Loading...
HomeMy WebLinkAbout020-1456-17-000Wisconsin Department 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)]. ermit Holder's Name: City Village X Township Ridley, Grego Hudson, Town of ST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic /~ L, _ ~//~ ~C.~ ~a.~` IvY /V I z sa F ~ ~d I ~ 6z ~1. sz5 Aeration - ------ - Holding ~ ---- _____ TANK SETBACK INFORMATION ~or+~ en o it n a e ep is ~ 5 NA- _ Z4 7 Sts / osmg era Ion o Ing PUMP/SIPHON INFORMATION anu ac urer eman y,.-- --- -- GPM o e um r i ~, nc ion oss ys em - ~~~ /" ~~ r emam eng ia. .7VIL HCS.7VKI I IVIV JTJ 1 CIYI ELEVATION DATA County: St. CroiX Sanitary Permit No: 488162 0 State Plan ID No: Parcel Tax No: 020-1456-17-000 Section/Town/Range/Map No: 11.29.19.2933 STATION BS HI FS ELEV. Benchmark Iv , o ~oc~ ~ o ~~ Alt. BM .,br 1 ~ 1 5 (~j / r'3 Bldg. ewer ~ /0.5 r18.s5 t t nlet ~ IZ S //~ SS t t ut et ~ ~Z.9~ l/~~IS ne 0 om ea er an. ~ ~ G ~ ~ 7.a cy cy o. ysem ~ .0 98,a ina ra e 3.40 /oz . Z over ~ ~i g 1 z 3 . Irt lvr+~ I l3. 15 118.95 /~ b /~ DIMENSIONS 2 ~ v Q~ ~ / ~ \~e~ ( n ~J~ ~ ~ \ INFORMATION CHAMBER OR l~~y~ ~~~c~e3~ C(7~J~r ~` ~~ ~~~ ~~- UNIT ~J, ~ r UIJ 1 ISIDU 1 IVIV .7 i J 1 CIYI /4/_riJ _ Z<~ ~- 7~S =- `f-b rdo'o-x. ~ ~ Length 9 Dia Pipe(s) \\ ~ Length_~ Dia Spacing ` \~i ~ 3 f fJ v~^ Q~ , wu....vv~rt x rressure systems only xx mouna yr ~~-uraur ~y~~r~~~~ viny Bed/Trench Center ~ 1 Bed/Trench Edges ~ Topsoil ` ~. \ ~s No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 1040 LaBarge Road Hudson,nW 154 16 (NE 1/4 SW 4 11 T29N R19W) Sunset Hills 1st Add Lo/It 17 1.) Alt BM Description = ~oP 2~ ,O ~d ~ ~ ~~ G ~ ~` '^~ S '~"~ ~ O ~- 2 S 2.) Bldg sewer length = Zy - amount of cover = ~ Plan revision Required? Yes o Use other side for additional information. SBD-6710 (R.3/97) - ~ i- `te I ~ ~1 _ _ . Inspection #2: / /_ Parcel No: 11.29.19.2933 a .~. _--- - // z - l0 cJ -- _C-ert.-N~- --- Sa an ings Division County 201 W. ingt Ave P.O. Box 7162 r~/p 1 X S ( iseonsin Madi -' 162. Sanitary Permit Number (to be filled in by Co ) 'Department of Commerce ~ (6 266- •''_~~~E® $/(p Z ,. Sanitary Permit Applicat o ~ ~ s e Plan LD. N u mber nn In accord with Comm 83.21, Wis. Adm. Code, personal infbrtna 'on yo id8r 1 Z OOO / ~ ~ / " may be used for secondary purposes Privacy Law, s15. (1)(m) Pr 'ect Address (ifdifferent than ailing address) ~ ST. C 8~~ f o- /~ ~6 L~~ar/ I. Application Information -Please Print All Information , v 1~Sp ~ ~~ ~yD ~ 6 t Property Owner's Name ~ 1 ~ Parcel # Hleek•~!T 5 r "' ~ :~} t 7 o~-iys6- I . Property Owner's Mailing A dress Property Locatio o '# f' S 5 w ' ' ~, City, State Zip Code Phone Number / t/ ~ /., /., Section t1 ~ 1 ~ p ~ ~ 3 ~'~ . Z ~ (~ (circle 2`133 T ~ ~ ~ ~ l I .Type of Building (check all that apply) ~ ~~ S f _ N; R • E o - o< ~ r- 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ^ Public/Commercial - Describe Use rr SU w Sa- ['1 i ~S ~s~' /~ ~ p ~ ~/ ^ State Owned -Describe Use !~p ' Q(/;'L~ ~ S ~ ~y. ~ (~~~/,Q S j ~ ( ~ ^City ^Village ^Township of ~ v ps N d III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration ~~ Plumber Owner '~ . ~ I S ~~ ! 1 5 W t IV. T e of POWTS S stem: Check all that a ~c~w+1 Off' 1 ~ _ Te L_ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitab ass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Le chin Chamber QDrip Line ^ Gravel-less Pipe ^ er (explain) V. Dis ersal/Treatment Area Information: ,,,f Design Flow (gpd) / Design"S~oil Application Rate(gpdsf) ~ Dispersal Area Required (sf)/ Dispersal Area Pr posed (sfJ System Elevation / / ©© / r ~57,~ J ~ ~ / ~~~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Eldsting 7l0 ~ ~ ®~ Fi't _ -F~ / {~ ~ 1 Tanks Tanks - Q~ ,/ Septic or Holding Tank ~ Z~,L f t . i W Aerobic Tleatrnent Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Plumber's~Address (Street, City, State, Zip Code) ono ~N~,~ ~ ~ ~~s~ w ~ yo,~ VIII. Coun /De artment Use Onl Approved ^ tsap Sanitary Permit Fee (includes Groundwater Date Iss Issui gent Signatur o S s) Own rven R enial Stucharge Fee) ~ , /~ d~ `~`' 5 ~ o~p IX. Conditions of ApprovaUReasons for Disapproval ` SYST~MOWNER: ,3 ~a pa~~- Orr h 5few~ ~~.~._, 1 Septic tank effluent finer and . , V dispersal cell must all be services !maintained ~ (` \ ~ ~ t , 5 e ~ ss per management plan provided by plumber. 2. AN setback requirements must be maintained ~ psr app cable code /ordinances. Y ^~ Y•""+ \•`• we a.uuuar Vua~/ aua aua: 6y6Kw Vu Nrper DU[ ICb$ maa bl/L L 11 IaCdC9 IL SILO ~_~ SBD-6398 (R. 01/03) /~ , ~ c G r~- t` v fv~ c ~ ., ~ i y ~ ~ ~-r ~ c. c .~ ~- i ~ -~ t+ U v ( ((O nl ~ C) f "~ ~ ?~ Jca~~ lye„~. lV ~ ~G'!'/ ~~~ ~Z ZS~ 3~ 7BY1~= ~57,34~ ~ f o~ oF' ~ c ~~E '~ o:~T ~3-/ti~~I~t2Ta2 Qvi~k ~s~~o~ ~ M ~ ~ . rte. ~~' ~ i ~ ~ ~~i R~~~ ~~ e~~ ~~/ i L,3,D. ~ (D,4 ~. r/ ~ ~ ~~ 5~ ~ - 92, -~ ~/ \~. ~ ~~ o~ ~,~ ~ , I\ .~ . ~ 60 ~~ o _s ~ ~~~ ~= o ' ~-,~ ~~~~0 1zSb~~c~r - ~ `~/ F/~ t~ /,Z ~p~sd ~ • 30 ~XSo . ~ S!o,~ ~.._.. ~ o ~;~ ~:. 0 . ~l/, LC~~ ~O~s~~~ s rJNs~T~/~~ s f-1~~-s / f~p~ (7'/onl ~c~~~ 1 ~ JCq a. ~' `T f3VK= ~?,34~ "Tod ~' ~ r" ~cE 1r O:~l'- -- ~ x ~ z ~ T2 EN~N e`er ~ 3- ~ ~J F 1 ~~2? a 2 Q~ rc K o s ,~~~ht L~ G - l a'1~a l ~/ - E NQ s ~--_..,...~ ~ M ~ ~ . r~.oo' ~ e~~ i i. r L, ~,D, S (D,q ~ ~' ~~ d' -~ ~A~~/ ~P~ t 60 'o~ 9~, ~\~ 'rrF g ..z ~~3 ,~.--~-~ l'-_,. v ~~ ~o io a-,~ . ~J ~ 3 a' N~ r ZSo ~oAl ST ~~F[T~/Z p.! S d ~ 3o~XSo 6 p,t,~ b~ , ~ ~ W~ ~t- 2~~ 3~ p~~V E s'o Q-~-~'`~ ~_--~. Wisconsin Department of Comm S IL E~/ALU ' Division of Safeiy and Buildings ,~h~~~~~n~l~G~4; rnmN~~t~!S. al[t ATION REPORT Arlm r'nrlo 1879 Page 1 of 4 A.C.E. Sal 8 Site Evaluations ' ~ ~ `J County Attach complete site plan on r not4~s tlw 1; 0 hes in size F Plan ' St. Crooc include, but not limited to: verb I and h i it (BM), percent slope, scale or dimem and dirt rection d ce to near O Parcel I.D. Pending from 020-1012-00-000 Please print all information. Revi Date Personal information you provide may be used for ~condary purposes (Privacy Law, s. 15.04 (1) (m)). a 3l bS" Property Owner Property Location Miller Homes Govt. Lot 1/4 1/4 g 11 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 868 Kelly Road 17 Sunset Hills First Addition City State Zip Code Phone Number ~ City ~ ~Ilage ~ Town Nearest Road Hudson ~ WI 54016 715-531-0714 Hudson LeBarge Road 1/ New Construction D~~ /~f/ Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement J Public or commercial -Describe: Parent material Glacial outWash Flood plain elevation, if applicable nor General comments and recommendations: Recommend installing two trenches at 3' X 87.50' using twenty eight (28)11" Standard Bio-Diffuser Chambers at elev. = 97.50' ^ Boring # ~ Boring >96° Pit Ground Surface elev. 101.00 ft. in. Depth to limiting factor Sal lication Rate App Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-7 10yr32 none sl 2fsbk mfr as 2fm,1c 0.6 1.0 2 7-14 10yr4/4 none grsl 2msbk mfr cvir 2fm,1c 0.6 1.0 3 14-28 10yr4/6 none gr Is 0 sg ml aw 1fm 0.7 1.6 4 28-96 10yr5/6 none s & gr 0 sg dl - - 0.7 1.6 ~,~ ti ~ti H#4 contains appr 20% gravel & Cobbles scattered throughout horizon. a Boring # ~ Boring Pit Ground Surtace elev. 102.45 ft. Depth to limiting factor >105" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roois GP D/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-7 10yr32 none sl 2fsbk mfr as 2fm,1c 0.6 1.0 2 7-16 10yr4/4 none grsl 2msbk mfr ctnr 2fm,1c 0.6 1.0 3 16-26 10yr4/6 none Is 0 sg ml aw 1fm 0.7 1.6 4 26-105 10yr5/6 none I s 0 sg dl - - 0.7 1.8 a~ , ,, ~j. yq. H#4 ins appr . 20% gravel 8 Cobbles scattered throughout horizon. ~~ ~~ 'Effluent #1 = BOD ya 30 <_ 220 mg/L and SS >30 < 1 mg/L * Effl #2 = BOD <30 mg/L and TSS <~0 mg/L CST Name (Please Print) Signatur . CST Number James K. Thompson = 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osceola. WI 54020 12272004 715-248-7767 Property Ovmer Miller Homes Parcel ID # Pending from 020-1012-00-000 Page 2 of 4 ~ 3 ~ u Boring # ~ Boring ~ Pit Ground Surface elev. 99.35 ft. Depth to limiting factor >97" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell pu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10yr32 none sl 2fsbk mfr as 2fm,1c 0.6 1.0 2 5-15 10yr4/4 none grsl 2msbk mfr cvv 2fm,1c 0.6 1.0 3 -22 10yr4/6 none gr Is 0 sg ml aw 1fm 0.7 1.6 4 22-97 10yr5/6 none s & gr 0 sg dl - - 0.7 1.6 G tl .z H#4 contains approx. 20% gravel & Cobbles scattered throughout horizon. Boring # J Boring 1/ Pit Ground Surtace elev. 94.25 tt. Depth to limiting factor >94" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell pu. Sz. Cont. Cobr Gr. Sz. Sh. *Eff#1 `Eff#2 1 0-16 10yr3/2 none sl 2fsbk mfr as 2fm,1 c 0.6 1.0 2 16-35 10yr4/4 none grsl 2msbk mfr cw 2fm,1c 0.6 1.0 3 35-42 10yr4/4 none gr Is 0 sg ml aw 1fm 0.7 1.6 4 42-94 10yr5/6 none s & gr 0 sg dl - - 0.7 1.6 H#4 contains approx. 25% gravel ~ Cobbles scattered throughout horizon. ^ Boring # ~ Boring _f Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell pu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 'Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS< 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 format, please contact the department at 608-266-3151 or TTY 608-264-8777. SOIL AND SITE EVALUATION 1879 Page 3 of 4 PROPERTY OWNER: Miller Homes P~(RCEL I.D.# Pending from 020-1012-00-000 A.C.E. Soil !~ Site Evaluations REPORT MEMO Soil evaluation completed prior to plat review. Changes in fot line locations or building site may result in additional soil evaluations being required. Lot line locations must be verified prior to permit issuance and system installation. /off i7 /et /G ~ - ~. /` ~ S °i / E/ct /uat~: do E/e/a-~E~Q., -~-- EXi Ski nq f~~'n ~ Sca/c. / = tlO~ ~i/~e/ /~ir~~s ~af/7 Sur+sG~ ~ _ _ __ ~ ~ ,' ,' -'' /QeF 'x/879 Ben ~ ~ 5 ~ oFiS. /`char; ,' ~ ~. Pau A~sk,ned ~te~ ~ a~: ~" ~' ~ T~~ s ` ' ' ` 8 ^/ ~\ tea,. ~ ~ 6 i pS ~ ,,Q ,S,a ' Z~ 6 6~ ~` -~. ~~ a2 ~ ~ Q~e ~ . g~ ~ ~ _ ~~ ~1 ~ ~•~~ ~ ~ ~i• ~ . ' • ~~, d3 -- ~ ~. --~ ~ \1 ~ ` , 1 ~ ~ ~ 1 ` ~ , ' ~~ ~ ``~ ~ \ \ ~ ~~ \ \ ,~~ 1 ~ ` `~ ~ t 1+ ~ I - 1 1 ~ ~ l ~/O.Z.O~C'pn~acr• ~ ~ ~ ~ i ~ ~ ~ ~QO.O S''6.D' X8.0' 9s!o' r~ . ~ a~ `~ y-. ~•~ ~eo27o p~nWQ11A.EAl ~~~ N 6 exonp>ta[wo ~ rpnrdgrtwo ~ ~a'mArapn[Er. n®pG,plRrdlMO ~ ROf ~ R~ ~ 1rIRMl9gg(gttn r~ IaUp9aWAa .. saaAnAar 4 `i [vi _.__ aupnus a py eae,ap f` ~ -._ no,~~ - ~ ~ ._. ~~ ~~W ---- = vaAptAaoA Ilipg:' AOGnHA~O1pJd ~~ M.00 pEplQltgl qx. ~^~opnuoi l10 •RIA Int67pAArGOBpp pMia iA.mmi nOAH~tYDn®agtc sort aaiaaAwnsurowmmad w.nMepe[nnxaawrt xapuaax wnnmmpeeatpuawptMOaam ~ MIg111a Mt nAiA0lna Ul6lpntl®A Mtta>SasnACiwaietE puA;a nappgaMlpGXMDWIQNgda ~R ^1n1a0pLAAQtA91gIMR1uBl ol'91R t3Agaaos~rw i I I PB @d~ ~ I ' .,,~, EfEx I EOdn al'p0f ~ ~~ - ~ una tnm rpa. [FiN altn0 , % MAASY9 w[n®~i~oeiuo \ / ~Ua~ElItA ;qpi EQIQINOL1Ei~ ~ I mamma ara ,; avrpa / ;b~ 8~ ~ ~ ~ ~ ~~ ~ I~ ~ Es \ j LOT 17 $ 7 I (~ IpAAe ' \Aql ua eA qae - E r[ x M16g16E~pamma ~~ MMfI®AnE1Ib1U(a/( ! f ~ ENSxpM xaapax i t °PARa ~ ~ NM.4lR / 1GMl®pLLW 6 auwsAnmt ~ ^w+rp 1 aAAeund WnNpGlpEgpOmApaLL ma 61AkM40RAn(a11GA Q ~ a'En~x1A0MRx = tlMYMU ~ 1 ~ M40~lamdtp ~ aaAttgi®Wgn[®fA0[ ~i X333 fa/lE1®pWlNq~llkit(M / Ma66n11 ®; lln.atA 1 \ ~'~ i , B' ` \ `. tp tpp I ~7~ ~~~ I - --t---- murn~p~AS n)Ap[apa®a118.YrtAEM®9.a tux arvwtaeaomtwpuva+ ma:aamuaAeapxApwuca n@I IAp x r6NpY4pAlaunxp ^N46ARW pa8Tdn6nanRObl M1Np tnAfblE1p11$giA6iElgIpAE Ail x x n MIC paFS uA IIME Nt NIMI WM411EiGA9AFx.1F. 6~OIIMBxApallp V MA6sp6fA AAE (DAp' an 100pE lAp p1aM0 IHa.At7p Al, Att/gp AMYII lOf 81085 Aapancl tva[nAAnppamevnc .nnaaaaoaxoaxpaamtm AnEpiII OnMVJa1Et}ngalaA A1R A 9dll pOnn11E RY161 W I W X01 x 06utl14apaBAanW91LLpID nltpl lQ M. tp IBYf 611A& gn10p1 x ApGan appElQWApAaAgaL aMAR2FEMMn. 0011 OAIpdAa 4lnppn nOMAIUEYInnitmpApggpppllmq pip aE 400 ap ma pa ~! 69P 9 ~ ~ I ~~~ I C~4 II I I I II II 6R7i '/~ I I n ii u i I 1 1~ SHEET 10F! BHEETi CUaVF fMTA TMIF -tQALEM„RIf„1 =107 ~~ 1b® I i I I I ~~ P - ~~ I . ~~I LOT 12 ~~ \ m b. I lagl ~up.aa \. j a e LOT 11 e E r ~D ms 11.77 ~ aa>tpq oanA &V •pla I ~~ .~ I 60'd 7 I I I 611 I I I I I I I I i ~ I COUNTY PLAT OF. SUNSET HILLS FIRST ADDITION LOCATED IN PART OF THE NE114 OF THE SW114, PART OF THE NW114 OF THE SE1/4, AND PART OF THE NE114 OF THE SE114 OF SECTION 11, T29N, A19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. ~~ ~ Loc~Trori B~~a+ ~~ ~~ rnnw goRarpq D6UlIVEY011 K In pIM ~ ioana30 I K d a nspasnei,rnaa naopucp=a e~< ~y~sis ~~~ 8T. C9AC! C0. M6. 1uAaYaWY~ r aye 4~tr / prsMdY 1~~ pprllgl 983~,944®l4 rn 2687At LOT 16 LOT 13 LOT 18 ~ ~~* ~ L 0T 14 !0M" LA PAgI b t ~ aNgl f aagr 3~ un•tnr " Emgr ~ ua.ee ~ ~ ~ ~ _ - «~ ArE9M ~ ~ pp.aAq .. \ ....... ... . . ~ ~~ , -- ---- ~ ` q ~ `;1 m ---- - _ s ' /M[Mp p ' e ' /--; -LaBAROE ROAD - - - ~~ - - i8 - - ~ ~ -~ i ma nrganaq p , . .f. ~ ~ ' r 11~ , pb N46171 ~ ~ q~ , y a 1 ~ \ s / : ~ / i ` * ~ i ~ ~ I ~ ~P° ? 10120 I 6@x'6 I lOT 19 1 ~ eaAOs ~ I tsAm ~~ nhua n. i aapn ba a I ~; I axowip i e ~ o ~ ~, oaiap , a, , ii-~.IDp ~ ~m wldrt ~ ~. MIOMV[g6pF ~ ~iA azata•nn nepap'Ta'n I I I 1982.6? IA~Mraptl 6949 ~-~a'a ----- '~ d9aC,RE3 G2664 I I ,~' 6~r2 i ~ / ~~/ / ~ / / /~// J SJU ~~ ~~~ Polylok PL-525 Support Stand Should you feel it necessary to add additional support to the PL-525 filter, use asix-inch Schedule 40 or SDR 35 pipe to extend from the base of the filter to the bottom of the tank. The exter~on pipe needs to be anchored to the filter housing with one or two #14.X 112" SS screws. --- Anchor 1-2 Stainless steel screws through housing and into pipe, Use #10 X 112" Pipe rests on bottom of tank ,= ------ 6"Schedule 40 Pipe s ~~ Sart- ~~" ~iS ~rt ~ i ~ 1 k , t ~ " • ~ . M1 - Qurck4 STANDARD CHAMB Ouick4 Standard Chamber ' i ~,. I C - _ 3'I° -------- --~ SEC T iON VIEW I MultiPort End Cap 1 52° ----- --. _ - Q e" --- ~E=FFECTNE LENGTH) I __._ - ~: r y ? ~ ~ I ~ - :; .~ ~E {r~~g~'~g ly ~~i Y ~, I~ I it ~ ~ ~i:~ ~I SIDE vlEw I ,>r Quick4 Standard Chamber Nominal:Specifications ^AultiPort End Cap Nominal Specifications Site (W x L x H) ;~,~; `34"-x 52" x 12" size (W x L x H) 34" x 16" x 12' Effective Length - ~~ a\;~ ~ 48" avert Height 8" or 1.25' Invert Height ~ a) ~;i3~ ~~~ :;+. - g" - ! r'+ ~I _.. IraFILTRATOR SYSTEMS INC. STANDARD LIMITED WARRANTY -- ' ^.+. _' " I,ar Y}., . pIA: C. wMgf Intl Olhgr M.(1r5w\ry ,m h'.. ,! .., ;vy;r',,. .. ....,.. ~.,. 'r:~~ r- , .. p vu:r wan nmvalnr-s mcnucl ,,.-. ~.• ._ ~., . n;o r ; ~'. ,e tla r • ,a a,e seplrc per ,1 s ssl ttt Ir>' ,n'~. .. . `:.~ .`. , .!~, :114•..r~.'llr .]M. ,Ile warranlV (lenCll wAl IH~(j ,l 111 I ~: '.I I,.r I, . r. ' - ,I Jnlc lnr llnnc (lrlf•rnnfrl+ r. ,.. + r._ r .r ..~ .a. .. v.. n:n!.lall:llrnr,;rl l'r. lln„V - ~ ~1 n V i Y n JI r ::F P.11 1 4E , IN GVl11+ARAl;RAVH lal nRF F.%GLl1SNl 1111'1 F. ~~ 'I r .' 11 ' + 41'1 , !`J'r Nr II ~;;Ar11]ANfIESnF MEH(:HANTAE11lIIY()11MINI +`i II .I+.i~ ., ., .. .IIt r .. r. nl'Irr f.l r; tlrr vCl !, na+rr laC.l, Itv: ~ ~. ~ ..~ 1 C I ... `. ,. .'.;, (; 3'~ ^.1 +~, a~.. nrlr^rl rf, na(Ir' I,I'Ilralpr ,;I•; Il nn' I:I.,r'~:., ..~ N .1 i ... I'^ i ~~ ! e. lu cods o: ou,el losses a ea NV,;o. I . 'l" a IC a' t.l narlr ir)'hr lln lS tll+n. In prtl nary w0:. I I I' ~ ~ .~, r ~:~,I nl I '~: rl,rn n t r ,r~ Ir raMC ry f>InC, CrN,tlIKN15 wl\CII ,tre nCl .rf nlll:ti l-~, r- .,. rr, ~. 4r:ar,r '~ . ~. t nr r .1:,11.".K•n rnSlrr rCllMi. IIN! pCCfTCnI nl + i ~. ,. I Arr.!! n r In n ,,,,+:( , n r, , r:~r I ++nra3el sv ng. orcres ye wale 1 ~ .~.. ' .. -,.~ In alc' -` n, ~, wnrranl ~ `,~' r ~ ; Nr n,. y511.3111,f vO.fI, IlM linlry ati r.„r~' ... A'~ r. , rr nrr,. rrr • ' , r. ~, . Iv. .l!:.1'.+' r I<,r Ili 4,: ; nr Ila na(IC le Il,r. , Ilir4• . I rr ril ~. .~~. ~ ,. ~ r r r ,- - :r: rr. r::. r.r It' Irv r • a , r'I ):lr,y I-n+ ,'. r r .., • ~ r.,. A v r . nlr _. ,I Ill tM1r'.,h I I ~_ ,. i I , n ~~ r ~ ' • ~ ~Y~T~ M ~ I N C Environmental Onsite Wastewater Solutions 6 Business Park Road • P 0 E3oY -`~ Old Saybrook, CT 06a 7~. 860'577-7000 • FAX 860-577-?rln• 800-221-4436 _ ~),tt '. 'S, X53. 5.39G(~1 i. :iA(1 'ri 5.`I:)t n,~~l-i'.-. .. ,,. Z'. q;la _ -- - .. 11`) "!-'•(' )'~v?r 1?IIP.n15 Uen(1 nG 1. ~ ,.. ,. .,. ,, - ~~ S 1n \ 7P lr!? rC1711t-1 P.(7 I, rl-[1P.111 ~7:'ks OI I11111r J71b ~,\til(?Il,s II•~ ~ ~ , r. r I :,! ~Jti'1'. -\i r• r..:., l' ~ t~..rCO C('.,I(~tlt. (,Or,lnllr SwIYP,I COn+1~l:ll(,I1 Mr (, (rr i.; •,,. ... f. ',I t;l '. ,:rl r, .r 1 .). ~.,~,,. 4EC rGl_'n ~. roc _ ~ -I .n ~n<.\ Ir f!Il a'llr'r S\alem•; 1nr. r7 2003 Inl llydlnr Syc;"~~ Inc i ... ... ~ ~a G I ~ ~~ ~~ r% +..~ ~ ,~ ~'; ~ .r i 1 ~ • ` ` \ •~. ~° ~ ~ ~~ ~ .~ ~. y \' i.. \ ... . .. .. .. ...... :~ ~ \ ~ A~'' ~ \ ~ `'~ ` fJ ` t ~._ ,,,. ~.. r .... ~ ~ t: ~ ~;, .. ......... ~ ~ ~- __ s ~ m ~ .~ ~ l ., ~ ~~ ~ ,, ;, '~ ~ ~ ~ e Z ~ Z ' 1C' lg ~ Q ___ r --_ ~ '~. ~ ~; ~ ~~ ~' S _~ _ ~ a ,~ $ -..~ ~ W ~,l ! ~ ~ ,$ ,,~ ,N ~ ° ~ ~ _. :.. • ---~•-~- .'mss.-. -- - _ N ~ ~.> ,. ~. ~>. ~ ~ ~c. ~: ,a ~ ~ \, ~ b ~ .~ ,/ -„- -, ~' ~ <. ~ ,; i ~ :~; ~ :~~ ~ u'~ DE'Z9t ~,. _. ,: ~ 1 ~, ~r ~ _ t/IAAS 3H1 ~O f/t3N ~ S ~,4 ~ `r 3Hi d0 3NIl 1S31y- ' ~~uu ~ ~ _ POWiiTrrS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ ~~ v -- • ,cE INFORMATION ~V N S ~T -T( ~L. S ~©'r~ ~ 7 --- SYSTEM SPECIFICATIONS Owner __ L_ __ ~'ermit ,'f - -- ~re ~ 1 ~ ., DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units NA Estimated flow (average) y SD al/da Design flow (peak), (Estimated x 1,51 ~O O O al/da Soil Application Rate 0 7 al/da /ft~ Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) S30 mg/L ^ NA Fecal Coliform (geometric mean) S10' cfu/100m1 Maximum Effluent Particle Size Ya in dia. ^ NA Other ^ NA 'valves typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Septic Tank Cepaclty ~ L S O al ^ N:. Septic Tank Manufacturer wC~.l S ~ ^ N:. Effluent Filter Manufacturer 2Q g E ^ r~:; Effluent Filter Model (~ - ~ Op ^ NA Pump Tank Capacity al ,fa NA Pump Tank Manufacturer ~ NA I Pump Manufacturer ($'NA Pump Model ~ ~? NA Pretreatment Unit m'NA ^ Sand/Gravel Flter ^ Peat Filter I ^ Mechanical Aeration ^ Wetland i ^ Disinfection ^ Other: Dispersal Cell(s- ^ r~ I In-Ground (gravity) ^ In-Ground (pre ssurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other. ^ N~ ~ j Other: G fvA I Other; ^ NA i Service Event Service Frequency Inspect condition of tank(s) At least once eve ~/~ O monthlsl (Maximum 3 ears) ear(s) y ^ N:. Pump out contents of tank(s) When combined sludge and scum equals one-third IY31 of tank volume C f~A Inspect dispersal cell(s) At least once every: ^ month(s) (Maximum 3 years) 3 ^ year(s) ^ NA i Clean effluent fitter At least once every: ^ month(s) / - Z- ear(s).. C Nr Inspect pump, pump controls & alarm At least once every: ^ month(s) r ^ year(s- C, ~ Flush laterals and pressure test At least once every: ~ ^ month(s) ^ yearlsl ^ N:. Other- At least once every: ^ month(s) ^ year(s) L-, N~ Other O N MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certificat~c-s Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servicing Operator. Tan• inspections must include a visual inspection of the tanklsl to identify any missing or broken hardware, identify any cracks or teaks. 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 celllsl shall be visually inspected to check the effluent levels in the observation pipes and to check for any pond~nG of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires cne immediate notification of the local regulatory authority. when the combined accumulation of sludge and scum in any tank equals one-third IY,I or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and dispoged 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, pretreacmen: 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, ~; ;`^ UP AND OPERATION Page T of _~ t.. _ 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 cell(s1. If high concentrations are detected have the contents o; the tank(s) 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 1 5 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 and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS, J~ T ~/ alua ' b e ai a '~fl~+-/I$ T1~~ ~i2- N~ CaN5772U~ p,~.Jank ^ 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 M ~~ ~ ~arn1~L~ Phone ~' ~ ~ r Zit ~ ~-. POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone This document was drafted in c I' Name S C ~ b ZOr~I (~(.l Phone '"J/S'- 3b~Co- !o (~ omp lance with Chapter Comm 83.2212)(b)(11(d1&(f) and 83.64111, (2) & (3), Wisconsin Administrative Code. Parcel #: 020-1456-17-000 05/03/2006 12:04 PM PAGE 7 OF 1 Alt. Parcel #: 11.29.19.2933 020 -TOWN OF HUDSON ` Current [X ', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 04/06/2005 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -RIDLEY, GREG GREG RIDLEY 930 ERASER LN HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): " =Primary Type Dist # Description " 1040 LABARGE RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.900 Plat: 10/054-SUNSET HILLS 1ST LOTS 11-20 020/05 SEC 11 T29N R19W PT NE SW SUNSET HILLS BlocklCondo Bldg: LOT 017 1ST ADD'N ' LO ( 05) T 17 (3.900AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 11-29N-19W NE SW Notes: Parcel History: Date Doc # Vol/Page Type 01/04/2006 815630 WD 04/06/2005 791515 10/054 PLAT 9AAR CI IMMARV Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 02/16/2006 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 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 -, "'' ~,ST CROIX COUNTY SEPTIC TANK MAIN"1'~~NANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~~4c~1 ~ ~ Mailing Address of ~ ~Q ~~~ Property Address ~ ~ ~ © LQ- ~°'~_S ~--- ~ ©~17 (Verification required from Planning Department for new construction City/State ~~ ~SOr~ u~ ~ Parcel Identification Number LEGAL DESCRIPTION Property Location '/., '/,, Sec. ~~ T Z~ N-R ~ W own of ~~~'~So v` Subdivision SV~s ~ ~-1;11s ~ ~/3"i- ~ ~~~ t;p+~ .Lot # ~ 7 Certified Survey Map # ~ ~ ~ ~ ~ ~ ,Volume ~ d ,Page # ~ Warranty Deed # ,Volume ,Page # Spec house ^ yes l8 no Lot lines identifiable (~ yes ^ no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper mainteraYc.e consists of pumping out the septic tank every three years or soo4er, if needed by a licensed pumper. What you put into the s}~ser: can affect the function of the septic tank as a treatment stage in the waste disposal system. The propcriy owner agrees to submit to St. Croix Zoning Department a certification form., signed by the owner and b;.' ` ~~. master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal systec~~ 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. Uwc, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certificaao stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office a~thin 3G days of th three year expiration e5 /03 / oy SIGNA O AP I ANT 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 o~~Te:ls) o' the property escribed above, 'clue of a warranty decd recorded in Register of Deeds Office. ~ v5 /03 ~0(p SIGNA O C DATE """ Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. """ " Include with th(s application; a stamped warranty decd from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty decd State Bar of Wisconsin Form 2-2003 WARRANTY DEED Document Number ~~ Document Name THIS DEED, made between Miller Homes of Hudson. LLC. a Wisconsin Limited Liability Comuanv ("Grantor," whether one or more), and Greg Ridlev, ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lot 17, Plat of Sunset Hills First Addition in the Town of Hudson, St. Croix County, Wisconsin. Exceptions to warranties~asements,restrictions and rights-of--way of record, if aoy. Dated ~ Z U Q ~ Miller Homes of Hudson, LLC ,E~- 1 5 6 3 Vj BATHLEEIN H. itALSH REGISTER OF DEEDS ST. CROIR CO., MI RECEIVED FOR RECORD 81/04/2881b 11:8AAl1 YARRAIITY DEED EXEMPT lk REC FEE: 11.08 1'RAlIS PEE: 38@.88 CpPY FEE: CC FEE: PAGES: 1 Recording Area ~~ Name and Return Address ,., t'.Q. E~':: 3~3 ~~~asc~~, ~vt s~o~o Part of 020-1012-00-000 & 020.1013-40-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) ~I~~`~' (SEAL) ~e~<~ ~ (SEAL) * *By: Sam E. Miller, Membe (SEAL) ~ (SEAL) * *By: Leo A. Drave mg, Member AUTHENTICATION Signature(s) Miller Homes of HudsonLLLC By Sam E. Miller Member and Leo A. Dravelin¢. Member authentica ed *Kristina O land TITLE: MEMBERS ATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) ACKNOWLEDGMENT STATE OF ) ss. COUNTY ) Personally came before me on the above-named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Notary Public, State of Attorney Kristina OtTland My Commission (is permanent) (expires: ) Hudson WI54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THiS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 • Type name below signatures. INFO-PROTM' Legal Forms 800-855-2021 www.infoproforms.com