent filter At least once every: months) ❑ NA y ear(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: •--- ❑ ear(s) Flush laterals and pressure test At least once every: ❑ monthis) ❑ NA ❑ earls) Other: ❑ monthls) ❑ NA At Least once Query: ❑ yearls) 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 (Y,) 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 S12 months, shall be performed by a certified POWTS Maintainer. 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('Verification regtdrod from planning Department for new construction) citylstate Parcel Identification Number 600 L ga DESCRIPUQN , r PMM tY Locatlma� V, 1� K Sec. IL T�N -Rh—W, Town of Subdivision v� Lot # . "t`(1 V �0 s �_ Ce rd Survc Map # Volume . Page # Waffanty Dad 7 6 Volume r" fl q- 66 page # ZZ Spec housed yes s q� , no Lot lines identifiable ayes O no SYSTEM MAt1V1'ETYA`r!CE Improm use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance Oft" of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can d kd the function 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 certification form, signed by the owner and by it maswplumber, journeymanplamber, restrictedplumber or a licensedpumper verifying that (1) the on -siba wastewaterdisposat system is in proper Operating condition and/or (2) actor WRwtion and vxnping (if necessary), the septic tank is less than 1/3 full of sludge. Un the have wadccsignad read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as sot by the Department of Commerce and the Department of Natural Resources, Stage of Wisconsin. Certification stating that your septic system has been maintained must be completed and retumed to the St. Croix County Zoning Office within 34 days of * three year expiration date. L J SIGNATEME OF APPLICANT DATE OMMR QZUMAM! I (we) certify that all statements on this form are true to the best of ray (our) knowledge. I (we) am (arc) the owner(s) of the Pro, potty descn'bed above, by virtue of a warranty deed recorded in Register of Deeds Office, V—X &"� J�J� . 4 3 SIQNAT'URB OF APPLICANT DATE * * * *** Any information that is mis- rapresetrtedtaay result in the sanitary permit being revoked by the Zoning Department. +• Include with this application: a stamped warranty deed front the Register of Deeds office a of �pY Nte certified survey nup if refer+enae L made in the war:aaty dmd DOCUMENT NO. I /� ( (l WARRANTY 9991 Q F `� 6 f� c n STATE OF W18CDMV4 -10AM 9 30005 Tali SPA= INIMM FM 101X� U TA T;E;IS Dw NTuM Made by Leonard J. Beer, also RLGISTERS OFFICE 4nown as Leonard Bppr, it_ si nRl p man ST. CROIX CO.. WIS. Recd for Record this_6th __ pastor of St f:rni X County, Wisconsin, bweby conveys and warnots day of_APTU_____ -Yo to Ri chard L_ RAAr and 21,1414 11 Bear, husban at__ UOP ____ M. and wife as Joint tenants + Ralt�i f R_ 11T111 TN of St. Croix County, Wisconsin, for the sum of Dnp Dollar and other val ronci dpration the following use of lead in St - rraiX 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 Easterly 40 chains to a point on the East line of said Northwest Quarter (NW 4) 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 (NWT) to the point of beginning: also The Southwest Quarter of the Northeast Quarter (SW 4 of NEB); the Southeast Quarter of the Northwest Quarter (SE'k of NWJ), except a parcel A land described as follows: Commencing at the Northwest corner of said heast Quarter of the Northwest Quarter (SE4 of NWiI); 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 West 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 (NE4 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 (SE4 of SW4) 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 rrserves the right to live in dwelling house on premises for his natural life. Subject to mortgage to Federal Land Bank in the sum of $11,450.00, which gra By rE§s n�e ag eorto W' set _b S hand —and seal this 2nd day of A ri I , A. D., 19 �D . l SIGNED AND SEALED IN PRESENCE OF ► (SEA Leona Beer (SEAL) J s (SEAL) Ruth A. Johnson (SEAL) Q >.� STATE OF WISCONSIN. �P.iPT St Crni x, County. _ Personally came before me, this 2 nd day of April , A. D., 192-. the above named Leonard J Beer, also known as enna Bptz a ainglp man to me known to be the person —who executed th ackngwledged the same. r • , 1 ! 975.0 � c� • ,' � 8 2� �. CR�S / t (135.727 SQ. Fr.) �, �'► L. B.O. = 917.0 • • tag CC � t LOT'S o a 2.61 ACRES c g (113.T70 60. FT.) L OT 2 I 2.04 ACRES � H,w.�. _ J A , (88,704, SQ, FT,) s g1s.a � L.B.Q. = 9170 � ' 2o' WIDE OMNAGE ' . EASEMENT • ' ' • • . . N3i`32'1WE 117,4$' :t LOT 1 . 2.40 ACRES (104,397 50. FT.) L.BA. - 917.0 Il e O 5 7 c � SO4°06'GIS • 66.17 WEST 16 �•- ` '�` o Lq t a , LOT 10 ''�,. 876r � p 2.43 Acmes ° r=� P' I (105,785 SCE. FT.) L.B.O. 906.0 • � `$ � i . 41 ' • ~ rs°327� E • � SB.52' 13. EAST -WEST 1/4 LINE NOWBE23 "E 569.09' M�1 `tr 171 D fsvIC CJ 9347 0 VXIE13t 88n2'23'W 523.69 - I9 NO. 5125 -02 DATE 03/06/20x3 REVISED: D4/22/2003 900 In SQa3Q 30 ?]3.LSI ag LS9t 99C 9TL IV9 LC :CT IHJ f0i91[/tO