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HomeMy WebLinkAbout020-1433-08-000 isconsin Department of Commerce County: � �� � PRIVATE SEWAGE SYSTEM St. Croix Safety arid Building Division INSPECTION REPORT Sanitary Permit No: 453173 0 GENERAL INFORMATION (ATTACH TO RMI + State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village X Township Parcel Tax No: .3eer, Richard Hudson Townshi 020 - 1433 -08 -000 CST BM Elev: Insp. BM Elev: Description: Section/Town /Range /Map No: d BM �—y �• � ,r`•e r.�- t l..1 11.29.19.2696 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration T Bldg. Sewer q Holding � St/Ht Inlet TANK SETBACK INFORMATION St/Ht outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic S i � � I � � Dt Bottom \ [To osing Header /Man. 9 Aeration Dist. Pipe _71 5 Holding Bot. System '73 95 Final Grade PUMP /SIPHON INFORMATION Manufacturer GP_nand St Cover 3 3977. . `]r 5 Model Number TDH Lift Friction Lo System Head TDH Ft Forcemain Len h Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width q / I Length 7A o. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liqui epth DIMENSIONS � \ 1 e �. _� SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR .L..1� e. Type Of System: 1 ! / / UNIT Model Number. 1 �1 / v tJ �• 4 DISTRIBUTION SYSTEM - 4 0, At, Z Z A, Header /Manifld /I Distribution x Hole Si x Hole Spa. c< Vent to Air Intake L� Pipe(s) i Length__ Dia 1 Length Die Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges \ \ Topsoil Yes No Yes No 14 L_ �1 - COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / l ( / l Inspection #2: Location:. 1064 Daniel Drive Unknown (SW 1/4 NE 1/4 11 T29N R19W) Mound View Estates Lot 8 Parcel No: 11.29.19.2696 1.) Alt BM Description = C 6Je,� �� � C S ,�j��, ? _ r �0,' 'D 2.) Bldg sewer length = 2_3 �c -`� 6 �� `� /"� G am ✓ Sy �� n � - amount of cover 9 � .3 Plan revision Required? Yes o \ ` `� Use other side for additional information.! b VK 3 175 SBD -6710 (R.3/97) Date Insepcto s Sign re Cert. No. r - Safety and Buildings Rivisiun County 1 201 W. Washington Ave., P,O. Box 7162 N VIscon s i n Maaison, WI 53707 - 7162 Sam ry Permit Number ( filled in by Cc (608) 266 -3151 Department of Commerce 3 Sanitary Permit Application smote Plan 1. D. Number I In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, sI5.04(1)tm) Project Addres (if different than mailing ddress) I. Application Information - Please Print All Informe on E? E� � � -A * d 7 _d � � __ ` o 2- c) - 3 —o - (Dab Property Owner's Na ms Parcel X Block Property Owner's M ailing Address Property Location r o1(p City, Static Zip Code Phone Number S � ' -A l/ f II. Type of Building (check all that apply) ✓ (' T �� N; RL_E or� f C 1 or 2 Family Dwelling - Number of Bedrooms 1 � " �Z� %� Subdivision Name CSM Number PubliciCommercial - Describe Use —_�— A ❑ State Owned - Describe Use % 2 D SP (�eUs 4_ 1i L4- Z 3 d4 �,yK GCity iViliage ownship ow �-tJ a III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. 0 Permit Renewal Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued I Before Expiration Plumber Owner � 3 / I IV. Type of POWTS System: (Check all that apply) _ Non -Pressurized In- Ground ❑Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter I Cl Constructed Wetland ❑ Pressurized In- Ground 0 Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit C Recirculating Sarni Filter ❑ Recirculado S nthedc Media Filter �eachin Cha ber G Drip Line E: Graveldess Pi El 0th (ox lain) I V. Die rsailTreatment Area Information `r C, { Design Flow (gpd) Design Soil Application Rato(gpdsf) Dispersal Area Required (sf) Dispersal Are ad (sf) System Elevatio VI. Tank Into Capacity in r Total Number Manufacturer Prefab I Site Steel 1 Fiber Plastic Gallons Gallons of Ututa Concrete Constructed Glass New Existing I Tanks Tanks Septic or Holding Tank Z�D lel e-;S �e - Y I Aerobic Treatment Unit Dwint Chamber CJ VII. ReSP01161bWty Statement I, th6 Widersigned, assume respon sibility for 4P41lation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature J& YJMPRS Number Business Phone Number Plumber's Addre as (Street, City, State. Zip Code) i VIII, t !De tm t>,t Use Onl pproved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Dat Issued I tng Ag t Signature tamps) Surcharge Fee) Gv ❑ Owner Given Reason for Denial LX. Conditions of ApprovaURettsons for Disapproval -- Attach amplete yaps (to the County oely) for the systttm oa paper not was than t1tj x 11 lnahes in size SBD -6398 (R. 01/03) a 4 '\ r �i, i P _.� ,�, _. s !\ e • °Q � F � � • � � x �� � � �� � �� , �� � � � .� � �w � F ���.sG Q s.'�� ��� � � n � 4 ��;� q 0 O 1 O Wi•!cotisin Department of Commerce SOIL EVALUATION REPORT ['ago _ _ ut _ 3 Ulvision of Satety and Buildings in amordaitce with Comm 05, Wis. Adrn. Code County �� Crc�� A(ladi complete site plan on paper trot less than 0 112 x 11 ercires irr size. Plan rnunl -- — Include, herd not limited to: vertical slid horizontal reference point (BM), direction and Palml I.D. 99 percent r hope, scale or dimenslons, mitt artow, and location and distance to nearest road. QL y f /y — _0_ 7— L Please print all blfonnation. ft ewe Dale Personal info mnllon you provide may be used for secondary purposes (Privacy Lan, s. 15.04 (1) 1m))• Property Owner PI opetty Localiot eyc 3bN--,Y. GovL Lot Std 114,6V1 s E (or) %0 - - - - -- --- - - - - -- - Property Owner's Mating Address L Block # Sub 1. Name or CSPoI# / /s2 G6 Jpa� _ ia a•.�1 � City State Zip Cale f'Ihone Number y ❑ Village W lows Nearest Road I /-/r . I S ysl6 I ( 1 .l ^ New Construction Use: L�4 Residenlial I Number of bedrooms _!— Code derived design flow rate --- yyC1f� 4 Q GPD ❑ Replacement ❑ Public or commercial - Describe: - - -__ -- Flood Plain elovalion if a rpficable C/ / f - - -- --- - - - -`- PAlellt material 1 --- - - - - -- R• General oormnents and rewnrmendaliars: ' ` Boring # f ❑t-��ll Brainy p' g Pit Ground surface elev. JE. 7d _ It. Depth to limiting factor - _I Z in. - -- _ Soil Application_ Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary llmis GPD /f t' _ In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'E ff #1 'Elf #2 6 Q 1 Z -- 5i ( 2m.5 bk f ��r C S _ 1 v� ' Z SL 2M5bk V -n- � — LQ /_b FZ1 Boring # Boring Pit Ground surface elev. '79, Od _ ft. Depth to limiting factor _ _ in. Sort Applicator Rate liohizon Depti DrxninantColor Redox Description Texture Structure Consistence Boundary flouts GG� PDlff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sir. 'Eff #1 'E"2 04 16 r 31z s i 1 2m- )b / c 5 (v-C . Z $ -Z9 5 C L- 3m,5b1< ��_ cs — q 3 29 - lam �e s fps ,�•,1 r. Z Effluent #1 = BOO > 30 220 mg/L and TSS >30 < 1W nrg/L ' Effluent #2 = BOD < 3U mg/L and 7SS < 30 mg/L CSJ Nahne (Please Print) Signature CST Number Sl make r - - z5�o�t Address va ua ion Telephone Number Z L ( goy �o rSe [�l�1 5 qz) Z s -- -- - - -- (7) 5 ) 7LPD - OZ -7 `3 - Parcel ID # - – -- - - - - - -- -- Page -- of _:L Properly Owner _ r � - - - -- ❑ Boring _ f Boring # _ – IJ I `–Pit Ground surface elev. 1t. Uopy, to GnNGng factor Sol n , icatirn, Rale kllllli Deptl, Dorninanl Color Redox Description Texture Structure Consistence Boundary Roots . Ellf I Dfl 'Ef<#2 in. Munsell Qu. Sz. Cont. Color _ Gr. Sz. Sh. — O- 3 �© 3 2 S i ( 5 �J .� 33 la 5 — e L — m� ►Y� i C S S b Jn � F1 Boring (� Boring # - -- — — U El Pil Ground surface elev. It. Depth to limiting factor Soo Applica Rate Horiza, Depth Dominant Cokx Redox Description Texture Structure Cons GPD11F c Boundary Roots — 'Eff #1 'Eff #2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sir. E] Boling U Boring Al Ground surface elev. ___ - -___ It. Depth to limiliny factor _ _ in. El Pit _ Sol Application Rate Horizon Deptl, Dornn,ant Color Redox Description texture Structure Consistence Boundary Roots GPD/IF in. Munsell Qu Sz. Cont. Color Gr_ Sz Sir. 'Eff #1 T1192 Effluent #1 = BOD > 30 < 220 rnglL and TSS >30 < 150 mg1L ' Effluent 112 = BOO, < 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 forntat, please contact the department at 608 - 266 -3151 or TIN 608 -264 -8777. SOD- 10MR.07/00r L ,M NAME: 0l(! I. I)LSl�ltll'I IOl' _ /1 I%l i � SCALE: I' ° - - -- I YU - - -- - -- - -- - -- - - - - - - -- ELEVA'1'ION:_ BM I DESCRII' I BM 2 ELEVA' 10N: - - -- ^- - - - -- - — - - - -- BNI 2 SYSTEM SYS'1'L•NI TWIT: d SIGNATURE. A � h n s cP 4 A4 v s s ,, ��a-41 e- Al � a O - Safety and Buildings Dig isiun Ccx:nty d. 201 W. Washington Ave., P.O. Box 7162 ✓ ��� Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) N e (608) 266 -3151 � / 7 3 De ar tment o Comme c Sanitary Permit Application state Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide A may be used for secondary purposes Privacy Law, s15.44(1) {m) Project Address {if different than mailing address) I. Application Information - Please Print All Int'ormatign...: Property ° Owner's Na me / Parcel # Lot N Block M 6t sc - P operty Owtter's M ailing Address Property Location O20 - / 3 - -c f - SGJ n id �,t ,S ectio City, State Zip Code �-- s (circle ) i 11. Type of Building (check all that apply) y p T u� w; R 8 0� /e$/ 3� �p Subd' lion Name CSM Number Xl or 2 Family Dwelling -Number of Bedrooms El Public/Commercial - Describe Use ❑ State Owned - Describe Use /ST. 22 City ^ cvillage Awaship of - 0 III. Type of Permits (Check only one box on - l ine A. Co et Une B if applicable) A. 1Vew system R e placement System y C p y ❑ Treaan olding Tank Replacement /Y ❑ J i t er odification to ng stem i B. 0 Permit Renewal ❑ Permit Revision ❑ Change of Permit Transf to New List IOUs i r d Date Issued I Before Expiration Plumber 0 er IV. Type of POWTS System: (Check all that apps l Non - Pressurized In- Ground l❑ Mound > 24 in. of suitable soil ❑ Mound < of suitable sail ❑ At- Grade ❑ Single Pau Sand Filter r C3 Constructed Wetland 171 Pressurized In- Ground C1 Holding Tank ❑ Peat F r Aerobic Treatment Unit El Recirculating i r t-' I ❑ Recirculating Synthetic Media Filter )( Leaching Chamber J Drip Line Grov -lass ❑ Other (expla V. Des reaUTreatment Area Information: --( U/ _ Design Flow (;pd) Design Soil Application Rate(gpdstl Dispersal Ar7&R e fired (sf) Dispersal ea Proposed (s Sys m Elevation 3, S C_ , 7 9jr� d Ile VI, Tank Into Capacity in Total Number Manufacturer Prev Site Steel Fiber Plastic Gallons Gallons of Units Co ncr Constructed Glass New Existing Tanks Tanks Septic or Holding Tank I _ � l .' ,e_5 .mot, - Aerobic Treaunent Unit i Dosing Dumber VII. Responsibility Statement I, the Undersigned, assume/espongibility for h allation of the POWTS shown an the attached plans. Plumber's Na me (Print) Plumber's Si gnature F 1( 5.M - PRS Number Business Phone Number '• ���a � �•d�P i- ,��c --� �- as 7 4 ��3 � 3� � •-3rd � 1 Plumber's Addle is (Straw, City, State, Zip Code) f VIII oust De par Use Onl i A rov Sanitary Permit Fee (includes Groundwater Aate pp 4d ❑ Disapproved slued Groundwater wing g t Signature ps) Surcharge Fee) 2 y �� D El Owner Given Reason for Denial IX. Conditions of Approval for Disapproval ( U Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. O4P� 2. All setback requirements must be maintained as jr applicable code /ordinances 3 u _ Attaeb C Mt� Pleas (90 the COUSty only) raw the system on net teal tbaa ti/2 X 11 in ets is size SBD -6398 (R. 01/03) I e f C t a J ` V c q �� 3 � Q a ��Z i A IQ S � A r t� 4 4 /1j�ac % 3 Q Y �t r W �,��,,,,,,�,� SOIL EVALUATION REPORT pe - Division nt Safely and Bindings in accordance with Comm 85, Wis. , Adm. Code Counly S4 Attach cxxrplele sfle plan on paW not less than 0 1 12 x 11 inches in size. Plan mum include, but not dmftd for vertical and horizontal r&%mnce Point (BM), dr«tlorr and Parcel I.D. Z 3 3 percent side, st=ale or dimensions, north arrow, and location and distance to nearest road. by as �rmatlon. iPlesse Prim rs -=nsr rsromuWan roe praMe may be ubd rot t>w. t5 :114 ( ) (m))• (� u�l/in- -� Property Owner : z Ole ham Pr Govt SLJ 1/4ill 1/a S // T 29 N R 19 E (°rL•J property Owner's mom Address � r # Block #R Subd. Name or CSW Cry Stale A; Code � NunvW City i ❑ Village [Noun t Road cISO Cull 5 11 ( _ .. } aDSo o 0 C (W New Co�truction user I Number of bedrooms code derived design flow rate GPD ❑ Replacement commercial - Describe: Parent material `cti.j- Flood Plain elevation if applicable ft. Generale c ,// 9 S a and, r ,datiarr>:: s ys-(4 � �aP� S � 3.S Borin # ® p f t Ground surface elev. 9 ft- Depth to factor _ 2 U soy Application Rate Horizon Depth Dominant color Redox Description Texture Sbudure Cor stenos Boundary Roots GPDIft< in. Munsell Qu. Sz. ;Cant. Color Gr. Sz. Sh. *81#1 'Ef0l2 i U -10 /O r3/3 — Si 2mc� m �r c, l V C S q �� — n,s �5 ►� I - ? I 2 4 / F -z l 'g ® p elev. Ground surface ev. �9.9U _ Depth to limiting facbr 1 �d I n . sot Application Rate Horizon Depth Daminant color . Redox Description Texture structure Consistenos Boundary Roots GPDIfP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfW1 'Eff#2 / O -iv /d , s / 'l 2 bk Z 0 -25 /D I — SiU 2rn k C 3 m 5 m / -- — 7) • Ef awl #1- WD j> 30 :5 220 mgt{: and TW >30 1so mWL • rent 02.= BOD < 30 mg&armed TSS <_ 30 mg& CST Name (Please .Signature CST Number y M12, jr Address Date Evaluation Conduclod Telephone Number t�xer Parcel ID # page Z o r – Property owner �]q ��\ ❑ 3 i s # Q Boring Ground srufacoe elev. � =-'= f. Depth >o know factor in. Sol Ion Rate 8 pit Roots GPDO Texture Structure Comae x DesaiptiDn 'Eti#2 Horizon Depth Dominant Color RedD 'Et�1 in. Munsd O Sz. Cant Color Gr. Sz. Sh. r .4 Z 10- IU 3 31 -119 — rn I El eon ❑ Boring ❑ Pit ;Gtocnd,srxface elev. __.___�ft• Depth b tirtr�r►g factor in- Sol Rate Horizon Depth Dominant Color Redox Description Texture Structure Cotce Boundary Roots GPD lo. Munsef Qu. Sz. Cont Color Gr. Sz Sh. 'Eft#1 ��2 i F—I Boring # Boring Ground surface elev. R. Depth to iting bCIOr in. Sol liar Rate ❑ Pit Domitattt Color Radar DeuxiPfbn Texture Structure Con tce Boundary Roots GPD1fP Hoftm Depth Gr. Sz Sh. 'Eff#1 'Eff#2 in. Munsell Qu. Sz. Cont Color * E&wt #1 = BOO > 30:S 220 mg1L and TSS >30 <_ 150 mgfL ' Effkm t #2 = BOD < 30 mgfL and TSS <_ 30 mgfL. 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 d e p ar t men t at 609-266 -3151 or TTY 60 8-264 -8777. ssn- a�wcr�mrom PAGE, OFa NAME: 9 e e r LOT# LEGAL DESCRIPTION:5V I14Ntl /4,S /IT N N,R, jtE(or)&j SCALE: 1 "= yd r µ{ ELEVATION: BM 1 DESCRIPTION: BM 2 ELEVATION: G /I 1 BM 2 DESCRIPTION: jYt± SYSTEM ELEVATION: 4S• So krr SYSTEM TYPE: ( d{v� �;c na f + _1 D L f r• SIGNATURE: /��� TE: &�Z •raMrr+r �.r `' r' ,� • L� 1 l °� � L � �j y r t " n � r. L , r • n - • irr...., '+" CI VENT PIPE 17" MIN. ABOVE GuDE E � 'Rt314 DOUR WINDOW OR 4EATNERPROOF FRESH AYR lxTAKE JL'NCTIO'd BGX APPRO'�ED FINISHE; G RAD E COND�JZ2 `4A.VNOiE CG'JE�, �RAI E W / PAD LOCK I 4 CZ RISER -�--• WARNIlG '.ABEL X . LET WA'►ER TIGHT SEALS w GAS- I TIGHT i SEAL PR Poo VE�3 �„� ; _._. ;� JOWL'S WrTh WE 3' ; B r ► -�cALM APP00 VED PIPE 3iY L S�'lL YD � � .�,... F S ON � � 3' ,ONTO M J C '1 SOLID, SOIL PUMP CPI' ELEV . F T , I jj ......... -'„- ►'�: i �� gSSE EXIT D PERMITTM cx;.Y ' IF TANK MIANUFACTIJRER S" APFRvVED B£DD UNDER TANK HAS APPROVAL SON - CRETE PAD SPECTFZCA.+ ;3� "5 L':�2IC r DQSE `ANX MANUFACTURER: �s•r� h "�M3ER %OSES PER DAY: .G .ANX SIZES: SE'"r'"'IC „I GAL. DOSW vcijj,ME INCLUDING DOSE a GAL. FLQWBACX: 1�9� GAT,. �LAR MANUFACTURER: ,�'...,. MODEL NUMBER: CAPA:IT?E5: A : '�� � :NCHES v AL. SWITCH Ty PL": ° ' Zara...,.,..,, -- a = 2 INCHES v ,•�...... , $,.��.: MANUFACTURER: MODEL NUMBER: - C ; INCHES r ( GAS/. SWITCH TYPE; D ,.J�L INCfiES = ��GAL. e.QU�RED DISCHARGE RAT Q GPM PUMP E ALARM WTRiNG AS PER ILHR 16.13' '4A CRI`CAL D =FFE'RES�CE 8E, Gi F AND IN'MUM NETW WISTR , H ORK SUPPLY PRE 12 I"EET FErT F ORCI;MAIN X R E T ?BUTTON PIPE , i'G F T /100 F:". n FEET T.ON FAATOR OT4L L YNAMIC :I~Ap s FEE rM M �T e g £RNAL DIM�':t'eTONS or , • , , r E„� W.T O TH ---- «j T r,� Q EPO4 aG . 3 8 7 1 E P05 APPLICATIONS • Fully submerged in high ■ EPOS Impeller. Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. • Effluent systems heat transfer. ■ Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto superior strength and corrosion ca,�dianstandardsAssoeanoo • Heavy duty sump matic models include resistance. • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatedng assembled and preset at the for efficient heat transfer, in "F" or "C ".) factory. strength, and durability. SP ECIFICATIONS ■ Motor Cover: Thermoplastic Goulds vamps is I SO 9001 Registemd. •Solids handling capability: FEATURES cover with integral handle and 9 Pa ity: float switch attachment points. 3 /4" maximum. ■ EPO4 Impeller: Thermoplas • Capacities: up to 60 GPM. tic Semi -open design with ■ Power Cable: Severe duty • Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water resistant. • Discharge size: 1 NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 104 (40 continuous METERS FEET 140OF (60 intermittent. o • Fasteners: 300 series - stainless steel. q ' --- ._- _.. —► t s oya+ _ ......._ ac' .. • Capable of running .......... dry without damage to 8 components. 25 . __ o� Motor: ---- v 6 20`` • EPO4 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 5 _ -- -- RPM, built in overload with _. EP05 automatic reset, a r • EF05 Single phase: 0.5 HP, o 115 V. 60 Hz. 1550 RPM, EPO4 built in overload with z automatic reset. - • Power cord: 10 foot standard length, 1613 ao 50 GPM S1TOW with three prong o o io . zo 30 optional 20 Op -- �-- --- -- `'`� —, o grounding plug. 1 51TW with o � foot Length, � o z three prong grounding plug CAPACI Goulds PumPs�_ (standard on EPOS), f ITT industries e 20012 Goulds Pumps Effective f•6ruary, 63671 . . ' STANDARD CHAMFER Quick4 Standard Chamber 48" (EFFECTIVE LENGTH) i 34" SIDE VIEW SECTION VIEW MultiPort End Cap SIDE VIEW TOP VIEW FRONT VIEW (1) on'd—f. I-d ly �t -,I, chwow, and Plato, wodq- and drier wrassot-y manufactured by Intiliraw Uniis�, mwn, i andopirraimt nairinali and workma,itrip to, ong yev ["I tire d In ert 1110 -plic permit is issued for the seplic system (:vnianng Ity, LHq proviaft, rinwever, pill I 4ial if i iolott: viormit jq nol required by ap aw, 'he wardany brinod will benin upon the date that installation of the s"Ittic 3wern r�rnences. To eme"Clso its Warranty righs, holder most ridity Infiltrator in willing at to GQrP0raI I'le&dqUarters In Old Saytboo�, C'unnedr,"t vothin viteen (15) days of imp alleged doled. infiltrator will supply rep;aciament inks ' or Units determined by Infiltrati to be covered bv this Li. Hired Wararny �tiern I �Ianufarlllled by mvy.ne other than hifill'alm Thii Urdied warranty does his Lowed W—anty shail be �Pcj it any part of t1le chamber sys SYSTEMS INC and ororos a an:1 materials, overri(mid. costs. or other losses ey expon"T, "' rd Domv, Sr-.1fically .drdiad! from LF"I(w.1 warranty ct:�waqe am, damage 1- the Units due to ordinary wear and i—. alteration, aodd9ni "ok or degrect Of the I the Unds; t a Units being JI t to -hidlo Intlific or other cor whrh are not Ponrlitted by thia ristallation to malrofir, gl". 6 Business Park Road - RO. Box 768 11i.um gr^jrNj om set lo"h the instaflolion hatriaclons; the pwament of improper materials into the system 'Pontail"Ing 11 . Uni & lak- I the Units " the -Plic ", am due to improner ailing or Improper qzv, exoisve water I.g., Improper greaGedsoosal, a impruivroperal"1 or any otne '01 ca by InfIllrat- This Urri Warranty sliall be vrod if he 10 7 0MIDIV will't all of Via tilarns set Forth In this Limited Old Saybrook, CT 06475 Wavanty 860-577-7000 - FAX 860-577-7001 Fi,,Ihw,,n no e�erd shal''rillfrolo, be responsible for any loss or dernaga In 110 frofider, the. Llints, or a thi p rest 1 1 with art sile conditions �qiaredf by stale and on C odes : s Ot aPPk mw t )nsla , it nor, 800-221-4436 fc!) No Infillfator has the atilhottv to change oriaidand this tuniled WIttrafrily No warranly applies lo any party oftity, than the origi. -I Holdol. Tt� abaw reprose the Standard Linall" Warranty offered by Infiltralor. A nriled ni—it of idales and d-rilies have df1weIrt warI req%vi , opy of tha apvIcabIra warranty, and should carri read that warranty prior 10 the U,,ftq Canadian 0 aten!s: 1 ,329,9,59; 2.004,W Other pateri Pending. Infiltrator, Equalizer and SideWindOr are registered trademarks of Infiltrator Systems lrv�. Infiltrator �s a registered traderriark in France. Infiltdator Systems Irc. :�, a registered tradomilarw: fi Vexicc, Contour, Corridor SvI Connection, l PofyTtiff, Snapl-�-*. ChamberSpazer, Poell-ock, Qv-,k0ur Chmokplay m;, or f rom any product lanlov cfatirs of Holder or any third party. r0r rile LnNW Warranty to apply, J110 Lites III fron, Ina atialion c, sho POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _ L 01 _ FILE INFORMATION SySTEM SPECIFICATIONS ®caner septic Tank Capacity ,� a i O NA c 0 NA Permit 9 � Septic Tank Manufacturer V OESIeN PARANISTE11% Effluent Filter Manufacturer Z,,- ❑ NA C) NA Number of Bedrooms d NA Effluent Futter Model d' Number of Public Facility units T--- NA Pump Tank Capacity ai C3 NA Estimated flow (average) e/ -d?- (,f?j gilds Pump Tank Manufacturer r S eY ❑ NA Design flow (peak), (Estimated x 1.5) d d aVda pump Manufact 41 ❑ NA 1 il Application Rate 02 x Pump Model 0 NA So �] al /da lft Standard InfluorWEffluent Quality Monthly average' Pretreatment Unit NA Fate, Oil & Grease IFOG) S30 mg;L ❑ SandlGravel Filter O Past Filter Biochemical Oxygen Demand ISOD 5220 mg1L O NA 0 Mechanical Aeration © Wetland Total Suspended Solids ITSS) 5150 mg/l. Ci Disinfection O Other: Pretreated Effluent Quality Monthly average Dispersal C011(6) 0 NA Biochemical Oxygen Demand (SOD X30 mg /L in- Ground (gravity) 0 in- Ground (pressurized) Total Suspended Solids (TSS) 530 mglL NA At -Car j is 0 Mound Fecal Coliform tgeomstric mean) s10` cfU.1100m1 0 Drip - Line 0 Other: Maximum Effluent Particle Size Y in dia. O NA Other: 0 NA Other: ❑ NA Other: Q NA "Values typical far dornestic wastewater and septic tank effluent. �K' ❑ NA MAINTENANCE SCHEDULE Servke Event 8ervioe Frequency Inspect condition of tanks) At least once every: 3 carts) a ( Maximum 3 years) ❑ NA Pump out oontents of tanks) When combined sludge and scum equals one-third (Yg) of tank volume i3 NA Inspect dispersal cells) At least once every: months) (Maximum 3 years) 0 NA 3 (r) Clean effluent filter 0 NA ter At least ones every: l ,'>0' ear(s) inspect pump, pump controls & alarm At least once every: _ _ months) O NA C� earls) Flush latersh maftthla) ❑ NA and pressure test At feast once every: 0 earls) Other: At least once every: ❑ card(&) ❑ NA Other: a 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. Tani inspections must include a visual inspection of the tanks) 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 collie) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pondin! of effluent on the ground surface. The ponding of effluent on the ground surface may Indicate a failing condition and requires th 1mmediato 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 acaordenos with chapter NR 113 Wisconsin Administrative Code, All other services, including but not limited to the servicing of effluent fitters, mechanic or pressurized components, pretreatmen units, and any servicing at Intervals of S12 months, shall be performed by a cartiflled POWTS Msintainer. 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C.e 'kurvey- Ma - # � ” 7� t( ��3 Volume - ..,,Page # �O Warranty Deed # Volume 4 14L, Page # �a 2 Spec house L yes k(no Lot lines identifiable q yes 0 no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pamper. What you put into the system can affect 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 a mastorplumber, journeymanplumber, restricted plumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 11we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of thg three year expiration date. IC-1,-� 4 / 6 SIGNATL= OP APPLICANT DATE QQV UR CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prWrty described above, by virtue of a warranty deed recorded in Register of Deeds Office, V 1 � k* b� SIGNATURE O APPLICANT DATE *sssss Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.*** •« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed DOCUMENT NO, j�[?(1 }�) N�ttAtTY •[[� - - `L � !! t " ." / / STATE OF WISQONEIN _VMM 9 3 0 0 0 5 5 V= RAM ti pR MOMM UTA THY$ VmzmvR[, Made by Leonard Rr_tGISTERS OFFICE Il4IyI1_8 -A -leD lard �e.er. a si nF,? �_ IDHLL ST. CROIX CO.. WIS. Recd for Record this-6:w- pastor __of `:1 _ Crni Y — Coun f day Of_ APA1____ A.D. �r W12xn@k% hemby convey. and trumts to RiGhard T. RPPr and Phi 9 1 nni ne 11. Beer, hukhnnd at__ x;R __ A K and_ w fP ag ,hint x. Pnnnt_a R1R tr t r x — ` - the (ollowhft "wt of 4ad in rn * X_ COMM State of Wiecanaia; The Northwest Quarter of Section Two (2), excepting therefrom: Commencing at the Northwest corner thereof; thence .South 159.6 feet: thence East 40 chains to a point on the Fast line of said Northwest Quarter (NWi) which is 121.3 feet South of the Northeast corner thereof: thence North to said Northeast corner; thence vest on the North Line of said Northwest Quarter (WO to the point, of beginninrr: als6 The Southwest Quarter of the Northeast Quarter (SW$ of NEi); the Southeast Qmarter of the Northwest Quarter .(SEI of NWT), except a parcel oand described as follows: Commencing at the Northwest corner of said SaWheast quarter of the Northwest Quarter (SEI of NWi); thence Ease 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 linp thereof for 100 feet to the place of be- inning; also an easemen for roadway purposes 20 feet wade on the `0,Pst side of said, excepted parcel,: also a right O w=,4v easement over the roadway as now traveled in a Northerly- Southery direction over the Northeast Quarter of the Northwest: Quarter (NF4 of NW;;) all in Section Eleven (11); all of t hP ahove I ncate l Nineteen (19) West. in Township Twenty -nine (29) North, of Ranr-v al so The Southeast Quarter of the SouthwestQuarter (SE1 of SWt) of Section Thi rtjy -f: ve (35) , Townsni;p Thirty (30) North, of Range Nineteen (1 1) 'hest . Subject to easements ani highways of record, and containinP 275 acre;, more or lass. Grantor rps erves the r»ht to live in dwelling; house, on - premises for his natural life. Subject to m ortl g a n ge to Federal Land Hank in the sum of :zi i, �50.t G, which P,r a ,�� 5'w�EIF. 9e 8AEd Kran o . _RU L __ bereunto set _h1 S hand _ . __ and seal .. - -- this A.h - r1 l _ . A. D., 14 70 . ' ` Y SIGNRD AND $F.AI,BD IN PRF.3ENCR OF � ! �` � _ (S&AI.) JQSph_�r` :__Hughes- � / f i ftuth A. Johnson (SEAL) STATE OF WISCONSIN. __ County. - «, i I' . Personally came before me, this _ __ -- 2nd A ril A. D, 19__7�� _ — - - -- --- _ —___ -- -day of _- - _ _ the above named - __lleonard - -J_. Beer_. also___k=wn as 1,eonard .1eer . . _3_ sal n 'le_ m an-- - - -- to me knoasn to be the Person— .._.who executed th otgg ruin and aclrn edged the same. t�>r aNOTARY i Joseph_ ._. ' _Hugh- T, , - sRAL Z �o 0 ��p N N n rJm d1 N LTI R3 A cn D � oI� NmV Lin Cn X CD 0 3 Qm� )SO49'041 / . 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