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Home My WebLink About020-1445-03-000I ~ ~ I ° n. ~ ~ co I N a m 7 { O ~ tab I ~ I ~ I 3 a I ~ I I I 0 I ~' I o I I N { n 0 I Z ~' I ~' o' 7 W I Q Z I ~ I ~ I o. 7 I I I I I I I I I I I I I I I I I I I 01 3 C 7 N j co ~ _ ~ 0 a o O m ..~ a m c, ~ ~ o. a c m Z ~ Q ~ ~ N n f~D O 7 7 ~ J ~ A ~N Q O ~. o O m Z ~ o S o. a c m C C ~ ~ ~ N N a a ~ m W W ~ ~ O m m c m m 7 N a ~~~ c~'~nm.a3 m~ m N N a n ~ m~ ~ ~~ ~a 7 ~ o o ~ ~~ a~ o v c m y a o ~o a Z ~ 3 m 7 -i0 $co m o v~ aavx co ~ p~ O. ~ ~ y ,0 2 S = ~ 3 N QO.QVi g o m c 7 ~nm o'° my 3 ~ tmir m c0 U1 O- m d ~ C Vi '' d CT 7 N~ O m~ ~ ~' N O. m ~:~< ~~c0 v a~ ~, c"~$ m aim 7 m ~d 7 ~ w~c<,O g °'~ o ~ ~ CT 7 m~~ m o ^~' 7~ W y ~~,a.o~m.o ~ 3 = go $ g.m m 7 N $ y ~ ~ >• v O m M o°o~a°' ~ ~ ~ $ v m $ = m Vl y O m O ~ O ~ 9s o m ~ ~ ~ A C N ~- ~ 7 O ~ ~ N CD 3 m z 0 °: 0 7 N o. 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'P ~ 7 Z -i ~ cNO Z .A ~ ~ ~ m ~ .~ d °C A7 r~3 ~1 ~• O (~~ • _ M 0 hl ~ fi A A b A ti V N °o H ti QO ;r A 'r N O ~y N 9 $a~y County r ` 201 W. W ingtotP ~, ~i~ ~ ~, (~1..(j-(~G ~ ~~ ,~~O g ad , WI 53707 - 7162 Sanitary Permit Numbu (to be filled in by Co.) i Department of Com~ merce 608 -3151 „~ ' ~ Sanitary Per tl~n State Plan LD. Number In accord with Comm 83.21, Wis. Adm. Code, personal in rtna t nu,~iblh'deC(IUNTY may be used for secondary purposes Privacy Law, 15.04(1);~h.!' N O r F i CE Project Address (if different than mailing address) L Application {nformation -Please Print All Information . D ~ ~ ~N. /(/ Propert Owner's Name Parcel # t # Block # J~ ~ /~~ ~ ' ' ~ ~ T v/ / Property Owner's Mailing Address Property Location 9 ° ~~ _ ~ `" 5 ~% Section ~'/. 1l City, S to Zip Code Pfione Number , , _ _ (D T ~ N; R~E oe dNJ~ 'l~+i 1( II. Type of Building (check all that apply) r ` . / ~ ~ / ~1 or 2 Family Dwelling - Number of Bedrooms `~ Subdivision Name CSM Nu ber ~ ~ ~ ^ Public/Commercial -Describe Use ' ^ State Owned -Describe Use ^City,^Villag ~'fo ship of III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) ~s A' New System ^ Replacement System ^ TreatmenUHoldin Tank Re lacement Onl g p Y ^ Other Modification to Existin S stem g Y B• ^ Permit Renewal '~Pennit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner yS 3y0 ?- 3-v ~ IV. T e of POWTS S stem: Check all that a I -. C~r~ on -Pressurized In-Ground ^ Mound >_ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching Cha 'p ine ^ Grave Pipe ^ Oth r explain) 22 V. Dis ersaUTreatment Area Information: ~, Y'- G Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sfj Dispersal Area Proposed (s ° Elevation ~ ~ oo ~ 7 ~o ~s ~ y , VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic a' Holding Tank Qp ~ /~t~0 / t ~ Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the unders' ned, assume responsibility for i fellation of the POWTS shown on the afUlched plans. Plumber's ame not Plumb Signet a MP PRS Number Business Phone Number / r~P ~ !J- ~~ ~ ~ ,~ ~j p ~~~5 - O Plumber's Address (Street, City, Sta e, Zip Code) VIII ount ~/De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes GroQUltdwater Surcharge Fee) / 4~ ~ ~ Date Issued Gf ~ 7Q Iss ~ g Ag t Signature (No Inps) ^ Owner Given Reason for Denial ((/ IX. (:onditions of Approval/Reasons for Disapproval /- , I - , Ip A ~ I l~~ .~ ~ Qh /O ZZ ~/a ~/65~~~~ ~~' ~ / ' ~ ~ bG--~eQ - • ~z~f '~ " - Attac¢'complctc plans (to the County only) for the ayaten/ paper not less than 812 x 11 inChea in size ~ V J _i O ~_ ~, ~d SBD-6398 (R. 01103) ~'~'`~ N~ laoo/goo u~~^- 5 Y,~.,-, 9~~ Yo ~ ® I3/h -1= ys~ - y ff ~-ioo z ~. ~ . ,~.do 3 s~.,....t- N-7.L. ~~ ~~ ~~~h~ da~3s~ /do ~T~~ ~i~~UL ~GOULDS PUMPS Submersible Effluent Pump .. EP04 & EP05 Series APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability; '/<" maximum, • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/z" NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: •EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP, 115 V or 230V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 SJTW with three prong grounding plug. Optional 20 foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer, Available for automatic and manual operation. Auto- maticmodels include Mechanical float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermoplas- tic semi-open design with pump out vanes for mechanical seal protection. METERS II FEET tOr 9 e 0 7 a W x v 6 a } S 0 a a 0 ~ 3~ z 5 t 0 00 io o z 6 CAPACITY ® 2003 Goulds Pumps ~~~,f Effective July, z003 63871 ^EP05 Impeller: Thermoptas- ticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water,resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING sP, Canadian Standards Association ,_ File # LR38549 Goulds Pumps is ISO 9001 Registered. 12 m~/h Goulds Pumps ITT Industries - _ -••• ~.a_x~ac.K LKOSS SECTION AND SPECIFICATIONS CI VENT PIPE 12" HTN. A80VE GRADE . T5 PROM DOOR. WINDOW OR E W~Ty~ PR00F FRESH AIR INTAKE JUNCTION BOX APPROVEt FINISHED GRADE 4" CI RISER WITH CONDUIT MANHOLE H/ PAD L( 6" !lIN. WARNING --- ABOVE G ADE ~ 18" IN. 6" MAX. + INLET ~'~ '. ~~ ~~ WATER TIGHT SEALS ~ • ~S_ ~ y„ ~ T TIGHTS CT PIPE BAFFLE ' A SEAL ~ '"~ APPROVED 3 ONTO "' ~ LAM B ~ JOINTS W. SOLID ' ON 'f- PIPE 3' 1 SOIL PUMP OFF ELEV . ~,FT. ~ C ~ -~ ~ ~ SOLID SO! ~ OFF '~ RISER D PERxITTtL IF TANK 3" APPROVED BEDDING UNDER TANK fiANUPACTU HAS APPRC SPECIFICATIONS CONCRETE PAD EPTIC / DOSE ~ •- - • --- -----••- -- -................. TANK MANUFACTURER: NUMBER DOSES PER DAY: ~rnNK SZZrS: SEPTIC f ~ - ~~ DOSE GAL' DOSE VOLUME INC WDING ~L' FLOii18ACK: p~~ 7 ~LARx MANUFACTURER: ,~ '~'- ~L' ~- MODEL NUMBER : CAPACITIES: A : j,/~NCHES ~yy/,.~ SWI?CH TYPE: -~ I'' U -_----- e = „? INCHES ~ --1-°~_G PUMP HANUFACTUR ER -~- MODEL NUMBER : C q, ~~NCHES e D~' SWITCH TYPE: - O KEOUTAED DISCHARGE RATE p~~ GpH D ~ INCHES = ~j5'- --- PUMP 6 ALARM HIRING AS PER ILHR VERTICAL OIFfERENCE BET4EEN pUHp OFF AND DI5TRI8UTION pipe , 16. 23 • MINIHUK NETWORK SUPPLY PRESSURE ~ ~-FEET ~~.,.. FEET FORCENAIN X . ~FT/ 100 FT. FRICTION FI~CTOR ~ . +'~'~ FEET . TOTAL DYNAHfC yip __ FEET INTERNAL OIHENSIONS OF PUMP TANK. LENGTH FEET : WIDTH ;~ DIAMETER LIQUID DEPTK • IGNED LICEl,1SE NUMaF,R ; ~~~' 1 ~ .,•... ain Department of Commerce and Bui:ding Ulvi.^.~n' ` PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Bast, Kernon Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: _ c1 cl .~l~ Q '- 1 '~a::~~ ~rJ ~ -~tvLr2L~ (~.. /o TANK INFORMATION ~/~„~ ~,...-, o ~ ~i.~ 1,.lir/ E EVATION DATA TYPE MANUFACTURER CAPACITY Septic ~,.:~ i ~.. S-..w--. IZ-iVC~ ~'C~ L Dosing ~~ ~U Aeration ~'~,. _ , Holding ~:.._:....__._ _ TANK SETBACK INFORMATION TANK TO P/L W BLDG. Vent to Air Intake ROAD SIC ~ ~1 ~ ~ O ` '" ~ 1, Dosing ~.~ Q-yt Aeration .. ~"'--~. Holding _ County: St. CrDiX Sanitary Permit No: 453408 0 State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: 11.29.19. STATION BS HI FS ELEV. Benchmark ~ ~~ ~/ ~dt7 C(C~. Alt. B - -~}a-n. S-~ ~ ~ . v /OD. /o Bldg. Sewer , 1~> ~ y~ ~ SUHt Inlet ,Z ,~ 9y ~ SUHt Outlet ~~ - Dt Inlet ~- Dt Bottom (J (~ Hea er n. , Dist. Pipe ~! ~ ~~ :j, ~,. , `~(! Bot. System ~ ' ~ Z ~ ~ ~' . u Final Grade i~SYS Cc.( ..~ ~-~S ~j+t fO.. -i. .. ~~~ ~ ~©,65 i I( ~ ~7~ D. PUMP/SIPHON INFORMATION ~'-N-DIGE~ Gtf,~~~~ Manufacturer Demand G Model Numb r m TDH L' t Friction Loss System d TDH Ft /- , r = Forcemain Len t~ ~ Dia. Dist. to Weil 4/ Z y SOIL ABSORPTION SYSTEM -- ~n•S t~ ~/L BEDITRENCH Width Length No. Of Tre PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ j ~ - SETBACK SYSTEM TO PIL BLDG WELL ' E/BYRE LEACHING anufacturer: INFORMATION I ~ CHAMBER O$ Type Of System: Grp rl uLn ~ : c. s. {.. / D t0 t \ ' ~~-j-~ / 1 ~ ~ i a Model N tuber. ` 7 .. ~ BUTTON SYSTEM _Sy~Q! ~ b''~ 9G Z " Header/ nifold Distribution x Hole Size x Hole Spacing Vent to Air Intake (~ Pipe(s) Length Dia Length Dia Spacing ~~ ~~ ~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onlv I~ ~ cvt-._~ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ S / Bed/Trench Edges Topsoil ~t~] Yes No ~ ~~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection~1: Q / /~ Inspectio #2: `~ / U Location: pending -Wild Turkey Trail Hudson, WI 54016 (NW 1/4 SE 1/4 11 T29N R19W) Sunse it s Lot l` ' `e ~~r el .2 .19. 1.)AItBMDescription= ~-] ~ ~'~'"~) Q~iCit/,t~ St'Wz'r~ 6Ni't~ J,,~~-dI~2~~7 4'"~1 2.) Bldg sewer length = ~ ~ t ~" ,~r7`'C.(~ `~ ~""" ~/~~~-'~ L~ -amount of cover = ~ ~ `1 ~ ~®-ytp,(~ ~ ~ ~~ ~ ~- p~ __ ~ r_ - ____, -- Plan revision = Yes ~ No ~ I~ ~/ Use other side for additional rmation. ~~ !~`._` L~ ~ I '~ __ ~~~_ -~~~~1/~/_~'~-- ----- ~ (lf0 ----..i 3BD-6710 (R.3/97) Date Insepctors Sign ure Cert. No. /- `'~ a~ ~,~ 3 ~~ qG. /.~ ~qs, as ~o~ ~T ~~~ qy.~y' ~ / ':sue 3~ y~/9~/ ~`~~ ~~i,~aao~s~ ' ^~ ~= a II Y ~ wscansin Dep ~ ~ ~ RECE~V~ E LUATION REPORT Page t of 3 Division of Sa end s m~acgra~ c wg omm as vvis. ram. ~,oue 1. ~ County Attach complete site er of less than 8 1/2 x 11 inches in ize Plan must lan on a p p . p include, but not limited to: vertical d ho~~ t (BM) direction and percent slope, scale or dimension north aLr®~~d ~id dis nce to nearest road. p~ I,p, Please print al in o eview y Date ~,~ 2Z Personal infomiaGon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location G `) Govt. Lot A/W 114 SL= 1/4 S / J T ~ N R / E (or AI Property Owner's Mailing Address ~ Lot # Block # Subd. Name or CSM# ' 3 5 s r~.. ~ ~ 3 s~,1.s~~- l ~ City Sta e p Code Phone Number ^ City ^ Vllage ®Town Nearest Road New Construction Use: ~ Residential / Number of bedrooms 3 _ y_ Code derived design flow rate `T ~ l~ O Q GPD ^ Replacement (^ Public or commercial -Describe: ._~ _ __ Parent material ~ U 'f'(~) e..e .~ l~ Flood Plain elevation if applicable .~// ~ ft. General comments S` / S~ ~ ~ e (,~ v q~-. d ~ 'y~.G~/~ and recommendations: T (~{, ~ -S _ ^ Boring v i~~r~ Boring # [~ pit Ground surface elev. 99 ~U ft. Depth to limiting factor ~~G in. Sa'I lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft in. Mansell Qu. Sz. Cont. Cdor Gr. Sz. Sh. •Eff#1 •Eff#2 i ~ -l0 16 ~~ L -- sal" ( >"+.s m~~ ~S v~ . S - ~ r ~ 3 ( ~" 5'~ U m b~ sir C S ~ ~ `~ . 3 3 r ~~ l6 s /~`~ r • ~" Z •~~ ~~-fin 2 Boring # ^ Boring // ?? // pit Ground surface elev. ~ . (J ft. Depth to limiting factor ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •E(f#2 ~' • Effluent #1 = BOD > 30 < ~0 nxyL and TSS >30 < 150 mglL ~_` • Effluent #2 = 8OD < 30 mgll and T55 < 30 mglL Name (Please Print) lure / CST Number ~u ~ S~ l~~ a ,~tr ~'~--~ ~'l Z 530 9 Address Date Evaluation Cortduded Telephone Number Zr(3 ~~ ~~~-1- ..~~r~l~~e ~ /.~/~ S`~~ZS- ~~Z~"~~ 7is"- JGo ~ z .~y . >, ~` -- Property Owner / ~t C- (Q ~ .Parcel ID # ~o ~" Page ~_ of ~_ 3 ^ Boring ~ ~ Boring # ® pit Ground surface elev. ~= ft. Depth to limiting factor / L in. Soil liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Z. Sh. Gr. S •Eff#i `Eff#2 C 1 Z -~ t~ - .L/ Z/ ~ C ~ - ~ fo ,~ v -f L8 d --- QS ! ~ ~ ~ Z ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor rn. Shc lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fl° in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/Ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 `EfF#2 'Effluent #1 = BODa > 30 < 220 nxyL and TSS >30 < 150 mglL 'Effluent #2 = BODb < 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. saus~w trtdaot "~ PAGE~OF 3 NAME LOT# LEGAL DESCRIPTION,NW'~a ?/a S f/ TZ N R ~ or SCALE: I"= ~'~~ BM 1 ELEVATION ~C` O • ~ BM 1 DESCRIPTION ~}~ ~ v ~ ~ O/ r- ~ •/J Q BM 2 ELEVATION BM 2 DESCRIPTION SYSTEM ELEVATION 9~- O~ ALTERNATE ELEVATION ~fi/ ~- ,,.,..T.„ro ~r ~veTinu SIGNATURE ~---- ~ - ~ lih i ~ ~ f v i ' 1 I ~~ ~ ~ ~. ~ ~~ ~ ~ \ \ ~\ \ '. \ \ •\ ~ ~ \ ~~ ~ \ ~. ~. \\ ~ ` ~ ~ C~ '~~~ 4 ~ DES ~ ~ ~ ~. ~. ~ ~ ~ ~ 9100' ~ , 2,5,5 ACRES `w w L801~ 891 p0' m l.~ -.1 _ ~ ~ - C.. -.- _ --- 207.57 -- ---- .'- s~27'99'E 642.07' ---WILD TURKEY TRAIL ---"_----- ~ ..ee.~7!~'1W 823.03' ~~ ~dL ~ - - - - ~.~~ - - _ 158_90' _ - _ - ' -- - - - - - - - i _ _ _ _ _ , ~ ~~~ / ~ ~~P~ : ,~ LOT 3 0 2. s / ,. Q ~1, 118213 SQ. Ff. ( ' LBD = 891.00' ~ S-A ~ ~,~'' LOT 2 ~ ~ ~~ '~ 2.00 ACRES ua m ,r~~' ~ 87,321 SQ. FT. ca LBO = 891.00' y ,~. ~A Ki ~ p G~~'i OG d04 ~ pdQ4 O[~ CzIMLa Cz]D 285s7 - -------------sa2:oo'----- ------- -- x x x $89°65'50"E 1253.47 ~ SOUTH IJNE OF THE NW1 /4 OF THE SE1/4 OF ~EC~Tia 11 SEPTIC' 0 LOT 1 3.00 ACRE t 30,680 SO. aOpC~Da~ [~~~Q4C~~ I f - - - ~o- ~ s ~ 4=' ~ ~-~.F s ~. - ~ - --- pLaC~[ ~- sNSar ~ o~ s sHSars ~ Rug 10 04 05:42p Wi~•CpISi11 Uepertrnelll 01 Cvrmnetce Ulvisivn of Satety and Bulklnrgs L I SR RNIV KROLL 715-246-5700 SOIL CVALUATION REPORT p.4 Payv _~., of _~ 17t84t.'9r{+8r11.8"1111 VVIIHII0:7, 71/S./\(All. liWe / -- CVWIly S/ ~ ' nlracll cvllRrb+a alle plan Vrr aper Iwt Mss Oran 0 112 x 11 ildros 1f1 size Plan moat ~i' ~ 777 p . bldude.llvtnot Ilmlted ro: vertical and horizontal refelsnce pond (OM), dkectbn arrd -.__ - Po+1al LU. - pet cool r lope, state or d6nenafvns, nW O+ avow, and lowOVn arN dtslance w nearest road. ~ _.__ Alease p~lrrt a/! ftlfurafrraUon. ~ ftovilmed by ^-' unto Ftwsonsr hM1»ewtbn yaa povMs Tai bs erred for ~aeondary pwpworr (Privacy law • a. 15.04 (I l tall). r'IOperty Owner ~~ 5 P+opa+ly Localkxl Govt Lul 7/~I tl~ 5 1' N li E (ur) W _ Property tJwrrets Melting fW +eaa Lvl 5 ~Ivck ff SuW. Na+rre a t:SM1VI ~~~ City Salto L Cix1v Pllune IVumlrer P - -- -- - [J Cdy L(Vltlayv ~¢ town Nealesl Rvsd ( ) ~ w •' d r~~ k•~ ~ New Construlyial Use:18 Residerltiai I Nurrlber of Hedrorxlts ~ - y Cafe derived desiyn Ikrn rate ~~~~ OC „__-_ _ _ _ Gi'U (_~Replacement ^ Public or cannlercnll-Describo: _- Pnlnnt rneteriel _-(j~G=~ t1 ----------- --__-•..._,_..----.._.._..._...--••-._-._-- Flood Plan elevatiuu R,p{Oic:nble _.._... ~!/~~- ----- -- R. Gorrelal oornrner,ls ~ ~f~~ _ /GV ly S^ Q ~ 7 ~ ~ 1 1 a,ld r9cOrrxnerxlatKxls: ~l --- 0vri11y 9olillg O r-~ ~~~ - - - LYl Pil [iruund su,tacc clCv, i _ R. epU1 to Ikultiuy factor ~~ tJ -- in. _- ---_ .... -..._ _ _ _ _ SuA /11~licaut~r Rate _ - Nu,iwrl UcyU1 UunlinelllColuf RedvxUCSCriplion Texl1A0 SbuGWe Cunststrerx:e Uurnltl:vy f?roll: GP U/IP in. MWlsett Qu. Sz. Cont. Cvlvr Gr. Sz. 511. •EIIM1 _ 'Eftd2 1 ~ Boring Af (L-~7 Bonny f I`~I D:! [.rnunrlmufo.~s du.. ~/J ~ a ~ ~/ '~ +4u1izW1 _ ,- UepO/ in. Uulninarll Color MWraett_ Redox Description Uu. Sz. t:rnN. Color Texture Sbuctu're Gr. Sz. Sh- Consistency ©uundary Ruvtc Sob Apphcaliorl Ra+o ~_ GPOIIt' _ _ 'Elfp1 'Effff2 _ _ __ _ Ellhlent Mt =BUD ~ 3U < 22U nlg/~ and 7S5 >30 < 150 mylL - Etrtvem q2 = BOU < 3V myJt end 7 SS : 30 ntglL CST Nana (Pfsrue pfir~ g~a - - - Gc f~ ~//%') 4 ~ ~~lur~~ CST qun,lrlr ~ rr+ss ~S3 0.~_ ~ Uate Evaluation l;un1 a ~I ---- -- -- l eleph +i~ Nun,bcr lid ~/~~~~ /-- - =~GVns~-.Le~ L/~ .S%6~S' ~ -zf~-_°~- - pis -_7Go ~ 4 ~f Rug 10 04 05:42p LISR RNN KROLL t'IVtlerly Owner _~ C ~Urf-~- -- ` ~ ~ Bo+ir+g # ^ Boring L _!J 715-246-5700 p.5 Parcel ID ff ~~dT ~/-___~--.- Pam' - ~ °t ~~ ~ Pit Grotn+tl surface elev. ~~ tl. Uopllr to prr+ilir+g lactw ~ ~ ~ +"• Soi icatia+ Rate i i T t re Structure Cons-stonce pvutrdary Ttvots GPD fIP t forizon Uetrtl+ in. Uomk+anl Cdvr Mrnrscll on Nt Redox Desa Qu. Sz. Cart Cobr ex u Gr. Sz. Sf+, _ 'EII# t •Elf#2 Bonny ~~ Bonny q _ ___ U Pit Ground surface elev. tt. Uepth to luretiny Iat:W+ _-___,- i'+• Soil A licadon Ra ( I Iorizal Ueplh Donrir+enl Color Rodox DesaiWtiOn Textwe 5dudure Coosistptce 8uurxiary Roots - GPDAP In. MunseN C1u. Sz. Gont. Cobr. Gr. SZ Sh. •[ifpl 'Etlll2 poring ~~ poring # _ _ ^ Pil Ground surface elev. _____- Il. Ueptl+ to lirr+itir+y (actor . ......... ...... .... in. { Sur} Jtuulic'- tia+ Rale~ I torizon Ueptl+ Dominarrt Cdor Redox Dosciiption Texture Structure Cwrsislonce Boundary Runts GP DltP in. Munsell Qu. Sz. Coral Cobr Gr. Sz. SI+. 'Et[If 1 •Ettp2 ' ElM1uent #1 = DOU,> 3U c 71Q rr+glL a+xl TSS >3U < 150 -stylt ' E{Iluent f11= 4UUa < 3U n+yll. m+d 7 SS c JO nx)!~ { he Lnpartatcnt of Comntcrcc is an cyual oppvrtmtity scrvicc ptvvirlcr anJ engrloycr. If you nccJ assistance to access aerviccs or aced material itt art atucmatc fixmat, please cnntact tt-c depatUnatt at GUR-2GG-31St or'{'CY GUB-2Grt-8777. SPn III MIR 0)10111 Rug 10 04 05:42p LISR RI`ItY KROLL 715-246-5700 t'ACe '3or 3 NA1VtE: G ~ LO"t'tt 3 LEGAL UESCRit''t'ION:T_1/a__"_t/a,S_t'___,N,R,G(ur)W SCALE: 1"= f' C~, -- ~:,~1 ELEvATION:~~) d -- Dht t DGSC[til'"I't0t•l: D o-~-,~ ,~"~~~ ~p-~ Btit ? L•LE~f1"I IUN:_ ____ ,~ F3h1 Z DCSCRII't'IOiJ: SYS'tEht >;Li:vn•t't~?ri:_~ !.'~. ~~ _.~._ SiGNATUii p.6 ~'Ip( ~ Y Qc! L _ O , ~ `` ' ~ Safety and Buildings Division ~ ~ ~ 201 W. Washington Ave., P.O. Box 7162 ~scons~n Madison, WI 53707 - 7162 Department of Commerce (~8) 266-3151 Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, perso may be used for secondary purposes Privacy aw, s( t~i ~~~ I. Application Information -Please Print All Informatio ~~1i_ ~ ~ Z~~4 Property Owner's Na me i ~ ~ ~ r< t County ~•- ~ -5/. ~- Sanitary Permit Number (to be filled in by Co.) State Plan'AI`.''D. Project Ad ess k Block N t Property Owner's M ailing Addre •-~"° -~--"°"-°"°- ~ 'Pr pfrt~,y~'L~sca~ion ~G~l',4,~S4,Section ~_ City, State Zip Code Phone Number ~~ 5 7~/ ~f (circle II. Type of Building (check all that apply) T ~ N; R~E oL'% f~l or 2 Family Dwelling -Number of Bedrooms ~"' ~ Subdivis~io~n~Na~me_ ~ lr umbe ~ ^.Public/Commercial -Describe Use ^~ ~ ~ 0~"".~r..rr~[ ~L~ ~T ^ State Owned -Describe Use ~ AJ Sj C,EI-US ~ 02~ ~ ~ ^City ^ illage ownship of ~•*" III. Type of Permit: (Check only one box on a A. Complete line B if applic I'e~;~-:. -~~ ~ `~' I New System I ^ Replacement System ~Trea[ment/Holding Tank Replacement Only I ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Chang f ^ Pe it Transfer to New List Prev~ us ermit Numbgr a D ssued Before Expiration Plumber Ow r ;~ IV. Type of POWTS System: (Check all that ap ly) Q ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ u < 24 in. of suitable soil ^ At rade ^ Singie Pass Sand Filter ^ Constructed Wetland ^ Pressurized-In-Ground ^ Holding Tank Peat Fi ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leachin Chambe ^ Dri ine rav Pss Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal q uire (sf) rea R'e Dis al Area Proposed (sf) System Elevation, / /s / t / V ~ ~ + ~ .~ / C~ G~ ~ ~~ ~O t 0 s ~ S T ~ ^ 7 VI. Tank Info Capacity in Total Number Manufacturer efab ite Steel Fiber Plastic Gallons Gallons of Units Co ete Cons tructed Glass New Existing Tanks Tanks Septic or Holding Tank t ~~ ~.,~ ~ _ Aerobic Treatment Unit /~- _~ __~ I VII. Statement- I, the undersigned, a responsibility for ' tallation of the POWTS shown on the attach plans. it) Plumber's Si r /MPRS Number Business Ph a Number Plumbe 's Addre ss (Street, City, State, Zip e) ! ~1 ~ ., ti ~ VIII ount /De artment Use Onl °anitary Permit Fee (includes Groundwater Date Issued Is ~ g t Si ature Stam s Approved ^ Disapproved ~ p ) Surcharge Fee) ~ ~ . ~' C ^ Owner Given Reason for Denial ~ ~O, ~ ~ !~ IX. Conditions of Approval/Reasons for Disappro~•al -~ ~~ ~ G(X~ ~~ S TEM OWNER: ep Ic an , e uen 1 er and ~~~0 3'S ~--~ dispersal cell must all be serviced / mamtalned , ~,, ~ ~p ~~a~-~ as per management plan provided by plumber. ~`'}~~~~ Cc ~it~~-~Q~ ",/~~ ~ "`-' 2. A se ac regwremen s mus a mam Ine ~ v ~- as per applicable code/ordinances. S .1=1'~y' Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 01/03) /- r `f ~ a~ ~~ ~ ~/ - ~~ ~~ J~So u~ ~ 7 =~ _ qG./.~~ ~ -1 ~~ ~~o ~T~ /~ '' ~~~ ~~ -a. qy.d~' r~°~/s 71~~~~~ fi-a = a~ ~,~,~ ~~ ~ l~' l/~ ~~~a~d°3s 7 T _1 s ~- ~ .- _ .1 ~ ~ ~ SOIh. EVAU1AT14N REPURT ~ ~~ _ / ~ 3 ionafsa~yand8uidngs ~ aaoordarsoe wig carom 85. H1As. /1dm. code ~,ae~s~p~,~r~l~>~suzx,z~~.,~ °a'~, ST ~=IPo~ k. irx:tude, tx~t not a: and refierence post tom. ana Peer~sto~e.scaleordot~s.notA~artow.aridioca~'onardd~noetonear~estn~ad. `~' o • io/3.70 • oaa ~rotin~.ywmee c,.r.. so4c+~c~u- ~o% ~Jp!/~N /~f}LEtg FEB 2 0 2004 toot W ra S~,ua s f~ r ~~ N r~~9 ffo~w a+~ertyowner$ n ~ # e~ ~ smd. rlane ~ • 1A3~ ~s/'I~IVE: ~ST.CROIX000NTY S!!/1/SEj` ~~~s ffuD.So~ ~/. syoi~ his 38~ • 9o~s `~' o+ c~.Tawn r~ ~ ~oit/ T.~•oEy, !-N -~"0" ~~i~otbearoorns codec>~ades~r-Aowraoe d- G'a c,~p ©x O «~- oes~e: ~Y~ et~T~i.~S1~., ~ ~a ~n a ire ~ ~, ~"' _ ~ ~~~ TES r~-v i S S vi' 7'"rF/,3 c,~ jco/t ~ iv~~ - CD~vv~Tf~,v,~G.. ~ d . t,~ . 1'.S _ 1 ' r ~`~ ~' e~rf~~vlmwr~r,..ele.. ~OO' ~~ ,,..:.......- ~_'~ ~~ ~~D" °'~' - -- * -~ - _ -~-- - ~---a ------ ~ i~edooc oesex~jplTon Taaclure Stn,cti,re oor~atenoe 8ounda~y Roots sow Rye tn. Mur~ei du. Sz. Cart, Cabr ~ Sz Sh. 'fit 'Et~z ~ d•~3 ~o yR 3/ ---- L zfs,~ie. ~fR W .3f . S ~- • 2~ i4 .--------. - S iG. S K ~ S ~ . 5 . ~ • D ~D S ~ SiG s d a.S •L .3 ` D s c .- y~ 7l s p , ~. sai ~ ~ x Raala cao~ ~. ~.sz. ~,t.~ ~ ~s~. -~, ~ 3 y- gay ~ s d. S ~ ~. z ~" Rte ~ Z/lJS,ei GGfT' ~~- z Z ~, 3 r S"'e~ - Date ca~a~,~a 1'eleptions Nued~x " itl0/~ . ~ ~' - men 3 •7iS • 77a. • 3 yyZ vluncnt & Associate . Private Sewage Co 28)2 ~ 0th Ave. Spring Valley, W154 ~- ~~ e~ n,~, ~Z -- s nsultants 767 ~Q~~ ~, .. ,G-D T ~ 3 _..__~___r__._r.~ i 2.5~~ `` ~ 3~ ~ ~~ ~~, ~, ~ y ~'~ '.- ,~~ ~ ~ ~~~ 5 /~p_ 2 ~ 2 ~n a o .----- ~ ~--~---__ r yg,g0 a __,__._.K...u~_____.~..______..._t s ~s GL ~~. I yG' 3 S U~ v~~f ~~'f f Dui ~ ~ ~~' ~~ ~~ ~ ~r ~ O ,~ ~, ~,~ ~ ~ s~ r ,~ ~ 70 ~ °~ `~'' ss 5.~-fit' ~ 1 ~ ~ r /O __ ~1 ~ /6 , ~ ~ -a y ~f~ Gd7 a ~,, D ~x~~ Tiv ~ ~jPiGLC ~u ~_ of ecmits and d~ignin~ hoc issuance P locates ~ = t~G,~~e p~.1 _S contact: Uibricht & As • ~, rivate Wastewater consultant andp ` ~' RECEIVED ~- • ~ ~ SOI EVALUATION REPORT - ~ ~ 3 aivisionols~yarxle JAN ~ 9 2004 ~e of Attad~ oomptete site pia tin r n ~w~ '~ 1 inches in size. Plan rrwst ~ include, txR not fanired t0. (BM), dtr~ton anii Pied ~oPe. scale or~• north arrow, and ioration and d~tanoe to nearest n~ad. `~ o o • /0/3. 70.4'n"a Please ptlirt all lnfornaattion. Pe~sord tntan~aon you povWe ~Y ba used torssoomhey pWop~ Y ~'. s.15.04 i~) f~k / /~/~LE'/g I'l/ Govt. L,e 1/4 5G 1/4 S // T Z~ N ~ ~ f W 9 {~ . /03o Tflvvv~ G.l~• - ~d# 3 ~ Sr~d. Name or CSA~ ,~,G. svNSCi- f~r~lS State T~ Gads Phone Number /`fvO.Sa~ w! s yo~G ~ his, 381 • ~Qas ^ ~y ^ y,~ ®.Town Nearest Ro®d how T~w•~~y ~,nv ~ ~ / Nurnbe<or oeoroon~ cone deriNed ~- use: now rate ~l4.6 -- Oa coo Pubes or mrrrrrerpat - Qesaibe: Parerrt rr+eteiat erj'/.~~4~. ~ Ft~a Plain eteration a ate _ N ~. Cerrerad CarNnerlts ~ • f~iCF~E- TES T~ / •S S' ~/' 7`x/,3 ~c~ ~~ ~.rJ iv~~-v cowr..~rla~,f.~ ~.a. ~ . r s ~/ ~°~°`~ ~ Gcnrsxlsurl~raeelev ~°° ~ `~ y •'' g~ - ~~ h - Sail lisle Horiman aeolh uantinant Fdedoot Desaiptfon Texture Struckire Catrsidarroe i3axrda,, Rods c ~ l au. sz. caul. Color Gr. sz. sh. ~1i1 ~z ~- • Z~ iD Y ~----.~ S i~ S k ~S ~ 5 5~ ~ /o s ~SiG s d a. S - • z . 3 D s ~ ~- • S ro y/z 7/ S . 0 ,~ ~. ~ Grorurd sur,at~ elev. n ?!- to fac4ar in. sa ~e l)anrrant i Te~brre Stye C.or 9ar~dary lZods Gpo~ ~- kar~se8 c>t,. Sz Cori. Cabr tY sz. Sh. -~i1 ~ l...A7GJ[ 1- l m WY •J W ~ 6GV n~glL and TSS >3p c 15 0 ~, • it t1+2 = BOD < 30 mg~l. and TSS _ 90 rrrgl . /~~} ~/~ Q ~ p W, .~OFiR • •-~II Ro fir"' Z1!-JSiei c1~7'_' s ~~~ z Z. ~, 3 rrsw~er ~wdress oele E:vak>~On C.anducled Teisplrars Number vtuncnt & Associates Private- Sewage Consultants 2812 10th Ave. SPring Valley, WI 5477 ~3Rlitw h'R~~ ~~ ,SvvS.~ f ~i~~s oZO-!6/3. 7d • t~ Z_~ 3 s~ Ram ~ r ~ Ram ~ ~~ 9 io%R a z lfsl~/~ ~fR ~ 3-F- . G 7•Sd 7• S `/1 ~~ • ~ S G . "~. i . Z ~~ (~~~ .- L! fit StS elev. ~. ~ ~ $ fatdor ~~. ~. Sod Rate tloriza~ t7~ Clorrurea~t Redmc U~aip6on Terre Sbvcture Canoe l3acy Roofs C ins. ter. S`E Cjoit Cator ' Gr. Sz Sh. 'lol'l '( i j Pit C3ro~d saafa©e~r, fi, to factor in. Sod Rate l'fD1f2.Y7ti tt ~ R9Ct00f lpti_ T S~U~mB '~ &xxf6aRy RCOIs i Kl. ~ Qli. SZ. ~Onf. Cobc . Sz. Sh. '~ 'l~2 .a4 P 3 Bcs-in9 ~ ~ t,Totxxt su:faoe #~- t~epf!'t ~ tinll~g faciot ~. [_.~ Sal Rye - ~ R _ Tencdrs Skuc~e ~ Y ftoo~s C~PDl~ its. Mtmsefl Qtt. Cunt. Ccfior Gr. Sz. Sh 'F~1i i i EffltDeiSt #'i = BQi33 > 3€i { 220 ti~gtl. ait~ ~ wTT >'.~ '~'t5U m~ ~ ~ s ~¢ ~ ~ ~9~- ~ ~ ~ ~ ~- ~-~T~ 3 ~` 5~ ,0 1 ~~ ~/ 5~~ ~% ~~ 25 ~~p~ d r ~'S , g0 a _.__.~x_ _._r__v~.._.__._. -~~u ~s ~~ { ecmits and deS~gnm9 lac issuance o ~ soc+ates Contact. Ulbricbt & ~ ivate wastewater consultant and p~ onnist2red pr .s v1~ v~`f ~~S c~ ~"~ T' ~tT ~ ~' - $~ - I yG' ~3 i M .~ S~ ~ ~~ 7o p °~ ~y y. f-~,G ~/ ~ O r /a ~1 ~ ~6~ ~7, -a yyfo ~, o ~ C____~~ ~Xr~~S Tiu ~' O~Pi~,u w ~._ . = ,~~L,~t~.e P, ~ r-s ss LoT 2 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of 2 FILE INFORMATION Owner Permit # ~?, DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ..~ ^ NA Estimated flow (average) yd 0 al/day Design flow (peakl, (Estimated x 1.5) ~(~ (~ gal/day Soil Application Rate ~ al/day/ftZ Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand IBOD51 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) <_30 mg/L Total Suspended Solids (TSS) <_30 mg/L ~NA Fecal Coliform (geometric meant 510° cfu/100m1 Maximum Effluent Particle Size YB in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity ~ al ^ NA Septic Tank Manufacturer a ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model -~~ ~ ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: NA Dispersal Cellls) In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTFIUAWr_F Cr_HFrll11 F Service Event Service Frequency Inspect condition of tank(s) At least once every: ^ month(s) (Maximum 3 years) earls) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y31 of tank volume ^ NA Inspect dispersal celllsl At least once every: ^ ear( )Isl (Maximum 3 years) ^ NA Clean effluent filter At least once every: ^ month(s) yearlsl ^ NA Ins ect um , pum controls & alarm P P P P At least once ever y' ^ month(s) ^yearlsl ^ NA Flush laterals and ressure test P At least once ever y~ ' ^ month(s) ^yearlsl ^ NA Other: At least once every: ^ Y art ,Is) ^ NA Other: ^ Nq 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 tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cellls) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY31 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 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Paga ~ of Z START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cellls). If high concentrations are detected have the contents of the tanklsl removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) in one large dose, overloading the cellls) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback andlor soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T ~~ alua ' a o mg tank b e ai a '~fZDfll'~ 1T~ ~r2 A~~ ~aNS7Rct~.n ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name u~~~- Phone lf'_ ..~~~f POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name s'j", C t d U 201J1 ~ Phone -]/S- 3g(~_ (0 (~ This document was drafted in compliance with chapter Comm 83.22(211b111)Idl&Ifl and 83.54111, 121 & 131, Wisconsin Administrative Code. ST CROIX COUNTY s SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP C;~RTIFICATION FORM Owner uyer ,L'~2n/o~/ ~~Sj- Mailing Address Property Address (Verification required from Planning Department for new City/State ~~a~~, ~ Parcel Identification Number ,Lj p~t„cl~,ti,~q~ T~ LEGAL DESCRIPTION Property Location /y ~{%, ~~ y., Sec. ~, T~N-R ~9 W, Town of /7" Subdivision .Sr/ ~' ~-,.~/ Certified Survey Map # ~~-a~~ d ~/VolUm~~ ~ . Pa e # g Lot # 3 . Warranty Deed # --Ll~.~~~~ Volume D~~ ~ ~o ,Page # O~ l (U Spec house~es ^ no Lot Lines identifiabie~es ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature.failure to beadle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage is the waste disposal system. The PmP~Y-owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journcymanplumber, restrictedplumberora licensedpumperverifyingthat(1)the on site wastewatardisposal 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. Uwe, the undersigned have read the above requirements and egret to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commence and the Deparizaent of Natural Resources, State of Wiscon9in. 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 the three year expiration date. ,~l ~ / O Y NATURE OF APPLICANT DATE OWNER 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 property described above by virtue of a warranty deed recorded in Register of Deeds Office. ~/ / 3/ ~~ I NATURE OF APPLICANT DATE «s«*** Any information that is rots-represented may result in the sanitary permit being revoked by the Zoning Department. ****** *s Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certifed survey map if reference is made in the warranty deed "~ •~• ~J 2586P 216 764514 STATE BAR OF WISCONSIN FORM l - 2000 KATHLEEN K. 11ALSli WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO. ~ MI This Deed, rnade between Brian H. Raleigh and Michelle L. RECEIVED FOR RECORD Raleigh, husband and wife, 06/02/2004 09:15A!! MARRANTY DEED EXEMPT t« 0 Grantor, and Kernon J. Bast and Donalda J. Speer-Bast, husband and wife, as survivorship marital property, Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): See attached Addendum A. Area REC FEE: 13.00 ?RAAS FEE: 1260.00 COPY FEE: CC FEE: PAGES: 2 Name and Return Address Edina Realty Title, Inc. 400 South Second Street Hudson, WI 54016 ~`~?.~ol~t 9 020-1013-70-000; 020-1013-60-000;OZO-1013-50-000 Parcel Identification Number (PIN) This is not homestead property. Together with all appurtenant rights, title and interests. (~i~ (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this ~{~ ~ day of May , 200 AUTHENTICATION Signahue(s) authenticated this day of ~_ ~heC`~°w .c * c}~{{otar ~ons~n TITLE: MEMBER STATE BAR DE'WI$C ONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Brent R. Johnson Lommea Nelson Law Firm, Hudson, Wisconsin (Signatures may be authenticated or acknowledged. Both are not necessary.) 4 /~ * Brian H. Raleigh • ~~ ~N * Michelle L. Raleigh--T ACKNOWLEDGMENT STATE OF WISCONSI ST. CROIX N ) ss. County ) Personally came before me this ~ ~ day of May 2004 the above named Brian H. Raleigh and Michelle L. Raleigh, husband and wife, to me known to be the person(s) who executed the foregoing insttumen d acknow edged the same. * Notary Public, State of WISCONSIN My Commission is permanent. (If not, state expiration date: \~ * Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN INFO-PRO (90055-2021 www.infoproforms.com FORM No. l - 2000 ,~ , 2586P 217 ADDENDUM A TO WARRANTY DEED PIN: 020-1013-70-000; 020-1013-60-000; 020-1013-50-000 GRANTORS: BRIAN H. RALEIGH AND MICHELLE L. RALEIGH GRANTEES: KERNON J. BAST AND DONALDA J. SPEER-BAST Legal Description Located in part of the NW '/< of the SE'/4 of Section 11, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; including part of Lot 5 of Joshua Hills recorded at the St. Croix County Register of Deeds Office; described as follows: Commencing at the S '/a corner of said Section 11; thence North 00 degrees 33 minutes 37 seconds East, along the west line of the SE '/< of said Section 1325.63 feet to the south line of the NW '/4 of the SE '/4; thence South 89 degrees 55 minutes 50 seconds East, along said south line, 13.67 feet to the point of beginning; thence continuing South 89 degrees 55 minutes 50 seconds East, along said south line, 876.02 feet to the west line of Lot 1 of the proposed Plat of Sunset Hills; thence North 00 degrees 18 minutes 45 seconds East, along said west line, 347.77 feet to the north line of said Lot 1; thence South 89 degrees 27 minutes 39 seconds East, along said north line, 377.45 feet to the west line of a Town Road (Tanney Lane); thence North 00 degrees 18 minutes 45 seconds East, along said west line, 33.00 feet; thence South 89 degrees 27 minutes 39 seconds East, along said west line, 19.14 feet; thence North 00 degrees 35 minutes 36 seconds East, along said west line, 33.00 feet to the south line of Lot 10 of said proposed plat; thence North 89 degrees 27 minutes 39 seconds West, along said south line and the south line of Lot 9 of said proposed plat; 434.50 feet to the west line of said Lot 9; thence North 00 degrees 36 minutes 12 seconds East, along said west line, 511.98 feet, thence North O1 degrees 19 minutes 09 seconds East 74.93 feet; thence North 89 degrees 44 minutes 56 seconds West 831.70 feet; thence South 00 degrees 54 minutes 40 seconds West 1003.69 feet to the point of beginning. Page 1 of 1 o ;gs~~ ~~ ~~ A ~~sT~ ~ 0 3 ~ ~~R~g~~ N ~~~~~$ s w ~ ~~~ ~~ ~~ 0 0 3 tP -t ~. a ~ ~~ ~A 3 a cn y o~ ~n ~ RESIDENCE FOR: M ~ ~ D ~ Q ~ D~a/tIn98Des[gn f+~t,. r" ~ Lrt~ 1,1nM~C, ° ~ ~ ~.~ w $af~(y - County r ~ m ` 201 W. W ingtott ~ (~--CSC, ,~~~~~I~ ad , WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 608 -3151 . Y ~ Sanitary Der ~~n State Plan LD. Number In accord with Comm 83.21, Wis. Adm. Code, personal in rma t oi%~t6~id4d;OUNT'v may be used for secondary purposes Privacy Law, 15.04(1))'~¢tl~);'~~( (1F- F i (;~ Project Address (if different than mailing address) L Application Information -Please Print All Information 0 r ~ n' , i/ Propert Owner's Name Parcel # t # Block # ~ ~ /~ ~ ' " ~0 ~ ' ~ t~/ T / Properly Owner's Mailing Address Property Location / p / ~~ ~ v 5 ~y. ~`/. Section ~~ City, S to Zip Code Phone Number , , ~ d ..--s i. ... - ,~ ~/ (circle T ~ N; >z~E o~ • II. Type of Building (check all th ply) ~1 or 2 Family Dwelling - Number of Bedrooms / ~ Subdivision Name CS-M/~Nu~/ber 5 ~ ^ PublicJCommercial -Describe Use iSNK ^ State Owned -Describe Use ^City_^Uillag ~I'o ship of III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) c ~~j ` '4' New System ^ Replacement System ^ Treatment/Holdin Tank Re lacement Onl g p Y ^ Other Modification to Existin S stem g Y B• ^ Permit Renewal ~Pennit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner yS 3y0 ?- 3-0 IV. T e of POWTS S stem: Check all that a 1 _ ~'~ on -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wet-and ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching Cha r'p ine ^ Grave Pipe ^ Oth r explain) 22 V. Dis ersaVTreatment Area Information: !L -~' ~.t :! G Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sfj Dispersal Area Proposed (s Elevation f oo 7 ~s 7 a ~a ~ ~~ ~ , Vi. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plas[ic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank DO ~ ` /t~t~~ ~ Aerobic Treatment Unit Dosing Cltamlxr VII. Responsibility Statement- I, the unders' ned, assume responsibility for i fellation of the POWTS shown on the attached plans. Plumber's ame~f not Plumb Signet a MP PRS Number Business Phone Number >~l~ ~ ~ t~~ ~ ~ .~ 7~3 - ~- ~ ~~ Plumber's Address (Street, City, Sta e, Zip Code) VIII ount /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Grooundwater Surcharge fee) / d~ ~ DAte Issued ~ ~ ~ lss ' g Ag t Signature (No mps ` ^ Owner Given Reason for Denial i(/V o ndi tio IX. C n of Approval/Reasons for Disapproval ~,(~ I_ ,' _ ) A,,~ ~ ~p~ ~ I ^ ,, ,,~~ / t ` ~ s ~h ~ ((// °v` ~/Zz ' ~ ~ Gam bU-ae~t ~ ~ ~/a ~/65~~~~~ ~~- ~~~.c ~- ~%q~a~ ~a°~~ d~ ~i~ ~ ~ S . ~f ~~ , SBD-6398 (R. 01/03) Attactrcomplete plaro (to the County only) for the systems paper not less than 81/2 x 11 inches in size / (/ J _/ s~ a' -~`- N~ laoo/goo u-u-^=~- s Y.~~-~ 9~, Y~ , v /3/h-/= /do lT%p~ ~~~f~UL ys~ - y f1-roo z~,~.. i'-- ~° 3 t~ N/~ ~~ ~~, ~ ~~ `~ fir/? d a ~3s ? ~GOULDS PUMPS APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability; s/<" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet, • Discharge size: 1'/z" NPT. • Mechanical seal: carbon- rotary/ceramic•stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V or 230V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 SJTW with three prong grounding plug. Optional ~0 foot length, 16/3 SJTW with three prong grounding plug (standard on EPOS). ® 2003 Goulds Pumps Effective July, 2003 63871 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermoplas- tic semi-open design with pump out vanes for mechanical seal protection. METERS FEET 10 g 30 8 25 o ~ Q w x v a 0 J 0 r s 4 3 2j 0 zo Submersible Effluent Pump .. EP04 & EP05 Series ^ EP05 Impeller: Thermoplas- ticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water,resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING S ~, Canadian Standards Assodation ,~ File # LR38s49 Goulds Pumps is I50 9001 Registered. --~~--s GPM - ; ~-2.s~ ~...__ r _ 00 10 20 0 2 4 6 8 CAPACITY ~~~~ 7 .~ 40 SO GPM 10 12 m~/h Goulds Pumps ITT Industries - • -••• ~;•..+~a~,~c t,KOSS SECTION AND SPEC?FIGTIONS CI VENT PIPE 12" HTN. A80YE GRADC E W~TygR pR00F _ 25 FROH DOOR, WINDOW OR JUKCTION BOX FRESH AIR INTAKE APPROVE! WITH CONDUIT KA1~lHOLE FINISHED GRADE V• CZ RISER W/ PAOL( 6" MIN. WARNING --- As OV E G AD E ~~ --~_ v ~• M ] 18" IN. 6" HAX. I NLEr/-'r '~ ~ ° "'` / ' WATER TIGHT SEALS ( ; GAS- ~ y„ / ~ TIGHTS . CI PIPE BAFFLE -.-/ A SEAL ~ ~ 3 ' ONTO "~' ~ ~ LH SOLID B SOIL '~- ; ON C ~ ' PUHP OFF ELLV . _~,,,,FT. ,-~, OFF+ D 1, 3" APPROVED BEDDING UNDER TANK SEPTIC / DOSE SPECIFICATIONS •A APPR OY ED JOINTS W. PIPE 3' ~ SOLID SO! ~~ RISER P£RHIT'T'CL IF TANK MANUFACTU HAS APPRC CONCRETE PAp NUMBER DOSES PER DAY: TANK MANUFACTURER: 'rnNK SIZrS; SEPTZC /apo GAL. DOSE ~ GAL. /~LARH MANUFACTURER; MODEL NiJMBER SWITCH TYPE: r~l1MP MANUFACTURER: HOD~L NUMBER SWITC1i TYPE: ,~~y~ KEOUIRED DISCHARGE RATE GS p}s DOSE YOLUliE INCLUDZNG fLONBACK: ~p~D? CAL. GPACITZES: A = l~/~NCHES c ~,~ B _,?r INCHES ~ --1.3_G C ~~ S~NCNES = D~' D ° ~ INCHES = GSr C PUHP E ALARM WIRING AS PER ILHR 16.23 VtRTICAL DZFFEReNC]: BETWEEN PUMP OFF AND DISTRIBU'T'ION pjpe • • MlNIHUH NETWORK SUPPLY PRESSURE !~~~-~FEFT ~ ~.~_ FEET FORCENAIlT X . ~FT/ 100 FT. FRICTION FACTOR ~ . ~ ~''~ FeFT INTERNAL oiHENSiONS OF PUHP TANK. F . TOTAL DYNAMIC Hip _ • FEET IGNED: EE"I' LENGTH ; WIOTH ._~_;' DIAMETER LIQUID DEPTH ---~=LL. . LICENSE MUMeq~: ~~~ 1 ....~... yin Dc3partment of Commerce and Building lwie.'~ri' PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village X Township Bast, Kernon Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ~/pa~,r,~ r ~~,~,,, yam/ E EVATION DATA TYPE MANUFACTURER CAPACITY Septic • -, Dosing ~` C~ Aeration `'.,, _.. _. _ Holding -:.........___. _ . _. TANK SETBACK INFORMATION TANK TO P/L W BLDG. Vent to Air Intake ROAD Dosing ~~ ~ Aeration ~- _ •~-` Holding - County: $t. CrDiX Sanitary Permit No: 453405 0 State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: 11.29.19. STATION BS HI FS ELEV. Benchmark 6 ~i, ~l (U~ ~((+..'7 1 Alt. B - ~.~d~ Si _ ~ - ~ /OD. (o Bldg. Sewer , ~~ ~ y~ ~ SUHt Inlet !Z , v 9 y (~ SUHt Outlet \ Dt Inlet ~- Dt Bottom ~ -; , z ,~~c ~~~ ~ U b ,~~ ~_ ~s, ~ 9l. s Hea er n. _ /s ~- ,~ 97- ( 5 Dist. Pipe ~ n- ~ ~~ ,. '- • ~ 7. Bot. System u ~ ~ ?/ ~ ~ ~' Final Grade i~QSYs ~ Cc.( .~ 1- pS 10 st c~ ~ _ 3 ~.~ ~.. 5~~ . `7 ~ C.. , U J' S ,/ ~ ~/ PUMP/SIPHON INFORMATION ~~ ~f~~~~ Manufacturer Demand G Model Numb r m TDH L' Friction Loss System Head TDH Ft ~ .1 ~- Forcemain Lent ~ Dia. Dist. to well ~ y ~--- SOIL ABSORPTION SYSTEM ~6-L.~2/~~-- ~ ~n.g ~; ~,L BEDITRENCH Width Length w No. Of Tre PIT DfMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ oC) ~ - SETBACK SYSTEM TO P/L BLDG WELL ' EISTRE LEACHING nufacturer: INFORMATION t ~ CHAMBER O$ Type Of System: -1 r ~ / D ~ \ ~ ~ l Model N tuber: c, r. tee, n ~.2-~~•. 10 l A ~ 1. DJS~RIBUTION SYSTEM Sli .r,~ /I ~! L,o ~'`Y QG UI Z " -~r~-f'i.~..// .(/~~fi Header/ nifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Gt Pipe(s) ~'-'-' _ Length Dia Length Dia Spacing ~ ~~ 7 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only li--- cvt-...~ Depth Over BedlTrench Center ~ Depth Over BedlTrench Ed es g xx Depth of To soil p xx Seeded/Sodded xx Mulched ~ ]Yes [] No r,, Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection~1: Q / /~ Inspectio #2: ~~ / v Location: pending -Wild Turkey Trail Hudson, WI 54016 (NW 1/4 SE 1/4 11 T29N R19W) Sunse ills Lot ~e ~t~r a .2 .19. 1.) Alt BM Description = +~ ~j ~"`7 Y~ G~ 2.) Bldg sewer length = ~ ~ ,~it~ j ~~ J /~~~'p"e~ 9 -amount of cover = :. f ~ `1 ~ ~®'ytQ.l,~) ~ ~ G~~ ~ ~ ~ ~~ ---- ---- --- ~-- i -- - -i i - Plan revision ='" Yes ~?i~ No C/ I~ ~ ~ ~ ' i ~ Use other side for additional rmatlon. ~/--- !~`._' L ___.~ __ ~~'~~'~:~~_l^_ _t<~~_._ i ~-- ~ 36D-6710 (R.3/97) Date Insepctor's Sign, ure Cert. No. ~-~ a ~ ~-/--~ ~ ~'1 ~ h \ , ~~% ~~ ~ `f ~ a~ ~~ ~ ~~ ~~ Faso ~ T-l_ qG./.~~ ~ = a = ~S~ gs t~l~ -1 = l°d ~ /~ '' ~~~ a . qy 6~ ~'~ ,, ~- ~ / s~~ ~° T- ~ ~ ~a3 ~~-~-~ fi-a = a~ ~,~,~ ~~~ ~~'r~aao~s, s~-- ~'~ ~ = a . 't ~ , D wsconsin p ~ e REC'E~V~ E LUATION REPORT Page t of 3 Division of Sa and m~acgra~~vv~~no~mm as vns. ream. woe l_i_ Cou ~ er of less than 8 1/2 x 11 i~ in ize Plan must Attach com lete ske lan on a . p p p p . indude, but not limited to: vertical d ho~pr~~~~t (BM) direction and percent slope, scale or dimension north air®~ a~id dis nce to nearest road. per( I,p, ~Q~ ~"" "`' E Please print al rn o eview y Date ~ C ~ Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~i Properly Owner Property Location ~,, S Govt. Lot ~~ 1/4 Sl= 1/4 S // T ~ N R / E (or~N Property Owner's Mailing Address ~ Lot # Block # Subd. Name or t~M# t , 3 5 s ~~ l~ 3 ` Sup S2T 6 Cily Sia a 'p Code Phone Number ^ City ^ ~Ilage ®Town Nearest Road [~ New Construction Use: ~ Residential / Number of bedrooms ~=Y Code derived design flow rate Ci'-~ ~t!o aQ GPD ^ Replacement ^ Public or commeraal - Qestxibe: __ _ __ Parent material ~ U -t'C~J u ~ ~ Flood Plain elevation if applicable .~~/ !~ f ft. General cort,rT,ents ~\ / S~ ~ ~ e I -~ V ~ 9,,~. O U ~h-I~~i~,- -d'Lic~ and recommendations: 7 .~ " ` s~ I 1 1 Boring # 0 Boring t t ' rl0 ~~1 /?~\ l_J ~ Plt VIUUnU SUnGI:C GICV. ••- - u. vapu~wnnuuny iauvi .~ - u~. Sorry ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/FF in. Mansell Qu. Sz. Cont. Caor Gr. Sz. Sh. •Eff#1 •Etf#2 I U -/O t0 rJ L ~-- 51 ~ ~ rr't.S YVt~r ~f v ~ . S - 3 3 i ~~ ~~ S I'yi ~ ' ~- Z •~~ ~~-(o Boring # ^ Boring /~ ~ / ~' pit Ground surface elev. U(J ft. Depth to limiting factor ~_ in. Sal lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftt in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 J / ~' Effluent #1 = BOD > 30 < 220 ntglL and TSS >30 < 150 rnglL ~--G • Effluerd #2 = BOD < 30 mglL and TSS < 30 mglL T Name (Please Print) lure CST Number ~a w~ Sal-w~a ~r,- ~i,~~~-,---.: ~-~ Z.~3.30 9 Address '• Date Evaluation Conducted Telephone Ntunber - Z ~( ~U -~S.1- .~~,-~-(~i ~e ~ ~ ~ Sr`/°ZS' ~ ~ ZfS _ °~ 7iS ~_ 7G o ~ z ~ s y Property Owner / /t C ~~ Parcel ID # ~°'L" Page ~_ of ~_ 3 ^ Boring ~ ~ ~°^~ # © pit Ground surface elev. ~~= ft. Depth to limiting factor / L in. Sal lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dlff in. Munsell Qu. Sz. Cont. Color Z. Sh. Gr. S 'Eff#1 •Eff#2 Q-(~ (~ .~ ~ / ~/ C dmJ r ~ ~ r ~(/1 i ~ ~' ~ Z `~ lU -- ,~I ~/ ~ l C G 3 v-~z8 a -- QS ~ r / Z ^ Boring # ^ Boring ^ Pit Ground surtace elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont, Color Gr. Sz. Sh. 'Etf#1 •Etf#2 Boring Bonng # Ground surface elev. ft. Depth to limiting factor in. ^ Prt - Soil lication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 • Effluent #1 =BODE > 30 < 220 rtrg/L and TSS >30 < 150 mg/L • Effluent #2 =BODE < 30 mg/l. and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate fomtat, please contact the department at 608-266-3 i 51 or TTY 608-264-8777. sao-uw ca.sroo) ~' PAGE ,~j OF 3 SCALE: I"= _ L C~ BM I ELEVATION rC` O - ~ BM 1 DESCRIPTION ~}~~I v ~- f Os ~e BM 2 ELEVATION BM 2 DESCRIPTION SYSTEM ELEVATION 9~ Oa ALTERNATE ELEVATION ~fi/ r4- SIGNATURE ~- - ~ - '"' 1 ~ `~ i 1 I ~ ti` ` ~ ~ ~ ~\ ~ ~. ~ ~ ~ \ ~ \ \ \\ \ ~\ ~. ~ ~\ ~ ~ ~ ~ ~~ ~ ~~ ~ 1 ~. \~ ~ 2.6b ACRES w w L801~ 8 1 0' m ~ I _ _ _ _ _` ---- -207 __ ~_-- ---- -. --- --- ~ .5T ~ , DES ~" ~ : ~ - --yyI LD TURKEY TRAIL - - -- _ -- - - - - - ~. F-r. ' ~ \ ~ ~ Nerz~~w sr3.a3~ 91.00 ~ ~~ 5 ~`~ O ~ SEPTIC' ~~P~~ '~'~' LOT 3 r ~~ 2 S ~. ~ : a1 . 118,213 SQ. Ff. S-A ~ . , LBD = 891,00' ~ ~~ LOT 2 n ~~ ~ ~ ~ LOT 1 • ~~~ 2.00 ACRES "~ 87,321 SQ. FT. m = 3.00 ACRE; Lsa = 891.00' ~ 13oseo sq. ~ f~_ ' . ~ ~ S-A ~G ~ p ~~ ©~ X04 ~ pda~ ~o~ _ aka as 285.sz - -34a2:ooar I x x x x 389°6S'S0°E 7 2S3.4T gp~~{ LINE OF THE NW1 /4 OF THE SE1/4 OF ~ 10 11 i I ~ aOp[~a~ ~~~Q4C~~ ------- ---------- I ~ , ~ ~_~ _~' 1 ~. --- ~ - --- - - PLaC~[ r~ W / ~.~ ~ ~ ~~_ iHtlT 7 O!~ ~ iHSlT~ /' / ~_ Rug 10 04 05:42p LISA RNh KROLL 715-246-5700 p•4 ` wi •COns41 uepertttr,er,t o1 Cormnetce SOIL EVALUATION REPORT f>ayo _~.• d _~ Ulvisivn of Safety end Bulklir,gs in aoswdarn,~e wiU+ Careu 05, Wis. Adrn. Cute / nltatf+ Wnq,b+e site pfart on pnpet rwt Mss Uran 0 1/2 x N ildroa Mr size. Plan moat ..-_ _ _ b,dude, ft•tt not Ilmlted to: vertical a„d horizontal reference point (DM), dkeetbrl arnl t's+txl I.U. pet cent r rope, scale or d6nenabns, uor tl+ auvw, an0 tocauon ar,d dblarrce W nearest roar). ~ -~ Uaty Please prfrtL 8/! f~rfurt>ttattOn, Rovitlvuvd by Prwsonrt hlbnnwrron yw povfds n,~y as urrsd /p rraeondary pwpotroY (Privacy few, a. 15.04 (1) fart). I'ropertyOwner P+oportyLocalkx, . ~~ 5 Gwt lot 114 t/4 5 1' N It E (or) W _ Property Owrrer's Melling Ad +eaa lot fA ~krck tf Sulxl. Na+r,e w t.$Brllf -~ . - --- - ~- City SWOO Lptiutly PlwrieNun,lter - y; ~ ~ [J cdy L1 naye ~ town flea est Ra d ( a o w•'d r~-F•~ (~ New Construtyion Use: ~ Residenlydt / Nuurber of bedraxns ~.- Y Code derived desiyn Ilurv +ate ~~~~ OC _ __--_ _ _ GPU (_-1 Replacement ^ Public w cannlercr.,l - Describo: ----__--..- _. _ •--._.-.__- •- -- ..--•-- -- Pnrant rneterial _~~~ ~ f1 _-_----^--- Fbad Plain elaval'wu ~ pplAicaWn -- --.- . ~C//~7- --- --- _-- -- R. t,;er,eraloornrnertts ~ ~/~~ _ /Lv fys Q ~ G J ~ t , l 7 arh! rowr,mrern)alitx,s: / I Puri ... _~ J fjote,g ff ^ Bvriny 1-~ -. ^•-- ... ~ - -~--- -~- - 94- 2n .. .. ... .. ... i 3 ---- - - - SuA /lpplicalir~n Rale 1IVrv-un Ueyt), Uurninaul Color Redorr Ueswiption TexlWe SbuGure _ Cunsis+ttrtr;e Dnnntlary _ _ (tnr,+s- GP UItP 1n. Mansell Qu. Sz. Cont. Cakx Gr. Sz. Sh. •EIlU1 _ 'EIfp2 ^ - - - - Z ~3~ o ~ ~ a~_ ~~' ~~- _ ~y ~ - ~~ mil- ~ , v ,. .._.. C>s ~ _.. a --- ~ ~ - ~ _ ~ ~~ ,_,(` - Bering At^7 Boriny ~n ~"I Pit Groundsurfarndav ![J(J U rr ns..n, w, t:...a:..., r....t... ~ ~/ ttx, -- Ueptlt irr. Uaninarn Cobr Murrsell_ Redux Description Uu. Sz. t'nnl. Cobr Textwe Sbuctu're Consistence Btwndary Routs Gr. Sz. SI,. Sots nDUlica6on fiats ~_ GPDrtP _ 'EffN1 'EffB2 _ _ _ -- zy l ~o~i ~ O m( - •~ l•~ ~....-- - - -- - ° ••'y~ ~N .~ ~w = ,av nxya. ' EffltrerA p2 = 8UU < 3U mg/t_ and 7SS < 3t1 rnglL (:S f Name (Pfe+ue priyj - .~ afore CST flund,ar ~w~t 5 Uale Evaluation Cone u ~ rl ? ~ ~~ ~~ ---- - -- leleph n^. Nurnbcr Rug 10 04 05:42p LISR RNN KROLL Plntlerly Owner _~ C ~~~~-- Botalg tt ^ 8airg 715-246-5700 p.5 Parcel ID !f _,.~D'~_-__--°- path' _ Z at /7 G txJ Pit Grutxrd surface Nev, „j 9- ylJ 1l. OepUr m irr,surg tacwr ' ~ " °4• I Iurizon UoPtlr Uombrenl Cdor Redox Desaiplpn Texture StruCtwe Consistonce Dvurrdary Runts Gr. Sz. Str. _ Oa Sz. Cari Cobr rs dl M in . u Soi n 'on Rate GPDItP g2 •Effp 1 •Eff _ ~~ ~~~~ ~~ 77 ~~ ~ / 3 ~~ /J `- . / ~j ^ Boriny ~~ Boriny p _ ___ ^ Pil Ground surface elev. tt. Uepth W lurtitiny IacWr _-_----• 111_ Sull A licatlon Ra I tolizal Ueplh Dtmrbranl Color Redox Description Texlve SUudure Consistdree Btwrxtary Rtwts _ GPDAP in. Mansell Du. Sz. Cont. Cobr. Gr. SL Slr. '[tlfJt 'EIIl12 ^ Boriny E3oring Il ^ Pit Ground Swtace elev. __-__- It. Uepih Io lirnitiny IaGur _ _ __.__. __._.__... in. { Snl} Nuulict' Gwr Rate I tarizor, UetrU+ Oomittxri Cutor Redox Descriptions Texture Structure (:vusistonce Bourtdaly Routs GP ttP in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Ef[Itt •Ettfl2 ' Effluent 01 =DUDS > 3V ~ 210 rrsglL alrxl TSS >3U < 1 SO rttylt ' EOluonl 112 = DUDS < 3U mttf L and 1 SS < ap nly(~ 1 he llcparttncnt of Cumn:ercc is an cyual oppoRunity scrviec ptvvirlcr and eaytluycr. f f yvu nccrl essistanee to access services or need material iu an alternate ftxitsat, ptt~se cunfact tlic depatUncut at GUR-2GG-315 t ur 't'I'Y GUB-2G4-8777. tRt11l1 MIR 011011! Rug 10 04 05:42p LISR RI`i!V KROLL 715-246-5700 hACe 301-_3 NA)v1E: G ~ LOl'1i ~ LL•GALllESCRI!''l'ION:~_f!~_l/4,S_I'^N,R~G(~r)W SCALE: 1"= ~v~ ont i Dcsclur'rlo~~i:~Q o-~ ~9 ~sf -~1 c~'o~ .r- - dM 2 DL•SCRfI'l'101J: q SYS't'Ehi L•Li;~'A"t'I~.~' ~:_.._. /'~ GV --- SYS'i'Chi'i'~'i'1:: ~r~,ea~n-i,)o~-.~-- .' SIGNA p.6 . ~~d ~. - _ ~ Safety and Buildings Division County ^ ~ ~ ~ ~ 201 W. Washington Ave., P.O. Box 7162 ~r -S / . (./l.0' ~% ~scons~n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (~8) 266-3151 ~3 Sanitary Permit Application State Pan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, perso "~ ~ may be used for secondary purposes Privacy aw, s( >~r , ; f Project Ad ess tf d' rent rt~iling ddres ~~ r t ~ ~ ~ - I. Application Information -Please Print All Informatio ~u~ ~~ ~ 2004 Property- Owner's Na me ~ Parcel ry of k Block rY 6~1 Property Ow n er's M ailing Addre ~`'°~-"""~°'"P` rt y L 'on f ~ ~~ ~~ A j fp City, State Zip Code Phone Number ~~~~ S ~~` ~l °~ ~ (circle ~ ~ II. Type of Building (check all that apply) ~ T N; R E ol:~ 1 or 2 Family Dwelling -Number of Bedrooms ~"' Subdivision Name ~ umbe / ^-Public/Commercial -Describe Use ~ C.I~'1~.Q..P~ .(,~~ 7~ ~ n ~ ~ ^~ ~ ^ State Owned -Describe Use ~ AI SJ (.~.C.C~-~ ~ ~~~- ~ ~.,7 ^City ^ illage ownship of °'"' III. Type of Permit: (Check only one box on a A. Complete line B if applic 1'e~x;,. A' New Systetn ^ Replacement System Trea[ment/Holding Tank R acement Only ^ Other Modification to Existing Syst m B. ^ Permit Renewal ^ Permit Revision ^ Chang f ^ Pe it Transfer to New List Prev' us ermit Numbgr a D ssued Before Expiration Plumber Ow r IV. Type of POWTS S stem: (Check all that ap ly) ~ ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ u < 24 in. of suitable soil ^ At rade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank Peat Fi ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leachin Chambe ^ Dri ine rav ess Pipe ^ Other (explain) V. Dis ersal/Treatment Area Informatton: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal rea Require (sf) Dis al Area Proposed (sf) System Elevatio ~ /s / / VI. Tank Info Capacity in Total Number Manufacturer efab ite Steel Fiber Plastic Gallons Gallons of Units Co ete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, as a responsibility for ' tallation of the POWYS shown on the attach plans. Plu ~me (Print) Plumber's Si r /MPRS Nyu~mb2er Business Ph a Number Q Plumbe~ Addre ss (Street, City, State, Zip ~) /" / ti ~ / //n I ~ C ~ ~ / VIII ount /De artment Use Onl Approved ^ Disapproved Ganitary Permit Fee (includes Groundwater ~ Date Issued ' Is g t Signature Stamps) C ^ Owner Given Reason for Denial °urcharge Fee) JJ ~ ~ ~ ~-f~ ~ ~ D IX. Conditions of Approval/Reasons for Disapproval - ~ G(Jk~ ~~ ~~ ~'~47~ ~ ~ - ZU~f S TE M OWNER: i~, ~ ` 1~ ep is an , e uen i er and 7J;Q,~^~ ~3 ~S ~~ dispersal cell must all be serviced ! ma- intained ' ~ "~ ~ ~~,~ ~ ~{ ~~ ~ ~ ,,/ as per management plan provided b l b ~ Q~""'e-" ; ~ t~~.~a~ '~ y p um er. `~~'2 y,~~ ~c i ,~ . 2. A se ac regwremen s mus a marn me -' ~ (/ as per applicable code/ordinances. S ' SBD-6398 (R. 01/03) acracn compete plans (to the County only) for the system on paper not less Wan 81/2 x 11 inches in size /~ ~~~ r "~ a~ ~~3 ~1- ~~.~1 ~ N Faso u~'! ~=a = gs,as ~/a '' ~~~ ,~~ -a. 9y.6~' r~v~/s ~ ~~~ ~~ ~~ ~~ ~ ~-- ~~ .~ ~ ~ ~~ Sail EVALUATiaN REPQRT ~ - ~ i~ ~ ~ 3 . aa~s~y~aar ire srmrim~e~a ~ (`.,~..... ftt iAB~ e.;.., r...m - -- ----------• ----- ----- ---- atrr~a, oomaeoe see par, ai swt rasa ~ 8 ~n x 1'l f~hes to sire. Ptan,nust ~,, ST cRot 1c,. ire, t,uc i,oc lima >~: , aAa l ~. +, a~sd fsla~e.s~«~,>~.~,«~~~~. - o • io/3.70 • oaa ~~ 1 Pa~roeaitntonertienyouparidd~rwemsa ' ~~,~sdttfnr. S.osc~)E~. ~o~o ~R% 1~f}GEtg FE8 2 0 2004 cotL NEt1 ra s~ v4 s 1~ r .2 ~ ~ It / ~ w 9 9 f~ /a3o T/9'/VNE ~ST. CROIX COUNTY ;~ ~ ~a Sl~A/SEt' ~~~ f /~vO.Sa~ w!. 5yo/G ~~f~ 38h • 9~S `:~ °' Tom' ~ ,~,v ~ Y ©~ ~~~ I r al'bed~oorres cafe deriaea flaw race b " d a ~p O ~coraonra~ f-oescx~be: _ l~+ent r D6~~/~,~ Flood Plain elevrdion ite ~ R. Genera[ c~ n f . an en s sna ~~ . f~if~ TD'S T~'l7 • S .S'vi• 7'",t/~3 LC~ X011 ~.v %v~~ - co~vv~r1~~.~~ ~?a.c,~. rs . ~~ G'~a~dstufe~oeelev rr n _...--._~ ~o r~re>~c ~. - soil fire fforinon ~fh Uaaisr~t f~edaor Desta~plian Tea~ure slrudire cocoa eoucasn- aoas ~• Du. Sz Cat color ter. s~ Sh. ( '~ Z- • Z~ i0 ~------ - Sim S k cS ~ . 5 . ~ ~ ~o s ----- s~G s d 2 s - • z. . 3 - D s c -- y~ ~! s D . t. ~ ~ ~~ ~ n ciu. sz c«K. Dolor CY sz. sn. ~, '~ l o• ~ 1o ye ~S .f ~ s ~v 3 ~ • w7 % Z `3 y. ~©y ~ s ~.s ~. ~•L ts7' ~tf~ieaea ~4 ~~J/~t+CLf~ ~ 22 (,~ 3CS. T ~nber Dena Evek>Iaion Contluc~ed efepNate Wisntter ill0/~. ~ G - men 3 7/S • 7'7~ • 3 X15/? vu~rrctf~ ~ Associates Private Sewage Consultants 2812 14itt Ave. SP~ng Valley, W154767 ~ Q ~ ~ n~ ~Z~~~~~.~ ~~lit~tl 1~'R~~ i~ ~- svus~ ~ ~i~ls DZO-l6t3. 7d - ~ ,~ 9~ ~U > ~ ~ ~ ~ ~ io ~ ------- .~ ~ t ~ ~l ~fcxzeon t ao Reamc ~ 7 Comae + Boors c ~. ~. sz. ~ c~ ~ ~ s~~. - its ~ ~ c~ocmd svsfeoeeie~-. ~. tv;r~g #ac~r ~,. ~ ~ sa Rafe riot ~ R+~Ox ~_ T one ~e ra~r #taors ` aR- i4rtxs5~ Qa. Sc t3ont. Coioc . S`~. Sh. - '~ ~,- .~ - P ~ ~ dsus~oe ~____,____!~ !ate tailor ~ ;~ ~e tiorsz~oti ~: r)aea~ana _ Te~s+e e ~ ticxa~deay Rods ~ ~r~#~=~;>3r}_<22(}trr~i.arn37SS>30~'t5f) ~~sg~6`~p~(•~~'~S_~»gi"' s ~t ~-o T~ 3 ~• ~~ ~~ ~ y, G T~~ ~~~ ~~~ 2S ~~O- ~ Z ~~ d O ~~--~ ~ R....e...~..-.-~_..., ._._._.x._ ~_~_~...____~~.._.._..__ ~,~ u ,~,,;,.~ r ~~ C- L- rmits and d~;gning for issuance of pe sociates Gontact~ Ulbricht a wastewater consultant and p~umb~ apaistered priva ~~. V ' y ~3 f S V ~ J~~~D~QS ~ oV~ ~ ~ ~~ t~ ~ ~ ~T ~ ~ T ~' ~M ~ r s~ T t~ ~ 70 ~' °~ y ss 5f -~~,' p 1 d e r /0 ~_ ~1 t /~ , f ~ --- a y ~s~ ~A s ~ Gi~-~ ~. D ~X i~4S Ti-~ .J` Q/I~iGLC GtJ F'~-- L1 =- G,dv ~v.L° S t LoT 2 f ~g,g0 RECEIVED ~ ~ JAN ~ 9- SOI , EVALUATION REPORT ~ Page ~ of 3 oi~etonots~y~rdets 2004 L AT<ar~ ~P~ ~ P~ at aper i T' C R I Xp T~ 1 s in size. Plan waist ~ ~ 57 : ~Ro~ ~ urdude. but not fanned 10: t (gM). won eutd • ~ ~ ~. nark arrow. acid bcatiort and d~tanoe to n~rest road. ~ o o • ~O13. 70 • oaa PJease print aN Irtformatlon. Pertronri ~ you provide mry bs used torsaoond~ry grposes (prtrscy taw,:15.04 (1) (+~?• fl P ~ i J~A-L E'! y ~i..~ cope. ~otL W va s~ va s ~~ r 2~ ra a / E w 9 t~ Pro~enyowr~rs ~ io3o T~9vuN~ L.v • lot # 3 Bbdc;~ 3t6d. Name a Q/NG. svNS~-7- lftt! S ~VO„7a~ state ~ ccde Prone Nuri6er w~ syoi~ ~ his, 38l~ • ~~s Q ~ 0 v~age .Town Nearest Rosa v how 7.~wN~y ~,,v . New Comm (~: ~ coos }lid _ O'a Cep Res&fen>tal ~ Ntrrnber of bedrooms Code derlvea ^ ~t ©Ptd~ «comrrrerp~ - Oes~xibe: Parent materiel ~~D ~ ebT"'Illf.~~, Flood Ptah- elavalion if appeCabie N tt, Generet oarrtrer~ks and ~ /4~t't%4- TES T~ / ~S s' ~/' 7'"1-/3 LC ~~ ,~,v %,l~~,Pp~tJ cowv~r-tr~,vf-~ ~.a. c,~ . r s . Bartng~ o >oo • ~ y ~ ~, ~~ pit c>~dsurfaoeelev. _ n Depdr,>a in. » R~ ~ ~ ~~ kr. l Qu. Sz. Cad. color Gr. s:. sn. 'E~1 '~ a /D ,S S/G s d ~ S . z . 3 ` D s ~ ~- 5 ~~y~7~ s D s .~ I• ~. P'it Gro[lnd s elev. tt. _ ~ b reratitg > +n. . sd ~e Te~ore ~ cPar~ ~ t~sea cif,. sz Coro. Cobr c~; sz. sn. 1 ~ Eta #'1= tiQD > 90 _<?2o rrgll and Tti~'.S >30 ~ 15 0 rrrgli. E1~ent ~2 = BoD < 30 tngA. and T~.S < 30 mgl . - /~r~ ~~//~~ W ~ t~0lf~C l ~ Print, ~~~ ~~~~~ 12o T' Z/!-JSi2i cG~7-' s ~ ~ z ~z,. ~, 3 r S peer Addre~ Date Evaw~on conducted Teteptforfe Number " itJO~~. ~, ~ - ~ 3 7tS • 77~ • 3 X15/2 ~"'~~~ & Associates Private- Sewage Consultants 2812 14th Ave. Spnn9 Valley, INI 54767 --11 1 , E S t ~ ~N ~3R%~w l~'R~~ ~~ ~~ svvs~f a~~l~s o~.d-l6~3. 7a • a~ . r~~ L. d ~' ~- 3 9~•~U > ~i ~ Z ~. 3 ' ,fir YR wvvsw..nww ucv. n. i/J}IYf 1. eaiMOi~~T.Kia r. 4A r_y •7NIF Fiv~toa in. ~ ~ Rer3Oac Desai~Ota fhs. Sz. Cant iklor Teaches Shtac#txe tY Sz. Sh. Carasistenae 8ouindtlry Roofs '~Fi -~ ~ ~' Q /D%R ~ L /fsl~/c iw- f/2 c1 3 -F' . G _ 7-SO 7• S ~ /1 n~zP • S S G . 7. ~ . Z ~~ Q .- ~ ~;c cr~e,-. ~. o~~+ ~ ~,. soa R~ i Chi Redmc D~xi~ott Ted s~n,a~e ~ Bau~daty ttoo~ ~. ~ spa. s~. t:attt. eaor ~ fr. s:. sh. -~'! '~ 3 i a ~ TiL "" ........,....... . T#..~ .-..... V .~ -.~.~.~~ .. ~ Ratt< L~.~. `~~` ~ y~~~-~j~_~y i~~- ~ ~y~~y~~ ~7tl 71WRa ~ ? Kt. ~ (lta. Sz i3ottat. Coda . Sz. Sh. '~f ~i?2 A ® - f~ {~rotaad saefaoe ~' [)spilt io fade ~ Sfx~ Rye Fioett>a+ iMtsaaatat R poaa. Te~xtu~s a iesaee 8oea>amY Roos t~3AF its. i~{uFwefl tltt. (.dtf. C.otot' Gc. ~z. Sh. '~# ` " EfRtaesat #1 = ids > 30 < 224 ~-and 1~ >3Q < 1~ ~ ' Efltc~t #2 = BOtI¢_< 3Q tttgli. axtd TSS A`. ~ tatgrt. LD T ~ 3 ~` 5~ ~e I ~ p ~~ ~ ~~~ ~~ , 25 ~~~~ ,z^ ~~ / Q $~ ~~ y y g, d0 b ~ ~~ _..___. ~3 ~%" ~~ and de$igninq For issuance at permr~ soc+ates d 1u~ Contact. Uibricht & Ps Qontstered pnvate wastewater consultant an ~s .sv1~~~~fD~s ~ou~'~.~.3°~ ~~~~ ~ ~T ~ O ~ ~' ~ ~- 5~ T ~~ T°~' °~ ~y 5S ~ i~ ~r ~ fib' l a ~=-• d -a y~so ~A 5 ~ ~~,~+.~ ~, o r ~X~'~S Ti-~ y' oiP~u-c w ~_ . = ,~~~,~~O.e P~ ~ 1~s Lt =~~ov~S nor POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of 2 FILE INFORMATION Owner Permit # ~-~ DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ,..~ ^ NA Estimated flow (average) yd 0 al/day Design flow (peakl, (Estimated x 1.5) ~(' (~ gal/day Soil Application Rate ~ al/day/ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) S30 mg/L Biochemical Oxygen Demand (BODS) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ~NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size YB in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity ~ al ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer . ^ NA Effluent Filter Model -~~ ~ ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: NA Dispersal Celllsl In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINT~NAN[_F Sr_HFr)111 F Service Event Service Frequency Inspect condition of tankls) At least once every: ^ month(s) (Maximum 3 years) earls) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cell(s) At least once every: ^ monthls) (Maximum 3 years) ear(s1 ^ NA Clean effluent filter At least once every: ^ month(s) yearls) ^ NA Inspect ump, pum controls & alarm P P At least once ever y' ^monthls) ^ year(s) ^ NA Flush laterals and ressure test P At least once ever y' ~ ^monthls) ^ year(s) ^ NA Other: At least once every: ^monthls) ^ yearlsl ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal 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 IY31 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 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Pagb y of 2 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s-. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T ~~ alua ' a o Ong tank b e a. a ~f10~-118 TCF~. ~~2 !~/~/ CaNS7KlJ~~'I. DnJ ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name (~-~~~ Phone l~' ~ - ~ ! / POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name sT. C l t7 U 7D~Il ~J Phone ~lS- 3~(p- (p (~ This document was drafted in compliance with chapter Comm 83.22(211b11111d1&If1 and 83.54(1-, (2) & 13), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP C,~RTIFICATION FORM Owner uyer Gh/ T- Mailing Address Property Address (Verification required from Planning Department for new City/State _1~~~~./, ~ Parcel Identification Number ~- ~4- LEGAL DESCRIPTION Property Location /(l t.(.~1/., ~~ ~/s, Sec. ~ T~N-R ~ / W, Town of /~' Subdivision _Svit/SET Certified Survey Map # / __ ____ ? vo~~n~~ ~ ,Page # Lot # 3 . Warranty Deed # ~~yj l ~~ Volume ~ ~ ~C Page # ~l CO Spec house~es ^ no Lot Imes identifiabie~es ^ no SYSTEM MAINTENANCE Improper use and maintenance of 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The PrePert3'~~ agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, jouraeymanplumber, restrictedplumberor a licensedpumperverifyingthat (1) the on site wastewatardisposal 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 sledge. Uwe, 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 Wiscon9in. 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 the three year expiration date. ~ c.~ ~ O Y NATURE OF APPLICANT DATE OWNER 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 property described above by virtue of a warranty deed recorded in Register of Deeds Office. I NATURE OF APPLICANT ~ ~ 3/ ~~ DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ***'`** ~a~~~,~ d '~" 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 .~~ •• ~J 2586 P 216 764514 KATHLEEN N. MALS[i STATE BAR OF WISCONSIN FORM 1 - 2000 REGISTER OF DEEDS Document Number WARRANTY DEED 5T. CROIX CO. , MI This Deed, made between Brian H. Raleigh and Michelle L. RECEIVED FOR RECORD Raleigh, husband and wife, 06/02/2004 09:15AM MARRANTY DEED EXEMPT # 0 Grantor, and Kernon J. Bast and Donalda J. Speer-Bast, husband and wife, as survivorship marital property, Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): See attached Addendum A. Area REG FEE: 13.00 TRAAS FEE: 1260.00 COPY FEE: CC FEE: PAGES: 2 Name and Return Address Edina Realty Title, Inc. 400 South Second Street Hudson, WI 54016 ~~Z6~~t9 020-1013-70.000; 020.1013-60.000; 020-1013-50.000 Parcel Identification Number (PIN) This is not homestead property. Together with all appurtenant rights, title and interests. bid (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this ~,(i ~ day of May 200 AUTHENTICATION Signature(s) authenticated this day of ~- Gher~Q`1`' is h1-- * c}Na{otac ~ons~n TITLE: MEMBER STATE BAR CSC ONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Brent R. Johnson Lommen Nelson Law Firm, Hudson, Wisconsin (Signatures may be authenticated or acknowledged. Both are not necessary.) 4 /~ * Brian H. Raleigh ..1~P~ d ,~ . ]~~iv -- *Michelle L. Raleig~ _ ACKNOWLEDGMENT STATE OF WISCONSI ST. CROIX N ) ss. County ) Personally came before me this ~ ~ day of May 2004 the above named Brian H. Raleigh and Michelle L. Raleigh, husband and wife, to me irnown to be the person(s) who executed the foregoing instrumen d aclotow edged the same. * Notary Public, State of WISCONSIN My Commission is permanent. (If not, state expiration date: \~ * Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN INF0.PR0 p FORM No. t - 2000 (80055-2021 www.info roforms.com 2586P 217 ADDENDUM A TO WARRANTY DEED PIN: 020-1013-70-000; 020-1013-60-000; 020-1013-50-000 GRANTORS: BRIAN H. RALEIGH AND MICHELLE L. RALEIGH GRANTEES: KERNON J. BAST AND DONALDA J. SPEER-BAST Legal Description Located in part of the NW '/a of the SE'/a of Section 11, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; including part of Lot 5 of Joshua Hills recorded at the St. Croix County Register of Deeds Office; described as follows: Commencing at the S %4 corner of said Section 11; thence North 00 degrees 33 minutes 37 seconds East, along the west line of the SE '/e of said Section 1325.63 feet to the south line of the NW '/a of the SE '/4; thence South 89 degrees 55 minutes 50 seconds East, along said south line, 13.67 feet to the point of beginning; thence continuing South 89 degrees 55 minutes 50 seconds East, along said south line, 876.02 feet to the west line of Lot 1 of the proposed Plat of Sunset Hills; thence North 00 degrees 18 minutes 45 seconds East, along said west line, 347.77 feet to the north line of said Lot 1; thence South 89 degrees 27 minutes 39 seconds East, along said north line, 377.45 feet to the west line of a Town Road (Tanney Lane); thence North 00 degrees 18 minutes 45 seconds East, along said west line, 33.00 feet; thence South 89 degrees 27 minutes 39 seconds East, along said west line, 19.14 feet; thence North 00 degrees 35 minutes 36 seconds East, along said west line, 33.00 feet to the south line of Lot 10 of said proposed plat; thence North 89 degrees 27 minutes 39 seconds West, along said south line and the south line of Lot 9 of said proposed plat; 434.50 feet to the west line of said Lot 9; thence North 00 degrees 36 minutes 12 seconds East, along said west line, 511.98 feet, thence North O1 degrees 19 minutes 09 seconds East 74.93 feet; thence North 89 degrees 44 minutes 56 seconds West 831.70 feet; thence South 00 degrees 54 minutes 40 seconds West 1003.69 feet to the point of beginning. 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