Loading...
HomeMy WebLinkAbout020-1433-09-000 c ~ ~ ~ ~ ~ ~ ~ ^' y N p :.. I ~ CA N I n 03i O cn O_ ID N W ~ N 7 ~ ~ fD O N WZJ• ~ I N _ 3 ~ ~ ~ ~ ~ d ~ O" n ~ ~ fD 7 3 ~ I ~ i w u ~ o l (n Z D W o. m ~ N Z D cn D ~' d ~ ~ ~ D W IW ~ I ~ ° ~ a p o A ~ I ~ -.. - , O ~ ~ ~ I ! Z O O a ~ ~ I y 0 0 0 1 z c~ ~ ~ ~ ~ ~ I o ~ ~ c~ N N N~ I ~ c~ ~ o v ~ I ~ m~ e'o ~ w ° d m m ~ m ~ 3 d ~ ~ .D . , N n -• ~ I Z 3 D m ~ I 0 ~~ ~ ~' o ~ = ro I ~ ~ ~ m y '~ CD (7 C ~ ~1 N C ' N. N v o C • co ~ - I ~ ~ w n m m I ~ I Z ~ ~ O ~ N a , a I v~ I o. 0o v I p, p w Z A I N a I ~•c°m~m0°•~o~ n n 3 0: ~ I ~ d s~ ag ~ c n : S~ Q~' ~ ~ ~~ ~ n ? o a I ~~ °o ~ ~~ ~~ o 0 0 ~ N I ~ 0 .=y °.y o`~vo yam N a ~ 00 ~ O.y N '. W N N . •. ~, I ate; __= as s.~ ' o. I ~ v ~3 omo-w OVN 3 co~ o , ~ X , ~ ~ ~ < a ~ N p O 1 O , ~ 9 N~ O ~ O c0 _• I fD Q ' • N d n~ ~ ° n~ ~ °'~ • tl ~ Q 7 0' ~ C C O ~ ~ ~ . . ~ O ~ ~ ? O_ ~ 7 N ( p ~ ~ O ~ ~ N o Q ~ ~ ~ O ~ m I m ~ ~ O ~ O L S L ~ ~ ~ y o ~ ~ W ~ J OD O ~ c a J o N N ~ CST N N N ~ v v, ~' M • a e3o ,.~,. D a d ~ o ~ ~ H C 7 C. N A G 3 C a ~ ~ a C •'•' B V! ~ d A y N n ~~ m c ~ a o 7 N 3 m o ~ v d ~ ~ _ ~ o C ~ O- IV _ O ~_ ~ A ~O W W p pNj b V G y O C 3 :'• a .. ~ d ;.. ~o ~ 0 c o. E m co A ZT n J M A ~ ~ N ~ ~_ z ? ~ z ~ m_ ~ d ~: r7 0 `t A7 O ~• O ~• ~• 0 A a o~ O~ H ~ N 6p ti A ~ ti ~ i ti Wisconsin D9partr~ent of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m) Permit Holder's Name: City Village X Township Glen Johnson Construction Hudson, Town of CST BM Elev: hh ~iV Insp. BM Elev: ~~w ~ BM De cription: ,~~ w J ~ ~T~/v ~ S L t. TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic / + ~,J I ~ ~--~\ (,J Dosing jj-j /, 7] ~ f~f~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/ ~.s ~ `~ WEL,,.~ ~ BLDG. f Vent to Air Intake ROAD Septic ~ ~ t `~ / ~ I Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer De and GPM Model Number TDH Lift Friction L ead TDH Ft Forcemain Dia. Dist. to Well SOIL ABSORPTION SYSTEM Z -E'' ELEVATION DATA County: St. CroiX Sanitary Permit No: 479318 0 State Plan ID No: Parcel Tax No: 020-1433-09-000 Section/Town/Range/Map No: 11.29.19.2697 STATION BS HI FS ELEV. Benchmark ~. / ,~ (QJ 02. r,' ~QU ~ Alter. B, M Bldg. Sewer ~ ,3 ~. O~ SUHt Inlet ~ ~. SUHt Outlet -'3 ~, b R3-~~ Dt Inlet / ,_,~,~ Dt Bottom ~-~' ,~ Header/Man ~ .- ~ ~~h ` 1 ` T q Z, - Dist. Pipe r-- ...~-r. ciaf` uy'f " / O' Bot. System j. 'L Final Grad `~ JF ~. (~ .G St Cover / ~~ ~" BEDITRENCH Width ~ Len ,4d , i~ No. Of Tre~ s PIT DIMENSIQDIS ~ No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ SETBACK SYSTEM TO P/L BLDG WEL LAKE/STREA LEACHING Manufact rer r j ~ L _ INFORMATION CHAMBER ( r~/ Ty Of System: ~ 3v' >~S ~ 7 (~' U Model Number: DISTRIBUTION SYSTEM <1 N - O'i1tieXJt.V- ,~4ar4, ~" Header if Id 9 l Di Distribution I Pipe(s) ~/ Q j ~ ~ , ~ tr ~pla C ~ Di L h `T - • S x Hole Size x Hole Sp/acing / Vent to Ai nt ~ i a Length pacng a engt ~~ ' SOIL COVER a Prowcura Svstwmw Anly YY Mound Or At-Grade SV8tBm8 Only ~ 1"d ~ ~ ~~~ /~n _ 7 Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edgas Topsoil Yes ~ No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ d~ 0 ~ Inspection #2: / / Location: 1060 Daniel Drive Hudson, WI 54016 (SW 1/4 NE 1/4 11 T29N R19W) Mound~View Estates Lot 9 ~~ Parcel N :11.29.19.2697 1.) Alt BM Description = ~ ~.V~/w ~ K. ~z /(~t(J"l"'^ ~ ~J~~~a' ,w' "~ ~~ ~ !~~ 2.) Bldg sewer length = 7i ~ ~uQ-r~~ l/t,~~' ' ~ ~~~~If ~ - amount of cover = 2 Plan revision Required? ^ Yes No n~ ~~,~ Use other side for additional information. ~ °~~ ~ ~ ~i~N~hX~ ti ~/t~}..i ~ Date Insepctor's Si ature Cert. No. SBD-6710 (R.3/97) t' 1 / /C ' ,r ~ ` Safety an~a i io ~ 201 W . Washington Av County ,~ ~~ f~'o ~` fC lscons~r~ Madison ~- ' . anitary Permit Number (to be fiNed in by Co.) Department of Commerce ~ , z _ ~ ,~~~ 1 ~-~- ~ Sanitary Permit Applicat on ~t,~k to Plan LD. Numbe r ' _ / ~ ~ In accord with Comm 83.21, Wis. Adm. Code, personal inform ion you r~~I~;CC)UN t Y 1 `y i may be used far secondary purposes Privacy Law s1S (1)(r6~~ ~IC~ jest Address (if different than mailin address} , . OF ~ ZpNING g I. Application Information -Please Print All Information ~~,~~. Property Owner's Na m/e 1 ~, _ _ Parcel # # Block # Property Owner's M ailing Address I J "1 ~ ~ Property Location DZa'/~ ~~~~QbC~ ,~ 1I t~ ~ f Q ~ ~~ ;4 Secti 1~ ~ ~~ ~ City, State Zip Code Phone Numbe , on _ ' +~- r ~ / •' ~ ~lrJ~ q (circle on ~ .2 b R ~Q E ~ T ~~ N or ~ , ; iI. Type of Building (check all that apply) 1 or 2 Family Dwelling -Number of Bedrooms __~>~~~ v ` __. _ Subdivision Name CSM Number ~ T ^ PublicfCommercial -Describe Use _ _ _ ~- _ ~/f~~,vl L/r'~[.3! r3'~____~ ( _ f ~ State Owr-ed -Describe Use __ ~ _ ~ ~ ^City_^Village I~iiwnship of ~~p,~t/ ~ III. T - -1------- ype of Permit: (Check only one box on line A. Complete line B if applicable) A. ~ ~ New System ~ ^ Replacement System ^ TreatmenUHolding Tank Replacement Only ~^ Other Modification to Existing System i R. ^ Permit Renews Permit Revision ^ Change of ermit Transfer to New List Previous Permit Number and Date Issued -~ Before Expiration Plumber Owner ly. __._ Type of PC-WTS System: (Check all that apply)^ ___ Non -Pressurized ln-Ground ^ Mound > 24 in. of suitable soil ! ~ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter it ^ Constructed Wetland ^ Pressurized ln-Ground ^ Holding Tank ^ Peat Filler ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ~ ^ Recirculating Synthetic Media Filter Leaching Cham ^ Drip L ^ Gravel-less Pi x lain _ ~ V. Bis rsal/Treatment Area Information: _~/~-, P - ~ ~ ~~ ~,,, cs -QS' Design Flow (gpd) Design Soil Application Rate(gpdsf) ispersai Are equired (sfl Dispersa ystem Elevation VI. Tank Info Capacity in Total Number Manufac[arer Prefab Site Steel ' Fiber plastic Gallons Gallons of Unite Concrete Constructed - Glass New Existittg '~ Tanks , Tanks 1 Septic or Hokfing Tank 1~~ _ / C j -~~~~ ~ _ -' Aerobic Treattent Unit Dosing Chamber _...._ ~-, i i Vll. Resportsihility Statement- I, the tmdersigned, assume responsibility for ' allation of the POWT5 shown on the attached plans. Plumber's Na me (Print) ~ Plutber's Si gnature MP MPRS Number Business Phone Number ,Plumber's Addre ss (Scree[, City, S tate, Zip Ca de ) // ~~ ~ ,~ VIII aunt !De artment Use +Dnl ~ m~ry Permit Fee (i lodes Groundwater Lat Issued Issuing ge Si cur amps) Approved ^ Disapproved ~S" Surcharge Fee) (; ~~dd ,,/ ~ ~ ^ Owner Given Reason for Denial (f5 ~~ _____ ~ _ IX. Conditions of Approva Reas s for Y)isagpr al ~_ TEM OWNER: - effluent filter and ~~~~^ 1 eptic tank ~ , ~ ll must all be serviced !maintained l i G ce spersa d as per management plan provide y plumber. ~ 3 /~/~h, „ „ 1-~ ''~ ~ - O -' F new ~- L ~ aG ~~-- 2. Afire ac regtilrements must be mam~al / ~ as er S~ 6~.~'~ ~' Acsaca compteu ptagtt lto motiounty ootyl for the sys[em on paper not tens than evz x t t incites in size CRT1_~40Q /A n~ rnz~ ~,~,n,~'lr~ ~~ 0 ~ e a ~` ~1 ~ O ~~ 'U \~ `~ v ~ ~ i ~~ ~~~ ~ ~~ J ~~- bid b g oro m T~ /~ O m O D v ~v 0 z z m r O v c ~_ z ^~ O Z C Jn 1 O Z O Z r D z m z ~ ~ v o ~ ~o - r V .~ _~ 0 z m ~ ~~ 5 ~~ a ~~~'~ ~~ ~ ~d~~ a ~ g~~~~~ ~m~ 3 IC !~~~ C ~ ~ Y ~ ~' > > ~~ m ~~~~ ~, ~_~ ~,m ~'~ ''o' ~r_,ZZ ~g ~ ~ ~.N fl,~r w S ~S ~~. ~ ~ ~o ~ o~_ ~,~ ° o ~ ~° ~ y C~ 7 p 7 ~ 'i3 0 (A Z a H Z N m -~ m O C z ,o ~~ D- m ~~ D z n m -~ z O `~ W W ~~ t~ 0 C . ~,... o ~~ ~~~ ~.~.x. Wisconsin Department of Commerce D ~ IL EVA(~U~j~N EPORT Page ~ of 3 Division of Safety and Buildings ~ / „ ~\ j in accoroance :wren ~op1m tea, ~ s ~~ ~pae 11~~ x County ~'ti 1 in Attach complete site plan on paper not less than 81/2 ,~,~ inducts, but not limited to: vertical and horizontal referen poi ( Parcel I.D. Lo-/ ~~_ ~~W~ v percent slope, scale or dimensions, north arrow, and loca on a ce to nearest road. Please print al! information. R awed by Date Personal iMormaGon you provide may be used (or secondary purposes (Prnracy Law. a. 15.04 (1) (m)). ~ ~7 G ~ d property Owner Property Location ~ ~~ ~ y\, Sa y'°~ Govt. Lot /,v U4,(/C 114 S ((T Z N R E (or~ Property Owners Mailing Address Lot # Block # Subd. Name or C/SM# ~ p ~( Q v /lot;. - City fate Zip Code Phone Number ~ City ^ Village Town ears d ' New Construction Use: Residential /Number of bedrooms ~ - y Code derived design flow rate ~ d ~ GPD ^ Replacement ~ Public or commercial -Describe: _ Parent material DC1 w ti Flood Plain elevation if applicable ~~Qy~ Q ft. and ~n~commenda~d'ons: S~,Sfe ~ ~ ~ ~ ~ r `~ J'~/~ ~~l/~ 'J ~ ~ J /L /S ~~ ~ ~ ~~, y ~ a ~ S/lt'/YrIYL ~ _9~' °~ ~/ I--I n Q,. I ` I ~ pit Ground surface elev. j lB ~'~ " ft. Depth to ummng raaor %~ ~ m. Soil ication Rate Horizon De th Dominant Color Redox Desrxiption Texture Structure Consistence Boundary Roots GP D/ff p in. Mansell Qu. Sz Cont. Color Gr. Sz. Sh. ~Eff#1 ~ -~ ~- ~3/z - S, ` 2 ~- ~ f I v 1 ~ - , ~i ~ !i a Boring # f~1 Boring L~/ L2y pit Ground surface elev. / (1' ~~Gft. Depth to limfing factor ~ ~ - in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIfP in. Mansell Qu. Sz. Corrt. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 r _- ~ ~6 ~ - s '/ rris~l ,- ~ s ~ ~ 1 - , e a - i ~ y/~ rJ ,M I - - , ~ y ~ '' ~~ 'Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 1 50 mglL 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL CST Name (Please Print ~ lure CST Number Y/l~r nation Telephone Number ifo ~ 4 Ss~~s~ .,r~,~~~~~~.~~~z~/ ~,~ s'~1a/~- f.-~~~~ 7~S-~~Q~z~ Property Owner J'=~~ ~ ~~ ` Parcel ID # cU ~ ~' ~ U ~,`e `'~-( Page ~ of ~a Pit Ground surface elev. J '~ ~ ft. Deptfi to limiting factor "~~ in. ~ licati~on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/iF in. Munseli Qu. Sz Cont. Color Gr. Sz Sh. •Eff#1 'Eff#Z o a, / -- C/ z.~ls ~ S ~-Sy ~~~ ~ 7 ~l ~ ~ S ~ ~ ~ -1 -.-- ~s l ..._ ~ ~ / ' .r ^ ~'~ # ^ Bonng ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate t i Redox Description Texture Structure Consistence Boundary Roots GPD/flz Horizon Depth in. nan Dom Mansell Qu. Sz Cont Color Gr. Sz Sh. •Eff#1 'Eft#2 Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to IimiHng factor in. Soil ication Rate Horizon Deptfr Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDIff in. Mansell Qu. Sz Cont. Color Gr. Sz Sh. •Eff#1 ~~ • Effluent #1 =BODE > 30 <_ 220 mgll. and TSS >30 < 150 mglL 'Effluent #2 = BODS < 30 mglL and TSS <_ 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seo-uw crt.sroo> PACs E ~O F NAME In ~ LoT# LEGAL. DESCRiP'TION w'/a•Ii '/a S I TZ N R E OR SCALE: f" _ ~Q HM 1 ELEVATION~L(~ • O BM T DEBCFtIPTiON~~'-~,,.t o..~ ;~,`nGQa...y ~'1 BM 2 ELEVATION ~ BM 2 DESCRIPTION SYSTEM ELEVATION 9d' ~ C> SYSTEM TYPE rl'ldL U~ /~ ~ ~ u ,tio.. 6_=y~' ~~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildii:g Divisiop INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Beer, Richard Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG Dosing PUMP/SIPHON INFORMATION Model Number Air GPM TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well Sell aRSORPTInN SYSTEM ELEVATION DATA STATION Benchmark Alt. BM Bldg. Sewer St/Ht Inlet Pipe County: St. Croix Sanitary Permit No'. 463383 0 State Plan ID No: Parcel Tax No'. 020-1433-09-000 Section/Town/Range/Map No: 11.29.19.2697 BS HI FS ELEV. BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer. Type Of System: UNIT Model Number. IIISTRIR11TInN SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing Q("111 Rf1VFR ., n.,,«...e c..~•e...~ n.,i.. .,., nn.,~~.,.~ nr AY-~ra flP SVCtPmC r)r11V Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1060 Daniel Drive Hudson, WI 54016 (SW 1/4 NE 1/4 11 T29N R19W) Mound View Estates Lot 9 Parcel No: 11.29.19.2697 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? I l Yes '] No ~ ' e i ~_ _ _ __ ~ ~ rt_ Use other side for additional information. I j Date Insepctors Signature . No. SBD-6710 (R.3/97) r---- ~ ~ ~arety a ~ fiutldi vt ~yt 7~- ~~~ 20I W, 'Washin ton Av (~`3'o~t ~~~0~ M di - __------ ._`-._ ___-_---- • ---- C'cwnty S BYO i a son, WI 53 7 -( If~1-~ De artment of Commerce ~ !608) 266-3151 Sanitary Permit Number (te be filled m by Ca ; r~ ~ ~ ~ ~ Sanitary ~'ermit Applicati n RE In accord with Comm 83.21, Wis. Adm. Code, personal irformati may be used far secondary purposes Privacy Law, x13.04( }E,n~ provide () 7 2~~5 ~' > ____.. s~ Plan LD. ~~ bee -.____.__ _~ Ai i t Ad _ ~ y _ F~.. I. Application ^Information -Please Print All i[naPorrnation o dress (tf dttferent than rtailin dressi /~iD ~ ~~u~ dJ/'1li`~ f S7 ,1;R01X COU E Property Owner's Na me } OZO - / ~--._Q ~-~...-_.___i s r G`i ay e e y steel ;y . g oc, TTr/GGG,((( ^[[[ ~~~~ ± ~wwk Property t?wner's M ailing Address '"~-'---°.-----__._..__~~ ~~~ G ~~ ~~ ~ ~ ` ... Pr ___ Pro try Location ~~~ ~ ~~ ~~_ . _ _ '-____......._ City Srs~T / ~ ~q ~L tb se d ~ . ~p Cade Phone Number , . c on _ .__ ~~~ ~1 I r _ ~.~t/_ II. Type of Buildin (check all th / t l /clrclz c . ~ ^,~~ T .?/ N; ~ Lh or~ g a~ ,~ a y) , app . l or 2 Family Dwelling -Number of Bedrooms '~ PubliclCommercial -Describe: Use ' Subdivision Name CSM Nutnber ~,d / ~L°~/ ~. ~- U State Owned -Describe Use ~ ( p~~ - aa!- 4' 3 ~ city ^Viliagt r)Township c f ~~,~ _ _ _.. _ _ ._._ ' _ - - --~ III, Type of Permit: (Check only one box on line A. Com tr line H if applicabl r ~ A. 'ew System ~~ Replacement System ^ Trertmen olding Tank Replac ent Oni ~ i ~ ~ . . _ __ ^ Other'Nadificaf xisting System - r• -. ~ ` ~•- B • ^ PorritR Renews) ~ Permit Revision ~ _ Change of L Permit ransfer to si i It umber and Date Issued + )&efore Fatpiration + Plumber caner ~ 1 ~'. ape of POW'CS System: (Check _aIl that appiY) ^4 , T. _,-.___._ -' _ _ _1 _ -~------_- ----..- ~---! i '~ Non -Pressurized !n-Ground G Mound ? 24 let. n2 SidfuhlC SL?!i I~ Mound 0. in. of sui to soil i i.~ Ao-Grade ~.J Single t'ass Sand Filter ^ Constrttcted Weiland ^ Pressurized 1o-Ground ^ Nulding Tank ~_~ Pe t t^iN ~~ Aerobic Treatment l.lnit ~ Recirculating Ssnd Filter j I U Recirculating Synthetic Media Filter .eaching Chamber ^ Drip Line ~1 Gra -less Pipe - ~ ~-6th xplainj ~~~-_ ; ~,~ f ~~?%~°' ° 't j V. Dix rsallTreatment Area Information: fi Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Are .et;uir^d (sf) - rsa -----, - posed (sf) ~ System Elevation p~ n q + VI+"I'~~ Ipfa Capacity in 7atal Numlxr ~ ~ Manut~~tCturrr 4 Prefab Site ~ Steel i Fiber ~ Plastic ` Giass Concrete~Consuuccrd ~ ~ Galloru GaUnns of Utuis ~ New Existing f } _ Tanks Tanks ____1~_ _.__.__ _._--________. .~ i -, i Sepuc or Holding Tank ~ /~~j0 ~~/ I rJ~ ~G4L' J~ ,~ - .. __~ ~ / '~ , ~ ' Aerc~ic Trtatntent Unit { ~ d~ ---.-.1 .__..~... ___._1 - posing Chamber G'~' ' ~ !'~.SSd _!_! ._ ~ ____ l __ 1`"--`_L__--~- VII. Respbtmsibility Statement- t, the Urrdersignsd, asyurn responsibility for inst Uatiou of the AOWTS shown o he attached platta_ ________..~ i P MFRS '~tumber usitess Phony Num'~er i ' s Si gnature Plumber I Plumber's Na me (Print) / ~ G ~ / jr (~~ , ~ Plumber's A.ddre ss (Street, City, State, Zip Code) M VIII. un~lpe~tttlent L.'se OnIY ~.~ Da a ssu sluing ~ e , ign e ( o Fs?~ ganifary Permit fieq,(.includrs Czrourtdwater ( j a pproved ^ Disapproved Surcharge Feei ~ O i1 / Cf __ ~~_ ` -- ~ ~ ------1- ~.T.~- i7 Owner Gsven Reason far I)eniai - ~--- - ~ iX. Conditions of ApprovailR ons r AisappravN~'"" ~Z~{~ ~/~-yy /J~J f,C -f~~j~l~~G~Zl~~~'w`'~ YSTEIVi v ' _ ~r~f ~OW7-S /'~ ~ 7 "" " ~ optic tank, effluent filter and ,~ ~ _/ _ ~~ f_ `~~ ~~ i ~ dispersal cell must all be serviced /maintained ~~~~'~" .. // Gf.~ lumber. GG~4~'L S ! as pe~.r mane em nt plan provided by p ~(~~ ~d ~ y ~ ~ 2. All setback requirements mus a mannatt~~~ s~s~ ~ _ S~C~(,yt-~Y~~-yr,~°~ ~ as per applicable code/ordinances. - ~ ~ bpi _ ` ~, r ~C'~c9'~~' . (! roe the :yatem on paper rot t ti12 x 11 iac n size 1 Attieil t,Ogtpkte pions {to tbz County oats) \~ 1 4Aq\,~ ry J. Q AV~^, \_ q ~~ \^1~\ y^ ,~ y a l~ ,~ ~, )~ I 0 ~~ ~ .. ~~ A ~~ ~~ 1~ ti ~~ u~ 1 l 1 ~~ ~ rt` ~~ --~ i ~GOULDS PUMPS APPUCaTtoHs Specifically designed for the fdlowing uses: • Effluent systems • Homes • Farms • keavy duty sump • Water transfer • pewaterfng SPECIE ICJtT10N5 • Solids handling capability. '1." maximum. • tapacities: up to fi0 GPM. • Total heads: up to 31 feet. • Discharge size:l'l~" NPT~ • Mechanical seal: carbon- rotarylceramic•stationary, BONA-N elastomers. • Temperature: tt)4°F (40°C} continuous t4t?°F (60gC} interrttittenL • Fasieners: 340 series stainless steel. • Capable of running dry without damage to components, Motor; • EP04 Single phase: O.A HP, 115 or 234 ~', 6a Hz,1550 RPM, built in overload with automatic reset. • EP45 Single phase: 4.5 HP, 115 V, b0 k1, t 550 RPM, buih in overload with automatic reset, • Power cord: tG foot standard length, 16/3 SJTOW with three prang grounding plug, Optional 24 foot length,16e13 SJTW with three prong grounding plug (standard on EP05). ~ 2000 Goulds h:nsps Effective fabruary, 2000 83871 • Fully wbmerged in high grade turbine oil ror lubrication and efficient heat transfer, Avellabk for automatic and manual operation. Auta• matlc models include Mecharticat float Switch assembled and preset at the factory. FEOITURES ^ EP04 tmpeller: Thermaplas- tk Semi-open design with pump out vanes far mechanical seal protection. Submersible Effluent Pump 3U~ I EP05 It EP05 Impeller: Themtoplas- tic enclosed design far improved performance. • lasing and Base: Rugged tbermoplast)c design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durat~lllity. ^ Motor lover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe dory rated oil and water resistant. ~ hearings: Upper and lower heavy duty ball bearing construction. AGENCY USTlNG ~' Cauadtan standards Assadation (CSA listed model numbers end ~ "F" or "C"•) Gou{ds iwnpa is ISO 9001 Ragged. 0 2 4 6 ~ 8 t 0 ~ 1 Z m~/h CAPACIri Goulds Pumps ITT Industries ~ u y :, v ~ ' SEPTIC TANK ~ PL7MP CHr'.MBER CROSS SECTION A1r`D "F°EGIF.:G~:TIO:~S 4" CI VENT PIPE I2" MIN. ABO"v'E GRADE > 25' FROM DOOR, WINDOW OR FRESH AIR INTAKE FINISHED GRADE ~ ~" CI RISER 18"' ~ IN. _ 6" MAX. t Syr l i tYLc\T WATER TIGHT SEALS .~._.. A P~~av~o ..~. 'IPE 3' ~... INTO SOLID C 'flp~' :~'JMP OFF E{ EV . FT. --~--•- D ~lERrf~fRPROOF JUNCTION BOX WITH CONDUIT .• •~l I ~ ` t GAS- ; 's i'iGHT i " SEAL r r 3" APPROVED BEDDING UNDER TANK APPROVED MANHOiE COVER W/ PADLOCK & WARNING LABEL ---4" M3N. ~i s4 VAPPROVEO ~olNrs wrr~ 'ACM APPROVED PIPE ON 3 ` ONTO ~ SOLID SOIL pFr ~~ R75ER EXIT PERMITTED ONLY ZP TANK MANUFACTURER HAS APPROVA C~NCREiE PAA SPECIFICATIONS SEPTIC / DOSE "'FINK MANUFACTURER: ~ ~~~~.~ TAN3~ SIZES : SEPTIC 1'Jt,~j Q CAL. ___..~^ DUSE ~ GAL. Ai.,ARM MANUFACTURER: ~s~.,:..~..~f~.~._ MODEL NUMBER: j~t..Y SWITCH TYPE: M~.,0.~ PUMP MANUFACTURER : ~~ MODEL NUMBER : (~ d SWITCH TYPE : me~~ R~EQ172RED DI SCH:ARGE RATE ~ ~ GPM NUMBER DJSES PER DRY: DOSE VOLUME INCLUD NG FLOW$ACK: » 9 GAL. CAPACITIES: A = ea~,e~ YNCHES = LI~'aal GAL. B ~ 2 INCHES = ~ ~- GAL. C = ~ INCHES = ~$ _GAL. D = ~ I NG HE S = ~_•,•.GA L . PU:4P ~ ALARM WIRING AS PER I LHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE ~~,. FEET ~ MINSMUM NETWORK SUPPLY PRESSURE 2.5 FEET + .~,_ FEET FORCEMAIN X :~~t~OFTllUO FT. FRICTION FACTOR . ~~3'. J FEET TOTAL DYNAMIC HEAD - 7 FEET iNTE1~NAL DIMENSIONS OF PUMP TANK: LENGTH ,~ ~ WIDTH ••-~' DIAMETER --` LIQUID ~" ~ 8 ~~ ~ 1 ~,~1 P~2 1 a ~.. ~~IGNED: _/,,,~,~,~%~~~~,~.----~ .. LICENSE NiJMBER: ~.~.`? Qq ~ DATE: 1/88 ~.....~. .~..~.. ~~` STANOAAD CHAMBFR Quick4 Standarc! Chamber ..~vl NlY Y{CYY FRpN? VIEW 5+~e(WxLxH; ' Effective Len t~ h Invert Height ---- 52x° r. S1t~E VIEW sl~~ v!~w TOP VIEW '--' :----..,^.r.+ t;.^I!x, .. _„ ter. .^ .^n^w, v o4rrwau.Yrla. .. - ~; ' r'r.y,.. `34" x 52" x 12'4 `. _SIze~1N x"L z H " °,; ~ ,ti_" 34" x 15" x 12rr ~~_ 48" invert Height 8° or 1.25' Ed.E;I~T~E-I4.9.. v~?'EM@~l~`;?a~tDa9~ll~JtEt? WARRANTY '~~i Ir(+lrv,~:i„ra, ', PfJ'aY d pa Y, ekarnllM, tYk! rxrlttl. w~/~ x ern] nthi A GG vo y z I t rE;rl trv xdii1rr11.x 1 ' _'r ul. 1. gx,Pn nul'ai"h1 it Yl ta,arfrlyri 'n /e+lGlGalcl RI Arl on n Styx srs pr .n accordance with rln t , { r „~, rlrr al mx7 wurkn a G ,t, 1-n~ rHw yl+ar Irorn Ihv q¢(o rhQl tre c ~ .': ku !G Ihii Jr Q r161 µurnexr t'Hu,Yar ! .~gaxr)1 rserk'nvr. rl, t I A sY! fr rwnut iti got r~~.,i cin nY n Mk aEr 1 s wu Fu Iw a(glix:. ny ,e r cu'+lr+ant~ tM V+m;: gruvaw, nv+vrnul, a{xkahlO law. !h • a tY :win%1 JI UCjrr ~':N: a r Udl,? Inat x. liratllu, Gd r,y ¢BPtic ¢YSIt:Rr C(rnrnHn~rrg •.. a E/. !i W2 IA I\ ag N$, NQGIBr r1,U51 nOllly l.Silfdlt^ xt W.ar'y Yl a:i {X{'vll:;.b hlYddltu 1 (rr,' !n (!t(i SaYOronY• '„r:flrY".'hCtA wxllin htlpWl {l y) Ala M tlta ac~-r,'en tt: ; sad!ratp vaix suo{,ly nplararrnrr V nts tc,r Un Un nn. ant+tt oy "a:fx !o Ap rrrvarrd t•y Ihls tlnar><71kau;uny 'n I rdtak Galvld,y Ixrrircah o"crudq,. the asst ,A ,rm_na' e',7,a utslacatxm u.:ni '}n.cs. 1~!Trr IROTf;~Jr'An':iA!vT1'AM~1 p[rkLYtS Ui:,Ul9ppjUtlURAf1i (il)AI&vh411!`.it4t rg;~iF AI'+(-.NClu1NEn WAgFtANTII'g trylihl RESPECT - f JNI i ;. N LUC)Ilvq; NO MF'tlF.p WARiAM7!ES Df INER(;hAN7AyN lTY A "r Jt i O!, A IM1?TI4JJJ+ PJAP06E. ."• u 111N L W r ' :Attl Jail? II anY Harl of Itr fna1 ttuyr sy'+ram TIA~ .V rr.llYFQ L x yOr;a 01 vi .hen Ylll~lalor tl'x? ~YC,IH? ,M~ttar"y dOtd lot t G d IO lncd al i. `asrxy lEnl al y;.v3G75 or YvJ¢acl dd hag9s IoGlfrzk ..Igll Lot ; P Mahrb y ;tw,pitiu.; fx i!auYfated d:xuetlas. Inrl„rjury) loss of /vr~l 1 trot nr ~p ryotn.,. ~tirlr ann n dteriar.. <Rrtr,•jl~dr~ pp5i5, pl atrt(U rrsS.OS Ui q',tiiexrser' r ~aur8u 11y the i{;ivhrt ur env IRvi: ~arl'1 " .gi4cailY Par lied 1 u' Last Y1 dPaniylC -,vdr-pB are darrradb to xy¢ ifias fJ.rb is WtiY ~.y) YMar and /Y.Nr, aIIHlalibt .:(a:It1aM, 1l11xidD, abuse « nn5/2CI Uf I~!P of l n 11:: v rear; J c'.!h~e!c i a vehicly Ira+Gc y cths cardkcne wi CS ' a rvrv, ;r, nWIrA by'nn installytgr msln Nora. la,furb r,t nrarrnan ,nb imlrllrrn Q.-rand t JerS -N ifx{n' Axr Yuinl'alcr 'rKilrWliUntl ihp U+aaemrr , ,mr,roFrr nateRaLi xnO lhfl byrlern UtMlakN !hH :ANis; i¢illrr¢ of arv U^rligrrrvwY rk t'nuSP.d H`rMilireto 4rTKrYr Mtmg ~ Y'irral'ar arty. lrx,uss"H wales saga rq.,rabrx grRasH rarsunsal. ur~aproi,or ooerarbn'. nr NSfrtan'y 1v¢ L;nu!'Od VJYRaray r: .u. Le r.: ;1 A xH •1~ac4.~ Idp¢ to crtrnply wxm aD of M.~ 1Nnr^ SYI Inryh in thl5 Lirna9U ~6,1~ r"!~ rr~tp,WUC:tr~rebN', ~ ro.~,dbin Ir'r w'y ks¢ar aa~rape to V,u hvb]p~.. ll,u U{Ills, a my Iniri paely rwLldtiny lnxn mstalisl;asn Or ship w,t:, all SrIP cru•.yitlfy'; !agliir Y ryairns a HoIQ9r.•od6aYdti VI'1Cr ny Fur IFa Orr V~d V'andnly lu p[.y11Y, 1ha Un116 n'n ~ cr I..g irKlli!iatl "1 acCVrr+A'tt;a Ott or stela arz[f WcW ^ aUill~:fpls iaa;; :mrt irviilratark ursY7nalwn -,^ n ; x ui ilt I lrs Ail !vu rtlUrose~Na:ive ct ¢,7Jt{3k r,ae 6,e- aldthMN9 la change or uxlw~,b Ihs L ritYC W;Yra^.`'Y NO Wur•:IDty dl$htes to dfly tarty attar Ilyr, lllP ntiy'. cat rir~i7ar. 'lli) dhova ryr,rbYH 't itta anct. d ' -,iRd War,yr iY nratOa by InfFl/a,a A Ililrt("7 r1rlR,1 PI I .IaMP.., ir.td (t !`:YI" ha' ¢ ("ItB,Hr11 wurle'd'I !q(rylr6- t~a^ s A y r,urt;.' r. or utits sr nud cnrnact Ntlitrato-'a (.-'Pasta NeaGyua.tarb Yt UY! arlYlrrpk, :tar rau.rc.d, i-xix to ¢t,;h o-r<iwsH k, utumn ,; -'cPY 41 the dpp~u, ,ae vnYlJnty, a'tl :~<Yi4d CareN,~Y «qu ihdl W'ananty pnOr W (fq Wircnawr u! Lrnua ~~ ~. SYSTEi~/iS fNC ~ E7grll'OlN1lplfB~ ~Ji1161yiEtdMY~AP'SD/U'tl0llb"" 6 Bus!nesa Park Road • P.O, t3c~x 768 Oid SaybrOOk, CT 06475 8(i0-571-7000 • FAX 860-577-~OOt eoo-zz~-aaas 1:. PaTtpnis: 4.7SB,vB}, ~,Qt7,^47. 5,158A88; E,:a96.o17; 3A0},t iG: 5.40+.J^9; :.,57 t,~:;; 5,7tti,t83; S,Sf38.'78:6.839,8gp ~ ul adlan Paler'la 7 d'a `JS'r,c.0~o,~tjk Older patfints rwndirt!). I' 1dtr(f!Or EgtJ ilizer and 'rlriclW.nUe1' are r@(+ISIerBd Uadt7TarkS ~! tf!liltraix ~',~te{f-.S ;n~.. al!UIrO!cJr is a rt>alateletr tradAmark ut France. InFdhator Syslrorns hte. a regrs',ertld trad„mark'~r• Iviezicp. Gtmtour, Clmroflr Swivel Goro'teCliUr~, Miwrpt,aaciliny, PoyTulf, SnOpLock. CharrGorScYacar Pned neL n..,..a,r~..r r,..:,.r.r„_ e....... _- ----- ------'--~--- yc•------_ ___- Mult+f'ort End Cap ~ . •Mrrsconein DeparU+-errt of cammetoe SOIL EVAIUATlON REPORT D;,,;sk,r, os'sah~y and Buildnigs ~ aaoorda~roe wan comer as, wrs. Adm. code Attach carnplete sae ~ orr > rat lesa than 8 if2 x i 1 inches in size. Plan must iru~ude, but not 6m(bd 1a vertil~l and horizontal raferertoe po&tt (BM), direcHorr and Parcel iD. percent slope, scale or ~mensiocre, north amrrr, and bcatlon and distance to nearest road. Please prh-t aJV ~ribrmaaon. AA~ Ferswrei inrwmatian you PCB ~Y ee used ro- law; ~: 5~ ~ (~))• ~ G~'/ z ~ s, . ~ g 1 ~/ ~ ~ ~_3 S-{- D~at//e 7~ pronertytJwrter~~ C hard ~e er Govt. Lot tS ti.i 1!4 nfL 1/4 S 1 I T 2"- N R I `~ E . „ ~ Subd. Name or Properly threat's MaWig Address ` , , c~ ~ Uv i~ v ti ^ ~ 0.~ S ~~5v c ~ A cay code Nurr~ . ' Cl ~r s CI vial ~T~, Nearest Rona __ , _ .. _ _ .. _.~ - ~1.,-.D ~,~ ,,, l i ~ini-,c_ y '~ New construction Use: ~ R I Number of bedrooms ~L~ Code derived design flow rate y-S-6~ D O ~ GPD ~ Rep~~ ~ ( ^~ Pubftc or cornmerdai - Oesa~e: ~ /~ ft. Parent m~eriai ~12U -~-~ ~- ~/'1 Fbod Plain etevadon if ttpplkmble •~~~=~~ General oanmertts S S-~fh1 P/z°v . ~/ ~-~- S~d~ ~C C~~~ and rercnmrnerxlations: Y ~ ,r,:,~o. ? ~ 3 , j~ 7o cam- S~ ~5~ ' ~ ~,o2uPit/~~ll.fy..- B i 4 3 z - ~_ G U U ~ Z `, Ground surface ekw_ ~ ~. OO ~ B°r~ # ® Pit in. pepyr to g resat _ soi Rate Horg an Depth Dominant Color Redox Descxiption Texture Strrxirrre Consistence Baurrdary Roots GPDflCr 'Etf~1 'EfM2 in. MunseU Qu. Sz. ;Goer Iola' Gr. Sz. Sh. ~ ~ g 5 1 b-II I©~ .~3 - Sr I 2r1'1G ~ ter c 5 . • Z I/-`f0 ID - S~'cl 2m5L`~ rr~-Gr ~ S - . `-f , ~o 3 5~d-(~2 IU rSl~ C3P7,5 ~ r`Ir'1o 5+'cl ' ~-~,~, c w _ ," ~ - ~ -1 - ~ yl~ ~ CAS m ~ _ _ 7 / , 2 Z U eora,g Ong ~ ®Prt Ground surface elev. ~_ ft• ~ ~r~r / `~ ~ ~• Sol Rate i fi Texture Structure Consystenoe aoutxia<y :Roofs GP DIfP Horizon. I pepln in. o-12 nomittantCaar Munsep x313 on p . Redoxflesa flu. Sz. Cotrt. Color 5'I Gr. Sz. Sh. c5 1 v-~' 'EfgF1 . 5 `EfM2 Z l2-~f0 / 5i"c~ ~ CS -a ~J TQQ t M .nnA EtRrrerN ~i = S3OD -> 3~ <T10 nrgl~ arKF i 5.'f 7JU = 7af/ ~wgra. _ _ __ ._.~ _ -._ _ _ CST Name (Please ) ' CST [mbar Tram ~~+~~ ' - ~C3 Q Address Y Die Evaluation Corxhrr~ed - Telephone Nimrber ~~ ~~r Parcel ID # ~~.d~ti ~~~A'ik- B ~aZ ~rh- Owtn~ ~ Borurg 7 ~/2Q ~~ ~ ~ in. , a Bourg # ~- p~ Ground surface .~~_• ~ ft. DePih b ~r9 faotDr Soi lion Rat Textt~e Cor,siatertoe Boundary Roots GPDlIP Horizon Depth Domir~t Color Recbx 'Et>#1 'Etitf2 ~. MunseM Qu. Sz. Cont. Cobr Gr. Sz. Sh. ~ ~-- 9 ~~, c3 3 ---, sl~ 2 r c 5 (~_-~ ~ 2 9-3~ ~ ~ Sl'c 2 r ~ S _ 1 ~~ 3 3~-44 ~~ ~ C P~.S y ~ ~I 2 ~r ~w _ ~ ~ u~l-i~ ~vvr`l~ ms ds" m~ /-Z ~9 # U Borhrg -- in. ^ Pit =Ground,surfacealev. ft. Depth m imi6n8 factor e Corrce Boundary Roots h S Soi ' .Rate ~ Horizon Dept in. Dominant Cobr MunseM Redox Deacripbon Qu. Sz Cont. Cobr Texture truc x Gr. Sz. Sh. ~~ ~iiaf2 Boring ~9 # Ground surface elev. it. Depth to ~9 factor in. ^ Pit Soi ~ iion Ram ttorizon Depth Dominant Color Radox Dasaription Texture Shudure Car~tence Boundary Raots GPDI'FEi in. MunseY Qu. Sz Cent Color Gr. Sz. Sh. 'Eff#1 'EtTax2 ' E~mnt #1 = 8OD5> 30 < 22i1 mg1L and TS5 >30 <_ 150 mgiL ` C-fF4~eM #2 =GODS < 30 mglt_ and TSS <_ 30 mgll- The Department of Commerce is an equal oppornmity service provider and employer. If you need assistance to access services or need material in an alternate format, Please contact the department et 608"266-3151 or TTY 608-264-877?. SBD-8J10/R.97/0~ PAGE 30F~ NAME: ~eC / LOT#~_LEGAL DESCRIPTiON:SW I/4yG I/4,S !/ T Z~f,N,R, I `~E(or~ i SCALE: 1"= yO ELEVATION: /d G • d ~ BM 1 DESCRIPTION:_T 6-~ ~ ~~C~ ,~o ~ ~ BM 2 ELEVATION: `j9~ ~ ~ ~ ~ PCB BM 2 DESCRIPTION:~~ cf~ yy ,~ .~ t / ~o ~ SYSTEM ELEVATION: ~T/• Sy SYSTEM TYPE: ~n u to ~-' ~ ~ ~ .~ SIGNATURE: 919 s °ay i 1 ~. ~ .ti . K, `~ x x x • x •---~- x -~+i x~ X -.. .- - ._. -.. .-.. ' -.. ._...-1~ -.. ~, . 927.5 ~ \ - LOT 6 ~ 80 2.22 Ac. ~~ L (i.rw Ac) . ~ ~ X 9 ~ • \ ~ •. 922.7 42g X ~ ~ \ ~ `-' y. ~ ~.~ \ ~ ~• . 8 s ~ , 4 7 ~ ~ ~ s ~~ ~ v 8 2.22A x 2 2 ~ \ . (gas Ac 2 . .:~ . ~ \ .A t 922 0.4 ~Ar~ •)C ~= ~ ~r N' \ ~ . ~ . x- ` ~ ~ ~. ~~ LOT \ ~. (2.44 AC) ,. ,`, ~, 6ti: t .~ . ~.~ .~ X Q~ ~ ~! • ,l 3~ _Q~ 913.0 5~0 r~~ . r X08.2 ~ X ` ~, yt i d : ~ ~ • ~ ~ ~ S 918.1 .\ i ~ 915 9 ~~ . ~ ,i. I L I ` 11 1 ` Ac. ~ ~ i 2.61 AC. _ : ~ H.W.E ~ ~.O ~ 13.3 ~ Ac) ' 1 ~ °' j ....... x... ... . ~.. ........ ~ ~ . ^ ~ ~ , 911. ; 905.9 I ~ _ 906.9 X ~ +•' ~ _ ~ ~ i . ~, M ~ ,. IF1~V _ ~ ,~. ........... ...... ... .... A . , \ ~ , ~.~ ~ , ~~ X 9t1~ ~ ~ __. sT cROtx covlvT^Y SEPTIC TANK MAIN'I'BNANCB At3RBBMENT AND OWNERSHIP CERTIFICATION FORM OwnarlBuyer _ ~ ` ~c~S~~, ~.~,e_ ~ __r__~. Mailing Address __`~!5 ~ ~..-~'~-l ~~ ~ ~ ~.,cQ..Sor Property Address (Verifieadon nqulrad from Planning 13epartment for new City/State ~,,~ ~ ~, .. ~__.,._. Parcel Idenrificarion Number ~~ -/ t{'a, 3 - (7 Ll~:(sAl. DE5C TiCEN Prd IACatiOI! u~ ~ ~ t (' 2 ~0 9 ~?') per' S _ /•~ ~~.. /4, Sec. _~ T..,~,.,~.N R ~ ,W. Tawn of ~ic~., p~ , Subdivision 'M o ~ ~ ~, ~ ~, s~, Lot # 1 CeHified Survey Map # Volume ._ .` Pago # . Warranty Deed # _~~b11 S-~ ~ Volume ~ Page # a-~'-~- Spec house yes d na Lot tines identifiable Q yes CJ na S~ST'EM MAINTENANf'F Imps ttse attd maintenancx of your septic system could result is its premsture failure to handle wastes. proper tnaiatenance txmsists of pumping out tht septic tank every three years or Sooner. if needed by a licensed pumper. What you put into the system eaa aflEect the funatian of the septic tank as s tt+eatYnent stage in the waste disposal system. The p~mpcrty owner agt+oes to submit to St. Croix Zoning Department s oestlfication form, signed by the owner sari by a wasDerplumber, f auraeyman plnmber, restricted plumber or a licensed pamper verifying that (1) the on-alto wastewater disposal system i; is proper aporating coaditiatt aadlor {Z} actor inspection and pumping (if necessary), the aeptio tank is less than. i/3 foil of sludge. 1fwe, the undccsigaed have road the abovo mquitrcments and agrtt; to maintain tine private sewage disposal aystetn wtth the standards set forth, herein, as set by the Ikpartment of Commerce and the Departrnent of Natural Resources, Stato of Wisconsin. Certification stating that your septic system has ban maintaintd must be completed and returned to the St. Croix County Zoning Ofl'ace within 30 days of the three year expiration daft. ~'_' ~~e~../ SIgNATtTRB O APPLICANT DATE QTR CERTIFIC,~TION t (we) certify first alI atatemcatts oa this form are true to the best of my (our} knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a wamaty deed recorded in Rogistor of Deeds Office. ~~.~.-- SIt3NATURB of AFPLrcANT DATE ~«««.~. •o'`•"• Any ittfommatian that is mis-ropresented racy result in the sanitary pemut being rovokcd by cite Zottirg Department. '~'` ioctade with this spplicatlon: a :tamped vvarnnty decd from the Register of Deeds office a copy of the oertf$ed survey trap if risferoa~ce is wde is the warranty deed ~' Powrs owntFR~~ MgIVU1#t, & MANAQEMENT Pi.AN e Permit ~ -- ~,.. f Number of Bedrooms c ~~~' ~ Number of Public Facility Unite ., G7 NA Estimated flow taveragel ~ s Design flow {peak), )Estimated x 1.51 ~a C~ ~ ~ d alld Sob ApAiication Rate Standard Intiuentltff{cent Quality ~irda Jfts Monthly ave-ag~" Fats, Oil 8: C3rease IFOG) 530 mg/t Biochemical Oxygen Demand loos.) 5220 rng/i. DNA Tatsi Suspended Solids iTS$) 5160 mQ/L Pretreated Effluent fiusiity Monthly svera9e Biochemlcat oxygen oemand {laoDel 530 may Total Suspended Solids {TSS) sat) mq/L Q NA Fecal Conform tgoometrlc meant 5104 cfultOOrnl Maximum Effluent Particle Size K In dla. p fVA Other: _ O NA ~ "Values tyPlcat for domertic wastewater and septic tonic effk,snt svgtasa gasr_RCU~etynue Page ~ of Z Septic Tank Capacity ~ C> al DNA t3epttc Tank Manufacturer ` O NA c , Effluent Ftlter Manufacturer • ~ ~ O NA Eftklont Filter Model /~0• d NA Pump Tank Capacity ~f sl DNA Pump Tank Manufacturer i ~,Y• p NA frump Manufacturer ~,~,~ / iJ NA Pump Model O NA Pretreatment Unit Q NA O $altd/Gravel Filter D Peat Fllter D Mechanical Aeration O Wetland frJ d~infsction D Other; Dispefasf Cattle) DNA Q tn-Ground tgravttyl C~ tn-Ground tpressurizedl O At•Cirade O Mound Q Q~lp-Line C7 Other: Off' DNA dam' ~ DNA Other: ^ NA MAfNTENANCE SCHI:Otli1,E SerWae Everrt 8arvke Frequency Inspect condition of tankts) At (east once every: 3 a e tMaxMntm 3 yesnr) DNA Pump out contenU of tanktsl When combined sludge and scum equals orre-third IYy) of tank volume L7 NA inspect dispersal cett(al At leaf once every; ~ ~ (sl iMatdntum 3 years) ^ NA Clean effluent tikar At leasft anae every: , t 0 ~~ sl ~' aerial O NA Inspect pump, pump controls & alarm At least once every: .~-- monthts) O aortal DNA Flush laterals and pressure test At )Oast once every: ~---- rtwnH~la) O carte) DNA Other: At feast once ovafy: _•„_ O month{al O ear{sl ^ NA Other: Q NA MAINTENANCE INSTRUCTIONS Inapsctions of tanks and dispersal cells shalt be made by en individual cerryinp one of the fotlowinQ licenses or esrtificadons: Master Plur;nbor; Master Plumber flestricted Sewer, Pt3WTS Inspector, POWYS Maintainer; 5eptage Serviein® Operator. Tank inspections must Include a visual inspection of the tanklsl to identify any m~sinq or broken hardware, identffy any cracks or leaks, measure the volume of combined sludge and scum anf! to check for any back up or pending of effluent on the ground aurfaco. The dispersal cell(s) shall be visually inspected to chock the effluent levola in the observation pipes and to check far any pondin;l of effluent on the ground surface. The pondinq of effluent on the ground surface may indicate a failing condhiors and requires the immediate notification of the local regulatory authority. When the combined accumulation of etudes ,end scum In any tank equals one-third tYsl or more of the tank volume, the entire CAntents of the tank shall be removed by a 8eptage t3arvioing Operator and disposed of in accordance with chapter NR i i 3, wlsconsin Adminlatrative Cods. Aii other services, including but not limited to the servicing of effluent fntsn, machsnicat or prsssurized components, pretreatment unite, and any servicing at intervals of 512 months, shall be perfdrmed by a certified POWTS Maintainer. A service report shalt be provided to the Iocal regulatory authority within t0 days of compietion of any service event. •apo~ anlieJistulwpy ulsuaoslM '!£} ~ iZ} '1!}45'£8 Pus ll}~B!P}!114411Z)EZ't:8 suwo~ ~aideya yilm eas-a!{dwoa u! pei}e~p •eM ww~unaop sn~ Q 9 _ ~, -~~1 L- ~4d 0uoyd ~~~ . J,S' oWVH awsN Ail3iOHlfiV A~OIV'll'i0~! ltt~01 1!l3dWRd! lIOlV3iSd0 ON101A>E138 3Qt/1d~S auoyd ___.. ~a~ rl3NIV1NIVW 81MOd ~'"~~" " .G ' l G euo4d -•l7~la ~~ ra,'fJ~' aweN ilr~~visnn s.amva siN~wwoo ~vNOUlaav '31g1$SpdWi r!3011h~l~N~ ~g JIVW ~N1Il tl d0 li01a31N13H.t Waa3 NOS!#~d d dQ 3i1~S~id •11ftS~a At/W Et1V30 'S3~NV1SWf1~!!1~ ANV >l~CINA ~INVI 1N1W1V~l1 li3H.10 li0 dWfld 'OI,Ld~S d tl31N3 lON Od 'N~OAXO 1N3i0idd11SN} g010NV S3S9VD 111H13'1 N{V1N0~ A11W SHNVl jrf~Vylp"dl~l 1i3N10 QN < <ON1NabM>s> •eu~li ley! ie ia•;}e u{ seln~ vyi yiln~ Aldusoa ssnw swais~ts vans ;o suolianJisuoaaa •eae}ans enl3eJil~u! ayi is iewo!q ayi to )anowaJ Sulnnollo; eoeld u! ps3aru3suoooJ •4 haw swaisAs uo-3dJOSge llos apaJB-ie pue punolry ails pu¢ lias e SJ.MOd u! se isnw swat As !!IM Beae 3 w Aq uodn peS , uolidJOSge llos o tl~r .LMOd Palls; 8yi soeldaJ of ilotaJ 3se) a se palisisul aq new ~lus~ o nw~vwy+~+ au BurJ~ag •suolie><lwll Ilos Jo/pus ~loagios of enp algal!ana iou sl aaJe 3uawaaeldaJ alga ,ns~~ p •auxi isyi is los}}e u! selnJ ayl y3lnrt Aldwoa ~ iueweast{daa •eeJe iuawaaeldaJ algellna a ysllgressa oz uolivnisna virs pua !!os nnau a Jo} paeu eyi u{ 3lnsas eaeldaJ ayi ioo3oJd of aan!!vd 'sllonn pua seal! iol •sJn3anJls pasodad pue 8ugalxa woJ~ s~{aegiss pe~{nbeJ u! sq iou pt~ys pue uo!iaedwoa pue oauegmxs!p u,a~ pslao3oJ~ eq p)nays Qo~e iuewaoeldaJ eyl •uraisAs ~ _waoelde.! a ~o ualisao! ayl ~o; pezl!)in aq Asw par pelerl~pne uaaq say seas i~,wwaosldaJ e{qe~+,rn d~ lue!ldwoa apoa a ®p!noJd of Jo 'ueaq enay samseaw aulMOpa~ - ------ §1MOd oy~ ll AON~DNIlNdO '1e1J836LLA pFIOS iJBUt Jayioue JO lava/~ '1105 yil^^ P~ll!d aaeds plop ayi pua panoweJ sJpnoa Jieyi Jo psnowaJ pue palanaaxa eq !lays si!d pus s~luei lls; '6uldwnd Jai;d • •~aieJedp Bu-olnJe$ BBeldeS a Aq ~o pasodsrp A~JSdad pus penowsJ a4 Ilsys sill pue s~{uei Ile ~¢ siueiuoo ayl • •poleos sBuluedo vdld pauopuegr oyi pue pv3aauuoasrp aq !lays sild pus! s~{uei of 8u!d!d Ild • :®poa enyeaisluluypb' ulsuoasl~ys `EE'£8 wiuo~ Joidayo yu,M eauellduJOa u! pauopuega Ale;BS pus AlJadaJd s~ weashs ®yi ~e~13 aansul ai usalel aq !lays sdaas dula-opc; ay3 salnJBS ;o ino us~isi Al3uauewJad s! Jo/pue alts; S N~WNO NdBV •aulJq Jasjai;os 3aiQN+ pue :suoduiei :sul:{deu tiJeilues :seplansad :sianpoJd Bwiulad :lw :suo!ieolpew :sdeJas ;saw :sepla!gJey :aseaJ6 :aullose6 :sSullaad a~ge1abvn pus ilnJ} :JaieM (dwnd dwns) uleJp uolistpuno; :3s7; ;siueioa),ulslp :sJedelp :ssol; le3usP :eJasQeJBap '~~BS.s~wea igo eie~~s oauai ~yi woi} 6ulM'allo; sly! }o uolieu!w! oliJO uosonpe~{ eul ;o a}ll ayi SuoloJd pue aaueuua~Jad ayi enoJdwl Aa os spaJ9-ia Jo punaw Aue ;o sdols unnop iaa; g E ulyi!~++ •BaJC4 Uplifi~os4tr !! ss,s syi 'ioedu.roa Jo q~nislp •s!nn~eylo Jo •~®no ~asd ~o enlJp iou od •s;laa les~adslp pve s~lue3 Jano selalyan {Jed Ja en!Jp iou oe:y •~luai dwnd ayi ulyilM alanal lewJOU eJOisas of sloJiuoa dwnd ayi pulisaedo Apenuaw ul islsse Oi Jeulsiu!~IN S.kMOd ao Jagwn~ a iaeiuoa ~o dxund luanl),;a eyi of Jannod Bu1101s9J 03 JOi3d JoisJadQ au!o!tisS sl3aida$ ~ Aq ponplllal ~UQl dulnd dyl ;o siUaiuoa ey3 8ney uolianllS sly! ploASt Ol •iuanl};a sae ns Jo dn~Iasq 9yl u! 3lnsaJ Aaw pus (s}lloa oyi 9ulp>ajJeno '~asop abJel suo u! (s}tlso lasJadslp at{i of peD~eyaslp ;o eOJeyaslp }~ •s end isiannydly !ew~ou snags !!!} Aew s~luai dwnd sa8eino JaMOd BulJnfl aq ql^^ J83sM83seM S6>3afce ayi peJOls81 S! JaMOd uss~M 1 ! •eae;ins enllo~i!!;u! ayi is U4YOJ), sJa suailpuoa llas usyM Jnaao iou pays do ua16 weisAs °ssn o; ~dlJd Jifleiedo @u!a!n~as e8eidvs a Aq panowoJ (sl~uyi eyi;o sJe suollenueauoa ybly ~! `lsHlga !ti'!gi~ds!p oyi a6awsp Jo/pua 9seaad iuawieaJi gyi apaduJ- A>:ut ley! siUB-U07 9yl ?h8y pDlasi®P s ulli luauuaaii ~~yo SiMOd stxl ;o ssn of Jolad 'uol3anJisuoa nnau Jo3 slealwsya Jayio ao sianpoJd 6utiuled ;0 80~ypgaJd ayi Ja; { }~l NQilt'I!l3d0 QNO- dfl 1.lItf1S rL ~o ~ e8ed Parcel #: 020-1433-~9-~~~ 04/08/2005 04:53 PM ' PAGE 1 OF 1 Alt. Parcel #: 11.29.19.2697 020 -TOWN OF HUDSON Current , X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ' =Current Owner * BEER, RICHARD L & PHILIPPINE RICHARD L & PHILIPPINE BEER 1150 CTY RD A HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): " =Primary Type Dist # Description ' 1060 DANIEL DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.610 Plat: 2189-MOUND VIEW EST LTS 1/10 020/03 SEC 11 T29N R19W PT SW NE MOUND VIEW Block/Condo Bldg: LOT 009 ESTATES LOT 9 610 2 C ( . A ) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 11-29N-19W SW NE Notes: Parcel History: Date Doc # Vol/Page Type 05/15/2003 721643 9/63 PLAT 2004 SUMMARY Blll #: Fair Market Value: Assessed with: 50571 57,400 Valuations: Description Class Acres Land RESIDENTIAL G1 2.610 44,400 Totals for 2004: General Property 2.610 44,400 Woodland 0.000 0 Last Changed: 07/21/2004 Improve Total State Reason 0 44,400 NO 0 44,400 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 7 ~ L ~ra ~'k a'ti 'Y~~, ~t ~ ~r~ =r r ~ fit, J~ ~ ~~' a•e ~~~~b ~~~ , Standard Erosion Control Plan for 1- ~ 2-Family Dwelling Construction Sites According to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, soil erosion control information needs to be included on the plot plan which is submitted and approved prior to the issuance of building permits for 1- ~ 2-family dwellingpunitr in those jurisdictions where the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Standard Erosion Control Plan is provided to assist in meeting this requirement. Instructions: 1. Complete this plan by filling in requested information, completing the site diagram and marking appropriate boxes on the inside of this form. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time of building permit application. PROJECT LOCATION ~O~ 9 BUILDER ~ f ~ E1 ~d .t„ra ~~'~ OWNER `T'~ E' y ~1 c+ ~ 5 Q,(J WORKSHEET COMPLETED BY DATE ~ - ~~ - CO`s Please indicate north by completing the arrow -N- EROSION CONTROL PLAN LEGEND _ _ PROPERTti' LINE EXISTING --~' DRAINAGc -_T TD TEMPORARY DIVERSION FINISHED -' DRAINAGE _ LIMITS OF GRADING SILT ~ ~--' FENCE .--.-. s r RAw BALES GRA~~EL O VEGETATION SPECIF~CA"ION TREE PRESER~'A' CN STOCKPILr,D SOIL SITE DIAGRAM scale: finch = -feet ~~ ~ ~~~ ~'~ ~~~' ~` 1~ ~ - ~~ ~' :.S se ~.n ~ r,:.. +s, :Z c C--csi'^'st s.:. W.o ;„,~ ~'~ 3 ~~~ v ~ \~~~ \ \ '~~~ . I ~ ,~ ao®aaom~- Boa anooowra~a~ ~ ~ t , -"" ~. ~ ~'~~~ g ~~ ~ ~ _ ... :~ J:. ~. ~ ~ A ~ ~ Q ~ '~~Q ~ ~ ~ ~~~ '~~ ~ +~ • ' UIIIO'aplrO ,: ,.••'' . ~,~. ~~ I ~ ...~.•.-.•.~ ... _ ~I ~ I ~ . - ~ ' ~ L ~, ~~ ~ :~ ~~ E I '' ~ i ~ I a ,,~g CI - . ~ n ~~ I ~ ~ ~ ~ i p ~~~ t ~., ~ ~ ~ a ~ ~ ~ ~ ~~~ ~ I ~~ ~~: ~ dV ~ ~~~ .. ~ i ~- ~e i i~~~~~~~~~~~~~~~~~~~~~~ '~ i • ~! ~ ~ ~ ~~ ~~ O ~J II ~' ~ Z ~ N V IV 0 .d I~, I~ ~o ~,~~ ~ ~ ~ Qmv ~ ~ ~ ~ v I~I~ ~ Q~ N "j A 1"' ~~~ ~~~ ~I~ Q~m o ~~ ~ I~I~ w 4v~A -• s~5°49~p,4"Vy 441 r •• - W N Zoo i O . rJ~1D ~~' ~ w - 111EL DRIVE - =~~~~ L~ ~ ' . • • • _ _ . ~.~5_ - - - - - __•_.. • i • • • • • . . . _ _ • ~ • • i~ ~ r 1 N • ~ N W W r ~ N o for' O~ ~ ~ ~, o u ~~~ ~. ~. ~ ~ ~~ ~ ~ ~~ /.Y ~ \ ~ 1. .: ~- ~ ? a' /S00°25'46"W 353.52' -.~ ~~ ~ ,~ ~ ~ _Yr ~, _ 1 ~ ),~ a.,